MINUTES OF A JOINTCouncil of Governors and Annual Members Meeting
held on Wednesday 17 September 2014 at 7.00 pm,
in Lecture Hall 1, The Academy, Great Western Hospital, Swindon
Present:
RogerHill(RH) / ChairmanShaneApperley(SA) / Staff Governor, Hospital Nursing and Therapy Staff
LisaCampisano(LC) / Staff Governor - Administrators, Maintenance, Auxiliary and Volunteers
LiamColeman(LC) / Non-Executive Director
AngelaGillibrand(AG) / Non-Executive Director
JemimaMilton(JM) / Non-Executive Director
OonaghFitzgerald(OF) / Director of Workforce & Education
ElizabethGarcia(EG) / Public Governor, Swindon Constituency
LouiseHill(LH) / Public Governor, Swindon Constituency
KevinMcNamara(KM) / Director of Strategy
MariaMoore(MM) / Deputy Chief Executive/Director of Finance
PeterPettit(PP) / Public Governor, West Berkshire and Oxfordshire Constiuency
GuyRooney(GR) / Medical Director
RosThomson(RT) / Public Governor, Swindon Constituency
NerissaVaughan(NV) / Chief Executive
HilaryWalker(HW) / Director of Nursing
RobertWotton(RW) / Public Governor, Swindon Constituency
Also in attendance
Robert Burns (RB) / Non-Executive DirectorDouglas Blair (DB)Robert Burns / Director of Community Services
Vimbai Lyons (VL) / Governance Officer
Carole Nicholl (CN) / Company Secretary and Head of Corporate Governance
Dr G Ramadurai (GR) / Consultant Stroke Physician
35 Members/Members of the public
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1 / Chairman's WelcomeWelcome and Apologies for Absence
The Chairman, Roger Hill welcomed everyone to the meeting and reported that apologies for absence had been received from Clive Bassett, Roger Bullock, Jon Elliman, Mike Halliwell, Peter Hanson, Ian James, Janet Jarmin, Kevin Parry, Brian Mattock, Margaret White and Ted Wilson (governors). Apologies for absence were also recorded from Steve Nowell, Non-Executive Director.
Chairman’s report
The Chairman, gave a verbal report as follows: -
Board Changes – RH stated that he had taken up the post of Chairman of the Trust in February 2014 and acknowledged the work of the previous Chairman Bruce Laurie. RH advised that Dr Alf Troughton, Medical Director had retired from the post at the end of March 2014 and that Dr Guy Rooney had taken up the position. RH commented that both Bruce and Alf had played a key role in developing the Trust to its current position.
Activity – RH commented that in his 6 years as a Non-Executive Director of the Trust, 2013/14 had been the most demanding year, as there were pressures both operationally and financially. RH stated that the landscape of patient care had changed and there was now a rise in patients with complex conditions and that this placed additional pressures on staff providing care for multiple complex conditions in a single patient. RH commented that these pressures had not abated so far in 2014/15.
RH stated that increased demand had resulted in the Trust not meeting Emergency Department (ED) national wait times. RH advised that the increase in activity meant that more staff were needed to care for patients due to the increase in number of patients and so agency staff had been engaged. There had been a large focus on recruiting nursing and therapy staff throughout the Trust to ensure patients were cared for by Trust staff rather than agency staff. Additionally, the cost of agency as well as other costs to combat the increased patient activity had meant that the Trust had achieved a small surplus only. However, the Trust had still invested in its staff and facilities and that Care Coordinators had been recruited and were now in place throughout Wiltshire and that the Emergency Department at the Great Western Hospital had been refurbished to include a children’s ED and an overall easier layout to make attending to patients easier for staff.
Support – RH acknowledged that despite the difficult economic climate experienced in 2013/14, staff had continued to be dedicated and caring. RH commented that the support received from stakeholders such as Swindon Borough Council, Wiltshire Council, Swindon Clinical Commissioning Group (CCG), Wiltshire Clinical Commissioning Group (CCG), SEQOL, the Council of Governors, Volunteers and Staff members contributed to the success of 2013/14, despite the additional pressures. RH advised that the Board of Directors would strive to address the challenges ahead with a focus on delivering high quality patient care.
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2 / Report from the GovernorsRos Thomson, Lead Governor presented a report from the Council of Governors on its activities in 2013/14. The presentation covered the following:-
- Governor activity 2013-14
- Planned Governor activity 2013-14
- Constituency changes 2013-14
- Governor appointments/end of terms 2013-14
- Membership update 2013-14
- Constituency changes in relation to the powers and duties of Governors (for members’ approval)
Planned Governor Activity 2014/15 – RT advised that Governors would be involved in recruiting two Non Executive Directors to the Trust. Governors would continue to challenge the Board of Directors on performance and would seek assurance on areas such as the Nurse Skills Mix, Bookings and Communications and Risk Management. RT stated that Governors would continue to engage with members to ensure that Governors were aware of local views to feed into the Board. RT emphasised that members could make Governors aware of issues at any event or at any time by emailing the Foundation Trust inbox.
Elections – RT advised that elections had commenced for two seats on the Council of Governors. RT stated that the Staff Constituency had been split into 4 sub classes, in 2013/14 increasing the number of staff Governor positions from three to four in order to ensure staff representation reflected the composition of the staff base. The four sub classes of the Staff Constituency were as follows;
- Hospital Nursing and Therapy
- Community Nursing and Therapy
- Doctors and Dentists
- Administrators, Maintenance, Auxiliary and Volunteers.
RT advised that in 2013/14 nominated Governors from Partnership Organisations had changed as a result of the abolition of Primary Care Trusts. RT outlined the new Governors that had come into their role in 2013/14 as well as 2014/15 to date.
RT advised that membership figures for members of the public had slightly decreased at 4751 members and that there had been a slight decrease in staff membership to 6353 members.
Constitution – The meeting was advised that under new legislation there was a requirement for any changes to the Constitution in relation to the powers and duties of the Governors to be approved by members. A paper containing the constitution provisions was circulated in advance of the meeting setting out amendments to the Constitution summarised as follows:-
- Annex 6 – Standing Orders for the Practice and Procedure of the Council of Governors – Provision 5 – Lead Governor and Deputy Lead Governor
- Appendix 3 – Board of Directors – further provisions – Provision 3 – Meetings
RESOLVED
that the following constitutional changes be agreed:-
Constitutional Provision / Proposed Change / Reason
Annex 6 – Standing Orders for the Practice and Procedure of the Council of Governors – Provision 5 – Lead Governor and Deputy Lead Governor / Deletion of paragraph 5.5 and the renumbering of the subsequent paragraphs – “These appointments shall be made from those Governors who have been elected as Governors from the Public Constituency.” / This will enable the Council of Governors to select any governor to be the lead and deputy lead governors and not restrict to the appointments to public governors only. This change reflects a request made at the Council of Governors in November 2013.
Appendix 3 – Board of Directors – further provisions – Provision 3 - Meetings / Amendment to 3.3 to provide that Meetings of the Committee will be chaired by the Chair of the Trust or in his absence the Vice-Chair. However, in the case of the appointment of non-executive directors or the chairperson, a governor should chair the committee. The person chairing the meeting shall have a second or casting vote in the event that any ballot results in an equality of votes. / To reflect the new Code of Governance provision B.2.4 refers.
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3 / Review of the Year 2013/14Nerissa Vaughan, Chief Executive made a presentation outlining a review of the year covering the following:-
- Headlines of the year
- Great Western Hospital performance
- Highlights of the year
- Our performance
NV explained that following the Francis report in February 2013 (an independent review of healthcare at Mid Staffordshire NHS Trust) a greater focus on quality was sought. NV stated that there were increasing financial challenges facing this Trust. Nationally there were more trusts reporting a financial deficit in 2013/14 than previously before. NV advised that approximately 1000 more new admissions were seen into the Trust per month than the previous three years. NV stated that the Trust’s bed occupancy rate had averaged 98% over the last 12 months and that 93% was the recommended level, this was an indication of how busy the Trust was. NV highlighted that each ward had approximately 36 beds and so there was increased activity against the same capacity. NV acknowledged that this was contributed to by the changing health environment and that there was an increase in elderly and frail admissions due to the population dynamics of today. NV emphasised that despite the increase in demand such as the 19% increase in Paediatric admissions in 2013/14 and that the quality of care was good, the Trust was working on system plans and supporting patient pathways.
Estates – NV advised that the refurbishment of the Emergency Department (ED) at the Great Western Hospital had been completed in 2013/14. NV commented that she and the Board were proud of the ED refurbishment, which now included a dedicated Paediatric ED. The refurbished ED provided a beautiful area with an effective layout in a very pressurised environment. NV informed that the Trust had also provided a much needed upgrade to the Princess Anne Wing in Royal United Hospital Bath.
Partnership – NV advised that the Trust had been working in partnership with other health organisations including working with Hope for Tomorrow, a local cancer charity in order to bring chemotherapy services closer to Savernake and Malmesbury via a mobile Chemotherapy Unit 5 days a week. The mobile unit helped alleviate pressures on the chemotherapy service at the Acute hospital and provide patients with care closer to home. NV commented that mobility of services placed additional pressures on the Trust but that the patient benefits warranted it. NV stated that the Trust had worked alongside Wiltshire Clinical Commissioning Group (CCG) to provide Care Coordinators into the community to coordinate and join up care in order to help keep patients at home and out of hospital.
Systems – NV advised that the Discharge Assessment and Referral Team (DART) was launched in 2013/14 in partnership with SEQOL and Wiltshire Council to improve the discharge process. NV commented that the service provided a good package of care and had proved to be invaluable for patients upon discharge. NV advised that Medway, a patient information system had been upgraded in 2013/14 which was a big achievement and that the Trust was successfully working through minor post installment problems.
Hospital Acquired Infections (HIA) – NV advised that the Trust was set national limits for the amount of HIAs that occurred and that the Trust was working towards achieving zero tolerance throughout the community and the acute. NV advised that there were 5 MRSA bacteraemia cases in 2013/14. NV reported that C. Difficile had fallen by 33% compared to 2012/13 with 23 cases of C.Difficile in 2013/14. NV advised that Hospital Standardised Mortality Ratio (HSMR) had achieved 98% in 2013/14 explaining that any score under 100 was good and that currently the Trust was achieving a lower percentage which was good. NV highlighted that there had been a large reduction in the number of pressure ulcers across the Trust with 276 in 2013/14 compared to 348 in 2012/13.
Complaints – NV stated that there had been a decrease in formal complaints made from 466 in 2012/13 to 360 in 2013/14. NV commented that providing excellent care to patients was essential and that the decrease in formal complaints indicated that the Trust was providing good care.
RESOLVED
that the Review of the Year 2013/14 presentation be received.
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4 / Financial ReviewMM presented on the financial overview of 2013/14 covering:-
- Financial headlines for 2013/14
- Income
- Patients treated
- How we spent the money
- Treatment costs
- Capital expenditure
Income – The largest income was from NHS Swindon Clinical Commissioning Group (CCG) and Wiltshire CCG.
Expenditure – MM advised that £8.5m had been spent on education which included Junior doctors training salaries as well as other clinical training provided through the Academy learning centre. MM stated that A&E attendance had cost £7.6m in 2013/14.
MM highlighted staffing spending was the largest expenditure and included £12m spent on Agency staff to cover the increased activity.
MM highlighted that the Trust had invested £1,128k to improving the Emergency Department (ED) environment, which included refurbishing the ED and creating a dedicated Paediatrics ED. This provided a better patient experience for children and adults alike, by making complex patient more visible and providing a better patient flow due to the improved layout.
RESOLVED
that the financial review of 2013/14 be received.
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5 / Great Western Hospital's NHS Foundation Trust - The FutureGuy Rooney, Medical Director presented on the future of the Trust covering:-
- Traditional causes of death
- Demographic changes
- Rise of long term conditions
- Conquering infectious diseases
- HIV in 2014
- Anitibitoic resistence
- Global pandemics
- Impact of technology
- Nano medicine
- Stem cells
- Genomics
Traditional causes of death – GR explained that as the population was living longer infectious diseases were becoming rare and that traditionally infectious diseases included Measles, Small Pox and Tuberculosis. GR stated that traditional causes of death such as heart diseases and cancer were being better treated resulting in them becoming less common causes of death than previously seen.
Demographic changes – Due to the aging population there was an increase in long term health conditions which made treating patients more complex. GR gave the example of diabetes which could cause complications to a person’s heart, eyes, and kidneys. Additionally there was a rise in long term conditions such a dementia as a result of the aging population. It was therefore important to build a health service to manage an aging and frail population.
So have we conquered Infectious Diseases? – GR stated that although the long term outcomes of the growing rise in people not having immunizing jabs was unknown, vaccinations had had a massive impact globally.
HIV in 2014 - GR advised that treatment for diseases had greatly improved over the years and explained that he had began working in HIV in 1992 and at that time life expectancies of 5 to 10 years were standard for HIV patients. GR highlighted that due to technological and medical advancements HIV was now more controlled and that the life expectancy of HIV patients could be the same as those without the disease.
Antibiotic resistance – GR advised that when Penicillin was introduced it had been used for treating common infections such as pneumonia and wound infections. GR commented that in the future antibiotics may become less effective due to antibiotic resistance.
Global Pandemics – GR listed the Global Pandemics that had spread in recent years including Swine Flu, Bird Flu, SARS, MERS and Ebola. GR cautioned that a further outbreak was likely in the coming 5 to 10 years.
Impact of Technology – GR commented that it was important to rethink how healthcare was delivered in order to be innovative and tackle illnesses. GR highlighted that simple solutions were the way forward such as clinical staff writing medical notes during their visits rather than back at a main base. GR acknowledged that already technology had come very far, highlighting that the Trust was fortunate to own a number of MRI scanners as opposed to previously when people were required to attend a national centre to have imagery taken.
GR stated that there was advancements in medicine through the work of nanotechnology, which could potentially deliver drugs via blood streams. GR advised that Stem cell advancements were also on the rise, explaining that Stem cells were basic cells which could be grown into other cells at a speed and that certain damage caused by conditions could be repaired through stem cell growth. GR advised that mapping genetics resulted in clinicians being able to work out potential conditions and that at present scientists were near to designing chemotherapy based on genetics, which would result in offering therapy that had fewer side effects and more of a success rate.
RESOLVED
that the “Great Western Hospital Foundation Trust The Future” Presentation be received.
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