King’s College Hospital Board of Directors
PUBLIC AGENDA
Time of meeting 14:00 Date of meeting Tuesday, 16 December 2014 Venue Dulwich Room, Hambledon Wing, Denmark Hill
Members: Prof. Sir George Alberti (GA) Trust Chair Graham Meek (GM) Non-Executive Director, Vice Chair Marc Meryon (MM1) Non-Executive Director Christopher Stooke (CS) Non-Executive Director Sue Slipman (SS) Non-Executive Director Tim Smart (TS) Chief Executive Angela Huxham (AH) Director of Workforce Development Trudi Kemp (TD) - Non-voting Director Director of Strategy Dr. Michael Marrinan (MM) Medical Director Roland Sinker (RS) Chief Operating Officer Simon Taylor (ST) Chief Financial Officer Dr. Geraldine Walters (GW) Director of Nursing & Midwifery Jane Walters (JW) - Non-voting Director Director of Corporate Affairs
In attendance: Tamara Cowan (TC) Board Secretary (Minutes) Prof. Sir Robert Lechler (RL) Executive Director, KHP Sally Lingard (SL) Associate Director of Communications Linda Smith KCH Charity Representative
Apologies: Prof. Ghulam Mufti (GM1) Non-Executive Director Faith Boardman (FB) Non-Executive Director
Circulation to: Board of Directors Circulation List
Enclosure Lead Time
1. STANDING ITEMS G Alberti 14:00 1.1. Apologies 1.2. Declarations of Interest 1.3. Chair’s Action 1.4. Minutes of Previous Meeting – 25/11/2014 Enc 1.4 1.5. Matters Arising/Action Tracking Enc 1.5 2. FOR REPORT/DISCUSSION 2.1. Update from Board Committee Chairs 14:05 2.1.1. Audit Committee Verbal C Stooke 2.1.2. Board Integration Committee Verbal C Stooke 2.1.3. Finance & Performance Committee Verbal G Meek 2.1.4. Quality & Governance Committee Verbal G Alberti 2.1.5. Strategy Committee Verbal S Slipman 2.1.6. Education & Workforce Dev. Committee Verbal M Meryon 2.2. Update on Council of Governors’ Activities Verbal G Alberti 14:25 2.3. Chief Executive’s Report Verbal T Smart 14:35 2.4. Consolidated Finance Report (Month 08) Enc. 2.5 S Taylor 14:45 2.5. Performance Reports (Month 08) Enc. 2.6 R Sinker 14:55 2.6. Quality & Safety Focus 2.6.1. Quarterly Patient Outcomes Report Enc. 2.7.1 G Walters 15:05 2.6.2. Annual Inclusion Report Enc. 2.7.2 T Smart 15:15 2.6.3. Monthly Nursing Reports Enc. 2.7.3 G Walters 15:25 2.7. KCH Charity Update Verbal L Smith 15:35 2.8. KHP Update Verbal R Lechler 15:45
3. FOR INFORMATION 16:00 3.1. Confirmed Board Committee Minutes 3.1.1. Finance & Performance Committee Enc. 3.1.1 28/10/2014
4. ANY OTHER BUSINESS 16:05 DATE OF NEXT MEETING 5. .
Tuesday, 27 January 2015 – Dulwich Committee Room
Enc 1.4
King’s College Hospital NHS Foundation Trust Board of Directors - PUBLIC Minutes of the meeting of the Board of Directors held at 14:00 on Tuesday, 25 November 2014 in the Dulwich Room, Denmark Hill
Members: Prof Sir George Alberti (GA) Trust Chair Graham Meek (GM) Non-Executive Director Marc Meryon (MM1) Non-Executive Director Chris Stooke (CS) Non-Executive Director Faith Boardman (FB) Non-Executive Director Ghulam Mufti (GM1) Non-Executive Director Tim Smart (TS) Chief Executive Angela Huxham (AH) Director of Workforce Development Trudi Kemp (TK) – Non-voting Director Director of Strategic Development Dr. Michael Marrinan (MM) Medical Director Roland Sinker (RS) Chief Operating Officer Simon Taylor (ST) Chief Financial Officer Dr. Geraldine Walters (GW) Director of Nursing & Midwifery Jane Walters (JW) – Non-voting Director Director of Corporate Affairs
In attendance: Prof. Sir Robert Lechler (RL) Executive Director – KHP Marion Mackay (MK) Trustee – KCH Charity Tamara Cowan (TC) Board Secretary Penny Dale ( Public Governor Fiona Clark Public Governor Raoul Pinnell Bromley Healthcare
Apologies: Sue Slipman (SS) Non-Executive Director
Item Subject Action
14/153 Apologies
Apologies for absence were noted.
14/154 Declarations of Interest
There were no declarations of interest reported.
14/155 Chair’s Action
There were no Chair’s actions to report.
14/156 Minutes of Previous Meeting
The minutes of the meeting held on 28 October 2014 were approved.
1 Enc 1.4 Item Subject Action
14/157 Matters Arising/Action Tracking
The action tracker was noted with no outstanding actions.
14/158 Update from Board Committee Chairs
Audit Committee CS reported that the Audit Committee had not met since the last meeting of the Board.
Board Integration Committee (BIC) CS reported that the Committee met on 06 November to consider the various workstreams of work being conducted to deliver the integration programme, CIPs and recovery plans.
Finance & Performance Committee GM reported that the Committee met earlier today and considered the continued trend of high activity, marginal improvement in quality and progress on recovery plans actions. More details about the operational and financial performance of the Trust will be provided under agenda items 2.5 and 2.6.
Quality & Governance Committee GM1 reported that the Committee had not met since the last meeting of the Board.
Strategy Committee SS reported that the Committee is due to meet next on 04 December.
Education & Workforce Development Committee MM1 reported that the Committee will have its next meeting on 08 December.
14/159 Update on Council of Governors’ Activities
The Board noted the following update on the Council’s activities: The current Council, although coming to the end of its term on 30 November, continued to be very active with the following events: o Two sub-committees of the Council met in October; o The KHP Governor Event, held on 04 November, was well attended by governors across all three foundation trusts. The presentations were very informative and welcomed.
New governors had their first formal induction on 12 November 2014;
The current Council also met on 12 November to hear more about the Trust’s current financial and operational position. The governors welcomed this meeting and agreed that the format would continue; and
On 27 November many of the Trust’s new and re-elected governors will participate in the GovernWell core skills training course which will be delivered by the Foundation Trust Network. Governors from KHP partners will also participate in the event.
2 Enc 1.4
Item Subject Action
14/160 King’s Health Partners’ (KHP)
The Board welcomed Prof. Sir Robert Lechler (RL) to the meeting.
RL provided an overview of a recent presentation he made on the future of medicine and the role of KHP. He highlighted that despite the pressures on the health system medicine is on the cusp of a biomedical revolution.
KHP is participating in this medical revolution and some initiatives include: 1. Precision medicine such as the 100k Genomes project which is using technology to unpick the way cells work;
2. Regenerative medicine being conducted through KHP initiatives including the ling with the Crick Institute;
3. Cell therapy involving bone marrow transplantation which has lots of interest as applied in cancer and autoimmune disease medicine;
4. Biologicals which are the basis of 50% of all new drugs on the market; and
5. Gene therapy work such as gene replacement exampled by the KHP joint project with UCL partners for Pfizer; and
6. Digital health which facilitates the process for patients being remotely monitored giving them more control of their care and resulting in less time in hospital.
This work is however predicated on getting the integrated care pathways embedded.
The following key points were noted in discussion: KHP’s unique selling points are in the areas of regenerative medicine, cell therapies, biologicals and gene therapy;
With people living longer and presenting with more complex medical issues KHP needs to get to grips with the real challenges and embed the integrated care framework to support the changing health economy; and
KHP needs to up its focus on digital health given the increased focus on technological transfers.
14/161 Chief Executive’s Report
The Board noted the Chief Executive’s report presented by TS.
The following key points were noted: It is important that the Trust reflects on the current challenges facing the NHS, in particular, the accuracy of reporting ED performance across the system;
There are very few trusts achieving the 95% target and this issue looms large in the political arena. 3 Enc 1.4
Item Subject Action
The Trust Emergency Department (ED) performance has become one of the best performing in London in recent weeks. The Trust staff have to be commended for their hard work;
The performance at the Princess Royal University Hospital (PRUH) has improved significantly in the last 10 days;
The combined Trust ED is running at 92% of the 95% target;
There is a broad level of stakeholder support and engagement;
The Care Quality Commission has advised that the Trust will have a planned inspection in the first quarter of 2015;
The introduction of KHP Online is a great development which supports effective treatment of patients across multiple sites and organisations; and
The Trust is enormously supportive of patients with cystic fibrosis and are frustrated by the delays to the provision of facilities for these patients.
14/162 Finance Report
The Board received the month 07 finance report presented by ST which was discussed at length at the Finance & Performance Committee, held earlier.
The following key points were noted:
Due to unprecedented levels of activity, the Trust is spending more money on staff to ensure high quality and safe levels of care continue to be delivered;
The continuity of risk rating dropped to two in the last month;
The Trust is working hard to stabilise the financial position and the Trust has been mobilised to focus on recovery plans;
Cash is tracking slightly above forecast position;
The Trust has commissioned PriceWaterhouseCoopers (PWC) to provide additional assurance around the deliverability of the Trust’s CIP plans and support with the development of a forward sustainable model;
PWC will also help manage the relationships with stakeholders and information requests;
The challenge to deliver access targets with the high levels of activity is contributing to the current financial position;
The Trust is having good dialogue with its commissioners and discussions about recurrent funding continues; and
4 Enc 1.4
Item Subject Action
Monitor recognises the core of the Trust’ financial challenges however, it would be useful to distil out the key themes around these challenges. This would assist in discussions with stakeholders.
14/163 Performance Report
The Board received the month 07 performance report presented by RS which was discussed at length at the Finance & Performance Committee held earlier.
The following key points were noted: Denmark Hill (DH) site There are numerous areas of strong performance at the DH site;
Emergency department (ED) performance has improved with targets reaching 96% attributed to the tremendous work of the staff;
There has also been good performance for access targets with improvement in outpatients, referral to treatment (RTT) targets and cancer although 62 day cancer waits remain at risk;
A number of actions are being taken to ensure resilience funding for activities such as using offsite working to clear the RTT backlog is maintained;
Infection control is off trajectory with the performance of c.diff;
There have been 4 suspected cases of Ebola at the Trust. None of these cases were positive for Ebola;
Princess Royal University Hospital (PRUH) and other sites There was strong performance for infection control and nationally the site came eighteenth out of 180 in the recent Stroke Audit;
The Trust has managed to integrate its patient information system across all its sites;
Since the Trust acquired the PRUH, it has focused on improving the ED performance. The Trust has seen significant improvement reaching the mid-80s. However, as the Trust moved into September 2014 the ED became much more challenged and unfortunately performance fell, albeit briefly, from 80-83% to 50% at its lowest point.
This position however moved again to 86% last week and went as high as 96% last night. This illustrates the tenuous situation with the PRUH ED performance despite significant effort on the part of the Trust.
The Trust has focussed on redirecting the number of medically fit patients waiting for discharge working with community partners. The key to longer term sustainability is to reinvigorate the pathways.
5 Enc 1.4
Item Subject Action
The Trust has also moved a number of senior doctors from the DH ED to the PRUH ED;
Other areas of challenge includes RTT which is marginally off trajectory as a result of bed capacity;
The Trust continues to focus on the challenges around medical records. The service is improving but there is a long way to go, ahead of the proposed re-location of the records library to Orpington Hospital, which is delayed due to issues with planning permission;
The Trust had not originally anticipated that it would have the current level of services at the Queen Mary Sidcup site therefore it is now exploring putting in place appropriate site based leadership structures;
The Trust has developed action plans to address its main issues. In relation to RTT commissioners fund elements of the plan however ED action are more complex. The point of care system is not currently funded; and
The weekend discharge process at the PRUH differs from the DH. The difference relates to the patient numbers and local population profile. The Trust is working hard to identify what is the right model for the PRUH including 24/7 working.
14/164 Quality & Safety Focus
14/164.1 Quarterly Patient Safety Report
The Board noted and considered the quarterly patient safety report.
The following key issues and points were noted: The Care Quality Commission (CQC) has advised that the Trust will have a planned inspection in early 2015;
The Trust is appointing a ‘duty of candour’ guardian and disclosures will be tracked on Datix;
The Trust is concerned by the three reported recent never events. Detailed investigations have been undertaken and immediate actions have been taken to address the issues around these events such as tightening up the safer surgery checklist processes.
The Trust protocols and expected levels of practice will be reiterated to all clinicians and MM will meet with Ophthalmologists on 12 December.
The Trust has reported these never events to the CQC;
The overall number of falls has decreased but the number of high severity falls has increased as a proportion. The number of pressure ulcers has also slightly increased;
6 Enc 1.4
Item Subject Action
The increase in the number of falls can be correlated to the increase in the number of older patients coming to the hospital; and
KHP will hold its safety conference on 08 December.
14/164.2 Doctors Revalidation Report
The Board noted and considered the doctors revalidation report.
The following key issues and points were noted: The Trust has made good progress with the revalidation system;
The revalidation process requires clinicians receives a 360o multi-source feedback. Clinicians such as pathologists are not necessarily patient facing therefore it is difficult to complete the process;
The PRUH is firmly part of the revalidation process; and
Nurses will be required to start revalidation next year.
14/164.3 Monthly Nurse Staffing Levels Report
The Board noted and received the monthly nurse staffing levels.
The Board agreed that: 1) For completeness all the comments sections should be completed; and GW
2) The nursing staff level data should be publicised in line with guidance.
14/165 King’s College Hospital Charity (KCHC) Update
The Board welcomed Marian McKay (MM) to the meeting. MM provided a short update on the Charity’s activities.
The following key points were noted: The Charity has increased its visibility at the Princess Royal University Hospital (PRUH) site;
Peter Gluckman is meeting with GW to support the leadership development programme;
A grant of £19k was provided to refurbish the changing facilities in the A&E department;
The Charity has begun considering its legal status given the impending regulatory changes for NHS charities. The Charity will meet with the Trust Board on 17 December and in the March 2015 to discuss this with a view of having the new structure in place by December 2015;
7 Enc 1.4 Item Subject Action
The Charity will hold a showcase event following the Trust’s Board meeting in February; and
The fundraising for the helipad is going better and more funding has been dedicated from London Ambulance Services. The Trust has made provisions in its capital programme to fund any shortfall.
14/166 FOR INFORMATION
14/166.1 Chair’s and Non-Executive Directors’ (NED) Activity Report
The Board noted the Chair’s and NEDs activity report for the period.
14/166.2 Confirmed Board Committee Minutes
The Board noted the confirmed minutes of the Finance & Performance Committee (30/09/2014).
14/167 Any Other Business
There were no matters of any other business raised for discussion.
14/168 Date of Next Meeting
Tuesday, 16 December 2014, Dulwich Room, Denmark Hill site.
8 Board of Directors – Public Meeting Action Tracker Enc 1.5
Meeting Item Action Who Due Date Notes Date COMPLETED 25/11/2014 14/163.4 Monthly Nurse Staffing Levels Report
The Board noted and received the monthly nurse staffing levels. GW ASAP The Board agreed that: 1) For completeness all the comments sections should be completed; and
Board of Directors Meeting – 16 December 2014 1 of 1 This page has been left blank Enc. 2.5
Finance Report
Month 8 (November) 2014/15
Finance Committee 16th December 2014 Report to: Public Board Date of meeting: 16th December 2014 Subject: Finance Committee Report – Month 8 (November 2014) Author(s): Simon Dixon, Nicola Hoeksema, Iris Lewis Presented by: Simon Taylor, Chief Financial Officer Sponsor: Simon Taylor, Chief Financial Officer History: First submission to Finance and Performance Committee Status: Decision/Discussion/Information
1. Purpose . The Finance Reports includes information on the Trust’s financial performance and position which support the in-year submissions to Monitor on a quarterly basis. . This report covers the Income & Expenditure position, Cost Improvement Programme, Capital and Working Capital Plans.
2. Action required . The Board is asked to approve the Finance Report
Page 2 3. Key implications
Legal: Reporting to Monitor and Commercial Bank
Trust reports financial performance and position against published plan and notifies the Financial: committee of financial risks, cost pressures and action plans to mitigate any material variance from financial targets. The summary and appendices provide assurance that the Trust is meeting Financial targets Assurance: (internal and those set by Monitor) and is compliant with its terms of authorisation.
Clinical: There is no direct impact on clinical issues
Equality & Diversity: There is no direct impact on E&D
Financial Performance against annual plan, budgets, CIPs and Monitor Risk Ratings and Performance: Limits.
Strategy: Performance against the Trust’s Annual Plan including Risk Ratings
There are implications for workforce recruitment in respect to service developments and Workforce: vacancies.
There are implication on the Trust’s estates strategy. Estates:
Finance Committee Report is provided to Monitor and Commercial Bankers as additional Reputation: information to support the quarterly Monitor Return.
Other:(please specify) None.
Page 3 Contents
Page(s)
. Month 8 - Executive Financial Summary 5 - 6 Contents . Month 8 - Continuity of Service Risk Ratings 7
. Recovery Plan 8 - 15
. Month 8 - I&E Summaries 16 . Divisional, Corporate and Trust Income Analysis 17 - 26 . Medical Outliers 27 - 28 . Temporary Pay Analysis 29 - 32
. Month 8 - CIP Update 33 – 34
. Capital Investment 35 - 38
. Working Capital Summary 39 - 41
. Statement of Financial Position 42
. Glossary 43
Page 4 Month 8 - Executive Financial Summary
Month 7 YTD YTD Movement Income and Expenditure Annual Budget YTD Budget YTD Actual Variance Variance in Month £'000 £'000 £'000 £'000 £'000 £'000 Income (excluding off Tariff Drugs) 966,889 638,907 657,128 18,221 20,168 (1,947) Off Tariff drugs Income 51,763 34,509 43,988 9,479 8,944 535 Pay (584,232) (390,658) (415,695) (25,037) (21,904) (3,133) Non-Pay (excluding off tariff drugs) (323,188) (212,795) (242,380) (29,585) (32,218) 2,633 Off Tariff Drugs Expenditure (51,763) (34,509) (43,988) (9,479) (8,944) (535) Capital Charges, Interest and Dividends (67,943) (45,295) (45,912) (617) 157 (774) SLR/Internal Recharges (282) 269 (309) (578) 4 (582) Consolidated Surplus/(Deficit) (8,756) (9,572) (47,168) (37,596) (33,793) (3,803) Impairment Expense 8,756 5,833 5,833 0 0 0 Consolidated Operating Surplus/(Deficit) 0 (3,739) (41,335) (37,596) (33,793) (3,803)
Current deficit position
1. The Trust is reporting an adverse variance to plan of £37.6m to date excluding the asset impairment of £5.8m (non-operating cost). The year to date plan is adverse due to the phasing of the CIP schemes which are geared towards the second half of the year. The Continuity of Service Risk Rating is 2 (page 7). The actual operational income and expenditure deficit movement in month was £3.578m to £41.335m.
2. The month 8 position has moved adversely by £3.8m against planned budget (average monthly deficit movement for the previous months was £4.798m). This is a positive movement in comparison to previous months but the underlying cost pressures at the PRUH (particularly the Emergency Care service) and the non-achievement of the transformational cost improvement schemes are still driving the monthly deficit. The other operating cost pressures relate to the high clinical locum usage and agency spend across all staff groups but particularly nursing. This spend is now reducing month on month. The Clinical Division’s are delivering recovery plans to mitigate the deficit outturn position and weekly financial meetings are being held to performance manage the action plans.
3. The CIP achieved to date is £18.7m and this is a £15.4m adverse variance against the original plan (see pages 33 and 34).
4. Medical and Nursing staffing budgets are £21.7m over-spent due to locum and agency spend as shown on page 21 which partly relates to non-recurrent resilience funding for Emergency Care Services. Clinical supplies are £10.2m and Drugs £10.3m over-spent as at month 8 and these variable operational costs including agency staff are being partially covered by the additional unplanned activity income generated (£27.7m above plan to date). The key financial issues by Clinical Division are reported on pages 16 to 19 and the Corporate Departments on page 20.
5. The contract income with Commissioner’s is over-performing by £24.6m by Clinical Division and the key variances are presented on pages 22 to 26. Page 5 Month 8 – Executive Financial Summary
Monitor reforecast plan
. The Trust submitted a reforecast plan to Monitor in September based on month 4 financial data which incorporated the Trust’s recovery plan. The planned deficit position at year end is £28m. This would achieve a rating of 3 subject to capital funding of the Guthrie Development (£20m) and the indemnity payment of £15m by the TDA.
. The Trust is ahead of the reforecast plan as at month 8 by £5.1m but this is due to the phasing of contract over-performance income from September to November and the additional resilience monies to achieve RTT and ED performance targets to cover existing and new schemes (£11.4m).
. The current y/e deficit projection of £34m is a £6m adverse movement from the £28m deficit reforecast plan and this is due to additional cost pressures being forecast for the development of Orpington Hospital for additional surgical activity in theatres and the development of the Neuro Rehab unit (initially 10 beds) to help deliver the RTT activity backlog. A more prudent position has now been taken on the recovery of the Foetal Medicine income through the maternity tariff due to current patient information data delays and the income projection has been reduced by £1m.
. The Trust has also prudently accounted for the Bexley CCG MSK contract which may not deliver the anticipated savings in year 1.
. There are further corporate cost pressures due to the increased valuation of land and buildings which impact adversely on the PDC dividend.
. The current year end projection excludes any further support from the TDA regarding the phasing of the bridging support and further LSB CCG investment in 14/15 to cover unfunded investments in the ED service and unplanned contract activity over- performance due to CCG led QIPPs. These discussions are on-going and should be resolved in early January at the latest.
. Cash support has been provided by Lambeth and Southwark CCG’s on the basis of a year end agreement (£8m to be paid 15th December in advance). The cash balance projected for the year end has reduced from £30.4m to £27.8m in line with the revised reforecast position moving from a £28m to £34.4m deficit. The staff pay costs have been adjusted for the nursing staff recruitment plans and the agency spend has been prudently reduced. The Trust is working with Commissioner’s including NHSE to recover the outstanding contract over-performance debt position which would materially improve the cash-flow position year end (see page 39).
. The cash flow is reflected on page 14. A working capital facility proposal of £10m is being discussed with the Trust bank in order to partially cover the worst-case scenario (page 15). This would be required if no TDA funding is received as noted above. Page 6 Month 8 - Continuity of Service Risk Rating
YTD - Month 8
Debt Service Cover
Revenue available for Debt Service (1,138) key to scoring Debt Service (28,047) Debt Service Cover 50% Debt Service Cover metric -0.04x 4 3 2 1 Debt Service Cover rating 1 2.5 1.75 1.25 <1.25
Liquidity
Cash for CoS liquidity purposes (11,053) key to scoring Operating Expenses within EBITDA, Total (702,359) Liquidity 50% Liquidity metric -3.8 4 3 2 1 Liquidity rating 3 0 -7 -14 <-14
Continuity of Service Risk Rating 2
Page 7 Recovery Plan - Summary as at Month 8 recovery Net Income & Expenditure M8 M8 M8 YE YE YE Positive / Positive / Reforecast Plan (Adverse) Reforecast Plan Actuals (Adverse) sent to Monitor Expected Actual Movement sent to Monitor Movement (as at m5) against Reforecast Plan
Clinical Divisions (53,177) (64,564) (11,387) (105,382) (126,550) (21,168)
Corporate Departments (31,508) (29,069) 2,439 (14,717) (13,324) 1,393
Corporate Income 32,396 46,464 14,068 83,286 96,684 13,398 (Inc. T&E, R&D)
Deficit (52,289) (47,169) 5,120 (36,813) (43,190) (6,377)
Impairment 5,833 5,833 0 8,750 8,750 0
Operating Deficit (46,456) (41,336) 5,120 (28,063) (34,440 ) (6,377 )
. The income and expenditure variances primarily relate to the additional resilience funding (£11.3m) to meet RTT and ED performance targets.
. The other expenditure variances relate to the investments at Orpington Hospital which were disclosed in the month 6 report (Liver, Renal and Surgery Clinical Division).
. Year end forecast is a £34.440m deficit pending agreement of TDA bridging support re-phasing and CCG additional investment for unfunded ED schemes (LSB CCGs) and contract over-performance (Bromley CCG).
. Year End Forecast deficit has increased by £1.7m this month due to a more prudent view on the recovery on Foetal Medicine Income Page 8 Recovery Plan – Clinical Divisions
Net Income & Expenditure M8 M8 M8 YE YE YE Positive / Reforecast (Adverse) Reforecast Positive / Plan sent to Expected Movement Clinical Divisions Plan sent to Actuals (Adverse) Key Reasons for Variance & Key Movements in Month Monitor Actual against Monitor Movement (as at m5) Reforecast Plan
Ambulatory Care and Local Networks (ACLN) 3,661 4,789 1,128 493 1,552 1,059 Favourable income within ACLN and vacancies within Dental. Continued cost pressures due to high consumables and instrumentation usage at Orpington (£1.8m). Anticipated additional costs relating to extending Critical Care, Theatres and Diagnostics (CCTD) (7,518) (9,436) (1,918) (9,574) (11,383) (1,809) pharmacy hours over winter(£150k) started in Oct 14. Increased bank and agency usage and consumables to cover lists within theatres (PRUH) . Over performance on Pathology contract with JV. The internal recharges (SLR) for additional activity (theatre and diagnostic usage) and the cost of off-site providers (£1.45m) to achieve RTT plans for Orthopaedic, General Surgery, Bariatric and Liver services have been reflected Liver, Renal and Surgery (LRS) (9,422) (18,060) (8,638) (19,099) (31,775) (12,677) in the divisional financial position. Also, the cost for operationalising Beckenham Beacon and Orpington sites andthe MSK contract financial risk are the other reasons for overall adverse variance. RTT off-site costs from Aug 14 to March 15 (£3.1m) are the key reason for the variance change in line with additional tranche 1 and 2 income held centrally Networked Services (NWS) (10,826) (12,068) (1,242) (22,715) (27,186) (4,471) (funding for July to Nov). The Neuro - Rehab facility at Orpington (Ontario ward) will open in November - initially only 10 beds out of the planned 20 beds. Investment of ED schemes to meet performance targets and schemes costing £11m remain unfunded by Commissioners (primarily at the PRUH). The Trauma, Emergency and Medicine (TEaM) (19,863) (19,990) (127) (36,264) (36,480) (216) forecast actual does include schemes funded on a non-recurrent basis included in the 14/15 contract baseline by CCGs; plus the new schemes this year (tranche 1 and 2 ) which again are funded non-recurrently. The YE variance is due to the Maternity Casemix Income reduction by £1.6m Women's & Children's (W&C) (11,955) (11,278) 677 (21,809) (23,492) (1,683) which is reflected in CCG contracts. Beds re-allocated for NHS patients due to RTT activity demands. The PP income is also under-achieving due to case-mix, loss of Liver Transplant Private Patients (PP) 2,746 1,479 (1,267) 3,586 2,214 (1,372) activity and the loss of trade with the Greek and Cypriot market due to the economic downturn. Service should operate at full capacity later in the year.
TOTAL (53,177) (64,564) (11,387) (105,382) (126,550) (21,168) Page 9 Recovery Plan – Corporate Departments
Net Income & Expenditure M8 M8 M8 YE YE YE Positive / Reforecast (Adverse) Reforecast Positive / Plan sent to Expected Movement Corporate Departments Plan sent to Actuals (Adverse) Key Reasons for Variance & Key Movements in Month Monitor Actual against Monitor Movement (as at m5) Reforecast Plan
Corporate Services (375) (547) (172) (602) (602) (1) Additional intepretation costs. Boiler room becoming increasingly expensive to maintain and additional day to Estates (735) (640) 95 (964) (1,068) (104) day maintenance costs all sites Increase in security staff and postage costs. Issues around Savoy data putting PT Facilities (825) (774) 51 (1,542) (1,526) 16 income risk Frank Cooksey rental (£1.4m) CIP not achieved. Additional cost pressures on Property and Capital Projects (1,415) (1,786) (371) (2,696) (2,652) 44 Beckenham Beacon & IB4 leases. Implementation of PA Consulting recommendations (8 temporary staff and 2 HR (513) (1,025) (512) (733) (1,212) (479) substantive staff). Occupational Health pressures due to increase volume of Trust staff. Income reallocation and SLR recharges (due to miscellaneous expenditure held Finance & Procurement (1,785) (927) 858 1,116 (50) (1,166) centrally in Finance). SLR budgets to be realigned in M9, which is cost neutral and built into year end Capital Charges (excluding Impairment) & (17,449) (18,356) (907) 250 (1,000) (1,250) forecasts for clinical divisions. Increased PDC Dividend payable due to capital SLR Central Reallocation over-spend and increase in value of land and buildings on revaluation. ICT (216) (266) (50) (430) (426) 4 Agency staff costs and additional maintenance contracts. Staffing cost pressures - clinical coders, medical records/clinic prep and increased Operations (831) (1,172) (341) (1,686) (1,824) (138) management team. Medical Executive team 0 90 90 0 116 116 Associate Director Vacancies. Central recruitment of nurses who are temporarily coded to EXC team budget Nursing Executive team (124) (675) (551) (248) (933) (685) until allocated to a ward. Strategic Development/Non Commercial R & D (854) 178 1,032 (1,350) 303 1,653 Staff vacancies and reduction in deferred income.
PFI (392) 812 1,204 (783) 2,000 2,783 Underspend will begin to reduce once Orpington fully up & running Integration posts and non-pay IT costs on hold and current interim posts to be Trustwide Integration (5,994) (3,981) 2,013 (5,050) (4,450) 600 scaled back.
TOTAL (31,508) (29,069) 2,439 (14,717) (13,324) 1,393 Corporate department overspends not recharged to Service Line Reporting (SLR). Page 10 Recovery Plan – Corporate Income
Gross Income only M8 M8 M8 YE YE YE Positive / Reforecast (Adverse) Reforecast Positive / Plan sent to Expected Movement Corporate Income Plan sent to Actuals (Adverse) Key Reasons for Movement in Month 8 and Year End Monitor Actual against Monitor Movement (as at m5) Reforecast Plan
Commissioner Contract activity over-performance held centrally (e.g. PRUH off-tariff drugs) due to potential challenges and data insufficient Corporate Income inc Project Diamond 32,396 43,464 11,068 60,216 68,992 8,776 to allocate by Clinical Division. Additional Training and Education funding for Flexible trainees (£800k fye). 13/14 access target and KPIs fines for 13/14 accrued. 14/15 fines to be CCG validation checks and Fines 13/14 & 14/15 0 (1,300) (1,300) (2,200) (2,200) 0 confirmed (QTR 1 £675k estimate). Assumption that the Trust will receive £3m Project Diamond funding Project Diamond shortfall and Bad Debts 0 0 0 (2,000) 0 2,000 but still a potential risk. The Trust should recover 13/14 CCG outstanding bills following the issue of credit notes for 13/14 fines. Trust to start billing other Provider Hospitals by the end of November. Delay due to data information to bill (extracting referral hospital from Foetal Medicine 0 0 0 3,500 2,500 (1,000) patient notes). This is due to notification in July by NHSE that this activity is now included in the Maternity pathway tariff paid by CCG's to local providers, potentially £1m at risk.
CCG Resilience (ED Tranche 1 & 2) 0 2,000 2,000 5,845 5,106 (739) Figures confirmed and billed.
NHSE to confirm funding on Emergency activity over-performance at NHSE Emergency Recovery Plan support inc. NICU (ED) 0 0 0 1,000 1,000 0 100% as opposed to 30% marginal rate and NICU additional capacity,
NHSE & CCG Resilience (RTT Tranche 1 & 2) 0 2,300 2,300 1,925 6,286 4,361 Figures confirmed and billed.
TDA still to confirm despite end of October timeline to formally TDA Indemnity 0 0 0 15,000 15,000 0 respond.
TOTAL 32,396 46,464 14,068 83,286 96,684 13,398
Page 11 Recovery Plan – Phasing and Month 8 Actual
REFORECAST PLAN AS SUBMITTED TO MONITOR M6 M7 M8 M9 M10 M11 M12
CAST
PLAN REFORE-
SUMMARY Reforecast Plan Deficit (41,246) (46,885) (46,456) (48,552) (46,389) (41,477) (28,063)
MONTH 8 ACTUAL M8 Actuals
Ambulatory Care and Local Networks (ACLN) 4,789 Critical Care, Theatres and Diagnostics (CCTD) (9,436) Liver, Renal and Surgery (LRS) (18,060) Networked Services (NWS) (12,068) Trauma, Emergency and Medicine (TEaM) (19,990) Women's & Children's (W&C) (11,278) Private Patients (PP) 1,479 CLINICAL DIVISIONS TOTAL (64,564) Corporate Services (547) Estates (640) Property and Capital Projects (1,786) Facilities (774) Human Resources (1,025) Finance, Procurement & Commercial Services (927) Capital Charges and Reserves (12,523) Information and Communication Technology (ICT) (266) Operations (1,172) Medical Executive team 90 Nursing Executive team (675) Strategic Development / R&D 178
PFI 812 MONTH 8 PERFORMANCE 8 MONTH Trustwide Integration (3,981) CORPORATE DEPARTMENTS TOTAL (23,236) Corporate Income inc Project Diamond 43,464 CCG validation checks and Fines 13/14 & 14/15 (1,300) Project Diamond shortfall and Bad Debts 0 Fetal Medicine 0 CCG Resilience (ED Phase 1 & 2) 2,000 NHSE Emergency Recovery Plan support inc. NICU (ED) 0 NHSE Resilience (RTT Phase 1 & 2) 2,300 TDA Indemnity 0 CORPORATE INCOME TOTAL 46,464 Deficit (41,336) Reforecast Plan Deficit (as submitted to Monitor) (46,456) The tableVariance above to Reforecast is an unconsolidated Plan expenditure analysis, excluding Trust subsidiaries. 5,120 Page 12 Recovery Plan - Surplus/(Deficit) Forecast Scenarios 14/15
Surplus/(Deficit) Forecast (excl. Impairment) Mid Case Best Case Worst Case Actual 10.000
0.546 0.000
(10.000)
(20.000)
(28.063)
(30.000) £'m (34.440) (40.000)
(47.169) (47.836) (50.000)
(60.000)
(70.000) m1 m2 m3 m4 m5 m6 m7 m8 m9 m10 m11 m12 Actual Actual Actual Actual Actual Actual Actual Actual Forecast Forecast Forecast Forecast Months
Page 13 Recovery Plan – Reforecast Cash Flow
TOTAL Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Forecast ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL FORECAST FORECAST FORECAST FORECAST
£'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s
Balance B/F 54,535 54,535 62,467 50,065 43,410 49,798 51,546 42,709 36,462 25,357 15,022 15,936 15,639
Income NHS Clinical Income LSB - SLA's 313,700 26,167 26,139 26,139 26,143 26,139 26,139 26,139 26,139 28,139 24,139 26,139 26,139 LSB - Other 12,624 2,550 513 3,756 168 30 509 1,822 1,066 551 553 553 553 SLA's - Other CCG 156,681 11,498 13,777 11,569 10,554 12,734 13,431 11,545 11,918 16,472 14,395 14,395 14,393 SLA - BSA (Dental) 1,716 138 138 144 139 141 140 141 141 165 143 143 143 NHSE - SLA's 323,500 25,236 23,646 30,174 27,833 25,958 30,308 26,551 26,697 26,774 26,774 26,774 26,774 NHSE - Other 9,856 1,379 335 984 0 (1,102) 1,697 303 53 1,551 1,552 1,552 1,552 CCG's - NCA & Misc 4,011 621 186 349 1,091 150 424 256 97 236 201 198 202 Additional Support CCG 0 0 0 0 0 0 0 0 6,000 1,500 1,500 1,500 Health Boards 2,000 235 84 55 118 130 78 909 86 77 76 76 76 NHS Trust 16,000 1,009 1,615 1,158 1,280 731 885 867 1,653 1,702 1,700 1,700 1,700 NHS Trust GSTT 4,246 342 68 141 234 134 1,319 842 290 216 220 220 220 RTA's 2,400 236 234 166 202 358 253 219 182 136 138 138 138 Maternity - WIP 2,786 2,478 308 0 0 0 0 0 0 0 0 0 0 Local Authorities 6,000 0 0 402 149 89 15 17 27 1,327 1,325 1,324 1,325 Dept of Health 3,002 91 198 388 144 165 516 144 144 303 303 303 303 Patient SLA Overperformance 2014/2015 20,000 0 0 0 0 0 (147) (23) (850) 5,256 5,256 5,256 5,252 Patient SLA Overperformance 2013/2014 32,688 2,007 8,405 7,757 2,941 6,751 2,743 (122) 206 500 500 500 500
Non-NHS Clinical Income Private Patients 15,107 1,416 1,446 1,514 1,761 1,270 780 931 744 1,235 1,235 1,540 1,235 Other Income Research and Development 4,782 0 201 214 874 79 911 93 18 598 598 598 598 Training & Educ: HEE T& E - SLA 45,000 10,952 0 0 11,737 0 0 11,893 0 0 10,418 0 0 HEE Other 1,000 182 19 17 500 18 11 21 50 46 46 46 44 HEE Dental 2,232 0 0 0 0 0 584 0 0 412 412 412 412 NHS Other Bodies 2,002 169 152 37 182 44 252 376 190 99 167 167 167 NHSE Support (SLHT) 41,100 0 0 0 12,758 0 6,850 3,425 3,425 4,367 3,425 3,425 3,425 NHSE Support (SLHT) 2013/14 11,590 11,590 0 0 0 0 0 0 0 0 0 0 0 Pathology 19,001 0 2,843 170 1,649 1,399 2,103 3 2,378 2,114 2,114 2,114 2,114 Non NHS Bodies 9,979 762 657 1,694 396 866 79 411 386 1,180 1,184 1,184 1,180 Miscellaneous 12,772 784 408 810 706 1,343 805 1,572 771 1,653 1,308 1,307 1,305 VAT reclaims 39,092 4,154 3,957 2,891 3,040 3,160 3,406 3,308 3,176 3,000 3,000 3,000 3,000 Consultant's Fees income (Private Patients) 2,323 368 226 327 230 326 194 176 192 71 71 71 71 sub-total 1,117,189 104,364 85,555 90,856 104,829 80,913 94,285 91,819 79,179 104,180 102,753 94,635 94,321
Expenditure Pay monthly (incl Pay Awards) 296,261 23,327 23,821 23,945 24,064 24,258 24,331 24,774 25,057 25,371 25,571 25,771 25,971 PAYE/NIC/SUPER (CHAPS) 227,104 18,244 18,808 18,748 18,896 18,838 18,517 18,772 19,070 19,311 19,300 19,300 19,300 Agency Spend (NHSP Bank) 41,028 2,126 2,765 2,471 2,452 3,227 3,122 5,341 5,423 4,316 3,259 3,256 3,270 Agency Spend (Agency) 56,749 4,000 6,500 5,500 4,500 6,000 6,000 5,228 6,415 4,316 2,508 2,842 2,940 Consultants' Fees 2,323 368 226 327 230 326 194 176 192 71 71 71 71 PFI project 72,207 6,797 5,789 6,095 6,077 5,908 5,903 6,045 5,809 5,946 5,946 5,946 5,946 AAH 6,285 500 558 544 560 592 500 531 500 500 500 500 500 Pathology (Joint Venture) 34,913 2,846 2,838 2,838 3,302 2,838 4,159 3,192 0 5,160 2,580 2,580 2,580 NHSLA Clinical Negligence 20,792 1,849 1,849 1,849 1,849 1,849 1,849 1,849 1,849 2,000 2,000 2,000 0 Non-pay Direct Debits (leases, rates) 21,802 1,495 2,211 2,015 2,694 2,031 1,691 1,648 2,337 1,420 1,420 1,420 1,420 Sainsburys 14,003 1,179 1,029 0 2,099 1,174 2,524 191 10 1,449 1,449 1,448 1,450 Non-pay Revenue Trade Creditors (Incl. CIPs) 321,756 29,869 24,848 27,679 26,261 21,667 28,237 19,385 17,805 39,790 28,123 20,272 37,820 sub-total 1,115,223 92,600 91,242 92,011 92,984 88,708 97,027 87,132 84,467 109,650 92,727 85,406 101,268
Cash from operations 1,967 11,764 (5,687) (1,155) 11,845 (7,795) (2,742) 4,687 (5,288) (5,471) 10,026 9,229 (6,947)
Capital & Financing Items Capital gross exp (Purchased) 56,171 1,610 4,494 2,133 3,176 2,738 3,265 8,669 3,552 4,412 6,492 6,904 8,725 Capital gross exp (Donated) 1,450 0 0 22 66 0 231 0 0 452 226 226 227 Capital Income (Donated) (680) 0 0 0 0 0 0 0 0 (114) 128 128 (822) PDC Dividends (TDR) 12,000 0 0 0 0 0 6,621 0 0 0 0 0 5,379 PDC Received (22,400) 0 0 0 0 (2,400) 0 0 0 0 0 0 (20,000) Indemnity Funding (15,000) 0 0 0 0 0 0 0 0 0 0 0 (15,000) Loan Received (22,000) 0 0 0 0 (12,100) (6,300) 0 0 (3,600) 0 0 0 Loan Repaid (Energy Centre) 562 0 0 281 0 0 0 0 0 281 0 0 0 Loan Repaid (Business Park) 450 0 0 225 0 0 0 0 0 225 0 0 0 Salix Loan Repaid 124 0 0 0 0 0 62 0 0 0 0 0 62 Capital Element of Finance Lease repayment 3,132 267 267 267 259 259 259 259 259 259 259 259 259 Interest on investments (143) (15) (16) (15) (14) (10) (13) (10) (10) (10) (10) (10) (10) Interest on Loans (Energy Centre) 434 0 0 217 0 0 0 0 0 217 0 0 0 Interest on Loans (Business Park) 80 0 0 40 0 0 0 0 0 40 0 0 0 Interest on Loans (CCU) 1,045 0 0 360 0 0 0 0 0 685 0 0 0 Interest on PFI & Finance Leases 17,320 1,443 1,443 1,443 1,443 1,443 1,443 1,443 1,443 1,443 1,443 1,445 1,445 PFI Contingent Rental Payments 6,604 527 527 527 527 527 527 573 573 574 574 574 574 sub-total 39,149 3,832 6,715 5,500 5,457 (9,543) 6,095 10,934 5,817 4,864 9,112 9,526 (19,161)
Net Inflow / Outflow (37,182) 7,932 (12,402) (6,655) 6,388 1,748 (8,837) (6,247) (11,105) (10,335) 914 (297) 12,214
Forecast Balance C/F 17,353 62,467 50,065 43,410 49,798 51,546 42,709 36,462 25,357 15,022 15,936 15,639 27,853 Page 14 Recovery Plan - Cash Flow Forecast Scenarios 14/15
Actual Mid Case Cash Flow forecast Best Case Worst Case 70.000 59.024 60.000
50.000
40.000 30.415 27.853
30.000 25.357 £'m 20.000 10.642 10.000
0.000
(10.000)
(20.000) m1 m2 m3 m4 m5 m6 m7 m8 m9 m10 m11 m12 Actual Actual Actual Actual Actual Actual Actual Actual Forecast Forecast Forecast Forecast Months
Page 15 Month 8 - I & E Summary
Income is £27.7m over-performing YTD, £1.4m adverse movement in M08
. Off tariff drugs income is over-performing by £9.4m YTD which is offsetting YTD drugs expenditure overspend of £10.3m which is a mixture of price and volume changes. . Details of the income over-performance are presented on pages 23 to 28.
Pay is £25m overspent YTD, £3.1m adverse movement in Month 8
. Nursing is £13.7m overspent YTD, £2.6m adverse movement in Month 8 The overspend is mainly in Medicine, Critical Care, Liver, Surgery, and Neuro. Nursing agency spend was approximately £1.8m per month in 13/14 (M7-12 average), in 14/15 agency spend is averaging £2.2m per month. This overspend is due agency spend and recruitment plans to reduce vacancies are in place, including overseas recruitment. There is a time lag due to training requirements and a cost impact to training (back-filling staff to train new nurses with agency staff). The training of overseas nurses can be anything from 2 to 12 months. Some additional medicine beds have been opened at the PRUH resulting in the wards booking additional shifts (approx. 30wte’s) as only 50% of the recommended increased staffing at the PRUH was funded. There has also been “specialing” for high dependency patients which has an impact on the use of bank and agency, a business case has been approved for “specialing” which should result in a reduction in agency spend and also the use of additional agency security staff.
. Medical is £8m overspent YTD, £600k adverse movement in month 8 The majority of the overspend is in Ambulatory Care, Theatres, Medicine, Surgery, Cardiac and Neuro and is caused by the use of locums covering vacancies. The vacancy rate for ED juniors is currently 42% and there are a number of consultant vacancies in acute medicine covering the additional posts in the 7/7 business case that was approved in January. Without Commissioner financial support on a recurring basis, these posts cannot be made substantive. Recruitment plans for medical staff need to be reviewed and Procurement are reviewing the rates paid to locums. There is approx. £422k of costs year to date relating to Junior Doctors non compliant rota’s (£1.2m estimated additional annual recurrent cost)
Non Pay is £40.m overspent YTD, £742m favourable movement in Month 8
. Drugs are £10.m overspent YTD. The majority of this overspend is due to off tariff drugs and is recoverable through income.
. Clinical Supplies are £10.2m overspent YTD. The majority of this is in Theatres, LRS, Neuro and Cardiac due to increased activity.
. Miscellaneous Expenses are £13.4m overspent YTD. £2.4m is due to a bad debt provision for overseas visitors income, £10.7m of costs relating to MSK contracts (offset by £9.1m of Income) the remainder relates to non-NHS contracted out services such as Medihome, Capita and various private sector hospitals re off-site working.
Page 16 Month 8 - Divisional Variance Analysis
LRS – Liver £4.9m overspent YTD, £600k adverse movement in Month 8
. Pay - Nursing Staff overspent by £1m YTD and £98k in month adverse variance mainly due to continued B&A staff usage in LITU, PRUH Endoscopy and Dawson Ward. There has been Bank and Agency spend of just over £1.1m in LITU which has been due to a high number of vacancies and overseas nurse supernumery costs. The nursing management continues to review alternatives ways of managing the double running of agency staff and the overseas nurses whilst they undergo their supernumery period. Weekly B & A usage view has now been intensified and reviewed with the support of Finance team. PRUH Endoscopy continues to overspend (£402k), due to the continued use of use of Bank and Agency staff to cover weekend work. . Non Pay is £5.4m overspent YTD. The overspend relates to clinical supplies, drugs, external contracting and establishment expenses relating to increased activity (transplants & organ retrieval), off tariff drugs, RTT (off site working) and overseas recruitment respectively. . Income in Liver is over performing by £2m YTD mainly due to over-performance of £2m YTD in Hepatology; Gastroenterology income £500k; Transplantation income £440k; Gastroenterology income £21k. However this continues to offset underperformance in HPB and LITU income by £1m and £300k respectively. The main area of over performance is in Off tariff drugs & devices income of £2.8m in the YTD.
LRS – Surgery £8.2m overspent YTD, £2.2m adverse movement in Month 8
. Income is over-performing by £185k YTD. Patient treatment income (CAT-A) is over performing by £3.7m YTD. All specialities are over performing but T&O activity across sites has specifically over performed, resulting in £2.6m income over achievement. The over performance is partially off set by the additional income targets relating to CIP's and coding optimisation and the full year effect of the IB4 and other business cases, previously approved. . Pay - Medical staff: over spent by £1.95m YTD of which £442k and £1.5m relate to Denmark Hill and PRUH sites respectively, this remains largely driven by bank and agency staff usage to cover vacancies that are proving difficult to recruit into especially at PRUH site. Non-compliant rotas due to gap in funded posts is the other contributor for high use of temporary staff. . Pay - Nursing: over spent by £1.5m, mainly at PRUH site. This is mainly driven by bank and agency staff usage to cover the existing 29 wte vacancies and comply with rotas within the Surgical Wards which remains partially funded. Recruitment plans kiare underway, 19.00wte new starters in Nov of which 11.00wte are at the PRUH and the other 8.00wte at DH. Bank and agency usage has also seen a sharp decline in monthly both at the PRUH and Denmark Hill. LRS – Bexley MSK £1.5m overspent YTD, £131k adverse movement in Month 8 . The MSK contract is reporting an adverse variance of £1.5m YTD with a full year forecast of £2.5m adverse variance. The YTD cost of providing the service in house and from sub contractors is £10.6m against YTD income of £9.1m. In order to improve the full year forecast, negotiations with the Bexley CCG are on going to agree the total contract value based on previous years activity levels. Page 17 Month 8 - Divisional Variance Analysis
Network Services - Neurosciences £5m overspent YTD, £179k adverse movement in Month 8
. Pay is over spent by £1.7m YTD due to usage of nurse agency staff at PRUH resulting from recruitment difficulties and increase in specialing, Locum Consultants usage due to long term sickness absence.
. Non Pay is overspent by £2.5m YTD mainly due to clinical supplies and drugs. Much of the devices expenditure and drugs expenditure is off-tariff and recoverable through income.
Network Services - Cardiac £4m overspent YTD, £588k adverse movement in Month 8
. Pay is over spent by £1.7m YTD, this is mainly due to nursing agency staff at the PRUH as a result of recruitment difficulties; locum consultants usage in Cardiology Services (PRUH) related to long term sickness absence; and high technical staff usage in the Echo service to achieve waiting list targets. Business case funding has been allocated but is dependent on a reduction in agency costs.
. Non Pay is overspent by £1.6m and this mainly relates to clinical supplies over spent due to increase in activity.
Women’s & Children- Women’s Health £3.6m overspent YTD, £380k adverse movement in Month 8
. Income is underperforming by £1.7k YTD due to underperformance in elective gynae and maternity at Denmark Hill
. Non Pay is overspent by £1m, this mainly relates to the provision of new-born hearing screening which is a part of maternity pathway tariff.
CCTD – Critical Care and Theatres £5.6m overspent YTD, £539 adverse movement in Month 8
. Pay is £2.9m overspent YTD, the majority of this overspend is in critical care nursing where there is still a high number of vacancies. Recruitment plans are in place and have been quantified as part of the recovery plan.
. Non Pay is £5.1m overspent YTD, this is mainly clinical supplies in Theatres and DSU as a result of increased activity.
Page 18 Month 8 - Divisional Variance Analysis
TEAM £10.4m overspent YTD, £1.8m adverse movement in Month 8
. Income £854k under-performance YTD, £921k adverse movement in Month 8. DH site underperforming by £1.3m, £613k adverse movement in month against non-elective income due to reduction in long stay patients and increase in zero LOS patients which attract a lower tariff. Movement in month is due to reduction in activity in November (6 beds on the DH site are currently closed).
. Pay - Medical staff £4.8m overspent, £351k adverse movement: PRUH site £3m overspent, £296k adverse movement - £422k cost pressure for non-compliant junior doctor rota (claim being pursued with TDA), rota is compliant from Aug 14 but new rota has been implemented resulting in 11 JCF added to the rota; there were also additional locums used prior to August to maintain performance and safety (£1.6m overspent YTD). Consultants £987k overspent due to 3 additional Acute Med Cons (budget not transferred on acquisition, claim being pursued with TDA) and 2 Geriatric Consultants on going from last winter. DH site is £1.8m overspent, £56k adverse variance - high cost locums covering vacancies and LTS, there was also an additional shift booked for performance Fri to Tues (this was stopped from Aug). Expenditure had reduced by £225k per month (18%) on the PRUH site and by £235k (13%) at DH from August due to recruitment to substantive posts.
. Pay - Nursing staff £5.1m overspent, £841k adverse movement: PRUH site £4m overspent, £558k adverse movement - wards £2.9m overspent due to increase in ward shifts for increased acuity and staffing to 1:8 ratio, high specialing and high cost agency used due to recruitment issues. ED is £1.1m overspent due to additional shifts added to rota to open majors B cubicles (unfunded). DH site is £1m overspent, £283k adverse movement - wards are £408k overspent due to high specialing, sickness and high cost agency used to cover vacancies; there was an increase of £117k in month compared to YTD average due to newly qualified starters and 3rd cohort of Filipino nurses starting in month currently supernumery, this should reduce from next month. ED is £615k overspent due to high sickness and high cost agency used to cover vacancies.
Page 19 Month 8 - Corporate Variance Analysis
Description of Variance Explanation of Variance
Income: £74k overachieving YTD, £2.8k favourable movement in M8 relates to funding received, which offsets non-pay costs in Volunteering. Pay: £167k overspent YTD, £35k Corporate Services - £547k favourable movement in month relates to the correction for duplicate legal fee costs, YTD overspend includes £40k costs associated with recruiting the new Chairman. Non- overspent YTD pay: £454k overspent YTD, although £91k favourable movement in M8 mainly relates to correction of duplicate charge for a £78k insurance costs, YTD overspend mainly relates to interpreting costs and legal fees associated with PRUH look back expenses.
Income: £17k overachieving YTD for providing external training courses. Pay: £291k overspent YTD, £19k adverse movement in M8, YTD relates to £87k talent pool recruits to be Executive Nursing - £677k transferred to divisions & £155k staffing over establishment for nurses in training cost (funding received and held centrally). Non-pay: £403k overspent YTD, £40k adverse overspent YTD movement in M8. YTD overspend relates to £92k clinical supplies (Infection Control Ice-Pods & training consumables IV lines, Ebola), £68k unachievable SLHT CIP target, £58k recruitment cost and £102k on CQC recommended equipment costs (Bed Head Signs)
Income: £65k overachieving YTD, £30k favourable movement in M8 relates to funding received for Integrated Care which is offset by Pay costs. Pay: £601k overspent YTD, £91k Operations - £1.2m adverse movement in month mainly due to Patient Records PRUH high agency spend and £82k for SLIC posts partly offset by income (BC to be submitted). Non-pay: £635k overspent YTD overspent YTD expenditure relates to storage costs £329k and £80k EPS benchmarking system (unfunded cost pressures), £78k unachievable SLHT CIP target, £67k due to SLIC costs, £61k equipment & stationery for PRUH Patient Records dept.
Income: £530k overachieving YTD, breakeven in month. Underspends YTD due to £256k funding received from e.g. Health Education South London for EDT (Apprenticeship funding) offset by related Pay Costs & £278k OH income from external contracts which is partially offset by associated pay and nonpay expenditure. Pay: £672k overspent YTD, Workforce (HR & OH) £1m £146k adverse movement in month relates to staff over establishment mainly concerning Occupational Health's TUPEd SLAM staff costs which are being offset by income, overspent YTD additionally medical locums (£25k in M8) are used as the level of staff required is not constant but needed to cover varying volume of appointments. Non-pay: £883k overspent YTD, £141k adverse movement in month mainly relates to overspend against consultancy, which is Capita contract costs.
Income: £137k overachieving YTD, £94k in month relates to Procurement rebate monies from Carefusion/3M/Vygon. Pay: £15k overspent YTD, favourable in month due to a Finance - £173k underspent budget reallocation for staffing. Nonpay: £51k underspent YTD, £815k positive movement in month due to a budget reallocation for consultancy fees, leasing charges and YTD PRUH unmet saving targets not relating directly to Finance.
Information - £264k Income: £91k underachieving YTD includes an unachievable historical income target (£19k p.a). Pay: £154k underspent YTD, £22k adverse movement in month relates to agency overspent YTD covering staff vacancies. Nonpay: £327k overspent YTD mainly relates to computer contract maintenance/services.
Income: £82k positive variance YTD, £6k in M8 for project work (Value Based Healthcare) which is offset by nonpay costs. Pay: £131k underspent YTD, £45k favourable Strategic Development - movement in month relates to vacancies and corrections to staff previously charged to this budget but related to Transition/Integration and also funding received from R&D for £209k underspent YTD work undertaken. Nonpay: £4k overspent YTD.
Page 20 Month 8 - Expenditure By Type
Annual YTD YTD YTD Last Month Movement Budget Budget Expend Variance Variance in Month £'000 £'000 £'000 £'000 £'000 £'000
PAY Medical Staff (186,946) (124,544) (132,598) (8,054) (7,447) (607) Nursing Staff (226,970) (152,449) (166,230) (13,781) (11,175) (2,606) A&C Staff/Senior Managers (92,425) (61,645) (63,638) (1,993) (2,238) 245 PAMS (28,939) (19,388) (18,106) 1,282 1,048 234 Directors (1,697) (1,131) (1,140) (9) 36 (45) Scientific/Professional (45,287) (30,187) (32,854) (2,667) (2,271) (396) Other (1,968) (1,314) (1,129) 185 143 42 Sub-total (584,232) (390,658) (415,695) (25,037) (21,904) (3,133) NON-PAY Clinical Supplies (83,456) (54,288) (64,514) (10,226) (8,940) (1,286) Drugs (97,384) (65,183) (75,539) (10,356) (8,740) (1,616) Non Clinical Supplies (48,728) (32,747) (38,612) (5,865) (5,600) (265) PFI (52,323) (33,356) 812 812 688 124 Capital Charges (30,975) (20,650) (20,681) (31) (8) (23) Interest and Dividends (36,968) (24,645) (25,231) (586) (149) (437) Leases and Rentals (12,898) (8,598) (11,658) (3,060) (2,442) (618) Services Provided by Non-NHS Bodies (28,983) (19,511) (19,978) (467) (851) 384 Subcontracted Healthcare - NHS Bodies (10,766) (7,177) (9,427) (2,250) (7,328) 5,078 Misc. Other Operating Expenses (40,696) (26,174) (67,760) (8,230) (7,631) (599) Sub-total (443,176) (292,330) (332,589) (40,259) (41,001) 742
Total Expenditure (1,027,408) (682,988) (748,284) (65,296) (62,905) (2,391)
Total Income 1,018,652 673,416 701,116 27,700 29,112 (1,412)
Trust Total (8,756) (9,572) (47,168) (37,596) (33,793) (3,803)
The table above is an unconsolidated expenditure analysis, excluding Trust subsidiaries. Page 21 Month 8 – Trust Income
Row Labels Annual Plan Month 8 Plan YTD Month 8 Actual YTD Month 8 Variance YTD ASLN 129,565,404 86,376,936 88,621,768 2,244,832 Ambulatory Services 92,484,432 61,656,288 65,069,254 3,412,966 Dental Institute 37,080,972 24,720,648 23,552,515 -1,168,133 CCTD 56,141,988 37,427,992 41,656,892 4,228,900 CCDS 25,557,300 17,038,200 17,227,962 189,762 Critical Care 27,254,640 18,169,760 22,212,171 4,042,411 Theatres 3,330,048 2,220,032 2,216,758 -3,274 Facilities (Estates) 7,351,656 4,901,104 7,349,205 2,448,101 Patient Transport 8,102,100 5,401,400 5,470,569 69,169 Trust Income -750,444 -500,296 1,878,636 2,378,932 LRS 188,372,748 125,581,832 132,932,364 7,350,532 Liver 56,494,320 37,662,880 40,607,731 2,944,851 Renal 32,129,556 21,419,704 21,394,031 -25,673 Surgery 99,748,872 66,499,248 70,930,602 4,431,354 Networked Services 175,206,864 116,804,576 123,494,383 6,689,807 Cardiovascular 50,534,364 33,689,576 34,512,067 822,491 Haematology 57,326,232 38,217,488 43,057,870 4,840,382 Neurosciences 67,346,268 44,897,512 45,924,447 1,026,935 TEaM 116,864,676 77,909,784 79,756,804 1,847,020 TEaM 113,260,944 75,507,296 77,378,607 1,871,311 Therapies 3,603,732 2,402,488 2,378,197 -24,291 W&C 125,850,384 83,900,256 83,690,822 -209,434 Child Health 60,621,384 40,414,256 42,041,080 1,626,824 Womens Health 65,229,000 43,486,000 41,649,742 -1,836,258 Grand Total 799,353,720 532,902,480 557,502,239 24,599,759
Performance by Division: Ambulatory Services And Local Network Increase in Outpatient activity due to seasonality. +£139k monthly movement of IP Elective at the PRUH due to Ophthalmology and Breast Surgery. There has been a negative monthly movement of -£411k for Drugs and Devices due to the removal of some QMS drugs that should not have been charged for - 69% (-£281k) of the monthly movement is for the Subfoveal choroidal neovascularisation which are the Lucentis/Eylea/Ozurdex drugs at QMS that were first processed in M6 and have now been challenged by the Commissioners. For Information: £442k of RTT was stripped out for Dental (£160k for IP Elective, OP procedure £273k and New and Follow- ups (£8k).The 76% table (+£112k) above of the is monthly an unconsolidated movement is for expenditureIP Elective - Increase analysis, was expected excluding due to Trust seasonality. subsidiaries . Page 22 Month 8 - Clinical Income by Division
Critical Care Theatres And Diagnostics At a Trust level Adult CC is over performing by £1.3m with an over performance at DH by +£1.5m and an under performance at PRUH by -£207k. There is also lot of variations between divisions. For Critical Care there is an over performance of +£2.2m at Denmark Hill. £945k (42%) of the over performance at Denmark Hill is for the LSB block contract. Liver Renal And Surgery Liver Over-Performance driven by Drugs & Devices (£2.5m) - Sofosbuvir (new HEP C drug) specially funded activity and a seperate trial that has been agreed with NHSE. Permacol Mesh (£40k of activity for frozen months) - at risk of being challenged by the commissioners. OP Follow up at DH - mostly due to KPI's, switch from multiprofessional to single Follow Ups for Hepatology. 56% (+£867k) of the monthly movement was due to IP elective. This was due to T&O activity at DH and Orpington (PRUH) now being maximised. 20% (+£307k) of movement due to IP emergency - more patients and complexity. For Information: M7 YTD there has been £529k of RTT was stripped out of General Surgery inpatients (£276k for Denmark Hill and £253k at PRUH). Networked Services 51% (+£187k) of the monthly movement is due to IP Elective and in particular IP Elective cardiothoracic (linked to decrease in Non-Elective). 24% (+£84k) of the movement is Critical Care due to 2 organs supported. 25% (+£83k) of the movement is Drugs and Devices to ICD’s (Most of the over performance is for PVRD (£283k). Whilst the positive monthly movement is due to ICD’s which is still under performing by -£63k (+£63 from M6 projected). For Information: In M7 £55k of RTT was stripped out for Cardiothoracic Surgery - this equates to 7 spells for October. Legacy Marginal Rate Adjustment has been applied for BMT adding +£656k to the actual value (Haematology). £390k of RTT has been stripped out for Neurosurgery. This equates to 149 spells/attendances for July, August, September and October.
TEAM IP Emergency – Over-Performance by £551k (+£248k from M6 projected). Under-Performance at Denmark Hill by -£186k (+£115k movement from M6 projected) and Over-Performance at the PRUH by £737k (+£133k from M6 projected). Monthly movement at PRUH is due to the M1 escalation ward re-opening which closed at the end of July to mid-September due to no demand. Overall IP Emergency at Denmark Hill is up in volume but down in value. This is due to a patient type change with a decrease in Emergency and an increase in Emergency zero LOS which attracts a lower tariff.
Women And Children Two technical adjustments at DH have been applied with a total value of -£498k for Child Health. This is made up of the Emergency Marginal Rate Adjustment (-£354k) and Quarter 1 Claims Adj (-£144k) - This is due to a recording change which commissioners were not given 6 months notice for. The recording change relates to coding optimisation work around the PB02Z - Minor Neonatal Diagnoses HRG. This adjustment actually relates to PRUH activity and will be corrected for M7 freeze. £149k of RTT was stripped out for Gynaecology, £57k for DH and £92k for PRUH. This is for activity in August, September and October. Quarter 1 Claims Adj – This has now been applied to Womens Health with a value of -£236k. Of this, £177 was for Q1 PRUH data that was refreshed without the commissioners agreement. This adjustment actually relates to PRUH activity and will be corrected for M7 freeze.
The table above is an unconsolidated expenditure analysis, excluding Trust subsidiaries. Page 23 Month 8 – Income Analysis Graphs
Trust Income Income by Division Income by Monitor Heading 74 £140 OUTPATIENT
72 £120
Millions Millions £100 OTHER 70 £80 68 NON ELECTIVE £60 ELECTIVE 66 £40
64 £20 A&E £0 62 ASLN CCTD Facilities LRS Networked TEaM W&C 0 100 200 300 A M J J A S O N (Estates) Services Millions
Budget Actual Month 8 Plan YTD Month 8 Actual YTD Month 8 Actual YTD Month 8 Plan YTD
Activity Volume Tariff Type Contract Income % Bexley MSK 470 PbR 4% Block Contract 460 19% Contracts Team
450 Non-PbR Thousands Dental 440 GUM GUM 430 37% LSB CCG Contract 420 Elective RTT NHSE Specialised 410 Non English 400 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Elective RTT GUM Non-PbR PbR 37% Not Known 390 Budget 0 4,335,416 184,865,192 343,701,872 A M J J A S O Actual 2,433,970 4,690,913 202,418,846 347,958,510 Other CCG Budget Actual Budget Actual Screening
The table above is an unconsolidated expenditure analysis, excluding Trust subsidiaries. Page 24 Month 8 – Contract Income
BROMLEY CCG LAMBETH CCG Projected Projected Projected Projected Projected Projected Month 8 Month 8 Month 8 Month 12 Month 12 Month 12 Month 8 Month 8 Month 8 Month 12 Month 12 Month 12 Row Labels Plan YTD Actual YTD Variance YTD Plan Actual Variance Row Labels Plan YTD Actual YTD Variance YTD Plan Actual Variance A&E Tariff 4,718,328 4,677,245 -41,083 7,077,492 7,015,868 -61,624 A&E Tariff 4,020,024 4,007,712 -12,312 6,030,036 6,011,568 -18,468 Critical Care 3,562,288 3,251,996 -310,292 5,343,432 4,877,994 -465,438 Critical Care 3,137,776 3,901,662 763,886 4,706,664 5,852,492 1,145,828 Dialysis 341,224 246,681 -94,543 511,836 370,022 -141,814 Dialysis 281,000 235,805 -45,195 421,500 353,708 -67,792 Elective 8,075,912 9,128,866 1,052,954 12,113,868 13,693,299 1,579,431 Elective 3,612,448 3,198,162 -414,286 5,418,672 4,797,244 -621,428 NO CODE -2,561,584 -4,419,583 -1,857,999 -3,842,376 -6,629,375 -2,786,999 NO CODE -2,378,360 -2,803,625 -425,265 -3,567,540 -4,205,437 -637,897 Non Elective 30,843,160 29,381,701 -1,461,459 46,264,740 44,072,551 -2,192,189 Non Elective 15,050,448 15,598,873 548,425 22,575,672 23,398,309 822,637 Off Tariff Devices 846,088 1,026,828 180,740 1,269,132 1,540,242 271,110 Off Tariff Devices 508,840 491,147 -17,693 763,260 736,721 -26,539 Off Tariff Drugs 432,360 229,733 -202,627 648,540 344,599 -303,941 Off Tariff Drugs 1,345,320 1,220,729 -124,591 2,017,980 1,831,093 -186,887 OTH Non Tariff 21,285,624 21,348,134 62,510 31,928,436 32,022,202 93,766 OTH Non Tariff 8,793,712 8,209,793 -583,919 13,190,568 12,314,689 -875,879 Outpatient 20,589,368 22,697,140 2,107,772 30,884,052 34,045,709 3,161,657 Outpatient 9,191,160 9,317,528 126,368 13,786,740 13,976,292 189,552 PSD Admission 13,055,104 14,988,176 1,933,072 19,582,656 22,482,264 2,899,608 PSD Admission 5,653,224 5,744,948 91,724 8,479,836 8,617,422 137,586 Grand Total 101,187,872 102,556,916 1,369,044 151,781,808 153,835,374 2,053,566 Grand Total 49,215,592 49,122,734 -92,858 73,823,388 73,684,101 -139,287
SOUTHWARK CCG BEXLEY CCG
Projected Projected Projected Sum of Sum of Sum of Projected Projected Projected Month 8 Month 8 Month 8 Month 12 Month 12 Month 12 Month 8 Plan Month 8 Month 8 Month 12 Month 12 Month 12 Row Labels Plan YTD Actual YTD Variance YTD Plan Actual Variance Row Labels YTD Actual YTD Variance YTD Plan Actual Variance A&E Tariff 4,428,128 4,468,777 40,649 6,642,192 6,703,165 60,973 A&E Tariff 551,280 558,561 7,281 826,920 837,842 10,922 Critical Care 3,306,048 3,715,985 409,937 4,959,072 5,573,978 614,906 Critical Care 526,016 659,155 133,139 789,024 988,733 199,709 Dialysis 275,872 218,193 -57,679 413,808 327,289 -86,519 Dialysis 281,968 258,299 -23,669 422,952 387,448 -35,504 Elective 4,414,808 3,724,291 -690,517 6,622,212 5,586,437 -1,035,775 Elective 1,228,136 1,221,914 -6,222 1,842,204 1,832,871 -9,333 NO CODE -775,216 -938,280 -163,064 -1,162,824 -1,407,419 -244,595 NO CODE -288,688 -665,948 -377,260 -433,032 -998,923 -565,891 Non Elective 15,562,312 14,656,165 -906,147 23,343,468 21,984,248 -1,359,220 Non Elective 4,462,608 4,960,487 497,879 6,693,912 7,440,730 746,818 Off Tariff Devices 671,000 647,389 -23,611 1,006,500 971,084 -35,416 Off Tariff Devices 145,248 204,836 59,588 217,872 307,254 89,382 Off Tariff Drugs 1,336,936 1,304,553 -32,383 2,005,404 1,956,829 -48,575 Off Tariff Drugs 176,968 197,550 20,582 265,452 296,326 30,874 OTH Non Tariff 10,336,072 9,894,542 -441,530 15,504,108 14,841,813 -662,295 OTH Non Tariff 2,010,192 2,262,495 252,303 3,015,288 3,393,743 378,455 Outpatient 11,206,440 11,023,626 -182,814 16,809,660 16,535,439 -274,221 Outpatient 3,683,152 3,673,273 -9,879 5,524,728 5,509,909 -14,819 PSD Admission 6,304,208 6,452,055 147,847 9,456,312 9,678,083 221,771 PSD Admission 2,035,752 2,340,447 304,695 3,053,628 3,510,670 457,042 Grand Total 57,066,608 55,167,297 -1,899,311 85,599,912 82,750,946 -2,848,966 Grand Total 14,812,632 15,671,068 858,436 22,218,948 23,506,603 1,287,655
NHSE SPECIALISED OTHER - Including NHSE Dental & Screening
Sum of Sum of Sum of Projected Projected Projected Sum of Sum of Sum of Projected Projected Projected Month 8 Plan Month 8 Month 8 Month 12 Month 12 Month 12 Month 8 Plan Month 8 Month 8 Month 12 Month 12 Month 12 Row Labels YTD Actual YTD Variance YTD Plan Actual Variance Row Labels YTD Actual YTD Variance YTD Plan Actual Variance A&E Tariff 0 0 0 0 0 0 A&E Tariff 3,877,192 3,819,453 -57,739 5,815,788 5,729,180 -86,608 Critical Care 28,491,680 28,743,182 251,502 42,737,520 43,114,773 377,253 Critical Care 7,684,768 10,439,433 2,754,665 11,527,152 15,659,149 4,131,997 Dialysis 11,932,048 12,876,244 944,196 17,898,072 19,314,365 1,416,293 Dialysis 1,107,784 1,001,077 -106,707 1,661,676 1,501,616 -160,060 Elective 21,944,480 19,689,987 -2,254,493 32,916,720 29,534,981 -3,381,739 Elective 9,892,112 12,762,341 2,870,229 14,838,168 19,143,511 4,305,343 NO CODE 7,460,272 12,232,196 4,771,924 11,190,408 18,348,294 7,157,886 NO CODE -1,956,720 -1,526,124 430,596 -2,935,080 -2,289,187 645,893 Non Elective 23,903,616 26,739,202 2,835,586 35,855,424 40,108,803 4,253,379 Non Elective 22,557,432 22,595,125 37,693 33,836,148 33,892,688 56,540 NSCT 26,263,144 24,330,966 -1,932,178 39,394,716 36,496,448 -2,898,268 NSCT -251,952 21,923 273,875 -377,928 32,884 410,812 Off Tariff Devices 3,159,528 4,190,643 1,031,115 4,739,292 6,285,964 1,546,672 Off Tariff Devices 2,716,448 2,891,046 174,598 4,074,672 4,336,569 261,897 Off Tariff Drugs 28,100,568 38,512,561 10,411,993 42,150,852 57,768,841 15,617,989 Off Tariff Drugs 3,116,656 2,523,075 -593,581 4,674,984 3,784,613 -890,371 OTH Non Tariff 21,454,248 21,701,791 247,543 32,181,372 32,552,687 371,315 OTH Non Tariff 22,876,304 23,364,902 488,598 34,314,456 35,047,353 732,897 Outpatient 11,815,136 11,840,656 25,520 17,722,704 17,760,984 38,280 Outpatient 32,616,960 34,004,864 1,387,904 48,925,440 51,007,296 2,081,856 PSD Admission 3,931,392 4,543,043 611,651 5,897,088 6,814,564 917,476 PSD Admission 17,926,680 17,686,638 -240,042 26,890,020 26,529,958 -360,062 Grand TotalThe table188,456,112 above 205,400,470is an unconsolidated16,944,358 282,684,168 expenditure308,100,705 analysis,25,416,537 excludingGrand Total Trust122,163,664 subsidiaries129,583,753. 7,420,089 183,245,496 194,375,630 11,130,134 Page 25 Month 8 – Sector Variance Report
Sector Variance Report
Over-Performancve of 4.6% at Denmark Hill same rate at month 6, PRUH performance up to 9.9% Elective RTT, Tranche 1 patients excluded, funding to be monitoring through additional reports dated back to month 4. Quarter 1 agreed claims have been put through. Quarter 2 yet to be agreed Specialist services marginal rates applied, with BMT performance being the main driver for NHSE Missing Datasets, applied actuals as plan - Unbundled IP including Chemotherapy (DH, PRUH), Unbundled Diagnostics (DH, PRUH) Patient Transport (from month 4 at DH) and Pathology (PRUH) Emergency marginal rates applied for NHSE have been applied, no adjustment for LSB applicable currently Uncoded Activity at PRUH - Month 6 figures due to system processing issue and was overstated, this was genuine uncoded activity and has been resolved for month 7
Performance Notes
Over-Performance
DENMARK HILL PRUH Small performance increase at Denmark hill from 5.9% in month 6 Activity being driven by Lambeth and Lewisham in the early part of the year. With Critical Care additional long stay Lewisham patient in Month 7 NHSE activity down from months 1-4 (where there were multiple high organ support patients) Driven by NHSE, with performance continuing on 14/15 trend for Lenalidomide, Performance driven by NHSE, trending around £1mil over plan month on month Adalimumab, Etanercept Activity driven by additional of Sofosbuvir for Hep C Drugs and Devices Other overperforming drugs continue on expected 14/15 trend for Immunosuppressants, Fingolimod and Mucolytics CCG commissioned drug trends continuing on 14/15 trajectory after above average month 6 Over performance sitting with Bromley, includes plan adjustments for QIPP and KPI's IP Elective and XBD's Haematology performance up on plan, continuing trend seen from 13/14 Overperformance largely related to Emergency Admissions QIPP non-delivery (sitting IP Emergency with Lambeth - £1.01mil), actuals on par with pre-QIPP adjusted plan NHSE performance up on Q2 trend for October 50/50 Care Pathway QIPP's at Bromley OP New & Follow up KPI's for First to Followup Over performance in T&O is on trend for 14/15 PTS and Quarter 1 claim adjustments have beenfiled under Denmark Hill site, even Other Technical Adjustments where PRUH specific
Under-Performance
Shorter stays at Bromley driving majority of under performance, other London CCG's Critical Care marginally up Under performance related to RTT problem specialties: Cardiothoracic, IP Elective Hepatobiliary/Pancreatic, Neurosurgery and T&O To note - Over performance sitting with Bromley (£980k) IP XSBDs Reduction in very long stay patients versus Q1 and 2 13/14 Continutation of 14/15 - Births and bookings are down on trend, Lambeth and Southwark Maternity (Bookings/Births) driving performance Casemix adjuster needs to be recalculated, currently negative adjustment is overstated. OP Follow Up NHSE driving under performance with removal of Fetal Med activity from actuals OP Procedure Lucentis activty growth not as expected, accounting for under performance over 300k Other PatientThe Modalities table above is anContinued unconsolidated under performance expenditure for BMT at NHSE analysis, excluding TrustContinuation subsidiaries of Anti Coag .QIPP delivery reductions Page 26 Month 8 - Medical Outliers
Medical Outliers and Lost Opportunity Income
1400 N u m 1200 b e r 1000 o f 800 2012-13 O 2013-14 B 600 D 2014-15 ' 400 s
200
0 April May June July Aug Sept Oct Nov Dec Jan Feb March Months
Net Loss April May June July Aug Sept Oct Nov Dec Jan Feb March Total
2012-13 262,310 150,428 180,038 71,171 38,943 81,840 111,901 109,492 187,549 300,264 142,998 255,127 1,892,061 2013-14 192,156 163,606 88,252 116,235 108,687 149,984 184,695 165,528 177,272 213,519 119,315 108,447 1,787,695 2014-15. 91,823 98,208 118,555 63,915 119,690 94,114 114,752 91,327 792,384
4,472,141 Page 27 Month 8 - Medical Outliers
Medical Outliers and Lost Opportunity Income
Summary
The graph shows the monthly number of bed days for General Medicine patients outlying in other Divisions wards.
The patients are from all specialties within General Medicine including Acute Medicine and Geriatrics.
The Lost opportunity income is an estimated net calculation based on the following:
1) An average income tariff lost per speciality by not filling their beds with their own patients. This is based on the number of occupied bed days. 2) An average income received by having General Medicine Patients in those beds.
The net difference between 1) and 2) is shown as a net loss per month. The total estimated loss is:
2012-13 £1,892,061 2013-14 £1,787,695 2014-15 £ 792,384
Total to date since April 2012 £4,472,141
Page 28 Month 8 – Nursing Bank & Agency Analysis
Page 29 Month 8 – Doctors Bank & Agency Analysis
Page 30 Month 8 – Nursing Bank & Agency Analysis
Page 31 Month 8 – Doctors Bank & Agency Analysis
Page 32 Month 8 - 2014/15 CIP YTD Summary
PERFORMANCE AGAINST PLAN BY DIVISION CIP PERFORMANCE AGAINST PLAN BY MAJOR PROJECT Identified YTD Target YTD Actuals Variance YTD ACLN 4,659 3,026 1,655 -1,371 Annual YTD Target YTD Actual Variance CCTD 5,708 3,215 2,427 -787 Scheme title (in trackers) Target £000 £000 £000 £000 TEAM 5,810 3,748 1,157 -2,591 Admin & Clerical Productivity 700 419 43 -376 LRS 5,980 3,948 2,070 -1,878 Divisional Agency/Locum plans 30 20 20 0 NWS 5,547 3,762 2,974 -788 Clinical Coding Improvement 3,061 2,040 2,504 463 W&C 2,889 1,855 763 -1,091 Divisional tactical Savings 12,452 7,791 6,435 -1,356 Facilities 2,879 1,687 736 -951 Drugs - Purchases 1,442 1,062 1,062 0 Corporate 5,109 3,850 3,780 -70 Drugs - Trustwide Transformational 75 50 95 45 Trustwide 14,494 9,046 3,170 -5,876 Drugs VAT 600 600 633 33 Energy Savings scheme 240 240 240 0 TOTAL 53,074 34,137 18,734 -15,404 Facilities central budgetary controls 200 133 100 -33 Neuro Rehab Move 1,438 959 0 -959 Year to date under performance against CIPs amounts to GSTS Viapath commercial profit 1,000 667 667 0 £15,404k, 54.9% achievement. Length of Stay Productivity 2,816 1,713 240 -1,473 Major YTD adverse variances : Medical productivity 1,219 810 278 -531 TIPMO Led schemes: Non Clinical Budget Reduction 2,418 1,612 981 -631 Nursing Productivity £3,116k: staff recruitment starting to impact. Now Nursing Productivity 5,634 3,756 640 -3,116 being reported under Recovery Plans (CCTD excepted) Offsite working reduction 1,672 1,115 1,106 -9 OP Productivity & QIPP £2,567k: actual results not yet reported, working OP Productivity & QIPP 4,500 2,567 0 -2,567 up savings if RTT work not carried out Other QIPP 3,960 2,555 40 -2,515 Length of Stay Productivity £1,473k: Scheme conflicts with A&E target & Procurement 5,092 3,060 2,425 -635 bed occupancy rates Capita Outsourcing - Recruitment & Theatre Productivity £977k: Work in progress regarding reporting Payroll 150 150 0 -150 Medical Productivity £531k: Locum reduction now being reported under Recovery Plans General Medicine Bed outlier reduction 2,300 1,420 803 -617 Admin & Clerical Productivity £376k: Further schemes required. Theatre Productivity 2,075 1,400 423 -977 Other Trustwide Schemes: Other QIPP £2,515k: In negotiation with Commissioners 53,074 34,137 18,734 -15,404 Non Clinical Budget Reduction £631k Other Schemes Neuro Rehab Move £959k: scheme will not be achieved Bed Outlier Reduction £617k Page 33 Month 8 - 2014/15 Divisional Assessment
CIP Identified YTD Target YTD Actuals YTD Variance DH PRUH Both DH PRUH Both DH PRUH Both DH PRUH Both ACLN 2,828 1,831 0 1,944 1,082 0 1,586 69 0 -358 -1,013 0 CCTD 3,702 2,005 0 2,229 986 0 1,830 598 0 -399 -389 0 TEAM 4,185 1,625 0 2,660 1,088 0 1,088 69 0 -1,572 -1,019 0 LRS 3,675 1,447 859 2,453 1,035 460 1,576 344 150 -877 -691 -310 NWS 4,725 822 0 3,257 505 0 2,542 432 0 -715 -73 0 W&C 1,493 636 760 928 420 506 502 262 0 -427 -158 -506 Facilities 2,293 586 0 1,393 295 0 385 351 0 -1,008 57 0 Corporate 2,622 2,486 0 2,232 1,618 0 2,162 1,618 0 -70 0 0 Trustwide 6,398 1,120 6,977 3,823 745 4,478 667 0 2,504 -3,156 -745 -1,975 Total 31,921 12,558 8,595 20,918 7,774 5,445 12,337 3,743 2,654 -8,581 -4,031 -2,791
The major variances are as follows: • ACLN: £281k Long Term Conditions, £200k Lucentis Tariff Implementation (Commissioner QIPP schemes – in negotiation), £200k Various Productivity Schemes, £169k Sevenoaks OP, £139k BDS Programme, £128k Reduction in Non Clinical Supplies, £121k Theatre Productivity, £78k Nursing Productivity • CCTD: £230k Reduction of Non Clinical Supplies, £164k Theatre Productivity, £114k Pathology Contract, £93k Auto-Replenishment Cabinets, £46k Radiology Inventory Management, £25k USS Direct Access (MSK) • TEAM: £708k Nursing Productivity, £445k UCC PRUH, £396k SLIC, £265k Long Term Conditions, £221k Outlier Reduction, £165k Short Term Step Up, £122k A & E Attendances, £83k Non Clinical Supplies, £65k Reduce UTI Admission, £59k ED Shift Handover Time LRS: £957k Nursing Productivity, £346k Theatre Productivity, £133k MCATS Clinical Assessment (QIPP), £117k Urology LOS reduction, £117k General Surgery LOS reduction, £113k Medical Productivity • NWS: £496k Nursing Productivity, £84k Reduction of Non Clinical Supplies, £67k Offsite Working, £60k Stroke Services, £51k Pacemaker Tender • W&C: £876k Nursing Productivity, £140k Theatre Productivity • Facilities: £959k Frank Cooksey, £33k Centralisation of Facilities Recharges, offset by (£61k) Non Emergency Transport • Corporate: £150k Project Oscar (outsourcing to Capita). Partially offset by (£81k) VAT rebate • Trustwide: £2,566k OP Productivity, £1,239k LOS, £488k Procurement, £379k Medical Productivity, £371k A&C, £242k Theatre Productivity, £210k Long Term Conditions, £207k DC2OP, £171k TAP, £147k XBD, £98k Reduction in Non Clinical Supplies, £75k Cyprus High Commission PP Activity, £30k PRUH Maternity. Partly offset by Clinical Coding (£463k)
Page 34 Capital Investment Summary 2014-2015
2014/15 Capital Investment Plan and YTD Expenditure
. The planned capital investment expenditure for 2014/15 is £56.894m (page 53). The total capital expenditure to month 8 was £22.788m against a reforecast period budget of £24.863m (page 54).
. 14/15 Capital Investment expenditure is forecast to overspend by £3m at year end due to new projects arising during the year and projected overspends against budget (see page 55). Subject to obtaining the additional capital indexation funding from the TDA (see below), the Trust will be able to manage the overspends within its budget through the re-phasing capital expenditure over the 5–year plan and the reduction in scope of certain projects.
. The 15/16 Capital plan reflects a capital funding requirement of £4.3m due to the additional cost of the Guthrie Development project (total cost £25m, requested funding £21.4m). In order to preserve the Trust’s liquidity position in 15/16 and beyond, consideration will need to be given to placing projects on hold until further funding has been identified. Therefore the Capital and Capacity Committee will need to make a decision as to which capital project will be stopped or deferred.
Capital Investment Funding
. The Trust is currently completing a business case to obtain capital funding from the Trust Development Authority (TDA) of £20m for Guthrie Wing expansion. The Trust will also request an additional £1.4m funding based on the current capital indexation rate of 7%. (see above)
. Helipad donations to be received total £3.5M (14/15 £800k) – The funding has been spread over 4 years in accordance with the agreement signed with the County Air Ambulance for their donation (£2m) and the Special Trustees (£1.5m).
. £10.708m of Critical Care Development expenditure in 14/15 will be financed by a loan received from the Foundation Trust Financing Facility.
. Other funding sources include donations (£0.65m), Integration funding (£8.2m), other PDC funded projects (£1.6m), with the balance to be funded internally by the Trust (Depreciation £22.1m).
2015/16 to 2018/19 Capital Plan
. The Trust plans to spend £89.6m in 2015/16, £73.8m in 2016/17, £38.4m in 2017/18 and £7.5m in 2018/19. The majority of the spend will be on Critical Care Unit Development (total cost of £65m) and Unit 7 & 8 Development (£82M).
. To improve the Monitor CoSR Rating over the next 5 years, the Trust has had to reduce internal capital investment funding by £20m and borrow the funds.
Page 35 Capital Investment Plan Summary 2014-2019
2014/15 2015/16 2016/17 2017/18 2018/19 Schemes £'000 £'000 £'000 £'000 £'000
Critical Care Unit 10,708 26,294 16,252 11,292 - Catering Courtyard Development 8,215 - - - - Unit 7 & 8 Development 400 23,900 40,340 17,500 - Site Wide Infrastructure 1,750 2,000 3,000 750 - Helideck 2,000 4,200 - - - Other Major Works - Denmark Hill 17,383 15,700 2,000 1,000 1,000 Orpington Hospital 1,795 2,250 - - - PRUH Hospital 1,110 2,825 100 - - Minor Works 2,454 5,605 5,400 2,275 1,545 ICT Projects 3,755 1,900 3,900 3,750 3,750 Medical Equipment 2,965 2,033 1,250 1,250 1,250 Integration Projects 4,359 2,960 1,600 600 -
Total Capital Budget Expenditure 56,894 89,667 73,842 38,417 7,545
External Funding Critical Care Unit Loan (10,708) (25,294) (12,252) (8,292) - TDA Funding - PDC (12,000) (8,000) - - - Unit 7 & 8 Development - FTFF Loan - (23,900) (40,340) (17,500) - Total External Funding (22,708) (57,194) (52,592) (25,792) -
Net Spend after External Funding 34,186 32,473 21,250 12,625 7,545
Internal Funding Donated - Equipment (250) (250) (250) (250) (250) Donated - Adult Cystic Fibrosis - (430) - - - Donated - Helideck (London Air Ambulance) (500) (500) (500) (500) - Donated - Helideck - Charity donations (300) (300) (300) (300) (300) Safer Hospitals Safer Wards - DH (800) - - - - Safer Hospitals Safer Wards - DH (c/f from 13/14) (345) - - - - Nursing Techonology - DH (c/f from 13/14) (497) - - - - Friends of Orpington - Orpington MRI (400) - - - - Integration Funding per Transaction Agreement (1,600) (900) (600) (300) - Integration Funding (c/f from 13/14) (7,600) - - - - Depreciation (Incl PRUH & ORP) (22,141) (25,727) (26,441) (28,713) (32,809) Total Internal Funding (34,433) (28,107) (28,091) (30,063) (33,359)
Additional Internal Funding (Available) / Required (247) 4,366 (6,841) (17,438) (25,814) Page 36 Month 8 - Capital Expenditure Summary
. Capital Expenditure . The total capital expenditure to month 8 was £22.788m against a reforecast period budget of £24.863m . Below is the summary of capital expenditure to month 8:
Capital Programme Budget Expenditure
Annual Plan Forecast Total per capital category 14/15 Period Budget Actual YTD Cost to Complete Total Cost 14/15 Variance
Major works 39,146 13,097 15,705 25,505 41,210 2,064 Capital Maintenance (Minor Works) 2,454 1,636 654 1,800 2,454 - Medical Equipment 6,630 4,420 1,333 6,171 7,504 874 IT and infrastructure 2,454 1,636 738 1,748 2,486 32 Intangibles (IT) 1,601 1,067 1,601 - 1,601 - Donated - Major Projects 250 100 100 150 250 - Integration Project 4,359 2,906 2,657 1,758 4,415 56
Total Capital Position : Overspend (+) / Underspend (-) 56,894 24,863 22,788 37,132 59,920 3,026 Anticipated Budget Period Budget Actual to date Changes Y/E Forecast
Gross capital expenditure b/f 56,894 37,863 22,788 37,132 59,920 (Intangible Assets Included Above) Gross Cost 56,894 37,863 22,788 37,132 59,920 Less: Capital Donations held on Trust, NOF monies 1,550 600 600 950 1,550 Capital Charge against Capital Resource Limit 55,344 37,263 22,188 36,182 58,370 Funding Sources External Borrowings - CCU 11,708 11,708 11,708 0 11,708 unit 7 & 8 Funding (TDA) - PDC 20,000 0 0 20,000 20,000 Safer Hospitals Safer Wards - DH 1,145 1,145 1,145 0 1,145 Integration PDC Funding 7,370 7,370 7,370 0 7,370 Nursing Technology PDC - Carried Forward 497 497 497 0 497 Depreciation 22,141 14,761 14,761 7,380 22,141 Internal Cash Resources (7,517) 1,782 (13,293) 5,776 (7,517) FT Capital Plan 55,344 37,263 22,188 33,156 55,344 Variance : + over / (-) under - - - 3,026 3,026
Page 37 Month 8 - Capital Investment Variance
. Capital expenditure variances
. At month 8 the Trust is forecasting an over-spend of £3m at year end.
. Below is the breakdown of this amount:
Budget per Annual Revised Forecast Net Variance Scheme Plan - 2014/15 Spend - 2014/15 2014/15 Comment £'000 £'000 £'000 Budgeted project over-spend partly due to enabling MRI -Catering Courtyard 5,200 5,944 744 works carried on relocation of the cofee shop Emergency Department Major Works 200 246 46 New Variety Childrens Hospital - 80 80 New project Sign-in Centre - 200 200 New project Ebola Isolation Ward - 150 150 New project Unfunded Major Works - 399 399 Unfunded prior year projects Ebola Ward (£120k) Prior year projects at PRUH PRUH Works 1,110 1,555 445 (£309k) Medical Equipment 6,630 7,504 874 New BRSG approved projects IT and Intangibles 4,055 4,087 32 Integration Projects 4,359 4,415 56
Total capital budget/ forecast / variance (+ over, - under spend) 21,554 24,580 3,026
Page 38 Month 8 - Working Capital Summary
Trade Debtors . As at the end of Month 8, outstanding trade debtors totalled £70.850m. Significant balances were as follows:
Organisation Debt Type £000 Private Patients and Overseas Visitors Private Patients and Overseas Visitors 11,354 NHS England Over-Performance 9,460 NHS England Other 5,010 CCGs CCGs Overperformance 2013/14 3,801 CCGs CCGs Overperformance 2014/15 6,189 CCGs Monthly SLAs 1,565 CCGs NCAs 2,346 CCGs CCGs - MSK Project 1,592 CCGs Patient Transport and Non-Recurrent Support 691 Oxleas NHS Foundation Trust Various 1,156 Guy's and St Thomas' NHS Foundation Trust Various 2,681 Lewisham and Greenwich Various 2,120 King's College London Various 3,917
South London and Maudsley NHS FT Various 849 Various Pathology 6,950 Provider Trusts Various 2,112 Other Non NHS Bodies Various 5,681
Trade Creditors . As at Month 8, outstanding trade creditors totalled £33.883m. This total includes the following outstanding amounts: . King’s College London £3m . Guy’s & St Thomas’ NHS Foundation Trust £0.9m
Working Capital Facility . The Trust has no facility at present, but it is proposed that a facility of £10m will be implemented from Q4 2014.
FT Borrowing . The Trust currently holds loans with the Foundation Trust Financing Facility totalling £66.7m as at 30 November 2104 and PFI Liabilities of £158.089m.
Page 39 Month 8 - Working Capital - Debtors
Aged Debt Analysis Summary as at 30 November 2014
Total Outstanding 0-30 days 31-60 days 61-90 days Over 90 days £'000 £'000 £'000 £'000 £'000 NHS Bodies CCGs 16,703 1,958 4,092 4,661 5,992 NHS England 14,704 2,257 5,118 6,514 815 Provider Trusts 8,945 2,161 1,688 865 4,231 Other NHS Bodies 1,664 641 1 1 1,021 NHS Trade Debtors 42,016 7,017 10,899 12,041 12,059 Provision for Bad Debts (2,931) - - - (2,931) NHS Bodies Total 39,085 7,017 10,899 12,041 9,128 Non NHS Bodies Scottish, Welsh & Irish Health Bodies 675 131 342 1 201 King's College London University 3,918 750 308 329 2,531 King's Charitable Trust 120 11 - 5 104 Other Non NHS Bodies 12,767 5,409 2,218 1,984 3,156 Non NHS Trade Debtors 17,480 6,301 2,868 2,319 5,992 Provision for Bad Debts (412) - - - (412) Non NHS Bodies Total 17,068 6,301 2,868 2,319 5,580
Total Accounts Receivable 59,496 13,318 13,767 14,360 18,051 % of Total Outstanding - Month 8 100% 22% 23% 24% 30% Month 7 100% 22% 39% 4% 36%
Private Patients Accounts Receivable 3,592 1,196 376 421 1,599 Provision for Bad Debts (108) - - - (108) Private Patients Accounts Receivable Total 3,484 1,196 376 421 1,491 Overseas Visitors Accounts Receivable 7,762 657 380 373 6,352 Provision for Bad Debts (5,036) (591) (342) (336) (3,767) Overseas Visitors Accounts Receivable Total 2,726 66 38 37 2,585
Total PP & Overseas Visitors Accounts Receivable 11,354 1,853 756 794 7,951
. Provision for Bad Debts is based on debts outstanding over 6 months. . The NHS Provision has been adjusted for debts which are not contested and are considered recoverable.
Page 40 Month 8 - Working Capital - Creditors
Aged Creditors Analysis Summary as at 30 November 2014 Total Outstanding 0-30 days 31-60 days 61-90 days Over 90 days £000 £000 £000 £000 £000 NHS Bodies Guy's and St Thomas' NHS Foundation Trust 906 - 228 183 495 Others 5,358 318 2,729 1,568 743 NHS Bodies Total 6,264 318 2,957 1,751 1,238 Non NHS Bodies King's College London 2,999 - 27 428 2,544 Others 24,621 3,332 12,270 6,551 2,468 Non-NHS Bodies Total 27,620 3,332 12,297 6,979 5,012
Total Accounts Payable 33,884 3,650 15,254 8,730 6,250 % of Total Outstanding - Month 8 100% 11% 45% 26% 18% Month 7 100% 14% 52% 12% 21%
Page 41 Month 8 - Statement of Financial Position
Reforecast STATEMENT OF FINANCIAL POSITION AS AT 31 March 2014 Qtr 1 Qtr 2 Consolidated 30 June 30 September 31 October 30 November Annual Plan 2014 2014 2014 2014 31 March 2015 £'000 £'000 £'000 £'000 £'000 £'000 NON-CURRENT ASSETS Intangible Assets 1,767 1,764 3,194 3,168 3,172 951 Property, Plant & Equipment 335,131 351,457 326,250 435,241 436,922 360,663 On-Balance Sheet PFI 236,487 217,271 241,605 135,940 135,461 237,309 Investments in associates 3,598 4,098 5,099 5,099 5,099 2,816 Trade and Other Receivables, Non- Current 4,167 4,167 4,167 4,167 4,167 4,169 Total Non-Current Assets 581,150 578,757 580,315 583,615 584,821 605,908 CURRENT ASSETS Inventories 15,293 13,128 18,354 19,022 16,224 13,128 Trade Receivables 85,691 65,412 46,563 51,027 58,458 81,340 Other Receivables 11,901 23,727 23,292 25,161 22,440 11,626 Impairment of Receivables (7,576) (8,822) (9,660) (9,861) (10,230) (8,822) Other Financial Assets 22,610 23,065 41,673 42,019 54,582 24,710 Prepayments 4,739 5,568 8,228 8,270 9,281 4,500 Cash & Cash Equivalents 54,535 43,410 42,709 36,463 25,357 30,416 Total Current Assets 187,193 165,488 171,159 172,101 176,112 156,898 CURRENT LIABILITIES Interest-Bearing Borrowings (1,091) (584) (523) (523) (523) (3,885) Deferred Income (9,989) (4,195) (4,913) (4,877) (5,740) (7,500) Provisions (1,387) (1,009) (858) (807) (757) (1,200) Current Taxes Payable (5,570) (11,259) (11,136) (11,327) (11,526) (11,700) Trade Payables (45,669) (23,386) (20,127) (26,686) (33,883) (43,838) Other Payables (14,552) (25,438) (24,825) (25,740) (21,395) (8,537) Other Financial Liabilities (71,322) (85,856) (90,114) (91,457) (97,116) (66,266) Total Current Liabilities (149,580) (151,727) (152,496) (161,417) (170,940) (142,926) Total Assets less Current Liabilities 618,763 592,518 598,978 594,299 589,993 619,880 NON-CURRENT LIABILITIES Interest-Bearing Borrowings (49,542) (49,542) (67,941) (67,941) (67,942) (67,612) Provision (6,643) (6,886) (6,886) (6,886) (6,886) (6,299) Other Financial Liabilities (156,748) (157,023) (157,023) (157,023) (157,023) (157,472) Total Non-Current Liablilities (212,933) (213,451) (231,850) (231,850) (231,851) (231,383) Total Assets Employed 405,830 379,067 367,128 362,449 358,142 388,497 Financed By (taxpayers' equity): Public Dividend Capital 162,874 228,136 230,536 230,536 230,536 250,536 Revaluation Reserve 144,998 144,998 144,998 144,998 144,998 144,997 Income & Expenditure Reserve 97,958 5,933 (8,406) (13,085) (17,392) (7,036) Total Taxpayers' Equity 405,830 379,067 367,128 362,449 358,142 388,497
Page 42 Glossary
. CIP – Cost Improvement Plan . SLA – Service Level Agreement . PDC – Public Dividend Capital . PSPP – Public Sector Payment Policy . Working Capital Facility - represents a sum of money reserved by the relevant bank for potential use by the Foundation Trust . Asset - An asset is a resource controlled by the enterprise as a result of past events and from which future economic benefits are expected to flow to the enterprise . Liability - an entity's present obligation arising from a past event, the settlement of which will result in an outflow of economic benefits from the entity . Equity - the residual interest in the entity's assets after deducting its liabilities . EBITDA – Earnings before Interest, Taxation, Depreciation and Amortisation . EBITDA Achieved (% of Plan) – measures the achievement of earnings against plan . EBITDA Margin (%) – Measures Earnings as a percentage of total income indicating underlying performance . Return on Assets excluding Dividends – Net surplus before Dividends as a percentage of average assets indicating financial efficiency . I & E Surplus margin net of dividends – Net surplus as a percentage of total income indicating financial efficiency . Liquidity Ratio (days) - The liquidity ratio (days) indicates the number of days that net liquid assets can cover operating expenses without further cash coming from cash sales of fixed or long-term assets.
Page 43 This page has been left blank Enc. 2.5a
Finance and Performance Committee 2014-15 Month 8 Performance @ Denmark Hill
Shortened Report
Roland Sinker Chief Operating Officer
1 Report to: Public Board Date of meeting: 16 December 2014 Subject: Performance Report, Month 8 2014/2015 Author(s): Steve Coakley, Acting Associate Director of Performance and Contracts Presented by: Roland Sinker, Chief Operating Officer Sponsor: Roland Sinker History: Status: For Information
1. Background/Purpose This report provides the details of performance achieved against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position for 2014/15. It also contains an update on the Trust’s contractual position with the CCG’s and NHS England at Month 8 including the latest position on CQUIN agreements. 2. Action required The Board is asked to approve the M8 performance reported against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position for Kings performance at the Denmark Hill site.
2 3. Key implications Legal: Statutory reporting to Monitor and the DoH. Financial: Trust reports financial performance against published plan. Assurance: The RTT position has not yet been finalised and is due for submission on 17 December. However, we plan to achieve the RTT performance targets with the exception of the RTT admitted completed target. On this basis, the summary report provides assurance that the Trust will have met the performance targets as defined within the Monitor Risk Assessment framework for the interim Q3 position with the exception of the RTT 18 Week Admitted target and the c-difficile threshold.
Clinical: There is no direct impact on clinical issues. Equality & Diversity: There is no impact on equality & diversity issues. Performance: Based on the expected RTT position for November as outlined above, the summary report demonstrates that the Trust will have achieved the performance indicators for the interim Q3 position as defined in the Monitor Risk Assessment framework, with the exception of the RTT 18 Week Admitted target and the c-difficile threshold.
Strategy: Performance against the Trust’s annual plan forecasts and key objectives. Workforce: None. Estates: There is no direct impact on Estates.
Reputation: Trust’s quarterly and monthly results will be published by Monitor and the DoH.
Other:(please specify) 3 Contents
•Executive Summary
4 Executive Summary (1/6)
1. Denmark Hill 2014-15 Key Areas of Performance for Month 8: 1.1 Good Performance 1.1.1 Access Targets – All Cancer waiting time targets have been achieved based on the latest in-month November position as well as for the latest Q3 position on the DH site, including the 62-day cancer target which was not meeting the 85% in October. However, achievement of the 62-day cancer target remains a concern for the overall Q3 position due to the pressure on inpatient beds seen during the first half of December. The Referral to Treatment (RTT) performance position is not due to be submitted to the DoH until 17 December, however, we do expect the RTT non-admitted completed pathway target and RTT Incomplete pathway target to be achieved for November. Whilst the month-end position has not been finalised, we are predicting that the admitted backlog will have been reduced to the target of 1,200 patients for the end of November. The number of patients waiting over 52-weeks has also been reduced from 44 patients waiting at the end of October to 15 patients waiting at the end of November. Action plans are in place to treat these patients before the end of December. 1.1.2 Emergency Care 4-hour Performance – • November 2014 Performance: Emergency care 4-hour All types attendance performance continued to improve during November, with over 95.8% of patients seen within 4 hours compared to 95.15% reported in October. Type 1 emergency attendance performance achieved the 95% in November for the first time since June 2013. This is also in spite of the fact that emergency attendances increased by over 1% in November compared to October, and there were 12 days during November where over 400 patients were seen in the Emergency Department (ED). Performance has however worsened during December where we saw 488 patients on 1 December, which is the highest number of patients seen on any given day within the ED. There have been 235 more patients seen in the first 9 days in December compared to the beginning of November, which represents a 7% increase. During this period we have seen an increase in acuity of patients and increase in medical admissions seen during this period. There has also been in increase in the number of paediatric patients attending the ED, with at least a 25% increase in attendances. The paediatric activity increase is being observed across London hospitals, and the London Ambulance 5 Executive Summary (2/6)
Service (LAS) has reported that they would typically transfer 40 children between London hospitals in a month, and had already transferred this number of children in the first week of December. The LAS has also issued an NHS01 escalation to all London Trust Gold contacts after the first weekend in December indicating that they had been struggling with demand for 3 consecutive days. The new junior doctor rotation started on Wednesday 3 December and we have placed additional registrar cover in the emergency department to support the new doctors during the day-time period. There have been issues extending this support into the night and the division are working on plans to provide this additional cover. •ED Action Plans: The Trust’s ED Recovery Action Plan continues to be reviewed and updated at the weekly Emergency Care Board (ECB) meetings, chaired by the Director of Operations. As reported last month, a number of planned capacity changes have come on-line including the surgical assessment unit and the opening of the Neuro step-down unit at Orpington hospital. Further initiatives are planned for the remainder of this month and Q4 combined with continued working with commissioners on rehabilitation, repatriation and elective referral restriction including: −Safer Faster Hospital (SFH): The SFH week took place 3-10 December as planned. Key successes include a considerable increase in the number of patients referred to the @Home service and the number of patients with recorded expected dates of discharges on our Electronic Patient Records system. An initial hot de-brief took place on Wednesday 10 December and a fuller de-brief following the event is being planned. −Point of Care Testing (POCT): We plan to introduce point of care testing within the Emergency Department (ED), which has been delayed due to IT-related issues. The required IT work has commenced and we are planning for POCT to become operational at the end of January 2015. −Mental Health (MH) patients: The number of MH patients attending ED is still high and clusters of MH patients attending ED impacts on patient flow, as cubicles in the majors area of the department are blocked whilst these patients are being seen. We continue to work with the commissioners to resolve these issues. −Repatriations: The number of repatriations remains high and we continue to work with commissioners and NHS England to resolve issues with delays in referring patients back to their 6 Executive Summary (3/6)
local hospital. The number of repatriation bedday delays increased from 443 in October to 620 in November, on average 21 patients per day. Over 440 bedday delays were reported in Neurosciences/stroke wards, nearly 130 bedday delays in Liver/Renal/Surgery wards and 35 bedday delays in Cardiovascular wards. • Governance: Weekly Emergency Care Board meetings continue to review progress and performance against the revised ED Action plan. 1.2 Performance challenges – 3 Areas 1.2.1 RTT Admitted – • November 2014 Performance: The RTT Admitted pathway position has not been validated at the time of publishing this report, but it will not achieve the 90% target as planned whilst we reduce the admitted over 18-week backlog. Based in the latest data available, the admitted backlog has been reduced to the planned level of 1,200 waiting as at the end of November. Backlog targets for inpatients were achieved in Neurosurgery, General/Bariatric Surgery and Gynaecology. There were 15 admitted patients waiting over 52-weeks at the end of November compared to 44 patients waiting at the end of October. We had planned to have zero patients waiting over 52-weeks by the end of November, however, this has not been achieved due to a number of factors including consultant illness, patient choice and patients not being well for surgery after their pre-operative assessment. Treatment plans are in place to see these patients in December. There are 16 patients who are breaching 52-weeks in December, and admission dates have been agreed for 11 patients, and 5 provisional dates waiting to be confirmed with patients for December. • Division action plans: RTT performance and progress against division action plans are tracked at the weekly RTT performance review meetings chaired by the Director of Operations. The Trust has treated over 400 patients off-site at private providers between September and November, as part of the additional RTT tranche 1 and tranche 2 funding bids which were signed-off by commissioners and NHS England. Due the number of backlog patients who already have admission offer dates in December the Trust has confirmed to its commissioners that the RTT admitted completed target will not be met at DH site for December. 7 Executive Summary (4/6)
There is still some further specialty-based backlog patients that we need to complete, and we are planning to continue to use off-site providers from December through to March. − Neurosurgery: There are 400 admitted patients waiting at the end of November, and we plan to treat a further 40 patients each month from December to March to reduce this backlog further, by continuing to use private providers at Harley Street and London Bridge Hospitals. − Cardiothoracic Surgery: We plan to continue to offer patients choice for treatment at the Cromwell Hospital with the intention of treating a further 14 patients per month from December to March. • Governance: The new Patient Access Board meets monthly which is chaired by the Director of Operations, and is responsible for reviewing performance and action plans for cancer, RTT and diagnostic waiting times. Commissioners are also invited to attend this meeting. The weekly RTT performance review meetings with divisions continue and are chaired by the Director of Operations. 1.2.2 Health Care Acquired Infection (HCAI) - • November 2014 performance: There have been no further MRSA cases attributed to the Trust in November, but a case relating to October has just been attributed to the Trust so 3 MRSA cases have been reported year-to-date. There have been a further 5 c-difficile cases reported in November, so 39 cases have been reported to-date. This is higher than the internal quota of 28 cases set for this November YTD position as noted in previous reports. Based on the reduction target for this year, we did declare this as a risk in our self-certification with Monitor for 2014/15. • HCAI Action Plan: The HCAI action plan was due to be completed for the end of September, however, this is now delayed due to the Ebola preparedness guidance and process work that the Infection Control team has been developing. Some key points based on the existing plan: − Multidrug resistant organisms: Management of CRE and VRE remains a concern. Admission testing for CRE is now in place in Haematology and screening has commenced in Critical Care and Renal. − C-difficile infection (CDI): Additional measures have been put in place to manage the number of cases attributed to-date including spot-checks of clinical departments by the Director for Infection Prevention and Control (DIPC) and Deputy DIPC, and weekly reported to Kings Executive. 8 Executive Summary (5/6)
− Ebola preparedness: The Trust has established a weekly Ebola Preparedness meeting which is chaired by the Director for Infection Prevention and Control and attended by representatives from all interested departments. Training has commenced with staff on the use of personal protective equipment from 20 October, and we are working with soft FM providers to ensure that they are ready to support clinical staff. • Governance: Quarterly divisional performance review meetings are in place to review infection control performance chaired by the Director of Nursing. 1.2.3 Finance position: Please refer to the separate Finance paper for more details on the financial position at Month 8. 2. Regulatory and Contractual Performance 2.1 Monitor Monitor interim Q3 position (Denmark Hill) – The RTT position for November returns has not yet been finalised, however, we expect that the RTT performance targets will be achieved with the exception of the RTT admitted completed pathway target. This is consistent with our plans to reduce the admitted backlog. On this basis, the Trust will have achieved the majority of the performance indicator targets in the Monitor Risk Assessment Framework for November with the exception of the RTT 18 Week Admitted target and the c-difficile target. A&E attendances and sustained emergency access pressures continued during November. However, the Trust did meet the 95% target with All Types performance achieving 95.8%. 5 C-Difficile cases were reported in November which is above the agreed quota for the month. 39 cases have been attributed year to date which is above the quota of 28 cases. The total attributable cases for this site for 2014/15 is 42 cases. Monitor interim Q3 position (Trust position) – For the reasons outlined above, we expect that the Trust will achieve the RTT performance targets in November with the exception of the RTT admitted completed pathway target. On this basis, the Trust will have achieved the majority of the performance indicator targets for November with the exception of RTT 18 Week Admitted target, the 4-hour A&E performance target and the c-difficile target. 9 Executive Summary (6/6)
A&E attendances and sustained emergency access pressures continued during November. The Trust did not meet the 95% target with All Types performance but improved to 90.9% across the DH and PRUH sites. 6 C-Difficile cases were reported in November which is below the quota for the month. However, 48 cases have been attributed year to date which is above the quota of 39 cases. The total attributable cases for 2014/15 is 58 cases across all sites. Monitor has written to the Trust on 17 September 2014 advising that is has updated our governance risk rating to ‘Under Review’ on the basis that the RTT 18 weeks admitted completed pathway target has not been achieved. 2.2 Care Quality Commission (CQC) 3.1.1 CQC Planned Inspection – Since publishing last month’s report, the CQC has now informed the Trust that the planned inspection due in January 2015 has been postponed until the next financial year, probably between April and June 2015. Jane Walters, our Director of Corporate Affairs, is the assigned executive lead and along with the Assurance Team will continue to work with divisions to collate and ensure that all necessary documentation is available prior to the visit. 2.3 Contractual 2.3.1 CCG - The Contract has been signed with the CCG Commissioners for 2014-15. All CQUIN schemes have now been agreed. 2.3.2 NHS England – There are three separate contracts with NHSE. The largest is specialised services which has now been signed. All elements of secondary care dental (activity, finance, QIPP and CQUIN) are agreed, as is the activity, finance and CQUIN for Public Health. 2.3.3 CQUIN 2014/15 – CCG update – The Trust achieved 100% CQUIN for Q1. Evidence has been submitted for Q2 and the commissioners have confirmed achievement of all targets with the exception of the falls CQUIN. This CQUIN was not achieved in August as there were 4 falls resulting in harm compared to the target of 3 cases. 2.3.4 CQUIN 2014/15 – NHS England update – The Trust has submitted evidence for Q2 and we are waiting for confirmation of the achievement. 10 Enc. 2.5b
Finance and Performance Committee 2014-15 Month 8 Performance @ PRUH
Shortened Report
Roland Sinker Chief Operating Officer
1 Report to: Finance and Performance Committee Date of meeting: 16 December 2014 Subject: Performance Report, Month 8 2014/2015 Author(s): Steve Coakley, Acting Assistant Director of Performance and Contracts Presented by: Roland Sinker, Chief Operating Officer Sponsor: Roland Sinker History: Status: For Information
1. Background/Purpose This report provides the details of performance achieved against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position. It also contains an update on the Trust’s contractual position with the CCG’s and NHS England at Month 8 including the latest position on CQUIN agreements for PRUH/QMS hospitals only. 2. Action required The Board is asked to approve the M8 performance reported against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position for Kings performance at the PRUH/QMS sites.
2 3. Key implications Legal: Statutory reporting to Monitor and the DoH. Financial: Trust reports financial performance against published plan. Assurance: The RTT position has not yet been finalised and is due for submission on 17 December. However, we plan to achieve the RTT performance targets with the exception of the RTT admitted and non-admitted completed targets. On this basis, the summary report provides assurance that the PRUH will have met the performance targets as defined within the Monitor Risk Assessment framework (RAF) for the interim Q3 position with the exception of the RTT 18 Week Admitted and Non-admitted completed pathway targets, the cancer 2-week wait and 62-day time to treatment targets, and the A&E 4-hour target. Clinical: There is no direct impact on clinical issues. Equality & Diversity: There is no impact on equality & diversity issues. Performance: Based on the expected RTT position for November as outlined above, the summary report demonstrates that the PRUH will have achieved the performance indicators for the interim Q3 position as defined in the Monitor RAF framework, with the exception of the RTT 18 Week Admitted and Non-admitted completed pathway targets, the cancer 2- week wait and 62-day time to treatment targets, and the A&E 4-hour target. Strategy: Performance against the Trust’s annual plan forecasts and key objectives. Workforce: None. Estates: There is no direct impact on Estates.
Reputation: Trust’s quarterly and monthly results will be published by Monitor and the DoH.
Other:(please specify) 3 Contents
•Executive Summary
4 Executive Summary (1/6)
1. PRUH 2014-15 Key Areas of Performance for Month 8: 1.1 Good Performance 1.1.1 Health Care Acquired Infection (HCAI) - PRUH continues to have no MRSA cases attributed since the acquisition in October 2014. There was 1 C-difficile case reported in November so 9 cases have been reported to-date which is still lower than the internal quota of 11 cases allocated to PRUH. 1.1.2 Stroke Unit – Following the recent high scores that the stroke unit at PRUH achieved in the recent Sentinel Stroke National Audit Programme (SSNAP), it has also performed well in a recent peer review. There has been a significant improvement in the proportion of patients being directly admitted to the Hyper Acute Stroke Unit (HASU) from the emergency department (ED). In Q2 and Q3 last year only 77% of patients were admitted directly. This now stands at 98% in Q2 2014-15, resulting in more patients receiving time-critical care in the HASU at an earlier stage and spending less time overall in the hospital. 1.2 Performance challenges – 4 Areas 1.2.1 Emergency Care 4-hour Performance – November 2014 Performance: Emergency care pathway 4-hour all types attendance performance improved from 82.7% in October to 84.2% in November. In November, Type 1 attendances increased by 1 % and all types by 2.3%, compared to October. Blue calls have increased by 22% compared to this time last year. On average, there are 180 daily attendances into the ED, but there were 6 days during November where over 200 patients were seen. The performance improvement in November was supported by additional capacity in the community however this remains fragile due to availability of placement homes and bed based rehabilitation. The number of patients who are medically suitable fit for discharge (MSFD) reduced in November to circa 50 patients. However, overall bed occupancy is remaining high at 96%.
5 Executive Summary (2/6)
ED attendances have remained high into December with a 7% increase in attenders to the ED in the first 9 days of December compared to November. There have also been days with high emergency admissions, and in particular increased surgical admissions. All types performance for December so far has reduced further to 77.5%, with some days of 50% performance. A revised trajectory has been agreed between the Trust and commissioners to bring performance back in-line with the original trajectory from January 2015 onwards. We are required to achieved 87.9% in December There are a number of actions to mitigate this, listed below: • Medihome: The Medihome service that has been in place at the DH site has now been implemented at PRUH, and so far 15 patients have been placed with Medihome with 8 currently active. Medihome are recruiting to increase capacity and work is on-going to raise awareness of the service at PRUH. • Out of hospital support: Community Escalation Plan agreed with additional capacity in Bromley health Care and reablement. • Additional staffing: We have introduced 4 additional Registered General Nursing staff (RGN) at night, re-alignment of the Heads of Nursing in ED, increased presence of ED Clinical Director, additional medical doctor, increase operational and project management support. • Price Waterhouse Coopers (PWC) support: PWC will be providing additional project management support to the transfer of care workstream, as part of the wider engagement that they are providing across all productivity programmes. • ED Action Plans: Details of our latest Action Plan and the revised performance trajectory will be published in the performance report in January. • Governance: Weekly Emergency Care Board meetings continue to review progress and performance against the revised ED Action plan.
6 Executive Summary (3/6)
1.2.2 RTT Admitted – • November 2014 Performance: The RTT Admitted pathway position has not been finalised at the time of publishing this report but the 90% target will not be achieved in November, as we reduce the over 18 week backlog. Whilst the RTT position has not yet been fully validated ahead of the submission deadline of 17 December to the DoH, we are expecting the backlog for PRUH/QMS to remain just below 1,000 patients. This is 550 higher than the trajectory of 450 patients which was set for the end of November position. Pressure on inpatient beds, delays in medical records being available on the day of admission and patients not agreeing to having their treatment at off-site private providers have contributed to the static backlog position at the end of November. Further detail on the backlog position and specialty action plans can be found below. • 52-week wait position: All 52-week wait patients have now been treated so there are no patients waiting over 52 weeks as at the end of November. • Division action plans: The main specialities of concern for 18-week admitted backlog reduction at the PRUH are: − ENT: Delays in BMI confirming off-site capacity and inability of private providers to accept paediatric patients have contributed to the backlog position being nearly 80 patients above trajectory. 15 patients have already accepted admission dates for December off-site, and further adult activity is planned to go off-site in January. This will free capacity on-site at PRUH to enable paediatric patients to be seen during January and bring the trajectory back on track by the end of January. − General Surgery: Whilst bariatric patients were treated promptly in August, there have been delays for non-bariatric patients and this cohort of patients were not sent for approval to be treated off-site until 6 November. There has been limited uptake from patients to be treated off-site, however, we plan to work with NHS England and GPs to support us in enabling patients to be seen using the capacity that we have now agreed with Chelsfield Park hospital. Subject to support from CCG;s, NHSE and GP’s, the backlog position should be back on-track by the end of February. − Gynaecology: Over 150 patients have already been treated off-site, and further activity is planned for December and January to bring the backlog back in-line with trajectory, which is currently 40 patients above plan. Support will be required as noted above for General Surgery to encourage patients to 7 Executive Summary (4/6)
take up offers at off-site private providers. − Ophthalmology: 45 cases were lost due to a combination of the wrong replacement microscope being delivered in the Day Surgery Unit (DSU) and cancellations due to medical records not being delivered on the day of surgery. The faulty microscope has now been replaced and a recovery plan in place to bring the backlog back on-track at the end of January. − Orthopaedics: The backlog position is over 180 patients above the planned position. We are reviewing capacity available at the South West London Orthopaedic Centre. Increased numbers of patients will be scheduled in the PRUH DSU, and improved utilisation and more accurate scheduling of backlog patients at Orpington will reduce the backlog to the target of 150 patients. We do not anticipate recovering the backlog trajectory position until the end of February.
• Governance: Progress is measured in weekly RTT performance meetings that are chaired by the Director of Operations, as well as within the monthly Patient Access Board as detailed in DH report. 1.2.3 Cancer Waiting Times – • Cancer waiting times were achieved across the PRUH sites in-month for November with the exception of the 62-day time to treatment target and 2-week waiting time target. For the current cumulative Q3 position, only the 62-day time to treatment target is not being achieved. The 2-week wait position at PRUH has deteriorated in December but teams are working hard to turn this position around. Initial analysis indicates that this is due to capacity as opposed to missing patient records which has impacted other services. Where cancer patients have been cancelled, their appointments have been re-booked. 1.2.4 Finance position – • Please refer to the separate Finance paper for more details on the financial position at Month 8. 2. Other areas of concern: 2.1 Diagnostic Waiting Times – The month-end position for 6+ week diagnostic waiting time breaches is still being finalised at the time of publishing this report, and the recent migration to the PiMS system has had an impact on reporting some of the diagnostic test activity. We are not expecting a reduction in the 8 Executive Summary (5/6) number of breaches to be reported for the November position compared to the 329 breaches reported at the end of October. This will mean that the national 1% target will not be achieved. The main breach areas are: − Non-obstetric ultrasound case tests: where the backlog is being reduced based on actions to improve cross-cover flexibility and securing additional locum consultant sessions. Evening and weekend sessions have continued and an office space is being converted into an additional scanning room to provide further capacity. − Cystoscopy tests: The service has now moved to Beckenham Beacon, but due to the number of 6- week diagnostic patients and planned patients, it is expected to take 2 months to clear the backlog. 2.2 Health Records: An immediate action plan has been put into place following the deterioration in provision of patient casenote records on the PRUH and Bromley sites after the migration to the PiMS system on 31 October. An additional General Manager, project manager and experienced patient records manager from the DH site have been brought in, and an additional 5 Patient Records staff have been recruited to increase capacity for preparing patient records. A number of next steps have been agreed: − Physical space: executive agreement on additional space is required. Plans are currently being reviewed to implement in January as an interim arrangement until portacabins come on stream in February 2015. − Additional staffing: plans to introduce a team of hunter/gatherers to source records and additional staff to assist with preparing casenotes to be sourced. − Management support in outpatient clinics: Senior managers to provide support to staff in outpatient clinics. − PiMS training: Additional focussed PiMS training for casenote tracking will be provided to Health Records staff.
9 Executive Summary (6/6)
3. Regulatory and Contractual Performance 3.1 Monitor Monitor interim Q3 position (PRUH) – The RTT position for November returns has not yet been finalised, however, we expect that the RTT performance targets will be achieved with the exception of the RTT admitted and non-admitted completed pathway targets. On this basis, the Trust will have achieved the performance indicator targets in the Monitor Risk Assessment Framework for November with the exception of the RTT 18 Week Admitted and Non-admitted completed pathway targets, the cancer 2-week wait and 62-day time to treatment targets, and the A&E 4-hour target. A&E attendances and sustained emergency access pressures continued during November. However, the Trust did meet the 95% target with All Types performance achieving 95.8%. One c-Difficile case was reported in November so 9 cases have been attributed year to date which is below the quota of 11 cases. 4. Other Sites Update 4.1.1 Orpington Hospital – 10 beds within the planned 20-bed Neuro step down unit opened in the first week of November on the Ontario ward in Orpington Hospital with plans to open the additional 10 beds by the end of February, subject to recruitment of staff. 4.1.2 Beckenham Beacon (BB) – The move of Paediatrics from BB to consolidate the service at the PRUH site have been completed. The Urology service move from PRUH to BB which provides outpatient as well as increased diagnostic capacity has also been completed in October, and clinics are operational. A number of outpatient clinic build issues following the migration to the PiMS system and availability of patient medical records are being worked through on the site. 4.1.3 QMS – A mock CQC inspection has been conducted on the QMS site and the outcomes from the inspection are currently being pulled together. Plans are in place to implement stronger site-specific managerial, nursing and medical leadership with greater senior leadership engagement on site. 4.1.4 Sevenoaks Hospital - Following the migration from the OASIS patient administration system to the Trust PiMS system, a number of issues relating to outpatient clinic build and availability of patient medical records are being worked through on the site. 10 Patient Outcomes Report: Q2, 2014-15
Ensuring clinical care at KCH achieves real health benefit, such as longer life, symptom relief or quicker recovery.
Report to: Board of Directors Meeting: 16 December 2014 Author: Claire Palmer, Head of Clinical Effectiveness Sponsor: Geraldine Walters, Executive Director of Nursing & Midwifery; Chair, Patient Outcomes Committee Status: For Report Executive summary (1/2)
1. Key concern • Hip fracture: • The National Hip Fracture Database identified a 30-day mortality rate as being more than two standard deviations higher than the national average for the PRUH site only, based on 2012-13 data. This may represent a mortality higher than expected for this period. • An internal Mortality Outlier Alert was triggered by the Medical Director’s Office and the standard Trust process to review data quality, coding, casemix and clinical care has been initiated. The review is due to conclude by end December 2014, and will be summarised in this report, Quarter 3 (see page 7). • Hip fracture had already been identified as an area for improvement and is a Trust Quality Priority 2014-15 (see page 14)
2. Areas of excellence • KCH (all sites) overall Summary Hospital Mortality Indicator (SHMI) is below expected at 87 for the 12 months to June 2014.
• Denmark Hill Hyper Acute Stroke Unit (HASU) achieved the 5th highest score nationally in the Sentinel Stroke National Audit Programme this quarter. PRUH HASU performed above national average.
• Targets for dementia, alcohol and smoking set out in CQUINs were all exceeded this quarter.
• Measurable improvements in quality governance at the PRUH in relation to clinical effectiveness (mortality monitoring, evidence-based practice and clinical audit).
2 Executive summary (2/2) Clinical effectiveness overview: the extent to which clinical care achieves real health benefit, e.g. longer life, symptom relief or quicker recovery (NHS Outcomes Framework Domains 1, 2, 3)
Indicators Monitoring source Risk rating Comment/action
DH PRUH
External monitoring
CQC Intelligent Monitoring Report indicators Hip fracture indicator (National Hip Fracture Database) Risk No evidence of Relates to proportion of patients achieving compliance with - July 2014 risk national criteria of best practice. Hip fracture is a 2014-15 Trust Quality Priority. AS REPORTED LAST QUARTER (NO NEW CQC REPORT PUBLISHED) Stroke indicator (Sentinel Stroke National Audit No evidence Some evidence Relates to proportion of patients directly admitted to a stroke unit Programme [SSNAP]) of risk of risk within 4 hours at PRUH . DH & PRUH above national average for overall SSNAP performance.
Mortality indicators (including SHMI) No evidence No evidence of Maternity indicators of risk risk Readmissions indicators
National audits National Cardiac Arrest Audit No evidence Risk 1. Mortality at PRUH for hip fracture may be above expected. - reporting this quarter Sentinel Stroke National Audit Programme (SSNAP) of risk Internal Mortality Outlier Alert initiated. Intensive Care National Audit & Research Centre (ICNARC) 2. Mortality ratio at PRUH critical care was above control limit Inflammatory Bowel Disease (Adult) – clinical audit Inflammatory Bowel Disease – paediatric for 2012-13 and is in public domain. For Jan-Jun-14 PRUH National Joint Registry was within control limits, possibly indicating a data or Severe Sepsis and Septic Shock (College of Emergency Med) coding issue -prior to KCH integration. Monitored by National Hip Fracture Database Mortality Monitoring Committee. 3. Management of severe sepsis and septic shock in PRUH ED below national average but measurable improvement made since last round of audit.
Internal monitoring
Trust Quality Priority 14-15 – Preventable ill-health CQUIN – Alcohol No evidence No evidence of Initiative proceeding on course to achieve objectives. CQUIN – Smoking of risk risk
Trust Quality Priority 14-15 – Hip fracture Internal monitoring No evidence No evidence of Initiative proceeding on course to achieve objectives. of risk risk
Mortality (Summary Hospital Mortality Indicator [SHMI]) Healthcare Evaluation Data (HED) No evidence No evidence of (deaths up to 30 days after discharge) of risk risk
CQUINs Alcohol No evidence No evidence of CQUIN targets all met/exceeded. Smoking of risk risk Dementia Long-term conditions (COPD)
Trust Performance Scorecard Trust Performance Scorecard, 2014-15, period 5 Risk Risk 14/16 indicators showing red status at DH • SHMI (in-hospital deaths) (August) – clinical effectiveness indicators (BIU) 8/13 indicators with data showing red status at PRUH • Elective crude mortality • Length of stay – elective and non-elective • Outliers • Elective inpatients with EDD • Diagnostic waits >4 weeks • Cancer waiting times • Unplanned admissions to ICU/HDU • Emergency readmissions within 30 days • Repatriation delays • RTT no. 40+ week admitted waiters; incomplete • 18 week waits (admitted & non-admitted pts) 3 • Emergency care performance Introduction
• The Patient Outcomes Report outlines King’s College Hospital NHS Foundation Trust (KCH) performance in relation to clinical effectiveness, which is defined as the extent to which clinical care achieves real health benefit, such as longer life, symptom relief or quicker recovery.
• The report is structured around the NHS Outcomes Framework Domains 1, 2 & 3 – clinical effectiveness.
Domain 1 Preventing people from dying prematurely Domain 2 Enhancing quality of life for people with long term conditions Domain 3 Helping people to recover from episodes of ill health or following injury Domain 4 Ensuring that people have a positive experience of care Domain 5 Treating and caring for people in a safe environment and protecting them from avoidable harm • The information included is derived from the following sources: – Care Quality Commission and Dr Foster reports – Healthcare Evaluation Data (HED) – National clinical audits – these are published at varying intervals over a 2-3 year cycle (dependent on the project) and results are provided along with the Clinical Effectiveness Committee’s rating (see Appendix 1 for definitions). – National registries of clinical data – CQUIN monitoring – KCH internal systems for monitoring NICE compliance and national audit participation.
• This report provides assurance that KCH: – Is delivering against the NHS Outcomes Framework – Routinely monitors clinical effectiveness and implements actions that support the achievement of excellent patient outcomes – Achieves CQC Essential Standards outcomes 4 & 16 in relation to clinical effectiveness – Is effective in improving clinical care in relation to the Trust’s chosen quality priorities – Minimises reputational risk in relation to patient outcomes. 4 Preventing people from dying prematurely (Domain 1) Mortality indicators (1/2)
Healthcare Evaluation Data (HED): KCH (all sites) Summary Hospital Mortality Indicator (SHMI) is below expected at 87.15 for the 12 months to June 2014.
SHMI Overview Poisson Distribution Funnel Plot SHMI SHMI
Number of expected deaths 12 months to Jun 2014
5 12 months to June 2014 Preventing people from dying prematurely Mortality indicators (2/2)
Healthcare Evaluation Data (HED): for the 12 months to June 2014, Denmark Hill SHMI is below expected at 82.04 and Princess Royal University Hospital is within expected range at 94.33.
SHMI Overview Poisson Distribution Funnel Plot Time Series (July 2013 – June 2014)
Denmark Hill Denmark Hill SHMI SHMI
95% CI 95% CI SHMI 77.8 86.5 86.5 100.6
Number of expected deaths 12 months to June 2014
Princess Royal University Hospital Princess Royal University Hospital SHMI SHMI
Number of expected deaths 12 months to June 2014 Number of expected deaths NB: No PRUH data for Q1 or Q2 Apr-Sep-13 12 months to June 2014 6 Preventing people from dying prematurely Outlier investigations in progress
1. Palliative care coding rate – Dr Foster Hospital Guide (Nov 2013) identified KCH Denmark Hill as having ‘higher than expected’ use of palliative care codes. – Previous review of palliative care coding concluded that coding is appropriate according to our casemix. – A follow-up review was initiated April 2014 and concluded September 2014. The report is in draft and a summary will be included in Patient Outcomes Report 2014-15 Quarter 3.
2. Hip fracture – internal mortality outlier alert initiated – Data from the National Hip Fracture Database identified a 30-day mortality rate as being more than two standard deviations higher than national average for the PRUH site only, based on 2013 data. – An internal mortality outlier alert was raised by the Medical Director’s Office on 8 October 2014 and the standard Trust process to investigate data quality, coding, casemix and clinical care has been initiated. – Due for completion by end December 2014 and reporting in Patient Outcomes Report 2014-15 Quarter 3.
7 Preventing people from dying prematurely Trust Quality Priority – preventable ill health
Background: • Nationally, smoking leads to premature death in half of all smokers; half of all hospital admissions are attributable to smoking. • Deaths from lung cancer in Southwark and Lambeth are among the highest in England. • Alcohol-specific hospital admissions in Lambeth and Southwark are much higher than the London average. Key objectives are to: • Increase the assessment of patients, number of staff trained to provide brief interventions, referrals into specialist services and number of smoking ‘quitters’. • Identify opportunities to promote exercise and healthy eating. Progress monitored by: • CQUIN reporting for smoking and alcohol. • Reporting to Public Health Committee. Progress to date – alcohol: • Denmark Hill – training targets and plan are in place, recording mechanisms are in place. • PRUH – 40% of Medical Admissions Unit (MAU) and 30% of Acute Surgical Unit (ASU) patients were screened for harmful alcohol use. A roll out plan is in place for maternity. Training targets and plan are in place. • Working on implementation of NCEPOD report ‘Measuring the Units’ on alcohol-related liver disease. Progress to date – smoking: • Denmark Hill – training targets and plan are in place, recording mechanisms are in place. • PRUH – 40% of MAU patients and 34% of ASU patients have been screened for smoking. 80% of MAU and 41% of ASU patients have been offered ‘ADVISE’ and ‘ACT’ elements of the evidence-based Very Brief Advice intervention. A roll out plan is in placefor maternity. Training targets and plan are in place. • Executive commitment for smoke-free King’s by 19 January 2015 and initiation of Smoke Free King’s communications plan. Progress to date – other: • Funding provided by commissioners for two Band 7 posts to support roll out of healthy lifestyle support to KCH patients. • Detailed overview of local community provision for exercise that can be given to patients (e.g. exercise classes, gyms in the park, seated exercise, exercise for new mothers). • Roll out of Commit to Care initiative, which includes monitoring the provision of nutrition support to KCH patients. PRUH – inpatient adult wards; PRUH and Denmark Hill paediatrics and intensive care – in progress.. 8 King’s National Clinical Audit Rating Key: Symbol Definition Preventing from people dying prematurely: * One of the highest performing Trusts nationally e.g. ranked within top 5 nationally. King’s performance is similar to or above the national average for 67 – 100% of audit standards / + outside expected range (positive outlier) King’s performance is similar to or above the national average for 66 – 34% of audit standards/ within National clinical audit results: (1/2) = expected range. King’s performance is similar to or above the national average for 0 – 33% of audit standards / - reviewed at Clinical Effectiveness Committee this quarter outside expected range (negative outlier) N/A Not applicable – national average comparable data not available
9 King’s National Clinical Audit Rating Key: Symbol Definition Preventing people from dying prematurely: * One of the highest performing Trusts nationally e.g. ranked within top 5 nationally. King’s performance is similar to or above the national average for 67 – 100% of audit standards / + outside expected range (positive outlier) King’s performance is similar to or above the national average for 66 – 34% of audit standards/ within National clinical audit results: (2/2) = expected range. King’s performance is similar to or above the national average for 0 – 33% of audit standards / reviewed at Clinical Effectiveness Committee this quarter - outside expected range (negative outlier) N/A Not applicable – national average comparable data not available
10 Improving quality of life for people with long-term conditions (Domain 2)
Dementia: • Improving identification, assessment and referral of patients aged 75 and over with dementia – CQUIN target = 90% for each element: • Denmark Hill: • Find: 95.9% • Assess: 98.5% • Refer: 100% • PRUH: • Find: 94.3% • Assess: 100% • Refer: 100% • On both sites, named clinicians are in place, along with training plan, baseline and targets in place.
COPD: • Improving care of patients admitted with exacerbation of COPD at the PRUH: • Process to develop and record the COPD bundle at the PRUH set up, along with GP letter, patient management plan and communication plan.
11 Improving quality of life for people with long-term conditions: dementia
• The National Dementia Audit recommends that the following information relating to the care of people with dementia is routinely reported at Board-level. This information is currently for Denmark Hill site only.
Readmissions for people with dementia:
In-hospital falls for people with dementia or delirium:
12 King’s National Clinical Audit Rating Improving quality of life for people with Key: Symbol Definition * One of the highest performing Trusts nationally e.g. ranked within top 5 nationally. King’s performance is similar to or above the national average for 67 – 100% of audit standards / + long term conditions: outside expected range (positive outlier) King’s performance is similar to or above the national average for 66 – 34% of audit standards/ within = expected range. National clinical audit results (1/1) King’s performance is similar to or above the national average for 0 – 33% of audit standards / - outside expected range (negative outlier) reviewed at Clinical Effectiveness Committee this quarter N/A Not applicable – national average comparable data not available
13 Helping people to recover from illness or injury (Domain 3) Trust Quality Priority – hip fracture
Background: Progress monitored by: • Hip fracture accounts for around 500 patients and over 12,000 • Routine internal data. bed days each year at KCH, and this is set to increase with the • National Hip Fracture Database (NHFD). aging population. Progress this quarter: • Specific areas for improvement in the care of this group of 1. Achievement of 9 best practice criteria – data not yet available for patients have been identified. Quarter 2. Key objectives are to: 2. NHFD data provided below (Denmark Hill only; PRUH not • Improvement work is focusing on achieving 9 criteria of best available) shows that Denmark Hill improved the achievement of all 9 criteria for all patients (the purple shaded area) from practice for all KCH patients: November 2013, but that this improvement has been difficult to 1. Surgery within 36 hours of admission sustain. 2. Shared care with surgeon and geriatrician 3. Improvement actions include: 3. Admitted on a care protocol agreed by geriatrician, surgeon and anaesthetist • establishment of a KCH-wide falls and fractures project 4. Assessment by geriatrician within 72 hours • development of an EPR template specific for fractured neck of femur 5. Pre-operative Abbreviated Mental Test Score (AMTS) taken • recruitment of a fractured neck of femur nurse at PRUH 6. Post-operative AMTS taken • scoping of the physiotherapy complement needed to provide a good 7. Geriatrician-led multidisciplinary rehabilitation service on both weekdays and weekends 8. Secondary prevention of falls • proforma available on EPR to assist junior doctors in capturing all the 9. Bone health assessment. information required against the best practice criteria • increased support from an orthogeriatric multidisciplinary meeting.
National Hip Fracture Database results, Denmark Hill only 14 King’s National Clinical Audit Rating Key: Symbol Definition Helping people to recover from illness or injury: * One of the highest performing Trusts nationally e.g. ranked within top 5 nationally. King’s performance is similar to or above the national average for 67 – 100% of audit standards / + outside expected range (positive outlier) King’s performance is similar to or above the national average for 66 – 34% of audit standards/ within National clinical audit results: (1/2) = expected range. King’s performance is similar to or above the national average for 0 – 33% of audit standards / reviewed at Clinical Effectiveness Committee this quarter - outside expected range (negative outlier) N/A Not applicable – national average comparable data not available
15 King’s National Clinical Audit Rating Key: Symbol Definition Helping people to recover from illness or injury: * One of the highest performing Trusts nationally e.g. ranked within top 5 nationally. King’s performance is similar to or above the national average for 67 – 100% of audit standards / + outside expected range (positive outlier) King’s performance is similar to or above the national average for 66 – 34% of audit standards/ within National clinical audit results: (2/2) = expected range. King’s performance is similar to or above the national average for 0 – 33% of audit standards / reviewed at Clinical Effectiveness Committee this quarter - outside expected range (negative outlier) N/A Not applicable – national average comparable data not available
16 Quality governance: clinical effectiveness 1. Routine outcomes monitoring
1. Mortality monitoring – specialty areas which have an M&M process in place and mortality reported to the Trust Mortality Monitoring Committee • DH – 100% • PRUH – 36%, and improving.
17 Quality governance: clinical effectiveness 2. Evidence-based practice
1. NICE technology appraisals – 100% implemented on all KCH sites
2. NICE – all guidance, fully implemented Please note, this will never reach 100% as there will always be a time delay between publication and full implementation and some clinical guidelines take years to achieve full implementation. • Denmark Hill – 83% (Aug-14) • PRUH – 59% and improving.
18 Quality governance: clinical effectiveness 3. Clinical audit a) National clinical audit: participation b) National clinical audit: results reviewed at Trust-level
Mandatory national audits and confidential enquiries ‐ Mandatory national audits ‐ results reviewed at participation Trust‐level
100 100 level ‐ 50 50 Trust participating
is at
KCH ‐ all sites 0 KCH ‐ all sites
KCH 0 Sep‐13 Oct‐13 Mar‐14 Jun‐14 Sep‐14 Denmark Hill Sep‐13 Oct‐13 Mar‐14 Jun‐14 Sep‐14 Denmark Hill (n = 19 (n = 19 (n = 35 (n = 49 (n = 57 (n = 47 at (n = 47 at (n = 47 at (n = 39 at (n = 44 at which at KCH) at DH; at DH; at DH; at DH; reviewed PRUH
PRUH
in KCH) DH; DH; DH; DH;
% 0 at 8 at 17 at 23 at % 35 at 35 at 25 at 32 at PRUH) PRUH) PRUH) PRUH) PRUH) PRUH) PRUH) PRUH) Time Time (n = total relevant national audits & confidential enquiries) (n = total published national audit results) c) National clinical audit: action plans in place d) Local clinical audit: programmes in place and reported
Mandatory national audits ‐ action plans in place within 3 months of results publication
100 action 50 with
KCH ‐ all sites 0 months
place Sep‐13 Oct‐13 Mar‐14 Jun‐14 Sep‐14 Denmark Hill
>3 in
(n = 19 (n = 19 (n = 26 (n = 30 (n = 40
at KCH) at DH; at DH; at DH; at DH; PRUH plan 0 at 9 at 10 at 18 at PRUH) PRUH) PRUH) PRUH) published
Time (n = total national audit results published > 3 months) results
%
19 This page has been left blank Enc. 2.7.2
Report to: Board of Directors
Date of meeting: 16 December 2014
Subject: Equality & Diversity Scheme – Inclusion Objectives
Author(s): Mark Preston, Associate Director: HR
Presented by: Tim Smart, Chief Executive
History: None
Status: For information
1. Background/Purpose
This report updates the Board on the progress against the Trust’s Inclusion Agenda following the dis-establishment of the Equality & Diversity Committee
2. Action required
The Board is requested to note current progress
3. Key implications
Legal: All employers are legally obliged to follow the requirements of the Equality Act 2010, and the Trust has specific duties it must complete under the public sector duties of the Act Financial: There are no specific financial implications
Assurance: All employers are required to abide by the Equality Act (2010)
Clinical: There are no specific clinical implications
Equality & Diversity: Given the diverse nature of the King’s community across all sites, it is essential that inclusion is a high priority on the Trust’s agenda for staff, patients and the local population. The management of the inclusion agenda needs to be robust so that managers understand and act on this accordingly Performance: Following the introduction of the new process for managing inclusion, consideration of the Inclusion Agenda is a key component in delivery of Trust services Strategy: Equality, diversity and inclusion are embedded in the Trust’s organisational values and delivered through its Workforce Strategy Workforce: Equality and fairness in the work environment promote a culture in which individual respect, well-being and equality of opportunity lead to staff feeling valued, enjoying job satisfaction and assists the Trust both in attracting and retaining a high calibre workforce
1
Enc. 2.7.2
Estates: There is no direct impact on Estates
Reputation: The Trust must set and meet their inclusion objectives to ensure that it is able to provide fair and equal treatment to patients and staff
4. Appendices
Appendix A – EDS Trust & Stakeholder Assessment 2014
Appendix B – King’s Inclusion Objectives 2014-16
2
Enc. 2.7.2
Equality & Diversity Scheme
Inclusion Objectives
Background
At the June 2014 Board, it was confirmed that following the dis-establishment of the Trust’s Equality and Diversity Committee (EDC), the Trust had been working towards finalising a framework which will allow us to devise, implement and deliver meaningful inclusion objectives for our patients and our staff.
This reports updates on progress towards this aim and highlights other achievements we have made with regard to inclusion.
Progress on Equality Delivery System 2
As part of the EDC Review, it was agreed that the Trust would further embed the Department of Health’s Equality Delivery System (EDS2), and that this would be used for assessing our current performance in relation to inclusion and for identifying our inclusion objectives.
We have now identified three Trust leads for inclusion who cover the different EDS2 criteria and these leads are based in Operational Management, Workforce, and Patient Involvement. Each of the leads will report back via the relevant committees for their areas of responsibilities (i.e. Operational Management via Finance & Performance Committee, Workforce via Education & Workforce Development Committee, and Patient Involvement via the Patient Experience Committee).
This allows for a wide range of inclusion issues to be considered and managed via the different leads and monitored via the three Trust committees. This is a more robust and meaningful process than that which was previously in place and ensures we are placing inclusion at the centre of everything that we do.
Setting and achieving our inclusion objectives, along with publishing our annual Equality & Diversity Report, also ensures we continue to meet the Public Sector Equality Duty.
We have also recently updated the Trust’s Equal Opportunities Policy and this has been reviewed and approved by staff side colleagues. This ensures we are following national legislation with regard to equality.
Assessment
The Trust has undertaken an assessment of current equality and diversity performance against the four EDS2 Objectives:
Better Health Outcomes Improved patient access and experience A representative and supported workforce Inclusive Leadership
The assessment is at Appendix A.
3
Enc. 2.7.2
The Trust assessment has been considered by relevant stakeholders (i.e. Joint Consultative Committee, Patient Involvement Group), and the operational objectives link to CQUINN targets.
From the assessment, we have been able to identify the Trust’s Inclusion Objectives (which are set out at Appendix B). As with our previous EDS Objectives we have set these objectives to be met over a two year period. Whilst these objectives will be monitored by the relevant Committees, I will keep the Board updated in my 6 monthly Inclusion Update.
Equality Forum and Other Activity
There have been some recent changes to the Chairs of the Equality Forums with new Chairs for both the Cultural Diversity Group and the LGBt Forum taking ‘office’ within the past three months. We are working with the chairs to support their activity, across all sites.
The Trust ran a successful Annual inclusion event on 15th September.
The Gold Michael Parker Inclusion Award was presented at the Trust’s AGM on 25th September 2014. The Gold Award was presented to members of the Occupational Health & HR Teams for their work in supporting and developing a Healthy Workplace. The Silver Award was awarded to Stephan Spencer-Adams for his work in rolling out the Stonewall Train the Trainer programme across the Trust.
Recommendation
Over the past six months, the Trust has been active in developing both strategic and operational objectives for inclusion and devising a framework to support the delivery of these objectives.
The Board is requested to note current progress in relation to Inclusion.
4
Enc. 2.7.2 APPENDIX A
EDS2 – Trust & Stakeholder Assessment
‘Better Health Outcomes’ King’s – Current / On-going Actions Lead 1.1 Services are commissioned, procured, Service Specific Trust wide Fiona Nicholls designed and delivered to meet the health needs Dementia CQUIN Improving Communication of local communities Improving Communication CQUINs; Discharge Summaries 1.2 Individual people’s health needs are assessed CQUIN; TALK KHP on-line/access to patient Fiona Nicholls and met in appropriate and effective ways Medication Review CQUIN records 1.3 Transitions from one service to another, for Care Planning/Bundles CQUIN; Safety Thermometer CQUIN; Fiona Nicholls people on care pathways, are made smoothly with COPD Bundle at PRUH pressure ulcers & falls everyone well-informed HIV telemedicine CQUIN / SH24 Transfer of Care projects 1.4 When people use NHS services their safety is Surgical checklist Alcohol & Smoking CQUIN Fiona Nicholls prioritised and they are free from mistakes, CQUIN – Care planning for mistreatment and abuse children Infrastructure measures 1.5 Screening, vaccination and other health CQUIN – short gut in children Physical Access Fiona Nicholls promotion services reach and benefit all local Transport communities See attached schedule for detail Language support ‘Improved patient access and experience’ of how projects address EDS2 Feeding support 2.1 People, carers and communities can readily requirements EIAs Fiona Nicholls access hospital, community health or primary care services and should not be denied access on unreasonable grounds 2.2 People are informed and supported to be as ‐ Regular monitoring of patient satisfaction with ‘involvement in Jessica Bush/Helen involved as they wish to be in decisions about their their care’ via patient feedback surveys Day care ‐ Continue pilot of Macmillan value based standards on selected wards ‐ Promote involving patients in their care through staff training e.g. use of patient video stories, patient comments ‐ Quality priority on discharge: increased focus on involving patients in decisions about their discharge ‐
Enc. 2.7.2 ‐ Commit 2 Care: Standardised care planning documentation to be Richard Lloyd Booth introduced trust-wide will include section for patient or / Helen Day carer/relative to sign to say that their care plan has been explained to them and that they have been involved in the development of that care plan. 2.3 People report positive experiences of the NHS Regular review of demographic data by the Patient Experience Committee to identify and manage any significant discrepancies by protected characteristics ‐ Engagement of protected groups in engagement on service reconfiguration ‐ Ensure that expanded national Friends and Family Test survey Jessica Bush collects demographic data in line with NHS England guidance 2.4 People’s complaints about services are ‐ Effective PALS and Complaints service covering all sites Sophie Dalton/Cathy handled respectfully and efficiently ‐ Triage system – allows concerns and complaints to be dealt with Varley in a way in which the patient/complainant wishes, e.g. PALS try to sort the problem out quickly, provide information ‐ Provide range of ways to raise concerns, including face-to-face, telephone, online form, email, letter ‐ Information and support available, i.e. advocacy services, interpreting services, bereavement services ‐ Complaint Handling Evaluation(ongoing) to inform continuous improvement ‐ Ensure that complaints are dealt with in a timely manner and in line with target response rates ‐ Twin-track system in place so less serious complaints can be dealt with and responded to quickly by the division
Enc. 2.7.2 - Complaints communication training (ongoing) ‐ to support staff to think about the impact a complaint response may have on the individual ‐ develop a new approach/style to responding to complaints that is open and deals with their worries and concerns
‘A representative and supported workforce’ King’s – Current / On-going Actions Lead 3.1 Fair NHS Recruitment and selection process - Produce meaningful data on R&S process Peter Absalom lead to a more representative workforce at all - Analyse data to ascertain any discrepancies in recruitment levels processes in line with protected characteristics 3.2 The NHS is committed to equal pay for work of - Trust follows nationally agreed Ts&Cs in relation to pay Kathy Renacre equal value and expects employers to use equal - Enact any amendments to nationally agreed pay rates to all staff pay audits to help fulfil their legal obligations 3.3 Training and Development opportunities are - On-going review of training and development attendance by Sarah James taken up and positively valued by all staff protected characteristic- Staff Survey metric monitored (% staff saying that training, learning, development had helped them do job better in past 12 months) - Key Account Meetings with HEIs review outcomes of post registration qualifications - Provider review meetings held to ensure quality of training delivery 3.4 When at work, staff are free from abuse, - Analyse staff survey results and anecdotal evidence Mark Preston harassment, bulling and violence from any source - Develop local action plans within Divisions / Corporate areas to tackle bullying and harassment identified through action point above
3.5 Flexible working options are available to all - Formal review of KingsFlex due 2014 Mark Preston staff consistent with the needs of the service and - Ensure managers are aware of how and where to apply KingsFlex the way people lead their lives in a supportive and equal manner 3.6 Staff report positive experiences of their - Kings in Conversation and cultural integration work supporting Mark Preston membership of the workforce development of positive working experiences - Staff Survey results show Trust in Top 20% nationally for staff engagement ‘Inclusive Leadership’ King’s – Current / On-going Actions 4.1 Boards and senior leaders routinely - 6 Monthly Board level updates on inclusion agreed as part of the Trust Board
Enc. 2.7.2 demonstrate their commitment to promoting dis-establishment of E&D Committee equality within and beyond their organisations - Timetable for updates to be confirmed by Board Secretary 4.2 Papers that come before Board and other - Improve communication to Trust to ensure equality impact major committees identify equality-related impacts assessments are meaningful including risks, and say how these risks are to be managed 4.3 Middle managers and other line managers - Inclusion woven into training and induction for managers Sarah James support their staff to work in a culturally competent ways within a work environment free from discrimination
Key: Excelling Achieving Developing Undeveloped
Enc. 2.7.2 APPENDIX B
Equality Delivery System King’s Inclusion Objectives Tracker (2014 – 2016)
Objective Lead(s) RAG Rating Controls in Adequacy Action summary / Objective place to ensure of Controls Completion compliance (high, Date medium, low) Continue to use informatics to Peter Absalom On-going Monthly review High support the development of of recruitment positive recruitment procedures in data line with protected characteristics
On an annual basis, produce and Mark Preston 30.09.15 Annual report High publish data on the Trust website required by the that ensures Trust compliance with Education & Public Sector Equality Duties Workforce Development Committee Provide guidance and advice to Mark Preston 31.12.15 Quarterly High newly appointed and current meetings with Chairs of Equality Forums, so Equality Forum these forums are proactively Chairs supporting the Trust’s Inclusion agenda
Work with Equality Forum Chairs Mark Preston / 31.12.16 Quarterly High to increase attendance at their Equality Forum meetings with meetings to ensure these are Chairs Equality Forum meaningful and support the overall Chairs Trust inclusion agenda
Enc. 2.7.2 Objective Lead(s) RAG Rating Controls in Adequacy Action summary / Objective place to ensure of Controls Completion compliance (high, Date medium, low)
Review Trust guidance on Equality Mark Preston 30.06.15 To be reviewed High Impact Assessments to ensure this by Trust’s Policy is useful for line managers Review Group and approved at Joint Consultative Committee Continue to monitor and review Mark Preston 31.12.16 Regular High outcomes of the annual National publication of Staff Survey and quarterly Staff Staff FFT results FFT to identify key staffing issues and annual (ie access to training, bullying and publication of harassment, etc), along with other national staff local informatics (eg ER statistics), survey results which are specifically related to staff with protected characteristics. Develop and implement action plans to tackle issues where identified.
Commit 2 Care: Standardised care Richard Lloyd- March 2015 Regular High planning documentation to be Booth / Helen monitoring at introduced trust-wide will include Day NMAS meetings section for patient or carer/relative to sign to say that their care plan has been explained to them and that they have been involved in the
Enc. 2.7.2 Objective Lead(s) RAG Rating Controls in Adequacy Action summary / Objective place to ensure of Controls Completion compliance (high, Date medium, low) development of that care plan. Ensure that expanded national Jessica Bush Monthly Regular High Friends and Family Test survey ongoing monitoring via collects demographic data in line Patient with NHS England guidance Experience Committee Ensure that complaints are dealt Sophie Dalton / Monthly - Regular High with in a timely manner and in line Cathy Varley ongoing monitoring with target response rates through Performance Meetings / Patient Experience Committee and Serious Complaints Committee Twin-track system in place so less Sophie Dalton / On-going Patient High serious complaints can be dealt Cathy Varley Experience with and responded to quickly by Committee / the division Serious Complaints Committee
Enc. 2.7.2 Objective Lead(s) RAG Rating Controls in Adequacy Action summary / Objective place to ensure of Controls Completion compliance (high, Date medium, low) - Complaints communication Sophie Dalton / Workshops Patient High training (ongoing) Cathy Varley held: 8.10.14 Experience ‐ to support staff to think about / 5.11.14. Committee the impact a complaint response may have on the One planned individual for 11.12.14 develop a new approach/style to responding to complaints that is open and deals with their worries and concerns Each year, working with local and Specific to each 31.12.16 and Milestones set, High national commissioners and other individual / or by end regularly stakeholders as appropriate, initiative. of relevant monitored and identify and deliver initiatives to Overview of financial reported achieve EDS2 goals, specifically CQUINs - year periodically both for people who have “Protected Regulatory internally Characteristics” and “Other Performance (F&PC) and Disadvantaged Groups” and to Team externally to address local identified needs. Operations commissioners Lead for EDS2 (quarterly). – Fiona Nicholls Provide regular Board and Board Mark Preston / 31.12.16 Regular updates High level committee reports on Fiona Nicholls / for Education & Inclusion and progress against Jessica Bush Workforce agreed inclusion objectives Development Committee, Finance & Performance
Enc. 2.7.2 Objective Lead(s) RAG Rating Controls in Adequacy Action summary / Objective place to ensure of Controls Completion compliance (high, Date medium, low) Committee and Public / Patient Involvement Committee Set and achieve SMART goals to Dependent on On-going Regular High move all but “excelling” EDS each objective monitoring by grades up to next grade until all relevant grades are excelling committee
Enc. 2.7.2 Appendix C
Equality Deliver System EDS2 – Operations – Current State and Future Plans Goals set out in EDS2 and allocated to Operations
‘Better Health Outcomes’ 1.1 Services are commissioned, procured, designed and delivered to meet the health needs of local communities 1.2 Individual people’s health needs are assessed and met in appropriate and effective ways 1.3 Transitions from one service to another, for people on care pathways, are made smoothly with everyone well-informed 1.4 When people use NHS services their safety is prioritised and they are free from mistakes, mistreatment and abuse 1.5 Screening, vaccination and other health promotion services reach and benefit all local communities
‘Improved patient access and experience’ 2.1 People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds
Enc. 2.7.2
EDS2 requires a focus specifically on the following:
Protected Characteristics (PC) Other Disadvantaged Groups (ODG)
Age Homeless Disability Poverty Gender re-assignment Long-term unemployed Marriage and civil partnership Stigmatised occupations Pregnancy and maternity Drug misuse Race including nationality and ethnic Limited family/social networks origin Geographical isolation Religion or belief Sex Sexual orientation
Local Identified Needs (LIN) – note local to KCH Denmark Hill, large proportion of ethical minorities in population so also fall within Protected Characteristics set out above. Diabetes Sickle Cell Elderly Sexual health Liver Children
Enc. 2.7.2
Current State – how Trust is delivering EDS2 (2014/15) Service Infrastructure Outcome Where LIN PC ODG Specific Initiative Cross Service initiative area measures addressed monitored Sickle Cell Disability Improving 1.3, 2.1 Performance & Race Communication CQUINs; Committee Discharge Summaries Y KHP on-line/access to CQRG patient records IGSG Elderly Age Dementia CQUIN Safety Thermometer 1.1,1.2, Performance Improving CQUIN; pressure ulcers 1.3,1.4, 2.1 Committee Physical Communication & falls Access CQUIN; TALK Improving CQRG
Medication Review Communication CQUINs; Y CQUIN Discharge Summaries IGSG Transport KHP on-line/access to
patient records Language Transfer of Care projects ISG support
Liver ? Race Alcohol Alcohol & Smoking 1.1, 1.3, Performance Feeding misuse CQUIN 1.5, 2.1 Committee support Improving
Communication CQUINs; CQRG Y EIAs Discharge Summaries KHP on-line/access to IGSG patient records
Respiratory Disability Smoking Care Alcohol & Smoking 1.1, 1.3, Performance Age (drug misuse) Planning/Bundles CQUIN 1.5, 2.1 Committee
CQUIN; COPD Improving Bundle at PRUH Communication CQUINs; CQRG
Enc. 2.7.2 Service Infrastructure Outcome Where LIN PC ODG Specific Initiative Cross Service initiative area measures addressed monitored Discharge Summaries KHP on-line/access to IGSG patient records
Diabetes Disability Improving 1.3 Performance & Race Communication CQUINs; Committee Discharge Summaries Y KHP on-line/access to CQRG patient records IGSG Sexual Age – Stigmatised HIV telemedicine Improving 1.1, 1.2, Performance Health youth occupation CQUIN / SH24 Communication CQUINs; 1.3, 1.5, Committee Discharge Summaries 2.1 Y KHP on-line/access to CQRG patient records IGSG Surgery Surgical Improving 1.3, 1.4 Performance checklist Communication CQUIN; Committee Discharge Summaries KHP on-line/access to CQRG patient records IGSG Paediatrics Y Age – CQUIN – Care Improving 1.1, 1,2, Performance youth planning for Communication CQUIN; 1,3, 2.1 Committee children Discharge Summaries CQUIN – short gut KHP on-line/access to CQRG in children patient records IGSG
Enc. 2.7.2 Future State – how Trust is planning to deliver EDS2 in 2015/16 – tba with local commissioners/other stake holders
Enc. 2.7.3
EXECUTIVE SUMMARY
REPORT TO THE BOARD OF DIRECTORS
HELD ON 16TH DECEMBER 2014
PURPOSE OF THE REPORT
This report provides the Board of Directors with information on the details of the actual hours of Registered nurses/midwives and Clinical Support staff’s time on ward day shifts and night shifts versus planned staffing levels for November 2014.
KEY POINTS
For each of the 77 clinical inpatient areas, the optimal number of hours of nursing or midwifery staff time required for day shifts and night shifts has been calculated for the month and the actual fill rate has been recorded.
Overall the actual fill rate for shifts for Registered Nurses was 99% and for other care staff against planned levels was 112% during day shifts. Overall the actual fill rate for shifts for Registered Nurses against planned levels was 101% during night shifts and for other care staff the actual fill rate was 131%.
This report details those areas where there was a variance of greater than 15% between actual fill rates and planned staffing levels. The reasons for the variance are given and any actions that were taken are detailed.
Enc. 2.7.3
At Kings College NHS Foundation Trust we aim to provide safe, high quality care to our patients and our staffing levels are continually assessed to ensure we meet this aim.
For most wards, there will be a difference between the planned and actual staffing hours. In some cases, departments will have used more hours than they planned to use and in other cases they will have used less hours than they planned. The reasons for using more staff hours than planned could include needing to open and staff additional beds, or needing to care for patients who are either more unwell or who have greater care needs than those patients usually cared for on that ward. The reasons for using less staff hours than planned could include using fewer beds than planned, or caring for patients who are less unwell or with fewer care needs than those patients usually cared for on that ward. The planned staffing level is based on optimal staffing levels and where actual staff is below this on a shift, the Trust has a number of mechanisms to ensure the staffing on that shift remains at a safe and appropriate level.
The average fill rate for the Trust and individual hospital inpatient sites in November 2014 was as follows:
DAY NIGHT
Site % Average fill % Average Fill % Average fill % Average rate RN rate HCA rate RN Fill rate HCA
Denmark Hill 97% 109% 97% 126%
PRUH 100% 114% 104% 135%
Appendices:
Variance report by ward/department (Appendix I) Unify upload (Appendix II)
Enc. 2.7.3
APPENDIX II
VARIANCE REPORT BY WARD / DEPARTMENT
The following wards have been identified as having a variance of greater than 15% against either their day or night staffing for either registered nurses /midwives or care staff during November. The Trust website lists the results for all the inpatient wards or departments and details whether there was a deficit or surplus between the planned and actual staffing.
Denmark Hill
Division Ward Name % % % % Review by HON/Matron/Ward where 15% or Average Average Average Average more of nursing hours did not meet agreed fill rate Fill rate fill rate Fill rate staffing levels (Highlighted in red) RN - HCA - RN - HCA - Day Day Night Night
Cardiac Victoria & Albert 101% 103% 102% 50% Ward operating at safe staffing levels as per the planned number. Red spot for HCAs did not affect patient care as HCA support not always required.
Division Ward Name % % % % Review by HON/Matron/Ward where 15% or Average Average Average Average more of nursing hours did not meet agreed fill rate Fill rate fill rate Fill rate staffing levels (Highlighted in red) RN - HCA - RN - HCA - Day Day Night Night
CCTD Frank Stansil Critical 100% 98% 99% 70% Ward operating at safe staffing levels as per the Care planned number. Red spot for Night shift HCA did not affect patient care as HCA support not always required.
Enc. 2.7.3
Division Ward Name % % % % Review by HON/Matron/Ward where 15% or Average Average Average Average more of nursing hours did not meet agreed fill rate Fill rate fill rate Fill rate staffing levels (Highlighted in red) RN - HCA - RN - HCA - Day Day Night Night
Children's Princess Elizabeth 87% 90% 97% 69% Ward operating at safe staffing levels as per the planned number. Red spot for HCAs did not affect patient care as HCA support not always required. Children's Rays Of Sunshine 91% 88% 93% 70% ROS is again red for HCA 70% at night. It is the same as it was last month: we haven’t filled one HCA post and we cover rather days well with HCAs than at night as this works better for our workload. Children's Thomas Cook CCCC 97% 83% 96% 83% Ward operating at safe staffing levels as per the planned number. Red spot for HCAs did not affect patient care as HCA support not always required.
Division Ward Name % % % % Review by HON/Matron/Ward where 15% or Average Average Average Average more of nursing hours did not meet agreed fill rate Fill rate fill rate Fill rate staffing levels (Highlighted in red) RN - HCA - RN - HCA - Day Day Night Night
Liver and Liver ICU 106% 33% 100% 33% Ward operating at safe staffing levels as per the Surgery planned number. Red spot for HCAs did not affect patient care as HCA support not always required.
Enc. 2.7.3
Division Ward Name % % % % Review by HON/Matron/Ward where 15% or Average Average Average Average more of nursing hours did not meet agreed fill rate Fill rate fill rate Fill rate staffing levels (Highlighted in red) RN - HCA - RN - HCA - Day Day Night Night
Neuro David Marsden 78% 197% 72% 186% Ward increased HCA support due to shortage of RNs in order to keep the ward safe. Neuro Kinnier Wilson HDU 97% 118% 101% 55% Ward operating at safe staffing levels as per the planned number. Red spot for Night shift HCA did not affect patient care as HCA support not always required. Neuro Murray Falconer 79% 155% 84% 145% There has been sickness during the month of November across band 6,5,2. We have 10 ONP staff who cover RN shifts and the shifts vacant to HCA staff. The ONP staff are counted in the HCA numbers as we do have HCA vacancies on MF. There has not been any special booking during November.
Enc. 2.7.3
Division Ward Name % % % % Review by HON/Matron/Ward where 15% or Average Average Average Average more of nursing hours did not meet agreed fill rate Fill rate fill rate Fill rate staffing levels (Highlighted in red) RN - HCA - RN - HCA - Day Day Night Night
Surgery Katherine Monk 98% 82% 97% 99% Ward operating at safe staffing levels as per the planned number. Red spot for Day shift HCA did not affect patient care as HCA support not always required. Surgery Trundle 104% 103% 99% 70% Ward operating at safe staffing levels as per the planned number. Red spot for HCAs did not affect patient care as HCA support not always required.
Division Ward Name % % % % Review by HON/Matron/Ward where 15% or Average Average Average Average more of nursing hours did not meet agreed fill rate Fill rate fill rate Fill rate staffing levels (Highlighted in red) RN - HCA - RN - HCA - Day Day Night Night
Women's Brunel 113% 58% 97% 106% Under established day HCA due to reduced beds during refurbishment work due for completion Women's William Gilliatt 100% 87% 100% 84% Ward operating at safe staffing levels as per the planned number. Red spot for HCAs did not affect patient care as HCA support not always required.
Enc. 2.7.3
Division Ward Name % % % % Review by HON/Matron/Ward where 15% or Average Average Average Average more of nursing hours did not meet agreed fill rate Fill rate fill rate Fill rate staffing levels (Highlighted in red) RN - HCA - RN - HCA - Day Day Night Night
TEAM Mary Ray 91% 101% 78% 130% Ward operating at safe staffing levels as per the planned number. Red spot on night shift for RNs did not affect patient care as additional HCA support was provided. TEAM R D Lawrence 95% 115% 85% 108% Ward operating at safe staffing levels as per the planned number. TEAM Twining 82% 93% 85% 102% The 82% is related to the high RN vacancies we have on the ward but patient safety care was not affected as ward managers supported where required.
Enc. 2.7.3 PRUH
Division Ward Name % % % % Review by HON/Matron/Ward where Average Average Average Average 15% or more of nursing hours did not fill rate Fill rate fill rate Fill rate meet agreed staffing levels RN - HCA - RN - HCA - (Highlighted in red) Day Day night night
CCTD Intensive Care Unit 93% 53% 94% 47% Ward operating at safe staffing levels as per the planned number. Red spot for HCAs did not affect patient care as HCA support not always required.
Division Ward Name % % % % Review by HON/Matron/Ward where Average Average Average Average 15% or more of nursing hours did not fill rate Fill rate fill rate Fill rate meet agreed staffing levels RN - HCA - RN - HCA - (Highlighted in red) Day Day night night
Children’s Children’s Ward 108% 100% 115% 25% Ward operating at safe staffing levels as per the planned number. Red spot for HCAs did not affect patient care as HCA support not always required.
Enc. 2.7.3
Division Ward Name % % % % Review by HON/Matron/Ward where Average Average Average Average 15% or more of nursing hours did not fill rate Fill rate fill rate Fill rate meet agreed staffing levels RN - HCA - RN - HCA - (Highlighted in red) Day Day night night
Network Coronary Care Unit (CCU) 103% 18% 100% 91% Ward operating at safe staffing levels as per the planned number. Red spot for HCAs did not affect patient care as HCA support not always required. Network Med 5 - S 97% 97% 96% 85% Ward operating at safe staffing levels as per the planned number.
Division Ward Name % % % % Review by HON/Matron/Ward where Average Average Average Average 15% or more of nursing hours did not fill rate Fill rate fill rate Fill rate meet agreed staffing levels RN - HCA - RN - HCA - (Highlighted in red) Day Day night night
Surgery Boddington (ORP) 78% 83% 87% 97% We adjust staffing to patient numbers so are not always running on full establishment. We also cancelled operating at beginning of November due to flooding in theatres so staffing numbers were dramatically reduced. Surgery Surgical Ward 4 84% 85% 85% 89% Although staffing has shown slightly lower staffing numbers against the plan ward support provided by Ward manager when required in order provide safe staffing levels.
Enc. 2.7.3
Division Ward Name % % % % Review by HON/Matron/Ward where Average Average Average Average 15% or more of nursing hours did not fill rate Fill rate fill rate Fill rate meet agreed staffing levels RN - HCA - RN - HCA - (Highlighted in red) Day Day night night
TEAM Medical Ward 3 81% 142% 101% 200% Ward operating at safe staffing levels as per the planned number. Additional support for specialling was required to support patient needs and RN shortages.
Division Ward Name % % % % Review by HON/Matron/Ward Average Average Average Average where 15% or more of nursing fill rate Fill rate fill rate Fill rate hours did not meet agreed RN - HCA - RN - HCA - staffing levels (Highlighted in Day Day night night red)
Women’s Maternity Unit (PRU) 75% 87% 99% 73% Although this Ward experienced low staffing numbers patient care was not compromised as Ward Managers and other senior staff ensured appropriate cover was allocated.
Enc. 2.7.3
APPENDIX II
UNIFY UPLOAD - PRUH NOVEMBER 2014
Day Day Day Day Night Night Night Night Divsion Ward Name Planned Actual Planned Actual Planned Actual Planned Actual RN RN % HCA HCA % RN RN % HCA HCA % Surgery Boddington (ORP) 1990 1553 78% 966 805 83% 1070 932 87% 380 368 97% Network Chartwell Unit 1127 1185 105% 725 644 89% 1104 1093 99% 380 460 121% Childrens Childrens Ward 1047 1127 108% 322 322 100% 1012 1162 115% 184 46 25% Network Coronary Care Unit (CCU) 1357 1392 103% 127 23 18% 1024 1024 100% 368 334 91% TEAM Emergency Assessment Unit (EAU)2070 2013 97% 702 725 103% 1725 1714 99% 656 713 109% TEAM Farnborough Ward 1921 1668 87% 1334 1990 149% 1415 1392 98% 771 1311 170% CCTD Intensive Care Unit 3105 2875 93% 345 184 53% 3105 2921 94% 345 161 47% Womens Maternity Unit (PRU) 1817 1369 75% 1001 874 87% 1047 1035 99% 679 495 73% Network Med 5 - H 2059 1898 92% 690 702 102% 2013 1955 97% 690 656 95% Network Med 5 - S 1380 1334 97% 1035 1001 97% 1380 1323 96% 782 667 85% TEAM Medical Ward 1 219 644 295% 518 679 131% 265 667 252% 276 345 125% TEAM Medical Ward 2 1254 1093 87% 978 1380 141% 1035 1012 98% 345 771 223% TEAM Medical Ward 3 1311 1058 81% 759 1081 142% 1058 1070 101% 437 874 200% TEAM Medical Ward 4 1323 1150 87% 690 713 103% 1035 1012 98% 345 380 110% TEAM Medical Ward 6 1357 1254 92% 690 725 105% 1035 1024 99% 345 610 177% TEAM Medical Ward 7 1323 1265 96% 978 1035 106% 1047 1024 98% 368 483 131% Network Medical Ward 8 1369 1334 97% 702 771 110% 1058 1024 97% 690 805 117% TEAM Medical Ward 9 2105 2013 96% 690 782 113% 1725 1702 99% 426 736 173% Childrens Special Care Baby Unit 1024 978 96% 58 173 300% 1024 966 94% 58 161 280% TEAM Surgical Ward 1 1288 1162 90% 1012 1633 161% 1035 1047 101% 345 1070 310% TEAM Surgical Ward 2 1162 1110 96% 1035 1461 141% 1047 1024 98% 437 1012 232% Surgery Surgical Ward 3 1495 1484 99% 782 828 106% 1047 1035 99% 437 437 100% Surgery Surgical Ward 4 1231 1035 84% 782 667 85% 897 759 85% 736 656 89% Surgery Surgical Ward 5 1944 1852 95% 1081 1472 136% 1438 1564 109% 725 978 135% Surgery Surgical Ward 6 1633 1461 89% 679 886 131% 1081 1035 96% 380 518 136% Surgery Surgical Ward 7 1748 1737 99% 1691 1668 99% 1438 1461 102% 1438 1507 105% womens Surgical Ward 8 1265 1242 98% 690 656 95% 1024 1012 99% 334 311 93%
Enc. 2.7.3
Denmark Hill
Enc. 2.7.3
UNIFY UPLOAD - DH NOVEMBER 2014
Planned Actual Planned Actual Planned Actual Planned Actual Ward Name RN/RMW RN/RMW % HCA/MSW HCA/MSW % RN/RMW RN/RMW % HCA/MSW HCA/MSW % Day Day Day Day Night Night Night Night Adult Cystic Fibrosis Unit 878 810 92% 0 15 200% 575 564 98% 0 12 100% Annie Zunz 2100 2100 100% 1358 1290 95% 1403 1507 107% 1035 1012 98% Brunel 1357 1530 113% 656 380 58% 1047 1012 97% 368 391 106% Byron 1590 1770 111% 1185 1425 120% 1093 1265 116% 414 667 161% Cheere Ward 1208 1081 90% 357 598 168% 713 713 100% 357 587 165% Christine Brown CCU 5520 5664 103% 345 408 118% 5520 5589 101% 345 380 110% Coptcoat Ward 1622 1449 89% 357 449 126% 1070 1070 100% 253 276 109% Cotton 1714 1679 98% 1035 1047 101% 1392 1369 98% 368 437 119% David Marsden 2415 1875 78% 1035 2036 197% 2415 1737 72% 1035 1921 186% Davidson 1714 1771 103% 667 656 98% 1380 1346 98% 345 564 163% Dawson 1610 1461 91% 667 679 102% 1392 1334 96% 690 644 93% Derek Mitchell Unit 1668 1639 98% 334 633 190% 1047 1070 102% 334 656 197% Donne 2085 2190 105% 1755 1763 100% 1116 1093 98% 1058 1047 99% ELF & LIBRA Ward 1702 1639 96% 736 966 131% 1380 1357 98% 725 943 130% Fisk Ward 1978 1702 86% 345 334 97% 1392 1277 92% 345 345 100% Frank Cooksey 1245 1170 94% 1343 1358 101% 782 736 94% 817 817 100% Frank Stansil Critical Care 4830 4842 100% 345 339 98% 4830 4784 99% 345 242 70% Frederick Still (Newborn Unit) 4830 5693 118% 0 0 100% 4830 5716 118% 0 0 100% Guthrie Ward 2036 1794 88% 357 357 100% 1035 1047 101% 345 345 100% Howard Ward 1265 1242 98% 575 564 98% 1035 1047 101% 345 357 103% Jack Steinberg Critical Care 5520 5537 100% 345 316 92% 5520 5474 99% 345 334 97% Katherine Monk 2772 2714 98% 1369 1116 82% 2082 2013 97% 1058 1047 99% Kinnier Wilson 1725 1725 100% 1047 1231 118% 1369 1300 95% 667 943 141% Kinnier Wilson HDU 2059 1990 97% 288 339 118% 2059 2082 101% 127 69 55% Lion 1001 966 97% 299 322 108% 1024 1001 98% 23 69 300% Lister 2415 2415 100% 713 920 129% 1380 1380 100% 690 702 102% Liver ICU 5900 6256 106% 35 0 33% 6118 6095 100% 35 0 33% Lonsdale 2280 2250 99% 1350 1410 104% 1737 1714 99% 759 840 111% Marjorie Warren 2408 2370 98% 1800 1680 93% 1380 1357 98% 1035 1035 100% Mary Ray 2648 2408 91% 1350 1358 101% 1748 1369 78% 1035 1346 130% Matthew Whiting 2001 1967 98% 1380 1604 116% 1415 1541 109% 736 805 109% Murray Falconer 2450 1932 79% 748 1162 155% 2036 1702 84% 713 1035 145% Oliver 3075 3330 108% 870 930 107% 2082 2231 107% 690 748 108% Paediatric Short Stay 667 621 93% 334 311 93% 690 679 98% 334 368 110% Princess Elizabeth 1185 1035 87% 357 322 90% 1070 1041 97% 184 127 69% R D Lawrence 3150 3000 95% 900 1035 115% 2105 1794 85% 690 748 108% Rays Of Sunshine 2415 2208 91% 345 305 88% 2093 1955 93% 345 242 70% Recovery Ward 1242 1208 97% 23 23 100% 1093 1081 99% 0 12 100% Sam Oram 1334 1346 101% 633 725 115% 1035 989 96% 58 357 620% Sam Oram CCU 1350 1350 100% 450 443 98% 1035 1035 100% 46 104 225% The Friends Stroke Unit 3150 2895 92% 1553 1875 121% 2415 2174 90% 1047 1357 130% Thomas Cook CCCC 3841 3726 97% 460 380 83% 3830 3692 96% 460 380 83% Todd 1875 1748 93% 1012 1024 101% 1691 1587 94% 713 713 100% Toni & Guy 1633 1530 94% 276 311 113% 1633 1426 87% 265 253 96% Trundle 1070 1116 104% 644 661 103% 834 828 99% 541 380 70% Twining 2670 2190 82% 1350 1260 93% 1737 1472 85% 1035 1058 102% V&A HDU Ward 1599 1610 101% 322 311 96% 1403 1392 99% 311 368 119% Victoria & Albert 1357 1369 101% 345 357 103% 1024 1047 102% 23 12 50% Waddington 1035 1139 110% 345 391 113% 1035 1041 101% 104 253 244% William Gilliatt 3105 3105 100% 2059 1794 87% 2588 2576 100% 1886 1576 84%
Enc. 3.1.1
King’s College Hospital Board of Directors - Finance & Performance Committee Minutes of the meeting of the Finance & Performance Committee held at 09:30 on Tuesday 28 October 2014 in the Dulwich Committee Room, Kings College Hospital NHS Foundation Trust
Present: Graham Meek (GM) Committee Chair/ Non-Executive Director Prof Sir George Alberti (GA) Trust Chair/ Non-Executive Director Faith Boardman (FB) Non-Executive Director Prof Ghulam Mufti (GM1) Non-Executive Director Sue Slipman (SS) Non-Executive Director Chris Stooke (CS) Non-Executive Director Tim Smart (TS) Chief Executive Officer Angela Huxham (AH) Director of Workforce Development Dr Michael Marrinan (MM) Medical Director Dr Geraldine Walters (GW) Director of Nursing and Midwifery Roland Sinker (RS) Chief Operating Officer Simon Taylor (ST) Chief Financial Officer Jane Walters (JW) Director of Corporate Affairs In attendance: David Dawson (DD) Interim Director of Strategy Simon Dixon (SD) Director of Finance Peter Fry (PF) Director of Operations Kath Dean (KD) Operational Site Lead (PRUH) Steve Coakley (SC) Acting Associate Director of Performance & Contracts Non Owen (NO) Corporate Governance Officer - minutes Apologies: Trudi Kemp (TK) Director of Strategic Development Marc Meryon (MM1) Non-Executive Director
Item Subject Action
14/78 Welcome & Apologies
The apologies for absence were noted.
14/79 Declarations of Interest
There were no declarations of interest.
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Enc. 3.1.1 Item Subject Action
14/80 Minutes of the Previous Meeting
The minutes of the meeting held on 30 September 2014 were approved as a correct record.
14/81 Actions Tracking/Matters Arising
The action tracker was noted with no outstanding actions.
14/82 Performance Reports – Month 06
(PF) and (KD) presented summaries of month 06 (September) performance at the Denmark Hill (DH) and Princess Royal University Hospital (PRUH) sites.
The Committee noted the month 06 performance and the following key points: RS reported that the DH and PRUH reports are positive in terms of continual performance. There has been sustained improvement in the acute targets. The successful delivery of these targets is however a significant financial cost to the Trust.
Denmark Hill (DH) site Cancer wait targets at the Denmark Hill (DH) site show continual strong performance;
Referral to treatment (RTT) targets remain a challenge to maintain on a monthly and quarterly basis together with cancer targets;
Issues with RTT relate to historic backlogs and the continual numbers of patients being referred to the Trust. The backlog has improved with continual off-site working and weekend working;
The backlogs are monitored weekly with any issues picked up with divisional managers;
Off-site working has been put in place to ease capacity pressures in the neurology department with complex cases remaining onsite;
Resilience monies cover the costs of off-site working;
The proportion of off-site working is relatively low with a requirement to spend the resilience funding by the end of November;
Emergency Department (ED) performance for September has begun to show improvement with 94% being achieved in the month;
Whilst this is not reportable as the 95% target it should be noted that there have been days and successive days at the DH site where this target has been achieved;
Rapid assessment and treat (RAT) is now online at the DH site which has led to increased capacity and the achievement of the 95% target for type 1 performance for the previous week;
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Enc. 3.1.1 Item Subject Action
It is estimated that the benefits from moving patients out of the ED and managing them away from the ED will translate into real benefits on the Katherine Monk ward by early November;
The neurological step down facility at the Princess Royal University Hospital (PRUH) site is due online in November which should lead to decompression at the DH site;
Some of the Trusts improvement actions are yet to be finalised. However, even with these improvements demand is still very high with 405 attendances at the ED the previous Sunday which resulted in 4 breaches of the ED target;
The picture is a fragile one and the key to sustainable performance is consistency;
The weekly Emergency Care Board continues to meet to provide the level of governance and monitoring of these issues;
Repatriation still remains an issue particularly in relation to Lewisham and Queen Mary's Sidcup hospitals although there has been some improvement;
Tools are in place to escalate repatriation and the electronic patient records (EPR) system helps speed up processes;
SC is focussing on issues with out of area stroke patients. He is working with ED and TEAM to understand these issues;
Other areas of positive performance include: o HCAI with no further cases of MRSA and the Clostridium Difficile (c.diff) run rate reported much lower; o The work on Ebola which GW has been leading on has been managed very well to date;
Theatre utilisation is a key Cost Improvement Programme (CIP) for the Trust. Key issues have been identified and work is being progressed;
There have been 6 pressure sore cases reported in surgery which is unusual. Root cause analyses will be conducted for all of these cases;
There has been one never event reported in ophthalmology. The investigation into this is being led by MM; and
The backlog of patient complaints had been considered at the recent Quality and Governance Committee. The Trust is focusing on this area which has resulted in good progress;
Princess Royal University Hospital (PRUH) site There have been areas of improvement at the PRUH site such as how are we doing (HRWD) and friends and family test (FFT) in the Emergency Department (ED);
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Enc. 3.1.1 Item Subject Action
Emergency Department (ED) performance has hit 94% and 96% in the last week which is a great improvement. The Safer Faster Hospital Week (SFHW) has provided the opportunity to focus on outflow. This signals that with the right focus the Trust can attain 95% when there is a good level of discharge;
Procedures for discharge have been analysed with Social Services, focus on local enterprise and community support;
There has been work with Bexley patients for better support and what appears to be more focused cooperation;
The MediHome contract has been extended from the DH site and there is no competition other than from Bromley Healthcare. It is thought that it will take 3-6 months to see the benefit to the Trust;
The ED is working very hard and in time the PRUH site hopes to have a similar RAT model to the DH site;
The RTT backlog is being monitored by the new Patient Access Board which meets monthly and which Commissioners are invited to attend;
Areas of key challenge in the cancer action plan for the PRUH are around the two week waiting time target which then affects the 62-day cancer wait standard;
There have been service moves progressed for gynaecology, urology and paediatrics services to relieve capacity and resource pressures;
There is further work to involve Clinical Nurse Specialists (CNS) but more to do to improve acceptance and improve effective urology pathways;
There has been recent stakeholder recognition of the good progress being made by the Trust;
Tessa Jowell MP and Harriet Harman MP visited the PRUH and Orpington sites. They welcomed the changes and improvements made by the Trust; and
The forthcoming PRUH Summit will be an important opportunity for the Trust to showcase the further improvements made since the acquisition.
Specific Performance Reports The Committee noted the updated action plans for: o ED Action Plan Update o RTT Action Plan Update and specific actions for reducing the 18 week backlog o Cancer Action Plan o Infection Control Update o Key Areas of Concern
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Enc. 3.1.1 Item Subject Action
14/83 Finance Report – Month 6
ST presented a summary of the financial position at the end of month 06 (September).
The Committee noted the month 06 financial report and the following key points: The content and format of the monthly financial report has been reviewed to ensure that it not only provides a factual account year to date but is also a useful tool to take decisions going forward;
The financial report now includes lots of detail from the divisions and corporate departments;
An analysis has taken place at the Board Integration Committee (BIC) to plot a best, medium and worst case scenario against the actual position for the Trust;
This financial position is a huge strain for the Trust and subject to a lot of conversations with key stakeholders;
The situation has highlighted the challenge of accessibility of these stakeholders and so the main focus of current conversation is through Monitor;
The month 6 run rate is broadly similar to the previous month and the basic position remains unchanged despite the hard work being done across the Trust;
Renal surgery is a key area of concern and discussions are being held with the divisions to deliver the recovery plan;
The continuity of risk service rating (CoSRR) is 3 for the Trust at month 6. This position is very fragile;
The recovery plan is now £1m out from where the Trust forecast when it was in place in August 2014;
Income analysis shows that the Trust over-performance relates to non payment by results (PbR) income;
This is the income which is not set by tariff capacity but on historic actual costs and there are conversations to be had with Clinical Commissioning Groups (CCGs) regarding additional income in this area;
The report highlights a downturn in bank and agency spending however it is critical that the Trust continues to monitor this area of work; and
Medical outliers and lost opportunity income has significantly reduced year on year;
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Enc. 3.1.1 Item Subject Action
The Committee thanked ST and his team for the work put into the extra detail of the report. It was agreed that the executive commentary should flag the key areas and comments of the report.
Should Monitor wish to conduct interviews with executives and non- executive directors then individuals need to be confident on the content of the report and details in it without it being too unwieldy;
14/84 Treasury Management Report – Month 6
The Committee noted the Treasury Management report for month 06 (September).
14/85 Monitor Monthly Return – Month 6
The Committee noted the Monitor Monthly Return for month 06 (September).
14/86 Any Other Business
Impact of PiMS data migration The Committee note that with the PiMS data migration scheduled to take place this weekend there may be a risk to production of the Unify statutory reports and the weekly reporting on RTT to Commissioners.
The Committee: 1) Noted the risk in relation to the migration to PiMS 2) Agreed that RS would write to Unify and Commissioners about the risks to producing the weekly reports 3) Noted that there is a manual system used for the time that the system is down and if there is any continual delay/problem the breach point will be Monday morning and an assessment will be made to rectify or roll back.
14/87 Date of next meeting
Tuesday 25 November 2014, 09:30-11:30 in the Dulwich Committee Room
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