King’s College Hospital Board of Directors
PUBLIC AGENDA
Time of meeting 14:30 - 17:00 Date of meeting Tuesday, 17 December 2013 Venue Dulwich Committee Room, Hambleden Wing
Members: Prof. Sir George Alberti (GA) Trust Chair Graham Meek (GM) Non-Executive Director, Vice Chair Marc Meryon (MM1) Non-Executive Director Christopher Stooke (CS) Non-Executive Director Faith Boardman (FB) Non-Executive Director Sue Slipman (SS) Non-Executive Director Tim Smart (TS) Chief Executive Angela Huxham (AH) Director of Workforce Development Dr. Michael Marrinan (MM) Medical Director Simon Taylor (ST) Chief Financial Officer Dr. Geraldine Walters (GW) Director of Nursing & Midwifery Jane Walters (JW) - Non-voting Director Director of Corporate Affairs
In attendance: Sally Lingard (SL) Associate Director of Communications Peter Fry (PF) Director of Operations Tamara Cowan (TC) Board Secretary (Minutes) Apologies: Prof. Ghulam Mufti (GM1) Non-Executive Director Roland Sinker (RS) Chief Operating Officer
Circulation to: Board of Directors Circulation List
Enclosure Lead Time
1. STANDING ITEMS G Alberti 14:30
1.1. Apologies 1.2. Declarations of Interest 1.3. Chair’s Action 1.4. Minutes of Previous Meeting – 26/11/2013 Enc 1.4 1.5. Matters Arising/Action Tracking Enc 1.5
2. FOR REPORT/DISCUSSION
2.1. Chair’s and Non-Executive Directors’ Activity Enc. 2.1 G Alberti 14:35 Report 2.2. Update from Board Committee Chairs 14:40 2.2.1. Audit Committee Verbal C Stooke 2.2.2. Board Integration Committee Verbal C Stooke 2.2.3. Equality & Diversity Committee Verbal M Meryon 2.2.4. Finance & Performance Committee Verbal G Meek 2.2.5. Quality & Governance Committee Verbal G Mufti 2.2.6. Strategy Committee Verbal S Slipman 2.3. Update on Council of Governors’ Activities Verbal G Alberti 15:00 2.4. Chief Executive’s Report & KHP Update Verbal T Smart 15:05 2.5. Consolidated Finance Report (Month 08) Enc. 2.5* S Taylor 15:15 2.6. Consolidated Performance Report (Month 08) Enc. 2.6 P Fry 15:25 2.7. Annual Workforce Report Enc. 2.7 A Huxham 15:35 2.8. Quality & Safety Focus 2.8.1. Quarterly Patient Experience Report Enc. 2.8.1 J Walters 15:45 3. FOR INFORMATION 16:00 3.1. Confirmed Board Committee Minutes 3.1.1. Finance & Performance Committee Enc. 3.1.1 29/10/2013
4. .ANY OTHER BUSINESS 16:05
5. 5DATE OF NEXT MEETING . Tuesday, 28 January 2014 at 14:00 in the Dulwich Committee Room, Hambleden Wing
*Report to follow Enc 1.4 Subject to Chair’s Approval
King’s College Hospital NHS Foundation Trust Board of Directors - PUBLIC Minutes of the meeting of the Board of Directors held at 14:30 on Tuesday, 26 November 2013 in the Dulwich Committee Room, King’s College Hospital.
Members: Prof Sir George Alberti (GA) Trust Chair Marc Meryon (MM1) Non-Executive Director Chris Stooke (CS) Non-Executive Director Sue Slipman (SS) Non-Executive Director Faith Boardman Non-Executive Director Tim Smart (TS) Chief Executive Roland Sinker (RS) Chief Operating Officer Simon Taylor (ST) Chief Financial Officer Dr. Michael Marrinan (MM) Medical Director Dr. Geraldine Walters (GW) Director of Nursing & Midwifery Jane Walters (JW) – Non-voting Director Director of Corporate Affairs
In attendance: Mary Currie (MC) Associate Director - Workforce Planning (AH deputy) Sally Lingard (SL) Associate Director of Communications Tamara Cowan (TC) Board Secretary (Minutes) Linda Smith (LS) KCH Charity Representative Joe Onabaworin Public Governor Fiona Clark Public Governor Jan Thomas Patient Governor Tom Duffy Patient Governor Prof John Moxham Executive Director, KHP Jill Lockett Director of Performance and Delivery - KHP Apologies: Angela Huxham (AH) Director of Workforce Development Graham Meek (GM) Non-Executive Director, Vice Chair Prof. Ghulam Mufti (GM1) Non-Executive Director Jacob West (JW1) - Non-voting Director Director of Strategy
Item Subject Action
13/194 Apologies
Apologies for absence were noted.
13/195 Declarations of Interest
The Board noted that SS was a Trustee at NEST, as the board would discuss NHS Pay Awards and Pensions. The Board agreed there was no conflict of interest.
1 Enc 1.4 Subject to Chair’s Approval Item Subject Action
13/196 Chair’s Action
There were no Chair’s actions to report.
13/197 Minutes of Previous Meeting
The minutes of the meeting held on 29 October 2013 were approved as a correct record.
13/198 Matters Arising/Action Tracking
The matters arising were noted.
13/199 Chair’s and Non-Executive Directors’ Activity Report
The Board noted the report on the activity of the Chair and non-executive directors.
13/200 Update from Board Committee Chairs
Audit Committee CS reported that there had been no further meeting of the Audit Committee since the last meeting of the Board.
Board Integration Committee CS reported that the Board Integration Committee had considered the work for the various workstreams that were currently underway to deliver the transformation integration programme. The appointment process for the Transformation Integration Director is also underway.
Equality & Diversity Committee MM1 advised the Committee met shortly before the Board meeting and discussed how to ensure that inclusion is mainstreamed. A full report would be presented to the Board for approval which includes proposals such explicitly tasking the CEO with the objective of developing the inclusion programme and identifying a lead non-executive director.
Finance & Performance Committee In the absence of GM, MM1 chaired the Committee meeting earlier. MM1 reported that the Committee discussed the operational challenges facing the Trust across its multiple sites and the actions plans which are being implemented to address these issues.
Quality & Governance Committee It was noted at its last meeting the Committee received a very interesting presentation on patient complaints. A new Serious Complaint Committee is being established, with both Executive and Non executive representation, to improve Board level scrutiny of complaint trends and promote learning from events.
2 Enc 1.4 Subject to Chair’s Approval
Item Subject Action
Strategy Committee SS advised that work is underway to develop the work plan for next year for the Committee.
13/201 Update on Council of Governors Activities
The Board noted the update from the recent joint KHP Governors Development Day and the activities of the governors who have been very busy doing work at the new sites.
GA advised due to a long-standing engagement he would be absent from the next Council of Governors meeting. MM1 would chair the meeting on 11 December 2013.
13/202 Chief Executive’s Report & KHP Update
The Board noted the Chief Executive’s report.
The following other key points were noted: The Trust is working hard to implement its integration plans however there are significant challenges which the Trust has estimated will take circa 18-20 months to improve substantively;
The high demand for services has been sustained throughout the year putting the hospital under significant pressure operationally and financially;
On the 01 October the new Monitor risk rating system came into force and this is the first month which the Trust will be reporting under the continuity of services risk (CSSR) rating scheme. The Trust's CSSR for this month is 4;
An interim director of strategy would be engaged to provide cover duringJacob West secondment. In addition the interviews for the Transformation Integration Director took place on Monday, 25 November and an offer has been made to a preferred candidate; and
The Trust is also preparing for the Care Quality Commission inspection visit to the Princess Royal University Hospital (PRUH) 01-03 December. The CQC will also meet with the Council of Governors.
13/203 King’s Health Partners (KHP)
Professor John Moxham and Jill Lockett provided the following update on the activities of KHP: The results from the accreditation interviews were due at the end of the meeting and a statement would be released with the results and the signal the next big steps for KHP; and
3 Enc 1.4 Subject to Chair’s Approval
Item Subject Action
Work is also underway to refresh the governance framework for the organisation and development of the clinical academic site strategy is picking up pace.
The Board noted the tabled reports including the outline of value-base-healthcare approach and the clinical academic groups (CAG) clinical outcome booklets.
The following comments were raised and noted: Over the next 21 months each CAG would produce a clinical outcomes booklet;
The reports need to speak more to the lay man;
The booklets cover the tripartite KHP agenda;
The booklets concentrate on the positive developments for each CAG; and
There are internal processes for tracking and flagging CAG performance issues.
13/204 Finance Report
The Board received the month 07 finance report presented by ST which was discussed at length at the Finance & Performance Committee held earlier.
The following key points were noted:
The Trust has obtained a continuity of services of risk rating (CSSR) of 4 this month under the new Monitor assessment framework;
Under the old risk rating scheme, the Trust would have achieved a financial risk rating (FRR) of 2.4 , lower than the FRR of 3 which the Trust has achieved historically. This is as a result of :
o Continued reliance on temporary and agency staff because of the demand on services;
o Capacity constraints which impact on the Trust’s ability carry out income generating activities; and
o The increase in drugs expenditure.
Additional bed capacity is coming online in the next few weeks in the Centenary Wing at Denmark Hill and at Orpington Hospital and there are plans to increase significantly critical care capacity at Denmark Hill through the new Critical Care Centre
4 Enc 1.4 Subject to Chair’s Approval
Item Subject Action
The Trust is looking at ways to streamline its recruitment processes to ensure the full staff complement is in place to reduce reliance on agency and temporary staff; and
The winter pressures continue and the Trust is awaiting confirmation of winter pressures funding from NHSE. The Board noted the finance report for month 07 and the action plans to address areas of challenge.
13/205 Performance Report
The Board received the month 07 performance report presented by RS which was discussed at length at the Finance & Performance Committee held earlier.
The following key points were noted: Denmark Hill As detailed in the full report the areas of good performance include: o Cancer waiting time targets; o Referral to treatment (RTT) non-admitted completed pathway; o RTT Incomplete pathway targets; and o 6-week diagnostic waiting time target.
Also as detailed in the full report are the key areas of challenge which include: o RTT admitted completed pathway – on track for some specialist services areas but there are areas which are off track which is putting the Trust behind annual trajectory with the big driver being the Centenary Wing (Infill Block 4) coming online; o Emergency care performance – two drivers of improvement in this area, include additional capacity (new CDU) and winter funding. A key component is also moving to 7-day a week working; and o Healthcare Acquired Infection (HCAI) with the seven further c-difficile cases reported in October and three further VRE bacteraemia cases.
Maintaining the 95% run-rate target in A&E is dependent on having the adequate capacity which is linked to having sufficient financial resources to provide additional capacity; and
There were more Mixed Sex Accommodation breaches in October. The Trust plans to have additional CDU capacity available imminently to enable better management of patients.
Princess Royal University Hospital (PRUH) October represented the first month that the Trust was fully accountable for the newly acquired sites and services;
There have been no significant surprises but there are areas of concern;
Areas of good performances include outpatients, diagnostic and finances have all been strong;
5 Enc 1.4 Subject to Chair’s Approval
Item Subject Action
One of the biggest areas of concern is emergency care at the PRUH where operational performance remains very low which is dependent on funding, capacity constraints and operational culture. GA, MM and RS would meet with NHS England and commissioning colleagues to highlight these challenges and explain the Trust’s annual plan; and
Other areas of challenges reflect the challenges identified through the clinical due diligence process and include low levels of staffing establishment, high levels of activity, internal processes requiring improvement, and the need for better clinical engagement.
The Board noted the performance report for month 07 and the action plans to address areas of challenge.
13/206 NHS Pay Awards and Pensions 2013
The Board noted the report on NHS pay awards and pensions, which detailed the changes to the pay, sick pay, and pensions ‘total’ reward package for NHS staff, together with costs incurred for automatic enrolment into the NHS Pension Scheme from April 2013.
It was noted that the Board needs a wider debate about staff recruitment and how best to attract and retain staff.
13/207 Quality and Safety Focus
13/207.1 Quarterly Patient Outcome Report
The Board noted and considered the quarterly patient outcomes report which was also discussed at the Quality and Governance Committee meeting on 07 November at some length.
13/207.2 Quarterly DIPC Report
The Board noted and considered the quarterly Director of Infection Control Report for quarter 2 which was also discussed at the Quality and Governance Committee meeting on 07 November at some length.
Fundamental challenges such as sufficiency of insolation bays and single rooms are affecting the Trust’s infection control processes. The Trust continues to implement its infection control action plans and enhanced its screening for VRE.
13/207.3 Safeguarding Adults Annual Report
The Board noted the contents and overview of risk and governance provided in the Annual Safeguarding Adults Report which was also discussed at the Quality and Governance Committee meeting on 07 November.
6 Enc 1.4 Subject to Chair’s Approval
Item Subject Action
13/207.4 Francis Working Group Report
The Board considered the update from the Francis Working Group.
The Board commented that the work from the 6 workstreams was working well and the following was noted: The report from the working group would be presented to the Council of Governors;
There needs to clear feedback to the staff from the listening events;
There needs to be broader statements about the Trust’s response to the Francis Report widely publicised and accessible to both patients and members of the public; and
The Trust should map what are the requirements laid out in the Francis Report against what the Trust think is right for its patients and staff.
It was agreed that RS and AH with support from SL would pull RS/AH/ together statements to go to staff and patients. SL
13/208 Directors Register of Interest
The ‘Directors Register of Interests’ was received and noted.
13/209 Governor Election 2013 – Timetable and Process
The Board noted the report detailing the timetable and process for the governor elections currently in progress.
13/210 Confirmed Board Committee Minutes
The Board noted the confirmed minutes of the Finance & Performance Committee on 30 September 2013.
13/211 Any Other Business
There was no other business raised for discussion.
13/212 Date of Next Meeting
Tuesday, 17 December 2013 at 14:30 in Dulwich Room
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Meeting Item Action Who Due Date Notes Date COMPLETED 26/11/2013 13/207.4 Francis Working Group Report Update to be provided at the Board. It was agreed that RS and AH with support from SL would RS/AH/SL 17/11/2013 pull together statements (about the feedback from listening events) to go to staff and patients.
NOT DUE 29/10/2013 13/187 The Board noted that an update on the Governance of Satellite Sites will be presented to the Board in February 25 2014. ST February 2014
Board of Directors Meeting – 17 December 2013 1 of 1 This page has been left blank Enc. 2.1
Report to: Board of Directors
Date of report: 17 December 2013
Subject: Chair’s and Non-Executive Directors’ Activity Report
Presented by: Professor Sir George Alberti, Chairman
Status: For information
1. Background/ Purpose This report details the activities undertaken by the Non-Executive Directors of the Board for the period 18 November - 6 December 2013.
2. Action required The Board of Directors is asked to note the contents of this report.
George Alberti- Chairman Date Activity 21 November Board Seminar
25 November Attended Education Committee meeting
KHP Site Strategy meeting with Roland, Mike and Joe Farrington Douglas
Meeting with Jonathan Lewis re working together with Bromley
Attended the KHP Steering Group
26 November Attended the Finance and Performance Committee
Chaired the Private Board meeting
Chaired the Public Board meeting
Attended the Equality and Diversity meeting
Chaired the NED meeting
27 November 1:1 Tim Smart
28 November Attended the Board agenda planning meeting Chaired the an interview panel for a Consultant in Cardiothoracic Surgery
Graham Meek – Vice Chairman, Chair of Finance & Performance Committee Date Activity No reported activity during the period.
1
Enc. 2.1 Chris Stooke –Chair of Audit and Board Integration Committees Date Activity 25 November Chaired Transformation Integration Director Interview Panel
26 November Attended Finance & Performance meeting
Attended Private Board Meeting
Attended Non-Executive Directors Meeting
Attended Public Board Meeting
2 December Visit to PRUH A&E Department
4 December Attended meeting with CQC
6 December Chaired Board Integration Committee
Marc Meryon –Chair of Equality & Diversity Committee Date Activity 26 November Chairing Finance & Performance Committee
Attended Private Board Meeting
Chairing Equality & Diversity Committee
Attended NED meeting
Attended Public Board meeting
Meeting with Chair
29 November Go See, Farnborough Ward, PRUH
4 December Attended CQC interview, PRUH
6 December Attended Board Integration Committee
Professor Ghulam Mufti – Chair of Quality and Governance Committee Date Activity 21 November 2013 Attended Board Seminar
3 December 2013 Attended NEDs pre-meet Princess Royal University Hospital
Attended meeting with CQC at Princess Royal University Hospital
1:1 meeting with Professor Sir Rick Trainor, Principal, King’s College London
2
Enc. 2.1 Faith Boardman – Non-Executive Director Lead for Quality Date Activity Go and See visits 21 November Attended Board Strategy Committee Attended Board Seminar Attended Finance and Performance Committee 26 November Attended Equalities Committee Attended Public Board
28 November Attended Strategy seminar of KCH charity
3 December Attended KCH Charity Board
4 December Attended NED input to CQC Inspection of PRUH
5 December Attended meeting with KCH Charity and KHP fundraisers
6 December Attended Business Integration Committee
Sue Slipman – Director of Strategy Committee Date Activity Attended Finance and Performance Committee ‘Go See’ visit with Roland Sinker
26th November Attended Board of Directors (Private) Attended NED Meeting Attended Board of Directors (Public)
4th December Meeting with CQC Inspection Team at PRUH
3
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Finance Report
Month 8 (November) 2013/14
Board of Directors 17th December 2013 Enc 2.5
Report to: Board of Directors Date of meeting: 17th December 2013 Subject: Finance Committee Report – Month 8 (November 2013) Author(s): Simon Dixon, Nicola Hoeksema, Iris Lewis Presented by: Simon Taylor, Chief Financial Officer Sponsor: Simon Taylor, Chief Financial Officer History: First discussed at Finance and Performance Committee Status: Decision/Discussion/Information
1. Purpose . The Finance Reports includes information on the Trust’s financial performance and position which support the in-year submissions to Monitor on a quarterly basis. . This report covers the Income & Expenditure position, Cost Improvement Programme, Capital and Working Capital Plans.
2. Action required . The Board is asked to approve the Finance Report
Page 2 Enc 2.5
3. Key implications
Legal: Reporting to Monitor and Commercial Bank
Trust reports financial performance and position against published plan and notifies the Financial: committee of financial risks, cost pressures and action plans to mitigate any material variance from financial targets. The summary and appendices provide assurance that the Trust is meeting Financial targets Assurance: (internal and those set by Monitor) and is compliant with its terms of authorisation.
Clinical: There is no direct impact on clinical issues
Equality & Diversity: There is no direct impact on E&D
Financial Performance against annual plan, budgets, CIPs and Monitor Risk Ratings and Performance: Limits.
Strategy: Performance against the Trust’s Annual Plan including Risk Ratings
There are implications for workforce recruitment in respect to service developments and Workforce: vacancies.
There are implication on the Trust’s estates strategy. Estates:
Finance Committee Report is provided to Monitor and Commercial Bankers as additional Reputation: information to support the quarterly Monitor Return.
Other:(please specify) None.
Page 3 Contents Enc 2.5
Page(s)
. Executive Financial Summary 5 - 7
. Continuity of Service Risk Ratings 8
. I&E Summaries 9 - 17 . Patient Spells and Medical Outliers 18 - 20 . Winter Pressure Schemes 21 - 22 . Divisional Variance Analysis 23 - 24 . Temporary Pay Analysis 25 - 26 . Drug Expenditure 27 - 30
. CIP Update 31 - 34
. Strategic and Operational Planning 35 - 38
. Capital, Working Capital & Cash Summary 39 - 50
. Statement of Financial Position 51 - 52
. Glossary 53
Page 4 Month 8 Executive Financial Summary Enc 2.5
Month 8 YTD Month 7 YTD Movement in Annual Budget YTD Budget YTD Actual Variance Variance Month £'000 £'000 £'000 £'000 £'000 £'000 Income (excluding off Tariff Drugs) 790,596 477,889 497,112 19,223 16,963 2,259 Off Tariff drugs Income 45,122 29,241 34,869 5,628 4,476 1,153 Pay (468,267) (287,132) (301,726) (14,594) (12,940) (1,654) Non-Pay (excluding off tariff drugs) (378,900) (222,705) (235,395) (12,690) (10,352) (2,337) Off Tariff Drugs Expenditure (45,122) (29,241) (34,869) (5,628) (4,476) (1,153) Capital Charges, Interest and Dividends 50,989 30,799 29,338 (1,461) (1,144) (317) SLR/Internal Recharges (418) (126) (3) 123 (29) 152 Total (6,000) (1,275) (10,674) (9,399) (7,502) (1,897) Impairment Expense 8,000 5,320 5,320 0 0 0 Consolidated Annual Surplus/(Deficit) 2,000 4,045 (5,354) (9,399) (7,502) (1,897) Financial Key issues:
. The Trust is reporting an operating deficit of £5.354m year to date excluding the asset impairment accrual of £5.320m. The Continuity of Service Risk Rating is 4.
. The annual surplus target for the year is £2m excluding the non-operating asset impairment cost of £8m for the year. The PRUH planned position is break-even incorporating the financial bridging support (see page 10). The phased operating surplus for the plan for month 8 is £4.045m and therefore the Trust is £9.399m adverse from plan. The adverse movement in month is £1.897m compared to the previous month of £7.502m.
. The estimated year end position is an operating deficit of £3.380m (see page 14) and a Continuity of Service Risk Rating of 4. This is based on the Trust receiving additional winter pressure funding and generating additional income from the new capacity coming on line including IB4, interim Critical Care Unit and Orpington Hospital. The year end projection includes the use of the bridging support and implementing non-recurring Divisional CIPs (e.g. holding non-clinical vacancies, reducing non-pay spend on non-clinical supplies). To minimise the deficit the Trust will have to utilise the integration contingency funds and the natural slippage on a number of integration schemes (see page 15). The year end estimate is based on two months financial data from the PRUH to date (see page 13) and therefore it is difficult to be precise about the year end position.
. The winter pressure estimated expenditure for the Denmark Hill site is £8.2m due to holding back the implementation of the short stay paediatric unit. The anticipated funding is £6.7m which is still a shortfall of £1.5m. An additional £2.4m of central funding has been allocated to KCH but any further funding from NHSE is yet to be confirmed (see page 21).The PRUH winter pressure funding of £1.9m has been agreed (see page 22). The revised shortfall is in the estimated year end position. Page 5 Month 8 Executive Financial Summary Enc 2.5
. In order to improve the financial position and bring the Trust position in line with plan, the Trust will have to reduce operating expenditure and risk not achieving activity targets. An example would be to stop using off-site private hospital facilities. The anticipated expenditure from January to March is £1.8m.
. The winter pressure funding gap (£1.5m) needs to be resolved by additional Commissioner financial support or schemes could be rationalised in line with the funding available.
Contract income over-performance
. As at month 8, the LSL contract over-performance position is £9.6m and the NHSE over-performance position is £12.2m. The Trust has also billed NHSE separately for the recurring Project Diamond Funding (£2.8m).
. The number of elective patient spells are still above last years phased outturn; which are partly driving the income over- performance (see page 18). However the medical outliers are still adversely impacting on the potential income of the Trust (see page 19 and 20). The Trust is potentially under performing against income by £1.8m per year.
Operating Expenses
. Medical and Nursing staff costs are still over-spending due to locums and agency staff to cover vacancies and to meet the increasing patient activity levels and patient acuity. . Critical Care, TEAM, Liver and Neurosciences are the key areas of concern (see page 25 and 26). There is still an upward trend despite the recruitment plans.
. The drugs expenditure is £7.4m over-spent to date and there has been a steep increase in usage since July (see pages 27-30). The Finance and Pharmacy departments are currently investigating the increased cost of drugs which is not proportional to the increase in activity at a high level review.
Cost improvement Programme
. The overall achievement to date is 74% against plan. The CIP value achieved to date is £19.1m and income generation is £11.5m (see pages 31-34) A key concern is the current level of RED RAG rated CIP schemes for both KCH and the PRUH. A contingency reserve was established to mitigate the KCH schemes and the remaining gap should be covered by additional activity capacity coming on line. There are a number of PRUH schemes that have now been deemed unachievable by the Division’s and this is a concern going into next year. This will put pressure on the Trust to achieve synergy CIPs earlier than planned. Page 6 Month 8 Executive Financial Summary Enc 2.5
Capital and Cash
. The capital plan is over-committed by £9.1m primarily due to 2 schemes. The delivery of the Orpington Hospital development in quick time to meet the capacity pressures and a further £2m re-phasing on the Energy Performance Scheme. A capital development strategy is under review to meet future requirements and within the available resources.
. The 2 major capital development schemes impacting on the future capital plan are the new Helideck (£5m) and Infill Block 5 (£50m).
. Outstanding debts from NHS England currently total £16.571m (including Integration and Bridging support and Project Diamond funding). The Trust has also raised invoices for the PFI Support (£10.5m). Outstanding CCG SLA and SLA over-performance debts total £14.888m. This will not impact on the risk rating but will generate a delay in payments to creditors.
. The Trust has received the PRUH PDC transactional funding (£23m) and part payment of the revenue integration funding from NHSE (£5.4m).
Operational Planning 2014/15
. The strategic and operational planning timetable is condensed into a much tighter timescale for 14/15; requiring a two year financial plan by 4th April as opposed to the end of May as in previous years (see pages 35-38). This will overlap with the year-end close down timetable and generate additional pressure on divisional management structures and corporate departments; particularly with the PRUH transaction.
. The projected cost improvement target for 14/15 is £66m. This is a challenging target due to the projected deficit carried forward, FYE of nursing investments and the FYE of funding the winter pressure schemes through the operational plan. The winter pressure income is non-recurring and this will be a key funding issue outside of the PBR tariff rules with the Commissioners. The QIPP challenge has yet to be disclosed by the CCG’s and NHSE.
Page 7 Continuity of Service Risk Rating Enc 2.5
YTD - Month8 Debt Service Cover
Revenue available for Debt Service 40,549 key to scoring Debt Service (14,176) Debt Service Cover 50% Debt Service Cover metric 2.86x Debt Service Cover rating 3 4 3 2 1 2.5 1.75 1.25 <1.25 Liquidity
Cash for CoS liquidity purposes 15,335 key to scoring Operating Expenses within EBITDA, Total (512,796) Liquidity 50% Liquidity metric 7.2 Liquidity rating 4 4 3 2 1 0 -7 -14 <-14
Continuity of Service Risk Rating 4
Page 8 Consolidated Reporting Structure Enc 2.5
Consolidated Income & Expenditure
KCH PRUH
KCH Baseline Integration PRUH Baseline Quality Budgets Support Budgets Investments
1. KCH 1. Revenue 1. PRUH 1. Nursing
2. Clinical Due 2. Orpington 2. Capital 2. QMS Diligence
3. Other Sites: 3. Corporate - Sevenoaks Departments - Beckenham Beacon
Page 9 Consolidated Revenue Budgets Enc 2.5
KCH Orpington PRUH QMS Consolidated Income Contract Income 594,471 8,080 85,711 7,753 696,015 Private Patients 14,000 0 211 41 14,252 Other Income (inc E&T) 79,178 0 6,022 1 85,201 Integration 14,000 0 0 0 14,000 Bridging Support 9,000 0 12,000 0 21,000 PFI Support 0 0 5,250 0 5,250 710,649 8,080 109,194 7,795 835,718
Expenditure Clinical/Corporate Budgets (685,649) (8,080) (94,844) (7,795) (796,368) Integration (14,000) 0 0 0 (14,000) Due Dilligence/Nursing cost pressure 0 0 (2,350) 0 (2,350) Contingency Reserves (9,000) 0 (12,000) 0 (21,000) (708,649) (8,080) (109,194) (7,795) (833,718)
Income and Expenditure Surplus/(Defecit) 2,000 0 0 0 2,000
Impairment (8,000) 0 0 0 (8,000)
Total (6,000) 0 0 0 (6,000)
Revised plan for Monitor quarterly returns will be submitted week commencing 16 December.
Page 10 Expenditure By Type Enc 2.5
Annual YTD YTD YTD Last Month Movement Budget Budget Expend Variance Variance in Month £'000 £'000 £'000 £'000 £'000 £'000
PAY
Medical Staff (150,393) (92,717) (96,884) (4,167) (3,086) (1,081) Nursing Staff (181,976) (110,878) (118,632) (7,754) (6,975) (779) A&C Staff/Senior Managers (73,294) (44,337) (44,225) 112 (702) 814 PAMS (23,169) (14,199) (14,362) (163) (204) 41 Directors (1,539) (1,024) (1,037) (13) (2) (11) Scientific/Professional (35,506) (22,384) (24,871) (2,487) (1,875) (612) Other (2,390) (1,593) (1,715) (122) (96) (26) Sub-total (468,267) (287,132) (301,726) (14,594) (12,940) (1,654) NON-PAY
Clinical Supplies (71,360) (45,115) (51,103) (5,988) (3,955) (2,033) Drugs (76,468) (47,918) (55,370) (7,452) (6,129) (1,323) Non Clinical Supplies (45,486) (25,234) (28,482) (3,248) (2,696) (552) PFI (38,295) (21,373) (22,576) (1,203) (512) (691) Capital Charges (26,406) (16,297) (14,932) 1,365 1,167 198 Interest and Dividends (24,583) (14,502) (14,406) 96 (23) 119 Recharges 117 (82) 0 82 137 (55) SLR Recharges 301 208 3 (205) (108) (97) Misc. Other Operating Exp (91,271) (50,960) (54,063) (3,103) (3,882) 779 Sub-total (373,451) (221,273) (240,929) (19,656) (16,001) (3,655)
Total Expenditure (841,718) (508,405) (542,655) (34,250) (28,941) (5,309)
All Income 835,718 507,130 531,981 24,851 21,439 3,412
Income and Expenditure (6,000) (1,275) (10,674) (9,399) (7,502) (1,897)
The table above is an unconsolidated expenditure analysis, excluding Trust subsidiaries. Page 11 Income and Expenditure by Division Enc 2.5
Last Months Annual Budget YTD Budget YTD Actual YTD Variance Variance Movement Division Heading £'000 £'000 £'000 £'000 £'000 £'000 Income 131,883 82,778 83,398 620 795 (175) Pay (55,557) (34,628) (34,925) (297) (308) 11 Non-Pay (36,205) (22,415) (24,432) (2,017) (1,616) (401) Recharges (174) (116) (107) 9 9 0 AMBULATORY SERVICES Total 39,947 25,619 23,934 (1,685) (1,120) (565) Income 169,995 110,418 114,124 3,706 1,639 2,067 Pay (66,503) (42,335) (45,351) (3,016) (2,718) (298) Non-Pay (53,227) (35,349) (42,378) (7,029) (5,495) (1,534) Recharges 652 439 540 101 91 10 NETWORKED SERVICES Total 50,917 33,173 26,935 (6,238) (6,483) 245 Income 55,228 33,649 35,760 2,111 1,617 494 Pay (87,746) (53,237) (55,727) (2,490) (1,846) (644) Non-Pay (69,665) (43,080) (46,528) (3,448) (2,080) (1,368) Recharges 0 0 399 399 380 19 CRITICAL CARE, THEATRES AND DIAGNOSTICS Total (102,183) (62,668) (66,096) (3,428) (1,929) (1,499) Income 177,667 107,209 105,612 (1,597) (362) (1,235) Pay (72,903) (44,691) (46,709) (2,018) (1,500) (518) Non-Pay (24,141) (15,875) (19,536) (3,661) (2,893) (768) Recharges 340 228 (187) (415) (387) (28) LIVER, RENAL AND SURGERY Total 80,963 46,871 39,180 (7,691) (5,142) (2,549) Income 96,938 56,807 60,535 3,728 2,788 940 Pay (71,396) (42,324) (46,159) (3,835) (3,127) (708) Non-Pay (7,996) (5,028) (7,752) (2,724) (1,961) (763) Recharges 0 0 0 0 0 0 TRAUMA, EMERGENCY & ACUTE MEDICINE Total 17,546 9,455 6,624 (2,831) (2,300) (531) Income 115,537 71,182 73,910 2,728 3,324 (596) Pay (65,704) (40,588) (40,883) (295) (313) 18 Non-Pay (8,645) (5,684) (6,911) (1,227) (881) (346) Recharges 0 0 41 41 41 0 WOMENS AND CHILDRENS Total 41,188 24,910 26,157 1,247 2,171 (924) Income 16,036 10,453 11,978 1,525 913 612 Pay (2,977) (1,962) (2,190) (228) (196) (32) Non-Pay (3,787) (2,526) (3,824) (1,298) (790) (508) Recharges (1,360) (907) (379) 528 454 74 Private Patient Service Total 7,912 5,058 5,585 527 381 146 Income 72,434 34,634 46,664 12,030 10,725 1,305 Pay (45,476) (27,369) (29,790) (2,421) (2,937) 516 Non-Pay (145,586) (76,921) (75,157) 1,764 (294) 2,058 Interest and Dividends (24,583) (14,502) (14,406) 96 (23) 119 SLR Recharges 659 274 (307) (581) (451) (130) Recharges 0 0 0 0 0 0 Corporate Services Total (142,552) (83,884) (72,996) 10,888 7,020 3,868 Income 835,718 507,130 531,981 24,851 21,439 3,412 Pay (468,262) (287,134) (301,734) (14,600) (12,945) (1,655) Non-Pay (349,241) (206,878) (226,518) (19,640) (16,010) (3,630) Interest and Dividends (24,633) (14,519) (14,406) 113 (15) 128 SLR Recharges 301 208 0 (205) (108) (97) Recharges 117 (82) 3 82 137 (55) Trust total Total (6,000) (1,275) (10,674) (9,399) (7,502) (1,897) Page 12 M8 Consolidated Variances Enc 2.5
Year To Date Variance Movement in Month KCH (plus PRUH (plus KCH (plus PRUH (plus SUBJECTIVE Orpington) other sites) Trust Total Orpington) other sites) Trust Total £'000 £'000 £'000 £'000 £'000 £'000 PAY
Medical Staff (3,808) (359) (4,167) (804) (277) (1,081) Nursing Staff (7,859) 105 (7,754) (598) (181) (779) A&C Staff/Senior Managers (765) 877 112 (1) 815 814 PAMS (252) 89 (163) 17 24 41 Directors (15) 2 (13) (13) 2 (11) Scientific/Professional (2,185) (302) (2,487) (427) (185) (612) Other (118) (4) (122) (22) (4) (26)
Sub-total (15,002) 408 (14,594) (1,848) 194 (1,654)
NON-PAY
Clinical Supplies (5,935) (53) (5,988) (1,991) (42) (2,033) Drugs (7,100) (352) (7,452) (1,274) (49) (1,323) Non Clinical Supplies (3,318) 70 (3,248) (571) 19 (552) PFI (202) (1,001) (1,203) 67 (758) (691) Capital Charges 1,366 (1) 1,365 282 (84) 198 Interest and Dividends 119 (23) 96 126 (7) 119 Recharges 247 (165) 82 30 (85) (55) SLR Recharges (216) 11 (205) (106) 9 (97) Misc. Other Operating Expenses (4,678) 1,575 (3,103) (565) 1,344 779
Sub-total (19,717) 61 (19,656) (4,002) 347 (3,655)
Total Expenditure (34,719) 469 (34,250) (5,850) 541 (5,309)
All Income 23,385 1,466 24,851 1,938 1,474 3,412
Income and Expenditure (11,334) 1,935 (9,399) (3,912) 2,015 (1,897)
Page 13 Year end Forecast 13/14 Enc 2.5
YTD (M08) Position Forecast Outturn Plan Actual Variance Plan Actual Variance Divison £'000 £'000 £'000 £'000 £'000 £'000 Ambulatory Services and Local Networks 769 -1,208 -1,977 787 -1,773 -2,560 Clinical Scientific & Diagnostic Service 1,051 2,366 1,315 -984 1,796 2,780 Critical care and Theatres -1,223 -1,929 -706 -1,486 -2,038 -552 Dental Institute 1,903 2,013 110 3,337 3,723 386 Liver -3,477 -5,990 -2,513 -5,284 -7,981 -2,697 Renal 2,460 1,951 -509 3,717 3,197 -520 Surgery 2,116 -4,025 -6,141 8,912 -836 -9,748 Cardiac -352 -2,478 -2,126 -748 -4,588 -3,840 Clinical Haematology -821 -7,951 -530 -3,142 -5,238 -2,096 Neurosciences -3,220 -1,351 -4,731 -1,730 -8,539 -6,809 Child Health 2,595 2,593 -2 5,596 5,132 -464 Womens Health -4,751 -4,219 532 -4,580 -3,570 1,010 Trauma, Emergency and Medicine -8,204 -11,799 -3,595 -7,480 -17,693 -10,213 Total Clinical Divisions -11,154 -32,027 -20,873 -3,085 -38,408 -35,323
Capital charges - inc impairment 2 1,555 1,553 0 3,250 3,250 Reserves - inc Bridging support -3,419 0 3,419 -19,752 -8,752 11,000 Corporate - inc Commercial Services -1,230 -302 928 -1,879 -1,379 500 Facilities & Estates -474 -596 -122 -1,106 -1,345 -239 Private Patients - Guthrie Clinic 2,677 3,245 568 4,351 5,051 700 Private Finance Initiative 0 -1,203 -1,203 0 -710 -710 Integration contingency and slippage 0 0 -0 0 5,432 5,432 Trust wide income - inc winter funding 12,323 18,654 6,331 15,471 27,981 12,510 Total all other Departments 9,879 21,353 11,474 -2,915 29,528 32,443
Grand Total -1,275 -10,674 -9,399 -6,000 -8,880 -2,880
Operating surplus excluding impairment 2,000 -3,380 -5,380 Page 14 PRUH Integration Summary Enc 2.5
Annual WTE PAY Budget
TEAM 171,373 3.81 LRS 200,714 5.00 Ambulatory 131,729 5.00 Networked Services 137,872 4.00 Womens and Childrens 52,733 2.00 CCTD 278,536 15.00 Corporate Services 266,813 11.00 HR 477,811 11.00 Finance 210,828 4.00 Operations 492,434 25.00 IT 998,016 42.00 Strategy 318,886 9.00 Nursing 232,459 9.00 Estates 165,053 6.00 Central 46,401 1.00 TOTAL 4,181,656 152.81
Annual NONPAY Budget TEAM 1,000 Corporate Services 445,000 HR 387,000 Finance 490,000 IT 2,681,600 Central 0 TOTAL 4,004,600 0
SUB TOTAL 8,186,256 152.81
Consultancy 4,532,728 CQC Inspection equipment 68,521 TOTAL 4,601,249 0
SUB TOTAL 12,787,505
Contingency Budget 1,212,495
GRAND TOTAL 14,000,000 Page 15 I & E Summary Enc 2.5
Income is over-performing by £24.9m YTD, £3.4m favourable movement in month. PRUH income is over-performing by £1.5m . £5.6m of the YTD over-performance and £1.2m in month favourable movement relates to off tariff drugs. . Outpatient referrals are particularly high in Neurosciences, Surgery, Women’s Health TEAM and Dental. . Vascular surgery elective/non-elective work is adverse against plan. . Critical care and the new Maternity pathway tariff are both over-performing in terms of volume and price. The new maternity pathway tariff reflects the activity case-mix and is generating additional income compared to the historic activity levels on a PbR flat rate tariff and community midwifery block contract . The CCG’s are claiming that this new tariff is not delivering the PbR1.3% efficiency on the contract value. . Winter pressure funding of £5.3m has been accrued to date which is the amount of non-recurring funding we are expecting to receive this year. The income accrual is currently held in the Corporate income budget as the funding has not all been agreed. . Income has over-performed this month mainly due to off tariff drugs planned same day and non elective activity. There has been an increase in BMT patients this month which has also contributed to the position movement in month.
Pay is overspent year to date by £14.6m, a £1.6m adverse movement in month. PRUH pay is £1.5m underspent . Nursing is £7.8m overspent year to date, £780k adverse movement in month. The overspend is mainly in critical care, neurosciences, liver and acute medicine. Nursing Bank and agency spend has been approximately £2m per month, this is 56% higher than the same period last year. This increase is mainly due to the number of vacancies in specialist areas such as critical care because of an increase in capacity. Divisions are working on recruitment plans to reduce the numbers of vacancies including overseas recruitment. There has also been an increase in “specialing” for high dependency patients which also has an impact on the use of bank and agency. There are also a high number of vacancies at the PRUH with high bank and agency usage but we are currently reporting an underspend. . Medical is £4.2m overspent to date, £1m adverse movement in month. The majority of the overspend is in emergency medicine, acute medicine and neurosciences caused by the use of locums covering vacancies. The recruitment of permanent staff does not appear to be a viable option to reduce locum costs. There is also a cost pressure for twilight ED locum SpR shifts, a continuation of last year winter pressure scheme. There is a small overspend at the PRUH due to the use of locums. . Professional, technical and scientific is £2.5m overspent to date, £600k adverse movement. This is again due to the use of temporary staffing (mainly agency) to cover vacancies in areas such as pharmacy, dental, liver theatres and cardiac. Cardiac are also using temporary staff to reduce echo waits. Page 16 I & E Summary Enc 2.5
Non Pay is overspent by £19.7m overspent year to date, a £3.7m adverse movement. PRUH non pay is £460k underspent
. Clinical supplies are £5.8m overspent, the majority of this is in Critical Care and Theatres due to an increase in activity and decontamination costs. Cardiac is also overspending on devices but this is recoverable through off tariff income. Neurosciences devices expenditure is overspent due to an increase in spinal and VNS work, . Drugs are overspent by £7.5m YTD and are offset by off tariff income of £5.6m. There was an adverse movement of £1.3m this month offset by £1.2m income. Further investigation is needed of the drugs position. This is currently being undertaken by pharmacy and finance . Non clinical supplies are overspent by £3.2m YTD, a £552k adverse movement. This includes the rental cost for of the CDU porta-cabin delivered last year to meet winter pressures. Also patients travel expenses, IT expenses (including hardware and software), postage, printing and stationery plus other general expenditure. . Misc. Other operating expenses are £3.1m overspent YTD. This overspend includes £2.6m year to date for unfunded costs relating to non–NHS healthcare services (off site working). A £1m bad debt provision has been made for unrecovered overseas visitors income. The current bad debt provision is £2m for other debts.
Page 17 Number of Patient Spells Enc 2.5
Category Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar All Inpatients - 2013/14 11324 11401 11036 12015 10852 11270 12057 11803 Non-elective - 2013/14 4675 4886 4688 4874 4485 4763 4970 4612 All Inpatients - 2012/13 9961 10938 10169 11187 10713 10682 11797 11318 9873 11085 10436 11264 Non-elective - 2012/13 4300 4575 4497 4706 4384 4580 4808 4517 4392 4669 4235 4895
Number of Patient Spells 14000
12000
10000
All Inpatients - 2013/14 8000 Non-elective - 2013/14 All Inpatients - 2012/13 6000 Non-elective - 2012/13
4000
2000
0 May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Page 18 Medical Outliers Enc 2.5
Medical Outliers and Lost Opportunity Income
Summary
. The graph shows the monthly number of bed days for General Medicine patients outlying in other Divisions wards.
. The patients are from all specialties within General Medicine including Acute Medicine and Geriatrics.
. The Lost opportunity income is an estimated net calculation based on the following: 1) An average income tariff lost per speciality by not filling their beds with their own patients. This is based on the number of occupied bed days. 2) An average income received by having General Medicine Patients in those beds.
. The net difference between 1) and 2) is shown as a net loss per month. The total estimated loss is: • 2012-13 £1,892,061 • To end of November 2013-14 £1,169,142
• Total to date for both years £3,061,203
Page 19 Medical Outliers Enc 2.5
Medical Outliers and Lost Opportunity Income 1400
N 1200 u m b 1000 e r 800
o 2012-13 f 600 2013-14 O B 400 D ' s 200
0 April May June July Aug Sept Oct Nov Dec Jan Feb March Months
Net Loss April May June July Aug Sept Oct Nov Dec Jan Feb March Total
2012-13 262,310 150,428 180,038 71,171 38,943 81,840 111,901 109,492 187,549 300,264 142,998 255,127 1,892,061 2013-14 192,156 163,606 88,252 116,235 108,687 149,984 184,695 165,528 0 0 0 0 1,169,142
3,061,203
Page 20 King’s Winter Pressure Schemes 2013/14Enc 2.5
Denmark Hill Site M1-8 M9-12 2013/14 Actual Exp Forecast Total £'000 £'000 £'000
Neuro Nursing needed to cope with the increased acuity of patients 536 268 804 CDU portacabin hire/ housekeeping & hostess service 302 151 453 LAS performance nursing/ admin 197 98 295 1 band 6 ED Paeds nurse shift 24/7 181 91 272 ED Twilight SpR shift 7/7 180 90 270 RDL additional beds (12 beds until 30/9/13 then increasing to 28 beds) 1,073 1,335 2,408 Acute Medicine wards nursing shift review 100 900 1,000 Acute Medicine Consultant rota review to support weekend cover for 7/7 working 0 210 210 Increased CDU capacity & new RAT/ majors assessment area 0 329 329 Paediatric Short Stay Unit 0 500 500 2 Story CDU/Paediatric short stay modular unit 0 500 500 Acute Medicine 7 day working 0 367 367 Other Schemes 403 389 792
Kings Total 2,972 5,228 8,200
Funding Agreed DOH/NHSE Cenral funding via LSL CCGs (TBC) 2,400 NHSE Emergency Admissions Tariff at 100% (TBC) 1,000 LSL CCG Emergency Admissions Tariff at 100% 2,300 LSL CCG Emergency 13/14 Baseline increase at full tariff 1,000 Total Funding 6,700
Funding Gap 1,500
Page 21 King’s Winter Pressure Schemes 2013/14Enc 2.5
PRUH Site
M1-8 M9-12 2013/14 Actual Exp Forecast Total £'000 £'000 £'000
Portacabin CDU facility outside EAU/ED & staffing 0 717 717 Winter pressure ward (M1) 97 234 331 2 additional nursing shifts in ED 24/7 (to include all new majors capacity and paeds) 69 139 208 Therapists - 7/7 working (ED/ CDU & EAU) 0 83 83 15 Paediatric Beds 0 187 187 Other Schemes 16 358 374 Total 182 1,718 1,900
Funding Agreed DOH/NHSE Central Funding via Southwark CCG 1,900 Total Funding 1,900
Funding Gap 0
Page 22 Divisional Variance Analysis Enc 2.5
LRS - Surgery - £6.1m adverse YTD, £1.3m adverse movement in month. • Income is £3.1m adverse ytd, £865k adverse in month. The adverse movement is in respect to the Division’s ability to achieve income targets with capacity constraints. This includes the plan for TEAM to reduce the number of medical outliers in surgical beds giving surgery more capacity to admit surgical patients. Year to date TEAM have only managed to reduce the outliers by 45%, so surgery have not been able to generate sufficient income to meet this target. There is also the target for the additional income that was expected on the opening of Infill Block 4 in September and Orpington in October. • Nonpay is £1.3m overspent YTD. The majority of this overspend is due to the unfunded cost of off site working. • Service Line Reporting recharges are £1.3m overspent YTD. This includes increases in theatre and radiology activity despite the capacity constraints.
Network Services - Neurosciences - £4.7m adverse YTD, £713k adverse movement in month. • Income is £1.2m favourable YTD, £237k favourable in month. Elective and outpatient income is over-performing in neurosurgery and stroke. Elective neurosurgery income has over-performed due to off site working but paediatric non elective activity is underperforming. The adverse movement in month is due to a reduction in off site activity and cancellations due to lack of beds. This should be resolved once Neurosurgery have the full use of Murray Falconer from mid November once surgery move into infill 4and the step down facility in Orpington is available. • Pay is £1.7m overspent, of which Medical pay is over spent by £665k due to unfunded pay arrears and high locum costs. Nursing pay is over spent by £889k due to high cost of specials and sickness cover. Overseas recruitment has taken place and there has been a reduction in temporary staffing expenditure. • £3.8m Non-pay overspend, is mainly clinical supplies due to activity increase in neurosurgery spinal and VNS work, and drugs (off set by income) and off site working (Harley Street).
Network Services - Haematology - £530k adverse YTD, £1.1m favourable movement in month • Income is £2.5m favourable. £1.7m favourable movement in month. £1.5m of the YTD variance relates to off tariff drug income. There has been an increase of BMT patients this month and we are currently over--performing by 9 patients. • Pay is overspent by £777k YTD. The majority of the overspend is in nursing and medical pay. Bank and agency spend is up due to vacancies, specials and sickness cover. • Non-pay is £1.7m overspent YTD. This is mainly clinical supplies and drugs; drugs are offset by income and clinical supplies relates to an increase in international donor tests
Page 23 Divisional Variance Analysis Enc 2.5
Network Services - Cardio-vascular - £2.1m adverse YTD, £188k adverse movement in month. • Income is £10k adverse. Vascular is underperforming due to the transfer of some services to GSTT and cancellations due to bed pressures. Off site work has started to clear the backlog. This is offset by over performance in cardiology activity. • Pay is overspent by £521k YTD. The majority of the overspend is in nursing and is caused by bank spend due to increased activity on CRU in V&A, plus further usage of the 5th and 6th beds on CRU; and specials and sickness cover. • Non-pay is £1.6m overspent YTD. The main drivers are clinical supplies which is activity driven (apart from in Vascular which is under spending) and external contracts due to HCA invoices for off site work done at London Bridge.
Ambulatory - £2.0m adverse YTD, £268k adverse movement in month • Income is £39k adverse. Diabetes and Ophthalmology income has improved, they are now on target where they were previously underperforming. • Drugs account for the majority of the expenditure overspend at £1.4m overspent YTD. The spend has been particularly high in Ophthalmology & Oncology. The division has a CIP to reduce FP10 usage by 40% which they have not been able to achieve due to the new dispensary being built. A CIP for VAT savings in outpatients was also removed from budgets.
Critical Care, theatres and Diagnostics - £610k favourable YTD, £1.1m adverse movement in month • Income is £2.16m favourable. Critical care have had very high bed occupancy levels over the last few months including a high proportion of level 3 patients which attract a bed rate tariff circa £1,800. • Nursing is overspent by £2m. Mainly in critical care and is caused by high bank and agency usage . Vacancies have reduced by 60% since April but temporary staffing remains high due to activity demand.
Women’s and Children’s - £532k favourable YTD, £1.1m adverse movement in month • Income is £2.7m favourable. The majority of the over-performance is due to the new maternity pathway tariff. There is a risk associated with this income, hence a prudent income accrual adjustment .
Corporate Departments . There are a number of unplanned cost pressures in corporate departments year to date including £114k for the KHP KIS project, £70k for the Francis/Listening project and £107k for the EPS benchmarking system. . Facilities is £459k overspent YTD. The main issues are a drop in car parking revenue, an increase in patient transport due to the number of patients being transferred between sites, and an increase in postage costs. . PFI is overspent by £1.2m YTD mainly due to infection control issues.
Page 24 Temporary Pay Analysis Trend Enc 2.5
. The graph to the left shows spend on bank and agency nursing over the previous periods and it is showing that the trend is on the increase. . B&A spend continues to be high and the main areas are still CCTD due to additional Critical Care capacity, weekend day surgery lists and the additional shifts in ED. . Shifts are being escalated to agencies as there is a need for more highly skilled nurses, particularly in ED. Additional controls are being put in place in an effort to reverse this trend.
. The graph to the right shows spend on agency medical staffing over the previous period and it is showing that the trend is starting to go up again and actual expenditure is erratic on a month to month basis. . Consultant posts that were previously covered by locums have now been recruited into but some junior positions (particularly in ED) are still reliant on locums to cover shifts.
Page 25 Temporary Pay Analysis by Division Enc 2.5
. Agency spend (shown to the left) is 118% up on the same period year to date last year, with increases in Critical Care & Theatres, LRS (Liver ITU) and TEAM (Emergency department) . Agency spend has been steadily increasing since last year and is particularly high in specialised areas where recruitment into vacancies is difficult. Some overseas recruitment is taking place but this is a slow and expensive process.
. Bank spend (shown to the right) is 3% up on the same period year to date last year, with increases in LRS and Networked services. Increase is mainly due to specialing and an increase in high dependency patients.
Page 26 Drug Expenditure Enc 2.5
• Total Drug expenditure has increased year on year. The total increase was 12% in financial year 2012/2013 and is forecast to be circa 15% in 2013/14.
• Network Services is forecasting to spend £5m more this year compared to last year, bringing their total expenditure to £30m. Network Services spent £5m more in 2012/13 as compared to 2011/2012 expenditure. The total percentage increase year-on-year is averaging at 20% increase in drug expenditure compared to 5% increase in activity.
• The increased drug expenditure this year is partly explained by the increased use of off-tariff drugs. Last year the off- tariff drug run rate was around £2.9m and this year’s run rate is at an average of £3.3m. The main reason for this increase is that companies are now billing via the Trust as compared to direct to PCTs as per the previous arrangement. This increase will show an overspend against the drug expenditure budget however this will be recovered via contract income. Pharmacy need to ensure that all off-tariff drug usage is recorded and billed to CCGs promptly.
• The remainder of the drugs which are within tariff have also increased compared to Trust activity. The average cost of drugs per patient activity was £236 last year compared to the current year average of £256; representing an 8.9% increase.
• In terms of groups of drugs, Anti-Lymphocyte Monoclonal Antibodies, HIV Infection & Rheumatic Suppressant were the largest drug expenditure groups.
Page 27 Drug Expenditure Enc 2.5
Page 28 Drug Expenditure Enc 2.5
Page 29 Drug Expenditure Enc 2.5
Total Drug expenditure Total Drug expenditure increase % increase Divisions 2011/12 2012/13 2013/14 2012/13 2013/14 2012/13 2013/14 £ £ £ £ £ Ambulatory Services And Local Network 18,857,357 20,035,719 21,495,122 1,178,361 1,459,404 6% 7% Critical Care Theatres And Diagnostics 2,653,590 2,348,161 2,554,548 (305,429) 206,387 -12% 9% Human Resources 46,448 43,556 43,458 (2,891) (98) -6% 0%
DRUGS Liver Renal And Surgery 9,510,715 10,206,968 11,256,665 696,253 1,049,697 7% 10% Networked Services 21,209,338 25,530,976 30,408,046 4,321,638 4,877,070 20% 19% Private Patients 789,780 891,266 881,234 101,486 (10,032) 13% -1% TEAM 2,850,314 3,362,561 5,073,942 512,247 1,711,380 18% 51% Womens And Childrens 2,749,308 3,103,693 3,835,516 354,385 731,823 13% 24% 58,666,850 65,522,902 75,548,532 6,856,052 10,025,630
Total FCE Total FCE increase % increase Divisions 2011/12 2012/13 2013/14 2012/13 2013/14 2012/13 2013/14 Ambulatory Services And Local Network 22,635 25,463 27,155 2,828 1,692 12% 7% Critical Care Theatres And Diagnostics 711 778 645 67 (133) 9% -17% Human Resources 0 0 0% 0%
FCE Liver Renal And Surgery 27,391 28,563 30,467 1,172 1,904 4% 7% Networked Services 28,556 30,404 31,974 1,848 1,570 6% 5% Private Patients 1,389 1,930 1,904 541 (27) 39% -1% TEAM 27,986 32,678 34,476 4,692 1,798 17% 6% Womens And Childrens 37,095 37,814 37,983 719 169 2% 0% 145,763 157,630 164,603 11,867 6,973
Page 30 2013/14 CIP YTD Summary Enc 2.5
CIP Identified % of total YTD Target YTD Actual YTD Variance
DH 5,994 15% 3,732 2,011 -1,721 Pay PRUH 4,039 70% 1,346 441 -905
DH 11,383 28% 6,455 5,111 -1,344 Non-Pay PRUH 1,213 21% 385 117 -269
DH 22,612 57% 13,750 11,517 -2,233 Income PRUH 479 8% 160 0 -160
DH 39,989 23,937 18,639 -5,298 Totals PRUH 5,731 1,891 557 -1,334 45,720 25,828 19,196 -6,632 Year to date under performance against CIPs amounts to £6,632k, 74% overall achievement. The aim is to achieve 75% of plan for Denmark Hill schemes and 50% for PRU schemes.
Key schemes achieved:- . Coding Optimisation - £3.0m over achieved (£2m YTD target) . PCT led QIPP (Demand Management) - £1.76m . NHSE QIPP - £882k Key schemes unachieved:- . Outpatient QIPP - £1m YTD target, £364k achieved . A&C Reduction - £727k . Income Generation - £3,327k (IFB4, Interim Critical Care Unit, Orpington Hospital) . Temporary staffing reduction - £785k YTD target, £195k achieved
A prudent position has therefore been taken in that, if no figures are available then the CIP is deemed unachieved. Further analysis of A&C & Business Cases is in progress. Actual achievement is therefore likely to be higher than currently reported. Page 31 2013/14 Divisional RAG Rating by site Enc 2.5
RAG RATING OF SCHEMES - DH RAG RATING OF SCHEMES - PRUH Green Amber Red Green Amber Red ACLN 2,966 893 1,247 ACLN 110 0 45 CCTD 3,401 335 1,026 CCTD 49 0 1,254 TEAM 1,795 77 1,105 TEAM 290 589 247 LRS 2,795 306 743 LRS 153 181 423 NWS 1,789 60 1,032 NWS 0 14 52 W&C 1,547 195 253 W&C 141 0 667 Facilities 16 100 0 Facilities 361 0 205 Corporate 990 143 115 Corporate 0 0 950 Trustwide 5,662 663 10,738 Trustwide 0 0 0 TOTAL 20,959 2,772 16,258 TOTAL 1,104 785 3,842
£39.989m stretch target CIPs identified for Denmark Hill, and £5.731m for PRU. However £20.951m (45.8%) are currently Red RAG rated.
RAG ratings are based on YTD performance if scheme has already started:-
• Red – less than 50% achievement • Amber – less than 95% achievement • Green – more than 95% achievement
If scheme has not yet started, RAG rating is based on delivery plan status.
Page 32 2013/14 Divisional Assessment Enc 2.5
CIP Identified YTD Target YTD Actuals YTD Variance Forecast DH PRUH DH PRUH DH PRUH DH PRUH DH PRUH ACLN 5,106 155 3,114 52 2,182 37 -932 -15 3,712 110 CCTD 4,762 1,303 2,808 415 2,342 35 -466 -380 3,692 35 TEAM 2,977 1,126 1,767 375 1,287 207 -480 -168 1,866 621 LRS 3,843 758 2,391 252 2,091 108 -300 -144 3,030 324 NWS 2,881 66 1,854 22 1,377 3 -477 -19 1,913 10 W&C 1,995 809 1,153 270 1,141 47 -12 -222 1,726 141 Facilities 116 566 16 189 16 120 0 -68 91 361 Corporate 1,248 950 776 317 701 0 -75 -317 1,095 -194 Trustwide 17,062 0 10,057 0 7,502 0 -2,555 0 7,078 0 TOTAL 39,989 5,731 23,937 1,891 18,639 557 -5,298 -1,334 24,204 1,407 The major variances are as follows :- . ACLN: £319k A&C staffing, £194k DNA rate reduction, £89k QIPP OP productivity, £72k DMO margin, £71k FP10s, £52k temporary staffing reduction, £24k Pharmacy schemes . CCTD: £216k temporary staffing reduction, £205k A&C staffing, £94k theatre procurement costs, £84k theatre nursing reconfiguration, £59k PRU pay schemes, £37k procurement schemes, £34k Cardiac flow income, £28k QIPP OP productivity . TEAM: £343k Outlier reduction, £176k CRU Income, £86k closure of 32 bed medical ward, £66k unidentified CIP balance. This is partially offset by an over achievement of QIPP OP productivity (£124k) . LRS: £159k temporary staffing reduction, £40k Cystoscopy best practice, £32k medical productivity consultants, £31k Bariatric efficiency, £28k Gastro closure, £27k unidentified CIP balance . NWS: £209k temporary staffing reduction, £72k microdisectomy day case procedures, £33k antifungals, £32k Saturday Cath Lab procedures, £25k CT surgery . W&C: £58k midwifery skill mix and reconfiguration, £50k CYP service redesign, £36k Paeds best practice tariff, £33k temporary staffing reduction, £46k Medical productivity (of which £31k is Jr Drs). This is partly offset by over achievement in gynaecology ambulatory procedures £39k. . Facilities: £48k Green Parks income, £18k Medical equipment cost reduction . Corporate: £122k temporary staffing reduction, £40k E-Rostering, £38k unidentified CIP balance, £27k Procurement savings, £27k translator services, £25k Project Oscar . Trustwide: £3,327k business cases, OP productivity QIPP £632k, £561k Service Line Reporting, £447k procurement, £175k A&C reduction, £150k Noteless scheme, £119k medical productivity. This is partially offset by an over achievement of Coding Optimisation income (£2,974k). Page 33 PRU CIP Exceptions Report Enc 2.5
A number of PRU schemes have been flagged up by Divisions as unachievable. The material ones are as follows:-
• £550k - Ward closure – unable to close ward
• £281k - Procurement savings – will not achieve in original format as not real plans
• £251k - Theatres nursing reduction – will not achieve as looking at improving productivity
• £244k - Unidentified – no plan therefore will not achieve
• £185k - Jr Dr non training post reduction – not viable as not enough Drs on rota
• £150k - Paeds CYP service consolidation – not viable due to SLHT dis-solution
• £142k - Outsource OP Pharmacy – no concrete plan in place
Divisions are working on identifying alternative plans where original plan is not viable, or looking to implement plans at a later date once further scoping work has been undertaken.
Page 34 Strategic and Operational Planning in the NHS Enc 2.5
• Tariff – Monitor and NHS England plan to publish the 2014/15 tariff in December. The 2014/15 tariff guidance has been strengthened to confirm that where a Trust is being reimbursed at less than 100% of the national tariff, both the provider and commissioner will be jointly engaged in the reinvestment decision. The scope of this improved arrangement includes the non-payment for emergency readmissions and the marginal rate emergency tariff and we would expect to see plans that demonstrate how this funding has been transparently re-invested in appropriate demand management and improved discharge schemes.
• Allocations – we will be able to notify CCGs of their financial allocations for both 14/15 and 15/16 in the week commencing 16 December and will also provide broad assumptions regarding allocations for years 3 – 5 to the same timescale.
• Efficiencies 2014/15 2015/16 – 2019/20
Efficiencies 4.0% * Published in December * Subject to consultation
• Cost Inflation
2014/15 2015/16 – 2019/20
Weighted Averaged Cost Inflation 2.1% * Published in December * Subject to consultation
• Price deflation – tariff 2014/15 2015/16 – 2019/20
Average tariff deflation 1.9% * Published in December * Subject to consultation. The 1.9% excludes the impact of CNST on specific HRG groups.
Any further forward guidance provided in December will be indicative only and will not represent a commitment to future tariff pricing beyond 2014/15, which will be subject to consultation in future years.
• CQUIN – NHS England is refreshing the CQUIN scheme and associated guidance for 2014/2015. It is proposed that the final CQUIN scheme will be agreed and published in December 2013.
Page 35 Key Planning Deadlines Enc 2.5
M9 FTC/ Annual Budget Setting Annual Plan Q3 Return Accounts Planned publication date of 2014/15 National Tariff Payment System 16-Dec-13 ISG/PMO CIP targets finalised 13-Jan-14 1st Cut Commissioner Contract proposals 17-Jan-14 Submission of completed M9 FTC 22-Jan-14 Board Approval of Q3 Return 28-Jan-13 Submission of Q3 return to Monitor 31-Jan-13 Initial CIPs completed 03-Feb-14 First draft budgets and cost pressure submitted 10-Feb-14 Budgets and cost pressures approved and revised control totals issued 28-Feb-14 Contracts Signed 28-Feb-14 Board approval (Budget & 2 year plan) 25-Mar-14 25-Mar-14 Submission of final 2 year plans 04-Apr-14 Submission of Unaudited FTCs and Accounts to Monitor 23-Apr-14 Board Approval of Annual Accounts 20-May-14 Board Approval of 5 year Plan 27-May-14 Submission of Audited FTCs and Accounts to Monitor 30-May-14 Submission of final 5 year plans 06-Jun-14
Page 36
Projected Cost Improvement Target 14/15 Enc 2.5
Provisional Cost Improvement Target 14/15 £'m
Deficit after bridging support carried forward from 13/14 3.4 1.9% Tariff deflator on clinical income streams (4% efficiency target less 2.1 %price inflation ) 12.0 Service quality developments not funded by income streams - FYE a) nursing establishment investment excluding winter pressure schemes 3.0 b) patient safety & quality business cases (staff and non-pay) 1.0 c) repleacment equipment - revenue leases 1.0 Winter Pressure ED/Acute Medicine Admissions schemes - FYE Denmark Hill (net impact assuming emergency admissions funded 100% by NHSE/CCGs) 8.0 PRUH 1.9 AfC net incremental drift and general banding drift 5.0 Pension cost pressure : staff increases/auto -enrolement staff impact/increased ER's contribution 5.4 Agency rates increase to cover employment rights (annual leave/pension) 0.5 Price inflation above Treasury funding @2.1% a) Pay awards (tbc) 0.0 b) Utilities 0.5 c) PFI KCH RPI 0.1 d) PFI PRUH RPI 0.2 PFI Contract variations a) deep cleaning & infection control 0.5 b) variations for additional porters/ extra linen (soft service increases) 0.5 c) increased equipment maintenance at PRUH (serviced via PFI) 1.0 NHSE QIPPs (tbc - awaiting Commissioner intentions - used 13/14 targets) 4.0 CCG QIPPs (tbc - awaiting Commissioner intentions - used 13/14 targets) 10.0 Training & Education tariff reduction/ Dental SIFT 1.2 KHP/SLIC investment (tbc) 0.0 Contingency Reserves 7.0 Total 66.2 Page 37 Projected CIP Identified Savings to Date Enc 2.5
£m Divisional targets 4% of recurring budget 33.00 Procurement 4.00 Clinical coding 3.00 Service level agreements 1.00 Energy scheme 0.30 Commercial Services 3.00 Medical Productivity * 0.80 Outpatients* 2.60 Nursing Productivity* 3.15 Theatre Productivity* 9.00 Improving LOS* 3.50 Admin & Clecial staff* 2.00 Emergency Pathway 1.00
Total 66.35
*50% of expected benefit - Source ISG papers
Page 38 Month 8 Capital Summary Enc 2.5
. Capital Plan (Page 43) • The annual budget for 2013/14 has been reduced from £52.586m to £30,699m due to the re-phasing of the Critical Care Unit (£21.887m) between 13/14 and 14/15. £13.095m of the Critical Care Unit is to be funded in 13/14 by the loan received from the Foundation Trust Financing Facility. • £1.024m of the Capital Plan will be funded by charitable donations, £3m is funded by an Energy Grant from the Department of Health Energy Fund, with the remaining being funded by internal Trust resources such as Depreciation. The £3m budget for Orpington major works is funded by SLHT. • The 2 major capital development schemes impacting on the future capital plan are the new Helideck (£5m) and Infill Block 5 (£50m). The Trust no longer has an external financing limit, but any borrowing needs to be managed within the Monitor rating.
. Forecast Capital Expenditure • Forecast capital expenditure for 13/14 has increased by £9.151m against the Trust’s Annual Plan budget. Below is the breakdown of the changes to date. Budget per Annual Revised Forecast Net Variance Scheme Plan - 2013/14 Spend - 2013/14 2013/14 Comment £'000 £'000 £'000 Additional costs for Fees and VAT, and project now incorporates the Maternity & Paediatrics 1,280 2,000 720 refurbishment of Suites 4 & 7 in the Golden Jubilee Wing Lease of a 2 storey Portakabin with CDU and Paediatric beds has reduced the Emergency Centre 1,279 550 (729) need for capital spend on this project. Christine Brown Ward upgrade works - 1,500 1,500 Upgrade of ASU to level 2 use Trundle Ward 750 200 (550) Scheme aborted Energy Performance Contract 4,000 6,080 2,080 VAT excluded from initial estimate and payment to supplier has been re-phased Scope of project reduced due to design viability issue, remaining project to be Ultrasound reconfiguration 700 50 (650) carried forward CT Scanner Enabling Works - 84 84 Additional enabling works to install CT Scanner on ground floor of GJW Helideck 43 143 100 Additional preparatory works Diabetic Foot Clinic 300 9 (291) Project to be carried forward Mortuary Expansion 300 25 (275) Project delayed due to works been carried out on Infill Blk 5 Decked Car Park 500 4 (496) Project to be carried forward Other major works - 76 76 Projects overspent at month 8 Minor Works - Capital Maintenance 1,000 1,150 150 Budget required to complete Corridor Refurbishment project. Medical Equipment 1,165 2,185 1,020 Additional funding required for Infill Block 4 Equipments and ED CDU unit Medical Equipment - CCU 349 1,173 824 Additional funding required for Infill Block 4 Equipments and ED CDU unit Overspend due to change in planned use of Orpington hospital resulting in Orpington Major Works 3,000 4,568 1,568 additional works been carried out. Orpington Equipment & IT - 2,700 2,700 IT Infrastructure, theatre and therapies equipments for Orpington Hospital Total - KCH 14,666 22,497 7,831 PRUH - Estate projects 1,320 1,320 Total - PRUH - 1,320 1,320 Total capital budget/ forecast / variance (+ over, - under spend) 14,666 23,817 9,151 Page 39 Capital Expenditure Summary - KCH Month 8 Enc 2.5
. Capital Expenditure - KCH • Capital expenditure to month 8 was £20.770m against a re-phased year-to-date budget of £22.996m. The current under-spend against year-to-date budget relates primarily to delays in the commencement of CCU major works projects, which is offset by over-spend in Orpington. • Overall, the Trust is forecasting to spend £41.530m at the end of the year against the budget of £33.699m, resulting in an overspend of £7.831m (excluding PRUH Integration).
Capital Programme - KCH Budget Expenditure
Annual Plan Forecast Total per capital category 13/14 Period Budget Actual YTD Cost to Complete Total Cost 13/14 Variance
Major works 25,010 16,673 11,943 14,636 26,579 1,569 Capital Maintenance (Minor Works) 1,000 667 599 551 1,150 150 Medical Equipment 1,165 777 1,888 297 2,185 1,020 IT and infrastructure 2,498 1,665 896 1,602 2,498 - Intangibles (IT) 2 2 2 - 2 - Donated - Major Projects 649 87 87 1,386 1,473 824 Donated - Medical Equipments 375 125 125 250 375 -
Orpington - Estate major works 3,000 3,000 3,968 600 4,568 1,568 Orpington - Equipments & IT - - 1,262 1,438 2,700 2,700
Total Capital Position : Overspend (+) / Underspend (-) 33,699 22,996 20,770 20,760 41,530 7,831 Anticipated Budget Period Budget Actual to date Changes Y/E Forecast
Gross capital expenditure b/f 33,699 22,996 20,770 20,760 41,530 (Intangible Assets Included Above) Non Cash Purchase of OMS Gross Cost 33,699 22,996 20,770 20,760 41,530 Less: Capital Donations held on Trust, NOF monies 1,024 212 212 812 1,024 Total 1,024 212 212 812 1,024 Capital Charge against Capital Resource Limit 32,675 22,784 20,558 19,948 40,506 Depreciation (Including Orpington) 15,876 10,584 8,580 7,296 15,876 PDC Receivable 2,980 2,980 2,980 0 2,980 SLHT Funding - Orpington 3000 3000 3000 0 3000 External Borrowings 13,095 12,100 12,100 995 13,095 Internal Cash Resources (2,276) (5,880) (6,102) 3,826 (2,276) FT Capital Plan 32,675 22,784 20,558 12,117 32,675 Variance : + over / (-) under 0 0 0 7,831 7,831 Page 40 Capital Expenditure Summary - KCH Month 8 – Major Works Enc 2.5
. Major capital works breakdown . There is a significant increase in the forecast for Energy Performance Contract, as the initial budget did not include VAT that will not be reclaimable, and Christine Brown Ward upgrade to an interim CCU. . Other projects are been re-phased to next financial year resulting in a net over-spend of £1.569m.
MAJOR WORKS PROJECTS Annual Plan Actual Spend Cost to Forecast Variance Scheme 2013/14 to Month 4 Complete Cost to Plan £'000 £'000 £'000 £'000 £'000 Maternity (MLU/MAU Expansion) 1,280 1,276 724 2,000 720 Emergency Centre (Majors & External Works) 1,279 76 474 550 (729) Christine Brown Ward upgrade works - - 1,500 1,500 1,500 Energy Performance Contract 4,000 2,905 3,175 6,080 2,080 Day Surgery Unit 377 171 59 230 (147) Liver Lab Research Facility 252 118 134 252 - Critical Care Unit - Phase 1 1,500 25 1,806 1,831 331 Critical Care Unit - Fees Phase 1 & 2 1,000 667 333 1,000 - CCU Enabling Works - general 1,700 205 1,495 1,700 - CCU Enabling Works - IFB 4 1,000 752 248 1,000 - CCU Enabling Works - IFB 5 3,500 621 379 1,000 (2,500) CCU Development - Unit 8 (Waste Compound) 1,770 2,003 111 2,114 344 Site Wide Infrastructure 2,625 1,207 3,243 4,450 1,825 Pharmacy Dispensing Expansion 84 68 16 84 - Helideck 43 24 119 143 100 Pet CT Scanner Enabling Works 1,000 792 208 1,000 - Diabetic Foot Clinic 300 9 - 9 (291) Office Moves & Reconfigurations (eg E-learning to Unit 4) 100 13 87 100 - Trundle Ward 750 62 138 200 (550) Ultrasound Reconfiguration 700 9 41 50 (650) Mortuary Expansion 300 - 25 25 (275) Endoscopy - Perfusionists Move 200 231 - 231 31 Endoscopy - Changing Rooms 50 1 49 50 - Endoscopy - Fire Damage Works 500 157 138 295 (205) Endoscopy - Building Works - 174 - 174 174 Decked Car Park 500 4 - 4 (496) Clinical Research Facility (Building) 200 171 29 200 - CT Scanner Enabling Works - 84 - 84 84 Other Major Works - 118 105 223 223 TOTAL 25,010 11,943 14,636 26,579 1,569 Page 41 Capital Expenditure Summary - Integration Month 8 Enc 2.5
. Capital Expenditure – PRUH Integration • There is a forecast overspend in integration works as we are currently forecasting to spend £12.320m of which £11m is funded by capital integration funding. • The overspend of £1.320 will impact on the Trust total overspend as this will have to be funded internally from depreciation
Budget Expenditure Capital Programme - Integration of PRUH
Annual Plan Cost to Total Cost Forecast Total per capital category 13/14 Period Budget Actual YTD Complete 13/14 Variance PRUH PRUH - Estate Projects - - 557 763 1,320 1,320 Integration Projects 11,000 3,667 769 10,231 11,000 - Total Capital Position : Overspend (+) / Underspend (-) 11,000 3,667 1,326 10,994 12,320 1,320
Anticipated Budget Period Budget Actual to date Changes Y/E Forecast Gross capital expenditure 11,000 3,667 1,326 10,994 12,320
Gross Cost 11,000 3,667 1,326 10,994 12,320
Depreciation - PRUH 1,944 1,296 0 1,944 1,944 PDC - Capital Integration Funding 11,000 11,000 11,000 0 11,000 Internal Cash Resources (1,944) (8,629) (9,674) 7,730 (1,944) FT Capital Plan 11,000 3,667 1,326 9,674 11,000 Variance : + over / (-) under 0 0 0 1,320 1,320
Page 42 3 Year Capital Plan Enc 2.5
Annual Plan Forecast Spend Variance 2013/14 2014/15 2015/16 2013/14 2014/15 2015/16 2013/14 2014/15 2015/16 Scheme £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Maternity (MLU/MAU Expansion) 1,280 0 0 2,000 720 0 0 Emergency Centre (Majors & External Works) 1,279 0 0 550 (729) 0 0 ASU upgrade works 0 0 0 1,500 1,500 0 0 Energy Performance Contract 4,000 3,000 0 6,080 2,383 2,080 (617) 0 Day Surgery Unit 377 0 0 230 (147) 0 0 Liver Lab Research Facility 252 0 0 252 0 0 0 Adult Cystic Fybrosis Inpatient Facility - Guthrie 0 860 0 860 0 0 0 Renal Dialysis Expansion 0 1,500 0 1,500 0 0 0 Critical Care Unit - Phase 1 10,000 5,536 0 2,500 13,036 (7,500) 7,500 0 Critical Care Unit - Fees Phase 1 & 2 1,000 4,000 1,000 4,000 0 0 0 CCU Enabling Works - general 1,700 0 0 1,700 0 0 0 CCU Enabling Works - IFB 4 & 5 4,500 0 0 3,500 1,000 (1,000) 1,000 0 CCU Development - Cyber Knife Enabling Works (IFB 5 Basement) 2,200 0 0 2,200 0 0 0 CCU Development - Unit 8 (Waste Compound) 1,770 0 0 1,770 0 0 0 Site Wide Infrastructure 4,625 2,625 2,000 (2,000) 2,000 0 Critical Care Unit - Phase 2 11,736 9,864 0 21,600 (11,736) 11,736 0 Consulting Rooms for ATOS (Funded by ATOS) 300 0 0 300 0 0 0 Pharmacy Dispensing Expansion 84 0 0 84 0 0 0 Helideck 43 0 0 143 100 0 0 Pet CT Scanner Enabling Works 1,000 0 0 1,000 0 0 0 Diabetic Foot Clinic 300 0 0 9 291 (291) 291 0 Office Moves & Reconfigurations (eg E-learning to Unit 4) 100 0 0 100 0 0 0 Trundle Ward 750 0 0 200 (550) 0 0 Ultrasound Reconfiguration 700 700 0 50 950 (650) 250 0 Mortuary Expansion 300 0 0 25 275 (275) 275 0 Additional Major Schemes 0 0 3,000 3,000 0 0 0 Endoscopy - Perfusionists Move 200 0 0 231 31 0 0 Endoscopy - Changing Rooms 50 0 0 50 0 0 0 Endoscopy - Fire Damage Works 500 0 0 469 (31) 0 0 Portakabin Replacement 0 350 0 350 0 0 0 Decked Car Park 500 0 0 4 496 (496) 496 0 Clinical Research Facility (Building) 200 0 0 200 0 0 0 CT Scanner Enabling Works 84 84 0 0 Other Major Works 223 223 0 0 Minor work schemes 1,000 1,000 1,000 1,150 1,000 1,000 150 0 0 Information Technology - Tangible Assets 2,000 1,500 1,500 2,000 1,500 1,500 0 0 0 Information Technology - Intangible Assets 500 500 500 500 500 500 0 0 0 Medical Equipment new and replacement 1,540 1,250 1,250 2,560 1,250 1,250 1,020 0 0 Medical Equipment new and replacement (Critical Care) 0 3,349 3,000 1,173 2,176 3,000 1,173 (1,173) 0 Orpington Major Works 3,000 0 0 4,568 1,568 0 0 Orpington Equipment & IT 0 0 0 2,700 2,700 0 0 Total Capital Budget Expenditure 55,586 35,609 10,250 41,530 57,367 10,250 (14,056) 21,758 0 CCU Capital Expenditure 35,331 20,269 0 13,095 42,505 0 22,236 (22,236) Net Spend after CCU Loan 20,255 15,340 10,250 28,435 14,862 10,250 8,180 (478) 0 Donated - Equipment 375 250 250 375 250 250 0 0 0 Donated - Critical Care Equipment 349 349 0 349 (349) 0 Donated - Consulting Rooms Atos 300 300 0 0 0 Donated - Adult Cystic Fibrosis 0 430 0 0 430 0 0 0 0 Energy Grant 2,980 2,980 0 0 0 SLHT Funding - Orpington 3,000 3,000 0 Depreciation 15,876 15,989 16,289 15,876 15,989 16,289 0 0 0 Internal Funding 22,531 17,018 16,539 22,880 16,669 16,539 349 (349) 0
Additional Internal Funding (Available) / Required - KCH (2,276) (1,678) (6,289) 5,555 (1,807) (6,289) 7,831 (129) 0
PRUH - Estate works 0 1,320 1,320 0 0 Integration & PRUH 11,000 11,000 0 0 0 Depreciation - PRUH (1,944) (1,944) 0 0 0 Integration & PRUH PDC Funding (11,000) (11,000) 0 0 0 Additional Internal Funding Required - Integration (1,944) 0 0 (624) 0 0 1,320 0 0
Total Additional Internal Funding (Available) / Required (4,220) (1,678) (6,289) 4,931 (1,807) (6,289) 9,151 (129) 0 Page 43 Month 8 Working Capital Summary Enc 2.5
Trade Debtors . As at month 8 outstanding trade debtors totalled £59m. This total includes the following outstanding amounts: • Private Patient and Overseas Visitors debts £9.633m • PCT Invoices 2012/2013 (net of credits) -£0.440m • CCG - SLA & NHS Commissioning monthly invoices 2013/2014 £3.329m • CCG - Over-performance 2013/2014 £11.559m • NHS England – Integration & Bridging support £5.795m • NHS England – Project Diamond 2013/2014 £2.800m • NHS England – Over-performance 2013/2014 £5.875m • NHS England – Other £2.101m • Health Education England (Funding Oct-Dec) £0.522m • South London Healthcare NHS Trust £2.436m • Guy’s & St Thomas’ NHS Foundation Trust £3.441m • King’s College London £3.846m
Cash . The Cash balance at the end of Month 8 was £30.561m against a forecast cash balance of £33.819m.
Trade Creditors . As at month 8, outstanding trade creditors totalled £17.5m. This total includes the following outstanding amounts: • King’s College London £1.021m • Guy’s & St Thomas’ NHS Foundation Trust £2.416m • NHS Supply Chain £1.225m . The Trust is meeting with GSTT to resolve outstanding balances week commencing 16 Decemeber.
Working Capital Facility . The Trust has not utilised its Working Capital Facility of £40m in the current financial year. . The Trust’s Working Capital Facility has been approved by NatWest and the new contract agreed.
FT Borrowing . The Foundation Trust Financing Facility agreed in December 2012 to provide external funding to the Trust to finance the construction of the Critical Care Unit. The first drawdown of funds against this loan was received in March 2013 for £4.4m and a further £5.9m was received in June 2013 and £6.2m in September 2013.
Page 44 Working Capital - Debtors Enc 2.5
Total Outstanding 0 - 30 days 31 - 60 days 61 -90 days Over 90 days £ £ £ £ £ NHS Bodies CCGs & Primary Care Trusts 14,958,256 3,656,166 4,717,332 6,692,907 (108,148) Department of Health / SHA 16,731,500 16,582,278 18,112 127,227 3,883 Provider Trusts 8,724,556 1,330,084 1,255,164 3,588,680 2,550,627 NHS Trade Debtors 40,414,312 21,568,528 5,990,608 10,408,814 2,446,362 Provision for Bad Debts (1,687,458) - - - (1,687,458) NHS Bodies Total 38,726,854 21,568,528 5,990,608 10,408,814 758,904
Non NHS Bodies Scottish, Welsh & Irish Health Bodies 629,337 217,547 401,282 3,412 7,095 King's College London University 3,846,683 186,565 633,706 242,712 2,783,699 King's Charitable Trust 270,346 115,127 46,089 12,404 96,726 Other Non NHS Bodies 4,223,912 2,159,349 442,543 321,013 1,301,008 Non NHS Trade Debtors 8,970,278 2,678,588 1,523,621 579,542 4,188,528 Provision for Bad Debts (336,294) - - - (336,294) Non NHS Bodies Total 8,633,984 2,678,588 1,523,621 579,542 3,852,234
Total Accounts Receivable 49,384,591 24,247,115 7,514,229 10,988,356 6,634,890
% of Total Outstanding - Month 8 100% 49% 15% 22% 13% Month 7 100% 65% 17% 3% 15%
Private Patients Accounts Receivable 6,030,787 730,899 408,975 602,555 4,288,358 Provision for Bad Debts (639,517) - - - (639,517) Private Patients Accounts Receivable Total 5,391,270 730,899 408,975 602,555 3,648,841
Overseas Visitors Accounts Receivable 3,602,823 674,226 485,567 355,090 2,087,941 Provision for Bad Debts (2,759,720) - - - (2,759,720) Overseas Visitors Accounts Receivable Total 843,103 674,226 485,567 355,090 (671,779)
Total PP & Overseas Visitors Accounts Receivable 9,633,611 1,405,125 894,542 957,645 6,376,299 . Provision for Bad Debts is based on debts outstanding over 6 months. . The NHS Provision has been adjusted for debts which are not contested and are considered recoverable. Page 45 Working Capital - Creditors Enc 2.5
Overall Total 0 - 30 days 31 - 60 days 61 -90 days Over 90 days £ £ £ £ £
NHS Bodies 5,764,795 5,466,142 4,314 53,750 240,589
Non NHS Bodies 11,726,307 11,278,005 7,905 53,474 386,923
Total 17,491,102 16,744,148 12,219 107,224 627,512
% of Total Outstanding - Month 8 100% 96% 0% 1% 4% - Month 7 100% 12% 50% 13% 25%
Page 46 Cash Summary Enc 2.5
Cash Balances
. The Cash balance at the end of Month 8 was £30.561m against a forecast cash balance of £33.819m.
. The Trust’s Working Capital Facility is £35m and the Trust has not utilised this Facility in the current financial year.
Cash Flow Variances to 30th November 2013
. To 30th November 2013, cash received from CCGs and other NHS Trusts was £2.4m more than forecast – This is due mainly to extra income received for SLA’s.
. Cash received for Training and Education was £590k more than forecast.
. VAT and Other Income received was £3.4m less than forecast – This is due mainly to the integration cost for November not received in November. The forecast has been adjusted for December.
. Payments to NHS Professionals for bank and agency staff were £567k less than forecast – payments in December will increase to maintain the balance at under 90 days.
. Payments against capital invoices were £3.8m less than forecast - this due to invoices not submitted for payments.
. Revenue creditors were paid £3.7 more than forecast in November. This was to cover the last two weeks in December when payments will not be made.
Page 47 Cash Flow Enc 2.5
TOTAL QTR 1 QTR 2 Oct-13 Nov-13 QTR 3 QTR 4 Forecast 2013/14 2013/14 ACTUAL ACTUAL 2013/14 2013/14 ACTUAL ACTUAL Forecast Forecast £'000s £'000s £'000s £'000s £'000s £'000s £'000s
Balance B/F 40,502 40,502 16,028 11,199 35,661 11,199 33,863
Income NHS Clinical Income LSL PCT 1,159 1,115 44 0 0 0 0 LSL CCG SLA 177,902 43,885 44,966 14,808 15,078 44,412 44,639 LSL CCg's Other 37 0 4 10 23 33 0 SLA CCG's & HB's 164,344 15,210 21,008 20,006 22,037 62,701 65,425 SLAs- NCB 282,837 50,697 87,847 22,406 26,187 72,193 72,100 Provider to Provider Income 15,449 2,895 2,908 2,084 783 4,200 5,446 NCA's - CCG's 3,500 0 36 151 176 782 2,682 NCA's - PCT 840 729 110 1 0 1 0 NCA's - HB 996 520 88 33 23 139 249 NCA's - NCB 600 0 0 0 20 140 460 NCA's - SLHT 9,858 0 3,286 4,929 4,929 RTA's 2,100 564 467 127 167 544 525 Patient SLA Overperformance 2013/2014 20,003 0 615 2,010 378 6,638 12,750 Patient SLA Overperformance 2012/2013 2,000 1,098 774 0 0 128 0 Patient SLA Overperformance 2011/2012 (142) (142) 0 0 0 0 0 Non-NHS Clinical Income Private Patients 14,539 4,411 3,502 1,213 1,225 3,484 3,142 Other Income Research and Development 4,300 1,176 669 94 154 1,573 882 Training & Educ: HEE T& E 44,128 8,830 13,157 10,909 590 11,499 10,642 Merit Awards 3,403 127 0 0 0 2,547 729 Energy Contract 1,250 0 0 0 0 500 750 Pathology (Joint Venture) 21,574 5,796 5,011 3,280 1,487 6,267 4,500 Caregroup Operational Income 66,018 8,330 8,178 6,941 6,840 27,293 22,217 VAT reclaims 24,844 6,083 5,597 2,010 2,354 6,564 6,600 Consultant's Fees income (Private Patients) 2,609 1,025 184 0 0 350 1,050 sub-total 864,148 152,349 195,165 86,083 80,808 256,917 259,717
Expenditure Pay monthly (incl Pay Awards) 240,471 51,055 51,714 22,602 23,100 68,702 69,000 PAYE/NIC/SUPER (CHAPS) 181,262 39,716 40,364 13,532 17,650 48,682 52,500 Agency Spend (NHSP Bank) 51,540 7,303 11,123 8,681 4,433 18,114 15,000 Consultants' Fees 2,609 1,025 184 0 0 350 1,050 PFI project 32,904 8,939 8,860 2,968 2,933 8,202 6,903 PFI (PRUH) 24,769 0 0 2,852 4,225 11,500 13,269 AAH 4,973 1,276 1,218 382 497 1,279 1,200 Pathology (Joint Venture) 34,352 8,985 8,499 2,834 2,834 8,468 8,400 NHSLA Clinical Negligence 11,070 3,321 3,321 1,107 1,107 3,321 1,107 Non-pay Direct Debits (leases, rates) 15,753 3,598 4,924 1,350 1,265 3,769 3,462 Non-pay Revenue Trade Creditors (Incl. CIPs) 247,425 50,149 60,103 21,996 25,677 64,673 72,500 sub-total 847,128 175,367 190,310 78,304 83,721 237,060 244,391
Cash from operations 17,020 (23,018) 4,855 7,779 (2,913) 19,857 15,326
Capital & Financing Items Capital gross exp (Purchased) 54,579 3,876 9,465 8,524 1,300 18,691 22,547 Capital gross exp (Donated) 675 0 90 131 0 416 169 Capital Income (Donated) (675) 0 0 0 0 0 (675) Receipts from sale of Capital Assets 0 0 0 0 0 0 0 PDC Dividends (TDR) 7,425 0 3,585 0 0 0 3,840 PDC Received (19,726) 0 0 (26,226) 0 (19,726) 0 Loan Received (17,900) (5,900) (6,200) 0 0 (5,800) 0 Loan Repaid (Energy Centre) 450 225 0 0 0 225 0 Loan Repaid (Business Park) 562 281 0 0 0 281 0 Loan Repaid ( Natwest) 0 0 0 0 0 0 0 Loan Received( Natwest) 0 0 0 0 0 0 0 Salix Loan Repaid 124 0 62 0 0 0 62 Capital Element of Finance Lease repayment 804 201 201 67 67 201 201 Interest on investments (82) (28) (17) (6) (7) (19) (18) Interest Paid on Revolving Credit Facility 68 17 17 0 0 17 17 Interest on Loans (Energy Centre) 89 46 0 0 0 43 0 Interest on Loans (Business Park) 458 232 0 0 0 226 0 Interest on Loans (CCU) 423 25 0 0 0 157 241 Interest on PFI & Finance Leases 2,484 621 621 207 207 621 621 PFI Contingent Rental Payments 7,440 1,860 1,860 620 620 1,860 1,860 sub-total 37,198 1,456 9,684 (16,683) 2,187 (2,807) 28,865
Net Inflow / Outflow (20,178) (24,474) (4,829) 24,462 (5,100) 22,664 (13,539)
Forecast Balance C/F 20,324 16,028 11,199 35,661 30,561 33,863 20,324 Page 48 Analysis of Cash Balances (Monthly) Enc 2.5
GRAPH A – Monthly Net Cash BalancesMonthly (incl. Cash Overdraft Balances) NatWest GBS- Citibank Cash Balance
45,000
40,000
35,000
30,000
25,000 £'000 20,000
15,000
10,000
5,000
- Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Date
Graph A shows the monthly net cash balance based on actual cash flows.
The level of balances held on the Citi Bank and Natwest accounts are frequently reviewed in order to maximise interest receivable and minimise interest payable and bank charges.
Page 49 Analysis of Cash Balances (Daily) Enc 2.5
GRAPH B – Daily Movement of Cash Balances (Net of Overdraft)
Daily Cash Balances Balance (£'000)
80,000
70,000
60,000
50,000
40,000 Balances(£)
30,000
20,000
10,000
- 31-Dec-12 31-Jan-13 28-Feb-13 31-Mar-13 30-Apr-13 31-May-13 30-Jun-13 31-Jul-13 31-Aug-13 30-Sep-13 31-Oct-13 30-Nov-13 Date
Graph B shows the fluctuation of cash balances on a daily basis.
This graph highlights the receipt of SLA contract income around the 15th of each month (indicated by the peaks between £30-40m), and the reduction of our cash balance between the 17th and 24th when large monthly payments e.g. payroll, P.A.Y.E and N.I. are paid.
Page 50 Statement of Financial Position (Balance Sheet) Enc 2.5
Consolidated Qtr 1 Qtr 2 Annual Plan STATEMENT OF FINANCIAL POSITION AS AT 31 March 2013 30 June 30 September 31 October 30 November Forecast 2013 2013 2013 2013 31 March 2014 £'000 £'000 £'000 £'000 £'000 £'000 NON-CURRENT ASSETS Intangible Assets 1,399 1,246 1,151 1,097 1,046 1,104 Property, Plant & Equipment 270,311 272,045 275,140 279,767 278,899 301,946 Investments in associates 816 816 816 816 816 1,749 On-Balance Sheet PFI 76,496 73,111 72,646 72,491 72,335 74,372 Trade and Other Receivables, Non- Current 3,834 3,834 3,834 3,834 3,834 3,834 Total Non-Current Assets 352,856 351,052 353,587 358,005 356,930 383,005 CURRENT ASSETS Inventories 11,333 11,250 13,299 11,670 12,190 11,300 Trade Receivables 38,684 17,871 32,398 51,512 48,956 39,934 Other Receivables 1,968 19,257 26,679 21,756 22,054 2,968 Impairment of Receivables (4,666) (4,821) (6,067) (5,938) (6,846) (4,667) Other Financial Assets 5,866 51,228 40,823 28,712 42,579 9,613 Prepayments 3,258 5,188 6,429 11,867 5,673 3,258 Cash & Cash Equivalents 40,502 16,028 11,200 35,661 30,562 26,551 Total Current Assets 96,945 116,001 124,761 155,240 155,168 88,957 CURRENT LIABILITIES Interest-Bearing Borrowings (1,135) (629) (567) (567) (567) (1,091) Deferred Income (5,552) (6,199) (7,635) (10,342) (9,516) (4,442) Provisions (3,316) (3,181) (1,327) (1,275) (1,228) (1,006) Current Taxes Payable (4,095) (8,173) (8,147) (10,495) (10,879) (4,400) Trade Payables (32,908) (33,358) (27,222) (22,159) (17,166) (30,908) Other Payables (14,958) (18,724) (19,640) (17,956) (21,103) (14,974) Other Financial Liabilities (31,664) (36,691) (49,287) (63,559) (67,766) (30,742) Total Current Liabilities (93,628) (106,955) (113,825) (126,353) (128,225) (87,563)
Total Assets less Current Liabilities 356,173 360,098 364,523 386,892 383,873 384,399
NON-CURRENT LIABILITIES Interest-Bearing Borrowings (15,349) (21,249) (27,449) (27,449) (27,449) (49,590) Provision (6,893) (6,893) (6,893) (6,893) (6,893) (6,384) Other Financial Liabilities (75,583) (75,584) (75,584) (75,584) (75,584) (74,702) Total Non-Current Liablilities (97,825) (103,726) (109,926) (109,926) (109,926) (130,676)
Total Assets Employed 258,348 256,372 254,597 276,966 273,947 253,723
Financed By (taxpayers' equity): Public Dividend Capital 135,678 135,678 135,678 161,904 161,904 135,678 Revaluation Reserve 87,538 87,757 87,302 87,302 87,563 88,913 Income & Expenditure Reserve 35,132 32,937 31,617 27,760 24,480 29,132
Total Taxpayers' Equity 258,348 256,372 254,597 276,966 273,947 253,723
. Trade and Other Receivables includes NHS and Non-NHS debtors on page 45 . Trade and Other Payables includes NHS and Non-NHS creditors on page 46 Page 51 Public Sector Payments Policy Enc 2.5
Paid to NHS Organisations Amount Paid on Time 2013/14PublicThrough APSectorDirect Debit TotalPaymentsThrough AP Direct Debit PolicyTotal % of % of % Paid Cum Ave £'000 £'000 £'000 £'000 £'000 £'000 AP DD on Target on Target April 2,505 2,783 5,288 1,480 2,783 4,263 59% 100% 81% 81% May 2,068 3,553 5,621 829 3,553 4,382 40% 100% 78% 79% June 1,826 4,288 6,114 53 4,288 4,341 3% 100% 71% 77% July 3,717 5,952 9,669 1,306 5,952 7,258 35% 100% 75% 76% August 2,080 3,980 6,060 846 3,980 4,826 41% 100% 80% 77% September 2,456 4,513 6,969 1,599 4,513 6,112 65% 100% 88% 79% October 3,009 9,787 12,796 1,249 9,787 11,036 42% 100% 86% 80% November 4,051 5,540 9,591 1,642 5,540 7,182 41% 100% 75% 79% 21,712 40,396 62,108 9,004 40,396 49,400 41% 100% 80%
Paid to Non NHS Organisations Amount Paid on Time
2013/14 Through AP Direct Debit Total Through AP Direct Debit Total % of % of % Paid Cum Ave £'000 £'000 £'000 £'000 £'000 £'000 AP DD on Target on Target April 17,447 8,582 26,029 9,413 8,582 17,995 54% 100% 69% 69% May 15,173 8,885 24,058 7,172 8,885 16,057 47% 100% 67% 68% June 14,877 7,999 22,876 8,213 7,999 16,212 55% 100% 71% 69% July 27,814 8,708 36,522 11,997 8,708 20,705 43% 100% 57% 66% August 15,934 7,964 23,898 8,922 7,964 16,886 56% 100% 71% 67% September 16,129 8,856 24,985 10,061 8,856 18,917 62% 100% 76% 68% October 28,724 11,281 40,005 15,845 11,281 27,126 55% 100% 68% 68% November 22,916 12,653 35,569 14,321 12,653 26,974 62% 100% 76% 69% 159,014 74,928 233,942 85,944 74,928 160,872 54% 100% 69%
Page 52 Glossary Enc 2.5
. CIP – Cost Improvement Plan . SLA – Service Level Agreement . PDC – Public Dividend Capital . PSPP – Public Sector Payment Policy . Working Capital Facility - represents a sum of money reserved by the relevant bank for potential use by the Foundation Trust . Asset - An asset is a resource controlled by the enterprise as a result of past events and from which future economic benefits are expected to flow to the enterprise . Liability - an entity's present obligation arising from a past event, the settlement of which will result in an outflow of economic benefits from the entity . Equity - the residual interest in the entity's assets after deducting its liabilities . EBITDA – Earnings before Interest, Taxation, Depreciation and Amortisation . EBITDA Achieved (% of Plan) – measures the achievement of earnings against plan . EBITDA Margin (%) – Measures Earnings as a percentage of total income indicating underlying performance . Return on Assets excluding Dividends – Net surplus before Dividends as a percentage of average assets indicating financial efficiency . I & E Surplus margin net of dividends – Net surplus as a percentage of total income indicating financial efficiency . Liquidity Ratio (days) - The liquidity ratio (days) indicates the number of days that net liquid assets can cover operating expenses without further cash coming from cash sales of fixed or long-term assets.
Page 53
Enc 2.6a
Board of Directors 2013-14 Month 8 Performance @ Denmark Hill
Roland Sinker Chief Operating Officer
1 Enc 2.6a
Report to: Board of Directors Date of meeting: 17 December 2013 Subject: Performance Report, Month 8 2013/2014 Author(s): Steve Coakley, Acting Associate Director of Performance and Contracts Presented by: Peter Fry Sponsor: Roland Sinker History: Status: For Information
1. Background/Purpose This report provides the details of performance achieved against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position. 2. Action required The Board is asked to approve the M8 performance reported against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 for Kings performance at the Denmark Hill site.
2 Enc 2.6a 3. Key implications Legal: Statutory reporting to Monitor and the DH. Financial: Trust reports financial performance against published plan. Assurance: The summary report provides assurance that the Trust has met the performance targets as defined within the Monitor Risk Assessment framework for the interim Q3 position with the exception of the RTT 18 Week Admitted target and the 4-hour Emergency Performance target, although the RTT indicators have not been fully validated for November. Subject to further feedback from Monitor, the Trust’s current risk rating is Green. Clinical: There is no direct impact on clinical issues. Equality & Diversity: There is no impact on equality & diversity issues. Performance: The summary report demonstrates that the Trust has achieved the performance indicators for the interim Q3 position as defined in the Monitor Risk Assessment framework, with the exception of the RTT 18 Week Admitted target as planned and the 4-hour Emergency Performance target.
Strategy: Performance against the Trust’s annual plan forecasts and key objectives. Workforce: None. Estates: There is no direct impact on Estates.
Reputation: Trust’s quarterly and monthly results will be published by Monitor and the DH.
Other:(please specify)
3 Contents Enc 2.6a
•Executive Summary •Specific Performance Reports • Infection Control Plan • ED Action Plan Update • RTT Action Plan Update
4 Executive Summary (1/5) Enc 2.6a
1. Denmark Hill 2013-14 Key Areas of Performance for Month 8: Due to the early Board meeting being held in December, a shortened Performance paper is being presented prior to scorecards and key national return data being available for the Month 8 position. 1.1 Performance challenges – 8 Areas RTT Admitted – The RTT Admitted pathway position has not been finalised for November, however, as planned, this performance indicator will not be achieved whilst the Trust continues to reduce the over 18 week backlog. Delays in the handover of Infill 4 have meant that the Trust is behind the original backlog trajectories that have been shared with the commissioners. All wards in Infill 4 are now operational including the surgical short-stay ward which the division is now planning to move to 7-day working for elective admissions. Revised trajectories have been agreed with the divisions and key challenged specialties are on-track with the exception of Bariatric Surgery and Orthopaedic Daycase and Inpatients. Neurosurgery remains our key area of concern based on the planned capacity moves. Emergency Care Performance – The Emergency Care performance target was not achieved in November with 94.6% of patients seen within 4 hours compared to the 95% target for all emergency type attendances. Achievement of this performance indicator is at significant risk for Q3 with the current position to-date at 94.3%. This would require a run-rate of 97.3% for the remainder of December in order to achieve the 95% target which will be difficult to achieve whilst the department remains under great pressure. This is one of the performance indicators that the Trust did highlight to Monitor as at risk of not achieving for Q3 in its annual plan as capacity and winter funding comes on-line. Health Care Acquired Infection (HCAI) – There were 2 further MRSA cases attributed to the Trust in November so 4 cases have been reported to-date this year, however, this is no longer tracked by Monitor in the Risk Assessment Framework from Q3. There were a further 6 c-difficile cases reported in November so 34 cases have been attributed to date which is above the trajectory of 34 cases. The Trust has a trajectory of 37 cases for Q3 so achievement of this quality indicator is at risk for the quarter. Finance position – The projected year-end financial position is -£15m for Denmark Hill. 5 Executive Summary (2/5) Enc 2.6a
Cancer Waiting Times – The continued pressure on acute and critical care beds has had an adverse impact on our ability to see our cancer patients. Two of the 31-day and two of the 62-day cancer targets were not achieved in November, however, the Trust is assessed for the quarter. For the interim Q3 position, the 62-day referral to treatment target is not being achieved and is at risk for the quarter. Never Events - There were 2 never events recorded for November – 1 case related to a retained guidewire following the removal of an arterial line and the other case was a wrong tooth extraction. Red Shifts – The number of ward-based red shifts decreased from 43 in October to 59 in November: with 22 red shifts reported in TEAM wards, 11 in Liver/Surgery wards, and 9 in Child Health wards. Complaints – The number of complaints received increased from 58 cases in October to 73 cases in November. Response times to complaints have also worsened with 73 cases still open or not responded to within 25 days compared to 46 cases reported in October. 1.3 Actions – 8 areas RTT Admitted - The Trust’s first priority remains the reduction of the number of 52+ week wait patients, and the number of breaches has reduced slightly from 32 patients waiting at the end of October to 30 patients waiting at the end of November. The opening of Infill 4 will provide additional capacity to treat the long-wait patients, however, a number of these patients require critical care input and there is currently limited capacity for ICU/HDU beds to support this. The Trust’s second priority is the reduction in the number of over-18 week wait patients, and revised trajectories have been worked-up with divisions which are monitored weekly to reduce the over 18-week backlog to the agreed number of 550 patients waiting by the end of March. Emergency Care Performance – The planned medical ward moves have now taken place and all beds on RDL are now part of the medical bed pool. The second Clinical Decision Unit (CDU) is planned to become operational in December which the new portacabin will house, and increase overall CDU capacity to 16 beds. This move will also release additional capacity in the majors area of the Emergency Department. Subject to the provision of additional winter monies funding, the Trust plans to implement the acute medical pathway and short-stay Paediatric CDU which should improve performance into Q4. 6 Executive Summary (3/5) Enc 2.6a
Weekly Emergency Care Board meetings are currently being held to review performance and progress against the revised Action Plan which is included later in this report. Health Care Acquired Infection (HCAI) – Management of in-dwelling devices (IV line and urinary catheter care) and consistent review of MRSA pre-admission screening of patients across all specialties remains the key area of focus. Following the recent MRSA cases and increased c-difficile cases that have been attributed to the Trust, we will re-invigorate the performance and governance framework that has already been established within the hospital. A full root cause and analysis is being conducted into the 2 MRSA cases for November, and the lead clinical for each case will present findings to the Chief Executive. The latest C-difficile Action Plan is included later in this report. Finance position - Meetings are scheduled for the 3rd week in January for each division to meet with the Finance and Operations executive team to review in detail their financial and CIP position. Cancer Waiting Times – Any potential cancer admission cancellations need to be approved by the Director of Operations. Potential 62-day cancellation breaches are being reviewed by the central Cancer Information team with the clinical divisions. Never Events – Following investigation by the Anaesthetics team and Dental team at Denmark Hill, the never event cases will be taken to the Serious Incident Committee. The Trust will be launching a full review of theatre practice through its Quality and Governance infrastructure. Red Shifts – All red shifts are reported to the Deputy Director of Nursing to manage on a daily basis in order to resolve any shortfall of staff on the wards. Red shifts are reviewed in more detail at the divisional Nursing & Midwifery meetings held by the Deputy Director of Nursing. Complaints - The complaints backlog continues to be challenged at the weekly Performance Improvement Group now chaired by the Director of Operations. 2. Other areas of concern: 2.1 Tertiary transfers - Repatriation bedday delays increased from 485 beddays in October to 708 beddays in November - effectively 24 beds per day on average for November compared to 16 beds per day 7 Executive Summary (4/5) Enc 2.6a
for October. The increase was largely observed in Renal, and delays also remain high on the Neurosciences wards. We continue to track and prioritise our Tertiary transfers on a daily basis. Repatriation delays are escalated daily to the Director of Operations at relevant Trusts. 2.2 Red Adverse Incidents (AIs) – 15 incidents were reported in November compared to 22 in October. 6 of the cases were hospital-acquired pressure sores and 2 cases were serious falls on two medical wards. 2.3 Slips, Trips and Falls – There was 1 fall In November, otherwise there have been at least 3 falls reported each month since July which resulted in moderate or major injury. These cases are investigated as serious incidences. 2.4 Mixed Sex Accommodation (MSA) breaches – There were 99 MSA breaches reported during November, all of which occurred on the Clinical Decision Unit (CDU) and were reported on the national return to the DH. When the portacabin is operational in December which will house the second CDU facility, then patient mixing will be able to better managed within this facility. There were also 4 further breaches which were delayed discharge patients from ICU. 3. Regulatory and Contractual Performance 3.1 Monitor Monitor position – Monitor has written to the Trust in early December confirming the governance risk rating of ‘Green’ for the Trust following its analysis of Q2 performance, recognising that we did not achieve the RTT admitted completed pathway indicator. The Trust is required to continue with quarterly monitoring and update the Monitor relationship team on RTT trajectory plan performance and progress at PRUH. The Trust has not yet finalised the November patient access returns for RTT and cancer waiting times, and achievement of the 62-day referral to treatment target remains a concern for Q3. The A&E performance target of 95% was not achieved in November with 94.6% of patients seen within 4 hours for all type attendances. There were 34 c-difficile cases attributed to the Trust for the cumulative position to November, which is one case above the trajectory of 33 cases. There has been 1 further case reported in December which puts achievement of this indicator at risk for Q3 compared to the trajectory of 37 cases. 8 Executive Summary (5/5) Enc 2.6a
3.2 Contractual Clinical Commissioning Group (CCG) - The Contract has been signed with the CCG Commissioners for 2013-14. NHS England (NHSE) – The Contract has been signed with NHSE. CQUIN 2013/14: CCG Q2 update – The Q2 CQUIN evidence has been submitted with 100% compliance. NHS England – Q2 CQUIN evidence has been submitted and we are forecasting 100% achievement and are awaiting a formal response for Q1 and Q2. 4. Specific Performance Reports and other updates This month’s reports includes updates for : 4.1 Key Areas of Concern Summary page to highlight key areas of concern on the Denmark Hill site under the categories of: Quality, Efficiency, Finance and Strategy. 4.2 Infection Control Action Plan Update Further details on the enhanced actions for 2013-14 can be found in the HCAI Action Plan, provided later in this report. 4.3 Emergency Department (ED) Action Plan Update Further details on the additional action plans to manage the 4-hour emergency care performance target can be found in the ED Action Plan update, provided later in this report. 4.4 RTT Performance Update Further details on the revised trajectories and additional action plans to reduce the over 18 week backlog can be found in the RTT Performance update, provided later in this report. 9 Contents Enc 2.6a
•Executive Summary •Specific Performance Reports • Infection Control Plan • ED Action Plan Update • RTT Action Plan Update
10 HCAI Action Plan Update (3/8)
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11 HCAI Action Plan Update (4/8)
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12 HCAI Action Plan Update (5/8)
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13 HCAI Action Plan Update (6/8)
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14 HCAI Action Plan Update (7/8)
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15 HCAI Action Plan Update (8/8)
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16 Contents Enc 2.6a
•Executive Summary •Specific Performance Reports • Infection Control Plan • ED Action Plan Update • RTT Action Plan Update
17 ED Action Plan Update (1/15)
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18 ED Action Plan Update (2/15)
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19 ED Action Plan Update (3/15)
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20 ED Action Plan Update (4/15)
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21 ED Action Plan Update (5/15)
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22 ED Action Plan Update (6/15)
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23 ED Action Plan Update (7/15)
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24 ED Action Plan Update (8/15)
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25 ED Action Plan Update (9/15)
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26 ED Action Plan Update (10/15)
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27 ED Action Plan Update (11/15)
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28 ED Action Plan Update (12/15)
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29 ED Action Plan Update (13/15)
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30 ED Action Plan Update (14/15)
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31 ED Action Plan Update (15/15)
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32 Contents Enc 2.6a
•Executive Summary •Specific Performance Reports • Infection Control Plan • ED Action Plan Update • RTT Action Plan Update
33 RTT Action Plan Update (1/5)
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34 RTT Action Plan Update (2/5)
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35 RTT Action Plan Update (3/5)
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36 RTT Action Plan Update (4/5)
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37 RTT Action Plan Update (5/5)
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38 Enc 2.6b
Board of Directors 2013-14 Month 8 Performance @ PRUH
Roland Sinker Chief Operating Officer
1 Enc 2.6b
Report to: Board of Directors Date of meeting: 17 December 2013 Subject: Performance Report, Month 8 2013/2014 Author(s): Steve Coakley, Acting Assistant Director of Performance and Contracts Presented by: Kath Dean Sponsor: Roland Sinker History: Status: For Information
1. Background/Purpose This report provides the details of performance achieved against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position for PRUH hospital only. 2. Action required The Board is asked to approve the M8 performance reported against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position for PRUH.
2 Enc 2.6b 3. Key implications Legal: Statutory reporting to Monitor and the DH. Financial: Trust reports financial performance against published plan. Assurance: Whilst the cancer waiting time position is being still being confirmed, none of the other indicators in the Monitor Risk Assessment framework for the November position have been achieved, with the exception of the RTT Incomplete pathway target and number of c-difficile cases attributed to PRUH.
Clinical: There is no direct impact on clinical issues. Equality & Diversity: There is no impact on equality & diversity issues. Performance: In absence of current cancer waiting time information, the summary report demonstrates that PRUH has achieved the RTT Incomplete pathway target for November and is currently meeting the Q3 trajectory for c-difficile cases but is at risk due to the low trajectory. The 4-hour emergency performance target has not been achieved.
Strategy: Performance against the Trust’s annual plan forecasts and key objectives. Workforce: None. Estates: There is no direct impact on Estates.
Reputation: Trust’s quarterly and monthly results will be published by Monitor and the DH.
Other:(please specify)
3 Contents Enc 2.6b
•Executive Summary •Regulatory/Contractual Performance • Monitor 2013-14 Q3 position • Care Quality Commission’s PRUH Site visit •Specific Performance Reports • HCAI Action Plan • Cancer Action Plan • RTT Action Plan • ED Action Plan • Learning Disability Action Plan
4 Executive Summary (1/5) Enc 2.6b
1. PRUH 2013-14 Key Areas of Performance for Month 8: Due to the early Board meeting being held in December, a shortened Performance paper is being presented prior to scorecards and key national return data being available for the Month 8 position. 1.1 Good Performance Infection Control – No MRSA cases have been attributed to the Trust since October 2013 and this quality indicator is no longer assessed by Monitor in the Risk Assessment Framework for Q3 onwards. There have been 3 c-difficile cases attributed to the Trust in October and no further cases in November, which is consistent with the revised trajectory that was re-set for the cumulative position from October 2013. 1.2 Performance challenges – 5 Areas RTT Completed Pathways – The November position for RTT indicator targets has not yet been finalised and requires further validation, although the RTT Incomplete pathway is already achieving the 92% target. Emergency activity remains high and is impacting on our ability to admit elective admissions as planned. Achievement of the RTT admitted target is further impacted with the service moves that are being undertaken across the former SLHT sites. The Trust has managed to arrange for the Sidcup RTT validation team who have been transitioned to Darenth Valley hospital to provide validation support for Queen Mary’s Sidcup pathway data. This team are responsible for identifying any data quality issues with the pathway data and correcting information recorded on the patient administration system. This primarily impacts on Ophthalmology and Dental Services and is an arrangement that will remain in place until the supporting pathway data is migrated to the Trust’s Patient administration system (PiMS), hosted at Denmark Hill. Emergency Care Performance – The Emergency Care performance target was not achieved in November for either the Type 1 A&E attendances at 76.6% or for all type attendances which includes the Urgent Care centre (UCC) at the PRUH. All type attendance performance achieved 84.4% for November compared to the 95% target, representing a slight improvement on the 82.8% achieved in October. Finance position - The projected year-end financial position is -£10m for PRUH. 5 Executive Summary (2/5) Enc 2.6b
Cancer Waiting Times - Cancer waiting time data for the current quarter position is not available, however, a high number of breaches are expected in the quarter which will put achievement of the 62-day waiting time to first treatment at risk. Red Adverse Incidents (AIs) and Never Events – There was an incident that took place in October which was being jointly investigated by the Kings and Lewisham Trusts which was flagged as a never event. This particular case which involved 3 separate procedures on the Queen Elizabeth and PRUH sites is going to be attributed to Queen Elizabeth hospital as a never event. The case will still be reported as a red incident for PRUH. 1.3 Actions – 5 areas RTT admitted – New RTT Board meetings have been setup at the PRUH site, similar to those that have been in place at the Denmark Hill which require Service Manager attendance at each meeting. The focus of this meeting is on the current waiting list and completed pathway performance. Additional waiting list review meetings are being held between the Business Intelligence Unit (BIU) and Service managers on a weekly basis. The BIU have also been reviewing current administration and booking processes for patients who are treated across the previous SLHT provider sites. A proposal is being taken to the next Performance Improvement Group meeting to change some of these historic processes where patients are effectively being transferred from one hospital to another following initial referral for subsequent treatment. Emergency Care Performance – Daily operational site performance meetings are held at 10:30 to highlight and review key areas of concern. An Action plan to improve 4-hour performance has been developed and updated which is reviewed at weekly Emergency Care Board meetings at PRUH. Immediate actions that are being implemented following the CQC visit include: introduction of 7/7 twilight consultant shifts with Denmark Hill consultants now undertaking shifts at the PRUH. Interviews are being held in December to recruit to all ED consultant vacancies and the team are seeking to undertake consultant swaps between the 2 site departments. A new LAS triage location is due to go-live by 18 December which will release assessment cubicle space and improve patient flow. Finance position - Meetings are scheduled for the 3rd week in January for each division to meet with the Finance and Operations executive team to review in detail their financial and CIP position. 6 Executive Summary (3/5) Enc 2.6b
Cancer Waiting Times – A Cancer Action Plan has been developed which will be signed-off by the Trust’s Board for submission to Monitor. Red Adverse Incidents (AIs) and Never Events – The never event that has now been attributed to the Queen Elizabeth hospital will still be presented to the Trust’s Serious Incidents Committee following the initial investigation, as it remains a red adverse incident for the Trust. 2. Other areas of concern: A number of areas of concern were highlighted following the CQC inspection at the PRUH site earlier in December which require immediate action and attention. Trust leads have been assigned to the following areas with the focus on implementation at PRUH. 2.1 Availability of medical records – existing medical records are not always made available on-site for patient admission or attendance at outpatient clinics. Immediate actions are to recruit bank staff to pull, chase and prepare records on the PRUH site ahead of plans to recruit to vacant posts. Transport are securing the services of an additional driver to move medical records between sites faster. Casenote tracking system to be reviewed and re-track notes that are not currently stored in the main libraries. The longer term solution is to create a library storage facility on the PRUH site to hold current and newly- generated records. 2.2 Hand hygiene compliance – a lack of hand gel dispensers and compliance with the ‘bare below the elbows’ policy were highlighted in the initial feedback following the recent CQC inspection in early December. New alcohol foam hand run dispensers and brackets are being installed on all inpatient beds on 11 December 2013. Individual tottles are being ordered to be distributed to doctors and other mobile clinical staff. A hand hygiene awareness campaign is planned which will be communicated by ‘Kingsweb’. 2.3 Staff identification – A communication will be sent to all staff to ensure that ID must be worn and be visible at all times. Staff will be asked to clip or pin their ID badge in the lapel area, as opposed to wearing lanyards. 2000 pin clips and 1000 clips have been ordered which will be distributed through divisions and staff. There is a further proposal for all staff to wear name badges, in place of the ID badge, which would cost approximately across the enlarged organisation. 7 Executive Summary (4/5) Enc 2.6b
2.4 Consultant and medical staffing – CQC raised concerns over medical leadership and behaviour that they observed during the 2-day visit. A meeting has been convened by the Trust’s medical director for all PRUH consultants to attend in the first instance, held on 11 December 2013, and a second meeting is planned at the Consultants’ Committee at the PRUH in January 2014. 3. Regulatory and Contractual Performance 3.1 Monitor Monitor Q3 position – The RTT pathway targets position has not yet been finalised for November although the RTT Incomplete target is already being achieved. A&E attendances and sustained emergency access pressures continued during November and PRUH did not achieve the 4-hour A&E performance target at 84.4% for All Types for November compared to the 95% target. 3 C-Difficile cases were reported in October with the Trust having 3 attributable cases YTD, due a new trajectory being set for Kings. This is below the trajectory of 5 cases for the quarter which puts this target at risk although no cases have been reported since October. Cancer waiting time data was not available at the time that this report was published but achievement of the 62-day cancer treatment target is currently at risk. 3.2 PRUH acquisition Action Plan conditions – As one of the conditions of the acquisition of the PRUH, Monitor require a submission of detailed action plans and threshold trajectories in January 2014 which have been signed-off by the Trust’s Board. The action plans that have been requested can be found later in the Specific Performance Reports section of this report.
8 Executive Summary (4/5) Enc 2.6b
3.3 CQC Visit update from December The CQC inspected the PRUH site as planned on the 3rd and 4th December. Initial feedback has been provided to the Trust and a formal written report will be submitted to the Trust in January 2014. The CQC commended the nursing care that is provided at the bed-side and also felt that the Trust has a good understanding of the strengths and challenges at the PRUH site. Some of the areas of concern that were highlighted by the CQC, of which the Trust is aware included: medical records, hand hygiene, responsiveness of teams, patient flow, staff identification and some privacy & dignity issues. A key issue that was raised was medical leadership and behaviour.
9 Contents Enc 2.6b
•Executive Summary •Regulatory/Contractual Performance • Monitor 2013-14 Q3 position • Care Quality Commission’s PRUH Site visit •Specific Performance Reports • HCAI Action Plan • Cancer Action Plan • RTT Action Plan • ED Action Plan • Learning Disability Action Plan
10 Regulatory/Contractual Performance
2013/14 (1/2) Enc 2.6b
1. Regulatory Performance 1.1 PRUH acquisition Action Plan conditions As one of the conditions of the acquisition of the PRUH, Monitor require the following: A submission of detailed action plans and threshold trajectories in January 2014, which have been signed off the Trust’s Board. These need to demonstrate a return to full compliance for PRUH and for the combined organisation within a satisfactory timescale. The action plans that have been requested are as follows: • Health Care Infections • Cancer • RTT • ED pathway • Learning Disability The Trust is then required to comply with monthly monitoring against these plans. Within a reasonable period post-transaction (i.e circa one year after the Transaction’s completion), the Trust’s Board will be required to commission an external review and assessment of the progress made in delivering the planned cultural change and clinical improvements at the PRUH (the scope and format to be developed and agreed between King’s, Monitor and the CQC). This will include monitoring the success of the submitted action plans. Actions: The detailed action plans can be found later in this report in the Specific Performance Reports section which the Board is asked to sign-off for submission to Monitor in January.
11 Regulatory/Contractual Performance
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1.2 CQC Visit update from December The CQC inspected the PRUH site as planned on the 3rd and 4th December following an initial briefing from the Trust executive team on Monday 2 December. Initial feedback has been provided to the Trust which is positive at this stage, and the CQC will submit a formal written report in January 2014. The full report is expected to be challenging but constructive in its commentary. The CQC commended the nursing care that is provided at the bed-side and also felt that the Trust has a good understanding of the strengths and challenges at the PRUH site. Some of the areas of concern that were highlighted by the CQC, of which the Trust is aware included: • Availability of medical records. • Hand hygiene and compliance with ‘bare below the elbows’ policy. • Responsiveness of teams. • Emergency Patient flow. • Staff identification. • Some privacy & dignity issues. A key issue that was raised was medical leadership and behaviour.
12 Contents Enc 2.6b
•Executive Summary •Regulatory/Contractual Performance • Monitor 2013-14 Q3 position • Care Quality Commission’s PRUH Site visit •Specific Performance Reports • HCAI Action Plan • Cancer Action Plan • RTT Action Plan • ED Action Plan • Learning Disability Action Plan
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17 Contents Enc 2.6b
•Executive Summary •Regulatory/Contractual Performance • Monitor 2013-14 Q3 position • Care Quality Commission’s PRUH Site visit •Specific Performance Reports • HCAI Action Plan • Cancer Action Plan • RTT Action Plan • ED Action Plan • Learning Disability Action Plan
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21 Contents Enc 2.6b
•Executive Summary •Regulatory/Contractual Performance • Monitor 2013-14 Q3 position • Care Quality Commission’s PRUH Site visit •Specific Performance Reports • HCAI Action Plan • Cancer Action Plan • RTT Action Plan • ED Action Plan • Learning Disability Action Plan
22 RTT Action Plan (1/2)
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23 RTT Action Plan (2/2)
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24 Contents Enc 2.6b
•Executive Summary •Regulatory/Contractual Performance • Monitor 2013-14 Q3 position • Care Quality Commission’s PRUH Site visit •Specific Performance Reports • HCAI Action Plan • Cancer Action Plan • RTT Action Plan • ED Action Plan • Learning Disability Action Plan
25 ED Action Plan (1/10)
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33 ED Action Plan (9/10)
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35 Contents Enc 2.6b
•Executive Summary •Regulatory/Contractual Performance • Monitor 2013-14 Q3 position • Care Quality Commission’s PRUH Site visit •Specific Performance Reports • HCAI Action Plan • Cancer Action Plan • RTT Action Plan • ED Action Plan • Learning Disability Action Plan
36 Learning Disabilities Action Plan
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37 This page has been left blank Enc 2.7
Education, Workforce and Development
Board of Directors
17th December 2013 Enc 2.7 Report to: Board of Directors Date of meeting: 17th December 2013 Subject: Annual Workforce Report Author(s): Angela Huxham Presented by: Angela Huxham, Director of Workforce Development Sponsor: Angela Huxham, Director of Workforce Development History: First submission to Board of Directors Status: Discussion
1. Background/Purpose • The Report summarises the Trust’s 2012-2013 workforce profile • Reviews directorate activity, progress and achievements in the year to December 2013 • Outlines planned future developments
2. Action required • The Board is asked to note the report
2 Enc 2.7 3. Key implications
Legal: Many aspects of employing and engaging staff and volunteers are legislated. The public sector in particular has unique duties imposed under both UK and European law Financial: Staff pay accounts for two thirds of trust expenditure
Assurance: Education and workforce development activity is summarised, providing assurance on the high quality of King’s teaching and development reputation, leadership and performance excellence Clinical: Effective workforce strategy and an engaged and involved workforce has been evidenced to significantly impact on organisational performance and clinical outcomes Equality & Diversity: For the period covered by this report, King’s compliance with statutory equality duties have been reported to the Equality and Diversity Committee Performance: The Board Strategy Committee receives reports from the Education Committee on education , learning and development; the Board Quality and Governance Committee receives reports from the Organisational Safety Committee on health and wellbeing
Strategy: Effective workforce strategy and an engaged and involved workforce has been evidenced to significantly impact on organisational performance and clinical outcomes Workforce: King’s workforce grew by 7% in the 12 months to 31 March 2013 and by 11% in the 18 months to September 2013 Estates: With the acquisition of the Princess Royal University Hospital (PRUH), on-site education facilities at Denmark Hill are now at capacity; those at the PRUH are unfit for purpose Reputation: King’s has a strong reputation as an employer to attract and retain high quality staff
3 Contents
Enc 2.7 •Executive Summary •Directorate Review • An Enlarged King’s • Resourcing and Retention • Education, Development and Talent Management • Workforce Integration and Productivity • Occupational Health and Wellbeing •Performance Summary • Staff Management Performance Scorecard March 2013 • Staff Management Performance Scorecard September 2013 •Workforce Profile 2012-2013 • Workforce breakdown by category • Education, Training and Development • Employee Relations • Occupational Health and Wellbeing
4 Executive Summary (1/2)
Enc 2.7 1. Executive Summary 1.1 Growth ‘Whole time equivalent’ is a useful metric for workforce capacity and benchmarking but the Workforce Directorate is concerned with individuals as people. Each person, whatever their job, has a role in influencing the care of our patients and every member of staff in Team King’s is important, whether employee, volunteer or honorary contract holder. At the end of the 2012-13 financial year, King’s was responsible for 9614 staff, up 8.6% on the previous 12 months. Of which 7883 were directly employed (up by 6.8%). Today, as the Trust continues to enlarge, Team King’s exceeds 14,200. 1.2 Structural Change and Organisational Development In the 18 months to 30 September 2013 all Workforce Directorate functions were engaged in supporting King’s through major reorganisation, facilitating significant structural change and organisational development. Working with the programme office, lawyers, external stakeholders, senior managers, trade unions and staff, the task has been to ensure the smooth transition of 5,800 staff from one organisation to five new destination organisations. Simultaneously, as one of the principal receiver organisations King’s developed its own organisation structure in advance of the arrival and integration of 2680 new colleagues from the dissolved South London Healthcare Trust (SLHT) on 1 October 2013. 1.3 Outsourcing Commencing summer 2012, King’s led a consortium of NHS Trusts in developing and market testing a new procurement framework for transactional HR, recruitment and payroll services. Once the PRUH acquisition transfer date became clear, ‘go-live’ for the new shared service provider was brought forward to coincide with the SLHT transfer, a significant challenge to project planners and implementers. 1.4 Employee Engagement and Satisfaction King’s benchmarks well in staff engagement in the national staff survey, ranking in the top 20%
5 Executive Summary (2/2)
Enc 2.7 1. Executive Summary 1.4 Employee Engagement and Satisfaction (Continued) King’s has initiated, or been involved in, a number of key activities designed to improve our understanding of what matters to our staff, for example ‘King’s in Conversation’ arising from the Francis Report. In addition a programme of cultural integration has been initiated for the enlarged organisation with an assessment of the cultural baseline. This wealth of quantitative and qualitative data is informing the development of our cultural integration plans for 2014. 1.5 Education The introduction of bespoke strategic and medical leadership programmes, continued expansion of King’s role as medical postgraduate education Lead Provider, developments in staff appraisal, improvements in mandatory training compliance and national recognition in awards. 1.6 Staff Wellbeing A challenge for the occupational health team has been growth in the population served. In particular a 52% rise in volunteers all requiring health checks and/ or vaccination prior to joining. Improvements in data quality and management information to our external contracts together with progress in service delivery particularly evidenced by the number of referrals to the in-house physiotherapy service. Our OHW senior physio was named King’s therapist of the year. 1.7 Staff Day nurseries The enlarged King’s runs four staff Day Nurseries with 222 nursery places for NHS staff. Ofsted rates one ‘outstanding’, 2 ‘good’ and one ‘satisfactory’.
6 Contents
Enc 2.7 •Executive Summary •Directorate Review • An Enlarged King’s • Resourcing and Retention • Education, Development and Talent Management • Workforce Integration and Productivity • Occupational Health and Wellbeing • Performance Summary • Staff Management Performance Scorecard March 2013 • Staff Management Performance Scorecard September 2013 •Workforce Profile 2012-2013 • Workforce breakdown by category • Education, Training and Development • Employee Relations • Occupational Health and Wellbeing
7 Directorate Review (1/7)
Enc 2.7 1. An Enlarged King’s Quarters 3 and 4 of 2012-13 initiated major organisational change and growth for King’s as the future for South London Healthcare Trust (SLHT), and its component hospitals emerged. The Trust Special Administrator’s report made scant reference to the potential impact on SLHT’s 5,800 staff and at the close of 2012, King’s was the catalyst in establishing an HR Directors’ Group which designed and implemented the organisational change framework. Thereafter an intensive programme of acquisition-related employee relations work followed and continued through to 30 September 2013:
• Dissolution and acquisition triggered the Cabinet Office Statement of practice (COSOP) on staff transfers in the public sector and King’s designed its new structure for an enlarged organisation • Working closely with the King’s Programme Management Office the Directorate took the lead in designing the organisational change process for a new and enlarged organisational structure • Together with HRDs and trade union (TU) colleagues across sender and receiver organisations we implemented staff consultation, transfer and selection processes • c.900 SLHT senior managers and staff in corporate areas were involved in applying for jobs in receiver organisations • On 1 October 2013, 2680 former SLHT staff transferred to King’s of which 270 had participated in the reorganisation, selection and redeployment processes 1.1 Workforce Acquisition Challenges • Two postponements in the transfer date increased uncertainty over future employment for SLHT • Developing the staff reorganisation processes with appropriate SLHT TU involvement in the initial timescale • Maintaining employee relations and good communication channels between SLHT, receiver organisations, TUs and staff at each stage of a developing and emerging process • Designing processes which addressed differences in the sender and receiver organisations’ objectives • Key posts viewed by King’s as business critical were vacated due to a combination of CIPs and attrition • Unprecedented recruitment volume to fill gaps in the structure and secure safe staffing levels on Day 1 8 Directorate Review (2/7)
Enc 2.7 2. Resourcing and Retention 2.1 The Technology Challenge Having all but eliminated advertising expenditure through online recruitment, pioneered identity verification document scanning technology and built our own ‘on-boarding’ website to familiarise and welcome new hires prior to start date, the challenge we faced was how to sustain and deliver high quality services for the operational front line which could maximise the speed and efficacy of 21st century advances in e- technology. We needed a partner for whom transactional HR services were ‘core business’; one with a track record of streamlining, refining and investing in these services; one with whom we could partner in developing new technological solutions within the NHS; and one with a proven track record of shared HR services, ideally within the NHS. 2.2 Project Oscar In 2012, NHS London seed funded a QIPP project to develop a new procurement framework for London. Led by King’s a consortium of 6 trusts worked on a specification and in June 2013, following a full OJEU process, King’s Board approved the outsourcing of King’s transactional HR, recruitment and payroll services under a 10 year contract with Capita Business Services Limited. 2.3 Capita Month 1 The outsourcing project was overtaken by the acquisition of staff, assets and services from the dissolved South London Healthcare Trust (SLHT) and Capita ‘go-live’ was brought forward. The challenges faced were: the demerge of SLHT’s Electronic Staff Record (ESR) to 5 receivers; transferring the pay of 11,000 staff from 2 former legacy systems and implementing a new recruitment process when recruitment in both sender and receiver organisations had peaked due to reorganisation. To the credit of all involved, sender, receiver and Capita, the ESR demerge and payroll were accomplished with negligible error. 2.4 Recruitment Spanning Acquisition The pre transfer legacy recruitment has created the biggest challenge with a backlog of successful candidates remaining in process which will be cleared by Christmas 2013. 9 Directorate Review (3/7)
Enc 2.7
2.4 Recruitment Spanning Acquisition (Continued) Post transfer, the new recruitment service which is delivered by the HR Shared Services Centre in Liverpool is performing well. 2.5 NHS Jobs 2 NHS Jobs is the world’s largest online recruitment website. King’s has been heavily involved in the development of NHS Jobs 2 which will go live in March 2014 delivering candidate tracking for the first time. 2.6 NHS Employers • King’s features in two national podcasts: the London Streamlining Project which facilitates the transfer of staff between NHS organisations; and our work in International Recruitment • We advise NHS Employers on best practice and policy, for example, national employment check standards • We led the use of document verification technology and are a national case study 2.7 Future Technology Developments Alongside the transactional services, King’s contract with Capita includes a package of new technology. With effect from April 2014, King’s will benefit from a web based portal, ‘PeopleHub’. PeopleHub will provide a single access point for all HR related systems, the first will be a new e-expenses system and in due course PeopleHub will include all King’s HR systems currently in use, such as rostering, training, etc. In addition, King’s will work in partnership with Capita and their technology partner, Core, to develop PeopleHub for the wider NHS and be the first to benefit from those developments.
10 Directorate Review (4/7)
Enc 2.7 1. Education, Development and Talent Management 1.1 Health Education South London (HESL) • King’s maintains strong involvement in HESL with a seat on both the Board and Members’ Council • We chair and are well represented at HESL’s Workforce Planning Advisory Group; the group provides regional input to the development of HESL’s investment plans • Success as a HESL Lead Provider for post graduate medical training programmes, adding 4 specialtiesin2012and6in2013 1.2 Review of Mandatory Training • Mandatory training was comprehensively reviewed by occupation, course delivery, curriculum and frequency and a new composite performance measure was introduced in June 2012 (53%); performance improved to 68% in March 2013 with an annual saving of £122,000 • E-learning exceeds 50% of training delivery for the first time
Training Delivery 2011 2012 2013 Classroom 86% 76% 54% e‐learning 14% 34% 46%
1.3 Organisational Development • Centred on our shared vision and values, King’s developed a new OD strategy for the enlarged organisation, key themes are: Performance assessment & development; Continuing Professional & Personal Development; Leadership; Talent management; and Staff engagement • Involvement in London’s OD Group will realise a post graduate certificate programme in OD in 2014 1.4 King’s Appraisal and Development (KAD) A new online appraisal system has been developed for King’s and will pilot 1000 staff from January • KAD links individual objectives to Trust objectives and values • Includes a self-assessment tool on which appraisal can be based • Holds Personal Development Plans • Links talent management to the NHS Leadership Framework 11 Directorate Review (5/7)
Enc 2.7 1.5 Leadership • The Centre for Innovation in Health Management was commissioned to deliver two new and bespoke multi professional programmes for strategic and senior leaders • Leadership development across King’s now available to all levels of the medical workforce • Places for King’s staff secured on the NHS National Leadership Programme 1.6 King’s Health Partners • We are working closely with KHP and CAG leads on the development of KHP’s OD strategy • King’s chairs KHP’s Leadership Group • Involvement in KHP’s Widening Participation and Education Quality Assurance 1.7 Highlights • PGMDE received the 2012 London Deanery Elisabeth Paice Award • Highly commended for Education Excellence in the London Deanery Academic Activity Awards • Joint winner of the London Deanery Educational Excellence Innovation Award • A GMC visit in 2012 identified our positive learning culture and other areas of good practice 1.8 Future Developments •2nd cohort for strategic leaders planned early 2014 for the new enlarged King’s • 20 new HESL funded apprentices • King’s will be Health Education England’s case study for best practice in Apprenticeships • Trust wide implementation of KAD • Roll out KAD talent management to Bands 8c and above • Improve educational and simulation facilities to meet the needs of the enlarged King’s, particularly at PRUH • Together with our partner VirtaMed, King’s is developing software which will enable King’s to become the first hospital group in the UK and Europe to have Arthroscopic Simulation Technology providing the platform for future orthopaedic training and simulation
12 Directorate Review (6/7)
Enc 2.7 1. Workforce Integration and Productivity 1.2 Staff Engagement and Cultural Integration In the 2012 staff survey, King’s benchmarks well in staff engagement scoring 3.95/5 and ranking in the top 20% (national average 3.69/5). Recent initiatives:-
• King’s participated in staff engagement research in conjunction with the Department of Health, NHS Employers and Imperial College • In July 2013, all KHP staff were invited to participate in an Organisational Health Index questionnaire • Arising from the Francis Report, a major staff listening exercise ‘King’s in Conversation’ commenced in summer 2013 and is continuing at our new sites
Post acquisition, detailed work commenced to establish a cultural baseline and understand the differences across our respective sites:-
• Adopting an academic model, King’s has undertaken a bespoke staff survey to identify organisational cultural maturity at each of our sites, this will enable us to develop a trust wide programme of cultural integration • The NHS 2013 national staff survey has just closed for Denmark Hill and although SLHT was unable to participate in the NHS staff survey, we have initiated our own parallel survey for new colleagues 1.3 Medical Productivity • New technology facilitated central records to support consultant job planning and HR advice facilitated medical productivity led by the Assistant Medical Director 1.4 Future Developments • E-rostering is being rolled out across new sites to maximise efficient deployment of staff in the best interests of patients • King’s reaccreditation as an Investor in People was postponed to February 2014 so that a trust wide assessment at that time would provide a future measure of integration progress 13 Directorate Review (7/7)
Enc 2.7 1. Occupational Health and Wellbeing (OHW) 1.1 Public Health Responsibility Deal Under the new Department of Health Public Health Responsibility Deal, King’s has committed to actively support its workforce to lead healthier lives; we have pledged to:
• Meet new occupational health standards and be accredited • Report annually on the health and well-being of employees • Actively manage sickness absence • Encourage smoking cessation and reduce workplace risks to respiratory health 1.2 SEQOHS Accreditation Formal assessment for the new SEQOHS standard (Safe Effective Quality Occupational Health Service) took place in November 2013. Final evidence is being submitted, but early indicators are positive with a decision expected in December.2013. 1.3 Highlights • Gold accreditation in the NHS Sport and Physical Activity Challenge inspired by the 2012 Olympics • Participation in KHP’s ‘Happier@Work’ (mental health awareness & smoking cessation programme) • King’s Staff Wellbeing Group is developing a staff wellbeing strategy • King’s Intranet promotes activity based events organised by individual groups across the Trust • Musculoskeletal problems receive particular focus as the top reason for referral to OHW 1.4 Future Developments • Outcome of SEQOHS accreditation expected this month • March 2014: King’s application for the Mayor of London’s Health Workplace Charter will be assessed • April 2014: PRUH OH services (currently outsourced) will be brought in house • July 2014: Participate in the NICE national organisational audit on health and work
14 Contents
Enc 2.7 •Executive Summary •Directorate Review • An Enlarged King’s • Resourcing and Retention • Education, Development and Talent Management • Workforce Integration and Productivity • Occupational Health and Wellbeing •Performance Summary • Staff Management Performance Scorecard March 2013 • Staff Management Performance Scorecard September 2013 •Workforce Profile 2012-2013 • Workforce breakdown by category • Education, Training and Development • Employee Relations • Occupational Health and Wellbeing
15 Enc 2.7
Trust Staff Management Performance ScorecardMar-13 Trust Staff Management Performance ScorecardMar-13
Status Status Metric Units Freq. Last Yr Last Mnth This Mnth(compard Target to Trend Metric Units Freq. Last Yr Last Mnth This Mnth(compard to Target Trend target) target)
Staff in post 3 mths with a local induction(C5) % monthly 65 21 18 100 Worse Reported BBV incidents (ytd) Number monthly 232 157 188 208
Corporate Induction(ARMS 3.1) % monthly 91 92.8 92.6 95 Worse Reported Health & Safety incidents (ytd) Number monthly 1491 1289 1440 1416 Actual Assaults in 12 mth period (rolling) Number monthly149 111 149 - --- Safety
Prof. Registration - M&D(C10) staff % monthly - 99.84 98.83 100 Worse & Health Verbal/Threat'nd Assaults in 12 mth period Number monthly 1840 1898 1880Better - Induction& Induction& Registration Prof.Registration - Non-med(C10) staff % monthly - 98.6 98.4 100 Worse
Staff appraised since 1st (C8;April C10) % monthly 93.5 55.9 86.7 90.0 Composite Statutory & Mandatory Training 52 66.4 67.9 95 Better %monthly Appraisal & PDP since 1st (C8;April C10) % monthly 77.5 49.9 - 90.0
Bullying & Harassment - All(ARMS staff 3.8) % monthly 64 78.1 75.3 95 Worse Reviews recorded on e-KSF % monthly 19.5 18.8 19.2 30 Better
Fire- All staff(ARMS 3.1) % monthly 39 57 61 95 Better Performance Assessments Appraisal training on e-KSF - All managers % monthly39.0 53 38.2 70 Worse
Health & Safety- All (ARMSstaff 3.1) % monthly 49 67.2 67.8 95 Better Establishment FTE monthly 7266 7678.0 7811.0 - Increase Inv. of Incidents, Complaints & (ARMSClaims 2.5)%monthly---95--- Staff Employed Headcount monthly 7379 7835 7883 - Increase Risk Awareness for Senior(ARMS Mgt 3.6) % monthly - 14.6 14.6 95 --- FTE monthly 6739 7158 7197 - Increase Consent - Identified (ARMSstaff 5.3) % monthly 16 43 42 95 Worse Honorary Staff Headcount monthly 1268 1641 1766 - Increase Hand Hygiene - All staff in clin. (ARMS areas 4.6)% monthly 38 59 60 95 Better N&M Bank & Agency FTE monthly 430 524 605 - Increase Health Record Keeping - All(ARMS staff 1.8) % monthly56686995Better A&C Bank & Agency FTE monthly 80 82 89 - Increase Staff EmployedStaff Inoculations Incident - All staff in clin. (ARMS areas 4.7)%monthly0 757695Better Number of Overpayments Number monthly - 12 12 0 --- Medicines Management(ARMS 5.10) % monthly38413995Worse Value of Overpayments £ monthly - £28,930.00 £41,699.00 0 Worse Moving & Handling - All(ARMS staff 3.7) % monthly 53 55 56 95 Better Vacancy Factor - all staff % monthly 7.6 7.0 8.2 5-8 Worse Medical Devices - Clinical(ARMS staff 5.5) % monthly - 0 0 95 ---
Slips, Trips & Falls (staff & others) (ARMS- All staff 4.3)% monthly 48 71 72 95 Better Vacancy Factor - N&M staff only % monthly 7.0 7.1 8.4 5-8 Worse Mandatory & Statutory Training & Statutory Mandatory
Slips, Trips & Falls (patients) - Clinical(ARMS staff 4.4) % monthly 43 76 77 95 Better Total Turnover - all staff % monthly 19.3 18.8 19.0 20 Worse
Transfusion Process - Clinical(ARMS staff 5.8)% monthly 27 47 48 95 Better Voluntary Turnover - all staff % monthly 8.4 9.20 9.40 10 Worse
Venous T'embelism - Clin.(ARMS Staff 5.9) % monthly53808195ette Br Total Turnover - N&M staff % monthly 10.0 11.70 12.32 12 Worse
Violence & Aggression - Identified (ARMS staff 4.2)% monthly 22 32 33 95Voluntary Better Turnover - N&M staff % monthly 8.1 10.2 10.6 10 Worse
Safeguarding Adults L1 - All(CQC staff outcome% 7) monthly 96 97.1 97.5 80Monthly Better Sickness Absence % monthly 2.8 3.8 3.0 3 Better
Annual Sickness Absence (YTD) % monthly 3.3 3.440 3.410 3 Better Safeguarding Children L1 - All(CQC staff outcome7% monthly 96 97.5 97.8 80 Better & Sickness Turnover Vacancy, Enc 2.7
Trust Staff Management Performance ScorecardSep-13 Trust Staff Management Performance ScorecardSep-13
Status Status Metric Units Freq. Last Yr Last Mnth This Mnth(compard Target to Trend (compard to Metric Units Freq. Last Yr Last Mnth This Mnth TargetTrend target) target)
Staff in post 3 mths with a local induction(C5) % monthly 32 83 94 100 Better Reported BBV incidents (ytd) Number monthly 85 88 103 89
Corporate Induction(ARMS 3.1) % monthly 92 92.2 92.5 95 Better Reported Health & Safety incidents (ytd) Number monthly704 716 850 684
Safety Actual Assaults in 12 mth period (rolling) Number monthly171 120 tbc - Worse Prof. Registration - M&D staff (C10) % monthly - 98.5 99.7 100 Better & Health
Induction& Induction& Verbal/Threat'nd Assaults in 12 mth period Number monthly 1775tbc 1944 - Worse Registration Prof.Registration - Non-med(C10) staff % monthly - 98.0 97.0 100 Worse
Staff appraised since 1st (C8;April C10) % monthly 10.9 6.6 9.1 45.0 Composite Statutory & Mandatory Training% monthly 58 72.2 71.7 95 Worse Appraisal & PDP since 1st(C8; April C10) % monthly 8.5 4.3 5.5 45.0 Bullying & Harassment - All(ARMS staff 3.8) % monthly 75 79.6 79.7 95 Better Reviews recorded on e-KSF % monthly 18.2 16.8 16.5 30 Worse Fire- All staff(ARMS 3.1) % monthly 41 73 70 95 Worse Performance Performance Assessments Appraisal training on e-KSF - All managers % monthly37.2 47 35.6 70 Worse Health & Safety- All (ARMSstaff 3.1) % monthly 46 76.8 77.4 95 Better Establishment FTE monthly 7456 7930.3 7961.3 - Increase Inv. of Incidents, Complaints & (ARMSClaims 2.5)% monthly - - - 95 --- Staff Employed Headcount monthly 7526 8165 8173 - Increase Risk Awareness for Senior(ARMS Mgt 3.6) % monthly 3 2.13 2.08 95 Worse FTE monthly 6876 7430 7438 - Increase Consent - Identified (ARMSstaff 5.3) % monthly 42 43 44 95 Better Honorary Staff Headcount monthly 1651 2040 2131 - Increase Hand Hygiene - All staff in clin. (ARMS areas 4.6)% monthly 52 64 63 95 Worse N&M Bank & Agency FTE monthly 454 599 534 - Decrease Health Record Keeping - All(ARMS staff 1.8) % monthly 59 72 73 95 Better A&C Bank & Agency FTE monthly 73 115 125 - Increase Staff Employed Inoculations Incident - All staff in clin. (ARMS areas 4.7)% monthly 69 79.4 78.5 95 Worse Number of Overpayments Number monthly 8 tbc tbc 0 --- Medicines Management(ARMS 5.10) % monthly 33 41 44 95 Better Value of Overpayments £ monthly £26,012.00 tbc tbc 0 --- Moving & Handling - All(ARMS staff 3.7) % monthly 52 56.3 55.8 95 Worse
Medical Devices - Clinical(ARMS staff 5.5) % monthly - 0 0 95 --- Vacancy Factor - all staff % monthly 7.8 6.5 6.8 5-8 Worse
Slips, Trips & Falls (staff & others) (ARMS- All staff 4.3)% monthly 60 74.5 74.3 95 Worse Vacancy Factor - N&M staff only % monthly 8.7 6.3 8.1 5-8 Worse Mandatory & Statutory Training & Statutory Mandatory
Slips, Trips & Falls (patients) - Clinical(ARMS staff 4.4) % monthly 69 77.7 78.0 95 Better Total Turnover - all staff % monthly 19.4 18.6 18.9 20 Worse
Transfusion Process - Clinical(ARMS staff 5.8)% monthly 44 56 55 95 Worse Voluntary Turnover - all staff % monthly 8.7 9.91 9.92 10 Worse
Venous T'embelism - Clin.(ARMS Staff 5.9) % monthly 64 81 75 95 Worse Total Turnover - N&M staff % monthly 11.3 12.91 13.00 12 Worse
Violence & Aggression - Identified (ARMS staff 4.2)% monthly 27 41 43 95Voluntary Better Turnover - N&M staff % monthly 9.5 11.6 11.5 10 Better
Safeguarding Adults L1 - All(CQC staff outcome% 7) monthly 96 94.2 93.6 80Monthly Worse Sickness Absence % monthly 3.0 2.8 3.1 3 Worse
Safeguarding Children L1 - All(CQC staff outcome7% monthly 97 96.93 96.94 80 Better Turnover&Vacancy, Sickness Annual Sickness Absence (YTD) % monthly 3.0 3.350 3.353 3 Worse Contents
Enc 2.7 •Executive Summary •Directorate Review • An Enlarged King’s • Resourcing and Retention • Education, Development and Talent Management • Workforce Integration and Productivity • Occupational Health and Wellbeing •Performance Summary • Staff Management Performance Scorecard March 2013 • Staff Management Performance Scorecard September 2013 •Workforce Profile 2012-2013 • Workforce breakdown by category • Education, Training and Development • Employee Relations • Occupational Health and Wellbeing
18 Staff In Post March 13
Enc 2.7
Staff in post (FTE) by occupational group - 31st March 2013 Staff in post - April 2011 to March 2013 3000 2529 8000 Headcount 2500 7800 FTE 2000 7600 1444 7400 1500 7200
FTE 820 1000 730 7000 437 561 591 6800 500 85 6600 0
FTE/Headcount 6400 6200 6000
Staff in post - March 2008 to March 2013 8500 • July 2012 - staff in post figures appear to drop due to a Headcount 8000 house-change (which always happens on a Tuesday) FTE 7883 7500 falling on exactly 31st July. This meant 222 junior 7379 7142 7197 doctors left and new rotation did not start until 1st Aug. 7000 6965 6739 6584 6500 6475 • The number of staff in post increased by 6.8% over the 6337 6090 past year and by 29% over the past 5 years. 6000 5972 5526 5500
5000 Employment Category, Status and Length of Service Enc 2.7
Staff in post by employment category - 31st March 2013 Staff in post by length of service - 31st March 2013
3000 2726
2500 2265 1604 2000 20% 1731 Full Time 1500 Part Time 1194 1000 Headcount 6309 500 80% 0 Less than 2 yrs 2 - 5 yrs 6 - 9 yrs 10 yrs plus
Staff in post by employment status - 31st March 2013
32 • 34% of staff have been in post for less than 2 years as 0.4% 44 1228 0.6% at 31st March 2013. 15% • 22% have been in post for more than 10 years as at 31st March, an increase of 2% when compared with March 2012.
Fixed Term Temp Locum 6612 Undefined 84% Permanent Vacancy, Honorary Contracts and Bank & Agency Enc 2.7
Vacancy % - April 2011 to March 2013 Bank & Agency usage (FTE per month) for N&M staff 12 600 All staff
11 Nursing staff 500
10 400
% 9 300
FTE Bank
8 200 Agency
7 100
6 0 Jul-11 Jul-12 Jul-11 Jul-12 Apr-11 Oct-11 Apr-12 Oct-12 Apr-11 Oct-11 Apr-12 Oct-12 Jun-11 Jan-12 Jun-12 Jan-13 Jan-12 Jun-11 Jan-13 Jun-12 Feb-12 Mar-12 Feb-13 Mar-13 Feb-12 Mar-12 Feb-13 Mar-13 Aug-11 Sep-11 Nov-11 Dec-11 Aug-12 Sep-12 Nov-12 Dec-12 Aug-11 Sep-11 Nov-11 Dec-11 Aug-12 Sep-12 Nov-12 Dec-12 May-11 May-12 May-11 May-12
Numbers of Honorary staff and Volunteers with a Kings contract (as at 31st March) 2000 Volunteers * 1731 • There has been a 52% increase in volunteers over the
Non-medical Hons 1465 past year. 1500 M&D Hons - Other 783 515 • There has been a slight increase in the overall Trust and 1000 M&D Hons - KCL N&M vacancy percentages over the past year. 745
Headcount • Bank and Agency usage has also risen over the same 585 627 500 453 666 period. 316 328
267 254 287 296 213 0 2009 2010 2011 2012 2013 * Volunteers not recorded on HR database until 2011/2012 Sickness Absence
Enc 2.7
Average number of sick days per person per year Rolling annual sickness % (Apr 10 to Mar 13) 12 10.1 10.7 4.0 10 8.3 8.3 7.8 7.5 7.3 6.9 8 6.2 6.5 3.8 4.9 4.6 4.7 6 4.7 3.9 4.0 3.6 4 2.0 1.7 3.4 2 % 3.2 No. of Days No. of 0 3.0 Target is 3% 2.8
2011/12 2.6 2012/13 Oct-12 Oct-11 Apr-12 Oct-10 Apr-11 Apr-10 Jun-12 Jun-11 Jun-10 Feb-13 Feb-12 Feb-11 Aug-12 Dec-12 Aug-11 Dec-11 Data taken from ESR Aug-10 Dec-10
Estimated cost of sickness absence - 2012/13 £3,500,000 £2,968,659 • The rolling sickness absence is still above the target of £3,000,000 £2,500,000 3% and has continued to rise over the past year. £2,000,000 £1,108,284 £1,500,000 • The estimated cost of sickness absence across all staff £821,288 £715,064 £1,000,000 group in terms of productivity has risen by 14% £158,832 £233,482 £309,577 £500,000 £81,808 (£782,835) £0
Total cost for all staff = £6,396,994 Data taken from ESR Pension Scheme Membership
Enc 2.7
Pension scheme membership - All Staff (April 2013) Pension scheme membership 100% - Nurses & Midwives (April 2013) 207 239 135 74 100% 42 71 45 17 80% 111 7 80% 31
60% 60% 1476 2250 1956 1093 40% 623 763 763 350 225 40% 8 46 20% 20%
0% 0% Under 20 20‐29 30‐39 40‐49 50‐59 60 + 20‐29 30‐39 40‐49 50‐59 60 + Age Group Age Group
IN PENSION SCHEME NOT IN PENSION SCHEME (10% or 773 staff overall) IN PENSION SCHEME NOT IN PENSION SCHEME (7.5% overall)
Pension scheme membership by ethnicity - All staff (April 2013) 100% Asian Other • 10% of employed staff are not in the pension scheme 90% Black African compared with 24% in March 2012. This follows the 80% auto-enrolment exercise. Black Caribbean 70% Black Other • A higher proportion of those not in the pension scheme 60% Indian Sub-continent (53%) are BME staff compared with those in the 50% pension scheme where 45% are BME staff. This Mixed Ethnic Origin 40% compares to the overall workforce where 45.5% are 30% Other BME staff. 20% Unknown 10% White 0% NOT IN PENSION SCHEME IN PENSION SCHEME Turnover and Appraisals
Enc 2.7
Performance Assessments - Quality of Appraisals 2007 - 2012 % % of staff appraised since 1st April (taken from annual staff survey) 100 50%
90 2009/10 45% 80 2010/11 2011/12 70 40% 2012/13 60 50 35% 40 30% 30 KCH Average 20 National Average 25% London Average 10 0 20% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2007 2008 2009 2010 2011 2012
Staff turnover by occupational group - 2012/2013 • KCH appraised 87% of staff who had been in post for a 25 year or more in the 12 months leading up to 31st March, against a target of 90%. However 62% of these 20 appraisals were carried out in the last 3 months of the 15 % year. 10 • The perceived quality of appraisals continues to improve 5 though less than 50% of staff still do not positively rank 0 the quality of their appraisal, and our quality of appraisal percentage has dropped below the London average. • Voluntary turnover excludes fixed-term contracts, including those of junior medical staff, redundancies, retirements and dismissals. • The voluntary turnover has risen from 8.4% to 9.4% over Total Turnover (Trust = 19.0%) Voluntary Turnover (Trust = 9.4%) this past year. Staff Training
Enc 2.7
Number of courses offered and administered by EDT % compliance against ARMS standards (May 12 & May 13) May-12 May-13 1,400 1195 VTE 1,200 Blood Transfusion 988 1,000 Medicines Management 820 864 800 703 Health Record Keeping 534 531 579 600 Violence & Aggression
400 Harassment & Bullying
200 Slips, Trips & Falls Manual Handling 0 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
PGME course attendance April 2010 - March 2013 • The number of courses offered and administered by EDT 1400 No. of external candidates 1213 is increasing year on year. 1200 No. of internal candidates • The peak in 2010 was due to the large amount of training 1000 associated with the flu pandemic. 808 804 800 • The compliance against NHSLA standards for S&M 600 training is increasing in all subject areas though none have reached the 90% target. 400
200 • The number of candidates attending PGMDE courses has increased by 51% from the previous year. 0 April 2010 - March 2011 April 2011 - March 2012 April 2012 - March 2013 Staff Training (cont.)
Enc 2.7
PGMDE faculty development - course attendance Simulation course attendance 80 74 Gastro 2011/2012 2012/2013 70 2012/2013 61 UG simulation (Medics and Nursing) 57 2011/2012 60 51 Team Trauma Members 50 Team Trauma Leaders
40 Paediatric Simulation 33 31 25 Hospital @ Night 30 24 17 Foundation Simulation 20 13 Deteriorating Patients 10 CMT & Nursing Simulation 0 Basic Knee Arthroscopy - CT trainees Keele Clinical Keele SpR Mentoring New Consultant Trainers Forum Leadership Management programme Course 0 2 4 6 8 10121416 programme
Specialty Lead Registrars Development Programme - 2010/2013 attendance
40 34 35 35 30 25 22 20
15 11 10 7 5 4 5 0 2010 2011 2012 2013 2011 2012 2013 Cohorts Cohorts Cohorts Cohorts Showcase Showcase Showcase Event Event Event Employee Relations
Enc 2.7
Internal Hearings & External Proceedings at Employment Tribunals Staff Survey Key Findings - National Rankings
350 7 Worst 7 300 12 2012 4 250 2011 Below average 7 200 5 2010 1 150 Average 7 5 100 3 Above average 10 50 9 13 0 Best 20% scores 7 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 7 Disciplinary Grievance 0% 10% 20% 30% 40% 50% Capability Sickness Absence The numbers at the end of each bar indicate the actual number of key findings in Appeals Applications to Employment Tribunal each group. In 2012 the number of key findings was reduced from 38 to 28.
• The number of internal hearings is relatively similar to the past two years, however spend on external legal advice has reduced significantly during 2012/13.
• There has been a significant increase in the number of top 20% scores across the Trust achieved in the 2012 Staff Survey compared to previous years. There was also an increase in the overall score for Staff Engagement and this was in the top 20% nationally. Enc 2.7 Department of Occupational Health and Wellbeing, Services to King’s College Hospital: April 2012 to March 2013 King’s staff and volunteer appointments: 3596 Walk-in Service: 1064
10 and over Needlestick incidents: 273; Body fluid exposures: 62; Other reasons included dermatitis and musculoskeletal problems: 730 5 to 9 730 4 800 3 600
person 2 400 273 1 200 0 1000 2000 3000 62 Number of appointments Number of per Number of workers 0 WALK IN ‐ WALK IN ‐ BLOOD SPL Walk in other NST/SHARPS Most visits were to our vaccine clinics: our practice nurses were ready for 4,802 appointments for immunisation or tests. Our doctors and senior nurses dealt with 2,043 appointments for management referrals, Infection control and our physio had 1,467 appointments. King’s immunisations or blood tests: 9,700 (excludes ‘flu); Doctors: 2,700; nurses: Appointments Appointment numbers (Attended, DNA, late 2,645; Volunteers: 600; Immunisation reminder letters: 6,498 cancellations) Vaccine/blood test 4802 Management referral 2043 Immunisations/ tests for KCH staff, by disease, Physio 1467 excluding flu Emergency reason 635 Counselling 347 Hep A Pre-placement health interview 106 19 1296 Hep B Self-referral 93 2560 Hep C Workplace assessment 88 1743 Health surveillance 48 HIV 272 815 Measles, Mumps, Rubella Psychiatry 31 862 Pregnancy 13 2140 Other Case Conference 4 TB Other 168 Varicella Total 9844 Enc 2.7 Department of Occupational Health and Wellbeing, Services to King’s College Hospital: April 2012 to March 2013
Top Six management referral reasons Referral Reasons by category 70.00% 60.06% The most common single reason for a referral to occupational health is musculoskeletal. Physical health 60.00% issues: 60%; Mental health issues, including stress: 21% 50.00% 40.00% Other 28% 30.00% 20.94% 20.00% Short term absences 3% 13.18% 10.00% 2.45% Nervous system disorders 3% 2.45% 0.00% 0.31% 0.31% 0.31% Pre/ Post Operation 4%
Sickness Absence 9%
Mental health issue (depression, anxiety etc) 17%
Musculoskeletal issue 36%
0% 5% 10% 15% 20% 25% 30% 35% 40%
King’s Pre-placement questionnaires: 3652 Attendances Pre-placement questionnaires are reviewed for immunisation status and checked for any
individual adjustments needed to help people in their work.
DNA rate: 16% Doctors: 1,000; Nurses: 715; Volunteers: 558 Other: 1363 Did not attend
Helpline and Training Sessions Cancelled within 24 hours
Manager helpline: 155 calls (the service is under utilised)
Educational sessions for new dental nurse students: 2 (80% found these valuable) Attended appointment
Clare Henson, our senior physiotherapist, was named King’s Therapist of the Year 2013. 0 2000400060008000 This page has been left blank Enc 2.8.1
Report to: Board of Directors
Date of meeting: 17 December 2013
By: Jane Walters, Director of Corporate Affairs
Subject: Quarterly Patient Experience Report
1. Executive Summary
1. This report reviews patient experience at King’s College Hospital over quarter 2 (July – September 2013). It also shows patient feedback where available for Denmark Hill and the Princess Royal site for October/November. The full King’s programme of patient experience has been rolled out at the PRUH and other new sites.
2. ‘King’s in Conversation’ has gathered views from over 800 staff and patients and a report on the findings was presented to the Board in November. ‘King’s in Conversation’ is currently being rolled out across the PRUH for both staff and patients as part of the programme of cultural change.
3. The Francis ‘Listening to Patients’ workstream has focussed on improving the Trust’s response to complaints and feedback. A new Serious Complaints Committee is being established and Faith Boardman is the new NED Champion for Patient Experience
4. Despite a deterioration in patient experience scores for Denmark Hill in Q2, October and November show an improving picture both at the PRUH and Denmark Hill. Initial results for the PRUH show an overall score of 84 compared to 86 for the Denmark Hill site (86 target).
5. Friends and Family scores for Q2 and October were somewhat disappointing. Response rates remain a challenge on both sites, but show an improving picture in October.
6. The HRWD outpatient score achieved or exceeded the benchmark in 2 out of 3 months, reflecting the improvements made in key areas of outpatients. Wider rollout of the improvement programme is underway.
7. King’s volunteers continue to increase in both number and range, with the1,000th volunteer now recruited at Denmark Hill. Analysis indicates that volunteers are having a positive impact on the experience of patients.
This report highlights 3 main areas of patient experience, and actions for improvement:
Responding to complaints/patient feedback Outpatients Volunteering
1 Enc 2.8.1
1. Responding to complaints and patient feedback
What have we done?
o Established Francis ‘Listening to Patients’ workstream o Improved access to the complaints procedure o Implemented feedback questionnaire for complaints o Reviewed and improved escalation of serious complaints o Regular patient story/complaint at each Quality & Governance Committee o Invited complainants to ‘King’s in Conversation Events’ (KIC) o Rolled out KIC to the PRUH o Established PALS team at PRUH to help resolve frontline issues o Rolled out Friends and Family and monthly HRWD survey to the PRUH o Appointed Patient Experience NED Champion: Faith Boardman
What do we plan to do?
o Revise Trust complaints procedure o Improve learning from complaints and PALS o Rollout Patient Video stories across all sites o Establish Serious Complaints Committee with Exec and NED membership from January 2014. The Committee will review ‘serious’ complaints, provide independent challenge, review complaints themes and actions and increase Board level scrutiny o Rollout patient experience systems fully at the PRUH
Patient experience performance for Q2 (and October/November where available).
1.1. Patient Experience Report
Denmark Denmark PRUH PRUH RAG Hill Hill October Rating Average RAG Score Q2 Rating Inpatient Overall Score 85 84 Outpatient Overall Score 83 - - Inpatient Patient Engagement 86 85 Inpatient Care Perceptions 87 86 Inpatient Environment 79 77 Inpatient Response Rate 38% 24% Friends and Family Test Inpatients 62 58 RAG not Friends and Family Emergency 35 51 available EMSA (ward or bay) 94 - Under EMSA (toilets and bathrooms) 90 - development
1.2. How are we doing? Denmark Hill
• Overall performance for Denmark Hill was variable with benchmark met for 1 out of 3 months. However, performance improved and hit the benchmark ( 86) in October
1.3. How are We Doing ? PRUH
Performance for October for PRUH inpatients was lower than Denmark Hill with an overall score of 84 – two points below the target score of 86
2 Enc 2.8.1
1.4. Friends and Family Inpatients
1.1. Inpatient Friends and Family
Scores for Denmark Hill for Q2 were in the low 60s Results for the PRUH site were lower in the mid 50s The score for both sites for October was 58 We have set ourselves a target score of 68 which would put King’s in the top quartile of London Trusts There is wide variation in the scores for wards on both main sites with some wards already achieving or exceeding the target score of 68 and others where there are significant improvements to be made. Response rates for DH site rose over the last 4 months to a high of 58% in October
1.5. Friends and Family Emergency Department
Scores for Denmark Hill for Q2 were variable, but with an improved score in October Results for the PRUH site were higher, and also with an improved score in October Achieving target response rates continues to be challenging on both sites and presents a risk to achieving linked CQUIN targets. Work is ongoing with teams on both sites to raise response rates. From January 2014 SMS text messaging will be introduced which has proved successful in other trusts.
1.6. Friends and Family Maternity
The Friends and Family Test for Maternity launched on 1st October. Women are asked for their views on their maternity services at three touch points:
1. Antenatal care – the 36 week antenatal appointment 2. Birth and care on the postnatal ward 3. Postnatal community care
3 Enc 2.8.1
1.7. Complaints
Overview Denmark Hill
• 204 complaints received for Q2, which is an increase on the previous quarter. Complaints numbers fell in October (58), rising again in November (76). • 54% of complaints relate to inpatient care while 46% relate to outpatients (including ED). • 55% of complaints received in Q1 13/14 were responded to within 25 working days, below the target of 70%
Main causes of complaints Half of all complaints relate to some aspect of clinical care, 11% to staff attitude, 8% to inpatient cancellations/delays and 7% to outpatient cancellations. Complaints about admission and discharge arrangements fell significantly this quarter
Overview PRUH
• 121 complaints for Q2, in line with previous levels • At 1 October 2013, 69 complaints remained open and were handed over to King’s. • At 1 October, there was 25.6% performance in responding within 25 working days. • Information relating to post integration complaints shows a decreasing trend. Of complaints received in October and November, 15/52 related to events post 1 October.
4 Enc 2.8.1
PRUH complaints April-September 2013
49% of complaints related to inpatient care while 51% related to outpatients The highest numbers of complaints were: outpatients, Emergency Department, Day Surgery, Maternity Unit, and ophthalmology. The main causes of complaint were: 46% clinical care,17% communication,14% outpatient appointment (cancellations/delays),13% staff attitude
1.8. PALS
Denmark Hill
In Q2 there were 1,038 PALS contacts of which 58% related to outpatient issues.
PRUH
October/November 2013
In October/November, over 400 concerns were resolved at the PRUH by the onsite PALS team. This is a new service and demand from patients has been consistently high. In comparison to Denmark Hill (42%), a higher proportion of PRUH PALS contacts are inpatients (62%).
Key inpatient issues - cancellation of elective patients due to bed capacity and non availability of records, waiting times for elective orthopaedic patients, discharge planning
Key outpatient issues - cardiology and ophthalmology appointment cancellations, delays in outpatient referral process, appointments cancelled on day because of lack of availability of medical records
5 Enc 2.8.1
2. Improving Outpatient Experience
Over the last three years, there has been a strong focus on improving outpatient services at King’s. Approximately 300,000 outpatients attend the GJW each year and it is often the first contact that a patient has with King’s, and it is important that their experience is a good one.
Suite 3 Transformation
The Ambulatory Care and Local Networks division (ACLN) has been piloting new ways of running outpatient clinics in the Golden Jubilee Wing. The overarching aim was to improve the flow of patients through clinics; to reduce waiting times for clinical consultations and to improve patient experience of the outpatient process
Suite 3 was chosen as the test area for this initiative as it sees the largest number of patients in GJW; accommodates specialties and staff from different divisions and was known to have long standing issues with poor flow and with patient and staff satisfaction. It includes clinics for diabetes, respiratory medicine, endocrinology, gastroenterology and rheumatology
The majority of outpatient clinics in GJW follow a generic pathway:
Standardisation has been achieved through :
Promotion of supported electronic check in to reduce queues at the reception desk. Volunteers and hospital staff have worked together to make this a success, moving clinic staff from the reception desk to help people check into the clinic. Staff have been reminded of the importance of being pleasant and helpful to patients at all times.
Amalgamation of three nurse assessment teams into one team, improving cross cover and reducing the need for multiple patient queues.
Installation of a call forward system to help manage patient flow through the suite and reduce the need for staff to leave their clinic rooms and escort people around the clinic. Large screens display the patient name and the location when it’s their appointment time. This reduces traffic in the clinic and supports the aim of having a calm environment as names are no longer called out across the waiting area. Signage has been redesigned help patients navigate their way around the clinic. The seating area has also been changed so that patients have a clear view of the screens.
An electronic room booking system to provide realtime information on room usage and clinic cancellations within the suite. This helps with better planning of clinics and allows empty space to be used productively to run additional clinics where necessary.
How are we Doing Survey results over the last year demonstrates that patient satisfaction has improved in Suite 3 since the introduction of the changes as illustrated in the table below. Changes have also been positively evaluated by Governors who have participated in the project.
6 Enc 2.8.1
Following the success of the pilot in Suite 3, a business case is being developed to re-design other outpatient services housed in the Golden Jubilee Wing.
The Trust will also be implementing its How are we doing? Outpatient survey on the PRUH site where currently there is no standardised patient feedback.
3 5 7 6 4 1 2
Phlebotomy
Patients have reported poor experience of the phlebotomy service over a number of years. Key issues included:
Long waiting times for blood tests Poor environment in the phlebotomy waiting area and the discharge lounge co-located resulting in over crowding Length of time to get results of tests
Work has been carried out this year to improve processes in phlebotomy and also improve the experience of patients.
7 Enc 2.8.1
Key actions have included:
Mapping peak activity times in the clinic and providing extra staffing at peak times to cater for the demand. Extending opening hours Improving IT systems Improvements to the environment
This has resulted in significant improvement in waiting times for blood tests. Work is continuing to improve other aspects of the service.
King’s Governors have been actively involved in the phlebotomy service improvement project.
“Phlebotomy has been upgraded and I must admit, I was impressed on the two occasions that I visited the department today. It was virtually empty. The whole layout is much better and I believe the average waiting time is about 15 minutes. Well done to all of those involved with its improvement.” Patient Governor
8 Enc 2.8.1
3. Volunteering
The King’s College Hospital volunteering service is continuing its rapid expansion to ensure as many patients as possible have access to support from volunteers. The numbers of volunteers at Denmark Hill are now over 1,000, with a further 200 plus volunteers across our new sites.
Volunteers at Denmark Hill are spread across key areas of the site with the largest number (61%) volunteering on wards and 24% in outpatient clinics.
It is encouraging that volunteers continue to represent our diverse community with over 60% of our volunteers coming from Black and Ethnic Minority groups.
9 Enc 2.8.1
The majority of volunteers are in the younger age range with nearly 70% aged under 30
The pilot Hospital to Home scheme launched in November, and is providing support to patients discharged from 4 wards in their own homes. Staff and volunteer feedback from the pilot has been positive so far, but this is a pilot scheme, and learning from the initial phase will inform wider rollout.
A further initiative is Community Health Ambassadors, where volunteers are trained to act as ambassadors in the local community to promote awareness of major public health issues. We have linked with Lambeth and Southwark Public Health Directorate, and local colleges to recruit and train volunteers to attend community events to raise awareness of the following public health issues : healthy eating, smoking cessation, alcohol awareness and mental health and well being.
Evaluating the Impact of Volunteering
.An evaluation of the Volunteering scheme on staff, patients and volunteers themselves is being conducted by the King’s Fund, and results will be available by March 2014. Some early indications of volunteer impact on patient experience show a positive trend. The following graph shows the percentage of patients who replied ‘extremely likely’ to FFT. This data is shown for those who had access to a volunteer during their hospital stay( c 35% of patients), and those who did not. Early indications suggest that there is a correlation between access to a volunteer and improved scores for the Friends and Family Test, however, this will need to be tested further, and will form part of the King’s Fund evaluation.
10 Enc 2.8.1
4. External ‘Radar’
King’s rating on NHS Choices (Denmark Hill) has remained at 4.5 stars for this quarter
• Cleanliness – 4 star • Staff Co-operation 4 star • Dignity and respect 4.5 stars • Involvement in decisions 4.0 stars • Single sex accommodation 4.5 stars
The PRUH site has not yet received sufficient reviews to be star rated.
During Q2 there were 11 comments posted about the Denmark Hill site, out of which 10 received a 5 star rating and 1 a 4 star rating.
“It is a very good A&E department from the moment you see the nurse in streaming to the doctor. The reception staff that register you could be a bit more pleasant but I suppose the people who normally attend this department may have hardened them. The doctor's treatment of me was excellent - he was also very kind with it.”
“I had a baby at King's and received a highly professional yet personal service from all members of staff at the maternity unit, community midwives and the Harris Birthright Centre. They were kind and attentive and I had 1:1 care throughout labour. Many thanks. Highly recommended
5. Recommendation
The Board is asked to note this report, and offer any comments.
11 This page has been left blank Enc 3.1.1
King’s College Hospital Board of Directors Finance & Performance Committee
Minutes of the meeting of the Finance & Performance Committee held at 08:30 on Tuesday 29 October 2013 in the Dulwich Committee Room, King’s College Hospital
Present: Graham Meek (GM) Committee Chair/ Non-Executive Director Prof Sir George Alberti (GA) Trust Chair/ Non-Executive Director Chris Stooke (CS) (from item 013/87) Non-Executive Director Sue Slipman (SS) Non-Executive Director Marc Meryon (MM1) Non-Executive Director Tim Smart (TS) Chief Executive Officer Simon Taylor (ST) Chief Financial Officer Roland Sinker (RS) Chief Operating Officer Angela Huxham (AH) Director of Workforce Development Dr Mike Marrinan (MM) Medical Director Jane Walters (JW) Director of Corporate Affairs Dr Geraldine Walters (GW) Director of Nursing and Midwifery Jacob West (JW1) Director of Strategy In attendance: Leonie Mallows (LM) Corporate Governance Officer (Minutes) Iris Lewis (IL) Associate Director of Finance For item 013/88 only: Sue Bowler Divisional Manager, TEaM Nick Sands Deputy Divisional Manager, TEaM Ed Glucksman Emergency Medicine Consultant, Clinical Director Lindsey Milford Senior Finance Manager, TEaM Denise Andrews Matron, TEaM Stacey Hood Matron, TEaM Apologies: Prof Ghulam Mufti Non-Executive Director Faith Boardman Non-Executive Director Simon Dixon Director of Finance Peter Fry Director of Operations
Item Subject Action
013/82 Welcome & Apologies
Apologies for absence were noted.
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013/83 Declarations of Interest
No declarations of interest were reported.
013/84 Chair’s Action
No Chair’s action was reported.
013/85 Minutes of the Previous Meeting
The minutes of the meeting held on 30 September 2013 were approved as a correct record, subject to the following changes:
Page 3, remove first sentence.
Page 3, item 013/76, 1st bullet point: amend to read ‘...to accommodate a Clinical Decision Unit and increased Majors capacity.’
Page 4, item 013/77, 5th bullet point: amend to read ‘…include the need to incorporate qualitative data as well as quantitative;
Page 4, item 013/77, 6th bullet point: amend to read ‘..and attendance/compliance with performance meetings’
013/86 Actions Tracking/Matters Arising
The action tracker was noted.
The Chair suggested that given the recent prominence of NHS complaints JW handling in the press, it would be prudent to bring forward the ‘root and branch’ discussion of the Trust’s complaints process.
Update on appointments RS reported the following new appointments: Peter Fry – Director of Operations
Kath Dean – Clinical Operational Lead (PRUH site)
Anna Clough – Integrated Care Lead, TEaM
013/87 Performance Report – Month 6
RS presented a summary of month 6 (September) performance.
The Committee noted the month 6 performance report and the following key points:
Good performance The Trust is working very hard to maintain its position;
Cancer waiting time targets, the emergency care ‘4-hour wait’ target and referral to treatment (RTT) targets for non-admitted complete and incomplete pathways were all achieved in September and for quarter Item Subject Action
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2; and
The 6-week diagnostic waiting time target was also been achieved, consistent with the plans communicated to commissioners.
Performance challenges There are five key areas where specific actions are being taken to address performance challenges.
The RTT admitted complete target has not been achieved, consistent with the Trust’s forecast set out in the 2013/14 annual plan. The Trust is on track against its trajectories to clear the backlog, with the exception of HpB (liver) surgery and orthopaedic day cases;
The opening of wards in the Centenary Wing and activity at the newly opened theatres at Orpington hospital should help this position;
The Trust achieved the emergency care target in month 6 but the target is under considerable pressure so far in month 7. A temporary Clinical Decision Unit is under construction to provide extra capacity;
There are concerns over the number of incidences of healthcare acquired
infections CRE and VRE, particularly in liver services;
The number of ward-based red shifts has decreased but remains a lead indicator of high levels of acuity and volume and reflects the on-going challenge to recruit sufficient numbers of staff;
GW, ST and RS met recently to discuss phased funding for recruitment which is in balance with the funding agreed in the full business case and promoting fast, solid recruitment;
The backlog of responses to patient complaints has now been cleared although the rate of responses requires further improvement;
The executive team will meet later this week to discuss complaints and the metrics being tracked and the method for bringing this kind of information to the Board in future;
The Trust’s financial position is adversely affected by the need to rely on temporary staffing to meet demand.
Other areas of concern There are seven other areas that are being closely monitored. The Committee noted these areas and the following key points:
The Trust will meet with representatives from St George’s and Lewisham hospitals to develop Heads of Terms for tertiary transfers; and
There has been an increase in the number of mixed sex accommodation breaches this month, almost all of which occurred in Critical Care. Following recently reissued national guidance, reporting arrangements have been agreed with commissioners. Item Subject Action
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Regulatory The Trust has achieved all the performance indicator targets in Monitor’s compliance framework with the exception of the 18-week RTT admitted complete target;
The Trust governance rating for quarter 2 as amber-green;
The CQC has announced a new quality surveillance scheme which has 150 broad-ranging metrics and indicators.
Contractual A local GP has been appointed as the link between the Trust and local Clinical Commissioning Groups (CCGs) and is usefully engaging on the quality agenda;
Positive conversations are on-going with local CCGs about improving RTT performance; and
The Trust is attempting to engage positively with NHS England and to reach agreement on a revised contract offer.
PRUH performance update From next month (month 7) a consolidated scorecard will be used to report performance across all the Trust’s sites;
Currently, the emergency department is under considerable pressure and cancer waiting time targets are very challenged;
Performance against RTT and healthcare acquired infection targets are better;
There has been a warm welcome from staff based at the PRUH although integration will be challenging. MM is working with PRUH-based clinicians to provide strong leadership; and
There were 9 cases where pay had not be received as expected during the first payroll run of the enlarged organisation on 24 October. These were resolved by the next day.
Specific Performance Reports The Committee noted the updated action plans for: Infection control; Emergency department; and RTT.
013/88 Trauma, Emergency and Medicine Divisional Report
The Committee welcomed staff from the Trauma, Emergency and Medicine (TEaM) division.
The Committee noted the divisional report and scorecard for month 6. Key discussion points included: Item Subject Action
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The division is responsible for the Trust’s two emergency departments situated at Denmark Hill and the PRUH. The key difference between the two is the Major Trauma Centre and therapies department at Denmark Hill;
Each year in March/April the division undertakes a review of the winter that has just passed and begins planning for the next. However, in 2013 there was a seasonal change in case mix but no seasonal change in case load. July 2013 was the busiest month ever;
The Emergency Pathway Improvement Plan is well developed at Denmark Hill and there has been progress against many of the actions since April 2013. Supporting activities are continuously reviewed;
The plan is less developed at the PRUH. However, the recent acquisition of assets and services from South London Healthcare Trust (including the PRUH) allowed a restructure of leadership roles especially senior nurses;
The workforce is fundamental to improving patient safety and experience. Activities in support of the overall improvement plan include development of five top priorities and associated initiatives by the nursing team;
The division has an operational financial deficit, mainly due to overspending on bank and agency staff and a lack of recurrent winter funding;
There is a move towards changing the focus of the emergency pathway so that it becomes linked with integrated care and hospital at home; and
The division is also responsible for the interface with social care, mental health providers and other partnership projects such as KHP alcohol and homelessness projects.
There were comments and questions from Committee members and the following key points were noted:
The division is currently working through a model to provide 24/7 consultant cover at Denmark Hill. This will require 12 acute medical consultants;
A more evolutionary approach will be required to achieve the same at the PRUH where currently there are a number of part time consultants;
At a national level, attempting to influence the strategy of NHS England in dealing with the pressure now being experienced in emergency departments system-wide may bring benefits to this and other trusts;
The redesign and redefinition of the boundaries of medicine and specialty accompanied by behavioural change and is key to balancing the flow of patients around the hospital;
Over the past 18 months there has been particular focus on recruitment;
There has also been a focus on the identification of deteriorating patients and initiatives such as ‘One Bay Everyday’ whereby feedback and learning is passed on to junior nurses; and
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There is strong local pressure on staff to deliver.
013/89 Finance Report – month 6
ST presented a summary of the financial position at the end of month 6 (September).
The Committee noted the month 6 finance report and the following key points:
The Trust currently has an operating surplus of £32k, excluding asset impairments;
The Monitor financial risk rating for month 6 and quarter 2 is 3, in line with the annual plan;
There are very significant levels of over performance and the Trust is challenged to manage use of bank and agency staff whilst at the same time deal with capacity constraints;
Managing the study/annual leave of the fixed establishment would support keeping a handle on bank/agency staff across all staff groups;
Accrued income has been added in to the figures based on assessed risk
and experience of the flow of money through the system.
It was agreed that the Committee would receive figures that do not include ST the accrued income to enable effective comparison.
Transaction money is starting to flow from NHS England and the Trust is in dialogue with commissioners about other income schemes to help meet the emergency and RTT targets, for example, the Clinical Decision Unit; and
Now that the Trust’s systems are in place at the PRUH it will be easier to understand the situation with regard to CIPs achievement and to make robust projections to year-end.
The Committee discussed the challenge of how to manage spend on bank and agency staff in an environment of continued high activity and demand. The following key points were raised and noted: Education commissioning is central to the long term provision of sufficient numbers of staff;
Previously a pan-London agreement had been reached regarding agency pay rates;
Offering financial incentives or any other benefits would be complex to implement.
013/90 Treasury Management Report – month 6
The Committee noted the Treasury Management report for month 6.
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013/91 Any Other Business
There were no other items of business raised for discussion.
013/92 Date of next meeting Tuesday 26 November 2013, 08:30-11:00 in the Dulwich Committee Room
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