Meeting of the Board of Directors

11.30am to 13.45 on Thursday 28 March 2019

Mickerson Hall, Chichester Medical Education Centre, St Richard’s Hospital, Spitalfield Lane, Chichester, PO19 6SE

AGENDA – MEETING IN PUBLIC

1. 11.30 Welcome and Apologies for Absence Verbal Chair To note

2. 11.30 Declarations of Interests Verbal All To note

3. 11.30 Minutes of Board Meeting held on 31 January 2019 Enclosure Chair To approve

4. 11.35 Matters Arising from the Minutes Enclosure Chair To note

5. 11.40 Chief Executive’s Report Enclosure Marianne To receive and agree any necessary actions Griffiths

PERFORMANCE REPORTS

6. 11.50 Quality Performance Enclosure George To receive and agree any necessary actions Findlay

6a. 12.05 Report from Quality Committee to Board Enclosure Joanna To receive and agree any necessary actions Crane

7. 12.15 Operational Performance Enclosure Jayne To receive and agree any necessary actions Black

8. 12.30 Organisational Development and Workforce Performance Enclosure Denise . Including Gender Pay Gap Review Farmer To receive and agree any necessary actions

9. 12.45 Financial Performance Enclosure Karen To receive and agree any necessary actions Geoghegan

OPERATIONAL ITEMS

10. 12.55 CNST ATAIN Action Plan Enclosure Nicola To note Ranger

11. 13.05 Use of Trust Seal Enclosure Glen To note Palethorpe

12. 13.10 Board Assurance Framework Enclosure Glen To receive and agree any necessary actions Palethorpe

13. 13.20 STP Population Health Check Enclosure Marianne To receive Griffiths

14. 13.25 Terms of Reference Enclosure Glen . Finance and Performance Committee – To approve Palethorpe . Quality Assurance Committee – To approve . Audit Committee – To note . Charitable Funds Committee – To note . Appointments and Remuneration Committee – To note

15. 13.30 Any Other Business

16. 13.35 Questions from the Public Verbal Chair

Following the close of the meeting there will be an opportunity for members of the public to ask questions about the business considered by the Board.

17. 13.45 Resolution into Board in Private Verbal Chair To pass the following resolution:

“That the Board now meets in private due to the confidential nature of the business to be transacted.”

18. 13.45 Date of Next Meeting Verbal Chair

The next meeting in public of the Board of Directors is scheduled to take place at 10.30am on 30 May 2019 in the John Bull Room, Worthing Health Education Centre, Worthing Hospital, Lyndhurst Road, Worthing.

19. 13.45 Close of Meeting Verbal Chair

Trust Board of Directors Quoracy A meeting of the Board shall be quorate and shall not commence until it is quorate. Quoracy is defined as meaning that at least half of the Board must be present, including one Non- executive Director and one Executive Director. This means that at least 6 voting members must be present. A Director shall be deemed as present if they join the meeting by telephone or other means, provided that he can hear and be heard by all other Directors present at the meeting

Minutes of the Board of Directors meeting held in Public at 10.00am on Thursday 31st January 2019, Bateman Room, Chichester Medical Education Centre, St Richard’s Hospital, Spitalfield Lane, Chichester, PO19 6SE

Present: Alan McCarthy Chairman Mike Rymer Non-Executive Director Jon Furmston Non-Executive Director Lizzie Peers Non-Executive Director Joanna Crane Non-Executive Director Dame Marianne Griffiths Chief Executive George Findlay Chief Medical Officer & Deputy Chief Executive Karen Geoghegan Chief Finance Officer Pete Landstrom Chief Delivery & Strategy Officer Denise Farmer Chief Workforce and OD Officer Maggie Davies Nurse Director Jayne Black Chief Operating Officer

In Martin Sinclair Non-Executive Director Adviser Kirstin Baker Non-Executive Director Adviser Attendance: Glen Palethorpe Group Company Secretary Jan Simmons Corporate Governance Officer

TB/01/19/01 Welcome and Apologies

1.1 The Chair welcomed all those present to the meeting and congratulated Marianne Griffiths on being made a Dame Commander of the Order of the British Empire and for all she had done to transform things for patients and for the Trust.

1.2 Apologies were received from Patrick Boyle.

TB/01/19/02 Declarations of Interests

2.1 There were no declarations of interest.

TB/01/19/03 Minutes of Board Meeting held on 25th October 2018

3.1 The Board received the minutes of the meeting held on 25th October 2018.

3.2 The Board resolved that the minutes of the Board meeting held on 25th October 2018, would be approved as a correct record of the meeting and signed by the Chairman.

TB/01/19/04 Matters arising from Minutes

4.1 The Matters Arising from previous meetings were received.

4.2 All Matters Arising were noted as having been completed.

TB/01/19/05 Chief Executive’s Report

5.1 Dame Marianne Griffiths presented the report which had previously been circulated and highlighted the following themes:

5.2 Extensive winter planning, many new initiatives and the Trust’s steadfast

commitment to patients and each other had put the organization in a much better position than a year ago, with 1,000 fewer A&E patients waiting more than four hours to be treated, admitted or discharged than the previous year. This was an incredible 54% reduction in 4-hour breaches, despite more people actually attending the emergency departments than did last year. This resulted in the Trust being the 11th best performance for type 1 A&E departments in England last month.

5.3 Marianne wished to commend and thank publicly all the hard-working staff and the hospital volunteers who supported them, as well as all the local health and social care partners.

5.4 The Royal College of Physicians GI joint advisory group had commended the ‘excellence’ of the Trust’s service at St Richard’s Hospital which had been awarded JAG accreditation, matching the same achievement in Worthing the year before. The assessors said they observed ‘exceptionally good examples of processes, both administratively and clinically’ that they wished to share ‘as examples of what can be achieved’. This was a truly fabulous endorsement of the service’s commitment to continuous improvement and a reflection of the impact the Patient First approach delivered. The JAG accreditation of endoscopy puts the Trust in the top 5% of best-performing services in the country.

5.5 The St Richard’s stroke care team had received a national award commending them as ‘Quality Improvement Champions’ in recognition of their achievements since introducing stroke thrombolysis 24 hours a day in Chichester last year. Marianne praised Lavant ward, A&E, radiology and all the stroke clinicians who, in the past six months, had more than doubled the number of patients receiving the clot-busting treatment within the critical timeframe, significantly exceeding the national average.

5.6 The Green Travel Team were finalists in the national Health Business Awards for the car parks and free minibus shuttle service between the hospitals. In the first two months it was estimated that the introduction of the staff minibuses led to a reduction of around 60 tonnes of carbon dioxide emissions. The Green Travel programme had also provided discounted public transport tickets and better cycling facilities for staff. Marianne asked Karen Geoghegan to thank the team on her behalf.

5.7 Western Sussex Hospitals and their main commissioner, Coastal West Sussex Clinical Commissioning Group were announced as joint finalists at the National health Finance Awards in the Innovation Award category for the new Aligned Incentive Contract.

5.8 The Care Quality Commission had continued its series of engagement visits to the Trust, most recently meeting with colleagues from the Medicine Division. The feedback received cited the many examples of good multidisciplinary team working and how much colleagues talked about the support and care of staff at Western Sussex Hospitals. The Trust will be welcoming the CQC back in March for an engagement visit with the Women & Children’s Division. It was also anticipated that the CQC would be undertaking a full inspection of the Trust in the 2019/20 financial year and already work was being put in place to support this.

5.9 A new CT scanner which both improved image quality and reduced exposure to radiation for patients was now operational in Worthing Hospital. Over the past three years in Worthing the Trust has replaced the CT and MRI scanners, upgraded digital X-ray and expanded the Interventional Radiology Suite. Exciting plans were now underway to replace the MRI

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scanner at St Richard’s Hospital.

5.10 Marianne then took the opportunity to update the Board on the key deliverables of the Management contract between the Trust and Brighton & Sussex University Hospitals NHS Trust (BUSH) and was delighted to report the following progress: - Exit from financial special measures achieved in July 2018 with the Trust’s deficit continuing to reduce. - Exit from quality special measures following the CQC re-inspection in October 2018 where the focus was on Core Services, well led and the use of resources. The outcome being a huge leap to ‘Good’ overall and ‘Outstanding’ for care. - Improving culture – there had been a vast improvement and shift in culture in the organization and without exception staff spoke positively about changes and that the Trust’s Patient First programme had enabled this. - Currently BSUH were on track, and on target, to deliver a new hospital.

5.11 The Board received and NOTED the Chief Executive’s report.

TB/01/19/06 Quality Performance

6.1 George Findlay introduced the Quality Performance report which had previously been circulated and highlighted the following key points.

6.2 The Board was advised that crude non-elective mortality had increased from 2.59% reported in November to 3.30% reported in December; this was slightly higher than the equivalent month in 2017 (3.26%). Worthing Hospital reported 3.71% in December, a rise from the previous month when 2.80% was reported.

6.3 The Trust’s HSMR for the twelve months to September 2018 remained good at 91.2% (1806 deaths against expected 1980). 100 was the level predicted by the Dr Foster model using the march 2018 benchmark.

6.4 The twelve month HSMR to September 2018 split by site continued to be lower for St Richard’s at 85.3% (801 deaths against an expected 940) than for Worthing and Southlands 96.6% (1005 deaths against expected 1041). There was now a better understanding of what had been driving the change between the two hospitals and the Worthing and Southlands site upward trend had now stabilized and both sites were within acceptable variation limits (below 100).

6.5 The Standardised Mortality Ratio for hip fracture (reported in September) had demonstrated a rise in September to 116.0 against a target of 100. St Richard’s SMR for hip fracture stood at 104.9 in September 2018 and Worthing at 12.9. A targeted mortality review was underway with partners in BSUH in view of the rising SMR.

6.6 The Trust had set the goal of achieving a position within the top 20% of Trusts as measured by HSMR. For the twelve months to September 2018, performance using this measure placed the Trust on the 20th centile (27 out of 134 Trusts).

6.7 George went on to draw attention to the following exceptions relating to effectiveness:

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6.8 Since July there had been a reported decrease in performance of emergency admissions staying over 72 hours screened for dementia. This was disappointing and work was under way to understand the cause and improve the performance.

6.9 December had also seen an increase in night time ward moves of patients with a dementia; the Trust was working hard to minimize this in the coming months.

6.10 A decrease in stroke patients admitted to the stroke unit within 4 hours of admission had decreased in performance from October (78.3%) to 64.5% reported in November. It was felt that this was most likely a consequence of the Trust operating at high capacity; an improvement next month was anticipated.

6.11 The Board was advised that the Trust’s TIA service was not currently delivering as required, partly due to capacity constraint. However, a new clinician had been appointed and the service should now improve to a more acceptable level of performance.

6.12 Maggie Davies went on to present the safety section of the report, noting the key areas as follows:

6.13 There were no outstanding Central Alert System (CAS) Safety Alerts for the Trust up to December 2018.

6.14 There had been five Serious Incidents Requiring Investigation (SIRIs) reported for December. A detailed report on these would be provided to the Committee section of the Trust Board.

6.15 The Board was reminded that on a monthly basis there was triangulation of information arising out of complaints, claims, serious incidents, Freedom to Speak Up themes, safeguarding (Serious Case Review) and inquests to identify any areas of learning or for focus.

6.16 Three cases of Clostyridium Difficile were reported in December and of these as lapse of care was identified in all three cases. One case at Worthing where issues were identified with the environment and two cases at St Richard’s that were still under investigation. The recommended actions from the Worthing review were being addressed with the Director of Estates. The Trust remained well below the national target but high vigilance remained important.

6.17 The end of year data showed a 37% reduction in falls overall over the past 4 years with over 25% reduction in falls causing serious harm (moderate and above).

6.18 During December the Trust reported a total of 21 incidents of pressure damage which continued the decrease from 30 reported in October but which remained negatively above the Trust’s target. However, the installation of the new electric beds in the hospitals was helping with this.

6.19 With regard to the Patient Safety Thermometer, Maggie reminded the Board that the actual number of patients who suffered no new harm during their inpatient stay at the Trust in December was 98.7%; the internal target of 99% was set by the organization and year to date the Trust was reporting 98.6% compliance.

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6.20 During December the Trust received 30 complaints, the top five themes were recorded as clinical treatment, admission transfer and discharge, date for appointment, end of life care and personal records.

6.21 Divisions continued to embed a more proactive response to new complaints to try to facilitate resolution quickly for patients and families. Complaint response turnaround within 25 days has reduced from 64% to 51%

6.22 Work continued to improve the Friends and Family Test inpatient response rates towards a target this year of 40% (with an interim target for A&E of 23% year to date actual 23.1%). December’s data reported 43.7% compliance (year to date 42.5%)

6.23 A&E Friends and Family Test response rates continued to improve, however, a slight decrease in performance was noted in both delivery and postnatal care.

6.24 Clinics cancelled with less than 6 weeks’ notice for annual/study leave demonstrated a significant improvement from 52 reported in October to 13 reported in December.

6.25 In December there were 20 mixed sex breaches reported in Worthing and 8 in St Richard’s critical care, this was an improvement on the Worthing site where there were 26 breaches in November, and 8 in St Richard’s.

6.26 Jon Furmston welcomed the mortality review for hip fractures but was concerned at the Trust’s rising Standardised Mortality Ratio (SMR) rate. George addressed this by pointing out that it was important to recognize the limitations of the Dr Foster data and that both Worthing and St Richard’s Hospitals were both performing better than average. There was no signal that more patients were dying than previously.

6.27 With regard to discharging patients before midday, Mike Rymer highlighted an instance where it took a patient until 6pm to obtain their medication. Maggie acknowledged that much more improvement work needed to be done and was pleased that this was one of the Patient First metrics.

6.28 Responding to a query from Joanna Crane, around the anticipated new baseline for mixed sex breaches following the change in the NHSE reporting requirements, Maggie confirmed that the process was being reviewed and a MD view of what the trajectory for improvement would be.

6.29 The Board received and NOTED the Month 9 (December) Monthly Quality Report

TB/01/19/6a Report from Quality Committee to Board

6a.1 Joanna Crane provided a verbal update to the Board and highlighted the following:

6a.2 A major discussion at the meeting had been around following up on Serious Incidents Requiring Investigation. This had focused more on whether the appropriate actions had been addressed rather than learning from the events. A draft report would be presented at the next Quality and Risk Committee meeting with a recommendation that it be submitted to the Trust Board.

6a.3 A number of deep dives had provided assurance in many areas especially neonatal deaths in maternity, dementia strategy and 7-day services.

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6a.4 The deep dive into maternity incidents and neonatal deaths had been very reassuring and provided great assurance in line with national averages and all the changes coming into the system.

6a.5 The deep dive into 7-day services showed that consultant review over the weekend required support and staffing was a big challenge but the Committee had been assured in other areas.

6a.6 The Committee had also received an update on Quality Impact Assessments (QIAs) which were important for safety and risk management and part of the Trust’s efficiency programmes. The Committee had been assured that there had been regular reviews which had been completed on time.

6a.7 Joanna reported that, although the NICE guidance data had not been very reassuring, the verbal updates received from the Divisions had confirmed progress was being made and full compliance by March 2019 was expected.

6a.8 The Board received and NOTED the report from the Quality Committee

TB/01/19/07 Financial Performance

7.1 Karen Geoghegan presented the Financial Performance report for Month 9 (December 2018) which had previously been circulated, and highlighted the following key areas:

7.2 The Trust had delivered its control total at the end of Q3 and was reporting an underlying surplus (excluding Provider Sustainability Fund (PSF) income) of £0.56m. Delivery of the financial control total alongside the achievement of the A&E waiting time trajectory, meant the Trust would receive £4.88m of income from the PSF.

7.3 Delivery of the control total in Q4 was challenging and would require close management of seasonal and operational pressures in the remaining quarter of year as well as further implementation and delivery of mitigating actions.

7.4 The Trust was reporting an FSRR rating of ‘1’.

7.5 Cumulatively income was £5.3m ahead of plan. All of the elective pathway activity types reduced in December from the levels reported in November. Private patient services continued to underperform against plan.

7.6 In comparison to November, pay expenditure remained at a similar level, albeit with increases in Nursing pay of £0.2m being offset by a similar level of reduction in Medical pay.

7.7 Nursing agency and WLI usage decreased but were offset by increased bank expenditure. Medical pay decreased by a further £0.2m with temporary staffing availability reducing, requiring alternative solutions to be implemented to cover absences relating to sickness, maternity and vacancies. Management and admin staff remained below plan with vacancies continuing to be held in non-clinical areas.

7.8 Year to date efficiency and transformation programme savings of £12.9m had been achieved against a plan of £13.2m. Slippage in Workforce and Surgical Productivity work programmes were the key contributors. The forecast out-turn was on plan to deliver £18m, however, delivery was increasingly challenging and would require close management of risks at an individual scheme level.

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7.9 At the end of December, capital expenditure totalled £8.5m which was £4.3m below plan due to later starts on some projects. A number of significant capital schemes had been approved and the year-end position was forecast to be on plan.

7.10 At the end of December cash was behind plan by £4.9m. Slippage on the capital programme and more cash being available following receivables receipts had been used to reduce the level of aged payables.

7.11 At the end of Q3 the Trust had delivered its control total with an underlying surplus (excluding PSF income) of £0.56m, however, the position remained challenging. Karen added that the Trust had been notified of its control total for 2019/20 and asked to deliver a surplus of £14.1m.

7.12 The Board received and NOTED the Financial Performance Report for December 2018

TB/01/19/07a Report from Finance Committee to Board

7a.1 Alan McCarthy presented the Finance and Investment Committee highlights report to the Board which was the subject of a separate paper tabled at the meeting. The Board noted the following:

7a.2 The Committee had received reports in respect of the Trust’s financial performance for Month 9, including the Trust’s activity and income, cash flow and efficiency programme delivery. They were pleased to note the Trust had delivered its control total at the end of Quarter 3 and would therefore receive £4.88m of provider sustainability funding.

7a.3 The Finance and Investment Committee discussed the risks and mitigating actions required to deliver the control total for Quarter 4. In particular pay costs would need to continue to be managed carefully, specifically those relating to medical pay costs.

7a.4 The Committee was assured streams of work were in place to address this and the other risks to the delivery of the control total.

7a.5 The Committee was satisfied with the Trust’s cash position and the processes applied to its monitoring.

7a.6 The Committee considered the 2018/19 efficiency programme and noted that on the basis of the month 9 position, and that whilst there was some risk, mitigations were in place that should see the Trust deliver its original plan.

7a.7 The Finance and Investment Committee had received a report in respect of the Trust’s workforce transformation programme providing assurance over the delivery of a number of initiatives.

7a.8 The Committee had received a report in respect of the Trust’s procurement function and was pleased to note the positive outcome of a recent assessment of the function.

7a.9 The Committee had received a report on the Trust’s 2019/20 financial planning framework and noted the work ongoing in respect of the Trust’s 2019/20- annual financial plan.

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7a.10 The Committee had received a report on the work of the Trust’s Capital Investment Group and was reassured that the programme should be substantively delivered by the year end.

7a.11 The Finance and Investment Committee had recommended that the Trust Board approve the control total.

7a.12 For clarification Martin Sinclair asked Karen expand the understanding of the control total for 2019/20. Karen explained that the control total of £14.1m included £8m of funding from the STF and the Trust had access to this during the current year. To deliver next year’s total it was understood that the efficiency requirement would be less than this year. From preliminary work the overall efficiency requirement was expected to be in the region of just under 3%.

7a.13 The Board received and NOTED the finance and Investment Committee Highlights Report from the meeting held on 29th January 2019.

TB/01/19/08 Operational Performance

8.1 Jayne Black introduced the Month 9 Performance Report which had previously been circulated. The following key areas were highlighted:

8.2 Operationally December had seen an increased level of A&E attendances and an increase in emergency admissions relative to the same period in 2017.

8.3 There had been a decrease in attendances of -1.9% for patients aged 65 and over and for patients aged 85 and over there had been a decrease of 3.6%.

8.4 Over 65 emergency admissions had increased marginally in December by 1.5% compared to December 2017 whilst for patients 85 and over there had been a decrease of -0.8%. For adults under 65 there had been a 7.1% increase compared to December 2017.

8.5 Formally reportable Delayed Transfers of Care totaled 3.56% for December being a marginal reduction from the November figure of 4.07%.

8.6 Average inpatient bed occupancy in December was 92.9%, a slight increase from 92.8% in November and significantly lower than December 2017 (95.9%).

8.7 A&E was non-compliant against the National Constitutional target in December, with 92.83% of patients waiting less than four hours from arrival at A&E to admission, transfer, or discharge, a 2.9% reduction against November performance of 95.72%. 925 patients waited for more than 4 hours in A&E.

8.8 In December just under half of Trust beds were occupied by patients with a length of stay (LOS) greater than 7 days, and 18.5% with patients exceeding 21 days stay.

8.9 Ambulance handovers within 15 minutes for the Trust deteriorated in December 2018 to 46.1% from 49.3% in November but had improved from 35% in December 2017. The Trust continued to work with SECAmb to address issues around numbers of patients waiting to be handed over by Ambulance crews to A&E and Emergency Floor departments.

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8.10 The Trust remained compliant with the 2-week referral rule for December 2018 with performance of 96.4% against the 93% target, a 0.6% improvement on the November position. Of the 57 breaches in month, 16 related to upper GI, 12 skin and 11 head and neck patients.

8.11 The Trust was not compliant against the combined 62 day rule with 81.99% (81.14% for 2 week GP referrals and 86.36% for screening referrals) against the target of 85.1%. Of the 21.5 62-day referral GP breaches, 4.5 of these related to Urology and 5 related to Colorectal.

8.12 Although Urology referrals had reduced since June from the high levels seen between March and May, the impact had taken a while to work through the system. October and November also saw above average 2-week wait referrals impacting on this specialty.

8.13 Referral to Treatment (RTT/18 weeks) was not compliant against the target of 92% in December with 81.27% of pathways waiting less than 18 weeks.

8.14 The Trust compliance for December was 0.83% over 6 week waiters across all diagnostic modes. This represented 53 over 6 week waiters of a total list of 6417 patients. It was a marginal worsening on the November position of 0.35% but remained compliant against the 1% national target.

8.15 The Trust had, as of December, remained compliant against this metric for an entire calendar year.

8.16 Responding to a question from Joanna Crane on whether the Trust has had to divert patients, Jayne Black explained that when the Trust was experiencing difficulties there were occasions when patients had to be diverted and times when patients had also been diverted between sites to help each other. George Findlay added that with regard to out of area diverts, patients on the borders would usually be taken to the least busy hospital where simple cases would be discharged but the more complex cases would be repatriated as soon as possible.

8.17 Mike Rymer was pleased to see the reduction in admissions and enquired if changes in the Community had helped. Jayne replied that a number of initiatives had been put in place with Community partners especially around frailty and it was hoped that this would be reflected in January’s performance figures.

The Board received and NOTED the content of the Trust’s Performance Report for Month 9, 2018/19

TB/01/19/9 Organisational Development and Workforce Performance Flu Compliance Update

9.1 Denise Farmer presented the report which had previously been circulated and highlighted the following key areas.

9.2 During Month 8 there had been an increased prevalence of short-term absence although the amount of stress related and MSK sickness remained the same. The range of in-month absence ranged from 2.8% in corporate areas to 6.9% with the Estates and Facilities Division.

9.3 Attendance rates on Safeguarding Adults fell again during December. Actions to address Level 1 training had now been agreed and plans to improve Level 2 and 3 training were being developed by the safeguarding leads.

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9.4 At the end of December, appraisal rates were 87.6%. Compliance within Corporate areas had improved to 88% although disappointedly the Medicine Division fell to 83.8%. The Estates and Facilities and Core Divisions continued to exceed 90% compliance.

9.5 The theme of this year’s Staff conferences was Inclusion. Two events were planned to take place on Friday 24th May and Thursday 13th June. The conferences would build on the last four years and would demonstrate a clear link to the patient, our people and Trust values. The objective would be to further integrate and increase awareness of diversity throughout the organization.

9.6 Market place stands would showcase traditions, cultures and religious festivals from around the world, and local communities representing our diverse populations would be approached to participate.

9.7 The national results of the Staff survey were expected in February; a full report would be brought to the Trust Board for the next meeting.

9.8 Flu Compliance Update To date more than 4,000 members of staff had received their flu vaccination in the Trust. This equated to 62% of all staff. 64% of frontline staff had been vaccinated. This number was an increase on last year but had not achieved the number hoped for. However, it was likely the numbers would increase now that flu was having an impact.

9.9 The review of the previous campaign reinforced the importance of workplace vaccinators in delivering the vaccine and ensuring a high proportion of staff were individually approached to be offered the vaccine.

9.10 Maggie Davies commented that whilst a higher number of cases of flu had been reported at Worthing Hospital, the introduction of in-house testing for flu and inpatients being offered vaccinations had had a positive impact. Flu vaccinations were continuing to be offered to Staff.

9.11 Replying to a comment from Mike Rymer that doctors appeared to be those with the poorest uptake of the flu vaccinations George Findlay said that, although it had been disappointing that medical staff had the lowest uptake actions were being introduced that would make it a regulatory body requirement to comply.

9.12 The Board received the reports and NOTED the actions that were being taken to ensure an improvement in the uptake of flu vaccinations by medical staff.

TB/01/19/10 Learning from Deaths – Quarter 2 108/19

10.1 George Findlay presented the report and that has been previously circulated.

10.2 The Trust currently screened deaths at consultant level using a set of prompts designed to cover Board areas where problems in care may have occurred and referral for Structured Judgement Review (SJR) may occur through this process. In Quarter 2 75% of deaths were screened through this process.

10.3 It was recognized that the current process for screening was limited and could lead to delays in identifying cases for full review. The Trust was currently streamlining the existing process whilst looking to test moving to a

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daily review process. This would be tested early in 2019 with a view to rolling out across the organization.

10.4 The Trust had now recruited to all its reviewer posts which would support resolving the issues related to capacity and timeliness of reviews.

10.5 A Learning from Deaths Manager was in the process of being recruited to coordinate review activity, lead on improving both screening and review processes and ensure learning is shared across the organisation.

10.6 In Quarter 2, 70 patients had been referred for Structured Judgement Reviews. There had been no deaths identified in the SJR process in Q2 that were considered more likely than not due to problems in the care of the patients.

10.7 The SJRs reviewed six discreet areas of care including overall assessment, end of life care and peri-op care and categorised problems into broad themes where issues identified. A feedback mechanism was also in place for learning.

10.8 For reviews of deaths in Q2 capacity remained an issue although it should be noted that first reviews were undertaken in all but one case where an SJR was requested or fell into a mandatory category.

10.9 Jon Furmston questioned whether changes actually happened once the learning and feedback had been given to appropriate groups as this was not clear from the report. George Findlay confirmed that feedback was given to clinicians on individual cases and they were also encouraged to bring cases for review.

10.10 The Board received and discussed the progress toward implementation of the Learning from Deaths policy and the learning identified from structured mortality reviews.

TB/01/19/11 Nursing Staffing Capacity Report

11.1 Maggie Davies presented the Nursing Staffing Capacity report and summarised the following key areas.

11.2 The report provided information on all adult inpatient wards at the Trust, maternity and children’s wards. It highlighted the need for further review on adult wards with current provision at 2 trained RNs at night and high nurse to patient ratios.

11.3 Recruitment of nursing and midwifery staff was essential and would need to continue at pace, locally, nationally and internationally. However, the supply of nurses and midwives was limited and focused activity in the Trust would be on retaining staff, increasing student numbers and how to develop our own people to become skilled registered practitioners. These measures were particularly important as Universities were reporting up to 32% reduction of applicants following the removal of the bursary for student nurses/midwives.

11.4 The vacancy factor for all areas was managed by the use of bank and agency staff, it was noted that the Board receive a monthly dashboard summarizing the percentage of filled shifts by ward and role. The monthly Quality Report also contained safety metrics including falls and pressure ulcers. Registered nursing staff continued to be recruited through monthly domestic campaigns led by the Lead Nurse for Workforce.

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11.5 The Overseas campaign remained successful. 26 nurses arrived between January and December 2018 with a current OSCE pass rate of 100%. A further 10 were expected in Quarter 4. A further trip to the Philippines was undertaken in October 2018 with a recruitment offer given to 110 candidates.

11.6 An escalation process was available for staff to follow when staffing did not meet the planned numbers and a process for recording red flag incidents was in place.

11.7 Maternity was a service that required flexible use of midwives and support staff across the labour and maternity ward settings. At times there was a need for escalation. Labour wards were prioritized and midwives would move from the maternity ward to labour ward when this was required for safety and this could, at times, impact on the numbers of midwives on the maternity ward who were available to support women. The service had recently reviewed the escalation procedure and there was a dedicated Midwifery Manager on call 24/7 to support staffing and decision making at times of increased activity.

11.8 The Head of Nursing for Paediatrics was currently leading a review of nursing establishments across both Paediatrics and neonates, to establish the safety and sustainability of the current nursing models as the current model had a seasonal variation. There was evidence to support that, although activity may reduce in the summer period, the acuity of the children on the children’s ward may not reduce and this needed to be reflected in the workforce establishment.

11.9 Following a question from Lizzie Peers, Maggie Davies explained that red flags relating to nursing shortfalls were picked up at bed meetings during the day and bank and agency staff used to supplement any gaps.

11.10 The Board received and NOTED the Nursing Staffing Capacity Report.

TB/01/19/12 Annual report on Organ Donation

12.1 Dr Ryck Albertyn, Clinical Lead for Organ Donation presented the Annual report.

12.2 2017/18 had been another active year for organ donation and associated activities across the Trust, supported by a strong, progressive and growing Organ Donation (OD) Committee. A total of 9 patients had benefited from life-changing donations.

12.3 The Organ Donation team had delivered a number of successful promotional events both in the hospital and throughout the Trust, organized a promotion with ‘Storm Knitters’ including a photoshoot with all members used in the local and national press. In addition three Organ Donation Team films had been completed to help deliver education.

12.4 Financially the Organ Donation Committee had supported the refurbishment of the Relatives Room in Worthing Hospital.

12.5 The Committee continued to strive to raise awareness of donation and the benefits to donor recipients and helped deliver an ongoing Trust-wide education and awareness strategy aimed at key stakeholders.

12.6 Significant work remained to maintain and improve key performance indicators including DCD referral and Donor Management. Volunteers would

Minutes page 12

continue to be utilized to help the work between the Trust and the local community promoting organ donation in line with NHSBT’s national 2020 strategy.

12.7 The Organ Donation Committee had committed to funding Nursing and Consultant educational including team building away days for both band 5 and 6 ITU nurses to provide valuable time to bond, develop leadership skills and communication, whilst also being a good opportunity for delivering education around organ donation.

12.8 The Board noted that as Dr Albertyn would be stepping down from his lead role the post was being advertised.

12.9 Lizzie Peers asked what the implications were for the service with the change in legislation to opting out. Dr Albertyn replied saying that with the exception of consent everything would remain the same. However, if a family were against giving consent it would not be overridden, but consent would be assumed if the patient had no relatives.

12.10 The Board thanked Dr Albertyn for doing such a fantastic job for the Trust.

12.11 The Board received and NOTED the Organ donation and Transplant Annual Report.

TB/01/19/13 Report from Audit Committee to Board

13.1 John Furmston presented the report from the Audit Committee which had previously been circulated.

13.2 The Committee had received positive (moderate) assurance from Internal Audit in respect of the systems of internal control over the following areas of the Trust; Key financial Systems, Divisional governance, Data Quality and Business Continuity.

13.3 A report from Internal Audit was received confirming the Trust continued to progress with developing its risk management maturity.

13.4 The Committee approved the accounting policies and approved the continued non-consolidation of charitable funds on the grounds of materiality.

13.5 The preferred counter fraud supplier was recommended for approval at the next Finance and Investment committee.

13.6 The committee agreed to pursue a joint WSHT and BSUH Internal Audit procurement process and endorsed the Trust’s BAF and its representation of the risk profile at the end of December.

13.7 The Board noted that the following items had been referred to the Board or another committee for decision or action: - Improved process required for monitoring and implementing the NICE guidance, ensuring Divisions were aware of their responsibilities. Actions taken back to the Quality and Risk Committee. - Continue to enhance the cross-divisional learning from complaints and incidents. - Internal Audit to continue to support the Trust risk maturity journey by ensuring their annual plan contained an element of time to provide assurance that the Trust was moving towards ‘embedded’ within the

Minutes page 13

risk management maturity rating they used. - The Board to be made aware of the progress with Declarations of Interest which currently stood at 91% and expected to achieve 100% completion by year end. - An audit had highlighted shortfalls in the approach to the security of patient property across all wards. Since then 60 patient property boxes had been purchased for roll out to the wards.

13.8 The Board received and NOTED the actions taken by the Committee, the matters referred to other committees for further action in respect of closing assurance gaps and the noteworthy matters referred to the Board.

TB/01/19/14 Emergency Preparedness and Resilience and Response Assurance (EPRR) Report

14.1 Jayne Black presented the report that had previously been circulated.

14.2 The report summarized the Trust’s assessment against the EPRR Core Standards for the 2018 Assurance which cited the Trust’s current rating as ‘Substantially Compliant’ based on NHS England’s requirements for Core Standard 50.

14.3 This year the revised EPRR Core Standards cited 64 individual standards covering Governance, Duty to Risk Assess, Duty to Maintain Plans Command and Control, Training and Exercising, Response, warning and Informing, Cooperation, Business Continuity and Chemical, Biological, Radiological, Nuclear (CBRN)

14.4 The overall Trust self-assessment assurance rating based on the revised NHS England’s core standards for 2018/19 and subject to any additional clarification from NHS England with regards to core standard 50 has been assessed as Substantially compliant.

14.5 The Board approved the findings of this report and agreed the overall compliance rating of Substantially Compliant.

TB/01/19/15 Annual Emergency Planning and Business continuity Report

15.1 Jayne Black presented the report and highlighted the following key areas.

15.2 The paper provided a report on the Trust’s preparedness to respond to emergencies in order to meet the requirements of the Civil contingencies Act (2004) and the NHS England Emergency Preparedness, Resilience and Response (EPRR) Framework 2015.

15.3 The Trust had a mature suite of policies and plans to deal with EPRR issues and specifically Critical Business Continuity and Major Incidents as defined by the NHS England EPRR framework.

15.4 The report provided an overview of the Trust’s current position with regard to the NHS England EPRR and focused on the following key areas: - Risk Assessment - Assurance - Policies and Plans - Business Continuity - Training and Exercising

15.5 Throughout 2018 the Emergency Planning and Business Continuity Team

Minutes page 14

developed, improved and updated Trust-wide EPRR policies and plans following learning from incidents, events and exercises and these were clearly shown in the Emergency Planning and Business Continuity Workflow 2019.

15.6 The Board APPROVED the Emergency Planning and Business Continuity 2018 Annual Report.

TB/01/19/16 Annual Equality and Diversity Performance Report 2018

16.1 Denise Farmer introduced the report that had previously been circulated and highlighted the following the key areas.

16.2 Recognising the Trust’s workforce and patients were core to achieving its business and social responsibilities the aim of the report was to help demonstrate progress in delivering the best possible inclusive healthcare services, and a workforce which was valued and reflective of the communities the Trust served.

16.3 Rated as Outstanding by the Care Quality Commission (CQC) in April 2016 a number of factors within the CQC’s well-0led inspection regime were linked with equality, diversity and inclusion.

16.4 The theme for the Trust’s 2019 Staff Conference was ‘Inclusion’. This continued the last four year’s conference themes of launching the Trust’s Patient First Programme – Where Better Never Stops, Making Improvements, Staff Experience and Patient Experience and the ‘Inclusion’ theme demonstrated a clear link to The Patient, Our People and Trust Values.

16.5 The objective of the staff conference would be to further integrate and increase awareness of diversity throughout the workforce. By working in collaboration and understanding the different needs of patients and staff, the Trust would improve patient services and establish stronger links in the local community.

16.6 The Board endorsed and APPROVED the report.

TB/01/19/17 Committee Reporting/Calendar 2019/20

17.1 Glen Palethorpe presented the schedule of Board and Council of Governor meetings for 2019/2020.

17.2 In constructing the schedule the desire to have meetings across the two key hospital sites of St Richard’s and Worthing had been taken into account. Board meetings would alternate between Worthing and St Richard’s.

17.3 The council of Governor meetings would also be held across both the two sites.

17.4 Both the Board and Council of Governor meetings had their agendas and supporting papers placed on the Trust’s website by the start of the week in which the meeting took place. The cycle of meetings would be publicized on the Trust’s website during the first week of February 2019.

17.5 The Board noted the dates for meetings of the public Board and public Council of Governors for April 2019 to May 2020 and NOTED that these dates would be publicized on the Trust’s website during the first week

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of February.

TB/01/19/18 Any Other Business

18.1 There was no other business to discuss.

TB/01/19/19 It was noted that the next Board Meeting would take place at 11.30am on 28th March 2019 in the Mickerson Hall, Chichester Medical Education Centre, St Richard’s Hospital, Spitalfield Lane, Chichester, PO19 6SE.

19.1 The Chair formally closed the meeting

TB/01/19/20 Questions from Members of the Public

20.1 With a lot of media coverage regarding supplies and staffing issues post Brexit, Alan Sutton asked what contingencies the Trust had in place. Alan McCarthy replied that a large amount of planning was being undertaken by the Trust, especially around procurement, as well with the Clinical Commissioning Group (CCG) to work through contingencies.

20.2 Marianne Griffiths expressed her concern that the level of violence and aggression shown to some of the Trust’s staff from Europe and elsewhere was increasing as a result of the Brexit negotiations. This would need to be monitored carefully in order to protect staff.

20.3 Replying to a question from Anita MacKenzie as to whether there was a risk of allergies being transmitted in patients undergoing organ transplants, George Findlay advised that the Trust did not undertake organ transplants but the benefits of organ donation was huge and donors were screened and excluded if necessary after assessing the risks.

20.4 With regard to delayed discharge of patients who were medically fit, Margaret Bamford asked what progress had been made with integrated care organisations. Marianne provided an update advising that discussions had been held with providers and had invited Adam Doyle to meet with the Executive Team.

Jan Simmons Corporate Governance Officer January 2019 Signed as an accurate record of the meeting

…………………………………………………. Chair …………………………………………………

Minutes page 16

MATTERS ARISING Trust Board Agenda Item: 4

Meeting Minute Ref Action Responsible Deadline Status Person 31 January TB/01/19/06.28 Quality Report – Mixed sex breaches On the forward agenda plan to come 2019 improvement trajectory to go to TEC in Jayne Black May 2019 back to Board as part of the Quality March and then return to Board in May. Report in May. 28 February Private Quality Report – Clarification required Updated report with correct figure 2019 regarding the C-Diff figure in the Maggie Davies Completed received post meeting and uploaded onto scorecard that did not correlate with the BoardPad. narrative in the report. 28 February Private Performance Report – RTT total growth Jayne Black March 2019 To be included in the Performance 2019 to date to be included in all future reports. Report.

Page 1 of 1

To: Trust Board Date: 28 March 2019

From: Marianne Griffiths, Chief Executive Agenda Item: 5

FOR INFORMATION

CHIEF EXECUTIVE’S BOARD PAPER

1. Highlights and headlines

‘Perfect’ March The trust is aiming for a ‘perfect’ end to the financial and performance year with a special focus on Referral to Treatment Time (RTT), cancer waits and patient flow during March. The initiative is based on the ‘perfect week’ model used successfully last summer to boost discharge plans and optimise our bed position by providing additional resources for ward teams and obtaining extra, targeted support from our community partners. In the first week, divisions, care groups and clinical teams applied a similar approach to accelerate progress towards compliance with RTT and cancer waiting time standards. In the second week they have been building on the actions of our winter plan to improve flow throughout the hospitals. In particular, we aim to reduce by 40 the number of ‘super-stranded’ patients in our care, close all escalation beds by the end of the month and increase early discharges by 2% on every ward. Progress will be reviewed at the end of the first two weeks and used to identify the most effective actions to be taken across the remainder of the month. The ‘perfect week’ model has been successful before in easing the pressure on our staff and services, and we hope it will do the same again as we head towards the end of what has been yet another toughest winter ever. I know how hard everyone has been working to maintain the standards of care we all want for our patients, and also the difference that making some more progress in these three key areas can have across the entire hospital system. Putting additional focus into them now will make sure we end the year in the best possible position and set ourselves up to continue improving quality of patient care and experience as we go into 2018/19. Staff engagement puts trust in Top 20 I am delighted to report that we have maintained our highest-ever staff engagement score in this year’s national survey of NHS employees. The trust scored 7.2 on the NHS Staff Survey’s new 10-point scale, which is unchanged from both 2016 and 2017 when results from those years are recalculated on the same basis. This puts us among the top 20 acute trusts in England.

Staff engagement is the key measure of the annual survey, as it’s a proven fact that engaged staff provide better care for patients and are better able to help their organisation improve. Engaged staff understand what an organisation is trying to achieve, know how they can play their part and feel valued for the contribution they make and the commitment they give. That is right at the core of Patient First’s ‘Our People’ theme and it is really heartening that the standards we set in earning our Outstanding rating from the CQC in 2016 have become our new normal rather than a high-water mark for the trust.

In total, 4,350 Western Sussex staff (63.7%) completed the survey – only 119 fewer than the record we set in 2017 and almost 1,000 more than just three years ago. That was also the fourth- highest response rate in the country, against an average for all acute trusts of 45.4%.

Official opening of maternity bereavement suite A suite designed to give parents a safe haven to stay in after the loss of a baby has been officially opened on the maternity unit at Worthing Hospital. The Maple Suite offers a home-from- home environment with a private entrance away from the delivery suite, with its own delivery bed, bathroom, sofa bed, television and kitchenette. Love Your Hospital, the trust’s dedicated charity and local families who had fundraised to support the suite’s development, the Mayor of Worthing cut a ribbon and expressed his heartfelt thanks to all involved. On behalf of all our staff, our past and future parents, I would like to extend my special thanks to everyone who has made the Maple Suite a reality.

Nine life-changing donations Nine people received life-changing organ donations in the past year thanks to the trust’s specialist organ donation clinicians, working alongside critical care and emergency colleagues, and supported by the work of the Organ Donation Committee. Committee chair, Angela Fisher, said: “I’m delighted with how the organ donation team has raised the profile of organ donation over the past year. We have had five referrals for donation which went on to help nine patients, which is a truly an amazing achievement.”

Sentiments I echo entirely and I thank everyone involved.

Brexit and EU Exit Planning Group I want to stress our continued and steadfast commitment to all our staff from European countries. EU citizens working in the health and social care sector can apply early to get settled in the UK before Brexit. The free EU Settlement Scheme is open to NHS workers before 30 March, when the scheme launches to the public, which will prompt a significant rise in demand. To apply, colleagues can visit www. gov.uk/eu-settled-status. The trust is working very closely with NHS England and partners to prepare the organisation for Brexit at the end of the month. Chief operating officer Jayne Black chairs a fortnightly meeting of the trust’s EU Exit Planning Group, where business continuity preparations, procurement, staffing, finance, information governance and other logistical issues are discussed.

Congratulations - double celebration for research Congratulations to our Research nurses who won an award for being the ‘Top Recruiter’ of participants into a national study looking at the use of saliva to predict oesophageal cancer, and potentially colorectal cancer. The National Institute for Health Research (NIHR) commended the trust’s research team for exceeding their target and recruiting 117 participants to the Saliva to Predict risk of disease using transcriptomics and epigenetics study, known as SPIT for short. Across the trust there are more than 160 clinical trials open in a wide range of clinical specialities, from maternity to older persons care, with almost 2,000 new patients taking part this year alone.

The Research & Development team has won two awards at the Partner Research Awards, organised by the National Institute for Health Research (Kent, Surrey & Sussex). Head of research, Dr Cate Bell, was a joint winner of the Improvement & Innovation Award, while clinical trials nurses Linda Folkes and Carla Lewis won the Involving Patients in Research Award.

I am delighted that all the fantastic work going on to support improved engagement with research – for both patients and staff – has been recognised in these recent awards. We know that organisations that support NHS research have better care and outcomes for patients and it’s good to see this recognised and celebrated as part of our already outstanding organisation.

Population Health Check The NHS has published a ‘long-term plan’ - www.england.nhs.uk/long-term-plan/ - that sets out the priorities and ambitions for the years ahead to make sure the NHS continues to provide high quality care across the country. Local organisations have been asked to work together as part of health and care systems to develop their own plans by autumn 2019 which will set out how the national long-term plan will work across local areas. To help develop the local plan, doctors, specialists and clinicians have come together across Sussex and East Surrey to develop a ‘Population Health Check’. They have looked at clinical evidence, patient experience and local population information and given a diagnosis of what needs to change from their expert point of view. They have found that 75% of deaths and disabilities across our local area are caused by five conditions – cancer, circulation and respiratory disease, diabetes, bone and joint conditions, and mental health conditions – and these cause the biggest impact on services. The Population Health Check sets out priority areas that we need to focus on to allow services to better meet the needs of our population:

• Looking at new ways to treat and care for more people • Looking at how our staff can work more effectively • Supporting people to manage their own health and care better • Supporting people to make the right lifestyle choices • Reducing unjustified differences in treatment and care • Providing services closer to home with good communication and co-ordination

The public is being asked for their views on how we should best meet the many challenges we face across the Sussex and East Surrey STP (Sustainability & Transformation Partnership) area. In West Sussex, events are taking place:

• Tuesday 19 March at The Barn, Field Place, Worthing, 5-7pm • Wednesday 20 March at Assembly Room, Chichester, 10am-12pm • Wednesday 27 March at The Grange Community Centre, Midhurst, 2-4pm

Find out more and via the STP website and read the Population Health Check document published earlier this month.

CQC engagement The Care Quality Commission has continued its series of engagement visits to the trust, most recently this month meeting with colleagues from our Women and Children’s Division and prior to that, Medicine. It is anticipated the CQC will also undertake a full inspection of Western Sussex Hospitals in the 2019/20 financial year and, again, we look forward to showcasing the many improvements staff have introduced since our last full inspection in December 2015, which resulted in our “Outstanding” overall rating from the health watchdog.

2. Events and Visits

Diary dates I would urge anyone wishing to keep in touch with trust news and dates of future events to become a member of the Foundation Trust. Please follow the link on our website to register your interest. Signing up is free, quick and easy. Members automatically receive our monthly e- newsletter called @WesternSussex.

• The next Trust Board public meeting will take place on Thursday 30 May 10.30 at Worthing hospital in Worthing Health Education Centre (WHEC) • The trust’s full Council of Governors (COG) met in public on Thursday 7 March at The Dome in Worthing. The governors, who represent our local population and stakeholder partners, discussed the trust’s performance, as well as trust membership and governance, and took questions from members of the public. The next COG meetings will take place at: th o St Richard’s - 4 July in Mickerson Hall, CMEC from 15.00 – 18.00.

Worthing - 3rd October in John Bull Room, WHEC from 15.00 – 18.00 o th o Worthing - 16 January in John Bull Room, WHEC from 15.00 – 18.00

3. Our People

Chief Nurse The trust’s chief nurse Nicola Ranger will be leaving in June to take up a new opportunity at King’s in London. Nicola is a fantastic advocate for nursing and midwifery and also champions improvements to patient experience in many ways. We are pleased she will be with us as we prepare for our forthcoming CQC inspection.

In light of Nicola’s move, I have sought views about nursing leadership and structure and had discussions with nursing colleagues across the trust over the past few weeks and confirm our plans to further strengthen the voice of nursing at board level. The new Western Sussex (WSHT) structure will include a Chief Nurse, a voting Trust Board member, dedicated to this organisation and the appointment process is underway. This is a change from the current structure where our Chief Nurse is a group role working across Brighton and Sussex University Hospitals (BSUH) and WSHT. A Chief Nurse will also be appointed at BSUH.

Temporary changes to operational leadership We have made some changes to our operational leadership team to enable Jayne Black, Chief Operating Officer (COO), to provide support at Brighton and Sussex University Hospitals (BSUH).

Jayne will be taking on the role of COO at BSUH over the six months from April 1, and will remain part of the senior team at Western Sussex. At the same time, Amanda Fadero will be joining us from the Coastal West Sussex Clinical Commissioning Group, where she is currently Executive Director of Commissioning, Partnerships and Planning. As our new Managing Director, Amanda will play a key role in the development of the Integrated Care Partnership and providing operational leadership support during Jayne’s absence.

This new arrangement will benefit the Trust by enabling further improvements at BSUH that will help reduce pressure on our own services, and allow us to use Amanda’s experience across the wider local health economy to help improve patient flow and better manage demand.

Clinical Chief Information Officers Two trust consultants have been appointed to the role of Clinical Chief Information Officers (CCIO), Dr James Hayward and Mr Dan Magrill. The role of CCIO is an important part of the IT strategy with their focus being to always ensure that IT developments reflect the needs of our patients and clinicians.

Mabuhay! Four more qualified nurses from the Philippines begin their new careers with Western Sussex. This is the 23rd cohort to arrive in the UK with more than 35 international nurses starting with the trust in the last year. Six more nurses are due to arrive next month.

Eight staff up for apprentice awards At the time of writing I wish our eight trust apprentices shortlisted for Health Education England’s Kent, Surrey & Sussex Apprentice Recognition Awards on 14 March every success! Those up for a prize at the regional ceremony in Crawley are Chloe Lambourne, Shiralee Bacon, Mike Brooks, Christine Thair, Lydia Taylor, Amanda Kimmins, Keith Baker and Marc Vincent. The trust itself has also been nominated as Employer of the Year. Currently, more than 100 trust staff (both new and existing) are learning and earning on apprenticeship courses. Since 2014, more than 300 colleagues have completed apprenticeships.

Congratulations to our January Employee of the Month winner Consultant cardiologist Dr Kathy Webb-Peploe won in recognition of a discharge blitz she enabled on Christmas Eve, which helped patients from Eartham ward spend Christmas with their families.

‘Pawly’ patient in A&E St Richard’s A&E team patched up a ‘pawly’ patient last month when they noticed an assistance dog had an injury. Belle’s owner, Mr Clow, explained: “Belle’s paw was bleeding and so they cleaned, dressed and bandaged her leg! I do believe Belle brightened up the busy shift for staff on duty!” Mr Clow explained that he and his wife are hearing-impaired, saying: “Staff of all grades, the ambulance crew, domestics, porters, nurses, radiographers, and clinical teams made that extra bit of effort needed to facilitate communication. We did thank them - and for their canine care too!”

Welcome to new colleagues Dr Daniel Freedman, fixed term Consultant in Acute Medicine, Worthing, joined in February to 24 February 2020

Dr Neelima Dixit, Consultant in Obstetrics and Gynaecology, St Richard’s from 4 March.

Dr Eleanor Glenday, Consultant (Resident On-call) in Paediatrics, Worthing 12 March 2019.

Dr Edward Yates, Consultant (Resident On-call) in Paediatrics, Worthing 18 March 2019.

Dr Peter Morgan, GP Consultant in A&E, St Richard’s from 1 January 2019.

Dr Annaliese Mawdsley, Fixed Term Consultant, Paediatrics at St Richard’s since January 2019 to 20 June 2019.

Agenda Item: 6 Meeting: Trust Board Meeting Date: March 2019 Report Title: Quality Report (February Month 11) Sponsoring Executive Director: Dr George Findlay (Chief Medical Officer) and Nicola Ranger (Chief Nurse) Author(s): Jo Habben Head of Clinical Governance and Patient Safety

Report previously considered by Quality Board and date: Purpose of the report: Information  Assurance  Review and Discussion  Approval / Agreement  Reason for submission to Trust Board in Private only (where relevant): Commercial confidentiality Staff confidentiality Patient confidentiality Other exceptional circumstances Link to Trust Strategic Themes: Patient Care  Sustainability  Our People  Quality  Systems and Partnerships  Any implications for: Quality  Financial Workforce Link to CQC Domains: Safe  Effective  Caring Responsive Well-led  Use of Resources Communication and Consultation:

Executive Summary:

The monthly quality report describes performance against quality outcome KPIs, including safety, infection control, experience, effectiveness and mortality.

This report pulls together key national, regional and local quality indicators relating to quality and safety providing assurance for the Board and (if necessary) highlighting issues.

Appendix 1: Quality Scorecard Appendix 2: Ward Staffing Scorecard

Key Recommendation(s):

The Board is asked to: Note the contents of this report.

1 INTRODUCTION

1.1 This report brings together key national, regional and local indicators relating to quality, performance and safety. The purpose of the report is to bring to the attention of the Trust Board quality performance within Western Sussex Hospitals Foundation Trust (WSHFT).

1.2 The paper describes performance on an exceptional basis determined by RAG (red/amber/green) ratings based on national, regional or local targets.

2 2018/19 REFRESH

2.1 There has been a refresh of the Monthly Quality Report for 2018/19 to reflect the key quality objectives for the next year aligned to Patient First and our True North objective1. The report follows the same format as previously using the same suite of metrics, with revised targets using similar logic in the interim to that applied for 2017/18:-

• If 2017/18 performance exceeded target, then 2017/18 actuals used as 2018/19 target • If 2017/18 performance did not meet target then 2017/18 target remains the same for 2018/19 • If there is a national or set target then that will continue as the measure • Any metrics with no target set continue as before

2.1.2 The Quality Scorecard for 2018/19 incorporates the following changes: • Site view New indicators: a) E45- % of Part 2 inpatient deaths reviewed b) E54- Reduced A&E visits for a cohort of frequent attenders who would benefit from MH interventions c) E59-Rate of discharges by midday under section ‘Increase discharge effectiveness’ d) E55-Normal delivery rate under section ‘To improve maternity care by encouraging natural childbirth’ e) E58-Induction of labour f) S48-Focus on anticoagulants: Average no. patients per day on VTE missing report (EPMA) g) X47- Local staff engagement score: I am able to make improvements happen in my area of work: • Removal of some indicators as advised • Some minor re-arranging of metrics and changes to metric definitions

1 Patient First is our long term approach to transforming services. ‘True North’ is the one constant towards which the four strategic themes for the organisation – sustainability, people, quality improvement and Systems & partnerships – should lead. 1 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

3 KEY QUALITY OBJECTIVES

3.1 Scorecard Definitions

3.1.1 The full Quality Scorecard is presented as Appendix 1. Figures are in-month figures (e.g. the number of falls reported in Febraury 2019) unless otherwise stated. The scorecard shows 13 months to allow trends to be identified, although some data items are reported retrospectively. Year to date actuals/targets are based on financial years unless otherwise stated (standardised mortality ratios are recorded as 12 month positions for example). A subset of the key measures from the report is presented at 3.3. These currently remain the same sub-set as last year and will be refreshed when the new scorecard is established.

3.1.2 Exception reports are included under the relevant section of this report (Effectiveness, Safety and Patient Experience).

3.1.3 Although the scorecard reflects 13 months of data, only the current financial year and year to date values are RAG rated - with the exception of those metrics reported in arrears where the most recent data-point of last year is RAG rated.

3.2 Domain scores

3.2.1 The score is an overall indication of the performance in relation to each of the domains - Effectiveness, Safety and Patient Experience. The score is calculated as follows: Each RAG rated indicator for a month is scored: red scores 1, amber scores 2, green scores 3. These scores are then totalled and divided by the total number of indicators with RAG ratings to give a score for the domain as a whole between 1 and 3. This final score can then itself be RAG rated with >2.5 giving an overall green, 1.5 to 2.5 amber and <1.5 an overall red score for the domain as a whole. For example if a domain had two greens and a red the calculation would be as follows:

3 (green) + 3 (green) + 1 (red) = 7 7 / 3 (i.e. the total number of metrics) = 2.33 i.e. amber overall.

3.2.2 Domain scores are calculated based on the year to date RAG ratings for each metric. Previous months are retrospectively updated to take account of any measures reported in arrears, and should additional metrics be added within the domain. As with any aggregate indicator, it remains essential that the Board retains sight of the individual elements as well as the domain score as a whole.

2 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

3.3 Overview of Key Quality Objectives

3.3.1 The following table shows performance against key quality objectives.

Indicator December January February 2018/19 2018/19 2018 2019 2019 to date Target / limit Effectiveness Domain Score 2.00 1.81 2.00 2.04

Safety Domain Score 2.20 2.07 2.46 2.18

Experience Domain Score 2.43 2.30 2.48 2.48

E01 Trust crude mortality rate (non-elective) 3.30% 3.28% 2.81% 2.64% 3.10%

E03 Hospital Standardised Mortality Ratio for top 56 diagnoses (Dr Foster, based on rolling 89.8 100 12 months) S06 Number of Serious Incidents Requiring 5 2 4 43 53 Investigation (number reported in month) S14 Numbers of hospital attributable MRSA 0 0 0 0 0

S28 Numbers of hospital C. diff where a 3 3 1 15 16 lapse in the quality of care was noted

X38 The Friends and Family Test: 97.3% 97.5% 97.8% 97.3% 97% Percentage Recommending Inpatients X39 The Friends and Family Test: 95.9% 95.6% 94.9% 95.3% 93% Percentage Recommending A&E X13 Mixed Sex Accommodation breaches 28 44 24 167 0 (number of breaches)* X18 Number of complaints 30 44 23 382 456

*Narrative summary/update Page 14

3 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

4 EFFECTIVENESS

4. 1 Crude Trust Mortality

4.1.1 Due to the low level of mortality experienced in elective care, the Trust measures mortality in relation to non-elective activity using the previous year as a benchmark.

4.1.2 Crude non-elective mortality reduced from 3.28% reported in January to 2.81% reported in February, also remaining lower than the equivalent month in 2018 (3.86%). Worthing Hospital reported 2.91% in February a reduction from the previous month when 3.53% was reported.

4.1.3 The number of non-elective patients (Crude) who died in February was 160 (3.28%) from 6367 discharges. Worthing and Southlands reported 84 deaths of 2887 discharges (2.91%) and St Richards Hospital reported 76 deaths of 2807 discharges (2.71%). The year to date mortality rate is 2.64% and the rolling 12 month mortality rate is 2.96%.

4.2 Hospital Standardised Mortality Ratio (HSMR)

4.2.1 There is a delay in data being available in Dr Foster tools to allow for coding and processing by NHS Digital and Dr Foster. The most recent data available is November 2018.

4.2.2 The Trust’s HSMR for the twelve months to November 2018 is 89.8 (1755 deaths against expected 1953) 100 is the level predicted by the Dr Foster model using the July 2018 benchmark.

4.2.3 The twelve month HSMR to November 2018 split by site continues to be lower for St Richard’s 87.5 (799 deaths against expected 912) than for Worthing and Southlands 91.8 (956 deaths against expected 1041). Both sites are within the acceptable variation limits (below 100).

4.2.4 E09. Standardised Mortality Ratio for hip fracture (reported November) – has demonstrated a reduction to 105.5 against a target of 100. St Richards SMR for hip fracture stands at 94.7 in November 2018 and Worthing SMR is recorded at 113.5. A targeted mortality review is underway in view of the rising SMR.

4.2.5 E10. 30 day crude mortality rate following hip fracture – remains relatively static in November 2018 reported at 6.8% against target of 5.70% (YTD actual 6.8%). A detailed paper was presented to the November Trust Board providing a ‘deep dive’ into #NOF mortality. The National Hip Fracture Database Annual Report (2018) showed case mix adjusted mortality rates that were better than the national average on both sites and significantly better on the Chichester site. The case mix adjustment of the Worthing data was large and reflected the patient demographic of elderly frail patients many of whom reside in care and nursing homes.

4.2.6 A further report is available to clinical leaders in the Trust showing the clinical diagnostic areas with high actual versus expected mortality and any mortality CuSum alerts.

4 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

4.2.7 The Trust has set the goal of achieving a position within the top 20% of Trusts as measured by HSMR. For the twelve months to October 2018 (benchmark period July 2018), performance using this measure places the Trust on the 22nd centile (29 out of 133 Trusts).

4.3 Summary Hospital-Level Mortality Indicator (SHMI)

4.3.1 The latest data made available by the Health and Social Care Information Centre is for the period to September 2018. The Trust value remains static at 0.98% from the previous reporting period -Q3 2017/18 (where 1.00 is the national average), with the Trust banded as “as expected”.

4.4 Exception Reports Relating to Effectiveness

4.4.1 E45. Percentage of part 2 inpatient deaths reviewed. In relation to the Trust mortality review (MR) process in February 60.9% of part 2 MR were completed against a Trust target of 100 (YTD 75.1%). Additional mortality reviewers have now been recruited and this will increase the capacity for timely reviews.

4.4.2 E58 Induction of labour (new indicator). February’s data reports a decrease from 34.3% to 32.4% from January, against a target of 29.4%. Increasing safe birth continues to be an area of focus for the division and rates are closely monitored via monthly divisional performance reviews.

4.4.4 E59. Rate of discharges by midday (new indicator). February’s data reports static performance in the discharge rate at 15.26% against a target of 45% (YTD 15.3%).

4.4.5 E18. % Emergency admissions staying over 72h screened for dementia. Since July there is a reported decrease in performance, February’s data reports 81.72% compliance against a Trust target of 90%.

4.4.6 E39. Ward moves for patients flagged with dementia. In February a total of 232 patients with a diagnosis of dementia were affected by ward moves, a decrease from 279 reported in January. In addition 58 patients diagnosed with dementia were moved at night. Improvement work continues as per summary report provided in Decembers report.

4.5 Stroke Care (Data to January)

4.5.1 The stroke metric information is updated each month, but provides a provisional position for the most recent 2-3 months, drawn from the SNNAP Database. Patient level information is fed from the clinical teams to the national database and can be added to and revised up to a quarter past the point at which the stroke activity took place, and as such is liable to fluctuation until such point as the SNNAP data is published (ordinarily a quarter in arrears). The information is provided on the basis that having an early view of likely performance is preferable to awaiting the finalised quarterly information 3 5 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

months in arrears. The other factor to note in the case of stroke metrics is that the numbers of patients can be fairly small in terms of patients eligible and given thrombolysis each month (by way of example) and as such can appear volatile as a symptom of changes to these small numbers and their impact on the metric performance percentages. It is also possible for patients to be thrombolysed en- route to Donald Wilson House, which is captured as a separate site on the SNNAP database. This explains why the sum of SRH and Worthing site may not equate to the Trust total performance.

4.5.2 E26. Percentage of CT scans undertaken within 12 hours is reported as 96.6% in January, exceeding the annual target of 95%.

4.5.3 E27. Stroke thrombolysis within 60 minutes of arrival reports 50.0% performance for January against a target of 95% (YTD 61.7%). Worthing Hospital reports 40% compliance and SHR reports 80% compliance.

4.5.4 E28. Percentage of swallow screen for stroke patients within 4 hours of admission has increased, reported as 93.7% in January, against an annual target of 95%.

4.5.5 E29. % Stroke patients admitted to stroke unit within 4 hours of admission. A decrease in performance is noted from December (78.8%) to 65.5% reported in January, Trust target is 90% and YTD total is recorded as 73.5%.

4.5.6 E30. % high risk TIA patients seen in 24 hours reports a performance of 21.1 % reported in January against an annual target of 60%.

4.5.7 Stroke performance is benchmarked against the Sentinel Stroke Audit (SSNAP), with sites being graded from A-D based on 10 domains (44 metrics). Data and grading is published in 4-monthly periods Dec-Mar, Apr-Jul and Aug-Nov.

4.5.8 The latest Sentinel Stroke Audit (SSNAP) data published for the period April – June 2018 showed an improvement in stroke performance for both sites. Worthing achieved an overall Grade A (Up from a B) and St Richards achieved a Grade B (Up from a C).

4.5.9 E23. Patients recruited with a CRN (Research) portfolio remains below trust target at 144.

6 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

5.0 SAFETY

5.1 Central Alert System (CAS) Safety Alerts

5.1.1 There are no outstanding alerts for the Trust up to February 2019.

5.2 Serious Incidents Requiring Investigation (SIRIs)

5.2.1 There were 4 reported incidents categorised as a Serious Incident (SI) requiring investigation in February.

5.2.3 Regarding serious incident’s investigated internally at WSHFT; three reported serious incidents were in relation to diagnostic and treatment delays (2 malignancy and 1 glaucoma diagnosis) and one incident was a in relation to the suboptimal care (death) of a deteriorating patient following a significant reaction to chemotherapy treatment.

5.2.4 A detailed serious incident report is provided to the committee section of the Trust board. The board should note there can be slight variation in the month-by-month numbers between the SI report and the number of significant incidents – this is because incidents are attributed to the month in which they occur whereas the SI data is based on the month in which the SI was reported externally.

5.2.5 Any incidents that are reported as causing significant harm (moderate, severe or resulting in the death of a patient) are notified immediately to the senior team in the Trust including the chief nurse and the chief medical officer with at least weekly updates on progress. In February 19 incidents were reported, against a yearly target of 153 (YTD actual 162), whilst above the Trust target, the increased focus and vigilance with reporting incidents and accurately grading the harm level, triangulated with the mortality reviews (and reporting harm on to the electronic incident reporting system Datix) may account for any rise.

5.2.6 On a monthly basis there is triangulation of information arising out of complaints, claims, serious incidents, Freedom to Speak Up themes, safeguarding (Serious Case Review) and inquests to identify any areas of learning or for focus. The Triangulation Committee continues to focus on how we share learning across the organisation, with a detailed ‘Deep Dive’ focus on an incident(s) (where the learning for the organisation is significant) being discussed at each meeting. Representatives from the CCG quality team attend the meetings on invite and have commented that the increase in quality of the SI investigation, timely submission and closure on first submission to the CCG Serious Incident Review Group is to be noted.

7 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

5.3 Infection control

5.3.1 There were 2 cases of Clostridium Difficile reported in February and of these, one lapse of care was identified at Worthing due to a delay in sampling.

5.3.2 The Trust remains within the C.diff trajectory and the Trusts C.diff trajectory will be refreshed for 2018/19.

5.3.3 The allocated Trust target limit for 2018/19 (C/Diff) is set at 38 2 and the Trust remains within the annual target (YTD 31).

5.3.4 S16a. Number of hospital attributable MSSA bacteremia cases in February has been reported as a total of 1; this case was reported at the SRH site and was potentially due to a contaminant.

5.3.5 S17a. Number of Hospital attributable E.coli cases in February has been reported as a total of 5. One of these cases was reported on the Worthing site and four at SRH. The root causes being identified as urosepsis or urinary source, and an ischaemic foot, 2 causes remain unidentified.

5.3.6 The lead IPC nurse has been invited to attend the NHSI UTI Collaboration four day event held from September – January 2019. This will support clinical practice improvement by providing a structured programme utilizing quality improvement theory and methodology to reduce gram negative blood stream infection. All learning is discussed at ICOG meetings.

5.3.7 S44 (reported January). Antimicrobial stewardship and consumption: 2% reduction in overall antibiotic consumption. Januarys data reports at 13% performance against a target of 0%

5.3.8 Total antimicrobials reaching this target remain difficult and the Trust is unlikely to meet the target for this aspect of the CQUIN but is still awaiting feedback from Public Health England. The organisation continues to look at specific areas to identify where interventions to reduce antimicrobial use can be made e.g. ED and the emergency floor. The Trust have taken a more active role in stewardship on micro-ward rounds and using daily antibiotics and sepsis flagged patients lists to identify patients who can be stepped down, stopped and reviewed in the medical notes.

5.3.9 Access, Watch and Reserve (AWaRe): The ACCESS antibiotics are first- and second-choice options for common infections; they should be readily available in all facilities. The WATCH group includes antibiotic classes that should be prescribed only for specific indications, since they are at higher risk of bacterial resistance. Some ACCESS antibiotics, such as ceftriaxone or azithromycin, are also part of the WATCH group. The RESERVE group is made up of last-resort options, such as colistin or IV fosfomycin.

2 NHSI (2017) Clostridium difficile infection objectives for NHS organisations in 2017/18 and guidance on sanction implementation. Page 5 8 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

5.3.10 AWaRe categories, again progress excellent. The Trust continues to ensure guidelines promote narrow-spectrum use and police the use and prescribing of antimicrobials for inpatients. Pharmacy is currently working with A&E to encourage reductions in broad-spectrum use.

5.3.11 S08. Medication incidents. Februarys reported data has seen a decrease in reporting to 78. As the Trust encourages a culture of transparency and incident reporting, the pharmacy team continues to link with the Trust analyst team to review the current scorecard targets and improvement trajectory.

5.4 Falls

5.4.1 During July the Trust and the Sussex Clinical Commissioning Groups Quality Team (within the Sustainability and Transformational Partnership STP) agreed a change in process for Serious Incident (SI) reporting in line with the NHSE Serious Incident Framework 2015. The SI process will only be triggered if following an internal panel review it is felt that the incident meets national SI reporting framework requirements. The existing panel meeting allocation for pressure ulcers will now also be used to review the SWARMs and concise investigation reports for all future moderate harm falls.

5.4.2 In February, inpatient falls decreased from a total of 161 reported in January, to 122 reported in February, marginally higher than the equivalent month last year (119). YTD of 1415 actual remains negatively above Trust target.

5.4.3 February has narrowly missed the goal of ≤120 falls in month with 123 falls during the month however the medical division achieved their target with 100 falls during February against a goal of 101.

5.4.4 End of Year data shows a 37% reduction overall over the past 4 years with over 25% reduction in falls causing serious harm (moderate and above).

5.3.1 Of the 122 falls reported, 86 resulted in no harm, 33 resulted in causing low harm and 4 resulted on moderate harm to patients. From the overall monthly total of 122, 52 were reported at St Richard’s Hospital and 70 at Worthing Hospital. The monthly total remains above the overall target of ≤120. Of note, the majority of falls reported in month were in relation to emergency admissions or escalation areas.

5.3.2 There were no reported falls resulting in a severe degree of harm to patients (or death).

5.3.3 Falls related to continence remains a strong theme, further promotion of continence work is underway, with an improvement workshop planned for early March.

5.3.4 The ‘How to hire specialist seating’ guide has been shared with therapists, matrons and ward managers a review of this will be take place at the beginning of April.

9 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

5.3.5 The number of falls in February equates to 4.75 per 1,000 bed days against a national figure of 6.63.3 Of the falls reported as resulting in harm in February, those causing significant harm (severe harm/death) equate to 0 per 1000 bed days against the national figure of 0.19.

5.4 Tissue Viability

5.4.1 During February the Trust reported at total of 27 incidents of pressure damage both equal to and greater than European Pressure Ulcer Advisory Group (EPUAP) category 2- an decrease in reporting from Januarys number of 44 (higher than the equivalent month last year -19) and remaining negatively above the Trust target- (YTD 277).

5.4.2 February noted high reporting on both orthogeriatric wards: work is underway to explore any opportunities for improvement in pressure ulcer prevention in patients presenting on the fracture neck of femur pathway. The TVN team continue to see skin assessment lapses where patient’s existing dressings are not taken down, the TV team are following up this theme at safety huddles. TED stocking related skin damage is also noted due to incorrect sizing and further ward based training underway.

5.4.3 The incidence of pressure ulcers, category 2 and above including those developing within 72 hours after admission per 1000 bed days in December was 1.05 against a national rate of 0.85 (as per the Safety Thermometer data).

5.4.4 Prompt skin assessment on transfer of care remains a concern, this is particularly important as the Trust faces seasonal pressure and an increase in patient flow. This will form a priority message for safety huddles attended by the tissue viability nurses throughout Q4. Supply of alternating pressure relieving mattresses has been maintained throughout this period of high activity and the evaluation of new slide sheets continues with extremely positive staff feedback to date.

5.4.5 There were 288 patients admitted to the Trust from the community with existing pressure damage, the majority being from the patient’s own home (211).

5.5 NHS Patient Safety Thermometer

5.5.1 The NHS Patient Safety Thermometer is used across all relevant acute wards. This tool looks at point prevalence of four key harms - falls, pressure ulcers, urinary tract infections and deep vein thrombosis (DVT) and pulmonary embolism (PE) in all patients on a specific day in the month. A dashboard is

4 Royal College of Physicians. National Audit of Inpatient Falls: audit report 2015. London: RCP, 2015.

10 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

available to each ward showing Trust-wide and ward-level data for each individual harm as well as the harm-free care score. These numbers are also shared via the new ward screens.

5.5.2 The Safety Thermometer includes harms suffered by the patient in healthcare settings prior to admission. The actual number of patients who suffered no new harm during their inpatient stay at WSHFT (indicator S03) in February was 98.1%, the internal target of 99% is set by the organisation and YTD the Trust is reporting 98.5% compliance.

5.5.3 S11. Compliance with VTE assessment of patients during February increased to 96.9% against a target of 100% (YTD 96.6%).

5.5.4 Anti-coagulants are widely used within the organisation for both prophylaxis and for treatment of venous thromboembolism (VTE). The use of the medication carries risks of error and omission – both within this organisation and nationally. Within the organisation over the last year a number of key areas were identified for focus of which the following areas have made significant progress:

 Prescribing of new oral anticoagulant drugs with varied or insufficient consultation and counselling – including the issue of a ‘preventable future death’ notice from the coroner in relation to a recent episode  Lack of clear information about anti-coagulated patients being transferred with patients at discharge

5.5.5 However there still remains areas that require further focus to reduce risk:

 Lack of VTE prophylactic prescribing despite completion of VTE risk assessment – approximately 20 patient per year experience a VTE episode due to lack of prophylactic prescribing.  Differences in process and guidelines for bridging patients on anti-coagulants and ensuring alignment to the revised Trust-wide bridging guidelines. Up to 70 surgical procedures per year cancelled due to anticoagulant issues.

5.5.6 National data relating to the NHS safety thermometer is available here: http://www.safetythermometer.nhs

5.5.7 S48. Focus on anticoagulants: Average no. patients per day on VTE missing report (Electronic Prescribing Medication Administration EPMA). January’s data reports a decrease to 68.0 against a Trust target of 50 (YTD 54.9).

5.5.8 To improve outcomes for patients, and reduce risk, there is an aligned review of patients appearing on the EPMA miss-match report jointly across core and medical divisions, including an assessment of the revised EPMA report within the ward rounds. 11 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

6.0 Safer Staffing

6.1.1 Safecare Live (Allocate) started to be introduced into the Trust in September 2016.

6.1.2 Safecare offers both nursing and operational leads from ward to board the ability to access staffing need compared to real time patient acuity and dependency. Additionally, it offers the ability to identify staffing variations and the potential solution from the system.

6.1.3 The Trust has run the existing staffing report in parallel for several months but has now moved this over to Safecare, however data may still demonstrate month on month variance whilst the electronic system is being fully embedded.

6.1.4 In February, there are some noted areas of lower RN fill in the safer staffing report; 85.9% was reported for the day shifts and 90.2% for the night shifts, compared with January when 89.2% was reported for the day shifts and 92.1% for the nights.

6.1.5 There are two reasons for this lower fill rate, one is the use of our flexible escalation, shifts need to be cancelled if not required, which causes some variations in the fill rate if the cancellation doesn’t appear. The other reason for lower fill is the lower availability of staff both our own substantive and bank staff to work during half term holidays, similarly with the lower availability of external agency staff availability to fill the shifts. We are also working on supporting improved rostering availability on the wards; this includes working with ward managers on managing higher levels of flexible working contracts and how the rosters are managed to support maximum availability to maintain the fill rate.

7.0 PATIENT EXPERIENCE

7.1.1 PALS and Complaints

7.1.2 During February the Trust received 23 complaints, the top four themes (in order) were recorded as clinical treatment, admission transfer and discharge, communication, and date for appointment.

7.1.3 Divisions continue to embed a more proactive response to new complaints to try to facilitate resolution quickly for patients and families. In February 2019, 50% of complaints collectively were closed within 25 working days, which continues the deteriorating trend since August 2018. This reduction in performance has been escalated to the clinical directors and heads of nursing for their action. The overall number of open complaints has also increased since August and is a concern as we approach the traditionally busier quarters of the financial year.

12 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

7.1.4 The Quarterly Complaints Report provides an in-depth analysis of trends and lessons learned. This is reviewed by the Patient Experience and Feedback Committee and is presented to the Trust Board.

8.1 Friends and Family Test (FFT)

8.1.1 Patients who access hospital services are asked whether they would recommend WSHFT to their friends or family if they needed similar treatment. Patients who access inpatient, outpatient, day-case, A&E and maternity are all offered the opportunity to respond to the question.

8.1.2 Immediate feedback is provided to wards and departments on a continuous basis to ensure staff can address problems or get positive feedback as quickly as possible. In addition to this, a dashboard is available giving wards access to their individual scores and a poster printed with ward performance to display to the public. Ward ‘recommend’ rates are shown on the screens installed on wards.

8.2.1 Friends and Family Test Response Rates:

8.2.2 Work continues to improve response rates (inpatient) towards a target this year of 40% (with an interim target for A&E of 23% YTD actual 24.6%). January’s data reports 35.3% compliance (YTD 41.2%).

8.2.3 A&E FFT response rates continue to improve, however a slight decrease in performance is noted in outpatients. The proportion of patients who would have recommended our services to friends and family in February compares favourably with the national median benchmark and also against our internal target as per the table below:

Percentage recommending Target WSHFT in December (plus YTD) Inpatient care 97.8% (97.3%) 97% A&E 94.9% (95.3%) 93% Maternity: Delivery care 99.2% (97.2%) 97% Outpatient care 96.7% (96.8%) 97% Maternity: Antenatal care 100% (97.4%) 97% Maternity: Postnatal ward 99.2% (97.2%) 97%

Maternity: Postnatal 100% (98.8%) 97% community care

8.2.4 X08. Percentage of re-booked outpatient appointments was recorded in February as 11.5% against an annual target of 7.8%. The services which are linked most often to PALS concerns related to waiting for appointments and cancellations of appointments are ophthalmology, trauma and orthopaedics and urology.

13 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

8.2.5 X09. Clinics cancelled with less than 6 weeks’ notice for annual/study leave demonstrates a significant increase from 19 reported in January, to 40 reported in February.

8.2.6 X13 Breaches of mixed sex accommodation arrangements demonstrates a continued rise for the first time this year. This is in relation to a change in the NHSE reporting requirements and the updated guidance is as listed below, this criteria supersedes any previously agreed local arrangements with the CCG.

8.2.7 Mixed sex breaches critical care A mix sex breach is declared when a patient is deemed as fit to be transferred to a ward but has not been transferred within 4 hours and is in a bed that is in a mixed sex area on critical care. This will only ever be on the high dependency (HDU) area of each unit. Worthing will always have a higher number of mixed sex breaches as there are 6 potential bed spaces where a mixed sex breach will occur, whereas St Richards only has 3 beds in the open HDU as they have a side room as part of the bed stock.

8.2.8 In February, there were 19 mixed sex breaches reported in Worthing and 5 in St Richards’s critical care, this is a decrease on both sites as Worthing reported 25 breaches in January, and SRH reported 19.

8.2.9 Some of the breaches on the Worthing critical care site are due to a decision being made not transfer the patient out of hours (if the ward bed has not been available until after 20.00) the transfer may be delayed to the next day as this is safer and a better experience for the patient, even though it will cause a mixed sex breach. The site team and the critical care have been working together to ensure early allocation of ward bed and timely discharge of the critical care patient.

9 RECOMMENDATION

9.1 The Board is asked to note the contents of this report.

Jo Habben Head of Clinical Governance and Patient Safety 19/03/19

14 Western Sussex Hospitals Foundation NHS Trust – Monthly Quality Report

Keith Ashall, Senior Health Intelligence Analyst t: 01903 205111 (ext 84478)

wshft FEBRUARY 2019 QUALITY SCORECARD - WSHFT DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB YTD Actual YTD Target Target Trend

EFFECTIVENESS Effectiveness domain score 2.29 2.22 2.30 2.47 2.00 2.16 2.12 2.12 2.04 2.04 2.08 2.04 2.00 1.81 2.00 2.04 Trust-wide mortality E01 Trust crude mortality rate (non-elective) 3.26% 4.25% 3.86% 3.52% 3.10% 2.21% 2.05% 2.26% 2.55% 2.24% 2.64% 2.59% 3.30% 3.28% 2.81% 2.64% 3.10% 3.10%

E02 Crude mortality rate (non-elective): 12 month rolling 3.05% 3.07% 3.10% 3.11% 3.13% 3.08% 3.03% 3.00% 2.99% 2.96% 2.91% 2.87% 2.88% 2.80% 2.72% 2.96% 3.11% 3.11%

E03 Trust Hospital Standardised Mortality Ratio (HSMR) (rollin 12M) 88.1 89.0 90.2 89.8 90.0 91.7 90.6 90.5 91.9 91.2 90.5 89.8 89.8 100 100

E04 Summary Hospital-level Mortality Indicator (SHMI) (rolling 12M) 0.97 0.97 0.98 0.98 1 1

E45 % of Part 2 inpatient deaths reviewed 84.5% 84.1% 84.3% 75.8% 79.1% 83.5% 84.4% 77.5% 68.6% 74.6% 74.1% 75.6% 72.5% 76.1% 60.9% 75.17% 100% 100% Improve mortality in specific conditions E47 % patients with sepsis receiving antibiotic therapy within one hour 80.4% 74.4% 77.3% 77.9% 71.7% 78.6% 81.0% 72.6% 77.1% 76.1% 79.0% 85.4% 81.5% 83.6% 79.0% 90% 90% Reduce mortality following hip fracture E09 SMR for hip fracture (all diagnoses/procedures) (rolling 12M) 88.5 95.0 97.3 101.5 100.2 117.4 105.6 105.7 111.0 116.0 107.6 105.5 105.5 100 100

E10 30 day mortality rate following hip fracture (rolling 12M) 6.8% 7.4% 7.6% 7.5% 7.5% 8.2% 7.8% 7.6% 7.5% 7.7% 7.0% 6.8% 6.8% 5.70% 5.70% Increase discharge effectiveness E59 Rate of discharges by Midday 13.9% 14.8% 13.7% 14.5% 12.82% 13.94% 15.61% 16.10% 14.88% 14.61% 16.36% 15.96% 16.45% 16.12% 15.26% 15.3% 45% 45% Reduce the rate of readmission following discharge from the Trust E11 Emergency readmissions within 30 days % 13.6% 13.2% 14.4% 13.8% 14.13% 14.44% 14.42% 14.39% 14.63% 14.01% 14.66% 14.58% 14.16% 14.19% 14.79% 14.40% 13% 13% To improve maternity care by encouraging natural childbirth E13 C-Section Rate 33.0% 29.4% 32.1% 31.3% 26.40% 28.20% 29.80% 29.20% 28.00% 25.60% 28.80% 28.50% 30.60% 31.50% 29.80% 28.76% 27.80% 27.8%

E15 % Deliveries complicated by post-partum haemorrhage 0.3% 0.5% 1.1% 0.2% 0.20% 1.00% 0.20% 0.20% 0.20% 0.50% 0.00% 1.00% 0.50% 0.00% 0.80% 0.42% 1% 1%

E17 Admission of term babies to neonatal care 3.8% 2.1% 3.8% 3.1% 4.30% 4.10% 4.40% 3.50% 4.20% 2.30% 2.90% 2.90% 2.30% 2.50% 2.60% 3.27% 10% 10%

E58 Induction of labour 41.8% 36.7% 34.1% 38.8% 37.90% 39.80% 35.80% 32.60% 31.70% 32.90% 31.50% 32.70% 33.50% 34.30% 32.40% 34.10% 29.4% 29.4%

E60 Normal delivery rate 30.5% 30.8% 31.0% 28.5% 34.0% 27.5% 29.8% 38.4% 31.9% 35.8% 34.2% 34.3% 29.1% 31.5% 32.7% 32.7% NA NA Caring for the elderly patient E18 % Emergency admissions staying over 72h screened for dementia 87.3% 93.8% 93.0% 88.9% 91.32% 91.01% 93.10% 87.39% 87.41% 83.42% 84.20% 87.77% 82.22% 81.54% 81.72% 86.40% 90% 90%

E39 Ward moves for patients flagged with dementia 217 236 193 182 207 186 203 232 200 151 191 201 204 279 232 2286 2069 2257

E42 Night-time ward moves for patients flagged with dementia : Total 66 42 44 59 45 26 35 33 40 31 35 43 44 66 58 456 458 500

E42 Night-time ward moves for patients flagged with dementia : % Total excluding Emergency Floor 20.0% 26.0% 42.7% 23.7% 15.6% 15.4% 22.9% 18.8% 20.0% 29.0% 20.0% 25.6% 13.6% 27.3% 32.8% 21.9% NA NA Stroke care E26 % CT scans undertaken within 12 hours 93.6% 91.9% 97.9% 95.9% 95.0% 95.7% 94.3% 96.1% 91.8% 94.3% 98.6% 98.0% 96.3% 96.6% 95.6% 95% 95%

E27 % Stroke thrombolysis within 60 minutes of hospital arrival 88.9% 66.7% 40.0% 50.0% 75.0% 81.8% 66.7% 64.3% 44.4% 60.0% 40.0% 75.0% 60.0% 50.0% 61.7% 95% 95%

E28 % Swallow screen for stroke patients within 4 hours of admission 71.8% 66.2% 85.4% 94.0% 84.8% 90.5% 86.1% 91.8% 85.7% 86.7% 91.7% 90.8% 84.1% 93.7% 88.6% 95% 95%

E29 % of stroke patients admitted to stroke unit within 4 hours of admission 68.1% 48.9% 73.6% 73.0% 75.0% 81.2% 70.5% 80.3% 69.4% 67.1% 78.3% 68.6% 78.8% 65.5% 73.5% 90% 90%

E30 % high risk TIA patients seen within 24 hours 0.0% 14.3% 0.0% 16.7% 15.4% 16.7% 17.6% 6.3% 10.0% 33.3% 5.9% 11.1% 27.3% 21.1% 16.5% 60% 60% Ensure active engagement with research E23 Patients recruited with CRN portfolio 147 119 298 409 173 179 158 211 108 120 144 2066 2567 2800 Data Quality E37 % inpatients with electronic discharge summaries produced 91.5% 92.2% 92.7% 92.0% 92.8% 92.2% 92.8% 92.6% 89.5% 90.5% 91.0% 90.9% 91.7% 90.6% 91.8% 91.5% 94.2% 94.2% Mental Health Care E54 Reduced A&E vists for a cohort of frequent attenders who would benefit from MH interventions 18 17 22 28 27 34 33 21 19 21 28 35 18 25 26 287 447 488 SAFETY Safety domain score 2.14 2.19 2.31 2.07 2.21 2.23 2.27 2.53 1.93 2.33 2.23 2.27 2.20 2.07 2.46 2.15 Safer staffing S36 Safer Staffing: Average fill rate - registered nurses/ midwives (day shifts) 94.1% 95.6% 92.2% 93.0% 92.0% 94.1% 93.4% 96.1% 84.6% 89.1% 91.9% 88.8% 87.7% 89.2% 85.9% 90.4% 95% 95%

6.1 Quality scorecard 1819_M11.1.Quality Scorecard - WSHFT Page 1 of 9 Printed 21/03/2019 10:32 Keith Ashall, Senior Health Intelligence Analyst t: 01903 205111 (ext 84478)

wshft FEBRUARY 2019 QUALITY SCORECARD - WSHFT DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB YTD Actual YTD Target Target Trend

S37 Safer Staffing: Average fill rate - registered nurses/ midwives (night shifts) 93.7% 97.1% 90.6% 90.1% 90.6% 94.8% 95.5% 96.3% 79.4% 81.2% 88.9% 93.1% 90.3% 92.1% 90.2% 89.3% 95% 95%

S38 Safer Staffing: Average fill rate - care staff (day shifts) 93.6% 93.8% 90.3% 90.5% 92.4% 94.0% 93.8% 96.2% 94.1% 98.7% 95.8% 91.8% 94.1% 92.5% 89.8% 93.9% 95% 95%

S39 Safer Staffing: Average fill rate - care staff (night shifts) 93.3% 95.8% 92.4% 92.7% 94.7% 94.9% 96.6% 96.8% 116.0% 124.0% 121.0% 102.6% 104.8% 105.9% 103.3% 106.8% 95% 95%

S41 Care Hours Per Patient Day (CHPPD) 6.4 6.4 6.3 6.6 6.5 6.8 7.1 7.3 7.2 7.1 7.3 7.3 7.3 6.9 7.3 7.1 NA NA NHS safety thermometer S02 Safety Thermometer: % of patients harm-free 92.8% 94.4% 95.3% 93.5% 96.0% 95.0% 94.5% 96.1% 93.9% 94.6% 94.6% 95.0% 95.4% 94.4% 94.3% 94.9% 95.70% 95.70%

S03 Safety Thermometer: % of patients with no new harms 97.5% 97.9% 98.7% 97.9% 98.5% 99.0% 97.7% 99.1% 98.5% 98.4% 98.5% 98.6% 98.7% 98.5% 98.1% 98.5% 99% 99% Monitoring of clinical incidents S19 NEVER events 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 3 0 0

S04 Total incidents 0 0 716 760 742 790 796 858 848 822 850 864 833 941 847 9191 8388 9150

S05 Total moderate, severe or death incidents 0 0 16 10 19 11 20 6 21 19 14 10 11 12 19 162 140 153

S06 Total serious incidents (SIRIs) 10 6 3 2 8 4 7 5 4 1 2 1 5 2 4 43 49 53

S07 Number of outstanding CAS alerts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Reducing medication error harm S08 Medication incidents 0 0 75 77 86 81 94 126 81 77 93 123 112 101 78 1052 1100 1200

S09 Moderate/severe medication incidents 0 0 0 0 1 0 1 0 1 3 1 1 0 0 0 8 5 5 Reduce incidence of healthcare acquired infections S14 Number of hospital attributable MRSA cases 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

S15 Number of hospital C.diff cases 1 6 3 5 2 4 1 2 4 2 3 3 3 5 2 31 35 38

S28 Number of C. diff cases where a lapse in the quality of care was noted 1 4 2 2 0 2 0 2 0 1 3 0 3 3 1 15 15 16

S16 Number of reportable MSSA bacteraemia cases 8 6 7 7 10 7 7 13 10 8 7 9 11 8 5 95 86 94

S16a Number of hospital attributable MSSA bacteraemia cases 2 1 3 1 0 3 0 4 5 1 1 2 3 4 1 24 20 22

S17 Number of reportable E.coli cases 25 35 29 33 32 32 30 27 29 30 33 24 28 25 22 312 688 751

S17a Number of hospital attributable E.coli cases 6 8 7 3 4 6 5 1 7 5 8 6 6 4 5 57 55 60 Improve theatre safety for patients S18 Full compliance with WHO Surgical Safety Checklist 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100.00% 100%

S30 SSIs: Total hip replacement 3.0% 2.0% 2.8% 2.4% 1.1% 1.1%

S33 SSIs: Total knee replacement 0.0% 0.6% 1.5% 1.0% 1.5% 1.5%

S34 SSIs: Large bowel surgery 5.4% 12.9% 12.2% 12.6% 12% 12%

S35 SSIs: Breast surgery 3.3% 4.2% 2.9% 3.5% 3.8% 3.8% Reduce number of falls in hospital S50 All falls 0 0 119 162 129 131 125 121 132 127 120 124 123 161 122 1415 1331 1452

S21 Falls resulting in harm 0 0 38 41 39 25 32 30 46 37 41 40 33 43 37 403 421 459

S22 Falls resulting in severe harm or death 0 0 1 0 0 0 0 0 2 0 1 0 0 0 0 3 1 1 Pressure ulcers S49 Grade 2+ pressure ulcers 46 43 19 37 27 23 26 5 21 34 30 22 21 41 27 277 220 240 Other safety metrics S11 VTE Assessment Compliance 93.0% 93.9% 94.1% 93.2% 96.7% 96.6% 97.0% 96.6% 96.7% 96.4% 96.6% 96.5% 96.4% 96.6% 96.9% 96.6% 100.0% 100.0% Medicines Optimisation S44 Antimicrobial stewardship and consumption: reduction in overall antibiotic consumption 7.6% 6.0% 4.7% 15.8% 16% 18% 18% 17% 16% 15% 13% 12% 13% 13% 15% 0.0% 0.0%

S45 Antimicrobial stewardship and consumption: reduction in the use of carbapenems 2.0% -1.0% 13.5% -5.7% -41% -33% -29% -31% -34% -31% -31% -29% -29% -30% -32% 0.0% 0.0%

S47 Focus on anticoagulants: Patients on Direct Oral Anticoagulants (NOACs) receiving counselling 46.0% 50.0% 46.0% 36.0% 62% 69% 75% 68% 72% 76% 69% 69.9% 50.0% 50.0%

S48 Focus on anticoagulants: Average no. patients per day on VTE prophylaxis missing report *NEW* 60.7 62.1 48.0 41.6 42.0 42.0 75.0 68.0 54.9 50 50

6.1 Quality scorecard 1819_M11.1.Quality Scorecard - WSHFT Page 2 of 9 Printed 21/03/2019 10:32 Keith Ashall, Senior Health Intelligence Analyst t: 01903 205111 (ext 84478)

wshft FEBRUARY 2019 QUALITY SCORECARD - WSHFT DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB YTD Actual YTD Target Target Trend

EXPERIENCE Experience domain score 2.52 2.52 2.48 2.32 2.48 2.43 2.61 2.57 2.39 2.52 2.13 2.52 2.43 2.30 2.48 2.48 Friends and Family Test X38 Trust Friends and Family Recommend %: Inpatient 95.7% 97.0% 97.0% 96.3% 97.2% 96.7% 97.2% 97.5% 97.7% 97.0% 96.7% 97.6% 97.3% 97.5% 97.8% 97.3% 97% 97%

X39 Trust Friends and Family Recommend %: A&E 84.5% 88.0% 88.5% 87.4% 91.7% 93.8% 95.6% 96.2% 94.2% 94.7% 96.7% 96.0% 95.9% 95.6% 94.9% 95.3% 93% 93%

X40 Maternity Friends and Family Recommend %: Antenatal care (36 weeks) 89.5% 100.0% 100.0% 100.0% 97.4% 100.0% 100.0% 100.0% 97.1% 92.3% 95.5% 100.0% 100.0% 90.9% 100.0% 97.4% 97% 97%

X41 Maternity Friends and Family Recommend %: Delivery care 97.9% 98.9% 98.4% 98.0% 97.5% 97.9% 97.2% 97.7% 94.5% 98.7% 96.3% 96.2% 97.9% 96.4% 99.2% 97.2% 97% 97%

X42 Maternity Friends and Family Recommend %: Postnatal ward 97.9% 98.9% 98.4% 98.0% 97.5% 97.9% 97.2% 97.7% 94.5% 98.7% 96.3% 96.2% 97.9% 96.4% 99.2% 97.2% 97% 97%

X43 Maternity Friends and Family Recommend %: Postnatal community care 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 92.3% 100.0% 100.0% 100.0% 0.0% 100.0% 100.0% 98.8% 97% 97%

X44 Trust Friends and Family Recommend %: Outpatient 97.2% 97.7% 96.5% 97.1% 96.7% 96.7% 96.3% 96.8% 96.5% 96.4% 97.2% 97.6% 96.8% 96.8% 96.7% 96.8% 97% 97% Friends and Family Test response rates X24 Trust Friends and Family Response Rate: Inpatient 35.2% 34.5% 39.0% 33.1% 37.6% 42.6% 43.7% 48.9% 44.8% 38.3% 39.9% 43.7% 34.9% 42.8% 35.3% 41.2% 40% 40%

X25 Trust Friends and Family Response Rate: A&E 11.0% 9.1% 8.0% 10.1% 10.4% 19.6% 27.5% 27.5% 23.4% 22.8% 25.7% 26.2% 24.2% 31.0% 32.6% 24.6% 23% 23%

X33 Maternity Friends and Family Response Rate: Delivery care 39.9% 87.9% 51.2% 48.1% 47.5% 47.0% 36.1% 39.1% 41.4% 54.0% 67.3% 76.4% 37.2% 63.5% 69.4% 52.4% 40% 40% Reduction in patients suffering a bad experience dealing with the Trust X08 Percentage of re-booked outpatient appointments 13.0% 12.4% 13.6% 14.1% 13.2% 11.8% 11.3% 11.1% 11.2% 11.6% 10.7% 10.8% 12.1% 11.0% 11.5% 11.4% 7.80% 7.8%

X09 Clinics cancelled with less than 6 weeks notice for annual/study leave 20 44 41 18 22 35 19 21 19 41 52 27 13 19 40 308 261 285

X11 PALS contacts relating to appointment problems ( % of total appts) 0.10% 0.10% 0.12% 0.13% 0.14% 0.15% 0.18% 0.18% 0.17% 0.18% 0.18% 0.17% 0.13% 0.15% 0.18% 0.17% 0.08% 0.08%

X12 Reduce patients cancelled on the day of surgery for non-clinical reasons 19 29 30 42 26 12 13 32 26 17 33 18 9 22 24 232 308 336

X13 Breaches of mixed sex accommodation arrangements 0 0 0 0 0 0 0 0 0 0 35 36 28 44 24 167 0 0 Nutritional Assessment X14 Compliance with MUST tool after 24 hours 83.4% 83.0% 85.6% 78.4% 87.7% 88.7% 91.6% 91.7% 90.1% 87.9% 87.4% 87.7% 82.8% 84.8% 81.6% 87.5% 80% 80%

X15 Compliance with MUST tool after 7 days 98.8% 98.1% 98.7% 100.0% 99.3% 98.9% 99.1% 99.2% 98.9% 98.9% 99.1% 98.8% 97.7% 98.3% 96.7% 98.6% 95% 95% Cleanliness / PLACE Survey X16 Internal PLACE compliance 96% 97% 97% 97% 98% 98% 97% 97% 97% 95% 97% 96% 94% 97% 93% 96% 95% 95% Improve our customer service and become a more caring organisation X18 Number of complaints 30 34 28 38 26 42 25 34 42 37 45 34 30 44 23 382 418 456

X19 Complaints where staff attitude or behaviour is an issue 3 1 0 3 1 2 2 5 9 3 5 4 1 5 1 38 40 43

X20 Complaints where staff communication is an issue 0 2 2 0 0 2 3 2 3 3 2 0 0 0 3 18 36 39

X21 Complaints about nursing 2 2 2 5 5 6 5 1 4 1 3 3 3 10 3 44 36 39 Staff engagement X47 Local staff engagement score: I am able to make improvements happen in my area of work 66.1% 60.3% 56.5% 59.6% 67.6% 64.2% 61.0% 67.3% 59.2% 66.1% 65.8% 64.2% 66.0% 69.5% 58.0% 64.4% 68% 68%

6.1 Quality scorecard 1819_M11.1.Quality Scorecard - WSHFT Page 3 of 9 Printed 21/03/2019 10:32 Keith Ashall, Senior Health Intelligence Analyst t: 01903 205111 (ext 84478)

WORT FEBRUARY 2019 QUALITY SCORECARD - Worthing Monthly_ FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB YTD Actual YTD Target Target Amber_M Amber_YTD Trend Target

QUALITY SCORECARD - Worthing Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 EFFECTIVENESS Effectiveness domain score 2.30 2.47 2.08 1.96 1.96 2.17 1.83 2.17 2.04 2.04 2.00 1.88 2.07 2.04 Trust-wide mortality E01 Trust crude mortality rate (non-elective) 4.04% 3.85% 2.96% 2.60% 2.11% 2.81% 2.81% 2.25% 3.19% 2.80% 3.71% 3.53% 2.91% 2.88% 3.10% 3.10% 3.57%

E02 Crude mortality rate (non-elective): 12 month rolling 3.40% 3.42% 3.40% 3.33% 3.29% 3.31% 3.31% 3.28% 3.21% 3.12% 3.14% 3.05% 2.97% 3.31% 3.11% 3.11% 3.58%

E03 Trust Hospital Standardised Mortality Ratio (HSMR) (rollin 12M) 95.6 95.9 96.8 97.3 96.1 96.5 97.5 96.6 94.4 91.8 94.4 100 100 115

E04 Summary Hospital-level Mortality Indicator (SHMI) (rolling 12M)

E45 % of Part 2 inpatient deaths reviewed 90.6% 82.9% 84.0% 94.6% 84.0% 86.8% 75.0% 59.8% 66.2% 73.5% 73.9% 64.9% 75.9% 76.24% 100% 100% 85.00% Improve mortality in specific conditions E47 % patients with sepsis receiving antibiotic therapy within one hour 77.3% 76.5% 72.00% 75.94% 81.16% 72.07% 76.15% 80.41% 81.08% 85.81% 83.02% 89.69% 81.08% 90% 90% 76.50% Reduce mortality following hip fracture E09 SMR for hip fracture (all diagnoses/procedures) (rolling 12M) 114.2 112.4 112.4 130.7 116.0 114.2 118.1 123.9 120.1 113.5 120.1 100 100 115

E10 30 day mortality rate following hip fracture (rolling 12M) 9.0% 8.5% 8.5% 9.4% 8.9% 9.0% 8.6% 8.9% 8.4% 7.8% 8.4% 5.70% 5.70% 6.56% Increase discharge effectiveness E59 Rate of discharges by Midday 13.5% 13.7% 11.9% 14.1% 15.1% 15.6% 14.0% 14.9% 16.4% 14.6% 14.5% 14.6% 13.6% 14.5% 45% 45% 38.25% Reduce the rate of readmission following discharge from the Trust E11 Emergency readmissions within 30 days % 15.1% 13.1% 14.81% 14.27% 14.78% 14.82% 16.17% 14.29% 15.89% 16.06% 14.70% 13.90% 13.94% 14.86% 13% 13% 14.95% To improve maternity care by encouraging natural childbirth E13 C-Section Rate 30.2% 29.9% 26.10% 28.30% 31.50% 28.20% 30.90% 27.50% 29.00% 27.80% 24.20% 29.20% 28.90% 28.33% 27.80% 27.8% 31.97%

E15 % Deliveries complicated by post-partum haemorrhage 1.6% 0.5% 0.00% 2.00% 0.50% 0.00% 0.00% 1.00% 0.00% 1.10% 0.60% 0.00% 1.20% 0.58% 1% 1% 1.15%

E17 Admission of term babies to neonatal care 3.2% 3.1% 3.40% 1.50% 1.90% 1.40% 3.60% 1.50% 1.30% 1.10% 1.70% 1.70% 1.20% 1.85% 10% 10% 11.50%

E58 Induction of labour 32.4% 34.5% 33.50% 41.80% 32.50% 30.60% 33.60% 33.50% 28.50% 35.00% 31.50% 37.40% 28.90% 33.35% 29.4% 29.4% 33.81%

E60 Normal delivery rate 34.6% 30.9% 37.4% 27.9% 31.5% 37.0% 29.5% 34.0% 38.5% 32.8% 33.1% 28.6% 37.0% 33.4% NA NA Caring for the elderly patient E18 % Emergency admissions staying over 72h screened for dementia 94.2% 91.8% 92.49% 94.41% 94.82% 89.81% 88.28% 85.35% 88.09% 92.20% 85.37% 85.47% 86.30% 89.28% 90% 90% 76.50%

E39 Ward moves for patients flagged with dementia 92 70 90 74 99 95 87 66 75 86 75 129 90 966 930 1014 85 97 1069

E42 Night-time ward moves for patients flagged with dementia : Total 25 26 19 13 18 16 22 16 13 23 22 38 21 221 227 247 21 24 261

E42 Night-time ward moves for patients flagged with dementia : % Total excluding Emergency Floor n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Stroke care E26 % CT scans undertaken within 12 hours 100.0% 97.7% 94.6% 91.9% 87.5% 95.8% 93.2% 97.0% 100.0% 95.9% 100.0% 95.4% 95% 95% 80.75%

E27 % Stroke thrombolysis within 60 minutes of hospital arrival 0.0% 40.0% 75.0% 80.0% 66.7% 60.0% 0.0% 60.0% 66.7% 60.0% 40.0% 54.2% 95% 95% 80.75%

E28 % Swallow screen for stroke patients within 4 hours of admission 100.0% 97.4% 100.0% 100.0% 97.2% 97.9% 85.3% 96.4% 96.0% 97.4% 88.9% 95.7% 95% 95% 80.75%

E29 % of stroke patients admitted to stroke unit within 4 hours of admission 78.9% 72.7% 86.5% 78.4% 70.0% 81.3% 61.4% 72.7% 69.0% 67.3% 85.4% 73.7% 90% 90% 76.50%

E30 % high risk TIA patients seen within 24 hours 0.0% 25.0% 28.6% 14.3% 22.2% 0.0% 14.3% 42.9% 7.1% 0.0% 0.0% 12.9% 60% 60% 51.00% Ensure active engagement with research E23 Patients recruited with CRN portfolio 78 80 75 130 105 130 111 131 59 64 78 1041 1283 1400 117 99 1091 Data Quality E37 % inpatients with electronic discharge summaries produced 92.2% 92.2% 92.1% 92.2% 92.5% 91.6% 89.4% 89.5% 92.2% 92.0% 91.1% 91.1% 91.7% 91.4% 94.2% 94.2% 80.07% Mental Health Care *NEW* E54 Reduced A&E vists for a cohort of frequent attenders who would benefit from MH interventions 2 12 6 5 5 11 3 7 6 5 5 6 4 63 200 218 18 21 230 SAFETY Safety domain score 2.31 2.07 2.34 2.33 2.56 2.52 1.93 2.26 2.15 2.11 2.33 2.19 2.22 2.00 Safer staffing S36 Safer Staffing: Average fill rate - registered nurses/ midwives (day shifts) 92.9% 92.8% 91.9% 93.9% 93.0% 94.4% 84.6% 90.7% 92.4% 88.0% 87.8% 90.7% 88.7% 90.7% 95% 95% 80.75%

6.1 Quality scorecard 1819_M11.1.Quality Scorecard - Worthing Page 4 of 9 Printed 21/03/2019 10:32 Keith Ashall, Senior Health Intelligence Analyst t: 01903 205111 (ext 84478)

S37 Safer Staffing: Average fill rate - registered nurses/ midwives (night shifts) 93.5% 90.5% 91.5% 96.2% 96.2% 95.8% 81.9% 83.3% 92.8% 93.6% 92.0% 94.4% 92.2% 91.1% 95% 95% 80.75%

S38 Safer Staffing: Average fill rate - care staff (day shifts) 89.3% 89.9% 92.7% 94.7% 94.9% 95.3% 93.1% 96.9% 93.0% 88.6% 93.2% 92.2% 88.9% 93.0% 95% 95% 80.75%

S39 Safer Staffing: Average fill rate - care staff (night shifts) 97.1% 95.8% 97.7% 96.9% 98.9% 97.4% 118.6% 126.8% 120.9% 97.3% 101.4% 102.8% 100.0% 105.9% 95% 95% 80.75%

S41 Care Hours Per Patient Day (CHPPD) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a NHS safety thermometer S02 Safety Thermometer: % of patients harm-free 95.1% 93.0% 95.6% 93.7% 94.0% 95.8% 92.4% 94.7% 95.2% 93.1% 94.9% 93.5% 94.8% 94.4% 95.70% 95.70% 81.35%

S03 Safety Thermometer: % of patients with no new harms 98.7% 97.7% 98.7% 98.8% 97.1% 99.3% 98.9% 98.9% 98.9% 98.4% 98.9% 98.4% 97.7% 98.6% 99% 99% 84.15% Monitoring of clinical incidents S19 NEVER events 0 0 1 0 0 0 0 0 0 0 0 1 0 2 0 0 0 0

S04 Total incidents 384 406 376 406 408 465 400 430 468 463 458 537 450 4861 4530 4942 412 474 5210

S05 Total moderate, severe or death incidents 10 6 7 7 12 2 9 11 7 6 9 11 11 92 75 82 7 8 86

S06 Total serious incidents (SIRIs) 3 1 3 3 4 3 3 0 1 1 2 2 3 25 25 27 2 3 28

S07 Number of outstanding CAS alerts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Reducing medication error harm

S08 Medication incidents 49 42 56 46 51 81 34 37 49 67 70 52 36 579 550 600 50 43 468

S09 Moderate/severe medication incidents 0 0 0 0 0 0 1 2 1 1 0 0 0 5 2 3 0 0 3 Reduce incidence of healthcare acquired infections S14 Number of hospital attributable MRSA cases 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

S15 Number of hospital C.diff cases 2 3 1 1 1 2 3 1 3 2 1 1 2 18 17 19 2 2 20

S28 Number of C. diff cases where a lapse in the quality of care was noted 1 2 0 0 0 2 0 1 3 0 1 1 1 9 7 8 1 1 8

S16 Number of reportable MSSA bacteraemia cases 5 4 8 5 4 6 7 5 4 6 6 5 3 59 43 47 4 5 50

S16a Number of hospital attributable MSSA bacteraemia cases 3 0 0 3 0 1 4 0 0 1 1 3 0 13 10 11 1 1 11

S17 Number of reportable E.coli cases 13 16 21 19 15 12 13 20 18 12 14 14 12 170 396 432 36 41 455

S17a Number of hospital attributable E.coli cases 4 0 3 4 2 1 4 2 5 4 4 1 1 31 28 30 3 3 32 Improve theatre safety for patients S18 Full compliance with WHO Surgical Safety Checklist 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100.00% 100% 85.00%

S30 SSIs: Total hip replacement n/a n/a n/a n/a n/a n/a

S33 SSIs: Total knee replacement n/a n/a n/a n/a n/a n/a

S34 SSIs: Large bowel surgery 4.4% 13.6% 15.5% 14.6% 12% 12% 13.80%

S35 SSIs: Breast surgery 3.6% 3.8% 2.7% 3.3% 3.8% 3.8% 4.37% Reduce number of falls in hospital S50 All falls 60 78 55 64 57 58 67 64 67 73 66 77 70 718 666 726 61 70 765

S21 Falls resulting in harm 22 24 18 13 16 13 29 22 26 26 15 21 18 217 233 254 21 24 268

S22 Falls resulting in severe harm or death 1 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1

S40 Repeat falls 5 9 4 3 1 2 7 5 1 6 3 5 3 40 57 62 5 6 65

S23 Falls assessment within 24hrs of admission (Surgery only) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Pressure ulcers S49 Grade 2+ pressure ulcers 13 22 19 19 13 4 9 19 14 14 11 24 15 161 110 120 10 12 127 Other safety metrics S11 VTE Assessment Compliance 95.1% 93.3% 96.1% 96.3% 97.1% 96.9% 96.7% 97.0% 97.6% 96.4% 97.1% 96.5% 97.3% 96.8% 100.0% 100.0% 85.00% Medicines Optimisation *NEW* S44 Antimicrobial stewardship and consumption: reduction in overall antibiotic consumption n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

S45 Antimicrobial stewardship and consumption: reduction in the use of carbapenems n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

S47 Focus on anticoagulants: Patients on Direct Oral Anticoagulants (NOACs) receiving counselling n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

S48 Focus on anticoagulants: Average no. patients per day on VTE prophylaxis missing report n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a EXPERIENCE Experience domain score 2.48 2.32 2.25 2.60 2.55 2.45 2.25 2.50 2.30 2.65 2.35 2.45 2.60 2.55 Friends and Family Test

6.1 Quality scorecard 1819_M11.1.Quality Scorecard - Worthing Page 5 of 9 Printed 21/03/2019 10:32 Keith Ashall, Senior Health Intelligence Analyst t: 01903 205111 (ext 84478)

X38 Trust Friends and Family Recommend %: Inpatient 96.8% 95.6% 97.1% 97.0% 96.8% 97.2% 97.6% 97.3% 97.0% 97.3% 96.9% 97.7% 98.2% 97.3% 97% 97% 82.45%

X39 Trust Friends and Family Recommend %: A&E 88.6% 89.5% 91.5% 95.5% 96.7% 96.7% 95.4% 95.7% 97.4% 96.5% 96.3% 96.3% 95.2% 96.1% 93% 93% 79.05%

X40 Maternity Friends and Family Recommend %: Antenatal care (36 weeks) 100.0% 100.0% 95.8% 100.0% 100.0% 100.0% 100.0% 83.3% 100.0% 100.0% 100.0% 88.9% 100.0% 97.7% 97% 97% 82.45%

X41 Maternity Friends and Family Recommend %: Delivery care 97.7% 97.1% 96.7% 95.5% 95.8% 97.2% 93.9% 98.5% 94.9% 94.5% 96.9% 98.1% 99.2% 96.8% 97% 97% 82.45%

X42 Maternity Friends and Family Recommend %: Postnatal ward 97.7% 97.1% 96.7% 95.5% 95.8% 97.2% 93.9% 98.5% 94.9% 94.5% 96.9% 98.1% 99.2% 96.8% 97% 97% 82.45%

X43 Maternity Friends and Family Recommend %: Postnatal community care n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

X44 Trust Friends and Family Recommend %: Outpatient 96.3% 97.4% 96.3% 97.1% 95.9% 83.3% 96.0% 95.6% 97.1% 97.3% 96.3% 96.3% 97.2% 95.4% 97% 97% 82.45% Friends and Family Test response rates X24 Trust Friends and Family Response Rate: Inpatient 37.9% 37.7% 36.9% 45.2% 43.4% 54.5% 45.9% 44.1% 45.3% 53.4% 38.7% 47.9% 42.1% 45.4% 40% 40% 34.00%

X25 Trust Friends and Family Response Rate: A&E 8.2% 12.3% 11.1% 26.7% 42.8% 42.1% 37.8% 32.9% 36.9% 38.9% 37.0% 37.8% 33.8% 34.4% 23% 23% 19.55%

X33 Maternity Friends and Family Response Rate: Delivery care 48.4% 35.6% 44.3% 43.8% 35.0% 33.3% 30.0% 67.5% 44.8% 71.1% 36.5% 94.2% 76.9% 51.2% 40% 40% 34.00% Reduction in patients suffering a bad experience dealing with the Trust X08 Percentage of re-booked outpatient appointments 14.1% 14.9% 13.7% 12.5% 11.7% 11.8% 11.9% 12.1% 11.2% 10.8% 12.3% 11.7% 12.2% 11.9% 7.80% 7.8% 8.97%

X09 Clinics cancelled with less than 6 weeks notice for annual/study leave 24 13 15 19 7 9 5 21 27 13 7 8 11 142 143 156 13 15 164

X11 PALS contacts relating to appointment problems ( % of total appts) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

X12 Reduce patients cancelled on the day of surgery for non-clinical reasons 5 16 16 5 5 4 5 9 5 11 2 7 2 71 154 168 14 16 177

X13 Breaches of mixed sex accommodation arrangements 0 0 0 0 0 0 0 0 20 26 20 25 19 110 0 0 0 Nutritional Assessment X14 Compliance with MUST tool after 24 hours 87.0% 75.0% 89.6% 90.3% 91.7% 90.2% 89.4% 86.3% 86.7% 83.3% 77.3% 80.6% 74.9% 85.5% 80% 80% 68.00%

X15 Compliance with MUST tool after 7 days 99.2% 100.0% 99.8% 99.3% 99.2% 99.4% 98.8% 98.9% 99.4% 98.9% 97.3% 99.1% 97.6% 98.8% 95% 95% 80.75% Cleanliness / PLACE Survey X16 Internal PLACE compliance 98% 98% 98% 98% 98% 97% 97% 95% 96% 97% 99% 97% 91% 97% 95% 95% 80.75% Improve our customer service and become a more caring organisation X18 Number of complaints 13 18 11 19 12 23 24 22 28 17 19 23 11 209 209 228 19 22 240

X19 Complaints where staff attitude or behaviour is an issue 0 1 0 1 1 3 4 3 1 2 0 2 1 18 20 22 2 2 23

X20 Complaints where staff communication is an issue 2 0 0 1 1 2 2 1 2 0 0 0 0 9 18 20 2 2 21

X21 Complaints about nursing 1 3 4 2 2 0 3 0 2 1 2 5 2 23 18 20 2 2 21 Staff engagement (indicators/targets not yet agreed) X47 Local staff engagement score: I am able to make improvements happen in my area of work n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

6.1 Quality scorecard 1819_M11.1.Quality Scorecard - Worthing Page 6 of 9 Printed 21/03/2019 10:32 Keith Ashall, Senior Health Intelligence Analyst t: 01903 205111 (ext 84478)

SRH FEBRUARY 2019 QUALITY SCORECARD - St Richards FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB YTD Actual YTD Target Target Trend

Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 EFFECTIVENESS Effectiveness domain score 2.30 2.47 1.83 1.96 2.08 2.08 2.08 2.04 2.04 2.17 1.71 1.60 1.53 2.00 Trust-wide mortality E01 Trust crude mortality rate (non-elective) 3.66% 3.17% 3.24% 1.78% 1.99% 1.70% 2.29% 2.23% 2.08% 2.37% 2.86% 3.02% 2.71% 2.39% 3.10% 3.10%

E02 Crude mortality rate (non-elective): 12 month rolling 2.78% 2.77% 2.84% 2.80% 2.76% 2.66% 2.65% 2.61% 2.59% 2.62% 2.60% 2.52% 2.46% 2.65% 3.11% 3.11%

E03 Trust Hospital Standardised Mortality Ratio (HSMR) (rollin 12M) 84.5 83.3 82.7 85.8 84.8 83.9 85.8 85.2 86.1 87.5 87.5 100 100

E04 Summary Hospital-level Mortality Indicator (SHMI) (rolling 12M)

E45 % of Part 2 inpatient deaths reviewed 76.3% 66.7% 64.2% 82.8% 81.7% 81.5% 79.2% 83.9% 75.0% 77.8% 82.2% 76.3% 61.7% 76.94% 100% 100% Improve mortality in specific conditions E47 % patients with sepsis receiving antibiotic therapy within one hour 77.3% 80.6% 70.8% 84.7% 80.0% 83.3% 81.5% 66.2% 74.6% 84.4% 77.0% 76.3% 76.9% 90% 90% Reduce mortality following hip fracture E09 SMR for hip fracture (all diagnoses/procedures) (rolling 12M) 77.8 88.3 85.9 102.7 93.3 94.2 101.4 104.9 90.5 94.7 94.7 100 100

E10 30 day mortality rate following hip fracture (rolling 12M) 5.9% 6.3% 6.3% 6.9% 6.5% 6.1% 6.3% 6.2% 5.4% 5.5% 5.5% 5.70% 5.70% Increase discharge effectiveness E59 Rate of discharges by Midday 13.9% 15.3% 13.8% 13.8% 16.2% 16.6% 15.7% 14.3% 16.3% 17.2% 18.3% 17.7% 16.8% 16.1% 45% 45% Reduce the rate of readmission following discharge from the Trust E11 Emergency readmissions within 30 days % 13.7% 14.5% 13.42% 14.61% 14.07% 13.96% 13.14% 13.73% 13.45% 13.17% 13.62% 14.47% 15.69% 13.93% 13% 13% To improve maternity care by encouraging natural childbirth E13 C-Section Rate 34.1% 32.6% 26.60% 28.10% 28.10% 30.20% 25.20% 23.90% 28.60% 29.20% 36.20% 33.20% 30.50% 29.07% 27.80% 27.8%

E15 % Deliveries complicated by post-partum haemorrhage 0.6% 0.0% 0.50% 0.00% 0.00% 0.40% 0.40% 0.00% 0.00% 1.00% 0.50% 0.00% 0.50% 0.30% 1% 1%

E17 Admission of term babies to neonatal care 4.4% 3.1% 5.10% 6.80% 7.00% 5.60% 4.80% 3.10% 4.50% 4.50% 2.80% 3.00% 0.50% 4.34% 10% 10%

E58 Induction of labour 35.7% 42.4% 42.10% 37.90% 39.20% 34.50% 29.70% 32.40% 34.50% 30.70% 35.30% 31.90% 35.50% 34.88% 29.4% 29.4%

E60 Normal delivery rate 27.4% 26.3% 30.8% 27.1% 28.1% 39.7% 34.2% 37.4% 30.0% 35.6% 25.6% 33.6% 29.1% 31.9% NA NA Caring for the elderly patient E18 % Emergency admissions staying over 72h screened for dementia 90.5% 85.0% 89.77% 87.92% 90.96% 84.78% 86.01% 80.98% 80.64% 82.98% 77.95% 78.48% 75.68% 83.33% 90% 90%

E39 Ward moves for patients flagged with dementia 101 102 117 112 104 137 113 85 116 115 129 150 142 1320 1130 1233

E42 Night-time ward moves for patients flagged with dementia : Total 19 33 26 13 17 17 18 15 22 20 22 28 37 235 231 252

E42 Night-time ward moves for patients flagged with dementia : % Total excluding Emergency Floor n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a NA NA Stroke care E26 % CT scans undertaken within 12 hours 96.4% 93.1% 94.7% 100.0% 100.0% 96.4% 89.5% 91.4% 97.4% 100.0% 92.3% 95.7% 95% 95%

E27 % Stroke thrombolysis within 60 minutes of hospital arrival 66.7% 66.7% 66.7% 80.0% 66.7% 66.7% 75.0% 75.0% 0.0% 81.8% 80.0% 67.2% 95% 95%

E28 % Swallow screen for stroke patients within 4 hours of admission 80.0% 89.3% 69.7% 76.9% 75.6% 80.8% 85.3% 77.4% 88.6% 85.7% 78.8% 80.8% 95% 95%

E29 % of stroke patients admitted to stroke unit within 4 hours of admission 69.0% 75.0% 63.2% 83.3% 69.6% 78.6% 76.3% 62.9% 85.0% 69.8% 71.4% 72.6% 90% 90%

E30 % high risk TIA patients seen within 24 hours 0.0% 0.0% 0.0% 20.0% 12.5% 12.5% 0.0% 0.0% 0.0% 25.0% 50.0% 14.7% 60% 60% Ensure active engagement with research E23 Patients recruited with CRN portfolio 68 32 217 95 63 40 45 69 47 53 66 795 1283 1400 Data Quality E37 % inpatients with electronic discharge summaries produced 93.2% 92.0% 93.4% 92.2% 93.1% 93.4% 89.6% 91.3% 90.0% 90.0% 92.2% 90.1% 91.9% 91.5% 94.2% 94.2%

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Mental Health Care E54 Reduced A&E vists for a cohort of frequent attenders who would benefit from MH interventions 20 16 21 29 28 10 16 14 22 30 13 19 22 224 200 218 SAFETY Safety domain score 2.31 2.07 2.23 2.48 2.11 2.58 2.22 2.30 2.37 2.78 2.26 2.15 2.30 2.26 Safer staffing S36 Safer Staffing: Average fill rate - registered nurses/ midwives (day shifts) 91.4% 93.1% 92.1% 94.3% 93.8% 98.1% 84.5% 87.3% 91.3% 89.7% 87.7% 87.4% 82.9% 90.1% 95% 95%

S37 Safer Staffing: Average fill rate - registered nurses/ midwives (night shifts) 87.0% 89.6% 89.4% 93.0% 94.6% 96.9% 76.4% 78.6% 84.2% 92.5% 88.3% 89.4% 87.8% 91.5% 95% 95%

S38 Safer Staffing: Average fill rate - care staff (day shifts) 91.6% 91.2% 91.9% 93.0% 92.2% 97.6% 95.2% 100.0% 99.0% 95.8% 95.2% 92.8% 90.9% 95.0% 95% 95%

S39 Safer Staffing: Average fill rate - care staff (night shifts) 85.8% 88.3% 90.6% 92.2% 93.4% 96.0% 112.7% 120.4% 121.2% 110.3% 109.8% 110.5% 108.3% 108.1% 95% 95%

S41 Care Hours Per Patient Day (CHPPD) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a NHS safety thermometer S02 Safety Thermometer: % of patients harm-free 95.3% 93.8% 96.4% 95.7% 95.1% 96.4% 95.2% 94.0% 93.8% 96.7% 96.0% 96.2% 93.7% 95.4% 95.70% 95.70%

S03 Safety Thermometer: % of patients with no new harms 98.6% 98.0% 98.2% 94.1% 98.3% 98.6% 98.0% 97.8% 98.1% 98.6% 98.4% 98.6% 98.6% 97.9% 99% 99% Monitoring of clinical incidents S19 NEVER events 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0

S04 Total incidents 332 354 366 384 388 393 448 392 382 401 375 404 397 4330 3857 4208

S05 Total moderate, severe or death incidents 6 4 12 4 8 4 12 8 7 4 2 1 8 70 68 74

S06 Total serious incidents (SIRIs) 0 1 5 1 3 2 1 1 1 0 3 0 1 18 26 28

S07 Number of outstanding CAS alerts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Reducing medication error harm

S08 Medication incidents 26 35 30 35 43 45 47 40 44 56 42 49 42 473 550 600

S09 Moderate/severe medication incidents 0 0 1 0 1 0 0 1 0 0 0 0 0 3 2 3 Reduce incidence of healthcare acquired infections S14 Number of hospital attributable MRSA cases 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

S15 Number of hospital C.diff cases 1 2 1 3 0 0 1 1 0 1 2 4 0 13 17 19

S28 Number of C. diff cases where a lapse in the quality of care was noted 1 0 0 2 0 0 0 0 0 0 2 2 0 6 7 8

S16 Number of reportable MSSA bacteraemia cases 2 3 2 2 3 7 3 3 3 3 5 3 2 36 43 47

S16a Number of hospital attributable MSSA bacteraemia cases 0 1 0 0 0 3 1 1 1 1 2 1 1 11 10 11

S17 Number of reportable E.coli cases 16 17 11 13 15 15 16 10 15 12 14 11 9 141 292 319

S17a Number of hospital attributable E.coli cases 3 3 1 2 3 0 3 3 3 2 2 3 4 26 28 30 Improve theatre safety for patients S18 Full compliance with WHO Surgical Safety Checklist 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100.00% 100%

S30 SSIs: Total hip replacement 3.0% 2.0% 2.8% 2.4% 1.1% 1.1%

S33 SSIs: Total knee replacement 0.0% 0.6% 1.5% 1.1% 1.5% 1.5%

S34 SSIs: Large bowel surgery 6.1% 12.3% 9.2% 10.8% 12% 12%

S35 SSIs: Breast surgery 2.9% 5.1% 3.4% 4.3% 3.8% 3.8% Reduce number of falls in hospital S50 All falls 59 84 74 67 68 63 65 63 53 51 57 84 52 697 666 726

S21 Falls resulting in harm 16 17 21 12 16 17 17 15 15 14 18 22 19 186 188 205

S22 Falls resulting in severe harm or death 0 0 0 0 0 0 1 0 1 0 0 0 0 2 0 0

S40 Repeat falls 3 4 3 2 6 4 5 3 4 0 4 5 4 40 33 36

S23 Falls assessment within 24hrs of admission (Surgery only) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

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Pressure ulcers S49 Grade 2+ pressure ulcers 6 15 8 4 13 1 12 15 16 8 10 17 12 116 110 120 Other safety metrics S11 VTE Assessment Compliance 92.9% 93.2% 97.5% 96.8% 96.8% 96.4% 96.6% 95.7% 95.5% 96.5% 95.5% 96.8% 96.4% 96.4% 100.0% 100.0% Medicines Optimisation S44 Antimicrobial stewardship and consumption: reduction in overall antibiotic consumption n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

S45 Antimicrobial stewardship and consumption: reduction in the use of carbapenems n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

S47 Focus on anticoagulants: Patients on Direct Oral Anticoagulants (NOACs) receiving counselling n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

S48 Focus on anticoagulants: Average no. patients per day on VTE prophylaxis missing report *NEW* n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a EXPERIENCE Experience domain score 2.48 2.32 2.65 2.30 2.40 2.45 2.25 2.40 2.15 2.30 2.35 2.20 2.20 2.25 Friends and Family Test X38 Trust Friends and Family Recommend %: Inpatient 97.2% 97.3% 97.4% 96.3% 97.7% 97.8% 97.9% 96.6% 96.3% 98.3% 98.0% 97.3% 97.2% 97.3% 97% 97%

X39 Trust Friends and Family Recommend %: A&E 88.3% 82.9% 91.9% 88.2% 87.5% 92.9% 83.3% 90.0% 93.5% 92.9% 92.5% 93.9% 94.5% 92.0% 93% 93%

X40 Maternity Friends and Family Recommend %: Antenatal care (36 weeks) 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 94.4% 100.0% 90.9% 100.0% 0.0% 92.3% 0.0% 97.1% 97% 97%

X41 Maternity Friends and Family Recommend %: Delivery care 99.0% 98.5% 98.1% 100.0% 98.6% 98.1% 94.9% 98.9% 97.0% 97.6% 98.7% 93.4% 99.2% 97.6% 97% 97%

X42 Maternity Friends and Family Recommend %: Postnatal ward 99.0% 98.5% 98.1% 100.0% 98.6% 98.1% 94.9% 98.9% 97.0% 97.6% 98.7% 93.4% 99.2% 97.6% 97% 97%

X43 Maternity Friends and Family Recommend %: Postnatal community care n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

X44 Trust Friends and Family Recommend %: Outpatient 97.3% 96.8% 97.0% 96.2% 96.7% 81.5% 96.9% 97.7% 97.4% 97.9% 97.7% 97.3% 96.3% 95.9% 97% 97% Friends and Family Test response rates X24 Trust Friends and Family Response Rate: Inpatient 40.3% 28.2% 38.4% 39.8% 44.1% 43.3% 43.8% 32.6% 34.5% 33.4% 30.8% 37.0% 28.4% 36.9% 40% 40%

X25 Trust Friends and Family Response Rate: A&E 7.7% 7.4% 9.6% 10.4% 8.0% 9.1% 5.3% 9.2% 10.7% 8.4% 6.8% 21.5% 30.9% 11.5% 23% 23%

X33 Maternity Friends and Family Response Rate: Delivery care 54.2% 58.9% 50.5% 50.2% 37.2% 44.4% 52.7% 41.9% 90.0% 81.2% 37.9% 40.3% 63.1% 53.5% 40% 40% Reduction in patients suffering a bad experience dealing with the Trust X08 Percentage of re-booked outpatient appointments 12.8% 13.0% 12.4% 10.8% 10.7% 10.1% 10.1% 11.0% 9.8% 10.9% 11.8% 10.1% 10.4% 10.7% 7.80% 7.8%

X09 Clinics cancelled with less than 6 weeks notice for annual/study leave 17 3 7 16 12 12 14 20 25 14 6 11 29 166 118 129

X11 PALS contacts relating to appointment problems ( % of total appts) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

X12 Reduce patients cancelled on the day of surgery for non-clinical reasons 25 26 9 7 8 28 21 8 28 7 7 15 22 160 154 168

X13 Breaches of mixed sex accommodation arrangements 0 0 0 0 0 0 0 0 15 10 8 19 5 57 0 0 Nutritional Assessment X14 Compliance with MUST tool after 24 hours 84.5% 81.7% 86.2% 87.3% 91.6% 93.1% 90.8% 89.2% 88.1% 91.6% 87.9% 88.5% 87.6% 89.3% 80% 80%

X15 Compliance with MUST tool after 7 days 98.2% 100.0% 98.9% 98.4% 99.0% 99.0% 98.9% 98.8% 98.7% 98.7% 98.2% 97.5% 95.7% 98.4% 95% 95% Cleanliness / PLACE Survey X16 Internal PLACE compliance 96% 96% 97% 97% 96% 96% 97% 95% 97% 95% 89% 96% 94% 95% 95% 95% Improve our customer service and become a more caring organisation X18 Number of complaints 15 20 15 23 13 11 18 15 17 17 11 21 12 173 209 228

X19 Complaints where staff attitude or behaviour is an issue 0 2 1 1 1 2 5 0 4 2 1 3 0 20 20 22

X20 Complaints where staff communication is an issue 0 0 0 1 2 0 1 2 0 0 0 0 3 9 18 20

X21 Complaints about nursing 1 2 1 4 3 1 1 1 1 2 1 5 1 21 18 20 Staff engagement (indicators/targets not yet agreed) X47 Local staff engagement score: I am able to make improvements happen in my area of work n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

6.1 Quality scorecard 1819_M11.1.Quality Scorecard - St Richards Page 9 of 9 Printed 21/03/2019 10:32 Operational Planning and Performance: Quality

SAFER STAFFING SCORECARD - Registered Nurses February 2019 YTD Shift Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Trend Actual Day 92.2% 93.0% 92.0% 94.1% 93.4% 96.1% 84.6% 89.1% 91.9% 88.8% 87.7% 89.2% 85.9% 90.4% WSHFT Night 90.6% 90.1% 90.6% 94.8% 95.5% 96.3% 79.4% 81.2% 88.9% 93.1% 90.3% 92.1% 90.2% 89.3% Day 94.3% 94.5% 92.3% 92.9% 96.0% 99.0% 89.7% 84.9% 90.6% 89.7% 85.1% 91.2% 82.2% 91.0% Acute Cardiac Unit M036 C Night 93.8% 91.9% 91.7% 95.2% 100.0% 99.2% 91.1% 81.5% 90.2% 93.6% 89.5% 97.2% 86.7% 91.9% Day 76.3% 81.4% 75.0% 73.3% 52.1% 40.4% 105.9% 70.9% Aldwick Ward S107 C Night 50.3% 51.8% 40.5% 50.3% 63.5% 8.3% 136.4% 50.4% Day 90.9% 93.9% 89.3% 90.0% 84.8% 97.1% 80.3% 82.0% 73.8% 79.1% 97.6% 88.0% 74.5% 85.5% Ashling Ward M403 C Night 80.4% 80.6% 81.7% 79.0% 80.0% 90.3% 82.8% 77.1% 78.8% 92.4% 78.9% 88.2% 100.9% 82.7% Day 81.3% 77.6% 90.2% 86.7% 85.3% 90.9% 94.6% 91.9% 90.8% 95.7% 92.8% 89.1% Balcombe Ward M606 W Night 90.0% 91.9% 96.7% 98.4% 96.9% 90.6% 103.8% 112.9% 113.4% 143.5% 121.4% 105.9% Day 92.9% 96.0% 93.6% 95.2% 93.6% 96.0% 88.9% 88.6% 92.9% 90.8% 85.0% 94.3% 82.8% 92.1% Barrow Ward M656 W Night 92.0% 92.7% 93.3% 99.2% 97.5% 98.4% 93.5% 93.3% 92.8% 96.6% 96.7% 95.2% 100.0% 95.7% Day 97.9% 97.4% 93.0% 96.5% 96.0% 97.4% 88.5% 104.1% 94.0% 92.4% 89.6% 88.4% 89.7% 94.1% Becket Ward M651 W Night 100.0% 90.3% 83.3% 96.8% 98.3% 95.2% 68.6% 82.1% 81.6% 98.4% 100.0% 96.9% 98.2% 89.0% Day 97.1% 90.4% 100.0% 97.4% 95.9% 100.0% 83.4% 100.5% 100.3% 92.8% 98.3% 98.6% 96.3% 96.2% Beeding Ward W702 W Night 94.2% 89.3% 100.0% 89.0% 98.6% 100.0% 84.9% 100.0% 100.0% 97.2% 100.0% 103.4% 99.9% 97.5% Day 92.0% 95.7% 92.0% 95.7% 93.0% 97.1% 102.8% 98.1% 109.5% 86.7% 82.8% 84.0% 76.9% 92.1% Birdham Ward M100 C Night 83.9% 91.9% 86.7% 93.5% 96.7% 98.4% 74.2% 103.3% 95.3% 96.7% 100.1% 87.0% 99.9% 93.1% Day 97.4% 100.0% 93.2% 95.1% 94.3% 94.8% 93.3% 103.3% 94.0% 100.9% 90.6% 91.9% 94.4% 95.0% Bluefin Ward W706 W Night 97.3% 98.3% 96.6% 96.3% 94.8% 94.5% 83.6% 86.5% 87.7% 100.7% 97.6% 91.0% 99.0% 93.2% Day 96.9% 92.7% 99.6% 98.8% 98.3% 100.0% 91.3% 91.9% 89.7% 96.3% 94.6% 90.9% 91.2% 95.2% Bosham Ward S100 C Night 96.4% 87.1% 95.0% 96.8% 98.3% 100.0% 75.9% 76.5% 89.5% 101.7% 99.9% 92.0% 94.3% 90.6% Day 89.8% 91.1% 87.7% 93.0% 92.7% 91.5% 83.9% 85.8% 99.4% 89.7% 97.0% 95.5% 80.6% 90.7% Botolphs Ward M666 W Night 89.3% 91.4% 91.1% 100.0% 100.0% 96.8% 100.0% 91.6% 114.9% 100.5% 92.8% 91.2% 83.6% 96.5% Day 88.8% 90.7% 88.3% 87.5% 90.4% 95.6% 87.6% 89.7% 92.9% 87.8% 85.8% 82.1% 73.1% 87.5% Boxgrove Ward M105 C Night 78.6% 80.6% 81.7% 79.0% 90.0% 93.5% 82.7% 74.4% 88.2% 94.2% 85.1% 91.4% 89.1% 85.9% Day 55.6% 83.1% 75.4% 80.3% 75.2% 76.7% 70.3% 73.3% Broadwater Ward M662 W Night 62.1% 73.3% 76.6% 76.6% 74.3% 74.9% 68.8% 72.4% Day 83.0% 81.7% 84.1% 96.7% 95.5% 93.3% 70.2% 89.0% 77.1% 58.2% 70.7% 76.1% 108.6% 82.3% Buckingham Ward M661 W Night 94.6% 85.5% 81.7% 100.0% 100.0% 98.4% 79.8% 71.1% 72.6% 76.7% 90.1% 76.8% 127.4% 85.0%

6.2 SaferStaffingScorecard_1819_M11 SaferStaffingWardNurseScorecard 1 of 10 21/03/2019 10:31 Operational Planning and Performance: Quality

SAFER STAFFING SCORECARD - Registered Nurses February 2019 YTD Shift Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Trend Actual Day 92.2% 93.0% 92.0% 94.1% 93.4% 96.1% 84.6% 89.1% 91.9% 88.8% 87.7% 89.2% 85.9% 90.4% WSHFT Night 90.6% 90.1% 90.6% 94.8% 95.5% 96.3% 79.4% 81.2% 88.9% 93.1% 90.3% 92.1% 90.2% 89.3% Day 94.1% 88.8% - Burlington Night 98.2% 90.3% - Day 92.9% 94.3% 95.6% 98.2% 95.9% 96.1% 94.9% 92.8% 94.0% 90.1% 86.3% 93.0% 87.6% 93.5% Castle Ward M603 W Night 84.5% 80.6% 93.3% 96.8% 97.8% 95.7% 97.8% 85.8% 95.8% 95.4% 86.9% 90.2% 76.1% 91.6% Day 90.7% 94.2% 92.4% 95.1% 90.8% 97.7% 78.4% 80.1% 87.9% 87.3% 89.8% 88.7% 87.2% 89.0% Emergency Floor M109 C Night 86.9% 92.1% 93.2% 93.4% 93.2% 96.5% 78.3% 84.2% 84.1% 92.7% 90.7% 90.9% 92.0% 89.2% Day 70.6% 77.2% 78.3% 82.7% 80.6% 92.5% 80.1% 80.4% Chichester Suite T401 C Night 77.0% 80.4% 85.7% 86.7% 83.9% 99.2% 100.1% 87.4% Day 93.8% 87.8% 91.7% 97.7% 97.1% 99.5% 80.8% 87.6% 87.4% 91.2% 80.1% 70.2% 69.3% 87.6% Chilgrove Ward S207 C Night 87.5% 77.4% 86.7% 98.4% 96.7% 98.4% 61.6% 64.4% 76.4% 100.0% 91.9% 97.0% 94.6% 84.6% Day 95.1% 94.4% 93.8% 95.2% 95.0% 96.8% 90.0% 100.4% 102.5% 104.1% 109.2% 100.9% 96.8% 98.0% Chiltington Ward S609 W Night 98.2% 91.9% 88.3% 98.4% 100.0% 100.0% 100.0% 98.3% 98.2% 98.3% 100.0% 100.0% 98.2% 98.4% Day 99.6% 98.4% 97.1% 96.4% 98.8% 97.2% 95.5% 95.9% 94.2% 101.4% 95.8% 94.1% 102.0% 97.1% Clapham Ward S608 W Night 96.4% 93.5% 93.3% 100.0% 98.3% 98.4% 76.5% 70.6% 77.4% 82.3% 80.4% 91.8% 85.4% 83.7% Day 93.3% 94.4% 91.3% 93.5% 99.2% 91.1% 82.9% 86.0% 105.4% 79.0% 89.3% 90.4% 90.5% 90.8% Coombes Ward S711 W Night 96.4% 82.3% 78.3% 96.8% 98.3% 87.1% 72.1% 74.9% 123.6% 106.3% 118.1% 133.7% 124.6% 101.5% Day 92.9% 94.8% 94.3% 94.8% 94.7% 96.5% 88.8% 87.6% 91.3% 82.2% 86.3% 85.3% 83.9% 90.8% Courtlands Ward M536 W Night 94.3% 92.9% 94.7% 94.8% 99.3% 96.8% 87.1% 80.8% 87.9% 87.6% 86.3% 85.4% 80.4% 88.9% Day 88.8% 88.5% 94.8% 96.8% 91.4% 95.9% 99.8% 98.8% 106.1% 91.7% 94.9% 96.3% 85.4% 95.6% Ditchling Ward M903 W Night 96.4% 93.5% 91.7% 98.4% 98.3% 93.5% 80.7% 81.1% 107.9% 98.7% 98.6% 101.6% 96.4% 94.2% Day 80.8% 88.2% 82.6% 85.8% 83.4% 90.3% 89.5% 85.7% Donald Wilson House M114 C Night 100.0% 100.0% 95.2% 100.0% 100.0% 98.4% 100.0% 99.1% Day 72.0% 67.2% 77.7% 74.1% 60.4% 82.8% 74.3% 72.5% Downlands Suite T901 W Night 91.9% 87.5% 98.4% 97.1% 82.3% 93.5% 80.4% 90.3% Day 96.9% 98.6% 94.8% 99.1% 94.3% 95.9% 107.6% 104.5% 96.8% 103.2% 101.5% 103.1% 101.5% 99.6% Durrington Ward M665 W Night 100.0% 98.4% 91.7% 100.0% 98.3% 93.5% 71.0% 92.0% 85.5% 100.0% 100.1% 103.2% 100.0% 92.5% Day 93.8% 91.1% 91.7% 96.4% 95.4% 91.5% 77.8% 82.0% 83.9% 87.6% 81.5% 82.4% 87.1% 88.1% Eartham Ward M658 W Night 95.2% 93.5% 95.6% 97.8% 100.0% 96.8% 70.0% 67.8% 78.9% 98.4% 95.8% 96.9% 96.6% 88.7%

6.2 SaferStaffingScorecard_1819_M11 SaferStaffingWardNurseScorecard 2 of 10 21/03/2019 10:31 Operational Planning and Performance: Quality

SAFER STAFFING SCORECARD - Registered Nurses February 2019 YTD Shift Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Trend Actual Day 92.2% 93.0% 92.0% 94.1% 93.4% 96.1% 84.6% 89.1% 91.9% 88.8% 87.7% 89.2% 85.9% 90.4% WSHFT Night 90.6% 90.1% 90.6% 94.8% 95.5% 96.3% 79.4% 81.2% 88.9% 93.1% 90.3% 92.1% 90.2% 89.3% Day 95.2% 91.3% 87.8% 90.1% 86.5% 94.3% 90.1% 82.4% 95.9% 91.5% 92.9% 90.1% 82.8% 89.6% Eastbrook Ward M602 W Night 96.4% 95.2% 90.0% 100.0% 100.0% 96.8% 76.4% 70.1% 98.3% 89.0% 97.7% 104.1% 98.9% 90.8% Day 87.6% 87.0% 88.1% 88.3% 85.3% 92.3% 84.9% 93.9% 86.2% 85.6% 85.2% 89.7% 86.5% 87.8% Emergency Floor M600 W Night 89.3% 86.0% 90.0% 92.2% 87.8% 94.1% 79.5% 86.1% 86.7% 89.1% 83.2% 87.9% 82.8% 86.8% Day 100.0% 99.2% 100.0% 100.0% 100.0% 98.4% 62.6% 64.3% 79.0% 99.6% 95.6% 98.2% 100.0% 89.3% ESCU S555 W Night 96.4% 100.0% 100.0% 100.0% 100.0% 96.8% 98.4% 93.3% 100.3% 100.0% 90.2% 100.0% 100.0% 97.7% Day 95.4% 97.7% 97.1% 95.9% 91.9% 94.0% 91.9% 95.8% 125.3% 86.8% 94.4% 102.4% 96.2% 97.0% Erringham Ward M604 W Night 91.1% 91.9% 90.0% 98.4% 98.3% 93.5% 71.8% 76.5% 127.7% 95.1% 95.3% 100.0% 98.2% 93.9% Day 87.9% 92.7% 88.3% 96.0% 95.0% 97.6% 95.2% 96.6% 100.6% 92.4% 95.0% 89.9% 90.8% 94.3% Fishbourne Ward M107 C Night 75.0% 80.6% 76.7% 87.1% 96.7% 95.2% 72.7% 66.0% 78.9% 86.4% 84.3% 84.7% 75.6% 80.5% Day 95.0% 97.1% 93.0% 94.5% 92.0% 98.4% 85.1% 81.9% 97.7% 94.1% 97.3% 92.3% 82.8% 92.2% Ford Ward M023 C Night 92.9% 92.5% 87.8% 93.5% 90.0% 97.8% 78.0% 85.3% 85.4% 93.6% 88.6% 89.8% 89.0% 88.6% Day 94.6% 98.3% 100.0% 100.0% 100.0% 96.1% 88.9% 105.9% 107.7% 96.3% 88.3% 84.8% 84.9% 94.1% Howard Ward W200 C Night 95.5% 100.0% 99.0% 100.0% 100.0% 94.1% 79.0% 99.1% 99.4% 100.1% 88.5% 79.6% 83.5% 91.1% Day 85.7% 90.7% 87.4% 90.7% 95.2% 99.3% 88.0% 90.4% 89.2% 85.6% 88.6% 84.7% 79.2% 89.5% Lavant Ward M111 C Night 66.1% 85.5% 75.0% 91.9% 93.3% 96.8% 86.2% 84.2% 78.4% 89.6% 82.9% 84.9% 72.7% 84.1% Day 84.4% 86.7% 88.3% 87.9% 90.4% 95.6% 77.2% 74.5% 98.6% 91.8% 89.2% 85.2% 81.9% 87.6% Middleton Ward M112 C Night 60.7% 71.0% 75.0% 79.0% 86.7% 87.1% 81.4% 71.1% 75.2% 87.7% 79.7% 80.7% 81.1% 80.0% Day 98.6% 98.8% 98.2% 96.5% 98.8% 95.1% 65.6% 91.0% 92.1% 98.5% 92.0% 92.6% 66.5% 87.1% SCBU W201 C Night 98.6% 100.0% 100.0% 100.0% 93.8% 100.0% 63.7% 83.6% 88.8% 99.2% 90.3% 97.9% 68.0% 86.2% Day 92.3% 95.7% 90.6% 96.2% 97.8% 99.5% 99.2% 92.2% 97.0% 103.7% 76.3% 81.1% 73.3% 96.9% Petworth Ward M104 C Night 94.6% 95.2% 91.7% 100.0% 98.3% 100.0% 71.0% 67.8% 80.3% 95.1% 77.4% 79.1% 76.3% 84.0% Day 93.5% 93.3% 97.0% 98.3% 95.7% 100.0% 92.8% 84.4% 86.4% 92.9% 92.8% 94.8% 95.2% 93.8% Selsey Ward S102 C Night 92.9% 93.5% 95.6% 94.6% 97.8% 100.0% 72.4% 67.2% 86.0% 101.3% 100.0% 100.3% 100.0% 90.6% Day 90.2% 90.7% 93.3% 97.2% 98.3% 99.6% 83.7% 97.4% 99.7% 89.1% 93.9% 94.2% 98.6% 95.2% Wittering Ward S205 C Night 83.9% 88.7% 90.0% 96.8% 98.3% 100.0% 66.1% 70.9% 93.5% 92.1% 100.1% 101.6% 104.6% 90.1%

6.2 SaferStaffingScorecard_1819_M11 SaferStaffingWardNurseScorecard 3 of 10 21/03/2019 10:31 Operational Planning and Performance: Quality

SAFER STAFFING SCORECARD - Care Staff February 2019 YTD Shift Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Trend Actual Day 90.3% 90.5% 92.4% 94.0% 93.8% 96.2% 94.1% 98.7% 95.8% 91.8% 94.1% 92.5% 89.8% 93.9% WSHFT Night 92.4% 92.7% 94.7% 94.9% 96.6% 96.8% 116.0% 124.0% 121.0% 102.6% 104.8% 105.9% 103.3% 106.8% Day 88.6% 95.5% 86.7% 89.7% 90.7% 95.5% 90.2% 87.5% 84.5% 84.6% 87.2% 88.4% 96.0% 89.2% Acute Cardiac Unit M036 C Night 67.9% 90.3% 73.3% 83.9% 76.7% 87.1% 134.7% 138.7% 127.6% 107.5% 152.9% 122.6% 165.2% 119.4% Day 63.7% 66.4% 83.0% 83.3% 75.1% 27.9% 100.0% 65.9% Aldwick Ward S107 C Night 0.0% 0.0% 0.0% 0.0% 993.2% 0.0% 0.0% - Day 94.4% 93.5% 93.8% 93.5% 95.2% 97.2% 108.9% 122.6% 135.0% 105.7% 99.3% 83.2% 85.2% 103.7% Ashling Ward M403 C Night 83.9% 85.5% 98.3% 90.3% 91.7% 95.2% 147.3% 142.8% 142.4% 125.9% 117.4% 117.7% 88.5% 120.9% Day 84.4% 94.4% 94.9% 95.0% 119.3% 119.4% 118.3% 88.9% 89.4% 87.1% 81.5% 96.1% Balcombe Ward M606 W Night 93.3% 100.0% 100.0% 96.8% 142.3% 149.9% 137.1% 98.8% 98.0% 97.6% 96.4% 111.5% Day 87.8% 86.0% 94.4% 93.5% 94.4% 94.9% 100.4% 98.1% 97.5% 94.3% 102.9% 106.4% 107.3% 97.1% Barrow Ward M656 W Night 99.1% 92.7% 99.2% 98.4% 99.2% 100.0% 131.5% 131.5% 124.4% 95.4% 97.3% 98.7% 101.5% 108.9% Day 87.9% 88.4% 92.9% 96.6% 96.5% 95.9% 92.1% 86.9% 86.4% 89.5% 86.7% 94.6% 80.7% 90.4% Becket Ward M651 W Night 100.0% 93.5% 100.0% 100.0% 100.0% 100.0% 138.7% 140.7% 145.2% 97.8% 97.8% 98.9% 97.7% 109.7% Day 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 87.1% 100.0% 96.2% 91.7% 103.2% 109.6% 107.4% 99.5% Beeding Ward W702 W Night 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 71.0% 95.7% 100.0% 91.7% 86.4% 100.0% 85.7% 92.9% Day 90.9% 93.3% 91.5% 94.8% 89.9% 97.4% 120.0% 132.2% 127.9% 94.0% 105.1% 99.0% 70.8% 99.3% Birdham Ward M100 C Night 85.7% 90.3% 85.0% 98.4% 93.3% 96.8% 133.2% 123.2% 136.3% 94.4% 89.6% 95.5% 84.9% 101.5% Day 97.6% 74.2% 88.3% 96.7% 94.1% 95.2% 96.0% 99.7% 85.8% 97.8% 97.3% 97.9% 97.2% 95.3% Bluefin Ward W706 W Night 92.6% 87.1% 100.0% 71.0% 77.4% 90.3% 142.7% 171.7% 132.7% 96.6% 97.1% 128.1% 108.5% 113.4% Day 93.6% 84.5% 91.3% 96.8% 98.7% 99.4% 91.7% 93.8% 99.1% 88.1% 83.2% 80.5% 84.9% 91.0% Bosham Ward S100 C Night 92.9% 88.7% 91.7% 96.8% 98.3% 100.0% 103.3% 111.6% 119.3% 97.1% 91.2% 91.2% 104.0% 100.4% Day 93.9% 90.0% 91.6% 92.3% 92.0% 91.9% 101.7% 102.3% 98.7% 84.3% 89.7% 90.0% 87.7% 92.5% Botolphs Ward M666 W Night 91.1% 98.4% 93.3% 95.2% 100.0% 96.8% 127.4% 133.3% 122.6% 96.2% 89.2% 96.9% 97.6% 103.7% Day 95.4% 92.6% 87.6% 92.2% 85.2% 97.7% 95.1% 97.5% 98.5% 97.4% 103.3% 104.6% 99.6% 96.1% Boxgrove Ward M105 C Night 89.3% 90.3% 81.7% 93.5% 85.0% 98.4% 96.7% 102.1% 108.0% 103.4% 99.7% 101.5% 108.2% 100.0% Day 68.4% 116.9% 85.0% 99.7% 93.5% 90.0% 86.0% 89.9% Broadwater Ward M662 W Night 95.3% 135.0% 98.9% 100.0% 94.3% 96.8% 99.0% 100.6% Day 77.0% 82.3% 89.3% 98.2% 93.7% 92.7% 74.3% 118.4% 76.4% 67.4% 96.3% 88.3% 111.5% 89.0% Buckingham Ward M661 W Night 92.9% 96.8% 93.3% 95.2% 100.0% 96.8% 92.5% 135.0% 100.0% 76.7% 109.9% 107.8% 124.4% 102.1%

6.2 SaferStaffingScorecard_1819_M11 SaferStaffingWardCareScorecard 4 of 10 21/03/2019 10:31 Operational Planning and Performance: Quality

SAFER STAFFING SCORECARD - Care Staff February 2019 YTD Shift Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Trend Actual Day 90.3% 90.5% 92.4% 94.0% 93.8% 96.2% 94.1% 98.7% 95.8% 91.8% 94.1% 92.5% 89.8% 93.9% WSHFT Night 92.4% 92.7% 94.7% 94.9% 96.6% 96.8% 116.0% 124.0% 121.0% 102.6% 104.8% 105.9% 103.3% 106.8% Day 93.0% 93.0% - Burlington Night 100.0% 93.5% - Day 94.9% 82.9% 95.7% 95.4% 95.2% 94.5% 95.3% 89.9% 98.9% 80.4% 89.0% 86.2% 93.4% 92.2% Castle Ward M603 W Night 92.9% 88.7% 93.3% 100.0% 100.0% 98.4% 135.5% 128.3% 139.0% 95.2% 112.2% 99.9% 99.9% 109.4% Day 92.6% 92.8% 90.9% 90.1% 91.7% 97.6% 99.7% 104.2% 95.5% 98.7% 104.8% 118.0% 114.8% 100.5% Emergency Floor M109 C Night 86.4% 84.9% 74.5% 79.6% 92.9% 91.8% 102.6% 95.9% 100.6% 100.4% 109.7% 111.9% 115.7% 101.2% Day 75.4% 86.7% 82.4% 83.0% 78.5% 76.4% 65.1% 78.3% Chichester Suite T401 C Night 96.8% 96.7% 90.5% 89.7% 96.8% 104.9% 92.9% 95.5% Day 84.8% 77.4% 91.7% 96.8% 97.5% 98.4% 88.6% 89.3% 84.8% 91.8% 80.6% 81.8% 68.0% 87.7% Chilgrove Ward S207 C Night 89.3% 83.9% 98.3% 98.4% 98.3% 96.8% 79.0% 81.7% 79.0% 90.8% 82.8% 81.1% 84.1% 87.1% Day 94.0% 93.5% 95.0% 94.1% 98.9% 96.8% 102.5% 97.4% 101.7% 92.6% 85.9% 92.4% 86.0% 94.8% Chiltington Ward S609 W Night 98.2% 98.4% 96.7% 96.8% 100.0% 91.9% 111.3% 105.0% 109.5% 94.3% 83.5% 91.4% 83.6% 96.0% Day 88.3% 91.7% 91.0% 97.2% 96.2% 94.5% 98.0% 91.7% 96.6% 94.5% 99.6% 102.7% 87.4% 95.4% Clapham Ward S608 W Night 98.2% 93.5% 98.3% 100.0% 98.3% 98.4% 141.9% 130.0% 140.8% 105.5% 128.9% 121.6% 90.9% 115.5% Day 91.1% 84.9% 90.0% 92.5% 95.6% 93.5% 107.4% 111.2% 95.9% 86.7% 102.3% 88.0% 81.0% 94.2% Coombes Ward S711 W Night 98.2% 96.8% 96.7% 95.2% 100.0% 96.8% 133.1% 136.0% 121.5% 100.9% 115.6% 104.7% 98.3% 110.9% Day 92.9% 92.9% 88.7% 95.5% 95.3% 97.4% 93.2% 93.7% 96.9% 85.8% 103.5% 100.9% 82.2% 94.0% Courtlands Ward M536 W Night 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 245.1% 212.5% 750.0% 232.3% - Day 85.7% 93.0% 90.0% 97.8% 94.4% 95.7% 107.5% 97.4% 101.7% 98.2% 97.4% 91.5% 85.4% 96.0% Ditchling Ward M903 W Night 96.4% 95.2% 98.3% 93.5% 98.3% 96.8% 129.0% 122.5% 122.6% 103.1% 97.8% 95.9% 98.8% 105.1% Day 101.1% 93.9% 107.4% 103.5% 105.2% 94.1% 96.1% 100.3% Donald Wilson House M114 C Night 0.0% 0.0% 0.0% 170.4% 0.0% 0.0% 285.0% - Day 58.6% 48.4% 54.7% 55.1% 57.6% 108.3% 74.9% 65.3% Downlands Suite T901 W Night 0.0% 0.0% 0.0% 400.0% 0.0% 677.8% 0.0% - Day 89.3% 94.8% 97.1% 95.6% 94.2% 94.0% 81.1% 92.7% 96.0% 91.8% 86.2% 82.5% 84.9% 91.2% Durrington Ward M665 W Night 100.0% 98.4% 100.0% 100.0% 98.3% 95.2% 135.5% 128.3% 145.2% 99.8% 94.6% 92.3% 95.2% 106.7% Day 76.4% 81.9% 92.0% 95.5% 90.7% 93.5% 110.4% 102.2% 96.0% 87.0% 93.9% 83.6% 86.8% 93.4% Eartham Ward M658 W Night 89.3% 100.0% 96.7% 93.5% 96.7% 93.5% 129.0% 139.7% 122.6% 103.4% 97.5% 96.3% 97.3% 108.2%

6.2 SaferStaffingScorecard_1819_M11 SaferStaffingWardCareScorecard 5 of 10 21/03/2019 10:31 Operational Planning and Performance: Quality

SAFER STAFFING SCORECARD - Care Staff February 2019 YTD Shift Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Trend Actual Day 90.3% 90.5% 92.4% 94.0% 93.8% 96.2% 94.1% 98.7% 95.8% 91.8% 94.1% 92.5% 89.8% 93.9% WSHFT Night 92.4% 92.7% 94.7% 94.9% 96.6% 96.8% 116.0% 124.0% 121.0% 102.6% 104.8% 105.9% 103.3% 106.8% Day 85.0% 88.4% 92.0% 94.2% 92.7% 94.2% 96.5% 111.7% 96.3% 91.3% 93.9% 96.4% 90.0% 95.1% Eastbrook Ward M602 W Night 94.6% 95.2% 100.0% 98.4% 96.7% 98.4% 106.5% 128.3% 124.1% 105.1% 105.5% 113.6% 102.0% 108.3% Day 90.0% 92.4% 93.2% 93.9% 96.0% 98.7% 96.8% 94.8% 95.5% 90.8% 92.3% 89.9% 87.6% 93.7% Emergency Floor M600 W Night 98.9% 97.4% 98.3% 97.7% 100.0% 98.4% 105.4% 105.0% 108.3% 97.4% 104.5% 96.5% 96.8% 100.6% Day 97.3% 98.4% 100.0% 100.0% 99.2% 96.8% 44.7% 39.8% 61.7% 96.2% 87.7% 96.3% 92.1% 83.7% ESCU S555 W Night 92.9% 96.8% 100.0% 96.8% 100.0% 96.8% 27.6% 38.4% 39.5% 63.3% 41.9% 58.1% 75.0% 59.6% Day 85.7% 97.4% 95.3% 86.5% 92.7% 92.9% 102.3% 105.5% 98.7% 97.6% 96.4% 92.9% 88.5% 95.2% Erringham Ward M604 W Night 98.2% 96.8% 98.3% 95.2% 100.0% 96.8% 120.3% 129.3% 137.1% 104.5% 96.0% 93.2% 96.8% 106.7% Day 92.3% 95.2% 86.7% 86.0% 93.9% 96.8% 108.4% 108.0% 101.2% 100.0% 95.7% 91.4% 89.8% 96.0% Fishbourne Ward M107 C Night 83.9% 93.5% 86.7% 87.1% 93.3% 93.5% 137.8% 147.2% 135.9% 136.6% 121.9% 127.1% 131.7% 121.2% Day 92.1% 90.3% 92.7% 93.5% 78.7% 96.8% 97.8% 107.2% 107.0% 111.7% 101.1% 100.1% 108.4% 99.3% Ford Ward M023 C Night 87.5% 88.7% 95.0% 96.8% 91.7% 95.2% 147.2% 146.6% 140.3% 136.1% 124.4% 127.3% 123.2% 123.3% Day 85.7% 96.8% 93.3% 80.6% 100.0% 100.0% 43.5% 83.3% 74.4% 77.4% 69.8% 58.4% 59.6% 68.4% Howard Ward W200 C Night 53.8% 74.2% 93.3% 71.0% 86.7% 89.7% 43.5% 100.0% 97.9% 100.0% 54.5% 47.5% 46.0% 66.0% Day 91.5% 90.3% 96.3% 92.7% 90.8% 98.4% 100.6% 105.1% 105.2% 96.6% 93.8% 95.2% 88.3% 96.4% Lavant Ward M111 C Night 82.1% 82.3% 93.3% 90.3% 86.7% 100.0% 119.4% 130.1% 127.8% 104.9% 126.6% 136.0% 145.5% 116.9% Day 88.6% 92.9% 90.0% 91.0% 96.0% 95.5% 113.1% 117.7% 107.6% 111.1% 111.3% 101.4% 95.0% 102.8% Middleton Ward M112 C Night 87.5% 90.3% 93.3% 91.9% 96.7% 93.5% 144.2% 145.3% 141.7% 141.7% 140.6% 149.4% 147.4% 129.8% Day 95.7% 96.2% 92.3% 95.2% 84.0% 89.3% 74.5% 110.1% 85.7% 100.8% 100.6% 100.3% 90.1% 92.5% SCBU W201 C Night 92.0% 100.0% 96.6% 96.3% 100.0% 96.6% 74.2% 113.2% 94.1% 95.5% 100.3% 104.6% 75.1% 94.2% Day 95.7% 96.1% 97.3% 93.5% 90.7% 96.1% 110.9% 106.2% 111.3% 103.6% 111.3% 130.5% 127.6% 100.2% Petworth Ward M104 C Night 94.6% 98.4% 96.7% 90.3% 95.0% 95.2% 107.7% 101.4% 109.4% 97.9% 147.2% 201.9% 222.8% 100.0% Day 94.2% 92.7% 96.2% 99.5% 97.8% 100.0% 91.0% 91.6% 98.0% 88.1% 87.3% 89.8% 88.1% 93.4% Selsey Ward S102 C Night 91.1% 88.7% 96.7% 100.0% 100.0% 100.0% 117.8% 137.4% 124.3% 117.7% 109.0% 115.2% 93.4% 111.0% Day 82.9% 80.6% 92.7% 99.4% 96.7% 100.0% 98.9% 96.0% 84.8% 87.6% 87.2% 82.1% 86.9% 91.4% Wittering Ward S205 C Night 82.1% 83.9% 93.3% 100.0% 100.0% 100.0% 102.0% 104.6% 97.7% 88.4% 93.6% 94.7% 92.6% 96.5%

6.2 SaferStaffingScorecard_1819_M11 SaferStaffingWardCareScorecard 6 of 10 21/03/2019 10:31 Operational Planning and Performance: Quality

SAFER STAFFING SCORECARD - CHPPD February 2019 Care Hours Per Patient YTD Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Trend Day (CHPPD) Average Nurse 3.7 3.7 3.7 4.1 4.1 4.2 3.9 3.8 3.9 4.0 3.9 3.7 3.7 3.9 WSHFT Care 2.6 2.6 2.7 3.0 3.0 3.1 3.4 3.3 3.3 3.4 3.4 3.3 3.3 3.2 Overall 6.3 6.3 6.5 7.1 7.1 7.3 7.2 7.1 7.3 7.4 7.3 6.9 7.0 7.1 Nurse 4.3 4.4 4.4 4.8 4.7 5.3 4.2 4.3 4.2 4.6 4.0 4.0 3.7 4.4 Acute Cardiac Unit M036 C Care 1.7 1.9 1.7 1.9 1.8 2.1 2.2 2.4 2.0 2.1 2.2 1.9 2.3 2.1 Overall 6.0 6.3 6.1 6.7 6.6 7.4 6.4 6.7 6.2 6.7 6.2 5.9 6.0 6.4 Nurse 7.5 5.3 6.8 5.7 3.3 0.3 0.9 3.5 Aldwick Ward S107 C Care 3.8 3.1 4.8 3.7 2.4 0.5 0.1 2.2 Overall 11.3 8.4 11.6 9.4 5.7 0.8 1.0 5.8 Nurse 3.2 3.3 3.1 3.4 4.0 3.5 3.0 3.0 2.8 3.0 2.5 2.5 2.3 3.2 Ashling Ward M403 C Care 2.7 2.7 2.8 2.9 3.6 2.9 3.0 3.3 3.3 2.7 2.8 3.1 2.8 3.0 Overall 5.9 5.9 5.9 6.3 7.6 6.4 6.0 6.2 6.1 5.7 5.3 5.6 5.1 6.2 Nurse 2.7 3.1 3.0 2.8 4.3 4.3 24.5 4.3 4.6 4.1 3.8 4.0 Balcombe Ward M606 W Care 2.1 2.7 2.3 2.2 3.7 3.8 21.5 3.6 3.3 3.4 3.6 3.4 Overall 4.8 5.7 5.3 5.0 8.0 8.2 46.1 7.9 7.9 7.5 7.4 7.4 Nurse 3.3 3.6 3.9 4.0 3.5 3.4 2.8 2.9 2.8 2.8 2.8 2.9 2.9 3.2 Barrow Ward M656 W Care 3.3 3.3 4.0 3.9 3.5 3.4 3.6 3.7 3.5 3.7 3.6 3.4 3.9 3.7 Overall 6.6 6.9 7.9 7.9 7.0 6.8 6.4 6.6 6.3 6.5 6.4 6.3 6.8 6.8 Nurse 4.6 4.4 4.4 4.8 4.4 4.4 2.7 3.2 2.8 2.9 2.7 2.8 2.9 3.4 Becket Ward M651 W Care 2.4 2.3 2.5 2.7 2.5 2.5 3.5 3.4 3.5 3.6 3.5 3.8 3.7 3.2 Overall 7.1 6.7 6.9 7.5 7.0 6.9 6.2 6.6 6.3 6.6 6.2 6.6 6.6 6.7 Nurse 6.0 7.4 7.1 6.1 6.8 8.9 11.6 11.8 18.0 22.9 11.2 8.5 10.7 10.2 Beeding Ward W702 W Care 2.5 3.0 3.2 2.7 2.9 3.7 3.6 3.6 6.2 6.8 3.0 2.7 3.2 3.4 Overall 8.5 10.4 10.3 8.8 9.7 12.5 15.2 15.4 24.2 29.7 14.2 11.2 13.9 13.6 Nurse 2.9 2.9 2.8 3.2 3.2 4.7 3.1 3.1 2.8 3.2 2.8 2.6 2.6 3.1 Birdham Ward M100 C Care 2.7 2.7 2.6 3.1 2.9 4.5 3.5 3.6 3.3 3.6 3.6 3.2 3.2 3.3 Overall 5.6 5.6 5.4 6.3 6.1 9.2 6.7 6.8 6.1 6.8 6.4 5.9 5.8 6.4 Nurse 5.3 4.6 5.1 5.0 5.1 6.6 10.7 7.2 8.6 8.6 9.9 9.4 9.1 7.7 Bluefin Ward W706 W Care 1.6 1.4 1.5 1.2 1.5 2.1 5.5 4.0 4.0 3.4 4.3 4.0 3.7 3.1 Overall 6.9 5.9 6.6 6.2 6.6 8.7 16.2 11.2 12.6 12.1 14.2 13.4 12.8 10.8 Nurse 3.4 3.3 3.5 3.8 4.1 3.7 3.3 3.3 3.2 3.7 3.6 3.3 3.2 3.5 Bosham Ward S100 C Care 2.3 2.2 2.3 2.6 2.9 2.6 2.9 3.0 3.1 3.3 3.2 3.1 3.2 2.9 Overall 5.7 5.4 5.7 6.4 6.9 6.3 6.2 6.3 6.3 6.9 6.8 6.4 6.4 6.4 Nurse 3.5 3.5 3.6 4.4 4.1 3.9 3.7 3.4 4.0 3.5 3.7 3.3 3.1 3.7 Botolphs Ward M666 W Care 3.3 3.2 3.4 3.9 3.7 3.6 3.8 3.7 3.5 3.8 4.2 3.9 3.8 3.7 Overall 6.8 6.7 7.1 8.3 7.9 7.5 7.5 7.1 7.5 7.4 7.9 7.2 6.9 7.4

6.2 SaferStaffingScorecard_1819_M11 SaferStaffingWardCHPPD 7 of 10 21/03/2019 10:31 Operational Planning and Performance: Quality

SAFER STAFFING SCORECARD - CHPPD February 2019 Care Hours Per Patient YTD Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Trend Day (CHPPD) Average Nurse 3.7 3.7 3.7 4.1 4.1 4.2 3.9 3.8 3.9 4.0 3.9 3.7 3.7 3.9 WSHFT Care 2.6 2.6 2.7 3.0 3.0 3.1 3.4 3.3 3.3 3.4 3.4 3.3 3.3 3.2 Overall 6.3 6.3 6.5 7.1 7.1 7.3 7.2 7.1 7.3 7.4 7.3 6.9 7.0 7.1 Nurse 2.8 2.8 2.8 2.8 2.9 3.0 2.8 2.7 2.7 2.8 2.5 2.6 2.7 2.8 Boxgrove Ward M105 C Care 2.7 2.6 2.5 2.8 2.5 2.8 3.3 3.5 3.6 3.8 3.5 3.5 3.5 3.2 Overall 5.5 5.3 5.3 5.6 5.4 5.9 6.1 6.2 6.3 6.6 6.0 6.0 6.2 6.0 Nurse 3.3 2.9 3.1 3.3 3.4 2.8 2.7 3.1 Broadwater Ward M662 W Care 3.6 3.4 2.9 3.6 3.6 3.4 3.6 3.4 Overall 6.9 6.4 6.0 7.0 7.0 6.2 6.3 6.5 Nurse 2.0 1.9 2.1 3.3 3.2 3.1 3.8 2.9 3.0 3.0 2.8 2.9 2.6 2.9 Buckingham Ward M661 W Care 1.6 1.7 1.9 2.8 2.7 2.6 3.5 3.4 3.8 3.9 4.1 3.5 3.1 3.2 Overall 3.6 3.6 3.9 6.1 5.9 5.7 7.3 6.3 6.7 7.0 6.8 6.4 5.7 6.1 Nurse 3.5 3.2 - Burlington Care 2.6 2.5 - Overall 6.0 5.8 - Nurse 3.5 3.5 3.7 4.1 3.8 3.8 3.4 3.1 3.2 3.7 3.2 3.3 2.9 3.5 Castle Ward M603 W Care 2.7 2.4 2.8 3.0 2.9 2.8 2.8 2.7 2.8 2.8 2.7 2.9 2.9 2.8 Overall 6.2 6.0 6.5 7.1 6.7 6.7 6.2 5.8 6.0 6.5 5.9 6.2 5.8 6.3 Nurse 3.9 3.9 4.2 5.0 5.0 5.1 4.8 4.8 5.0 4.9 5.1 4.9 5.2 4.9 Emergency Floor M109 C Care 2.2 2.1 2.2 2.6 2.8 2.8 3.9 3.7 3.5 3.6 4.0 4.0 4.3 3.4 Overall 6.1 6.1 6.4 7.6 7.8 8.0 8.7 8.5 8.5 8.5 9.1 8.9 9.5 8.3 Nurse 5.1 4.6 5.0 6.3 5.5 6.1 7.7 5.7 Chichester Suite T401 C Care 4.0 3.7 3.7 4.4 4.0 3.7 4.7 4.0 Overall 9.1 8.3 8.7 10.6 9.5 9.9 12.4 9.6 Nurse 5.2 4.9 4.5 5.2 5.3 7.0 4.4 3.9 4.2 4.1 5.8 2.8 6.2 4.6 Chilgrove Ward S207 C Care 3.3 3.1 3.2 3.5 3.6 4.7 4.3 3.5 3.7 3.8 5.4 2.7 5.6 3.8 Overall 8.5 8.0 7.8 8.7 8.9 11.7 8.7 7.4 8.0 7.9 11.2 5.5 11.8 8.5 Nurse 4.1 4.2 4.1 4.7 4.4 4.4 3.5 3.4 3.6 3.5 4.1 3.6 3.4 3.9 Chiltington Ward S609 W Care 3.2 3.4 3.4 3.8 3.7 3.4 3.6 3.1 3.4 3.2 3.6 3.3 3.4 3.4 Overall 7.3 7.6 7.4 8.5 8.1 7.8 7.0 6.6 7.0 6.8 7.6 6.9 6.8 7.3 Nurse 3.2 3.2 3.2 3.5 3.3 3.4 3.1 3.2 3.1 3.3 3.1 3.2 3.3 3.2 Clapham Ward S608 W Care 2.6 2.8 2.8 3.1 2.9 3.0 3.2 3.1 3.2 3.2 3.5 3.5 3.1 3.1 Overall 5.8 6.0 6.0 6.6 6.3 6.3 6.3 6.4 6.4 6.5 6.6 6.6 6.3 6.4 Nurse 3.0 3.1 3.1 3.2 3.4 3.0 2.6 2.9 3.4 3.7 3.8 3.1 2.8 3.2 Coombes Ward S711 W Care 2.4 2.4 2.6 2.5 2.7 2.5 4.0 4.4 3.5 4.3 4.1 4.3 4.2 3.6 Overall 5.4 5.6 5.7 5.7 6.1 5.4 6.6 7.3 6.9 7.9 7.8 7.3 7.0 6.7

6.2 SaferStaffingScorecard_1819_M11 SaferStaffingWardCHPPD 8 of 10 21/03/2019 10:31 Operational Planning and Performance: Quality

SAFER STAFFING SCORECARD - CHPPD February 2019 Care Hours Per Patient YTD Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Trend Day (CHPPD) Average Nurse 3.7 3.7 3.7 4.1 4.1 4.2 3.9 3.8 3.9 4.0 3.9 3.7 3.7 3.9 WSHFT Care 2.6 2.6 2.7 3.0 3.0 3.1 3.4 3.3 3.3 3.4 3.4 3.3 3.3 3.2 Overall 6.3 6.3 6.5 7.1 7.1 7.3 7.2 7.1 7.3 7.4 7.3 6.9 7.0 7.1 Nurse 8.1 7.9 8.6 8.0 8.6 8.7 5.7 5.6 5.7 6.0 5.9 5.6 5.6 6.7 Courtlands Ward M536 W Care 2.7 2.6 2.7 2.7 2.8 2.9 1.7 1.9 1.8 1.8 2.1 2.0 2.0 2.2 Overall 10.8 10.5 11.3 10.7 11.5 11.7 7.4 7.5 7.5 7.8 8.0 7.6 7.6 8.9 Nurse 2.9 2.9 3.0 3.2 3.2 3.1 3.0 3.0 3.3 3.3 2.7 2.7 2.5 3.0 Ditchling Ward M903 W Care 2.5 2.6 2.6 2.8 2.9 2.8 3.1 2.9 3.1 2.9 3.3 3.1 3.2 3.0 Overall 5.4 5.5 5.6 6.0 6.0 5.9 6.1 5.9 6.3 6.2 6.0 5.8 5.7 6.0 Nurse 4.7 5.1 5.1 5.9 5.7 5.4 4.9 5.2 Donald Wilson House M114 C Care 3.8 3.6 5.1 6.2 4.8 3.8 3.9 4.4 Overall 8.5 8.7 10.1 12.1 10.5 9.2 8.8 9.6 Nurse 8.5 7.6 7.7 8.9 9.2 4.0 7.0 7.0 Downlands Suite T901 W Care 3.2 2.6 2.2 2.8 4.2 4.1 4.3 3.4 Overall 11.8 10.2 9.9 11.6 13.5 8.1 11.3 10.4 Nurse 3.2 3.3 3.1 3.4 3.2 3.1 2.9 3.2 2.8 2.8 2.8 2.9 2.8 3.0 Durrington Ward M665 W Care 3.3 3.5 3.6 3.7 3.5 3.4 3.0 3.2 3.5 3.5 3.3 3.2 3.2 3.4 Overall 6.6 6.8 6.7 7.2 6.7 6.5 6.0 6.4 6.3 6.3 6.1 6.0 6.1 6.4 Nurse 4.2 4.1 4.3 4.7 4.7 4.4 2.9 2.9 2.8 3.0 3.1 2.9 3.0 3.5 Eartham Ward M658 W Care 1.9 2.0 2.4 2.5 2.4 2.4 3.5 3.4 3.1 3.0 3.4 3.3 3.4 3.0 Overall 6.1 6.1 6.7 7.2 7.2 6.8 6.4 6.3 5.9 6.0 6.6 6.2 6.4 6.5 Nurse 3.3 3.3 3.1 3.6 3.2 3.5 3.3 2.9 3.3 3.5 3.2 3.3 3.0 3.3 Eastbrook Ward M602 W Care 2.3 2.4 2.4 2.7 2.5 2.6 2.5 2.9 2.6 2.6 3.0 3.0 2.4 2.7 Overall 5.6 5.7 5.5 6.3 5.7 6.1 5.8 5.8 5.9 6.2 6.2 6.3 5.5 5.9 Nurse 4.5 4.2 4.9 5.7 4.8 5.0 4.7 5.1 4.9 5.0 4.8 4.8 4.4 4.9 Emergency Floor M600 W Care 3.9 3.8 4.4 5.0 4.5 4.4 3.6 3.6 3.6 3.5 3.5 3.3 3.2 3.8 Overall 8.4 8.0 9.4 10.7 9.3 9.3 8.4 8.7 8.5 8.5 8.3 8.2 7.6 8.8 Nurse 8.7 9.9 9.5 10.3 9.7 8.7 11.6 10.6 11.0 10.2 12.4 10.3 10.5 10.4 ESCU S555 W Care 8.4 9.7 9.5 10.3 9.6 8.6 4.0 3.9 3.9 4.0 4.4 4.0 4.4 6.1 Overall 17.1 19.6 19.0 20.6 19.3 17.3 15.6 14.6 14.9 14.2 16.8 14.3 14.9 16.4 Nurse 3.2 3.3 3.4 3.6 3.3 3.4 3.2 3.1 4.1 3.5 3.1 3.1 2.8 3.3 Erringham Ward M604 W Care 2.4 2.6 2.7 2.6 2.6 2.6 3.2 3.2 3.1 2.9 3.0 2.8 2.7 2.9 Overall 5.6 5.9 6.1 6.1 5.8 6.0 6.4 6.3 7.2 6.5 6.1 6.0 5.5 6.2 Nurse 2.8 3.0 2.8 3.2 4.6 4.1 3.1 3.1 3.3 4.0 3.4 3.1 3.3 3.4 Fishbourne Ward M107 C Care 2.4 2.5 2.3 2.4 3.7 3.2 3.2 3.4 3.0 3.6 3.0 2.8 2.9 3.0 Overall 5.2 5.5 5.1 5.6 8.3 7.4 6.3 6.5 6.3 7.6 6.4 5.9 6.2 6.4

6.2 SaferStaffingScorecard_1819_M11 SaferStaffingWardCHPPD 9 of 10 21/03/2019 10:31 Operational Planning and Performance: Quality

SAFER STAFFING SCORECARD - CHPPD February 2019 Care Hours Per Patient YTD Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Trend Day (CHPPD) Average Nurse 3.7 3.7 3.7 4.1 4.1 4.2 3.9 3.8 3.9 4.0 3.9 3.7 3.7 3.9 WSHFT Care 2.6 2.6 2.7 3.0 3.0 3.1 3.4 3.3 3.3 3.4 3.4 3.3 3.3 3.2 Overall 6.3 6.3 6.5 7.1 7.1 7.3 7.2 7.1 7.3 7.4 7.3 6.9 7.0 7.1 Nurse 4.1 4.1 3.9 4.2 4.0 5.5 2.9 3.0 3.3 3.4 3.3 3.3 3.1 3.6 Ford Ward M023 C Care 2.1 2.1 2.1 2.3 2.0 2.9 2.8 3.0 2.9 3.1 2.9 3.1 3.2 2.8 Overall 6.3 6.2 6.1 6.5 6.0 8.4 5.8 6.0 6.2 6.5 6.2 6.4 6.3 6.3 Nurse 6.1 5.2 5.2 5.7 4.6 5.5 10.1 10.7 10.9 10.3 10.3 13.7 10.7 8.7 Howard Ward W200 C Care 1.1 1.2 1.5 1.4 1.4 1.6 3.3 3.8 3.5 2.6 2.7 3.8 2.9 2.5 Overall 7.2 6.3 6.6 7.1 6.1 7.1 13.4 14.6 14.4 12.9 13.0 17.5 13.5 11.2 Nurse 2.8 3.1 3.0 3.5 3.6 4.2 3.1 3.2 3.1 3.1 3.2 3.0 2.9 3.3 Lavant Ward M111 C Care 2.8 2.8 3.1 3.2 3.1 3.8 3.0 3.2 3.2 3.2 3.1 3.0 3.2 3.2 Overall 5.6 6.0 6.1 6.7 6.7 8.0 6.1 6.4 6.3 6.3 6.2 6.0 6.1 6.4 Nurse 2.6 2.7 2.7 3.0 3.1 4.0 2.9 2.8 3.1 3.3 3.1 2.9 2.9 3.1 Middleton Ward M112 C Care 2.0 2.1 2.0 2.2 2.4 2.8 3.3 3.5 3.0 3.3 3.2 3.0 2.9 2.9 Overall 4.6 4.7 4.8 5.2 5.5 6.8 6.2 6.3 6.1 6.7 6.2 6.0 5.8 5.9 Nurse 5.5 6.4 7.3 9.1 7.3 7.0 13.0 7.8 7.2 10.9 9.8 11.3 9.2 8.9 SCBU W201 C Care 1.7 2.0 2.4 2.7 2.1 2.4 3.7 2.4 2.6 3.1 3.2 3.9 2.8 2.8 Overall 7.2 8.5 9.7 11.9 9.4 9.5 16.7 10.2 9.7 14.0 12.9 15.2 12.1 11.7 Nurse 3.1 3.2 3.1 3.4 4.6 3.5 4.0 3.0 3.0 3.1 3.5 3.6 3.4 3.4 Petworth Ward M104 C Care 2.8 2.8 2.9 2.8 3.8 2.9 3.9 2.9 3.0 3.3 3.2 3.0 3.0 3.1 Overall 5.9 6.0 5.9 6.2 8.4 6.4 7.9 5.8 6.0 6.4 6.7 6.6 6.4 6.5 Nurse 3.6 3.8 3.6 4.0 3.8 4.1 3.3 3.0 3.5 3.6 3.5 3.2 3.5 3.5 Selsey Ward S102 C Care 2.7 2.8 2.8 3.1 3.0 3.1 3.1 3.2 3.7 3.6 3.3 2.9 3.6 3.2 Overall 6.4 6.6 6.4 7.1 6.8 7.1 6.3 6.1 7.2 7.2 6.8 6.1 7.1 6.7 Nurse 3.1 3.0 3.1 3.4 3.8 3.8 2.9 3.3 3.2 3.4 3.1 2.9 3.7 3.3 Wittering Ward S205 C Care 2.0 1.9 2.2 2.4 2.6 2.7 3.7 3.7 3.3 3.6 3.8 3.3 3.5 3.2 Overall 5.2 4.9 5.3 5.8 6.4 6.4 6.6 7.0 6.5 7.0 6.9 6.2 7.2 6.5

6.2 SaferStaffingScorecard_1819_M11 SaferStaffingWardCHPPD 10 of 10 21/03/2019 10:31

Agenda Item: 6a Meeting: Trust Board Meeting Date: 28 March 2019 Report Title: Quality and Risk Committee Report to Board Sponsoring Executive Director: Joanna Crane, Non-Executive Director Author(s): Joanna Crane, Non-Executive Director Report previously considered by Not applicable as direct report and date: Purpose of the report: Information  Assurance  Review and Discussion  Approval / Agreement ☐ Reason for submission to Trust Board in Private only (where relevant): Commercial confidentiality ☐ Staff confidentiality ☐ Patient confidentiality ☐ Other exceptional circumstances ☐ Link to Trust Strategic Themes: Patient Care  Sustainability  Our People  Quality  Systems and Partnerships ☐ Any implications for: Quality Financial Workforce Link to CQC Domains: Safe  Effective  Caring  Responsive  Well-led  Use of Resources ☐ Communication and Consultation:

Executive Summary:

The Quality and Risk Committee met on the 08 March 2019 and was attended by the Chief Nurse, Chief Workforce & Organisational Development Officer, Trust Medical Director and the Group Company Secretary along with the Chiefs of both Surgery and Core Division.

The meeting was quorate and the Committee was able to discharge its planned items through the receipt and debate of the reports in accordance with its cycle of business.

Key Recommendation(s):

The Board is asked to CONSIDER: That the Committee would support a change in process for completing incidents on Datix to make it more timely and efficient for staff.

The Board is asked to APPROVE: The revised Terms of Reference based on the recommendation of the Committee.

To: Trust Board Date: 28 March 2019

From: Quality and Risk Committee Agenda Item: 6a

COMMITTEE HIGHLIGHTS REPORT TO BOARD

Meeting Meeting Date Chair Quorate Quality and Risk Friday 08 March Joanna Crane yes no Committee 2019  ☐ Declarations of Interest Made None Actions taken by the Committee . The Committee RECEIVED a presentation on a Deep Dive into the British Orthopaedic Association Status one year on from the initial visit and was assured by the positive improvements made in line with the action plan from the BOA. . The Committee RECEIVED the Quarter 3 Patient Experience Report for 2018/19, which is now going to be a standing item on the QRC agenda. The maternity inpatient Survey was a highlight with very positive results. . The Committee RECEIVED the Annual Clinical Audit Plan for 2019/20, which links closely to a number of CQC Key Lines of Enquiry (KLOE). In addition it was noted that lessons learned as a result of SIRIs will be more closely linked to future Clinical Audit activity. . The Committee RECEIVED an update on Corridor Clutter as part of the Risk Register, it was noted that further work is still required the Estates Department is working closely with the Director of Nursing to resolve the issue. . The Committee RECEIVED the report from the Audit Committee on 16 January, referring the matter of oversight of NICE guidance which was taken forward by the Committee. This Committee continues to receive assurance on the divisional oversight. The Committee reflected that a number of Divisions have improved their position in the period after the audit recommendation was made. . The Committee RECEIVED the Freedom to Speak Up report, the Committee asked the guardian to return to the next meeting to speak to the committee as the report was taken in their absence. . The Committee APPROVED the draft Terms of Reference subject to a clarification on the level of Quoracy ahead of it going to Board for approval in March. Actions to come back to Committee (Items Committee keeping an eye on) . Datix reporting to be discussed further with a view to confirming a deadline on changing the process of reporting to improve efficiency. . Patient Experience Report to include assurance that any complaints related to medical staff behaviours and attitudes can be associated with the respective individual, to ensure that issues are dealt with appropriately when closing the complaint. . Vascular Surgery pathway to be added to the Risk Register to reflect the concerns raised in the Surgery Clinical Governance Review. . Committee Terms of Reference to be discussed with the Chief Medical Officer, with a view to amending Quoracy to include Trust Directors and one Executive Director. Items referred to the Board or another Committee for decision or action Item Referred to An improved process for completing Datix in a time Trust Executive Committee (TEC) to action – Board efficient way to be taken to Trust Executive for information. Committee. Board to be made aware that completion of NICE Trust Board – for information Guidance requires continued focus, the Committee noted that some Divisions had managed to improve compliance in the previous quarter. The Committee received and noted the actions Trust Board – for information from the Audit Committee on 16 April 2019

Board to receive the revised Terms of Reference Trust Board – for approval for the Quality Assurance Committee for approval.

th Agenda Item: 7 Meeting Trust Board Meeting 28 March : Date: 2018 Report Title: Trust Performance Report, Month 11 Sponsoring Executive Jayne Black, Chief Operating Officer Director: Author(s): Giles Frost, Interim Director of Performance Report previously considered by and date: Purpose of the report: Information  Assurance  Review and Discussion  Approval / Agreement ☐ Reason for submission to Trust Board in Private only (where relevant): Commercial confidentiality ☐ Staff confidentiality ☐ Patient confidentiality ☐ Other exceptional circumstances ☐ Link to Trust Strategic Themes: Patient Care  Sustainability ☐ Our People ☐ Quality  Systems and Partnerships  Any implications for: Quality Describes Responsiveness metrics which impact on quality Financial Describes productivity metrics and activity relevant to financial performance Workforce Workforce metrics described Link to CQC Domains: Safe ☐ Effective  Caring ☐ Responsive  Well-led  Use of Resources  Communication and Consultation:

Executive Summary: The paper sets out organisational compliance against national and local key performance metrics. The report summarises both in year and projected year end performance for Western Sussex Hospitals NHS Foundation Trust, as detailed in dedicated performance scorecards relating to Quality Board indicators aligned to the Quality Strategy, the NHSI Single Oversight Framework and, when relevant, other indicators. This paper describes performance on an exceptional basis determined by RAG rating, key national/regulatory significance, or in year trend analysis.

Key Recommendation(s):

To note content of report

1

To: Trust Board Date: 28th March 2019

From: Jayne Black, Chief Operating Officer Agenda Item: 7

FOR INFORMATION

WSHFT PERFORMANCE REPORT: MONTH 11, 2018/19

1. INTRODUCTION

1.1 This report summarises both current in year and projected performance for Western Sussex Hospitals NHS Foundation Trust, with further detail provided in the appendices relating to: • The NHSI Single Oversight Framework • Key Performance Deliverables Report • Operational Performance Scorecard • Sustainability and Transformation Fund Performance Monitoring

1.2 This paper provides the Board with an update on performance on a specific basis determined by RAG rating, national significance, or in year trend analysis.

1.3 Introduced as a condition of the National Sustainability and Transformation Programme and Funding, all Trusts have again submitted joint performance trajectories on the key areas of A&E, RTT, and Cancer. The detailed tracking of the Trust’s performance against this trajectory is included in an Appendix of this report, and performance against the requirements is summarised for each relevant performance area. The trajectory has changed for 2018/19 based on specific criteria for all indicators. The Sustainability and Transformation Fund payments in 2018/19 are indicatively based on A&E performance against trajectory as per NHS Improvement guidance.

2. SUMMARY PERFORMANCE

2.1 Under the Single Oversight Framework, the Trust was provisionally non-compliant for Cancer 62 day performance. RTT 18 week compliance was below the national constitutional target and STF performance trajectory for February. A&E performance was below the NHS constitutional target of 95% but exceeded the STF target for Quarter 4 2017/18 (90.07%). Diagnostics remained compliant against national target for February.

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2.2 Operationally February saw an increased level of A&E demand, and an increase in emergency admissions relative to the same period in 2018.

• 11,051 A&E attendances compared to 10,128 in February 2018 (representing a 9.11% increase on this time last year or an extra 923 attendances). For patients aged 65 and over there was an increase in attendances of 12.87% and for aged 85 and over, there was an increase of 12.3%. Growth remained high in the under 18 age group with a 12.2% increase in attendances from the same period last year. Paediatrics account for approximately a fifth of attendances at A&E. • 4,771 emergency admissions in February 2019 compared to 4,557 in February 2018, an increase of 4.7%. There was an increase of 7.2% in admissions for patients with a length of stay of less than 2 days. • Over 65 emergency admissions increased in February 2019 by 7.4% compared to February 2018. For patients 85 and over, there was an increase of 5.0%. For adults under 65, there was a 3.5% increase compared to the previous February. • Formally reportable Delayed Transfers of Care totalled 3.25% for February 2019. This is a 0.54% increase from the January figure of 2.71%. • Average Inpatient Bed Occupancy was 95.29% in February, a 0.17% decrease from 95.46% in January, and 0.1% lower than February 2018. The highest occupancy the trust reached during the month was 98.82% on the 3rd February and the lowest was 90.42% on 21st February. On average, approximately 28 escalation beds per day were open across the trust during February, ranging from between 24 to 40 beds. This is approximately 6 on average less than during January. The Trust flexes the number of open beds to respond to fluctuations in demand.

3. KEY AREAS OF PERFORMANCE

3.1 A&E Compliance

3.1.1 The Trust was non-compliant against the National Constitutional target in February, with 91.92% of patients waiting less than four hours from arrival at A&E to admission, transfer, or discharge, a 0.8% improvement against January performance of 91.1%. 945 patients waited for more than 4 hours in A&E. This includes attendances from Bognor Minor Injuries Unit, but excludes emergency floor activity from both sites following a change in methodology as reported and published by NHSE in the monthly NHS statistics.

3.1.2 By site, St Richard’s Hospital (SRH) performance in February was 94.77%, with Worthing (WSH) achieving 88.92%. Emergency admissions at SRH increased by 8.0% in comparison to February 2018 whilst there was a 1.7% increase at Worthing. For the 65+ age group (the cohort more likely to have an extended ward stay), SRH emergency admissions increased by 5.7% whereas

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Worthing increased by 9.0% which equates to an additional 112 admissions relative to February 2018.

3.1.3 Worthing saw an average of 495 beds occupied in February, the same as for January, but an additional 8 compared to February 2018. Worthing had an average occupancy of 97.31% in February, compared to an average of 95.63% in January and 96.34% February 2018. Emergency medical length of stay at Worthing increased slightly to 6.8 days in February from 6.7 days in January. 21.4% of surgical and medical patients had a LOS of over 21 days. SRH saw an average of 364 beds occupied in February, an average of 17 fewer beds than in January 2018, and 19 fewer than average February 2018. Occupancy at SRH averaged 92.67% in February 2019 compared to 95.25% in January and 94.17% in February 2018. For SRH, emergency medical length of stay decreased slightly to 5.2 days on average in February compared to 5.5 in the previous month. 15.5% of surgical and medical patients had a LOS of over 21 days.

3.1.4 In February, delayed transfers of care (DTOC) increased to 3.25% compared to 2.71% in January. February DTOCs peaked at 3.94% on 26th February, from a low of 2.45% on 24th February. In real terms, this reflects an impact in ‘lost’ beds that fluctuated between a minimum of c21 beds and a high of c34 beds during the month, which is the same range as observed January.

3.1.5 Patients who were medically fit for discharge (MFFD) remained broadly similar to January figures with 158 per day on average compared to 160 in January. The number of patients medically fit for discharge fluctuated between 140 patients on 8th February and 184 on 26th February.

3.1.6 There were 436 patients on average in February 2019 with a LOS greater than 7 days at the trust, 22 fewer than January and 15 fewer than February 2018. There were on average 161 patients in hospital for more than 21 days February 2019, which is unchanged from January but 13 fewer than last year. In February, just over half of Trust beds were occupied by patients with a LOS greater than 7 days, and 18.8% with patients exceeding 21 days stay.

3.1.7 National performance deteriorated by 0.16% to 84.38% in February 2019 for all attendances with 4 acute trusts meeting the 95% target. Board members should note these figures also include type 3 A&E attendances (such as minor injuries units). Regionally, compliance for the South of England deteriorated to 83.4%

3.1.8 The publication of national data confirms that the trust was 16th highest performing trust nationally in February 2019 (22nd year to date), and 2nd best in Surrey and Sussex. Note that these figures include type 3 attendances for other non-acute providers in the Coastal West Sussex Acute Trust Footprint.

3.1.9 For type 1 attendances only (major A&E Unit activity), the Trust’s performance for February 2019 was 91.45% and was ranked 8th best performing trust and 9th best year to date.

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3.1.10 March performance up to and including the 17th March was 93.3%, an improvement from February performance and a 3.4% improvement on March 2018. The Trust is aiming for 95% compliance, which requires approximately no more than 12 four hour breaches per respective day Trust wide for the remainder of the month.

Ambulance Handovers

3.1.11 The Trust continues to work with SECAmb to address issues around numbers of patients waiting to be handed over by Ambulance crews to A&E and Emergency Floor departments. The national target is that all handovers should be completed within 15 minutes of arrival at hospital. Regionally, trusts have been tasked with having no waits beyond 1 hour and working towards minimising those over 30 minutes.

3.1.12 The trust continues to develop a set of actions to improve patient flow and prevent handover delays when bed occupancy is high. As part of winter planning, a number of “Operational Triggers for Alert” have been developed including handovers exceeding 30 minutes. These triggers identify a set of actions for divisions designed to improve patient flow through the hospital. The trust also continues to monitor the effectiveness of streamlined handover processes with SECAmb colleagues and the impact of SECAmb immediate handover of clinically stable patients at 1 hour.

3.1.13 Ambulance handovers within 15 minutes for the trust deteriorated in February 2019 to 42.2% from 44.0% in January but have improved from 39.5% in February 2018. Ambulance Handovers over 1 hour were recorded as 42 in February, fewer than the 45 recorded in January. This equates to around 1.2% of handovers – the total across the whole SECAmb area being 3.1% for February. This is a improvement for the trust from last February with 62 handovers exceeding 1 hour, approximately 2% of handovers. In February, 10.2% of handovers took more than 30 minutes, an improvement from 10.5% in January and 14.4% in February 2018. For the Ambulance Service measure of “hours lost” for turnarounds taking more than 30 minutes, Trust figures reduced to 431 in February against the January figure of 471 and 521 in February 2018.

3.1.14 The number of conveyances in February 2019 was 7.8% above the level seen in the same period last year for the Trust. Worthing Hospital observed an 8.3% increase and St Richard’s Hospital a 7.2% increase. This compares to 3.2% across the whole SECAmb area. On average, the trust saw 10 additional conveyances per day in February, with Worthing hospital an additional 6 and 4 for SRH. The growth in conveyances 18/19 to date is 1.4 % relative to the same period 17/18.

3.1.15 Within the region covered by SECAmb, Worthing Hospital had the 3rd best performance for the 15 minute handover target and St Richard’s Hospital was 9th out of the 17 acute hospitals with major A&E units in the South East covered by SECAmb. The overall average for 15 minute handovers across the SECAmb region was 37.2%, 0.4% up on January figures. For handovers beyond 1

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hour, St Richard’s Hospital was 9th with 1.3% (22 handovers) of all handovers and Worthing Hospital was 7th with 1.1% or 20 handovers.

3.2 Cancer 3.2.1 For the Single Oversight Framework for February, the Trust was not compliant against the combined 62 day rule with 76.82% (75.0% for 2 week GP referrals and 90.48% for screening referrals) against the target of 85.2%. The board should note that this is a provisional position which will be finalised next month, and is likely to marginally improve due to a lag in histopathology reporting.

3.2.2 The 62 day position worsened in February due to increases in patient demand (described in more detail below in point 3.2.5) and a targeted reduction in prospective over 62 day patients (to do the latter requires a short period of worsened retrospective performance). Of the 38 urgent 62 day referral GP breaches, 15 of these relate to Urology, 6 relate to Gynaecology, and 5 relate to Head and Neck, and Upper GI anatomical sites.

3.2.3 The trust remained compliant with the 2 week referral rule for February 2019 with performance of 97.78% against the 93% target. Of the 36 breaches in month, 10 related to lung, 5 to breast and 6 to upper GI patients.

3.2.4 Breast symptomatic performance remained compliant in February with provisionally 95.16%.

3.2.5 2 Week Cancer referrals continue to outstrip levels seen in previous years with an increase of 18.1% between April 2018 and February 2019 in comparison to the previous year. Referrals increased in February by 20% increase on the same period last year. Colorectal referrals have increased by 43.4% compared to the same period 2017/18 as illustrated below.

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3.2.6 Urology (+16.5%), Skin (+18.7%), Breast (+27.2%) and Head & Neck (+12.3%) have also experienced significant increases in demand. Referrals for Breast have increased particularly over the past 2 months, with February seeing the highest number recorded ever at the trust. The average number of monthly referrals in 2018 was 294, with 384 recorded in February, almost a third higher.

3.2.7 As noted last month, the Trust is implementing a range of actions to improve cancer 62 day performance from April 2019 which by necessity worsens the reported retrospective performance for February and March to reduce the number of patients prospectively waiting more than 62 days. These include: • The implementation of Optimum Pathway project (for colorectal patients) plus equivalent streamlined processes for prostate cancers. • Additional specialist nursing capacity for prostate cancer • Additional diagnostic capacity (imaging and histopathology) via additional funding from the Cancer Alliance. • Enhanced daily tracking for over 62 day waiters with clear escalation rules, to expedite next steps for each patient.

3.2.8 Latest comparative nationally published data relating to January 2019 shows national aggregate compliance for cancer attendance deteriorated by 4.8% to 76.2% for treatment within 62 days from GP referral (target 85.0%). Trust performance for January was just above the national average with 77.4%, and also above the NHS South East trusts average of 76.7%. In December 2018, 28% of Trusts receiving GP referrals in England were compliant against this standard.

3.2.9 Nationally, performance against the 2 week referral target (93%) deteriorated by 2% to 91.7% from the previous month. Performance nationally, apart from December 2018 has been non- compliant since March 2018. Just over a third of trusts were non-compliant in January. The trust was compliant in January with 94.9%, missing the 93% target twice this year – in June and September.

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3.3 Referral to Treatment (RTT/18 Weeks)

3.3.1 The Trust was non-compliant against the National Constitutional Target of 92% in February with 82.28% of pathways waiting less than 18 weeks. This is a continued improvement from January (81.53%) despite operational non-elective pressures. Numbers of patients waiting over 18 weeks reduced by 206 patients whilst total waiters increased by 364 cases. The waiting list size remains below the March-18 position (which is one of the key targets for the 2018/19 operating framework).

3.3.2 There was one patient waiting over 52 weeks at the end February 2019.

3.3.3 Referrals starting RTT clocks between April and February 2018 have increased by 1.3% compared to the equivalent time frame in 2017/18. Over the same period, there have been 1.1% more clock stops. The waiting list size February 2019 is approximately the same as the end March-2018. The weekly trend in RTT clock starts 2018/19 and 2017/18 is shown below: -

3.3.4 Recovery actions continue across the main non-compliant areas. This is in particular for ophthalmology, orthopaedics, and neurology but across all specialties.

3.3.5 Theatre productivity (using a metric which compares touch time to scheduled theatre time) was 79.3% February 2019, 5.8% higher than February 2018.

3.3.6 The Trust completed 11,193 RTT patient pathways in February 2019, 1040 more than February 2018 (+9.3%)

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3.3.7 Latest published national data relates to January 2018 and shows national compliance has slightly increased to 86.73% from 86.61% in December. Trust performance for January 2019 of 81.53% was 5.2% under the national average. 57% of Trusts were non-compliant in January.

3.3.8 As noted at the June board, the Trust has been undertaking a focussed project reviewing patients who are overdue follow up attendances according to the Trust PAS system, to ensure these are reviewed via clinical or electronic triage to validate, prioritise, treat and/or discharge accordingly to improve patient experience. Since March the cohort of 16120 patients Trust wide has reduced by 52% to 7737 12th March (an increase since February however) with work ongoing to reduce this cohort.

3.4 Diagnostic Test Waiting Times

3.4.1 The Trust compliance for February 2019 was 0.47% over 6 week waiters across all diagnostic modes. This represents 34 over 6 week waiters of a total list of 7309 patients. The position is improved compared to January with 0.83% and remains compliant against the 1% national target.

3.4.2 The latest available National data for January 2019 shows aggregate compliance at 3.6%, a deterioration of 0.3% on the December position. WSHFT performance for January was 0.86%. In the NHS England South region, the trust was one of a third of acute trusts with a waiting list of over 1,000 which were compliant against the under 1.0% target. The average performance for the trusts in this region was 4.0%.

4 RECOMMENDATION

4.1 The Board is asked to receive the Month 11 position.

4.2 The Board is also asked to note the quarterly performance against the delivery requirements of the Sustainability and Transformation Fund (STF) for A&E, and in month provisional non- compliant position for cancer 62 day performance and RTT.

Jayne Black, Chief Operating Officer

21st March 2019

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Mark Dennis, Head of Information Services t: 01903 285273 (ext 85273)

OPERATIONAL PERFORMANCE FEBRUARY 2019 2018/19 2018/19 SCORECARD Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan FEB YTD Target Trend NATIONAL AND OPERATIONAL PERFORMANCE TARGETS A&E : Four-hour maximum wait from arrival to admission, transfer O01 89.5% 92.8% 90.0% 94.2% 96.4% 95.7% 94.4% 93.1% 95.2% 93.8% 95.7% 92.8% 91.1% 91.9% 93.99% 95% or discharge

O02 Cancer: 2 week GP referral to 1st outpatient 95.94% 96.84% 97.12% 96.49% 96.08% 90.7% 96.34% 96.07% 90.1% 94.11% 95.79% 96.34% 94.90% 98.40% 95.06% 93%

O03 Cancer: 2 week GP referral to 1st outpatient - breast symptoms 91.58% 99.32% 95.53% 93.53% 88.04% 65.13% 93.23% 96.62% 87.39% 91.48% 96.24% 99.34% 93.02% 95.16% 91.10% 93%

O04 Cancer: 31 day second or subsequent treatment - surgery 100.0% 100.0% 100.0% 95.0% 100.0% 100.0% 100.0% 93.8% 100.0% 100.0% 96.4% 100.0% 94.7% 95.2% 98.17% 94%

O05 Cancer: 31 day second or subsequent treatment - drug 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 96.00% 100.0% 99.1% 98%

O06 Cancer: 31 day diagnosis to treatment for all cancers 100.0% 100.0% 99.6% 100.0% 100.0% 100.0% 99.5% 98.9% 94.96% 97.9% 99.3% 99.6% 96.3% 99.3% 98.7% 96%

O07 Cancer: 62 day referral to treatment from screening 85.19% 96.55% 97.62% 90.70% 98.15% 84.21% 98.46% 100.00% 92.65% 83.15% 93.1% 88.64% 79.10% 90.5% 90.6% 90%

O08 Cancer: 62 day referral to treatment from hospital specialist 84.00% 96.77% 82.76% 90.91% 89.74% 75.00% 92.86% 96.43% 71.88% 82.76% 89.47% 77.14% 70.83% 65.63% 81.8% N/A

O09 Cancer: 62 days urgent GP referral to treatment of all cancers 88.06% 86.03% 90.56% 88.07% 77.78% 76.60% 78.31% 81.42% 79.58% 80.07% 81.19% 81.15% 77.42% 75.47% 79.6% 85%

O14 RTT - Incomplete - 92% in 18 weeks 86.64% 86.36% 85.10% 84.34% 85.17% 83.87% 83.04% 81.01% 80.01% 80.64% 81.26% 81.27% 81.53% 82.28% 0.00% 92%

RTT delivery in all specialties O15 13 11 12 11 12 13 12 14 13 13 13 13 13 11 11 0 (Incomplete pathways)

O16 Diagnostic Test Waiting Times 0.83% 0.68% 0.97% 0.85% 0.98% 0.43% 0.43% 0.79% 0.59% 0.53% 0.35% 0.83% 0.86% 0.47% 0.64% <1%

O17 Cancelled operations not re-booked within 28 days 3 2 3 7 3 1 1 2 0 0 4 2 2 1 23 -

O18 Urgent operations cancelled for the second time 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -

Clinics cancelled with less than 6 weeks notice for annual/study O19 44 41 21 22 35 19 21 19 41 52 29 13 19 40 270 - leave

O20 Mixed Sex Accommodation breaches 0 0 0 0 0 0 0 0 0 35 36 28 44 24 143 0

O33 Delayed transfers of care 3.07% 3.14% 2.99% 2.52% 2.66% 3.46% 3.12% 4.62% 3.96% 3.81% 4.07% 3.56% 2.71% 3.25% 3.42% 3.0%

IMPROVING CLINICAL PROCESSES

O23 % hip fracture repair within 36 hours 96.2% 83.3% 88.1% 70.1% 84.5% 71.4% 90.6% 88.1% 78.8% 85.5% 82.9% 84.6% 83.3% 90% Patients that have spent more than 90% of their stay in hospital on O24 84.3% 84.0% 88.5% 98.0% 81.0% 82.9% 82.4% 81.4% 89.8% 96.6% 85.1% 82.9% 92.5% #N/A 88.0% 80% a stroke unit+

Operational performance scorecard M11.2.SCORECARD Page 1 of 2 Printed 21/03/2019 15:32 Mark Dennis, Head of Information Services t: 01903 285273 (ext 85273)

OPERATIONAL PERFORMANCE FEBRUARY 2019 2018/19 2018/19 SCORECARD Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan FEB YTD Target Trend OPERATIONAL EFFICIENCY

O36 Average length of stay - Elective 2.95 3.13 3.41 2.97 3.10 2.74 3.10 2.93 3.22 3.11 2.88 3.41 3.39 3.16 2.97 3.72

O37 Average length of stay - Non-elective Surgery 5.80 5.89 5.51 5.91 5.70 5.01 5.46 5.33 5.70 5.71 5.54 5.47 5.74 5.22 5.48 6.07

O38 Average length of stay - Non-elective Medicine 8.03 7.88 7.93 7.73 7.39 7.15 7.22 7.11 6.90 7.40 7.31 6.91 7.32 7.35 7.32 7.80

Day case rate (CQC day case basket of procedures) O39 93.86% 93.40% 91.35% 91.36% 90.76% 91.57% 92.02% 85.84% 91.81% 91.91% 89.80% #N/A #N/A #N/A 91.40% 75.0% source: Dr Foster (reported 2-3 months in arrears)

O40 Elective day of surgery rate (DOSR) 98.9% 98.9% 96.5% 98.3% 98.5% 98.0% 98.8% 98.2% 98.8% 99.1% 98.6% 99.2% 98.7% 98.8% 98.6% 90.0%

O41 Did not attend rate (outpatients) 6.11% 6.32% 6.26% 5.92% 6.16% 6.46% 6.46% 6.18% 6.05% 5.93% 5.79% 5.90% 6.08% 5.57% 5.88% 7.65%

SUSTAINABILITY

O43 Bank staff - % of all staff pay 7.49% 8.62% 8.46% 8.90% 8.36% 8.69% 8.44% 8.44% 9.13% 8.69% 8.27% 9.23% 8.56% 9.84% 8.67% 7%

O44 Agency staff - % of all staff pay 4.30% 3.67% 3.96% 3.79% 4.40% 3.98% 4.12% 3.50% 3.60% 4.09% 3.77% 3.08% 3.14% 3.05% 3.75% 2%

O45 Nurse : occupied bed ratio 1.690 1.760 1.729 1.768 1.888 1.910 1.902 1.879 1.855 1.840 1.864 1.864 1.758 1.814 1.869 -

O46 % nurses who are registered 68.49% 68.58% 68.35% 68.25% 68.46% 68.33% 68.08% 67.96% 68.42% 68.70% 68.79% 68.42% 68.73% 68.76% 68.45% -

O47 % Staff appraised 87.70% 87.00% 86.20% 87.32% 86.80% 87.50% 86.50% 87.10% 86.20% 87.30% 88.10% 87.60% 88.70% 87.50% 87.50% 90%

Sickness Absence: % Sickness O48 4.30% 3.58% 3.68% 3.50% 3.10% 3.20% 3.40% 3.70% 3.80% 3.90% 4.00% 3.80% 4.30% #N/A 3.70% 3.3% (reported one month in arrears)

O49 Staff Turnover: Turnover rate (YTD position) 7.70% 7.40% 7.50% 7.48% 7.80% 7.60% 7.80% 7.60% 7.60% 7.60% 7.70% 8.10% 8.10% 8.20% 8.20% 11%

ACTIVITY

A01 Day Cases 5,056 4,471 4,613 4,621 4,885 4,859 5,044 4,696 4,659 5,438 5,140 4,201 5,445 4,806 24,105 65,791

A02 Elective Inpatients 362 484 410 407 546 541 505 523 542 574 603 491 407 459 2,522 7,950

A03 Non-elective inpatients 6,076 5,387 6,229 5,985 6,162 6,077 6,024 6,222 5,801 6,284 6,115 6,166 6,375 5,697 30,470 74,930

A04 Outpatient First attendances 13,444 11,509 12,483 12,136 13,463 13,069 13,204 12,657 12,722 14,788 14,655 11,449 14,599 13,490 64,529 181,895

A05 Outpatient Follow-up attendances 23,174 19,733 20,969 21,793 24,097 22,796 23,179 22,552 22,196 25,787 26,082 19,810 25,488 22,291 114,417 277,837

A06 Outpatients with procedure 6,612 6,407 5,948 6,146 6,867 6,794 6,507 7,101 6,145 7,763 7,584 5,966 7,312 6,846 33,415 79,490

A07 A&E Attendances 10,648 10,127 11,805 11,770 12,538 12,277 13,009 12,358 11,824 11,966 11,646 12,061 12,018 11,051 61,952 155,438 Notes 1 National reporting for these performance measures is on a quarterly basis. Data are subject to change up to the final submission deadline due to ongoing data validation and verification. 2 Data are provisional best estimates and will be amended to reflect the position signed-off in the relevant statutory returns in due course. 3 Staff sickness is reported one month in arrears. 4 A&E counting amended in retrospect from April 2018 to exclude emergency floor reporting in accordance with revised NHSE guidance. Please note this has not been adjusted before 2018/19

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Key Performance Deliverables Report FEBRUARY 2019

A&E 4-hour waiting time target Description / Comments / Actions Target Month YTD Projected O/T Patients can expect to be admitted, transferred or discharged in 4 hours from arrival in A&E 95% 91.92% 93.99% >95%

100% Sustained increases in underlying demand and acuity. Increased demand challenging ability to maintain hospital/system flow essential to delivery of A&E waiting time. 95% 90% 85% 80% Actions: 75% 1. Enhanced discharge planning arrangements 70% 2. Augmented patient flow arrangements in conjunction with external partners 65% 3. Dedicated operational delivery review cycle under the leadership of the Chief Operating Officer 60% 55% 50% Jul Jan Jun Oct Apr Sep Feb Feb Dec Aug Nov Mar May

Cancer - Two weeks from urgent GP referral to first appointment Description / Comments / Actions Target Month YTD Projected O/T Patients can expect to be seen within 2 weeks following an urgent GP referral for suspected cancer. 93.0% 98.40% 95.06% >93% Significant and sustained increases in demand level. 100% 95% 90% 85% 80% Actions: 75% 1. Management/tracking oversight through DDO led Cancer Delivery Group 70% 2. Dedicated weekly review led by Chief Operating Officer 65% 60% 55% 50% Jul Jan Jun Oct Apr Feb Feb Sep Dec Aug Nov Mar May

Cancer - Two weeks from urgent GP referral to first appt - Breast symptoms Description / Comments / Actions Target Month YTD Projected O/T Patients with breast symptoms can expect to be seen within 2 weeks following an urgent GP referral. 93% 95.16% 91.10% >93%

100% Significant and sustained increases in demand level. 95% 90% 85% 80% Actions: 75% 1. Management/tracking oversight through DDO led Cancer Delivery Group 70% 2. Dedicated weekly review led by Chief Operating Officer 65% 60% 55% 50% Jul Jan Jun Oct Apr Feb Feb Sep Dec Aug Nov Mar May

Cancer - 62 days from referral to treatment following screening contact Description / Comments / Actions Target Month YTD Projected O/T Patients with cancer can expect to commence treatment within 62 days following referral after a positive screening test. 90% 90.48% 90.63% >90%

100% Delays in receipt of onward referral from screening which reduces the time to secure capacity to treat patients. 95% 90% 85% 80% Actions: 75% 1. Management/tracking oversight through DDO led Cancer Delivery Group 70% 2. Dedicated weekly review led by Chief Operating Officer 65% 60% 55% 50% Jul Jan Jun Oct Apr Feb Sep Feb Dec Aug Nov Mar May

Key deliverables report M11.1.Exception Report Page 1 of 2 Printed 21/03/2019 15:29 Mark Dennis, Head of Information Services t: 01903 285273 (ext 85273)

Key Performance Deliverables Report FEBRUARY 2019

Cancer - 62 days from referral to treatment following urgent referral by a GP. Description / Comments / Actions Target Month YTD Projected O/T Patients with cancer can expect to commence treatment within 62 days following urgent referral by a GP. 85% 75.47% 79.63% >85%

100% Demand pressure exposing pathway efficiencies. Reduces the time to secure capacity 95% to treat patients. 90% 85% 80% Actions: 75% 1. Management/tracking oversight through DDO led Cancer Delivery Group 70% 2. Dedicated weekly review led by Chief Operating Officer 65% 60% 55% 50% Jul Jan Jun Oct Apr Feb Feb Sep Dec Aug Nov Mar May

Referral to treatment - Incomplete Pathways Description / Comments / Actions Target Month YTD Projected O/T All patients can expect to commence treatment within 18 weeks of a referral to consultant. 92.0% 82.28% 82.22% >90%

100% Non-compliance an expected outcome of planned RTT recovery programme.

95%

90% Actions: 85% 1. Increase in internal capacity as per Monitor/NHSE agreed Joint Recovery Plan developed with support from IMAS 80% 2. CCWSCCG commitment to reduced demand levels as supporting component of Joint Recovery Plan. 75% 3. Dedicated weekly Divisional review meeting, with overarching assurance review by Chief Operating Officer (also weekly) 70% 4. System Summit meetings with Monitor/NHSE to ensure partner deliver of agree Joint Jul Jan Jun Oct Apr Feb Feb Sep Dec Aug Nov Mar Recovery Plan actions. May

% Medically fit hip fracture patients going to theatre within 36 hours Description / Comments / Actions Target Month YTD Projected O/T To ensure the best possible outcomes, hip fracture patients who are medically fit should be operated on within 36 hours of admission. This standard is part of the 'Best 90% 84.60% 83.30% >90% Practice Tariff' payment process under PbR. 100% Increased volume of demand and variation of demand have impacted sustained 90% compliance. 80% 70% 60% Actions: 50% 1. Improved tracking and escalation processes in place to manage fluctuations in 40% demand on a daily basis 30% 2. Revised protocol introduced based on four key demand based triggers to ensure 20% early escalation/intervention in periods of abnormal demand. 10% 0% Jul Jan Jun Oct Apr Feb Sep Dec Aug Nov Mar May

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NHS Improvement FEBRUARY 2019 Single Oversight Framework Year to Threshold Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Date Trend Operational Performance Metrics A&E: maximum waiting time of four hours from arrival to OP1 95% 94.2% 96.4% 95.7% 94.4% 93.1% 95.2% 93.8% 95.7% 92.8% 91.1% 91.9% 94.0% admission/transfer/discharge Maximum time of 18 weeks from point of referral to treatment in aggregate OP2 92% 84.3% 85.2% 83.9% 83.0% 81.0% 80.0% 80.6% 81.3% 81.3% 81.5% 82.3% 82.2% – patients on an incomplete pathway

OP3A All cancers : 62-day wait for first treatment following urgent GP Referral 85% 88.1% 77.8% 76.6% 78.3% 81.4% 79.6% 80.1% 81.2% 81.2% 77.4% 75.5% 79.6% All cancers : 62-day wait for first treatment following consultant screening OP3B 90% 90.7% 98.2% 84.2% 98.5% 100.0% 92.7% 83.2% 93.1% 88.6% 79.1% 90.5% 90.6% service referral

OP4 Maximum 6-week wait for diagnostic procedures 1% 0.85% 0.98% 0.43% 0.43% 0.79% 0.59% 0.53% 0.35% 0.83% 0.86% 0.47% 0.64%

Notes

Single Oversight Framework M11.1.SCORECARD Page 1 of 1 Printed 21/03/2019 15:31

Agenda Item: 8 Meeting: Trust Board Meeting Date: 28.03.19 Report Title: Report on Organisational Development and Workforce Performance Sponsoring Executive Director: Denise Farmer, Chief Workforce and OD Director Author(s): Jennie Shore, Human Resources Director Report previously considered by and date: Purpose of the report: Information ☐ Assurance  Review and Discussion ☐ Approval / Agreement ☐ Reason for submission to Trust Board in Private only (where relevant): Commercial confidentiality ☐ Staff confidentiality ☐ Patient confidentiality ☐ Other exceptional circumstances ☐ Link to Trust Strategic Themes: Patient Care ☐ Sustainability ☐ Our People  Quality ☐ Systems and Partnerships ☐ Any implications for: Quality Provision of high quality, engaged staff has a direct impact on the quality of care. Financial Supports good financial performance Workforce Link to CQC Domains: Safe  Effective ☐ Caring ☐ Responsive ☐ Well-led  Use of Resources  Communication and Consultation:

Executive Summary:

This provides an update to the Board on workforce performance, initiatives and risks.

Appendix 1 – Gender Pay Gap report

Workforce scorecard with KPIs

Key Recommendation(s):

The Board is asked to NOTE the report.

Final version 19.11.18 TH

To: Trust Executive Committee Date: March 2019

From: Denise Farmer, Chief Workforce and OD Officer Agenda Item: 8

FOR INFORMATION

WORKFORCE AND ORGANISATIONAL DEVELOPMENT REPORT

1.00 Introduction 1.01 This sets out the key headlines relating to the Trust’s workforce at 28 February 2019.

2.00 Workforce Capacity

2.01 Workforce capacity increased during February to 97% of budgeted establishments. Although an additional 90.10 wte was used compared to last month, this is 64 wte less than February 2018.

2.02 10% of the workforce capacity was filled by temporary workforce with 8.2% filled through the staff bank. This is an increase from 7.6% in M10.

2.03 In M11, overall workforce spend was £24.96m. This is slightly higher than M10 and £56k above budget. Year to date, the paybill remains £2.7m adverse. Medical workforce spend continues to drive the adverse position and whilst agency spend overall was at its lowest during 2018/19, medical agency spend deteriorated in month.

2.04 Agency use in nursing reduced in month. A residual volume of Tier 2a agency remains in use in Medicine, with Surgery largely now only working within Tier 1/breakglass supply. With vacancies remaining around 12%, the need for agency continues. Improvements in ward leave management is required to reduce fluctuating demand for temporary workforce, alongside divisional efficiency plans to reduce the Trust’s bed requirement through clinical pathway changes and flow improvements.

3.00 Workforce Efficiency and Transformation

3.01 All divisions have developed schemes for medical workforce efficiencies in their 2019/20 cost improvement plans. This includes:

• Progression of the A&E business case • Workforce scheme that improves the rostering through junior doctor allocation in medicine • Expansion of alternative roles including clinical fellows, physician associates, surgical care practitioners, resident on-call consultants • Completion of problem solving A3 for radiology workforce • Continued alternate roles by non-medical staff including scientists, AHPs and therapists • Completion of the Collaborative Accelerator Programme to improve understanding, management utilization of rosters • Go Live of reduced rate card for medical locums in Medicine from 1 April

3.02 Improvements for the nursing workforce includes:

• A review of rostering across wards to share best practice and to support improved holiday scheduling • The completion of Theatres Agency Exit plan which will include a review of the supernumerary period post-recruitment and complementary retention actions to avoid high turnover • Aligning the budgeted establishment with the Medicine division’s New Models of Care phased bed closure plan from May • A refresh of SafeCare usage to enable live data to be reviewed and support daily operational staffing decisions and improve CHPPD quality of data

3.03 The STP is also undertaking a programme of work to target agencies charging above cap rates. The first cohort of action is being targeted at Tier 2a agencies that provide nursing workforce.

For WSHFT, only one tier 2a supplier of nurses remains and this has been highlighted by all the acute trusts in the STP.

3.04 Delivery of a number of the workforce efficiencies rely on support from the HR workforce systems team. A significant amount of HR-led reconfiguration work is currently being undertaken in the background, including data cleansing, improved interfaces with Healthroster and ESR and capability building of the team.

4.00 NHSI Levels of Attainment and Meaningful Use of Standards

4.01 A self-assessment against the NHSI Job Planning Attainment Levels is currently being undertaken. This will identify the gap analysis and inform the improvement plan required to meet the new requirements by March 2021.

4.02 The self-assessment will be undertaken with the Head of Workforce Systems and reviewed by the Medical Director and Chiefs of Service before consideration by the Finance and Investment Committee.

5.00 ESR Employee Self Service

5.01 Drop in sessions and Super-user clinics have been held during February and March in advance of implementation of on-line payslips from 1 April. To date over 200 staff have attended a session, and in excess of 1,300 enquiries have been sent and responded to via the ESR self service inbox.

5.02 The regional ESR Account Manager and Functional Advisor have been supporting with the successful resolution of a number of resulting technical configuration issues.

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5.03 Whilst the implementation is very labour intensive, there are a number of benefits to staff and the introduction of employee self-service is being generally well received.

5.04 It is anticipated that the financial savings of moving to e-payslips is circa £30k.

6.00 Health and Wellbeing

6.01 Sickness absence increased during January to 4.3%. This is not unexpected given the high numbers of staff reported absent with short term illness and respiratory conditions.

6.02 The number of episodes rose by over 300 and short term absence increased by 0.5% to 2.5%.

6.03 With the exception of the Medicine division, all divisions experienced an increase in sickness absence ranging from 3.4% in the Core division to 6.9% in the Estates and Facilities division.

6.04 The mental health of staff has been a growing concern with a number of well-meaning initiatives being developed by an increasing number of interested groups across the organisation. This includes piloting mental health first aid training by the PGME for clinical and educational supervisors and suicide prevention training through SPFT. A Kaizen event workshop, using a structured problem solving approach, is being held on 11 April. It is hoped that this will identify two or three schemes that will have maximum impact to improve mental health across all staffing groups.

7.00 Appraisals

7.01 Whilst compliance of appraisal fell marginally in month to 87.5%, the corporate division dropped by over 3% to 83.8%. This is being addressed with an expectation that compliance is achieved by the end of March.

7.02 The current appraisal policy has been reviewed to ensure it is continues to align to Patient First, and the new pay progression framework including leaders standard work. It is intended that appraisal will be initiated by staff and the supporting documentation will act as the prompt for a quality conversation that reflects on past and future performance, behaviours, health and wellbeing, career aspirations, training, education and development needs. This approach has been well received by staff side representatives and managers alike.

7.03 Because this is a new approach, it will be tested by some early adopters (where current compliance requires improvement) before roll out more widely. A proposal is currently being developed and will be socialized with the Trust Management Board before ratification of the policy and roll out of staff briefings and manager training.

8.00 Staff Survey

8.01 The results of the 2018 staff survey at divisional level are now available although the detail remains against the previous key findings (rather than the 10 themes) and the scores remain on the scale of 1-5 (rather than the new 1-10).

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8.02 Posters against the 10 themes have been developed and are being displayed across the Trust.

8.03 Of particular note is the significant improvement made within the Estates and Facilities division across the key findings. Of 79 questions that can be compared 75% improved on last year including a 10% increase in the number of staff recommending the Trust as a place to work and a 14% increase in staff feeling their work is valued by the organization.

8.04 Quality Health has been commissioned to provide trend reports against the 10 themes at divisional level although this taking longer than anticipated due to the complexity of the analysis.

8.05 The monthly engagement score collected at the health and safety days has been re-calculated using the new methodology. In February staff engagement was 7.67 compared to 7.2 in the 2018 staff survey.

9.00 Gender Pay Gap report

The second Gender Pay Gap report is attached in appendix 1. This is due to be published by 31 March.

10.00 Statutory and Mandatory Training

10.01 Attendance on seven out of nine of the modules remains at or above the Trust’s target of 90%.

10.02 Attendance on resuscitation is remains below the Trust’s target, but is continuing to increase and is currently at 86.8% (a 0.9% increase since last month). An action plan to provide additional training for these groups of staff has been agreed with the new Trust Resuscitation Lead and a number of addition training sessions have been organised to increase attendance.

10.03 Attendance rates on Safeguarding Adults continues to decrease and has fallen by a further 0.4% in the last month to 84.9%. The Learning and Development team has been working with the Safeguarding teams to develop an action plan to increase attendance. A number of level 2 Safeguarding Adults courses have now been established and it is anticipated that training attendance will now improve. A booklet has also now been developed which will replace Level 1 (non clinical) training for both Safeguarding Adults and Safeguarding Children.

11.00 Widening Participation

11.01 The Levy

During February the Apprentice Service (TAS) Account was £108k. Whilst the spend during M11 was £20k, it is expected that by year end, the spend will be significant higher due to a technical delay in enrolling apprentices.

Our Digital Account balance is currently £2m.

11.02 Procurement

We are currently procuring for level 6 healthcare science and pharmacy apprenticeships as previous tenders have been fulfilled.

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11.03 Degree apprenticeships and apprentice salaries

The Widening Participation team is continuing to liaise with universities to determine demand for degree apprenticeships such as Occupational Therapy, Operating Department Practitioners and Healthcare Science. In the absence of any national agreement on pay rates for Trust apprenticeship both at entry and higher level the trust are now engaging with the STP and local employers in order to develop a local salary framework.

11.04 Work Experience and Careers Events

During the month the Widening Participation team attended two career event and eight students attended work experience in the Trust.

The Widening Participation lead is continuing to engage with the local job centres on a monthly basis.

11.05 Health Education England (Kent, Surrey and Sussex) apprentice awards

The Trust submitted 11 nominations for the apprentice awards which will took place on the 14 March. Eight of these were shortlisted and seven apprentices attended the event. The following awards were received:

• Apprentice employer of the year – Runner up • Higher Apprentice-runner up • Level 3 non clinical - 2 runner up , 1 winner • Level 2 non clinical – 1 winner • Level 3 clinical – 1 winner • Higher apprenticeship – 1 runner up • Workforce heroes - 3 runners up

12.00 Strategic communications

12.01 The communications team has continued to work with colleagues from across the trust to provide support for a number of strategic campaigns and initiatives.

12.02 Winter – the communications team has been encouraging people to use our NHS services appropriately (#HelpUsHelpYou & #StayWellThisWinter), providing seasonal advice to the public and supporting the safe and timely discharge of patients (#Let’sGetYouHome) during the busy winter months. In addition to briefing local media, the team has been successfully using the trust’s social media channels to directly communicate with thousands of local people to ease pressure in A&E our departments, reduce avoidable hospital attendances and admissions, promote better discharge planning. Posts have been timed to reach as many people as possible at peak service-use time and, as a result, significant public engagement has been achieved. For example, from February 18 to 12 March, the trust’s winter messaging had an online reach of nearly 17,900 through social media, with more than 6,839 actively engagements through likes, shares or comments. Page 5 of 12

12.03 Recruitment – with recruitment issues continuing as a national issue for the NHS, the communications team has been using our growing social media channels to directly advertise job opportunities to thousands of local people and to specialists further afield. Every week, the team highlights current vacancies advertised by trust departments via social media. From 18 February to March 12, the team’s social media recruitment content had a reach of more than 22,700 through social media, with nearly 5,053 active engagements through likes, shares or comments. Featured departments and teams included, nursing, A&E, and physio.

12.04 Staff engagement – the communications team regularly shares news, information, improvements and achievements with staff across the trust via a variety of communications channels, including the weekly staff newsletter Headlines, staff intranet, trust website and social media. The trust’s Facebook page in particular receives thousands of visits and engagements from both staff and the public. For example, recent stories included:

• A&E department at Worthing recruitment – reach of 6,332, with 455 likes, shares or comments • International Women’s Day – reach of 4,105 audience, with 470 likes, shares or comments • A&E stands for Accident and Emergency – reach of 12,816 audience, with 684 likes, shares or comments.

12.05 The communications team also organises the trust’s Employee of the Month staff recognition scheme which enables the organisation to recognise and reward staff and volunteers who go above and beyond. The scheme goes from strength to strength and now receives more than 10 nominations every month, with all those nominated receiving recognition each month.

February’s winner was Clair McDermott Health Care Assistant on Ditchling Ward for going above and beyond her duty of care for a patient with a dementia. Clair will be presented with her certificate later this month. This was a very strong scoring round with two members of staff being nominated twice. Letters have been given to the divisional teams to present to their nominees, which provides useful opportunities to increase visibility in departments and wards

12.06 Wellbeing Wednesdays – the regular promotion of Wellbeing Wednesdays, which provide free health and wellbeing activities and services for staff, continues to improve awareness of the wider staff health & wellbeing programme across the trust.

12.07 Social media – the communications team continues to use social media to communicate directly with thousands of people living locally, as well as our staff and interested parties further afield. The number of followers our main social media channels attract continues to grow.

• Facebook (@westernsussexhospitals) – 4,442 followers (+1.4% in a month) • Twitter (@westernsussex) – 3,657 followers (+1.3% in a month) • Instagram (@westernsussexhospitals) – 1,446 followers (+3.2% in a month)

12.08 The communications team also provides support and guidance to other teams, specialties and departments to use social media to improve staff engagement, as well as communication with

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patients, partners and stakeholders. The communications team regularly sets up new accounts and provides advice to colleagues managing trust social media channels. Currently, the trust has more than 30 associated Twitter, Facebook and Instagram accounts. Staff and public are encouraged to use the hashtag #WSHT to help people track the organisation on social media.

13.00 Love Your Hospital

13.01 Corporate and Community fundraising

The Apprentice Quiz night held at the Zee Bar at Chichester University was a great success reaching full capacity and raising more than £1000.

Staff from across the Trust will be taking part in a ‘Stars in their Eyes’ night to support the charity. The event was postponed due to the current pressures on all staff and will be rearranged for a future date.

The charity hosted the official opening of the Maple Suite at Worthing Hospital which was attended by the Mayor and Mayoress of Worthing, along with local families and businesses who fundraised to help the maternity bereavement suite become a reality. The event was supported by Morrisons in Worthing who kindly donated all the refreshments on the day free of charge.

A bucket collection was held at Tesco superstore in Bognor Regis marking our first onsite collection with the branch. A total of £710 was raised on the day.

Keydell Nurseries in Horndean raised a fantastic £4,490 from customer’s visiting their Christmas grotto and winter wonderland walk which was adorned with giant gingerbread men, polar bears, thousands of twinkling lights and, of course, Santa Claus. They kindly donated to the Maternity Bereavement Suite at St Richards Hospital.

13.02 Marketing

To support the Trust’s 10th birthday celebrations, the charity is working closely with the communications team to provide discounts for WSHT staff with corporate supporters across West Sussex. There will also be ongoing support for the #wesTENsussex social media campaign for the duration of the celebrations.

Love Your Hospital’s Spring newsletter is now available to view and download from the charity’s website: www.loveyourhospital.org/publications/

Two plaques will be mounted in May by the Ben Nevis pictures by ‘rest stops’ at St Richard’s and Worthing Hospitals to celebrate two years since our Hospital Hikers conquered the mountain to raise more than £16,000 for dementia care. The charity will take this opportunity for an internal push encouraging staff to take on a fundraising challenge to support their own ward funds.

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Design work is underway to replace existing and outdated LYH banners for display at St Richard’s, Worthing and Southlands Hospitals and at external charity events.

13.03 Lottery

New lottery sign-ups have now reached 211 new plays for 178 new players.

Public onsite recruitment is going well, the appetite for the lottery is very positive.

13.04 Direct Marketing

The LYH Newsletter mailed in February and has so far raised £635 with donations continuing to come in.

Mailing plans have been built in to the strategy for 2019/20 to include two newsletters and two financial asks.

14.00 Recommendation

The Board is asked to NOTE the report.

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Appendix 1

Gender Pay Gap Report (31 March 2018 snapshot)

1) Introduction GPG reporting shows the difference in average hourly pay and bonus payments between men and women. This is the second Gender Pay Gap (GPG) report Western Sussex Hospitals NHS Foundation Trust (WSHFT) has produced following the introduction of the requirement in March 2017.

All Public Sector organisations listed in Schedule 2 of The Equality Act 2010 (Specific Duties and Public Authorities) Regulations 2017 are subject to the mandatory Gender Pay Gap (GPG) reporting requirements, if they have more than 250 employees under a contract of employment. This includes all staff under Agenda for Change, Medical & Dental and Very Senior Managers (VSM).

Data relating to the pay period in which the snapshot date of 31 March 2018 is required, with full publication on 31 March 2019 and annually thereafter.

There are six basic calculations the Trust is required to report on:

• Mean gender hourly pay gap • Median gender hourly pay gap • Mean bonus gender pay gap • Median bonus gender pay gap • Proportion of male and female staff receiving a bonus payment • Proportion of male and female staff in each of the four equal quartiles

The pay period is a snapshot of the gross hourly pay rate of all employees, excluding bank workers on the 31 March 2018 and includes the following elements:

• Basic pay including other allowances • Paid leave, including annual leave, sick leave, maternity, paternity, adoption or parental leave (except where an employee is paid less than usual because of being on leave) • Bonus pay (if paid in the pay period) i.e.: VSM bonus or Clinical Excellence Award (CEA)

The report does not include:

• Overtime pay, waiting list initiatives (WLI), expenses, value of salary sacrifice schemes, benefits in kind, redundancy pay and tax credits. Page 9 of 12

2) Purpose GPG reporting shows the difference in average hourly pay and bonus payments between men and women. WSHFT are required to analyse the information to identify any underlying root causes for GPG and put in place remedial actions to address and mitigate this. The results will be used to assess:

• the level of gender equality • the balance of male and female employees in each of the four salary range quartiles • how effectively talent is being maximised and rewarded

The benefits of reporting GPG include building a reputation for being known as a fair and progressive employer, attracting a wider pool of recruits, enhancing productivity and creating a culture committed to tackling inequality.

3) Analysis

Gender mean and median - hourly pay gap The table below shows the mean and median hourly rates for male and female employees in the Trust and the actual gap in monetary and percentage terms in 2018. The 2017 figures are shown in brackets.

There is a 21.16% (19.62% in 2017) difference in favour of male employees when using the mean hourly rate; this is an increase of 1.54% on 2017. This however, moves to 0.98% (0.89%) in favour of female employees when the median hourly rate is used, this is marginally up on the previous year.

Gender Mean Hourly Rate Median Hourly Rate

Male £ 19.28 (£ 18.32) £ 13.30 (£ 13.06)

Female £ 15.20 (£ 14.73) £ 13.55 (£ 13.18)

Difference £ 4.08 (£ 3.59) -£ 0.25 (- £0.12) Pay Gap % 21.16% (19.62%) -0.98% (0.89%)

Gender mean and median – bonus pay gap

The table below includes Medical and Dental employees who received a Clinical Excellence Award (CEA) and Very Senior Managers (VSM) who received a bonus.

Gender Mean Bonus Median Bonus

Male £13,230.18 (£13,200.79) £ 9,040.50 (£ 8,950.75) Female £ 6,636.09 (£ 6,438.90) £ 3,917.52 (£ 3,804.34)

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Difference £ 6,594.09 (£ 6,761.89) £ 5,122.98 (£ 5,146.41)

Pay Gap % 49.84% (51.22%) 56.67% (57.50)

Proportion of male and female receiving a bonus payment

A total of 132 (139) employees in the Trust received a bonus payment; this is shown as a percentage of the overall workforce.

Gender Employees VSM Medical & Total %WSHFT Paid Bonus Staff Dental WSHFT Workforce (% of this Paid Staff Paid Workforce group) Bonus Bonus Female 42 31.8% 3 (4) 39 (38) 6,138 0.68% (42) (30.2%) (5,524) (0.76%) Male 90 68.2% 1 (0) 89 (97) 1,884 4.78% (97) (69.8) (1,702) (5.70%)

Proportion of male and female staff in each quartile band

The Trust is required to rank every employee by rate of pay on the 31 March 2018 (not by pay banding). The data has been presented in 4 equal quartiles in the table below:

Quartile Bracket/Band Female Male Total Female Male % % Top £18.20 - £ 82.65ph 1,421 588 2,009 70.7 29.3 £18.00 - £ 75.00ph (1,278) (572) (1,850) (69.1) (30.9) Upper £13.50 - £ 18.20ph 1,670 332 2,002 83.4 16.6 Middle £13.00 - £ 18.00ph (1,493) (271) 1,764 (84.6) (15.4) Lower £ 10.00- £ 13.49ph 1,564 442 2,006 80.0 20.0 Middle £ 9.70 - £ 13.00 ph (1,401) (406) (1,807) (77.5) (22.5) Lower £ 5.60 - £ 9.97 ph 1,482 522 2,004 74.0 26.0 £ 5.30 - £ 9.69 ph (1,352) (453) (1,805) (74.9) (25.1) WSHFT 6,137(5, 1,884(1, 8,021 76.5 23.5 Total 524) 702) (7,226) (76.5) (23.5)

4) Development Throughout 2017

Since April 2017 the Executive Team at Western Sussex Hospitals NHS Foundation Trust (WSHFT) has been providing leadership support to its neighbour Brighton and Sussex University Hospitals (BSUH). In July 2017 Trust Directors where appointed at WSHFT and therefore associated costs connected to the 3 year contract may be influenced as part of the gender pay gap review.

5) Publication of data The Trust is required to publish information and make it accessible on the Trusts website. The published information is uploaded to the government website with a written statement

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confirming the calculations are accurate. This must be signed by an appropriate senior person, such as a Director or Chief Executive. Organisations are required to provide written narrative to support understanding of why a gender pay gap is present and what the organisation intends to do to reduce the gap.

6) Goals and Summary

Western Sussex Hospitals NHS Foundation Trust’s goal is to support the workforce by providing flexibility, skills and rewards to develop.

Following the NHS contract refresh the Band 1 pay scale closed to new entrants with effect from 1 December 2018 and employees now commence employment on Band 2. In implementing the NHS contract refresh the trust now ensures the workforce is paid at a level above the living wage. Actions taken to address the gender pay gap are not directly linked to pay; however ensuring a more inclusive balance across the trust will support achieving a greater satisfied and motivated workforce.

To support and attract female talent into the organisation we continue to develop and expand our Apprenticeship programme. Supporting a workforce to shape future career paths and desired aspirations we aim to recruit 3% of our workforce onto an apprenticeship qualification during 2019.

7) Actions to take Forward

The Trust is committed to ensuring an equitable workforce and this paper highlights the gender pay gap data as of 31 March 2018 and the proposed actions that need to be taken in response to the requirement of the GPG.

In the next 12 months we will focus on: • Undertake a further review of the 2019 CEA applications to ensure both female and male employees feel able, are encouraged and confident to apply and outcomes treated fairly. • Monitor the applications of Trust policies such as flexible working. • Develop better career pathways for all lower paid staff. • Making sure there is fair and equitable access to all leadership & management development opportunities.

Authors: Andy Hughes, HR Business Partner - Core Division and Trust Pay & Reward Lead Nikki Kriel, Organisational Development Manager

March 2019

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Gender Pay Gap Report 2016/17

...... 7,226 employees £14.73 is the 19.62% gap between hourly rates

average mean hourly for females and males is largely due to:

rate for females

of which £18.32 is the average mean hourly 28.1% of 71.9% of KEY FINDINGS KEY 76.45% are female female medical male medical rate for males consultants consultants

23.55% are male receive Clinical Excellence Awards

Produce a further DEVELOP REVIEWING our PAY GAP REPORT better career Clinical Excellence in September 2018 to pathways for all Awards process so all identify any changes lower paid staff staff feel able and MAKING SURE confident to apply there is fair and equitable access to all CONTINUING TO leadership & SUPPORT management the living wage for development our workforce opportunities

TAKING ACTION 2018/19 2018/19 ACTION TAKING

Read the full report on our website at www.westernsussexhospitals.nhs.uk Figures taken as at 31 March 2017 Gender Pay Gap Report 2017/18

...... 8,021 employees £15.20 is the There is a 21.16% mean gap Our workforce has an average mean hourly difference between hourly rates for employee base that is female and male employees. predominately female rate for females

up £0.47

£19.28 is the 0.68% (39) 4.72% (89) average mean hourly During 2017 we launched and encouraged female medical male medical KEY FINDINGS KEY 76.51% are female rate for males applications clinical excellence applications consultants consultants

from female consultants 23.49% are male up £0.96 Received Clinical Excellence Awards

DEVELOP REVIEWING our better career Clinical Excellence pathways for all Awards process so all lower paid staff staff feel able and confident to apply MAKING SURE MONITOR the SUPPORT the living there is fair and applications of wage for our equitable access to all polices such as workforce through leadership & flexible working the NHS Contract management Refresh development

TAKING ACTION 2018/19 2018/19 ACTION TAKING

Read the full report on our website at www.westernsussexhospitals.nhs.uk Figures taken as at 31 March 2018 WSHFT WORKFORCE SCORECARD February 2019

2018/19 Target/ Key performance Indicators Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb YTD Ceiling Amber Limit Trend 1) WORKFORCE CAPACITY NB Budgeted FTE 6634.6 6638.1 6741.1 6757.0 6735.4 6743.2 6731.7 6733.9 6793.7 6794.9 6819.7 6811.1 6811.1 6770.3 N/A N/A

Total FTE Used 6652.4 6669.1 6668.1 6579.4 6528.8 6542.6 6539.6 6510.5 6487.0 6528.8 6556.7 6498.3 6588.4 6548.0 N/A N/A

Total FTE Used Variance from Budget 17.8 31.0 -73.0 -177.6 -206.6 -200.6 -192.1 -223.4 -306.7 -266.1 -263.1 -312.8 -222.8 N/A N/A N/A

Total FTE Used Vacancy Factor -0.3% -0.5% 1.1% 2.6% 3.1% 3.0% 2.9% 3.3% 4.5% 3.9% 3.9% 4.6% 3.3% 3.3% N/A N/A

Substantive Contracted FTE 6034.8 6049.1 6031.2 6003.9 5972.9 5992.3 6015.6 6032.3 6034.6 6023.2 6038.3 6045.1 6049.8 6021.7 N/A N/A

Substantive FTE Worked 5939.3 5971.5 5936.8 5900.8 5878.5 5864.7 5910.9 5875.3 5865.1 5877.4 5919.9 5911.9 5925.2 5897.0 N/A N/A

Substantive FTE Used Vacancy Factor 9.0% 8.9% 10.5% 11.1% 11.3% 11.1% 10.6% 10.4% 11.2% 11.4% 11.5% 11.2% 11.2% 11.1% N/A N/A

Bank Usage As % Of Total FTE Used 9.1% 8.8% 9.3% 8.4% 8.4% 8.7% 8.1% 8.2% 8.0% 8.2% 8.2% 7.6% 8.8% 8.4% N/A N/A

Agency Usage As % Of Total FTE Used 1.6% 1.7% 1.7% 1.9% 1.6% 1.6% 1.5% 1.5% 1.6% 1.8% 1.5% 1.4% 1.2% 1.6% N/A N/A 2) WORKFORCE EFFICIENCY NB Rolling 12 Month Sickness Absence 1 3.5% 3.6% 3.6% 3.6% 3.6% 3.6% 3.6% 3.6% 3.6% 3.7% 3.7% 3.7% N/A 3.3% 3.3%

In Month Sickness Absence % 3.6% 3.7% 3.5% 3.1% 3.2% 3.4% 3.7% 3.8% 3.9% 4.0% 3.8% 4.3% 3.7% 3.3% 3.3%

In Month Maternity Leave % 2.3% 2.4% 2.4% 2.5% 2.6% 2.7% 2.5% 2.5% 2.5% 2.6% 2.6% 2.3% 2.5% N/A N/A

In Month Other Absence % 1.8% 1.7% 1.6% 1.7% 1.8% 1.5% 1.4% 1.8% 2.0% 2.1% 1.5% 1.7% 1.7% N/A N/A

In Month Total Absence % 7.8% 7.8% 7.5% 7.3% 7.6% 7.6% 7.6% 8.0% 8.3% 8.8% 7.8% 8.3% 7.9% N/A N/A

Sickness Episodes 1381 1473 1321 1165 1148 1214 1227 1257 1414 1486 1426 1737 N/A

Maternity Heads 190 187 195 194 212 216 204 197 190 219 198 180 N/A N/A N/A

In Month Long Term Sickness Absence % (28 Days Or More) 1.3% 1.5% 1.5% 1.5% 1.3% 1.7% 1.9% 1.9% 1.8% 1.8% 1.7% 1.8% 1.7% N/A N/A

In Month Short Term Sickness Absence % (<28 days) 2.3% 2.2% 2.0% 1.6% 1.9% 1.8% 1.8% 1.9% 2.0% 2.2% 2.0% 2.5% 2.0% N/A N/A

In Month Stress Related Sickness Absence % 0.7% 0.6% 0.7% 0.6% 0.6% 0.8% 0.9% 0.8% 0.8% 0.8% 0.8% 0.7% 0.8% N/A N/A

In Month Musculo Skeletal Sickness Absence % 0.7% 0.8% 0.7% 0.7% 0.7% 0.8% 0.9% 0.8% 0.9% 0.9% 0.7% 0.8% 0.8% N/A N/A

Number of Staff breaching Management Triggers for sickness absence 1028 1029 1032 1030 1026 1022 1038 1019 1027 1036 1021 1029 N/A

% of Staff (headcount) 14.6% 14.6% 14.7% 14.7% 14.6% 14.5% 14.8% 14.4% 14.5% 14.7% 14.4% 14.5% N/A

Rolling 12 Month Turnover 7.4% 7.5% 7.5% 7.8% 7.6% 7.8% 7.6% 7.6% 7.6% 7.7% 8.1% 8.1% 8.2% N/A 8.5% 8.5% 3) TRAINING & PERSONAL DEVELOPMENT NB % Appraisals Up To Date 87.0% 86.2% 87.3% 86.8% 87.5% 86.5% 87.1% 86.2% 87.3% 88.1% 87.6% 88.7% 87.5% N/A 90.0% 80.0%

% In Date - Fire 93.4% 93.7% 94.6% 94.4% 94.0% 93.0% 92.9% 92.1% 92.7% 93.3% 93.0% 93.5% 93.5% N/A 90.0% 80.0%

% In Date - Infection Control (Role Specific) 92.3% 92.0% 93.1% 92.8% 92.8% 91.2% 91.2% 90.8% 91.8% 91.9% 91.6% 92.5% 92.6% N/A 90.0% 80.0%

% In Date - Back Training (Role Specific) 94.1% 94.2% 94.4% 94.1% 94.0% 94.4% 93.7% 93.7% 93.9% 93.9% 94.3% 94.8% 95.0% N/A 90.0% 80.0%

% In Date - Child Protection (Role Specific) 98.0% 98.2% 98.1% 97.8% 97.6% 97.2% 95.1% 95.3% 95.2% 95.5% 93.5% 94.2% 94.7% N/A 90.0% 80.0%

% In Date - Information Governance 92.1% 91.8% 93.0% 92.8% 92.3% 91.6% 90.8% 90.8% 91.6% 91.7% 91.4% 91.9% 91.9% N/A 90.0% 80.0%

% In Date - Adult Protection 96.4% 96.1% 95.7% 95.0% 93.8% 93.4% 89.3% 88.2% 87.2% 86.3% 85.9% 85.3% 84.9% N/A 90.0% 80.0%

% in Date - Equality & Diversity 95.0% 95.5% 96.4% 96.7% 96.8% 96.8% 96.1% 96.1% 96.6% 96.6% 96.4% 96.5% 96.5% N/A 90.0% 80.0%

% in Date - Health & Safety 91.2% 91.2% 91.3% 91.2% 91.2% 91.0% 90.0% 90.1% 90.5% 91.7% 92.9% 93.5% 93.8% N/A 90.0% 80.0%

% in Date - Resus 81.4% 81.4% 82.1% 82.2% 84.2% 83.3% 85.3% 83.4% 84.1% 85.5% 85.5% 85.9% 86.8% N/A 90.0% 80.0% 4) REAL-TIME STAFF FEEDBACK NB Total Respondents To Survey 204 288 309 269 330 226 188 194 173 199 103 63 91 2145 N/A N/A

% Respondents who would recommend this trust as a place to work 87.7% 85.9% 87.4% 87.3% 87.5% 89.7% 82.1% 85.0% 89.4% 82.8% 81.2% 86.9% 94.4% 86.7% N/A N/A

% Respondents happy with standard of care if a friend/relative needed treatment 93.1% 95.4% 93.9% 92.5% 92.2% 91.6% 96.6% 90.4% 91.1% 92.3% 89.8% 93.2% 97.8% 92.7% N/A N/A

Overall Staff Engagement Composite Score 3 7.45 7.51 7.69 7.74 7.55 7.68 7.48 7.50 7.65 7.45 7.47 7.54 7.67 N/A tbc tbc

Notes: 1 Absence data is available one month in arrears. 3 Overall indicator for staff engagement is a composite score using 3 key finding questions, friend and family recommendation, motivation and making improvements. 3 WSHT Total Respondents To Survey is greater than the sum of the divisional Total Respondents To Survey as some staff did not select a division when completing the survey. 3 Baseline Data from 2016 Staff Survey, Overall Staff Engagement Score - 3.88

Agenda Item: 9 Meeting: Trust Board Meeting Date: 28th March 2019 Report Title: Financial Performance Report Sponsoring Executive Director: Karen Geoghegan, Chief Financial Officer Author(s): Alison Ingoe, Finance Director; Karen Seabridge, Deputy Director - Financial Management Report previously considered by N/A and date: Purpose of the report: Information  Assurance ☐ Review and Discussion ☐ Approval / Agreement ☐ Reason for submission to Trust Board in Private only (where relevant): Commercial confidentiality  Staff confidentiality ☐ Patient confidentiality ☐ Other exceptional circumstances ☐ Link to Trust Strategic Themes: Patient Care ☐ Sustainability  Our People ☐ Quality ☐ Systems and Partnerships ☐ Any implications for: Quality Financial planning principles have been established to ensure that expenditure budgets reflect anticipated activity levels and that agreed staffing levels are maintained. Financial Report on year to date financial performance. Workforce N/A Link to CQC Domains: Safe ☐ Effective ☐ Caring ☐ Responsive ☐ Well-led  Use of Resources  Communication and Consultation:

Executive Summary: In February the Trust reported a deficit of £ 0.59m (excluding PSF income), reducing the cumulative position to £0.5m deficit. The year-end control total is a surplus of £1.185m and achievement of the control means that the Trust will be eligible for £5.7m of PSF income. The Trust is forecasting achievement of the control, however, this will be challenging and will require close management of a number of operational and contractual risks. The Trust is reporting an FSRR rating of '1'.

Key Recommendation(s):

The Trust Board is asked to NOTE the Financial Performance Report for February 2019.

Final version 19.11.18 TH Finance Report M11 2018/19

Summary:

In February the Trust reported a deficit of £ 0.59m (excluding PSF income), reducing the cumulative position to £0.5m deficit. The year-end control total is a surplus of £1.185m and achievement of the control means that the Trust will be eligible for £5.7m of PSF income. The Trust is forecasting achievement of the control, however, this will be challenging and will require close management of a number of operational and contractual risks. The Trust is reporting an FSRR rating of '1'.

SOF Finance Rating G Control Total (exc PSF) Surplus £k A Premium Pay Spend £k G

Plan Actual/Forecast Plan Actual / Forecast Plan Actual Year to Date 1 1 Year to Date £k 72 (507) Agency Ceiling (YTD) £k 13,844 9,957 Year End Forecast 1 1 Year End Forecast £k 1,185 1,185 WLI Payments (YTD) £k 1,633 2,536 Total Premium Pay (YTD) £k 15,477 12,492

The Trust is reporting an FSRR rating of '1', in line with the planned position for February. The Trust reported a deficit of £0.59m in month resulting in a cumulative deficit of £0.5m. Income Premium pay expenditure is £3.0m below plan. WLI expenditure increased marginally in February has over-performed in month due to higher than planned levels of emergency activity. The cost as a result of additional RTT activity undertaken. In aggregate agency expenditure remained static. base remains above plan with medical pay and non-pay budgets continuing to be significant drivers of the overspend.

Income £k G Operating Costs £k R Agency Ceiling £k G

Plan Actual/Forecast Plan Actual/Forecast Plan Actual/Forecast Year to Date £k 401,825 408,497 Year to Date £k (380,091) (388,461) Year to Date £k 13,844 9,957 Year End Forecast 439,263 448,074 Year End Forecast £k (414,447) (424,153) Year End Forecast £k 14,969 11,056

Income is £6.7m ahead of plan at the end of February. The value of Income from Activities has At the end of February Operating costs are £8.37m adverse to plan. In comparison to January, the In aggregate agency expenditure remained at a similar level to January with increases in both been greater than planned for daycase spells, non-elective spells, A&E attendances and pay run rate has increased by £0.2m and the non pay run rate decreased by £0.46m. Medical and Nursing agency being mitigated by decreases in Estates following the exit of outpatients this month. Underperformance reported in elective spells has been offset by the over temporary resource relating the implementation of the green travel project. Cumulatively agency performance in daycases. Private patient services continue to underperform against plan. expenditure is £3.9m below the agency ceiling. Agency expenditure is forecast to be at £11.0m by the end of the year, which will be £3.9m below the agency ceiling.

Cash £k A Capital £k A Efficiency & Transformation Programme £k A

Plan Actual/Forecast Plan Actual/Forecast Plan Actual/Forecast Year to Date £k 20,599 8,934 Year to Date £k 16,337 12,795 Year to Date £k 16,434 16,352 Year End Forecast £k 16,974 11,188 Year End Forecast £k 19,145 19,168 Year End Forecast £k 18,235 18,235

At the end of February cash is behind plan by £11.7m. The full year forecast has been updated to At the end of February, capital expenditure totalled £12.8m which is £3.5m below plan due to Year-to-date savings of £16.3m have been achieved against a plan of £16.4m (99%). Workforce, reflect the latest outturn position. Slippage on the capital programme and more cash being later starts on some projects. All capital schemes have been approved with expenditure expected Surgical Productivity and Pathology work programmes have been key areas of underdelivery. The available following receivables receipts has been used to reduced the level of aged payables. to be £6.4m in Mar-19 and for out-turn expenditure to be £19.2m. programme is forecast to deliver in full at year-end.

Key Risks: 1. The Trust has agreed 2018/19 activity and income on an aligned incentives (AIC) basis with its main commissioner, Coastal West Sussex CCG. In the year to date there has been significant over-performance in non-elective activity which represents a risk to the year-end position. A programme of work has been agreed within the AIC to address and reduce costs in these areas and discussions with commissioners are ongoing regarding the management in 2018/19. 2. Reducing premium staffing costs remains a significant challenge. Although the Trust has seen some successes in reducing agency expenditure within nursing, in other areas costs have increased, predominantly within medical staff. A medical workforce action group with Director leadership has been established to provide oversight and focus in this area. 3. Alignment of capacity to non-elective and elective activity levels and responsiveness to changes in levels of demand particularly over the winter period. Close management of capacity and flow will be required to ensure that capacity and workforce are able to be flexed as required.

B Finance Report FI 2018_19 M11 Page 1 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 SOF Finance Rating G

At the end of February the finance rating is a '1'. The distance from financial plan metric is a '2' reflecting the adverse variance from plan.

Plan Plan Actual Actual Year to Date Metric Rating Metric Rating

Capital Service Capacity 3.5 1 3.6 1

Liquidity 2.3 1 0.5 1

I&E Margin 3.6% 1 3.3% 1

Distance from Financial Plan 0.0% 1 (0.2)% 2

Agency Spend (21.6)% 1 (28.1)% 1

2018/19 Finance Rating 1 1

Area Metric Construction Rating Weighting 1 2 3 4 (best) (worst) Revenue available for capital service Capital Service Capacity = 2.5x 1.75x 1.25x <1.25x 20% Annual debt service Financial Sustainability Working capital balance x 360 Liquidity Days = 0.0 (7.0) (14.0) <(14.0) 20% Annual operating expenses

I&E Surplus or deficit Financial Efficiency I&E Margin = 1% 0% (1)% ≤(1)% 20% Total Operating and Non Op Income

YTD Actual I&E Surplus/Deficit - YTD Planned I&E Surplus/Deficit Distance from Financial Plan = 0% (1)% (2)% ≤(2)% 20% YTD Planned I&E Surplus/Deficit Financial Controls YTD Actual Agency Ceiling - YTD Planned Agency Ceiling Agency Ceiling = 0% 25% 50% ≥50% 20% YTD Planned Agency Ceiling

B Finance Report FI 2018_19 M11 Page 2 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 Surplus A

The Trust reported a deficit of £ 0.59m in February reducing the cumulative position (excluding PSF income) to £0.5m deficit. In order to achieve the control total and be eligible to receive a further £5.7m of PSF funding, the Trust needs to deliver a surplus of £1.7m in March. The Trust continues to forecast delivery of the control total, but this remains challenging and will require close management of operational and contractual risks over the next month.

Year to Date Full Year £k Plan Actual Variance £k Plan Forecast Variance

Underlying Surplus (Deficit) excluding PSF 72 (507) (580) Underlying Surplus (Deficit) excluding PSF 1,185 1,185 0 add Provider Sustainability Fund 14,356 14,356 0 add Provider Sustainability Fund 16,252 16,252 - Performance against Control Total including PSF 14,428 13,849 (580) Performance against Control Total including PSF 17,437 17,437 0

At the end of February the cumulative income position is £6.7m above plan. Continuing the trajectory seen in previous months, A&E attendances and Emergency activity increased again in February and remain significant contributors of the overperformance in income. Elective pathway activity decreased during February although in aggregate income levels exceeded the plan for the month. Private patient activity decreased significantly resulting in income reflecting the lowest level of income all year and cumulatively the variance to plan has increased to £1.26m.

In comparison to January, pay expenditure increased by £0.2m with Medical and Nursing expenditure increasing, which was partially offset by reductions in Professional and technical staff and Management and Admin. Medical pay increased accross all staff types due to middle grade vacancies in A&E and increased activity being taken to manage RTT delivery resulting in high locum expenditure being incurred alongside continued WLI and agency usage.

Non pay in aggregate decreased by £0.46m, after normalising for PbR excluded drugs and devices, the costs of which are matched by income the underlying positon was £0.21m lower that January's expenditure. As planned, increased outsourced Orthopaedic activity resulted in increased expenditure relating to services from NHS bodies, however this was mitigated by reduced clinical supplies and services with in the Surgical division where lower levels of elective activity were undertaken. High tariff drug expenditure and significant expenditure within clinical supplies and services incurred in previous months continue to be the key contributor to the adverse non pay position.

Year to Date Full Year £k Prior Year Plan Actual Variance £k Plan Forecast Variance

Income 393,862 401,825 408,497 6,672 Income 439,263 448,074 8,812 Pay (260,580) (268,746) (270,619) (1,873) Pay (293,345) (296,467) (3,122) Non-Pay (tariff) (83,492) (83,109) (88,205) (5,096) Non-Pay (tariff) (90,309) (95,701) (5,392) Non-Pay (PbR exc) (28,266) (28,236) (29,637) (1,401) Non-Pay (PbR exc) (30,793) (31,985) (1,192) EBITDA * 21,524 21,734 20,036 (1,698) EBITDA * 24,816 23,921 (895) 0.00% Profit / Loss on Disposal of Fixed Assets 7 - 12 12 Profit / Loss on Disposal of Fixed Assets - 9 9 Interest Payable (730) (537) (515) 22 Interest Payable (586) (549) 37 Interest Receivable 22 22 74 53 Interest Receivable 24 69 45 Depreciation (12,892) (13,411) (13,178) 233 Depreciation (14,630) (14,581) 49 Impairments - - - - Impairments - - - Public Dividend Capital Dividend (7,142) (7,723) (7,466) 257 Public Dividend Capital Dividend (8,425) (8,368) 57 Net Surplus / (Deficit) 790 85 (1,035) (1,120) Net Surplus / (Deficit) 1,199 501 (698) less: Impairment - - - - less: Impairment - - - Retained Surplus/(Deficit) 790 85 (1,035) (1,120) Retained Surplus/(Deficit) 1,199 501 (698) Donated Assets (529) (859) (290) 569 Donated Assets (937) (207) 730 Donated Asset Depreciation and Amortisation 850 846 818 (28) Donated Asset Depreciation and Amortisation 923 891 (32) Control Total excluding PSF 1,111 72 (507) (580) Control Total excluding PSF 1,185 1,185 0 add Provider Sustainability Fund 6,473 14,356 14,356 0 add Provider Sustainability Fund 16,252 16,252 - Control Total including PSF 7,583 14,428 13,849 (580) Control Total including PSF 17,437 17,437 0 * EBITDA Earnings before Interest Taxation Depreciation and Amortisation

Control Total by Month Cumulative Control Total by Month 2,000 2,000

1,500 1,500 1,185 1,000 1,000 500

500

0

0 Budget Budget £000s £000s (500) Actual Actual (500) (1,000) (1,000) (1,500) (1,500) (2,000) (2,000) (2,500) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

B Finance Report FI 2018_19 M11 Page 3 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 Provider Sustainability Fund A

In M11, the control total was not achieved, however, the Trust is forecasting delivery of the control total and has therefore accrued PSF income for M11. A total of £5.7m is available in Q4 subject to delivery of the control total at the end of the quarter and achievement of the 95% A&E 4 hr standard in March. In total £10.6m of PSF income has been earned to the end of Q3.

Cumulative YTD Q1 Q2 Q3 Jan-17 Feb-17 2018/19

Plan £k (884) 177 549 1,065 73 1,184 Financial Control Total (exc PSF) Actual £k (822) 193 556 79 (508) 0

Eligible for PSF Funding

PSF Income Available £k 2,438 5,688 10,564 12,460 14,356 16,252

Achieved? Yes Yes Yes No No Delivery of Financial Control Total Income 70.0% 1,707 3,982 7,395 8,722 10,049 11,376

Achieved? Yes Yes Yes Yes Yes A&E Waiting Times Income 30.0% 731 1,706 3,169 3,738 4,307 4,876

Total PSF Income Achieved (£000s) 2,438 5,688 10,564 12,460 14,356 10,564

B Finance Report FI 2018_19 M11 Page 4 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 Income G

The Trust is ahead of plan for income by £6.7m year to date. Overperformance in income from activities is offset by under performance in the other operating income services, particularly private patient services.

Year to Date Full Year £k Prior Year Plan Actual Variance £k Plan Forecast Variance

Total Income 393,862 401,825 408,497 6,672 Total Income 439,263 448,074 8,812

In February, the value of contract activity has been greater than planned for daycase spells, non-elective spells, A&E attendances and outpatients this month. With the underperformance reported in elective spells more than offset by the over performance in daycases. Private patient services continue to be behind plan in February.

Year to Date Full Year £k Prior Year Plan Actual Variance £k Plan Forecast Variance Income Income Coastal West Sussex 280,112 288,790 292,201 3,411 Coastal West Sussex 315,889 318,784 2,895 Other Clinical Commissioning Groups 17,281 18,616 19,030 414 Other Clinical Commissioning Groups 20,337 20,760 423 NHS England 44,649 44,053 45,953 1,900 Specialist LAT 48,048 50,131 2,083 WSCC - Sexual Health 4,708 4,119 4,595 476 WSCC - Sexual Health 5,420 5,013 (407) NCA 5,114 3,455 4,775 1,320 NCA 2,774 5,209 2,435 Other Trust Income 2,572 4,122 4,426 304 Other Trust Income 4,494 6,981 2,487 Income From Activities 354,436 363,155 370,980 7,825 Income From Activities 396,962 406,877 9,915 Income from other patient care (includes Private Patient Income from other patient care (includes Private Patient 7,575 7,323 5,988 (1,336) 8,098 6,803 (1,295) Income) Income) Education, Training and Research 13,970 13,476 13,721 245 Education, Training and Research 14,700 14,379 (321) Donated Asset / Grant Income 529 859 290 (569) Donated Asset / Grant Income 937 205 (732) Other Income (exc PSF) 17,352 17,012 17,519 507 Other Income (exc PSF) 18,565 19,810 1,245 Other Operating Income 39,426 38,670 37,517 (1,153) Other Operating Income 42,301 41,197 (1,104) Total Income 393,862 401,825 408,497 6,672 Total Income 439,263 448,074 8,812 Provider Sustainability Funding (PSF) 6,472 14,356 14,356 0 Sustainability and Transformation Funding (PSF) 16,252 16,252 0 Total Income including PSF 400,334 416,181 422,853 6,672 Total Income including PSF 455,515 464,326 8,812

of which : PbR Drugs/Devices 28,266 25,802 27,132 1,330

Monthly Income Monthly Income Yearly Comparison Budget Actual Prior Year Actual 39,000 39,000

38,000 38,000

37,000 37,000

36,000 36,000 £000 35,000 £000 35,000

34,000 34,000

33,000 33,000

32,000 32,000 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

B Finance Report FI 2018_19 M11 Page 5 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 Contract Performance G

The Trust reports income based on the contract monitoring position for prior months and an estimate of income for the current month based on priced and coded activity in the month as available. An estimate is made for the value of uncoded spells and missing days and included within the reported income position.

1) Context The Trust signed two-year contracts with all of its major commissioners in 2017/18. The Trust has agreed contract envelopes for 2018/19 with its major commissioners that are in line with the anticipated values in the financial plan.

2) YTD Report Trust internal monitoring information shows underperformance against the Trust's main CCG contract. It is important to note that the performance indicated is compared to the Trust's plan and does not necessarily reflect the over-performance against commissioner contracts.

Table 1. Table 2. Total Income from Activities Values from Commissioners Activity and Income by Point of Delivery £k Activity Volumes £k Estimated Values (inc. CQUIN) FYE Plan YTD Plan YTD Actual YTD Var Point of Delivery YTD Plan YTD Actual YTD Var YTD Plan YTD Actual YTD Var Coastal West Sussex 315,889 288,790 292,201 3,411 Daycases 55,264 53,794 (1,470) 34,996 34,863 (133) Other CCG Acute contracts 20,337 18,616 19,030 414 Elective Spells 6,378 5,343 (1,035) 21,387 19,649 (1,738) NHS England 48,048 44,053 45,953 1,900 Elective Excess Bed days 746 775 29 187 195 8 Integrated Sexual Health Services 5,420 4,119 4,595 476 Non Elective Spells 52,181 53,367 1,186 116,060 121,991 5,931 Non Contract Activity 2,774 3,455 4,775 1,320 Non Elective short-stay 11,995 13,541 1,546 9,082 10,549 1,467 Total 392,468 359,033 366,553 7,521 Non Elective Excess Bed days 14,665 11,744 (2,921) 3,671 2,990 (681) Outpatients 563,235 567,772 4,537 57,718 56,968 (750) NB: Variances are reported against Western Sussex Hospitals Planned Income Levels A&E 127,746 132,518 4,772 16,629 17,938 1,309 PbR exclusions 28,236 29,637 1,401 Critical Care 12,783 11,917 (866) Maternity Pathway 9,942 9,759 (183) OP Diagnostic Imaging 7,119 7,319 200 Sexual Health 4,849 4,595 (254) Direct Access Pathology 9,487 9,276 (211) Other Direct Access (Imaging and Dietetics) 2,053 2,084 31 Other 22,294 24,701 2,407 CQUIN 6,662 6,548 (114) Total Income from Activities 363,155 370,979 7,824

Table 3. Table 4. Reconciliation to Income Reporting Contract Income by CCG and NHS England (inc CQUIN)

£k £k

FYE Plan YTD Plan YTD Actual YTD Var SUSSEX CCGs and NHS ENGLAND YTD Plan YTD Actual YTD Var

Total Income received from Commissioners 392,560 359,033 366,553 7,520 NHS Coastal West Sussex CCG 288,790 292,201 3,411 NHS Horsham & Mid Sussex CCG 5,384 4,944 (440) This table represents the Trusts assessment Income recieved from (passed through to) other organisations NHS Brighton & Hove CCG 4,667 5,602 935 of the performance against commissioners Maternity pathway payment (197) (181) (169) 12 NHS High Weald, Lewes & Havens CCG 525 454 (71) only with whom a Contract SLA has been Cystic Fibrosis 146 134 183 49 NHS Crawley CCG 362 334 (28) agreed. Other invoicing 0 0 145 145 NHS Eastbourne, Hailsham & Seaford CCG 428 410 (18) 2018/18 A4C Pay Award 4548 4,169 4,267 98 NHS Hastings & Rother CCG 235 245 10 There are some differences between the Subtotal 4,497 4,122 4,426 304 NHS SE Hampshire CCG 5,621 5,746 125 Trust's income plan and the agreed contract NHS Portsmouth CCG 565 565 0 values due to QIPP assumptions Total Income from Activities 397,057 363,155 370,979 7,824 NHS Fareham & Gosport CCG 318 295 (23) Provider Sustainability Fund (PSF) 16,252 14,356 14,356 0 NHS Guildford & Waverley CCG 511 436 (75) Total Income from Activities plus PSF 413,309 377,511 385,335 7,824 Subtotal CCG Acute Contracts 307,406 311,232 3,826 NHS England 44,053 45,953 1,900

Total Contract Income for CCGs & NHS England 351,459 357,185 5,726

Note: changes to the work in progress adjustment are embedded in the contracted income value

B Finance Report FI 2018_19 M11 Page 6 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 Operating Costs R

At the end of February Operating costs are £8.37m adverse to plan. In comparison to January, the run rate decreased by £0.24m in aggregate, with reduced expenditure on clinical supplies and services offsetting increased outsourcing to Sussex Orthopaedic Centre. Within pay, Medical and Nursing expenditure both increased with high locum and bank expenditure being incurred respectively. After normalising for expenditure relating to PbR excluded drugs and devices, in comparison to January non pay decreased by £0.2m. Outsourcing of imaging reporting continued and increased orthopaedic activity was undertaken by SOTC, these costs were mitigated by reduced clinical supplies and services expenditure primarily within the Surgical division as elective activity decreased.

Year to Date Full Year £k Prior Year Plan Actual Variance £k Plan Forecast Variance Pay (260,580) (268,746) (270,619) (1,873) Pay (293,345) (296,467) (3,122) Non Pay (111,758) (111,345) (117,842) (6,497) Non Pay (121,102) (127,686) (6,584) Operational Costs (372,338) (380,091) (388,461) (8,370) Operational Costs (414,447) (424,153) (9,706)

Pay: The underlying pay position increased in aggregate by £0.22m in comparison to January, predominantly within Medical staffing, and a smaller increase was noted within Nursing expenditure. Medical pay increased within all staffing groups with substantive expenditure increasing as a result of increased National CEA awards, for which income is received. Emergent middle grade vacancies within A&E have impacted on high locum usage and increased RTT delivery across both Medical and Surgical specialties has been achieved through use of locum, WLI and agency resources. Reductions within junior doctors utilised in Elderly Medical wards have continued, and increased medical staffing levels remain within Emergency areas supporting patient flow and discharge. In comparison to January, Nursing expenditure increased by £0.1m predominantly within bank expenditure. Substantive expenditure decreased following a number of leavers, and the vacancies were covered with increased bank staff. In both Surgical and Emergency areas pressure continued from supporting patients requiring specialist mental health care. Capitalisation of staff working on specific projects and vacancy control within admin and managerial posts in non-clinical areas is partially mitigating the pressures being experienced in clinical areas. The movement on the quarterly review of annual leave is contributing to the favourable variance within other pay, however in reflection of the pattern of annual leave taking, this provision is likely to be increased in Q4.

Non Pay: In comparison to January there was a £0.46m decrease within non pay, of which £0.24m related to reduced PbR excluded drugs and devices expenditure which is matched by income. As reported last month, there was an increase in relation to Orthopaedic activity outsourced to Sussex Orthopaedic Centre which is reflected within services from other NHS bodies, these costs are offset by income from repatriation of work to the Independent Sector. Clinical Supplies and Services decreased by £0.39m primarily within the Surgical Division, reflecting lower levels of Elective activity being planned and undertaken in comparison to January.

Year to Date Full Year £k Prior Year Plan Actual Variance £k Plan Forecast Variance Pay Pay Management & Admin (36,819) (39,804) (38,266) 1,538 Management & Admin (43,445) (41,876) 1,569 Medical and Dental Staff (75,569) (75,646) (79,867) (4,220) Medical and Dental Staff (82,605) (87,201) (4,596) Nursing & Midwifery (99,118) (101,197) (101,912) (716) Nursing & Midwifery (110,618) (111,468) (850) Other Healthcare (36,698) (36,978) (36,591) 387 Other Healthcare (40,302) (39,817) 485 Estates (13,768) (15,064) (14,761) 303 Estates (16,418) (16,105) 313 Other Staff 1,393 (57) 778 836 Other Staff 43 - (43) Total Pay (260,580) (268,746) (270,619) (1,873) Total Pay (293,345) (296,467) (3,122) Non-Pay Non-Pay Services from Other NHS Bodies (2,580) (2,499) (2,721) (223) Services from Other NHS Bodies (2,731) (3,240) (509) Purchase of Healthcare from Non NHS Bodies - - - - Purchase of Healthcare from Non NHS Bodies - - - Drugs & Medical Gases - tariff (11,863) (11,983) (13,009) (1,026) Drugs & Medical Gases - tariff (13,072) (13,873) (801) Drugs & Medical Gases - PbR excluded (23,483) (23,879) (24,113) (234) Drugs & Medical Gases - PbR excluded (22,370) (25,670) (3,300) Drugs & Medical Gases - Cancer Drug Fund (1,450) (1,064) (2,063) (999) Drugs & Medical Gases - Cancer Drug Fund (4,834) (2,251) 2,583 Supplies and Services - Clinical (31,640) (31,454) (32,425) (970) Supplies and Services - Clinical (34,296) (33,939) 357 Supplies and Services - Clinical PbR Excluded (3,333) (3,293) (3,461) (168) Supplies and Services - Clinical PbR Excluded (3,590) (4,064) (474) Supplies and Services - General (3,517) (3,291) (3,361) (70) Supplies and Services - General (3,572) (3,757) (185) Establishment Expenses (5,391) (5,158) (5,625) (467) Establishment Expenses (5,514) (6,821) (1,307) Premises (14,476) (14,610) (14,828) (219) Premises (15,947) (16,043) (96) Education and Training (825) (1,000) (858) 142 Education and Training (1,203) (936) 267 Clinical Negligence Premium (9,319) (10,929) (10,646) 283 Clinical Negligence Premium (13,223) (12,397) 826 Other Non-Pay (3,881) (2,185) (4,732) (2,547) Other Non-Pay (751) (4,695) (3,944) Total Non-Pay (111,758) (111,345) (117,842) (6,497) Total Non-Pay (121,102) (127,686) (6,584) Total Expenditure (372,338) (380,091) (388,461) (8,370) Total Expenditure (414,447) (424,153) (9,706)

Monthly Pay Monthly Non Pay Budget Actual Budget Actual

30,000 12,000

25,000 10,000

£000s £000s

20,000 8,000 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Monthly Operating Costs Monthly Pay Yearly Comparison Budget Actual 2017-18 2018-19

38,000 26,000

36,000 24,000 £000s £000s 34,000 22,000

32,000 20,000 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar B Finance Report FI 2018_19 M11 Page 7 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 Payroll & Premium Pay Costs G

Agency Waiting List Initiative Payments Year to Date Year to Date £k 2016/17 2017/18 Ceiling Actual Variance £k Plan Actual Variance Division Medical and Dental Staff (6,226) (6,287) (7,886) (5,832) 2,054 Surgery (952) (919) 34 Nursing & Midwifery (8,755) (4,201) (4,654) (2,591) 2,063 Medicine - (701) (701) Other Healthcare (2,086) (1,303) (1,304) (1,005) 299 Core (659) (821) (162) Management & Admin (195) (96) - (379) (379) Women & Children (11) (87) (76) Ancillary Staff (182) (7) - (149) (149) Corporate (11) (8) 2 (17,443) (11,894) (13,844) (9,957) 3,888 (1,633) (2,536) (903)

Medical Locum Agency Expenditure Comparison Year to Date Agency Ceiling Agency Spend £k Plan Actual Variance 1,500 Division

Surgery (256) (986) (730)

Medicine (593) (5,679) (5,086) 1,000 £000s Core (483) (575) (91) Women & Children (102) (904) (802) Corporate (20) (18) 2 500 (1,454) (8,161) (6,707) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Payroll Staff in post incl Bank Year to Date Year to Date £k Prior Year Plan Actual Variance Prior Year Plan Actual Variance WTE WTE WTE WTE Medical and Dental Staff (61,106) (70,118) (63,693) 6,425 748 831 814 17 Nursing & Midwifery (94,513) (100,688) (98,966) 1,722 2,812 2,854 2,744 109 Other Healthcare (35,395) (36,503) (35,586) 918 1,004 1,062 993 69 Management & Admin (36,723) (39,743) (37,887) 1,856 1,270 1,336 1,275 61 Estates (13,762) (15,064) (14,612) 452 619 653 600 53 Other Staff 1,393 (57) 778 836 - 0 - 0 (240,107) (262,173) (249,966) 12,208 6,452 6,735 6,426 309

B Finance Report FI 2018_19 M11 Page 8 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 Divisional Performance R

Surgery: Increased delivery of elective & day case activity within General Surgery is Medicine: Continued increased emergency activity above plan through A&E during Core: Contract income from activities remains on plan with overperformance on income offsetting income underperformance within Trauma & Orthopaedics and Ophthalmology. In February has resulted in higher than anticipated tariff drug and clinical supplies expenditure. relating to increased usage of high cost drugs and devices, which are matched by aggregate activity in February was at a similar level in comparison to January, although The pressure in the Emergency departments coupled with some substantive staffing expenditure within non pay. Non commissioned income is significantly above plan due to there were fluctuations within specialty casemix. Pay expenditure is adverse to plan as a reductions across various specialties has led to Medical pay costs being higher than recovery of expenditure for drug supplies to other NHS trusts, the direct costs of which are result of increased nursing agency usage to provide additional support to patients with planned, with medical staffing contributing significantly to the adverse pay position. Nursing again within non pay. Pay expenditure reflects the impact of continued premium staffing mental health needs as well as to manage sickness cover. Clinical supplies and services expenditure continues to be driven by requirements to provide RMN cover to support usage within Radiology and Pathology, stemming from substantive recruitment pressures. expenditure decreased in February, primarily within Orthopaedics, however expenditure in patients with mental health needs across both sites. High usage in of clinical supplies and services in previous periods, increased costs relating prior periods continues to drive the adverse performance within non pay. to Radiology outsourcing and non pay savings delivery constraints contribute to the overall adverse non pay position.

Year to Date Year to Date Year to Date £k Plan Actual Variance RAG £k Plan Actual Variance RAG £k Plan Actual Variance RAG

Contract Income 92,406 92,371 (34) R Contract Income 156,570 161,602 5,031 G Contract Income 44,771 45,284 513 G Other Income 1,547 1,735 188 G Other Income 1,732 1,785 54 G Other Income 9,751 10,484 732 G Total Income 93,953 94,107 154 G Total Income 158,302 163,387 5,085 G Total Income 54,522 55,767 1,245 G Pay (58,574) (58,710) (137) R Pay (82,535) (87,085) (4,550) R Pay (52,024) (52,684) (660) R Non Pay (18,438) (20,053) (1,615) R Non Pay (30,558) (33,339) (2,781) R Non Pay (21,877) (24,542) (2,665) R Total Expenditure (77,012) (78,764) (1,752) R Total Expenditure (113,093) (120,424) (7,331) R Total Expenditure (73,901) (77,226) (3,325) R

EBITDA Surplus/(Deficit) 16,941 15,343 (1,598) R EBITDA Surplus/(Deficit) 45,209 42,963 (2,246) R EBITDA Surplus/(Deficit) (19,379) (21,458) (2,080) R

Contribution 18% 16% Contribution 29% 26% Contribution (36%) (38%) Women & Children: Contract income remained above plan in month, driven by continued Facilities & Estates: The division remains within plan, with pay savings across estates and Corporate: Increased Emergency NHS activity within the hospital impacting on bed pressures on non elective activity and the delivery of elective and outpatient Gynaecology facilities disciplines mitigating lower than expected car park income following changes in availability in February, coupled with reduced activity bookings resulted in the lowest level of activity repatriated from the independent sector. Costs to deliver this repatriated work tariff, and pressures on non pay resulting from estates works across all sites. Expenditure private patient income all year. This has increased the cumulative income variance to £1.2m increased within month, though remain within planned levels. Medical staffing spend was reduced in month primarily due to the exit of agency following recruitment of drivers for the behind plan. Activity is forecast to significantly increase in March based on current booking consistent with the Q4 trend, which is a reduction on expenditure levels incurred earlier in cross site minibus service and the exit of an agency staff member managing laundry and data, but will be contingent on bed availability. Pay and non pay expenditure remains the year, but still above plan as a result of recruitment, sickness and maternity leaves, transport. Major capital and revenue change projects including patient catering continue to favourable to plan with non clinical posts being held were practical and discretionary particularly within paediatrics. Underspends against PbR excluded drugs and an additional be delivered during the quarter. controls remaining heightened. rebate for midwifery CNST have supported higher than planned drug and clinical supply spend in year.

Year to Date Year to Date Year to Date £k Plan Actual Variance RAG £k Plan Actual Variance RAG £k Plan Actual Variance RAG

Contract Income 57,010 56,943 (67) R Contract Income - - - G Contract Income 12,398 14,780 2,382 G Other Income 520 637 117 G Other Income 4,037 3,758 (279) R Other Income 20,652 18,668 (1,984) R Total Income 57,530 57,579 50 G Total Income 4,037 3,758 (279) R Total Income 33,051 33,448 397 G Pay (29,335) (30,100) (765) R Pay (15,184) (14,765) 419 G Pay (30,787) (27,098) 3,689 G Non Pay (11,702) (11,434) 269 G Non Pay (11,340) (11,448) (108) R Non Pay (14,737) (14,335) 402 G Total Expenditure (41,037) (41,534) (496) R Total Expenditure (26,524) (26,213) 311 G Total Expenditure (45,524) (41,433) 4,091 G

EBITDA Surplus/(Deficit) 16,492 16,045 (447) R EBITDA Surplus/(Deficit) (22,487) (22,455) 32 G EBITDA Surplus/(Deficit) (12,473) (7,985) 4,489 G

Contribution 29% 28%

B Finance Report FI 2018_19 M11 Page 9 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 Statement of Financial Position

The Trust Balance Sheet is produced on a monthly basis and reflects changes in the asset values as well as movement in liabilities. Note: The Full Year Forecast has been updated to reflect the updated forecast outturn position.

Year to Date Full Year £k Plan Actual Variance Notes £k Plan Forecast Variance Notes

Property, Plant and Equipment 272,255 269,152 (3,103) 1 Property, Plant and Equipment 269,850 274,230 4,380 Intangible Assets 6,616 6,771 155 Intangible Assets 6,616 6,839 223 Other Assets - - - Other Assets - - - Non Current Assets 278,871 275,923 (2,948) Non Current Assets 276,466 281,069 4,603 Inventories 6,455 7,474 1,019 Inventories 6,450 8,052 1,602 Trade, Other Receivables, Other Current Assets 41,966 34,428 (7,538) 2 Trade, Other Receivables, Other Current Assets 47,569 38,304 (9,265) Cash and Cash Equivalents 20,599 8,934 (11,665) Cash and Cash Equivalents 16,974 11,188 (5,786) Non Current Assets Held for Sale - - - Non Current Assets Held for Sale - - - Current Assets 69,020 50,836 (18,184) Current Assets 70,993 57,544 (13,449) Trade and Other Payables (24,205) (19,393) 4,812 3 Trade and Other Payables (28,030) (31,427) (3,397) Borrowings (619) (2,199) (1,580) 4 Borrowings (2,198) (2,149) 49 Other Financial Liabilities (20,705) (17,898) 2,807 Other Financial Liabilities (17,196) (13,063) 4,133 Provisions (531) (212) 319 Provisions (559) (226) 333 Other Liabilities (2,795) (40) 2,755 Other Liabilities (2,795) (1,883) 912 Current Liabilities (48,855) (39,743) 9,112 Current Liabilities (50,778) (48,749) 2,029 Borrowings (20,536) (19,150) 1,386 4 Borrowings (18,378) (18,571) (193) Trade and Other Payables - - - Trade and Other Payables - - - Provisions (2,655) (2,784) (129) Provisions (2,627) (2,777) (150) TOTAL ASSETS EMPLOYED 275,845 265,082 (10,763) TOTAL ASSETS EMPLOYED 275,676 268,516 (7,160) Financed by: Financed by: Public Dividend Capital 240,844 240,844 0 Public Dividend Capital 240,844 240,844 - Retained Earnings (13,717) (26,693) (12,976) Retained Earnings (9,886) (23,259) (13,373) Surplus/(Deficit) for Year - - - Surplus/(Deficit) for Year - - - Revaluation Reserve 48,718 50,931 2,213 Revaluation Reserve 44,718 50,931 6,213 TOTAL TAXPAYERS EQUITY 275,845 265,082 (10,763) TOTAL TAXPAYERS EQUITY 275,676 268,516 (7,160)

1. The non current asset position includes the impact of the District Valuer's valuation and slippage on the year to date capital programme, however all schemes are now approved and are in progress. 2. The Trade Receivables are lower than plan due to the timings of significant payments including the PSF payments and a concerted effort to collect more cash by resolving historic issues. 3. Slippage on the capital programme and more cash being available following receivables receipts has been used to reduced the level of aged payables and improve our BPPC KPIs. 4. The Current, short term element (repayable within 12 months) of Borrowings has been moved into Current Liabilities as per Accounting Policies and should be read in conjunction with the Non Current Liabilities movement. IFRS9 Financial Instruments has been applied in year (with loan interest payable disclosed as a current liability).

B Finance Report FI 2018_19 M11 Page 10 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 Cash A

At the end of February cash is behind plan by £11.7m. The full year forecast has been updated to reflect the latest outturn position. Slippage on the capital programme and more cash being available following receivables receipts has been used to reduced the level of aged payables and improve our BPPC KPIs.

Year to Date Full Year £k Plan Actual Variance £k Plan Forecast Variance

Cash Balance 20,599 8,934 (11,665) Cash Balance 16,974 11,188 (5,786)

Year to Date Full Year £k Plan Actual Variance £k Plan Actual Variance

EBITDA 35,345 34,102 (1,243) EBITDA 40,257 39,972 (285) Movement in Working Capital (533) (13,705) (13,172) Movement in Working Capital (1,403) (5,504) (4,101) Provisions - (202) (202) Provisions - (194) (194) Cashflow from Operations 34,812 20,195 (14,617) Cashflow from Operations 38,854 34,274 (4,580) Capital Expenditure (14,330) (11,648) 2,682 Capital Expenditure (17,145) (18,178) (1,033) Cash receipt from asset sales - - - Cash receipt from asset sales - 9 9 Cashflow before financing 20,482 8,547 (11,935) Cashflow before financing 21,709 16,105 (5,604) PDC Received - - - PDC Received - - - PDC Repaid - - - PDC Repaid (8,425) (8,831) (406) Dividends Paid (4,212) (4,325) (113) Dividends Paid - - Interest on Loans and leases (630) (275) 355 Interest on Loans and leases (690) (549) 141 Interest received - 74 74 Interest received - 69 69 Donations received in cash - 290 290 Donations received in cash - 205 205 Drawdown on debt - - - Drawdown on debt - - - Repayment of debt (1,579) (1,579) - Repayment of debt (2,158) (2,012) 146 Cashflow from financing (6,421) (5,815) 606 Cashflow from financing (11,273) (11,119) 154 Net Cash Inflow / (Outflow) 14,061 2,732 (11,329) Net Cash Inflow / (Outflow) 10,436 4,986 (5,450) Opening Cash Balance 6,538 6,202 (336) Opening Cash Balance 6,538 6,202 (336) Closing Cash Balance 20,599 8,934 (11,665) Closing Cash Balance 16,974 11,188 (5,786)

B Finance Report FI 2018_19 M11 Page 11 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 Aged Debtors

The Trust debtors are a mixture of invoiced debtors, accrued income and prepayments as set out in the table below. The Trust has outstanding debtors of 31 days or more of £8.2m. The most significant debtors greater than 90 days relate to outstanding balances with four hospital trusts for provider to provider agreements and specialist drugs/services.

Overdue Overdue Within 1-30 31-60 61-90 > 90 £k Total Terms days days days days 1,693k

CCG's 492 468 382 - 560 1,903 NHS England (in Health Education England) 1,123 672 344 128 173 2,440 NHS Trusts 288 21 529 161 1,088 2,088 Foundation Trusts (157) 201 351 468 2,070 2,934 Other NHS - - (0) - 92 91 Non-NHS 261 331 122 95 1,644 2,453 1,728k Total 2,008 1,693 1,728 853 5,627 11,908 5,627k 17% 14% 15% 7% 47%

Provision for Bad Debts (inc. RTA Provision) (978) Accrued Income (including Work in Progress) 16,136 1-30 31-60 Prepayments 2,079 853k days days Other Debtors 5,282 61-90 > 90 Total Trade & Other Receivables 34,428 days days

Other debtors includes £2.4m of RTA debtors, £1.6m of Private Patients, £0.5m relates to Charity funding (of which £0.02m relates to the League of Friends and £0.52m relates to LYH) and £0.8m relating to VAT and other debtors. A plan has been agreed with Love Your Hospital (LYH) to clear the debt and is ongoing. Accrued income includes £8.7m PSF income for 2018/19, £1.5m of provider to provider income, work-in-progress £3.0m and £2.9m of other accrued income including commissioner and training income.

B Finance Report FI 2018_19 M11 Page 12 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 Capital A

At the end of February, capital expenditure totalled £12.8m which is £3.5m below plan due to later starts on some projects. The largest areas of expenditure include £1.5m Evolve, £1.3m Domestic hot & cold water, £0.6m CT Scanner Replacement, £0.4m replacement Body Store & £0.7m Colposcopy suite refurbishment.

All capital schemes have been approved with expenditure expected to be £6.4m in Mar-19 and for out-turn expenditure to be £19.2m including the newly and recently approved PDC funded Pathology ward order comms of £790k. Also included in the Mar-19 expenditure will be £1.2m on Endoscopy Scopes.

Year to Date Plan Actual Variance Full Year Plan Forecast Variance £k £k Total Capital Expenditure 16,337 12,795 (3,542) Total Capital Expenditure 19,145 19,168 23

£k Year to Date £k Full Year Plan Actual Variance Plan Forecast Variance Source of Funds Source of Funds Depreciation (net of IFRIC 12) 13,783 12,361 (1,422) Depreciation (net of IFRIC 12) 15,036 15,420 384 Loan Repayments (579) (579) - Loan Repayments (1,158) (1,158) - Charitable Funds 401 290 (111) Charitable Funds 437 379 (58) Donation/Grants 458 (458) Donation/Grants 500 790 290 NHS England (Evolve) 165 165 - NHS England (Evolve) 180 180 - Cash Reserves/Other 3,271 3,271 - Cash Reserves 4,150 4,286 136 17,499 15,507 (1,992) 19,145 19,897 752 Application of Funds Application of Funds Other Service Developments 10,458 3,504 (6,954) Other Service Developments 11,185 6,441 (4,744) Medical Equipment 2,040 2,146 106 Medical Equipment 2,514 2,337 (177) Facilities & Estates 1,622 1,740 118 Facilities & Estates 2,018 2,609 591 Information Technology 3,347 2,295 (1,051) Information Technology 4,237 4,420 183 Misc - 85 85 Misc - 89 89 Deferred Scheme 1,836 2,152 316 Deferred Scheme 2,086 2,305 219 Charitable Funds 422 284 (138) Charitable Funds 437 379 (58) 2017/18 Carried Forward - 588 588 2017/18 Carried Forward 1,750 588 (1,162) Overprogramming (3,387) - 3,387 Overprogramming (5,082) - 5,082 Total Capital Expenditure 16,337 12,795 (3,542) Total Capital Expenditure 19,145 19,168 23

B Finance Report FI 2018_19 M11 Page 13 of 14 19/03/2019, 17:10 Finance Report M11 2018/19 Efficiency and Transformation Programme A

Year-to-date savings of £16.3m have been achieved against a plan of £16.4m (99%). Workforce, Surgical Productivity and Pathology work programmes have been key areas of underdelivery. The programme is forecast to deliver in full at year-end.

Year to Date Full Year £k Plan Actual Variance Plan Forecast Variance Workstream Back Office & Corporate Support 2,590 4,371 1,781 2,865 4,995 2,130 Core 2,762 2,348 (413) 3,186 2,693 (493) Estates & Facilities 953 983 30 1,083 1,095 11 Medicine 3,917 3,573 (345) 4,267 3,947 (320) Medicines Management 180 280 101 195 301 107 Private Patients 1 1 - 1 1 - Procurement 2,158 2,206 47 2,385 2,391 7 Surgery 2,473 862 (1,611) 2,747 963 (1,784) Women and Children 1,401 1,729 328 1,506 1,849 343 Efficiency Plan Total 16,434 16,352 (82) 18,235 18,235 0 99.5% Year to Date Plan vs. Actual

Plan Actual 5,000 4,500 4,000 3,500

3,000

2,500 £000s 2,000 1,500 1,000 500 0 Back Office & Corporate Core Estates & Facilities Medicine Medicines Management Private Patients Procurement Surgery Women and Children Support

B Finance Report FI 2018_19 M11 Page 14 of 14 19/03/2019, 17:10

Agenda Item: 10 Meeting: Board of Directors Meeting Date: 28 Mar 19 Report Title: CNSTATAIN Action Plan Sponsoring Executive Director: Nicola Ranger, Chief Nurse and Patient Safety Officer Author(s): Elliott Argent, PMO Business Partner Emma Eden, PMO Project Manager Report previously considered by and date: Purpose of the report: Information ☐ Assurance ☐ Review and Discussion ☐ Approval / Agreement  Reason for submission to Trust Board in Private only (where relevant): Commercial confidentiality ☐ Staff confidentiality ☐ Patient confidentiality ☐ Other exceptional circumstances ☐ Link to Trust Strategic Themes: Patient Care  Sustainability  Our People ☐ Quality  Systems and Partnerships ☐ Any implications for: Quality Improved patient outcomes in Maternity and Neonatology Financial Safety action #3 in the 2019 Clinical Negligence Scheme for Trusts (Maternity) worth 10% of annual maternity premiums (~£625k) Workforce Link to CQC Domains: Safe  Effective  Caring  Responsive  Well-led  Use of Resources  Communication and Consultation:

For internal review and approval at Trust Board

Executive Summary:

NHS Improvement has identified that nationally over 20% of admissions of full term babies to neonatal units could be avoided. There is evidence that suggests separation of mother and baby soon after birth interrupts the normal bonding process, potentially leading to a lasting effect on maternal and baby health.

Following review of patient safety reports, neonatal hospital admission data and litigation claims data, the areas of focus for avoiding term admissions are: - Respiratory conditions - Hypoglycaemia - Jaundice - Asphyxia

The national ATAIN project is delivered through the neonatal networks to audit admission of term infants to neonatal units and promote the establishment of clinical practice and service provision which enables <4% of term infants to require admission to a neonatal unit.

The 19/20 maternity incentive scheme for CNST has identified this as one of the key standards and require the Board to have sight of and approve the ATAIN action plan.

The attached paper demonstrates the Trust’s plan to address this.

Final version 19.11.18 TH Key Recommendation(s):

- Action plan is reviewed and agreed at Trust Board level - Audit trail completed providing evidence and rationale for developing the agreed action

Final version 19.11.18 TH Term Admission Action Tracker RAG Status Key: Red: Not on target - risk of failure to deliver Amber: Deviation from plan but anticipate recovery Green: On target for completion Blue: Action complete Date Description of Action Action Plan Responsible Person Progress Deadline Rag Status Opened

06/07/2017 Reduce term admissions wIntroduction of new Hypoglycaemia Pathway ATAIN team 01/12/2017 Complete Research current literature around antenatal steroid use for elective LCSC in babies 37-39 Reduce term admissions weeks gestation and repeat doses of steroids 06/07/2017 with RDS in preterm babies. Dr Vamvakiti & Miss Hon 02/02/2018 Complete

Produce a clear pathway for maternal pyrexia to Review of neonatal and Sepsis guidance. New sepsis determine which babies Maternity team attend paediatric handover guidance is in 06/07/2017 will receive antibiotic cover and babies are discussed. Dr Vamvakiti & Miss Hon circulation. 01/07/2018 Green Bid successful- awaiting Reduce readmissions with Community midwifes have put bid in to receipt of 06/07/2017 jaundice purchase bilirubinometers Community team equipment 01/01/2018 Complete Action 3 requirements to meet CNST

Action 3 Can you demonstrate that you have transitional care services to support the ATAIN Programme ?

Timeframe Minimum evidential requirement for Trust Board by Sun 3rd Feb 2019 Pathways of care for admission into and out of transitional care have been jointly approved by maternity & Local policy available; based on principles of BAPM TC Framework. neonatal teams with neonatal involvement in decision making and planning care for all babies in transitional care. Evidence of neonatal involvement in care planning Admission criteria meets minimum of HRG XA04. There is an explicit staffing model The policy is signed by maternity/neonatal clinical leads by Sun 3rd Feb 2019 A data recording process for TC is established, in order to produce a commissioner return for HRG 4/XA04 as Data is available on TC activity (electronic or paper based)which has been per NCCMDS v 2 recorded as per NCCMDS v2. by Sun 10th March 2019 An action plan has been agreed at Board level and with your LMS & ODN to address local findings from ATAIN An audit trail providing evidence and a rationale for developing the agreed reviews. action plan to address local findings from ATAIN reviews.

by Sun 19th May 2019 Progress with the agreed action plans has been shared with your Board and your LMS & ODN. Action plan has been signed off by Trust Board, ODN & LMS and progress with action plan is documented within minutes of meetings at Board ODN/LMS. ATAIN Trust Action plan for National ATAIN scheme 2019/20

Trust name Western Sussex NHS Hospital Foundation Trust

Unit name Neonatal Unit, St Richard's Hospital Unit name if more than one unit Beeding Ward, Worthing Hospital

ATAIN lead names Obstetrician Niamh Maguire Senior midwife Tracey Mudd & Juliette Phelan Neonatal/Paeds clinical lead Nicholas Brennan & Katia Vamikiti Neonatal matron Zita Warren Maternity Safety Champion Maternity Patient Safety Maternity Exec Board Champion Lynn Wooley

LMS lead Lisa Jeffrey ODN lead: SE Neonatal Network Vaness Atrell & Gina Outram

Rate of term admissions into NNU 2017/18: Neonatal Unit: 6.9% Beeding Ward: 2.6% Rate of term admissions into NNU 2018/19: Neonatal Unit: 7.8% Beeding Ward: 3.0% Top 5 reasons for admission : completed using Data Neonatal Unit: Beeding Ward: South ATAIN Dashboard 1 Resiratory Respirtory 2 Infection Jaundice 3 Jaundice Infection 4 Hypoglycaemia Hypoglycaemia 5 Monitoring + suspected HIE Monitoring + suspected HIE

Transitional care facilities in place? Yes Brief description of the model/s of TC in place, location, staffing. ATAIN Trust Action plan for National ATAIN scheme 2019/20

Trust name Western Sussex NHS Hospital Foundation Trust

Unit name Neonatal Unit, St Richard's Hospital Unit name if more than one unit Beeding Ward, Worthing Hospital

ATAIN lead names Obstetrician Niamh Maguire Senior midwife Tracey Mudd & Juliette Phelan Neonatal/Paeds clinical lead Nicholas Brennan & Katia Vamikiti Neonatal matron Zita Warren Maternity Safety Champion Maternity Patient Safety Maternity Exec Board Champion Lynn Wooley

LMS lead Lisa Jeffrey ODN lead: SE Neonatal Network Vaness Atrell & Gina Outram

Rate of term admissions into NNU 2017/18: Neonatal Unit: 6.9% Beeding Ward: 2.6% Rate of term admissions into NNU 2018/19: Neonatal Unit: 7.8% Beeding Ward: 3.0% Top 5 reasons for admission : completed using Neonatal Unit : Beeding Ward: 1 Resiratory Respirtory 2 Infection Jaundice 3 Jaundice Infection 4 Hypoglycaemia Hypoglycaemia 5 Monitoring + suspected HIE Monitoring + suspected HIE

Transitional care facilities in place? Yes Brief description of the model/s of TC in place, location, staffing. Term Admission Action Tracker The action tracker is designed to ensure that the division manages agreed actions towards improving patient care and patient outcomes. RAG Status Key: Red: Not on target - risk of failure to deliver Amber: Deviation from plan but anticipate recovery Green: On target for completion Blue: Action complete

Date Opened Description of Action Action Plan Responsible Person Progress Deadline Rag Status Introduction of new Hypoglycaemia 08/08/2018 Reduce term admissions with HypoglyPathway ATAIN team 01/02/2019 Complete Research current literature around antenatal steroid use for elective LCSC in babies 37-39 weeks gestation and repeat doses of steroids in preterm Dr Brennan & Dr 10/08/2018 Reduce term admissions with RDS babies. Maguire 02/02/2018 Complete Review of neonatal and Sepsis Produce a clear pathway for maternal guidance. Maternity team attend pyrexia to determine which babies will paediatric handover and babies are Dr Brennan & Dr New sepsis guidance is 01/08/2018 receive antibiotic cover discussed. Maguire in circulation. 05/07/2019 Green

Community midwifes have put bid in to Bid successful- awaiting 10/09/2018 Reduce readmissions with jaundice purchase bilirubinometers Community team receipt of equipment 01/07/2019 Amber

Tangmere Ward Manager and ATAIN Reducing term readmissions to the team and dicussions Further meetings with NNU due to weight loss and poor Review of case notes and discussions with senior team about senior team to discuss 10/09/2019 feeding in the community with maternity team pathways to NNU pathways 01/12/2019 Green Look at the Transitional care pathway Work on joint documentation for TC with Dr Brennan & Dr 01/03/2019 for SRH babies Maternity and Neonatal Team Maguire 2nd draft in place Amber For inclusion For on Risk Discussion Register with other Division RAG Status Care Groups Yes N/A Red Paediatrics No Surgery Amber Neonatology Core Green Estates Complete Corporate Finance

Agenda Item: 11 Meeting: Board of Directors Meeting Date: March 2019 Report Title: Use of Trust Seal 2018/19 Sponsoring Executive Director: Glen Palethorpe, Group Company Secretary Author(s): Glen Palethorpe, Group Company Secretary Report previously considered by and date: Purpose of the report: Information ☐ Assurance  Review and Discussion ☐ Approval / Agreement ☐ Reason for submission to Trust Board in Private only (where relevant): Commercial confidentiality ☐ Staff confidentiality ☐ Patient confidentiality ☐ Other exceptional circumstances ☐ Link to Trust Strategic Themes: Patient Care  Sustainability  Our People  Quality  Systems and Partnerships  Any implications for: Quality Financial Workforce Link to CQC Domains: Safe ☐ Effective ☐ Caring ☐ Responsive ☐ Well-led  Use of Resources 

Communication and Consultation:

Executive Summary:

It is a requirement of the Trust Standing Orders that a register of sealing is maintained, its use is affixed in the presence of two senior employees duly authorised by the Chief Executive and that the use of the Common Seal is reported to the Trust Board.

Below is the detail of the use of the Seal or the period April 2018 to March 2019

No. Date of Seal Title of Sealed Document, Signed in Signed in Presence Of (1) Presence of (2)

36 19th January Alterations (internal) to Ridgeworth Chief Finance Chief Workforce 2018 House in Liverpool Gardens. Signed Officer and under Seal as this property is subject Organisational to a lease. Development Officer

37 2nd July 2018 Shawbrook Bank Ltd. Master Lease Chief Finance Chief Workforce Agreement number: WSH001. Officer and Medstrom Ltd. Organisational Development Officer **

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38 24th January Lease between Birch Sites Limited Chief Finance Chief Operating 2019 and the Trust in respect of Park Officer Officer Road, Worthing, West Sussex.

** This confirmation was provided retrospectively that the document had been duly signed and sealed

Key Recommendation(s):

The Board is asked to NOTE the use of the Trust seal, and that its use has been in compliance with the Trust’s standing orders.

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Agenda Item: 12 Meeting: Board of Directors Meeting Date: 28 March 2019 Report Title: Board Assurance Framework – 2018/19 – Quarter 4 Sponsoring Executive Director: Glen Palethorpe, Group Company Secretary Author(s): Glen Palethorpe, Group Company Secretary Report previously considered by TEC 21 March 2019 and date: Purpose of the report: Information ☐ Assurance  Review and Discussion ☐ Approval / Agreement  Reason for submission to Trust Board in Private only (where relevant): Commercial confidentiality ☐ Staff confidentiality ☐ Patient confidentiality ☐ Other exceptional circumstances ☐ Link to Trust Strategic Themes: Patient Care  Sustainability  Our People  Quality  Systems and Partnerships  Any implications for: Quality Quality related strategic risks Financial Finance related strategic risks Workforce Workforce related strategic risks Link to CQC Domains: Safe  Effective  Caring  Responsive  Well-led  Use of Resources  Communication and Consultation:

The Board Assurance Framework has been prepared in conjunction with each of the five Chief Officers, focussing on respective strategic objectives and associated strategic risks and the Q4 update has been taken to the Trust Executive Committee in March.

Executive Summary:

The Board Assurance Framework (BAF), reflective of the position at quarter 4, was considered by the Trust Executive Committee at its meeting in March before being presented to the Board.

The BAF summary shown below provides the position at the 21 March 2019 for Q4 with regards to the five strategic objectives and the associated 11 strategic risks. The detailed information is recorded in the attachment to this paper.

The table also shows pictorially the movement in risk between the current score for Q4 and that recorded for Q3. ( No change, an increase in risk and a decrease in risk

BAF SUMMARY

The table overleaf shows by risk the current Q4 score and the target risk score, noting that not all risks will achieve their target score within the current financial year:

Page 1

BAF: Strategic Objectives and Risk Scores Q3 Q4 Target Strategic Risks (Key: I = Impact L = Likelihood T = I L T I L T I L T Total) 1. Patient Quality and Risk Committee 1.1 As a result of patients having a poor experience, adverse feedback is received which impacts on our 3 3 9 3 4 12 3 2 6 Friends and Family Test scores. 2. Sustainability Finance and Investment Committee 2.1 We cannot deliver ongoing efficiencies and flex 16 our resources in an agile way resulting in failure to 4 4 16 4 4 3 3 9 deliver our control total and to earn the full value of the PSF income available to the Trust. 2.2 The local health economy is not sustainable and 16 commissioners are not able to afford activity levels. 4 4 16 4 4 3 3 9

3. People Quality and Risk Committee 3.1 Operational pressures and available capacity impacts on staff availability to engage and 3 4 12 3 3 9 3 3 9 There is dissonance in organisational values and staff experience 3,2 The roll out of PFIS to clinical areas disengages some groups of staff 3 3 9 3 2 6 3 2 6

4. Quality Improvement Quality and Risk Committee 4.1 The mortality reviews highlight patients with delays in recognising and responding to patients end of life care needs and the Trust capacity for 3 3 9 3 3 9 3 3 9 structured judgement mortality case note reviews is limited 4.2 As Safety Thermometer is a once a month prevalence measure and only measures 4 harms on that day (Falls; Pressure Damage; Catheter 4 3 12 4 3 4 2 8 associated urinary tract infections; and Venous 12 Thromboembolism) there may be other harms that are not immediately identified 4.3 Maintaining a sustained reduction in falls whilst keeping our patients active to reduce the likelihood of 3 3 9 3 2 6 3 2 6 deconditioning . 5. Systems and Partnerships Finance and Investment Committee 5.1 Increased volumes, reduced flow, and non- delivery of activity volumes lead to a poor patient 4 4 16 4 3 4 3 12 experience and waiting times and there is a failure to 12 achieve National RTT 18wk constitutional target 5.2 Changes to system wide capacity increases demand on hospital services and impacts on A&E delivery and potential failure to meet STF metrics and 4 3 12 4 2 8 4 2 8 as we are highly reliant on temporary staffing, there are possible shortfalls impacting pressures on existing staff. 5.3 Winter Pressures impact upon the Trust’s ability to meet patient demand and the Programme is 3 4 12 3 3 9 3 3 9 unsustainable

Page 2 Changes in Q4

In summary the Trust has been assured that it has managed 7 of its BAF risks to their stated target risk scores. There remain four risks that are above their target score. For the two with significant current risk scores there are actions being undertaken across the month of March which are planned to reduce these risks and assurance will flow through the F&I Committee to their March meeting.

Reduced risks

Based on assurances logged during the Quarter six risks have reduced during Quarter 4.

Risk 3.1 – this has reduced to 9 which is its target score, based on the assurance received at QRC and the Board in respect of the Trust’s staff survey.

Risk 3.2 - this has reduced to 6 which is its target score, based on the assurance received at QRC and the Board in respect of the Trust’s staff survey.

Risk 4.3 – this has reduced to 6 which is its target score, based on the assurance received at QRC and Board which is linked to the delivery of the Trust’s breakthrough objective in this area which will see this objective replaced for next year with one focused on VTE.

Risk 5.1 – this has reduced as the performance at the end of the year for cancer and RTT has improved. The residual risk level recognises that the performance level for RTT is below the constitutional target as that activity level was not commissioned for within 2018/19 and the Trust recognised it would have limited options to improve to the constitutional target in the 2018/19 year.

Risk 5.2 – this has reduced to 8, which is its target score based on the assurance received at Board in respect of A&E performance and the delivery of the Trust’s winter plan.

Risk 5.3 – this has reduced to 9, which is its target score. Linked to the assurances for risk 5.2 on the delivery of the Trust’s winter plan.

Increased risks

There has been one risk that has increased in Q4.

Risk 1.1 – this has increased to a rating of 12 during Q4 which indicates a deteriorating picture. This increase in risk is based on increased volumes of feedback from patients experiencing delays waiting for tests, results, clinic appointments or elective admission. The Trust’s ability to respond to formal complaints within 25 days has also deteriorated to 50% at the time of reporting and 4 cases have been referred to the PHSO which is a higher number compared to previous trends.

No recorded movement

There are four risks where there has been no movement in the risk score.

Risk 4.1 regarding mortally and the learning from structured judgement reviews has not changes as this risk had already achieved its target score of 9 last quarter and assurance continues to be received at TEC, QRC and Board to sustain this risk at its target score, recognising that the Trust’s mortality rate has reduced again this year, which will see an adjustment to the breakthrough performance target for this area in 2019/20.

Page 3 Risks 2.1 and 2.2 are awaiting the outcome of the corporate and divisional control actions being undertaken across the month of March in respect of budgetary control and efficiency plan delivery along with the final negotiations in relation to the health economy contracts. The actions and there success of the previous months of quarter 4 have been reported to F&I and Board.

Risk 4.2 whilst improvement has been made in respect of falls and the assurance over this has reduced risk 4.3, this risk also covers VTE and Pressure Care which remain a focus and therefore the assurance logged is not sufficient to see a reduction in this risk. The Board should note that in respect of VTE this area will become incorporated within a breakthrough objective in 2019.

Risk Appetite

When the Board received the quarter 3 update it felt it would be useful to have recorded as an appendix to the report the Trust’s stated risk appetite. This is included as an Appendix to this report. It should be noted that the Trust’s risk appetite is referred to when determining the target risk score for each risk noting that there may be more than one component to be considered when determining the individual target risk score.

Wider reporting

The Trust’s Annual Governance Statement which forms part of the Trust’s annual report will make reference to the Trust’s Board Assurance process along with a note in respect of the two high risks that remain above their target score at the time of the update to the Quarter 4 BAF.

Key Recommendation(s):

The Board is recommended to consider the level of current risk recorded within the BAF against reported assurances via the various Committees and the assurances provided direct to the Board over the final quarter of the year and agree that this represents a balanced view of assurance and its impact on the key risks to the achievement of the Trust’s stated objectives.

To endorse the reflection of the remaining key risks within the Trust’s Annual Governance Statement which will form part of the Trust’s annual report and accounts.

Page 4 Appendix A

Risk Appetite Statement

The Boards of NHS Trusts are accountable for ensuring the quality, safety and sustainability of the services they provide to patients. Brighton and Sussex University Hospitals NHS Trust sets clear expectations for the Trust through strategic objectives.

The Trust operates in a high risk environment and the day to day management of risk is an expected and integral part of the business of any healthcare provider. Overall, the Board has a moderate appetite for risk in relation to the achievement of its objectives and takes active and ongoing actions as part of our daily operational management and strategic planning to reinforce our risk controls in order to minimise risk to a tolerable level.

Our Board Assurance Framework and risk registers will continue to reflect material risks that may prevent the Trust from fulfilling its role in delivering clinical services which meet regulatory and NHS Constitutional standards and the expectations of our stakeholders and patients. We have defined our appetite for risk in relation to our strategic objectives as follows:

Patient Care: We make delivering an excellent care experience for our patients our highest priority. However, we will accept moderate risks to patient experience if this is required to achieve patient safety and quality improvements.

We have a low risk appetite for actions and decisions that, whilst taken in the interests of ensuring quality, safety and sustainability, may affect the reputation of the Trust or of the wider NHS. Such actions and decisions would be subject to a rigorous risk assessment and be signed off by the Board.

Safety: We will deliver safe, high quality clinical services and demonstrate they achieve optimal clinical outcomes and deliver best practice for our patients whilst ensuring we meet regulatory standards. Overall, our risk appetite for safety is low. Specifically:

We have a low appetite for risks that could result in poor quality care or unacceptable clinical risk, non-compliance with standards or poor clinical or professional practice.

We have a low appetite for risks that may jeopardise patient safety.

We recognise that it can be in the best interests of patients to have a moderate appetite for some individual patient care and treatment risks in order to achieve the best outcomes. Therefore we support our staff to work in collaboration with the people who use our services to develop appropriate and safe care and treatment plans based on assessment of need and clinical risk.

We will apply strict safety protocols for all of clinical and non-clinical activity, when and wherever possible. We will report, record and investigate our incidents and ensure that we continue to learn lessons to improve the safety and quality of our services.

Page 5 Sustainability: We strive to use our resources efficiently and effectively for the benefit of our patients and their care and ensure our services are clinically, operationally, and financially sustainable. We will always aim to achieve this objective; however, overall we have a moderate appetite for risk in this area. Specifically:

We have a moderate appetite for some financial risks where this is required to mitigate risks to patient safety or quality of care. We will ensure that all such financial responses deliver optimal value for money.

We are committed to providing patient care in a therapeutic environment and providing staff with an environment and supporting infrastructure in which to perform their duties. However, we have a moderate appetite for some risks related to our infrastructure and estate except where these adversely impact on patient safety, care quality and regulatory compliance

We will increase our appetite for financial risk to significant in some instances and consider all potential delivery options to ensure the delivery of our objectives. Our appetite for risk in this area recognises the financial environment in which NHS trusts are operating, and the requirement to maintain regulatory and constitutional standards. A decision to take this level of risk would be based on a rigorous risk assessment and a review of the robustness of the controls and would require sign off by the Board.

We are prepared to support investments for return and minimise the possibility of financial loss by managing associated risks to a tolerable level. Value and benefits will be considered and resources allocated in order to capitalise on opportunities.

People: We value and respect all our staff equitably, involve them in decisions about the services they provide and offer the training and development they need to fulfil their roles. We will rarely accept risks that would limit our ability to achieve this objective and the Trust’s overall risk appetite for workforce related risks is low. Specifically:

We have a low appetite for risks related to the recruitment, retention and training of staff to deliver safe, high quality services and good patient experience.

We have no appetite for risks associated with unprofessional conduct, bullying, or an individual’s competence to perform roles or tasks safely nor any incidents or circumstances which may compromise the safety of any staff members and patients or contradict our values.

We have a moderate appetite for risks associated with the implementation of non- NHS standard terms and conditions of employment, innovative resourcing, and staff development models where these enhance or improve patient safety, care quality, service delivery or financial sustainability.

Page 6 We have no appetite for any risk that could result in staff being non-compliant with legislation, or any frameworks provided by professional bodies.

We have no appetite for any risk that could result in us being in breach of our contractual or statutory responsibilities in relation to our staff or in a breach of our staff’s employment rights.

Systems and Partnerships: We will collaborate with commissioners, local authorities, our other partners and other care providers to prevent ill health, plan and deliver services that meet the needs of our local population and deliver operational and NHS constitutional standards. Overall we have a moderate appetite for risks to the achievement of this objective. Specifically:

We have a moderate appetite for risk where this results in improvements in the design or delivery of healthcare services for our patients or the population we serve. Our appetite for risk in this area recognises that the Trust operates in a complex environment and is subject to very challenging economic conditions and changing demographics with intense scrutiny. We consider the risks associated with innovation, creativity and clinical research to be an essential part of the Trust’s risk profile. We increase our appetite for risk in this area to significant in order to maximise the opportunities to improve patient outcomes and the Trust’s sustainability. . A decision to take this level of risk would be based on a rigorous risk assessment and a review of the robustness of the controls and would require support of the Board.

We will collaborate with commissioners, local authorities, our other partners and other care providers to prevent ill health, plan and deliver services that meet the needs of our local population and deliver operational and NHS constitutional standards.

Page 7

Agenda Item: 14 Meeting: Trust Board Meeting Date: 28 March 2019 Report Title: Sustainability Transformation Partnership - Population Health Check Sponsoring Executive Director: Marianne Griffiths, Chief Executive Officer Author(s): Report previously considered by East Sussex & Surrey STP and date: Purpose of the report: Information  Assurance ☐ Review and Discussion ☐ Approval / Agreement ☐ Reason for submission to Trust Board in Private only (where relevant): Commercial confidentiality ☐ Staff confidentiality ☐ Patient confidentiality ☐ Other exceptional circumstances ☐ Link to Trust Strategic Themes: Patient Care  Sustainability  Our People  Quality  Systems and Partnerships  Any implications for: Quality Financial Workforce Link to CQC Domains: Safe  Effective  Caring ☐ Responsive ☐ Well-led  Use of Resources ☐ Communication and Consultation:

Executive Summary:

The ‘Population Health Check’ for Sussex and East Surrey has been developed by the STP Clinical and Professional Cabinet. Membership of the Cabinet includes the Medical Directors and Clinical Chairs of partner organisations, as well as representation from Chief Nurses, NHS England, Public Health, the Academic Health Science Network and the Clinical Senate. The Population Health Check represents a diagnostic for our system and highlights the priority areas that need focus to allow health and care services to better meet the needs of our populations. It builds on local plans and intelligence and aims to provide a unified picture of the key areas for change across the health and care system.

There are five priority areas highlighted in the Health Check:

• Workforce and capacity strategy • Shared decision-making and patient activation • Re-framing our cultural norms to make the right lifestyle choices easy to make. • Addressing unwarranted clinical variation. • Mental and physical health services and social services closer to home with good communication and co-ordination.

Key Recommendation(s):

The Board is asked to RECEIVE this report.

Final version 19.11.18 TH Sussex & East Surrey Sustainability & Transformation Partnership

Sussex & East Surrey Sustainability & Transformation Partnership

Sussex & East Surrey Sustainability & Transformation Partnership (STP) Sussex & East Surrey OURSustainability POPULATION & Transformation Partnership HEALTH CHECK

A CLINICALLY-LED DIAGNOSIS OF WHAT NEEDS TO CHANGE SUBHEAD STYLE

Contents Introduction

“We have many great services and people, delivering great care. 3 Introduction However, there is an urgency to address the gaps in the quality 4 What is this “population health check”? and responsiveness of some of our services. There has been an 6 Why do we need an STPpopulation health check when we already have local plans? under-investment in prevention and self-care and not enough

6-7 How do we offer best value? emphasis on wellbeing and care. Services are not operationally 7-9 What did we find are the key themes? or financially sustainable in the current set-up, which is based on 10-14 What do we need to change to address these key themes? historic and isolated services, not built around what local people 15-18 Our Population Health Check in context need now. In essence, there is less partnership working than we 19 What we found: our evidence base need between patients and clinicians and between services. Given 19-34 Our evidence: Our Population and Demographics our demography, we need to rely as much on technology-enabled 35-39 Our evidence: Our Public and our Patients care as on state funded clinical and domiciliary workforce. There 40-67 Our evidence: Our Services just won’t be as many employees available in future as would be 68-69 Our evidence: Our Staff needed to provide current services to a larger population with 70-73 Our evidence: Our Infrastructure more retired people and not many more working-age citizens. This 74-75 Our Priorities Population Health Check represents a case for change and provides 76 Next Steps the evidence of the key issues and the priorities we will deliver 76 We need to develop a clinical strategy which delivers “best value” together to ensure we offer sustainable services. Doing nothing is and patient centred care. neither affordable nor sustainable” 76-78 We need to develop a clinical strategy which is future proofed 79-80 We need to develop a clinical strategy which is clear on the optimal Dr Minesh Patel and Mr Peter Larsen-Disney, Co- Chairs, Sussex and population size to lead delivery East Surrey STP Clinical and Professional Cabinet 81 The process of developing the clinical strategy 82-84 Agreement from core members of the STP Clinical and Professional Cabinet 85-87 Contribution list 88-91 References and bibliography 2 3 OUR POPULATION HEALTH CHECK OUR POPULATION HEALTH CHECK

l We will be consistent with our messages on increasing population health Population Health Check and well-being and the importance of delivering value for money. l We are able to identify and work together on addressing unwarranted clinical variation to deliver value for money services across the system. This Population Health Check has been developed and agreed by a STP group called the Clinical and Professional Cabinet, which consists of the l We will work together to improve communication and collaboration most senior medical and nursing leaders across our partnership. across the system and between clinicians and the public to enable decision based on objective, best value evidence and conversations.

l We will support each other to manage the impact of the 3Ts WHAT IS THIS “POPULATION HEALTH CHECK”? development at Brighton and Sussex University Hospitals NHS Trust This document is a diagnostic analysis of the key issues we are facing in our (BSUH), which will reduce bed capacity in the short term through We are able to local health systems today. This analysis provides the strong evidence base collaborative redesigning our model of services to enable care closer to identify and we need for the next phase, which will be an STP-wide Clinical Strategy. home (delivering the lowest level of effective care). work together The overall goal of the Population Health Check is to identify the l We will provide STP-wide senior clinical support for local plans which on addressing challenges facing our population’s health and our system’s sustainability in may help the pace of change, with consistent messaging on delivering unwarranted order to develop a strategy, which will see people living with better health value based services. clinical variation that is value focussed and patient centred. l We will develop simpler collaborative commissioning, whilst to deliver value maintaining local engagement and ownership, to make best use of for money services WHY DO WE NEED AN STP POPULATION HEALTH CHECK WHEN WE limited resources and to integrate care for patients, across the system ALREADY HAVE LOCAL PLANS? Our STP is comprised of four ‘places’ responsible for locally driven l We will share best practice and offer support on implementation of community and integrated care with the aim of improving health local transformation plans to deliver better value care at a faster pace, outcomes for our communities and reducing avoidable illness and health and care expenditure. Each place is building a model that best responds l We will further develop the skills of clinical leadership, workforce to both the local health needs and context of the health and care development and resilience through learning from others outside our organisations in the region, however many commonalities exist between neighbouring systems, them. Each place will oversee radical clinical transformation of Long Term Conditions, frailty, mental health, community, social care, general practice l We will support consistent access to supportive mental health services The STP is not one and urgent services to transform outcomes and quality. to reduce costly reactive responses to crisis care. single separate plan. It is a way of The STP is not one single separate plan. It is a way of making sure that l We will develop system-wide digital technology to support the plans of all the partners across the area are joined up and working communication across the system, making sure that together. It aims to ensure that no part of the health and care system the plans of all the operates in isolation. We know that what happens in GP surgeries, for l We will contribute to the strategic planning for the development of partners across example, impacts on social care, which also impacts on hospital wards, estates to ensure we are able to deliver care closer to home across the area are joined and so on. With services feeling the strain, working together will give our the system. nurses, doctors and care staff the best chance of success. up and working l We will provide consistent key message to the public so that A&E is not the together. The “added value” of an STP Population Health Check, which option chosen as the urgent care option but that the public understand 4 complements those Place Based Plans and delivers best value is: the benefits of accessing alternative services in the community. 5 OUR POPULATION HEALTH CHECK SUBHEAD STYLE

THE SYSTEM WILL, THEREFORE, COME TOGETHER ON ISSUES WHICH MAKE SENSE TO DO TOGETHER. Some of these initiatives, such as the STP Mental Health Strategy, are OUTCOME already underway and demonstrating significant improvements. However, (health and social) it is crucial that the changes identified throughout are interconnected VALUE with the delivery of the STP Mental Health Case for Change, Mental (of an intervention) = Health Delivery Plan, Mental Health Workforce Plan and the identified RESOURCED REQUIRED (to deliver the coutcome) Mental Health priority work streams and vice versa. This will then emphasise the importance of parity of esteem where mental health is valued equally with mental health. For example – some of the changes will impact and are interdependent with this overall STP Population Health Check e.g. impact of Improving Access to Psychological Therapies (IAPT) Long-term conditions developments on Diabetes, Musculoskeletal (MSK) Forward View. The first principle within the ‘New Care Models’ to and Cardiovascular, the life gap for people with severe mental illness and engage people and communities is that care and support is person- the high proportion of smokers having an severe mental illness. Also the centred: personalised, coordinated, and empowering. Person-centred mental health Crisis & Urgent Care workstream need to work closely with approaches has recently beenpublished by Skills for Health, Skills for the Urgent and Emergency Care workstream. Care and Health Education England as a core skills education and training framework for the health and care workforce. HOW DO WE OFFER BEST VALUE? We need to offer best value care to our patients. In July 2017, the South l We need to begin focusing on assets and “what matters to people” East Clinical Senate produced a briefing entitled ‘Emphasising Quality, rather than “what’s the matter with” people. Delivering Value’ (South East Clinical Senate 2017a), which recognises that: l “The inexorable rise in demand for healthcare and growing We need to improve communication between services. The way pressures and constraints on the workforce and finance threaten the that clinicians work together in providing care to individual patients, sustainability of the NHS. For clinicians across all disciplines, this means and how they communicate with each other, is vital to providing an that we need to focus our combined resources on the care that delivers integrated, coordinated, patient-centred approach, and for delivering the greatest value. the best experience of care and outcomes for patients. Phone calls and conventional letters have been the default means of communication for l Value in healthcare is defined as the achievement of the best outcomes decades, whilst over time technological changes, increasing specialisation, for individual patients and for the public within available resources. It the need for greater efficiency, changing organisational and professional also means doing less of things that add little or no value to patients. boundaries, and changing patient expectations, have ceaselessly evolved. (SE Clinical Senate. 2017b) The inexorable l To achieve best value will require the development and use of rise in demand for standardised outcome measures that are more relevant to patients healthcare and (such as the impact on their functional status and wellbeing), and their WHAT DID WE FIND ARE THE KEY THEMES? more active involvement through the process of shared decision making We found that: growing pressures with well-informed patients. It also involves recognising unwarranted l There are four main unhealthy behaviours of smoking, alcohol misuse, and constraints on local variation in the delivery of high value care and addressing it. poor diet and lack of physical activity, as well as poor emotional and the workforce and mental well-being, which are responsible for at least a third of ill health l Value is not a financial term. It is a term that integrates high quality, and are amenable to cost-effective preventative interventions. Focusing finance threaten safe and cost effective care that improves patient or population on prevention earlier in the life-course will accumulate greater benefits, the sustainability outcomes. It can be represented as follows:” but even in middle and older age groups, preventative approaches are of the NHS. cost-effective. Prevention requires prioritisation and investment across 6 l Better Conversations’ is a fundamental part of delivering the Five Year the system. This includes the need to treat symptoms early in primary 7 SUBHEAD STYLE OUR POPULATION HEALTH CHECK

care to stop the development of a long-term condition. To date, across l Bed capacity is expected to increase by 176 beds by 2023/24 at BSUH our STP, there has been an under-investment in prevention and self-care as a result of the 3Ts rebuild. However, in the meantime, there will be a Digital technology and not enough emphasis on wellbeing and care. detrimental impact on capacity which needs to be supported across the needs to better wider system. support l There were 1,314 stillbirths in the South East between 2013-2015, equating to roughly 36 stillbirths per month. A large proportion of l Care is often un-co-ordinated and duplicated leading to poor quality integrated care, stillbirths are attributable to risk factors some of which are fully or partly care with multiple hand-offs. The supportive systems are often difficult population health avoidable, indicating an opportunity for rate reduction. Independent for the public to navigate, resulting in increased attendance to A&E. management and risk factors for stillbirth include: obesity, smoking, acquired medical disorders (diabetes) and disadvantaged populations. l Communication between clinicians across organisations and between empower patients clinicians and patients requires improvement. in managing l The STP covers a wide geographical area and many organisations, with their care. a notable amount of variation in financial performance. For 2017/18, l We have a high level of mental illness and dementia, with the need to the combined net deficit (surpluses and deficits added together) for increase access to supportive services. Clinical Commissioning Groups (CCGs) and Trusts in the footprint was £228.2m. l Digital technology needs to better support integrated care, population health management and empower patients in managing their care. We l There is significant expected growth in the population generally and have not been good at establishing systems for self-support which are an enormous growth in the 65+ and 85+ age groups. Significantly, this cheap, cost effective and improve outcomes – (patient held records, includes an increase in life expectancy for people in poor health. One patient educational materials /fora via online platforms for example) in three over-65s and half of those over 80 will suffer a fall each year. despite 90% of the population owning a smartphone / tablet or PC. In addition to the physical consequences, falls can have a damaging psychological impact, resulting in loss of confidence and independence, l We have unmet need at one end of the spectrum and unnecessary and increased isolation and depression. The Department of Health has and/or non-evidenced treatments at the other with variably informed stated that a falls prevention strategy could reduce the number of falls decision-making in the middle. by 15-30%. l There is variation across the trusts in delivering our constitutional l Pressures on our GP services are critical causing issues with access standards (the standards everyone should expect) including Referral for patients and staff stress. General Practice across the country is to Treatment Times (RTT), emergency admissions, Delayed Transfers of struggling to maintain services, and this situation is mirrored in Sussex Care, bed occupancy, cancer waits and A&E 4-hour performance. The population and East Surrey. The population is getting older, many more people live with multiple chronic diseases, people are seeing their doctor more l Our data shows us we have significant unwarranted variation across is getting older, often and with more complex problems. General Practice has coped the STP that are impacting on quality in many areas but particularly in many more people well so far, but we need to address these issues if we are not to face MSK, Cardiovascular and Falls/Fragility Fractures. There is also evidence live with multiple much bigger problems. that we over treat patients in some specialties. chronic diseases, l We have significant workforce shortages across the system, in particular l Too many people are dying away from their usual place of residence or people are seeing in GP surgeries, mental health and social care, with increasing demand. in a place that is not of their choosing. their doctor more often and with l There have been many years of under-investment in estates, which l Doing nothing is neither affordable nor sustainable. has resulted in non-compliance, high backlog maintenance and an more complex inefficient estate with high running costs. This hampers our ability to 8 problems. shift care closer to home. 9 OUR POPULATION HEALTH CHECK

WHAT DO WE NEED TO CHANGE TO ADDRESS THESE KEY THEMES? l There are several points of contact for access to services, fragmented We concluded that: pathways and gaps in service availability (geographic and time of We have not focussed enough on promoting the determinants of good day), particularly around admissions avoidance and to support health because: hospital discharges. l There remains considerable, and unacceptable, differences in life expectancy between areas across the STP and within local CCG / local Our patients with mental health needs are not always able to access authority areas. Service access, take up and outcomes need to be support when they need it because: addressed for disadvantaged groups. l There is a lack of a 24/7 crisis support.

l There are four main unhealthy behaviours of smoking, alcohol misuse, l Capacity needs to be built in primary care, closer to home and thereby poor diet and lack of physical activity, as well as poor emotional and reduce presentations and referrals to physical and mental health mental well-being, which are responsible for at least a third of ill health secondary care. and are amenable to cost-effective preventative interventions. l The prevalence of severe mental illness is 5% higher than nationally, l Focusing on prevention earlier in the life-course will accumulate affecting 25,000 individuals greater benefits, but even in middle and older age groups, preventative approaches are cost-effective. Prevention requires prioritisation and l For dementia, prevalence is 25% higher than nationally, will increase investment across the system. Prevention includes the reduction of falls further as the population ages, while the proportion of those with a in the elderly and healthy living to reduce still births. diagnosis is 5% lower. A quarter of those patients with dementia who are fit to leave acute care wait over 50 days for discharge. In order to keep up with increasing demand, we need to collaboratively There is an redesign our service models to bring care closer to home because: l There is an increasing problem of addiction and its impact on the increasing l There is an imbalance of bed/un-bedded capacity and demand in acute, individual and the system. problem of primary, community and social care. addiction and its We do not have the workforce numbers and skills to meet current and l BSUH is undergoing a significant re-build programme through 3Ts, future demands because: impact on the which will have an impact on bed capacity until it is completed. l There is an imbalance in staffing capacity and demand across the whole individual and health and social care system. This includes front line staff providing the system. l We want more people to die in their usual place of residence and place direct patient/client care, back office staff, and key services e.g. of choice. pathology and radiology.

l Bringing care closer to home, cannot be delivered without addressing l The average retirement age is 59 and we have 15 % of staff aged 55 the issue that the sustainability of primary care is significantly years and over. challenged across the system. Dedicated effort to address primary care challenges is crucial. l The turnover rate for all registered nursing, midwifery and health visiting staff ranges from 13% - 20%. Our Urgent and Emergency Care services cannot keep up with demand because: l In social care there is a significant annual turnover of 26% for l Attendances to A&E and handover delays continue to put immense registered nurses. pressure on our services. l There are difficulties recruiting and retaining substantive mental health l Over a quarter of A&E attendances could be treated at another suitable nurses and psychiatrists. location e.g. primary care. 10 l In June 2017, the Sussex and East Surrey STP had a shortfall of GPs 11 (Full-time equivilants) of 193. OUR POPULATION HEALTH CHECK OUR POPULATION HEALTH CHECK

Our digital technology does not meet current and future needs because: THE FOLLOWING CHART SUMMARISES THE KEY THEMES AND We need to l There is a lack of ability and confidence to access shared information to WHAT WE NEED TO CHANGE IN OUR SES STP enable our support for Clinicians, professionals, patients and carers in: (a) Direct Care and Self-Management, 5 BEHAVIOURS workforce to have (b) Population Health Management and Evaluation, 1. Smoking 2. Physical inactivity conversations (c) Research and Innovation. 3. Unhealthy diet which enable 4. Excess alcohol patients to make l Digital systems do not yet integrate effectively enough to support new 5. Social isoloation models of care or meet expectations. LEADS the right decision TO about care l There is a lack of health and care services digital maturity, partnerships 5 RISK FACTORS and agility to take advantage of the opportunities of emerging 1. Hypertension and breathing problems 2. Obesity and High Chloesterol technologies (e.g. Artificial Intelligence (AI), Precision Medicine, Internet 3. Hyperglycaemia of Things) 4. Frailty and falls 5. Anxiety and depression LEADS There is a lack of demand management to create the most efficient TO pathways because: 5 DISEASES l There is a lack of working practice changes required to encourage 1. Cancer ‘channel shift.’ 2. Circulation and respiratory disease 3. Diabetes l There is a lack of standardised communication and engagement 4. Bone and joint conditions 5. Mental Health conditions strategies to reduce demand on the system. LEADS TO l Communication between clinicians across boundaries needs to be 75% OF DEATHS AND DISABILITY addressed as a priority. 5 IMPACTS ON PATIENTS AND SERVICES Unwarranted clinical variation exists across the system leading to inequity 1. There is an increase in life expectancy (increased in access to the good standards of care because demand), which includes an increase of people l There is unwarranted variation in referrals guidelines, treatment, living longer in poor health (higher acuity). medicines and Continuing Healthcare funding when we compare 2. The capacity in the NHS and social care cannot keep up with demand leading to delays and poor ourselves to our demographic peers. quality care. 3. Insufficient numbers of dying patients being cared l There is insufficient shared decision-making between patients and for in their usual place of residence. 4. There is an increase in reactive, urgent care. their healthcare professional. We need to enable our workforce to 5. There is an increase in the cost of delivering have conversations which enable patients to make the right decision services. about care, based on objective evidence and dialogue and containing LEADS TO expectations to value based care. 5 STP PRIORITIES 1. STP workforce and capacity strategy. 2. Shared decision-making and patient activation. 3. Re-framing our cultural norms to make the right lifestyle choices easy to make. 4. Addressing unwarranted clinical variation. 5. Mental and physical health services and social services closer to home with good communication 12 and co-ordination. 13 OUR POPULATION HEALTH CHECK IN CONTEXT

OUR POPULATION HEALTH CHECK HAS TRIANGULATED PREVIOUS ANALYSIS INTO A SINGLE CASE

PRIORITY AREA STP EXECUTIVE STP CLINICAL AND STP PLAN AND EXISTING Our Population Health PROFESSIONAL CABNIET REFRESHED SYSTEM PLAN (11 KEY TARGETS/ INTERVENTIONS) MEASURES Older people + 11 Right: bone and joint, MSK Older people, Delayed Check in context disabilities/ Long- interventions unwarranted variation, Falls and dementia end transfers of term conditions MSK Get It Fagility fractures, end of life care, of life care, re- care, dementia Right (GIRFT), over treatment, medicalisation ablement, falls indicators Continuing reduction (improvement There are 24 large organisations in our partnership – NHS Commissioners Healthcare and Assessment Brighton & Hove CCG (CHC), Framework local authorities, providers and clinical commissioning Coastal West Sussex CCG Clinically (IAF), Urgent Effective and Emergency groups. This STP recognises the very critical part Crawley CCG Commissioning, Care GP access, played by so many other smaller but core health, care East Surrey CCG Medicines, Learning Eastbourne Hailsham & Optimisation disabilities and wellbeing organisations across the STP. Seaford CCG Hastings & Rother CCG Circulation and Clinically Rightcare 5:5:5 (prevention, Adults with Quality and Respiratory Effective detection, management / risk physical disability Outcomes High Weald Lewes Havens (cardiovascular Commissioning reduction) – Stable angina, Atrial build knowledge Framework Our footprint is home to 1.7 million people providing health and social CCG disease, coronary (CEC) / Fibrillation (AF) / Hypertension and change (QOF), care at a cost of £4bn. It cannot be under-estimated the importance of Horsham & Mid-Sussex CCG heart disease, Procedures of and breathing problems / High behaviours RightCare, Specialised Commissioning cronic obstructive limites clinical Cholesterol, Hyperglycaemia, diabetes. planning changes to care across the health and social care system so that pulmonary disease effectiveness obesity, diabetic foot Maternal changes are not made in isolation but in partnership, with the impact of (NHS E South) (COPD), diabetes) (POLCE) amputations). Shared decision- smoking, obesity changes being clear and mitigating any negative consequences together. Total = 9 making and social activation (IAF) NHS Providers Cancer 5:5:5 (cancer risk factors; Acute liaison, 2 week wait, screening; early detection and SEMI 31 days, 62 Brighton & Sussex University treatment, survivorship) days Screening, Hospitals stage 1 and 2, East Sussex Healthcare diagnosed in Queen Victoria Hospital A&E South East Coast Ambulance POPULATION SIZE BY LOCATION (M) Mental health Mental health Mental health in relation to 5:5:5 Acute liaison, IAF, IAPT / Service strategy (prevention, wellbeing, early SEMI dementia / acute Surrey & Borders Partnership intervention, social isolation, crisis / CYP East Surrey 0.18 Surrey & Sussex Healthcare mental health and long-term conditions and dementia) Sussex Community Crawley 0.13 Sussex Partnership Urgent and Urgent and Capacity across the health and Rapid response in A&E 4 hour Western Sussex Hospitals Emergency Care emergency care system community and waits GP Providers care including acute services 111, 3Ts Total = 9 (excluding GP Providers) HMS 0.23 Co-ordinated and Digital Strategy Improving communication across Discharge Recruitment well communicated Workforce primary and secondary care. planning Single and retention HWLH 0.17 Non-NHS Providers care strategy Patient activation point of access Agency spend H&R 0.19 Brighton & Hove City Council Specialist advice CWS 0.51 Integrated care East Sussex County Council Surrey County Council Maternity Better Births Supporting a good start in life Still birth West Sussex County Council reduction B&H 0.31 First Community Health and EHS 0.19 Care IC 24 Total = 6

14 STP Total = 24 15 IN CONTEXT SUBHEAD STYLE

STPs are a way for the NHS to develop its own, locally appropriate l Sussex Partnership NHS Foundation Trust (SPFT): Developing a single We must also proposals to improve health and care for patients. They are working in access point to ensure that people in crisis can access services 24 hours acknowledge partnership with democratically elected local councils, drawing on the a day and a no ‘wrong front door’ approach with access points for expertise of frontline NHS staff and on conversations about priorities other services. They have set up a front door staffed by peer workers, some of the many with the communities they serve. Partnerships will be forums for shared care navigators, carers, voluntary sector staff and mental health examples we decision making, supplementing the role of individual boards and clinicians. have of great care organisations. Their immediate focus is on refining and implementing across the health their sustainability and transformation plan so that patients can see l South East Coast Ambulance Service NHS Foundation Trust (SECAmb): practical benefits in their local health system. STPs do not replace new 999, Emergency Operations Centre and 111 Rotational Workforce: and social care care models; instead they will allow the ability to build on their success, by Working with HEE and commissioners, SECAmb is developing a services across providing a collaborative system of leadership and governance which will number of rotational workforce positions. These are focussed on our STP. allow new care models to evolve and spread. (NHS England, 2018) rotating staff out (e.g. Paramedic Practitioners in primary care) and rotating staff in from other organisations (e.g. midwives). This is Although this document focusses on what we need to change, we must allowing the Trust to test workforce and governance issues before also acknowledge some of the many examples we have of great care beginning wider work on rotational workforce approaches such as across the health and social care services across our STP. For example: mental health nurses and rotating SECAmb paramedics into hospice and urgent care centre settings. l East Sussex Better Together: Health and Social Care Connect (HSCC) which offers both the public and professionals a single point of access l Sussex Community NHS Foundation Trust: Healthy Child Programme, for adult health and social care enquiries, assessments, services and which provides a range of health interventions and support, beginning referrals. Streamlining access frees GPs to see other patients rather than in pregnancy and continuing through to the end of formal schooling. having to refer to several different services for a patient. It also supports faster access to the services for patients in their home. l IC24: Developing the multi-professional urgent care workforce and strengthening the role of the GP as a clinical leader. l Central Sussex and East Surrey Commissioning Alliance (CSESCA) North: Integrated, patient-centred teams developing in Primary Care l Specialist Palliative Care: The adult and children’s hospices and Homes. East Grinstead is a rapid test site for a Primary Care Home Specialist Palliative Care services serving the STP area are all supported model: Key work-streams are addressing urgent ‘on the day’ primary by their local communities to provide holistic multi-professional care for care capacity with GPs working in the Minor Injury Units (MIUs). those facing death and bereavement. Adults known to hospice services are less likely to die in hospital and have a higher chance of dying in l Central Sussex and East Surrey Commissioning Alliance (CSESCA) their usual place of residence. South: Dementia Golden Ticket in HWLH. The Golden Ticket delivers a holistic mix of services to address health and wellbeing, supporting l Academic Health science Network: The Atrial Fibrillation (AF) project people with dementia and their carers in every aspect of their lives. identified 580 individuals who were eligible for anticoagulation and Adults known to Evaluation of the project shows that it is already reducing GP visits would benefit from a change of treatment to reduce their risk of an hospice services and emergency admissions to hospital. People who said that they had AF-related stroke. By the end of May 2018, 219 individuals had had are less likely to previously felt isolated received support to live more independently. their medicines optimised by their GP practice. This has reduced the die in hospital risk of AF-related strokes to such an extent that the equivalent of six l Coastal Care: Frailty pathway redesign. The Paramedic and AF-related strokes have been avoided, avoiding debilitating effects on and have a higher Occupational Therapy team work together on the Falls Response individuals and their families and avoiding costs to state-funded health chance of dying in vehicle, provided by Sussex Community NHS Foundation Trust, with the and social care of over £160,000. their usual place pilot being funded by Coastal West Sussex CCG. So far the conveyance rate for this vehicle in the first four weeks is 9.18% compared to Some residents living within our STP, are treated in Kent and Medway of residence. 16 20.5% for the previous 5 weeks. and Surrey and are also affected by their STP Cases for Change. Kent and 17 IN CONTEXT OUR EVIDENCE

Medway STP, Surrey Heartlands STP and Frimley STP have all identified the People with same issues in their Cases for Change in that: mental ill health l There is not enough focus on maintaining independence and ill What we found health prevention, have poor

outcomes and l There are challenges in primary care provision, which is extremely may not always fragile in some areas, (our evidence) be able to access l There are gaps in service and poor outcomes for those with long term services health conditions, Our evidence: Our Population and Demographics

l We do not support people with long-term conditions and needs to look OUR APPROACH TO HEALTH AND WELLBEING INEQUALITIES after themselves as effectively as we should,

l Many people are in hospital who could be cared for elsewhere, ltural and ic, cu env l There is a growth in demand from older, more complex patients, m iro no nm co e -e Living and working n l Planned care is not delivered as efficiently and effectively as it could be, io ta c conditions l c so o l n l There are particular challenges in the provision of cancer care, d ra Work it e mu Unemployment i n environment om nity o l People with mental ill health have poor outcomes and may not always d c n e n et n G a w s be able to access services, al l lifestyl o ci ua e f r Water and Education o d a k l There are capacity issues, vi c s sanitation S i to d r s In l There is a lack of Digital integration and innovation, Health care services Agriculture l They have an unsustainable workforce model, and food production Age, sex and Housing l They need to reduce clinical variation, constitutional factors

l Urgent and Emergency care needs to reduce.

In addition they have also identified the following which we have not Ref: Determinants of Health, identified in that some local hospitals find it difficult to deliver services Dahlgren and Whitehead (1991) for seriously ill people: some services are vulnerable and potentially Our approach reflects the responsibilities of the whole system in unsustainable. There is a need to review their specialist acute model addressing health and well-being – NHS, councils, police, education, including mental health. Existing capacity needs to be redesigned to be voluntary sector, communities and individuals. This well-being approach used much more productively. recognises that health is created by wider factors than health services. This approach requires a strategic commitment to building a culture in which individuals, organisations and communities work together to 18 identify and pool their capacity, skills, knowledge, assets and resources 19 OUR EVIDENCE OUR EVIDENCE

Our Joint Strategic Needs Assessment (JSNA) show our health priorities RELATIVE CONTRIBUTION OF THE DETERMINANTS OF HEALTH are largely the same as elsewhere – good mental health and wellbeing Unhealthy underpins success; poor physical health is linked to lifestyle behaviours, behaviours of SOCIO- HEALTH CLINICAL BUILT health inequalities result from social and income inequality; healthy ECONOMIC smoking, alcohol BEHAVIOURS CARE ENVIRONMENT futures are built on good employment and decent homes. However, FACTORS there are extreme variations in terms of socioeconomic status, health misuse, poor 30% 40% 20% 10% outcomes, environment and economic prosperity. These are often masked diet and lack of by averages, meaning health outcomes can seem on a par with the physical activity, rest of England, when for parts of Sussex and East Surrey the reality is significantly and enduringly worse. as well as poor emotional and Ref: Adapted from to improve health and wellbeing outcomes for all our residents. Such an There remain considerable, and unacceptable, differences in life mental well-being Gonnering RS and Riley WJ expectancy between areas across Sussex and East Surrey and within local approach requires a shift from a demand management approach to a are responsible for (2018) Robert Wood Johnson CCG / local authority areas. Service access, take up and outcomes need to and University of Wisconsin whole system approach to prevention which addresses “the causes of the be addressed for disadvantaged groups. at least a third of Population Health Institute causes” as identified in Dahlgren and Whitehead model (1991) above. The “causes of the causes” recognises that if the causes of poor health ill health are social, economic and environmental then the solutions need to be too Four main unhealthy behaviours of smoking, alcohol misuse, poor diet – from social determinants to those of the built environment, and these and lack of physical activity, as well as poor emotional and mental well- solutions require concerted, sustained, partnership working. being are responsible for at least a third of ill health and are amenable to cost-effective preventative interventions. Substance misuse, in all its forms, continues to present challenges across the STP area, and notably in CAUSES OF THE CAUSES the Hastings and Brighton and Hove areas.

Social Creating opportunities for people to participate in the life of the community: includes education and early childhood MODIFIABLE RISK FACTORS AND LONG TERM CONDITIONS development, providing a sense of place, belonging and safety, information, inclusion, informal social support, health and community services, arts and culture, sport and leisure. MODIFIABLE RISK FACTORS METABOLIC CHANGES LONG- TERM CONDITIONS (these can be reduced or (the biochemical processes Economic Encouraging sustainable economic development and equitable controlled by intervention, involved in the body’s normal access to resources includes regeneration, job creation, training, social protection, benefits, occupational health and and by doing so reduce the functioning) safety and incentives. probability of disease)

Natural Looking after natural surroundings and ecosystems: includes clean water, air, soil, natural, land care, waste recycling, energy consumption and climate change adaption. Tobacco use Raised blood pressure Cardiovascular disease

Physical inactivity Raised total cholesterol Diabetes

Built Altering physical surroundings icludes: urban layout, building Alcohol use Elevated glucose Cancers design and renewal, housing quality, affordability and density, From Health in All Our parks and recreatio facilities, roads, paths and transport and the provision of other amenities, such as seating and toilets. Poor diet (increased fat Overweight and obesity Policies (Local Government and sodium, with low fruit Association 2016) and vegetable intake).

Emotional and mental well-being 20 21 OUR EVIDENCE

LIFE COURSE APPROACH A WHOLE SYSTEM APPROACH TO PUBLIC HEALTH As well as individual service interventions, public health interventions to Improving the START WELL LIVE WELL AGE WELL build stronger and more resilient communities and places which support public’s health people to maintain independence and manage their own health and will help secure wellbeing across the course of their lives, are an important components the future of 1 100+ of a whole system approach to prevention across NHS, local authorities, voluntary sector, community groups and wider stakeholders. these services and deliver longer, Starting well in life is important for every child. The first few years of Working together, we can achieve the cultural shift we need to sustain healthier lives for life are critical for readiness to learn, educational achievement, income improvements for people wherever they live and create a focus on health and economic status - strong predictors of future health and wellbeing. rather than the treatment of illness. This is increasingly important if public all our residents. What happens during pregnancy and early years impacts on their risk services are to be sustainable in the future – all parts of the public sector of long term ill health such as obesity, substance misuse, risk of heart face significant budget pressures and the NHS and local government are by disease, dental decay and poor mental health. These differences are no means exempt. Improving the public’s health will help secure the future almost entirely explained by deprivation and inequalities. Public health of these services and deliver longer, healthier lives for all our residents. interventions have an important part to play to stem the tide of long- term conditions and increasing costs. Focusing on prevention earlier in the life-course will accumulate greater benefits, but even in middle and CURRENT RESIDENT POPULATION AND PROJECTED TO 2030 older age, preventative approaches are cost-effective. Prevention requires (DATA ROUNDED TO NEAREST 100) prioritisation and investment across the system. Sources: Aggregated CCG 2016 POPULATION 2030 PROJECTED % CHANGE data provided by ONS. OVERALL RESIDENT POPULATION 2016 Population - ONS Mid-Year Estimate (Resident Self Care Continuum ESBT 375,200 417,900 11.4% Population) 2016. 2030 Environmental Coastal 498,900 558,800 12.0% Place solutions to make the Projected - ONS Population level solutions healthier choice the CSESCA North 528,600 578,900 9.5% Prevent Self care easier choice projections for clinical Social marketing/ CSESCA South 461,800 504,100 9.2% Daily Choices community led commissioning groups and Lifestyle support 0-19 YEARS NHS regions ESBT 79,300 83,00 4.7% Self-managed ailments Community Coastal 104,400 111,200 6.5% level solutions Long terms conditions Digital solutions for CSESCA North 130,100 139,00 6.8% Reduce self-management CSESCA South 99,400 103,900 4.5% Actute conditions 65-84 YEARS Individual/Service level solutions Compulsory psychiatric care ESBT 82,400 109,700 33.1% Major trauma Community - connectivity Coastal 109,200 143,000 31.0% Delay Residential care /changing social norms CSESCA North 79,000 104,900 32.8% Public and patient CSESCA South 66,600 86,900 30.5% support & materials 85 AND OVER Enablers: Asset based needs assessment Systematic workforce development ESBT 16,000 22,200 38.8% Aligned Strategies Embedding prevention into care pathways Coastal 20,200 28,500 41.1% Collaborative partnerships Systematic self care & digital support CSESCA North 14,500 20,600 42.1% CSESCA South 11,700 15,500 32.5%

22 23 Disability Free Life Expectancy MEN (2010 - 2012) Source: ONS

72

70

68

66

England = 64.1 years 64

OUR EVIDENCE 62 OUR EVIDENCE

Disability-free life expectancy (DFLE) Years 60

62.5 63.2 64.9 65.7 66.3 67.6 68.0 69.1 58 Hastings & Brighton & Eastbourne, Crawley Coastal W High Weald East Surrey Horsham & Rother Hove Hailsham Sussex Lewes Mid Sussex and Seaford Havens

The resident population across the overall area is projected to increase WOMEN (2010 - 2012) Source: ONS between 2016 and 2030, from a projected 9.2% increase in the CSESCA 71 South area to 12% in Coastal. The greatest increases are projected in the older age groups, notably amongst people aged 85 years or over. 70 Growth in the child population is lower than overall change. The overall 69 population increase, and the rise in the older age groups will impact the 68 demand for health and social care services, with frailty and the number of people with one or more long-term health condition rising. 67 66 England = 65.0 years Disability Free Life Expectancy 65 MEN (2010 - 2012) Source: ONS 64 72 63 62 70 Disability-free life expectancy (DFLE) Years 61 64.1 65.2 65.6 66.2 67.5 68.7 69.0 69.4 68 60 Hastings & Brighton & Eastbourne, Crawley Coastal W High Weald East Surrey Horsham & Rother Hove Hailsham Sussex Lewes Mid Sussex 66 and Seaford Havens

England = 64.1 years 64 Life expectancy varies considerably across the area; this reflects deprivation, with shorter life expectancies in the most deprived local authority areas. 62 In Hastings male disability-free life expectancy is over five years lower than

Disability-free life expectancy (DFLE) Years 60 that in Horsham and Mid Sussex, East Surrey and High Weald, Lewes and the Havens. 62.5 63.2 64.9 65.7 66.3 67.6 68.0 69.1 58 Hastings & Brighton & Eastbourne, Crawley Coastal W High Weald East Surrey Horsham & Rother Hove Hailsham Sussex Lewes Mid Sussex Hastings and Rother also has the lowest female disability-free life and Seaford Havens expectancy at 64.1 years compared with Horsham and Mid Sussex at 69.4 years. WOMEN (2010 - 2012) Source: ONS

71 DEPRIVATION - INDEX OF DEPRIVATION 2015 70 While overall the STP area is relatively affluent, there are some areas, 69 notably along the coastal strip in Hastings, Brighton and Hove and 68 Littlehampton, which rank within the most deprived areas in England; deprivation that has persisted over many years. 67

66 In relation to child poverty, rates at a CCG level (2013) range from 7.3% in England = 65.0 years 65 Horsham and Mid Sussex to 22.7% of children in Hastings and Rother, but again there are neighbourhoods where more than a third of children live in 64 low income households. 63 24 62 25 Disability-free life expectancy (DFLE) Years 61 64.1 65.2 65.6 66.2 67.5 68.7 69.0 69.4 60 Hastings & Brighton & Eastbourne, Crawley Coastal W High Weald East Surrey Horsham & Rother Hove Hailsham Sussex Lewes Mid Sussex and Seaford Havens OUR EVIDENCE OUR EVIDENCE

POPULATION – KEY FACTS LONG TERM CONDITIONS - DATA FROM QOF REGISTERS OF PATIENTS IDENTIFIED V MODELLED The pace of The population is increasing, with higher increases in the older age ESTIMATES OF PREVALENCE change in older groups. It is also important to note that the pace of change in older age ASTHMA ATRIAL COPD DEMENTIA DIABETES HYPERTENSION age will increase will increase markedly over the next ten years. In the first five years, the FIBRILLATION annual increase in the 65+ population is projected to be between 6,000 markedly over the to 8,000(across the whole STP area) but this then starts to rise, and peaks next ten years at around 14,000 in the next 10 years. Figures rounded to nearest 50. Register data relate to 2016/17 QOF Register Estimated undianosed QOF Register Estimated undianosed QOF Register Estimated undianosed QOF Register Est diagnosis rate (65+) QOF Register Estimated undianosed QOF Register Estimated undianosed YEAR-ON-YEAR CHANGE IN THE POPULATION AGED 65 OR OVER Brighton & 16,750 4,100 1,850 4,250 1,700 64% 10,500 7,800 28,900 27,950 2017 TO 2041 (COMBINED EIGHT CCGS AREAS) Hove Given the increase in the old age groups, there will be more people Coastal 32,750 13,900 3,650 10,050 5,750 63.2% 30,250 9,250 83,400 54,550 living with a long term health condition. Many people will have multiple West long term conditions. There will be considerable challenges in sustaining Sussex services and maintaining quality. Crawley 7,650 1,950 750 2,050 800 64.3% 7,100 1,150 16,250 11,750 No recent estimate No recent estimate

East- 12,900 6,350 700 4,400 2,500 67.3% 10,750 4,900 34,100 22,100 bourne Year-on-year change in the population aged 65 or over 2017 to 2041 (Combined eight CCGs areas) Hailsham & Seaford 16,000 East Surrey 10,600 3,800 750 2,500 1,500 68.2% 7,800 3,300 22,250 17,050 14,000 12,000 Hastings 10,250 5,000 950 4,250 1,950 65.0% 10,150 5,450 30,700 17,650 10,000 and Rother 8,000 High 10,150 4,300 950 2,900 1,700 66.0% 7,750 4,300 25,750 17,300 Weald 6,000 Lewes 4,000 Havens 2,000 Horsham & 14,750 5,050 1,650 3,250 2,200 67.9% 10,400 4,400 33,650 22,850 0 Mid Sussex 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 % Of Patients Reporting a Long Term Source: ONS Population Projections (combined CCG areas) Musculoskeletal Problem (2017 LA Level)

25%

20%

15%

10%

5%

18.7% 15.7% 14.5% 14.2% 15.4% 16.5% 0% East Sussex West Sussex Brighton & Surrey SE England England 26 Hove 27 OUR EVIDENCE OUR EVIDENCE

MENTAL HEALTH ESTIMATION OF COMMON MH MENTAL START WELL HEALTH PROBLEMS Smoking at the time of delivery In 2017/18,C 1,600 women were known to be smokers at the time of delivery (9.1% of MENTAL HEALTH B those withA recorded status). The percentage in Hastings and Rother was over 15%. Estimation of Common Mental Health Problems MH 5 2014/15 % of 16-74 years Breastfeeding initiation£ is high C Over 82% of mothers breastfed£ their babies in the first 48hrs after delivery in 2016/17. High Weald Lewes Havens 12.0% B A The rate was highest in Brighton & Hove (88.2%), lowest in Hastings and Rother (73.3%) Eastbourne, Hailsham & Sfd 12.4% 5 Crawley 12.7% Readiness£ for School C In 2017, the£ percentage of children achieving a good level of development in Brighton & Horsham & Mid Sussex 12.8% B A Hove (69.7%) and West Sussex (70.6%) lags behind East Sussex and Surrey, and is lower ? ? Coastal West Sussex 12.9% ? FOR SALE than England. ? ? 5 East Surrey 13.3% £ Social£ mobility rated very good in ...Tendridge (Surrey) Hastings & Rother 13.8% C B But rated very poor in Arun,? Crawley and Hastings A ? ? Brighton & Hove 17.3% FOR SALE ? ? 5 £ Obesity Serious Mental Illness C £ 7.8 % fo reception pupils and 15% of year 6 pupils were measured as obese in the STP B ? ? SERIOUS MENTAL ILLNESS A ? FOR SALE area (2014/15? ? to 2016/17). Higher percentages of excess and obese children in more 1.4 deprived areas. 5 £ £ 7 hours + of sedentary behaviour 1.2 C ? B ? In the 2014/15C “What about Youth” Survey over 60% of 15 years olds surveyed in the A ? FOR SALE ? ? B 1.0 STP area reportedA a mean daily sedentary time (in the last week) over 7 hours per day 5 0.8 £ Smoking at age 15 years 5 £ The percentage of 15 £year olds who said they were “current smokers” was high in ? ? ? £ 0.6 FOR SALE ? ? C Brighton & Hove (14.9%), East Sussex (12.8%) and West Sussex (10.6%). Nationally the B A rate was 8.2%. 0.4 Hospital admissions for self-harm5 (10-24 years) £ ? In STP areas compared with England, Brighton & Hove, Hastings and Rother and Coastal 0.2 ? £

Prevalence of mental health conditions, percent ? ? FOR SALE ? ? West Sussex have particularly high? rates? of admission. FOR SALE ? ? 0.0 Horsham & Crawley East Surrey High Weald Coastal W Eastbourne, Hastings & Brighton & Mid Sussex Lewes Sussex Hailsham Rother Hove Havens and Seaford

? ? ? FOR SALE ? ? 28 29 C OUR EVIDENCE B A

5 £ C £ B A

C 5 B £ LIVEA WELL AGEC WELL £ B A Low Unemployment 5 Over 110,000 older people live? alone? ? in the overall STP area £ FOR SALE C STP area has, overall, a low unemployment rate, but some areas higher such Of the older people living on their? own? the vast majority are women (over 70%). Over £ 5 B A as Hastings £83% of older people are owner occupiers £ C But low wages in some areas B 70,000 households? estimated? to be in fuel poverty 5 A ? £ FOR SALE C Notably full-time wages (2017) are low in Adur, Hastings and Eastbourne. Not restricted to older? people,? but health effects can be greater on the very young and £ B A very old. 5 ? ? £ ? C FOR SALE £ ? ? B ? Housing5 Pressures A Admissions? after a fall are high £ ? FOR SALE ? Over 40,000C households on council waiting lists, 450-500 households a quarter In old age groups? a fall can trigger a move into residential care. For people aged 80+ £ B accepted Aas homeless and in priority need. Brighton5 & Hove, Surrey and West Sussex rates of emergency admissions are far higher ? ? £ ? C than the England rate FOR SALE £ ? ? B Over 250,000 smokers on GP registers 5 A C £ ? ? C Considerable differences across the patch and between socio-economic groups. High Over? 183,000B Carers C £ FOR SALE A B rates in Brighton and Hove and Hastings . ? ….in? the STP area, including over 37,000 people who area caring for 50 hours a week A B 5 ? ? ? A £ or more, including 15,000 carers aged 65 or overs. FOR SALE ? ? £ 5 5 Falling short of the “5-a-day” £ £ 5 ? Across the £STP area, adults consume only 2.5 to 3 portions of fruit & vegetables a day, and ? ? C 18,000+ on Dementia£ Registers £ C FOR SALE ? ? B estimates of £overweight or obese adults at local authority level range from 48% to 64%. A But we know that many people with dementia are not diagnosed. B A ? ? ? FOR SALE 250,000+ adults estimated to? be ?“binge” drinkers 5 5 ? £ £In 2016/17 there were over 1,600 alcohol-specific hospital admissions ? Social isolation and loneliness ? £ C FOR SALE ? ? £ Frequently reported by older people? ? and has an impact on mental and physical ? B ? ?A FOR SALE ? ? ? wellbeing. Over 60% of carers ?known? to social care say they do not have as much social FOR SALE ? ? ? FOR SALE Over 155,000 adults? with? depression on GP registers contact as they would like. 5 £ This represents over 10% of patients. Again there is variation – with 13% of patients in C £ Eastbourne, Hailsham and Seaford identified with depression. Deaths at home Overall a higher percentage (50.7% in 2016) of people in the STP die B ? A in their usual residence? (including care homes), compared with England, but this is far ? ? ? ? FOR SALE ? ? FOR SALE Physical? activity? rates vary lower in Crawley (37.2%) 5 £ Measured at local authority level, the % of adults undertaking the recommended £ physical activity level vary from 78% in Brighton & Hove to 62.2% in Crawley. Variation in Disability Free Life Expectancy (DFLE) Hastings and Rother has the lowest DFLE for both men and women (62.5 years and ? ? Rates? of physical inactivity vary 64.1 years respectively) and Horsham and Mid Sussex the highest (69.1 years for men FOR SALE ? ? In Eastbourne 27% of adults are estimated to undertake less than 30 minutes of and 69.4 years for women) physical activity per week. ? ? ? FOR SALE ? ?

30 31 OUR EVIDENCE

CASE STUDY - WELLBEING PRESCRIPTION SERVICE – EAST SURREY CASE STUDY - EAST SUSSEX - EMBEDDING PREVENTION The Wellbeing Prescription service allows GPs and other health and ACROSS THE SYSTEM social care workers to refer people to local Wellbeing Advisors. The The Personal and Community Resilience Programme in East Wellbeing Advisors are trained to identify the clients’ needs, provide Sussex brings together partners across the statutory (CCGs, local them with advice and signpost them to relevant local services and authorities, Healthcare Trusts, Police, Fire and Rescue Service, activities. The service is delivered in partnership by Tandridge District Department for Work and Pensions) and voluntary and community Council, Reigate & Banstead Borough Council and East Surrey GP sectors to take action to grow strong communities which improve practices and is commissioned working closely with NHS East Surrey health; and to co-ordinate activity to embed prevention across the Clinical Commissioning Group and Surrey County Council through system. The programme includes transformation programmes in key the Better Care Fund. ‘settings’ (the places where people spend their lives) such as schools, nurseries, and healthcare settings including GPs, pharmacies, Quarter 1 18/19 monitoring report shows that 77% of people who hospitals and community health care services, to support them to have used the Wellbeing Prescription service made a positive change play a greater role in improving health. As part of this: to their lifestyle and 75% have visited their GP less often since using l 3,169 frontline staff have been trained to ‘Make Every Contact the service. The Wellbeing Advisors can help people with issues such Count’ as weight management, getting more active, smoking cessation, social isolation and support with mental and emotional wellbeing. l 96% of all primary and secondary schools have developed and are In addition there is Wellbeing Prescription Plus service, which is delivering whole school health improvement plans provided in the homes of patients with multiple, complex needs, as part of an integrated care approach. l 81% of all nurseries (private and local authority) have audited and are improving their healthy eating and physical activity offer

l 89% of General Practices are undertaking new health CASE STUDY - WEST SUSSEX - SUGAR REDUCTION PROGRAMME improvement programmes in their practices The West Sussex Sugar Reduction Programme was launched in January 2015 (N.B. primary school meals sugar reduction began at the end of l 96% of pharmacies registered as Healthy Living Pharmacies 2014). Whilst the overall programme has been successful, sugar (HLP) Level 1, and 30 targeted pharmacies are being developed The programme reduction in primary school meals has achieved particularly significant as HLP Level2 includes results, winning a Public Health England (PHE) award in September transformation 2016 in recognition of this. To date, the following achievements have l 88,579 people received their NHS Health Check (over the past programmes in been made: 5 years) l Primary school meals now have over 2 kilos less sugar, per child, per key ‘settings’ average school year. l A whole systems approach to Social Value is being developed such as schools, across the county, linked to local priorities and growing nurseries, and l Daily sugar consumption reduced from 18.5g to 6.6g per child strong communities healthcare l The total amount of sugar reduced equals 5 double decker London settings including buses per school year! GPs, pharmacies, hospitals and l That’s a 65% sugar reduction in just 3 years! community health 32 l 30,000 children per day are benefiting care services 33 OUR EVIDENCE OUR EVIDENCE

Our evidence: Our public and our patients This programme is CASE STUDY – BRIGHTON AND HOVE ADOLESCENT We always value the views of patients and carers and we have quoted aiming to reduce HEALTH OFFER This programme is aiming to reduce the harm caused by substance a few examples of patient experience throughout. Some show excellent the harm caused misuse and unsafe, early sexual behaviour in young people. The care and some highlight areas for improvement. For example: by substance offer is a single, integrated service including: misuse and l Music workshops and mentoring programme for young people GOOD EXPERIENCES unsafe, early use cannabis but do not see it as a problem sexual behaviour l DASH (Drug, Alcohol and Sexual Health) Prevention team which “Every staff member I have in young people provides a package of resilience building interventions encountered has been l Specialist Substance Misuse Treatment Service brilliant, respectful and knowledgeable.” l School based health drop-ins staffed by school nurses and youth workers and text messaging support via CHATHEALTH

l PSHE (Personal, Social, Health and Economic) direct support to schools to improve the universal curriculum

l Communication plan, including social media campaign which “When my husband had a is aimed at equipping parents to have direct conversations with young people to explain the harms caused by using drugs / TIA, I could not fault the care drink / tobacco. of ambulance crew, A&E at hospital, emergency floor”

EXAMPLE A homeless woman with mental health issues including suicidal thoughts, supported by an outreach team to apply for funding, diary reminders for appointments. The support has dramatically reduced her illicit substance use and she feels more in control.

34 35 OUR EVIDENCE SUBHEAD STYLE

EXPERIENCES THAT COULD BE BETTER Whenever we get into a discussion with patients and the general public there are a number of recurring themes which regularly surface, they are: l Good access to primary care, “Not enough people know EXAMPLE about the wide range of 87 year old discharged post-surgery and told l Keeping care local, to expect a visit from social care that day. No services pharmacies can one came. Only allowed one visit to change l Care that is well coordinated, offer.” her dressing. (ESBT) l Having the right information to support self-care and as much focus on wellbeing as on health,

EXAMPLE l In addition, local people recommended expansion of the range of local The importance of continuity of relationships services in local communities so these would be more integrated and (for young people) with professionals came accessible both for patients and also for family and carers. out in her frustration with the variability and short term nature of those encounters. All across the STP, commissioners have been engaging the public to gain (Coastal Cares) their views on current services and/or proposed changes. In the Alliance, CCGs have been conducting a series of discussions called the ‘Big Health and Care Conversation’ and more of these events are planned.

IDEAS FOR IMPROVING CARE Once we have agreement on the content and strategic direction of the Population Health Check we will engage more widely with our staff, wider partners, Health Overview and Scrutiny Committees etc. and “I would like advocates, “People need to be mobilise our communications and engagement resources to widen debate community navigators and more aware of healthy and gain ownership of the plan. health coaches to have a lifestyles and to take more greater role in supporting responsibility for own OUR EVIDENCE: WHAT DO PATIENTS EXPERIENCE? We need to move from how things are now, a fragmented and reactive people to understand their health. So more education.” system, to a future system designed around the individual. health conditions and medicine” How it looks now: l A fragmented system with multiple providers, characterised by a lack of coordination, We need to move from how l A service which is reactive not proactive, things are now, a EXAMPLE l Pathways of care that are unnecessarily complex. fragmented and The daughter of a 95 year old woman with dementia raised concerns over her mother’s reactive system, care in a care home. Even though they were to a future system funding the care, support to raise concerns designed around would have been welcomed. 36 the individual. 37 OUR EVIDENCE SUBHEAD STYLE

OUR EVIDENCE: WHAT SHOULD OUR PUBLIC AND PATIENTS EXPECT collaboratively with your health and care professionals to develop a We need to work (PRINCIPLES OF CARE)? care and support plan describing what’s important to you. with our local We understand the importance of a person centred asset based approach to empowering people to develop the knowledge skills and confidence to l There is likely to be a key worker or co-ordinated assigned to you. communities to self-manage. help people help l You will have a care record which you will be able to see and add to. themselves. This is The focus needs to be on our population rather than organisational silos, what most people with prevention and self-management at its core. This is enabled through l If you need hospital care, there may be changes to how and where strength based social care, shared decision making, making every contact this is offered, with hospitals working as partners to provide more tell us they want. count, collaborative care and support planning and health coaching. specialised services and with more technology-enabled care.

People have the right to a high-quality health and care service when they l If you are frail and elderly and you need to go into hospital, you are really need it. more likely to receive support to go straight home to recuperate, rather than having to go somewhere else first. With rights, however, come responsibilities. We need to work with our local communities to help people help themselves. This is what most l Health and social care services will work with you as a partner to help people tell us they want. We need to work with people to redesign the you to live your life independently system. To do this, we will adopt the following principles of care: l Make Prevention Everybody’s business, l You can make the last stage of your life as good as possible because everyone works together confidently, honestly and consistently to help l Maximise Independent Living and Self-Care, you and those important to you, including your carers. (ref: National Palliative and End of Life Care Partnership,2015) l Target proactive care of people at highest risk of hospitalisation and needing higher intensity care,

l Reduce the time people stay in hospital for and discharge them safely, Health and social care services will l Make patient journeys more joined up, without waste, repetition work with you as or duplication, a partner to help l Make Sussex and East Surrey STP a great place to work in all our you to live your life local organisations, independently

l Prioritise investment areas which bring maximum benefit for patients.

OUR EVIDENCE: WHAT WILL THIS MEAN FOR US ALL? l You will be empowered and supported to develop the knowledge, skills and confidence to self-manage and stay well.

l We will create environments which make it easier to be healthy. You are also more likely to be offered a personal care or health budget.

38 l If you become unwell with a long-term condition, you will work 39 OUR EVIDENCE

Our evidence: Our services Whilst some “Due to the people receive DYING complexity of four excellent care, l We want more patients to die in their usual place of residence. parties being involved “I can’t think of anything you can others experience Across the STP we have a high number of care homes and we should in our mother’s care improve on, I am 91 years old and fragmented capitalise on this and support more residents to die in these supported and homely environments. ([hospice], [care my wife passed away in March and poorly co- home], District nurses of this year at the age of 95. She ordinated care. l In the Sussex and East Surrey STP, there were 19,585 deaths in 2015. and the GP) there had Parkinson’s and dementia, The percentage of all deaths with dementia as an underlying or contributory cause of death were higher in 50% of the CCGs. were times when she wanted to die at home so I communication and looked after her at home for 3 l The percentage of all deaths that are aged 85 years and older were responsibility were years or more and the help and higher than the national average for all CCGs. disconnected” care I got from the NHS was l We are poor at identifying people who are at the end of their life. St Catherine’s hospice so good I can’t say a bad word about it.” l There is fragmentation of services and lack of shared records. Coastal Care-Primary and Urgent

l Whilst some people receive excellent care, others experience care survey) fragmented and poorly co-ordinated care.

3.3.1 Dying 3.3.2.1 A&E 4hr waiting time performance STP wide Percentage of death in different locations by CCG A&E 4HR WAITING TIME PERFORMANCE STP WIDE

94.0% 60 Brighton & Hove Coastal West Sussex 92.3% Crawley East Surrey 92.0% 50 Eastbourne, Hailsham & Seaford Hastings & Rother 91.0% 90.1% 90.1% High Weald Lewes Havens Horsham & Mid-Sussex 90.0% 91.0% 89.7% 40 88.5% 89.5% 88.0% 86.9% 30 87.8% 86.0% 20 85.8% 85.9% 84.0% 10 82.0% 0 15 1615 1615 1615 1616 1716 1716 1716 1717 1817 1817 1817 18 40 Hospital Hospice Home Care Home Other Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 41 OUR EVIDENCE OUR EVIDENCE

A&E BREACHES STP WIDE Although there is no right or wrong formula of what services should be 3.3.2.2 A&E Breaches STP wide provided in a non-acute setting, it is generally viewed that an over-reliance on acute based care is comparatively more expensive due to the prevailing 20000 17787 18199 payment system (Payment by Results).

15876 17475 15000 15873 14936 There is variation across the trusts in delivering on Referral to Treatment 14343 13741 13030 Times (RTT). 10000 11628 10570 3.3.3.1 Admissions CCG Outcomes Indicator Set- domain 3 3.1 Emergency admissions for 5000 acute conditions that should not usually require hospital admission (2016-2017 (Jul-Jun)) East Surrey and Sussex

0 94.7 - 98.3 15 1615 1615 1616 1716 1716 1716 1717 1817 1817 1817 18 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 98.4 - 113.7

113.8 - 125.6

Whilst individual Trusts occasionally meet the 95% 4 hour A&E waiting 125.7 - 129.7 time standard, as a whole, the Sussex and East Surrey STP has not met the standard since it was formed in late 2015.

4/4 acute providers have breached the four hour waiting time target at Q3 16/17. In 2016/17, 2 of the acute trusts were more than 5% below the expected 95% of patients to be seen within 4 hours – for Type 1 A&E attendances. The other 2 trusts were above 90% but below 95% for 3 of the 4 quarters. The NHS Planning Guidance (2018/19) expects 95% to be achieved by month 12.

There are significant hand over delays at our hospitals. Between 24- 12-2017 and 02-01-2018 SECAmb lost in excess of 3,200 operational RTT performance STP wide ambulance hours to turnaround delays greater than 30 minutes. This was a 13% increase over the same period last year. This is equivalent to losing 91.0% 13 ambulances on duty every day of this 10 day period. 89.8% 90.0% 89.6% Coastal West ACCESS 89.0% Sussex and East 88.3% Sussex areas 88.0% ADMISSIONS 87.3% showing levels There is very large variation in patterns of hospital use for conditions that 87.0% 86.9% 87.1% of hospitalisation would not usually require hospitalisation, with Coastal West Sussex and East 86.8% 86.2% Sussex areas showing levels of hospitalisation almost four times as high as 86.0% almost four times in other areas of the STP. as high as in other 85.0% areas of the STP. The reasons for this are multi-fold and span patient behaviours but also the 84.0% 16-17 16-17 16-17 16-17 17-18 17-18 17-18 17-18 42 availability, accessibility and responsiveness of non-hospital based services. Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 43 OUR EVIDENCE OUR EVIDENCE

CANCER3.3.4.1 Cancer MORTALITY Mortality “I was recently diagnosed with breast cancer following my first over 50 CCG Outcomes Indicator Set- domain 1 1.9 Under 75 mortality rates from cancer (2015) East Surrey and Sussex screening. I have had the surgery and I have just started chemotherapy. I just wanted to let you know how amazing the staff at BSUH have been; 94.7 - 98.3 The radiographers and nurses in the breast care unit, pre assessment clinic, 98.4 - 113.7 theatre and Ansty ward at PRH and imaging.” 113.8 - 125.6

125.7 - 129.7

l There is significant variation in mortality rates from cancer, with patients in coastal areas, in particular Brighton and East Sussex being in some instances 20% more likely to die from cancer than patients in Horsham/Mid Sussex.

l In our STP, cancer incidence is high, with low diagnosis at stage 1 and 2. Take up of cervical and breast screening is low.

l We lack of access to modern, high quality and local radiotherapy services.

l There is inadequate introduction and adoption of timed pathways in 3.3.4.2CANCER Cancer SURVIVAL survival Lung, Prostate and Colorectal cancer. CCG Outcomes Indicator Set- domain 1 1.10 One-year survival from all cancers (Diagnosed 2014) East Surrey and Sussex l There is variation across the trusts in delivering on cancer waits.

66.7 - 67.5 l Diagnostic capacity and workforce shortages continue to be an issue. 67.6 - 69.6 (Ref: STP dashboard 69.7 - 71.1 2018) 71.2 - 72.3 LATEST LATEST RANK SPINE CHART PERIOD VALUE WITHIN = selected STP SOUTH = middle 50% of South STPs = England average = STP median

WORST BEST

Cancer incidence (total tumours)^ 2014 11403 13/13

Cancer incidence (rate) 2014 611.8 9/13

Breast cancer screening coverage 2015/15 72.4% 12/13

Cervical cancer screening coverage 2015/16 73.7% 9/13

Bowel cancer screening coverage 2015/16 60.3% 8/13 44 Diagnosis at stage 1 or 2 2015 50.6% 12/13 45 OUR EVIDENCE

UNWARRANTED VARIATION UNWARRANTED VARIATION: CARDIOVASCULAR STROKE We know there are areas of healthcare, which demonstrates variation in In stroke care there is: practice and quality across our STP. l Inadequate achievement of NICE (National Institute for Health and Care Excellence) Guidelines standards for non-elective stroke care and Key areas of variation in our STP are: the South East Clinical Network Stroke standards. l Cardio Vascular Disease (including Stroke care, Atrial Fibrillation, stable angina and diabetes) l There continues to be variation across the STP in stroke services, especially in relation to access to allied access to six-month reviews. l Trauma and Injuries (Falls and Fragility Fractures)

Routinely Trust Brighton East Maidstone Maidstone Medway Surrey and Western Western Admitting and Sussex Sussex and and NHS Sussex Sussex Sussex l MSK Teams University Healthcare Tunbridge Tunbridge Foundation Healthcare Hospitals Hospital Hospitals NHS Trust Wells NHS Wells NHS Trust NHS Trust NHS Trust NHS Trust NHS Trust Trust Trust

Team Royal Eastbourne Maidstone Tunbridge Medway East Surrey St Richards Worthing Name Sussex District District Wells Maritime Hospital Hospital Hospital “After my stroke, I felt County General General Hospital Hospital isolated and lost Hospital Hospital Hospital Number of Admit confidence” patients 200 149 110 140 89 191 164 189

Disch 167 175 101 142 84 198 156 186

Patient D1 Centred Scan A A A A C A B A Data “Mum wasn’t admitted to D2 B B C D E D C C the ward for 9 hours” SU D3 Throm B C C D D B B B

D4 SpecAsst A B B C D B C A

D5 OT B C A B E B C A

D6 PT B C A A D C C B “The aftercare failed to D7 SALT C E A B C C B C

meet any expectations” SOUTH ENGLAND - EAST SCN PATIENT CENTRED - APRIL TO JULY 2017 CENTRED - APRIL TO JULY PATIENT D8 MDT D D B C D B C B

D9 Std Disch A A C D A B B A

D10 Disch Proc B B B B B D C D

PC KI Level B C A C D B C B

Six Month Number Assessment Applicable 126 109 73 84 85 124 112 106

% Applicable 98% 100% 100% 100% 98% 99% 99% 100%

Number assessed 8 14 0 0 3 3 0 0

% 46 Assessed 6% 13% 0% 0% 4% 2% 0% 0% 47 OUR EVIDENCE

Routinely Trust Brighton East Maidstone Maidstone Surrey and Western Western UNWARRANTED VARIATION: CARDIOVASCULAR: STROKE Admitting and Sussex Sussex and and Sussex Sussex Sussex PREVENTION AND ATRIAL FIBRILLATION (AF) Teams University Healthcare Tunbridge Tunbridge Healthcare Hospitals Hospital Hospitals NHS Trust Wells NHS Wells NHS NHS Trust NHS Trust NHS Trust For every 25 high risk patients treated for AF, one serious/debilitating NHS Trust Trust Trust stroke is avoided. The chart below shows that, compared with our Team Royal Eastbourne Maidstone Tunbridge East Surrey St Richards Worthing demographic peers, we often have a gap between our expected Name Sussex District District Wells Hospital Hospital Hospital County General General Hospital prevalence versus our actual prevalence. Eastbourne, Hailsham and Hospital Hospital Hospital Seaford CCG and Hastings and Rother CCG are identifying more cases Number of Admit than their comparative peers. Where we are finding patients and putting 210 146 122 148 193 148 164 patients them on blood thinners, our spend on non elective stroke is lower than Disch 180 188 111 132 177 145 159 our demographic peers because we are preventing strokes. Within three years we could stop 660 Strokes if we treated all patients with AF with Patient D6 anti coagulation. This equates to £11.2 million. Centred PT A B A A B C B Data D7 B E A B C C C SALT Stroke-Stroke- Non-electiveNon-elective spendspend onon dischargesdischarges -- BestBest 55 Stroke-Stroke- Non-electiveNon-elective spendspend onon dischargesdischarges -- CCGCCG D8 B D B B B C B MDT Direct current cardioversion (Majority PBC=10C) - Direct current cardioversion (Majority PBC=10C) - Total spend on discharge - Best 5 Total spend on discharges - CCG D9 B A D D A A A Std Disch AF & CHADS2 score 1: % currently treated with AF & CHADS2 score 1: % currently treated with anti-coagulation therapy - Best 5 anti-coagulation therapy - CCG D10 SOUTH ENGLAND - EAST SCN

PATIENT CENTRED - APRIL TO JULY 2017 CENTRED - APRIL TO JULY PATIENT Disch Proc B C B C D D C AF observed prevalence compared to AF observed prevalence compared to expected prevalence - Best 5 expected prevalence - CCG PC KI 100% Level A B B C B C A 8,000 100%

Six Month Number 90% Assessment Applicable 104 126 75 88 158 114 124 7,000 80% % 6,000 Stroke- Non-elective spend on discharges - Best 5 Stroke- Non-elective spend on discharges - CCG Applicable 98% 100% 100% 100% 98% 100% 100% 6,000 70% Number Direct current cardioversion (Majority PBC=10C) - Direct current cardioversion (Majority PBC=10C) - 5,000 60% assessed 2 13 0 0 0 0 0 Total spend on discharge - Best 5 Total spend on discharges - CCG 60% AF & CHADS2 score 1: % currently treated with AF & CHADS2 score 1: % currently treated with 50% % 4,000 anti-coagulation therapy - Best 5 anti-coagulation therapy - CCG 50% Assessed 2% 10% 0% 0% 0% 0% 0% AF observed prevalence compared to AF observed prevalence compared to 40% 3,000 expected prevalence - Best 5 expected prevalence - CCG 100% 8,000 30% 2,000 90% 7,000 20% 1,000 80% 1,000 6,000 10% 70% 0% 0 5,000 60% NHS Brighton NHS Coastal NHS Crawley NHS East NHS NHS Hastings NHS High NHS & Hove CCG West Sussex CCG SurreySurrey CCGCCG Eastbourne, and Rother Weald Lewes Horsham and 50% 4,000CCG Hailsham and CCG Havens CCG Mid Sussex SeafordSeaford CCGCCG CCG 40% 3,000 30% EST. AF PREVALENCE2,000 1.97% 3.44% 2.04% 2.51% 3.58% 3.52% 3.11% 2.81% 20%

EST. BEST 5 PREVALENCE1,000 2.06% 3.07% 2.24% 2.42% 3.15% 3.21% 2.97% 2.53% 10%

0 0% NHS Brighton NHS Coastal NHS Crawley NHS East NHS NHS Hastings NHS High NHS & Hove CCG West Sussex CCG Surrey CCG Eastbourne, and Rother Weald Lewes Horsham and 48 CCG Hailsham and CCG Havens CCG Mid Sussex 49 Seaford CCG CCG OUR EVIDENCE

UNWARRANTED VARIATION: CARDIOVASCULAR DISEASE: DIABETES CCG Major amputations per Major amputations per Major amputations per The NHS reports In diabetes care there is wide variation in: 1,000 diabetic patients 1,000 diabetic patients 1,000 diabetic patients that people who l The number of major and minor amputations and length of stay. April 2011 - March 2014 April 2012-2015 2013-14 2015-16 have diabetes are England 0.8 0.8 0.81 l The average number of major amputations in England is 8.1 per 10,000 East Surrey CCG 1.0 (19) 0.8 (17) 0.9 (19) 15 times more (standardised rate). Across our STP the rate ranges from 5.8 High Horsham & Mid Sussex CCG 0.6 (15) 0.8 (21) 0.82 (21) likely to undergo Weald Lewes Havens CCG to 10.2 Eastbourne, Hailsham and Seaford Crawley CCG 0.5 (9) 0.9 (17) 0.93 (16) amputations than CCG. The average number of minor amputations in England is 20.7 per 10,000 (standardised rate). Across our STP the rate ranges from 17.7 Coastal West Sussex CCG 0.9 (71) 1.0 (79) 0.54 (80) other people (Crawley CCG) to 28.9 Eastbourne, Hailsham and Seaford CCG. Brighton & Hove CCG 1.0 (32) 0.9 (29) 0.8 (27) without the High Weald, Lewes & 0.6 (12) 0.6 (14) 0.58 (16) condition. l Our current diabetic foot amputation rate will continue to rise. Havens CCG Currently 52% of our diabetic foot ulcers are rated as severe and at Hastings & Rother CCG 1.0 (27) 0.9 (27) 0.81 (29) least 56% were unhealed at 12 weeks, with 83% of patients waiting Eastbourne, Hailsham & 1.7 (47) 1.1 (33) 1.02 (36) Seaford CCG more than two days for referral and triage and 38% waiting at least 14 South East Coast Total 578 581 0.82 (613) days (NICE recommendation for referral and triage within two days). CCG Minor amputations, annual Minor amputations, annual Minor amputations, annual rate per 1,000 adults with rate per 1,000 adults with rate per 1,000 adults with l There is still a gap in the actual to expected prevalence rate of diabetes. diabetes diabetes 2012-2015 diabetes 2013-2016 There is variation across our STP in terms of Primary Care achievement England 1.7 1.8 2.1 of quality targets such as blood sugar management, blood pressure, cholesterol and the other 8 Care processes. East Surrey CCG 2.6 (51) 2.3 (48) 2.42 (57) Horsham & Mid Sussex CCG 1.5 (39) 2.0 (57) 2.23 (67)

Crawley CCG 1.4 (25) 1.4 (26) 1.77 (30) KEY FACT Coastal West Sussex CCG 1.9 (143) 2.1 (163) 1.84 (184) The NHS reports that people who have diabetes are 15 times Brighton & Hove CCG 2.1 (66) 1.8 (58) 2.07 (71)

more likely to undergo amputations than other people without High Weald, Lewes & 2.3 (49) 1.8 (39) 2.15 (59) the condition. Diabetes is one of the leading causes of amputation Havens CCG of the lower limbs throughout the world. Charity Diabetes UK Hastings & Rother CCG 2.4 (68) 2.4 (69) 2.05 (74) notes that problems of the foot are the most frequent reasons for Eastbourne, Hailsham & 2.7 (76) 2.9 (84) 2.89 (98) hospitalisation amongst patients who have diabetes. Seaford CCG South East Coast Total 2.02 (1334) (SEC average) 2.07 (1274) 2.33 (1739)

“In the first 5 weeks of attending (the National Diabetes Prevention Programme tailored education) I had lost almost a stone in weight and my cholesterol is falling”

50 51 OUR EVIDENCE OUR EVIDENCE

UNWARRANTED VARIATION: CARDIOVASCULAR DISEASE: UNWARRANTED VARIATION: TRAUMA AND INJURIES (FALLS AND We have a OVER-TREATING PATIENTS WITH STABLE ANGINA FRAGILITY FRACTURES) higher spend The NICE pathway states that patients with stable angina should have The chart below shows that there is wide variation in the number and a computerised temography angiogram first which is non-invasive and treatment of falls compared with our demographic peers: One in three on angiography cheaper than an invasive angiogram. Only about 20% of patients who over-65s and half of those over 80 will suffer a fall each year. The and stents than have had a CT angiogram would need to go on to have an invasive Department of Health and Social Care has stated that a falls prevention our demographic angiogram. 80% should be given medication to manage their angina. strategy could reduce the number of falls by 15-30%. Admissions relating peers but not If the medication does not help the pain, a shared decision-making to fractures where a fall has occurred, notably hip fractures and those conversation should take place which makes it clear that if the patient has people over 65 without significant injury and are not always getting a always resulting in a stent inserted, it will not prolong their life, with the exception of a small multifactorial falls assessment and exercises, which we know reduce better outcomes defined cohort of our population, but it will help with chest pain. The subsequent falls by 24%. We do not always have effective case-finding chart below shows that compared with our demographic peers, we have and appropriate drug treatment for osteoporosis, particularly after the a lower reported prevalence of CHD than our estimated numbers. Also first fracture has occurred. We know if this treatment is taken then there we have a higher spend on angiography and stents than our demographic is a reduction in the risk of the next fracture by 50%. peers but not always resulting in better outcomes. There is variation in the

implementation of these NICE guidelines across our STP, resulting in too Tendency to fall, not elsewhere classified (R296): Tendency to fall, not elsewhere classified (R296): many invasive angiograms and stents. NEL Spend - per 1,000 - Best 5 NEL Spend - per 1,000 - CCG K633, K364, K636: Angiography - Total spend on K633, K364, K636: Angiography - Total spend on discharges - Best 5 discharges - CCG Rate of injuries due to falls in people aged 65+ per 100,000 Rate of injuries due to falls in people aged 65+ per 100,000 K633, K364, K636: Angiography - Total spend on K633, K364, K636: Angiography - Total spend on age-sex weighted population - Best 5 age-sex weighted population - CCG dischargesK751, K752: - BestStents 5 - Total spend on discharges - Best 5 K751,discharges K752: - CCGStents - Total spend on discharges - CCG

K751, K752: Stents - Total spend on discharges - Best 5 K751, K752: Stents - Total spend on discharges - CCG Percentage of GP registered population aged 75+ - Best 5 Percentage of GP registered population aged 75+ - CCG Reported to estimated prevalence of CHD (%) - Best 5 Reported to estimated prevalence of CHD (%) - CCG

Reported to estimated prevalence of CHD (%) - Best 5 Reported to estimated prevalence of CHD (%) - CCG Mortality from CHD: under 75 - Best 5 Mortality from CHD: under 75 (%) - CCG 3,500 100% 90% Mortality from CHD: under 75 - Best 5 Mortality from CHD: under 75 (%) - CCG 3,000 80% 6,000 100% 2,500 70% 90% 100% 6,000 K633, K364, K636: Angiography - Total spend on K633, K364, K636: Angiography - Total spend on 5,000 discharges - Best 5 discharges - CCG 80% 60% 90% 2,000 5,000 K751, K752: Stents - Total spend on discharges - Best 5 K751, K752: Stents - Total spend on discharges - CCG 70% 50% 4,000 80% 60% 1,500 40% 4,000 Reported to estimated prevalence of CHD (%) - Best 5 Reported to estimated prevalence of CHD (%) - CCG 70% 3,000 50% 60% 1,000 30% Mortality from CHD: under 75 - Best 5 Mortality from CHD: under 75 (%) - CCG 40% 3,000 50% 20% 2,000 30% 40% 500 10% 2,000 20% 100% 1,000 6,000 30% 10% 90% 0 0% 20% Brighton & Coastal West Crawley East Surrey Eastbourne, Hastings and High Weald Horsham and 1,000 5,000 80% 0% Hove CCG Sussex CCG CCG CCG Hailsham and Rother CCG Lewes Mid Sussex 0 10% NHS Brighton NHS Coastal NHS Crawley NHS East NHS NHS Hastings NHS High NHS Seaford CCG Havens CCG CCG 4,000 70% & Hove CCG West Sussex CCG Surrey CCG Eastbourne, and Rother Weald Lewes Horsham and 0% 0 60% NHS Brighton NHSCCG Coastal NHS Crawley NHS East HailshamNHS and NHS CCGHastings HavensNHS High CCG MidNHS Sussex & Hove CCG 3,000West Sussex CCG Surrey CCG SeafordEastbourne, CCG and Rother Weald Lewes HorshamCCG and 50% CCG Hailsham and CCG Havens CCG Mid Sussex 40% 2,000 Seaford CCG CCG CCG CHD PREVALENCE 2.19% 4.11% 2.77% 2.77% 4.12% 4.20% 3.11% 2.96% 30% 1,000 20% BEST 5 PREVALENCE 2.86% 3.71% 2.71% 2.69% 3.89% 3.85% 3.33% 2.70% 10% 0 0% NHS Brighton NHS Coastal NHS Crawley NHS East NHS NHS Hastings NHS High NHS & Hove CCG West Sussex CCG Surrey CCG Eastbourne, and Rother Weald Lewes Horsham and 52 CCG Hailsham and CCG Havens CCG Mid Sussex 53 Seaford CCG CCG OUR EVIDENCE

UNWARRANTED VARIATION: MSK Surgical site infection rates per Trust for Total Hip Replacement For example, In musculoskeletal surgery there is wide variation in: 3.5%

l The volume of Total Hip Replacement surgery per surgeon. 34% of 3.0% surgeons do less then 10 procedures a year, 54% do less than 20 2.5% procedures a year and only 30% perform greater or equal to 50 2.0%

l The number of revisions within a year post joint replacement per surgeon 1.5%

1.0% l The rate of infection post joint replacement per hospital 0.5%

0.0% 2014 2015 2016 Number of Total Hip Replacement per surgeon

10 UNWARRANTED VARIATION: MSK - TOTAL KNEE REPLACEMENT 9 The chart below shows that we are doing more procedures, spending more 8 on elective care and delivering poorer outcomes than our demographic 7 peers. The % of patients 60 and over having same side knee replacement 6 within one year of arthroscopy is declining but is still six times higher 5 than the national average. Nice Guidance recommends conservative 4 management (exercise/weight management/patient education) before 3 consideration for surgery as these approaches can reduce pain, improve 2 function and avoid the need for a Joint replacement as osteoarthritis is not 1 always a progressive condition. Good quality Shared decision making is 0 important to give patients the information they need to make a decision 50+ 30-50 20-29 10-19 0-9 that’s right for them. Total Knee Replacement 1 year revision rates Primary Knee Replacement - Age-Sex Standardised Primary Knee Replacement - Age-Sex Standardised 2.5 Spend per 1,000 - Best 5 Spend per 1,000 - CCG % Of people (over 45) who have knee osteoarthritis % Of people (over 45) who have knee osteoarthritis (total) - Best 5 (total) - CCG 2.0 1.92 Knee Replacement (primary), EQ-SD Index, Health Knee Replacement (primary), EQ-SD Index, Health Gain - Best 5 Gain - CCG 1.59 1.5 18,000 40%

1.20 16,000 35% 14,000 1.0 1.00 30% 0.90 12,000 25% Revision rate (%) 0.66 10,000 0.54 0.50 0.50 0.50 20% 0.5 0.41 0.40 8,000 15% 0.30 0.29 6,000 0.10 4,000 10% 0.0 0.00 0.00 0.00 0.00 0.00 0.00 2,000 5%

WSH-8 WSH-6 WSH-9 WSH-1 0%

WSH-4 WSH-5 WSH-2 0 BSUH-9 BSUH-3 BSUH-1 BSUH-2 BSUH-4 BSUH-6 BSUH-5 BSUH-7 BSUH-8 WSH-13 WSH-14 WSH-11 WSH-12 WSH-16 Hastings and High Weald Eastbourne, Coastal West Crawley Horsham and Brighton & East Surrey Rother CCG Lewes Hailsham and Sussex CCG CCG Mid Sussex Hove CCG CCG 54 Surgeon Havens CCG Seaford CCG CCG 55 OUR EVIDENCE SUBHEAD STYLE

UNWARRANTED VARIATION: MSK - TOTAL HIP REPLACEMENT The chart below shows we are spending more than our demographic “Some people only know peers with health gain worse (apart from Eastbourne, Hailsham and to go to A&E for urgent Seaford CCG) and prevalence is identical. “I would like Community care – there is a lack of Primary Knee Replacement - Age-Sex Standardised Primary Knee Replacement - Age-Sex Standardised Navigation to be extended awareness about other Spend per 1,000 - Best 5 Spend per 1,000 - CCG in the city. I would like places people can go. “ % Of people (over 45) who have knee osteoarthritis % Of people (over 45) who have knee osteoarthritis (total) - Best 5 (total) - CCG patients to be able to self-refer and to have Knee Replacement (primary), EQ-SD Index, Health Knee Replacement (primary), EQ-SD Index, Health Gain - Best 5 Gain - CCG navigators in communities, 18,000 40% like a “go to” person. 16,000 35%

14,000 30% 12,000 25% 10,000 20% 8,000 15% “More needs to be done to promote the 6,000 alternative to A&E and opening times.” 4,000 10% 2,000 5% 0 0% Hastings and High Weald Eastbourne, Coastal West Crawley Horsham and Brighton & East Surrey Rother CCG Lewes Hailsham and Sussex CCG CCG Mid Sussex Hove CCG CCG Havens CCG Seaford CCG CCG

Ambulatory care sensitive conditions AMBULATORY CARE SENSITIVE CONDITIONS CCG Outcomes Indicator Set- domain 2 2.6 Unplanned hospitalisation Attendances at our A&E Departments continue to rise with a 4% increase for chronic ambulatory care sensitive conditions (2016-2017 (Jul-Jun)) East Surrey and Sussex reported over the first 3 quarters of 17-18 compared to 16-17. 156.9 - 239.9

Over a quarter of all attendances at A&E could have been treated at 240.0 - 574.2

another suitable location (e.g. primary care provision) however patient 574.3 - 661.6 behaviours and the availability of alternative pathways continue to drive 661.7 - 752.9 this increase in activity.

There are several points of contact for access to services, fragmented pathways and gaps in service availability (geographic and time of day), particularly around admissions avoidance and to support hospital discharges. This results in multiple handoffs and confusion over the correct pathways, building in inefficiencies in how services are being delivered, increasing conveyance and admissions and the length of stay in hospitals. 56 57 OUR EVIDENCE

DELAYED TRANSFER OF CARE (DTOCS) FLOW There are many patients in hospital beds who should be cared for at home. A bed audit carried out across the STP identified 22% of patients across 49% of patients Sussex and East Surrey that are “fit to leave” their current setting of care. who were An increasing rate of incomplete to complete pathways has caused classified as fit to a worsening performance against the Referral to Treatment 18 week A total of 49% of patients who were classified as fit to leave their current incomplete standard. At quarter 2 of 2017/18, 5 out of the 6 providers setting of care have remained in hospital for over a week. There were leave their current breached the standard. In 2016/17 bed occupancy was at 92.7% (ranked 97% of acute patients fit to leave who were admitted as non-elective setting of care as 35/44 across the STPS) and the percentage of beds attributable to patients. A total of 75% of acute patients and 92% of community have remained in Delayed Transfers of Care (DTOC) was 8.9% (ranked as 37/44 across the patients fit to leave their current setting of care are over the age of 70. A hospital for over STPs). 1 = best, 44 = worst. majority of delays are attributed to patients awaiting social care, although patient and family choice is a major cause for delay in the community a week. A disproportionate number of those fit to leave their current setting of setting. (CF April 2017). care have dementia, with over a quarter of patients with dementia or a cognitive impairment fit to leave waiting for over 50 days to leave their settings of care. Beds Occupied by Stranded Patients (7+ days) Sussex and East Surrey

KEY FACT 59% 58% 47% of carers in the “Counting the Cost” survey reported that Surrey and Sussex Healthcare being in hospital had a significant detrimental effect on the general 57% NHS Trust 56% physical health of the person with dementia and 54% reported a East Sussex Healthcare NHS Trust negative effect on the symptoms of dementia such as becoming 55% 54% Western Sussex Hospitals NHS more confused and less independent (Alzheimer’s Society 2009) 53% Foundation Trust 52% Brighton and Sussex University 51% Hospitals NHS Trust South East DTOC % (Bed day delays per occupied bed) 50% Sussex & East Surrey 49% 48% 8.0% 47% South East 46% 7.0% Kent, Surrey and Sussex 45% Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 6.0% Brighton and Sussex University Hospital NHS Trust 5.0% Western Sussex Hospital NHS Foundation Trust 4.0% Surrey and Sussex Healthcare 3.0% NHS Trust

2.0% East Sussex Healthcare NHS Trust Queen Victoria Hospital NHS 1.0% Foundation Trust

0.0% 58 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 59 OUR EVIDENCE OUR EVIDENCE

Beds Occupied by Extended lenght of stay Patients (21+) Reduction in beds: Sussex and East Surrey The Royal Sussex County Hospital site in Brighton is delivering a 10-year strategy to improve their estate, which will impact on their ability to 25% deliver care in a timely way. A strategic/system-wide solution is needed to Surrey and Sussex Healthcare 24% NHS Trust support those pathways affected as all Trusts will be affected.

23% East Sussex Healthcare NHS Trust

22% Western Sussex Hospitals NHS BED DAY UTILISATION Foundation Trust 21% There are currently 3,519 acute inpatient beds across the STP. Bed Brighton and Sussex University occupancy across all sites is forecast to increase in 2016/17. 20% Hospitals NHS Trust

19% Today

18% 3Ts by 2023/24 17% 37 Proposed Emergency Floor redevelopment RSCH Bed capacity 16% will increase as a 176 result of 3Ts and a 15% proposed emergency Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 oor redevelopment

Inpatient Beds 586 315 44 695 544 465 465 341 69

BED DAY UTILISATION Royal Sussex Princess Royal East Surrey Worthing St Richards Conquest Eastbourne Queen Across the STP, bed occupancy per provider ranged from 62% (at the County Royal Alexandra Hospital Hospital Hospital Hospital DGH Victoria Hospital Hospital Childrens Hospital specialist provider) to 96% at Quarter 2 2017/18. Hospital Today Compared with our peers, there is statistically significant variation in the BSUH SaSH WSHT 3Ts by ESHT2023/24 QVH number of bed days across all common conditions. There are currently 37 Proposed Emergency Floor redevelopment RSCH Bed capacity 3,519 acute inpatient beds across the STP. will increase as a 176 result of 3Ts and a l Average length of stay (AloS) increased between 2010/11 – 2016/17. proposed emergency BED OCCUPANCY oor redevelopment

l Over the last three years, the general and acute bed base has remained 15/16 93% 72% 85% 94% 89% 85% 88% 101% 62% Inpatient Beds relatively constant but bed occupancy has increased over time. 16/17 96%586 74%315 88%44 96%695 91%544 87%465 90%465 103%341 64%69 Demand must be l Bed capacity is expected to increase by 176 beds by 2023/24 at BSUH Royal Sussex Princess Royal East Surrey Worthing St Richards Conquest Eastbourne Queen managed to align County Royal Alexandra Hospital Hospital Hospital Hospital DGH Victoria as a result of the 3Ts rebuild. Hospital Hospital Childrens Hospital acute capacity and Hospital BSUH SaSH WSHT ESHT QVH demand and to l Elective referral rates are increasing across the system and longer prevent shortfalls lengths of stays are driving a significant elective backlog at all Trusts.

in available beds l Demand must be managed to align acute capacity and demand to meet the needs and to prevent shortfalls in available beds to meet the needs of the population. 60 of the population. 61 SUBHEAD STYLE OUR EVIDENCE

Average occupancy by quarter CARE QULITY COMMISSION (CQC) RATINGS Q1 2014 - Q3 2016 Brighton and Sussex University Hospitals NHS Trust (BSUH): The Trust Everything was was last inspected in April 2016 and updated in August 2016. CQC found rated as ‘good’ 100% them to be inadequate in the areas of safety, responsiveness and leadership. or ‘outstanding’, SES Weighted Average The culture of the Trust was viewed as exceptionally challenging. Since the England inspection, Western Sussex Hospitals NHS Foundation Trust has taken over apart from the the management of the BSUH and improvements have been seen in a Emergency 95% number of areas. Department at Eastbourne, East Sussex Healthcare NHS Trust: In June 2018, the CQC noted the Trust which was rated 90% has made a marked improvement in the quality of its care, and concludes that the Trust no longer needs to be in special measures for quality. In the areas as ‘requires inspected by the CQC, everything was rated as ‘good’ or ‘outstanding’, apart improvement’, but from the Emergency Department at Eastbourne, which was rated as ‘requires ‘good’ for well led 85% improvement’, but ‘good’ for well led and caring. and caring. SECAmb: Following CQC inspection in 2017 the Trust was rated as Inadequate. This resulted in the Trust remaining in Special Measures and the development of 80% a recovery plan that addresses CQC findings together with work across different Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 2014 2014 2014 2014 2015 2015 2015 2015 2016 2016 2016 areas of the Trust. This includes an overarching Culture and Organisational Development and an extensive programme of work dealing with workforce, recruitment, training and retention. CQC is conducting an inspection of the Trust in July (Core Services and Emergency Operations Centre) and August (Well Total general and acute bed base Q1 2014 - Q3 2016 Led) this year. The results of the inspection will be published in the Autumn. The work across the Trust is also being informed by a jointly commissioned Demand 1,000 and Capacity review to identify resource requirements to fully meet Ambulance Response Programme standards. 900

800 TRUST CQC RATING BSUH Good 700 ESHT Requires improvement 600 WSHT Outstanding BSUH 500 SASH Outstanding SaSH 400 QVH Good WSHT 300 SPFT Good ESHT SCFT Good 200 QVH FCH Outstanding 100 SB Good

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 SECAMB Inadequate 2014 2014 2014 2014 2015 2015 2015 2015 2016 2016 2016 62 IC24 Good 63 SUBHEAD STYLE OUR EVIDENCE

MENTAL HEALTH SERVICES l For dementia, prevalence is 25% higher than nationally, will increase The health and life outcomes for people experiencing mental health issues further as the population ages, while the proportion of those with a “My partners in our STP will continue to fall short of those of the general population diagnosis is 5% lower. mental health unless we act to deliver the opportunities aligned with the five year forward view for mental health. To meet the government target of 21,000 new l A quarter of those patients with dementia who are fit to leave acute and mine wasn’t mental health posts by 2021, the STP projected response is set out below care wait over 50 days for discharge. a priority after my stillborn, The Sussex and East Surrey STP has an agreed Mental Health Strategy l Three quarters of first episodes of mental ill health occur in young following a detailed Case for Change which identified that: people before the age of 25. they took slightly l Sussex and East Surrey STP need to ensure that 25% of people living better care but with common mental health problems are seen by a local Improved no mention of Access to Psychological Therapies service every year. KEY FACT Life expectancy for those with severe mental illness is twenty years’ mental care at any l Capacity needs to be built in primary care, closer to home and thereby worse than the general population appointments” reduce presentations and referrals to physical and mental health secondary care.

l The prevalence of Severe Mental Illness is 5% higher than nationally, GP SERVICES affecting 25,000 individuals. The National Picture Workload: Actual GP appointment numbers are not routinely collected by NHS England but the information we have would suggest significant rises, for instance 15.4% between 2010/11 and 2014/15. The Kings Fund (2016) estimated that there had been a 15 per cent overall increase in Posts People contacts, 13 per cent increase in face-to-face contacts and a 63 per cent 6000 increase in telephone contacts. Clinical posts: 446 169 Workforce numbers: Nearly a quarter (23%) of the GP workforce is over 5000 446 Impact 271 727 55. Less than a quarter (22%) of GP trainees plan to practise full-time Non-Clinical - 163 vacancy one year after qualifying, according to a recent study by the King’s Fund, 564 posts: 271 242 4000 difference 467 falling to 5% who expect to be working full time after 10 years. ‘The 501 501 636 312 intensity of the working day’ was cited as the most common reason. 3000 - 385 Staff in Post difference Morale: A 2017 survey conducted by Exeter University in the South West indicated that over half of the GP workforce reported low or very low 2000 morale, and 40% of all GPs intended to retire within five years.

Assumption Assumption Less than a modelled modelled Practice Closures: Increasing numbers of practices are either closing their

Mental Health Services - Posts and People 1000 on observed on observed Choice Choice trend Choice trend Choice Fixed Choice lists to new patients (a medium term approach) or capping their list (a quarter (22%) of 3,905 4,290 shorter term approach), in order to maintain the quality of the service to GP trainees plan 0 existing patients within the resources they have. 2016 New posts Transfer Leavers - Replace- Leavers - Improved Newly New roles Dynamic V Static inputs to practise full- in growth posts to Non ment Staff Clinical retention Qualified (Nurse areas transfor- Clinical (Local) Staff from Associates, time one year mation & training Physicians Estates Issues: A 2018 BMA Survey revealed that four out of 10 GPs feel growth Associates after qualifying areas Base Staff in Post Vacancies etc) their premises are not adequate for patient care, describing how they are 64 + Change - Change struggling to provide essential services in buildings that are cramped and 65 OUR EVIDENCE SUBHEAD STYLE

outdated. It also reported that six out of 10 GPs in England are forced to closure of a practice of 8,000 patients. The retirement of partners and Pressure through share consulting rooms or ‘hot-desk’ around their surgeries. salaried GPs has been a contribution factor to 16 practice closures and 10 retirement of mergers. STP examples partners and l Increasing elderly: The West Sussex Joint Services Needs Assessment (JSNA) l Utilising the GP international recruitment scheme has not delivered the volume salaried GPs estimates that the local population aged 70+ will grow at the fastest of new GPs anticipated. A target of 25 was set for 2018 but has been a rate of any demographic; and that by 2039 more than 30% of the CCG only five have been recruited. contributing resident population will be aged 65 or over. They also project that this means that the number of adults in this age group admitted to hospital factor to 16 with falls will nearly double over the same period. There are already OUR SERVICES – KEY FACTS practices closing some small areas of West Sussex where more than 50% of the resident l Our pathways are often fragmented and there are frequent breakdowns in and 10 mergers population are aged 65 or above. Between 2018 and 2030 the JSNA handoffs between agencies. predicts that the number of cases of dementia will rise by 45%. since 2013 l There are delays in people accessing services and therefore may be missing l Workforce: According to NHS England figures, in 2015 there were 960 full out on timely treatment. time equivalent (FTE) GPs across East Surrey and Sussex. In order to deliver the growth required to deliver our proportion of the 5,000 extra GPs l There is a lack of timely access to effective primary and community services promised in the GP Forward View we would need to boost that to 1106 driven by insufficient capacity in primary care and community services. FTE GPs (so an increase of 146) . However the GP FTE across the patch as of Sept 2017 number 936 – a fall of 24 FTE, or 170 short of the target l Discharge arrangements from acute care is variable, which means patients 1106. Figures for nurses seem to be broadly stable, GP Nurses FTE as of spend longer than necessary in hospital. There are gaps in Sept 2015 numbering 502, and as of June 2018, 522. Large percentage reaching minimum of both practice nurses and GPs in our area that are over 55 and coming l We are often not meeting our constitutional standards for A&E, Referral – up to retirement. It is anticipated that there will be a loss of a third of GPs to-Treatment. standards of care over next 10 years as they reach 55+. The retirement risk in ESBT is 46% of in such areas as practice nurses in Hastings and Rother and 31% in Eastbourne, Hailsham l There are gaps in reaching minimum standards of care in such areas as stroke, stroke, diabetes and Seaford age 55+ with GPs 55+ at 24% in Hastings and Rother and diabetes and cancer. and cancer. 17% in Eastbourne, Hailsham and Seaford. Currently 210 GPs (18.5% of the workforce) are over 55 years. l General practice is facing significant issues in workforce with a backdrop of increasing demand l The STP has 203 practices. There are 12 single-handed GP practices and 189 partnerships, with the smallest registered list of 1,379 and the largest MAIN CHALLENGES: being 25,054. Pressure through retirement of partners and salaried GPs l Addressing the significant un-warranted variation in MSK, Cardiovascular and has been a contributing factor to 16 practices closing and 10 mergers falls/ fragility fractures. since 2013. The GP workforce across the STP is in decline, of between 3% in the Coastal West Sussex area to 15% in Hastings and Rother CCG. l Making a step change in managing flow, stranded and super stranded In Brighton, nine surgeries (out of an initial total of 44) have closed in patients. the last four years, displacing more than 33,000 patients, and putting extra pressure on already-struggling practices nearby. Brighton has been l Improving shared decision making. described in the press as possibly ‘the hardest hit town in the whole of the UK?’ In Hastings and St Leonards, at one point in the last 12 months 10 THE CONSEQUENCE WE OBSERVE: out of 14 practices had either closed or capped their patient lists, putting l Frequent, unnecessary admissions to hospital when patients could be cared for enormous pressure on the remaining practices. In Arun in Coastal West in a different setting. 66 Sussex, three out of six practices have had to cap their lists due to the 67 l Challenge in meeting and maintaining A&E and elective care targets. OUR EVIDENCE OUR EVIDENCE

Our evidence: Our staff l In social care there is a significant annual turnover of 26% for registered nurses, which rises to 32% turnover amongst support Difficulty OUR PEOPLE - OUR CHALLENGES workers providing direct care in East Sussex. recruiting and retaining l Skills for care estimates that in Brighton & Hove, 8.6% of roles in adult CROSS RECRUITMENT LEADERSHIP STAFF substantive CUTTING social care were vacant, this equates to around 700 vacancies at any & RETENTION CAPABILITY HEALTH THEMES one time. This vacancy rate was similar to the region average, at 6.8% mental health and similar to England at 6.6%. nurses and

l Difficulty recruiting and retaining substantive mental health nurses and psychiatrists, has CROSS COLLABORATIVE USE OF STAFF CUTTING WORKING TEMPORARY psychiatrists, has led to a sustained and increasing agency spend (in led to a sustained ENGAGEMENT THEMES ACROSS STP STAFF Sussex agency spend in mental health services was £2.6m in 2012/13 and increasing rising to £9.8m in 2015/16). agency spend

CROSS LACK OF REDUCTION IN SIGNIFICANT l In June 2017, the SES STP had a shortfall of GPs (FTE) of 193. CUTTING SPECIALIST EDUCATION VARIATIONS IN THEMES POSTHOLDERS FUNDING WORKFORCE l The average level of sickness absence across acute trusts for 2014-15 was just over 4%. Just a 1% improvement in sickness absence equates to £280m in staff costs – without accounting for lower dependence on

CROSS MENTAL HEALTH PRIMARY & ACUTE SECAMB SOCIAL CARE agency staff and reduced cancellations. LOCAL CUTTING Recruitment and COMMUNITY Reliance on High attrition Finding & THEMES CARE retention of staff temporary staff Attraction to keeping the right l Spend on temporary staffing continues to increase. Culture of Lack of GPs Mode/hospital skilled roles staff (current & working in variations Culture Terms & mental health future) conditions of Nursing, Leadership KEY ISSUES: Complex Demographic of midwifery, service structures and workforce medical and AHP Job roles l We have significant issues relating to workforce and need to ensure we links to social Cross site recruitment Working have the right people in the right place at the right time to deliver care. care working/ conditions collaboration New roles l required to Given our demography, we need to rely as much on technology- meet increasing enabled care as on state funded clinical and domiciliary workforce. demand There just won’t be as many employees available in future as would be needed to provide current services to a larger population with more KEY FACTS retired people and not many more working-age citizens. l There are 10,926 headcount staff and 9,375.90 FTE Registered Nursing, Midwifery and Health Visiting Staff across Sussex and East Surrey STP. l We have an inadequate number of mental health posts to meet the needs of our population. l The average retirement age is 59, with 15.38% of staff aged 55 years and over. The staff groups with over 20% of staff aged 55 and over l We need to increase the workforce within Primary Care to support that may be approaching retirement ranges from Registered School changes to the way we deliver care across the system. Nurses at 31% to Community Services (excl. Health Visitors and District Nurses) at 20.68%. THE CONSEQUENCES WE OBSERVE: l There is a real risk that we are failing to attract and retain the best talent. l The Turnover Rate for all Registered Nursing, Midwifery and Health Visiting Staff ranges from 12.84% in Maternity Services (excl. l There is a significant risk to the resilience of services and the 68 Registered Midwives) to 20.29% in district nursing. sustainability of a workforce. 69 OUR EVIDENCE OUR EVIDENCE

Our evidence: Our infastructure DIGITALISATION Significant Individual Digital Maturity of secondary care providers is broadly in line elements of the ESTATES with national average with evidence of improvement over the past year. estate are either There is a diverse legacy of primary, community and acute provider estate However the maturity levels between providers vary significantly. across the STP. functionally There is significant variation in technology usage across the STP with unsuitable or Historically there have been many years of under-investment in estate, limited consolidation of suppliers except for PACS (Picture and compromised which has resulted in non-compliance, high backlog maintenance and Communication System) for Radiology, which represents a significant inefficient estate with high running costs. opportunity. in the current

configuration Significant elements of the estate are either functionally unsuitable or There is a lack of effective information sharing which presents a significant compromised in the current configuration. barrier to implementing new models of care.

There is multiple ownership of the estate, which ranges from NHS acute Population Health Management and Risk Stratification are fragmented and community provider organisations, GP partners, NHS Property and vary in use and sophistication. Services, third party commercial landlords, public/private partnerships to local authority partners. The information governance community is capable and enthusiastic, but capacity is variable and is a limited resource overall. There is a lack of formal lease/licence agreements in place resulting in ambiguity over estates running costs, occupation and utilisation information. Clinicians and professionals lack clarity and confidence to support information sharing. Estates running costs are higher than the national “Carter” benchmark indicators. Key high cost acute sites include the Royal Sussex County Digital Maturity - Secondary Care Sussex and East Surrey 2016 Hospital, St Richards Hospital, Worthing Hospital, East Surrey Hospital and Sussex and East Surrey 2017 Eastbourne District General Hospital. There is also a substantial backlog 100 maintenance requirement across the acute and community estate, with high and significant risk elements exceeding £81million (excluding primary care and NHS Property Services community estate). 75

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Records Strategy Information Orders & Remote & Asset & Business & Leadership Resourcing Governance Assessment Transfer of Medicine Decision Enabling Standards Alignment Governance Results Assistance Resource Clinical & Plans Care Optimisation Support Infrastructure 70 Management Care Optimisation Intelligence 71 SUBHEAD STYLE OUR EVIDENCE

FINANCE OUR INFRASTRUCTURE – KEY FACTS Current situation: The STP covers a wide geographical area and many There is a multiplicity of IT system many of which do not communicate Our community organisations, with a notable amount of variation in financial to each other. and primary care performance. In 2017/18, seven out of nine Trusts ended the year in assets are not surplus. The two trusts in deficit - East Sussex Healthcare NHS Trust and l We have Information Governance issues. Brighton and Sussex University Hospitals NHS Trust - are in Financial optimised or Special Measures. Of eight CCGs in the footprint, one ended the year in l There is a significant mismatch between revenue and expenditure. necessarily fit for surplus. Overall the combined net deficit (surpluses and deficits added purpose. together) for CCGs and trusts was £228.2m. It should also be noted that l We have higher use of acute services that are proportionally this figure includes significant amounts of one-off funding, including more expensive. Sustainability and Transformation Funding, which was released at the end of the year. l Our community and primary care assets are not optimised or necessarily fit for purpose. 2018/19 planning: Control totals (the required surplus/deficit set by regulators) for 2018/19 add up to a total net deficit of £185.8m for CCGs Main challenges: and Trusts, including one-off sustainability funding for providers. An l The provision of a balanced estate portfolio that is fit for purpose additional £111.6m of commissioner sustainability funding is available to in a constrained capital environment and meets the needs of those CCGs that meet their deficit control totals. the population.

Strategic Financial Framework: The STP has a Strategic Financial l Achieving a sizable reduction in the current deficit position of the STP. Framework that sets out the approach to system-wide financial sustainability over a 5-year time horizon. It is comprised of four elements: l Rising to the Digital requirements as a priority. l Improving productivity and efficiency The consequence we observe: l Delivering the right care to improve value l Duplication in processes.

l Transforming and investing for change l Inability to maximise use of technology for patient benefits.

l Improving system contracting/admin

These elements are progressed through 11 STP programme priority areas and supported by four enabling work streams.

The STP five-year financial model brings these aspects together and calculates their combined medium to long-term financial impact, taking account of risk, to allow financial sustainability to be assessed. This is updated iteratively to reflect the progress and evolution of ongoing transformation work, and to allow reassessment of its financial impact.

72 73 OUR PRIORITIES OUR PRIORITIES

l Reduced productivity. Our priorities l We cannot afford to continue to pay for services at the current rate. 5. Reducing A&E attendances through ensuring the resources are available The evidence presented in the Population Health Check naturally leads to to support patients nearer home, including addressing fragmented pathways, gaps in service availability, communication across services, the following priorities. mental health support and digital shortfalls which block shared access to information. Make navigating the system easy for the public and l Addressing capacity and demand encourage the development of advance and anticipatory care plans which are accessible to all who need to see them. l Tackling unwarranted clinical variation

l Focussing on workforce

l Moving to a people centred value based system

l Reducing the financial deficit

We need to deliver value across our STP i.e. the best outcomes for the individual and for our population within the available resources. This includes doing less of things that add little or no value to patients. This includes reducing the over – medicalisation of care.

This requires: 1. The development and implementation of a clear workforce and capacity strategy, which will address the short-term and long term (future-proofing) crisis in relation to the number of staff and skills.

2. Improving shared decision making i.e. more active involvement with well-informed patients and developing and using standardised outcome measures that are more relevant to patients (such as the impact on their functional status and wellbeing).

3. Leading the reframing our cultural norms, so that making the right choice in relation to lifestyle changes, is the easy choice. This includes putting initiatives, such as “Making Every Contact Count” and healthy eating, into relevant contracts to deliver the highest standards of work- based health.

4. Recognising unwarranted clinical variation and addressing it. We can achieve this through the combination of Right Care, Clinically Effective Commissioning and Getting it Right First Time (GIRFT) all of which 74 describe key clinical areas where Quality Improvement is required. 75 NEXT STEPS NEXT STEPS

length of stay and bed occupancy (note the Carnell Farrar data and information provided by Rightcare), and the consequent opportunity this An empowered Next steps affords the STP. This provides both the immediate case for change and the and more initial targets. digitally aware and competent We need to develop a clinical strategy which delivers “best value” and Eric Topol is conducting his review with Health Education England for the patient centred care. Secretary of State on how technology will impact care and the training of population carers. This review builds on Facing the Facts, Shaping the future (Health will demand at Education England, December 2017) and starts with acknowledging that the least that PERSON CENTRED APPROACHES FRAMEWORK (SKILLS FOR the pace of development of genomics, digitisation and data analytics, HEALTH/SKILLS FOR CARE/HEALTH EDUCATION ENGLAND) machine learning and AI, biotech, nanotech and robotics is game the medical changing. information

VELOPMEN H DE T OF known about OUG THE HR W An empowered and more digitally aware and competent population will T OR AY LCEoAvers K them is recorded RNaItNio FO W S with Gns t R demand at the least that the medical information known about them IS E peop OoU e C H OM le TnCg E T C Oag , in a way that N T Me O is recorded in a way that promotes their care. We already see both the I U E R K O S G R G A success and acceptability of care records that can be read by paramedics, O IN RS N promotes their U D RELA I W N AN TION S R IO ON SH A primary care and the emergency department. Advanced care decisions O A V TI I T E P I T A A B O care. L H IC U E N that are not paper based and don’t need to be sought and transferred

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e t length of stay has been demonstrated. s o t 3 Beyond this people will increasingly expect a better offering, more tailored 2 to them as an individual, responsive when they need it not batched for le ab en o provider convenience. Again, within this STP, there are models of care that L B s t E EH ion le A AV rsat op R IOU Conve pe are not face to face and are IT-enabled. These have reduced out-patient NI RS port NG and sup OU attendance, crowding in waiting rooms, and cost (e.g. Digital virtual TCOM ES clinics for people living with inflammatory bowel disease and Virtual Fracture Clinics in BSUH). Importantly they have left patients feeling better supported and better able to manage their long term conditions and stay motivated in their recovery. They provide a digital relationship and WE NEED TO DEVELOP A CLINICAL STRATEGY WHICH IS FUTURE connection to clinicians and healthcare professionals more suited to the PROOFED always on expectations of our digital selves. On a local level Sussex and East Surrey is facing significant challenges in providing sustainable care for its population. These challenges include The importance of the digital agenda has been underlined by the Prime financial pressures as well as workforce recruitment and retention minister in her Macclesfield speech. The Office for Life sciences (OLS) shortfalls. Much of this Population Health Check describes variation in has issued a variety of challenges and at the present time there are open consumption of healthcare, through variation in referral from primary calls for a second wave of digital and Internet of Things (IOT) test beds, 76 care, through to differences locally to peers in secondary care intervention, industrial strategy challenge funding, ageing grand challenges, an active 77 NEXT STEPS NEXT STEPS

call for new Collaborations of Leadership in Applied Health Research and WE NEED TO DEVELOP A CLINICAL STRATEGY WHICH IS CLEAR ON Brighton ranked Care (this time badged as Applied Research Collaborations). All of these THE OPTIMAL POPULATION SIZE TO LEAD DELIVERY particularly calls have tens of millions of pounds available to demonstrate new ways Some of the changes needed will be led and delivered locally, supported by of working, drawing on modern and forward-facing technology, that the STP as the direction of travel. A few will be led by the STP organisations strongly in its deliver improved outcomes with a different kind of workforce. All require together, providing that adds value and does not duplicate local work. innovation for scalability and all require a legacy to be left locally. data, virtual reality, health Our STP contains a medical school, two universities, thoughtful and effective collaborations between health and social care, between E - REGIONAL & and artificial academia and industry and care. It has an abundance of small and EMERGENCY SYSTEM - ≈4.5M intelligence medium enterprises with Brighton & Hove ranked fourth in a new index despite being highlighting the size and success of digital industries around the country D - CLINICAL & and their potential for growth. Brighton ranked particularly strongly in relatively DIAGNOSTIC NETWORKS - ≈2.5M its innovation for data, virtual reality, health and artificial intelligence smaller than its despite being relatively smaller than its competitors. It has a strong record competitors of research and of education. It is bracketed by two STPs with similarly C - STP/SYSTEM WIDE - ≈1.75M strong records of new models of care (Kent vanguard, Surrey wave one Internet of Things test bed). Its hospitals already connect digitally around imaging and diagnostics. B - PLACE BASED CARE COMMUNITY - ≈500K

We also should not miss the link that investment in the local economy improves job prospects, affluence and helps mitigate the impact that A - LOCAL COMMUNITY TEAM - ≈30-50K poverty has on the health and wellbeing of our local population. There are strong digital and IT economic sectors already in our local economies with around 25% of Brighton & Hove’s economy is in the Creative Digital and BUSINESS LANDSCAPE IT sector which has seen 40% growth over the past 5 years, with strong academic relationships through the Digital Catapult and one of the first National Engagement Emergency System Partner Support Regional & Emergency System (E) 5G testbeds in the country. Surrey & Sussex Regional Diagnostics Population Health Clinical & Diagnostic In our quest to drive out waste and address historic financial over spend, Cancer Alliance Alliance Intelligence Networks (D) which is urgent, we will take the opportunity to work on models of care Operational Delivery Population Health Integrated Care/ wider STP/Urgent Care that put our people at the heart of new pathways. We must not lose Networks Management system pathways System (C) sight of this. Expert Opinion Capacity Planning & Integrated Urgent & Place Based Care & Diagnostics Coordination Emergency Care Community (B)

Prevention & Self Patient Identification MDTs Local Community Management & Care Planning Team (A)

78 79 NEXT STEPS NEXT STEPS

LOCAL COMMUNITY TEAM 30-50K THE PROCESS OF DEVELOPING THE CLINICAL STRATEGY (ADDED POST SIGN OFF. STP EXEC GROUP AGREEMENT) This Clinically- Prevention & Self Management Patient identification & care planning Multi-disciplinary Teams The Population Health Check provides the rationale for addressing certain led Strategy will l Falls prevention l Identifying frail & vunerable patients l Care coordination themes as priorities; it does not attempt to offer solutions. l Social prescribing l Developing and implementing care l Reablement describe how we l Health coaching plans l Bringing integrated Health and Social l Building knowledge & changing Care into the home In order to achieve that, we will now: will be moving behaviours l Develop a public-facing version of the report, which will include l Support for people to manage their forward on long term condition graphics and a visual explanation of the report for the open section of delivery of the Boards and Governing Bodies. priorities at pace. PLACE BASED CARE COMMUNITY ≈500K l Draft an engagement and communication strategy in order to ensure Expert Opinion & Diagnostics Capacity Planning & Coordination Integrated Urgent & Emergency Care we are engaging at the earliest opportunity on how to address the

l Timely diagnostics l Demand & Capacity Planning l A&E coordination themes identified. l Access to expert opinion l Transitions of care & patient flow l See and Treat l Timely assessment l Mental health liaison l Rapid response l Our Medical Directors and Chief Nurses will be discussing the report l Social care coordination l Single Point of Access l Community & capacity development l Telecare/health more widely internally with their clinical colleagues and with their Executive leads.

STP/WIDER SYSTEM ≈1.7M l We will be ensuring that co-dependent strategies, such as workforce, Operational Delivery Networks and Population Health Management Integrated Care/wider system pathways clinical networks digital technology, estates etc. are aligned with the Population Health

l Trauma l Population health planning l 111 Service Check and the developing Clinical Strategy. l Maternity l research and Evaluation l UEC l Vascular l Provider and collaboration l Mental Health l Develop a plan to deliver a Clinical Strategy within six months. This l Burns l Capacity (3Ts) l Clinical networks: specialist l Clinical variation Clinically-led Strategy will describe how we will be moving forward on cardiology, cardiac surgery, renal l Maternity delivery of the priorities at pace. dialysis, and paediatric surgery

l Have had an opportunity to contribute to its development. CLINICAL & DIAGNOSTIC NETWORKS ≈12.5 l Agree with the Population Health Check, including the next steps. Clinical & Diagnostic Networks Population Health analytics

l Surrey & Sussex Cancer Alliance l Sussex & Surrey Integrated Dataset l Are committed to championing the Population Health Check and l Radiology Network l Research and Evaluation l Pathology contributing to the development and delivery of the resulting Clinical l South East Clinical Networks Strategy.

REGIONAL & ≈1.7M

National Engagement Emergency System Partner Support

l NHS England l 999 & Ambulance Service l HEE KSS l NHS Improvement l care Plan Sharing service l KSS AHSN l NHS Digital l NIHR Clinical Research Network KSS l Specialist Commissioning l South East Coast Clinical Senate 80 81 AGREEMENT AGREEMENT

David Walker Medical Director East Sussex Healthcare NHS Trust 22/08/2018 Agreement from the Core Ed Pickles Medical Director Queen Victoria Hospital NHS FT 17/09/2018 Karen Eastman Clinical Lead for Unwarranted SES STP 12/09/2018 members of the STP Clinical Clinical Variation Fionna Moore Medical Director South East Coast Ambulance 29/08/2018 Services NHS FT and Professional Cabinet Des Holden Medical Director Surrey and Sussex Healthcare 02/10/2018 NHS Trust

Richard Quirk Medical Director Sussex Community NHS FT 13/09/2018 We would like to formally confirm our support for Rick Fraser Consultant Psychiatrist and Sussex Partnership NHS FT 30/08/2018 this Population Health Check. We confirm that we: Chief Medical Officer

Justin Wilson Chief Medical Officer Surrey and Borders Partnership 09/10/2018 l Have had an opportunity to contribute to its’ development NHS Trust

Sue Marshall Executive Chief Nurse Sussex Community NHS FT 13/09/2018 l Agree with the Population Health Check, including the next steps Jonathon Warren Chief Nurse Surrey and Borders Partnership Trust 22/08/2018 l Are committed to championing the Population Health Check and Liz Mouland Chief Nurse and Director of First Community Health and Care 21/08/2018 contributing to the development and delivery of the resulting Clinical Clinical Standards Strategy Patricia Brayden Medical Director St Catherine’s Hospice, Crawley 31/08/2018

Andrew Catto Medical Director IC24 31/08/2018

Name Title Organisation Date agreed Alison Taylor Deputy Medical Director NHSE 29/08/2018

Minesh Patel Clinical Chair (Co-chairperson) NHS Horsham and Mid Sussex CCG 25/09/2018 Allison Cannon Chief Nurse STP Commissioners 28/08/2018

Peter Larsen-Disney Clinical Director of 3Ts Brighton and Sussex 20/08/2018 Karen Devanny Chief Nurse and Director CSESCA 12/09/2018 (Co-chairperson) University Hospital NHS FT of Quality

Rob Haigh Medical Director Brighton and Sussex University 14/09/2018 Guy Boersma Managing Director KSS AHSN 17/09/2018 Hospitals NHS Trust Michael Bosch RCGP STP Ambassador and Alliance for Better Care 20/08/2018 George Findlay Chief Medical Officer/ Deputy Brighton and Sussex 02/10/2018 Alliance for Better Care GP GP Federation CEO University NHS Trust and Federation Western Sussex Hospitals NHS FT Anna Raleigh Director of Public Health WS CC-Evidence: Our Population 18/09/2018 David Supple Clinical Chair NHS Brighton and Hove CCG 05/09/2018 and Demographics

Gill Galliano Acting Lay Chair NHS Coastal West Sussex CCG 02/10/2018 Richard Brown Medical Director S&SLMCs 20/09/2018 Laura Hill Clinical Chair NHS Crawley CCG 05/09/2018

Elango Vijaykumar Clinical Chair NHS East Surrey CCG 25/09/2018

Martin Writer Clinical Chair NHS Eastbourne, Hailsham and 02/10/2018 Seaford CCG

David Warden Clinical Chair NHS Hastings and Rother CCG 13/09/2018 82 Elizabeth Gill Clinical Chair NHS High Weald Lewes Havens CCG 25/09/2018 83 AGREEMENT CONTRIBUTORS

Agreement from the Core Contribution list

members of the STP Clinical List of colleagues who have received and have been given the opportunity to contribute to the Population and Professional Cabinet Health Check so far

We would like to formally confirm our support for Bob Alexander STP Executive Chair SES STP this Population Health Check. We confirm that we: Bruce Allan GP Worthing Medical Group Sam Allan Chief Executive SPFT

l Have had an opportunity to contribute to its development Helen Atkinson Executive Director of Public Health and Head of Surrey County Council Adult services

l Agree with the Population Health Check, including the next steps Michael Bailey STP workforce Project lead SES STP

Gaynor Baker STP Estates Lead SES STP

Paul Bennett Delivery and Improvement Director NHSI (SE) Name Title Organisation Date agreed Sarah Billiard Chief Executive First Community Health and Care Lawrence Goldberg Chair South East Clinical Senate 20/08/2018 Michael Bosch RCGP STP Ambassador and Alliance for Better Alliance for Better Care GP Care GP Federation Federation

Guy Boersma Managing Director KSS AHSN

Patricia Brayden Medical Director St Catherine’s Hospice, Crawley

Karen Breen TP Programme Director SES STP

Richard Brown Medical Director Surrey and Sussex LMC

Jessica Britten Chief Operating Officer ESBT

Adrian Bull Chief Executive ESHT

Allison Cannon Chief Nurse STP Commissioners

Andrew Catto Medical Director IC24

Jacqueline Clay Principal Manager West Sussex Public Health and Social Research Unit

Karen Devanny Chief Nurse and Director of Quality CSESCA

Sarah Doffman Chief of Medicine Brighton and Sussex University Hospital NHS FT

Adam Doyle Accountable Officer CSESA and CWS CCG 84 Karen Eastman Lead for Unwarranted Clinical Variation SES STP 85 CONTRIBUTORS CONTRIBUTORS

Fiona Edwards Chief Executive Surrey and Borders NHS Trust Ralph McCormack Programme Director – Commissioning Programmes STP

Amanda Fadero Director Coastal Care Liz Mouland Chief Nurse and Director of Clinical Standards First Community Health and Care

George Findlay Chief Medical Officer/ Deputy CEO Brighton and Sussex University Minesh Patel CCG Clinical Chair and Co-chairperson of the SES NHS Horsham and Mid Sussex Hospitals NHS Trust STP Clinical and Professional Cabinet CCG Western Sussex Hospitals NHS FT Maggie Patching Workforce Transformation Lead HEKSS

Pennie Ford Director of Assurance and Delivery NHSE (SE) Amanda Philpott Accountable Officer HR CCG and EHS CCG

Rick Fraser Consultant Psychiatrist and Chief Medical Officer Sussex Partnership NHS FT Ed Pickles Medical Director Queen Victoria Hospital NHS FT

Darrell Gale Director of Public Health East Sussex County Council Mark Preston Director of Organisational Development & People SASH

Elizabeth Gill Clinical Chair NHS High Weald Lewes Havens Richard Quirk Medical Director Sussex Community NHS FT CCG Anna Raleigh Director of Public Health and co-ordinating lead West Sussex CC Rachel Gill Consultant in Public Health Surrey County Council for SES STP DsPH input

Lawrence Goldberg Chair South East Clinical Senate Rosalind Ranson Primary Care Lead IC24

Marianne Griffiths Chief Executive WSHT and BSUH Nicola Rosenberg Public Health Consultant BH CC

Tom Gurney Communications Lead SES STP Paul Simpson Chair SES STP Finance Group

Rob Haigh Medical Director Brighton and Sussex University Ashley Scarff Director of Commissioning & Deputy Chief Officer HWLH CCG Hospitals NHS Trust Sam Stanbridge Director of Commissioning East Surrey CCG (CSESA) Des Holden Medical Director Surrey and Sussex Healthcare NHS Su Stone Clinical chair NHS Coastal West Sussex CCG Trust David Supple Clinical Chair NHS Brighton and Hove CCG Laura Hill Clinical Chair NHS Crawley CCG Alison Taylor Deputy Medical Director NHSE Jackie Huddleston NHS England – South East (Kent, Surrey, Sussex) NHS England – South East (Kent, Surrey, Sussex) Tim Taylor Medical Director Western Sussex Hospitals NHS FT

Caroline Huff Clinical Programme Director SES STP Sarah Valentine Strategic Director of Contracting & Performance Sussex & East Surrey CCGs

Steve Jenkin Chief Executive QVH David Walker Medical Director East Sussex Healthcare NHS Trust

Maggie Keating STP UECN Senior Programme Manager SES STP David Warden Clinical Chair NHS Hastings and Rother CCG

Peter Kottlar Chief Operating Officer East Surrey CCG (CSESA) Jonathan Warren Chief Nurse Surrey and Borders Partnership Trust Peter Larsen-Disney Clinical Director of BSUH 3Ts and Co-chairperson Brighton and Sussex University of the SES STP Clinical and Professional Cabinet Hospital NHS FT Mark Watson Digital Programme Manager SES STP

David Lipscomb Chair Diabetes Oversight Group Sussex and Surrey STP SCFT Justin Wilson Chief Medical Director Surrey and Borders Partnership NHS FT Hugo Luck Associate Director of Operations HWLH CCG and CSESA (S) Michael Wilson Chief Executive SASH Nick Lake Deputy Medical Director SPFT Martin Writer Clinical Chair NHS Eastbourne, Hailsham and Vaughan Lewis Medical Director Specialised Commissioning NHS South NHSE Seaford CCG Susan Marshall Chief Nurse Sussex Community NHS FT Elango Vijaykuma Clinical Chair NHS East Surrey CCG Siobhan Melia Chief Executive SCFT

Alistair Hill Director of Public Health BH City Council 86 Fionna Moore Medical director South East Coast Ambulance Services NHS FT 87 REFERENCES REFERENCES

ESBT (East Sussex Better Together) (Nov 2016) The Case for Change in East Sussex (Accountable Care) References/bibliography http://news.eastsussex.gov.uk/east-sussex-better-together/wp-content/uploads/ sites/10/2016/11/The-Case-for-Change-in-East-Sussex-Accountable-Care.pdf Eastman, K (2017) Presentation to the SES STP Clinical Board. Available on request. Gonnering RS and Riley WJ (2018) Robert Wood Johnson and University of Wisconsin Population Health Institute: Health Outcomes and Health Factors. https://link.springer.com/chapter/10.1007/978-3-319-73636-5_13 Alzheimer’s Society (2009) Counting the cost: Caring for people with dementia on hospital wards. Hunt, Jeremy (2015) ‘New Deal for General Practice’. https://www.alzheimers.org.uk/sites/default/files/2018-05/Counting_the_cost_ https://www.gov.uk/government/speeches/new-deal-for-general-practice report.pdf House of Commons Library (2015) BMA (2018) GP premises not fit for patients. https://publications.parliament.uk/pa/cm201516/cmselect/cmhealth/408/40807.htm https://www.bma.org.uk/news/2014/july/gp-premises-not-fit-for-patients Kings Fund (2009) General Practice in England. Carnell Farrer (CF) (March 2017) Acute services work stream: demand and https://www.kingsfund.org.uk/sites/default/files/General-practice-in-England-an- capacity review. (On application STP Office) overview-Sarah-Gregory-The-Kings-Fund-September-2009.pdf Carnell Farrer (CF) (April 2017) Sussex and East Surrey STP review and Kings Fund (2015) Place-based systems of care: A way forward for the NHS refresh. Summary report. (On application STP Office) in England. www.kingsfund.org.uk Carnell Farrer (April 2017b) Capped expenditure process information for benchmarking and opportunities. Available on application Kings Fund (2016) Understanding pressures in General Practice. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/ Carter, (2016) (DoH) Operational productivity and performance in English Understanding-GP-pressures-Kings-Fund-May-2016.pdf NHS acute hospitals: Unwarranted variations. An independent report for the Department of Health by Lord Carter of Coles Kings Fund (2018) Through the eyes of GP trainees: workforce of the future https://www.gov.uk/government/uploads/system/uploads/attachment_data/ https://www.kingsfund.org.uk/blog/2018/08/gp-trainees-workforce-future file/499229/Operational_productivity_A.pdf National Palliative and End of Life Care Partnership (20150 Ambitions for Central Sussex and East Surrey Alliance (2016) Place Based Delivery Plan Palliative and End of Life Care. http://www.brightonandhoveccg.nhs.uk/sites/btnccg/files/files/CSESA%20Place%20 http://endoflifecareambitions.org.uk/wp-content/uploads/2015/09/Ambitions-for- Based%20Plan%20FINAL.pdf Palliative-and-End-of-Life-Care.pdf CSESA Primary Care Cornerstone of the PBP, (2016) Available on application Nuffield (2017) Shifting the Balance of Care. https://www.nuffieldtrust.org.uk/files/2017-02/shifting-the-balance-of-care-report- Coastal Care (2016): Inspiring healthy communities together web-final.pdf https://www.coastalwestsussexccg.nhs.uk/building-first-class-health-and-care- system-for-sussex-and-east-surrey NHSE (2018) https://www.england.nhs.uk/integratedcare/stps/faqs/ Coastal Care (2017) Coastal Care Delivery Plan (2017) on application NHS Rightcare (2016) Commissioning for Value Focus pack: cardiovascular Dahlgren and Whitehead (1991) Determinants of Health, Dahlgren, G., & disease. Whitehead, M. (1991). Policies and strategies to promote social equity in https://www.england.nhs.uk/rightcare/intel/cfv/data-packs/south/#21 health. Stockholm: Institute for Future Studies. Google Scholar NHS Rightcare (2016b) Commissioning for Value pack: Long Term Conditions https://www.england.nhs.uk/rightcare/products/ccg-data-packs/long-term- DoH (2016) (Professor Tim Briggs: The Future of Commissioning for Planned conditions-packs/#south Surgery Getting it right for orthopaedics Learning from the first round of ‘Getting it Right First time’ NHS Rightcare (2017) Tools and Techniques. http://www.futurefocusedfinance.nhs.uk/sites/default/files/media-posts/163299_ ESBT (East Sussex Better Together) (2014): Commissioning a sustainable, Tools%20%26%20Techniques.pdf integrated health and social care system that best meets population need http://www.eastbournehailshamandseafordccg.nhs.uk/intranet/resources/east- NHS Rightcare (2017b) Mental Health conditions packs 88 sussex-better-together/ https://www.england.nhs.uk/publication/mental-health-conditions-packs-2017-south/ 89 REFERENCES REFERENCES

NHSE (2016) Better Births: Improving outcomes of maternity services in SE Clinical Senate (2016) Reducing avoidable hospital based care: re-thinking England. A Five Year Forward View for maternity care. out of hospital clinical pathways. https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity- [email protected], www.secsenate.nhs.uk review-report.pdf SE Clinical Senate (2017a) Emphasising Quality, delivering value. PHE-Public Health England (2017a) Public Health outcomes framework. [email protected], www.secsenate.nhs.uk http://fingertipsreports.phe.org.uk/public-health-outcomes-framework/e10000011. SE Clinical Senate (2017b) Improving Clinical Communications Between pdf Primary and Secondary Care Clinicians: A review and recommendations for PHE-Public Health England (2017b) Public Health outcomes framework. the Sussex and East Surrey STP. http://fingertipsreports.phe.org.uk/public-health-outcomes-framework/e10000011. [email protected], www.secsenate.nhs.uk pdf SE Clinical Network (2017) Sussex and East Surrey Local Maternity System PHE-Public Health England (2017c) Public Health outcomes framework. (LMS): 10/05/2017: Laura Ansboro presentation. Available on application. http://fingertipsreports.phe.org.uk/public-health-outcomes-framework/e10000011. Skills for Health/Skills for Care/Health Education England (2017) Person- pdf Centred Approaches. Empowering people in their lives and communities to PHE-Public Health England (2017d) Public Health outcomes framework. enable an upgrade in prevention, wellbeing, health, care and support. http://fingertipsreports.phe.org.uk/public-health-outcomes-framework/e10000011. http://www.skillsforhealth.org.uk/images/pdf/Person-Centred-Approaches- pdf Framework.pdf?s=form Public Health (2017) Local Alcohol profile. SPFT (April 2017) Clinical Strategy: The next steps in our journey 2017-2010. http://www.eastsussexjsna.org.uk/profiles http://www.sussexpartnership.nhs.uk/our-clinical-strategy PHE Public Health England (2016a) Health profile. Stevens, Simon (June 2016) speech to NHS Confederation. http://www.eastsussexjsna.org.uk/profiles https://www.england.nhs.uk/2016/06/simon-stevens-confed-speech/ PHE Public Health England (2016b) Health Profile STN (Sussex Trauma Network) (2017) Operational Policy. Available on http://fingertipsreports.phe.org.uk/health-profiles/2016/e06000043.pdf application. PHE Public Health England (2016c) Health Profilehttp://fingertipsreports.phe. Surrey and Sussex Cancer Alliance (March, 2017) – Delivery Plan: A high- org.uk/health-profiles/2016/e06000043.pdf level Cancer Transformation plan to ensure the sustainable development and delivery of cancer services. Available on request. PHE Public Health England (2016d) Health Profile http://fingertipsreports.phe.org.uk/health-profiles/2016/e06000043.pdf PHE, CQC, NHSE (2017) End of Life Care: STP Support tool. PULSE (2018) Revealed: 450 GP surgeries have closed in the last 5 years. http://www.pulsetoday.co.uk/news/hot-topics/stop-practice-closures/revealed-450- gp-surgeries-have-closed-in-the-last-five-years/20036793.article PULSE (2018) Brighton: the hardest hit town in the whole of the UK. http://www.pulsetoday.co.uk/news/hot-topics/postcards-from-the-edge/brighton- the-hardest-hit-town-in-the-whole-of-the-uk/20036786.article Simpson, P. and Holden, D (Jan 2017) Getting it right first time: orthopaedics – Model Hospital Data (available on application) SES STP (Sussex and East Surrey Sustainability and Transformation Plan). http://www.brightonandhoveccg.nhs.uk/search/site/Central%20Sussex%20 and%20East%20Surrey%20Alliance%20%282016%29%20Place%20Based%20 Delivery%20Plan SES STP Finance Group (2017) Capped Expenditure Process: Sussex & East Surrey STP: response stage #2. Available on application. SES STP (July 2017) Mental health in Sussex and East Surrey: the case for 90 change (v0.5) available on application 91 Sussex & East Surrey Sustainability & Transformation Partnership

Sussex & East Surrey Sustainability & Transformation Partnership

Sussex & East Surrey Sustainability & Transformation Partnership (STP) Sussex & East Surrey Copyright © 2019 Sussex and East Surrey Sustainability & Transformation Partnership Sustainability & Transformation Partnership Produced by [email protected] Published February 2019 All information correct at time of printing

Agenda Item: 14 Meeting: Board of Directors Meeting Date: March 2019 Report Title: Revised Finance and Performance and Quality Assurance Committee Terms of Reference Sponsoring Executive Director: Glen Palethorpe – Group Company Secretary Author(s): Glen Palethorpe – Group Company Secretary Report previously considered by The Quality Assurance Committee ToR has been considered and date: and recommend to the Board for approval by the Quality and Risk Committee in March 2019

The Finance and Performance Committee ToR has been considered and recommend to the Board for approval by the Finance and Investment Committee in February 2019 Purpose of the report: Information ☐ Assurance ☐ Review and Discussion ☐ Approval / Agreement  Reason for submission to Trust Board in Private only (where relevant): Commercial confidentiality ☐ Staff confidentiality ☐ Patient confidentiality ☐ Other exceptional circumstances ☐ Link to Trust Strategic Themes: Patient Care  Sustainability  Our People  Quality  Systems and Partnerships  Any implications for: Quality Financial Workforce Link to CQC Domains: Safe  Effective  Caring  Responsive  Well-led  Use of Resources ☐ Communication and Consultation:

Executive Summary:

The Quality and Risk Committee has reviewed its terms of reference to incorporate the activity of the Patient Experience and Feedback Committee to allow all aspects of quality to be considered in the one meeting thus removing the need for the separate patient experience and feedback committee. As part of the review the Committee is to be retitled to the Quality Assurance Committee. The Quality and Risk Committee reviewed the draft revised terms of reference and recommended these to the Board for approval.

The Finance and Investment Committee has reviewed its terms of reference to record that the Committee will consider performance recognising the strong linkage between performance and finance. As part of the review the Committee is to be retitled to the Finance and Performance Committee. The Finance and Investment Committee reviewed the draft revised terms of reference and recommended these to the Board for approval, subject to a small number of changes to provide clarity over the inter-relationship between the Finance and Performance Committee and the Audit Committee and to be explicit over the Finance and Performance Committee’s role in respect of the Trust’s capital plan. These changes have been made to the ToR attached to this paper.

Attached to these two Terms of Reference are those of the Audit Committee, Charitable Funds Committee and the Remuneration and Nomination Committee to allow the Board to see the full suite of Terms of Reference for all its Committees. Key Recommendation(s):

The Board is asked to APPROVE the Terms of Reference for the Quality Assurance Committee and the Finance and Performance Committee.

Appendix 1

WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST

FINANCE AND PERFORMANCE COMMITTEE

TERMS OF REFERENCE

1.00 PURPOSE

1.01 The purpose of the Finance and Performance Committee is to support the Board to ensure that all appropriate action is taken to achieve the financial and operational performance objectives of the Trust through regular review of financial and operational strategies and performance, investments, and capital and estates plans and performance.

1.02 The Committee shall also provide information to the Audit Committee and Quality Assurance Committee as appropriate to assist those Committees in ensuring good structures, processes, and outcomes across all areas of governance.

2.00 MEMBERSHIP AND ATTENDANCE AT MEETINGS

2.01 The membership of the Committee shall be:

• Chair: a nominated non-executive Director

• Two further nominated non-executive Directors

• Chief Executive

• Chief Financial Officer (co Lead Officer for the Committee)

• Director of Strategy and Delivery (co Lead Officer for the Committee)

• Chief Medical Officer

• Chief Nursing and Patient Safety Officer

• Chief Workforce and Organisational Development Officer

• Chief Operating Officer

2.02 The Trust Chair shall propose which non-executive Directors will be most suitable for nomination as Chair and members of the Committee. The Trust Board shall approve the appointment of the Committee Chair and members, based on the Chair’s recommendations. At least one of the Committee members should have recent and relevant financial experience.

2.03 Those normally in attendance at the Committee meetings shall be (as appropriate):

• Trust Director of Finance

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• Programme Director, Programme Management Office

• Group Director of Performance

Any member of the Board of Directors shall have the right to be in attendance at any meeting of the Committee by prior agreement with the Chair.

2.04 The executive members of the Committee may exceptionally send a deputy to the meeting but the deputy will not have voting rights at the meeting. Those who are in attendance may exceptionally send a deputy to the meeting.

2.05 Other Trust managers and clinicians may be invited to attend for particular items on the Agenda that relate to areas of risk or operation for which they are responsible.

2.06 The Group Company Secretary or their nominee shall act as Secretary to the Committee and shall attend to take minutes of the meeting and provide appropriate support to the Chair and Committee members.

3.00 ROLE AND RESPONSIBILITIES

AUTHORITY

3.01 The Committee shall have the delegated authority to act on behalf of the Board of Directors in accordance with the Constitution, Standing Orders, Standing Financial Instructions, and Scheme of Delegation. The limit of such delegated authority is restricted to the areas outlined in the Duties of the Committee and subject to the rules on reporting, both as defined below.

3.02 The Committee shall have delegated authority to award Contracts and approve Business Cases up to the value delegated to it by the Trust Board.

3.03 The Committee is empowered to investigate any activity within its Terms of Reference, and to seek any information it requires from staff, who are required to co-operate with the Committee in the conduct of its enquiries.

3.04 The Committee is authorised by the Board of Directors to obtain independent legal and professional advice and to secure the attendance of external personnel with relevant experience and expertise, should it consider this necessary. All such advice should be arranged in consultation with the Company Secretary.

DUTIES

Financial and Operational policy, management and reporting

3.04 To ensure the Trust develops and maintains an appropriate financial strategy in relation to both revenue and capital.

3.05 To consider the Trust’s annual financial plans and annual budgetary policy and proposals before submission to the Trust Board.

3.05 To ensure the Trust develops and maintains an appropriate operational strategy and annual plan in relation to Trust performance.

3.06 To consider the Trust’s annual operational plan and supporting proposals before submission to the Trust Board. Page 2 of 5

3.07 To commission and consider risk-based, in-depth reviews of financial performance (in particular service areas/Divisions or Trust-wide), including the relationship between underlying activity, workforce performance and utilisation, income and expenditure, and budgets.

3.08 To monitor all efficiency programmes, including to obtain assurance that no efficiency programme has an unforeseen detrimental impact on quality of care (linked to the work delivered through the Quality Committee) or on the performance of the Trust especially in respect of constitutional and key operational metrics; and to make recommendations as necessary to the Board about action required in-year.

3.09 To monitor all Workforce Transformation programmes, including to obtain assurance that no programme has an unforeseen detrimental impact on quality of care ((linked to the work delivered through the Quality Committee) or on the performance of the Trust especially in respect of constitutional and key operational metrics; and to make recommendations as necessary to the Board about action required in-year.

3.10 To receive assurances on the robustness of governance processes overseen by the Programme Management Office relating to Efficiency and Transformation programmes.

3.11 To consider proposals for major capital expenditure business cases and estates developments and their funding sources and to make recommendations to the Board as appropriate.

3.12 To commission any necessary reviews of strategic finance and performance issues affecting the Trust, and to review the results before submission to the Board.

3.13 To review, as necessary, the efficacy of the financial and operational control processes that support the Trust’s financial statements and the disposition of its funds and assets, and refer any concerns to the Audit Committee.

3.14 To monitor and receive assurances on the robustness of the Trust’s main income sources, the contractual safeguards, and efficiency programmes, and to make reports to the Audit Committee and the Board as appropriate.

3.15 To receive and scrutinise, as appropriate, reports on ‘commercial’ activities of the Trust and to make recommendations to the Board as appropriate.

3.16 To review, as necessary and receive assurance over the data quality systems and processes that support the Trust’s operational performance reporting.

3.17 To receive reports on changes in statutory and regulatory requirements that fall under the remit of the duties of the Committee.

Cash management and reporting

3.18 To approve the Trust’s cash management policy.

3.19 To receive regular reports on the Trust’s cash position.

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Procurement strategy and policy

3.20 To review the Trust’s procurement strategy and policies on a regular basis and to make recommendations to the Board.

3.21 To consider any significant variations to the Trust’s existing procurement methodology as set out in the Trust’s Standing Orders and Standing Financial Instructions.

Capital programme

3.22 To review and approve the Trust’s capital programme.

3.23 To monitor progress and risks associated with the delivery of this programme and to escalate to the Board any significant risks within its delivery and to the Quality Assurance Committee

Estates strategy

3.23 To review the estates strategy and recommend it to the Board, and to monitor progress against and risks associated with the strategy, and monitor other estates-related improvement plans.

3.24 Where appropriate, to make recommendations to the Board on necessary actions or approvals relating to the matters in this section.

Information management and technology

3.25 To review the IM&T strategy and recommend it to the Board, and to monitor progress against and risks associated with the strategy, and monitor other IM&T-related improvement plans

3.26 Where appropriate, to make recommendations to the Board on necessary actions or approvals relating to the matters in this section.

Organisational controls

3.27 In support of the Audit Committee, the Committee will report to the Audit Committee any identified risks to the adequacy and effectiveness of the Trust’s financial and operational performance reporting frameworks.

3.28 To make arrangements to ensure that all Board members maintain an appropriate level of knowledge and understanding of key financial issues affecting the Trust.

3.29 To examine any other matter referred to the Committee by the Trust Board.

3.30 To review draft Trust policies pertaining to the Committee’s function prior to their being considered by the Board.

REPORTING AND RELATIONSHIPS

3.31 The Committee shall be accountable to the Board of Directors of the Trust.

3.32 The Committee shall make recommendations to the Board of Directors concerning any issues that require decision or resolution by the Board.

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3.33 The Committee shall refer to the Audit Committee any matters requiring review or decision- making in that forum.

3.34 The Committee chair will provide annually a report to the Board detailing how the Committee has discharged its Terms of Reference.

3.35 The Committee shall review its own performance, constitution and terms of reference at least every two years to ensure it is operating at maximum effectiveness. Any proposed changes to the terms of reference should be agreed by the Trust Board.

4.00 CONDUCT OF BUSINESS

4.01 The Committee shall conduct its business in accordance with the Standing Orders of the Trust.

4.02 The Committee shall be deemed quorate if there are at least two non-executive Directors and two executive Directors present, one of whom should be either the Chief Executive or Director of Finance. A quorate meeting shall be competent to exercise all or any of the authorities, powers and duties vested in or exercised by the Committee.

4.03 The Committee shall meet not less than six times in each financial year.

4.04 At the discretion of the Chair of the Committee business may exceptionally be transacted through a teleconference provided all parties are able to hear all other parties and where an agenda has been issued in advance, or through the signing by every member of a written resolution sent in advance to members and recorded in the minutes of the next formal meeting.

4.05 Agendas and briefing papers should be prepared and circulated in sufficient time for Committee Members to give them due consideration.

4.06 Minutes of Committee meetings should be formally recorded and distributed to Committee Members within 10 working days of the meetings. Subject to the approval of the Chair, the Minutes will be submitted to the Trust Board at its next meeting and may be presented by the Committee Chair. The Committee Chair will draw to the attention of the Board any issues that require disclosure to the full Board, or require executive action.

5.00 STATUS OF THESE TERMS OF REFERENCE

Reviewed by the Finance and Investment Committee 28 February 2019

Approved by Trust Board: 28 March 2019

Next Review: March 2021

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Appendix 2

WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST

QUALITY ASSURANCE COMMITTEE

TERMS OF REFERENCE

1.00 PURPOSE

1.01 The purpose of the Quality Assurance Committee is to support the Board in ensuring that the Trust’s management, and clinical and non clinical processes and controls are effective in setting and monitoring good standards and continuously improving the quality of services provided by the Trust in line with the principles and values of the Patient First programme.

1.02 The Committee will also support the Board in ensuring that the Trust manages comments, compliments, concerns and complaints from patients and the public in a sensitive and effective manner and that a process of organisational learning is in place to ensure that identified improvements are embedded within the organisational framework.

1.03 The Committee shall also provide information to the Audit Committee, when requested, to assist that Committee in ensuring good structures, processes, and outcomes across all areas of governance.

2.00 MEMBERSHIP AND ATTENDANCE AT MEETINGS

2.01 The membership of the Committee shall be:

• Chair: a nominated Non-executive Director

• Two further nominated Non-executive Directors

• Chief Medical Officer (the joint Lead Officer for the Committee)

• Chief Nursing and Patient Safety Officer (the joint Lead Officer for the Committee)

• Chief Operating Officer

• Chief Workforce and organisational Development Officer

2.02 Those normally in attendance at the Committee meetings shall be:

• Trust Medical Director

• Trust Nursing Director

• Head of Clinical Governance and Patient Safety

• One of either the Chief of Service. Head of Nursing or Divisional Director for each Clinical Division. From the four divisional representatives it is expected that two will be clinical.

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• Head of Patient Experience

• Director of Estates and Facilities

2.03 The Trust Chair shall propose which Non-executive Directors will be most suitable for nomination as Chair and members of the Committee. The Trust Board shall approve the appointment of the Committee Chair, based on the Chair’s recommendations.

2.04 Any member of the Board of Directors shall have the right to be in attendance at any meeting of the Committee by prior agreement with the Chair.

2.05 The executive members of the Committee may exceptionally send a deputy to the meeting but the deputy will not have voting rights at the meeting.

2.06 Other Trust managers and clinicians, and patients, members of the public or governors, may be invited to attend for particular items on the agenda that relate to areas for which they are responsible or on which the Committee requires advice or information.

2.07 The Group Company Secretary or their nominee shall act as Secretary to the Committee and shall attend to take minutes of the meeting and provide appropriate support to the Chair and Committee members.

3.00 ROLE AND RESPONSIBILITIES

AUTHORITY

3.01 The Committee shall have the delegated authority to act on behalf of the Board of Directors in accordance with the Constitution, Standing Orders, Standing Financial Instructions, and Scheme of Delegation. The limit of such delegated authority is restricted to the areas outlined in the Duties of the Committee and subject to the rules on reporting, both as defined below.

3.02 The Committee is empowered to investigate any activity within its Terms of Reference, and to seek any information it requires from staff, who are required to co-operate with the Committee in the conduct of its enquiries.

3.03 The Committee should challenge and ensure the robustness of information provided.

3.04 The Committee is authorised by the Board of Directors to obtain independent legal and professional advice and to secure the attendance of external personnel with relevant experience and expertise, should it consider this necessary. All such advice should be arranged in consultation with the Company Secretary.

DUTIES

Quality strategy, targets and outcomes

3.05 To review and recommend to the Board the Quality Strategy of the Trust, and to monitor progress against the strategy and other improvement plans such as improvement programmes within Patient First that may impact on clinical quality.

3.06 To ensure there are robust systems for monitoring clinical quality performance indicators within Divisions and to receive reports on clinical quality performance measures.

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3.07 Review and Monitor Quality Impact Assessments (QIA) relating to Efficiency and Transformation programmes to gain assurance that there will be no unforeseen detrimental impact on quality of care for patients.

3.08 In response to requests from the Board, or where appropriate as decided by the Committee, monitor the implementation of action/improvement plans in respect of quality of care, particularly in relation to incidents, survey outcomes (including Staff Survey) and similar issues.

Compliance and Regulation

3.09 To receive and consider the necessary action in response to external reports, reviews, investigations or audits (from DH, NHS I (Monitor), CQC, other NHS bodies) which impact on clinical quality or patient safety and experience.

3.10 To monitor the Trust’s responses to all relevant external assessment reports and the progress of their implementation, including the reports of the Care Quality Commission.

3.11 To receive a commentary on the CQC’s insight report in respect of the Trust and consider if the Trust’s quality risk profile should be amended as a result.

Clinical governance and risk management

3.12 Through reports from the (executive) Quality Board and by other means, monitor and obtain assurance as to the effectiveness of the processes, systems and structures for good clinical governance at the Trust, and to seek their continuous improvement.

3.13 To consider reports from Divisional Governance Reviews, to ensure that the reviews are effective and that actions arising from them are addressed in a timely and appropriate manner under the management oversight of the (executive) Quality Board.

3.14 To review the themes, trends, management, and improvements relating to serious untoward and other incidents, (both staff and patient).

3.15 To gain assurance that appropriate feedback mechanisms are in place for those raising incidents and that a culture of openness and transparency in respect of incident reporting is encouraged supporting the Speak Up agenda and to receive reports from the Freedom to Speak up Guardian.

3.16 To review regularly the Board Assurance Framework (including through in-depth reviews of specific risks) and the High Level Operational Risks with a significant potential for impact on the Trust’s quality risk appetite, and promote continuous quality improvement with regard to the management of clinical and non-clinical risk and the control environment throughout the Trust.

3.17 To receive and consider the Trust’s clinical governance and clinical and non-clinical risk management annual reports, and agree recommendations on actions for improvement.

3.18 To ensure there is a comprehensive clinical audit programme in place to support and apply evidence-based practice, implement clinical standards and guidelines, and drive quality improvement, including through approving and monitoring progress against the Clinical Audit Strategy.

3.19 To maintain oversight of research and innovation activity, ensuring that it is well governed and is focused on and delivers improvement in respect of the Trust’s clinical quality priorities.

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3.20 To consider reports from the Committee’s reporting groups, including the Quality Board. To consider these reports in the context of quality risks and assurances over the Trust’s system of internal control as reflected within the BAF.

3.21 To consider reports from the Trust’s Caldicott Guardian and Data Protection Officer where quality risks have been identified by them.

3.22 To consider reports from the Guardian of Safe Working in the context of the Trust’s quality, safety and patient experience processes.

3.23 To consider reports from the Health and Safety Committee and to gain assurance of the completion of action plans arising from areas of concern.

3.24 Where appropriate, to consider reports from other operational groups addressing improvement in patient care, and to monitor the completion of action plans arising from areas of concern.

Patient experience

3.25 To consider reports from the Customer Relations Team, the Patient Advice & Liaison Service and other sources of feedback (such as Healthwatch) on all formal and informal patient feedback, both positive and negative, and to consider action in respect of matters of concern.

3.26 To consider the results the issues raised and the trends in all patient surveys (including real- time patient feedback systems), of in-patients and out-patients activities and estate surveys such as PLACE that may impact on clinical quality, and to gain assurance of the development of robust improvement plans and the subsequent completion of action taken to address issues raised.

Complaints and reviews

3.27 To review the themes, trends, the management of, and the learning and improvements made relating to complaints.

3.28 To consider national reports from the Ombudsman, to identify matters of relevance requiring action within the Trust, and to make recommendations to the Board.

3.29 To review the complaints procedure in conjunction with the periodic review of the complaints policy.

Development, education and training

3.30 To consider reports on national and local surveys including the staff survey and GMC survey as they relate to clinical quality, and to monitor the implementation of action taken to address issues raised.

3.31 To ensure that medical, nursing and other staff recruitment, retention, development, education and training strategies and plans are aligned with and support the Trust’s quality strategy.

3.32 To ensure that other education and training-related issues, themes and trends are addressed, to promote high standards of care quality.

REPORTING AND RELATIONSHIPS

3.33 The Committee shall be accountable to the Board of Directors of the Trust.

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3.34 The Committee shall report to the Board after each of its meetings and make recommendations to the Board of Directors concerning any issues that require decision or resolution by the Board.

3.35 The Committee shall report as required to the other Trust Committees any matters that require the attention or decision of that Committee.

3.36 The Committee chair will provide annually a report to the Board detailing how the Committee has discharged its Terms of Reference. Any identified significant changes to the terms of reference must be subject to approval by the Trust Board.

4.00 CONDUCT OF BUSINESS

4.01 The Committee shall conduct its business in accordance with the Standing Orders of the Trust.

4.02 The Committee shall be deemed quorate if there are at least the Chair, one Non-executive Director, one Executive Director (which must be either the Chief Medical Officer or Director of Nursing & Patient Safety). A quorate meeting shall be competent to exercise all or any of the authorities, powers and duties vested in or exercised by the Committee.

4.03 The Committee shall meet at least four times in each financial year. The Chair may request an extraordinary meeting if he/she considers one to be necessary.

4.04 At the discretion of the Chair of the Committee business may exceptionally be transacted through other technologies provided all parties are able to hear all other parties and where an agenda has been issued in advance, or through the signing by every member of a written resolution sent in advance to members and recorded in the minutes of the next formal meeting.

4.05 Agendas and briefing papers should be prepared and circulated five working days before each meeting, to give sufficient time for Committee Members to give them due consideration.

4.06 Minutes of Committee meetings should be formally recorded and distributed to Committee Members within 10 working days of the meetings.

5.00 STATUS OF THESE TERMS OF REFERENCE

Reviewed by the Quality and Risk Committee 8 March 2019

Approved by Trust Board: 28 March 2019

Next Review: March 2021

Page 5 of 5

Appendix 3

WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST

AUDIT COMMITTEE

TERMS OF REFERENCE

1.0 PURPOSE

1.01 The purpose of the Audit Committee is to support the Board of Directors to deliver the Trust’s responsibilities for the conduct of public business and the stewardship of funds; to be responsible for providing assurance to the Board that appropriate systems of internal control and risk management are in place covering all corporate and clinical areas of the Trust; and to make recommendations to the Council of Governors on the appointment of external auditors.

1.02 The Committee shall seek to ensure that business is conducted in accordance with the law and proper standards; public money is safeguarded and properly accounted for; Financial Statements are prepared in a timely manner and give a true and fair view of the financial position of the Trust for the period in question; services are managed so as to secure economic, efficient and effective use of resources; and that reasonable steps are taken to prevent and detect fraud and other irregularities.

2.00 MEMBERSHIP AND ATTENDANCE AT MEETINGS

2.01 The membership of the Committee shall be:

• Chair: a nominated non-executive Director

• Two further nominated non-executive Directors

2.02 The Trust Chair shall propose which non-executive Directors will be most suitable for nomination as Chair and members of the Committee. The Board shall approve the appointment of the Committee Chair and non-executive members, based on the Trust Chair’s recommendations. (The Foundation Trust Code of Governance requires that the Committee should be composed of at least three independent non-executive Directors, at least one of whom has recent and relevant financial experience.)

2.03 Those normally in attendance at the Committee meetings shall be:

• Chief Financial Officer (the Lead Officer for the Committee)

• Chief Workforce and Organisational Development Officer

• External Auditors

• Internal Auditors

• Local Counter Fraud Specialist ( as appropriate) • Group Company Secretary

• Trust Director of Finance

Any member of the Board of Directors shall have the right to be in attendance at any meeting of the Committee by prior agreement with the Chair of the Committee.

2.04 Those who are normally in attendance may exceptionally send a deputy to the meeting.

2.05 Other managers and clinicians may be required to attend for particular items on the Agenda that relate to areas of risk or operation for which they are responsible.

2.06 The Chief Executive should be invited to attend at least annually to discuss with the Audit Committee the process for assurance that supports the Annual Governance Statement .

2.07 The Trust Chair shall not be a member of the Committee.

2.08 At least once a year the Committee should meet privately with the External Auditors, Internal Auditors and Local Counter Fraud Service

2.09 The Group Company Secretary or their nominee shall act as Secretary to the Committee and shall attend to take minutes of the meeting and provide appropriate support to the Chair of the Committee and Committee members.

3.00 ROLE AND RESPONSIBILITIES

AUTHORITY

3.01 The Committee shall have the delegated authority to act on behalf of the Board of Directors in accordance with the Constitution, Standing Orders, Standing Financial Instructions, and Scheme of Delegation. The limit of such delegated authority is restricted to the areas outlined in the Duties of the Committee and subject to the rules on reporting, both as defined below.

3.02 The Committee is empowered to investigate any activity within its Terms of Reference, and to seek any information it requires from staff, who are required to co-operate with the Committee in the conduct of its enquiries.

3.03 The Committee is authorised by the Board of Directors to obtain independent legal and professional advice and to secure the attendance of external personnel with relevant experience and expertise, should it consider this necessary. All such advice should be arranged in consultation with the Company Secretary.

DUTIES

Governance, Risk Management and Internal Control

3.04 The Committee shall assure itself that the Trust has established and maintains an effective integrated system of governance, risk management and internal controls, across the whole of the Trust’s activities (both clinical and non-clinical) that supports the achievement of the Trust’s objectives.

3.05 In particular, the Committee shall assure itself (either directly or through the work of the Quality and Risk Committee) of the accuracy, adequacy and effectiveness of: • All risk and control-related disclosure statements (in particular the Annual Governance Statement and relevant declarations of compliance with the requirements of Monitor and the Care Quality Commission), together with any accompanying statement from the Head of Internal Audit, any external audit opinion or other appropriate independent assurances, prior to endorsement by the Board.

• The underlying assurance processes that indicate the degree of the achievement of corporate objectives and the effectiveness of the management of principal corporate and clinical risks. These will include but will not be limited to: the Board Assurance Framework; the Risk Management Strategy; and the Risk Register along with realistic prioritised action plans and targets to eliminate or minimise risk.

• The policies and controls for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification.

• The policies and procedures for all work related to fraud and corruption as set out by NHS Protect

3.06 In carrying out this work the Committee will primarily utilise the work of Internal Audit, External Audit, Local Counter Fraud Service (LCFS), and other assurance functions, but will not be limited to these audit and assurance functions.

3.07 The Committee will seek assurance from the Quality and Risk Committee, to the extent that this is reasonable and possible, that the quality and clinical risk elements of the Trust’s Board Assurance Framework, Risk Register, Risk Management Strategy and underpinning risk management and clinical governance processes are in place, fully effective and in line with best practice. It will also seek reports and assurances from Directors and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness.

Internal Audit and Counter Fraud

3.08 The Committee shall ensure that there is an effective internal audit function established by management that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the Audit Committee, Chief Executive and Board.

3.09 The Committee shall also satisfy itself that the organisation has adequate arrangements in place for countering fraud.

3.10 This will be achieved by:

• Approval of the appointment of the Internal Auditor.

• Consideration of the provision of the Internal Audit service, the cost of the audit service and any questions of resignation and dismissal.

• Reviews and approval of the Internal Audit Strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation as identified in the Assurance Framework and Risk management Strategy.

• Consideration of the major findings of internal audit work and the response of managers, ensuring that recommendations are followed-up and any lessons are learned within the Trust.

• Ensuring that the Internal Audit function is adequately resourced and has appropriate standing within the organisation.

• Annual review of the effectiveness of internal audit and of co-ordination between the Internal and External Auditors to optimise audit resources.

• Regular review of resource allocation to the local counter-fraud service (LCFS), progress against the LCFS work plan and ongoing LCFS investigations, and the outcomes, learning and actions resulting from counter fraud work.

External Audit

3.11 The Committee shall support the Council of Governors with their duty to appoint, re-appoint, or remove the external auditor. The Committee shall:

• agree the criteria for appointment or removal with the Council of Governors, and advise on the external audit terms and conditions including fees;

• report to the Council of Governors annually on the performance of the external auditor;

• and agree with the Council of Governors a policy on the engagement of the external auditor to provide non-audit services.

3.12 The Committee shall review the work and findings of the External Auditor and consider the implications and management’s responses to their work. This will be achieved by:

• Consideration of the performance of the External Auditor, as far as the rules governing the appointment permit.

• Discussion and agreement with the External Auditor, before the audit commences, of the nature and scope of the audit as set out in the Annual Plan, and ensure coordination, as appropriate, with other External Auditors in the local NHS.

• Discussion with the External Auditors of their local evaluation of audit risks and assessment of the Local Health Economy and associated impact on the audit fee.

• Reviewing all External Audit reports, ensuring appropriate management responses and monitoring the implementation of responses

• agreement of the annual audit letter before submission to the Board and any work carried outside the annual audit plan, together with the appropriateness of management responses.

Other Assurance Functions

3.13 The Audit Committee shall receive assurance from the Quality and Risk Committee on its review of the findings of other significant assurance functions, both internal and external to the organisation, and consider the implications to the governance of the organisation. These will include, but will not be limited to, any reviews by Department of Health Arms Length Bodies or Regulators/Inspectors (e.g. Care Quality Commission, NHS Litigation Authority etc), professional bodies with responsibility for the performance of staff or functions (e.g. Royal Colleges, accreditation bodies, etc). 3.14 The Committee shall review the work of other Committees within the organisation whose work can provide relevant assurances. This will particularly include the Quality and Risk Committee, the Finance and Investments Committee and any other risk management Committees that may be established. In reviewing the work of the Quality and Risk Committee and issues concerning clinical risk management, the Audit Committee will wish to satisfy itself on the assurance that can be gained from the clinical audit function.

3.15 The Committee shall review all decisions made by the Board to suspend Standing Orders or Standing Financial Instructions.

3.16 The Committee shall receive reports at least Quarterly on the work of the Security Executive Group.

Management

3.16 The Committee shall require and review reports and positive assurances from Directors and managers on the overall arrangements for governance, risk management and internal control.

3.17 The Committee may also require specific reports from individual functions within the organisation (e.g. clinical audit) as they may be appropriate to the overall arrangements.

Financial Reporting 3.18 The Audit Committee shall monitor the integrity of the financial statements of the Trust and any formal announcements relating to the Trust’s financial performance.

3.19 The Committee shall ensure that that the systems for financial reporting to the Board, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the Board.

3.20 The Audit Committee shall review the Annual Report and Financial Statements before submission to the Board, focusing particularly on:

• the wording in the Annual Governance Statement and other disclosures relevant to the Terms of Reference of the Committee; • changes in, and compliance with, accounting policies and practices; • unadjusted mis-statements in the financial statements; • significant judgements in the preparation of financial statements; • significant adjustments resulting from the audit; • letter of representation • qualitative aspects of financial reporting.

REPORTING AND RELATIONSHIPS

3.21 The Committee shall be accountable to the Board of Directors of the Trust.

3.22 The Committee shall make an annual report to the Board of Directors to demonstrate the Committee’s discharge of its duties and to confirm the fitness for purpose of the Trust’s assurance framework, risk management, and governance processes.

3.23 The Committee shall make recommendations to the Board of Directors concerning any issues that require decision or resolution by the Board. 3.24 The Committee shall make an annual report to the Council of Governors identifying any matters where it recommends that action or improvement is necessary; and reporting on the performance of the external auditor.

3.25 The Committee shall review the minutes and recommendations of the Quality and Risk Committee and other Committees as appropriate.

3.26 The Committee shall review its own performance, constitution and terms of reference at least every two years to ensure it is operating at maximum effectiveness. Any proposed changes to the terms of reference should be agreed by the Trust Board.

4.00 CONDUCT OF BUSINESS

4.01 The Committee shall conduct business in accordance with the Standing Orders of the Trust.

4.02 The Committee shall be deemed quorate if there are at least two non-executive Directors present. A quorate meeting shall be competent to exercise all or any of the authorities, powers and duties vested in or exercised by the Committee.

4.03 The Committee shall meet not less than four times in each financial year. The Chair of the Committee may request an extraordinary meeting if he/she considers one to be necessary. The External Auditor or Head of Internal Audit may request a meeting of the Committee if either or both consider that one is necessary.

4.04 At the discretion of the Chair of the Committee business may exceptionally be transacted either: through a teleconference where an agenda has been issued in advance; or through the signing by two thirds of members of a written resolution sent in advance to members and recorded in the minutes of the next formal meeting.

4.05 Agendas and papers should be prepared and circulated five clear days before each meeting.

4.06 Minutes of Committee meetings should be formally recorded and distributed to Committee Members, normally within 10 working days of the meetings. Subject to the approval of the Chair of the Committee, the Minutes will be submitted to the Trust Board at its next meeting and may be presented by the Chair. The Chair will draw to the attention of the Board any issues that require disclosure to the full Board, or require executive action.

5.00 STATUS OF THESE TERMS OF REFERENCE

Approved by Trust Board: 27 September 2018

Next Review: March 2021

Appendix 4

WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST

LOVE YOUR HOSPITAL CHARITY

CHARITABLE FUNDS COMMITTEE

TERMS OF REFERENCE

1.00 PURPOSE

1.01 The purpose of the Charitable Funds Committee is to monitor progress and performance against the strategic direction of the Charitable Trust’s fundraising activity as approved by the Board of Trustees; to approve and monitor expenditure of charitable funds in line with specified priority requirements; and to monitor the management of the Charity’s investment portfolio ensuring that the Charity at all times adheres to Charity Law and to best practice in governance and fundraising.

The Trustee of the Charity is the Board of Directors of the Trust acting as Corporate Trustee.

2.00 MEMBERSHIP AND ATTENDANCE AT MEETINGS

2.01 The membership of the Committee shall be:

• Chair: a nominated non-executive Director

• One further nominated non-executive Director

• Chief Workforce and Organisational Development Officer

• Trust Director of Finance

2.02 The Trust Chair shall propose which non-executive Directors will be most suitable for nomination as Chair and members of the Committee. The Board of Trustees shall approve the appointment of the Committee Chair and members, based on the Chair’s recommendations.

2.03 Those normally in attendance at the Committee meetings shall be (as appropriate):

• Director of Communications and Engagement

• Head of Charity Operations

• Assistant Director of Finance (with responsibility for the Charity)

Any member of the Board of Trustees shall have the right to be in attendance at any meeting of the Committee by prior agreement with the Chair.

2.04 The Chief Workforce and Organisational Development Officer may exceptionally send a deputy to the meeting but the deputy will not have voting rights at the meeting. Those who are in attendance may exceptionally send a deputy to the meeting. 2.05 Other Trust managers and clinicians may be invited to attend for particular items on the Agenda that relate to areas of risk or operation for which they are responsible.

2.06 The Group Company Secretary or their nominee shall act as Secretary to the Committee and shall attend to take minutes of the meeting and provide appropriate support to the Chair and Committee members.

3.00 ROLE AND RESPONSIBILITIES

AUTHORITY

3.01 The Committee shall have the delegated authority to act on behalf of the Board of Trustees in accordance with the Constitution of the Charity and the Constitution, Standing Orders, Standing Financial Instructions, and Scheme of Delegation of the Trust. The limit of such delegated authority is restricted to the areas outlined in the Duties of the Committee and subject to the rules on reporting, both as defined below.

3.02 The Committee is empowered to investigate any activity within its Terms of Reference, and to seek any information it requires from staff, who are required to co-operate with the Committee in the conduct of its enquiries.

3.03 The Committee is authorised by the Board of Trustees to obtain independent legal and professional advice and to secure the attendance of external personnel with relevant experience and expertise, should it consider this necessary. All such advice should be arranged in consultation with the Group Company Secretary

DUTIES

Governance, Legalities & Financial Statements

3.04 To ensure compliance by the Charity with Charity Law and NHS guidance on charitable funds.

3.05 To ensure that the Charity regularly benchmarks the governance arrangements and fundraising activity of its Charitable Funds against best practice and implements any lessons learned.

3.06 To advise the Board of Trustees, on any significant issues or variations from good practice, and to keep the Trustees informed of any developments.

3.07 To recommend to the Board of Trustees approval of the annual financial accounts and annual report, prior to their submission to the Charity Commission.

Fundraising Strategy and Activity

3.08 To propose the strategic direction of the Charitable Trust’s fundraising activity to the Board of Trustees for approval.

3.09 To approve investment plans and programmes.

3.10 To monitor progress and performance against the strategic direction of the Charity’s fundraising activity and to approve changes in strategy and any action to be taken in-year.

3.11 To receive regular reports on the fundraising activity carried out at the Trust and the income generated.

3.12 To keep under review all fundraising literature developed and circulated by the Trust and all information provided to the public through literature and websites.

Investments

3.13 To appoint investment managers and monitor their investment performance.

3.14 To inform the investment managers of the Trustees short and long-term financial goals for the charity.

3.15 To review details of the charitable funds investment portfolio quarterly and to take action where necessary to ensure that returns are maximised.

3.16 To ensure that charitable funds are invested to maximise return but on a secure and ethical basis as far as is possible.

3.17 To update investment policies every two years (or as required), for approval by the Board of Trustees, and by agreement the appropriate value of any reserves held by the Charity to ensure these are sufficient to support on-going operations of the Charity and deliver the approved strategy.

Expenditure

3.18 To monitor adherence to an expenditure policy for the management of the donated funds of the Charity, policy to be determined by the Trustees.

3.19 To review delegating spending authority for Charitable Funds and to recommend delegated limits to the Board of Trustees for approval.

3.20 To approve the expenditure of charitable funds in line with delegated financial limits

3.21 To prepare detailed guidance on the correct use of charitable funds, and the process for considering requests for funds, directly in relation to the NHS statutory duty.

3.22 To ensure gifted income is used in accordance with the Trust’s Standing Financial Instructions and any purpose that may be specified by the donor.

3.23 To monitor income and expenditure against budgets and activity against funds.

3.24 To review expenditure projections, based on projected income together with bids approved but not yet spent.

3.25 To ensure that the Trust develops and maintains an up-to-date list of priority requirements, e.g. equipment, environmental requirements, that could be funded by charitable donations.

Risk Management

3.26 To ensure that the Charitable Trust has in place appropriate arrangements to manage the risks associated with its operations, particularly fundraising and expenditure.

3.27 To ensure that Trustees are advised at least annually, or as required, on any risk management issues associated with the operation of fundraising and to advise on any implications for the Trustee role.

REPORTING AND RELATIONSHIPS

3.28 The Committee shall be accountable to the Board of Trustees.

3.29 The Committee shall regularly report to the Board of Trustees to demonstrate the Committee’s discharge of its duties and to confirm the fitness for purpose of the Charity’s assurance framework, risk management, and governance processes.

3.30 The Committee shall make recommendations to the Board of Trustees concerning any issues that require decision or resolution by the Board of Trustees.

3.31 The Committee shall report to the Audit Committee as appropriate on any matters requiring action or decision-making by that Committee.

3.32 The Committee shall review its own performance, constitution and terms of reference at least every two years to ensure it is operating at maximum effectiveness. Any proposed changes to the terms of reference should be agreed by the Board of Trustees.

3.33 The Committee may establish a sub-committee for a specific purpose. For example an Investment sub-committee or a Fundraising/ Appeal Committee for a particular project.

4.00 CONDUCT OF BUSINESS

4.01 The Committee shall conduct its business in accordance with the Standing Orders of the Trust.

4.02 The Committee shall be deemed quorate if there is at least one non-executive Director present together with either the Chief Workforce and Organisational Development Officer or the Trust Director of Finance. A quorate meeting shall be competent to exercise all or any of the authorities, powers and duties vested in or exercised by the Committee.

4.03 The Committee shall meet not less than four times in each financial year.

4.04 At the discretion of the Chair of the Committee business may exceptionally be transacted through a teleconference provided all parties are able to hear all other parties and where an agenda has been issued in advance, or through the signing by every member of a written resolution sent in advance to members and recorded in the minutes of the next formal meeting.

4.05 Agendas and briefing papers should be prepared and circulated in sufficient time for Committee Members to give them due consideration.

4.06 Minutes of Committee meetings should be formally recorded and distributed to Committee Members within 10 working days of the meetings. Subject to the approval of the Chair, the Minutes will be submitted to the Trust Board (noting that they will be received in the capacity of Corporate Trustee) at its next meeting and may be presented by the Committee Chair. The Committee Chair will draw to the attention of the Board of Trustees any issues that require disclosure to the full Board, or require executive action.

5.00 STATUS OF THESE TERMS OF REFERENCE

Approved by Trust Board: 27 September 2018

Next Review: March 2021

Appendix 5

WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST

APPOINTMENTS AND REMUNERATION COMMITTEE

TERMS OF REFERENCE

1. Membership

Chair: the Chair of the Trust

All Non-Executive Directors

2. In attendance

2.1 The Chief Executive should be invited to attend as appropriate, but particularly when the Committee is discussing Executive Director appointments and/or remuneration, but should not be present for discussions about his/her own remuneration and terms of service.

2.2 Other executive officers should be invited to attend as appropriate, but particularly when the Committee is discussing areas of risk or operation that are the responsibility of that officer.

2.3 The Chief Workforce and Organisational Development Officer should attend all meetings in an advisory capacity, but should not be present for discussions about his/her own remuneration and terms of service.

2.4 The Group Company Secretary or his/her nominee shall act as Secretary to the Committee.

2.5 No member or attendee shall take part in any discussion relating to his/her post and must declare at the beginning of any meeting any such interest in any items for that meeting.

3. Duties

The duties of the Committee are as follows:

3.1 To decide on the recruitment and selection process (including the preparation of a description of the role and capabilities required for the appointment of the Chief Executive post on the Trust Board), the appointment, appraisal, remuneration and terms of service of the Chief Executive.

3.2 In conjunction with the Chief Executive, oversee the recruitment and selection process (including the preparation of a description of the role and capabilities required for the appointment of the Executive Director posts on the Trust Board), and the appointment of all Executive Directors, and decide on their terms and conditions of service.

3.3 As part of 3.2 ensure that the requirements of the Fit and Proper Person Test are applied appropriately.

3.4 Remuneration will consist of a base salary in combination with any or more of the following elements:

Performance related element Pensions Other benefits

Remuneration should be decided in accordance with Best Practice guidance as set out in Annex A of these Terms of Reference.

3.5 In informing the Committee, the Chief Workforce and Organisational Development Officer will prepare annually the following information:

• list of current basic salary rates for Executive Directors • list of comparable rates compiled from relevant salary surveys, advertised market rates, the level of experience and qualifications of the Executive Directors and any other relevant factors. • in determining basic pay increases for senior managers of the Trust, a recommendation for pay increases taking into account national guidelines and advice.

3.5 To monitor the performance of the Chief Executive and, with the Chief Executive, other Executive Director posts.

3.6 To determine appropriate contractual arrangements and termination payments for Executive Directors, taking into account national guidance, where appropriate.

3.7 To act on any other matters delegated by the Monitor, Department of Health or NHS Executive to Remuneration and/or Appointments Committees.

3.8 To consider and, subject to current regulatory guidelines approve recommendations in respect of contractual and non-contractual severance and redundancy payments to staff leaving the Trust.

3.9 To consider the principal elements of the structure and terms of appointment for senior roles within the Trust, particularly clinical management roles.

3.10 To receive reports about Consultant appointments within the Trust, including remuneration arrangements.

3.11 To receive reports on significant employee relations issues, items of litigation and to approve redundancy payments.

3.12 To review its own performance, constitution and terms of reference on an annual basis to ensure it is operating at maximum effectiveness.

4. Quorum

4.1 The Committee shall be deemed quorate only if three Non-executive Director members are present. A duly convened meeting of the Committee at which a quorum is present shall be competent to exercise all or any of the authorities, powers and duties vested in or exercised by the Committee.

5. Authority

5.1 The Committee is invested with the delegated authority to act on behalf of the Trust Board. The limit of such delegated authority is restricted to the areas outlined in the Duties of the Committee (above) and subject to the rules on Reporting, as defined below. The Committee is empowered to investigate any activity within its Terms of Reference, and to seek any information it requires from staff, who are requested to co-operate with the Committee in the conduct of its inquiries.

5.2 The Committee is authorised by the Trust Board to obtain independent legal and professional advice and to secure the attendance of external personnel with relevant experience and expertise, should it consider this necessary. All such advice to be arranged in consultation with the Group Company Secretary.

6. Frequency of meetings

6.1 The Committee shall meet at such times as the Chair of the Committee shall require, subject to there being at least two meetings in each calendar year.

7. Minutes and Reporting

7.1 Agendas and briefing papers should be prepared and circulated in sufficient time for Committee Members to give them due consideration.

7.2 The Committee should report to the Board on any items that are appropriate to do so.

8. Conduct of Business

8.1 The conduct of business will conform to guidance set out in the Trust Board Standing Orders, unless alternative arrangements are defined in these Terms of Reference. 8.2 At the discretion of the Chair business may exceptionally be transacted through a teleconference provided all parties are able to hear all other parties and where an agenda has been issued in advance, or through the signing by every member of a written resolution sent in advance to members and recorded in the minutes of the next formal meeting. 9. Annual General Meeting

9.1 The Chair of the Committee shall attend the Annual General Meeting prepared to respond to any stakeholder questions on the Committee's activities.

10.0 STATUS OF THESE TERMS OF REFERENCE

Approved by Trust Board: 27 September 2018

Next Review: March 2021