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1.2 NHS Improvement
Governance
Rating
Board Integrated Performance Report
26th May 2016
April 2016 Data
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Good
1.1 CQC Compliance 1.3 NHS Improvement
Sustainability and Performance
Risk Rating
Minimum Requirement: 3
4
Agenda Item: 10
Lead Director: Director of Finance,
Contracting and Facilities
Presented For: Discussion
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
The purpose of this Integrated Performance Report is to assist the Board in assessing the Trust’s performance and progress in
delivery of a broad range of key targets and indictors.
Board Action Key Highlights Slides
NHS Improvement
Assurance • All NHS Improvement performance requirements for month one have been met.
4 - 6
Quality
Exception
Assurance
Exceptions
• One Duty of Candour incident was reported in April 2016, concerning the inappropriate application of a wound
dressing.
• The draft reports relating to the Care Quality Commission (CQC) focussed inspection conducted in January
2016 were received by the Trust on 5 May 2016. The draft reports confirm that the Trust is now rated as good
for the safe domain; this provides the Trust with a rating of good across all five domains.
• Labour turnover remains above the Trust target of 10%. The report outlines issues and actions relating to the
retention of staff.
• Sickness absence remains above the Trust’s 4.0% target, but shows a continued reducing trend. The report
outlines issues and actions relating to responses to both long and short term absence.
7
13
15
Business Unit
Updates • In early May, the Improving Access to Psychological Therapies (IAPT) service moved onto a new clinical
system, PCMIS. Whilst performance monitoring is continuing at the business unit performance meeting it has
been jointly recognised by Commissioners and the Trust that there are likely to be temporary reported
reductions in performance during implementation of the new system.
• April performance was reviewed at the business unit performance meetings. The issues identified for
escalation to the Board relate to financial pressures and risks captured within the finance report and Business
Unit Risk Logs that will be used to track mitigating actions.
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
The purpose of this Integrated Performance Report is to assist the Board in assessing the Trust’s performance and progress in
delivery of a broad range of key targets and indictors.
Board Action Key Highlights Slides
Change Programme
Information • Six of the eleven projects being monitored by the Change Programme Board are rated green. Four projects
are rated amber with actions and mitigation in place to manage the risks and issues.
• The Intensive Therapy Centre project continues to be red rated. Change Programme Board received a report
outlining arrangements the Trust has set in train to close the unit to new admissions from mid April. This
means that the unit will close when current admissions are discharged. The Programme Board discussed
actions to mitigate resulting trading losses and to ensure the safe ongoing treatment of service users on the
unit.
23 - 25
Finance
Exceptions
• Performance at the end of April highlights the level of challenge anticipated when the 2016/17 Annual Plan
was approved and signifies the need for urgent remedial actions.
• The Month 1 position on all key indicators is rated amber, with the exception of the Statement of Financial
Position which is rated green.
• The Trust planned to make a surplus of £111k at the end of the period but has reported a £100k deficit and
adverse plan variance of £211k.
• Cost Improvements are £103k behind plan at the end of the period with further details and mitigating actions
highlighted.
• Capital Expenditure is £81k below plan year to date, reflecting E-Rostering billing slippage and uncommitted
contingency reserves (for anticipated in-year pressures) of £240k.
• The position reflects achievement of a Financial Sustainability Risk Rating of 3, compared to a plan rating of
4, with the forecast position being an achievement of a rating of 4, but noting elevated risks relating to
achievement of the planned surplus and attendant cash impacts.
27
28
33 – 35
36
32
Summary and Recommendations
The Board integrated performance report shows strong performance against non financial targets in April 2016 but a number of financial
pressures that will require robust ongoing financial management if the Trust is to achieve a challenging financial plan in 2016/17. The Trust is
introducing revised Performance Management arrangements to increase the opportunity for detailed financial discussion and action planning.
Correlation of quality information (including patient experience and safety related measures), performance, finance, workforce and health and
safety information has taken place and did not identify any other areas of particular concern.
The Board is recommended to:
• review and consider the exceptions highlighted and note the actions and mitigations.
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Indicator M4: In April 2016 there were 0.5% delayed transfers of care including patients on Section 3.
Indicator M6: The number of new psychosis cases seen by early intervention teams has been removed because from April 2016 the
indicator has been replaced by the new national standard, indicator M7.
Indicator M7: Data is provided in relation to the waiting time element of the new standard for Early Intervention in Psychosis (EIP). This
shows patients who started treatment in April 2016 within two weeks of referral. The number of incomplete pathways (patients waiting) at the
end of April 2016 was 16; 13 of these patients have been waiting for more than two weeks. RAG rating has not been applied as although the
waiting time element of the new standard is being met, the other components of the standard (extended age range and provision in
accordance with NICE recommendations) are not yet in place. All components must be met for the standard to be deemed to have been
achieved. Additional CCG investment in EIP was confirmed from 1 April 2016; allowing staff recruitment and training to commence. This will
enable the Trust to extend the age range for EIP services to adults up to 65 and to provide a full package of NICE recommended care. As a
result of the recent investment the Trust therefore projects meeting all components of the new standard from
quarter 3 of 2016/17.
NHS Improvement Indicators
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
0.0%
50.0%
100.0%
150.0%
200.0%
250.0%
May14
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
90.0%
92.5%
95.0%
97.5%
100.0%
May14
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
May14
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Q2 Q3 Q4 Apr May Jun Q1 Q1 Q1
Outturn Outturn OutturnNumerator
Outturn
Denominator
OutturnOutturn
M3
RTT dental 18 weeks waits - incomplete
pathways
(Number of patients who have waited 18
weeks or less/Number of patients waiting)
92.0% 96.3% 212 220 96.3%92.1%
as of Feb 16
M4 Mental Health Delayed Transfers of Care <=7.5% 0.0% #DIV/0! #DIV/0! 0 5488 0.0%
M5
Admission to inpatients services had
access to Crisis Resolution Home
Treatment Teams
95.0% 100.0% 50 50 100.0%
98.3% as of Q4
15/16
Next publication date:
June 2016
M7
Early intervention in Psychosis (EIP):
People experiencing a first episode of
psychosis treated with a NICE approved
care package within two weeks of referral
50.0%
73%
March
2016
Data
86.9% 20 23 86.9%
GraphNational
Benchmark
Indicator
No.
Indicator
Target
80.0%
85.0%
90.0%
95.0%
100.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
90.0%
92.5%
95.0%
97.5%
100.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
80.0%
85.0%
90.0%
95.0%
100.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
80.0%
85.0%
90.0%
95.0%
100.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
90.0%
92.5%
95.0%
97.5%
100.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
80.0%
85.0%
90.0%
95.0%
100.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
80.0%
85.0%
90.0%
95.0%
100.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
90.0%
92.5%
95.0%
97.5%
100.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
0.0%
50.0%
100.0%
150.0%
200.0%
250.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
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NHS Improvement Indicators
Indicator M8: April 2016 performance has improved significantly, with 62 out of 63 clients on Care Programme Approach (CPA) followed
up within seven days of discharge.
Indicators M10 and M11: The new national waiting time standards for Improving Access to Psychological Therapies (IAPT) apply from
April 2016 and require that 75% of people are treated within six weeks of referral and 95% are treated within 18 weeks of referral.
The quarterly targets provided in column 3 were local trajectories for 2015/16 to support achievement of the new standards from April
2016.
The Health and Social Care Information Centre is due to publish February 2016 IAPT data on 20 May 2016.
NHS England Benchmark
Target
Key
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
0.0%
50.0%
100.0%
150.0%
200.0%
250.0%
May14
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
90.0%
92.5%
95.0%
97.5%
100.0%
May14
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
May14
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
0.0%
50.0%
100.0%
150.0%
200.0%
250.0%
May14
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
90.0%
92.5%
95.0%
97.5%
100.0%
May14
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
May14
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
0.0%
50.0%
100.0%
150.0%
200.0%
250.0%
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
90.0%
92.5%
95.0%
97.5%
100.0%
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
0.0%
50.0%
100.0%
150.0%
200.0%
250.0%
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
90.0%
92.5%
95.0%
97.5%
100.0%
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
0.0%
50.0%
100.0%
150.0%
200.0%
250.0%
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
90.0%
92.5%
95.0%
97.5%
100.0%
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
0.0%
50.0%
100.0%
150.0%
200.0%
250.0%
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
90.0%
92.5%
95.0%
97.5%
100.0%
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
0.0%
50.0%
100.0%
150.0%
200.0%
250.0%
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
90.0%
92.5%
95.0%
97.5%
100.0%
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
Q2 Q3 Q4 Apr May Jun Q1 Q1 Q1
Outturn Outturn OutturnNumerator
Outturn
Denominator
OutturnOutturn
M8
CPA patients receiving
follow-up contact within 7
days of discharge
95.0% 98.4% 62 63 98.4%
95.7% as of
Q4
15/16
Next publication date:
June 2016
M9
CPA patients having
formal review within 12
months
95.0% 97.1% 1744 1795 97.1%
77.1% as of
Nov 15
Next publication date:
To be confirmed
M10
2.a. People with common
mental health conditions
referred to the IAPT
programme will be treated
within 6 weeks of referral
Q1 - 10%
Q2 - 20%
Q3 - 30%
Q4 - 60%
69.1%
Q2
85.0%
Q3
88.4%
Jan &
Feb
0.0%
84.3% as at
Jan 2015
Next publication date:
20th May 2016
M11
2.b. People with common
mental health conditions
referred to the IAPT
programme will be treated
within 18 weeks of referral
Q1 - 50%
Q2 - 60%
Q3 - 70%
Q4 - 80%
92.4%
Q2
94.7%
Q3
97.6%
Jan &
Feb
0.0%
96.4% as at
Jan 2015Next publication date:
20th May 2016
Indicator
No.
Indicator
TargetNational
BenchmarkGraph
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
90.0%
92.5%
95.0%
97.5%
100.0%
Apr15
May15
Jun15
Jul15
Aug15
Sep15
Oct15
Nov15
Dec15
Jan16
Feb16
Mar16
Apr16
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Indicator M17: Compliance for the Mental Health Minimum Dataset (MHMDS) Part 2 has reduced slightly from 79.5% to 78.9%. This is
due to a slight increase in the denominator for all three measures; accommodation status, HoNos (clinical outcome measure) and
employment status. The numerator for all three measures has not increased significantly.
NHS Improvement Indicators
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Q2 Q3 Q4 Apr May Jun Q1
M12Access to health care for people with a learning
disability 6 Green 6 Green 6 Green
M13 Data completeness Referral to treatment information 50.0%64.2%
Q2
65.0%
Q3
M14 Data completeness Referral information 50.0%91.9%
Q2
92.9%
Q3
M15 Data completeness treatment activity information 50.0%99.7%
Q2
99.7%
Q3
M16 Data Completeness: identifiers (MHMDS Part 1) 97.0% 99.6% 99.6%
M17Data Completeness: outcomes for patients on CPA
(MHMDS Part 2)50.0% 78.9% 78.9%
Indicator
No.
Indicator 16/17
Outturn Target
National
BenchmarkTrend
Q1 Data available in June 2016
Q1 Data available in June 2016
Q1 Data available in June 2016
99.4% as of Nov
2015
Q2 Q3 Q4 Apr May Jun Q1
M12Access to health care for people with a learning
disability 6 Green 6 Green 6 Green
M13 Data completeness Referral to treatment information 50.0%64.2%
Q2
65.0%
Q3
66.6%
Q4
M14 Data completeness Referral information 50.0%91.9%
Q2
92.9%
Q3
92.5%
Q4
M15 Data completeness treatment activity information 50.0%99.7%
Q2
99.7%
Q3
99.7%
Q4
M16 Data Completeness: identifiers (MHMDS Part 1) 97.0% 99.6% 99.6%
M17Data Completeness: outcomes for patients on CPA
(MHMDS Part 2)50.0% 78.9% 78.9%
Q1 Data available in July 2016
Q1 Data available in July 2016
Q1 Data available in July 2016
99.4% as of Nov
2015
TrendIndicator
No.
Indicator 16/17
Outturn Target
National
Benchmark
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The rating on 'button' 1.3 on slide 1 of the report reflects the outcome
of the CQC focussed inspection conducted in January 2016 (as a
follow up to the previous full inspection conducted in June 2014).
The January 2016 reports were received by the Trust on 5 May 2016.
The main points to note are a) it is confirmed that the Trust is now
rated as GOOD for the safe domain; this provides us with a rating of
GOOD across all five domains and b) there are no 'should do' or 'must
do' actions identified in any of the three reports.
Three reports were provided as follows (see below). These are
currently in draft format; the Trust is able to comment on / challenge
any issues of factual accuracy (deadline 19 May) prior to publication.
Report summaries:
Acute Wards - there was a particular focus on the implementation of
the Continuous Care Medical Model (there was a previous compliance
action against this element); the CQC were assured in relation to the
way this is working and therefore rated the 'responsive' domain for the
acute wards as 'good' (previously rated as 'requires improvement' for
the acute wards and 'good' for the Trust).
Crisis Services & Health Based Places of Safety - despite the
report title, only the two HBPoS were inspected (there was a previous
compliance action against this element); the CQC were assured in
relation to the improvements made to the environments and therefore
rated the 'safe' domain for the service as 'good' (previously rated as
'requires improvement' for the service and for the Trust overall).
Trust report - this provides a summary of the above reports and also
information against the well-led domain (though no rating was given
for this domain).
CQC Compliance, Period : Current Position (Indicator Number Q2)
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
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This data is monitored in more detail via the
Quality and Safety Committee (QSC) on a
quarterly basis.
At its 6 May 2016 meeting, the QSC
requested a deep dive report into the
reasons for the rise in pressure ulcers.
Indicator No.15/16
outturn April 2016 Performance
16/17
YTD
Q3 141 15 15
Serious Incident Numbers
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
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Indicator Q4: Four Serious Incident reports were completed in the month, with all achieving the 12 week target and no themes
or trends.
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
No. Closed this
month within
target
(Numerator)
Total number
completed in
month
(Denominator)
Percentage
completed in
target time
Q4(a)
Serious incident reports
completed(Total):
Q4(b) + Q4(c)
48.9% 100% 4 4 100.0% 100.0%
Q4(b)Serious incident reports
completed (Pressure Ulcers) 33.3% 100% 3 3 100.0% 100.0%
Q4(c)Serious incident reports
completed (all others causes) 90.9% 100% 1 1 100.0% 100.0%
Indicator
No.Indicator
15/16
outturn
16/17
Target
16/17
YTD
FOT
16/17
Q5 Never events 0 0 00
Number of Never events
FOT
16/17
April 2016 Performance
Serious incident reporting timescales: Percentage of reports completed within target time
Indicator
No.Indicator
15/16
outturn
16/17
Target
16/17
YTD
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16
Pressure Ulcers Others target
Serious Incident Reporting, and Never Events
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Indicator
NumberIndicator
15/17
outturn
16/17
Target
April 2016
Performance
16/17
YTD
Q6 Claims Numbers 8 N/A 1 1
Q8 Complaints numbers 74 N/A 4 4
Q9 Compliments numbers 658 N/A 40 40
Indicator Q6: 1 claim was received this month. Indicator Q8: 4 complaints were received this month, with no pattern with regards to the distribution of the complaints.
Indicator Q9: 40 compliments were received in total; 12 related to podiatry, as did the significant fall in overall numbers of
compliments. The increase in compliments in the previous two months was attributed to podiatry.
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Claims, Complaints and Compliments
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Workforce
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Indicator Q17b: Agency providers were advised that from 1 April 2016 the Trust would not deploy Tertiary Staff who are non-compliant with
information governance training.
All tertiary staff who worked during April have been confirmed as compliant and performance for Tertiary Staff is therefore 100%.
Indicator
No. Indicator
15/16
outturn
16/17
Target Numerator Denominator
Current
Performance
FOT
16/17 Graph
Q17
% Mandatory training
(excl. Information
Governance
Compliance)
91.90% 80.00% 9037 10193 88.66%
Q17a
% Information
Governance Training -
Substantive Staff Only
97.94% 95.00% 2408 2553 94.43%
Q17b
% Information
Governance Training -
Tertiary Staff Only
85.83% 95.00% 321 321 100.00%
Q17c
% Information
Governance Training -
Substantive and
Tertiary Staff
Combined
96.50%
95.00%
2729 2874 94.96%
Q18 % Staff Receiving
Appraisal 83.14% 80.00% 2084 2532 82.31%
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Workforce – Top 3 / Bottom 3 Service Areas - Mandatory Training
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Information Governance (IG) Training
IG training compliance has fallen below the
95% target. There are currently 145 staff who
are non compliant. 84 have fallen out of date
since last month. 78 of the 145 are at the top
of their pay band. 17 staff need to renew IG
training to achieve the 95% target. Workforce
development team reminders are issued and
senior managers are being alerted to this, and
when staff are due to lapse, in their one to
one meetings with the HR Team. In Business
Units where compliance has slipped, the HR
Business Partners are liaising with the Head
of Operations to ensure appropriate action is
taken. HR Business Partners have cascaded
the email link to managers to distribute to staff
so that they can access the IG Training with
ease.
Moving & Handling & Fire Safety training
10 out of 12 Business Units are compliant
with the 80% target for Moving & Handling.
11 out of 12 Business Units are compliant
with the 80% target for Fire Safety.
Appraisal
Whilst appraisal rates have dropped by 0.8%
in month, this represents a 2.5% increase
since April 2015.
3 out of 12 Business Units show an increase
in appraisal rates since last month.
Information Governance Current performance 94.43% Fire Safety Current performance 90.04%
Change from the previous month -3.51% Change from the previous month -2.93%
% Change % Change
Service Governance 100.00% 0.00% Service Governance 100.00% 0.00%
Research & Development 100.00% 0.00% Childrens Services 92.63% -1.23%
Specialist Services & Nursing 100.00% 0.00% Commercial Directorate 92.16% -5.92%
Specialist Inpatient Services, Dentistry and Administration93.87% -5.76% Estates, Facilities & Finance 85.64% -4.92%
Mental Health - Acute Inpatient and Community Services92.81% -3.57% Research & Development 83.33% -1.28%
Trust Management 86.36% -4.94% Medical 50.00% -36.67%
94.43% -3.51% 90.04% -2.93%
Infection Prevention Current performance 86.08% Moving & Handling Current performance 84.04%
Change from the previous month -3.85% Change from the previous month -2.64%
% Change % Change
Research & Development 100.00% 0.00% Research & Development 91.67% -0.64%
Medical 100.00% 0.00% Specialist Services & Nursing 91.30% -5.25%
Specialist Services & Nursing 95.83% 2.61% Service Governance 91.30% -4.35%
Adult Physical Health Community Services 88.83% -3.53% Mental Health - Acute Inpatient and Community Services80.37% -3.01%
Childrens Services 87.02% -3.48% Trust Management 78.95% 5.26%
Mental Health - Acute Inpatient and Community Services75.10% -6.71% Medical 50.00% -27.78%
86.08% -3.85% 84.04% -2.64%
Appraisal Current performance 82.31%
Change from the previous month -0.83%
% Change
89.80% 1.09% Key
88.91% -0.10% Top three teams and above target
88.46% -3.21% Above target - but in bottom three
Research & Development 78.57% 11.90% Below target and in bottom three
Commercial Directorate 70.59% -6.33%
Trust Management 44.44% -22.22%
82.31% -0.83%
Business Unit
Business Unit
Business Unit
Grand Total
Grand Total
Business Unit
Grand Total
Grand Total
Business Unit
Grand Total
Specialist Services & Nursing
Specialist Inpatient Services, Dentistry and Administration
Service Governance
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Indicator
No. Indicator
15/16
outturn
16/17
Target Numerator Denominator
Current
Performance
FOT
16/17 Graph
Q19 % Labour Turnover 11.62% 10.00% 298.87 2485.35 12.03%
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Workforce – Labour Turnover
Indicator Q19: Labour Turnover (LTO) is calculated on a rolling 12 month basis and has increased by 0.4% to 12.03% compared to last
month. A total of 243.1 WTE leavers were recorded for the 12 months to April 2015 compared to 298.9 WTE for the 12 months to April
2016. This is an increase of 55.8 WTE leavers and accounts for the overall increase in LTO over the last 12 months. There have been
367.1 WTE new starters over the last 12 months, indicating ‘net’ recruitment of 68.18 WTE more than were lost through LTO.
The next slide analyses the reasons staff have given for leaving. The top 3 reasons over the last 12 months are (with the exception of Not
Known/Other); relocation (58.7 WTE or 19.7%), retirement (53.4 WTE or 17.9%) and work/ life balance (32.6 WTE or 10.9%), with the
number of retirements consistent with the Trust’s age profile. Reason codes for bank and agency cover are being reviewed and will be
included in future monthly reports. A new process is being developed to increase numbers of staff who engage with the exit interview
process so that the Trust can develop appropriate interventions to increase staff retention rates.
The next slide provides an initial analysis of areas that account for highest absolute numbers of leavers. More than 52% of Trust leavers in the
12 month rolling period were attributed to the five areas listed, as were 56% of the Trusts new starters over the same time period. These areas
have also recorded high levels of sickness and high volumes of recruitment activity over the last 12 months. 16.3% (48.6 WTE) of leavers left the
Trust within 12 months of employment. A deeper dive to assess the impact of internal staff ‘leavers’ within turnover was undertaken for Specialist
Inpatient Services and identified some of the wards as having high levels of staff movement within teams and also across to wider services.
Current actions to mitigate the increase in labour turnover include:
• Rolling recruitment adverts in hot spot areas to help ensure vacancies are filled as quickly as possible;
• Piloting the new exit interview process;
• Drilling down and further analysis to review LTO alongside vacancy, sickness and temporary staffing levels ongoing together with a deeper
dive into reasons for staff leaving within 12 months of employment.
Indicator
No. Indicator
15/16
outturn
16/17
Target Numerator Denominator
Current
Performance
16/17
YTD
FOT
16/17
Q21
%
Vacancy
rate
7.17% 10% 215.59 2700.94 7.98% 7.98%
Indicator: Q21 – The current vacancy rate of 7.98%
equates to approximately 215.6 WTE with current
recruitment activity levels remaining highest across
Inpatient Nursing and District Nursing areas.
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Reasons for leaving - 12 months (May 15 to Apr 16)
Reasons for Leaving WTE %
VR - Relocation 58.73 19.65
VR - Other/Not Known 57.73 19.32
Retirement 53.38 17.86
VR - Work Life Balance 32.63 10.92
VR - Promotion 29.51 9.87
Dismissal 15.00 5.02
End of Fixed Term Contract 12.49 4.18
VR - Better Reward Package 9.00 3.01
VR - To undertake further education or training 8.10 2.71
VR - Health 7.92 2.65
VR - Child Dependants 4.06 1.36
Death in Service 3.00 1.00
VR - Lack of Opportunities 2.91 0.97
VR - Incompatible Working Relationships 2.40 0.80
VR - Adult Dependants 2.02 0.68
298.87
Hotspot areas / ExceptionsTurnover percentage starters and leavers WTE per month - May 15 to Apr 16
Labour
Turnover Leavers Starters
% WTE WTE
Specialist Inpatient Specialist - Inpatient 20.91% 52.37 70.70453 Daisy Hill Intensive Therapy Centre - ITC (113019) 28.72%
453 Dementia Assessment Unit - DAU (113501) 46.69%
453 Bracken Ward (OPMH) - (113600) 52.23%
453 Medical Psychology (OPMH) (113701) 18.52%
Adult Physical Health Community Nursing 14.92% 47.79 55.31453 DN Team Windhill MC (115027) 44.35%
453 DN Team WG1 (115036) 30.00%
453 DN Team Thornton Road (115039) 25.84%
453 DN Team Parklands Team 2 (115042) 32.57%
453 DN Team Queensbury and Odsal (115045) 23.83%
453 DN Team Haigh Hall MC (115057) 47.23%
453 DN Team Moorside (115059) 64.60%
MH Acute and Community Acute - Inpatient 14.15% 33.83 45.11453 Ashbrook Ward (AMH) - (113003) 16.89%
453 Oakburn Ward (AMH) (113005) 29.66%
453 Clover (PICU) (113010) 42.11%
MH Acute and Community IAPT 10.72% 13.03 26.55453 Centre for MH Project (114708) 20.00%
453 Mental Health PC Airedale (115225) 53.78%
453 Mental Health PC South (115228) 52.82%
MH Acute and Community CMHT - Adult 9.14% 11.89 10.62453 Airew harfe CMHT Medical Staff (113035) 35.71%
453 South & West CMHT Medical Staff (113038) 26.32%
453 CMHT Community 7 (114040) 33.33%
Hotspot area Leavers Total (WTE) 158.90 208.29Trustwide Leavers Total (WTE) 298.87 Trustwide Starters Total (WTE) 367.05
% Hotspot area total against Trustwide total 53.17% % Hotspot area total against Trustwide total 56.75%
Hotspot area Starters Total (WTE)
Business Unit Service Area
Number of leavers - leaving within first 12 months of employment
Reason for Leaving WTE
Dismissal - Capability 4.00
Dismissal - Conduct 2.00
Employee Transfer 1.84
Redundancy - Compulsory 0.60
Retirement Age 0.45
Voluntary Resignation - Adult Dependants 0.95
Voluntary Resignation - Better Rew ard Package 1.50
Voluntary Resignation - Child Dependants 1.00
Voluntary Resignation - Health 3.20
Voluntary Resignation - Incompatible Working Relationships 1.60
Voluntary Resignation - Other/Not Know n 10.16
Voluntary Resignation - Promotion 2.50
Voluntary Resignation - Relocation 9.80
Voluntary Resignation - To undertake further education or training 3.00
Voluntary Resignation - Work Life Balance 6.00
48.60
Board Integrated Performance Report September 2015 Board Integrated Performance Report October 2015 Board Integrated Performance Report October 2015 Board Integrated Performance Report November 2015 Board Integrated Performance Report December 2015 Board Integrated Performance Report January 2016 Board Integrated Performance Report March 2016 15 of 36 Board Integrated Performance Report - May 2016
Workforce
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Indicator
No. Indicator
15/16
outturn
16/17
Target Numerator Denominator
Current
Performance
16/17
YTD
FOT
16/17
Q20
%
Sickness
absence
rate
4.53% 4% 3251.92 74634.14 4.36% 4.36%
Indicator Q20: The sickness absence rate for April
2016 shows a reduction of 0.17% from the revised
March figure of 4.53% (originally reported in last
month’s Board report as 4.38%). This continues a
reducing trend over the last 3 months.
Long Term Absence the number of cases has
increased in month to 86, with stress and anxiety
being the main cause. The number of life threatening
cases has increased to 5. 15.12% of long term
sickness is attributed to musculoskeletal / back
concerns. Analysis is being undertaken to correlate
sickness related to agile working to ensure support
and prevention good practice is embedded.
Short Teem Absence The Bradford Factor Score
table opposite demonstrates that short term absence
is reducing and details the number of cases being
managed under each stage of the Bradford Factor
Score system. There were 271 new episodes of
sickness absence in April 2016: 38.0% of those were
due to either gastrointestinal problems (18.8%) or
cold/flu (19.2%). 54 of those episodes remain open;
16.7% of those are due to musculoskeletal problems,
24.1% are due to stress/anxiety.
The Bradford Score data demonstrates that short
term cases are being managed through to capability
review meetings (those with a score of 300+) in a
timely manner.
Bradford Factor Score PointsPrevious
Month
Current
Month
Informal process: 20 - 99 points 588 427
Informal process: 100 - 299 points 127 131
Formal process: 300 points and above 68 45
3.5%
4.0%
4.5%
5.0%
5.5%
6.0%
6.5%
Apr-
15
May-1
5
Ju
n-1
5
Ju
l-15
Aug
-15
Sep
-15
Oct-
15
Nov-1
5
Dec-1
5
Ja
n-1
6
Feb
-16
Mar-
16
Apr-
16
Sickness Absence Rate
Sickness Rate Target
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Workforce – Top 3 / Bottom 3 Service Areas - Sickness
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Mental Health – Acute Inpatient and Community Services
In month: short term 2.26%, long term 3.27%. Long term
absence has increased, with 30 long term cases currently being
actively managed. 11 cases have been closed since March 2016
with 14 new cases now being monitored. 12 relate to stress and
2 are life threatening. 14 of the 30 cases are within Inpatient –
Acute Care Services. The top hot spot areas are Heather,
Oakburn, Clover and Intensive Home Treatment Team Airedale.
All exceed 8% sickness, with short term sickness predominantly
due to cold/flu or stress.
Specialist Inpatient Services, Dentistry & Administration
In month: short term 2.53%, long term absence 2.32%. Long
term absence has increased, with 23 long term cases currently
being actively managed. 4 cases have been closed since March
2016 with 14 new cases now being monitored. 10 relate to stress
and 2 are life threatening. 11 of the 23 cases are within Inpatients
– Specialist Services. The top 3 hotspot areas are Dementia
Assessment Unit, Bracken and Thornton. All exceed 5%
sickness, with short term sickness predominantly due to cold/flu,
stress or gastrointestinal.
Estates, Facilities & Finance
In month: short term 1.33%, long term absence 2.78%. Long
term absence has increased, with 9 long term cases currently
being actively managed. 2 cases have been closed since March
2016 with 4 new cases now being monitored. 6 relate to MSK. 6
of the 9 cases are within Hotel Services. The main hotspot area
is Airedale Housekeeping, with short term sickness
predominantly due to cold / flu, musculoskeletal or chest /
respiratory problems.
Research & Development Whilst the team shows the highest
sickness absence rate the small size of the business unit means
that this represents just 1 long term sickness absence.
Absence Current performance 4.36%
Current YTD 4.36%
Change from the previous month -0.17%
% Change
Service Governance 0.00% -2.28%
Commercial Directorate 0.52% -0.40%
Medical 0.59% 0.36%
Specialist Inpatient Services, Dentistry and Administration4.85% 0.57%
Mental Health - Acute Inpatient and Community Services5.54% 0.40%
Research & Development 6.16% 5.48%
4.36% -0.17%
Key
Top three teams and above target
Above target - but in bottom three
Below target and in bottom three
Grand Total
Business Unit
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
Apr-
15
May-1
5
Ju
n-1
5
Ju
l-15
Aug
-15
Sep
-15
Oct-
15
Nov-1
5
Dec-1
5
Ja
n-1
6
Feb
-16
Mar-
16
Apr-
16
Long Term/ Short Term - Sickness Absence Rate
Long Term Short Term
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Q23a - Safer Staffing: Inpatient Services
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Risks:
- High number of vacancies (particularly in DAU)
meaning safe staffing levels cannot be
sustained long term without posts being
permanently recruited to.
Contingency / Mitigating Actions:
- Roster review / risk assessment in place on a
daily basis
- Staff re-distributed across services as required.
- New eRostering system will allow baseline
requirements to be amended in real time.
- Redeployment of staff from ITC/ATU to fill
vacancies
No. shifts
Exact/ Over Compliance 2336
Under Compliance 327
Non Compliance 0
Narrative on data extracts regarding staffing levels on 13 wards during April 2016
Exact/over compliant shifts - Over compliant shifts recorded in April were mainly attributed
to the acute wards, Dementia Assessment Unit (DAU), and Clover (PICU), due to the acuity
(complexity of need) of the ward and the requirement for skill mix within the units. 30% of all
shifts worked were bank or agency filled with 62% of these shifts requesting unregistered
staff. The main requirement reasons for bank and agency are; Vacancy (48%) - although
this should reduce over the next few weeks following completion of the pre-employment
process for 13.5wte Support Worker roles and 14.5wte Qualified Nursing roles from the
recent recruitment drive for Inpatient services. Regarding Observations/Specialling (37%) –
DAU, Clover and Ashbrook have recorded the highest requirement in April.
'Under compliant' shifts - There were 62 incidents reported relating to staffing shortages in
April (this is consistent with previous months). 35 of which related to the Dementia
Assessment Unit due to the ward having a number of long terms sick cases and vacancies;
with acute services reporting 27 incidents mostly relating to a specialling requirement and
vacancy. Work is underway to fill the vacancies. However, this is being impacted by the
recent notice to close the Intensive Therapy Centre (ITC) and reduce additional beds on the
Assessment and Treatment Unit (ATU). The wider issues are being addressed
organisationally through the overtime scheme for substantive staff working within Inpatient
services and also development of a peripatetic / relief team to fill urgent shift requirements.
The internal Staff Bank is also now live, with the new eRostering system (inclusive of the
Bank module) currently being implemented.
'Non-compliant shifts' - No shifts were recorded as non-compliant in April. However, there
were two days overall (Maplebeck on 16 April and Oakburn on 25 April), recorded with very
low levels of staff due to sickness. Care was not compromised on the wards and was
managed internally through the re-distribution of staff.
Board Integrated Performance Report September 2015 Board Integrated Performance Report October 2015 Board Integrated Performance Report October 2015 Board Integrated Performance Report November 2015 Board Integrated Performance Report December 2015 Board Integrated Performance Report January 2016 Board Integrated Performance Report March 2016 18 of 36 Board Integrated Performance Report - May 2016
Q23a - Safer Staffing: Inpatient Services
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Total
monthly
planned staff
hours
Total
monthly
actual staff
hours
Total
monthly
planned staff
hours
Total
monthly
actual staff
hours
Total
monthly
planned staff
hours
Total
monthly
actual staff
hours
Total
monthly
planned staff
hours
Total
monthly
actual staff
hours
Fern710 - ADULT MENTAL
ILLNESS982.5 1095 817.5 667.5 511.5 446.4 604.5 641.7 111.5% 81.7% 87.3% 106.2%
Heather710 - ADULT MENTAL
ILLNESS915 1297.5 900 922.5 279 279 837 771.9 141.8% 102.5% 100.0% 92.2%
Bracken710 - ADULT MENTAL
ILLNESS907.5 1012.5 1335 1342.5 279 279 837 846.3 111.6% 100.6% 100.0% 101.1%
Ashbrook710 - ADULT MENTAL
ILLNESS937.5 1230 1320 1515 279 288.3 837 1116 131.2% 114.8% 103.3% 133.3%
Maplebeck710 - ADULT MENTAL
ILLNESS922.5 975 1320 1290 316.2 390.6 790.5 892.8 105.7% 97.7% 123.5% 112.9%
Oakburn710 - ADULT MENTAL
ILLNESS960 1170 1267.5 1185 288.3 325.5 818.4 864.9 121.9% 93.5% 112.9% 105.7%
Baildon710 - ADULT MENTAL
ILLNESS960 930 1065 945 279 279 558 688.2 96.9% 88.7% 100.0% 123.3%
Ilkley710 - ADULT MENTAL
ILLNESS900 735 1087.5 990 279 297.6 558 595.2 81.7% 91.0% 106.7% 106.7%
Thornton710 - ADULT MENTAL
ILLNESS907.5 840 900 1140 279 288.3 837 604.5 92.6% 126.7% 103.3% 72.2%
Assessment & Treatment
Unit (LD)
700- LEARNING
DISABILITY900 855 1350 1950 279 288.3 1116 1041.6 95.0% 144.4% 103.3% 93.3%
Clover (PICU)710 - ADULT MENTAL
ILLNESS915 1050 1732.5 2295 279 306.9 1116 1385.7 114.8% 132.5% 110.0% 124.2%
Step Forward (Rehab)710 - ADULT MENTAL
ILLNESS525 750 600 727.5 288.3 288.3 269.7 269.7 142.9% 121.3% 100.0% 100.0%
Dementia Assessment Unit
(DAU)
710 - ADULT MENTAL
ILLNESS900 847.5 1800 2617.5 279 520.8 1116 1515.9 94.2% 145.4% 186.7% 135.8%
Average fill
rate - care
staff (%)
Average fill
rate -
registered
nurses/mid
wives (%)
Average
fill rate -
care staff
(%)
Fill rate indicator returnStaffing: Nursing, midwifery and care staff
Specialty 1
Day Night
Ward name
Registered
midwives/nursesCare Staff
Registered
midwives/nursesCare Staff
Average fill
rate -
registered
nurses/mid
wives (%)
Day Night
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Q23b - Staffing Ratio (Trends): Community Services
Recommended Ratio
The recommended ratio for Family Nurse Partnership (FNP) is based on the national licensing agreement.
The Health Visitor ratio is based upon nationally recommended levels amended to reflect local needs.
The School Nursing ratio has been locally developed based on pupil numbers and numbers of pupils in pre-determined priority support
needs and is reflective of the school nursing staff mix, not just school nurses.
Special Needs School Nursing does not have a national recommendation and has therefore been set locally.
EIP/AOT, CMHT and CAMHS ratios are based on national standards.
The Matrons and Case Managers ratio is based on the Bradford & North Commissioning Alliance Service Delivery Plan.
The red, amber, green thresholds have been established by local managers using their professional judgement.
April Actual
Service Arearecommend
ratio
Ratio of
Cl ients to
s taff
Amber i f
greater
than
Red i f
greater
than
M J J A S O N D J F M A
FNP 25:1 18 25 28
Health Visitors 312:1 293 312 362
School Nursing New Ratio 2200:1 2245 2200 2500
Special Need School Nursing 75:1 55 85 90
EIP 15:1 16 15 18
AOT 15:1 17 15 18
CMHT 35:1 30 33 35
CAMHS 40:1 47 35 40
Community Matrons 70:1 74 77 84
Case Managers 70:1 54 77 84
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Board Integrated Performance Report September 2015 Board Integrated Performance Report October 2015 Board Integrated Performance Report October 2015 Board Integrated Performance Report November 2015 Board Integrated Performance Report December 2015 Board Integrated Performance Report January 2016 Board Integrated Performance Report March 2016 20 of 36 Board Integrated Performance Report - May 2016
0 10 20 30
FNP
0 5 10 15 20
EIP/AOT
0 100 200 300 400 500
Health Visitors
0 20 40 60 80 100
Special Needs School Nursing
0 20 40 60 80 100 120
Matrons and Case Managers
0 10 20 30 40
CMHT
0 10 20 30 40 50
CAMHS
0 1000 2000 3000
School Nursing
Deputy Director
Nursing, Children’s and Specialist Services
School Nursing: Improvements to working
practices in school nursing are being established
to free up resources. The new pupils to staff ratio
is now being used.
FNP: No concerns, work progressing on
developing the new service delivery model
known as ADAPT.
Health Visitors: Remains green – no concerns.
Following completion of the review of the health
visiting service by the Local Authority in mid June
2016, the ratios used to measure the service and
method of presentation may change.
Q23b - Staffing Ratio: Community Services
Deputy Director
Mental Health Acute and Community EIP and
AOT: the team has been joined by a new starter
(Local Authority staff). The post occupied by a
member of staff on long term has been backfilled
by agency staff,
CAMHS: 4 Primary Mental Health worker posts
are currently being recruited; agency staff are
covering priority vacancies.
Deputy Director
Adults Community Physical Health Matrons
and Case Managers: In the short term, to
mitigate risks the workload is being shared
across the team. The figures are skewed by the
work style in the South and West team which is
concentrated on care homes.
Legend / Glossary:
FNP: Family Nurse Partnership
EIP: Early Intervention in Psychosis
AOT: Assertive Outreach Team
CAMHS: Child and Adolescent Mental Health Services
CMHT: Community Mental Health Teams
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Board Integrated Performance Report September 2015 Board Integrated Performance Report October 2015 Board Integrated Performance Report October 2015 Board Integrated Performance Report November 2015 Board Integrated Performance Report December 2015 Board Integrated Performance Report January 2016 Board Integrated Performance Report March 2016 21 of 36 Board Integrated Performance Report - May 2016
Indicator Q40: Service User Experiences
The Friends and Family Test (FFT) questionnaire asks if service users: “felt safe”; “were treated with kindness and
compassion”; “were involved in their care as much as they would have liked”; if “they were treated with kindness and
compassion”. Where a reviewer responds to these questions with “Totally” a score of 5 is recorded, where the
response is “Not at all” then a score of 1 is recorded. The charts show the average score for business units, and
starts at 3 (a neutral opinion).
Over 11,000
reviews have
been received
since recording
began.
In January and April 2016 the average score for “were you involved as much as you liked?” for the Inpatient Services, Dental and Administration
business unit fell below the Board’s target of 4 out of 5. In January this was as a result of the impact of 5 reviewers (from 62) who offered a score
of 1 out of 5. Of these 2 were extremely likely to recommend the service, 2 were likely and 1 was extremely unlikely to recommend the services. 4
of these were for Bracken Ward and 1 for Thornton. No comments were provided to explain why the users did not feel involved. For the reviewer
who was unlikely to recommend the service, although they said the “hospital needs better facilities” they scored being ‘treated with kindness and
compassion’ as 5 out 5, being ‘treated with dignity and respect’ as 4 out of 5. In April 1 reviewer from 29 received scored 1 out of 5 in response to
the ‘were you involved’ question. This review was for Assessment and Treatment Unit. Their scores for the other questions were 3 out of 5. In
using the option to provide a commentary this reviewer said “no comment”, thus no reason for the low score was offered. Any themes or trends
that have been identified are reported to operational manager.
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
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Quality Assurance
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Indicator
Number Target Target met this month
Q7 Meet Central Alert System (CAS) timelines Y
Q10 No MRSA bacteraemia cases Y
Q11 No Methicillin sensitive staphylococcus aureus (MSSA) bacteraemia cases Y
Q12 No Clostridium difficile (C.diff) cases Y
Q15 Meet nationally mandated Commissioning for Quality and Innovation (CQUINs) –
Forecast 2016/17.
Y
Q15 Meet CCG local Commissioning for Quality and Innovation (CQUINs) – Forecast
2016/17 Y
Q16 Meet NHS England Commissioning for Quality and Innovation (CQUINs) – Forecast
2016/17 Y
Q32 No Complaints to Information Commissioners Office (ICO) Y
Q33 No Information Governance Serious Incidents (STEIS) Y
Q34 Maintain Mixed sex accommodation status Y
Q35 Meet Dental Referral To Treatment within 52 weeks Y
Q36 Meet IAPT Recovery rate N
Q37 Maintain Publication of the Formulary on Provider’s website Y
Q38 No duty of candour incidents (see slide 2) N
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Programme summary: 2016/17
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
There are currently 11 transformational projects and 29 transactional cost improvement projects (CIP) that are being monitored by the
Change Programme Board during 2016/17.
In May 2016, six of the transformational projects are progressing to plan and are rated green. Four projects are rated amber with
actions and mitigations in place to manage the risks and issues. The Intensive Therapy Centre (ITC) project is rated red. A decision
to close the unit to new admissions was taken during April, with closure plans confirmed at the Change Programme Board in May.
The purpose of the Change Programme is to effectively govern the Trust's strategic transformation projects. Projects for major change
activities are reported to and monitored by the Change Programme Board and have project management arrangements in place to
ensure project delivery and a consistent approach to Quality Impact Assessments.
Specific tasks of the Change Programme are to:
• Monitor both Transformational and Transactional Change Programme Board Projects;
• Provide highlight reports for transformational projects;
• Approve detailed Project Initiation Documents to reflect emerging and new Change Programme Board projects;
• Provide appropriate and effective governance arrangements including reporting structure and highlights reports;
• Review the overall programme risks and ensure appropriate mitigation is in place;
• Monitor the Quality Impact Assessment status of the projects in the Change Programme.
Overall Programme Summary
Mar-16 Apr-15 May-15
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
PTP PP SE M KPI RM BR QIA PTP PP SE M KPI RM BR QIA
PTP PP SE M KPI RM BR QIA PTP PP SE M KPI RM BR QIA
PTP PP SE M KPI RM BR QIA PTP PP SE M KPI RM BR QIA
Closure report Action Plan received and approved at Change Programme
Board. The first meeting of the ITC Closure Steering Group held 10/05/2016
and monthly meetings scheduled.
Complete closure of the Centre likely 2nd September 2016 (this date is
indicative and is based on completion of all 6 month programmes).
The centre is closed to further admissions from this point onwards. Lessons
Learned to be scheduled August 2016
No Highlight Report monitoring as part of performance monitoring.
Project allocated as Transformational Monitor
1.2 Agile Resource Reductions K Jolaoso & D Gilderdale 2.1.3 Out of Area Placements D Gilderdale
Capital funding for the agile programme has been removed from 2016/17
project budget and IM&T and Estates capital funds are to provision the agile
working environments.
The Project Initiation Document (PID) has been updated to reflect this.
Estates provision of Touchdown Points is behind forecast due to focus work on
flood remediation. Replan required
Steering Group meetings have not taken place due to not being quorate.
Funding secured to align System1 to new clusters and merge 5 Health
Visitor modules into one. This is due to go live before end May
Remaining IT workstream (Patient communications secure email,
Audio and Video conferencing, Text,) is delayed and pending
resources. A business case being developed for email).
Estates workstream awaiting outcome of revised estates
rationalisation plan.
Children and Young People and parent friendliness/marketing of
BDCFT web presence; the delivery/scope plan is to be developed and
resourced.
Key issue: Progress in delivery of Technology to support service re-
1.2 Agile Project K Jolaoso & D Gilderdale 1.11 Children's Schemes - C Woffendin
3.1.1 ITC1 A Bingham 3.3 Substance Misuse % reductions K Jolaoso
Staffing reductions have been quality impact assessed and on track to reduce
as per the original business case for the financial year 2016/17. Clinical
increase in face to face time and performance indicators are being tracked and
monitored by the agile steering group.
No Highlight Report as thnis projec tis now in monitoring phase and
forms part of performance and service improvement workstream.
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Quality
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
PTP PP SE M KPI RM BR QIA PTP PP SE M KPI RM BR QIA
PTP PP SE M KPI RM BR QIA PTP PP SE M KPI RM BR QIA
PTP PP SE M KPI RM BR QIA PTP PP SE M KPI RM BR QIA
PTP Project Team Performance
PP Project Plan
SE Stakeholder Engagement
M Milestones
KPI Key Performance Indicators(including Cost Improvement Programme)
RM Risk Management
BR Benefits Realised
QIA Quality Impact Assessment
Key
Plan developed however not signed off by agile steering
group/business units as phasing of estates release has needed to be
revised.
No Highlight Report as no Steering Group set up however meeting scheduled
for 26th may to baseline and establish scope.
Project allocated as Transformational Monitor
5.5.3 Reduction in SLA costs for pharmacy A Tinto 5.20 Bank + Agency Fiona Sherburn
No Highlight Report as project is in mobilisation phase.
Project Initiation Document , guiding principles, strategy and Terms of
Reference are drafted for the steering group to mobilise during May will
define a number of elements in scope of the project and delivery
phases/dependencies on procurement of telephony elements (mobile,
Infrastructure, landlines etc.).
No Highlight Report completed for May 2016 as project Steering Group
is yet to meet and agree milestone plan and steering group TOR on
23rd May 2016. Terms of Reference and plan of delivery is drafted.
5.2.1 Estates Rationalisation A Morris5.1 IM&T - Telephony Mark Gregson
5.7 CPPP C Risdon-Transfer to D Gilderdale planned May 2016
Project Steering Group has in the last few months not been quorate however
the group met in April 2016 to refocus the work plan for 2016/17. There have
been significant resource changes. The confirmation of 2017/18 payment
approach to be used at BDCFT is still to be agreed with commissioners.
Performance demonstrating clustering is still well below target at 85.9% but
demonstrating a year on year improvement.
Operational Deputy Director Project lead to take the project forward and
integrate Clustering within performance monitoring.
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Executive Summary
Proposed Board RAG Rating Year to
Date Forecast 2016/17
Commentary
Statement of Comprehensive
Income (SoCI)
A deficit of £100k for the period is £211k below the planned surplus of
£111k. This reflects the degree of challenge in the financial plan for
2016/17 and will require rapid, ongoing and robust action planning to
ensure delivery of the planned surplus.
Statement of Financial Position
(SoFP)
Current assets (including receivables, accruals, prepayments) are
£6,548k above plan. Current liabilities are £3,881k above plan. These
variances underpin the adverse year to date cash flow variance.
Statement of Cash Flows
(SoCF)
Cash balances are £2,717k below plan at the end of the period,
largely driven by delayed contract payments following the relatively
late agreement of 2016/17 contracts (during April). The forecast is still
achievement of the cash target of £14,589k but noting elevated risks
relating to achievement of the planned surplus.
Financial Sustainability Risk
Rating (FSRR)
Achievement of a Financial Sustainability Risk Rating (FSRR) of 3 in
Month 1 with the forecast being the achievement of a rating of 4.
Cost Improvement
Programmes (CIPs)
Under achievement of £102k compared to planned CIPs reflects
further work now needed to secure financial savings. This includes
schemes rated RED when the plan was approved. Full delivery of the
annual CIP of £5,789k is forecast, with Programme Leads now
progressing required (mitigating) actions to ensure delivery.
Capital Expenditure
Capital expenditure is £81k below plan at the end of the period mainly
due to the timing of expenditure for the E-rostering systems and no
calls on the capital contingency at this early point in the year. Plans
are in place to fully commit the capital programme.
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Plan Actual Variance Plan Actual Variance
Operating income (inc in EBITDA)
NHS Clinical income (8,717) (8,795) 78 (104,952) (105,494) 542
Non-NHS Clinical income (1,626) (1,591) (35) (19,510) (19,013) (497)
Non-Clinical income (440) (598) 158 (6,150) (7,270) 1,121
Total (10,783) (10,984) 201 Green (130,612) (131,777) 1,165 Green
Operating expenses (inc in EBITDA)
Employee expense 8,540 8,604 (64) 103,878 102,973 904
Non-Pay expense 1,705 2,066 (361) 20,285 22,345 (2,059)
PFI / LIFT expense 17 17 0 199 199 0
Total 10,262 10,687 (425) Red 124,362 125,517 (1,155) Amber
EBITDA (521) (297) (224) Green (6,250) (6,260) 10 Green
EBITDA Margin % 4.83% 2.70% Green 4.79% 0 Green
Operating expenses (exc from EBITDA)
Depreciation & Amortisation 262 264 (2) 3,143 3,153 (10)
Total 262 264 (2) Green 3,143 3,153 (10) Green
Non-operating income
Finance income (5) (4) (1) (63) (63) 0
Total (5) (4) (1) Green (63) (63) 0 Green
Non-operating expenses
Interest expense (PFI / LIFT) 13 13 0 158 158 0
PDC expense 140 124 16 1,678 1,678 0
Total 153 137 16 Green 1,836 1,836 0 Green
(Surplus) / Deficit after tax (111) 100 (211) Red (1,335) (1,335) 0 Amber
Statement of Comprehensive Income
Year to Date£000's
Forecast
RAG
Year End ForecastYTD RAG
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Statement of Comprehensive Income
Area Impacted Risk Mitigation
Children’s
Services
Risks relating to 2 CIPs (Better Start and Use of Technology) are
outlined in the CIP section of this report including mitigations. An issue
relating to potential loss of income as a consequence of loss of paper
records in the floods is being followed up.
The Business Unit log has been developed and mitigations for the CIP issues have
been identified.
The need for actions relating to impacts form the floods will be explored once this issue
is better understood.
Specialist
Inpatients,
Dental &
Admin
Anticipated trading risks relating to the ITC, admin hub agency staffing /
reception pressures, DAU and Bracken Ward, Inpatient specialling and
Ward therapy costs were identified as risks for escalation/action
The Business Unit risk log has been developed. Mitigations are now being explored.
Work to review the admin hub issues is in train. Change Programme Board discussed
the ITC closure and options to further mitigate attendant non-recurrent trading risks.
Acute &
Community
Mental Health
Projected pressures relating to IAPT room hire, drugs, medical locums,
CAMHS and EIP agency (pending recruitment), Police Control Room
and First Response travel costs were identified as risks for
escalation/action
The Business Unit log has been developed. Mitigations are now being explored.
Estates are helping to identify alternatives to room hire. The Head of Pharmacy is
supporting drugs cost analysis and actions. A decision on Police Control Room
Funding is due in June. Controls and actions to minimise Medical Locum costs are
being led by the DD, Head of Service and Medical Director.
Adult Physical
Health
Projected pressures relating to District Nursing pay and non-pay,
Continence products, Nursing Support Team recharges & £188k Agile
CIP rated RED at plan were identified as risks for escalation/action.
The Business Unit log has been developed and mitigations are now being.
Corporate
Functions
Estates Engineering maintenance pressures and unachieved CIPs are
contributing to the adverse variance in non pay expenditure.
Detailed Engineering analysis and forecasting is now underway to assess the impacts
of mitigations and bring the costs in line with plan. CIP mitigations/actions are outlined
on the CIP slides
Agency/fixed term staff costs to cover vacancies/providing year end
cover following the Finance restructure/3 retirements.
Adverts, shortlisting/recruitment is being progressed as quickly as possible. 2 contracts
are due to end by the start of June. Non pay mitigations will be progressed to offset
and residual pressure.
Non pay CIPs slippage for Finance SLAs, IM&T Telephony & SMS
external accommodation recharges.
Mitigations/actions are outlined on the CIP slides.
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Key Risks Key Mitigations & Action Plans
Cashflow – The adverse cash variance for April relates to
Local Authority and Airedale CCG Commissioners not paying
block contract invoices in Month 1. This reflects the late
agreement of financial contract values due to slippage in
contracting deadlines for 2016/17.
Other liabilities includes accruals that have been made for
NHS Property services for 2015/16 and Month 1 of 2016/17.
Receivables continue to be monitored closely with escalation
plans are in place. Both contract invoice issues have been
resolved in May 2016.
A national newsletter was issued by the DH on 5th April
providing clear guidance on charging principles to be adopted
by NHSPS. The Trust wrote immediately to NHSPS to
request applying these principles to outstanding and
previously disputed charges.
Plan Actual Variance Plan Actual Variance
Non-current Assets
Intangible assets 0 0 0 0 0 0
Property, Plant & Equipment 49,398 48,882 516 50,520 50,520 0
On-balance sheet PFI 4,649 4,578 71 4,220 4,220 0
Other 0 0 0 0 0 0
Total 54,047 53,460 587 Green 54,740 54,740 0 Green
Current Assets
Cash and cash equivalents 14,978 12,261 2,717 14,589 14,589 0
Other current assets 4,645 11,193 (6,548) 3,830 3,830 0
Total 19,623 23,454 (3,831) Green 18,419 18,419 0 Green
Current Liabilities
Overdrafts and drawdowns in committed facilities0 0 0 0 0 0
PFI / LIFT leases-CA (343) (343) 0 (339) (339) 0
Other borrowings-CA 0 0 0 0 0 0
Other current liabilities-CA (11,673) (15,555) 3,881 (10,253) (10,253) 0
Total (12,016) (15,898) 3,881 Green (10,592) (10,592) 0 Green
Non-current Liabilities
PFI / LIFT leases-NCA (3,033) (3,061) 28 (2,721) (2,721) 0
Other borrowings-NCA 0 0 0 0 0 0
Other non-current liabilities-NCA (630) (672) 42 (630) (630) 0
Total (3,663) (3,733) 70 Green (3,351) (3,351) 0 Green
Total Assets Employed 57,991 57,283 708 Green 59,216 59,216 0 Green
Reserves 57,991 57,283 708 Green 59,216 59,216 0 Green
Statement of Financial Position
Forecast
RAG£000's
Year to Date Year End ForecastYTD RAG
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Key Risks Key Mitigations & Action Plans
The cash position for April is £2.7m below plan, reflecting balances
outstanding from AWC CCG (£1.6m) and BMDC (£1.2m) – see
previous slide.
The cashflow position will continue to be monitored on a monthly
basis, with variations from plan being thoroughly investigated.
Actions will be identified to rectify variances from plan at an early
stage.
Specifically in respect of key Commissioners the Head of
Contracting is liaising personally with counterparts to ensure that
cash receivable is remitted in full going forward.
Plan Actual Variance Plan Actual Variance
Surplus (Deficit) from Operations 261 (91) 352 Green 3,141 3,141 0 Green
0
Operating activities 263 264 (1) Green 3,155 3,155 0 Green
0
Movements in working capital (1,829) (4,432) 2,603 Green (2,223) (2,223) 0 Green
0
Investing activities (266) (190) (76) Green (3,795) (3,795) 0 Green
0
Financing activities (42) (38) (4) Amber (2,280) (2,280) 0 Green
0
Opening cash and cash equivalents less bank overdraft 16,591 16,748 (157) 16,591 16,591 0 Green
Closing cash and cash equivalents less bank overdraft 14,978 12,261 2,717 Amber 14,589 14,589 0 Green
£000'sYear to Date Forecast
RAG
Statement of Cash FlowsYear End ForecastYTD
RAG
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Description of Key Metrics
Capital Service Cover: Metric currently weighted at 25% and shows how many times income covers the servicing of capital costs.
Liquidity: Metric currently weighted at 25% and shows how liquid the Trust is in respect of days’ operating expense cover.
I & E Margin: Metric currently weighted at 25% and shows normalised surplus as a % of income.
I & E Margin Variance From Plan: Metric currently weighted at 25% and shows I & E Margin actual compared to planned.
Overall Rating: Aggregate rounded average of all metrics.
Key Risks, Mitigations & Actions
Key risks stem from the requirement to achieve a 1% surplus in the period to maintain an I&E Margin metric of 4. The I&E margin %
rating is 1.93% below plan to date. This reflects a RED rating due to the Monitor formula used for variation.
The Trust will report a FSRR of 3 for April and by bringing the forecast back in line with plan projects achieving an outturn rating of 4
against the FSRR for 2016/17. Mitigating action plans are being progressed as a priority.
Plan Actual Variance Plan Actual Variance
Capital Service Cover
Revenue Available for Capital Service 529 301 (228) 6,360 6,323 (37)
Capital Service (185) (166) 19 (2,218) (2,184) 34
Capital Service Cover metric 2.86 1.81 (1.05) 2.87 2.90 0
Capital Service Cover rating 4 3 4 4 Amber
Liquidity
Working Capital for FSRR 7,589 7,538 (50) 7,809 7,809 0
Operating Expenses within EBITDA, Total (10,259) (10,687) (428) (124,316) (125,517) (1,201)
Liquidity metric 22.2 21.2 (1) 1.9 1.9 (0.02)
Liquidity rating 4 4 4 4 Green
I & E Margin
Surplus/(deficit) before impairments,
disposal on FA & restructuring costs 110 (100) (210) 1,335 1,335 (0)
Total operating & non operating income 10,788 10,988 200 130,676 131,840 1,164
I & E Margin % metric 1.02% -0.91% -1.93% 1.02% 1.01% -0.01%
I & E Margin % rating 4 2 4 4 Red
I & E Margin Variance
I & E Margin 1.02% -0.91% -1.93% 1.02% 1.01% (0)
I & E Margin variance from plan -0.02% -0.89% -0.87% -0.02% 1.03% 1.06%
I & E Margin Variance From Plan Rating 3 3 3 4 Green
Financial Sustainability Risk Rating 4 3 4 4 Amber
Financial Sustainability Risk Ratings
£000'sYear to Date Year End Forecast RAG
Rating
(YTD)
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Business Unit & CIP Scheme
Plan Actual Variance Plan Actual VarianceRAG
RatingAdult Physical Health Community Services : 56 56 0 1,250 1,250 0
1.2-Agile project staffing 44 44 0 776 776 0 Green
1.2-Agile project staffing - (No plans for CIP) 16 16 0 187 187 0 Green
1.2-Agile project staffing - RED rated 0 0 0 168 168 0 Green
1.2b-Agile project staffing (phasing for OD) (30) (30) 0 (193) (193) 0 Green
1.1.3-SLT Income generation contribution 2 2 0 25 25 0 Green
3.3-Substance Misuse % reductions 24 24 0 287 287 0 Green
Childrens : 88 51 38 1,058 1,058 (0)
1.11-Childrens - New models for FNP 29 0 29 352 352 (0) Green
1.11-Childrens - Secondments & career breaks 4 4 0 45 45 0 Green
1.11-Childrens Management overhead reduction 15 15 0 180 180 0 Green
1.11-Childrens Non pay procurement savings 3 3 0 30 30 0 Green
1.11-Childrens -Reduction in staff hours 6 6 0 71 71 0 Green
1.11-Childrens Skill mix efficiencies 23 23 0 281 281 0 Green
1.11-Childrens Use of technology to free clinical time 8 0 8 99 99 0 Green
Corporate : 15 10 5 488 487 1
2.1.2-CAMHS Eating disorders contribution (contract income) 2 2 0 20 20 0 Green
5.4.2-Corporate overheads - Executive PAs 4 4 0 49 49 0 Green
5.5.1-Drug pricing target reductions 4 0 4 50 50 0 Amber
5.21-Executive director savings 4 4 0 49 49 0 Green
5.5.3-Pharmacy SLA savings 0 0 0 81 81 0 Green
5.4.1-Salary sacrifice increased income from new and existing schemes 0 0 0 226 226 0 Green
5.22-Trust Board efficiencies 1 0 1 13 12 1 Amber
Estates & Facilities : 36 11 25 557 557 0
1.2-Agile - Estates Project 20 0 20 235 235 0 Amber
5.2.1-Estates rationalisation 0 0 0 125 125 0 Green
5.23-Mitigate Stoney Ridge cost pressure by CIP 5 0 5 61 61 0 Amber
5.9-Release of NHS property services overhead costs 11 11 0 136 136 0 Green
Cost Improvement Schemes 2016/17
Year to date April 2016 Year End Forecast
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Business Unit & CIP Scheme
Plan Actual Variance Plan Actual Variance
RAG
RatingFinance : 13 10 3 250 250 0
5.15-Reduce computer maintenance & support 3 3 0 30 30 0 Green
5.17-Reduce finance training budget 1 1 0 10 10 0 Green
5.14-Reduce Finance SLA costs 3 0 3 30 30 0 Amber
5.16-Reduce trust wide finance budget 3 3 0 35 35 0 Green
5.18-Restructure finance team 4 4 0 45 45 0 Green
5.13-Salary sacrifice increased income from new and existing schemes 0 0 0 100 100 0 Green
Human Resources : 12 12 0 210 210 0
5.11-HR Childcare cost reduction 2 2 0 25 25 0 Green
5.11-HR Contribution from CCG's HR/OD Contract 6 6 0 74 74 0 Green
5.11-HR non pay efficiencies 4 4 0 42 42 0 Green
5.11-Salary sacrifice increased income from new and existing schemes 0 0 0 69 69 0 Green
IM&T : 32 5 28 389 389 0
5.6-CHIS cost reduction from CSU contract 5 5 0 55 55 0 Green
5.20-IM&T Agency savings 0 0 0 0 0 0 Green
5.1-IM&T Strategy CIP (telephony) 28 0 28 334 334 0 Amber
Medical Director : 19 19 0 223 223 0
2.1.1-Locum budget reserve reduction 13 13 0 150 150 0 Green
5.8.1-Research & Development recurrent reduction 1 1 0 6 6 0 Green
5.8.1-Research & Development non recurrent vacancy reduction 3 3 0 40 40 0 Green
5.8.1-Research & Development reduce BDCT provision 2 2 0 27 27 0 Green
Mental Health Acute & Community Services : 61 61 0 813 813 0
1.2b-Agile NR reserve (phasing for OD) (10) (10) 0 (63) (63) 0 Green
1.2-Agile project staffing 37 37 0 447 447 0 Green
2.1.4-IAPT post reductions 0 0 0 29 29 0 Green
2.1.3-Out of area placements reduction 33 33 0 400 400 0 Green
Specialist Inpatients : 4 4 0 44 44 0
3.6-Dental savings 4 4 0 44 44 0 Green
Trust wide : 42 37 5 506 509 (3)
1.2-Agile - Travel cost reductions 8 11 (3) 96 99 (3) Green
5.5.2-Procurement savings 19 19 0 224 224 0 Green
5.4.2-Reduction in operational management costs 8 8 0 92 92 0 Green
5.10-SMS external accomodation recharge 8 0 8 94 94 0 Amber
Total 377 274 103 5,787 5,789 (2)
Cost Improvement Schemes 2016/17
Year to date April 2016 Year End Forecast
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Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Current Status, Key Risks & Mitigations Current Status, Key Risks & Mitigations
Children's Business Unit: £352k CIP relating to Better Start
Bradford will not commence until month 3. The shortfall will be
mitigated from vacancies within the FNP teams and adjusted for
reporting at Month 2.
Plans for the £99k Use of technology to free clinical time CIP are
being completed. The shortfall will be mitigated from vacancies
from the Shipley team and adjusted at Month 2.
Estates: The Agile Estates CIP is expected to achieve in full, but
from quarter 2, incorporating mitigations that are now being
agreed. The team is confident that the annual savings will be
delivered in line with plan. An assurance report is planned for the
next Change Programme Board. The Stoney Ridge CIP was
agreed in March to mitigate cost pressures. Savings from the site
closure are not expected until the end of the year when the site is
vacant. Mitigations including energy re-contracting are being
progressed and are expected to fully offset.
Substance Misuse Services External Recharge - Negotiations
are underway but there is a risk of underachievement that may
require substitution.
Reduce Finance SLA values - A meeting is being arranged to
commence negotiations – the CIP is expected to achieve later in
the year and will be mitigated from other substitute savings.
IM&T Strategy CIP (telephony) – The CIO is confident of being
able to deliver the CIP and is preparing an assurance report for the
next Change Programme Board.
Drugs - Drugs cost reductions have not been realised in Month 1.
A plan is being be drawn up with the Head of Pharmacy to identify
mitigations.
312624
9641,350
1,7402,188
2,6393,094
3,5524,022
4,4964,973
016
31
110
189
268
347
425
504
603
703
816
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12
Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast
£000
's
CIP Plans Deliverability
Unachieveable - substitution required Achievable but risks identified Delivered/deliverable Target
Board Integrated Performance Report September 2015 Board Integrated Performance Report October 2015 Board Integrated Performance Report October 2015 Board Integrated Performance Report November 2015 Board Integrated Performance Report December 2015 Board Integrated Performance Report January 2016 Board Integrated Performance Report March 2016 35 of 36 Board Integrated Performance Report - May 2016
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Key Risks Key Mitigations & Action Plans
Capital under spending – under spending on capital could be
interpreted by the regulator that there would be minimal impact from
introducing a capital control total.
Close management of all capital schemes is required to ensure
that the schemes are brought in on budget and also in the months
that expenditure has been profiled, as all funding in the first 6
months represents anticipated minimum capital requirements.
Uncertainty regarding the timing or value of any 2016/17 capital
control total
The capital plan has been constructed to phase £700k into the last
6 months of the financial year to mitigate against nationally set
control totals.
Plan Actual Variance Plan Actual Variance
Capital expenditure
Plant and equipment - Information Technology 97 41 56 723 723 0
Plant and equipment - Other 20 0 20 940 940 0
Property, plant and equipment - other expenditure 154 149 5 2,193 2,193
Total 271 190 81 Amber 3,856 3,856 0 Green
Capital expenditure funding sources
Disposal Proceeds (pure cash flows) 0.000 0 0
Depreciation 263 264 (1) 3,155 3,155 0
Other 8 (74) 82 701 701 0
Total 271 190 81 Amber 3,856 3,856 0 Green
Variance 0.000 0.000 0.000 0.000 0.000 0.000
£000'sYear to Date Forecast
RAG
Capital ExpenditureYear End ForecastYTD
RAG
Board Integrated Performance Report September 2015 Board Integrated Performance Report October 2015 Board Integrated Performance Report October 2015 Board Integrated Performance Report November 2015 Board Integrated Performance Report December 2015 Board Integrated Performance Report January 2016 Board Integrated Performance Report March 2016 36 of 36 Board Integrated Performance Report - May 2016
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance
Monitor Agency Price Cap
Key Risks, Mitigations & Action Plans
Monitor introduced price caps for all agency staff from 23 November 2015. The price cap rates for clinical staff reduced in 2 subsequent
stages; from 1st February 2016 and 1st April 2016. The purpose of the caps is to reduce premium hourly rates paid for agency staff
relative to permanent staffing. There is an escalation procedure for approval of non compliant agency staff however patient safety is the
only reason viewed as being acceptable by NHS Improvement for non compliance.
Current performance : 35 nursing shifts are above the Monitor Price Cap – 11 of the shifts are only marginally outside of the cap (less
than 10p per hour) and the Trust will ensure that these are negotiated to within the cap immediately. For the remaining 24 shifts, urgent
conversations are being taken forward with Retinue to ensure that rates quoted by them are accurate and that staff are placed with
agencies that are compliant with the price cap arrangements.
There are 26 non compliant non clinical shifts – Plans are in place to stop using agencies for 16 of the shifts by the end of June and a
further 5 shifts in July.
Medical Locum agencies remain the high risk area with expected ongoing compliance breaches. Issues are being experienced at a local
and national level due to Medical agencies failing to respond to the NHS price caps..
0
50
100
150
200
23/11 30/11 07/12 14/12 21/12 28/12 04/01 11/01 18/01 25/01 01/02 08/02 15/02 22/02 29/02 07/03 14/03 21/03 28/03 04/04 11/04 18/04 25/04
Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual
Agency shifts worked that cost over the monitor price cap
Clinical contracts Non Clinical contracts Medical & Dental Scientific, Therapeutic & Technical (AHPs) Administration and Estates Other Nursing, Midwifery & Health Visiting