GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST MINUTES OF A MEETING OF THE COUNCIL OF GOVERNORS HELD IN PUBLIC ON THURSDAY 2 FEBRUARY 2017 AT 4.30PM, IN LECTURE HALL 1, THE ACADEMY, GREAT WESTERN HOSPITAL, SWINDON Present: Roger Hill (RH) Claire Brooks (CB) Anna Collings (AC) Peter Hanson (PH) Louise Hill (LH) Ian James (IJ) Sheila Parker (SP) Kevin Parry (KP) Rosemarie Phillips (RP) Martin Rawlinson (MR) Roger Stroud (RS) Ros Thomson (RT) Margaret White (MW) Also in attendance Karen Johnson (KJ) Julie Marshman (JM) Carole Nicholl (CN) Julie Soutter (JS) Simon Denning (SD) Chair Staff Governor, Allied Health Professionals Nominated Governor, Wiltshire CCG Staff Governor, Doctors & Dentists Public Governor, Swindon Constituency Nominated Governor, Swindon CCG Nominated Governor, Wiltshire Council Public Governor, Swindon Constituency Public Governor, Swindon Constituency Public Governor, Bath and North East Somerset Constituency Public Governor, Swindon Constituency Public Governor, Swindon Constituency Public Governor, Central Wiltshire Constituency Director of Finance Deputy Chief Nurse (Community) Director of Governance & Assurance Non-Executive Director Governance Officer Matters Open to the Public and Press Minute Description Action by whom 75/16 Apologies for absence and Chairman's Welcome Action by when RH welcomed everyone to the meeting and advised that apologies for absence had been received from the following: David Barrand (Nominated Governor, Prospect Hospice) Penny Bowen (Public Governor, Wiltshire Northern Constituency) Brian Ford (Nominated Governor, Swindon Borough Council) Janet Jarmin (Public Governor, Wiltshire Central Constituency) Peter Pettit (Public Governor, West Berkshire & Oxfordshire Constituency) Nick Bishop (Non-Executive Director) Andy Copestake (Non-Executive Director) Oonagh Fitzgerald (Director of HR) Adrian Griffiths (Interim Chief Operating Officer) Kevin McNamara (Director of Strategy) Jemima Milton (Non-Executive Director) Steve Nowell (Non-Executive Director) Guy Rooney (Medical Director) Nerissa Vaughan (Chief Executive) Hilary Walker (Chief Nurse) 76/16 Declarations of Interests There were no declarations of interest.
77/16 Minutes that the minutes of the meeting of the Council of Governors held in public on the 24 November 2016 be adopted and signed as a correct record. 78/16 Action Tracker The Council of Governors had before it an action tracker and governors were asked to consider progress against planned actions. CN highlighted that the re-appointment/appointment of Non-Executive Directors would be included on the agenda at the meeting of the Council of Governors in April 2017. CN commented that Governors would have the opportunity to feed into strategy development later in the meeting. CN advised that there were no other issues to draw to governor s attention. that the Action tracker be received 79/16 Questions from the public and governors CN reported that questions had been submitted in advance of the meeting and the responses were noted as follows:- 1. People who are new to using the eye clinic and who have failing sight still find it difficult to find the location of the clinic. Would the Trust please consider putting a large sign next to the lifts which makes it clear that the eye clinic is on the first floor? Response from Rupert Turk (Acting Director of Estates & Facilities) - Following consultation with the Eye Department, the Trust will install two large print signs by the lift. The signs will be ordered this week. 2. In to-day s Times newspaper, one Governor was concerned to read that 430,000 is being spent on stand-ins in hospital. (Some directors are being paid as much as 1,800 per day.) How much money is being spent at the GWH, on stand-ins? Response from Oonagh Fitzgerald, Director of HR - The Great Western Hospital has a robust process in place to ensure all agency spend is reviewed and approved only in circumstances that are completely necessary. In the first instance managers are required to explore options internally before considering the use of agency. Any requests require Executive Director approval. The Trust has spent 681k this financial year on interim cover for vacant posts within the Trust, on a short term basis. The Trust has made significant progress with reducing agency spend for Admin, Clerical and Management roles this financial year. Whilst Jim Mackey s letter raises concerns regarding the use of agency, the letter does also recognise the need for flexible resource via short-term contracts and when there is a genuine and unavoidable need for experienced leadership on a short-term basis. The Trust is committed to improving and fully maximising the talent that is
already in the organisation and succession planning is underway to minimise the use of interim posts in the future. 3. Are the IR 1 forms fully fit for purpose in promoting a training and not blaming culture within the hospital environment? Does this data feed in to a safety management system? Are staff who make genuine mistakes (i.e. not violations) given training and support? Response from Daniel Boden, Manager for Clinical Risk and Patient Safety - All incidents both clinical and non-clinical are raised via our local risk management system known as Safeguard. Incidents are raised via an Incident Notification form (Formally known as an IR1). The current incident notification form has been recently reviewed and amended to make sure that the form is fit for purpose, and is as time efficient as possible to complete, whilst still retaining all key information and fields required by the National Reporting and Learning service (NRLS), as this informs the theming and trending analysis of Nationwide incidents whereby mitigating actions are then implemented and shared via all NHS organisations. The Clinical Risk Team is continually engaged in programmes of work where the key aim is to promote a culture of openness and transparency. It is through these programmes of work that we are able to provide support and guidance to staff and to instil a non-blaming culture globally across the entire Trust. To complement the work that we do staff also have access to a whole host of materials and points of contact obtained via our internal Clinical Risk intranet web page. During incident investigations support is offered to any member of staff by any means that is reasonably practicable. It is reiterated that the main aim of any investigation is to focus on policy and process, and not solely concentrate on one individual. Staff are provided with our contact details for any questions and/or queries that may have so that we are able to keep them fully updated and supported throughout any incident investigation process. The Clinical Risk Team has been facilitating regular drop in sessions within the acute Trust and Community Services towards the backend of 2016, and have dates confirmed for January 2017. The main aim of the drop in sessions is to support our key objectives of continuing to promote an open culture of incident reporting where incidents are not secrets and it is a positive that staff raise incidents. We have created a Patient Safety video to help us reach as many staff members as we can and spread our message please see link below. https://www.youtube.com/watch?v=4aqvsnl-q5k As well as the creation of our Patient Safety video we have; Rebranded the IR1 incident form from a negative to a more positive name of - Incident Notification Form. We are running a Quality Improvement piece of work where the main focus is incident reporting, learning from incidents and how best to share key learning s. We are reviewing the processes and options of learning that could be gained from the multiple analysis of incidents by means of grouping, theming and trending by cause group that will inform timely and meaningful investigation outcomes and how this impacts key learning from incidents. The Clinical Risk and Patient Safety Team is passionate about the work that we do to promote Patient Safety across the Trust and will continue on
our path to encourage and support all our staff to report incidents from fear of blame, and to recognise the amazing things that can happen by reporting incidents. KP highlighted that he had submitted a question on behalf of a member of the public prior to the meeting of the Board of Directors in January 2017. CN explained that this had been discussed at the Board meeting with responses circulated back to the member of public. that the questions and answers as set out above be received and it be agreed that there are no issues to draw to the attention of the Board for further response. 80/16 Listening to our patients The Chairman invited governors to identify any issues flagged to them by patients or carers in respect of Trust services. There were no items to discuss. 81/16 Report of the Chairman The Chairman made a verbal report as follows:- Operational Performance The Chairman reported that the Trust continued to operate under pressure due to high levels of patient activity, both in terms of admissions and patient flow through the hospital. The Trust had performed below the national standard of 95% with 84% of patients having stayed a maximum of 4 hours in the Emergency Department (ED). However RH commented that the Trust s ED performance remained above the national average. The Chairman highlighted that the Trust had met Referral to Treatment (RTT) targets of 92% for the fifth month in a row. The Chairman highlighted that there continued to be difficulties in discharging patients with 91 patients in the hospital currently who were fit for discharge on the site. RH praised the performance of clinical staff who continued to provide safe levels of care despite pressures on each department. Ambulatory Care The Chairman reported that ambulatory care had been expanded within the hospital which would reduce the number of patients in the ED by up to 26 patients each day. Staff Recruitment & Retention The Chairman highlighted that the Trust s staff retention rates had improved when compared to previous months data. RH commented that international recruitment campaigns had been widened to target both Doctors and Nurses from Commonwealth countries, particularly Australia. Governor Effectiveness Day The Chairman explained that the Trust had held its annual Governor Effectiveness Day on 19 January 2017 and this had been well attended by both Governors and Non-Executive Directors. RH highlighted that discussions had taken place
regarding the relevance of information and the content and format of governor meetings. It was noted that a meeting had been arranged with a selection of Governors to discuss and agree the future format of all Governor meetings. Swindon Adult Community Services RH commented that due diligence exercises and discussions with staff had been completed which ensured that the Board of Directors was fully informed before contract negotiations had been authorised. Sustainability & Transformation Plan (S&TP) RH explained that there had been a pause in S&TP activity due to on-going stakeholder consultations. Board of Directors The Chairman reported that Liam Coleman and Robbie Burns term of office as Non-Executive Director had ended on 31 December 2016 and 31 January 2017 respectively. The Chairman expressed his thanks and appreciation to Liam Coleman and Robbie Burns for their contributions to the Board of Directors over several years. that the report of the Chairman be received. 82/16 Report of the Chief Executive On behalf of Nerissa Vaughan, KJ presented the Chief Executive report which covered the following:- Operational pressures since the beginning of the year UK s first four-lead pacemaker fitted at GWH 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 UK s first four-lead pacemaker fitted at GWH KJ reported that the Cardiology Team based at GWH had displayed fantastic innovation by implanting the UK s first four-lead pacemaker. Recruitment event for Swindon community staff KJ highlighted that a recruitment event for Swindon Community staff had taken place on 29 January 2017 with 24 people registering their interest in nursing roles in the Community. KJ confirmed that due to the success of the recruitment event it was expected to be repeated later in the year. Maternity support worker receives national award nomination KJ reported that Kerry Wheeler, Maternity Support Worker at GWH had been nominated for a national award by the Royal College of Midwives. It was commented that the award ceremony would be held in London on 7 March 2017. More than 50 per cent of staff protected against flu KJ highlighted that 58% of staff who had regular contact with patents had received a flu jab, which had been an increase in previous years. In response to a question from IJ, KJ explained that despite operational pressures on the Trust over winter, the number of cancelled elective operations remained low
and the Trust continued to achieve Referral to Treatment Times (RTT) targets. KJ commented that the Trust s elective performance had been better than other neighbouring Trust s and although some cancellations had been made during January the backlog had now been addressed. Following a question from CB, JM explained that the Occupational Health Team continuously review reasons why members of staff did not wish to receive the flu jab. It was reported reasons included phobia of needles and beliefs that the flu jab would either not work or would result in getting the flu. JM commented that a ward within the Swindon Intermediate Care Centre (SWICC) needed to be closed due to staff and patients getting the flu. Therefore many staff within SWICC had established a campaign and helped promote the importance of receiving the flu jab. KJ advised that there had only been one Trust within the country who had achieved the target for the number of staff receiving the flu jab and they had offered financial incentives to staff. that the report of the Chief Executive be received. 83/16 Finance Report Month 9 KJ presented the Finance Report for Month 9 (ending 31 December 2016) which covered the following:- Financial Overview Activity Income Pay Costs (Total) Pay Costs Trend Pay WTE Trend Non-Pay Expenditure Cost Improvement Programmes Balance Sheet Capital Spend Rolling Cash Flow Forecasts In presenting the report the following points were made:- KJ reported that the Trust had been successful in its appeal over a loss of Sustainability & Transformation Funding (S&TF) for non-achievement of A&E targets in quarter 2. This appeal had been based on pressures within A&E were part of a national issue and not the fault of the Trust. KJ advised that this additional income of 278k had resulted in a change to the year-end forecast position to a planned surplus of 44k. Following a question from MR, KJ confirmed that the Sustainability & Transformation Funding (S&TF) reduced during 2017/18 but reminded Governors that this had originally been implemented as a one year scheme. RT expressed concern that the Cost Improvement Plans (CIPs) remained below trajectory and this would make savings during 2017/18 even more difficult. KJ explained that savings would be discussed in more detail during the presentation on
the 2 Year Operational Plan (minute 99/16 refers). In response to a question from RT, KJ explained that as part of the S&TP, the Trust was required to maintain a cash balance above 1.8m and this had led to a build-up of historical creditors. KJ confirmed that the Trust had entered discussions regarding receiving a loan of 6m to cover debts with the loan set to be repaid through efficiency savings. KJ also advised that the debtors position highlighted within the Finance report had been due to delayed payments from the Commissioning Groups and this had now been cleared. IJ commented that the healthcare economy finances within the South West were more favourable than many other areas of the country. Following a question from SP, KJ explained that prepayments identified on the balance sheet related to Private Finance Initiative (PFI) payments. In response to a question from SP, KJ explained that the Finance & Investment Committee reviewed and tracked the movement of the creditor position. that the Finance Report Month 9 (ending 31 December 2016) be received and it be agreed that there are no issues to draw to the attention of the Board. 84/16 CQC inspection The Council of Governors received a presentation on the Care Quality Commission Inspection 2017 which covered the following:- Care Quality Commission Ratings Our last CQC Inspection 2015 Inspectors use Key lines of Enquiry (KLOE) across core services Our ratings areas for focus CQC Inspection 2017 Evidence/PIR How we are preparing National Picture In making the presentation the following points were made:- Care Quality Commission CN reported that the Care Quality Commission (CQC) had held a focus group with Governors prior to their previous inspection and it was expected that another focus meeting would be arranged for the forthcoming inspection in March. CN explained that the Trust had two regulators; NHS Improvement which reviewed the financial position and governance arrangements and the CQC which ensured health and social care services were safe, effective, responsive, caring and wellled. Ratings CN highlighted that the Trust had been rated as requires improvement following the previous CQC inspection in 2015. It was noted that the Trust was not an outlier with 60% of Trust s receiving the requires improvement rating. Our last CQC Inspection 2015 CN reported that the previous CQC inspection had lasted 2 weeks with around 70 inspectors attending forums as well as unplanned and weekend visits.
In response to a question from AC, JM highlighted that the cost to the Trust for registration to the CQC was approximately 90k per annum however subsequent inspections and action plans helped to drive improvements within the Trust. Following a question from RP, CN confirmed that the CQC would welcome the opportunity to meet with Governors on an individual or group basis. In response to a question from KP, RH explained that it was difficult to accurately self-assess the Trust s likely rating. CN commented that 50% of Trust s had received the same CQC rating or a deteriorating in their follow up inspection. that the CQC Inspection presentation be received and it be agreed that there are no issues to draw to the attention of the Board. 85/16 Local Quality Indicators The Council of Governors received and considered a presentation on the Annual Quality Account from JM covering:- What Are Quality Accounts? Background Proposed Indicators Proposed Indicators 2017/18 Consultation Next steps Background JM informed the Council of Governors that it was a requirement for all Foundation Trusts to publish Annual Quality Accounts. JM advised that the quality indicators reported within the Annual Quality Accounts were selected from a combination of local priorities plus mandated indicators. JM highlighted that every year the Trust was required to consult on the proposed indicators to ensure agreement. Proposed Indicators JM informed governors that indicators might be included if they reflected current initiatives within the Trust, for example Sign up to Safety. JM reported that indicators could be excluded if they had been reported in previous years, even if they were still current and important issues. JM set out the proposed local indicators which were Reducing Pressure Ulcers, Recognition of the Deteriorating Patient, Acute Kidney Injury, Patient Experience & Engagement, Clinical Handover and Emergency Department Patient Safety. JM advised that the mandatory indicators were RTT incomplete standard, 12 month arithmetic average and A&E 4 hour standards. Consultation JM informed the Council of Governors that the consultation was performed by the Trust as well as the CCGs and Healthwatch, while the External Auditors (KPMG) could provide advice. JM requested than Governors contact her over the forthcoming 10 days with any recommendations for an additional indicator. JM highlighted that the additional indicator would need to be measurable by auditors. Next Steps At this point in the meeting the Council of Governors unanimously agreed to approve the proposed local indicators as set out in the presentation. a) that the proposed Quality Indicators and Priorities for 2017/18 be.
approved; and b) that Governors are invited to suggest an additional indicator to Julie Marshman before the deadline of the 12 February 2017. 86/16 Quality Report JM presented the Quality Report for January 2017 which covered the following:- Mortality Rates Patient Safety Indicators Clinical Audit and Effectiveness Infection Prevention and Control Clinical Incidents Serious Incidents Overdue IR1 Investigations Medicines Safety Complaints, Concerns and Compliments Complaint Themes Friends and Family (FFT) Patient Experience Patient Safety visits Sign up to safety In presenting the report, the following points were made: - Mortality Rates JM reported that although the Hospital Standard Mortality Rate (HSMR) had increased slightly to 99.56 it still remained within the nationally expected range of below 100. Infection Prevention and Control JM highlighted that the Trust had reported 3 cases of Clostridium Difficile (C-Diff) during December 2016. Clinical Incidents JM reported that there had been 392 overdue investigations into incidents (by more than 14 days). It was noted that by opting to investigate incidents within 14 days the Trust had a much shorter timeframe than many other neighbouring Trusts. JM advised that incident benchmarking had taken place and the Trust had performed above average when compared to other healthcare providers. Serious Incidents (SI s) JM advised that there had been 4 serious incidents and 2 internal Root Cause Analysis (RCA s) reported during December 2016. Freedom to Speak Up JM reported that 1 Freedom to speak up alert was received during December 2016. IJ referred to the patient story section within the Quality Report and questioned how the Trust could measure whether improvements to patient experience were being made. JM explained that the Trust used a variety of sources for the patient stories, including NHS Choices and Patient Opinion. JM advised that it had been easier to measure Trust performance through the number of complaints and concerns received by the Patient Advise & Liaison Service (PALS) team each month. that the Quality Report for January 2017 be received and it be agreed that
there are no issues to draw to the attention of the Board. 87/16 Patient Quality & Operational Performance Working Group The minutes of the meeting of the Patient Quality & Operational Performance Working Group held on 7 November 2016 were received. 88/16 Finance & Staffing Working Group The minutes of the meeting of the Finance & Staffing Working Group held on 2 November 2016 were received. 89/16 Governor Representatives The Council of Governors was invited to appoint representatives for Healthwatch, noting that nominations had been invited prior to the meeting. SD reported that in previous years Louise Hill and Janet Jarmin had been appointed as Governor Liaison representatives on Swindon Healthwatch and Wiltshire Healthwatch respectively. SD advised that he had been in contact with Healthwatch and reassurances had been received that Governors would be more effectively engaged going forward. SD explained that Governors would be invited to attend regular Public & Patient Participation Forums as well as any other meetings deemed appropriate. SD highlighted that Pauline Cooke had expressed an interest in becoming the representative for Wiltshire Healthwatch and requested that any Governor who had been interested in representing Swindon Healthwatch get in contact with him outside the meeting. a) that Pauline Cooke be elected as Governor Liaison representative for Wiltshire Healthwatch until February 2020; and b) that a nomination for a Governor Liaison representative for Swindon Healthwatch until February 2020 be agreed with the Lead Governor and reported to the next meeting. 90/16 Sign off training declaration The Council of Governors received and considered a report which provided details of all training opportunities provided to Governors during 2016/17. CN reported that the Trust was required to submit a training declaration to NHS Improvement which would evidence that the Provider Licence condition had been complied with around training of Governors. CN advised that the Membership and Governor Training Working Group had not flagged any concerns regarding the provision of training. that it be agreed that the requirements of s151(5) of the Health and Social Care Act 2012, to provide training for governors in 2016/17 to ensure they are equipped with the skills and knowledge they need to undertake their role have been fulfilled.
91/16 Effectiveness Update CN explained that following the annual Governor Effectiveness Day on 19 January 2017 a small focus group would be established to discuss and propose amendments to the format of future Governor meetings. CN highlighted that the Trust had always sought ways to continually improve effectiveness of the Council of Governors and welcomed further suggestions from Governors. that the update be received. 92/16 Date of Next Meeting The next meeting of the Council of Governors would be held on 20 April 2017 at 4.30pm in Lecture Hall 1, The Academy, Great Western Hospital, Swindon. 93/16 Public Urgent Items (if any) None. 94/16 Exclusion of the Public and Press that representatives of the press and other members of the public be excluded from the remainder of the 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:- Private Minutes Non-Executive Director appointment Sustainability & Transformation Plan Swindon Adult Community Services 2 Year Operational Plan Private Urgent Items (if any) PUBLIC SUMMARY OF ITEMS CONSIDERED IN PRIVATE 95/16 Minutes The Council of Governors adopted and signed as a correct record the minutes of the meeting of the Council of Governors held in private on 24 November 2016. 96/16 Non-Executive Director appointments - Minutes of the Joint Nominations Committee The Council of Governors considered a verbal update following the meeting of the Joint Nominations Committee and recommendations contained therein were approved. 97/16 Sustainability & Transformation Plan The Governors received a presentation providing an overview of the Sustainability & Transformation Plan.
98/16 Swindon Adult Community Services The Governors received a presentation providing an overview of Swindon Adult Community Services. 99/16 2 Year Operational Plan The Governors received a presentation providing an overview of the 2 Year Operational Plan. 100/16 Private Urgent Items (if any) None. The meeting ended at 7.00 pm Chair. Date