agenda and papers f ormal meeting of the kent …...agenda and papers for the f ormal meeting of the...

Agenda and Papers

for the

Formal meeting of the

Kent Community Health NHS Foundation Trust Board

In Public

to be held at 10am on

Thursday 23 May 2019

in

Rooms 6 and 7 Kent Community Health NHS Foundation

Trust offices Trinity House

110 – 120 Upper Pemberton, Ashford Kent

TN25 4AZ

Meeting of the Kent Community Health NHS Foundation Trust Board

to be held at 10am on Thursday 23 May 2019 in the Rooms 6 and 7,Kent Community Health NHS Foundation Trust offices, Trinity

House,110-120 Upper Pemberton, Ashford Kent

TN25 4AZ

This meeting will be held in Public

AGENDA

1. STANDARD ITEMS

1.1

Introduction by Chair

Trust Chair

1.2 To receive any Apologies for Absence

Trust Chair

1.3 To receive any Declarations of Interest

Trust Chair

1.4 To agree the Minutes of the Kent Community Health NHS Foundation Trust Board meeting held on 28 March 2019

Trust Chair

Page 4

1.5 To receive Matters Arising from the Kent Community Health NHS Foundation Trust Board meeting held on 28 March 2019

Trust Chair

Page 15

1.6 To receive the Trust Chair’s Report

Trust Chair

Page 19

1.7 To receive the Chief Executive’s Report

Chief Executive Page 26

2. BOARD ASSURANCE/APPROVAL

2.1

To receive the Patient Story Chief Nurse (Interim)

2.2

To receive the Board Assurance Framework

Corporate Services Director

0

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Page 1 of 177

Board Committee Reports

2.3

To receive the Quality Committee Chair’s Assurance Report

Chair of Quality Committee

Page 37

2.4

To receive the Strategic Workforce Committee Chair’s Assurance Report

Chair of Strategic Workforce Committee

6

2.5 To receive the Finance, Business and Investment Committee Chair’s Assurance Report

Chair of Finance, Business and Investment Committee

Page58

2.6

To receive the Audit and Risk Committee Chair’s Assurance Report

Chair of Audit and Risk Committee

Page 71

2.7 To approve the 2018/19 Annual

Report and Accounts (i) 2018/19 Annual Quality

Report

Director of Finance Chief Nurse (Interim)

Page

2.8 To receive the Integrated Performance Report

Director of Finance/Executive Directors

Page 74

2.9 To Approve the Digital Strategy Director of Finance Page 120

3. REPORTS TO THE BOARD

3.1 To receive the Patient Experience

and Complaints Report

Chief Nurse (Interim) Page 140

3.2 To receive the Learning From Deaths Report

Medical Director Page 152

3.3

To receive the Freedom To Speak Up Report


Page 165

3.4 To receive the Emergency Planning and Business Continuity Annual Report


Page 168

4. ANY OTHER BUSINESS

To consider any other items of business previously notified to the Trust Chair

Trust Chair

Page 2 of 177

5. QUESTIONS FROM MEMBERS OF THE PUBLIC RELATING TO THE AGENDA

6. DATE AND VENUE OF NEXT MEETING

Thursday 25 July 2019

Suite 1, The Orchards, New Road, East Malling, West Malling Kent ME19 6BJ

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Page 3 of 177

Unconfirmed Minutes

of the Kent Community Health NHS Foundation Trust Board meeting held at 10am on Thursday 28 March 2019

in Rooms 6 and 7, Kent Community Health NHS Foundation Trust Offices, Trinity House, 110 – 120 Upper Pemberton, Ashford Kent TN25 4AZ

Meeting held in Public

Present: John Goulston, Trust Chair (Chair) Pippa Barber, Non-Executive Director Paul Bentley, Chief Executive Peter Conway, Non-Executive Director Martin Cook, Non-Executive Director Professor Francis Drobniewski, Non-Executive Director Richard Field, Associate Non-Executive Director Gordon Flack, Director of Finance Steve Howe, Associate Non-Executive Director Louise Norris, Director of Workforce, Organisational

Development and Communications Dr Sarah Phillips, Medical Director Dr Mercia Spare, Chief Nurse (Interim) Bridget Skelton, Non-Executive Director Gerard Sammon, Director of Strategy Lesley Strong, Deputy Chief Executive/Chief Operating Officer Jen Tippin, Non-Executive Director Nigel Turner, Non-Executive Director In Attendance: Gina Baines, Committee Secretary (minute-taker) Natalie Davies, Corporate Services Director Observer: Nicola Coles, EY Plum Consulting

28/03/1 Introduction by Chair

Mr Goulston welcomed everyone present to the Public Board meeting of Kent Community Health NHS Foundation Trust (the Trust). Mr Goulston advised that this was a formal meeting of the Board held in public, rather than a public meeting, and as such there would be an opportunity for public questions relating to the agenda at the end of the meeting.

Min

utes

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of 7

28/03/2 Apologies for Absence

There were no apologies. The meeting was quorate.

28/03/3 Declarations of Interest

No conflicts of interest were declared other than those formerly recorded.

28/03/4 Minutes of the Meeting of 31 January 2019

The Board AGREED the Minutes.

28/03/5 Matters Arising from the Meeting of 31 January 2019

29/11/8 Patient Story – Dr Spare had met with the service manager who had confirmed that it had been a process error. The Trust’s internal root cause analysis had been shared with the feed company. A joint action plan had been developed to teach parents how to order feeds correctly on the system. Action closed. 31/01/13 Integrated Performance Report (IPR) – Operational Report – It was agreed to close the action. 31/01/15 Winter Pressures Update Report – The Rapid Transfer of Care Service would continue to operate throughout the year. Action closed. All other actions were confirmed and closed. The Board RECEIVED the Matters Arising.

28/03/6 Trust Chair’s Report Mr Goulston presented the report to the Board for information.

On 12 March 2019, Mr Goulston had attended the Senior Leaders Conference and not the Council of Governors meeting as indicated in the report. Mr Goulston and Mr Bentley had attended the East Kent Partnership Board earlier in the week. Following his recent meeting with Mr Paul Carter, Leader and Cabinet Member for Health Reform at Kent County Council (KCC), Mr Goulston would be meeting with him again after the Easter break. Mr Cook stated that he had attended two sessions run by the Trust to support the replacement of its Community Information System (CIS). He had been impressed by the number of staff who had attended and participated with energy and enthusiasm. He thanked them on behalf of the Board for their commitment and investment in time. He was satisfied that the process was being well run and that the lessons that had been learnt from the previous CIS procurement exercise had been taken on board.

Page 5 of 177

of 7

In response to a comment from Prof Drobniewski regarding considering an alternative venue for future Council of Governor meetings, it was agreed that this would be discussed with the Governors at their Development Day in April 2019. Action – Ms Davies The Board RECEIVED the Trust Chair’s Report.

28/03/7 Chief Executive’s Report Mr Bentley presented the report to the Board for information.

Mr Bentley thanked the non-executive directors for attending the Senior Leaders Conference earlier in the month. Ms Tippin commented that the results from the 2018 NHS Staff Survey had indicated good progress for the Trust and congratulated the Executive Team. Dr Phillips indicated that the Board could follow the range of Quality Improvement (QI) projects that were underway in the Trust by accessing the online Live QI web site. She would circulate the link. Action – Dr Phillips In response to a question from Mr Field regarding how issues were addressed where collaborative arrangements were in place, such as with the South East Coast Ambulance NHS Trust, Ms Strong indicated that previously these were managed through discussions with the commissioners of the service. The Board RECEIVED the Chief Executive’s Report.

28/03/8 Patient Story Dr Spare presented the video to the Board. The story related to a Quality Improvement project to reduce podiatric surgery on-the-day cancellations. Following Ms Barber’s question as to whether a Quality Improvement (QI) approach could be used to pre-empt some of the pre-operational preparation that patients had to undergo, Mr Sammon questioned whether the appointments could be better managed to improve the patient experience and increase service efficiency. Dr Phillips suggested that there could be further QI related tools which the team could use to assess the process further. In response to a question from Mr Howe as to whether the service would address other reasons why a patient’s operation was cancelled on the day, Dr Spare explained that the service had noticed a particular pattern of cancellations because of high blood pressure readings from some patients on the day of their operation and this had triggered this specific project. She suggested that this was the first step. The service would be sharing its

Min

utes

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learning with other services. Mr Flack commented that there was an opportunity to liaise with similar services in the acute trusts to avoid working from first principles. Mr Goulston concluded that he had visited the Podiatric Surgery Service at the Queen Victoria Memorial Hospital, Herne Bay and met with Mr Simon Pendleton, Quality Improvement and Podiatric Surgery Manager. They had discussed the project and it had been agreed that the service would look into reaching out to similar services in other trusts to share learning and good practice. It was agreed that the comments from the Board would be fed back to the service. Action – Dr Spare

The Board RECEIVED the Patient Story.

28/03/9 Board Assurance Framework (BAF) Ms Davies presented the report to the Board for assurance.

In response to a question from Mr Conway regarding Risk 102 relating to the workforce, Ms Skelton confirmed that the Strategic Workforce Committee had reviewed it. The wording of the risk had been updated and reflected the Committee’s discussions. In response to a question from Mr Conway regarding Risk 103 relating to the system architecture, there was a discussion as to how the Executive Team had reached its conclusion regarding the risk’s confidence assessment and associated rating. Mr Conway said he was assured as a result of the explanation. Mr Cook MC asked for further assurance which was provided by Ms Davies. In response to a question from Prof Drobniewski regarding Risk 101 relating to Brexit, Ms Davies confirmed that the Trust had been fully involved in preparing the organisation and the wider system in Kent for the potential impact on business continuity if the UK left the European Union without a deal at the end of the month. Preparations had been locally led and managed, feeding in national support as it was available. The Department of Health had been helpful in assessing and managing the potential impact of Brexit on national contractual arrangements. As the BAF was a dynamic document, it was suggested that the Management Committee and the Audit and Risk Committee would continue to review it taking into account the comments made by the Board. The Board RECEIVED the Board Assurance Framework. Ms Tippin left the meeting.

28/03/10 Quality Committee Chair’s Assurance Report Ms Barber presented the report to the Board for assurance.

Page 7 of 177

of 7

The Board RECEIVED the Quality Committee Chair’s Assurance Report.

28/03/11 Strategic Workforce Committee Chair’s Assurance Report Ms Skelton presented the verbal report to the Board for assurance.

The Strategic Workforce Committee had met the previous week. There have been wide ranging discussions which had included the improving performance of turnover, sickness absence and retention; the Nursing Academy; the Time to Change programme; the 2018 NHS Staff Survey; workforce hotspots and the use of bank staff in operations; the Transforming Integrated Care in the Community (TICC) programme; E-Rostering. The HR element in the Trust 2019/20 Operational Plan and the People Strategy Implementation Plan had both been approved. The Trust would be publishing its Gender Pay Gap Report at the end of the month and a number of actions had been agreed to enhance performance in this area. In response to a question from Mr Conway regarding the findings of the Trust’s Gender Pay Gap Report, Ms Norris confirmed that the Trust was bucking the national position. Female staff in the Trust were found to have a slightly higher pay rate than male staff. . It was agreed that the report would be circulated to the Board. Action – Ms Norris In response to a question from Prof Drobniewski as to whether the conclusions of the report would be circulated to staff, it was agreed that a message would be communicated via the weekly staff bulletin. Action – Ms Norris The Board RECEIVED the Strategic Workforce Committee Chair’s Assurance Report.

28/03/12 Audit and Risk Committee Chair’s Assurance Report Mr Conway presented the report to the Board for assurance.

The Board RECEIVED the Audit and Risk Committee Chair’s Assurance Report.

28/03/13 Integrated Performance Report (IPR)

Assurance on Strategic Goals Mr Flack presented the report to the Board for assurance. Quality Dr Spare presented the report to the Board for assurance. In response to a question from Mr Cook regarding the proposed revision to

Min

utes

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the sickness absence Key Performance Indicator (KPI), Ms Norris explained that the Trust had demonstrated that it had been doing everything possible that was considered best practice to improve performance. However, the conclusion was that the target would still not be met. Consequently, it had been suggested that the target should also be revised to determine if it was the right one. Benchmarking data would be analysed in order to identify a deliverable target. This would be discussed at the Strategic Workforce Committee meeting in May 2019 and if necessary a recommendation would be made to the Board. In response to a question from Prof Drobniewski regarding the omitted insulin incidents, Dr Spare confirmed that considerable work was being undertaken around reporting and this would be scrutinised further by the Quality Committee. A deep dive report had also been presented to the Patient Safety and Clinical Risk Group recently which explained a QI project that was underway to improve performance. Mr Field commented on the excellent work that staff had undertaken to achieve the high number of Friends and Family Test survey responses. Workforce Report Ms Norris presented the report to the Board for assurance. In response to a comment from Mr Field regarding the number of KPIs included in the report, Mr Flack confirmed that at the beginning of the financial year, there would be a review of those that were included to ensure that they remained relevant. He anticipated that there would be some changes to the 2019/20 IPR. Finance Report Mr Flack presented the report to the Board for assurance. Operational Report Ms Strong presented the report to the Board for assurance. In response to a question from Mr Turner regarding the recent dip in performance by the Paediatric Audiology Service which had contributed to the Trust slipping from Segment One to Segment Two on the Single Oversight Framework, Ms Strong confirmed that the service was working hard to improve its performance. Its ability to meet its Referral To Treatment waiting times (RTT) KPI was specifically linked to its ability to recruit specialist staff . The Service had presented its action plan to the Quality Committee. It was agreed that the service’s presentation would be circulated to the Board. Those other services that had reported a breach of their RTT KPI were now meeting them. Action – Ms Strong

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In response to a question from Mr Field as to whether the Trust was improving its performance with regards to the number of End of Life patients with an updated Personalised Care Plan, Dr Spare indicated that there had been some improvement but she was not confident that it was sustainable at this time. A QI approach was being applied which she anticipated would deliver more sustainability by the end of Quarter One. However, aside from this, she was confident that the Trust was delivering good end of life care to its patients. In response to a question from Mr Goulston regarding whether the service which delivered the National Child Measurement Program for year R and Six pupils locally was offering further follow-on services to its commissioner on the back of the data that had been collected. Ms Strong confirmed that discussions were underway with KCC. She would be happy to provide the Board with further information. Action – Ms Strong The Board RECEIVED the Integrated Performance Report. Ms Tippin rejoined the meeting.

28/03/14 Constitutional Amendment Mr Flack presented the report to the Board for approval.

The Board APPROVED the Constitutional Amendment.

28/03/15 Charitable Funds Committee Chair’s Assurance Report Ms Tippin presented the report to the Board for assurance.

The Board RECEIVED the Charitable Funds Committee Chair’s Assurance Report.

28/03/16 2019/20 Operating Plan Mr Bentley presented the report to the Board for approval.

Strategic Priorities Mr Sammon confirmed that the priorities had been considered by the Management Committee earlier in the week. A minor change to the wording had been proposed to the ‘Join-up care’ priority. In response to a question from Mr Cook regarding the use of the word digital as a noun in the fourth priority, it was agreed that this would be clarified. Action – Mr Sammon

Min

utes

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Quality Priorities Dr Spare confirmed that the priorities had been considered by the Management Committee earlier in the week. There had been some debate around the wording at the meeting and the agreed revisions were confirmed to the Board. In response to a comment from Ms Skelton regarding the consistency of language that was used in relation to ‘people’, it was agreed that this would be reviewed. Action – Dr Spare Financial Plan Mr Flack confirmed that the plan had been considered by the Finance, Business and Investment (FBI) Committee the previous day. For clarification, Mr Goulston suggested that a note was added to the plan that the minus notated against the total figure indicated a surplus and not a loss. Action - Mr Flack The Board APPROVED the 2019/20 Operating Plan, incorporating the priorities, subject to the amendments.

28/03/17 2018 NHS Staff Survey Report Ms Norris presented the report to the Board for assurance.

The Board RECEIVED the 2018 NHS Staff Survey Report.

28/03/18 Seasonal Infection Prevention and Control Report Dr Spare presented the report to the Board for assurance.

In response to a question from Mr Bentley regarding the recent levelling off of the number of reported Urinary Tract Infections (UTI) and Catheter Associated UTIs, Dr Spare indicated that further data needed to be included. With regards to how the Trust’s performance compared with the previous year, it was agreed that this would be confirmed outside of that day’s meeting. Actions – Dr Spare In response to a question from Mr Goulston as to whether the data related only to UTIs and Catheter Associated UTIs identified in the Trust’s community hospitals, it was suggested that more data would be available in the Annual Infection Prevention and Control Report which the Board would receive in July 2019. Actions – Dr Spare In response to a question from Mr Cook regarding the report that was awaited from the Authorised engineer for decontamination, Dr Spare confirmed that the Quality Committee had received a verbal update at its

Page 11 of 177

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meeting the previous week. She confirmed that the Trust was compliant with the sterilisation of its medical devices. The issue that had been identified related to the level of service that the Trust was receiving from its supplier and mitigation was in place to ensure that services were not impacted. It was agreed that the Quality Committee would monitor the decontamination service and provide a further update to the Board through the Committee Chair’s Assurance Report in May 2019. Action – Ms Barber It was confirmed that the Trust was compliant with the Hygiene Code. The Board RECEIVED the Seasonal Infection Prevention and Control Report. The Board APPROVED the Trust’s Infection Prevention and Control Declaration 2019.

28/03/19 Patient Experience and Complaints Report Dr Spare presented the report to the Board for assurance.

In response to a question from Ms Tippin regarding the recent decline in performance of the NHS Friends and Family Test (FFT) scores, Dr Spare indicated that this was a seasonal movement. Dr Phillips suggested that the decline might also reflect natural variation which could be tested further when there were more data points available. It was agreed that this would be monitored. Action – Dr Spare In response to a comment from Mr Bentley, it was agreed that reference to the Norfolk Community Health and Care NHS Trust would be removed from future reports, albeit the performance of the Trust might be a helpful measure. Action – Dr Spare The Board RECEIVED the Patient Experience and Complaints Report

28/03/20 Risk Management Strategy Ms Davies presented the report to the Board for approval.

The Audit and Risk Committee had reviewed the strategy at its meeting in February 2019 and recommended it to the Board. It was confirmed that reference to the Strategic Workforce Committee and Management Committee would be included in the final published version. The Audit and Risk Committee would review the strategy again in September 2019. In response to a comment from Mr Cook regarding reference within the strategy that there joint membership between all the committees, it was agreed that this would be checked for accuracy. Action – Ms Davies

Min

utes

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In response to a comment from Mr Goulston regarding the risk grading the Trust applied, it was agreed that the Audit and Risk Committee would consider this further. Action – Ms Davies In response to a comment from Mr Turner regarding whether there should be a policy statement within the strategy explaining why the Trust was reducing the number of clinical audits it was undertaking year on year, it was agreed that such a statement would be included if it was felt to be helpful. Action – Ms Davies In response to a question from Ms Norris as to whether the document was a policy rather than a strategy, Ms Davies indicated that it set out the framework as to how the Trust would measure risk and the strategic aims of the organisation. It was agreed that the Board’s comments would be incorporated into the document. Following scrutiny and approval of the revised version by Mr Conway, Chair of the Audit and Risk Committee, the document would be circulated to the Board for virtual approval. Action – Ms Davies The Board NOTED the Risk Management Strategy.

28/03/21 Use of the Trust Seal Report Ms Davies presented the report to the Board for assurance.

The Board RECEIVED the Use of the Trust Seal Report.

28/03/22 Minutes of Charitable Funds Committee Meeting of 29 November 2019 Ms Tippin presented the report to the Board for assurance.

The Board RECEIVED the Minutes of Charitable Funds Committee Meeting of 29 November 2019.

28/03/23 Any Other Business

There was no further business to discuss. Mr Goulston thanked Mr Field and Mr Howe for their long service to the Trust. Mr Field had been Vice Trust Chair, Acting Trust Chair and Chair of the FBI Committee. Mr Howe had been the Chair of the Quality Committee. Both had given a tremendous amount of effort into being non-executive directors.

28/03/24 Questions from members of the public relating to the agenda There were no questions from the public.

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The meeting ended at 12.45pm.

28/03/25 Date and Venue of the Next Meeting

Thursday 23 May 2019, Rooms 6 and 7, Kent Community Health NHS Foundation Trust Offices, Trinity House, 110 – 120 Upper Pemberton, Kennington, Ashford, TN25 4AZ

Min

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Page 17 of 177

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Page 18 of 177

Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 23 May 2019

Agenda Number: 1.6

Agenda Item Title: Trust Chair’s Report

Presenting Officer: John Goulston, Trust Chair

Action - this paper is for: Decision ☐ Information ☒ Assurance ☐

Report Summary

The report sets out the service visits and partnership meetings that were attended by the Trust Chair and non-executive directors between 1 February and 23 May 2019.

Proposals and /or Recommendations

To note the report.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒

High level position described and no decisions required.

Natalie Davies, Corporate Services Director Tel: 01622 211900

Email: [email protected]

Tru

st C

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s R

epor

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Page 19 of 177

SERVICE VISITS AND PARTNERSHIP MEETINGS ATTENDED BY THE CHAIR AND NON EXECUTIVE DIRECTORS OF KENT COMMUNITY HEALTH NHS

FOUNDATION TRUST

Period covered - 1 February to 23 May 2019

Name Service visits Stakeholder/ Partnership meetings / events

Other meetings / events

John Goulston

5th February – Whitstable & Tankerton Hospital. 11th February –Victoria Memorial Hospital 18th February – Adult Speech and Language Therapy & Clinical Nutrition and Dietetics (including visit to care home for swallowing assessment) Tonbridge and Edenbridge Community Hospitals 27th February - Estuary View Medical Centre, Whitstable

5th February – Kent and Medway STP clinical lead 13th February - Kent and Medway Integrated Care System Simulation Event 18th February - Hosted Kent & Medway providers chairs and CEOs 22nd February - GP clinical lead for East Kent 12th March - Leader of Kent County Council 13th March - Interview panel member for Kent and Medway STP chair 26th March - East Kent Integrated Care Partnership Board 2nd April – Tonbridge Cottage Hospital - League of Friends Chair and Vice Chair 15th April – Kent & Medway Provider Chairs and CEO meeting 17th April - Stakeholder’s event for prospective Chair candidates of Kent & Medway Partnership NHS Trust 23rd April – GP clinical lead for West Kent 24th April – Chair & CEO meeting with Maidstone & Tunbridge Wells Hospitals NHS Trust 14th May - West Kent

7th February – KCH Council of Governors 12th March – KCH Council of Governors 18th March – Lead and Deputy lead KCH Governors 29th March – NHS Community Network 4th April – Governors’ Development Day 23rd April - Transforming Integrated Community Care – Buurtzorg Masterclass

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Page 20 of 177



Integrated Care Partnership Board

Peter Conway

7th February – KCH Council of Governors 18th February - Extra ordinary QC 20th February - Audit and risk committee. 27th February - Finance, Business and Investment Committee 28th February - joint Management /board meeting. 1st March- Deputy Medical Director Interview 19th March quality committee 20th March – Strategic Workforce Committee 27th March - Finance, Business and Investment Committee 28th March – NED only Meeting 28th March – KCHFT Board Meeting 24th April - Finance, Business and Investment Committee 25th April - KCHFT Board 8th May - CQC inspection interview 15th May - Audit and Risk Committee 15th May - Strategic Workforce Committee

Bridget Skelton

20th February – Audit & Risk Committee 21st February – Niche Training - CQC 28th February - joint

Page 21 of 177



Bridget Skelton (continued)

Management /board meeting. 6th March - Meeting Director HR/OD 12th March - Seniors Leaders meeting 27th March – Finance Business Investment Committee 28th March – NED only Meeting 28th March – KCHFT Board Meeting 28th March – Meeting with CEO 4th April – Governors’ Development Day 8th April – Appraisal of Chair KCHFT 8th April – Feedback from CQC 25th April - Meeting Director HR/OD 25th April - KCHFT Board Meeting 9th May - CQC inspection interview 13th May - Nominations Committee 15th May - Audit and Risk Committee 15th May - Strategic Workforce Committee 16th May - Time to Change Conference 20th May - Meeting Director HR/OD 23rd May - KCHFT Board meeting

Pippa Barber

2nd April - Visit to Two Rapid Transfer of Care teams; QEQM and WHH

9th March - Dementia Friends Event, Westgate Halls Canterbury. Public event in partnership with KCHFT and EKHUFT.

6th February - Meeting with chief nurse 6th February - Meeting with niche.

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Page 22 of 177



Pippa Barber (continued)

18th February - Extra ordinary QC 19th February - QC 20th February - Audit and risk committee. 28th February - joint Management /board meeting. 12th March Seniors Leaders meeting 19th March quality committee 28th March – KCHFT Board Meeting 4th April – Governors’ Development Day 16th April – Quality committee 25th April - KCHFT Board 14th May – Quality Committee 15th May - Audit and Risk Committee 16th May - Time to Change Conference 23rd May - KCHFT Board meeting

Martin Cook

6th March – CIS Replacement process – Attended supplier demonstration and moderation day. 2nd April - RTOC service at QEQM and William Harvey 13th May -RTOC service at QEQM and William Harvey

5th February - Well- led for the future: development for NHS Board Members 15th March - Well- led for the future: development for NHS Board Members 28th April – CQC well led interview

Jen Tippen

21st February - Meeting with Niche (Emma & Kate) 27th February - Finance, Business and Investment Committee 28th February - joint

Page 23 of 177



Jen Tippin (continued)

Management /board meeting. 20th March – Strategic Workforce Committee 27th March - Finance, Business and Investment Committee 28th March – NED only Meeting 28th March – KCHFT Board Meeting 4th April – Governors’ Development Day 8th April - Board Development 1 - 1 Interviews 25th April – Appraisal John/Jen 25th April - KCHFT Board 15th May - Audit and Risk Committee 15th May - Strategic Workforce Committee 23rd May – Charitable Funds Committee 23rd May - KCHFT Board meeting

Professor Francis Drobniewski

7th February – KCH Council of Governors 28th February - joint Management /board meeting. 19th March- Quality Committee 20th March – Strategic Workforce Committee 28th March – NED only Meeting 28th March – KCHFT Board Meeting 4th April – Governors’ Development Day 16th April- Appraisal John/Francis

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Professor Francis Drobniewski (continued)

16th April- Quality Committee 23rd April - Transforming Integrated Community Care – Buurtzorg Masterclass 15th May - Strategic Workforce Committee 23rd May – Charitable Funds Committee 23rd May - KCHFT Board meeting

Nigel Turner

To be confirmed.

Richard Field

12th March - Senior Managers Conference, Detling Conference Centre

Page 25 of 177



Agenda Number: 1.7

Agenda Item Title: Chief Executive’s Report

Presenting Officer: Paul Bentley, Chief Executive

Action - this paper is for: Decision ☐ Information ☒ Assurance ☐

Report Summary

This report highlights key business and service developments in Kent Community Health NHS Foundation Trust in recent weeks.


Not applicable.



No ☒

High level position described.

Paul Bentley, Chief Executive Tel: 01622 211903


Chi

ef E

xecu

tive’

s R

epor

t

Page 26 of 177

CHIEF EXECUTIVE’S REPORT

May 2019

As previously I wanted to highlight to the Board the following significant developments since my last formal report during the Board meeting in April 2019, my regular practice is to categorise the report into patients, our people staff teams and partnerships. Patients

1. Makaton Friendly Canterbury

We are one of several organisations involved in a drive to make Canterbury the first Makaton-friendly city in the world. Canterbury is hoping to follow in the footsteps of Romsey, which became the first Makaton-friendly town in the world in February 2018. Canterbury wants to become the first Makaton-friendly city, by May 2020. To achieve this, 40 Canterbury organisations need to join up. Makaton uses signs and symbols to help people communicate and it is used by more than 100,000 children and adults. It is used by people with communication difficulties and the people who share their lives, such as parents and other family members, friends, carers and education and health professionals. 2. National Experience of Care Week This is a national campaign to celebrate the work that’s happening to improve the experiences of care for our patients, families/carers and staff. This will put experience of care in the spotlight and give people the opportunity to share and celebrate work going on locally to better improve their experiences of health and care services. 3. Health visitor’s film

A short film aiming to support Roma women to breastfeed has been premiered at the Turner Contemporary in Margate.

Chi

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Page 27 of 177

The film was made by one of our health visitor's, Philippa Burden. The project is the result of a year’s work combining her role with us and a Darzi Fellowship post graduate course she has been doing with the Centre for Health Services Studies at the University of Kent. On the course Philippa has been working on a Becoming Breastfeeding Friendly project linked with Yale University in America, together with Professor Sally Kendall. The film is called Roma Women Talk About Breastfeeding and was co-produced with Slovakian Roma mothers living in Margate, Dover and Folkestone. It aims to encourage breastfeeding in the Roma and other migrant communities, where rates are low. It is also to help support women to breastfeed and to educate about the benefits.

Our People

1. CQC Well Led Inspection

The second phase of the inspection conducted by the Care Quality Commission took place in early May, the inspection team including specialist advisors and inspectors from the Commission itself undertook a series of interviews with team members in leadership roles. The lead inspectors met with the Chair and I briefly at the end of the series of interviews and observed how open the Trust was and how patient focussed the Trust was, and wished to thank those who they had met. The inspection process now enters a phase when all the inspection evidence is reviewed by the Commission and then we will have contact from the commission later in the summer. I want to thank all those interviewed by the Commission for the professional and compassionate manner in which they conducted themselves during the process. 2. Launch of the Staff Awards

This years staff awards were launched in March, every year we recognise the efforts of individuals and teams that go above and beyond in their everyday role. The event will take place on 21 June 2019 at the Kent Event Centre, Detling.

3. Celebrating International Nurse’s Day and People’s Day

Sunday, 12 May was International Nurses’ Day, which marked the anniversary of Florence Nightingale’s birth. However, in recognition of the contribution of all our colleagues, we also marked the following day with our own People’s Day – celebrating all that is good about each other and the work we do. Various events across the Trust were arranged including some mad hatters tea parties across east Kent.

Page 28 of 177

Partnerships

1. TICC Masterclass

Board members, Directors, Assistant Directors and Commissioners for both Health and Social care were invited to meet with Jos de Blok, the founder and CEO of Buurtzorg, on 23rd April 2019. The purpose of the event was for Jos to share his views, lessons learnt and how he and his team revolutionised community care in the Netherlands also to discuss the business case behind the model, and what it takes from an organisation and its leadership to adopt it successfully. 2. New architecture of the NHS in Kent and Medway Since the last time we met work has been continuing on the response of the health and social care system to the long term plan for the NHS. In Kent and Medway this has included work on the development of the Integrated Care System, the four Integrated Care Partnerships and the emergent Primary Care Partnerships. The work has continued to align the new architecture to ensure the benefits to patients and the people we serve, not just ensuring that the governance is right. The Trust is heavily involved in all the conversations and will continue to be so.

Paul Bentley Chief Executive May 2019

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Page 29 of 177



Agenda Number: 2.2

Agenda Item Title: Board Assurance Framework

Presenting Officer: Natalie Davies, Corporate Services Director

Action - this paper is for: Decision ☐ Information ☐ Assurance ☒

Report Summary

The function of the Board Assurance Framework (BAF) is to inform and elicit discussion about the significant risks which threaten the achievement of the Trust’s strategic objectives.

To provide assurance that these risks are being effectively managed, the BAF details the controls in place to mitigate each risk, any gap in control, assurance of the controls’ effectiveness, the actions planned and being executed together with the date by when the actions are due to be completed.

The full BAF as at 16 May 2019 is shown in Appendix 1.


The Board is asked to note this report.



No ☒


Barry Norton, Head of Risk Management Tel: 01233667744


Boa

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ssur

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Fra

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Page 30 of 177

BOARD ASSURANCE FRAMEWORK

1. Introduction

1.1 The Board Assurance Framework (BAF) is comprised of strategic risks

identified against the strategic goals defined within the Integrated Business Plan (IBP) in addition to risks identified against the achievement of business and operational objectives with a high gross (inherent) risk rating.

1.2 The BAF is therefore comprised of high risks. Refer to section 7 below for a definition of high risk.

1.3 Risks may be identified by Services or Directorates and escalated

upwards to the Executive Team, or may be identified at the Board or any of its sub Committees.

1.4 The Executive Team review newly identified high risks to ensure that those

with significant potential to impact on the achievement of strategic goals are recorded on the BAF and reported to the Board. This allows the Board to monitor mitigating actions. As actions are implemented, controls improve and this can enable the exposure to risk to reduce.

1.5 The full BAF as at 10 May 2019 is shown in Appendix 1. This version has

not previously been presented. 2. New risks

2.1 Since the BAF was last presented to the Board there has been one new risk identified against the strategic objectives. BAF ID104 ‘Inability to meet CIP targets as detailed in 19/20 plans as growing reliance on economy level transformation for savings’.

3. Risks that have been closed since the last report

3.1 Since the BAF was last presented to the Board one risk has been closed:

BAF ID 100 - Risk that the organisation’s ‘services may suffer significant challenges as result of the impact of winter pressures’. This risk has been removed as all actions have been completed and the 2018/19 winter period has passed.

4. Risks that have been de-escalated since the last report

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Page 31 of 177

2

4.1 Since the BAF was last presented to the Board one risk has been de-

escalated: BAF ID 101 – ‘Uncertainty around Brexit may affect our ability to deliver core objectives’. Due to the current political situation relating to Brexit the risk has been decreased. The risk is now scored as 3x3 and therefore de-escalated to appropriate directorate risk register. It is recommended that this risk is reviewed again by the Exec Team in the autumn

5. Risks previously de-escalated to Directorate risk registers that have

closed 5.1 There are no risks that have been de-escalated to Directorate risk

registers that have now closed.

5.2 The total number of risks documented on the BAF is four. Figure 1 (below) provides a visual representation of the organisational risk profile based on the current risk rating within section 1 of the BAF.

5.3 Figure 1: Organisational High Risk Profile

6. High risk definition 6.1 A high risk is defined as any risk with an overall risk rating of 15 or above,

as well as those risks rated as 12 with a consequence score of 4. The risk matrix below provides a visual representation of this.

6.2 Figure 2: Trust risk matrix

← Consequence / Severity →

Page 32 of 177

3

Insignificant Minor Moderate Major Catastrophic

↓Likelihood ↓ 1 2 3 4 5

Rare 1 1 2 3 4 5

Unlikely 2 2 4 6 8 10

Possible 3 3 6 9 12 15

Likely 4 4 8 12 16 20

Almost Certain 5 5 10 15 20 25

The scores obtained from the risk matrix are assigned grades as follows:

1 – 6 Low risk

8 – 12 Medium Risk

12 – 25 High Risk

7. Risk Overview 7.1 The total number of open risks within the Trust stands at 310 this is

comprised of 147 low risks, 150 medium risks and 13 high risks. Figure 3 (below) provides a visual representation. Low risks are initially reviewed by Heads of Service with further reviews by the responsible officer at least bi monthly. Medium risks would initially be reviewed by Heads of Service and then onward to the Community Service Director/Assistant Director for approval, these would normally be reviewed on a monthly basis. All risks are extracted by the Risk Team on a weekly basis and the officer responsible for those risks that have passed their review date or target completion date are contacted by the team to prompt a review.

7.2 Figure 3: Organisational Risk Overview.

7.3 Figure 4: Open Risks by Type and Risk Level

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Page 33 of 177

4

8. Recommendation

8.1 The Board is asked to consider the Board Assurance Framework in Appendix 1 and determine whether sufficient mitigating actions are in place to address these.

Barry Norton Head of Risk 10 May 2019

Page 34 of 177

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k D

escri

pti

on

(Sim

ple

Exp

lan

ati

on

of

the R

isk)

De

ve

lop

Su

sta

ina

ble

Se

rvic

es

(S

tra

teg

ic O

bje

cti

ve

En

ab

lers

)

Jan 2019

312H

Govern

ance s

tructu

re &

pro

ject

pla

n in p

lace

Eng

ag

em

ent

with t

he p

roje

ct

team

deliv

ering

the K

ent

Care

Record

Pro

ject

Leaders

hip

team

job d

escriptions

Phase im

ple

menta

tion p

lan a

nd r

esourc

ing

appro

priate

ly

Com

munic

ation p

lans d

evelo

ped w

ith s

takehold

ers

inc.

com

mis

sio

ners

.

Opera

tional risk a

nd m

itig

ations log

99

Up

date

d 1

6 M

ay

2019

De

fin

itio

ns:

Initia

l R

ating

= T

he r

isk r

ating

at

the t

ime o

f id

entification

Curr

ent

Rating

= R

isk r

em

ain

ing

with c

urr

ent

contr

ols

in p

lace.

This

is

revie

wed m

onth

ly a

nd s

hould

decre

ase a

s a

ctions

take e

ffect.

Targ

et

Date

= M

onth

end b

y w

hic

h a

ll actions s

hould

be c

om

ple

ted

Init

ial ra

tin

gC

urr

en

t ra

tin

g

Ap

pen

dix

1

Ris

ks w

ith a

hig

h n

et risk r

ating w

hic

h h

ave n

ot been tole

rate

d.

Acti

on

sta

tus k

ey:

Actions c

om

ple

ted

On tra

ck b

ut not ye

t deliv

ere

d

Orig

inal ta

rget date

is u

nachie

vable

Pla

nn

ed

Acti

on

s a

nd

Milesto

nes

Bo

ard

Assu

ran

ce F

ram

ew

ork

Secti

on

1

Reg

ula

r B

oard

report

s lin

ked t

o o

ther

pro

jects

Pro

ject

Gro

up r

eport

to E

xec

Team

and

Board

Tim

escale

s t

o im

ple

ment

new

syste

m

Com

pre

hensiv

e p

rog

ram

me p

lan f

or

repla

cem

ent

syste

m t

o b

e d

evelo

ped in

response t

o e

merg

ing

tim

escale

s

Nov 2019

43

High

Inte

gra

te S

erv

ice

s

High

Mar 2021

Paul Bentley

103

Imple

menting

a c

linic

al syste

m inclu

din

g d

ouble

runnin

g w

ith

the e

xis

ting

syste

m a

nd a

t th

e s

am

e t

ime a

s t

he

Kent

Care

Record

is b

ein

g im

ple

mente

d m

ay n

eg

atively

im

pact

on

pro

duction o

f tim

ely

info

rmation a

nd s

erv

ice d

eliv

ery

.

4

43

12H

104

Apr 2019

Lesley Strong

Inabili

ty t

o m

eet

CIP

targ

ets

as d

eta

iled in 1

9/2

0 p

lans a

s

gro

win

g r

elia

nce o

n e

conom

y level tr

ansfo

rmation f

or

savin

gs.

4F

inance B

usin

ess a

nd I

nvestm

ent

ToR

s a

nd a

gendas.

PM

O d

ocum

ente

d p

rocess &

peer

revie

w

Syste

m level B

oard

s -

futu

re t

ransfo

rmation

Executive led b

usin

ess p

lannin

g a

nd r

evie

ws

Whole

syste

m s

trate

gy/S

TP

pro

cess a

nd g

roups

Perf

orm

ance

Revie

ws f

or

all

serv

ices

Reg

ula

r re

port

ing

PM

O g

ate

way r

evie

ws o

f pla

ns

ST

P im

ple

menta

tion p

lans

FB

I re

port

s t

o B

oard

ST

P P

roductivity P

lan A

ctive

Hig

h r

isk s

chem

es d

ependent

on w

hole

syste

m c

hang

es

Mar 2020

43

12H

Lesley Strong

Medium

Boa

rd A

ssur

ance

Fra

mew

ork

Page 35 of 177

ID

Opened

Board Level Risk

OwnerC

L

Rating

Co

ntr

ols

Descri

pti

on

Po

sit

ive A

ssu

ran

ces

Gap

s in

co

ntr

ol o

r N

eg

ati

ve A

ssu

ran

ce

CL

Rating

Action owner

Confidence

Assessment

Target Date (end)

Ris

k D

escri

pti

on

(Sim

ple

Exp

lan

ati

on

of

the R

isk)

Init

ial ra

tin

gC

urr

en

t ra

tin

g

Pla

nn

ed

Acti

on

s a

nd

Milesto

nes

Ind

ivid

ual

Acti

on

sO

wn

er

Targ

et

Co

mp

leti

on

(end)

Sta

tus

Scopin

g e

xte

nsio

n t

o c

linic

al academ

yLouis

e N

orr

isS

ep 2

019

A

Inte

rnational re

cru

its a

rriv

eLouis

e N

orr

isJun 2

019

A

Deliv

er

the B

ig L

iste

n a

ction p

lan

Paul B

entley

Mar

2020

A

Deliv

er

QI

str

ate

gy a

ction p

lan

Sara

h P

hill

ips

Mar

2020

AD

eliv

er

well

bein

g a

ction p

lan

Louis

e N

orr

isM

ay 2

019

A

Develo

p,

com

mis

sio

n a

nd im

ple

ment

a B

oard

Develo

pm

ent

pro

gra

mm

e

Louis

e N

orr

isN

ov 2

019

A

12H

De

live

r H

igh

Qu

ali

ty C

are

at

Ho

me

an

d i

n t

he

Co

mm

un

ity

102

Jan 2019

Louise Norris

Inabili

ty t

o r

ecru

it a

nd r

eta

in s

taff

could

have a

detr

imenta

l

impact

on m

ain

tain

ing

qualit

y o

f care

and m

ora

le

4

Louise Norris

43

12H

vacancie

s 9

.69%

, tu

rnover

18.1

4%

Medium

Mar 2020

Str

ate

gic

Work

forc

e C

om

mitte

e T

oR

s,

Serv

ice q

ualit

y v

isits

Directo

r of

Work

forc

e J

D;

Work

forc

e S

trate

gy A

gre

ed

Opera

tional w

ork

forc

e r

eport

s

Com

pla

ints

syste

m e

sta

blis

hed a

gain

st

ag

reed p

olic

y

Friends a

nd F

am

ily T

est

Tale

nt

Manag

em

ent

Str

ate

gy

Tim

e t

o C

hang

e C

ham

pio

ns s

yste

m e

sta

blis

hed

Serv

ice v

isit r

eport

ed t

o q

ualit

y c

om

mitte

e,

Work

forc

e r

eport

to b

oard

, IP

R K

PIs

report

ed a

nd r

evie

wed b

y B

oard

, S

afe

r

Sta

ffin

g r

eport

s,

work

forc

e p

lans,

Tim

e t

o

hire b

enchm

ark

s p

ositiv

ely

, bank f

ill r

ate

s

impro

vin

g,

ag

ency u

sag

e r

eport

.

Work

forc

e r

eport

to S

WC

3

Page 36 of 177



Agenda Number: 2.3

Agenda Item Title: Quality Committee Chair’s Assurance Report

Presenting Officer: Pippa Barber, Chair of Quality Committee


Report Summary

The paper summarises the Quality Committee meetings held on 16 April and 14 May 2019.


The Board is asked to receive the Quality Committee Chair’s Assurance Report.



No ☒


Pippa Barber, Non-Executive Director Tel: 01622 211906

Email:

Qua

lity

Com

mitt

ee C

hair’

sA

ssur

ance

Rep

ort

Page 37 of 177

QU

AL

ITY

CO

MM

ITT

EE

CH

AIR

’S A

SS

UR

AN

CE

RE

PO

RT

Th

is r

ep

ort

is fo

un

ded

on

th

e Q

ua

lity C

om

mitte

e m

eetin

g h

eld

on d

ate

16 A

pril 2

01

9.

Ag

en

da i

tem

A

ss

ura

nc

e a

nd

Key p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Ad

ult L

ea

rnin

g D

isab

ility

Se

rvic

e M

ort

alit

y

Revie

ws

The

Com

mitte

e r

ece

ive

d a

pre

sen

tatio

n f

rom

th

e L

ea

rnin

g

Dis

ab

ility

(L

D)

Se

rvic

e lea

d o

n th

e p

roce

ss b

ein

g

un

de

rta

ken

in

th

e L

D s

erv

ice f

or

revie

win

g d

ea

ths.

Assu

ran

ce

wa

s r

ece

ived

th

at th

e p

roce

ss w

as lin

kin

g w

ell

with

th

e T

rust’s M

ort

alit

y S

tee

rin

g G

rou

p a

nd

exte

rna

lly

with

oth

er

pa

rtn

ers

.

The

se

rvic

e a

gre

ed

to

co

ntinu

e to

ra

ise

aw

are

ne

ss o

f w

ha

t th

e L

D s

erv

ice c

ou

ld

pro

vid

e w

ith

co

mm

un

ity n

urs

ing t

ea

ms.

Pa

tie

nt

Safe

ty A

nd

Clin

ica

l R

isk G

rou

p

Assu

ran

ce

wa

s r

ece

ived

rega

rdin

g t

he

De

nta

l S

erv

ice r

isk

rela

tin

g t

o th

e q

ua

lity o

f co

ntr

act

de

live

ry b

y I

HS

S,

the

lo

ca

l

ste

rile

se

rvic

es p

rovid

er,

It

wa

s c

onfirm

ed

th

at th

e r

isk

rela

ted

to

th

e d

eliv

ery

of

instr

um

en

ts a

nd

no

t th

e q

ua

lity o

f

ca

re o

f th

e d

eco

nta

min

atio

n. P

rofe

sso

r D

rob

nie

wski

en

do

rsed

th

is a

s h

e h

ad

re

ce

ive

d s

imila

r re

port

s a

bou

t

IHS

S’s

co

ntr

act

de

live

ry.

Assu

ran

ce

wa

s r

eceiv

ed

on

the

mitig

atio

n o

f th

e r

isk

Qua

lity

Com

mitt

ee C

hair’

sA

ssur

ance

Rep

ort

Page 38 of 177

Ag

en

da i

tem

A

ss

ura

nc

e a

nd

Key p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Qu

alit

y R

ep

ort

T

he

Com

mitte

e n

ote

d th

e c

on

tin

ue

d g

oo

d p

rogre

ss w

ith

the

red

uction

s o

n p

ressu

re u

lcers

, A

vo

ida

ble

me

dic

atio

n

incid

en

ts c

on

tin

ue

d to

red

uce

as d

id low

ha

rm m

ed

ica

tio

n

incid

en

ts.

Me

dic

al D

evic

es r

ep

ort

T

he

re

po

rt p

rovid

ed

the

Co

mm

itte

e w

ith

assura

nce

th

at

the

re w

as n

ow

an

eff

ective

pro

ce

ss f

or

EM

E m

ain

tena

nce

in p

lace f

or

me

dic

al d

evic

es w

ith

th

e K

ey P

erf

orm

an

ce

Ind

icato

r (K

PI)

of

98

% b

ein

g m

et

con

sis

ten

tly.

Assu

ran

ce

wa

s r

ece

ive

d o

n h

ow

th

is w

ou

ld b

e m

ain

tain

ed

and

mo

nito

red g

oin

g f

orw

ard

.

Qu

art

erly r

ep

ort

s w

ill b

e p

rovid

ed

to

th

e

Pa

tie

nt

Safe

ty a

nd

Clin

ical R

isk G

rou

p a

nd

exce

ptio

n r

ep

ort

s w

ill b

e in

clu

de

d in t

he

Ch

air’s

re

po

rt to

the

Qu

alit

y C

om

mitte

e.

Clin

ica

l E

ffe

ctive

ne

ss

Re

po

rt

The

pro

gra

mm

e o

f w

ork

fo

r e

nh

an

cin

g p

erf

orm

an

ce

on

pe

rsona

lise

d p

lan

s o

f ca

re w

as d

escrib

ed t

o th

e

Co

mm

itte

e. T

he

pro

gra

mm

e w

ou

ld b

e d

eliv

ere

d v

ia p

roje

ct

gro

up

s a

nd

re

po

rte

d m

on

thly

to

th

e c

linic

al eff

ective

ne

ss

gro

up

and

qu

art

erly t

o th

e Q

ua

lity C

om

mitte

e.

Pro

gre

ss h

ad

bee

n m

ad

e w

ith

th

e r

evie

w o

f N

ICE

co

mp

lian

ce

; o

uts

tan

din

g r

evie

ws 3

7 (

pre

vio

usly

88

).

The

Q4 C

QU

IN ta

rge

t of

80

% o

f w

ou

nd

s th

at h

ad

no

t

he

ale

d w

ith

in f

ou

r w

eeks r

ece

ivin

g a

fu

ll w

oun

d

asse

ssm

en

t h

as b

ee

n s

urp

assed

with

95

% in W

est K

en

t

an

d 9

1%

in

Ea

st

Ke

nt.

The

Qua

lity C

om

mitte

e w

ill r

ece

ive

up

da

tes

via

th

e Q

ua

lity P

rio

ritie

s R

ep

ort

.

Page 39 of 177

Ag

en

da i

tem

A

ss

ura

nc

e a

nd

Key p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

En

d O

f L

ife

Care

(EO

LC

) S

tee

rin

g G

roup

Work

Pla

n

Go

od p

rogre

ss w

as b

ein

g m

ade

on

all

are

as o

f th

e a

ctio

n

pla

n w

ith

EO

LC

ca

re p

lan

s n

ow

re

ach

ing t

he 6

0%

ta

rge

t.

The

20

19/2

0 a

nn

ua

l p

lan

will

in

clu

de

the

follo

win

g a

rea

s:

pla

ns o

f ca

re, le

arn

ing f

rom

pa

tien

t e

xp

erie

nce

inclu

din

g le

arn

ing f

rom

tho

se a

cce

ssin

g th

e s

erv

ice

ove

rnig

ht.

Le

arn

ing F

rom

Mo

rta

lity

Revie

ws

The

Com

mitte

e r

ece

ive

d th

e r

ep

ort

co

ve

rin

g t

he

pe

rio

d

Ja

nua

ry t

o M

arc

h 2

01

9 a

nd n

ote

d t

he le

arn

ing f

rom

th

e

revie

ws a

nd

the

the

mes a

nd s

ub

se

qu

en

t a

ctio

ns in

pla

ce

.

Qu

alit

y I

mp

rove

me

nt

(QI)

Upd

ate

Re

po

rt

Dr

Sa

rah

Ph

illip

s p

resen

ted t

he

re

po

rt t

o t

he

Com

mitte

e f

or

assu

ran

ce

. A

nd

with

go

od

assu

ran

ce

re

ce

ive

d o

n

pro

gre

ss.

Confirm

atio

n w

as r

ece

ive

d t

ha

t ta

rge

ts h

ad

bee

n s

et fo

r th

e n

um

be

r of

pe

op

le w

ho

we

re d

oin

g t

he

QI tr

ain

ing.

Liv

e

QI

wa

s b

ein

g u

sed

to g

ive

ove

rsig

ht

of

all

the

pro

jects

th

at

we

re r

un

nin

g.

Ou

tcom

es m

ea

su

res w

ere

in

pla

ce

with

tw

o

me

asu

res s

et

aga

inst e

ach

drive

r a

nd

the

ou

tco

me

be

nefits

we

re m

ea

su

red

th

rou

gh

the

sta

ff s

urv

ey.

Fu

ture

rep

ort

s w

ill inclu

de

info

rma

tion

on

wh

ere

QI

pro

jects

are

be

ing u

nd

ert

ake

n s

o

the

bre

adth

of

the

sp

rea

d o

f th

e p

roje

ct

are

as c

an

be

see

n.

Clin

ica

l G

uid

an

ce

Fo

r

Pu

blic

He

alth

; H

ea

lth

Vis

itin

g S

erv

ice

Weig

hin

g M

ea

su

rin

g

An

d W

eig

ht

Ma

na

ge

me

nt O

f

Child

ren

Age

0 t

o 5

Ye

ars

The

po

licy w

as r

evie

wed

an

d a

gre

ed

.

Qua

lity

Com

mitt

ee C

hair’

sA

ssur

ance

Rep

ort

Page 40 of 177

Ag

en

da i

tem

A

ss

ura

nc

e a

nd

Key p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Qu

alit

y I

mpa

ct

Asse

ssm

en

ts o

f th

e

Co

st

Imp

rove

men

t

Pla

ns

The

Ea

st

Ke

nt

sch

em

es w

ere

scru

tin

ised

by th

e

Co

mm

itte

e w

ith

assu

ran

ce

pro

vid

ed o

n h

igh

ris

k a

rea

s.

Esta

tes s

ch

em

es w

ill b

e s

ubm

itte

d to

th

e

Co

mm

itte

e a

s th

ey a

re d

eve

lop

ed

.

Inte

gra

ted

Pe

rfo

rma

nce

Rep

ort

Op

era

tion

al

Dee

p D

ive

The

Ch

ief

Ope

ratin

g O

ffic

er

pre

sen

ted

a r

ep

ort

co

ve

rin

g

Hea

lth

Vis

ito

r a

nte

na

tal vis

its.

Assu

ran

ce

wa

s g

ive

n o

n th

e

actio

ns in

pla

ce

to in

cre

ase

pe

rfo

rman

ce

aga

inst

this

targ

et.

Action

s in

clu

de

d im

pro

ve

d c

om

mu

nic

atio

ns w

ith

mid

wife

ry p

rovid

ers

, d

ata

flo

w im

pro

ve

me

nts

, a

nd

ris

k

asse

ssm

en

t of

fam

ilies.

Th

e r

eco

mm

en

da

tio

ns in

the

rep

ort

we

re a

gre

ed

and

su

pp

ort

ed

.

Rap

id T

ran

sfe

r of

Care

Se

rvic

e:

The

Qu

alit

y I

mp

act

Asse

ssm

en

t fo

r th

e s

erv

ice w

as c

on

sid

ere

d b

y t

he

Co

mm

itte

e.

Pro

gre

ss w

ill b

e m

on

ito

red

th

rou

gh

th

e

Inte

gra

ted

Pe

rfo

rma

nce

Re

po

rt w

ith

fu

rth

er

up

da

tes to

th

e C

om

mitte

e in t

he

sum

me

r.

A f

urt

he

r u

pd

ate

will

be

ad

de

d to

th

e

Com

mitte

e’s

fo

rwa

rd p

lan

.

Pip

pa

Ba

rber

Ch

air

of

Qu

ali

ty C

om

mit

tee

10

Ma

y 2

01

9

Page 41 of 177

QU

AL

ITY

CO

MM

ITT

EE

CH

AIR

’S A

SS

UR

AN

CE

RE

PO

RT

Th

is r

ep

ort

is fo

un

ded

on

th

e Q

ua

lity C

om

mitte

e m

eetin

g h

eld

on 1

4 M

ay 2

01

9

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Bo

ard

Assu

ran

ce

s

Fra

me

wo

rk (

BA

F)

The

BA

F w

as p

rese

nte

d a

nd

re

vie

we

d w

ith

dis

cu

ssio

n o

n

clin

ica

l risks a

nd

sco

rin

g.

Su

gge

stio

ns w

ere

co

nsid

ere

d t

o

risk 1

02

. It w

as f

elt it

larg

ely

en

ab

led

qu

alit

y im

pa

ct

to b

e

reco

gn

ise

d a

nd

man

age

d.

Ho

we

ve

r, it

co

uld

be

str

en

gth

ene

d b

y a

dd

ing

th

e ‘Q

ua

lity R

ep

ort

’ to

the

co

ntr

ols

de

scrip

tio

n.

Wid

er

pe

rfo

rma

nce

are

as w

ill b

e c

on

sid

ere

d

by t

he

Ch

ief

Ope

ratin

g O

ffic

er

an

d

Exe

cu

tive

Te

am

. T

his

wo

uld

be

esca

late

d

thro

ugh

exis

tin

g g

ove

rna

nce

syste

ms if

ne

ed

ed

.

Mo

nth

ly Q

ua

lity R

ep

ort

T

he

Com

mitte

e r

ece

ive

d th

e u

pda

ted

re

po

rt in

a n

ew

form

at

pu

ttin

g m

ore

em

pha

sis

on

com

mu

nity a

s w

ell

as in

pa

tien

t a

rea

s. T

he

repo

rt w

as w

ell

rece

ive

d.

It w

as f

elt

ve

ry h

elp

ful to

ha

ve

the

assu

ran

ce

se

t o

ut

cle

arly f

or

ea

ch

are

a.

The

ne

w n

atio

na

l d

efinitio

ns o

f re

co

rdin

g p

ressu

re

incid

en

ts w

ere

exp

lain

ed

. A

ssu

ran

ce

wa

s g

ive

n o

n

su

ppo

rt t

o W

est

Vie

w In

tegra

ted C

are

Cen

tre

an

d

Ed

enb

rid

ge

and

Dis

tric

t W

ar

Mem

oria

l H

osp

ita

l.

To a

dd

ba

ck in

to t

he

rep

ort

the

ne

ed

fo

r

ha

rms o

n s

hifts

wh

en

on

e R

N w

as d

ow

n.

Qu

alit

y R

ep

ort

20

18

/19

T

he

ye

ar-

en

d p

ositio

n o

f th

e 2

018

/19 Q

ua

lity R

ep

ort

wa

s

pre

se

nte

d to

th

e C

om

mitte

e. T

he

re

po

rt h

as b

een

Qua

lity

Com

mitt

ee C

hair’

sA

ssur

ance

Rep

ort

Page 42 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

co

nsid

ere

d b

y t

he

au

dito

rs.

Assu

ran

ce

wa

s s

ou

gh

t on

th

e

follo

win

g a

rea

s:

En

d O

f L

ife

Ca

re a

ch

ieve

me

nt o

f pe

rso

na

lised

ca

re

pla

nn

ing q

ua

rte

r 4

ach

ieve

me

nt, c

om

mu

nity m

ort

alit

y

revie

ws,

Ca

re Q

ua

lity C

om

mis

sio

n r

equ

ire

me

nt n

otice

follo

win

g H

MP

(H

er

Ma

jesty

’s P

riso

n S

erv

ice

) in

sp

ection

,

pa

tien

ts a

nd

fam

ilie

s s

urv

eye

d o

n th

e r

oo

t cau

se

an

aly

sis

(RC

A)

pro

ce

ss.

Fo

rmat

of

the

Qu

alit

y C

om

mitte

e.

It w

as r

eco

gn

ise

d a

nd

ackn

ow

led

ge

d t

ha

t th

e r

ep

ort

co

nta

ine

d a

hu

ge

am

ou

nt of

exce

llen

t w

ork

th

at

ha

d

de

mo

nstr

ate

d im

pro

ve

d o

utc

om

es a

nd e

xp

erie

nce

s fo

r

pa

tien

ts u

sin

g t

he

Tru

st’s s

erv

ice

s.

The

Com

mitte

e r

ecom

me

nd

ed

ap

pro

va

l b

y t

he

Boa

rd

su

bje

ct to

co

mm

en

ts m

ade

at

the

Com

mitte

e.

Safe

med

Vis

its:

Om

itte

d

An

d D

ela

ye

d D

ose

Re

po

rt

Th

is r

ep

ort

re

qu

este

d b

y t

he

Com

mitte

e r

evie

we

d t

hem

es

an

d tre

nd

s id

en

tifie

d f

rom

mis

sed

, de

laye

d a

nd

om

itte

d

do

se

in

cid

ents

be

twe

en

Sep

tem

be

r 2

01

8 a

nd F

eb

rua

ry

20

19

. A

Qu

alit

y I

mp

rove

men

t (Q

I) a

pp

roa

ch

wa

s b

ein

g

take

n w

ith

te

am

s,

intr

od

ucin

g a

‘m

ed s

avvy’ Q

I a

pp

roa

ch

.

Assu

ran

ce

wa

s r

ece

ive

d f

rom

th

e T

rust’s L

ea

d P

ha

rma

cis

t

tha

t im

me

dia

te a

ctio

ns h

ad b

ee

n p

ut

in p

lace

to

sup

po

rt

team

s a

s n

ee

ded

. T

hese

in

clu

de

d th

e p

ee

r re

vie

w

pro

ce

ss fo

r ch

eckin

g fo

rms,

imp

rove

d e

du

ca

tio

n o

n c

ritica

l

Alth

ou

gh

it w

as a

ckn

ow

led

ge

d t

ha

t th

e

nu

mb

er

of

incid

en

ts a

ga

inst

con

tacts

wa

s

low

, it w

as a

gre

ed

tha

t b

en

ch

ma

rkin

g d

ata

wh

ere

ava

ilab

le w

ill b

e s

ou

gh

t a

nd a

dd

ed t

o

the

In

tegra

ted

Pe

rfo

rma

nce

Re

po

rt.

A s

ix m

on

th f

ollo

w u

p r

ep

ort

will

co

me

ba

ck

to t

he

Com

mitte

e t

o t

rack p

rogre

ss.

Page 43 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

m

ed

icin

es a

nd

pro

fessio

na

l o

ve

rsig

ht

an

d s

upp

ort

.

The

‘m

ed

sa

vvy’ fo

rum

s w

ere

in

pla

ce

in e

ast a

nd

we

st

Ke

nt

with

the

aim

of

red

ucin

g o

mitte

d d

ose

s a

nd

imp

rovin

g m

ed

icin

e r

ou

nd

s.

It w

as r

ep

ort

ed

th

at

sta

ff w

ere

en

thu

sia

stica

lly w

ork

ing o

n t

he

le

arn

ing a

nd

imp

rove

men

ts.

Po

licie

s f

or

Ra

tifica

tio

n

The

Syrin

ge

Dri

ve

r P

olic

y w

as r

atifie

d b

y t

he

Co

mm

itte

e.

The

Ca

the

ter

Ma

na

gem

ent

Po

licy f

or

an

Adult P

atien

t w

as

ratified

by t

he

Com

mitte

e.

Le

ga

l R

ep

ort

T

his

rep

ort

co

ve

red

the

pe

riod

Jan

ua

ry t

o M

arc

h 2

019

. A

furt

he

r u

pda

te w

ou

ld b

e p

rovid

ed

by t

he

Me

dic

al D

ire

cto

r

at

the

ne

xt

mee

tin

g

wh

ere

fu

rth

er

info

rma

tion

wa

s b

ein

g

so

ugh

t.

Assu

ran

ce

wa

s s

ou

gh

t o

n p

ath

wa

ys o

f ca

re w

ith

de

terio

ratin

g p

atien

ts a

nd

assu

ran

ce

wa

s r

ece

ive

d t

ha

t

this

wa

s a

Qua

lity P

rio

rity

fo

r th

e c

om

ing y

ea

r.

Th

is w

ou

ld

inclu

de

exa

min

ing if

anyth

ing f

urt

he

r co

uld

be d

one

to

ad

dre

ss th

e a

rea o

f p

ressu

re u

lce

rs le

ad

ing o

n to

sep

sis

.

The

Qua

lity T

ea

m a

gre

ed

to

lo

ok a

t h

ow

lea

rnin

g is b

ein

g c

ap

ture

d a

nd

fe

d into

th

e

Pa

tie

nt

Safe

ty A

nd

Clin

ica

l R

isk G

rou

p.

20

18

/19 P

atie

nt

Exp

erie

nce

an

d

Co

mp

lain

ts A

nn

ua

l

Re

po

rt

Ke

y t

hem

es a

nd t

rends w

ere

id

en

tifie

d w

ith

le

arn

ing

cle

arly s

et

ou

t. T

he

num

be

r of

co

mp

lain

ts c

on

tin

ue

d to

red

uce

and

the

lin

k w

ith

QI u

se

d t

o im

pro

ve

pe

rfo

rman

ce

.

It w

as a

ckn

ow

led

ge

d th

at

lo

ts o

f e

xce

llen

t w

ork

wa

s

ca

ptu

red

in

th

e r

ep

ort

with

go

od

exa

mp

les o

f ch

an

ge

s

Qua

lity

Com

mitt

ee C

hair’

sA

ssur

ance

Rep

ort

Page 44 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

ma

de

wh

en

lea

rnin

g h

ad

be

en id

en

tifie

d .

It w

as p

lea

sin

g

to n

ote

th

e r

ed

uctio

n in P

AL

S e

nqu

ire

s fo

llow

ing t

he

imp

rove

men

ts m

ad

e b

y s

erv

ice

s.

The

Com

mitte

e r

ecom

me

nd

ap

pro

va

l of

the A

nn

ua

l

Re

po

rt a

t th

e B

oa

rd.

Clin

ica

l E

ffe

ctive

ne

ss

Gro

up

An

up

date

on

pro

gre

ss w

ith

th

e T

rust’s Q

ua

lity S

tra

tegy

wa

s d

iscu

sse

d a

nd

goo

d p

rogre

ss in

all

are

as w

as n

ote

d.

Ca

re Q

ua

lity

Co

mm

issio

n (

CQ

C)

Up

da

te

A v

erb

al u

pda

te w

as g

ive

n o

n p

ossib

le t

ime s

ca

les f

or

fee

db

ack f

rom

th

e r

ecen

t in

spe

ctio

n.

Ve

rba

l up

da

tes w

ere

giv

en

on

mo

re r

ece

nt

rep

ort

s fo

r o

the

r p

rovid

ers

wh

ere

KC

HF

T s

erv

ice

s w

ere

als

o p

rese

nt.

CQ

C r

ep

ort

s r

ece

ive

d b

y o

the

r p

rovid

ers

wh

ere

Tru

st

se

rvic

es a

re p

resen

t w

ill b

e

rep

ort

ed

to Q

ua

lity C

om

mitte

e.

Re

spo

nse

s

will

be

ris

k a

sse

ssed

an

d lea

rnin

g id

en

tifie

d

an

d a

ssu

ran

ce

pro

vid

ed

as r

equ

ire

d.

Te

rms o

f R

efe

ren

ce o

f

the

Qu

alit

y C

om

mitte

e

The

se

we

re c

on

sid

ere

d b

y t

he

Co

mm

itte

e a

nd

som

e

ch

an

ge

s a

gre

ed

. W

ith

th

ese c

han

ge

s t

he

y w

ere

reco

mm

en

ded

to

the

Bo

ard

.

Pip

pa

Ba

rber

Qu

ali

ty C

om

mit

tee

14

Ma

y 2

01

9

Page 45 of 177



Agenda Number: 2.4

Agenda Item Title: Strategic Workforce Committee Chair’s Assurance Report

Presenting Officer: Bridget Skelton, Chair of Strategic Workforce Committee


Report Summary

The paper summarises the Strategic Workforce Committee meetings held on 20 March and 15 May 2019.


The Board is asked to receive the Strategic Workforce Committee Chair’s Assurance Report.



No ☒


Bridget Skelton, Non-Executive Director Tel: 01622 211906

Email:

Str

ateg

ic W

orkf

orce

Com

mitt

ee C

hair’

s R

epor

t

Page 46 of 177

ST

RA

TE

GIC

WO

RK

FO

RC

E C

OM

MIT

TE

E C

HA

IR’S

AS

SU

RA

NC

E R

EP

OR

T

Th

is r

ep

ort

is fo

un

ded

on

th

e S

tra

tegic

Wo

rkfo

rce

Com

mitte

e m

ee

tin

g h

eld

on

20

Ma

rch

20

19

. A

ge

nd

a i

tem

A

ss

ura

nc

e a

nd

Ke

y p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Work

forc

e R

ep

ort

T

his

mon

th 1

5/1

8 k

ey m

etr

ics a

re s

tab

le o

r be

tte

r, th

is is a

ve

ry p

ositiv

e p

ositio

n a

nd

th

e m

om

en

tum

ap

pe

ars

to

be

go

ing in

th

e r

igh

t d

ire

ctio

n,

als

o e

vid

en

ced

by th

e

imp

rove

d s

taff

su

rve

y s

co

res.

Tu

rno

ve

r is

ta

ngib

ly r

ed

ucin

g p

art

ly a

s a

re

sult o

f B

IG

Lis

ten

wo

rk a

nd

Qua

lity I

mp

rove

me

nt

(QI)

hea

lth

vis

itin

g

red

esig

n.

Sta

bili

ty:

the

tre

nd is u

p (

ind

ivid

ua

ls s

tayin

g m

ore

th

an

a

ye

ar)

; h

igh

ligh

tin

g t

he

im

po

rta

nce

of

the

on b

oa

rdin

g a

nd

me

nto

rin

g w

ork

. T

he

re is n

o n

ation

al ta

rge

t. W

e h

ave

se

t

a t

arg

et

of

85

% w

hic

h is s

tre

tch

ing b

ut

rea

listic a

nd w

ill b

e

revie

we

d in

six

mo

nth

s.

Sta

rte

r num

be

rs a

re g

ett

ing c

lose

r to

le

ave

r n

um

be

rs. T

he

da

ta f

urt

he

r en

han

ce

d in

th

e f

utu

re b

y o

ve

rla

yin

g t

his

with

va

ca

ncy n

um

be

rs.

Sic

kn

ess is b

ein

g c

ontr

olle

d th

rou

gh

ro

bu

st p

roce

ss a

nd

att

en

tio

n t

o a

llevia

te s

tre

ss,

and

sup

po

rt m

en

tal h

ea

lth

Actio

ns a

nd p

rogre

ss a

ga

inst

the B

AF

Work

forc

e R

isk is t

o b

eco

me

a s

tan

din

g

ite

m o

n th

e S

WC

.

A p

ropo

sa

l to

re

du

ce

th

e r

isk r

atin

g f

rom

16

– 1

2 is t

o b

e p

resen

ted a

t th

e n

ext

SW

C.

The

re is m

uch e

vid

en

ce

to

su

pp

ort

th

e

red

uction

of

the

mo

rale

pa

rt o

f th

e r

isk b

ut

the

SW

C r

equ

este

d a

little

lo

nge

r to

tra

ck

the

im

pro

ve

me

nt a

ga

inst

the q

ua

lity p

art

of

tha

t risk.

A r

ecom

me

nda

tion

is c

om

ing t

o t

he

ne

xt

SW

C t

o r

econ

sid

er

the s

ickn

ess ta

rge

t to

se

t

it a

t a s

tre

tch

ing b

ut

rea

listic t

arg

et

in th

e to

p

qu

art

ile o

f ou

r com

pa

rato

r T

rusts

. It

will

be

revis

ed

fro

m 3

.9%

up

wa

rds b

ut

the

de

gre

e

of

str

etc

h is b

ein

g lo

oke

d a

t.

Str

ateg

ic W

orkf

orce

Com

mitt

ee C

hair’

s R

epor

t

Page 47 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

an

d m

uscu

loske

leta

l (M

SK

) ca

used

sic

kn

ess.

Ma

rgin

al

furt

he

r im

pro

ve

me

nt

ca

n b

e p

ossib

le, b

ut th

e c

urr

en

t

targ

et

is n

ot a

ch

ieva

ble

.

Nu

rsin

g A

ca

dem

y

Up

da

te

Stu

de

nts

are

all

no

w in

th

eir f

irst

pla

cem

ent.

Lo

st fo

ur

due

to p

ers

on

al circum

sta

nce

no

w 4

2. M

erid

ian

Ne

ws 2

0

Ma

rch

film

ed

to p

rom

ote

the

Acad

em

y o

n th

e n

ew

s,

inte

rvie

win

g b

oth

Lou

ise

and

tw

o s

tud

en

ts.

Full

tea

m in

po

st

su

ppo

rtin

g s

tude

nts

, w

ork

ing c

lose

ly w

ith

th

e O

pen

Un

ive

rsity n

ot

with

ou

t te

eth

ing c

ha

llen

ge

s. L

esso

ns a

re

be

ing le

arn

t.

Att

raction

of

the

Acad

em

y h

as p

rom

pte

d m

uch

in

tere

st

into

ho

w it

ca

n b

e e

xte

nd

ed

acro

ss a

rea

s o

f th

e T

rust.

Issu

es o

f cap

acity,

pla

ce

men

t o

ppo

rtu

nitie

s, su

pe

rvis

ion

an

d s

up

po

rt a

t a

lo

ca

l le

ve

l a

re a

ll co

nsid

era

tio

ns b

efo

re

an

y c

om

mitm

en

t.

Op

era

tion

al E

xe

cu

tive

to

de

term

ine

Str

ate

gic

re

so

urc

ing n

ee

ds a

nd

Ma

na

ge

me

nt to

prio

ritise

befo

re a

bu

sin

ess

ca

se

will

co

me

to

Ma

y S

WC

with

exp

an

sio

n

pla

ns fo

r 2

01

9 –

20

20, a

nd

be

yo

nd

.

Re

ten

tio

n U

pd

ate

R

ete

ntio

n h

as b

een

a p

rio

rity

an

d e

ffo

rt t

o a

dd

ress t

his

ha

s r

esu

lte

d in

lo

we

r tu

rno

ve

r. W

ork

on

va

lue

s a

nd

cu

ltu

re,

su

ppo

rtin

g n

ew

sta

rte

rs,

intr

od

ucin

g w

he

re

po

ssib

le f

lexib

le w

ork

ing a

nd

be

tte

r d

eve

lopm

en

t a

nd

ca

ree

r p

lan

nin

g is a

ll ha

vin

g a

po

sitiv

e im

pa

ct o

n s

taff

.

The

ou

tcom

e c

an

be

se

en

no

t o

nly

in

lo

we

r tu

rno

ve

r

figu

res b

ut a

lso

th

e S

taff

Su

rve

y o

utc

om

es a

nd

gre

ate

r

en

erg

y a

nd

po

sitiv

ity p

icke

d u

p in

sta

ff a

nd

tea

m

me

etin

gs.

Page 48 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Pro

du

ctivity a

nd

Eff

icie

ncy o

f th

e H

R

Fu

nctio

n

Usin

g t

he

Mo

de

l H

osp

ita

l d

ata

, th

e C

om

mitte

e lo

oke

d a

t

the

pro

du

ctive

ly a

nd

eff

icie

ncy o

f th

e H

R f

un

ctio

n a

nd

th

e

resu

lts w

ere

po

sitiv

e,

with

so

me

op

po

rtu

nitie

s f

or

refin

ing

ide

ntified

. F

urt

he

r w

ork

ca

n b

e d

one

to s

ho

rten

the

tim

e to

hire

bu

t n

ot

ab

out

co

st/eff

icie

ncy,

mo

re a

bo

ut ca

nd

ida

te

do

cum

en

tatio

n a

nd b

en

efitt

ing f

rom

th

e r

ete

nd

erin

g o

f

Occu

patio

na

l H

ea

lth.

The

ap

pra

isa

l co

mp

letio

n s

co

re is e

xce

llen

t. T

he

re is n

ow

a n

ee

d to

co

ncen

tra

te o

n th

e q

ua

lity o

f th

e a

pp

rais

al.

Fu

rth

er

wo

rk is a

lso

und

erw

ay t

o lo

ok a

t th

e s

tra

tegic

dire

ctio

n o

f E

du

catio

n a

nd

Tra

inin

g a

nd its

str

uctu

re.

Tim

e to

Ch

an

ge

Up

da

te

The

Sta

ff a

nd

Wellb

ein

g G

rou

p d

ete

rmin

ed

the

nee

d to

focu

s o

n m

en

tal h

ea

lth a

nd in

Ju

ly t

he T

rust

agre

ed

to

su

ppo

rt t

he

Tim

e t

o C

ha

nge

in

itia

tive

. It

s p

urp

ose

is to

red

uce

stigm

a a

rou

nd

me

nta

l he

alth

an

d r

ais

e a

wa

ren

ess.

Ove

r 1

00

Tim

e t

o C

han

ge

Ch

am

pio

ns h

ave

be

en

tra

ine

d

to c

onfid

en

tly s

ign

po

st a

nd r

un

eve

nts

to r

ais

e

aw

are

ne

ss.

On 1

6 M

ay C

ha

mp

ion

s c

om

e to

ge

the

r to

sh

are

exp

erie

nce

an

d le

arn

ing.

Po

sitiv

e o

utc

om

es w

ith

nu

mb

er

of

Ch

am

pio

ns, a

nd a

mo

un

t of

activity,

ultim

ate

ly

wo

rkin

g t

ow

ard

s r

ed

ucin

g s

ickn

ess,

de

cre

asin

g s

tre

ss a

nd

en

ga

gin

g p

eo

ple

with

su

ppo

rt.

Sta

ff S

urv

ey

Su

rve

y f

ind

ings f

or

20

18

are

ve

ry p

ositiv

e in

mo

st a

rea

s

with

so

me

sig

nific

an

tly b

ette

r sco

res th

an la

st ye

ar

an

d

Lo

ca

l A

ctio

n p

lan

s t

hen

aggre

ga

ted

are

b

ein

g d

eve

lope

d to

add

ress t

he

po

ore

r p

erf

orm

an

ce

are

as:

Str

ateg

ic W

orkf

orce

Com

mitt

ee C

hair’

s R

epor

t

Page 49 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

co

mpa

red t

o o

ur

na

tion

al com

pa

rato

rs. T

he

se

re

su

lts w

ill

de

mo

nstr

ate

to

sta

ff tha

t w

ha

t th

ey h

ave

to

sa

y r

ea

lly d

oe

s

ma

tte

r an

d th

at a

s a

Tru

st

we

do

lis

ten

an

d w

e d

o a

ct o

n

fee

db

ack.

The

Tru

st

ha

d a

re

sp

on

se

ra

te o

f 5

9.7

%, 2

% le

ss t

han

la

st

ye

ar

bu

t e

xce

llen

t a

ga

inst

an

ave

rage

re

sp

onse

ra

te fo

r

co

mm

un

ity t

rusts

of

53%

an

d n

atio

na

l a

ve

rage

of

45

.7%

.

The

Tru

st

sig

nific

antly im

pro

ve

d in

fiv

e k

ey t

he

me

s –

equ

alit

y,

div

ers

ity a

nd

in

clu

sio

n, im

me

dia

te m

an

age

r, s

afe

en

viro

nm

ent,

safe

ty c

ultu

re,

sta

ff e

nga

ge

men

t) T

his

de

mo

nstr

ate

s th

at th

e d

evo

lve

me

nt

cu

ltu

re p

rogra

mm

e is

co

ntinu

ing t

o h

ave

an

im

pa

ct

an

d th

e s

taff

en

ga

ge

me

nt

wo

rk h

as b

een

po

sitiv

ely

re

ce

ive

d.

When c

om

pa

rin

g t

he

ke

y q

ue

stio

ns K

CH

FT

sco

red

sig

nific

an

tly b

ette

r th

an la

st

ye

ar

in 3

5%

of

qu

estio

ns,

sig

nific

an

tly w

ors

e in

4%

of

qu

estio

ns a

nd t

here

wa

s n

o

sig

nific

an

t d

iffe

ren

ce in t

he

rem

ain

ing 6

1%

com

pa

red

to

last

ye

ar’s f

ind

ings.

•

Sta

ff f

ee

ling p

ressu

rised

to

co

me

to

w

ork

•

En

su

re tra

inin

g a

nd

deve

lop

me

nt

is

ide

ntified

an

d a

ctio

ns

•

Sta

ff e

xp

erie

ncin

g M

SK

pro

ble

ms a

s

a r

esu

lt o

f w

ork

•

Re

du

ce t

he n

um

be

r of e

rro

rs,

ne

ar

mis

se

s th

at

wo

uld

ha

ve

hu

rt s

taff

or

pa

tien

ts.

At

the

sam

e t

ime

pla

ns t

o c

on

tinu

e s

taff

e

nga

ge

men

t w

ill c

on

tinu

e a

s p

art

of

the

cu

ltu

re c

ha

nge

in t

he

Tru

st.

Op

era

tion

al W

ork

forc

e

Re

po

rt

- T

ICC

Up

da

te

- R

evie

w W

inte

r

The

Com

mitte

e d

iscu

sse

d th

e im

pa

ct

of

the

win

ter

ince

ntive

on

th

e u

se o

f b

an

k s

taff

ove

r Ja

nu

ary

an

d

Fe

bru

ary

wh

ich

is in

co

nclu

siv

e.

It

did

in

cre

ase

the

nu

mb

er

on

th

e B

an

k a

lbe

it n

ot

imp

act

po

sitiv

ely

th

e

Fu

rth

er

wo

rk is r

equ

ire

d t

o d

ete

rmin

e w

ha

t

the

in

ce

ntive

sh

ou

ld b

e a

s p

art

of

loo

kin

g a

t

sta

ffin

g n

ee

ds f

or

ne

xt

Win

ter,

and

wh

eth

er

an

y o

the

r m

otiva

tio

ns c

an

be

id

en

tified

to

Page 50 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Pre

ssu

res

pe

rce

nta

ge

fill

ra

te a

s d

em

and

wa

s h

igh

er.

The

Com

mitte

e w

as u

pd

ate

d o

n p

rogre

ss w

ith

esta

blis

hin

g s

elf-m

an

age

d t

eam

s u

nde

r th

e T

ran

sfo

rmin

g

Inte

gra

ted

Ca

re in t

he

Co

mm

un

ity (

TIC

C)

pro

ject.

A n

ew

team

is b

ein

g e

sta

blis

he

d in

Ch

arin

g m

ad

e u

p o

f a

ll o

ur

ow

n s

taff

with

Ke

nt

Cou

nty

Co

un

cil

(KC

C)

man

agin

g t

he

do

mic

ilia

ry c

are

ele

men

t. T

he

se

diffe

ren

t m

od

els

will

pro

vid

e v

alu

ab

le e

vid

en

ce

to

hig

hlig

ht

ch

alle

nge

s o

f se

t

up

, m

an

age

me

nt a

nd

co

ord

inatio

n.

en

cou

rage

mo

re o

nto

th

e B

an

k.

Sic

kn

ess A

bse

nce

Ta

rge

t/ B

en

chm

ark

ing

The

Com

mitte

e r

equ

este

d a

com

pa

riso

n b

etw

ee

n t

he

Tru

st’s S

ickn

ess A

bsen

ce

Ma

na

ge

me

nt P

roce

du

res to

NH

S E

mp

loye

rs G

uid

e.

Assu

ran

ce

wa

s g

ive

n t

ha

t th

e

Tru

st

is in

lin

e, a

lbe

it w

ith

som

e m

ino

r e

nh

an

ce

men

ts o

f

gu

ida

nce

to

man

age

rs h

ow

to

su

pp

ort

sta

ff w

ith

a c

an

ce

r

dia

gn

osis

, w

ith

ca

rin

g r

esp

on

sib

ilitie

s a

nd

a m

ore

info

rma

tio

n in

the

tra

inin

g f

or

ma

na

ge

rs.

Giv

en

it

is u

nlik

ely

th

at th

ese im

pro

vem

ents

will

ha

ve

sig

nific

an

t im

pa

ct o

n r

ed

ucin

g

sic

kn

ess f

urt

he

r it w

as p

rop

ose

d to

re

vis

e

the

sic

kne

ss ta

rge

t fr

om

3.9

% to

a t

op

qu

art

ile a

mb

itio

us b

ut re

alis

tic t

arg

et.

A

pro

po

sa

l is

com

ing t

o th

e n

ext

SW

C.

E -

ro

ste

r P

erf

orm

an

ce

(Allo

ca

te in

sig

ht)

The

Tru

st

ha

s c

om

mis

sio

ne

d ‘A

lloca

te,

its e

–ro

ste

r

su

pp

lier

to r

un

an

‘in

sig

ht’ s

erv

ice

pro

vid

ing p

erf

orm

an

ce

me

asu

res a

cro

ss s

ix k

ey m

etr

ics,

hig

hlig

htin

g h

ow

we

are

do

ng n

atio

na

lly a

nd

with

ou

r p

ee

r gro

up

. T

his

is a

va

lua

ble

so

urc

e o

f da

ta to

ide

ntify

ho

t sp

ots

wh

ere

the

re a

re issue

s

with

ap

pro

va

l, u

na

va

ilab

ility

, a

dd

itio

na

l d

utie

s a

nd

unfille

d

ho

urs

, a

s w

ell

as h

igh

ligh

t b

est p

ractice

are

as t

o lea

rn

Str

ateg

ic W

orkf

orce

Com

mitt

ee C

hair’

s R

epor

t

Page 51 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

from

. O

pe

ratio

na

l le

ads w

ill w

ork

with

e-r

oste

r te

am

to

en

su

re m

axim

um

va

lue

is e

xtr

acte

d f

rom

the

da

ta.

Work

forc

e P

lan

D

raft

na

rra

tive

and

num

erica

l p

lan

s d

eve

lop

ed

fro

m t

he

bo

tto

m u

p b

y e

ach

of

the

se

rvic

es illu

str

ate

s fu

rth

er

en

ga

ge

men

t a

nd d

evo

lve

d r

esp

on

sib

ility

ta

kin

g in

to

co

nsid

era

tio

n b

ud

ge

ts, w

ays o

f w

ork

ing a

nd

ch

alle

nge

s

with

re

ga

rds t

o r

ecru

itm

ent.

Re

su

ltin

g in

gre

ate

r

ow

ne

rsh

ip o

f re

so

urc

e p

lan

nin

g a

nd

sta

ff m

ake

up.

NH

S I

mp

rove

me

nt

ha

s p

rovid

ed

po

sitiv

e f

ee

db

ack

ackn

ow

led

gin

g t

ha

t th

e T

rust h

as a

pla

n a

nd th

e p

lan

is o

f

a g

oo

d s

tand

ard

.

Pe

op

le S

trate

gy

Imp

lem

en

tatio

n P

lan

Re

ce

ive

d t

he

pla

n f

or

ne

xt

ye

ar

an

d r

ece

ive

d a

ssu

ran

ce

tha

t th

e P

eo

ple

Str

ate

gy a

nd

wh

at

the

Tru

st

is d

oin

g

dire

ctly lin

ks t

o t

he T

rust’s s

tra

tegy.

Bri

dg

et

Sk

elt

on

Str

ate

gic

Wo

rkfo

rce

Co

mm

itte

e

20

Ma

rch

201

9

Page 52 of 177

ST

RA

TE

GIC

WO

RK

FO

RC

E C

OM

MIT

TE

E CHAIR’S

AS

SU

RA

NC

E R

EP

OR

T

T

his

rep

ort

is fo

un

ded

on

th

e S

tra

tegic

Wo

rkfo

rce

Com

mitte

e m

ee

tin

g h

eld

on

15

Ma

y 2

019

.

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Work

forc

e R

ep

ort

T

he

wo

rkfo

rce r

ep

ort

co

ntinu

es to

illu

str

ate

an

im

pro

vin

g b

ut

ch

alle

ngin

g p

ictu

re, h

igh

ligh

ts in

clu

de

:

- tu

rno

ve

r in

Ma

rch

saw

an

in

cre

ase

du

e t

o T

UP

E t

ran

sfe

r of

24

from

Esta

tes,

an

d a

hig

h le

ve

l o

f re

tire

es, n

orm

al fo

r th

e t

ime

of

ye

ar.

Ap

ril figu

res h

ave

re

turn

ed

to

no

rma

l le

ve

ls,

with

99

ne

w

sta

rte

rs a

nd

41

le

ve

rs.

- str

ess a

bse

nce c

on

tin

ue

s to

im

pro

ve

, w

ith

Tim

e to

Ch

an

ge

(TT

C)

no

w d

eve

lop

ed b

y a

ll se

rvic

es.

- th

e v

aca

ncy r

ate

ha

s s

ligh

tly in

cre

ase

d to

9.8

% in

Ap

ril

prim

arily

du

e t

o b

ud

ge

ted

esta

blis

hm

en

ts h

avin

g in

cre

ase

d a

nd

no

t ye

t fille

d.

- o

ccu

patio

na

l h

ea

lth

ap

po

intm

en

ts c

on

tin

ue to

be a

pro

ble

m fo

r

recru

itm

en

t, h

en

ce

clo

se

ma

na

gem

en

t of

the

co

ntr

act.

Ca

nd

idate

s fa

ilin

g t

o b

rin

g t

he

ir d

ocu

me

nts

is e

ve

n m

ore

ch

alle

ngin

g.

The

Bo

ard

Assu

ran

ce

Fra

me

wo

rk r

isk o

n W

ork

forc

e w

as

revie

we

d a

nd

assu

rance

re

ce

ive

d b

oth

on

qua

lity issu

es a

nd

mo

rale

to

sa

tisfy

a1

2H

sco

re.

Str

ateg

ic W

orkf

orce

Com

mitt

ee C

hair’

s R

epor

t

Page 53 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Nu

rsin

g A

ca

dem

y

Up

da

te

43

stu

den

ts s

till

on

tra

ck.

Ch

alle

nge

s in

clu

de e

nsu

rin

g t

he

rig

ht

skill

s a

re b

ein

g le

arn

t at

ea

ch

wo

rk b

ase

, a

nd

ho

w t

he

Tru

st

acco

mm

od

ate

s a

ll th

e s

tud

en

ts (

inte

rna

l an

d e

xte

rna

l) w

ith

rou

gh

ly 1

50

pla

cem

en

ts.

Le

arn

ing

fo

r fu

ture

coho

rts t

o e

nsu

re

sca

le o

f p

lacem

en

ts is p

ossib

le.

Work

forc

e f

or

the

Fu

ture

R

ece

ive

d p

ape

r se

ttin

g o

ut

initia

l w

ork

on

the

sh

ape

of

ou

r

futu

re w

ork

forc

e a

nd t

he

pla

ns t

o p

ut

tha

t in

to p

lace

. W

ork

forc

e

pla

ns to

su

sta

in th

e d

eliv

ery

of

se

rvic

es h

ave

hig

hlig

hte

d g

ap

s

in b

oth

cap

acity a

nd c

ap

ab

ility

with

actio

ns t

o a

dd

ress th

ese

issu

es.

An

Aca

dem

y B

oa

rd h

as b

een

set

up

to o

ve

rse

e th

e

de

ve

lop

me

nt

of

ca

ree

r p

ath

wa

ys,

ne

w r

ole

s a

nd

th

e

prio

ritisa

tio

n o

f ap

pre

ntice

sh

ip p

rogra

mm

es a

cro

ss t

he

Tru

st

(Ph

ysio

the

rap

y b

ein

g th

e n

ext

aca

de

my e

xp

an

sio

n).

Fu

rth

er

wo

rk is u

nd

erw

ay t

o d

esig

n a

n

ap

pro

ach

th

at fo

cu

se

s o

n n

ew

an

d

exte

nd

ed

ro

les,

skill

s a

nd

ne

w w

ays o

f

wo

rkin

g.

Mo

re w

ork

is r

equ

ire

d t

o lo

ok a

hea

d a

t

mo

de

ls a

nd

skill

s t

ha

t w

ill b

e r

equ

ire

d

to s

up

po

rt m

ore

com

ple

x p

atie

nts

.

Fu

rth

er

wo

rk o

n fu

ture

le

ad

ers

hip

mo

de

ls a

nd

skill

re

qu

ire

men

ts is a

lso

esse

ntia

l.

Work

forc

e E

qu

alit

y

Sta

nd

ard

s U

pd

ate

WR

ES

an

d W

DE

S r

epo

rts a

re d

ue in

Se

pte

mb

er.

D

ata

ga

the

rin

g,

ana

lysis

an

d a

ction

pla

nn

ing

com

es t

o th

e

Co

mm

itte

e in

Ju

ly.

He

alth

an

d W

ellb

ein

g

Up

da

te –

Tim

e to

Ch

an

ge

TT

C C

ham

pio

ns a

re t

o a

tten

d a

n e

ve

nt

on

16

Ma

y t

o s

ha

re

lea

rnin

g a

nd

in

sig

hts

. T

TC

aim

s t

o r

ais

e a

wa

ren

ess b

ut T

TC

will

als

o b

e a

sked

ho

w t

hey c

ou

ld m

ea

su

re h

ow

th

eir r

ole

s h

ave

ha

d im

pa

ct.

Page 54 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Ge

ne

ral D

ata

Pro

tection

Re

gu

latio

n (

GD

PR

)

Co

mp

lian

ce

Pro

gre

ss

TIA

A a

ud

it p

rovid

ed

‘lim

ited assurance’ in

re

latio

n to

th

e

co

nte

nt,

rete

ntio

n a

nd

de

str

uction

of

pe

rso

nne

l file

s. T

he

Co

mm

itte

e r

ece

ive

d a

ssu

ran

ce

of

actio

ns t

o a

dd

ress issue

s

inclu

din

g e

du

ca

tion

, com

mu

nic

atio

n, m

on

thly

file

re

vie

ws a

nd

the

de

ve

lopm

ent

of

a b

usin

ess c

ase

fo

r e

lectr

on

ic f

ilin

g.

Fu

rth

er

wo

rk t

o id

en

tify

ho

w w

e t

rack

su

cce

ssfu

l p

rogre

ss t

ow

ard

s

co

mp

lian

ce

.

Op

era

tion

al W

ork

forc

e

Re

po

rt

The

Ca

re Q

ua

lity C

om

mis

sio

n (

CQ

C)

requ

este

d a

pap

er

to

evid

en

ce

the

sig

nific

ant

wo

rkfo

rce

inn

ova

tio

ns t

akin

g p

lace in

the

Tru

st. W

ha

t th

is illu

str

ate

d w

as t

he

hu

ge

ra

nge

of

ch

alle

ngin

g a

nd n

ew

wa

ys o

f w

ork

ing t

he

Tru

st

ha

s a

ch

ieve

d

rece

ntly.

Th

ree

se

rvic

es u

nd

erg

oin

g p

ote

ntia

l m

ajo

r cha

nge

and

the

refo

re b

ein

g n

urt

ure

d a

re:

- E

ast

Su

sse

x S

ch

oo

l n

urs

es w

ith

se

rvic

e c

ha

nge

s

- T

he

Min

or

Inju

rie

s U

nit a

t G

rave

se

nd

tra

nsfe

rrin

g t

o D

VH

- S

exu

al H

ea

lth

in

the

we

st

an

d n

ort

h t

ran

sfe

rrin

g t

o t

he

Ma

idsto

ne

an

d T

un

bridge

t W

ells

NH

S T

rust

(MT

W).

Str

ateg

ic W

orkf

orce

Com

mitt

ee C

hair’

s R

epor

t

Page 55 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Actio

n L

ea

rnin

g

Se

ts/C

oa

ch

ing

Ne

two

rk

Bu

dge

t to

ad

dre

ss g

ap in

se

nio

r sta

ff d

eve

lopm

ent

resu

lte

d in

the

pro

cu

rem

en

t of

thre

e in

itia

tive

s –

De

ve

lop

men

t of

coa

ch

ing

skill

s,

actio

n lea

rnin

g s

ets

an

d 1

-1 c

oa

ch

ing. T

he

pro

cu

rem

en

t

pro

ce

ss is liv

e w

ith

th

e f

irst m

od

ule

due

to t

ake

pla

ce

in

Jun

e.

The

in

ten

t is

to

giv

e s

taff

tim

e o

ut to

im

pro

ve

pro

du

ctivity.

De

term

ine

ho

w t

he

Tru

st

co

mb

ine

s

se

lf-m

an

age

d d

eve

lopm

ent

with

str

ate

gic

prio

ritie

s.

Work

with

su

pp

liers

to

esta

blis

h m

ea

ns

of

me

asu

rin

g im

pa

ct

an

d v

alu

e.

De

fin

e h

ow

th

e m

ea

sure

s o

f su

cce

ss

are

go

ing t

o b

e b

uilt

in

to t

he

de

sig

n.

En

su

re m

ech

an

ism

s a

re in

pla

ce

to

ma

na

ge

the

con

tra

ct

we

ll, in

clu

din

g

co

mm

un

ica

tio

ns,

briefin

g,

revie

ws w

ith

on

-go

ing f

ee

db

ack, re

de

sig

n a

nd

eva

lua

tio

n.

Occu

patio

na

l H

ea

lth

Co

ntr

act

The

cu

rre

nt

con

tra

ct exp

ire

s in

Ju

ly,

giv

ing t

he

cu

rre

nt su

pp

lier

a s

ix m

on

th e

xte

nsio

n.

The

ne

w p

rocu

rem

en

t p

roce

ss s

ets

ou

t gre

ate

r cla

rity

aro

un

d

Ke

y P

erf

orm

an

ce

Ind

ica

tors

(K

PIs

) a

nd h

ow

issu

es w

ill b

e

reso

lve

d w

ith

fin

an

cia

l p

ena

ltie

s a

nd

th

e p

ote

ntia

l ea

rly c

losu

re

of

the

con

tra

ct

sh

ou

ld th

ey n

ot

co

mp

ly.

Qu

estion

s to

en

su

re the

Tru

st

tests

po

ten

tia

l sup

plie

rs u

sin

g s

ce

na

rio

s i.e

.

ou

t of

ho

urs

ne

ed

s.

Pa

yro

ll C

on

tra

ct

The

ne

w p

ayro

ll p

rovid

er

(pa

rt o

f K

en

t C

ou

nty

Co

un

cil)

is b

ein

g

clo

se

ly m

an

aged

with

fo

rtn

igh

tly m

ee

tin

gs a

nd

mo

nth

ly K

PIs

, on

an

up

wa

rds t

raje

cto

ry w

ith

a p

ositiv

e a

ttitud

e to

re

so

lvin

g

issu

es.

Page 56 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Re

cru

itm

en

t C

am

pa

ign

20

19

/20

Assu

ran

ce

wa

s g

ive

n o

n th

e p

lan

s fo

r bu

sin

ess a

s u

su

al an

d

ne

w p

lan

s f

or

recru

itm

en

t ca

mp

aig

ns f

or

the

up

com

ing y

ea

r.

Ne

w m

ark

etin

g m

ate

ria

ls,

usin

g ‘Take

a d

iffe

ren

t view’ w

eb

site

,

en

ga

ge

men

t w

ith

Ken

t su

ppo

rte

d E

mp

loym

ent,

and

wo

rkin

g

acro

ss t

he

Su

sta

ina

bili

ty a

nd

Tra

nsfo

rma

tio

n P

art

ne

rsh

ip (

ST

P)

on

Ke

nt-

wid

e in

itia

tive

s.

Usin

g a

tten

dan

ce

at o

pen

/ca

ree

r d

ays

an

d w

ork

ing m

ore

clo

se

ly w

ith

sch

oo

ls.

Lin

k u

p w

ith

Ma

tth

ew

Wrigh

t a

Tru

st

Ap

po

inte

d G

ove

rno

r fr

om

th

e H

ea

d

Tea

ch

ers

Asso

cia

tio

n.

Qu

alit

y I

mp

rove

me

nt (Q

I) r

ecru

itm

en

t

pro

ce

ss,

sco

pe s

till

to b

e d

ete

rmin

ed

an

d s

up

po

rt r

esou

rce

se

cu

red

.

Cle

ve

r T

oge

the

r M

ovin

g t

he

Big

Lis

ten

fo

rwa

rd,

ha

ve

be

en

aw

ard

ed

fu

nd

ing

from

Hea

lth

Ed

uca

tion

En

gla

nd

to

loo

k a

t w

ork

ing w

ith

Dig

ita

l

Cro

wd

So

urc

ing P

latf

orm

to

ga

the

r/de

ba

te s

taff

vie

ws o

n k

ey

issu

es c

om

ing o

ut

of

the

sta

ff s

urv

ey.

Ad

va

nce

d C

linic

al

Pra

ctitio

ne

rs (

AC

P)

up

da

te

All

dire

cto

rate

s h

ave

be

en

in

dis

cu

ssio

ns a

bou

t e

xp

and

ing

th

e

use

of

AC

Ps in

the

se

rvic

es.

A n

ation

al te

nder

is c

urr

en

tly o

n

go

ing w

he

re H

EIs

are

in

tere

ste

d in p

rovid

ing a

co

urs

e. T

he

Tru

st

is in

ten

din

g t

o e

xte

nd t

he

AC

Ps to

a m

inim

um

of

7,

4

fun

de

d b

y u

s a

nd

the

oth

ers

by t

he c

linic

al com

mis

sio

nin

g

gro

up

s (

CC

Gs).

Bri

dg

et

Sk

elt

on

Ch

air

, S

tra

teg

ic W

ork

forc

e C

om

mit

tee

15

Ma

y 2

01

9

Str

ateg

ic W

orkf

orce

Com

mitt

ee C

hair’

s R

epor

t

Page 57 of 177



Agenda Number: 2.5

Agenda Item Title: Finance, Business and Investment Committee Chair’s Assurance Report

Presenting Officer: Martin Cook, Chair of Finance, Business and Investment Committee


Report Summary

The reports provide a summary of the meetings that took place on 27 March and 24 April 2019. A verbal update on the meeting held on 22 May 2019 will also be provided.


The Board is asked to receive the Finance, Business and Investment Committee Chair’s Assurance Report.


None


No ☒. High level position described and no decisions required.

Martin Cook, Non-Executive Director Tel: 01622 211906

Email:

Fin

ance

, Bus

ines

s an

dIn

vest

men

t Com

mitt

ee R

epor

t

Page 58 of 177

FIN

AN

CE

, B

US

INE

SS

AN

D I

NV

ES

TM

EN

T C

OM

MIT

TE

E C

HA

IR’S

AS

SU

RA

NC

E R

EP

OR

T

Th

is r

ep

ort

is fo

un

ded

on

th

e F

ina

nce B

usin

ess a

nd I

nve

stm

en

t C

om

mitte

e m

ee

tin

g h

eld

on

27

Ma

rch

20

19

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Bu

sin

ess D

eve

lop

me

nt

an

d S

erv

ice

Imp

rove

me

nt R

epo

rt

All

ma

in c

on

tra

cts

are

sig

ne

d a

nd

typ

ica

lly t

he

se

are

pro

vin

g t

o b

e lon

g t

erm

, th

ree y

ea

rs p

lus c

on

tra

cts

, so t

ha

t

the

Tru

st

ca

n b

e c

onfide

nt

tha

t m

an

y in

co

me

str

ea

ms a

re

locke

d in f

or

the

ne

xt fe

w y

ea

rs a

nd

th

at

it c

an

pla

n

acco

rdin

gly

. T

his

is a

gre

at

resu

lt b

y t

he

Tru

st’s

ne

go

tia

tion

team

.

No

ne

the

less, th

e E

ast K

en

t R

AG

ind

ica

tor

is a

t am

be

r

refle

ctin

g t

hat

furt

he

r w

ork

is n

eed

ed

on

the

imp

lem

enta

tion

of

se

rvic

es t

o s

up

po

rt d

ischa

rge

an

d

wh

ole

syste

m f

low

. W

ork

co

ntinu

es in

re

lation

to

urg

en

t

tre

atm

ent

cen

tre

s a

nd

me

etin

gs h

ave

be

en h

eld

with

all

pro

vid

ers

to

esta

blis

h b

ase

line

s a

nd

ne

xt

ste

ps,

alth

ou

gh

no

de

cis

ion

s c

an

ye

t be

ma

de a

bo

ut lo

ca

tio

ns in

ea

st

Ken

t

in t

he a

bse

nce o

f d

ecis

ion

s o

n s

itin

g o

f A

&E

se

rvic

es.

CQ

UIN

ach

ieve

men

t in

ea

st K

ent

ha

s b

ee

n a

gre

ed

at

80

% t

ran

sla

tin

g t

o a

n in

co

me

of

£1

,43

7k.

The

re is s

om

e g

oo

d n

ew

s o

n D

isco

ve

ry O

rth

otics in

tha

t it

A t

ab

le w

ou

ld b

e p

rod

uce

d fo

r th

is r

ep

ort

in

futu

re th

at

wo

uld

sho

w t

he

am

oun

t of fu

ture

inco

me

alre

ad

y s

ecu

red

and

we

igh

ted

fore

ca

sts

aga

inst o

uts

tan

din

g t

en

de

rs t

o

giv

e f

urt

he

r a

ssu

ran

ce

aga

inst

the

in

com

e

line

s in

th

e 2

019

/20

bud

ge

t a

nd

su

bse

qu

en

tly.

A p

ap

er

wo

uld

be

pro

du

ce

d h

igh

ligh

tin

g t

he

me

asu

rab

le b

en

efits

ach

ieve

d t

hro

ugh

the

Qu

alit

y I

mp

rove

me

nt (Q

I) p

rogra

mm

e

ove

rall

so

th

at

the

Tru

st

ca

n h

elp

to

en

su

re

mom

en

tum

is m

ain

tain

ed

as a

ke

y

inve

stm

en

t fo

r o

ur

pe

op

le in

tra

inin

g a

nd

en

ga

ge

men

t.

De

nta

l se

rvic

es s

ho

uld

be

sch

edu

led

in

to

the

fu

ture

wo

rk p

rogra

mm

e fo

r a

fu

ll se

rvic

e

revie

w.

Fin

ance

, Bus

ines

s an

dIn

vest

men

t Com

mitt

ee R

epor

t

Page 59 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

ha

s f

ina

lly la

nd

ed

a £

75

k c

ontr

act

with

Ma

idsto

ne

an

d

Ton

brid

ge

Wells

NH

S T

rust

(MT

W),

ha

s in

cre

ase

d

vo

lum

es in

its

re

latio

nsh

ip w

ith

Gu

ys a

nd

St T

ho

ma

s N

HS

Fo

un

da

tion

Tru

st

an

d h

as fo

und

an

eco

nom

ic u

se

fo

r th

e

vo

id s

pa

ce

at

the

ba

ck o

f th

e fa

cili

ty in

Sa

nd

wic

h.

Co

nve

rse

ly,

the

Tru

st

is s

till

wo

rkin

g w

ith

MT

W to g

et

the

op

era

tio

n o

f S

exu

al H

ea

lth

Se

rvic

es r

eso

lve

d.

An

d in

rela

tio

n to

pu

blic

he

alth

se

rvic

es,

wh

ist

the

re is n

ot

sch

edu

led

to

be

an

y r

e-t

en

de

rin

g b

efo

re M

arc

h 2

02

0,

Ke

nt

Co

unty

Co

un

cil

(KC

C)

is n

ow

to

un

de

rta

ke

a

co

mp

reh

en

siv

e r

evie

w a

s t

o th

e v

alu

e it

de

rive

s f

rom

all

the

ir c

ontr

acts

, of

wh

ich

the

Tru

st d

eliv

ers

abo

ut h

alf.

Th

e

Tru

st

is g

oin

g to

tre

at

this

exe

rcis

e a

s a

sa

les o

ppo

rtu

nity.

Fin

an

ce

Re

po

rt M

on

th

11

The

Tru

st a

ch

ieve

d a

su

rplu

s o

f £

46

64

k y

ea

r to

date

at

the

en

d o

f F

eb

rua

ry 2

01

9 a

nd

th

e C

om

mitte

e c

an

giv

e

str

on

g r

e-a

ssu

ran

ce

tha

t th

e T

rust

will

me

et a s

urp

lus o

f

£5

m a

t ye

ar

en

d.

Th

e ta

ke

-on

of

Hilt

on

Nu

rsin

g P

art

ne

rs is

go

ing w

ell.

T

he

fu

ll yea

rs C

ost

Imp

rove

me

nt P

rogra

mm

e

(CIP

) ta

rge

t of

£4

08

0k is s

till

fore

ca

st

to b

e m

et

alth

ou

gh

the

esta

tes e

lem

en

t is

still

no

t com

ple

tely

se

cu

red

so t

he

RA

G in

dic

ato

r sta

nd

s a

t am

be

r. C

ash is h

ea

lth

y a

t 5

9

da

ys e

xp

en

ditu

re e

qu

iva

len

t.

Ca

pita

l sp

en

d is e

xp

ecte

d t

o

me

et

aro

un

d 9

6%

of

the

pla

n

with

th

e v

aria

nce

due

to

failu

re t

o o

bta

in v

alu

e fo

r m

on

ey t

end

ers

on

en

erg

y

eff

icie

ncy p

roje

cts

, in

clu

din

g n

ew

EV

cha

rgin

g p

oin

ts.

The

Dire

cto

r of

Fin

an

ce

wo

uld

se

e if

the

re

wa

s a

wa

y o

f b

rin

gin

g o

ut

in t

he

na

rra

tive

in

futu

re a

roun

d p

rofit a

nd

lo

sse

s w

he

re th

e

latt

er

inclu

de

d in

ve

stm

en

ts to

se

cu

re lon

ge

r

term

co

ntr

acts

or

oth

erw

ise

re

pre

se

nte

d

inve

stm

en

ts in

Ke

nt-

wid

e p

roje

cts

an

d

initia

tive

s,

with

ou

t com

pro

mis

ing t

he

accu

racy a

nd

tra

nspa

ren

cy o

f th

e T

rust’s

acco

un

ts.

The

Com

mitte

e is a

lso

se

ekin

g c

larifica

tio

n

as t

o w

hy s

om

e c

om

mis

sio

ne

rs’ u

plif

t to

co

ve

r th

e A

ge

nd

a fo

r C

ha

nge

(A

fC)

pa

y

Page 60 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Ea

st

Su

sse

x is y

et

to s

ign

th

e n

ew

20

18

co

ntr

act

alth

ou

gh

it is s

ub

sta

ntia

lly a

gre

ed

.

aw

ard

ha

s n

ot

be

en

app

lied

.

20

19

/20 R

eve

nu

e a

nd

Ca

pita

l B

ud

ge

ts

As p

revio

usly

agre

ed

by t

he

Bo

ard

, aft

er

scru

tin

y,

the

bu

dge

ts r

eco

rd th

e T

rust

as p

lan

nin

g to

ma

ke a

su

rplu

s o

f

£2

.35

m in

20

19

/20

su

pp

ort

ed b

y £

2.2

mill

ion

of

Pro

vid

er

Su

sta

ina

bili

ty F

un

d (

PS

F)

fun

din

g.

Th

e b

ud

ge

ts h

ave

be

en

pro

du

ced

in

lin

e w

ith

pla

nn

ing g

uid

elin

es a

nd

assu

mp

tion

s a

gre

ed p

revio

usly

by t

he

Boa

rd. P

oin

ts

pre

vio

usly

ra

ise

d b

y B

oa

rd a

nd

Co

mm

itte

e m

em

be

rs h

ave

be

en

pro

pe

rly in

co

rpo

rate

d,

fo

r e

xa

mp

le p

hasin

g o

f

ca

pita

l sp

end

, in

pa

rtic

ula

r IT

spe

nd

, is

cle

are

r.

Th

ere

is

als

o a

hig

he

r d

egre

e o

f tr

an

spa

ren

cy a

bou

t th

e m

ain

ris

ks

an

d p

ote

ntia

l u

psid

es to

the

bu

dge

t. In

pa

rtic

ula

r, t

he

Co

mm

itte

e r

ece

ive

d a

ssu

ran

ce

on

ho

w t

he

issu

e o

f

va

ca

ncie

s is t

rea

ted

for

bu

dge

tin

g a

nd

pla

nn

ing p

urp

ose

s,

as t

his

is th

e b

igge

st

sin

gle

“sw

ing”

ite

m.

In e

ffe

ct,

co

nsis

ten

t w

ith

ou

r po

licy o

f de

lega

tin

g b

ud

getin

g t

o

dire

cto

rate

le

ve

l, t

he b

ud

ge

t is

ba

se

d a

rou

nd

agre

ed

co

mp

lem

en

ts th

at

are

als

o a

lign

ed

with

safe

sta

ffin

g

ratio

s. T

he

Com

mitte

e d

oe

s n

ot w

ish

to

re

du

ce

the

co

mm

itm

en

t a

nd

eff

ort

fu

lly t

o r

ecru

it t

o th

at

co

mp

lem

en

t,

alth

ou

gh

re

alis

tica

lly u

nd

ers

pe

nd o

n p

ay,

is th

en

hig

hly

like

ly t

o o

ccu

r. T

his

is th

en

refle

cte

d in

th

e p

ote

ntia

l

up

sid

es a

nd

ma

tch

ed b

y c

orr

esp

on

din

g o

pe

ratio

na

l a

nd

sta

ffin

g r

isks e

lse

wh

ere

.

Fin

ance

, Bus

ines

s an

dIn

vest

men

t Com

mitt

ee R

epor

t

Page 61 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

The

Com

mitte

e r

ecom

me

nd

th

e b

ud

ge

ts f

or

the

Bo

ard

’s

fina

l ap

pro

va

l.

20

19

/20 A

nn

ua

l P

lan

S

imila

rly,

the

Com

mitte

e r

ecom

men

ds to

th

e B

oa

rd to

ap

pro

ve

sub

mittin

g t

he f

ina

l ve

rsio

n o

f th

e A

nn

ua

l P

lan

to

NH

S I

mp

rove

me

nt (N

HS

I).

Th

e p

lan

ha

s n

ow

be

en

up

da

ted in

lin

e w

ith

NH

SI

com

me

nts

on

th

e d

raft

th

e T

rust

su

bm

itte

d in

Feb

rua

ry a

s w

ell

as in

co

rpo

rating p

revio

us

co

mm

en

ts f

rom

Bo

ard

mem

be

rs. T

his

in

clu

des t

he

Tru

st’s

pla

ns to

me

et

the

na

tion

al six

we

ek d

iagn

ostic t

arg

et

in

rela

tio

n to

ch

ildre

n’s

au

dio

logy I

ncid

en

tally

, u

nlik

e m

ost

oth

er

NH

S o

rga

nis

ation

s in

Ke

nt, t

he

Tru

st’s d

raft

re

ce

ive

d

a g

ree

n R

AG

ra

tin

g f

rom

NH

SI,

co

rre

ctly,

in th

e

Co

mm

itte

e’s

vie

w,

refle

ctin

g t

he g

oo

d w

ork

of

the t

ea

m in

pu

ttin

g th

e p

lan

to

ge

the

r.

20

19

/20 C

ost

Imp

rove

me

nt

Pro

gra

mm

e P

ositio

n

We r

ece

ive

d a

n u

pd

ate

on t

he

20

19

/20

Co

st Im

pro

ve

me

nt

Pro

gra

mm

e,

wh

ich

the C

om

mitte

e a

lso r

ecom

me

nd

to t

he

Bo

ard

fo

r ap

pro

va

l. O

f th

e a

gre

ed

ta

rge

t of

£5,2

99

k o

r

2.2

% o

f th

e T

rust’s b

ud

ge

t, 2

6%

of

sch

em

es a

re f

ully

de

ve

lop

ed,

41

% a

re p

lan

s w

ell

in p

rogre

ss 2

8%

are

at

op

po

rtu

nity s

tage

an

d ju

st

7%

are

un

iden

tified,

the b

ulk

in

ea

st

Ke

nt.

Qua

lity I

mpa

ct

Asse

ssm

en

ts fo

r £3

545

k h

ave

no

w b

ee

n a

pp

rove

d b

y t

he

Ch

ief

Nu

rse (

Inte

rim

) a

nd

Me

dic

al D

ire

cto

r, £

55

1k is a

wa

itin

g a

pp

rova

l.

In

acco

rdan

ce

with

po

licy a

ny n

ew

se

rvic

es id

en

tified

or

The

Com

mitte

e w

ill r

evie

w p

rogre

ss a

ga

inst

pla

n a

s a

sta

nd

ing a

gen

da

ite

m.

In

ad

ditio

n

to d

ee

p d

ive

s u

nde

rta

ke

n in

Qu

alit

y

Co

mm

itte

e t

o h

igh

ris

k a

rea

s,

the

Co

mm

itte

e w

ill a

lso

in

ve

stiga

te in

de

pth

are

as o

r se

rvic

es t

ha

t m

ay r

ep

resen

t som

e

hig

he

r risk f

rom

a c

om

me

rcia

l o

r fin

an

cia

l

po

int of

vie

w,

pa

rtic

ula

rly,

the

tra

de

-off

be

twe

en

th

e h

igh

er

savin

gs t

arg

et

allo

ca

ted

to IT

an

d t

he p

rio

rity

th

e T

rust

giv

es t

o d

igita

l

Page 62 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

firm

ed

up

th

rou

gh

th

e y

ea

r, p

art

icu

larly in

esta

tes,

will

be

revie

we

d b

y t

he

Ch

ief N

urs

e (

Inte

rim

) a

nd

Me

dic

al

Dire

cto

r.

in its

str

ate

gy.

Se

rvic

e R

evie

w –

Ra

pid

Tra

nsfe

r of

Ca

re

Th

e C

om

mitte

e r

ece

ive

d a

n in

terim

rep

ort

fro

m th

e E

ast

Ke

nt

Co

mm

un

ity S

erv

ice

s D

ire

cto

r.

A h

uge

am

oun

t of

wo

rk h

ad

bee

n d

one

in t

he

te

eth

of

win

ter

pre

ssu

res in

re

-

en

gin

ee

rin

g t

he e

xis

tin

g s

erv

ice

s a

nd

wh

ilst

the

re w

as s

till

a n

ee

d to

do

mo

re fa

st p

rob

lem

-so

lvin

g o

n t

he

gro

un

d, a

se

rvic

e h

ad

be

en c

on

str

ucte

d th

at

wa

s d

eliv

erin

g

co

nsid

era

ble

va

lue

to

pa

tien

ts,

as s

up

po

rte

d th

rou

gh

an

ecd

ote

ra

the

r th

an

qu

an

tita

tive

da

ta t

o d

ate

. T

his

is a

co

nsid

era

ble

ach

ieve

me

nt

in a

tra

ditio

na

lly d

ifficu

lt

rela

tio

nsh

ip e

nviro

nm

en

t. T

he

re is a

sp

ecific

ou

tsta

nd

ing

fina

ncia

l risk o

f up

to £

0.5

m in

re

latio

n t

o c

are

hom

e

se

rvic

es b

ed

s.

Dis

cu

ssio

ns a

nd

wo

rk a

re o

ngo

ing t

o

esta

blis

h a

gre

ed

en

d to

end

pa

thw

ays,

co

mm

on

pro

ce

du

res a

nd

da

ta s

ets

.

Pip

pa

Ba

rbe

r, N

on

-Exe

cu

tive

Dire

cto

r a

nd

I

will

jo

intly u

nd

ert

ake

a s

erv

ice

vis

it in

Ap

ril to

ge

t a

be

tte

r fe

el fo

r w

ha

t is

ha

ppe

nin

g o

n

the

gro

und

. T

he

Com

mitte

e w

ill t

ake

an

up

da

te a

t th

e e

nd o

f th

e n

ext

qu

art

er

wh

ere

it is e

xp

ectin

g m

an

y o

f th

e o

uts

tand

ing

issue

s t

o h

ave

re

so

lved

to

ste

ad

y s

tate

and

a f

ull

se

rvic

e r

evie

w a

ga

in a

t m

id-y

ea

r.

Te

rms O

f R

efe

ren

ce

Re

vie

w A

nd

Oth

er

Bu

sin

ess

I re

po

rte

d p

ositiv

ely

to

th

e C

om

mitte

e o

n v

isits I

had

ma

de

to p

art

s o

f th

e p

rocu

rem

ent

pro

ce

ss fo

r th

e r

ep

lacem

en

t

for

the C

om

mu

nity I

nfo

rma

tion

Syste

m (

CIS

). A

s w

ell

as

we

ll-ru

n,

the

pro

cu

rem

en

t p

roce

ss is p

ositiv

ely

co

ntr

ibu

tin

g t

o im

ple

me

nta

tio

n in b

uild

ing e

nga

ge

me

nt

an

d a

Tru

st-

wid

e m

en

talit

y a

mo

ngst

ou

r p

eo

ple

and

ch

am

pio

ns f

or

the

ne

w s

yste

m.

I r

eco

gn

ise

d a

nd

th

an

ke

d

The

Com

mitte

e a

gre

ed t

o c

om

ple

te its

Te

rms o

f R

efe

ren

ce

revie

w n

ext

mo

nth

and

in p

art

icu

lar

wo

uld

co

nsid

er

fre

qu

en

cy a

nd

tim

ing o

f m

ee

tin

gs,

with

a r

eb

utta

ble

hyp

oth

esis

th

at six

mee

tin

gs a

ye

ar

mig

ht b

e

a g

oo

d b

ala

nce

be

twe

en

th

e fo

rma

l a

nd

le

ss

str

uctu

red u

se o

f co

mm

itte

e m

em

be

rs’ tim

e.

Fin

ance

, Bus

ines

s an

dIn

vest

men

t Com

mitt

ee R

epor

t

Page 63 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

on

be

ha

lf o

f th

e B

oa

rd th

e c

on

sid

era

ble

in

ve

stm

ent

in t

ime

an

d e

ne

rgy t

he

50

or

so

of

ou

r pe

op

le e

nga

ge

d w

ere

ma

kin

g.

Ma

rtin

Co

ok

Ch

air

, F

ina

nc

e B

us

ine

ss

an

d I

nve

stm

en

t C

om

mit

tee

27

Ma

rch

210

9

Page 64 of 177

FIN

AN

CE

BU

SIN

ES

S A

ND

IN

VE

ST

ME

NT

CO

MM

ITT

EE

CH

AIR

’S A

SS

UR

AN

CE

RE

PO

RT

Th

is r

ep

ort

is fo

un

ded

on

th

e F

ina

nce B

usin

ess a

nd I

nve

stm

en

t C

om

mitte

e m

ee

tin

g h

eld

on

24

Ap

ril 2

019

. A

ge

nd

a i

tem

A

ss

ura

nc

e a

nd

Ke

y p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Bu

sin

ess D

eve

lop

me

nt

an

d S

erv

ice

Imp

rove

me

nt R

epo

rt

Giv

en

th

e t

eam

’s s

ucce

ss in

lo

ckin

g in

all

of

the

Tru

st’s

ma

jor

blo

cks o

f w

ork

for

a m

inim

um

of

thre

e y

ea

rs,

the

Tru

st h

as th

e r

ela

tive

lu

xu

ry o

f a

pp

roa

ch

ing t

en

de

r w

ork

str

ate

gic

ally

, w

ith

th

e IT

T fo

r E

ast S

usse

x S

ch

oo

l N

urs

ing,

du

e in

Ma

y 2

019

, ta

kin

g p

rio

rity

. W

ork

con

tin

ue

s t

o fu

lly

imp

lem

ent

the

Rap

id T

ran

sfe

r of

Ca

re (

RT

OC

) se

rvic

e in

ea

st

Ke

nt a

nd

wh

ilst

the

com

mis

sio

ne

rs h

ave

aske

d fo

r a

rem

ed

ial p

lan

, th

e T

rust

wa

s g

ive

n a

ssu

ran

ce

th

at th

is

wa

s n

ot

ad

ve

rse

ly a

ffectin

g r

ela

tio

nsh

ips w

ith

co

mm

issio

ne

rs.

Work

con

tin

ue

s o

n u

rge

nt

trea

tmen

t cen

tre

s f

or

the

Sou

th

Ke

nt

Co

ast, w

ith

th

ree

op

tion

s u

nd

er

dis

cu

ssio

n.

The

Com

mitte

e r

ece

ive

d fu

rth

er

info

rma

tio

n a

rou

nd

the

su

cce

ssfu

l D

isco

ve

ry O

rth

otic s

ale

s w

hic

h a

pp

ea

r to

be

of

a lo

we

r vo

lum

e t

ha

n o

rigin

ally

re

po

rte

d. T

he r

ep

ort

ed

£7

5k c

on

tra

ct

with

Ma

idsto

ne

an

d T

un

brid

ge

Wells

NH

S

Tru

st

(MT

W)

is a

ctu

ally

on

ly w

ort

h £

25

k a

s y

et.

The

Tab

les s

ho

win

g o

uts

tan

din

g t

en

de

r

wo

rk w

ill in

futu

re ind

ica

te th

e s

tra

tegic

va

lue

of

ea

ch

te

nd

er

to t

he

Tru

st

an

d th

e

rea

so

n w

hy w

e a

re g

oin

g t

o b

id r

ath

er

than

no

bid

.

Fin

ance

, Bus

ines

s an

dIn

vest

men

t Com

mitt

ee R

epor

t

Page 65 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

No

ne

the

less, th

e s

ale

s f

unn

el sho

ws g

oo

d o

pp

ort

un

itie

s t

o

exp

an

d fu

rth

er,

pa

rtic

ula

rly a

t M

TW

an

d G

uys a

nd

St

Tho

ma

s N

HS

Fou

nda

tio

n T

rust.

Le

sson

s le

arn

ed

fro

m

co

ntr

act n

ego

tiatio

ns

The

pa

pe

r p

resen

ted

by t

he

Bu

sin

ess D

eve

lop

men

t T

eam

em

ph

asis

ed

th

e p

art

pla

ye

d b

y r

ela

tio

nsh

ip-b

uild

ing a

nd

ma

na

ge

me

nt, p

art

icu

larl

y a

mon

gst

all

the c

om

mis

sio

nin

g

gro

up

s in

ea

st

Ke

nt, in

th

e s

ucce

ssfu

l o

utc

om

e t

o c

on

tra

ct

ne

go

tia

tion

s.

Th

e C

om

mitte

e r

ece

ive

d a

ssura

nce

th

at th

e

team

exe

rcis

ed

th

oro

ugh

sta

ke

ho

lde

r m

an

age

men

t in

term

s o

f id

en

tify

ing t

he k

ey p

eo

ple

to b

uild

ing a

nd

ma

inta

inin

g r

ela

tion

sh

ips w

ith

, in

clu

din

g r

ole

s,

ke

y

co

nta

cts

, an

d s

o o

n.

The

Com

mitte

e p

rais

ed

the

wo

rk o

f th

e

ne

go

tia

tion

team

an

d n

ote

d t

ha

t th

e T

rust

wa

s in

a s

tro

ng f

inan

cia

l a

nd

str

ate

gic

po

sitio

n g

oin

g f

orw

ard

. F

urt

he

r

co

nsid

era

tio

n w

ou

ld b

e g

ive

n a

s to

wh

eth

er

an

y s

pe

cific

too

ls m

ight

su

pp

ort

sta

ke

ho

lde

r

ma

na

ge

me

nt a

nd

cu

sto

me

r re

latio

nsh

ips

go

ing f

orw

ard

. I

n a

dd

itio

n,

tho

ugh

t w

ou

ld

als

o b

e g

ive

n a

s t

o h

ow

th

e r

ela

tio

nsh

ips t

he

Tru

st h

ad

cou

ld b

e p

ut o

n a

mo

re

su

sta

ina

ble

fo

otin

g b

y d

eve

lop

ing f

urt

he

r

rela

tio

nsh

ips w

ith

th

e n

ext

tie

r d

ow

n/r

isin

g

sta

rs o

n b

oth

sid

es.

CQ

UIN

Re

vie

w A

nd

Ou

ttu

rn

The

tota

l C

QU

IN o

uttu

rn f

or

20

18

/19

is £

2,7

39,4

45 o

r 87

%

of

the

to

tal va

lue

of

£3

,14

1,6

71,

be

tte

r th

an

fore

ca

st,

bu

t

slig

htly d

ow

n o

n la

st

ye

ar,

du

e p

rim

arily

to

a c

ap

pin

g

agre

em

en

t w

ith

Ea

st K

en

t. T

he

va

lue

of

CQ

UIN

is

red

ucin

g b

y h

alf th

is c

urr

en

t fin

an

cia

l ye

ar

to 1

.25

%. T

he

Co

mm

itte

e r

ece

ive

d a

ssu

ran

ce

th

at,

wh

ilst

this

wa

s g

oo

d

ne

ws in

te

rms o

f re

du

cin

g f

ina

ncia

l risk t

o t

he

Tru

st,

ove

rall,

th

ere

wo

uld

be n

o let

up

on

se

ekin

g t

o im

pro

ve

Page 66 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

pe

rfo

rma

nce

on

th

e th

ings t

ha

t C

QU

IN a

tte

mp

t to

ta

rge

t.

The

re w

as a

rem

ain

ing f

ina

ncia

l risk in

re

sp

ect

of

flu

imm

un

isa

tion

ta

rge

ts in

ea

st

Ken

t a

s t

he

pa

ym

ent

thre

sh

old

is in

cre

asin

g t

o 6

0%

.

Qu

alit

y I

mp

rove

me

nt

(QI)

Qu

art

erly R

evie

w

The

Com

mitte

e r

ece

ive

d a

ssu

ran

ce

tha

t th

ere

had

be

en

co

nsid

era

ble

pro

gre

ss w

ith

th

e T

rust’s Q

ua

lity

Imp

rove

me

nt in

itia

tive

. I

nve

stm

en

t ye

ar

to d

ate

ha

d b

een

low

er

tha

n e

xp

ecte

d b

eca

use

su

pp

ort

had

bee

n p

rovid

ed

by N

HS

Im

pro

ve

men

t ra

the

r th

an

an

exte

rna

l p

rovid

er:

c £

133

k h

ad

be

en

spen

t a

ga

inst a

bu

dge

t of

£3

00

k.

De

sp

ite

th

e u

nde

rsp

end

201

8/1

9, th

e f

ull

£3

00

k b

ud

ge

t w

ou

ld b

e r

eta

ine

d a

nd

is

co

mm

itte

d fo

r th

is f

inan

cia

l ye

ar

to r

efle

ct

the

im

po

rta

nce o

f th

e in

itia

tive

fo

r th

e T

rust.

Fin

an

ce

Re

po

rt M

on

th

12

The

Tru

st

met

all

its d

utie

s f

or

the

eig

hth

ye

ar

in a

ro

w.

It

ach

ieve

d a

su

rplu

s o

f £

5,0

26

k fo

r th

e y

ea

r, inclu

din

g

£2

47

4k P

SF

. T

his

wa

s £

1,8

98

k b

ett

er

tha

n p

lan

. T

he

Tru

st e

xp

ects

fu

rth

er

ge

ne

ral, in

ce

ntive

an

d b

on

us

Pro

vid

er

Su

sta

ina

bili

ty F

un

d (

PS

F)

fund

ing t

akin

g t

he

to

tal

su

rplu

s t

o £

89

02

k.

The f

ull

ye

ar’s C

ost

Imp

rove

men

t

Pro

gra

mm

e (

CIP

) ta

rge

t of

£40

80

k w

as m

et. C

ash

is

he

alth

y a

t 4

7 d

ays e

xp

en

ditu

re e

qu

iva

len

t. C

ap

ita

l sp

end

wa

s £

3,6

52

k a

ga

inst a

re

vis

ed

pla

n o

f £3

,71

6k.

Age

ncy

exp

en

ditu

re w

as a

bo

ve

tra

jecto

ry f

or

Ma

rch

bu

t w

ell

be

low

tra

jecto

ry f

or

the y

ea

r o

ve

rall.

Se

rvic

e R

evie

w –

Mu

scu

loske

leta

l

Ph

ysio

the

rap

y S

erv

ice

Th

e C

om

mitte

e r

ece

ive

d a

fin

an

cia

l re

vie

w o

f th

e

Inte

gra

ted

Mu

scu

loskele

tal se

rvic

es f

or

201

8/1

9 a

s w

ell

as

pla

ns to

ach

ieve

a b

rea

k e

ve

n r

un r

ate

by t

he e

nd o

f

The

pla

ns fo

r 2

01

9/2

0 w

ill b

e r

evie

we

d t

o

inclu

de

im

pa

ct,

tim

eta

ble

to

ach

ieve

and

critica

l su

cce

ss f

acto

rs a

nd s

ent

to t

he

Fin

ance

, Bus

ines

s an

dIn

vest

men

t Com

mitt

ee R

epor

t

Page 67 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Re

vie

w

20

19

/20.

The

re h

ave

be

en

co

nsid

era

ble

challe

nge

s a

nd

ch

an

ge

s to

th

e w

ay t

he

se

se

rvic

es h

ave

be

en

co

mm

issio

ned

ove

r th

e p

ast fe

w y

ea

rs a

nd

wh

ilst

imp

rove

d o

ve

r th

e c

ou

rse

of

the la

st

ye

ar,

th

e s

erv

ice

is

still

run

nin

g a

con

sid

era

ble

deficit o

f ab

out

£1.3

mill

ion

.

Eve

ry a

rea

of

ph

ysio

the

rap

y h

as b

een

re

vie

we

d lea

din

g t

o

pla

ns to

re

du

ce

se

rvic

e o

ve

rhe

ad

s,

rede

sig

n o

f th

e c

linic

al

mo

de

l of

se

rvic

e d

eliv

ery

an

d r

ecru

itin

g t

o r

e-d

esig

ne

d

wo

rkfo

rce

pla

ns.

Com

mu

nity O

rtho

pae

dic

s h

as s

ho

wn

so

me in

cre

ase

d r

efe

rra

ls a

nd

the

re is p

ha

sed

re

cru

itm

en

t

in p

lace t

o e

xp

an

d th

e w

ork

forc

e a

ltho

ugh

re

cru

itm

en

t

ch

alle

nge

s h

ave

co

mpro

mis

ed t

he

opp

ort

un

ity t

o m

ake

the

mo

st of

pa

ym

en

t by t

ariff

op

po

rtu

nitie

s. T

he

Co

mm

un

ity C

hro

nic

Pa

in s

erv

ice

ha

s fa

ced

sig

nific

an

t

ca

pa

city issu

es. B

ut w

aitin

g t

ime

s in

ea

st

Ken

t w

hic

h

pe

ake

d a

t m

ore

th

an

26

we

eks c

urr

en

tly s

tand

s a

t six

to

twe

lve

we

eks,

wh

ich

is g

oo

d p

rogre

ss. T

he

Co

mm

itte

e

rece

ive

d s

om

e a

ssu

ran

ce

th

at th

ere

are

pla

ns in

pla

ce

to

ad

dre

ss th

e d

eficit in

20

19

/20

bu

t w

ill r

evie

w t

he

situa

tio

n

in s

ix m

on

ths.

Co

mm

itte

e o

ff-lin

e.

In

ad

ditio

n,

som

e f

urt

he

r

cla

rity

will

be

pro

vid

ed

on

th

e p

rop

ose

d

tra

jecto

ry in

te

rms o

f e

rad

ica

tin

g t

he

deficit

an

d th

ere

fore

th

e lik

ely

ou

ttu

rn a

t ye

ar

–en

d.

Ele

ctr

on

ic P

atien

t

Re

co

rd U

pda

te

A p

ap

er

wa

s p

resen

ted

sh

ow

ing t

he

ou

tcom

e o

f th

e

pro

cu

rem

ent

exe

rcis

e a

nd

se

ekin

g t

o m

ove

to

the

ne

xt

ste

p o

f cho

osin

g a

pre

ferr

ed

sup

plie

r. T

he

Com

mitte

e

so

ugh

t fu

rth

er

assu

rance

aro

un

d th

e n

atu

re o

f th

e

pa

ss/fa

il te

st fo

r co

re a

pp

lica

tio

n a

nd

ho

stin

g w

hic

h o

nly

Page 68 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

on

e o

f th

e s

up

plie

rs h

ad

fa

iled

, bu

t a

su

pp

lier

with

a m

uch

hig

he

r u

sa

bili

ty s

co

re th

an

th

e p

refe

rre

d s

up

plie

r a

nd

oth

erw

ise

ve

ry c

lose

in

th

e s

co

red

ele

me

nts

. (

Th

is w

as

su

bse

qu

en

tly p

rese

nte

d a

nd

en

do

rse

d to

pro

ce

ed

with

the

pre

ferr

ed

su

pp

lier

at

the

Boa

rd m

eetin

g t

he n

ext

da

y.)

The

Com

mitte

e w

as c

on

ce

rned

tha

t th

e g

ain

s t

ha

t h

ad

be

en

ma

de

th

rou

gh

enga

gin

g s

taff

th

rou

gh

ou

t th

e p

roce

ss

sh

ou

ld n

ot b

e c

om

pro

mis

ed

by c

ho

osin

g a

pre

ferr

ed

su

pp

lier

with

a r

ela

tive

ly lo

w u

sa

bili

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co

re a

nd

th

e

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mm

itte

e r

ece

ive

d s

om

e a

ssu

ran

ce

ab

ou

t p

lan

s to

ma

na

ge

th

is r

isk.

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rms O

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vie

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sin

ess

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ecid

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to

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is r

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ars

in

a r

ow

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om

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pla

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ee

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air a

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en

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an

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ap

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n o

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llen

ge

s a

s t

o w

he

the

r th

ose

du

tie

s s

ho

uld

rem

ain

at

all.

The

Te

rms o

f R

efe

rence

of

all

com

mitte

es

are

be

ing r

evie

we

d in

th

e lig

ht

of

the

Boa

rd

de

ve

lop

me

nt w

ork

be

ing d

on

e b

y E

Y/P

lum

.

Bu

t in

pa

rtic

ula

r w

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ee

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exp

lore

wh

at

is

me

an

t in

pra

ctice b

y t

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ir r

eco

mm

en

datio

n

tha

t th

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BI

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mitte

e s

hou

ld ta

ke

ove

rsig

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of

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nce

.

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ance

, Bus

ines

s an

dIn

vest

men

t Com

mitt

ee R

epor

t

Page 69 of 177

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey p

oin

ts t

o n

ote

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urt

he

r a

cti

on

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nd

fo

llo

w u

p

form

ally

at

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mitte

e’s

me

etin

g.

Ma

rtin

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ok

Ch

air

, F

ina

nc

e B

us

ine

ss

an

d I

nve

stm

en

t C

om

mit

tee

30

Ap

ril

21

09

Page 70 of 177



Agenda Number: 2.6

Agenda Item Title: Audit and Risk Committee Chair’s Assurance Report

Presenting Officer: Peter Conway, Chair of Audit and Risk Committee


Report Summary

The paper summarises the Audit and Risk Committee meeting held on 15 May 2019.


The Board is asked to receive the Audit and Risk Committee Chair’s Assurance Report.



No ☒


Peter Conway, Non-Executive Director Tel: 01622 211906

Email:

Aud

it an

d R

isk

Com

mitt

eeC

hair’

s A

ssur

ance

Rep

ort

Page 71 of 177

AU

DIT

AN

D R

ISK

CO

MM

ITT

EE

CH

AIR

’S A

SS

UR

AN

CE

RE

PO

RT

Th

is r

ep

ort

is fo

un

ded

on

th

e A

ud

it a

nd

Ris

k C

om

mitte

e (

AR

AC

) m

ee

tin

g h

eld

on

da

te 1

5 M

ay 2

01

9.

Are

a

As

su

ran

ce

Is

su

es

an

d/o

r N

ext

Ste

ps

An

nu

al R

epo

rt a

nd A

ccou

nts

1

) A

cco

unts

: th

e A

RA

C c

onsid

ere

d t

hese

in d

eta

il d

urin

g a

te

lecon

on 9

Ma

y 2

01

9. T

hey h

ave

be

en

pre

pa

red t

o a

hig

h s

tanda

rd a

nd t

here

we

re n

o

sig

nific

ant is

su

es. T

his

is t

he T

rust’s e

igh

th y

ear

of

deliv

ering

a s

urp

lus a

nd

va

lue f

or

mo

ne

y

2)

An

nu

al R

epo

rt: at th

e tim

e o

f th

e m

eetin

g, th

e

Re

po

rt h

ad n

ot

bee

n f

inalis

ed. T

he A

RA

C g

ain

ed

a

ssura

nce o

n th

e R

em

un

era

tion

Sta

tem

ent,

Su

sta

inab

ility

Re

po

rt a

nd A

nnu

al G

ove

rna

nce

Sta

tem

ent.

1)

Su

bje

ct to

fin

al ch

ecks b

y t

he A

uditors

(w

hic

h w

ill b

e

advis

ed t

o t

he B

oard

if

the

re a

re a

ny c

hang

es fro

m th

e

ve

rsio

n c

on

sid

ere

d b

y A

RA

C),

th

e A

cco

unts

are

re

com

me

nd

ed f

or

appro

va

l 2

) P

rovid

ed

th

e B

oard

is h

ap

py w

ith

th

e A

nnu

al R

epo

rt,

the A

RA

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eco

mm

end

s its

appro

va

l in

clu

din

g t

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nnu

al

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ve

rnan

ce S

tate

me

nt.

Ris

k M

ana

gem

ent

1)

Bo

ard

Assura

nce

Fra

me

wo

rk (

BA

F):

deta

iled

action

s s

ho

uld

be fo

rwa

rd lo

okin

g w

ith

co

mp

lete

d

action

s d

ele

ted

2)

Ris

k A

ppetite

: th

e A

RA

C a

gre

ed

with

th

e

Ma

na

ge

me

nt

Com

mitte

e d

iscu

ssio

ns o

n p

urp

ose,

sco

pe

, b

en

efits

and

alig

nm

ent w

ith

th

e B

oard

d

eve

lopm

ent

pro

gra

mm

e

3)

Ris

k M

ana

gem

ent S

tra

teg

y a

nd

Po

licy: fu

rth

er

am

en

dm

ents

we

re s

ug

ge

ste

d.

1)

the B

AF

will

re

ceiv

e f

urt

her

enh

an

cem

ents

in

clu

din

g

how

Bo

ard

su

b-c

om

mitte

es w

ill g

ain

assura

nce o

n t

he

hig

hest risks

2)

Ms N

ata

lie D

avie

s,

Co

rpo

rate

Se

rvic

es D

ire

cto

r to

d

eve

lop p

rop

osals

on r

isk a

pp

etite

deve

lopm

ent n

ext

ste

ps

3)

Th

e R

isk M

ana

ge

me

nt

Str

ate

gy a

nd P

olic

y w

ill b

e r

e-

writt

en t

o m

ake it m

ore

use

r-fr

iend

ly,

refle

ct cu

rren

t g

ove

rna

nce a

rra

ng

em

ents

and d

iffe

rentia

te b

etw

een

str

ate

gy,

polic

y a

nd

pro

ce

ss. It w

ill a

lso

be

alig

ned

with

risk a

pp

etite

de

ve

lopm

ent,

Aud

it an

d R

isk

Com

mitt

eeC

hair’

s A

ssur

ance

Rep

ort

Page 72 of 177

Are

a

As

su

ran

ce

Is

su

es

an

d/o

r N

ext

Ste

ps

Cyb

er

Se

curity

C

urr

ent sta

te a

nd

ong

oin

g a

ssu

rance

we

re

co

nsid

ere

d. T

here

is s

om

e v

ery

go

od

wo

rk g

oin

g

on a

nd

th

e T

rust ca

n b

uild

on

its

go

od p

rog

ress to

date

.

1)

Th

e A

ssu

ran

ce D

ashbo

ard

will

be f

urt

her

deve

lope

d

pro

vid

ing

add

itio

na

l d

eta

il o

n w

hat

by w

hen

2

) T

hird lin

e o

f d

efe

nce a

ssu

ran

ce w

ill b

e c

onsid

ere

d a

t a

futu

re m

eeting

3

) T

here

will

be a

de

ep d

ive

on

busin

ess r

esili

ence

in

Au

gu

st

201

9

4)

Th

ere

will

be a

de

ep d

ive

on

th

ird

part

y r

isks in

D

ecem

ber

201

9.

De

leg

ate

d A

uth

ority

and

E

mp

ow

erm

ent

Th

e A

RA

C id

en

tifie

d in

sta

nce

s w

here

loca

l a

ctions

had

led

to f

inan

cia

l lo

ss. T

his

le

d t

o d

iscu

ssio

n o

f d

evo

lution

, e

mp

ow

erm

en

t, c

entr

alis

ation

, lo

cal

respo

nsib

ilitie

s a

nd

au

tho

rities, e

tc.

Th

e A

RA

C w

ill c

onsid

er

how

best

to g

ain

assura

nce

th

at

De

leg

ate

d A

uth

ority

and

em

po

we

rme

nt is

bein

g d

one

eff

ective

ly.

Pe

ter

Co

nw

ay

Ch

air

, A

ud

it a

nd

Ris

k C

om

mit

tee

Ma

y 2

01

9

Page 73 of 177



Agenda Number: 2.8

Agenda Item Title: Integrated Performance Report Part One

Presenting Officer: Gordon Flack, Director of Finance and Executive Directors


Report Summary

The Integrated Performance Report is presented with the use of Statistical Process Control (SPC) charts. The use of these charts has been presented and agreed through the Executive Team, as well as the revised summary scorecard. It should be noted that the full Finance, Workforce and Quality reports are presented at their respective committees. The report has been produced in collaboration with the Executive Team and their support teams. This report contains the following sections:

• Corporate Scorecard and Summary

• Quality Report

• Workforce Report

• Finance Report

• Operational Report

Historic data has been provided to show trends, with the SPC charts being used to show a rolling 2 year view of performance for each indicator. Upper and Lower control limits are used to indicate a shift in performance over a sustained period and to highlight where performance deviates from these expected ranges. Key Highlights from report A KPI review is in still in process for the indicators included within the corporate scorecard to ensure all the metrics are still relevant with realistic targets and new indicators are added to ensure our business objectives and quality goals are represented. Further changes are expected in the coming months. Changes made this month are:

• Pressure Ulcers KPI, previously Grades 3/4, re-worked in line with national guidance to be reported as all grades attributable to lapses in care

• Rapid Transfer Excess Bed Days (KPIs 3.6) re-named (previously named EK Home First)

Within NHS Improvement's Single Oversight Framework, KCHFT was moved from segment 1 to segment 2. This level is categorised as "targeted support offer" (segment 1 is "maximum autonomy"). The move from segment 1 to segment 2 was

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 74 of 177

as a result of deterioration in performance in RTT and 6 week diagnostics and while RTT is now meeting target, 6 week diagnostics is failing to meet the 1% standard consistently (99% of the waiting list under 6 weeks). See the operations section for details of actions to improve performance to meet the 1% standard and move KCHFT back to segment 1 planned for June 2019 There are 10 KPIs moving favourable in month and 10 moving unfavourably whilst 27 are in normal variation. There are 8 KPIs consistently failing target including the two system targets tracked of A&E wait times at MTW and EKUFT. The others are:

• KPI 1.1 Stop smoking at 84.6% with some improvement with the model under review

• KPI 1.2 Health checks carried out at 87.8% but with strong positive improvement

• KPI 2.8 Contract activity at 97.8% for 2018-19 and activity targets have been rebased for 2019-20 where necessary e.g. reflecting changes in service model and demography.

• KPI 4.1 Percentage of LTC/ICT Face to Face Contacts carried out in a clinic (target to increase) at 3.7% against 5% target and a measure that is under review for its usefulness.

• KPI 5.3 Turnover (planned and unplanned) at 17.3% against 16.5% target and hovering around the lower control limit.

• KPI 5.6 Stability (% of workforce who have been with the trust for 12 months or more) at 84.7% marginally below the 85% target.

Of the 9 indicators not measured by SPC charts 7 are achieving target and the two that have not are KPI 3.3 CQUIN for Q4 18-19 meeting 86.6% and KPI 2.18 Research: Participants recruited to national portfolio studies with only 18 in April against a 300 annual target or 25 per month which represents a stretch target as performance has historically been good. Quality

• 4 lapses in care identified and pending investigation which

resulted in patients developing pressure ulcer.

• Pressure ulcers identified as Category 2; Category 3. Category

4 and ungradable. The Category 4 is under investigation to

determine whether it meets the serious incident criteria.

• There was one serious incident reported in April for Canterbury

Community Nursing Team relating to a pressure ulcer incident

during March.

• Majority of incidents reported due to ‘administration or supply of

a medicine from a clinical area’.

Workforce

• Increase in turnover in March 2019 but since dropped back to

previous levels. March increase was due to TUPE transfer.

Page 75 of 177

• Sickness absence in March dropped to 3.71% with slight

increase in April to 3.85%.

• Vacancy rates have increased to 9.68% in April.

• An increase in bank shift requests over the last year.

Finance

• £231k of savings for April 19 against risk rated plan of £438k.

£207k behind target.

• Capital Expenditure spend to April was £132k against YTD plan

£169k (78% achieved)

• End of April the Trust achieved surplus £216k (1.1%)

Operations

• NHS Health Checks and Stop Smoking Quits now showing

period of positive variation following recalculation of Control

limits due to new data system.

• New birth visits appears to be experiencing the beginning of an

adverse trend with month 12 below target hoping this will

improve following data cleanse (currently 89%)

• Referral to treatment incomplete wait times for consultant-led

services performing well with 96.4% of waits are now below 18

weeks with the average is 20.8 weeks.

• Audiology 6 week diagnostics has been performing above the

mean for the last 8 months. Although recently marginally below

the challenging 99% target within 6 weeks. The Audiology team

currently has 11.8% of clinical staff on maternity leave and 21%

on term time only contracts. 1 permanent member of staff has

been recruited with another audiologist for the Bank. A tracking

process has also been implemented to forecast and prevent

breaches.

• The End of Life indicator is new for 18/19 with no data available

prior to April 2018. Performance for the year to date equates to

39.7% with the care planning window being monitored and

performance is improving achieving target for first time in M12.

• Delayed Transfers of Care (DTOCs) KCHFT target to reduce to

average 7 per day in East & West Kent which is a rate of 9.5%.

Position has improved month on month with M12 above target at

11.1%.

• Looked After Children the Initial Health Assessment is achieving

target most months. Performance is variable due to late

requests from KCC. The Review Health Assessment has met

target and improving.

• Bed Occupancy is showing varying trend but with no cause for

concern. Months 5-7 and 9 were below target and lower than

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 76 of 177

mean level of occupancy. With improvement to the M10-12

position above mean the dip in performance does not indicate a

concern at this stage.


The Board is asked to note this report.


Not Applicable


No ☒


Nick Plummer, Assistant Director of Performance and Business Intelligence

Tel: 01233 667722


Page 77 of 177

Integrated

Perform

ance Rep

ort 2

019/20

May 2019 repo

rt

Part One

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 78 of 177

Con

tent

s

P

age

3

P

age

4

Glo

ssar

y of

Ter

ms

Ass

uran

ce o

n St

rate

gic

Goa

ls

Pag

e 5-

8

Cor

pora

te S

core

card

Pag

e 9-

14

Q

ualit

y R

epor

t

Pa

ge 1

5-20

Wor

kfor

ce R

epor

t P

age

21

F

inan

ce R

epor

t

Pa

ge 2

2-36

Ope

ratio

nal R

epor

t P

age

37

A

ppen

dix

1 –

SPC

Cha

rts

Page 79 of 177

Glo

ssar

y of

Ter

ms

SPC

– S

tatis

tical

Pro

cess

Con

trol

LTC

– L

ong

Term

Con

ditio

ns N

ursi

ng S

ervi

ce

ICT

– In

term

edia

te C

are

Ser

vice

Qua

lity

Scor

ecar

d –

Wei

ghte

d m

onth

ly ri

sk ra

ted

qual

ity s

core

card

s

C.D

iff –

Clo

strid

ium

Diff

icile

MR

SA –

Met

hici

llin

Res

ista

nt S

taph

yloc

occu

s A

ureu

s

MIU

– M

inor

Inju

ry U

nit

RTT

– R

efer

ral t

o Tr

eatm

ent

GU

M –

Gen

itour

inar

y M

edic

ine

CQ

UIN

– C

omm

issi

onin

g fo

r Qua

lity

and

Inno

vatio

n

MTW

– M

aids

tone

and

Ton

brid

ge W

ells

NH

S T

rust

WTE

– W

hole

Tim

e E

quiv

alen

t

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 80 of 177

Non

-SPC

KPI

on

targ

etN

on-S

PC K

PI p

erfo

rman

ce u

nder

revi

ewN

on-S

PC K

PI o

ff ta

rget

Spec

ial C

ause

Not

e - t

his

indi

cate

s th

at s

peci

al c

ause

var

iatio

n is

occ

urrin

g in

a K

PI,

with

the

varia

tion

bein

g in

a fa

vour

able

dire

ctio

n.

Hig

h ( H

)spe

cial

cau

se n

ote

indi

cate

s th

at v

aria

tion

is u

pwar

ds in

a K

PI w

here

per

form

ance

is id

eally

abo

ve a

targ

et li

ne e

.g. N

ew B

irth

Vis

its. L

ow (L

) spe

cial

cau

se n

ote

is w

here

the

varia

nce

is d

ownw

ards

for a

bel

ow ta

rget

KP

I e.g

. DN

A R

ate.

1.0

Ass

uran

ce o

n St

rate

gic

Goa

ls

Spec

ial C

ause

Con

cern

- th

is in

dica

tes

that

spe

cial

cau

se v

aria

tion

is o

ccur

ring

in a

KP

I, w

ith th

e va

riatio

n be

ing

in a

n ad

vers

e di

rect

ion.

Lo

w ( L

) spe

cial

cau

se c

once

rn in

dica

tes

that

var

iatio

n is

dow

nwar

ds in

a K

PI w

here

per

form

ance

is id

eally

abo

ve a

targ

et li

ne e

.g. N

ew

Birt

h V

isits

. Hig

h sp

ecia

l cau

se c

once

rn (H

) is

whe

re th

e va

rianc

e is

upw

ards

for a

bel

ow ta

rget

line

KP

I e.g

. DN

A R

ate

Ove

rall,

of t

he 4

1 in

dica

tors

that

we

are

able

to p

lot o

n a

stat

istic

al p

roce

ss c

ontro

l (SP

C) c

hart,

24.

4% a

re e

xper

ienc

ing

favo

urab

le in

-mon

th v

aria

tion

(10,

KPI

s 1.

1, 1

.2, 2

.5, 2

.8, 2

.9, 2

.24,

3.4

, 3.6

, 5.4

and

5.6

), 9.

8% a

re s

how

ing

in- m

onth

adv

erse

var

ianc

e (4

, KPI

s 2.

15, 2

.21,

4.3

and

4.4

) and

the

rem

aini

ng 6

5.9%

(27)

are

sho

win

g no

rmal

var

iatio

n.

26.8

% o

f the

KPI

s ar

e co

nsis

tent

ly a

chie

ving

targ

et (K

PIs

1.4,

2.1

2, 2

.13,

2.1

6, 2

.19,

2.2

0, 2

.23,

3.2

, 4.3

, 4.5

and

19

.5%

(KPI

s 1.

1, 1

.2, 2

.8, 3

.5, 3

.7, 4

.1, 5

.3 a

nd 5

.6) a

re c

onsi

sten

tly fa

iling

,

w

ith th

e re

mai

ning

53.

7% v

aria

bly

achi

evin

g ta

rget

with

no

trend

of c

onsi

sten

t ach

ieve

men

t/fai

lure

.

Of t

he 9

indi

cato

rs w

here

an

SPC

cha

rt is

not

app

ropr

iate

, 77.

8% (7

) hav

e ac

hiev

ed th

e in

-mon

th ta

rget

.

With

in N

HS

Impr

ovem

ent's

Sin

gle

Ove

rsig

ht F

ram

ewor

k, K

CH

FT h

ave

been

mov

ed fr

om s

egm

ent 1

to s

egm

ent 2

. Thi

s le

vel i

s ca

tego

rised

as

"tar

gete

d su

ppor

t offe

r" (s

egm

ent 1

is "

max

imum

aut

onom

y").

The

mov

e fr

om s

egm

ent 1

to s

egm

ent 2

is a

s a

resu

lt of

det

erio

ratio

n in

per

form

ance

in R

TT a

nd 6

wee

k di

agno

stic

s an

d w

hile

RTT

is n

ow m

eetin

g ta

rget

, 6 w

eek

diag

nost

ics

is fa

iling

to m

eet t

he 1

%

stan

dard

(99%

of t

he w

aitin

g lis

t und

er 6

wee

ks).

See

the

oper

atio

ns s

ectio

n fo

r det

ails

of a

ctio

ns to

impr

ove

perf

orm

ance

to m

eet t

he 1

% s

tand

ard

and

mov

e K

CH

FT b

ack

to s

egm

ent 1

.

0%20%

40%

60%

80%

100%

Preven

t Ill He

alth

Deliver high‐qu

ality

care at

home an

d in th

e commun

ity

Integrate Services

Develop

Sustainab

le Services

Be The

Best E

mployer

Favourable Variance KP

Is (%

)

0%20%

40%

60%

80%

100%

Preven

t Ill Health

Deliver high‐qu

ality

care at

home an

d in th

e commun

ity

Integrate Services

Develop

Sustainab

le Services

Be The

Best E

mployer

Common

Variance KP

Is (%

)

0%20%

40%

60%

80%

100%

Preven

t Ill He

alth

Deliver high‐qu

ality

care

at hom

e an

d in th

ecommun

ity

Integrate Services

Develop

Sustainab

leServices

Be The

Best E

mployer

Adverse Va

riance KP

Is (%

)

Page 81 of 177

Met

ricLo

wer

Mea

nU

pper

KPI

1.1

Sto

p Sm

okin

g - 4

wee

k Q

uitte

rsM

arch

201

984

.6%

Fail

100%

71%

83%

96%

KPI i

s ex

perie

ncin

g hi

gh p

ositi

ve v

aria

tion,

w

ith th

e la

st 9

mon

ths

perfo

rmin

g ab

ove

the

mea

n

KPI i

s cu

rren

tly u

nlik

ely

to m

eet t

arge

t with

out

a pr

oces

s ch

ange

with

the

uppe

r con

trol l

imit

belo

w th

e ta

rget

leve

l

KPI

1.2

Hea

lth C

heck

s C

arrie

d O

ut

Mar

ch 2

019

87.8

%Fa

il10

0%60

%74

%88

%KP

I is

expe

rienc

ing

a pe

riod

of p

ositi

ve

spec

ial c

ause

var

iatio

n w

ith th

e la

st 7

mon

ths

mov

ing

in a

pos

itive

tren

d

KPI i

s cu

rren

tly u

nlik

ely

to m

eet t

arge

t with

out

a pr

oces

s ch

ange

with

the

uppe

r con

trol l

imit

at th

en ta

rget

leve

l

KPI

1.3

Hea

lth V

isiti

ng -

New

Birt

h Vi

sits

Und

erta

ken

by 1

4 da

ysM

arch

201

989

.0%

90%

89%

92%

96%

KPI w

ill m

ostly

ach

ieve

targ

et b

ut th

e co

ntro

l lim

its in

dica

te th

at fa

iling

the

targ

et is

a

poss

ibilt

y w

ithin

the

curr

ent p

roce

ss

KPI

1.4

Hea

lth V

isiti

ng -

6-8

wee

k ch

eck

unde

rtak

en b

y 8

wee

ksM

arch

201

987

.0%

80%

85%

90%

94%

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et w

ith

the

low

er li

mit

abov

e th

e ta

rget

. Thi

s su

gges

ts

faili

ng to

mee

t the

targ

et is

unl

ikel

y to

occ

ur.

KPI

1.5

(N) S

choo

l Hea

lth -

Rec

eptio

n C

hild

ren

Scre

ened

for

Hei

ght a

nd W

eigh

tA

pril

2019

94.0

%90

% (y

ear

end)

KPI i

s cu

mul

ativ

e th

roug

h th

e sc

hool

yea

rKP

I has

ach

ieve

d th

e ta

rget

for t

he 1

8/19

sc

hool

Yea

r

KPI

1.6

(N) S

choo

l Hea

lth -

Year

6

Chi

ldre

n Sc

reen

ed fo

r Hei

ght a

nd

Wei

ght

Apr

il 20

1993

.7%

90%

(yea

r en

d)KP

I is

cum

ulat

ive

thro

ugh

the

scho

ol y

ear

KPI h

as a

chie

ved

the

targ

et fo

r the

18/

19

scho

ol Y

ear

KPI

1.7

LTC

/ICT

- Adm

issi

ons

Avoi

danc

e (u

sing

agr

eed

crite

ria)

Mar

ch 2

019

6385

5257

4414

5778

7142

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

1.8

% L

TC/IC

T pa

tient

s th

at h

ad

at le

ast o

ne v

isit

whi

ch A

void

ed a

H

ospi

tal A

dmis

sion

Mar

ch 2

019

18.8

%15

.0%

12.8

%16

.6%

20.5

%KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

Met

ric

18/1

9 YT

D

Actu

al

18/1

9 YT

D

Targ

etK

PI 2

.1 N

umbe

r of T

eam

s w

ith a

n Am

ber o

r Red

Qua

lity

Scor

ecar

d R

atin

g M

arch

201

90

16

8Th

ere

have

bee

n 6

Ambe

r/Red

ratin

gs fo

r the

fin

anci

al y

ear t

o da

te w

ith A

pril

(2) b

eing

the

high

est m

onth

KPI

2.2

(N) N

ever

Eve

nts

Apr

il 20

190

00

0N

o ne

ver e

vent

s ex

perie

nced

this

yea

r. La

st

even

t in

Dec

embe

r 201

6

KPI

2.3

(N) I

nfec

tion

Con

trol

: C.D

iffA

pril

2019

00

10

Last

cas

e in

Jan

uary

201

9

KPI

2.4

(N) I

nfec

tion

Con

trol

: MR

SA

case

s w

here

KC

HFT

pro

vide

d ca

reA

pril

2019

00

40

4 ca

ses

in 2

018-

19 (O

ne in

eac

h of

Apr

il,

Augu

st, S

epte

mbe

r and

Oct

ober

)

Ken

t Com

mun

ity H

ealth

NH

S Fo

unda

tion

Trus

t - C

orpo

rate

Sco

reca

rd

Actu

alTa

rget

Com

men

tary

1. Prevent Ill Health

Actu

alTa

rget

Com

men

tary

*NO

TE: N

atio

nal T

arge

ts a

re d

enot

ed b

y (N

) in

the

KPI

nam

e2. Deliver high-quality care at home and in

the community

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 82 of 177

Ken

t Com

mun

ity H

ealth

NH

S Fo

unda

tion

Trus

t - C

orpo

rate

Sco

reca

rd*N

OTE

: Nat

iona

l Tar

gets

are

den

oted

by

(N) i

n th

e K

PI n

ame

Met

ricLo

wer

Mea

nU

pper

KPI

2.5

Inpa

tient

Fal

ls (M

oder

ate

and

Seve

re H

arm

) per

100

0 O

ccup

ied

Bed

Day

sA

pril

2019

0.00

0.19

-0.1

80.

040.

25KP

I is

expe

rienc

ing

low

pos

itive

var

iatio

n, w

ith

the

last

10

mon

ths

expe

rienc

ing

no m

oder

atre

an

d se

vere

falls

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

2.6

Avo

idab

le P

ress

ure

Ulc

ers

- La

pses

in C

are

Apr

il 20

194

1-1

.71.

64.

9KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

.

KPI

2.7

Per

cent

age

of E

nd o

f Life

pa

tient

s w

ith a

n up

date

d Pe

rson

alis

ed C

are

Plan

(PC

P)A

pril

2019

60.4

%60

.0%

Cur

rent

ly to

o fe

w d

ata

poin

ts to

plo

t an

SPC

ch

art

KPI i

s co

nsis

tent

ly fa

iling

the

targ

et, w

ith s

igns

of

impr

ovem

ent.

This

KPI

is a

new

targ

et a

nd

data

col

lect

ion.

See

Ope

ratio

nal R

epor

t for

m

ore

deta

il

KPI

2.8

Con

trac

tual

Act

ivity

: YTD

as

% o

f YTD

Tar

get

Mar

ch 2

019

97.8

%10

0.0%

95.8

%97

.8%

99.8

%KP

I is

expe

rienc

ing

high

pos

itive

var

iatio

n,

with

the

last

10

mon

ths

perfo

rmin

g ab

ove

the

mea

n

KPI w

ill c

onsi

sten

tly fa

iling

the

targ

et, w

ith th

e up

per l

imit

belo

w th

e ta

rget

. Thi

s su

gges

ts

achi

evem

ent i

s lik

ely

to b

e do

wn

to c

hanc

e w

ithou

t a p

roce

ss o

r tar

get c

hang

e

KPI

2.9

Tru

stw

ide

Did

Not

Atte

nd

Rat

e: D

NAs

as

a %

of t

otal

act

ivity

Mar

ch 2

019

3.1%

4.0%

3.1%

3.6%

4.1%

KPI i

s ex

perie

ncin

g lo

w p

ositi

ve v

aria

tion,

with

th

e la

st 7

mon

ths

perfo

rmin

g be

low

the

mea

n

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs.H

owev

er, t

he ta

rget

is n

ear t

he

uppe

r lim

it su

gges

ting

failu

re to

mee

t tar

get i

s un

likel

y.

KPI

2.1

0 LT

C/IC

T R

espo

nse

Tim

es

Met

(%) (

requ

ired

time

varie

s by

pa

tient

)M

arch

201

998

.4%

95.0

%95

.0%

96.9

%98

.8%

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs, a

lthou

gh fa

ilure

is u

nlik

ely

with

th

e ta

rget

mar

gina

lly a

bove

the

low

er li

mit

KPI

2.1

1 Pe

rcen

tage

of R

apid

R

espo

nse

Con

sulta

tions

sta

rted

w

ithin

2hr

s of

refe

rral

acc

epta

nce

Mar

ch 2

019

96.4

%95

.0%

88.9

%94

.8%

100.

7%KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

KPI

2.1

2 (N

) Tot

al T

ime

in M

IUs:

Le

ss th

an 4

hou

rsM

arch

201

999

.5%

95.0

%99

.5%

99.8

%10

0.1%

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et w

ith

the

targ

et s

igni

fican

tly b

elow

the

low

er li

mit

KPI

2.1

3 (N

) Con

sulta

nt L

ed 1

8 W

eek

Ref

erra

l to

Trea

tmen

t (R

TT) -

In

com

plet

e Pa

thw

ays

Mar

ch 2

019

95.9

%92

.0%

92.5

%95

.0%

97.6

%KP

I is

now

sho

win

g no

rmal

var

iatio

n fo

llow

ing

a pe

riod

of n

egat

ive

varia

tion

belo

w th

e m

ean

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et w

ith

the

low

er li

mit

abov

e th

e ta

rget

, sug

gest

ing

failu

re to

mee

t tar

get i

s an

unl

ikel

y ev

ent.

KPI

2.1

4 (N

) Con

sulta

nt L

ed 1

8 W

eek

Ref

erra

l to

Trea

tmen

t (R

TT) -

W

aitin

g Li

st S

ize

(>18

wee

ks)

Mar

ch 2

019

216

532

9437

064

6KP

I is

now

sho

win

g no

rmal

var

iatio

n fo

llow

ing

a pe

riod

of n

egat

ive

varia

tion

belo

w th

e m

ean

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

2.1

5 AH

P (N

on-C

onsu

ltant

Led

) R

efer

ral t

o Tr

eatm

ent T

imes

(RTT

) M

arch

201

989

.5%

92.0

%90

.6%

93.8

%97

.1%

KPI i

s ex

perie

ncin

g lo

w a

dver

se v

aria

tion

with

th

e la

st 1

1 m

onth

s be

low

the

mea

n, a

lthou

gh

show

ing

sign

s of

impr

ovem

ent

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

2.1

6 (N

) Acc

ess

to G

UM

: with

in

48 h

ours

Mar

ch 2

019

100.

0%10

0.0%

100.

0%10

0.0%

100.

0%

Con

sist

ently

mee

ting

targ

et. F

ailu

re to

mee

t ta

rget

wou

ld b

e co

nsid

ered

a c

hanc

e ev

ent

with

out a

pro

cess

cha

nge.

Has

met

targ

et fo

r th

e la

st 5

yea

rs

KPI

2.1

7 Le

ngth

of C

omm

unity

H

ospi

tal I

npat

ient

Sta

y (M

edia

n Av

erag

e)

Mar

ch 2

019

22.7

21.0

15.0

20.3

25.6

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

2.1

8 R

esea

rch:

Par

ticip

ants

re

crui

ted

to n

atio

nal p

ortfo

lio

stud

ies

(Yea

r to

Dat

e)A

pril

2019

1830

0KP

I is

cum

ulat

ive

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et o

f 75

per q

uarte

r

Actu

alTa

rget

Com

men

tary

2. Deliver high-quality care at home and in the community

Page 83 of 177

Ken

t Com

mun

ity H

ealth

NH

S Fo

unda

tion

Trus

t - C

orpo

rate

Sco

reca

rd*N

OTE

: Nat

iona

l Tar

gets

are

den

oted

by

(N) i

n th

e K

PI n

ame

Met

ricLo

wer

Mea

nU

pper

KPI

2.1

9 Pe

rcen

tage

of p

atie

nt

goal

s ac

hiev

ed u

pon

disc

harg

e fo

r pl

anne

d an

d th

erap

y se

rvic

esM

arch

201

991

.2%

80.0

%85

.8%

90.6

%95

.4%

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et a

s th

e lo

wer

lim

it is

sig

nifc

antly

abo

ve th

e ta

rget

. Th

is w

ould

mea

n fa

ilure

to m

eet t

arge

t wou

ld

likel

y be

due

to c

hanc

e

KPI

2.2

0 (N

) Frie

nds

and

Fam

ily -

Perc

enta

ge o

f Pat

ient

s w

ho w

ould

R

ecom

men

d K

CH

FTA

pril

2019

97.6

%95

.0%

95.4

%97

.1%

98.7

%KP

I is

cons

iste

ntly

ach

ievi

ng th

e ta

rget

as

the

low

er li

mit

is a

bove

the

targ

et. T

his

sugg

ests

fa

iling

to m

eet t

arge

t is

an u

nlik

ely

even

t.

KPI

2.2

1 Fr

iend

s an

d Fa

mily

Tes

t (P

atie

nts

surv

eyed

for M

IUs

&

Com

m. H

osp)

- R

espo

nse

Rat

eA

pril

2019

15.4

%20

.0%

11.7

%16

.8%

21.8

%KP

I is

expe

rienc

ing

low

adv

erse

var

iatio

n w

ith

the

last

8 m

onth

s pe

rform

ing

belo

w th

e m

ean

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

2.2

2 C

linic

al A

udit:

% o

f aud

it re

com

men

datio

ns im

plem

ente

d by

de

adlin

eA

pril

2019

72.0

%45

.0%

49.8

%75

.7%

101.

7%KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

KPI

2.2

3 (N

) NIC

E Te

chni

cal

Appr

aisa

ls re

view

ed b

y re

quire

d tim

e sc

ales

follo

win

g re

view

Apr

il 20

1910

0.0%

100.

0%10

0.0%

100.

0%10

0.0%

Con

sist

ently

mee

ting

targ

et. F

ailu

re to

mee

t ta

rget

wou

ld b

e co

nsid

ered

a c

hanc

e ev

ent

with

out a

pro

cess

cha

nge.

Has

met

targ

et fo

r th

e la

st 5

yea

rs

KPI

2.2

4 (N

) 6 W

eek

Dia

gnos

tics

Apr

il 20

1996

.8%

99.0

%80

.8%

92.8

%10

4.9%

KPI i

s ex

perie

ncin

g hi

gh p

ositi

ve v

aria

tion,

w

ith th

e la

st 8

mon

ths

perfo

rmin

g ab

ove

the

mea

n

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

Met

ricLo

wer

Mea

nU

pper

KPI

3.1

Del

ayed

Tra

nsfe

rs o

f Car

e fr

om a

Com

mun

ity H

ospi

tal b

ed a

s a

% o

f Occ

upie

d B

ed D

ays

Mar

ch 2

019

11.1

%9.

5%4.

8%10

.0%

15.2

%KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

KPI

3.2

Per

cent

age

of L

TC/IC

T R

efer

rals

com

ing

from

with

in

KC

HFT

Mar

ch 2

019

15.1

%10

.0%

14.8

%18

.8%

22.9

%KP

I is

cons

iste

ntly

ach

ievi

ng th

e ta

rget

with

th

e ta

rget

con

side

rabl

y be

low

the

low

er li

mit

KPI

3.3

CQ

UIN

s (%

of C

QU

IN m

oney

ac

hiev

ed to

18/

19 Q

4)M

arch

201

986

.6%

100%

SPC

not

app

ropr

iate

for t

his

met

ricKP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

, with

3 o

f the

last

8 q

uarte

rs

achi

evin

g 10

0%

KPI

3.4

Hom

e Fi

rst i

mpa

ct -

redu

ctio

n in

ave

rage

exc

ess

bed

days

(Wes

t Ken

t)Fe

brua

ry 2

019

0.18

0.20

-0.1

20.

631.

38KP

I is

expe

rienc

ing

low

pos

itive

var

iatio

n w

ith

the

last

9 m

onth

s pe

rform

ing

belo

w th

e m

ean

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

3.5

(N) A

vera

ge w

ait t

ime

(min

utes

) for

MTW

Acc

iden

t and

Em

erge

ncy

Serv

ices

Febr

uary

201

933

924

026

430

835

3

KPI i

s co

nsis

tent

ly fa

iling

the

targ

et a

s th

e lo

wer

lim

it is

abo

ve th

e ta

rget

. Thi

s su

gges

ts

perfo

rman

ce is

unl

ikel

y to

dec

reas

e to

mee

t ta

r get

with

out a

pro

cess

cha

nge

KPI

3.6

Rap

id T

rans

fer i

mpa

ct -

redu

ctio

n in

ave

rage

exc

ess

bed

days

(Eas

t Ken

t)Fe

brua

ry 2

019

0.07

0.20

-0.1

00.

190.

47KP

I is

expe

rienc

ing

low

pos

itive

var

iatio

n w

ith

the

last

9 m

onth

s pe

rform

ing

belo

w th

e m

ean

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

3.7

(N) A

vera

ge w

ait t

ime

(min

utes

) for

EK

HU

FT A

ccid

ent a

nd

Emer

genc

y Se

rvic

esFe

brua

ry 2

019

391

240

282

348

414

KPI i

s co

nsis

tent

ly fa

iling

the

targ

et a

s th

e lo

wer

lim

it is

abo

ve th

e ta

rget

. Thi

s su

gges

ts

perfo

rman

ce is

unl

ikel

y to

dec

reas

e to

mee

t ta

rget

with

out a

pro

cess

cha

nge

3. Integrate Services2. Deliver high-quality care at home and in the community

Actu

alTa

rget

Com

men

tary

Actu

alTa

rget

Com

men

tary

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 84 of 177

Ken

t Com

mun

ity H

ealth

NH

S Fo

unda

tion

Trus

t - C

orpo

rate

Sco

reca

rd*N

OTE

: Nat

iona

l Tar

gets

are

den

oted

by

(N) i

n th

e K

PI n

ame

Met

ricLo

wer

Mea

nU

pper

KPI

4.1

Per

cent

age

of L

TC/IC

T Fa

ce

to F

ace

Con

tact

s ca

rrie

d ou

t in

a cl

inic

(tar

get t

o in

crea

se)

Mar

ch 2

019

3.7%

5.0%

2.8%

3.7%

4.6%

KPI i

s co

nsis

tent

ly fa

iling

the

targ

et w

ith th

e ta

rget

abo

ve th

e up

per l

imit.

Thi

s su

gges

t ac

hiev

ing

targ

et w

ithou

t a p

roce

ss c

hang

e w

ill

be d

own

to c

hanc

e an

d is

bei

n g re

view

ed

KPI

4.2

Bed

Occ

upan

cy: O

ccup

ied

Bed

Day

s as

a %

of a

vaila

ble

bed

days

Mar

ch 2

019

91.2

%87

.0%

84.1

%89

.4%

94.6

%KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

KPI

4.3

Inco

me

& E

xpen

ditu

re -

Surp

lus

(%)

Apr

il 20

191.

1%1.

0%1.

1%1.

5%1.

9%KP

I is

expe

rienc

ing

low

neg

ativ

e va

riatio

n w

ith

the

curr

ent m

onth

per

form

ing

belo

w th

e lo

wer

co

ntro

l lim

it

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et a

s th

e lo

wer

lim

it is

abo

ve th

e ta

rget

. Thi

s su

gges

ts

perfo

rman

ce is

unl

ikel

y to

dec

reas

e to

bel

ow

tar g

et

KPI

4.4

Cos

t Im

prov

emen

t Pla

ns

(CIP

) Ach

ieve

d ag

ains

t Pla

n (%

)A

pril

2019

52.7

%10

0.0%

65.3

%83

.0%

100.

7%KP

I is

expe

rienc

ing

low

neg

ativ

e va

riatio

n w

ith

the

curr

ent m

onth

per

form

ing

belo

w th

e lo

wer

co

ntro

l lim

it

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs, e

xpec

ially

ear

ly in

eac

h fin

anci

al y

ear

KPI

4.5

Ext

erna

l Age

ncy

spen

d ag

ains

t Tra

ject

ory

(£00

0s)

Apr

il 20

19£4

96,4

24£6

28,0

00£1

81,2

62£3

99,5

85£6

17,9

08

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et a

s th

e up

per l

imit

is b

elow

the

targ

et. T

his

sugg

ests

pe

rform

ance

is u

nlik

ely

to in

crea

se to

abo

ve

tar g

et

Met

ricLo

wer

Mea

nU

pper

KPI

5.1

Sic

knes

s R

ate

Apr

il 20

193.

85%

3.90

%3.

81%

4.47

%5.

13%

SPC

sug

gest

s ta

rget

is u

nlik

ely

ot b

e ac

hiev

ed

regu

larly

and

is b

eing

revi

ewed

KPI

5.2

Sic

knes

s R

ate

(Str

ess

and

Anxi

ety)

Apr

il 20

191.

01%

1.15

%0.

99%

1.29

%1.

59%

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

5.3

Tur

nove

r (pl

anne

d an

d un

plan

ned)

Apr

il 20

1917

.29%

16.4

7%17

.12%

18.4

1%19

.70%

KPI i

s co

nsis

tent

ly fa

iling

the

targ

et w

ith th

e ta

rget

bel

ow th

e lo

wer

lim

it. T

his

sugg

est

achi

evin

g ta

rget

with

out a

pro

cess

cha

nge

will

be

dow

n to

cha

nce

and

need

s re

view

KPI

5.4

Man

dato

ry T

rain

ing:

C

ombi

ned

Com

plia

nce

Rat

eA

pril

2019

96.0

%85

.0%

94.0

%95

.4%

96.8

%KP

I is

expe

rienc

ing

high

pos

itive

var

iatio

n w

ith

the

last

7 m

onth

s pe

rform

ing

abov

e th

e m

ean

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et a

s th

e lo

wer

lim

it is

abo

ve th

e ta

rget

KPI

5.5

Gro

ss V

acan

cy F

acto

r (%

of

the

budg

eted

WTE

unf

illed

by

perm

anen

t wor

kfor

ce)

Apr

il 20

199.

7%9.

7%6.

8%9.

0%11

.2%

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

5.6

Sta

bilit

y (%

of w

orkf

orce

w

ho h

ave

been

with

the

trus

t for

12

mon

ths

or m

ore)

Apr

il 20

1984

.7%

85.0

%81

.4%

82.8

%84

.3%

KPI i

s ex

perie

ncin

g hi

gh p

ositi

ve v

aria

tion

with

th

e la

st 7

mon

ths

perfo

rmin

g ab

ove

the

mea

n

New

targ

et h

as b

een

set a

t 85%

. Whi

le th

e ta

rget

cur

rent

ly s

its a

bove

the

uppe

r con

trol

limit,

cur

rent

per

form

ance

sho

uld

see

the

uppe

r lim

it in

crea

se a

bove

targ

et

Actu

alTa

rget

Com

men

tary

5. Be The Best Employer4. Develop sustainable services

Actu

alTa

rget

Com

men

tary

Page 85 of 177

2.0

2.1

AsQ

ualit

y R

ess

uran

ce o

n Sa

Thre

e co

mw

eigh

ted

riW

ards

inc

rpa

tient

s w

it W

est V

iew

and

the

As

impa

cted

oepor

t af

er S

taffi

ng

mun

ity h

ospi

tal s

sk s

core

of 0

.27

reas

e th

e us

e o

th in

crea

sed

cog

w is

par

t of K

CH

ssoc

iate

Dire

ctor

on A

pril’

s av

erag

s ha

d a

shift

fill

7 bo

th a

re b

elow

of h

ealth

car

e a

gniti

ve im

pairm

e

FT s

ince

Apr

il 2

r of

Gov

erna

nce

ge m

onth

ly s

hifts

rate

bet

wee

n 7

w th

e av

erag

e w

eas

sist

ants

to

exen

t dur

ing

this

tim

2019

and

ther

efe

have

a s

ched

us

data

alo

ng w

ith71.7

and

89.

2. E

eigh

ted

risk

scor

xpan

d ge

nera

l c

me.

fore

incl

uded

wit

uled

vis

it w

ith th

h E

denb

ridge

an

Ede

nbrid

ge h

as

re.

capa

city

esp

ecia

thin

the

com

mu

he te

am. D

ue to

d

QV

MH

a w

eigh

ted

risk

ally

dur

ing

nigh

t

nity

hos

pita

ls d

ath

e va

canc

y ra

tk sc

ore

of 0

.14

a

t sh

ifts.

Thi

s is

ata

set.

The

De

te a

nd lo

w R

N’san

d Q

VM

H h

as

done

to

supp

o

eput

y C

hief

Nur

ss

on s

hift

this

ha

a ort

se

as

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 86 of 177

2.2

A

2.3

A

ssur

ance

on

P r

Dur

ing

Apr

ulce

r. Th

e sin

vest

igat

io

Ther

e w

ere

Ther

e w

asoc

curr

ed d

u

ssur

ance

on

Fa

Ther

e w

ere

duce

d s ire

ssur

e U

lcer

s

il 20

19, 4

occ

asse

wer

e id

entif

ied

on to

det

erm

ine

w

e no

inci

dent

s re

s on

e se

rious

inur

ing

Mar

ch.

alls

re 6

3 fa

lls re

por

ince

Q1

May

20io

ns o

f lap

ses

ind

as a

cat

egor

y w

heth

er it

mee

ts

epor

ted

whe

re p

r

ncid

ent

repo

rted

rted

acro

ss K

CH

17 a

nd re

mai

ns n

care

wer

e id

en2;

cat

egor

y 3;

cs

the

serio

us in

c

ress

ure

ulce

r da

in A

pril

for

Ca

HFT

in A

pril

2019

cons

iste

ntly

lownt

ified

and

pen

dica

tego

ry 4

and

aci

dent

crit

eria

.

amag

e w

as c

aus

ante

rbur

y C

omm

9, n

one

of w

hich

w w

ith a

slig

ht ri

sng in

vest

igat

ion

an u

ngra

dabl

e. T

sed

by a

med

ica

mun

ity N

ursi

ng t

e

wer

e fo

und

to b

se in

Dec

embe

r . Thi

s re

sulte

d in

The

cate

gory

4 p

l dev

ice.

eam

rel

atin

g to

be a

void

able

. Th

and

Febr

uary

w

n pa

tient

s de

vel

pres

sure

ulc

er is

a pr

essu

re u

lc

he n

umbe

r of a

vow

hich

is c

omm

on

opin

g a

pres

sur

cur

rent

ly u

nder

er in

cide

nt w

hic

oida

ble

falls

has

n ca

use

varia

tion

re

r ch

s n.

Page 87 of 177

2.4

Ass

uran

ce o

n M

The

maj

ori

patie

nt’s

ow

adm

inis

tere

Med

icat

ion

inci

d

ty o

f in

cide

nts

wn

hom

es a

nd

ed’.

dent

s

repo

rted

rela

te

31%

occ

urre

d ito

‘adm

inis

tratio

in c

omm

unity

ho

on o

r su

pply

of

ospi

tals

. Th

e hi

g

a m

edic

ine

from

ghes

t ca

tego

ry m

a c

linic

al a

reof

med

icat

ion

in

ea’.

48%

of

inci

dnc

iden

ts r

elat

ed

dent

s oc

curre

d d

to ‘m

edic

ine

n

in

ot

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 88 of 177

2.5

A

2.

5

2.5

All

med

ica

man

agem

e

Med

savv

y pr

ogra

mm

e

ssur

ance

on

Pa

5.1

Mer

idia

n Pa

5,75

7 su

rve

Sur

vey

volu

larg

est i

ncr

and

heal

th

5.2

The

NH

S Fr

In A

pril,

97

to re

com

min

Mar

ch.

disa

bilit

y tetio

n in

cide

nts

aen

t will

als

o fo

rm

is a

Qua

lity

Ime

of w

ork

impl

em

atie

nt E

xper

ien

atie

nt E

xper

ienc

eys

wer

e co

mpl

e

umes

hav

e in

cre

reas

e in

sur

vey

visi

ting.

iend

s an

d Fa

m

7.5%

of o

ur p

atie

end

the

serv

ice

23 o

f the

‘don

’t ea

ms.

The

rem

aare

revi

ewed

by

m p

art o

f the

‘We

mpr

ovem

ent

(Qm

ente

d fo

llow

ing

nce

ce s

urve

y re

sul

eted

by

KC

HFT

ease

d in

Apr

il b

volu

mes

whe

n

ily T

est (

FFT)

ents

reco

mm

end

they

rece

ived

, ckn

ow’ r

espo

nse

aini

ng 1

2 w

ere

foy th

e P

harm

acy

e C

are’

vis

its.

QI)

proj

ect

whi

cg

the

lear

ning

fro

lts

patie

nts,

rela

tiv

by 4

33. T

he n

ewco

mpa

red

with

ded

us, t

his

is s

lico

mpa

red

with

1es

wer

e fro

m c

hor

a v

arie

ty o

f seTe

am w

ho a

re

h ai

ms

to i

mpr

om a

his

toric

al in

es a

nd c

arer

s w

wbo

rn h

earin

g se

Mar

ch.

An

incr

ghtly

hig

her t

ha1%

in M

arch

. 46

hild

ren

and

ther

eer

vice

s.

e un

derta

king

ta

rove

med

icin

e nc

iden

t.

with

a c

ombi

ned

s

ervi

ce, c

omm

unea

se w

as a

lso

s

n M

arch

’s s

core

peo

ple

chos

e th

e w

ere

7 fo

r the

arge

ted

wor

k w

adm

inis

tratio

n a

satis

fact

ion

scor

nity

nur

sing

team

seen

for

the

lym

e (9

5.3%

). In

Apr

he ‘d

on’t

know

’ rde

ntal

ser

vice

aith t

he s

peci

fic

and

patie

nt s

af

re o

f 97.

3% in

A

ms

and

the

dent

mph

edem

a, c

hro

ril, 0

.5%

of o

ur p

resp

onse

in A

pran

d 4

for t

he c

o

team

. M

edic

ine

fety

. Th

is w

as

Apr

il.

al c

linic

s sa

w th

onic

pai

n, p

odia

t

patie

nts

chos

e n

ril c

ompa

red

to 7

omm

unity

lear

nin

es

a he

ry

ot

70

ng

Page 89 of 177

2.6

Ass

uran

ce o

n C

linic

al A

udit

and

Res

earc

h

2.6.

1 A

udit

The

annu

al K

PI t

arge

t is

95%

of c

linic

al a

udit

reco

mm

enda

tions

to b

e im

plem

ente

d. T

his

is a

chie

ved

via

a st

eppe

d ta

rget

dur

ing

the

year

. Th

e ta

rget

for A

pril

was

ach

ieve

d.

2.6.

2 C

linic

al A

udit

Rep

ortin

g

Rep

ortin

g - R

ecei

pt b

y C

linic

al A

udit

of fu

ll re

port

with

in ti

mef

ram

e. T

he a

nnua

l KP

I tar

get i

s 80

% w

ith a

targ

et o

f 50%

for e

ach

mon

th o

f qu

arte

r 1.T

imef

ram

es a

re li

sted

bel

ow:

Rec

eipt

of f

inal

repo

rt fro

m le

ad w

ithin

60

days

of r

ecei

pt o

f das

hboa

rd fo

r aud

its w

ith fu

ll or

sig

nific

ant a

ssur

ance

Rec

eipt

of f

inal

repo

rt fro

m le

ad w

ithin

30

days

of r

ecei

pt o

f das

hboa

rd fo

r aud

its w

ith li

mite

d as

sura

nce

Rec

eipt

of f

inal

repo

rt fro

m le

ad w

ithin

15

days

of r

ecei

pt o

f das

hboa

rd fo

r aud

its w

ith n

o as

sura

nce

Full

repo

rt w

ith a

ctio

n pl

an lo

oked

at b

y qu

ality

or g

over

nanc

e gr

oup

or C

hair

of s

aid

grou

p w

ithin

30

days

of r

ecei

pt

Ann

ual K

PI t

arge

t is

80%

with

mon

thly

targ

et o

f 80%

. Fi

gure

s do

not

app

ly to

this

Apr

il as

no

repo

rts c

ompl

eted

so

not r

equi

red.

KP

Is fo

r re

porti

ng i

ndic

ate

dela

ys e

xist

at

all

stag

es o

f th

e re

porti

ng p

roce

ss;

how

ever

, th

ese

are

activ

ely

mon

itore

d an

d es

cala

ted

with

go

vern

ance

gro

ups.

2.6.

3 R

esea

rch

KC

HFT

wor

ks to

del

iver

an

annu

al re

crui

tmen

t ple

dge

to th

e K

ent S

urre

y an

d S

usse

x C

linic

al R

esea

rch

Net

wor

k to

del

iver

hig

h qu

ality

na

tiona

l stu

dies

(kno

wn

as p

ortfo

lio s

tudi

es) t

o lo

cal p

atie

nts.

Int

erna

lly w

e ex

ceed

this

ple

dge

and

have

set

a m

ore

stre

tchi

ng ta

rget

as

our K

ey P

erfo

rman

ce In

dica

tor f

or re

sear

ch.

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 90 of 177

2.6.

4 N

atio

nal I

nstit

ute

for C

linic

al E

xcel

lenc

e (N

ICE)

In te

rms

of r

ecen

t NIC

E g

uida

nce/

stan

dard

s 14

wer

e is

sued

in M

arch

201

9.

2 of

thes

e w

ere

deem

ed a

pplic

able

to a

t lea

st o

ne s

ervi

ce

thro

ugho

ut th

e Tr

ust.

Th

e ai

m in

tern

ally

is to

hav

e th

e in

itial

rev

iew

com

plet

ed b

y 1

July

201

9 gi

ving

the

nom

inat

ed le

ad 3

mon

ths

to

com

plet

e th

e ba

selin

e as

sess

men

t for

eac

h pi

ece

of g

uida

nce

– th

is is

not

a s

tatu

tory

tim

efra

me.

22

(ou

t of 2

18 is

sued

) pi

eces

of N

ICE

Gui

danc

e fro

m J

anua

ry 2

018-

Jan

uary

201

9 ha

ve b

een

unde

r re

view

for

mor

e th

an 3

mon

ths.

In

addi

tion

a fu

rther

18

from

201

7 ar

e st

ill u

nder

initi

al re

view

. Thi

s is

bei

ng m

onito

red

by C

EG

and

the

NIC

E T

ask

and

Fini

sh G

roup

. D

espi

te th

is s

ubst

antia

l pro

gres

s ha

s be

en m

ade

redu

cing

the

num

ber o

f not

ass

esse

d gu

idan

ce d

own

from

630

to 0

. Sta

tuto

ry ti

mef

ram

e of

90

days

is o

nly

in p

lace

for T

echn

olog

y A

ppra

isal

s (T

A).

Rev

iew

s fo

r TA

s ar

e co

mpl

eted

by

Med

icin

es M

anag

emen

t with

in ti

mef

ram

e.

Page 91 of 177

3.0

3.1

A 3.1

3.1W

orkf

orce

Plea

se n

otpr

oces

ses

ssur

ance

on

Re

1.1

Turn

over

Turn

over

stra

nsfe

r ou

in re

cent

m(4

1 st

aff).

Adi

scus

sion

en

gage

men

1.2

Stab

ility

Sta

bilit

y c o

indi

catin

g a

been

affe

cte R

epor

t: te

that

due

to t

s co

mpl

ete.

Th

eten

tion

saw

an

incr

ease

t o

f 24

staf

f fro

mm

onth

s. T

his

has

Ana

lysi

s of

sta

ffan

d ag

reem

ennt

in th

e co

min

g

ontin

ues

to p

erfo

a co

ntin

ued

stro

ted

by th

e hi

gh lhe

ear

ly p

rodu

cis

incl

udes

Vac

in M

arch

201

9;m

Est

ates

, and

hs

likel

y be

en h

ef e

xit s

urve

ys is

nt o

n w

ays

to a

yea

r and

a fu

rth

orm

abo

ve th

e m

ong

perio

d of

pe

leve

ls o

f lea

versct

ion

of th

is re

pca

ncy

rate

s, A

g

; how

ever

, it h

ahi

gh le

vels

of r

elp

ed b

y hi

gh le

vs

unde

rway

to id

addr

ess

this

. Fo

her d

iscu

ssio

n w

mea

n th

roug

h a

erfo

rman

ce. A

pri

s in

Mar

ch.

port

som

e of

thge

ncy

spen

ds a

s si

nce

drop

ped

tiree

s in

Ope

rat

vels

of n

ew s

tart

dent

ify a

reas

of

ollo

win

g th

is y

ew

ill ta

ke p

lace

at

perio

d of

spe

cia

il’s

perfo

rman

cehe m

etric

s m

ay

and

Abs

ence

ra

d ba

ck d

own

to

ions

. Apr

il’s

tur n

ers

in A

pril

(99

sco

ncer

n w

hich

ar

’s s

taff

surv

eyt t

he M

ay M

anag

al c

ause

var

iatio

e ha

s dr

oppe

d s

chan

ge a

s th

eat

es.

prev

ious

leve

ls.

nove

r lev

els

hav

staf

f), a

nd a

retu

will

be

take

n to

y re

sults

we

hage

men

t Com

mitt

on, a

nd a

chie

ved

light

ly fo

r th

e fir

usu

al m

onth

e

. Thi

s in

crea

se i

ve re

turn

ed b

ack

urn

to m

uch

low

o th

e M

anag

eme

ave

agre

ed t

o c

tee

as to

how

be

d its

new

targ

et

rst t

ime

sinc

e M

aend/

mon

th s

tart

in M

arch

was

du

k to

the

norm

al l

wer

leve

ls o

f lea

ven

t Com

mitt

ee

cont

inue

to

focu

est t

o do

this

.

of 8

5% in

Mar

cay

201

8 as

it h

a

t ue a

TU

PE

le

vels

see

n ve

rs in

Apr

il in

Jun

e fo

r us

on

staf

f

h,

as

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 92 of 177

3.2

A 3.2ss

uran

ce o

n Si

2.1

Sick

ness

Ab

The

in-m

onim

prov

eme

leve

ls o

f an

It sh

ould

be

wai

t for

7 pic

knes

s

bsen

ce

nth

sick

ness

ab

ent i

n pe

rform

annn

ual l

eave

bei

n

e no

ted

that

this

poin

ts o

f sig

nific

absen

ce f

igur

e in

ce

it is

not

ent

ireng

boo

ked.

s do

es n

ot y

et c

oan

t var

iatio

n be

fo

Mar

ch s

harp

ly

ely

unex

pect

ed g

onst

itute

a s

igni

for

e re

cogn

isin

g

drop

ped

to 3

.7gi

ven

that

sic

kne

fican

t shi

ft in

the

a sh

ift in

per

form71

%,

with

a s

liges

s fig

ures

hav

e

e pe

rform

ance

of

man

ce.

ht r

ise

in A

pril

e hi

stor

ical

ly d

ro

f thi

s m

etric

. S

P

to 3

.85%

. W

hiop

ped

in M

arch

,

PC

met

hodo

logi

elst

this

is a

larg

partl

y du

e to

hig

es d

icta

te th

at w

ge

gh

we

Page 93 of 177

3.22.

2 St

ress

Abs

e

Stre

ss a

bsA

pril

2019

.m

omen

tum

The

Tim

e t

OD

BP

s to

16

th M

ay ben

ce

senc

e ha

s co

ntin

How

ever

, as

tm

on

Trus

t ini

tiati

to C

hang

e pr

oje

help

them

iden

tbr

ingi

ng to

geth

ernued

to

refle

ct t

he m

etric

per

for

ives

will

con

tinue

ect c

ontin

ues

wi

tify

good

pra

ctic

r cha

mpi

ons

fromth

e em

ergi

ng t

rerm

ance

con

tinue

e.

ith a

ctio

n pl

ans

ce h

ighl

ight

ed in

m

acr

oss

the

Truen

d of

impr

oved

es to

var

y w

e ar

now

hav

ing

bee

thes

e ac

tion

pla

ust.

d pe

rform

ance

, re

not

yet

con

sid

en d

evel

oped

ban

s.

Ano

ther

timw

ith c

ontin

ued

derin

g a

long

ter

y al

l ser

vice

s.

me

to c

hang

e e

impr

ovem

ent

inrm

cha

nge

to b

e

Thes

e ha

ve b

eeve

nt is

als

o du

en bo

th M

arch

an

e in

pla

ce, a

nd s

en s

hare

d ac

ros

e to

take

pla

ce o

nd

so

ss

on

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 94 of 177

3.3

A 3.3ss

uran

ce o

n Fi

3.1

Esta

blis

hme

The

vaca

nsu

mm

er. T

parti

cula

rlyTr

ust

illin

g Va

canc

ies

ent a

nd V

acan

c

cy r

ate

has

inc

Ther

e ha

ve b

een

y in

Eas

t and

Wes ci

es

crea

sed

sign

ifica

n 2

fact

ors

behi

est K

ent.

Sec

on

antly

to

9.68

%

nd th

is in

crea

send

ly, t

he h

igh

levin

Apr

il. T

his

foe.

Firs

tly, b

udge

vels

of l

eave

rs iol

low

s a

perio

d te

d es

tabl

ishm

ein

Mar

ch h

ave

r

of s

usta

ined

im

ents

hav

e in

crea

redu

ced

the

con m

prov

ed p

erfo

rmas

ed w

ith th

e ne

ntra

cted

sta

ffing

man

ce s

ince

la

ew fi

nanc

ial y

eale

vels

acr

oss

th

st

ar,

he

Page 95 of 177

3.3

3.33.

2 Te

mpo

rary

S

Bot

h to

tal f

stea

dily

inc

Rec

ruitm

enw

ith F

ebru

a

Alth

ough

Tto

tal r

eque

ssh

ift re

ques

3.3

Age

ncy

Spe

The

use

of

incr

ease

d nSt

aff U

sage

fill r

ates

and

ba

crea

sing

ove

r the

nt to

the

Ban

k ha

ary

- 56

and

Ma

Tota

l Fill

rate

s ap

sted

shi

fts fi

lled

sts

and

a lim

ited

end agen

cy a

cros

s nu

mbe

rs o

f shi

ftnk fi

ll ra

tes

are

e la

st y

ear,

with

as a

lso

incr

ease

rch

– 61

leve

ls).

ppea

r st

able

, va

by B

ank

staf

f (F

d po

ol o

f Ban

k w

the

Trus

t has

co

ts s

ent t

o th

e ba

expe

rienc

ing

coM

arch

see

ing

th

ed in

Apr

il, w

ith 7

. aryi

ng a

roun

d th

Fill

Rat

e - B

ank

cw

orke

rs ra

ther

th

ontin

ued

to ri

se i

nk o

ffice

as

noteom

mon

cau

se v

he h

ighe

st le

vels

71 s

taff

curr

ently

e m

ean

of 8

7.5%

char

t bel

ow).

Wan

a re

duct

ion

in

in M

arch

and

Ap

ed in

the

prev

iouva

riatio

n ar

ound

s

of b

ank

requ

es

y go

ing

thro

ugh

%, t

here

doe

s a

We

are

look

ing

inn

Ban

k w

orke

r u

pril

2019

. Th

is fo

us s

ectio

n.

the

mea

n.

De

sts

yet i

n 20

18/2

recr

uitm

ent c

he

appe

ar to

be

a d

to th

is b

ut it

is li

utili

satio

n.

ollo

ws

a pe

riod

oman

d fo

r B

ank

2019

.

ecks

to jo

in th

e B

decl

inin

g tre

nd in

kely

to b

e du

e to

of w

inte

r pre

ssush

ifts

has

been

Bank

(com

pare

d

n th

e nu

mbe

r of

o an

incr

ease

in

res

and

f

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 96 of 177

3.4

A 3.4ss

uran

ce o

n Tr

4.1

Man

dato

ry T

Man

dato

ry

Man

dato

ry

mon

th m

ov

rain

ing

Com

plia

Trai

ning

Com

p

Trai

ning

fig

ure

Trai

ning

sub

jec

ving

it b

ack

in to

ance

lianc

e

s ar

e cu

rren

tly

cts

are

curr

ently

com

plia

nce

in a

sta

te o

f na

y sh

owin

g as

coat

ural

var

iatio

n m

plia

nt w

ith ta

rgarou

nd t

he m

eage

ts. F

ire fo

r co

an,

and

are

con

omm

unity

hos

pit

nsis

tent

ly a

bove

tals

has

incr

ease

e th

e ta

rget

. A

lled

by

3.4%

this

s

Page 97 of 177

4.0

Fina

nce

Rep

ort:

4.1

Ass

uran

ce o

n Fi

nanc

ial S

usta

inab

ility

4.

2 K

ey M

essa

ges

Surplus: Th

e Trust achieved

a surplus of £2

16k (1.1%) to the en

d of April. P

ay und

erspen

t by

£60

8k and

non

‐pay and

dep

reciation/interest have

overspen

t by £9

2k and

£8k re

spectiv

ely. Incom

e has u

nder‐recovered

by £4

78k.

Continuity of S

ervices Risk Rating: EBITD

A Margin achieved

is 2.6%. The

Trust sc

ored

1 against th

e Use of R

esou

rces Rating, th

e be

s t possib

le sc

ore.

CIP: £23

1k of savings has been achieved

for the

mon

th against a risk ra

ted plan

of £

438k which is £20

7k beh

ind target.

Cash and

Cash Eq

uivalents: The cash and

cash eq

uivalents balance was £24

,130

k, equ

ivalen

t to 39 days expen

diture. The Trust recorded

the

following YTD pu

blic se

ctor paymen

t statistics 9

7% fo

r volum

e and 93

% fo

r value

.

Capital: Spe

nd to

April was £13

2k, against a YTD

plan of £16

9k (7

8% achieved).

Agen

cy: Tempo

rary staff costs for Ap

ril w

ere £9

43k, rep

resenting 6.6%

of the

pay bill. Of the

tem

porary staffing

usage in

April, £36

5k related

to

external agency and £1

31k to lo

cums, 3.5% of the

pay bill. Th

ere were gross vacancies of 428

WTE, an increase of 6

8 compared to M

arch, and

9.7%

of th

e bu

dgeted

establishm

ent.

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 98 of 177

5.0

5.1

A 5.1O

pera

tion

ssur

ance

on

Na

1.1

Hea

lth C

hec

Hea

lth C

he

Hea

lth C

heth

e co

ntro

l ne

w IT

sys

outli

ned.

This

is

on

reso

lved

mK

CH

FT a

reas

pos

sibl

e

al re

port

: at

iona

l Per

form

cks

and

SS Q

ui

ecks

ecks

is n

ow e

xpe

limits

due

to th

stem

pro

cure

d b

the

Hea

lth I

mp

mos

t of t

he in

vita

e co

ntin

uing

to e

e.

man

ce S

tand

ard

ts

erie

ncin

g a

perio

e si

gnifi

cant

cha

by K

CC

. KC

C w

a

prov

emen

t ris

k r

atio

n er

rors

that

ex

plor

e ot

her o

pds a

nd C

ontr

ac

od o

f pos

itive

va

ange

whe

n th

eas

aw

are

of th

is

regi

ster

als

o. T

hw

ere

repo

rted.

portu

nitie

s fo

r H

ctua

l Tar

gets

aria

tion

for t

he la

NH

S H

ealth

Ch

s is

sue

and

is p

e

he c

hang

e to

m T

he ta

rget

traj

Hea

lth C

heck

deas

t 7 m

onth

s w

ithe

cks

IT in

frast

ruer

form

ance

man

mon

thly

que

ries

ecto

ry h

as b

een

liver

y in

an

effo

rth a

n im

prov

ing

uctu

re c

hang

ed

nagi

ng th

e co

ntr

has

impr

oved

tn

amen

ded

in li

nrt

to m

aint

ain

an

trend

, fol

low

ing

on th

e 1s

t Apr

ira

ct to

try

and

re

the

qual

ity o

f da

ne w

ith ‘a

mbe

r’ nd

impr

ove

perfo

a re

calc

ulat

ion

ol 2

018

whi

ch is

es

olve

the

issu

e

ata

impo

rted

anfig

ures

, alth

oug

orm

ance

as

muc

of a es

nd

gh

ch

Page 99 of 177

5.1

Stop

Sm

ok

Sto

p S

mok

path

way

s i

inte

rven

tion

supp

ort t

o S

mok

ing

pK

CC

and

K

1.2

Hea

lth V

isiti

New

Birt

h

Per

form

anc

cont

rol l

imi

invo

lves

tere

cord

ed c

mon

thly

diski

ng Q

uits

king

qui

ts a

lso

hin

to o

ne a

s pe

n ou

tcom

es o

nto

upda

te o

utco

me

reva

lenc

e co

ntin

KC

HFT

will

be

m

ing Visi

ts

ce lo

oks

like

it i

t. Th

e m

onth

12

ams

rece

ivin

g a

corr

ectly

. Th

e ta

stric

t lev

el re

portha

d a

sign

ifica

ntr

the

new

con

to

the

new

dat

a es

pul

ling

us in

nu

es to

mov

e in

mee

ting

to d

iscu

s

is e

xper

ienc

ing

2 le

vel w

ill h

opef

a pa

tient

leve

l lis

arge

t of

90%

is

ts a

nd is

sho

wint e

vent

afte

r th

etra

ctua

l ag

reem

syst

em.

Q2-

Q4

line

with

201

7 n

a do

wnw

ards

tss

new

app

roac

h

the

begi

nnin

g o

fully

impr

ove

fol

st o

f chi

ldre

n w

hge

nera

lly b

eing

ng v

aryi

ng p

erfo

r ON

E Y

OU

Ser

ent

with

KC

C,

4 sh

ows

an u

plpe

rform

ance

, wtre

nd, a

nd w

ith t

hes

to e

ngag

ing

of a

n ad

vers

e tr

low

ing

a da

ta c

lho

hav

e ha

d no

g

achi

eved

(ac

hrm

ance

acr

oss

trvic

es h

ad im

ple

mai

nly

impa

ctin

ift fr

om Q

1 as

3w

ith th

e la

st 9

mth

e su

cces

sful

oth

e co

unty

’s to

u

end

with

mon

thle

anse

, clo

ser t

ovi

sit,

DN

A o

r re

ieve

d in

Q4

and

he d

istri

cts.

emen

ted

a ne

w

ng t

he a

bilit

y o

3rd p

artie

s ha

ve

mon

ths

show

ing

outc

omes

of t

he

ughe

st a

nd h

ard

12

perfo

rmin

g o

the

targ

et (c

uref

usal

rec

orde

d d

for

the

year

)

IT s

yste

m c

omb

f ou

r 3rd

par

ties

rece

ived

focu

sea

posi

tive

shift

H

ome

Vis

its fo

res

t to

reac

h sm

o

belo

w ta

rget

an

rren

tly a

t 89%

). T

for

them

to e

nsu

is c

lose

ly m

onitbi

ning

thre

e cl

ies

to u

ploa

d th

eed

and

sus

tain

eab

ove

the

mea

r pre

gnan

t mum

oker

s.

nd n

ear

the

low

eTh

e da

ta c

lean

sur

e th

eir

stat

us

tore

d th

roug

h th

nt

eir

ed

n.

s,

er

se

is

he

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 100 of 177

6-8

Wee

k C

Ther

e w

as

Per

form

anc

and

perfo

rmtre

nds

and C

heck

s

a di

p in

mon

ths

ce h

as s

ince

imp

min

g cl

ose

to t

him

prov

e th

e da

ts 5-

7, w

ith m

ont

prov

ed a

nd h

as

he lo

wer

con

trota

qua

lity

whe

re th

6 p

erfo

rmin

g st

abili

sed,

with

l l

imit.

Mon

thly

is

sues

are

iden

outs

ide

of th

e c

the

targ

et b

eing

proc

esse

s co

ntnt

ified

.

cont

rol l

imits

and

cons

iste

ntly

ach

inue

to

be in

pld

mon

ths

5 an

d hi

eved

, alth

ough

lace

for

loca

litie

7 cl

ose

to th

e lo

h M

onth

12

has

es t

o dr

ill d

own

ower

con

trol l

imw

orse

ned

slig

h tin

to a

ny a

dver

s

it.

tly

se

Page 101 of 177

5.1

5.1

1.3

Nat

iona

l Ch

The

mea

suth

e 90

% ta

1.4

Min

or In

jury

KC

HFT

’s a

with

the

co

ild M

easu

rem

e

urem

ent p

rogr

amar

get f

or th

e sc

ho

y U

nits

(MIU

) 4

achi

evem

ent o

f tnt

rol r

ange

sug

g

Curren

t Mo

18/19 Scho

oYear to

Mar

17/18 Scho

oYear

Annu

al Targen

t Pro

gram

me

mm

e fo

r Yea

r R

ool y

ear

Hou

r Wai

t Tar

g

he 4

hou

r wai

t ta

gest

ing

that

faili

n

Year

R

onth

94.0%

ol

r‐19

94.0%

ol

97.3%

get

90%

(NC

MP)

and

6 pu

pils

has

get

arge

t for

Min

or I

ng ta

rget

is h

igh

Year

6

93.7%

93.7%

95.7%

90%

0.0%

50.0%

100.0%

s m

et th

e tra

ject

Inju

ries

Uni

ts h

aly

unl

ikel

y to

hap

Sep‐18

Oct‐1 to

ry fo

r the

18/

19

as c

onsi

sten

tly b

ppen

.

18Nov‐18

Dec

18/19 Scho

o

Year R

Ye 9 sc

hool

yea

r, w

een

high

, with

v

c‐18

Jan‐19

Fe

ol Year

ear 6

with

bot

h pr

ogra

m

very

littl

e va

riatio

eb‐19

Mar‐19

mm

es a

chie

ving

on fr

om th

e m

ea

g n,

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 102 of 177

5.1

5.11.

5 G

UM

48h

r

Acc

ess

to G

1.6

Con

sulta

nt-

The

prop

o rpe

rform

ing

The

abov

ebe

low

18

wm

eetin

g ta

r

GU

M c

linic

s w

ith

-Led

RTT

Inco

m

rtion

of p

atie

nts

wel

l with

a 5

mo

tab

le s

how

s th

wee

ks,

with

no

wrg

et

KC O C Chin

48hr

s ha

s be

mpl

ete

Wai

ts O

v

on a

con

sulta

nton

th p

erio

d of

no

he c

urre

nt b

reak

wai

ts a

bove

36

KCHF

T To

tal

Chronic Pain

Ortho

paedics

Children's A

udiolog

Community

Paediaee

n co

nsis

tent

ly

ver 1

8 w

eeks

t-led

Ref

erra

l to

orm

al v

aria

tion,

kdow

n of

the

wa

wee

ks.

The

av

0‐12

Wk

528

3797

431

636

5392

gy atrics

y 10

0%, w

ith n

o r

Trea

tmen

t (R

TTbo

th a

bove

the

aitin

g lis

t fo

r al

l ve

rage

wai

t fo

r p

ks12

‐18 Wks

18‐3

38 665 2 161

866

repo

rted

brea

ch

T) p

athw

ay a

t mm

ean

and

targ

e

serv

ices

on

a c

patie

nts

wai

ting

36 W

ks36

‐52 Wks

180

185

00

029

023

20

es

mon

th e

nd w

ho a

et le

vel.

cons

ulta

nt-le

d p

over

18

wee

k s

s52

+ Wks

< 18

09

09

01

09

09

are

wai

ting

less

athw

ay.

96.4

%

s is

20.

8 w

eeks

,

8 Weeks

96.9%

96.0%

00.0%

96.5%

96.4%

than

18

wee

ks

of w

aits

are

no

, w

ith a

ll se

rvic

e

is

ow

es

Page 103 of 177

5.1

1.7

6 W

eek

Dia

g

6 w

eek

dia

perfo

rmin

g ov

er 6

wee

The

1% s

taim

pact

of s

brea

chin

g t

The

Aud

iol

only

con

tr aex

pect

ed to

Ban

k. T

hes

To m

ake

fupr

even

t br

eal

low

s a

pr

As

a co

nse

(rec

eivi

ng tgn

ostic

s (A

udio

agno

stic

s w

aits

ab

ove

the

me a

eks

as p

er N

HS

I

anda

rd is

cha

llesi

ngul

ar p

atie

nts

the

stan

dard

on

ogy

serv

ice

is a

acts

. The

ser

vice

o be

in p

ost b

y J

se m

easu

res

hav

urth

er s

tride

s to

each

es b

y ta

kin

oact

ive

solu

tion

eque

nce

of c

onta

rget

ed s

uppo

rtolog

y)

for

paed

iatri

c a

an. H

owev

er, r

ecS

ingl

e O

vers

igh

engi

ng f

or t

he t

rto

the

achi

evem

aver

age

for t

he

a sm

all t

eam

of 1

e ha

s pr

iorit

ised

Ju

ly b

ut in

the

inve

had

a p

ositi

v

o ac

hiev

ing

the

sng

ear

lier

actio

nfo

cuse

d ap

pro a

tinua

l bre

ache

st)

but w

ill b

e m

ovaudi

olog

y is

exp

cent

per

form

anc

ht F

ram

ewor

k st

rust

to

achi

eve

men

t. A

vera

ge w

stan

dard

to n

ot

12.6

8 W

TE w

hic

new

refe

rral

s a

nter

im th

ey h

ave

e im

pact

on

the

stan

dard

reg

ula

. Th

is t

rack

ing

ach

to c

halle

nge

of

the

1% s

tan

ved

back

to s

eg

perie

ncin

g a

per

ce is

gen

eral

ly m

tand

ard)

.

give

n th

e sm

alw

aitin

g nu

mbe

rs

t be

met

(ofte

n c

ch c

urre

ntly

has

nd

recr

uite

d 1

pe

join

ed K

CH

FT

April

per

form

a n

arly

, the

Aud

iolo

gpr

oces

s is

now

s

that

may

aris

e

ndar

d, K

CH

FT a

gmen

t 1 w

hen

co

riod

of p

ositi

ve

mar

gina

lly b

elow

l vol

umes

of

paat

mon

th e

nd a

caus

ed b

y pa

tien

11.8

% o

f clin

ica

perm

anen

t mem

bst

aff b

ank.

The

nc

e.

gy s

ervi

ce h

as

fully

ope

ratio

nae.

are

with

in s

egm

onsi

sten

t ach

ieve

spec

ial c

ause

vw

the

chal

leng

ing

atie

nts

the

stan

dar

e 43

0, th

eref

ornt

DN

As)

.

al s

taff

on m

ater

ber o

f sta

ff to

co

serv

ice

has

recr

impl

emen

ted

a al

and

wee

kly

te

men

t 2

of t

he N

Hem

ent c

an b

e de

varia

tion,

with

th

g 99

% ta

rget

wit

dard

rel

ates

to

are

it o

nly

requ

ire

rnity

leav

e an

d 2

over

mat

erni

ty le

ruite

d a

furth

er a

track

ing

proc

esel

econ

fere

nces

HS

I S

ingl

e O

ver

emon

stra

ted

he la

st 8

mon

thth

in 6

wee

ks (

1%

and

ther

efor

e th

s 5

patie

nts

to b

21%

on

term

tim

eave

and

they

ar

audi

olog

ist f

or th

s to

fore

cast

an

are

in p

lace

, th

rsig

ht F

ram

ewo

hs

%

he

be

me re

he

nd

his rk

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 104 of 177

5.1

5.11.

8 En

d of

Life

C

The

end

ofth

eir

time

o39

.7%

, the

achi

eved

taa

mon

thly

b

1.9

Del

ayed

Tra

KC

HFT

’s ta

9.5%

as

a tra

nsfe

rs i n

Car

e

f life

indi

cato

r is

of d

eath

; the

refo

e pe

rson

alis

ed c

arge

t for

the

firs

basi

s to

val

idat

e

ansf

ers

of C

are

arge

t for

del

aye

rate

of o

ccup

ied

n ea

st K

ent,

alth

o

Curren

18/19

17/18

Annu

anew

for 1

8/19

, or

e no

tren

d da

care

pla

nnin

g w

it t

ime

in M

12. A

e an

d im

prov

e ar

(DTO

Cs)

d tra

nsfe

rs is

t od

bed

days

. An

ough

the

posi

tio

nt M

onth

60.4%

YTD

39.7%

N/A

al Target

60.0%re

porti

ng th

e pe

ata

is a

vaila

ble

pnd

ow o

n C

IS is

A

new

pro

cess

isre

as o

f und

erpe

o re

duce

to a

n a

incr

ease

d le

vel

on h

as im

prov

ed

% % A %

0.0%

20.0%

40.0%

60.0%

80.0%

erce

ntag

e of

End

prio

r to

Apr

il 20

bein

g m

onito

res

bein

g se

t up

lorfo

rman

ce.

aver

age

of 7

per

l was

exp

erie

ncm

onth

on

mon

td of

Life

pat

ient

s18

. Whi

le th

e p

d at

a lo

calit

y le

cally

so

that

tea

r da

y in

bot

h ea

sed

in m

onth

s 7

hs s

ince

, with

M

End of Life

PCP

s w

ho h

ad a

n u

erfo

rman

ce fo

r ev

el a

nd p

erfo

rmam

will

rece

ive

d

st K

ent a

nd w

esan

d 8,

cau

sed

M12

abo

ve ta

rgetpd

ated

per

sona

the

year

to d

ate

man

ce is

gen

era

ata

for n

on-c

om

st K

ent,

whi

ch e

by a

n in

crea

sed

t at 1

1.1%

.

alis

ed c

are

plan

e

equa

tes

to o

nal

ly im

prov

ing

anm

plia

nt p

atie

nts

o

equa

tes

to a

roun

d le

vel o

f del

aye

at

nly nd

on

nd

ed

Page 105 of 177

5.1

5.1

5.11.

10 L

ooke

d A

ft

Initi

al H

ealt

still

var

iabl

ean

d w

hich

th

e re

ferr

al

Com

plia

nce

dipp

ed in

M

1.11

NH

S N

umb

NH

S N

umb

a N

HS

num

1.12

Bed

Occ

up

Bed

Occ

uppa

rticu

lar c

the

dip

in p

ter C

hild

ren

Ini

th A

sses

smen

t (e

and

liabl

e to

faK

CH

FT is

stru

gg w

hich

ach

ieve

s

e w

ith th

e R

evie

M9

(but

stil

l met

t

ber C

ompl

eten

e

ber c

ompl

eten

esm

ber a

ssig

ned

(a

panc

y

panc

y is

sho

win

conc

ern.

Alth

oug

perfo

rman

ce s

ho

tial H

ealth

Ass

(IHA

) per

form

anai

ling

targ

et s

omgl

ing

to in

fluen

ces

targ

et m

ost m

o

ew H

ealth

Ass

esta

rget

), th

is h

as

ess

ss a

cros

s K

CH

Fal

thou

gh la

ter u

p

ng a

var

ying

tre

gh m

onth

s 5-

7 a

ould

not

be

of c

oessm

ents

(IH

A

ce is

sho

win

g no

me

mon

ths

(as

ine.

We

have

an

aon

ths.

ssm

ent t

arge

t wa

impr

oved

aga

in

T’s

mai

n sy

stem

pdat

ed) a

nd O

ve

end

with

no

pean

d 9

wer

e be

loon

cern

at t

his

staAs)

and

Rev

iew

orm

al v

aria

tion

an

mon

th 1

1 at

pre

addi

tiona

l KP

I to

as e

xper

ienc

ing

n in

M10

and

M1

ms

are

cons

iste

ner

seas

MIU

atte

n

erio

ds o

f sp

ecia

w ta

rget

and

low

age,

esp

ecia

lly w

Hea

lth A

sses

s

and

is a

chie

ving

esen

t). T

his

is d

o en

sure

that

we

a pe

riod

of p

osi

1 ntly

c.1

00%

, with

ndan

ces.

l ca

use

varia

ti ow

er th

an th

e m

ew

ith th

e im

prov

emen

ts (R

HA

s)

g ta

rget

mos

t mo

ue to

late

requ

e c

ompl

ete

the

IH

tive

varia

tion

ab

h th

e m

ain

exce

p

on o

r ch

ange

s i

ean

leve

l of o

ccu

men

t in

the

M10on

ths.

How

ever

, es

ts b

eing

rece

ivH

A w

ithin

23

day

bove

the

mea

n a

ptio

n be

ing

new

in p

erfo

rman

ce

upan

cy. T

his

ha0-

12 p

ositi

on a

bo

perfo

rman

ce is

ve

d fro

m K

CC

ys

of r

ecei

pt o

f

and

alth

ough

had

birth

s ye

t to

hav

that

wou

ld b

e as

hig

hlig

hted

thov

e th

e m

ean.

d ve a at

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 106 of 177

5.1

5.2

A 5.21.

13 C

QU

IN

The

Q4

CQ

CQ

UIN

S m

ssur

ance

on

ac

2.1

Act

ivity

Dur

ing

Ma r

KC

HFT

are

varia

nces

aQU

IN a

chie

vem

mea

ns th

at a

pro

ctiv

ity a

nd p

rod

rch

2019

KC

HF

e 2.

2% b

elow

ta

are

with

in In

termm

ent

(% o

f po

ten

porti

onal

ly h

ighe

duct

ivity

FT c

arrie

d ou

t 1

arge

t fo

r se

rvic

em

edia

te C

are

Sent

ial i

ncom

e) is

er

val

ue is

pla

ce

68,4

77 c

linic

al c

es t

hat

have

co

rvic

es (-

10.1

%)

at 8

4% (

100%

ed

on

Q4,

cau

sin

cont

acts

, of

whi

ontra

ctua

l act

ivit

and

Spe

cial

ist a

in Q

3),

with

th

ng th

e fu

ll ye

ar p

ich

10,8

20 w

ere

ty t

arge

ts in

pla

and

Ele

ctiv

e S

er

e Y

TD p

ositi

on

posi

tion

to d

rop

e M

IU a

ttend

anc

ace,

the

sam

e a

rvic

es (-

6.3%

).

at 8

6.6%

. Th

eto

86.

6%.

ces.

For

the

yea

as t

he M

11 p

os

wei

ghtin

g of

th

ar t

o M

arch

201

sitio

n. T

he la

rge

he

19

st

Page 107 of 177

The

follo

wi

Ele

ctiv

e S

eC

ondi

tions

ha

s ex

peri

expe

rienc

edu

e to

the

serv

ice

rat h

Hou

se. T

hi

Interm

ediate Care

Community

Hospit

Long Term Con

diti

Service Type

Children's S

pecialis

Learning Disa

bilitie

Dental Service ‐ All

All Services (contr

*Children's U

nivers

All Services (includ

MIU Attendances

Community

Hospit

Specialist a

nd Elect

Community

Hospit in

g ch

arts

sho

wer

vice

s, w

ith b

oan

d S

ES

Ser

vien

ced

low

er t

hed

in A

shfo

rd a

nex

tend

ed h

ours

her t

han

Rap

ids

s ha

s be

en a

dd

tal O

ccupied Be

d Da

ys (EK)

ons

st Services

es ‐ Face to

Face

l currencies

ractua

l)

sal Services

ding

those with

out targets)

tal Adm

issions

tive Services

tal O

ccupied Be

d Da

ys (W

K) w th

e m

onth

ly a

cth

Lon

g Te

rm C

ces

are

both

ex

han

aver

age

lev

d S

outh

Ken

t Cs

intro

duce

d in

s

(hen

ce th

e in

crre

ssed

thro

ugh 54 18 10 2 2 25 3 27 15 8 13 16

M12 ct

ivity

aga

inst

taC

ondi

tions

and

xp

erie

ncin

g pe

riove

ls i

n th

e la

st

Coa

st. W

hile

ther

Long

Ter

m C

onre

ase

in L

TC a

cth

e ac

tivity

pla

ns

4,518

649,941

8,030

231,342

0,820

132,210

181

2,300

2,176

24,934

2,512

27,828

5,312

316,411

3,039

78,817

7,853

777,318

5,743

183,465

8,293

115,482

35,073

1,656,085

68,477

2,125,392

2 Ac

tual

YTD Ac

tual

arge

t for

Lon

g T

Spec

ialis

t an

d E

ods

of n

orm

al v

a9

mon

ths.

On

re h

ave

been

st

nditi

ons

that

has

ctiv

ity a

gain

st p

las

for n

ext y

ear i

n

652,250

‐

257,353

‐1

110,985

1

1,820

2

25,718

‐

337,598

‐

183,291

0

123,645

‐

1,692,660

‐

N/A

YTD Target

YTD

erm

Con

ditio

ns,

Ele

ctiv

e se

rvic

ear

iatio

n; w

ith th

ee

of t

he m

ain

affin

g sh

orta

ges

s re

sulte

d in

a p

an),

as w

ell a

s a

n E

ast K

ent

‐0.4%

Positive

10.1%

Negative

19.1%

Positive

26.4%

Negative

‐3.0%

Positive

Positive

‐6.3%

Positive

Negative

Negative

0.1%

Positive

‐6.6%

Positive

‐2.2%

Positive

N/A

Positive

Mov

emen

tVa

riance

, Int

erm

edia

te C

es s

how

ing

an im

e bi

gges

t con

cere

ason

s fo

r th

iss,

ther

e ha

s be

epo

rtion

of a

ctiv

ita

redu

ced

bed

b

Contra

Internal BRA

G

Car

e S

ervi

ces

am

prov

emen

t in

er

n is

ICT/

Rap

id

s is

due

to

the

en a

redu

ctio

n in

ty n

ow b

een

cap

base

in W

estv

iew

*these figures a

totals as th

ey d

target

act B

RG

nd S

peci

alis

t an

M12

. Lo

ng T

erR

espo

nse

whi

ce

larg

e va

rianc

en

activ

ity th

is y

eapt

ured

with

in th

w a

nd W

estb

roo

Internal

Contract

>+5%

>+10%

>‐5%

>‐10%

+/‐ 2

.5‐5%

n/a

<+/‐ 2.5%

<+/‐ 10%

No Targe t

are no

t included in th

e table

don’t h

ave a contractual

nd

m

ch

es

ar

at

ok

t

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 108 of 177

5.2

5.22.

2 D

NA

rate

s

DN

A ra

tes

This

KP

I is

uppe

r co

ntat

tribu

ted

tse

rvic

es.

2.3

Clin

ic b

ased

cont

inue

to fa

ll s

now

exp

erie

nctro

l lim

it in

dica

to

wor

k w

ithin

C

d ac

tivity

belo

w th

e ta

rge

ing

spec

ial c

aus

ing

that

it

is u

nhi

ldre

n’s

serv

iceet

of 5

%, a

lthou

gse

var

iatio

n w

ithnl

ikel

y th

at l

eve

es to

redu

ce D

Ngh a

re s

igni

fican

h th

e la

st 7

mon

tel

s w

ould

inc

rea

NA

rat

es th

at w

ontly

hig

her w

ithin

ths

now

per

form

ase

abov

e ta

rge

ould

oth

erw

ise

bn so

me

serv

ices

min

g be

low

the

met

. Th

e sp

ecia

l e

impa

ctin

g ac

c , par

ticul

arly

chi

mea

n, w

ith th

e ta

caus

e ca

usin

gce

ss a

nd K

PI t

ar

ildre

n’s

ther

apie

arge

t clo

se to

th t

he r

educ

tion

rget

s w

ithin

thos

s.

he

is

se

Page 109 of 177

5.2

5.2

The

targ

et

incr

ease

d t

achi

eve

thi

limit

is a

rou

revi

ew ta

kin

2.4

Adm

issi

ons

Ther

e ha

veva

riabl

e m

ope

rform

anc

guar

ante

ed

2.5

Rap

id R

esp

Whi

le t

he

gene

rally

imta

rget

, it’s

ufor L

ong

Term

ath

roug

h in

itiat

ive

s ta

rget

with

out

und

4.6%

whi

ch

ng p

lace

for 2

01

s A

void

ed

e be

en a

hig

her

onth

to m

onth

wce

aga

inst

tar

gd.

The

targ

et is

b

onse

refe

rral

s s

mea

n le

vel

of p

mpr

oved

with

Mun

likel

y th

e co

ntand

ICT

serv

ices

es s

uch

as th

e w

som

e fo

rm o

f pr

wou

ld s

ugge

st r

9/20

repo

rting

a

leve

l of a

dmis

sw

ith a

hig

h le

vel

et i

s fa

vour

abl

bein

g re

view

ed f

seen

with

in 2

h

perfo

rman

ce i

s M

12 a

t ov

er 9

6%tro

l lim

its w

ill fu

lls is

to in

crea

se c

wou

nd c

linic

s, w

itro

cess

cha

nge

ore

achi

ng 5

% is

uan

d w

ill b

e re

vise

sion

s av

oide

d in

of

vol

atili

ty, r

esu

e, a

lthou

gh w

itfo

r 201

9-20

hour

s

curr

ently

sitt

ing

%.

If th

is c

ontin

uy

mov

e ab

ove

thclin

ic b

ased

act

ivth

the

proc

ess

lior

re-e

valu

atin

g un

achi

evab

le in

ed

the

last

12

mo n

ultin

g in

a b

road

th p

erfo

rman

ce

g m

argi

nally

bel

ues

the

mea

n s

he ta

rget

leve

l in

vity

to a

t lea

st 5

mits

reca

lcul

ate

the

targ

et. T

he a

the

curr

ent e

nvi

nths

, alth

ough

thd

rang

e be

twee

n b

eing

var

iabl

e

ow t

he t

arge

t le

shou

ld in

crea

se,

n th

e ne

ar fu

ture%

of a

ll ac

tivity

ced

from

Aug

ust 2

abov

e ch

art s

horo

nmen

t, so

is b

he a

bove

cha

rt n

the

uppe

r and

e,

ach

ievi

ng t

he

evel

of

95%

, pe

, al

thou

gh g

iven

e to

giv

e fu

ll as

sucarr

ied

out.

Whi

2017

, we

are

cur

ows

that

the

curr

bein

g lo

oked

at a

indi

cate

s th

at p

elo

wer

con

trol l

ime

targ

et m

onth

erfo

rman

ce s

inc

n th

e vo

latil

ity a

uran

ce o

f con

tin

le th

is h

as

rren

tly u

nlik

ely

tore

nt u

pper

con

troas

par

t of t

he K

P

erfo

rman

ce is

st

mits

. Yea

r to

dat

ly i

s no

t al

way

ce M

ay 2

018

haan

d th

e hi

gh 9

5%ua

l ach

ieve

men

o ol

PI till te

ys

as

%

nt.

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 110 of 177

5.2.

6 Fr

iend

s an

d Fa

Whi

le th

e l

sign

of i

mp

nota

bly

Sh

seen

the

ure

flect

ion

ow

ill fu

rther

amily

Tes

t (Pa

ti

evel

of p

erfo

rma

prov

emen

t with

Mep

pey,

Sitt

ingb

oup

take

is d

iffic

ult

of th

eir v

isit

just

en

cour

age

pati eie

nts

surv

eyed

ance

has

sho

wn

M1

expe

rienc

ing

ourn

e an

d S

eve

t to

ach

ieve

. O

cth

e bo

okin

g in

pen

ts to

com

plet

e

for M

IUs

& C

o

n a

perio

d of

ad

g an

incr

ease

d no

aks.

Pat

ient

s cc

asio

nally

pat

iepr

oces

s. E

mai

line

it.

mm

unity

Hos

p

vers

e va

riatio

n nu

mbe

r of

sur

v ear

e as

ked

to c

oen

ts c

ompl

ete

thng

the

link

to th

eitals

) - R

espo

ns

with

the

last

8 m

eys.

The

dec

line

ompl

ete

the

surv

he s

urve

ys w

hil

e su

rvey

has

beese

Rat

e

mon

ths

perfo

rmi

e ha

s be

en e

vid

veys

bef

ore

they

st t

hey

are

in t

hen

tria

lled

but t

h ing

belo

w th

e m

dent

acr

oss

mos

y le

ave

but o

nce

he w

aitin

g ro

omhi

s ha

s no

t wor

k

mea

n, th

ere

was

st

MIU

site

s, m

oe

they

hav

e be

em

but

thi

s is

not

ke

d. R

ecep

tioni

s

a st

en a

sts

Page 111 of 177

5.3

5.

43 A

ssur

ance

on

Wai

ting

timpe

rform

anc

perfo

rman

cpa

rticu

larly

focu

s on

cl

4 O

utco

mes

Agg

rega

te

outc

ome

i nbe

low

cha

rth

e ra

nge

on Lo

cal W

ait T

im

mes

for

all

non

ce b

eing

bel

ow

ce is

a re

sult

of

y w

ithin

Wes

t Ke

earin

g lo

ng w

ait

outc

omes

are

n

the

vast

maj

orrt

also

sho

ws

tha

of p

erfo

rman

ce vm

es

cons

ulta

nt-le

d th

e m

ean,

wit h

a m

ixtu

re o

f the

ent B

lock

AQ

P P

ts, a

hig

her p

rop

curr

ently

rep

ort

rity

of c

ases

on

at a

chie

vem

ent

vary

ing

mon

th to

AH

P s

ervi

ces

h M

12 f

allin

g b

e cl

earin

g of

the

Phy

siot

hera

py a

porti

on o

f com

ple

ed f

or A

dult

Sp

a co

nsis

tent

ba

of ta

rget

is a

lwa

o m

onth

sho

uld

nare

still

with

in

belo

w t

he t

arge

tba

cklo

g in

som

and

as a

res

ult p

eted

wai

ts is

exp

peci

alis

t an

d C

has

is, w

ith th

e be

ays

likel

y to

occ

uno

t fal

l low

eno

ua pe

riod

of s

pt

leve

l of

92%

. m

e se

rvic

es, w

ithpe

rform

ance

is f

perie

nced

.

hild

ren’

s Th

erap

yel

ow s

how

ing

nour

unl

ess

a pr

ocug

h to

bre

ach

tapeci

al c

ause

va

The

spec

ial

c ah

a vi

ew to

redu

cfo

reca

st to

impr

y se

rvic

es,

with

o sp

ecia

l cau

sece

ss c

hang

e oc

crg

et.

riatio

n w

ith t

he

ause

var

iatio

n in

ced

long

wai

ts o

rove

into

201

9-2

h pa

tient

s re

ceiv

e va

riatio

n in

rec

curs

, as

the

con

last

11

mon

thn

com

plet

ed w

aon

the

wai

ting

lis20

. With

a g

reat

e

ving

a f

avou

rab

cent

mon

ths.

Th

trol l

imits

indi

cat

hs’

ait

st, er

le

he

te

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 112 of 177

The

follo

wi

deta

il on

osu

mm

aris

e

Worsene

Not Ach

Partiall y

Mostly

AFully Achng

tabl

e an

d ch

outc

omes

. E

ach

ed.

S Ele

ed ieved

y Ac

hieved

Achieved

hieved

hart

show

s th

e p

out

com

e w

ill b

pecialist and

ectiv

e Services

C

2.0%

6.9%

31.4%

10.6%

49.1%

prop

ortio

n of

the

be s

peci

fic t

o th

Children's S

peciali

Services

0.0%

2.3%

13.1%

14.4%

70.3%

e gr

adin

g of

eac

he p

atie

nt a

nd w

st

ch o

utco

me

for

tw

ill b

e pe

rson

althe

year

to d

ate

lised

, th

eref

ore

e, s

plit

by s

ervi

cno

t al

low

ing

fuce ty

pe fo

r fu

rthe

rther

det

ail

to b

er

be

Page 113 of 177

App

endi

x - S

core

card

SPC

Cha

rts

1. P

reve

nt Il

l Hea

lth

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

140.0%

Stop

Smok

ing Quits

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

110.0%

Health Che

cks

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

6‐8 Wee

k Ch

ecks

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

3750

4250

4750

5250

5750

6250

6750

7250

7750

Admission

s Av

oide

d

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

% LT

C/ITC Patie

nts with

an avoide

d ad

mission

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

New

Birth Visits

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Data Outsid

e Limits

Common

Variance

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 114 of 177

2. D

eliv

er h

igh-

qual

ity c

are

at h

ome

and

in th

e co

mm

unity

‐0.30

‐0.20

‐0.10

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

Mod

erate an

d Severe fa

lls per 1,000

bed

days

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

‐3.0

‐2.0

‐1.00.0

1.0

2.0

3.0

4.0

5.0

6.0

Pressure Ulcers (Lapses in

Care)

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

102.0%

Contractua

l activity

against ta

rget

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

DNA Ra

te

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%

LTC/ICT Re

spon

se Tim

es Being

Met

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

82.0%

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

102.0%

% 2Hr

Rap

id Respo

nses m

et

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%

101.0%

MIU 4Hr

Target

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

82.0%

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

102.0%

Consultant‐Led

RTT

Incomplete Waits

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

‐1000

100

200

300

400

500

600

700

800

900

Consultant‐Led

RTT

Incomplete Waits (w

aitin

g list size

>18

wee

ks)

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

Page 115 of 177

2. D

eliv

er h

igh-

qual

ity c

are

at h

ome

and

in th

e co

mm

unity

99.0%

99.2%

99.4%

99.6%

99.8%

100.0%

100.2%

GUM Access with

in 48H

rs

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

0.00

5.00

10.00

15.00

20.00

25.00

30.00

Med

ian length of stay (days)

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Positiv

e ou

tcom

es achieved for p

lann

ed care an

d therap

y services

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

93.00%

94.00%

95.00%

96.00%

97.00%

98.00%

99.00%

Percen

tage of p

atients who

wou

ld re

commen

d ou

r services

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Friend

s an

d Family Respo

nse Ra

te (M

IU and

Inpa

tients)

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Clinical Aud

it Im

plem

entatio

ns by de

adlin

e

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

98.0%

98.5%

99.0%

99.5%

100.0%

100.5%

NICE gu

idan

ce re

view

ed with

in timescales

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

87.0%

89.0%

91.0%

93.0%

95.0%

97.0%

99.0%

AHP Non

Con

sulta

nt‐le

d 18

Wee

k complete waits with

in 18

wee

ks

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

105.0%

110.0%

6 wee

k Diagno

stics

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 116 of 177

3. In

tegr

ate

Serv

ices

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

Delayed Tran

sfers of Care

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Percen

tage of ICT/LTC

Referrals from with

in KCH

FT

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

‐0.50

0.00

0.50

1.00

1.50

2.00

Excess Bed

Days ‐W

est K

ent

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

050100

150

200

250

300

350

400

Average wait tim

e (m

inutes) for Acciden

t and

Emergency

Services (W

est K

ent)

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

050100

150

200

250

300

350

400

450

Average wait tim

e (m

inutes) for Acciden

t and

Emergency

Services (E

ast K

ent)

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

‐0.20

‐0.10

0.00

0.10

0.20

0.30

0.40

0.50

0.60

Excess Bed

Days ‐E

ast K

ent

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

Page 117 of 177

4. D

evel

op s

usta

inab

le s

ervi

ces

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

LTC/ICT % Con

tacts in clin

ic

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

78.0%

80.0%

82.0%

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

Bed Occup

ancy

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

0.00

%

0.50

%

1.00

%

1.50

%

2.00

%

2.50

%

Income an

d Expe

nditu

re Surplus vs plan

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

CIP Ac

hieved

Against Plan

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

0

100000

200000

300000

400000

500000

600000

700000

800000

External Agency Sp

end

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 118 of 177

5. B

e Th

e B

est E

mpl

oyer

3.0%

3.5%

4.0%

4.5%

5.0%

5.5%

6.0%

Absence

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

0.6%

0.8%

1.0%

1.2%

1.4%

1.6%

1.8%

Absence (Stress)

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

22.0%

Turnover (P

lann

ed and

Unp

lann

ed)

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

82.0%

87.0%

92.0%

97.0%

102.0%

107.0%

Man

datory Training Ra

te

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

Variance

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%

13.0%

Vacancy Ra

te

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

70.0%

72.0%

74.0%

76.0%

78.0%

80.0%

82.0%

84.0%

86.0%

Stab

ility

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

Variatio

n

Page 119 of 177



Agenda Number: 2.9

Agenda Item Title: Digital Strategy

Presenting Officer: Gordon Flack Director of Finance

Action - this paper is for: Decision ☒ Information ☐ Assurance ☐

Report Summary

This paper is the refreshed Digital Strategy for the period 2019-2024 which has been recommended by the Management Committee for approval. This strategy has been refreshed in line with the other strategies and in line with the Long term Plan. The high level aims are: • Safe to promote and support patient safety • Simplified to reduce complexity for staff and within the infrastructure • Secure to maintain data and information security • Shared to promote the sharing of data for patient benefit • Speedy to provide rapid access to information Underpinned by the implementation principles that:- •Patients: If willing and able to do so, will be empowered by new tools to become more actively involved and engaged in their care. The patient generated data will be interpreted by algorithms enabling personalised self-management and self-care. •Evidence: The introduction of any technology must be grounded in robust research evidence and a fit for purpose and ethical governance framework that patients, public and staff can all trust. •Releasing time to care: Whenever possible, the adoption of technology should be used to give more time for care, creating an environment in which the patient-clinician relationship is enhanced. Specifically there are eight objectives: 1.To review and replace core Digital applications 2.To upgrade network infrastructure 3.To refresh end user devices and operating systems 4.To seek opportunities for infrastructure technologies eg. Cloud enabled, Internet first etc. 5. Build and enhance cyber and information security 6. Work with the STP Digital on developments for the system 7. Seek opportunities to enhance quality of patient care and decrease costs with digital services 8. Develop digital capabilities for all staff.

Dig

ital S

trat

egy

Page 120 of 177


To approve the Digital Strategy



Yes ☒

No issues identified.

Gordon Flack Director of Finance Tel: 01622 211934


Page 121 of 177

Version 1.0 Page 1 of 18 May 2019

Digital Strategy

2019- 2024

Dig

ital S

trat

egy

Page 122 of 177


Document Reference No. TBC

Status Approved

Version Number 1.0

Replacing/Superseded

policy or documents

Information Management and Technology Strategy 2013-

2018

Number of pages 14

Target Audience/ applicable

to

All Trust staff

Author Mark Ashby AD for ICT

Acknowledgements Comments from Management committee and IT steering

group

Contact Point for Queries IT Department

Date Ratified 29th April 2019

Date of

Implementation/distribution 7th May 2019

Circulation Policy Dissemination / Flo

Review date Annualy with full review April 2024

Copyright Kent Community Health NHS Foundation Trust 2019

Related Policies/Procedures

Document Tracking Sheet

Version Status Date Issued to/approved by

Comments / summary of changes

0.1 Draft 29/11/18 Finance and Business Support Directorate – Senior Team

Minor textural additions plus the inclusion of information from the Topol review

19/11/18 IMT Steering Group Textural additions and points of clarification

0.2 Draft 20/01/19 Exec Team Outcome measures added

0.3 Draft 29/01/19 Management Committee

Extend the work plan to include exploration of Apps

0.4 Draft 29/04/19 IT Steering Group Addition of AHP strategy reference, addition

1.0 Final 07/05/19 Trust Board Updated strategy on a page and minor format changes

Contents

Title Reference

• KCHFT Business Strategy. • KCHFT Estates Strategy. • KCHFT Procurement Policy. • KCHFT People Strategy. • KCHFT Quality Strategy. • KCHFT Standing Financial Instructions

Flo

Page 123 of 177


(i) Foreword

(ii) Strategy on a Page

1 Strategy Aim

2 Alignment with Organisational Strategy

3 Triangulation and Links

4 Strategy Implementation

5 Scope

6 Objectives

7 Annex 1 – Digital Work Programme

8 References

Dig

ital S

trat

egy

Page 124 of 177

Kent Community Health NHS Foundation Trust Digital Strategy


(i) Foreword

Kent Community Health NHS Foundation Trust provides out of acute hospital, community-

based NHS healthcare services for over one million people across Kent, Medway, and East

Sussex and within London.

Our Organisational Strategy recognises the importance of providing high quality services and

is central to our vision, mission and values. The Digital Strategy is fundamental in supporting

our goals to empower patients in their own care, use decision support and artificial

intelligence to help clinicians in applying best practice, eliminate unwarranted variation and

support personalised self-management. This will have the positive effect of releasing more

patient facing time for frontline staff.

As outlined in the Long Term Plan (2019) digitally-enabled care will become the mainstream

across the NHS. Technology is continually opening up new possibilities for prevention, care

and treatment. The practical priorities include:

• Ensure that clinicians can access and interact with patient records and care plans

wherever they are.

• Use predictive techniques to support local health systems to plan care for

populations.

• Use intuitive tools to capture data as a by-product of care in ways that empower

clinicians and reduce the administrative burden.

• Encourage a world leading health IT industry in England with a supportive

environment for software developers and innovators.

We have spent the last two years fulfilling a leadership role in the Sustainability and

Transformation Partnership (STP) in the Kent and Medway health economy with the drive to

local care delivered out of acute hospital settings, a greater emphasis on prevention of ill-

health and a greater emphasis on supporting the workforce. Through its experienced Board

and leadership team, we are building stronger relationships with new commissioning leaders,

strengthening the technology capability of the Trust and driving the integration of services

across the local health economy. The Digital Strategy underpins this by substantial

investment in new digital tools including a new electronic patient record system to integrate

with the STP Kent and Medway Care Record.

The Digital Strategy for 2019-24 is to deliver a quintuple aim:

• Safe to promote and support patient safety

• Simplified to reduce complexity for staff and within the infrastructure

• Secure to maintain data and information security

• Shared to promote the sharing of data for patient benefit

• Speedy to provide rapid access to information

We will focus on developing our digital capability to support delivery of high quality services

and build our shared leadership role within the STP. It is our technical staff working closely

with clinicians and other team members who will ensure we deliver our digital aims through

their skill, commitment and imagination.

Gordon Flack (Director of Finance)

Page 125 of 177



(ii) Organisational Strategy on a Page

Dig

ital S

trat

egy

Page 126 of 177



1 Strategic Aims

The Digital strategy’s aims can be summarised as ‘fives S’s’ as follows:-

• Safe to promote and support patient safety

• Simplified to reduce complexity for staff and within the infrastructure

• Secure to maintain data and information security

• Shared to promote the sharing of data for patient benefit

• Speedy to provide rapid access to information

Applied appropriately, digital technology has the capability to enhance many areas of patient

safety and provide an environment where patient safety is paramount. This will underpin the

Trust’s reputation in the delivery of safe patient care and will enhance the Trust's ability to

pursue additional business opportunities.

Simplified architecture and a standardised user experience will assist in staff productivity by

removing more complex procedures and workarounds that exist to alleviate shortcomings in

current systems. This will also allow greater flexibility as service models change and develop

since staff will have a familiar look and feel to their digital experience across the Trust.

Security of data and information, especially in the cyber arena, is essential to ensure all of

the Trust’s digital assets are available for use in patient care. Steps have already been taken

to strengthen the security regime of the Trust but there is more to do as threats develop. All

organisations handling sensitive data will be required to meet minimum standards in data

security in order to conduct and develop their business.

The importance of sharing data in patient care has been evident for many years in national

strategy and this will be essential in the delivery of future new models of care where patient

pathways extend across multiple health and care organisations. The Trust will deploy

systems and services that meet NHS interoperability standards and will allow the information

to follow the patient across care settings.

Clinical information must be made available in a timely manner. Systems and networks will

be optimised to ensure the delivery of information to users will be as fast as possible.

Management information must also be made available rapidly to allow decisions to be taken

quickly. All of this will underpin the ability of the Trust to work in an agile manner to deliver

current and future services.

Digital is recognised as an enabler which will underpin the delivery of the NHS Long Term

Plan (NHSE, 2019) as well as the Trust’s own mission. With appropriate funding and resourcing

the ‘five S’s’ philosophy can support financial viability by working “smarter not harder” and

will support the delivery of sustainable services for the future.

Digital services for the purposes of this document include all of the IT infrastructure and

services internally together with any interaction between the Trust and patients via their own

digital devices.

Page 127 of 177



2 Alignment with Organisational Strategy

The Digital strategy is an enabler to the achievement of KCHFT’s mission which involves

prioritising innovation, transformation, productivity, leadership and partnership working in

order to deliver sustainable services and support the organisational goals:

Strategic Goals

1. Prevent ill health

2. Integrate services

3. Deliver high quality care at home and in the community

4. Develop sustainable services

Fig 1 – Alignment of strategic goals with the Digital strategy

The Digital Strategy promotes innovation that will be the key to unlocking potential in

supporting and developing services. Empowering patients in the management of their

conditions through the development of self-care clinical apps and online access to clinical

records for children (the online red book) are just two examples where digital is supporting

the innovation of care by placing information under the patient’s own control (NHSE, Harnessing

Technology and Evolution, 2017)

Dig

ital S

trat

egy

Page 128 of 177



3 Triangulation and Links

Digital services within and outside of KCHFT provide a means to deliver and enhance the

day to day business activities of the Trust as well as provide support to deliver the ambitions

identified in the other organisational strategies and wider regional and national programmes

of work.

The most relevant links are listed below:-

1. The NHS Long Term Plan. By ensuring that the Trust Digital services support the

strategic ambitions of the NHS Long Term plan and closely align with the “Digitally

Enabled Care” section (chapter 5) and its timetable for delivery

2. Sustainability and Transformation Partnership (by ensuring that affordability and

efficiency are considered at every level as we move to a more preventative and

integrated approach with our partners in the health and care economy)

3. Sustainability and Transformation Partnership (STP) has identified a Digital work

stream promoting and delivering the Local Digital Roadmap (LDR) to support the new

models of care. The KCHFT Digital strategy will support this initiative as well as the

productivity and local care STP work streams with digitally supported change. The

first deliverable from this work stream is the Kent and Medway Care Record (KMCR)

which provides an integration Health and Social Care record for the Kent citizen.

4. Supporting clinical effectiveness and evidence-based practice by ensuring that

relevant digital technology is deployed to assist in particular, areas where there are

limited clinical resources and to support better outcomes for patients.

5. Supporting clinical risk management and patient safety with digital technology

underpinning the delivery of the GIRFT principles (getting it right first time) and

assisting in minimising incidents that adversely impact patient safety.

6. Providing new platforms to support better performance monitoring through the

delivery of new digital tools. This will provide dashboards at organisation,

departmental and team levels as well as deliver contractual key performance

indicators to demonstrate the reliability of the Trust as a provider and partner as well

as support ownership and accountability across operational teams.

7. To deliver the benefits of digital technology, workforce development will need to be

supported to include the necessary competencies for all KCHFT staff. Health

Education England’s digital literacy programme states “Excellent digital capabilities

include a positive attitude towards technology and innovation and its potential to

improve care and outcomes. With improved overall digital literacy capabilities, we

can all maximise that potential”.

8. Digital technology has the ability to support devolution of decision-making and

accountability to the closest point to patient care across the whole organisation in line

with the “People Strategy”. (1c Engaging and empowering our people). Also by

making the digital environment easier to use will assist with recruitment and retention

(3a Recruiting and retaining).

Page 129 of 177



9. All procurement and purchases to support the digital strategy will be in line with the

Procurement Strategy, Statements of Internal Control and Trust Standing Financial

Instructions.

10. Supporting the Estates strategy to deliver a more mobile workforce to drive transformations of care (Principle 1) and facilitating value for money through the more efficient use of estate technology enabled change (Principle 2).

4 Strategy Implementation Digital technology has become part of the mainstream and digital skills are essential for the modern clinical workforce. For this reason, the implementation of this strategy will rely, firstly on the technical specialists to provide the necessary internal infrastructure, secondly for all Trust leaders to work to develop a “digital culture” for the organisation and most importantly, every member of staff to engage in the delivery of digital services for their area of work. Education, both formal and informal will be required in order to develop a “digital culture” for our staff, patients and service users. Principles to be followed during strategy implementation will be:-

• Patients: If willing and able to do so, will be empowered by new tools to become more actively involved and engaged in their care. The patient generated data will be interpreted by algorithms enabling personalised self-management and self-care.

• Evidence: The introduction of any technology must be grounded in robust research evidence and a fit for purpose and ethical governance framework that patients, public and staff can all trust.

• Releasing time to care: Whenever possible, the adoption of technology should be used to give more time for care, creating an environment in which the patient-clinician relationship is enhanced. (Topol Review, 2018)

The additional considerations are as follows:

4.1 Ownership:

The success of this strategy will be reliant on all services taking steps to embed digital in their business as usual processes. To this end the Director of Finance will work with other directors to ensure that the Digital agenda is developed and resourced to meet actual Trust needs and priorities. The NHS ten year plan states “In 2021/22, we will have systems that support population health management in every Integrated Care System across England, with a Chief Clinical Information Officer (CCIO) or Chief Information Officer (CIO) on the board of every local NHS organisation” (NHS Long-term Plan, 2019) Whilst the Trust currently have a CCIO on the Board, the executive responsibility for IT currently rests with the Director of Finance. During the period encompassed by the Digital Strategy the Trust will consider its options in order to meet this milestone.

4.2 Resourcing:

Resourcing the strategy will be through a combination of the existing IT budgets delivering digitally enhanced “business as usual” services and the development of the strategic programme of work supported by specific investment cases for each major element. The organisation will also need to identify “digital champions” within the various services to act as a focal point for the delivery of the local digital agenda and ensure there is sufficient capacity to deliver what is required for the services.

Dig

ital S

trat

egy

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4.3 Structure:

The Information Communication Technology (ICT) department resides in the Finance and Business Support Directorate which facilitates close cooperation between these corporate departments. Information received from performance and business development in particular will be of use when modifying the programme of work to deliver the Digital strategy.

4.4 Sharing Intelligence

The Trust has an IT Steering Group which is composed of senior managers from

Trust services and chaired by the Director of Finance. The Assistant Director of ICT

reports progress against all aspects of ICT including the Digital programme of work.

In addition, information is shared at the monthly management committee meetings

informally and formally reported as required.

5 Scope

As stated, digital technology is now mainstream and so the target audience for this strategy

is all managers of the organisation. Additionally, an awareness of digital technology is

required by all KCHFT staff and how this can be used to improve their day to day working

life. This links directly to the duty to safeguard Trust assets and resources and to strive to

develop better ways of working.

In addition to the IT steering group other key groups of staff will have responsibility for

overseeing the development of the Digital agenda within the organisation. This includes:

• Members of the Board

• Directors and Assistant Directors

• Service Leads or Heads of Department

• Finance Business and Investment Committee

• Quality Committee

• Finance and Business Support Directorate

• External agencies and regulators (particularly NHSD and NHSI).

Page 131 of 177



6 Objectives and Targets

This section describes the overarching targets for the Digital strategy over the next five years

which is supplemented by a programme of work outlined in Annex 1. Given the fast moving

nature of digital technology this programme of work will be kept under regular review to

ensure it remains aligned with KCHFT’s business objectives and that it takes account of

changes and advancements in digital services.

1. To review and replace where required KCHFT core Digital applications:

Outcome – to ensure all digital applications are up to date and fit for purpose to

deliver improved patient experiences and support new models of care

2. To upgrade KCHFT’s network infrastructure including wide area and local connections Outcome – to allow faster and more reliable connectivity for all staff to clinical and non-clinical applications. Improving efficiency and resilience

3. To refresh end user devices and operating systems to current versions Outcome – To protect the Trust from the risk of unsupported software and to improve the user experience when accessing their Digital applications

4. To investigate opportunities to refresh infrastructure across the five year horizon in line with national NHS strategy guidelines (i.e. Cloud enabled, Internet first etc.) Outcome – to provide a simplified architecture thus improving the resilience of the Trust’s infrastructure and allowing new opportunities to deliver fresh Digital applications

5. Build and enhance the current level of Trust cyber and information security

Outcome – an improved security infrastructure to ensure patient and other sensitive information remains safe and available for all staff who require legitimate access.

6. To maintain engagement with all areas of the Digital workstream for the STP

Outcome – to ensure better health and social care information exchange by involvement in the design and implementation of the KMCR. Also to influence the development of the Digital agenda across Kent to support the KCHFT strategy

7. Investigate opportunities to deliver services digitally to enhance quality of patient care

and decrease costs Outcome – to adopt new practice underpinned by enhanced Digital services, such as AI. This objective will deliver new ways of working and opportunities for improved patient care and reduction of cost.

8. Develop digital capabilities for all staff through engagement, training and communication. Plans to be developed and implemented

Dig

ital S

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egy

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Outcome – an engaged and digitally mature workforce who will embrace the new opportunities offered by the new digital services provided through this strategic programme. This will ease future implementations and result clinically led, digitally enabled patient benefit.

Key performance indicators will be reviewed and further ones developed as the strategy is rolled out to ensure changes are having the desired effect and unintended consequences are identified and dealt with accordingly. Improvement against the national Digital Maturity Assessment metrics will also be expected and monitored to benchmark the Trust with similar organisations in England. Reporting on progress will be via the IT Steering group and the Trust Management Committee on a quarterly basis. Strategic objectives will also be translated to personal objectives for all IT (and other) staff and monitored through the normal performance appraisal system.

Page 133 of 177

Kent

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Dig

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Page 134 of 177

Kent

Com

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HS

Fo

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Page 135 of 177

Kent

Com

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lth N

HS

Fo

und

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Tru

st

Dig

ita

l S

trate

gy

Vers

ion 1

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P

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Dig

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trat

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Kent

Com

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ea

lth N

HS

Fo

und

ation

Tru

st

Dig

ita

l S

trate

gy

Vers

ion 1

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P

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6 o

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ay 2

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9 References and Bibliography External references:

• Department of Health: (2007), Our NHS Our Future. NHS Next Stage Review. Interim Report. Crown Copyright.

• Department of Health and Social Care: (2018), The future of Healthcare: Our vision for digital, data and technology in Health Care.

• NHS (2014), Five Year Forward View. NHS England, Public Health England, TDA, Monitor, CQC.

• NHS: (2019), (The) NHS Long-term Plan. www.longtermplan.nhs.uk

• NHSE: (2019) A Digital Framework for Allied Health Professionals Internet Ref: https://www.england.nhs.uk/wp-content/uploads/2019/04/a-digital-framework-for-allied-health-professionals.pdf

• NHSE: (2017) Harnessing Technology and Innovation Internet Ref: https://www.england.nhs.uk/five-year-forward-view/next-steps-on-the-nhs-five-year-forward-view/harnessing-technology-and-innovation/

• STP Local Digital Roadmap (2016) “A Digital Roadmap for Kent and Medway”

• The Topol Review (2018) Preparing the healthcare workforce to deliver the digital future (Interim report, a call for evidence)

KCHFT Internal References:

• KCHFT Business Strategy.

• KCHFT Estates Strategy.

• KCHFT Procurement Policy.

• KCHFT People Strategy.

• KCHFT Quality Strategy.

• KCHFT Standing Financial Instructions.

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Agenda Number: 3.1

Agenda Item Title: 2018/19 Patient Experience and Complaints Annual Report

Presenting Officer: Dr Mercia Spare, Chief Nurse (Interim)


Report Summary

This report outlines key areas in relation to patient experience and complaints for the year 2018/19 provides assurance to the Board that patients and carers are involved in the review of patient experience data and that learning, and changes in practice are taking place.


To note the report.



No ☒


Sue Mitchell Tel: 07393 240018

Assistant Director Patient Safety and Experience


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Patient Experience and Complaints Annual Report 2018/19

1.0 Introduction

The aim of this report is to provide assurance that Kent Community Health NHS Foundation Trust

collected on-going patient feedback in real time, responded to complaints and used that

information to improve services. It contains details of patient and service user feedback for the

period of 1 April 2018 to 31 March 2019 captured using a variety of different sources, including

Meridian surveys, on-line forums such as NHS Choices and Care Opinion, contacts with our

Patient, Advice & Liaison Service, compliments and complaints.

2.0 Patient Experience 2.1 Meridian data survey volumes and satisfaction scores 2.1.1 A total of 66,085 surveys were completed by patients, relatives and carers with a combined

satisfaction score of 96.9%. 2.1.2 There was an increase in survey volumes when compared with 2017/18 (63,731) with a similar

overall satisfaction score of 96.8%. 2.1.3 Survey volumes for 2018/19 generally followed the trend seen in 2017/2018 with the exception of

a slight decrease in May 2018 and an increase in August 2018, February and March 2019. The decrease in December for both years is a usual trend due to the Christmas period.

2.1.4 Monthly satisfaction scores for 2018/19 remained more consistent than in the previous year, with

results ranging from 96.6% to 97.2%.

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2.2 Friends and Family Test (FFT) data 2.2.1 64,638 people answered the FFT question in 2018/19 which was an increase on 2017/18

(59,144). The score for 2018/19 demonstrated a positive recommend rate of 96.9%, which was marginally lower than 2017/18 (97.2%).

2.2.2 All surveys with an unlikely or extremely unlikely response to the FFT question were included in

reporting and teams continue to take action and make improvements in response to negative feedback. Of the 5,494 additional surveys completed in 2018/19, 3% fewer patients decided to choose the ‘extremely likely’ option. An additional 2.7% of patients choosing the ‘likely’ answer option.

2.3 National FFT datasets from April 2018 to February 2019 2.3.1 As of 11 April 2019 the latest national datasets published run to February 2019. Therefore

analysis for the 2018/19 year currently includes data from April 2018 through to February 2019. KCHFT has completed 55,405 FFT responses from April 2018 to February 2019. This is the highest of all the service providers that feature on the national community health datasets. As the scatter graph below shows KCHFT’s percentage (97%) recommend for the FFT is above the national average (96%) for the April to February period and at the top of the upper quartile for surveys completed.

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2.3.2 Most of the service providers that fall in the upper quartile for percentage recommended fall in the lowest quartile for surveys completed. There are 5 service providers with a percentage score over 99.5% and 4 of these are among the lowest 5 for numbers of responses.

2.4 Patient Advice & Liaison Service (PALS) enquiries 2.4.1 The role of PALS is to be the first point of contact for the public, patients and their families/carers

should they have a problem or need information. The team guides people in the right direction by signposting them to services and providing contact details. They liaise with staff and managers to help patients and relatives find a quick resolution to any problems they are experiencing or concerns they may have. More involved concerns or complaints are promptly escalated to the Patient Experience Team for logging and investigation.

2.4.2 The PALS team took a total of 6,308 calls during 2018/2019, less than in 2017/18 (6,871). Calls

received were requests for telephone numbers, appointments and signposting. 2.4.3 The main issue that handled during 2018/19 was for patients wishing to contact the Podiatry

Service. In September 2017 the service changed their appointment booking process and PALS received many calls from patients who were unhappy that they could not access the admin hub, leading to delays in their appointments/care. Following a spike of calls to PALS in Q1 2018/2019, the following improvements were made:

The service successfully recruited admin staff trained specifically for the role.

The network issues on the Queen Victoria Memorial Hospital site in Herne Bay were addressed which increased connectivity speed and improved the volume of calls able to be handled.

Patients not getting through to the team first time have the option of leaving a voice message. These actions significantly improved the accessibility to the service and all calls are responded to within 24 hours. A subsequent non-executive director led deep dive provided further assurance that accessibility to the service had improved.

2.4.4 An identified theme has been patients making calls to PALS thinking they were contacting

services directly. This was due to patients misreading information on service appointment letters. These templates were amended by the Communications Team to prevent future problems and numbers of calls have gradually decreased.

2.4.5 PALS also received calls regarding long waiting times for follow-up appointments with the

Community Paediatric service and missed or delayed community nursing visits.

The Community Paediatric service is working to allocate all new referrals meeting the criteria to an autism assessment within 9 to 12 months of referral. This ensures children receive a diagnosis within a consistent timeframe and enables the service to be clear from the outset about waiting times for this specialist assessment.

Concerns raised regarding missed or delayed community nursing visits are addressed and shared with the teams to prevent similar problems from happening again. Staff in Thanet are working on a project to implement a new local referral unit process to ensure visits are allocated effectively and not missed.

2.5 Patient reviews received during 2018/9 via sources other than Meridian surveys 2.5.1 146 reviews were received using on-line forums such as NHS Choices and Care Opinion, the

patient experience team generic email and social media. 74% were positive, 18% were negative and 8% were mixed.

2.5.2 The main positive themes related to care and compassion, communication, staff attitude and

waiting times. Similarly negative themes related to communication, staff attitude and waiting times.

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2.6 Compliments recorded on Meridian 2.6.1 Two tools were built in 2018/19 for staff to use to record any compliments they receive. This has

worked well with 1,679 compliments being logged from patients/carers/families mainly thanking staff for their kindness and the quality of care received. 107 compliments were also logged from external providers/other organisations. These compliments include positive feedback from school staff and social services regarding their positive interactions and joint working with KCHFT staff.

3.0 Complaints received in 2018/19 3.1 In 2018/2019, 267 complaints for services were received in comparison to 303 in 2017/2018

which was a 12% reduction. This followed a reduction of 10% on the previous year 2016/2017. However it is clear that the complexity of complaints and involvement with other organisations has increased, as 30 (23%) of cases over the last 6 months included liaising with other organisations. This was an increase from 25 (17.5%) of cases in the previous 6 months.

3.1.1 The following graph shows the numbers of complaints received in 2018/2019 which are variable

each month.

01020304050

Number of Complaints

Months

Complaints for April 2018 to March 2019

Complaints

Mean

UCL

LCL

3.2 Levels of complaints 3.1.2 The following graph shows levels 1 to 4 complaints received by month for the last 3 years.

April to March 2016/17 Total 336



Average 28 per month Average 25 per month Average 22 per month

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3.2.1 Complaints are logged under levels determined by the nature and complexity of the complaint following the Trust’s Customer Care (Complaints) policy.

Category Description

Level 1 Minor

It should be possible to get a quick solution and does not warrant a full complaint’s investigation

Level 2 Significant

Requires contact with one or more service which involves some correspondence and an investigation to be carried out

Level 3 Major A serious complaint that may involve more than one provider and requires a full investigation.

Level 4 Complex

A serious complaint involving more than one provider (multi-agency).

3.3 Complaints in adult services 3.3.1 Numbers of complaints for adult services for 2018/19 are shown in the chart below.

Community nursing services continue to have the largest number of complaints increasing from 63 in 2017/2018 to 82 in 2018/2019. This service have the highest number of patient contacts (623,506), making a complaint to contact percentage of 0.013%.

The other two services receiving the highest numbers of complaints are community hospital inpatients (53,410 bed days in 2018/19) and the minor injury units (MIUs) (127,184 contacts in 2018/19) with 21 and 18 respectively, which is consistent with 2017/2018.

3.4 Complaints in Public Health and Children’s’ Specialist Services and Dental Services 3.4.1 Numbers of complaints for children’s and dental services for 2018/19 are shown in the following

chart:

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Community Paediatrics had the highest number of complaints for 2018/2019 with 23, an increase of 6 when compared to 2017/2018 (complaints to contacts percentage of 0.195%.

Dental saw a reduction from 30 complaints in 2017/2018 to 18 in 2018/2019 (complaints to contacts percentage of 0.015%).

The Health Visiting service also saw more than a 50% drop in formal complaints from 16 in 2017/2018 to 7 in 2018/19 (complaints to contacts percentage of 0.002%).

Other services remained fairly consistent.

3.5 Themes and trends by subject 3.5.1 The top 3 themes of complaints remained the same as in 2017/18 with clinical treatment as the

most common, followed by communications, appointments, access to treatment and staff.

Clinical treatment - Complaints that fall into this category involve aspects of clinical care provided by health professionals, medical nursing or allied health professionals. They involve complaints about the patient’s diagnosis and treatment, complications that may arise either during or after treatment, patient falls, nutrition and hydration, infection control measures, hygiene and pressure area care.

Communications - Complaints are received which relate to communication across all services between hospitals, GPs, patients, staff and carers.

Appointments including delays and cancellations - This category includes appointments including delays and cancellations and waiting times. For example waiting times to be seen by chronic pain service and cancellations made by the dental service, waiting times for equipment for children, delays and difficulties in getting podiatry and dental appointments, delays in receiving speech and language therapy.

3.6 Complaints Handling 3.6.1 General question on surveys relating to complaints handling During 2018/19, 42,747 people answered the survey question ‘If you recently raised a concern or

complaint directly with this service, do you feel it was responded to and acted upon?’ with a

satisfaction score of 97.2%. This was a higher score than in 2017/18 (92.89%) when less people

answered this question (36,950).

3.6.2 Following a lower than mean score in Q1 and Q2 of 2018/19, results for this question increased

in Q3 and were sustained in Q4. It is anticipated that the introduction of the e-learning

complaints handling training for all staff, in addition to the face to face training package, has

helped to support staff throughout the complaints process.

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3.7 Complaints training for staff 3.7.1 During 2018/19, 31 staff attended the complaints handling, face to face, half day training intended

for investigators, team leaders and managers delivered by the senior complaints officer. 3.7.2 A total of 169 staff undertook the newly developed complaints handling level 1 e-learning training

designed for all staff to give them an overview of the trust’s complaints procedure and what to do if they are contacted by a patient, relative or member of the public wishing to raise a concern. This is not mandatory but completion is actively encouraged. It is a requirement of staff to complete this e-learning prior to attending the face to face complaints handling training. Staff will continue to be encouraged to undertake complaints handling training through 2019/2020.

3.8 Feedback from complaints survey 3.8.1 The Patient Experience Team surveys complainants to capture feedback on their experience of

the complaints handling process. In 2018/19 a total of 177 surveys were sent to complainants with their complaint response as cases were closed. 22 surveys were returned, giving a response rate of 12.5%. Feedback gathered by this survey was mixed as complainants continue to find it difficult to separate the outcome of their complaint from the way it has been handled by the team. This has been discussed at the Kent and Medway NHS Complaints Managers Network and is a common problem across organisations. Further contact was made with complainants that requested it, either by the service or the Patient Experience Manager. Feedback from complainants has indicated that face to face meetings is beneficial to help resolve any complaints and to provide a more compassionate response. This practice is actively encouraged by the Patient Experience Team on behalf of the trust for all services investigating complaints.

3.9 Audit of complaints management 3.9.1 In July 2018 the Patient Experience Team completed an audit of complaints handled during the

previous financial year to provide assurance that the complaints handling process is of a high standard and to evidence compliance with the KCHFT Customer Care (complaints) policy. The audit was also undertaken to test assurance with the Care Quality Commission (CQC) Responsive domain.

3.9.2 This was the first KCHFT complaints audit and is to be repeated on an annual basis. 10% (31

cases) of level 1 to 4 closed complaints responded to during the previous financial year were audited by peer review.

3.9.3 The audit identified a high number of areas of good practice. For example:

100% of complaints were acknowledged within 3 working days

100% of level 4 complaints (KCHFT leading) were responded to within 60 working days

In 100% of cases, all elements of the complaint had been investigated and responded to 3.9.4 Recommendations and actions from the audit were as follows:

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Continue to encourage all services to seek assistance when comments/concerns are handled locally.

Continue to ensure that complaints are formally logged to ensure that a full investigation is completed and response letters are quality assured following the approval process.

The Patient Experience Team to continue to identify appropriate actions and areas for improvements resulting from complaints’ investigations to facilitate shared learning across KCHFT.

Complaints officers to work together to standardise the method of recording complaints on Datix to ensure uniformity. A document outlining the standards has been created.

3.10 Closed Complaints 3.10.1 During 2018/2019, 271 complaints were closed and of those 241 (88.9%) were closed within the

agreed timeframe.

0

20

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% Complaints closed

Mean

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3.10.2 For the 30 complaints that did not meet our timescales, delays were related to receiving the

required information and the completion of the approval process. Complainants are kept updated on any delays using their preferred method of communication. Timeframes are closely monitored and an escalation process forms part of the standard operating procedure which details the trust’s complaints handling process.

3.11.2 This remains a focus for 2019/2020 through early resolution meetings with complainants,

embedding of complaints training throughout the organisation and a review of the process. 3.11 Re-opened complaints 2018/2019 3.11.1 The team monitors the number of re-opened complaints. 35 (12%) complaints re-opened in

2018/2019 which was a reduction on 43 in 2017/2018. 33% (12) re-opened complaints were for children’s services regarding service provision and 22% (8) were for community nursing services and mainly related to communication issues. The remaining 15 reopened cases were for a variety of services. The graph below demonstrates that re-opening is most common in level 1 complaints with 20 cases re-opened are are generally due to mis-communications in the initial response. Level 1 complaints are those which are anticipated to be resolved quickly by the services with support from the Patient Experience Team. There were also 11 level 2 complaints re-opened and 4 level 4.

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3.12 Benchmarking against other providers 3.12.1 KCHFT is benchmarked against other community trusts via the Benchmarking Network. KCHFT is below

the average number of formal complaints per 1,000 WTE staff members (highlighted in orange below).

3.13 Parliamentary and Health Service Ombudsman (PHSO) cases 3.13.1 8 cases were opened by the ombudsman in 2018/2019.

4 were opened for enquiry and closed with no investigation undertaken.

1 was opened and closed as not upheld.

1 was opened and closed after investigation as partially upheld.

2 remain open, 1 as an enquiry and 1 as under investigation. 3.13.2 The partially upheld case was from 2015 when a root cause analysis was completed at the time.

Although the PHSO was assured by the changes and learning from this case they felt that these had not been clearly communicated to the complainant. They recommended that KCHFT wrote to apologise and to share the learning from the case. The PHSO was subsequently satisfied that their recommendations were complied with.

4.0 Learning from patient feedback

The Patient Experience Team continues to monitor improvements made by services as a result of patient feedback. In total 108 actions were recorded by the team, 63 resulting from complaints,

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27 from feedback received via Meridian surveys and 18 from other sources. 55 of these actions were uploaded on the KCHFT public website as examples of ‘You said …. We did……’.

4.1 Improvements made as a result of feedback from complaints during 2018/19 include:

Dover/Deal Community Nurses: A family member complained that the patient had not received a visit following an urgent referral from the GP. The process was reviewed and telephone referrals are now processed by the local referral unit and followed up with notes being added to the electronic notes system (CIS) to avoid any miscommunication.

East Canterbury Community Nurses: A patient complained that no contact had been made by the service after a GP referral requesting a repeat continence assessment. A scoping exercise into management of continence assessments was undertaken. The service now holds continence clinics for non-housebound patients to avoid unnecessary delays.

Children’s Speech and Language Therapy: A parent complained that following their child’s paediatric dietetic consultation, no prescription letter request was sent to the GP for calorie supplements. The service now ensures that administration is completed on the same day by seeing fewer children but holding clinics more frequently. A standard operating procedure was created to include the new process re GP prescription requests.

Dental Service, Hainault Health Centre: Patients were not always receiving notification of cancelled or changes to their appointments. Their system was updated so a text message is sent to patients when an appointment is cancelled or changed.

4.2 A selection of improvements made as a result of feedback captured by patient experience

surveys is shown below:

Hawkhurst Community Hospital: Feedback was received from patients regarding disturbance caused by TV noise from single rooms. The League of Friends installed headphones for use with televisions in all side rooms. Patients also reported disturbance on the ward due to the loud noise made by falls’ sensor alarms. Existing alarms were reviewed and a new system installed which alerts staff at the nurses’ station when chair or bed sensor alarms are activated.

Postural Stability service: When attending a group exercise class, patients with a hearing impairment said they found it difficult to hear the presenter. The service tested various types of equipment with patients and found the Roger Pen the most effective. This equipment is now available for patients attending group sessions.

Health Checks: A patient arrived for an appointment on time and had to leave without being seen due to the advisor not being available. In the event of advisor having to leave the clinic rooms, a clear sign is now being displayed on the doors with contact details for the advisor.

Health Visiting Service: Some mothers asked for more advice on food intolerance and reflux. The health visitors have been trained by a dietitian to be able to provide support. Information has also been added to the Red Book signposting where more specialist breastfeeding advice can be obtained.

5.0 Key quality improvements during 2018/19 5.1 The new method of using Meridian for staff to record compliments received from

patients/relatives/carers and other external providers is working well. A wide variety of services

have recorded compliments since the system went live in March 2018. All staff with a Meridian

Desktop login has access to this data to facilitate reporting and sharing with colleagues at team

meetings etc.

5.2 A member of the Patient Experience Team is attending local patient experience group meetings held by services to develop discussions on patient feedback and quality improvement.

5.3 The Patient Experience Team has produced flowchart guidance for new staff to be given as part

of their local induction pack. These cover key information about both the Meridian surveys and

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11

the complaints handling process. This is available for new and existing staff to view and print from the Patient Experience Team’s pages on flo.

5.4 Patient Advice and Liaison Service (PALS) – Following feedback from patients and carers the

name changed from the Customer Care Team to PALS. All the alternative formats of the PALS leaflet are available on the Trust’s website and paper copies of the leaflet are available for services in paper format.

5.5 Community Learning Disability Service: A short audio/pictoral survey for use at every

intervention was developed and rolled out at the end of November 2018 and is going well with a total of 160 completed up to 31.03.19. These surveys have an overall satisfaction score of 99.2%. The overall scores were 99.4% for the question ‘Did we help you today?’, 100% for ‘Were you happy with what we did?’ and 98.1% for ‘Would you like us to come back?’.

5.6 The Forget Me Not Patient Feedback form for patients with a confirmed diagnosis of dementia

or those with a cognitive impairment was piloted in Hawkhurst and Faversham community hospitals and rolled out across all community hospitals in January 2019. As at 31.03.19 a total of 143 surveys had been completed with an overall satisfaction score of 85.8%. The introduction of the survey was overseen by the two specialist nurses for dementia and the dementia link workers are assisting the patients to complete the forms. The dementia link workers have received support and guidance from the specialist dementia nurses and their matrons/managers.

5.6.1 As from 15 January 2019, a Client Experience feedback form was also introduced at Edenbridge

Day Hospital. The health activities assistant, who is also the dementia link worker, has undertaken to complete the survey with clients who attend and this survey is planned to be repeated every 6 months to review their experience.

5.7 Dental Services: An easy read/pictoral survey was introduced during December 2018. It is

available in paper format and via the public website. This survey is targeted for completion by patients with learning disabilities and those for whom English is not their first language. The Immigration Removal Centres and London clinics will gain valuable feedback using this survey as they treat patients from diverse cultures. A total of 1,655 surveys were completed by patients accessing 21 dental clinics from 1.12.18 to 31.3.19 with an overall satisfaction score of 99.6%.

6.0 Summary 6.1. The trust has seen an increase in survey volumes in 2018/19 and satisfaction scores remain

high. Services continue to use the feedback from their patients to improve the delivery of care provided. Services are developing new and different ways of capturing feedback are continually being developed to meet the needs of the patients accessing the wide range of services provided by the trust. Texting is to be trialled as an additional option for patients to give their feedback in 2019/20.

6.2. The introduction of complaints training and updated guidance has received excellent feedback

and has supported staff across the organisation to resolve complaints in a compassionate and more timely manner. This work will continue throughout 2019/2020 to further improve the quality of complaints management.

Name: Sue Mitchell Role: AD Patient Safety & Experience 10 May 2019

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Agenda Number: 3.2

Agenda Item Title: Learning From Deaths Report

Presenting Officer: Dr Sarah Phillips, Medical Director


Report Summary

In line with National guidance on learning from deaths KCHFT collects and publishes mortality data and learning points quarterly via a paper to Quality Committee and Public Board. This data includes the total number of the Trust’s inpatient deaths and those deaths that the Trust has subjected to case record review. Of those deaths reviewed, the Trust must provide estimates of how many deaths were judged more likely than not to have been due to problems in care. The dashboard included has been based on national suggested format. As the Board is aware, the KCHFT Mortality Review and Responding to Deaths Policy was developed following recommendations made by the National Guidance on Learning from Deaths (2017). Other national publications were also used to guide the content of the policy. The scope of reviews includes all community hospital inpatient deaths, any patients who die under our care with serious mental health needs and all patients with a learning disability. A sample deaths under the care of our community teams has also been added to the scope from November 2018. Mortality reviews are conducted through a centralised process where the review team is made up of a doctor, a ward matron or other senior clinical staff member, a pharmacist, a quality lead and centralised administrative support. Members rotate monthly to maintain a degree of independence. An internal process for reviewing deaths of patients with Learning Disabilities has been put in place alongside the LeDeR process for additional assurance, best practice and to meet the Trust’s ethical obligations. Learning from these reviews is submitted to the Mortality Surveillance Group and is included in this report. Following scrutiny at Quality Committee, the Board is asked to note that patients who die with learning disabilities and those that die in the community (not inpatients) are generally all receiving multiagency support. For example patients on the community nurse case load may also have been receiving care from their GP or been recently discharged from hospital. Most deaths of patients with learning disabilities occur in acute hospitals. In all cases when deaths are received by KCHFT all care provided by KCHFT is scrutinized and any learning for other organisations is shared. There are also discussions taking place about how to continuously improve this sharing. E.g. at regional level.

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The committee is asked to note that from February 2019, Mortality Surveillance Group meetings have been reduced from monthly to bi-monthly. This was felt to be appropriate as process changes are significantly less now that procedures are becoming more deeply embedded across the Trust. It is also hoped that less frequent meetings will encourage higher attendance rates. As defined in the Policy, the Trust Board has overall responsibility for ensuring compliance with all legal and statutory duties, along with best practice including having oversight of mortality review processes and awareness of the learning that emerges from reviews that drive improvements in care. The focus of trust mortality review is on quality improvement and sharing meaningful learning.


For assurance.



No ☒


Dr Sarah Phillips Tel: 01622 211922

Medical Director Email: [email protected]

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LEARNING FROM DEATHS REPORT (JANUARY TO MARCH 2019)

1. Introduction 1.1 National guidance on learning from deaths requires KCHFT to collect and

publish mortality data quarterly via a paper to the Quality Committee and Public Board. The quarterly report must include mortality data and learning points. Guidance states this data should include the total number of the Trust’s inpatient deaths and those deaths that the Trust has subjected to case record review. Of those deaths reviewed, the Trust must provide estimates of how many deaths were judged more likely than not to have been due to problems in care.

2. March Dashboard 2.1 The dashboard below has been based on national suggested format and refers

to deaths in community hospitals.

Total Number of Deaths in Scope

Total Deaths Reviewed

Number of deaths judged to be more likely than not due to problems in healthcare

This Month Last Month This Month Last Month This Month Last Month

5 3 4* 1 0 0

This Quarter (QTD) Last Quarter



11 13 13 11 0 0

This Year (YTD) Last Year This Year (YTD) Last Year

This Year (YTD) Last Year

11 66 13 66 0 0

*Deaths reviewed in a given calendar month can exceed the number of deaths reported that month because the figure includes deaths which took place in the previous month, but have fallen into the next month for review. 2.2 The graph below shows the number of inpatient deaths in community hospitals

per month this quarter along with the average.

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3. Learning from Mortality Reviews 3.1 The tables below outline key areas of good practice along with areas for

learning identified in reviews completed this quarter, along with the actions taken. These are also reviewed in the monthly Mortality Surveillance Group (MSG).

3.2 All areas of good practice and areas for learning are reported at monthly matrons’ meetings in the East and West and wider dissemination to all ward staff is encouraged. A monthly report is also reviewed at the End of Life QI Group.

Areas of Good Practice aligned to the Five Priorities for Care of the Dying Person

Recognise

- All medications were written up and ward staff were prepared for an end of life patient – QVMH

- Medication was reviewed and end of life recognised – Faversham

- Advance care plan and ceilings of treatment documented early – QVMH

- Anticipatory care plan and

advance care plan in place. Ceilings of care in terms of use of IV fluids and transfer to acute was clearly documented and there was a further review of ceilings of care as the patient deteriorated – Whitstable & Tankerton

Support

- Good feedback received from the family that they were happy with the care and support received – QVMH

- Documentation of communication with patient’s wife; notes confirm that she was made welcome to stay overnight – QVMH

- Comment recorded from patient’s

Involve

- Thorough documentation that the patient and family were involved with decision making, such as the decision to stop rehab – Sevenoaks

- Good documentation that patient understood risks of aspiration pneumonia if drinking un-thickened fluids but was choosing to take the risk, demonstrating respect for the patient’s wishes – QVMH

- Good documentation of discussion about patient’s wishes after out of hours doctor visited; patient remained on Heron Ward as he did not wish to be transferred to the acute – QVMH

- Very person-centred care shown, e.g. patient was given analgesia just before lunchtime and it was noted that she was happy to remain in bed to eat until afterwards when she could be helped to get up once it had taken effect – Faversham

- Detailed notes on CIS confirm the patient's wishes including details of his desired funeral

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daughter that she was very happy with the care her mother received – Whitstable & Tankerton

arrangements – QVMH

- It was documented that it was the patient’s choice to die in hospital – Deal

- This is Me completed by friend of the patient showing a holistic approach. Significant evidence of recognising the patient's needs and wishes, including support for vegan dietary choices and trying to arrange contact with sister (who was an inpatient at QEQM). Clearly documented when patient did not want to eat or drink, evidencing respect for her wishes – Whitstable & Tankerton

- Clear evidence of involvement shown by documentation of attempt to initiate conversation about advance care planning with the patient – Whitstable & Tankerton

- The dietician review provided a clear plan including patient preferences and eating for enjoyment, showing excellent person-centred care – Whitstable & Tankerton

- Clear documentation of effort to involve the family in the decision process as deterioration continued, including exploration of religious and spiritual needs – Whitstable & Tankerton

Plan & Do

- Very good examples of detailed care planning with clear actions, particularly around care of sacral wound – Sevenoaks

- Evidence of clear documentation with initial assessments clearly dated, signed and fully completed,

Communicate

- Good evidence of communication with family that the patient was expected to deteriorate – Sevenoaks

- Excellent detail on CIS around discussions with the patient re end of life which was professionally

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and very detailed records on CIS about daily care of patient - QVMH

- Pressure ulcer identified promptly on admission and reported on Datix – QVMH

- Prompt, thorough clerking and clear notes around the aim of admission. Appropriate medication written up - Faversham

- Initial assessments completed thoroughly and an individualised plan of care in place. Good detail in notes around reason for admission - QVMH

- All end of life documentation and personalised care plan in place. MCA, Consent and Safeguarding assessments thoroughly completed and very good examples of nursing documentation, such as a detailed rationale for why the decision was made to call an ambulance - Deal

- Thorough assessments completed on admission. Death was verified on the ward so there was no need for a GP visit – Deal

- Efficient handling of the situation when a drug chart from A + E was not transferred over with the patient; staff promptly chased the acute and received it by email shortly after – Whitstable & Tankerton

- Prompt clerking on admission with appropriate referrals. Assessments all completed promptly and thoroughly. Clear documentation of board rounds showing safeguarding and dietician input – Whitstable & Tankerton

and clearly written with strong evidence that the patient’s wishes were being listened to and respected – QVMH

- Good documentation of discussions with the patient and family around being at end of life, evidencing that the patient was aware of the situation and agreed that she was in her final days - Faversham

- Excellent example of communication documented with the patient’s daughter around nutrition and hydration, and understanding the patient was at end of life. Very detailed conversation in line with best practice – Deal

- Very good documentation of communication with case manager as well as contact with the patient’s sister and friend – Whitstable & Tankerton

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- Assessment of the patient’s needs

regarding pain and discomfort throughout. Skin, diet and bowel records very well documented on CIS – Whitstable & Tankerton

Themes for Learning

Comments/Actions

Transfers of Care

- In one case handover information from the acute was not clear as to any ongoing or resolved issues with vomiting and nausea.

- In one case, there was a discrepancy of documentation; the acute handover notes stated the patient had a pacemaker but there was no evidence that this was the case, or any mention of it in the GP medical record.

- Staff have been reminded that all

Transfer of Care issues should be reported on Datix. These issues are then taken forward with the acute by the Assistant Director for Patient Safety and Experience as part of the Transfers of Care Task & Finish Group.

Documentation

- In some cases, written care plans do not consistently translate into day-to-day action, and end of life care plans/advance care plans are not always in place.

- In one case, documentation on CIS after death could have been more detailed including support offered to family.

- In one case, an MCA should have

- Feedback from mortality reviews around quality of care plans has been sent to the Assistant Director for Clinical Governance and a wider piece of work around care plans is ongoing, with a report due to be discussed at Clinical Effectiveness Group on 25th March.

- Feedback has been sent to the ward matron for sharing with staff and has been included in the monthly report of learning from mortality reviews which goes to the East and West Matrons’ Meetings as well as the End of Life QI Group.

- Training around Lasting Power of

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been documented as the patient did not have capacity. In some cases, the advance decision and welfare attorney section on DNA CPR forms are left blank, and there is a lack of confidence and clarity around Lasting Power of Attorney.

- At Deal Hospital, medical documentation printed from the ‘Dragon’ dictation machine is unsigned, undated and stuck loosely into the paper notes, at risk of falling out.

- In one case, suction was given on the day of death and the day before but there was no documentation as to why this decision was made with regard to the patient’s best interests, as glycopyrronium had not been administered.

- In one case, there was a lack of awareness around what to do when a patient dies with no known next of kin leading to a delay in collection of the body.

Attorney is planned for staff at community hospitals, to clarify the difference between LPAs for health and finances and the importance of documenting they have been verified. The Lead Practitioner for Palliative and End of Life Care, and the Head of Quality, Governance and Professional Standards for East Kent will take this forward.

- The Medical Director has

discussed concerns around medical record keeping with the Strategic Delivery Manager for Urgent Care in the East to take forward.

- Feedback has been sent to the ward matron for sharing with staff and has been included in the monthly report of learning from mortality reviews which goes to the East and West Matrons’ Meetings as well as the End of Life QI Group.

- Legal are assisting with producing written guidance to be circulated to community hospitals for clarity This guidance will also be added to the Care After Death policy for future reference.

Recognition

- In some cases, recognition of end of life could have been earlier and there are missed opportunities to start end of life care planning. There is sometimes little evidence of linking care to the Five Priorities for Care of the Dying Person.

- Monthly feedback submitted to Matrons’ Meetings and the End of Life QI Group is now broken down into categories to reflect the Five Priorities; this should make staff more aware of the importance of Recognise, Involve, Plan & Do, Communicate and Support. The Lead Practitioner for Palliative and End of Life Care and the Nurse Consultant for End of Life Care are working to encourage earlier recognition across the Trust.

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3.3 Although the Trust is only required to review inpatient deaths in community hospitals and there is no national mandate to review deaths in the community, a process has begun which aims to sample one to two deaths per month from across East and West community teams to incorporate into the existing mortality review process, subject to capacity of the review teams. Deaths are selected by team leaders who identify cases for review where there may be particularly rich learning, such as where there were problems or if something went well despite challenges.

3.4 For assurance, there are processes in place to liaise with PALs, SI and Safeguarding teams so that all deaths where a complaint or concern has been raised will be reviewed, even if not normally in scope. Deaths going through the SI process may not be re-reviewed to avoid duplication, if the RCA already identifies detailed learning. Cases deemed not to be SIs and not subject to an RCA will undergo a mortality review to ensure no learning is missed.

3.5 The tables below outline areas of good practice and areas for improvement identified from the three sample community reviews completed this quarter.

Areas of Good Practice Areas for Learning

Hawkhurst Hospital (flagged for review as patient died at home on day of

discharge)

- All assessments carried out and well documented in a timely manner. Excellent documentation of difficult conversations regarding capacity and encouraging patient to stay in hospital. Good use of safeguarding team for advice.

- Lack of documented conversations about end of life or DNA CPR.

Ashford Community Nursing (flagged for review as complaint received)

- Good documentation throughout

and assessments completed thoroughly including End of Life assessment. Good evidence that team tried to meet all the patient's requests and needs. It was good practice to visit in pairs after a complaint was made as it was noted that one nurse felt intimidated. Good care given despite challenging circumstances. The complaint was responded to appropriately and thoroughly.

- No further areas for learning identified from the mortality review. The response to the complaint had already identified that the Local Clinical Resource Manager in Ashford would address communication styles with the team. Additionally it advised that a new ordering system had been implemented since the concerns were raised (the Online Non-Prescription Ordering Service – ONPOS) which has improved the efficiency

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of the process for ordering dressings, allowing a designated chemist to deliver dressings to nurses within 72 hours. It is hoped this will be rolled out to other areas soon.

Wateringbury and Paddock Wood Community Nursing

- On several occasions, the

patient’s husband forgot to collect medication but the team did everything possible to contact the dispensing practice and help with collection. Issues were pre-empted and there were regular reviews of medication needs and appropriate increases and reductions in pain medication dosage, all thoroughly documented. The family were present during each visit and were given information about where to seek further advice if needed. No gaps in care provision despite the need to transfer care from Paddock Wood to Wateringbury team due to capacity issues, which was done efficiently and did not result in undue delay. Good liaison with the GP and Hospice doctor.

- No areas for learning identified.

4. Mortality Surveillance Group Meeting Frequency

4.1 The committee is asked to note that from February 2019, Mortality

Surveillance Group meetings have reduced from monthly to bi-monthly. This was felt to be appropriate as process changes are significantly less now that procedures are becoming more deeply embedded across the Trust. Additionally, it is hoped that less frequent meetings will encourage higher attendance rates.

5. Cross-organisational working 5.1 A data sharing agreement with EKHUFT is in progress which would support

the future exchange of information for mortality reviews of mutual patients

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5.2 Discussions have taken place with the Interim Head of Patient Safety at KMPT and it has been agreed that we will share learning if either trust identifies a mutual patient during mortality review. This will help us to meet our obligation to ensure that the deaths of any patients with serious mental illness are reviewed.

6. Learning Disability (LD) Mortality Review Process Update 6.1 A separate report is provided by the Learning Disability service which is

embedded below.

Learning Disability review report Jan-March 2019.docx

Sarah Phillips Medical Director April 2019

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Learning Disability Service – Q4 Mortality Review Report

There have been 97 reported deaths within the CLDT from April 2017 March 2019.

Between January and March 2019 there have been 8 reported deaths.

Month Number

October 10

November 7

December 5

January 1

February 5

March 2

There were no Serious Incidents or any deaths attributable to the service.

Learning Disability mortality review meetings.

There have been 5 multi-professional meetings during January to March 2019. At the meetings enhanced reviews are discussed in detail from a MDT perspective. Outside of these meetings Mandy Setterfield (Specialist Practitioner) continues working on gathering information and completing standard reviews based upon the review criteria.

Table 2 below shows the number of reviews completed and pending overall;

Completed reviews Enhanced Standard

93 22 71

Pending 2 1

TBC 1 0

The 3 pending reviews require more information from the coroner or datix requires more explanation and or further explanation around the person’s death.

The progress to date has been good. The review process is on track to meet the anticipated trajectory by April 2019

Learning and Findings from the reviews from KCHFT perspective

Initial findings indicate that causes of death are similar to those reported nationally (e.g. respiratory, circulatory disorders and cancer).

0

50

100

150

Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19

LD mortality reviews - trajectory

Total (new) Awaiting review

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The majority of service users were on end of life care.

There were no avoidable/preventable deaths (from KCHFT perspective) or Serious Incidents (the LeDeR reviews will picks up learning from other pathways).

Highlighted good practice around EOL pathway, anticipatory care planning and joint working with GP’s, Hospice etc.

Practitioners who attend the LD mortality review meetings have given very positive feedback.

We have seen an improvement in quality of Datix reporting since the process was introduced.

• Outside of KCHT, through the reviews there remains an issue with End of Life medication being prescribed to late or not at all even when EOL plans and anticipatory care plans are in place. Another area is Do Not Resuscitate, best interest process is not being followed and clinical reason not being used as the decision for the DNACPR. These concerns were due to be feedback to the Kent and Medway LeDer steering group in January this meeting was cancelled so will be feedback in April and picked up there as an action.

Table 3 shows number of deaths and Cause of Death.

Cause of Death Number of deaths

Pneumonia/bronchial, chest infections etc. 23

Cancer (various) 15

Aspirational Pneumonia 11

Heart Failure 9

Kidney failure 5

Sepsis 10

Sudden death in epilepsy 1

Pulmonary embolism 1

Anaphylactic shock due to medication 1

We are awaiting the coroner’s findings for five deaths.

Table 4 identifies ages and number of deaths in age bracket.

Age Deaths

18 - 29 2

30 - 40 2

40 - 50 7

50 - 60 18

60 - 70 22

70 - 80 28

80 – 90 + 10

Awaiting confirmation of 7 people’s Date of Birth.

Mandy Setterfield Specialist Practitioner Mark Anderson Dept. Head of service

17th March 2019

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Agenda Number: 3.3

Agenda Item Title: Freedom To Speak Up (FTSU) Report



Report Summary

The report provides a summary of concerns raised by staff between 1 January 2019 and 1 May 2019.


To note the report.


Freedom To Speak Up Policy


No ☒

High level position described.

Sarajane Poole, Head of Quality, Governance and Professional Standards/ Freedom To Speak Up Guardian

Tel: 07500 605 263


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FREEDOM TO SPEAK UP GUARDIAN REPORT

1. Introduction

1.1 There are now more than 570 Freedom to Speak Up Guardians and Ambassadors across NHS organisations in England. Some of these are full-time posts, some part-time and some are added to people’s day job. In the period up to March 2018, they had dealt with over 3,000 concerns, 1,240 of which related to patient safety issues and over 60 per cent related to unacceptable behaviour, including alleged bullying and harassment1.

1.2 Sir Robert Francis QC has urged NHS Boards and managers to welcome staff raising concerns (whistleblowing), in the same way as staff are encouraged to report incidents. Kent Community Health NHS Foundation Trust’s (KCHFT) policy is in line with the national Freedom to Speak Up (Whisteblowing) policy. This says that staff should initially try to raise concerns with their manager or a more senior manager, but if this does not lead to satisfactory action (for example an investigation) or if the staff member feels more comfortable for whatever reason, they can contact the Freedom to Speak Up Guardian for advice and support. It is all in support of creating a more open culture that puts patient and staff safety at the heart of what we do.

1.3 No-one should experience discrimination or be victimised for speaking up,

but we know fear of this can prevent staff from doing so. Those who raise concerns via the Freedom to Speak Up process can expect to receive support and advice from the Trust’s Freedom to Speak Up Guardian, as will managers with whom the concerns are raised. The role of the Freedom to Speak Up Guardian is to be impartial and ensure that a fair and timely investigation into concerns takes place and that outcomes, actions and learning are shared.

1.4 This report covers the period 1 January 2018 to 1 May 2019.

2. Summary of cases

2.1 12 cases have been opened during the period of 1 January to 1 May 2018, this compares to 4 in the previous report. One of these is a collective of 9 members of staff, who whilst part of one case have also sort individual support. Of these cases 2 remain open and staff members are being supported to take the issues forward. A summary of the categories covered is below:

1 Source: National Office of the Freedom to Speak Up Guardian

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• Attitude and behaviour of managers – alleged bullying culture

• Patient safety

2.2 Within the data submitted 0 cases were raised by staff members going through either the Capability or Disciplinary process. This is a change on the previous reporting period.

2.3 A 3 month follow up of the situation is now being offered by the FTSU Guardian to establish that any changes that have been put into place are sustainable.

2.4 It remains difficult to obtain written feedback and the 3 month review has

encouraged staff members to reflect on their experience of speaking up.

3. Fostering a culture of openness

3.1 The number of FTSU champions within the Trust has reduced from 16 to 14 with champions leaving the Trust.

3.2 Following the publication of FTSU details within FLOMail 4 members of

staff across the Trust have expressed interest in becoming champions. A small upskilling session is to take place within June to ensure that they have the confidence to undertake the role.

3.4 The We Care reviews highlighted that some staff members are not aware

of the FTSU Guardian or Ambassadors roles or how to access the service. This has and is being addressed through attendance at team meetings. The yearly We Care programme is underway and FTSU understanding is being looked at to ensure that the work undertake to highlight the role has become embedded.

3.5 The recommendations and action plan shared at the previous meeting is

currently underway and an update will be provided in the next report.

3. Forward Plan

• To continue to implement the action plan that was shared via the previous report.

• A FTSU away day for ambassadors to be developed to ensure that the ambassador role is embedded within services.

4. Recommendation The Board is asked to note the report.

Sarajane Poole Freedom to Speak Up Guardian May 2019

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Agenda Number: 3.4

Agenda Item Title: Emergency Planning and Business Continuity Annual Report



Report Summary

This report is to provide assurance to the Board that plans and systems are in place to meet the Trust’s obligations with respect Emergency Preparedness, Resilience and Response and relevant statutory obligations under the Civil Contingencies Act 2004. The report sets out the Trusts state of readiness to respond to major incidents and disruptive events that impact on the delivery of services and performance.


The Board receives assurance of KCHFT state of preparedness.



No ☒


Jan Allen, Head of Emergency Preparedness, Resilience and Response

Tel: 07769 931666


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1. Introduction This report describes the work undertaken in 2018/19 on the Trust’s emergency preparedness in order to meet the requirements of the Civil Contingencies Act (CCA) 2004 and the NHS England Emergency Preparedness Framework 2015 The Trust has a mature suite of plans to deal with Major Incidents and Business Continuity issues. These conform to the CCA (2004) and current NHS guidance. All plans have been developed in consultation with partner organisations to ensure cohesion with their plans. The report covers the following;

• The training and exercising programme delivered

• The continuing development of the emergency planning arrangements

• A summary of incidents the Trust has responded to

2. Risk Assessment

The CCA (2004) places a legal duty on responders to undertake risk assessments and publish risks in a Community Risk Register. The purpose of the Community Risk Register is to reassure the community that the risk of potential hazards has been assessed, that preparations are undertaken and that response plans exist. Those standing risks currently identified on the Kent Community Risk Register include;

• Influenza-type disease (pandemic)

• Flooding

• Severe Weather

• EU Exit

As a result of risk assessments with internal services there has been progress made across services in pursuing the necessary actions to control and mitigate the risks. The Head of EPRR and the Resilience Officer have developed a close working relationship with services and assisted in the development of service level business continuity plans including detailed information on the Recovery Time Objectives and the Maximum Tolerable Period of Disruption for Information Technology across services. Within this reporting period the Trust has met four times at the combined On Call/EPRR meeting. Attendance by relevant managers/staff at these meetings has improved throughout 2018 -19, senior management support is in place to ensure appropriate attendance at these meetings. 3. Compliance EPRR remains a key priority for the NHS and forms part of the NHS Commissioning Board Framework (Everyone Counts; Planning for Patients), the NHS Standard

EMERGENCY PREPAREDNESS RESILIENCE AND RESPONSE (EPRR)

ANNUAL REPORT APRIL 2018 – MARCH 2019

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Contract and the NHS Commissioning Board Emergency Planning Framework (2015). A set of core standards for EPRR have been in place since April 2013. All organisations who receive NHS funding are asked to carry out a self- assessment against the NHS Standards for EPRR. KCHFT completed this exercise in August and NHS England agreed with KCHFT’s assessment that it was successful in meeting all of the requirements for rewarding ‘substantial compliance’ consistent with last year’s assessment. 4. Partnership working The Trust works in collaboration with a range of partner agencies through formal standing meetings and ad hoc arrangements. Formal committees of which the Trust is a member include the Kent and Medway Local Health Resilience Partnership (LHRP). The purpose of this group is to ensure that effective and coordinated arrangements are in place for NHS emergency preparedness and response in accordance with national policy and direction from NHS England – South, South East. The LHRP work plan is delivered by the Trust as required. An area of responsibility agreed at the LHRP for the Emergency Preparedness leads across the county is accountability to the local authorities for the medical risk assessment of community events taking place; the Head of EPRR is responsible for the Dover authority. 4.1 Student Placement

The EPRR team facilitated a university student placement in June 2018; the student who was approaching her third year of her university course is considering a career in EPRR

5. Planning 5.1 Major Incident Plan The Major Incident Plan is reviewed annually to ensure it continues to accurately reflect the role of the Trust in a major incident and how this role fits with the plans of other NHS organisations and the emergency services. The Major Incident Plan was reviewed in August 2018 and ratified by the Corporate Assurance Risk Management Committee on behalf of the Executive Management Team

5.2 Emergency Resilience and Business Continuity Policy The Emergency Resilience and Business Continuity Policy outline’s how the Trust will continue to discharge core functions in the event of disruption to business operations. Each service has its own Business Continuity Plan which is reviewed annually. There is a rolling programme of review and work completed with the Minor Injury Units and the Community Teams and Hospitals. 5.3 Heatwave Plan The Heatwave Plan for the Trust was updated as required for 2018. The Trust received health watch alerts for the period 1 June - 15th September 2018 and remained at Level 1 preparedness throughout this period. The plan allows for escalation of operational services, and specific actions would be implemented to safeguard patients and staff as necessary.

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5.4 Lockdown Policy The trust is required to have lockdown plans for appropriate sites, such as the Community Hospitals. The Head of EPRR has developed a Lockdown policy and working collaboratively with the Head of Health, Safety and Security to embed this in to the Trust. The Trusts seven Minor Injuries Units are located on National Health Service Property Services (NHSPS) sites, the aim of each of these is to develop and embed multi occupancy Lockdown Plans, this has proved challenging with lack of engagement from NHSPS. 5.5 EU Exit Planning In preparation for an exit from the European Union (EU) the Trust commenced planning in accordance with the EU Exit Operational Readiness Guidance, the guidance summarised the Government’s contingency planning and covered all actions that health and adult social care organisations had to prepare for. In accordance with the guidance and in partnership with multiagency partners the Trust has prepared extensively for an EU Exit, this has included a significant focus on the following; • supply of medicines and vaccines;

• supply of medical devices and clinical consumables;

• supply of non-clinical consumables, goods and services;

• workforce;

• reciprocal healthcare;

• research and clinical trials; and

• data sharing, processing and access.

The Trust was represented at a large number of exercises and meetings set up in anticipation of the UK’s exit from the European Union. Lessons identified and planning required was discussed at the Trust EU Exit exercise facilitated by the Head of Emergency Preparedness Resilience and Response. The exercise allowed these discussions to assist in the formulation of the Trust operational EU Exit plan Strategic meetings took place by weekly, nine work streams reported directly into the strategic meeting. As part of workforce planning Vismo is currently being implemented, this software allows the strategic managers a visual representation of the location of staffs home addresses, and identification of individual staff member’s skills, these may be required to support the delivery of care of Tier One services if the Trust were to instigate locality management. 6. Training and Exercising In order to comply with our obligations the Trust must undertake a number of emergency preparedness activities; these include a robust training programme facilitated by the Head of EPRR, in the current year the Kent Resilience Forum (KRF) facilitated the annual seminar with a focus on response on Recovery of services

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following major incident. KCHFT was widely represented with attendance from senior managers. A rolling programme of exercises designed to test and develop our plans are undertaken. These are:

• a communication test every six months

• a desktop exercise once a year

• a major live exercise every three years

• Command Post exercise every 3 years

6.1 Training

Extensive training is delivered to staff throughout the reporting period, this includes

the following;

The Head of EPRR in partnership with the Emergency Planning Officer from

Maidstone and Tunbridge Wells NHS Trust facilitated training for staff employed in

the Minor Injuries Unit (MIUs) on the management of a patient presenting with a

possible radiation injury, This training has been cascaded to staff working in the MIU

departments.

Within this reporting period KCHFT IT staffs have undertaken business continuity

awareness training, focusing their awareness of incidents relevant to their service and

the command and control processes in place.

Media training was provided to the Trust on call Directors on 10th September 2018;

this was delivered by staff from Meridian Studios. Attendees commented on the

positive content of the training and skills gained being used in other areas.

6.2 Exercises

Multiple exercises have taken place throughout the reporting period involving staff

from differing services, the exercise include the following;

A walk through Lockdown exercise took place at the Sittingbourne Minor Injuries Unit

on Friday 6th July, the learning identified from the exercise has been used to develop

the Trust Lockdown plan

An entire no notice water failure exercise took place at Hawkhurst Hospital on

Tuesday 11th September, this exercise was facilitated in partnership with South East

Water. Staff were professional and responsive in their response, lessons identified

were discussed at the internal Trust debrief facilitated by the Head of EPRR

. A multiagency evacuation exercise took place on the 30th November; the location of the Rest Centre was Edenbridge Leisure Centre. Staff from KCHFT participated, assessing and treating 21 volunteer patients, lessons were identified and all agreed the exercise was a valuable experience.

Skype for Business has been communicated to staff, the EPRR Team in partnership with IT facilitated a live no notice exercise on February 25th, lessons identified highlighted a lack of understanding for some staff on the process, further testing of the system and staffs understanding of Skype for Business are planned for 2019.

The Trust has therefore exceeded these requirements in 2018/19.

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7. Incidents

Throughout the year there have been a number of incidents across the Trust which has involved implementation of Service Level Business Continuity arrangements. Examples of incidents are documented below; The fire alarms at Sittingbourne Hospital were active on July 10th, following on from this incident a debrief took place involving staff from Virgin Health Care, KCHFT, and NHSPS. Challenges remain for multi-agency occupied sites, these are being discussed with partners from other agencies, and an exercise is currently being planned for Sittingbourne Hospital to test planning assumptions.

A Trust wide IT failure 3rd September resulted in activation of business continuity arrangements, no known harm occurred to patients. A report was developed by the IT department detailing the incident and actions taken. The Trust has been fully engaged in the activation of the Local Health Resilience Partnership Outbreak Policy. On Friday 27th April 2018 Head of EPRR for KCHFT received an email from Public

Health England (PHE) informing of individual with Hepatitis A at a hotel in the

Canterbury area. Within three days 85 individual working at the hotel received

vaccinations, this was provided by 3 vaccinators from KCHFT.

At the end of 2018 and within the first three months of 2019 the Trust again provided

an immediate responded to three further outbreaks, a fruit farm in Faversham, a

school in Dartford and a care home in Tonbridge, the interpreter service provided

support to KCHFT staff at the fruit farm incident.

A fire broke out in a supermarket in Folkestone on the 22nd November resulting in an impact on staff working in the area; a command centre was implemented by the Kent Resilience Team led by Kent Fire and Rescue. March 2019 - Sittingbourne Minor Injuries Unit reported a potential Chemical incident, a patient presented with unexplained symptoms; staff immediately recognised the patient presentation as a potential contamination and evoked the Chemical exposure plan. Command and Control was managed by the strategic manager for the Minor Injuries Units in the North of the county

8. Summary The Trust continued to develop its resilience arrangements throughout 2018/19 in 2019/20 this work will continue, ensuring the Trust maintains the ability to respond to emergencies and business continuity incidents. Lessons learned and good practice have been identified and shared amongst staff. On-going embedding of the EPRR arrangements remains a key priority. The focus for the continued development of the service in 2019/20 will be;

• To maintain compliance with the EPRR requirements

• To continue the planned works in respect of Lockdown

• To facilitate exercises for Clinical and Non Clinical Services

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The Board is asked to note the progress of the service in 2018/19 and endorse the continued development of the service for 2019/20. Jan Allen Head of Emergency Preparedness, Resilience and Response 10.05.2019

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