COUNCIL OF GOVERNORS Thursday 5 September 2019, 09:30 – 12:30 Marsh Jackson Lecture Room, The Academy, Level 4, YDH AGENDA Action Presenter Time Enclosure
1 Welcome and Apologies for Absence To Note Paul von der Heyde 09:30 Verbal
2 Declarations of Interest Relating to Items on the To Note Paul von der Heyde Verbal Agenda
3 Minutes from 6 June 2019 and to Discuss any To Approve Paul von der Heyde 09:35 Appendix 1 Actions/Matters Arising
4 Executive Report To Receive Jonathan Higman 09:40 Appendix 2
5 Annual Report, Quality Report 2018/19 and the To Receive Ben Edgar-Attwell 09:55 Annex A External Audit Opinion Bernice Cooke Presentation
6 Governor Quality and Operational Performance To Receive Jonathan Higman 10:20 Appendix 3 Dashboard and an Update on Financial Shelagh Meldrum Performance
7 Patient Experience Report To Receive Shelagh Meldrum 10:45 Appendix 4
8 YDH Priorities and Strategy Update To Receive Jonathan Higman 10:55 Presentation
Tea/Coffee Break – 11:20-11:30
9 Sepsis Care at Yeovil Hospital To Receive Leigh Beard 11:30 Presentation Emma Young
10 NED Update and Board Assurance Committee To Receive NEDs 11:50 Verbal updates*: Committee • Governance Committee Attendees • Audit Committee • Workforce Committee
11 Governor Committees and Working Groups**: • Membership and Communications To Receive Tony Robinson 12:00 Appendix 5 • Strategy and Performance Alison Whitman • Patient Experience Janette Cronie • Board Attendance Governor Attendees
12 Any Other Business and Close of Meeting To Note All 12:15 Verbal
13 Date and Time of Future Meetings: To Note All Verbal Thursday 5 September 2019, Marsh Jackson Lecture Room, The Academy, Level 4, YDH
14 Exclusion of the Public Paul von der Verbal To RESOLVE that representatives of the press and other Heyde members of the public be excluded from the remainder of the meeting due to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.
15 Review of Meeting by Governors Alison Whitman Verbal An opportunity for governors to consider the matters presented in the meeting in the absence of the officers of the Trust, and to confirm that the governors have received sufficient information to enable them to discharge their statutory duties.
COUNCIL OF GOVERNORS Minutes of the Council of Governors held on 06 June 2019, Marsh Jackson, Level 4, YDH
Present: Paul von der Heyde Chairman Alison Whitman Public Governor Tony Robinson Public Governor Virginia Membrey Public Governor Alan Harrison Public Governor Janette Cronie Public Governor Mick Beales Public Governor Lou Evans Appointed Governor Faye Purbrick Appointed Governor Fiona Rooke Staff Governor Sekhar Thananki Partnership Governor Caroline Moore Non- Executive Director Maurice Dunster Non-Executive Director Jane Henderson Non-Executive Director
In Attendance: Jonathan Higman Chief Executive Shelagh Meldrum Deputy Chief Executive and Chief Nurse Mike Barber Interim Director of Finance Ben Edgar-Attwell Company Secretary Melissa Mitchell Assistant Company Secretary Alison Van Laar Psychiatric Liaison Team, Somerset Partnership Jo Howarth Deputy Chief Nurse Amy Rose General Manager, A&E Tom Norton Chief Information Officer & Director of Transformation
Apologies: Jennie Flory Public Governor Roger Wharton Public Governor Nigel Stone Public Governor Sue Bulley Public Governor Sue Brown Public Governor John Webster Public Governor David Recardo Appointed Governor Paul Porter Staff Governor Martyn Scrivens Non-Executive Director Graham Hughes Non-Executive Director
Ref: No: Action 1- 1 WELCOME AND APOLOGIES FOR ABSENCE 1920 1.1 The Chairman welcomed those in attendance. Apologies were noted as above. Mike Barber was introduced and welcomed to the Council.
2- 2 DECLARATIONS OF INTEREST RELATING TO ITEMS ON THE AGENDA 1920 2.1 Paul von der Heyde stated his declarations as follows: Trustee and Adviser Howlands Furniture Group, Office Furniture Manufacturer Sister-in-law is the sister of Dr Ali Parsa who is the Founder and Chief Executive Officer of Babylon Healthcare Services Director of The Worshipful Company of Furniture Makers’ Charitable Funds incorporating the Furnishing Trades Benevolent Association
Director and Shareholder of Herswell Consulting Chairman of Psoriasis and Psoriatic Arthritis Alliance & PAPAA Enterprises Ltd Director and Shareholder of Sweetfish Limited.
3- 3 MINUTES FROM MARCH AND MATTERS ARISING 1920 3.1 The minutes of the March meeting were approved as an accurate record subject to minor amendments.
4- 4 RECOMMENDATIONS FROM THE APPOINTMENTS COMMITTEE 1920 4.1 Paul von der Heyde informed the Council that following the recent Appointments Committee, electronic approval had been sought from the full Council of Governors for the reappointment of relevant Non-Executive Directors.
4.2 It was noted that Paul von der Heyde was successfully reappointed for a further year as Chairman and Maurice Dunster and Jane Henderson were both successful in being reappointed for another year in their NED roles. Caroline Moore was successfully reappointed for a further 3-year term.
5- 5 GOVERNOR ELECTIONS 1920 5.1 Paul von der Heyde advised the Council that following the recent Governor elections, two new Governors have been successful in election. Paul von der Heyde confirmed that Jennie Flory was successfully elected for South Somerset (South & West) and Roger Wharton was successfully elected for Greater Yeovil. It was noted that both new Governors will be attending the Governors’ Breakfast meeting in July 2019 where official introductions will take place. Paul von der Heyde welcomed back Fiona Rooke and Paul Porter who have been re-elected as staff Governors and Tony Robinson who had been re-elected for South Somerset.
5.2 Paul von der Heyde informed the Council that Peter Shorland had stood down as Appointed Governor for Dorset following the recent local elections.
6- 6 GOVERNOR FOCUS CONFERENCE 1920 6.1 Tony Robinson and Nigel Stone attended the Governor Focus conference in May 2019. Tony Robinson provided the Council with an update following the conference to include national policy updates, equality and diversity, closer working opportunities for the benefit of patients and the work of the Governor Advisory Committee.
6.2 Tony Robinson advised the Council that system working was highlighted at the conference. He informed the Council that all Sustainable and Transformation Plans (STPs) are to become Integrated Care Systems (ICS) by 2021. Tony Robinson added that all ICS’s will likely have a partnership board, a non- executive chair and be fully engaged with primary care. He added that all providers will be required to contribute to the ICS performance.
6.3 Tony Robinson advised that funding of the NHS was considered and discussed and the current financial position for providers was reviewed. Paul von der Heyde asked if there was discussion with Governors at the conference about future funding allocations. Tony Robinson advised that there was no open discussion, this was discussed via the presenters.
6.4 Tony Robinson advised the Council that it was noted at the conference that workforce is a problem across the country. Shelagh Meldrum said there are a
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number of nurses coming through the system as a result of the Trust’s overseas recruitment campaign.
6.5 Tony Robinson advised the Council that Healthwatch England was one of the main focusses at the conference. He went on to say that Healthwatch England’s role is to ensure the voice of the public is heard in the planning, design and delivery of health and care services. Ben Edgar-Attwell said that Healthwatch comment on the Trust’s Quality Account and Jonathan Higman added that they also work on a system level. Lou Evans advised that a representative from Healthwatch England observes Somerset Clinical Commissioning Groups (CCG) Board.
6.6 Tony Robinson spoke of the Workforce Race Equality Standard (WRES) session at the conference. It was noted that 1.4 million people work in the NHS. 20% of staff are from BME backgrounds, 28% of GPs are from BME backgrounds and 40% of hospital doctors are also from BME backgrounds. Tony Robinson highlighted that less than 6% of senior managers are from a BME background. Paul von der Heyde said that Yvonne Coghill has been to board and presented to Board level. Shelagh Meldrum added the Trust benchmarks well in this area.
6.7 Tony Robinson advised the Council that it was a very good conference and feels the event should be attended by Governor representatives on an annual basis and Paul von der Heyde agreed, saying that it appeared to be a good conference and he feels it is something that should be attended every year.
7- 7 PSYCHIATRIC LIASON TEAM 1920 7.1 Alison van Laar attended the meeting from Somerset Partnership NHS Foundation Trust to give a presentation on the Psychiatric Liaison service.
7.2 Alison van Laar gave a review of the year which included the teams’ first annual report. She advised the Council that Liaison Psychiatry is a sub-speciality of psychiatry concerned with the assessment and management of mental disorders in the acute hospital setting.
7.3 Alison van Laar presented an activity graph to show referral rates to the service from the Emergency Department and wards. Paul von der Heyde asked how the Trust compares to other organisations in terms of referrals. Alison van Laar advised that referrals are average across all organisations. Tony Robinson asked whether figures from the Emergency Department include re-attending patients. Alison van Laar advised that these do appear in the figures.
7.4 Paul von der Heyde asked if any analysis has been completed regarding the age of patients. Alison van Laar said that no analysis has been done with age as yet however agreed this would be an interesting analysis to carry out.
7.5 Jonathan Higman advised that he spent a morning with Lucy Knight within the team, which he really enjoyed. He advised that this session highlighted a barrier and challenges in the accessibility of systems and technology and there was an opportunity to address this and developing training and learning for staff members. He asked whether the team would require extra resources to complete this. Alison van Laar said they need an open forum closed training session and also training and learning on the wards. Jo Howarth added that Dementia Nurses are now prescribers which is an increased help and there is a CQUIN this coming year which will be focusing on prescribing. Lou Evans asked if the team have access to the GP records. Alison van Laar said that the system Somerset Partnership use does not link to the Trust’s systems.
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8- 8 PATIENT EXPERIENCE 1920 8.1 Shelagh Meldrum and Jo Howarth presented the Patient Experience Report and activities to the Council.
8.2 Jo Howarth informed the Council that a new patient experience strategy was launched in 2018 which includes a more proactive approach for the Patient, Advice and Liaison Service (PALs). It was noted that the strategy is focused on how the Trust engages with use of services and it also reflects ambitions of personalised care. Jo Howarth explained that the strategy focusses on the co- design and adoption of Always Events methodology.
8.3 Jo Howarth said the use of ‘Esther Cafes’ are included within the Strategy. She added that the cafes are patient centred forums and stories are told around a table in a café culture. The cafes enable staff to hear stories from a patient perspective. Jo Howarth advised that the first café that took place was a test of the methodology and the approach taken was very powerful. Positive learning has been taken from the first event and the next Esther café is to take place on 16 August 2019 and all Governors are invited to attend.
8.4 Shelagh Meldrum spoke to the Council about the new Patient Experience Report. She advised that that report is clear and confirmed that the response rate of complaints and compliments received will be added on the next report. Shelagh Meldrum advised that the report looks at the positives and a lot of learning can be taken from the compliments. Shelagh Meldrum informed the Council that the Trust need to ensure that feedback is given to individuals and that any personal comments to staff are received. Paul von der Heyde asked how Governors will have access to the report going forward. Shelagh Meldrum advised that the report is available on a monthly basis and Governors can receive this via Mel Mitchell.
9- 9 A&E HEATMAP 1920 9.1 Amy Rose joined the Council to present the Accident and Emergency (A&E) Heatmap.
9.2 Amy Rose provided an overview of the Emergency Departments (ED) quality indicators and brought particular attention to the four-hour performance indicator which the Trust is doing exceptionally well on. She advised that only 1 in 7 trusts are currently achieving this four-hour standard.
9.3 Amy Rose went on to talk about the South Western Ambulance Service NHS Foundation Trust (SWAST) handover times which is also a quality indicator for ED. She explained that this measure is monitored closely and the majority of ambulance handovers are within the 15-minute target. It was noted that the number of patients who left without being seen, unplanned attendances and time to treatment are also measured and the ED management team monitor all measures closely.
9.4 Amy Rose shared the ED attendees by week and four-hour performance with the Council to show how performance has improved from January 2016. It was apparent that the closure of the walk in centre has seen the biggest increase in ED demand. Amy Rose said that within ED additional minor rooms have been implemented to assist with the response in the growth alongside the work with the Patient Flow Team which is ongoing.
9.5 Lou Evans asked how busy the out of hours’ service becomes. Amy Rose advised that increased activity is seen in the evenings due to patients not being able to see their GPs. 4 | P a g e
9.6 Lou Evans asked if there were any improvements which could be made in collaboration with SWAST to stem the growth in demand. Amy Rose confirmed that the ED department have a very good relationship with SWAST with a number of improvements in recent years. In an ideal world, ambulance arrivals would be staggered throughout the day rather than high periods of activity although this is an unknown and not possible to facilitate.
9.7 Tony Robinson asked whether there was data available for Ambulatory Emergency Care (AEC). Amy Rose advised that there has been growth within this service. It was noted the AEC figures are not included within the ED figures. She added the AEC unit is reviewing ways to provide additional support to ED.
10- 10 CHIEF EXECUTIVE UPDATGE AND CQC RESULTS 1920 10.1 The circulated executive report was noted. In addition to the circulated report, Jonathan Higman gave the Council an update on the system operational plans for 2019/20. He advised that a plan was submitted at the end of May 2019.
10.2 Jonathan Higman informed the Council that there is a significant amount of transformation and developments across the wider Somerset system that would need to be addressed within the four organisations. Jonathan Higman advised that the Clinical Commissioning Group (CCG) have agreed to hold the balance of the financial risk as the plan moves forward. Jonathan Higman explained that in order to build system sustainability, the Somerset system needs to ensure that aspects outlined within the plan are actioned accordingly.
10.3 Jonathan Higman advised that the system now needs to work on the development of neighbourhoods and the establishment of primary care networks. He added that management and referral centres within the system need to be reviewed and a significant programme of work will take place looking at the acute provision of work. Jonathan Higman confirmed that developments will proactively be fedback to the Governors as and when available.
10.4 Jonathan Higman advised the Council that for the Trust, the financial challenge means the cost improvement plan (CIP) for this year is £5.7m; this is an extremely challenging target, for which there is a current unidentified gap in plan amounting to approximately £1.3m. Mike Barber advised that the system plan was submitted £19.9 system wide deficit to be held entirely by CCG to enable providers to hit their control totals. This will allow providers the opportunity to access provider sustainability funding.
10.5 Jonathan Higman added that as part of the overall operational plan, elective care and waiting times across providers were reviewed. Jonathan Higman advised that the Trust has agreed to take up to an additional 1200 elective referrals to support Musgrove Park Hospital (MPH). Paul von der Heyde added that this was address the waiting times disparity across the county.
10.6 Tony Robinson asked what the biggest risk is in relation to the finances. Paul von Der Heyde advised that the biggest risk is the continuous growth in demand. Mike Barber added that there are also significant risks relating to cost improvement plans with a risk in the Trust not being able to deliver savings targets. Shelagh Meldrum also added that there is a risk of time being spent on discussion about finance and losing sight on clinical and safety. She advised we need to be mindful what this feels like for our workforce.
10.7 Alan Harrison asked how much engagement takes place with Dorset as he notices that house builds are ongoing in Sherborne also which will lead to further 5 | P a g e
demand on hospital services. Jonathan Higman advised the Trust is engaging with the Dorset system with the intention to work together for the best outcomes for patients.
CQC Results 10.8 Shelagh Meldrum presented the results following the recent Care Quality Commission (CQC) inspection which took place in December 2018 and the ‘Use of Resources’ inspection that followed in January 2019.
10.9 Shelagh Meldrum presented the Council with the 2016 CQC ratings in the first instance. She went onto advise that CQC Inspections this year took place in the ‘requires improvement’ areas from the last inspection. The results of the new inspection showed that the core services received a ‘Good’ overall rating following the CQC visit.
10.10 Tony Robinson asked whether the end of life rating of ‘requires improvement’ rating was unexpected. Shelagh Meldrum advised that the rating was disappointing and that this is partly due to the Trust not having a dedicated end of life department. A number of positive aspects of the service were however recognised.
10.11 Jonathan Higman went onto discuss the Use of Resources review which is led by NHS Improvement along with the CQC. Jonathan Higman advised that the Trust received a ‘good’ rating for clinical services and an ‘inadequate’ rating for the use of resources resulting in an overall Trust rating of ‘Requires Improvement.’ Jonathan Higman went onto say that the overall rating had been driven by the Use of Resources rating. He added that the Trust needs to demonstrate a better oversight of financial governance and that more robust plans for addressing and reducing elements of the deficit that are within the Trust’s control.
11- 11 QUALITY AND OPERATIONAL PERFORMANCE 1920 11.1 The Quality and Operational Performance dashboard was circulated with the papers. Paul von der Heyde asked the Council whether they had any rising queries or questions in relation to the dashboard.
11.2 It was highlighted that appraisal compliance rates are now green which is a fantastic achievement made by all within the Trust.
11.3 Alison Whitman noted that the cancer data still shows areas of concern. Shelagh Meldrum confirmed that in the last year the Trust has seen a 14% increase in cancer referrals and there has also been a national increase. She went on to say that Dermatology are facing challenges and the level of Urology cancer referrals has had a slight impact too. Shelagh Meldrum informed the Council that the Trust are confident in addressing the 62-day treatment cancer target however stated that the two week wait is a continuous challenge and the Trust is facing busy times at the moment. Fiona Rooke added that the targets are set at a national level and patient personal choice is not considered within these targets and the Trust will be recorded as breaching the target if the patient decides to postpone appointments or takes additional time to consider their treatment. Janette Cronie said when surgery is delayed for medical reasons this is recorded and questioned whether this could not be recorded for cancer too. Jonathan Higman said that there are very clear national rules. Shelagh Meldrum said Referral to Treatment (RTT) national rules have also changed too.
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11.4 Jonathan Higman advised that the system has to work as a system and the regulators are currently reviewing the submitted operational plan. A long-term plan is required to be submitted towards the end of the year to cover a 4-5 year period.
FINANCIAL PERFORMANCE 11.5 Mike Barber advised the financial accounts have been signed off by KPMG as the Trust’s auditors and performance for the first month of financial year was on track with budget, although it was important to note the risk to the financial position as discussed earlier in the meeting.
12- 12 DIGITAL UPDATE 1920 12.1 Tom Norton joined the meeting and provided an update on Digital and Trakcare.
12.2 Tom Norton advised the Council that the digital approach is made up of three principles of which are, sorting the basics, maximising existing investments and future proofing and innovating. He went on to say that the delivery aims to reduce paper, improve availability and quality of the IT estate, and to improve training and access to systems. Tom Norton informed the Council that the Digital team are looking at how the Trust can maximise the existing investments in systems and technology. To ensure that the Trust is in line with national programmes, STP collaboration and support development of innovative new technology, Tom Norton said that the current solutions in place will be future proofed, and not developed in isolation.
12.3 Tom Norton advised that the Trust has initiated a rolling digital programme called ‘this is IT!’. The programme changes the approach from a general level of support across the whole Trust, to a specific focus on all aspects of IT, Information Governance and Training in each area of the Trust – one department at a time. This will support a full systems and data audit, ensuring Trust compliance with GDPR, will deliver refined training package, and deliver key projects and milestones such as removing all fax machines, and reducing paper consumption where possible. Single sign-on will also be fully embedded in each department, whilst equipment (PCs, laptops and tablets) will be reviewed. As a result, the availability of technology will be increased and there will be a detailed understanding of the workforce IT needs within the IT and Transformation teams.
12.4 Tony Robinson asked how integration would be categorised with Dorset. Tom Norton advised that although this is not a mandated activity, there are strong links between Dorset County Hospital NHS Foundation Trust (DCH) and YDH, where opportunities to procure solutions together and share resource are discussed regularly. Tom Norton added he will be meeting with new Chief Information Officer at Dorset to continue the close working, and continuing the good relationship with the Director of Finance at Dorset.
12.5 Virginia Membrey questioned the lack of follow up appointment reminders being received and asked Tom Norton whether this is being addressed. Tom Norton advised that he wasn’t aware of this specific challenge, but agreed to look into TN this to see if there have been any reports of problems. Shelagh Meldrum added that going forward, patient initiated follow ups are being investigated as part of the Outpatient Department Efficiency Programme.
12.6 Lou Evans asked when all digital systems (including RiO (social care record system)) would be connected across the health system in Somerset and beyond. Tom Norton advised that this isn’t something within the control of the YDH team. It is a complicated problem that will continue to exist whilst providers are 7 | P a g e
procuring systems at different times, from suppliers that do not yet conform to Open Digital Standards (as set out by NHS digital). He added that NHS Digital has said by 2020 all systems are required to adapt to the open standards, and that in line with this, NHS Improvement have dictated a maximum contract period of two years in an effort to support alignment of contracts and re- procurement of systems.
13- 13 NON-EXECUTIVE DIRECTOR UPDATE AND COMMITTEES OF THE BOARD 1920 Governance and Quality Assurance Committee 13.1 Jane Henderson gave an update following the most recent Governance and Quality Assurance Committee. She advised that patient safety report was reviewed at the committee and digital update was also received. Jane Henderson added that the risk register is reviewed at each committee and advised that risk management systems are having an overhaul and the Board are now looking at how the Trust assesses the risk appetite. Jane Henderson advised that learning from deaths is reviewed and also a strong review is carried out at the committee of all the cases of patients who have died within the Trusts’ care.
Audit Committee 13.2 Caroline Moore gave an update following the most recent Audit Committee which was held in May 2019, which was to consider and review the Trust’s accounts. Caroline Moore informed the Council that good discussion took place at the last Audit Committee and this ensured that assurance and systems are working as they should be.
Workforce Committee 13.3 Maurice Dunster gave an update from the Workforce Committee. He advised that the committee takes place bi-monthly with the last meeting was in April 2019. Maurice Dunster highlighted that at the last meeting, discussion took place about junior doctors and exception reporting under their junior doctor contract. He also advised that Junior Doctors attended the Board of Directors Meeting yesterday to present their quality improvement projects; this was a very valued session for all involved. Maurice Dunster advised that Jo Howarth attended the last committee to present an update on the new roles of Nursing Associates and Assistant Practitioners to support the Trust and advised that this will be rolled out and will be monitored over the next year to review the benefits of these roles to the Trust.
14- 14 GOVERNOR WORKING GROUP UPDATES 1920 Membership and Communications Working Group 14.1 Tony Robinson advised the Council that a few Governors attended the St Margaret’s Hospice in May 2019. He said the Governors attended with the Academy and it was very successful and interactions with members of the public were positive. Tony Robinson advised that the Membership and Communications Working Group are now considering other events they could possibly attend with the support of the Academy. Tony Robinson advised that there is a potential opportunity for all Governors to access ‘Conflict Resolution’ training. Mel Mitchell advised that this training will take place at the September Council of Governors meeting. Ben Edgar-Attwell added that PALS are “on call” when Governors Surgeries take place to provide extra support if required.
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Strategy and Performance Working Group 14.2 Alison Whitman informed the Council that there was a long discussion about the Somerset system and STP as outlined in the minutes. She added that the Council will receive and review the estates master plan when it has been finalised. Jonathan Higman added that the Trust are now three months into the new residential accommodation build and good progression is being made.
Patient Experience 14.3 Janette Cronie gave an update following the recent Patient Experience meeting. She advised that a bell is to be introduced to inform staff and patients of meal times on the wards. The bell will be rung ten minutes before meal times so everyone is aware. Janette Cronie advised the Council that discussions were made about carers visiting patients and it was suggested that carers wear a badge so they can easily be identified when visiting. This is currently being reviewed by the group.
15- 15 ANY OTHER BUSINESS 1920 15.1 Tony Robinson asked if Symphony Healthcare Services (SHS) had any plans to integrate any more practices. Jonathan Higman advised that at this stage there were no integrations planned in the near future.
16- 16 DATE OF NEXT MEETING 1920 16.1 Thursday 5 September 2019, Marsh Jackson, The Academy, Level 4, YDH.
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Appendix: 2 REPORT TO: Council of Governors REPORT BY: Executive Team PRESENTED BY: Jonathan Higman, Chief Executive EXEC SPONSOR: Jonathan Higman, Chief Executive REPORT TITLE: Executive Director Report DATE: 5 September 2019
Purpose of Paper (Please select any which are relevant to this paper)
☒ For Assurance ☐ For Approval / Decision ☒ For Information
Reason for Presentation to The Executive Director Report to the Board includes matters of Committee/Board topical importance and key business items. It is also an opportunity for the Executive Team to highlight achievements and to provide updates on the latest developments within the Trust.
The Council are asked to note the key items within this report. A verbal report of other matters of importance may also be provided. Any Key Issues to Note
Links to Strategic Priorities / Board Assurance Framework (Please select any which are impacted on / relevant to this paper) ☒ Care for our Population ☒ Develop our People
☒ Innovate and Collaborate ☒ Develop a Sustainable System
Implications/Requirements (Please select any which are relevant to this paper) ☒ Financial ☒ Legislation ☒ Workforce ☒ Estates ☒ ICT ☒ Patient Safety / Quality
Reference to CQC domains (Please select any which are relevant to this paper)
☒ Safe ☒ Effective ☒ Caring ☒ Responsive ☒ Well Led
Is this paper clear for release under the Freedom of Information Act 2000? ☒ Yes ☐ No
Operational Update
Hospital demand remains high particularly for the emergency department with attendances up across the county. Fortunately, efforts to improve Same Day Emergency Care – particularly ambulatory care and frailty – have meant that the impact on bed pressures has been minimised although there has still been some escalation beds used at points. Given the increased demand being seen across Somerset, a piece of work is currently being undertaken to stress-test winter plans to ensure they are adequate to deal safely with probable demand particularly following Christmas.
During August, the Kingston Wing has had some refurbishment works to support plans to grow income from private patients to support our NHS services. Work is ongoing across wards to further improve fire compartmentalisation and will be complete before winter.
Relevant Committee Oversight: Board of Directors, Governance and Quality Assurance Committee, Hospital Management Team
HSJ Awards Finalists
We’re pleased to announce the Trust has been shortlisted for two HSJ Awards, in the ‘Staff engagement’ and ‘Workforce Initiative of the Year’ categories. The HSJ Awards are the most prestigious in UK health and social care, receiving around 2,000 nominations for 23 categories each year.
The next step in the process is two presentations to judging panels in late September, with the awards presented at a ceremony in London in November. This is our third confirmed finalists place in national awards in as many months; on 25 September the Trust is due to attend the Nursing Times Workforce Awards to find out if we have won the ‘Best International Recruitment Experience’ award.
Relevant Committee Oversight: Board of Directors
Anticoagulation Awards
The Trust’s Ambulatory Emergency Care unit has been shortlisted for the Anticoagulation Awards. The unit has been shortlisted for the Best Comprehensive Thrombosis Management Centre. The Awards, established in 2017, celebrate outstanding practice across multiple healthcare providers of exemplary anticoagulation services. The ceremony is due to be held at the House of Commons in October. The awards are supported by an extensive judging panel representing multiple stakeholders, respected globally and representing clinical, provider and patient experience.
Relevant Committee Oversight: Board of Directors
Adult Inpatient Survey Results
On an annual basis, Yeovil District Hospital participates in the Care Quality Commission Adult Inpatient Survey. This survey is the longest running survey in the NHS Patient Survey Programme, which covers a range of topics including maternity care, children and young people’s inpatient and day case services, urgent and emergency care and community mental health.
The initial high-level results from the 2018 Adult Inpatient Survey have been released, placing YDH as 37th out of 344 Trusts. There were three areas where YDH is rated significantly better than the national average: • Choice of food • Pain control • Information given pre-operatively or before a procedure.
YDH saw one area of significant improvement from the 2017 survey – Noise at nights caused by other patients. This had been highlighted as an issue within previous surveys so it is extremely encouraging to see an improved score.
There were however a number of areas where the scores decreased from the 2017 survey.
These relate to: • Information provided before a bed move • Information given on condition and treatment • Concerns around discharge timings • Views of quality of care • Information provided on complaints procedures
These areas are to be reviewed and investigated in detail with action plans under development and a full report will be provided to the Governance and Quality Assurance Committee.
Relevant Committee Oversight: Board of Directors, Governance and Quality Assurance Committee
Somerset Long-Term Plan The NHS Long Term Plan was published in January 2019, setting out a 10-year practical programme of phased improvements to NHS services and outcomes, including a number of specific commitments to invest the agreed NHS five-year revenue settlement.
As part of this NHS Long Term Plan, Sustainability and Transformation Partnerships (STPs)/Integrated Care Systems (ICSs) are asked to create five-year strategic plans by November 2019 covering the period 2019/20 to 2023/24.
The requirements of this plan include: • System Narrative Plan: to describe how systems will deliver the required transformation activities to enable the necessary improvements for patients and communities as set out in the Long Term Plan. • System Delivery Plan: to set the plan for delivery of finance, workforce and activity, providing an aggregate system delivery expectation and setting the basis for the 2020/21 operational plans for providers and CCGs. The system delivery plan will also cover the LTP ‘Foundational Commitments’.
YDH is working with the wider Somerset system in the development and drafting of the Somerset Long Term Plan.
Relevant Committee Oversight: Board of Directors
Annual General Meeting (AGM)
YDH │ Council of Governors
│ Meeting - September 2019
1 Outcome, Safety & Workforce Indicators
Results Summary Trend Results May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Mortality Actual number of deaths 59 48 48 67 63 38 41 73 81 72 46 54 61 67 51 Crude mortality rate (Deaths/Discharges) 1.7% 1.4% 1.3% 1.9% 1.8% 1.0% 1.0% 2.0% 2.0% 1.9% 1.2% 1.3% 1.5% 1.7% 1.2%
Finance & Monitor score I&E position distance from plan (£m) (YTD) 0.23 0.39 0.47 0.46 0.44 0.29 -0.18 0.19 -1.06 -2.69 -1.86 -0.04 0.02 0.20 0.09 % of Cost Improvement Plans in place (YTD Achievement vs Plan) 93.90% 108.50% 101.90% 101.80% 106.10% 102.10% 97.15% 103.39% 84.43% 73.84% 69.6% 75.5% 134.2% 144.7% 143.1%
Patient Experience F&F Test - % Extremely Likely & Likely to Recommend 95.60% 95.00% 96.40% 96.69% 96.41% 96.11% 96.51% 97.35% 93.59% 92.98% 95.7% 97.8% 98.0% 98.8% 98.5% F&F Test - Response rate 17.00% 14.90% 16.53% 15.81% 17.81% 19.02% 18.01% 13.72% 13.04% 8.68% 14.2% 8.1% 8.4% 14.5% 13.4% Number of Complaints 5 4 7 7 7 4 3 7 5 5 4 6 8 5 4 Number of Compliments 24 34 31 47 214 289 276 189 111 57 108 57 227 74 100 Cancelled Ops - Breaches of <28day readmission 0.00% 3.23% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.0% 0.0% 8.3% 0.0% 0.0% Cancelled Ops - Breaches <=5 cal day offer of new date 0.00% 16.13% 0.00% 0.00% 0.00% 0.00% 20.00% 0.00% 11.11% 0.00% 9.09% 0.00% 0.00% 0.00% 0.00%
Safety Total C difficile cases 1 0 0 0 0 0 0 1 1 0 1 2 1 2 4 C Difficile Cases due to Lapses in Care 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MRSA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Patient falls 64 43 50 62 60 70 43 81 70 92 72 92 56 67 57 Pressure ulcers +2 12 4 7 5 5 0 5 4 8 4 4 2 10 5 3
Workforce YDH Group Figures Sickness Absence (avg) % 3.20% 3.40% 3.40% 2.97% 2.96% 2.80% 2.92% 3.15% 3.34% 3.43% 2.87% 3.06% 2.85% 2.43% -- Annual Appraisal (avg) % 87.90% 88.60% 88.10% 86.90% 88.00% 88.67% 89.76% 89.71% 89.97% 88.91% 90.12% 90.74% 91.76% 90.79% 91.66% Mandatory Training (avg) % 86.30% 88.60% 87.50% 88.00% 88.88% 89.23% 87.67% 87.52% 86.81% 86.70% 88.37% 87.98% 90.15% 90.94% 88.40% Staff Turnover (avg) % 18.09% 17.88% 18.75% 18.94% 18.12% 17.55% 16.94% 16.03% 16.71% 16.35% 16.19% 16.30% 16.38% 16.43% 16.67%
Please note that the trust's internal targets for Labour Turnover and Mandatory Training have been changed from July 2019. Historic data from before this point will be RAG rated against the prior set of targets for these measures.
2 Early Warning Indicators
Results Summary Trend Results May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 RTT 18wks RTT - Incomplete Pathways 92.90% 92.60% 92.20% 91.00% 90.01% 91.03% 91.10% 90.59% 90.77% 90.78% 90.53% 89.82% 90.19% 90.74% 90.79%
Admissions Total admissions (inc Emergency) 3,728 3,804 3,936 3,746 3,721 4,052 4,147 3,832 4,328 3,900 4,250 4,105 4,262 4,095 4,324 Total Elective admissions 1,761 1,839 1,826 1,835 1,789 1,979 2,019 1,698 2,022 1,846 2,040 1,980 2,058 2,044 2,076 Day Case admissions 1,570 1,559 1,552 1,568 1,507 1,722 1,744 1,496 1,793 1,612 1,710 1,721 1,804 1,816 1,843 Daycase Rate 89.15% 84.77% 84.99% 85.45% 84.24% 87.01% 86.38% 88.10% 88.67% 87.32% 83.82% 86.92% 87.66% 88.85% 88.78%
Efficiency 1st to follow up (ratio 1:n) 2.26 2.19 2.19 2.25 2.13 2.22 2.21 2.19 2.26 2.21 2.27 2.25 2.22 2.15 2.08 Proportion of overnight discharges (10pm - 7am) (patients 3.15% 3.13% 3.11% 2.55% 3.41% 2.84% 3.13% 2.80% 2.43% 3.53% 2.79% 2.98% 2.71% 2.63% 3.50% who have left the Trust, excluding deaths and Labour Ward discharges) Average length of stay (elective) 2.18 1.99 2.42 2.51 2.01 2.13 2.22 2.05 3.38 2.40 1.90 2.03 2.42 1.79 1.92 Average length of stay (non elective) 3.84 3.88 3.92 4.17 4.13 4.08 4.01 3.83 4.34 4.13 3.78 4.11 4.02 3.95 3.92
A&E A&E attendances 4,839 4,624 4,925 4,373 4,615 4,501 4,693 4,868 4,553 4,396 4,939 4,774 5,018 4,891 5,251 A&E attendances - % inc / dec vs LY 15.13% 10.27% 14.29% 8.99% 10.36% 2.49% 3.52% 8.03% 10.49% 10.60% 10.44% 8.80% 6.12% 6.01% 6.17% A&E - % patients seen and discharged 4 hrs 98.78% 98.53% 98.72% 98.56% 96.92% 97.60% 97.55% 96.32% 94.64% 95.06% 96.78% 95.48% 96.57% 96.14% 95.73% Ambulance Handovers < 30mins 99.35% 98.60% 98.21% 98.28% 98.44% 99.93% 100.00% 100.00% 99.87% 99.86% 99.93% 99.87% 99.93% 99.80% 99.86% Unnecessary ED Attendances 806 879 977 762 859 692 806 808 681 790 925 857 870 964 1,164 Unnecessary ED Attendances Rate 16.66% 19.01% 19.84% 17.43% 18.61% 15.37% 17.17% 16.60% 14.96% 17.97% 18.73% 17.95% 17.34% 19.71% 22.17%
3 Mortality Rates Safe Number of Inpatient Deaths 120 110 100 July 19 90 80 Weekend Number of Crude Mortality Latest HSMR 70 Mortality Trustwide Rate (Deaths / Apr-18 to Mar-19 60 Relative Risk Deaths Discharges) 50 40 0.860 0.888 53 1.23% 30 20 10 July 18 0
Weekend Number of Crude Mortality HSMR Mortality Trustwide Rate (Deaths / Apr-17 to Mar-18 -3σ Centre Line +3σ Number of Deaths Relative Risk Deaths Discharges) 0.976 1.133 51 1.30% HSMR Trend (Rolling 12 Month Periods) 1.40
1.30
1.20 RAG status: Achieved 1.10
The trust's HSMR was 86.0 in March 19. The Trust continues to 1.00
perform significantly better than the National Average. Risk Relative 0.90 Further information is available in the quarterly mortality report. 0.80
0.70
4 Patient Falls and Pressure Ulcers Safe Patient Falls 100
July 19 14 days Bed 1000 per Rate Patient Falls Patient Falls rate Pressure 80 12 Patient Falls Causing Harm per 1000 bed days Ulcers 10 60 57 3 6.08 3 8 40 6
Number ofNumber Falls 4 July 18 20 2 Patient Falls Patient Falls rate Pressure Patient Falls 0 0 Causing Harm per 1000 bed days Ulcers 50 3 5.56 7
Additional notes Patient Falls Patient Falls per 1000 Bed Days Count Diff % Diff • Patient Falls YTD: 272 59 +27.70% Pressure Ulcers +2 • Patient Falls YTD LY: 213 14 3
• Pressure Ulcers YTD: 19 Days Bed 1000 per Rate -10 -34.48% 12 • Pressure Ulcers YTD LY: 29 2.5 10 • Pressure Ulcers 6M Avg: 4.5 2 -1.2 -20.59% 8 • Pressure Ulcers 6M Avg LY: 5.7 1.5 6 1 RAG status: Achieved 4 2 0.5 Targets Failed. Reason: Number of PressureUlcers 0 0 The increase in YTD compared to last year is believed to be down to Patient Cohort rather than an specific identifiable reason. TAG care is currently being relaunched and promoted. Pressure Ulcers Pressure Ulcers per 1000 Bed Days
5 Admissions and LOS Responsive Average Length of Stay (Days) July 19 6 5 Elective Non-Elective Average Average Non - Admissions Admissions Elective LOS Elective LOS 4 2,076 2,248 1.92 3.92 3 2 July 18 1 Elective Non-Elective Average Average Non - 0 Admissions Admissions Elective LOS Elective LOS 1,826 2,110 2.42 3.92 LOS Elective LOS Non-Elective
Additional notes Count Diff % Diff Admissions • Elective Admissions YTD: 8,148 +974 +13.58% 2500 • Elective Admissions YTD LY: 7,174 2250 • Non-Elective Admissions YTD: 8,627 +472 +5.79% • Non-Elective Admissions YTD LY: 8,155 2000 • Average Elective LOS vs LY diff: -0.5 -20.66% 1750
• Average Non-Elective LOS vs LY diff: +0.0 +0.02% 1500
1250 RAG status: Achieved 1000 Targets Met. Please note that the Maternity admissions are included within the Non-Elective admissions category. Total Elective Admissions Non-Elective Admissions
6 Delayed Discharges Effective Monthly Delayed Transfers of Care Rate
7% July 19 6% Number of Stranded 40% 5% Lost Bed Days Patients (21+ Days LOS) - Reduction 4% as at month end Ambition 3% 30 95 24 2% 1% July 18 0% Number of Stranded 40% Lost Bed Days Patients (21+ Days LOS) - Reduction as at month end Ambition DTOC Rate 122 -- -- Number of Stranded Patients with 21+ day LOS
60 (as at the end of the reporing month) Additional notes Count Diff % Diff 50 • Lost Bed Days YTD: 1,306 -2,941 -69.25% 40 • Lost Bed Days YTD LY: 4,247 30
20 RAG status: Achieved 10
Targets Met. 0
Stranded Patients (21+ Day LOS) Reduction Ambition
7 Responsive Cancelled Operations Hospital non Clinical On the Day Cancellation of Elective Operations Jul-19
July 19 Equipment failure / unavailable On the Day YTD On the Day Rebooked Urgent Non-Clinical Non-Clinical within 28 Day Cancellations Insufficent session time / session overrun Reasons Reasons Target 13 34 100.00% 3 More urgent case too priority - elective only e.g. cancer July 18 TCI / Appointment rescheduled - requires alternative clinican On the Day YTD On the Day Rebooked Urgent TCI / Appointment rescheduled - requires Non-Clinical Non-Clinical within 28 Day Cancellations alternative session / clinic Reasons Reasons Target 8 69 100.00% 6 0 1 2 3 4 5 6 Number of Cancelled Operations 35 Additional notes 30 The figure for Total Cancelled due to Lack of Beds only includes 25 on the day cancellations. 20 Note: For any elective operation cancelled by the trust on the day of the operation/admission, an offer of a new date must be 15 within 28 days of the cancelled operation date. 10 5
RAG Status: Achieved 0
Targets Met.
On the Day - Cancelled Operations
8 Diagnostic Waits Responsive Diagnostic 6 Week Waits % July 19 100% 98% Overall Diagnostic 6 Week Waits 96% 97.18% 94% (Target 99.0%) 92%
90% Additional notes The area with the lowest diagnostics performance was: Diagnostic 6 Week Waits % Target DM01 % - Trajectory Physiological Measurement % 91.47% Diagnostic Waits by Type of Test 100%
RAG status: Failed 95%
Targets Failed. Reason: 90% Decline in performance is a result of an increase in 85% Echocardiogram breaches. A full review of the service 80% capacity and patients waiting has been undertaken with 75% associated next steps identified, as well as a process to identify additional capacity. A recovery trajectory for 70% the service is in place. The South West regional DM01 performance was 93.5% in April. Imaging % Physiological Measurement % Endoscopy %
9 Responsive Cancer Performance 2 Week Cancer Targets 100% June 19 95% 90% 2 Week Suspected Cancer 2 Week Breast 85%
90.05% 89.36% 80%
(National Target - 93.00%) (National Target - 93.00%) 75%
70%
31 Day Treatment First 62 Day Treatment Standard 2WW Breast 2WW Suspected Cancer 19/20 2WW Suspected Cancer Trajectory 95.96% 86.73% 62 Day Treatment Standard (National Target - 96.00%) (National Target - 85.00%) 100% 95% 90% 85% RAG status: Failed 80% Targets Failed. Reason: 75% The trust failed the 2WW target failed due to 114 skin 70% capacity breaches and 20 lower GI endo breaches. 65% There were also 28 patient choice breaches across all 60% sites.
62 Day Treatment Standard 19/20 62 Day Treatment Standard Trajectory
10 Outpatients Transformation Responsive Number of Outpatient Attendances
20000 2019/20 YTD 16000 Total Outpatients Outpatient Procedures Virtual Clinic Activity Activity Proportion Proportion 12000 68162 15.62% 4.8% 8000 Average Wait to First ASI Rate DNA Rate OP (Weeks) 4000
31.60% 7.73 5.31% 0
All Appointment Patient Cancellations Trust Cancellations Cancellations 28.26% 11.61% 16.65% New OP Attendances Follow-Up OP Attendances Proportion of Virtual Clinic Activity
6.0%
5.0%
4.0% Comments 3.0% Please note that 'Virtual' Clinic activity includes Telephone follow-up clinics. 2.0% 1.0%
0.0%
Virtual Clinic Activity %
11 New to Follow up Ratio New : Follow up Ratio 2.5 July 19 2.3 New to Follow up New Appointments Follow up Appointments Ratio Attended Attended 2.1
1 : 2.08 5,559 11,590 1.9
July 18 1.7 New to Follow up New Appointments Follow up Appointments 1.5 Ratio Attended Attended 1 : 2.19 5,094 11,164 New to Follow up ratio New to Follow up Ratio 6M Avg
Additional notes Apr 2018 to Jan 2019 - 1st to Follow Up Ratio by Speciality Count Diff % Diff • New Appointments YTD: 19,976 1400 6 +383 +1.95% Follow to New Ratio up • New Appointments YTD LY: 19,593 1200 5 • Follow up Appointments YTD: 43,345 1000 -701 -1.59% 4 • Follow up Appointments YTD LY: 44,046 800 3 600 2 Attendances 400 Comments 200 1 0 0
New Follow Up Rate
12 ED Transformation Responsive A&E 4 Hour Performance - All Attendances July 19 100% A&E 4 Hour Average A&E 98% Total A&E Attendances Performance Attendances per day 96% 95.73% 5251 169.39 94% Attendances resulting Unnecessary A&E 12 Hour Trolley Waits in an Inpatient stay Attendances Proportion 92% 30.01% 22.17% 0 90%
Median Time to Triage Median Time to Median Time in Emergency (hh:mm) Treatment (hh:mm) Department (hh:mm) 4Hr Performance 6 Month Moving Average 00:10 01:04 02:54 Avg A&E Attendances per day Ambulance Handovers Number of Ambulance Average Ambulance 200 Performance Handovers Arrivals
99.86% 1450 45.48 150
100 Comments
Nationally, unnecessary A&E attendances have been defined as the "First 50 attendance with some recorded treatments or investigations all of which may have been reasonably provided by a GP, followed by discharge home or to 0 GP care."
Avg A&E Attendances per day Avg Ambulance Arrivals per day Avg Emergency Admissions Per Day
13 Unnecessary ED Attendances Responsive
July 19 Number of A&E Number of Unnecessary % of Unnecessary A&E Attendances A&E Attendances Attendances Unnecessary A&E Attendances 5251 1164 22.17% 1400 25.00% July 18 1200 20.00% Number of A&E Number of Unnecessary % of Unnecessary A&E 1000 Attendances A&E Attendances Attendances 800 15.00% 4925 977 19.84% 600 10.00% 400 Additional notes 5.00% Count Diff % Diff 200 • Unnecessary A&E Attendances YTD: 3,855 +532 +13.80% 0 0.00% • Unnecessary A&E Attendances YTD LY: 3,323 • A&E Attendances YTD: 19,934 +1,158 +6.17% • A&E Attendances YTD LY: 18,776 Number of Unnecessary Attendances % Unnecessary Attendances
Comments
Nationally, unnecessary A&E attendances have been defined as the "First attendance with some recorded treatments or investigations all of which may have been reasonably provided by a GP, followed by discharge home or to GP care."
14 Friends and Family Test Friends and Family Test Inpatient / ED / Maternity Response to 'Extremely Likely' and 'Likely' to recommend YDH July 19 100% 11.3% 10.7% 10.1% 12.8% 13.4% 14.6% 14.4% 14.6% 13.9% 15.4% 16.2% 13.1% 12.3% 12.0% Overall Response Extremely Likely / Likely 80% Rate to Recommend 60% 13.37% 98.49% 88.7% 40% 81.7% 81.8% 82.3% 81.8% 82.2% 81.2% 81.2% 80.5% 80.7% 83.7% 86.5% 87.3% 85.7%
July 18 20% Overall Response Extremely Likely / Likely 0% Rate to Recommend 16.53% 96.36% % Extremely Likely % Likely
Additional notes Friends and Family Test % of Inpatient / ED / Maternity Count Diff % Diff Responses • Number of Respondants YTD: 2,577 7000 20% -1,053 -29.01% • Number of Respondants YTD LY: 3,630 6000 5000 15% 4000 5151 10% Comments 4859 4565 4928 4936 3000 4718 4509 4371 4381 4746 4680 5212 5307 4199 From April 2015, the Friends and Family Test was extended to 2000 5% include Outpatients, Daycases and children. 1000 (%) rate Response 824 962 847 947 1029 1003 755 702 818 834 795 0 399 460 488 0%
No of Respondants No of No Response % of Responses
15 Vacancies Being Recruited to - YDH Group Well Led
Vacancies being recruited to (FTE) May-19 Jun-19 Jul-19 Additional Clinical Services 4.0 1.3 2.1 Additional Prof Scientific & Technical 2.0 0.0 2.0 Admin & Clerical 11.6 11.1 12.2 Allied Health Professionals 8.6 7.2 9.6 Ancillary 0.0 0.0 0.0 Estates 0.0 0.0 0.0 HCA's 5.5 2.0 10.0 Medical 6.5 9.8 7.0 Medical Training 1.0 0.0 0.0 Senior Managers 1.0 0.0 0.0 SSL 2.9 3.9 2.4 DCUK 0.0 0.0 3.0 Specialist Nursing / Band 6 5.6 12.2 5.0 Nursing and Midwifery (Band 5 And Below) - Childrens 1.0 3.0 0.6 Nursing and Midwifery (Band 5 And Below) - Ward Areas 1.0 0.0 3.0 Nursing and Midwifery (Band 5 And Below) - EAU / ED 0.0 0.0 0.0 Nursing and Midwifery (Band 5 And Below) - ICU 0.0 0.0 0.0 Nursing and Midwifery (Band 5 And Below) - Outpatients 1.0 2.0 1.0 Nursing and Midwifery (Band 5 And Below) - Midwifery 0.0 1.0 0.0 Nursing and Midwifery (Band 5 And Below) - Theatres 5.0 5.0 5.0 Nursing and Midwifery (Band 5 And Below) - Total 8.0 11.0 9.6 Total 56.7 58.5 62.9
16 Turnover Well Led Labour Turnover - YDH Only 25.0%
July 19 20.0%
YDH Group YDH DCUK SHS SSL 15.0%
16.67% 16.81% 23.42% 16.44% 14.68% 10.0%
July 18 5.0% 0.0% YDH Group YDH DCUK SHS SSL
18.75% 17.51% 25.81% 27.27% 18.47% YDH Turnover Target Lower Limit Taget Upper Limit
Additional notes Rolling Turnover by Skills Group Achievement Diff • Group Turnover: 16.67% Additional Clinical Services -- Additional Prof Sci & Tech • Group Turnover LY: -- Admin & Clerical • YDH Turnover: 16.81% -0.70% Allied Health Professionals • YDH Turnover LY: 17.51% Ancillary Medical & Dental Non-Registered Nursing Comments Nursing & Midwifery Reg SHS turnover now includes practice staff from April 2018 Senior Managers onwards. From July 2019 onwards, the trust's internal labour SSL SHS turnover target has changed to be within 12% - 17%. DCUK
0% 5% 10% 15% 20% 25% 30% Jul-17 Jul-18 Jul-19
17 Absence Well Led Absence vs Target 5.0%
June 19 4.0%
YDH Group YDH DCUK SHS SSL 3.0%
2.43% 2.37% 4.32% 3.01% 1.97% 2.0%
June 18 1.0%
0.0% YDH Group YDH DCUK SHS SSL
3.36% 3.18% 4.08% 3.45% 4.38% YDH Absence Target
Additional notes Absence by Skills Group Count Diff Additional Clinical Services • Group Absence: 2.43% -0.93% Additional Prof Sci & Tech • Group Absence LY: 3.36% Admin & Clerical • YDH Absence: 2.37% Allied Health Professionals -0.81% • YDH Absence LY: 3.18% Ancillary Medical & Dental Non-Registered Nursing Comments Nursing & Midwifery Reg The national average absence rate for acute trusts is 4.36%. Senior Managers All staff with high absence rates have an action plan for SSL SHS improvement. DCUK Please note that the Absence figures only relate to sickness absence, and is reported one month in arrears. 0% 2% 4% 6% 8% 10% Jun-17 Jun-18 Jun-19
18 Mandatory Training Well Led Mandatory Training vs Target - YDH Only 100%
July 19 90%
YDH Group YDH DCUK SHS SSL 80%
88.40% 86.99% 86.09% 94.70% 91.11% 70%
July 18 60% 50% YDH Group YDH DCUK SHS SSL
87.45% 89.10% 99.27% 84.81% 75.33% YDH Mandatory Training Target
Additional notes Mandatory Training Nonachievement by Skills Group Count Diff Additional Clinical Services • Group Mandatory Training: 88.40% 0.95% Additional Prof Sci & Tech • Group Mandatory Training 87.45% Admin & Clerical • YDH Mandatory Training: 86.99% Allied Health Professionals -2.11% • YDH Mandatory Training LY: 89.10% Ancillary Medical & Dental Non-Registered Nursing Comments Nursing & Midwifery Reg New mandatory training e-learning platform embedded but Senior Managers SSL staff training on the system is on-going. To improve SHS performance, face to face training is available for staff. From DCUK July 2019, the trust's internal mandatory training target has been changed from 90% to 85%. 0% 10% 20% 30% 40% 50% Jul-17 Jul-18 Jul-19
19 Mandatory Training Elements Well Led
Adults Protection Achievement vs Target - YDH Only July 19 Overall Conflict Equality Achievement Conflict 88.40% 92.00% 91.00% Equality Information Fire Infection Control Governance Fire 93.12% 88.52% 86.82%
Infection Control Manual Handling Prevent Resus
88.18% 82.84% 81.42% Information Governance
Childrens Adults Safeguarding Manual Handling Safeguarding 88.72% 89.10% Prevent
Comments Resus The Conflict, Equality, Information Governance and Prevent elements of mandatory training have been reported for the Adults Safeguarding overall YDH Group from November 2018 onwards. Childrens Safeguarding
50% 60% 70% 80% 90% 100% Jul-18 Jul-19
20 Safeguarding Training Well Led Childrens Safeguarding Achievement vs Target - YDH Only 100% July 19 90% Childrens Adults Safeguarding Safeguarding 80% 89.10% 88.72% 70% Childrens Childrens Childrens Safeguarding - Safeguarding - Safeguarding - 60% Level 1 Level 2 Level 3 50% 91.17% 86.75% 85.71%
YDH Childrens Safeguarding Achievement Target Additional notes Achievement Adults Safeguarding Achievement vs Target - YDH Only • Childrens Safeguarding Level 1 - YDH 92.15% 100% • Childrens Safeguarding Level 2 - YDH 86.74%
• Childrens Safeguarding Level 3 - YDH 85.71% 90% • Childrens Safeguarding Level 1 - 75.00% • Childrens Safeguarding Level 2 - 86.96% 80% • Childrens Safeguarding Level 3 - -- 70% • Adults Safeguarding - YDH 87.49% • Adults Safeguarding - DCUK 85.19% 60%
Comments 50%
YDH Adults Safeguarding Achievement Target
21 Appraisals Well Led Appraisals vs Target - YDH Only 100%
July 19 90%
YDH Group YDH DCUK SHS SSL 80%
91.66% 91.00% 87.04% 89.94% 98.64% 70%
July 18 60%
50% YDH Group YDH DCUK SHS SSL
88.14% 87.40% 97.87% 92.96% 97.87% YDH Appraisals Achievement Target
Additional notes Appraisals by Skills Group Count Diff Additional Clinical Services • Group Appraisals: 91.66% 3.52% Additional Prof Sci & Tech • Group Appraisals LY: 88.14% Admin & Clerical • YDH Appraisals: 91.00% Allied Health Professionals 3.60% • YDH Appraisals LY: 87.40% Ancillary Medical & Dental Non-Registered Nursing Comments Nursing & Midwifery Reg The YDH Group 12 months appraisals achievement in July was Senior Managers SSL 74.0%. SHS DCUK
0% 20% 40% 60% 80% 100% Jul-17 Jul-18 Jul-19
22 Appendix A - Slide Index Appendix
Slide Index 1) Council of Governors Title Slide 16) Vacancies Being Recruited to - YDH Group 2) Outcome, Safety & Workforce Indicators 17) Staff Turnover 3) Early Warning Indicators 18) Absence 4) Mortality Rates 19) Mandatory Training 5) Patient Falls and Pressure Ulcers 20) Mandatory Training Elements 6) Admissions and Length of Stay 21) Safeguarding Training 7) Delayed Discharges 22) Appraisals 8) Cancelled Operations 9) Diagnostic Waits 10) Cancer Performance 11) Outpatients Transformation 12) First to Follow up Ratio 13) ED Transformation 14) Unnecessary ED Attendances 15) Friends and Family Test
23 Appendix - Terms
HSMR Weighted risk of mortality against national average [Hospital standardised mortality ratio] I&E Income & Expenditure CIP Cost improvement plan F&F Friends and Family RTT targets % patients that started consultant-led treatment within 15/18 weeks (admitted / non-admitted patient) (complete / incomplete pathway) 1st to follow up Ratio – number of follow up appointments to 1st appointment Ambulance handover Time it takes from when ambulance arrives to when we accept the patient into A&E DNA Did not attend
24 YDH │ Consolidated Financial Performance
│ Month 4 - July 2019 Group I&E bridge and KPI's
Jul-19 YTD
£'000' £'000' Comments
Control Total target (1,347) (7,473)
Impacted by:
Clinical income 73 100 Driven by Spec Com and NCAs overperformance in month, and insourced activity Escalation costs within nursing (£12k) and medical (£16k) in month; YTD - nursing £96k, medical £37k, Escalation costs (28) (146) ancillary £5k, non-pay £8k CIP 11 295 CIP achieved ahead of plan supported by non-recurrent savings (excluding SHS) In month cancer £33k adv, 7 day working £27k fav; YTD - Elective £69k and 7 day working £100k fav, cancer 62 Phasing of budgets (7) 144 day £25k adv Medical staff 5 (154) YTD variance predominantly due to premium cover of vacancies and sickness
Somerset CCG HCDs (65) (151) Somerset CCG high cost drugs spend not fully recovered under block contract Adverse movement in RTA income (£59k) in month, YTD includes underspends in admin & clerical and Other (43) 102 senior managers Subtotal -54 190
Control Total actual (1,401) (7,283)
Actual Variance Actual Variance July 2019 RAG Comments In month fav/(adv) YTD fav/(adv)
Total CIP £'000' 456 130 1,404 423 See efficiencies report for further breakdown. Mainly driven by vacancies in surgery, anaesthetic, acute physians and SHS. Agency Spend £'000' (335) (19) (1,235) 72 £360k locum reimbursement recognised YTD in SHS SSL position £'000' 129 12 492 3 Timing of IT refresh programme and underspends in consumables Mainly driven by assumption that SHS will not be reimbursed for locum SHS position £'000' (111) (20) (460) (24) spend in Martock and South Petherton (Q2 support not yet agreed). Workforce pressures across practices remain the key challenge.
RAG key: >5% below the target <5% below the target Target reached or above Group I&E
July 2019 £'000' YTD Annual Variance Variance Plan Actual Plan Actual Plan Comments excl offset items fav/(adv) fav/(adv) Spec Com overperformance £85k (£29k adv YTD), NCAs £56k (£89k 12,206 11,952 255 NHS Clinical Income 46,754 46,244 509 139,406 YTD) and insourced £23k fav; Dorset £103k adv (£36k fav YTD) RTA £59k adv, PP £52k adv as activity lower than expected and budget 126 247 (121) Non NHS Clinical Income 747 916 (169) 2,809 phased high in month (net position £36k adv) £88k fav in month - £25k R&D income, £15k catering, pathology £11k. 1,727 1,595 131 Other Income 6,615 6,363 252 19,208 See income breakdown in appendices 14,059 13,794 265 Total Income 54,115 53,523 592 161,423 £57k adv CIP not achieved in month (£165k adv YTD), escalation £16k (3,027) (2,852) (175) Medical Pay (12,115) (11,538) (577) (34,385) (£37k YTD), remaining - additional duties claims and locum spend £12k in month escalation costs (£96k YTD), SHS £63k adv (£162k adv (3,389) (3,353) (36) Nursing Pay (13,792) (13,606) (186) (40,815) YTD) (3,132) (3,191) 59 Other Pay (12,642) (12,956) 314 £32k CIP, admin & clerical £10k fav and senior managers £31k fav (38,202)
(9,548) (9,396) (152) Total Pay (38,549) (38,101) (449) (113,402) Somerset CCG high cost drugs £65k in month (£151k YTD) and in-tariff (1,841) (1,711) (130) Drugs (6,765) (6,823) 58 (20,425) drugs £56k adv (£115k fav YTD) (919) (974) 54 Consumables Non Pay (3,905) (3,935) 30 £18k fav in month across various areas - see breakdown in appendices (11,696) £14k fav IT refresh programme, £45k one-off redundancy benefit for PY (2,670) (2,589) (80) Other Non Pay (10,282) (10,267) (14) (29,513) settlement; catering £15k adv. See non-pay breakdown in appendices (5,430) (5,273) (157) Total Non Pay (20,952) (21,026) 74 (61,634)
(919) (875) (44) EBITDA (5,386) (5,603) 217 (13,613)
(482) (472) (10) Below EBITDA (1,897) (1,870) (27) £6k higher interest on loans, expected £52k higher full year effect (5,726)
(1,401) (1,347) (54) Adj Control Total Basis (7,283) (7,473) 190 (19,338)
(14) 42 (56) Donated Assets (72) 168 (240) Timing differences, expected increase going forward 503 Accrued assuming Q2 control total achieved, £140k extra PSF allocation 1,338 1,338 0 PSF/FRF/MRET 4,676 4,536 140 19,339 related to prior year from DHSC (77) 33 (111) I&E surplus/(deficit) (2,679) (2,769) 90 504 Summary group efficiencies highlight report July 2019 Group cash flow forecast
£m Daily cashflow forecast
16
14
12
10
8
6
4
2
0 Consolidated statement of comprehensive income
Prior Months Actuals In Month - Jul-19 Year to date Variance Variance Annual Plan May 19 June 19 Actual fav/(adv) % var £'000' Actual fav/(adv) % var 2019/20 11,942 11,166 12,206 255 (2.1%) Clinical Income 46,754 509 (1.1%) 139,406
204 223 126 (121) 96.1% Non NHS Clinical Income 747 (169) 22.6% 2,809
2,777 2,822 3,077 88 (2.9%) Other Income 11,325 202 (1.8%) 39,217
14,923 14,212 15,409 222 (1.4%) Total Income 58,825 543 (0.9%) 181,433
(2,592) (2,595) (2,581) 15 0.6% Registered Nursing (10,433) 130 1.2% (31,620)
(847) (839) (808) (51) (6.4%) Unregistered Nursing (3,359) (315) (9.4%) (9,195)
(3,097) (3,031) (3,027) (175) (5.8%) Medical Staff (12,115) (577) (4.8%) (34,385)
(1,843) (1,847) (1,803) 73 4.1% Estates, Admin & Clerical (7,430) 242 3.3% (22,526)
(833) (873) (894) (12) (1.3%) Pay - Scientific, Therapeutic & Technical (3,483) 74 2.1% (10,601)
(431) (423) (434) (2) (0.5%) Pay - Ancillary (1,729) (2) (0.1%) (5,075)
(9,643) (9,608) (9,548) (152) (1.6%) Total Pay Expenditure (38,549) (449) (1.2%) (113,402)
64.6% 67.6% 62.0% Pay % of revenue 65.5% 62.5%
(1,720) (1,451) (1,841) (130) (7.1%) Drugs (6,765) 58 0.9% (20,425)
(433) (409) (364) 51 14.0% Consumable M&SE (1,648) 54 3.3% (5,020)
(222) (217) (208) 4 1.8% High Cost M&SE (839) 10 1.2% (2,523)
(2,783) (2,973) (3,016) (81) (2.7%) Other (incl. referred tests) (11,700) (49) (0.4%) (33,666)
(5,159) (5,049) (5,430) (157) (2.9%) Total Non Pay Expenditure (20,952) 74 0.4% (61,634)
34.6% 35.5% 35.2% Non pay % of revenue 35.6% 34.0%
121 (445) 431 (87) 20.2% EBITDA (676) 167 24.8% 6,396
(499) (512) (509) (23) (4.6%) Other Technical (2,003) (77) (3.9%) (5,892)
(377) (957) (77) (111) Surplus / (Deficit) (2,679) 90 504
2.5% 6.7% 0.5% Surplus/Deficit % of revenue 4.6% -0.3% Group income summary
July 2019 £'000' YTD Annual Variance Variance Plan Actual Plan Actual Plan Comments fav/(adv) fav/(adv) 7,948 8,016 (68) Somerset CCG 30,817 30,981 (164) Offset in drugs £65k in month and £152k YTD 93,208 Based on PbR value - key variances relate to critical care and non- 1,314 1,417 (103) Dorset CCG 5,462 5,426 36 16,404 elective activity below plan by £37k and £23k respectively Based on PbR value - SCBU above plan by £87k in month. Includes 387 301 86 Spec Com & Public Hlth 1,144 1,173 (29) 3,507 CMDT risk relating to prior years PP activity lower than planned, SHS private medical element adv 9k in 152 214 (62) Private Patients (group) 670 783 (113) 2,335 month and £45k YTD £101k locum reimbursement reflected in medical pay and £37k fav 1,182 1,025 157 SHS 4,472 4,098 373 12,433 Federation income in month 88 65 23 Insourced Activity 138 113 25 Recognised insourced activity at full tariff value 207 Fav in month Spec Com £78k, Somerset £65k and Dorset £14k; adv 1,022 948 73 High Cost Drugs 3,886 3,733 153 11,198 HepC £20k and CDF £60k NCAs £56k and military contract £8k fav in month, CIP £16k, RTA £59k 239 213 26 Other (incl. NCAs, I CRS) 913 854 59 2,923 adv 12,332 12,198 134 Total clinical income 47,500 47,160 340 142,215
90 65 25 R&D Income 274 260 14 Timing difference 779
366 372 (7) Education & Training 1,493 1,489 4 4,468
104 112 (8) Pharmacy & Maintenance 444 446 (3) 1,339
211 196 15 Catering 806 784 22 Reflected in non pay costs 2,351
93 99 (6) Car Parking 409 397 12 1,191
83 71 11 Accommodation 335 285 50 Reflected in non pay costs 856
450 449 1 Other Drugs Income 1,691 1,787 (96) Reflected in drugs expenditure 5,358 Midwifery early adopters income £8k and Home First £19k reflected in 330 231 98 Other 1,163 915 248 2,867 pay costs, Pathology £11k fav, overseas recruit £10k fav 1,727 1,595 131 Total non clinical income 6,615 6,363 252 19,208
14,059 13,794 265 Total Income 54,115 53,523 592 161,423 Group activity summary
Accident & Emergency - all CCGs Non Elective (exc excess bed days and maternity deliveries) - all CCGs 5,500 2,200
5,000 2,100
4,500 2,000
4,000 1,900
3,500 1,800
3,000 1,700
2,500 1,600
2,000 1,500
Actua ls PY Annual Plan Actua ls CY Actua ls PY Annual Plan Actua ls CY
Elective (exc excess bed days and insource)- all CCGs Outpatients (exc insource ) - all CCGs
1,800 19,000
1,600 17,000
1,400 15,000
1,200 13,000
1,000 11,000
800 9,000
600 7,000
400 5,000
Actua ls PY Annual Plan Actua ls CY Actua ls PY Annual Plan Actua ls CY Group cash balance at the bank, on 31 July, £2.2m
Cash balance Schedule of loan support received £'000' 9,000 Loan Loan Annual Principal 8,000 Loan name value £m value £m interest repayment date 7,000 actual plan rate 6,000 Revenue - 2015/16 17.5 1.5% Jan 2020 5,000 Capital - 2015/16 4.9 1.97% Feb 2033 4,000 Revenue - 2016/17 17.0 1.5% Feb 2021 3,000 Capital - 2016/17 1.5 0.45% Mar 2024 2,000
Revenue - 2017/18 17.5 1.5% Jan 2020 1,000
Revenue - 2018/19 21.5 1.5% tbc 0
Revenue - 2019/20 6.6 2.8 3.5% tbc
Total 86.4 Actua l cash Mininum required cash
0-30 31-60 61-90 Over 90 BPPC passed Total % days days days days 100 Aged Debtors £'000' £'000' £'000' £'000' £'000' 80 60 Receivables NHS 12,529 12,053 126 149 201 40
Movement from PY (1,976) (1,936) 86 (33) (93) 20 0 Receivables non NHS 1,126 640 77 11 398
Movement from PY (2,743) (2,624) (130) (109) 119 Prior year Current year Target Bad debt provision: £245k as at 31-Jul-19 (was £278k at year end) excluding ICRS Jul 2019 Yeovil Hospital Friends and Family Test Feedback
We would like you to think about your experience in the ward where you spent the most time during this stay. How likely are you to recommend our ward to friends and family if they needed similar care or treatment?
The boxes below show the number of responses in each category for Yeovil Hospital, in Jul 2019.
Extremely likely Likely Neither Unlikely Extremely unlikely Don't know
1025 134 4 3 4 3
Online responses 390 Paper responses 814 TOTAL 1204
The charts below show how likely respondents said they were to recommend Yeovil Hospital to their friends and family in July 2019.
87%
11%
Extremely likely Likely Neither Unlikely Extremely unlikely Don't know
extremely/ Yeovil Hospital 99% likely
The following chart shows the proportion of respondents who said that they would be Extremely likely/Likely to recommend the hospital to their friends and family, over the past 24 months.
FFT Likely To Recommend
105% 100% 95% 90% 85% 80%
75%
Jan-19 (933) Jan-19
Feb-18 (788) Feb-18 (523) Feb-19
Jul-18 (1263) Jul-18 (1204) Jul-19
May-19 (984) May-19
Jan-18 (1074) Jan-18
Jun-18 (1097) Jun-18 (1365) Jun-19
Oct-17 (1401) Oct-17 (1406) Oct-18
Apr-19 (1000) Apr-19 Apr-18 (1246) Apr-18
Sep-17 (1169) Sep-17 (1247) Sep-18
Aug 17 (1545) 17 Aug
Dec-17 (1197) Dec-17 (1165) Dec-18
Nov-18 (1395) Nov-18 Nov-17 (1039) Nov-17
Mar-18 (1288) Mar-18 (1086) Mar-19
May-18 (1340) May-18 Aug - 18 (1177) - 18 Aug Events Mean Lower Upper Outlier Run
Jul 2019 Page 2
Patients were asked to rate various elements of their experience using a scale of 5=Totally to 1=Not at all.
Were you treated with kindness and compassion by 5.0 the staff looking after you? (1143)
5.0 Were you treated with dignity and respect? (1143)
4.9 Was the location clean? (1145)
4.9 Did you feel involved enough in decisions made about you? (1140) 4.8 Did you receive timely information about your care and treatment? (1144)
Base: All respondents
Demographic breakdown
Patient type Ethnic group
White 98% The patient 89% Mixed / Multiple Ethnic Groups
A carer 2% Asian / Asian British 1%
Black / African / Caribbean / Black British 1% A family member 9% Other Ethnic Group
Base: All respondents, Jul 2019 (1124) Base: All respondents, Jul 2019 (1123)
Age Disability
A long•standing illness 32% 85+ 9% 20% A long•standing physical condition 13% 65-74 21% Deafness or severe hearing impairment 12% 17% A mental health condition 7% 45-54 10% Blind or partially sighted 2% 7% 25-34 10% A learning disability 2% 5% 50% 0-15 1% I do not have a long•standing condition
0% 10% 20% 30% Base: All respondents, Jul 2019 (967)
Base: All respondents, Jul 2019 (1125)
Gender
39% Male
61% Female
Base: All respondents, Jul 2019 (1136)
You can make a difference What you told us in July 19 … and what we did
You told us that all the nurses are
wonderfully kind and caring, although You told us that everyone involved made you are confused as to what the me feel comfortable and valued. You sug‐ colours of tunics/dresses and stripes gested that we could supply longer pads for mean. You aren't sure what rank and a er the procedure. posi on staff have. We knew the department supply the panty We have now added details of liners that are in colposcopy, but we have uniforms onto the ward TV screens. now added some of the maternity pads that we give to day case pa ents (the thick ones in the orange packets) in the colposcopy room changing area, that our pa ents can readily access if required.
You told us the staff were very caring and friendly but felt that communica on could be be er, and staff should introduce themselves by their name. We reiterated to staff the importance of intro‐ ducing themselves to our pa ents. We already have a pledge signed by the staff members to say “ Hello my name is”. Also we are looking to create staff name badges with their first names printed on.
You asked us to provide a recycling bin for You told us the team were wonderful and cardboard cups, as we have containers for that there was minimal improvement re‐ cans, plas c bo les and general waste. quired however, you felt disabled walking So we contacted our supplier and are in the frames should be le close to pa ent, to process of asking for a quote for the enable them to get to the toilet quickly appropriate recycling bins. enough. So we discussed this with the team and Occupa onal Therapy/Physiotherapy and as a result we took ac on to issue an indi‐ vidual walking frame with the pa ent’s name on which can be le at their bed side. Also we have placed, s cks/Crutch holders on pa ents bed side lockers for easy access.
MEMBERSHIP AND COMMUNICATIONS WORKING GROUP Draft Minutes of the Membership and Communications Working Group held on 11 July 2019 at Yeovil District Hospital
Present: Tony Robinson Public Governor [Chair] Sue Brown Public Governor Janette Cronie Public Governor Nigel Stone Public Governor
In Attendance: Ben Edgar-Attwell Company Secretary Tori Birch Communications Manager
Apologies: Faye Purbrick Appointed Governor Michael Beales Public Governor
Ref: No: Action 11- 1 WELCOME AND APOLOGIES FOR ABSENCE 1920 1.1 Tony Robinson welcomed those present to the meeting and apologies were noted as above.
12- 2 MINUTES OF THE MEETING HELD ON DATE 2019 1920 2.1 The minutes of the meeting held on were approved as a true and accurate record.
13- 3 ACTION PLAN REVIEW AND MATTERS ARISING 1920 3.1 With regard to the action to encourage members of staff from the Trust’s subsidiary companies to become members of the hospital, Ben Edgar-Attwell advised that they would be required to become public members rather than staff members. He suggested that this could be added to the various subsidiary BEA company newsletters.
3.2 In terms of the action for governors to receive Conflict Resolution training, Ben Edgar-Attwell advised that this was to be scheduled for the Council of Governors session in September 2019. In addition, following feedback from members of the public and governors, the PALS room and PALS team were now “on call” during the Governor Surgeries sessions.
3.3 Tori Birch confirmed that the Trust membership information was included on the ward and outpatient screens. Governor election information was also included during this period.
3.4 Tori Birch said that she had received limited feedback regarding the options for website accessibility. She advised that there was a plan to go ahead with a four- week trial of one of the providers at the end of August 2019. This trial is taking place across a number of the healthcare organisations within the county.
14- 4 MEMBERSHIP STATISTICS AND REVIEW OF THE PROGRESS AGAINST 1920 THE GROUP OBJECTIVES 4.1 Ben Edgar-Attwell presented the latest membership statistics which show an upward trend for the number of public members. It is believed this follows the success of recent membership events.
4.2 Ben Edgar-Attwell said that the group’s objectives would once again be added to the meeting’s agenda for adequate oversight. Tony Robinson said that he understood that good progress was being made towards the objectives.
4.3 David Recardo asked about the communication methods used with the members of the Trust. Ben Edgar-Attwell provided an overview, confirming that communications are mainly electronic based, following past discussion by the working group. David Recardo challenged this and suggested that paper based material is more likely to be read. This was discussed within the group with differing viewpoints provided. Tori Birch added that the Trust’s strategy is to become more “paper-lite”. Ben Edgar-Attwell advised that the Trust is exploring options to send an AGM letter to postal members, taking the opportunity to encourage members to provide email addresses.
15- 5 EVENTS FEEDBACK AND FUTURE EVENTS 1920 St Margaret’s Event: 5.1 Tony Robinson provided feedback on the governors’ attendance at the St Margaret’s Summer Fete. The event was considered very successful, largely due to the additional attendance of staff from the Academy who provided a number of different activities to particularly draw young families to the stand. He added that this resulted in good quality contact with members of public of all ages with good feedback received. He also advised that it would be useful to have a number of clipboards to assist the completion of membership applications at future events. BEA Ben Edgar-Attwell said he would locate some clipboards.
5.2 Tony Robinson said that he thought it would be sensible for the governors to concentrate on two or three main events within the year that included participation of the Academy team; rather than attending many events without the supporting draw of their activities.
Future Events: 5.3 Tori Birth said that the National Play Day was taking place on 7 August 2019 and there was a planned event at Nine Springs Park in Yeovil. She suggested that this would be a suitable event and would get the contact details from the Council. TB Ben Edgar-Attwell agreed and said he would start to liaise with the Academy and seek volunteers to help on the day. BEA
5.4 The group considered the Yeovil Super Saturday event that the governors had previously attended. It was agreed that the governors would not attend the event this year.
5.5 Tori Birth suggested that the Christmas Light Switch On event in Yeovil might be TR/ an option. It was agreed that this would be considered at the next meeting. BEA
5.6 David Recardo said that the District Council were starting preparations for an event celebrating VE Day in May 2020. He agreed to circulation more information when available.
16- 6 PATIENT VOICE SURVEY RESULTS 1920 6.1 Ben Edgar-Attwell advised that the results from the questions regarding to Trust membership within the recent Patient Voice Survey had been collated.
6.2 Out of 53 respondents, results as follows: Does the patient know what a foundation trust is? No 65%, Yes 35%.
Does the patient know that Yeovil NHS Trust has elected governors? No 65%, Yes 35%.
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Is the patient a member of Yeovil Trust or would they consider becoming a member? Members 0%, 86% not interested in being a member, 14% interested. Appropriate leaflets were given to those interested in joining.
6.3 The group discussed the results where it was recognised that many people might not be interested in how the hospital is run as long as it continues to provide the services they require. Tony Robinson suggested that there is a requirement to promote the fact that the hospital is a foundation trust. However, Ben Edgar- Attwell disagreed with this suggesting that the concentration should be on membership and the associated benefits; the fact that the hospital is a foundation trust is not necessarily an important aspect to members of the public.
17- 7 MEMBERSHIP AND COMMUNICATIONS PROGRAMME PROPOSAL 1920 7.1 Tony Robinson asked whether it was possible to create an electronic governors’ portal where they would be able to access various digital information, such as the governors’ induction pack and meeting dates etc. Ben Edgar-Attwell said that this could be explored and asked for members of the group to send him ideas for ALL inclusion on this portal.
18- 8 IDEA FOR INCLUSION AT THE COUNCIL OF GOVERNORS 1920 8.1 Tony Robinson said that he would raise the concept of the governors’ portal at the next Council of Governors meeting.
8.2 Feedback on the recent events the governors have attended would also be provided.
09- 9 ANY OTHER BUSINESS 1920 9.1 Sue Brown suggested that the Academy was not the best venue for the AGM and preferred the event that was held at the Manor Hotel a number of years previously. Ben Edgar-Attwell advised that the event at the Manor Hotel had one of the lowest attendance rates. He also advised that due to the messaging and presentations to be made at the AGM regarding the Trust’s financial position, it was not appropriate to rent off-site venues. To mitigate this, the Trust is intending to utilise volunteers and ensure the Academy is suitably sign posted. Tony Robinson suggested that free parking is provided for AGM attendees. Tori Birch said that it would challenging and provide mixed messages if the Trust was able to provide free parking for the AGM and not for patients or carers although this BEA/ would be explored. TB
Sue Brown suggested that the Trust does a radio interview for the AGM. Tori Birch said that this option is explored on an annual basis although there has been little uptake from the local media channels on this offer. She added that she is exploring options on promotion of the Trust within the South Somerset District County Newsletter.
Ben Edgar-Attwell said that the development of a full and comprehensive members’ welcome pack was planned. This would build upon the work completed by the recruitment teams in pulling together information on the hospital for medical recruitment.
10- 10 DATE OF NEXT MEETING 1920 10.1 10 October 2019, MR6, Level 1, YDH
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STRATEGY AND PERFORMANCE WORKING GROUP Draft Minutes of the Strategy and Performance held on 11 July 2019 at Yeovil District Hospital
Present: Alison Whitman Public Governor [Chair] Paul von der Heyde Chairman Tony Robinson Public Governor Nigel Stone Public Governor Virginia Membrey Public Governor Alan Harrison Public Governor Roger Wharton Public Governor Jennie Flory Public Governor [from item 6.6]
In Attendance: Jonathan Higman Chief Executive Ben Edgar-Attwell Company Secretary
Apologies: Paul Porter Staff Governor
Ref: No: Action 11- 1 WELCOME AND APOLOGIES FOR ABSENCE 1920 1.1 Alison Whitman welcomed everyone present to the meeting. Apologies for absence were noted as above.
12- 2 DECLARATIONS OF INTEREST 1920 2.1 No specific declarations of interest were made in relation to items on the agenda. Alan Harrison advised that he was Trustee Director of Sherborne Sports and Leisure Limited.
13- 3 NOTES OF THE MEETING HELD ON 4 APRIL 2019 AND TO DISCUSS ANY 1920 MATTERS ARISING 3.1 The notes of the previous meeting held on 4 April 2019 were approved as a true and accurate record.
3.2 Alison Whitman asked about progress on the implementation of the radiology managed equipment service. Ben Edgar-Attwell said that this was now in place and was running well. Jonathan Higman added that there is potential for collaborative working with neighbouring organisations on elective diagnostics.
3.3 Alison Whitman asked if there was an update on the proposed Daycase UK building. Jonathan Higman advised that NHS capital funding was significantly reduced this financial year following a national over commitment. As such, a review of capital projects within the Somerset Sustainability and Transformation Partnership has been completed; YDH is not expecting an impact on YDH agreed capital plans for this financial year. With regard to the Daycase UK building, the Trust is reviewing alternative funding options.
14- 4 PROGRESS AGAINST THE GROUP’S OBJECTIVES 1920 4.1 The members of the working group reviewed progress against the group’s objectives. Alison Whitman asked if the Annual Report, Quality Account and Financial Accounts had been formally submitted. Ben Edgar-Attwell advised that the reports had been laid before Parliament and would be published imminently.
4.2 Alison Whitman asked if there were any proposals to increase the proportion of the Trust’s non-NHS income by 5% or more. Jonathan Higman advised that there were no proposals expected in the near future. Nigel Stone noted that the
2019/20 Operational Plan outlined that up to an additional 1200 referrals would be received from the Taunton and Somerset NHS Foundation Trust’s (TSFT) catchment area in order to rebalance the waiting times across the county. He asked if this would affect the income within the private Kingston Wing. Jonathan Higman said that this additional activity was not expected to affect the private patient ward and activity, which typically operates out of hours etc.
4.3 Alison Whitman asked when the YDH site masterplan was expected to be reviewed. Jonathan Higman said the masterplan was under review during the summer period and would be presented to the Governors in late Autumn/Christmas time. Tony Robinson asked what timeframe the report covered. Jonathan Higman said that this is a 25-year plan. Paul von der Heyde said that the residential accommodation construction was progressing well with an expected completion date in late Spring 2020. Tony Robinson asked whether the masterplan reviewed the projected demographics for the county and region. Jonathan Higman said that the masterplan is reviewed in line with the clinical service strategies and reviews.
15- 5 EXECUTIVE UPDATE 1920 5.1 Jonathan Higman provided a verbal update of the Trust’s recent activity levels; there have been periods of significant demand, which had been challenging although the Trust is able to quickly respond and recover due to hard working teams across the hospital site.
Alan Harrison noted that there had been some national press coverage regarding Sepsis in recent weeks and asked how the Trust compares. Jonathan Higman said that the Trust generally performs well within this area. Ben Edgar- Attwell added that YDH performs better than the national average in 12 of the 14 areas reported by NHS England (including figures for flu vaccinations and Clostridium Difficile). Jonathan Higman suggested that it would be good to have a presentation from the clinical teams on the good management of Sepsis within YDH at the next Council of Governors meeting. This would be scheduled. BEA
16- 6 DRIVERS OF THE DEFICIT REPORT 1920 6.1 Jonathan Higman spoke to the previously circulated Drivers of the Deficit presentation. He advised that this review had been completed by NHS Improvement (NHSI) approximately 12 months previous; it is important to note that the figures within the report were not absolute, mainly due to how expenditure and costs were categorised; there has been some movement between the different categories.
6.2 The report outlined the main causes of the Somerset system deficit position across three main headings: structural, strategic and operational. Structural issues are defined as “outside of the control of the system such as geographical isolation or nationally determined funding mechanisms”. Strategic issues are about the way the system organises and develops its services but are “outside of the control of a single organisation”. They are “within the control of the system”. Operational causes are “within the control of a single organisation such as the inefficiency due to poor historical cost improvement plan achievement or high corporate and back office costs”.
6.3 Jonathan Higman said that it was important to note that the figures were based on reference cost submissions from 2017/18 where some inconsistencies had been noted. The submission of 2018/19 costs was due in the coming weeks which would result in an updated Drivers of the Deficit report.
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6.4 Tony Robinson asked if this report considered potential and future investments in services. Jonathan Higman said that additional growth funding is provided each year, which was previously utilised to deal with the additional demand; this year there is a move towards investing in alternatives to stem the flow and growth in demand.
6.5 Jonathan Higman said that the Trust’s underlying deficit had been largely stable within recent years although was high as a portion of turnover. In comparison, neighbouring organisations’ deficits have significantly grown in recent years. Virginia Membrey asked if this was a direct result of YDH’s deficit position. Jonathan Higman said that it was not directly linked but was largely a result of increasing demand across the country. Tony Robinson asked if TSFT was still progressing with their planned theatre reconstruction. Jonathan Higman said that this was progressing although required a full business case to be approved by NHS Improvement and England.
6.6 Jennie Flory joined the meeting.
6.7 Jonathan Higman said that the total system deficit drivers amounted to £58- £75million. The three foundation trusts within Somerset account for £39- £45million. Paul von der Heyde said that this was within a system that has a total income of approximately £800million. The group received a full overview of the Clinical Commissioning Group (CCG) drivers, which include an “overspend” on acute services; this is due to a variation of rate of referrals from different areas. Consequently, there is a focus on reducing variation across the county and reducing spend on additional activity through the provision of alternative services. The CCG drivers also include an element of underfunding which is to be addressed nationally over the coming years.
6.8 From a provider perspective, there is an element of sub-scale services (partly due to geography and scale). Both YDH and TSFT are recognised as small hospitals on a national level; they therefore potentially suffer on their scale of services, which require a certain level of overheads.
6.7 Jonathan Higman said that there are issues in the equality of services and waiting times across the system, with some independent providers having lower waiting times than the NHS organisations. This inequality is being addressed through the 2019/20 Operational Plan although this is challenging with the independent providers within the system. Discussions on a system level are taking place regarding this although there are contractual challenges.
6.8 Jonathan Higman provided an overview of the service level detail of the drivers of the deficit that covers a number of specialties. There is a lack of a good base for community services, which needs to be addressed; in addition, there are staffing challenges within the various community hospitals across the system that results in potential safety concerns. Nigel Stone asked if community hospitals make the provision of community neighbourhoods easier to facilitate. Jonathan Higman agreed that this was possible however current arrangements mean a variable usage of the hospitals throughout the county.
6.9 In order for maternity services to be sustainable, there is a need for around 3000 births; at present YDH has about 1600. The CQC inspection rated the service at YDH as Good with no workforce concerns. Jonathan Higman said a review of the service and the challenges faced is to be completed, which will account for the geography and patient need whilst ensuring patient safety is maintained.
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6.10 In terms of Paediatrics, there is a need to review Child and Adolescent Mental Health Services (CAMHS), which is provided by Somerset Partnership NHS Foundation Trust. The Trust receives a growing number of CAMHS admissions however the ward was not designed to facilitate this service.
6.11 Jonathan Higman said that there are a number of required services in order to maintain a full 24 hours emergency department, such as ICU and emergency surgery facilities. He advised that the cost per patient for the emergency department has significantly decreased in recent years following successes in recruitment and a reduction in agency expenditure. The unit is trauma accredited due its geography although this is potentially being reviewed by the Trauma Network. This review is being challenged by YDH due to rurality and good outcomes. Nigel Stone asked if the department received additional attendances due to the good waiting times within the unit. Jonathan Higman said that this was a factor.
6.12 Jonathan Higman pointed out that it was important to consider and review clinical developments, such as stroke thrombectomies. These advancements can only be completed within specialist centres and this should be considered as part of the wider service review.
6.13 The various drivers of the deficit are being reviewed to understand what can be done immediately to address the position otherwise the financial deficit will continue to deteriorate. In addition, discussions on a national scale are to take place on the national funding of rural services.
6.14 Roger Wharton said that plans appeared to be focussed on demand mitigation and bending the demand curve. Jonathan Higman agreed and said that there is an urgent need to invest in services and procedures in order to do this. Demand will inevitably continue to grow if investments are not made.
6.15 Tony Robinson asked if a continued growth in demand would lead to potential economies of scale and services becoming more efficient. Jonathan Higman said that this was a potential outcome; the emergency department is one example of a growth in demand but a reducing patient cost. He added that the existing unit would not be able to manage with a continuing growth in demand. Paul von der Heyde suggested that services and healthcare might be provided in different ways, including through various new technologies. Jonathan Higman said that there is potential for a change in day case offerings at YDH and joining services together to ensure that people get their care in the right place. This may include differing staff skill mix and workforce models.
6.16 Jennie Flory advised that when she was Governor a number of years previous, there had been talks about the potential requirement for a new hospital. She said it was amazing to see how the hospital had been able to manage demand in recent years. She said that this was testament to the management arrangements in place.
6.17 Jennie Flory asked whether the Trust utilises South Petherton Community Hospital. Jonathan Higman advised that the Trust does use it for clinics and specialties but suggested that a review of patient pathways across the entire Somerset system was needed to identify whether it could be used further.
6.18 Alison Whitman said that it would be useful to receive an update of the report following the submission of the 2018/19 reference costs. Jonathan Higman BEA/ agreed that this update could be presented at a future Strategy and JH
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Performance Working Group.
17- 7 YDH PRIORITIES AND STRATEGY 1920 7.1 Jonathan Higman said that the Trust had recently completed a review of the 2018/19 priorities and strategy to understand the developments and progress made and to ensure that these remain relevant and achievable for 2019/20. This review was completed against the Somerset STP ambitions for modern health and care services within Somerset; which largely concern prevention, development of local services, developing an Integrated Care System etc.
7.2 Tony Robinson questioned how improving access to services aligns with actions identified from service reviews; he suggested that this might reduce accessibility. Jonathan Higman agreed with these concerns and said it was therefore important to maintain the voice of the local population and ensure that people are not disadvantaged. Paul von der Heyde added that it was about delivering adequate and safe services whilst recognising the challenges the whole system faces. This may include different ways of accessing services and using technological advancements. Alan Harrison said the expectations of people are important and raising awareness of the challenges and restrictions is paramount. Jonathan Higman agreed and said that this would form the basis for the consultation period as part of the Fit for my Future programme. Jennie Flory said that it would be interesting to understand the cost of the NHS, such as an average cost per bed, appointment etc. Jonathan Higman advised that the average bed cost was around £300 per day, an outpatient appointment was circa £110 and an emergency department attendance was circa £190.
7.3 Jonathan Higman explained that priorities that had not been fully achieved within 2018/19 had been developed further and included within the priorities for 2019/20. One of these included the continued development of Symphony Healthcare Services (SHS) and making this self-sufficient. Nigel Stone asked about progress with this. Jonathan Higman advised that there was a planned deficit for this financial year although it was important to recognise the savings realised by SHS across the wider Somerset system, including the impact of bending on the demand growth for non-elective admissions. Alison Whitman asked whether these benefits had been recognised by the system. It was confirmed that the CCG had recognised these benefits and the premium costs required for challenging services. Jonathan Higman reported that SHS was investing in new technologies and digital solutions with a number of plans in progress. Virginia Membrey said that she had some feedback to provide following the integration of Bruton Surgery into SHS. It was suggested that links JH/ to the central SHS team would be made. BEA
7.4 The members of the group reviewed and agreed with the priorities identified within the presentation and thanked Jonathan Higman for the update.
18- 8 PERFORMANCE DASHBOARD 1920 8.1 The group reviewed the previously circulated performance dashboard where the following was discussed in further detail:
• Tony Robinson asked if the referral to treatment (RTT) performance included the redirected referrals from TSFT. Jonathan Higman advised that referrals had started to be received and said it would be beneficial for the trajectory from the Operational Plan 2019/20 to be added to the summary dashboards. Tony Robinson asked a follow up question about the specialties that were
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affecting performance. It was advised that there was increased demand across a number of specialties, including Ophthalmology. • The Trust’s financial income and expenditure position was slightly ahead of plan. Jonathan Higman advised that the latter part of the year is traditionally more challenging. He added that there is a risk to the cost improvement plans of approximately £1million; plans for this gap have not yet been identified although work continues in this area. • The group questioned the performance for the breaches of the 28 day cancelled operations readmission. Ben Edgar-Attwell advised that patients cancelled on the day for a non-clinical reason are required to be offered a new readmission date within 28 days and that it was one breach which caused the drop in rebooking performance. • The governors noted the staff turnover rate was rag rated as red. Ben Edgar-Attwell advised that the Workforce Committee had recently undertaken a review of the targets for the workforce KPIs to ensure consistency with neighbouring organisations. The turnover target is therefore being adjusted. It is important to note that turnover has decreased across multiple staff groups over the year. • It was agreed that the new Governor Indicator would be added to the BEA summary dashboards. • Alison Whitman drew attention to the large-scale improvements and reduced costs associated with delayed discharges of care compared to the previous year. Jonathan Higman said this improvement in performance was multi- factorial, including the development of the Home First service pathways for care out of the hospital. • The group said that it was useful to have the additional detail on the mandatory training modules within the report.
19- 9 IDEAS FOR INCLUSIONS AT THE NEXT COUNCIL OF GOVERNORS 1920 9.1 It was agreed that the following items would be considered for the next Council of Governors meeting: • A presentation on Sepsis within the Trust • An overview of the updated priorities for 2019/20.
20- 10 ANY OTHER BUSINESS 1920 10.1 No other items of business were raised.
21- 11 DATE OF NEXT MEETING 1920 11.1 Thursday 10 October 2019, MR 6, Level 1, YDH
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