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STHW841-V1-Biomerieux-Blood-culture-guidance

Description: BLOOD CULTURE A key investigation for diagnosis of bloodstream infections OUR SPECIAL THANKS GO TO Dr Susan M. Novak-Weekley
Url: /Media/SUHTExtranet/DepartmentOfInfection/STHW841-V1-Biomerieux-Blood-culture-guidance.pdf

Papers Trust Board - 11 November 2025

Description: Date Time Location Chair Agenda Trust Board – Open Session 11/11/2025 9:00 - 13:00 Conference Room, Heartbeat
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2025-Trust-documents/Papers-Trust-Board-11-November-2025.pdf

Papers Trust Board - 9 September 2025

Description: Date Time Location Chair Apologies Agenda Trust Board – Open Session 09/09/2025 9:00 - 13:00 Conference Room, Heartbeat Education Centre Jenni Douglas-Todd David French, Tim Peachey 1 Chair’s Welcome, Apologies and Declarations of Interest 9:00 Note apologies for absence, and to hear any declarations of interest relating to any item on the Agenda. 2 Patient Story The patient story provides an opportunity for the Board to reflect on the experiences of patients and staff within the Trust and understand what the Trust could do better. 3 Minutes of Previous Meeting held on 15 July 2025 9:15 Approve the minutes of the previous meeting held on 15 July 2025 4 Matters Arising and Summary of Agreed Actions To discuss any matters arising from the minutes, and to agree on the status of any actions assigned at the previous meeting. 5 QUALITY, PERFORMANCE and FINANCE Quality includes: clinical effectiveness, patient safety, and patient experience 5.1 Briefing from the Chair of the Finance and Investment Committee 9:20 David Liverseidge, Chair 5.2 Briefing from the Chair of the People and Organisational Development 9:25 Committee Jane Harwood, Chair 5.3 Briefing from the Chair of the Quality Committee 9:30 including Maternity and Neonatal Safety 2025-26 Quarter 1 Report Tim Peachey, Chair 5.4 Chief Executive Officer's Report 9:35 Receive and note the report Sponsor: David French, Chief Executive Officer 5.5 Performance KPI Report for Month 4 10:00 Review and discuss the report Sponsor: David French, Chief Executive Officer 5.6 UHS Operating Plan 2025-26 and Board Assurance Statement 10:30 Receive and approve the Plan Sponsor: Andy Hyett, Chief Operating Officer Attendee: Duncan Linning-Karp, Deputy Chief Operating Officer 5.7 Break 10:40 5.8 Finance Report for Month 4 10:55 Review and discuss the report Sponsor: Ian Howard, Chief Financial Officer 5.9 ICS Operational Delivery Report for Month 4 11:05 Receive and discuss the report Sponsor: Ian Howard, Chief Financial Officer 5.10 11:10 People Report for Month 4 Review and discuss the report Sponsor: Steve Harris, Chief People Officer 5.11 Learning from Deaths 2025-26 Quarter 1 Report 11:20 Review and discuss the report Sponsor: Paul Grundy, Chief Medical Officer Attendee: Jenny Milner, Associate Director of Patient Experience 5.12 Annual Complaints Report 2024-25 11:30 Receive and discuss the report Sponsor: Gail Byrne, Chief Nursing Officer Attendee: Jenny Milner, Associate Director of Patient Experience 5.13 11:40 Medical Appraisal and Revalidation Annual Report including Board Statement of Compliance Receive and note the Annual Report. Approve the Statement of Compliance. Sponsor: Paul Grundy, Chief Medical Officer 5.14 Safeguarding Annual Report 2024-25 and Strategy 2025-26 11:50 Receive and discuss the report and strategy Sponsor: Gail Byrne, Chief Nursing Officer Attendees: Corinne Miller, Named Nurse for Safeguarding Adults/ Dannielle Honey, Named Nurse for Safeguarding Children 6 STRATEGY and BUSINESS PLANNING 6.1 Board Assurance Framework (BAF) Update 12:05 Review and discuss the update Sponsor: Gail Byrne, Chief Nursing Officer Attendees: Craig Machell, Associate Director of Corporate Affairs and Company Secretary/Lauren Anderson, Corporate Governance and Risk Manager Page 2 7 CORPORATE GOVERNANCE, RISK and INTERNAL CONTROL 7.1 Feedback from the Council of Governors' (CoG) Meeting 16 July 2025 12:20 (Oral) Sponsor: Jenni Douglas-Todd, Trust Chair 7.2 People and Organisational Development Committee Terms of Reference 12:30 Review and approve Sponsor: Steve Harris, Chief People Officer 8 Any other business 12:35 Raise any relevant or urgent matters that are not on the agenda 9 Note the date of the next meeting: 11 November 2025 10 Items circulated to the Board for reading 10.1 South Central Regional Research Delivery Network (SC RRDN) 2025-26 Quarter 1 Performance Report Note the report Sponsor: Paul Grundy, Chief Medical Officer 11 Resolution regarding the Press, Public and Others Sponsor: Jenni Douglas-Todd, Trust Chair To agree, as permitted by the National Health Service Act 2006 (as amended), the Trust's Constitution and the Standing Orders of the Board of Directors, that representatives of the press, members of the public and others not invited to attend to the next part of the meeting be excluded due to the confidential nature of the business to be transacted. 12 Follow-up discussion with governors 12:45 Page 3 Agenda links to the Board Assurance Framework (BAF) 9 September 2025 – Open Session Overview of the BAF Risk 1a: Lack of capacity to appropriately respond to emergency demand, manage the increasing waiting lists for elective demand, and provide timely diagnostics, that results in avoidable harm to patients. 1b: Due to the current challenges, we fail to provide patients and their families / carers with a high-quality experience of care and positive patient outcomes. 1c: We do not effectively plan for and implement infection prevention and control measures that reduce the number of hospital-acquired infections and limit the number of nosocomial outbreaks of infection. 2a: We do not take full advantage of our position as a leading University teaching hospital with a growing, reputable, and innovative research and development portfolio, attracting the best staff and efficiently delivering the best possible treatments and care for our patients. 3a: We are unable to meet current and planned service requirements due to the unavailability of staff to fulfil key roles. 3b: We fail to develop a diverse, compassionate, and inclusive workforce, providing a more positive staff experience for all staff. 3c: We fail to create a sustainable and innovative education and development response to meet the current and future workforce needs identified in the Trust’s longer-term workforce plan. 4a: We do not implement effective models to deliver integrated and networked care, resulting in sub-optimal patient experience and outcomes, increased numbers of admissions and increases in patients’ length of stay. 5a: We are unable to deliver a financial breakeven position, resulting in: inability to move out of the NHS England Recovery Support Programme, NHS England imposing additional controls/undertakings, and a reducing cash balance impacting the Trust’s ability to invest in line with its capital plan, estates/digital strategies, and in transformation initiatives. 5b: We do not adequately maintain, improve and develop our estate to deliver our clinical services and increase capacity. 5c: Our digital technology or infrastructure fails to the extent that it impacts our ability to deliver care effectively and safely within the organisation, 5d: We fail to prioritise green initiatives to deliver a trajectory that will reduce our direct and indirect carbon footprint by 80% by 2028-2032 (compared with a 1990 baseline) and reach net zero direct carbon emissions by 2040 and net zero indirect carbon emissions by 2045. Agenda links to the BAF No Item Linked BAF risk(s) 5.5 Performance KPI Report for Month 4 5.6 Operating Plan October 2025 – September 2026 5.8 Finance Report for Month 4 5.9 ICS Operational Delivery Report for Month 4 5.10 People Report for Month 4 5.11 Learning from Deaths 2025-26 Quarter 1 Report 5.12 Annual Complaints Report 2024-25 5.13 Medical Appraisal and Revalidation Annual Report including Board Statement of Compliance 5.14 Safeguarding Annual Report 2024-25 and Strategy 2025-26 1a, 1b, 1c 1a, 1b, 1c 5a 5a 3a, 3b, 3c 1b, 3b 1b, 3b 3b, 3c 1b Appetite (Category) Minimal (Safety) Current risk rating 4x5 20 Cautious (Experience) Minimal (Safety) 4x4 16 4x4 16 Open (Technology & Innovation) 3x4 12 Open (workforce) Open (workforce) Open (workforce) 4x5 20 4x3 12 4x4 16 Cautious (Effectiveness) 3x3 9 Cautious (Finance) 5x5 25 Target risk rating 4 x 2 Apr 6 27 3 x 2 Apr 6 27 2 x 3 Apr 6 27 3 x 2 Mar 6 27 4 x 3 Mar 12 30 4 x 2 Mar 8 30 3 x 2 Mar 6 29 3 x 2 Dec 6 25 3 x 3 Apr 9 30 Cautious (Effectiveness) Open (Technology & Innovation) Open (Technology & Innovation) 4x5 20 3x4 12 2x4 8 4 x 2 Apr 8 30 3 x 2 Apr 6 27 2 x 2 Dec 4 27 Does this item facilitate movement towards or away from the intended target risk score and appetite? Towards Away Neither x x x x x x x x x Minutes Trust Board – Open Session Date Time 15/07/2025 9:00 – 13:00 Location Chair Conference Room, Heartbeat/Microsoft Teams Jenni Douglas-Todd (JD-T) Present Gail Byrne, Chief Nursing Officer (GB) Keith Evans, Deputy Chair and NED (KE) David French, Chief Executive Officer (DAF) Paul Grundy, Chief Medical Officer (PG) Steve Harris, Chief People Officer (SH) Jane Harwood, NED/Senior Independent Director (JH) Ian Howard, Chief Financial Officer (IH) Duncan Linning-Karp, Interim Chief Operating Officer (DL-K) David Liverseidge, NED (DL) Tim Peachey, NED (TP) Alison Tattersall, NED (AT) In attendance Craig Machell, Associate Director of Corporate Affairs and Company Secretary (CM) Lauren Anderson, Corporate Governance and Risk Manager (LA) (shadowing CM) Julie Brooks, Deputy Director of Infection Prevention and Control) (JB) (item 5.12) Phil Bunting, Director of Operational Finance (PB) (item 7.2) Martin De Sousa, Director of Strategy and Partnerships (MDeS) (item 6.1) Christopher Kipps, Clinical Director of R&D (CK) (item 6.2) Christine Mbabazi, Equality & Inclusion Adviser/Freedom to Speak Up Guardian (CMb) (item 5.11) Laura Purandare, Deputy Director of R&D (LP) (item 6.2) Julian Sutton, Clinical Lead, Department of Infection (JS) (item 5.12) Karen Underwood, Director of R&D (KU) (item 6.2) 1 members of the public (item 2) 4 governors (observing) 3 members of staff (observing) 1 members of the public (observing) Apologies Diana Eccles, NED (DE) 1. Chair’s Welcome, Apologies and Declarations of Interest The Chair welcomed attendees to the meeting. There were no interests to declare in the business to be transacted at the meeting. It was noted that apologies had been received from Diana Eccles. 2. Patient Story Verity Elbro-White was invited to present her experience of the birth of her second child at Princess Anne Hospital. The mother was diabetic, and the pregnancy was complex. It was noted that: Page 1 • Both the community midwife and diabetic team had been excellent. The midwife had advised that the patient go to hospital because she was feeling unwell, following which she underwent a caesarean section. • The patient felt valued and listened to, with the care patient-centred. • The surgical and neonatal intensive care teams were also excellent and compassionate. • Attention was also paid to family members. 3. Minutes of the Previous Meeting held on 13 May 2025 The draft minutes tabled to the meeting were agreed to be an accurate record of the meeting held on 13 May 2025. 4. Matters Arising and Summary of Agreed Actions The matters arising and actions were noted. It was noted that action 1247 could be closed. 5. QUALITY, PERFORMANCE and FINANCE 5.1 Briefing from the Chair of the Audit and Risk Committee Keith Evans was invited to present the Committee Chair’s Report in respect of the meeting held on 9 June 2025, the content of which was noted. It was further noted that: • There had been a delay in the production of the Trust’s Annual Report and Accounts due to issues with reconciling information from the Trust’s ledgers into the accounts. NHS England had been notified, and it had been agreed that the Trust would submit its accounts by 21 July 2025. • The committee had reviewed the internal auditor’s report for 2024/25 and noted that out of the six reviews undertaken during the year, the results were good overall. • The committee received an update from the Trust’s external auditor and noted that it was necessary for the Trust to simplify its processes in order to prevent a repeat of the delay in producing end-of-year accounts. 5.2 Briefing from the Chair of the Finance and Investment Committee David Liverseidge was invited to present the Committee Chair’s Reports in respect of the meetings held on 2 June 2025 and 23 June 2025, the content of which was noted. It was further noted that: • The committee reviewed the Finance Reports for Month 1 and Month 2 (item 5.8), noting that the Trust’s reported deficit remained in line with its plan. • The Trust’s underlying deficit remained at c.£7m per month. • The committee reviewed the Trust’s Cost Improvement Programme, noting that the Trust was targeting £110m of savings for 2025/26. It was further noted that even with full delivery of the Trust’s workforce plans, there would still be a shortfall. • The committee received an update on the contracting process for 2025/26, noting that there was a risk that there would be £20-30m of unfunded activity during the year based on the current position. • The committee also continued to monitor the Trust’s cash position. Page 2 5.3 Briefing from the Chair of the People and Organisational Development Committee Jane Harwood was invited to present the Committee Chair’s Report in respect of the meeting held on 25 June 2025, the content of which was noted. It was further noted that: • The committee reviewed the People Report for Month 2 (item 5.10), noting that the Trust was on track in terms of its plan to reduce its workforce by c.700 and had received more than 220 applications under the Mutually Agreed Resignation Scheme. • The committee received an update on organisational change and the support being given to staff on managing change. • An update was provided in respect of the Trust’s education programmes, noting that there was a risk due to a lack of resource. • The committee would be reviewing the recently published 10-Year Plan in detail, particularly in terms of the organisational development elements and the plan’s implications for the Trust. 5.4 Briefing from the Chair of the Quality Committee Tim Peachey was invited to present the Committee Chair’s Report in respect of the meeting held on 2 June 2025 and to provide an update following the meeting held on 14 July 2025, the content of which was noted. It was further noted that: • There had been a further never event, although no harm had resulted. • The committee received a report on pressure ulcers and noted some concerns with respect to the regular turning of patients. • An update on the Fundamentals of Care programme was received and it was noted that improvement in general standards was limited in the absence of sufficient staff. • The committee noted an update in respect of job planning and that this provided good assurance of the process. • The committee reviewed the Maternity and Neonatal Safety Report for Quarter 4 and confirmed that there was nothing requiring escalation to the Board. Tim Peachey was invited to present the Maternity and Neonatal Workforce Report, the content of which was noted. It was further noted that: • The Trust expected to be compliant with the requirements of the NHS Resolution Maternity Incentive Scheme for 2025/26. • Although the Birthrate Plus assessment indicated a reduction in the birth rate, the acuity was, however, higher. • According to assessment, the Trust was approximately nine midwives below the required level. However, there was a plan in place to address this shortfall using the existing workforce. • There was a national shortage of neonatal nurses, although the Trust was attempting to address this issue through its in-house training programme. • In terms of the obstetrics workforce, there remained an issue with the number of trainees. 5.5 Chief Executive Officer’s Report David French was invited to present the Chief Executive Officer’s Report, the content of which was noted. It was further noted that: • The Trust had opened a new Neonatal ICU facility on 11 July 2025 as part of its work to improve the quality of the environment in the department. • The Government had published its 10-Year Health Plan for the NHS in England, which was based on reforming the NHS through three shifts: hospitals to community; analogue to digital; and sickness to prevention. Page 3 • NHS England had published the NHS Oversight Framework for 2025/26 under which organisations would be segmented based on their performance against a range of metrics. Whilst the Trust was one of the best performing trusts, the impact of a financial override and being in the Recovery Support Programme meant that the Trust would be placed in segment 5, the lowest category of performance. • Whilst the NHS waiting list nationally had fallen, the Trust’s waiting list has continued to grow. This was partially due to the impact of the cap on elective funding which had caused the Trust to cease outsourcing some procedures on the basis that it was not financially viable. • Notification had been received from the British Medical Association that resident doctors would embark on a five-day strike commencing on 25 July 2025. There was a risk of industrial action by other staffing groups, as both the Royal College of Nursing and Unite were conducting consultative ballots in respect of the 2025/26 pay award and other matters. 5.6 Performance KPI Report for Month 2 Duncan Linning-Karp was invited to present the Performance KPI Report for Month 2, the content of which was noted. It was further noted that: • In the spotlight on Referral To Treatment, despite the Trust treating more patients, its waiting list had grown by 1%. Certain services accounted for much of this growth, with other services seeing flat or reducing waiting lists. The increase had also been driven by the decision to cease outsourcing some specialities due to the impact of the elective recovery funding cap. • There were three ways to address the increasing size of the waiting list: refusing referrals, validation, and treating more. The ‘patient choice’ agenda made refusing out-of-area referrals difficult. • The Trust’s performance across the constitutional standards indicated that the Trust was operating in a challenging environment and was delivering at activity levels far in excess of pre-COVID-19 levels. • Attendances at the Emergency Department remained high, averaging 433 attendances per day across March, April and May 2025. The Trust’s performance against the four-hour standard was 56.2%, a reduction of 4.5% compared to April 2025. • There had also been a reported increase in the number of Category 2 Pressure Ulcers (per 1,000 bed days) to 0.37 in May 2025, above the target of 0.3. • The Trust continued to benchmark in the top quartile when compared to peer teaching organisations against the national cancer performance targets. • Pressure on flow had caused an increase in overnight ward moves. 5.7 Break 5.8 Finance Report for Month 2 Ian Howard was invited to present the Finance Report for Month 2, the content of which was noted. It was further noted that: • The Trust had reported an in-month deficit of £3.8m, which was consistent with the Trust’s annual plan. The underlying monthly deficit remained at £7.2m. • There had been a number of ‘one-offs’ during the month which had reduced the underlying deficit to meet the planned level of deficit. The Trust continued to target recurrent savings. • Whilst the Trust remained on an improving trajectory, there was some concern regarding the pace of improvement. Page 4 • The Trust was involved in a number of contractual disputes in respect of currently unfunded or insufficiently funded services. • The Trust’s cash position remained an area of concern and continued to be closely monitored. The Trust had five operating days of expenditure, although this was supported in month by holding c.£13m of payments. There remained a significant risk that the Trust’s cash balance would reduce to close to zero in the first half of 2025/26. 5.9 ICS Operational Delivery Report for Month 2 Ian Howard was invited the present the ICS Operational Delivery Report for Month 2, the content of which was noted. It was further noted that: • The previous ICB Finance Report had been expanded to now include operational and performance information across the system. • The Hampshire and Isle of Wight Integrated Care System had reported that it was on plan for Month 2 with a reported deficit year-to-date of £18.25m against a planned deficit of £18.3m. • All organisations in the system would receive deficit support funding for Quarter 1 and Quarter 2. Whilst there was no clear national picture, it was believed that other organisations were in a similar position. • The South East region’s plan for 2025/26 was for a deficit of £95m at Month 2. 5.10 People Report for Month 2 Steve Harris was invited to present the People Report for Month 2, the content of which was noted. It was further noted that: • In May 2025, the workforce grew by 19 whole-time-equivalents (WTE), although was still below plan by 107 WTE. In addition, in June 2025, there had been a reduction in the overall workforce size of 99 WTE driven by the closure of surge capacity and higher turnover during the month. • There had been a freeze on hiring for administrative and clerical roles since March 2025 and only 70% of clinical leavers were being replaced. However, patient demand was not reducing. • The Trust had carried out a divisional restructure, reducing its clinical divisions from four to three. • Even full delivery of the Trust’s Cost Improvement Programme workforce reduction schemes would still produce a shortfall in terms of the Trust’s achievement of its 2025/26 plan. Whilst the Trust was currently on plan in terms of its workforce numbers, it was expected that it would deviate from this later in the year. • The Trust had accepted 42 applications under the Mutually Agreed Resignation Scheme and a number of others were under consideration. The majority of accepted applicants were from clinical administration teams, • The Trust was carrying out work to benchmark its temporary pay rates against others. • Transparency about the changes was key to mitigate against the anxiety in the workforce. A number of engagement activities were taking place, including regular ‘Talk To David’ sessions. • An Equality and Quality Impact Assessment process was in place and was undertaken in respect of decisions. The impact of decisions would be monitored through the Quality Governance Steering Group. It was also Page 5 necessary to ensure that there was a strategic view of decisions rather than just individual cases. The Board discussed the controls on recruitment. The content of the discussion is summarised below: • It was questioned whether a complete freeze on non-clinical recruitment could be sustained for the full year, and that shortages in administrative staff were already having an impact. It was noted that there had already been restrictions on recruitment for these staff groups during the previous year. • It was noted that decisions made by providers in isolation could impact other providers. However, chief medical officers across the system had agreed to discuss plans collectively. 5.11 Freedom to Speak Up Report Christine Mbabazi was invited to present the Freedom to Speak Up Report, the content of which was noted. It was further noted that: • The Trust had received 37 Freedom to Speak Up cases between December 2024 and June 2025, compared to 64 cases during the same period in 2023/24. There had also been a lower number of patient safety and health and safety reports. • Although there had been fewer reports via Freedom To Speak Up, there were other routes for raising concerns and Freedom To Speak Up was meant to provide a route where other options were unavailable or not possible. • It had been reported that the National Guardian Office function was to be abolished. The Board discussed the report, the key points from which are summarised below: • The Freedom to Speak Up framework was designed to facilitate reporting of patient safety related concerns. However, there had been few such reports through this route, with the mechanism being used more as a conventional ‘speak up’ method to report matters such as bullying and harassment. • Moreover, it was not clear whether the lack of such reports via Freedom to Speak Up was an indicator whether the more conventional reporting mechanisms were working effectively and hence there was no requirement to use Freedom to Speak Up. • It was agreed that it would be helpful to have data from the other means of reporting patient safety concerns included in the report in order to provide greater assurance. Action Christine Mbabazi to include data from other mechanisms for reporting concerns in future Freedom to Speak Up reports. 5.12 Infection Prevention and Control 2024-25 Annual Report Julian Sutton and Julie Brooks were invited to present the Infection Prevention and Control 2024/25 Annual Report, the content of which was noted. It was further noted that: Page 6 • The Trust had exceeded the threshold for Clostridioides Difficile and Methicillin-resistant Staphylococcus aureus (MRSA) cases during the year. However, the Trust had been successful in improving antimicrobial stewardship by 1%. • There had been a surge in respiratory infections in early 2025, which the Trust had managed well due to the use of its rapid testing diagnostic tool. The Trust had also successfully mitigated outbreaks of norovirus. • The measures taken to prevent the spread of Candida auris had been successful with only four acquisitions since September 2024. • Only 59% of areas had achieved the accreditation scheme standard, but there were actions in place to address this and improve standards as well as support through the Fundamentals of Care programme. 5.13 Guardian of Safe Working Hours Quarterly Report Paul Grundy was invited to present the Guardian of Safe Working Hours Quarterly Report, the content of which was noted. It was further noted that: • There was a resident doctor vacancy rate of 8%, which was good compared with others. • Exception reports had decreased since the winter months. 711 exception reports had been received over the past 12 months, an average of 59 per month. • The People and Organisational Development Committee would continue to receive updates in respect of work being carried out to improve the lives of resident doctors. • The main challenge in terms of steps required to improve working conditions remained the Trust’s estate and the limited options for providing office space. 6. STRATEGY and BUSINESS PLANNING 6.1 Corporate Objectives 2025-26 Quarter 1 Review Martin de Sousa and Kelly Kent were invited to present the Corporate Objectives 2025/26 Quarter 1 Review, the content of which was noted. It was further noted that: • Twelve objectives had been agreed for 2025/26. • The Trust was on track with 75% of objectives recorded as ‘green’ and the balance being ‘amber’. • The main risks to achieving the Trust’s objectives related to availability of people and financial constraints. 6.2 Research and Development Plan 2025-26 Karen Underwood and Chris Kipps were invited to present the Research and Development Plan 2025/26, the content of which was noted. It was further noted that: • 2024/25 had been a challenging year, but despite this there had been a number of significant successes. These included an award to host a new Commercial Research Delivery Centre, launch of the South Central Regional Page 7 Research Delivery Network, and securing funding for a secure data environment. • There remained challenges in terms of available capacity to set up and deliver studies. • Key Performance Indicators were to be focused on national priorities. • The plan for 2025/26 would focus on efficiency and working regionally. • The Trust had increased the size of its commercial portfolio. However, there needed to be a balance with non-commercial studies to support the Trust’s wider strategy. Decision Having considered the proposed Research and Development Plan for 2025/26, the Board approved the plan. 6.3 Board Assurance Framework (BAF) Update and Risk Appetite Statement Lauren Anderson was invited to present the Board Assurance Framework (BAF) Update, the content of which was noted. It was further noted that: • All risks had been reviewed by the relevant executive(s) and by the Board’s committees since the Board Assurance Framework was last presented to the Board. • The risk ratings had been increased for three risks. This was broadly due to the tension between the Trust’s finances and increasing demand. As a result, 60% of BAF risks were now at the ‘critical’ level. • The risk descriptions indicated crossover in terms of mitigations, demonstrating a holistic approach to risk management. Lauren Anderson was invited to present the Trust’s Risk Appetite Statement, the content of which was noted. It was further noted that: • The Trust’s Risk Appetite Statement had been updated following the Trust Board Study Session held on 3 June 2025. • Due to the current environment, the Trust was required to tolerate a higher level of risk. • The main changes in terms of risk appetite were to reflect the need to make decisions that might adversely impact patient experience and a lower appetite for financial risk. Decision: The Board agreed the Risk Appetite Statement tabled to the meeting. 7. CORPORATE GOVERNANCE, RISK and INTERNAL CONTROL 7.1 Register of Seals and Chair’s Actions Report The paper ‘Register of Seals and Chair’s Actions Report’ was presented to the meeting, the content of which was noted. Page 8 Decision: The Board agreed to ratify the application of the Trust Seal to the documents listed in the ‘Register of Seals and Chair’s Actions Report’. 7.2 Review of Standing Financial Instructions 2025 Ian Howard was invited to present the review of the Standing Financial Instructions, the content of which was noted. It was further noted that: • There were two main changes proposed: an additional section on employee expenses and reducing non-pay approval limits for certain bands. • The Standing Financial Instructions had been benchmarked against others to address differences of approach. • The proposed changes had been reviewed and supported by the Audit and Risk Committee at its meeting held on 9 June 2025. Decision: The Board approved the proposed changes to the Standing Financial Instructions tabled to the meeting. 8. Any other business There was no other business. 9. Note the date of the next meeting: 9 September 2025 10. Resolution regarding the Press, Public and Others Decision: The Board resolved that, as permitted by the National Health Service Act 2006 (as amended), the Trust’s Constitution and the Standing Orders of the board of directors, that representatives of the press, members of the public and others not invited to attend to the next part of the meeting be excluded due to the confidential nature of the business to be transacted. The meeting was adjourned. Page 9 List of action items Agenda item Assigned to Deadline Status Trust Board – Open Session 13/05/2025 - 5.6 Performance KPI Report for Month 12 1246. Virtual outpatients appointments Linning-Karp, Duncan 09/09/2025 Pending Explanation action item Duncan Linning-Karp agreed to investigate why the number of virtual outpatients appointments had reduced. Trust Board – Open Session 15/07/2025 - 5.11 Freedom to Speak Up Report 1267. Data Mbabazi, Christine 13/01/2026 Pending Explanation action item Christine Mbabazi to include data from other mechanisms for reporting concerns in future Freedom to Speak Up reports. Page 1 of 1 Agenda Item 5.1 i) Committee Chair’s Report to the Trust Board of Directors 9 September 2025 Committee: Finance and Investment Committee Meeting Date: 21 July 2025 Key Messages: • • • • • • • • • The committee reviewed the Finance Report for Month 3, noting that the Trust had reported a £4.5m in-month deficit. This was £1.1m above the plan submitted to NHS England. The Trust’s underlying deficit was £6.5m in month and income had been lower than expected. Whilst the Trust’s financial trajectory was improving, it was not improving at the rate required to deliver the plan. The committee received an update in respect of the Trust’s cash position, noting that the Trust had received additional cash from the ICB during the month. However, the Trust expected to record a negative cash balance in December 2025. Accordingly, the Trust was investigating further measures to manage its cash position. There was also a risk due to any unfunded elements of the pay award and additional costs due to industrial action. The committee reviewed the Trust’s CIP performance, noting that whilst the Trust was close to full achievement, there had been fewer recurrent schemes delivered than anticipated with a greater proportion of savings being delivered through non-recurrent savings. The committee received an update in respect of the Trust’s productivity, noting that this would be one of the metrics to be included in the new NHS Oversight Framework. The committee received an update regarding the Outpatient Transformation Programme. The committee reviewed Wessex NHS Procurement Limited’s performance, including its delivery of CIP. The committee received the quarterly UHS Digital report. The committee received an update on the proposed Hampshire and Isle of Wight elective hub and on a possible Urgent Treatment Centre at Southampton General Hospital. Assurance: N/A (Reports/Papers reviewed by the Committee also appearing on the Board agenda) Any Other N/A Matters: Assurance Rating: Substantial There is a robust series of suitably designed internal controls in place upon Assurance which the organisation relies to manage the risk of failure of the continuous and effective achievement of the objectives of the process, which at the time of our review were being consistently applied. Reasonable There is a series of controls in place, however there are potential risks that Assurance may not be sufficient to ensure that the individual objectives of the process are achieved in a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. Page 1 of 2 Limited Assurance No Assurance Not Applicable Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Significant improvements are required to improve the adequacy and effectiveness of the controls. There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls. Where assurance is not required and/or relevant. Risk Rating: Low Medium High Not Applicable Based on the report considered by the committee, there is little or no concern that the Trust will be unable to meet its stated objectives and/or plans. There is some concern that the Trust might not be able to fully meet its stated objectives and/or plans based on the information contained in the report considered by the committee. There is a significant risk that the Trust will not be able to meet its stated objectives and/or plans based on the information contained in the report considered by the committee. Where risk rating is not relevant. Page 2 of 2 Agenda Item 5.1 ii) Committee Chair’s Report to the Trust Board of Directors 9 September 2025 Committee: Finance and Investment Committee Meeting Date: 2 September 2025 Key Messages: • • • • • • The committee reviewed the Finance Report for Month 4 (see below). The committee reviewed and discussed a draft of the Trust’s Financial Recovery Plan, which was to be reviewed by the Board on 9 September 2025. The committee requested some clarifications and proposed some additions to ensure that long-term implications were understood. These changes would be incorporated into the paper to go to the Board. Suggestions for further action were also raised, but some of these had been discounted due to the impact on operations and detriment to the short-term position. The committee received an update in respect of the Trust’s cash position, noting that the Trust had received cash advances in June and July and that the ICB had agreed to provide additional cash in August and September. In addition, the process for requesting cash support from NHS England had now been published, although this would likely require some adjustments to the Trust’s governance to establish a ‘cash committee’ – it was considered appropriate to review the terms of reference for the Finance and Investment Committee and possibly to separate out the cash monitoring activities. It was further noted that NHS England had published guidance which suggested that trusts should have a minimum of four days’ operating expenditure in cash. The committee supported the submission of a request for cash support from NHS England, noting that the consequences of not receiving such support would be extremely serious (see also BAF review below). The committee received an update in respect of ongoing and recent contracting disputes, noting that a number of significant disputes had been closed and two remain in dispute and have been escalated. Assurance: (Reports/Papers reviewed by the Committee also appearing on the Board agenda) 5.8 Finance Report for Month 4 Assurance Rating: Risk Rating: Substantial High • The Trust had recorded a year-to-date deficit of £19.5m, which was £5.8m above its 2025/26 plan. • There had not been the one-off benefits seen in previous months during Month 4, which meant that the Trust’s position had worsened. However, its underlying month-on-month deficit was improving with £6.5m being recorded in month (previous months had been c.£7m). • The Trust had also received less income than anticipated from areas such as the Channel Islands, genomics, pathology, and CAR(T). There was also a risk that the Trust would not be fully paid for its over performance in terms of elective work, but this was being pursued with the relevant commissioners. • The Trust was also above its workforce plan by 55 whole-timeequivalents and the unfunded element of the pay award amounted to £2.4m per annum, of which £1.4m related to the training and Page 1 of 2 Any Other Matters: education contract and the balance being as a result of the settlement not accurately reflecting the Trust’s staffing mix. • However, the Trust was on track in terms of its CIP delivery, albeit there had been higher non-recurrent delivery than expected. 6.1 Board Assurance Framework (BAF) Update Assurance Rating: Risk Rating: Substantial N/A • Risks 5a, 5b and 5c have been updated, following discussions with the respective Executive Director(s). • It had been agreed to increase the rating of risk 5a from 20 to 25 on the basis that the Trust did not, currently, have an agreement for the provision of cash support, and that the Trust was reliant on third parties to resolve many of the underlying issues. It was also noted that the need to reduce activity and spending now would likely require increased expenditure in future years in order to recover the Trust’s position. • It was agreed that the target risk ratings should be amended to show a rating of 20 at April 2026 and 15 at April 2027. The committee noted new guidance in respect of strengthening financial management and supporting delivery in 2025/26. Assurance Rating: Substantial There is a robust series of suitably designed internal controls in place upon Assurance which the organisation relies to manage the risk of failure of the continuous and effective achievement of the objectives of the process, which at the time of our review were being consistently applied. Reasonable There is a series of controls in place, however there are potential risks that Assurance may not be sufficient to ensure that the individual objectives of the process are achieved in a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. Limited Assurance Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Significant improvements are required to improve the adequacy and effectiveness of the controls. No Assurance There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls. Not Applicable Where assurance is not required and/or relevant. Risk Rating: Low Medium High Not Applicable Based on the report considered by the committee, there is little or no concern that the Trust will be unable to meet its stated objectives and/or plans. There is some concern that the Trust might not be able to fully meet its stated objectives and/or plans based on the information contained in the report considered by the committee. There is a significant risk that the Trust will not be able to meet its stated objectives and/or plans based on the information contained in the report considered by the committee. Where risk rating is not relevant. Page 2 of 2 Agenda Item 5.2 i) Committee Chair’s Report to the Trust Board of Directors 9 September 2025 Committee: People and Organisational Development Committee Meeting Date: 21 July 2025 Key Messages: • • • • • • • The committee reviewed the People Report for Month 3 and noted that the size of the workforce had reduced during June 2025. There had been 110 whole-time-equivalent (WTE) staff who left during the month and the Trust was phasing new starters. In addition, the Trust had been able to close surge capacity and was closing wards, which had led to a reduction in bank staff use. Based on the forecast, the Trust expected to be c.350 WTE short of its 2025/26 plan based on the delivery of the ‘green’ and ‘amber’ rated CIP programmes. The Trust continued to experience increased demand and there had been an increase in the number of patients having no criteria to reside. In addition, new resident doctors and newly qualified nurses would impact the Trust’s workforce numbers and the forecast made no assumptions regarding industrial action. The committee noted that administrative and clerical staff had been hardest hit by the recruitment restrictions over the past two years, which was causing difficulties in some areas. The committee discussed the potential intake of newly qualified nurses, noting the difficulty of balancing the Trust’s short-term concerns of needing to reduce its workforce with the longer term need for qualified staff. The committee received an update on the organisational change activities underway, including the proposed divisional restructure and MARS programme. The committee received an update in respect of the planned industrial action by resident doctors. The committee reviewed the National Education and Training Survey for 2024, which covered all staff in training posts in the NHS. Assurance: N/A (Reports/Papers reviewed by the Committee also appearing on the Board agenda) Any Other Matters: • The committee reviewed five draft Equality and Quality Impact Assessments relating to the measures required to deliver the Trust’s 2025/26 plan. Assurance Rating: Substantial There is a robust series of suitably designed internal controls in place upon Assurance which the organisation relies to manage the risk of failure of the continuous and effective achievement of the objectives of the process, which at the time of our review were being consistently applied. Reasonable There is a series of controls in place, however there are potential risks that Assurance may not be sufficient to ensure that the individual objectives of the process are achieved in a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. Page 1 of 2 Limited Assurance No Assurance Not Applicable Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Significant improvements are required to improve the adequacy and effectiveness of the controls. There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls. Where assurance is not required and/or relevant. Risk Rating: Low Medium High Not Applicable Based on the report considered by the committee, there is little or no concern that the Trust will be unable to meet its stated objectives and/or plans. There is some concern that the Trust might not be able to fully meet its stated objectives and/or plans based on the information contained in the report considered by the committee. There is a significant risk that the Trust will not be able to meet its stated objectives and/or plans based on the information contained in the report considered by the committee. Where risk rating is not relevant. Page 2 of 2 Agenda Item 5.2 ii) Committee Chair’s Report to the Trust Board of Directors 9 September 2025 Committee: People and Organisational Development Committee Meeting Date: 1 September 2025 Key Messages: • • • • • • The committee reviewed the People Report for Month 4 (see below). The committee noted the recent announcement by the Government of a ‘graduate guarantee’ for nurses. It was noted that, prior to this announcement, the Trust had decided to increase the level of offers to newly qualified nurses, but to phase start dates in line with predicted turnover and anticipated vacancies in nursing posts. The committee noted that there were significant challenges across the organisation with staff impacted by multiple factors, including: increased car parking rates, building work requiring temporary relocation of 300-400 car park users to Adanac (Park and Ride), a reduction in enhanced bank rates back to standard Agenda for Change levels, and a decision to no longer offer free tea and coffee in theatres for staff (in line with other areas of the Trust). This coupled with the ongoing financial environment and workforce controls would impact staff engagement and satisfaction with the Staff Survey due to launch at the end of September 2025. The committee also expressed its concern for staff – particularly those from overseas – in view of the recent political climate regarding immigration. The committee reviewed the workforce related elements of the Trust’s proposed recovery plan, noting that the Trust was dependent on a number of material assumptions in order to be able to meet its 2025/26 plan. These included: availability of funding for further restructuring, reductions in mental health and no criteria to reside numbers, and reduction in overall activity levels. The committee received an update in respect of the industrial action undertaken by resident doctors in July 2025 and noted that about one third of staff eligible took part in the strike and that most clinical activity continued. It was also noted that F1 doctors were to be balloted separately by the BMA with the focus more on pay and availability of training places. The Trust has been required to produce a selfassessment of ten actions relating to doctors’ working conditions and to determine how to achieve these actions which will be presented to committee and to Board through the update by the Guardian of Safe Working at UHS. Assurance: (Reports/Papers reviewed by the Committee also appearing on the Board agenda) 5.10 People Report for Month 4 Assurance Rating: Risk Rating: Substantial High • The overall workforce had increased by 10 whole-time-equivalents (WTE) in July 2025. Whilst the substantive workforce had decreased by 18 WTE, increased numbers of mental health cases, coupled with industrial action, had led to an increase in use of temporary staff. • Accordingly, the Trust was above the NHSE 2025/26 workforce plan by 55 WTE. • 65 applications under the Mutual Agreed Resignation Scheme (MARS) had been approved with all successful applicants due to leave Page 1 of 2 Any Other Matters: by the end of November 2025. This would deliver a recurrent saving of £2.2m based on the whole-year saving, albeit at a one-off cost of £1.1m, which meant that it was broadly cost neutral for 2025/26. • The Trust completed its divisional restructure on 1 July 2025, which was expected to deliver a saving of £700k and 12 WTE 7.2 People and Organisational Assurance Rating: Risk Rating: Development Committee Terms N/A N/A of Reference • The committee reviewed its terms of reference and recommended that the Board approve the updated terms of reference. • Only one minor change was proposed – to remove reference to the Charitable Funds Committee on the basis that this committee no longer existed. N/A Assurance Rating: Substantial There is a robust series of suitably designed internal controls in place upon Assurance which the organisation relies to manage the risk of failure of the continuous and effective achievement of the objectives of the process, which at the time of our review were being consistently applied. Reasonable There is a series of controls in place, however there are potential risks that Assurance may not be sufficient to ensure that the individual objectives of the process are achieved in a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. Limited Assurance Controls in place are not sufficient to ensure that
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Papers Trust Board - 13 May 2025

Description: Agenda Trust Board – Open Session Date Time Location Chair Apologies In attendance 13/05/2025 9:00 - 13:00 Conference Room, Heartbeat Education Centre Jenni Douglas-Todd Keith Evans, Alison Tattersall Helena Blake, Head of Clinical Quality Assurance (shadowing Gail Byrne) Raquel Domene Luque, Interim Lead Matron, Ophthalmology (shadowing Gail Byrne) 1 Chair’s Welcome, Apologies and Declarations of Interest 9:00 Note apologies for absence, and to hear any declarations of interest relating to any item on the Agenda. 2 Patient Story (This item has been postponed until the next meeting) The patient story provides an opportunity for the Board to reflect on the experiences of patients and staff within the Trust and understand what the Trust could do better. 3 Minutes of Previous Meeting held on 11 March 2025 Approve the minutes of the previous meeting held on 11 March 2025 4 Matters Arising and Summary of Agreed Actions To discuss any matters arising from the minutes, and to agree on the status of any actions assigned at the previous meeting. 5 QUALITY, PERFORMANCE and FINANCE Quality includes: clinical effectiveness, patient safety, and patient experience 5.1 Briefing from the Chair of the Audit and Risk Committee 9:10 Keith Evans, Chair 5.2 Briefing from the Chair of the Finance and Investment Committee 9:15 Dave Bennett, Chair 5.3 Briefing from the Chair of the People and Organisational Development 9:20 Committee Jane Harwood, Chair 5.4 Briefing from the Chair of the Quality Committee 9:25 Tim Peachey, Chair including Maternity and Neonatal Safety 2024-25 Quarter 3 Report 5.5 9:30 5.6 10:00 5.7 10:40 5.8 10:55 5.9 11:05 5.10 11:10 5.11 11:20 5.12 11:30 5.13 11:40 6 6.1 11:50 Chief Executive Officer's Report Receive and note the report Sponsor: David French, Chief Executive Officer Performance KPI Report for Month 12 Review and discuss the report Sponsor: David French, Chief Executive Officer Break Finance Report for Month 12 Review and discuss the report Sponsor: Ian Howard, Chief Financial Officer ICS Finance Report for Month 12 Receive and discuss the report Sponsor: Ian Howard, Chief Financial Officer People Report for Month 12 Review and discuss the report Sponsor: Steve Harris, Chief People Officer UHS Annual Staff Survey Results 2024 Report Discuss and note the report Sponsor: Steve Harris, Chief People Officer Attendees: Ceri Connor, Director of OD and Inclusion/Sophie Limb, HR Project Manager Guardian of Safe Working Hours Quarterly Report Receive and discuss the report Sponsor: Paul Grundy, Chief Medical Officer Attendee: Diana Hulbert, Guardian of Safe Working Hours and Emergency Department Consultant Learning from Deaths 2024-25 Quarter 3 and 4 Reports Review and discuss the reports Sponsor: Paul Grundy, Chief Medical Officer Attendee: Jenny Milner, Associate Director of Patient Experience STRATEGY and BUSINESS PLANNING Corporate Objectives 2024-25 Quarter 4 Review Review and feedback on the corporate objectives Sponsor: David French, Chief Executive Officer Attendees: Martin De Sousa, Director of Strategy and Partnerships/Kelly Kent, Head of Strategy and Partnerships Page 2 6.2 Board Assurance Framework (BAF) Update 12:00 Review and discuss the update Sponsor: Gail Byrne, Chief Nursing Officer Attendees: Craig Machell, Associate Director of Corporate Affairs and Company Secretary/Lauren Anderson, Corporate Governance and Risk Manager 6.3 South Central Regional Research Delivery Network (SC RRDN) 2024-25 12:10 Annual Performance Review and 2025-26 Annual Plan Receive and note the annual report and plan Sponsor: Paul Grundy, Chief Medical Officer Attendee: Clare Rook, Chief Operating Officer, CRN: Wessex 7 CORPORATE GOVERNANCE, RISK and INTERNAL CONTROL 7.1 Feedback from the Council of Governors' (CoG) meeting 29 April 2025 12:25 (Oral) Sponsor: Jenni Douglas-Todd, Trust Chair 7.2 Register of Seals and Chair's Actions Report 12:30 Receive and ratify In compliance with the Trust Standing Orders, Financial Instructions, and the Scheme of Reservation and Delegation. Sponsor: Jenni Douglas-Todd, Trust Chair 8 Any other business 12:35 Raise any relevant or urgent matters that are not on the agenda 9 Note the date of the next meeting: 15 July 2025 10 Resolution regarding the Press, Public and Others Sponsor: Jenni Douglas-Todd, Trust Chair To agree, as permitted by the National Health Service Act 2006 (as amended), the Trust's Constitution and the Standing Orders of the Board of Directors, that representatives of the press, members of the public and others not invited to attend to the next part of the meeting be excluded due to the confidential nature of the business to be transacted. 11 Follow-up discussion with governors 12:40 Page 3 Agenda links to the Board Assurance Framework (BAF) 13 May 2025 – Open Session Overview of the BAF Risk 1a: Lack of capacity to appropriately respond to emergency demand, manage the increasing waiting lists for elective demand, and provide timely diagnostics, that results in avoidable harm to patients. 1b: Due to the current challenges, we fail to provide patients and their families / carers with a high-quality experience of care and positive patient outcomes. 1c: We do not effectively plan for and implement infection prevention and control measures that reduce the number of hospital-acquired infections and limit the number of nosocomial outbreaks of infection. 2a: We do not take full advantage of our position as a leading University teaching hospital with a growing, reputable, and innovative research and development portfolio, attracting the best staff and efficiently delivering the best possible treatments and care for our patients. 3a: We are unable to meet current and planned service requirements due to the unavailability of staff to fulfil key roles. 3b: We fail to develop a diverse, compassionate, and inclusive workforce, providing a more positive staff experience for all staff. 3c: We fail to create a sustainable and innovative education and development response to meet the current and future workforce needs identified in the Trust’s longer-term workforce plan. 4a: We do not implement effective models to deliver integrated and networked care, resulting in sub-optimal patient experience and outcomes, increased numbers of admissions and increases in patients’ length of stay. 5a: We are unable to deliver a financial breakeven position, resulting in: inability to move out of the NHS England Recovery Support Programme, NHS England imposing additional controls/undertakings, and a reducing cash balance impacting the Trust’s ability to invest in line with its capital plan, estates/digital strategies, and in transformation initiatives. 5b: We do not adequately maintain, improve and develop our estate to deliver our clinical services and increase capacity. 5c: Our digital technology or infrastructure fails to the extent that it impacts our ability to deliver care effectively and safely within the organisation, 5d: We fail to prioritise green initiatives to deliver a trajectory that will reduce our direct and indirect carbon footprint by 80% by 2028-2032 (compared with a 1990 baseline) and reach net zero direct carbon emissions by 2040 and net zero indirect carbon emissions by 2045. Agenda links to the BAF No Item Linked BAF risk(s) 5.6 Performance KPI Report for Month 12 5.8 Finance Report for Month 12 5.9 ICS Finance Report for Month 12 5.10 People Report for Month 12 5.11 UHS Staff Survey Results 2024 Report 5.12 Guardian of Safe Working Hours Quarter 3 Report 6.1 Corporate Objectives 2024-5 Quarter 3 Review 6.3 South Central Regional Research Delivery Network Annual Performance Review and 2025-26 Annual Plan 1a, 1b, 1c 5a 5a 3a, 3b, 3c 3b 3b, 3c All 1b, 2a Appetite (Category) Minimal (Safety) Current risk rating 4x5 20 Cautious (Experience) Minimal (Safety) 3x3 9 4x4 16 Open (Technology & Innovation) 3x3 9 Open (workforce) Open (workforce) Open (workforce) 4x5 20 4x3 12 4x4 16 Cautious (Effectiveness) 3x3 9 Cautious (Finance) 4x5 20 Target risk rating 4 x 2 Apr 6 27 3 x 2 Mar 6 26 2 x 3 Apr 6 27 3 x 2 Dec 6 25 4 x 3 Mar 12 26 4 x 2 Mar 8 27 3 x 2 Mar 6 29 3 x 2 Dec 6 25 3 x 3 Apr 9 30 Cautious (Effectiveness) Open (Technology & Innovation) Open (Technology & Innovation) 4x5 20 3x4 12 2x3 6 4 x 2 Apr 8 30 3 x 2 Apr 6 27 2 x 2 Dec 4 27 Does this item facilitate movement towards or away from the intended target risk score and appetite? Towards Away Neither X X X X X X X X Minutes Trust Board – Open Session Date Time 11/03/2025 9:00 – 13:00 Location Chair Conference Room, Heartbeat/Microsoft Teams Jenni Douglas-Todd (JD-T) Present Dave Bennett, NED (DB) Gail Byrne, Chief Nursing Officer (GB) Jenni Douglas-Todd, Chair (JD-T) Diana Eccles, NED (DE) Keith Evans, Deputy Chair and NED (KE) David French, Chief Executive Officer (DAF) Paul Grundy, Chief Medical Officer (PG) Steve Harris, Chief People Officer (SH) Jane Harwood, NED/Senior Independent Director (JH) Ian Howard, Chief Financial Officer (IH) Duncan Linning-Karp, Interim Chief Operating Officer (DL-K) David Liverseidge, NED (DL) Tim Peachey, NED (TP) Alison Tattersall, NED (AT) In attendance Martin De Sousa, Director of Strategy and Partnerships (MDeS) Craig Machell, Associate Director of Corporate Affairs and Company Secretary (CM) Lauren Anderson, Corporate Governance and Risk Manager (LA) (item 6.2) Kelly Kent, Head of Strategy and Partnerships (KK) (item 6.1) 2 members of the public (item 2) 5 governors (observing) 7 members of staff (observing) 1 members of the public (observing) 1. Chair’s Welcome, Apologies and Declarations of Interest The Chair welcomed attendees to the meeting. There were no interests to declare in the business to be transacted at the meeting. 2. Patient Story Gregg and Serra [SURNAME] were invited to present their experience as the parents of a child who underwent successful open-heart surgery at Southampton General Hospital in September 2024, having been diagnosed with an atrioventricular septal defect in 2023. It was noted that: • The care provided by the Trust’s staff had been exceptional, including for being able to put matters into layman’s terms to assist understanding. • The interaction between staff and the child patient was also praised, with the parents reporting that their child had been viewed first of all as a person, rather than as simply another patient. 3. Minutes of the Previous Meeting held on 7 January 2025 The draft minutes tabled to the meeting were agreed to be an accurate record of the meeting held on 7 January 2025. Page 1 4. Matters Arising and Summary of Agreed Actions An update was provided in respect of the following actions: • 1200: it was noted that discussions had been had with Natasha Watts and Jenny Milner and the action was ongoing. • 1201: it was noted that an update would be presented in the closed session of the meeting. • 1202: the Trust had written to the Integrated Care Board. • 1203: it was noted that a meeting had been arranged to discuss Freedom to Speak Up on 21 March 2025. 5. QUALITY, PERFORMANCE and FINANCE 5.1 Briefing from the Chair of the Audit and Risk Committee The chair of the Audit and Risk Committee was invited to present the Committee Chair’s Report in respect of the meeting held on 20 January 2025, the content of which was noted. It was further noted that: • The committee considered the accounting policies and management judgements for the 2024/25 annual accounts. • The committee reviewed the Trust’s compliance with the Code of Governance for NHS Provider Trusts, noting that the Trust was compliant in all areas or had appropriate explanations for the few areas of non-compliance. • The committee had received a report on cyber risk, noting that the main risk was from suppliers not having adequate protection and the Trust’s operations being impacted as a result of the loss of service. • The committee considered a report in respect of the risk of individuals impersonating agency staff and noted the Trust’s controls to mitigate against this risk. 5.2 Briefing from the Chair of the Finance and Investment Committee The chair of the Finance and Investment Committee was invited to present the Committee Chair’s Reports in respect of the meetings held on 27 January and 24 February 2025, the content of which was noted. It was further noted that: • The committee reviewed the Finance Report for Month 10 (item 5.8), noting that the Trust was forecasting a year-end deficit of £17.65m and delivery of £76m in efficiencies under the Cost Improvement Programme. • It was further noted that the Trust was anticipating that it would have carried out c.£40m of unpaid activity by the end of the year. • The committee considered a draft of the Trust’s annual plan submission, noting that 2025/26 would present a significant challenge. 5.3 Briefing from the Chair of the People and Organisational Development Committee The chair of the People and Organisational Development Committee was invited to present the Committee Chair’s Reports in respect of the meetings held on 24 January and 24 February 2025, the content of which was noted. It was further noted that: • The committee reviewed the People Report for Month 10 (item 5.10), noting that whilst the Trust was forecasting to be 125 whole-time-equivalents (WTE) above its 2024/25 plan, the total substantive workforce would be 50 WTE lower than in March 2024. • There had been high levels of sickness absence over the period, which had resulted in increased use of bank staff. Concern was expressed in respect of the low uptake rate for vaccinations by staff compared to previous years. Page 2 • Appraisal rates were lower than anticipated, but it was possible that this was due to issues with the transfer of recording of appraisals to the Virtual Learning Environment system. 5.4 Briefing from the Chair of the Quality Committee The chair of the Quality Committee was invited to present the Committee Chair’s Report in respect of the meeting held on 27 January 2025, the content of which was noted. It was further noted that: • The committee had received an update in respect of the ‘Fundamentals of Care’ programme and noted that the programme was progressing well. • The committee reviewed the progress of the Always Improving outpatients and discharge programmes. • The committee reviewed the interim Maternity and Neonatal Safety Report, noting that there was nothing to escalate to the Board. 5.5 Chief Executive Officer’s Report David French was invited to present the Chief Executive Officer’s Report, the content of which was noted. It was further noted that: • There had been significant changes in the leadership of NHS England with effectively all executive directors having resigned. Furthermore, there were expected to be significant reductions in the NHS England workforce and changes in the relationship between NHS England and the Department for Health and Social Care. • The Trust had received a request to provide feedback on a proposed management and leadership standard for the NHS. The Trust intended to respond to the consultation. • Concerns had been raised in respect of the Trust’s adult cardiac waiting list due to a mismatch in referrals against operations performed, which had resulted in an improvement plan being submitted to NHS South East Region and a quality visit on 4 February 2025. The Trust’s congenital cardiac team was also under pressure due to insufficient capacity. • Positive feedback had been received following a visit to the Trust’s maternity services by NHS South East Region and the Local Maternity and Neonatal System team. • On 28 February 2025, the Trust had announced the opening of the refurbished Muslim prayer room facilities. • The Trust’s mechanical thrombectomy service was now a 24/7 service and that it was expected that the service would treat up to 1,200 patients a year over the next five years. • Dr Stephen Harden, a consultant in cardiothoracic radiology at the Trust, had been elected as the incoming president of the Royal College of Radiologists for a three-year term commencing on 1 September 2025. 5.6 Performance KPI Report for Month 10 Duncan Linning-Karp was invited to present the Performance KPI Report for Month 10, the content of which was noted. It was further noted that: • The Emergency Department remained under significant pressure due to the level of attendances (11,728 during January 2025), with performance against the four-hour wait target being 61% in January 2025 and 55% in February 2025. • The average number of patients having no criteria to reside was 232 during January 2025. • The Trust’s performance in respect of the 62- and 28-day cancer targets remained high at 79.1% and 83.6% respectively for December 2024. The Page 3 Trust’s performance in these areas was higher than the national targets for March 2026. • Compared to equivalent teaching hospitals, the Trust was second in the country for 65-week waits and joint first in the country for 78-week waits. It was expected that the outstanding 65-week wait patients at March 2025 would be limited to those awaiting material for corneal transplants, of which there was a national shortage, and a small number of complex patients. • The Trust’s mortality rate had fallen as expected and the Trust was ranked as having one of the lowest mortality rates in England. • There had been an increase in the number of incidents of pressure ulcers during January and February 2025. It was noted that often there was an increased number of patients with co-morbidities during the winter months, who were at greater risk of developing pressure ulcers. • Whilst staffing levels had been problematic during September and October 2024 in the Maternity service, the situation had since improved as newlyqualified nurses became substantive. • Further work was ongoing to promote wider use of virtual clinics as an alternative to face-to-face appointments. • The Trust was intending to spend £1.5m on hardware by the end of the year to address the issues caused by the average age of the Trust’s IT estate. Action Craig Machell agreed to add A/I to a future Trust Board Study Session agenda. Gail Byrne agreed to present a deep-dive on pressure ulcers to the Quality Committee. 5.7 Break 5.8 Finance Report for Month 10 Ian Howard was invited to present the Finance Report for Month 10, the content of which was noted. It was further noted that: • The Trust had been working with system partners to agree a ‘landing plan’ for the system for 2024/25 to deliver a break-even position. The Trust’s forecast was for a year-end deficit of £17.65m. • The Trust had recorded a £7.5m in-month surplus and a year-to-date deficit of £15.2m, £11.8m behind its plan. However, there remained an underlying deficit of c.£6.5m, which would pose a significant challenge for 2025/26. • The Trust was forecasting to have insufficient cash in May 2025 and therefore would require additional cash support. It was noted that cash support would require certain commitments from applicants and that requests were not always fulfilled. • The messaging from NHS England appeared to be that difficult decisions would be required to deliver a financially sustainable NHS and that there would be no additional funding. It was noted that a number of these decisions would be better made at a national level to ensure consistency across the country. 5.9 ICB Finance Report for Month 10 The ICB Finance Report for Month 10 was noted. 5.10 People Report for Month 10 Steve Harris was invited to present the People Report for Month 10, the content of which was noted. It was further noted that: Page 4 • Unison had put an offer to its members to resolve the dispute over Band 2/3 pay. It was expected that the vote would conclude at the end of March 2025. • The consultation in respect of the transfer of staff to UHS Estates Limited had progressed well, with the transfer expected to take place on 1 April 2025. • Progress continued to be made in respect of the action plan agreed with portering staff. • The Trust had exceeded its workforce plan by 153 whole-time-equivalents (WTE) at the end of January 2025. There had been a significant increase in use of bank staff due to continued high levels of sickness absence and the need to open surge capacity. • It was forecast that the Trust would be 125 WTE above its plan for 2024/25. It was noted that the Trust had anticipated a reduction in staffing numbers of c.220 WTE due to reductions in patients having no criteria to reside and delivery of system transformation programmes. However, these assumptions had not materialised. 5.11 Mortuary Standards Compliance Update Gail Byrne was invited to provide an update in respect of the actions required following the Fuller Inquiry, the content of which was noted. It was further noted that: • The action plan and outputs from the Fuller Inquiry had been presented to the Board at its meeting held on 6 June 2024. • It was noted that all the actions identified had been completed. 6. STRATEGY and BUSINESS PLANNING 6.1 Corporate Objectives 2024-25 Quarter 3 Review Martin De Sousa and Kelly Kent were invited to present the ‘Corporate Objectives 2024-25 Quarter 3 Review’, the content of which was noted. It was further noted that fifty per cent of objectives were on track to be delivered in full (a reduction compared to the second quarter), 37.5% were amber and 12.5% were red. 6.2 Board Assurance Framework (BAF) Update Lauren Anderson was invited to present the Board Assurance Framework Update, the content of which was noted. It was further noted that: • There were six risks rated as ‘critical’ (i.e. 15 or above), with one risk (risk 3c) having been upgraded from 12 due to increased likelihood given reductions in the available funding and workforce. • The target dates for six risks had also been extended, including two out to April 2030 due in part to uncertainty in respect of funding availability. 7. CORPORATE GOVERNANCE, RISK and INTERNAL CONTROL 7.1 Feedback from the Council of Governors’ (CoG) meeting 29 January 2025 The Chair presented a summary of the Council of Governors’ meeting held on 29 January 2025. It was noted that the meeting had considered the following matters: • Chief Executive Officer’s Performance Report Page 5 • Chair and Non-Executive Director Appraisal Process • Audit and Risk Committee Terms of Reference • Governors’ Nomination Committee Terms of Reference • Annual Business Plan • Noting the appointment of David Liverseidge following the original approval given in 2024. • Governor Attendance • Membership Engagement 7.2 Register of Seals and Chair’s Actions Report The paper ‘Register of Seals and Chair’s Actions Report’ was presented to the meeting, the content of which was noted. It was further noted that the following items had been sealed on 7 March 2025: • TP1 Land Registry between University Hospital Southampton NHS Foundation Trust and Prime Infrastructure Management Services 4 Limited (the Transferor) and University Hospital Southampton NHS Foundation Trust (Transferee) relating to Land forming part of an accessway adjoining Plot 2, Bargain Farm, Frogmore Lane, Nursling, Southampton, Hampshire SO16 0XS. Seal number 291 on 7 March 2025 • TP1 Land Registry between University Hospital Southampton NHS Foundation Trust and Prime Infrastructure Management Services 4 Limited (Transferor) and University Hospital Southampton NHS Foundation Trust (the Transferee) relating to Land forming part of an accessway adjoining Plot 2, Bargain Farm, Frogmore Lane, Nursling, Southampton, Hampshire SO16 0XS. Seal number 292 on 7 March 2025. • Underlease between Just Retirement Limited (the Landlord) and University Hospital Southampton NHS Foundation Trust (the Tenant) relating to Aseptic Pharmacy and Offices on the Ground, 1st and 2nd Floors at Plot 2 Adanac Health and Innovation Campus, Nursling, Southampton, Hampshire SO16 0XS. Seal number 293 on 7 March 2025. • Reversionary Underlease between Just Retirement Limited (the Landlord) and University Hospital NHS Foundation Trust (the Tenant) relating to Ground and first Floor Sterile Services Unit and Offices at Plot 2 Adanac Health and Innovation Campus, Nursling, Southampton, Hampshire SO16 0XS. Seal number 294 on 7 March 2025. • Underlease between Just Retirement Limited (the Landlord), IHSS Limited (the Tenant) and University Hospital Southampton NHS Foundation Trust (the Trust) relating to Ground and first Floor Sterile Services Unit and Offices at Plot 2 Adanac Health and Innovation Campus, Nursling, Southampton, Hampshire SO16 0XS. Seal number 295 on 7 March 2025. • Sub-Underlease between University Hospital NHS Foundation Trust (Landlord) and UHS Estates Limited (Tenant) of Aseptic Pharmacy and Offices on the Ground, 1st and 2nd Floors at Plot 2 Adanac Health and Innovation Campus, Nursling, Southampton, Hampshire SO16 0XS. Seal number 296 on 7 March 2025. Page 6 Decision: The Board agreed to ratify the application of the Trust Seal to the documents listed in the ‘Register of Seals and Chair’s Actions Report’ and in respect of the items listed above. 7.3 Audit and Risk Committee Terms of Reference Craig Machell was invited to present the proposed changes to the Audit and Risk Committee’s Terms of Reference, the content of which was noted. It was further noted that: • The Audit and Risk Committee had reviewed its terms of reference at its meeting on 20 January 2025, following which input had been sought from the Council of Governors at its meeting held on 29 January 2025. • It was proposed to amend a reference in paragraph 10.2 and to update Appendix A. Decision Having considered the proposed amendments to the Audit and Risk Committee’s Terms of Reference, the Board approved the changes. 7.4 Finance and Investment Committee Terms of Reference Craig Machell was invited to present the proposed changes to the Finance and Investment Committee’s Terms of Reference, the content of which was noted. It was further noted that: • The Finance and Investment Committee had reviewed its terms of reference at its meeting on 27 January 2025. • It was proposed to update Appendix A. Decision Having considered the proposed amendments to the Finance and Investment Committee’s Terms of Reference, the Board approved the changes. 7.5 Quality Committee Terms of Reference Craig Machell was invited to present the proposed changes to the Quality Committee’s Terms of Reference, the content of which was noted. It was further noted that: • The Quality Committee had reviewed its terms of reference at its meeting on 27 January 2025. • It was proposed to amend a reference in paragraph 10.2 and to update Appendix A. Decision Having considered the proposed amendments to the Quality Committee’s Terms of Reference, the Board approved the changes. 7.6 Remuneration and Appointment Committee Terms of Reference Craig Machell was invited to present the Remuneration and Appointment Committee’s Terms of Reference, the content of which was noted. It was further noted that: Page 7 • The Remuneration and Appointment Committee had reviewed its terms of reference at its meeting on 11 March 2025. • No changes were proposed. Decision Having considered the Remuneration and Appointment Committee’s Terms of Reference, the Board approved the terms of reference. 7.7 Trust Executive Committee Terms of Reference Craig Machell was invited to present the proposed changes to the Trust Executive Committee’s Terms of Reference, the content of which was noted. It was further noted that: • The Trust Executive Committee (TEC) had reviewed its terms of reference at its meeting on 12 February 2025. • It was noted that the most significant amendments were in respect of the following: o Introduction of the pre-TEC process for business cases requiring additional expenditure; o The role of the TEC as a forum for discussion of significant strategic matters; o The TEC’s role in identification of opportunities for system collaboration; o Updates to reflect the current role of the Trust Investment Group and the TEC under the Standing Financial Instructions; and o Other amendments to add clarity about the TEC’s operation and reports received. Decision Having considered the proposed amendments to the Trust Executive Committee’s Terms of Reference, the Board approved the changes. 8. Any other business There was no other business. 9. Note the date of the next meeting: 13 May 2025 10. Items circulated to the Board for reading The item circulated to the Board for reading was noted. There being no further business, the meeting concluded. 10. Resolution regarding the Press, Public and Others Decision: The Board resolved that, as permitted by the National Health Service Act 2006 (as amended), the Trust’s Constitution and the Standing Orders of the board of directors, that representatives of the press, members of the public and others not invited to attend to the next part of the meeting be excluded due to the confidential nature of the business to be transacted. The meeting was adjourned. Page 8 List of action items Agenda item Assigned to Deadline Status Trust Board – Open Session 25/07/2024 5.4 Briefing from the Chair of the Quality Committee (Oral) 1163. Impact of technology Machell, Craig 03/06/2025 Pending Explanation action item Craig Machell agreed to add an item covering the impact of technology over the next 5-10 years to a future Trust Board Study Session agenda. Update: Item deferred to Study Session on 03/06/2025. Trust Board – Open Session 07/01/2025 5.13 Infection Prevention and Control 2024-25 Quarter 2 Report 1204. Infection prevention Byrne, Gail 03/06/2025 Pending Explanation action item Gail Byrne agreed to include an item on infection prevention control at a future Trust Board Study Session to include details of an Australian study, point of care testing, and progress on the roll out of the Fundamentals of Care programme. Update: Item tentatively scheduled for TBSS on 03/06/2025. Trust Board – Open Session 11/03/2025 5.6 Performance KPI Report for Month 10 1217. Artificial Intelligence (A/I) Machell, Craig Explanation action item Craig Machell agreed to add A/I to a future Trust Board Study Session agenda. 03/06/2025 Pending Update: Tentatively scheduled for TBSS on 03/06/2024. Agenda item Assigned to Trust Board – Open Session 11/03/2025 5.6 Performance KPI Report for Month 10 1218. Pressure ulcers Byrne, Gail Explanation action item Gail Byrne agreed to present a deep-dive on pressure ulcers to the Quality Committee. Deadline Status 13/05/2025 Pending Page 2 of 2 Agenda item 5.1 Committee Chair’s Report to the Trust Board of Directors 13 May 2025 Committee: Audit & Risk Committee Meeting Date: 17 March 2025 Key Messages: • • • • • • The committee considered the going concern assessment for the 2024/25 accounts and agreed that the accounts should be prepared on a ‘going concern’ basis. The external auditor reported that there had been no significant issues resulting from the transfer to a new finance system. The committee received a report on losses and special payments during 2024/25 and noted that the levels were similar to previous years. These payments were generally related to lost patient property. The committee reviewed the Trust’s Treasury Policy, confirmed the current bank mandate and approved certain minor changes to the Treasury Policy. An update was received in respect of Information Governance. It was noted that the Trust – in common with most others – was not expected to meet the standards set out in the Data Security and Protection Toolkit for 2024/25 due to the introduction of the Cyber Assurance Framework. The Trust had reported six breaches to the Information Commissioner since 1 January 2024, but none of the incidents resulted in further action on the part of the regulator. The committee agreed the Fraud team’s work plan for 2025/26. Assurance: (Reports/Papers reviewed by the Committee also appearing on the Board agenda) 6.2 Board Assurance Framework (BAF) Update Assurance Rating: Risk Rating: Substantial N/A • All risks had been reviewed with the relevant executive director(s). • It was suggested that Risk 3c should be reconsidered in terms of what the main risk was given the increase in risk rating to 16, particularly whether the main concern was running out of trained staff as opposed to being unable to deliver training and development. Any Other Matters: • The committee reviewed the outputs from the internal audit reports in respect of rostering, the discharge process, and core financial controls noting that there was nothing significant which required escalation to the Board. Assurance Rating: Substantial There is a robust series of suitably designed internal controls in place upon Assurance which the organisation relies to manage the risk of failure of the continuous and effective achievement of the objectives of the process, which at the time of our review were being consistently applied. Reasonable There is a series of controls in place, however there are potential risks that Assurance may not be sufficient to ensure that the individual objectives of the process are achieved in a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. Limited Assurance Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Significant improvements are required to improve the adequacy and effectiveness of the controls. Page 1 of 2 No Assurance Not Applicable Risk Rating: Low Medium High Not Applicable There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls. Where assurance is not required and/or relevant. Based on the report considered by the committee, there is little or no concern that the Trust will be unable to meet its stated objectives and/or plans. There is some concern that the Trust might not be able to fully meet its stated objectives and/or plans based on the information contained in the report considered by the committee. There is a significant risk that the Trust will not be able to meet its stated objectives and/or plans based on the information contained in the report considered by the committee. Where risk rating is not relevant. Page 2 of 2 Agenda Item 5.2 i) Committee Chair’s Report to the Trust Board of Directors 13 May 2025 Committee: Finance & Investment Committee Meeting Date: 24 March 2025 Key Messages: • • • • • • The committee received an update in respect of the Trust’s 2025/26 annual plan. It was noted that the NHS in England was forecasting a deficit of £6.6bn, which had resulted in significant intervention by Government, including the abolition of NHS England and 50% reductions in integrated care boards’ costs. These reductions would be supplemented by a national mutually agreed resignation scheme. The Trust anticipated running out of cash in May 2025, but it was understood that cash support would no longer be provided. The Hampshire and Isle of Wight Integrated Care System was aiming to reach a breakeven position in 2025/26. This would necessitate additional controls on recruitment and 5-10% reductions in expenditure/headcount as well as achievement of challenging Cost Improvement Programme targets. The committee reviewed the Finance Report for Month 11. It was noted that the Trust had recorded an in-month surplus of £8.2m due to a number of one-off items. There had been an increase in the use of bank staff due to the need to open surge capacity and the demand resulting from patients with mental health issues. The committee received an update in respect of the transformation plans regarding the ‘living within our means’, urgent and emergency care, and elective care recovery workstreams. The committee reviewed the quarterly update from Estates, Facilities and Capital Development. It was noted that there was a plan for removal of all reinforced autoclaved aerated concrete (RAAC) on the Southampton General Hospital site. It was further noted that the steam ducts on the site continued to be an issue and there was a risk that the Trust was at the limit for electricity usage on the site. Assurance: (Reports/Papers reviewed by the Committee also appearing on the Board agenda) N/A Any Other Matters: The committee considered a business case in respect of a Hampshire and Isle of Wight Elective Hub in Winchester. It was noted that this proposal was reviewed and approved at the Trust Board meeting on 25 March 2025. Assurance Rating: Substantial There is a robust series of suitably designed internal controls in place upon Assurance which the organisation relies to manage the risk of failure of the continuous and effective achievement of the objectives of the process, which at the time of our review were being consistently applied. Page 1 of 2 Reasonable Assurance Limited Assurance No Assurance Not Applicable There is a series of controls in place, however there are potential risks that may not be sufficient to ensure that the individual objectives of the process are achieved in a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Significant improvements are required to improve the adequacy and effectiveness of the controls. There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls. Where assurance is not required and/or relevant. Risk Rating: Low Medium High Not Applicable Based on the report considered by the committee, there is little or no concern that the Trust will be unable to meet its stated objectives and/or plans. There is some concern that the Trust might not be able to fully meet its stated objectives and/or plans based on the information contained in the report considered by the committee. There is a significant risk that the Trust will not be able to meet its stated objectives and/or plans based on the information contained in the report considered by the committee. Where risk rating is not relevant. Page 2 of 2 Agenda Item 5.2 ii) Committee Chair’s Report to the Trust Board of Directors 13 May 2025 Committee: Finance and Investment Committee Meeting Date: 28 April 2025 Key Messages: • • • • • • • The committee reviewed the Finance Report for Month 12 (see below). The committee received an update in respect of the Trust’s cash position, noting that the Trust’s cash position had been relatively stable during the fourth quarter due to receipt of additional one-off funding and careful supplier payment management. However, the Trust was highly likely to require cash support in either Q1 or Q2. The committee noted the report from the Trust’s digital services, noting the successful negotiation of a discount for purchasing new laptops due to the number required. In addition, there had been a leak in GICU which had impacted the switch network, but which had since been rectified. It was further noted that, during the first months of the year, the Trust had blocked more attempted cyber attacks than in the whole of 2024. It was noted that trusts had been set challenging targets for reducing the size of their corporate services, and as such were expected to reduce the size of these services by 50% of the growth since 2018/19. The committee received an update on the Trust’s 2025/26 capital plan, noting that the plan was under review owing to the Trust’s cash position. In addition, it had been agreed to prioritise maintaining the Trust’s level of expenditure on strategic maintenance and to defer the refurbishment of the neuro theatres. The committee reviewed the update from the Trust’s commercial team, including in respect of private and overseas patients, the proposed private patient unit, and Adanac Park. The committee supported the Trust’s participation in the proposed Elective Hub at Winchester. Assurance: (Reports/Papers reviewed by the Committee also appearing on the Board agenda) 5.8 Finance Report for Month 12 Assurance Rating: Risk Rating: Substantial High • The Trust had successfully ended the year at where it expected to do so with a deficit of £7m at year end. • The Trust’s underlying position remained a concern with a £6.9m deficit recorded during the month. • The committee reviewed the high use of bank staff during months 8 to 12, noting that the Trust had opened surge capacity during this period and was experiencing significant demand. • The Trust had achieved 127% elective recovery performance against the national target of 113%, and had also delivered its 2024/25 Cost Improvement Programme target in full (£85m). • The Trust had also spent £96m of capital during 2024/25. 6.2 Board Assurance Framework (BAF) Update Assurance Rating: Risk Rating: Substantial N/A • Risks 5a, 5b and 5c have been updated, following discussions with the respective Executive Director(s). Page 1 of 2 Any Other Matters: • The committee discussed whether the 2030 target for risk 5b was realistic and whether the rating to be achieved by 2030 should be increased. N/A Assurance Rating: Substantial There is a robust series of suitably designed internal controls in place upon Assurance which the organisation relies to manage the risk of failure of the continuous and effective achievement of the objectives of the process, which at the time of our review were being consistently applied. Reasonable There is a series of controls in place, however there are potential risks that Assurance may not be sufficient to ensure that the individual objectives of the process are achieved in a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. Limited Assurance Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Significant improvements are required to improve the adequacy and effectiveness of the controls. No Assurance There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls. Not Applicable Where assurance is not required and/or relevant. Risk Rating: Low Medium High Not Applicable Based on the report considered by the committee, there is little or no concern that the Trust will be unable to meet its stated objectives and/or plans. There is some concern that the Trust might not be able to fully meet its stated objectives and/or plans based on the information contained in the report considered by the committee. There is a significant risk that the Trust will not be able to meet its stated objectives and/or plans based on the information contained in the report considered by the committee. Where risk rating is not relevant. Page 2 of 2 Agenda Item 5.3 i) Committee Chair’s Report to the Trust Board of Directors 13 May 2025 Committee: People & Organisational Development Committee Meeting Date: 24 March 2025 Key Messages: • • The committee reviewed the People Report for Month 11. It was noted that February 2025 had continued to be challenging due to high sickness rates, with the Trust close to calling a critical incident. This had driven much higher bank rates. There had been a lower than forecast number of leavers during the month (44 whole-timeequivalents (WTE) against a forecast of 100). The Trust was 267 WTE above its plan. The Trust’s draft Workforce Plan for 2025/26 was reviewed. The Trust was required to deliver a breakeven plan. Accordingly, the Trust was anticipating a freeze on all non-clinical vacancies and holding 30% of clinical vacancies. In addition, there would potentially be a target to reduce headcount by 5-10% as well as additional reductions in use of bank and agency staff. It was further proposed to reorganise the four existing Divisions into three in order to deliver efficiencies. It was noted that even if the Trust achieved fully against all performance targets and implemented the restrictions and reductions above, there would still be a deficit. Assurance: (Reports/Papers reviewed by the Committee also appearing on the Board agenda) 5.11 UHS Staff Survey Results 2024 Report Assurance Rating: Risk Rating: Reasonable Low • The committee reviewed the Staff Survey results for 2024. • The Trust had maintained its above average position across all of the People Promise domains. • The Trust’s results remained broadly similar to those in 2023, although there had been improvements in some areas, such as satisfaction with immediate managers, flexible working, appraisals, and confidence in reporting unsafe practice, violence, bullying and harassment. • The participation rate was low at 39%, which gave rise to some concern about how reflective of the workforce the results were. A significant difference in engagement between non-clinical and clinical staff was noted. 6.2 Board Assurance Framework Assurance Rating: Risk Rating: Update Substantial N/A • Risks 3a, 3b and 3c had been updated, following discussions with the respective Executive Director(s). • Risk 3c had been upgraded from 12 to 16 to reflect the reduction in national funding for education and training and the more restrictive funding framework. In addition, it was noted that the intended reduction in NHS corporate infrastructure would impact training and development staff. • The committee agreed to review the Board Assurance Framework again once the 2025/26 plan had been approved. Any Other Matters: • The committee received an update in respect of the Band 2/3 pay dispute and in respect of the portering department. Page 1 of 2 Assurance Rating: Substantial There is a robust series of suitably designed internal controls in place upon Assurance which the organisation relies to manage the risk of failure of the continuous and effective achievement of the objectives of the process, which at the time of our review were being consistently applied. Reasonable There is a series of controls in place, however there are potential risks that Assurance may not be sufficient to ensure that the individual objectives of the process are achieved in a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. Limited Assurance Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Significant improvements are required to improve the adequacy and effectiveness of the controls. No Assurance There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls. Not Applicable Where assurance is not required and/or relevant. Risk Rating: Low Medium High Not Applicable Based on the report considered by the committee, there is little or no concern that the Trust will be unable to meet its stated objectives and/or plans. There is some concern that the Trust might not be able to fully meet its stated objectives and/or plans based on the information contained in the report considered by the committee. There is a significant risk that the Trust will not be able to meet its stated objectives and/or plans based on the information contained in the report considered by the committee. Where risk rating is not relevant. Page 2 of 2 Agenda Item 5.3 ii) Committee Chair’s Report to the Trust Board of Directors 13 May 2025 Committee: People & Organisational Development Committee Meeting Date: 25 April 2025 Key Messages: • • • • • • • The committee reviewed the People Report for Month 12 (see below). The committee noted the significant challenges for 2025/26 in delivering the Trust’s Annual Plan and the implications for its workforce. In particular, the Trust was anticipating having to reduce its overall workforce by 6% during the year, coupled with a 20% reduction in bank staff and 30% reduction in agency staff. It was noted that the organisational changes would need to happen at pace, but that there was not presently central funding to support this. The Trust had implemented strict recruitment controls, including a freeze on all non-clinical recruitment and would hold 30% of clinical vacancies. Delivery of the Trust’s 2025/26 plan also assumed significant reductions in the numbers of mental health patients and in patients having no criteria to reside. It had been announced that the Trust would be restructuring its divisions, reducing from four to three. It was anticipated that this would be completed by 1 July 2025. Furthermore, the Trust had a medium- to long-term objective of developing and implementing shared services with other organisations in the Hampshire and Isle of Wight Integrated Care System. The organisational and workforce changes envisaged were to be supported by both an equality and a quality impact asse
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2025-Trust-documents/Papers-Trust-Board-13-May-2025.pdf

Papers-CoG 26.04.2023

Description: Agenda attachments 1 CoG Agenda - 26.04.2023.docx Date Time Location Chair Agenda Council of Governors 26/04/2023 14:00 - 16:05 Microsoft Teams Jenni Douglas-Todd 1 Chair’s Welcome and Opening Comments 14:00 2 Declarations of Interest 14:02 3 Minutes of Previous Meeting 14:03 Approve the minutes of the previous meeting held on 25 January 2023 4 Matters Arising/Summary of Agreed Actions 14:04 5 Strategy, Quality and Performance 5.1 Annual Report and Quality Accounts Timetable 14:05 Note the Annual Report and Quality Accounts Timetable Sponsor: David French, Chief Executive Officer Attendee: Craig Machell, Associate Director of Corporate Affairs and Company Secretary 5.2 Chief Executive Officer's Performance Report 14:10 Receive and note the report Sponsor: David French, Chief Executive Officer 5.3 Operational Plan 2023/24 14:30 Receive and note the update Sponsor: Ian Howard, Chief Financial Officer Attendees: Andrew Asquith, Director of Planning and Productivity and Philip Bunting, Director of Operational Finance 5.4 Non-NHS Activity 14:50 Receive and note the update Sponsor: Ian Howard, Chief Financial Officer Attendee: Pete Baker, Commercial and Enterprise Director 15:00 Break 6 Governance 6.1 Appointment of Deputy Lead Governor 15:10 Note the appointment of Sandra Gidley as Deputy Lead Governor Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Karen Russell, Council of Governors' Business Manager 6.2 Review Terms of Reference - Council of Governors and Working Groups 15:15 Approve the proposed changes to the terms of reference Sponsor: Jenni Douglas-Todd, Trust Chair Attendees: Craig Machell, Associate Director of Corporate Affairs and Company Secretary and Karen Russell, Council of Governors' Business Manager 6.3 Council of Governors' Elections 2023 15:20 Note the timetable for the Council of Governors' elections Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Karen Russell, Council of Governors' Business Manager 6.4 Appointed Governor for Hampshire County Council (Oral Update) 15:25 Receive an update regarding the appointed governor for Hampshire County Council Sponsor: Jenni Douglas-Todd, Trust Chair 6.5 Proposal for Filling the Vacancy in the Rest of England and Wales 15:30 Constituency Approve the proposal for filling the vacancy in the Rest of England and Wales constituency Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Karen Russell, Council of Governors' Business Manager 7 Membership Engagement and Governor Activity 7.1 Membership Engagement 15:35 Receive and note the report Sponsor: David French, Chief Executive Officer Attendee: Sam Dolton, Events and Membership Officer 7.2 Feedback from Strategy and Finance Working Group 15:45 Chair: Mandy Fader 7.3 Feedback from Patient and Staff Experience Working Group 15:50 Chair: Sandra Gidley 7.4 Feedback from Membership and Engagement Working Group 15:55 Chair: Kelly Lloyd 8 Review of Meeting 16:00 Review and feedback on the content of this meeting Sponsor: Jenni Douglas-Todd, Trust Chair 9 Any Other Business 16:02 Raise any relevant or urgent matters that are not on the agenda 10 Date of Next Meeting: 26 July 2023 16:04 Note the date of the next meeting Page 2 3 Minutes of Previous Meeting 1 3 COG Minutes Open Session Final - 25.01.2023.docx Minutes - Council of Governors (CoG) Open Session Date Time Location Chair Present 25 January 2023 14.00-16.00 Conference Room, Heartbeat Education Centre and Microsoft Teams Jenni Douglas-Todd, Trust Chair Jenni Douglas-Todd, Trust Chair Theresa Airiemiokhale, Elected, Southampton City Shirley Anderson, Elected, New Forest, Eastleigh and Test Valley Patricia Crates, Elected, New Forest, Eastleigh and Test Valley Dr Nigel Dickson, Elected, New Forest, Eastleigh and Test Valley Helen Eggleton, Appointed, Hampshire and Isle of Wight Integrated Care Board Lesley Gilder, Elected, Southampton City Sathish Harinarayanan, Elected, Medical practitioners and dental staff Linda Hebdige, Elected, Southampton City Sandra Gidley, Elected, New Forest, Eastleigh and Test Valley Jenny Lawrie, Elected, Southampton City Kelly Lloyd, Elected, Health Professional and Health Scientist Staff and Lead Governor Councillor Cathie McEwing, Appointed, Southampton City Council Catherine Rushworth, Elected, Isle of Wight Liz Taylor, Elected, Non-clinical and support staff Quintin van Wyk, Elected, Rest of England and Wales Professor Emma Wadsworth, Professor of Work Environment and Vice Provost Research and Innovation, Solent University JDT TA SA KB PC ND HE LG SH LH SG JL KL CMc CR LT QvW EW In attendance Tracey Burt, Minutes Sam Dolton, Events and Membership Officer Steve Harris, Chief People Officer (for Item 6.1 Craig Machell, Associate Director of Corporate Affairs and Company Secretary Karen Russell, Council of Governors’ Business Manager David French, Executive Officer (for Item 5.1) TB SD SHa CMa KR DAF Apologies Katherine Barbour, Elected, Southampton City KB Professor Mandy Fader, Appointed, University of Southampton MF Councillor Alexis McEvoy, Appointed, Hampshire County Council AM Esther O’Sullivan, Elected, New Forest, Eastleigh and Test Valley EO Ian Ward, Elected, Rest of England and Wales IW 1 Chair’s Welcome and Opening Comments JDT welcomed everyone to the meeting and in particular EW who was attending for the first time. 1 2 Declarations of Interest There were no new declarations of interest relating to matters on the agenda. 3 Minutes of Previous Meeting The minutes of the meeting held on 19 October 2022 were approved as an accurate record of the meeting. 4 Matters Arising/Summary of Agreed Actions The updates on the actions in the paper were noted. Young governor representatives (action no. 444) was on the agenda for discussion (item 6.3). 5 Strategy, Quality and Performance 5.1 Chief Executive Officer’s Performance Report DAF joined the meeting to present the performance report. He also provided updates on the last three months and the Trust’s financial position. He advised that the last peak of Covid-19 had been in October 2022, when there had been nearly 100 patients with Covid-19 in the hospital, although most had been admitted for other reasons. That had caused operational challenges as it had been necessary to cohort patients with Covid-19, which had not been the most efficient way to run the hospital and was also not ideal for the patients. Despite national and local efforts, the uptake of flu vaccinations had been less strong than in previous years. Going into December another wave of Covid-19 had just started and there had also been a high prevalence of flu and RSV. Children’s ED and 111 had been close to being overwhelmed and ED attendances had more than doubled at UHS, which had put massive pressure on the hospital. That picture had been mirrored nationally and many hospitals (excluding UHS) had gone into critical incident mode. It had been an exceptionally difficult time going into Christmas and pressure created by non-elective emergency patients had continued throughout the holiday period. A year ago, attendances during a typical day in ED at UHS (excluding Eye Casualty) had been around 300 but during December, that number had exceeded 500 on several days. Whilst the hospital had regained a more normal feel during the latter half of January, the RCN strikes had commenced. UHS had not been impacted by the first wave of industrial action but it had experienced two days of action last week and the Trust had aimed to achieve four things: 1. to respect people’s right to strike. 2. to keep as much work going as possible, even with the capacity problems the hospital faced. 3. to keep the hospital safe. 4. to ensure that there was not polarisation amongst the staff after the strikes. DAF said that he felt the Trust had done reasonably well at achieving its aims but around 700 of its nurses had taken industrial action on both days, which had been higher than expected. The Trust had, however, kept roughly half the elective surgery going and he thanked the planning team and senior nurses for their efforts. 2 In response to questions from governors, DAF advised that issues around contractual pay and conditions were a matter for the government to resolve but UHS had tried to focus on the smaller things it could do to support staff, e.g. discounted meals/food and reduced parking costs. The Staff Satisfaction Survey had, however, shown a deterioration in satisfaction levels but UHS remained one of the top ten hospitals in the country to work in. With regard to the Trust’s financial position, DAF advised that the hospital was currently spending around £4m more each month than it was earning and the reserves it had built up over the years for capital investment, were dwindling. The number of patients in the hospital’s beds was higher than planned due to the difficulties of discharging to social care and the cost of staffing those extra beds was significant. Trusts had been challenged to do 104% more activity than they had done in the year prior to Covid-19. UHS had achieved 106% and in some months around 110%, which was more than many Trusts and was worth around £25m. The Trust had not, however, received any money for that activity and it was lobbying for payment. SA queried whether the extra activity was impacting on quality. DAF advised that the Trust’s clinical outcomes remained strong but it was beginning to have an impact and he noted that organisations under pressure often did less well. Staff tended to suffer morale injury if they were so busy they felt unable to do the best for their patients and that was being seen across the country. DAF described the hospital as feeling like a hamster wheel and he advised that the Trust Board had recently discussed how it could be slowed down. If it was not possible to increase capacity, then it may be necessary to consider ways of reducing demand. HE highlighted the cancer metrics and the psychological impact on patients who had to wait longer for their treatment. DAF noted that cardiac patients faced similar delays, due to capacity issues, and acknowledged that whilst work was being done to improve these situations, more work was needed. 6 Governance 6.1 Chair and Non-Executive Director Appraisal Process SHa advised that each year the Non-Executive Directors (NEDs) and the Trust Chair were required to participate in an annual appraisal process. The results were shared with the Governors’ Nomination Committee (GNC) and the CoG. The appraisal process was based on a national framework from NHSE and guidance provided by them would be used. High quality, multi-source feedback would be obtained from Trust Board members and governors for both the NED and Chair appraisals. Feedback from the Integrated Care System (ICS) would also be sought as part of the Chair’s appraisal process. The Chair would conduct individual appraisal meetings with each NED, once feedback had been collated and would consider objectives for the following year. The appraisal process for the Chair would be undertaken by Jane Harwood, NED and Senior Independent Director (SID) and a summary would be provided to the NHSI Regional Director. 3 SHa advised that he would guide KL through the process of collecting feedback from the governors as this was her first term as Lead Governor. He also acknowledged that many governors were relatively new in their roles and he assured them that guidance would be provided in good time. Decision: The CoG approved the appraisal process as recommended by the GNC, following its meeting on 11 January 2023. 6.2 Annual Business Plan 2023/24 KR highlighted the Business Plan and advised that the CoG was required to review (and approve) it on an annual basis, prior to commencement of the new financial year. Decision: The CoG approved the Annual Business Plan for 2023/24. 6.3 Composition of the Council of Governors CM advised that as part of a review of the composition of the CoG, the Membership and Engagement Working Group had discussed proposals regarding the representation of young people on the CoG. In the past, two young people had been appointed to the CoG, one from a college and one from a university. The Trust already had a Youth Ambassador Group (made up of service users) and it had been suggested that the group was asked to provide two representatives (one each from the 16-18 and 18-25 age groups) to join the CoG as associate members. They would be non-voting roles and would not affect the formal composition of the CoG or require any change to the Trust’s constitution. Following discussion, the governors agreed that the young governor representatives should be invited to become associate members for up to two years. The possibility of reaching out to other minority groups, in a similar way, was also suggested and may be considered in the future. Decision: The CoG approved the proposal to invite two representatives from the Trust’s Youth Ambassador Group (one each from the 16-18 and 18-25 age groups) to become associate members of the CoG for up to two years. 6.4 Vacancy for the Nursing and Midwifery Staff Governor JDT advised that Wendy Marsh, who had been elected as the governor for the Nursing and Midwifery staff group, with effect from 1 October 2022, had stood down for personal reasons with effect from 6 December 2022. In accordance with the Trust’s constitution, the paper outlined the three options available to fill the vacancy but JDT advised that given the circumstances, the first was the only viable option. KR advised that once the election had been arranged, the vacancy would be publicised and Gail Byrne, Director of Nursing and Midwifery, would be asked to encourage interest from within the Trust’s nursing and midwifery community. Decision: The CoG approved Option 1 to fill the vacant seat for the Nursing and Midwifery staff group by calling an election to coincide with the scheduled governor elections in 2023. 4 6.5 Confirmation of Chair of the Patient and Staff Experience Working Group JDT advised that a vacancy had arisen for the chair role of the CoG Patient and Staff Experience Working Group as the previous incumbent had stood down when his first term of office had ended on 30 September 2022. SG had expressed an interest in the role and the working group had voted unanimously to support her appointment. Decision: The CoG confirmed the appointment of SG as chair of the CoG Patient and Staff Experience Working Group following her election by the working group. 6.6 Appointment of Deputy Lead Governor JDT advised that HE would complete her first term of office as Deputy Lead Governor on 11 March 2023. Any governor who wished to apply for the role would be required to submit a written statement to the Company Secretary by a specified date (tbc). The statements would then be circulated to all governors by email and an electronic vote would take place. HE advised that she would be happy to talk to any governor about the role. Decision: The CoG noted the process for the appointment of a new Deputy Lead Governor. 6.7 Audit and Risk Committee Terms of Reference The Terms of Reference for all Board committees should be reviewed regularly, and at least once annually, to ensure that they reflected the purpose and activities of each committee. The NHS Foundation Trust Code of Governance required consultation with the Council of Governors on the Audit and Risk Committee Terms of Reference. The Terms of Reference were then to be approved by the Board of Directors (the Board). The Terms of Reference ensured that the purpose and activities of the Audit and Risk Committee were clear and supported transparency and accountability in the performance of its role and complied with the NHS Foundation Trust Code of Governance. The Code of Governance for NHS Provider Trusts, applicable from April 2023, included provisions which stated that the Deputy Chair should not be Chair of the Audit Committee. However, the key concern was that the Audit Committee Chair should be independent, and where the Deputy Chair was expected to act as Chair of the Board, there was potential for the director’s independence to become compromised over time. It was proposed to include the proviso in the Audit and Risk Committee Terms of Reference, that should the Deputy Chair have to act as Chair of the Board for an extended period of time, they would resign as committee Chair in order to preserve the independence of the committee Chair. Given the current committee Chair’s experience and qualifications, it was considered appropriate that he should remain as committee Chair and that the non-compliance could be justified under the ‘comply or explain’ principle and that the underlying concern in respect of independence was to be mitigated through that proviso. This explanation was to be documented in the Trust’s Annual Report. This had been discussed with the Audit and Risk Committee and the CoG Governors’ Nomination Committee (GNC) had also been consulted. 5 An additional consideration was that, as part of succession-planning and Board composition discussions, the Board was to consider the need for an additional suitably (financially) qualified individual to be a member of the committee, who could replace the committee Chair should he have to resign due to his Deputy Chair commitments. The CoG was asked for its views on the proposals: • in response to questions from SG and CMc about the possibility of replacing either the Audit and Risk Chair or Deputy Chair, CMa advised that this would be difficult due to the relevant experience and qualifications of the individual. CMa also explained that the Code of Governance for NHS Provider Trusts was not in alignment with corporate business and agreed that feedback on the change should be provided in the annual review. • KL felt that the proposals had been well considered and were justified but agreed that feedback on the change should be provided. Decision: The CoG agreed with the proposals subject to feedback being provided regarding the changes introduced to the Code of Governance and that its views would be considered when the proposals were reviewed by the Board. 7 Break 8 Membership Engagement and Governor Activity 8.1 Membership Engagement SD introduced the Membership Engagement report and noted that over the last three months most of the Trust’s membership engagement had been through virtual and digital platforms but there had been some activity in the community. He highlighted the following: • a Connect membership newsletter had been sent out in October and December 2022; • approximately 275 postal members of the Trust had now provided their email address which would make it easier to keep in touch with them on a more cost effective basis; • in October public members who specified a stated interest in cardiac, orthopaedics or rheumatology had been invited to take part in real examinations from final year University of Southampton medical students on placement at the Trust. This had resulted in a good interest rate among members; • the Annual Members’ Meeting had taken place in November and had included highlights from the report and accounts as well as a look at progress made in implementing the Trust’s five-year strategic plan. An update on the membership strategy had kindly been provided by HE; • as part of the global men’s health awareness month in November, the Trust had held a men’s health matters event for both public and staff members. IT had focussed on raising awareness on prostate and testicular cancer and also mental health; • members had been invited to a virtual event to mark 20 years of the Trust’s Wessex Blood and Marrow Transplant Programme in November, with staff and former patients reflecting on the service; • the Trust had marked Disability History Month in November with a virtual event looking at how Workforce Disability Equality Standards data was put into action to improve the experience of its disabled staff, with guest speaker Pete Loughborough, a senior analyst at NHS England; • to mark Black History Month in October, Lou Taylor, director of Black History Month South, had been invited to speak about his organisation’s new 6 partnership with the Trust. Staff of black heritage had been encouraged to take part in a project; • a virtual event had been held in January inviting members to contribute to the Trust’s plans to become a tobacco smoke-free hospital site, with examples of interventions to help patients to quit smoking; • the Trust, including some of the governors, had taken part in community sessions in public libraries across Southampton. These provided an opportunity for the public to learn more about how they could get involved in developing UHS services, participate in specific projects and give their views on care received; and • there had been good engagement with stories on social media. For example, a team of UHS medics had received the Best Team award at The Sun’s Who Cares Wins awards after transporting 21 young Ukrainian cancer patients back to England so they could continue their life-saving treatment. Priorities included: • the continuation of virtual health education events exclusively for members; • production of an edition of Connect in February 2023; and • engagement with the University of Southampton Students Union and other stakeholders on attracting younger members. As most of the recent community activities had taken place in the Southampton area, SD encouraged public governors from other constituencies to contact him if they would like any support in engaging with their constituents. 8.2 Feedback from Governors’ Nomination Committee (GNC) A meeting of the GNC had been held on 11 January 2023 to consider the Chair and Non-Executive Director appraisal process for 2022/23. This had been presented to the CoG for approval earlier in the meeting. There was still a vacancy on the GNC and KR had emailed governors on 18 January 2023 to invite expressions of interest. JDT encouraged governors to consider if they would like to volunteer for this additional role. 8.3 Feedback from Strategy and Finance Working Group A meeting of the Strategy and Finance Working Group had been scheduled for 24 January. Unfortunately, this had been cancelled as the Chair had become unwell. This would be re-arranged once she had recovered. 8.4 Feedback from Patient and Staff Experience Working Group A meeting of the Patient and Staff Experience Working Group had been held on 17 January. SG, who had been appointed by the Working Group members as its new Chair, had been unable to attend. KR advised that following a request from the Southampton City governors, there had been a discussion on tackling health inequalities which included a presentation on a prevention project related to diabetes which was underway at the Trust. The presentations had been well received by governors. 8.5 Feedback from Membership and Engagement Working Group A meeting of the Membership and Engagement Working Group had been held on 19 January. SD had attended to provide an update on membership engagement which had also been covered at Item 8.1, and there had been a discussion regarding proposals for young governor representatives which had been presented to the CoG at Item 6.3. 7 KL also advised that where virtual membership events had been recorded and the videos were available for viewing at a later date, via social media, these could incorporate a link to join as a member of the Trust. Consideration was also to be given to inviting network leads to attend future Membership and Engagement Working Group meetings. Proposals for financial support for international staff had been put to SHa which included a possible loan. 9 Any Other Business A question was raised as to whether governors could use the Park and Ride facility when attending CoG meetings as car parks on site could be extremely busy. KL reminded governors that Hampshire and Isle of Wight ICB were to hold a virtual strategy update event for governors on 14 February from 5.30pm-7pm. KR had circulated the calendar invitation. Action: KR to establish whether governors could use the Park and Ride facility when attending CoG meetings. 10 Review of Meeting There were no comments following the meeting. 11 Date of Next Meeting - 26 April 2023 The next meeting would be held on 26 April 2023. 8 4 Matters Arising/Summary of Agreed Actions 1 4 Action items as at 19 April 2023.docx List of action items Agenda item Assigned to 19 April 2023 17:56 Deadline Status Council of Governors 31/03/2021 5.5 Amendment to the Trust's Constitution - CCG Merger 444. Review the Council of Governors' Composition Craig Machell Karen Russell 26/04/2023 Explanation action item A review of the Council of Governors' composition is to be carried out to check that it still remains appropriate. Closed Following discussions by the Membership and Engagement Working Group, proposals for a change to the composition of the CoG, it was agreed to reduce the number of governors representing the Rest of England by one governor; and to increase the number of governors representing New Forest, Eastleigh and Test Valley by one governor. Suggestions regarding young governor representatives were considered further at a sub-group on 24 August 2022 and these will be discussed at the Membership and Engagement Working Group at its meeting on 17 October 2022. Proposals have now been prepared and will be presented at the Membership and Engagement Working Group Meeting on 19 January 2023. Explanation Russell, Karen At its meeting on 25 January 2023, the CoG approved the proposal to invite two representatives from the Trust’s Youth Ambassador Group (one each from the 16-18 and 18-25 age groups) to become associate members of the CoG for up to two years. We have now been advised that the two associate members have been selected and details of their appointment was confirmed to governors on 19 April 2023. 19 April 2023 17:56 Council of Governors 19/10/2022 8.2 Governors' Nomination Committee Feedback 868. Public and Staff Governor Vacancies on the Governors' Nomination Committee (GNC) Russell, Karen 26/04/2023 Closed Explanation action item There were two vacancies on the GNC. Governors who were interested in joining the GNC were invited to submit an expression of interest to the Chair. KR also circulated an email to governors inviting expressions of interest on 24 October 2022. KR circulated an email to governors inviting expressions of interest on 24 October 2022. Shirley Anderson submitted an application and the CoG approved her membership of the GNC by written resolution in November 2022. A further email to invite expressions of interest for the remaining vacancy was sent to governors on 18 January 2023. Patricia Crates submitted an application and the CoG approved her membership of the GNC by written resolution in March 2023. Council of Governors 25/01/2023 10 Any Other Business 890. Use of the Park and Ride facility by governors Russell, Karen 26/04/2023 Closed Explanation action item Two governors asked about the possibility of using the Park and Ride facility when attending CoG meetings as car parks on site could be extremely busy. Explanation Russell, Karen It has been agreed that governors are able to use the Park and Ride facility. Information regarding its use was circulated to governors on 7 February 2023. Page 2 5.1 Annual Report and Quality Accounts Timetable 1 5.1a Annual Report and Quality Accounts timetable cover sheet.doc Report to the Council of Governors Title: Agenda item: Sponsor: Author: Date: Purpose Issue to be addressed: Annual Report and Quality Accounts Timetable 5.1 David French, Chief Executive Officer Craig Machell, Associate Director of Corporate Affairs and Company Secretary 26 April 2023 Assurance Approval or reassurance Ratification Information Y NHS England has published the timetable for the 2022/23 annual report and accounts and associated guidance. The Trust is required to produce an annual report and accounts as well as a Quality Account. The Trust has decided to align the timetables of both the Quality Account and the annual report and accounts, and to incorporate these into the same document. Response to the issue: Implications: Risks: Summary: Conclusion and/or recommendation The Quality Account is required to be published by 30 June 2023, whereas the annual report and accounts cannot be published until after they have been laid before Parliament. Parliament’s summer recess commences on 20 July 2023. The Trust has taken the decision to produce the annual report and accounts and the quality accounts on the same timetable as a single document. However, due the additional work required to complete the value for money external audit, the quality accounts will be published as a separate document by 30 June 2023. The attached timetable sets out the process in greater detail. The Trust meets the requirements of the National Health Service Act 2006, The National Health Service (Quality Accounts) Regulations 2010 and the NHS foundation trust annual reporting manual 2022/23. 1. Non-compliance with the National Health Service Act 2006, The National Health Service (Quality Accounts) Regulations 2010 and the NHS foundation trust annual reporting manual 2022/23. 2. Ensuring openness, transparency and accountability regarding the performance and activities of the Trust. 3. Pressure on staff to provide information for inclusion in the annual report and accounts and the quality accounts as the Trust deals with significant emergency pressures and delivers the elective recovery programme. The Council of Governors is asked to note the timetable. 1 5.1b Annual Report and Quality Accounts Timetable.doc Annual Report and Accounts (including the Quality Accounts) 2022-23 Timetable NHS England (NHSE) has published the timetable for the 2022/23 annual report and accounts and guidance on producing the annual report and accounts. The proposed timetable is set out below Action Draft quality account reviewed at Council of Governors’ meeting Deadline for draft accounts submission to NHSE Issue final draft quality accounts to ICB, Local Healthwatch, Overview and Scrutiny Committee and Council of Governors for one month consultation Early May Bank Holiday Coronation Bank Holiday Circulation of first draft annual report to external auditor, Board of Directors and Council of Governors Draft annual report and accounts reviewed at Audit and Risk Committee meeting Draft quality account reviewed at Quality Committee meeting Draft annual report and accounts reviewed at Board of Directors meeting Spring Bank Holiday Final draft annual report and accounts including quality accounts reviewed at Audit and Risk Committee meeting Final draft annual report and accounts including the quality accounts approved by Board of Directors Deadline for submission of signed annual report and accounts and supporting documentation to NHS England Add quality accounts to Trust website and forward the link to quality-accounts@nhs.net Final audit opinion and audit certificate (following completion of value for money external audit) Submit annual report to Parliament Publish annual report and accounts (including quality accounts) on Trust website Present update on annual report and accounts and external audit report to Council of Governors (in closed session) Present final annual report and accounts (including the quality accounts) to Council of Governors Annual Members’ Meeting Date Wednesday, 26 April 2023 Thursday, 27 April (noon) By Friday, 28 April 2023 Monday, 1 May 2023 Monday, 8 May 2023 w/c Monday, 8 May 2023 Monday, 22 May 2023 Monday, 22 May 2023 Thursday, 25 May 2023 Monday, 29 May 2023 Monday, 19 June 2023 Monday, 19 June 2023 By Friday, 30 June 2023 (noon) Friday, 30 June 2023 TBC TBC TBC TBC - Tuesday, 19 July 2022 TBC TBC Page 1 of 1 5.2 Chief Executive Officer's Performance Report 1 5.2a Council of Governors Cover Sheet.docx Report to the Council of Governors Title: Agenda item: Sponsor: Author: Date: Purpose Chief Executive Officer’s Performance Report 5.2 David French, Chief Executive Officer Jason Teoh, Director of Data and Analytics 26 April 2023 Assurance Approval or reassurance Ratification Information Y Issue to be addressed: Information about Trust performance supports the Council of Governors in their role. Response to the issue: This report is intended to inform the Council of Governors about aspects of the Trust’s performance. Implications: This report provides performance information relating to a broad range of Trust services and activities. There are no specific implications. Risks: This report is provided for the purpose of information. Summary: This report is provided for the purpose of information. 1 5.2b COG Chief Executive's Performance Report Apr 2023 FINAL.docx UHS Council of Governors 26th April 2023 Chief Executive’s Performance Report 1. Purpose and Context The purpose of this report is to summarise the Trust’s performance against a range of key indicators. Where available, this report covers data from the period December 2022 to February 2023, noting that some performance data in relation to some of the targets is reported further in arrears. This has again been a challenging operational period for the Trust. Notable features of the period included: • Ongoing high volume of attendances to the Emergency Department – particularly in December 2022 due to a high number of paediatric attendances due to Strep A. • A significant number of patients not meeting the criteria to reside, usually at between 180 – 210 patients, continuing to occupy hospital beds, restricting flexibility in our elective programmes, and impacting flow through the hospital (including patients awaiting admission from the Emergency Department onto wards). • Challenges with cancer services due to higher cancer referral volumes and the need to balance staffing capacity. • A number of days of industrial action impacting elective services during the period. • Ongoing growth in the RTT waiting list due to higher post-pandemic referral volumes causing the waiting list to rise to over 54,000 patients. However, good progress has been made in reducing the longest waiting patients at both 104+ and 78+ weeks. 2. Safety Infection Control Clostridium Difficile infection MRSA Bacterium infection Target 95.0% ≥ 90.0% Dec 2022 55.9% 66.2% Jan 2023 65.4% 72.9% Feb 2023 68.6% 73.3% Attendances to the Emergency Department (ED) have remained high through this period, averaging 371 per day (compared to 347 per day a year before – a 7% increase). This included a particularly challenging 12 day period in December 2022 where daily attendances were over 400 each day, including two days with over 500 attendances, due to the Strep A incidents before Christmas. The improvement in performance in January and February 2023 is linked to lower attendances compared to December 2022. Alongside the ongoing flow challenges due to the number of patients no longer meeting the Criteria to Reside, means that UHS four-hour performance remains below target. However, we continue to benchmark well against other trusts which demonstrates that this is a national challenge. In the period of December 2022 to February 2023, UHS ranked in the top quartile of the 17 teaching hospitals that we benchmark against (Type 1 attendances). In addition, UHS continues to ensure that we do not delay ambulance handovers. The average time to handover remains stable (approximately 16 minutes), and we have one of the lowest volumes of ambulance handover delays over 30+ and 60+ minutes in the South East and South West regions. Page 3 of 5 Referral to Treatment (RTT) % incomplete pathways within 18 weeks in month Total patients on a waiting list Target => 92% Dec 2022 63.3% 53,941 Jan 2023 63.7% 54,254 Feb 2023 63.1% 54,692 The number of patients on the RTT waiting list continues to increase as higher referrals continue above prepandemic levels. The proportion of patients that we have being treated within 18 weeks is in line with other teaching hospitals, with UHS within the top third of teaching hospitals. UHS continues to make good progress in reducing the longest waiting patients. We ended the year with no patients waiting over two years for treatment, and only 15 patients (all complex patients) who had waited over 78 weeks for treatment. Cancer Target Urgent GP referrals seen in 2 weeks => 93% Diagnosis within 28 days > =75% Treatment started within 62 days of urgent GP referral => 85% Dec 2022 79.6% 79.1% 55.3% Jan 2023 82.3% 68.7% 50.8% Feb 2023 Check after 31.03 Check after 31.03 Check after 31.03 As a specialist teaching hospital, we treat some of the more complex cancer cases from the region. However, all cancer services are under pressure from higher demand and this is a national trend. In January and February 2023, cancer referrals were 9.3% higher than the equivalent months in 2019. UHS has historically benchmarked in the upper quartile, relative to our teaching hospital peers. Our position slipped in the face of operational challenges in October and November 2022, into the second and third quartiles. To correct this each tumour site has developed clear recovery action plans, and we have seen signs of recovery and an upward performance trajectory in between December 2022 to February 2023. The Trust is focussed on progressing the action plans with support from the ICB and Wessex Cancer Alliance. 5. Finance The financial position for the trust is particularly challenging with a forecast deficit for 2022/23 of £11m. However, this position is supported by a number of non-recurrent measures including additional income, meaning our underlying deficit is well in excess of this position. The key drivers are: • COVID-19 related cost pressures – patient numbers remained significant in the early part of the year and staff sickness absence has also remained above pre-COVID levels. This has generated a cost pressure compared to plan assumptions. • Inflationary pressures especially related to energy costs – these are emerging to a greater extent as the year progresses with energy costs particularly high over the winter period despite the government price cap offering some protection. Energy costs are more than three times greater than they were in 2019/20. • An increase in the volume of patients not meeting the criteria to reside who are medically optimised for discharge – this is causing particularly acute operational challenges and means the trust has unfunded bed capacity open. This has also limited the Trust's ability to deliver additional elective activity supressing Elective Recovery Funding (ERF). • More recently industrial action is also creating one off costs due to backfill requirements needing to be put in place at short notice. This is likely to remain a challenge into 2023/24. Despite this the cost improvement programme for the Trust continues to deliver savings with the £45m savings plan forecast to be delivered in full. Page 4 of 5 Looking forward, there is a significant challenge for 2023/24 in improving both the Trust and HIOW Integrated Care System’s finances. For UHS we are currently projecting a £35m deficit, predicated on the achievement of a £60m (5%) cost improvement programme. Both internally, and with system partners, there is a focus on productivity improvement and exploring initiatives that can make a scalable difference. Similarly, financial controls and governance have been reviewed to ensure there isn’t any further deterioration. The Trust has made significant progress with its capital programme, including a new wards project and theatres refurbishments. The Trust remains on target to spend its full capital budget of £48m for 2022/23. Additional to this the Trust has been successfully awarded external capital of c£27m for spend in 2022/23 which will further support investment in capacity, infrastructure and digital. This will be spent in full in this financial year. 6. Human Resources Indicator Staff recommend UHS as a place to work Staff survey engagement score Target - Q3 22/23 6.91 7.1 Q4 22/23 6.92 7.02 The Pulse Survey results shows a small improvement in recommendation of UHS as a place to work (although down compared to last year), and a further decline in the engagement score. We believe this reflects the ongoing challenging environment that staff are working in. However, we remain slightly better than national averages. Indicator Turnover (internal target) Sickness absence 12 month rolling (internal target) Nursing Vacancies (Registered Nurse only in clinical wards) (internal target) Target 65 weeks by March 2024 • Deliver a balanced income and expenditure budget i.e. no financial deficit • Improve A&E waiting times to at least 76% within 4 hours • Improve maternity staffing ‘fill’ rates and safety 3 National Financial Framework 2023/24 • How will the trust be paid? – Fixed income in relation to most hospital activity, non-elective admissions in particular – Variable payments, at national tariffs, for elective, daycase, and outpatient activity (excluding follow ups) • Funding allocated for other specific service opening / increases requested of UHS, typically for specialised services • £28m (2.9%) increase for inflation (risk given headline CPI @ 10%) • £27m (2.8%) decrease relating to efficiency requirements (Covid reductions of £11m + Efficiency £16m) • Challenge therefore to 'consume your own smoke' 4 UHS Context 2022/23 • Exceptional growth in attendances to Emergency Department since 19/20 (15% approximately), deterioration in treatment times to 75% within 4 hours • Elective waiting list size increasing by 3% per annum, but waiting times > 104 weeks eliminated and waiting times > 74 weeks reduced to under 150 patients • UHS and HIOW ICS delivering relatively high levels of elective activity, but with relatively high costs / deficit compared to other ICSs / Regions • Increase in UHS staff by 2000 (18%) since 19/20, approximately ¼ for specific new services, ½ for activity/capacity increases, ¼ for a range of other reasons • UHS continues to be productive / cost effective in comparison with other hospital trusts, though our costs have grown faster than activity since 2019/20 5 UHS Context 2022/23 • Underlying UHS financial deficit (difference between expenditure and income) of £45m, largely as a result of factors outside local control e.g. inflation, energy costs, COVID funding reduction, increase in delayed discharges, sickness absence rates, unfunded cost of new NHS approved drugs • Increased Cost Improvement target of £45m delivered in full during 22/23, though only half of these savings were made through recurrent schemes, and savings were mainly achieved through non-pay costs • £88m Capital invested (using a combination of local funds and external bids mainly to NHSE programmes), including ward construction, theatre refurbishment, MRI scanner replacement, ‘park and ride’ for staff • Reducing levels of cash held, as a result of both the revenue deficit, and funding capital investments i.e. Buildings, Medical Equipment, IT Systems 6 Our Plan 2023/24 (Submitted 30th March with UHS Board Approval) • Increase elective activity levels to 113%, or ideally higher • Planned reduction in the number of follow-up appointments of 10%, compared to 2022/23 • Reduce the rate of growth in the elective waiting list size, and hold this level from Q4 onwards • Eliminate waiting times for treatment greater than 65 weeks • Reduce waiting times for cancer treatment and diagnostic tests, return to the national target of 85% of cancer treatment starting within 62 days • NHSE funded service expansions including Mechanical Thrombectomy, CAR- T, Paediatric ICU retrieval, and two inpatient wards to support elective activity 7 Our Plan 2023/24 (Submitted 30th March with UHS Board Approval) • Plan to keep numbers of staff posts level – increases of approx. 300 related to funded expansions, offset by reductions through efficiency / cost improvement • Plan to increase the number of employed staff (WTE) by 340, reducing the use of bank/agency workers by a similar amount • Cost Improvement requirement of £60m (6%), plan to achieve through pay / non-pay savings, financial contributions on additional NHS activity/income etc. • Financial Deficit of £35m (since improved to £30m), with the intention of fully recovering financial balance in 2024/25 • Avoid cash deterioration beyond £30m • Capital investment of £70m, including £21m externally funded 8 Our Plan 2023/24 (Submitted 30th March with UHS Board Approval) 9 Our Plan 2023/24 (Submitted 30th March with UHS Board Approval) Supporting notes: • The UHS Plan is submitted to NHSE as part of a combined HIOW ICS Plan which includes the ICB, 4 Acute Trusts, Solent, Southern, South Central Ambulance Trusts • Current NHS arrangements are ‘System by default’ i.e. NHSE expects to hold ICS to account collectively for their performance, and also seeks to distribute the majority of NHS funds via ICBs on a population based ’fair-shares’ basis • Our plan is the product of intensive focus on both planning and implementation, governance including consideration by UHS Executive Committee and Board monthly since January, and significant dialog between UHS and HIOW ICB and system partners 10 HIOW ICS 23/24 position, and NHSE view • ‘Re-submission’ (typically an amended submission) will be required from all NHS organisations / ICS at the start of May • NHSE has not accepted our current plan • We are being challenged, as part of HIOW ICS, to: • Justify the level of workforce growth since 19/20 • Set a sustainable (affordable) workforce and financial model, and trajectory as to how quickly we could reach this • Increase the scale of ambition in relation to follow-up activity reduction • There is substantial concern that HIOW ICS would, otherwise, be anticipating a large financial deficit in the year 23/24 11 Commentary • Our plan is extremely challenging, as a result of the combination of financial and non-financial objectives • Delivery of our plan in full is our intention, but is not guaranteed • UHS has reasons for positivity, including investments in physical capacity, our recruitment levels, our people, and record of efficiency / control / innovation • Aligning both the right physical capacity and staffing levels will be critical to delivering higher volumes of treatment and care whilst operating efficiently • The impact of ICS initiatives to better manage emergency demand and reduce discharge delays, that both impact on hospitals, is very important • Achieving further / more rapid financial improvements a part of plan re- submission is being considered by the Executive and Board currently 12 Implementation and Monitoring • We are in the process of communicating the detailed requirements by service / budget area, and securing agreement of these 23/24 plans • Transformation programmes (for inpatient ‘Flow’/Outpatient improvement/ Theatres) are established and resourced to support improvement • A Trust Savings Group was established in 22/23, chaired by the Chief Financial Officer, this oversees other financial recovery programmes of work • Additional financial controls have been implemented • Progress against our plan and national targets is reported and monitored monthly by both the Trust Executive Committee and by Trust Board • Supported by a range of other groups / meetings focused on the review of specific topics or areas e.g. Operational Performance, Value for Money 13 Council of Governors - Operating Plan for 23/24 Questions? Phil Bunting, Director of Operational Finance Andrew Asquith, Director of Planning and Productivity 26 April 2023 University Hospital Southampton NHS Foundation Trust Tremona Road, Southampton Hampshire, SO16 6YD www.uhs.nhs.uk 5.4 Non-NHS Activity 1 5.4 Non NHS Activity.doc Report to the Council of Governors Title: Agenda item: Sponsor: Author: Date: Purpose Non-NHS Activity 5.4 Ian Howard, Chief Financial Officer Peter Baker, Commercial & Enterprise Director 26 April 2023 Assurance or Approval reassurance Ratification Information Issue to be addressed: X One of the responsibilities of the Council of Governors is to determine whether the Trust’s non-NHS activity would significantly interfere with its principal purpose, which is to provide goods and services for the health service in England, or the performance of its other functions. This paper seeks to provide an update to the Council on the portfolios of activity within the Commercial Service. Response to the issue: Commercial Services undertake activity in a range of portfolios, delivering additional value through non-core income to the Trust. The below outlines activities that we will be focussed on for the financial year 2023-24. Private Patients: During the past financial year, the Trust will have supported clinicians to undertake activity in their own time. By supporting clinical staff to undertake this work, we can secure new income. The alternative to not undertaking this work is that the activity would be undertaken by another private provider such as Spire or Nuffield, and the profit would likely go to their shareholders rather than be ploughed back into the NHS. UHS has zero permanent beds for private patient activity. The plan for 2023/4 is to focus on key areas of service that can provide growth to generate income to support the services financial plans, areas such as neuro, paediatrics, and robotics. Overseas Visitors: All patients are able to access NHS services for emergency treatment, no matter what their nationality or permanent residence. However, for ongoing treatment, cost can be recovered for non-UK nationals and UK nationals not residing in the UK. New processes and investment into the overseas visitor’s team will see delivery of increased income 2023-24. Partnership: This area of the service focuses on how we can better interact with busi
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Governors/Papers-CoG-26.04.2023.pdf

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