Agenda

Group Name: Trust Board – Open Session Date of Meeting: 1 March 2018 Venue: Parent Education Seminar Room, F Level, Princess Anne Hospital Time: 9.00-11.00am Apologies to: Sue Diduch, Corporate Affairs Administrator

9.00 1. Chair’s Welcome, Apologies and Declarations of Interest

2. Minutes of Previous Meeting held on 1 February 2018 Enclosure 1

3. Matters Arising/Summary of Agreed Actions

9.10 4. Integrated Performance Report for Month 10 including: Enclosure 2 • Quarterly Infection Prevention & Control

9.45 5. Quality & Safety Discussion Items 9.45 5.1 Improving Air Quality Enclosure 3 (Fiona Dalton, Chief Executive/Debbie Chase, Public Health Service Lead, Southampton City Council/Neil Tuck, Sustainable City Team Leader, Southampton City Council/Ben Marshall, Consultant Respiratory Physician and Honorary Associate Professor of Medicine/Shannon Lennock, Foundation Year 2 Doctor)

6. Finance Discussion Items 6.1 Finance Report for Month 10 Enclosure 4 (David French, Chief Financial Officer)

7. Operational Performance Discussion Items 7.1 Draft Five-Year Staff Strategy 2018-2023 Enclosure 5 (Fiona Dalton, Chief Executive/Steve Harris, Human Resources Director/Joanna Mountfield, Director of Education)

10.45 8. Governance Decision Items 8.1 CRN: Wessex 2017/18 Quarter 3 Performance Report and Enclosure 6 2018/19 Annual Plan Enclosure 7 (Derek Sandeman, Medical Director/Rebecca McKay, Chief Executive, CRN: Wessex) 8.2 Chief Executive’s Report including items for ratification Enclosure 8 (Fiona Dalton, Chief Executive)

Discussion Items 8.3 Briefing from Chair of Strategy & Finance Committee Oral (Simon Porter, Chair, S&FC)

8.4 Briefing from Chair of Quality Committee Oral (Mike Sadler, Chair, QC)

9. Any other business

10. To note the date of the next meeting: Thursday, 29 March 2018 in the Conference Room, Heartbeat Education Centre, F Level, North Wing, SGH

In attendance: Debbie Chase, Public Health Service Lead, Southampton City Council Neil Tuck, Sustainable City Team Leader, Southampton City Council Ben Marshall, Consultant Respiratory Physician and Honorary Associate Professor of Medicine Shannon Lennock, Foundation Year 2 Doctor Steve Harris, Human Resources Director Joanna Mountfield, Director of Education Rebecca McKay, Chief Executive, CRN: Wessex

Items Circulated: The following items have been circulated to the Board since the last meeting. Executive directors are happy to take questions from individual members, before the meeting, by e-mail or telephone, or to meet separately to discuss in more detail.

29 January 2018 Press Release: Saints legend backs children's emergency department appeal 5 February 2018 Press Release: Researchers to address "mismatch" in care for patients with neurological conditions 9 February 2018 Press Release: Eye experts in Southampton to trial pioneering drug to prevent sight loss 12 February 2018 Press Release: Southampton researchers find arthritis drug could reduce dementia risk 21 February 2018 Press Release: Children's ED campaigners launch drive for next million

EXCLUSION OF PRESS, PUBLIC AND OTHERS The public and representatives of the press may attend all meetings of the Trust, but shall be required to withdraw upon the Board of Directors resolving as follows “that representatives of the press, and other members of the public, be excluded from the remainder of this meeting as publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted”

11.15-11.30 Follow-up discussion with governors

11. 45-1.00 Clinical Visit

UHSFT – Directors’ Actions Summary for 1 March 2018 Trust Board – Open Session

______Action & Minute Reference By whom Target Date Current Status Trust Board 1 February 2018 Guardian of Safe Working Hours Quarterly Report (Minute Ref 6/18) KN/DS to ensure the next Guardian of Safe Working Hours KN/DS 26/4/18 Agenda TB 26/4/18. Quarterly Report includes additional detail in relation to locum spend and whether this was gross or net of staff costs which would otherwise have been incurred.

Equality, Diversity and Inclusivity (EDI)/Workforce Race Equality Standards (WRES) Action Plan Quarter Report (Minute Ref 7/18) • GG/GB to establish whether there is national guidance in GG/GB 26/4/18 To be included in the next report – Agenda TB 26/4/18 relation to Trust Boards supporting the EDI agenda, and share this information as necessary.

• Report format to be updated to include an activity summary GG/GB 26/4/18 The report format will be updated for the next report as above. and to reflect the organisational commitment to diversity and inclusion.

as at 19/2/18

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Enclosure 1

Trust Board Minutes – Open Session

Minutes of the Open Trust Board meeting held on Thursday 1 February 2018, in the Conference Room, Heartbeat Education Centre, North Wing, University Hospital Southampton, commencing at 09.00 and concluding at 10.50.

Present: Mr P Hollins, Trust Chair PH Ms F Dalton, Chief Executive FD Mr D French, Chief Financial Officer DAF Dr C Marshall, Chief Operating Officer CM Mrs G Byrne, Director of Nursing & Organisational Development GB Dr D Sandeman, Medical Director DS Mr S Porter, Senior Independent Director/Deputy Chair SP Ms L Lockyer, Non-Executive Director LL Dr M Sadler, Non-Executive Director MS Ms J Douglas-Todd, Non-Executive Director JD-T Prof C Cooper, Non-Executive Director CC Ms J Bailey, Non-Executive Director JB

In Attendance: Ms A Lowe, Associate Director: Corporate Affairs AL Mr B Bird, Lead Governor BB Dr K Nash, Consultant Hepatologist and Interim Guardian of Safe KN Working Hours Ms G Genco, Head of Equality, Diversity & Inclusivity GG Mr N Pearce, Associate Medical Director for Patient Safety NP Mr Ellis Banfield, Head of Patient Experience EB Ms N Cadavieco, Corporate Affairs & Policy Manager (minutes) NC Ms R Davies, Divisional Head of Nursing/Professions, Division A RD (shadowing Mrs G Byrne) Ms L King, Cost Improvement & Transformation Lead Programme LK Manager (shadowing Ms J Hayward) Dr M Jonas, Staff Governor Cllr S Blatchford, Appointed Governor 2 members of staff 1 member of public

1/18 Apologies Apologies were received from Ms J Hayward, Director of Transformation & Improvement. Action By 2/18 Chair’s Welcome, Opening Comments and Declarations of Interest PH welcomed JB and CC to their first Trust Board meeting since their appointments as Non-Executive Directors. There were no declarations of a conflict of interest with any items on the agenda.

3/18 Minutes of Previous Meeting (Agenda item 2. Enclosure 1) The minutes of the meeting held on 30 November 2017 were AGREED as an accurate record.

4/18 Matters Arising/Summary of Agreed Actions (Agenda item 3) 4/18 a) Minute Ref 139/17: Action Complete. 4/18 b) Minute Ref 147/17: Progress against this action would be included as part of the Equality, Diversity and Inclusivity (EDI)/Workforce Race Equality Standards (WRES) Action Plan Quarter Report, scheduled on the agenda.

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4/18 c) Minute Ref 148/17: Action complete. 4/18 d) Minute Ref 156/17: Action complete. 4/18 e) The Board NOTE the progress updates provided.

5/18 Integrated Performance Report for Month 9 (Agenda item 4. Enclosure 2) 5/18 a) FD summarised the report and reflected on performance in month, noting that December saw the highest ever levels of Emergency Department (ED) activity, which contributed to bed pressures. FD noted that these high levels of activity were exacerbated by Queen Alexandra Hospital in Portsmouth declaring a major incident on 31 December, which led to UHS taking 186 additional ambulances and nearly 60 additional admissions. 5/18 b) Safety GB noted an anomaly in the falls data on the patient safety report, however the data was correct in the IPR. GB confirmed that ‘SIRIs overdue by 60 days’ had been reduced to zero. 5/18 c) Clinical Effectiveness There were no comments on this section of the report. 5/18 d) Patient Experience including Quarterly Patient Experience Report GB advised of the low response rate for the ED Friends & Family Test (FFT), adding that the rate had been a focus for improvement during the summer with support from volunteers. In order to meet the internal target and improve the data presented,1000 responses per month would be required.GB proposed that this data instead be reported either quarterly or twice yearly. MS highlighted the discussion at Quality Committee in relation to this noting that the population able to provide responses was limited, making a quarterly review preferable. MS suggested that a series of ‘deep dive’ reviews into specific experiences would be helpful. JB agreed that picking targets and ensuring the right questions were asked would provide more valuable information. EB highlighted the new report format, noting a greater focus on key themes and qualitative information some of which correlates to FFT responses; in particular, ward environments and communication. EB advised that there had been an increase in concerns and complaints between Q2 and Q3. EB advised that there has been an embargoed release of the National Inpatient Survey Data which indicated that the Trust was above average in six areas, but below average in areas such as noise at night and care provided by non-clinical staff. JD-T said that the work being done seemed excellent and queried whether there had been a deep dive into patient concerns. EB noted that the team were planning to roll-out a revised inpatient survey in order to better pinpoint some of the issues raised; CC queried the increase in complaints over the past five years. GB confirmed that the total number of complaints had actually decreased, but the number of concerns had increased. CC sought clarification in relation to how the Trust prevents concerns from becoming complaints. EB provided an overview of the process noting that the concern route would only be offered where it is believed that the issue can be resolved within the stipulated 48 hour timeframe. PH highlighted that encouraging patients to raise concerns makes it difficult to draw conclusions from trend data. JB queried whether the high survey response rate for Division D was related to the high staff vacancy levels within that division. EB confirmed that the nature of the services provided within Division D makes obtaining patient feedback easier thereby contributing to the continually high response rates from this division.

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5/18 d) PH queried whether the triangulation of themes from all patient feedback channels cont’d had prompted any new thoughts on the process. EB re-iterated the key themes

noting there was a need to review the issues raised in order to better understand where improvements can be made. 5/18 e) Patient Experience – Care Home Concerns EB summarised the feedback provided by care homes which focussed largely on concerns around discharge, communication and medication coordination. The level of concerns raised was increasing. This is being addressed by improving relationships with care homes through engagement and improved communication. A Care Home Survey has been finalised and a direct point of contact with the Trust had been provided to care home staff. 5/18 f) Responsive The Chief Executive summarised the Trust’s performance noting: • The trust had set a system wide delayed discharge target of 50 by Christmas, and despite the increased activity over this period, a reduction to 70 was achieved. • Emergency Access Performance: It was re-iterated that ED continues to face challenges; however the urgent care streaming service has seen positive outcomes, with good team-working noted between the GPs and ED consultants. • Cancer: The targets for ‘Urgent GP referrals seen in 2 weeks, ’31 Day Decision to Treat’ and the ’62 Day-Consultant Upgrades’ were on target for achievement this quarter. The issues in achieving the remaining targets were summarised. • Referral to Treatment (RTT): The Trust did not meet the 92% target in December. A trajectory had been set for achievement of the target by August 2018, focusing on clearing the number of patients in the backlog which was currently ahead of plan. • The Sustainability and Transformation Fund (STF) target for Q3 had been achieved and funding confirmed. MS added that there was a discussion at Quality Committee around the numerous sources of data, the lack of clarity about what is included in the figures reported to enable comparison and the ability to connect this data to patient experience. FD noted that it has become difficult to compare data across systems because of local variations, however, UHS follows the mandate on what should be reported. SP sought clarification in relation to the RTT backlog and how close the Trust was to achieving it. CM advised that it varied by specialty, however there was a specific focus on better managing the patient backlog. FD added that it was important that the Trust continues to work towards achieving the 92% RTT target; in order to do so the backlog would need to be reduced to 2400. JD-T queried if the patient experience work undertaken in relation to care homes linked to the patient volume issues in Hampshire. FD stated that it was unlikely to have addressed the issues around volume and capacity. 5/18 g) Well Led JD-T queried the decrease in the level of appraisals completed. FD advised that work continued on revising the appraisal process to focus more on quality conversations and values rather than paperwork. PH noted the lack of achievement of Research and Development targets and queried if this was a true representation of the current position. DS advised the target was unlikely to be met in year however a review of the current KPIs was to be undertaken to ensure more accurate reporting. 5/18 h) Productive DAF advised that there was an action tracker in place to address the decline in ‘maintenance completed within planned time’.

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5/18 i) RESOLVED That the Board NOTE the Month 9 Integrated Performance Report.

Quality & Safety 6/18 Guardian of Safe Working Hours Quarterly Report (Agenda item 5.1. Enclosure 3) 6/18 a) KN summarised the report, noting that locum spend remains high, but the actual vacancy rate was quite low. There was low engagement with the exception system in some areas and additional work was required to improve this, noting this could have a financial impact on the Trust. LL highlighted the safety aspect of the report, and queried whether an exception report would be more appropriate. DS confirmed that it is a nationally mandated requirement to report this data. MS queried the immediate safety concerns and whether any safety issues had been identified. KN provided assurance that in these incidences capacity was increased resulting in no safety issues being reported, only concerns. CC queried the distribution of the £700k locum spend. KN confirmed that the data was not broken down by area therefore this could not be provided, however would be useful to understand. The Board requested this data was included in the next report. ACTION: KN/DS to ensure the next Guardian of Safe Working Hours Quarterly KN/DS Report includes additional detail in relation to locum spend and whether this was gross or net of staff costs which would otherwise have been incurred. 6/18 b) RESOLVED That the Board NOTE the Guardian of Safe Working Hours Quarterly Report.

7/18 Equality, Diversity and Inclusivity (EDI)/Workforce Race Equality Standards (WRES) Action Plan Quarter Report (Agenda item 5.2. Enclosure 4) 7/18 a) GG summarised the report and noted the following points:- • There were a number of engagement events planned in the coming weeks to consult on the future EDI strategy. Members of the Board were invited to attend if they were able • The action plan was on track with renewed impetus in terms of delivery • The workforce profile on the Gender Pay Gap would be presented to the March Trust Board meeting • A working group has been established in order to plan for the National Inclusion Week in October 2018 • Preparation for the publication of workforce disability quality standards was due to begin in April 2018 with formal reporting starting in August 2019 MS queried whether the report was given enough time for discussion on the meeting agenda given the importance of the topic and queried how aware staff were on the EDI agenda and whether there should be a compelling narrative to further engage staff. GG advised that there were areas of good practice and high levels of engagement with staff and the strategy consultation and activities were being utilised to focus on increasing this engagement. GB acknowledged that when the strategy is agreed and launched this should include a compelling narrative. FD noted that initial focus has been on process and infrastructure and acknowledged there is more to be done. GB noted that the Board has received equality and diversity awareness training by Eden Charles in a Trust Board study session as part of the inclusivity talent management programme and the next steps planned are for an similar awareness session to be delivered to senior managers, how we will engage with the 48 staff who will have completed the Inclusivity talent management programme and plans for a future programme in 2018/19.

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7/18 a) JD-T highlighted that the WRES action plan did not capture all of the activity cont’d ongoing in this area and the progress being made. JD-T queried what the Board could do further to progress the EDI agenda and whether there was National Guidance in this respect. GB/GG agreed to look into this. Action: GB/GG to establish whether there is National Guidance in relation to GG/GB Trust Boards supporting the EDI agenda and share this information as

necessary. JB noted that the report did not specify how the Trust was performing Nationally. GB noted that WRES serves as a national benchmark and added that the Trust’s position on diversity reflects the national average NHS position and that the Trust was not named as an outlier in the Nationally published WRES report. The next report would include a workforce profile, which will include a comparison. GB added that there needed to be more work to increase inclusivity for both staff and patients. MS and JD-T requested that the report format be updated to include a summary of activity and key points and to better reflect the organisational commitment to this initiative. Action: Report format to be updated to include an activity summary and to GG/GB reflect the organisational commitment to diversity and inclusion. JD-T also noted a typo on ‘Objective 3’- 2017 to be changed to 2018. 7/18 b) RESOLVED That the Board NOTE the Equality, Diversity and Inclusivity (EDI)/Workforce Race Equality Standards (WRES) Action Plan Quarter Report.

8/18 Learning from Deaths Quarterly Report (Agenda item 5.3. Enclosure 5) 8/18 a) NP summarised the report, noting that the 2018/19 review would be focused on quality of care with new measures to be introduced. CC highlighted the low incidence of avoidability and queried whether it would be better to look at case studies in order to focus on the quality aspects. NP advised that this was discussed as part of mortality reviews and that higher avoidability scores resulted in more scrutiny. MS queried the numbers on the ‘IMEG and mortality review process (Q1 & Q2- 2017)’.. NP noted that this was due to the reporting timescale and recommended that the report be shifted back one month to allow for inclusion of all relevant data. NP added that immediate actions resulting from reviews would still be dealt with as and when required. SP queried whether data of deaths occurring in the community could be incorporated into the report. NP advised that this data would be difficult to collect, however Solent NHS Trust inform the Trust of deaths in the community where they believe it is appropriate, and the Mortality Review Group were building links with Primary Care to assist with this. 8/18 b) RESOLVED That the Board NOTE the Learning from Deaths Quarterly Report.

Finance 9/18 Finance Report for Month 9 (Agenda item 6.1. Enclosure 6) 9/18 a) DAF presented the report, noting for Month 9: - The surplus was £3.4m, £1.5m above plan. After 9 months, the Trust has delivered a control total surplus of £16.3m, £0.5m above plan. The Trust needs to deliver a further £10.8m surplus in the remainder of the year to achieve the year-end target control total surplus of £27.1m.

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9/18 a) - CIP delivery in month was £2.2m against a target of £3.5m. To month 9, the cont. Trust is £1.6m short of the planned CIP delivery of £21.4m. - Operating costs were £1.8m adverse in month (compared to £5.6m in November). YTD operating costs are £22.6m adverse to plan due to non- achievement of QIPP (£16.9m) and the associated cost of pay and clinical supplies. - The cash position is £9.5m below plan. This was primarily driven by delays in receipt of 2017/18 over-performance payments. DAF noted that the Trust was forecast to achieve the year-end target control total for 2017/18. The conclusion of the Complete Fertility transaction would contribute to this total as it is expected to complete in year. SP commented that the current financial performance was a significant achievement. 9/18 b) RESOLVED That the Board NOTE the Month 9 Finance Report.

Governance 10/18 Chief Executive’s Report (Agenda item 7.1. Enclosure 7) 10/18 a) FD summarised the Isle of Wight (IOW) review of services, noting that the Trust would be working with the IOW and Portsmouth to review the details and determine how they can best be supported. 10/18 b) RESOLVED That the Board NOTE the Chief Executive’s Report. 10/18 c) Items for Ratification Actions taken by the Chair as set out in paragraphs 6.1 – 6.2 were ratified.

11/18 Feedback from Council of Governors’ Meeting 16 January 2018 (Agenda item 7.2) 11/18 a) PH provided a summary of the last Council of Governors (COG) meeting, noting that the Council reviewed the Chief Executive’s Report, discussed Non-Executive Director (NED) recruitment and approved the quality account indicators for 2018/19. BB stated that the new governors were impressed by the Q&A session with the NEDs and found it very helpful. 11/18 b) RESOLVED That the Board NOTE the feedback from the January Council of Governors Meeting.

12/18 Briefing from Chair of Audit & Risk Committee (Agenda item 7.3) 12/18 a) SP summarised the recent activity of the Audit & Risk Committee, noting that the internal audit plan and the preparation of accounts, including quality accounts, were on schedule. The group received an update on General Data Protection Regulation (GDPR) and a deep dive of Board Assurance Framework (BAF) Priority 10 was presented to the group. 12/18 b) RESOLVED That the Board NOTE the briefing from the Chair of the Audit & Risk Committee.

13/18 Briefing from Chair of Quality Committee (Agenda item 7.4) 13/18 a) MS summarised the most recent Quality Committee meeting, noting the following areas covered: - Recruitment and retention. - Thematic review of inpatient falls. - Never Event Update. - Clinical Effectiveness Review, with feedback from Burlesdon House, Paediatric Intensive Care Unit (PICU), Paediatric Cardiac Surgery and Pharmacy. - Getting It Right First Time (GIRFT) report on general surgery.

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13/18 b) RESOLVED That the Board NOTE the briefing from the Chair of Quality Committee.

14/18 Briefing from Chair of Strategy & Finance Committee (Agenda item 7.5) 14/18 a) SP advised that the committee considered the business cases to be reviewed during the closed Trust Board session. DAF confirmed that there had not yet been any guidance on financial reporting planning for the next financial year, but it was expected by 2 February 2018. SP added that the committee were following up on a recommendation from the Audit & Risk Committee to review the Patient Level Information and Costing Systems (PLICS). 14/18 b) RESOLVED That the Board NOTE the briefing from the Chair of Strategy & Finance Committee.

15/18 Annual Report 2017/18 including Quality Account Process (Agenda item 7.6) 15/18 a) There were no comments on this report. 15/18 b) RESOLVED That the Board NOTE the Annual Report 2017/18 update.

16/18 Any Other Business 16/18 a) PH noted that this was LL’s last Trust Board meeting and thanked her for her hard work.

17/18 Date and Time of Next Meeting Thursday, 1 March 2018, commencing at 9.00am in the Parent Education Seminar Room, F Level, Princess Anne Hospital.

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Enclosure 2

February 2018

Integrated KPI Board Report Page 1

Integrated KPI Board Report for January 2018 (unless otherwise stated)

Executive Sponsors

Jane Hayward Director of Transformation [email protected]

Date of Board Meeting 1 March 2018

February 18 UHS Integrated KPI Trust Board Report – Executive Digest Page 2

Are we safe? (Page 5)

Overall performance on the safety KPIs remains very good. This month there were four cases of Clostridium difficile in January bringing the year to date number of cases to 31 which is a similar position to this time last year (30). Medication errors were over the target for the third month in a row with the year on year comparative gap widening (2533 v 2493 YTD, whilst this seems unusual the view is that a greater number of reported errors promote a safety culture). There were no SIRIs in January 2018 and the plan to have zero SIRIs waiting for investigation at the end of December was achieved. VTE assessments increased this month to 93.5%; an IT solution to support is still with external provider for development. The number of avoidable pressure ulcers (all types) fell again for the third month in a row and year on year comparison for Grade 2 ulcers remains very good (71v 208 YTD).

Are we effective? (Page 8)

In the rolling 12 months to October the Hospital Standardised Mortality Ratio is 96.1. This is now the 8th month that the Trust has been below 100. This change is partly caused by improvements in the accuracy of clinical coding, particularly the capture of patient co-morbidities. Whilst HSMR performance remains positive, it has been increasing slowly but consistently since May-17, so we must continue to monitor this very carefully. On further analysis there has been a change in the process for obesity scoring. This will be corrected from February onwards and a review is being undertaken of prior episodes. In January four national audit reports were reviewed, none have been identified raising any areas of concern.

Are we caring? (Page 9)

The number of patients completing a Friends and Family Test return in the emergency department has dropped again in January and an alternative approach to obtaining patient feedback is being considered with a review scheduled in February. Inpatient response rate rose to 14.61% in January. F&F test results remain good and in January Maternity received a negative score of 0.00%. Total complaints in January were 55. In January there were 38 Same Sex Accommodation breaches. NHSE has formally agreed to suspend fines for this type of breach until the end of January.

Are we responsive? (Pages 10 - 14)

Please note some elements of data from October 17 now include patients being treated at Lymington Hospital, this impacts activity and some performance targets.

In January the emergency access 4 hour performance increased to 87.1% for UHS ED’s (Types 1, 2 & 3 inc Lymington). This performance, while an improvement, was impacted by an extremely challenging month for the whole Hampshire Isle of Wight area. The Trust began January on black alert, alongside our own bed pressures we continued to take ambulance diverts from Portsmouth Hospital, to maintain patient safety across Hampshire. Our Trust has received formal letters of thanks from local commissioners and Portsmouth Hospital NHS Trust for the part we have played during this difficult period. There was also an increase in patients admitted to the trust with Influenza, with a 340% increase year on year, which was well managed by the hospital but also was a contributing factor to bed pressures and the 4 hour performance

Demand for the main ED (excluding other units) is up 3.7% year to date. A full formal recovery action plan is in place to achieve 95% during the month of March 2018.

The Trust did not meet the 92% target for Referral-to-Treatment in January and performance reduced to 86.82%. The backlog also rose 290 in the month. It is planned that the Trust will achieve 92% by August 2018

February 18 UHS Integrated KPI Trust Board Report – Executive Digest Page 3

and based on the January results the Trust is currently on track. A formal recovery action plan has been requested by the CCGs, however this request has been delayed given the national instruction to stop non- urgent elective work in January. Actions to recover include recruitment to medical staff in a number of key specialty areas. This has to be finely balanced against a request not to increase the contract overperfomance.

In January we did not meet the target for 62 day Screening Service to First Treatment, this standard is one with small monthly figures (28 cases in December). Looking at quarterly performance shows we met the standard in Q3. Three standards were reported below target in Q3 – Breast Symptoms, 31 Day Standard and 31 Day subsequent treatment (Surgery). A locum consultant with specialist interest in Breast is now in post to supplement the team and an improvement has been seen in January and February. A business case has been approved to support substantive recruitment of this post. Failure of the 31 Day Standard and 31 Day Subsequent Treatment reflects pressures on capacity within theatres and the surgical teams that provide treatment for cancer. The trust is taking a variety of actions to address these challenges.

The Trust did not meet the diagnostics target again in December for the 4th month. There are a very small number of breaches and the plan is to recover this as quickly as possible. Contributing factors for this performance include high demand for capsule endoscopy and breakdowns of cardiac MRI machine and endoscopy decontamination machines. The trust is seeking to address the reliability issues with both sets of equipment.

Delayed Transfer of Care reduced at Christmas which helped the Trust support local and regional patients through this period. In January this increased significantly particularly in the Hampshire system. A number of meetings have been held but there is no clear plan to meet the 3.5% target by March 2018. This system is currently preparing for a CQC review; this will take place in Feb and March 2018.

The Hospital remains incredibly busy, new referrals are up 5.2% year to date and new Cancer referrals have raised by 7.7%. The rolling 12 month LOS for emergency and elective patients is down fractionally at an average of 5.78 days and 4.49 days respectively.

Are we well-led? (Pages 15 - 22)

Turnover over a rolling 12 month period has dropped slightly to 13.16%. In January the registered nursing posts that are vacant did not increase for the first time since September, the figure has stabilised at 18.0%. There continues to be overseas recruitment to boost the numbers.

Rolling 12 month appraisals increased to 85.75% in January. A new appraisal process was agreed at TEC including a redeveloped appraisal training package.

Are we productive? (Page 23)

Estates have had a slight increase in performance on percentage of maintenance completed within planned time, which is associated with a small decrease in logged jobs. Other Estate indicators reported sustained achievement or slight improvement.

Full details of financial performance are shown in the Finance Report. February 18 Trust Overview Page 4

Page Ref. KPI Target Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 Jan 18

5 1.1.4 Clostridium Difficile Reduction (confirmed lapse in care) <=4 6 3 5 2 3 5 8 2 3 1 1 2 4 5 1.1.2 MRSA Bacteraemia Infection 0 0 0 0 1 0 0 0 0 0 0 0 0 0 5 1.1.1 Never Events 0 1 0 1 0 0 0 0 0 0 1 0 0 0 5 1.1.7 SIRIs (month in arrears) N/A 6 6 5 4 3 7 1 3 0 2 1 0 N/A 1. Safe 1. 5 1.1.13 Safety Express Thermometer =>95.0% 98% 95% 98% 96% 98% 98% 97% 98% 97% 97% 98% 98% 96% 6-7 Focus: Infection Prevention Summary Q3 2017/18 Notes: None

8 2.5.1 Rolling 12-Month HSMR - UHS (reported 3 months in arrears) <100 104.53 103.75 94.00 93.46 92.44 93.16 94.16 95.07 95.57 96.1 N/A N/A N/A 8 2.5.2 Rolling 12-Month HSMR - SGH (reported 3 months in arrears) <100 97.40 97.09 87.00 86.97 86.18 87.00 87.93 88.91 89.91 90.3 N/A N/A N/A 2. N/A 2.1.4 Readmissions (month in arrears) =<10% 9.6% 10.7% 11.0% 11.1% 11.2% 11.8% 10.5% 10.8% 10.7% 10.3% 10.5% 10.9% N/A

Effective N/A Focus: None this month Notes: None 9 3.1.2 FFT Negative Score - Inpatients <=5% 0.73% 0.84% 1.16% 1.34% 0.32% 0.54% 0.66% 1.04% 0.59% 1.39% 0.72% 1.33% 1.15% 9 3.1.4 FFT Negative Score - ED <=5% 0.56% 3.00% 1.79% 1.83% 1.53% 2.17% 1.35% 1.06% 1.76% 0.98% 2.12% 5.00% 0.00% 9 3.1.6 FFT Negative Score - Maternity <=5% 1.20% 1.48% 0.60% 1.26% 1.33% 0.65% 1.37% 0.83% 1.15% 0.66% 1.37% 1.43% 0.00% 9 3.1.10 Complaints Received (month in arrears); current month is provisional N/A 29 35 23 30 54 41 42 49 33 51 42 35 55

3. Caring 3. 9 3.1.9 Nutrition >=95% 73.95% 76.98% 79.94% 78.80% 85.58% 86.73% 78.57% 84.68% 85.11% 78.66% 79.52% 83.47% 80.27% N/A Focus: None this month Notes: None 10 N/A Rolling 12-Month Total Inpatients (Elective, Non-Elective & Day Case combined) N/A 152,928 153,820 155,737 156,009 157,327 157,794 158,076 158,720 158,780 158,892 158,357 157,588 157,036 10 N/A Rolling 12-Month Total Outpatients (New & Follow-up combined) N/A 587,197 587,153 595,272 592,451 599,897 602,534 607,465 608,661 611,200 616,548 619,676 621,063 625,736 10 N/A Rolling 12-Month Total ED Attendances (All types combined) N/A 118,563 117,810 117,869 118,117 118,486 118,659 118,752 121,039 123,040 125,074 127,186 129,236 131,388 11 4.1.3 A&E: % patients spending less than 4 hours in ED (Type 1) =>95.0% 82.1% 79.2% 88.3% 87.9% 85.5% 84.7% 90.1% 85.8% 91.5% 89.2% 87.1% 77.6% 82.3% 11 4.1.8 A&E: % patients spending less than 4 hours in ED (Types 1, 2 & 3) =>95.0% 84.4% 82.1% 89.7% 89.5% 87.4% 86.7% 91.4% 89.5% 93.3% 91.9% 90.5% 83.2% 87.1% 12 4.2.1 RTT: % Incomplete Pathways Within 18 Weeks in Month =>92.00% 91.37% 92.00% 92.39% 92.06% 92.10% 92.01% 91.00% 90.39% 89.23% 88.11% 88.34% 87.86% 86.82% 12 4.2.5 RTT: Total Patients in Backlog <1200 2,326 2,171 2,050 2,163 2,199 2,240 2,496 2,933 3,371 3,739 3610 3771 4061 13 4.3.1 Cancer: Urgent GP referrals seen in 2 weeks (month in arrears) =>93.0% 94.1% 94.0% 95.5% 92.2% 96.3% 95.5% 95.0% 90.4% 94.0% 95.5% 91.7% 91.8% N/A 13 4.3.3 Cancer: Treatment started within 62 days of urgent GP referral (month in arrears) =>85.0% 76.1% 78.4% 82.1% 86.7% 88.9% 88.0% 85.6% 81.5% 86.4% 86.0% 85.8% 89.5% N/A

4. Responsive 14 4.5.2 Complex Discharge Census (monthly average) <=38 123.9 116.5 115.8 119.8 114.97 96.73 91.3 97.7 103.7 115.3 100.93 88.87 102.42 14 4.5.6 Red Alerts (monthly total) N/A 54 56 24 13 26 21 1 30 14 27 26 44 46 14 4.5.7 Black Alerts (monthly total) N/A 3 0 0 0 2 0 0 0 0 4 0 2 8 14 4.5.9 % Elective Operations Cancelled at the Last Minute <=1.0% 1.61% 1.56% 1.14% 0.80% 1.01% 1.29% 1.23% 1.05% 1.01% 1.03% 1.97% 1.87% 1.70% N/A Focus: None this month Notes: Lymington Hospital Minor Injuries Unit included in total ED attendance figures and line 4.1.8 from August 2017.

15 5.1.6 Staff FFT - % of Staff Likely or Extremely Likely to Recommend UHS as a Place to Work =>76% 77% 77% 76% N/A - Trust completes N/A

15 5.1.1 Turnover - Rolling 12-months <=12.00% 12.78% 12.65% 12.87% 13.16% 13.00% 13.00% 13.04% 13.00% 12.92% 12.88% 12.83% 13.33% 13.16% 15 5.1.2 Sickness Absence - Rolling 12-months <=3.00% 3.55% 3.54% 3.52% 3.53% 3.53% 3.52% 3.58% 3.60% 3.56% 3.57% 3.55% 3.54% 3.56% 15 5.1.4 Nursing Vacancies <=8.00% 13.0% 12.9% 12.8% 13.7% 13.6% 14.4% 14.6% 15.5% 13.4% 13.0% 12.5% 12.8% 13.0% 5. Well-Led 16-20 Focus: Ward Staffing Report - January 2018 Notes: 5.1.1 Target changed from April 2017; previously <=10.00%.

The Finance data sheet and indicators were withdrawn from the Integrated KPI Board Report in October 2017.

6. N/A Focus: Notes: Full details of financial performance can be found in the separate Finance Report. Productive February 18 1. Safe Patient Safety Page 5

This Year Last Year Theme Ref. Indicator Target Source Nov Dec Jan QTD YTD Month YTD Detail

1.1.1 Never Events 0 National 0 0 0 0 1 1 3 1.1.2 MRSA bacteraemia infection National 0 0 0 0 1 0 0 1.1.3 MRSA bacteraemia contaminant 0 National 0 0 0 0 0 0 0 Clostridium difficile reduction (Confirmed lapse in 1.1.4 <=4 National 1 2 4 4 31 6 30 care) 16/17 1.1.5 Medication Errors Internal 258 210 271 271 2533 254 2493 +10% 1.1.6 Medication Errors (Severe/Moderate) 3 Internal 8 2 3 3 24 2 22 1.1.13 Safety Express Thermometer =>95.0% Internal 97.71% 98.00% 96.12% 96.12% 97.26% 97.55% 97.52% This Year Last Year Oct Nov Dec QTD YTD Month YTD

1.1 Patient 1.1.7 Serious Incidents Requiring Investigation (SIRI) N/A Internal 4 2 0 6 27 7 43 Safety 1.1.14 SIRIs reported within 48 hours to CCG 100% Internal 100.00% 77.78% 100.00% 92.00% 93.94% 87.50% 84.21% 1.1.15 Number of overdue SIRIs 0 Internal 6 5 0 N/A N/A 7 N/A Grade 2 Pressure Ulcers (of which avoidable). 1.1.8 <=10 Internal 19 (12) 5 (1) 4 (2) 29 71 16 208 Reported a month in arrears. Avoidable Hospital Acquired Grade 3 and 4 1.1.9 <=2 Internal 5 2 1 8 14 2 18 Pressure Ulcers 1.1.10 Avoidable High Harm Falls <=1 Internal 2 0 0 2 5 0 4 1.1.11 % Thromboprophylaxis Patients Assessed >=95 National 94.00% 93.30% 93.49% 93.60% 93.91% 94.01% 94.93% 2017/18 2016/17 Q1 Q2 Q3 Q4 N/A Q1 Q2 Diabetes: Insulin-related medication errors (high 1.1.12 <8 a year 0 0 - - harm)

1.1.4 Clostridium difficile reduction - 4 cases against target of 4. (31 cases year to date against a target of 43) 2/4 no lapse in care identified. 1/4 Lapse in care affecting patient safety - Delay in isolation, 1/4 minor process failures identified MUST Score and monitoring fluid balance. 1.1.6 Medication Errors. Three incidents in Jan. One is relates to missed doses of anticonvulsants which resulted in avoidable harm, one related to poor IV fluid management resulting in dehydration and AKI, the third relates to inappropriate prescribing and monitoring of oxygen. All incidents are being followed up by the medication safety team to ensure learning. 1.1.8 - There were 4 grade 2 hospital acquired pressure ulcers in December, of these at scoping 2 were found to be avoidable, 1 on the heel and 1 on the top of the ear. 1 was deemed unavoidable, and 1 is awaiting scoping as was found on removal of a POP within paediatrics and the senior team are reviewing the notes to establish learning. 1.1.9 There was 1 grade 4 Avoidable pressure ulcer in December to the heel. There were 3 pressure ulcers deemed unavoidable for December 2 grade 3 sacrum's and 1 grade 4, to the bridge of the nose (device related). There is 1 outstanding case awaiting presentation at panel as undetermined at scoping review. 1.1.11 IT solutions to prevent prescribing of medication before a VTE risk assessment has been completed and have been put on the EMIS development list. Timescales to be confirmed, Feb 2018 at the earliest but May/June more likely.

February 18 UHS Quarterly Infection 1. Safe Prevention Report Page 6

UNIVERSITY HOSPITAL OF SOUTHAMPTON NHS FOUNDATION TRUST Infection Prevention Report Quarter 3 - 2017/18

Title Infection Prevention Q3 2017/18 Report Report to TEC 14 February 2018 Report from Graeme Jones, Director of Infection Prevention Unit Julie Brooks Head of Infection Prevention Kieran Hand, Consultant Pharmacist in Anti-infectives Sponsoring Gail Byrne, Director of Nursing and Organisational Development Executive Aim of Report The full paper (from which this summary extract is drawn) presented TEC with 2017/18 Q3 Report on infection prevention within UHS.

Review History to TEC and Trust Board have received regular updates on infection prevention. Date TEC Trust Board • 17 May 2017 • 1 June 2017 • 16 August 2017 • 12 September 2017 • 15 November 2017 • 12 December 2017 • 14 February 2018 • 1 March 2018

TEC and Trust Board also receive the corporate performance report monthly, which provides a numerical update on performance and progress against the national MRSA bacteraemia reduction trajectory, the Clostridium difficile infection reduction target, and the more detailed monthly Clinical Quality Report.

Assurance SO1, SO1c Framework Strategic Objectives 1 & 3: To be trusted on quality and excellence in healthcare. Strategic Specifically to ensure rates of healthcare-associated infection are below nationally Objectives set trajectory, and that the Trust retains a reputation for delivering clean, safe care Ref: thereby raising public confidence. Recommendations Members of TEC were asked to: - 1. Review the full report and the identified actions detailed in each section and ensure these are addressed via the Divisional Quality Governance processes, with relevant teams and staff groups. 2. Support measures proposed to improve basic infection prevention practice, reduce MRSA and C difficile infection and improve antimicrobial stewardship. 3. Recognise the achievement of UHS staff in controlling transmission of infection to month 10 in difficult circumstances.

Key Items for • 97 bed days lost to norovirus in Q1-3 2017/18 vs 232 days in 2016/17 Noting: • 281% increase in laboratory-confirmed influenza admissions vs 2016/17 with 79% due to influenza B • No significant increase in in-hospital transmission of influenza detected as a result of switching to high-prevalence control policies compared to last year. • Total antibiotic usage 1.7% above CQUIN target ytd. May improve when accurate Q3 denominator admission data is finalised.

February 18 UHS Quarterly Infection 1. Safe Prevention Report Page 7

1 Summary of progress

Category Q3 RAG YTD Action /Comment RAG Targets: MRSA bacteraemia No attributable MRSA BSI in Q3. One G R reduction attributable MRSA BSI in Q1.

MRSA screening 21 patients acquired MRSA colonisation in G G and acquisition UHS in Q3

28 attributable cases in Q1, 2 & 3 2017-18. Clostridium difficile G G 25 cases with a lapse in care against an infection reduction annual target of 43.

Provide Overall compliance with CQC outcome 8. The assurance CQC assurance Trust continues to implement actions to G G of basic framework improve performance relating to cleanliness infection and isolation. prevention practice: Hand hygiene and Overall compliance with hand hygiene and Saving Lives high saving lives high impact intervention remains G G impact interventions high.

Total antibiotic usage 1.7% above target for Prudent antibiotic A A Q3. This uses Dec 2016 denominator data prescribing and will likely improve with final figures

February 18 2. Effective Clinical Effectiveness Page 8

2017/18 2016/17 Theme Ref. Indicator Target Source Q1 Q2 Q3 Q4 YTD Target Total Detail

2.1 National Participation in eligible National Audits (Quality Audit 2.1.1 47 National 46 0 0 N/A 46 60 59 Accounts) Participation

2.2 NCEPOD 2.2.1 Participation in eligible NCEPOD* studies 3 National 3 0 0 N/A 3 6 6

2017/18 2016/17 Sep Oct Nov Dec Jan YTD N/A Number of recently published National Audit 2.3.1 N/A National 4 4 10 4 4 N/A N/A 2.3 National reports Audit Reports 2.3.2 National Audit reports with areas of concern N/A National 0 1 2 0 0 N/A N/A

2017/18 2016/17 Q1 Q2 Q3 Q4 YTD Target Total

2.4 Outcomes 2.4.1 Development of Outcomes by Specialty 83 Internal 36 3 1 N/A 40 97 36 Workstream

Rolling 12-Months Last Year to Jun 17 to Jul 17 to Aug 17 to Sep 17 to Oct 17 YTD N/A 2.5.1 HSMR - UHS <=100 Internal 93.16 94.16 95.07 95.57 96.1 N/A N/A 2.5 HSMR 2.5.2 HSMR - SGH <=100 Internal 87.00 87.93 88.91 89.91 90.3 N/A N/A 2.5.3 HSMR - Crude Mortality <=100 Internal 3.90% 3.95% 3.97% 3.97% 4.00% N/A N/A

2.1 UHS have participated in 46/47 National Audits to date. Did not participate in UK Parkinson's Audit data entry due to case ascertainment. Data entry may be done at a later date but will not form part of the National Report. There are still 6 audits TBC. 2.2 *National Confidential Enquiry into Patient Outcome and Death, currently participating in Cancer in Children, Teens and Young Adults Study, Heart Failure Study and Perioperative Diabetes. 2.3.1 Four national audit reports were reviewed in January 18. National Oesophageo-gastric cancer audit 2017 report (data range 1 April 2014 to 31 March 2016), National COPD Audit programme secondary care 2017 based on 2016 data, BTS Paediatric Pneumonia Audit report. 1 November 2016 to 31 January 17 and National audit of small bowel obstruction (NASBO) audit report 2017 2.3.2 No audit reports have been identified as raising areas of concern. 2.5.2 & 2.5.3 Dr Foster new tool only reports HSMR to one dp, old tools now discontinued February 18 3. Caring Patient Experience Page 9

This Year Last Year Theme Ref. Indicator Target Source Nov Dec Jan QTD YTD Month YTD Detail 3.1.1 FFT response rate - Inpatients >=20% National 16.96% 14.08% 14.61% 14.61% 17.99% 16.81% 19.60% 3.1.2 FFT Negative Score - Inpatients National 0.72% 1.33% 1.15% 1.15% 0.88% 0.73% 1.00% 3.1.3 FFT response rate - ED >=10% National 2.88% 1.24% 0.21% 0.21% 5.90% 4.86% 6.76% 3.1.4 FFT Negative Score - ED National 2.12% 5.00% 0.00% 0.00% 1.41% 0.56% 2.22% 3.1.5 Maternity FFT response rate >=20% National 35.78% 31.25% 29.69% 29.69% 31.78% 35.47% 28.34% 3.1.6 Maternity FFT Negative Score <=5% National 1.37% 1.43% 0.00% 0.00% 1.01% 1.20% 0.81% 3.1 Patient Same Sex Accommodation (Non Clinically 3.1.8 20 National 49 33 38 38 137 3 3 Experience Justified Breaches) 3.1.9 Nutrition: % Patients with a care plan in place >=95% National 79.52% 83.47% 80.27% 80.27% 82.00% 73.95% 81.32%

This Year Last Year Oct Nov Dec QTD YTD Month YTD 3.1.10 Total Complaints Received (month in arrears) N/A Internal 51 42 35 128 377 45 352 Complaints per 1000 bed days 3.1.11 <1.2 Internal 1.31 1.05 0.87 1.07 1.08 1.14329 0.99316 (month in arrears)

3.1.1: Winter pressures continue to impact response rates, especially in ED. Work is underway on refreshing patient surveys, including the adult inpatient and paediatric surveys to ask more relevant and informative questions. Review of how we collect ED service user feedback scheduled for end of Feb. This will include better promotion of the survey in the ED department, but also a commitment to an interval approach to response rates. Recommend rates continue to be high, with low negative scores across the areas. 3.1.8 We have seen as predicted a higher number of breaches over the difficult winter period. NHSE have formally agreed to suspend fines for MSA breaches until the end of January. These 38 patients relate to 8 breaches in both HASU, ASU, MAOS and AMU in January. 3.1.9: New documentation is with the printers, it has been finalised and agreed. Plans for roll out are being made. February 18 4. Responsive Activity Page 10

Compared to last year Ref. To Target Month QTD YTD R-12 Month QTD YTD R-12 We received…

4.6.1 New referrals** Dec N/A 14,647 50,941 156,633 209,608 -2.6% 3.0% 5.2% 6.5% 4.6.2 Urgent cancer referrals Dec N/A 1,376 4,470 13,200 17,376 0.6% 7.9% 7.7% 9.0%

We treated….

4.6.3 Main ED attendances Jan N/A 8,273 8,273 86,550 102,521 0.5% 0.5% 3.7% 2.5% 4.6.4 Other ED attendances incl Eye Unit & MIU* Jan N/A 3,460 3,460 25,928 28,867 N/A N/A N/A N/A 4.6.5 Non-elective Spells Jan N/A 6,255 6,255 60,928 73,190 2.4% 2.4% 3.1% 3.7% 4.6.6. Elective Inpatient Spells** Jan N/A 1,474 1,474 16,233 19,664 -5.1% -5.1% -1.9% -2.2% 4.6.7 Elective Day Case Spells** Jan N/A 4,780 4,780 52,619 64,182 -14.4% -14.4% -0.5% 3.0% 4.6.8 Combined Elective Spells** Jan N/A 6,254 6,254 68,852 83,846 -12.4% -12.4% -0.9% 1.8% 4.6.9 New outpatient appointments** Jan N/A 19,226 19,226 183,776 220,558 4.7% 4.7% 6.4% 6.6% 4.6.10 Follow-up outpatient appointments** Jan N/A 36,291 36,291 336,603 405,178 5.3% 5.3% 5.5% 6.1%

Our efficiency… Month QTD YTD R-12

4.6.11 Elective Length of Stay Jan N/A 4.49 0.14 4.6.12 Non-Elective Length of Stay Jan N/A 5.78 0.01 4.6.13 Adult Medical Length of Stay Jan N/A 5.52 0.03 4.6.14 Outpatient DNAs** Jan N/A 4,678 4,678 46,414 55,594 -31 -31 2,289 3,384 4.6.15 Outpatient DNA Rate** Jan N/A 7.80% 7.80% 8.20% 8.20% -0.40% -0.40% 0.00% 0.10% 4.6.16 Adult Midday Bed Occupancy Dec 90-95% 93.50% 94.50% N/A N/A 2.00% -1.40% N/A N/A 4.6.17 Paediatric Midday Bed Occupancy Dec 80-85% 79.90% 88.83% N/A N/A -9.30% -6.17% N/A N/A * Includes Lymington Minor Injuries Unit (MIU) following service transfer August 2017 ** From August 2017 will include activity transferred from Southern Health to UHS as part of the Lymington service move. February 18 4. Responsive 4 Hour Performance Page 11

This Year Last Year Theme Ref. Indicator Target Source Nov Dec Jan YTD R-12 Month YTD Detail 4.1.1 Main ED (type 1) attendances N/A N/A 8,583 8,836 8,273 86,550 102,521 8,230 83,490 4.1.2 Main ED (type 1) breaches N/A 1,107 1,979 1,462 11,962 14,502 1,472 9,574 % Patients spending less than 4 hours in Main 4.1.3 >95% National 87.1% 77.6% 82.3% 86.2% 85.9% 82.1% 88.5% ED (type 1) 4.1.4 ED Conversion (Type 1) N/A N/A N/A N/A N/A N/A N/A 28.2% 26.5% 4.1.5 Emergency reattendance within 7 days (Type 1) <5% National 6.6% 6.9% 6.9% 7.1% 7.0% 6.1% 6.3% Time to initial assessment - 95th Centile (Types 4.1.9 00:15 National 01:04 01:24 01:19 N/A N/A 00:59 00:52 1, 2 & 3) 4.1.10 Time to treatment - Median (Types 1, 2 & 3) 01:00 National 01:26 01:35 01:14 N/A N/A 01:22 01:16 Total time spent in ED - 95th Centile (Types 1, 2 4.1.11 04:00 National 05:47 07:21 07:05 N/A N/A 07:37 05:56 & 3) % patients who left the department before 4.1.12 <5% National 5.60% 7.30% 6.30% 5.3% 5.2% 3.1% 3.1% being seen (Types 1, 2 & 3) 4.1 ED This Year Last Year Performance Nov Dec Jan YTD R-12 Month YTD

4.1.13 Ambulance handover delays fines N/A N/A £ 600 £ 200 £ 200 £ 4,600 £ 4,800 £ 600 £ 5,200 This Year Last Year Nov Dec Jan YTD R-12 Month YTD % patients spending less than 4 hours in UHS 4.1.8 >95% National 90.5% 83.2% 87.1% 89.1% 88.7% 84.4% 90.2% ED's (Types 1, 2 & 3) % patients spending less than 4 hours in ED - UHS 4.1.14 ≥ 90% Local 89.1% 81.0% 85.3% N/A N/A N/A N/A Main ED, Eye Casualty & Urgent Care Hub % patients spending less than 4 hours in ED - 4.1.15 ≥ 95% N/A 99.9% 99.7% 99.7% N/A N/A N/A N/A Lymington Minor Injuries Unit % patients spending less than 4 hours in ED - 4.1.16 ≥ 95% N/A 100.0% 99.8% 99.8% N/A N/A N/A N/A RSH Minor Injuries Unit % patients spending less than 4 hours in ED - Delivery 4.1.17 ≥ 90.30% 93.0% 87.7% 90.5% N/A N/A N/A N/A Combined system total Board 4.1.8 - Lymington Hospital Minor Injuries Unit (MIU) included in attendance, breach and 4 hr performance measures from August 2017. 4.1.9 - 4.1.12 - Lymington Hospital MIU data not currently reported in these indicators from August 2017. 4.1.4 Reporting not currently available due to changes associated with new Emergency Care Dataset implementation. Reporting will be revised and backdated. February 18 4. Responsive RTT Performance Page 12

This Year Last Year Theme Ref. Indicator Target Source Nov Dec Jan YTD R-12 Month R-12 Detail % incomplete pathways within 18 weeks in 4.2.1 =>92% National 88.34% 87.86% 86.82% N/A N/A 91.37% N/A month % admitted patients within 18 weeks in month 4.2.2 N/A N/A 81.39% 80.84% 80.18% N/A N/A 81.60% N/A (adjusted for patient choice) % non-admitted patients within 18 weeks in 4.2.3 N/A N/A 84.88% 86.81% 87.17% N/A N/A 90.96% N/A month Total number of patients on an incomplete 4.2.4 N/A N/A 30,972 31,070 30,818 N/A N/A 26,944 N/A Below 4.2 RTT pathway Performance 4.2.5 Total patients in backlog N/A N/A 3,610 3,771 4,061 N/A N/A 2,326 N/A Below 4.2.6 Weeks waited for first outpatient appointment N/A N/A 8.03 7.85 8.48 N/A N/A 7.10 7.40 % of Patients waiting over 6 weeks for 4.2.7 <=1% National 1.83% 2.18% 3.65% N/A N/A 1.52% 0.78% diagnostics This Year Last Year Oct Nov Dec YTD R-12 Month YTD

4.2.8 New referrals received(month in arrears) N/A N/A 18,322 17,972 14,647 156,633 209,608 15,034 148,878 Below

Rolling 12-Month Referrals 250000 200000 150000 100000 50000 0 Oct-13 Oct-14 Oct-15 Oct-16 Oct-17 Apr-13 Apr-14 Apr-15 Apr-16 Apr-17

From August 2017 figures will include 18 week pathway patients transferred to UHS from Southern Health under the Lymington service move. February 18 4. Responsive Cancer Performance - Whole Trust Page 13

This Year Last Year Theme Ref. Indicator Target Source Oct Nov Dec QTD YTD Month QTD Detail

4.3.1 Urgent GP referrals seen in 2 weeks =>93% National 95.5% 91.7% 91.8% 93.1% 93.6% 89.4% 94.1% 4.3.2 Breast symptoms referral seen in 2 weeks =>93% National 94.6% 62.1% 41.7% 63.3% 77.2% 88.3% 91.3% Treatment started within 62 days of urgent GP 4.3.3 =>85% National 86.0% 85.80% 89.50% 87.10% 87.2% 82.8% 81.0% referral Treatment started within 62 days of referral 4.3.4 =>90% National 95.0% 98.0% 89.3% 93.8% 93.8% 82.6% 94.7% (Breast, Cervical & Bowel) 4.3.5 62 Day - Consultant Upgrades =>86% National 100.0% 63.0% 100.0% 87.0% 91.6% 81.0% 90.0% 4.3 Cancer Rare Cancers - 31 Day Performance 4.3.6 N/A N/A None 100.0% 100.0% 100.0% 80.0% 66.7% 80.0% Treatment started within 31 days of decision to - Whole 4.3.7 =>96% National 96.5% 95.1% 93.3% 95.0% 96.8% 97.6% 96.2% Trust treat Second or subsequent treatment (surgery) 4.3.8 =>94% National 94.1% 83.1% 89.9% 89.0% 93.5% 88.8% 88.9% started within 31 days of decision to treat Second or subsequent treatment (anti cancer 4.3.9 drugs) started within 31 days of decision to National 100.0% 100.0% 99.3% 99.8% 99.8% 100.0% 100.0% treat Second or subsequent treatment (radiotherapy) 4.3.10 =>94% National 100.0% 98.3% 100.0% 99.4% 99.6% 100.0% 100.0% started within 31 days of decision to treat

4.3.3. 62 Day Standard using Interim IPT / breach allocation rules. February 18 4. Responsive Flow Page 14

This Year Last Year Theme Ref. Indicator Target Source Nov Dec Jan YTD R-12 Month YTD Detail

4.5.1 Delayed transfers of care (CQC Calculation) <=3.50% National 8.15% 6.96% 7.34% 8.60% 8.78% 10.71% 11.39% 4.5.2 Complex Discharge Census (average) <=38 Local 100.93 88.87 102.42 102.99 105.18 123.9 133.4 Average Number of Complex Discharges per 4.5.3 =>26 Local 19.36 24.26 21.65 21.37 21.10 21.0 21.0 Working Day 4.5.4 Early discharge on day (pre-midday) =>30% Internal 22.90% 20.56% 22.59% 20.82% 20.91% 20.95% 21.13% 4.5.5 Weekend Discharge (EL & NEL Combined) =>80% Internal 64.13% 67.93% 57.42% 61.49% 61.61% 56.73% 61.72% 4.5.6 Red Alerts N/A N/A 26 44 46 248 328 54 291 4.5 Flow 4.5.7 Black Alerts N/A N/A 0 2 8 16 16 3 11 4.5.8 Last minute cancelled operations N/A N/A 121 98 94 755 922 80 728 % elective operations cancelled at the last 4.5.9 <=1% National 1.97% 1.87% 1.70% 1.29% 1.29% 1.34% 1.26% minute Number of patients who are not readmitted 4.5.10 N/A N/A 10 9 19 75 91 15 55 within 28 days % elective operations cancelled and not 4.5.11 <=5% National 8.26% 9.18% 20.21% 9.93% 9.87% 18.75% 7.55% readmitted within 28 days

4.5.4 Target reduced from =>30% to =>25% during October, November, December 2017. Returned to =>30% from January 2018. February 18 5. Well Led Human Resources Page 15

This Year Last Year Theme Ref. Indicator Target Source Nov Dec Jan YTD R-12 Month YTD Detail

5.1.1 HR - Turnover - Rolling 12-months <=12% ESR 12.83% 13.33% 13.16% N/A N/A 12.78% N/A 5.1.2 HR - Sickness absence - Rolling 12-months <=3.4% ESR 3.55% 3.54% 3.56% N/A N/A 3.55% N/A W HR - Appraisals completed (non-medical) - 5.1.3 =>92% ESR 83.79% 83.09% 85.75% e N/A N/A 85.24% N/A Rolling 12-months h 5.1.4 Nursing Vacancies (Total Clinical Wards) <=8.00% Internal 12.52% 12.84% 13.02% N/A N/A 13.0% N/A Nursing Vacancies (Registered Nurse only in 5.1 Human 5.1.5 <=8.00% Internal 17.6% 18.10% 18.0% N/A N/A 17.6% N/A resources clinical wards) 2016/17 2017/18 2015/16 Q1 Q2 Q4 Q1 Q2 Q2 Q4

5.1.5 Staff FFT response rate 25% Picker 22% 20% 19% 25% 24% 27% 24% Staff FFT - % of staff likely or extremely likely to 5.1.6 76% Picker 76% 76% 77% 77% 76% 73% 76% recommend UHS as a place to work.

We have done an analysis based on 8 Model Hospital Peers Hospitals' 12 month rolling turnover rate covering December 2016 to November 2017. The results are stated as below: - Turnover rate for All Staff (excluding Junior Doctors): The lowest is 7.93% and the highest is 17.5%, UHS had the 4th lowest turnover rate of 11.3% - Turnover rate for Nursing and Midwifery Registered: The lowest is 7.75% and the highest is 15.95%, UHS had the 5th lowest turnover rate of 11.58%

Sickness Absence - There continues to be a focus on sickness absence from the Employee Relations Service in partnership with Divisional HRPB oversight. Sickness absence remains at just over 3.5%. - The Live Well and Inspire Healthy workplace campaign continues with a focus on generating awareness for the range of activities and support available to staff. There has been a specific awareness campaign during September including staff briefings and an event on 27th of September in the front of the hospital to promote healthy living. Health checks for all staff have been launched in November. This includes the opportunity to undertake a quick assessment using an automated machine in the front entrance, or book a more detailed face to face appointment with Occupational Health. - Vaccination is now well underway for the 2017 Flu campaign. 67.4% of staff have received vaccination against a target of 70%.

Appraisals - A new appraisal process has been agreed at TEC for Agenda for change staff. Its focus is on improving the quality of conversation and embedding the Trust values. The new process is accompanied by a re-developed appraisal training package.

February 18 Ward Staffing Report 5. Well Led January 2018 Page 16

The following highlight report (in fulfilment of the National Quality Board (NQB) expectations on trust board awareness of safe staffing) focuses on any ‘hotspot’ areas in January 2018 which the board needs to be aware of in each Division after review of the overall staffing figures, daily staffing reports and staffing incident reports.

The table below represents the high level summary of the planned and actual ward staffing levels reported for January 2018. This is the information which has been uploaded and will be for public display via NHS choices from early March 2018. Detailed ward by ward information is also included as part of this KPI report.

From May 2016 Care Hours Per Patient Day (CHPPD) showing average care hours per patient for SGH, PAH and CMH has been included as part of the Model Hospital dashboard and is included in this report. Costs per ward have also been included in the model hospital dashboard since December 2016.

Staffing position for January 2018

Day Night Care Hours Per Patient Day January 2018 (CHPPD)1 Average fill rate - Total Average fill rate Average registered Average care - registered fill rate - nurses/ fill rate - Reg. hours nurses/ care staff Midwives care midwives/ Care per Site Name Midwives (%) (%) (%) staff (%) nurses Staff patient SOUTHAMPTON GENERAL 83.0%↑ 118.6%↑ 93.1%↑ 132.5%↑ 5.1↔ 3.2↓ 8.3↔ HOSPITAL COUNTESS MOUNTBATTEN 90.6%↓ 136.5%↑ 94.3%↓ 122.3%↑ 3.3↓ 4.2↑ 7.4↓ HOUSE PRINCESS ANNE 84.0%↑ 69.2%↑ 101.6%↑ 80.3%↑ 6.2↓ 2.1↑ 8.3↔ HOSPITAL

NB: Arrows indicate changes against the previous month and do not represent either a positive or negative performance position.

Whilst it can be seen that we were not able to staff many clinical areas with our planned level of registered staff due to current vacancy levels, we maintained our staffing levels at or above minimum safety levels. This was achieved by using our nursing/midwifery bank and agency, through reviewing staffing on a daily basis across the Trust and deploying non-ward based staff to support.

‘Hotspot’ areas for nursing/midwifery staffing in January 2018

Key metrics show that staffing and capacity challenges continued to be extreme during periods in January. Acuity and dependency remained high across the trust and staff sickness impacted a number of areas. Exceptions by Division are detailed below:

1 CHPPD, split into registered nurses/midwives and health care support workers is calculated using this formula:- Actual hours worked_ Patient count at midnight

February 18 Ward Staffing Report 5. Well Led January 2018 Page 17

Division A Surgery – The surgical ward vacancies continued to improve slowly, with a conscious over-recruitment of support staff, but the wards continued to be challenged with staffing during January. Cancer Care –Registered nursing vacancies at CMH continue to be a challenge but a targeted recruitment event has been successful with new starters now in the pipeline. The band 6 team are rotating around the care group to share practice and education and to improve engagement of staff in assisting other areas. AOS has not been used overnight during January and this has reduced the pressure at night. Critical Care – All critical care areas have seen a rise in occupancy and flow throughout January. This has led to challenges to staffing the fluctuating levels of activity. The overall registered nurse vacancy has reduced to 8.8% 29 FTE) across the 4 units.

Division B The Divisional registered nurse vacancy position remains significant at 24.1% (118 FTE) and has deteriorated during January. Focussed work continues on recruiting additional support staff to various areas of the division to support overall staffing levels. The division’s daily staffing challenges have remained consistent in January with some shifts remaining at ‘critical’ levels. Key mitigating actions and daily senior nurse focus have supported the ward teams to keep patients safe; golden key release is monitored carefully in order to ensure that high cost agency is only used for true ‘break glass’ eventualities however January has seen a rise in the number of requests to maintain safety. Following consultation, all the divisions’ matrons are now providing a core hours, evening and weekend on site service and one element of their role is to lead safe staffing planning and decision making. ED and AMU - The registered vacancy position within the Emergency Care group remained stable in January at 12.5% (24 FTE). The trustwide capacity challenges have continued in January and have been particularly focussed on ED and AMU activity. This was reflected in the requests for high cost agency for break glass safety reasons. A scoping exercise has been completed against the National Quality Board: Improvement resource for Urgent and Emergency Care (issued for consultation in November 2017). This has shown UHS to be broadly compliant with the recommendations and a consultation response has been returned. Emergency medicine wards & Medicine for Older People – Registered nurse vacancies rose to 35% (92 FTE) and this was reflected in the need to use high cost agency for break-glass safety reasons and an increase in staff moving from across the hospital to support. This represents a concerning continued rise in registered vacancies in these areas and reflects the wider national picture of shortfalls in registered staff. Medicine continues to over-recruit unregistered staff which really supports the risk associated with the RN vacancy rate.

Division C Child Health - RN vacancies across child health rose slightly to 15.6% (51 FTE) nurses. This has impacted on the ability to open the beds closed over the summer however there is an improved pipeline of starters expected from February. A scoping exercise has been completed against the National Quality Board: Improvement resource for children and young people’s inpatient wards in acute hospitals (issued for consultation in November 2017). This has shown UHS to be broadly compliant with the recommendations and a consultation response has been returned.

February 18 Ward Staffing Report 5. Well Led January 2018 Page 18

Maternity & Neonates– Vacancies for midwives have remained stable this month. A scoping exercise has been completed against the National Quality Board: Improvement resource for Neonatal Care (issued for consultation in November 2017). This has shown UHS to be broadly compliant with the recommendations and a consultation response has been returned.

Division D The overall Divisional registered nurse vacancy position increased to 22% (102 FTE) with a pipeline of 13 registered nurses to start in the next 3 months. Staffing of uncommissioned capacity to support the capacity challenges has resulted in an increased usage of high cost agency. T&O and Neurosciences remain areas of focus with registered nurse vacancies of 37.8% (48 FTE) and 26.3% (37 FTE) respectively, an increase for both areas in the month. High vacancies are being managed with staff doing bank shifts, over recruitment of band 3 and 4’s and deploying staff across wards. ------Staff continue to reference the ‘red flags’ identified in the NICE guidance on safe staffing when completing adverse event reports (AER) linked to staffing. These red flags highlight when patient care has potentially been impacted due to staffing shortfalls. These AERS are reviewed, actioned and mitigated in real-time to reduce the risks. They are also themed monthly and identified actions taken forward linked to the reporting on safe staffing and the trust risk register. Care group and divisional reports are also available to enable focus on trends in incidents being reported from each clinical area.

In January there were 52 staffing incident reports in total covering 9 different staff groups. This is a significant decrease on the 110 incidents reported in December and brings the reporting back to normal levels. These incidents have been rated from near miss to moderate (6) impact. This also shows a significant fall on the number of incidents rated at moderate (18 in December) and brings reporting back to normal levels. Of these incidents, 52 were related to nurse staffing, a fall on the 88 reported in December. There were 2 Midwifery incidents reported for the month. Hotspot areas identified through the reporting are being closely reviewed by the divisions.

In addition to the existing system, in August 2017 we introduced the capability to report red flag incidents in real-time on the safecare acuity/dependency system in healthroster. Following a rostering and safecare masterclass in January this facility has now been rolled out trustwide and the red flags will be reviewed at the daily staffing meetings. ------The overall vacancy level for ward staffing (registered, unregistered and other support roles) was maintained in January and now stands at 409 FTE (12.9%). This however masks a worsening position for registered staff and an improved position for unregistered staff. The current vacancies are 395 FTE (18.9%) registered vacancies and -15 FTE (- 1.7%) unregistered vacancies as a result of conscious over-recruitment. It should also be noted that, with the arrival of the most recent cohort of nurses from overseas, an increased number of 61.5 FTE registered overseas nurses are currently working as unregistered nurses as they await the results of their English language testing (IELTS) requirements and competency requirements stipulated for NMC (Nursing and Midwifery Council) registration.

February 18 Ward Staffing Report 5. Well Led January 2018 Page 19

Graph 1 below details the breakdown of temporary staffing cover across the last year.

Overall use fell slightly in the month, however high cost agency usage rose by 1 FTE with 7 FTE (126 shifts) in January 2018 for break glass safety reasons. This equates to 1.9% of the total temporary nursing staff usage. Shifts escalated to high cost agency remained unfilled in a number of cases and all measures were taken to manage staffing across the trust to ensure safety was maintained. The proportion of bank to agency usage continued to increase as planned with 29% of the temporary staff usage filled by agency compared to 38% 12 months ago.

Daily escalation processes continue to support the most effective deployment of staff in real-time with the use of ‘safecare’ acuity/dependency data embedded as part of the daily staffing reviews.

Graph 1:

February 18 Ward Staffing Report 5. Well Led January 2018 Page 20

Graph 2 – Ward Staffing - Predicted vacancies

February 18 5. Well Led Education & Training Page 21

This Year Last Year Theme Ref. Indicator Target Source Nov Dec Jan YTD R-12 Month YTD Detail

5.2.1 Safeguarding Adults 85% Internal 83% 82% 84% N/A N/A 80% N/A 5.2.2 Child Protection (L3 only) Internal 77% 71% 71% N/A N/A 69% N/A 5.2.3 Infection Prevention - Clinical 85% Internal 86% 88% 87% N/A N/A 82% N/A 5.2.4 Infection Prevention - Non Clinical Internal 85% 85% 85% N/A N/A 84% N/A 5.2.5 Moving and Handling - Practical Only 85% Internal 75% 75% 76% N/A N/A N/A N/A 5.2.6 Fire Safety 85% Internal 84% 82% 81% N/A N/A 82% N/A 5.2.7 Basic Life support and AED Clinical 85% Internal 77% 79% 77% N/A N/A 75% N/A 5.2.8 Basic Life support Non Clinical 85% Internal 79% 77% 81% N/A N/A 66% N/A 5.2.9 Local Induction Internal 88% 88% 88% N/A N/A 85% N/A 5.2.10 Information Governance 90% Internal 84% 83% 82% N/A N/A 80% N/A 5.2.11 Equality & Diversity 85% Internal 88% 88% 89% N/A N/A 81% N/A 5.2 5.2.12 Prevent Training 85% Internal 87% 87% 88% N/A N/A 75% N/A Education & Training 2017/18 2016/17 Q1 Q2 Q3 Q4 Q2 Q3 Quality of practice experience for doctors in Minor Minor Minor Minor 5.2.13 training (annual report with quarterly No risk Internal Minor Risk N/A Risk Risk Risk Risk qualitative updates) National Learning and Development Agreement Minor Minor Minor 5.2.14 No Risk Internal Minor Risk N/A N/A Compliance (Q2 & Q4 only) Risk Risk Risk 18 30 5.2.17 % Uptake of Apprenticeship in 2017/18 250 Internal n/a starters - starters - N/A N/A N/A 7.2% 12% Percentage of new starters who have 5.2.18 completed their care certificate within the 85% Internal N/A 27% 28% N/A N/A N/A allocated timeframe for the quarter

5.2.17 New indicator introduced from 2017/18 quarter 2. Replaces 5.2.15 previously reported. 5.2.18 New indicator introduced from 2017/18 quarter 2. Replaces 5.2.16 previously reported. February 18 5. Well Led Research & Development Page 22

This Year Last Year Annual Source Nov Dec Jan QTD YTD Month YTD Detail Theme Ref. Indicator Target Grant Applications Value of awarded grant applications led by UHS - NIHR 5.3.8 1.2 (£m) Internal £0.00 £0.00 £0.00 £0.00 £2.58 N/A N/A funders Value of awarded grant applications led by UHS - all 5.3.9 2.3 (£m) Internal £0.00 £0.00 £0.08 £0.08 £5.20 N/A N/A funders (incl. NIHR) CRN Portfolio Recruitment This Year Last Year Nov Dec Jan QTD YTD Month YTD National ranking for recruitment to CRN portfolio - all 5.3.10 Top 5 Internal 6th 6th 6th N/A N/A N/A N/A CRN portfolio studies (of 500 NHS orgs) National ranking for recruitment to CRN portfolio - 5.3.11 Top 5 Internal 12th 9th 9th N/A N/A N/A N/A interventional studies (of 500 NHS orgs) National ranking for recruitment to CRN portfolio - 5.3.12 Internal 15th 16th 16th N/A N/A N/A N/A commercial studies (of 144 English Trusts) Percentage of commercial CRN portfolio studies closing 5.3 Research 5.3.13 ≥ 80% Internal 100% 60% 100% N/A N/A N/A N/A & on target (NIHR CRN metric) Percentage share within Wessex of weighted Development 5.3.14 45% Internal 32% 33% 33% N/A N/A N/A N/A recruitment to CRN portfolio studies (of 14 trusts) Number of participants recruited to CRN portfolio 5.3.15 20950 Internal 1,134 895 604 604 12,891 N/A N/A studies NIHR Central Commissioning Fund Metrics - Quarterly in arrears 2017/18 Last Year Q1 Q2 Q3 Q4 Month YTD ‘70 day target' - 1st patient recruited within 70 days for 5.3.16 ≥95% Internal 100% 93% N/A N/A N/A N/A UHS R&D confirmation of capability and capacity

Percentage of all commercial studies closing on time 5.3.17 ≥65% Internal 50% 46% N/A N/A N/A N/A (NIHR CCF metric)

Finances This Year Last Year Nov Dec Jan QTD YTD Month YTD 5.3.18 Total R&D Income - invoiced 16.2 (£m) Internal £1.51 £1.61 £1.66 £1.66 £16.21 N/A N/A

The Research & Development KPI page was revised in October 2017 and new KPI indicators were introduced. Consequently comparative data for 2016/17 is not available. 5.3.10 Absolute recruitment has dropped in 2017/18. This is in part due to the premature closure of a high recruiting study. However of concern is the drop in recruitment across a large number of specialties all at the same time. Performance in Division B is a particular concern. 5.3.11 Recruitment to complex studies is improving as expected in Q3 and Q4 although remains a concern. 5.3.12 As a subset of total recruitment, commercial studies are being affected by the overall downturn. 5.3.14 Decreased recruitment is impacting on market share within Wessex. Recovery plans to improve UHS position in the short term are being pursued. Longer term strategic plans are also in development with some already being actioned. 5.3.18 Income from research grants and commercial work has increased through a number of initiatives and is an indicator of how much work is being performed by research staff. Headcount for research staff has not increased. Annual planning looking at investment in staff to deliver increased recruitment and secure income. February 18 6. Productive Estates Page 23

This Year Last Year Theme Ref. Indicator Target Source Nov Dec Jan QTD YTD Month YTD* Detail

6.3.1 Estates - Total Logged Maintenance Jobs N/A N/A 2,259 2,315 2,117 2,117 21,250 1,726 13,112

Estates - % Maintenance completed within 6.3.2 85% Internal 83.7% 78.7% 79.2% 79.2% 83.8% 89.8% 77.3% planned time

6.3.3 Estates - Statutory Logged Maintenance Jobs N/A N/A 110 131 63 63 1,041 105 1,479

Estates - % Planned Maintenance Completed - 6.3.4 95% Internal 100.0% 100.0% 96.8% 96.8% 98.7% 96.2% 91.6% Statutory 6.3 Estates 6.3.5 Estates - Mandatory Logged Maintenance Jobs N/A N/A 347 371 329 329 3,027 306 2,773

Estates - % Planned Maintenance Completed - 6.3.6 95% Internal 98.8% 99.7% 98.8% 98.8% 98.9% 92.5% 89.4% Mandatory Estates - Good Practice Logged Maintenance 6.3.7 N/A N/A 99 100 94 94 892 90 1,088 Jobs Estates - % Planned Maintenance Completed - 6.3.8 85% Internal 100.0% 100.0% 98.9% 98.9% 96.7% 100.0% 95.1% Good Practice

* Data reported from Dec-15 onward are automatically generated from the Estates department maintenance database. Enclosure 3

Trust Board meeting 1 March 2018

Title Improving Air Quality

Sponsoring Executive Fiona Dalton, Chief Executive

Authors’ names & Job Debbie Chase, Public Health Service Lead Southampton City titles Council Neil Tuck, Sustainable City Team Leader, Southampton City Council Ben Marshall, Consultant Respiratory Physician and Honorary Associate Professor of Medicine, UHSFT Shannon Lennock, Foundation Year 2 Doctor, UHSFT

Purpose of the paper For To note ☑ Formal For decision  information  approval 

History Poor air quality is a significant public health issue for the population of Southampton. In 2014, the City was identified as one of five cities where nitrogen dioxide levels exceed European standards. As with most cities, the main pollutants are primarily a consequence of motor vehicle transport. For Southampton, the shipping industry is also a large contributor.

Executive Summary Southampton City Council (SCC) is leading a strategic approach to improve air quality across the city and this includes the introduction of a Clean Air Zone. The SCC Clean Air Strategy (2016-2025) covers a broad programme of measures to deliver improvements. The aim is that Southampton is a clean and healthy city in which to live and work.

Action Required This paper is a call to action to University Hospital Southampton Foundation Trust (UHSFT) to become an exemplar acute trust in its approach to improving air quality and reducing risk for those who are most vulnerable. UHSFT is already delivering many activities to support this work. This proposal is to recognise, co- ordinate and scale up these activities to become a nationally recognised organisation in efforts to protect the public.

Page 1 of 9 UHSFT: An exemplar acute trust in improving air quality

1. Introduction

Poor air quality is a significant public health issue for the population of Southampton. In 2014, the City was identified as one of five cities where nitrogen dioxide levels exceed European standards. As with most cities, the main pollutants are primarily a consequence of motor vehicle transport. For Southampton, the shipping industry is also a large contributor.

About 100 deaths in Southampton are attributed to pollution and there are health consequences throughout the life course. Strongest evidence is of the link between air pollution and induction of and subsequent exacerbations of respiratory (asthma, COPD, pneumonia and cancer) and cardiovascular conditions (atheroma, MI, strokes). Evidence also suggests links with low birth weight, cognitive function in childhood, Type II diabetes and potentially dementia and cognitive decline in older age. Furthermore, air pollution has a disproportionately negative effect on the most vulnerable members of our community, contributing to health inequalities.

Southampton City Council (SCC) is leading a strategic approach to improve air quality across the city and this includes the introduction of a Clean Air Zone. SCC published a Clean Air Strategy in 2016 on actions being taken forward until 2025. The strategy calls on businesses and organisations to identify ways to support these actions.

This paper is a call to action to University Hospital Southampton Foundation Trust (UHSFT) to become an exemplar acute trust in its approach to improving air quality and reducing risk for those who are most vulnerable. UHSFT is already delivering many activities, some of which are highlighted in this paper, to support this work. This proposal is to recognise, co-ordinate and scale up these activities to become a nationally recognised organisation in efforts to protect the public.

2. Background

Air pollution and health

In the UK, outdoor air pollutants are mainly products of motor vehicle traffic combustion and tyre and brake ware. Those known to have the greatest effects on health are particles (PM10, PM2.5), oxides of nitrogen, ozone, polyaromatic hydrcarbons (PAHs), sulphur dioxide and carbon monoxide. Diesel vehicles are the worst offenders in producing particles. In a good state of health, short term exposure to moderate levels of air pollution is unlikely to have any serious short term effects. However, short term exposure to high levels of air pollutants can cause a range of adverse effects, such as exacerbations of asthma, effects on lung function and consequent increases in hospital admissions for respiratory and cardiovascular conditions

Long term exposure to air pollution increases the risk of premature deaths from cardiovascular, cerebrovascular and respiratory conditions, including lung cancer and pre- existing lung and heart conditions. Chronic effects of pollution include triggers of new disease, worsening in severity through an increase in symptoms or acceleration in or progression of disease over time. Children, the elderly and people with existing lung or

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Page 2 of 9 heart conditions are the most susceptible to the health effects of air pollution. The effects of pollution disproportionately affect those most in our society who are the most deprived.

More recent evidence has shown that air pollution has effects across the life-course. It is associated with low birth weight, premature birth, organ damage and even stillbirth. Exposure to ultrafine particles in pregnancy has been linked to adverse developmental abnormalities in children including low IQ. Children living in highly polluted areas are four times more likely to have reduced lung function in adulthood than those living in an area of low pollution. Strategies to reduce their exposure can reverse this effect.

Ambient particulate matter (PM) is the indicator used most widely for monitoring air pollution against health indicators. PM is a heterogeneous mixture of solid and liquid particles suspended in the air. Particle size affects impact on health, with particles less than 10µm in diameter (PM10) able to penetrate the lungs, and they do so to a greater extent the smaller they become (PM2.5 and ultrafine particles – PM0.1). It is estimated that at least 29,000 early deaths, and an associated loss of total life of 340,000 life years in the UK each year can be attributed to exposure to particulate emissions. This figure could exceed 50,000 deaths when also considering NO2 exposure. The health impact of PM2.5 pollution from human activities in the UK is estimated to cost between £8.5 billion and £18.6 billion a year.

Situation in Southampton

Southampton’s port is the busiest cruise terminal and second largest container port in the UK. Its continued success is vital to the City’s economy and as a regional retail and economic centre, Southampton’s economy is heavily reliant upon its transport links. There is a close spatial relationship between the Port, City Centre and residential areas. The health consequence of this is that many residents are living very close to areas of consistently moderate to high levels of air pollution and therefore are exposed to this health risk regularly. Furthermore, the areas where there are the highest levels of air pollution are also some of the most deprived areas in the City.

Computer simulation modelling undertaken by Ricardo, AEA in 2015 has shown that road transport is the biggest contributor to outdoor emissions in Southampton, followed by industry and port operations: 34% of outdoor air pollution is attributed to heavy goods vehicles, 7.5% to light goods vehicles, 4.5% to buses and 24% to cars. The operations within the port are significant along the middle part of the Western approach into Southampton.

The national public health outcome framework uses ‘fraction of mortality attributable to particulate air pollution’ as an indicator of the impact of outdoor air pollution on health. For Southampton, this shows that 5.2% of mortality is attributable to particulate air pollution (estimation based on 2015 data). This is the equivalent to just under 100 early deaths amongst those aged 25 years and over in Southampton each year. In comparison, the England average is 4.7% and that of the South East, 4.7%. Southampton’s attributable fraction has reduced since figures began in 2010 (from 6.2% to 5.2%).

Mapping of Chronic Obstructive Pulmonary Disease hospital admissions, asthma hospital admissions and cardiovascular hospital admissions against air quality management areas in Southampton City show close correlation. Those areas in Southampton with the highest pollution levels are also areas where hospital admissions for these conditions are highest. These are also areas of significant deprivation and where we would expect health outcomes to be worse. Mapping of Chronic Obstructive Pulmonary Disease and asthma prevalence

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Page 3 of 9 against air quality management areas also shows some degree of correlation (see figure for COPD prevalence below, data extracted August 2013).

Southampton’s strategic approach

The Department of Food and Rural Affairs (Defra) published the UK Air Quality Plan in December 2016. The document identified Southampton as one of five cities which will be required to implement a mandatory Clean Air Zone (CAZ) at the earliest opportunity and no later than 2020. The Department for Environment Food & Rural Affairs (Defra) is responsible for ensuring that the UK complies with European Directives and has indicated that Brexit would not alter the requirement for compliance under proposed UK legislation.

In response, Southampton City Council (SCC) developed a Clean Air Strategy and CAZ implementation plan (published November 2016). The Clean Air Strategy (2016-2025) covers a broad programme of measures to deliver improvements. The aim is that Southampton is a clean and healthy city in which to live and work. There are four priority areas for action, to:

Reduce local emissions of nitrogen dioxide and particulates - A Clean Air Zone in place which may include penalty charges for the most polluting vehicles by 2019/20. Identification of alternative fuel options and the development of City infrastructure to better support walking, cycling and use of public transport also form key components.

Support businesses and organisations - Setting up a Clean Air Network with key stakeholders in the City and region in 2018. This launched on the 7th February 2018. Working with the Sea Port to reduce contribution of shipping associated activities to air pollution and encouraging businesses to reduce their associated pollution. Shared learning on air pollution

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Page 4 of 9 health impact and what is working to deliver change will be strengthened through links with the University of Southampton.

Collaborate with communities and residents - Working with and alongside residents associations and community groups to advocate and support change. Working with schools to raise awareness of air pollution impact and promote active travel opportunities and supporting behaviour change through campaigns.

Promote sustainability - Ensure policies to enable sustainability, reduce the number of vehicles on the road and the distance they travel into and out of the City Centre and promote sustainable working. Increase the use of the Sustainable Consolidation and Distribution Centre in 2017/18 to permit more efficient movement of goods across the City.

3. Activities undertaken at UHSFT UHSFT has been actively involved in this agenda; notably through: • Actively participating in National Clean Air Day in June 2017. Providing training for staff in the respiratory team to become air quality champions, poster stand in hospital foyer and press attention with Professor Stephen Holgate as spokesperson; • Air pollution messages provided at congenital heart services patient open day in June 2017; • Park and ride and park and walk schemes for UHS staff; • Early development of a centre for sustainable healthcare.

4. Example of good practice Barts Health NHS Trust, the City of London and the London Boroughs of Newham, Tower Hamlets and Waltham Forest have led the way nationally in delivering cross-sector support to tackle air pollution. The project was funded by the Mayor’s Air Quality Fund, GLA and DEFRA. It ran up to 2016 and delivered five interventions to help improve air quality in the East London community;

1. Protecting Patients – Clinicians at Barts Health NHS Trust providing advice to vulnerable patients on how to reduce their exposure to air pollution; 2. Community Based Emissions – patients in Tower Hamlets receiving energy packs to help them stay Warm and Well in their homes over winter while also reducing boiler emissions, a cause of air pollution; 3. Breathing Spaces – creating green havens within the hospital ground; 4. Active Travel – working with Barts Health staff to encourage them to leave their car at home and use other ways to get to work; 5. Cleaner Fleets, Healthier Streets – ERS Medical being proactive in improving air quality by reducing emissions from their own fleet vehicles.

In terms of outputs, over 100,000 people were reached with key air pollution messages in East London and 6,000 Air Pollution packs were deployed, over 300 Barts Health professionals were trained and over 300 volunteers were engaged.

5. UHSFT: An exemplar acute trust – recommendations for action This proposal is for UHSFT to be recognised as a leading acute centre in delivering action to improve air quality and protect the most vulnerable in the community through both its

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Page 5 of 9 medical and operational practices. There are several approaches that can be taken forward and promoted to support this endeavour, building on good work already underway. Recommendations below for UHSFT are categorised by person centred, technological, supply chain, staff travel and City/key stakeholder.

A. Person centred: Staff can support vulnerable patients e.g. with respiratory conditions, cardiovascular conditions, in pregnancy and neonatal through:

- Promotion of air alert: http://www.airalert.info/Hants/Default.aspx - Training for clinicians – to provide advice impact and actions to reduce risk

Behaviour change for staff, patients and their visitors should be promoted, encouraging walking and cycling where possible.

B. Technological: Reduce the impact of tailpipe emissions from vehicles associated with the hospital through the use of alternative fuel technologies. Of note, South Central Ambulance Service has made steps to reduce the amount of fuel used its vehicles through the installation of solar panels to supply the secondary battery used to charge the mobile data technology, medical equipment, blue flashing lights and radio equipment on board.

Another technological option is the use of Southampton District Energy Scheme for sustainable and efficient supply of heat for the hospitals facilities.

C. Supply Chain: Optimise the hospitals supply chain by developing a Supply Chain Strategy that consolidates and sequences inbound materials and equipment and significantly reduce goods vehicles travelling to the Trust. Currently between 900 and 1000 vehicles visit the General Hospital site per week – there are options available to the Trust that would see this figure drop dramatically.

D. Staff Travel: The movement of staff and patients to and from the hospital site has a significant impact on the local road network. It is estimated that 5% of all road traffic is attributed to NHS related travel. Options include:

1. Continuing to reduce the number of staff traveling on their own to and from work by car through more promotion of car sharing, active travel, bus travel, park and ride and park and walk schemes. Regular staff travel surveys could track progress 2. Incentivise and support electric vehicle use by staff and visitors 3. Participate in upcoming air quality related campaigns including the City Council’s anti- idling campaign and National Clean Air Day 2018 4. Support electric taxi and volunteer car services visiting the Trust

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Page 6 of 9 E. City/national key stakeholder: UHSFT can showcase the best practice already adopted by the UHSFT to other health organisations nationally and become a partner organisation in the city’s newly established Clean Air Network to facilitate the exchange to best practice and actively participate in joint local initiatives to improve air quality, see: http://www.southampton.gov.uk/environmental- issues/pollution/air-quality/working-together-for-cleaner-air.aspx

Lastly, as a University Hospital there are opportunities to strengthen and better promote research endeavours to monitor and reduce the risk of air pollution and ensure that teaching on the health impact of air pollution is a component within both undergraduate and postgraduate teaching programmes.

Authors:

Debbie Chase, Public Health Service Lead Southampton City Council Neil Tuck, Sustainable City Team Leader, Southampton City Council Ben Marshall, Consultant Respiratory Physician and Honorary Associate Professor of Medicine, UHSFT Shannon Lennock, Foundation Year 2 Doctor, UHSFT

With special thanks to Professor Stephen Holgate, Royal College of Physicians Special Advisor in Air quality, MRC Clinical Professor of Immunopharmacology and Honorary Consultant Physician, University of Southampton for initiating and informing this proposal

References for further information:

Royal College of Physicians report: https://www.nice.org.uk/guidance/indevelopment/gid- phg92/documents UK Parliament briefing: http://researchbriefings.parliament.uk/ResearchBriefing/Summary/POST-PN-458 NICE guidance: https://www.nice.org.uk/guidance/indevelopment/gid-phg92/documents 14 cost effective actions to cut Central London air pollution: https://www.rbkc.gov.uk/pdf/air_quality_cost_effective_actions_full_report.pdf St Barts work: https://www.globalactionplan.org.uk/cleaner-air-with-barts-health https://www.globalactionplan.org.uk/Handlers/Download.ashx?IDMF=6c048fcc-7736- 4a0b-a30b-531d4878d87b Southampton’s Clean Air Strategy: http://www.southampton.gov.uk/images/clean-air- strategy-2016-2025_tcm63-389498.pdf Health Outcomes Travel Tool: https://www.sduhealth.org.uk/delivery/measure/health- outcomes-travel-tool.aspx Launch of Clean Air Network: http://www.dailyecho.co.uk/news/15932516.New_Clean_Air_Network_launches_in_Sout hampton/

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Page 7 of 9

Medicine

To: Mr Peter Hollins, Chairman, From: Prof. Stephen T Holgate, Southampton University Hospitals NHS Trust Board, MRC Clinical Professor, Trust Management Offices Clinical and Experimental Sciences, Mailpoint 18 Faculty of Medicine, Southampton General Hospital Sir Henry Wellcome Laboratories, Tremona Road Mail Point 807, Level F South Block, Southampton Southampton General Hospital, Hampshire SO16 6YD Southampton SO16 6YD, UK.

8th February, 2018

Dear Peter and Fellow Board Members. As you will have become increasingly aware over the last year or so, the importance of air pollution on human health here in the UK has become an increasingly important issue both in the public eye, politically and through its impact on a range of diseases across the lifecourse. I write this supporting letter In my capacity as Chair of the RCP Working Party that published the report, Every breath we take: the lifelong impact of air pollution, which identified the 40,000 deaths attributable to pollution in the UK as well as an enormous financial burden through increased incidence and worsening of chronic disease. I have been delighted to see the interest that the SUHT was taking to setting an example in the City and beyond of developing strategies for reducing exposure and effects. One of the recommendations of our Report was that the NHS should lead by example. The NHS is one of the largest employers in Europe, contributing 9.1% of the UK’s gross domestic product (GDP). The health service must no longer be a major polluter; it must lead by example and set the benchmark for clean air and safe workplaces. In turn, this action will reduce the burden of air-pollution-related illness on the NHS. As pointed out in two earlier reports, the Department of Health, NHS England and the devolved administrations must give commissioners and providers incentives to reduce their emissions, and protect their employees and patients from dangerous pollutants. The SUHT played a major role in National Clean Air Day last June and it was clear then that there were some exciting new opportunities opening up in Southampton with the City Council, Commercial, Health and Education Sectors coming together. Dr Deborah Chase, Dr Ben Marshall and Dr Matthew Loxham at the hospital, in public health and on behalf of the University Faculty of Medicine have kept the interest going including the constructive meeting with Fiona Dalton last autumn. As the Board will no doubt know, Southampton is

Please reply to: Clinical and Experimental Sciences Faculty of Medicine, Southampton General Hospital, Mailpoint 810, Level F, South Academic Block, Tremona Road, Southampton SO16 6YD United Kingdom

University of Southampton, Highfield Campus, Southampton SO17 1BJ United Kingdom Tel: +44 (0)23 8059 5000 Fax: +44 (0)23 8059 3131 www.southampton.ac.uk

Page 8 of 9 one of the 5 worst polluted cities in England and this was the reason it was selected by Government to have clean air zones in place by 2020. Southampton City Council are also undertaking a raft of new air pollution reduction and mitigation measures as part of their Clean Air Network (https://www.southampton.gov.uk/environmental-issues/pollution/air- quality/working-together-for-cleaner-air.aspx/). The Southampton Health Air Pollution Team are presenting to you several additional opportunities that would place the SUHT in the vanguard of the NHS leading from the front. By acting, the argument for better health is already clear especially in relation to a hospital that contains some of the most vulnerable. Access to the new Regional Web air quality assessment tool (https://uk- air.defra.gov.uk/forecasting/locations?q=Southampton/) indicates that at peak time during the day the roads around the hospital are some of the most polluted in the City with the high use of ambulances, buses, commercial and idling stationary vehicles in traffic queues. I had the opportunity of appearing before the Joint Parliamentary Select Committee on Air

Pollution and vehicle emission NO2 levels recently, and it was clear that further central government action is likely. In addition, the Chief Medical Officer, Dame Sally Davies’, Annual Report on the Health of the Nation (to be published in April) is focused on pollution with over 20 recommendations and what we can do as a society to reduce the health hazards and risks. Finally, in early March with the RCP, I have convened a Round Table discussion of progress and challenges since the RCP Report was published exactly 2 years ago. Several ministers (Therese Coffey, Defra; Steve Brine, Public Health and Jesse Norman, Transport) as well as influential members of the Lower and Upper Houses of Parliament will be attending. It would be wonderful if I could use the SUHT as a flagship of pollution action when I introduce the progress we have made locally. Thank you, again, for putting the necessary time aside to consider this important public health issue. I am only sorry I could not be with you myself to speak to this issue directly, but I shall be in the US at an allergy and immunology conference. Kind Regards, Yours Sincerely,

Stephen T Holgate CBE, BSc, MD, DSc, FRCP, FRCPath, FFPH, FRSB, FERS, MAE, FMedSci RCP Special Advisor in Air Quality MRC Clinical Professor of Immunopharmacology and Honorary Consultant Physician, University of Southampton. Email: [email protected]

2

Page 9 of 9 Enclosure 4 2017/18 Finance Report - Month 10 Executive Summary:

Strategy & Finance In Month and Year to date Highlights: Report to: Committee February 2018 1. In January the control total surplus was £3.7m, £0.9m lower than Plan. For the ten months year-to-date (YTD), the surplus is £19.9m, £0.5m behind Plan (compared to £1.9m ahead of Plan at Q1 and £0.5m ahead at both Q2 & Q3) and has delivered a control total Finance Report for surplus of £19.9m. Following the award of winter pressure monies not included in our forecast (£1.8m), the revised control total Title: Period ending 31/01/2018 target is now £28.9m so a further £9m surplus in the remaining 2 months of 2017/18 is required.

2. Under the single oversight framework, the score for Finance and Use of Resources remains at ‘1’.

3. CIP delivery in the month was £2.5m against a target of £3.5m. To month 10 the Trust is £2.6m short of the planned CIP delivery of Author: Paul Goddard £24.9m. From October the Trust CIP target increased to £3.5m per month and will continue at this rate until March 2018.

4. Clinical income (excluding all STF income) in January was £57.5m, £0.7m more than December but £0.4m less than Plan. Net of the QIPP target agreed with Commissioners, the Trust was £1.5m ahead of Plan in the month. After 10 months, the Trust is 3.7% Sponsoring David French (£20.1m) ahead of the clinical income Plan, of which £18.9m relates to QIPP which is assumed to have not been achieved. Director: 5. Operating costs were £3.7m adverse in the month (compared to £1.8m in December) due to non-achievement of cost reduction related to QIPP (£1.9m), £0.4m CIP shortfall, £1m subcontracting cost increase and winter pressures related pay overspend. YTD Purpose: Standing Item operating costs are £26.3m higher than Plan due mostly to non-achievement of QIPP (£18.8m), behind Plan pay CIP performance and clinical supplies.

6. Cash at bank is £12.4m below Plan due primarily to higher working capital of £16.9m (delays in receipt of 2017/18 over- performance income from Commissioners), partially offset by lower capital expenditure investment. The Committee is asked to note the report

1 Page 1 of 10 2017/18 Finance Report - Month 10

Finance: I&E Summary Overall: Green

Metric 2017/18 Total income excl QIPP was £0.6m YTD Actual YTD Metric YTD Plan favourable against Plan, £1.8m Capital service cover rating 2.57 1 1 higher than in December and £2.7m Liquidity rating 4.57 1 1 higher than the average for the I&E Margin Rating 3.02% 1 1 year. I&E Margin Variance Rating -0.19% 2 1 Agency Variance from ceiling 25.43% 1 1 Inpatient activity was on Plan in Use of Resources Average Metric 1.20 1.00 Use of Resources Final Metric 1 1 elective and £1m over plan in non- elective. Outpatient income is

currently estimated to be over Plan by £0.2m.

High cost drugs and devices were below plan in the month by £1.5m Current Month Year to Date Full Yr Prior Year to Date although this will be reflected in an A ve To underspend in operating costs Plan Actual Variance Plan Actual Variance Plan Actual Var Done Do within drugs and clinical supplies. £m £m £m £m £m £m £m £m £m £m £m NHS Income: Clinical 57.9 57.5 -0.4 564.1 565.3 1.2 G 677.5 522.3 8% 56.5 56.1 OPEX was £1.8m adverse to Plan QIPP Reduction -1.9 - 1.9 -18.9 - 18.9 G -22.7 - excl QIPP. Overall expenditure was £1.6m higher than in December and Other income Other Income excl. STF 7.6 8.6 1.0 76.1 79.9 3.8 G 91.3 84.6 -6% 8.0 5.7 £1m higher against the average for Core STF Income 2.1 2.1 - 13.7 13.7 - G 17.8 14.5 -6% 1.4 2.1 the year. Total income 65.7 68.2 2.5 635.0 658.9 23.9 G 764.0 621.4 6% 65.9 61.8

Costs Pay 36.6 38.7 2.1 369.7 375.2 5.5 A 442.8 357.3 5% 37.5 33.8 The in month position was worse Drugs 8.4 6.9 -1.5 84.4 78.4 -6.0 G 101.1 77.1 2% 7.8 11.4 than the forecast and relates to a Clinical supplies 6.9 6.0 -0.9 67.6 71.6 4.0 R 81.2 72.4 -1% 7.2 4.8 mixture of lower income and higher costs, with the impact of winter Other non pay 8.3 10.4 2.1 84.4 88.4 4.0 R 101.5 77.0 15% 8.8 6.5 pressure demands and lower CIP QIPP Reduction -1.9 - 1.9 -18.8 - 18.8 R -22.5 - delivery. Total expenditure 58.4 62.0 3.7 587.3 613.6 26.3 R 704.0 583.8 5% 61.4 56.5 EBITDA 7.3 6.2 -1.1 47.7 45.3 -2.4 A 59.9 37.7 20% 4.5 7.3 Depreciation 1.9 1.8 -0.1 18.9 17.6 -1.3 G 22.7 17.6 0% 1.8 2.6 Executive Directors continue to PDC and interest 0.8 0.8 -0.1 8.4 7.8 -0.5 G 10.1 7.8 0% 0.8 1.1 monitor this performance with each Control Total Surplus / (Deficit) 4.6 3.7 -0.9 20.4 19.9 -0.5 A 27.1 12.2 63% 2.0 3.6 Division; working on actions to reduce expenditure with a heavy focus on the pay bill. I&E Margin 3.21% 3.02% -0.19% A 3.55%

2 Page 2 of 10 2017/18 Finance Report - Month 10

Use of Resource Metric Overall Risk-Rating 0.0

Plan 1.0

1 rating

2.0 2 rating Risk Rating

3.0 3 rating Overall the Trust’s Use of Resources Actual score is ‘1’ with our forecast 4.0 position to be a ‘1’ at the end of the Jul-17 Jan-18 Jun-17 Oct-17 Apr-17 Feb-18 Sep-17 Dec-17 Aug-17 Nov-17 Mar-18 financial year. May-17

Capital Service Cover ‘1’ Capital Service Cover EBITDA would need to be £1.2m 3.0 lower to achieve a '2' and £22.8m 2.5 lower to deteriorate to a '3'. CSC Actual 2.0 Liquidity Rating ‘1’ CSC Plan 1.5 Liquidity would need to reduce by 1 rating 1.0 £9.3m to reduce to a '2'. Cover (no. times)of 0.5 2 rating

0.0 3 rating

Jul-17 Jan-18 Jun-17 Oct-17 Apr-17 Feb-18 Sep-17 Dec-17 Aug-17 Nov-17 Mar-18 May-17

6 Liquidity Rating 4 2 0 LR Actual -2 -4 -6 LR Plan Liquid Days -8 -10 1 rating -12

-14 2 rating -16

3 rating Jul-17 Jan-18 Jun-17 Oct-17 Apr-17 Feb-18 Sep-17 Dec-17 Aug-17 Nov-17 Mar-18 May-17

3 Page 3 of 10 2017/18 Finance Report - Month 10

Use of Resource Metric

I&E Margin 4%

3% I&E Margin Actual 2%

1% I&E Margin Plan

I&E Margin ‘1’ Margin 0% YTD surplus would need to reduce 1 rating by £19.8m to reduce to a 2. -1% 2 rating -2%

-3% 3 rating

I&E Margin Variance ‘2’ Jul-17 Jan-18 Jun-17 Oct-17 Apr-17 Feb-18 Sep-17 Dec-17 Aug-17 Nov-17 Mar-18 YTD surplus would need to fall by May-17 £6.4m before reducing to a '3' or I&E Margin - Variance increase by £1.4m to improve to a 2.5% '1'. 2.0% 1.5% I&E Margin Variance Actual Agency Ceiling ‘1’ 1.0% 0.5% I&E Variance Plan Agency spending could increase by 0.0% £3.2m before falling to a '2'. -0.5% 1 rating Margin Variance -1.0% -1.5% 2 rating -2.0% -2.5% 3 rating Jul-17 Jan-18 Jun-17 Oct-17 Apr-17 Feb-18 Sep-17 Dec-17 Aug-17 Nov-17 Mar-18 May-17

Agency Variance from ceiling 40.0% 30.0% 20.0% 1 rating 10.0% 0.0% 2 rating -10.0% -20.0%

Margin Variance 3 rating -30.0% -40.0% -50.0% Agency Variance from ceiling -60.0% Jul-17 Jan-18 Jun-17 Oct-17 Apr-17 Feb-18 Sep-17 Dec-17 Aug-17 Nov-17 Mar-18 May-17

4 Page 4 of 10 2017/18 Finance Report - Month 10

Bedstate Bedstate 2015/16 - 2017/18

120.0% The bed state information shown

highlights a 3 year comparison. 100.0% B B B B B B B B B B RB B B B B B B B B B B B B B B B B B B B R B R B B R B R R R R The January 2018 bed state R R R R 80.0% R R illustrates a challenging picture R R R A R R when compared with January A R A R R R R A R 2017 and 2016 with both black A 60.0% R A A R R and red alert status on the A R R R A R R R increase and amber and green A A A decreasing. 40.0% A A A A A A G A A G G A G This will explain the inpatient G G A 20.0% G A G A income performance versus Plan A A A G A G G G G G A G A G in the month based on the draft G G G G G A A G G A activity information received for 0.0% G G G G G G G G GA G G January, where elective A15 A16 A17 M15M16M17 J15 J16 J17 J15 J16 J17 A15 A16 A17 S15 S16 S17 O15O16O17 N15N16N17 D15 D16 D17 J16 J17 J18 F16 F17 F18 M16M17M18 performance is on plan and non- elective is significantly over.

5 Page 5 of 10

2017/18 Finance Report - Month 10

Sustainability & Transformation Funding

In 2017/18 70% of the STF will be awarded based on achieving the Sustainability & Transformation Funding 2017/18 control total surplus (excl STF income). The remaining 30% 2.50 will be linked to ED performance to include implementing the GP streaming service from Q3 onwards. 2.00 ED The full £11.6m of STF has been included in our results for Q1, Q2 & 1.50 ED ED ED Q3. To date STF cash has been £m £ ED received in full for Q1 plus the non ED element of Q2, £5.2m in total. 1.00 ED ED ED ED ED ED £ The Trust is still awaiting final £ £ £ 0.50 outcome of an appeal lodged with £ £ £ NHSI regarding Q2 ED performance £ £ £ and related payment (£1.1m). 0.00

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 The proportion of STF increased to 30% (from 20%) in Q3 (£1.8m per month) and increases again to 35% in Q4 (£2.1m per month).

The full STF for January has been assumed in these results as, with partners, the Trust achieved ED performance of 90.5%. In Q4 the ED performance is being measured solely on success against the 95% target for March only.

6 Page 6 of 10

2017/18 Finance Report - Month 10

Clinical Income

2016/17 2017/18 Prod Plan 2017/18 Prod Plan Monthly Run Rate YTD In Month In Month The chart shows clinical income in YTD Actuals Annual Plan YTD Plan YTD Actuals In Month POD GROUP Variance Actual Variance Done To Do December, including an estimate £000s £000s £000s £000s Plan £000s for final cut. £000s £000s £000s Inpatients £196,592 £320,245 £241,287 £244,755 £3,468 £26,607 £27,605 £998 £27,195 £25,164 Inpatient performance was better Outpatients £61,657 £91,788 £68,733 £70,335 £1,601 £7,128 £6,797 (£331) £7,815 £7,151 than planned levels in December. Other Activity £65,889 £105,502 £79,186 £74,838 (£4,348) £8,814 £8,535 (£279) £8,315 £10,221 Exclusions £84,077 £135,064 £100,376 £98,273 (£2,103) £11,555 £9,762 (£1,793) £10,919 £12,264 Outpatient performance was Financial Adjustments £9,721 (£9,202) (£6,014) £13,213 £19,226 (£672) £3,955 £4,627 £1,468 (£7,472) slightly lower than planned in December. S& T Funding £11,600 £17,806 £11,277 £11,277 £0 £1,781 £1,781 (£0) £1,253 £2,176

Maternity pathway bookings and Grand Total £429,536 £661,204 £494,845 £512,690 £17,845 £55,213 £58,435 £3,222 £56,966 £49,504 direct access activity were both lower in December, driving the underperformance in other activity.

The underperformance in exclusions is driven by high cost drug activity being below planned levels.

Commissioner QIPP activity reduction plans are not delivering and this is driving the over performance in financial adjustments.

The Trust continues to provide for commissioner challenges (post the month 6 alignment agreements) and CQUIN failure which will be resolved as data and reports become available.

7 Page 7 of 10 2017/18 Finance Report - Month 10

Overall WTEs and Staff Costs Overall Headcount WTE Overall Pay Budget v Actual WTE £000 10900 Substantive, Bank & Agency – 39,000 10400 38,000 37,000 9900 Overall worked headcount in 36,000 9400 35,000 34,000 the Trust decreased by 33wtes 8900 33,000 from December to 9,975wtes. 8400 32,000

Agency usage increased by £0.2m with £1m being spent, an increase of £0.1m compared Medical Headcount WTE Medical Budget v Actual WTE £000

to the average for the first 9 1,600 13,500 13,000 1,500 months of the year. Agency 12,500 WTE increased by 22wtes. The 1,400 12,000 1,300 11,500 11,000 usage remains well within the 1,200 10,500 NHSI agency ceiling. 1,100 10,000

Bank usage increased to £1.6m from £1.4m in December. This Nursing Headcount WTE Nursing Budget v Actual is back to pre December levels WTE £000 4,000 13,500 3,900 with the demand being related 13,000 3,800 to winter pressures. Bank WTE 3,700 12,500 3,600 increased by 42wtes. 3,500 12,000 3,400 11,500 3,300 3,200 11,000 Net of staff recharges, the monthly pay-bill was £38.7m, £2.1m higher than Plan as the Plan assumed a ramp up in pay Other Clinical Headcount WTE Other Clinical Budget v Actual WTE £000 CIP delivery from October and 3,300 9,000 3,200 8,500 3,100 £1m more than December. 3,000 8,000 2,900 7,500 2,800 2,700 7,000 2,600 Service developments such as 6,500 2,500 Lymington and the opening of 2,400 6,000 Hybrid theatre were not including in the NHSI Plan. Admin Headcount WTE Admin Budget v Actual WTE £000

Delivery of cost efficiencies 2,100 5,500 2,000 (CIP) is key to remaining within 1,900 1,800 5,000 the pay targets for the 1,700 1,600 remainder of the year and 1,500 4,500 1,400 1,300 going into 18/19. 1,200 4,000

Budget

Actual 8 Page 8 of 10 2017/18 Finance Report - Month 10

1,600,000 2017/18 Agency NHSI Ceiling and Spend Temporary Staff Costs 1,500,000

1,400,000

1,300,000 January’s agency spend across all staff groups was 1,200,000 £1m in the month. This is an 1,100,000

increase of £0.2m compared 1,000,000 to December although is still 900,000 2017/18 NHSI £0.3m lower than the 17/18 Ceiling NHSI ceiling. £ 800,000 Nursing qualified 700,000 Nursing unqualified Trust-wide bank expenditure 600,000 Medics was £0.3m higher than December and £0.1m higher 500,000 Scient & Tech than the average for 17/18. 400,000 Admin & Estates

300,000 Tot al Agenc y Bank expenditure paid at standard NHS rates, is 200,000 expected to continue to grow 100,000 in 17/18 offsetting more 0 expensive agency however, due to the pressure in

substantives and impact on vacancies, both agency & bank increased this month.

18,000,000 16,000,000 2017/18 Agency Year to Date Spend 14,000,000 12,000,000

10,000,000 Agency £ 8,000,000 Spend 6,000,000 NHSI Ceiling 4,000,000 2,000,000 0

9 Page 9 of 10 2017/18 Finance Report - Month 10

Capital Expenditure

In addition to previously confirmed Month Year to Date NHSI PDC funding of £1m for GP Plan Actual Var Plan Actual Var Plan streaming capital, £5m under the Scheme £000's £000's £000's £000's £000's £000's £000's Global Digital Exemplar (GDE) , and £0.7m for Cyber Security Resilience, Childrens Hospital 20 23 3 200 102 (98) 2,800 the Trust will now receive £1.8m for IT Schemes 300 954 654 5,258 4,672 (586) 6,600 an additional linear accelerator this Linac Bunker (67) 1 68 1,073 816 (257) 1,140 Strategic Maintenance 200 316 116 2,103 2,345 242 2,400 year. It is not yet confirmed Medical Equipment Panel 231 27 (204) 1,627 764 (863) 2,169 whether there will be any funding Radiotherapy Equipment Replacement 0 16 16 100 295 195 5,438 for a linac anticipated in 2018/19. SHDU Expansion 0 2 2 1,220 1,078 (142) 1,260 GICU Expansion 20 8 (12) 200 99 (101) 2,412 Donated income is now forecast to Theatre Modernisation 0 1 1 1,161 1,117 (44) 2,140 be £0.3m under plan for the year as Other Schemes 3,453 (162) (3,615) 17,586 7,559 (10,027) 16,638 a result of slippage on the Total Excluding Finance Leases 4,157 1,186 (2,971) 30,528 18,847 (11,681) 42,997 Children’s Hospital scheme. Leased additions- IISS 0 877 877 7,025 4,211 (2,814) 9,015 Leased additions- Other 0 1,249 1,249 9,988 9,773 (215) 10,554 In month lease additions are related to the Nuclear Medicine scheme, Total 4,157 3,312 (845) 47,541 32,831 (14,710) 62,566 which is being accounted for as part of the IISS enabling works, and Less: Endoscopic imaging where there is Losses on disposals - - - - 6 6 - an underlying lease within a Donated asset additions (130) - 130 (1,298) (1,038) 260 (1,556) managed service. Performance against Capital Departmental Expenditure Limit (CDEL) 4,027 3,312 (715) 46,243 31,799 (14,444) 61,010

10 Page 10 of 10 Enclosure 5

Trust Board meeting 1 March 2018

Title New Five-Year Staff Strategy

Sponsoring Executive Fiona Dalton – Chief Executive Officer Gail Byrne – Director of Nursing and OD

Authors’ names & Job Steve Harris – Director of HR titles Jo Mountfield – Director of Education, Training and Workforce

Purpose of the paper For To note  Formal For decision  information  approval ☑

History The strategy has been approved at TEC on 14 February 2018 and discussed with UHS staff side representatives

Main issues / Executive This paper sets out a joint 5 year strategy for staff in UHS based Summary on the forward vision. It provides key goals to be achieved by 2023 and metrics by which these will be measured.

The paper reflects UHS strategic ambitions and is sensitive to local and national pressures relating to the workforce.

Implications This strategy looks to address our continuing drive to be one the best NHS employers, to meet the continuing complex needs of healthcare in context of skills gaps in key areas, and further grow our opportunities for supply by developing new and existing education pathways.

It is consistent with the proposed national 10 year workforce strategy for the NHS in consultation at present.

Action Required 1. To review the strategy and provide comments 2. To approve the strategy

Next Steps If approved:

1. Publication on the Trusts external website including revision into the Trusts corporate imagery and format 2. Creation of an annual programme of objectives to be monitored on a 6 month basis by TEC and Trust board

1 Introduction

1.1 The Trust, as set out in the Forward Vision document, aims to be create an organisation where we can recruit, support, motivate and develop the highest calibre of staff. At a time when workforce is such a critical issue for the NHS, UHS needs to set out its strategic direction to meet the objectives of the Forward Vision, and ensure that steps are taken to address the supply and labour market challenges facing the NHS.

Page 1 of 15

1.2 The attached strategy is a joint statement of direction till 2023 between education, training and workforce and the HR directorate. This provides clarity of our intended direction of travel, takes into account national strategic NHS factors, and provides a platform for annual objectives, resource allocation and prioritisation for workforce issues.

1.3 The full strategy is set out in Appendix 1. It is designed to be simple and goal focused.

2 Key Issues

2.1 The strategy sets out 7 areas of core focus. Each has specific goals to be achieved by 2023. These areas of focus are:

• Planning for, attracting, retaining, and deploying the best staff by creating the culture and work environment that makes UHS an employer of choice. • Delivering the UHS culture though our values, and embedding this into all of our day to day work. • Continue to invest in education and training opportunities for our staff, including leadership development. • Focusing on the staff and students of the future by developing our education and training capability for clinical and non-clinical staff. • Ensuring that our leaders and staff understand and deliver our equality, diversity and inclusivity agenda. • Prioritising excellent communication that allows the voice of our staff to be heard and acted upon. • Working with our education stakeholders to offer excellent learning, and placement opportunities to bring high calibre people into roles in the hospital.

3 Next Steps

3.1 Each year a set of objectives to drive progress towards these goals will be set out in an annual plan with smart targets.

3.2 Progress will be reported by HR and TDW at intervals (normally 6 months) to TEC and Trust Board. Resources required for delivery in excess of annual budgets will be identified during budget setting

4 Recommendation

4.1 It is recommended Trust board agree this strategy and support a process of annual objective creation and monitoring through TEC and Trust Board.

Page 2 of 15

DRAFT

UHS - Staff Strategy 2018 - 2023

Delivering the Forward Vision through our workforce

Gail Byrne - Director of Nursing and OD Steve Harris - Director of HR Jo Mountfield - Director of Education and Workforce

1

Page 3 of 15 Introduction

University Hospital Southampton NHS Foundation Trust (UHS) has a growing national reputation as a top teaching hospital in the UK and abroad. It attracts candidates locally, nationally and internationally and is also one of the largest employers in Southampton. With over 10,500 staff working in a diverse range of healthcare related fields, the Trust offers an exciting, rewarding and happy place to work.

The Trust’s ‘Forward Vision’ document places the workforce at the heart of delivering a successful and sustainable organisation moving forward for the patients its serves. Much has already been achieved at UHS in relation to its workforce. The Trust has excellent staff survey results that have continued to improve, our education provision and partnership with local institutions is strong with an excellent reputation regionally. We have a national profile in relation to our delivery of health and wellbeing initiatives; have a strong success with resourcing and recruitment overseas, and a track record of delivering prudent financial performance in relation to workforce expenditure, including reductions in agency spending.

The Trust has been awarded ‘Outstanding’ by the CQC in the ‘Well-led’ domain, attributed to a strong positive culture, which has developed throughout the organisation.

The Trust has much to be proud of, but the challenge is far from over. The Forward Vision sets out further ambition for the Trust that recognises the delivery of healthcare is changing. An ageing population, with increasing complexity of healthcare needs and an exponential demand on services places the NHS under national strain. The need to provide our services to the patient round the clock, seven days a week, and in new ways, is an increasing need. Our existing and future workforce is also changing, with evolving and differing generational expectations on employment and types of work, and constraints on supply of current and future staff.

There are opportunities for UHS. Greater system and service integration (Hospital Without Walls), technological advancement as leaders in the Global Digital Excellence programme, and the exciting research and development agenda make the importance of planning, recruiting, retaining, effectively deploying and developing our workforce more fundamental than ever.

Purpose

The purpose of this document is to outline the key areas of focus for the Workforce Agenda for the next 5 years.

It will provide:

• Our goals by 2023. • How this will be delivered. • How we will judge success.

2

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Our key aims as per the Forward Vision

The NHS faces a number of challenges to ensure a sustainable workforce in the future. A number of professions, including nursing, face shortages now, and in the future. The uncertainty of the international recruitment market provides further challenges; national efforts to drive up our domestic supply (through increased training of professions) will not take effect within the next year, and places additional requirements on local supervision and support. This is set against a growing demand for healthcare services at all times of the day, and every day of the week, as the population ages, morbidities become multiple, highly complex and the pressure on emergency services increases.

Healthcare faces an unprecedented workforce challenge, and therefore, UHS must ensure that it delivers locally on a number of key priorities, to help ensure that we sustain our services to the Southampton population and our regional population now, and in the future.

Our vision for our workforce is simple:

“We need to create an organisation where we can recruit, support, motivate and develop the highest calibre of staff”

Fiona Dalton CEO

This document sets out 7 key areas that underpin our strategy for the next 5 years, these are:

• Planning for, attracting, retaining, and deploying the best staff by creating the culture and work environment that makes UHS an employer of choice. • Delivering the UHS culture though our values, and embedding this into all of our day to day work. • Continue to invest in education and training opportunities for our staff including leadership development. • Focusing on the staff and students of the future by developing our education and training capability for clinical and non-clinical staff. • Ensuring that our leaders and staff understand and deliver our equality and diversity agenda. • Prioritising excellent communication that allows the voice of our staff to be heard and acted upon. • Working with our education stakeholders to offer excellent learning, and placement opportunities to bring high calibre people into roles in the hospital.

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Page 5 of 15 The National Context - A national Strategy for the NHS

In December 2017, Health Education England (HEE) published a draft workforce strategy for the NHS. This provided a summary of the current national and international supply challenges and core areas of focus for the coming 10 years.

The principles of this strategy match the direction of intended travel at UHS. Primarily, both focus on building capacity and capability in staff; through focusing on increasing supply, building on good management practices such as retention, and focusing on other aspects that will improve workforce productivity and efficiency.

The key principles that will underpin national workforce decisions are outlined as follows:

1. Securing the supply of staff that are needed to deliver high quality care.

2. Training, educating and investing in the workforce.

3. Providing career pathways for all staff rather than just ‘jobs’.

4. Ensuring that people from all backgrounds have the opportunity to contribute to, and benefit from, healthcare.

5. Ensuring that the entire NHS is a modern model employer, with flexible working patterns, career structures, and reward mechanisms.

6. Ensuring that in the future, service, financial, and workforce planning are intertwined.

Appendix 1 shows how the UHS staff strategy meets the national principles.

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Page 6 of 15 Planning for, attracting, retaining, and deploying the best staff by offering them a better deal, and the best place to work

UHS will develop its resourcing and deployment practices to ensure the best ‘deal’ for staff, and to ensure that value is maximised from our workforce pay bill.

Plan

Retain Attract

Develop

Deploy Select

Secure

By 2023, we will aim to achieve the following:

• Design and implement a recruitment and resourcing strategy sensitive to shortages, and meeting the differing generational needs, alongside national and international market pressures. This will include robust planning of the workforce based on demand and capacity. • Continued delivery of sustained improvements in our staff survey results, including maintaining our position as one of the best University Teaching Hospitals. • To be recognised as a leading NHS Employer on supporting its staff in their health and wellbeing. • To have developed and embedded a regionally recognised employer brand, supported by a range of valued benefits for staff. • To have excellent core Human Resources services to ensure speed, simplicity and fairness, whilst maximising opportunities for productivity. • To be an exemplar site for rostering and deployment of staff, recognising the changes in the demand for flexible working in employee expectations, and also the demands of a 24/7 patient service. • To be recognised as an exemplar site for partnership working with trade unions at local and corporate level. • To continue to meet regulatory control targets on use of agency spending, and continue to control our workforce costs to meet our agreed financial plans. • To have robust, fully financially integrated workforce plans. • Tailored talent management and succession planning processes adapted for different groups of staff, and applied appropriately at all levels. • Support the delivery the UHS Research and Development strategy by fostering an environment that recruits develops, and nurtures roles to support the ‘Research for all’ Vision.

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Delivering the UHS culture though our values, embedding this into all of our day to day work

Our three values of Patients First, Working Together and Always Improving are central to the way in which we work at UHS. Our culture has been internally and externally overall recognised as being positive, but we need to go further in order to fully maximise our potential.

Our values drive our behaviours, drive our actions and support our performance and delivery.

By 2023 we will:

• Have developed and embedded a full set of behaviours that underpin our values. These will be the currency of every day work; they will drive our systems of recruitment, appraisal, development, promotion and reward. • Be recognised as an exemplar site for quality improvement where ‘always improving’ is seen as an integral and fundamental part of every employee’s job. • Ensure that the majority of our staff report through the staff survey that the values are recognised and deployed in all aspects of their employment. • Ensure that we engage with contractors for outsourced services that reflect our vision and values in the management and development of staff. • Ensure our values and principles are aligned in any subsidiary companies created, or acquired, by UHS.

Focus on the future by developing our education and training capability for employees

Our employer brand will ensure prospective and existing staff understand their entitlement to education, training, and development. Continuing professional development will be a core aspect for all staff, whether in clinical, support or administrative roles.

The national and international shortages of healthcare professionals means that UHS must ensure that it plans its workforce with care and attention. We must work with our clinical leaders within the Trust, to ensure that we capitalise on the opportunities for development of roles to advanced practice, and maximise our employee skills and talent to the boundaries of their scope of practice.

We will need to continuously review our education offering, to ensure that where possible we can address our skills gaps by training and developing our own staff, whilst also offering enriching career progression.

We should also recognise that experienced and well-qualified staff could continue to offer support to current staff following retirement from full-time roles, and invest in developing innovative schemes to retain their wisdom and expertise.

By 2023 we will:

• Have assessed the local gaps in healthcare supply, and the changing face of healthcare work to identify, develop and train for new roles to meet this need. • Ensure that all of our staff have fair access to training and development, and are afforded appropriate opportunities for personal development consistent with their objectives, career goals and role. • Support education providers to recruit students/learners on their programmes, to retain them over the course of the programme, and to maximise employment opportunities at the end of their course.

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Page 8 of 15 • Continue to be an active partner with both education providers and other placement providers, to assure that learners are afforded clinical experience, knowledge and skills that enable transition into qualified posts. • Take opportunities to develop our own programmes, with partner organisations where appropriate, to meet current and future workforce needs. This will include schools, colleges, higher and further education institutes. • Gain a reputation for excellence as an accredited provider of apprenticeships and other programmes for training and work experience. • Be an exemplar site for the education, training, and development of our junior doctor workforce in partnership with the Deanery. • Work with education providers across all age groups, to provide information and opportunities to raise awareness of the diversity of UHS career opportunities in order to inspire early pursuit of health careers.

Continue to invest in leadership development at all levels

Our leadership development will be shaped around our forward vision and our values to deliver resilient, compassionate, forward- thinking and capable leaders needed for the future.

By 2023 we will:

• Embed a range of opportunities to develop our leaders, and those with potential aligned to our values. • Have developed a regionally recognised graduate training scheme for our managers and leaders of the future, in both operational and corporate functions. • Ensure that we have clear leadership programmes to support clinical leaders in moving into management positions in the Trust. • Have a clear and ongoing programme of leadership development ensuring that ongoing resources are invested wisely to deliver the best outcomes. • Ensure that our leadership programmes reach, and are available to a diverse range of individuals, and support underrepresented groups to gain access to promotion.

Ensure that our leaders and staff understand and deliver our equality, diversity and inclusivity agenda

Our values of working together and always improving mean that we strive to improve our inclusivity as an employer. Nationally, the NHS still shows a long way to go with regards to its engagement and inclusivity of diverse groups, with particular challenges in Black Asian Minority Ethnic (BAME) and disabled staff groups.

UHS wants to aim to be a beacon for diverse and inclusive employment.

By 2023 we will:

• Be recognised as a leading organisation on maximising the diversity and inclusivity of its workforce to meet our organisational goals. • Deliver sustained improvements in our BAME and disabled staff engagement in the annual staff survey results. For our BAME staff to report a similar experience to white colleagues in relation to fairness, and equity of opportunity. • Have increased numbers of BAME leaders in middle and senior management positions by developing internal talent and seeking the best diverse talent from the labour market. • Be recognised as a great place to work by the Lesbian, Gay, Bisexual, Transsexual (LGBT) community by being ranked in the Stonewall 100 best employers.

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Page 9 of 15 • Have developed sustained partnerships with representative local and regional groups to increase our inclusivity, supply of diverse talent; and build a reputation for fairness, inclusivity and true diversity.

Prioritise excellent communication that allows the voice of our staff to be heard and acted upon

Effective communication is a key aspect of our ability to recruit, retain and develop our best staff. It underpins our staff engagement, is an indicator of the health of our culture, and illustrates how we live our values every day.

The growth in digital technology, emerging new trends and the explosion of social media provides exciting opportunities to engage in innovative ways with existing and prospective staff, particularly those in the younger generations.

It is vital that our staff can receive communication in a way that meets their needs, which ensures that the right information is provided at the right time, and provides a platform for dialogue on issues of importance to be created at all levels of the Trust. It’s vital that the leaders in the Trust engage, listen and act on feedback and ideas provided.

It is also vital that we strive to be an exemplar in quality communication skills at all levels through our recruitment, training and development of staff. We need to continue to ensure that staff can have purposeful two way conversations, providing and receiving quality feedback at all levels.

By 2023 we will:

• Ensure effective communication skills (both face to face and digital) are embedded into all aspects of management, staff and leadership development. • Promote and enable more individuals than ever before to have honest, purposeful and quality conversations, wherever they work. • Ensure that our staff are supported and guided in the use of digital technology, for communication, social media and education and training, and keeping pace with new developments. • Have a recognised culture of raising concerns in an open and transparent manner in line with the Freedom to Speak up national requirements. Ensure that staff feel that concerns are listened to and acted upon as appropriate.

Work with our education stakeholders to offer excellent education opportunities to bring high calibre people into roles in the hospital

The pathways created by new mechanisms for training for roles provide the opportunity to transform how we grow the future workforce.

The national apprenticeships agenda, coupled with new frameworks for the training of healthcare professionals provides UHS with a platform to deliver education in partnership with new and emerging education providers who are entering the market. Traditional direct entry via degree based healthcare education will remain an important entry point into the NHS, this will however be supplemented by a parallel vocational mechanism of training to professional roles.

By 2023 UHS will:

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• Partner with a wide range of top quality providers to support placement capacity for new and existing programmes, to ensure that we can train our own staff for current and future roles, particularly for highly specialist roles eg: healthcare science. • Have developed clear partnerships with local schools and higher education providers to ensure clear, well known career pathways for those looking for entry level jobs to healthcare. • Have developed a regionally recognised work experience programme in partnership with local schools and education providers. • Be recognised as a leading employer for apprenticeships in the Southampton area with over 250 apprentices employed and undertaking vocational training each year. • Be delivering an increasing percentage of newly qualified nurses through the degree apprenticeship route. • Have developed an exciting employment and development offering career grades in medical staffing, including re-introducing the associate specialist grade and continuing to grow our clinical fellow workforce. • Provide a range of accessible programmes for local applicants to pursue health careers.

How we will deliver this

Each year, Training, Development & Workforce and Human Resources will draft annual plans in line with these objectives, which will be agreed by Board. Progress against these objectives will be reported to Trust Executive Committee and Trust Board.

Key performance indicators focusing on recognised workforce metrics, providing an indication of workforce productivity and engagement will be reported monthly to Trust Executive Committee and Trust Board.

We will ensure operational excellence, monitoring service delivery in all aspects of HR and training delivery against agreed service standards. These will be regularly reported to stakeholders, challenged and continually reviewed to seek opportunities for improvement.

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How we will measure success

Metrics will be designed for each of the key goals. These will be to gauge the success of our strategy. Progress against the metrics will be reported as part of each year’s annual plan.

Key metrics for success will be as follows:

Goal Measurement Position in Target by 2023 February 2018 Attracting and National Staff 74% 80% of staff recommending UHS retaining the best Survey and FFT as a place to work. staff by offering them a better deal 3.96 A staff engagement score of 4 and the best place to out of 5 work

Workforce Data 15.43% A reduction in overall nursing (18.9% in vacancies to 12%. clinical wards)

A reduction in overall staff vacancies to 10% 3.45% To sustain sickness absence at no greater than 3.3%.

Ensure that our Workforce Data 7.5% 15% of positions at Band 7 and leaders and staff above are occupied by BME understand and staff. deliver our equality diversity, and inclusivity agenda Staff Survey Disabled staff BMAE staff and disabled staff Data 3.85 reporting a staff engagement score of at least 4 out of 5 (the BMAE staff same as all other staff) 4.03

WRES data Below BMAE and disabled staff average for all reporting the same experience as WDES data staff other staff groups in WRES and DES data

UHS to be in top National Staff Above UHS to be in top 20%. 20% for all aspects Survey Results average (Score of 4.2) of the national staff (Score of 4.0) survey with regards to quality of non mandatory training, development and education

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Page 12 of 15 UHS to provide high Evaluation and All partner Maintain HEI partner quality placements Quality HEI’s assessments of the quality of /attachment learning Assurance assessed placements as positive experiences for non- reporting from UHS as a medical, medical all HEI’s for positive undergraduates and which UHS placement / post graduate provides non- attachment medical trainees. medical learning provider for all experiences undergraduate

GMC survey for Noted Ongoing year on year Post Graduate significant improvement noted through the Medical trainees improvement GMC Survey in 2015 in relation to the GMC survey report which in 2017 demonstrated on going improvement To continue to be CQC Outstanding in To remain as outstanding in the rated as outstanding assessments July 2017 ‘well-led’ domain. by the CQC in the ‘well-led’ domain

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Page 13 of 15 Appendix 1: How the UHS staff strategy matches the National Strategic Principles.

National Strategic UHS Strategic Principle Principle Planning for, Delivering the Focus on the staff Continue to invest Ensure that our Prioritise excellent Work with our attracting, UHS culture of the future by in education and leaders and staff communication education retaining, and though our values, developing our training understand and that allows the stakeholders to offer deploying the embedding this education and opportunities for deliver our voice of our staff excellent education best staff by into all of our day training capability our staff including equality and to be heard and opportunities to bring offering them a to day work for clinical and leadership diversity agenda acted upon high calibre people better deal and non-clinical staff development into healthcare roles the best place to in the hospital work

Securing the supply of staff that are needed to deliver high quality care

Training, educating and investing in the workforce

Providing career pathways for all staff rather than just ‘jobs’

Ensuring that people from all backgrounds have the opportunity to contribute to, and benefit from, healthcare

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Page 14 of 15 Ensuring that the entire NHS is a modern model employer with flexible working patterns, career structures, and reward mechanisms

Ensuring that in the future service, financial and workforce planning are intertwined

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Page 15 of 15 Enclosure 6

Trust Board meeting 1 March 2018

Title CRN Wessex Quarter 1-3 Report 2017-18

Sponsoring Executive Dr Derek Sandeman, Medical Director

Authors’ names & job Rebecca McKay, Chief Operating Officer, CRN Wessex titles Graham Halls, Business Intelligence Manager, CRN Wessex

Purpose of the paper For To note  Formal For decision  information ☑ approval 

History Quarterly report.

Main issues / Executive The report sets out the NIHR Clinical Research Network Wessex Summary (NIHR CRN Wessex) performance for the period 1 April 2017 to 31st December 2017 (Q1 – Q3) 2017/18.

Key achievements: • All 12 NHS trusts have recruited into NIHR CRN portfolio studies. • CRN Wessex is ranked 4th for recruitment compared to the other 14 LCRNs when adjusted for population. • Over 31,000 participants were recruited into NIHR CRN portfolio studies within Wessex in Q1-Q3.

Implications While it is anticipated that the 2017/18 financial year recruitment target will be met, other LCRNs have out-performed CRN Wessex on recruitment weighted for complexity.

A significant percentage of the funding to the LCRNs is based on weighted activity. The fall in activity will have an impact on funding in 19/20. The current funding model has a -5% ‘collar’, which would equate to £850K reduction in funding on a £16.8M budget.

Action Required The Board is asked to note the performance of the network and the actions to mitigate the risks.

1 Purpose/Context/Introduction This report is to inform the partnership group of the performance of CRN Wessex and the planned actions to mitigate risk. LCRNs are funded by an activity based model. The model is weighted for complexity i.e. interventional studies that change the care pathway for patients attract more funding as they are more resource intensive. The national funding allocation is fixed. This means that LCRNs need to maintain their percentage share of national activity to safeguard their allocation or improve it to gain a budget increase.

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2 Key Issues Table 2 provides a summary of CRN Wessex’s current performance against the NIHR’s CRN high level objectives. CRN Wessex is currently exceeding the local recruitment goal agreed with the NIHR for the 2017/18 financial year (HLO 1, see also chart 1). The network is also improving its performance on HLO 2a year on year (62% 2016/17 Q1-3), suggesting that the partner organisations are better capitalising on their existing portfolio of commercial studies. The performance of the individual organisations in Wessex against this objective are summarised in table 1.

Closed commercial studies in Q1- % Studies recruiting to time and Trust 3 2017/18 FY to target DCHFT 5 100% HHFT 7 57% ICs 6 100% PHFT 1 0% PHT 14 79% RBCH 9 89% SFT 3 100% SHFT 6 83% UHS 35 66% Table 1: Performance against NIHR Higher Level Objective HLO2a in Wessex organisations 2017/18 Q1-Q3 ICs = Independent Contractors refers to, but is not exclusive to; GP Surgeries, pharmacies, private healthcare providers.

The early phase of study delivery has been highlighted as an issue (HLOs 4 & 5) and will be addressed by the research delivery teams via their contact with the support teams at each partner organisation. For the remainder of the financial year the priority will be increasing complexity weighted recruitment at our partner organisations and further improving the commercial performance.

NIHR CRN High Measure 2017/18 CRN Level Objective Target Wessex Q1-3

HLO 1 Number of participants recruited in the - 39,339 31,028 reporting year

HLO 2 Increase the proportion of closed (a) Commercial RTT 80% 75% studies recruiting to Time and Target

(b) Non-Commercial RTT 80% 67%

HLO 3 Number of commercial studies recruiting - - 157 in year (cumulative)

HLO 4 Proportion of studies achieving NHS set - 80% 62% up at all sites within 40 calendar days

HLO 5 Recruit first participant within 30 days (a) Commercial 80% 18%

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from first site confirmed (b) Non-Commercial 80% 44%

HLO 6 NHS Trusts recruited into NIHR CRN (a) Trusts recruiting into non- 99% 100% Portfolio studies commercial studies

(b) Trusts recruiting into 70% 77% commercial studies

HLO 7 Increase the number of participants - 2016/17 Q1- 864 recruited into Dementia and Q3: 670 Neurodegeneration studies on the NIHR CRN Portfolio

Table 2: Performance against NIHR Higher Level Objectives in Wessex 2017/18 Q1-Q3

Chart 1 shows recruitment to NIHR CRN Portfolio studies across Wessex for the 2017/18 financial year (Q1-3) and 2016/17. At the end of Q3 2017/18 the region was recruiting above both the year to date 2017/18 goal and the same point in 2016/17.

Chart 1: Recruitment against target in Wessex 2017/18 (Q1-3)

Ten of the twelve trusts within CRN Wessex were meeting or exceeding their recruitment target at Q3 (chart 2). This balances a shortfall at UHS, in main due to lower than planned recruitment to their largest study: ‘OAE Maturation’ which is currently suspended.

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Chart 2: Recruitment by partner organisation in Wessex against target 2017/18 (Q1-3)

The NIHR split specialities into six divisions (see glossary on page 8 for further details) and each is set an independent recruitment target for the financial year within CRN Wessex (chart 3). All are recruiting above their Q3 target. This is the anticipated position at this stage of the financial year to account for a ‘non-specified’ recruitment target of 7,114 that is not allocated against a division at the beginning of the year. Recruitment from studies that are led outside of England are also not assigned a division.

Chart 3: Recruitment by NIHR Division in Wessex against target 2017/18 (Q1-3)

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CRN Wessex are ranked 10th of 15 networks in England when reviewing overall recruitment weighted for complexity (chart 4a). Study complexity is banded, for example interventional studies (Band 3) that change the care pathway for patients are weighted highly to attract more funding as they are considered more resource intensive. Please refer to the glossary on page 8 for the weightings used for each study type.

To regain the seventh position achieved at the close of the 2016/17 financial year it has been estimated that CRN Wessex needs to reach a complexity weighted recruitment target of 216,000 by the end of 2017/18. If Q3 recruitment is repeated in Q4 the predicted year end total is 192,553. While this would be a 5.8% growth on 2016/17 most other clinical research networks have also seen a corresponding increase in activity. An increase in rank for Wessex is therefore unlikely without a significant uplift in complexity weighted recruitment in Q4 2017/18.

Chart 4a: Comparison of recruitment weighted by complexity against other LCRNs 2017/18 (Q1-3)

Each organisation’s complexity weighted recruitment for 2017/18 (Q1-3) is shown in chart 4b, with 2016/17 (Q1-3) included for comparison. The most active trusts continue to be Southampton and Portsmouth but both are reporting declining activity year on year.

While increasing overall recruitment by 20% compared to the last financial year, Solent have added 67% to their complexity weighted recruitment performance. This is principally through a partnership on a community health promotion study with the University of Portsmouth Dental Academy.

The independent contractors in the region have shown a dramatic increase year on year in both recruitment and the complexity of the studies they are participating in. Much of the uplift in interventional recruitment is a result of two studies: ‘ASSIST’ and ‘FORECEE’; the former is managed within Wessex by the University of Southampton.

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Locally developed and led studies will be one of the main focuses for CRN Wessex in Q4 2017/18 and onwards due to the opportunities they present for addressing the needs of the local population.

Chart 4b: Comparison of recruitment weighted by complexity within Wessex – 2016/17 (Q1-3) & 2017/18 (Q1-3)

When recruitment is adjusted for LCRN population CRN Wessex was ranked fourth in England (chart 5). The highest performing Wessex specialties are Cancer, Critical Care, ENT, MSK and Respiratory; all are ranked first in England.

Chart 5: Comparison of recruitment by LCRN adjusted for population 2017/18 (Q1-3)

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3 Next Steps / Way Forward / Implications / Impact

Actions 1. The partnership group agreed an incentivisation scheme in October to highlight the challenge facing partner organisations and to offer additional funding to them if they were able to increase recruitment in Q3 & Q4. The effect of this scheme will be assessed in the Q4 report.

2. Partner organisations are being made aware each month of CRN Wessex’s championed studies that offer the greatest potential for patients to enrol in new projects and contribute to the performance of CRN Wessex. These studies are identified to support the goal of increasing complexity weighted recruitment. Their participation in these studies is being monitored by the research delivery teams.

3. Commercial performance will be monitored by the industry team at the partner organisations with a goal to reach at least 80% of commercial studies closing having met their target by the end of this financial year.

4. The hard work and commitment of research teams funded by CRN Wessex will be recognised in an awards ceremony on 15th March 2018 at St Mary’s Stadium.

Risks When CRN Wessex is benchmarked against the other 14 LCRNs it has dropped in ranking compared to 2016/17 from 7th to 10th and the share of recruitment adjusted for complexity has dropped. If this was to remain the position for the final quarter the network is at risk of a budget cut in 2019/20.

4 Recommendation The partnership group will be updated on progress with quarterly performance reports.

5 Glossary The following performance indicators have been used in this report:

. NIHR HLOs - National Institute for Health Research High Level Objectives.

Ratios used for weighting complexity of recruitment (non-commercial recruitment only):

. Interventional studies (1:11) . Observational (1:3.5) . Large Scale >10,000 target (1:1).

Local Clinical Research Network (LCRN) abbreviations & populations used by the NIHR:

. Eastern (3,787,682) . EM - East Midlands (4,474,101) . GM - Greater Manchester (2,962,515) . KSS - Kent, Surrey and Sussex (4,539,969) . NENC - North East and North Cumbria (3,122,653) . NT - North Thames (5,554,518) . NWC - North West Coast (3,705,762) . NWL - North West London (2,034,996) . SL - South London (3,195,885) . SWP - South West Peninsula (2,249,056)

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. TVSM - Thames Valley and South Midlands (2,345,894) . Wessex (2,742,482) . WM - West Midlands (5,713,284) . WoE - West of England (2,419,720) . YH - Yorkshire and Humber (5,468,101).

The divisional recruitment includes the following specialties:

. Division 1 - Cancer . Division 2 - Cardiovascular, Diabetes, Metabolic & Endocrine Disorders, Renal, Stroke. . Division 3 - Genetics, Haematology, Paediatrics, Reproductive Health & Childbirth . Division 4 – Dementias and Neurodegenerative Diseases, Mental Health, Neurology . Division 5 - Age and Ageing, Dentistry, Dermatology, Health Services Research, Musculoskeletal, Public Health, Primary Care . Division 6 - Anaesthesia/Peri-operative Medicine & Pain Management, Critical Care, Ear Nose & Throat, Gastroenterology, Hepatology, Infectious Diseases/Microbiology, Injuries & Emergencies, Ophthalmology, Respiratory, Surgery.

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Enclosure 7

Trust Board meeting 1 March 2018

Title CRN Wessex Annual Plan 2018/19

Sponsoring Executive Dr Derek Sandeman, Medical Director

Authors’ names & job Rebecca McKay, Chief Operating Officer, CRN Wessex titles Graham Halls, Business Intelligence Manager, CRN Wessex

Purpose of the paper For information  To note  Formal approval For decision  ☑

History Annual Plan

Main issues / The report sets out the strategic direction for NIHR Clinical Research Executive Summary Network Wessex (NIHR CRN Wessex) in 2018/19. CRN Wessex was one of only two LCRNs to receive the maximum funding uplift for 2018/19.

Implications The plan sets an ambitious plan of activity to build on the success of 2017/18 and protect funding in future years.

Action Required The LCRN Host Organisation is asked to review and approve the plan as a reasonable way forward to build on local performance, successes, challenges and priorities from 2018/19.

1 Purpose/Context/Introduction 1.1. LCRNs have been asked to submit an Annual Delivery Plans for 2018/19 in advance of publication of the final DH/LCRN Host Organisation Agreement for 2018/19 and is based on Appendix A NIHR CRN Performance and Operating Framework 2018/19 Version 0.9 (POF). This document includes the proposed High Level Objectives (HLOs), Clinical Research Specialty Objectives and LCRN Operating Framework Indicators for 2018/19, in Appendices A, B and C of this document, respectively. It also builds on the NIHR CRN Performance Management Framework.

1.2. The POF sets out the organisational requirements and the national performance objectives, measures and targets for the NIHR CRN, which will be used to measure

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the success of the LCRN. The LCRN Annual Plan has been developed with close reference to this.

1.3. The LCRN Annual Plan has been developed in collaboration with the relevant local governance groups including the LCRN Operational Management Group and LCRN Partnership Group, and with Partner organisations, Clinical Research Specialty Leads and other key stakeholders. In addition CRN Wessex has engaged with CRNCC Directorates and Research Delivery Divisional teams, and National Specialty Leads for advice and expertise as required. and the CRN Improvement Objectives, set out in sections 2 and 4 of Part B: Performance Framework, of the POF.

1.4. The CRNCC have provided a Google template for LCRN Annual Delivery Plans and all LCRNs are mandated to use a copy of the template for submission of their plan

1.5. The LCRN Annual Financial Plan will be submitted separately via the CRN Finance Tool on 6 April 2018

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2 Summary of key issues and actions The table below summarises the key issues and actions detailed in the full plan attached.

1 Recruitment Increase the opportunities for patients in Wessex participate in research by ensuring parity of opportunity to participate in research by: • achieving recruitment target of 44,000 • ensuring studies are set-up rapidly and recruit to time and target • supporting specialty leads to develop portfolios in under- represented areas to match disease burden and participation • using social media channels to promote studies 2 NHS Work with partners to ensure that learning is shared across the Engagement network by: • promoting the wider benefits of research to the whole system and ensuring visibility at board level • developing cross specialty recruitment in Wessex • celebrating the success of research with an awards event • working with partners in the accountable care system in Dorset to develop ‘Research Active Dorset’ 3 Public and Celebrate the successes and benefits that research brings to patient patients and work with patients to ensure the research offer in engagement / Wessex is accessible to all by: communications • promoting the benefits of research through news stories • recruiting and working with patient research ambassadors • promoting parity of access through multi-media channels 4 Workforce Conduct a listening exercise with partner organisations to development understand the challenges of providing a fit for purpose research workforce and develop a coherent plan with partners to provide the right staff in the right place.

5 Working with Ensure that Wessex offers a consistent service to pharma by: life science • streamlining study set-up industry • delivering studies to time and target with reliable study feasibility informed by database searches • ensuring there is a well trained workforce to deliver studies

6 Information and Drive efficiency by ensuring that all partners have real time accurate knowledge data to inform business decisions and drive improvements by: • offering access to bespoke apps on the open data platform • facilitating access to ‘big data’ via cloud platforms to allow cohort analysis and patient identification

7 Business Work with small to medium size enterprises in conjunction with the development AHSN to help commercial innovators gather NHS evidence on their and marketing products, and get effective innovations to patients faster.

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3 Next Steps / Way Forward / Implications / Impact See above

4 Risks When CRN Wessex is benchmarked against the other 14 LCRNs it has dropped in ranking in 2017/18 compared to 2016/17 from 7th to 10th when recruitment adjusted for complexity is compared. The funding allocation for 2018/19 was safeguarded as the allocation was based on a two year rolling average. However, if this was to remain the position the network is at risk of a budget cut in 2019/20.

5 Recommendation The partnership group will be updated on progress with quarterly performance reports.

6 Glossary Local Clinical Research Network (LCRN) abbreviations & populations used by the NIHR:

. Eastern (3,787,682) . EM - East Midlands (4,474,101) . GM - Greater Manchester (2,962,515) . KSS - Kent, Surrey and Sussex (4,539,969) . NENC - North East and North Cumbria (3,122,653) . NT - North Thames (5,554,518) . NWC - North West Coast (3,705,762) . NWL - North West London (2,034,996) . SL - South London (3,195,885) . SWP - South West Peninsula (2,249,056) . TVSM - Thames Valley and South Midlands (2,345,894) . Wessex (2,742,482) . WM - West Midlands (5,713,284) . WoE - West of England (2,419,720) . YH - Yorkshire and Humber (5,468,101).

The divisional recruitment includes the following specialties:

. Division 1 - Cancer . Division 2 - Cardiovascular, Diabetes, Metabolic & Endocrine Disorders, Renal, Stroke. . Division 3 - Genetics, Haematology, Paediatrics, Reproductive Health & Childbirth . Division 4 – Dementias and Neurodegenerative Diseases, Mental Health, Neurology . Division 5 - Age and Ageing, Dentistry, Dermatology, Health Services Research, Musculoskeletal, Public Health, Primary Care . Division 6 - Anaesthesia/Peri-operative Medicine & Pain Management, Critical Care, Ear Nose & Throat, Gastroenterology, Hepatology, Infectious Diseases/Microbiology, Injuries & Emergencies, Ophthalmology, Respiratory, Surgery.

Page 4 of 89 Clinical Research Network Wessex

Annual Delivery Plan 2018/19

Date of submission: 16 March 2018

Submitted by: Rebecca McKay

Page 5 of 89 Host Organisation Approval Confirmation that this Annual Plan has been reviewed and agreed by the LCRN Partnership Group: Yes

Date of the LCRN Partnership Group meeting at which this Annual Plan was agreed: 12/04/18

Confirmation that this Annual Plan has been reviewed and approved by the LCRN Host Organisation Board: Yes

Date of the LCRN Host Organisation Board meeting at which this Annual Plan was (or will be) approved: 01/03/18

If this plan has not been approved by the LCRN Host Organisation Board at the time of submission to CRNCC, then the LCRN Host Organisation Nominated Executive Director should provide that confirmation by email to the CRNCC once the Board has approved the Plan

Page 6 of 89 Please confirm, at this point in time do you anticipate the Host Organisation and LCRN Partners being able to deliver the LCRN in full compliance with the Performance and Operating Framework Yes 2018/19? If you have answered 'no' to this question, please identify below the specific areas/clauses of the POF which are of concern by selecting the appropriate boxes, provide a brief explanation of the reasons for non-compliance. Any area of non-compliance must be mitigated by the inclusion of a Key Project in Section 2 of this Annual Plan in order to achieve compliance. Include a cross- reference to the Key Project ID.

POF area Fully compliant? Commentary Part A: Context 3. Working Principles Yes Part B: Performance Framework 2. LCRN Performance Indicators 2.1 High Level Objectives Yes See key projects with details of actions to mitigate the identified problems 2.2 Specialty Objectives Yes See key projects with details of actions to mitigate the identified problems 2.3 LCRN Operating Framework Indicators Yes 2.4 Initiating and Delivering Clinical Research Indicators Yes See key projects with details of actions to mitigate the identified problems 2.5 LCRN Partner Satisfaction Survey Indicators Yes 2.6 LCRN Customer Satisfaction Indicators Yes 2.7 LCRN Patient Experience Indicators Yes 3. Performance Management Processes Yes Part C: Operating Framework 2. Governance and Management Yes 3. Financial Management Yes 4. CRN Specialties Yes 5. Research Delivery Yes 6. Information and Knowledge Yes 7. Stakeholder Engagement and Communications Yes 8. Organisational Development Yes 9. Business Development and Marketing Yes

Page 7 of 89 Ref Key project Outcome Lead Milestone Links Milestone date n/a Continuous Improvement CRN Wessex will support a culture of Alex Jones Delivery of projects as defined below and feedback of contunious improvement ongoing continuous improvement as demonstrated in lead at national meetings the projects listed below 1. Governance and Management 2.1.1 Support preparation of host organisation LCRN Host Organisation to submit an NHS Jonathan Pillinger-Cork, Submission of 2018/19 NHS Information Governance Toolkit annual assessment March 2019 Information Governance Toolkit Information Governance Toolkit annual Trust Information to NHS Digital assessment submission for 2018/2019 assessment to NHS Digital and have attained Governance Manager Level 2 or Level 3 jonathan.pillinger- [email protected] 023 8120 4743 - supported by Graham Halls, Business Intelligence Manager, CRN Wessex Ref Key project Outcome Lead Milestone Milestone date 2. Financial Management 2.2.1 Finance supra network Meetings with senior management colleagues Lewis Towner-White TORs to be agreed by four LRCNs April 2018 Report into chief operating officer(COO) supra-network group Six monthly Share best practice Ongoing 2.2.2 Finance monitoring visits Reassurance that all partner organisations are Lewis Towner-White Annual visit to all partner organisations March 2019 meeting the minimum control standards Issues identified, addressed and resolved March 2019 Annual meeting of management accountants from partner organisations February 2019 3. High Level Objectives 2.3.1 HLO 4 80% of studies set up within a median time of Clare Rook Wessex wide workshop to be held in June (as part of established study support June 2018 40 days across participating sites for Wessex meeting) involving Jen Harrison from HRA. led studies and improvement in local C&C Introduce reporting from SPC charts to identify early changes in performance. April 2018 times for studies with participating sites in Wessex, monitored via the Wessex app. Regional SIVs as appropriate Ongoing Continued delivery of the shared Wessex ETC Wessex CCGs invoiced for population based contributions into the Wessex ETC April 2018 fund to support swift set up of studies incurring fund ETCs at participating NHS organisations Rebecca McKay Research Active Dorset - group meeting chaired by Dorset ACS Director for ongoing every 6 weeks Transformation looking at ways to align research processes across Dorset 2.3.2 HLO 5 80% in 30 days Emily Horsfall Using number of validation errors at end of 2017/18 as a baseline we will June 2018 demonstrate a reduction in number of validation errors by the end of the first quarter of 2018/19 data cut. This will be demonstrated on the national and Wessex ODP apps. Introduce reporting from SPC charts to identify early changes in performance. April 2018 Collaboration with User-focused research to identify the benefits of innovative digital recruitment and March 2019 Southampton CTU retention tools for more efficient conduct of randomised trials 2.3.3 HLO 7 Target of 1,171 is reached achieving a 79% Dr Chris Kipps and David Active review of the portfolio leading to a higher national ranking (8/15 LCRNs) March 2019 increase on 2017/18 target; a significantly Higenbottam in the number of recruiting studies supported by: higher uplift than the national target of 11% An increase in the number of CIs/PIs leading studies supported by trained raters Ongoing CIs/PIs supported by increasing links with Universities, developing the PD Ongoing Excellence Network and achieving HD critical mass through links between UHS and PHFT Care home research activity at Solent and IOW trusts Ongoing Study access to JDR and ResearchLine supporting increased activity Ongoing 2.3.4 HLO2, HLO4 and HLO5 (commercial) Meet 80% RTT in all organisations and Carolina Paras / Anoop Monthly performance reports (including HLO2, 4 and 5) to be distributed to See 2.3.6 Ongoing achieve set-up in 70 days Chauhan partner organisations. Quarterly performance reports (HLO2) to be distributed to commercially active Ongoing primary care sites. Monthly and quarterly industry themed meetings with R&D teams scheduled Ongoing

Page 8 of 89 2.3.5 HLO 1 Agreed targets for 2019/20 based on site data Graham Halls Performance will be tracked from the Wessex ODP application. For the first year March 2019 provided by the Wessex BI team from the partner organisatons will be set both a recruitment and complexity recruitment LPMS target. Introduce reporting from SPC charts to identify early changes in performance. April 2018 Piloting social media marketing for study Alex Jones and Kim Piloting social media marketing for the identification and recruitment of March 2019 recruitment Appleby participants. This will be done in collaboration with the Southampton Clinical Trials Unit who will identify a suitable study. 2.3.6 Wessex ODP application Real time visualisation of data Graham Halls, Alex Implement a live HLO dashboard for the network on the Wessex ODP application, September 2018 development for HLOs Babbage and Tom filterable by organisation. Simpson Add a commercial performance section to allow the industry team to monitor April 2018 performance of the local sites against HLO2a & 5a and automate existing regular reports. Use of app to capture and implement robust management of primary care May 2018 recruitment. This will include performance monitoring against the RSI scheme using combined LPMS and CPMS data. Championed studies that have been identified by our divisional teams as having June 2018 the potential to be highly successfully at Wessex sites will be monitored in their own section of the ODP Wessex application Create custom recruitment dashboards as requested by partner organisations to March 2019 inform their performance leads and reduce duplication of reporting. Ref Key project Outcome Lead Milestone Milestone date 4. LCRN Specialty Activities 2.4.1 Primary Care - Supra network meeting Shared offering for set up and delivery of Arlene Lee/ Alex Jones TORs to be agreed by four LRCNs April 2018 primary care studies Report into COO supra-network group Quarterly Agenda setting Ongoing 2.4.2 Primary care research sites initiative Practice sign up for new studies and shared Alex Jones Completion of sessional and level 2 events with attendance from local CIs from PCPS November 2018 events practice between GP teams for delivery of Primary Care and Population Sciences, University of Southampton. current studies 2.4.3 Develop non malignant haematology Open eight studies in 2018/19. Only two Jocelyn Walters and Dr Support study co-ordinator to ensure HLO 2, 4 and 5 are achieved March 2019 commercial research at Southampton opened in 2017/18. Savita Rangarajan 2.4.4 Ageing and dementia Meet recruitment target of 681 and 630 in both David Higenbottam and Research ideas and projects are progressed to achieve portfolio eligibility. March 2019 specialties working together specialties Alex Jones Establish and maintain regular meetings and seminars with academics at Bournemouth and Portsmouth Universities. Capturing accurate information regarding the age of patients recruited across See 2.6.4 Wessex will be important for measuring the growth of ageing research and the numbers of patients recruited onto portfolio studies. BI will support this. 2.4.5 Develop reproductive health portfolio Increase recruitment and achieve target of Jane Forbes, Jocelyn Coordinated, Wessex-wide submission of EOIs, site feasibility and SIVs led by March 2018 xxx. Walters,Tom Simpson, CRSLs and Midwife Champion. Increased profile of portfolio through blogs, news Profs Ying Cheong articles and web page . Initiate trials activity in DCHFT, RBCH and HHFT with and Vanora Hundley support from additional staff supported from contingency funding. 2.4.6 Review Wessex CancerLine cllinical Tool that receives positive feedback from Ann Nicholls Completion of Southampton University Business Programme. CRN successfully Autumn 2018 trials database activity clinicians and researchers with evidence of bid for a place on the 17/18 programme which allows a group of university patient referrals students to work on a specific project. The title of the project is: Evaluating the acceptability and impact of an online search tool designed to help users easily identify and contact clinical research studies that are running in the Wessex area. The project will complete by early summer. Positive feedback from users at Wessex CRSL Meeting. Autumn 2018 2.4.7 Ophthalmology research event Establish a culture of research within Caroline Gillett/Carolina Dorset based ophthalmology event to be held at RBCH (agenda to be agreed with April 2018 ophthalmology services in RBCH and DCHFT Paras RBCH)

2.4.8 Respiratory local objectives ILD specialist centre at PHT offers research Sophie Fletcher/Clare Meeting between PHT R&D Director and respiratory specialty lead to discuss April 2018 opportunities to patients Rook national expectation that ILD specialist centres are research active Develop respiratory research portfolio in Sophie Fletcher/Clare Site visits to respiratory teams at DCHFT and RBCH June 2018 Dorset Rook 2.4.9 Cardiovascular surgery An increase in the number of PIs involved in Charlie Dukes Active review of cardiovascular portfolio to identify, open and recruit to additional Ongoing cardiovascular surgery research in studies Southampton. David Higenbottam/Emily Arrange and hold a meeting with active cardiovascular surgery researchers June 2018 Watkins

Page 9 of 89 Cardiovascular surgery An increase in the number of PIs involved in cardiovascular surgery research in Southampton.

David Higenbottam/Emily Agree a written plan to encourage new PIs to participate in cardiovascular surgery June 2018 Watkins research Charlie Dukes/Emily Discuss the plan with broader group of vascular surgeons September 2018 Watkins 2.4.10 Cardiovascular/Stroke Establish cross specialty working between Charlie Dukes/Debbie Establish joint meetings. Cross specialty working to be kick started with joint July 2018 meetings stroke and cardiovascular research teams Dellafera stroke/CV Wessex conference in March 2018

2.4.11 Diabetes Improve primary-secondary care collaboration Charlie Dukes/Dr Mike Active review of diabetes portfolio to identify, open and recruit to additional Ongoing Cummings studies. Current baseline is 91 recruitment to 2 studies. Anticipated portfolio for 18/19 = 5 studies delivering recruitment of 100 Charlie Dukes/David Explore links between primary and secondary care services focusing on clinical June 2018 Higenbottam/Dr Hermione care and research Price Charlie Dukes/David Hold second diabetes research forum July 2018 Higenbottam Carolina Paras Active promotion of commercial portfolio Ongoing Alex Jones/ Charlie Dukes Delivering FARSITE across primary and secondary care. See 2.6.3 Ongoing 2.4.12 Dental Build dental portfolio activity Alex Jones Employ dental practitioner at Portsmouth Dental Academy in collaboration with See oral and dental October 2018 Solent NHS Trust. Recruitment to study ID 39258 already underway. 2.4.13 Renal Disorders Increase research activity provided by Wessex Dr Adam Kirk Band 5 Nurse employed at each of the dialysis units for 1.5 hours per week to See renal March 2019 Kidney Centre based at the Queen Alexandra promote/recruit to renal disorders studies. Total costs £12,660 supported by Hospital Network contingency funding 2.4.14 Public Health Establish a community of public health Alex Jones/Sarah CRSL meeting with key stakeholders to discuss public health and development of See PH. August 2018 researchers Williams/Himanka Rana/ working groups with a view to supporting new projects including Isle of Wight Julie Parkes public health 2.4.15 Gastroenterology specialty lead to Endoscopists develop studies to establish Fraser Cummings/Clare Agenda to be set and inaugural meeting to be held See GI May 2018 establish an endoscopy research group evidence base to support the use of Rook endoscopy equipment within the NHS Ref Key project Outcome Lead Milestone Milestone date 5. Research Delivery 2.5.1 Study Support Service supra network Consistent study support service offering Emily Horsfall TORs to be agreed by four LRCNs April 2018 across supra network Report into COO supra-network group Quarterly Share best practice Ongoing 2.5.2 Regional specialty meetings Forums for sharing best practice, trouble- Clare Rook Development of a programme of regional specialty meetings for 2018/19 April 2018 shooting recruitment challenges, sharing opportunities to become a recruiting site, meeting local and national specialty objectives. Share the programme of specialty meetings across divisions to promote cross specialty working, PPI involvement, communications opportunities and collaboration with the industry team 2.5.3 A core team approach to the delivery of Comprehensive study support service that Emily Horsfall Agree training schedule with divisional teams at portfolio managers meeting April 2018 the CRN study support service offers end to end support for CIs and PIs Proactive early engagement with CIs through monitoring of grants approved by Ongoing NETTSCC, liasion with trust and university R&D teams and monitoring of portfolio applications. Active performance management of study set and delivery through collaborative Ongoing working with SSS SPOC and divisional portfolio management teams. Consistent delivery across specialties with divisional teams able to support and Ongoing provide cover for other divisions and work collaboratively on studies spanning specialties and divisions. Development of the local portfolio through review of studies open to new sites via Ongoing the study support app (study progress tracker). Monthly mail chimp of 'championed studies' to CEOs and senior R&D colleague to Monthly highlight key opportunities to open new studies or maximise recruitment to existing studies.

Page 10 of 89 2.5.3 A core team approach to the delivery of Comprehensive study support service that Emily Horsfall the CRN study support service offers end to end support for CIs and PIs

Regular meetings with UoS RIS manager to develop shared working practices Quarterly and identify areas of duplication. Provide research specific training to local investigators and students and develop links with academic supervisors and programme leaders. Specialty research events held at specific sites where there is opportunity to tbc develop the portfolio in a particular specialty e.g. ophthalmology and respiratory research acorss Dorset. Ref Key project Outcome Lead Milestone Milestone date 6. Information and Knowledge 2.6.1 BI supra network Co-ordinated BI offering across supra network Graham Halls TORs to be agreed by four LRCNs April 2018 Report into COO supra-network group Quarterly Share best practice Ongoing 2.6.2 ResearchLine and Join Dementia Democratise access to research through data Dr Chris Kipps/Charlie Working with developers Frank Design continue to improve access tools within Ongoing Research platforms Dukes/David Higenbottam ResearchLine website alongside Oncology Line development (JDR)

Engage in active promotion of ResearchLine working with clinicians and ResearchLine Ongoing researchers to demonstrate opportunities relating to open studies. Ensure processes are in place that maintain an accurate and up to date study Ongoing inventory Put in place a process to regularly review and take action on site activity June 2018 Working with Communications Lead on a JDR stakeholder engagement and See 2.7.6 Ongoing communications plan. Use the launch of the JDR ODP application in April 2018 to initiate targeted June 2018 promotional campaigns, and use the new reporting tools to measure any related increase in JDR volunteer numbers. To review a plan for primary care promotion/GP texting scheme for JDR June 2018 Voluntary areas such as Alzheimer's Society and Memory Cafes have been September 2018 approached for support Existing promotional equipment (kiosks) are utilised fully in community trusts September 2018 2.6.3 FARSITE Deliver rapid and accurate study feasibilty Alex Jones Recruit primary care practices to sign-up. Plan to recruit 20 practices with June 2018 assistance from local AHSN primary care nurse Promote use of FARSITE via specialty group meetings to encourage primary and Ongoing secondary care links across all specialties Feasibility support for new projects Ongoing 2.6.4 Developing BI systems Accessible information available for delivery Graham Halls / Carolina Gathering feedback from Trusts on rollout of LPMS to support commercial SSS. July 2018 teams and management decisions, promoting Paras / Alex Jones Industry Study Support Services management through LPMS to go live. October 2018 self service where possible. Engage partner organisations in reporting data on the age range of recruited April 2018 More efficient site selection process through participants to the Wessex BI team. wider use of the LPMS. Continued use of the CRN CC study startup ODP application to manage common Ongoing date and missing site errors. Frequent communications to sites for date errors and Improvements in data quality to facilitate the action plans on how to improve the dataset at local data manager meetings. research activity phase of the CPMS-LPMS Develop a process for identifying studies that have missing sites before they April 2018 project. upload C&C data to the CPMS. Development of the Edge data checker section of the ODP Wessex application to April 2018 flag to the partner organisations where the minimum dataset for C&C assessment is missing on their instance of the LPMS See 2.3.4 - 2.3.6 for further information Ref Key project Outcome Lead Milestone Milestone date 7. Stakeholder Engagement and Communications 2.7.1 Communications and PPI supra network Collective offering from supra network in Kim Appleby TORs to be agreed by four LRCNs April 2018 communications and PPI Report into COO supra-network group Quarterly Collective agenda setting Ongoing

Page 11 of 89 2.7.2 Experienced and dedicated A lead for communications in post with a Kim Appleby Details provided to the CRN Coordinating Centre. Ongoing communications function workplan and dedicated budget as detailed in AFP. 2.7.3 Communications and action plan CRN Wessex will increase collaboration Kim Appleby Attend quarterly face to face meetings and monthly telecons for updates on Ongoing aligned to both NIHR CRN and NIHR between all parts of the NIHR, helping emerging NIHR strategies and take a proactive approach in supporting them. strategies stakeholders to recognise a single NIHR. Implement the Communications Contract Support Document. March 2019 Story telling at a local level, through campaigns, new stories, social media and Joint working with counterparts in the supra network, sharing best practice and See 2.7.1 Ongoing events, will ensure the value of the NIHR is ideas. recognised and the LCRNs positive reputation NIHR collaborations to continue through the Wessex Public Involvement Network Ongoing is maintained. (see 2.7.6). At least three patient and one staff stories to be gathered and hosted on the NIHR March 2019 website. CRN Wessex has a plan for local delivery of national campaigns (please see Ongoing Appendix 6.7). Additional staff and patient case studies and social media acitivity per campaign will show the value of the NIHR locally. Deliver a collaborative ICTD and NHS 70 campaign with partner organisations April to July 2018 and local NIHR infrastructure, with the campaign including local events, at least one press release, social media activity and promotion through all communication channels. Ensure the whole CRN operates in line with the brand guidelines, operational Ongoing requirements and national messaging as advised by the CRN CC. Make certain that partner organisations and researchers acknowledge NIHR funds and support when applicable. 2.7.4 Senior leader with experience and A lead for PPIE with an agreed workplan. Kim Appleby Details provided to the NIHR CRN CC. Ongoing identified responsbility for PPIE

2.7.5 Recording metrics of research CRN Wessex will record and analyse a range Kim Appleby Monthly reports on: website analytics, social media engagement, open rate of March 2019 opportunities of metrics which showcase its reach to CRN Wessex newsletters, readership of VISION, campaigns, events delivered patients and the public. and the number of media stories. Discuss and feedback at national PPIE and comms meetings. Share data in monthly PPIE and comms telecons as required. Regular reporting on metrics, for example to the CRN CC in monthly PRA progress/activity update. 2.7.6 Deliver collaborative PPIE workplans CRN Wessex will work with partners to Kim Appleby Non-pay budget line for PPIE and whole time equivalent staff detailed in finance March 2019 across CRN and partners with promote research opportunities in line with the plan. measurable outcomes for the delivery of NHS Constitution. The network will ensure Delivery of a coordinated PPI strategy through the Wessex Public Involvement March 2019 learning resources partners actively engage and involve patients, Network (PIN), ensuring PIN and CRN objectives are aligned. carers and the wider public in all aspects of Support nationally agreed PPIE initiatives and attend national PPIE meetings and March 2019 local research delivery to improve quality, teleconferences. delivery and access. Colloborative working across partners will plan for the provision of Build on good examples of early patient engagement by encouraging and sharing March 2019 learning resources. best practice with investigators. Share learning resources and research opportunities with partners, patients and See 2.7.9 March 2019 the public through CRN Wessex communications channels. Plan and deliver one Building Research Partnerships event with partners in October 2019 Portsmouth. Regular communications and networking with trust PPI leads to build March 2019 relationships, share ideas, best practice and resources. Showcase best practice through communications channels (see 2.7.3) and the See 2.7.3 March 2019 CRN Wessex awards event, where PPIE will be celebrated through the See 2.7.11 'Excellence in PPIE' category. Continue to ensure all LCRN funded staff have easy access to the NIHR hub and March 2019 other digital channels. Host a tweet chat in collaboration with the Wessex PIN to increase opportunities May 2018 for patients and the public to engage with reseach. Help lead on the development of the Wessex PIN website, a static web page March 2018 offering patients and the public a clear and coordinated offer of local NIHR PPIE opportunities. Support partners to embed and develop the Patient Research Ambassador March 2019 Project. 2.7.7 Support and implement the NIHR CRN Ensure patient choice, equality and diversity, Kim Appleby Explore appropriate patient representation with the partnership group. October 2018 PPIE strategy experience, leadership and involvement will be integral to all CRN Wessex activity. Ensure that patients, the public and carers will be involved in research activities to continuously improve patient experience. Page 12 of 89 2.7.7 Support and implement the NIHR CRN Ensure patient choice, equality and diversity, Kim Appleby PPIE strategy experience, leadership and involvement will be integral to all CRN Wessex activity. Ensure Work with partners to ensure research information and opportunities to take part March 2019 that patients, the public and carers will be are both visible and accessible. All partners will be asked to display information involved in research activities to continuously about research on outpatient letters. improve patient experience. Conduct a review of demographics within Wessex to better understand the March 2019 population. Use demographic information collected in the 2017/18 patient survey to reach parts of the community that are under represented. Outreach work to take place in collaboration with the Wessex PIN. The Wessex PIN will continue to gather up-to-date information on contact March 2019 with patient, carer, public groups and stakeholder organisations and make it available in line with the NIHR CRN PPIE Information Framework. Implement the optimising patient research experience checklist and address the March 2019 findings of the 17/18 patient research experience survey with partners. Use CRN CC template, the 5 Os, to record examples of diversity and inclusion in research. 2.7.8 Raise awareness and support the All appropriate stakeholders will be aware of Kim Appleby Four tweets or retweets a month to promote JDR on Twitter. Share JDR literature March 2019 delivery of CRN Coordinating Centre CRN CC managed services. Local patients locally, ensuring JDR has a presence at all CRN Wessex events. Work with managed services such as Join and the public will have access to information partner organisations across primary and secondary care to ensure that JDR is Dementia Research and UK Clinical about opportunities to take part in research, in visible and accessible. Trials Gateway (UKCTG) line with the NHS Constitution. Support Dementia Awareness Week with social media activity and an online news May 2018 story. Support World Alzheimer's Month with social media activity and an online news September 2018 story. Promote UKCTG to all stakeholders, including key messaging in communications See 2.7.5 Ongoing and campaigns as appropriate.

2.7.9 Continue to deliver the Patient CRN Wessex will have further developed the Kim Appleby Regular reporting on the development of the PRA role in Wessex, recording Ongoing Research Ambassador project PRA project, supporting partner organisations metrics on the impact of PRA activities. to recruit and develop PRAs. The network will Four tweets or retweets a month to promote the PRA project. Develop PRA case Ongoing increase PRA activities by widening their studies to showcase the role. involvement in network activity. PRAs to represent Wessex in the National PRA Advisory Group. Ongoing Involve PRAs in organisation and planning of local events and campaigns for March 2019 example the CRN Wessex nurse forum (July 2017) and the ICTD/NHS 70 campaign (May to July 2018). Ongoing Work with PPI leads in partner organisations to support and embed PRAs, sharing best practice and ideas. Hold one PRA development event, bringing together PRAs from across the region March 2019 to network, share ideas and collaborate.

2.7.10 Deliver the patient research Work with partner organisations to deliver the Kim Appleby Planning (March to June 2018), delivery (October to December 2018), analysis March 2019 experience survey (PRES) PRES across primary and secondary care. and results (January to March 2019).

Develop the survey in collaboration with partners organisations and the Wessex March 2019 PIN, in order to increase the uptake of the survey across primary and secondary care. Attend PRES telecons and share ideas with other PPIE leads. Telecon with LCRN March 2019 North East and North Cumbria for advice on increasing uptake of the PRES in Wessex. 2.7.11 Develop and implement a plan to deliver Continue to raise the profile of clinical Kim Appleby High quality news stories shared on the website, in regional press and on social March 2019 the CRN NHS Engagement Strategy research in the locality by promoting its media (monthly and ongoing). Secure at least two pieces of media coverage in importance with local health providers. Work 2018/19, and deliver one media story per CRN CC campaign. with local clinicians and patients to develop Regular newsletters to highlight good news and engage stakeholders. Wessex Monthly Monthly and fortnightly high quality stories about the activities of the network. Promote research to key Wessex News stakeholders such as patients and the public, Regular maintenance of the CRN Wessex microsite. Monthly helping to increase the number of people participating in research. Regular social media activity to support campaigns and highlight research March 2019 opportunities. At least one tweet or retweet a day and Twitter followers grown to over 800.

Page 13 of 89 2.7.11 Develop and implement a plan to deliver Continue to raise the profile of clinical Kim Appleby the CRN NHS Engagement Strategy research in the locality by promoting its importance with local health providers. Work with local clinicians and patients to develop high quality stories about the activities of the network. Promote research to key stakeholders such as patients and the public, helping to increase the number of people participating in research.

Produce at least one issue of VISION magazine to showcase research success VISION magazine- Issue September 2018 across Wessex. 4- Winter 2018 2.7.12 CRN Wessex awards Deliver award ceremony in March 2019 to Kim Appleby Event planning July - February 2019 celebrate the achievements of the research Event delivery community in Wessex. March 2019 Ref Key project Outcome Lead Milestone Milestone date 8. Organisational Development 2.8.1 WFD supra network Co-ordinated approach to WFD across supra Kelly Adams TORs to be agreed by four LRCNs April 2018 network Collective agenda setting Ongoing Report into COO supra-network group Quarterly Share best practice Ongoing 2.8.2 CRN Wessex Workforce Plan Thorough understanding of the workforce and Kelly Adams Scoping and plan for listening exercise April 2018 the challenges and opportunities in providing a Written report detailing themes and outcomes from listening exercise with partner July 208 responsive workforce organisations, HEE (Wessex) and CSU WFD plan September 2018 2.8.3 Wessex NIHR Work Placement CRN Wessex & Southampton CTU scheme to Kelly Adams Second placement scheme of 9 weeks to be framed following the evaluation of December 2018 Scheme run for a second time with the possible the first cohort. inclusion of NETSCC. Joint working opportunities from initial programme implemented. 2.8.4 NIHR CRN awareness Clinical Research is Everyone's Future' video Kelly Adams, Kim Appleby, Roll out of video to begin with issue 2 of Wessex WFD Bulletin April 2018 used by partner organisations in staff induction Rebecca McKay & Exploratory letter sent to OD leads about the inclusion of the video in induction April 2018 programmes. Introduction of a COO and CD Professor Rob Peveler programmes. welcome webinar for all new funded posts. Promotion of NIHR CRN during key Development of a slide-set and programme for the COO/CD welcome webinars. May 2018 campaigns. Work with Patient Research Ambassadors to promote awareness of the NIHR See 2.7.7 Ongoing CRN and clinical research with patients and the public. Promotion of and partcipation in key NIHR campaigns across POs. Appendix 6.7 Ongoing (see appendix 6.7) 2.8.5 Continuing development of learning Highly skilled, motivated and high trusting Kelly Adams & Emily Support for the development of all courses on the NIHR National Learning Ongoing and development resources/materials teams. Horsfall, CIs and specialty Directory. Continued support for GCP Programme Lead role. Contribution to leads nationally shared courses/materials e.g. chairing a national working group to update the Paediatric Informed Consent course.

Work with SW Peninsula and West of England to deliver a regional leadership April 2018 training courses for pharnacists and pharmacy technicians. Completion of 'Sucessful Pharmacy Clinical Trials Team Management' course on 20 April 2018. Wessex-wide training and support programme to encourage the use of the NIHR December 2018 Training & Delegation Decision Aid and fundamentals suite. Increase in number of NHS POs adopting decision aid & Fundamentals of Clinical Research Delivery training from 1 to 4. Development of a CI awareness raising webinar. To be developed with local CIs July 2018 and/or specialty leads. To be aimed at medics, nurses and AHPs looking to develop into the role of CI. Initial discussion meeting by July 2018. Completion of evaluations for all internally and externally led courses and Ongoing workshops. 50% of active LCRN GCP facilitators to have used the NIHR Quality Framework. March 2019 2.8.6 Extension of core team development Sharing of knowledge, skills and expertise and Kelly Adams, Clare Rook, Regular 'Lunch & Learn' sessions Bi monthly programme the creation of a shared platform for innovative Emily Horsfall and Alex Bi-annual core team development days June 2018 January 2019 practice. Jones

Wessex representation on NIHR Advanced Leadership Programme. End of April 2018 current cohort (18 July 2018) and deadlines for the application process for 2018/19 cohort (t.b.c). Wessex representation at the clinical research practitioners 'Leading our Future' April 2018 event. Local meeting with attendees to provide feedback from the 'Leading our Future' event and to inform content of the Wessex WFP.

Page 14 of 89 2.8.6 Extension of core team development Sharing of knowledge, skills and expertise and Kelly Adams, Clare Rook, programme the creation of a shared platform for innovative Emily Horsfall and Alex practice. Jones

Feedback from bi-annual team days and themes from core team focus group September 2018 discussions to inform the identification of opportunities to create and embed innovative new practices. Team days in June 2018 and January 2019. Focus groups to be held by September 2018. Use of a ring-fenced budget for WFD activities as a core team including formal April 2018 and informal training and educational activities. Ongoing programme of 1:1s and appraisals. Increase the number of core team members undertaking the 360 appraisal process from 2 to 5. Ensure all members of core team have MBTI profiles and undertake team buildings exercise to better understand these.

See 2.8.11 2.8.7 Quality training standards for NIHR High quality, fit for purpose training provision. Kelly Adams Continued support for GCP Programme Lead role to ensure national March 2019 courses requirements are adhered to and to act as a mentor for Wessex GCP facilitators. Bi-annual Wessex-wide GCP facilitator development meetings. 50% of Wessex GCP facilitators to have used the NIHR Quality Framework . Completion of evaluations for all internally and externally led courses and workshops. Apply for local courses/resources to be adopted to the NIHR National Learning Ongoing Programme Directory, National Learning Resources Directory and Endorsed Training as appropriate. Ensure local adoption of learning programmes from the national directory. 2.8.8 CRN Wessex Research Fellow Appointment, development and retention of Kelly Adams, Clare Rook & Deadline for applications to RF Programme 2018/19 of 23/02/18, decision via GRANULE Programme and development of early medical trainees and AHPs transforming into Dr Tom Brown panel on 01/03/18. Programme of research training and support to Wessex-wide career researchers clinical academics and early career specialty trainees including attendance of local surgical trainees at Bristol based researchers. GRANULE workshop, GCP Refresher training when required and attendance of other key specialty training events, e.g. Wessex SpR Emergency Medicine Research Event. 2.8.9 Wellbeing Clare Rook Meeting with wellbeing lead from host organisation to develop a coordinated April 2018 Co-ordinated well being programme plan plan Staff survey facilitated workshop to explore themes and develop action plan July 2019 Ref Key project Outcome Lead Milestone Milestone date 9. Business Development and Marketing 2.9.1 SME engagement and Technology A local technology support programme helping Anoop Chauhan/ Sandra Project overview and key milestones. Appendix 6.10 a Support Programme (TSP) innovatiors to gather evidence on their product Nwokeoha / Carolina Paras Follow up SME TSP round 1- developing research projects and signposting TSP April-June 2018 and accelerated adoption of technologies (in collaboration with accordingly. Gathering feedback and reviewing future calls. relevant for the Wessex patient population. . AHSN) Gathering further information about current local clinical needs- letter to STPs, April 2018 commisionners and clinical experts to gain insight of local needs. Meeting NIHR partner organisations and other collaborators (including MedCity) Ongoing to integrate services and strenghten local offer. Please see Appendix 6.10a for current collaborative workstreams. Technology Support Programme workshop (round 2 and 3). June & September 2018 Bespoke consultation services for SME Sandra Nwokeoha Engagement with SME through study support services (early engagement and CRN Wessex SME offer Ongoing available through our SSS feedback) Ad hoc SME consultation including: clinical trial pathway, protocol design Ongoing feedback, gap analysis and sign posting to partner organisations accordingly (e.g. business case- AHSN) (see Appendix 6.10a) Networking the Research and Innovation Associates (supra network) April 2018 Deliver SME event to promote the Sandra Nwokeoha / Event overview and progress Appendix 6.10a development of CI-led projects and technology Carolina Paras / Kim Southampton based event to be held in June 2018 in collaboration with AHSN June 2018 adoption. Appleby (in collaboration and CCF. with AHSN and CCF) 2.9.2 Primary Care commercial research Skilled research ready workforce in primary Carolina Paras / Alex Key milestones and progress Appendix 6.11 training programme care to deliver commercial research Jones Building up the success of workshops delivered last financial year, running May- Feb 2018 bimontlhy themed webseminars (including: robust feasibility, negotiating commercial trial costs, protocol adherence and data quality, among others) Industry themed workshops planned to run throughout the year (targeting Level 2 Ongoing practices) to promote participation and patient referrals to clinical trials. 2.9.3 Wessex offer to the Life Science Wessex research offer visible through Carolina Paras / Kim Wessex profile to be updated and available at micro website Apr 2018 Industry microwebsite and development of new Appleby resources to promote the local offer.

Page 15 of 89 Wessex offer to the Life Science Wessex research offer visible through Carolina Paras / Kim Industry microwebsite and development of new Appleby Create an interactive dashboard integrating local patient population data and Dec 2018 resources to promote the local offer. clinical research resources. To be used as a local marketing tool for site identification process and ad hoc interactions with pharma representatives. Ref Key project Outcome Lead Milestone Milestone date 10. Life Sciences 2.5.1 Commercial supra network Consistent commercial study support service Emily Horsfall TORs to be agreed by four LRCNs April 2018 offering across supra network Report into COO supra-network group Quarterly Share best practice Ongoing 2.10.1 Biosimilars event Sharing best practice, provide insights of Carolina Paras / Kim Event overview and progress Appendix 6.12 Ongoing opportunities and the future of biosimilras in Appleby Southampton based event to promote biosimilar research and showcase current June 2018 the UK. Engagement with the local pharmacist local work and opportunities community.

2.10.2 Improving local customer service (life Raising the profile of Wessex to pharma and Carolina Paras Life sciences industry ecosystem is very diverse. In order to meet our customers Survey to be released in July science industry) and monitoring study's offering bespoke support based on companies needs and provide the best possible service to all, the industry team will develop 2018 and to continue throughtout progress at all levels needs. a survey to gather feedback to monitor our local services quality and trigger the year. continuous improvements plans. Bespoke pathway for customer interactions to be implemented (early contact and May 2018 engagement) Develop relationships with key industry partners and regular meetings with local Ongoing pharma representatives Monitoring survey results quarterly at industry themed meetings with partner See 2.3.4 August, November 2018 and organisations and the executive board. February 2019

Page 16 of 89 HLO LCRN Target CRNCC Target 44,000 1

1171 7 Awaiting Trust feedback, any further discussion and negotiation to be completed before final submission of annual plan on 16 March

Page 17 of 89 Section 4: Specialty Objectives RM Specialty Local activities to achieve the national objective Links 1 Ageing [1] Division 5 RDM will be supporting a collaboration with Our Organisation Makes People Happy (OOMPH) along with the CRN ageing specialty lead to respond to the OOMPH NIHR themed call for ‘Community-wide interventions for physical activity’. Co applicants have been approached from University of Bournemouth and Solent 2.4.4 University. Early contact and engagement with Dr Greg Rogers and input from the Research Design Service (RDS) and the University of Bournemouth has enabled submission of an NIHR Research for Patient Benefit (RfPB) application - ‘Feasibility study utilising a point-of-care-testing smart-phone app to diagnose epilepsy in the elderly’. Support will be provided to the CI if successful to begin HRA process and site identification. Cross Divisional events with Dementia specialty at Bournemouth University and Portsmouth University will promote engagement from new researchers. Dorset STP are committed to supporting research and are primed for research in this specialty due to their high elderly population. The CHAIN subgroup has been established to look at care of frail older people and research delivery manager and specialty lead have joined this to identify potential areas for collaboration. Comprehensive Care event included local researcher Jackie Bridges and focused on frailty, awaiting key areas for future research to be disseminated. CHAIN 2 Anaesthesia, Perioperative Medicine We will liaise with the national specialty group to understand what the baseline measure is and look at opportunities within Wessex for trainees to be co- SPARC and Pain Management [2] investigators/chief investigators. There is an established trainee research group (SPARC) that have previously delivered portfolio trials and have a small portfolio of non-NIHR research, led by trainees, which we will explore for potentially eligible studies. 3 Cancer [3] During 17/18 Wessex met this objective, achieving recruitment targets for 12 of the13 disease specialties. Based on the anticipated portfolio of studies in 18/19 we expect to continue to deliver this objective facilitated by the implementation of Wessex CancerLine website which will raise the profile of the portfolio across the region and encourage patient referrals 4 Cardiovascular Disease [4] We will work with the Cardiovascular Specialty Lead Richard Bala and Clinical & R&D colleagues in Southampton to identify investigators who have recruited to cardiovascular surgery portfolio studies (currently 4 based on studies recruited to ODP) as well as clinicians who have expressed interest in these studies. We will then meet with all parties to discuss and agree a plan to increase the number of investigators involved in cardiac surgery research. Currently 17% of recruitment studies are cardiac surgery delivering 2.5% recruitment. Our target through engagement with cardiac surgeons and vascular surgeons in general at Southampton will be to achieve 5% recruitment to cardiac surgery studies in line with the cardiovascular specialty in total 5 Children [5] CRN Wessex are currently amber for this specialty objective with 10/12 trusts active. Our two non active trusts are South Coast Ambulance Service (SCAS) and Dorset Healthcare Foundation Trust (DHUFT), a community trust. DHUFT have two studies open but yet to recruit and there are no relevant studies available for SCAS to run. We will continue to review all available studies at our monthly teleconferences. 6 Critical Care [6] St Mary's ICU on the Isle of Wight is the only non-recruiting ICU in the region. We will continue to identify studies on the portfolio that could be delivered at smaller ICUs such as this but across Wessex we anticipate activity at 8/9 (89%) ICUs which exceeds the national target (80%) 7 Dementias and Neurodegeneration [7] Currently the majority of research is conducted by experienced PIs. To generate interest in early career researchers we will encourage all trusts particularly 2.8.8 community trusts to apply for research fellow posts to DeNDRoN studies. In addition for dementia we will focus opportunities at the Memory Assessment and Research Centre (Dr Jay Amin to be supported by SHFT, NIHR CRF in Southampton and for Parkinson's the Southampton and IOW Parkinson's Excellence Network will continue to include clinicians new to research 8 Dermatology [8] Dermatology is already successfully running in two sites who have strong nurse teams in place (Sonia Baryschpolec at PHT and Charlotte Barclay at PHFT. A job share between two new specialty leads from PHT will enable the division 5 team to promote this role. Biosimilar expertise in UHS at international level can be used to support dermatology colleagues. Dr Miriam Santer will be running SAFA (Spironalactone for adult acne) with the Southampton CTU which will allow both primary and secondary care teams to develop as PIs. This will build upon relationships established from earlier studies Dr Santer has led on which have run across care settings (Study ID 34104). 9 Diabetes [9] We will build on work already underway to understand the influence of different infrastructures across NHS services in acute & community trusts and primary care 2.4.11 in order to facilitate better feasibility and therefore increase the number of studies that open in Wessex (in 2017/18 Teachable Moments ID 33683 at three CCGs and SUSTAIN-8 ID 31994 at one CCG). This will include holding a second diabetes research forum, continuing to develop commercial links and capacity and the continued success of SHFT in development of relationships beeen research nurses and clinical nurse specialists. The promotion and introduction of FARSITE across primary and secondary care sites will significantly improve study feasibility. 10 Ear, Nose and Throat [10] The ENT research portfolio has been limited but engagement with the ENT trainees to deliver trials will continue 2.8.8 11 Gastroenterology [11] 40 participants per 100,000 population equates to 1,105 participants in Wessex. Wessex performance in gastroenterology research is strong, consistantly ranking 2.4.15 within the top third of LCRNs, and we expect this recruitment target to be met in 2018/19. We plan to establish a research endoscopists group to promote endoscopy trials across the patch. 12 Genetics [12] CRN Wessex funded Research Fellow (Andrew Crean) in post at Southampton early 2018/19 to deliver this objective. Wessex Specialty Lead, Diana Baralle, has 2.8.8 been awarded a recent NIHR professorship which we expect will lead to greater early career involvement in region

Page 18 of 89 13 Haematology [13] We will appoint a Research Fellow at Southampton supported by CRN Wessex. Wessex Specialty Lead, Dr Savita Rangarajan, is a world leader in gene therapy for NEJM Haemophilia and recently published a NEJM paper showing a single infusion of high-dose vector-encoded factor VIII led to sustained normalization of factor VIII paper activity. She has established links with a number of commercial companies including Biomarin (with whom she wrote the NEJM paper) and Bayer and has recently moved to Southampton to further develop her research 14A Health Services Research [14] Professor Cathy Pope appointed as specialty lead will assist to develop the portfolio in Wessex. 14B Health Services Research [15] Health Services research in Wessex has been supported by large recruiting studies such as HiSLAC which recruited from 7 organisations and will commence HSR activity again in 18/19. 17/18 baseline data shows recruitment at 16 organisations across 24 sites. Professor Sue Latter, University of Southampton will commence a Toolkit project looking at access to medicines at end of life a which will recruit from a variety of settings including hospices and GP sites. The NIHR Health Services Toolkit is now accessible and is designed for the research community and to help people to do better HSR research in the UK, specialty lead Cathy Pope will promote this. 15 Hepatology [16] It is anticipated that recruitment into studies on cirrhosis and NAFLD/NASH will continue into 2018/19 16 Infection [17] Named champion for sexually transmitted infection to be identified, we do not anticipate any particular challenges with this 17 Injuries and Emergencies [18] After very successfully recruiting into the Paramedic 2 trial (ID 17177), SCAS are yet to identify the next study/studies they will deliver in 2018/19. The Division 6 RDM and I&E specialty lead will continue to work closely to support SCAS to identify their next study 18 Mental Health [19] Based on current recruitment we will target a figure of 52 to deliver a 5% increase for 2018/19. Our focus will be to identify portfolio studies that fit current service provision in our specialist metal health trusts, and in addition work with colleagues in primary care to recruit participants that receive care from their GPs. The following studies will be open to recruitment during 2018/19: Adult Autism Spectrum ID 18481, INTER-STAARS ID 19033, Patient preferences for psychological help ID 34784, PPiP2 ID 18451 19 Metabolic and Endocrine Disorders We will initially work with our CRSL Tristan Richardson to identify staff that are currently working on open metabolic and endocrine led studies, followed by [20] those who are not currently active. Once this is completed we will organise a Wessex wide forum which will enable us to establish a support structure to encourage wider participation in the metabolic and endocrine portfolio 20 Musculoskeletal Disorders [21] A. MSK CRSL and division lead (rheumatology consultant) have discussed the role of orthopaedic champion and two potential candidates identified for this: Katie Castle - physiotherapist at Solent and Lyndsey Goulston atUHS. Research Delivery Manager will facilitate this and ensure that a champion has been identified for 18/19. Specialty lead for surgery, Mr Jim Byrne has also expressed support for the musculoskeletal specialty in terms of cross specialty working. B. Current 17/18 recruitment to XXX orthopaedic studies. KReBs has been successful at two sites in Wessex however this is due to close in 2018. The trial team are currently not open to new sites but will consider Wessex if they revisit this decision and extend. REACTS (32370) and BOSS (20624) will be key to delivery of this objective also. This will require cross divisional support and RDMs will all be made aware of this to promote at key specialty meetings. Commercially MUSC 5528 will continue to be delivered at RBCH with estimated recruitment of 16 per annum. 21 Neurological Disorders [22] The research fellow posts supported by CRN Wessex is part of a rolling program that will continue to support current and new research fellows throughout 2018/19. 2.8.8 We will also work to ensure that an increase in neurological portfolio activity is used to support early career PIs 22 Ophthalmology [23] Currently 85% hospitals with eye services are offering research opportunities to patients and we anticipate maintaining this into 2018/19. Plans to extend into RBCH 2.4.7 and DCHFT. 23 Oral and dental health [24] Specialty group meeting planned for February 2018 with local dental academy to promote research moving forward into 2018/19. PHE survey (Study ID 36050) has 2.4.12 only been commissioned in one region of Wessex, providing 20 sites to recruit from. However, this will help to locate potential dental sites for development and the Division 5 team will make contact with these sites to promote NIHR and portfolio research. Solent NHS Trust have also been awarded funding to support University of Portsmouth Dental Academy via a practitioner post with exitsing portfolio study (Study ID 35298) and to develop new studies. 24 Primary Care [25] Two GP champions in place will continue for 18/19 based in Wareham (Dorset) and Abbeywell (West Hampshire). Discussions with Tom Brown who leads fellows programme about potential training for the Wessex Deanary to include GPs regarding NIHR and research roles. 25 Public Health [26] A. Prof Julie Parkes acting as CRSL for the Wessex region B. Currently, the public health portfolio in Wessex is small - ESEE (ID 19075) is open at one site. There are however strong cross divisional links with community 2.4.14 oral and dental services via University of Portsmouth and primary care (ATTACK study) which the network are supporting to develop. There is also appetite to develop public health projects on the Isle of Wight and both GP Lead Himanka Rana and Solent R&D manager Sarah Williams will be key to developing this - a specialty meeting will facilitate discussions between key individuals and specialty lead to explore this further. Ageing specialty lead is supporting a bid into community excercise interventions which is public health funded which would be worked up during 18/19. Another grant has also been awarded to Prof Julie Parkes and will be looking into custody health working with Hampshire Constabulary. 26 Renal Disorders [27] Division 2 team will work with the CRSL Adam Kirk and commercial colleagues to identify potential new PIs, focusing initally on renal centres in 2.4.13 Dorchester and Portsmouth where the majority of commercial activity takes place 27 Reproductive Health and Childbirth Wessex currently meets this objective with 6 of 8 relevant trusts active. There are studies on the portfolio which can realistically be delivered at all Wessex sites and 2.4.5 [28] we plan to invest CRN funds during 18/19 to initiate research at inactive trusts. The baseline for recruitment as a proportion of infant mortality in the region will be established and tracked.

Page 19 of 89 28 Respiratory Disorders [29] Wessex is currently ranked first for recruitment. It is anticipated that Wessex will be one of the 10 LCRNs recruiting into rare disease studies, particularly with the 2.4.8 research active regional centre for cystic fibrosis and interstitial lung disease (ILD). 29 Stroke [30] Current performance nationally on the ODP app highlights that no LCRN is achieving the 8% target. In Wessex the closure of 3 high recruiting RCTs has adversely 2.4.10 affected our performance. We will continue to hold regular meetings with local stroke research teams to identify and open portfolio studies that contribute to this national objective Currently ATTEST 2 (ID 33335) and MAPS 2 (ID 33770) studies are in set-up with others such as RECAST 3 appearing in the pipeline 30 Surgery [31] Wessex currently meets the objective and we expect to continue to meet the objective into 2018/19 with portfolio studies recruiting into 12 out of 14 subspecialties.

Page 20 of 89 [1] Increase early career researcher involvement in NIHR CRN Portfolio research

[2] Increase the number of NIHR CRN Portfolio studies led by trainees as Chief Investigator or co-Chief Investigator

[3] Increase patient access to Cancer research studies across the breadth of the Cancer subspecialties (Brain, Breast, Colorectal, Children and Young People, Gynae, Head & Neck, Haematology, Lung, Sarcoma, Skin, Supportive & Palliative Care and Psychosocial Oncology, Upper GI, and Urology)

[4] Develop the research workforce in cardiovascular surgery

[5] Increase NHS participation in Children's studies on the NIHR CRN Portfolio

[6] Increase intensive care units’ participation in NIHR CRN Portfolio studies

[7] Increase early career researcher involvement in NIHR CRN Portfolio research

[8] Develop the Dermatology Principal Investigator (PI) workforce

[9] Improve primary-secondary care collaboration in the delivery of Diabetes research

[10] Increase trainee involvement in NIHR CRN Portfolio research

[11] Improve recruitment to NIHR CRN Gastroenterology studies

[12] Increase early career researcher involvement in NIHR CRN Portfolio research

[13] Establish links with the relevant professional organisations to encourage and support trainee involvement in NIHR CRN Portfolio studies

[14] Increase the number of recruitment sites for NIHR CRN Portfolio studies funded by the Health Services and Delivery Research programme

[15] Increase the number of recruitment sites for NIHR CRN Portfolio studies funded by the Health Services and Delivery Research programme

[16] Increase access for patients to Hepatology studies on the NIHR CRN Portfolio

[17] Develop research infrastructure (including staff capacity) in the NHS to support clinical research

[18] Increase participation in pre-hospital studies via Ambulance Trusts

[19] Increase participation in Mental Health studies involving children and young people

[20] Understand and develop the research workforce that work in Metabolic and Endocrine-led studies

Page 21 of 89 [21] Increase engagement of orthopaedic champions to support the delivery of Musculoskeletal Disorders studies on the NIHR CRN Portfolio

[22] Increase early career researcher involvement in NIHR CRN Portfolio research

[23] Increase NHS participation in Ophthalmology studies on the NIHR CRN Portfolio

[24] To develop the Oral and Dental research workforce in order to meet the demands of the expected growth in the portfolio following the JLA Priority Setting Partnership

[25] Increase engagement of GP registrars and First Five GPs with NIHR CRN Portfolio research

[26] Develop research infrastructure (including staff capacity and working with local authorities) to support research in Public Health

[27] Increase the number of 'new' Principal Investigators (PIs) engaged in commercial Renal Disorders studies on the NIHR CRN Portfolio

[28] Increase the proportion of NHS Trusts recruiting into Reproductive Health and Childbirth studies on the NIHR CRN Portfolio

[29] Wessex is current ranked first for recruitment. Increase access for patients to Respiratory Disorders studies on the NIHR CRN Portfolio

[30] CRN recruitment to Stroke RCTs should be at least 8% of the 2017/18 Sentinel Stroke National Audit Programme (SSNAP)-recorded hospital admissions

[31] Increase patient access to Surgery research studies on the NIHR CRN Portfolio across the breadth of the surgical subspecialties

Page 22 of 89 MASTER TEMPLATE CRN Wessex Annual Delivery Plan 2018/19 v1.0 12.12.17

Section 5: Financial Management 5.1 Please provide details of the plans that you anticipate impacting on the allocation of LCRN None at present funding for 2018/19. (For example particular studies that require large investment, concentration on a particular specialty) 5.2 In respect of the LCRN 2018/19 local funding model, please complete the following table* by entering the proportion of LCRN funding (%) within the funding elements detailed. If there are any other elements to the model please describe what this is for and the proportion of funding allocated to this. Funding Element Examples Description of model £ % of Total CRN Funding Budget 2018/19 Budget Host Top sliced element Core Leadership team, Host Support costs, LCRN Centralised Core team see organogram in appendices. Host costs 2% of total budget. £1,463,582 8 Research Delivery team Block Allocations Primary care, Clincal support services (i.e. pharmacy) Primary care RSI scheme, primary care research nurses x 6, GP research locality leads x 5 and primary care service support cost budget. £45,500 is provided to the regional genetics laboratory at Salisbury to support genetic diagnostics related to research £1,068,115 6 across Wessex. Other clinical support services are funded by partner organisations from their core allocations Activity Based Recruitment HLO 1, number of studies Based on percentage of recruitment into band 2 and 3 studies adjusted for complexity £12,064,171 68 excluding primary care as that allocation is top sliced Historic allocations PO funding previously agreed - - 0 Performance Based HLO performance, Green Shoots funding There are three elements to this performance premium for commercial and non commercial RTT. The commercial RTT isd £3,000 per 'green' closed study and £10,000 per first global patient. In 2018/19 there was an additional element to encourage partner £1,126,000 6 organisations to focus on a balanced portfolio to maximise complexity weighted recruitment. Complexity because of the weighted ratios cannot be maximised within a defined funding envelope without looking at a balanced portfolio. Population Based Adjustments for NHS population needs - - - Project Based Study start up Included in core team and allocation to partner organisations. Total equal 4.6% of total - - budget. Contingency / Strategic funds Funds held centrally to meet emerging priorities during the year Funding to support within year cost pressures £786,050 4 Other funding allocations CRSL and divisional leads £ 456,250; Executive Group and Partnership chair £52,000; Commercial Lead £12,500; Research Fellow Lead £12,500; Research Fellows £500, 000; The post holders for these positions have been recruited from partner organisations £1,196,211 8 and the funding is passed out the partner organisations. LPMS £112,961; other £50,000. Total £17,704,129 100

Cap and Collar Please provide your upper and lower limits if applicable -5% - Minimum £20,000 uplift 5% - *Notes 1. It is assumed that the Local Funding Model is net of any National Top Slice as these are pass through costs 2. If the funding element category is not applicable to your Local Funding Model, please enter 0% 3. The percentages (%) entered in the table should equate to 100% 5.3 If the 2018/19 local funding model methodology has changed since 2017/18 please give a brief No change in methodology description of the changes 5.4 Please confirm whether monitoring visits will be taking place over the course of 2018/19. If yes, Yes. Senior management account will schedule visits with all the partner organisation in 2018/19 please provide details of which Partner organisations will be covered and the rationale behind this decision. Please also indicate what proportion of your Partner organisations are being monitored (Category A Partners). 5.5 What are the key financial risks and mitigations for 2018/19? None identified at present

Page 23 of 89 MASTER TEMPLATE CRN Wessex Annual Delivery Plan 2018/19 v1.0 12.12.17

5.6 Please provide details of any planned audit of the LCRN Host Organisation in 2018/19 Host internal auditors have it scheduled in their work plan for 2018/19

Page 24 of 89 MASTER TEMPLATE CRN Wessex Annual Delivery Plan 2018/19 v1.0 12.12.17

Section 6: Appendices Ref no Title Link 6.1 Business Development and Marketing Profile 6.2 Risk and Issues Log https://drive.google.com/file/d/19yGGnJo-HGbNDoVSdgxoEEnddj9gTgf-/view?usp=sharing 6.3 Funding model 6.4 Organogram 6.5 Finance monitoring visits 6.6 High level overview of planned educational activities https://drive.google.com/file/d/1aDCh9ctB6qxVbS9Po1r9KzsdTBCeMkmU/view?usp=sharing 6.7 CRN Wessex Campaigns 2018/19 https://docs.google.com/document/d/15WHu-EcHytVCoT6ssK1OkmTyoDKZE1nUSnxtcmmktVk/edit?usp=sharing 6.8 WFD Infographic Wessex Jan 18 https://drive.google.com/file/d/1kgHqyvvE20zyim_WlYhsx_8Q-NvS8ebT/view?usp=sharing 6.9 Workforce Profile Data https://drive.google.com/file/d/15dSm3zOeiXgSdAPUID6ACbNEvRWZfKVw/view?usp=sharing 6.1 SME engagement programme milestones https://drive.google.com/open?id=1PdhmBghaIpr9pW5_jwA_aiowspQk7nsOY69Gt-j-z34 6.11 Primary Care workshops https://drive.google.com/open?id=1y1fIDW3GUXHwnjHN79uqIWFacd7KFDijUHsggevafSU 6.12 Working with Life Sciences https://drive.google.com/open?id=1hfmnkEETcLYsLTWxxno2LUJ3_FeOJX7Na7Jf_qXnB2U 6.13 Weblinks

Page 25 of 89 Section 7. Glossary Abbreviation Definition ACS Accountable Care Systems AHSN Academic Health Science Network BI Business Intelligence C&C Capacity and capability assessment CCG Clinical Commisioning Group CD Clinical Director CI Clinical Investigator COO Chief Operating Officer CPMS Central Portfolio Management System CRN CC Clinical Research Network Co-ordinating Centre CRSL Clinical Research Specialty Lead CSU Commissioning Support Unit CTU Clinical Trials Unit DCHFT Dorset County Hospital NHS Foundation Trust DHUFT Dorset HealthCare University Foundation Trust ETC Excess Treatment Costs HD Huntington's Disease HEE Health Education England HHFT Hampshire Hospitalsl NHS Foundation Trust HLO High Level Objectives HRA Health Research Authority HSR Health Services Research ILD Interstitial lung disease IOW Isle of Wight NHS Trust JDR Join Dementia Research LCRN Local Clinical Research Network LPMS Local Portfolio Management Service MSK Musculoskeletal NAFLD Non-alcoholic fatty liver disease NASH Non-alcoholic steatohepatitis NIHR National Institute for Health Research ODP Open Data Platform OOMPH Our Organisation Makes People Happy PD Parkinsons Disease PHFT Poole Hospital NHS Foundation Trust PHT Portsmouth Hospitals NHS Trust PI Principle Investigator PIN Public Involvment Network PPIE Patient Public Involvement Engagement PRA Patient Research Ambassador RAD Research Active Dorset RBCH Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust RCT Randomised Controlled Trials RSI Research Site Initiative

Page 26 of 89 SCAS South Central Ambulance NHS Foundation Trust SFT Salisbury NHS Foundation Trust SHFT Southern Health NHS Foundation Trust SIV Site Initiation Visit SME Small and Medium sized Enterprises SOLENT Solent NHS Trust SPARC Southcoast Perioperative Audit and Research Collaboration SPC Statistical Process Control SPOC Single Point of Contact SSS Study Support Service STP Sustainability and Transformation Partnership TOR Terms of Reference TSP Technology Support Programme UHS University Hospital Southampton NHS Foundation Trust WFD Work Force Development

Page 27 of 89 LCRN HOST ORGANISATION CONTRACT UPDATED FROM 1 APRIL 2018

APPENDIX A

PERFORMANCE AND OPERATING FRAMEWORK

Part A: Context

1. Structure and Purpose of the NIHR CRN

1.1. The NIHR CRN provides world-class health service infrastructure to support clinical research in the NHS in England.

1.2. The NIHR CRN comprises 15 Local Clinical Research Networks (LCRNs) and the National CRN Coordinating Centre working together with shared principles, values and behaviours. The LCRN Host Organisation and the LCRN Partners together form the single system that is the LCRN.

1.3. The purpose of the NIHR CRN is to provide efficient and effective support for the initiation and delivery of funded research in the NHS. Some of this research is funded by the NIHR but most of it is funded by NHS non-commercial partners and industry. This activity makes an important contribution to improve the health of the population and to support economic growth; and the NIHR CRN features in the government’s Strategy for UK Life Sciences.

1.4. The NIHR CRN allocates and manages funding to meet NHS Support and other specified costs for eligible studies, as defined by the Authority’s Eligibility Criteria for NIHR CRN Support (which can be found at: https://www.nihr.ac.uk/funding- and-support/study-support-service/eligibility-for-nihr-support/). These comprise randomised controlled clinical trials of interventions (including prevention, diagnosis, treatment and care) and other well designed studies for commercial and non-commercial sponsors.

2. Aims of the NIHR CRN

2.1. The aims of the NIHR CRN are defined by the Department of Health and are set out in the NIHR Briefing Document for the NIHR CRN, available at: https://www.nihr.ac.uk/about-us/documents/4.01-Clinical-Research-Network.pdf

2.2. The aims of the NIHR CRN are to: (a) Promote equality of access, ensuring that wherever possible, patients have parity of opportunity to participate in research (b) Improve the quality, speed and co-ordination of clinical research by removing the barriers to research in the NHS

1

Page 28 of 89 LCRN HOST ORGANISATION CONTRACT UPDATED FROM 1 APRIL 2018

(c) Streamline and performance manage NHS Support for eligible studies to ensure the NHS Service Support Costs of these studies are met in a timely and efficient manner (d) Work in partnership to unify and streamline administrative procedures associated with regulation, governance, reporting, and approvals (e) Meet the research delivery needs of the life sciences industry including: pharmaceutical; biotechnology; diagnostic; medical technology; and contract research organisations (CROs) (f) Further integrate health research and patient care (g) Engage the providers of NHS services in research in line with the NHS Constitution to promote research participation and a research culture.

3. Working Principles

3.1. The work of the National CRN Coordinating Centre and the LCRNs is guided by a set of principles:

(a) Patient-centred: We never lose sight of the fact that the research we help to carry out is for patient benefit. Patients are at the core of what we do (b) Good Governance: We are an organisation with clear accountability arrangements, in control of things for which we will be held to account (c) Inclusive: We welcome everyone within the NHS, including all providers of NHS services, who are committed to the delivery of high-quality clinical research (d) Equity of access: We work to ensure patients, carers, the public, and healthcare professionals, from all parts of England and from all areas of healthcare, have opportunities to participate in and benefit from the widest range of high-quality clinical research studies. LCRNs should seek to offer a balanced portfolio of research, giving opportunity according to local population needs. LCRNs should monitor and where appropriate influence their portfolio of research, taking into consideration the principle that patients should have the opportunity to participate in studies relevant to their health condition and conducted in accessible locations. Therefore the placement of studies should take into account where the greatest burden of a particular health condition is found. LCRNs should monitor and give consideration when conducting studies to the following dimensions:

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 Health burden (prevalence/incidence)  Study setting (primary care, secondary care, tertiary care, palliative care, social care)  Geographical scope (international multi-site, UK multi-site and single site)  Primary study design (interventional/observational/both)  Randomisation status (randomised/non-randomised) Study type (commercial/non-commercial) (e) Patient involvement: We are committed to engaging patients, carers and the wider public as partners in all aspects of our activity to improve research quality and ensure the experience of involvement and participation in clinical research is positive and fulfilling (f) Partnership working: We are committed to working with all partners across the Network, facilitating collective decision making that supports national strategy. The Network is a collective endeavour and collaborative working is key to our success. The LCRN Host Organisation and all LCRN Partner organisations should work with integrity and mutual respect, recognising that the success of the Network is measured by the success of the LCRN Partner organisations (g) Collaborative national working: The LCRN leadership team and management staff, including Research Delivery staff, will work closely with counterparts in other LCRNs and in the National CRN Coordinating Centre. These will form national, function-specific teams with direction, guidance and support provided by the relevant lead in the National CRN Coordinating Centre (h) Transparency: We are open and transparent, sharing information freely at all levels of the organisation, with all partners and with the public. It is clear how and why decisions are made (i) Consistency: We aim to provide a consistent, excellent service to researchers in all studies, in all parts of the country, for all clinical Specialties, and across all NHS sectors (j) Flexibility: We work flexibly, promoting integration, working across boundaries and conducting work at the right level (national or local). We find flexible and pragmatic solutions to ensure success and minimise bureaucracy (k) Responsive to stakeholders: We have strong and responsive relationships with our stakeholders. We listen to feedback and use it to improve the way we do business (l) Efficiency: We use our money for the purposes intended. We understand the importance of increasing efficiency and demonstrating value for money to the taxpayer

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(m) Effectiveness: We improve the quality, speed and cost- effectiveness of clinical research by continuous review and improvement of all our structures and systems (n) Research Culture: Research is our core business. Our organisation promotes a research culture ensuring research is embedded within clinical care (o) Workforce Development: Our workforce has a shared sense of purpose and the skills and understanding to meet the changing needs of the organisation. We are committed to developing and supporting our staff and those patients and carers actively contributing to the delivery of research (p) Evidence based: We will make informed decisions guided by effectively utilising timely, accurate and reliable data and other information.

4. NIHR CRN Priorities 2018/19

4.1. Context

4.1.1. The National CRN Coordinating Centre and the Department of Health Science, Research and Evidence Directorate agree a set of national priorities for the CRN on an annual basis.

4.1.2. These priorities are set in pursuance of the vision, goals and aims of the CRN. These priorities should be reflected in the Annual Business Plan for the National CRN Coordinating Centre and for each LCRN.

4.2. NIHR CRN Strategies

4.2.1. The NIHR CRN has seven high-level strategies for the National CRN Coordinating Centre contract period 2015-20, for the following areas:

(a) Business Development and Marketing (b) Communications (c) Information and Knowledge (d) NHS Engagement (e) Patient and Public Involvement and Engagement (f) Workforce Development (g) Working with the Life Sciences Industry. 4.2.2. These strategies were a Department of Health contract requirement, and were approved by the Department of Health through the Department of Health / National CRN Coordinating Centre Contract Management Board. Each strategy set out a work plan of projects and deliverables for each National CRN

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Coordinating Centre contract year; these annual work plans are incorporated in the National CRN Coordinating Centre Annual Business Plan.

4.2.3. It should be noted that typically 2018/19 will be the final full year of implementation of these strategies, entering a review phase in 2019/20.

4.3. ‘One NIHR’ Programmes

4.3.1. The five NIHR National Coordinating Centres shall from April 2018 collaborate to deliver a number of work programmes in areas that ‘cut across’ the five centres and that will benefit the NIHR as a whole (‘One NIHR’ programmes).

4.3.2. These programmes will be managed through the NIHR Centres Executive Board.

4.3.3. The NIHR Centres Executive Board has agreed the following One NIHR programmes for the contract year 2018/19:

(a) NIHR Digital Programme – this programme shall implement the approved NIHR Digital Strategy (b) NIHR Communications Programme – this programme shall implement the approved NIHR Communications Strategy (c) ‘Push the Pace’ Project (d) NIHR Standard Application Form Project (e) Global Health Research Programme (f) Research Charity Engagement Programme

4.3.4. The Annual Plan for each of these programmes - the ‘NIHR Programmes Joint Annual Plan’ - will be submitted for Department of Health approval through the NIHR Centres Executive Board. Once approved, it will be included in each Coordinating Centre’s Annual Business Plan.

4.4. Further optimisation of the NIHR CRN

4.4.1. The Department of Health has requested that the NIHR CRN undertakes a number of service development and continuous improvement activities in 2018/19, which typically form part of wider NIHR advancement initiatives.

4.5. NIHR CRN High Level Objectives

4.5.1. The purpose of the NIHR CRN is to provide efficient and effective support for the initiation and delivery of funded research in the NHS. The performance of the NIHR CRN in meeting this purpose is measured against the CRN High Level Objectives (HLOs). The priority for the NIHR CRN is to meet and if possible exceed the HLO targets set on an annual basis by the Department of Health.

4.5.2. For 2018/19 a primary focus will remain on all LCRNs meeting the target that 80% of NIHR CRN Portfolio studies are delivered to recruitment target and time

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(HLO 2A relating to commercial studies and HLO 2B relating to non-commercial studies).

4.6. Optimisation of CRN study data integration

4.6.1. The programme of work for data integration between the NIHR CRN Central Portfolio Management System (CPMS) and the Local Portfolio Management Systems (LPMS) of the 15 LCRNs will bring multiple benefits, including:

● Enabling an efficient and coordinated way of exchanging research study performance and research management data, removing the need to enter recruitment data and study information into multiple systems; ● Driving the efficient provision and best use of intelligence for NIHR research studies; ● Supporting the government view that providing better information about public organisations will deliver better value for money in public spending, drive growth and inform choice; ● Supporting the UK Information Strategy which applies to all aspects of the NHS, including research.

4.6.2. This initial data integration is formed of three elements:

(1) “Get Study”, this being the functionality to exchange core details of NIHR CRN studies between CPMS and LPMS’; this element has been fully implemented; (2) “Capacity and Capability”, this being the functionality to exchange information on the readiness of research sites to conduct a NIHR CRN study; implementation of this element is in progress; (3) “Research Activity”, this being the functionality to exchange information on participation and participants in a NIHR CRN study; implementation has not commenced. 4.6.3. Element (2) will be delivered by March 2018. Element (3) is being developed in 2017/18 and will be completed in 2018/19.

4.7. CRN Funding Model

4.7.1. The Department of Health and the National CRN Coordinating Centre have identified a number of potential changes to the CRN Funding Model as part of wider NIHR initiatives. These are:

● Moving towards a better geographical match between disease burden and NIHR CRN participant recruitment; ● Incentivising Trusts and Principal Investigators for involvement and performance in industry studies; ● Incentivising LCRNs to maintain a ‘balanced portfolio’ of studies.

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4.7.2. The National CRN Coordinating Centre has undertaken substantial work on each of these three topics in the course of the contract year 2017/18, however further development and validation is required in order for these factors to be reflected in the NIHR CRN Funding Model. The intention is that these factors will be included in the NIHR CRN Funding Model that will determine LCRN funding allocations from the financial year 2019/20 onwards.

4.8. CRN staff skills development in new sciences, technologies and methodologies

4.8.1. The rapidly changing clinical research landscape is both an asset and a challenge. It has generated the need for many more practitioners and patients throughout the Health and Social Care system to have a better understanding of new types of science, new innovations in application of technologies and new methodologies associated with research.

4.8.2. This demand, coupled with a tight economic environment in the NHS, Public Health and Social Care setting, has seen a significant reduction in the investment in skills development through continuing professional development. There is a need for the NIHR to take a more assertive approach to the upskilling of front line staff and the investigator community.

4.8.3. The NIHR CRN has had significant experience and success through the delivery of the GCP programme, ensuring high quality skills development using online learning and we would wish to be more active in this space. This could be through the more timely development of easily accessible "bite size" learning using NIHR funded staff, but also through the curation and signposting of high quality materials from other sectors. This would then ensure that time-poor front line staff are clearly supported to use their learning time to best effect. The NIHR CRN has well-established reach and reputation to ensure this is achievable.

4.8.4. The National CRN Coordinating Centre, using digital learning resources to best effect, will support the development of understanding and confidence in the NIHR CRN funded workforce to deliver new, novel and innovative clinical research.

4.9. Implement Optional Services as required

4.9.1. Under clause 7.5 (“Optional Services”) of the Department of Health contract for the National CRN Coordinating Centre, “…the Authority may require the Supplier to provide any Optional Services at any time by giving notice to the Supplier in writing and following the procedure in paragraph 6.1 of Schedule 21 (Governance)”. The implementation and commencement of any additional Optional Services would be a priority activity should additional Optional Services be required by the Authority.

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Part B: Performance Framework

1. Introduction

1.1. This Part B of Appendix A sets out the NIHR CRN Performance Framework effective from 1 April 2018. 1.2. Performance management in the NIHR CRN is built on four principles: (a) Transparency – that the NIHR CRN openly publishes and reports performance information (b) Collaboration – that the LCRN Host Organisation and LCRN Partner organisations put in place effective partnership working arrangements to ensure that all stakeholders work collaboratively to develop and deliver against objectives (c) Information Integrity – that national and local information systems are managed and utilised consistently across the NIHR CRN to enable accurate and up to date information to be available to support effective performance management (d) Continuous Improvement - that LCRN Host Organisations and LCRN Partners embed a culture of continuous performance improvement, delivered for the benefit of patients whilst maximising value for money. 1.3. The purpose of the current NIHR CRN Performance Framework is to set out the objectives, measures and targets for the NIHR CRN which will be used to measure the success of the LCRN. 1.4. The NIHR CRN Performance Framework will be supported by a series of LCRN Contract Support Documents which will specify the data points and methodology used for all objectives and measurements, and will also provide details of the NIHR CRN annual reporting cycle.

2. LCRN Performance Indicators - Background

2.1. The following sets of indicators will be used by the National CRN Coordinating Centre and Department of Health to assess LCRN performance:

No. Indicators Aspect of LCRN performance 1 NIHR CRN High Level The performance of the LCRN in the Objectives (HLOs) delivery of NIHR CRN Portfolio studies 2 NIHR CRN Clinical The contribution of the LCRN to the delivery Research Specialty of the national objectives for the NIHR CRN Objectives Clinical Research Specialties

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3 LCRN Operating The performance of the LCRN in operating Framework Indicators in compliance with mandated operational structures and processes 4 Initiating and Delivering The performance of individual providers of Clinical Research Indicators NHS services in initiating and delivering clinical research as set out in Section 3A of the Contract between the LCRN Host Organisation and the Department of Health 5 LCRN Partner Satisfaction The performance of the LCRN Host Indicators Organisation and LCRN Leadership/Management Team in delivering an inclusive and effective LCRN 6 LCRN Customer The performance of the LCRN in delivering Satisfaction Indicators a responsive and flexible service that meets the needs of our customers 7 LCRN Patient Experience The performance of the LCRN in delivering Indicators excellence in patients’ experience of research

2.2. Some specific indicators will require LCRN-level targets. As part of the LCRN annual planning process, LCRNs will propose LCRN-level targets for these indicators. These proposals will be considered by the National CRN Coordinating Centre and the National CRN Coordinating Centre will confirm the final LCRN- level targets. The annual performance of the LCRN will be measured against these final LCRN-level targets.

Set 1 – NIHR CRN High Level Objectives (HLOs)

2.3. The HLOs are the national, overarching objectives for Clinical Research Network research delivery, and constitute the most important set of NIHR CRN Performance Objectives. The HLOs are collective objectives for the whole NIHR CRN system. 2.4. The LCRN Host Organisation will plan and report on the LCRN’s contribution to these national HLOs. 2.5. The NIHR CRN HLOs are presented in Table 1 below.

Set 2 – Clinical Research Specialty Objectives

2.6. The Clinical Research Specialty Objectives are the development and performance objectives for the 30 NIHR CRN Clinical Research Specialties. Each Specialty ordinarily has a single objective each year. The NIHR CRN National Specialty Groups propose the objectives on an annual basis, for

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approval by the National CRN Coordinating Centre and the Department of Health. 2.7. The LCRN Host Organisation will plan and report on the LCRN’s local contribution to these national Clinical Research Specialty Objectives and targets. 2.8. Although each Specialty has its own objective, these should not be taken in isolation, and LCRNs are expected to promote cross-Specialty working in order to maximise the overall performance of the LCRN and network as a whole. Recognition and support should be provided to Specialties which are contributing to the objectives of other Specialties in line with the NIHR CRN’s “one Network” approach to delivery. 2.9. All Specialty Groups must also focus on delivering against the HLOs from a Specialty perspective. There is an NIHR CRN wide focus on delivery of clinical research to time and target (HLO 2). 2.10. The Clinical Research Specialty objectives are presented in Table 2 below.

Set 3 – LCRN Operating Framework Indicators

2.11. The NIHR CRN Operating Framework (Section C of this document) defines the organisational requirements, operational systems and processes that LCRNs are required to implement in order to ensure consistency across the LCRN infrastructure and, where necessary, standards for locally defined arrangements and systems. 2.12. The NIHR CRN Operating Framework is a comprehensive document with a substantial number of provisions. On an annual basis, the National CRN Coordinating Centre selects a number of provisions, typically provisions in respect of key operational arrangements, which form the set of indicators. These indicators are used by the National CRN Coordinating Centre in order to assess each LCRN’s compliance with the Operating Framework provisions. 2.13. The LCRN Operating Framework Indicators are presented in Table 3 below.

Set 4 – Initiating and Delivering Clinical Research Indicators

2.14. The Plan for Growth, published by the Government in March 2011, and which can be found at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/31 584/2011budget_growth.pdf, announced the transformation of incentives at local level for efficiency in initiation and delivery of research which includes the publication of clinical trial start-up times against public benchmarks. 2.15. The definitions in relation to the Performance in Initiating and Delivering Clinical Research exercise have evolved since its original implementation. The latest information on the current requirements can be found on the NIHR website at https://www.nihr.ac.uk/research-and-impact/nhs-research- performance/performance-in-initiating-and-delivering-research/ : with data points

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definitions as described here: https://www.nihr.ac.uk/research-and-impact/nhs- research-performance/hra-approvals-and-nihr-metrics.htm 2.16. The LCRN Host Organisation Agreement and the “flow down” agreement between the LCRN Host Organisation and Category A LCRN Partner include - at Clause 3A - the standard NIHR contract clauses implementing the Government’s Plan for Growth provisions and requirements relating to the Performance in Initiating and Delivering Clinical Research; which involves the reporting of achievement against the initiation benchmark for all clinical trials and delivery of recruitment to time and target for commercial contract clinical trials. 2.17. The Authority will hold the LCRN Host Organisation and each Category A LCRN Partner individually accountable for its performance with respect to Clause 3A. Additional wording has been added to the standard text in the LCRN Host Organisation Agreement to ensure there are no grounds for confusion over the LCRN Host Organisation’s responsibilities in this domain. 2.18. The LCRN Host Organisation and Category A LCRN Partner will each submit their data directly to the Authority via the national system as advised by the Authority. The Government’s aims in introducing these clauses were to see a dramatic and sustained improvement in the performance of providers, to increase the number of patients that have the opportunity to participate in research and to enhance the nation’s attractiveness as a host for research. The Authority effects any changes to funding as a result of poor performance, via the Research Capability Funding allocations to Trusts, not via NIHR CRN funding. 2.19. Other providers of NHS services, including Category B LCRN Partners, shall not be required to report against the Performance in Initiating and Delivering Clinical Research exercise. Nevertheless, it is important they understand that they have an important part to play in increasing performance in the initiation and delivery of research.

Set 5 – LCRN Partner Satisfaction Survey Indicators

2.20. The effective operation of the LCRN is dependent upon all LCRN Partner organisations working together in a mutually supportive and collaborative way – i.e. as a network. It is the contractual responsibility of the Host Organisation to ensure the provision of LCRN leadership, management, resources, systems, governance and operational arrangements to achieve this. 2.21. Therefore it is of primary importance that LCRN Partners are content with this provision by the Host Organisation, that the National CRN Coordinating Centre seeks direct assurances of this from LCRN Partners, and that the National CRN Coordinating Centre is sufficiently informed in order to address any material issues with the LCRN Host Organisation and leadership. 2.22. In order to gain this assurance, the National CRN Coordinating Centre will undertake an annual survey of LCRN Partners, referred to as the ‘LCRN Partner Satisfaction Survey’. The survey will elicit LCRN Partners’ views on the range of

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LCRN Host Organisation responsibilities, these forming a set of indicators of LCRN Partner Satisfaction.

Set 6 – LCRN Customer Satisfaction Indicators

2.23. The ‘customers’ of the NIHR CRN are research funders – both commercial and non-commercial – and the investigators and research teams conducting that research. As the primary purpose of the NIHR CRN is to provide NHS support services to these customers, it is self-evident that NIHR CRN customers need to be content with the provision of LCRN services, including systems, processes, facilities, staff, communication, and the general relationship and interactions. 2.24. In order to gain this assurance, the National CRN Coordinating Centre will undertake an annual survey of LCRN customers, referred to as the ‘LCRN Customer Satisfaction Survey’. The survey will elicit LCRN customers’ views across the dimensions of LCRN service provision, these forming a set of indicators of LCRN Customer Satisfaction. Set 7 – LCRN Patient Experience Indicators 2.25. The research that the NIHR CRN helps to carry out is for patient benefit and patients are at the core of what we do. 2.26. The LCRN Host Organisation will coordinate an annual survey of patients, referred to as the ‘Patient Research Experience Survey’. The survey will elicit patients’ views of their experience of taking part in research. Each LCRN will include a number of standard questions which will form a set of indicators of LCRN Patient Experience.

3. Performance Management Processes

Annual Plan and Annual Report

3.1. The LCRN Host Organisation will adhere to the requirements of the annual business planning cycle as defined by the National CRN Coordinating Centre. This will include the preparation and submission to the National CRN Coordinating Centre of LCRN plans and reports, including an LCRN Annual Plan and an LCRN Annual Report, following the specification set by the National CRN Coordinating Centre in respect of structure, content, quality and submission timelines. 3.2. The LCRN Annual Plan will set the direction for the LCRN for that contract year. It must include the initiatives, projects and activities, including milestones and targets, where applicable, to support the achievement of the LCRN Performance Indicators as set out in this Part B of Appendix A. 3.3. The LCRN Annual Plan will include a financial plan. The financial plan will include the annual funding allocations to the LCRN Host Organisation and LCRN Partners.

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3.4. The LCRN Annual Report will provide an assessment of the LCRN’s delivery against the Annual Plan, and it will report LCRN performance against the LCRN Performance Indicators. 3.5. The LCRN Annual Report will include a year-end financial report. 3.6. The LCRN Annual Plan and LCRN Annual Report should be supported and agreed by the LCRN Partnership Group and formally approved by the LCRN Host Organisation board. 3.7. These plans and reports should be developed in collaboration with the governance, management and influencing groups set out in Part C of this Appendix A (including but not limited to the LCRN Operational Management Group and the LCRN Partnership Group).

Performance management by the National CRN Coordinating Centre

3.8. The detailed arrangements for the performance management of the LCRN by the National CRN Coordinating Centre are set out in the CRN Performance Management Framework document, which shall be provided to the LCRN Host Organisation. 3.9. The LCRN leadership team, as defined in Part C of this Appendix A, will attend two performance review meetings per year with senior representatives from the National CRN Coordinating Centre (a Mid-Year Review meeting and an Annual Review meeting). 3.10. The Mid-Year review meetings will be attended by members of the National CRN Coordinating Centre Executive team and the LCRN Clinical Director(s) and LCRN Chief Operating Officer. The LCRN Host Organisation Nominated Executive Director and Partnership Group Chair are invited to attend but attendance is not mandatory. Up to two additional LCRN observers may also attend. 3.11. The annual performance review meetings will be attended by members of the National CRN Coordinating Centre Executive team and the LCRN Clinical Director(s) and LCRN Chief Operating Officer. The LCRN Host Organisation Nominated Executive Director and Partnership Group Chair are expected to attend. 3.12. The LCRN Annual Report will be reviewed at the Annual Review meeting in the second quarter of each contract year. 3.13. The National CRN Coordinating Centre will monitor compliance of LCRN Host Organisations in respect of the DH/LCRN Host Organisation Agreement, including the Performance and Operating Framework via a Contract Compliance Framework. 3.14. Where issues in the performance of the LCRN in respect of the LCRN Performance Indicators are identified, the LCRN Host Organisation shall put in

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place a remedial action plan, to be agreed with the National CRN Coordinating Centre. The issue(s) should be documented in the LCRN’s Risks and Issues Log. 3.15. If the performance of the LCRN against the remedial action plan fails to improve within a period specified by the National CRN Coordinating Centre and to the levels agreed with the National CRN Coordinating Centre, the Agreement may be terminated, as set out in Clause 19.1 of the Agreement.

Performance management by the LCRN Host Organisation

3.16. The overall performance of the LCRN will be determined by measuring the performance of the LCRN Host Organisation and its LCRN Partners. The LCRN Host Organisation will therefore need to ensure robust performance management processes are in place across the LCRN. 3.17. LCRN Partner organisations and Specialty Groups will set and agree their performance goals on an annual basis with the LCRN Host Organisation. The LCRN Host Organisation will provide this information to the National CRN Coordinating Centre on request. 3.18. The LCRN Host Organisation will actively manage and monitor performance against the LCRN Annual Plan and provide reports, including LCRN performance reports, to the National CRN Coordinating Centre as required. 3.19. The LCRN Host Organisation will promote active local performance management approaches within the LCRN in relation to achievement of the LCRN Performance Indicators set out in this Part B of Appendix A. 3.20. In order to support the production of high quality performance data and reporting, the LCRN Host Organisation must ensure all NIHR CRN Portfolio recruitment data is recorded on NIHR CRN information systems in a timely and efficient manner, in line with guidance set out by the National CRN Coordinating Centre. 3.21. The LCRN Host Organisation will be responsible for ensuring all LCRN Partners have access to timely LCRN performance data. 3.22. The LCRN Host Organisation should encourage LCRN Partner organisations to maintain Board level scrutiny of NIHR CRN key performance indicators via appropriate local Board reports. 3.23. The LCRN Host Organisation will support local performance improvement projects which address underperformance against the NIHR CRN objectives. 3.24. The LCRN Host Organisation will engage the LCRN Partnership Group as a key forum for driving LCRN performance, challenging underperformance, supporting increased participation and improved delivery, and sharing best practice. 3.25. The LCRN Host Organisation and its LCRN Partner organisations will actively contribute to national programmes for development, performance review and support.

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3.3. LCRN Contract Support Documents

LCRN Leadership Teams should ensure that all elements of the LCRN operate in compliance with the following LCRN Contract Support Documents in respect of the LCRN Performance Indicators which are accessible on the NIHR Hub:

Ref Title

PM/002 NIHR CRN High Level Objectives Data Point Grid

PM/041 NIHR CRN Specialty Objectives Data Point Grid

PM/031 NIHR CRN Performance Management Framework

PM/033 Requirements for LCRN Annual Delivery Planning

PM/034 Requirements for LCRN Annual Delivery Reporting

PM/035 Risks and Issues Log Requirements

PM/060 NIHR CRN Annual Reporting Cycle

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4. LCRN Performance Indicators - Tables

Table 1 – NIHR CRN High Level Objectives

Objective Measure 2018/19 1 Increase the number of participants Number of participants recruited in a reporting year into NIHR CRN 650,000 recruited into NIHR CRN Portfolio studies Portfolio studies

2 Increase the proportion of studies in the A: Proportion of commercial contract studies achieving or surpassing 80% NIHR CRN Portfolio delivering to their recruitment target during their planned recruitment period, at recruitment target and time confirmed Network sites

B: Proportion of non-commercial studies achieving or surpassing their 80% recruitment target during their planned recruitment period

3 Increase the number of commercial A: Number of new commercial contract studies entering the NIHR 700 contract studies delivered through the CRN Portfolio NIHR CRN B: Number of new commercial contract studies entering the NIHR 75% CRN Portfolio as a percentage of the total commercial MHRA CTA approvals for Phase II–IV studies 4 Reduce the time taken for eligible studies Proportion of eligible studies achieving NHS set up at all sites within 40 80% to achieve set up in the NHS calendar days (from “Date Site Selected” to “Date Site Confirmed”)

5 Reduce the time taken to recruit first A: Proportion of commercial contract studies achieving first participant 80% participant into NIHR CRN Portfolio studies recruited within 30 days at confirmed Network sites (from “Date Site Confirmed” to “Date First Participant Recruited”)

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Objective Measure 2018/19

B: Proportion of non-commercial contract studies achieving first 80% participant recruited within 30 days at confirmed Network sites (from “Date Site Confirmed” to “Date First Participant Recruited ”)

6 Increase NHS participation in NIHR CRN A: Proportion of NHS Trusts recruiting each year into NIHR CRN 99% Portfolio Studies Portfolio studies

B: Proportion of NHS Trusts recruiting each year into NIHR CRN 70% Portfolio commercial contract studies

C: Proportion of General Medical Practices recruiting each year into 45% NIHR CRN Portfolio studies 7 Increase the number of participants Number of participants recruited into Dementias and Neurodegeneration 25,000 recruited into Dementias and (DeNDRoN) studies on the NIHR CRN Portfolio Neurodegeneration (DeNDRoN) studies on the NIHR CRN Portfolio

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Table 2 – Clinical Research Specialty Objectives

# Specialty Objective Measure Target 1 Ageing Increase early career researcher Number of LCRNs that have evidenced increased early 15 LCRNs involvement in NIHR CRN Portfolio career researcher involvement in NIHR CRN Portfolio research research 2 Anaesthesia, Increase the number of NIHR CRN Number of LCRNs with a study/studies led by a trainee 5 LCRNs Perioperative Portfolio studies led by trainees as (Chief Investigator or co-Chief Investigator) Medicine and Pain Chief Investigator or co-Chief Management Investigator 3 Cancer Increase patient access to Cancer Number of LCRNs achieving on-target recruitment into at 15 LCRNs research studies across the least 8 of the 13 Cancer subspecialties, where "on-target" breadth of the Cancer means either improving recruitment by 10% from 2017/18 subspecialties or meeting the following recruitment targets per 100,000 population served:

a) Brain: 0.2 b) Breast: 10 c) Colorectal: 3 d) Children and Young People: 3 e) Gynae: 3 f) Head & Neck: 1.5 g) Haematology: 7 h) Lung: 4 i) Sarcoma: 0.1 j) Skin: 0.5 k) Supportive & Palliative Care and Psychosocial Oncology: 4 l) Upper GI: 3 m) Urology: 12

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# Specialty Objective Measure Target 4 Cardiovascular Develop the research workforce in LCRNs will identify the cohort of investigators who work on 15 LCRNs Disease cardiovascular surgery cardiovascular-led NIHR CRN Portfolio studies at cardiothoracic surgery centres in their geography. In consultation with this cohort the LCRN will make a written plan on how it will help those who are interested become Principal Investigators. 5 Children Increase NHS participation in Proportion of NHS Trusts recruiting into Children's studies 90% Children's studies on the NIHR on the NIHR CRN Portfolio CRN Portfolio 6 Critical Care Increase intensive care units’ Proportion of intensive care units recruiting into studies on 80% participation in NIHR CRN Portfolio the NIHR CRN Portfolio studies 7 Dementias and Increase early career researcher Number of LCRNs that have evidenced increased early 15 LCRNs neurodegeneration involvement in NIHR CRN Portfolio career researcher involvement and provided the names of research at least two new early career researchers that have become local Principal Investigators for DeNDRoN studies on the NIHR CRN Portfolio during 2018/19 8 Dermatology Develop the Dermatology Principal Number of new Nurse PIs for managed or supported 1 new Nurse Investigator (PI) workforce Dermatology studies entering the NIHR CRN Portfolio PI per LCRN 9 Diabetes Improve primary-secondary care Increase recruitment into studies that require collaboration Overall collaboration in the delivery of between primary and secondary care national Diabetes research increase of 5% from baseline 10 Ear, nose and Increase trainee involvement in Establish links with the relevant professional organisations 15 LCRNs throat NIHR CRN Portfolio research involved in research for patients with Ear, nose and throat, Hearing and Balance conditions to encourage and support trainee involvement in NIHR CRN Portfolio studies 11 Gastroenterology Improve recruitment to NIHR CRN Recruitment of 40 participants per 100,000 population to 15 LCRNs Gastroenterology studies Gastroenterology studies on the NIHR CRN Portfolio

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# Specialty Objective Measure Target 12 Genetics Increase early career researcher Number of LCRNs that have evidenced increased early 15 LCRNs involvement in NIHR CRN Portfolio career researcher involvement in NIHR CRN Portfolio research research 13 Haematology Establish links with the relevant Number of LCRNs that have evidenced increased trainee 15 LCRNs professional organisations to involvement in NIHR CRN Portfolio research encourage and support trainee involvement in NIHR CRN Portfolio studies 14A Health Services Develop research infrastructure Number of LCRNs with a lead for Health Services 15 LCRNs Research (including staff capacity) in the Research NHS to support clinical research in Health Services Research 14B Health Services Increase the number of recruitment Number of new sites for existing and new studies on the 1 new site per Research sites for NIHR CRN Portfolio NIHR CRN Portfolio funded by the Health Services and LCRN studies funded by the Health Delivery Research programme Services and Delivery Research programme 15 Hepatology Increase access for patients to Number of LCRNs recruiting to Hepatology studies on the 15 LCRNs Hepatology studies on the NIHR NIHR CRN Portfolio in the disease areas of: cirrhosis and CRN Portfolio its complications; and/or non alcoholic fatty liver disease (NAFLD) or non alcoholic steatohepatitis (NASH) 16 Infection Develop research infrastructure Named champion for sexually transmitted infection 15 LCRNs (including staff capacity) in the NHS to support clinical research 17 Injuries and Increase participation in pre- Number of LCRNs that have recruited via Ambulance 15 LCRNs Emergencies hospital studies via Ambulance Trusts to two or more pre-hospital care managed or Trusts supported Injuries and Emergencies studies on the NIHR CRN Portfolio

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# Specialty Objective Measure Target 18 Mental Health Increase participation in Mental Increase the number of NIHR CRN Portfolio studies 5% increase Health studies involving children recruiting participants aged 16 years or under from 2017/18 and young people 19 Metabolic and Understand and develop the Accurately record the Principal Investigators and Submission of Endocrine research workforce that work in recruitment staff (nurses and trial coordinators) working on data by 15 Disorders Metabolic and Endocrine-led Metabolic and Endocrine-led studies, on the NIHR CRN LCRNs studies Portfolio open during the 2018 calendar year 20 Musculoskeletal Increase engagement of A: Named orthopaedic champion identified in each LCRN 15 LCRNs Disorders orthopaedic champions to support the delivery of Musculoskeletal B: Increase the number of participants recruited into 10% increase Disorders studies on the NIHR orthopaedic studies on the NIHR CRN Portfolio from 2017/18 CRN Portfolio 21 Neurological Increase early career researcher Number of LCRNs that have evidenced increased early 15 LCRNs Disorders involvement in NIHR CRN Portfolio career researcher involvement in NIHR CRN Portfolio research research 22 Ophthalmology Increase NHS participation in Proportion of acute NHS Trusts that provide eye services 70% Ophthalmology studies on the recruiting into Ophthalmology studies on the NIHR CRN NIHR CRN Portfolio Portfolio

23 Oral and Dental To develop the Oral and Dental LCRNs to survey dentists and dental care professionals 15 LCRNs health research workforce in order to within their geographies to identify their research meet the demands of the expected readiness and interests in order to gain an understanding growth in the portfolio following the of the local capacity and capability JLA Priority Setting Partnership 24 Primary Care Increase engagement of GP LCRNs to identify and fund a minimum of two named 15 LCRNs registrars and First Five GPs with individuals in a GP registrar/First Five nurturing role to NIHR CRN Portfolio research undertake Research Champion activities 25 Public health A: Number of LCRNs with a lead for Public Health 15 LCRNs

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# Specialty Objective Measure Target Develop research infrastructure B: Number of LCRNs recruiting to at least five studies on 15 LCRNs (including staff capacity and the NIHR CRN Portfolio managed by Public Health working with local authorities) to support research in Public Health 26 Renal Disorders Increase the number of 'new' Number of LCRNs with one or more ‘new’ PIs (defined as 15 LCRNs Principal Investigators (PIs) researchers who have not engaged as PI in any engaged in commercial Renal commercial study in the last 3 years) Disorders studies on the NIHR CRN Portfolio 27 Reproductive Increase the proportion of NHS A: Proportion of acute NHS Trusts, which provide 70% Health and Trusts recruiting into Reproductive maternity services, recruiting into Reproductive Health and Childbirth Health and Childbirth studies on Childbirth studies on the NIHR CRN Portfolio the NIHR CRN Portfolio B: Recruitment within the LCRN geography as a Establish proportion of infant mortality data for that region baseline to determine appropriate level of growth for 2019/20 28 Respiratory Increase access for patients to Number of LCRNs recruiting participants into respiratory At least 10 Disorders Respiratory Disorders studies on rare disease studies on the NIHR CRN Portfolio (e.g. LCRNs the NIHR CRN Portfolio pulmonary fibrosis, pulmonary hypertension, cystic fibrosis, lymphangioleiomyomatosis, pulmonary alveolar proteinosis). 29 Stroke CRN recruitment to Stroke RCTs CRN Stroke RCT recruitment as a % of SSNAP-recorded 8% national should be at least 8% of the admissions target 2017/18 Sentinel Stroke National Audit Programme (SSNAP)- recorded hospital admissions

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# Specialty Objective Measure Target 30 Surgery Increase patient access to Surgery Number of LCRNs recruiting into at least 12 of the 14 15 LCRNs research studies on the NIHR CRN surgical subspecialties (breast, cardiac, colorectal, Portfolio across the breadth of the general, head & neck, hepatobiliary, neurosurgery, surgical subspecialties orthopaedics, plastics and hand, transplant, trauma, upper GI, urology, vascular) AND at least 2 patients/100,000 population into at least 6 of the 14 surgical subspecialties

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Table 3 – LCRN Operating Framework Indicators

ID Domain Indicator Assessment Approach 1.1 Governance and LCRN provides an Annual Plan, Annual Report and Monitoring of provision of key documents requested by Management other documents as requested by the National CRN the National CRN Coordinating Centre Coordinating Centre 1.2 Governance and LCRN Clinical Director and/or LCRN Chief Operating Attendance registers for National CRN Coordinating Management Officer attend all National CRN Coordinating Centre/LCRN Liaison meetings Centre/LCRN Liaison meetings 1.3 Governance and LCRN Host Organisation and LCRN Category A Analysis of information on the NHS Digital Information Management Partners submit an NHS Information Governance Governance Toolkit website which provides open access Toolkit annual assessment to NHS Digital and attain to attainment levels for all submitting organisations Level 2 or Level 3 1.4 Governance and Category A LCRN Partner flow down contract LCRN Annual Report Management templates used to contract with all Category A LCRN Partners 1.5 Governance and Category B LCRN Partner flow down contract LCRN Annual Report Management templates used to contract with all Category B LCRN Partners 2.1 Financial Internal audit in respect of LCRN funding managed by Monitoring of audit reports provided by the LCRN Host Management the LCRN Host Organisation, undertaken at least once Organisation to the National CRN Coordinating Centre every three years and which meets the minimum scope requirements specified by the National CRN Coordinating Centre

2.2 Financial Deliver robust financial management using appropriate ● Monitoring by the National CRN Coordinating Centre of Management tools and guidance percentage variance (allocation vs expenditure) quarterly and year-end (target is 0%)

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ID Domain Indicator Assessment Approach ● Monitoring by the National CRN Coordinating Centre of proportion of financial returns completed to the required standard and on time (target is 100%) ● Monitoring of financial management via LCRN financial health check process 2.3 Financial Distribute LCRN funding equitably on the basis of NHS Comparison by the National CRN Coordinating Centre of Management support requirements annual LCRN Partner funding allocations and NHS Support requirements 3.1 CRN Specialties LCRN has an identified Lead for each NIHR CRN The LCRN Host Organisation shall: Specialty (1) Provide the National CRN Coordinating Centre with access to a list of LCRN Clinical Research Specialty Leads, which includes each individual’s start/end dates and contact information (2) Notify the National CRN Coordinating Centre if there are changes within the financial year (3) Provide a narrative to justify intentional vacancies or the expected timeframe to fill vacancies

3.2 CRN Specialties Each LCRN Clinical Research Specialty Lead attends Attendance registers for National Specialty Group at least 2/3 of National Specialty Group meetings meetings

3.3 CRN Specialties Each LCRN provides evidence of support provided to Review by the National CRN Coordinating Centre of their LCRN Clinical Research Specialty Leads to evidence of support provided in LCRN Annual Plan and enable them to undertake their role in contributing to Report the NIHR CRN’s nation-wide study support activities, specifically in respect of commercial early feedback and non-commercial expert review for the eligibility decision and including where applicable, local feasibility activities, delivery assessments and performance reviews

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ID Domain Indicator Assessment Approach 4.1 Research Delivery Each LCRN consistently delivers the local elements of Monitoring by the National CRN Coordinating Centre of the CRN’s nation-wide Study Support Service as provision of the individual components of the Service via specified in the latest version of the Standard the study progress tracker application on Open Data Operating Procedures produced by the National CRN Platform where the LCRN is assigned as the Lead LCRN Coordinating Centre and available as part of the LCRN and/or Performance Lead Contract Support Documents

4.2 Research Delivery Each LCRN provides near time Minimum Data Set ● Monitored via Open Data Platform reports, the single data items as specified by the National CRN research intelligence system and the Research Coordinating Centre, which have been quality assured Delivery Assurance Framework to accurately reflect research activity measures and ● Analysis of percentage of missing and inaccurate data enable collaborative delivery of studies across the points from each LCRN NHS 5.1 Information and LCRN provides an LPMS to capture for their region Monitoring by the National CRN Coordinating Centre of Knowledge the required Minimum Data Set data items as system integration, usage and data transfer as part of the specified by the National CRN Coordinating Centre, single research intelligence system and enables timely sharing of information as one element of the single research intelligence system 5.2 Information and LCRN provides support for ongoing provision of an Review of budget line for provision of an LPMS in LCRN Knowledge LPMS solution Annual Financial Plan 5.3 Information and Each LCRN has a nominated representative in Attendance registers for national NIHR CRN Virtual Knowledge attendance at all national NIHR CRN Virtual Business Business Intelligence meetings Intelligence meetings 5.4 Information and Each LCRN has a nominated representative in Attendance registers for national CPMS-LPMS meetings Knowledge attendance at all national CPMS-LPMS meetings where either a) strategic sign off is required or b) an operational working perspective is required

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ID Domain Indicator Assessment Approach 6.1 Stakeholder LCRN has an experienced and dedicated ● Individual’s name and contact details provided to the Engagement and communications function National CRN Coordinating Centre Communications ● Non-pay budget line for communications identified in LCRN Annual Plan

6.2 Stakeholder Each LCRN has a defined approach to ● Review and monitoring of LCRN Annual Plan Engagement and communications and action plan aligned with both the ● Review of outcomes as reported within LCRN Annual Communications NIHR CRN and NIHR strategies Report ● Evidence of joint work with local NIHR infrastructure reviewed 6.3 Stakeholder The LCRN has in place a senior leader with Individual's name and contact details provided to the Engagement and experience and identified responsibility for PPIE National CRN Coordinating Centre Communications 6.4 Stakeholder The LCRN records metrics of research opportunities ● The LCRN will hold information on its reach with Engagement and offered to patients patients and the public (metrics may include local Communications website usage, leaflet distribution, social media reach etc) ● Evidence of local patient evaluation system ● Progress discussed at national PPIE meetings and reported in LCRN Annual Report 6.5 Stakeholder The LCRN has collaborative PPIE workplans across ● LCRN Annual Plan includes PPIE workplan with clear Engagement and CRN and partners with measurable outcomes for outcomes, milestones and measurable targets Communications delivery of learning resources ● Non-pay budget line for PPIE and WTE for PPIE role(s) identified in LCRN Annual Plan ● Progress reported in LCRN Annual Report 6.6 Stakeholder Each LCRN supports awareness of, engagement with ● Review of outcomes as reported within LCRN Annual Engagement and and delivery of National CRN Coordinating Centre- Report Communications managed services, such as Join Dementia Research ● Review of performance on JDR (JDR) and the UK Clinical Trials Gateway (UKCTG) 6.7 Stakeholder Each LCRN delivers the Patient Research ● Review and monitoring of LCRN Annual Plan Engagement and Ambassadors (PRAs) project ● Review of outcomes as reported within LCRN Annual Communications Report

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ID Domain Indicator Assessment Approach 6.8 Stakeholder Each LCRN delivers the patient experience survey, as ● Review and monitoring of LCRN Annual Plan Engagement and specified by the National CRN Coordinating Centre ● Review of outcomes as reported within LCRN Annual Communications Report 6.9 Stakeholder Each LCRN develops and implements a plan to deliver ● Review and monitoring of LCRN Annual Plan Engagement and the CRN NHS Engagement Strategy ● Review of outcomes as reported within LCRN Annual Communications Report 7.1 Workforce, Learning The LCRN has in place a senior leader with identified ● Individual's name and contact details provided to the and Organisational responsibility for the wellbeing of all LCRN-funded National CRN Coordinating Centre Development staff ● Implementation of the local action plan to support the wellbeing framework and action plan 7.2 Workforce, Learning Each LCRN has an active programme of activities that ● Evidence of programme of learning opportunities and Organisational engage the wider workforce to promote clinical provided in LCRN Annual Plan and Report Development research as an integral part of healthcare for all ● Increased engagement of local partners in promoting the work of the NIHR 7.3 Workforce, Learning The LCRN has in place a senior leader with identified ● Evidence of programme of activities provided in LCRN and Organisational responsibility for driving a culture of Continuous Annual Plan and Report Development Improvement (Innovation and Improvement) supported ● Effective approaches shared by Continuous by an action plan aligned to local and national Improvement Leads at national meetings initiatives and performance metrics 8.1 Business Each LCRN has an up to date business development ● Profile template submitted as part of LCRN Annual Development and and marketing Profile using the template provided by Plan Marketing the National CRN Coordinating Centre ● Contact details provided for assigned LCRN Profile lead in LCRN Annual Plan 8.2 Business The LCRN has an action plan for promoting the ● Review and monitoring of LCRN Annual Plan Development and industry agenda aligned with the national business ● Review of outcomes as reported within LCRN Annual Marketing development strategy Report 8.3 Business The LCRN actively contributes to the intelligence ● LCRN reports interactions with NIHR CRN Customers Development and gathering process from NIHR CRN Customers using at the Life Sciences Industry Forum meetings Marketing the template provided by the National CRN Coordinating Centre

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Part C: Operating Framework

1. Introduction

1.1. This Part C of Appendix A sets out the NIHR CRN Operating Framework effective from 1 April 2018. 1.2. The Operating Framework defines the organisational requirements, operational systems and processes that LCRNs are required to implement in order to ensure consistency across the LCRN infrastructure and, where necessary, standards for locally defined arrangements and systems.

2. Governance and Management

2.1. General Principles

2.1.1. In accepting the Authority's contract for the LCRN, the LCRN Host Organisation will need to:

(a) work to ensure the success of the LCRN and to secure a vibrant local NHS research environment within the LCRN's area and as part of a national system (b) ensure the terms of the contract with the Authority are fully met (c) ensure resources allocated to support clinical research activity are properly utilised, through the LCRN. 2.1.2. The LCRN Host Organisation board is accountable for the effective governance of the LCRN. The Board shall apply, in a proportionate and appropriate way, the principles of good governance and thereby promote:

(a) robust, transparent and accountable LCRN governance (b) effective and supportive LCRN hosting arrangements (c) effective and proportionate contracts with LCRN Partners and other organisations in receipt of LCRN funding or resources (d) governance arrangements that ensure effective local performance management, LCRN Partner participation and engagement, research delivery and value for money. 2.1.3. The LCRN Host Organisation board will put in place governing structures, systems, terms of reference and local policies for the LCRN. As a minimum these shall include the specific governance requirements detailed in this contract in respect of:

(a) key personnel

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(b) the Scheme of Delegation and LCRN Host Organisation board controls and assurances (c) assurance framework and risk management system (d) escalation process (e) LCRN Partners (f) The LCRN Partnership Group. 2.1.4. NHS patients, carers and the public are the key stakeholders in NIHR CRN research, and are to be included in LCRN governance arrangements.

2.1.5. LCRN governance arrangements should be documented in a single, up-to-date document and formally agreed by the LCRN Host Organisation board and by the National CRN Coordinating Centre.

2.2. Scheme of Delegation and Host Board Controls and Assurances

2.2.1. The LCRN Host Organisation shall have agreed a specific delegation of authority to the LCRN leadership team. This should be by a documented decision by the LCRN Host Organisation board.

2.2.2. As part of the delegation to the LCRN leadership team, the LCRN Host Organisation shall identify and agree appropriate board level controls and assurances around LCRN activities including:

(a) receipt of an LCRN Annual Plan, from the Nominated Executive Director, for approval (b) receipt of an LCRN Annual Report, from the Nominated Executive Director, for approval (c) submission of the LCRN Annual Plan and LCRN Annual Report to the National CRN Coordinating Centre for approval (d) provision of the approved LCRN Annual Plan and LCRN Annual Report to all members of the LCRN Partnership Group. 2.2.3. The LCRN Host Organisation shall ensure the proper management of the LCRN in terms of compliance with the governance framework and processes of the LCRN Host Organisation, including human resources, standing financial, audit and standards of business conduct instructions. The LCRN Host Organisation shall ensure internal policies and standing financial instructions, as they affect the LCRN, do not unreasonably diminish the efficient management of the LCRN.

2.2.4. The LCRN Host Organisation shall ensure the LCRN is run in accordance with relevant laws and regulatory requirements, relevant national NHS policies and requirements, and the NHS Constitution.

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2.3. Assurance Framework and Risk Management System

2.3.1. The LCRN Host Organisation shall maintain an assurance framework including a risk management system in respect of the LCRN.

2.3.2. The LCRN assurance framework will be scrutinised by the LCRN leadership team at their regular meetings, and shared with the LCRN Partners at LCRN Partnership Group meetings.

2.3.3. The LCRN Host Organisation will ensure robust and tested local business continuity arrangements are in place for the LCRN. This is to enable the LCRN Host Organisation to respond to a disruptive incident, including a public health outbreak, e.g. pandemic or other related event, maintain the delivery of critical activities/services and to return to “business as usual”. Business continuity arrangements should be in line with guidance set out by the National CRN Coordinating Centre.

2.3.4. Annually, the LCRN Host Organisation must review its role in discharging the Authority contract for hosting the LCRN and must provide a report on this within the LCRN Annual Report. This report shall be shared with the LCRN Partnership Group and provided to the National CRN Coordinating Centre.

2.3.5. The LCRN Host Organisation must ensure LCRN activity is included in the local internal audit programme of work.

2.4. Escalation Process

2.4.1. The LCRN Host Organisation shall set out, implement and maintain a documented LCRN escalation process, which is in line with the accountability arrangements.

2.4.2. There will be identified points of contact within the LCRN management structure, the LCRN Host Organisation, and the National CRN Coordinating Centre for concerns and issues to be escalated.

2.4.3. Escalation routes and levels shall include:

(a) LCRN Clinical Director and/or Chief Operating Officer (b) LCRN Host Organisation Nominated Executive Director for the LCRN (c) LCRN Host Organisation Chief Executive Officer (d) Chief Operating Officer, National CRN Coordinating Centre (e) Chief Executive Officer, National CRN Coordinating Centre.

2.5. Corporate Support Services

2.5.1. The LCRN Host Organisation shall act as an effective steward of LCRN resources and ensure all management processes, facilities and support services

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necessary for the effective leadership and management of the LCRN are provided.

2.5.2. These management processes, facilities and services shall include:

(a) governance, risk and assurance arrangements, including information governance (b) financial management and reporting (c) Human Resources (HR) services for LCRN staff, provided in a timely and expedited manner; this is to include streamlined HR and site access arrangements so that LCRN staff can work flexibly across all research sites (d) Information and Communications Technology equipment as necessary and access to information systems as specified by the National CRN Coordinating Centre (e) good-quality, modern office space, facilities and equipment for LCRN staff. The office for LCRN leadership and management staff is the de facto ‘head office’ of the LCRN, and it is important that it has the identity and is recognised as the local office of the NIHR CRN. The office must be provided by the LCRN Host Organisation to the satisfaction of the LCRN Clinical Director and LCRN Chief Operating Officer. The office should: ● be in an area accessible and welcoming to external visitors, including patients and members of the public ● include an allocation of private office space ● display appropriate NIHR CRN signage ● include separate reception arrangements; or, if this is impractical, shared reception arrangements agreed with the LCRN Clinical Director and LCRN Chief Operating Officer ● be clearly defined and demarcated from the space occupied by other LCRN Host Organisation departments if the LCRN space is within an open-plan environment. (f) legal and contracting support, including sub-contracting administration. 2.5.3. An annual funding allocation will be made available to the LCRN Host Organisation to support the provision of these services. Support should be provided by suitably qualified and experienced staff commensurate with the level of funding.

2.6. Information Governance

2.6.1. The LCRN Host Organisation and LCRN Partners shall comply with the legal framework for information storage and access, and the information governance standards specified in the Authority’s Information Governance Toolkit, and shall

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complete the annual return in the timeframe specified by NHS Digital, with an attainment of Level 2 or above on all requirements.

2.6.2. In the event the LCRN Host Organisation receives any NHS Information Governance Toolkit scores of Level 1 or 0 in any financial year, it must investigate whether these deficiencies arise from or impact on NIHR CRN-funded activities. If so, the LCRN Host Organisation shall propose remedial actions. Remedial actions taken must be reported by the LCRN Host Organisation to the National CRN Coordinating Centre as part of the LCRN Annual Report.

2.6.3. The LCRN Host Organisation must put in place measures to assure itself that LCRN Partners are compliant with information governance requirements as set out in section 2.6.1 in respect of LCRN funded activities. The LCRN Host Organisation may be required to provide confirmation of information governance compliance of LCRN Partners in respect of LCRN funded activities, as part of the National CRN Coordinating Centre annual information governance audit.

2.6.4. The LCRN Host Organisation must ensure a process exists to report all information security incidents arising from LCRN-funded activities to the National CRN Coordinating Centre in a timely manner. Information governance incidents should be notified to [email protected].

2.6.5. The LCRN Host Organisation must ensure that, where there is a requirement to share data relating to the management and performance of research related activities, either within the LCRN and/or its LCRN Partner organisations, any such data are shared across LCRN boundaries/information systems in accordance with information governance best practice.

2.6.6. The LCRN Host Organisation will ensure any third party commercial information received by itself or LCRN Partner organisations from the NIHR CRN or accessed via NIHR CRN hosted information systems in support of any research related activities which is deemed commercially sensitive or marked as confidential will be treated as such, only used for the purpose for which it was provided and will be distributed as required only to those LCRN Partner organisations in agreement of the disclosure terms.

2.6.7. The LCRN Host Organisation must actively promote and enable good information governance within the LCRN Host Organisation and LCRN Partner organisations and make available someone with specialist knowledge of information governance to respond to queries raised relating to LCRN-funded activities. The LCRN Host Organisation must report this information to the National CRN Coordinating Centre within the LCRN Annual Plan.

2.7. Accountable Officer

2.7.1. The Chief Executive Officer of the LCRN Host Organisation is the Accountable Officer for this Agreement.

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2.8. Leadership Team

2.8.1 Overview

2.8.1.1. The LCRN Host Organisation shall appoint an LCRN leadership team, including as a minimum:

(a) the Nominated Executive Director (b) the LCRN Clinical Director (c) the LCRN Chief Operating Officer. 2.8.1.2. The core responsibilities of the LCRN leadership team are to:

(a) provide leadership across the range of LCRN activities (b) ensure LCRN activities are delivered in line with the governance requirements within this contract (c) carry out such activities as may be necessary for the proper governance of the LCRN (d) ensure a proper and auditable process is executed for the fair and effective distribution of LCRN funding (e) be available for regular meetings as a core leadership team (f) support scrutiny and transparency, e.g. by providing any information as required for the internal auditors, and attending the audit committee of the LCRN Host Organisation as requested (g) ensure the timely delivery of performance and other reports (h) support the LCRN Host Organisation by adhering to any local governance requirements, such as the local standing financial instructions and all relevant national NHS requirements (i) convene regular LCRN Partnership Group meetings (j) make freely available to the LCRN Host Organisation and all LCRN Partner organisations, as requested, any information that is not commercial and/or in confidence and in line with national NHS policies (k) manage the LCRN so as not to compromise either the LCRN Host Organisation or LCRN Partner organisations through reasons of conflicting issues such as competition law or data protection. 2.8.1.3. LCRN Host Organisations must inform the National CRN Coordinating Centre in writing and at the earliest opportunity of any changes in personnel or long-term absence of any member of the LCRN leadership team, including the Deputy Chief Operating Officer.

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2.8.1.4. The LCRN Clinical Director and the LCRN Chief Operating Officer will participate in LCRN support and development programmes developed by the National CRN Coordinating Centre.

2.8.2 The Nominated Executive Director

2.8.2.1. The LCRN Host Organisation Chief Executive Officer shall nominate an executive director, who is a voting member of the LCRN Host Organisation board, to act as the Board Director responsible for the LCRN (the “Nominated Executive Director”).

2.8.2.2. The Nominated Executive Director will be the line manager for the LCRN Clinical Director.

2.8.2.3. The Nominated Executive Director may be the LCRN Host Organisation's Board level lead for research; however the nominated Executive Director should not be the organisation’s R&D Director or equivalent. There must be a clear separation between accountability for the LCRN and accountability for the LCRN Host Organisation’s own research activities.

2.8.2.4. The Nominated Executive Director role will include:

(a) where the LCRN Host Organisation is not the employer of the LCRN Clinical Director, ensure that all necessary contractual arrangements are in place between the LCRN Host Organisation and the employer in order that the LCRN Clinical Director can fulfil the duties of the role in full and with delegated authority equivalent to a substantive employee of the LCRN Host Organisation (b) meet regularly with and generally support the LCRN Clinical Director and LCRN Chief Operating Officer in the delivery of the LCRN Work Programme, and be assured that this is being delivered (c) ensure the LCRN assurance framework and risk management system are being properly managed (d) be part of the escalation process for issues and concerns (e) be available to members of the LCRN Partnership Group as part of the escalation process (f) have the right to attend the LCRN Partnership Group meetings (g) produce the annual review of the LCRN Host Organisation’s role in discharging the Authority contract for hosting the LCRN, which will include details of LCRN Host Organisation Board oversight around controls and assurances, any relevant audit committee and internal audit activity, and statements of compliance in respect of the required Board approvals.

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2.8.2.5. The LCRN Host Organisation Nominated Executive Director will delegate responsibility to the LCRN Clinical Director and LCRN Chief Operating Officer for the day-to-day leadership, management and oversight of the LCRN.

2.8.3 Clinical Director

2.8.3.1. The LCRN Clinical Director shall be the senior officer responsible for overall leadership and management of the LCRN.

2.8.3.2. The LCRN Clinical Director will be the line manager for the LCRN Chief Operating Officer.

2.8.3.3. The Clinical Director may be employed by the LCRN Host Organisation or by one of the LCRN Partner organisations, on condition that the provision of the Clinical Director and authority and lines of reporting and accountability are clearly set out in a documented agreement between the LCRN Host Organisation and the Clinical Director’s employer.

2.8.3.4. The LCRN Clinical Director should have an annual appraisal meeting with the LCRN Host Organisation Nominated Executive Director, to monitor performance and identify opportunities and need for continuing professional development, including the NIHR leadership programme. The Nominated Executive Director must advise the National CRN Coordinating Centre in advance of the appraisal meeting in order to enable Coordinating Centre involvement in the appraisal.

2.8.3.5. At the discretion of the LCRN Host Organisation, the post of LCRN Clinical Director may be filled as a job-share; in this situation, however, one individual must be nominated as the senior post-holder who reports to the LCRN Host Organisation Nominated Executive Director.

2.8.3.6. LCRN Clinical Director posts should be reappointed every three years, with a possible extension of no more than two years.

2.8.3.7. The LCRN Host Organisation shall ensure that the National CRN Coordinating Centre is involved in the selection process for LCRN Clinical Directors. All LCRN Clinical Director appointments must be ratified by the National CRN Coordinating Centre.

2.8.4. Chief Operating Officer

2.8.4.1. The LCRN Chief Operating Officer will be responsible for the operational delivery of the contract and overall operational management of the Network. The Chief Operating Officer must be employed by the LCRN Host Organisation. The line management report must be to the LCRN Clinical Director. 2.8.4.2. The LCRN Chief Operating Officer should have an annual appraisal meeting with the LCRN Clinical Director, to monitor performance and identify opportunities and need for continuing professional development, including the NIHR leadership programme. The LCRN Clinical Director must advise the National CRN

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Coordinating Centre in advance of the appraisal meeting in order to enable Coordinating Centre involvement in the appraisal. 2.8.4.3. The LCRN Host Organisation shall ensure the National CRN Coordinating Centre is involved in the selection process for Chief Operating Officers.

2.8.5. Deputy Chief Operating Officer

2.8.5.1. It is a requirement that there is in place a named deputy for the LCRN Chief Operating Officer, by means of either (a) a substantive post of ‘Deputy Chief Operating Officer’ or (b) another LCRN senior manager who is the named deputy in the absence of the Chief Operating Officer.

2.9. Management Team

2.9.1. The arrangements for the management of LCRN activities will be critical to LCRN success and delivery of the contract requirements. The LCRN Host Organisation will implement management arrangements in line with the management structures and staffing set out in this Part C of Appendix A.

2.9.2. The LCRN Host Organisation shall appoint an LCRN management team that is sufficiently resourced to provide:

(a) effective management of the delivery of the LCRN portfolio of studies across all Clinical Research Specialties; and (b) effective management of all necessary supporting activities; and (c) effective engagement with the National CRN Coordinating Centre and other LCRNs in the continuous improvement of the nation-wide NIHR CRN systems and processes.

2.9.3. The LCRN management team must include identified managers for the following functions as a minimum:

(a) Study Support Service (including management of Divisional Research Delivery, Cross-divisional Research Delivery, and Industry Operations) (b) Workforce Development (c) Business Intelligence (d) Patient and Public Involvement and Engagement (e) Communications (f) Information and Communications Technology (g) Finance (h) Human Resources (i) General administration.

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2.9.4. The core responsibilities of the LCRN management team are to:

(a) deliver the management and operational (i.e. non-clinical) activities of the LCRN (b) ensure LCRN activities are delivered in line with the governance requirements within this contract, and raise any non-compliance issues with the LCRN Leadership Team (c) support the LCRN leadership team to ensure activities are carried out as may be necessary for the proper governance of the LCRN (d) ensure CRN Portfolio studies, including life sciences industry research, are delivered in accordance with any specific agreed governance requirements.

2.9.5. Members of the LCRN management team may be employed by the LCRN Host Organisation, or by any LCRN Partner organisation, by agreement between the LCRN Host Organisation and the LCRN Partner organisation.

2.9.6. The LCRN Host Organisation will ensure all appointments to the LCRN management team are conducted in line with good human resources practice and in an open and competitive manner, and appointments do not favour those employed by the LCRN Host Organisation over other candidates.

2.10. Standard Role Outlines

2.10.1. The LCRN Host Organisation shall adopt the standard role outlines provided by the National CRN Coordinating for the following roles, ensuring all responsibilities listed in the role outlines are fully supported:

(a) Clinical Director (b) Chief Operating Officer (c) Clinical Research Specialty Lead (d) Divisional Research Delivery Manager (e) Industry Operations Manager.

2.11. Management Groups

2.11.1. The LCRN Leadership Team shall put in place the following LCRN management groups as a minimum:

(a) Executive Group (b) Clinical Research Leadership Group (c) Operational Management Group.

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2.11.2. The Nominated Executive Director shall convene the LCRN Executive Group, whose membership shall include, as a minimum, the Nominated Executive Director, LCRN Clinical Director and LCRN Chief Operating Officer.

2.11.3. The LCRN Clinical Director shall convene the LCRN Clinical Research Leadership Group whose membership shall include the Clinical Director (Chair) and the Clinical Research Specialty Leads. The role of the Clinical Research Leadership Group is to advise the LCRN Executive Group, with particular respect to:

(a) clinical implications of national policy at the local level (b) the balance of the LCRN portfolio across Specialties, sites, patient groups and study composition, seeking opportunities to expand research participation (c) resource allocations (d) other clinical intelligence and advice to support LCRN research delivery.

2.11.4. The LCRN Chief Operating Officer shall convene the Operational Management Group. The role of the group will be to ensure effective LCRN management and performance, acting as the forum to address cross-divisional and operational issues. The group will liaise with the Clinical Research Leadership Group and LCRN Clinical Research Specialty Groups regarding performance issues, resource allocation, the balance of the LCRN portfolio and availability of opportunities in the LCRN area for all patients to participate in research. The Operational Management Group will monitor the day-to-day operational performance of the LCRN, in particular delivery of objectives, and work with the National CRN Coordinating Centre at an operational level on national work relating to the LCRN. This includes managing performance of NIHR CRN Portfolio studies by Specialty and Division and identifying ways to address underperformance. The Operational Management Group membership shall consist of the Chief Operating Officer (Chair) and the LCRN senior operational managers who comprise the LCRN management team, including Research Delivery Managers and the Industry Operations Manager.

2.11.5. The LCRN Leadership Team shall ensure that Terms of Reference are in place for each of these groups, in line with the LCRN Contract Support Documents provided by the National CRN Coordinating Centre.

2.11.6. The LCRN Leadership Team may convene other management groups as deemed necessary, such as meetings of Research and Development Directors and Managers.

2.12. LCRN Partners

2.12.1. Organisations in receipt of LCRN funding to support NIHR CRN Portfolio research will be known as the LCRN Partners.

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2.12.2. LCRN Partners will be of two types, of equal importance:

(a) Providers of NHS services with substantial levels of research activity, such that the organisation will receive a planned annual allocation of LCRN funding (“Category A Partners”) (b) Providers of NHS services with relatively low levels of research activity, typically ad hoc or intermittent in nature, involving low numbers of patients and/or low numbers of research studies, such that the organisation will not require a planned annual allocation of LCRN funding and instead will be reimbursed as required for costs incurred; this category is likely to include most primary care service providers, and other non-NHS organisations providing NHS services (“Category B Partners”).

2.12.3. LCRN Host Organisations shall use the Category A LCRN Partner and Category B LCRN Partner flow down contract templates to contract with LCRN Partners, or any other sub-contract arrangements as instructed by the National CRN Coordinating Centre from time to time.

2.12.4. The LCRN Host Organisation will inform the National CRN Coordinating Centre in writing of the dissolution, merger or change of name of any LCRN Partner organisation.

2.13. LCRN Partnership Group

2.13.1. The LCRN Host Organisation will constitute a formal forum for LCRN Partners. This forum may also include those commissioning organisations that have contracts with such providers of NHS services. This forum shall be known as the LCRN Partnership Group. The LCRN Partnership Group should be formed of delegates with authority to represent and make decisions on behalf of their organisation. The LCRN Partnership Group will include lay representation.

2.13.2. The LCRN Host Organisation will agree an appropriate process that enables less research-active providers, primary care and independent contractors to the NHS, to be represented on the LCRN Partnership Group. Options for this might include, but are not limited to, representatives from NHS Clinical Commissioning Groups, NHS England regional teams and Directors of Public Health, as well as research-active independent contractors.

2.13.3. Where an LCRN has a large number of LCRN Partnership Group members, an arrangement for representation may be adopted, provided the LCRN Partner organisations within that arrangement delegate responsibility in writing from their Chief Executive Officer (or equivalent) to their representative organisation on the LCRN Partnership Group.

2.13.4. The LCRN Partnership Group must be chaired by a Chief Executive Officer from an LCRN organisation; either from the LCRN Host Organisation or from an LCRN Partner organisation.

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2.13.5. The LCRN Host Organisation should be considered an LCRN Partner in its capacity as a recipient of NIHR CRN funding to support clinical research, a capacity separate to the LCRN hosting role. The LCRN Host Organisation therefore should be represented on the LCRN Partnership Group as an LCRN Partner, in order to represent the interests of the LCRN Host Organisation outwith the LCRN hosting function.

2.13.6. Expected frequency of meetings is four times each year as a minimum.

2.13.7. The Terms of Reference of the LCRN Partnership Group will include:

(a) reviewing and agreeing LCRN business plans and reports, including annual financial and business plans, development plans and the Annual Report, in advance of approval by the LCRN Host Organisation board (b) informed by financial and activity data, active oversight and constructive mutual challenge of LCRN activity and performance, including delivery performance compared to funding allocated, in order to raise ambition and improve performance in each LCRN Partner organisation (or group of organisations, for less research-active LCRN Partners) (c) monitoring of any compliance requirements of LCRN Partner organisations.

2.13.8. As a condition to receiving LCRN funding, and as set out in the Agreement between the LCRN Host Organisation and the LCRN Partner, ‘Category A’ LCRN Partner organisations will be required to support the LCRN Host Organisation in effective governance by:

(a) identifying an individual who has authority to represent and act on behalf of the organisation, preferably a voting member of the Organisation’s Board, or alternatively a member of the Organisation’s executive or senior management team. Regardless of position, in all cases the representative must have full authority to act and vote on behalf of the Partner Organisation. Should the representative be unable to attend a Partnership Group meeting, and where the Terms of Reference of the Partnership Group permit deputies, the deputy should have the same authority to act for the purposes of that meeting (b) ensuring activities and funding in LCRN Partner organisations are managed in accordance with good governance (c) ensuring any relevant governance or compliance matters, such as research governance or information governance or internal audits, are properly attended to and relevant details shared with the LCRN leadership team (d) facilitating all NIHR CRN related internal audit reviews and investigations (e) receiving the LCRN Annual Report at the Organisation’s Board, to include details of their local involvement in the LCRN via a supplementary report from the organisation’s LCRN Partnership Group representative

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(f) reviewing and scrutinising LCRN business and funding plans, and performance against these, in order to maintain assurance around LCRN activities.

2.14. LCRN Contract Support Documents

LCRN Leadership Teams should ensure that all elements of the LCRN operate in compliance with the following LCRN Contract Support Documents in respect of Governance and Management which are accessible on the NIHR Hub:

Ref Title

PM/003 NIHR Clinical Research Network Governance, Leadership & Management

PM/036 Notification of Absence of LCRN Host Organisation Nominated Executive Directors, LCRN Clinical Directors or LCRN Chief Operating Officers

PM/037 Process for Notification of Changes to LCRN Host Organisation Nominated Executive Directors, LCRN Clinical Directors or LCRN Chief Operating Officers

M/009 Representation on LCRN Partnership Groups of primary care and independent contractors to the NHS

3. Financial Management

3.1.1. The LCRN Host Organisation will receive, manage and distribute the allocated funding within the LCRN via the Department of Health-approved standard template sub-contracts as instructed by the National CRN Coordinating Centre. 3.1.2. The LCRN Host Organisation will use the funding solely to support the delivery of research activities as set out in this contract. The LCRN Host Organisation will put in place measures to provide assurance that LCRN funding provided to LCRN Partners is used solely for these purposes. 3.1.3. The LCRN Host Organisation will ensure that national ‘top-sliced’ funding is spent specifically on the purpose intended and underspends are not redistributed within the LCRN. Any national ‘top-sliced’ funding underspends should be reported, at the earliest opportunity to the National CRN Coordinating Centre where reallocation decisions will be made. 3.1.4. The LCRN Host Organisation, through the LCRN Executive team, will set out an annual local funding allocation model which will clearly describe the basis on which funding is allocated to LCRN Partner organisations. The local funding allocation model will be publicly available. Further detail regarding the required controls can be found in the Funding Allocations section of the LCRN Minimum Controls.

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3.1.5. The LCRN Host Organisation will ensure that all payments made to distribute allocated funding are valid, complete, accurate, appropriately authorised and made promptly and within 30 days (as per Clause 6.2 of the DH/Host contract). Further detail regarding the required controls can be found in the Payments section of the LCRN Minimum Controls. 3.1.6. The LCRN Host Organisation, through the LCRN Executive team, will draw up an Annual Financial Plan for the LCRN as part of the LCRN Annual Plan. The LCRN Partnership Group will review and comment on the Annual Financial Plan. The plan shall be approved by the LCRN Host Organisation board and submitted to the National CRN Coordinating Centre for approval. 3.1.7. The LCRN Host Organisation will implement a budgetary control system to monitor actual expenditure to the Annual Financial Plan to ensure a full year forecast is produced at least quarterly. This forecast will be managed to ensure a breakeven position. Further detail regarding the required controls can be found in the Budgetary Control section of the LCRN Minimum Controls. 3.1.8. The LCRN Host Organisation will implement a system to ensure that financial reports provided to the National CRN Coordinating Centre are accurate, complete and up to date. Further detail regarding the required controls can be found in the Reporting section of the LCRN Minimum Controls. 3.1.9. The LCRN Host Organisation will report to the National CRN Coordinating Centre: (i) a forecast outturn for the financial year which agrees to the Annual Financial Plan together with quarterly financial returns, via the NIHR CRN Finance Tool or any other system specified by the National CRN Coordinating Centre, to agreed deadlines. Further detail regarding the required controls for the NIHR CRN Finance Tool can be found in the Finance Tool section of the LCRN Minimum Controls. (ii) an end-of-year financial return to the National CRN Coordinating Centre in respect of all LCRN funding received. The financial return must report on all LCRN funding and expenditure, for all organisations in receipt of that funding, and agree to the year-end figures in the respective Trusts’ or other organisations’ accounts by the deadlines specified by the National CRN Coordinating Centre. (iii) the end-of-year financial return to the National CRN Coordinating Centre must include a signed disclosure statement from the LCRN Host Organisation Director of Finance and LCRN Chief Operating Officer. Disclosure statement Version 1.0 can be found as an appendix of the LCRN Minimum Controls. 3.1.10. The LCRN Host Organisation must obtain assurance that the financial information provided by the LCRN Partner Organisations is accurate and complete and that all costs are valid and appropriately authorised. Further detail

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regarding the required controls can be found in the Monitoring of LCRN Partner organisations section of the LCRN Minimum Controls. 3.1.11. The LCRN Host Organisation will obtain a signed disclosure statement from each Partner organisation signed by the Director of Finance of the Partner organisation. The disclosure statement can be found as an appendix of the LCRN Minimum Controls. 3.1.12. The LCRN Host Organisation must ensure the financial management, budgeting and reporting of LCRN funding is managed by suitably qualified and experienced finance staff both within the LCRN Host Organisation and in LCRN Partners, commensurate with the level of funding. 3.1.13. The LCRN Host Organisation must obtain assurance from the Host and LCRN Partner organisations that NIHR funding is not used to subsidise commercial research. A cost recovery basis as stated in HSG(97)32 “Responsibilities for meeting patient care costs associated with research and development in the NHS” and reiterated in “Attributing the costs of health and social care Research and Development” (AcoRD) guidance issued by the Authority and its eligibility criteria for NIHR CRN Support, which is available from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/14 0054/dh_133883.pdf should be adopted within the LCRN Host Organisations and Partner organisations standard operating procedures. Further detail regarding the required controls can be found in the Commercial Cost Recovery section of the LCRN Minimum Controls. 3.1.14. LCRN funding cannot be used to meet redundancy costs. 3.1.15. CRN funding must be treated as a ring-fenced budget. Therefore, CRN funding must not be subject to spending restrictions that might be applied to other budgets in LCRN Host or Partner organisations, e.g. restrictions on recruitment of staff or non-pay spend. CRN funding cannot be used for the purposes of contribution to an organisation’s Cost Improvement Programme or similar cost saving exercises. It is expected that LCRN funding is held within ring-fenced accounts in the financial ledgers of the LCRN Host Organisation and LCRN Partner organisations to facilitate financial management and reporting. 3.1.16. The LCRN Host Organisation shall comply with any other financial guidance from the National CRN Coordinating Centre in respect of LCRN funding.

3.2. NIHR CRN Finance Tool Data Protection

3.2.1. The National CRN Coordinating Centre processes personal data consisting of information provided by LCRN Host Organisations relating to staff funded in part or in whole by the NIHR Clinical Research Network, including name, employer and salary details.

3.2.2. These data are processed for the following purposes: (a) in order to ensure public funds are spent appropriately

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(b) in order to aid in financial audit (c) to provide aggregated anonymised information on numbers, types and grades of staff funded by the NIHR CRN (d) for resource management activity for which the National CRN Coordinating Centre has responsibility. 3.2.3. The National CRN Coordinating Centre processes these personal data in order to exercise its function as the managing agent for the Authority. The Authority is the Data Controller for these data. 3.2.4. The National CRN Coordinating Centre processes all data fairly and lawfully in accordance with the Data Protection Act. 3.2.5. Access is granted solely to those with responsibility for carrying out these activities. 3.2.6. Only relevant data are collected and there is no further processing other than for those reasons noted in section 3.2.2. above. 3.2.7. All data are saved on a secure network that is regularly backed-up. 3.2.8. Data are retained for seven years post contract end date and are then destroyed via secure means. 3.2.9. The LCRN Host Organisation is responsible for informing its CRN-funded staff that their data will be shared with the National CRN Coordinating Centre, including the nature of the data and why it is shared.

3.3. Audit

3.3.1. The LCRN Host Organisation must undertake an internal audit at least once every three years in respect of LCRN funding. 3.3.2. The internal audit must cover the Minimum Control standards specified by the National CRN Coordinating Centre. 3.3.3. The LCRN Host Organisation shall provide a report of each internal audit to the National CRN Coordinating Centre ([email protected]) within a month following receipt of the final audit report, including the summary, recommendations and implementation plan. 3.3.4. Further updates regarding the implementation of the audit recommendations should be provided to the National CRN Coordinating Centre, timings as agreed with the NIHR CRN Finance team. The LCRN shall provide additional information in respect of the internal audit request by the National CRN Coordinating Centre. 3.3.5. An Internal audit in respect of LCRN funding managed by Partner organisations should be undertaken in the event of a material or reputational risk being identified by the LCRN Host Organisation through the monitoring visits or by any other means. Further detail on the monitoring visits is contained in the Minimum Controls document. It is our expectation that the audit is undertaken by the Partner organisations internal audit provider and any areas of concern related to

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NIHR funding are highlighted to the Host Organisation and the National CRN Coordinating Centre. 3.3.6. The costs incurred by the LCRN Host Organisation or the Partner organisations in undertaking an internal audit can be charged against LCRN funding.

3.4. LCRN Contract Support Documents

LCRN Leadership Teams should ensure that all elements of the LCRN operate in compliance with the following LCRN Contract Support Documents in respect of Financial Management which are accessible on the NIHR Hub:

Ref Title

F/004 CRN Funding Reporting Guidance

F/007 LCRN Minimum Controls

4. CRN Specialties

4.1.1. The NIHR CRN has adopted a framework of 30 Clinical Research Specialties for the purposes of engagement with clinical research communities and to enable clinical leadership and oversight of the NIHR CRN Portfolio of research studies. 4.1.2. The LCRN will engage with local patient and clinical research communities through local Clinical Research Specialty Groups that provide the structure through which those working in Specialties within the LCRN area are able to network and engage with study delivery. Each LCRN Clinical Research Specialty Group will maintain an overview of the Specialty research portfolio, ensuring it is balanced, where possible, includes both non-commercial and commercial contract research, and includes clinical trials (including prevention, diagnosis, treatment and care) and other well designed studies relevant to the needs of the local patient population. The LCRN Clinical Research Specialty Groups will promote consistent delivery to time and target of the local research portfolio, underpinned by robust feasibility, and contribute to the Study Support Service, as appropriate. It will be essential for the LCRN Clinical Research Specialty Groups to seek opportunities to expand participation in relevant studies on the NIHR CRN Portfolio and those progressing through the funding pipeline. It is expected that these groups will have representation from the full range of clinical professionals. 4.1.3. Each LCRN Clinical Research Specialty Group will be led by an appointed LCRN Clinical Research Specialty Lead. The LCRN Clinical Research Specialty Leads will report to the LCRN Clinical Director or Clinical Research Leads (Divisional), and to the relevant National Clinical Research Specialty Lead. LCRN Clinical Research Specialty Leads will be responsible for the clinical leadership of their research communities within the LCRN area, development of LCRN Clinical

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Research Specialty Groups and clinical oversight of the performance of the Specialty portfolio of studies. 4.1.4. The LCRN Host Organisation will ensure that support is provided to the LCRN Clinical Research Specialty Leads to enable them to undertake their role in contributing to the NIHR CRN’s nation-wide study support activities, specifically in respect of commercial early feedback and non-commercial expert review for the eligibility decision and including where applicable, local feasibility activities, delivery assessments and performance reviews. 4.1.5. The LCRN Host Organisation must inform the National CRN Coordinating Centre of any changes to LCRN Clinical Research Specialty Leads. 4.1.6. LCRN Clinical Research Specialty Leads will be expected to play an active role in the national Clinical Research Specialty Group for each Specialty, which comprises the Clinical Research Specialty Leads from all the LCRNs. Each national Clinical Research Specialty Group is led by a National Clinical Research Specialty Lead who reports to a Specialty Cluster Lead within the National CRN Coordinating Centre. Together with other LCRN Clinical Research Specialty Leads and the communities of practice within that Specialty, they will constitute national networks of Specialty expertise. 4.1.7. The LCRN Clinical Research Specialty Leads will provide clinical intelligence and advice, particularly to the Divisional Research Delivery Manager(s) and through the nation-wide Study Support Service elements including commercial early feedback, non-commercial expert review, delivery assessments and performance reviews to support research delivery across the LCRN, addressing resource allocations and the balance of the LCRN portfolio across Specialties, sites, patient groups and study composition, as well as providing guidance on the clinical implications of national policy at the local level. 4.1.8. LCRN Clinical Directors and LCRN Clinical Research Specialty Leads may be employed by the LCRN Host Organisation or one of the LCRN Partner organisations within the LCRN area through a formal agreement between the LCRN Host Organisation and the relevant organisation.

4.2. LCRN Contract Support Documents

LCRN Leadership Teams should ensure that all elements of the LCRN operate in compliance with the following LCRN Contract Support Documents in respect of CRN Specialties which are accessible on the NIHR Hub:

Ref Title

PM/039 Process for the Management and Escalation of Issues Relating to Local Specialty Performance

M/014 NIHR CRN Urgent Public Health Research: Urgent Public Health Champion role outline

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5. Research Delivery

5.1. Research Delivery Divisions

5.1.1. Operational management and delivery of the LCRN portfolio of studies will be organised through Research Delivery Divisions. These Divisions are determined nationally and each will manage research delivery for a cluster of Clinical Research Specialties. 5.1.2. The 30 Clinical Research Specialties are grouped into 6 Divisions for operational management purposes, typically as follows: (a) Division 1: Cancer (b) Division 2: Cardiovascular disease; Diabetes; Metabolic and endocrine disorders; Renal disorders; Stroke (c) Division 3: Children; Genetics; Haematology; Reproductive health and childbirth (d) Division 4: Dementias and neurodegeneration (DeNDRoN); Mental health; Neurological disorders (e) Division 5: Ageing; Dermatology; Health services and delivery research; Oral and dental health; Musculoskeletal disorders; Primary care; Public health (f) Division 6: Anaesthesia, perioperative medicine and pain management; Critical care; Ear, nose and throat; Gastroenterology; Hepatology; Infectious diseases and microbiology; Injuries and emergencies; Ophthalmology; Respiratory disorders; Surgery. 5.1.3. This grouping may be amended locally at the discretion of the LCRN Leadership Team in order to reflect local circumstances and operational efficiency. Each Specialty must be able to map to a Division detailed in 5.1.2 to support national oversight and clinical engagement. 5.1.4. Each local Division will have a nominated Research Delivery Manager to provide operational leadership. In each Division, Research Delivery Managers will also form national networks of operational expertise for Divisional groupings of Specialties, led by the Research Delivery function at the National CRN Coordinating Centre. A local Research Delivery Manager may provide operational leadership for more than one Division. 5.1.5. Research Delivery Managers will be responsible for the local management and delivery of all NIHR CRN Portfolio studies (commercial, collaborative and non- commercial), through nation-wide processes as defined by the Study Support Service, relating to the grouping of Specialties within their Division. They will work with the LCRN Operational Management Group to manage Divisional resources, identifying innovative and flexible approaches where appropriate. Effective interfaces with the Industry Operations Manager are essential. Each Research Delivery Manager will be the local single point of initial contact for all matters related to their respective portfolio of studies. The LCRN single point of

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contact for commercial studies will triage to the Research Delivery Manager or other appropriate person. The LCRN single point of contact is used by the national Research Delivery function for feasibility requests and portfolio management, and external industry partners for study site queries, issues and escalation. Study level matters relating to commercial research studies will be initially channelled to the national single point of contact and cascaded to LCRNs, as appropriate. 5.1.6. Research Delivery Managers will work closely with all LCRN Clinical Research Specialty Leads to support clinical research within those Specialties. 5.1.7. Research Delivery Managers will work closely with the LCRN Industry Operations Manager to ensure an effective Study Support Service is delivered for commercial research in each of the LCRN Research Delivery Divisions. 5.1.8. Research Delivery Managers may be employed by the LCRN Host Organisation or other LCRN Partner organisations through a formal agreement between the LCRN Host Organisation and the relevant organisation.

5.2. Cross-divisional Research Delivery Team

5.2.1. The LCRN will have a cross-divisional research delivery team to undertake activities that support all clinical Specialties. This will include the LCRN Industry Operations Manager. The core functions of the cross-divisional team will include provision of the Study Support Service as defined by the National CRN Coordinating Centre adhering to the relevant Standard Operating Procedures and LCRN Contract Support Documents. This includes: (a) industry operations activities, working closely with the Research Delivery Managers to include provision of a single point of contact service for the life sciences industry (b) support for local confirmation of capacity and capability under the Health Research Authority (HRA) Approval process. 5.2.2. LCRNs should continue to drive and support arrangements that streamline and simplify these functions, such as “mutual recognition” and “single sign off” arrangements. 5.2.3. Members of the cross-divisional research delivery team may be employed by the LCRN Host Organisation or LCRN Partner organisations within the LCRN area through a formal agreement between the LCRN Host Organisation and the LCRN Partner organisation. These members are considered as LCRN staff working to deliver NIHR CRN support activities to the nation-wide standards defined by the Study Support Service.

5.3. Delivery of Research

5.3.1. The LCRN Host Organisation shall ensure all LCRN Partners adhere to national systems, Standard Operating Procedures and operating manuals in respect of research delivery as specified by the National CRN Coordinating Centre.

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5.3.2. The LCRN Host Organisation shall ensure the LCRN management team provides effective study performance management, in line with Standard Operating Procedures and LCRN Contract Support Documents issued by the National CRN Coordinating Centre, in order to ensure all NIHR CRN Portfolio studies recruit to agreed timelines and targets; this is an organisation wide priority. 5.3.3. The LCRN Host Organisation will scope out appropriate mechanisms for engaging with and optimising performance in primary care to improve delivery of all studies. 5.3.4. The LCRN Host Organisation will ensure the LCRN develops and implements a local engagement and communication strategy with stakeholders involved in the research delivery pathway (to include patients, carers and the public, other NIHR Infrastructure such as NIHR Research Design Services, Clinical Trials Units, Sponsors (industry/HEI) and Academic Health Science Networks). The strategy should promote a shared understanding of NIHR CRN processes and develop a culture that encourages early contact between the parties to facilitate the successful set-up and delivery of research. 5.3.5. The LCRN Host Organisation will demonstrate a “one Network” approach to delivery, supported by engagement with and implementation of the Study Support Service, and will ensure that duplication of nation-wide support activities is avoided. 5.3.6. The LCRN Host Organisation will ensure the LCRN carries out its appropriate role in delivering all support activities throughout the research delivery pathway in line with the AcoRD guidance. Where the LCRN or any LCRN Partner determines it cannot carry out the role set out in this policy for any ‘high priority’ CRN Portfolio study (as defined in the CRN Eligibility Criteria) on grounds other than non-feasibility, the LCRN must advise the National CRN Coordinating Centre in advance of communication of this decision to the investigator. Any such refusal of a high-priority study must be reported in the LCRN Annual Report to the National CRN Coordinating Centre. Use of national standard templates referenced in the AcoRD guidance are mandatory for the presentation, negotiation and agreement of study costing and/or attribution, for example the NIHR CRN Industry Costing Template. 5.3.7. The nation-wide support activity areas are defined below. They include a number of sub-activities as described by the Study Support Service to ensure consistent support for researchers: (a) Early contact and engagement (b) Early Feedback (c) Site Identification (d) Study optimisation (e) Effective Study Set-up

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(f) Study Performance.

5.3.8. The LCRN Host Organisation will ensure the LCRN involves patients, carers and the public in its activities at all stages of the research delivery pathway as part of a documented patient, carer and public involvement plan. 5.3.9. The LCRN Host Organisation must ensure appropriate arrangements are in place to support the rapid delivery of urgent public health research, which may be in a pandemic or related situation. It shall ensure the LCRN has an urgent public health research plan which can be immediately activated in the event the Authority requests expedited urgent public health research. The LCRN Host Organisation must also appoint an active clinical investigator as the LCRN’s public health champion to act as the key link between the LCRN and the National CRN Coordinating Centre and support the Urgent Public Health Research Plan in the event of it being activated.

5.4. Life Sciences Industry

5.4.1. The LCRN Industry Operations Manager will work closely with the LCRN Chief Operating Officer to enable the implementation of the NIHR CRN Working with the Life Sciences Industry Strategy within the LCRN. The Industry Operations Manager will lead the oversight of the Study Support Service for commercial research, including the single point of contact service, within the LCRN. The Industry Operations Manager will work closely with the Research Delivery Managers to deliver an effective and responsive local service which improves delivery to time and target and increases the number of commercial studies delivered within their LCRN. The Industry Operations Manager will liaise with the Study Start Up & Feasibility Research Delivery and Research Operations functions within the National CRN Coordinating Centre to ensure consistency of feasibility, study performance and national delivery of the Study Support Service for commercial research across the LCRNs. The Industry Operations Manager will be responsible for the promotion of the industry agenda to LCRN Partner organisations and investigators, delivering aspects of the NIHR CRN Working with the Life Sciences Industry Strategy and the NIHR CRN Business Development and Marketing strategy.

5.5. Delivering on the Government Research Priority of Dementia

5.5.1. In line with the Government’s priority, the LCRN Host Organisation will ensure the LCRN will prioritise dementia research and will work with the National CRN Coordinating Centre and the office of the NIHR National Director for Dementia Research to deliver the NIHR CRN response to the Prime Minister’s challenge on dementia. 5.5.2. The High Level Objective for dementia for the NIHR CRN is to increase the number of people participating in Dementias and Neurodegeneration (DeNDRoN) studies on the NIHR CRN Portfolio (Table 1: HLO 7). To achieve this, the LCRN will deliver activities to increase the number of Dementias and

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Neurodegeneration (DeNDRoN) studies on the NIHR CRN Portfolio that are conducted within the LCRN and improve how they are delivered across different healthcare settings. 5.5.3. The dementias and a range of other neurodegenerative diseases are increasingly understood to have commonalities both in terms of their underlying mechanisms, and in patient presentation, experience and management. It is recognised that advances in understanding of these diseases and new treatments are likely to come from inter-disciplinary research. Measuring the number of people recruited into Dementias and Neurodegeneration (DeNDRoN) studies on the NIHR CRN Portfolio, as opposed to recruitment into dementia- specific studies, will reflect the commonality across the dementias and other neurodegenerative diseases. The LCRN Host Organisation will ensure the LCRN supports this strategy by: (a) engaging with local patient and clinical research communities at a disease level, in particular Dementias and Neurodegeneration (which includes Parkinson’s disease, Huntington’s disease and motor neurone disease) (b) identifying and nominating a clinical research lead in each of these two disease areas to support the delivery of the Dementias and Neurodegeneration (DeNDRoN) studies on the NIHR CRN Portfolio through local clinical leadership and participation in national activities, including national feasibility review. 5.5.4. To support recruitment to dementia studies, the NIHR, in partnership with the Alzheimer’s Society and Alzheimer’s Research UK, manages a nationally consistent consent-for-approach system: (known as the “Join Dementia Research” system) for implementation by the NIHR and wider NHS. The LCRN will promote and support use of this system as advised by the National CRN Coordinating Centre and ensure its staff supporting the delivery of dementia studies are trained and equipped to use it. 5.5.5. The LCRN Host Organisation will ensure the LCRN works to increase access to research for people living in care homes and improve the delivery of dementia research in care homes by establishing a network of research-ready care homes. 5.5.6. The NIHR CRN has created a web-based toolkit, as part of the Healthcare Professionals section of the Join Dementia Research website, to support NHS organisations to improve recruitment to dementia studies on the NIHR CRN Portfolio. The LCRN Host Organisation will promote use of the toolkit in its LCRN Partner organisations and encourage them to share learning through it. 5.5.7. The LCRN Host Organisation will ensure the LCRN identifies resources at appropriate levels and sites to underpin the implementation of the CRN National RATER Programme required to support dementia research delivery.

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5.6 LCRN Contract Support Documents

LCRN Leadership Teams should ensure that all elements of the LCRN operate in compliance with the following LCRN Contract Support Documents in respect of Research Delivery which are accessible on the NIHR Hub:

Ref Title

RD/021 Confidential information arrangements for the Life Sciences Industry feasibility services - Confidential Disclosure Agreement (CDA process)

RD/023 Provision of good practice in assessing, arranging and confirming local capacity and capability for participating organisations delivering NIHR CRN Portfolio studies

RD/024 Provision of good practice for sponsors to enable assessing, arranging and confirming local capacity and capability for participating organisations delivering NIHR CRN Portfolio studies

RD/040 Eligibility criteria for NIHR CRN support - Implementation document

RD/027 Eligibility criteria for NIHR CRN support - Annex A-Frequently Asked Questions

RD/042 NIHR CRN Study Support Service: Principles and Process for Setting and Amending Study Site Targets

RD/043 Principles for Local NIHR CRN Site Identification Process for commercial studies SOP

RD/044 Research Delivery Meeting Structure SOP

RD/045 Eligibility criteria for NIHR CRN support. Annex B - Overview of non-commercial eligibility review process

RD/046 Eligibility criteria for NIHR CRN support. Annex C - Overview of the self declaration process for NIHR non-commercial partners

RD/048 Eligibility criteria for NIHR CRN support. Annex D - Assessing the need for NIHR CRN support

RD/049 NIHR CRN Study Support Service: for Activity Attribution Support and Review SOP

RD/050 NIHR CRN Study Support Service: Early Contact & Engagement with Researchers SOP

RD/051 NIHR CRN Study Support Service: Industry Costing Template Validation SOP

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RD/052 NIHR CRN Study Support Service: Study Performance Monitoring SOP

RD/053 National Study Delivery Assessment

RD/054 Effective Study Start-up

RD/055 Commercial Study Milestone Schedule Process

RD/056 Study Support Service Helpdesk SOP

RD/057 Commercial Eligibility and Feasibility Process SOP

RD/010 NIHR CRN Urgent Public Health Research: Set Up

RD/011 NIHR CRN Urgent Public Health Research: Initiation

RD/012 NIHR CRN Urgent Public Health Research: Delivery

RD/013 NIHR CRN Urgent Public Health Research: Reporting

M/014 NIHR CRN Urgent Public Health Research: Urgent Public Health Champion role outline

M/022 Provision of infrastructure support for research delivery in primary care settings

F/006 Income distribution from NIHR CRN Industry Portfolio Studies

6. Information and Knowledge

6.1. Information Systems

6.1.1. The LCRN Host Organisation must ensure appropriate, reliable and well maintained information systems and services are in place and fully operational. 6.1.2. The LCRN Host Organisation must adhere to the National CRN Coordinating Centre’s Information Security Policy and the Acceptable Use Policy for the NIHR Hub issued by the Department of Health. 6.1.3. In order to ensure the safe, secure and legal management of public finances the LCRN Host Organisation must provide, or secure access to, a system to ensure robust financial management. This system should have the ability to undertake audit and provide financial reports as required. 6.1.4. The LCRN Host Organisation should ensure a suitable staff management system is in place to be able to provide (but not exclusively) mandatory HR returns on staffing levels and ethnicity. The system should also be capable of enabling the LCRN Host Organisation to conduct staffing audits and ensure effective workforce planning.

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6.1.5. Where the LCRN Host Organisation undertakes any new or incremental development of local Information Systems that support LCRN activities, the LCRN Host Organisation must ensure the new or changed system interface aligns with existing NIHR CRN Information Systems. 6.1.6. Where the LCRN Host Organisation has procured information systems or applications to support LCRN activities (e.g. a Local Portfolio Management System) it is the responsibility of the LCRN Host Organisation (in association with the third-party provider) to ensure service management support is provided, as detailed in the National CRN Coordinating Centre LCRN Contract Support Documents. 6.1.7. For information systems or applications which support LCRN activity (e.g. research delivery), the LCRN Host Organisation must, in association with any third-party provider, ensure service management support is provided, as detailed in National CRN Coordinating Centre LCRN Contract Support Documents. 6.1.8. Where an issue with a national system cannot be resolved locally (e.g. an issue with the NIHR Hub), the LCRN Host Organisation must ensure the issue is escalated to the national NIHR CRN Service Desk, as detailed in National CRN Coordinating Centre LCRN Contract Support Documents. The LCRN Host Organisation must ensure information systems utilised in LCRN activities comply with the 2015-17 NIHR Information Strategy v2.0. 6.1.9. LCRN Host Organisations and LCRN Partner organisations must ensure business-critical information and associated information systems are of sufficient quality so that they are fit for purpose, accurate and trusted to support the business operations.

6.2. Local Portfolio Management System (LPMS)

6.2.1. The LCRN Host Organisation must ensure LCRN research delivery is supported by an LPMS solution that conforms to the requirements of the National CRN Coordinating Centre. This system should support all LCRN Partner organisations to capture the defined nation-wide minimum data set to support HLO reporting, research activity and local performance management of NIHR CRN Portfolio research as part of the single research intelligence system - a virtual network to collect, share and visualise intelligence using multiple local portfolio management systems and an overarching central system. The LPMS System of Choice requirements’ specification and supporting documentation are available from https://sites.google.com/a/nihr.ac.uk/crncentral/knowledge-info/information- systems/lpmssoc-1. 6.2.2. The LCRN funding allocation provides for the ongoing provision of an LPMS solution, for use by LCRN-funded staff supporting research delivery in the LCRN Host Organisation and LCRN Partners. This should be made available for LCRN Partners to use for both NIHR CRN Portfolio and non-NIHR CRN Portfolio studies.

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6.2.3. Where there is a requirement to migrate data from existing systems, the LCRN Host Organisation should work with its preferred supplier to support migration.

6.3. LCRN Business Intelligence

6.3.1. The LCRN Host Organisation is responsible for providing a specialist, experienced and dedicated LCRN Business Intelligence function which will provide information and data analysis relating to the performance of LCRN- funded activities. 6.3.2. The LCRN Host Organisation must ensure the LCRN Business Intelligence function has access to necessary Business Intelligence tools (i.e. QlikView) and adheres to requirements set out in the relevant LCRN Contract Support Documents provided by the National CRN Coordinating Centre. 6.3.3. The LCRN Host Organisation must ensure LCRN Business Intelligence staff contribute to the work of the national CRN Business Intelligence function, and support and collaborate with peers in other LCRNs, as required by the National CRN Coordinating Centre. 6.3.4. When sharing or citing LCRN performance data, e.g. in LCRN Annual Reports, plans and local communications, the LCRN Host Organisation must ensure that the data used are the official data as issued by the National CRN Coordinating Centre. Data should be generated from the NIHR CRN Open Data Platform as set out in the National CRN Coordinating Centre policy on data use and reporting.

6.4. LCRN Contract Support Documents

LCRN Leadership Teams should ensure that all elements of the LCRN operate in compliance with the following LCRN Contract Support Documents in respect of Information and Knowledge which are accessible on the NIHR Hub:

Ref Title

SM/028 Business Acceptance Test Practice and LCRN Information Support

SM/059 Local Portfolio Management System Minimum Data Set

7. Stakeholder Engagement and Communications

7.1. Engagement and Communication

7.1.1. The LCRN Host Organisation has a duty to promote research opportunities to patients and public in line with the NHS Constitution for England, including informing patients about research that is being conducted within the LCRN area. Engagement opportunities offered by the National CRN Coordinating Centre- managed services such as Join Dementia Research (JDR) and the UK Clinical

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Trials Gateway (UKCTG) should be communicated to all appropriate stakeholders. 7.1.2. The LCRN Host Organisation will take a proactive approach to supporting new and emerging NIHR strategies containing Stakeholder Engagement and Communication goals, relevant to the delivery of NIHR CRN objectives. 7.1.3. A sufficient non-pay budget line to deliver patient and public involvement, stakeholder engagement and communications activities should be provided. This includes LCRN-level resource required to deliver the JDR service. 7.1.4. The communications resource may be employed by the LCRN Host Organisation or another organisation, but the lead for communications must report directly to the LCRN Executive. 7.1.5. The LCRN Host Organisation will ensure the LCRN communications function develops and delivers a local communications plan that recognises the LCRN’s position as part of a national system, and that supports: (a) the implementation of the NIHR CRN NHS Engagement and Communications strategies and the NIHR Communications Strategy (b) the implementation of the Communications Contract Support Document (c) the development and maintenance of the LCRN’s positive reputation (d) transparency of local performance on research delivery (e) strong internal and external stakeholder relationships (f) patient, staff, carer and public awareness of local clinical research opportunities (g) effective working with other parts of the NIHR, at a local, regional and national level. 7.1.6. The LCRN communications plan should also encompass local delivery of national NIHR campaigns. 7.1.7. The LCRN Host Organisation must contribute to national NIHR campaigns and initiatives in line with LCRN Contract Support Documents from the National CRN Coordinating Centre. 7.1.8. The LCRN Host Organisation must ensure the whole LCRN operates in line with the brand guidelines, operational requirements and national messaging as advised by the National CRN Coordinating Centre. 7.1.9. LCRN Partner organisations or researchers that are in receipt of funds or support from the NIHR should acknowledge this in publications.

7.2. Patient and Public Involvement and Engagement (PPIE)

7.2.1. The LCRN Host Organisation has a duty to promote research opportunities to patients and the public, in line with the NHS Constitution for England, including informing patients about research that is being conducted within the LCRN area,

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and continuously improving patient experience of research through actively involving and engaging patients in research processes and engaging patients, carers and the public in research activities. 7.2.2. The LCRN Host Organisation will support the development and implementation of the NIHR CRN Patient and Public Involvement and Engagement Strategy and will write and deliver an adequately resourced workplan with outcomes, milestones and measurable targets for ensuring that patient choice, equality and diversity, experience, leadership and involvement are integral to all aspects of LCRN activity, in partnership across NIHR CRN. The LCRN Host Organisation must ensure adherence to the requirements set out in the Stakeholder Engagement Contract Support Document provided by the National CRN Coordinating Centre. 7.2.3. The LCRN Host Organisation will ensure it and LCRN Partners actively engage and involve patients, carers and the wider public in all aspects of local research delivery activity to improve the quality and delivery of NIHR CRN Portfolio research and patient access to it. 7.2.4. The LCRN Host Organisation will actively promote and facilitate LCRN Partners in hosting and supporting Patient Research Ambassadors and report on progress in the development of these roles via the LCRN Annual Report and to the PPIE Forum. 7.2.5. The LCRN Host Organisation will work with other local research organisations (e.g. Collaborations for Leadership in Applied Health Research and Care, Biomedical Research Centres, Biomedical Research Units, the Research Design Service and regional INVOLVE initiatives) to provide an accessible, coherent and consistent local patient offer of information about, access to, and involvement in clinical research. 7.2.6. The LCRN Host Organisation will gather feedback from study participants and potential participants in NIHR CRN Portfolio studies in line with the NIHR CRN Patient Experience and Continuous Improvement Framework as part of a local managed programme of innovation with LCRN Partner organisations to optimise patient and public experience of research. 7.2.7. The LCRN Host Organisation will roll out the patient experience survey to research participants and arrange for findings to be shared with the National CRN Coordinating Centre. The LCRN Host Organisation will actively support implementation of any specific recommendations arising from the survey, as part of continuous improvement activities. 7.2.8. The LCRN Host Organisation will actively support collaboration across LCRN Partners in developing joint work plans with measurable outcomes for provision of learning resources (e.g. Building Research Partnerships, Massive Online Open Courses (MOOCs)). 7.2.9. The LCRN Host Organisation will ensure LCRN-funded staff have easy access to the NIHR Hub, digital and social media and other developing sites as required by

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the National NIHR CRN Coordinating Centre in order to reach out and engage diverse audiences in the development and delivery of engagement and involvement activities. 7.2.10. The LCRN Host Organisation will hold up-to-date information on its contact with patient, carer, public groups and stakeholder organisations and make it available in line with the NIHR CRN PPIE Information Framework. 7.2.11. The LCRN Host Organisation must identify a senior leader to take responsibility for PPIE within the LCRN. The identified lead will participate in nationally agreed PPIE initiatives and support the delivery of an integrated approach to PPIE across the NIHR CRN.

7.3. Health and care systems engagement

7.3.1. The LCRN Host Organisation has a duty to promote research opportunities to patients and the public, in line with the NHS Constitution for England, including ensuring healthcare and care professionals are informed about research that is being conducted within the LCRN area, and continuously improving processes through actively involving and engaging staff and their representative organisations in research activities. This will include promoting awareness of, and engagement with the National CRN Coordinating Centre managed services, such as Join Dementia Research and the UK Clinical Trials Gateway. 7.3.2. The LCRN Host Organisation will support the development and implementation of the NIHR CRN NHS Engagement strategy, and will work to deliver an adequately resourced workplan with outcomes, milestones and measurable targets, in partnership across NIHR CRN and the wider NIHR. 7.3.3. The LCRN Host Organisation must ensure adherence to the requirements set out in the Stakeholder Engagement Contract Support Document provided by the National CRN Coordinating Centre.

7.4. LCRN Contract Support Documents

LCRN Leadership Teams should ensure that all elements of the LCRN operate in compliance with the following LCRN Contract Support Documents in respect of Stakeholder Engagement and Communications which are accessible on the NIHR Hub:

Ref Title

COM/016 Communications Contract Support Document

SEC/058 Stakeholder Engagement Contract Support Document

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8. Organisational Development

8.1. Workforce, Learning and Organisational Development

8.1.1. The LCRN Host Organisation will support the development of effective networking leaders, who take an innovative and evidence-based approach to developing the capacity and capability of the workforce to deliver timely and high quality research in all clinical care settings. 8.1.2. The LCRN Host Organisation will support the continued implementation and refresh of the NIHR CRN Workforce Development strategy. 8.1.3. In order to ensure consistency in the provision of LCRN services, the LCRN Host Organisation will ensure LCRN-funded staff, patients and carers involved in the delivery of LCRN activities have learning and development commensurate with their role. LCRN Host Organisations will ensure that an awareness of clinical research is provided to staff at induction. 8.1.4. The LCRN Host Organisation shall establish a profile of NIHR CRN funded staff employed within the LCRN geography and demonstrate active workforce planning developed in partnership with relevant stakeholders. 8.1.5. The LCRN Host Organisation will develop a comprehensive workforce plan for LCRN staff that will enable a responsive and flexible workforce to deliver NIHR CRN Portfolio studies both current and anticipated. This will be developed in partnership with relevant stakeholders. 8.1.6. The LCRN Host Organisation shall identify a senior leader to coordinate workforce planning, recruitment, development and retention within the LCRN. The identified lead will participate in nationally agreed workforce development initiatives and support the delivery of an integrated approach to workforce development across the NIHR CRN. 8.1.7. The LCRN Host Organisation will contribute to the continuing development of learning and development resources in support of the NIHR CRN its services and people. Time should be released for funded CRN staff to contribute their knowledge and expertise across workforce, learning and organisational development initiatives. In addition the LCRN will champion a culture of improvement and innovation including knowledge transfer across the NIHR and the development of best practice. 8.1.8. The LCRN Host Organisation will be responsible for adhering to NIHR CRN defined quality standards and processes applicable to learning materials, resources and tools made available by the National CRN Coordinating Centre via the National Directory. The LCRN Host Organisation will ensure the LCRN adopts resources from the National Directory where appropriate. 8.1.9. The LCRN Host Organisation will attend to the wellbeing of all LCRN-funded staff by providing a positive work environment including appropriate professional line management, performance reviews, continuing professional development plans

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and opportunities to undertake learning and development, in line with the NIHR CRN Workforce Development strategy. 8.1.10. The LCRN Host Organisation must ensure all LCRN-funded staff have opportunities to engage with the strategic initiatives of the NIHR CRN.

8.2. Continuous Improvement

8.2.1. The LCRN Host Organisation will promote and sustain a culture of Continuous Improvement (innovation and improvement) across all areas of LCRN activity to develop the NIHR CRN and its services including optimising performance. 8.2.2. The LCRN Host Organisation will ensure the LCRN adopts a breadth of appropriate approaches and interventions to ensure that it is responsive to the needs of its customers and the business, delivering innovative, streamlined, efficient and high quality services that demonstrate impact and benefit. 8.2.3. The LCRN Host Organisation will ensure continuous improvement awareness, knowledge and skills are a core competency of LCRN staff as appropriate to their role and that building capability (expertise and leadership) in this area is incorporated within the LCRN's workforce development strategy. 8.2.4. The LCRN Host Organisation shall identify a senior leader to take responsibility for embedding continuous improvement across the LCRN to: (a) ensure the local delivery of the nation-wide Study Support Service is subject to continuous improvement, improving local processes and working arrangements to achieve the nation-wide service deliverables (b) ensure LCRN leadership contributes to national/NIHR CRN-wide innovation and improvement programmes and projects (c) work with the LCRN Chief Operating Officer and other key staff to oversee the development and execution of appropriate responses to improving local performance.

8.3 LCRN Contract Support Documents

LCRN Leadership Teams should ensure that all elements of the LCRN operate in compliance with the following LCRN Contract Support Documents in respect of Workforce, Learning and Organisational Development which are accessible on the NIHR Hub:

Ref Title

WL/025 NIHR CRN Good Clinical Practice programme

WL/026 National Learning and Development programmes

AHP/026 Embedding Continuous Improvement across the NIHR CRN

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9. Business Development and Marketing

9.1.1. Business development with established national life science companies and non- commercial funders is the responsibility of the National CRN Coordinating Centre. Engagement with local small and medium sized enterprises within LCRN areas is the responsibility of the LCRNs with support from the National CRN Coordinating Centre. 9.1.2. The LCRN Host Organisation will ensure close working and open communication with the Business Development and Marketing team in the National CRN Coordinating Centre to ensure the needs of the customer are being met and the NIHR CRN is responsive to change. 9.1.3. The LCRN Host Organisation will: (a) promote the continued importance of the industry agenda to LCRN Partner organisations and clinical teams (b) work in partnership with the national Business Development and Marketing team to support national business development initiatives e.g. Biosimilars offer (c) provide intelligence on interactions with NIHR CRN customers (d) maintain an up to date LCRN “profile” to highlight the unique selling points of the LCRN for use by the National CRN Coordinating Centre for marketing purposes nationally and internationally (e) supported by the national Business Development and Marketing team in ensuring that life sciences companies are appropriately briefed about the NIHR CRN Study Support Service offer during the NIHR CRN Industry Costing Template validation stage.

9.2. LCRN Contract Support Documents

LCRN Leadership Teams should ensure that all elements of the LCRN operate in compliance with the following LCRN Contract Support Documents in respect of Business Development and Marketing which are accessible on the NIHR Hub:

Ref Title

BDM/032 Business Development & Marketing Contract Support Document

END OF DOCUMENT

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Page 89 of 89 Enclosure 8

Trust Board Meeting 1 March 2018

Title Chief Executive’s Report on Current Issues

Sponsoring Executive Fiona Dalton, Chief Executive

Authors’ names & Job Amanda Lowe, Associate Director: Corporate Affairs titles Purpose of the paper For To note ☑ Formal For decision  information  approval ☑

1. To alert Trust Board to current news items available on the website. 2. To inform Trust Board of business undertaken by TEC. 3. To inform Trust Board of the signing and sealing undertaken in accordance with SFIs. 4. To seek ratification of the Chair’s actions undertaken with regard to contracts in accordance with SFIs.

History Monthly report.

Action Required 1. Ratify the actions undertaken by the Chair (paragraphs 5.1 – 5.3). 2. Note this report.

1. Current News Current news is available on the Trust website at http://www.uhs.nhs.uk and CEO blog at Chief Executive’s Blog 19 February 2018

2. Recent Press Stories 2.1 BBC News, ITV News, BBC Radio Scotland, BBC South Today, BBC Radio Solent, the Daily Mail, the i newspaper, The Metro, The Times, the Huffington Post, NBC News (US) and the Daily Echo reported Professor Diana Eccles and her team’s study of 3,000 women which found young breast cancer patients with faulty BRCA genes have the same survival chances as those without. 2.2 The Sun’s Fabulous magazine featured the story of cancer patient Andy Szasz, whose recovery from a coma on the general intensive care unit following an admission for pneumonia at SGH was aided by a visit from his pet dog Teddy. 2.3 The Daily Mirror, the Daily Record, the Yorkshire Post, The Press, the Northern Echo, The Scotsman, the Press and Journal, the Western Morning News, the Times of Malta, the Daily Echo and BBC Radio Solent covered a new treatment for knee arthritis being trialled by surgeons in Southampton which involves injecting patients with a strengthened form of their own blood. 2.4 BBC South Today visited SGH to find out more about the role of volunteers as mealtime assistants and as part of the trust’s ‘eat, drink, move’ initiative. This was also covered by BBC Radio Solent.

Page 1 of 5

2.5 Respiratory physician Dr Ben Marshall talked to the Daily Mail about the importance of the flu vaccine, particularly among people with underlying medical conditions that increase the risk of complications. 2.6 The Guardian, The Daily Telegraph, The Independent and the i newspaper reported liver expert Dr Nick Sheron’s comments during a debate on a 50p minimum unit price of alcohol at the joint health and home affairs committee. His comments were also covered by 324 local and regional publications across the UK. 2.7 Dr Sheron also talked to The Sun about alcohol consumption over the festive period and the effects of ‘dry January’. 2.8 The Daily Mirror, Health Business, the Daily Echo, BBC Radio Solent, ITV Meridian and 245 other local and regional publications across the UK covered the launch of a nationwide trial of a ‘soft’ laser therapy pioneered by doctors in Southampton to help prevent side effects in adult patients undergoing treatment for head and neck cancer. 2.9 The Daily Mail and the Daily Mirror reported the story of 12-year-old Olivia Parslow, who is one of the youngest in the world to suffer from ovarian cancer. She is now in remission following treatment at UHS. 2.10 The Daily Echo reported a fundraising campaign launched by 13-year-old Felix Barrow after he made a miracle recovery following a car accident has reached £110,000. 2.11 The Daily Echo ran an item on a pioneering national initiative being led by researchers in Southampton to incorporate alcohol awareness into breast screening and breast cancer clinic appointments. 2.12 The Daily Echo ran its annual New Year babies’ feature and included twin girls delivered at the Princess Anne Hospital 23 minutes apart but in different years. This was also covered by The Sun, the Daily Mirror and the Daily Mail. 2.13 The Daily Echo, Andover Advertiser, Romsey Advertiser and the Basingstoke Gazette ran items on winter pressures facing hospitals across the south and the cancellation of some non-urgent operations. 2.14 The Pharmaceutical Journal reported the role of pharmacists in supporting emergency departments during winter pressures and talked to James Allen, deputy chief pharmacist at UHS. 2.15 Business South and the Daily Echo ran articles on a £17,000 donation from Barrett Homes to Southampton Hospital Charity for Hamwic Ward at SGH. 2.16 The Daily Echo and the Isle of Wight County Press covered the inquest of baby Betsy Riley, who died following the inadvertent insertion of a PICC line into her right artery. This was also covered online by The Sun, the Daily Mail, The Metro and the Daily Mirror. 2.17 The Daily Echo ran an item on medical negligence payments by trusts in the south. 2.18 The Daily Echo reported a visit from Finnish business leaders and government representatives to find out more about innovations in digital technology at UHS. 2.19 The Daily Echo covered consultant ophthalmologist Parwez Hossain’s warning that some patients in the UK may be losing their sight unnecessarily due to a “poor understanding” of the effectiveness of emergency corneal transplantation. 2.20 The Daily Mail ran a piece on changes to NHS England’s standard contract which states hospital trusts ‘must not enter into, extend or renew any contractual arrangement’ with any company which might lead to a legal claim against any part of the NHS and referenced the Trust’s agreement with Kiteleys Solicitors. 2.21 The Daily Echo, BBC South Today, ITV Meridian, BBC Radio Solent, Wave 105 FM and the Wessex Scene ran items on the University of Southampton reaching its £25 million fundraising target for a pioneering centre for cancer immunology at Southampton General Hospital.

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2.22 Medical oncologist Professor Christian Ottensmeier appeared on BBC 2’s Victoria Derbyshire programme to discuss advances in cancer treatment including immunotherapy. 2.23 The Daily Echo ran an articles on the children’s emergency and trauma department appeal following a pledge of support from law firm Paris Smith, while Eastleigh News and Sam FM reported Saints legend Franny Benali’s support for the campaign. 2.24 The Daily Mirror, the Daily Record, the Daily Echo, Wave 105 FM, BBC Radio Solent and Optometry Today ran items on Professor Andrew Lotery’s involvement in as the first in the UK to trial a drug which could prevent sight loss caused by currently untreatable condition Stargardt’s disease. 2.25 The Daily Express (front page), the Daily Mirror, The Sun, The Daily Telegraph, The Times, the Daily Mail, BBC News Channel, Sky News, BBC Radio Solent, Wave 105 FM and a number of specialist publications covered the results of a study led by Professor Chris Edwards at the NIHR Southampton Biomedical Research Centre which found drugs used to treat rheumatoid arthritis could halve the risk of developing dementia

3. Trust Executive Committee (TEC) The Trust Executive Committee (TEC) is a formal standing committee of the Trust, which executes actions from the Board and supports the operational management of the Trust. The agenda for the February 2018 meeting is attached at Appendix 1 and reports are available to Board members on request.

4. Signing & Sealing The Seal of the Trust is required to be fixed to some documents. There were no seals fixed for the period of this report

5. Chair’s Actions The Board has agreed that the Chair may undertake some actions on its behalf. The following actions have been undertaken by the Chair. All awards of contract are subject to a full tender process. 5.1 Award of Contract for Hybrid Pressure Mattress Capital Purchase from Direct Healthcare via NHS Supply Chain (NHSSC), within an EU Compliant National Framework Agreement, at a cost of £557,230 excluding vat. Approved by the Chair on 30 January 2018. 5.2 Award of Contract for Chiller Replacement and Installation from ARB Mechanical at a cost of £2,297,790 excluding vat. Approved by the Chair on 7 February 2018. 5.3 Single Tender Action for an Extension of Contract for the Provision of a Managed Laboratory Service for 17 months ensuring continuity of service provision whilst the Trust concludes a new contract, from Beckman Coulter UK Ltd at a cost of £2,830,000 excluding vat. Approved by the Chair on 19 February 2018.

6. Recommendation 6.1 To ratify the actions undertaken by the Chair (paragraphs 5.1 – 5.3). 6.2 To note this report.

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Trust Executive Agenda Committee

Date of Meeting: 14 February 2018 Venue: Conference Room, Heartbeat Education Centre, F Level, North Wing, SGH Time: 8.00-10.30am Apologies to: Sue Diduch, Corporate Affairs Administrator

Time Agenda Item Enc/Oral 8.00 1. Chair’s Welcome, Apologies and Declarations of Interest 2. Minutes of Previous Meeting held on 17 January 2018 Enclosure 1 3. Matters Arising/Summary of Agreed Actions Enclosure 2 4. Quality & Safety Discussion Items 8.10 4.1 Quality & Safety Update including HSMR Enclosure 3 (Gail Byrne, Director of Nursing & Organisational Development/ Derek Sandeman, Medical Director/Ric Meakin, Associate Marketing & Clinical Data Quality Manager) 8.20 4.2 Infection Prevention & Control 2017/18 Quarter 3 Report Enclosure 4 (Gail Byrne, Director of Nursing & Organisational Development/ Graeme Jones, Director, Infection Prevention Unit) 8.30 4.3 Home Before Lunch Enclosure 5 (Gail Byrne, Director of Nursing & Organisational Development) Oral 5. Forward Planning 2018/19 Discussion Items 8.40 5.1 Draft Budget-Setting 2018/19 Enclosure 6 (David French, Chief Financial Officer/Paul Goddard, Director of Finance/Gavin Hawkins, Director of Finance) 8.50 5.2 Draft Capital Plan 2018/19 Enclosure 7 (Jane Hayward, Director of Transformation & Improvement/ David French, Chief Financial Officer/Sue Leamore, Deputy Director of Strategy) 9.00 5.3 Demand and Capacity Forecasts Enclosure X (Jane Hayward, Director of Transformation & Improvement/ Sue Leamore, Deputy Director of Strategy) 6. Operational Performance Discussion Items 9.10 6.1 Draft 5-year Staff Strategy Enclosure 8 (Fiona Dalton, Chief Executive/Steve Harris, Human Resources Director/Joanna Mountfield, Director of Education) 9.20 6.2 Review of Appraisals Process Enclosure 9 (Fiona Dalton, Chief Executive/Steve Harris, Human Resources Director/Joanna Mountfield, Director of Education/Adam Pitt, Human Resources Business Partner/David Young, Head of Leadership Development) 9.30 6.3 Access Times and Operational Performance for January 2018 Oral (Caroline Marshall, Chief Operating Officer/Andrew Asquith, Deputy Chief Operating Officer)

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7. Finance Discussion Items 9.40 7.1 Finance Report for Month 10 Enclosure 10 (David French, Chief Financial Officer) 9.50 7.2 Finance and Procurement Systems Implementation Enclosure 11 (David French, Chief Financial Officer/Paul Goddard, Director of Finance) 8. Information Items NO DISCUSSION 8.1 Clinical Effectiveness/Outcomes 2017/18 Quarter 3 Report Enclosure 12 (Derek Sandeman, Medical Director) 8.2 Vertical Shell Business Case Enclosure 13 (Jane Hayward, Director of Transformation & Improvement) Board report 8.3 Annual Report 2017/18 including Quality Account Process Enclosure 14 (Fiona Dalton, Chief Executive) Board report 8.4 Staffing Status Report Enclosure 15 (Gail Byrne, Director of Nursing & Organisational Development) 8.5 Reference Cost Index - Outcome of 2016/17 Submission Enclosure 16 (David French, Chief Financial Officer) 8.6 Replacement Consultant Business Case: Ophthalmology (VR) Enclosure 17 (Derek Sandeman, Medical Director) 8.7 Replacement Consultant Business Case: Ophthalmology Enclosure 18 (Oculoplastic) (Derek Sandeman, Medical Director) 9. Minutes from TEC Sub-Committees and Reporting Groups 9.1 Quality Governance Steering Group 21 November 2017 Enclosure 19 (Gail Byrne) 9.2 Research & Development Steering Group 18 January 2018 Enclosure 20 (Christine McGrath) 9.3 Trust Investment Group 11 January 2018 (David French) Enclosure 21 9.4 Division D Board 8 December 2017 (Jacqui McAfee) Enclosure 22 9.5 Division C Board 18 December 2017 (Martin DeSousa) Enclosure 23 9.6 Division A Board 21 December 2017 (Greg Chapple) Enclosure 24 9.7 Division B Board (Duncan Linning-Karp) Not received 10.00 10. Any Other Business 10.1 Agenda for the next meeting – 14 March 2018 (papers to be received by Enclosure 24 Corporate Affairs by noon 8 March 2018)

Apologies: David French (Paul Goddard to attend), Derek Sandeman, Greg Chapple, James Adams (Dan Baylis to attend), Amanda Lowe

In Attendance: Ric Meakin, Associate Marketing & Clinical Data Quality Manager Graeme Jones, Director, Infection Prevention Unit Gavin Hawkins, Director of Finance Sue Leamore, Deputy Director of Strategy Adam Pitt, Human Resources Business Partner David Young, Head of Leadership Development Katherine Walker, ST7 Registrar, Anaesthetics (shadowing Fiona Dalton) Ciara Haddadeen, Specialty Registrar, Specialist Medicine (observing)

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