Annual Members’ Meeting Welcome Bruce Laurie Chairman

1. Annual Members’ MeetingWelcome Bruce LaurieChairman 3rd September 2012

2. Annual Members’ Meeting 2012Governors’ update Harry Dale Lead Governor

3. Work of the Council of Governors • 4 formal Council of Governor meetings held and 1 joint meeting with the Trust Board • 12 meetings of the Council of Governors working groups • Appraisals and appointment of Non-Executive Directors considered • Approval of the appointment of the Chief Executive • Governor drive for improvements to responding to complaints and listening to our patients • Continue to be the ‘eyes and ears’ of the Trust and feed back concerns to management which are incorporated into the Trust’s Patient Experience action plan • Championing improved patient experience, and involvement in patient safety walkabouts

4. Changes to constituencies • Governors approved changes to the constitution in order to make constituencies more representative of our local communities by splitting the current Wiltshire Constituency into three separate areas: • Northern Wiltshire (2 seats) • Central Wiltshire (2 seats) • Southern Wiltshire (1 seat) • Elections in October/November to elect governors to these new seats and to Swindon (1 seat) and Gloucestershire and BANES (1 seat)

5. Changes to the Council of Governors • Clive Bassett (Appointed governor – Prospect House), replaced Andy Cresswell (Thames Valley Chamber of Commerce) • Dr Jon Elliman (Appointed governor, The Academy) replaced Lesley Donovan (Academy) • Cllr Jemima Milton (Appointed governor – Wiltshire Council) replaced Carole Soden (Wiltshire Council) End of Terms: • Kevin Parry (public governor- Swindon) replaced Katherine Usmar

6. Membership update

7. Developingmembership • Targeting existing forums to spread the word about membership (parish councils, health forums) • Focus on increasing youth membership, involvement in the Trust’s “School’s day” • Plans to visiting community sites to raise awareness of membership for patients and staff

8. Upcoming dates/events • Elections in November for seats in Swindon, Gloucestershire and BANES, Northern Wiltshire, Central Wiltshire, Southern Wiltshire and Staff constituencies • Council of Governors 8 October 2012 at 5.00pm GWH, Academy • Council of Governors 29 November 2012 at 4.30pm GWH Academy • Look out for events taking place to celebrate 10 year anniversary of the Great Western Hospital

9. Annual Members’ Meeting 2012The Year in ReviewNerissa Vaughan Chief Executive

10. The environment we’re working in A period of uncertainty and change • Health and Social Care Act 2012 made into law after considerable debate • The shift in responsibility for commissioning has begun – moving from Primary Care Trusts (PCTs) to GPs (via Clinical Commissioning Groups – CCGs). • PCTs and Strategic Health Authority (SHAs) due to be abolished in March 2013 • National Commissioning Board established • Local Involvement Networks to be abolished and replaced with Health Watch organisations • Local Health and Wellbeing Boards bringing together health, social care, local authority, and CCGs to work in a more joined up way • A range of other bodies set up as part of the new structure of the NHS

11. The NHS is facing “zero growth” in NHS spending compared to an historic average of 3.2% a year

12. A challenging but successful year • 2011-2012 • Merger with WCHS – most significant change in past year • The first year spent aligning services, getting to know people and understand what works and what we could do better together • Work started on delivering the benefits of an integrated organisation: • Improving patient flow across the Trust – GWH and community staff, Social Services and GPs • Productive Ward being rolled out across the Trust • Developing a new Ambulatory Care service • Appointment of Interim Chief Nurse, Hilary Walker, to lead work on raising profile of nursing

13. A challenging but successful year • 2011-2012 - continued • Very good performance across over 200 key indicators • Just two cases of MRSA across the Trust (out of 1.3m pt contacts) • 19 cases of Clostridium difficile (C.diff) – 50 fewer than the threshold • Just one case of Grade 4 pressure ulcer at GWH, 10 fewer than last year • 23 cases of Grade 3 and 4 in community – well below 40 threshold • GWH became a designated Trauma Unit in April 2012 • Improvements in PEAT scores – especially Princess Anne Wing at the Royal United Hospital in Bath

14. A challenging but successful year • 2011-2012 - continued • In the top three Trusts in the South West in the latest independent staff survey results (and in top 20% nationally for staff satisfaction) CQC Staff Survey • 9/10 patients rate their care as good or excellent • From over 1.4m patient contacts last year we received 444 formal complaints – which is 0.03% of the patients we cared for • Compared with the previous year when we were responsible solely for the GWH, we had 242 complaints representing 0.04% of patients we cared for • Increased the number of parking spaces for patients at visitors at the GWH by 10%. After some teething problems the new pay on exit system now means the car park reaches capacity on far fewer occasions than before

15. Areas for improvement • Endoscopy • National growth in demand in all Endoscopy units being experienced nationally • PCT Performance notice to improve Endoscopy six week waiting times by October • GWH now on track to deliver against the trajectory • All fast track and urgent patients treated within appropriate timescales. Improvements also taking place to provide capacity for this growth and improve the estate to provide more single sex accommodation

16. Areas for improvement • Clinical correspondence – clinic letters to be typed and sent to GPs within two working days • A challenging target which the Trust has continued to focus on improving the speed with which letters are sent to GPs • Over the course of the year there has been gradual improvements • Delayed Transfers of Care • Over the course of the year there’s been a rise in the number of patients who are medically fit to be discharged but who remain in hospital • Big challenge for health and social care as it relies on both social care and the NHS playing its part • Working together with Local Authorities to tackle this problem to free up beds

17. Extra scrutiny • Nine unannounced inspections from the Care Quality Commission in 12 months across the Trust – five at GWH and four in the community. • Concerns raised: • Hydration document on wards • Consistency of safety checks in theatres • Use of Extra Bed Spaces (EBS) on the wards • Following sustained focus, as the Trust we’ve now been given the all clear and are compliant with every area the CQC measure. • Hydration documentation is much improved (and acting as an example to other Trusts) • Consistent implementation of the World Health Organisation (WHO) Safer Surgical Checklist and Team Briefing in theatres has improved processes • By the end of September the final few Extra Bed Spaces will be removed which is good news for patients and good news for staff • We expect many more inspections over the next 12 months

18. The year ahead (1) A new strategy • An ageing population, rising costs, increasing competition, reductions in funding, new technology and drugs and rising expectations mean we can’t stand still. • Work has begun on developing a new five year strategy for the Trust – designed to put us in the best position to meet future challenges • Six workstreams are looking at where we need to get to, to provide patients with the best services not just now but in the future: • Maternity • Patient Flow • New Technology • Long Term Conditions • Community Hospitals & Neighbourhood Teams • Marketing • We want to be the Trust that delivers the best for our patients and commissioners.

19. The year ahead (2) Pay and Reward • Regional Pay, Terms and Conditions Consortium established to look at options around how we can meet the financial and operational challenges in the future • 20 Trusts involved • 70% of our income is spent on pay – this year pay pressure has added an extra £1.7m on our pay bill and this pressure grows each year • We’ve already looked at a whole range of other areas where we can reduce cost and we need to seriously look at what we do with pay and reward • The aim is to avoid some of the more difficult decisions we may have to make in the future if we don’t deliver savings i.e. redundancies • No decisions on what this means in practice for staff have been made – work at this stage is simply looking at the options • Final decision rests with the Trust Board here

20. Financial overviewMaria MooreDirector of Finance and Performance

21. Financial headlines for 2011/12 • Income £290.5m • Surplus £536k • Financial risk rating 3 • Payment of suppliers 88%within 30 days • KPMG External Auditors opinion • Unqualified Opinion on the Trust’s Financial Statements • Limited assurance opinion on Trust’s Quality Accounts (the best you can have)

22. Income £290.5m Other income £22.9m Education & Research £7.5m Other PCT & Trusts £30.3m NHS Wiltshire £117.2m

23. Patients Treated

24. How we spent the money Services fromother Trusts and NHS bodies £16.3m All otherexpenses £14.7m Clinical insurance £5.7m Supplies/services for clinical & general requirements £25m Other services inc Facilities Management £18m Pay £172.1m Drugs £17.8m Building & Estates £20.3m Approximately £794,000 spent each day to provide Trust services

26. Capital Expenditure £4.1m

27. Speech and Language Therapy Service in Wiltshire Jennifer Lewin Head of Speech and Language Therapy

28. What is communication ?Universal

29. Why are Pictures Powerful?Specialist

30. Speech and Language Therapy Services in Wiltshire Provided to:- Children Adults ALD population in Wiltshire with the exclusion of adults in the south (SFT.) and in Swindon.

31. School nurses

32. Range of cases Complex feeding issues in babies ASD diagnostic team Acquired communication impairment Specific language Impairment Phonological disorders AAC from high tech-low tech Progressive neurological conditions Voice disorders Fluency CVA Oral cancer

33. Focussed on community model The best care close to home Engaging with families who find it hard to access traditional models of healthcare Working with others Focus on early intervention Flexible workforce to meet needs Service Aims

34. Adults Provided in : Local community hospitals Residential and nursing homes Client’s homes Provision : Specialist assessment, diagnosis and advice Group intervention 7.2 wte SLT/SLTAs supporting the Adult Service

35. Referrals are received from : 52 Nursing and Residential Care Homes GP surgeries 11 Neighbourhood Teams 3 community hospitals 1 stroke unit 1 hospice Consultants from surrounding Acute Hospitals

36. Children The children’s speech and language therapy service in Wiltshire went out to tender in 2009New service commenced May 2010, 3 yr contract with option of extending to 5yrsJointly commissioned by Wiltshire Council and NHS Wiltshire

37. Children • 340 Early Years settings • 240 schools • 14 clinics • 4 District Specialist Centres. • 3600 current caseload • 150-200 referrals a month • 23 wte SLT/As supporting the children’s service • 150 requests for statutory assessment per annum

38. Newly commissioned model of service delivery ensures: Early identification of need by all professionals Single point of entry. All referrals are be triaged. Signposting to other services, the SLT website and advice line. Choice of location and time. Children will be assessed by a specialist Speech and Language Therapist within 13 weeks. Programmes of care delivered by the TAC to develop communication rich environments. The service is flexible to meet the needs of the population of Wiltshire.

39. Choice Making

40. Visual Timetables Transition times To let children know what is expected

42. TEACCH Structured teaching Change activities to maintain interest Reward at the end Focus on adult agenda and timescale

44. Sentences

46. “Thank you for helping me with my talking. I’m a lot happier now and have lots of fun playing with friends and talking to everyone. Mummy and Daddy keep smiling at all the new words I say.” Parents writing for their child

47. “Jack… came for a course of speech therapy, although he was reluctant to get involved at the time we have continued to do the worksheets. His speech is now 100% improved.” School

49. “I just wanted to say that the information you gave us last night was really helpful – so good to be given it rather than have to find it out! I hope there will be more training opportunities like this for SENCOs and other school staff too.” SENCO

50. “Meeting other people makes me feel less isolated. I didn’t want to attend, but thank you for including me” Natter Matters: Parkinsons group