Trust Board Papers

Isle of Wight NHS Trust

Board Meeting in Public (Part 1)

to be held on Wednesday 7th December 2016 at 9.30am - Conference Room, School of Health Sciences (South Hospital) St. Mary’s Hospital, Parkhurst Road, NEWPORT, Isle of Wight, PO30 5TG

Staff and members of the public are welcome to attend the meeting. Refuse Store

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Gate 14 Newport, Isle of Wight, 09 PO30 5TG Tel: (01983) 534256 Fax:(01983)525157 Cherry Gate Drain Project Title 09 St Mary's Hospital Isle of Wight

Drawing Title Conference Room in Site Plan 45 Scale Date Drawn the School of Health Not to Scale @A1 06/10/2014 Site No. Block. Level. Project No. Science Building - ALL201 Building No 16 *Starred items have direct links to

Quality care for everyone, every time *A positive *Work with others *Excellent patient experience for *Skilled and *Cost effective, to keep improving care patients, service capable staff sustainable services

Goals our services users and staff

Working “Beyond Boundaries” to be the preferred choice for sustainable integrated care

.Improve mortality .*Create and maintain . *Improve what .All staff continue to . * Design services to rate partnerships with people think of develop deliver best practice .Prevent avoidable other organisations their care .All staff understand within our harm so that we can .*Improve how staff how their resources . *Improve care of: deliver excellent care feel about work contribution helps . * Ensure value for

- older people .*Develop an .*Provide Excellent to achieve our money for each - people with integrated IT End of Life Care Vision service dementia infrastructure . *Develop our . * Develop efficient - children and . *Develop 24/7 and 7 workforce to and effective Priorities young people day services embrace integration processes with *Improve the and co-production minimal waste Implementation *Improve culture of the and monitoring communication organisation to *Improve the Reduce Incidence QI the effectiveness QI with patients and QI improve patient QI Discharging QI of Patient Harm of the sepsis care carers experience Planning Process bundle

Our Values Our vision and goals guide us; our values underpin everything we do

The next meeting in public of the Isle of Wight NHS Trust Board will be held on Wednesday 7th December 2016 commencing at 9.30am in the Conference Room, School of Health Science, St Mary’s Hospital, Newport, IW PO30 5TG

Staff and members of the public are welcome to attend the meeting. Staff and members of the public are asked to send their questions in advance to [email protected] to ensure that as comprehensive a reply as possible can be given. AGENDA Indicative No. Item Who Purpose Enc, Timing Pres or Verbal This meeting will be recorded for the purposes of assisting in preparing the minutes and actions from the meeting.

09:30 1 Apologies for Absence, Declarations of Interest and Confirmation that meeting is Quorate 1.1 Apologies for Absence: Chair Receive Verbal Lena Samuels, Associate Non-Executive Director Charles Rogers, Non-Executive Director Chris Palmer, Executive Director of Financial & Human Resources (Iain Hendey, Deputy Director of Information with deputise)

1.2 Confirmation that meeting is Quorate Chair Receive Verbal No business shall be transacted at a meeting of the Board of Directors unless one-third of the whole number is present including: The Chairman; one Executive Director; and two Non- Executive Directors. 1.3 Declarations of Interest Chair Receive Verbal 09:35 2 Minutes of Previous Meetings 2.1 To approve the minutes from the meeting of the Isle of Wight Chair Approve Enc A NHS Trust Board held on 5th October 2016 2.2 Chairman to sign minutes as true and accurate record 2.3 Review Schedule of Actions Chair Receive Enc B 09:45 3 Chairman’s Update 3.1 The Chairman will make a statement about recent activity Chair Receive Verbal 09:50 4 Chief Executive’s Update 4.1 The Chief Executive will make a statement on recent local, CEO Receive Enc C regional and national activity. 5 WORKFORCE 5.1 Employee Recognition of Achievement Awards CEO Receive Pres

5.2 Employee of the Month CEO Receive Pres 10:00 6 QUALITY 6.1 Patient Story CEO Receive Pres 6.2 Quality Governance Committee Chair Report QGC Receive Enc D Chair 6.3 Reports from Serious Incidents Requiring Investigation AEDNQ Receive Enc E (SIRIs) 6.4 Safer Staffing monthly report AEDNQ Receive Enc F 6.5 Chair of Local Safeguarding Board - Safeguarding & Looked AEDNQ Receive Enc G after Children Annual Report 2015/16 6.6 Mortality Update EMD Receive Pres

10:45 7 STRATEGY & PLANNING 7.1 Sustainability & Transformation Plan (STP) CEO Receive Enc H

Meeting in public on 7th December 2016 Isle of Wight NHS Trust Board – Page 1

7.2 Board Assurance Framework incorporating Principal Risk CS Receive Enc I Register Report 11:00 8 PERFORMANCE 8.1 Finance, Investment, Information & Workforce Committee FIIWC Receive Enc J Chair Report Chair 8.2 Performance Report EMD Receive Enc K

8.3 Chief Operating Officers Report COO Receive Enc L

11:45 9 GOVERNANCE 9.1 Corporate Governance Framework: CS Approve Enc M - Extension to Scheme of Reservation & Delegation 9.2 Top Key Issues & Risks arising from Sub Committees for CS Receive Enc N raising at Trust Board. Minutes Included: Quality Governance Committee held on 8th November & 29th November 2016 Finance, Investment, Information & Workforce Committee held on 25th October and 29th November 2016 Mental Health Act Scrutiny Committee held on 18th October 2016 ICT Assurance Committee held on 18th November 2016 Audit & Corporate Risk Committee held on 8th November 2016

9.3 Board & Board Seminar Dates for 2017 CS Approve Enc O

10 Any Other Business Chair 11 Questions from the Public Chair

12 Issues to be covered in private. The meeting may need to move into private session to discuss issues which are considered to be ‘commercial in confidence’ or business relating to issues concerning individual people (staff or patients). On this occasion the Chairman will ask the Board to resolve: 'That representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest', Section 1(2), Public Bodies (Admission to Meetings) Act l960.

The items which will be discussed and considered for approval in private due to their confidential nature are: • Strategic Business Case – New Models of Care • Operating Plan Update • NHSI Investigation Response Report • Contracts & Tenders Update • Informed Client Group Update • Vectasearch Business Case • Procurement Service Revised Contract Value • Carbon Energy Fund - Addendum to Business Case • Joint Adult & Child Safeguarding Report - Qtr 2 July – September 16 • Chief Executive's Update on Hot Topics • Employee Relations Issues • Medical Staffing Update by NED lead. • NHSI Agency self-certification checklist: Board sign off • Approval of External Auditor • Minutes of Auditor Panel - 9th August and 8th

Meeting in public on 7th December 2016 Isle of Wight NHS Trust Board – Page 2

November 2016 • Clinical Claims Report - Qtr 2 July - September 2016 11:50 13 Date of Next Meeting The next meeting of the Isle of Wight NHS Trust Board to be held in public is on Wednesday 8th February 2017 in the Conference Room - School of Health Science Building, St Mary's Hospital, Newport, IW PO30 5TG

There will also be an Extraordinary Meeting of the Isle of Wight NHS Trust Board to be held in public is on Tuesday 20th December 2016 at 8.45am in the Conference Room - School of Health Science Building, St Mary's Hospital, Newport, IW PO30 5TG Following the conclusion of the agenda items in Part 1 of the Trust Board, the Board will now convene as Corporate Trustee 1 Board Convened as Corporate Trustee 1.1 Minutes of the Charitable Funds Committee Meeting held on CFC Approve Enc P 20th Sept 2016 Chair 1.2 Charitable Funds Annual Accounts and Report 2015/16 EDFHR Approve Enc Q

Meeting in public on 7th December 2016 Isle of Wight NHS Trust Board – Page 3

Enc A

Minutes of the meeting in Public of the Isle of Wight NHS Trust Board held on Wednesday 5th October 2016 in the Conference Room, School of Health Science, St Mary’s Hospital, Newport, IW PO30 5TG

PRESENT: Eve Richardson Chair David King Non-Executive Director Dr Nina Moorman Non-Executive Director Charles Rogers Non-Executive Director (SID1) Vaughan Thomas Non-Executive Director Karen Baker Chief Executive Chris Palmer Executive Director of Financial and Human Resources Alan Sheward Executive Director of Nursing & Quality Shaun Stacey Chief Operating Officer Dr Oliver Cramer Deputy Medical Director (Deputising for Executive Medical Director)

In Attendance: Mark Price Company Secretary Jon Burwell Executive Director of Strategy & Planning Lena Samuels Associate Non-Executive Director Andy Hollebon Head of Communications

For item 16/T/176 Wendi Cowburn Ward Clerk, St Helens Ward For item 16/T/176 Nigel Eason, Maintenance Technician For item 16/T/176 Tom Milne Capital Projects Manager For item 16/T/176 Rebecca Craig Acting Senior Staff Nurse - Intensive Care Unit For item 16/T/176 Jane Gallop Cleanliness Assistant - Seagrove Ward For item 16/T/176 Sam Harding Cleanliness Assistant For item 16/T/176 Robert Digby Cleanliness Assistant For item 16/T/176 Joanna Dowers Patient Transport Service (on behalf of Team) For item 16/T/176 Michael Smith Patient Transport Service (on behalf of Team) For item 16/T/176 Kathryn Grimes Medical Secretary - Mottistone For item 16/T/176 Michael Lyons Volunteer – Emergency Department For item 16/T/180 Jackie Hazeldine End of Life Care Lead Nurse, and, For item 16/T/180 Amanda Pushparajah MacMillan/Palliative Care Nurse Specialist For item 16/T/180 Dr Paul Howard Consultant in Palliative Medicine, Earl Mountbatten Hospice For items16/T/185+186 Lucie Johnston Head of Corporate Governance For item 16/T/187 Michaela Morris Head of Emergency Planning For item 16/T/188 Phil Orwin Interim Turnaround Director Observers: John Bowker Committee Member of Healthwatch Chris Orchin Chair of Healthwatch Linda Fair Chair of Patient Council Phil Hartwell Head of Governance, IW Clinical Commissioning Group Heather Williams Communications & Engagement Manager, IW Clinical Commissioning Group Minuted by: Lynn Cave Board Governance Officer

Members of the There were 8 staff members attending to support the Employee Award recipients. Public in There were no members of the public present. A representative from the IW County attendance: Press also attended Minute No.

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th IOW NHS Trust Board Meeting Pt 1 1 5 October 2016

16/T/171 APOLOGIES FOR ABSENCE, DECLARATIONS OF INTEREST AND CONFIRMATION THAT THE MEETING IS QUORATE Apologies for absence were received from Dr Mark Pugh, Executive Medical Director, Jessamy Baird, Non-Executive Director and Lizzie Peers, Non-Executive Financial Advisor. Oliver Cramer, Deputy Medical Director deputised for Mark Pugh.

The Chair announced that the meeting was quorate.

Declarations of Interest were received from Charles Rogers and the Executive Director of Financial & Human Resources in their role as Directors of Wightlife Partnership.

16/T/172 MINUTES OF PREVIOUS MEETING Minutes of the meetings of the Isle of Wight NHS Trust Board held on 1st June 2016 and 7th September 2016 were reviewed and approved.

The Chair advised that she had received positive feedback from the IW Council following the last Board meeting and they had extended a further invitation to hold a future Board meeting at County Hall.

16/T/173 REVIEW OF SCHEDULE OF ACTIONS The Board received the schedule of actions with the following updates:

a) TB/215 – Oncology Implementation Plan: The Executive Director of Nursing & Quality advised that following the Oncology Review which occurred in May 2016 an alignment of services across the Portsmouth, Southampton and Isle of Wight was agreed and this was now awaiting a funding decision by the CCG. He advised that a further progress update would be given at the next meeting.

b) TB/218 – Patient Story: The Chief Operating Officer confirmed that he has an appointment to meet with the patient concerned and advised that he was willing to be involved in the review to improve experiences for all.

c) TB/222 – Cases of Pressure Ulcers as a result of delayed discharge: The Chair confirmed that a good discussion had taken place at the last meeting and that she had met with the Chair of the CCG who agreed that this would be an agenda item at the next Board to Board meeting between the IW NHS Trust and the IW CCG. Nina Moorman confirmed that this was discussed at QGC2. It was agreed that the Executive Director of Nursing & Quality and Nina Moorman would present the item at the Board to Board meeting.

16/T/174 CHAIR’S UPDATE The Chair reported on the following:

a) Organ Donation Day: She had attended the event which was held at Tesco in Ryde, raising public awareness. She confirmed that it had been a very successful day resulting in increased numbers of organ donors on the Island.

b) Friends of St Mary’s Annual General Meeting: She confirmed that she had attended the event and was impressed by the reports presented. She gave thanks to the Friends for all the work they do to support the Trust.

c) Sustainability & Transformation Plan: She had attended a number of key events with the Chief Executive both regionally and nationally.

2 Quality Governance Committee

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The Isle of Wight NHS Trust Board received the Chair’s Update

16/T/175 CHIEF EXECUTIVE’S UPDATE The Chief Executive presented the report and highlighted the following: National a) Doctors Industrial Action: Strike action postponed. Doctors in training have reported very positive experiences working within the Trust.

b) Seven Day Services: This has commenced with the introduction of four priority standards which are being rolled out across the country. The Island has offered to be in the second cohort to implement these standards

Regional c) Sustainability & Transformation Plans (STPs): The Trust is working with the Local Authority and the IW CCG along with partner organisations across Hampshire and the Isle of Wight to create a regional plan which ‘dove tails’ with the Island’s My Life a Full Life programme. The deadline for submission of the draft plan is 21st October with NHSI3 carrying out a review and feedback by November.

Local d) Health Education England (HEE) visit: Chair of HEE, Sir Keith Pearson visited the Trust and commended Maria Lynch, Associate Medical Director, on her work with young people to encourage them to consider careers within the NHS.

e) System Pressures: System pressures continue across the Island. There is some great partnership working taking place to ensure patients are in the right place for them.

f) Transformation: The System Transformation Plan has a target of £10.2m CIP4, which currently include 16 core transformation programmes identified to deliver the cost savings. These are aligned with the My Life a Full Life programme and the Hampshire & IW Sustainability & Transformation Plan.

g) Staff Recognition: Awards have been presented to staff that were unable to attend the Board meeting in the usual way.

h) Catering Services Option Appraisal: External review of our catering services looking at 4 options with a preferred option coming to the Board in December. The Chief Executive stressed that no decision has been made at this time and that staff, patients, visitors and other stakeholders would be engaged during the process.

i) Stay Well This Winter / Flu: The Chief Executive stressed the importance for staff to have their flu vaccination and commended the work being undertaken by Occupational Health and the Communications team to raise awareness.

j) Endoscopy inspection and accreditation: An external inspection was undertaken in September which resulted in the unit being declared ‘perfect’. Congratulations go to the team on this fantastic result.

k) Beacon Health Centre and the new Urgent Care Service: A joint open letter from IW NHS Trust and IW CCG has been sent to the Island public about changes to the Beacon Health Centre and the new Urgent Care Service. The Chief Executive stressed that it was important to educate the population as to what the service is for and how to access treatment.

3 NHS Improvement 4 Cost Improvement Programme

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David King stated that the new Urgent Care Service was a big change and there were challenges still to be faced to ensure that the Emergency Department performance was on target. The Chief Operating Officer advised that following the change to the new service on 1st October performance would be reviewed regularly to assess if any attendees could have gone elsewhere but chose not to. He confirmed that the Trust was working with the CCG to challenge the impact on the Emergency Department and to ensure that patients are sent home with a treatment plan where applicable and admissions to hospital are not increased.

The Isle of Wight NHS Trust Board received the Chief Executive’s Update

WORKFORCE 16/T/176 EMPLOYEE RECOGNITION OF ACHIEVEMENT AWARDS The Chief Executive presented the Employee Recognition of Achievement Awards. This month the nominations were as follows:

Category 2 – Employee Role Model: • Wendi Cowburn, Ward Clerk, St Helens Ward • Nigel Eason, Maintenance Technician • Tom Milne, Capital Projects Manager

Category 3 – Going the Extra Mile: • Rebecca Craig, Acting Senior Staff Nurse - Intensive Care Unit • Jane Gallop, Cleanliness Assistant - Seagrove Ward • Sam Harding and Robert Digby, Cleanliness Assistants • The Integrated Patient Transport/Non Patient Transport Service Team • Kathryn Grimes, Medical Secretary - Mottistone

Category 5 – Volunteer Working: • Michael Lyons, Volunteer – Emergency Department

The Chief Executive congratulated all the recipients on their achievements.

The Isle of Wight NHS Trust Board received the Employee Recognition of Achievement Awards

QUALITY 16/T/177 PATIENT STORY The Executive Director of Nursing & Quality advised that the patient story was entitled Brenda’s Story, and explained that this was an account by a carer of a patient with dementia and their experiences over a period of 3 admissions to the hospital. He advised that the film demonstrated clear progression with the experience improving at each stage. He advised that there were clear issues raised into looking after a patient with dementia and confirmed that the first visit coincided with the launch of a national awareness campaign and as part of this campaign highlighted that it was always preferable for a dementia patient to remain in their familiar surroundings. He highlighted a number of actions which were being introduced across the Trust which included additional training for all staff including using this story. He confirmed it was important when assessing dementia patients in the community that the default was not to bring them into hospital and that more work is done to keep them in their home environment where possible.

Nina Moorman confirmed that this story had been seen by the QGC. She noted that two out of the three incidents had required the patients admission to hospital but that the issuing of carers passports was a ‘win win’ situation for both the carer and patient and the Trust, and this scheme should be rolled out across the Island.

The Executive Director of Nursing & Quality advised that the My Life a Full Life programme had a work stream dedicated to fragility care and that Di Goring, Crisis Response Lead Nurse/Acute Dementia Lead, had been seconded for a year to the project to progress the project at a much faster pace. th IOW NHS Trust Board Meeting Pt 1 4 5 October 2016

The Chair stated that carers and volunteers need to be trained up and more creative initiatives developed to utilise our specialist mental health, memory and dementia trained staff to assist patients to remain in their homes.

David King suggested that more discussion should be had with the CCG to commission the right care in the community for dementia patients and highlighted that an admission avoidance pathway for dementia patients which needed to be different to the standard community care response. The Chair advised that due to the demographic of the Island it was important to ensure that these patients avoided coming into the Emergency Department unless absolutely necessary.

The Isle of Wight NHS Trust Board received the Patient Story

16/T/178 QUALITY GOVERNANCE COMMITTEE CHAIR REPORT Nina Moorman reported on the Quality Governance Committee (QGC) meeting held on 27th September 2016 She highlighted the following areas:

• Surgical site infections. • Cancelled operations. • Patient Flow. • Serious Incidents Requiring Investigation (SIRIs). • Infection Prevention and Control Annual Report • Emergency Department (ED) 4 hour wait • Clinical Audit • Commissioning for Quality Programme (CQUIN) • 7 day services

David King expressed concern over the ongoing Emergency Department 4 Hour wait performance The Chief Operating Officer advised that the system wide plan shows that 70% of actions actually sit with other organisations and stakeholders. He outlined the current activity regarding beds in the community and advised that he would circulate the Urgent Care Improvement Plan to the Board. He confirmed that he was working closely with the IW Council, the Earl Mountbatten Hospice and Residential & Domiciliary Care Services to deliver changes in community services.

Action: Chief Operating Officer to circulate the current version of the Urgent Care Improvement Plan in advance of Board discussion at Seminar and Board 2 Board meetings on 3rd November 2016; and the Quality Governance Committee on 8th November. Action by: COO

The Isle of Wight NHS Trust Board received the Quality Governance Committee Chair Report

16/T/179 NATIONAL CARE OF THE DYING AUDIT REPORT Jackie Hazeldine, End of Life Care Lead Nurse together with Amanda Pushparajah, MacMillan/Palliative Care Nurse Specialist and Dr Paul Howard, Consultant in Palliative Medicine from the Earl Mountbatten Hospice attended to present the report.

Jackie Hazeldine advised that the National Care of the Dying Audit identifies the key areas of good practice that need to be promoted. The Trust submitted 29 sets of audited notes; however, only 24 were included in their report. The report highlights that we need to continue with the current End of Life Care developments, concentrating on the patient experience in meeting their priorities and ensuring that our approach to care encompasses those close to the patient. The Trust continues to audit the outcomes to care of the dying through the weekly Mortality Review and the Bereaved Relatives Survey.

th IOW NHS Trust Board Meeting Pt 1 5 5 October 2016

The recommendations from the National Care of the Dying have been bench marked against current activity within the Trust to develop End of Life Care. Recognising dying at the appropriate point in the patient’s journey remains a challenge but a recent initiative of proactively visiting Emergency Department (ED) and Medical Assessment Unit (MAU) has proved worthwhile, in as much as patients have been returned to their usual place of residence rather die in an acute hospital setting. It has also raised awareness of promoting choice at the end of a patient’s life.

The Deputy Medical Director thanked Jackie Hazeldine who confirmed that the foundations of good practice are in place with clinical delivery continuing to improve and be embedded across the organisation.

The Deputy Medical Director stated that the audit will be a continuous process. The Chair thanked Jackie Hazeldine for all her work with the Trust. over 40 years and wished her a happy retirement.

The Isle of Wight NHS Trust Board received the National Care of the Dying Audit Report

16/T/180 REPORTS FROM SERIOUS INCIDENT REQUIRING INVESTIGATION (SIRIS) The Executive Director of Nursing & Quality reported that there was one SIRI of an unexpected death in Mental Health which was reported to the Isle of Wight CCG during August 2016. He also confirmed that the Trust has 25 open SIRI cases.

He confirmed that there were some delays in processing the SIRI investigations but together with the Chief Operating Officer, he was working with the CBUs to improve the process. He advised that over the past 3 years the number of SIRI cases resulting in serious harm had significantly reduced. He also stated that transparency in reporting is key to providing assurance, awareness and reassurance.

The Isle of Wight NHS Trust Board received the Serious Incident Requiring Investigation (SIRIs) Report.

16/T/181 SAFER STAFFING MONTHLY REPORT The Executive Director of Nursing & Quality presented the report and highlighted that there continued to be concern with the number of nursing vacancies. He advised that the registered nurse fill rates for the majority of the time had been 90% with agency and bank usage also being good. Agency staff were mainly being utilised in high vacancy areas such as Emergency Department and areas where shortfall indicated the need due to acuity and dependency. He advised that all requests for bank and agency staff continue to be scrutinised. A more detailed report would be presented at the next Board meeting.

The Executive Director of Nursing & Quality reported that the cohort of nurses from the Philippines are all now here with the exception of those nurses who failed to achieve the OSCE5 examinations. He advised that this applied to two nurses who have returned to their homes.

David King asked if there were bursaries for training and recruitment. The Executive Director of Nursing & Quality confirmed that NHSI have provided details on available bursaries and an update would be provided at a future Board Seminar.

Action: The Executive Director of Nursing & Quality to circulate the NHSI national data on bursaries and salaries for new trainees in advance of the Board Seminar item on Medical Recruitment. Action by: EDNQ

The Isle of Wight NHS Trust Board received the Safer Staffing Monthly Report

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16/T/182 SAFEGUARDING & LOOKED AFTER CHILDREN ANNUAL REPORT 2015/16 The Executive Director of Nursing & Quality presented the report and advised that work had been undertaken to achieve all actions identified with the exception of the business plan to provide increased clinical support to the Children in Care Nurse which was still in development.

Vaughan Thomas queried if Board Members also should receive the safeguarding training. The Company Secretary confirmed that a training session has been arranged in addition to the electronic training which all members of staff complete. Vaughan Thomas also asked for further information relating to the levels of training compliance. The Executive Director of Nursing & Workforce confirmed the current compliance and that measures were in place to improve this.

Nina Moorman stated that this report had been received at QGC but questioned why the report was only now being presented. The Executive Director of Nursing & Quality advised that this was due to team pressures and the Isle of Wight Safeguarding Board report was also only just being issued in draft. He advised that it was planned to bring the report earlier for 2016/17.

The Isle of Wight NHS Trust Board received Safeguarding & Looked After Children Report 2015/16

STRATEGY & PLANNING

16/T/183 DELIVERING TRUST STRATEGY – PRIORITY OBJECTIVES 2016/17 The Executive Director of Strategy & Planning presented the report and confirmed that following the approval of the Trust Strategy and the Operating Plan that the Trust’s Directorates identified over 400 objectives for delivery in 2016/17 which in hindsight has proven to be too many, with a need to focus on the key elements that will mitigate risk and take the Trust forward in the delivery of its core strategic priorities and ultimately strategic goals. This is evidenced by more than 137 of the Directorate objectives being flagged for removal and 217 being behind plan at the end of Quarter 2 2016/17.

To support Directorates in focusing on the key areas in 2016/17 that will help deliver operational, clinical and financial improvement in 2016/17 alignment with the STP6 and MLaFL7, the 2016/17 objectives have been reviewed and reduced to the key priorities for the next six months. These revised objectives have also been aligned with key quality priorities.

The Executive Director of Strategy & Planning requested that the Board approve the proposed objectives as the Trust’s areas of focus for the next six months and confirmed that routine monitoring of progress will be put in place led by the Head of Strategy and Planning.

The Isle of Wight NHS Trust Board approved the Delivering Trust Strategy – Priority Objectives 2016/17

16/T/184 BOARD ASSURANCE FRAMEWORK INCORPORATING PRINCIPAL RISK REGISTER REPORT The Company Secretary presented the report and advised that there were currently 8 Principal Risks and 31 Corporate Risks. He advised that many Corporate risks span more than one risk type and the report included an analysis of these.

The Company Secretary confirmed that the risks are subject to monthly confirmation and challenge by the Executive team through an Executive Principal Risk review meeting.

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th IOW NHS Trust Board Meeting Pt 1 7 5 October 2016

David King commended the progress made in the development of this report and stressed the need to look at the work being undertaken to address these risks and triangulate this across the organisation in order to see improvements. The Chair also advised that alignment with the risk appetite was also key.

The Isle of Wight NHS Trust Board received the Board Assurance Framework Incorporating Principal Risk Register Report

16/T/185 RISK MANAGEMENT STRATEGY & POLICY The Company Secretary presented the revised strategy and policy and confirmed that this had been seen and agreed at the Audit & Corporate Risk Committee. He confirmed that the document had been revised in line with recommendations following the Governance Review and also to reflect the Trust Strategy.

The Executive Director of Financial & Human Resources requested that an amendment be made to p15 section 11 which currently showed the 2015/16 Goals & Priorities. It was agreed that this would be amended to include the 2016/17 version.

Action: The Company Secretary to amend the Risk Management Strategy & Policy to include the 2016/17 Goals & Priorities ‘House’. Action by: CS

The Isle of Wight NHS Trust Board approved the Risk Management Strategy & Policy with one amendment.

16/T/186 EMERGENCY PLANNING CORE STANDARDS 2016 The Executive Director of Nursing & Quality advised that the report provided an update on the Trust’s performance against Emergency Core Standards issued last year. He advised that the Trust’s self-assessment along with discussions with the CCG has shown the Trust is able to declare full compliance with 74 (73%) of the 101 applicable standards, the remaining 27 standards (27%) are detailed within the EPRR8 work plan. The Head of Emergency Planning confirmed that work is being undertaken to improve compliance by the end of March 2017.

David King asked for an update on the finalisation of a formal agreement with South Central Ambulance Service and the achievement of ISO accreditation. The Head of Emergency Planning advised that the formal agreement was in place but was awaiting formal signing off. In relation to ISO accreditation the Trust had entered into an agreement with the Local Authority to access their auditor and a review was planned. A longer three year integrated plan is being prepared.

David King asked when the training needs analysis would be completed. The Head of Emergency Planning advised that an ongoing phased process was in place with a review of services and a service business plan being developed.

The Isle of Wight NHS Trust Board approved the Emergency Planning Core Standards 2016

PERFORMANCE

16/T/187 FINANCE, INVESTMENT, INFORMATION & WORKFORCE COMMITTEE CHAIR REPORT Charles Rogers reported on the 27th September meeting of the Finance, Investment, Information & Workforce Committee and highlighted the following areas:

Human Resources • Rostering

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• Temporary Staffing

Financial • Risk to Delivery of Control Total • Income • Cost Improvement Plan ( CIP) 2016/17 • Cash flow • Medium/Long Term Financial Plan 2016-2020

The Isle of Wight NHS Trust Board received the Finance, Investment, Information and Workforce Committee Chair Report 16/T/188 PERFORMANCE REPORT The Chief Operating Officer presented the Performance Report.

Highlights:

• No Mixed Sex Accommodation Breaches in August • No new cases of MRSA9 • Symptomatic Breast Referrals Seen <2 weeks, Cancer patients seen <14 days after urgent GP10 referral, Cancer Patients receiving subsequent Chemo/Drug <31 days and Cancer diagnosis to treatment <31 days, Cancer Patients receiving subsequent surgery <31 days, Cancer Patients treated after screening referral above target for July • No new cases of C Diff11 • No falls resulting in significant injury • High risk TIA12 fully investigated & treated within 24 hour and Stroke patients (90% of stay on Stroke Unit) above the target • 0 Clinical Incidents (Major) resulting in harm • FFT13 - % Recommending - Total (without A&E14) is above target

Lowlights: • 16 formal complaints in month • Staff sickness remains above plan • Emergency care 4 hour standard remains below target • Theatres utilisation below target • Category A 8 Minute Response Time (Red 1), Category A 8 Minute Response Time (Red 2) and Category A 19 minute response times are all below target • Referral To Treatment Time - % Incomplete pathways below 92% target • % of Care Programme Approach patients having formal review within last 12 months below target • NHS 111 All calls to be answered within 60 seconds of the end of the introductory message below target • 62 day urgent referral to treatment of all cancers below target • Governance Risk Rating of 11 for August 2016

David King stated that he was encouraged to hear the changes being made to improve the Ambulance performance but queried why the Referral to Treatment target was not achieved. The Chief Operating Officer advised that there had been two main reasons – access to elective beds and delays in discharging medically fit patients. He advised that the past six weeks had been particularly challenging but that staff were looking at different ways of working to increase capacity including adding operating lists to existing clinical time and lists on weekends for no significant

9 Methicillin-resistant Staphylococcus Aureus (bacterium) 10 General Practitioners 11 Clostridium Difficile 12 Transient Ischaemic Attack (also known as 'mini-stroke') 13 Friends & Family Test 14 Accident & Emergency

th IOW NHS Trust Board Meeting Pt 1 9 5 October 2016

extra costs. He confirmed that the treatment backlog was growing as we are not treating enough people at the front end of the list but were maintaining the outpatient backlog. He confirmed that an improvement plan linked to the wider system wide approach was being developed.

The Isle of Wight NHS Trust Board received the Performance Report

16/T/189 CHIEF OPERATING OFFICER’S REPORT The Chief Operating Officer presented his report which provides an overview of current service issues, challenges, good news, risks, opportunities and commissioning issues or changes affecting the five Clinical Business Units for the period 29th August 2016 to 23rd September 2016.

David King queried the fact that despite national coverage of an increase in spending on Mental Health the CCG would not be providing the Trust with this investment. The Chief Operating Officer advised that as part of the financial recovery plan for the Isle of Wight system the CCG have confirmed that they have not provided the investment the Trust had applied for this year and would not be providing the investment next year. We are therefore, looking at how we can work through to provide the statutory requirements for mental health through a single point of access. The Mental Health team along with the CCG and colleagues in Social Care are looking at how these services can best be provided going forward.

David King questioned how this could be communicated to the public. The Chief Executive confirmed that regionally there was investment in Mental Health Services but had appreciated that the Island would not be receiving funding. She confirmed that this would be raised with the Sustainability & Transformation Board by the Executive Team.

The Chair expressed concern that the excellent joint working being undertaken with the police would cease. The Chief Operating Officer assured her that the Serenity Project was safe and would continue. He confirmed that a review of mental health services had been as part of the WISR15 project.

The Isle of Wight NHS Trust Board received the Chief Operating Officer’s Report.

GOVERNANCE

16/T/190 SYSTEM WIDE GOVERNANCE The Chief Executive advised that following much discussion with the Local Authority and the CCG we are proposing the new system wide governance structure which demonstrates how the system will be managed across the Island. She gave an overview of the various levels of the structure.

Charles Rogers questioned if the Turnaround Board was time limited. The Chief Executive confirmed that that this was the case and anticipated it would last for at least 6 months.

Nina Moorman queried why the System Resilience Group (A & E Delivery Board) was so titled and was it historical. The Chief Executive explained that this was a national title and was run by the CCG. Nina Moorman stated that it sounded like it was wholly hospital based. The Chief Executive advised that it was about delivery against the Emergency Care 4 hour standard which effect all areas of service/providers on the Island.

David King requested that a decision making map be included which showed which groups were advisory and which were decision making. He also did not know what the lines were meant to demonstrate and suggested removing them.

15 Whole Integrated Systems Review

th IOW NHS Trust Board Meeting Pt 1 10 5 October 2016

The Company Secretary advised that at present there was no formal agreed delegation of authority and therefore, some decisions may still be required to be made by the Trust Board. He advised that Executive Directors had decision making powers in accordance with the Standing Financial Instructions and Standing Orders.

The Executive Director of Nursing & Quality expressed concern that it looked like another tier of accountability by which the Trust would be held accountable. He felt that it would be useful to have a clear line on how the system is held to account.

Vaughan Thomas commented that all parties involved should have an agreed set of common principles. The Chief Executive assured him that within the My Life a Full Life programme there were a core set of principles which all parties had signed up to.

The Chief Executive requested that the Board approve the proposed structure at this point in time and the comments made would be raised with the system leaders to take into account for the further development of the system governance.

The Isle of Wight NHS Trust Board approved the System Wide Governance

16/T/191 BOARD SUB COMMITTEE TERMS OF REFERENCE The Company Secretary presented the Terms of Reference for: • ICT Assurance Committee (ICTAC)

The Executive Director of Financial & Human Resources requested a correction to the number reference to Standing Orders in the ICTAC Terms of Reference in Section 7d). This was agreed.

The Isle of Wight NHS Trust Board approved the Board Sub-Committee Terms of Reference with one amendment

16/T/192 CORPORATE GOVERNANCE FRAMEWORK – CODE OF ACCOUNTABILITY FOR NHS BOARD (INCORPORATING CODE OF CONDUCT) The Company Secretary advised that the Code of Conduct – Code of Accountability for NHS Boards was originally published in April 1984, but has had three revisions since that time. The document has not been revised or refreshed since April 2013 and as such the attached version is the most recent iteration and is still live. He asked Board formally to adopt the document throughout the duration of its lifecycle. He also confirmed that the Corporate Governance Department would continue to check quarterly for revisions.

Charles Rogers queried if an audit of the Trust’s compliance took place. The Company Secretary advised that aspects of our compliance were audited such as the declaration of interests but an audit of compliance with the whole document will take place and an annual report would be produced.

Action: An annual report of compliance against the Code of Accountability (Code of Conduct) would be presented at the end of the financial year. Action by: CS

The Isle of Wight NHS Trust Board approved the Corporate Governance Framework – Code of Accountability for NHS Board (incorporating Code of Conduct) for the duration of its lifecycle.

16/T/193 TOP KEY ISSUES AND RISKS ARISING FROM SUB-COMMITTEES The Company Secretary presented the Top Key Issues and Risks arising from Sub- Committees.

The Isle of Wight NHS Trust Board received the Top Key issues and Risks arising from Sub-Committees

th IOW NHS Trust Board Meeting Pt 1 11 5 October 2016

16/T/194 ANY OTHER BUSINESS a) Media Interest on Diabetes: David King advised that there had been a national TV documentary on Diabetes recently which suggested that an epidemic was imminent. He asked what the Trust was doing about this. The Chair advised that the Diabetes team had featured at a recent Medicine for Members event and that they were nominated for a national award. Nina Moorman stated that at QGC they were looking at how services rated against national standards and benchmarks. She confirmed that she would update the Board via her Chair of QGC report on progress.

Action: The Company Secretary to arrange for the Medicine for Members Diabetes presentation to be circulated to Board members. Action by: CS

b) Annual Awards Ceremony: The Company Secretary confirmed that this would take place on Friday 3rd March 2017 at Cowes Yacht Haven.

c) Carers Passports: Vaughan Thomas asked that the Patient Council and Healthwatch promote the Carers Passports through their sources. Patient Council and Healthwatch representatives at the meeting confirmed that they were aware of these and supported their promotion.

16/T/195 DATE OF NEXT MEETING The Chair confirmed that the next meeting of the Isle of Wight NHS Trust Board to be held in public is on Wednesday 7th December to be held in the Conference Room, School of Health Science Building, St Mary’s Hospital, Newport, IW PO30 5TG

The meeting closed at 12.35pm

Signed………………………………….Chair Date:…………………………………….

th IOW NHS Trust Board Meeting Pt 1 12 5 October 2016 Enc B ISLE OF WIGHT TRUST BOARD Pt 1 (Public) - April 16 - March 17 ROLLING SCHEDULE OF ACTIONS TAKEN FROM THE MINUTES

Key to LEAD: Chief Executive (CE) Executive Director of Financial & Human Resources (EDFHR) Executive Director of Strategy & Planning (EDSP) Executive Medical Director (EMD) Executive Director of Nursing & Quality (EDNQ) Deputy Director of Nursing (DDN) Company Secretary (CS) Board Governance Officer (BGO) Head of Communications (HC) Head of Corporate Governance (HCG) Chief Operating Officer (COO)

Non Executive Directors: Eve Richardson (ER) Charles Rogers (CR) Nina Moorman (NM) David King (DK) Jessamy Baird (JB) Vaughan Thomas (VT)

Designate/Associate Non Executive Directors: Non Executive Financial Advisor: Lizzie Peers (LP) Associate Non-Executive Director (LS)

Date of Minute No. Action Item Action Exec Lead Update Report Further Action Due Date Forecast Progress Date Closed Meeting No. Author by Other Date RAG Committee

08-Jun-16 16/T/103 TB/215 Oncology Implementation An Update to be provided in 3 EDNQ 31/08/16 - Update to be provided to the October meeting 07-Sep-16 07-Dec-16 Progressing Plan months on this plan 05/10/16 - The Executive Director of Nursing & Quality advised that following the Oncology Review which occurred in May 2016 an alignment of services across the Portsmouth, Southampton and Isle of Wight was agreed and this was now awaiting a funding decision by the CCG. He advised that a further progress update would be given at the next meeting.

06-Jul-16 16/T/129 TB/218 Patient Story The Chief Operating Officer COO 25/08/16 - The COO following the last board meeting has obtained 07-Sep-16 05-Oct-16 Closed 14-Nov-16 would ask his team to look templates from around the Trust and is arranging a meeting with key again at the appointment stakeholders including patient experience team and information systems letters and also engage with and will include a patient council representative to review and revise these the patient who had proposed – due to annual leave etc this has been difficult to get in up until now but will improvements. be in during September to take forward. Once we are at the point of revised templates we will include the gentlemen in the patient story if he is happy with this so he can input to the process aswell. 05/10/16 - The Chief Operating Officer confirmed that he has an appointment to meet with the patient concerned and advised that he was willing to be involved in the review to improve experiences for all. 14/11/16 – A meeting has been arranged for key individuals from the Trust to review the letters and agree the changes going forward. The meeting will take place on 23 November 2016.

07-Sep-16 16/T/156 TB/222 Cases of Pressure Ulcers as David King stated that there EDNQ 05/10/16 - The Chair confirmed that a good discussion had taken place at QGC & 07-Dec-16 07-Dec-16 Progressing a result of delayed discharge. needed to be a deep dive into the last meeting and that she had met with the Chair of the CCG who Board Pt 1 the length of stay for the past agreed that this would be an agenda item at the next Board to Board year to show how many meeting between the IW NHS Trust and the IW CCG. Nina Moorman patients were affected by the confirmed that this was discussed at Quality Governance Committee. It delay in discharge. The Chief was agreed that the Executive Director of Nursing & Quality and Nina Operating Officer to arrange for Moorman would present the item at the Board to Board meeting. a deep dive into length of stay 14/11/16 - Responsibility for this action to be transferred to EDNQ from for patients for the past year. COO

05-Oct-16 16/T/178 TB/223 Urgent Care Improvement Chief Operating Officer to COO 31/10/16 - On programme for Board Development Session and Board to Board 2 03-Nov-16 03-Nov-16 Closed 03-Nov-16 Plan circulate the current version of Board with CCG on 3rd November 2016. Board with the Urgent Care Improvement 03/11/16 - This action is now completed CCG Plan in advance of Board discussion at Seminar and Board 2 Board meetings on 3rd November 2016; and the Quality Governance Committee on 8th November.

01/12/2016 1 of 2 Enc B Date of Minute No. Action Item Action Exec Lead Update Report Further Action Due Date Forecast Progress Date Closed Meeting No. Author by Other Date RAG Committee

05-Oct-16 16/T/181 TB/224 NHSI national data on The Executive Director of EDNQ 01/12/16 - Information received from Executive Director of Nursing & 15-Nov-16 01-Dec-16 Progressing bursaries and salaries for Nursing & Quality to circulate Quality and will be circulated to members by email ahead of the Board new trainees the NHSI national data on meeting. bursaries and salaries for new trainees in advance of the Board Seminar item on Medical Recruitment.

05-Oct-16 16/T/185 TB/225 Risk Management Strategy & The Company Secretary to CS 14/10/16 - Amended and loaded to intranet 31-Oct-16 31-Oct-16 Closed 14-Oct-16 Policy amend the Risk Management Strategy & Policy to include the 2016/17 Goals & Priorities ‘House’.

05-Oct-16 16/T/192 TB/226 Annual report of compliance An annual report of compliance CS 30-Apr-17 30-Apr-17 Progressing against the Code of against the Code of Accountability (Code of Accountability (Code of Conduct) Conduct) would be presented at the end of the financial year.

05-Oct-16 16/T/194a) TB/227 Medicine for Members The Company Secretary to CS 10/10/16 - This was circulated on 10 Oct 16 31-Oct-16 31-Oct-16 Closed 10-Oct-16 presentation on Diabetes arrange for the Medicine for Members Diabetes presentation to be circulated to Board members.

01/12/2016 2 of 2

Enc C

REPORT TO THE TRUST BOARD (Part 1 - Public) ON 7th December 2016

Title Chief Executive Officer’s Report Sponsoring Executive Karen Baker, Chief Executive Officer Director Author(s) Andy Hollebon, Head of Communications and Engagement Purpose For information Action required by the Receive X Approve Board: Previously considered by (state date):

Sub-Committee Dates Key Issues, Concerns and Discussed Recommendations from Sub Committee

Trust Leadership Committee

Audit and Corporate Risk Committee

Charitable Funds Committee Finance, Investment, Information & Workforce Committee Mental Health Act Scrutiny Committee Remuneration & Nominations Committee Quality Governance Committee ICT Assurance Committee Please add any other committees below as needed Board Seminar

Other (please state) Staff, stakeholder, patient and public engagement:

This report is intended to provide information on activities and events that would not normally be covered by the other reports and agenda items. This report covers the period 28th September to 29th November 2016. Information which relates to the five Clinical Business Units appears in a separate Chief Operating Officers report. My report will cover issues of national and regional importance and local issues which come within the remit of the Trust’s corporate services. Executive Summary & Analysis: This report provides a summary of key successes and issues which have come to the attention of the Chief Executive over the last month. The report covers the following issues:

National • NHS Providers Conference Regional • Sustainability & Transformation Plans (STPs) • Our Emerging New Care Model • Pioneering partnership in mental health care

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Local • Care Quality Commission (CQC) Inspection • System Pressures and Diarrhoea & vomiting (D&V) • Flu vaccination • Impressive results in diabetes weight management • Employees of the Month – July and September • Crisis Response team making headlines • SHINE Awards • Hepatitis C • Governance - Trust Leadership Committee

Recommendation to the Board: The Board is recommended to note the contents and receive the report.

Attached Appendices & Background papers

For following sections – please indicate as appropriate:

Trust Goals & Priorities All

Principal Risks (BAF) None Legal implications, regulatory and None consultation requirements

Date: 29th November 2016 Completed by: Andy Hollebon, Head of Communications and Engagement

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Chief Executive’s Report covering the period 28th September to 29th November 2016 My report covers issues of national and regional importance, and local issues which come within the remit of the Trust’s corporate services. Information which relates to the five Clinical Business Units appears in the separate Chief Operating Officers report. National NHS Providers Conference NHS Providers – the body which represents NHS Trusts and Foundation Trusts – has published a new report ‘The state of the NHS provider sector’. The report demonstrates that, despite rising challenges, trusts deliver when they have an achievable task and are given appropriate support and funding, including:

• Successfully treating a record number of patients: 5% more emergency hospitals admissions, 8% more A&E attendances and 4% more ambulance calls in September 2016 compared to September 2015 for all NHS trusts and foundation trusts. • On track to reduce last year’s record £2.45 billion deficit to -£669 million, cut agency spending by a quarter and realise £3.2 billion cost improvement gains this year - this is £346 million (12%) more than last year. • Addressing staff shortages by increasing recruitment from overseas, developing and piloting new roles like the nursing associate role, and using technology to roster staff more effectively and meet staff requests to work more flexibly.

• Leading NHS transformation by developing new care models that integrate hospital, GP and community and social care into a single service that offers better care closer to home; and leading nearly half of the 44 Sustainability and Transformation Plans (STPs). However, the report also reveals across the country a range of growing concerns over how services for patients and service users can be sustained at current levels: • In the face of much higher demand than predicted and, despite their best efforts, trusts are missing nearly all of their key performance targets. Fewer than one in three (30%) trust chairs and chief executives expect performance against these targets to improve over the next six months.

• Trust leaders share the CQC’s concern that whilst there is much good care being delivered, there is clear evidence of service quality starting to deteriorate. Only 10% of trust chairs and chief executives are “confident” or “very confident” they can maintain the level and quality of services over the next six months within the resources available.

• While there is good progress to deliver the short term plan to eliminate provider deficits, trust leaders share the NAO’s concern that there is no sustainable plan to cope with the sharply lower NHS funding increases of the next four years. Almost half (49%) of chairs and chief executives think their trusts’ financial position will deteriorate in the next six months. • Trusts are struggling to meet a series of workforce challenges including shortages in key specialties and rising pressure on staff. More than half (55%) of chairs and chief executives say they are “worried” or “very worried” about whether their trust has the right numbers, quality and mix of staff to deliver high quality healthcare. Most expect this to deteriorate over the next six months.

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• Comments on workforce included: “This concerns me more than the money”, “There are simply not enough high quality clinical staff in the country to cover some specialties”, and “Brexit has caused drying up of recruitment from the rest of Europe”. • While trusts are leading NHS transformation, government and arms length body assumptions on how quickly the required changes can be delivered and the financial benefits that will result are far too optimistic. Fewer than one in 10 trust chairs and chief executives are confident their local area is transforming quickly enough to provide sustainable care and financial balance. This is all food for thought and puts our local position into context. The pressures on frontline and managerial staff were discussed at length and there were big messages about leadership and valuing people. Both the Secretary of State and NHS and Jim Mackey, Chief Executive at NHS Improvement, spoke very positively about the NHS and Mr Hunt made announcements on a number of workforce-related measures that are focused on flexible working, career progression, leadership and doctors in training. This reflects the increasing focus on workforce strategies and policy at the Department of Health, about which we will continue to seek and reflect your views.

Key announcements:

• Development of a ‘skills escalator’ to progress staff through entry-level apprenticeships to a nursing degree apprenticeship. • A requirement that, by the end of 2017, all trusts must be meeting the best practice on e- rostering, as outlined in NHS Improvement’s best practice guide. • A new programme and review to encourage more clinicians to go into senior managerial roles. • A major review of the assessment and appraisal process for junior doctors, to make it simpler and more helpful.

Other announcements include:

Career progression:

• The Department of Education has approved a degree-level nursing apprenticeship standard, which employers can offer to new or existing staff from September. • Work continues on the development of the apprenticeship standard for the new nursing associate role. • Proposals are in development for a progression path to help nurses reach advanced practitioner level. • The health secretary has written to the chair of the NMC to seek agreement to regulate nursing associates, with work starting as soon as possible on the necessary legislation. • The government will consult next year on whether the physician associate role should also be regulated. • The government is reviewing the viability of a career path for advanced nurse practitioners who wish to become doctors.

Flexible working:

• A requirement that all employers comply with established best practice on e-rostering. • A new best practice sharing initiative will be established, to allow trusts that are meeting the standard to share their knowledge with other organisations. • A £1m GP Career Plus scheme, to encourage GPs who are close to retirement to remain in practice.

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Leadership:

• The NHS Leadership Academy is to send 30 students each year to world-leading universities (such as Yale), as part of a fast-track development programme to support more clinicians to move to senior management level. • HEE will consider whether doctors should be able to take clinical leadership as a specialism, and whether a dedicated programme is viable. • The NHS will partner with British universities to offer an NHS MBA for senior NHS professionals, with the first students enrolling in September 2017. • From 2018, HEE will double the number of places on the graduate management scheme.

Doctors in training:

• A review of the assessment process for doctors in training, intended to simplify the process and improve the educational experience of medical colleagues. • New HEE plans will better manage training and rotations to help couples who are training or who have caring responsibilities. • £10m funding will be made available to help HEE implement new programmes with the Colleges to improve support for doctors returning to training after maternity leave and approved time out. • HEE will work with the BMA, Royal College of Surgeons and a number of hospitals to explore whether a modern ‘firm’ structure might better support trainees.

Regional Sustainability & Transformation Plans (STPs) The route to some of the changes we may need make is the Hampshire and Isle of Wight Sustainability and Transformation Plan (STP) which was published on Wednesday 23rd November. It can be found on the Trust website at http://www.iow.nhs.uk/about-us/Partnership- working/sustainability-and-transformation-plan.htm. We already work closely with mainland organisations but there is more we can do to ensure that Islanders get an improved quality of service by working even more closely with mainland Trusts. A separate paper about the STP appears elsewhere on the agenda for the Board meeting. Our Emerging New Care Model The work to redesign our health and care system continues as we prepare to discuss our emerging new care model with staff, partners and the Island community early in the new year. In essence, it focuses on: • Integrated health & care provided as close to home as possible by shifting many services traditionally provided in a hospital setting to out of hospital/community based care • This will enable a person-centred community care system with diverse, multi-disciplinary services to deliver non-specialist support that embraces digital access, self-care and self- management by default • Our future acute model of care will be through an Urgent and Planned Care Centre where appropriate care will be delivered on the Island with links to more complex, specialist services across the Solent • Mental health services will continue to be provided on island where appropriate but with clear pathways to off island services

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Pioneering partnership in mental health care The innovative Serenity Integrated Mentoring project - a collaboration between Hampshire Constabulary, IW NHS Trust and Wessex Academic Health Science Network to improve the lives and prospects of patients in complex mental health situations – has been recognised by royalty as the winner of the HRH Prince of Wales Award for Integrated Approaches to Care at this year’s Nursing Times awards. Describing the project one of the judges said: “This is a truly original project with tremendous impact. Lives have been changed; not only for the service users but for their loved ones, their communities and for those who had previously managed their care.”

Local Care Quality Commission (CQC) Inspection The Care Quality Commission (CQC) carried out an inspection of our services between Tuesday 22nd and Thursday 24th November. The next step is for the CQC to write to us providing feedback on their preliminary findings. The letter does not replace the report the CQC will prepare about the inspection or any action the CQC may subsequently take. It will simply confirm initial findings providing a basis for the Trust to consider what action is needed rather than waiting for the full inspection report. The CQC have not told us when we will get their full report but last time that took about three months and it will only be then that we will know how we have fared overall taking account of the good practice, innovation and excellence staff demonstrated to them. System Pressures and Diarrhoea & vomiting (D&V) There continue to be substantial pressures in the system which has been exacerbated by D&V circulating in the Island community. There has been some excellent teamwork and innovation throughout the organisation with everyone pulling together to resolve the service pressures we have faced. Unfortunately we have had to delay some day case and inpatient surgery to ensure that we had sufficient capacity in the system to care for medically ill patients. With regards to D&V we had a small problem with Luccombe Ward which was resolved but we need to ensure that staff, their friends, family and work colleagues, Islanders, indeed everyone observes good hand hygiene at all times. Flu vaccination At 18th November 1,127 staff had received their flu vaccination. By Clinical Business Unit this breaks down as follows: • Medicine: 46% • Ambulance, Urgent Care and Community Services: 37% • Surgery, Women's and Children's Health: 38% • Mental Health and Learning Disabilities: 35% • Clinical Support, Cancer and Diagnostic Services: 29% We are encouraging as many clinical staff to be vaccinated as possible. My expectation is that Ward Sisters and above should be setting an example unless they have a valid medical reason. There are lots of myths about the vaccine but plenty of good medical information is available such as the NHS Choices (www.nhs.uk) website.

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Impressive results in diabetes weight management The Trust’s Diabetes Service won second place for having the largest impact on body weight and waist circumference after competing against 72 other Trusts and Health Centres across the UK. The Trust was presented with the award by charity X-PERT Health after seeing impressive results for its patients attending diabetes education sessions during 2014 and 2015. The Diabetes Centre at St Mary’s has been running the X- PERT Insulin self-management programme. The programme includes six sessions, lasting two- and-a-half hours each week, delivered at the Centre to educate patients so they can make informed decisions about their lifestyle, to help them manage their diabetes. Commenting on the Trust’s success Dr Trudi Deakin, founder and Chief Executive of X-PERT Health said: “Isle of Wight NHS Trust is doing a fantastic job helping patients make meaningful lifestyle changes which are having a huge positive influence on their health. I’m delighted they’re helping to provide the evidence we need to keep pushing diabetes education to the top of the agenda, and I congratulate them on their success.” Employees of the Month – July and September Congratulations to Marc McCarthy-Millard, OPARU Officer and Joseph Caya, Staff Nurse, Stroke Unit who were our Employees of the Month for July and September. Both were nominated by patients and have gone the ‘extra mile’ for them. They received their certificates of recognition in November. Crisis Response team making headlines The Crisis Response team were making headlines recently in the Nursing Standard with an article focusing on their work to help keep over-65s out of emergency departments. The article referenced the fact that more than 1,000 older patients were diverted from emergency care in the 14 months leading to June 2016, thanks to the team on the Isle of Wight. The crisis response team, part of the Integrated Care Hub, has also helped bring about better access to social care for older people and helped pick up undiagnosed dementia cases. The team, which includes nurse practitioners, paramedics, assistant practitioners, social workers, an occupational therapist and an Age UK representative. Referrals are taken from anywhere and the team provide a holistic health and social care service. SHINE Awards I’ve been sent a letter from Health Education Wessex following the annual Shine Awards. The Awards celebrate excellence in education and training for the NHS. It’s fantastic that Paediatric staff Nurse and Clinical Practice Educator Lucy Grist was Commended in the Inspiring Educator of the Year category; Jacqui Skeel, Workforce Development Lead was nominated for Education and Training Innovation Champion of the Year and commended in the Chair’s Award for their ‘Coffee, cake condoms & contraception’ initiative were Steph Barnes, Senior Staff Nurse, Sharon Creer, Bev Doncaster, Simon Bull, Tiffany Wheeler and Kay Marriott from the Sexual Health Service. Well done to you all – a tremendous effort. Hepatitis C There’s some fantastic work going on to ensure that those who may suffer with Hepatitis are identified and treated. Drs Ryan Buchannan and Leonie Grellier and the Hepatology service at St. Mary’s Hospital are transforming the quality of life for people diagnosed with hepatitis C. With

Page 7 of 8

advances in medication and new technology now being used on the Island, patients diagnosed with the virus are able to be treated and monitored much more effectively. You can read more on the Trust website at http://www.iow.nhs.uk/news/Its-never-too-late-to-treat-Liver-disease.htm. Well done to everyone involved in this initiative. Governance - Trust Leadership Committee The Trust Leadership Committee (TLC) comprises Executive Directors and Clinical Business Unit representatives and meets monthly. The following key points were approved/discussed: 22nd September 2016 • System Wide Governance Structure – TLC approved • Strategy Update 2016/17 Strategic Objectives – TLC approved • Study and Professional Leave for Medical Staff Policy – TLC approved • Beacon Walk-in Centre and GP Out of Hours Contract Exit Plan – TLC approved • Business Case – Director of Operations – TLC approved 20th October 2016 • National Raising Concerns (Whistleblowing) Policy – TLC approved • Business Case: Provision of Flexible Scopes for ENT Department – TLC approved • Business Case: Ophthalmology Satellite Clinic – TLC approved with conditions • Business Case: Takeover of commercial studies currently hosted by Vectasearch Clinic Limited – TLC approved subject to due diligence • Governance Review Action Plan: Closedown Report – TLC approved

Karen Baker Chief Executive Officer 29th November 2016

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Enc D

REPORT TO THE TRUST BOARD (Part 1 - Public)

ON 7th December 2016

Title Report from Chair of Quality Governance Committee Sponsoring Executive Nina Moorman, Chair of Quality Governance Committee Director Author(s) Nina Moorman, Chair of Quality Governance Committee Purpose To receive the report from the Chair of the Quality Governance Committee Action required by the Receive X Approve Board: Previously considered by (state date):

Sub-Committee Dates Key Issues, Concerns and Discussed Recommendations from Sub Committee Trust Leadership Committee

Audit and Corporate Risk Committee Charitable Funds Committee Finance, Investment, Information & Workforce Committee Mental Health Act Scrutiny Committee Remuneration & Nominations Committee Quality Governance Committee 29/11/16 ICT Assurance Committee Please add any other committees below as needed Board Seminar

Other (please state) Staff, stakeholder, patient and public engagement:

Not applicable Executive Summary: The Chair of the Quality Governance Committee will report on the following areas as discussed at the meetings held on 8th November and 29 November 2016 • Use of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). • Falls • Health care acquired infection • Nutrition

Page 1 of 4

• Patient experience • Sepsis • Quality Improvement plan. • Learning lessons from adverse events

Recommendation to the Trust Board: The Board is recommended to receive the assurance report by the Chair of the Quality Governance Committee

Attached Appendices & Background papers Report

For following sections – please indicate as appropriate:

Trust Goals & Priorities Excellent Patient Care – Implementation and monitoring the effectiveness of the sepsis care bundle Work with others to keep improving our Services – Improve communication with patients and carers A positive experience for patients, service users and staff – Improve the culture of the organisation to improve patient experience Skilled and capable staff – Improve the discharge planning process Cost Effective, sustainable services – Reduce incidents of patient harm

Principal Risks (BAF) Principal Risk 674 Quality and Harm

Legal implications, regulatory and consultation requirements

Date: 30 November 2016 Completed by: Nina Moorman, Chair of the Quality Governance Committee

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Quality Governance Committee

Assurance Report for Board

November 30th 2016

This assurance report is based on the QGC meetings of November 8th (which replaced the postponed meeting for October) and 29th November 2016. The minutes for both these meetings are in the Board papers.

From the assurance and mitigation reports of the rolling quarterly programme of the Quality Improvement Plan I would like to highlight the following:

• Use of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). There is a requirement for all clinical staff to be trained in the correct application of the MCA and to be aware of the safeguards for DoL in patients who do not have capacity to make their own decisions. To date the numbers being trained have been insufficient and the knowledge and implementation in all clinical settings has been patchy. With the appointment of an experienced safeguarding adults lead, the emphasis has shifted to training the senior nurses and junior doctors so that all staff can learn through experience of routine practice. Assurance limited, update in 2 months.

• Falls. A National audit of falls has previously shown this Trust to have above average numbers of falls causing harm, and an improvement plan was put in place. A local re audit of the same criteria in September showed a 25% decrease from the previous year. Work continues to understand and prevent falls. Assurance limited, update 3 months.

• Health care acquired infection. Clostridium difficile cases remain low this year (4) although 2 new cases are currently being investigated. There are low MRSA bacteraemia cases and there is particular focus at the moment on Peripheral Intravenous Cannula Care and catheter care. An outbreak of norovirus on one ward was effectively contained with no spread to other areas. Assurance positive, review 3 months

• Nutrition Screening of all patients for nutritional status on admission to hospital is advised by NICE but in January 2016 we achieved only 65%. Following the appointment of a Nutrition Nurse Specialist the results in September were 84%. The work now will concentrate on ensuring the assessments are acted upon with attention to protected meal times and dietary support for those that require it. Assurance limited, update 3 months

• Patient experience There is still a paucity of real time feedback from patients that could help improve our services. We discussed the potential for obtaining more and also using the National surveys more effectively. There will be a detailed review of our approach by the Acting Director of Nursing with proposals brought to QGC in January 2017. Assurance negative.

Sepsis is an overwhelming response to infection which can lead to catastrophic organ failure and annually about 37,000 patients die from this in the UK. 70% of cases arise in the

Page 3 of 4 community and prompt recognition and early treatment with antibiotics is required. Mortality in St Mary’s in Q2 last year was 15% and in Q2 2016 it was 7.7% (the National average is 7%). The National CQUIN this year requires monthly detailed scrutiny of case notes for compliance with good practice. Currently good practice is achieved for newly admitted patients but the challenge remains for deteriorating patients on the ward. Assurance positive, review 3 months.

Quality Improvement plan. The 20 areas of work (tiles) are reviewed in a rolling schedule but QGC also heard about 20 additional areas of quality improvement within the Trust. Some of these were in evidence on posters at the Patient Safety Conference held on November 25th here for information. All projects use the same collaborative model endorsed and promoted by the Academic Health Science Network.

Learning lessons from adverse events such as Serious Incidents Requiring Investigation (SIRIs), complaints, concerns and never events. The committee has noted the various routes for informing staff of lessons to be learnt, and the efforts to ensure that changes to practice are embedded, but recent reports of events recurring has prompted a request for proposals to improve this. The work will be led by the Acting Director of Nursing, to be discussed at QGC in January 2017.

Dr Nina Moorman Chair Quality Governance Committee 30 November 2016

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Enc E

REPORT TO THE TRUST BOARD (Part 1 - Public) 7th December 2016

Title Serious Incidents Requiring Investigation (SIRI) Report - October 2016 Data Sponsoring Sarah Johnston, Acting Executive Director of Nursing & Quality Executive Director Author(s) Karen Kitcher, Quality Assurance Lead. Deborah Matthews, Deputy Director of Quality Purpose To receive Action required by Receive X Approve the Board: Previously considered by (state date):

Sub-Committee Dates Key Issues, Concerns and Discussed Recommendations from Sub Committee

Trust Leadership Committee

Audit and Corporate Risk Committee

Charitable Funds Committee Finance, Investment, Information & Workforce Committee Mental Health Act Scrutiny Committee Remuneration & Nominations Committee Quality Governance Committee 29/11/16 Information & Communications Technology Assurance Committee Please add any other committees below as needed Board Seminar Patient Safety, Experience & Clinical 8/11/2016 Effectiveness (SEE) Group Other (please state) Staff, stakeholder, patient and public engagement:

Patient Representative in attendance at SEE – Nil representation on this occasion in SEE

Executive Summary & Analysis: This report provides an overview of Serious Incidents Requiring Investigation (SIRI) activity during October 2016. 6 serious incidents were reported to the Isle of Wight Clinical Commissioning Group (CCG) during October 2016

1. Surgical Patient fall 2. General Surgery Delay in treatment 3. Community Grade 4 pressure ulcer 4. Emergency Care Delay in treatment 5. Medicine Grade 3 pressure ulcer 6. Mental Health Unexpected death

During September 2016 – We have received a directive from the CCG with potential contractual consequences. From 01 November 2016 the CCG will allow no more than a 10% number of SIRI cases can be overdue.

Whilst we aim to complete SIRI’s within a 60 day timeframe this can be difficult due to complexity of case or,failure to identify and release staff to complete reviews. This has been discussed at Operational Management Group and a plan put in place to direct requirements for investigations through the Heads of Nursing to enable teams to quickly consider capacity of staff to deliver. This is a risk for the Trust currently as we do not have evidence to suggest we can deliver this timescale consistently although we recognise the importance of this.

Recommendation to the Board:

The Board is asked to receive this report.

Attached Appendices & Background papers

For following sections – please indicate as appropriate:

Trust Goals & Priorities Excellent Patient Care: Prevent Avoidable Harm

Principal Risks (BAF) Principal Risk 674 Quality and Harm

Legal implications, regulatory and National standards require SIRI’s to be completed within 60 consultation requirements days.

Date: 24 November 2016 Completed by: Karen Kitcher, Quality Assurance Lead and Deborah Matthews, Deputy Director of Quality

2 | SIRI activity report

Serious Incident Requiring Investigation (SIRI) Activity Report For Trust Board October 2016 data

(1) NEW INCIDENTS REPORTED AS SIRIs: During October 2016 the Trust reported 6 Serious Incident to the Isle of Wight Clinical Commissioning Group (CCG). Below is a summary of the incident:

Under whose care Summary

Surgical Patient fall General Surgery Delay in treatment Community Grade 4 pressure ulcer Emergency Care Delay in treatment Medicine Grade 3 pressure ulcer Mental Health Unexpected death

(2) PRESSURE ULCERS – Community and Acute: The hospital collaborative has been meeting since January 2016 for pressure ulcers and as part of the cluster review process, the clinical team leaders in hospital have developed an action plan. Responsibilities for delivery of the clinical elements will occur at each ward level and within each clinical business unit.

The outcome following September’s audit against pressure ulcer prevention is available within the latest Assurance and Mitigation report for pressure ulcers (copy available from Quality Governance Team)

The graphs below show the top 5 issues identified when clustering Grade 2 pressure ulcers in acute

Grade 2 Pressure Ulcers: in-patient areas Grade 2 Pressure Ulcers: Community District Nursing Teams Top 5 findings (year to date) Top 5 findings (year to date)

60 30 50 25

40 20

30 15 choices given

20 10 Advice declined Refusal to change lifestyle Equipment declined Reduced mobility history taking) Examination declinedExamination 5

10 Deterioration condition of Equipment/Advice declined No No evidence advice/ info of Poor documentation (inc

Deterioration condition of 0 0 in-patient areas and in community district nursing areas.

(3) SLIPS/TRIPS/FALLS – Community and Acute: As with pressure ulcer clustering, the clinical team leaders have developed an action plan to reduce the risk of patient falls and consequently the harm that occurs as a result. Again, the responsibility for delivery of the clinical elements will occur at ward level and within each clinical business unit. 3 | SIRI activity report

As part of the CQUIN requirement the Trust needs to demonstrate peer review of falls standards in adult inpatient settings; the plan is for ward sisters and matrons to review each other’s clinical areas using the falls audit protocol.

The outcome following this audit can be viewed in the latest In-patient Falls Prevention Assurance and Mitigation report (copy available from Quality Governance Team).

The graph below shows the top 5 issues arising when analysing the information submitted relating to minor falls in acute in-patient areas from April – Sept 2016.

TOP 5 issues highlighted during

60 clustering of minor falls 55 Acute areas (including community rehab) (year to date) 50 40 40 37 30 32 24 20

10

0

(4) CURRENT POSITION: This table provides the current status of open SIRIs as of 08 November 2016

SIRIs HOSPITAL & CBU 1 CBU 2 CBU 3 CBU 4 CBU 5

AMBULANCE Surgery, Medicine Clinical Ambulance Mental Women's & Support, , Urgent Health & Children's Cancer & Care, Learning Diagnostic Community Disabilities OVERDUE CASES • With Coroner 0 0 0 0 0 0 • With Clinical Business Unit 0 1 0 0 0 0 • With Quality team 0 0 0 0 0 0

• With Execs 0 0 0 0 0 0 • With Commissioner 0 3 4 2 3 1 • Returned from 2 1 0 0 0 0 Commissioner - further work TOTAL 2 5 4 2 3 1 CURRENT CASES • With Coroner 0 0 0 0 0 0 • With Clinical Business Unit 0 3 3 2 2 3 • With Quality team 0 0 0 0 0 0 • With Execs 0 0 0 0 0 0 • With Commissioner 0 0 0 0 0 0 • Returned from 0 0 0 0 0 0 Commissioner - further work 4 | SIRI activity reportTOTAL 0 3 3 2 2 3 TOTAL NUMBER OF OPEN CASES 2 8 7 4 5 4 30

(4a) At the time of producing this report (08 November 2016) there are currently 4 overdue cases, 3 of which have been returned by the Commissioners for further work.

Sept 2016 – We have received a directive from the CCG with potential contractual consequences. From 01 November 2016 the CCG will allow no more than a 10% number of SIRI cases can be overdue.

(5) CLOSED SIRI CASES – During October 2016, and at the time of reporting, the IW CCG has advised on the closure of 3 cases. Below is a list of the identified learning from those cases.

Case 1: • Arrangements have been made for liaison between the Adult Safeguarding team, and others to gain an understanding of CA12 (referral/triaging) processes within all organisations; meeting will ensure processes are embedded within all teams

• The draft standard operating procedure is being reviewed and amended to include clear expectations of what referral information will be documented, and where it should be documented.

• Clinical Director to ensure a meeting takes place with Team Leaders and Modern Matron to agree and develop good practice; Clinical Director will ensure that protected time is allocated to staff to give time to monitor and develop practices within the team.

• A written protocol for liaison and referral to a Single Point of Access is to be written.

• Communication to be given to staff regarding the required standards for documenting risk assessments, including risk formulation.

• Via action plan, Local Safeguarding Children’s Board Joint Working Protocol to be embedded within all mental health teams

• Work to be undertaken within the Trust in partnership with the Local Authority to ensure timely availability of Safeguarding Children Training Level 3; training to be rolled out across mental health in a timely fashion

• Planned changes to the PARIS patient record should support the routine assessment of risks to dependents

• Via action plan, arrangements will be made to ensure all teams have the appropriate level of access to all electronic systems within Mental Health, as the use of multiple recording systems can result in inadequate internal communication & multi-agency working, leading to unclear communication and deficits in risk assessment and management.

Case 2: • Removal of 1:1 at short notice; difficult decision made by Clinical Site Co-ordinator with information made available at the time.

5 | SIRI activity report

• Compliance to Falls Policy and awareness of falls management & prevention was poor.

• All staff to attend falls teaching sessions to set expectations around completion of the falls care plan, risk assessment and strategies to manage risks identified. Development of close supervision/1:1 staff policy

Case 3: • Documentary evidence needed at each visit to confirm that patients care needs are being met appropriately standard operating procedure has been updated to reflect this and education arranged. Team aware of importance of the sensitivity of integrated working relationships; this case has highlighted the importance of team discussion and debate to accurately identify timely intervention.

• Referral by community team to social services not acknowledged or actioned; The Deputy Director of Nursing is to work with Social Services to clarify and explore referral process to them and agree a monitoring timescale.

(5a) LESSONS LEARNT: Following closure of SIRI cases, the learning is shared across the Trust via various methods: Trust’s monthly Quality reports; organisational and local Quality Governance meetings; audits; newsletters; clinical education, Morbidity & Mortality groups. Outcomes are also captured via quarterly collation of outcomes by subject, e.g. communication, clinical care, education etc., and is available for staff to access via the SIRI page of the Trust’s intranet site.

(6) OVERVIEW OF SIRI SUBJECTS: The following table demonstrates the key subject matter of the SIRI’s: 1st April 2015 to 31st March 2016 are the lower blue blocks in each pairing and 1st April 2016 to 31st October 2016 are the upper blocks in purple.

6 | SIRI activity report

(7) ACTION PLANS: The Quality Governance Team, together with the Clinical Business Units continues to monitor and update all actions plans arising from previous/current SIRI cases. Completed action plans are then forwarded to Patient Safety, Experience and Clinical Effectiveness Committee for review and final sign off.

Sarah Johnston Acting Executive Director of Nursing & Quality November 2016

Paper produced and prepared by: Karen Kitcher, Quality Assurance Lead (08.11.16) Deborah Matthews, Deputy Director of Quality (24.11.2016)

7 | SIRI activity report

Enc F

REPORT TO THE TRUST BOARD (Part 1 - Public) ON 7th December 2016

Title Safer Staffing Report for Nursing and Midwifery for December 2016 (September and October data) Sponsoring Sarah Johnston, Acting Executive Director of Nursing & Quality Executive Director Author(s) Sarah Johnston, Acting Executive Director of Nursing & Quality Purpose For assurance Action required by Receive X Approve the Board: Previously considered by (state date): Sub-Committee Dates Key Issues, Concerns and Discussed Recommendations from Sub Committee Trust Executive Committee

Audit and Corporate Risk Committee

Charitable Funds Committee Finance, Investment, Information & Workforce Committee Mental Health Act Scrutiny Committee Remuneration & Nominations Committee Quality Governance Committee Foundation Trust Programme Board Please add any other committees below as needed Board Seminar

Other (please state) Staff, stakeholder, patient and public engagement: None

Executive Summary & Analysis: • The Trust achieved an improved overall position from August for nurse fill rates. We have achieved more ward areas in the amber and red rating particularly for RN’s in the day. • Specific ward areas with staffing issues include Woodlands, Shackleton and MAAU. Woodlands and Shackleton have received additional support to ensure adequate booking of temporary staffing in good time to achieve the staffing requirements. MAAU is significantly below requirement at only 77% of planned hours achieved. This is our busiest area and is high acuity and dependency and a deep dive into this area is now required as this is not improving from August. • Sickness rates remain above 3% in most areas • Bank and agency fill rates are good; 83% of Bank and agency requests were met. Agency requests continue to be lower than earlier in the year and this is driven down by our cohorts of overseas nurses achieving registration and filling RN vacancies, alongside the roster management and Matrons are working on • Maternity absence is a potential risk for the organisation. It is identified that CCU will have 4 staff on maternity leave and this level of absence will need to be covered. Proposals for strategies to manage this are being sought from Heads of Nursing & Quality to enable an

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approach other than bank and agency to be considered. This will be done jointly with the HR recruitment team. • The 6 monthly report has not been delivered to the Board as planned. This report was rescheduled for December, to allow for establishment reviews to be completed. Whilst this has been achieved a number of issues have been raised, in particular a concern about breaks for staff at night, and a potential further of review of surgical areas being required. The Board should note that the 6 monthly report will now be at the next Trust Board to enable the recommendation for nurse staffing to take account of this.

Recommendation to the Board: The Board is recommended to receive this report as assurance that a level of staffing is being achieved against the backdrop of significant nursing and support staff vacancies.

Attached Appendices & Background papers: Appendices are provided (referenced in paper)

For following sections – please indicate as appropriate:

Trust Goals & Priorities Excellent patient care Skilled and capable staff Principal Risks (BAF) Principal Risk 674 – Quality Governance Legal implications, regulatory and The National Quality Board guidance sets out requirements of consultation requirements the Board in relation to safe staffing - the Board should receive nurse staffing data on a monthly basis.

Date 30th November 2016 Completed by: Sarah Johnston, Acting Executive Director of Nursing & Quality

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EXECUTIVE DIRECTOR OF NURSING Monthly Safer Staffing Report December 2016 Report Sept and October 2016 POSITION

1. Monthly data

1.1. Care Hours per Patient per Day (CHPPPD) is an automatic calculation provided by the input of our data. The measure indicates, for each ward area, and by registered and non- registered staff, the number of care hours available for each person in a 24 hour period.

1.2. The measure will be utilised to benchmark against other organisations and ward types. The summary measure provides only an average and this is not adequate assurance for the Board as areas differ greatly in levels of care needed. Intensive Care, for example, would be expected to be significantly higher CHPPPD than a rehab ward which relies on a more diverse group of professionals to provide care to patients, not just nurses. The Board should consider the more detailed ward measures as a better indicator of the provision of care for each ward or patient group.

1.3. For September, CHPPPD indicates our organisation provides an average of 4.5 hours of Registered Nursing Care and an average of 3.2 hours of Care staff time. See Appendix 1, Table 1. This is similar to both the month previous (Aug) and also October. It was expected that we would be able to benchmark ourselves against other hospitals but data is not now going to be provided in this way. This measure will therefore be for an internal measure and to use to assure nursing that care hours are adequate, improving or deteriorating. Nursing will be considering how best to utilise this measure going forward in conjunction with a potential upgrade of our MAPs system (used for monitoring shifts)

1.4. Drilling down into ward areas (see Appendix 1, table 2) there is a range of provision of nurse’s hours for patients. Colwell and Rehab have below 3 hours of RN care per day and below 3 hours for HCA care. Although we do not have a current target or benchmark below 3 hours a day is low number. For rehab the ward will have other disciplines attending patients which we are not able to capture however Colwell manages acute patients and a number of dementia patients which require higher care. This will be reviewed.

1.5. Overall, the Trust achieved over 90% fill rate for RN and HCA in day and night, however, the overall measure is an average of all area and there are still significant challenges for acute Inpatient and Mental Health wards. Of the twenty areas that combine to make up the overall measure – eight areas were below 90% fill rate for RN on day shifts which is a significant improvement from thirteen areas below 90% in the previous report. There have been reviews of both Shackleton and Woodlands and plans put in place to maintain staffing whilst recruitment is being achieved. One area was below 80% - this is MAAU..

1.6. Woodlands (Mental Health) rehab had been significantly understaffed for both RN and HCA during August and this was reported in the previous report. As discussed above, a review has been undertaken to ensure staffing is in place for Woodlands, agency and bank are being utilised for this. This area has recently closed to admissions due to the high acuity of patients and we know that the low level of staffing is preventing patients being able to go on escorted leave.

1.7. Medical Assessment Unit has been below planned hours during August in the day and this remains the same from Unify data despite agency/bank nurses being available. This area is one of our busiest areas with our most acute patients and quality KPI’s from September indicate this area is under pressure. An assurance report is being sought from the MAU

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team to understand the situation and to ensure staff are booking the required number of nurses needed to maintain safety. Sickness is higher than 3% target at 4.3% but not as high as other areas.

1.8. Three areas have had low staffing at night – below 80%. These areas are utilising HCA cover at night where RN cover is not available.

1.9. For short term staffing bank staff are utilised where possible and we achieved a 83% fill rate for temporary RN staffing in October. This includes agency. Appendix 1 Graph 4c and 4d indicate the number of requests and the number of shifts filled for temporary staffing and it is clear that agency requests are diminishing during this quarter compared to earlier in the year.

1.10. See Appendix 1 Table 1 - Unify average fill rate data for each ward and quality and safety indicators.

1.11. See Appendix 1 Table 2, - Safe Staffing average fill rates over time against our locally set target of 90% fill rate.

1.12. Staff sickness is above 3% in most areas. This is not improving and directly links to requirement for bank and agency.

1.13. See Appendix 1 Table 5. Information and analysis is provided to support review of this for the Board.

2. Assessment of monthly position

2.1. The monthly position is improved: more areas are achieving amber and green in the achieved hours against planned.

2.2. The overall position can hide areas that are having difficulty as ITU and CCU, areas that require higher patient to staff ratio’s, bring the average up. The position is improved for October however we are aiming for 95% fill rate and a number of areas are below this , some significantly. This is discussed with the Heads of Nursing & Quality at the Director of Nursing team (DNT) meeting to ensure assurance of patient safety can be provided. We know that staff are under significant pressure with the volume of patients and the pressure on flow through the system and we are seeking ways to gain assurance of safety alongside the data provided by Unify.

2.3. Despite an overall improved position, there are a number of shifts that are reported as low on staffing by staff working and we are not always capturing high risk days.

2.4. Covering sickness, either long or short term is a challenge for all the ward managers. Linking into the health and wellbeing agenda to consider preventative strategies is required as well as good staff management.

2.5. Maternity leave cover is not accounted for in ward budgets. There are a number of staff planning maternity leave in the next few months – identified initially on CCU where 4 staff will be off at the same time. Strategies for managing this other than with bank and agency are required and will be considered at DNT, linking in with HR department.

3. Actions in place

3.1. Establishment reviews have been completed however this work is not completed due to issues raised over break times at night, and also further review of surgical areas potentially required. This will identify requirements for 2016/2017

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3.2. Agency planning for areas that cannot achieve bank and have vacancies that impact on safe effective care are being well managed with a planned approach to using temporary staff. This is utilising agency at the lowest cost times (i.e. not weekends or night) to reduce spend.

3.3. Datix report to be established as part of reporting mechanism. In particular this will highlight where staff are moving to other areas to cover contingency areas and are perhaps not being taken off their usual MAPS roster.

3.4. We continue with our recruitment drive in the Philippines and our next cohort will arrive in April or May 2017.

3.5. A recruitment drive for Mental Health staff in Ireland took place.

3.6. The training programme to improve management and use of the MAPS system continues. There was initially thought to be significant improvement however this has dropped significantly although Heads of Nursing believe there to be a reporting issue. This has been discussed at the Operational Management Group and a clear message on expectation has been sent.

3.7. Community staffing needs to be incorporated into the safe staffing reporting, as does theatres and day surgery. This is being planned for.

Sarah Johnston Acting Executive Director of Nursing & Quality

Prepared by: Sarah Johnston Acting Executive Director of Nursing November 2016

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Appendix 1

Table 1. Site Summary of Nurse staffing Data as per Unify report 1a September 2016

R1F Isle Of Wight NHS Trust September_2016-17 Day Night Registered midwives/nurses Care Staff Registered midwives/nurses Care Staff Day Night Care Hours Per Patient Day (CHPPD)

Cumulative Average fill Average fill count over rate - rate - the month of Registere Total monthly Total monthly Total monthly Total monthly Total monthly Total monthly Total monthly Total monthly registered Average fill registered Average fill patients at d planned staff actual staff planned staff actual staff planned staff actual staff planned staff actual staff nurses/midwiv rate - care nurses/midwi rate - care 23:59 each midwives Care Site Code Site Name hours hours hours hours hours hours hours hours es (%) staff (%) ves (%) staff (%) day / nurses Staff Overall R1F01 ST MARY'S HOSPITAL 30724.2 28307.5 18799.75 18437 14223.75 13388.75 8699.5 10555.5 92.1% 98.1% 94.1% 121.3% 9167 4.5 3.2 7.7

1b October 2016

R1F Isle Of Wight NHS Trust October_2016-17 Day Night Registered midwives/nurses Care Staff Registered midwives/nurses Care Staff Day Night Care Hours Per Patient Day (CHPPD)

Cumulative Average fill Average fill count over rate - rate - the month of Registere Total monthly Total monthly Total monthly Total monthly Total monthly Total monthly Total monthly Total monthly registered Average fill registered Average fill patients at d planned staff actual staff planned staff actual staff planned staff actual staff planned staff actual staff nurses/midwiv rate - care nurses/midwi rate - care 23:59 each midwives Care Site Code Site Name hours hours hours hours hours hours hours hours es (%) staff (%) ves (%) staff (%) day / nurses Staff Overall R1F01 ST MARY'S HOSPITAL 33146.5 30258.754 20509.75 21249.167 15841.25 14847.917 9582 11420.584 91.3% 103.6% 93.7% 119.2% 9523 4.7 3.4 8.2

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Table 2. Percentage rate and KPI’s for each area, RAG rated 2a September 2016

Sep-16 Day Night Care Hours Per Patient Day (CHPPD) Cumulative Average fill Average count over Average fill rate - rate - Average fill Registered fill rate - the month Mandatory Pre ssure Ward name registered registered rate - care midwives/ Care Staff Overall Sickness Falls care of patients Training Ulcers nurse s/midw ive s (%) nurse s/mid staff (%) nurses staff (%) at 23:59 w i ve s (%) each day SHACKLETON 85.1% 79.2% 101.5% 96.1% 208 4.8 8.6 13.4 5.0% 93% 1 0 ALVERSTONE WARD 91.1% 93.9% 98.3% 119.3% 377 3.9 2.2 6.2 14.4% 73% 0 0 SEAGROVE 89.6% 123.6% 143.5% 113.2% 216 9.0 9.3 18.3 3.2% 80% 0 0 OSBORNE 94.9% 89.9% 97.5% 104.7% 483 4.2 3.3 7.5 6.2% 87% 0 0 MOTTISTONE 96.9% 104.9% 100.8% - 273 6.0 1.5 7.5 8.2% 81% 0 0 ST HELENS 87.5% 92.0% 100.0% 100.0% 428 3.8 2.5 6.2 5.6% 81% 0 2 STROKE 88.3% 120.4% 66.7% 180.5% 775 3.2 3.8 7.0 10.8% 79% 0 1 REHAB 81.6% 80.9% 100.3% 103.3% 900 2.6 2.6 5.2 3.7% 76% 0 0 WHIPPINGHAM* 188.5% 168.8% 100.0% 273.3% 789 3.1 2.8 5.9 6.8% 61% 2 1 COLWELL 86.1% 93.9% 72.4% 135.5% 821 3.1 2.8 5.8 0.7% 78% 0 0 INTENSIVE CARE UNIT 86.7% 122.8% 97.1% 130.6% 182 26.1 2.8 28.9 3.0% 74% 0 4 CORONARY CARE UNIT 90.2% 81.3% 90.2% 93.3% 520 6.8 1.6 8.3 3.7% 78% 1 6 NEONATAL INTENSIVE 97.7% 78.1% 96.7% 96.7% 49 31.3 12.4 43.7 CARE UNIT 6.8% 78% 0 0 MEDICAL ASSESSMENT 81.8% 86.1% 105.4% 90.5% 767 4.1 2.5 6.6 UNIT 4.3% 75% 3 5 AFTON 106.5% 88.8% 100.0% 135.2% 336 4.8 5.4 10.2 5.5% 94% 0 0 PAEDIATRIC WARD 83.3% 87.9% 85.6% 100.0% 136 15.9 5.1 21.0 1.7% 74% 0 0 MATERNITY 103.0% 101.0% 100.6% 106.2% 219 14.0 8.0 22.0 5.3% 79% 0 0 WOODLANDS 98.6% 42.9% 100.0% 100.0% 180 6.1 3.3 9.4 15.8% 81% 0 0 LUCCOMBE WARD 92.5% 136.2% 100.0% 135.7% 682 2.8 3.2 6.0 3.3% 67% 2 4 APPLEY WARD 87.8% 100.6% 74.8% 121.4% 826 3.1 2.9 5.9 3.9% 78% 2 0 *Ward template set to 16 beds only and 27 beds utilised 95% - 100% fill rate <=3% >75% 0 0 90% - 94.9% fill rate 4% 70 - 75% 2 2 <90% fill rate <4% <70% >2 >2

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2b October 2016 (NB Data availability issue for Quality KPI’s for October)

Oct-16 Day NigOt Care Hours Per Patient Day (CHPPD) Cumulative Average fill rate - count over Average fill rate - Registered Average fill rate - registered Average fill rate - tOe montO Care Ward name registered midwives/ Overall care staff (%) nurse s/midw ive s care staff (%) of patients Staff nurse s/midw ive s (%) nurses (%) at 23:59 eacO day SHACKLETON 99.9% 87.8% 103.0% 104.1% 208 5.6 9.8 15.4 ALVERSTONE WARD 91.1% 102.2% 100.3% 138.0% 355 4.3 2.7 7.0 SEAGROVE 87.5% 121.2% 111.9% 105.8% 229 7.8 8.6 16.4 OSBORNE 103.2% 108.2% 99.8% 93.6% 542 4.0 3.3 7.3 MOTTISTONE 91.1% 105.0% 99.8% - 272 5.9 1.5 7.4 ST HELENS 91.0% 89.7% 100.0% 96.8% 416 4.0 2.5 6.6 STROKE 80.4% 99.9% 71.0% 146.1% 784 3.1 3.2 6.3 REHAB 82.2% 89.5% 99.9% 96.8% 947 2.4 2.6 5.0 WHIPPINGHAM* 190.9% 173.7% 100.0% 300.9% 829 3.2 2.9 6.0 COLWELL 77.2% 104.9% 72.0% 132.3% 849 2.8 2.9 5.7 INTENSIVE CARE UNIT 81.8% 139.8% 95.9% 144.4% 182 25.9 2.8 28.8 CORONARY CARE UNIT 90.1% 82.0% 91.8% 100.0% 546 6.6 1.6 8.2 NEONATAL INTENSIVE 90.3% 87.3% 96.1% 100.5% 58 25.8 11.7 37.4 CARE UNIT MEDICAL ASSESSMENT 77.2% 95.8% 119.4% 92.4% 821 3.9 2.6 6.6 UNIT AFTON 103.2% 111.9% 100.0% 149.6% 270 5.9 8.2 14.1 PAEDIATRIC WARD 89.6% 79.0% 80.6% 93.5% 187 12.2 3.5 15.7 MATERNITY 100.2% 102.5% 94.6% 100.4% 251 11.7 7.5 19.3 WOODLANDS 91.6% 68.5% 93.5% 100.0% 217 4.8 3.6 8.4 LUCCOMBE WARD 99.2% 129.2% 100.0% 136.0% 703 2.9 3.2 6.0 APPLEY WARD 84.1% 107.9% 75.3% 126.0% 857 2.9 3.0 6.0 *Ward template set to 16 beds only and 27 beds utilised 95% - 100% fill rate 90% - 94.9% fill rate <90% fill rate

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Table 3. Safer staffing levels overall since July 2014

Average fill rate for Nurses and Midwives Inpatient areas Acute and Mental Health (local target 90%) 130.0% 120.0% 110.0% 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16

Average Fill rate - Registered nurses/midwives (Day) Average Fill rate - Care staff (Day) Average Fill rate - Registered nurses/midwives (Night) Average Fill rate - Care staff (Night)

Page 9 of 16

Table 4: Bank and Agency Fill rates 4a Fill rates September 2016

Fill rate for Bank and Agency September 2016

1435 1500 1210

1000 712 548 Filled Requested 500 243 258

0 Registered Non Registered Agency Registered

4b Fill rates October 2016

Fill rate for Bank and Agency October 2016

1398 1500 1138

1000 817 652 Filled

500 Requested 169 175

0 Registered Non Registered Agency Registered

4c Request rates for temporary staffing

3500

3000

2500

2000 HCA bank requests 1500 Agency requests

1000 RN Bank requests

500

0

4d Fill rates for temporary staffing

Page 10 of 16

2500

2000

1500 HCA bank filled 1000 Agency filled RN Bank filled 500

0 Jul-16 Jan-16 Jun-16 Oct-16 Apr-16 Feb-16 Sep-16 Dec-15 Aug-16 Mar-16 May-16

Page 11 of 16

Tables 5a, 5b, 5c and 5d Shift by Shift Data September and October 2016

• The National Quality Board Guidance – ‘How to ensure the right people with the right skills, are in the right place at the right time’ (2014) sets out expectations in relation to manging and obtaining assurance around nurse staffing. Expectation 1 (Accountability and Responsibility) states ‘Boards monitor staffing capacity and capability through regular and frequent reports on actual staff on duty on a shift by shift basis, versus planned staff staffing levels.’ (p5, p 12).

• The purpose of this data is to highlight those wards where staffing capacity (i.e. numbers) and capability (RN and HCA is a guide to this) frequently falls short of what is required to provide quality care for patients.

• Where areas fall below 80% of expected staffing this would be flagged red. This report highlights where areas are either frequently red or consistently red over a period of time.

• The organisation should understand the gap and take actions to address this.

Summary and analysis of data

• Red rated areas at night are much less prevalent and in a particular area that we are aware of and consistent. Through the establishment reviews we have looked at where skill mix or numbers are consistently under and considered if that needs to be in place or covered differently.

• We require further assurance that staff are escalating correctly if they feel their area is short of staff on the day and their areas needs support. Training in using the new escalation process is planned to be implemented during Sept/Oct to support this.

Page 12 of 16

Table 5a Registered Nurses Shift by Shift data September 2016 Sum of RN% Column Labels Row Labels 01/09/2016 02/09/2016 03/09/2016 04/09/2016 05/09/2016 06/09/2016 07/09/2016 08/09/2016 09/09/2016 10/09/2016 11/09/2016 12/09/2016 13/09/2016 14/09/2016 15/09/2016 16/09/2016 17/09/2016 18/09/2016 19/09/2016 20/09/2016 21/09/2016 22/09/2016 23/09/2016 24/09/2016 25/09/2016 26/09/2016 27/09/2016 28/09/2016 29/09/2016 30/09/2016 Grand Tota Afton Ward J61794 150% 150% 100% 150% 150% 150% 200% 150% 150% 150% 100% 150% 100% 100% 200% 150% 100% 150% 100% 100% 100% 100% 100% 150% 150% 100% 100% 100% 100% 100% 128% Alverstone Ward J61111 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% Colwell Ward J61254 100% 100% 60% 60% 80% 100% 100% 80% 120% 120% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 120% 100% 100% 80% 80% 100% 100% 100% 100% 100% 96% Coronary Care J61190 100% 100% 100% 100% 80% 80% 80% 80% 120% 80% 80% 100% 100% 100% 80% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 100% 100% 80% 80% 100% 94% Intensive Care Unit J61120 100% 100% 86% 86% 86% 86% 86% 100% 100% 86% 100% 114% 100% 100% 100% 100% 100% 100% 86% 100% 100% 129% 100% 100% 86% 100% 100% 100% 100% 86% 97% MAAU J61231 100% 120% 100% 80% 120% 100% 100% 60% 100% 80% 100% 80% 100% 100% 100% 100% 100% 100% 80% 120% 100% 100% 100% 100% 100% 120% 80% 100% 100% 120% 99% Maternity Services J61500 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 125% 100% 100% 101% Mottistone Suite J61090 100% 100% 100% 100% 100% 100% 150% 150% 100% 100% 100% 150% 100% 100% 100% 100% 100% 100% 150% 100% 150% 100% 100% 100% 100% 150% 150% 150% 100% 50% 112% Neonatal Intensive Care Unit J61 50% 100% 100% 100% 100% 100% 150% 200% 100% 100% 100% 150% 150% 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 107% Osborne Ward J61915 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 50% 100% 50% 150% 100% 100% 100% 100% 150% 100% 100% 103% Paediatric Ward J61372 100% 100% 100% 100% 75% 75% 75% 100% 50% 100% 100% 100% 75% 75% 100% 100% 100% 100% 75% 75% 100% 75% 75% 100% 133% 75% 100% 75% 75% 75% 88% Seagrove Ward J61916 100% 150% 100% 100% 150% 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 107% Shackleton J61791 200% 200% 200% 200% 200% 100% 200% 200% 200% 200% 200% 200% 100% 100% 100% 100% 100% 200% 200% 100% 100% 200% 100% 200% 100% 100% 100% 200% 100% 100% 153% St Helens Ward J61102 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% Whippingham Ward J61101 200% 250% 150% 250% 200% 250% 250% 200% 200% 250% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 207% Woodlands J61913 100% 100% 100% 100% 200% 100% 100% 100% 100% 100% 100% 100% 200% 100% 100% 100% 100% 100% 100% 200% 100% 100% 100% 100% 100% 100% 200% 100% 100% 100% 113% Appley Ward J61250 100% 100% 100% 75% 100% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 100% 100% 100% 100% 100% 120% 100% 100% 100% 100% 80% 120% 100% 100% 120% 100% Luccombe Ward J61112 133% 100% 100% 100% 100% 67% 100% 133% 100% 100% 100% 100% 100% 133% 100% 167% 100% 100% 100% 100% 100% 133% 133% 100% 133% 133% 100% 100% 100% 100% 109% The Stroke Unit J61221 100% 80% 100% 80% 120% 100% 120% 80% 80% 100% 100% 100% 120% 120% 100% 100% 100% 100% 100% 100% 100% 120% 100% 80% 80% 100% 100% 100% 100% 100% 99% General Rehabilitation Unit J612 60% 80% 100% 100% 100% 100% 100% 120% 100% 125% 100% 120% 100% 100% 100% 80% 100% 100% 100% 100% 80% 100% 100% 100% 100% 80% 100% 100% 80% 80% 96% Accident & Emergency J61230 71% 57% 86% 100% 71% 86% 86% 100% 114% 100% 86% 100% 86% 86% 100% 100% 100% 71% 86% 100% 86% 86% 100% 100% 100% 86% 86% 86% 100% 100% 90% Grand Total 100% 103% 97% 99% 103% 100% 107% 107% 105% 106% 101% 110% 103% 103% 105% 105% 103% 101% 100% 101% 104% 105% 103% 103% 103% 101% 104% 105% 97% 100% 103%

Vlook Late

Sum of RN% Column Labels Row Labels 01/09/2016 02/09/2016 03/09/2016 04/09/2016 05/09/2016 06/09/2016 07/09/2016 08/09/2016 09/09/2016 10/09/2016 11/09/2016 12/09/2016 13/09/2016 14/09/2016 15/09/2016 16/09/2016 17/09/2016 18/09/2016 19/09/2016 20/09/2016 21/09/2016 22/09/2016 23/09/2016 24/09/2016 25/09/2016 26/09/2016 27/09/2016 28/09/2016 29/09/2016 30/09/2016 Grand Tota Afton Ward J61794 150% 150% 150% 100% 100% 100% 150% 200% 100% 100% 150% 100% 100% 150% 150% 100% 200% 150% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 122% Alverstone Ward J61111 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% Colwell Ward J61254 75% 125% 75% 75% 100% 125% 125% 75% 125% 125% 100% 100% 100% 100% 100% 100% 100% 100% 100% 125% 100% 100% 100% 75% 100% 100% 100% 125% 100% 100% 102% Coronary Care J61190 100% 100% 100% 100% 80% 100% 80% 80% 80% 80% 100% 100% 100% 80% 80% 100% 100% 100% 100% 80% 100% 100% 80% 100% 100% 100% 100% 100% 100% 100% 94% Intensive Care Unit J61120 100% 100% 86% 86% 86% 86% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 86% 100% 100% 71% 114% 100% 100% 100% 100% 100% 86% 86% 96% MAAU J61231 100% 100% 100% 80% 120% 80% 100% 60% 100% 100% 80% 80% 100% 100% 100% 100% 100% 100% 100% 120% 80% 100% 100% 100% 100% 120% 80% 100% 100% 100% 97% Maternity Services J61500 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Mottistone Suite J61090 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 103% Neonatal Intensive Care Unit J61 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 150% 150% 150% 100% 100% 100% 100% 100% 150% 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 110% Osborne Ward J61915 100% 100% 100% 150% 100% 100% 150% 100% 100% 100% 100% 100% 100% 150% 150% 100% 100% 150% 150% 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 113% Paediatric Ward J61372 100% 100% 100% 100% 75% 100% 100% 75% 100% 100% 100% 100% 100% 100% 75% 100% 100% 100% 100% 75% 75% 75% 75% 100% 100% 100% 100% 75% 75% 75% 91% Seagrove Ward J61916 150% 100% 100% 100% 100% 50% 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 100% 103% Shackleton J61791 100% 200% 200% 100% 200% 100% 200% 200% 100% 200% 100% 100% 100% 100% 100% 200% 100% 100% 100% 100% 200% 100% 200% 100% 200% 200% 100% 200% 100% 100% 140% St Helens Ward J61102 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Whippingham Ward J61101 200% 200% 150% 250% 200% 200% 250% 150% 200% 250% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 202% Woodlands J61913 200% 100% 100% 100% 100% 100% 200% 200% 100% 100% 100% 200% 200% 200% 100% 100% 100% 100% 100% 200% 100% 0% 100% 100% 200% 100% 100% 200% 100% 100% 127% Appley Ward J61250 100% 100% 100% 75% 100% 125% 100% 125% 100% 125% 100% 100% 125% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 75% 100% 100% 100% 100% 125% 103% Luccombe Ward J61112 100% 100% 67% 67% 67% 67% 67% 133% 100% 100% 100% 100% 67% 133% 67% 100% 100% 67% 67% 133% 67% 100% 133% 100% 133% 100% 67% 100% 100% 100% 93% The Stroke Unit J61221 100% 100% 100% 75% 100% 100% 125% 100% 100% 100% 100% 100% 125% 125% 100% 100% 100% 100% 100% 125% 100% 125% 100% 100% 75% 100% 100% 100% 100% 100% 103% General Rehabilitation Unit J612 75% 75% 75% 100% 100% 100% 100% 100% 100% 100% 100% 125% 100% 100% 100% 100% 100% 100% 100% 100% 125% 75% 100% 100% 100% 50% 75% 100% 75% 100% 95% Accident & Emergency J61230 63% 50% 75% 88% 75% 88% 75% 100% 88% 88% 88% 100% 88% 88% 88% 88% 100% 63% 88% 100% 88% 88% 100% 100% 100% 75% 75% 88% 100% 100% 86% Grand Total 100% 100% 96% 96% 97% 100% 107% 103% 101% 106% 103% 106% 106% 109% 101% 103% 106% 100% 100% 109% 101% 96% 104% 103% 106% 100% 96% 104% 100% 103% 102%

Vlook Night

Sum of RN% Column Labels Row Labels 01/09/2016 02/09/2016 03/09/2016 04/09/2016 05/09/2016 06/09/2016 07/09/2016 08/09/2016 09/09/2016 10/09/2016 11/09/2016 12/09/2016 13/09/2016 14/09/2016 15/09/2016 16/09/2016 17/09/2016 18/09/2016 19/09/2016 20/09/2016 21/09/2016 22/09/2016 23/09/2016 24/09/2016 25/09/2016 26/09/2016 27/09/2016 28/09/2016 29/09/2016 30/09/2016 Grand Total Afton Ward J61794 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Alverstone Ward J61111 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% Colwell Ward J61254 67% 67% 67% 67% 100% 67% 100% 100% 67% 100% 67% 67% 67% 100% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 72% Coronary Care J61190 80% 80% 100% 80% 100% 100% 80% 100% 80% 80% 100% 80% 100% 80% 100% 100% 80% 100% 80% 100% 100% 100% 100% 80% 80% 100% 80% 100% 100% 80% 91% Intensive Care Unit J61120 86% 86% 86% 86% 86% 86% 100% 100% 100% 86% 86% 114% 114% 114% 114% 86% 86% 86% 86% 100% 100% 100% 86% 100% 100% 100% 86% 100% 86% 86% 94% MAAU J61231 100% 100% 100% 100% 133% 133% 100% 100% 100% 133% 133% 133% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 67% 100% 100% 100% 100% 100% 100% 133% 106% Maternity Services J61500 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 75% 75% 75% 98% Mottistone Suite J61090 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Neonatal Intensive Care Unit J61 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% Osborne Ward J61915 100% 100% 100% 150% 150% 150% 100% 100% 100% 100% 50% 50% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Paediatric Ward J61372 67% 67% 67% 100% 67% 100% 100% 100% 100% 100% 67% 100% 100% 100% 100% 67% 67% 67% 100% 67% 100% 100% 67% 67% 67% 100% 67% 100% 100% 100% 86% Seagrove Ward J61916 100% 100% 100% 100% 100% 150% 50% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% Shackleton J61791 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% St Helens Ward J61102 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Whippingham Ward J61101 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Woodlands J61913 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Appley Ward J61250 33% 67% 67% 67% 100% 100% 100% 100% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 100% 100% 100% 67% 67% 67% 67% 100% 100% 67% 67% 67% 76% Luccombe Ward J61112 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% The Stroke Unit J61221 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% General Rehabilitation Unit J612 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Accident & Emergency J61230 100% 100% 100% 100% 75% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% Grand Total 88% 89% 91% 93% 96% 100% 95% 96% 93% 95% 91% 93% 95% 96% 96% 91% 89% 91% 93% 93% 95% 95% 89% 91% 91% 96% 91% 93% 91% 91% 93%

Page 13 of 16

Table 5b Health Care Assistants Shift by Shift Data September 2016 Vlook Early

Sum of HCA % Column Labels Row Labels 01/09/2016 02/09/2016 03/09/2016 04/09/2016 05/09/2016 06/09/2016 07/09/2016 08/09/2016 09/09/2016 10/09/2016 11/09/2016 12/09/2016 13/09/2016 14/09/2016 15/09/2016 16/09/2016 17/09/2016 18/09/2016 19/09/2016 20/09/2016 21/09/2016 22/09/2016 23/09/2016 24/09/2016 25/09/2016 26/09/2016 27/09/2016 28/09/2016 29/09/2016 30/09/2016 Grand Total Afton Ward J61794 50% 50% 100% 50% 50% 100% 0% 100% 100% 50% 150% 100% 100% 100% 50% 50% 150% 100% 150% 100% 100% 150% 150% 150% 100% 150% 100% 100% 100% 150% 98% Alverstone Ward J61111 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% Colwell Ward J61254 125% 150% 125% 125% 100% 100% 100% 150% 125% 75% 125% 100% 100% 100% 100% 100% 100% 125% 100% 100% 75% 100% 100% 100% 100% 100% 100% 100% 125% 100% 108% Coronary Care J61190 50% 100% 100% 100% 100% 50% 100% 50% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 50% 100% 50% 100% 100% 100% 100% 50% 50% 50% 100% 100% 85% Intensive Care Unit J61120 200% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 0% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 118% MAAU J61231 100% 67% 100% 133% 100% 133% 67% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 133% 100% 133% 100% 100% 100% 133% 100% 100% 100% 103% Maternity Services J61500 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 50% 100% 50% 50% 50% 25% 50% 25% 50% 50% 50% 50% 50% 50% 50% 66% Mottistone Suite J61090 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% Neonatal Intensive Care Unit J61520 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Osborne Ward J61915 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 50% 100% 150% 100% 100% 50% 50% 50% 92% Paediatric Ward J61372 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Seagrove Ward J61916 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 50% 100% 50% 50% 100% 150% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 50% 100% 100% 90% Shackleton J61791 67% 67% 67% 33% 67% 67% 67% 67% 67% 67% 67% 67% 100% 100% 100% 67% 100% 67% 67% 100% 100% 67% 100% 33% 100% 100% 100% 67% 67% 100% 77% St Helens Ward J61102 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Whippingham Ward J61101 200% 100% 200% 150% 200% 200% 150% 200% 200% 150% 200% 200% 200% 200% 200% 200% 200% 100% 200% 200% 150% 150% 200% 150% 250% 200% 150% 200% 200% 200% 183% Woodlands J61913 0% 100% 100% 100% 0% 0% 0% 100% 100% 100% 0% 100% 0% 100% 0% 100% 0% 0% 0% 100% 100% 100% 100% 0% 100% 100% 0% 0% 100% 100% 57% Appley Ward J61250 100% 125% 140% 120% 150% 100% 125% 75% 75% 100% 100% 100% 100% 100% 100% 100% 100% 100% 75% 100% 75% 100% 100% 80% 80% 100% 125% 100% 100% 100% 102% Luccombe Ward J61112 100% 133% 133% 133% 133% 167% 133% 133% 133% 133% 133% 133% 133% 133% 133% 133% 100% 133% 100% 133% 133% 133% 100% 167% 100% 100% 133% 133% 133% 133% 129% The Stroke Unit J61221 150% 175% 125% 150% 125% 150% 125% 150% 175% 125% 175% 175% 125% 125% 125% 125% 125% 125% 125% 100% 125% 125% 125% 125% 150% 100% 125% 125% 125% 125% 134% General Rehabilitation Unit J61226 100% 75% 100% 100% 100% 125% 100% 100% 100% 100% 100% 75% 100% 100% 125% 100% 100% 75% 100% 75% 75% 75% 100% 75% 100% 50% 75% 100% 100% 100% 93% Accident & Emergency J61230 300% 200% 200% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 200% 100% 100% 100% 0% 100% 100% 100% 0% 100% 100% 100% 100% 110% Grand Total 113% 111% 118% 111% 107% 111% 98% 104% 113% 102% 113% 104% 104% 107% 104% 100% 111% 94% 98% 100% 94% 98% 104% 96% 109% 94% 100% 94% 106% 106% 104%

Vlook Late

Sum of HCA % Column Labels Row Labels 01/09/2016 02/09/2016 03/09/2016 04/09/2016 05/09/2016 06/09/2016 07/09/2016 08/09/2016 09/09/2016 10/09/2016 11/09/2016 12/09/2016 13/09/2016 14/09/2016 15/09/2016 16/09/2016 17/09/2016 18/09/2016 19/09/2016 20/09/2016 21/09/2016 22/09/2016 23/09/2016 24/09/2016 25/09/2016 26/09/2016 27/09/2016 28/09/2016 29/09/2016 30/09/2016 Grand Total Afton Ward J61794 50% 50% 50% 100% 150% 100% 50% 50% 150% 150% 100% 150% 150% 50% 100% 150% 0% 50% 150% 100% 150% 150% 150% 150% 100% 100% 150% 150% 150% 150% 110% Alverstone Ward J61111 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% Colwell Ward J61254 133% 167% 133% 133% 100% 67% 100% 133% 133% 67% 133% 100% 100% 100% 100% 100% 100% 100% 100% 67% 100% 100% 100% 100% 100% 67% 100% 67% 133% 100% 104% Coronary Care J61190 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 200% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 0% 0% 0% 90% Intensive Care Unit J61120 100% 100% 100% 100% 100% 0% 0% 100% 100% 100% 100% 100% 100% 100% 0% 200% 100% 100% 100% 100% 0% 100% 100% 100% 100% 0% 100% 100% 100% 0% 100% MAAU J61231 100% 67% 100% 133% 100% 133% 100% 67% 100% 100% 100% 100% 100% 100% 67% 100% 100% 100% 100% 100% 133% 100% 100% 133% 133% 100% 100% 100% 100% 100% 102% Maternity Services J61500 100% 100% 100% 100% 67% 100% 100% 100% 67% 100% 100% 67% 67% 67% 100% 100% 100% 60% 60% 40% 60% 40% 20% 40% 60% 40% 60% 60% 60% 60% 68% Mottistone Suite J61090 100% 100% 100% 100% 100% 100% 200% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 136% Neonatal Intensive Care Unit J61520 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Osborne Ward J61915 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 50% 50% 100% 100% 100% 100% 200% 100% 100% 100% 100% 100% 98% Paediatric Ward J61372 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Seagrove Ward J61916 100% 100% 100% 100% 100% 100% 50% 100% 150% 50% 100% 50% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 150% 100% 150% 100% 50% 98% Shackleton J61791 100% 67% 67% 100% 67% 100% 67% 67% 67% 67% 100% 67% 100% 100% 100% 67% 100% 67% 100% 67% 33% 100% 67% 67% 67% 67% 100% 67% 100% 100% 80% St Helens Ward J61102 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% Whippingham Ward J61101 100% 150% 150% 100% 150% 200% 50% 200% 200% 100% 200% 200% 200% 200% 200% 200% 200% 100% 150% 200% 150% 150% 200% 150% 200% 200% 150% 200% 200% 150% 167% Woodlands J61913 100% 0% 0% 100% 100% 100% 0% 0% 0% 100% 0% 0% 0% 0% 100% 100% 100% 100% 100% 0% 100% 100% 0% 100% 0% 100% 100% 0% 0% 0% 50% Appley Ward J61250 100% 133% 133% 133% 133% 67% 133% 67% 100% 133% 100% 133% 67% 100% 100% 100% 100% 100% 67% 100% 67% 133% 100% 100% 67% 100% 100% 67% 67% 67% 99% Luccombe Ward J61112 150% 200% 200% 250% 250% 200% 200% 100% 200% 150% 150% 150% 200% 100% 200% 150% 150% 200% 200% 100% 200% 100% 100% 150% 100% 100% 200% 150% 150% 150% 163% The Stroke Unit J61221 167% 167% 133% 200% 100% 133% 133% 167% 133% 100% 200% 200% 133% 133% 133% 133% 133% 133% 133% 100% 133% 133% 100% 133% 167% 133% 133% 133% 133% 133% 140% General Rehabilitation Unit J61226 75% 100% 100% 75% 75% 125% 100% 75% 100% 100% 100% 100% 100% 100% 125% 100% 75% 75% 75% 75% 100% 100% 100% 75% 100% 100% 100% 100% 100% 100% 94% Accident & Emergency J61230 200% 150% 150% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 50% 100% 100% 100% 50% 100% 150% 50% 50% 102% Grand Total 110% 112% 115% 126% 107% 107% 98% 100% 112% 103% 121% 110% 107% 100% 107% 112% 105% 98% 100% 86% 100% 102% 93% 100% 112% 93% 109% 102% 100% 91% 104%

Vlook Night

Sum of HCA % Column Labels Row Labels 01/09/2016 02/09/2016 03/09/2016 04/09/2016 05/09/2016 06/09/2016 07/09/2016 08/09/2016 09/09/2016 10/09/2016 11/09/2016 12/09/2016 13/09/2016 14/09/2016 15/09/2016 16/09/2016 17/09/2016 18/09/2016 19/09/2016 20/09/2016 21/09/2016 22/09/2016 23/09/2016 24/09/2016 25/09/2016 26/09/2016 27/09/2016 28/09/2016 29/09/2016 30/09/2016 Grand Total Afton Ward J61794 100% 100% 100% 100% 150% 150% 100% 150% 150% 150% 150% 100% 150% 150% 150% 150% 150% 150% 150% 100% 150% 150% 150% 150% 150% 150% 100% 150% 150% 150% 137% Alverstone Ward J61111 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 123% Colwell Ward J61254 150% 100% 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 100% 150% 100% 150% 100% 150% 150% 100% 150% 113% Coronary Care J61190 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 93% Intensive Care Unit J61120 100% 100% 100% 100% 100% 100% 0% 0% 0% 100% 100% 100% 100% 100% 0% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 91% MAAU J61231 100% 100% 67% 67% 67% 67% 100% 100% 67% 100% 100% 67% 133% 133% 67% 67% 67% 50% 67% 67% 100% 67% 67% 100% 133% 100% 100% 100% 100% 67% 87% Maternity Services J61500 50% 100% 100% 100% 100% 50% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 93% Mottistone Suite J61090 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Neonatal Intensive Care Unit J61520 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Osborne Ward J61915 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 102% Paediatric Ward J61372 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Seagrove Ward J61916 50% 100% 100% 150% 100% 100% 100% 150% 100% 100% 100% 100% 50% 50% 100% 150% 150% 150% 150% 150% 100% 50% 100% 50% 100% 100% 150% 100% 150% 100% 107% Shackleton J61791 50% 50% 50% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 93% St Helens Ward J61102 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Whippingham Ward J61101 300% 300% 300% 300% 300% 300% 300% 300% 200% 200% 200% 300% 200% 200% 300% 200% 300% 300% 300% 200% 300% 300% 300% 200% 300% 300% 300% 200% 300% 400% 273% Woodlands J61913 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Appley Ward J61250 150% 100% 150% 100% 100% 50% 100% 100% 150% 100% 150% 100% 150% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 150% 150% 100% 150% 150% 150% 100% 117% Luccombe Ward J61112 100% 150% 150% 150% 100% 150% 100% 150% 150% 150% 150% 150% 150% 150% 150% 100% 150% 150% 150% 150% 150% 150% 150% 150% 100% 150% 100% 100% 150% 100% 137% The Stroke Unit J61221 200% 200% 150% 200% 200% 200% 200% 200% 150% 150% 200% 200% 200% 200% 200% 150% 150% 200% 200% 200% 200% 200% 100% 150% 200% 200% 150% 100% 200% 200% 182% General Rehabilitation Unit J61226 133% 100% 100% 167% 167% 133% 67% 100% 100% 67% 100% 100% 100% 100% 67% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 103% Accident & Emergency J61230 200% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 200% 100% 100% 100% 100% 107% Grand Total 116% 113% 117% 128% 116% 113% 100% 123% 110% 114% 131% 116% 119% 116% 110% 113% 121% 125% 119% 110% 116% 116% 113% 114% 138% 123% 119% 110% 126% 119% 117%

Page 14 of 16

Table 5c Registered Nurses Shift by Shift data October 2016

Vlook Early

Sum of RN% Column Labels Row Labels 01/10/2016 02/10/2016 03/10/2016 04/10/2016 05/10/2016 06/10/2016 07/10/2016 08/10/2016 09/10/2016 10/10/2016 11/10/2016 12/10/2016 13/10/2016 14/10/2016 15/10/2016 16/10/2016 17/10/2016 18/10/2016 19/10/2016 20/10/2016 21/10/2016 22/10/2016 23/10/2016 24/10/2016 25/10/2016 26/10/2016 27/10/2016 28/10/2016 29/10/2016 30/10/2016 31/10/2016 Grand Total Afton Ward J61794 100% 100% 100% 100% 100% 100% 150% 150% 100% 100% 100% 150% 100% 100% 100% 100% 150% 100% 100% 100% 100% 150% 150% 100% 100% 100% 150% 100% 100% 150% 150% 115% Alverstone Ward J61111 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Colwell Ward J61254 100% 40% 100% 100% 80% 80% 100% 80% 100% 60% 80% 80% 60% 100% 100% 80% 80% 100% 100% 80% 80% 100% 80% 100% 80% 80% 80% 100% 100% 100% 80% 86% Coronary Care J61190 100% 100% 60% 100% 100% 100% 100% 100% 100% 80% 100% 80% 80% 100% 100% 120% 80% 80% 100% 100% 100% 120% 100% 80% 120% 140% 100% 120% 80% 80% 80% 97% Intensive Care Unit J61120 100% 100% 86% 86% 100% 100% 86% 100% 86% 100% 100% 100% 129% 100% 86% 86% 100% 100% 100% 86% 86% 86% 86% 86% 86% 100% 100% 100% 100% 100% 100% 95% MAAU J61231 100% 80% 80% 120% 80% 100% 100% 80% 120% 80% 80% 100% 80% 100% 100% 120% 100% 100% 100% 80% 100% 100% 120% 100% 60% 100% 100% 80% 100% 120% 80% 95% Maternity Services J61500 100% 100% 100% 100% 100% 100% 100% 100% 100% 125% 100% 100% 100% 100% 100% 75% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Mottistone Suite J61090 100% 100% 100% 200% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 103% Neonatal Intensive Care Unit J6 100% 100% 150% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 150% 100% 50% 100% 100% 100% 100% 102% Osborne Ward J61915 100% 100% 150% 100% 150% 100% 100% 100% 100% 200% 100% 150% 100% 100% 100% 50% 150% 100% 100% 100% 100% 150% 150% 150% 150% 100% 100% 150% 100% 100% 100% 116% Paediatric Ward J61372 100% 100% 75% 75% 100% 100% 75% 67% 100% 100% 100% 100% 75% 100% 100% 100% 100% 100% 100% 100% 100% 100% 133% 125% 75% 100% 100% 100% 100% 100% 100% 96% Seagrove Ward J61916 100% 100% 150% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% Shackleton J61791 100% 200% 200% 100% 100% 100% 100% 100% 100% 200% 200% 100% 200% 100% 200% 100% 200% 200% 100% 200% 100% 100% 200% 100% 100% 100% 200% 100% 200% 200% 100% 142% St Helens Ward J61102 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Whippingham Ward J61101 200% 200% 200% 200% 200% 200% 250% 250% 200% 200% 200% 200% 200% 200% 200% 200% 250% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 150% 200% 200% 203% Woodlands J61913 100% 200% 100% 100% 200% 100% 100% 100% 100% 100% 100% 100% 100% 200% 100% 100% 100% 200% 100% 200% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 116% Appley Ward J61250 75% 75% 100% 80% 100% 100% 100% 100% 75% 100% 80% 80% 100% 80% 125% 100% 80% 100% 100% 100% 100% 100% 125% 100% 100% 100% 100% 100% 100% 100% 120% 97% Luccombe Ward J61112 100% 133% 133% 100% 133% 100% 100% 100% 133% 133% 167% 100% 100% 167% 100% 100% 100% 133% 100% 100% 133% 100% 100% 133% 167% 133% 100% 133% 100% 133% 100% 118% The Stroke Unit J61221 80% 100% 80% 100% 100% 80% 100% 80% 80% 100% 100% 100% 100% 100% 100% 80% 80% 80% 80% 80% 100% 80% 80% 100% 80% 100% 100% 100% 100% 80% 80% 90% General Rehabilitation Unit J61 75% 100% 80% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 80% 80% 80% 80% 80% 100% 100% 80% 100% 100% 100% 80% 100% 75% 100% 93% Accident & Emergency J61230 71% 71% 86% 86% 100% 86% 86% 86% 100% 86% 100% 100% 71% 71% 86% 86% 86% 100% 100% 100% 100% 100% 86% 100% 71% 100% 71% 86% 86% 86% 71% 88% Grand Total 96% 97% 99% 101% 104% 99% 100% 99% 100% 103% 103% 101% 97% 103% 103% 97% 100% 101% 99% 100% 100% 104% 106% 103% 99% 105% 100% 103% 100% 103% 97% 101%

Vlook Late

Sum of RN% Column Labels Row Labels 01/10/2016 02/10/2016 03/10/2016 04/10/2016 05/10/2016 06/10/2016 07/10/2016 08/10/2016 09/10/2016 10/10/2016 11/10/2016 12/10/2016 13/10/2016 14/10/2016 15/10/2016 16/10/2016 17/10/2016 18/10/2016 19/10/2016 20/10/2016 21/10/2016 22/10/2016 23/10/2016 24/10/2016 25/10/2016 26/10/2016 27/10/2016 28/10/2016 29/10/2016 30/10/2016 31/10/2016 Grand Total Afton Ward J61794 100% 100% 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 150% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 150% 100% 100% 150% 200% 100% 113% Alverstone Ward J61111 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% Colwell Ward J61254 100% 75% 100% 75% 100% 100% 100% 100% 100% 75% 75% 75% 75% 125% 100% 75% 75% 100% 75% 100% 75% 100% 75% 100% 75% 75% 100% 100% 100% 100% 75% 90% Coronary Care J61190 100% 100% 100% 80% 100% 100% 100% 80% 80% 80% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 100% 100% 100% 100% 120% 80% 100% 100% 80% 100% 100% 96% Intensive Care Unit J61120 86% 86% 86% 86% 86% 100% 86% 86% 100% 100% 100% 86% 100% 100% 86% 86% 86% 86% 86% 71% 86% 71% 86% 86% 86% 100% 100% 100% 100% 100% 100% 90% MAAU J61231 80% 80% 80% 100% 80% 100% 100% 80% 120% 60% 80% 100% 80% 100% 80% 100% 80% 80% 80% 60% 100% 100% 120% 100% 60% 100% 100% 100% 100% 120% 80% 90% Maternity Services J61500 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 125% 75% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Mottistone Suite J61090 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 102% Neonatal Intensive Care Unit J6 100% 100% 100% 150% 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 150% 100% 200% 150% 100% 100% 100% 150% 113% Osborne Ward J61915 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 150% 100% 50% 100% 100% 100% 150% 150% 150% 200% 100% 100% 100% 100% 110% Paediatric Ward J61372 100% 100% 75% 75% 100% 75% 75% 100% 100% 125% 100% 100% 100% 125% 100% 100% 100% 100% 100% 100% 75% 100% 100% 75% 75% 100% 100% 100% 100% 100% 75% 95% Seagrove Ward J61916 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% Shackleton J61791 200% 200% 200% 200% 200% 200% 200% 100% 200% 100% 100% 200% 200% 100% 100% 100% 200% 100% 200% 100% 100% 200% 100% 100% 100% 100% 100% 100% 200% 200% 100% 148% St Helens Ward J61102 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Whippingham Ward J61101 200% 200% 200% 200% 200% 200% 200% 250% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 200% 100% 198% Woodlands J61913 100% 100% 200% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 200% 100% 100% 100% 100% 100% 100% 100% 100% 100% 106% Appley Ward J61250 50% 75% 75% 100% 100% 75% 100% 100% 75% 100% 75% 75% 100% 75% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 125% 100% 100% 100% 100% 94% Luccombe Ward J61112 67% 100% 100% 100% 133% 100% 67% 100% 67% 100% 133% 67% 67% 167% 100% 100% 100% 133% 100% 100% 100% 67% 67% 133% 100% 133% 100% 67% 67% 67% 100% 97% The Stroke Unit J61221 75% 100% 75% 100% 100% 100% 100% 75% 75% 100% 100% 100% 100% 100% 100% 100% 75% 100% 100% 100% 100% 75% 100% 100% 100% 100% 100% 100% 75% 100% 100% 94% General Rehabilitation Unit J61 100% 100% 100% 100% 100% 75% 100% 75% 75% 100% 75% 100% 100% 100% 100% 100% 75% 75% 75% 75% 100% 100% 100% 75% 75% 100% 75% 75% 75% 75% 100% 89% Accident & Emergency J61230 75% 75% 88% 88% 100% 88% 88% 88% 100% 88% 100% 100% 75% 75% 88% 88% 88% 100% 100% 100% 100% 88% 75% 100% 75% 100% 75% 88% 88% 88% 75% 88% Grand Total 93% 96% 99% 99% 103% 99% 99% 96% 99% 96% 99% 100% 99% 104% 100% 99% 97% 100% 99% 96% 99% 99% 97% 104% 94% 107% 104% 99% 99% 104% 94% 99%

Vlook Night

Sum of RN% Column Labels Row Labels 01/10/2016 02/10/2016 03/10/2016 04/10/2016 05/10/2016 06/10/2016 07/10/2016 08/10/2016 09/10/2016 10/10/2016 11/10/2016 12/10/2016 13/10/2016 14/10/2016 15/10/2016 16/10/2016 17/10/2016 18/10/2016 19/10/2016 20/10/2016 21/10/2016 22/10/2016 23/10/2016 24/10/2016 25/10/2016 26/10/2016 27/10/2016 28/10/2016 29/10/2016 30/10/2016 31/10/2016 Grand Total Afton Ward J61794 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Alverstone Ward J61111 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Colwell Ward J61254 67% 67% 67% 67% 67% 67% 67% 100% 100% 67% 67% 67% 67% 67% 67% 100% 67% 67% 67% 100% 67% 67% 100% 67% 67% 67% 67% 67% 67% 67% 67% 72% Coronary Care J61190 100% 100% 100% 100% 80% 80% 80% 80% 100% 100% 80% 100% 80% 80% 80% 100% 100% 100% 80% 100% 100% 100% 80% 80% 80% 100% 100% 100% 80% 100% 100% 92% Intensive Care Unit J61120 86% 86% 100% 86% 86% 86% 86% 71% 86% 100% 100% 100% 100% 86% 100% 86% 100% 86% 100% 86% 86% 86% 100% 86% 100% 100% 86% 100% 86% 100% 86% 91% MAAU J61231 67% 100% 100% 133% 100% 133% 133% 100% 100% 133% 133% 100% 100% 133% 133% 100% 133% 133% 133% 133% 100% 133% 133% 133% 133% 133% 133% 133% 100% 133% 100% 119% Maternity Services J61500 100% 100% 100% 100% 100% 100% 100% 100% 100% 75% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% Mottistone Suite J61090 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% Neonatal Intensive Care Unit J6 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 95% Osborne Ward J61915 100% 150% 100% 100% 100% 100% 100% 100% 100% 150% 150% 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 50% 0% 100% 100% 100% 103% Paediatric Ward J61372 100% 100% 67% 100% 100% 100% 100% 67% 100% 100% 100% 67% 67% 100% 100% 67% 100% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 100% 81% Seagrove Ward J61916 100% 100% 100% 100% 100% 150% 150% 150% 100% 100% 100% 100% 150% 100% 100% 150% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 150% 100% 111% Shackleton J61791 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% St Helens Ward J61102 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Whippingham Ward J61101 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Woodlands J61913 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 94% Appley Ward J61250 67% 67% 100% 100% 67% 67% 67% 67% 67% 67% 67% 100% 100% 67% 67% 67% 67% 67% 67% 67% 67% 67% 100% 67% 67% 100% 100% 100% 67% 67% 67% 75% Luccombe Ward J61112 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% The Stroke Unit J61221 67% 67% 67% 67% 67% 67% 67% 67% 100% 100% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 67% 100% 67% 67% 67% 67% 67% 67% 67% 100% 67% 71% General Rehabilitation Unit J61 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Accident & Emergency J61230 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 75% 100% 100% 100% 100% 99% Grand Total 91% 93% 95% 96% 89% 95% 95% 91% 96% 98% 96% 96% 93% 91% 95% 95% 96% 93% 93% 95% 91% 95% 96% 91% 95% 96% 91% 91% 89% 98% 93% 94%

Page 15 of 16

Table 5d Health Care Assistants Shift by Shift Data October 2016

Vlook Early

Sum of HCA % Column Labels Row Labels 01/10/2016 02/10/2016 03/10/2016 04/10/2016 05/10/2016 06/10/2016 07/10/2016 08/10/2016 09/10/2016 10/10/2016 11/10/2016 12/10/2016 13/10/2016 14/10/2016 15/10/2016 16/10/2016 17/10/2016 18/10/2016 19/10/2016 20/10/2016 21/10/2016 22/10/2016 23/10/2016 24/10/2016 25/10/2016 26/10/2016 27/10/2016 28/10/2016 29/10/2016 30/10/2016 31/10/2016 Grand Total Afton Ward J61794 150% 100% 150% 150% 150% 150% 150% 100% 150% 150% 150% 100% 150% 150% 150% 150% 100% 150% 150% 150% 150% 100% 100% 150% 150% 150% 100% 100% 150% 100% 50% 132% Alverstone Ward J61111 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 94% Colwell Ward J61254 100% 100% 100% 100% 125% 125% 100% 100% 100% 100% 100% 125% 100% 100% 100% 125% 100% 100% 100% 100% 125% 100% 125% 75% 75% 100% 100% 100% 100% 100% 125% 104% Coronary Care J61190 100% 100% 100% 100% 100% 50% 100% 100% 100% 50% 100% 100% 100% 100% 100% 50% 50% 100% 100% 100% 100% 50% 100% 100% 50% 0% 100% 50% 100% 150% 50% 85% Intensive Care Unit J61120 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% MAAU J61231 133% 167% 100% 100% 133% 100% 100% 133% 100% 133% 133% 100% 133% 100% 133% 100% 133% 100% 100% 167% 100% 167% 100% 100% 133% 67% 67% 100% 100% 100% 133% 115% Maternity Services J61500 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 75% 50% 50% 50% 100% 75% 75% 75% 100% 75% 50% 50% 75% 75% 75% 75% 75% 50% 50% 75% 62% Mottistone Suite J61090 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% Neonatal Intensive Care Unit J 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Osborne Ward J61915 100% 150% 50% 100% 50% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 150% 150% 150% 150% 100% 100% 150% 150% 50% 150% 100% 150% 100% 150% 110% Paediatric Ward J61372 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Seagrove Ward J61916 50% 100% 100% 100% 50% 50% 100% 100% 50% 150% 50% 150% 100% 100% 100% 150% 150% 100% 150% 50% 100% 50% 100% 100% 100% 150% 100% 100% 100% 100% 100% 98% Shackleton J61791 100% 67% 67% 100% 100% 100% 100% 33% 67% 33% 100% 133% 100% 133% 100% 100% 100% 100% 133% 67% 100% 67% 67% 100% 133% 133% 100% 100% 67% 100% 100% 94% St Helens Ward J61102 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 50% 95% Whippingham Ward J61101 200% 200% 200% 200% 200% 200% 150% 100% 150% 150% 200% 200% 200% 150% 200% 200% 200% 200% 150% 200% 200% 200% 100% 200% 200% 200% 200% 200% 200% 200% 150% 184% Woodlands J61913 100% 100% 0% 100% 0% 0% 100% 0% 0% 0% 100% 0% 0% 0% 100% 100% 100% 0% 100% 0% 100% 0% 0% 100% 100% 100% 100% 0% 0% 100% 0% 48% Appley Ward J61250 100% 140% 75% 75% 100% 75% 100% 80% 80% 100% 100% 125% 100% 125% 100% 100% 100% 100% 125% 100% 100% 120% 100% 100% 100% 100% 100% 100% 100% 100% 100% 101% Luccombe Ward J61112 133% 100% 100% 133% 133% 133% 167% 133% 133% 133% 133% 133% 133% 100% 100% 167% 133% 100% 133% 133% 67% 167% 133% 100% 100% 133% 100% 100% 133% 100% 133% 124% The Stroke Unit J61221 100% 125% 150% 125% 125% 125% 125% 150% 125% 125% 100% 75% 100% 125% 125% 100% 100% 125% 100% 100% 100% 125% 100% 75% 100% 100% 100% 100% 100% 100% 100% 110% General Rehabilitation Unit J6 100% 100% 125% 100% 125% 100% 100% 125% 75% 100% 100% 100% 100% 100% 75% 100% 100% 75% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Accident & Emergency J61230 100% 200% 0% 200% 100% 200% 100% 100% 200% 200% 100% 200% 200% 200% 200% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 200% 129% Grand Total 104% 115% 98% 109% 107% 102% 104% 100% 98% 102% 104% 109% 106% 106% 109% 117% 104% 102% 113% 109% 109% 106% 98% 102% 106% 102% 102% 98% 102% 104% 102% 105%

Vlook Late

Sum of HCA % Column Labels Row Labels 01/10/2016 02/10/2016 03/10/2016 04/10/2016 05/10/2016 06/10/2016 07/10/2016 08/10/2016 09/10/2016 10/10/2016 11/10/2016 12/10/2016 13/10/2016 14/10/2016 15/10/2016 16/10/2016 17/10/2016 18/10/2016 19/10/2016 20/10/2016 21/10/2016 22/10/2016 23/10/2016 24/10/2016 25/10/2016 26/10/2016 27/10/2016 28/10/2016 29/10/2016 30/10/2016 31/10/2016 Grand Total Afton Ward J61794 100% 150% 100% 150% 100% 150% 150% 100% 100% 150% 150% 150% 100% 150% 100% 150% 100% 100% 150% 150% 100% 150% 100% 100% 150% 100% 150% 150% 100% 50% 100% 123% Alverstone Ward J61111 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 200% 100% 100% 200% 200% 100% 200% 200% 200% 200% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 123% Colwell Ward J61254 100% 100% 67% 100% 100% 133% 100% 100% 100% 100% 67% 133% 133% 100% 100% 133% 100% 100% 133% 100% 100% 100% 133% 67% 133% 100% 100% 67% 100% 100% 133% 104% Coronary Care J61190 100% 0% 100% 100% 100% 0% 100% 100% 200% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 0% 200% 100% 0% 100% 0% 0% 84% Intensive Care Unit J61120 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 0% 100% 100% 0% 125% MAAU J61231 167% 133% 100% 100% 133% 100% 100% 167% 100% 133% 100% 100% 100% 100% 133% 100% 167% 100% 100% 133% 100% 167% 100% 100% 167% 67% 100% 67% 133% 100% 133% 116% Maternity Services J61500 40% 40% 60% 60% 40% 60% 40% 40% 60% 60% 40% 60% 40% 40% 60% 60% 40% 60% 60% 20% 60% 20% 40% 60% 40% 80% 20% 60% 40% 40% 60% 48% Mottistone Suite J61090 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 200% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 138% Neonatal Intensive Care Unit J 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Osborne Ward J61915 100% 100% 50% 100% 150% 150% 200% 150% 100% 100% 50% 100% 100% 150% 100% 100% 200% 150% 150% 100% 100% 150% 150% 150% 50% 100% 100% 150% 150% 100% 150% 121% Paediatric Ward J61372 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Seagrove Ward J61916 100% 50% 100% 50% 100% 150% 100% 100% 100% 50% 50% 50% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 150% 50% 150% 100% 50% 100% 50% 100% 50% 92% Shackleton J61791 67% 33% 67% 67% 67% 67% 0% 67% 67% 100% 100% 67% 67% 67% 100% 100% 33% 67% 67% 133% 100% 100% 67% 100% 133% 100% 133% 133% 67% 67% 100% 81% St Helens Ward J61102 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 50% 95% Whippingham Ward J61101 200% 200% 150% 200% 200% 200% 200% 100% 200% 200% 200% 200% 200% 200% 150% 150% 100% 150% 150% 200% 200% 200% 150% 200% 200% 200% 150% 200% 200% 200% 250% 184% Woodlands J61913 0% 100% 100% 100% 100% 0% 100% 0% 100% 100% 0% 0% 100% 0% 100% 100% 100% 200% 0% 0% 100% 100% 100% 100% 100% 0% 0% 100% 100% 100% 100% 71% Appley Ward J61250 133% 133% 67% 67% 67% 67% 100% 100% 67% 100% 133% 133% 133% 167% 100% 100% 67% 100% 133% 67% 100% 100% 100% 100% 100% 100% 100% 100% 133% 100% 100% 102% Luccombe Ward J61112 200% 150% 100% 100% 150% 150% 200% 150% 250% 100% 150% 200% 200% 100% 100% 100% 200% 100% 150% 150% 150% 200% 150% 100% 150% 100% 150% 200% 200% 200% 150% 153% The Stroke Unit J61221 167% 133% 167% 133% 133% 100% 100% 167% 133% 100% 133% 100% 100% 133% 133% 133% 133% 133% 100% 100% 67% 133% 100% 100% 100% 100% 67% 100% 100% 100% 100% 116% General Rehabilitation Unit J6 100% 100% 125% 100% 125% 75% 100% 100% 100% 100% 125% 100% 100% 100% 75% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 75% 100% 100% 100% 102% Accident & Emergency J61230 100% 150% 50% 150% 100% 150% 150% 100% 150% 150% 100% 150% 150% 100% 150% 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 100% 100% 150% 116% Grand Total 112% 107% 93% 100% 105% 102% 105% 105% 115% 102% 100% 112% 107% 107% 107% 110% 105% 105% 110% 102% 102% 117% 107% 95% 112% 100% 91% 102% 107% 98% 105% 105%

Vlook Night

Sum of HCA % Column Labels Row Labels 01/10/2016 02/10/2016 03/10/2016 04/10/2016 05/10/2016 06/10/2016 07/10/2016 08/10/2016 09/10/2016 10/10/2016 11/10/2016 12/10/2016 13/10/2016 14/10/2016 15/10/2016 16/10/2016 17/10/2016 18/10/2016 19/10/2016 20/10/2016 21/10/2016 22/10/2016 23/10/2016 24/10/2016 25/10/2016 26/10/2016 27/10/2016 28/10/2016 29/10/2016 30/10/2016 31/10/2016 Grand Total Afton Ward J61794 100% 100% 100% 150% 150% 150% 150% 150% 150% 150% 150% 100% 150% 150% 100% 150% 150% 100% 150% 150% 100% 150% 150% 100% 150% 150% 100% 150% 150% 150% 150% 135% Alverstone Ward J61111 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 133% Colwell Ward J61254 100% 150% 100% 100% 150% 150% 150% 50% 100% 150% 150% 100% 100% 100% 100% 50% 150% 100% 150% 100% 100% 100% 100% 150% 150% 150% 150% 150% 150% 150% 100% 121% Coronary Care J61190 100% 100% 100% 100% 100% 100% 100% 100% 0% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 200% 200% 100% 100% 100% 100% 100% 100% 100% Intensive Care Unit J61120 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 0% 100% 100% 100% 122% MAAU J61231 133% 100% 67% 67% 67% 67% 133% 100% 67% 67% 100% 100% 100% 100% 100% 100% 100% 100% 100% 67% 67% 100% 100% 100% 67% 100% 67% 67% 100% 100% 100% 90% Maternity Services J61500 100% 50% 50% 100% 100% 100% 100% 100% 50% 50% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 50% 50% 100% 100% 87% Mottistone Suite J61090 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Neonatal Intensive Care Unit J 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Osborne Ward J61915 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 50% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 50% 100% 100% 100% 100% 100% 92% Paediatric Ward J61372 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Seagrove Ward J61916 150% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 150% 100% 100% 100% 100% 100% 150% 150% 100% 200% 150% 50% 50% 100% 100% 50% 50% 103% Shackleton J61791 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% St Helens Ward J61102 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% Whippingham Ward J61101 400% 400% 300% 300% 300% 300% 200% 300% 300% 300% 300% 300% 300% 300% 300% 300% 300% 300% 400% 300% 300% 200% 300% 300% 300% 300% 300% 300% 200% 300% 300% 300% Woodlands J61913 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Appley Ward J61250 100% 100% 100% 100% 150% 150% 150% 150% 100% 150% 100% 100% 100% 100% 150% 100% 150% 100% 100% 100% 150% 100% 100% 150% 150% 100% 100% 100% 150% 150% 150% 121% Luccombe Ward J61112 150% 150% 150% 150% 100% 100% 100% 150% 150% 150% 150% 150% 150% 150% 150% 150% 100% 150% 150% 150% 150% 150% 150% 100% 150% 150% 150% 50% 100% 150% 150% 137% The Stroke Unit J61221 200% 100% 150% 200% 100% 150% 100% 200% 150% 100% 200% 150% 200% 150% 100% 100% 200% 200% 150% 100% 100% 100% 150% 150% 150% 150% 150% 150% 100% 50% 100% 140% General Rehabilitation Unit J6 100% 100% 100% 100% 100% 100% 67% 100% 100% 67% 100% 100% 100% 100% 67% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% Accident & Emergency J61230 100% 100% 100% 100% 200% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% Grand Total 134% 117% 106% 116% 116% 116% 113% 128% 110% 103% 119% 110% 123% 117% 114% 111% 119% 116% 123% 110% 113% 121% 124% 123% 123% 113% 106% 103% 114% 114% 113% 116%

Page 16 of 16

Enc G

REPORT TO THE TRUST BOARD (Part 1 - Public)

ON [insert board date]

Title Isle of Wight Safeguarding Children Board (IOWSCB) Annual Report 2015- 2016 Sponsoring Sarah Johnston, Acting Executive Director of Nursing & Quality Executive Director Author(s) Chair of Isle of Wight Safeguarding Children Board Purpose To receive for information Action required by Receive X Approve the Board: Previously considered by (state date): Sub-Committee Dates Key Issues, Concerns and Discussed Recommendations from Sub Committee Trust Leadership Committee

Audit and Corporate Risk Committee

Charitable Funds Committee Finance, Investment, Information & Workforce Committee Mental Health Act Scrutiny Committee Remuneration & Nominations Committee Quality Governance Committee Information & Communications Technology Assurance Committee Please add any other committees below as needed Board Seminar 03/11/16

Other (please state) Staff, stakeholder, patient and public engagement: N/A

Executive Summary & Analysis: Statutory bodies that work together to safeguard children are required to receive the Safeguarding Children Board report on an annual basis.

The Annual Report is a transparent assessment of the effectiveness of safeguarding and the promotion of children’s well-being across the Isle of Wight. · Section 1 sets out the governance and accountability arrangements for the Isle of Wight Safeguarding Children Board (IOWSCB) providing information about the structures in place that support the IOWSCB to do its work effectively. · Section 2 sets out the context for safeguarding children on the Isle of Wight. · Section 3 sets out the vulnerable groups of children and their journey in IOWSCB safeguarding systems. · Section 4 sets out how the voice of the child is heard. · Section 5 sets out progress made on the 2014 Ofsted recommendations and the IOWSCB

REPORT TO THE TRUST BOARD (Part 1 – Public)V13 Page 1

Business Plan priorities during 2015/16 and any barriers or challenges encountered. · Section 6 sets out other areas of progress made in safeguarding children during 2015/16 and the challenges going forward. · Section 7 sets out how the IOWSCB has identified lessons through learning and improvement systems and activity as well as through reviews of child deaths and serious incidents and used them to take actions and provide training to improve child safeguarding and protection across the Island. · Section 8 sets out the key priorities going forward to safeguard children on the Isle of Wight.

Alan Sheward, Executive Director of Nursing & Quality is the Trust’s representative on the IOWSCB. During his secondment this is covered by Sarah Johnston, Acting Executive Director of Nursing & Quality.

Recommendation to the Board: The Board is recommended to receive the report for assurance and information

Attached Appendices & Background papers

Enc G2 – Isle of Wight Safeguarding Children Board Annual Report 2015-2016

For following sections – please indicate as appropriate:

Trust Goals & Priorities Excellent patient Care Principal Risks (BAF) Principal Risk 674 Quality and Harm

Legal implications, regulatory and · Childrens Act 2004 consultation requirements · Working Together to Safeguard Children Statutory Guidance 2015

Date: 29 November 2016 Completed by: Sarah Johnston, Acting Executive Director of Nursing & Quality

REPORT TO THE TRUST BOARD (Part 1 – Public)V13 Page 2

Isle of Wight Safeguarding Children Board Annual Report 2015-2016

IOWSCB Annual Report 2015-16. Approved 29-Sep-16 www.iowscb.org.uk www.twitter.com/IOWSCB

Foreword from the Independent Chair

mental illness on children. Inclusion of pupils from a new Neglect Strategy will be officially launched at local sixth form and the Youth Council in the table our Annual Conference in October 2016 and discussions was successful and their contributions further training and support will be introduced. invaluable. Safeguarding children remains a high priority for Other key developments during the year have been all organisations on the Isle of Wight, as further a new 'missing panel' to reduce the risks to children I am pleased to introduce the 2015/16 Annual changes in how children are protected are who go missing from care. Report for the Isle of Wight Safeguarding Children introduced through new national legislation. It is Board. The commitment, drive and strong The IOWSCB has encouraged all schools to host the vital that the Council, NHS and Police services work partnership working by IOWSCB member play Chelsea’s Choice across Island Secondary closely with schools and other community based organisations has resulted in a real shift to a position Schools to raise awareness of sexual exploitation organisations to continue to ensure that children where partners are meeting their statutory duties in among Island children and professionals. are given the best services possible on the Island. safeguarding children. There remain challenges for partner agencies Through open and trusting relationships across the Island. Social media and pressures on practitioners are working together on identified children relating to bullying and sexting within pressure points towards a more secure position. school remain concerns and it is important that all Information is shared more openly and children are families, including those where children are given the right help at the right time. electively home educated, understand the risks of on line grooming as well as other forms of child I am pleased that two Lay members have been abuse or exploitation. recruited during this year and hope that they will provide an independent voice to the partnership The IOWSCB will continue to seek assurances from and a commentary on how organisations are Language Schools operating on the Isle of Wight working together. with regards to their procedures to protect children At the end of the day the IOWSCB must be able to and will want assurance that children with disabilities are effectively protected. support front line staff in the difficult and challenging work they do to protect children. We Our priorities for 2016/17 are set out later in this held our second conference for 172 practitioners in report and include giving practitioners the tools to October 2015 with a focus on raising awareness of better identify types of neglect and the effect of the impact of domestic abuse, drugs and parental long term neglect on children’s well being. Our

IOWSCB Annual Report 2015-16. Approved 29-Sep-16 www.iowscb.org.uk www.twitter.com/IOWSCB

About the Annual Report Contents

The Annual Report is a transparent assessment of the effectiveness of safeguarding and the promotion of children’s well-being across the Isle of Wight.  Section 1 sets out the governance and accountability arrangements for the Isle of Wight Safeguarding Children Board (IOWSCB) providing information about the structures in place that support the IOWSCB to do its work effectively.  Section 2 sets out the context for safeguarding children on the Isle of Wight .  Section 3 sets out the vulnerable groups of children and their journey in IOWSCB safeguarding systems.  Section 4 sets out how the voice of the child is heard.  Section 5 sets out progress made on the 2014 Ofsted recommendations and the IOWSCB Business Plan priorities during 2015/16 and any barriers or challenges encountered.  Section 6 sets out other areas of progress made in safeguarding children during 2015/16 and the challenges going forward.  Section 7 sets out how the IOWSCB has identified lessons through learning and improvement systems and activity as well as through reviews of child deaths and serious incidents and used them to take actions and provide training to improve child safeguarding and protection across the Island.  Section 8 sets out the key priorities going forward to safeguard children on the Isle of Wight.

IOWSCB Annual Report 2015-16. Approved 29-Sep-16 www.iowscb.org.uk www.twitter.com/IOWSCB 3

1. The Board What is the IOWSCB Two Key Principles Our Vision The IOWSCB is the key statutory body overseeing Everything we do is underpinned by two key “Working together to ensure high quality outcomes multi-agency child safeguarding arrangements principles: for all children, young people and their families and to across the Isle of Wight. Our work is governed by enable them to access sustainable support and  Safeguarding is everybody’s responsibility - for the statutory guidance in Working Together to services to be effective each professional and services” Safeguard Children 2015. organisation should play their full part This Vision is shared with the Children’s Trust Board, Section 14 of the Children Act 2004 sets out the the Health and Wellbeing Board and the Isle of Wight  A child centred approach - for services to be statutory objectives of Local Safeguarding Children effective they should be based on a clear Council. Boards, which are: understanding of the needs and views of the  To co-ordinate what is done by each person or individual children whilst recognising the support body represented on the Board for the purposes parents and carers may require. of safeguarding and promoting the welfare of The IOWSCB consists of the independent chair and children in their area; and members who are senior representatives from the  To ensure the effectiveness of what is done by principle stakeholders. The Board is collectively each such person or body for those purposes. responsible for strategic oversight of safeguarding arrangements: it does this by leading, co- ordinating, challenging and monitoring the delivery of safeguarding practice by all agencies across the Island. The IOWSCB is independently chaired by Maggie Blyth and she is accountable to the Chief Executive of the Isle of Wight Council. She met both the Chief Executive and Council Leader and the Director of Children’s Services on the Isle of Wight regularly throughout 2015/16.



IOWSCB Annual Report 2015-16. Approved 29-Sep-16 www.iowscb.org.uk www.twitter.com/IOWSCB 4

Structure of the Isle of Wight Safeguarding Children Board (and Functional Links)

IOWSCB Annual Report 2015-16. Approved 29-Sep-16 www.iowscb.org.uk www.twitter.com/IOWSCB 5

Day to day Functions

Day to day, the work of the IOWSCB includes: The Undertaking of multi-agency Managing the completion and thematic audits and partnership publication of Serious Case reviews into the effectiveness of Reviews, ensuring that the learning services. In 2015/16 this included from these improves services for audits in relation to: children.  Cases where the child had a Ensuring that partners are fulfilling Child in Need plan (CIN) their statutory obligations in relation to safeguarding and  Cases where the child was at risk of Sexual Exploitation promoting the welfare of children (CSE) within their organisations through audits, visits and challenge days to  Cases where the child was encourage reflective practice and looked after (LAC) evidence of self-assessments. PCC Grant Annual Ensuring that effective quarterly Funded Finance data and analysis reports are Conference CSE Plays £4,500 A contingency of £53,224 was available and presented through £8,200 the PQA meetings, so that we can carried forward from 2014/15 be clear on the needs of children making the total income available to the Board £227,654. This income and the priorities in relation to improving safeguarding in our ensured that the overall running area. costs of IOWSCB were met at year end. Overseeing the training and learning opportunities that are Charges for non-attendance at available for the children's training events totalled £856 and workforce, and reviewing the helped cover increased expenditure effectiveness of these through in 2015/16 arising from Serious evaluations, observations and Case Review costs. longer term impact audits. £15,000

IOWSCB Annual Report 2015-16. Approved 29-Sep-16 www.iowscb.org.uk www.twitter.com/IOWSCB 6

Relationships The Isle of Wight Council is The Designated Doctor and Nurse responsible for establishing a take a strategic and professional Local Safeguarding Children lead on all aspects of heath service Board (LSCB) in their area and contributions to safeguarding ensuring that it is run effectively. children. Designated professionals The lead member for Children’s are a vital source of professional Services has the responsibility for advice for Health related issues making sure their organisation and CDOP arrangements. fulfils their legal responsibilities to safeguard children. Relationships with other Boards - Partner agencies are committed The IOWSB directly influences and to ensuring the effective improves performance in the care operation of IOWSCB. This is and protection of children. This is supported by a constitution achieved through robust document that defines the arrangements with key strategic fundamental principles through bodies across the partnership. which the IOWSCB is governed. During 2015/16 engagement Members of the Board hold a continued with the Safeguarding strategic role within their Adults Board, Health and organisations and are able to Wellbeing Board, Children’s Trust speak with authority, commit to and Community Safety matters of policy and hold their Partnership. The Isle of Wight has organisations to account. a long standing relationship with The Independent chair meets Hampshire, Portsmouth and regularly with leads from both the Southampton LSCBs through the NHS Trust and the Clinical 4LSCB arrangement with shared Commissioning group (CCG), as policies and protocols. well as Lead officers in Hampshire Constabulary, the Police and Crime Commissioner (PCC) and the Isle of Wight Council.

IOWSCB Annual Report 2015-16. Approved 29-Sep-16 www.iowscb.org.uk www.twitter.com/IOWSCB 7

Subgroups The IOWSCB has the following Sub Groups, which meet regularly throughout the year:

Workforce Development Group Missing, Exploited & Trafficked Serious Case Review Group This group co-ordinates, promotes, quality Group (MET) assures & evaluates training and development (SCR) and Child Death opportunities for This strategic group works to meet legislative Overview Panel (CDOP) the children’s requirements, government guidance and implement recognised best practise to improve The SCR group supports the Chair in workforce on the safety and outcomes for children and making decisions where a review of a child behalf of the IOWSCB. young people in the following areas of risk: protection incident and review or audit of Child Sexual Exploitation, Child Trafficking and practice in one or more agencies on the Modern Slavery and Children who are missing. Isle of Wight is needed. The Child Death

Overview Panel meets quarterly and aims to better understand how and why children on the Isle of Wight die and use Performance & Quality the findings to prevent avoidable deaths. Assurance Group (PQA) This group co-ordinates quality assurance and evaluates the

effectiveness of what is done by IOWSCB partner agencies, to

safeguard and promote the welfare of children. It has oversight of audits Education & Schools Group and analysis of performance data This group facilitates communication Executive Group about safeguarding in relevant agencies. across the education sector on their The group meets between Board statutory safeguarding duties, and meetings and helps drive the challenges and is responsible for improvement agenda forward in disseminating learning from audits and safeguarding children. It provides serious case reviews as well as leadership and direction and holds identifying issues and challenges. partners to account for progress on Business Plan actions and deadlines.

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Communications The IOWSCB has worked hard to develop effective communication systems to enable practitioners and the public to access information and guidance.

Website Twitter Visits Made: The IOWSCB website contains information and The IOWSCB Twitter account guidance for parents and practitioners on a variety (@IOWSCB) has 390 followers and is used of safeguarding subjects e.g. bullying. It also to share current articles and up to date news contains policies, links to national legislation and reports on safeguarding related issues. other helpful websites. Data shows that over IOWSCB Newsletter 10,000 people used the site during the year, The newsletter is generated quarterly and contains double the number the year before. Feedback decisions taken at board meetings, news and about the website has been very positive, with information from the IOWSCB as well as links to many saying it is useful and simple to use. websites and documents. This has been well received by practitioners.

Presentations Presentations have been made on the work of the

IOWSCB to the Head Teachers Forum and Early Years Settings Managers meeting in March 2016 and the IOW Youth Council. Further presentations are planned for Children’s Home staff and local Ferry companies and these serve to raise awareness and give a voice to front line staff in shaping the work of the board.

Walkabout sessions Board members have been to visit a range of service providers during the year to look at the work they are doing and to talk to staff. They were asked to record findings from their visit. These visits provide an opportunity for front line staff to meet Board members and for Board members to understand how IOWSCB activity impacts on services for children.

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2. Safeguarding on the Isle of Wight: Context and Overview Population and Demographics Health Indicators

The population on the Isle of Wight is not growing In 2015, 6% of school children were from minority 55 (23.3%) girls under 18 conceived on the Island, as rapidly as regional and national averages. The ethnic groups compared to 21% in the South East which is 0.4% higher than the national figure and 65+ age group on the Island is over represented and 29% nationally. The largest minority ethnic 5.4% higher than the average for the South East. and expected to grow to 36% by 2035. groups of school children on the Island were Mixed 16% of those conceptions were in under 16s. The 60-69 year old and the 90 and over age groups or Asian. Healthy life expectancy at birth for Males on the have the highest rates of growth with the 5-9 and Island is 64 years similar to that of the South East 10-19 year old groups showing the largest decline. and Nationally. However, for females the expec- tancy is 62, lower than the 64 years national Deprivation on the Isle of Isle of Wight is ranked 109/326 on the 2015 Indices of Deprivation, and 66 regionally. with 1 being the most deprived. This is a Island 4-5 year olds show slightly higher drop of 17 places in the last 5 years as levels of obesity than children nationally the Island was ranked 126 in 2010. with 23.8% compared to 21.9% classified as In 2010 there were 5 areas on overweight or obese. Excess weight in 10-11 the Isle of Wight among the year olds reflects the national average of 32%. 20% most deprived in the country. There are now 13. The Public Health national “What About Youth Survey“ (WAY 2015) showed 6.9% of 15 year olds In comparison to the rest of the “South East”, one on the Island smoked compared to 5.5% of the most affluent areas in the country, the Island has much higher levels of Deprivation. The nationally. 22.2% had tried E-cigarettes at least once compared to 18.4% nationally. most deprived neighbourhoods are found in towns. However, the lack of access to housing, The Island has the highest rate of hospital and key local services such as regular transport admissions in 0-4 year olds (almost double that of and the remoteness of rural communities, causes 2% of Island pupils attended special schools other areas) and in 0-14 year olds due to injury social isolation. compared to 1% nationally. English was not the (unintentional and deliberate) in the Southeast. first language for 3% of primary school children The proportion of children entitled to free school Following exploration by the IOWSCB it seems that (19% nationally) and 2% of secondary school meals is 15% compared to a national average of much of these are due to the way in which A&E 16%. In secondary schools it is 13% compared to a children (15% nationally). contacts are recorded on the Island as admissions. national average of 15%.

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Local Partnership and Accountability Arrangements Board members

The IOWSCB Independent Chair is directly seen in the Children’s Trust Strategic Plan for 2016. We have membership from the following services: accountable to the Chief Executive of the Isle of Wight Council and works closely with the Director The Voluntary Sector Forum on the Island has  CAFCASS of Children’s Services. The strategic partnership elected representatives that sit on the Board and  Isle of Wight Children’s Services arrangement for children’s services introduced subgroups to ensure that Voluntary Sector  Isle of Wight Education Services between the Isle of Wight Council and Hampshire providers have a voice in safeguarding children County Council in October 2013 is well provision. The forum is kept well informed of  Isle of Wight NHS Trust established. IOWSCB activity through inputs at their regular  Hampshire Constabulary meetings which are well attended by a range of Close liaison is maintained between the national and local voluntary organisations.  Office of the Police and Crime Commissioner Independent Chair and Hampshire Constabulary and the Police and Crime Commissioner, the The Independent Chair and the Board Manager met  National Probation Service Council’s executive member for children’s services with members of the Family Justice Board to  Hampshire and Isle of Wight Community and the Chair of the Health and Wellbeing Board develop a memorandum of understanding for both Rehabilitation Company on the Island. Moreover, the Independent Chair the Hampshire Safeguarding Children Board and the maintains a close relationship with the Island’s IOWSCB which clearly describes how the two  Isle of Wight Clinical Commissioning Group CCG and NHS Trust and Public Health. Boards will link with the Family Justice Board and  Designated Doctor this is due to be ratified in 2016. The IOWSCB Annual Report for 2014/15 was  Designated Nurse presented at the Children’s Trust meeting in “Inter-agency relationships are good, with November 2015 and links to the report can be other agencies reporting a good  NHS England understanding of thresholds, and confidence  Primary School in the work of Children’s Services staff.” (Peer  Public Health review December 2015)  Secondary School The Board works closely with the Local Safeguarding Adult Board and Domestic Abuse  Youth Offending Service Forum on areas such as substance misuse, domestic  Voluntary Sector Forum violence and parental mental health issues. A full list of members can be found at the back of A protocol was agreed with these strategic this report. partnerships and the Health and Wellbeing Board in 2014 to clarify responsibility and accountability Two Lay members were appointed at the end of between the Boards, and to align priorities and the year and will be inducted in 2016. We booked make best use of resources. The two Board for the new members to attend the Lay member managers meet informally and attend each other’s conference in Brighton in the summer 2016 to Board and sub group meetings whenever possible. support their induction.

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3. Vulnerable Groups of Children and the Journey of the Child Contacts, referrals and assessments In order to address this high level of contact the In total over the last twelve months 14,511 following actions have been taken: contacts have progressed to referral and The Children’s Reception Team (CRT) and transferred to MASH for further work. The level  The process for managing Children and Young Multiagency Safeguarding Hub (MASH) are now of contacts progressing to MASH has remained People Reports (CYPR) from the Police has been well established and manage the ‘front door’ on consistent over the year indicating consistent streamlined. behalf of the Isle of Wight Children’s Services. application of thresholds. There are separate telephone numbers for the  The out of hours service is now assisting with public and professionals to use and the CRT takes triage of CYPR reports. The thresholds applied by MASH have been all initial ‘contacts’ to answer questions about  The Reports are being scrutinised to ensure supported by internal audits and IOWSCB audits. children or to receive reports or child protection appropriate use to report child welfare concerns. Referrals are progressed and transferred to concerns and resolves 70% of contacts. The other MASH in a timely way, but the high level of 30% of contacts are progressed to MASH for Contacts by Agency weekend CYPRs continues to present a challenge further assessment and investigation. and a new staffing structure should help with this issue. In line with national trends, there have

All Section 47 referrals are subject to a face to face Individual been some challenges in staff recruitment and strategy meeting between Children’s Services, Education 2,527 retention and it has been necessary to employ Police and Health. Isle of Wight health information 2,495 agency and temporary staff. However, a new is fed into these discussions through a named staffing structure has been agreed and this will Other Health contact on the Isle of Wight. Education Local Authority have a positive impact on capacity in 2016/17. 1,761 information is accessed through a designated Services Education officer who is able to provide education 1,161 CRT has sought feedback from parents and specific information and sign post the MASH Social Health professionals through use of a survey monkey Other Legal Worker to the appropriate professionals involved 1,020 and telephone surveys. Comments and in the case. Agencies responses were generally positive. IOW 301 professionals have been welcomed on visits to Over the last twelve months there were 17,047 CRT and MASH to increase understanding and contacts received from the IOW and managed by awareness of the work they do and these have CRT. This is an average of 1,300 contacts per been well received. month arising from emails, telephone calls and

CYPRs. 46% of all contacts were made by police.

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Children with an Early Help Plan The Common Assessment Framework (CAF) has Locality meetings are led by the Coordinators to Following a competitive tendering process, the been re-branded over the last twelve months as provide networking opportunities, case discussions, integrated Early Help contract was awarded to Early Help. Assessment remains part of the Early peer support and service information. These are Barnardo’s from April 2015. The contract brings Help offer within Children’s Services and continues well used by practitioners from a variety of together Children's Centres, parenting and to support families at the earliest opportunity to agencies. A named CAMHS practitioner for each family support, the Troubled Families prevent them escalating to higher level services. locality now attends these meetings. Programme and other Early Help services across -19 age range. Within Children’s Social Care Early Help Referrals for Early Help Assessments are completed the 0

Co-ordinators work across the three locality areas mainly by Schools, Health Practitioners and Staff within family centres are delivering a wide on the IOW to support and challenge lead Barnardo’s Family Workers. Revised step up and range of evidence based programmes including professionals, assuring the quality of Early Help step down procedures are in place for cases that the Solihull approach, Five to Thrive, Incredible assessments and provision and appropriate either need higher level support or can successfully Years, Family Links, New Forest ADHD and management of thresholds. Co-ordinators might be stepped down to universal services only. These Triple P. Counselling, Child Sexual Exploitation attend Team around the Family Meetings (TAF) or procedures should ensure effective and seamless U-Turn support and Community Support for meetings to ensure smooth transitions where cases handover of cases. Offenders Families (CSOF) are also now delivered are stepped down from CSC to Early Help. through Family Centres.

2015/2016 Early Help Statistics

Source: 2015/2016 Early Help Report Help 2015/2016 Early Annual Source:

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Children with an Early Help Plan Early Help services are also delivered by a range of Barnardo’s are commissioned to deliver the Targeted Youth Support (TYS) are based within partner agencies including, Schools, Health Strengthening Families Programme and it was Early Help Services to work with children prior to colleagues and Community based or Voluntary agreed that their staff would take on the temporary their involvement with Social Care. Children are Sector providers. Early Help Action plans are lead for these families during school holidays where referred to them for one to one interventions . reviewed at least every 12 weeks to ensure they were not already the lead professional, to progress is made against agreed targets. ensure continuity of service. 35% of their cases in the last financial year were open to Children’s Social Care (Tier 4). 59% were Weekly meetings are held in each locality to triage open to Targeted Early Help (Tier 3) and 6% were all new cases referred for support. Barnardo’s have open to Early Help (Tier 2) with single agency their own electronic system for case management support. The referral process changed in of families with Early Help plans within their part of September 2015 and the team now only accept the service. cases open to Tiers 3 and 4, with an appropriate assessment and a completed, signed referral Early Help Assessment forms are being updated to form. (See page 34 for further information include the impact of Neglect on children. Work is regarding Targeted Youth Support) under way to support Early Years settings in using “[my child] feels encouraged to attend the Early Help Assessment tools and taking on the appointments regarding her health and in role of lead professional. general feels listened to and supported by the TAF group” (Mother, regarding Targeted Early Outcomes and impacts of Early Help Assessments Help Support ). are monitored through the use of a distance travelled tool.

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Children with a Child in Need Plan (CIN)

A Child in Need (CIN) is one that has been Key strengths: assessed under Section 17 of the Children  The voice of the child was strong in the cases Act 1989 as being unlikely to maintain a examined. reasonable level of health or development, or whose health or development is likely to In 2015/16 the Disabled Children’s Team (DCT)  Transitions between service areas were be impaired without the provision of services; or a developed internal processes to enable it to be found to be good. child who is disabled. more responsive to the safeguarding needs of  Case notes were thorough. disabled children on the island. The team is now The Child in Need strategy (2014) is now the responsibility of the operational service The survey results demonstrated that embedded in practice across the IOW and the manager with a focus on the Child In Need practitioners had a good understanding of Child in Child in Need category is being used more widely processes. Need and 80% of respondents thought that CIN resulting in higher caseloads. In order to address work had a positive impact on children. The survey this a third CIN team was set up and has now had a An audit of children with CIN plans took place in indicated that not all professionals were receiving positive impact on reducing average caseloads July 2015. 12 case audits were completed. There copies of CIN plans and that there were still mixed across the 4 teams (which includes the Disabled was also a survey completed by 157 frontline views when cases were stepped down. Children’s Team) from between 28.5 - 33.8 cases professionals from across the Island. in 2015 to an average of between 16.1 and 30.3 cases in 2016. A family whose children were on CIN plans were interviewed. The mother spoke positively about the social worker and felt everything had been explained clearly to her.

Of the cases audited, five were rated as good overall, six required improvement and one was inadequate. This was a huge improvement on a previous audit of CIN cases, but illustrates there is still further work to be done.

Since the audit work has been undertaken to develop the confidence of practitioners in the application of thresholds and development of CIN plans.

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Children with a Child Protection Plan (CPP) Children require a child protection plan if they are There have been difficulties in production of This is due in part to a robust review of open cases judged to be suffering, or likely to suffer, minutes from conferences and an agreement has and assessment of risk and greater confidence in significant harm. An Initial Child Protection been made to make reports SMART, not the use of CIN plans to manage risk. This will be Conference (ICPC) will be convened and attended duplicating information already held in the reports closely monitored in 2016/17 and we hope to see by family members and the child if appropriate, to the conference. a continued decline in numbers. together with professionals to plan how to The children and young people’s guide to services is As part of the Department for Education safeguard the child. If the conference considers now in place and this is supporting children in Innovations programme two CIN teams have that the child is at a continuing risk of significant understanding the processes. recruited mental health, substance misuse and harm they will be made subject to a child domestic abuse workers to pilot a multi-agency, protection plan (CPP). The IOWSCB was concerned by the high numbers of children with CP plans and undertook a deep dive whole family approach, to the Toxic Trio. This has Children with a plan will be considered to be in started to have a positive impact to children and analysis of this issue asking partner agencies to need of protection from either neglect, physical, contribute. families outcomes. However, further audit and sexual or emotional abuse or a combination of one analysis is required to evidence this. or more. The plan will detail the main concerns for The report found that CSC was effective and that the child, what action will be taken to reduce those children are being made subject to a plan to concerns and by whom, and how professionals and address risk, but that numbers have been too the family and child (where appropriate) will know high. when progress is being made. Agencies need to be better at managing risk At the end of March 2016, 213 children were at pre social care level and this can be done subject to a CPP. This is a fall of 51 with 264 by raising the confidence of practitioners children being subject to a CPP at the end of March and offering support and advice. The higher 2015. Two of the children with a CPP had been referral numbers from schools and subject to a previous plan. Neglect is now the main comparatively low referrals from health category of registration with 59% of all CP plans need further analysis and understanding. put in place for Neglect. Girls between 10 and 15 are more likely to be subject to a CP plan. This does reflect the national trend in respect of forecasting adolescent risk. Numbers of children on CP plans are now beginning to stabilise and are more in line with statistical neighbours and national averages.

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Children Looked After by the Local Authority

A child looked after by the Local Authority is known There was a need to further develop Independent as a Child in Care (CIC). In some cases the child has reviewer contact and communication with children been placed in care voluntarily by parents. In other between reviews and ways to engage particularly cases Children’s Social Care will have intervened older children. The audit also identified the needs because a child was at risk of significant harm. to ensure all health assessments were undertaken in a timely way and that all children had dental Children in Care may be placed with foster parents, checks. may be in a residential children’s home or at home with their parents under the supervision of the There were unmet training needs for some foster Local Authority. Some children are placed on the carers on the importance of bonding and mainland or in specialist units. In all cases the best attachment and the need for them to fully match between the assessed needs of the child participate in reviews and assessments. Oversight and the placement is key. from the Virtual Head and her team ensures that Children in Care are closely monitored. The number of children who are looked after remained static on the Island; at the end of March 2015 there were 205 children who were looked after; at the end of March 2016 there were 204 children who were looked after. 33 children were in off-Island placements. This number remains consistently higher than the national figures and those of statistical neighbours.

The IOWSCB carried out an audit of 12 cases of Children in Care in December 2015. There was evidence of good use of pupil premium monies to enhance opportunities for the child and good use of Personal Education Plan (PEPs) toolkits in schools. The best placements unsurprisingly were those where there was a large element of nurture CIC Care Plan Audit and meeting the child’s emotional needs as well as The fourth LAC Care Plan Audit was undertaken basic care needs. Placements worked best where throughout November 2015 of 41 looked after there was good cooperation and communication children. A number of areas for development between carers and families and partner agencies. and areas of good practice were identified.

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Children who are Care Leavers Children in Private Fostering Children and Bullying Care leavers can be particularly vulnerable as they Parents may make their own arrangements for An anti-bullying conference was held in November make the transition to adulthood. In March 2016 their children to live with other families. These are 2015. When asked what they would stop doing there were 108 children open to the care leaver privately fostered children. The Local Authority most of the children said: service. There are six Personal Advisors who must be notified of these arrangements. There has support all care leavers from the age of 15.5 years been a great deal of work done by Children’s Social to develop skills towards independent living. They Care services to raise awareness of the need to offer support and guidance through pathway register children being privately fostered. This has plans. Advisors come from a variety of working led to Language Schools who have children staying backgrounds. with host families on the IOW for more than 28 days coming forward now to register the children Currently 83% of care leavers are in education, as privately fostered. employment or training which is higher than the national average of 61%. Eight students are At the end of March 2016 there were 18 children undertaking a Bachelor of Arts at university which registered as being in private fostering is 7.6% of the total cohort. This is higher than the arrangements, the majority of which were national average of 6%. Therefore there are just language school students. This has risen from 5 17% Not in Education, Employment or Training children in June 2015 following successful (NEET). 95.5% of the care leavers are in suitable awareness raising activity. accommodation which is higher than the national average of 83%. When asked what they would continue doing In the last financial year, Targeted Youth Support some chose personal attributes and others supported 24 children who presented to the organised activities. service at risk of or homeless. Out of these The personal attributes children valued were: children, only 25% of those who presented were escalated; the remaining 75% were successful in securing accommodation that met their needs. The IOW has a 123 programme which is a scheme of work related activity. Care leavers are offered short work experience placements or longer traineeships and finally apprenticeships. In the Peer review (December 2015) there was strong evidence highlighting the strength of support from the council for their care leavers. Source: Children and Young Peoples Survey 2015/16

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Children with a Disability

The Disabled Children‘s Team (DCT) work with The group have undertaken a survey across The IOWSCB has called for an Annual report for disabled children on the IOW. The caseload at the professionals. This has provided clear areas for DCT and for Beaulieu House to be presented to end of the year in DCT was 252 children. During improvement e.g. taking into account a child's the PQA Group to assure the Board of work to the year, 91 children within 54 families were disability when communicating with them. safeguard disabled children. subject to Section 47 enquiries with 122 enquiries made, meaning that some children were subject An action plan has been developed and is being Staff have had training around risk assessments to to more than one investigation. monitored through the Performance and Quality improve outcomes for children. Changes in Assurance Group (PQA) group. Progress has been security and procedures at Beaulieu House have 31 of these enquiries led to children being placed made in relation to strengthened training for been made in line with Ofsted recommendations. on the child protection register. The main safeguarding children with a disability to category of registration was neglect (10 cases). incorporate matters arising from the plan. IOWSCB 360 children were supported to actively engage in learning sessions in the autumn of 2015 following short breaks activity. Other families chose to A new audit tool is in place for internal case Serious Case Reviews included information on the audits within Children’s Social Care and overall access activities using their gateway card plus. Autism Act 2015 and implications for working with compliance within the Disabled Children’s Team parents and older children. was 92.9% in February 2016, which is an There are a team of ‘young inspectors’ drawn from disabled children who are willing to sample improvement from 86.2% in May 2015. A multi-agency case file audit has been planned to the short breaks activities and report back on the look at Section 47 Enquiries for disabled children quality and accessibility of provision. This ensures As part of the focus on improving safeguarding and how, if any, their experiences differ from other that children have a voice in shaping services. services for children with a disability, a multi- children in this process. This will be completed in agency Task and Finish group was established in April 2016. May 2015 to consider the safeguarding of disabled children on the Isle of Wight. Beaulieu House is the only Children’s Home on the IOW owned and run by the IOW Council. It has six permanent beds and 4 respite beds. All of the children who stay in the provision have significant and complex disabilities. SCIP training is delivered to all staff to enable them to de-escalate challenging behaviour and CAMHS support the setting.

“I am more aware of the myths and attitudes of others towards children with disability” (Attendee, Safeguarding Disabled Children, February 2016)

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Children in Elective Home Education (EHE) Exclusions

Parents have the right to educate their child at The IOWSCB expects all agencies working with Developing inclusive practice has been a focus for home as long as they provide an education that is parents who elect to home educate their children, schools. In autumn 2015 a Headteacher workshop “efficient” and “suitable” for the child’s needs and to promote the children’s wellbeing, support was held to examine the data and to seek aptitudes. There is a requirement for the Local children being adequately safeguarded in their solutions for the high number of exclusions. There Authority (LA) to monitor annually that the educational setting and, where appropriate, to has been positive impact from this work in most children educated at home are receiving a notify other agencies of any concerns. The EHE schools. suitable education. lead officer has Level 3 Safeguarding training and is As seen in the data for 2015/16 there has been a an active participant in IOWSCB activity. The LA is expected to “intervene if it appears that downward trend in fixed term exclusions by just parents are not providing a suitable education“. Between September 2015 and March 2016 162 under 10%. The number of education days lost The LA sends the Elective Home Education policy home visits were made by the LA. In addition through exclusions is down by 33%. The to every family who decide to home educate and contacts were made by email, phone and written proportion of children receiving more than 3 this explains the IOWSCB’s responsibility to reports. Approximately 80% of families are exclusions remains static. promote the wellbeing of all children whether receiving an annual home visit. In 2015/16 there were no permanent exclusions home or school educated. from any Primary School on the IOW. There were The IOWSCB is concerned at the increasing number 6 permanent exclusions for Secondary Schools. of families electing to home educate their children There has been a steady downward trend in the and to understand more fully their reasons for number of permanent exclusions from 20 in doing so and the implications for the wellbeing of 2012/13. these children and the wider schools population on the IOW.

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Children Missing, Exploited and Trafficked (MET) The Missing, Exploited and Trafficked (MET) group shares information and reviews the sexual the group on LADO referrals, outcomes and has a comprehensive strategic action plan in place exploitation risk assessment framework (SERAF) actions taken. in response to recent government and local scores for individual children. The school transport team agreed to check the reports. It evidences an improving picture for the safety standards of transport providers for children Isle of Wight, with good progress being made in with Special Educational Needs (SEN) against the the key areas of member and corporate safeguarding policy standards now in place as part engagement and scrutiny, review of licensing and st of the contract by 31 March 2016. When transport policies and management oversight of transport is first requested for a child with SEN, cases where children are identified as at risk of relevant safeguarding information will be captured child sexual exploitation. on the transport request form by the SEN Team. Government legislation placed new duties on The content of this form will be reviewed to ensure LSCBs to conduct regular assessments on the it is fit for purpose. effectiveness of responses to child sexual As part of the refresh of the existing Licensing exploitation. Members of the MET group were Policy all drivers are required to have completed asked to complete a Local Effectiveness the IOWSCB e-learning module on CSE. Existing Assessment Tool for the first time in 2016. drivers and escorts will be required to pass the It was agreed that the first tool would be a general training at the latest by 30 September 2016. audit to assess professional awareness and understanding of issues across Board Partners All new drivers and escorts will be required to followed by assessments of specific areas of CSE complete it before being granted a drivers licence work. or commencing work as an escort.

Failure to pass the training by the 30th September On the Isle of Wight we know that at any one time The recent establishment of the Missing Children 2016 will result in a taxi driver’s licence being there are between four and six children at high risk Panel will allow direct links to be made between suspended and a chaperone not being permitted to of potential sexual exploitation. These are children missing and CSE so that appropriate assessments undertake this role until a pass certificate has been known to be highly vulnerable and risk reduction are in place and interventions deployed to reduce provided. plans are in place for each of them. the incidence of missing and manage the risk of CSE. The monthly Missing, Exploited, Trafficked Risk “U Turn really turned my child’s head around, Assessment Conference (METRAC) collects and Information is shared by the Licensing Department since he had been very fully groomed and with the LADO about any complaint or issue with a thought he was in a relationship and then that it “The Police officer on my case was good at taxi driver. The lead for Licensing is a member of was his fault. He is doing well at school now and keeping in contact in regards to updates the MET group and the designated transport has recovered well.” (CSE Deep Dive Audit 2015) regarding the Police case” (CSE Deep Dive Audit safeguarding lead. Regular reports are provided to 2015)

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Missing, Exploited, and Trafficked Children at Risk of Radicalisation Risk Assessments Conference Radicalisation is driven by an ideology that (METRAC) sanctions the use of violence and encourages the rejection of a cohesive and integrated society. The Isle of Wight has a robust approach to CSE work. There is effective co-ordination between Often those who are most vulnerable are the Police, Social Care and Health, who with deliberately targeted through a narrative that partner agencies participate in Missing, Exploited makes this ideology seem both attractive and and Trafficked Risk Assessment Conference compelling. As part of the Counter Terrorism and (METRAC) chaired by the police. Members meet Security Act 2015 Local Authorities are expected bi-monthly and share information so that each to assess the threat of radicalisation in their area agency represented can manage and increase the and take appropriate action. safety of children who are at high risk of CSE. They are also there to reduce the risk of future The IOWSCB has free E Learning on the PREVENT harm and repeat victimisation and crime. agenda and staff across the IOW have been trained as trainers and can ensure that their staff CSE day teams are all trained. The Safer Communities Partnership have taken a lead on establishing a The Missing, Exploited and Trafficked group channel panel on the IOW. (see Page 29 ) planned activities to mark national CSE awareness Missing day on 18 March 2016. In September 2015 Children’s Services Children Missing from Education The group produced a power point presentation implemented a missing from home and care for use in Secondary Schools to promote procedure and set up a missing panel from October When a child is on a school role but not attending, understanding and awareness of CSE. Activity to 2015 which meets monthly. Children remain on the and they cannot be traced, the Local Authority panel agenda until their number of missing support the campaign to raise awareness and must try to find that child. If necessary, the child make personal pledges was undertaken. episodes decreases, or ceases, to ensure that the right actions are being taken to manage risks. will be identified as missing on the national Participating schools were given wrist bands for all database. There are robust systems for tracking A total of 21 children were discussed over the first pupils to support the campaign which was well children on the Isle of Wight. received. Primary schools were also given the three months of the panel meetings. materials to use with staff or parents for training Workshops were delivered to Children’s Services In the academic year 2015/16, 85 children were purposes. staff and foster carers to ensure they understood identified as missing from education. 12 of these the new procedures. were placed on the school to school (s2s) website A greater number of return interviews are taking as they weren’t traced in a satisfactory time. In place for children not in care by the Targeted Youth 2014/15 there were 93 children identified as Support team and through NYAS for Children in missing from education; 13 were placed on the s2s Care. website. IOWSCB Annual Report 2015-16. Approved 29-Sep-16 www.iowscb.org.uk www.twitter.com/IOWSCB 22

Children’s Health and Well Being Self-harm Accidental and Non-Accidental Injuries Children with a Family Member in the Criminal Justice The Performance and Quality Assurance (PQA) There were 13 children brought for examination The work of (CSOF) (Community Support for group have been closely monitoring the number of in the last quarter of the year for possible non Offenders Families) on the IOW has shown that children attending A&E for self harming. In the last accidental injuries (NAIs) The age range was there is a need for children and families of quarter of 2015/16, 44 children attended A&E with between 3 weeks and 12 years. 3 were under 1 offenders to have support. Feedback from families self-harm. The age range was between 11 and 17 year old. shows what a positive difference this support can years. make to their wellbeing.

CSOF, which is funded by Barnardo's, has 27 were Female 17 were Male supported 23 families of offenders over the year.

At the CSOF family lunch, families were able to get to talk to other people with the same experiences 10 children were open to Children’s Social Care. Four were LAC. as them, reducing stigma and fostering peer support.

8 of the children required admission. Work has been developed in signatory organisations through the roll out of a Charter which sets out the aims of CSOF. Organisations are 25 children were known to CAMHS prior to attendance. 11 children were seen by Adult reviewing their policies and practice to see if they Mental Health services. (See page 35 of this report can better support children with offending in the for CCAMHS information) family. This year key organisations that have signed up include Public Health, Local Authority Early Help There were 14 children took overdoses, Service, Island Family Centres and there are now seven children with cuts to arms, The Health Visiting and School Nursing Teams have 28 organisations signed up to the charter. and three children who had suicidal new joint leadership with increased focus on thoughts or intentions. There are now 33 Champions for the Charter who safeguarding children for the school nurses. meet quarterly to share resources, ideas and best There were a total of six children attending A&E Cases where there are concerns or a need for practice. CSOF has offered training for practitioners with alcohol intoxication, three females and three escalation are discussed at the joint Police, Health called “Hidden Harm” to raise awareness of the males aged between 14 and 16 years. and Children’s Social Care meeting and issues needs of children who have a family member in the resolved. criminal justice system. In 2015-16, 148 people Bi-monthly Operational Safeguarding Children were trained. meetings are held by the Trust to discuss all The bruising protocol for immobile babies has safeguarding issues and ensure that appropriate been revised and is well used by IOW practitioners. The coming year will be a transition year for CSOF actions are taken by services within the IW NHS A leaflet for parents was updated in 2016, helping as they work to embed the Charter and up skill Trust. ensure that families are fully informed of the frontline staff to continue with this agenda, once bruising protocol and how it works. the service comes to an end.

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Children’s Health and Wellbeing (Public Health Children and Young People Survey 2015) A survey was undertaken with 1,600 children from Primary and Secondary Schools in years 6, 8, and 10. The response rate was 40% of those eligible with an even split between girls and boys. They were asked questions which covered a range of aspects of health and wellbeing. Here are some of the safeguarding elements. Public Health have analysed the data and decided on areas of focus for their work in the coming year. Percentages reflect the number of children who responded.

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Children at Risk of Offending

The Youth Offending team work with children From February 2016, a Triage Panel has been in The number of children entering the youth justice who are involved in Youth Justice. They often place and the YCP worker, under direct line system on IOW has reduced steadily over time, have complex needs and need support and management of YOT, will link in with this process and a reduction in custodial sentencing is also advice. and have a role in Community Resolutions, as emerging. Numbers attending Youth Court have appropriate. The work being done now should reduced steadily, and there is a growing trend to The latest figures show a reduction of children entering the youth justice system compared to have a positive impact on reducing youth impose out of court disposals where possible the equivalent periods in the past two years. offending. (overseen via Triage) which will serve to reduce IOW levels of youth offending are slightly higher the impact of convictions in childhood over life- than both the national and comparator average. IOW YOT are also required to undertake course. This is an improving picture compared to ‘Viewpoint’ questionnaires, and recently exceeded the target set for 2015/16. Results are currently Re-offending rates remain challenging, and are previous data. being collated and analysed to inform service indicative of the complexity identified within a During the year, the work of the Youth Crime delivery. A new, more challenging Viewpoint target decreasing cohort of young people who are hard Prevention (YCP) team has gradually increased has been set for 2016/17 and work is already to reach. Only a multi-agency approach will be and the latest return to the Office of the Police underway to meet it. effective in addressing this going forward, and and Crime Commissioner (OPCC) indicates a total work is already underway to support this. of 82 young people who were identified by referring agencies as being at risk of offending have received a service from YCP over the last 12 months.

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4. Voice of the Child Engagement with children & families “The help I am getting has been great I have Rights and Participation been happy at school and everything that was There has been a concerted effort to ensure that on my mind has gone. Mum is more active Within Children’s Services the Rights and the voice of the child is both heard and actively because the help she’s getting” (Child aged 11 Participation team has been working to maximise used to influence service delivery. years, regarding Targeted Early Help Support). the opportunities young people have to have their The Children in Care Council meet monthly and voice heard and influence how services are there are consultations held with these children. Links with Youth Council delivered. Children are now reporting that they are consulted The IOWSCB is forming closer links with the Youth Further ways that children influence the delivery on the practicalities around engaging with their Council and has attended meetings this year. Youth of services include: workers and meeting arrangements. Children are Council members have social wellbeing as one of  asked their preferred venue and arrangements Delivering training to over 25 staff members and their key priorities and have linked with the around timing etc. as these were areas highlighted councillors in how to involve young people and IOWSCB on Anti-bullying work and deep dive for improvement in the last IOWSCB audit. ensure their voice is heard. analysis work on self-harming via the Children's  Being part of the recruitment process for new In the Rights and Participation newsletter (RAP) Rights and Participation officer. children shared feedback on work experience, staff. traineeships and apprenticeships (the 123 Hearing Young Peoples Experiences  Visiting parliament up to 5 times a year to programme) for care leavers. (HYPE) represent children’s views on the IOW care system. The feedback shared has helped the programme co Hearing Young People’s Experiences (HYPE) is a -ordinators to make it more appealing to group of children in care and care leavers that meet  Two Care Leavers also supported the Peer participate and are also more aware of the support monthly to talk about the service they receive. They Inspection of Children’s Services in Hampshire. they will need to offer children who take part. have developed a strong working relationship with They gave very insightful feedback which influenced the final report. the Corporate Parenting Board where the majority of the agenda for councillors and senior

management is now discussions about the issues HYPE have generated and how they can be addressed. Young Inspectors Disabled children carry out secret shopper activity to evaluate short breaks provision and ensure that it is both accessible and safe for service users with disabilities. IOWSCB Annual Report 2015-16. Approved 29-Sep-16 www.iowscb.org.uk www.twitter.com/IOWSCB 26

5. Progress made on Ofsted Inspection Recommendations and 2015/16 Business Plan Leadership and Governance

Aim: To build on the transparent and effective Overall rating: GREEN Areas requiring further work: partnership structure in place by holding to  Improved performance of core child protection  Strengthen links with Family Justice Board and account the key strategic partnerships impacting work ratify the memorandum of understanding on the safeguarding arrangements and services on  Executive Group established within the IOWSCB the Island. The Board will achieve an open, and  CSE strategy and action plan established effective dialogue with these bodies so that it can monitor, challenge practice and identify barriers to  Community Safety Partnership work around safe improvement transportation of children and safeguarding issues at Music Festivals progressing well

 Privately fostered children now being registered  Participation of children, families and front line staff in IOWSCB activity increased  Capacity of School Nurses and Health Visitors being increased and co-ordinated  Training Programme for addressing Toxic Trio has been full and Conference theme in October 2015 addressed this issue  Public Health lead for CDOP now in place  Recruitment of 2 Board Lay Members, plans for Youth Council member in 2016  Domestic Abuse Forum (VAWG) has been re- designed and has a new chair in place  Analysis of Public Health School Survey results, identification of actions needed and monitoring of progress

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Scrutiny, Performance and Assurance

Aim: To evaluate the effectiveness of the Overall rating: GREEN Areas requiring further work: safeguarding system with a specific focus on  4 Multi agency audits completed for MASH, CIN,  Further refinement of agency data sets to understanding the effects of substance misuse, CSE and CIC and audit planned for April 2016 to ensure greater analysis of key issues and actions parental mental health and domestic abuse on examine S47 enquiries for disabled children needed parental capacity, the prevalence and response to  Greater analysis of data sets  Robust planning in response to disabled children neglect and the provision of child and adolescent  First Deep Dive Audit on “Reasons for High audit mental health services. Numbers of Children with CP Plans on IOW”  Further focus on Child and Adolescent Mental  Section 175 and 157 audits revised and sent out Health Services

 Section 11 audit revised by 4LSCB group and sent  Assurances around safeguarding of the growing out in March 2016 number of children Educated at Home on IOW

 Neglect Strategy nearing completion  Alignment of PQA datasets to JTAI themes.

 Missing Panel established & feeding data into

MET group

 Greater structure and guidance for monitoring visits to schools in place for 2016

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Improving Quality of Practice

Aim: To engage Practitioners and their managers Overall rating: GREEN Areas requiring further work: in multi-agency audits, and all types of case  Annual Conference attended by 172 practitioners  Effective systems to measure longer term reviews so that they can learn and directly apply  Training programme workshops attended by 575 impact of training the findings to their practice. The Board will test practitioners  Workshops planned to explore a range of issues the robustness of supervision and management  Planned observations of all training fully in place from Case Audits oversight, the use of local escalation procedures and the effectiveness of information sharing by all  Reflective Annual Reports by all agencies  Neglect training needed in tiers to ensure all in agencies. children’s workforce are aware of types of  Thresholds and Escalation procedures tested via Neglect and how to work with families case audits effectively  Learning workshops attended by 137 practitioners and plans to include learning from case audits  CSE procedures tested through audits – plans for CSE day and refreshed MET plan  MET Problem Profile format has been drafted and will be in place shortly  e-Safety training for parents/carers added to training programme for 2016  Written assurances from agencies regarding their safeguarding supervision arrangements.

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6. How the Board has worked to Safeguard Children on the Isle of Wight in 2015/16

Children’s Social Care Allegations against staff and volunteers Innovation Fund monies have been used to meet Moving forward CSC are working to : All LSCBs have responsibility for ensuring there rising demands with less resources: are effective procedures in place for investigating allegations against people who Family Intervention Teams: two teams work with children. The Local Authority started November 2015 in Children’s Designated Officer (LADO) should be Social Care for one year initially. Good informed of allegations against adults example of partner agencies working working with children. The officer also together to appoint/second substance provides advice and guidance to ensure that misuse, adult mental health and cases are resolved as quickly as possible so domestic abuse workers from the Island that children are protected. Recovery Integrated Services (IRIS), adult mental health and the Refuge. There have been a rise in LADO referrals from 156 to 224 from April 2015 to March Social Worker Personal Assistants: PAs 2016. Most referrals come from within have been recruited to free up social schools. The LADO works closely with workers from the office and computer schools, pre-schools and other Education to spend more time effecting change settings as well as more widely across Social within families Care and the Voluntary Sector.

In addition, Homestart have trained The LADO has delivered 47 safe practice specialist volunteers to work alongside training sessions during 2015/16 and this has social care supporting families. raised awareness of LADO processes and safe conduct.

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Independent Reviewing Service (IRS) Children’s Trust The Independent Reviewing Officers are There is a need to develop completion and The Trust members aim to work together to independent chairs for Child Protection recording of permanency plans with just 57% ensure high quality outcomes for all children and Conferences and work closely with children who having gone to permanency planning. There is a to enable them to access sustainable support and are looked after by the local authority. IROs need to increase the number of IRO visits to services. They have 3 strategic priorities for additionally have responsibilities for Children in children between reviews. children that link closely to the IOWSCB business Care placed off island. plan: Most children aged 4 – 17 participated in their Two new IROs were successfully recruited and will looked after child reviews with 238 (58.5%)  Children enjoy the best possible mental, take up their posts in 2016/17 and this will impact attending and a further 156 (38%) not attending emotional and physical health – with a focus on positively on service provision and stability. The but conveying their views. Work is underway to reducing teenage pregnancy rates, reducing the IROs in post all have substantial post qualifying identify a lead IRO for participation. need for Social Care support through Child experience and have the status and experience to Protection Plans and increasing children’s challenge professional practice. In the coming year there will be a greater emotional health and resilience and reducing emphasis on auditing performance and taking treatment for anxiety, stress and depression. Children looked after figures have remained steps to improve performance. The service has  Children feel safe and behave safely – with a stable with a monthly average of 201. There has greater staff stability and reduced caseloads and focus on fewer children in the criminal justice been a downward trend since September 2015 is well placed to take forward the areas for system, fewer children admitted into hospital and this will be monitored closely. development. for unintentional injuries and lower levels of

obesity seen in children. The Neglect Strategy  Children have high aspirations and are able to The impact of Neglect on children can be achieve their full potential – with a focus on enormous. A multi-agency working group was achievement at the end of KS2 and KS4 being established to develop a Neglect Strategy. This higher and higher levels of children 16-19 in group has linked with Hampshire and the education, employment or training. strategy is nearing completion and will be launched at the IOWSCB Annual Conference in October 2016.

This will provide clear guidance for practitioners on how to recognise types of Neglect and provide appropriate services for children and families to reduce safeguarding risk associated with Neglect which is currently the most used category in Child Protection cases.

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Ending Violence Against Woman and Girls Strategy (VAWG) 2016-2020

The Isle of Wight VAWG Strategic Partnership has perpetrator and crime reduction programmes such now agreed a four year strategy 2016-2020 to run as FIP (Family Intervention Programme in in tandem with the above HM Portsmouth) where a perpetrator Government VAWG Strategy. The prevention programme is delivered. Strategy contains four key themes of delivery based upon Preventing  A Domestic Abuse coordinator is now in Violence, Provision of Services, post and a refreshed plan for strategic work is Partnership Working and Justice in place. A case file audit on MASH with a focus Outcomes/Risk Reduction and will on domestic abuse is planned for 2016. impact on children and families (including men and boys) through the following strategic goals; Multi-Agency Risk Assessment

 Ensure effective information Conference (MARAC) sharing and training for MARAC meetings are held once a month professionals to improve their and are jointly chaired by the Police and awareness for signposting and Women’s Refuge. There is good multi- support to victims and families. agency representation at meetings. The  To ensure a robust approach to CCG now attend and represent the voice of domestic abuse and healthy GPs. relationships is part of education Approximately 25 cases are discussed per in schools and colleges. meeting and there is effective assessment of risk.  Provide intensive support to Cases involving children are always children and families who have discussed first and there is therefore experienced and/or witnessed robust identification of high risk cases domestic or sexual abuse and where children are involved. violence.  Address domestic abuse from a ‘life course’ perspective.  Maximise opportunities to join Hampshire wide

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FGM  Identify and prevent maltreatment or  Prepare: Reduce the harm caused by modern impairment of health or development, and slavery through improved victim identification Under section 47 of the Children Act 1989, ensure children are growing up in circumstances and enhanced support. anyone who has information that a child is consistent with safe and effective care. potentially or actually at risk of significant harm is The Partnership aims to equip the community required to inform social care or the police.  Safeguard and promote the welfare of groups of with the skills, knowledge and tools to be able to: children who are potentially more vulnerable Female Genital Mutilation has been illegal in the than the general population.  Identify modern slavery in Hampshire and the UK since 1985. The law was strengthened in 2003 Isle of Wight  Increase understanding of safeguarding children to prevent children travelling from the UK to issues in the professional and wider community,  Support potential victims of modern slavery undergo FGM abroad. In April 2014 it became promoting the message that safeguarding is mandatory for Health professionals to record  Support the police in ensuring that the everybody’s responsibility. FGM in patient’s health care records. perpetrators face appropriate consequences for Professionals working with children are required The FGM strategy also contains tools to help their actions to report known cases of FGM to the police. practitioners and signpost them to further  Disrupt, disable and eliminate modern slavery in information and support. Hampshire and the Isle of Wight altogether. In the 2011 census there were 262 residents on the Isle of Wight who were born in countries of Modern Slavery A range of free online resources and training high FGM prevalence. There is no breakdown by events have been made available to the The Modern Slavery Partnership for Hampshire age or gender available. workforce. The Missing Exploited and Trafficked and the Isle of Wight is a multi-agency partnership. group will receive regular feedback from Modern There have been no reported cases of FGM on It was set up by Hampshire Constabulary in 2013 Slavery Partnership meetings and will be able to the Isle of Wight since records began. It is funded and chaired by the Office of the Police and raise questions and concerns about children important to note that the probability of FGM Crime Commissioner. An Isle of Wight group was involved in Modern Slavery in the coming year. occurring on the Isle of Wight is still present in set up and is supported by a steering group of up light of the demographics. to nine separate agencies and is coordinated by the Medaille Trust. The IOW FGM strategy was jointly developed to define a co-ordinated and effective set of The key aims of the partnership are: responses to the threat of FGM between Public  Pursue: Prosecute and disrupt individuals and Health, IOWSCB, IOWSAB, Domestic Abuse Forum groups responsible for modern slavery. and front line professionals across the Isle of Wight.  Prevent: Prevent people from engaging in and being a victim of modern slavery. The IOWSCB has a duty and responsibility to promote activity amongst local agencies and in the  Protect: Strengthen safeguards against modern community in order to: slavery by protecting vulnerable people from exploitation and increasing awareness of and resilience against this crime. IOWSCB Annual Report 2015-16. Approved 29-Sep- 16 www.iowscb.org.uk www.twitter.com/IOWSCB 33

CAFCASS Targeted Youth Service through an emergency Bed at The Foyer without referring to Children’s Social Care, which will lead CAFCASS has two practitioners working on the In the last financial year, TYS supported 24 children to fewer referrals to Tier 4. IOW. There are no cases of FGM locally at who presented to the service at risk of or homeless present. There have been cases of radicalisation in line with part three of The Children Act 1989. TYS have identified children with higher level in Hampshire but none on the IOW. Out of these children, only 25% of those who support needs beyond those of Early Help. Once presented were escalated and the remaining 75% these needs have been addressed by Children’s There has been an improvement in completion of were successful in securing accommodation that Social Care, the aim is to ‘step these cases down’ care proceedings and good standard of work for met their needs. to TYS for ongoing support to sustain the change IOW reported by CAFCASS. This was verified by achieved. the peer inspection in December 2015: The TYS team were given training to equip staff with the skills to mediate, negotiate and Probation CRC “Court work is improving with strong communicate more effectively with families. This management oversight and a good grip on has led to a noticeable decline in the amount of The probation services are undergoing a PLO and court work, which on the while has cases escalating to Children’s Social Care for significant reorganisation in terms of staffing resulted in cases being dealt with to a good assessment. structure and the way in which cases are standard and in a timely manner” managed. Despite this, the commitment to The Isle of Wight do not currently have any access safeguarding remains. to immediate accommodation, therefore when a MAPPA Within the CRC, the main area for concern child presents to TYS and does not have a safe Multi-agency Public Protection Arrangements regarding safeguarding children is with domestic place to stay for that evening, this can lead to a (MAPPA) are statutory measures for managing abuse cases. By the time the CRC gets a case referral to Children’s Social Care where mediation sexual and violent offenders under the Criminal from Court, assessments have largely been with the family does not work. TYS are part of the Justice Act 2003. The Police, prison and probation completed by Children’s Services and it is a case Housing Strategy group that is exploring options to services have a duty and responsibility to ensure of ensuring that if the case is open, that there is enable TYS to secure immediate accommodation MAPPA are established in their area for the appropriate liaison between CRC staff managing assessment and management of risk of all the perpetrator and Children’s Services staff. CRC identified MAPPA offenders. staff regularly attend Core Groups and review meetings. The purpose of MAPPA is to help reduce the 29 Cases were assessed to present a risk to reoffending behaviour of sexual and violent children on the IOW. offenders in order to protect the public from serious harm, by ensuring all agencies work 16 Offenders who were given a community together effectively. order/licence condition to complete Building Better Relationships programme on the IOW. 80 MAPPA meetings were held between April 2015 and March 2016 Five cases assessed to present a risk to children on the IOW where home visit has

been undertaken in the last quarter IOWSCB Annual Report 2015-16. Approved 29-Sep-16 www.iowscb.org.uk www.twitter.com/IOWSCB 34

Licensing Community Safety Partnership PREVENT The requirement for all taxi drivers to have The Isle of Wight Community Safety Partnership In the past year the CSP has delivered workshops undertaken Safeguarding Training before a new (CSP) produced a strategic assessment for 2015) to raise awareness of Prevent (WRAP) to train drivers licence can be issued has been which is the evidence base for the CSP strategic frontline staff and Councillors to recognise the implemented. There is also a requirement for all plan. signs of vulnerable people being drawn into existing drivers to have completed the course by extremist and radicalised behaviour and to 30 September 2016.The training is provided online As part of this process community consultation was understand the referral process and provide and was developed by the Licensing Manager, and carried out with a variety of age groups and interventions for safeguarding. A Prevent Board Adult and Child Safeguarding teams along with the communities including older children. The majority for the Island has recently been established and Education Centre. All taxi drivers are required to of older children (68%) said they did feel safe but a will produce a delivery and engagement plan to hold a valid enhanced DBS at the point of high number said they were concerned about drugs carry out the statutory Prevent duty. licensing. This also applies to contracts for drivers and alcohol being consumed by young people they Further information on Isle of Wight Community and escorts. knew and a large number of children identified Safety Partnership can be found on the IOW Child Sexual Exploitation (CSE) and Anti-Social Community Partnership Website Child Safeguarding support was formalised and Behaviour (ASB) as a priority. introduced at the IW Festival. The work proved to Trading Standards be a success and was welcomed by the event An awareness session on Child Sexual Exploitation Test purchasing exercises and enforcement organisers and the Police. Some joint working was was held in January 2016 for CSP partners to continue to be in place for alcohol, tobacco and introduced and a number of reactive incidents understand the extent of the problem. Using knives to ensure they are not being sold to were dealt with on site. This is something which the CSP Strategic Assessment, partners agreed a children on the IOW. IOWSCB would like to continue each year. Officers priority within the strategic plan ‘Protecting are currently discussing similar working Vulnerable Members of the Community’. arrangements with the organisers of Bestival. The Community Safety team works with other partners to provide gatekeeping within schools. This initiative identifies young people who are at risk of engaging in ASB and low level crimes and then provides interventions to distract young people into more positive behaviours. To tackle ASB with all age groups the Joint Action Group (JAG) for ASB has been set up to consider serious, complex cases, carry out problem solving of hot spot areas and provide partnership solutions to improve neighbourhood community safety.

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Community Child and Adolescent Mental Health Service (CCAMHS) Community Child and Adolescent Mental Health 97 professionals completed a brief follow-up survey. Service (CCAMHS) recognise the importance of 83% reported that they are using what they learned Average waiting time in weeks from providing preventative and early intervention very often, often, or occasionally; 100% said that allocation to first appointment was 3 services. CCAHMS have provided training they would attend further workshops run by weeks (goal of 14 weeks) workshops focused on some of the common CCAMHS. mental health issues for children and young people As well as client based contacts, there was also Referrals in 2015/2016 or other professionals in the community. attendance at professionals meetings, ward rounds, CP, CIN and TAFs meetings and

consultations with schools.

476 Attendees New and Ongoing Cases in 2015/2016

During the year 218 of clients seen 74 were urgent 708 New were 1-10 years old. referrals Referrals 13 Anxiety 10 Self Harm 4 Building Workshops Workshops Resilience 654 of new referrals went to initial assessment—all During the year 935 of clients seen Workshops received a service either through short term were 11-20 years old.

The workshops helped to build closer working intervention or longer term inputs. 753 were “Further partnership working is required relationships with professionals in the community discharged. between Social care & CAMHS to effectively and support them to identify when CCAMHS input meet the emotional & mental health needs of is required. The workshops were delivered Over the year there has been a noticeable pressure looked after children.” (Children’s Social Care regularly in the evenings by a range of CCAMHS to work with young people with eating disorders peer review December 2015) practitioners. (both anorexia and obesity); anxiety linked to social,

Attendees completed an evaluation form to assess school and self esteem; issues related to children on their experience of the workshops : the autistic spectrum and ADHD; long term health conditions; trauma ;nd self harm.

During 2015/16 649 or 56% of clients

seen were Female

During 2015/16 506 or 44% of clients seen were Male

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7. Learning and Improvement How the Board responds to Child Deaths on the Isle of Wight

Every child’s death is a tragedy. When a child dies, There will be shared learning and data sharing on a A Memorandum of Understanding (MOU) will be the Child Death Overview Panel (CDOP) requires a minimum annual basis. There will also be a joint established to formalise these principles and systematic review to help understand why the annual report. make provision for the production of the 4LSCB death occurred. CDOP Annual Report and annual submission to the Department for Education, both to be led by By focussing on unexpected deaths in children, the HSCB. panel can recommend interventions to help improve child safety and to prevent future deaths. When a child dies unexpectedly, a ‘Rapid The panel is also able to consider any wider public Response’ process takes place where a group of health or safety concerns. key professionals work together to review the circumstances and inform understanding about From April to October 2015 the four Local the reasons for the child’s death. Safeguarding Children Boards in the Isle of Wight, Hampshire, Southampton and Portsmouth were The IOWSCB ran two multi-agency ‘Rapid part of a joint CDOP. From November 2015 it was Response’ training sessions in 2015/16 for front decided to disband this arrangement and the Isle line staff and these were attended by 56 people. of Wight established its own CDOP. We also produced leaflets to help parents and siblings understand what CDOP was. To ensure consistency of practice across the four areas, and to reduce any unnecessary duplication Feed back from Rapid Response Training: The CDOP members on the Isle of Wight have or burden to shared partners, the 4LSCB met twice between November and March and Independent Chairs agreed that: “Very useful session. A lot of information I examined 4 cases. In total there were 9 child was unaware of”. deaths on the Isle of Wight in 2015/16 of which Each LSCB is committed to having agreed Rapid 1 was unexpected. Response procedures, as well as standard CDOP “Useful to be able to ask questions, which we forms, across the four areas. did!”

“Good delivery of a difficult subject”.

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Serious Case Reviews

monitor whether recommendations have been LSCBs are responsible for carrying out reviews of . serious cases . A serious case is one where: acted upon. a) Abuse or neglect of a child is known or Agencies are accountable to the Board for ensuring suspected; and that required actions. The SCR group regularly The SCR was asked to address: reviews the combined action plan, considered a) Either actions that have been completed and those that  The consideration and identification of risk, remain outstanding. and the assessments undertaken when  the child has died; or ‘stepping up’ and ‘stepping down’ the case and  the child has been seriously harmed and there whether it was being managed at the right is cause of concern as to the way the level. authority, their board partners or other relevant persons have worked together to  The effectiveness of agency involvement, safeguard the child information sharing and co-ordination of services in supporting the child and family to The purpose of a Serious Case Review (SCR) is to reduce and manage child’s risky behaviour? identify any lessons to be learnt from the case about multi- agency safeguarding practice.  The decision by the Community Child & Adolescent Mental Health Service (CCAMHS) to SCRs also identify areas of good practice and discharge the child from its service consider how these can be shared and embedded. The IOWSCB acts to ensure that lessons learnt Recommendations: from reviews inform practice improvement.  The Board will seek a review of the EIPT and Working Together 2015 advises that if the criteria CCAMHS services including how they are to carry out an SCR are not met, the LSCB might linked, with a focus on clarifying referral still decide to commission a Partnership Review to pathways, triage and case allocation processes make sure that learning from the case. as well shared knowledge and understanding

During 2015/16 two Serious Case Reviews were  The Board will review its pathways/protocols commissioned and published. The Serious Case for supporting sexually active teenagers and Review Sub group maintains a combined action their parents plan for all reviews undertaken so that they can

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Serious Case Reviews

Recommendations

 Quality assurance processes ensure effective child in need plans that secure the safety and wellbeing of all children.

 Practitioners must have knowledge and The SCR was asked to address: understanding of young carers and parent carers with regards to autism and to apply to  To what extent was there efficient inter- their work. agency information sharing to facilitate the effective delivery of services to child D and  Occupational Therapy and Disabled Children’s his sibling and to his mother? Team must have formally agreed standards for working together to enable effective and timely  How well informed were the professional meeting of children’s support needs. assessments of mother’s ability to keep her children safe before and after the diagnosis  Effective and compliant records must be of autism in 2014? established and improve service provision for children.  How well co-ordinated was the work of the many agencies involved with the family?  Greater clarity in terms of aims and progress, rigour with respect to timeframes for action and  Were the longer term consequences for the greater consistency of practice amongst children as well as the immediate risks partners. associated with neglect sufficiently recognised?  Enhanced confidence that child-centred assessments become the norm and actively  To what extent was the ‘lived experience’ of inform planning of specific, measurable, child D and his sibling understood? achievable, realistic and timely (SMART) targets for improvements for the child .

All recommendations from Serious Case Reviews are monitored by the SCR subgroup and are held in a combined SCR Action Plan. IOWSCB Annual Report 2015-16. Approved 29-Sep-16 www.iowscb.org.uk www.twitter.com/IOWSCB 39

Learning from Serious Case Reviews and Partnership Reviews

7 Learning sessions were held at a range of venues across the IOW and on different days and times, with a total of 137 Practitioners attending. There were representatives from a wide range of service providers including the third sector. The aims of the workshops were to:

 Hear findings and lessons from recent Isle of Wight Serious Case Reviews and Partnership Reviews  Be aware of themes emerging from national Serious Case Reviews  Be able to apply this learning to own practice

The workshops received positive evaluations and one session was observed by a Workforce Development group member for quality assurance. Participants were asked to write down two actions they would take as a result of the session:

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Section 11 audit Section 175/157 audit Section 11 of the Children Act 2004 places duties The Board should be assured that Schools and on a range of organisations and individuals to Colleges give due consideration to safeguard and ensure that they have regard to the need to promote the welfare of children. There was 100% safeguard and promote the welfare of children. completion rate of the audit tool by schools and The IOWSCB has a duty to assess whether partners colleges on the IOW in 2016. are fulfilling these obligations. In 2016, Section 11 The tool was sent to the language schools that auditing was undertaken jointly by Hampshire and operate on the Isle of Wight and one completed Isle of Wight to avoid repetition by some agencies audit was received from the IOW College. The and to align the content and process. IOWSCB Business Unit has had helpful contact with This will provide an additional level of scrutiny to EF and Hamilton Idiomas Language schools who are the Board’s quality assurance role, and give a clear working with the IOWSCB. One further Language message about how important safeguarding is on school did not respond to the audit tool and this the Isle of Wight. will be a priority area for 2016/17. We have agreed Discussions have begun with the key Ferry to revise the audit for Language schools to focus on basic safeguarding practices. companies about how they can provide assurances that their staff operate safely and are aware of Main findings from the 2016 Schools Audit Report: child safeguarding and local procedures, and we There were sixteen areas of performance in will develop this dialogue and some support safeguarding that schools were asked to grade materials in the coming year. We have also themselves against as well as some additional data. engaged a church based organisation that does youth work on the Isle of Wight and they have The audit has provided the Board with information agreed to complete an audit tool. about the support and training schools need to safeguard children. All schools have a designated safeguarding lead (DSL) and at least one deputy and a safeguarding Governor in place. Schools with Early Years provision on site have at least one person who has completed 12 hours paediatric first aid training. A dip sample of visits to 10 schools are booked for June 2016 to verify evidence of safeguarding audit scores and to meet with pupils and Governors to ask their views.

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Thematic Case file audits CSE 1 and 2 Oct 2015 - the audit consisted of 2 confidence at holding cases at CIN. This together A planned cycle of themed multi-agency case file audit days, a dip sample of all cases coming in to with the use of agency workers and the review of audits take place each year. In 2015/16 there were MASH over one month to look for SERAF thresholds were all considered to be factors in the three completed with a fourth on MASH presented completion, a practitioner survey completed by 213 current situation. to the board: people from across 10 agencies and a phone interview with a parent and a key worker interview A bulge of cases in the children protection system with a child. The audit focussed on the was recognised as being a factor and one that understanding and use of SERAF in cases where would take two to three years to clear. An increase children were at risk of exploitation. in referrals was also expected while the new Early Help contract was embedded. All partner agencies CIC 3 and 15 Dec 2015 3 - the audit consisted of 2 were invited to provide their views. audit days and interviews with two parents and a Children’s Social Care has monitored the data for child. The audit tool covered a range of areas of child protection cases closely and it shows signs provision: Health, Education, Support, Placements, now of reducing and this pattern of reduction is a Child’s Voice, and Case Management. welcome sign of improvement and will be monitored over the coming year. Deep Dive Analysis of Key Partnership

issues In addition to the multi-agency audits, it was decided to pilot a thematic approach to audits for issues highlighted through the data sets and analysis work of the Performance and Quality Assurance group.

Child Protection plans on the IOW (that were significantly higher than statistical neighbours) were CIN 1 and 3 July 2015 – the audit consisted of 2 not reducing. Therefore, since further analysis was audit days, a Practitioner survey completed by 157 needed across agencies to unpick the reasons the people from across 11 agencies, and an interview high numbers were high, this was chosen as the with one family. The audit was comprehensive in first theme. looking at the child’s journey from identification of need through to review and management It was highlighted that previous service oversight. inadequacies had resulted in a culture of risk

aversion among practitioners and also a lack of

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Training and Quality Assurance The IOWSCB co-ordinates, promotes, quality Training Observations assures and evaluates training and The group implemented a standardised observation 2015/16 Training Programme Data development opportunities for multi-agency form and process to help assure the quality of partners designed to improve frontline training delivered. A total of seven training sessions practice in safeguarding and promote the were observed by Workforce Development Group welfare of children. There is a training members in 2015/16. programme in place each year, which is aligned “A very successful session with powerful images to the priorities in the Business Plan, findings shown. Participants commented in the break from inspections, audits, and Serious Case about how powerful the training was and how Reviews. much they were gaining from it.” (Observer, Child “Excellent discussion of cultural differences and the A needs analysis process takes place every year Trafficking) to ensure the views and needs of all partner impact this has regarding ” “Lots of CSE involves trafficking and lots of agencies are reflected in the training safeguarding children February 2016 trafficking involves CSE and they are bound programme. Training is delivered both in house together so we might want to think about and through commissioned providers and it is combining the two courses.” (Trainer, Child quality assured through training observations Trafficking) made by Workforce Development group members. “Relaxed and informal atmosphere but the importance of the topic was never lost. Groups A pilot evening workshop was delivered for were divided from usual work colleagues to Parents/Carers regarding online safety with a encourage discussion and wider workforce clear message about enabling children to learning with other agencies.” (Observer, access the opportunities of the online Learning Lessons 2015) community, but safely through establishing clear rules and good communication. Further “Trainer has a clarity and confidence in her style training for Parents/Carers will be delivered in of delivery. The session was paced well and a lot 2016. We have been piloting ways of of subject content was covered in 2 measuring long term impact of training and hours.“ (Observer, Safeguarding Children with a the use of longer term evaluations of impact Disability) on practice with attendees. “I am heartened to receive positive responses in Excellent discussion of cultural light of increasing the opportunities for training in differences and the impact this has this area. I intend to work with a variety of teams regarding safeguarding and agencies to develop the content to meet ‘multi-agency’ disciplines.” (Trainer, Safeguarding children” (Attendee, Toxic Trio) Children With a Disability) IOWSCB Annual Report 2015-16. Approved 29-Sep-16 www.iowscb.org.uk www.twitter.com/IOWSCB 43

Annual Conference Chelsea’s Choice Chelsea’s Choice The theme for the 2015 Annual Conference was Chelsea’s Choice is a hard hitting play Responses from students: the Toxic Trio Revisited. The conference was about how a girl becomes sexually exploited. “If you know any of your friends might be in attended by 172 practitioners. There was a We secured Police and Crime Commissioner grant danger let someone know“ consultation in the afternoon on the proposed funding to provide this to Secondary Schools across Neglect Strategy and this workshop proved useful. the Island again this year. At the end of the “The play left me stunned at what can happen!” performance the actors provide a question and A number of sixth form students and Youth “Groomers use their victim’s vulnerabilities to answer session and a chance for the children Council members were in attendance. They create false trust“ evaluated a play exploring domestic violence watching to be reassured and informed and to seek called ‘Behind Closed Doors’ that was shown at help if they need it. At the evening performance a the conference, and whether it was suitable for few attendees had concerns about children that they needed to explore school aged pupils. They also joined table discussions during the day. as a result of watching the play and they were offered suitable support and advice. Comments from professionals regarding how the Nine Schools had performances of conference would impact practice included: Chelsea’s Choice in 2015/16. This involved “Feel more confident discussing issues with other 1379 children from years 8, 9, and 10. In professionals addition, 48 professionals from a variety of agencies including Housing workers and 12 “Share information more/access MASH more” parents and foster carers attended an “Importance of speaking to Mothers without evening performance. partners present“ A community venue was booked so that children and their parents who Electively Home Educate could attend a performance, but this was cancelled due to lack of response. One parent of a home educated child was able to attend the evening performance instead. During school audit visits in June 2015, children still spoke about seeing the play and the impact it had on them and their awareness of this issue and this is what the IOWSCB had hoped for.

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8. Future priorities for the Board

Priority One: Leadership and Priority Two: Scrutiny, Priority Three: Improving Governance Performance and Assurance Quality of Practice Aim: Aim: Aim: To ensure a ‘HOT’ (honest, open and trusting) The Board will evaluate the effectiveness of Practitioners and their managers will engage in culture in partnership working, holding to account safeguarding systems. There will be a specific focus multi-agency audits, case reviews and Learning the key strategic partnerships impacting on on: Workshops so that they can learn and directly safeguarding arrangements and services on the apply the findings to their practice. The Board will  The effectiveness of responses to substance Island. The Board will use the honest, open and misuse, parental mental health and domestic seek to ensure consistency of Safeguarding case trusting dialogue with these bodies to monitor and abuse on outcomes for children. supervision practice and the effectiveness of the challenge practice, identify and overcome barriers Joint Working Protocol by all agencies. to improvement through agreed actions and  The implementation of a comprehensive Training will be developed to support celebrate best practice. Neglect Strategy implementation of the Neglect Strategy and there There will be a focus on further development of  The provision of child and adolescent mental will be training needs emerging from the deep links with Hampshire LSCB being mindful of the health services and other services to meet the dive analysis of underage sexual activity and needs of older children and those with Wood report published in June 2016. consent taking place in 2016. disabilities. Other aims include: There will be an exploration of new approaches to quality assurance including a more thematic  Re-development of the IOW response to approach to data analysis. Domestic Abuse. CSE, Modern Slavery and the PREVENT agenda will  Development of the VAWG strategic plan. remain focus areas.  The voice of the Child and their influence on service delivery will remain high priority The task and finish group for disabled children will continue to assure improvements in safeguarding provision for these children.

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IOWSCB Members Board Members oar Members Board Members Maggie Blyth Amanda Gregory Mandy Tyson Independent Chair Community Safety Partnership IOW CCG Head of Safeguarding and Designated Nurse Stuart Ashley Rich John Isle of Wight Council Children's Services Hampshire Constabulary Julie Davies (SCR Group Chair) Loretta Kinsella Isle of Wight Council - Children's Services IOW CCG - Quality and Clinical Services Phillip Sharpe Jonathan Bacon Scott Mackechnie Isle of Wight Council - Adult Social Care Isle of Wight Council - Leader Hampshire Constabulary (MET Chair) Sarah Jackson Laura Bosworth Christopher Magier Hampshire Constabulary Primary Schools IOW CCG - Designated Doctor Justin Harden Steve Cottrell Kathy Marriott Isle of Wight Fire Service Isle of Wight Council - Education Isle of Wight Council - Children's Services (Education and Schools Group Chair) (PQA Chair) Business Unit Staff Steve Crocker Rachel McKernan Isle of Wight Council Children's Services Voluntary Sector Forum Jane Leigh Nirmala Dutta Interim Board Manager CAFCASS Nicola Priest NHS England Debbie Pledge Rida Elkheir Senior Administration Officer Isle of Wight Council - Public Health David Renouf CDOP Administrator National Probation Service Laura Franklin Assistant Police and Crime Commissioner Alan Sheward NHS Trust Fleur Gardiner Isle of Wight Local Safeguarding Adults Board Alison Smailes Isle of Wight Youth Offending Team Pat Goodhead (Workforce Development Group Chair) Secondary Schools Barbara Swyer Community Rehabilitation Company

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REPORT TO THE TRUST BOARD (Part 1 - Public) ON 7 December 2016

Title Hampshire and Isle of Wight Sustainability and Transformation Plan Sponsoring Karen Baker, Chief Executive Executive Director Author(s) Karen Baker, Chief Executive Purpose To receive the HIOW Sustainability and Transformation Plan which was published on the 23 November 2016. Action required by Receive X Approve the Board: Previously considered by (state date): Sub-Committee Dates Key Issues, Concerns and Discussed Recommendations from Sub Committee Trust Leadership Committee

Audit and Corporate Risk Committee

Charitable Funds Committee Finance, Investment, Information & Workforce Committee Mental Health Act Scrutiny Committee Remuneration & Nominations Committee Quality Governance Committee Information & Communications Technology Assurance Committee Please add any other committees below as needed Board Seminar

Other (please state) Staff, stakeholder, patient and public engagement:

Proposals in the plan which involve fundamental changes will be developed with local people and where appropriate formal consultations will be held.

Executive Summary & Analysis: The Isle of Wight NHS Trust has been working with health and care organisations across Hampshire and the Isle of Wight to agree how best to meet the many opportunities and challenges facing the local health and care system. This has focused on both the need to empower people to stay well and also on how we can provide safe, high quality, consistent and affordable health and care to everyone. The plan, which has been developed by all the health and care organisations across the area, also describes how the local NHS will implement a number of critical national programmes, including the Five Year Forward View for mental health and for general practice and covers a period of five years from 2016 to 2021. Recommendation to the Board: The Board is recommended to receive the HIOW Sustainability and Transformation Plan. Attached Appendices & Background papers Enc H2 - HIOW Sustainability and Transformation Plan Summary Enc H3 - HIOW Sustainability and Transformation Plan Final

REPORT TO THE TRUST BOARD (Part 1 – Public)V13 Page 1

For following sections – please indicate as appropriate:

Trust Goals & Priorities Excellent Patient Care Work with others to keep improving our services A positive experience for patients, service users and staff Skilled and capable staff Cost effective, sustainable services Principal Risks (BAF) Principal Risk 672 Financial Resources Principal Risk 673 Strategy and Planning Principal Risk 677 Local Health and Social Care Economy Resilience Principal Risk 676 Information Communication Technology Legal implications, regulatory and n/a consultation requirements

Date: 23 November 2016 Completed by: Karen Baker, Chief Executive

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Hampshire and Isle of Wight Sustainability and Transformation Plan

Summary

DRAFT November 2016

2

CONTENTS

Introduction page 3

Our local area or ‘footprint’ page 6

Why do we need to change how we provide services? page 7

Meeting the challenges page 9

Looking to the future page 13

Involving local people page 14

Glossary page 15

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INTRODUCTION

Over the past eight months, health and care organisations across Hampshire and the Isle of Wight have been working together to agree how best to meet the many opportunities and challenges facing the local health and care system around the need to empower people to stay well and to provide safe, high quality, consistent and affordable health and care to everyone.

While people in Hampshire and the Isle of Wight are generally living longer, many of us are also living with multiple long-term physical and mental health conditions. Too many people stay in hospital longer than they need to because of difficulties in getting the necessary support outside and there are increasing gaps in the number of doctors, nurses and other health workers needed to care for us.

General practice is facing significant challenges which, if not resolved, will significantly impact the whole health and social care system and its ability to care for people effectively at home and in the community. It is the first port of call for the vast majority of the population, with over 90% of all contacts with the NHS taking place in general practice, and if it fails the whole NHS will fail.

Additionally, there is a gap between the money available to the NHS and the cost of providing the services that patients need. If NHS organisations across Hampshire and Isle of Wight do nothing to change the rising demand for services and the way they are provided, by 2020/21 there will be a gap of £577 million between the money received and what is needed. This does not include the challenge faced by Local Authority social care services.

We also need to recognise that there are plans to build thousands of new homes in Hampshire over the coming five years, ranging from 1,420 in Gosport to 5,924 in Basingstoke and Deane. These exciting developments will, however, bring ever increasing demands for health and care provision.

These challenges are not new and, in parts of Hampshire and the Isle of Wight, we are already testing ways of providing care differently that are acting as blueprints for the future.

These include:  'My Life A Full Life' on the Isle of Wight (http://www.mylifeafulllife.com/);  Better Local Care in Southern Hampshire (http://www.betterlocalcare.org.uk/);  ‘Happy, healthy, at home’ - North East Hampshire and Farnham CCG (http://www.happyhealthyathome.org)  The Practice (http://www.betterlocalcare.org.uk/in-your-area/west-new- forest/what-we-are-doing/the-practice/).  University Hospital Southampton NHS Foundation Trust and Portsmouth Hospital NHS Trust are working together to plan a world-class service for vascular (vein and artery) surgery at Southampton General Hospital that will serve patients from both areas. This will include additional surgeons and a new £2 million 'hybrid theatre'.

Transforming health and care in Hampshire and the Isle of Wight:

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 Hampshire and Isle of Wight health and care organisations are already taking part in a new Cancer Alliance that will build on existing services to create world-class cancer care for local people. In addition, Better Care Southampton (http://www.southamptoncityccg.nhs.uk/better-care-southampton) has been underway for several years.

The role of the Hampshire and Isle of Wight transformation programme is NOT to replace or slow down local transformation programmes. Instead, we have come together across Hampshire and the Isle of Wight to do the things that can only be achieved by working together, such as identifying more opportunities like the improvements to vascular services outlined above. We have learned a great deal from working with and listening to local people over the past few years and this plan is rooted in these local discussions. Working together also allows us to better share best practice and ensure we are co-ordinated when we make local changes.

These programmes are changing the way that health and care is provided in many ways. Some offer patients more choice about when and where to receive treatment, less travelling time to attend appointments and less time waiting for appointments, diagnostic tests and test results. Other changes may mean patients travelling further than they do today to make sure they receive the very best care possible for their condition, with all the benefits that that brings.

If we are to have services that are sustainable in the future, we must build on these new ways of planning and providing them - and that means changing how our local NHS works today. Individual organisations like hospital trusts or GP practices cannot provide the answers on their own because many of these issues affect more than just one organisation or community.

These challenges are not unique to our area; in fact, Hampshire and the Isle of Wight is one of 44 areas across England that are developing detailed local transformation and sustainability plans (STPs) to find ways of solving these problems.

You can read more about the challenges we face and our proposals for dealing with them on the next pages.

We have tried to make this sort of transformational change before but this was typically not co-ordinated or was done in a piecemeal fashion. This time will be different - the STP represents the first time that local health (NHS) services have come together with local authorities across the whole of Hampshire and the Isle of Wight to address the challenges facing the health and social care system. We have a shared vision of helping local people to lead healthier lives by promoting wellbeing and ensuring they have access to the safest, highest quality and consistent care 24 hours a day, seven days a week, as close to home as possible.

Transforming health and care in Hampshire and the Isle of Wight:

healthier lives, world class sustainable services, strong primary and community care 5

The plan covers a period of five years from 2016 to 2021 and, while there are some changes that can be made PARTNERS IN DEVELOPING quickly, others will take longer to develop and substantial OUR TRANSFORMATION PLAN engagement and, where required, formal consultation

Frimley Park Hospital NHS with local people before they can be implemented. Foundation Trust Hampshire Hospitals NHS Foundation Trust Isle of Wight NHS Trust Portsmouth Hospitals NHS Trust Solent NHS Trust South Central Ambulance Service NHS Foundation Trust Southern Health NHS Trust University Hospital Southampton NHS Foundation Trust

Fareham and Gosport CCG Isle of Wight CCG North East Hampshire and Farnham CCG North Hampshire CCG Portsmouth CCG Southampton City CCG South-East Hampshire CCG West Hampshire CCG

Wessex Local Medical Committees

Hampshire County Council Isle of Wight Council Portsmouth City Council Southampton City Council

Hampshire Health and Wellbeing Board Isle of Wight Health and Wellbeing Board Portsmouth Health and Wellbeing Board Southampton Health and Wellbeing Board

Thames Valley and Wessex Leadership Academy

Wessex Academic Health Science Network

Wessex Clinical Networks and Senate

Health Education Wessex

NHS England South (Wessex)

Transforming health and care in Hampshire and the Isle of Wight:

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OUR LOCAL AREA OR ‘FOOTPRINT’

Hampshire and the Isle of Wight (HIOW) has a population of over two million people, with a complex geography: substantial urban settlements primarily in the south and north contrast the large open areas interspersed with market towns and villages. This diversity gives our area great strength but also means there are variations in deprivation, housing and health that will require slightly different solutions.

Our HIOW footprint is made up of the following organisations: • Eight clinical commissioning groups: Fareham & Gosport CCG, Isle of Wight CCG, North Hampshire CCG, North East Hampshire and Farnham CCG, Portsmouth CCG, Southampton City CCG, South Eastern Hampshire CCG and West Hampshire CCG; • Three unitary authorities and one county council: Portsmouth City Council, Southampton City Council and Isle of Wight Council and Hampshire County Council; • NHS England is a major commissioner in the area responsible for commissioning all specialised care, screening and military health. • 226 GP surgeries; • Hampshire Hospitals NHS Foundation Trust, Isle of Wight NHS Trust, Portsmouth Hospitals NHS Trust, University Hospital Southampton NHS Foundation Trust and Frimley NHS Foundation Trust all provide acute secondary care; • Southern Health NHS Foundation Trust, Isle of Wight NHS Trust and Solent NHS Trust provide the majority of mental health and community services on our footprint. • South Central Ambulance Service and the Isle of Wight NHS Trust provide ambulance and NHS 111 services; • Other organisations providing care in the footprint include: Salisbury NHS Foundation Trust, Care UK, Sussex Partnership Foundation Trust, Surrey, and Borders Partnership NHS Foundation Trust and Dorset Healthcare University NHS Foundation Trust.

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WHY DO WE NEED TO CHANGE HOW WE PROVIDE SERVICES?

The NHS’s Five Year Forward View highlights three 'gaps' that must be closed if we are going to provide the health and care that people need that is safe and affordable. Health and wellbeing: if the nation fails to get serious about prevention, recent progress in healthy life expectancies will stall and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness. Care and quality: unless we make best use of technology and drive down variations in the quality and safety of care, patients’ changing needs will go unmet, people will be harmed who should have been cured and unacceptable variations in outcomes will persist. Funding and efficiency: we have to live within our budgets and that will mean doing things differently in future: fewer admissions to hospital for conditions that can be managed better closer to home. Alongside this, there are local issues that need to be tackled at the same time;

Delays in discharging people from acute hospitals are a significant issue across the Hampshire and Isle of Wight area. We know that longer hospital stays, particularly for older people, leads to poorer health and a need for more care when a person leaves hospital.

Too many people are still being admitted to hospital with conditions and treatments that can be managed effectively in the community, combining the expertise of specialist consultants and GPs.

People are also staying in hospital for a long time even though many are medically fit to leave. The longer people stay in hospital, the more likely they are to develop complications and become less independent.

People in our area are living longer with increasing numbers of long term chronic conditions. We need to treat the whole person and the multiple illnesses that they have, rather than focusing on each condition individually. The current situation means that people have to repeat themselves many times over to different professionals who are using different systems with different information. We need to take the same approach to people with mental health problems.

Mental health needs to be given the same focus and priority as physical health. Mental and physical health need to be considered together, of equal priority, as they are highly interlinked; people with long term physical health conditions are two to three times more likely to develop mental health problems. Similarly, the life expectancy of people with serious mental illness is 15-20 years less than the average life expectancy and two-thirds of these deaths are due to avoidable causes. There are also challenges about providing care for young people who require ongoing mental health and care in adult life.

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There are a number of challenges in mental health services that are impacting our ability to deliver high quality services for people with mental illness. For example, too many people with mental illness are having to be cared for outside our area because we don’t have enough staff and capacity in both community and inpatient services.

We must also improve the experience and outcomes of people living with learning disabilities, which include ensuring that they are able to live in the most independent setting possible and making sure that their mental health needs are given the same focus and priority as their physical health needs.

Health and care in Hampshire and the Isle of Wight is facing a growing financial challenge as increases in funding are outstripped by increasing demand because of a growing and ageing population and cost inflation. This in turn makes it more difficult to provide new technologies, seven-day- a-week services and national policies to improve mental health, cancer and maternity services. If we don’t take do anything about this, the size of the financial gap in Hampshire and Isle of Wight is forecast to be £577m by 2020/21. This gap is equivalent to 18% of the funding that local health services will receive in 2020/21. This gap does not reflect the financial challenge in social care. Health and social care must work ever more closely in future to provide the co- ordinated services that local people want.

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MEETING THE CHALLENGES

There are some changes we can bring in quickly because they involve simple efficiencies within the NHS itself. Some proposals are more fundamental and may mean a significant change in how services are provided in future. In either case, we will always involve local people in developing these plans and, where appropriate, hold a formal consultation about them.

Reducing delays in leaving hospital We have developed a plan that will tackle delays in people leaving hospital. It will ensure that every patient has a discharge plan that is understood by the patient, their relatives and carers (where appropriate) and health and care professionals and includes plans for any anticipated future care needs. The plan will also ensure that patients with complex needs are identified as early as possible when admitted to hospital so that their future needs can be understood and planned, so reducing the likelihood of them needing to be readmitted to hospital later.

Living healthier for longer We will reduce the gap between how long people live and how long they live in good health. This means supporting more people to live in good health for longer and helping people to manage their own health conditions, which has the added benefit of reducing the need and demand for health and care services. Over the next months, we will implement programmes to identify and target people who smoke and also have a long term condition to ensure that they know how to find help with stopping smoking. We have started to implement the NHS Diabetes Prevention Programme (NDPP) across Hampshire and the Isle of Wight. We will improve screening uptake so that more people are identified with cancer earlier at Stage 1 or 2. Health and care staff will routinely give advice to their patients about safe drinking levels. We will also improve falls prevention services to ensure all those who have had a fall or are at risk of a fall get support to improve their muscle strength and balance.

Taking control of our own health More and more of us expect to take control of our own health and information in the same way that we do other parts of our lives. We live in a digital age and many people have expressed frustration that they cannot book and manage appointments, update their personal details, manage any long term conditions safely and access care at a time, place and way that suits them. We must provide these services for the people who want them. Patients will be able to do this through a new 'patient portal'. The portal will allow patients to view their records and treatment, access self-help information, manage their appointments, provide pre-assessment data and order repeat prescriptions. It will offer 24/7 support and information and also allow online consultations, so reducing the need for hospital visits. Work on this will start early next year and we expect the portal to start rolling out across Hampshire and the Isle of Wight in mid- 2018. Support will be provided for those who need help to access the portal.

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We will build on the existing Hampshire Health Record to create a secure digital health record for people in Hampshire and the Isle of Wight that includes information about all the care and treatment a patient receives. Health professionals will be able to access it on smart devices in a range of different settings - for example, at the patient’s bedside - and they will be able to search and find patient information from across the system easily and quickly. This will save patients from needing to repeat information.

Providing the highest quality acute care for southern Hampshire and the Isle of Wight University Hospital Southampton NHS Foundation Trust, Portsmouth Hospitals NHS Trust, the Isle of Wight NHS Trust and Lymington Hospital are working together to deliver the highest quality safe and sustainable hospital services to people living in southern Hampshire and the Isle of Wight, with a particular focus on making sure that Isle of Wight residents have sustainable hospital services. The Island faces unique challenges because its small population means that some services don’t see enough patients to allow staff to maintain and build their skills, while the costs of providing some services are often higher than on the mainland where resources can be shared. Added to this, the Island is currently struggling to recruit and retain people across general practice, nursing, therapies, consultants and care workers, with gaps in a number of specialties. This means that some services are currently provided on the Island on a five days a week or less basis. In order to address these challenges and start to achieve the best possible outcomes for all Hampshire and Isle of Wight residents, wherever they live, services will be reviewed on a service by service basis to find the right balance between travel for highly specialist inpatient services and local care for outpatient services. Where possible and appropriate the aim will be to create seven day a week services that provide the same high quality and are safe and sustainable and only seek to involve patient travel where necessary. The Island has a strong history of working in partnership with neighbouring hospitals with clinicians visiting the Island for inpatient and outpatient services and more complex treatment at mainland services. This principle needs to be extended to other services where appropriate. It will be essential that local people continue to have every opportunity to get involved in these proposed changes and can help shape the way they are implemented. Island residents have already been discussing these issues as part of the ‘My Life a Full Life’ new care model and further engagement is planned for early 2017.

Providing more care nearer to home

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People are still going to acute hospitals with conditions that could be managed in their local community and people are staying in hospital too long when they could be safely managed in the community or at home. The bedrock of our plan builds on the work already underway in Better Care Southampton, the Portsmouth Care Blueprint and Better Local Care in Southern Hampshire by providing a wider range of more accessible services serving local 'natural communities'. Those services would typically include:  Routine care, screening, baby clinics and checks, contraception services and prevention advice.  Rapid same-day access to GP-led urgent care, with on-site diagnostic testing including imaging and x-rays.  Secondary care consultations and minor procedures.  Rehabilitation and services to support recovery after periods of ill-health.  24/7 crisis support to help people receive the urgent care they need without going into hospital. The range of professionals working in these new models of care means that a patient won't necessarily have to see a GP to get the help they need. For example, care navigators are trained members of staff who work from GP practices with patients who need extra help to access services in the health, social and voluntary sector, freeing up GPs to spend more time with people who have complex medical conditions.

Improving mental health services The four NHS trusts that provide mental health services in Hampshire and the Isle of Wight (Southern Health Foundation NHS Trust, Solent NHS Trust, Sussex Partnership Foundation NHS Trust and Isle of Wight NHS Trust) have formed an alliance with the health care planners, local authorities, third sector organisations and people who use services to improve the quality, capacity and access to mental health services in the area. This will mean that patients will have access to the same high quality care wherever they live in the area as close to home as possible and will be supported to live independently. People will have access to services 24 hours a day, seven days a week through inpatient and community-based rehabilitation, community rehabilitation teams, supported accommodation services and services that support service users’ occupation and work. The number of people who have to go outside the area for inpatient care will be reduced, with a goal that no-one will have to do this by 2020/21. The Alliance is also focusing on helping more people avoid a mental health crisis. Individuals for whom a crisis can be foreseen will have their own crisis plan shared by all agencies that support them, including primary care. All acute hospitals will have all-age mental health liaison teams in place to reduce length of stay. This will lead to a reduction in people having no choice but to go to emergency departments when they are in crisis.

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Improving mental health and learning disabilities services at Southern Health NHS Trust Southern Health Foundation NHS Trust has faced a lot of criticism in the past year. The Care Quality Commission (CQC) told the Trust in April 2016 that it must make significant improvements to protect patients who are at risk of harm while in the care of its mental health and learning disability services. The CQC also issued a warning notice requiring the Trust to improve its internal arrangements for making sure that all patient incidents and deaths were fully investigated so that lessons could be learned and future risks reduced. Part of the Trust's response to how it can improve has been to begin a four month review into the services it provides, which will be completed early in 2017. The purpose of this is to understand how their services should be designed to best meet the needs of local communities in the future. The Trust is working with people who use its services, their families and Trust staff to ensure that a range of views and ideas are heard. The Trust has partnered with experts from a company called Deloitte LLP and Northumberland Tyne and Wear NHS Foundation Trust (NTW). NTW is an organisation providing similar kinds of care to Southern Health and has been rated ‘outstanding’ by the CQC. The Alliance will make sure that all improvements in care resulting from the review will be built into its plans for mental health services for people in Hampshire and the Isle of Wight.

Future proofing hospital services in north and mid Hampshire The right configuration of acute services for people living in north and mid Hampshire has been under discussion for several years. Hampshire Hospitals NHS Foundation Trust proposed building a critical treatment hospital that would bring together services for the most critically ill and sickest patients, with consultant doctors on site 24 hours a day, seven days a week. West Hampshire and North Hampshire CCGs, which plan and buy health services for their populations, had concerns about the affordability of a new hospital at a time of unprecedented national and local financial pressures. They were also unclear whether the Trust's plan had fully taken account of which services should remain at the hospitals in Basingstoke and Winchester and the potential impact on other hospitals in the area. An independent review of the proposal is now underway and is scheduled to be completed by the end of January 2017. At that point, Hampshire Hospitals NHS Foundation Trust, West Hampshire CCG and North Hampshire CCG can consider its report at their Board meetings and jointly reach a conclusion on ensuring sustainable, high quality and affordable acute services for the people of north and mid Hampshire in the future.

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LOOKING TO THE FUTURE

So what will your health and care look like in 2021, as a citizen of Hampshire and the Isle of Wight, when the proposals set out in the transformation programme have been tested, amended and rolled out across our area? Here are some of the big benefits we believe you will experience.

You are living in good health for longer and taking advantage of all the help the NHS and care services can offer you, such as early cancer screening and information about stopping smoking, using alcohol safely, eating sensibly and taking exercise

When you do need to be treated in hospital, you receive care that is safe, consistent, affordable and world class, so that you get better more quickly and go home sooner

You have control of your own health and information, going online to view your records and treatment, access self-help information, manage your appointments, provide pre-assessment data, order repeat prescriptions

You can choose to have an outpatient appointments online or on the phone

More health and care services are provided closer to or in your home, resulting in more choice about when and where you receive treatment and less time waiting for appointments, diagnostic tests and test results

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If you have one or more long term conditions, you are confident about managing it yourself with the right support and help when you need it and you are treated as a person, not a collection of different conditions all treated separately

If you have mental health problems, you receive care that is safe, consistent, affordable and world class when and where you need it, 24 hours a day, seven days a week

INVOLVING LOCAL PEOPLE We have learned a great deal from working with and listening to local people over the past few years and this plan is rooted in those local discussions. Working together also allows us to better share best practice and ensure we are co- ordinated when we make local changes. So we will continue to work with and listen to local people as we develop and implement these proposals in the months ahead. All the organisations that have helped develop the programme will continue to work with their own local stakeholders as we redesign services and develop our new models of care, working together where this makes sense to avoid confusion and duplication. Your local NHS Trust, Clinical Commissioning Group, Local Authority or in some areas ‘new care model’ website will have details of how you can get more involved in this important work. In parallel to this, we plan to work with the four local Healthwatch organisations in Hampshire, Southampton, Portsmouth and the Isle of Wight on a period of further engagement and involvement with local people and local stakeholders about the ambitions in the plan and any refinements we can make. Healthwatch is the independent body that represents the voice of patients and public. We will kick this off with a series of road shows across Hampshire and the Isle of Wight early next year to talk about the plan and listen to the views, ideas and concerns of local people and voluntary and community groups and staff. Details of the road shows will be publicised in the New Year. Our staff will also have a key role to play. Each partner organisation will develop a detailed communications and engagement plan so that staff can champion, shape and help implement changes to services. We will also make sure that there are plenty of opportunities for our partners in the voluntary and charitable sector to help us deliver the programme in ways that bring benefits for them and for local people.

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GLOSSARY Acute care: a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery. Typically this takes place in hospital. Care navigator: a new role that helps to co-ordinate a person's care and make sure they can gain access to any services and community support they want or need; often based in a GP surgery. Clinical commissioning groups (CCGs): statutory NHS bodies led by local GPs that are responsible for the planning and commissioning of health care services for their local area. Hampshire Health Record (HHR): a computer system used in the NHS in Hampshire to share important information safely about a patient with those treating them. This leads to faster and more accurate care. The Hampshire Health Record shows the medication you are currently taking, your allergies, test results and other critical medical and care information. Health and care staff can access your information if they have your permission to do so. Community hub: typically serving a population of 30k-50k, these will be open between 8am and 8pm on weekdays, offering same day access for urgent primary care, community and specialist clinics, an extended primary care team and wellbeing and illness prevention support. Natural communities: geographical areas based on a centre of population and its surrounding communities that allows health care to be tailored more accurately to local needs and, more importantly, helps identify the main causes of some common and preventable diseases. New models of (integrated) care: make health services more accessible and more effective for patients, improving both their experiences and the outcomes of their care and treatment. This could mean fewer trips to hospitals as cancer and dementia specialists hold local clinics or surgeries, one point of call for family doctors, community nurses, social care and mental health services, or access to blood tests, dialysis or even chemotherapy closer to home. Primary care: a patient's main source for regular medical care, such as the services provided by a GP practice. Secondary care: medical care that is provided by a specialist after a patient is referred to them by a GP, usually in a hospital or specialist centre. Third sector organisations (TSOs): a term used to describe the range of organisations that are neither public sector nor private sector. It includes voluntary and community organisations (both registered charities and other organisations such as associations, self-help groups and community groups), social enterprises and co- operatives. Vanguards: individual organisations and partnerships coming together to pilot new ways of providing care for local people that will act as blueprints for the future.

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REPORT TO THE TRUST BOARD (Part 1 - Public)

ON 7th December 2016

Title Board Assurance Framework incorporating Principal Risk Register Report Sponsoring Mark Price, Company Secretary Executive Director Author(s) Lucie Johnson, Head of Corporate Governance Purpose To provide an update to the Trust Board in relation to current Principal Risks and underpinning Corporate Risks registered on the risk register Action required by Receive X Approve the Board: Previously considered by (state date): Sub-Committee Dates Key Issues, Concerns and Discussed Recommendations from Sub Committee Trust Executive Committee

Audit and Corporate Risk Committee

Charitable Funds Committee Finance, Investment, Information & Workforce Committee Mental Health Act Scrutiny Committee Remuneration & Nominations Committee Quality Governance Committee Please add any other committees below as needed

Other (please state) Staff, stakeholder, patient and public engagement:

The Executive team meet on a monthly basis to review the Principal risk register and undertake a confirm and challenge session. Executive Summary & Analysis:

There are currently 8 Principal Risks identified as follows:- 1. Risk 671, Workforce If the Trust is unable to attract, recruit and retain sufficient staff of the right quality and skillset then it will be unable to meet demand. Since the last Trust Board review, no new actions have been added, however, two actions have been completed, as follows:- ü Outcome of Appraisals used to inform PDP training priorities ü Review and Revise as required Management Development Programme 2. Risk 673, Strategy and Planning If our Trust Strategy is not robust and embedded then staff will be unable to create effective service plans. One new actions has been added to this risk since the last Trust Board review, namely, Produce Trust Strategic Plan including explicit links with My Life a Full Life, however, no actions have been completed. 3. Risk 674, Quality Governance If the Trusts quality governance processes are not robust and embedded then the Trust may not be

REPORT TO THE TRUST BOARD (Part 1 – Public)V12 Page 1

able to maintain adequate patient safety, patient experience and clinical effectiveness. The risk score relating to this risk has been amended since the last Trust Board review from possible x moderate (9) to Possible x Major (12). 2 New actions have been added as follows:- v Review groups (agenda and ToR) reporting to SEE v Redesign SEE, to ensure it is effective and efficient 2 actions were completed in October as follows:- ü Complete actions identified through QGAF self-assessment ü Review each CBU Quality Assurance Governance against the well led framework 4. Risk 675, Culture If the Trusts culture does not reflect our core values then we will be unable to deliver our vision, goals and priorities. 1 new actions has been identified since the last Trust Board review as follows:- v Recruit permanently to the freedom To Speak Up Guardian role No actions have been completed since the last update report. 5. Risk, 676 ICT Strategy If the Trust is unable to deliver against the ICT Strategy, then there will be a negative impact on quality, Income, Performance, Information Governance Compliance and Staff morale. One new action has been added since the last Trust Board review, as follows, this action has been completed:- v Effective risk oversight report to ICT Programme Board 6. Risk 677, Local Health and Social Care Economy Resilience If there is insufficient resilience in the local health and social care economy then we will be unable to deliver safe effective and financially viable care. No new actions have been added since the last Trust Board review, however, one action has been completed as follows:- ü Hampshire and IOW Sustainability Transformation plan to be developed 7. Risk 705, Board Capacity and Capability If there is not sufficient capacity and capability within the Executive and Non-Executive Team, then the Trust will not be able to achieve its strategic ambitions. No new actions have been added and none have been completed since the last Trust Board review. 8. Risk 712, Financial Resources If the Trust is unable to manage within the revenue and capital financial resources it receives then it may become financially unsustainable in 16/17 and in future years. No new actions have been added and no actions have been completed since the last Trust Board review.

As indicated in the previous report to the Trust Board, one new action has been added to each risk to ensure that all risks are reviewed on a monthly basis, however this action is greyed out on the attached report.

It is prudent to note that whilst a number of actions have been completed, these have not resulted in a reduced risk score. It is imperative that actions determined are SMART and targeted at mitigating the risk. It is also worthy of note that a number of the risks, have either a limited number or no determined actions, and as such, it would be valuable to consider what further activity is required.

There are currently 35 underpinning Corporate Risks identified, an increase of 4 from the last Trust Board review, many of which span a number of risk types. Work is ongoing to identify the primary and secondary risk types to aid better trend analysis, however, the summary below provides a helpful pulse check. Further to this the Trust now has in operation an Issues Log, which also acts as a good pulse check, and should support the Trust to identify matters for immediate resolution.

9. Corporate Governance risks = 5 10. Facilities risks = 3 11. Finance risks = 13 12. Information risks = 12

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13. Mental Health Act risks = 1 14. Quality risks = 23 risks 15. Reputational risks = 18 16. Workforce risks = 12 Recommendation to the Board: Note the updates provided on the Principal risks and confirm and challenge risk mitigation activity as required to ensure it is robust. Consider the underpinning corporate risks in terms of their bearing on the Principal risk register. Seek to identify further risks or issues for inclusion on the risk register/issue log as appropriate. Attached Appendices & Background papers

For following sections – please indicate as appropriate:

Trust Goals & Priorities This paper sets out risks to the achievement of the Strategic Goals and Priorities Principal Risks (BAF) All Legal implications, regulatory and consultation requirements

Date: 29-11-16 Completed by: Lucie Johnson, Head of Corporate Governance

REPORT TO THE TRUST BOARD (Part 1 – Public)V12 Page 3

ID Risk Owner Description Opened Rating Rating Review date Most recent update to Action Plan Action due Action Principal objectives Gaps in Gaps in controls (current) (Target) progress notes date completed assurance date 671 Palmer, Chris - If the Trust is 07/10/201 12 4 [Johnson, Lucie Refresh the 2014/15 (5 01/03/2016 02/03/2016 Skilled and capable Director of unable to attract, 5 19/09/16 09:28:44] year) Human Resources staff Finance recruit and retain Update via Executive Strategy. sufficient staff of Governance Review the right quality and meeting. Part time, Introduce HR Management 26/02/2016 20/01/2016 skillset then it will system wide HR Group (Exec led) be unable to meet Director appointed and demand in post. Review HR Dashboard 14/10/2016 reporting

Roll out of values based 31/12/2016 recruitment Undertake further career 02/05/2016 26/07/2016 fairs and promotion of NHS careers through volunteer opportunities

Review and Revise as 02/11/2016 03/11/2016 required Management Development Programme

Promote and Increase 16/01/2017 Apprenticeships Promote and increase 23/01/2017 Coaching & Mentoring for staff

Outcome of Appraisals 02/11/2016 03/11/2016 used to inform PDP training priorities

Review Risk on an monthly 14/10/2016 basis in line with Risk Management Strategy and Policy

Appoint System Wide HR 15/08/2016 Director 673 Burwell, Jon - If our Trust Strategy 07/10/201 12 6 12/12/2016 [Burwell, Jon 12/10/16 Produce Trust Strategic 19/09/2016 19/09/2016 A positive All gaps in All gaps in Interim is not robust and 5 13:02:10] Trust Plan including explicit links experience for assurance are controls are Executive embedded then reviewed priority with My Life a Full Life Patients, Service addressed in addressed in Director of staff will be unable objectives to deliver Users and Staff, Cost actions actions Strategy, to create effective strategic priorities and effective sustainable Planning, ICT service plans. goals approved at Trust services, Excellent Communicating the Trust 04/12/2016 and Estates Board on 5th October Patient Care, Skilled Strategy 2016. objectives and capable staff, aligned with STP and Work with others to MLaFL. Comms plan Completion of supporting 31/03/2017 keep improving our being worked up Strategy (ICT, Estates, Services currently. Business Finance) plans being updated with Executive Review Risk on an monthly 16/09/2016 19/09/2016 Challenge session on basis in line with Risk 24th October 2016, Management Strategy and draft submission on 23 Policy November 2016.

674 Johnston, Sarah If the Trusts quality 07/10/201 12 4 30/12/2016 [Johnson, Lucie Revise Clinical Governance 31/03/2016 31/03/2016 A positive - Deputy governance 5 21/11/16 09:45:15] arrangements experience for Director of processes are not Updated via Executive Patients, Service Nursing robust and Governance Review Users and Staff, Cost embedded then the meeting:- Further to effective sustainable Trust may not be the NHSI review 30th Complete actions identified 28/10/2016 31/10/2016 services, Excellent able to maintain September and initial through QGAF self Patient Care adequate patient feedback 31st October assessment safety, patient 2016:-Thereare issues experience and relating to Capacity to Role out of QIF through 31/03/2016 16/05/2016 clinical deliver the quality Trust Busines Planning effectiveness. agenda, and clarity in process relation to quality structure and specific roles. Refresh and Revise Actions 31/05/2016 21/06/2016 to demonstrate complianc with the Trust Quality Improvment Plan

A review of Quality 06/05/2016 06/05/2016 Governance Assurance at Clinical Business Unit

Complete Self assessment 29/07/2016 27/07/2016 of Fundemental Standards 674 Johnston, Sarah If the Trusts quality 07/10/201 12 4 30/12/2016 [Johnson, Lucie A positive - Deputy governance 5 21/11/16 09:45:15] experience for Director of processes are not Updated via Executive Patients, Service Nursing robust and Governance Review Users and Staff, Cost embedded then the meeting:- Further to effective sustainable Trust may not be the NHSI review 30th services, Excellent able to maintain September and initial Patient Care adequate patient feedback 31st October safety, patient 2016:-Thereare issues experience and relating to Capacity to clinical deliver the quality effectiveness. agenda, and clarity in relation to quality structure and specific roles.

Update Risk Entry 31/10/2016

Review each CBU Quality 28/10/2016 26/10/2016 Assurance Governance against the well led framework

Review groups (agenda and 19/12/2016 ToR) reporting to SEE

Redesign SEE, to ensure it 02/01/2017 is effective and efficient

Review CBU and Quality 05/12/2016 Team interface to ensure sufficient capacity

675 Palmer, Chris - If the Trusts culture 07/10/201 16 8 30/09/2016 [Johnson, Lucie Close down of staff survey 18/01/2016 14/06/2016 A positive Director of does not reflect our 5 19/09/16 09:21:20] group with project experience for Finance core values then we Updated via Executive completion reports Patients, Service will be unable to Governance Review 19- Users and Staff, Cost deliver our vision, 9-16. Majority of effective sustainable goals and priorities. actions have been Annual staff survey analysis 18/01/2016 14/06/2016 services, Excellent completed, however, guidance to inform next Patient Care, Skilled new actions identified staff survey report and capable staff, in order to address response Work with others to risk. Establish Programme Plan 15/06/2016 27/07/2016 keep improving our for improvement against Services Staff Survey responses

Delivery of Staff Experience 17/08/2016 19/08/2016 Group, Health & Wellbeing Group and Quality Champions to be reported to HR & OD Sub- Committee monthly 675 Palmer, Chris - If the Trusts culture 07/10/201 16 8 30/09/2016 [Johnson, Lucie A positive Director of does not reflect our 5 19/09/16 09:21:20] experience for Finance core values then we Updated via Executive Patients, Service will be unable to Governance Review 19- Users and Staff, Cost deliver our vision, 9-16. Majority of effective sustainable goals and priorities. actions have been services, Excellent completed, however, Patient Care, Skilled new actions identified and capable staff, in order to address Work with others to risk. keep improving our Services

Review resources 17/08/2016 30/08/2016 dedicated to culture and leadership development to ensure appropriately focused Evaluate the Leadership 22/08/2016 30/08/2016 Development Programme and recommend future focus Review of Ambassador 23/09/2016 04/09/2016 programme to be undertaken in conjunction with review of LiA post

Commision Culture review 01/09/2016 02/09/2016 of Ambulance Service

Identify, consult on and 31/12/2016 approve appropriate KPI's to measure achievement of cultural improvement

Ensure actions identified 28/02/2017 following last staff survey are delivered and result in improved scores

Review risk on a monthly 31/12/2016 basis in line with the Risk Management Strategy and Policy

Recruit permanently to the 31/01/2017 freedom To Speak Up Guardian role 675 Palmer, Chris - If the Trusts culture 07/10/201 16 8 30/09/2016 [Johnson, Lucie A positive Director of does not reflect our 5 19/09/16 09:21:20] experience for Finance core values then we Updated via Executive Patients, Service will be unable to Governance Review 19- Users and Staff, Cost deliver our vision, 9-16. Majority of effective sustainable goals and priorities. actions have been services, Excellent completed, however, Patient Care, Skilled new actions identified and capable staff, in order to address Work with others to risk. keep improving our Services

Recruit permanently to the 31/01/2017 freedom To Speak Up Guardian role

676 Burwell, Jon - If the Trust is 10/11/201 20 12 04/01/2016 [Burwell, Jon 12/10/16 Executive Led ICT 29/01/2016 29/03/2016 Cost effective All gaps in All gaps in Interim unable to deliver 5 12:54:48] Deputy Committee to be setup sustainable services assurance are controls are Executive against the ICT Director of ICT has addressed in addressed in Director of Strategy, then there reviewed risks and ICT Strategy to be 31/03/2017 actions actions Strategy, will be a negative updated. Next stage is refreshed Planning, ICT impact on quality, it to improve the and Estates Income, reporting coming to Review all ICT risks on risk 17/10/2016 12/10/2016 Performance, the Exec Led ICT register Information Programme Group for Align ICT capital plans with 24/06/2016 01/08/2016 Governance oversight and risk register Compliance and assurance. IT Staff morale requirements for the My Life a Full Life is Current position against ICT 12/09/2016 19/09/2016 being worked up Strategy to go to alongside Trust September Board seminar business planning and Informatics Strategy Review Risk on an monthly 10/10/2016 12/10/2016 development. This will basis in line with Risk include some Trust and Management Strategy and island workshops. Policy Effective risk oversight 12/11/2016 01/11/2016 report to ICT Programme Board 677 Baker, Karen - If there is 07/10/201 20 9 30/09/2016 [Johnson, Lucie Internal review of 30/11/2015 25/02/2016 Work with others to Chief Executive insufficient 5 21/11/16 09:31:22] processes keep improving our resilience in the Update via Executive Services local health and Governance Review System Resilience Action 30/11/2015 16/05/2016 social care economy meeting:- In May 2016 plan to be developed then we will be we added 15 beds at unable to deliver Adelaide and Goldings, Whole Island System 31/03/2017 safe effective and plus 15 beds through Review being undertaken financially viable the Local Authority re- as part of My Life a Full Life care. ablement team for complex discharge in difficult to reach areas. System discussion 30/11/2015 22/09/2016 In October SRG agreed facilitated by the LGA to to an additional 20 define governance beds for discharge to structures for the MLAFL assess in nursing and HWBB homes, plus 3 Hampshire and IOW 31/10/2016 21/11/2016 additional dom care Sustainability teams through the Transformation plan to be Local Authority re- developed ablement team. In My Life a Full Life 30/12/2016 22/09/2016 April we opened 29 Governance Arrangements additional beds to the to be determined and baseline. implemented

Formulating and recruit to 03/06/2016 19/09/2016 a system wide transformation Directors post Establish a monthly CFO 13/07/2016 meeting to review financial position across the system

Review Risk on an monthly 21/12/2016 basis in line with Risk Management Strategy and Policy Develop urgent care 23/09/2016 23/09/2016 improvement plan

Develop a protocol for 09/12/2016 opening the day surgery unit as an emergency ward, aligned witht the Trust escalation plan 705 Baker, Karen - If there is not 22/02/201 12 8 21/12/2016 [Johnson, Lucie Secondment Policy to be 29/02/2016 26/02/2016 A positive Chief Executive sufficient capacity 6 21/11/16 09:14:28] circulated to all Managers experience for and capability Update on behalf of Patients, Service within the Executive Executive Governance Users and Staff, Cost 1-2-1 reviews to be 25/04/2016 20/06/2016 and Non Executive review meeting:- All effective sustainable undertaken with all Team, then the Clinical Director posts services, Excellent members of the Executive Trust will not be are filled. 1 vacancy Patient Care, Skilled Team to ascertain pinch able to achieve its remaining in and capable staff, points strategic ambitions. Triumvirate leads (HOO Work with others to My Life A Full Life 23/05/2016 25/07/2016 for AUCC). Business keep improving our Programme Director to be Case approved via TLC Services asked to undertake a for Director of staffing requirements Operations, post review and provide info re currently vacant. Director of ICT, Strategy 06/06/2016 20/06/2016 Development of and Planning and Estates individuals is being (Secondment) 6-6-16 driven through leadership programme Recruit to S&ICT 05/09/2016 15/08/2016 (Isle Learn). substantive appointment to replace secondee

Recruit to Interim System 29/07/2016 05/07/2016 Director post

Appoint System Wide HR 22/08/2016 18/08/2016 Director Work with other STP 30/09/2016 leaders to create capacity

Develop the CBU 20/01/2017 Leadership Team in order to free up capacity within the Executive team

Appoint replacement NED 18/08/2016 and associate NED

Review Risk on an monthly 21/12/2016 basis in line with Risk Management Strategy and Policy Recruit to System Wide 16/09/2016 16/09/2016 Transformation Director Post 712 Palmer, Chris - If the Trust is 08/06/201 16 6 14/12/2016 [Palmer, Chris Align all CIP and Financial 29/07/2016 27/07/2016 A positive Director of unable to manage 6 08/11/16 08:57:03] Deep dives into 1 meeting experience for Finance within the revenue Month 6 financial Patients, Service and capital financial position on plan Users and Staff, Cost resources it although activity under- Executive Led Turnaround 27/07/2016 26/07/2016 effective sustainable receives then it may performance has Sub Committee to be held services, Excellent become financially worsened to £1m less weekly Patient Care, Skilled unsustainable in than plan. CIP delivery and capable staff, 16/17 and in future continues although a Trust Capital Plan to be 30/06/2016 26/07/2016 Work with others to years. significant value is agreed, and approved keep improving our being delivered non- (June 16) Services recurrently. Cash has been successfully Quarterly CBU integrated 07/07/2016 04/08/2016 managed but has performance reviews to be proved challenging due scheduled to less cash being secured from central Interim System Director to 28/07/2016 05/07/2016 funds than agreed be recruited plan. Capital spend is below plan and monthly meetings Output of Reference Costs 04/01/2017 continue to ensure the to be reviewed and and capital resource limit is reported to CBUs to ensure fully committed against Cost Base Review findings prioritised bids. Ensure a programme of CIP 01/12/2016 Monthly finance deep is in place to deliver the dives continue with requiredlevel of CBU's to highlight risks recurrent/non-recurrent and opportunities and Ensure delivery of activity 22/12/2016 to ensure robust and performance to budgetary control. underpin the contracted income assumptions Ensure cash is managed 08/12/2016 and cash funding is sought to enable transactions to be achieved within an Review Risk on an monthly 14/12/2016 basis in line with Risk Management Strategy and Policy Enc J

REPORT TO THE TRUST BOARD (Part 1 - Public)

ON 7th December 2016

Title Report from Chair of Finance, Investment, Information & Workforce Committee Sponsoring Executive Charles Rogers, Chair of Finance, Investment, Information & Director Workforce Committee Author(s) Charles Rogers, Chair of Finance, Investment, Information & Workforce Committee Purpose To receive the report from the Charles Rogers, Chair of Finance, Investment, Information & Workforce Committee Action required by the Receive X Approve Board: Previously considered by (state date):

Sub-Committee Dates Key Issues, Concerns and Discussed Recommendations from Sub Committee Trust Leadership Committee

Audit and Corporate Risk Committee Charitable Funds Committee Finance, Investment, Information & 29/11/16 Workforce Committee Mental Health Act Scrutiny Committee Remuneration & Nominations Committee Quality Governance Committee ICT Assurance Committee Please add any other committees below as needed Board Seminar

Other (please state) Staff, stakeholder, patient and public engagement:

Not applicable Executive Summary: The Chair of the Finance, Investment, Information & Workforce will report on the following areas as discussed at the meeting held on 29 November 2016

Human Resources • Recruitment and Retention • Mandatory Training Compliance Levels of Medical Staff

Page 1 of 4

Education, Training and Organisational Developmen: • CQUIN • Appraisals • Staff Survey • Friends & Family Test:

Estate Resources • Carbon Energy Fund

Finance • Key Financial Risks • CIP • Cash

Commercial and Business Planning • NHS Creative • Vectasearch

Recommendation to the Trust Board: The Board is recommended to receive the assurance report by the Chair of Finance, Investment, Information & Workforce Committee

Attached Appendices & Background papers Report

For following sections – please indicate as appropriate:

Trust Goals & Priorities Goals: • Cost Effective, sustainable services • Skilled & Capable Staff

Principal Risks (BAF) Principal Risk 671 Human Resources Principal Risk 672 Financial Resources Principal Risk 673 Strategy and Planning

Legal implications, regulatory and consultation requirements

Date: 1 December 2016 Completed by: Charles Rogers, Chair of Finance, Investment, Information & Workforce Committee

Page 2 of 4

FINANCE, INVESTMENT, INFORMATION AND WORKFORCE COMMITTEE MONTHLY ASSURANCE REPORT TO ISLE OF WIGHT TRUST BOARD: DECEMBER 2016

This report to the Trust Board follows from the November meeting of the Finance, Investment, Information and Workforce Committee (FIIWC) held on 29th November 2016.

Human Resources • Recruitment and Retention: A business case has been written proposing incentives to attract people to join the Trust, recruit difficult to fill vacancies and reduce agency spend. It was presented by the Deputy Medical Director. The Committee welcomed the initiative and proposed additions to the document before it was taken to Trust Board: o paper needs to be clear that the contents cover all staff including Ambulance; o analysis of the cost benefits of the scheme need to be included and o the proposed scheme needs to be reviewed for consistency and fairness. Limited Assurance.

• Mandatory Training Compliance Levels of Medical Staff: The Committee received a presentation from the Deputy Medical Director on the low compliance levels recorded for the completion of mandatory training by medical staff. A number of risks were identified as a result of the discussion and the Committee proposed actions to improve compliance. An action plan has been requested in order to provide rapid progress towards 100% target which should include mandatory training for Bank staff. Limited Assurance.

Education, Training and Organisational Development • CQUIN: The Trust has a CQUIN target to vaccinate 75% of frontline staff which equates to 1612 people. So far 870 doses have been given. • Appraisals: The level of appraisal completion in the Trust has now reached over 79% for 2016/17. • Staff Survey: The Staff Survey for 2016 has been sent out to all staff and the cut off for return is 2ND December. • Friends & Family Test: A report has been received providing results and themes from returns of the Friends and Family Test for Staff covering the first two quarters of the year. The results are mixed with approximately 50% of staff not prepared to recommend the Trust as a place to work. The Committee consider that the results are a worrying indicator of organisational health with some comments referring to poor management and leadership, feeling devalued and bullying. The Committee will continue to monitor staff feedback to the organisation and await the results from the Staff Survey. The Director of Finance and Human Resources will ensure that this information is used along with other available knowledge to continue to provide initiatives for the improvement to staff health and wellbeing. Limited Assurance.

Estate Resources • Carbon Energy Fund: The Committee received a revision to the business case that had previously been agreed by the Trust Board. The project covers a range of energy saving measures that have been developed and were first presented to the Trust Board in 2014 but which have been delayed primarily because of external pressures. The Committee recommend to the Trust Board approval of this latest proposal.

Page 3 of 4

Positive Assurance

Finance • Key Financial Risks: At Month 7 the main pressure continues to be the underperformance of the main CCG PbR contract at £1.334m behind plan. Current financial forecasts assume that this will be £1.423m at year end but operational pressures will continue to put this forecast at risk. Taking into account other risks, opportunities and mitigating actions the present end of year outlook is: o Best case £4.630m o Possible case £7.368m o Worst case £9.736m • CIP: The Cost Improvement Programme remains on plan at £10.217m and although the position is improving £7.3m of this is expected to be non-recurrent. This non- recurrent position will have a negative impact on the starting position for 2017/18. • Cash: The cash position for the Trust remains a key risk. A deficit in excess of the planned £4.630m would result in a significant impact on the cash forecast position for the Trust. Negative Assurance.

Commercial and Business Planning • NHS Creative: The Committee have received a three year business plan for NHS Creative. The case has been written with market conditions for general design and print declining. More positively, microsite development which provides better profitability margins, is growing. The plan provides for small but positive contributions for each year and assumes further recruitment. Recruitment will be managed through Trust procedures and the Interim Turnaround Director is to work with the Company Secretary to advise on efficiency measures and best practice. Limited Assurance.

• Vectasearch: The Committee were asked to consider a business case for the Trust to take over the commercial studies currently hosted by VectaSearch Clinic Limited, which is a research facility, and their personnel following the dissolution of the private company. The Committee agreed to support the business case when it is presented to Trust Board subject to the addition of a section covering risk together with a forecast of future work and associated income. Additional work agreed by the Medical Director. Limited Assurance.

Chair Finance, Investment, Information and Workforce Committee November 2016

Page 4 of 4

Enc K Isle of Wight NHS Trust Board Performance Report 2016/17 October 16

Title Isle of Wight NHS Trust Board Performance Report 2016/17

Sponsoring Executive Director Chris Palmer - Executive Director of Financial & Human Resources Author(s) Iain Hendey - Deputy Director of Information Purpose To update the Trust Board regarding progress against key performance measures and highlight risks and the management of these risks. Action required by the Board: Receive X Approve Previously considered by (state date): Trust Leadership Committee Mental Health Act Scrutiny Committee Audit and Corporate Risk Committee Remuneration and Nominations Committee Charitable Funds Committee Quality Governance Committee 29/11/2016 Finance, Information, Investment & Workforce Committee 29/11/2016 Information & Communications Technology Assurance Committee Please add any other committees below as needed

Other (please state) Staff, stakeholder, patient and public engagement:

Executive Summary:

This paper sets out the key performance indicators by which the Trust is measuring its performance in 2016/17. A more detailed executive summary of this report is set out on page 4.

For following sections – please indicate as appropriate: Trust Vision: Quality care for everyone, everytime Excellent patient care; Working with others to keep improving our services; A positive experience for patients, service users and staff; Trust Goals & Priorities : Skilled and capable staff; Cost effective, sustainable services

673 Strategy & Planning, 672 Financial Resources, 671 Human Resources, 674 Quality and Harm, 675 Culture, 677 Local Health and Principal Risks (BAF) Social Care Economy Resilience, 676 Information Communication Technology, 705 Capacity and Capability of the Executive Team. Legal implications, regulatory and consultation requirements None

Date: Tuesday 29th November 2016 Completed by: Iain Hendey, Deputy Director of Information

Page 1 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Index

Balanced Scorecard - Aligned to 'Key Line of Enquiry' (KLOEs)………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..3 Executive Summary…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………4 Performance Summary Pages…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………5-11 Surgery, Women's and Children's Health…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..5 Medicine……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………6 Clinical Support, Cancer and Diagnostics……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..7 Ambulance, Urgent Care and Community…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………8 Mental Health and Learning Disabilities…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………9 Highlights………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………10 Lowlights………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………11 Exception Reports…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..12-19 Pressure Ulcers……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..12 Patient Safety…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..13 Formal Complaints…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….14 A&E Performance - Emergency Care 4 hours Standard……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..15 Cancer………………………………………………………………………………………………………………………………………………………………………………………………………………. 16 Ambulance………………………………………………………………………………………………………………………………………………………………………………………………………………. 17 Theatre Utilisation……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..18 Referral To Treatment Times……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..19 Benchmarking of Key National Performance Indicators……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….20-23 Summary Report……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..20 IW Performance Compared To Other 'Small Acute Trusts'…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..21 IW Performance Compared To Other Trusts in the 'Wessex Area'…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….22 Ambulance Performance……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………23 Data Quality……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………24 Workforce Report……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..25-40 Summary……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..25 Sickness…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….26 Sickness Information………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..27-28 Employee Relations Activity………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..29 Recruitment Strategy Update………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..30 Nursing and AHP Agency Usage Information………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..31 Medic Agency Use……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..32-33 Overpayments Information………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..34 e-Rostering Approval Information………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..35 E-Rostering Finalising/Lockdown Information……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..36 Appraisal Information………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..37 Future Information………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..38 Finance Report………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….39-47 Executive Summary & Key Financial Risks……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..39 Income & Expenditure…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….40 Income, Sustainability and Transformation Fund…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….41 Agency…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….42 Plan Phasing and Forecast Outturn…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….43 CIP Performance………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..44 Cash…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….45 Capital Programme…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….46 Use of Resources Rating………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………47 Governance Risk Rating…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..48 Glossary of Terms…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….Page 2 49 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Balanced Scorecard - Aligned to Our Goals

Annual Actual Month A positive experience for patients, Annual Cost effective, sustainable In month Actual Annual Month Excellent Patient Care Area YTD Area Actual Performance YTD Month Trend Area YTD Target Performance Trend service users and staff Target services plan Performance Target Trend

3 (80% Patients that develop a grade 4 pressure ulcer TW reduction on 0 Oct-16 2  Emergency Care 4 hour Standards AUC 95% 83% Oct-16 87%  RTT % of incomplete pathways within 18 weeks - IoW CCG TW 89.6% 88% Oct-16 92% 89%  15/16) Number of patients who have waited over 12 hours in A&E from decision to Patients that develop an ungraded pressure ulcer TW 4 Oct-16 23  AUC 0 8 Oct-16 16  RTT % of incomplete pathways within 18 weeks - NHS England TW 92% 94% Oct-16 92% 94%  admit to admission

VTE (Assessment for risk of) TW >95% 99.4% Oct-16 99.1%  Ambulance Category A Calls % < 8 minutes AUC 75% 70% Oct-16 70.3%  Zero tolerance RTT waits over 52 weeks (Incomplete Return) TW 0 0 Oct-16 0 2 

MRSA (confirmed MRSA bacteraemia) TW 0 0 Oct-16 0  Ambulance Category A Calls % < 19 minutes AUC 95% 93% Oct-16 92%  No. Patients waiting > 6 weeks for diagnostics TW <8 5 Oct-16 <100 36 

C.Diff TW 7 1 Oct-16 4  Number of Ambulance Handover Delays between 1-2 hours AUC N/A 48 Oct-16 155  % Patients waiting > 6 weeks for diagnostics TW <1% 0.5% Oct-16 <1% 0.5%  (confirmed Clostridium Difficile infection - stretched target)

Clinical Incidents (Major) resulting in harm TW 17 1 Oct-16 6  % of CPA patients receiving FU contact within 7 days of discharge MH 95% 100.0% Oct-16 96.3%  Theatre utilisation SWC / CCD 83% 77% Oct-16 83% 80%  (all reported, actual & potential, includes falls & PU G4) Clinical Incidents (Catastrophic) resulting in harm TW 2 Oct-16 8  % of CPA patients having formal review within last 12 months MH 95% 99.3% Oct-16 95.5%  Total pay costs (inc flexible working) (£000) TW £10,237 £10,172 Oct-16 £71,957 £72,086 (actual only - as confirmed by investigation) % of MH admissions that had access to Crisis Resolution / Home Falls - resulting in significant injury TW 5 0 Oct-16 0  MH 95% 81.5% Oct-16 94.3%  Staff in Post (£000) TW £10,193 £9,233 Oct-16 £71,357 £64,743 Treatment Teams (HTTs)

SWC / Symptomatic Breast Referrals Seen <2 weeks* CCD 93% 100.0% Oct-16 97.8%  All Cancelled Operations on/after day of admission 28 Oct-16 148  Variable Hours (£000) TW £43 £939 Oct-16 £600 £7,343 CCD Cancelled operations on/after day of admission SWC / Cancer patients seen <14 days after urgent GP referral* CCD 93% 98.4% Oct-16 97.0%  (not rebooked within 28 days) - including those not rebooked at the time of 0 0 Oct-16 2  Staff sickness absences TW 3% 4.50% Oct-16 3% 4.23% CCD reporting

Cancer Patients receiving subsequent Chemo/Drug <31 days* CCD 98% 100.0% Oct-16 100.0%  Patient Satisfaction (Friends & Family test - Total response rate) TW 26% Oct-16 26%  Staff absences - Acute Acute 3.5% 4.16% Oct-16

Cancer Patients receiving subsequent surgery <31 days* CCD 94% 92.9% Oct-16 97.6%  Patient Satisfaction (Friends & Family test - A&E response rate) TW 4% Oct-16 4%  Staff absences - Ambulance Ambulance 5.5% 7.63% Oct-16

Cancer diagnosis to treatment <31 days* CCD 96% 95.8% Oct-16 99.4%  Mixed Sex Accommodation Breaches TW 0 0 Oct-16 0  Staff absences - MHLD MHLD 4.5% 5.12% Oct-16

Cancer Patients treated after screening referral <62 days* CCD 90% 100.0% Oct-16 89.4%  Formal Complaints TW 14 Oct-16 107  Staff Turnover TW 5% 0.73% Oct-16 5% 4.45%

No measured Cancer Patients treated after consultant upgrade <62 days* CCD operational 100% Oct-16 100%  Compliments received TW N/A 198 Oct-16 1,816  Mandatory Training TW 80% 78.00% Oct-16 78.00% standard

Cancer urgent referral to treatment <62 days* CCD 85% 94.7% Oct-16 82.1%  Appraisal Monitoring TW 100% 75.34% Oct-16 75.34%

Summary Hospital-level Mortality Indicator (SHMI) Published TW 1 0.986 N/A  Employee Relations Cases TW 0 34 Oct-16 152 Apr-14 - Mar-15 Jan 2016

Never events TW 0 0 Oct-16 1  Achievement of adjusted financial performance TW (£319k) Oct-16 (£4.6m) (£4,102k)

Stroke patients (90% of stay on Stroke Unit) M 80% 83% Oct-16 85%  Variance against adjusted financial performance TW (£1k) Oct-16 £0 £2k

High risk TIA fully investigated & treated within 24 hours (National 60%) M 60% 100% Oct-16 98%  Liquidity ratio days TW Oct-16 4.0 4.0

*Cancer figures for September are provisional. Capital Servicing Capacity (times) TW Oct-16 4.0 4.0

Working with others to keep Annual Actual Month In month Year to Area YTD Skilled and capable staff Area Actual Performance YTD Agency spend variance against plan (£000) TW £0 £57 Oct-16 £0 £137 improving our services Target Performance Trend plan date plan

Capital Expenditure as a % of YTD plan TW 23% Oct-16 =>75% 43%

Delayed Transfer of Care (lost bed days) - (MH) TW N/A 231 Oct-16 1055  Total Workforce (inc flexible working) (FTE's) TW 2,832.16 2,908.8 Oct-16 N/A N/A I&E Margin Rating TW Oct-16 4.0 4.0

Delayed Transfer of Care (lost bed days) - (Acute) TW N/A 197 Oct-16 949  Total workforce SIP (FTEs) TW 2,680.47 2,702.1 Oct-16 N/A N/A I&E Margin Variance from Plan TW Oct-16 1.0 1.0

Delayed Transfer of Care (lost bed days) - (Community) TW N/A 113 Oct-16 660  Variable Hours (FTE) TW 151.7 206.7 Oct-16 1061.8 1390.0 Single Oversight Framework - Use of Resources TW Oct-16 3.0 3.0

Notes Debtors over 90 days as a % of total debtor balance TW Oct-16 =<5% 16.8%

Improvement on previous Delivering or exceeding Target Creditors over 90 days as a % of total creditor balance TW Oct-16 =<5% 2.7% month  Key to Area Code

No change to previous Underachieving Target Agency Spend above Ceiling TW Oct-16 4.0 4.0 month  TW = Trust Wide

Deterioration on previous Failing Target Total CIP savings achieved, in month TW 100% 100.0% Oct-16 100% 100.0% month  SWC = Surgery, Women's and Children's Health

M = Medicine Recurring CIP savings achieved, in month TW 100% 43.6% Oct-16 100% 31.7% As reported previously the balanced scorecard has been reviewed and a few slight changes have been made to reflect metrics which are reported monthly to NHS Sparkline graphs wil be included in M1 CCD = Clinical Suppprt, Cancer and Diagnostics Improvement. The Continuity of Service Risk Rating has been replaced by a Single Oversight Framework – Use of Resources, which now also includes use of Agency Report to present the trends over time for Staff against the Cap. Key Performance Indicators AUC = Ambulance, Urgent Care and Community MH = Mental Health and Learning Disabilities Page 3 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Executive Summary Quality Indicators have been agreed and are now in the Board Report. Main focus areas are - Emergency Care 4 Hour Standard, Referral To Treatment, Cancer, Finance and Diagnostics. NHS Improvement have published a Single Oversight Framework which is intended to help providers attain, and maintain, CQC ratings of ‘Good’ or ‘Outstanding’. This framework will supersede the Governance Risk Rating and we are including in our report next month.

Excellent Patient Care:

Pressure ulcers: The Clinical Directorates took full responsibility for the management of pressure ulcer incidents in June including approval status and checking for duplicates. This is a move away from overall final responsibility for pressure ulcers incidents sitting with the Nutrition and Tissue Viability Service. Increased awareness is continuing to lead to increased numbers being reported.

C.diff: There has been one new case of Healthcare acquired Clostridium Difficile identified in the Trust during October.

There have been no new cases of MRSA within the Trust during October.

All performance positive with the exception of Cancer Patients receiving subsequent surgery <31 days 92.9% v 94.0% and Cancer diagnosis to treatment <31 days 95.8% v 96.0%.

A positive experience for patients, service users and staff: Skilled and capable staff:

Ambulance - Due to service demand and wider patient flow challenges, the Ambulance Service was unable to meet targets in Across the Trust sickness continues to be higher than the targets that have been set. There has been much work in month, and further October. Data reporting issues are resting with ongoing improvements in A+E handovers. This is a similar picture across work will continue to have a positive impact. ambulance services across the country. There are a number of initiatives outlined in the report that will show how pro-active recruitment is working to source candidates for employment in the Trust Agency use is now only against vacancies. Emergency Care 4 Hour Standard - The 95% target was not achieved in October due to ongoing system wide pressures The majority of overpayments are being caused by managers not completing Change or Termination Forms. A plan is in place to highlight impacting upon patient flow and appropriate bed capacity.The recovery trajectory of 92% was also not achieved. The System these managers to senior managers for performance management as required. Resilience Winter Action Plan and ED improvement plans continue to be monitored weekly and monthly with the Clinical The Trust is not adhering to the roster approval timetable. The roster team will work to drive for compliance Commissioning Group. Revised trajectories for the year have been set based on capacity and demand planning for 16/17; this The Trust appraisal position has increased to 76.34%. Information is being provided to identify those outstanding so that this position can has been informed by historical activity and performance, as well as the intended impact of the above actions currently being be improved implemented now and throughout quarter 2. In addition, the impact of our system partners' actions are incorporated and, once agreed, will be monitored by the System Resilience Group.

Mixed Sex Accommodation - There were no mixed sex accommodation breaches during October.

We have received 14 formal complaints during October (16 in September).

We have received 198 compliments during September (243 in September).

Cost effective, sustainable services:

The Referral to Treatment (incomplete pathway) - The Trust's overall performance in October was 88.14% (for CCG and NHSE commissioned activity), which is an under performance against the 91.82% trajectory (target is 92%). This is disappointing given earlier good performance in the year against the trajectory, however, is due to the continuing level of cancelled admitted activity, as well as an increasing backlog in ophthalmology (both non admitted and admitted) due to vacancies; this issue is being addressed with the support of locum cover whilst recruitment continues. Delivering admitted (daycase and inpatient) activity continues to be impacted upon by levels of emergency activity and patient flow, both within the hospital and in the community, however, emergency activity, urgent operations and cancer operations continue to be prioritised.

The percentage utilisation of Main Theatre facilities is 76.2% in October 2016 and Day Surgery Unit utilisation is 79.2%, against the 83% targets for both. The under performance in Main Theatres is due to the combination of increased level of cancellations of inpatient activity, short notice booking and case mix, however, emergency activity, urgent operations and cancer operations continue to be prioritised. Activity was also impacted in Day Surgery when the a single sex bay in the was converted to be used for emergency surgical admissions requiring assessment.

The Trust has delivered a cumulative deficit of £4.102m as at 31 October. This is £2k better than plan meaning that the Trust has achieved its year to date financial control total thereby securing access to the Sustainability and Transformation Fund each month to date. The main pressure continues to be the under performance on the main CCG PbR contract, at £1.334m behind plan. This is being offset in expenditure by non-recurrent benefits and non investment from reserves for which funding had been allocated. However, there remains considerable risk within the Trusts financial position, and action is required to mitigate these risks to ensure the Trust continues to achieve against plan in the remaining months of the year. Within this position, savings of £4.523m have been achieved, which is on plan. The full year savings forecast remains at £10.217m, although £7.3m of this is expected to be non recurrent. As at 31 October £0.4m of capital allocation has been committed, which is £0.2m less than planned at this point in the year. The cash position for the Trust remains a key risk. The Trust’s Use of Resources Rating is a score of 3 (1 being best and 4 being worst). Page 4 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Performance Summary - Surgery, Women's and Children's Health

Balanced Scorecard - Surgery, Women's and Children's Health

Latest In Month YTD A positive experience for patients, Latest In Month YTD Excellent Patient Care data Target Actual Target Actual service users and staff data Target Actual Target Actual

MRSA (confirmed MRSA bacteraemia) Oct-16 0 0 0 0 Mixed Sex Accommodation Breaches Oct-16 0 0 0 0 C.Diff (confirmed Clostridium Difficile infection) Oct-16 0 1 No. of Complaints Oct-16 6 28 Clinical Incidents (Major) resulting in harm Oct-16 1 1 3 4 No. of Concerns Oct-16 21 143 (all reported, actual & potential, includes falls & PU G4) Clinical Incidents (Catastrophic) resulting in harm Oct-16 0 3 No. of Compliments Oct-16 78 764 (actual only - as confirmed by investigation) Cancelled operations on/after day of admission Falls - resulting in significant injury Oct-16 0 0 (not rebooked within 28 days) - including those not rebooked at Oct-16 0 0 0 2 the time of reporting Emergency 30 day Readmissions Oct-16 3.0% 3.2% All Cancelled Operations on/after day of admission Oct-16 28 148 Never Events Oct-16 0 0 0 0 Theatre utilisation Oct-16 83% 77.4% 83% 80.1% Pressure Ulcers - Grade 1 Oct-16 5 12 No. of Reported SIRIs Oct-16 2 5 Pressure Ulcers - Grade 2 Oct-16 1 13 Physical Assaults against staff Oct-16 1 5 Pressure Ulcers - Grade 3 Oct-16 0 1 Verbal abuse/threats against staff Oct-16 5 15 Pressure Ulcers - Grade 4 Oct-16 0 0 Pressure Ulcers - Ungradable Oct-16 0 7

Working with others to keep Latest In Month YTD Latest In Month YTD Skilled and capable staff improving our services data data Target Actual Target Actual Target Actual Target Actual Appraisals 09/11/16 92.5%

Latest In Month YTD Cost effective, sustainable Latest In Month YTD Income** data services data Plan Actual Plan Actual Target Actual Target Actual RTT % of incomplete pathways within 18 weeks (IoW CCG + NHS Total SLA Value Sep-16 £ 3,654,310 £ 3,319,960 £ 21,656,316 £ 20,114,858 Oct-16 92% 85.4% 92% 89.5% England) Zero tolerance RTT waits over 52 weeks (Incomplete Return) Oct-16 0 0 0 2 % Sickness Absenteeism Oct-16 3% 4.45% **The Acute Service Level Agreement performance reports a month behind, therefore figures are from September 2016.

Bed availability continues to impact adversely on the CBU’s ability to deliver 18 weeks, SLA income and theatre utilisation. Options are being worked up to mitigate this. Sickness is being robustly managed in accordance with the Trust's relevant policies. We have now met with HR and OH to look at options for further enhancing management of this.

Page 5 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Performance Summary - Medicine

Balanced Scorecard - Medicine

Latest In Month YTD A positive experience for patients, Latest In Month YTD Excellent Patient Care data Target Actual Target Actual service users and staff data Target Actual Target Actual

MRSA (confirmed MRSA bacteraemia) Oct-16 0 0 0 0 Mixed Sex Accommodation Breaches Oct-16 0 0 0 0 C.Diff (confirmed Clostridium Difficile infection) Oct-16 1 3 No. of Complaints Oct-16 4 19 Clinical Incidents (Major) resulting in harm Oct-16 1 0 3 0 No. of Concerns Oct-16 7 77 (all reported, actual & potential, includes falls & PU G4) Clinical Incidents (Catastrophic) resulting in harm Oct-16 0 0 No. of Compliments Oct-16 0 299 (actual only - as confirmed by investigation) Falls - resulting in significant injury Oct-16 0 0 No. of Reported SIRIs Oct-16 1 5 Emergency 30 day Readmissions Oct-16 9.0% 9.3% Physical Assaults against staff Oct-16 4 12 Stroke patients (90% of stay on Stroke Unit) Oct-16 80% 83.3% 80% 85.1% Verbal abuse/threats against staff Oct-16 4 16 High risk TIA fully investigated & treated within 24 hours (National Oct-16 60% 100.0% 60% 97.7% 60%) Never Events Oct-16 0 0 0 0 Pressure Ulcers - Grade 1 Oct-16 1 8 Pressure Ulcers - Grade 2 Oct-16 4 32 Pressure Ulcers - Grade 3 Oct-16 0 1 Pressure Ulcers - Grade 4 Oct-16 0 1 Pressure Ulcers - Ungradable Oct-16 4 9

Working with others to keep Latest In Month YTD Latest In Month YTD Skilled and capable staff improving our services data data Target Actual Target Actual Target Actual Target Actual Appraisals 09/11/16 61.9%

Latest In Month YTD Cost effective, sustainable Latest In Month YTD Income** data services data Plan Actual Plan Actual Target Actual Target Actual RTT % of incomplete pathways within 18 weeks (IoW CCG + NHS Total SLA Value Sep-16 £ 1,557,439 £ 1,671,358 £ 9,857,981 £ 10,624,875 Oct-16 92% 98.6% 92% 87.1% England) Zero tolerance RTT waits over 52 weeks (Incomplete Return) Oct-16 0 0 0 0 % Sickness Absenteeism Oct-16 3% 3.89% **The Acute Service Level Agreement performance reports a month behind, therefore figures are from September 2016.

Sickness absenteeism is lower in month than the YTD % but is still failing the 3% target. The Leadership team will continue to monitor sickness absence in the monthly Leadership meetings. RTT is better in month than the YTD %. Geriatric medicine does have capacity challenges but the patients currently waiting over 18 weeks are due to patient choice and inpatient admissions.

Page 6 Isle of Wight NHS Trust Board Performance Report 2015/16 October 16 Performance Summary - Clinical Support, Cancer and Diagnostics

Balanced Scorecard - Clinical Support, Cancer and Diagnostics

Latest In Month YTD A positive experience for patients, Latest In Month YTD Excellent Patient Care data Target Actual Target Actual service users and staff data Target Actual Target Actual

MRSA (confirmed MRSA bacteraemia) Oct-16 0 0 0 0 Mixed Sex Accommodation Breaches Oct-16 0 0 0 0 C.Diff (confirmed Clostridium Difficile infection) Oct-16 0 0 No. of Complaints Oct-16 0 10 Clinical Incidents (Major) resulting in harm Oct-16 1 0 3 0 No. of Concerns Oct-16 14 117 (all reported, actual & potential, includes falls & PU G4) Clinical Incidents (Catastrophic) resulting in harm Oct-16 0 2 No. of Compliments Oct-16 71 534 (actual only - as confirmed by investigation) Cancelled operations on/after day of admission Falls - resulting in significant injury Oct-16 0 0 (not rebooked within 28 days) - including those not rebooked at the time of Oct-16 0 0 0 2 reporting Emergency 30 day Readmissions Oct-16 0.0% 0.2% All Cancelled Operations on/after day of admission Oct-16 28 148 Symptomatic Breast Referrals Seen <2 weeks* Oct-16 93% 100.0% 93% 97.8% Theatre utilisation Oct-16 83% 77.4% 83% 80.1% Cancer patients seen <14 days after urgent GP referral* Oct-16 93% 98.4% 93% 97.0% No. of Reported SIRIs Oct-16 0 3 Cancer Patients receiving subsequent Chemo/Drug <31 days* Oct-16 98% 100.0% 98% 100.0% Physical Assaults against staff Oct-16 0 3 Cancer Patients receiving subsequent surgery <31 days* Oct-16 94% 92.9% 94% 97.6% Verbal abuse/threats against staff Oct-16 1 12 Cancer diagnosis to treatment <31 days* Oct-16 96% 95.8% 96% 99.4% Cancer Patients treated after screening referral <62 days* Oct-16 90% 100.0% 90% 89.4% Cancer urgent referral to treatment <62 days* Oct-16 85% 94.7% 85% 82.1% Never Events Oct-16 0 0 0 1 Pressure Ulcers - Grade 1 Oct-16 1 15 Pressure Ulcers - Grade 2 Oct-16 5 30 Pressure Ulcers - Grade 3 Oct-16 0 0 Pressure Ulcers - Grade 4 Oct-16 0 0 Pressure Ulcers - Ungradable Oct-16 0 5

Working with others to keep improving Latest In Month YTD Latest In Month YTD Skilled and capable staff our services data data Target Actual Target Actual Target Actual Target Actual Appraisals 09/11/16 76.8%

Latest In Month YTD Cost effective, sustainable Latest In Month YTD Income** data services data Plan Actual Plan Actual Target Actual Target Actual

Total SLA Value Sep-16 £ 1,020,944 £ 1,078,697 £ 6,028,687 £ 6,034,617 RTT % of incomplete pathways within 18 weeks (IoW CCG + NHS England) Oct-16 92% 89.9% 92% 93.6% Zero tolerance RTT waits over 52 weeks (Incomplete Return) Oct-16 0 0 0 0 No. Patients waiting > 6 weeks for diagnostics Oct-16 <8 5 <100 36 % Patients waiting > 6 weeks for diagnostics Oct-16 <1% 0.5% <1% 0.5% % Sickness Absenteeism Oct-16 3% 4.35% *Cancer figures for October are provisional. These are subject to further validation and may change. **The Acute Service Level Agreement performance reports a month behind, therefore figures are from September 2016. Cancer Breach Analysis All standards provisionally achieved for October with the exception of 31 DTT for Treatment with 2 admission cancelled breaches due bed availability and patient unfit for treatment (1 x breast, 2 x urology ) giving potential performance of 95.8%. 31 Day Subsequent Surgery admission cancelled breach due to bed availability (1 x breast) giving potential performance of 92.9%. Full breach analysis and root cause analysis performed for every breach. Performance data and issues reviewed twice weekly by Performance Lead and Operational Managers. Cancellation Analysis Cancelled operations on/after day of admission (not rebooked within 28 days)- targets may not be missed, as the 28 day pathway is ongoing at present so these may be rebooked in time. Theatre Utilisation Analysis The theatre utilisation targets were not achieved due to bed capacity both the theatre underutilisation and cancelled appointments were as a result of ongoing bed pressures. The CSCD Management team is fully engaged with improving patient flow and attend daily bed meeting to expedite actions. Continuing to challenge the utilisation data and capturing activity manually to compare figures. RTT % of incomplete pathways within 18 weeks (IoW CCG + NHS England) The 3 CBU specialties which have an RTT incomplete target are all achieving their outpatient incomplete target. Chronic Pain continues to fail inpatient target due to lack of theatre capacity, demand and list cancellations when DSU has been converted to a ward. The recovery plan for Chronic Pain has been included in the elective recovery plan being tabled at OMG and TLC. Sickness Absence Monitoring Analysis Management is addressing long term absences and supporting their return to work. Never event SIRI Closed by CCG - Actions being monitored until completion via CBU. Page 7 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Performance Summary - Ambulance, Urgent Care and Community

Balanced Scorecard - Ambulance, Urgent Care and Community

Latest In Month YTD A positive experience for patients, Latest In Month YTD Excellent Patient Care data Target Actual Target Actual service users and staff data Target Actual Target Actual

MRSA (confirmed MRSA bacteraemia) Oct-16 0 0 0 0 Mixed Sex Accommodation Breaches Oct-16 0 0 0 0 C.Diff (confirmed Clostridium Difficile infection - stretched target) Oct-16 0 0 No. of Complaints Oct-16 4 34 Clinical Incidents (Major) resulting in harm (all reported, actual & potential, Oct-16 1 0 3 1 No. of Concerns Oct-16 13 110 includes falls & PU G4) Clinical Incidents (Catastrophic) resulting in harm(actual only - as confirmed by Oct-16 1 2 No. of Compliments Sep-16 0 149 investigation) Falls - resulting in significant injury Oct-16 0 0 Emergency Care 4 hour Standards Oct-16 95% 82.9% 95% 86.7% Number of patients who have waited over 12 hours in A&E from decision to admit to Never Events Oct-16 0 0 0 0 Oct-16 0 8 0 16 admission Pressure Ulcers - Grade 1 Oct-16 3 15 Category A 8 Minute Response Time (Red 1) Oct-16 75% 66.7% 75% 63.2% Pressure Ulcers - Grade 2 Oct-16 2 12 Category A 8 Minute Response Time (Red 2) Oct-16 75% 70.3% 75% 70.8% Pressure Ulcers - Grade 3 Oct-16 0 0 Category A 19 Minute Response Time Oct-16 95% 92.8% 95% 92.2% Pressure Ulcers - Grade 4 Oct-16 0 1 Number of Ambulance Handover Delays over 1 hours Oct-16 48 155 Pressure Ulcers - Ungradable Oct-16 0 2 No. of Reported SIRIs Oct-16 2 5 Physical Assaults against staff Oct-16 4 13 Verbal abuse/threats against staff Oct-16 1 16

Working with others to keep In Month In Month Latest YTD Skilled and capable staff Latest YTD improving our services data data Target Actual Target Actual Target Actual Target Actual Appraisals 09/11/16 63.2%

Latest In Month YTD Latest In Month YTD Income** data Cost effective, sustainable services data Plan Actual Plan Actual Target Actual Target Actual Total SLA Value Sep-16 £ 3,071,645 £ 3,228,778 £ 19,167,143 £ 19,243,900 % Sickness Absenteeism Oct-16 3% 4.34% Ambulance re-contact rate following discharge from care by telephone Oct-16 3% 4.6% 3% 5.9% Ambulance re-contact rate following discharge from care at scene Oct-16 2% 3.3% 2% 2.7% Ambulance time to answer call (in seconds) - median Oct-16 1 1 N/A N/A Ambulance time to answer call (in seconds) - 95th percentile Oct-16 5 1 N/A N/A Ambulance time to answer call (in seconds) - 99th percentile Oct-16 14 12 N/A N/A NHS 111 Call abandoned rate Oct-16 5% 1.9% 5% 2.1% NHS 111 All calls to be answered within 60 seconds of the end of the introductory Oct-16 95% 94.3% 95% 94.6% message NHS 111 Where disposition indicates need to pass call to Clinical Advisor this should Oct-16 95% 95.9% 95% 95.8% be achieved by ‘Warm Transfer’ NHS 111 Where the above is not achieved callers should be called back within 10 mins Oct-16 100% 30.2% 100% 35.7%

**The Acute Service Level Agreement performance reports a month behind, therefore figures are from September 2016.

Emergency Care Standard - The 95% target was not achieved in October due to ongoing system wide pressures impacting upon patient flow and appropriate bed capacity.The recovery trajectory of 92% was also not achieved. The System Resilience Winter Action Plan and ED improvement plans continue to be monitored weekly and monthly with the Clinical Commissioning Group. Revised trajectories for the year have been set based on capacity and demand planning for 16/17; this has been informed by historical activity and performance, as well as the intended impact of the above actions currently being implemented now and throughout quarter 2. In addition, the impact of our system partners' actions are incorporated and, once agreed, will be monitored by the System Resilience Group.

Ambulance - Due to service demand and wider patient flow challenges the Service was unable to meet targets in October - However there has been a susatined improvement in both Red 2 and 19 minute performance. Data reporting issues are resolving with ongoing improvements in A&E handovers processes and technical data capture. The key issues facing the service is its ability to provide a high quality of care against a back drop of system wide pressures and flow of patients through the hospital setting leading to delays in responding at times. This is a similar picture across ambulance services across the country. Recruitment to paramedic posts is also a challenge but we are currently recruiting for 3 vacancies with plans to secure qualified staff or students due to qualify in the summer. The 111 service failed the calls answered in 60 secs target. It has been recognised that a change in practice following recommendations from a SIRI has reduced additional ad hoc call handling support from the Hub Performance Support Officers affecting performance. Reduced GP capacity means 111 receives a higher level of activity at times, (especially OOH and Weekends). We continue to mitigate this by arranging for an additional call handler to be on duty whenever available. We are monitoring the success and costs of this closely through weekly performance meetings and the implementation of daily performance huddles.

Page 8 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Performance Summary - Mental Health and Learning Disabilities

Balanced Scorecard - Mental Health and Learning Disabilities

Latest In Month YTD A positive experience for patients, Latest In Month YTD Excellent Patient Care data Target Actual Target Actual service users and staff data Target Actual Target Actual

MRSA (confirmed MRSA bacteraemia) Oct-16 0 0 0 0 FFT - % Response Rate Oct-16 1.5% 1.3% C.Diff (confirmed Clostridium Difficile infection) Oct-16 0 0 FFT - % Recommending Oct-16 90% 98% 90% 93% Clinical Incidents (Major) resulting in harm Oct-16 1 0 3 0 Mixed Sex Accommodation Breaches Oct-16 0 0 0 0 (all reported, actual & potential, includes falls & PU G4) Clinical Incidents (Catastrophic) resulting in harm Oct-16 1 1 No. of Complaints Oct-16 0 8 (actual only - as confirmed by investigation) Falls - resulting in significant injury Oct-16 0 0 No. of Concerns Oct-16 2 28 Never Events Oct-16 0 0 0 0 No. of Compliments Oct-16 13 64 % of EIP pathways completed within two weeks Oct-16 50% 100.0% 50% 81.8% No. of Reported SIRIs Oct-16 1 5 IAPT – Proportion of people who have completed treatment and Oct-16 50% 51.9% 50% 51.0% Physical Assaults against staff Oct-16 21 91 moving to recovery Verbal abuse/threats against staff Oct-16 20 107 % of CPA patients receiving FU contact within 7 days of discharge Oct-16 95% 100.0% 95% 96.3%

% of CPA patients having formal review within last 12 months Oct-16 95% 99.3% 95% 95.5% % of MH admissions that had access to Crisis Resolution / Home Oct-16 95% 81.5% 95% 94.3% Treatment Teams (HTTs)

Working with others to keep Latest In Month YTD Latest In Month YTD Skilled and capable staff improving our services data data Target Actual Target Actual Target Actual Target Actual Delayed Transfer of Care (lost bed days) - (MH) Oct-16 231 1,055 Appraisals 09/11/16 77.5%

Latest In Month YTD Cost effective, sustainable Latest In Month YTD Income** data services data Plan Actual Plan Actual Target Actual Target Actual RTT % of incomplete pathways within 18 weeks (IoW CCG + NHS Total SLA Value Sep-16 £ 1,834,418 £ 1,834,418 £ 11,006,511 £ 11,006,511 Oct-16 92% 100.0% 92% 99.0% England) Zero tolerance RTT waits over 52 weeks (Incomplete Return) Oct-16 0 0 0 0 % Sickness Absenteeism Oct-16 3% 5.12%

**The Acute Service Level Agreement performance reports a month behind, therefore figures are from September 2016.

- CRHT indicator was not achieved in the month of October due to a number of patients being admitted on a MH Act section not being gatekept. A meeting will be arranged with the Service Lead and LA Lead to review the process. - The percentage of patients on CPA followed up in 12 months has been achieved again in month of October.. The CBU Operational Management team, as part of Quality Improvement Fellowship work, have set up a quality improvement initiative and this will continue to be rolled out across mental health services over the next few months to ensure that we continue to meet the target. - The CPA 7-day follow-up was achieved in month and is cumulatively on track to achieve at hear end.

Page 9 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Highlights

Highlights

No Mixed Sex Accommodation Breaches in October

No new cases of MRSA

Symptomatic Breast Referrals Seen <2 weeks, Cancer patients seen <14 days after urgent GP referral, Cancer urgent referral to treatment <62 days, Cancer Patients receiving subsequent Chemo/Drug <31 days and Cancer Patients treated after screening referral <62 days days above target for October

198 compliments received in October

No falls resulting in significant injury

High risk TIA fully investigated & treated within 24 hours

% of CPA patients receiving FU contact within 7 days of discharge above target

% Patients waiting > 6 weeks for diagnostics is below the 1% maximum target

% of Care Programme Approach patients having formal review within last 12 months above target Financial plan achieved year to date securing System Transformation Funding for Quarter 2.

Page 10 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Lowlights

Lowlights

14 formal complaints in month

Staff sickness remains above plan for all categories

Emergency care 4 hour standard remains below target

Theatres utilisation below target Category A 8 Minute Response Time (Red 1), Category A 8 Minute Response Time (Red 2) and Category A 19 minute response times are all below target Referral ToTreatment Time - % Incomplete pathways below 92% target

1 Clinical Incident (Major) resulting in harm

NHS 111 All calls to be answered within 60 seconds of the end of the introductory message below target

Cancer Patients receiving subsequent surgery <31 days and Cancer diagnosis to treatment <31 days below target

Governance Risk Rating of 11 for October 2016

One new case of C Diff

Stroke patients (90% of stay on Stroke Unit) below the target

Page 11 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Pressure Ulcers

Commentary: General: Pressure ulcer development contributes to clinical incident numbers and the higher grades contribute to the numbers of Analysis: Serious Incidents Requiring Investigation. (SIRIs). Quality Account Priority 2 & National Safety Thermometer CQUIN schemes The Clinical Directorates took full responsibility for the management of pressure ulcer incidents in June including approval status and checking for duplicates. This is a move away from overall final responsibility for pressure ulcers incidents sitting with the Nutrition and Prevention & Management of Pressure Ulcers Tissue Viability Service. Increased awareness is continuing to lead to increased numbers being reported. Hospital: The Pressure Ulcer Collaborative continues to review all pressure ulcers that occur in the IW NHS care on a weekly basis. This has focussed further attention on this issue and raised awareness in the Business Units. Whilst there has been a rise in the overall reporting, this has been mainly in the area of grade 1 and 2 pressure ulcers. There are a number of ungradable pressure ulcers that are still under review. Community: The Pressure Ulcer collaborative is also looking at the community and in this setting no grade 3 pressure ulcers and 2 grade 4 pressure ulcers have been reported and attributed to NHS care during the review period. The trend overall is encouraging, and the reviews are now focussing on the root cause analysis and cluster review of grade 2 pressure ulcers as the Trust has set itself the target of reducing the occurrence of this grade of pressure ulcers by 50% in the next year. The overall trend across 2015/16 was decreasing incidence across all grades and this is generally continuing.

The report now separates out Ungradable pressure ulcers as a distinct reporting line so that it is clear that these ulcers (which were previously counted as grade 4s) have not yet been assigned a grade and do not automatically mean that this is an incident that has resulted in patient harm.

Pressure Ulcers benchmark

The graph shows improving trend. In October the Trust has been above the national average. Action Plan: Person Responsible: Date: Status:

• Trust wide Pressure Ulcer Prevention Group continues to meet. . • Deep dives for each Business Unit going ahead to look at why expected reductions were not achieved last year. • Action plans for pressure ulcer reduction have been reviewed and are being amalgamated into a single master plan for coming year. Clinical Business Unit Heads of Nursing & Quality • Local quarterly Tissue Viability and MUST audits are being established by Tissue Viability Service. Nov-16 Ongoing & Tissue Viability Nurse Specialist • Pressure Ulcer Reporting has been handed to Matrons and Locality leads to supervise to develop local ownership of reporting and understanding the scale of the issue. •Work is also ongoing to identify where patients are admitted from their home address who have been receiving non NHS care assistance.

The pressure ulcer collaborative continues to meet weekly. The overall trends are encouraging and the recent increases in Clinical Business Unit Heads of Nursing & Quality numbers are more indicative of increased awareness and reporting of lower grades than of increasing incidence. The trend Nov-16 Ongoing & Tissue Viability Nurse Specialist continues to decrease. Page 12 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Patient Safety

Commentary: Analysis: Clostridium Difficile infections against national and local targets

Clostridium difficile There were no MRSA bacteraemia cases identified during October and 1 case of C Diff, bringing our year to date total to 4. We remain within our target, with a significant (75%) decrease on this time last year. The investigation concluded that there was a delay in sending the stool sample and this constituted a lapse in care. There is a new move toward offering a probiotic to patients at risk that can be taken during and for a short while after specific antibiotics are prescribed and this will be offered where appropriate. There are a number of Isle of Wight NHS Trust C. Difficile cases (Cumulative) people within the wider community who are known to be MRSA or C Diff positive although the infection may be 8 neither active nor causing symptoms at the time and these people may require admission for other conditions. 7 There are a high number of cases identified with E-Coli currently in the community. 6 5 During 2015/16 the Trust was under considerable pressure and was unable to achieve the target of 7 identified 4 cases of Healthcare Acquired Infection of Clostridium Difficile bacteraemia. The target for 2016/17 is to remain 3 within the threshold of 7 cases across the year and the increased availability of single rooms in the Medical 2 Assessment and Admissions Unit and decontamination of isolation rooms using the gas fogging 'BioQuell' 1 system is helping to achieve this. Additionally, the Trust has joined with others across the country in an 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar innovative 90 day improvement approach programme where reporting to peers and a national body invigorates Total cases 0 1 1 1 2 3 4 4 4 4 4 4 and spreads good practice between organisations. This Trust has chosen to target bed-space cleaning between patients (which is required to balance maximum cleanliness with minimum patient delay) as their particular area National Target 1 1 2 2 3 3 4 4 5 6 6 7 to improve and staff on participating wards have been working with the Infection Prevention & Control team to develop a Bed Space Champion role and critiquing existing methodology with a view to redesigning training and identifying any equipment needs. Improved methodology and results will be shared, both within the Trust and then with participating organisations at the national meetings.

Methicillin-resistant Staphylococcus Aureus (MRSA) Isle of Wight NHS Trust There have been no cases identified as Healthcare acquired infections during October. MRSA Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Acute Target 0 0 0 0 0 0 0 0 0 0 0 0 0 Actual 0 0 0 0 0 0 0 0 0 0 0 0 0

Action Plan: Person Responsible: Date: Status: Infection Prevention & Control team/ Business Unit Head of Participation in National 90 day improvement programme with results discussed at national meeting Oct-16 Continuing Nursing & Quality/ Ward Managers End of June Improved stool sampling, with ward staff to complete e-learning and sign off on education poster Ward sister Completed 2016

Ongoing until consistent Rotation of cleanliness team staff Hotel Services compliance Continuing achieved at audit. Use of BioQuell gas fogging intensive cleaning following surface cleaning between patients where isolation has Infection Prevention & Control Oct-16 Continuing been in place. Page 13 team / Hotel services Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Formal Complaints

Commentary: Analysis: Complaints only

There were 14 formal Trust complaints received in October 2016 (16 in Primary Subject Aug-16 Sep-16 Oct-16 RAG rating the previous month) with 198 compliments received by letters and cards Access to treatment or drugs 0 2 1  of thanks for the same period. In addition to the 14 formal complaints, a Admissions and discharges 0 3 2  further 61 concerns were raised. Appointments 4 0 0  Clinical Treatment 0 3 7  Commissioning 0 0 0  Across all complaints and concerns in October 2016: Communication 5 6 1  Top subjects were: Consent 0 0 0  - Communication (23) End of Life Care 0 0 0  - Clinical Treatment (16) Facilities 0 0 0  - Values and Behaviours (Staff) (6) Integrated Care 0 0 1  Mortuary 0 0 0  Top areas of complaints and concerns were: Other (Use with Caution) 0 0 0  - OPARU (11) Privacy, Dignity and Wellbeing 0 1 0  - Emergency Department (10) Prescribing 0 0 0  - Gynaecology (5) Patient Care 2 1 0  - Paediatrics (5) Restraint 0 0 0  Staff numbers 0 0 0  Trust admin/Policies/Procedures 2 0 1  Transport (Ambulances) 1 0 1  Values and Behaviours (Staff) 2 0 0  Waiting Times 0 0 0 

Action Plan: Person Responsible: Date: Status:

The complaints process continues to be reviewed on an ongoing basis to ensure we Executive Director of Nursing / Patient are providing a high quality service to our complainants; and that we are truly learning Dec-16 Ongoing Experience Lead lessons from complaints.

Page 14 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Emergency Care 4 hours Standard (ECS)

Commentary: Analysis: Emergency Care 4 hours Standard For 2016/17, the Trust has set trajectories for some key national performance standards where there was under performance during 2015/16. This is to enable 100.0% an informed, manageable and sustainable improvement in performance during the year until the target is achieved. 80.0%

The Trust's performance in October was 82.9%, which is an under performance 60.0% against the 92% trajectory (target is 95%). This under performance continues 40.0% due to patient flow and staffing level issues; both of these are being addressed at an operational level. The strategic change required to improve the Trust's 20.0% Target not achieved Target achieved Target Trajectory delivery of urgent care is being undertaken via the Urgent Care Improvement Analysis: Plan, which is under pinned by 6 workstreams; these are focusing on the 0.0% improved delivery for ambulance, urgent care service (previously known as Jul 16Jul Jan 16 Jan Jun 16 Jun Oct 16 Apr 16 Feb16 Sep16 Dec 15 Aug 16 Nov 15 Nov Mar 16 Beacon), ED patient flow, ambulatory care, internal flow and discharge. May 16

The Urgent Care Service (to replace the previous Beacon Walk in Centre in October 2016) has seen a reduction in the number of attendances, thereby, releasing some pressure on ED patient flow, however, this reduction in activity level has had a negative statistical impact on the Trust's % performance against the ECS of between 2-3%. The ED Project actions and milestones are being quantified to determine their individual % impact and timing on the overall ECS performance with the aim of achieving a more sustainable level during quarter 4.

Action Plan: Person Responsible: Date: Status:

Ensure robust data information Programme Lead Nov-16 In progress

Review of nursing resources across including vacancies, skill mix, management and Head of Nursing & Quality Nov-16 Continuing processes

Finalise Urgent Care Improvement Plan programme documentation and delivery & Programme Lead Nov-16 In progress monitoring framework

Implementation of Ambulatory Care Model Programme Lead Nov-16 Commenced Page 15 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Cancer Patients receiving subsequent surgery <31 days, Cancer diagnosis to treatment <31 days

Commentary: Analysis: Cancer Patients receiving subsequent surgery <31 days

The Trust underperformed against two 31day cancer performance targets in October. 120.0% 100.0% For those patients receiving subsequent surgery, one patient out of the 14 treated during October did not receive 80.0% their subsequent surgery within 31days due to bed cancellations at the time; this led to an underperformance of 60.0% 92.9% against the 94% national target. 40.0% 20.0% Target achieved Target not achieved Target For those patients requiring treatment within 31 days of their diagnosis, 3 patients out of the 72 patients treated 0.0% during October did not receive their treatment within 31 days; 2 were due to bed cancellations and 1 was due to the Jul-16 Jan-16 Jun-16 Oct-16 Apr-16 Feb-16 Sep-16 Dec-15 Aug-16 Nov-15 Mar-16 patient being unfit for treatment upon admission. This led to an underperformance against the 96% target of 95.8%. May-16 Analysis: Cancer diagnosis to treatment <31 days

120.0% 100.0% 80.0% 60.0% 40.0% 20.0% Target achieved Target not achieved Target 0.0% Jul-16 Jan-16 Jun-16 Oct-16 Apr-16 Feb-16 Sep-16 Dec-15 Aug-16 Nov-15 Mar-16 May-16

Action Plan: Person Responsible: Date: Status:

Improved breach analysis at tumour level including monitoring against timed tumour level pathways and monthly improvement Head of Operational Performance Nov-16 Commenced plan meetings with key staff

Page 16 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Ambulance Performance

Commentary: Analysis:

For 2016/17, the Trust has set trajectories for some key national performance standards where there was under performance during 2015/16. This is to enable an informed, Cat A 8 minutes response time (Red 1) manageable and sustainable improvement in performance during the year until the target is achieved. 100.0% Cat A 19 minutes response time 100.0%

Due to service demand and wider patient flow challenges, the Ambulance Service was unable to meet targets in October; the key issues facing the service is its ability to 75.0% provide a high quality of care against a back drop of system wide pressures and flow of patients through the hospital setting leading to delays in responding at times. This is 50.0% a similar picture across ambulance services across the country. 50.0%

25.0% Target achieved Target not achieved As reported for the Emergency care Standard performance, the strategic change required to improve the Trust's delivery of urgent care is being undertaken via the Urgent Target achieved Target not achieved Target Trajectory Target Trajectory Care Improvement Plan, which is under pinned by 6 workstreams; these are focusing on the improved delivery for ambulance, Beacon, ED patient flow, ambulatory care, 0.0% 0.0% internal flow and discharge. The ambulance project is now in place and commencing delivery against key milestones; weekly reporting on the progress and impact of that

Analysis: Jul-16 Jan-16 Jun-16 Oct-16 Apr-16 Jul-16 Feb-16 Sep-16 Dec-15 Aug-16 delivery is distributed throughout the Trust. The Ambulance Project actions and milestones are being quantified to determine their individual % impact and timing on the Nov-15 Mar-16 Jan-16 Jun-16 May-16 Oct-16 Apr-16 Feb-16 Sep-16 Dec-15 Aug-16 Nov-15 Mar-16 overall Ambulance targets performance with the aim of achieving a more sustainable level during quarter 4. May-16

Cat A 8 minutes response time (Red 2) 100.0%

80.0%

60.0%

40.0%

20.0% Target achieved Target not achieved Target Trajectory

0.0% Jul-16 Jan-16 Jun-16 Oct-16 Apr-16 Feb-16 Sep-16 Dec-15 Aug-16 Nov-15 Mar-16 May-16

Action Plan: Person Responsible: Date: Status:

Continuous monitoring of performance targets, amending REAP (Resourcing Escalatory Action Plans) level as appropriate and sharing status with fellow Senior Managers and Operations Manager Sep-16 Complete - Process in place increase staffing levels

Improved validation of handover performance information with increased resourcing Operations Manager Oct-16 Ongoing

Commence delivery of key milestones within Ambulance project Project Lead Oct-16 Commenced

Finalise Urgent Care Improvement Plan programme documentation and delivery & monitoring framework Programme Lead Oct-16 Completed

Page 17 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Theatre Utilisation

Commentary Analysis: Main Theatres The percentage utilisation of Main Theatre facilities is 76.2% in October 2016 and 100.0% Day Surgery Unit utilisation is 79.2%, against the 83% targets for both. The under 80.0% performance in Main Theatres is due to the combination of increased level of 60.0% cancellations of inpatient activity, short notice booking and case mix, however, 40.0% 20.0% Target failed Target met emergency activity, urgent operations and cancer operations continue to be Target DSU and Main Total prioritised. Activity was also impacted in Day Surgery when the a single sex bay in 0.0% the was converted to be used for emergency surgical admissions requiring Jul 16 Jul Apr 16 Apr 16 Oct Jan 16 Jan 16 Jun Mar 16 Mar Feb 16Feb Nov 15 Nov 15 Dec 16 Aug 16 Sep assessment. 16 May

The daily activity performance huddle continues to review on a daily basis the DSU scheduled theatre activity for the current and forthcoming weeks, as well as the 100.0% avoidance of cancelled theatre lists and the rebooking of patients when required. 80.0% The weekly patient access group monitors the inpatient and day case waiting list 60.0% ensuring pre assessments, anaesthetic reviews and operation dates are scheduled 40.0% to our patients waiting in turn, addressing any delays as required. 20.0% Target failed Target met 0.0% Target DSU and Main Total Jul 16 Jul Apr 16 Apr 16 Oct

To support the delivery of more transformational and sustainable change that is 16 Jan 16 Jun Mar 16 Mar Feb 16Feb Nov 15 Nov 15 Dec 16 Aug 16 Sep May 16 May required within the theatre environment, a Theatres Project has been established to focus and resource the prioritised areas for improvement. One of the priorities is to review the daily activity levels within DSU and increase them to equalise the flow and provide a consistent capacity level throughout the week; it is aimed this will be undertaken during November and the benefits realised from December onwards.

Action plan Person Responsible: Date: Status:

Daily performance activity huddle in place to monitor elective activity and manage Head of Operational Nov-16 Ongoing operational issues. Performance

Cancellation reasons being reported and analysed to inform necessary actions to reduce Operational Manager for Nov-16 In progress cancellations in qtr 3. Theatres

Operational Manager for Review DSU activity levels and capacity available to increase weekly flow Page 18 Nov-16 Commenced Theatres Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Referral to Treatment Times

Commentary: Analysis:

For 2016/17, the Trust has set trajectories for some key national performance RTT Incomplete IoW CCG RTT Incomplete NHS England standards where there was under performance during 2015/16. This is to enable 100.0% 150.0% an informed, manageable and sustainable improvement in performance during the 80.0% 100.0% year until the target is achieved. 60.0% 40.0% 50.0% The Trust's overall performance in October was 88.14% (for CCG and NHSE 20.0% commissioned activity), which is an under performance against the 91.82% 0.0% 0.0% Jul 16 Jul Jul 16 trajectory (target is 92%). This is disappointing given earlier good performance in 16 Jan Jun 16 Jun Oct 16 Oct Apr 16 Apr Feb 16 Sep 16 Jan 16 Jan Dec 15 Dec Jun 16Jun Aug 16 Aug Oct 16 Oct Nov 15 Nov Apr 16 Apr Feb 16 Sep 16 Mar 16 Mar Dec 15 Dec Aug 16 Aug May 16 May Nov 15 Nov Mar 16 Mar the year against the trajectory, however, is due to the continuing level of cancelled 16 May admitted activity, as well as an increasing backlog in ophthalmology (both non Target achieved Target not achieved Target achieved Target not achieved admitted and admitted) due to vacancies; this issue is being addressed with the Target Trajectory Target Trajectory support of locum cover whilst recruitment continues. Delivering admitted (daycase and inpatient) activity continues to be impacted upon by levels of emergency activity and patient flow, both within the hospital and in the community, however, RTT Incomplete IOW NHS Trust emergency activity, urgent operations and cancer operations continue to be 100.0% prioritised. 80.0%

In response to this a specialty level recovery plan with various options to improve 60.0% the current position is being discussed and the way forward agreed. 40.0%

20.0%

0.0% Jul 16 Jul Jan 16 Jan Jun 16 Jun Oct 16 Apr 16 Apr Feb 16 Feb 16 Sep Dec 15 Dec Aug 16 Aug Nov 15 Nov Mar 16 Mar May 16 May

Target achieved Target not achieved Target Trajectory

Person Responsible: Date: Status:

Daily performance activity huddle in place to monitor elective activity and manage operational Head of Operational Performance Nov-16 Ongoing issues.

Transfer proportion of elective capacity currently being used for non elective activity back to Head of Operations Oct-16 In planning elective enabling delivery of planned elective activity

Discuss RTT recovery plan options and agree way forward to improve the current position Trust Leadership Committee Dec-16 Commenced

Page 19 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Benchmarking of Key National Performance Indicators: Summary Report

National National Performance IW IW Rank IW Status Data Period Target Performance Best Worst Eng Emergency Care 4 hour Standards 95% 100% 73% 90.3% 87.6% 112 / 167 Amber Red Qtr 1 16/17

RTT % of incomplete pathways within 18 weeks 92% 100% 77% 90.3% 88.2% 160 / 184 Red Sep-16

%. Patients waiting > 6 weeks for diagnostic 1% 0% 15% 1.5% 0.5% 82 / 180 Amber Green Sep-16

Ambulance Category A Calls % < 8 minutes - Red 1 75% 71% 63% 68.3% 71.1% 1 / 11 Green Sep-16

Ambulance Category A Calls % < 8 minutes - Red 2 75% 73% 53% 62.0% 72.7% 2 / 11 Amber Green Sep-16

Ambulance Category A Calls % < 8 minutes - Red 1 & Red 2 75% 73% 0% 62.3% 72.6% 2 / 11 Amber Green Sep-16

Ambulance Category A Calls % < 19 minutes 95% 94% 85% 90.6% 93.0% 2 / 11 Amber Green Sep-16

Cancer patients seen <14 days after urgent GP referral 93% 100% 58% 93.7% 95.5% 64 / 151 Amber Green Qtr 1 16/17

Cancer diagnosis to treatment <31 days 96% 100% 77% 97.6% 100.0% 1 / 158 Green Qtr 1 16/17

Cancer urgent referral to treatment <62 days 85% 100% 0% 82.3% 77.9% 123 / 156 Amber Red Qtr 1 16/17

Symptomatic Breast Referrals Seen <2 weeks 93% 100% 34% 91.8% 96.2% 43 / 130 Amber Green Qtr 1 16/17

Cancer Patients receiving subsequent surgery <31 days 94% 100% 0% 95.3% 97.9% 73 / 153 Amber Green Qtr 1 16/17

Cancer Patients receiving subsequent Chemo/Drug <31 days 98% 100% 92% 99.4% 100.0% 1 / 141 Green Qtr 1 16/17

Cancer Patients treated after screening referral <62 days 90% 100% 25% 91.3% 84.1% 117 / 142 Red Qtr 1 16/17

Key: Better than National Target = Green Top Quartile = Green Worse than National Target = Red Median Range Better than Average = Amber Green Median Range Worse than Average = Amber Red Bottom Quartile Red

Page 20 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Benchmarking of Key National Performance Indicators: IW Performance Compared To Other 'Small Acute Trusts'

National IW RA3 RA4 RBD RBT RBZ RC1 RC3 RCD RCF RCX RD8 RE9 RFF RFW RGR RJC RJD RJF RJN RLQ RLT RMP RN7 RNQ RNZ RQQ RQX Data Period Other Small Acute Trusts Target

Emergency Care 4 hour Standards 95% 87.6% 18 84.9% 23 91.1% 13 91.8% 11 87.5% 20 95.2% 3 92.8% 9 N/A 95.4% 2 93.3% 7 87.9% 17 95.1% 4 92.8% 8 94.7% 5 N/A 87.0% 21 95.8% 1 N/A 89.3% 16 85.4% 22 89.8% 15 91.4% 12 90.4% 14 83.5% 24 87.6% 19 92.7% 10 77.9% 25 93.4% 6 Qtr 1 16/17 RTT % of incomplete pathways within 18 weeks 92% 88.2% 95.4% 89.6% 86.3% 93.7% 92.7% 93.3% N/A 94.8% 91.8% 92.6% 89.9% 95.2% 94.2% N/A 92.2% 92.3% N/AN/A 89.5% N/A 92.1% 93.1% 94.0% N/A 92.2% 93.3% 96.5% Sep-16 21 2 19 22 7 11 8 4 17 12 18 3 5 15 13 20 16 10 6 14 9 1 %. Patients waiting > 6 weeks for diagnostic 1% 0.5% 1.2% 0.9% 8.2% 0.1% 0.8% 0.3% N/A 0.0% 0.0% 0.4% 1.9% 0.0% 0.1% N/A 8.2% 1.4% N/A 1.3% 0.5% 0.0% 0.1% 0.95% 0.2% N/A 0.7% 5.8% 0.0% Sep-16 13 18 16 23 7 15 10 5 1 11 21 1 8 24 20 12 1 6 17 9 14 22 1 Cancer patients seen <14 days after urgent GP referral 93% 95.5% 95.6% 95.1% 95.7% 97.2% 88.1% 93.0% N/A 95.6% 97.6% 97.9% 94.8% 96.4% 94.1% N/A 91.5% 95.7% N/A 95.5% 98.1% 83.8% 96.0% 96.5% 92.0% 95.9% 93.7% 93.4% 97.0% Qtr 1 16/17 14 12 16 11 4 24 21 13 3 2 17 7 18 23 10 15 1 25 8 6 22 9 19 20 5 Cancer diagnosis to treatment <31 days 96% 100.0% 99.1% 98.6% 98.2% 100.0% 99.2% 97.4% N/A 99.6% 100.0% 99.7% 98.8% 100.0% 99.1% N/A 100.0% 96.6% N/A 99.2% 98.8% 97.6% 99.4% 99.5% 100.0% 97.1% 98.5% 98.4% 98.0% Qtr 1 16/17 1 13 17 20 1 12 23 8 1 7 15 1 14 1 25 11 16 22 10 9 1 24 18 19 21 Cancer urgent referral to treatment <62 days 85% 77.9% 80.2% 82.3% 85.0% 92.3% 89.6% 85.3% N/A 89.3% 92.5% 83.1% 87.3% 87.7% 84.3% 100.0% 87.8% 83.2% N/A 81.0% 86.0% 78.8% 87.4% 93.5% 86.0% 86.5% 89.1% 90.7% 89.2% Qtr 1 16/17 26 24 22 18 4 6 17 7 3 21 13 11 19 1 10 20 23 16 25 12 2 15 14 9 5 8 Breast Cancer Referrals Seen <2 weeks 93% 96.2% 93.8% 96.6% 97.8% 96.6% 69.4% 88.0% N/A 96.2% 97.1% 98.2% 95.4% N/A 91.0% N/A 85.1% 94.4% N/A 82.6% 92.6% 44.6% 94.3% 95.5% 93.5% 97.4% 90.9% 95.5% 97.3% Qtr 1 16/17 8 15 6 2 6 23 20 9 5 1 12 18 21 13 22 17 24 14 11 16 3 19 10 4 Cancer Patients receiving subsequent surgery <31 days 94% 97.9% 100.0% 90.0% 94.9% 100.0% 97.6% 93.2% N/A 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% N/A 100.0% 95.7% N/A 95.7% 100.0% 96.6% 100.0% 100.0% 100.0% 100.0% 98.8% 100.0% 100.0% Qtr 1 16/17 18 1 25 23 1 19 24 1 1 1 1 1 1 1 21 21 1 20 1 1 1 1 17 1 1 Cancer Patients receiving subsequent Chemo/Drug <31 days 98% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% N/A 100.0% 100.0% 100.0% 99.2% 100.0% 100.0% N/A 100.0% 100.0% N/A 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Qtr 1 16/17 1 1 1 1 1 1 1 1 1 1 25 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Cancer Patients treated after screening referral <62 days 90% 84.1% 21 100.0% 1 100.0% 1 94.7% 15 89.4% 19 100.0% 1 73.2% 25 N/A 90.0% 17 94.7% 15 98.1% 8 77.8% 23 83.3% 22 94.9% 14 N/A 100.0% 1 95.0% 13 N/A 97.9% 9 96.2% 11 89.5% 18 100.0% 1 100.0% 1 95.3% 12 88.2% 20 96.3% 10 75.0% 24 100.0% 1 Qtr 1 16/17

Key: Better than National Target = Green R1F ISLE OF WIGHT NHS TRUST RC3 EALING HOSPITAL NHS TRUST RFW WEST MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST RLT GEORGE ELIOT HOSPITAL NHS TRUST Worse than National Target = Red RA3 WESTON AREA HEALTH NHS TRUST RCD HARROGATE AND DISTRICT NHS FOUNDATION TRUST RGR WEST SUFFOLK NHS FOUNDATION TRUST RMP TAMESIDE HOSPITAL NHS FOUNDATION TRUST Target Not Applicable for Trust = N/A RA4 YEOVIL DISTRICT HOSPITAL NHS FOUNDATION TRUST RCF AIREDALE NHS FOUNDATION TRUST RJC SOUTH WARWICKSHIRE GENERAL HOSPITALS NHS TRUST RN7 DARTFORD AND GRAVESHAM NHS TRUST RBD DORSET COUNTY HOSPITAL NHS FOUNDATION TRUST RCX THE QUEEN ELIZABETH HOSPITAL KING'S LYNN NHS TRUSTRJD MID STAFFORDSHIRE NHS FOUNDATION TRUST RNQ KETTERING GENERAL HOSPITAL NHS FOUNDATION TRUST RBT MID CHESHIRE HOSPITALS NHS FOUNDATION TRUST RD8 MILTON KEYNES HOSPITAL NHS FOUNDATION TRUST RJF BURTON HOSPITALS NHS FOUNDATION TRUST RNZ SALISBURY NHS FOUNDATION TRUST Note the large font figure represents the Trusts performance and the small font figure represents the Trust Ranking RBZ NORTHERN DEVON HEALTHCARE NHS TRUST RE9 SOUTH TYNESIDE NHS FOUNDATION TRUST RJN EAST CHESHIRE NHS TRUST RQQ HINCHINGBROOKE HEALTH CARE NHS TRUST out of the 28 other small acute trusts RC1 BEDFORD HOSPITAL NHS TRUST RFF BARNSLEY HOSPITAL NHS FOUNDATION TRUST RLQ WYE VALLEY NHS TRUST RQX HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST

Page 21 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Benchmarking of Key National Performance Indicators: IW Performance Compared To Other Trusts in the 'Wessex Area'

National IW R1C RBD RD3 RDY RDZ RHM RHU RN5 RW1 Data Period Target

Emergency Care 4 hour Standards 95% 87.6% 7 N/A 91.8% 4 90.4% 6 100.0% 1 94.1% 3 91.6% 5 79.5% 9 80.7% 8 99.0% 2 Qtr 1 16/17 RTT % of incomplete pathways within 18 weeks 92% 88.2% 98.7% 86.3% 92.4% 98.8% 91.2% 92.0% 88.9% 92.8% 93.3% Sep-16 9 2 10 5 1 7 6 8 4 3 %. Patients waiting > 6 weeks for diagnostic 1% 0.5% 0.0% 8.2% 0.2% 2.8% 0.0% 0.4% 1.0% 0.3% 0.0% Sep-16 7 1 10 4 9 3 6 8 5 1 Cancer patients seen <14 days after urgent GP referral* 93% 95.5% N/A 95.7% 99.0% N/A 91.6% 93.0% 95.3% 94.9% N/A Qtr 1 16/17 3 2 1 7 6 4 5 Cancer diagnosis to treatment <31 days* 96% 100.0% N/A 98.2% 98.7% 100.0% 97.6% 98.0% 98.2% 98.8% N/A Qtr 1 16/17 1 6 4 2 8 7 5 3 Cancer urgent referral to treatment <62 days* 85% 77.9% N/A 85.0% 86.5% 0.0% 86.4% 88.0% 77.0% 89.3% N/A Qtr 1 16/17 6 5 3 8 4 2 7 1 Breast Cancer Referrals Seen <2 weeks* 93% 96.2% N/A 97.8% 97.7% N/A 100.0% 85.3% 91.6% 95.2% N/A Qtr 1 16/17 4 2 3 1 7 6 5 Cancer Patients receiving subsequent surgery <31 days* 94% 97.9% N/A 94.9% 100.0% 0.0% 97.1% 96.2% 91.7% 100.0% N/A Qtr 1 16/17 3 6 1 8 4 5 7 1 Cancer Patients receiving subsequent Chemo/Drug <31 days* 98% 100.0% N/A 100.0% 100.0% N/A 100.0% 100.0% 100.0% 100.0% N/A Qtr 1 16/17 1 1 1 1 1 1 1 Cancer Patients treated after screening referral <62 days* 90% 84.1% N/A 94.7% 95.3% N/A 100.0% 94.0% 90.0% 100.0% N/A Qtr 1 16/17 7 4 3 1 5 6 1

Key: Better than National Target = Green R1F Isle Of Wight NHS Trust Worse than National Target = Red R1C Solent NHS Trust RBD Dorset County Hospital NHS Foundation Trust Note the large font figure represents the Trusts performance and the small font figure represents the Trust Ranking RD3 Poole Hospital NHS Foundation Trust out of the 10 other trusts in the Wessex area RDY Dorset Healthcare University NHS Foundation Trust RDZ The Royal Bournemouth And Christchurch Hospitals NHS Foundation Trust RHM University Hospital Southampton NHS Foundation Trust RHU Portsmouth Hospitals NHS Trust RN5 Hampshire Hospitals NHS Foundation Trust RW1 Southern Health NHS Foundation Trust

Page 22 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Benchmarking of Key National Performance Indicators: Ambulance Performance

National IW RX9 RYC RRU RX6 RX7 RYE RYD RYF RYA RX8 Data Period Target Performance

Ambulance Category A Calls % < 8 minutes - Red 1 75% 71.1% 70.3% 70.3% 70.1% 63.3% 69.5% 69.8% 62.6% - - - Sep-16 1 2 3 4 7 6 5 8 10 9 11 Ambulance Category A Calls % < 8 minutes - Red 2 75% 72.7% 57.3% 63.6% 63.3% 65.8% 61.8% 73.4% 52.8% - - - Sep-16 2 7 4 5 3 6 1 8 10 9 11 Ambulance Category A Calls % < 8 minutes - Red 1 & Red 2 75% 72.6% 57.9% 63.9% 63.5% 65.7% 62.2% 73.2% 53.3% 0.0% 0.0% 0.0% Sep-16 2 7 4 5 3 6 1 8 9 9 9 Ambulance Category A Calls % < 19 minutes 95% 93.0% 84.9% 92.0% 92.9% 91.3% 89.0% 94.5% 90.0% - - - Sep-16 2 8 4 3 5 7 1 6 10 9 11

Key: Better than National Target = Green Worse than National Target = Red RX9 East Midlands Ambulance Service NHS Trust RYC East of England Ambulance Service NHS Trust R1F Isle of Wight NHS Trust RRU London Ambulance Service NHS Trust RX6 North East Ambulance Service NHS Foundation Trust RX7 North West Ambulance Service NHS Trust RYE South Central Ambulance Service NHS Foundation Trust RYD South East Coast Ambulance Service NHS Foundation Trust RYF South Western Ambulance Service NHS Foundation Trust RYA West Midlands Ambulance Service NHS Foundation Trust RX8 Yorkshire Ambulance Service NHS Trust

Page 23 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Data Quality

Commentary: Analysis:

The information centre carry out an analysis of the quality of provider data submitted to Secondary Uses Service (SUS). They review 3 main data sets - Admitted Patient Care (APC), Outpatients (OP) and Accident & Emergency (A&E). The latest information is for April 2016 to September 2016. Overall we now have 8 red rated indicators down from 9 last month. Four of the red indicators are in the Admitted Patient Care (APC) Dataset, one in the Outpatient Dataset and three in the A&E Dataset.

Admitted Patient Care (APC): Two of the red indicators in the APC dataset are Primary Diagnosis and the HRG4 (Healthcare Resource Grouping). Although these improved from last month they remain red due to the high volume of activity on the coding backlog. We also have high number of invalid or missing patient pathways. Our investigation has shown that the increase relates to Direct Access Endoscopy patients as these are not allocated a pathway at the point of referrral for a diagnostic test in accordance with the national guidance. Prior to recording Endoscopies as daycases these patients would have been recorded in the outpatient CDS. THIS IS NOT A DATA QUALITY ISSUE AND NO FURTHER ACTION IS REQUIRED. The final red indicator in the APC dataset is the NHS number, this relates mostly to prisoners who's NHS number is not always available. The reported figure is in line with previous months. Outpatients Dataset (OP): The red indicator in the OP dataset relates to patient pathways. This was red in 2015/16 and was investigated, it is due to the number of patients that have an open episode but a closed RTT pathway, it is not considered a data quality issue. A&E Dataset: There are now three red indicators in the A&E dataset from 4 last month. The remianing red indicators are the Commissioner Code, the Departure Time, and the HRG4 code. Proportionally the Commissioner Code and the Departure time have not significantly changed from last year however the HRG4 have dipped in the last 3 months. We have looked into these anomolies and they are mostly on Symphony (i.e. A&E patients) as opposed to Beacon patients. A meeting has been set up with the department to share findings and seek a resolution to this issue.

Action Plan: Person Responsible: Date: Status:

Investigate the high proportion of invalid or missing patient pathways in the APC Dataset and Deputy Director of Information Sept 2016 Complete develop appropriate action plan to address any issues found. Investigate the Red RAG rated indicators in the A&E Dataset and develop appropriate action Deputy Director of Information Oct 2016 Complete plan to address any issues found.

Meet with the A&E department lead to share findings of investigation and seek an appropriate Deputy Director of Information Nov 2016 Ongoing resolution.

Page 24 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 HR Performance Report

Summary What will the report tell you?

This new format report is provided to give assurance for the Headlines from this report are: following areas: • Across the Trust sickness continues to be higher than the targets that have been set. There has been much work in month, and further work will • Trust Sickness continue to have a positive impact. • Recruitment • There are a number of initiatives outlined in the report that will show how • Recruitment Strategy pro-active recruitment is working to source candidates for employment in • Nursing and Allied Health Professions – Agency Usage the Trust • Agency Usage – analysis of funded / unfunded costs • Agency use is now only against vacancies. • Overpayments • The majority of overpayments are being caused by managers not completing • e-Rostering Approval information Change or Termination Forms. A plan is in place to highlight these managers • e-Rostering Finalising / Lockdown information to senior managers for performance management as required. • Appraisal information (Trust level) • The Trust is not adhering to the roster approval timetable. The roster team will work to drive for compliance • The Trust appraisal position has increased to 76.34%. Information is being provided to identify those outstanding so that this position can be improved

HR Performance Report 25

Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Sickness

Top 3 Departments with Highest Sickness - Acute : Sickness LTS/STS FTE Days FTE Days split Organisation Available Lost Sickness % Headcount Sickness KPI Sicknes 470 4Paediatric 1 LTS / 1 FTE Days FTE Days Sickness Sickness s Oct 16 Variance Diabetic Nurse J61373 49.60 32.40 65.32% 2 STS Organisation Available Lost Target % Sep 16 % % in month Headcount 470 4Governance & Assurance J61685 288.51 73.16 25.36% 10 2 LTS Acute 67524.59 2811.09 3.50% 3.85% 4.16% 0.31% 2581 470 4Postgraduate 1 LTS / 1 Ambulance 5136.91 391.84 5.50% 7.36% 7.63% 0.27% 182 Medical Centre J61700 134.76 32.00 23.75% 5 STS MHLD 11102.43 567.98 4.50% 4.97% 5.12% 0.15% 394 Top 3 Departments with Highest Sickness - Ambulance:

Sickness LTS/STS FTE Days FTE Days split Organisation Available Lost Sickness % Headcount What the data shows 470 4Transport 1 LTS/

J61170 195.51 32.00 16.37% 7 1STS Summary Data: 470 4Patient 1 LTS Transport Services /1 STS Sickness absence has increased in October 16 within Acute, Ambulance and J61173 352.16 38.56 10.95% 15 MHLD. All three areas are above their KPI sickness targets in October 16. 470 4Ambulance Emergency Services 3 LTS/ From the 12 long term sickness cases within the top 3 departments 10 cases J61172 2307.44 231.68 10.04% 78 25 STS are known to HR and or Occupational Health. Top 3 Departments with Highest Sickness - MHLD: FTE Days Sickness FTE LTS/ST Short term sickness absence is managed in accordance with Attendance Organisation Available Days Lost Sickness % Headcount S split Management/ Capability policy. A HR Officer is assigned when an issue progresses to the formal stages. 470 4Reablement Team J61914 124.00 23.00 18.55% 4 2 STS 470 4MHLD 1 LTS Management Team /3 See next slide for further detail J61842 355.47 48.00 13.50% 13 STS 2 LTS 470 4CMHS WS / 6 J61933 700.60 78.27 11.17% 26 STS

HR Performance Report 26 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Sickness Information

How we have impacted change Further work Ambulance: Patient Transport / Transport - All LTS cases being managed in line with Acute: policy. Post Grad Medical Centre – HR to contact manager to seek assurance Ambulance Emergency Services - All LTS cases being managed in line with regarding management of LTS and STS case. policy. New manager in post - aware of high short term frequent sickness absence has undertaken sickness absence audit and has implemented the MHLD: following: CMHS – HR to contact line manager within CMHS and Reablement team to 1) Developing attendance culture within the team. seek assurance regarding LTS /STS absence management. 2) All employees that has met the triggers outlined in the attendance management policy has been sent a letter outlining expectations. AMBULANCE: 3) Attendance meetings and case conference meetings have been set up MSK issue identified as a trend in Ambulance. Further investigation found with employees. that MAST training/classroom based practical learning required. Health & Safety have worked with Ambulance to create a plan to deliver this. This Acute: will be an on going programme. Governance – All LTS cases being managed in line with policy. Paediatric Diabetic – LTS case being managed and STS managed informally in line with policy.

MHLD: Management team: LTS case referred to occupational health - HR Officer to be assigned. HR Officer to be assigned to support manager with STS case.

Key: LTS – Long Term Sickness STS – Short Term Sickness

HR Performance Report 27 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Sickness Information

Sum of FTE Days Lost Top 5 Absence Reasons Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Variance S10 Anxiety/stress/depression/other psychiatric illnesses 804.98 776.32 739.15 904.95 1044.93 1096.77 1192.21 8.00% S11 Back Problems 187.53 208.52 181.89 324.01 364.08 353.32 349.16 -1.19% S12 Other musculoskeletal problems 539.47 592.41 607.99 566.41 505.27 357.55 344.25 -3.86% S13 Cold, Cough, Flu - Influenza 430.33 333.13 278.91 222.47 106.92 256.98 526.17 51.16% S25 Gastrointestinal problems 476.21 414.93 361.85 344.77 367.86 364.59 423.94 14.00%

What the data shows Further work • Trust wide highest reason for sickness absence remains Anxiety, Stress, • Free Chamber Health checks for staff will be available every Tuesday Depression showing a slight increase in month by 8%. Cold Cough Flu from 06 December 2016. showed the largest increase in month of 51% this is likely to be attributed • Free Smoking Cessation drop in sessions will be available every Tuesday to seasonal trends. from 06 December 2016. • Training is being developed for managers which will focus on How we have impacted change recognising mental health and supporting health and wellbeing of staff. • Occupational Health now offer private physiotherapy for musculoskeletal • Continuous trend analysis is undertaken by Health and Safety to design (MSK) health for staff. training to support shortfalls with MSK and Stress. • Free flu jab campaign is in place for staff (current performance ahead of • An increase in MSK related absence is seen within Ambulance – specific trajectory) training has been implemented to support this by the Back Care team. • Employee Assistance Programme launched. • Implementation of the NHS Employers Sickness Absence Toolkit for • Reminder to all staff via e-bulletin on the wide range of services the managers Employee Assistance Programme (EAP) can provide to employees. • Free bike safety check sessions offered to employees on 6th October 2016. • Supporting Staff HWB - OCTOBER is National Cholesterol Month information was shared on e-bulletin. • Making a Life While Making a Living: a free Work-life Balance Webinar was offered to staff to take part on Tuesday 18 October 2016. • New Stress Management Training is in place – two training sessions have taken place.

HR Performance Report 28

Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Recruitment Information

A B C D E F G H Anticipated Phased Start Dates Staff Group Budget In Post FTE Vacancy (In Total FTE Total FTE Total FTE Total Gap not being Establishment FTE October 16 Post - Recruitment Recruitment Active actively recruited to Oct 16 (Source: (Source: ESR) Budget) FTE activity prior activity recruitment - Excluding CIP Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 Finance) to awaiting (Vacancy - Active appointment clearances Recruitment)

Add Prof Scientific and Technic 81.11 124.84 -43.73 4.00 6.00 10.00 -53.73 7.00 0.00 3.00 0.00 0.00 0.00 Additional Clinical Services 617.67 507.27 110.40 23.21 17.71 40.92 69.48 11.42 5.87 12.03 10.06 1.54 0.00 Administrative and Clerical 607.06 575.42 31.64 28.79 8.65 37.44 -5.80 4.10 10.12 10.57 11.65 1.00 0.00 Allied Health Professionals 212.61 219.29 -6.68 15.16 4.50 19.66 -26.34 7.00 2.00 3.66 4.00 3.00 0.00 Estates and Ancillary 224.47 216.21 8.26 0.80 0.00 0.80 7.46 0.00 0.56 0.80 0.00 0.00 0.00 Healthcare Scientists 68.85 54.13 14.72 2.00 0.00 2.00 12.72 0.00 0.00 1.00 1.00 0.00 0.00 Medical and Dental 248.68 214.04 34.64 24.00 13.00 37.00 -2.36 1.00 8.00 1.00 7.00 3.00 9.00 Nursing and Midwifery Registered 947.73 790.86 156.87 65.45 69.77 135.22 21.65 88.03 14.10 13.10 19.19 0.80 0.00 CIP Delivery Target -170.58 Total 2837.6 2702.06 135.54 163.41 119.63 283.04 23.08 118.55 40.65 45.16 52.90 9.34 9.00

What the data shows How we have impacted change • The table above shows the Budget Establishment by staff group, current • The overseas recruitment of 40 FTE nurses is still ongoing. In January we in-post FTE and active recruitment activity within those staff groups. should see the first cohort of a maximum of 13 nurses commencing • The proposed CIP workforce value of 170.58 FTE is recorded at cost work with IOW NHS Trust. The intention is that the remainder of the centre level as an overall FTE value. The CIP value is not recorded by nurses will be in post by mid 2017. professional group so cannot be reconciled in the table above. For these reasons the CIP FTE has been provided on a separate line to provide an accurate total budgeted establishment of 2837.6 FTE. Further work • The source of the live vacancy data is extracted from the Vacancy Data • Please see next slide Tracking Master spreadsheet maintained by the Resourcing Team.

HR Performance Report 30 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Recruitment Strategy Update

Budget In Post FTE Vacancy (In Post Total FTE Establishment - Budget) FTE Active FTE recruitment Total 2837.6 2702.06 135.54 283.04

What have we done and how we have Further work • Deployment of first cohort of overseas nurses (12) from most impacted change recent campaign (June 2016) During October the Resourcing Team has led or supported the following • Attendance at Bournemouth University Careers Fair (February initiatives; 2017) • Employability Week Presentation – Southampton University • ‘Cookies and Careers’ – working with Training and Development to • Direct Recruitment for Occupational Therapy via agency interview and appoint year 3 student nurses • Launch new ‘Check and Challenge’ process to include electronic • Workforce Challenge Attract and Recruit Proposal to be present to vacancy approval and robust bank/agency request process TLC for approval • Attendance at Southampton University Careers Fair • HR Acute Alliance (IOW/PHT/UHS) network to continue to explore • Converted agency workers to substantive posts joint opportunities for attendance at careers events. • ‘Workforce Challenge Attract and Recruit’ - Drafted a proposal for • HR Acute Alliance (IOW/PHT/UHS) network exploring other further incentives to take up a post on the Isle of Wight including professional groups available overseas. subsidised or free accommodation, reimbursement of ferry passenger fares, reimbursement of hospital parking fees, the Isle of Wight Building Opportunities through outstanding Scholarship Training (BOOST), Explore opportunities to engage with final year medical students – hosted visits to the island, medical outreach days, use of student BMJ for advertising Note: The number of active recruitment • HR Acute Alliance Meeting – exploring opportunities to partner with is higher than vacancy owing to pro-active Portsmouth/Southampton Hospitals. Resourcing sub group to be set activity ahead of current post holders up. Initiatives to be scoped include; OSCE boot camp for overseas leaving their post. recruitment being scoped, co-ordinated attendance at Recruitment Fairs, Retention Hotline, Clinical fellowship programmes. HR Performance Report 31 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Nursing and AHP Agency Usage Information

ITU A&E OT SLT CMHS Stroke MAAU Colwell Appley GeneralTheatre Seagrove Gen Rehab Pharmacy Whippingham Bio-chemistry Hours 606 157.5 175.75 22.5 731.75 13.5 203 32.5 20 5.5 561 764 255 90 148 FTE 4.04 1.05 1.17 0.15 4.88 0.09 1.35 0.22 0.13 0.04 3.74 5.09 1.7 0.6 0.99 Vacancy Vacancy Vacancy Vacancy Vacancy Vacancy Vacancy Vacancy Vacancy Vacancy Vacancy gap Out to advert Appointed to Out to advert Interview s gap 4.88 FTE gap 1.0 FTE gap 2.14 FTE gap = 1.41 gap 10.03 gap 0.52 FTE gap 2.45 FTE gap 5.67 FTE gap 2.31 FTE gap 5.64 FTE 1.0FTE band for 2 FTE Band 6 for Band 6 8/11 Comments Band 5 and 6 Band 6 Band 5 FTE Band 6 FTE Band 5 and Band 5 Band 5 Band 5 Band 5 7, 1.6 band 6 band 7 and 4 15/11. Band 1.0 FTE aw aiting and 1.65 FTE 1.53 FTE and 1.0 FTE FTE band 6 8 & 7 out to outcome band 5 Band 6 band 5 advert

What the data shows How we have impacted change • Agency hours used in October by department and FTE equivalent • Worked with CBU’s to ensure that agency use is in line with vacancy • Vacancy gaps by department – all agency use is within vacancy gap gap • Any variance between Agency usage and Vacancy gap would be a • Robust agency request process, ensuring that only framework result of heads of service using their professional judgement. Could agencies are used and where possible achieving cap rates also mean that bank staff are also being used to bridge the gap. • Converting agency workers to bank workers • Converted agency OT to permanent

Further work • Currently working with SOEP to secure Master Vendor agreements with agencies for Nursing and AHPs (anticipated go- live January 2017). • Targeted recruitment campaigns to reduce vacancy gaps • Deployment of 40 overseas nurses – starting early 2017

HR Performance Report 32 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Medic Agency Usage

Acute Medicine Anaesthetics - General General Haematology - Ophthalmology Orthopaedic & Psychiatry - MH Respiratory Urology - - Medicine CSCD Medicine Surgery CSCD - SWCH Trauma & LD Medicine - SWCH Surgery - Medicine SWCH

Hours 472.5 68.5 1267.5 24 1001 165 46 202.5 157.5 722 FTE/£ 2.95 FTE / 0.43 FTE / 7.9 FTE / £87.7k 0.15 FTE / *6..3 FTE / 1.03 FTE / £24k 0.29 FTE / 1.27 FTE / 0.98 FTE / *4.5 FTE / £53.9k £6.3k £1.7k £76.6k £3.1k £15.7k £25.7k £61.1k Comments 2 Cons 2 SD 1 Consultant 1 vacant O&G 2 Cons 1 Cons vacancy No vacancies – 2 x Cons 1 Consultant 1 Cons vacancy vacancies: vacancies, out vacancy (out to GPST post - vacancies: & 1 SD vacancy agency to vacancies, both vacancy, out (Dr to start 1 appointed to advert advert) & 3 x locum used to 1 started both out to cover sickness out to advert. 1 to advert Dec 16) and 1 15.11.16, (start ST3+ vacancies (2 cover 31/10/16 and 1 advert junior doctor SD vacancy (Dr date tbc) & 1 appointed to weekend on starting not working on to start out to advert. start Jan & Mar call on SOG 01/04/17 call as soon to 28/11/16) 1 ST3+ vacancy 17) & 1 out to rota * Includes go on mat *includes on advert constant on call leave call hours What the data shows Further work • Agency doctors are being used to fill vacancies as well as helping • Attendance at Acute and General Medicine Conference in the organisation to respond to increasing demand to maintain November with the aim to attract applicants to the Medicine patient safety. vacancies • Areas above show Medical Agency usage by hours, conversion to • 6 doctors are waiting pre-employment clearances, start dates will FTE with spend (inclusive of on call hours) and current recruitment vary by individual. activity to reduce this • Presentation to the Board in December to seek approval to extend • FTE Agency used in some specialities is higher than current the range of recruitment incentives vacancies, this is as a result of the on-call shifts being fulfilled by an • Agency booking request narrative can be provided if required agency doctor • Investigation into Orthopaedic and Surgery usage – possible incorrect recording of requests • Reporting to include Bank use by substantive Medics that are How we have impacted change covering posts, preventing Agency use but still incurring high cost • Supported clinical managers to fill vacancies to Trust • Continue to develop data recording to support triangulation between medical resourcing and temporary staffing teams to HR Performance Report improve monthly reporting 33

Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Medic Agency Usage

What the data shows • The graph to the right shows Total Agency spend for 16/17, with forecasts to the end of the year with proposed reductions • We have included the impact of recruiting substantive medics in the ‘Forecast with Recruitment of Posts’ line that will reduce agency spend by approximately £620k • This reduction is based on current agency cost and usage for October and with the assumption that cost will be avoided going forwards when the substantive posts are recruited to and staff in post. • The assumptions made in relation to the achievement of recruitment is forecasting a reduction in agency spend of just under the 25% threshold. The achievement of this reduction is dependent on our ability to successfully How we have impacted Further work attract candidates. • Reporting to include Bank use by substantive Medics • To achieve the nationally set ceiling change that are covering posts, preventing Agency use but still figure of £4,990, Agency use would • Supporting clinical managers to fill vacancies incurring high cost to Trust th have to almost completely stop, a 90% • Direct engagement has gone live (10 October • Senior HR Managers to meet Business Units to plan reduction. 2016), and so far VAT savings are £11,729 (as at reduction of Agency spend below nationally set ceiling 16th October 2016). of £4,990k • In February 2017 we will provide the first quarter reporting from Direct Engagement • Further reporting of funded/unfunded agency levels HR Performance Report grouped by Medics/Nursing/Other 34

Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Overpayments Information

Total New Overpayments 1st April 2016 - October 2016 Sum of Sum of New Reason Occurrences Overpayment £ Incorrect information on form 5 14101 Input error 4 3156 Late change form 25 22615 Late e-termination 17 27641 Roster error 2 909 SBS 15 20445 Sickness recording 5 4963 Grand Total 73 93830

What the data shows How we have impacted change • Total Trust Overpayments outstanding have increased from £89,000 in • Introduced e-termination form to improve timeliness of notification of April to £130,000 in October. leaver. • New overpayments totalled £93,830 this financial year. While current • Reminders via Trust Communications regarding timely submission of employees are making repayments, keeping the balance outstanding to forms. around £45,000, the balance outstanding to leavers is increasing as very • Overpayment Summary Reporting to Business Units on a monthly little is being repaid. basis • The majority of new overpayments are caused by late Change or Termination forms, totalling £50,000 in this period. Further work • Overpayments deep dive scheduled for January 2017 • Overpayments impact highlighted in High Performance Leaders and Managers Programme • Focus on Leavers overpayment recovery • Implement audit recommendation to inform senior managers where line managers have caused overpayments.

HR Performance Report 35 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 e-Rostering Approval Information

4 week roster approval % 2016 by Business Unit 8 weeks roster approval for roster commencing week 13th 100.00% November 2016 Ambulance, Urgent Care & Community Services Cost 80.00% Cost Centres % of CBU Chief Operating Officer Business Unit Centres to Approved Approved approve 60.00% Clinical Support, Cancer & Diagnostic Services Ambulance, Urgent Care & Community Services 5 2 40.00% 40.00% General Medicines Clinical Support, Cancer & Diagnostic Services 4 0 0.00% % Approved General Medicines 4 0 0.00% Mental Health & Learning 20.00% Mental Health & Learning Disability 5 0 0.00% Disability Surgical & Women & Child Health Services 8 2 25.00% Surgical & Women & Child 0.00% Health Services Total 26 4 15.38% 21-Aug 18-Sep 16-Oct 13-Nov What the data shows How we have impacted change • The Trust is not adhering to the roster approval timetable. • Rosters are now being approved, albeit not aligned to the approval • For each date given, the next four week roster should be fully timetable produced. approved. This is not occurring, thereby delaying scrutiny, • Weekly figures reported to DNT – evidence (as above) suggests this restricting ability to improve rosters, and staff receiving less notice is not sufficiently supporting increased approval rates. when they are due on shift to make arrangements impacting on work/life balance and childcare. • COO included Mottistone Suite, which has now moved into SWCH Further work BU and thus will be removed from forthcoming reports. • Continue submitting weekly approval rates. • Best performing CBU’s are SWCH and AUCC, although 40% is not • HROD to drive compliance with meeting this Trust requirement. sufficient. • Ward managers will be involved directly with the rostering team over coming months to begin building Auto Roster. Importance of Why this is important approving will be highlighted. • 2 templates are still to be submitted from the Nursing body for Lord Carter’s Review highlighted improved rostering of all clinical • the above (A&E/MAAU) staff has the potential to make significant savings. • Approving rosters is a governance process that ensures the rosterHR Performance Report 36 created is of high standard meeting key metrics of efficiency.

Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 E-Rostering Finalising/Lockdown Information

No. missed Cost Centres not finalised in time by Business Unit Business Unit deadline 30 Ambulance, Urgent Ambulance, Urgent Care & Community Services Care & Community Business Unit 11 25 Services Chief Operating Officer 1 Chief Operating Clinical Support, Cancer & Diagnostic Services Business

20 Officer Unit 6 Finance & Performance Mgt 7 Clinical Support, 15 Cancer & Diagnostic General Medicines Business Unit 3 Services Mental Health & Learning Disability Business Unit 4 Cost Centres 10 Finance & Nursing Directorate 6 Performance Mgt Strategic & Commercial Directorate 8 5 General Medicines Surgical & Women & Child Health Services Business Unit 8 0 Trust Administration 6 Jul-16 Aug-16 Sep-16 Oct-16 Total 60

What the data shows How we have impacted change • Every month cost centres are not finalised or locked down by the • Communication is sent out within two hours of the deadline to HOO’s, deadline as laid out in the rostering timetable. HONQ’s and Operation Managers to be cascaded and acted upon. • Where some improvements are made in the BU’s other areas lapse. • Last month reminder notification (email) sent to named first approvers • Time and effort is invested to ensure units are locked so complete to build awareness and move to a proactive situation rather than data sets can be sent for processing. Each unit not finalised by a reactive. new date are excluded, therefore deteriorating data quality sent to SBS and reported on i.e. incomplete sickness reporting and unpaid (enhancements and overtime) staff. Further work • Locking down October, 60 units missed the deadline, broken down • More targeted communication to be sent including reminder to CBU level in table top right. emails sent prior to deadline. This needs improving and a list of roster approvers is in process of collation.

HR Performance Report 37 Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Appraisal Information

What the data shows How we have impacted change • Trust Appraisals % reported have increased from 1.42% to 76.34% • There was a drive to have all appraisals completed by June 2016. This • All business Units had achieved less than 10% in April 2016 was not achieved and weekly reporting commenced in August, when • All Business Units have achieved more than 60% appraisals by we improved our reporting process by using ESR BI. November 2016 • The report excludes Medics, External secondments, Maternity leave, • General Medicines BU has the lowest % achieved, at 61.9% long term sickness (28 days +), career breaks, suspensions, Bank, and • Allergy were included in Surgical BU % prior to October when they new starters (who have been in post less than 3 months – after 3 became a separate BU. months they are included), and includes appraisals from the 1st April 2016 onwards. • We are able to advise areas which employees have not had an appraisal yet and explain the impact on the criteria of the report. Further work

• Continue with weekly reporting to highlight where improvements are required. • Include names of outstanding appraisals within report to assist Business Units increase appraisal compliance HR Performance Report 38 The following areas will feature in future reports:

• Volunteers • Future Careers • Medical Workforce • Junior Doctor contract implementation • Job Planning • Apprenticeships • Mandatory training • Occupational Health • Supporting staff through the STP process

HR Performance Report 39

Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Executive Summary & Key Financial Risks

Executive Summary Key Financial Risks

The Trust has delivered a cumulative deficit of £4.102m as at 31 October. Key risks can be summarised as follows: This is £2k better than plan meaning that the Trust has achieved its year to date financial control total thereby securing access to the Sustainability and 1. Achievement of £4.630m deficit plan

Transformation Fund each month to date. Forecast outturn from the Business Units indicates a deficit position of £8.593m. The main pressure continues to be the underperformance on the main CCG With other risks, opportunities and mitigating actions the likely scenarios PbR contract, at £1.334m behind plan. are This is being offset in expenditure by non-recurrent benefits and non- Best case £4.630m investment from reserves for which funding had been allocated. Possible case £7.368m Worst case £9.736m However, there remains considerable risk within the Trusts financial position, and action is required to mitigate these risks to ensure the Trust continues to 2. Recurrent Cost Improvement Programme achieve against plan in the remaining months of the year. Although the CIP programme remains on plan, over 70% is non recurrent. This will have a negative impact on the starting position for Within this position, savings of £4.523m have been achieved, which is on 2017/18. Non recurrent balance sheet benefits as CIP also pose a plan. The full year savings forecast remains at £10.217m, although £7.3m of significant risk to the Trusts 2016/17 cash forecast. this is expected to be non-recurrent.

As at 31 October £0.4m of capital allocation has been committed, which is 3. CCG PbR Contract under performance £0.2m less than planned at this point in the year. The CCG contract continues to underperform against plan and has risen to £1.334m behind plan. Current financial forecasts assume that this will The cash position for the Trust remains a key risk. be £1.423m at year end. Operational pressures put this forecast at risk.

The Trust’s Use of Resources Rating is a score of 3 (1 being best and 4 4. Cash being worst). A deficit position in excess of the planned £4.630m would result in a significant impact on the cash forecast position for the Trust. Other risk factors affecting the cash forecast are:  Non cash benefits to achieving plan eg balance sheet reviews  Cash repayment requested by CCG for under performance  Non achievement of STF funding  Accelerated spend in capital programme

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Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Income & Expenditure

Income and expenditure Income

To date the Trust is reporting a deficit of £4.102m against a deficit plan to Under performance on the main CCG PbR contract has increased by a further date of £4.103m, a favourable variance of £0.002m. £0.315m in month, to a cumulative £1.334m behind plan. A summary of the income and expenditure position to date is set out in the table below. STF funding is behind plan due to non-achievement of the A&E Four-hour Plan Actual Variance wait, and RTT incomplete pathways criteria. This is shown in more detail later £000s £000s £000s in this report.

Income 102,734 101,920 (814) Pay (71,997) (72,126) (129) Overall, income is £0.814m behind plan to date.

Non Pay (29,074) (28,122) 951 EBITDA 1,663 1,671 8 Plan Actual Variance Depreciation & Amortisation (3,750) (3,743) 7 £000's £000's £000's PDC (1,994) (1,994) 0 NHS Isle of Wight CCG Profit/(Loss) on Asset Disposal 0 (2) (2) Service Level Agreements 75,137 74,994 (143) Interest Receivable/(Payable) (74) (87) (13) PbR Contract under performance (1,334) (1,334) Bank Charges (3) (3) (0) Non PbR Drugs 1,284 1,188 (96) RETAINED SURPLUS / (DEFICIT) (4,158) (4,158) (0) Cost per Case contract 1,772 1,734 (38) Depreciation - Donated Assets 55 56 2 Other services & investments 1,286 1,367 81 REVISED RETAINED SURPLUS / (DEFICIT) (4,103) (4,102) 2 NHS England Service Level Agreements 3,441 3,482 41 Non PbR Drugs 1,718 1,846 128 The main pressure continues to be the underperformance on the main CCG Isle of Wight Council 3,086 2,897 (189) PbR contract, at £1.334m behind plan. Commissioning Support Unit 187 190 3 This is being offset in expenditure by non-recurrent benefits and non- investment from reserves for which funding had been allocated. Non Contractual Activity 1,111 1,172 61 Sustainability & Transformation Funding 2,042 1,859 (183) Southampton University Hospitals FT 61 44 (17) SLA INCOME TOTAL 91,126 89,439 (1,687)

Business Units and other income 11,608 12,481 873 TOTAL INCOME 102,734 101,920 (814)

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Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Income, Sustainability and Transformation Fund

Sustainability and Transformation Fund A summary of the income and expenditure position by Business Unit is set out

in the table below. The Trust has achieved the financial control total to date, and has assumed Plan Actual Variance STF funding in full to date for this criteria. SLA INCOME £000's £000's £000's Performance against both the A&E four-hour wait and RTT incomplete NHS Isle of Wight CCG 79,479 77,949 (1,531) pathways criteria has not been met in full, and STF funding of £182k to date NHS England 5,159 5,328 169 has not been assumed for these. Isle of Wight Council 3,086 2,897 (189)

Commissioning Support Unit 187 190 3 Actions – the Trust are pursuing a challenge against the loss of STP funding Non Contractual Activity 1,111 1,172 61 for these criteria in line with the NHS Improvement appeals process. Sustainability & Transformation Funding 2,042 1,859 (183)

Southampton University Hospitals FT 61 44 (17) Current activity performance also puts at risk the Trusts ability to achieve the SLA INCOME TOTAL 91,126 89,439 (1,687) RTT performance trajectory in future months, and thus the achievement of the BUSINESS UNITS & OTHER EXPENDITURE full STF funding. Operational Division Surgery, Women's & Children's Health (12,773) (13,189) (416) The current financial position against the Fund is set out below. Medicine (10,026) (9,986) 40 Clinical Support, Cancer & Diagnostics (22,800) (23,593) (792) Criteria 2016/17 STF AVAILABLE YEAR TO DATE Ambulance, Urgent Care and Community (16,250) (15,984) 266 Mental Health and Learning Disabilities (9,137) (8,844) 293 Weighting Value Budget Actual Variance Chief Operating Officer (1,629) (1,733) (104) % £000s £000s £000s £000s Operational Division (72,614) (73,327) (713) Financial Control Total 70.0 2,450 1,429 1,429 0 RTT Incomplete pathways 12.5 438 255 219 (36) Corporate Division A&E Four-hour wait 12.5 438 255 109 (146) Financial & Human Resources (3,502) (3,342) 160 Cancer 62-day wait 5.0 175 102 102 0 TOTAL 100.0 3,500 2,042 1,859 (182) Nursing (1,539) (1,375) 164 Transformation & Integration (6,551) (6,293) 258 Trust Administration (3,409) (3,411) (2) Criteria Apr May Jun Jul Aug Sep Oct Total YTD Corporate Division (15,001) (14,421) 580 £000s £000s £000s £000s £000s £000s £000s £000s Financial Control Total 204 204 204 204 204 204 204 1,429 RTT Incomplete pathways 36 36 36 36 36 36 0 219 Other A&E Four-hour wait 36 36 36 0 0 0 0 109 Research & Development (0) 0 0 Cancer 62-day wait 15 15 15 15 15 15 15 102 TOTAL 292 292 292 255 255 255 219 1,859 Capital Charges (5,744) (5,739) 5 Finance Costs (77) (91) (14) Reserves (1,848) (20) 1,828 Criteria met and STF received Criteria being met and income accrued assuming criteria will be met for quarter BUSINESS UNITS & OTHER TOTAL (95,284) (93,597) 1,687 Criteria not met RETAINED SURPLUS / (DEFICIT) (4,158) (4,158) (0)

Impairment and donated assets 55 56 2 ADJUSTED RETAINED SURPLUS / (DEFICIT) (4,103) (4,102) 2

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Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Agency

Agency 2016/17 ACTUAL SPEND Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar TOTAL The in month spend on agency staff is £0.487m, cumulatively £4.623m to £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Medical 344 341 383 380 327 357 232 2,365 date. Nursing 303 363 78 354 183 380 169 1,831 Planned spend for the year was £7.289m, with a year to date plan of £4.760m. Clinical 32 115 (39) 20 36 101 69 334 Currently the Trust is £0.137m ahead of its planned trajectory. Administration 3 4 (20) 88 (48) 41 8 76 Other 0 15 (3) (6) 3 8 18 The Trust 'ceiling' spend for the year is £4.990m, with a year to date ceiling of Total spend 682 824 418 839 492 881 487 4,623 £2.922m. Currently the Trust is £1.701m behind the ceiling level. Plan - month 613 610 1,032 705 676 580 544 538 528 504 477 482 Based on current agency expenditure, the year-end forecast would be Plan - cumulative 613 1,223 2,255 2,960 3,636 4,216 4,760 5,298 5,826 6,330 6,807 7,289 £7.325m. A 10% reduction in current expenditure each month would result in Ceiling - month 421 419 417 416 416 417 416 413 413 414 414 414 a year end forecast expenditure of £7.055m. Ceiling - cumulative 421 840 1,257 1,673 2,089 2,506 2,922 3,335 3,748 4,162 4,576 4,990

Actions – HR developing a business case to address the recruitment and retention of a skilled and capable workforce, with a benefit of reducing agency spend. This was reviewed at Turnaround Board on 15 November.

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Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Plan Phasing & Forecast Outturn Plan phasing & forecast outturn

The graph below shows the monthly financial plan for 2016/17. To date the deficit Forecast outturn from the Business Units indicates a deficit position of plan is £4.103m. The plan for the remaining 5 months is £0.527m. This is a major £8.593m. financial challenge for the Trust. Assumptions included are:  CCG contract under performance of £1.423m Monthly deficit plan  400 No further deterioration in STF achievement  CCG funding covers all investment costs incurred to date 200

0 With other risks, opportunities and mitigating actions taken into account, (200) the likely scenarios are (400) Best case £4.630m deficit

£'000 (600) Possible case £7.368m deficit (800) Worst case £9.736m deficit

(1,000)

(1,200) Actions (1,400) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar  Challenge Business Units on forecast outturn at Finance Deep Monthly deficit plan (1,156) (1,022) (305) (462) (440) (402) (317) (285) (66) (159) (233) 217 Dive meetings

 Target business units with spend reduction

 Review balance sheet for opportunities  The improvement in planned deficit represented the planned continuing  Negotiate investment release from CCG for costs being incurred development of CIP throughout the year

 The additional £1.7m CIP, agreed as part of the revised £4.63m deficit

control total, was phased for delivery over the final 4 months of the year

 The planned deficit increase in January and February acknowledged the likely impact of additional pressures over the winter period

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Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 CIP Performance CIP Performance

Cumulatively there is an achievement of £4.523m against a target of £4.523m. Of this, £3.091m has been achieved non recurrently.

The full year forecast is a delivery of £10.214m, although £7.323m of this is predicted to be non-recurrent. The total now includes additional savings of £1.714m required to achieve the new agreed control total deficit of £4.63m.

CIP Target Recurrent Non Recurrent CIP achieved year to date achieved year achieved year year to date Business Unit £'000 to date to date £'000 Medicine 385 (3) 118 114 Surgery, Women's & Children's Health 732 75 394 469 Ambulance, Urgent Care and Community 989 258 838 1,096 Mental Health and Learning Disabilities 549 50 739 789 Clinical Support, Cancer & Diagnostics 1,158 53 416 469 Chief Operating Officer 144 61 1 62 Financial & Human Resources 62 13 87 100 Nursing 93 0 121 121 Transformation & Integration 299 3 381 384 Trust Administration 112 0 79 79 Trust Reserves 0 923 (84) 839 Grand Total 4,523 1,431 3,091 4,523

Recurrent Non Recurrent CIP achieved CIP Target achieved achieved year end 2016/17 forecast year forecast year forecast Business Unit £'000 end end £'000 Medicine 723 11 228 239 Surgery, Women's & Children's Health 1,376 273 522 795 Ambulance, Urgent Care and Community 1,859 377 1,138 1,515 Mental Health and Learning Disabilities 1,032 86 1,039 1,125 Clinical Support, Cancer & Diagnostics 2,177 299 444 744 Chief Operating Officer 271 104 1 105 Financial & Human Resources 116 198 87 286 Nursing 175 0 126 126 Transformation & Integration 562 202 381 583 Trust Administration 210 0 158 158 Trust Reserves 1,714 1,340 261 1,601 To be identified 0 0 2,936 2,936 Grand Total 10,214 2,891 7,323 10,214

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Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Cash Cash

The cash balance of £3,307k held at the end of October was £2,292k more than planned. Receivables decreased by £116k. Payables increased by £451k. During the month no further Revolving Working Capital facility was drawn down which meant that £1.1m less than was planned has been accessed in the first seven months of the year, but this is offset by the receipt of the first quarter's Sustainability and Transformation funding. Payments to suppliers will need to be prioritised during November and early December due to maintaining the minimum £1m cash balance.

Plan Year to date Variance £000s £000s £000s Cash Flows from Operating Activities Operating Surplus/(Deficit) (2,086) (2,073) 13 Depreciation and Amortisation 3,749 3,742 (7) Interest Paid (83) (81) 2 Dividend (Paid)/Refunded (1,613) (1,614) (1) (Increase)/Decrease in Inventories 252 106 (146) (Increase)/Decrease in Trade and Other Receivables (5,187) (4,549) 638 Increase/(Decrease) in Trade and Other Payables (1,208) 1,273 2,481 Provisions Utilised 0 (134) (134) Increase/(Decrease) in Movement in Non Cash Provisions 0 (7) (7) Net Cash Inflow/(Outflow) from Operating Activities (6,176) (3,337) 2,839 Cash Flows from Investing Activities Interest Received 10 11 1 (Payments) for Property, Plant and Equipment (net of movements in capital creditors) (1,692) (998) 694 (Payments) for Intangible Assets (218) (331) (113) Net Cash Inflow/(Outflow) from Investing Activities (1,900) (1,318) 582 NET CASH INFLOW/(OUTFLOW) BEFORE FINANCING (8,076) (4,655) (3,421) Cash Flows from Financing Activities Revolving Working Capital Support Facility Accessed 6,512 5,401 (1,111) Capital element of payments relating to PFI, LIFT Schemes and finance leases (59) (77) (18) Net Cash Inflow/(Outflow) from Financing Activities 6,453 5,324 (1,129) NET INCREASE/(DECREASE) IN CASH AND CASH EQUIVALENTS (1,623) 669 2,292 Cash and Cash Equivalents (and Bank Overdraft) at Beginning of the Period 2,638 2,638 0 Opening Balance Adjustment 0 0 0 Restated Cash and Cash Equivalents (and Bank Overdraft) at Beginning of the Period 2,638 2,638 0 Effect of Exchange Rate Changes in the Balance of Cash Held in Foreign Currencies 0 0 0 Cash and Cash Equivalents (and Bank Overdraft) at YTD 1,015 3,307 2,292

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Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Capital Programme Capital programme Year to Date Full Year The source of funds includes £607k relating to the Capital to Revenue transfer in 2015/16 which is Plan Actual Variance Plan Forecast Variance expected to be repaid as Exceptional PDC in the £k £k £k £k £k £k SOURCE OF FUNDS current year. Initial Capital Resource Limit 668 668 0 6,346 6,346 0 Current Capital Resource Limit 668 668 0 6,346 6,346 0 So as not to show an underspend against budget, for presentational purposes only this is included under a Property Sales 0 0 0 250 0 (250) separate heading within the application of funds. Donated Funds 0 0 0 50 50 0 Exceptional PDC (return of 2015/16 Cap to Rev) 0 0 0 607 607 0 Other 0 0 0 127 139 12 A further £67k was spent in month bringing the year Total Funds Available 2016/17 668 668 0 7,380 7,142 (238) to date spend to £437k against a planned spend of £668k.

APPLICATION OF FUNDS Plan Actual Variance Plan Forecast Variance

£k £k £k £k £k £k Risk Strategic Schemes Ward Reconfiguration Level C 0 0 0 103 0 103 R Carbon Energy Fund 0 0 0 1,213 1,213 0 G 0 0 0 1,316 1,213 103 Operational Schemes Estates Schemes 200 36 164 1,500 820 680 G GS1 0 0 0 1,500 750 750 G IM&T RRP 0 0 0 500 138 362 G IM&T New Schemes 0 59 (59) 0 874 (874) G Equipment RRP 269 112 157 500 1,074 (574) G Estates Staff Capitalisation 72 64 8 180 180 0 G Contingency/Unallocated 0 0 0 516 313 203 G Donated Assets 0 0 0 50 50 0 G PARIS Implementation 127 127 0 0 127 (127) G Veterans Funding Orthotic Equipment 0 12 (12) 0 12 (12) G Other (Non RRP, Equipment) 0 27 (27) 461 984 (523) G Uncommitted Expenditure re Exceptional PDC 0 0 0 607 607 0 668 437 231 5,814 5,929 (115)

Total Expenditure 2016/17 668 437 231 7,130 7,142 (12)

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Isle of Wight NHS Trust Board Performance Report 2016/17 October 16 Use of Resource Rating

Use of Resources Rating

NHS Improvement’s new Single Oversight Framework and Use of Resources Rating was introduced from 1 October 2016, replacing the Financial Risk Rating.

The Trusts Use of Resources Rating as at 31 October 2016 is set out below.

Year To Date Plan Actual Rating Rating Variance Single Oversight Framework - Use of Resources Liquidity Ratio 4 4 0

Capital Servicing Capacity (Times) 4 4 0

I&E Margin Rating 4 4 0

I&E Margin Distance from Plan 1 1 0

Agency Metric 4 4 0

Overall Use of Resources Rating 3.4 3.4 0

The Trust’s Use of Resources Rating is a score of 3 (1 being best and 4 being worst).

47 Isle of Wight NHS Trust Board Performance Report 2016/17 October Governance Risk Rating

GOVERNANCE RISK RATINGS Isle of Wight NHS Trust Insert YES (target met in month), NO (not met in month) or N/A (as appropriate) With effect from the November report, the GRR has been realigned to match the Risk Assessment Framework See separate rule for A&E as required by 'Monitor'.

See 'Notes' for further detail of each of the below indicators Historic Data Current Data Thresh- Weight- Q4 Q1 Q2 Q3 Improvement Ref Indicator Sub Sections Oct Nov Dec Notes old ing 2015/16 2016/17 2016/17 2016/17 Trajectory

1 Maximum time of 18 weeks from point of referral to treatment in aggregate – admitted 90% 1.0 No No No No No

Nov 16 - On 2 Maximum time of 18 weeks from point of referral to treatment in aggregate – non-admitted 95% 1.0 No No No No No trajectory

3 Maximum time of 18 weeks from point of referral to treatment in aggregate – patients on an incomplete pathway 92% 1.0 No No No No No

Local Trajectory 92% by October - 4 A&E: maximum waiting time of four hours from arrival to admission/ transfer/ discharge 95% 1.0 No No No No No Currently behind trajectory

Urgent GP referral for suspected cancer 85% Sep 16 - On 5 All cancers: 62-day wait for first treatment from: 1.0 No No No Yes Yes NHS Cancer Screening Service referral 90% trajectory

surgery 94% 6 All cancers: 31-day wait for second or subsequent treatment, comprising: anti-cancer drug treatments 98% 1.0 No No Yes No No radiotherapy 94%

7 All cancers: 31-day wait from diagnosis to first treatment 96% 1.0 Yes Yes Yes No No

All urgent referrals (cancer suspected) 93% 8 Cancer: two week wait from referral to date first seen, comprising: 1.0 No Yes Yes Yes Yes For symptomatic breast patients (cancer not 93% initially suspected) Access Receiving follow-up contact within seven 95% Sep 16 - On 9 Care Programme Approach (CPA) patients, comprising: days of discharge 1.0 Yes No No Yes Yes trajectory Having formal review within 12 months 95%

10 Admissions to inpatients services had access to Crisis Resolution/Home Treatment teams 95% 1.0 No Yes No No No

Red 1 calls 75% 1.0 No No No No No Sep 16 - On 11 Category A call – emergency response within 8 minutes, comprising: trajectory Red 2 calls 75% 1.0 No No No No No

Sep 16 - Behind 12 Category A call – ambulance vehicle arrives within 19 minutes 95% 1.0 No No No No No trajectory Early intervention in Psychosis (EIP): People experiencing a first episode of 13 psychosis treated with a NICE approved care package within two weeks of 50% 1.0 - - Yes Yes Yes referral

People with common mental health conditions referred to the IAPT programme 75% 1.0 No Yes Yes Yes Yes will be treated within 6 weeks of referral 14 Improving access to psychological therapies (IAPT) People with common mental health conditions referred to the IAPT programme 95% 1.0 Yes Yes Yes Yes Yes will be treated within 18 weeks of referral

Is the Trust below the de minimus 12 No Yes Yes Yes Yes 15 Clostridium difficile – meeting the C. difficile objective 1.0 Is the Trust below the YTD ceiling 4 No Yes Yes Yes Yes

16 Minimising mental health delayed transfers of care ≤7.5% 1.0 No No No No No

17 Mental health data completeness: identifiers 97% 1.0 Yes Yes Yes Yes Yes

18 Mental health data completeness: outcomes for patients on CPA 50% 1.0 Yes Yes Yes Yes Yes Outcomes 19 Certification against compliance with requirements regarding access to health care for people with a learning disability N/A 1.0 Yes Yes Yes Yes Yes

Referral to treatment information 50% 20 Data completeness: community services, comprising: Referral information 50% 1.0 Yes Yes Yes Yes Yes Treatment activity information 50%

TOTAL 12.0 12.0 11.0 11.0 0.0 0.0 11.0 R R R R R R R RAG RATING : GREEN = Score less than 1 AMBER/GREEN = Score greater than or equal to 1, but less than 2 AMBER / RED = Score greater than or equal to 2, but less than 4 RED = Score greater than or equal to 4

Page 48 Isle of Wight NHS Trust Board Performance Report 2015/16 October Glossary of Terms

Terms and abbreviations used in this performance report

Quality & Performance and General terms QCE Quality Clinical Excellence Ambulance category A Immediately life threatening calls requiring ambulance attendance RCA Route Cause Analysis BAF Board Assurance Framework RTT Referral to Treatment Time CAHMS Child & Adolescent Mental Health Services SUS Secondary Uses Service CBU Clinical Business Unit TIA Transient Ischaemic Attack (also known as 'mini-stroke') CDS Commissioning Data Sets TDA Trust Development Authority CDI Clostridium Difficile Infection (Policy - part 13 of Infection Control booklet) VTE Venous Thrombo-Embolism CQC Care Quality Commission YTD Year To Date - the cumulative total for the financial year so far CQUIN Commissioning for Quality & Innovation DNA Did Not Attend DIPC Director of Infection Prevention and Control EMH Earl Mountbatten Hospice Workforce and Finance terms FNOF Fractured Neck of Femur CIP Cost Improvement Programme GI Gastro-Intestinal CoSRR Continuity of Service Risk Rating GOVCOM Governance Compliance CYE Current Year Effect HCAI Health Care Acquired Infection (used with regard to MRSA etc) EBITDA Earnings Before Interest, Taxes, Depreciation, Amortisation HoNOS Health of the Nation Outcome Scales ESR Electronic Staff Roster HRG4 Healthcare Resource Grouping used in SUS FTE Full Time Equivalent HV Health Visitor HR Human Resources (department) IP In Patient (An admitted patient, overnight or daycase) I&E Income and Expenditure JAC The specialist computerised prescription system used on the wards NCA Non Contact Activity KLOE Key Line of Enquiry RRP Rolling Replacement Programme KPI Key Performance Indicator PDC Public Dividend Capital LOS Length of stay PPE Property, Plant & Equipment MRI Magnetic Resonance Imaging R&D Research & Development MRSA Methicillin-resistant Staphylococcus Aureus (bacterium) SIP Staff in Post NG Nasogastric (tube from nose into stomach usually for feeding) SLA Service Level Agreement OP Out Patient (A patient attending for a scheduled appointment) OPARU Out Patient Appointments & Records Unit PAAU Pre-Assessment Unit PAS Patient Administration System - the main computer recording system used PALS Patient Advice & Liaison Service now renamed but still dealing with complaints/concerns PATEXP Patient Experience PATSAF Patient Safety PEO Patient Experience Officer - updated name for PALS officer PPIs Proton Pump Inhibitors (Pharmacy term) PIDS Performance Information Decision Support (team) Provisional Raw data not yet validated to remove permitted exclusions (such as patient choice to delay) Page 49 Enc L

REPORT TO THE TRUST BOARD (Part 1 - Public) On 7th December 2016

Title Chief Operating Officers Report Sponsoring Executive Shaun Stacey, Chief Operating Officer Director Author(s) Rachel Buswell-Green, Interim Executive Assistant Purpose To inform Trust Board of current service issues and challenges, good news, risks, opportunities and commissioning issues or changes affecting the five clinical business units. Action required by the Receive X Approve Board: Previously considered by (state date): Sub-Committee Dates Key Issues, Concerns and Discussed Recommendations Trust Executive Committee n/a

Audit and Corporate Risk Committee n/a

Charitable Funds Committee n/a Finance, Investment, Information & n/a Workforce Committee Mental Health Act Scrutiny Committee n/a Remuneration & Nominations Committee n/a Quality Governance Committee n/a Please add any other committees below as needed Staff, stakeholder, patient and public engagement: n/a Executive Summary & Analysis: The report provides a brief overview of current service issues and challenges, good news, risks, opportunities and commissioning issues or changes affecting the five clinical business units. · Surgery, Women’s and Children’s Health Clinical Business Unit (SWCH) · Ambulance, Urgent Care and Community Clinical Business Unit (AUCC) · Clinical Support, Cancer and Diagnostic Service Clinical Business Unit (CSCDS) · Medicine, Clinical Business Unit · Mental Health and Learning Disabilities Clinical Business Unit (MHLD)

This report will cover the period 26th September to 25th November 2016.

The layout of the report has been adjusted; please can you let us know your thoughts on whether the layout is effective. Recommendation to the Board: Trust Board is asked to receive and note the contents of the report Attached Appendices & Background papers Chief Operating Officer report For following sections – please indicate as appropriate:

Trust Goals & Priorities All Trust Goals and Priorities Principal Risks (BAF) Principal Risk 671 Human Resources Principal Risk 672 Financial Resources Principal Risk 673 Strategy and Planning Principal Risk 674 Quality and Harm Principal Risk 675 Culture Principal Risk 677 Local Health and Social Care Economy Resilience

REPORT TO THE TRUST BOARD (Part 1 – Public) Page 1

Principal Risk 676 Information Communication Technology

Legal implications, regulatory and n/a consultation requirements

Date: 25 November 2016 Completed by: Rachel Buswell-Green, Interim Executive Assistant

REPORT TO THE TRUST BOARD (Part 1 – Public) Page 2

CHIEF OPERATING OFFICERS REPORT TO TRUST BOARD 7th December 2016

The purpose of this report is to provide a brief monthly overview of current service issues, challenges, or risks affecting the five clinical business units balanced with good news, and opportunities. This report covers the period 26th September 2016 to 25th November 2016.

Salient Points The Trust’s two year operating plan for FY2018 & FY2019 has been developed according to an accelerated timeframe set by NHS Improvement (NHSI) requiring plans to be submitted 3 months earlier than in previous years. Final submissions are required on 23 December 2016.

The Trust submitted its draft plan according to the NHSI timetable and continues to develop its two year operating plan with this initial submission being a draft covering the progress made by 24 November 2016. Due to the timing of the draft submission, gaps remain with respect to the provision of detailed information required to develop a robust triangulated plan and significant work will be undertaken before final submission to ensure that the plan will be robust. Over the coming weeks CBUs will be working on detailed cost improvement plans. They will also be revising current draft plans against the impacts of STP and My Life a Full Life (MLAFL) service developments and the Clinical Commissioning Group’s (CCG) proposed reduction in income as further detail is obtained. This is a challenging timeframe given the current gaps in information and operational pressures. September and October has seen sustained pressures across the health and social care system, but during October no black alerts were declared.

The teams are focussed on reducing length of stay and managing the complex discharges, some of which have been impacted on by care agency capacity. Executive Led, multiagency meetings continue to take place in order to ensure patient flow continues system wide.

Expressions of interest for the Clinical Capacity and Pathway Manager post have been requested to ensure cover is provided for an initial secondment period of 4 months whilst an external recruitment process takes place to secure a permanent replacement.

Mental Health & Learning Disabilities

Issue Mitigation Who When Ligature Points Quick wins have been David Sellers/Estates December 2016 actioned and costings for further work to resolve these issues is being completed by estates Care Programme Approach Meeting on 7 December All Operations Managers March 2017 (CPA)/Community Mental with all clinical staff. Action Health Survey plan to be developed and rolled across all community and mental health services

Good News and General Update: 1. The Island Recovery Integrated Services (IRIS) team have achieved 100% in 14 of its payment by results (PBR) targets. 2. They are also celebrating the success of the 12 step programme which aims to help clients recover from drug addiction and/or alcoholism. The course is a 12 week rolling programme and since it started 18 months ago there have been 240 lessons, 1845 attendances averaging 8 to a group, 25 successful completions with five of these celebrating a year of sobriety. 3. Work continues to develop a mental health alliance working in partnership with Solent NHS Trust, Southern Health Mental Health NHS Foundation Trust and meetings have now been set up. The first formal meeting of the group was held on Friday 23rd September 2016 4. Serenity won the Nursing Times Award for Integrated Care in mental health 5. Closer links being formed with Solent Healthcare with the Chief Medical Officer from Solent visiting mental health services on Friday 18 November 2016. A further team from the IOW to visit Solent is in the process of being arranged in keeping with partnership working

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6. The business unit have successfully completed 97% of their appraisals

Risk and Challenges: 1. Work is now underway to fix the ongoing issues with information systems and lack of IT hardware within the Mental Health and Learning Disabilities Clinical Business Unit. Osbourne Ward’s computers have now been upgraded and repaired 2. Latest community service user survey results was released by the CQC on Tuesday 15 November 2016 which showed the IOW to be a poor performer in providing mental health services for community patients. The mental health management team are reviewing the results 3. Care Programme Approach (CPA): A complete deep dive audit was undertaken on 1,300 patients in community mental health services to review if they meet the criteria and if they have had a yearly review undertaken. This audit was completed at the end of September and was fed back in to the Quality Fellowship workshop. A half day away day has now been arranged on 7 December 2016 to provide the feedback from the audit of CPA’s to all staff, where an action plan will be developed to improve CPA compliance 4. Further to the Care Quality Commission (CQC) visit from Tuesday 22 – Thursday 24 November 2016, they have highlighted to be addressed: a) ligature risks within Sevenacres that need to be resolved b) issues with recruitment and retention across mental health services c) care planning across mental health services

Medicine

Issue Mitigation Who When Medical Patients exceeding The patient flow project is Ab Abdi December 2016 medical bed capacity underway. The Reablement team are now present at the hospital on a daily basis 7 days a week and weekend discharge teams are provided for medical senior review including medical cover, porters, physiotherapists, Occupational Therapists and Reablement

Need for additional medics Use of agency and Locum Ab Abdi Ongoing to cover medical patients on staff non-medical wards

Clinical Business Unit Actively recruiting to fill Ab Abdi Ongoing (CBU) wide vacancies vacant posts

Good News and General Update: 1. The Diabetes Unit received a highly commended in the national award for patient transition from paediatric to adult services. Judges’ comments were “This is a good transition model and great to see the patient “in the driver’s seat” when planning the service, as well as consulting young adults who had already been through the process. The audit results were very impressive." 2. Medicine have seen a reduction in the use of agency Registered Nurse’s (RN) recently. This is due to having recruited 1 RN and all of the overseas nurses have now received a pin (bar two) therefore they have now been added to our staffing levels. 3. The CBU has now appointed a Head of Operations – Ab Abdi and Clinical Director – Andrew Woolley. 4. Patient Flow project has commenced on both Appley and Colwell Wards. 5. Key people within the CBU attending the Acute and General Medicine conference to promote medical vacancies within the CBU. 6. Pilot of rapid access to respiratory clinics for ambulatory care has begun 7. Outsourcing of the gastro service remains ongoing – Medinet have seen a total of 319 new patients and115 endoscopies have been completed 8. The logistic of a project looking in to “discharge to assess” will commence within the next 2 weeks

Risks and Challenges: 1. The ongoing need to provide consultants and junior doctors for medical patients on non-medical wards continues to cause pressures. Medical patients exceeded the medical bed base in month resulting in the reliance on agency locum consultants to provide ongoing management of these medical patients. This is presenting significant challenges to the medical teams and to the financial situation of the CBU causing the budget to become overspent. The patient flow project is underway.

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2. Resignation of the Cardiology Consultant who leaves at the start of January 2017. The job description has been approved by the Royal College and awaiting scrutiny approval prior to advertising for the post. 3. Sickness absence on the medical wards is higher than the 3% target. Sickness absence is monitored through the monthly Leadership meeting and appropriate action is being taken. 4. The CBU is currently not meeting the end of life and dementia Key Performance Indicators (KPI’s) and have put actions in place to address this. 5. Experiencing continued inpatient delays across Medical Wards due to delays in the whole system (Social Services, Continuing Health Care etc.). The patient flow project is underway. 6. There are a number of Consultant vacancies 1X Cardiology from January, 1X Respiratory current, 1X Gastroenterology current and 1X General Medicine current. The CBU is actively recruiting to these vacant posts. 7. There are high number of nursing vacancies – across medical inpatient areas 8. The CBU is working with the appraisal monitoring team to ensure all completed appraisals are accurately captured. The CBU believe that 84% of appraisals have been completed. 9. Rehab clinics have been cancelled due to bed pressures and lack of junior doctors. 5 patients are currently waiting 18+ weeks. Dr Gladdish will undertake an additional clinic this month to accommodate these patients

Ambulance Urgent Care and Community

Issue Mitigation Who When 111 Service performance A business case has been Chris Smith December 2016 submitting requesting additional staff to match increase in demand 4 Hour Emergency Care Emergency Care Chris Smith/Paul Cordy January 2016 Standard turnaround plan is monitored on a weekly basis. Community Nurses, Physiotherapy, and Crisis Response Team continue to support admission avoidance at the front door. An ED Crowding Protocol is being approved Community Waiting Lists Additional clinics have been Emma Pugh January 2016 set up over the past quarter to reduce these waiting times

Good News and General Update: 1. The CBU are involved in an urgent care collaborative reviewing the alignment of community services 2. The Beacon Centre changed over on the 1st October 2016 to the Urgent Care Service. Internal and external communication plans to advise the public on appropriate use of services will continue 3. Ambulatory Emergency Care was implemented on 1st November 2016 and a pathway has been agreed 4. Laura Bail, currently Quality Manager in the Chief Operating Officer team, successfully secured a secondment to the Assistant Operational Manager within the Ambulance Urgent Care and Community CBU and commenced in post on 1st November 2016 5. Lucy Abel has stepped down as Head of Operations for the Ambulance Urgent Care and Community CBU to focus on the urgent care improvement plan and Charlise Cuthbert will cover this post for a secondment period whilst the recruitment process takes place to ensure this vital role is covered 6. The Trust have strategically placed Automated External Defibrillators (AEDS) across the island community, training has also been provided by the Commercial Ambulance Training team to these Residential and Nursing Home providers

Risk and Challenges: 1. Performance targets continue to remain a challenge and the action plans continue to be implemented and monitored on a weekly basis. The Ambulance turnaround plan is a key factor in assisting the service to meet the Red 1 and Red 2 performance trajectories. The Emergency Department (ED) handover continues to be implemented and results in more efficient turnaround times are being seen. September and October were particularly challenging in terms of performance for the Ambulance Service, however over the first few weeks of November a sustained improvement in performance for all 3 trajectories has been seen. 2. 111 call handling performance has begun to drop below the 95% trajectory due to a sustained increase in demand. A business case has gone to the Systems Resilience Group Urgent Care Committee requesting additional staffing to match the increased demand on the service. Providing that this case is successful, the positive impact on performance will be demonstrated in Quarter 4 to recover performance trajectories.

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3. The Emergency Care Standard also continues to remain a challenge and the Emergency Care turnaround plan is monitored on a weekly basis for actions implemented. The Community Nurses, Physiotherapy, and Crisis Response Team continue to support admission avoidance at the front door. An ED Crowding Protocol is in the Trusts governance process for approval. 4. Appraisals continue to be chased via the CBU meetings and progress monitored weekly. Capacity to complete is challenging but the CBU continue to make progress towards the target 5. Community Waiting Lists continue to remain a challenge with high numbers of referrals impacting upon waiting times for patients. Additional clinics have been set up over the past quarter to reduce these waiting times 6. Substantive nursing staff recruitment for ED is underway; this should have a positive impact on team stability, financial position and the Emergency Care Standard. 7. Awaiting substantive recruitment to the Medical Assessment Unit (MAU) medical consultant posts, which should also have a positive impact on team stability, financial position and the 4 Hour Emergency Care Standard 8. Continued impact of delayed discharges and reduced patient flow upon the Emergency Care Standard remains challenging for the ED and the MAUs

Clinical Support, Cancer & Diagnostic Services

Issue Mitigation Who When High level of locum staff Reviewing terms of Diane Adams and inability to recruit to recruitment long term vacant posts

High levels of cancelled RTT Recovery Plan is Kathryn Taylor Currently in the approval elective activity currently being established process

Staffing over the Christmas Diane Adams Immediately period for Microbiology

Good News and General Update: 1. Whilst Intensive Care Unit (ICU) demand remains challenging, the initial rotation of staff from Coronary Care Unit (CCU) to ICU has resulted in avoidance of 25 hours of potential agency usage this week and 45 hours next week. CCU is backfilling with bank which is a £2500-£2900 cost saving against an ICU agency request. A third staff member is starting their rotation in November. 2. The CBU is exploring the potential of partnership working in Pathology, Pharmacy and Oncology 3. Theatres have been providing out of hours and weekend staffing in recovery to manage ICU capacity 4. Out-Patient Department (OPD) support ED in providing the plaster room to manage minors at points of high pressure 5. Triumvirate management structure now in place within the CBU 6. First substantive Consultant Haematologist is now in post 7. Long term locum Microbiologist has been secured until June 2017

Risks and Challenges: 1. Locum cover has been arranged for Haematology to cover periods of booked Christmas leave, although the service would be left vulnerable should the locum fail to attend 2. Workload pressures on senior staff picking up Consultant work. This will increase in November when two specialist Biomedical Scientists leave (unsuccessful recruitment to Band 7 post) 3. Second substantive Haematologist not starting until April 2017 4. Consultant Microbiologists at Portsmouth Hospital will provide phone cover during the day and out of hours for the period of annual leave the Trust has to honour for the newly appointed locum Consultant. The service would be left vulnerable should this fail

Surgery, Women’s and Children’s Health

Issue Mitigation Who When Medical Staffing Recruitment is currently Vicky Lauchlan/Diane Ongoing underway to fill vacant Adams posts Staff sickness levels The Trust Policy is being Vicky Lauchlan/Diane Ongoing followed Adams High number of short notice Recovery Plan is currently Vicky Lauchlan/Diane Ongoing theatre cancellations due to being developed Adams patient flow issues

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Good News and General Update:

1. Isle of Wight (IOW) maternity working and part of the maternity pioneer SHIP 2. Agreement in principle from University Hospital Southampton (USH) and Portsmouth Hospital Trust (PHT) that they wish to collaborate in the provision of Urology Services on the Island 3. The business unit have managed to achieve 91.7% of their appraisals to date and continue to ensure these are being completed through business unit management meetings 4. “I Want Great Care”; positive comments and patient feedback has been received across a number of areas 5. A Clinical lead for Head and Neck has successfully been appointed 6. Day Surgical Unit (DSU) has been taking patients from ED/MAU to assist with patient flow 7. Endoscopy has been taking patients requiring biopsies to prevent them from having a ward bed 8. Theatres held a patient experience feedback meeting. It described the positive outcome and learning has been shared throughout the CBU’s

Risks and Challenges:

1. Last minute changes to outpatient clinics due to changes in locums is causing a significant challenge on Out Patients, Assessment and Records Unit (OPARU) 2. Medical staffing remains the business unit’s biggest challenge 3. Consultant Anaesthetist and Consultant Radiologist have pulled out of recent interviews 4. 4 current Serious Incidents Requiring Investigation (SIRI’s) being investigated, including one Never Event 5. The CBU is not currently achieving the 3% sickness target and there are some high levels of sickness particularly in Theatres. This is being reviewed monthly at the leadership meeting, working in line with Trust policies to manage this situation. 6. Loss of elective operating cases, leading to last minute changes and increased pressure on Pre Assessment and Admissions Unit (PAAU) to utilise lists fully

Shaun Stacey Chief Operating Officer November 2016

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REPORT TO THE TRUST BOARD (Part 1 - Public) ON 7th December 2016 Title Corporate Governance Framework - Scheme of Reservation & Delegation Sponsoring Mark Price, Company Secretary Executive Director Author(s) Lynn Cave, Board Governance Officer Purpose For approval Action required by Receive Approve the Board: X Previously considered by (state date): Sub-Committee Dates Key Issues, Concerns and Recommendations from Discussed Sub Committee Trust Executive Committee

Audit and Corporate Risk Committee 10/05/16

Charitable Funds Committee Finance, Investment, Information & Workforce Committee Mental Health Act Scrutiny Committee Remuneration & Nominations Committee Quality Governance Committee Foundation Trust Programme Board Please add any other committees below as needed

Other (please state) Staff, stakeholder, patient and public engagement:

Executive Summary & Analysis: The attached document, is part of the Trusts Corporate Governance Framework. All parts of the Framework are reviewed at least annually to take account of changes in governance during the year.

At its June 2016 meeting the Board approved an extension to the review period for this document. Any change to our Scheme of Reservation and Delegation will need to be consistent with the Trusts response to the recent NHSI investigation. In view of this a further 4 month extension is now proposed. Recommendation to the Board: Approve a 4 month extension to the Scheme of Reservation and Delegation to 5th April 2017. Attached Appendices & Background papers Current Scheme of Reservation and Delegation which expires on the 08/12/2016 For following sections – please indicate as appropriate:

Trust Goals & Priorities All Goals Principal Risks (BAF) Principal Risk 673 Strategy and Planning Principal Risk 675 Culture Principal Risk 705 Capacity and Capability Legal implications, regulatory and N/A consultation requirements

Date: 29 November 2016 Completed by: Lynn Cave, Board Governance Officer

REPORT TO THE TRUST BOARD (Part 1 – Public)V10 Page 1

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FOR PRESENTATION TO TRUST BOARD ON 7 DECEMBER 2016

Top Key Issues and Risks arising from Sub Committees for raising at Trust Board

Quality Governance Committee meeting held on 8 November 2016 (see Enc N2)

Min. No. Top Key Issues & Risks for Raising at Trust Board 16/Q/182 Exception Report from SEE 1 Committee - The DDQ presented the SEE Committee Report covering Safeguarding, DoLs/MCA2, Dementia, Mixed Sex Accommodation, Safer Staffing and Fundamental Standards. The Committee noted there were examples of nil assurance. 16/Q/186 Serious Incidents Requiring Investigation (SIRI) – The Committee is still concerned about ensuring lessons learnt are properly embedded within the organisation. 16/Q/187 Emergency Department 4 Hour Wait and Closure of Beacon (Urgent Care Centre) - The Committee expressed support for the Emergency Care Improvement Programme Local Policy and requested this is reported to QGC for assurance in January 2017. 16/Q/189 External Agencies Update - The committee agreed for CEL and the Chair to review how to utilise one portal for all external agencies reporting expected visit and outcome of the visit to enable reporting of these to QGC by exception.

Quality Governance Committee meeting held on 29 November 2016 (see Enc N3)

Min. No. Top Key Issues & Risks for Raising at Trust Board 16/Q/195 Exception Report From SEE Committee – The AEDNQ presented the SEE Committee Report covering Pressure Ulcers, Falls, Health Acquired Infections and Nutrition. The Committee noted there were examples of negative and limited assurance. 16/Q/197 Care Quality Commission (CQC) Inspection Update – The Committee noted estate work being undertaken when issues have been identified and if risks have been factored into the decision when the work would take place. It was agreed to request Capital Investment Group to factor in risk when reviewing requests for Estate work. 16/Q/199 Deep Dive Into DoLs And MCA - The Committee required more assurance on the training that has been undertaken and that reports are joined up with the Mental Health Act Scrutiny Committee and QGC. 16/Q/202 Serious Incidents Requiring Investigation (SIRIs) – The Committee is still concerned about ensuring lessons learnt are properly embedded within the organisation.

Finance, Investment, Information & Workforce Committee meeting held on 25 October 2016 (see Enc N4)

Min. No. Top Key Issues & Risks for Raising at Trust Board 16/F/376 Provider Control Totals: The Committee had an in depth discussion on the key actions to take forward for the improvement needed to meet the NHSI requires particularly around the agency ceiling. 16/F/377 Human Resources Report: The Committee was concerned that on most of the key areas there were continued issues that are not been resolved, including Sickness levels, Rostering in safe staffing areas, expensive nurse recruitment from abroad and overpayments growing consistently month on month. Because of these concerns, the assurance level be moved from Limited Assurance to Negative Assurance.

1 Patient Safety, Experience & Clinical Effectiveness 2 Deprivation of Liberty Safeguards / Mental Capacity Act

Top Key Issues & Risks for Raising at Board –7 December 2016 Page 1 of 4 16/F/378 Medical Staffing Agency Usage: The Committee noted the downward trend in agency staff usage week by week and was assured that there is an action plan to reduce the use of agency staff and that it is being managed. 16/F/381 Appraisal Compliance: The Committee expressed concern regarding the very low level of medical staff appraisal compliance. 16/F/398 Cash Flow: The Committee was concerned that NHSI had refused the request for cash funding indicating that they would only do so where the Trust is threatened with supplier restrictions. They have also indicated that in November when the Trust is anticipating a £1.4m requirement, they are only likely to fund £446k.

Finance, Investment, Information & Workforce Committee meeting held on 29 November 2016 (see Enc N5 to follow)

Min. No. Top Key Issues & Risks for Raising at Trust Board 16/F/416 Recruitment and Retention Business Case: The Committee considered that this was an important piece of work to define and make clearer the cost benefits to the organisation. The overall objective is to reduce reliance on agency locum staff and move towards a more sustainable workforce. The Committee welcomed the initiative and proposed additions to the document before submission to the Trust Board. 16/F/417 Mandatory Training Compliance Levels of Medical Staff: The Committee received a presentation from the DMD on the low compliance levels recorded for the completion of mandatory training by medical staff. A number of risks were identified as a result of the discussion and the Committee proposed actions to improve compliance. An action plan is to be presented to the February 2017 FIIWC. 16/F/418 Education, Training and Organisational Development CQUIN: The Trust has a CQUIN target to vaccinate 75% of frontline staff which equates to 1612 people. So far 870 doses have been given Appraisals: The level of appraisal completion in the Trust has now reached over 79% for 2016/17 Staff Survey: The Staff Survey for 2016 has been sent out to all staff and the cut off for return is 2nd December. Friends & Family Test: A report has been received providing results for the first 2 quarters of the year. The results are mixed with approximately 50% of staff not prepared to recommend the Trust as a place to work. The Committee consider that the results are a worrying indication of organisational health with some comments referring to poor management and leadership, feeling devalued and bullying. 16/F/421 Carbon Energy Fund: The Committee agreed the revised Business Case for recommendation to the Trust Board for approval. 16/F/429 NHS Creative: A 3 year business plan has been submitted which provides for small but positive contributions for each year and assumes further recruitment. The Interim Turnaround Director is to work with the Company Secretary to advise on efficiency measures and best practice. 16/F/430 Vectasearch: The Committee agreed the Business Case in principle subject to the inclusion of a section on risk together with a forecast of future work and associated income 16/F/431 Finance Report – Key Financial Risks: At Month 7 the main pressure continues to be the underperformance of the main CCG PbR contract which is behind plan. Talking into account other risks, opportunities and mitigating actions the present end of year outlook is Best Case £4.630m, Possible case £7.368m and Worst case £9.736m CIP: The programme remains on plan and although the position is improving, the non- recurrent element will have a negative impact on the starting position for 2017/18 Cash: The cash position for the Trust remains a key risk. A deficit in excess of the planning £4.630m would result in a significant impact on the cash forecast position for the Trust.

Top Key Issues & Risks for Raising at Board –7 December 2016 Page 2 of 4

Mental Health Act Scrutiny Committee meeting held on 18 October 2016 (see Enc N6)

Min. No. Top Key Issues & Risks for Raising at Trust Board 16/032 MH/046 - Hospital Managers’ (now MHARM) Training: The Committee received assurance that training sessions were being arranged to maximise the number of NEDs and MHA Review Managers on site. 16/032 MH/050 – MHA & MCA Training Numbers: The Committee expressed concern that clear evidence of effective MCA/DoLS training would not be present when the CQC next visited St Mary’s Hospital. Assurance was given that this was being reviewed and that MCA and DoLs referral figures were regularly reviewed by the Clinical Standards Committee and the SEE Committee. 16/036 Community Treatment Order (CTO) Audit: The Committee received assurance updates on the audit. It was also confirmed that following training there would be a re- audit led by the Service Leads.

ICT Assurance Committee meeting held on 18 November 2016 (see Enc N7)

Min. No. Top Key Issues & Risks for Raising at Trust Board 16/I/030 IT Training: The Committee expressed concern over the provision of IT training within the organisation and has requested a review. 16/I/030 TPP SystmOne programme for Community Nursing: The Committee reports that the business case for the introduction of this system progressing with Trust Leadership Approval 16/I/030 Joint Working with Council: The Committee reports that options for joint working are continuing to be discussed and developed. 16/I/032 IG Tool Kit Compliance: The Committee noted that progress towards full compliance with the ICT elements of the IG Tool Kit was very challenging but was planned to be complete by the end of Financial Year.

Audit & Corporate Risk Committee meeting held on 8 November 2016 (see Enc N8)

Min. No. Top Key Issues & Risks for Raising at Trust Board

16/A/093 Principal Risk – Develop an Integrated IT Infrastructure: The Committee was concerned that, with the complexity of the external agenda, i.e. STP, MLAFL and WISR, the Trust did not have a clear IT strategy but noted that a draft Strategy would be produced by the end of the year. 16/A/094 Principal Risk – Cost Effective, Sustainable Services: The Committee was updated on the financial and operational performance challenges which affect the Trust’s financial resilience and breakeven duty and the work being undertaken in mitigating and containing these effects caused by external influences. 16/A/097 Corporate Governance Framework – Declaration of Interests: The Committee was concerned at the low level of compliance for consultants as it considered that the Declaration of Interests helps clarify where there is a potential conflict of interest. The Committee felt that the direction of travel was for the Declaration of Interests to be more transparent and that there was a need to hold staff to account for the mandatory completion of Declaration of Interest Forms. 16/A/099 External Governance Review – Action Plan: The Committee acknowledged that it was now the role of the Executive Led Sub Committees to take forward and oversee the

Top Key Issues & Risks for Raising at Board –7 December 2016 Page 3 of 4 completion of the 9 outstanding actions and requested that the sub-committees provide forecast dates for the completion of the work. 16/A/100 Review of Achievement of Trust Goals and Priorities: The Committee was assured that a consistent approach towards monitoring and management of delivery of the priorities is being put in place during November 2016 in order to track delivery and the impact of the programmes of work initiated to deliver objectives and ensure effective assurance arrangements are in place.

Full Minutes of Meetings

Please note that the full minutes of these meetings are available electronically and have been previously circulated to members.

Mark Price Company Secretary 6 December 2016

Top Key Issues & Risks for Raising at Board –7 December 2016 Page 4 of 4 Enc O

REPORT TO THE TRUST BOARD (Part 1 - Public) ON 7th December 2016 Title Board & Board Seminar Dates January 2017 – December 2017 Sponsoring Mark Price, Company Secretary Executive Director Author(s) Lynn Cave, Board Governance Officer Purpose To approve the dates for the Board Meetings and Board Seminars for the period January 2017 to December 2017 Action required by Receive Approve X the Board: Previously considered by (state date and outcome): Sub-Committee Dates Discussed Key Issues, Concerns and Recommendations from Sub Committee Trust Leadership Committee Audit and Corporate Risk Committee Charitable Funds Committee Finance, Investment, Information & Workforce Committee Mental Health Act Scrutiny Committee Remuneration & Nominations Committee Quality Governance Committee Information & Communications Technology Assurance Committee Please add any other committees below as needed Board Seminar Various dates Staff, stakeholder, patient and public engagement: Not applicable

Executive Summary: Following previous discussion and an email on 30th November 2016 from the Chair to all Board members the attached dates are suggested for the period January 2017 to December 2017.

All meetings will commence at 9.00am and will be held at either St. Mary’s Hospital, Newport, Isle of Wight, PO30 5TG or at a Community Based Location - venue for these meetings will be confirmed on our Website

An Extraordinary Meeting- Formal signing off of the Annual Report, Annual Accounts and Quality Account will be held on 30th May 2017 to enable the Accounts to be submitted on 1st June 2017 deadline. Recommendation to the Trust Board: Approve the proposed dates for January 2017 to December 2017

Attached Appendices & Background papers Enc O2- Board & Board Seminar Dates for 2017

REPORT TO THE TRUST BOARD (Part 1 – Public)v8 Page 1

For following sections – please indicate as appropriate:

Trust Goals & Priorities ALL Principal Risks (BAF) ALL Legal implications, regulatory and N/A consultation requirements

Date: 28th November 2016 Completed by: Lynn Cave, Board Governance Officer

REPORT TO THE TRUST BOARD (Part 1 – Public)v8 Page 2

Isle of Wight NHS Trust Board & Board Seminar Meetings January 2017 – December 2017

This document outlines the dates of the Isle of Wight NHS Trust Board and Board Seminars for the period January 2017 to December 2017.

Trust Board

nd Meetings will be held on the 1st Wednesday of the month unless specified.( * indicates 2 Wednesday of month)

No Meeting in January 17 No Meeting in August 17 Wednesday 8 February 17 * Wednesday 6 September 17 nd (2 Wednesday – FIIWC & QGC on 31 Jan) Wednesday 4 October 17 Wednesday 8 March 17 * nd Wednesday 8 November 17 * (2 Wednesday – FIIWC & QGC on 28 Feb) (2nd Wednesday – FIIWC & QGC on 31 Oct) Wednesday 5 April 17 Wednesday 6 December 17 No Meeting in May 17 Wednesday 7 June 17 Wednesday 5 July 17

Additional Meetings:

These are shorter meetings to discuss specific items. Times and Venues vary from main Board meetings.

Tuesday 30 May 17 Formal signing off of the Annual Report, Annual Accounts and Quality Account (Accounts to be submitted on 1st June 2017)

All meetings will commence at 9.00am and will be held at either St. Mary’s Hospital, Newport, Isle of Wight, PO30 5TG or at a Community Based Location - venue for these meetings will be confirmed on our Website

* Extraordinary Meeting- Formal signing off of the Annual Report, Annual Accounts and Quality Account (Accounts to be submitted on 1st June 2017)

Trust Board Seminar

Seminars will be held on 3rd Tuesday of the month unless specified Please note: July* Seminar will be shortened to accommodate the AGM

2017 Tuesday 17 January 17 Tuesday 15 August 17 Tuesday 21 February 17 Tuesday 19 September 17 Tuesday 21 March 17 Tuesday 17 October 17 Tuesday 18 April 17 Tuesday 21 November 17 Tuesday 16 May 17 Tuesday 19 December 17 Tuesday 13 June 17 (2nd Tues this month only) Tuesday 18 July 17 *

Members are asked to keep these dates available in their diaries as they will be used for Board Development Sessions, Workshops with CBUs and Board Walkabouts as well as Seminars.

As at 1-Dec-16 Page 1 Trust Board & Board Seminar Meetings Jan 2017 – Dec 2017 Annual General Meeting

Meeting to be held prior to a Medicine for Members event.

Tuesday 18 July 17 Time & Venue: 1pm – 2pm in Education Centre, St Mary’s Hospital

Mark Price, Company Secretary 29 November 2016 (Version 7)

As at 1-Dec-16 Page 2 Trust Board & Board Seminar Meetings Jan 2017 – Dec 2017

Trust Board Convened as Corporate Trustee for the following

item Enc P

FOR PRESENTATION TO CORPORATE TRUSTEE ON 7 DECEMBER 2016

CHARITABLE FUNDS COMMITTEE

Minutes of the meeting of the Charitable Funds Committee held on the 20 September 2016 at 3.00 p.m. in the School of Health Sciences, St. Mary’s Hospital, Newport.

PRESENT Nina Moorman Non Executive Director (Chair) Christine Barringer Patient Council Representative Deputising for Dennis Ford Maria Lane Head of Financial Management (HFM) Deputising for the Executive Director of Financial & HR Lesley Myland Friends of St. Mary’s David King Non Executive Director Sarah Johnston Deputy Director of Nursing (DDN) Mark Price Company Secretary (CS) In Attendance Katie Parrott Senior Financial Accountant (SFA) Michael Irons Financial Accountant (FA) Alison Toney Communications & Engagement Officer(C&EO) Item16/C042 Bisi Lawal-Rieley Staff Activities Co-ordinator (SAC) Item 16/C047 Jacky Harry NICU Fund Manager Minuted by Linda Mowle Corporate Governance Officer

Min. No. Top Key Issues 16/C043 Staff Co-ordinator Post: extension funded until 31 March 2016 to cover the Awards Ceremony and to explore the feasibility of future funding sources. 16/C045 Guidance for Staff on Charitable land Fundraising Activities on IOW NHS Trust Premises: Draft guidance agreed for circulation to the Corporate Trustee for approval and then to be uploaded on the CFC website. 16/C046 Static Fund Policy: In line with the Policy, 4 funds have been identified and transferred to the General Fund. 16/C050 Friends of St. Mary’s Bids: The list of bids was agreed totalling £115,735.57 which will benefit both staff and patients alike. 16/C053 Annual Accounts & Report 2015/16: The finalised Accounts and Report will be presented to the Corporate Trustee on the 7th December 2016 for approval in order to meet the Charity Commission’s deadline.

16/C036 APOLOGIES Received Chris Palmer (Executive Director for Financial & Human Resources), and Dennis Ford (Patient Representative) 16/C037 QUORACY The Chair confirmed that the meeting was quorate.

The Chairman welcomed Mark Price, Company Secretary, to his first meeting of the Committee as a member. 16/C038 DECLARATIONS OF INTEREST There were no declarations.

Charitable Funds Committee 1 20 September 2016 16/C039 MINUTES The minutes of the meeting held on the 21st June 2016 were agreed. 16/C040 MATTERS ARISING FROM PREVIOUS MEETINGS The Committee received the schedule of actions as follows:

Min. No. 14/010 The Koan: Update email from Guy Eades, Healing Arts, dated 13th September 2016 received. Lottery application for funds to undertake the exterior report works by BLAX. If grant successful, BLAX will undertake work May 2017 onwards. Plan is also to complete the replacing of the fibre optic lighting by this same time. A Press Release will also be provided. Further updates will be provided as work progresses. Min. No. 15/C021 Charitable Funds Strategy 2014-2017/18: To be an agenda item for the next meeting in December 2016. Action: EDFHR

Min. No. 15/C041 Southampton Hospital Charity Leaflet: The Committee noted the Staff Newsletter. Status – closed.

Min. No. 16/C028 Fund Managers’ Expenditure Plans – Fund Balances: Noted that balances have been sent to DDF. The Committee to be advised whether the Fund Balances had been raised at the CBUs and OMG. The HFM agreed to follow up with the DDN and report back. Action: HFM

Min. No. 16/C0032c Funding for Future Careers Development Facilitator: The Committee noted that the post has been filled with the appointment of Cathy Armstrong and that development of a work plan had commenced. The Committee requested that Hannah Joyce, Volunteer Co-ordinator, and Cathy Armstrong attend the December 2016 meeting to present a written report on progress. Action: SFA/HJ/CA 16/C041 CFC MEMBERSHIP The CS updated the Committee on the following vacancies: • Non Executive Director: It is proposed that the new Associate NED be invited to become a member of the Committee. • Staff Representative (Fund Manager): The Chief Operating Officer (COO) has provided 2 possible Fund Managers for the CS to meet and take forward the appointment.

The CS envisaged that both vacancies would be filled by the next meeting in December 2016. Action: CS 16/C042 STAFF ACTIVITIES The Committee received the update report outlining the activities the SAC has been undertaking. The SAC commented on the following

(a) The Summer Ball 2016: The costings for the Ball were all covered which was successful with good feedback.

(b) Recognition of Staff 40+ Long Term Service at the AGM: The Nutcracker award presented to staff at the AGM was hand made by Andy Fortune of Mulberry Tree Wood Turnery in Arreton Barns and signifies how each one of the staff have been the ‘nuts and bolts’ of the NHS over the past 40+ years. Eleven members of staff were recognised, however 2 other staff members have been now identified with 40+ years of service but were not invited to the AGM. HR is in the process of ensuring that staff who have not had continuous service are also included. The Long Term Service Policy is to be reviewed to take account of staff who have not had continuous service.

Charitable Funds Committee 2 20 September 2016

The Committee requested that the paper to be submitted to the December 2016 meeting from the SAC includes the future intention for the Long Service Awards. Action: SAC

(c) Staff Activities – 10,000 Steps a Day Walking Challenge: The uptake for this challenge has been very positive with over 500 people signing up to take part as a result of the wide publicity. In addition, free health checks are being given to staff before and after the event which will be on-going until the beginning of November. Staff ‘stories’ of their walking challenge will also be publicised together with the prizes which have been donated.

(d) Staff Survey: Following the staff survey fitness classes have been introduced within the organisation and investigation/preparation for the introduction of the following events: • Arts & Craft Classes which will hopefully also generate artwork for the hospital • Access to a local gym • Creating more fitness classes • 10 minute treats for staff from money raised through fundraising activities • Bake off and Mad Hatters Tea Party • Christmas Quiz – Sarah Morrison organising and overseen by the SAC • Christmas grotto, fayre and party • Awards Night 2017 – sponsorship being sought to cover all costs

The C&EO advised that staff would really like the opportunity to have a ‘say’ in the selection of events as, in this way, the staff would ‘own’ the event and therefore become more involved.

The Committee agreed that in the new year, Communications to invite staff to vote on their preferred choice of staff events. The C&EO and SAC to meet to take forward 2/3 options for staff to vote on. Action: C&EO/SAC

The DDN hoped that the SAC could help staff with organising departments/teams’ individual events. However, the CS pointed out that there was limited scope as the SAC’s post was only 20 hours per week and that she was currently working through the priorities particularly arising from the staff survey. He considered that there might be scope for help and assistance for individual team events from the Celebrations Group or volunteers, which the SAC could help to provide support.

The Committee agreed to the setting up of a Staff Health & Wellbeing Fund as the SAC felt that this would encourage staff to fundraise/seek sponsorship knowing that part of the monies raised would be banked into the fund to pay for future events for staff. Action: SFA

The Committee requested that updates continue to be presented to the quarterly meetings. Action: SAC 16/C043 5-6 CLUB – FUTURE UTILISATION OF FUNDS The CS referred to the funding for 12 months for the Staff Activities Co- ordinator post who commenced in post in November 2015 with the end of the 12 months being in 2 months’ time in November 2016.

Charitable Funds Committee 3 20 September 2016 Of the funding for the post, he explained that there had not been as much non-pay expenditure as predicted but there was a shortfall of £2,000 if the post was to be extended to the 31st March 2017 which would include organising the Awards Ceremony for next year. In addition, if the contract was extended to the 31st March 2017 this would allow time to explore properly the potential for sponsorship to cover all the costs of the Ceremony. Also, to explore the feasibility of funding sources for a part-time SAC role and whether the role could be funded via sponsorship.

With regard to the £3,850 funding for the 5-6 Club, no money has been spent during the year and the CS proposed that in order to extend the SAC’s contract to the 31st March 2017, £2,000 is reverted back into the General Fund and that this sum is re-allocated to fund the extension of the SAC. This would leave £1,850 within the 5.-6 Club which will be reviewed again in March 2017.

The Committee agreed the funding from the 5-6 Club to extend the SAC’s post until the 31st March 2017. The Committee requested that the Executive Team debate and explore options for future funding of the post including exchequer funds, as well as exploring the sponsorship/fundraising route between now and March 2017. Action: CS/SFA 16/C044 AWARDS CEREMONY 2016/17 The CS advised that sponsorship continues to be sought and that there may be scope within the Celebrations Budget to fund some of the shortfall. An update on the costings will be presented to the December 2016 meeting. Action: CS 16/C045 GUIDANCE FOR STAFF ON CHARITABLE AND FUNDRAISING ACTIVITIES ON IOW NHS TRUST PREMISES The Committee received the final draft guidance which is designed to provide a guide for both the Communications & Engagement Management (CEM) Team and Trust staff on what is possible and the limited support the CEM Team can provide.

The guidance to be circulated to members of the Corporate Trustee for agreement and then to be loaded onto the CFC website. Action: CS/C&EO 16/C046 FUND MANAGERS’ EXPENDITURE PLANS 2016/17 The SFA advised that a spending plan template was circulated to Fund Managers for completion. To date there are still 15 funds that have not responded.

With regard to the Protocol for Static Funds, the following funds have been identified as static and transferred to the General Fund: • Breast Screening Unit • District Nurses • Learning Disability • Luccombe Ward

The SFA reported that having reviewed the balances at 31st July 2016, there are no funds qualifying currently. However, the following funds are at risk of being transferred if no expenditure is made within the next 3 months: • Sevenacres • Cardiac Investigations • Appley • Community Stroke • Afton

Charitable Funds Committee 4 20 September 2016 • Alverstone • Dr. Magier Research • St. Helens • Helipad An e-mail has been sent to fund managers reminding them of the Static Fund Policy and asking them to consider how their funds can be spent.

The Committee agreed that Fund Managers should be advised that if, by the end of October 2016, a clear indication of their plans to spend the money in their Fund is not forthcoming, then the Funds will be closed and the monies moved into the General Fund. However, the Committee will take into consideration any extenuating circumstances should plans not be made available. Action: SFA

With regard to the Spending Plan for Laidlaw (restricted legacy), the Committee requested additional information outlining the courses and international and national conferences. Action: SFA (Post meeting note: In response to an email from SFA dated 23rd September 2016 requesting details of who, what and where, Elaine Healey (Fund Manager) advised: “The exact training details are not yet known as it depends upon individuals learning development plans and if services can release them for study leave at the time. However, I have recently been made aware of some possible development plans for the unit which may require significant funding from the legacy fund so spending large amounts is now on hold. There needs to be work done to upgrade the kitchen, restyle the reception area and modify the physio consulting area.”

The SFA is not aware of the development plans and there is nothing in the capital programme at the moment.

Nina Moorman commented on how much the fund managers know the responsibilities of their role and that a training session/workshop should be held for the fund managers.)

The SFA to provide an updated Fund Managers Plans schedule for the December 2016 meeting. Action: SFA 16/C047 BALANCES, INCOME AND EXPENDITURE The SFA presented the current income, balances and expenditure for the period April to July 2016 and advised that the General Fund is overspent by £6,000. However, this might be mitigated once VAT reclaims and other items have been checked.

Combined Fund for NICU (Including Barely Born) and Maternity: Jacky Harry, Fund Manager for NICU, attended in order to understand the decision of the Committee to merge the two funds. She pointed out to the Committee that the combining of the funds had not been discussed with her and that there is a close relationship with families who expect donations to be used for the purpose they are given. However, Jacky Harry agreed to combining the funds if this would be of benefit to Maternity and Paediatrics and that this is publicised to the families.

The Chair outlined the background to the decision which had commenced at the CFC meeting on the 9th September 2014 when Annie Hunter had agreed

Charitable Funds Committee 5 20 September 2016 to discuss with the SFA outside of the meeting the alignment of the funds as the priorities for the Unit had now been achieved. With no paper forthcoming from Annie Hunter and her subsequent resignation from the Committee, it was agreed to combine the funds in order to bring resolution to the action.

The Chair explained that there would be an expectation to respect the wishes of donors should they stipulate a specific purpose.

The Committee having reviewed the decision in conjunction with Jacky Harry, agreed that the funds should be merged under the name of the NICU, Maternity and Paediatrics Fund. Decisions on how the monies would be spent to be made at a meeting of the Fund Managers from the 3 areas. In relation to the CFC leaflet which is available on the wards, it was agreed that a sticker would be placed on the leaflet holder publicising the new NICU, Maternity and Paediatrics Fund. Action: C&EO (Post meeting Note: SFA and fund managers to meet 3 October to finalise arrangements) 16/C048 ACKNOWLEDGEMENT LETTERS TO MAJOR DONORS The SFA advised there had been no major donors since the last meeting. The Chair to continue signing acknowledgement letters. 16/C049 LEGACIES UPDATE The SFA presented the update on the status of unspent legacies as at 20th September 2016 and advising that another large legacy was in the pipeline for Chemotherapy. 16/C050 REQUESTS FOR CONSIDERATION

a) Friends of St. Mary’s – Unity Lottery: Following discussion and with Lesley Myland’s agreement, the Committee decided that the Unity Lottery should continue to be promoted as it stands within the Friends of St. Mary’s. Promotion of the Lottery to be made through the Communications Team.

b) Friends of St. Mary’s Hospital Bids: Lesley Myland tabled the agreed list of applications together with the list of unsuccessful applications. In addition to the agreed bids listed, following additional information the chairs for the Pathology staff rest room have also been agreed. The remaining bids for Breast Screening (3 x sectional examination couches) and Cellular Pathology (Macro imager with accessories) to be discussed with the Fund Managers of related charitable funds for cancer services with a view to funding them from that source. Action: SFA/DDN

The Committee, on behalf of the Trust, thanked the Friends of St. Mary’s for their generosity in funding the bids which was greatly appreciated and benefitted both staff and patients alike.

On behalf of the Friends of St. Mary’s, Lesley Myland thanked the SFA, the DDN and Jon Burwell, Executive Director of Strategy & Planning, for their support and advice in the bids process which was very much appreciated and contributed to the smooth process.

The C&EO advised that the Co-Op Store on the Island has chosen to donate to the Trust as its next charity. Five items of equipment have been selected for the Co-Op to choose from, but 3 are on the list of agreed bids from the Friends of St. Mary’s.

Charitable Funds Committee 6 20 September 2016 The Committee agreed that the C&EO follow up with the Co-Op the possibility of selecting one of the remaining 2 items or whether additional items needed to be provided. If further items required for the Co-Op to vote on, then the C&EO to take forward in order that all areas of the Trust are covered, e.g. Ambulance, Hospital, Community and Mental Health. Action: C&EO 16/C051 FEEDBACK ON FUNDING ‘Incest & Child Abuse Survivors’ Commemorative Garden: The Committee received the email from Carmelle Ryan-Sammon thanking the CFC for funding the Commemorative Garden. 16/C052 HEALING ARTS MANAGEMENT COMMITTEE The minutes of the meetings held on the 21 April and 21 July 2016 were received for information. 16/C/053 CF ANNUAL ACCOUNTS & REPORT 2015/16 The SFA advised that the draft Annual Report & Accounts were still being compiled, with the audit to commence in the middle of October. Once completed they will be emailed to members for agreement and comment. The finalised Accounts and Report will be presented to the Corporate Trustee on the 7th December 2016 for approval in order to meet the Charity Commission’s deadline of 31st January 2017. 16/C054 E-BULLETIN ITEMS The following items to be included in E-Bulletin in order to promote the work of Charitable Funds, funding for • Fund Managers’ Spending Plans reminder to be received by the end of October 2016 • Combined Fund for NICU (including Barely Born) and Maternity • Friends of St. Mary’s Agreed Bids – to co-ordinate with the Friends of St. Mary’s letters confirming the application Action: C&EO/SFA 16/C055 DATE OF 2016 MEETING Meeting to be held at 3.00 – 5.00 p.m. 20 December

Signed: …………………………………………………………….. Dated: CHAIR

Charitable Funds Committee 7 20 September 2016 Enc Q

REPORT TO THE TRUST BOARD (Part 1 - Public)

ON 7 DECEMBER 2016

Title Annual Accounts & Report of the Isle of Wight NHS Trust Charitable Funds 2015/16 Sponsoring Chris Palmer, Executive Director of Financial & Human Resources Executive Director Author(s) Katie Parrott, Senior Financial Accountant Purpose As Corporate Trustee, sign Letter of Representation and approve and adopt the Annual Report and Accounts for 2015/16 Action required by Receive Approve X the Board: Previously considered by (state date): Sub-Committee Dates Key Issues, Concerns and Discussed Recommendations from Sub Committee Trust Executive Committee

Audit and Corporate Risk Committee

Charitable Funds Committee Nov 2016 via e-mail Finance, Investment, Information & Workforce Committee Mental Health Act Scrutiny Committee Remuneration & Nominations Committee Quality Governance Committee Information & Communications Technology Assurance Committee Please add any other committees below as needed Board Seminar

Other (please state) Staff, stakeholder, patient and public engagement:

Executive Summary & Analysis:

The Annual Accounts & Report of the Isle of Wight NHS Trust Charitable Funds were agreed and recommended for adoption to the Corporate Trustee by the Charitable Funds Committee via e-mail voting in November 2016. This will be officially minuted at their meeting on 20 December 2016. The format and content of the Annual Accounts and Report follow the standard published by the Charity Commission and the guidance contained within SORP 2005. The Accounts were subject to an independent examination by our External Auditors during October 2016. The draft Independent Examiner’s Report is attached and will be signed by Ernst & Young once the accounts have been signed by the Corporate Trustee. The Annual Accounts and Report are required to be submitted to the Charity Commission by 31 January 2017. A Letter of Representation for auditors Ernst & Young is also required to be signed.

REPORT TO THE TRUST BOARD (Part 1 – Public)V10 Page 1

Recommendation to the Board: The Corporate Trustee is asked to: · Sign two copies of the Letter of Representation · Approve, adopt and sign 3 copies of the Annual Report and Accounts for the Isle of Wight NHS Trust Charitable Funds for 2015/16.

Attached Appendices & Background papers Letter of Representation 2015/16 Annual Report and Accounts Draft audit opinion

For following sections – please indicate as appropriate: Goal: Cost effective, sustainable services Trust Goals & Priorities Priority: Ensure value for money for each service

Goal: Work with others to keep improving our services Priority: Make every service the best it can be.

Goal: A positive experience for patients, service users and staff. Priority: Improve what people think of their care Improve how staff feel about work

Principal Risks (BAF) Principal Risk 672 Financial Resources

Legal implications, regulatory and To be in accordance with Charity Commission regulations consultation requirements

Date: 09/11/16 Completed by: Katie Parrott, Senior Financial Accountant

REPORT TO THE TRUST BOARD (Part 1 – Public)V10 Page 2

ISLE OF WIGHT NHS TRUST

Isle of Wight NHS Trust Charitable Funds Annual Report & Accounts

Year Ended: 31st March 2016

Registered Charity No. 1049606

ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

Who We Are

Welcome to our annual report for 2015/16. IOW NHS Trust Charitable Funds is a registered charity, number 1049606 and operates as the umbrella charity of the Isle of Wight NHS Trust.

We would like you to support us in our valuable work so please read on and let us tell you more about ourselves, what we do, what we have achieved and how we go about spending the money given to us.

Objectives and Activities during the year

Key Strategic Aim

The Charitable Funds strategy will focus on ensuring utilisation of those funds in an effective and timely way:-

· To ensure that legacies and donations are maximised through Gift Aid and applied in accordance with the donors’ wishes, but in line with the charity objectives · To raise the profile of Charitable Funds using a variety of means such as training events for fund managers and publication of funding decisions in e Bulletin. · To promote, develop and implement specific projects through an integrated approach with Fund Managers, Friends of St. Mary’s and Healing Arts in order to focus effort and avoid duplication. · To ensure that there is an Investment/Reserve Policy which maximises income and capital growth while complying with the requirements of Acts of Parliament and Trustee responsibility to minimise risk

Objectives

· invest in the improvement of patient healthcare and welfare through enhancing the environment and services provided by the IOW NHS Trust · enhance the working lives of staff by supporting the Trust to be an employer of choice. · make the most effective use of all available charitable funds, ensuring that the funds are spent appropriately · enhance and not substitute government funding of the core services of the NHS · maintain effective stewardship and use of the funds in accordance with the donors’ wishes. This includes careful consideration and scrutiny towards the purpose of any funds and the nature of fundraising activities to ensure they are aligned to our objectives and strategic direction.

The accounting records and the day-to-day administration of the funds are dealt with by the Finance Department located on the St Mary’s Hospital site.

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

Activities

The Charity’s main fund has NHS wide objectives as follows: “To ensure that legacies and donations are applied in accordance with the donor’s wishes, whilst making the maximum contribution to enhancing both patient and staff welfare and amenities.”

The Corporate Trustee takes account of the Charity Commission’s guidance on public benefit in reviewing the spending plans for each year and in setting or reviewing the guidelines for fund managers who are authorised to spend charitable funds.

Annual Review

During the year, the funds continued to support a wide range of charitable and health related activities benefiting both patients and staff. In general they are used to purchase the very varied additional goods and services that the NHS is unable to provide. Every effort is made to utilise funds for the charity’s purpose.

The ward charitable funds receive many donations specifically given to thank the staff and these are used for training, morale boosting facilities or amenities which strengthen the Trust staff’s capacity to serve their patients well.

The charitable funds also enable staff to attend courses, not funded by the NHS, which will update them on the new ideas and modern techniques in their specialties.

The General Fund receives donations and legacies that can be used for any charitable purpose relating to the NHS. This flexibility has been used to contribute towards other departments/wards purchase additional equipment when their own ward funds are insufficient.

Healing Arts: Isle of Wight

Healing Arts, working as a department of the Trust, provides a comprehensive range of high quality programmes linking the arts with healthcare to bring about recovery from illness, improvements in health, and promoting the well-being of the Trust’s patients, staff and the Island community.

Healing Arts is held as a restricted fund within the Isle of Wight NHS Trust’s Charitable Funds.

Risk Management

The major risks to which the charity is exposed have been identified and considered. They have been reviewed and systems established to mitigate those risks. These have been carefully considered and there are procedures in place to review the Investment Policy and to ensure that both spending and firm financial commitments remain in line with income.

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

Reserves Policy

The Corporate Trustee has agreed that the level of the reserves should be a minimum of £200,000 which is equal to approximately one year’s operational costs and estimated annual commitments. The Corporate Trustee can revise this amount at any time according to relevant circumstances. The Reserves currently stand at £639k and are calculated as follows:-

Unrestricted Reserves – General Fund £115k Unrestricted Reserves – Designated Fund £265k Restricted Reserves £259k Total Reserves £639k

Review of Finances, Achievements and Performance

Performance

The net assets of the charitable funds as at 31st March 2016 were £639k, a decrease of £10k from 2015.

The charity continues to rely on donations, legacies and investment income as the main sources of income. Total incoming resources increased by £263k overall compared to 2015. There was a decrease in general donations of £43k plus an increase of £218k in legacy income.

Included in the £425k income received during the year, the charity accepted a total of £192k from legacies which were for unrestricted use.

Of the total expenditure, £430k was spent on direct charitable activity across a range of programmes, compared to £274k last year.

Patient Welfare & Amenities

The total spend of £245k represents a vital and valuable contribution to enhancing the provision of clinical care. In addition to numerous smaller items, some larger purchases were made as follows:-

- Improvements to Diagnostic Imaging waiting room - Specialist trolley for ICU - Cold caps for Chemotherapy - Various toys for Children’s Ward - Garden furniture for Stroke Unit - Service leaflets for the Chaplain - Complimentary therapies for breast care patients

Isle of Wight NHS Trust Charitable Fund 3 Annual Report & Accounts 31st March 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

Some funds were also spent on Christmas festivities and gifts for the patients helping to make their stay as enjoyable and comfortable as possible.

The total spend figure also includes £51k funding from the Friends of St Mary’s for numerous items including:-

- Portable ultrasound bladder scanner for District Nursing and Continence Service - Works to the shop at Ryde Community Clinic - Accuvein vein viewing system for Afton ward - Vital signs monitor for MAAU - Battery powered wheelchair for porters - Various smaller items for other departments including Community Rehabilitation, Paediatric Speech & Language and Podiatry

Staff Welfare & Amenities

A total of £74k was spent on smaller items of equipment such as office furniture and IT equipment helping to create efficient working environments for staff. Some funds were also spent on staff functions to benefit staff morale, where donations had been left specifically for this purpose.

Staff Education – Resources & Courses

A total of £111k included a contribution of £49k to Trust wide Further Education Awards plus numerous other ad hoc courses. Funding of £14k was spent on resources such as educational and training materials, all helping to further the knowledge and experience of a wide range of clinical staff.

Investments

Cash is held within the Charities Official Investment Fund (COIF) specifically designed for charities which obtains a competitive investment income return during the year. The interest rate for the period ended 31 March 2016 was 0.45% p.a.

Plans for Future Periods

Mindful of the many changes in the NHS, including efficiency reviews, Service Line Reporting etc, the future direction of the charity will be shaped by changes in the NHS. The reconfiguration of services and the plans for redesigning patient care to meet the needs of the future will influence the priorities for spending charitable funds.

The Corporate Trustee reviews the spending priorities for the charity annually and aligns them with the Trust’s corporate objectives and the charity’s purpose. The focus for the coming year will cover:–

Isle of Wight NHS Trust Charitable Fund 4 Annual Report & Accounts 31st March 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

- improvements to the patient experience - provide support to staff through Further Education and the Trust Awards Ceremony - refinements to locality working to promote integrated care - support Service Transformation

The Corporate Trustee will make every effort to utilise as much of the available funds as possible in furtherance of the charity’s objectives.

Reference and Administrative Details

The Charity, Registered Number 1049606, was entered on the Central Register of Charities on 4 October 1995.

Following the transfer of provider services from the Isle of Wight NHS Primary Care Trust to form the Isle of Wight NHS Trust, the Charity now operates as the umbrella charity of the Isle of Wight NHS Trust. Within this umbrella are the individual designated funds that relate to the various wards, departments and special projects within the Trust.

The charity office and principal address is:

Charitable Funds Isle of Wight NHS Trust St Mary’s Hospital Newport Isle of Wight PO30 5TG

Tel: 01983 822099 x 6274

Corporate Trustee

With effect from 1 April 2012, the Corporate Trustee changed to the Isle of Wight NHS Trust and is governed by the law applicable to Trusts, principally the Trustee Act 2000 and the Charities Act 2011.

The names of those people who served as agents (Trustees) for the Corporate Trustee during the year ended 31 March 2016, as permitted under regulation 16 of the NHS Trusts (Membership and Procedures) Regulations 1990 were as follows:

Danny Fisher Chairman (ceased July 2015) Eve Richardson Chair (from August 2015) Karen Baker Chief Executive Christine Palmer Executive Director of Finance (until September 2015) Executive Director of Financial & Human Resources (from October 2015) Isle of Wight NHS Trust Charitable Fund 5 Annual Report & Accounts 31st March 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

Dr Mark Pugh Executive Medical Director Alan Sheward Executive Director of Nursing & Quality Katie Gray Executive Director of Transformation & Integration (ceased 18 August 2015) Shaun Stacey Chief Operating Officer (from 18 August 2015) Dr Nina Moorman Non Executive Director Charles Rogers Non Executive Director David King Non Executive Director Jessamy Baird Non Executive Director Jane Tabor Non Executive Director Lizzie Peers Non Executive Financial Adviser (non voting)

Under a scheme of delegated authority approved by the Corporate Trustee, the Fund Managers have authority to approve all expenditure up to £1,000. Anything above this limit will follow the process defined in the Trust’s Standing Financial Instructions.

Mrs Katie Parrott, Senior Financial Accountant, acted as the principal officer overseeing the financial management and accounting for the charitable funds during the year. Miss Karrie Kennedy, Assistant Financial Accountant, undertook the day to day duties.

Advisers

Principal Professional Advisers

Bankers Independent Examiner Barclays Bank PLC Ernst & Young LLP St James Square Wessex House Newport 19 Threefield Lane Isle of Wight Southampton SO14 3QB

Tel: 01983 276130 Tel: 023 8038 2285 Contact: Kathy Davis

Investment Company COIF Investment Management Ltd COIF Charity Funds 80 Cheapside London EC2V 6DZ

Tel: 020 7489 6010

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

Structure, Governance and Management

The charity’s unrestricted fund was established using the model Declaration of Trust and all funds held on trust as at the date of registration were either part of this unrestricted fund or registered as separate restricted funds under the main charity. Subsequent donations and gifts received by the charity that are attributable to the original funds are added to those fund balances within the existing charity.

The Corporate Trustee fulfils its legal duty by ensuring that funds are spent in accordance with the objects of each fund and by designating funds the Corporate Trustee respects the wishes of our generous donors to benefit patient care and advance the good health and welfare of patients, carers and staff. The Corporate Trustee has given due consideration to Charity Commission published guidance on the operation of the public benefit requirement.

The charitable funds available for spending are allocated to specialties within the Trust’s management structure. Each allocation is managed by use of a designated fund within the general unrestricted fund. For example, there are charitable funds for Respiratory, Coronary Care Unit, Chemotherapy etc., plus funds for numerous wards. This maintains a clear focus on different patients and patient conditions treated at the hospital sites and enables donor wishes to be more easily respected.

Non-Executive Members of the Trust Board were appointed in 2015/16 by the Trust Development Authority and Executive members of the Board are subject to recruitment by the Trust Board. Members of the Trust Board are not individual trustees under Charity Law but act as agents on behalf of the Corporate Trustee.

Newly appointed members of the Trust Board are provided with copies of the Corporate Trustee’s annual report and accounts, minutes, and information about trusteeship, including Charity Commission booklet CC3, The Essential Trustee.

Partnership Working and Networks

The Isle of Wight NHS Trust is the main beneficiary of the charity and is a related party by virtue of being Corporate Trustee of the charity. By working in partnership with the Trust, the charitable funds are used to best effect. When deciding upon the most beneficial way to use charitable funds, the Corporate Trustee has regard to the main activities, objectives, strategies and plans of the Trust.

We remain indebted to the work of the volunteers of the Isle of Wight Friends of St Mary’s, who raise thousands of pounds each year for St Mary’s Hospital and also to the many members of staff who give up much of their spare time to fund raise.

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

On behalf of the staff and patients who have benefited from improved services due to donations and legacies, the Corporate Trustee would like to thank all patients, relatives and staff who have made charitable donations.

Approved on behalf of the Corporate Trustee:-

Signed Date

Signed Date

Isle of Wight NHS Trust Charitable Fund 8 Annual Report & Accounts 31st March 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

Statement of Corporate Trustee Responsibilities

The Corporate Trustee is responsible for:

- keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the funds held on trust and to enable them to ensure that the accounts comply with requirements in the Charities Act 2011 and those outlined

- establishing and monitoring a system of internal control; and

- establishing arrangements for the prevention and detection of fraud and corruption.

The Corporate Trustee is required under the Charities Act 2011 and the National Health Service Act 1977 to prepare accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the financial position of the funds held on trust, in accordance with the Charities Act 2011. In preparing those accounts, the trustees are required to:

apply on a consistent basis accounting policies laid down by the Secretary of State - with the approval of the Treasury;

- make judgements and estimates which are reasonable and prudent;

state whether applicable accounting standards have been followed, subject to any - material departures disclosed and explained in the accounts;

prepare the financial statements on the going concern basis unless it is inappropriate - to presume that the charity will continue in business.

They are also responsible for safeguarding the assets of the charity and hence for taking reasonable steps or the prevention or detection of fraud and other irregularities

The Corporate Trustee confirms that they have met the responsibilities set out above and complied with the requirements for preparing the accounts. The financial statements set out on pages 10 to 27 attached have been compiled from and are in accordance with the financial records maintained by the trustees.

By Order of the Corporate Trustee

Signed: ……………………………….. Chair

Date: ………………………………... Isle of Wight NHS Trust Charitable Fund 9 Annual Report & Accounts 31st March 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUNDS 2015-2016

Statement of Financial Activities for the year ended 31 March 2016

2014-15 Note Unrestricted Restricted Endowment Total Total Funds Funds Funds Funds Funds £000 £000 £000 £000 £000 Income and Endowments from:- Donations & Legacies 4 364 52 0 416 157 Charitable Activities 0 0 0 0 0 Other Trading Activities 0 0 0 0 0 Investment income 6 2 0 0 2 2 Other 7 0 0 7 3

Total incoming resources 373 52 0 425 162

Resources expended

Raising Funds 7 5 0 0 5 0 Charitable activities 8 Patient Welfare & Amenities 233 12 0 245 172 Staff Welfare & Amenities 72 2 0 74 18 Staff Education - Courses & Resources 104 7 0 111 84 Other 0 0 0 0 0

Total resources expended 414 21 0 435 274

Net (outgoing)/incoming resources before transfers (41) 31 0 (10) (112) Transfers:- Gross transfers between funds 19 0 0 0 0 0

Net (outgoing)/incoming resources before other recognised gains and losses (41) 31 0 (10) (112)

Other recognised gains and losses Gains on revaluation of fixed assets for charity's own use 0 0 0 0 0 Gains/losses on investment assets 0 0 0 0 0 Acturial gains/losses on defined benefit pension schemes 0 0 0 0 0

Net Movement in Funds (41) 31 0 (10) (112)

Reconciliation of Funds Total Funds brought forward 421 228 0 649 761 Total Funds carried forward 380 259 0 639 649

Isle of Wight NHS Trust Charitable Fund 10 Annual Report & Accounts 31st March 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUNDS 2015-2016

Balance Sheet as at 31 March 2016

Notes Unrestricted Restricted Endowment Total at 31 Total at 31 Funds Funds Funds March 2016 March 2015 £000 £000 £000 £000 £000 Fixed Assets Investments 14 385 0 0 385 385 Total Fixed Assets 385 0 0 385 385

Current Assets Debtors 15 35 0 0 35 26 Short term investments and deposits 0 0 0 0 0 Cash at bank and in hand 16 294 9 0 303 309 Total Current Assets 329 9 0 338 335

Liabilities Creditors: Amounts falling due within one year 17 84 0 0 84 71

Net Current Assets 245 9 0 254 264

Total Assets less Current Liabilities 630 9 0 639 649

Creditors: Amounts falling due after more than one year 0 0 0 0 0

Total Net Assets 630 9 0 639 649

Funds of the Charity

Expendable Endowment Funds 0 0 0 0 0 Restricted Income Funds 0 259 0 259 228 Unrestricted Income Funds 380 0 0 380 421

Total Funds 380 259 0 639 649

The notes at pages 12 to 27 form part of these accounts.

Signed: Date

Designation:

Signed: Date

Designation:

Isle of Wight NHS Trust Charitable Fund 11 Annual Report & Accounts 31st March 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUNDS 2015-2016

Statement of Cash Flow at 31 March 2016

Notes Total at 31 Total at 31 March 2016 March 2015 £000 £000 Cash Flows from operating activities: Net cash provided by (used in) operating activities (8) (4) Cash Flows from investing activities: Dividends, interest and rents from investments 2 2 Net cash provided by (used in) investing activities 2 2

Change in cash and cash equivalents in the reporting (6) (2) period Cash and cash equivalents at the beginning of the reporting period 309 311

Cash and cash equivalents at the end of the reporting 303 309 period

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

Notes to the Accounts

1 Accounting Policies

1.1 Basis of Preparation

The financial statements have been prepared under the historic cost convention, with the exception of investments which are included at fair value.

The accounts (financial statements) have been prepared in accordance with the Statement of Recommended Practice: Accounting and Reporting by Charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) issued on 16 July 2014 and the Financial Reporting Standard applicable in the United Kingdom and Republic of Ireland (FRS 102) and the Charities Act 2011 and UK Generally Accepted Practice as it applies from 1 January 2015.

The Corporate Trustee considers that there are no material uncertainties about the IOW NHS Trust Charitable Funds ability to continue as a going concern. There are no material uncertainties affecting the current year’s accounts.

In future years, the key risks to the Charity are a fall in income from donations.

The Charity is a public benefit entity.

1.2 Reconciliation with previous generally accepted accounting practice

In preparing these accounts, the Corporate Trustee has considered whether any restatement of comparatives was required to comply with FRS 102 and the Charities SORP FRS 102. No restatements were required although there has been a change in the analysis of governance costs.

Previously, these had been separately analysed on the face of the statement of financial activity. Governance costs are now classified as a support costs and have therefore been apportioned between fundraising activities and charitable activities. There is no effect on the total expenditure for 2014/15 or 2015/16. The analysis of support costs is shown in Note 10.

1.3 Structure of funds

Where there is a legal restriction on the purpose to which a fund may be put, the fund is designated in the accounts as a restricted fund. Funds where the capital is held to generate income for charitable purposes and cannot itself be spent are accounted for as endowment funds. Other funds are classified as unrestricted funds. Funds which are not legally restricted but which the Trustees have chosen to earmark for set purposes are designated funds. The major funds held in these categories are disclosed on notes 20.1 and 20.2.

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

1.4 Incoming Resources a) All incoming resources are included in full in the Statement of Financial Activities as soon as the following three factors can be met:

i) entitlement - arises when a particular resource is receivable or the charity's right becomes legally enforceable; ii) certainty - when there is reasonable certainty that the incoming resource will be received;

iii) measurement - when the monetary value of the incoming resources can be measured with sufficient reliability. b) Legacies

Legacies are accounted for as incoming resources once the receipt of the legacy becomes reasonably certain. This will be once confirmation has been received from the representatives of the estates that payment of the legacy will be made or property transferred and once all conditions attached to the legacy have been fulfilled.

1.4 Resources expended and irrecoverable VAT

The funds held on trust accounts are prepared in accordance with the accruals concept. All expenditure is recognised once there is a legal or constructive obligation to make a payment to a third party. a) Cost of generating funds

The cost of generating funds are the costs associated with generating income for the funds held on trust. b) Grants payable

Grants payable are payments, made to third parties (including NHS bodies) in the furtherance of the funds held on trust's charitable objectives to relieve those who are sick. They are accounted for on an accruals basis where the conditions for their payment have been met or where a third party has a reasonable expectation that they will receive the grant. This includes grants paid to NHS bodies. c) Support Costs

These are accounted for on an accruals basis and are recharges of appropriate proportions of the costs from the Isle of Wight NHS Trust, apart from the audit fee.

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

1.5 Fixed Assets

The only fixed assets that the Fund has are investment assets.

1.6 Investment Fixed Assets

Investment fixed assets are shown at market value. Other investment fixed assets are included at trustees' best estimate of market value.

1.7 Debtors

Debtors are amounts owed to the charity. They are measured on the basis of their recoverable amount.

1.8 Cash and cash equivalents

Cash at bank and in hand is held to meet the day to day running costs of the charity as they fall due. Cash equivalents are short term, highly liquid investments, usually in 90 day notice interest bearing savings accounts.

1.9 Creditors

Creditors are amounts owed by the charity. They are measured at the amount that the charity expects to have to pay to settle the debt.

Amounts which are owed in more than a year are shown as long term creditors.

1.11 Realised gains and losses

All gains and losses are taken to the Statement of Financial Activities as they arise. Realised gains and losses on investments are calculated as the difference between sales proceeds and opening market value (or date of purchase if later). Unrealised gains and losses are calculated as the difference between market value at the year end and opening market value (or date of purchase if later).

1.12 Value Added Tax (VAT)

No income is generated by the charity which includes VAT. Purchases made by the charity are subject to VAT. Purchases of a medical nature are liable to zero rated VAT when purchased by the charity and VAT zero rated certificates are sent when ordering these goods. Irrecoverable VAT is charged against the category of resources expended for which it was incurred.

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

2 Prior year comparatives by type of fund

2.1 Unrestricted Funds - Statement of Financial Activities for the year ended 31 March 2016

2015-16 2014-15 £000 £000 Income and Endowments from:- Donations & Legacies 364 149 Charitable Activities 0 0 Other Trading Activities 0 0 Investment income 2 2 Other 7 3 Total incoming resources 373 154

Resources expended Raising Funds 5 0 Charitable activities Patient Welfare & Amenities 233 135 Staff Welfare & Amenities 72 18 Staff Education - Courses & Resources 104 79 Other 0 0 Total resources expended 414 232

Net (outgoing)/incoming resources before transfers (41) (78) Transfers:- Gross transfers between funds 0 0

Net (outgoing)/incoming resources before other recognised gains and losses (41) (78)

Other recognised gains and losses Gains on revaluation of fixed assets for charity's own use 0 0 Gains/losses on investment assets 0 0 Acturial gains/losses on defined benefit pension schemes 0 0

Net Movement in Funds (41) (78)

Reconciliation of Funds Total Funds brought forward 421 499 Total Funds carried forward 380 421

Isle of Wight NHS Trust Charitable Fund 16 Annual Report & Accounts 31st March 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

2.1 Unrestricted Funds - Balance Sheet as at 31 March 2016

Total at 31 Total at 31 March 2016 March 2015 £000 £000 Fixed Assets Investments 385 385 Total Fixed Assets 385 385

Current Assets Debtors 35 26 Short term investments and deposits 0 0 Cash at bank and in hand 294 80 Total Current Assets 329 106

Liabilities Creditors: Amounts falling due within one year 84 70

Net Current Assets 245 36

Total Assets less Current Liabilities 630 421

Creditors: Amounts falling due after more than one year 0 0

Total Net Assets 630 421

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

2.2 Restricted Funds - Statement of Financial Activities for the year ended 31 March 2016

2015-16 2014-15 £000 £000 Income and Endowments from:- Donations & Legacies 52 8 Charitable Activities 0 0 Other Trading Activities 0 0 Investment income 0 0 Other 0 0 Total incoming resources 52 8

Resources expended Raising Funds 0 0 Charitable activities Patient Welfare & Amenities 12 37 Staff Welfare & Amenities 2 0 Staff Education - Courses & Resources 7 5 Other 0 0 Total resources expended 21 42

Net (outgoing)/incoming resources before transfers 31 (34) Transfers:- Gross transfers between funds 0 0

Net (outgoing)/incoming resources before other recognised gains and losses 31 (34)

Other recognised gains and losses Gains on revaluation of fixed assets for charity's own use 0 0 Gains/losses on investment assets 0 0 Acturial gains/losses on defined benefit pension schemes 0 0

Net Movement in Funds 31 (34)

Reconciliation of Funds Total Funds brought forward 228 262 Total Funds carried forward 259 228

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

2.2 Restricted Funds - Balance Sheet as at 31 March 2016

Total at 31 Total at 31 March 2016 March 2015 £000 £000 Fixed Assets Investments 0 0 Total Fixed Assets 0 0

Current Assets Debtors 0 0 Short term investments and deposits 0 0 Cash at bank and in hand 9 229 Total Current Assets 9 229

Liabilities Creditors: Amounts falling due within one year 0 1

Net Current Assets 9 228

Total Assets less Current Liabilities 9 228

Creditors: Amounts falling due after more than one year 0 0

Total Net Assets 9 228

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

3 Related Party Transactions

The Isle of Wight NHS Trust as Corporate Trustee receives the majority of the benefit provided by Charitable Funds. However, the individual members have not undertaken any material transactions with the Isle of Wight NHS Trust Charitable Funds during the year.

During the year the staff involved in administering the charity were employed by the Trust and their costs totalling £13,217 were recharged to the charity.

4 Income from donations and legacies 2016 2015 Unrestricted Restricted Total Total Funds Funds £000 £000 £000 £000

Donations from individuals 114 6 120 135 Coporate Donation 58 0 58 0 Legacies 192 46 238 20 364 52 416 155

5 Role of Volunteers

Like all charities, the IOW NHS Trust Charitable Fund is reliant on many volunteers for their involvement in fundraising by way of organising, publicising or undertaking physical challenges to raise funds for all areas of the Trust. The volunteers consist of members of the public and employees of IOW NHS Trust.

In accordance with the SORP, due to the absence of any reliable measurement basis, the contribution of these volunteers is not recognised in the accounts.

6 Total gross Income from investments 2016 2015 Held in UK Held in UK Total Total £000 £000

COIF Interest 2 2 2 2

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

7 Analysis of expenditure on raising funds 2016 2015 Unrestricted Restricted Total Total Funds Funds £000 £000 £000 £000

Fundraising events 5 0 5 0 Support Costs 0 0 0 0 5 0 5 0

8 Analysis of Charitable Expenditure 2016 2015 Activities Grant Undertaken Funded Support Directly Activity Costs Total Total £000 £000 £000 £000 £000 Patient Welfare & Amenities (inc. equipment) 0 234 11 245 172 Staff Welfare & Amenities 0 71 3 74 18 Staff Education & Resources 0 14 1 15 13 Staff Education - Courses 0 92 4 96 71

Total 0 411 19 430 274

9 Analysis of grants

The charity does not make grants to individuals. All grants are made to the IOW NHS Trust to provide for the care of NHS patients in furtherance of our charitable aims. The total cost of making grants, including support costs, is disclosed on the face of the Statement of Financial Activities and the actual funds spent on each category of charitable activity, is disclosed in note 8.

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

10 Allocation of Support Costs and Overheads

Raising Charitable 2016 2015 Basis of Funds Activities Total Total Allocation £000 £000 £000 £000 Finance 0 14 14 15 Information Technology 0 4 4 3 See note Audit - Internal 0 0 0 2 below Audit - External 0 2 2 3 Indemnity insurance 0 -1 -1 1 Total 0 19 19 24

Unrestricted Funds 0 16 16 24 Restricted Funds 0 3 3 0 Total 0 19 19 24

Support costs are allocated ina two stage process. On a monthly basis, we take 5% of each donation amount and transfer it to unallocated to cover a proportion of the support costs. If the total of the costs exceeds the yearly contributions then the balance is taken from the General Fund. The total value of support costs is then allocated on a pro-rata basis against the activities for annual reporting purposes. The amount allocated against Raising Funds was under £1,000 so is not evident from this table.

11 Trustees Remuneration & Expenses

The Trustees have received no remuneration or expenses in 2015/16

12 Analysis of Staff Costs 2016 2015 Total Total £000 £000 Salaries & wages 11 11 Social security costs 2 2 Other pension costs 1 2 Total 14 15

Average monthly number of employees in the year 2 2

Employees: Senior Financial Accountant and Financial Accountant - both full time members of staff with IOW NHS Trust. A proportion of their time is recharged to the Isle of Wight NHS Trust Charitable Fund. They are both members of the IOW NHS Trust pension scheme. Neither employees had emoluments in excess of £60,000

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

13 Auditor’s remuneration

The auditor’s remuneration of £2,430 (2015: £3,240) related solely to the audit with no other additional work being undertaken.

14 Analysis of Fixed Asset Investments. 2016 2015 £000 £000

Market value at 31 March 385 385 Less: Disposals at carrying value 0 0 Add: Acquisitions at cost 0 0 Net gain on revaluation 0 0 Market value at 31 March 385 385

Historic cost at 31 March 385 385

Note: These investments are all held with CCLA Investments in a Charities Official Investment Fund (COIF).

15 Analysis of Current Debtors 2016 2015 Amounts falling due within one year: £000 £000 Amounts due from subsidiary and associated undertakings 0 0 Trade debtors 0 0 Prepayments 0 0 Accrued income 22 20 Other debtors 13 6 Total debtors falling due within one year 35 26

16 Analysis of cash and cash equivalents 2016 2015 £000 £000

Cash in hand 303 309 Total cash and cash equivalents 303 309

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ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

17 Analysis of Current Liabilities

2016 2015 Amounts falling due within one year: £000 £000 Loans and overdrafts 0 0 Trade creditors 0 0 Amounts due to subsidiary and associated undertakings 0 0 Other creditors 82 71 Accruals 2 0 Deferred income 0 0 Total creditors falling due within one year 84 71

18 Reconciliation of net income/(expenditure) to net cash flow from operating activities

2016 2015 £000 £000 Net income/(expenditure) for 2015/16 (as per the Statement of Financial Activities) -10 -112 Adjustments for: Depreciation charges 0 0 (Gains)/losses on investments 0 0 Dividends, interest and rents from investments -2 -2 Loss/(profit) on the sale of fixed assets 0 0 (Increase)/decrease in stocks 0 0 (Increase)/decrease in debtors -9 100 Increase/(decrease) in creditors 13 10 Net cash provided by (used in) operating (8) (4) activities

19 Details of transfers between funds

Transfer Reason Amount Fund Type From fund To fund £000

Funding as Breast Care Wig agreed 2.5 Unrestricted Breast Screening General Unused balance 0.1 Unrestricted

Cardiac Investigations General Unused balance 0.4 Unrestricted Diagnostic Imaging General Unused balance 0.3 Unrestricted Luccombe Ward General Unused balance 0.1 Unrestricted Paediatric Diabetes General Unused balance 0.2 Unrestricted Speech & Language General Unused balance 0.1 Unrestricted Stoma Care General Unused balance 0.1 Unrestricted Isle of Wight NHS Trust Charitable Fund 24 Annual Report & Accounts 31st March 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

20 Analysis of Funds

20.1 Restricted funds Balance Incoming Resources Transfers Gains and Balance 31 March Resources Expended Losses 31 March 2015 2016 £000 £000 £000 £000 £000 £000 Material funds A Healing Arts 8 0 (1) 0 0 7 B Legacy 0 0 0 0 0 0 C Legacy 30 0 (1) 0 0 29 D Legacy 157 46 (15) 0 0 188 E NICU - Barely Born 33 6 (4) 0 0 35 Total 228 52 (21) 0 0 259

Name of fund Description of the nature and purpose of each fund

A Healing Arts Links arts with healthcare to improve recovery & promote well-being Funds are reserved for maintenance & repairs to existing art works

B Restricted Legacy (Elderly) Legacy bequeathed for Elderly Services - Now closed

C Restricted Legacy (Laidlaw ) Legacy bequeathed for Laidlaw Day Hospital

D Restricted Legacy (ITU) Legacy bequeathed for Intensive Care

E NICU - Barely Born Specific appeal for Neonatal Intensive Care Unit - note this was incorrectly included under Unrestricted funds in 2012/13.

Isle of Wight NHS Trust Charitable Fund 25 Annual Report & Accounts 31st March 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

20.2 Unrestricted Funds

The purpose of all Unrestricted funds is to benefit patient and staff welfare including education and training where appropriate.

Balance Incoming Resources Transfers Gains and Balance 31 March Resources Expended Losses 31 March 2015 2016

£000 £000 £000 £000 £000 £000

General Fund 119 258 (264) 2 0 115

Designated Funds Breast Care 69 6 (17) (3) 0 55 Cancer Research 19 0 0 0 0 19 Chapel 5 5 (3) 0 0 7 Chemotherapy 66 8 (12) 0 0 62 Childrens Ward 4 11 (10) 0 0 5 Colwell Ward 4 0 0 0 0 4 Community Heart Failure 17 1 (11) 0 0 7 Coronary Care Unit 8 0 0 0 0 8 Dr Harms Research Fund 5 3 (1) 0 0 7 Intensive Therapy Unit 2 4 (2) 0 0 4 Nurses 4 0 (1) 0 0 3 Orthopaedic Department 4 0 (1) 0 0 3 Post Grad Med Centre 6 0 0 0 0 6 Respiratory Department 18 6 (13) 0 0 11 Rheumatology Fund 22 0 (3) 0 0 19 Stroke Services 8 3 (5) 0 0 6 Wig Fund 3 0 (4) 3 0 2 Other funds with movements less than £1000 or balances less than £4000 ** 36 14 (13) (2) 0 35 See next section Friends of St Marys 0 51 (51) 0 0 0 Roundings 2 3 (3) 0 0 2 Sub Total 421 373 (414) 0 0 380

The purpose of all Unrestricted funds is to benefit patient and staff welfare including education and training where appropriate.

Isle of Wight NHS Trust Charitable Fund 26 Annual Report & Accounts 31st March 2016

ISLE OF WIGHT NHS TRUST CHARITABLE FUND ANNUAL REPORT & ACCOUNTS AS AT 31 MARCH 2016

20.2 Unrestricted Funds (Continued)

Balance Incoming Resources Transfers Gains and Balance 31 March Resources Expended Losses 31 March 2015 2016

** Breakdown of other funds with movements less than £1,000 or balances less than £4,000

£ £ £ £ £ £ Accident & Emergency 1,481 175 (9) 0 0 1,647 Afton Ward 968 0 (120) 0 0 848 Allergy Research 126 0 (126) 0 0 (0) Alverstone Ward 1,099 125 (176) 0 0 1,048 Ambulance General 3,135 825 (241) 0 0 3,719 Appley Ward 3,173 50 (2,472) 0 0 751 Breast Screening Unit 88 155 (8) (107) 0 128 Cancer CNS 2,513 2,506 (1,627) 0 0 3,392 Cardiac Investigations 396 770 0 (396) 0 770 Childrens Community Fund 484 1,990 (135) 0 0 2,339 Community Fund 0 0 0 0 0 0 Community Stroke (CSRT) 519 300 (197) 0 0 622 Diabetic Centre 3,339 0 (459) 0 0 2,880 Diagnostic Imaging 338 0 0 (338) 0 (0) District Nurses 904 0 0 0 0 904 Dr Al-bahrani Research fund 878 2,923 (878) 0 0 2,923 Dr Magier Research Fund 1,961 519 (1,887) 0 0 593 Endoscopy Unit 1,181 0 0 0 0 1,181 England Fund Sevenacres 592 1,905 (923) 0 0 1,574 Helipad 613 0 531 0 0 1,144 Learning Disability Fund 556 0 (127) 0 0 429 Luccombe Ward 237 33 (102) (102) 0 66 Maternity 1,127 300 (1,155) 0 0 272 Medical Assesment Unit 1,333 103 (219) 0 0 1,217 Ophthalmic Department 1,821 0 (1,821) 0 0 0 Paediatric Diabetes 275 0 0 (275) 0 0 Rehabilitation Unit 2,171 150 (908) 0 0 1,413 Sevenacres Staff Fund 471 60 160 0 0 691 Speech & Language Therapy 100 0 0 (100) 0 (0) St Helens Ward 941 0 (100) 0 0 841 Stoma Care 93 0 0 (93) 0 0 Urology Unit 1,424 1,250 (40) 0 0 2,634 Whippingham Ward 1,232 45 (137) 0 0 1,139 35,569 14,184 (13,176) (1,411) 0 35,166 Rounded to £000's 36 14 (13) (2) 0 35

Isle of Wight NHS Trust Charitable Fund 27 Annual Report & Accounts 31st March 2016

St. Mary’s Hospital Newport Isle of Wight PO30 5TG Tel No. (01983) 822099 8 December 2016

Ernst & Young LLP Apex Plaza Forbury Road Reading RG1E 1YE

Dear Sirs

This representation letter is provided in connection with your audit of the financial statements of Isle of Wight NHS Charitable Funds (“the Charity”) for the year ended 31 March 2016.

We recognise that obtaining representations from us concerning the information contained in this letter is a significant procedure in enabling you to form an opinion as to whether the financial statements give a true and fair view of the financial position of Isle of Wight NHS Charitable Funds of 31 March 2016 and of its financial performance for the year then ended in accordance with Accounting and reporting by Charities; Statement of Recommended Practice (Charities SORP [FRS102]) and applicable UK Accounting Standards and Charities Act 1993, 2006 and 2011.

We understand that the purpose of your audit of our financial statements is to express an opinion thereon and that your audit was conducted in accordance with International Standards on Auditing (UK and Ireland), which involves an examination of the accounting system, internal control and related data to the extent you considered necessary in the circumstances, and is not designed to identify - nor necessarily be expected to disclose – all fraud, shortages, errors and other irregularities, should any exist.

Accordingly, we make the following representations, which are true to the best of our knowledge and belief, having made such inquiries as we considered necessary for the purpose of appropriately informing ourselves:

A. Financial Statements and Financial Records

1. We have fulfilled our responsibilities, as set out in the financial statements, for the preparation of the financial statements in accordance with Accounting and reporting by Charities; Statement of Recommended Practice (Charities SORP [FRS102]) and applicable UK Accounting Standards and Charities Act 1993 and 2006 and 2011.

2. We acknowledge, as members of the corporate trustee, our responsibility for the fair presentation of the financial statements. We believe the financial statements referred to above give a true and fair view of the financial position, financial performance and cash flows of the Charity in accordance with Accounting and reporting by Charities; Statement of Recommended Practice (Charities SORP [FRS102]) and applicable UK Accounting Standards and Charities Act 1993 and 2006 and 2011 and are free of material misstatements, including omissions. We have approved the financial statements.

3. The significant accounting policies adopted in the preparation of the financial statements are appropriately described in the financial statements.

4. As members of the corporate trustee of the Charity, we believe that the Charity has a system of internal controls adequate to enable the preparation of accurate financial statements in accordance with Accounting and reporting by Charities; Statement of Recommended Practice (Charities SORP [FRS102]) and applicable UK Accounting Standards and Charities Act 1993 and 2006 and 2011 are free from material misstatement, whether due to fraud or error.

B. Fraud

1. We acknowledge that we are responsible for the design, implementation and maintenance of internal controls to prevent and detect fraud.

2. We have disclosed to you the results of our assessment of the risk that the financial statements may be materially misstated as a result of fraud.

3. We have no knowledge of any fraud or suspected fraud involving management or other employees who have a significant role in the Charity’s internal controls over financial reporting. In addition, we have no knowledge of any fraud or suspected fraud involving other employees in which the fraud could have a material effect on the financial statements. We have no knowledge of any allegations of financial improprieties, including fraud or suspected fraud, (regardless of the source or form and including without limitation, any allegations by “whistleblowers”) which could result in a misstatement of the financial statements or otherwise affect the financial reporting of the Charity.

C. Compliance with Laws and Regulations

1. We have disclosed to you all known actual or suspected noncompliance with laws and regulations whose effects should be considered when preparing the financial statements.

D. Information Provided and Completeness of Information and Transactions

1. We have provided you with:

· access to all information of which we are aware that is relevant to the preparation of the financial statements such as records, documentation and other matters as agreed in terms of the audit engagement;

· additional information that you have requested from us for the purpose of the audit; and

· unrestricted access to persons within the entity from whom you determined it necessary to obtain audit evidence.

2. All material transactions have been recorded in the accounting records and are reflected in the financial statements. 3. We have made available to you all minutes of the meetings of trustees and sub- committees of trustees (or summaries of actions of recent meetings for which minutes have not yet been prepared) held through the year to the most recent meeting.

4. We confirm the completeness of information provided regarding the identification of related parties. We have disclosed to you the identity of the Charity’s related parties and all related party relationships and transactions of which we are aware, including sales, purchases, loans, transfers of assets, liabilities and services, leasing arrangements, guarantees, non-monetary transactions and transactions for no consideration for the period ended, as well as related balances due to or from such parties at the year end. These transactions have been appropriately accounted for and disclosed in the financial statements.

5. We have disclosed to you, and the Charity has complied with, all aspects of contractual agreements that could have a material effect on the financial statements in the event of non-compliance, including all covenants, conditions or other requirements of all outstanding debt.

E. Liabilities and Contingencies

1. All liabilities and contingencies, including those associated with guarantees, whether written or oral, have been disclosed to you and are appropriately reflected in the financial statements.

2. We have informed you of all outstanding and possible litigation and claims, whether or not they have been discussed with legal counsel.

3. We have recorded and/or disclosed, as appropriate, all liabilities related litigation and claims, both actual and contingent. No guarantees have been given to third parties.

F. Subsequent Events

1. There have been no events subsequent to period end which require adjustment of or disclosure in the financial statements or notes thereto.

G. Accounting estimates

1. We believe that the significant assumptions we used in making accounting estimates, including those measured at fair value, are reasonable.

H. Restricted and Endowed Funds

1. We have identified whether any income or assets received is for restricted or endowed purposes. In such cases this income/these assets have been ring fenced and matched with related expenditure and disclosed separately as such funds in the financial statements.

Specific representations In connection with your audit of the comparative financial statements for the year ended 31 March 2016 we represent, to the best of our knowledge and belief, the following:

1. There have been no significant errors or misstatements, or changes in accounting policies that would require a restatement of the amounts from the financial statements for the year ended 31 March 2015 which are shown as comparative amounts in the financial statements for the year ended 31 March 2016. Any differences in the comparative amounts from the amounts in the financial statements for the year ended 31 March 2015 are solely the result of reclassifications for comparative purposes.

Ownership of investment assets

1. The Charity has satisfactory title to all assets appearing in the balance sheet(s), and there are no liens or encumbrances on the Charity’s assets, nor has any asset been pledged as collateral. All assets to which the Charity has satisfactory title appear in the balance sheet.

2. There are no formal or informal compensating balance arrangements with any of our cash and investment accounts.

Contingent Liabilities

1. We are unaware of any violations or possible violations of laws or regulations the effects of which should be considered for disclosure in the financial statements or as the basis of recording a contingent loss (other than those disclosed or accrued in the financial statements).

2. We are unaware of any known or probable instances of non-compliance with the requirements of regulatory or governmental authorities, including their financial reporting requirements, and there have been no communications from regulatory agencies or government representatives concerning investigations or allegations of non-compliance.

Use of the Work of an Expert

1. We agree with the findings of the experts engaged to manage the Charity’s investments and who provide valuations for those investments which are recorded in our balance sheet for the year ended 31 March 2016.

2. We have evaluated their valuations and have adequately considered the qualifications of the experts in determining the amounts and disclosures included in the financial statements and the underlying accounting records. We did not give or cause any instructions to be given to the experts with respect to the values or amounts derived in an attempt to bias their work, and we are not otherwise aware of any matters that have had an effect on the independence or objectivity of the experts.

Yours Faithfully,

Chair

Signed on behalf of the Corporate Trustee

Independent examiner’s report to the trustees of Isle of Wight NHS Trust Charitable Funds

I report on the accounts of the Trust for the year ended 31 March 2016, which are set out on pages 10 to 27.

This report is made solely to the trustees, as a body, in accordance with the Audit Commission’s engagement letter dated 31 July 2012. The examination has been undertaken so that we might state to the trustees those matters that are required to be stated in an examiner’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charity and the trustees as a body, for this examination, for this report, or for the statements made. Respective responsibilities of trustees and independent examiner The charity’s trustees are responsible for the preparation of the accounts. The trustees consider that an audit is not required for this year under section 144(2) of the Charities Act 2011 (the 2011 Act) and that an independent examination is needed.

It is my responsibility to:

„ examine the accounts under section 145 of the 2011 Act;

„ to follow the procedures laid down in the general Directions given by the Charity Commission under section 145(5)(b) of the 2011 Act; and

„ to state whether particular matters have come to my attention.

Basis of independent examiner’s report My examination was carried out in accordance with the general Directions given by the Charity Commission. An examination includes a review of the accounting records kept by the charity and a comparison of the accounts presented with those records. It also includes consideration of any unusual items or disclosures in the accounts, and seeking explanations from you as trustees concerning any such matters. The procedures undertaken do not provide all the evidence that would be required in an audit and consequently no opinion is given as to whether the accounts present a ‘true and fair view’ and the report is limited to those matters set out in the statement below.

Independent examiner’s statement In connection with my examination, no matter has come to my attention:

1. which gives me reasonable cause to believe that in any material respect the requirements:

„ to keep accounting records in accordance with section 130 of the 2011 Act; and

„ to prepare accounts which accord with the accounting records, comply with the accounting requirements of the 2011 Act have not been met; or

2. to which, in my opinion, attention should be drawn in order to enable a proper understanding of the accounts to be reached.

Paul King For and on behalf of Ernst & Young LLP 2

Chartered Institute of Public Finance and Accountancy Apex Plaza Forbury Road Reading RG1 1YE

XX Dec 2016