Meeting of the Board of Directors to be held in public on Wednesday 1 August 2018 at 2pm in the Lomas Suite, Stratford Hospital
AGENDA
1. Apologies for Absence – Angela Brady, Glen Burley, Anne Coyle (Adam McKeown deputising),
2. Declarations of Interest
3. Minutes of the Meeting held on 4 July 2018 Enclosure A
4. Matters Arising and Actions Update Report Enclosure B
5. Performance Review and Assurance Monthly Reports 5.1 Chief Executive’s Report Enclosure C Jayne Blacklay 5.2 Integrated Performance Dashboard Enclosure D Jayne Blacklay - Mortality Update Charles Ashton 5.3 Nurse Staffing Report Enclosure E Fiona Burton 5.4 Clinical Governance Committee Report for 11 July 2018 Enclosure F Bruce Paxton 5.5 Lorenzo and Electronic Patient Record Monthly Update Enclosure G Danny Roberts
Other Reports 5.6 Foundation Group Strategy Sub-Committee Report for 23 July Enclosure H Simon Page 2018 5.7 Finance and Performance Committee Report for 19 July 2018 Enclosure I Simon Page 5.8 Out of Hospital Care Collaborative Quarterly Update Report – Enclosure J Adam McKeown Transformation Programme Update
6. Items for Noting and Information 6.1 Managing Director Role –Updated Corporate Governance Enclosure K Meg Lambert Arrangements 6.2 Summary of Ratified Policies Enclosure L Jayne Blacklay 6.3 Appointment of a Consultant in: - Emergency Medicine Enclosure Mi Ann Pope - Colorectal Surgery Enclosure Mii Ann Pope 6.4 Board Committee Minutes Enclosure N - Clinical Governance Committee on 13 June 2018 Bruce Paxton - Finance and Performance Committee on 21 June 2018 Simon Page
7. Any Other Business
8. Questions from Governors and Members of the Public
9. Adjournment to Discuss Matters of a Confidential Nature (to adjourn to confidential business at 3.40pm)
10. Apologies for Absence – Angela Brady, Glen Burley, Anne Coyle (Adam McKeown deputising),
11. Declarations of Interest
12. Confidential Minutes of the Meeting held on 4 July 2018 Enclosure 1
13. Confidential Matters Arising and Actions Update Report Enclosure 2
Page 1 of 2 14. SWFT Clinical Services Ltd Quarterly Update Report Enclosure 3 John Coyne/ (to follow) Jayne Blacklay 15. Report on Tender Returns – Lakin Flats Enclosure 4 Jayne Blacklay
16. Finance and Performance Committee Report for 19 July 2018 – Enclosure 5 Simon Page Closed Meeting
17. Board Committee Confidential/Closed Minutes Enclosure 6 - Group Strategy Committee on 22 May 2018 Simon Page - Clinical Governance Committee on 13 June 2018 Bruce Paxton - Finance and Performance Committee on 21 June 2018 Simon Page
18. Any Other Confidential Business
19. Date and Time of Next Meeting
The next meeting will be held on Wednesday 5 September 2018 at 2pm in the in the Brooke Suite, Warwick Hospital.
Overall Finish Time – 4.30pm
Page 2 of 2 Enclosure A SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Minutes of the Board of Directors Meeting Held on Wednesday 4 July 2018 at 2.00pm in the Brooke Suite, Warwick Hospital
Present: Russell Hardy (RHa) Chairman Charles Ashton (CA) Medical Director Jayne Blacklay (JB) Director of Development Tony Boorman (TB) Non-Executive Director (NED) Angela Brady (AB) NED Glen Burley (GB) Chief Executive Fiona Burton (FB) Director of Nursing Rosemary Hyde (RHy) NED Kim Li (KL) Director of Finance Simon Page (SP) NED Bruce Paxton (BP) NED Sue Whelan Tracy (SWT) NED
In attendance: Anne Coyle (AC) Managing Director for Out of Hospital Care Collaborative (OOHCC) Simon Illingworth (SI) Associate Director of Operations – Elective Care (deputising for the Director of Operations) Meg Lambert (ML) Trust Secretary Mary Powell (MP) Head of Communications and Fundraising Danny Roberts (DR) Chief Technology Officer Caroline Samouelle (CS) Associate Director of Organisational Development (deputising for the Director of Human Resources) Sarah Collett Board Administrator
There were also 8 Governors, 8 members of public and 1 member of press present.
MINUTE ACTION 18.194 APOLOGIES FOR ABSENCE
Apologies for absence were received from the Director of Operations and Director of Human Resources.
18.195 DECLARATIONS OF INTEREST
No declarations of interest were made.
18.196 MINUTES OF THE MEETING HELD ON 23 MAY 2018
Annual Equality and Diversity Report (Minute 18.177 refers) Page 9, section (d), the wording ‘… on recruitment of different ethnicity profiles’ be amended to read ‘… on best practice leadership for a diverse workforce’.
Resolved – that, subject to the above amendment, the Minutes of the meeting held on 23 May 2018 be confirmed as an accurate record of the meeting and signed by the Chairman.
18.197 MATTERS ARISING AND ACTIONS UPDATE REPORT
18.197.01 Actions Listed as Complete SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting Held Wednesday 4 July 2018
MINUTE ACTION
The actions listed as complete in the Actions Update Report were noted and would now be removed from the report.
Resolved – that the position be noted.
18.197.02 Integrated Performance Dashboard (Minute 18.126 refers)
The Managing Director for OOHCC explained that an update on the actions had been included in the Integrated Performance Dashboard report submitted to this meeting (Minute 18.200 refers). It had not been possible to provide clarity on the number of hours of domiciliary care that were waiting to be received. Process mapping sessions had taken place with the Customer Services Centre and with HomeFirst teams. A workshop with Brokerage teams was being held over the summer. This should provide clarity on waits at each point and provide a better understanding.
The HomeFirst exit blocks graph had been broken down within the report to this meeting, to clarify reasons for exit blocks. The report also included the Place Based Teams’ plan.
Resolved – that the position be noted.
18.197.03 Nurse Staffing Report (Minute 18.161.04 refers)
The Director of Nursing covered the action relating to the quality and safety results for all wards showing a comparison of several months’ data, under the main agenda item (Minute 18.201 refers).
Resolved – that the position be noted.
18.197.04 Summary of Reports for Noting and Information (Minute 18.161.05 refers)
The Chief Executive explained that he had clarified the roles of the Senior Information and Risk Officer (SIRO) and Caldicott Guardian with the individuals to ensure the roles were clear and to ensure there were no gaps between the two roles.
Resolved – that the position be noted.
18.197.05 Appointment of Consultant Reports (Minute 18.178 refers)
The Associate Director of Organisational Development confirmed that future reports on the appointment of Consultants would state whether the appointment was new, replacement or for another reason.
Resolved – that the position be noted.
18.197.06 Comment from a Public Governor (West Stratford and Borders) (Minute 18.181.02 refers)
The Director of Operations would provide the Patient Care Committee with an Page 2 of 13 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting Held Wednesday 4 July 2018
MINUTE ACTION update on the Improving the Patient Experience Working Group at its next meeting on 23 July 2018. The Director of Nursing clarified that this related specifically to inpatients.
Resolved – that the position be noted.
18.198 PROPOSAL TO EXPAND FOUNDATION GROUP
The Chief Executive explained that the Board had discussed the potential expansion of the Foundation Group to include George Eliot Hospital NHS Trust (GEH) at the Board Workshop on 23 May 2018. The Board was asked to formally consider the expansion of the Foundation Group to include GEH as detailed in the report which also included the benefits of the group model to GEH and existing members. The updated terms of reference for the Group Strategy Committee were appended to the report, subject to approval of the proposal. A similar report would be considered by the Board of Wye Valley NHS Trust (WVT) on 6 July 2018.
The Chairman invited questions and perspectives, and of particular note were the following points:
(a) Mr Boorman (NED) sought clarification around the consolidation of accounts across the Foundation Group. The Chief Executive clarified that the proposal was to strengthen the group model and that each Trust would remain a separate organisation. The consolidation of accounts or finances was therefore not being proposed, also each Trust would retain a separate Care Quality Commission (CQC) scorecard, and (b) Mr Boorman (NED) noted previous concerns relating to management stretch and sought assurance that a further expansion to the Foundation Group would not impact the performance of the Trust. The Chief Executive explained that if the proposal was approved then the leadership in the Trust would be strengthened through the appointment of a Managing Director in the Trust. This post would take on the responsibilities of the Chief Executive and would ensure that the Trust continued to improve.
Following consideration the Board approved the proposal to expand the Foundation Group to include GEH. The Group Strategy Committee terms of reference were also approved, however the Chairman proposed that the Group Strategy Committee be renamed to the Foundation Group Strategy Sub-Committee which would be reflected in the terms of reference.
Resolved – that (A) the proposal to expand the Foundation Group to include GEH through the proposed changes in membership of the Group Strategy Committee be approved, and (B) the Trust Secretary ensure the Group Strategy Committee be ML renamed to the Foundation Group Strategy Sub-Committee and its terms of reference be updated accordingly.
Page 3 of 13 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting Held Wednesday 4 July 2018
MINUTE ACTION 18.199 CHIEF EXECUTIVE’S REPORT
The Chief Executive presented this report and highlighted the key points. Of particular note were the NHS Smoke Free Pledge, national focus on reducing length of stay, Pathology IT issues, Midwifery Led Unit (MLU) and the announcement of a new NHS funding settlement and the development of a longer term NHS plan sections. The Chief Executive explained that the first baby had been born in the MLU earlier that day.
The Chairman invited questions and perspectives, and of particular note were the following points:
(a) Mr Paxton (NED) sought clarification around whether the NHS Smoke Free Pledge included vaping. The Chief Executive confirmed that the pledge did include vaping which was not allowed; (b) Mr Paxton (NED) highlighted the Pathology IT issues and explained that he had referred to the problems the Trust was experiencing following the implementation of the Pathology Laboratory Information Management System (LIMS) particularly with the reporting package, Citrix, in his report (Minute 18.202 refers). The Pathology Network was due to report back to the Clinical Governance Committee on 11 July 2018. The Chief Executive explained that he had escalated the matter to the Chief Executive of University Hospitals Coventry and Warwickshire NHS Trust (UHCW) and expressed concern that, as UHCW was not affected by the problem, the resolution of the problem had not been given enough priority. The Chief Technology Officer explained that a meeting was taking place that day but he had not yet received feedback. Mr Paxton (NED) asked whether there had been sufficient engagement from the Trust’s team to ensure UHCW could resolve the problem. The Chief Executive believed there had been GB sufficient engagement from the Trust but agreed to check; (c) Mr Page (NED) sought clarification around when an update and the outcomes of Café Lomas, Stratford Health and Wellbeing Centre, would be shared with the Board. The Chief Executive explained that measuring outcomes could be difficult, however there were a range of areas that could be reported back on. The footfall was likely to change due to new housing in the area, and (d) Dr Brady (NED) commended the work that the Health and Wellbeing Centre had undertaken and sought clarification around an appropriate time to extend to other areas. The Chief Executive explained that opportunities would be considered at appropriate times and as they arose. Learning was being shared and the Health and Wellbeing Centre had been built on best practice across the country.
Resolved – that (A) the Chief Executive's Report be received and noted, and (B) the Chief Executive clarify whether the Trust’s team had been GB sufficiently engaged with UHCW around the Pathology IT issues and report back to the Board.
Page 4 of 13 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting Held Wednesday 4 July 2018
MINUTE ACTION 18.200 INTEGRATED PERFORMANCE DASHBOARD
The Chief Executive introduced this report and the Director of Nursing, Associate Director of Operations – Elective Care, Managing Director for OOHCC, Associate Director of Organisational Development and Director of Finance in turn gave updates on their respective areas of performance.
The Chairman invited questions and perspectives, and of particular note were the following points:
(a) Mr Paxton (NED) highlighted the relaunch of iWantGreatCare and noted that the material needed to be more engaging and consideration be given to the client group as social media was not appropriate for all patients; (b) the Medical Director commended the A&E performance which had increased to 95% and noted that the teams should be commended due to the significant work that had been undertaken to ensure performance was improved; (c) the Director of Nursing highlighted an error on the dashboard, the maternity breast feeding at 6-8 weeks target should be 46% and not 70% as per the contract. She would ensure this was amended for FB future reports; (d) the Director of Nursing noted the increase in medication error incidences to 12% and explained that work was taking place to understand the increase as this could be due to a change in reporting; (e) the Chairman sought clarification around when e-prescribing would be implemented. The Chief Executive explained that a report would be submitted to the next Board meeting around a different approach for the journey to paperless. E-prescribing was being implemented across community hospitals; it had already been implemented at one community hospital. Implementation across the acute would be next year; (f) Mrs Whelan Tracy (NED) highlighted the Main Call Centre Response Rate section and felt that it was not clear that there had been an increase in 6,500 calls which was an increase of 40% and therefore the call handlers should be commended for their hard work. The reason for the increase was being investigated, however the majority of calls were 1-2 minutes long which highlighted that the self-serve work remained critical; (g) as reported under the Chief Executive’s Report (Minute 18.199 refers), cancer performance had been effected by the Pathology IT system. The Chief Executive explained that an upgrade to the software had been released that week and the Trust was expected to be upgraded the following week; (h) the Director of Nursing highlighted the performance against the ‘vacancies – percentage of unfilled posts against budget’ target which was 8% and felt that it would be helpful to review the target as the majority of unfilled vacancies were qualified nurses in emergency. The Chairman suggested that the Director of Human Resources AP included narrative in her commentary on the detail of unfilled posts with a percentage and also information on staff retention. It was Page 5 of 13 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting Held Wednesday 4 July 2018
MINUTE ACTION noted that recruitment and retention was scheduled for a future Board Workshop; (i) Dr Brady (NED) sought assurance around the Cost Improvement Programme (CIP) performance and whether there was anything else that could be done. The Director of Finance welcomed suggestions as a significant amount of work had been undertaken to identify CIPs, particularly looking at the model hospital. Further opportunities were being considered and there was a need to consider transformation opportunities. The Chairman noted that the Trust was the only acute trust in the Midlands that was delivering a surplus which would be difficult to sustain; (j) the Medical Director provided an update on mortality performance which remained within the control limits; (k) Mr Boorman (NED) sought assurance that the GPs undertaking work within the Trust had prescribing rights and there was satisfactory governance in place. The Medical Director confirmed that this was in place. GPs provided care to patients on Nicol Ward at Stratford Hospital and the governance arrangements were clear within the end of life care pathway which was audited. The Multidisciplinary Team and community staff discussed any learning, and (l) the Chairman sought clarification around whether the baby death FB incidents at the Countess of Chester Hospital NHS Foundation Trust provided any learning for the Trust’s MLU and asked that an update be provided to the Board.
Resolved – that (A) the Integrated Performance Dashboard be received and noted; (B) the Director of Nursing ensure the maternity breast feeding at 6- FB 8 weeks target be amended to 46% on the dashboard for future reports; (C) the Director of Human Resources consider reviewing the AP ‘vacancies – percentage of unfilled posts against budget’ target and include narrative in her commentary on the detail of unfilled posts with a percentage, and also information on staff retention, and (D) the Director of Nursing clarify whether the baby death incidents FB at the Countess of Chester Hospital NHS Foundation Trust provided any learning for the Trust’s MLU, and report further to the Board.
18.201 NURSE STAFFING REPORT
The Director of Nursing presented this report which included the information relating to the current inpatient nurse staffing levels for May 2018. Of particular note was the overall gap in acute nurse staffing between the planned and actual staffing levels which was 2%.
The Chairman invited questions and perspectives.
The Chief Executive noted that the report referred to a need to update planned numbers of ward staffing and sought clarification around when this would be reported back to the Board. The Director of Nursing confirmed that Page 6 of 13 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting Held Wednesday 4 July 2018
MINUTE ACTION this should be included in the next report.
Resolved – that the Nurse Staffing Report be received and noted.
18.202 CLINICAL GOVERNANCE COMMITTEE REPORT FOR 13 JUNE 2018
Mr Paxton (NED) presented this report and highlighted the key points. Of particular note were the following points:
(a) the Women and Children’s Division Audit and Operational Governance Group Quarterly Report was assuring. There had been an increase in the caesarean section rate, so work was taking place to separate elective and emergency caesareans. The Committee had requested a governance statement to cover the operation of the new MLU at the next meeting; (b) the relaunch of iWantGreatCare which was expected to increase the response rate and feedback quality; (c) concerns around the Pathology LIMS, a report was scheduled from the Pathology Service to the next Clinical Governance Committee meeting and it was hoped that improvements had been made, and (d) the Committee welcomed the first governance report from SWFT Clinical Services Ltd. The Care Quality Commission (CQC) inspection and rating of ‘requires improvement’ for Stratford Clinic was not satisfactory. An action plan was being monitored, clinical engagement had improved and patient feedback was positive.
Resolved – that the Clinical Governance Committee Report for the meeting held on 13 June 2018 be received and noted.
18.203 LORENZO AND ELECTRONIC PATIENT RECORD (EPR) MONTHLY UPDATE
The Chief Technology Officer presented this report and explained that the roll out of the System for Electronic Notification and Documentation (SEND) had been completed. The roll out of Requests and Results (R&R) was going well. It had been rolled out across all community sites, 7 acute wards were live and more to go live the following week. EMIS (a healthcare record system to share information across all healthcare professionals) had commenced. The Managing Director for OOHCC explained that she had met with teams the previous week and received positive feedback, the system was liked and the staff found it intuitive.
Resolved – that the Lorenzo and EPR Monthly Update report be received and noted.
18.204 AUDIT COMMITTEE REPORT FOR 23 MAY 2018
Mrs Hyde (NED) presented this report and explained that the majority of items had subsequently been considered and approved at the Board meeting on 23 May 2018, with the exception of the External Auditors’ report on the findings and recommendations from the 2017/18 Quality Report Audit.
Page 7 of 13 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting Held Wednesday 4 July 2018
MINUTE ACTION Resolved – that the Audit Committee Report for 23 May 2018 be received and noted.
18.205 FINANCE AND PERFORMANCE COMMITTEE REPORT FOR 21 JUNE 2018
Mr Page (NED) presented his report and highlighted the key points. Of particular note were the financial position as the month 2 position showed a £200,000 deficit, and A&E performance. The Associate Director of Operations – Elective Care had provided a presentation on cancer performance at the Trust which had showed a surprising increase in demand for cancer services. The Chairman suggested that the Executive Team made Execs more visible the year on year activity increase in their reports. This should help members of the public understand the pressures the Trust was under.
Resolved – that (A) the Finance and Performance Committee Report for 21 June 2018 be received and noted, and (B) the Executive Team make more visible the year on year activity Execs increase in their reports to help members of the public understand the pressures the Trust was under.
18.206 GROUP STRATEGY COMMITTEE REPORT FOR 22 MAY 2018
Mr Page (NED) presented his report and highlighted the key points. Of particular note were the five year plan update and the proposal to develop a joint procurement function was supported. However it was noted that longer term, procurement may extend further across the wider Sustainability and Transformation Partnership (STP) footprint.
Further to the Proposal to Extend the Foundation Group (Minute 18.198 refers), it was agreed that the Group Strategy Committee would be renamed to Foundation Group Strategy Sub-Committee.
Mrs Whelan Tracy highlighted the proposals for consideration section which outlined the proposed approach to procurement across the Group and that this may extend further across the wider STP footprint. She sought clarification around which Trusts were being referred to. Mr Page (NED) clarified that it was referring to this Trust. The Chairman suggested that this be clearer in future reports.
The Chairman sought assurance from Mr Page (NED) whether he felt the Committee was working satisfactorily. Mr Page (NED) confirmed that the Committee was functioning well.
Resolved – that the Group Strategy Committee Report for 22 May 2018 be received and noted.
18.207 REPORT FROM COUNCIL OF GOVERNORS MEETING ON 17 MAY 2018
Resolved – that the Report from the Council of Governors Meeting on 17 May 2018 be received and noted. Page 8 of 13 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting Held Wednesday 4 July 2018
MINUTE ACTION 18.208 CAPITAL PROGRAMME QUARTERLY UPDATE REPORT
The Director of Development presented this report and highlighted the key points. Of particular note was that the Trust was still working with NHS Improvement (NHSI) to secure the capital funding for the Electronic Patient Records (EPR) projects. The Capital Programme was dependent on securing the funding. Also there were an increasing number of issues with the maintenance of buildings managed by Property Services Ltd.
The Chairman invited questions and perspectives.
Dr Brady (NED) sought clarification around if there was a patient safety issue at a building managed by Property Services Ltd, who was obliged to rectify the issue. The Director of Development explained that the Trust paid a property management charge for the properties to be maintained to a specific standard, and that the Trust was not able to spend capital on such properties.
Resolved – that the Capital Programme Quarterly Update Report be received and noted.
18.209 PROGRESS UPDATE ON IMPLEMENTATION OF THE END OF LIFE CARE STRATEGY
The Director of Nursing provided a presentation for a 6 month update on the progress being made to implement the End of Life Care Strategy. During the CQC inspection in January 2018, the CQC had acknowledged the improvements in end of life care and areas of outstanding performance. The Director of Nursing and Medical Director had previously had joint responsibility for end of life care, however the Director of Nursing was now the Executive Lead.
The Chairman was encouraged by the progress made and asked that the FB Director of Nursing continued to provide 6 monthly updates.
The Chief Executive highlighted the vacancy in north Warwickshire for a Consultant in Palliative Care and explained that it had been reported at the GEH Board meeting earlier that day, that the post had now been appointed to and the individual should be in post later in the year.
Dr Brady (NED) felt encouraged by the significant work undertaken in a short timeframe.
Resolved – that (A) the Progress Update on Implementation of the End of Life Care Strategy be received and noted, and (B) the Director of Nursing continue to provide the Board with 6 FB monthly updates on the implementation of the End of Life Care Strategy.
18.210 BOARD ASSURANCE FRAMEWORK AND RISK QUARTERLY REPORT
The Chief Executive presented this report which proposed the end of year Page 9 of 13 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting Held Wednesday 4 July 2018
MINUTE ACTION Board Assurance Framework (BAF) for 2017/18 be agreed, the BAF for 2018/19 be approved and the 15-25 (red) risks on the Organisational Risk Register be received and noted.
The Chairman invited questions and perspectives, and of particular note were the following points:
(a) the Chief Executive highlighted Risk ID 1134 which related to 62 day cancer breaches. He explained that the Trust had taken steps for additional locum cover whilst discussions took place with UHCW on improving oncology capacity, and (b) Mrs Whelan Tracy (NED) highlighted the STP objective on the 2017/18 BAF and sought assurance around how the Board would be kept appraised of the STP governance arrangements. The Chief Executive explained that the STP was going through the transition process with some structures starting to emerge. Unfortunately the STP had not made satisfactory progress in a number of areas. Updates would continue to be provided to the Board through the Chief Executive’s Report. The Director of Development added that a redesign of the governance model was being facilitated by Pricewaterhousecoopers to move into an Integrated Care System (ICS) so an appropriate timescale to bring this back to the Board would be after the workshops.
Resolved – that (A) the end of year BAF for 2017/18 be agreed; (B) the BAF for 2018/19 be approved, and (C) the 15-25 (red) risks on the Organisational Risk Register be received and noted.
18.211 FREEDOM TO SPEAK UP GUARDIAN’S REPORT
The Associate Director of Organisational Development presented this report and highlighted the key points. Of particular note was the work between the Freedom to Speak Up Guardian and the Organisational Development team and ensuring the Speak Up and Wellbeing Ambassadors were supported in their roles and received appropriate training. The Chairman asked the Associate Director of Organisational Development to thank the Freedom to CS Speak Up Guardian for the significant work being undertaken.
The Chairman invited questions and perspectives.
Mrs Whelan Tracy (NED) raised concern around three cases being closed as staff were no longer employed by the Trust. She sought assurance that there was a process in place to continue to investigate the concerns raised by individuals who left as the issues could have contributed to the reason why the member of staff left. The Associate Director of Organisational Development explained that ongoing work was taking place to ensure such process was in place and to follow through on issues that had been raised. It was agreed that future reports would include more detail on the process and reporting mechanism.
Page 10 of 13 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting Held Wednesday 4 July 2018
MINUTE ACTION The Chief Executive provided assurance that he and the Director of Human Resources met with the Freedom to Speak Up Guardian to discuss the detail of the cases. A thorough investigation was undertaken into all cases regardless of whether the member of staff continued to be employed by the Trust. Mrs Whelan Tracy (NED) was advised to liaise with the Director of Human Resources or Freedom to Speak Up Guardian outside of the meeting.
Resolved – that (A) the Freedom to Speak Up Guardian’s Report be received and noted, and (B) the Associate Director of Organisational Development ensure CS the Board’s appreciation be passed onto the Freedom to Speak Up Guardian for the significant work being undertaken.
18.212 SUMMARY OF REPORTS FOR NOTING AND INFORMATION
The Associate Director of Operations – Elective Care presented this report which provided a summary of the Health and Safety Annual Report for 2017/18 and the Annual Security Report for 2017/18.
Resolved – that the Summary of Reports for Noting and Information be received and noted.
18.213 APPOINTMENTS OF A CONSULTANT IN GASTROENTEROLOGY AND CARE OF THE ELDERLY
The Associate Director of Organisational Development presented this report and explained that both appointments were replacements. The successful candidates had previously been trainees at the Trust.
Resolved – that the Appointments of a Consultant in Gastroenterology and Care of the Elderly reports be received and noted.
18.214 BOARD COMMITTEE MINUTES
Resolved – that the Minutes of the Business Performance and Investment Committee meeting held on 19 April 2018, Audit Committee meeting held on 16 May 2018 and Clinical Governance Committee meeting held on 9 May 2018 be received and noted.
18.215 ANY OTHER BUSINESS
18.215.01 NHS 70th Birthday
The Director of Development explained that the NHS 70th Birthday was on 5 July 2018 and informed the Board that Warwick Hospital had actually been there for 170 years that year.
Resolved – that the position be noted.
Page 11 of 13 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting Held Wednesday 4 July 2018
MINUTE ACTION 18.215.02 Annual Council of Governors’ and Members’ Meeting
The Chairman noted that it was the Trust’s 9th Annual Council of Governors’ and Members’ Meeting on 5 July 2018 at 9.30am at the Conference and Banqueting Centre, The Warwickshire Golf & Country Club (Leek Wootton, Warwick, Warwickshire, CV35 7QT). There would be an opportunity to meet members of the Board and Council of Governors at 9am.
Resolved – that the position be noted.
18.216 QUESTIONS FROM GOVERNORS AND MEMBERS OF THE PUBLIC
18.216.01 Comment from a Public Governor (West Stratford and Borders)
The Public Governor noted that the volume of patients seen, treated and admitted had increased and felt it would be useful for a report to be provided to the Board twice yearly on the volume of patients generally.
The Chief Executive explained that he had produced a slide for the Annual Council of Governors’ and Members’ Meeting the following day which showed this information. The Chairman added that, as reported under the Finance and Performance Committee Report for 21 June 2018 (Minutes 18.205 refers), he had requested that the Executive Team made more visible the year on year activity increase in their reports to help members of the public understand the pressures the Trust was under.
Resolved – that the position be noted.
18.216.02 Comment from a Public Governor (West Stratford and Borders)
The Public Governor was pleased to note that the Trust was addressing concerns relating to haematology as well as oncology with UHCW. The Medical Director noted that the Trust had appointed an additional Consultant Haematologist.
The Public Governor noted that the Council of Governors was scheduled to receive an update on Café Lomas at its meeting in November 2018.
The Public Governor noted that the Board monitored the number of vacancies for nursing and medical posts but sought assurance that vacancies across the Allied Health Professionals (AHPs) were also monitored and the Trust had a strategy in place. The Chief Executive provided assurance that vacancies across all staff groups were reviewed and AHPs were part of the overall Workforce Strategy.
Resolved – that the position be noted.
18.216.03 Comment from a Public Governor (East Stratford and Borders)
The Public Governor raised concerns regarding the MLU (Bluebell Centre). Firstly the signage was not clear from the road when driving to car park C. Also visitors were encouraged to use car park B, however access was not Page 12 of 13 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting Held Wednesday 4 July 2018
MINUTE ACTION particularly easy or safe as there was no access from the hospital.
The Chief Executive explained that it could be difficult when making enhancements to the site. Users of the Bluebell Centre were pre-booked so should be familiar with the location, however they were encouraged to use car park B which was being reviewed through the Car Parking Working Group. The Chief Executive agreed to review the signage and ensure it was sufficient.
Resolved – that the Chief Executive review the signage to the Bluebell GB Centre and ensure it was sufficient.
18.217 ADJOURNMENT TO DISCUSS MATTERS OF A CONFIDENTIAL NATURE
18.218 APOLOGIES FOR ABSENCE
18.219 DECLARATIONS OF INTEREST
18.220 CONFIDENTIAL MINUTES OF THE MEETING HELD ON 23 MAY 2018
18.221 CONFIDENTIAL MATTERS ARISING AND ACTIONS UPDATE REPORT
18.222 APPOINTMENTS AND REMUNERATION COMMITTEE REPORT FOR 13 JUNE 2018
18.223 PAYROLL CONTRACT TENDER AWARD
18.224 FINANCE AND PERFORMANCE COMMITTEE REPORT FOR 21 JUNE 2018 – CLOSED MEETING
18.225 BOARD COMMITTEE CONFIDENTIAL MINUTES
18.226 LEGAL SERVICES ANNUAL REPORT 2017/18
18.227 COMMERCIAL AND STRATEGIC PARTNERSHIP OPPORTUNITY
18.228 ANY OTHER CONFIDENTIAL BUSINESS
18.229 DATE AND TIME OF NEXT MEETING
The next meeting would be held on Wednesday 1 August 2018 at 2pm in the Lomas Suite, Stratford Hospital.
Signed ______(Chairman) Date ______Russell Hardy
Page 13 of 13 Enclosure B SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
ACTIONS UPDATE: PUBLIC BOARD OF DIRECTORS MEETING – 1 AUGUST 2018
AGENDA ITEM ACTION LEAD COMMENT
ACTIONS COMPLETE 18.198 To ensure the Group Strategy Committee be renamed to the Foundation Group ML Complete Proposal to Expand Foundation Strategy Sub-Committee and its terms of reference be updated accordingly. Group (04.07.18) 18.199 To clarify whether the Trust’s team had been sufficiently engaged with UHCW GB Satisfactory work around Chief Executive’s Report around the Pathology IT issues and report back to the Board. now in place, reporting (04.07.18) backlog now cleared. 18.209 To continue to provide the Board with 6 monthly updates on the implementation FB Added to the Board’s Progress Update on of the End of Life Care Strategy. Schedule of Business. Implementation of the End of Life Care Strategy (04.07.18) 18.216.03 To review the signage to the Bluebell Centre and ensure it was sufficient. GB To be discussed at Project Comment from a Public Governor Team. (East Stratford and Borders) (04.07.18)
ACTIONS IN PROGRESS 18.200 To ensure the maternity breast feeding at 6-8 weeks target be amended to 46% FB Integrated Performance on the dashboard for future reports. Dashboard To consider reviewing the ‘vacancies – percentage of unfilled posts against AP (04.07.18) budget’ target and include narrative in her commentary on the detail of unfilled posts with a percentage, and also information on staff retention. To clarify whether the baby death incidents at the Countess of Chester Hospital FB NHS Foundation Trust provided any learning for the Trust’s MLU, and report further to the Board. 18.205 To make more visible the year on year activity increase in their reports to help Execs Finance and Performance members of the public understand the pressures the Trust was under. Committee Report for 21.06.18 (04.07.18)
1 AGENDA ITEM ACTION LEAD COMMENT
ACTIONS IN PROGRESS (Continued) 18.211 To ensure the Board’s appreciation be passed onto the Freedom to Speak Up AP Freedom to Speak Up Guardian’s Guardian for the significant work being undertaken. Report (04.07.18)
REPORTS SCHEDULED FOR FUTURE MEETINGS
ACTIONS REFERRED TO BOARD OF DIRECTORS SUB-COMMITTEES
2 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Chief Executive’s Report Enclosure C
Nature of item For information For approval For decision
Decision The Board is asked to receive and note this report. required (if any)
General Report Author Glen Burley, Chief Executive Information Lead Director Glen Burley, Chief Executive
Received or Meeting approved by Date
Resource Revenue Implications Capital Workforce Use of Estate Funding Source
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public
South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Chief Executive’s Report
Provider Segmentation
The segmentation of NHS providers associated with the Single Oversight Framework has recently been updated on the NHS Improvement (NHSI) website. This confirms that the Trust is in Segment 1 which is further defined as ‘maximum autonomy, no support needs identified’.
There are 228 providers listed, 39 of which are in segment 1. But of these only 6 are general acute providers with the Trust being the only one in the West Midlands.
Year of Wellbeing
The Health and Wellbeing Boards of Coventry and Warwickshire now regularly meet together as the Joint Place Forum. At the most recent meeting we reaffirmed our commitments with an update to the Concordat we agreed as part of the early work on the Sustainability and Transformation Partnership (STP). The revised Concordat is attached at Appendix A. The Forum has also recently adopted a version of the Trust’s (and Wye Valley NHS Trust (WVT)) strategy diagram which emphasises the health and wellbeing focus on ‘helping you to help yourself’ and demonstrates the approach to integration and partnership working. Linked to this the two local authorities have agreed that 2019 will be a ‘Year of Wellbeing’ with a number of linked initiatives being organised and branded under that banner. Each of the key organisations in the patch has been asked to pledge to lead on a supporting initiative which focuses on some of the areas where we need to target our efforts to improve outcomes and the health status of our communities. This will include areas such as dementia awareness, childhood obesity and smoking cessation.
Subsidiary Companies
There has been much discussion recently about ‘arms-length’ or subsidiary companies which have been set up by NHS providers. I thought that it might be useful to provide some clarity and context on the matter which was also usefully clarified by NHS Providers. As the Board knows, we set up our own ‘SWFT Clinical Services Ltd’ (SWFT CS) soon after we became a Foundation Trust and it was one of the first of its kind and certainly the first to be granted social enterprise status.
In setting up a wholly owned subsidiary, NHS trusts retain 100% of the shares in the company, ensuring that the organisation, staff and the relevant funding remains within the NHS family. Contrary to some assertions, they are not a new concept in the NHS. The legislation enabling trusts to create wholly owned subsidiaries has been in place since 2006, introduced under the last Labour government and it is only recently that concerns have been raised about their use.
Currently, only foundation trusts, as legally independent public benefit corporations, have the statutory power to set up subsidiary companies on their own. There has been growing pressure for the same freedom to be extended to NHS trusts but, at present, NHS trusts can only set up a wholly owned subsidiary with permission from the Secretary of State.
2
Trusts have been actively setting up wholly owned subsidiaries since 2010 and they have been operating without controversy for a considerable period of time. However there has been an increase in the number of wholly owned subsidiaries being established in the NHS in recent months. This is in response to a number of developments including supporting new models of service delivery, wider system collaboration and integration and the delivery of operational productivity improvements. The use of wholly owned subsidiaries is seen by many trusts as a key tool in enabling them to respond effectively to these new requirements.
Wholly owned subsidiaries are an organisational and governance form that NHS providers can legally adopt to manage part of their organisation. In the case of our own, we were very careful to work with HMRC to ensure that we were compliant with their rules as the taxation arrangements are more akin to those used by non-NHS service providers including PFI companies. We undertook extensive due diligence before deciding to create our wholly owned subsidiary.
The detail of each subsidiary, its precise purpose, its method of operation and the functions it discharges, is specific to the Trust and context concerned. It is therefore inaccurate and misleading to say that the establishment of wholly owned subsidiaries is a new phenomenon or being pursed to avoid VAT, privatise the NHS, or to reduce terms and conditions for NHS staff. In our case we now run a range of services through SWFT CS and in doing so we have improved the efficiency and customer focus of the services in question.
Trust Annual Council of Governors’ and Members’ Meeting and 70th Birthday Celebrations
It was great to use our Annual Council of Governors’ and Members’ meeting as a further opportunity to celebrate the 70th Anniversary of the NHS. I know that Board members really enjoyed the trip down memory lane provided by our Director of Nursing and Medical Director. It is fair to say that the trip for one of them was slightly shorter than for the other.
There was a great buzz around the organisation and indeed around the UK as we celebrated the best healthcare system in the world. It was also fitting to look back locally on one of our most successful years from a performance and service development perspective.
The Annual Report and Financial and Quality Accounts are now live on our website and demonstrate not only our significant achievements but also our openness and transparency.
Glen Burley Chief Executive
3
SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Integrated Performance Dashboard Enclosure D
Nature of item For information For approval For decision
Decision The Board of Directors is asked to receive the report and note the month required (if any) 3 financial position for 2018/19
General Report Author Glen Burley, Chief Executive Information Fiona Burton, Director of Nursing Helen Lancaster, Director of Operations Anne Coyle, Managing Director for Out of Hospital Care Collaborative Ann Pope, Director of Human Resources Kim Li, Director of Finance Lead Director Glen Burley, Chief Executive
Received or Meeting approved by Date
Resource Revenue Implications Capital Workforce Use of Estate Funding Source
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Integrated Performance Dashboard
Chief Executive’s Commentary
The Trust still stands out as a local employer of choice and generally continues to attract specialist clinicians where vacancies arise. In keeping with the rest of the NHS, the recruitment and retention of Band 5 nurses is a particular challenge. This is more stark in the Emergency Division. As a result we have initiated a number of solutions which are referred to in the detailed report. Sickness levels continue with a generally positive trend.
Feedback from the General Medical Council (GMC) relating to the University of Buckingham Medical School initiative is very positive as we gear up to further expand student numbers next year.
Whilst we report one Serious Incident as a wrong site surgery never event, it should be noted that this referred to a toenail procedure which was not commenced following initial injection. Medication incidents are higher than plan but those which cause harm are relatively low. It is also encouraging to see VTE assessment compliance increasing which is now a fraction below the required national standard. Nursing Care Indicators are below target but this may be explained by the introduction of a new audit process. Next month’s results should clarify this.
Delayed Transfers of Care have fallen significantly over the past year and are now below target. This is a positive reflection of the integrated working between Health and Social Care locally. The challenge now will be to sustain this over the entire year. Length of stay in community hospitals is longer than plan and Integrated Single Point of Access response times have worsened. This may be in part due to the requirements to schedule on two systems whilst we complete our so far otherwise positive community PAS deployment. It is however pleasing to see that the Quarter 1 milestones of the Out of Hospital Contract have been met.
Performance against cancer standards continues to be a concern with the Trust position still being affected by the Pathology IT problems and capacity constraints in Radiology. The likely negative impact of patient choice on appointment times over the summer months suggests that this will not improve before September 2018.
18 weeks Referral to Treatment (RTT) performance remains better than the target and recent national data showed a particularly strong waiting times position in Orthopaedics. The A&E 4 hour waiting time position for June 2018 was above the 95% standard at 96.1%. This is one of the best positions in the NHS but sadly was not sufficient to achieve the Provider Sustainability Funding (PSF) ‘bonus’ payment. This is due to the Trust having one of the highest targets nationally due to previous performance.
We are appealing the position on PSF but have assumed the worst case in our financial report. Ignoring PSF we are slightly ahead of our surplus target. We should not forget however that we need to deliver more cost improvement savings over the remainder of the year. Currently we are significantly behind plan on Cost Improvement Programme (CIP) identification despite positive reports from the Divisions. We therefore need to ensure that possible schemes become costed definite schemes in our plan. 2 Integrated Performance and Quality Dashboard
June 2018
Performance Against Target - Regulatory & Financial Performance Against Target - Activity, Access, Local ● Meeting Target ● Meeting Target ● Not Meeting Target ● Not Meeting Target ● Agreed threshold above / below target Activity Monthly YTD Target YTD June 2018 YTD Quarter Month Target A&E Activity 19,345 19,871 6,378 6,861 ● ● ● Emergency Ambulatory Pathways - First Attendances 1,114 859 377 253 ● ● ● Emergency Ambulatory Pathways - Follow Up Attendances 386 0 131 0 ● ● ● Non-elective activity (Adult & Paediatric) 6,158 6,585 2,030 2,258 ● ● ● Maternity Activity (Deliveries) 606 650 200 233 ● ● ● Elective activity 9,970 8,946 3,377 3,053 ● ● ● Outpatient Activity - New (excl AHP & AEC) 22,244 22,034 7,534 7,240 ● ● ● Outpatient Activity - Follow Up (excl AHP, incl AEC) 49,399 50,669 16,732 16,998 ● ● ● Outpatient Activity - AHP 22,090 25,390 7,482 8,589 ● ● ● OOHCC - Community Contacts 202,834 206,084 68,884 65,955 ● ● ● Regulatory Measures Target June 2018 YTD Quarter Month A&E max wait time 4hrs from arrival to departure 95% 96.1% ● ● ● Referral to Treatment Times - Open Pathways (92% within 18 weeks) 92% 92.1% ● ● ● Cancer 62-Day 2WW Ref to treat, all cancers revised breach allocation methodology - one month in arrears 85% 82.9% ● ● ● Cancer 62-Day 2WW Ref to treat, all cancers - one month in arrears 85% 80.1% ● ● ● Cancer 62-Day 2WW Ref to treat, all cancers patients waiting - one month in arrears - 73.0 Cancer 62-Day National Screening Programme - one month in arrears 90% 85.7% ● ● ● Waiting Times - Diagnostic Waits <6 weeks 99% 97% ● ● ● Cancer 2WW all cancers, Urgent GP Referral - one month in arrears 93% 96.2% ● ● ● RTT Volume of Patients on Incomplete Pathways Waiting List - one month in arrears - 17194 RTT Number of Patients over 52 weeks on Incomplete Pathways Waiting List - one month in arrears 0 0 ● ● ● Financial Compliance Target June 2018 YTD Quarter Month Liquidity (Days) - one month in arrears 1 1 ● - - Capital Service Capacity (Times) - one month in arrears 1 1 ● - - I&E Margin % - one month in arrears 1 1 ● - - Variance in I&E Margin % - one month in arrears 1 2 ● - - Agency Ceiling % - one month in arrears 1 1 ● - - Overall Financial Sustainability Risk Rating - one month in arrears 1 1 ● - - Access Target June 2018 YTD Quarter Month RTT Data Quality Audit: % Unaffected - one month in arrears 90% 62.6% ● ● ● A&E - Ambulance handover within 30 minutes 98% 97.7% ● ● ● A&E - Ambulance handover over 60 minutes 0% 0.0% ● ● ● A&E Quality Indicator - 12 Hour Trolley Waits 0 0 ● ● ● A&E - % of admitted patients who are admitted within 4 hours 90% 91.2% ● ● ● Cancelled Operations on day of Surgery 0.8% 0.0% ● ● ● Over 28 Day readmission following short notice cancelled operation 0 3 ● ● ● Delayed Transfers of Care - Acute 2.5% 3.0% ● ● ● Delayed Transfers of Care - Community 7.5% 12.8% ● ● ● Homefirst Referral > 1st Assessment; completed on same day as referral 80% 55.8% ● ● ● iSPA call response rate within one minute 95% 56.3% ● ● ● Main call centre response rate within one minute 95% 78.6% ● ● ● Local Performance Targets and Measures Target June 2018 YTD Quarter Month Elective - Theatre Utilisation 85.0% 68.9% ● ● ● Elective - Daycase rate 85.0% 90.7% ● ● ● Outpatient - DNA rate (consultant led) 6.5% 7.4% ● ● ● BPT - Fracture Neck of Femur - one month in arrears 75% 68.6% ● ● ● BPT - Laparascopic Cholesystectomies 60% 46.7% ● ● ● BPT - Stroke 60% 57.9% ● ● ● Occupancy Acute Wards Only 90% 89.2% ● ● ● Maternity - Normal Births 60% 53.4% ● ● ● 3 Maternity - Elective C-Sections 10% 13.3% ● ● ● Maternity - Emergency C-Sections 15% 19.7% ● ● ●
Integrated Performance and Quality Dashboard
June 2018
Performance Against Target - Clinical, Experience, Harm Performance Against Target - Workforce ● Meeting Target ● Meeting Target ● Not Meeting Target ● Not Meeting Target ● Agreed threshold above / below target
Clinical Outcomes Target June 2018 YTD Quarter Month HSMR - rolling 12 months - Apr 17 to Mar 18 100 99.8 ● - - Mortality RAMI - rolling 12 months - Jun 17 to May 18 100 77 ● - - Mortality SHMI - rolling 12 months - Jan 17 to Dec 17 88-112 101 ● - - Avoidable Deaths - Rolling 12 months - Apr 17 to Mar 18 0 1 - - - Serious Incidents - Reported - 1 Never events 0 1 ● ● ● MRSA Bactereamia 0 0 ● ● ● C-Difficile 2 0 ● ● ● Falls with harm (per 1000 bed days) 1.53 1.74 ● ● ● Medication Error Incidences <6% 6.8% ● ● ● Pressure sores (Confirmed avoidable Grade 3,4) 0 0 ● ● ● Maternity - Breast Feeding Initiation Rate (Warwick Hospital) 81% 80.0% ● ● ● Maternity - Breast Feeding at 6 - 8 weeks (Community Midwives & Health Visitors) - Quarter 4 46% 45.2% ● ● ● Patient Experience Target June 2018 YTD Quarter Month Friends and Family Test Score: A&E% Recommended by Patients >96% 92.6% ● ● ● Friends and Family Test: Response rate (A&E) >20% 0.6% ● ● ● Friends and Family Test Score: Inpatients % Recommended by Patients >96% 96.8% ● ● ● Friends and Family Test: Response rate (Inpatients) >20% 22.4% ● ● ● Friends and Family Test Score: Maternity % Recommended by Patients >96% 100.0% ● ● ● Friends and Family Test: Response rate (Maternity) >20% 22.7% ● ● ● Friends and Family Test Score: Out of Hospital % Recommended by Patients >96% 97.1% ● ● ● Mixed Sex Accommodation Breaches - Confirmed 0 1 ● ● ● Patient ward moves emergency admissions (acute) 3% 0.7% ● ● ● Catering Surveys (Patients rating food as Good or Excellent) 85% 96% ● ● ● Staff Friends and Family Test: Recommended place for Care / Treatment - Quarter 1 >85% 96.0% ● ● ● Reducing Harm Target June 2018 YTD Quarter Month Cleaning Standards: Acute (Very High Risk) 95% 98% ● ● ● Cleaning Standards: Community (Very High Risk) 95% 97% ● ● ● Hand Hygiene 80% 97.6% ● ● ● Combined MRSA Screening 95% 93.2% ● ● ● Sepsis screening - A&E (% screened) - Quarter 4 90% 100.0% ● ● ● Sepsis screening - Inpatients (% screened) - Quarter 4 90% 100.0% ● ● ● Safety thermometer 96% 97.6% ● ● ● VTE Risk Assessments 95% 94.8% ● ● ● Nurse Care /Community Care Indicators 97% 94.1% ● ● ● WHO Checklist 100% 99.4% ● ● ●
Workforce Measures Target June 2018 YTD Quarter Month Midwife to birth ratio - last 12 months 1:27 1:28 ● - - Overall Sickness - one month in arrears 3.8% 4.1% ● ● ● Appraisals 85.0% 80.9% ● - - Vacancies - percentage of unfilled posts against budget 8% 5.5% ● ● ●
4 Director of Nursing – Performance Exceptions
1. Clinical Outcomes
1.1 Serious Incidents (SIs)
One SI occurred in June 2018, relating to wrong site surgery, which is classified as a Never Event. This is still being investigated however some learning opportunities have already been implemented. The incident is due to go to Clinical Governance Committee in August 2018.
1.2 Falls with Harm
The number of falls with harm (21) out of all reported falls (87) is comparative to numbers reported for the last 6 months. Of the 21 falls resulting in harm 19 were categorised as a low harm event. Wards that reported a high number of falls have introduced new initiatives; these include intensified training for staff, review of all repeat fallers, new alert method and Ward ‘Fall Prevention Newsletter’.
1.3 Medication Incidents
The number of medication incidents reported remains high for June 2018 at 88, which is a rise from 83 reported in May. The rate of harm arising from medication incidents is above the target of 6% (6.82%) but this has dropped significantly from the 12.05% in May 2018. All of these incidents have been reviewed at the monthly Drugs Therapeutics and Medication Safety Committee. From this review it was identified that the number of insulin related incidents has increased over time and therefore the committee has asked the diabetic team to undertake some improvement work with the specific teams as required.
1.4 Breast Feeding at 6-8 weeks
The position reported in the Dashboard is Quarter 4 2017/18 position, since the dashboard has been published the Quarter 1 2018/19 position has been released which is at 46.65%.
5 This Key Performance Indicator (KPI) is reported for Warwickshire as a whole and the split of compliance varies across the county greatly. The East and South of the county are frequently above the target (50-55%) however North is significantly below (30-35%) which brings down the overall rate. The North team have recently introduced ‘peer support training’ and a Breast Feeding Support Service to help improve this rate.
2. Patient Experience
2.1 I Want Great Care (IWGC)
The response rate for A&E is very disappointing considering the efforts made to relaunch the patient experience survey. A number of things have caused this including confusion and lack of communication within A&E about the change in process, high patient activity in A&E, some completed cards going missing and therefore not being submitted before the month end deadline, a lack of engagement and commitment to gaining patient feedback from the A&E team.
The Director of Nursing has spoken to the senior team in A&E and is working with them to improve their compliance. A weekly compliance is now being monitored by the Director of Nursing so that appropriate escalation is made in a timely manner.
2.2 End of Life Care - Deaths/Preferred Place of Care (PPC)
A patient’s PPC should be appropriately discussed and reviewed regularly with all patients who are deemed to be in their last year of life. An after death audit is conducted on a monthly basis of all patients known to the palliative care service, which includes place of death and whether PPC has been achieved or not. The results of these audits are shown below:
April 2018 North South Rugby Warwick Hospital Deaths 20 27 14 7 PPC Documented 16/20 80% 23/27 85% 13/14 93% 5/7 71% PPC achieved (where 14/16 88% 21/23 91% 13/13 100% 1/5 20% documented) Died Unseen 4 1 1 0
May 2018 North South Rugby Warwick Hospital Deaths 13 34 12 8 PPC Documented 13/13 100% 29/34 85% 11/12 92% 5/8 63% PPC achieved (where 8/13 62% 29/29 100% 11/11 100% 2/5 40% documented) Died Unseen 2 4 2 2
June 2018 North South Rugby Warwick Hospital Deaths 14 32 9 4 PPC Documented 13/14 93% 29/32 91% 9/9 100% 2/4 50% PPC achieved (where 10/13 77% 28/29 97% 8/9 89% 1/2 50% documented) Died Unseen 2 2 0 1
6 The percentage of PPC documented in the North and Warwick Hospital has fallen in June 2018, however it has increased in the South of the county. Although numbers are low for Warwick Hospital, non-compliance has been discussed with the team to identify actions to address this position.
For the North, of the 3 patients not achieving their PPC in June 2018, 2 were admitted to George Eliot Hospital to rule out reversible causes; 1 patient died before a bed became available at a hospice. In the South 1 patient died in Myton Hospice before they could go home. In Rugby, 1 patient died before a bed became available at a hospice and at Warwick Hospital 1 patient died before they could be transferred to a hospice. These themes will be fed into the Working Together Board and the End of Life Operational Group.
3. Reducing Harm
3.1 VTE Compliance
Following a Trust wide drive to improve the Trust’s overall VTE compliance, further progress was seen in June 2018 with compliance rising to 94.8%. This is still below the 95% target and work is being done on a ward by ward basis each week where compliance is low.
3.2 Nurse Care Indicators (NCIs)
NCIs are below target for the second month in a row. The reason for this is mostly likely due to the fact that in May, a new style Emergency Admission booklet was piloted and some of the NCI audit questions and the audit methodology was amended. Following the pilot, feedback has been received from wards and further amendments will be made with a new version due to be rolled out in August 2018.
3.3 WHO Checklist
In June 2018, the Trust achieved strong compliance for the completion of the WHO checklist although slightly below the Trust target of 100%. Compliance is broken down as follows:
• Day Surgery Unit: 99%; • Main theatres: 100%; • Paediatrics: 100%; • Obstetrics and Gynaecology: 100%.
WHO checklist compliance continues to be monitored at the Clinical Governance Committee and Audit and Operational Governance Groups (AOGGs). This is the first time this year (since January 2018) that the overall compliance with the WHO checklist is not 100%. In DSU, 2 patients did not have their sign out completed.
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Director of Operations Report
4. Regulatory Performance Measures
4.1 Cancer Performance – May 2018
Performance around the main cancer standards has been under pressure in recent months, primarily as a result of the IT issues and capacity constraints in Radiology. After a positive start in April 2018, May 2018 saw performance dip substantially as delays in obtaining pathology results became more severe and capacity issues for TRUS biopsies and Non Obstetric Ultrasound hit. There has also been an unusual rise in demand for 2 week wait appointments. Combined, this meant that performance fell in May and this is likely to be felt into June and July 2018 as well, as patients adjust their pathway and receive final treatment.
Some progress in addressing these issues has been made in recent weeks, with improvements to ultrasound and TRUS biopsy capacity seen in recent weeks. Pathology has also seen a temporary fix with regards to the IT issues, although this is not sustainable and a longer term solution is still needed. It is expected that the backlog for this service will be reduced in the coming weeks.
Looking ahead, it is predicted that June will not meet the 62 day standard (although this is not yet published so is subject to validation and change). July 2018 is expected to see a marginal improvement on the June 2018 position; however August and September 2018 are usually very difficult months with patients delaying the start of their treatments until after the summer holidays. Past performance shows that the 62 day measure has been missed in September 2018 for the last 3 years and so, even if performance improves significantly in July and August 2018, it may dip again after the summer.
Table 1: 2018/19
4.2 18 Weeks RTT Performance – June 2018
The Trust achieved the RTT standard in June 2018, achieving 92.04%. This is clearly very marginal although in response to rising demand in all areas along with sustained poor performance in ENT and Orthodontics, both of which are specialties with well-known capacity and service challenges.
8 Whilst there was a general improvement in RTT across most areas there are capacity challenges developing in Dermatology and in General Surgery. Additional staffing is being sought for both these specialties over the coming months.
4.3 A&E Performance – June 2018
There has been a continued improvement in Emergency Department (ED) performance against the 4 hour standard in June 2018, with 96.1% of patients seen within 4 hours. This has not been enough to recover the quarter. Attendances continue to exceed the contract. In response to this, work continues around red to green and stranded patients as well as the redesign of the frailty pathway and assessment which is leading to an increase in discharges home, for this cohort of patients, of around 50%. The ED team are also running a triage PDSA in July 2018.
The Elective Division are planning on implementing a revised pathway for surgical GP attends and the admissions for 0 to 1 day LOS have increased substantially in the last year.
5. Activity – June 2018
Emergency admissions are up against contract, by 16% in month and 11% year to date (YTD). ED attenders are up 7.5% against plan. Outpatient activity also continues to be above plan although by a smaller amount and in June the number of new attenders was slightly below plan, down by 1.5%.
Compared to the previous year A&E activity is 6% and Non Elective Activity (Adult) is up 12% with Elective Activity up 5.5% - all on the same period last year.
Maternity activity (deliveries) is slightly above plan for the month and year to date.
6. Notable Performance
The main areas of notable performance for June 2018 include:
6.1 Ambulance handovers within 30 and 60 minutes – June 2018
The number of handover delays over 60 minutes continues to perform well with no ambulances reported as waiting to handover for more than 60 minutes in June 2018 or YTD. This is despite the significant rise in demand for ED services over the last year.
6.2. Stroke Admissions with CT scan within 24 hours
The stroke service aim for a CT head scan to occur within 12 hours of admission, as per national guidelines (Trust work to 24 hours). The team has worked hard to ensure that the median average time for a stroke nurse review is 5 hours from diagnosis, again this is in line with national audit. Once the nurses are involved in patient care they will ensure that all diagnostics are requested and completed in good time. Radiology is very good as they prioritise the stroke patients according to the 12 hour national target. Generally the only patients that miss the 24 hour scan are those with a delayed diagnosis (i.e. where stroke was an accidental finding).
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6.3 Elective Day Case Rate - June
The elective day case rate has improved significantly, achieving 90.7% against a target of 85%. This is believed to be as a result of changes in ENT which have now shifted the majority of their tonsillectomy operating towards day-case, including paediatrics, as a result of the Getting It Right First Time (GIRFT) recommendations. There has also been an improvement in the numbers of patients seen as a day case in Urology.
6.4 Main Call Centre Response Rate – June 2018
Around 25,000 calls per month are received across all the main booking areas. This is very high and the Trust priority is to try and reduce this number over the coming year.
Despite this large volume of calls, call answering rates remain generally positive especially in Orthopaedics and Patient Access, although there remain issues in some of the outlying areas. Initial plans are to try and move therapy services to e-RS which will reduce the need for all patients to call in. Initial analysis of ‘reason for calling’ across Patient Access, Orthopaedics and Ophthalmology show that around 30% of calls are to reschedule an appointment, 7% to cancel and 20% to check their appointment date. Development of an effective patient hub that allows patients to achieve this without the need to the speak to a call operator is therefore important in bringing down the call volume.
An action plan is in place in Ophthalmology with a trajectory for improvement by the end of September 2018 while work is just starting in Oncology / Haematology, Podiatry and Radiology and each area will be developing a local improvement plan in the next month. We will also be moving towards standardising the call answering measure across all areas at 95% within 1 minute - and this will be in place for next month.
Table 2: Call answering standards – All areas (exc. Community iSPA)
7. Performance Concerns
The main areas of performance concerns for June 2018 include:
7.1 Diagnostics
Diagnostic target was missed again in June although the position was much improved on the previous month at 97%. The reason for the failure to reach the 99% standard related to performance for Non Obstetric ultrasound, which had around 250 patients who waited
10 more than 6 weeks for their diagnostic appointment. Since this time there have been considerable changes and the team is expecting further improvements in performance in July 2018.
7.2 Outpatients over threshold (follow up no date)
This measure remains stubbornly high with very little improvement seen in recent months despite the hard work of the operational teams. To try and improve matters, a Trust project group, with PMO support, is being established to look at how specialties might drive down demand for face to face follow up. This project will report directly to the Programme Delivery Board. A select number of specialties will be targeted with reductions over the coming year and learning shared across other areas. This is due to commence from September.
7.3 Best Practice Tariff (BPT) for Fractured Neck of Femur (#NOF)
This quality measure continues to struggle against the national standard. Time to theatre remains a problem but more detailed analysis suggests that within this domain there are four key reasons affecting performance including; emergency theatre availability, fitness of the patient, anticoagulation rules and anaesthetic decision to operate.
To try and improve matters the service is looking at rearranging lists to support more emergency theatre time, devising a protocol for better management of anti-coagulation patients and ensuring better list management by Consultants. The service has also recently appointed a new ACP to work within the trauma pathway.
11 Managing Director for Out of Hospital Care Collaborative
8. Delayed Transfers of Care (DTOC)
DTOC continue to be overseen via the system wide DTOC Board. This month combined data shows overall Trust performance at 3% against a target of 2.5%. DTOC in the community continues to show a positive trajectory reporting 12.8% against a 7.5% target. Community DTOC has shown an improvement for the fifth consecutive month with joint work continued across health and social care to achieve the target.
After detailed analysis of reason codes for delays the top three areas of concern for this month remain as:
• Residential Home placement • Nursing Home placement • Care package in own home
It is important to point out that the care packages within ‘own home’ shows an improved position for this month as expected.
Length of stay across Community Beds and Pathway 2 & Pathway 3 remains below target. However, recent changes to social care criteria are expected to have an impact on this. A joint operational oversight group has been established between the Out of Hospital Care Collaborative and Warwickshire County Council to look at harmonising health and social care processes and proposals for health management of reablement assessments. Proposals brought forward include health teams becoming first point of contact for assessment to better enable us to manage flow of patients and direct priorities. An impact on health capacity is currently being undertaken by the General Manager to understand the impact ahead of pilot and implementation.
9. HomeFirst Access
Exits from HomeFirst show an improved position during June 2018. Capacity is still being lost to support packages of care but this has reduced from 2,359 hours lost in February 2018 to 962 hours lost in month. Reason codes to understand delay issues continue to be explored with a ‘snap shot’ audit included below:
12 HomeFirst North delay reasons weekly 1 day snapshot 7/6/18 - 5/7/18
Total brokerage 12
brokerage - sourcing within 2 weeks 1
brokerage - sourcing within 1 week 11
waiting for POC - In (CCS)- received and in… 11
waiting SS to contact family of patient 10
waiting financial discussion 4
Out of Area 1
HF to contact family 1
waiting for POC - CCS not received referral HF to… 2
2
Declined POC 1
0 2 4 6 8 10 12 14
no of patients
HomeFirst South delay reasons weekly 1 day snapshot 7/6/18 - 5/7/18
Total brokerage 29 brokerage - sourcing within 2 weeks 3 brokerage - sourcing within 1 week 26 waiting Private POC 16 waiting for POC - In Customer Care Centre… 14 new referral needed due to change in pts… 5 waiting POC to start 5 Out of Area 4 CSC quering referral and ask for info to be resent 3 waiting SS to contact family of patient 3 Waiting CHC 2 waiting financial discussion 2 HF to contact family 1 Awaiting Equipment 1 waiting for POC - CCS not received referral HF… 1 0 10 20 30 40
no of patients
13 North referrals have continued to remain below the target expected; however, a redesign of the North pathway to include UPCA is underway and expected to have a positive impact on this.
Same day response times continue to be investigated as June reports a 55% achievement in same day response against an 80% target. It is important to note, however, that June 2018 has seen the deployment of the Electronic Patient Record (EPR) for South teams and the training programme to support this deployment which was anticipated to have a negative impact upon response times. Proposals to redesign shift patterns, as part of Trust capacity planning, have been brought forward to release more healthcare support worker capacity to positively impact upon same day response times. This redesign will be undertaken through August and September 2018 with anticipated benefits being realised from October 2018.
10. Integrated Single Point of Access (iSPA)
As expected June 2018 has been a difficult month for our performance reporting to 56.3% against a target of 95%. During June 2018 our iSPA staff have been included in the first cohort of our EPR roll out. EMIS (Community Electronic Patient Record) training prior to the ‘go live’ date was also undertaken to ensure all 15 staff had the appropriate training. This did impact upon HomeFirst performance even with contingency bank planning in place.
Post ‘go-live’ EMIS iSPA staff are required to use two systems when managing referrals whilst all teams in Out of Hospital are mobilised on to the EPR system. A divisional risk has been added to the risk register with team leader capacity being directed to support direct call capacity during July and August. A rectification plan for iSPA performance, which has been shared at Working Together Boards across the county, will oversee the completion of actions from an external review of efficiency within the service.
11. Out of Hospital (OOH) mobilisation
Overall progress on the OOH programme is good and the programme is on track. Work has begun to develop a model of system evaluation which will support the outcomes based approach and associated reporting.
An end of Quarter 1 summary presentation has been produced and is being shared with partners to highlight the progress made. A paper setting out progress will be considered at the Board of Directors meeting on 1 August 2018. Focus now moves to Quarter 2 milestones these are detailed below:
• expand telephone referral system, in line with the agreed needs assessment; • enable access to urgent and same day appointments via the single front door to cover all ‘in scope’ OOH community services; • confirm Place Based Team model based on the review and evaluation of pilot sites; • agree appropriate MDT to address personalised care needs of the registered patient population; • implement workforce plan and Organisational Development plan; • implement multi-agency change management plan; • implement public health delivery plan, and • establish regular reporting of outcome measures which are currently reportable from existing systems.
14 Director of Human Resources Report
12. Recruitment
12.1 Nurse and Clinical Recruitment
Our recruitment to clinical roles continues to be very successful, we have a very strong employer brand both locally and nationally and we continue to recruit both graduate and experienced staff across a range of disciplines.
There are areas of concern particularly related to band 5 nurses. This difficulty is reflected nationally, however we do continue to attract nurses to the organisation in strong numbers. The main hotspot areas we have are a concern from both a recruitment and retention point of view and we target those as much as possible in order to recruit in the Emergency Division.
The recruitment of our non-qualified clinical staff has seen a positive upsurge in numbers recently, due to the number of recruitment events and Open Days we have undertaken. As a result, our pipeline for this staff group is very healthy.
12.2 Non Clinical Recruitment
Some roles remain difficult to recruit to, particularly in areas of IT, due to the employment market of this sector.
13. Retention
We continue to develop our understanding and response to the ongoing staff retention challenges. Since 2010 voluntary turnover at the Trust (a measure of those that choose to resign) has risen steadily from 10% to a high of 14% in 2017. The Trust has a target to reduce this figure by 1% point per year over the next four years. We are currently undertaking a series of diagnostic exercises with a range of staff groups to better understand their experiences of working for the Trust and to understand what changes could be made that would improve this. These interventions are being led from the newly formed Clinical Retention Group which has a range of leaders from clinical and non-clinical backgrounds in attendance. The group aims to provide knowledge, intelligence and understanding as to why (specifically) clinical staff are leaving the Trust and what can be done to reduce this. The group aims to develop resources for managers to help them improve retention and staff experience rates in their own areas. This includes the awareness and understanding of the key data by which turnover is measured.
These interventions have been: - a six month programme (started in May 2018) to offer a Leavers Discussion to all clinical leavers at band 5 and 6. This discussion is to delve deeper into the reasons why they are leaving; - Staff Experience Questionnaires to all ward nurses at Warwick and Leamington Hospital – project live for July 2018; - Staff Experience Sessions – sessions offered to all band 5 and 6 clinical staff across the Trust to establish what’s good, what gets in the way and what they would improve in relation to their employment experience – currently live and will be complete late August 2018;
15 - New Starters survey – survey emailed to all new starters once they have completed 3 months’ service; - Staff Experience Survey (12 month) – survey emailed to all new starters once they have completed 12 months’ service, and - Ongoing work to improve data quality and information capture relating to leavers information.
In addition a number of specific actions have been implemented over the past 12 months designed to improve retention of key staff. These have included: - Changing the notice period of band 5 staff to 2 months; - Increasing the salary paid to nurses that have joined the Trust as graduates but are waiting for their professional registration, and - Full roll out of the Ward Operational Co-ordinator post to more areas across the Emergency Division – designed to support ward managers releasing time for them to lead.
We are expecting the full range of data to come together in early autumn 2018 when the group will make formal recommendations to the Workforce Strategy Group.
A full written report will be submitted twice yearly to Board outlining the latest position in terms of staff retention, planned actions and their impact. This first report will be in October 2018 when the results of the current diagnostics are known.
14. Sickness
The overall Trust sickness figure for May 2018 was 4.10%, a slight increase on the April 2018 sickness level of 4.02%. The figure for June 2018 is not yet available.
For the 6 months from December 2017 to May 2018 the divisional sickness rates were as follows:
Division % % % % % % sickness sickness sickness sickness sickness sickness Dec 2017 Jan 2018 Feb 2018 March April May 2018 2018 2018 Trust 4.71 5.26 4.94 4.18 4.02 4.10 Corporate 3.01 3.47 3.27 2.36 3.14 2.94 Division Elective 5.91 5.63 4.90 4.23 4.23 3.82 Care Division Emergency 4.26 5.02 4.93 3.26 3.62 4.23 Care Division Out of 4.95 6.29 5.91 5.69 5.28 5.55 Hospital Care Support 3.49 4.09 3.98 3.42 2.92 2.82 Services Division Women and 5.72 5.97 5.83 5.05 3.94 4.17 Children’s
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Sickness levels across the Trust have fallen from the relatively high levels recorded between December 2017 and February 2018. In January and February 2018 a significant proportion of sickness was due to cold/cough/flu, and this has decreased significantly in April and May 2018. Sickness levels in the Out of Hospital Care Collaborative (OOHCC), Emergency Care and Women & Children’s Divisions have increased this month whilst Elective Care and Support Services Divisions have continued their downward trend.
Adult Community Services remains an improved position, and work is on-going to reduce sickness absence in other consistently high areas of the OOHCC.
Compliance to formal sickness absence management processes is very good in all areas of the OOHCC. However, a recent audit in Children’s Services has identified that there still needs to be improvement on the return to work interviews taking place and being recorded on HealthRoster. A discrete piece of work and further audit throughout the whole of the collaborative will be taking place over the next six months.
15. Leadership and Organisational Development
The Organisational Development Team continues to develop and deliver a range of interventions across the Trust and the wider Health and Social Care system. This includes work with the OOCC, Coventry City Council, Wye Valley NHS Trust and GP practices in South Warwickshire. This work is focused on improving leadership capability and system level working as well as delivering sessions on Insights Discovery. Work also continues on understanding the Trust’s retention position through the Clinical Retention Group and a number of planned and underway discovery interventions.
15.1 Mary Seacole Programme
The Trust has just launched cohort 9 of the Mary Seacole Leadership Development Programme. To date 40 staff members have completed the programme and 60 members of staff are currently underway. The team has also recently introduced a more formal and robust method of course evaluation specifically to understand impact, improvement and growth of individual leaders. This will take place in two phases, firstly at the start of the programme and secondly after 12 months of the programme starting. Initial feedback on this evaluation will be available shortly.
15.2 Executive Coaching Programme
An element of our organisational development programme is to increase our offering of coaching to current and developing senior leaders. In support of this we have commissioned an ILM level 7 coaching programme to training 13 of our senior leaders to become executive coaches. This will provide a larger network of coaches from medical, clinical and non-clinical backgrounds who will be available to the Trust to support, develop and enhance our development offerings to staff. The programme will be completed over the next 9 months.
16. University of Buckingham Medical School
The Trust attended a planned GMC visit at the University of Buckingham Medical School (uBMS) on 5 July 2018. The purpose of the visit was to ensure that both uBMS and its
17 educational providers were on track to achieve final accreditation of the MBChB course to be signed off in 2019.
The Trust was able to demonstrate that we were working to a detailed action plan to expand teaching space for the increase in student numbers from March 2019.
Verbal feedback received outlined a list of things the GMC considered the University and its partners were doing well including:
• the academic and pastoral support; • engendering a culture of understanding and cooperation between health care professionals; • time in consultant job plans for educational activity at partner organisations, and • the continuing development of resources and facilities at the Trust was to be commended.
The Trust will receive a copy of the full report in due course.
18 Director of Finance Report
17. Executive Summary
The Trust agreed a financial plan with NHS Improvement (NHSI) to deliver a retained surplus of £9.507m which includes £0.6m Donated Income. Excluding the Donated Income and the impact of donated depreciation gives the Trust an agreed control total of £9.227m for 2018/19. The control total includes £6.879m of PSF. NHSI approved a re-phased plan submitted by the Trust for reporting from month 3.
The Trust’s 2018/19 Annual Plan includes a total CIP requirement of £9.2m.
The financial position for the month ending 30 June 2017 is a consolidated surplus of £0.748m which is an adverse variance of £0.283m compared to the control total plan of £1.031m. Excluding PSF this is a favourable variance of £0.026m.
Operating expenditure is above plan by £0.672m and operating Income is above plan by £0.384m.
18. Statement of Comprehensive Income
£000's
Annual In Month In Month In Month YTD YTD REVENUE including PSF of £6.879m Budget Budget Actual Variance Budget YTD Actual Variance Operating Income £294,699 £23,920 £24,547 £627 £72,033 £72,417 £384 Operating Expenses (£281,433) (£23,573) (£23,662) (£89) (£70,041) (£70,713) (£672) Operating Surplus £13,265 £347 £885 £538 £1,992 £1,704 (£288) Finance Costs Finance Income £648 (£84) (£110) (£26) £24 £24 £0 Finance Expense - Financial Liabilities (£931) (£41) (£70) (£29) (£196) (£227) (£32) Finance Expense - Unwinding of Discount on Provisions (£118) (£10) £0 £10 (£30) £0 £30 PDC Dividend Payable (£3,357) (£280) (£280) £0 (£839) (£839) £0 Net Finance Costs (£3,758) (£414) (£459) (£45) (£1,041) (£1,042) (£2) Corporation Tax £0 £0 £0 £0 £0 £0 £0 Retained surplus in SOFP £9,507 (£67) £426 £493 £951 £662 (£289)
Adjusted Financial Performance Remove capital donations / grants Income Impact (£600) £0 £0 £0 £0 £0 £0 Remove capital donations / grants Depreciation Impact £320 £27 £33 £6 £80 £86 £6
Control Total including PSF Income £9,227 (£40) £459 £499 £1,031 £748 (£283)
Provider Sustainability Fund £6,879 £344 £241 (£103) £1,031 £722 (£309)
Total Trust Surplus excluding PSF Income £2,348 (£384) £218 £602 (£0) £26 £26
19. PSF Income
The Trust’s 2018/19 financial plan includes £6.879m of PSF Income. Guidance issued by NHSI sets out the following conditions:
• Achievement of financial control total for each quarter weighted at 70% of the Trust’s allocation (£4.815m) • Achievement of A&E performance trajectory weighted at 30% of the Trust’s allocation (£2.064m)
19 To access the performance element, the Trust will need to achieve A&E performance in 2018/19 that is the better of either 90% or the equivalent quarter for 2017/18.
In quarter 1 2017/18 the Trust achieved A&E performance of 95.6% and although the Trust has achieved 90.5% in April 2018; 94.6% in May 2018 and 96.1% in June 2018 the Trust’s cumulative Quarter 1 position of 93.8% was below the equivalent quarter in 2017/18 and therefore the Trust will not be eligible for the performance element funding.
The Trust has achieved the year to date control total and therefore will receive its full amount of PSF financial funding for quarter 1.
20. Income
Divisional Income is overperforming across a number of areas but this is offset by underperformance of commissioner income.
21. Expenditure
Operating expenditure is overspent against plan by £0.672m. Some non-recurrent underspends have been offset against CIP but there are remaining areas of overspend that need to be mitigated. Recruitment to vacancies, sickness and unfunded posts are all resulting in continued high agency expenditure.
Other expenditure pressures include slippage against CIP targets.
22. Progress Against CIP
The Trust’s 2018/19 Annual Plan includes a total CIP requirement of £9.2m
£s Total CIP Division Required
Emergency Division 1,820,954 Elective Care Division 2,165,080 Support Services 1,538,244 Corporate Division 1,120,767 Out of Hospitals Care Collaborative 1,601,771 Women & Children's Division 953,185 Total 9,200,001
The charts below show the progress of CIPs in year and on a recurrent basis. In year 25.6% of schemes have now been presented and approved by Management Board including recognition of non-recurrent in year underspends.
On a recurrent basis the position currently stands at 23.2% approved and a further 23.1% awaiting approval or are being worked up.
20
CIP delivery with the divisions continues to be reviewed in detail in regular meetings with the Executive Directors.
23. New Use of Resources Metrics (UoR)
NHSI implemented a new Single Oversight Framework (SOF) from 1 October 2016 to assess the financial performance of providers via the UoR comprising the following five metrics:
• Liquidity Ratio • Capital Servicing Capacity • I&E Margin • I&E Distance from Plan • Agency
NHSI published an updated SOF on 13 November 2017 and no changes were made to the UoR. Providers are scored 1 (the highest / best score) to 4 (the worst / lowest score) equally weighted metrics. The average across the metrics determines the Trust’s Use of Resources (UoR) score. Based on the month 3 financial position the Trust scored a 1 (the highest score) under the UoR metric.
Finance and Use of Resources rating Ytd M3 Capital service cover rating 1 Liquidity rating 1 I&E margin rating 1 I&E margin: distance from financial plan 2 Agency rating 1 Overall UoR Score 1
24. Agency Expenditure
In 2018/19 the Trust has been set an annual agency expenditure ceiling by NHSI of £6.018m.
Total agency expenditure in June was £361k which is below the NHS Improvement’s ceiling limit for the month of £502k. This represents 2.39% of total staff costs compared to 2.59% in June last year.
This significantly improved position continues and
21 reflects the impact of tightening up the rules on the use of personal service companies and IR35.
25. Agency Analysis by Staff Group
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26. Statement of Financial Position
For the Period Ending June-18
GROUP As At As At As At Statement of Financial Position 31/03/18 30/04/18 31/05/18 £000s £000s £000s NON CURRENT ASSETS The statement of financial position reflects a Property plant and equipment 135,287 135,167 136,402 consolidated position. Intangible assets 2,086 2,009 1,901 Investments 0 0 0 Other assets 1,011 1,011 1,011 TOTAL NON CURRENT ASSETS 138,384 138,187 139,314 The Trust continues to work on resolving CURRENT ASSETS: outstanding queries in relation to Debtors Inventories 4,010 4,191 4,054 Short Term Loan 0 0 0 which mainly relate to NHS organisations. An Trade and other receivables 33,880 34,672 44,607 Cash and cash equivalents 21,185 22,027 15,372 element of these NHS debtors relate to local TOTAL CURRENT ASSETS 59,075 60,890 64,033 provider to provider service level agreements Non-current assets held for sale TOTAL ASSETS 197,459 199,077 203,347 (SLAs), where the Trust also a corresponding CURRENT LIABILITIES Trade and other payables (42,733) (44,245) (48,300) level of trade creditors outstanding. Borrowings (1,473) (1,473) (1,473) Provisions (399) (399) (399) Other liabilities (1,961) (2,176) (1,683) Resolution of these local provider to provider TOTAL CURRENT LIABILITIES (46,566) (48,293) (51,855) NET CURRENT ASSETS/(LIABILITIES) 12,509 12,597 12,178 SLAs will therefore show an improvement in TOTAL ASSETS LESS CURRENT LIABILITIES 150,893 150,784 151,492 the level of outstanding NHS debtors and NON CURRENT LIABILITIES Trade and other payables (391) (391) (391) creditors. Borrowings (27,262) (27,246) (27,245) Provisions (1,968) (1,922) (1,922) Other liabilities 0 0 0
TOTAL ASSETS EMPLOYED 121,272 121,225 121,934
FINANCED BY TAXPAYERS EQUITY Public Dividend Capital 64,957 64,957 64,957 Retained Earnings 40,210 40,163 40,872 Revaluation reserve 16,105 16,105 16,105
TOTAL TAXPAYERS EQUITY 121,272 121,225 121,934
27. Cashflow
The graph opposite shows the actual cash position, together with the monthly cash balance submitted in the Annual Plan for the Group.
The cash balance at the end of June 2018 was £15.372m for the Group, which is £5.927m below the £21.299m planned for the month. The reduction against plan is explained by an increase in debtors, the largest increase of which is £2m with Health Education England for quarter 1 education and training monies, where payment is now expected in July 2018.
The 12 monthly rolling cash forecast is shown in the graph below. 28. Capital Programme
The Trust’s budgeted capital programme funding for 2018/19 is £19.736m, which is made up of £3.660m carry forward from
23 2017/18, £10.498m of internally generated funds, £4.978m Public Dividend Capital (PDC) and £0.6m charitable funds. The £4.978m PDC relates to the Trust’s £9.42m STP OOH capital bid, of which £4.978m is planned to be spent in 2018/19 on the OOH Adult and Children’s EPR and population health schemes. Whilst the Trust’s outline OOH capital bid has been successful, it is still subject to final business case sign off by Department of Health and Social Care.
The capital programme year to date spend at month 3 is £2.646m.
29. Recommendation
The Board of Directors is asked to note delivery of the month 3 position for 2018/19.
24 Appendix 1 – Provider Sustainability Funding Achievement
Quarter 1 Quarter 2 Quarter 3 Quarter 4
PSF Criteria Total Value (£m) Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Plan (£m) £0.536 £1.072 £1.031 £1.682 £2.334 £2.985 £3.865 £4.745 £5.627 £6.622 £7.617 £8.649 Delivery of the YTD provider financial control total £4.815 Actual (£m) £0.326 £0.866 £0.748
Access Standards
Plan 95.6% 95.0% 90.1% 90.0% £2.064 Actual 90.50% 94.60% 96.10%
Provider Sustainability Fund Total £6.879
Provider Sustainability Funding Achievement Financial Criteria £0.241 £0.241 £0.241 £0.321 £0.321 £0.321 £0.482 £0.482 £0.482 £0.562 £0.562 £0.561
Access Criteria £0.000 £0.000 £0.000 £0.138 £0.138 £0.137 £0.206 £0.206 £0.206 £0.241 £0.241 £0.240 Total STF Funding £0.241 £0.241 £0.241 £0.459 £0.459 £0.458 £0.688 £0.688 £0.688 £0.803 £0.803 £0.801
25 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Nurse Staffing Report Enclosure E
Nature of item For information For approval For decision
Decision The Board is asked to receive and note this report. required (if any)
General Report Author Caroline Jackson, Deputy Director of Nursing Information Lead Director Fiona Burton, Director of Nursing
Received or Meeting approved by Date
Resource Revenue Implications Capital Workforce Use of Estate Funding Source
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public
South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Nurse Staffing Report
Executive Opinion
This report provides assurance that the Trust has appropriate oversight and governance arrangements in place to robustly monitor and triangulate staffing levels across inpatient wards and Integrated Health Teams (IHTs) and directly compares these with patient safety and quality indicators.
When scrutinising patient safety and quality indicators data, there are a number of wards and IHTs that demonstrate the challenges they face in terms of staff vacancies and availability and patient safety and quality indicators. These teams will be monitored closely to ensure that patient outcomes are being met and that there are plans in place to improve patient safety outcomes.
Executive Summary
This report provides information related to the inpatient and IHT nurse staffing levels compared to the planned numbers, skill mix, patient acuity and dependency. The overall gap in relation to planned staffing levels versus actual staffing levels in the inpatient areas in June 2018 is currently 4% which was slightly greater than the 2% in May 2018. June 2018 continued to be challenging due to sustained high numbers of emergency attendances and the ongoing need for some extra capacity beds, particularly at weekends. There are still some areas with high vacancy and sickness rates, and ongoing dedicated recruitment events continue. Gaps in staffing continue to be mitigated by reviewing acuity and dependency of patients, backfilling where required with bank and agency staff and escalated to the Corporate Nursing and Operational teams as appropriate.
Effects on quality and safety are scrutinised especially on those inpatient wards that are breaching 1:8 ratio and have a gap in their planned and actual staffing levels of >5% and in those IHTs that have large caseload numbers.
Recommendations
• Continue to monitor on a daily basis the staffing levels compared to patient acuity, dependency and escalating any gaps to assure all is done to reduce these. • Maintain the proactive recruitment activity and prioritise those areas with the highest vacancy factor. • Continue to implement retention strategies to identify and address the reasons for staff leaving. • Continue to manage unavailability across all areas to ensure our staff’s health and wellbeing is supported. • Fully implement ward manager development and support programme. • Utilise ‘I want Great Care’ feedback to motivate and recognise good practice, develop our services and raise staff morale. • Promote the staff reward and recognition systems and celebrate and communicate quality improvement initiatives.
2
• For Out of Hospital Care Collaborative (OOHCC) to undertake a review of the IHT staffing models in the next six months, following the publication of the NQB staffing guidance related to district nursing teams and the development of place based teams.
Fiona Burton Director of Nursing
3
South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Nurse Staffing Report
1. Introduction
This report presents the nurse staffing data across all inpatient wards during June 2018 and the IHTs during Quarter 1 2018/19. The purpose of this report is to update the Board in relation to the inpatient nurse staffing levels and specifically the gap between the planned and actual levels, the reasons for this gap, any effects this gap may have had on the quality of patient care and how any risks are being mitigated. In addition it gives an overview of the nurse staffing capacity, skill mix and quality and safety indicators for the IHTs.
2. Inpatient areas
2.1 Summary of Inpatient Nurse Staffing during June 2018
Graph 1 demonstrates that the overall gap in nurse staffing between the planned and the actual numbers reported on duty across the inpatient wards in June 2018 was 4%, which is an increase from the previous month (2% in May 2018).
Graph 1
All staff during both shifts staff levels % Sum of % actual Sum of % gap
4% 100% 90% 80% 70% 60% 50% 96% 40% 30% 20% 10% 0% -10% -20% -30%
Graph 2 shows this gap is made up of wards that were understaffed and overstaffed. In June 2018, Avon, Chadwick, Oken, Farries, Greville, Mary, Maternity, Nicholas, Special Care Baby Unit (SCBU) and Willoughby Wards had over 5% gap in their actual staffing numbers. Avon, Farries, Maternity, Nicholas and SCBU have a larger gap than the previous month but the gap is smaller in Chadwick, Oken and Greville and remains consistent compared to previous months in Mary and Willoughby Wards.
4
Graph 2
All staff during both shifts Staff levels % by all Wards Sum of % actual Sum of % gap 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% -10% ITU Nicol Avon Mary SCBU Castle Squire Farries Feldon Greville Victoria Thomas Nicholas Campion Chadwick Maternity Beaumont Cardiology Charlecote MacGregor Willoughby Ellen Badger Surgical Unit Fairfax/Oken
Staffing continues to form an integral part of the daily operational meetings where safe staffing is discussed alongside patient demand and acuity, thus informing decision making about redeploying staff to ensure safety across the Trust. Ward Managers have been reminded of the importance of ensuring the Safecare census data is inputted routinely and in a timely manner so that accuracy can be assured.
The main reasons for the gaps in the nurse staffing figures are vacancies, sickness, maternity leave or short term reduction in the staffing due to reduced patient demand. The main reason why some areas appear overstaffed are where additional staff have been booked to special high risk patients, or staff extra capacity beds.
A comparison has also been made between days and nights for registered nurses/midwives and care staff. Graphs 3, 4, 5 and 6 show these differences for the month of June 2018. This information demonstrates that the inpatient wards were understaffed in registered nursing staff during the day by 11% and at night by 10%. These figures demonstrate a decline in position when compared with the previous month, where the gap was 8%.
5
Graphs 3-6
Registered Nurse / Midwife Staffing Registered Nurse / Midwife Staffing Levels in the Day Levels in the Night Sum of Registered % Gap Day Sum of Registered % gap Night 100% 100% 11% 10% Under 10% 10% Under 90% 90% 80% 20% Under 80% 20% Under
70% 30% Under 70% 30% Under 60% 60% 50% 50% 89% 90% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% -10% -10% -20% -20% -30% -30%
Care Staff Levels in the Day Care Staff Levels in the Night Sum of Care % Actual Day Sum of Care % gap Day Sum of Care % Actual Night Sum of Care % gap Night 4% 100% 100% 10% Under 90% 90% 20% Under 80% 80% 30% Under 70% 70% 60% 60% 123% 50% 50% 96% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% 10% Over -23% 10% Over -10% -10% 20% Over 20% Over -20% -20% 30% Over 30% Over -30% -30%
An analysis of the fill rate by substantive, bank staff and agency staff, for both day and night shifts, has been shown in Appendix 1. This demonstrates that the majority of agency usage is at night when there are fewer registered nurses on duty or on wards where additional capacity beds have been opened or ‘specials’ have been required. This is a concern because the supervision of agency nurses by senior substantive staff is an important safety measure when using temporary workers. As a means of mitigating this a number of actions are being taken to reduce the reliance on agency nurses and these include a review of Bank pay rates to incentivise staff to join the bank, a dialogue with the agency to request the block booking of agency staff to provide a more stable workforce, an increased training and development offer to bank workers.
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SafeCare
The SafeCare module of HealthRoster enables each ward to calculate the number of staffing hours they require each shift according to the actual dependency and acuity of their patients, and compares this to their planned and actual staffing numbers. The information is being used to support the most safe and efficient use, and movement of resources on a shift by shift basis based on the acuity of patients rather than just the number.
The SafeCare information for June 2018 is displayed in the graphs below and is similar to the data reported in May. The red rostered bars are the number of staff actually on duty across the month per ward. The green line is the planned hours of nursing staff according to the ward roster templates and the blue line indicates the hours of staff time required according to the actual patient acuity during the month.
Squire Ward and Victoria ward continue to report increased acuity and demand against planned hours. This will be mitigated by re-prioritising workload or booking additional staffing as required. Fairfax (Oken) ward’s safecare data input is inconsistent and therefore unreliable at this point. This may be due to the unpredictability of the workload and demands in this area, coupled with the gaps in regular staff. The Deputy Director of Nursing has commenced a project this month to review the safecare data input with the intention of engaging the ward managers in inputting it in a more timely and consistent manner.
Rostered Care vs Required Care vs Planned Hours June 2018 Rostered Care Required Care Planned Hours
8000 7000 6000
5000 4000
Hours 3000 2000 1000 0 Avon Ward Avon Mary Ward Mary Castle Ward Squire Ward Squire Surgical Unit Surgical Farries Ward Fairfax Ward Greville Ward Victoria WardVictoria Thomas Ward Thomas Nicholas Ward Campion Ward Campion Cardiology Unit Chadwick Ward Chadwick Beaumont Ward Beaumont Charlecote WardCharlecote MacGregor Ward MacGregor Willoughby Ward
1:8 Ratio
The number of shifts where the number of qualified nurses per patient has breached the national guidance of 1:8 was 154 in June 2018, which is a marginal increase on May’s figure of 145. The wards that breached most were Squire, Farries and Victoria. These occasions would have been appropriately escalated through the site and corporate nursing
7
teams to support the ward to prioritise workload, secure additional staffing, or change the ward skill mix to keep patients safe.
Incidents
During the month there were 32 incidents reporting inadequate staffing levels, which is a decrease from previous months. These have been categorised as either a breach in 1:8 registered nurses during the day, a breach of 1:10 registered nurses at night and if these have had any impact on the patients. The following charts demonstrate the wards and departments where staffing incidents have been reported and the number of times patient care has reportedly been affected.
Staffing Incidents by Ward/Site (June 2018) 12 11 10 8 6 3 4 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 0
Staffing Incidents by Sub-category (June 2018)
Delay in contact in maternity assessment suite… 3 Less than 1 Qualified nurse to 8 patients - During… 3 Delay in performing both maternal/neonatal… 1 Staff shortages in supporting teams 14 Community - Staff Shortage 1 Medical staff (Doctor) shortage 1 Staffing below the minimum level in all… 4 (blank) Delay in 1.1 care in established labour in any… 1 No impact to patient care 4
0 2 4 6 8 10 12 14 16
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Care Hours Per Patient Day (CHPPD)
Following the publication of the Carter Review (2016), NHS Trusts have been mandated to calculate and report on a monthly basis, the care hours provided by registered nurses and care workers to each patient per day. The aim of this was to allow national benchmarking but a simultaneous reduction in variation and increased efficiency where possible. The Carter Review (2016) stated that the average care hours per patient in the pilot sites was 9.1 hours of care provided by registered nurses and care workers per patient day with a variation from 6.33 to 15.48 hours.
In the chart below you can see the reported CHPPD per ward in June 2018. A total of 10 acute inpatient adult areas were below the national minimum, which were Avon, Beaumont, Castle, Farries, Feldon, Nicol, Squire, Thomas, Victoria and Willoughby Wards.
CHPPD June 2018
26 24 22 20 18 16 14 12 10 8 6 4 2 0 ITU SCBU Mary Avon Castle Squire Farries Feldon Greville Victoria Thomas Nicholas Campion Maternity Chadwick Nicol unit Beaumont Charlecote Macgregor Ellen Badger Ellen Willoughby Surgical Unit Surgical Fairfax/Oken Cardiology Unit
Reasons for Current Gaps in Staffing
There are a number of reasons for the staffing gaps that have been identified. These remain unchanged from previous reports and include a continued vacancy factor, sickness and maternity rates in some wards and extra capacity beds remaining open particularly at weekends, which is unusual during the summer months.
Unavailability
The Carter Review (2016) has also given organisations the impetus to consider how they manage and monitor the unavailability of staff to ensure best use of resources. Inpatient wards are currently budgeted with headroom of 22% that is used to backfill annual leave at a percentage of 14%, sickness at 4% study leave at 2% and management time at 2%. If there is more than 22% of staff unavailable to work, then this is not budgeted for, if they are backfilled.
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The following graphs show the unavailability of staff by reasons across the inpatient wards during June 2018. It is expected that there will be some variation in these figures during each month depending on the service and unavailability that managers do not have control over e.g. maternity leave. However, it is expected that unavailability levels are monitored and managed closely by the Divisional Teams to ensure that we are addressing the reason for some of the staffing gaps wherever possible and managing annual leave evenly throughout the year.
Registered Staff Unavailability June 2018
Sum of Annual Leave Sum of Sickness Sum of Study Leave Sum of Working Day Sum of Parenting Sum of Other Leave 40% 35% 30% 25% 20% 15% 10% 5% 0% ICU SCBU Nicol Unit Avon Ward Avon Mary Ward Mary Castle Ward Squire Ward Squire Ellen Badger… Ellen A&E Nursing Surgical Unit Surgical Farries Ward Feldon Ward… Feldon Fairfax Ward Greville Ward Victoria WardVictoria Thomas Ward Thomas Nicholas Ward Maternity Unit Maternity Campion Ward Campion Cardiology Unit Chadwick Ward Chadwick Beaumont Ward Beaumont Charlecote WardCharlecote MacGregor Ward MacGregor Willoughby Ward
Unregistered Staff Unavailability June 2018
Sum of Annual Leave Sum of Sickness Sum of Study Leave Sum of Working Day Sum of Parenting Sum of Other Leave 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% ICU SCBU Nicol Unit Avon Ward Avon Mary Ward Mary Castle Ward Squire Ward Squire Ellen Badger… Ellen A&E Nursing Surgical Unit Surgical Farries Ward Feldon Ward… Feldon Fairfax Ward Greville Ward Victoria WardVictoria Thomas Ward Thomas Nicholas Ward Maternity Unit Maternity Campion Ward Campion Cardiology Unit Chadwick Ward Chadwick Beaumont Ward Beaumont Charlecote WardCharlecote MacGregor Ward MacGregor Willoughby Ward
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2.2 Effects on Quality and Safety
Patient Care Sensitive Indicators (previously Nurse Care Indicators)
The Patient Care Sensitive Indicator results for June 2018 were 94% which is a drop from 96% compliant and short of the national target (95%) and Trusts Internal target of 97%. The wards that did not meet the 97% target can be seen in Appendix 2.
This was a disappointing, but somewhat predicted decline following the introduction of the revised nursing documentation and subsequent review of the patient care sensitive indicator audit questions. The corporate nursing team are working in conjunction with the Ward and Department managers to recover this position and improvements are expected to be seen in August. This was the second draft of the new nursing booklet.
Safety Thermometer
The Trust overall compliance for the safety thermometer in June was 97.6% with all divisions exceeding the national target of 95%. The Out of Hospital Division performed most favourably with a score of 98%.
During June 2018 there were 10 new harms attributed to the Trust. These are detailed as:
. Greville- 1 New UTI with Catheter . Chadwick - 1 New UTI with Catheter . Castle - 1 New Grade 3 pressure ulcer . Charlecote - 1 New Grade 3 pressure ulcer . Squire - 1 New Grade 2 pressure ulcer . Macgregor - 1 New Grade 2 pressure ulcer . IHT2 – 1 New UTI with Catheter . IHT4 – 1 New Grade 2 pressure ulcer . IHT7 - 1 New UTI with Catheter . IHT8 North - 1 New Grade 3 pressure ulcer
I Want Great Care (IWGC)
Following the relaunch of the ‘we listen, we care’ as part of the ‘I Want Great Care’ campaign we have seen an improvement in the number of responses we have received from the inpatient, outpatient and integrated teams with the majority of responses being positive. Those wards that did not meet the 96% target can be seen in Appendix 2.
When the comments that have been provided by the patients as part of the IWGC survey have been analysed for any themes, the following have been identified:
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Positive Themes
The themes identified in June 2018 were: positive, cheerful staff attitude, good food and food choices and exemplary care.
Areas for Improvement
Themes identified were: long wait for discharge medication, noise at night and conflicting information being given.
3. OOHCC Adult Nurse Staffing
The next section of this report presents the nurse staffing data across adult nursing in the Out of hospital teams during Quarter 1 2018 (Q1).
The purpose of this report is to update the Board in relation to the nurse staffing levels. The report draws attention to the planned, actual and the new model levels, the reasons for this gap, any effects this gap may have had on the quality of patient care and how any risks are being mitigated.
3.1 Skill mix, caseloads and acuity
In previous reports it has been highlighted that the workforce within the Community Adult service was predominantly an 85% qualified to a 15% unqualified skill mix. This is due to the high demand for administration of medication, complex wound care, palliative/end of life care, catheter and bowel care, that have previously all been managed by registered nurses.
Following a review of this skill mix undertaken in 2016, a 60 / 40 skill mix was established for all OOHCC adult teams. This change in skill mix was inputted into the IHT e-roster templates in 2017, however there will be a delay in full implementation whilst we wait for natural turnover of staff. It is envisaged that this will be completed by 2019.
Graph 1 shows the difference between the actual staff in post across all teams compared to the new skill mix model. In summary this shows we are over established in the Band 5 establishment but under established in band 3 and 4 positions. The overall vacancy position against that future model across Adult and HomeFirst nursing teams is approximately 20wte Band 3 and Band 4 posts. This calculates to a 5.5% gap. There is an active recruitment process in place.
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Graph 1
The Division is actively supporting recruitment into these posts and has implemented a process of reviewing every new vacancy to decide for each individual team the safest option to fill the position. To aid this decision making, data is reviewed related to new referrals per month, numbers of patients on the teams’ caseloads and the complexity of those patients as recommended by the recently published National Quality Board staffing recommendations related to district nurse staffing (NQB, 2018).
Graphs 2, 3 and 4 shows some of the data for June 2018 which is used to make these decisions.
Graph 2
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Graph 3
Graph 4
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Chart A visits by pathways IHT8 IHT8 Pathway IHT1 IHT2 IHT3 IHT4 IHT5 IHT6 IHT7 IHT9 IHT10 IHT11 Total Nth Sth SSKIN & Equipment 159 131 116 73 213 156 233 247 173 303 225 157 2186 Wound Routine 105 53 63 132 141 123 71 134 64 70 137 69 1162 Catheter Care 115 95 82 119 102 64 113 91 65 72 83 48 1049 Administration of Medication 66 50 65 48 90 77 41 54 34 43 33 39 640 Palliative Care / Support 17 14 10 12 33 20 22 32 23 40 26 19 268 LTC Review / Symptom Control 36 44 12 20 13 19 4 6 27 14 18 10 223 Essential Care 2 8 7 11 12 25 4 11 16 11 19 7 133 Equipment Provision 1 9 14 14 17 10 12 15 9 16 8 125 Administration Of Medication OD 11 4 7 2 8 6 15 8 14 12 7 12 106 Pressure Ulcer Grade 1 & 2 8 7 4 3 14 6 15 11 4 9 13 5 99 Wound Management 4 1 7 7 12 2 18 8 7 8 3 77 Wound Complex 9 2 4 11 8 6 12 2 7 7 6 1 75 Administration Of Medication BD 10 7 12 5 9 12 1 3 3 7 4 1 74 Pressure Ulcer Grade 3 & 4 5 5 4 7 3 14 2 3 5 4 2 54 Compression bandaging 2 legs 6 3 10 1 6 3 13 1 4 47 Compression bandaging 1 leg 8 5 2 1 2 2 8 3 1 3 1 2 38 Psychological Support 2 9 4 3 2 1 4 6 6 1 38 Self-Management 1 1 3 4 7 2 5 2 1 26 Ear Syringing 3 9 4 1 1 18 Specialist Palliative Care 2 1 2 1 2 3 1 3 1 16 Rehabilitation / Therapy 1 1 2 1 3 2 10 Last Days Of Life Care 1 1 1 1 2 1 1 1 9 TWOC 1 3 3 2 9 Syringe Driver Management 1 1 1 1 1 1 6 Line care 1 1 1 1 4 Social Support / Sign Posting 1 1 Grand Total 565 436 418 472 692 576 583 647 477 624 612 391 6493
Incidents During Q1 there were 2 incidents reporting inadequate staffing levels. These were both due to weekend short notice sickness. All teams have been reminded of the escalation process and their business continuity plans. Locality managers now meet up weekly prior to the weekend to review all staffing levels across all teams and establish the gaps and plan accordingly.
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3.2 Effects on Quality and Safety
Appendix 3 provides an overview of the patient safety and experience indicators alongside the staffing target measures. All quality indicators are discussed by team leaders in the local monthly quality meeting and then at the monthly AOGG.
Caseloads, Referrals and Visits On reviewing the data around caseloads, referrals and visits it is clear there has been a slight decrease in referrals in the month of June. Caseload numbers per wte nurse are high in team IHT 8 North, IHT 10 and IHT 11. Patient visits per wte nurse are higher than average in team IHT 7, IHT 8 North and IHT 10. The Head of Nursing is undertaking a review of these teams to better understand if some of these patients can be discharged or if more resource is required to support a reduction in these caseloads.
Community Care Indicators The Community Care Indicator results for Q1 are 90-95% compliant, which is an improvement on previous quarters but lower than the Trust’s internal target of 97%. This is partly due to the new format which is being used to reflect the revised nursing document which was launched late 2017. Although early indications are that the new document has been positively received. It has also been crucial in the development of the core clinical template for EMIS. Work is underway with teams IHT10 and Home first to improve this compliance.
Safety Thermometer The Trust overall compliance for the safety thermometer in May 2018 was 97.19%, with OOHCC exceeding the national target of 95%. All harms are reviewed and relate to long standing pressure ulcers and catheters.
I Want Great Care (IWGC) (formerly known as FFT) Feedback from IWGC remains positive. The division is also developing a patient survey in line with domain B of the outcome framework. Later in the year this information will be triangulated with the IWGC, the CODE survey to gain a real understanding from our patients to enable us to improve services.
Pressure Ulcers, Falls, Medication incidents The largest reported incidents are on pressure ulcers, falls and medication. All incidents are reviewed with the teams and lesson learnt shared. Where there is an increase in incidents, especially with harm, a review of the teams’ performance is undertaken to identify any performance, capability or capacity challenges that require addressing.
4. Conclusion
In conclusion, this report provides information related to the current inpatient and OOHCC Adult and Home First nurse staffing levels compared to the planned numbers, skill mix, patient acuity and dependency. This information has then been triangulated with national benchmarks and guidance and patient safety and quality indicators data. This shows a continuing challenging picture with some of the acute inpatient wards particularly who continue to work with gaps in their actual staffing levels and some challenges in their quality and safety Key Performance Indicators (KPI’s).
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The Board of Directors should be assured that considerable work continues to support staff recruitment, retention, temporary staffing fill rate and ward leadership to improve this situation and governance processes to address any short-term consequences are robust.
5. Recommendations
• Continue to monitor on a daily basis the staffing levels compared to patient acuity, dependency and escalating any gaps to assure all is done to reduce these. • Maintain the proactive recruitment activity and prioritise those areas with the highest vacancy factor. • Continue to implement retention strategies to identify and address the reasons for staff leaving. • Continue to manage unavailability across all areas to ensure our staff’s health and wellbeing is supported. • Fully implement ward manager development and support programme. • Utilise ‘I want Great Care’ feedback to motivate and recognise good practice, develop our services and raise staff morale. • Promote the staff reward and recognition systems and celebrate and communicate quality improvement initiatives. • For OOHCC to undertake a review of the IHT staffing models in the next six months, following the publication of the NQB staffing guidance related to district nursing teams and the development of place based teams.
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Appendix 1: Breakdown of staff by substantive, bank and agency
Registered Staffing split for the Night shift - Care Staffing split for the Night shift - June June 2018 2018
Sum of REG Substantive % Night Sum of REG Bank % Night Sum of Care Substantive % Night Sum of Care Bank % Night Sum of REG Agency % Night Sum of Care Agency % Night
100% 100% 80% 80% 60% 60% 40% 40% 20% 20% 0% 0% ICU ICU SCBU SCBU Campion… Campion… Chadwick… Chadwick… Nicol Unit Nicol Unit Maternity… Maternity… Charlecote… Charlecote… MacGregor… MacGregor… Avon Ward Avon Ward Mary Ward Mary Ward Willoughby… Willoughby… Castle Ward Castle Ward Ellen Badger… Ellen Badger… Squire Ward Squire Ward Squire Surgical Unit Surgical Unit Farries Ward Farries Ward Feldon Ward… Feldon Ward… Fairfax Ward Fairfax Ward Fairfax Greville Ward Greville Ward Victoria Ward Victoria Ward Victoria Thomas Ward Thomas Ward Thomas Nicholas Ward Nicholas Ward Nicholas Registered Staffing split for the Day shift - Care Staffing split for the Day shift - June June 2018 2018 Sum of REG Substantive % Day Sum of REG Bank % Day Sum of Care Substantive % Day Sum of Care Bank % Day Sum of REG Agency % Day Sum of Care Agency % Day
100% 100% 90% 90% 80% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% ICU ICU SCBU SCBU Nicol Unit Nicol Unit Avon Ward Avon Ward Mary Ward Mary Ward Castle Ward Castle Ward Ellen Badger… Squire Ward Squire Ellen Badger… Squire Ward Squire Surgical Unit Surgical Unit Farries Ward Farries Ward Feldon Ward… Feldon Ward… Fairfax Ward Fairfax Fairfax Ward Fairfax Greville Ward Greville Ward Victoria Ward Victoria Victoria Ward Victoria Thomas Ward Thomas Thomas Ward Thomas Nicholas Ward Nicholas Nicholas Ward Nicholas Maternity Unit Maternity Unit Campion Ward Campion Ward Chadwick Ward Chadwick Chadwick Ward Chadwick Cardiology Unit Cardiology Unit Charlecote Ward Charlecote Ward Beaumont Ward Beaumont Beaumont Ward Beaumont MacGregor Ward MacGregor MacGregor Ward MacGregor Willoughby Ward Willoughby Ward
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Safecare Lower Patient IWGC >5% gaps in than Safety sensitive 1:8 Number Test Avoidable Pressure Wards gap in demand vs average Thermometer Indicators Complaints breaches of Falls (Target ulcers (June 2018) staffing rostered CHPPD (target >96%) (target 96%) numbers (6.33) >97%)
Avon ward 100.00% 6 88.20% 92.00% 0 0 Beaumont ward 100.00% 0 97.90% 100.00% 0 0 Campion ward 100.00% 7 97.00% 0 0
Cardiology Unit 100.00% 4 100.00% 95.50% 0 0 Castle ward 95.45% 2 93.30% 93.00% 0 0 Chadwick ward 93.75% 2 97.00% 0 0
Charlecote ward 85.00% 0 100.00% 94.00% 0 0 Ellen badger 92.31% 0 90.00% 95.00% 0 0 Farries ward 100.00% 11 100.00% 98.00% 0 0 Feldon ward 100.00% 13 100.00% 93.00% 0 0 Greville ward 95.00% 2 97.10% 90.00% 1 0 ITU 100.00% 0 100.00% 100.00% 0 0 Labour ward 100.00% 0 100.00% 0 0 Mary ward 100.00% 2 93.30% 90.00% 0 0 McGregor ward 91.67% 0 98.50% 94.00% 0 0 Nicholas ward 92.31% 5 100.00% 94.00% 0 0 Nicol ward 100.00% 1 100.00% 99.00% 0 0 Oken/Fairfax ward 95.45% 9 97.10% 89.00% 0 1 SCBU 0 100.00% 0 0
Squire ward 90.00% 9 100.00% 93.00% 0 0 SSSU 97.22% 1 96.50% 94.50% 0 0 Swan ward 100.00% 0 94.70% 81.50% 0 0 Thomas ward 100.00% 1 94.70% 90.00% 0 0 Victoria ward 100.00% 10 94.10% 97.00% 0 0 Willoughby 100.00% 0 100.00% 95.00% 0 0
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Appendix 3 Quality and staffing indicators for OOHCC Quarter 1
Out of Hospital Care Population Planned Team Caseload / Visits Average Vacancy- Average Appraisals JUNE18 Collaborative supported WTE Caseload 1 actual JUNE 18 visit per WTE Gap sickness JUNE 18 JUNE 18 WTE WTE JUNE 18 JUNE18 IHT 1 (Rural North) 53785 28.29 500 17.3 3750 132 1 2.20 79.17 IHT 2 (Camphill) 49374 21.27 400 18.8 2500 117 2 4.34 95.65 IHT 3 (The Manor) 48351 20.84 480 18.2 3000 143 0 7.05 74.07 IHT 4 (Bedworth) 51008 18.20 400 21.9 1900 104 0 14.17 90.48 IHT 5 (Rugby) 55708 28.92 580 20 3750 130 2 4.87 90.91 IHT 6 (Rugby) 47295 23.52 450 19 3400 117 0 3.27 92.59 IHT 7 (Kenilworth & 68649 21.02 530 25 3500 166 1.8 6.31 95.00 Warwick) IHT 8 north 47919 18.67 540 28.9 2750 147 0.8 2.64 87.50 IHT 8 south 43866 22.56 410 18 2500 110 1.16 5.49 83.33 IHT 9 (Stratford) 43397 21.11 570 27 2600 123 1 2.71 86.36 IHT 10 (Alcester) 40374 16.37 520 31.7 2400 146 0 2.91 81.25 IHT 11 (Shipston) 32100 13.18 350 26.5 1700 128 2 0.28 100.00 Homefirst North 158662 35.09 180 5 2600 74 2 6.46 71.77 Homefirst South 115871 64.78 510 7.8 4560 70 5 4.40 68.32
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Out of Hospital Care Avoidable WWGC Number Community Safety Incidents Reporte Reported medication Collaborative Pressure Friends of formal care Thermom reported d Falls incidents with HARM Ulcers 3,4 and complaint indicators eter Q1 Q1 with Q1 2018 Q1 2018 Family Q1 2018 Q1 2018** 2018 2018* HARM Q1 2018 Q1 2018 IHT 1 (Rural North) 0 4.97 0 96.5 97.21 72 0 0 IHT 2 (Camphill) 0 4.92 0 95.5 98.10 42 0 1 IHT 3 (The Manor) 0 4.79 0 90.5 96.69 52 0 0 IHT 4 (Bedworth) 0 4.86 1 94.5 90.83 44 0 0 IHT 5 (Rugby) 0 4.96 0 98 99.60 42 0 0 IHT 6 (Rugby) 0 4.93 0 98 98.78 47 0 0 IHT 7 (Kenilworth & 0 4.87 0 97 97.01 62 0 0 Warwick) IHT 8 NORTH 0 5.00 0 89 100.00 26 0 0 IHT 8 SOUTH 0 4.85 0 95 100.00 40 0 0 IHT 9 (Stratford) 0 4.90 0 93 99.39 63 0 0 IHT 10 (Alcester) 0 4.91 1 78 99.33 18 0 0 IHT 11 (Shipston) 0 4.72 0 96.5 100.00 11 0 0 Homefirst North 0 4.88 0 85.5 100.00 20 0 0 Homefirst South 0 4.92 0 88.5 98.04 96 0 0
21 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Clinical Governance Committee Report Enclosure F for 11 July 2018
Nature of item For information For approval For decision
Decision The Board of Directors is invited to receive and note the report and to required (if any) consider any items highlighted for its attention.
General Report Author Bruce Paxton, Non-Executive Director Information (Committee Chair) Lead Director Fiona Burton, Director of Nursing
Received or Meeting approved by Date
Resource Revenue Implications Capital Workforce Use of Estate Funding Source
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Clinical Governance Committee Report for 11 July 2018
Executive Opinion
As a result of the issues presented and discussed through the Clinical Governance Committee (CGC), we are assured that there are appropriate plans and monitoring in place to ensure that care is of high quality and provides good patient experience and outcomes.
Fiona Burton Charles Ashton Director of Nursing Medical Director
1. Previous Minutes for Clinical Governance Committee held on 13 June 2018 Clarification was made in that ‘Mother and Babies: Reducing Risk Through Audit and Confidential Enquiry’ (MBRRACE) across the UK indicated in the 2014 report (released July 2016) that the perinatal death rate was up to 10% higher (than otherwise reported nationally). As a result, all extended and perinatal deaths are to be reported as Serious Incidents. MBRRACE has produced tools, pathways and review methods which were reviewed in 2017 and by the Serious Incident Group (SIG) in May 2018. From May 2018 the SIG agreed a nationally recognised process.
2. Infection Prevention and Control Monthly Report This was an assuring report with continuing good outcomes. Hand hygiene was now in a better position. A concern raised by a cardiologist about a rise in infection in pacemaker surgical sites has triggered an audit in the Cath Lab, appropriate and immediate changes, and a business case preparation for enhanced environmental changes. It will come back to CGC when more detail is available.
3. Patient Safety Monthly Report One Serious Incident was a wrong site surgery Never Event, for which investigations are continuing. Some rise in medication incidents is being reported, with a large proportion assigned as ‘low harm’. The reporting standards and process are being reviewed, and a replacement Medication Safety Officer/Principal Pharmacist will be welcome. The VTE assessment rate is improving by month, reported at 94.8% (target 97%). The new drugs chart is in print and is expected to further support improvement when introduced. There was a discussion on the apparent drop in numbers of patients on the bundles for Sepsis and Acute Kidney Injury, for which enquiries will be made for discussion at the next Clinical Governance Committee.
4. Patient Experience Monthly Report Normal compliance around complaints is reported, with positive and encouraging feedback through public portals such as NHS Choices. IWantGreatCare is recording a high percentage recommendation for Trust services, although response rates remain disappointingly low in Emergency Department (improved for Inpatients and Maternity). Increased awareness and staff engagement with the process is encouraged, with a higher visibility of materials.
2 5. SI Monitoring Report Continues to be a vital oversight tool to ensure the progress of action plans.
6. Emergency Care Division Audit and Operational Governance Group (AOGG) Quarterly Report Local Safety Standard for Invasive Procedures (LocSSIPs) and NICE guidance compliance has improved. There is a change in the process of review of deaths, arising from the initiative of Learning from Deaths (LfD) which is expected to reduce the workload for second level reviews. The Director of Nursing is challenging all AOGG’s to show that innovative and outstanding improvements are being made, to support the Trust’s desire to become a Care Quality Commission (CQC) Outstanding Trust. The Chair of the AOGG is stepping down, and was thanked for his contribution during his tenure.
7. Mortality Surveillance Quarterly Report The indicators of RAMI and SHMI remain in the ‘as expected’ range, with an encouraging direction of movement. There has been a spike in crude mortality for January 2018, and it is a credit to the Trust that RAMI remained steady during this challenging period. In the LfD processes, the Associate Medical Director for Governance reported on the formalising of arrangements after discharge and in the primary care zone. The Medical Director reported progress on a new improved mortality dashboard for both CGC and Board.
8. Care Quality Commission (CQC) Progress Monthly Report and Action Plan Progress is being made on many of the actions required, some are behind the agreed completion date and some are proving more difficult than had been thought. Actions and discussion are pursued at the CQC Monitoring Group meeting.
9. Midwifery Pathway Statement The Midwifery Led Unit (MLU) opened on 2 July 2018, and has had 9 births to date. The paper clearly states the clinical governance of the path with the new unit, the criteria for expectant mothers to qualify and remain on the MLU low-risk path. It also makes clear the criteria for diversion (e.g. to the Obstetric Unit). The processes for transfer to the Obstetric Unit and additional support from on-site specialists have been well thought through. It is expected that the first few months of operation will raise changes, and a review comment is requested in the Women and Children’s Division AOGG meeting in about nine months’ time.
10. Coventry and Warwickshire Pathology Network Service Update The Director of Operations for the Pathology Network brought a welcome verbal update on the service of the communication of results. The short term solution in place appears to be working, and the Clinical Governance Committee has requested the identification of any breaches in pathway and any patient harm arising from the unacceptably poor service recently. A longer term software fix for the reporting packages is expected around week commencing 23 July 2018. There has been significant impact on cancer pathways, and the Trust is urged to press the Pathology Network for a practical and workable solution through the operating partner University Hospitals Coventry and Warwickshire NHS Trust.
11. Elective Division AOGG Terms of Reference Review The changes proposed to the Terms of Reference make clear that all specialties are represented. A Quality Improvement statement is requested to be inserted in AOGG
3 Terms of Reference for each Division. This will link to the Quality Improvement and Audit work.
Confidential Section
Two Serious Incidents were recommended for closure and closed.
Bruce Paxton Non-Executive Director and Chair of the CGC
4 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Lorenzo and Electronic Patient Record Enclosure G Monthly Update
Nature of item For information For approval For decision
Decision The Board is asked to receive and note this report. required (if any)
General Report Author Danny Roberts, Chief Technology Officer Information Paul Elwell, EPR Programme Manager Lead Director Danny Roberts, Chief Technology Officer
Received or Meeting approved by Date
Resource Revenue Implications Capital Workforce Use of Estate Funding Source
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Lorenzo and Electronic Patient Record (EPR) Monthly Update
Executive Opinion
Positive progress has continued with the roll out of radiology and pathology requesting in Lorenzo. A number of issues have arisen with the interface to the pathology system, hosted by the Coventry and Warwickshire Pathology Service and these are currently under investigation. If the issues cannot be resolved then they may present a risk to further roll out. The implementation of Out of Hospital (OOH) EPR to the HomeFirst service is also progressing well with positive user feedback of the system, although some are experiencing problems with mobile connectivity that is under investigation.
Danny Roberts Chief Technology Officer
Clinical Opinion
Electronic requesting continues to roll out to more wards across the acute site. No major unanticipated issues have been reported so far, and patient safety has been enhanced as a result. Further roll out will continue over the next few weeks and months. The business case for inpatient prescribing is still being looked at, but we are now being asked to report to NHS Digital as to whether the Lorenzo product is ready for Trust-wide deployment. As the pilot has gone well and there are no outstanding major technical issues, we shall conclude that it is.
Bernhard Usselmann Associate Medical Director – Technology and Transformation
2
Business As Usual (Lorenzo Phase 1)
Key Metrics: May Jun # of IT support calls per month System Availability 100% 100% 500 Lorenzo IT support calls raised 249 262 400 Outstanding major issues / PANs n/a n/a 300 200 Notes: • Volume of Lorenzo calls remains stable. 100
0 Jul-17 J an -17 J an -18 Jun-17 Jun-18 Oc t- 17 Apr-17 Apr-18 Feb-17 Sep-17 Feb-18 Dec-17 Aug-17 Nov-1 7 Mar- 17 Mar- 18 May- 17 May- 18
Release notes Next major release: 2.15 Scheduled: Sep-18 Time to complete key Lorenzo functions Status: Green Expected: Sep-18 following upgrade releases 03:00 Notes: • 2.15 release is currently scheduled for 9th September 2018. 02:30 R&R* • Lorenzo performance monitoring: The time taken to complete 02:00 01:30 Auto GP Letter key Lorenzo activities is now collected after each Lorenzo release 01:00 Clinician OPD to enable us to track any performance changes. 2.14 upgrade did 00:30 Ou tc om ing not uncover any significant change in performance. Further 00:00 Receptopn OPD measurements will now be undertaken following the 2.15 upgrade. R2.11 R2.12 R2.13 Ou tc om ing* Time taken: Minutes / Seconds Minutes taken: Time
Lorenzo Phase 2: Inpatient Requesting & Results [R&R] Key Metrics: Status: Amber Scheduled: Live Expected: Live Wards Deployed to: 13 # wards deployed to Wards planned to go live next Month 12 Outstanding major issues Sev 1: 0 Sev 2: 2 30 Notes: • R&R went live with a further 5 Acute Wards on 3rd July with no 20 major problems reported. Rollout will continue at a rate of 6 additional wards every 2-4 weeks and we will also go-live with the 10 new Doctor intake at the beginning of August. • Most significant issue has been with Pathology message failings 0 and work is ongoing with the Pathology Network to resolve. Interim measures are in place to ensure continuity of service but is a risk to further rollout.
Lorenzo Phase 2: Outpatient R&R Key Metrics: Status: TBC Scheduled: tbc Expected: tbc Departments Deployed to n/a n/a Dept's planned to go live next Month 0 Outstanding major issues Sev 1: n/a Sev 2: n/a Notes: • Re-planning in line with Inpatient R&R planning above, expected to follow on from in the Autumn.
Lorenzo Phase 3: EPMA (Inpatient Prescribing and Medical Administration [IPPMA]) Key Metrics: Initial Deployment go-live: Scheduled: 21-Mar-18 Status: Green Expected: Live Notes: • Go-live took place on Feldon Ward in March and went well. No major issues have occurred and feedback from clinical staff has been largely positive. • Plans to deploy the system more widely in 2018 are subject to Business Case approval, now due to Board of Directors in August 2018. Plans to rollout to Community Wards in the Autumn 2018 have now been agreed, with rollout to Acute Wards moved to April 2018.
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Lorenzo Phase 2: EPMA (TTOs (To Take Outs) / OP Prescribing) Key Metrics: Status: TBC Scheduled: tbc Expected: tbc Wards Deployed to n/a n/a % TTOs electronic (Lorenzo) Trust-wide n/a n/a
Wards planned to go live next Month 0 Outstanding major issues Sev 1: n/a Sev 2: n/a Notes: • Currently re-planning. Rollout of TTOs / Outpatient prescribing on- hold pending decisions about R&R and Inpatient Prescribing. • Further deployment not expected until late 2018.
Paperless Outpatients Key Metrics: Status: Green May Jun ___ Projected / ___ Actual % of notes for clinics either electronic or not 92% 94% requested [i.e. Total % 'Scan on Demand'] Total % Scan on Demand 100 90 80 Notes: •The take-up of not sending historical notes routinely to outpatient 70 60 has stabilised at 70% of all clinics and some inpatient Wards have 50 40 now also stopped routinely requesting historical notes. 30 20 •Historical record scanning volumes has increased further to 10 0 around 4,500 records per month. Trust-wide Scan on Demand has now reached 94%.
Key Metrics: Status: Complete May June Wards Deployed to 35/ 36 36/36
Wards planned to go live next Month 0 Outstanding major issues Sev 1: 0 Sev 2: 1 Notes: • Rollout to ED went ahead in early June and the SEND system is now fully rolled out. Project will be closed in August 2018
Community EPR (EMIS) - Adults Key Metrics: Initial Deployment go-live: Scheduled: 26-Jun-18 Status: Green Expected: Live
Notes: • The first service (Homefirst South) went live as planned on the 26th June, with Homefirst North now scheduled for September 2018, and full rollout due to complete across by March 2019. • With the exception of some connectivity issues in the first week (now resolved) the go-live went well and the new system has been well received by users.
Paul Elwell EPR Programme Manager
4 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Foundation Group Strategy Sub- Enclosure H Committee Report for 23 July 2018
Nature of item For information For approval For decision
Decision The Board is asked to receive and note this report. required (if any)
General Report Author Simon Page, Non-Executive Director Information Lead Director Jayne Blacklay, Director of Development
Received or Meeting approved by Date
Resource Revenue Implications Capital Workforce Use of Estate Funding Source
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Foundation Group Strategy Sub-Committee Report for 23 July 2018
1. Foundation Group Development
The Chief Executive provided an update on the further development of the Foundation Group. He confirmed that he had been appointed as Chief Executive at George Eliot Hospital NHS Trust (GEH) and that WVT and SWFT have both approved the proposal for the GEH to join the Group.
2. Provider Development Paper
The Chief Executive presented a paper outlining the proposed development of a Provider Alliance. The Committee discussed how this alliance could work effectively. The current thinking would underpin the move to Strategic Commissioning. The Commissioners would then be responsible for defining the outcomes required for a population and the resource limits. The Provider Alliance would then agree the appropriate delivery model. The Committee acknowledged that this was a similar approach to the one used across Coventry and Warwickshire for the Out of Hospital Contract.
3. SWFT Clinical Services Ltd (SWFTCS Ltd) Business Plan
The Director of Finance for SWFT CS Ltd presented an overview of the draft Business Plan for the Company. He highlighted that the key areas for development included Pharmacy, Estates, Private Healthcare and Consultancy. He also highlighted some of the constraints including most recently the updated guidance regarding the required NHSI approval for NHS Trusts. The final draft of the plan would be considered for approval at the next company Board.
4. Five Year Plan Update
The Committee agreed to delay the final publication of the plans to allow the finance teams within each Trust to consider the updated funding recently announced. The plans will come back to the Committee in September 2018 prior to final approval by each Board.
5. Clinical Leadership Development
The Group Medical Director provided an update on the recruitment to the new Group Associate Medical Director (AMD) roles. Appointments were due to be made before the end of August 2018.
6. Next Meeting
The Mortality Review will be presented at the next meeting. It was also proposed that a Thought Piece on a specific topic is presented at each future meeting. Information Technology was proposed as the first topic.
Simon Page Non-Executive Director and Committee Member SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Finance and Performance Committee Enclosure I Report for 19 July 2018 – Open Meeting
Nature of item For information For approval For decision
Decision The Board is asked to receive and note this report. required (if any)
General Report Author Simon Page, Non-Executive Director and Information Committee Chair Lead Director Simon Page, Non-Executive Director and Committee Chair
Received or Meeting approved by Date
Resource Revenue Implications Capital Workforce Use of Estate Funding Source
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Finance and Performance Committee Report for 19 July 2018 – Open Meeting
1. CQUIN Quarterly Update
The Assurance Manager reported that the Trust had made all the submissions for Quarter 4 requirements but a formal response from the Clinical Commissioning Group (CCG), has not yet been received confirming achievement.
Discussions have taken place with the CCG to agree targets and thresholds and some points of clarity for the 2018/19 CQUINS. There are some areas of risks relating to CQUIN performance. CQUIN 2a, the timely identification of sepsis has a risk relating to Quarter 3 and Quarter 4 achievement.
CQUIN 2d, the reduction in antibiotic consumptions per 1,000 admissions, is also at risk. The Director of Nursing advises that whilst prescribing is good in A&E, the target is ‘tight’.
The Director of Human Resources commented that for CQUIN 1, relating to health and wellbeing of NHS staff, the Trust is below target on the stress element, but was still above the national average. The Associate Director of Finance advised that if the Trust did not achieve on all three components for CQUIN 1, the Trust would only receive 25% of that component.
The financial implications of under-achievement were generally not clear to the meeting. CQUIN values will be reported going forward.
2. Data Quality Report
The Associate Director of Information and Performance presented the Data Quality Report. There were no new issues of note relating to this area.
3. Finance Report
The Trust is reporting a financial surplus of £0.748m for month ending June 2018; £0.283m below plan, after the re-phasing of the Cost Improvement Programme (CIP) to reflect its back-end phasing. Performance excluding Provider Sustainability Funding (PSF), reflects an above plan return of £0.26m. Operating expenditure was above plan by £0.672m, to some extent a reflection of increased activity and operating income was above plan by £0.384m.
It was confirmed that the Trust is underperforming against its A&E target with a performance of 93.8% versus a target of 95.6%. This was largely the consequence of continued high levels of demand beyond seasonal norms; demand is currently 12% ahead year on year (YoY), with some of the additional volume coming from non-core post codes. The Quarter 1 negative financial impact will be £310k. There may be grounds for the Trust to successfully appeal and receive these funds, if a meaningful case can be constructed.
The Trust has achieved the year to date control total and will receive the full amount of PSF financial funding for Quarter 1.
2
Whilst the Trust is still behind its re-phased Quarter 1 CIP target, the Director of Development confirmed that reassurance was given at Management Board that CIP schemes are being identified, implemented and were being monitored.
4. A&E Performance and Improvement Plan for Quarter 2
Meeting high A&E targets continues to be a challenge for the Trust but it is worth reflecting that numbers are 12% ahead YoY and that performance continues to be well above the NHS average. A&E is a strong area of focus and work to improve performance is considered and detailed. The Finance and Performance (F&P) Committee noted Emergency Division’s front and back door improvement plan for Quarter 2. Some of the highlights worth teasing out are as follows but these are by no means the only actions in place:
a) A&E performance for Quarter 1 was 93.8%; 94% as of 18 July 2018. A&E attendances currently average more than 30.6 attends/day. The Director of Operations also noted that there was pressure on length of stay as many patients were waiting for Diagnostics; b) there was a shift in surgical emergencies of approximately 10-11%; c) The Red 2 Green Initiative will play an important part in improving performance with the focus on doing things differently. The Director of Operations would review any need for additional beds after August 2018. d) two triage nurses will be in place at the front door of A&E, from late July 2018; e) discussion took place on patients who would not wait to see their GP and attend A&E instead; this is 30% of A&E demand. The Executive Leadership Team are clear that close engagement of primary care is crucial to managing and mitigating demand, including effective use of a two-way protocol with GPs. The leadership team plan to refine and reinforce this element of their A&E plan, and f) discussion took place on extending A&E hours at Stratford where there is additional capacity.
5. Cancer Update for NHS Improvement (NHSI)
Since the last F&P Committee meeting, temporary solutions have been put in place and Cancer is back on track with Ultra; reporting is up to date and timely.
Increased demand for cancer services is a reflection on national pathways that encourage GPs to refer. This however, exacerbates capacity issues and we have particularly seen a 50% growth in dermatology referrals, to some extent linked to the hot sunny weather experienced this summer.
Root Cause Analysis (RCA) was performed on patients who had missed the 62 day Cancer target. For June 2018, the target reached 77% (82.9% in May). Issues have been identified and addressed with pathology relating to reporting, with radiology access which has not improved and biopsies where more capacity has been put in. The Leadership Team expect to be back ‘on track’ in August 2018, with sustained improvements from September 2018.
Simon Page Non-Executive Director and Committee Chair
3 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Out of Hospital Care Collaborative Enclosure J Quarterly Update Report - Transformation Programme Update
Nature of item For information For approval For decision
Decision The Board is asked to receive and note this report. required (if any)
General Report Author Elaine Coates, Out of Hospital Programme Information Manager Lead Director Anne Coyle, Managing Director Out of Hospital Care Collaborative
Received or Meeting July’s Warwickshire Working Together Boards (s) approved by Out of Hospital Care Collaborative Divisional Board Date July 2018
Resource Revenue Implications Capital Workforce Use of Estate Funding Source
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Out of Hospital Care Collaborative Quarterly Update Report - Transformation Programme Update
1. Executive Summary
The Board of Directors received a paper at its meeting in November 2017 that set out the work completed following the decision to award the Out of Hospital contract. This included the governance framework and progress made on implementation of the Out of Hospital model. The Board was updated on the shadow plans prior to service commencement on 1 April 2018.
This paper sets out a self-assessment of progress against each Out of Hospital work stream in the first Quarter of the programme and includes a forward look at Quarter 2 milestones. Key challenges for the Out of Hospital programme are outlined and actions underway to mitigate risks.
The Out of Hospital programme remains on track to progress within the agreed framework to fully implement the Out of Hospital model in Warwickshire by 2019/20. This position has yet to be formally considered and agreed with Commissioners.
Anne Coyle Managing Director Out of Hospital Care Collaborative
2. Background
In November 2017 the Trust signed a three year contract to become the lead provider for Out of Hospital Services across Warwickshire. The contract commenced in April 2018. The purpose of the Out of Hospital Programme is to reconfigure both the provision of services and the culture of care to enable our population to live safe, happy and healthy lives at home for as long as possible.
In practice this means:
• For people to receive the support they need to maximise their independence, wellbeing, quality of life and potential for recovery after an episode of ill health. • To empower individuals to stay healthier for longer within their local communities. • To do all we can to promote prevention of ill-health, particularly doing more to target help for frail and vulnerable people and people with long term conditions such as diabetes or heart trouble. • To provide rapid response to escalating health needs. • To provide timely, supported discharge with an emphasis on promoting recovery and reablement. • To operate within clear consistent pathways of care including working with voluntary and community groups.
2 3. Transformation Programme Structure
An ambitious two year transformation programme has been established to drive the redesign of services to meet these aims.
The programme has a number of core workstreams as detailed below:
• Governance Responsible for leadership of Warwickshire Locality Working Together Boards, outcomes development and evaluation of Out of Hospital Programme. • Stakeholder engagement Communication and engagement of stakeholders in delivery and progress of the Out of Hospital programme. • Integrated Single Point of Access (iSPA) This work stream has completed a ‘Needs based service’ development exercise. Next steps are to streamline referral routes, clinical triage, telehealth and implementation of digital self-help solutions. • Electronic Patient Record (EPR) In the first phase this workstream is focussing on implementation of EMIS across all community services. Next phases of this workstream is a Population Health development system, specifically system integration. • Place Based Teams (PBT) and Locality Working This workstream is co-ordinating the phased roll out of 12 place based teams across Warwickshire. In Year 2, locality hubs to support PBT working will emerge supporting, where appropriate to do so, Hospital based services in Out of Hospital setting; for example, Frailty. • Patient Pathways In Year 1, the workstream focus is Warwickshire-wide Frailty, End of Life, Diabetes pathway development, with a focus on Heart Failure and COPD (Chronic Obstructive Pulmonary Disease) pathway development and implementation in Year 2. • Prevention / Health and Wellbeing Year 1 focus is on Health and Wellbeing plan development and implementation linked to place Joint Strategic Needs Assessment. • Sub contracts This workstream aligns to pathway development Hospices and emotional health support to Place Based Teams
Contractual milestones are aligned within each workstream on a quarterly basis. These are linked to an increasing proportion of payment by outcome delivery through each year of the three year contract.
4. Out of Hospital Programme Quarter 1 progress
The following sections outline the progress of each workstream to June 18. Relevant contractual milestones for Quarter 1 are highlighted.
4.1 Governance
In December 2017, multi-agency governance for the programme was established through locality based Working Together Boards in Warwickshire North, Rugby and South
3 Warwickshire. A range of partners are represented on each Board including Community and Acute Health Providers, Clinical Commissioning Groups, General Practice, Social Care, Public Health, Hospices and the Voluntary sector. West Midlands Ambulance representation attends the quarterly Joint Working Together Board.
Significant work has been undertaken around outcomes reporting against the six domains (A-F) of the outcomes framework and wider system evaluation. Existing reporting has been mapped to the outcomes framework and a proposal developed. All areas are believed to be covered in domains A-E except for staff training, which needs further development of quarterly reporting. Domain F requires additional work with a current focus on the use of Therapy Outcome Measure (TOM).
Following an initial workshop facilitated by NHS-I in May 2018, a second workshop on system evaluation was held in mid June 2018 to progress with the development of measures at a system level. A paper has been drafted with an approach to take forward this development and a small technical group will meet over the summer to progress this.
A staff survey has been agreed and will be launched in mid July 2018. This was developed and tested with a small group of staff from across community services, with support from HR and Staff Side.
Patient and carer survey proposals were tested at public engagement sessions and the Carers’ Conference. Based on this, a new approach is being explored. Discussions have been initiated with R-outcomes to use their validated patient survey as a potential option.
Quarter 1 • High level outcomes measures specified and agreed On track milestones
4.2 Stakeholder Engagement
Individual interviews with Working Together Board (WTB) members were undertaken ahead of the launch which informed the Board set up. A joint WTB was held in April, which included a visualisation exercise. This identified key areas of focus for change management activity. Volunteers from the Boards have been requested to form a task and finish group to formulate the ongoing change management activity.
A series of six public engagement events were held around the county in April 2018. Co- hosted with Public Health, around 100 individuals attended to understand more about the Out of Hospital transformation programme, to provide feedback on the proposed patient survey and to share their knowledge of local services.
A newsletter was published and shared with partners in April 2018 which outlined the programme. A first draft of a county-wide Communication and Engagement Plan was shared with WTBs for their input in May 2018. The plan has been updated based on feedback received and is progressing to implementation. A key gap has been identified in capacity to support communication requirements and this is being scoped. Communication activity will be very limited unless additional resource is secured.
The GP survey has been completed with 82 responses received from 40 practices. A report has been drafted and is being shared with the Working Together Boards in July 2018 for comment.
4
• Stakeholder engagement and communication plan Quarter 1 agreed On track milestones • GP survey undertaken • Multi-agency change management plan in place
4.3 Integrated Single Point of Access (iSPA)
A detailed ‘demand needs assessment’ has been undertaken and taken to the Working Together Boards in June. High level actions have been identified and this is now being worked up into a full action plan.
Plans are underway to bring all services under a single phone number to streamline referral routes across Out of Hospital and Allied Health Professional services. This is planned to become operational in September.
Following the award of indicative Sustainability and Transformation Partnership (STP) capital funding, a business case is being drafted to move the iSPA to a ‘fit for purpose’ location, which will support ongoing development and enable the next stages in the programme to develop triage services.
Quarter 1 • iSPA demand needs assessment completed Complete milestones
4.4 Electronic Patient Record (EPR)
HomeFirst South (and iSPA support for HomeFirst South) went live with EMIS on 26 June 2018.
Connectivity issues were experienced by staff using laptops in the first two weeks, however these have largely been resolved and the system is in active use.
Learning from the HomeFirst South launch is informing the wider roll out. HomeFirst North will follow in the autumn, with all integrated health teams (IHT) joining the system before Christmas. The third wave in the new year will bring specialist nurses and some therapies on to the system by March 2019.
Quarter 1 • First services operational on EPR Complete milestones
4.5 Place Based Teams (PBT) and Locality Working
Two Place Based Team pilots are operational in Alcester and Atherstone. A range of partners are involved alongside health services, including the Fire Service, Social Care and Voluntary Sector organisations such as Age UK and MIND. Learning has also been taken from the previous Integrated Neighbourhood Teams in Rugby. 'Recipes' for ‘go live’, developed by the pilot sites, will be shared in July to 'pass it on' to the next teams scheduled for deployment. These will be in Bedworth and Rugby.
5
A workforce strategy has been agreed and individual workforce plans for services drafted. These will develop as the programme progresses in line with the wider programme delivery. Staff engagement sessions are being held in July 2018 to support the transformation plans.
A risk stratification approach is being developed. A key principle is for there to be a shared tool with primary care. Pilot place based teams are using High Intensity User data in the first instance to identify relevant patients. We are also exploring the use of ‘Gemima’, an Arden GEM Commissioning Support Unit tool.
• CCG clinical and managerial support for PBTs confirmed Quarter 1 • Location and management of PBTs agreed On track milestones • PBT pilots operational and services agreed • Workforce plans in place • Risk stratification mechanism agreed
4.6 Patient Pathways
A series of Frailty workshops have been held in South Warwickshire to progress the pathway development. A high level pathway has been mapped and there is broad agreement to progress using the Rockwood scale to identify frailty across the system. A key focus for development will be around work with Care Homes.
In the North of the county an initial meeting has been held with George Eliot Hospital NHS Trust and Social Care to discuss how frailty work can be developed across the county. The next steps will be to share in more detail the progress to date in both areas, build relationships with GPs and embed pathway development in Place Based Teams.
Work is also progressing on an End of Life pathway in both North and South of the county with workshops held and links made into existing forums to take forward developments. Agreement has been reached to launch an End of Life group in Rugby, a first meeting is scheduled for August 2018.
4.7 Prevention / Health and Wellbeing
The first draft of a county-wide Health and Wellbeing plan, co-developed with Public Health, was shared with Working Together Boards for their input in May and an updated version of the plan was agreed with Working Together Boards in June. This plan will now be progressed to implementation.
Work is progressing on developing the business case for a population health system following the award of indicative capital funding. This will link closely to developments in our approach to system evaluation. NHS-E have provided support to progress this work.
Quarter 1 • Public health delivery plan written On track milestones
6
5. Out of Hospital Programme - Quarter Two Forward View
By the end of Quarter 2 it is expected that the Out of Hospital Programme will have achieved the following:
• All OOHCC service referrals routed through iSPA, therapies operating as a ‘virtual’ shared service using the same phone and email contacts. Scoping started for clinical triage and telehealth. • Two pilot Place Based Teams (PBT) have been operational for 3 months. A review has been undertaken. The next two PBTs are now live. • EMIS is live for iSPA and HomeFirst North. IHTs are undertaking training ready for autumn deployment. • Frailty and End of Life pathways agreed and mobilisation plans initiated. Diabetes pathway is agreed and the mobilisation plan is being drafted. • The health and wellbeing plan is being implemented. Risk stratification tools are being trialled / evaluated. A business case for a population health system is in final draft for submission to NHS-I. • Working Together Boards are embedded and partners are increasingly engaging with the programme. Regular communications have been initiated for a range of stakeholders. • Staff, patient and carer surveys have been undertaken, analysed and reported. Actions resulting from this are being developed. • Regular reporting on the outcomes framework has started from existing systems.
5.1 Governance
Quarter 2 work will focus around the progression of system evaluation and establishment of regular reporting. A model dashboard will be agreed, which will provide the basis for ongoing development of system metrics.
A joint Working Together Board will be held in September to bring together the three locality based Boards. This is a key opportunity to promote consistency and alignment of developments across the county and share learning.
Quarter 2 • Establish regular reporting of outcome measures On track milestones which are currently reportable from existing systems
5.2 Stakeholder Engagement
Regular monthly briefings on the programme are being established and will be shared widely with relevant individuals and organisations. A significant element of the GP survey action plan relates to communication and engagement activity, so this will need to be an area of focus.
Video ‘stories’ on the development of Place Based Teams are being developed, including filming a patient and a GP point of view. These will help to showcase and embed new ways of working.
7 An intranet page for staff will be established to provide an opportunity for core information to be shared more widely across the organisation.
The extent of further communications activity will be dependent on the resource available.
Quarter 2 • Implement multi-agency change management plan On track milestones
5.3 Integrated Single Point of Access (iSPA)
The key focus for iSPA in Quarter 2 will be on implementing a single phone number for referrals across all Out of Hospital Care Collaborative (OOHCC) and relevant Allied Health Professional (AHP) services as a virtual front door. This will reduce complexity for referrers and provide a base for future developments.
The roll out of EMIS will impact iSPA at each phase until the planned end of the use of GAP (Community scheduling tool) removes the need for two systems towards the end of year. The impact on the service during this period will continue to be monitored and steps taken to reduce the impact on service delivery.
Following agreement to the business case, plans to move to a ‘fit for purpose’ location will be progressed.
• Expand telephone referral system, in line with the agreed needs assessment Quarter 2 • Enable access to urgent and same day appointments On track milestones via the single front door to cover all ‘in scope’ OOH community services
5.4 Electronic Patient Record (EPR)
Configuration work for deployment of EMIS to Community Nursing has started in preparation for ‘go live’ in Quarter 3. All teams will be set up in a consistent manner across the whole county.
EPR roll out plans in Quarter 2 are focused on HomeFirst North with staff training due to start in late August for implementation in September.
5.5 Place Based Teams (PBT) and Locality Working
Following learning from the pilot sites, two additional teams in Bedworth and Rugby will ‘go live’ with the Place Based Team model. Work will continue to engage partners and to establish new ways of working across all operational PBT sites.
Workforce and Organisational Development plans are being implemented to support the developments and promote culture change, both within the organisation and with partners.
8 • Confirm PBT model based on the review and evaluation of pilot sites Quarter 2 • Agree appropriate MDT to address personalised care On track milestones needs of the registered patient population • Implement workforce plan and OD plan
5.6 Patient Pathways
Development work continues on End of Life, Frailty and Diabetes pathways across the county.
The focus for the Frailty pathway will be on initiating the use of the Rockwood score across all partners, development of data sharing around frailty and support for care homes.
End of Life developments in South Warwickshire are initially focused on progressing a 24/7 community based service. Care Homes are also a key area of development in this pathway. An End of Life group in Rugby will be established to drive forwards pathway development in this area.
5.7 Prevention / Health and Wellbeing
The Health and Wellbeing plan implementation will have a key focus on staff wellbeing and supporting staff to promote wellbeing with their patients in preparation for the 2019 Year of Wellbeing.
The population health system business case will be completed, aligned to the developments of system evaluation.
Quarter 2 • Implement public health delivery plan On track milestones
6. Key Out of Hospital Programme Challenges
The following key risks and challenges have been identified:
• Capacity to support communication and engagement activity; in particular engagement with primary care.
Current communications support capacity has been mapped and a proposal developed to increase the capacity within the communications team. Additional support from STP and CCG communication teams is being explored.
• Wide ranging information governance developments are required and that could stall elements of the programme if not resolved.
Support has been sought from the STP level Information Governance Advisory Group on how we can progress with understanding and implementing appropriate information governance to support multi-disciplinary working and the sharing of information. Some key actions to progress this have been identified. This will support a wide range of partners to have confidence in establishing appropriate information sharing arrangements.
9 • Operational impact on iSPA during Year 1 of the programme while EMIS and the virtual front door are implemented
A risk mitigation plan is in place to reduce the impact of EMIS roll out on the iSPA service delivery. This includes the recruitment of additional posts during the roll out period to reduce the operational impact of using multiple systems while all teams are migrated.
Detailed mapping work is being undertaken to establish the best set up for the shared phone number; routing callers directly to the correct service wherever possible.
7. Conclusion
The paper provides the Board with the background to the Out of Hospital Transformation Programme and progress in delivery of agreed milestones and outcomes in Quarter 1 of the programme and includes a forward look at Quarter 2 milestones. Key challenges for the Out of Hospital programme are outlined and actions underway to mitigate risks.
The Out of Hospital programme remains on track to progress within the agreed framework to fully implement the Out of Hospital model in Warwickshire by 2019/20. This position has yet to be formally considered and agreed with Commissioners.
8. Recommendation
The Board is invited to receive and note this report.
Elaine Coates Programme Manager Out of Hospital Programme
10 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Managing Director Role – Updated Enclosure K Corporate Governance Arrangements
Nature of item For information For approval For decision
Decision The Board of Directors is invited to:- required (if any) (a) receive and note the updated Register of Directors and Register of Directors’ Interests, and (b) note work to be undertaken on the Standing Financial Instructions, Scheme of Delegation and Standing Orders of the Board of Directors, which will be submitted to Audit Committee for consideration and the Board for approval in due course.
General Report Author Meg Lambert, Trust Secretary Information Lead Director Meg Lambert, Trust Secretary
Received or Meeting approved by Date
Resource Revenue Implications Capital Workforce Use of Estate Funding Source
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Managing Director Role – Updated Corporate Governance Arrangements
1. Background
Following on from the approval of the expansion of the Foundation group at the Board of Directors meeting on 4 July 2018 (Minute 18.198 refers), a number of corporate governance documents now require updating to accommodate the new role of Managing Director.
These include the Register of Directors, Register of Directors’ Interests, Standing Financial Instructions, Scheme of Delegation and Standing Orders for the Board of Directors.
2. Register of Directors and Register of Directors’ Interests
Both Registers have been updated to include Jayne Blacklay in the new role of Managing Director for the Trust, which is a voting position and Sophie Gilkes as the Acting Director of Development, which is a non-voting position.
The updated registers are attached at appendices A and B. Amendments are highlighted in bold text. They will be made available to the public via the Trust’s website and will be available for physical inspection through the Trust Secretary.
Directors are reminded of their responsibility to advise the Trust Secretary promptly of any changes to their register entries.
3. Standing Orders, Standing Financial Instructions and Scheme of Delegation
In order to ensure the Managing Director role has the appropriate authority to act, amendments need to be made to the Standing Orders, Standing Financial Instructions and Scheme of Delegation. This work is being undertaken by the Trust Secretary and Director of Finance, and the updated documents will be submitted to Audit Committee for consideration prior to seeking Board approval.
For the Board’s information; Glen Burley as Chief Executive of the Trust remains as the Accounting Officer for the organisation.
4. Recommendations
The Board of Directors is invited to:- (a) receive and note the updated Register of Directors and Register of Directors’ Interests, and (b) note work to be undertaken on the Standing Financial Instructions, Scheme of Delegation and Standing Orders of the Board of Directors, which will be submitted to Audit Committee for consideration and the Board for approval in due course.
Meg Lambert Trust Secretary
2 Appendix A
The Trust is required to compile a Register of Directors (as below), in accordance with the Constitution, and to make the register available for public inspection.
The register is maintained by the Trust Secretary who can be contacted on (01926) 495321 x8040. Register of Directors (August 2018)
Voting Directors
Name Designation
Russell Hardy Chairman Tony Boorman Non-Executive Director Angela Brady Non-Executive Director Rosemary Hyde Non-Executive Director Simon Page Non-Executive Director Bruce Paxton Non-Executive Director Sue Whelan Tracy Non-Executive Director
Glen Burley Chief Executive Charles Ashton Medical Director Jayne Blacklay Managing Director Fiona Burton Director of Nursing Helen Lancaster Director of Operations Kim Li Director of Finance
Non-Voting Directors
Name Designation
Anne Coyle Managing Director, Out of Hospital Care Collaborative Sophie Gilkes Acting Director of Development Ann Pope Director of Human Resources
Meg Lambert Trust Secretary
3
Appendix B
The Trust is required to compile a Register of Directors’ Interests (as below), in accordance with the Constitution, and to make the register available for public inspection.
The register is maintained by the Trust Secretary who holds the original signed declaration forms. These are available for inspection by contacting the Trust Secretary on (01926) 495321 x8040. Register of Directors’ Interests (August 2018)
Voting Board Members Name Designation Declared Interest Charles Ashton Medical Director - Member of Solihull CCG Governing Body - Medical Director, Wye Valley NHS Trust
Jayne Blacklay Managing Director - Director of SWFT Clinical Services Ltd Director of Development (a wholly owned subsidiary of South Warwickshire NHS FT) - Director of Helpforce ( a Community interest company promoting the use of volunteers within the healthcare survey )
Tony Boorman Non-Executive Director - Director of SWFT Clinical Services Ltd (a wholly owned subsidiary of South Warwickshire NHS FT) - Spouse is trading as Thinkvivid (a market research consultancy) and is on the advisory Board of Coventry Rape and Sexual Abuse Centre Ltd - Employed in a senior position by a subsidiary Company of IBM plc
Angela Brady Non-Executive Director - Member and Chair of local association - Employed GP at Budbrooke Medical Centre - Part-owner of Lisle Court Medical Centre (premises only) - Spouse is a GP partner at Croft Medical Centre - Clinical Lead for mental health at Solihull CCG - Trustee of Hatton Park Residents’ Association
4 Name Designation Declared Interest Glen Burley Chief Executive - Chief Executive, Wye Valley NHS Trust - Spouse is the Chair of Governors at Myton School - Spouse is a Practice Nurse at Rother House Medical Centre
Fiona Burton Director of Nursing - No interests declared - Russell Hardy Chairman - Chairman of Nuffield Health and Nuffield Health Pension Scheme - Chairman and majority owner of Maranatha 1 Ltd (trading as Fosse Healthcare Limited and Fosse ADPRAC) - Chairman of ‘Cherished’ - Chairman, Wye Valley NHS Trust - Rosemary Hyde Non-Executive Director - Director and Shareholder of RPR Consultants Ltd - Trustee of Stratford upon Avon Arts House Trust - Director of Stratford upon Avon Arts House (Trading) Ltd - Spouse is Director and Shareholder of Brian Hyde Ltd - Spouse is Director of RPR Consultants Ltd
Helen Lancaster Director of Operations - Board member of West Midlands Quality Review Service - Specialist Adviser for the Care Quality Commission
Kim Li Director of Finance - Director of SWFT Clinical Services Ltd (a wholly owned subsidiary of South Warwickshire NHS FT
Simon Page Non-Executive Director - Owner and Director of Weathervane Consulting
Bruce Paxton Non-Executive Director - Spouse is an employee of the Trust - Lay member on the Admissions Steering Group at Warwick Medical School
Sue Whelan Tracy Non-Executive Director - No interests declared
5 Non-Voting Board Members Name Designation Declared Interest Anne Coyle Managing Director Out - Spouse is Managing Director of Mini of Hospital Care Digital Limited Collaborative Sophie Gilkes Acting Director of - Partner is a Fund Manager for NFU Development Mutual, which includes investments in healthcare organisations Ann Pope Director of Human - Director of SWFT Clinical Services Ltd Resources (a wholly owned subsidiary of South Warwickshire NHS FT)
Meg Lambert Trust Secretary
6 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Summary of Ratified Policies Enclosure L
Nature of item For information For approval For decision
Decision The Board is asked to receive and note the summary of the following required (if any) policies: 1. SWH 00422 - Access to Health Records Policy, and 2. SWH 00455 - Lone Working Policy.
General Report Author 1. Lauren Haye, Information Governance/Privacy Information Officer 2. Jo Beales, Lead Risk, Health & Safety Adviser Lead Director Glen Burley, Chief Executive
Received or Meeting Policy Review Group approved by Date 9 July 2018
Resource Revenue Implications Capital Workforce Use of Estate Funding Source
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Summary of Ratified Policies
The following policies were ratified by the Policy Review Group on 9 July 2018:
SWH 00422 - Access to Health Records Policy
This policy was reviewed in light of new legislation; the General Data Protection Regulation 2016 and Data Protection Act 2018.
Updated information relating to charges, in which the Trust was able to charge an administration fee of £10 or £50 depending on the number of volumes, with the new regulation the fee has been eliminated. However, where the request is manifestly unfounded or excessive the Trust may charge a “reasonable fee” for the administrative costs of complying with the request. The Trust can also charge a reasonable fee if an individual requests further copies of their data following the first request. Under the Data Protection Act 1998, it was 40 days to comply with all Subject Access Request, under the current regulation, the time has been reduced to one calendar month.
The policy also includes the role of the Data Protection Officer, which is a mandatory requirement for all organisations that process confidential and special categories of data.
SWH 00455 - Lone Working Policy
This policy is designed to reflect good practice in relation to the protection of lone workers and should be used to develop or revise Divisional/Departmental specific procedures and systems to protect lone workers, reflecting the local needs of staff and the environments within which they work. Where it is possible, systems will be adopted to avoid employees working alone. In cases where this is not possible the Trust will provide an appropriate level of guidance, training and support to employees so that they are aware of, and comply with, best practice in relation to lone working.
This policy has been reviewed in line with the schedule. No significant amendments have been made to the policy.
2 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Appointment of a Consultant in Enclosure Mi Emergency Medicine
Nature of item For information For approval For decision
Decision The Board of Directors is asked to note the outcome of the required (if any) Appointments Advisory Committee held recently to appoint 1 full time substantive Consultant in Emergency Medicine.
General Report Author Andrew Millman, Deputy Medical Staffing Information Manager Lead Director Ann Pope, Director of Human Resources
Received or Meeting approved by Date
Resource Revenue The total cost for the appointment including Implications employer on costs is: £121,542.96 Capital Workforce Replacement Post Use of Estate Funding Source Approved staffing level
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Appointment of a Consultant in Emergency Medicine
Report from the Consultant Appointments Advisory Committee - held on 25 June 2018
An Appointments Advisory Committee (AAC) was convened and appointed one Consultant in Emergency Medicine.
The AAC was constituted as follows:-
Non-Executive Director – Mr B Paxton Chief Executive – Mrs H Lancaster (Acting Chief Executive) Medical Director – Dr C Ashton Royal College Representative – Dr P Doyle Consultant Emergency Medicine – Dr C Hetherington Service Manager Surgical Specialties – Mrs R Williams
Human Resources – Mr A Millman
1 candidate was interviewed.
The AAC decided unanimously to appoint Dr Rajan Paw
Recommendation
The Board of Directors is asked to note the outcome of the AAC held recently to appoint 1 substantive Consultant in Emergency Medicine. Dr Paw’s start date is to be confirmed.
SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Appointment of a Consultant in Colorectal Enclosure Mii Surgery
Nature of item For information For approval For decision
Decision The Board of Directors is asked to note the outcome of the required (if any) Appointments Advisory Committee held recently to appoint 1 full time substantive Consultant in Colorectal Surgery.
General Report Author Andrew Millman, Deputy Medical Staffing Information Manager Lead Director Ann Pope, Director of Human Resources
Received or Meeting approved by Date
Resource Revenue The total cost for the appointment including Implications employer on costs is: £92,113.2 Capital Workforce Replacement Post Use of Estate Funding Source Approved staffing level
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public South Warwickshire NHS Foundation Trust
Report to Board of Directors – 1 August 2018
Appointment of a Consultant in Colorectal Surgery
Report from the Consultant Appointments Advisory Committee - held on 29 June 2018
An Appointments Advisory Committee (AAC) was convened and appointed one Consultant in Colorectal Surgery.
The AAC was constituted as follows:-
Non-Executive Director – Mrs R Hyde Chief Executive – Mrs H Lancaster (Acting Chief Executive) Medical Director – Dr D Aldulaimi (Acting Medical Director) Royal College Representative – Dr S Ramcharan (Acting) Consultant General Surgery – Dr J Francombe Service Manager Surgical Specialties – Mr S Bahrawy
Human Resources – Mr A Millman
1 candidate was interviewed.
The AAC decided unanimously to appoint Dr Henry Ferguson
Recommendation
The Board of Directors is asked to note the outcome of the AAC held recently to appoint 1 substantive Consultant in Colorectal Surgery. Dr Ferguson’s start date is to be confirmed.
SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting Board of Directors Date 1 August 2018
Subject Board Committee Minutes Enclosure N
Nature of item For information For approval For decision
Decision The Board is asked to receive and note the following public/open Board required (if any) Committee Minutes: 1. Clinical Governance Committee on 13 June 2018, and 2. Finance and Performance Committee on 21 June 2018.
General Report Authors 1. Liz Wheeler, Committee Administrator Information 2. Colleen Tooze, Committee Administrator Lead Directors 1. Fiona Burton, Director of Nursing 2. Helen Lancaster, Director of Operations
Received or Meeting 1. Clinical Governance Committee approved by 2. Finance and Performance Committee Date 1. 11 July 2018 2. 19 July 2018
Resource Revenue Implications Capital Workforce Use of Estate Funding Source
Applicable Integrated Care Patient Experience – Quality Mental Health Improvement Normal Birth Rates VTE Risk Assessments Priorities Learning from Death Medicines Management Patient Experience – Booking Electronic Patient Record Patient Experience – End of Life
Freedom of Confidential (Y/N) No Information (if yes, give reasons) Final/draft format Final
Ownership Trust
Intended for release Yes to the public
SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Minutes of the Clinical Governance Committee Meeting held on Wednesday 13 June 2018 at 13.30 hours in the Brooke Suite, Warwick Hospital
Present: Bruce Paxton (BP) Non-Executive Director (NED) (Chair) Dr Charles Ashton (CA) Medical Director Dr Angela Brady (AB) NED Fiona Burton (FB) Director of Nursing Chris Day (CD) Head of Governance Claire Hinds (CH) Associate Director of Operations (ADO) Support Services Rosemary Hyde (RH) NED Simon Illingworth (SI) ADO Elective Services Division Wendy Jones (WJ) ADO Women and Children’s Division Helen Lancaster (HL) Director of Operations Fraser Millard (FM) Associate Medical Director (AMD) for Governance Penny Smith (PS) Trust Governor Sue Whelan-Tracy (SWT) NED
In attendance: Vinodhini Clarke (VC) Chair of Women and Children’s Audit and Operational Governance Group (AOGG) (present for Minute 18.113) John Coyne (JC) Managing Director SWFT Clinical Services (present for minute number 18.124) Ruth Gibson (GB) Patient Safety Manager Malcolm Hunter (MH) Director of Operations Pathology Network (present for minute number 18.123) Dipa Parekh (DP) Laboratory Scientific Officer (present for minute number 18.123) Sumara Parvez (SP) Head of Pharmacy (present for minute number 18.125) Katie Randall (KR) Consultant Haematology (present for minute number 18.121) Emma Ratley (ER) Acting Trust Assurance Manager Suki Sandhu (SS) Hospital Transfusion Practitioner (present for minute number 18.122) Becky Talbot (BT) Clinical Governance Midwife (present for Minute 18.113) Dr Judith Timms (JT) UHCW (present for minute number 18.123) Dominique White (DW) Quality Governance Manager SWFT Clinical Services (present for minute number 18.124) Liz Wheeler (LW) Committee Administrator
MINUTE ACTION 18.109 APOLOGIES FOR ABSENCE
Apologies for absence were received from Sean Ramcharan
18.110 DECLARATIONS OF INTEREST
There were no declarations of interest made at the meeting.
SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Clinical Governance Committee Meeting held on Wednesday 13 June 2018
MINUTE ACTION 18.111 MINUTES OF PREVIOUS MEETING HELD ON 9 MAY 2018
The Committee Chair asked that on page 4, fifth paragraph, ‘heparinised salve’ should this be heparinised saline? It was agreed that this should be changed.
Dr Brady (NED) asked that on page 4, first paragraph ‘falls medical prevention medical devices’ should there only be one word ‘medical’. This was agreed and the minutes would be changed.
Resolved – that, subject to the above amendments, the Minutes of the meeting held on 9 May 2018 be confirmed as an accurate record of the meeting and signed by the Committee Chair.
18.112 MATTERS ARISING AND ACTIONS UPDATE REPORT 18.112.1 All items on the action log were included on the agenda.
18.113 AUDIT AND OPERATIONAL GOVERNANCE GROUP FOR WOMEN AND CHILDREN’S DIVISION QUARTERLY REPORT
The Chair of the Women and Children’s AOGG reported that the Women and Children’s AOGG meet quarterly and the meeting was well attended.
During the quarter: • There had been 479 incidents, a slight increase on the previous quarter. Five Initial Management Reviews had been completed. • Two new Clinical Negligence Scheme for Trusts (CNST) claims were received in Quarter 4 and two existing CNSTs were settled. • There were four new formal complaints received and seven complaints were closed in Q4. There were five open complaints at the end of Q4. • A business case had been approved for additional paediatric consultants which would provide consultant presence in paediatrics until 10.00 p.m. Recruitment was currently underway. • In Gynaecology a re-audit had taken place of consent for clinical procedures which had shown significant improvement in consent compliance with Gynaecology now ranking the second best specialty in the Trust compared to being the worst performing specialty in 2016. • In Maternity, Saving Babies Lives, a care bundle that supports the delivery of safer maternity care to reduce the number of stillbirths, had been achieved and implemented in all elements of the bundle which was a fantastic achievement for the maternity team. • This had created a knock-on effect with regard to caeserian sections (CS) with babies being born by CS increasing as the maternity team are recognising babies that are at risk and bringing them in earlier for their procedure. The Medical Director asked if there was a
Page 2 of 15 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Clinical Governance Committee Meeting held on Wednesday 13 June 2018
MINUTE ACTION difference between the planned and emergency CS, and the Clinical Governance Midwife reported that both are increased. The Director of Operations asked if the analysis could be made available as there BT is a national drive to reduce CS rate and therefore if the guidelines are increasing the number this would show in the performance figures. • The Clinical Governance Midwife reported that a Smoking Cessation Midwife had been employed to work with women who smoke and BT offer them 1-1 support to decrease smoking in pregnancy. This new role was working well and smoking at time of delivery rates are much lower. The Director of Nursing asked if the numbers could be shown in the report.
Mrs Smith (Trust Governor) asked what could be done to get to women and talk to them about smoking before they get pregnant. The Director of Nursing commented that one of the Trusts CQUINs (and also a national CQUIN) was around alcohol and smoking and was something that all women are asked if they want to stop. This was also on the public health agenda.
The Clinical Governance Midwife reported that with regard to neonatal triggers, there was a workstream looking at why babies are being admitted to SCBU and whether they are being admitted correctly. The workstream was identifying trends and making service improvements and the reviews would be collated into monthly reports.
The Clinical Governance Midwife reported that ‘Mother and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK’ (MBRRACE) had an up to 10% higher than national average rate of extended perinatal deaths for the calendar year 2014 (report released June 2016). As a result it was agreed in 2016 that all extended perinatal deaths were going to be reported to the Serious Incidents Group (SIG) in a formal review for one year and this process was to be reviewed in 2017. MBRRACE have since produced a review tool and pathway that enables the Trust to carry out multidisciplinary reviews in a structured format that is replicated nationally. The SIG agreed in May 2018 that the new nationally recognised process would replace the current process of extended perinatal deaths being reviewed at SIG
Mrs Whelan-Tracy (NED) asked about deaths of babies which would usually have gone through as Serious Incidents and would normally be reported at Clinical Governance Committee. With the new process, where would these serious incidents be reported? The Patient Safety Manager reported that she was satisfied that these incidents did not need that level of scrutiny and the MBRRACE tool was more appropriate for those reviews. If the severity was at a level that the SI threshold was triggered, it would remain reportable as an SI and come to Clinical Governance Committee for review and closure.
Page 3 of 15 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Clinical Governance Committee Meeting held on Wednesday 13 June 2018
MINUTE ACTION The Director of Operations asked who would be reporting to this Committee and it was agreed that it would be either an Obstetrician or if the Midwifery Led Unit was involved, the midwife. VC Mrs Whelan-Tracy (NED) commented on the increase in Child Protection and Safeguarding issues due to the reporting of incidents on Datix and asked if this would stay at these levels. The Chair of the Women and Children’s AOGG commented that every incident was now logged on Datix.
Mrs Whelan-Tracy (NED) commented that on the maternity dashboard, postnatal readmissions had been in red for 12 months now and the target was zero and asked if the target should be changed. The Clinical Governance Midwife replied that there would always be readmissions BT and that there was a national baseline for readmissions.
The Director of Nursing commented that the list of clinical audits included in the report, whilst being useful, would be so much better if the learning that had come out of the audits could be reflected in the next report. The Chair of the Women and Children’s AOGG replied that action plans could be available. It was agreed that changes that have been made to care of patients through the audits should be included in future reports.
The ADO for Women and Children’s Division was asked for clarification of the risk on the risk register regarding non-achievement of CIP targets and if this was non-achievement of financial targets or non-achievement of clinical care. The ADO for Women and Children’s Division reported that the risk was the Division not identifying schemes to achieve their CIP target which for 2018/19 was £953K and current schemes are £400K. However, there are more schemes coming through.
The Committee Chair reported that he was expecting a governance statement to be included in the report for the Midwifery Led Unit from July 2018.
Resolved – that, A. The data showing CS rates be provided to the meeting to be BT included in future AOGG reports. B. The data showing the number of women who have stopped BT smoking will be shown in future AOGG reports. C. The outcomes from clinical audits should show any learning VC that has been achieved. D. The Women and Children’s Division Quarterly Report be received and noted.
18.114 PATIENT EXPERIENCE MONTHLY REPORT
The Director of Nursing reported that with regard to FFT responses, Page 4 of 15 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Clinical Governance Committee Meeting held on Wednesday 13 June 2018
MINUTE ACTION patients are saying that they get good experience from using the hospital, this was coming through in FFT responses, and in thank you cards and messages. What was not so good is the actual formal response rate and there are plans to improve this. There will be a rebranding and relaunch of the patient feedback process under the banner ‘IWantGreatCare’ which commences week commencing 18 June 2018. Regarding the complaints, there had been a problem with complaints resolved within the agreed time frame which was showing red in the month.
The Director of Nursing reported that there would be a change in the way responses to complaints are measured with the lead investigator phoning the complainant to let them know if more time is required and this being put onto Datix to ensure that there is not a breach in the response time.
In April 2018 the main subject for formal complaint was clinical care and for PALS it was appointment issues.
The ADO for Women and Children’s Division commented that on page ER 12/13 of the report there were graphs for four Divisions but Women and Children’s Division was not included. This would be corrected in July.
Mrs Whelan-Tracy (NED) asked about the comments regarding waiting for telephone calls from the virtual clinics which features in the Choices section of the report and asked if these problems are sent on to the Patient Experience team. The ADO for the Elective Care Division updated on this particular problem which was the first patient in the first clinic and the patient was not called back – this problem has now been corrected.
The Head of Governance commented that learning from the complaint ER on page 7 which was partially upheld was not included and this should be corrected. Mrs Hyde (NED) commented that learnings were not included for the complaint on page 6 and this should be included.
The Director of Nursing commented that previously the Committee had discussed having a quarterly patient experience report and producing a FB shorter ‘live’ document monthly which shows issues, successes, etc. The Committee Chair suggested that this be trialled for six months. The Committee agreed to this.
The Committee Chair commented that one of the actions on the action SI log was for the ADO of Elective Care Division to review the 4 star review as a case study for the project team. The ADO for the Elective Care Division replied that this was in progress and he would put on the agenda for a future meeting.
Resolved – that, Page 5 of 15 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Clinical Governance Committee Meeting held on Wednesday 13 June 2018
MINUTE ACTION A. Women and Children’s Division need to be included in the ER graphs in the Patient Experience Monthly Report. B. Learnings from complaints need to be included in the ER Patient Experience Monthly Report. C. The Committee agreed that a shorter ‘live’ complaints report FB be presented to future meetings on a trial basis for six months. D. The Patient Experience Monthly Report be received and noted.
18.115 PATIENT SAFETY MONTHLY REPORT
The Patient Safety Manager reported that the Information Team were taking over the compiling of an automated report. The report summary included: • There had been an increase in incidents reported from 893 in April to 906 in May. • Two serious incidents occurred in May. • Medication incidents increased from 82 in April to 83 in May, the rate of harm arising from medication incidents in April was 12.05% (target 6%) with 10 low harm incidents. Incidents are now reviewed at the monthly Drugs and Therapeutics Committee. • Falls decreased from 79 in April to 53 in May with a harm rate of 1.07. The Director of Nursing reported that this was the lowest rate for 13 months. Although the reason for this was not known, it was thought to be as a result of PJ Paralysis, although this was not certain. Since the opening of the new ward at Ellen Badger there had been no falls there. The Director of Operations commented that PJ Paralysis had had a massive impact during the time it had taken place, and also the frailty pilot had been in place during most of May. The new frailty assessment area was discharging 50% of patients that go through and more patients are going home rather than being admitted. • Safety thermometer performance was 97.19% which exceeds the 95% national harm-free target and the 96% internal target. • Mrs Whelan-Tracy (NED) noted the increase in medication incidents with harm involving insulin where good work had been done in the past and asked what was being done regarding this. The Director of Nursing reported that she felt that the number of incidents had not increased, it was the level of harm that has changed which was because of the methodology used. • The Director of Nursing commented that she had not had chance to read the report in-depth because of its lateness. The AMD for Governance suggested that the Committee receive the report a month in retrospect to enable Committee members to read the report, however the Director of Operations commented that because the Committee have to report to the Board of Directors
Page 6 of 15 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Clinical Governance Committee Meeting held on Wednesday 13 June 2018
MINUTE ACTION this was not possible as up to date information was required for Board. • Discussion took place regarding the content of the report and suggested that the Head of Governance bring proposals CD regarding content to a Committee in the next few months. The Director of Operations commented that there are many charts but not enough narrative and therefore not getting the detail of trends.
Resolved – that, (A) That the Head of Governance bring to Committee CD proposals regarding the content of the Patient Safety Report, and (B) The Patient Safety Monthly Report be received and noted.
18.116 SERIOUS INCIDENT ACTION PLAN TRACKER
The Patient Safety Manager reported that 10 of the open incidents can be taken off the log. Mrs Hyde (NED) commented that on the action log, all of the incidents were from December 2017 and none were from 2018. The Patient Safety Manager replied that incidents do not appear on the action log until there had been an investigation review and the investigations were seen in the confidential Committee.
The Patient Safety Manager reported that there had been no serious incidents in April and two in May and these would go to the Falls Review Group. Discussion took place regarding the pathway for investigation reports and it was thought that many of the incidents take too long to investigate. The reports need to go to Divisional AOGG meetings and narrative included in them to progress them through the system. The Director of Operations commented that actions that are six months out ADOs of date is unacceptable.
Resolved – that, A. ADOs need to update Serious Incidents Action Tracker at ADOs AOGG in order that the Serious Incident Action Plan Tracker can be up to date when it is reported at Clinical Governance Committee. B. The SI Action plan Tracker Report be received and noted.
18.117 INFECTION PREVENTION AND CONTROL MONTHLY REPORT
The Director of Nursing reported that the Infection Prevention and Control report was an assuring report which demonstrated good infection prevention outcomes.
The team had achieved all targets at the end of the year and the first two months of the new year were on track to have another successful year. There had been no serious concerns in the month. Page 7 of 15 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Clinical Governance Committee Meeting held on Wednesday 13 June 2018
MINUTE ACTION Hand hygiene has been discussed and a number of actions put in place. The Director of Nursing had attended the A&E Governance Meeting and discussed leadership between medical staff and nursing staff with an agreement that a change in ownership and culture was required with very clear expectations.
The Director of Operations asked about Surgical Site Infections and commented that in previous years the Committee have asked for updates regarding this and would need some assurances regarding what they are going to do differently to ensure a reduction in these infections.
On page 4 of the report there was a challenge which had been identified during RCA – ‘Ensure robust processes for equipment and environmental cleaning’ – the Director of Nursing reported that there had been teething problems with ISS at the start of the contract but there were now no concerns and it was thought that ISS were an improvement on the previous contract.
The Head of Governance asked why some areas had done more hand hygiene audits than others and the Director of Nursing reported that this was as a response to queries or incidents and that generally audits are done regularly.
Mrs Hyde (NED) noted three cases of Ecoli Bacteraemia and asked if this was a concern, the Director of Nursing reported that there was no problem in terms of environment and the Medical Director reported that the infection was isolated within one ward, which was a gastroenterology ward, so this was to be expected.
Resolved – that the Infection Prevention and Control Monthly Report be received and noted.
18.118 AUDIT AND OPERATIONAL GOVERNANCE REPORT FOR ELECTIVE CARE QUARTERLY REPORT
The Committee Chair asked about the Elective AOGG Terms of Reference that were expected to be reviewed and the ADO for Elective Care Division reported that he would include these for the next meeting. SI
The ADO for Elective Care Division reported: • The WHO Checklist had achieved 100% compliance in all domains which was excellent and was reassuring that staff are fully engaged with the checklist when compared to the same period last year. • Assessment of usage of controlled drugs achieved a satisfactory compliance of 90%. • FFT results were good for the Division. With regard to the management of complaints, the General Managers were working Page 8 of 15 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Clinical Governance Committee Meeting held on Wednesday 13 June 2018
MINUTE ACTION hard to turn complaints round in a timely manner and also to ensure a good quality of response. • Emergency surgery demand was high – with a 5% increase year on year. • There are pressures with ENT and Urology Cancer cases and the inability to recruit Consultants. The posts are out to advert and the Division was looking at developing the ACP roles in these areas. • As reported previously, support in Oncology was not being received from UHCW. • VTE assessment compliance needs to improve across the Division. • Issues with Pathology was having an impact on performance.
Mrs Smith (Trust Governor) asked about the shortage of Radiologists and the effect this would have on cancer waiting lists. The ADO for Elective Care Division commented that this does have an effect on the Division but that there is a national shortage of radiologists. The AMD for Governance commented that there had been a number of retirements in Radiology and this had been a significant challenge for the department – initiatives have been put in place but this had not yet improved the situation.
Mrs Whelan-Tracy (NED) asked about the comment on page 3 of the report – ‘the length of stay could improve, as often we admit patients the day before rather than on the day of surgery to avoid occupancy by acute patients’. The Director of Operations commented that this was not correct and not something that the Trust support.
Resolved – that, A. That the Elective Division AOGG Terms of Reference be SI discussed at the next meeting. B. That the Audit and Operational Governance Report for Elective Care Quarterly Report be received and noted.
18.119 CANCER SERVICES CARE ANNUAL REPORT
The ADO for Elective Care Division reported that the performance in cancer services had been good despite growing demand and the service had continued to meet national targets. There remains some challenges within the service such as DVT and the demand for radiology diagnostics. • 2WW referrals continue to rise. • There had been an increase in demand for Radiology. • There had been an increase in demand for Pathology and Endoscopy. • The number of patients with a diagnosed cancer remains static at around 100 per month. The total number of patients without a
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MINUTE ACTION diagnosis of cancer had increased slightly.
The ADO for Elective Care Division reported that Cancer Services had not been able to roll out the oncology service fully at Stratford because of the shortage of consultants, there should be four sessions there per week but this seldom happened. It is running as a nurse led unit but should be led by a Consultant.
In DVT the service is training nurses to prescribe and this will put the service in a much better position.
A full review of CNS workforce had been completed and development of this service would enable the Trust to improve some of the outcomes of cancer patients. The ADO for Elective Care Division would be reporting to Management Board in the future.
The following items set out key areas of focus for the cancer team during 2018/19: • Work towards the delivery of diagnosis by day 28; • Develop the primary care DVT pathway ready for go-live in Q3; • Implement the Lead Cancer Nurse role; • Develop a case for investment into the cancer CNS team to drive improvements in the national cancer survey and the national quality surveillance programme. • Deliver actions in the NHSI action plan related to the reduction in the numbers of late referrals to tertiary centres; • Continue to work with UHCW on the recruitment into vacant Oncology gaps; and • Move H&N pathway back to UHCW.
Mrs Hyde (NED) asked about the capacity at Stratford for chemotherapy and with a nurse led unit was it working at capacity. The ADO for Elective Care Division replied that it was not working to capacity but not because it was nurse led, there was more capacity available but not the demand at the moment. The unit was working well as a nurse led unit.
Mrs Whelan-Tracy (NED) asked about the workforce strategy in Cancer and the challenges around the available staff. The ADO for Elective Care Division and the ADO for Support Services Division would be presenting to F&P Committee to update on the workforce strategy for Cancer Services.
Resolved – that the Cancer Services report be received and noted.
18.120 AUDIT AND OPERATIONAL GOVERNANCE GROUP FOR SUPPORT SERVICES QUARTERLY REPORT
The ADO for Support Services Division reported on the AOGG report for
Page 10 of 15 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Clinical Governance Committee Meeting held on Wednesday 13 June 2018
MINUTE ACTION Support Services.
• The issue with ISS regarding measles had been discussed with them and they have now introduced a system whereby the Occupational Health Department send appointments for any ISS staff directly to the Contracts Manager. • There had been issues surrounding non-emergency ambulance pick-ups and this had created a problem with bed availability. The commissioners are now serving a Variation from Contract on the Ambulance Service. • Two physiotherapists had been successfully recruited into ACP roles and now support therapy and orthopaedics. • The Division had supported the inspection and review of the Millbrook mattress decontamination facility following previously identified failings. A further inspection was taking place in July.
The Director of Nursing asked about the BMI figure at the top of page 9 which shows ‘BMI or centiles in children’ of 79.32% and ‘Is there a record at each appointment of who attended/was present with the patient’ of 84.03% and suggested that this was a significant safeguarding risk and would need to be investigated. The ADO for CH Support Services would arrange for this to be looked into.
Concern was expressed regarding the lone worker audits and the ADO CH for Support Services would feedback on this.
Resolved – that, A. The BMI figures be investigated due to safeguarding risk. CH B. The lone work audits to be reported on in the next report. CH C. The Audit and Operational Governance Group for Support Services Quarterly Report be received and noted.
18.121 HAEMOSTASIS AND THROMBOSIS COMMITTEE SIX MONTHLY REPORT
The Consultant Haematologist reported that the Haemostasis and Thrombosis Committee continue to monitor the VTE risk assessments and are falling behind target. This change in trend may be because of a change in the data collection methodology. The Consultant Haematologist reported that staff were working hard to achieve the target but this was not a long term solution and better ways of collecting data was sought.
Discussion took place regarding the recent NICE guidance on thromboprophylaxis in adults to reduce the risk of hospital acquired VTE events. There were potentially a number of changes to local policy and this would have an impact on who will need risk assessments.
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MINUTE ACTION Mrs Smith (Trust Governor) asked about the Anticoagulation Service which had waiting lists of up to six months and asked about the current situation. The Director of Operations explained about the current situation with staffing with managerial leadership from the Band 7 staff, ongoing support from the Consultant Haematologist, and Trust pharmacists. The work in this area was ongoing.
Resolved – that the Haemostasis and Thrombosis Committee Six Monthly Report be received and noted.
18.122 HOSPITAL TRANSFUSION COMMITTEE SIX MONTHLY REPORT
The Hospital Transfusion Practitioner reported that the Trust complied with all National Blood Transfusion regulations and guidance due to the implementation of the revised British Committee for Standards in Haematology (BCSH) guidance for sample validity on 4 December 2017.
There had been an increase in cord sample rejections from Maternity which was being monitored. Blood Transfusion had been added to the Maternity mandatory training sessions.
The risk associated with the blood share arrangement with Nuffield Hospital had been a problem with them sending units back from Derby and Leicester and therefore we do not supply them with blood any longer and the wastage figure was coming down.
The risks detailed in the report regarding ‘Incorrect blood components issued due to failure of clinical areas to request appropriate products’ and ‘Aging equipment used for blood storage over 10 years old which is beyond the life expectancy due to the lack of a replacement programme resulting in loss of stock and service disruption’. These risks should remain on the register as they were not yet resolved.
Resolved – that the Hospital Transfusion Committee Six Monthly Report be received and noted.
18.123 COVENTRY AND WARWICKSHIRE PATHOLOGY SERVICES GOVERNANCE SIX MONTHLY REPORT AND ANNUAL MHRA BLOOD TRANSFUSION COMPLIANCE REPORT
Phlebotomy The Laboratory Scientific Officer reported that full 7 day working had been implemented in December to support the in-patient service, and provide a more robust and consistent domiciliary and out-patient service across 5 days.
A Phlebotomy Patient Satisfaction Survey form had been created and would be discussed and approved at the next Patient Forum.
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MINUTE ACTION Pathology The Director of Operations for the Pathology Network explained about the current situation with the computer system at UHCW to operate the Pathology system. Currently this was not going well. The system was upgraded to LIMS Ultra in March 2018 and connectivity between SWFT, GEH and UHCW was on Citrix. Since the upgrade there had been a problem with Citrix.
UHCW IT have been carrying out a large amount of work to identify the problem but it was still not known what the problem was and UHCW have called in an external expert on Citrix but the cause was still not known.
UHCW were also looking at an alternative method of communication between SWFT and UHCW by means of VDI which was a virtual private network to access a virtual PC sited at SWFT. However, although the initiation was by UHCW, and they would develop and test it, it was felt that SWFT had not fully engaged in this.
The Director of Operations commented that this situation had been on- going for 10 weeks and there had not been a resolution to the problem. Patient safety was becoming a problem with patients missing their first MDT causing further delays in their pathway. This was also a performance issue with potential for patients to breach. A solution was needed and we need something in the interim until a final solution could be found.
The Committee Chair commented that SWFT IT need to be fully engaged in this process and asked about the risk to patients. The Director of Nursing replied that Board level discussions had taken place but Clinical Governance Committee need to know more detail of the risk and the scale of the problem has not yet been identified. The ADO for Elective Care Division would provide a list of patients who have missed SI MDTs.
The Director of Operations reported that this would be reported at the Board of Directors meeting on 4 July 2018 when it was thought that the Non-Executive Directors would be asking for assurance that a solution was in place.
The Medical Director asked if there was another system that could be put in place that was labour intensive. The Director of Operations for the Pathology Network replied that secretarial staff at SWFT could type the reports into word and email to UHCW and UHCW incorporate them into Ultra. Another option could be to send the staff who type the reports to UHCW and ask them to put the results into Ultra. There is a risk around transcription and also around sending staff to Coventry. A third option would be to get the secretary and consultant in UHCW to input.
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MINUTE ACTION The Committee Chair asked the Director of Operations to ensure that SWFT IT are fully engaged and that the Director of Operations for the HL/MH Pathology Network attend the next meeting on 11 July 2018.
Resolved – that, A. That the Director of Operations ensure that SWFT IT are fully engaged in the process to get the Pathology system HL up and running. B. That the Director of Operations for the Pathology Network attend the next Clinical Governance Committee MH meeting and that Pathology is an agenda item. C. the Coventry and Warwickshire Pathology Services Governance Six Monthly Report and Annual MHRA Blood Transfusion Compliance Report be received and noted.
18.124 SWFT CLINICAL SERVICES GOVERNANCE REPORT
The Quality Governance Manager for SWFT Clinical Services reported that the report had been provided at the request of Clinical Governance Committee to provide an overview of activity and key developments within the clinical divisions of SWFT Clinical Services.
SWFT Clinical Services had recently been inspected by the CQC and had received a final rating of ‘Requires Improvement’. Although the rating was not satisfactory, it was what was expected and a large amount of work had gone into getting that rating.
The Quality Governance Manager for SWFT Clinical Services reported that patient feedback regarding the Service was always positive and there had been no complaints this year. Pharmacy always receive positive feedback. Governance processes had improved and there was now a risk register in place. Clinical engagement was not good but was being resolved. A Medical Advisory Committee was being put in place with Terms of Reference now available.
Incident reporting had increased with NIL harm in all incidents. General processes at the clinic were lacking and work on quality and procedures had taken place to improve this.
The Managing Director for SWFT Clinical Services outlined the financial challenges that the company faces and the work that was taking place to improve this.
Resolved – that the SWFT Clinical Services Governance Report be received and noted.
18.125 DRUGS AND THERAPEUTICS AND MEDICAL SAFETY COMMITTEE QUARTER 4 REPORT
Page 14 of 15 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Minutes of the Clinical Governance Committee Meeting held on Wednesday 13 June 2018
MINUTE ACTION The Head of Pharmacy reported during Quarter 4 a number of policies had been approved which was crucial and medicine safety work was continuing.
CD storage and management on wards were audited and 10 locations did not meet the 90% target with Macgregor, A&E Resus and Beaumont under performing. Work was continuing to improve this.
The Committee continued to receive the medication safety reports and considers action to be taken regarding these.
The Medication Safety Officer leaves in two weeks and has not yet been replaced.
Resolved – that the Drugs and Therapeutics and Medical Safety Committee Quarter 4 Report be received and noted.
18.126 ANY OTHER BUSINESS
There was no further business.
18.127 CONFIDENTIAL MINUTES FROM THE MEETING HELD ON 9 MAY 2018
There were no matters arising from the meeting held on 9 May 2018.
18.128 MATTERS ARISING AND ACTIONS UPDATE REPORT
There were no items included on the action plan.
18.129 SERIOUS INCIDENT – 2018/7069
18.130 SERIOUS INCIDENT – 2018/7932
18.131 ANY OTHER CONFIDENTIAL BUSINESS
There was no further business.
18.132 DATE AND TIME OF NEXT MEETING
The next meeting would be held on Wednesday 11 July 2018 at 13:00pm in the Brooke Suite, Warwick Hospital.
Signed ______Date 11 July 2018 (Chair of the Clinical Governance Committee)
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Open Minutes of the Finance and Performance Committee Meeting Held on Thursday 21 June 2018 at 8.30am in the Brooke Suite, Warwick Hospital
Present: Simon Page (SP) Committee Chair Glen Burley (GB) Chief Executive (Present from Minute 18.008) Fiona Burton (FB) Director of Nursing Anne Coyle (AC) Managing Director, Out of Hospital Care Collaborative (OOHCC) (Present to Minute 18.014) Rosemary Hyde (RH) Non-Executive Director (NED) (deputising for Mr Paxton, NED) Helen Lancaster (HL) Director of Operations Kim Li (KL) Director of Finance Danny Roberts (DR) Chief Technology Officer (Present from Minute 18.036) Sue Whelan Tracy (SWT) NED
In attendance: Ravi Basi (RB) Associate Director of Finance – Income and Contracts Claire Hinds (CH) Associate Director of Operations – Support Services Division (Present from Minute 18.013 to 18.017) Simon Illingworth (SI) Associate Director of Operations – Elective Division (Present from Minute 18.012 to 18.017) Wendy Jones (WJ) Associate Director of Operations – Women and Children’s Division (Present from Minute 18.015 to 18.020) Fiona Langworthy (FL) Head of Business Development (deputising for the Director of Development) Roger Lloyd (RL) Governor Observer Greg Stevens (GS) Associate Director of Information and Performance Rachel Williams (RW) Associate Director of Operations – Emergency Division (present from Minute 18.012 to 18.017) Colleen Tooze (CT) Committee Administrator
MINUTE ACTION 18.001 APOLOGIES FOR ABSENCE
Apologies for absence were received from the Director of Development, Acting Trust Secretary, and Mr Paxton, NED.
18.002 DECLARATIONS OF INTEREST
No declarations of interest were made.
18.003 MINUTES OF THE BUSINESS PERFORMANCE AND INVESTMENT COMMITTEE HELD ON 19 APRIL 2018 – OPEN MEETING
Resolved – that the Minutes of the Business Performance and Investment Committee - Open Minutes of the meeting held on 19 April 2018 be confirmed as an accurate record of the meeting and signed by the Committee Chair.
18.004 BUSINESS PERFORMANCE AND INVESTMENT COMMITTEE - MATTERS ARISING AND ACTION UPDATE REPORT – OPEN MEETING
18.004.01 Actions Listed as Complete SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Open Minutes of the Finance and Performance Committee Meeting Held on Thursday 21 June 2018
MINUTE ACTION
The actions listed as complete in the Actions Update Report were noted and would now be removed from the report.
Resolved- that the position be noted.
18.004.02 High Cost Drugs (Business Performance and Investment Committee meeting (Minute 17.099 refers)
The Associate Director of Finance provided an update on the outcome of the risk share agreement on High Cost Drugs in that South Warwickshire Clinical Commissioning Group (SWCCG) made a provision whereby it would exclude price changes. The Trust would have the same gain share as 2016/2017. If there were any price changes then the benefit would be realised in October 2018.
The Associate Director of Finance explained that good progress had been made and that an action plan was being followed.
Resolved- that the position be noted.
18.005 MINUTES OF THE FINANCE AND PERFORMANCE EXECUTIVE HELD ON 30 MAY 2018
Resolved – that the Minutes of the Finance and Performance Executive for all Divisions held on 30 May 2018 be confirmed as an accurate record of the meeting.
18.006 FINANCE AND PERFORMANCE EXECUTIVE – MATTERS ARISING AND ACTIONS UPDATE REPORT
The Director of Operations stated that any outstanding actions would be addressed within the Divisions.
Resolved – that the position be noted.
18.007 FINANCE AND PERFORMANCE COMMITTEE – TERMS OF REFERENCE
The Director of Operations presented the Finance and Performance Committee – Terms of Reference. A number of members had been excluded from the Membership / Attendance and were highlighted as tracked changes.
Mrs Whelan Tracy, NED queried the language around business cases as she suggested that more time should be spent on reviewing business cases. The Director of Operations suggested that Mrs Whelan Tracy, NED provide her with some narrative to that effect. Mrs Whelan Tracy, NED suggested that there be a protocol on business cases being published in order to eliminate reviewing business cases at short notice. Discussion took place on the timeliness of business cases. The Committee agreed that if a business case had a value of £500k or more than it had to be reviewed at this Page 2 of 9 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Open Minutes of the Finance and Performance Committee Meeting Held on Thursday 21 June 2018
MINUTE ACTION Committee and recommended for Management Board otherwise the process would remain the same. The Committee Chair recommended the business case was referenced as a return on investment, replacement or patient experience.
Resolved – that (A) the Finance and Performance Committee – Terms of Reference be received and noted, and (B) Mrs Whelan Tracy, NED provide narrative to the Director of SWT Operations on reviewing business cases.
18.008 SCHEDULE OF BUSINESS
The Director of Operations presented the Schedule of Business. The Committee Chair confirmed that the Committee would learn and adapt moving forward.
Resolved – that the Schedule of Business be received and noted.
18.009 CALENDAR OF MEETINGS
Discussion took place on the timing of information for the report writing in order for the Committee to have the most current data. It was suggested for the meeting dates to be pushed back by one week. The Director of HL Operations would review meeting dates and the Committee Administrator CT would review and align diaries accordingly.
Resolved – that (A) the Calendar of Meetings be received and noted, and (B) the Director of Operations review meeting dates, and HL (C) the Committee Administrator review and align diaries CT accordingly. 18.010 DATA QUALITY REPORT
The Associate Director of Information and Performance presented the Data Quality Report and highlighted the ongoing data quality issues which were being managed within the Divisions and supported by the Data Quality teams. Key areas highlighted were Admission, Discharge, Transfer (ADT) performance against 30 minute targets, A&E coding, outpatient attended and outcomes as well as the Out of Hospital specific metrics.
Discussion took place on the introduction of an electronic system for Central Alerting System (CAS) cards and the challenges in relation to bed management. Also the data included in the report was only a snapshot.
The Committee Chair queried the self-service of self-service reports on the intranet. The Director of Operations provided assurance that it was an expectation of the Divisional Associate Director of Operations (ADOs) to use the information and reports generated for their Division / Teams accordingly.
Resolved – that the Data Quality Report be received and noted. Page 3 of 9 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Open Minutes of the Finance and Performance Committee Meeting Held on Thursday 21 June 2018
MINUTE ACTION
18.011 EXTENDED PERFORMANCE DASHBOARD
The Associate Director of Information and Performance presented the Extended Performance Dashboard.
The Director of Operations explained that the Extended Performance Dashboard was quite new and its aim was to take the “noise” out from the Board report. If there were any particular issues / challenges then they would be brought back to the next meeting with a plan.
The Committee Chair queried how best to use the data and suggested that going forward, the Executive Team should identify and report on those areas which were of concern to them at the meeting. The Chief Executive suggested that it would be helpful to identify which Committees were providing assurances. The Director of Operations agreed that a column HL would be added to the glossary of the extended performance dashboard to identify which oversight committee reviewed and provided assurance to each of the metrics reported.
The Committee Chair asked what the areas of concern were at the moment. The Director of Operations outlined the following concerns:
a.) Accessible targets to ensure significant improvement across the system; b.) Referral to Treat (RTT) target had been met this month but ensure the target is met during the winter period.
It was agreed that the concerns above would be tabled at subsequent HL meetings for discussion.
The Chief Executive sought assurance that stranded patients was on the dashboard.
Mrs Whelan Tracy, NED queried if the dashboard was the full dashboard. The Director of Operations confirmed that it was the full dashboard and the purple dots in the report indicated the short version that was reviewed at the Board of Directors meeting.
Resolved – that (A) the Extended Performance Dashboard be received and noted, and (B) the Director of Operations ensure that a column would be added HL to the glossary of the Extended Performance Dashboard to identify which oversight committee reviewed and provided assurance to each of the metrics reported, and (C) the Director of Operations table discussions on accessible HL targets and the RTT target at subsequent meetings.
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MINUTE ACTION 18.012 FINANCE REPORT
The Director of Finance presented the Finance Report and highlighted the Trust’s bottom line Month 2 position which was a £200k deficit.
She explained that the reason for the deficit was due to slippage and not enough CIPs converting into cash savings. Due to a number of triangulation issues, the month 2 position was re-submitted. CIPs had been phased so they are at the back end to maximise Sustainability and Transformation Funding money. 2018/19 was likely to prove to be a difficult year. Discussion took place on what could and could not be re-submitted. Discussion took place on the clarity of the A&E money. The Chief Executive GB highlighted that the A&E target would be challenged and would report back to the Committee as appropriate. The Committee Chair confirmed that the Trust did not achieve its 95% target for Quarter 1. Mrs Hyde, NED commented that June 2018 was critical for Finance. The Committee Chair queried in terms of extra costs if it was volume related or higher operating costs. The Director of Finance confirmed that it was a mixture of both as Stratford was increasing its cost base. Mrs Hyde, NED asked how work was going to be done with the Divisions. The Director of Finance explained that Quarterly Divisional meetings were already scheduled in the diary to address concerns. The Director of Operations added that another level of scrutiny had been added to Management Board as ADOs sit with their Clinical Directors and is the right forum for debate.
The Director of Finance commented that the Trust had achieved a score of two and the re-phasing of the plan would change that. The Chief Executive concurred that with re-profiling it could change to a one.
The Committee Chair queried the extra 1% staff and if it had an impact on the profit and loss and costs. The Director of Finance commented that it was still within the pay budget.
Discussion took place on what report was required for next month. The preference was to review the report going to Board but still with Divisional headlines. Mrs Whelan Tracy, NED confirmed that a narrative would be provided to identify trends but there would be an appendix to the report to on the Divisions.
Resolved – that the Finance Report be received and noted and the Chief Executive report back to the Committee on the challenge raised GB in relation to the A&E target.
18.013 TRUSTWIDE AGENCY PERFORMANCE REPORT
The Director of Finance presented the Trust wide Agency Performance Report and highlighted that it had been reviewed at the Temporary Workforce Group and that the agency ceiling had reduced to £6m.
The Director of Finance queried if the report was too much detail for this Committee. Page 5 of 9 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Open Minutes of the Finance and Performance Committee Meeting Held on Thursday 21 June 2018
MINUTE ACTION
The Committee Chair commented that the information provided in the report was a subset to Finance and that it did not have to be debated at every meeting but to be brought back by exception if required.
Resolved – that the Trust wide Agency Performance Report be received and noted.
18.014 CANCER
The ADOs for the Elective Division and Support Services Division provided a presentation on Cancer Delivery at the Trust.
It was reported that clear evidence of good work was being undertaken and an improvement in performance was noted. It was also noted that demand for services continues to rise in line with a higher profile for cancer, leading to higher referral rates but no comparable increase in the numbers of cancers detected.
The Trust had challenges around recruitment, Haematology, Radiology capacity and issues with the upgrade of the Ultra system for Pathology. There had been a drop in performance in Pathology over the last few months. The system was controlled by University Hospitals, Coventry and Warwickshire NHS Trust (UHCW) and the Chief Executive raised it with the Chief Executive, UHCW as a serious concern. Work was in hand to address the IT bridge between Ultra and local operation systems but no workable solution was currently available. The Chief Executive would report back to GB the Committee on progress made with UHCW and the Ultra issue.
Resolved – that the position be noted and the Chief Executive report back to the Committee on progress made with UHCW and the Ultra GB issue.
18.015 DIAGNOSTICS
The ADO - Emergency Division provided a presentation on Diagnostics.
It was noted that Radiology had to address skill shortages, due to Consultant retirement over the past 12 months. Work had been undertaken to increase capacity by 14.9% but demand still exceeded current capacity. Trust biopsy demand had at least doubled due to a new consultant employed by the Trust and waiting list initiatives increasing demand. It was highlighted that normal practice was to move staff around to ensure cover for obstetric lists which had reduced further the capacity for non-obstetric scans. Sleep Studies was due to be decommissioned in May 2018 but Oxford had informed the Trust that there was no capacity to undertake this work and also the SWCCG had requested a review.
Resolved – that the position be noted.
18.016 COST IMPROVEMENT PROGRAMME (CIP) SCHEMES Page 6 of 9 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Open Minutes of the Finance and Performance Committee Meeting Held on Thursday 21 June 2018
MINUTE ACTION
The Director of Finance presented the Divisional CIP schemes. £6.5m of schemes were identified against a £9.2m target. There was a real drive to get CIPs for cash releasing reductions. The Committee Chair confirmed that this was a subset of Finance and that the need to dig deeper would be for assurance purposes, if targets were not being met. NEDs sought assurance that there would be more visibility on activities. The Director of Finance commented that Programme Delivery Board provided a lot of visibility and the two could be mapped together.
Resolved – that the Cost Improvement Programme (CIP) Schemes were received and noted.
18.017 CARTER / SERVICE LINE REPORTING (SLR) OVERVIEW
The Director of Finance reviewed the productivity and efficiency on key performance indicators.
Of particular note during discussion was the following:
a.) The Committee Chair queried if the Trust’s income included the Sustainability Transformation fund money. The Director of Finance confirmed that it was trading income; b.) The Committee Chair commented that it was a positive trend apart from Month 1 but did not show the level of volume. It was agreed that KL the Director of Finance would address the volume issue; c.) Mrs Hyde, NED queried the non-consultant led figure, as it appeared to cost more than the income generated. The Director of Finance commented that she would review the figure, and KL d.) The Chief Executive queried weight related activities. The Director of Finance would look into the information as it was not to hand.
Resolved – that
(A) the Carter / SLR Overview report be received and noted, and KL (B) the Director of Finance address the volume issue and look into the information on weight related activities.
18.018 GETTING IT RIGHT FIRST TIME (GiRFT)
The Director of Operations explained that GiRFT was a programme for all specialities which outlined specialty benchmarking across the country for best practice.
Resolved – that the position be noted.
18.019 GiRFT OBS AND GYNAE ACTION PLAN
The Associate Director of Operations – Women and Children’s Division presented the GiRFT Obs and Gynae Action Plan and highlighted her only concern was that of Gynae / Urology as it may require some support.
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MINUTE ACTION
The Committee Chair queried the issue on degree of harm – percentage severe or death is 1.42% compared to England’s average of 0.42%. It was answered that this audit had used 2015 data and significant improvements had been made in Obstetrics and that the service had moved on considerably since then.
Resolved – that the position be noted.
18.020 ANY OTHER BUSINESS
18.020.01 Gosport War Memorial Hospital
The Committee Chair queried if the issues at Gosport War Memorial Hospital could happen in other Trusts and how it could be flagged.
The Chief Executive explained that many Trusts had done a lot of work on mortality data and that a good level of governance was in place. There was good clinical leadership and transparency of data and outcomes.
Resolved – that the position be noted.
18.021 WHAT WORKED WELL, WHAT DID NOT AND WHAT CAN WE DO BETTER FOR THE OPEN MEETING
The Committee Chair asked the Governor Observer for any observations of the meeting. The Governor Observer commented that he realised that it was the first Finance and Performance Committee meeting and that there was still some work on what reports should be discussed at this meeting. He highlighted a level of concern for the depth of financial analysis required and that the Cancer Review was worthwhile and a reassuring picture.
The Director of Operations commented that it was valuable to learn what should come to this meeting and that time would be given back to Divisions to focus on innovation.
Mrs Hyde, NED sought assurance that key items would not get missed if Divisions were brought back by exception and queried the quarterly items. It was confirmed that the Director of Finance and Director of Operations would work together on identifying the exception items.
The Committee Chair commented that he was aware that more time could have been given to CIPs and the Trust wide Agency Report.
The Chief Executive commented that it would take some time for the Committee to find its feet but reinforced the exception reporting by Divisions.
Resolved – that the position be noted.
18.022 APOLOGIES OF ABSENCE – CLOSED MEETING Page 8 of 9 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST Open Minutes of the Finance and Performance Committee Meeting Held on Thursday 21 June 2018
MINUTE ACTION
18.023 DECLARATIONS OF INTEREST – CLOSED MEETING
18.024 MINUTES OF THE BUSINESS PERFORMANCE AND INVESTMENT COMMITTEE MEETING HELD ON 19 APRIL 2018 – CLOSED MEETING
18.025 BUSINESS PERFORMANCE AND INVESTEMENT COMMITTEE - MATTERS ARISING AND ACTION UPDATE REPORT – CLOSED MEETING
18.026 ELECTRONIC PRESCRIBING AND MEDICINES ADMINISTRATION (EPMA) BUSINESS CASE
18.027 ANY OTHER CONFIDENTIAL BUSINESS
18.028 WHAT WORKED WELL, WHAT DID NOT AND WHAT CAN WE DO BETTER FOR THE CLOSED MEETING
18.029 DATE AND TIME OF NEXT MEETING
The next meeting to be held on Thursday 19 July 2018 at 8.30-11.30am, Room TBC.
Signed ______(Committee Chair) Date 19 July 2018 Simon Page
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