Public Minutes of a Joint Meeting of The

Public Minutes of a Joint Meeting of The





Directors and Governors:

Bruce Laurie (BL)Chairman of the Trust (in the Chairman)

Vicki Barnett (VB)Staff Governor

Clive Bassett (CB)Nominated Governor (Prospect House)

Helen Bourner (HB)Director of Business Development

Robert Burns (RB)Non Executive Director

Rowland Cobbold (RC)Deputy Chairman and Non Executive Director

Harry Dale (HD)Public Governor (Swindon Constituency) and Lead Governor

Geraint Day (GD)Public Governor (Swindon Constituency)

Bill Fishlock (BF)Nominated Governor (Swindon PCT)

Godfrey Fowler (GF)Public Governor (Wiltshire Constituency)

Marcus Galea (MG)Staff Governor

Angela Gillibrand (AG)Non Executive Director

Janet Jarmin(JJ)Public Governor (Wiltshire Constituency)

Srini Madhavan (SM)Public Governor (West Berkshire and Oxfordshire Constituency)

Maria Moore (MM)Director of Finance

Phil Prentice (PP)Public Governor (Swindon Constituency)

David Stevens (DS)Nominated Governor (Wiltshire PCT)

Margaret White (MW)Public Governor (Wiltshire Constituency)

Ros Thomson (RT)Public Governor (Swindon Constituency and Deputy Lead Governor)

Dr Alf Troughton (AT) Medical Director

Nerissa Vaughan (NV) Chief Executive

Also in attendance:

Maxine BuyangaMatron, Emergency Care

Dr Charlotte CannonLead Consultant AMU

Leighton Day Deputy General Manager, Unscheduled and Community Care

Chris GristInterim General Manager, Unscheduled Care

Claire Litchfield(CL)Governance Officer

Ruth Lockwood Associate Director, Patient Safety and Quality

Carole Nicholl (CN)Company Secretary and Head of Corporate Governance

Jo OsorioSwindon LINk

Members of the public – 1


No. / Minute / Action by Whom
1/11 / Chairmanman’s Welcome
The Chairmanman welcomed everyone to the meeting.
2/11 / Apologies for absence
Apologies for absence were received from governors
  • Jon Elliman,
  • Jemima Milton,
  • Kevin Parry,
  • Brian Mattock,
  • Kevin Parry,
  • Peter Hanson and Non Directors Liam Coleman, Oonagh Fitzgerald, Roger Hill, Sue Rowley and Kevin Small.

3/11 / Declaration of Interests
4/11 / Questions from the Public
There were no questions from the public.
5/11 / Chairman’s report on behalf of the Board
(i)Chairman and Non Executive Director Appraisals
The Chairman reported that the questionnaire forming part of the appraisal process for of the Chairman and Non Executive Directors had been revised in consultation with the Lead and Deputy Lead Governors and the Senior Non Executive Director.
(ii)NHS Constitution
It was reported that Monitor had published a revised NHS Constitution details of which would be presented to a future meetings of the Board and Council of Governors.
(iii)10th Birthday Celebrations – Great Western Hospital
The Chairman advised that plans were underway to mark the 10th Birthday of the hospital in a fitting way. It was reported that the Head of Marketing and Communications would be leading this work and Governors were encouraged to get involved. GF commented that he would be willing to help and it was agreed that the Head of Marketing and Communications would contact GF outside of the meeting.
(iv)Patient Experience
The Chairman reported that he and the Medical Director had attended a presentation in Oxford about patient experience. He explained that the presentation had been very informative and AT would consider what lessons learned could be applied to the Trust.
That the report of the Chairman be received. / KM
6/11 / Update from the Chief Executive
(i)Carillion/GMB Dispute
The Chief Executive provided an update regarding the ongoing dispute between Carillion and the GMB union. She advised that there were three main issues:-
a)Bullying and harassment allegations
b)Holidays and annual leave arrangements
c)Recognition of the GMB as a union by Carillion
She reported that Carillion was working to address the concerns raised and had conducted interviews with 109 members of staff. She advised that a further 10 days of industrial action was planned, in addition to the 12 days that had already taken place.
The Chief Executive advised that levels of service in respect of cleaning and meal services were being maintained, reporting that recent PEAT inspections had been satisfactory. She advised that she was working closely with Carillion to ensure that standards were maintained.
In response to a question regarding reputational damage to the hospital the Chief Executive advised that she had been working with the Marketing and Communications Team to manage this. In addition she commented that the Board was satisfied that processes were in place at Carillion to manage the situation.
(II) Resignation of Director of Business Development
The Chief Executive reported that Helen Bourner, the Director of Business Development was leaving the Trust in early April to take up the post of Director of Commercial and Corporate Development at Warrington and Halton NHS Foundation Trust. She advised that recruitment was underway to appoint a new Director of Strategy and that governors would be involved in the process.
The Chairman and the Chief Executive were joined by the governors and directors in thanking Helen for her contribution to the Trust, acknowledging her key role in respect of the bid for Wiltshire Community Healthcare Services, wishing her every success in the future.
That the report of the Chief Executive be received.
7/11 / Presentation on Acute Medical Unit (AMU)
The Board and the Governors received a presentation from Dr Charlotte Cannon, Lead Consultant in Ambulatory Care and Leighton Day, Deputy General Manager of Unscheduled and Community Care regarding the work of the AMU since its inception in November 2011. It was reported that the unit had been established as a trial with the aim of treating patients quickly without the need for them to be admitted into hospital.
Dr Cannon advised that the Acute Medical Unit was established in order to provide the following:
•a decrease in Length of Stay for all medical conditions across the Trust
• a decrease in the number of medical outliers on non medical wards
•improvement to the pathways for patients using the ED service
•single sex accommodation for all
•a decrease in the number of medical outliers
•rapid diagnostics to patients on the Acute Medical Unit and Ambulatory Care unit
•a decrease in the number of ward moves for admitted patients
•improvement in the time to initial senior medical decision for new attendances and
•a reduction in the number of emergency admissions.
It was reported that in order to achieve this, the 25 bedded AAU had been moved to Linnet Acute Medical Unit, which had 33 beds. Dr Cannon advised that the previous AAU had been opened as an improved area for Emergency Department Observation patients, along with facilities for ambulatory care patients. She advised that the service for ambulatory care was consultant led, with designated junior medics and enhanced diagnostic services, which provided a “pull” approach to taking patients out of the Emergency Department.
As a result of the changes, it was reported that there had been an 8.9% reduction in the number of emergency admissions. In addition, the length of stay had been reduced by 0.9 days for ambulatory conditions. It was reported that there had been improvements in performance in 6 out of 10 key performance indicators, as reported below:
KPI / Nov 2010 - Feb 2011 / Nov 2011 - Feb 2012
ED Attendances / 21366 / 22585
Attendances with a ambulatory care condition / 2483 / 2667
Ambulance handover within 20 minutes / 92.60% / 94.10%
4 hour breaches within ED associated with medical bed availability / 36.20% / 31%
Medically expedited patients being seen within the ED / average of 31 per week / average of 27 per week
Mixed sex accommodation / 98 / 4
3 or more moves between different wards as an inpatient / average of 40 / average of 8.5
Discharged from a non medical ward (Outlier) / average of 44.7 per week / average of 44.7 per week
Number of days with bays or wards closed due to infection reasons / 17 / 55
Escalation ward open / 45 / 27
In terms of the future, it was reported that the aims of the AMU was to
•Improve the number of patients receiving their care in the ambulatory care setting.
•Review other pathways that could be delivered in Ambulatory care with medical specialities
•Review other pathways that could be linked through integrated relationships with SEQOL
•Work with other directorates to review all 49 ambulatory care conditions for greater service delivery to patients.
Dr Cannon advised that providing a 24/7 service should be considered, commenting that the unit could double the number of patients it received by extending the day and opening at weekends. She advised that this would require investment in terms of the provision of consultants and diagnostic services. One Governor commented that he agreed with the 24/7 approach and that it would be advantageous to the Trust to carefully consider the management of patients in respect of surgical admissions. At this point AT clarified that a different process was in place for patients suffering a heart attack or stroke where strict requirements needed to be met in terms of treatment.
The Chairman congratulated the AMU staff for its achievements since November which was echoed by the governors and Board.
That the presentation be received.
8/11 / Presentation on Health Watch
The Joint meeting of the Trust Board and Council of Governors received a presentation from Jo Osorio, from Swindon Local Involvement Network, regarding the future of LINk under the Health and Social Care Bill.
He advised that the Bill established Local HealthWatch networks, which would
retain all involvement and scrutiny functions of the LINk, including:
• promoting involvement
• obtaining views
• monitoring health and adult care services
• making reports and recommendations
• carrying out Enter & View visits
It was reported that in addition to the functions listed above, the Bill provided that HealthWatch would provide information to support patient choice (responding to questions about information which the PCT Patient Advice and Liaison Service currently does). In addition, he advised that a HealthWatch representative would be included at the Health Overview and Scrutiny Committee.
He advised that the intention was for local Healthwatch to:
• carry out statutory functions;
• be corporate bodies, embedded in local communities;
• act as local consumer champion representing the collective voice of patients,
service users, carers and the public, on statutory health and wellbeing boards;
• play an integral role in the preparation of the statutory Joint Strategic
Needs Assessments and joint health and wellbeing strategies on which local
commissioning decisions will be based;
• have real influence with commissioners, providers, regulators and Healthwatch
England using their knowledge of what matters to local people; and
• support individuals to access information and independent advocacy if they need
help to complain about NHS services
JO showed the Board and Governors example pages of the LINk website, which provided opportunities for the public to comment and provide feedback on services. He advised that it had taken around a year to establish the blogs and interactivity of the website and that he was pleased with the levels of involvement.
He advised that it was the government’s aim was for local Healthwatch to hold commissioners and providers of services to account, acting as a critical friend to help bring about improvements. He commented that this required local Healthwatch to foster good relationships with all its partners in the health and care system speaking up for local people and helping those responsible for services to improve outcomes.
Finally JO circulated a leaflet entitled “Tell us your story” – patient and public feedback. The Chairman thanked JO for his presentation.
That the presentation be received.
9/11 / Annual Business Planning Presentation
The Chairman advised that this item would be considered in the private part of the meeting.
10/11 / Presentation by Non Executive Directors on the work of their committees
Further to a request by the Council of Governors, Angela Gillibrand, Rowland Cobbold and Robert Burns each provided a summary of the role and work of the committees that they Chaired.
Audit, Risk and Assurance Committee
Angela Gillibrand advised that she was the current Chairman of the Audit, Risk and Assurance Committee. She distributed the terms of reference for the Committee.
She advised that the committee was responsible for overseeing corporate governance ensuring effective internal control and ensuring robust processes for risk management. She reported that the committee had assisted in the development of the assurance framework, which enabled the Trust to effectively manage risks. She reported that the committee sought assurances by challenging entries on the corporate risk register. She advised that it was important to have clinical input and the committee had co-opted Dr Troughton in order to achieve this.
AG advised that the committee had challenged directorates around risk management and also the need to be more responsive to audits. AG explained that the committee had regular private dialogue with the auditors.
In response to a question raised by BF it was confirmed that the Trust had a Whistleblowing policy and that Rowland Cobbold, the Senior Independent Director was the Non Executive Director contact.
DS questioned how the Committee set its agenda to which AG responded that she was currently discussing this with the auditors again.
GD referred to the Committee’s consideration of data quality to which AG responded that this was addressed via audits but the terms of reference of the Committee were to be strengthen in relation to this area. Maria Moore advised that there was an Information Governance Steering Group which considered data quality and that the group reported into the Audit Risk and Assurance Committee.
HD referred to the Corporate Risk Register requesting a copy. CN reported that copies had previously been available at open meetings of the Board; however she undertook to circulate a link to the governors after the meeting.
Patient Safety and Quality Committee
Rowland Cobbold advised that he was the Chairman of the Patient Safety and Quality Committee. He reported that the committee was concerned with clinical management, providing assurance to the Board in respect of patient safety and patient experience.
He reported that the committee reviewed all serious incidents and any action plans were overseen by a clinician. He advised that the committee received quality accounts data and monitored performance against key indicators. He advised that the committee was interested in external sources of information, such as Dr Fosters and any Care Quality Commission reports. He advised that the committee received the Quality Risk Profile, which identified CQC outcomes where there had been changes in compliance rating. He commented that it was important for the Trust to anticipate the areas of focus for the CQC.
In response to a question raised by DS, RC commented that in his view the scrutiny and challenge by the Patient Experience Working Group could be improved.
RC explained that a full report on patient safety and quality was considered by the Board at each meeting. RC advised that should governors have specific concerns he would be happy to discuss them and provide more information as necessary.
GF commentedthat the governors felt that they should receive more feedback from the Board. Top this end it was agreed that they should be sent the link to the open papers of the Board.
Remuneration and Nominations Committee
Rowland Cobbold advised that he was the Chairman of the Remuneration and Nominations Committee. He stated that the committee was responsible for remuneration policy and the implementation of the processes for appointment of the Chief Executive and Executive Directors. He reported that the committee received input from external consultants who had experience in the NHS.
Finance Committee & Charitable Funds Committees
RobertBurns introduced himself and advised that he was the Chairman of both the Finance and Charitable Funds Committees. He advised that the committee was primarily concerned with providing challenge and scrutiny of the financial plans and forecasts prepared by the Trust. He advised that the committee was also concerned with the impact of financial plans on patient safety and the quality of services provided. He commented that scrutiny of accuracy of forecasting was very important, and providing assurance that management was committed to achieving their aims.
A copy of the Strategic Aims of the Charitable Funds Committee was available at the meeting.
That the presentations be received. / CL/CN
11/11 / Quality Accounts update
It was noted that the Patient Experience Working Group had recently received an update on the work currently being undertaken in respect of Nutrition and Hydration, which had been identified by the Council of Governors as a key indicator.
Ruth Lockwood, the Associate Director of Patient Safety and Quality advised that she had provided the Council of Governors with a detailed report in November and provided a summary as follows:
•56 Quality Improvement Indicators within Quality Account
•50/56 (89%) Quality Improvements within trajectory
•Never Events (3 GWH only)
•Nutritional Assessments
•Some Patient Experience Indicators 44-48
•CQC Compliance (GWH site only, Outcomes 4 & 5)
RL advised that the annual report was currently being drafted and the quality account report would be completed and returned within this.
That the Quality Accounts Update be received.
12/11 / Patient Experience Report
Dr Troughton introduced the Patient Experience Report advising that comments regarding the format and content were welcome. He advised that it was a shorter report and included details of internal audits, complaints trends and compliments.
He advised that the report contained information on the comment cards, patient choice, complaints, compliments and the work of the Patient Advice and Liaison Service (PALS). He advised that work was being undertaken in respect of the turnaround time of complaints and reported that in addition, the quality of complaint responses could be improved.
AT reported that each month the Board would be considering a patient story with a view to learning and improving, AT invited governors to inform the Board of any patient stories they were aware of where it was considered that there was a learning opportunity.
That the Patient Experience Report be received.
13/11 / Urgent Business
It was resolved 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.
The following items were considered: -
Item 15 - Annual Business Planning
Item 16 - Private Urgent Business