COUNCIL OF GOVERNORS
Thursday 8 September 2016 09:00 – 13:15 Marsh Jackson Lecture Theatre, Academy, Level 4, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, Somerset, BA20 2EN
AGENDA
Item Presenter Time Enclosure
1 Welcome and Apologies for Absence Paul von der Heyde 09:00 Verbal
2 Declarations of Interest Relating Paul von der Heyde Verbal to Items on the Agenda
3 To Approve the Minutes of 9 June 2016 and to Discuss Paul von der Heyde Appendix 1 any Actions/Matters Arising
4 To Receive the Annual Report, Quality Report and Jade Renville 09:05 Accounts 2015/16 and the External Audit Opinion Copies can be obtained under “publications” at: http://www.yeovilhospital.co.uk/about-us/corporate- information/
5 Executive Report (Inc. TrakCare, Car Park, CQC Paul Mears 09:15 Tabled Feedback, La Manga, an update on plans for systemised Shelagh Meldrum surgery with DayCase UK) Kelvin Donald
6 To Receive the Governor Quality and Operational Paul Mears 10:15 Appendix 2 Performance Dashboard and to Receive an Update on Sheena Morrow Financial Performance
Tea / Coffee Break – 10:45
7 To Receive a Presentation on the Estates Masterplan Jonathan Higman 11:00 Presentation
8 Board Assurance Committee Updates*: Governor Observers 11:30 Verbal • Governance Committee Sue Bulley • Audit Committee John Park and Alison Whitman • Workforce Committee Sue Bulley and Yvonne Thorne • Finance Committee John Park • Quality Committee Sue Bulley and John Webster
9 Patient Experience Group Update Paul von der Heyde 11:40 Verbal Judith Lindsay-Clark Yvonne Thorne
10 Governor Committees and Working Groups**: 11:50 • Membership and Communications Hala Hall Appendix 3 • Strategy and Performance Alison Whitman
11 Any Other Business All 12:00 Verbal
12 Date and Time of Future Meetings: All Verbal
• Tuesday 06 December 2016 – Abbey Manor Business Centre, The Abbey, Preston Road, Yeovil, 09:00-15:00
13 Exclusion of the Public To RESOLVE that representatives of the press and other members of the public be excluded from the remainder of the meeting due to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.
14 To Approve the Contract Award for the Procurement of Jade Renville 12:05 Appendix 4 External Audit Services Chris England Alison Whitman
15 Review of Meeting by Governors An opportunity for governors to consider the matters presented in the meeting in the absence of the officers of the Trust, and to confirm that the governors have received sufficient information to enable them to discharge their statutory duties.
Lunch 12:30 – 13:15
*If present at the meeting, the non-executive directors (NEDs) will also be invited to add any points from the assurance committees they chair.
**To ensure timeliness of oversight, the Council will receive draft copies of working group minutes. They will be approved at the subsequent working group meeting.
The Public Engagement Event and Annual General Meeting will take place following the Council of Governors meeting at the Manor Hotel, 26 Henford, Yeovil, BA20 1TG 14:30 – 17:30.
APPENDIX 1 COUNCIL OF GOVERNORS
COUNCIL OF GOVERNORS DRAFT Minutes of the Council of Governors meeting held on 9 June 2016 Mandeville Room, Abbey Manor Business Centre, Preston Road, Yeovil, Somerset, BA20 2EN
Present: Paul von der Heyde Chairman Tony Robinson Public Governor Sue Bulley Public Governor Phillip Tyrrell Public Governor Alison Whitman Public Governor Jeremy Hughes Public Governor John Park Public Governor Sue Brown Public Governor Mary Belcher Public Governor Hala Hall Public Governor John Webster Public Governor John Hawkins Public Governor Judith Lindsay-Clark Staff Governor Paul Porter Staff Governor Yvonne Thorne Staff Governor Fiona Rooke Staff Governor Peter Shorland Appointed Governor David Recardo Appointed Governor
In Attendance: Paul Mears Chief Executive Maurice Dunster Non-Executive Director Jane Henderson Non-Executive Director Jade Renville Company Secretary Ben Edgar-Attwell Assistant Company Secretary Jonathan Higman Director of Strategic Developments [item 20] Sheena Morrow Associate Director of Finance [item 21] Jo Howarth Associate Director Patient Safety & Quality [item 22] Bernice Cooke Head of Governance & Assurance [item 22] Mark Appleby Head of Workforce Performance [item 23]
Apologies: Michael Fernando Staff Governor John Tricker Public Governor Monica Denny Public Governor Helen Ryan Director of Nursing and Clinical Governance Rob Childs Appointed Governor Lou Evans Appointed Governor Jane Lock Appointed Governor
Action 15/16 WELCOME AND APOLOGIES Paul von der Heyde welcomed the governors, Non-Executive Directors and those in attendance to the meeting. Apologies were noted as listed above.
16/16 GOVERNOR ELECTION RESULTS AND INTRODUCTIONS FROM NEW GOVERNORS Governor Elections took place in May 2016 for three new Public Governors and two Staff Governors. Paul von der Heyde expressed a warm welcome to the newly elected Governors, Tony Robinson, Mary Belcher, Jeremy Hughes, Fiona Rooke and the newly Appointed Governor Peter Shorland, followed by a brief introduction from each new Governor.
17/16 DECLARATIONS OF INTEREST Paul von der Heyde stated his declarations noted in the previous Council meeting on 3 March still applied [item 2/16]. There were no other declarations of interest.
18/16 MINUTES OF THE PREVIOUS MEETING AND MATTERS ARISING Mary Belcher queried whether item 4/16 should state 2016 and not 2015. Jade Renville confirmed that this was an error and would be corrected. JR
Subject to the above correction, the minutes of the meeting held on 3 March 2016 were approved as a true and accurate record.
John Park raised the issue of card payments in the hospital car parks. Paul Mears PM provided an explanation on the situation and he would also seek a further update on the progress of resolving the issue. John Park said it would be a good idea to have a sign stating that card payments are out of order.
19/16 TO RECEIVE THE EXECUTIVE REPORT The Council of Governors noted the content of the executive report presented by Paul Mears (which included updates on the implementation of TrakCare, medical recruitment, the development of the multi-storey car park, CQC inspection and the junior doctor strike). There was particular discussion of the following:
-John Webster asked whether previous medical notes would be migrated to TrakCare. Paul Mears provided an explanation of the decision not to scan all documents into the new system, but that going forward all new documents will be included on TrakCare.
-John Park queried if there were any specialty initiatives in regards to catch up of elective operations after the junior doctor strikes. Paul Mears said that the catch up after the strikes was being built into general day to day work and also confirmed that evening clinics were still continuing as before.
-Paul Mears provided an overview of Symphony Healthcare Services (SHS). SHS was created as a subsidiary of Yeovil Hospital and had taken on the management of three local GP practices; with another seven practices due to join within the next few months. All practices will continue with their own identities, but there is now one overall back office support for integrated practices, which includes responsibility for GP recruitment. Recruitment is proving a challenge which is currently an issue nationwide. Paul von der Heyde noted that this new model is working well and the Trust’s influence on the walk in centre in Boots, Yeovil may help reduce demand on A&E services.
20/16 OUTCOMES BASED COMMISSIONING (SOMERSET TOGETHER), VANGUARD, SYMPHONY AND THE STP
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Jonathan Higman presented to the Council an overview of the various plans in development and how these link together, the key elements of which were discussed as follows:
Somerset Together: Somerset Together aims to pool the health sector funding and long term contracts and move to an outcomes-based commissioning approach.
Symphony Vanguard: Symphony Health Care Services manages those GP practices which have been integrated and the Symphony hub delivers Complex Care. Enhanced Primary Care is currently being implemented and positively received by practices and the Symphony Hub is currently serving around 200 patients which has reduced attendances at the hospital by around 30%.
Yvonne Thorne queried whether there was any reason for not scaling up the hub to take on more patients. Jonathan Higman spoke about the differing perceptions of the GP’s; many see it as a loss of input into the care of their patients, but the service has positive feedback from patients.
Hala Hall asked whether there was any incentive for GPs to keep their patients rather than Symphony Hub taking over their care. Paul Mears confirmed that the surgeries will keep the patients in their systems and therefore will be no loss of income.
Hospital Transformation: Yeovil Hospital currently has a number of different plans under development to change the way in which services are provided. The additional rehabilitation beds commissioned by YDH from Cookson Court are working well and discussions are now taking place to see whether this could be developed further, such as home care provision.
Discussions are underway to develop a Health and Care College to enable the training and recruitment of nurses locally. This will reduce the need for trainees to travel to Bournemouth or Plymouth and will ensure a continuous pool of nurses for workforce planning purposes.
The Estates Masterplan outlines the Trust’s plan over the next 15 years. The enabler for this is the new car park currently under development which will free up space on site for further development.
Mary Belcher queried whether there was the possibility of increasing the number of Cookson Court beds. Jonathan Higman suggested that 24 beds were adequate should this be supplemented with more home care.
Sue Brown raised the issue of delayed transfers of care and the Trust’s contract with the Red Cross to help address some of the challenges.
Sustainability and Transformation Plan: The Sustainability and Transformation Plan (STP) is currently under development to illustrate how local services will evolve and become sustainable over the next five years. The Somerset STP has its own footprint, whereas other plans have a far wider area; the original footprint included Bristol but this was renegotiated at the very early stages.
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Despite this, there is still the need to be aware of other plans surrounding Somerset, especially Dorset considering Trust’s location and shared services. Future funding is likely to be based on this plan so there is strong need to ensure that it is robust and credible; the timeline for the STP has recently been extended to provide time to ensure this.
David Recardo queried whether this consolidation would not merely move the problem and create a bigger deficit shared across the STP. He also asked whether it would be case where those with the ‘loudest voice’ would get a larger share of the budget. Paul von der Heyde outlined that this was a rare opportunity for South Somerset, in which we are ahead of other similar plans. Due to the current situation, if things are to continue in their present form, the county deficit will be circa £200 million within the next 5 years; there is a strong need to do something radical. Continuing to provide a full cohort of services at smaller Trusts may prove challenging and it may give rise to a requirement to assess the way in which existing services at Yeovil Hospital are provided and consider how these are to be sustainable in the future.
Peter Shorland noted that plotting this new system using a general map overview will not provide good services for patients. It may appear that we are close to neighbouring Trusts, but in reality these are not necessarily easily accessible for patients.
Jeremy Hughes queried the two different plans for Somerset and Dorset and how this will affect patients who live on the borders. Paul Mears confirmed that there are continued discussions between the relevant CCGs.
21/15 UPDATE ON FINANCIAL PERFORMANCE AND OPERATIONAL PERFORMANCE DASHBOARD
Financial Performance: Sheena Morrow presented the financial year end 2015/16 position which was £0.2 million favourable to plan. The presentation provided an overview of the key variances to the budget. There were a number of areas with an overspend which was mitigated by underspend in other areas; this included Other Non-Pay & Pay, Cookson Court, rental of Nursing accommodation and independent providers utilised to achieve RTT Trajectories. Total expenditure was in line with the budget.
Following discussions regarding the cash position and interim Department of Health loans, Mary Belcher questioned the payment of interest on the loan. Paul von der Heyde confirmed that interest would only be paid when the Trust is in surplus.
Discussions also took place regarding NHS Improvement’s plans and control totals. The control total that was placed on the Trust for this financial year would not have been achievable, therefore the Trust took the decision not to agree on this total; Musgrove Park Hospital also did not agree to their control total. As a consequence, it means that the Trust will not have access to the additional 4.5million funding which would have been paid in quarterly payments on achievement of the plan.
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Paul Mears informed the Council that the Trust’s Charity had received a legacy of £2.5million from a patient along with other legacies totalling nearly £800k. Discussions will take place where these legacies will be spent for the benefit of patient care.
Operational Performance: Paul Mears highlighted key areas from the governor information dashboard where it was noted that: • The Trust has not had a case of MRSA case for over 12 months. • Percentage of patients who would recommend the Trust is high; however there have been challenges in the response rate due to some teething issues when moving to a new streamlined system to capture the data. • Elective operations have had to be cancelled due to acute care pressures, although this has improved within the last month. • There is ongoing work to include the annual appraisal rate. • Referral to Treatment Ongoing Pathways performance has improved with an achievement of 91.7% against the 92% target. • A&E performance was not achieved during the winter period, however this has improved in recent weeks with the Trust ranking 8th in the country for A&E 4 Hour waits. March had seen a 13.1% increase in emergency admissions.
Tony Robinson asked whether A&E attendances are analysed, Paul Mears confirmed that A&E data is analysed and discussions are taking place how we can continue to manage the demand, especially with minor attendances which links in with discussions regarding the STP.
Jeremy Hughes queried whether South Western Ambulance Service NHS Foundation Trust was treating a large number of patients in situ. Yvonne Thorne confirmed that this was happening and the Trust only receives a small number of patients compared to the number of ambulance call outs.
John Park asked about the monthly RTT fines; Paul Mears confirmed that it was a significant amount but did not have the exact figure to hand. Paul von der Heyde confirmed that the fines are reinvested within the NHS system. PM
Jeremy Hughes asked whether benchmarking against other Trusts took place with regards to our measured performance metrics. Paul Mears agreed to pick this up.
22/16 QUALITY AND SAFETY UPDATE (INC. QUALITY STRATEGY AND GOVERNOR INDICATOR
Quality and Safety: Jo Howarth presented to the Council the Quality Improvement Strategy. This is a piece of work that has been developed over a number of months to identify the Trust’s intended actions in the coming years. The Strategy provides 7 key aims including: − No preventable deaths − Deliver continuous reduction in avoidable harm − Achieve high standards of clinical care in line with best practice − Deliver a reduction in MRSA and C.Diff − Deliver integrated and innovative models of care which support and improve health, wellbeing and independent living − Deliver the implementation of electronic health records and use of IT
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systems to enhance care deliver for patients and staff − Working partnerships with patients, carers and their families to deliver what matters most and meets their needs.
Discussions took place regarding HSMR and the change over from the DrFoster system to CRAB. This change should provide more real-time data rather than monitoring several months previously.
Governor Indicator: The Council was updated on the requirement for a new Governor Indicator for this financial year. There is a lack of ability to be able to audit the previous indicator (experience of discharge).
Jade Renville explained to the Council that they have the ability to choose from a range of measures, as long as they are measureable and auditable. Concerns arose where it might create more work for members of staff. Suggestions were discussed including: hospital moves at night, complaints/compliments, diabetics and food. It was agreed that Jade Renville would email the Governors asking for suggestions for the Indicator and that these would be reviewed for suitability of JR data capture and discussed/agreed by email.
23/16 STAFF SURVEY FEEDBACK Mark Appleby attended the meeting to provide an overview of the feedback from the 2015 Staff Survey; this included where the Trust performed well and where improvements could be made. It was noted that the results from the survey were positive which is in keeping with the general trend from previous years after a change in the way staff were managed.
Tony Robinson asked whether the survey included agency staff; Mark Appleby confirmed that it did not include agency staff.
Discussions took place regarding the percentage of staff that experience physical violence with Paul Porter asking where this was attributed. Mark Appleby confirmed that this was mainly within A&E and by patients with dementia. Paul Mears noted that security would be called in these situations along with the police and that training to help start sensitively support patients with dementia is ongoing to avoid the situation occurring.
Sue Bulley asked what work was being undertaken to ensure that members of staff are reporting errors, near misses etc. Paul Mears explained that everyone is responsible for ensuring that these are reported. The culture of reporting incidents had improved but more could be done. Fiona Rooke spoke about the issue that some members of staff are not aware they are able to report these incidents/near misses. Yvonne Thorne also noted that that feedback is not always provided to the person reporting the incident; there is a need to solve this as feedback and action plans are paramount to encouraging continued reporting.
Hala Hall noted that although that 19% of staff stated they had experienced harassment, bullying etc within the workplace there did not appear to be a corresponding number of formal complaints. Mark Appleby explained that some questions do not provide a definition and that is it open to interpretation by the person answering as to what they may consider harassment.
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Paul Porter asked whether there was the possibility to provide feedback regarding the survey; Mark Appleby confirmed that the Trust provides feedback to Capita each year, but progress in changes is slow.
24/16 REPORTS FROM ASSURANCE COMMITTEES AND GOVERNOR GROUPS
Governance Committee: Sue Bulley provided a verbal update of the latest Governance meeting advising in particular of the following topics that were discussed and presented: the national maternity review which would allow expectant mothers to be allocated a personal budget and security on the maternity unit. Yvonne Thorne confirmed that there were plans in place to review the maternity unit security. Jane Henderson also updated that discussions took place whether the Trust wishes to become a pioneer on maternity services; the CCG would need to agree to this before it could commence.
Audit: John Park provided a verbal update of the meeting held on the 18 April 2016, commenting in particular on the discussions to consolidate 400 policies in the same manner as the HR policy. The BDO Annual Report was also presented in the meeting where the Auditors had moderate assurance, which is the second highest rating.
Alison Whitman provided a verbal update of the meeting on the 23 May 2016. This was a technical meeting for the year end. The external auditors presented their opinion and the Annual Accounts and Charity Accounts were discussed. The Quality Report was also reviewed.
Paul von der Heyde noted that the external auditors were very positive regarding Yeovil Hospital.
Workforce: Sue Bulley provided a verbal update on the recent meetings which take place on a monthly basis to review staff and workforce plans. She noted that agency spend is a major financial issue this year, with a large variance in agency costs. As such, there is now a preferred list of agencies in place. There is a requirement for further training on E-Rostering with some issues regarding bank holidays/school holidays. There is a high turnover of certain groups of staff such as HCAs for which changes are already in progress i.e. weekly pay and bank pay increases. Yvonne Thorne noted that there was lots of focus on continued development of internal staff.
Maurice Dunster noted that the Workforce Committee was an ‘innovation’ and that lots of progress had been made in a short space of time.
Patient Experience Group: Fiona Rooke provided a verbal update on the latest meetings of the Patient Experience Group which included discussions on the following points: National standards on complaints and comparison to these. There is a need to be cautious and structured with regards to responses.
Following questions about Governors involvement in patient experience work, the PvdH Chairman agreed to give this further thought and report back to the Council in September.
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Appointments Committee: Paul von der Heyde provided a verbal update of the meeting on 19 May 2016 where it was noted that Jane Henderson had completed her first term and the Committee recommended that we would appoint her for a second term. The Council of Governors agreed this reappointment. Paul von der Heyde also asked for agreement from the Council regarding a 1% pay increase for the Non- Executive Directors in line with the 1% increase for Agenda for Change staff members. The Council supported this.
Membership and Communications Group: Hala Hall provided a verbal update to the group explaining that the reduction in the membership numbers was due to a data cleansing exercise. Discussions had also taken place regarding using the Friends and Family test to encourage membership sign up.
Jade Renville noted that we may be asking for some Governors to attend future events.
Strategy and Performance Working Group: The minutes of the previous meeting were noted by the Council.
25/16 ANY OTHER BUSINESS
Mary Belcher queried how new Governors join the various Groups and Committees. Jade Renville confirmed that the membership lists are to be reviewed and for Governors to contact Ben Edgar-Attwell with their preferred groups. It would also provide an opportunity for existing Governors to change groups should they wish.
Mary Belcher raised the issue of hospital security, especially on the wards. She suggested that there be automatic locks on the wards that would only be accessible during visiting hours. Paul Mears noted that there were discussions currently in place on making the visiting hours more flexible but that this was something that would be reviewed.
Somerset CCG Board Meeting: Alison Whitman provided a verbal update on attendance at the Somerset CCG Board Meeting. She noted that there had been a recent change in the Board Chair due to the previous Chair now working on the Sustainability and Transformation Plan. Alison noted it was a formal meeting with the requirement to submit questions in writing prior to the meeting.
26/16 EXCLUSION OF THE PUBLIC The Council resolved to exclude the public and others for the remainder of the meeting.
27/16 DATE OF NEXT MEETING The next meeting will be held on Thursday 08 September 2016.
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TABLED COUNCIL OF GOVERNORS 8 SEPTEMBER 2016
Report to: Council of Governors
Subject: Report from the Chief Executive
Date: 8 September 2016
CQC Inspection Update
Following the CQC inspection in March 2016, and the resulting rating of “requires improvement”, we have worked with the CQC to develop an action plan made up of a number of “must-dos” as well as some “should-dos”. A copy of the action plan for the “must- dos” will be tabled at the Council of Governors and Jo Howarth, Associate Director of Patient Safety and Quality, will be in attendance to answer any questions. All the actions within the report are either on track or have been completed.
Car Park Update
During July, the main activity on site was erecting the steel frame and (pre cast) concrete car park decking, starting at the west end of the site, which should be completed by the end of the month. Work was also progressed on the second lift and stair cores on site.
During September, we are pouring the structural topping on levels 1, 2 and 3. Drainage and ground works beneath the steel frame will continue, with ground floor slabs poured this week. We will mostly be occupying the previously suspended parking bays to accommodate for the change in deliveries from steel to ready-mix concrete. There are more lorry movements scheduled, but very few of these will be articulated lorries.
On the link road, the new medical gases compound was installed and commissioned which saw the old one demolished. The A37 drainage works has completed with traffic now flowing normally. Exploratory works have started on the Higher Kingston side.
TrakCare Update
A considerable amount of hard work and dedication across the organisation and the TrakCare project team paved the way during the weekend of the 11th June for a smooth transition to our new TrakCare system. The Go Live weekend was a particular success and has attracted recent media coverage. There were a few key areas which required further support adjusting to the changes brought in with the new system which were handled as a matter of priority. We hosted a TrakCare networking and open day on the 22nd August, where colleagues from the NHS and Nuffield Health joined us to hear our experiences and models that were used for Data Migration and Cutover in particular, in addition the group heard from Dr Matt Sephton, consultant in Medical Oncologist and Mandy Carney, Head of Patient Flow on their initial experience and advice to new deployments. Moving on from this, a virtual forum “JIVE” is being set up to continue the networking and develop a TrakCare user group.
The next stage of the TrakCare journey will be the safe transition into Phase 2 which brings electronic prescribing, clinical noting and enhanced clinical functionality.
La Manga
As many of you will be aware YDH has launched a new partnership with renowned health and wellbeing destination La Manga Club Resort in Murcia, South West Spain.
This partnership means that we are able to offer our staff an exclusive 10 to 15 per cent discount on holidays and activities at the La Manga Club Resort, including unlimited access to the impressive spa facilities the resort offers. As well as benefiting our team here at Yeovil, we are also going to be promoting the resort to our patients, and offering a 10 per cent discount on the cost of a stay.
This partnership has caused some mixed feedback both amongst the staff group and also locally where it has gathered the attention of the local press.
To date there have been 90 unique page views since we set up the web page but as yet no one has taken up the offer.
Director of Nursing
As we have previously communicated, Helen Ryan, our Director of Nursing, is intending to retire from her post, and the NHS, at the end of May next year. Helen has worked at YDH for 24 years and has enjoyed a long and successful 39-year nursing career, culminating in her most recent role as Director of Nursing. Clearly, her retirement will be a huge loss to us at YDH and the wider NHS, but Helen feels that the time is now right for her to retire and spend time pursuing other interests outside the hospital. We will begin a process for recruiting Helen’s successor this month to ensure that we have a smooth transition to a new Director of Nursing next year and, of course, we will be planning a fitting celebration to mark Helen’s retirement in 2017.
The systematised surgery model delivers a range of quality and efficiency benefits
Quality & clinical Patient experience Efficiency Personnel experience outcomes
• Proven superior clinical • More comfortable & • High efficiency model means • Working in an efficient unit outcomes across a range of accessible lower costs per procedure designed around their metrics, e.g. workflow • Tight processes with shorter • High quality means lower – Adenoma detection rates waiting times overall costs • Specialised teams provide – Colonoscopic perforation – Fewer complications and better support rate • Highly trained personnel hospitalisations • Evidence-based guidelines, – Rate of posterior capsule provide an excellent – Fewer repeat operations specialisation and high tear and / or vitreous loss experience – High correct diagnosis rate volume leads to superior – Rate of endophthalmitis • Superior outcomes avoiding unnecessary clinical outcomes • Defined protocols and diagnostics or treatment AmSurg patient centre ratings AmSurg clinician centre ratings pathways with compliance – Early diagnosis leading to monitoring 100% 4% lower intensity treatment 100% 0 or 6 out of 10 0 or 6 out of 10 7% 7 or 8 out of 10 • High integration with other • Transparency & superior 7 or 8 out of 10 parts of the healthcare performance on quality 9 or 10 out of 10 50% 95% 9 or 10 out of 10 50% system to ensure top quality 90% downstream treatment • Higher patient satisfaction 0% 0%
AMBULATORY SURGERY INTERNATIONAL 0 AmSurg is the largest provider in the US and has refined its top class day case surgery model over the past 25 years
Summary Centre network
257 1.7million centres in operation surgical procedures
billion $1.6 $450 million revenues EBITDA • Largest operator of freestanding day surgery centres in the World • Co-founded in by ASI’s David Manning
20% $4.0billion • 3,000 physician partners and utilisers at 250+ centres 5-year annual revenue growth rate market cap. in >30 states – ~150 gastrointestinal endoscopy – ~50 multiple specialty – ~40 ophthalmology 7% 99% – ~9 orthopaedic 5-year annual procedure growth Physician facility satisfaction rate • Operates the largest eye surgery centre network in the US
AMBULATORY SURGERY INTERNATIONAL 1 ASI and Yeovil are well suited partners with complementary strengths
1. Well known NHS innovator, adopting 1. World class day surgery expertise and new models of care operating model 2. Experience building successful 2. Agile, flexible partnership approach partnerships emphasising cooperation 3. Major development plans with capable 3. Long track record designing and estates partner delivering new surgery centres 4. ~10k procedures which could be 4. Significant expansion ambitions in the carried out in a standalone unit UK and internationally
AMBULATORY SURGERY INTERNATIONAL 2 YDH │Council of Governors
Governor Quality & Operational Performance Dashboard
Meeting – September 2016
1 Contents Dashboard - Outcome, Safety & Workforce Indicators Dashboard - Early Warning Indicators Mortality Rates Patient Falls and Pressure Ulcers Cancelled Operations First to Follow up Ratio RTT Pathways Diagnostic Waits ED Attendances Ambulance Handovers Cancer 2 Week Wait Cancer 31 and 62 Day Targets Admissions and Length of Stay Friends and Family Test Staff Turnover Sickness Absence Mandatory Training Appraisals Appendix I - Terms
2 2 Outcome, Safety & Workforce Indicators
Results Summary Trend Results Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16
Mortality Actual number of deaths 38 46 45 58 54 70 64 59 59 69 50 63 66
Finance & Monitor score I&E position distance from plan (£m) (YTD) -0.06 0.02 0.17 0.17 0.18 0.17 0.15 0.20 -0.17 0.06 0.02 0.02 -0.08 % of Cost Improvement Plans in place (YTD Achievement vs Plan) 94% 96% 96% 99% 99% 99% 99% 98% 99% 65% 95% 95% 97%
Patient Experience F&F Test - % Extremely Likely & Likely to Recommend 94.7% 93.7% 94.6% 94.7% 95.2% 91.8% 91.7% 90.8% 90.9% 93.3% 93.3% 93.0% 92.0% F&F Test - Response rate 15.8% 12.9% 16.2% 7.8% 11.9% 12.2% 13.9% 11.4% 16.5% 17.1% 17.4% 15.8% 16.0% IWantGreatCare (5 Star Score) n/a n/a n/a 4.61 4.70 4.60 4.64 4.64 4.63 5.63 6.63 7.63 8.63 Number of Complaints 21 8 13 6 13 10 15 14 13 18 5 14 12 Number of Compliments 62 45 76 65 61 62 44 71 57 64 57 40 36 Cancelled Ops - Breaches of <28day readmission 0.0% 0.0% 4.8% 12.5% 0.0% 0.0% 7.6% 13.3% 18.6% 10.3% 0.0% 4.2% 0.0% Cancelled Ops - Breaches <=5 cal day offer of new date 0.0% 37.5% 9.5% 12.5% 3.2% 0.0% 19.7% 7.0% 7.0% 10.3% 4.8% 0.0% 36.4%
Safety Total C difficile cases 2 0 2 0 2 2 0 3 0 0 0 1 0 C Difficile Cases due to Lapses in Care 1 0 0 0 0 0 1 1 0 0 0 1 0 MRSA 0 0 0 0 0 0 0 0 0 0 0 0 0 Patient falls 80 86 73 77 66 88 80 81 93 66 88 75 78 Pressure ulcers +2 9 10 11 13 10 11 6 8 7 5 11 8 12
Workforce Sickness Absence (avg) % 3.2% 2.8% 2.9% 2.9% 2.7% 3.1% 3.8% 3.3% 3.2% 3.3% 2.5% 2.7% Annual Appraisal (avg) % 76.7% 76.7% 77.0% 80.0% 79.6% 80.7% 82.7% 83.6% 85.2% 84.8% 83.5% 81.6% 80.9% Mandatory Training (avg) % 87.6% 88.0% 88.6% 89.0% 92.0% 91.7% 91.7% 91.4% 91.0% 91.2% 90.2% 92.4% 93.0% Staff Turnover (avg) % 15.2% 15.8% 15.5% 14.7% 15.2% 15.6% 15.6% 15.8% 15.6% 16.1% 15.9% 16.4% 17.3%
3 Early Warning Indicators
Results Summary Trend Results Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16
RTT 18wks RTT - Admitted Pathways 79.6% 79.7% 75.8% 77.1% 78.6% 79.4% 77.3% 77.7% 80.1% 80.6% 76.7% 50.0% 60.8% 18wks RTT - Non-admitted Pathways 93.0% 91.8% 92.7% 91.7% 92.3% 90.8% 89.4% 89.1% 89.4% 89.6% 92.3% 50.0% 77.5% 18wks RTT - Incomplete Pathways 89.3% 89.4% 88.9% 91.4% 90.8% 90.3% 91.6% 92.1% 91.5% 90.7% 91.3% 89.3% 89.3% 18wks RTT - Incomplete Non-Admitted Pathways 93.6% 93.6% 92.6% 94.7% 94.5% 94.4% 96.0% 96.8% 96.4% 95.6% 95.8% 93.6% 92.8% 18wks RTT - Incomplete Admitted Pathways 76.2% 76.2% 76.9% 81.4% 81.6% 79.7% 79.8% 79.7% 77.9% 76.5% 78.0% 78.1% 74.2%
Admissions / Waiting lists Total admissions (inc Emergency) 3,524 3,227 3,446 3,478 3,458 3,471 3,488 3,488 3,596 3,461 3,524 3,631 3,590 Total Elective admissions 1,810 1,586 1,756 1,802 1,822 1,622 1,723 1,729 1,728 1,726 1,762 1,820 1,710 Day Case admissions 1,489 1,339 1,507 1,487 1,493 1,339 1,452 1,465 1,496 1,467 1,450 1,450 1,435 Daycase Rate 82.3% 84.4% 85.8% 82.5% 81.9% 82.6% 84.3% 84.7% 86.6% 85.0% 82.3% 79.7% 83.9% Waiting List Size - Outpatients inc C2C. 3,725 3,712 3,701 3,621 3,800 3,332 3,481 3,491 3,890 4,241 4,312 tbc tbc Waiting List Size - Inpatients / Day case 2,153 2,149 2,168 2,211 2,172 2,300 2,245 2,245 2,281 2,341 2,262 tbc tbc
Efficiency 1st to follow up 1:2.2 1:2.2 1:2.2 1:2.2 1:2.3 1:2.2 1:2.2 1:2.2 1:2.3 1:2.3 1:2.2 1:2.4 1:2.3 Proportion of overnight discharges (10pm - 7am)* 19.6% 18.7% 16.5% 15.1% 16.0% 10.2% 13.6% Average length of stay 4.5 Days 4.3 Days 4.5 Days 4.8 Days 4.6 Days 4.8 Days 4.9 Days 5.3 Days 5.2 Days 4.9 Days 4.5 Days 4.5 Days 4.5 Days
A&E A&E attendances 3,820 3,828 3,804 4,028 3,840 4,003 3,838 3,675 4,207 3,813 4,156 3,992 4,172 A&E attendances - % inc / dec vs LY -6.0% -5.5% -5.3% -4.2% -3.5% -3.0% -2.1% -1.3% -0.5% -0.9% 5.1% 3.9% 5.2% A&E - % patients seen and discharged 4 hrs 97.6% 95.3% 95.4% 92.0% 91.9% 93.0% 90.5% 91.2% 88.1% 92.1% 92.7% 88.6% 91.0% Ambulance Handover < 30mins 99.8% 99.7% 99.7% 99.2% 99.2% 99.7% 99.3% 99.1% 98.2% 98.3% 98.5% 97.3% 99.5% Ambulance Handover fines £400 £800 £600 £2,200 £2,200 £800 £2,000 £2,200 £5,800 £4,400 £4,000 £6,800 £1,200
* New indicator
4 Mortality Rates Safe [1]
July 2016
Latest HSMR 12 July Number of Months to Nov 15 Deaths 98.7 66
Hospital Standardised Mortality Ratio (HSMR) Actual number of deaths 120 100
100 80 80 60 60 40 40 20 20
0 0 Jul-12 Jul-13 Jul-14 Jul-15 Jan-13 Jan-14 Jan-15 Sep-12 Sep-13 Sep-14 Sep-15 Feb-13 Feb-14 Feb-15 Feb-16 Nov-12 Nov-13 Nov-14 Nov-15 Mar-13 Mar-14 Mar-15 Aug-12 Aug-13 Aug-14 Aug-15 Nov-12 Nov-13 Nov-14 Nov-15 May-12 May-13 May-14 May-15 May-12 May-13 May-14 May-15 May-16
Monthly data 6 month moving average Monthly data 6 month moving average
RAG Status: Significantly better than national average, Within expected range, Significantly higher than national average. Please note: Due to the termination of the DrFoster Contract, HSMR data will no longer be available from Nov15 onwards.
5 Safe Patient Falls and Pressure Ulcers [2]
July 2016
Patient Falls Pressure Ulcers 78 12 (80 in July 15) (9 in July 15)
Patient falls Pressure ulcers +2 140 25 120 20 100 80 15 60 10 40 5 20 0 0 Jul-12 Jul-13 Jul-14 Jul-15 Jul-16 Jul-12 Jul-13 Jul-14 Jul-15 Jul-16 Jan-13 Jan-14 Jan-15 Jan-16 Jan-13 Jan-14 Jan-15 Jan-16 Sep-12 Sep-13 Sep-14 Sep-15 Sep-13 Sep-14 Sep-12 Sep-15 Nov-12 Nov-13 Nov-14 Nov-15 Nov-12 Nov-13 Nov-14 Nov-15 Mar-13 Mar-15 Mar-16 Mar-14 Mar-13 Mar-14 Mar-15 Mar-16 May-14 May-15 May-13 May-16 May-13 May-14 May-15 May-16
Monthly data 6 month moving average Monthly data 6 month moving average
6 Effective Cancelled Operations [1]
Hospital Non Clinical On the Day Cancellations of Elective Operations 2016 - 2017 YTD July 2016 Equipment Failure/Unavailable On the Day Non- Rebooked within 28 Clinical Reasons Requires Alternative Session/Specialty Day Target 11 11 Session Cancelled (19 – July 15) Administrative Reasons
No Beds Available Total Cancelled due to Lack of Beds Urgent Case took Priority 1 0 5 10 15 20 25 30 35
Hospital Non Clinical On the Day Cancellations of Elective Operations Additional Notes - June 16 The figure for Total Cancelled due to Lack of Beds includes cancellations with more than 1 day notice given. TCI / Appointment rescheduled - requires…
Insufficent session time / session overrun Note: For any elective operation cancelled by the trust on the Requires Alternative Session/Specialty day of the operation/admission, an offer of a new date must be made within 5 calendar days, and the newly offered date must Administrative Reasons be within 28 days of the cancelled operation date. No Beds Available
Urgent Case took Priority
0 0.5 1 1.5 2 2.5 3 3.5
RAG Status: <=15 Cancellations, 16-24 Cancellations, >=25 Cancellations
7 Effective First to Follow up Ratio [2] New:Follow Ratio 2.7 July 16 2.5 2.3 2.1 New to FU Ratio YTD Average 1.9 1 : 2.6 1 : 2.3 1.7 1.5 Jul-13 Jul-14 Jul-15 Jul-16 Jan-14 Jan-15 Jan-16 Sep-13 Sep-14 Sep-15 Nov-13 Nov-14 Nov-15 Mar-14 Mar-15 Mar-16 May-14 May-15 May-16
New:Follow Ratio 6 month moving average April 2016 - March 2017 1st to Follow Up Ratio by Speciality 3500 9 Additional Notes 3000 8 7 2500 6 NHS Better Care, Better Value 15/16 Q3 Ratio: 1 : 1.97 2000 5
1500 4 rate 3 attendances 1000 2 500 1 0 0
1st Follow Up Rate
8 Responsive RTT Incomplete Pathways [1]
July 16 RTT Incomplete Pathways with All Stops 11,000 10,000 9,000 Admitted Patients over Non-Admitted Patients 8,000 18 Weeks over 18 Weeks 7,000 6,000 486 498 5,000 4,000 3,000 2,000 1,000 Patients over 26 Patients over 52 0 Weeks Weeks Jul-13 Jul-14 Jul-15 Jul-16 Jan-13 Jan-14 Jan-16 Jan-15 Sep-12 Sep-13 Sep-14 Sep-15 Nov-12 Nov-13 Nov-14 Nov-15 Mar-13 Mar-14 Mar-15 Mar-16 281 0 May-13 May-14 May-15 May-16 RTT Incomplete Pathways RTT incomplete pathways > 18 weeks Number of Stops
RTT Incomplete pathways - Aging 600 500 Additional Notes 400 300 Patients that delay treatment through choice are 200 counted as an incomplete pathways until they 100 receive their treatment, or it is decided that they 0 don’t need treatment.
The completed pathway position for June is currently unavailable pending validation of >18 weeks >19 weeks >20 weeks >21 weeks >22 weeks >23 weeks >24 weeks >26 weeks >25 Weeks pathways with unknown start dates. Non Admitted Admitted
9 Responsive Diagnostic Waits [2]
Diagnostic 6 Week Waits % July 2016 100.0%
Overall Diagnostic 6 Imaging 6 Week 98.0% Week Waits % Waits % 99.1% 100% 96.0% (98.5% - Jul 15) (98.0% - Jul 15) 94.0%
92.0% Physiological Endoscopy 6 Week Measurement Waits % Waits % 90.0% 98.4% 96.0% (99.7% - Jul 15) (99.2% - Jul 15) Diagnostic 6 Week Waits % Target DM01 % - Trajectory
July 16 Diagnostic 6 Week Wait Breaches Additional Notes The Trust continues to achieve the National Target for Diagnostic Endoscopy Waits. Breaches
Physiological Measurement Breaches
0 10 20 30 40 50
10 Responsive ED Attendances [3]
Avg A&E Attendances per Day July 16 160 A&E Performance 140 90.98% 120 (97.62% July 15) 100 80 Average A&E Average Breaches 60 Attendances per day per Day 40 12.6 134.7 20 (123.2 – July 15) (2.9 – July 15) 0 Average Emergency Average Ambulance Jul-14 Jul-15 Jul-16 Jan-15 Jan-16 Jun-14 Jun-15 Jun-16 Oct-14 Oct-15 Apr-14 Apr-15 Apr-16 Sep-14 Feb-15 Sep-15 Feb-16 Dec-14 Dec-15 Aug-14 Aug-15 Nov-14 Nov-15 Mar-15 Mar-16 Admissions per day Arrivals per day May-14 May-15 May-16 41.3 43.8 Avg A&E attendances per day Avg ambulance arrivals per day (42.5 – July 15) (37.4 – July 15) Avg Emergency Admissions Per Day
A&E 4 hour performance - All Attendances 100% Additional Notes 98% 96% 94% A&E activity over the two month period June and July was up 92% by 5.4% vs last year (+416 attendances). 90% 88% YTD attendances (16133) vs last FY YTD (15330). 86% 84% 82% Average Emergency Admissions excludes Paediatrics and Maternity. Jun-12 Jun-13 Jun-14 Jun-15 Jun-16 Oct-12 Oct-13 Oct-14 Oct-15 Apr-12 Apr-13 Apr-14 Apr-15 Apr-16 Feb-13 Feb-14 Feb-15 Feb-16 Dec-12 Dec-13 Dec-14 Dec-15 Aug-12 Aug-13 Aug-14 Aug-15
Monthly data 6 month moving average
11 Responsive Ambulance Handovers [4]
30 Minute Handovers July 16 YTD Fines 99.5% £16,400 (99.8% July 15) (£19,000 in 15/16)
Ambulance Handovers Per Month 1,600 £18,000 1,400 £16,000 1,200 £14,000 £12,000 1,000 £10,000 800 £8,000 600 £6,000 400 £4,000 200 £2,000 0 £0 Jul-13 Jul-14 Jul-15 Jul-16 Jan-14 Jan-15 Jan-16 Jun-14 Jun-15 Jun-16 Oct-13 Oct-14 Oct-15 Apr-14 Apr-15 Apr-16 Sep -1 3 Feb -1 4 Sep -1 4 Feb -1 5 Sep -1 5 Feb -1 6 Dec-13 Dec-14 Dec-15 Aug-13 Aug-14 Aug-15 Nov-13 Nov-14 Nov-15 Mar-14 Mar-15 Mar-16 May-16 May-14 May-15
Ambulance Handovers Fines
£4,400 £4,000 £6,800 £1,200
£0 £2,000 £4,000 £6,000 £8,000 £10,000 £12,000 £14,000 £16,000 £18,000 £20,000 Apr-16 May-16 Jun-16 Jul-16 RAG Status: >=99%, 97-99%, <97%
12 Responsive Cancer 2 Week Wait [5] Draft Data 2 Week Cancer Targets 100.0%
95.0% July 2016 90.0% 85.0% 2 Week Suspected 2 Week Breast Cancer 80.0% 98.0% 92.1% 75.0% (Target 93%) (Target 93%) Jul-14 Jul-15 Jul-16 Jan-14 Jan-15 Jan-16 Sep-14 Sep-15 Nov-14 Nov-15 Mar-14 Mar-15 Mar-16 May-14 May-15 May-16 2WW Suspected Cancer 2WW Breast
Number of Referrals Seen Additional Notes 600 100
500 80 The Trust achieved the 2 Week Wait Suspected Cancer 400 60 and the 2 Week Breast Cancer Targets last quarter but 300 draft July data indicates a slightly under achievement in the 40 200 2 Week Wait Suspected Cancer Target. breast symptons suspected cancer 20 - - 100 0 0 Jul-14 Jul-15 Jul-16 Jan-14 Jan-15 Jan-16 Sep-14 Sep-15 Nov-14 Nov-15 Mar-14 Mar-15 Mar-16 May-14 May-15 May-16 no. referrals referrals no. No. referrals referrals No. 2WW Suspected Cancer 2WW Exhibited Breast Symptoms
13 Responsive Cancer 31 and 62 Day Treatment Targets [6] Draft Data July 2016 31 Day Treatment First 62 Day Treatment 100.0% 31 Day Treatment First Standard 98.0% 96.3% 96.0% (Target 96%) 89.0% (Target 85%) 94.0% 92.0% 31 Day Treatment 62 Day Treatment 90.0% Subsequent Surgery Screening 88.0% 77.8% 100% 86.0% (Target 94%) (Target 90%) 84.0% 31 Day Treatment 62 Day Treatment Jul-14 Jul-15 Jul-16
Subsequent Drugs Upgrades Jan-14 Jan-15 Jan-16 Sep-14 Sep-15 Nov-14 Nov-15 Mar-14 Mar-15 Mar-16 May-14 May-15 May-16 100% 100% (Target 98%) (Target 90%) Achievement % Target % 6 month rolling %
62 Day Treatment Standard Additional Notes 100.0% Draft data for July indicates that the Trust will achieve the 62 90.0% Day Standard Target but not the 31 Day Subsequent Surgery 80.0% Target.
70.0%
60.0%
50.0% Jul-14 Jul-15 Jul-16 Jan-14 Jan-15 Jan-16 Sep-14 Sep-15 Nov-14 Nov-15 Mar-14 Mar-15 Mar-16 May-15 May-16 May-14
Achievement % 6 Month Rolling % Target %
14 Responsive Admissions and LOS [7]
Average Length of Stay (Days) 6.0 July 2016 5.0 4.0 Elective Admissions Non-Elective Admissions 3.0 1,710 1,880 (1,810 July 15) (1,714 July 15) 2.0 1.0 0.0 Elective LOS Non-Elective LOS 3.0 Days 4.5 Days Jul-13 Jul-14 Jul-15 Jul-16 Jan-14 Jan-15 Jan-16 Sep-13 Sep-14 Sep-15 Nov-13 Nov-14 Nov-15 Mar-16 Mar-14 Mar-15 (-0.2 vs July 15) (-0.2 vs July 15) May-14 May-15 May-16 LOS Ele ctive LOS Non Elective Admissions 2,500 Additional Notes 2,000 1,500 Elective admissions have increase, and non-elective admissions have decreases compared to the same period 1,000 last year. 500 Both Length of Stay for Elective and Non-Elective are 0 comparable to July last year.
Jul-12 Jul-13 Jul-14 Jul-15 Jul-16 Jan-13 Jan-14 Jan-15 Jan-16 Sep-12 Sep-13 Sep-14 Sep-15 Nov-12 Nov-13 Nov-14 Nov-15 Mar-13 Mar-14 Mar-15 Mar-16 May-13 May-14 May-15 May-16 Total Elective admissions Non Elective admissions
15 Caring Friends and Family Test [1]
Friends and Family Test % of Inpatient / ED / Maternity Responses
July 2016 7000 25% 6000 20% 5000
Extremely Likely & 15% Overall Response 4000 Likely to 5645 5432 5577 5390 54475328 Rate 5433 53115380 4924 Recommend 3000 5300 5025 4814 4071 10% 3480 16.0% 92.0% 32393380 320229903190 (15.8% July 15) 2000 31192808 (94.7% July 15) 5% 1000 890 878 890 841 950 842 814 735 576 462 451 601 705 694 758 699 631 656 774 575 771 0 414 0% Jul-15 Jul-16 Jan-15 Jan-16 Jun-15 Jun-16 Oct-14 Oct-15 Apr-15 Apr-16 Feb-15 Sep-15 Feb-16 Dec-14 Dec-15 Aug-15 Nov-14 Nov-15 Mar-15 Mar-16 May-15 May-16 No of Respondants No of eligible Patients % of responses Friends and Family Test Inpatient / ED / Maternity Response to 'extremely likely' and 'likely' to recommend YDH Additional Notes 100.0% 90.0% From April 2015, the Friends and Family Test was extended 17.2% 21.6% 21.6% 23.1% 20.2% 21.5% 19.8% 21.2% 20.5% 21.3% 19.5% 18.2% 80.0% 22.6% 23.9% 21.6% 20.3% to include Outpatients, Daycases and children. 70.0% 60.0% The Trust has engaged with provider Iwantgreatcare to 50.0% support the further rollout of the questionnaire to all areas and 40.0% 74.5% 77.4% 74.9% 74.0% 73.5% 73.8% 72.9% 72.6% 71.9% 72.2% 69.2% 67.8% 69.2% 70.6% 72.9% 72.0% to enable near real-time patient feedback to clinical teams. 30.0% 20.0% 10.0% 0.0% Jul-15 Jul-16 Jan-16 Jun-15 Jun-16 Oct-15 Apr-15 Apr-16 Sep-15 Feb-16 Dec-15 Aug-15 Nov-15 Mar-16 May-15 May-16 % Extremely Likely % Likely
16 Well Led Labour Turnover [1]
Labour Turnover 20.0% 18.0% July 16 16.0% 14.0% 12.0% 10.0% 17.3% 8.0% (July 15 – 15.2%) 6.0% 4.0% 2.0% 0.0% Jul-14 Jul-15 Jul-16 Jan-14 Jan-15 Jan-16 Mar-14 Mar-15 Mar-16 Nov-13 Nov-14 Nov-15 Sep-13 Sep-14 Sep-15 May-14 May-15 May-16 Turnover Target Lower Limit Target Upper Limit
Additional Notes Figures based on previous 12 months.
Excludes bank people and doctors in training.
Turnover in July has increased, partly due to MARS.
17 Well Led Sickness [2]
June 16
Percentage 2.7% (June 15 – 3.0%)
Additional Notes Sickness is reported one month in arrears.
HR are focusing on ward sickness, nursing and HCA.
18 . Well Led Mandatory Training [3]
July 16
Compliance Percentage 93% (July 15– 88%)
Additional Notes Safeguarding Adults is now included as mandatory from June 16 along with Fire, Infection Control, Resus, Manual Handling and Child Protection.
19 Well Led Appraisals [4]
July 16
Compliance Percentage 81% (July 15 – 77%)
Additional Notes Performance is disappointing and there have been problems with the e-appraisal system. Working to rectify this and significantly simplify the process.
20 Appendix I - Terms
HSMR [Hospital standardised mortality ratio] Weighted risk of mortality against national average I&E Income & Expenditure CIP Cost improvement plan F&F Friends and Family RTT targets % patients that started consultant-led treatment within 15/18 weeks (admitted / non-admitted patient) (complete / incomplete pathway) 1st to follow up Ratio – number of follow up appointments to 1st appointment Ambulance handover Time it takes from when ambulance arrives to when we accept the patient into A&E DNA Did not attend
21 21 YDH │Council of Governors Financial Performance
YTD Month 4 – July 2016
Executive Summary (Whole Trust) 4 months to the end of July 2016 - adverse variance to budget £81k.
(5,000)
(5,200)
(5,400)
(6,166) (5,600) (6,248)
183 (5,800)
226 (6,000) (686)
£’000 (Deficit) / Surplus 238 (6,200) (126) (39) 52 (94) 164
(6,400)
Underspend Overspend Pay expenditure & temporary staffing (BAU) 4 months to end of July underspent by £226k.
8,000
7,500
7,000
6,500 £’000
6,000
5,500
Agency Bank & Locum Substantive
Notes • Nursing pay is £148k underspent due to skill mix savings, capacity developments not yet started and less supernumerary shifts than budgeted.
• Medical staff are overspent by £158k due to vacancies, sickness, additional duties and extra junior cover on the wards.
• Estates, Admin & Clerical are £154k underspent mainly due to vacancies. CIP Achievement £1.8m achieved in line with plan
900
800
700
600
500 Plan £’000’s 400 Achieved
300
200
100
0 April 2016 May 2016 June 2016 July 2016 Aug 2016 Sep 2016 Oct 2016 Nov 2016 Dec 2016 Jan 2016 Feb 2016 Mar 2016 Capital Spend to end of July £1,650k - underspend of £585k – forecast breakeven year end 1400 Actual 1200 Plan 1000 Forecast £’000 800
600
400
200
0 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Capital Expenditure Year to Date Actual Variance Operational Capital Spend Total General Site Capex 809 151 Medical Equipment 44 299 Radiology 4 (4) IT Upgrades/ Developments 0 102 Strategic Developments IT - Trakcare 785 11 Donated Schemes in Year 7 26 Total 1,650 585 Cash Cash balance at 31st July £1.4m 11,000 Total revised planned cash support for 2016/17 of £18.6m to cover revenue and capital. 9,000
7,000
5,000 9600 £’000 3,000 5828
4000 3172 4053 1,000 3455 2,496 400 0 0 181 1,605 1,660 1,461 1,869 650 650 545
-1,000
Actual Cash Actual / Planned Cash Support Planned cash Revised forecast
Notes
• At end of July 2016 cash balance was £1.4m which is £0.3m adverse to plan. The variance is mainly timing differences on payments.
• Temporary working capital facility has been increased to £12.2m. Up until the end of August £11.8m utilised. Loan not required in September due to Vanguard and STF cash now being received.
• Review underway for capital programme and loan. Awaiting confirmation of loan facility.
Content
• Highlight key elements of the Trusts Estates Masterplan • Update on progress with new Car Park • Set out future priorities for the Hospital site
What have we done this year?
Key Enablers • New Ward – opened in February 2016 aids future internal reconfiguration
What have we done this year?
Key Enablers • New Ward – opened in February 2016 aids future internal reconfiguration • Multi Story Car Park – opens in February 2017; frees up key development space
A plan for the future
• Car Park 1 – Clinical expansion space • Convamore – Health Education expansion space
Other priorities • Residential Accommodation • Health & Care College • Long term office accommodation solution Current priority projects
• Systemised Surgery Unit • Emergency & Urgent Care Zone • Office accommodation • Health & Care College
Systemised Surgery Unit
New state of the art Systematised Surgery Unit • Will remove the current day theatres and free-up vital space in the main tower • Options being worked up; likely to be within the Car Park 1 site • Considering current/future requirements and consider any other clinical services that should/could move to a new facility on Car Park 1 • Site investigation works underway
Emergency & Urgent Care Zone • We are developing a mini-masterplan for this zone on Level 3 of the hospital which becomes vacant, following the development of the Systemised Surgery Unit
Women’s Hospital
Progress Women’s Hospital improvement works • Current feasibility works to demonstrate the most cost effective option based on upgrading/maintenance costs over the coming 25 years. Office Accommodation
Short term solution Cost effective off-site accommodation to allow vacated space to be used by clinical services.
Long term solution Included as part of all other development work to identify the most efficient and cost effective solution.
Health and Care College
A business case for the Health and Care is being developed. Moving forward
• Priority projects are all being taken forward • Workshops with key Clinical/Estate leads to take place imminently to inform estates decisions • The Masterplan is a live document and will be regularly updated and reviewed by the Board od Directors
Membership and Communications Governor Working Group DRAFT Notes of the Meeting Held on 12 July 2016 in Meeting Room 6, Level 1, Yeovil District Hospital
Present: Hala Hall Public Governor [Chair] Judith Lindsay-Clark Staff Governor David Recardo Appointed Governor Tony Robinson Public Governor Sue Brown Public Governor
In Attendance: Ben Edgar-Attwell Assistant Company Secretary Amy Helliar Communications
Apologies: Philip Tyrrell Public Governor Monica Denny Public Governor
Action 20 WELCOME AND APOLOGIES FOR ABSENCE 20.1 Hala Hall welcomed everyone present to the meeting with a warm welcome to the new members of the group. Apologies for absence were received as noted above.
21 TO APPROVE THE NOTES OF THE LAST MEETING, REVIEW ACTION PLAN AND TO DISCUSS ANY MATTERS ARISING 21.1 The notes of the meeting held on 14 April 2016 were approved as a true and accurate record.
21.2 Hala Hall queried whether there was any progress on attendance at Yeovil College BEA Fresher’s Fair. Ben Edgar-Attwell noted this would be reviewed in the coming weeks and he would liaise with Simon Blackburn and Debbie Matthewson regarding representation. Sue Brown asked whether there had been any contact with UCY; the group agreed that this is something that could also be considered.
21.3 Ben Edgar-Attwell informed the group that a new banner had been purchased for future events to encourage signup to hospital membership.
21.4 Hala Hall asked whether there was progress in regard to contacting the Primary BEA Care Liaison Manager for local GP surgeries to arrange for membership leaflets to be placed. Ben Edgar-Attwell confirmed he would follow up on this with the Communications department.
21.5 Sue Brown inquired how much information regarding membership was given on leaflets and at various events. The group reviewed the information on the current membership leaflets and Ben Edgar-Attwell provided overview of the material available for events. Judith Lindsay-Clark spoke about members of the public being concerned with the level of accountability should they become members of the hospital.
21.6 Sue Brown noted that there was a lack of Friends and Family boxes to be found AH around the hospital – Radiology department in particular did not have a box in which to return completed forms. Amy Helliar agreed to follow this up.
22 TO NOTE THE MEMBERSHIP STATISTICS 22.1 The group noted the membership statistics presented by Ben Edgar-Attwell. There had been little variation in the data compared to the previous quarter post the internal quality assurance assessment. Tony Robinson asked how the data appeared when Yeovil Hospital first became a Foundation Trust. Ben Edgar-Attwell explained the data was not currently available and there would also be issues around the data quality during that period. David Recardo mentioned that more active promotion took place during the first few years as a Foundation Trust.
22.2 Further discussions took place regarding the membership database and the quality assurance work. Hala Hall asked the group whether there was an agreement to havingdata presented from January 2016 going forward as a benchmark ; this was agreed. Tony Robinson suggested that data be presented within graphical form from which the group could review which events are more successful; this will be BEA reviewed for the next meeting.
23 TO CONSIDER TOPICS FOR AUTUMN/WINTER MEMBERSHIP EVENTS 23.1 Ben Edgar-Attwell provided a brief update on the previous events which had taken place (Sherborne Health and Wellbeing Fair and the YDH Abseil), from which some members had been recruited.
23.2 In previous meetings, discussions took place with the agreement that the group would focus on two or three key events with the next being The Yeovil Show on 16 & 17 July. A timetable has been drawn up for Governor attendance throughout the BEA/ weekend. Super Saturday is due to take place on 24 September. Amy Helliar and AH Ben Edgar-Attwell will organise a Hospital Membership stand.
24 TO REVIEW PROGRESS AGAINST THE SIX MONTH OUTCOME PLAN 24.1 The group reviewed the six month objectives:
24.2 Increase Numbers of Members Aged 26 and Under: The group noted that this was an ongoing objective.
24.3 Diversify Communication Methods to Attract a Greater Number of Members from Black Minority and Ethnic (BME) Communities Hala Hall raised the question whether this objective required reconsideration as the ethnicity of public members is representative to the population of Somerset and North Dorset.
24.4 The group noted that there were diversity groups within the hospital which Debbie Matthewson organises. Ben Edgar-Attwell would liaise with Debbie for consideration of a member of the Membership and Communication Group to BEA attend.
24.5 Discussions took place whether it would be more meaningful to introduce another ethnic category to monitor, such as Eastern European. Ben Edgar-Attwell noted that this may require a review of the existing Membership leaflet and that this would not take place until the existing supply was low. It was agreed that the group would monitor the ‘Any other white background’ classification in which Eastern European
members of the public would fall.
24.6 Engage with GP Practices in the Yeovil Hospital Catchment Area to Consider Whether Governors Could Use Patient Participation Groups as a Channel for Communications with Members/Public in their Constituencies Amy Helliar agreed that she would liaise with Lisa Pyrke, Symphony Communications and Engagement Manager, regarding the Symphony GP Practices which form part of the Trust’s subsidiary company. She would also speak
with Caroline Maddams, Communications Manager, regarding the possibility to add membership leaflets in other GP Practices. AH
24.7 Discussions took place regarding Governors approaching their local GP practices in order to promote membership. Sue Brown mentioned that all practices have practice meetings and questioned whether this is something that members of the group could attend. It was agreed the Communications Team will lead on approaching practice managers. AH/CM
24.8 Tony Robinson noted that individual Governors approaching local practices is a scatter approach to solving the problem and is not something that is measurable.
25 COMMUNICATIONS – SOCIAL MEDIA 25.1 Hala Hall noted there had previously been concerns within the group regarding social media, but that it is an important platform that can be used to promote the hospital and membership.
25.2 Amy Helliar presented the Communication Department’s social media guide for Twitter which outlines how to set up an account, tweeting, retweeting and how to favorite tweets etc. She also explained she would be happy to help governors set up accounts and guide them through the basics in person.
26 USE OF SOCIAL MEDIA 26.1 Tony Robinson presented his paper on social media, which included an overview of the usage of social media, especially covering Facebook. The paper highlighted that social media platforms do not need to provide a platform for discussion but can merely be used to present information. He also outlined the different ‘groups’ which can be created on social media.
26.2 Judith Lindsay-Clark queried who would join these groups and raised concerns they may be used as a platform for complaints rather than through appropriate channels.
26.3 David Recardo noted that social media can also become an easy platform for abuse. He also suggested the younger generations have moved away from Facebook and Twitter in recent years and we may not be capturing the attention of those groups we are keen to reach.
26.4 Amy Helliar explained that there would need to be careful consideration regarding the usage of these groups, especially when there are existing corporate accounts of most social platforms. She also noted that privacy settings would need to be considered as many people post personal information on their pages which they may not wish to be accessible.
26.5 Hala Hall provided a summary of the discussions, noting that there was a wider
need for communication with hospital members and there has previously been more resource put towards monitoring the number of members rather than how to communicate with them. It was agreed that the corporate accounts could be used further to promote membership and the information to be shared needs to come from a central source for the governors to use.
26.6 It was agreed that Amy Helliar, Tony Robinson and Ben Edgar-Attwell would meet to discuss the current social media channels available and how these can be BEA utilised further. Hala Hall then suggested that the topic of social media be included AH/TR on the agenda for the next Membership and Communications meeting in order to draw up an action plan and provide direction.
GOVERNANCE SURVEY RESULTS 27.1 Ben Edgar-Attwell presented to the group the results of the Governance Survey.
27.2 Judith Lindsay-Clark raised the point that the report raised several methods of engagement with members and that it suggested that there areas which Yeovil could improve.
27.3 Hala Hall explained that previously Samantha Hann had asked for governors to suggest different events that are taking place within their local areas, but only a few suggestions were provided. Hala Hall felt that she does not adequately accessthe views of her constituency, a view shared by the other governors in respect of their own constituencies.
27.4 Tony Robinson raised the concern that the hospital website does not adequately promote hospital membership or the governors. He also noted that there were no contact details on the website should a member of the public wish to contact their local governor. Amy Helliar agreed that this would be reviewed. AH
27.5 Ben Edgar-Attwell suggested that a central ‘Governors email’ account could be created and agreed to contact the IT department to look into the creation of this. BEA
27.6 It was agreed that governor responsibilities and how well the current governors feel BEA/ they are completing these would be an item at a future Council of Governors JR meeting.
28 Review of MCWG Achievements and Priorities 28.1 Hala Hall asked the attendees what they believed were the reasons for the perceived governor reluctance to join the group. Discussions took place regarding the name of the group and its responsibilities.
28.2 It was noted that that there are no Terms of Reference for the group. Hala Hall expressed a wish to draw up some Terms of Reference and it was suggested that HH/JR/ Hala Hall, Jade Renville and Ben Edgar-Attwell meet to discuss. BEA
28.3 Prior to the meeting, Ben Edgar-Attwell had drawn up a list of previously completed actions from the group. Hala Hall presented these, noting that there were a large number of positive achievements.
28 IDEAS FOR INCLUSION AT FUTURE COUNCIL OF GOVERNORS MEETINGS 28.1 As per item 8.6, an item on governor responsibilities and the achievement of these was suggested as an agenda item for the Council of Governors.
29 ANY OTHER BUSINESS 29.1 There were no other items of business.
30 DATE OF NEXT MEETING 30.1 Wednesday 19 October 2016 13:15-15:15 Meeting Room 6, Level 1, YDH
APPENDIX 1 STRATEGY AND PERFORMANCE Strategy and Performance Working Group DRAFT Notes of the Meeting Held on 12 July 2016 Room 5, Academy, Level 4, Yeovil District Hospital
Present: Alison Whitman Public Governor [Chair] Michael Fernando Staff Governor John Park Public Governor John Tricker Public Governor Tony Robinson Public Governor Mary Belcher Public Governor John Webster Public Governor Paul Porter Staff Governor Sue Brown Public Governor
In Attendance: Paul von der Heyde Trust Chairman Jonathan Higman Director of Strategic Development Ben Edgar-Attwell Assistant Company Secretary
Apologies: Paul Mears Chief Executive
Action 13 WELCOME AND APOLOGIES FOR ABSENCE 13.1 Alison Whitman welcomed everyone present to the meeting, expressing a warm welcome to the new Governor members of the Group. Apologies were noted as above.
14 DECLARATIONS OF INTEREST 14.1 There were no declarations of interest relating to items on the agenda.
15 NOTES OF THE MEETING AND MATTERS ARISING 15.1 The notes of the previous meeting held 19 May 2016 were approved as a true and accurate record.
16 REVIEW PROGRESS AGAINST THE GROUP’S OBJECTIVES
16.1 It was agreed that the objectives for 2013/14 be removed. BEA
16.2 Alison Whitman and Jade Renville had met prior to the meeting to discuss this year’s objectives; it was agreed that there were a number of changes to be made.
16.3 John Tricker asked whether there was a need to introduce short term objectives as these are likely to change in the current evolving climate.
16.4 Paul von der Heyde noted the Sustainability and Transformation Plan is currently in the development stages and would not fall under a short term objective; the same with Symphony Healthcare Services.
16.5 Alison Whitman raised the question whether Symphony Healthcare Services would be monitored within this group. Paul von der Heyde confirmed that monitoring of SHS would be through the Trust Board rather than within this group. The GP practices will remain as independent practices and Maurice Dunster (Non- Executive Director) is monitoring SHS progress and performance.
John Park asked whether the different practices have individual budgets or if there is one overall shared budget. Paul von der Heyde confirmed that there is an overall budget, but there are also individual cost budgets. Discussions took place whether the individual practices would effectively ‘help each other out’. Jonathan Higman noted that SHS is one entity, however the Trust’s strategic priorities were being reviewed and it would be appropriate to bring this back to a future Strategy and Performance meeting after the Board has reviewed the plan.
16.6 Sue Brown queried whether SHS has its own Board as it is a Ltd company. Paul von der Heyde confirmed SHS does have a Board which would report to the YDH Board.
17 Update from the Chief Executive 17.1 In the absence of Paul Mears, Paul von der Heyde presented the Chief Executive update.
17.2 Car Park: Progression on the car park is on schedule and due to open in January 2017. Alison Whitman asked whether the asbestos had been cleared; Jonathan Higman confirmed that this has been resolved.
17.3 TrakCare: TrakCare has now gone live and the ‘switch on’ weekend went extremely well with successful migration of records from PAS to TrakCare. In the first few weeks, there were delays contributed to the use of the new system within the emergency department but this is being addressed with ongoing work and the position has since improved. There are still some challenges to be resolved within the Contact Centre and some secretaries are still facing some difficulties. The relevant teams are aware of these issues and are addressing these as a priority. Staff members are now becoming much more familiar with the system which is improving the situation.
17.4 CQC Report: The draft CQC report has been received and the Trust had 10 days to challenge areas of factual inaccuracy. Trust feedback has been submitted today noting a number of inaccuracies and the final CQC report is expected to be released towards the end of July 2016.
17.5 Recruitment Programme: Jonathan Higman noted that the recruitment position has improved with strong recruitment in the radiology department. The emergency department has recruited an experienced ED Clinical Director and they are due to start in September 2016. The biggest challenge in recruitment remains in nursing although much work is being undertaken to improve this position, including an increased usage in bank staff. Michael Fernando queried the recruitment of nurses from abroad. Jonathan Higman provided an update to the group on the recruitment drive in India and the Trust is now in the logistical stages of appointment, advising that a number of job offers were made.
17.6 In terms of nurse staffing, Paul von der Heyde noted that when the Trust goes into escalation, YDH then faces staff shortages which often results in the use of bank and/or agency staff. Due to the Trust’s geographical position, there are continued struggles with nursing recruitment and this has been noted by NHS Improvement.
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17.7 Discussions have also taken place with Yeovil College in an effort to train nurses locally, reducing the need to travel to institutions such as Bournemouth University. John Webster asked whether this would keep all training on site. The concept is to keep training on site, and there are discussions regarding which University the course would be linked; Plymouth, Bournemouth and Exeter Universities are being considered.
17.8 Tony Robinson asked how Brexit would affect recruitment drives abroad. Paul von der Heyde noted that a large majority of recruitment is currently from Asia with a small number of programmes within the European Union. It is still early stages to understand what the impact of Brexit will have on our ongoing recruitment.
17.9 Ambulatory Service Partner: The contract with Ambulatory Surgery International (ASI) has been signed and the next stages are now underway. John Park asked whether this would include more than just Day Surgery. Paul von der Heyde confirmed that this is the sole purpose in the project although there may be a possibility of some inpatient bed capacity. Paul Porter asked about the time scales of the project and it was noted that there may be a fully functioning new Day Surgery unit operating using the systemised model in 2 years’ time.
17.10 Control Total: The group was given an overview of the control total: An agreement with NHSI that the Trust’s deficit will not be more than this amount. YDH’s control total has been agreed and Paul von der Heyde noted this enables access to the additional £4.5million funding. Michael Fernando asked whether this additional funding is a loan; this will be a grant, and the remaining amount will take place as a loan.
17.11 Discussions took place regarding the introduction of Payment by Results (PbR). Jonathan Higman explained that this introduction of PbR means there is now a greater need to reduce the number of elective cancellations during winter pressures.
18 Update on the Sustainability and Transformation Plan 18.1 Jonathan Higman explained that the first phase of the STP was submitted at the end of June and feedback has been provided by NHSI and Jim Mackey, Chief Executive of NHS Improvement. It was noted that the plan was progressing well. The plans are currently rated on a scale of 1-3; Somerset STP is currently rated as a 2 with some work still required.
18.2 The plan quantifies the financial gap of £380million for the county which includes NHS Improvement, NHS England and Social Care.
18.3 The STP is working with Optum on plans to put in place an outcomes based model of commissioning. There is a real focus on prevention and a redesign of primary care to address the sustainability of primary care but also to manage complex care elsewhere rather than within the hospital setting.
18.4 There are continued challenges ahead with further discussions required to consider the sustainability of health and care locally and how these services should be best delivered in future.
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19 Overview Presentation on Symphony Health Services 19.1 Joanne Farnworth and Olga Loucheva provided an overview presentation on Symphony Health Services which illustrated the ongoing issues regarding primary care, how SHS is structured and the future of the organisation.
19.2 Tony Robinson questioned whether Dorset practices would be included within SHS. Joanne Farnworth confirmed that discussions are ongoing after the previous success seen within the model in South Somerset but no formal plans had yet been agreed.
19.3 Mary Belcher raised the issue of liability and indemnity of the practices and where this would sit. Joanne Farnworth confirmed that SHS and the practices within it would be treated as one organisation and that there are indemnity polices in place.
20 To Review the Performance Dashboard 20.1 Jonathan Higman presented the Performance Dashboard. He noted that RTT is still an ongoing concern after continued winter pressures affected the trajectory. Trust performance is now on track to achieve the statutory 92% performance with a plan to get to 93% before this year’s winter pressures. The Trust is still utilising Shepton Mallet Treatment Centre with ongoing work underway to improve patient flow within the hospital and discharge patients who no longer require acute care. There is also work underway to ring fence the Trauma and Orthopedic beds on Ward 6A.
20.2 ASI is also reviewing processes within the hospital with the aim to free up space. There is an ongoing need to ring fence day theatre beds as CDUP is currently used as escalation. When the Trust needs to escalate, there is a direct effect on day theatre elective operations; in the long term this will be resolved with the joint venture with ASI.
20.3 John Tricker asked whether the backlog of patients had been treated. Jonathan Higman updated the group that the backlog had not yet been cleared, but that this would be expected by October.
20.4 Jonathan Higman spoke of the benefits of Cookson Court. Of the patients who have been through this service, 40% have seen their long term care needs reduced. This is beneficial for the patient and also reduces demand on hospital services. Sue Brown queried the cost of utilising Cookson Court and Jonathan Higman stated that it costs around £750,000 which is significantly less than an acute ward.
20.5 Discussions also took place regarding the community hospitals within the region where it was noted that all beds are open at South Petherton and that Wincanton Community hospital is now designed for GP referrals rather than utilised for the transfer of patients from acute care. John Park suggested the usage of Yeatman Community Hospital and The Willows. It was noted that these are run by Dorset HeathCare University Foundation Trust.
20.6 Jonathan Higman provided the group with an update on A&E performance. This is still an ongoing issue which was exacerbated by the introduction of TrakCare. The new system unfortunately caused delays in the first few weeks due to a combination of its configuration and staff unfamiliarity. Performance is improving but there is still work underway to improve this further. A&E attendances are still increasing with records on the number of patients a day being broken.
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20.7 Alison Whitman noted that it appears that the compliments and complaints data JH/ appears to be incorrect. Ben Edgar-Attwell/Jonathan Higman agreed to check this. BEA
20.8 After discussions regarding the Friends and Family results, Sue Brown noted that there was a need to increase the number of boxes for patients to post their BEA responses as some departments do not have one.
20.9 It was noted that HMSR would now be replaced by the observed vs expected deaths ratio based on POSSUM data from the Copeland Risk Adjusted Barometer BEA (CRAB) system.
20.10 Mary Belcher queried whether the complaints are founded. It was confirmed by Jonathan that all complaints are investigated and Alison Whitman also noted that there is another group that looks further into complaints.
20.11 Mary Belcher queried why there was an increase in the number of patient falls. John Webster confirmed that this had been raised within the Quality Committee. It is worth noting that trips and slips are counted within the falls data.
21 IDEAS FOR INCLUSION AT THE NEXT COUNCIL OF GOVERNORS
21.1 Alison Whitman suggested a presentation on the Estates Master Plan at the next JH/ Council of Governors meeting in September. BEA
22 ANY OTHER BUSINESS
22.1 Alison Whitman raised the question of the Governor Indicator for this financial year. Ben Edgar-Attwell provided an update: the suggestions from Governors had been put forward for their suitability and measurability as an indicator to the Clinical Governance and Information teams. The recommendation was for the Indicator to be measuring overnight ward discharges and moves; this would also be an area in which data could be retrospectively analysed to capture a full financial year. The group agreed with this recommendation.
23 DATE AND TIME OF FUTURE MEETINGS 23.1 Wednesday 19 October 2016, 13:15-15:15, M6, Level 1, YDH
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