council of governors – february 2013 ref: cg/13/02/14 ... · council of governors – february...

COUNCIL OF GOVERNORS – FEBRUARY 2013 REF: CG/13/02/14

CoG Feb 2013: 14_a Board.doc

14

BOARD OF DIRECTORS

1 MEETING PAPERS & AGENDA

1.1 The agenda for the latest meeting of the Board of Directors held in public on 31st January 2013, is attached for information. The minutes of the previous meeting, held on 20th December 2012, are also attached. Further copies are available on the Trust’s website or on request from the Secretary to the Board.

1.2 The latest performance report is attached too, as presented to the Board at its meeting in January. Progress against delivery of the strategic objectives/ transformation programme for the 2012/13 business plan will be monitored through the sub-groups (please see sub-group Minutes for more detail) and the performance report will continue to be reviewed regularly at the Strategy & Performance sub-group.

1.3 Copies of the full reports from all Board meetings held in public are available on the Trust’s website (www.barnsleyhospital.nhs.uk) or on request from the Secretary to the Board (Carol Dudley, 01226 435000 or email [email protected]).

2 FUTURE MEETINGS 2.1 Governors, staff and members of the public are welcome to come along to any

meetings of the Board held in public. 2.2 The next meeting of the Board will be held on 28th February 2013, 2pm in the

Education Centre.

3. RECOMMENDATION Governors are asked to receive the attached Agenda, Minutes and Performance Report for information.

Stephen Wragg CHAIRMAN February 2013

A MEETING OF THE BOARD OF DIRECTORS WILL TAKE PLACE ON THURSDAY 31ST JANUARY 2013, 2PM

IN THE EDUCATION CENTRE, BARNSLEY HOSPITAL

AGENDA

No Item Enclosure

1. Apologies and Welcome

2. To receive and review the Register of Interests and receive any declarations of interests

13/01/P/02

3. To receive and approve the Minutes of the meeting of the Board of Directors held in public on 20th December 2012

13/01/P/03

4. To review and note progress on Matters Arising 12/07/P/04

Quality & Governance

5. Patient’s Story

6. To approve action plans re Quality in the NHS 13/01/P/06

7. To receive the quarterly report on Hospital Standardised Mortality Ratio and Summary Hospital Mortality indicator (SHMI)

13/01/P/07

8. To receive and note the Board Assurance Framework 2012/13 13/01/P/08

9. To receive and endorse the latest Assurance Report of the Audit Committee 13/01/P/09

10. To receive and note a progress report on Volunteers and voluntary work within the Trust

13/01/P/10

Performance & Finance

11. To consider the implications of the National Commissioning Board’s planning guidance: Everyone Counts, Planning For Patients

Presentation

12. To receive and review the monthly Integrated Performance Report 13/01/P/12

13. To consider and approve the report to Monitor for Quarter 3 2012/14 13/01/P/13

14. To receive and consider the Communications review for Quarter 3 2012/13 13/01/P/14

15. To receive a report from the Chairman, Mr S Wragg 13/01/P/15

16. To receive a report from the Chief Executive, Mr P O’Connor 13/01/P/16

17. To receive and support the quarterly report of the Medical Director 13/01/P/17

18. To receive and endorse the latest Assurance Report of the Finance Committee

13/01/P/18

19. In accordance with the Trust’s Standing Orders and Constitution, to resolve that representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted. Date of next meeting: - 28th February 2013, 2pm, at Education Centre, Barnsley Hospital

Signed: ………………………….. Chairman

REF: 13/01/P/03

REPORT TO THE BOARD OF BARNSLEY HOSPITAL NHSFT

03_12_Dec mins PUM.doc Page 1 of 12

MINUTES OF A MEETING OF THE BOARD OF DIRECTORS

HELD ON 20TH DECEMBER 2012 EDUCATION CENTRE, BARNSLEY HOSPITAL

PRESENT: Mrs J Ashby Director of Finance & Information Mrs S Brain England OBE Non Executive Director (present by electronic link, 2-4pm) Mrs L Christon Non Executive Director Mr S Houghton CBE Non Executive Director (present until 4pm) Dr J Mahajan Medical Director Mr P O’Connor Chief Executive Mr F Patton Non Executive Director Mr D W Peverelle Chief Operating Officer Mr P Spinks Non Executive Director Mr S Wragg Chairman

IN ATTENDANCE:

Ms A Bielby Deputy Chief Nurse (attending for Chief Nurse) Mrs H Brearley Director of HR & Organisational Development Ms C E Dudley Secretary to the Board Mrs S Gibson Head of Midwifery (Minute 21/298 refers) Mrs E Jeffers Director of Transformation Mrs E Libiszewski Director of Quality & Performance Ms H Stevens Associate Director of Communications & Marketing

APOLOGIES:

Mrs H Mcnair Chief Nurse

12/297 APOLOGIES & WELCOME Members and attendees noted above were welcomed, including Ms Bielby, representing the Chief Nurse, and Mrs Gibson, attending to present this month’s report for the Patients’ Story. Several Governors and members of staff and the public were also welcomed to the meeting as observers.

ACTION

12/298 DECLARATIONS OF INTERESTS None.

12/299 PATIENTS’ STORY Members were reminded that patients’ stories were not discussed at the meeting but were presented to emphasise the focus for the business of the Board – keeping patients at the centre. This month’s report had a wider remit than some earlier reports, focussing on the progress and achievements of the Trust’s midwifery team recently shortlisted for a national award: Royal College of Midwifery (RCM) maternity unit of the year. Ms Gibson, Head of Midwifery, was welcomed to the meeting to give a presentation on the team’s work. In her informative presentation, Ms Gibson outlined some of the unit’s achievements and innovative work over the past year and plans for the future,


all of which had contributed to the team being nominated for the national award. She advised that whilst the team had appreciated being nominated, they had originally questioned the rationale believing their approach to maternity services to be mirrored across the country; they had been delighted to realise that the unit was a leader in many fields and were proud to be part of the team. The presentation outlined the background of the unit and highlighted some of the challenges specifically facing patients in Barnsley. It emphasised the growth and value of community-wide work too, to ensure a cohesive approach, more support and improved services for the families it looked after. The Board thanked Ms Gibson for attending the meeting and reiterated its congratulations to her and all the team on being shortlisted for the RCM award, which the Board believed to be a well deserved acknowledgement of the team’s hard work, dedication and innovation. Ms Gibson left the meeting following her presentation.

12/300 MINUTES OF LAST MEETING (12/12/P/04) The Minutes of the meeting of the Board of Directors held in public on 29th November 2012 were received and accepted as an accurate record.

12/301 MATTER ARISING (12/12/P/05) The progress report on matters arising from the last and previous meetings held in public was received and noted.

12/302 2013/14 QUALITY ACCOUNT (12/12/P/06) Mrs Libiszewski presented the progress report on the 2013/14 Quality Account. She explained that the proposals set out in the report for the 2013/14 local priorities and indicators had been built following consultation with Governors at both general and sub-group meetings of the Council of Governors, thus capturing input from the wider membership too. The next phase of the work would focus on developing formal indicators and measurements and would take account of the recent planning guidance issued by the National Commissioning Board (NCB), before final proposals were presented to the Board of Directors and Council of Governors for approval. In discussion it was suggested and agreed that it would be useful for the agreed priorities to be shared with a number of external stakeholders, including the local Health & Wellbeing Board and Clinical Commissioning Group (CCG), albeit not necessarily for comment as it would not be appropriate for the Trust’s priorities and indicators to be led by contractual drivers. The next phase would also include consideration of the Trust’s data collection systems for both the local and mandatory indicators, to ensure these were sufficiently robust. The Board appreciated the report and affirmed its support for the progress, approach and proposed priorities and indicators identified to date.

LL

12/303 END OF LIFE CARE PATHWAY (12/12/P/07) On behalf of the Chief Nurse, Ms Bielby presented the report on the Trust’s protocols and policies regarding End of Life (EOL) Care for patients at Barnsley Hospital. The report outlined the background to EOL care, the national guidance and the specialist teams and support systems established within Barnsley. Collectively these had helped to form the Trust’s holistic approach, which included the Liverpool Care Pathway but was also underpinned by community-wide EOL and specialist palliative care teams as well as specialised training for both registered and non-registered staff, thus ensuring patients were


supported by trained staff as well as specialist and generalist teams. The Trust had, however, acknowledged the need for improvements and more recently a revised pathway had been introduced to improve support to patients and families in the Intensive Care Unit; this had proven to be very successful and was now being rolled out for patients and families in the Emergency Department too. The comfort care packs and EOL pathway discharge systems for patients who wished to end their lives at home were also working well. The Board was pleased to note that EOL care was regularly audited across the Trust to check that required standards were being met and any areas of improvement quickly identified. Ms Bielby assured the Board that more work was ongoing to ensure further improvements to help and support patients and families facing an EOL care pathway. One of the gaps recently identified was the need for an EOL steering group within the Trust, in addition to the district-wide group already established. The first meeting of the internal group would be held in January 2013 and one of its key aims would be to review the NICE standards around EOL care pathways. In discussion it was agreed that the group should also look at other aspects such as potential learning from the Torbay hospital upheld as a national exemplar for EOL care, facilities within the Trust (eg more access to single rooms on the wards) and issues such as the recording of EOL discussions. Regarding the latter, the report showed discussions recorded with 70% of patients and relatives; whilst it was believed that the actual figure was much higher (and it was agreed that the Trust should be aiming for 100%), Ms Bielby suggested that such discussions were not always properly documented in patients’ notes. She affirmed that this would be redressed so that the Board and Governors could be assured that required discussions took place with the patients and/or their families whenever possible, in accordance with the Trust’s protocols, and were evidenced by being fully recorded. The Chairman shared feedback from recent sub-group meetings of the Council of Governors, where Governors had reported on members’ experience of EOL care at Barnsley Hospital, including one case where a patient had reportedly been put on an EOL pathway but her husband had not been aware of this. It had also been queried whether the Trust could be considered to be starving patients by withdrawing sustenance. Mrs Christon, Chair of the Clinical Governance Committee (CGC), advised that the lack of family involvement had featured in a small number of complaint letters too. Ms Bielby reiterated that this was against the Trust’s standard practice; EOL protocols should support the families’ involvement and she would ensure this position was reviewed and addressed as indicated earlier. With regard to withdrawal of medication and/or sustenance, Ms Bielby suggested that this too linked to discussions with patients and families around how care should be taken forward at the end of life: there was no intention to starve patients or deprive them in any way, rather the aim was to help them die with dignity in accord with their individual needs and wishes. When, as was the Trust’s intention, all EOL care pathways were discussed and agreed with patients and their families and were properly recorded, this would be evidenced in the audit outcomes (the frequency of which would be increased). Mrs Libiszewski stated that any exceptions identified through the audits would be reported to the CGC via regular reporting from QSIEB (Quality, Safety Investment & Effectiveness Board); action plans were required by the CGC for all exception reports and would be subject to close scrutiny and monitoring by both QSIEB and the CGC. This approach would also enable greater triangulation against complaints and would ensure that Board members were assured on progress and improvements.

AB


The Board accepted the report and noted the proposed actions.

12/304 FAMILY & FRIENDS TEST (12/12/P/08) Ms Bielby reiterated the requirement, as outlined in the Chief Nurse’s previous report on the Family & Friends Test (November 2012), for Boards to review and approve the project plans for the implementation of the Family & Friends Test (FFT) within their respective organisations. The Board received and considered the implementation plan for Barnsley Hospital (BHNFT). Ms Bielby highlighted some of the key elements, including the data submission test due in early January 2013, the need for robust data capture systems, appointment of a project manager (currently being progressed), development of a communications strategy (to support awareness and understanding across both public and staff) and internal and external options to ensure effective data analysis. As identified in the implementation plan, the work would be further developed and led through a dedicated steering group. It was acknowledged that there were considerable risks and costs associated with the project. It was further acknowledged that the FFT was a national initiative, not internally-led, it would be useful therefore to collate and share information on the costs and risks with the Foundation Trust Network for upwards reporting to national co-ordinators and/or the Government. Ms Bielby affirmed that the proposed implementation plan would ensure appropriate supplemental questions were developed. All organisations had to ask the central question, “Would you recommend this [department/ward] to your family and friends?”, the responses to which would be submitted centrally for collation and national benchmarking. Trusts were allowed to ask supplementary questions, which, if used wisely, would give opportunity to glean more specific information too. The questions could – and would – vary across each ward/department. The methodology of asking the questions was also largely at the discretion of each Trust albeit Ms Bielby advised that experience from pilot sites nationally had shown paper-based systems to offer the best response rates. Whilst the Board supported the initiative, the Chief Executive and Chairman highlighted some additional aspects for consideration. The Chief Executive commented on the potential impact of the national benchmarking, which would report against six different response categories with only two being favourable. The Chairman pointed out the potential for issues around data ownership, particularly if any aspect of the project were to be outsourced. The Board agreed it was important that ownership of the data remained with the Trust and that this should be clearly set out in any related contracts. The Board noted the report and approved the proposed implementation plan.

AB(HM)

12/305 CLINICAL GOVERNANCE COMMITTEE (CGC) (12/12/P/09) Mrs Christon drew attention to the changes to the Board’s agenda, bringing the assurance reports from the governance committees higher up the running order. Whilst all agenda items were equally important, she welcomed this move, giving emphasis to the vital role of assurance from the committees. The assurance report from the CGC’s latest meeting held in December was received and several items were highlighted:


• expanded focus on the Board Assurance Framework (BAF). It was noted that both the CGC and the Non Clinical Governance & Risk Committee (NCGRC) were committed to carrying out more detailed reviews of the BAF at every meeting. In December the CGC had focussed on any items identified as having a gap in control or assurance. These had been reviewed in detail and the CGC had gained assurance that each gap would be fully addressed by the year end. Consequently the Committee had agreed that these items should be removed from the next issue of the BAF;

• other issues relating to the BAF had been reviewed and discussed as detailed in section 3 of the report. The Committee had been particularly pleased to receive assurance that progress was now being made on the Children’s Strategy for Barnsley (section 3.2.6 of the report refers);

• the Committee continued to receive and monitor a number of assurance reports from internal reports and external assurance visits. At the last meeting this had included a report on progress for the action plan developed in response to the latest visit of the Human Tissue Authority;

• the Committee had received and approved the updated External Visits Policy. The Committee had also agreed that the policy needed to be supported by improved communications to ensure more staff awareness and reporting of external visits centrally, and

• the list of identified red risks (four items), as appended to the assurance report and presented for the Board’s attention. Mrs Libiszewski pointed out that the same risks were also reported via the NCGRC. She confirmed that these were in alignment with the risks identified and being progressed through the BAF.

Mrs Ashby also provided an update on winter planning, further detail on which had been received very recently when NHS North of England had issued information regarding additional allocations from the Department of Health for winter pressures. The North of England would receive £82 million, of which £25 million had been allocated for local authorities and BHNFT could expect to receive £370,000. The Board noted and appreciated the assurance report from the CGC.

12/306 NON CLINICAL GOVERNANCE & RISK COMMITTEE (12/12/P/10) Mr Patton, Chair of the Non Clinical Governance & Risk Committee (NCGRC), confirmed that, as noted above, the Committee had adopted the same approach as the CGC with respect to the BAF and the red risk register. He also presented the assurance report following the NCGRC’s latest meeting and drew attention to a number of aspects, including: • confirmation from the Information Commissioner’s Office (ICO) that no further

action would be taken on the reported information governance incident. Mr Patton believed this could be credited to the Trust’s pro-active response submitted at the time of the incident: whilst a mistake had been made, the Trust had made a robust and speedy response to the situation;

• monitoring and continued challenge of appraisals and training would be taken up by the NCGRC, a report on which was scheduled to go to the Transformation Programme Workforce Board in January prior to a further report to the NCGRC in February;


• the Committee’s review of the BAF was highlighted in section 3 of the report, with particular focus on management of the 4 hour target across the Trust, training and the long term capital programme.

It was noted that the Committee had approved a number of updated policies: • Study Leave (Non Medical) Policy • Work Shadowing and Work Experience Policy • Risk and Governance Strategy Additionally the Committee had reviewed a number of new and/or significantly revised policies, which were recommended to the Board for approval: • Travel Policy • Space Utilisation • Electricity at Work Policy • Pressurised Systems Policy Ms Brearley sought permission to withdraw the Travel Policy in light of further comments received recently and the need for further consideration. This was agreed. With this exception, the Committee’s recommendation was accepted and the remaining three policies were approved. Mr Patton reported the Committee’s view that too many policies were being presented to the Board unnecessarily. The Committee had undertaken to review this in more detail in terms of the number and nature of policies per se and would make further recommendations to the Board subsequently. This was appreciated. Mr Spinks and Mr Peverelle referred to the National Programme for Information Technology (NPFIT) and the patient flow system. Whilst some elements of this had been discussed quite extensively at the last meeting, it was agreed that a fuller update report would be appreciated early in the new year. Mr Peverelle advised that discussion with the current provider for the patient flow system had continued but the providers had failed further tests, consequent to which the Trust was now considering its legal position and alternative providers. The Board appreciated and noted the NCGRC’s assurance report.

FP/ NCGRC

JA/DWP

12/307 ANNUAL REPORT ON PRIVACY & DIGNITY (12/12/P/11) Ms Bielby presented the report, which outlined the progress on privacy & dignity made across the Trust over the past year and highlighted the continuing challenges inherent within the related workstreams. The Board was pleased to note the action being taken to address the previously poor attendance for related training and the impact of the appointment of a lead nurse for Learning Disabilities, which had enabled a steering group to be established under her leadership to drive this workstream further forward. The Board was also pleased to note the overall positive patient feedback regarding patient and dignity and the continued good delivery on single sex accommodation (no reported breaches since May 2011). In terms of future development, the adult safeguarding team had recently launched two workstreams using DVDs and materials supported by regional funding. These had been launched in the Emergency Department, with good responses already being received, and would start in January with Band 7 nurses across the Trust. The team would welcome the Board’s support with this workstream to ensure its further development.


The Board readily affirmed its support and suggested that, whilst time would not permit a full presentation of the training DVDs at a Board meeting, it would be useful to share it at a future meeting of the Council of Governors’ Patient & Access sub-group (open to all Board members as well as Governors); additionally the training dates should be circulated to Board members so that they could attend suitable dates (Mrs Ashby advised that she had recently attended the Trust’s safeguarding training and had found it both useful and informative). Dr Mahajan suggested that the training sessions could be further enhanced by the involvement of patients, who would help to illustrate the importance of privacy & dignity based on their personal experiences. The Chairman and Chief Executive suggested it would be a useful topic to share with the local CCG too, particularly in view of the CCG’s emphasis on engagement. They would also like the team to explore options for posting some aspects of the training/awareness DVDs on the Trust’s website, provided actors had been used and no personal data would be breached. Ms Bielby welcomed the Board’s support and feedback and undertook to progress each aspect further.

AB

12/308 MONTHLY INTEGRATED PERFORMANCE REPORT (12/12/P/12a&b) The integrated performance report, which provided an overview of the Trust’s progress in terms of key activity, finance, quality, workforce issues and the transformation programme to the end of November 2012 was received and reviewed. The lead Directors expanded on the relevant sections as presented in the report: Activity Mr Peverelle presented the report on activity for November 2012 and highlighted a number of areas currently under pressure, including: • the cancer two week wait target, which was close to its threshold. The

cancer management team had reviewed the referral patterns of the past four years and identified a year on year increase in a number of sectors. This was being reviewed in more detail;

• continuing pressures on the emergency department, which had resulted in a decrease to 93.4% in the month against the 95% target for “4 hour waiting time”. The report outlined the main causes, largely reflecting the increased attendances and acuity of patients, the changing patterns of attendances and the impact of high levels of activity across the Trust. Mr Peverelle also highlighted the particular pressures in children’s services, which had recently resulted in the nearest available bed being some distance outside of the region – this seemed to be a national pressure. Pressures had continued into December. The ambulance service had declared a “majax” (major emergency) earlier in the month when demand had risen due to the extreme icy conditions. The situation continued to affect services and had put the Monitor target at risk for quarter 3 (Q3). Whilst the pressures were acknowledged, the Trust was not complacent and Mr Peverelle advised that a formal action plan had been implemented and had been discussed with both of the governance committees recently. He emphasised that plans were not just focussed on short term fixes but aimed to address longer term capacity and capital issues too. Mr Spinks referred to the regional data on A&E attendances and admissions distributed by the Chief Executive each week. The latest data showed only one Trust performing less well than BHNFT, however, it was stressed that


the data could not reflect the specific pressures facing the Trust, particularly the severity of the illnesses patients were presenting with and the diverse rationale(s) for admissions. Mr Peverelle undertook to circulate further information, which would better illustrate the mix of patients/illnesses. In addition to the action plans already developed, the Chief Executive welcomed the CCG’s growing awareness of their impact on the A&E position; the CCG had identified a lead for unplanned care who would sit on the Trust’s transformation programme, which would be useful for both organisations. It was also acknowledged and agreed that it would be important to consider how best to use the additional winter planning funding mentioned earlier, which served to illustrate the pressures currently being faced nationally, to help address the immediate position as well as support future planning. The Chief Executive assured the Board that the Executive Team would continue to deliver – and revise – the action plans, to look at all contributory factors and strive to maintain high quality and safe services for patients as well as protecting the Trust’s governance rating. Whilst discussing the ambulance service and A&E attendances, the Chief Executive referred to recent national reporting on ambulances waiting outside hospitals and allegations that some Trusts were not starting the “clock” until patients entered the hospital’s doors. The Board was assured that this had been checked internally and, as expected, it had been confirmed that it was not a practice employed at Barnsley.

With regard to DNAs (did not attends), the Chairman enquired about options for an electronic system to support patients wising to cancel appointments. He had tried to phone in to cancel an appointment recently but, undoubtedly due to other demands on staff’s time, had not received any response. Mrs Jeffers undertook to log this as an item for the transformation programme to pursue. Quality Mrs Libiszewski expanded on the Quality section, which showed two red exceptions: handwashing (still marginally below 100% but improving, with significant actions being led by the Infection Prevention & Control team and monitored through QSIEB to ensure assurance for the Board) and Serious Incidents (five, as listed in the report). She also drew attention to the safety thermometer, the data for which was beginning to stabilise. National guidance still asked Trusts not to use the data as comparative information but there was a growing need internally to use it to gauge the Trust’s position and help to inform the need for improvements/stretch targets on issues such as falls with harm (currently being addressed within the working group on falls). Workforce Ms Brearley highlighted the increased sickness and absence rate for November. Whilst this followed seasonal patterns it continued to be a concern and would have an adverse impact on the Trust’s cumulative plan against the annual target of 3.9%. The HR team continued to work closely with identified departments and Clinical Service Units (CSUs) to support improvements – both short and long term. The Chairman commented that he and the Governors had appreciated the data shared with the Council of Governors’ Staff & Environment sub-group recently, which had illustrated the huge variance across the CSUs. As a point of order, it was noted that the report inadvertently presented the statistics in a different order this month; Mrs Brearley confirmed this would be redressed for the next report.

DWP

EJ

HB


Finance Mrs Ashby reviewed each of the items in the report, key issues from which included the continued financial risk rating (FRR) of 3, the reforecast capital expenditure accepted by Monitor, the continuing downward trajectory on agency costs (pay), and the non achievement of contract income against CQUINS (commissioning of quality and innovations) for Q3 and the overall projection of c£1 million surplus at the end of the financial year. The RAG (red/amber/green) rating against the efficiency programme was queried again. The latest report showed it as green, in line with earlier discussions and agreement that the report should reflect the Trust’s position against the year end projection, which currently was expected to be achieved in view of non recurrent support. It was acknowledged, however, that this could be open to misinterpretation. It was further acknowledged that some form of dual reporting may be required to answer both requirements - performance against overall projection and performance against the transformation programme - and it was agreed that this should be revisited by the Finance Committee at its next meeting, in January. It was also affirmed that the current slippage against efficiencies had been explained and made clear to both Monitor at the recent Stage 2 review debrief meeting and to the CSUs in the latest workshop discussions between the Board and Clinical Directors. Mrs Ashby referred to the single plan identified as “red”: this related to pharmacy, as had been reported previously, and would be mitigated by replacement plans. Transformation Programme Mrs Jeffers advised that each of the eight programmes continued to gather momentum and had also begun to trigger other associated workstreams as they progressed. The CCG had identified leads for each programme and Mrs Jeffers would be meeting with the CCG’s Chief Executive designate early in the new year to discuss how to make the best use of the limited time that would be available for the CCG’s nominated representatives. A communications lead had also been appointed to support the transformation work (Emma Bodley), currently working with Mrs Jeffers to develop the first stakeholder event for the programme in January 2013, aimed at obtaining stakeholders’ understanding of the Trust’s work. For good order, Mrs Jeffers also advised that the IT Strategy, previously scheduled for review in December, had been deferred to January in order to take account of the Board’s response to the proposals presented on the PAS/EPR (patient administration system/electronic patient records) in November. Whilst the Board appreciated the report, Mr Patton expressed some concerns regarding the current status with all programmes shown as amber and no clear assurance on the required run rate for the year end. Mr Patton’s concerns were echoed by the Chairman and other Non Executive Directors, particularly in light of the delay in the planned external challenge and the low number of exception reports (only one presented despite all programmes being rated at amber). Mrs Jeffers acknowledged these concerns but advised that with progress increasing and more information now available she would be able to provide a clearer report for the Board in January. It was acknowledged that some of the Non Executives’ queries would be answered through their closer involvement in the programme, with a Non Executive now nominated to sit on each of the programme boards. Mrs Libiszewski also advised that the Transformation Delivery Group had agreed a modified approach on quality and risks, which would significantly improve measurability/measures of success, would provide

SW/ Finance

Cttee

EJ

EJ


better links to the risk log and would support clearer reporting. The Board agreed to await further clarification at the next meeting, albeit with some reservations as the time to redress any shortfall by the year end would be quite tight at that point. Mr Houghton left the meeting at this juncture, due to other commitments. Transformation programme: Gateway review The Board noted that three of the transformation programmes – Workforce, Urgent Care and Elective Care – had undergone an internal gateway review. As shown in the report, the review had identified a number of issues common across each of the programme boards. These would be helped by (i) the Transformation Delivery Group – this had already been set up and was proving to work well; (ii) agreement to adopt more focus on QIPP (Quality, Innovation, Productivity and Prevention) rather than CIP (cost improvement plans), and (iii) agreement that, in future, all new schemes should be reviewed by the Transformation Delivery Group in the first instance to check that the scheme encompassed all elements of QIPP. In discussion it was affirmed that the gateway review had been intended primarily as a stocktake on the identified programmes, to look at the current programmes and refocus/redefine areas where needed. The Chief Executive emphasised that the review had also been necessary to ensure that the right design was in place to deliver the aims of the transformation programme overall, with the capacity in place to do so - and action plans developed for any identified gaps. The review had made good inroads into this aspect of the work but fuller answers would be provided in next month’s reports. It was acknowledged that waiting until next month could create further pressures with the year end then only three months away, but it was necessary to have the fuller answer before making definitive responses. The Board received and noted the report and accepted the recommendations of the gateway review.

EJ

12/309 CHAIRMAN’S REPORT (12/12/P/13) The Chairman’s report, which provided an overview on a number of activities since the last Board meeting and several items of interest, was received and noted. The Chairman referred to section 2.2, regarding the immediate disqualification of one of the public governors under section 8.12(vi) of the Constitution following his conviction for benefit fraud, although it was noted that he had also offered his resignation. In addition the Chairman reported on the outcome of the single public constituency (Constituency B), which had gone to ballot in the latest round of elections to the Council of Governors. Mrs Buttling had been re-elected and the Chairman had written to congratulate her on her re-appointment. He had also written to the unsuccessful candidate to thank him for his continued interest and support for the Trust and to invite him to explore other ways of working with the Council of Governors; a response was awaited. The Chairman commented on the Trust’s Carol Service, held on 19th December. It had been Father Peter Needham’s first such event since his appointment as Hospital Chaplain and the Chairman was pleased to report that it had been a well attended and very successful service. Two additional reports were received from the Non Executive Directors:


• Mrs Christon had attended a very useful King’s Fund event recently on behalf of the Board, linked to the Trust’s project on frail elderly patients (reported previously). It had been an interesting event and Mrs Christon was keen to remain involved with the project.

• Mr Patton provided a brief verbal report on the progress of Barnsley Hospital Support Services Limited (BHSS), a wholly owned subsidiary of the Trust. More regular reports would be presented to the Board in the coming year. Mr Patton reminded the Board that a range of pharmacy services would be among the first to be supported through BHSS. The new premises and robot system were ready and services were expected to be rolled out in January 2013, with plans to be fully operational in February. The Board agreed that the work of everyone involved in the project was to be applauded. The Chairman highlighted the role of the estates team in this and many other projects across the Trust. The team constantly worked extremely hard to introduce and maintain high standards across the Trust and their efforts were greatly appreciated. The Chairman had recently written to the team to thank members for their involvement with the Acute Medical Unit (AMU) and it was agreed that the Board’s appreciation of their wider work should go out to them too through the Chief Executive. The contribution of other staff regarding the AMU had not gone unnoticed and was reflected in this month’s winners of the BRILLIANT Staff Awards, with Matron Gwyn Morritt and Charge Nurse Kev Hall named as joint winners of the individual category and the Healthcare Initial’s cleaning staff (on the AMU) winners of the team award.

POC

12/310 CHIEF EXECUTIVE’S REPORT (12/12/P/14) The Chief Executive’s report was received and reviewed. Several points were expanded upon in discussion, including: • Section 2: the outcome of the CCG’s authorisation application was awaited

and would be reported to the Board as soon as possible; • Section 3.2: With the NCB’s planning guidance launched recently, the

clinical senate had been deferred until January 2013 and further information on the Clinical Network Arrangements would be shared at the next meeting.

• Further details on the NCB’s planning guidance, “Everyone Counts, Planning for Patients”, would also be presented at the next meeting of the Board. As an early observation, however, the Chief Executive believed it provided a better balance between quality and output to financial rewards/penalties. It also outlined some key elements to ensure timely reporting. The guidance was presented in three sections: - “must dos”, financial rewards and penalties - expectations, reinforcing what should be the priorities for CCGs - five public offers around seven day working (with an emphasis on

diagnostics and emergency, which had been anticipated in the Trust’s own transformation programme); transparency; listening to patients; better and more consistent data; and emphasis on safety.

• Section 5 – In addition to the information provided on the Chancellor’s Autumn Statement, Mr Spinks enquired how/ if the impact of the allocations announced for CCGs (a 2.3% increase, above inflation) would impact on the

POC

POC

POC


Trust’s budget for 2013/14. Mrs Ashby affirmed that the Statement also included a 4% efficiency target and cost inflation of 2.7%. Although this would result in an overall tariff reduction of 1.3%, it was still better than the Trust’s previous projections and had potential to improve slightly after the national “road test” of the tariff had been completed. The Chief Executive also clarified that the 2.3% was a flat rate allocated to Primary Care Trusts initially.

12/311 BOARD ASSURANCE FRAMEWORK (12/12/P/15) The Board Assurance Framework was received and noted. The report was presented on an exception basis, showing two identified risks: the 4 hour target (discussed earlier and reviewed with the governance committees) and financial viability in view of slippage on the Trust’s cost improvement programme. Mrs Libiszewski acknowledged that the latter might present a conflict with financial reporting elsewhere on the agenda and the Board agreed that it would be useful for this to be explored further at the next meeting of the Finance Committee.

SW/ Finance

Cttee

12/312 COUNCIL OF GOVERNORS (12/12/P/16) The agenda of the meeting of the Council of Governors held on 12th December 2012 and approved minutes of the previous meeting held in October 2012 were received and noted.

12/313 LISTENING TO STAFF (12/12/P/17) The report on the latest “Listening to Staff” session, in October 2012, were received and noted. The Chairman and Non Executive Directors involved had visited the Diagnostics and Nuclear Medicine team, led by Dr Yates. It had been a very interesting session, providing valuable assurance on direction and timelines and a useful insight into some of the team’s work. Mr Peverelle was pleased to advise that the second CT scanner had been delivered on site earlier in the week and was scheduled to be commissioned in the new year.

12/314 ANY OTHER BUSINESS & DATE OF NEXT MEETING a) Public comments

Mr Unsworth, Lead Governor, welcomed the lengthy discussions on End of Life Care Pathways. He had brought the report mentioned by the Chairman to the Governors’ meetings and appreciated the Board’s response to this sensitive and important issue. Mr Brannan, Partner Governor for Voluntary Action Barnsley, took the opportunity to thank the Board for their work throughout 2012. He looked forward to the continued progress of the transformation programme in 2013.

b) Date of Next Meeting

The next meeting of the Board of Directors was scheduled for 31st January 2013, commencing at 2pm.

In accordance with the Trust’s Constitution and Standing Orders, it was resolved that members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted.

REF: 13/01/P/12

REPORT TO THE BOARD OF BARNSLEY HOSPITAL NHSFT

SMT:\Board\Templates & Agenda\12_Integrated Board Report_1.doc

SUBJECT: MONTHLY INTEGRATED TRUST BOARD REPORT – REPORT PERIOD MONTH 9

DATE: JANUARY 2013

PURPOSE: To provide an overview of the Trust’s performance in terms of quality, activity, workforce, finance and the transformation programme for December 2012.

Board Assurance Framework:

BAF Key risk

To provide positive Assurance against the following Trust business objectives: 1a, 1b, 2c, 3c, 5b.

RECOMMENDATIONS: The Board of Directors is asked to receive and consider the contents of the report.

AUTHOR:

Janet Ashby, Director of Finance and Information David Peverelle, Chief Operating Officer Liz Libiszewski, Director of Quality & Performance Hilary Brearley, Director of Human Resources and Organisational Development Elaine Jeffers, Director of Transformation

SMT:\Board\Templates & Agenda\12_Integrated Board Report_1.doc Page 2 of 2_

CORE IMPLICATIONS

i) Business Plan Objectives The report is intended to show progress against delivery of the Trust’s business plan and highlight any issues of concern.

ii) Public and Patient Involvement None directly, although much of the quality data reflects public and patient feedback.

iii) Communication The Trust’s continuing good performance and delivery, and support for its patients and staff is vital to its reputation.

iv) Risk Issues (including reputation) Inherent within the report.

v) Sustainability Considered.

vi) Legal Nil.

vii) Resources Inherent within the report.

NHS Constitution: In determining this matter, the Board should have regard to the Core principles contained in the Constitution of:

• Equality of treatment and access to services • High Standards of excellence and professionalism • Service user preferences • Cross community working • Best Value • Accountability through local influence and scrutiny

1

Monitor targets

2

Monitor Exception

PERFORMANCE DASH BOARD REPORT December 2012 4 hour target

The Trust performance against the 4 hour target dipped significantly in December, continuing the trend from November. This is summarised below: December 90.83%, quarter 93.36% and year to date 94.82% November 93.43% October 95.83% As anticipated at the last Board meeting this situation means the Trust has failed the target for the third quarter which results in a “penalty point” against the Monitor governance ratings, failure to secure the quarterly CQIN target for the second time this financial year. Failure to achieve the full year could incur financial a financial penalty against the Trusts contract with the PCT. At the time of writing the report (21st January) the estimated levels of achievement required to achieve the quarter and full year target are 95.47% and 96.86% respectively. Performance has continued to be a problem through early January although this was starting to improve. A verbal update will be given at the Board meeting. The background to the current position covers a number of factors, these are summarised below. Levels of activity

Month Activity

Plan 12/13 Activity

Actual 12/13 Activity

Actual 11/12 Variance

October 6715 6807 6604 203 November 6396 6580 6152 428 December 6566 6829 6188 641

+1272

It can be seen that the levels of attendances have continued to increase above both contracted targets actual attendances for the corresponding periods to date. These activity levels have included a number of significant events, notably 7th & 8th December where high volumes of patients presented late at night (70 each occasion), 14th December YAS declared a Region wide MAJAX due to inclement weather conditions which resulted in 348 ED attendances and 96 admissions to the Trust, Boxing Day saw an unprecedented number of patients attend requiring admission causing a significant number of breaches.

3

All of these events take several days for the Trust to recover. A summary review of the number of attendances through December on other occasions would not indicate any apparent causes for breaches to the 4 hour target. However behind these figures other issues have had an impact, including continuing high levels of Paediatric cases presenting (a feature continuing from November), some increased delays in discharge (the Trust is starting to see delays from Social Services, Nursing Homes, out of area repatriation and capacity issues with Community in reach teams – ICAT and Rapid Response), however generally the length of stay of unscheduled admissions in Medicine shows a trend of reduction. The assessment and triaging of patients by Emergency Department (ED) and Acute Medical Unit (AMU) is working generally well, the key constraint are the corresponding flows of patients from the admitting wards causing congestion in ED and AMU and subsequently impacting on the 4 hour target. The Trust has undertaken a number of actions • Early December met with “shadow” Clinical Commissioning Group (CCG) to review

performance against the Health Community 4 hour target. A written response was subsequently sent to the Chief Officer (designate) of the CCG including revised information regarding the numbers of attendances. A follow on meeting is planned for 5th February which it is anticipated will involve all Health Care Partners. The Trust will present a number of key suggestions at that meeting that have been identified with Clinical Directors (CDs) and will also include details of a “Care Coordination Service” that is being developed in Rotherham that appears to be having an impact of reducing numbers of patients attending ED.

• Instigated the holding of a Health Community “teleconference” on Tuesday 15th January chaired by Public Health to address continuing pressures – this ensured that the PCT and SWYPFT were alert to operational issues facing the Trust and also regarding increasing discharge delays.

• Internal actions – the Chief Operating Office (COO) and Executive Team have held several intensive meetings with CDs to review current performance and identify key actions to improve performance of patient flow. Two Medical CDs have taken on the responsibility of managing escalation issues.

• Produced a revised internal action plan (outline previously presented to Non Clinical Governance Risk Committee).

• Further work to be undertaken to revise and formalise escalation procedures.

• Production of daily predicted levels of admissions and required discharges for each ward area

• Clinical Service Unit (CSUs) and their teams challenged on arrangements for ensuring the timely review of patients at each bed meeting.

• On a number of occasions “silver command” control has been established to manage excessive patient flow problems and improve overall coordination

• Appointment of an interim Deputy Chief Operating Officer for the Medical Cluster – with key focus on improving patient flow

• Appointment of a part time project manager to support the unscheduled care programme

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• Commenced building work, as part of the Transforming Urgent care Programme, to provide a new 10 bed Observation Unit and expanded resuscitation unit in the Emergency Unit – it is expected this work will be completed by July 2013.

5

Performance

7

Performance exceptions

8

Quality

10

Exceptions

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Quality Falls Analysis

Key actions: Falls working group in place.

• Cohorting of patients at risk on ward 19 to provide intensive therapy support. • Falls escalation procedure in development. • Business case in development for warning devices. • Bone health audit and actions in place. • Audit programme to include bed height, falls risk status and observation procedures. • SI investigations triggered where fall with harm meets SI policy criteria.

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Key Arrows represent the change between the current and previous month position

Deterioration in performance Improvement in performance Deterioration in performance Improvement in performance No Change in performance

AHP Allied Health Professions ANP Advance Nurse Practitioner COPD Chronic Obstructive Pulmonary Disease CQUIN Commissioning for Quality and Innovation CSSD Central Sterile Services Department CSU Clinical Service Unit DNA Did Not Attend ED Emergency Department EPR Electronic Patient Record FCSE Finished Consultant Episode FFCE First Finished Consultant Episode KPI Key Performance Indicator LOS Length of Stay PAS Patient Administration System PROMS Patient Reported Outcome Measures RTT Referral to Treatment SAU Surgical Administration Unit VTE VenousThrombo-Embolism YTD Year to Date

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Workforce

14

Exceptions

Green

= on target

Improvement in performance

Amber

= under performance (within 5% of target)

Deterioration in performance

Red

= fail (>5% target) No change in

performance

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Financial Performance Summary

Key Issue RAG Trend Financial Performance Summary

Financial

Reporting Indices

The Trust’s overall financial risk rating at month 9 is a 3 as planned. Capital expenditure is now 89% of plan.

Statement of

Comprehensive Income

The overall position for month 9 is a £1,234,000 surplus, against plan position of £538,000 surplus. EBITDA is 100% of plan.

Income

Contract income £1,908,000 ahead of plan at month 9. This is net of unachieved CQUIN income of £324,000. It should be noted £374,000 is in relation to donated funds. Other Income £2,284,000 ahead of plan at month 9.

Efficiency

Programme

Overall

Achievement at month 9 is £3,822.000, which is £1,485,000 behind plan

Identified schemes Underperformance is £381,000.

Green

Green

Green

Amber

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Key Issue RAG Trend Financial Performance Summary

Transformation schemes Underperformance is £1,104,000. The phasing on transformation is mitigated by contingency and other reserves coupled with the non-recurrent support received to ensure the delivery of the Transformation Programmes.

Pay

Total pay expense is showing an adverse variance of £3,107,000. This is predominantly attributable to the unplanned agency spend within the medicine CSU’s; some of which is mitigated by vacancies and the non-recurrent funding of escalation wards and the transformation programmes. The run rate on the use of agency staff is showing a downward trajectory over the last 4 months although the trend slowed significantly in December. It should be noted that premium rates paid for agency will still reflect an adverse position.

Statement of

Financial Position

Deferred income is £6.3 million above plan, due to additional financing from NHS Barnsley.

Cash

The cash position at the end of month 9 is £18.3 million, £5.7 million ahead of plan. Operating cash is equivalent to 44 days at month 9, and the overall liquidity metric is 41 days.

Capital

Capital expenditure is £5,883,000 year to date, £694,000 lower than the revised plan. The majority of the adverse variance relates to the window replacement project, Pathology roof, roads and pavings which have been delayed due to adverse weather conditions. It should also be noted that £156,000 relates to expenditure on PAS which was previously capitalised but has now been taken to revenue following the Board decision to go with the national offering.

Red

Amber

Green

Green

Green

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Transformation Programmes

Highlight Report

January 2013 1. Progress

1.1 Summary of Progress

The Transformation Board is confident that by the end of 2012/13 the Transformation Programme as a whole will be capable of delivering the required full year effect in 2013/14. Transformational monies have been invested throughout the year in the various programmes to ensure service re-design delivers the efficiencies as planned and that the ‘run rate’ of the Transformation Programme is at the pace required. This assurance will be achieved by a combination of the following: • Recurrent savings from identified Cost Improvement Plans • Recurrent savings from identified Transformation workstreams • Recurrent savings from current and newly identified Clinical Service Unit (CSU)

schemes Transformation is a dynamic process and as a result a number of additional schemes have already been identified throughout the course of the year that will further support the financial requirements to meet the Business Plan in 2013/14. These schemes have been designed in line with the Quality Innovation Pproductivity and Prevention (QIPP) agenda and each one will undertake a robust governance process by way of a full Quality Impact Assessment (QIA) to ensure that any adverse risks – both clinical and financial – are identified and appropriately mitigated. Each newly identified scheme is presented to the Transformation Delivery Group for approval, allocated to the relevant Transformation Programme where it is held to account and will provide assurance of delivery to the Transformation Board. Work is underway to ensure that the requirement to continuously identify and drive the QIPP approach to service delivery is thoroughly embedded within each Clinical Service Unit (CSU) business agenda. Section 1.2 provides an overview of each of the eight Transformation Programmes, highlighting overall progress and where there are current risks and concerns around specific aspects of the programme.

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1.2 Programme Overview Key: Green Programme on track and identified milestones and deliverables achieved Amber/Green Programme generally on track but concerns/slippage on a specific milestone/deliverable but

with appropriate mitigation in place Amber Slippage on milestones /deliverables but action being taken to bring programme back on

track Amber/Red Slippage on milestones/deliverables that have the potential to significantly delay delivery Red Programme not on track and milestones/deliverables not achieved. No actions identified for

recovery 1. URGENT CARE PATHWAYS

Executive Lead Heather Mcnair Overall Programme progress (RAG rated)

AMBER This is a large and complex programme with a number of workstreams that rely on input and commitment from other agencies, particularly GP and community provider colleagues (SWYPFT). This has posed a challenge in meeting agreed milestones and having appropriate representation from all stakeholders, particularly where key decisions are required. A further challenge has been the programme manager resource. Leads have been identified within specific workstreams; however a Programme Manager appointment has been made.

This programme is progressing well against all identified worksteams. A proactive Programme Board is in place with good attendance. The GP lead from the Clinical Commissioning Group has been identified and will attend the programme Board meetings as does the Non-Executive Director representative, however it has proved difficult to identify the appropriate individual from SWYPFT. There has been a positive response from stakeholders to the specific workstreams identified and recognition that this is where the focus is required. Four new schemes under the QIPP agenda have commenced. These include; Emergency Readmissions, the COPD Service re-design, Triage and Virtual Ward Development. All schemes were presented to the Transformation Delivery Group (TDG) on 15th January for approval. These schemes will strengthen the Urgent Care Programme agenda planning to deliver significant change over the next 3 years. Exception Report & remedial action

A lack of senior input to specific workstreams from SWYPFT remains a concern. This has been recognised by SWYPFT who have confirmed their offer of support and commitment. A meeting between the Chief Operating Officer (SWYPFT) and the Director of Transformation is scheduled for 30/1/13 to clarify appropriate representation arrangements. The absence of operational leadership for this programme will be addressed with the appointment of an Urgent Care Programme Manager from 24/1/13. It is expected that this individual will pick up key workstreams from this

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programme and rapid progress will be made.

Comment a) Emergency readmissions – a briefing paper highlighting the analysis, considerations and recommendation was presented at the TDG on 15/1/13. The paper and recommendations were accepted.

b) Expansion of virtual ward – following a successful pilot a proposal to expand this scheme will be taken to the TDG on the 12/2/13. This paper focuses on the expansion of the scheme but specifically the expected outcomes and benefits.

c) COPD Service re-design – A high level Project Initiation Document (PID) is due to be presented to the Urgent Care Programme Board on 23/1/13. The paper outlines the requirements of a best practice Chronic Obstructive Pulmonary Disease (COPD) Pathway supported by NICE Guidance, the process required for achievement and the resources required. A separate business case outlining resource implications is currently being prepared and will be presented to the TDG on 12/2/13. It is worth noting that this workstream is being developed in conjunction with all stakeholders and is being proactively driven by the clinical team.

d) Triage – this is a new programme with a key objective to reduce the number of unscheduled patients attending the hospital, particularly those attending the Emergency Department. There are examples of where an Urgent Care Triage system has been implemented in other organisations but a clearer understanding of where this may impact with the national ‘111 service’ is required. GPs within Barnsley have yet to make a decision as to whether they will be using the 111 service to support out of hours care or whether an alternative model is required. However, this scheme will look wider than those patients needing support out of normal working hours but will work with GP colleagues and Commissioners to determine appropriate service models and alternative care options. A draft Mandate and PID will be presented to the February Urgent Care Programme Board.

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2. STRATEGIC SERVICE REVIEW

Executive Lead David Peverelle Overall Programme progress (RAG rated)

AMBER /RED This is a complex programme that cannot be delivered in isolation of the wider health and social care community. Due to changes within the Commissioning body engagement with commissioners and external clinical colleagues has been somewhat limited. The development of a South Yorkshire –wide Clinical Strategy, supported by a review of Acute Service Provision is supported by the Trust but discussions with partner organisations are still in the early stages.

There are marked differences across each of the Clinical Service Units (CSU) with regards to the range of issues and understanding of the strategic possibilities and future requirements of service provision. Clinical Directors have completed initial presentations of their future vision to peer colleagues and the executive team; however a further challenge to their thinking is still required. Clinical leads from the Clinical Commissioning Group (CCG) have been identified and initial contact has been made, with the intention of holding an event in February to provide an opportunity for both Clinical Directors and Commissioners to share service vision and future commissioning intentions. Exception Report & remedial action

A key element of the Strategic Service Review (SSR) for each individual CSU is to challenge current thinking and to encourage CSUs to ensure that the ultimate direction of travel results in a high quality, clinically sustainable, financially viable service model. This has been delayed beyond the initial expected delivery date due to the failure to secure a suitable external partner to focus the teams on seeking out examples of best practice and questioning current service delivery. This is expected to take place through February/March. Following the initial presentations by each Clinical Director an opportunity is yet to be given for internal challenge to their presented vision.

Comment a) External Challenge - The submission date for bids to provide the external challenge exercise is 23/1/12. A decision will be made on 28/1/12 at the Informal Transformation Board.

b) Internal challenge of Strategic Vision – agenda item for Senior Leader’s Meeting 1/2/13.

c) External engagement event – proposed date 15/2/13 d) South Yorkshire Provider Dialogue re Acute Service Review –

ongoing.

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3. NON CLINICAL SUPPORT

Executive Lead Janet Ashby Overall Programme progress (RAG rated)

AMBER/GREEN The programme started well with all workstreams on track. However some elements are now delayed and there are particular concerns around relationships with the community provider specifically in relation to the proposals for the IT reconfiguration.

This programme has established a number of workstreams and has focussed initially in understanding where these services currently benchmark against a defined number of like organisations. A key objective of the programme is to understand where there are appropriate opportunities or where it makes good business sense to outsource services or where it may be appropriate to be the provider of choice for other organisations. Dialogue is taking place with other health providers in South Yorkshire to understand where there may be economies of scale across a wider health economy. Exception Report & remedial action

Work is progressing in each area but some work is delayed beyond the original timescales. The reconfiguration of IT services is being delayed due to complex TUPE considerations with regards to staff working on the SWYPFT Contract who will then transfer to a new service provider at some point in 2013. Detailed negotiations are taking place with SWYPFT to ensure that TUPE is applied appropriately; an outcome is expected in late January. The agreement of a Service Level Agreement (SLA) with the CCG has also been delayed whilst they put their staff in place; again the aim is to resolve this in January.

Comment a) Clinical Coding – Market testing commenced in January seeking a partnership arrangement for coding services following the HR and workforce engagement that took place throughout December. Interim service improvements are underway with a clinical engagement approach agreed and contact made with all clinical teams.

b) Benchmarking – Detailed benchmarking reviews of all Information, Governance, Occupational Health and Learning and Development (L&D) are underway with review meetings scheduled for late January/early February.

c) ICT – Transition work for Information Communication Technology (ICT) services for SWYPFT is on hold due to concerns regarding TUPE implications, however the plan remains in place to terminate the current SLA with SWYPFT on 31/3/13. There are ongoing risks for GP services and the CCG as commissioning staff are not yet fully in place.

d) Sterile Services Department (SSD) – Tender processes are underway and we await responses from Bradford and Rotherham.

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4. IT & ESTATES

Executive Lead Janet Ashby Overall Programme progress (RAG rated)

IT AMBER

Although this is a combined programmed the Transformation Board felt it prudent to separately identify the RAG Rating for Estates and IT in order to provide clarity of the progress on each individual element.

Estates AMBER/GREEN

This programme is divided into two clear sub-programmes – IT and Estates. Due to the number and complexity of the individual workstreams each component is led by a separate programme manager. The measures of success of each element of the programme remain on track with a confidence that this trend will continue to the end of the financial year. Exception Report & remedial action

The majority of the programme is progressing with minimal delay within some components. The key programme issue is the suspension of the Patient Flow Project and the subsequent inability to deliver the benefits within the required timescales. Options for delivering patient flow through other routes are being investigated if the procured system cannot be implemented satisfactorily. The options to be explored and the mitigation plan will be developed throughout January and a full update will be given to both the Transformation Board and Trust Board in February.

Comment a) PAS/EPR Replacement – Pursuing the national solution (Lorenzo) is now the preferred option with a recommendation presented to the Trust Board on 29/11/12 and accepted. The programme team is working with CSC on the Engagement phase of the programme and developing the Lorenzo Investment Case (LIC).

b) Patient Flow (Extramed) – The patient flow supplier (Hospedia/Extramed) presented the project to the Project Team on 30/11/12 resulting in full user acceptance testing being taken forward by the Trust. Testing was not successful and further options are now being considered.

c) Electronic Document Management – Potential options for electronic document management for medical records are being explored with suppliers to understand options and potential costs/benefits.

d) Additional systems – Other areas of potential IT systems are being explored including – vital signs monitoring and mobile devices for use in clinical/ward areas.

e) Space Utilisation – The Space Utilisation Policy has been agreed and the software package to support this project has been assessed and the procurement of this software and the site survey is underway. Project Management resource will be in place by the end of January

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5. ELECTIVE CARE PATHWAYS

Executive Lead David Peverelle Overall Programme progress (RAG rated)

AMBER/RED Programme Manager capacity has been a challenge for this programme due to the dual operational role of the current lead and this has impacted on the momentum of progress. Additional resource has been allocated to work specifically on the Productive Operating Theatre Project and it is expected that further resource will be available for other worksteams following the recent appointment of a Project Manager to the Urgent Care Programme who may have capacity after March 2013.

A number of workstreams were identified within this Transformation Programme but a key driver for change is the achievement of Best Practice Tariffs (BPT) in Orthopaedics and designing service models to maximise the incentivised Day Case tariffs. A Programme Board is in place with Clinical Director representation and there has been effective input from the Trust Service Improvement Team in the initial pathway redesign and process mapping events. Exception Report & remedial action

The key issue for this programme is the overall re-design of the Orthopaedic Service. The pathway work for the Fragility Hip (Fractured Neck of Femur) currently sits within the Urgent Care Transformation Programme as would the new proposal to re-design the pathway for those patients attending the Emergency Department with musculo – skeletal problems whilst the Enhanced Recovery Pathway (ERP) for Hip and Knee surgery and the development of a 5 day Orthopaedic Elective Suite sits within the Elective Care Transformation Programme. The Programme Board and the Orthopaedic Team feel that it would be less fragmented to design a Programme that looks at the orthopaedic service as a whole and a Project Initiation Document outlining this proposal will be presented to the Transformation Delivery Group on the 29/1/13.

Comment a) Productive Operating Theatre – the project re-launched in January to align with the Elective Care Transformation Board reporting structure. A paper outlining the key performance indicators and performance dashboard will be presented to the January Programme Board. The team has undertaken work to identify metrics for each individual surgical Clinical Service Unit (CSU) and is currently running a theatre scheduling project within Gynaecology to improve efficiency and reduce cancellations. This will then be rolled out across other specialties. An external review of Theatres has been commissioned and a report will be provided for the Programme Board in March.

b) ERP Hip and Knee – Pathway re-design workshop undertaken with a key issue identified in relation to pre-assessment. A further workshop to look at the pre-assessment process was well attended with an action plan now in place. A key task identified was to seek out best practice in other Orthopaedic Units to challenge traditional and historical working practices.

c) 5 Day Orthopaedic Elective Suite – now included within the overall

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Orthopaedic proposal d) Dedicated Orthopaedic Assessment area – this is a new worksteam

that is currently being worked up by the Orthopaedic Clinical Director / Deputy Chief Operating Officer (DCOO) in conjunction with the Emergency Department and will be included in the overall orthopaedic service re-design proposal.

e) Best Practice Tariff/Incentivised Day Case Tariff – a working group led by the DCOO for the surgical cluster and consisting of the relevant service, finance managers and CSU analysts has been put together to monitor the achievement of BPTs and to ensure that incentivised tariffs are attained for Day Case Surgery. This group will identify those areas where transformational changes are required to ensure these tariffs are maximised and develop transformation and QIPP schemes accordingly.

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6. OUTPATIENTS

Executive Lead Jugnu Mahajan Overall Programme progress (RAG rated)

AMBER/RED There were initial challenges with the implementation of this programme due to the delay in appointing a suitable programme manager. Since this has been in place significant progress has been made within the individual workstreams. Due to the delay in the tender process for the self check-in kiosks and the risks identified within the CQUIN target the overall programme progress has been RAG rated at Amber/Red.

The Outpatient Transformation Programme continues to make progress with a number of workstreams established. Workstream leads have been identified and a robust Programme Board is in place. The programme objectives are to understand why patients attend the outpatient department, challenge and review current practice and reduce the number of face to face contacts where appropriate considering where the use of technology can make a difference. Exception Report & remedial action

a) Self-check in kiosks for the outpatient dept. Tenders have been received from two suppliers following the procurement process. A final decision has been temporarily suspended due to the recent agreement to select the national solution (Lorenzo) for the EPR/PAS replacement (subject to business case). There is an opportunity to include the self check-in module within this package and a scoping exercise is underway. It is expected that whichever kiosk is selected there will be minimal delay to the implementation of this process. Work is underway to understand the pathway and subsequent staffing implications.

b) CQUIN Target 5 day turnaround for GP letters - A red risk has been identified around the use of Digital Dictation across all specialties and the ability to meet the CQUIN Target for the timely turnaround of GP letters. Assurance has been given that this is being addressed and a further report is due to be presented at the Transformation Delivery Group on 29/1/13, to take this work forward.

Comment a) New Patients / Follow Up (NP/FU) Ratio – Currently working with the

specialties of Colorectal Surgery and Rheumatology. Initial targets are to ensure specialities are within the contracted ratios; however the specialities will also be looking at benchmarking against national best practice.

b) A Patient Experience Benchmarking Report has been produced and will be presented to the Transformation Board in February.

c) Model of service delivery - The Outpatient Programme is working closely with the Estates Department as part of the Space Utilisation Project to understand the opportunities to both improve the environment and to make best use of the space available.

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7. WORKFORCE

Executive Lead Hilary Brearley Overall Programme progress (RAG rated)

AMBER Although there are specific workstreams in place for this programme there will be workforce implications resulting from workstreams across all Transformation Programmes. It is essential that this information is captured and work is ongoing to develop a method of doing so through the Transformation Delivery Group and the status update reports to the Transformation Board.

Work continues to progress for all the Transformation Projects. Each project lead has completed a plan which identifies actions, projected savings and any risks and issues for the current financial year and those that will continue into 2013/14. All of the workstreams are on track to achieve planned action with the exception of the Agenda 4 Change (A4C) local terms and conditions. Exception Report & remedial action

The milestone of the final report on the outcomes of the Nursing Review has slipped due to the introduction of the Safer Nursing Care Tool data collection and the quality of the original benchmarking information. The initial analysis of the medical workforce requires further work, which will be informed by the introduction of the e-job planning system – currently subject to Investment Board approval – this is expected 23/1/13. The levels of sickness absence due to stress across the Trust remains a concern. Additional work is in progress to analyse trend and link to the Health and Wellbeing Strategy, currently in draft form and for consideration at the Workforce Board in January. The national pay negotiations and discussions with neighbouring Trusts have delayed progress on local A4C terms and condition changes. Work continues to monitor national progress and local discussions are ongoing.

Comment a) Nursing - Baseline data and benchmarking completed. This will be used to inform the final report to the Transformation Board in March. The Safer Nursing Care Tool data collection commenced on 14/1/13 across all ward areas and is expected to be carried out over a period of 21 days. This is an additional piece of work but will be completed in sufficient time to inform the final paper for March. A review of Matrons and Clinical Nurse Specialists (CNSs) is underway. The Advanced Nurse Practitioner Review now sits within the Consistency in Care Programme as part of providing extended senior cover and supporting the Hospital 24/7 Project.

b) Medical - The Trust has now agreed and is in the process of implementing an internal medical staffing bank and the use of a master vendor system. This will contribute to a reduction in the use of locum staff and ultimately reduce costs. The Business Case for E-Job planning is due to be presented at

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Investment Board 23/01/13. c) Sickness Absence - A review of the current interpretation of the

Sickness Absence Policy has been completed. A working group to focus on Additional Clinical Services staff is underway with an aim of reducing sickness within this staff group as they have a significantly higher sickness rate than other staff groups.

d) Allied health Professionals (AHP) - The project lead is now in post and currently collecting baseline information and meeting with the relevant key staff within the three areas (Physio, Occupational Therapy (OT), and Dietetics). Project plan in place for completion by March 2013 as planned.

e) Admin & Clerical - This covers several areas and projects for review. A review of General Office Admin staff has taken place and recruitment to the revised structure completed. By the end of January the programme lead will have met with key managers to review and agree a plan for the areas outstanding.

f) A4C - An options paper for a non A4C salary structure for senior managers will be presented to the Transformation Board in February. Discussions with neighbouring Trusts re local agreements as an alternative to elements of A4C terms and conditions are ongoing, but are unlikely to be concluded by March 2013.

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8. CONSISTENCY IN CARE

Executive Lead Jugnu Mahajan Overall Programme progress (RAG rated)

AMBER This programme is complex and will necessitate significant changes to current working practices and particularly the culture of medical and other clinical staff across the organisation. Effective working relationships will be required to negotiate traditional contracts to ensure that the identified workstreams can be agreed and implemented.

Overall the programme is progressing well with a well established and attended Programme Board. The Project Initiation Document (PID) for the 24/7 Project and the 24/7 Project Workforce Plan are due to be presented to the Programme Board in February. The full implications of providing extended senior cover seven days a week will need to be fully risk assessed in order to understand where there may be skills gaps and budgetary pressures as a result of changing rotas and working patterns. Exception Report & remedial action

The Hospital at Night Project (now re-named as ‘Hospital 24/7 Project’) has made a good start but concern remains around the identification of suitable technology to support the required communication systems. This issue is being addressed with the Director of IT as part of the development of the Trust IT Strategy with a focus on what the system needs rather than the preferences of individual clinicians. An options appraisal will be presented to the Consistency in Care Programme Board in March.

Comment a) Visioning exercises – these will be supported by the lead clinician from Sheffield Teaching Hospitals who successfully implemented ‘Hospital at Night’ in 2012 and are aimed at a multidisciplinary focus group of staff to engage with and contribute to the development of the service model. The outcomes of these exercises will be presented to the Programme Board for consultation and then to the Transformation Board in March.

b) 12 hour Consultant cover - An options paper has been circulated to all consultants and a poll set up. The outcome and decision of the way forward will be made on the 25/1/13.

c) Extended diagnostics – the 2nd CT Scanner will be operational from 22/1/13; however CT sessions on Saturday morning commenced in December to expand the current capacity. Although recruitment plans are in place for additional Radiographers the current industrial dispute is yet to be resolved although final agreement is close to sign off.

d) Medicines Management – This is a new QIPP scheme that was approved for inclusion within the Transformation Programme at the Transformation Delivery Group on 18/12/12. The Governance and clinical approval of the change required for this Trust-wide approach to Medicines Management was given at the Medicines Management Committee on 10/1/13. The Consistency in Care Programme has adopted this scheme. An outline report was given at the Programme Board in January with a detailed PID due to be presented in February.

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2. Financial Overview 2.1 Summary of Progress against the re-profiled plan. Efficiency Plan by Theme

Annual Identified Transfom Identified Identified Identified Transform Transform Transform Total Total Total

Plan Plans Plan M9 PlanM9

ActualM9

Variance M9 Plan M9 ActualM9

VarianceM9

PlanM9

ActualM9

Variance£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Workforce 2,804 1,273 1,531 939 814 -125 577 286 -291 1,516 1,100 -416Outpatients 585 35 550 26 26 0 205 84 -121 231 110 -121Elective 401 101 300 71 31 -40 42 50 8 113 81 -32Urgent Care 1,075 225 850 163 163 0 433 370 -63 596 533 -63Consistency in Care 0 0 0 0 0 0 0 0 0 0 0 0Non Clinical Support 1,055 656 399 480 473 -7 144 306 162 624 779 155Strategic Review of Services 605 605 0 350 141 -209 0 0 0 350 141 -209Estates & IT 690 95 595 71 71 0 220 421 201 291 492 201General Efficiencies 785 785 0 586 587 1 0 0 0 586 587 1TOTALS 8,000 3,775 4,225 2,687 2,306 -381 1,621 1,517 -104 4,307 3,823 -484

3. Trust Board Considerations/Feedback Measures Progressed

Workstream Date Reference Comment Action & Response

Clinic Utilisation Dec 2012 12/308 (DNAs)

Options for electronic system to support process for patients wishing to cancel appointments

To be logged to appropropriate Transformation Programme.

Logged to Outpatients Programme (Clinic Utilisation)

Dec 2012 12/308 (overview)

Concerns re level of programmes at Amber

More detail promised (and provided) in January 2013 report.

Gateway review Dec 2012 12/308 (gateway)

Initial findings noted; fuller answers to be provided in next report.

Completed; as shown in revised report (expanded, enabling fuller detail on exception items).

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BHNFT Transformation Programme Risk LogRisk ID Risk

Owner / Author

Date Logged

Risk Managed By

Risk Domain Risk Level Risk Description Impact Description Original Likelihood

(1-5)

Original Impact

(1-5)

Original Risk

Score

Mitigation Action Action Owner

Planned Action Completion Date

TP0056 Jugnu Mahajan

18/01/13 18/01/13 Outpatients Programme Digital Dictation roll out and uptake by CSU's poor

OPD will not achieve CQUIN target

5 3 15 TDG discussion and plan formulated by working group Jan 13

David Peverelle

Feb-13

KeyGreen - On targetAmber - Progressing subject to issues or delaysRed - On hold/ Major Issues

1

Transformation ProgrammeKey Milestones

TimescaleMilestone Deadline Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Recommendations for AHP improvements - review completed 11/03/13 - 30/03/13 Implementation TBC 02/05/13 - 29/10/13

Nursing review update 24/01/2013 Implementation 01/02/13 - 31/10/13

Locum & Agency review at TDG 15/01/2013 Electronic job plans review 25/01/2013 Completion & implementation of electronic job planning 01/04/2013

Review progress of admin reviews 01/01/13 - 02/02/13 Reviews completed 29/02/2013 Implementation 01/03/13 - 20/07/13

Update absence performance indicators 28/03/2013

Update on pay performance schemes for senior management 20/02/13

Stakeholder Engagement 15/02/2013 External challenge 23/01/2013 Agreement of Strategic Services - Transformation Programme Board 12/03/2013

Implementation & Delivery of Agreed Strategy 29/03/13 - 29/12/13

PID 28/02/2013 Implement Primary Care Stream in the Emergency Department 04/03/13 - 27/07/13 Ambulatory Care Pathways Reconfiguration 01/04/13 - 20/08/13

Agreed specification for the enhanced VW 31/01/2013 Phase 2 - Implementation of the enhanced VW 20/02/13 - 31/07/13

PID submission - Urgent Care Board 23/01/2013 Implementation of 'quick wins' 31/03/2013 Sign off of future service including clinical pathway guidelines & operational processes & procedures 01/06/12 - 28/06/13 Re-audit against NICE quality standards 28/02/2013 Full implementation of changes to service model 01/12/2013

Approval to proceed formal request paper to TDG 15/01/2013 Initiate programme activity and engagement 16/01/2013 Approval of governance arrangements and next steps at Urgent Transformation Board 23/01/2013 Approval of the Project Mandate at Urgent Care Transformation Board 28/02/2013

Transforming Urgent Care

Virtual Ward

COPD Redesign

Triage

Urgent Care Programme

Workforce Programme

Nursing Review

AHP Review

Medical Review

Admin & Clerical

20142013

Absence Management Review

Strategic Service Review Programme

Agenda for Change & Reward Strategy

Stakeholder Engagement


2


20142013

Approval of final PID at Urgent Care Transformation Board 21/03/2013 Formal agreement with CCG/ Regional agreement 10/06/2013 Implementation 19/07/2013 Implement triage for unscheduled care (Phase 1) 01/06/13 - 13/12/13 Review service Model and ongoing plan for implementation 01/11/13 - 30/04/14

Establish need for and develop Paediatric Assessment Tool in Emergency Department 30/04/2013 Undertake survey of parents/ carers/ children and young people re: reason for choosing ED in Action Plan 31/01/2013 Discharge information leaflet given to all parents/ carers of children who present with Fever in ED and document on Assessment document 28/03/2013

Audit adherence to NICE guidance for assessment and management of feverish illness 30/04/2013

Action Plan Reviewed at TDG 12/02/2013 Implement Recommendations 01/03/13 - 20/07/13

Regional discussion regarding implementation 20/01/2013 Project approach signed off by Steering Group 14/02/2013 National event 13/02/2013 Implement Recommendations 0/04/13 - 01/08/13

PID approval at TDG 12/02/2013 Implementation 25/02/2013 Recommendations going forward 01/05/2013

Review of action plan with TDG 12/02/2013 Implementation 01/04/13 - 23/08/2013

Review of Productive Theatre progress & recommendations going forward 20/01/2013 Productive Theatre specification & PID 10/02/2013 Implementation 02/04/13 - 25/08/13 Phase 2 Review and Delivery 02/07/13 - 21/11/13Demand & Capacity Approval to Proceed 15/01/2013 Establish Management Team and support arrangements 20/02/2013 Recommendations & PID 05/03/2013 Implement agreed solution 01/03/13 - 24/07/13Other Ongoing Workstreams Dedicated Orthopeadic Assessment Area Best Practice Tariff/ Incentivised Day Case Tariff

PID ready for approval at OP Programme Board 08/02/2013 PID approval at TDG 05/02/2013 Pilot for OP speciality review methodology (Rhuem & Colorectal) 01/01/13 - 29/03/13

Roll out across all CSU's and Specialities 02/04/13 - 30/09/13 Phase 2 - Agree model of service delivery for OP 03/06/13 - 30/09/13 Business Plan ready for changing model OP service delivery 01/10/2013

King's Fund Elderly Care

Emergency Readmissions

Trauma Hip Pathway

ERP Hips & KneesElective Care

Outpatients Review

Children's Fever

Productive Theatre

Outpatients


3


20142013

Space utilisations plans Agreed 25/01/2013 Reviews 09/04/13 - 20/07/13

Self Check in project proposal/scope/Timeline/ Urgent Review 30/01/2013

Digital Dictation ANC Performance Management Clincal Engagement & take-up

SWYFT SLA Ends - Engagement from January 13th with CCG 20/03/2013

Review & Publish Prior Information Notice (PIN) for coding services 20/01/2013 Service improvement 28/02/2013 Market testing TBC

Review 20/01/2013

Review 20/01/2013 Review information for potential suppliers, Occupational health;Learning Development; Governance & Risk 15/01/13 - 05/03/13

Phase 2 Delivery of Recommendations 01/04/13 - 01/06/13 Regional discussions regarding shared model 01/02/2013

Hospital 24/7 model of working (8pm - 8am) Project Manager appointed and in place 04/02/2013 Implementation 01/08/2013

New model of service delivery for Radiology in place 01/10/2013 Recruitment of additional Radiographers 03/06/2013

12 hour working days for Consultants 01/03/2012

Establish performance management and governance at Consistency in Care Board & Medicines Management Committee 11/01/2013

Approval of Project Mandate at Consistency in Care Board 15/02/2013 Update TDG on the progress of the programme 26/02/2013 Approval of final PID at Consistency in Care Board 15/03/2013 Complete Programme Plan to 31st March 2015 22/03/2013 Provide financial status to year end to Executive Lead 19/04/2013 Approval of the MM Strategy at the MMC 18/05/2013 Status report on all (35) MM QIPP scheme initiatives (Quarterly) 28/06/13 - 31/03/13 Annual review/ benchmarking against new National QIPP MM indicators 28/06/2013 Bi-annual VFM review of procurement/ purchasing arrangements for Medicines 20/09/2013

Benchmarking & Department Reviews

Sterile Services

Space Utilisation

Self-Serve Check-In

IT Services

Clinical Coding

Hospital at Night

Extended Diagnostics

Consistency In Care

Non Clinical Support

Medicines Management

Extended Senior Medical Cover

5 Day OPD Letter Target (CQUIN)


4


20142013

IMT Strategy 29/04/2013

Trust approve Lorenzo Investment Case V1.0 19/02/2013 Trust approve Project Brief 08/04/2013 Trust approve Lorenzo Investment Case V2.0 25/04/2013 Trust approve PID 13/06/2013 Trust approve Lorenzo Investment Case V3.0 20/06/2013 Local configuration complete 31/12/2013 Validation stage complete 25/04/2013 Go-Live 25/04/2013 Mobile Deployment/Plan 25/02/13 - 10/04/13Electronic Patient Flow Project Review Meeting - review of options 12/02/2013

Submission to Trust Board Completed 15/12/2012 Residential accommodation review TBC Upgrade & renewal of 'O' Block TBC Space Utilisation Group to be established 12/02/2013 External staff SLA review & recommendations 19/03/2013 Site Surveys 28/02/2013 Space utilisation Roll Out 22/01/2013

PAS/ EPR

Estates Strategy

IM&T StrategyIM&T and Estates Programme

council of governors – february 2013 ref: cg/13/02/14 ... · council of governors – february...

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