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Trust Board Papers

Isle of Wight NHS Trust

Board Meeting in Public

to be held on

Thursday 12 December 2019

at

1.30pm - Conference Room

Level B Main Hospital

(opposite Full Circle Restaurant)

St. Mary’s Hospital, Parkhurst Road,

NEWPORT, Isle of Wight, PO30 5TG

IW NHS Trust Board (Public) 12 December 2019 - Page | 1

27NARU Update NARU Update

AGENDA

No. Item Lead Purpose Enc/Verbal 1.30pm PROCEDURAL 1 Apologies Chair Receive Verbal 2 Confirmation that meeting is quorate Chair Receive Verbal 3 Declarations of Interest Chair Receive Verbal 4 Minutes of previous meeting – minor amendments to be notified in

advance. By exception Chair Approve A

5 Matters Arising and Schedule of Actions – by exception Chair Receive B 1.45pm STRATEGY 6.1 Chair's Update Chair Receive C 6.2 Chief Executive's Update Maggie Oldham Receive D 6.3 Acute, Ambulance and MHLD Transformation Report

Nikki Turner Lesley Stevens

Receive E

6.4 Winter Plan update Joe Smyth Assurance F 2.30pm PERFORMANCE 7.1 Committee Report from Quality Committee held on 11 December 2019

This report will provide assurance on the following items. Board may wish to gain further assurance to that provided by the Committee.

Tim Peachey Assurance Verbal Supporting

papers in Enc G

• Quality Performance Report – lead Suzanne Rostron

Approve G1

7.2 Committee Report from Performance Committee held on 11 December 2019 This report will provide assurance on the following items. Board may wish to gain further assurance to that provided by the Committee.

Caroline Spicer Assurance Verbal Supporting

papers in Enc I

• Financial Performance Report – lead Darren Cattell H1

Isle of Wight NHS Trust Board Meeting in Public Date: 12 December 2019 Time: 1.30pm – 3.15pm Venue: Conference Room – Level B Main Hospital (opposite Full Circle Restaurant), St. Mary’s Hospital, Newport, Isle of Wight PO30 5TG


• Hospital Report – lead Joe Smyth HI2 • Ambulance – lead Joe Smyth H3 • Community Services – lead Alice Webster H4 • Mental Health and Learning Disabilities Services – lead Lesley

Stevens H5

7.3 Committee Report from HR&OD Committee held on 11 December 2019 This report will provide assurance on the following items. Board may wish to gain further assurance to that provided by the Committee

Anne Stoneham Assurance Verbal Supporting

papers in Enc I • Workforce Performance Report – lead Julie Pennycook I1 • Director of Nursing Report – lead Alice Webster I2 • Medical Director’s Report – lead Alistair Flowerdew I3 7.4 Committee Report from Audit Committee held on 11 December 2019

Phil Berrington Assurance Verbal

3.05pm CLOSING MATTERS 8 Confidential issues to be covered in Private

• Patient Safety matters • Commercial matters

Chair Receive Verbal

9 Questions from the Public on issues raised and covered on this agenda Chair Receive Verbal 10 Any Other Business Chair Receive Verbal 3.15pm 11 The next meeting in Public of the IW NHS Trust Board will be on:

Date: Thursday 13 February 2020 Venue: Conference Room - Level B, St Mary's Hospital, Newport, IW PO30 5TG

Chair Receive Verbal

Code of Conduct and Rules Protocol for people attending Isle of Wight NHS Trust Board, meetings and events. • This meeting will be held in accordance with the Code of Conduct and Rules Protocol for people attending Isle of Wight NHS Trust Board, meetings and events. • Staff and members of the public are welcome to attend the meeting but must adhere to the rules and standards of behaviour outlined in the protocol. • The Chair reserves the right to exercise his conduct of the meeting in line with the Trust’s Code of Conduct protocol. Questions for the Board Staff and members of the public are asked to send their questions in advance by 5pm on the Monday preceding the Board meeting to [email protected] to ensure that as comprehensive a reply as possible can be given. Please can you ensure you clearly identify within the email

mailto:[email protected]


subject as 'Question for the Trust Board'. Any member of the public who has a question following their observation of the Board meeting will be given the opportunity to ask this at the end of the meeting, if time allows. All questions posed verbally must relate to the meeting and not introduce new issues. If time is insufficient to receive questions, members of the public may leave these in writing to be responded to outside of the Board meeting. Issues to be Covered in Private The meeting may need to move into private session to discuss issues which are considered to be ‘commercial in confidence’ or business relating to issues concerning individual people (staff or patients). On this occasion the Chairman will ask the Board to resolve: 'That representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest', Section 1(2), Public Bodies (Admission to Meetings) Act l960. Recording of Meeting This meeting will be recorded for the purposes of assisting in transcribing the minutes and actions from the meeting. Confirmation of Quoracy No business shall be transacted at a meeting of the Board of Directors unless one-third of the whole number is present including: The Chairman; one Executive Director; and two Non-Executive Directors. Apologies Received from

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IOW NHS Trust Board Meeting in Public 14 November 2019 1

And

Minutes of the meeting of the Isle of Wight NHS Trust Board held in public on Thursday 14 November 2019 in the Conference

Room, St Mary’s Hospital, Newport, IW PO30 5TG PRESENT: Non-Executive Vaughan Thomas Chair Kemi Adenubi Non-Executive Director Phil Berrington Non-Executive Director (Non-voting) Dr Tim Peachey Non-Executive Director Caroline Spicer, Non-Executive Director Anne Stoneham Non-Executive Director Sara Weech Non-Executive Director (Non-voting) Executive Directors Maggie Oldham Chief Executive (CEO) Darren Cattell Director of Finance, Estates and IM&T &

Deputy CEO (DFEI) Mr Alistair Flowerdew Medical Director (MD) Julie Pennycook Director of Human Resources &

Organisational Development (DHROD) (Non-voting)

Suzanne Rostron Director of Quality Governance (DQG) Mr Steve Parker Clinical Director—Clinical Support, Cancer &

Diagnostics (Deputising for the Chief Operating Officer)

Dr Lesley Stevens Director of Mental Health & Learning Disabilities (DMHLD) (Non-voting)

Dr Nikki Turner Director of Acute Transformation (DAT) (Non-voting)

Alice Webster Director of Nursing, Midwifery, AHPs & Community Service (DNMAC)

Attendees Sarah Anderson Associate Director of Corporate Affairs Kirk Millis-Ward Associate Director of Communications Daniel Robinson Corporate Governance & Risk Manager Isobel Wroe Director of Strategy & Service Development,

South Central Ambulance Service Observers Jay Chappell Staff Side Representative Pam Fenna Chair of Patient Council Cathy Frost Quality Improvement Lead (Shadowing the

Director of Quality Governance) Minuted by Lynn Cave Board Governance Officer (BGO) Members of Staff and Public in attendance:

There were members of the public and Isle of Wight Councillors present. There was a media representative present

The meeting commenced at 1.30pm and closed at 2.55pm Minute No. PROCEDURAL 19/T/215 APOLOGIES FOR ABSENCE, CONFIRMATION THAT THE MEETING IS

QUORATE AND CHAIR’S OPENING REMARKS Apologies for absence were received from:

• Joe Smyth, Chief Operating Officer (Deputy present)

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• Dr Paul Evans, Non-Executive Director • Dudley Delannoy, Healthwatch Representative

The Chair confirmed that the meeting was quorate. The Chair welcomed Isobel Wroe from South Central Ambulance Services and advised that there would be no representatives from NHSI/E or CQC attending.

19/T/216 DECLARATIONS OF INTEREST Declarations of interest were received from:

• Phil Berrington as an employee of IBM • Darren Cattell, Director of Wightlife Partnership • Dr Tim Peachey, Non-Executive Director at University Hospital

Southampton NHS Foundation Trust • Sara Weech as Chair of Mountbatten

19/T/217 MINUTES OF PREVIOUS MEETING The minutes of the meeting of the Isle of Wight NHS Trust Board held on 10

October 2019 were reviewed and the following amendment was requested:

a) 19/T/205 – Page 12: Change the HR&OD Committee to read the Quality Committee.

b) 19/T/212b) – Page 16 last paragraph 2nd sentence: Should read - … The Chief Executive could not…….

Resolution The Chair requested that the minutes of the meeting held on 10 October 2019 be Approved subject to the above amendments. The motion was carried unanimously.

19/T/218 MATTERS ARISING AND SCHEDULE OF ACTIONS a) Matters Arising:

i. Glossary of Terms: The Chair advised that he had received a request from the Healthwatch representative to the Board, requesting that a glossary of terms be made available to provide greater clarity to lay readers. He confirmed that this was being prepared and would be made available on the Trust Board webpage.

b) Schedule of Actions:

i. The following actions were approved for closure: TB/383, TB/384, TB/385, TB/386, TB/387 and TB/389.

ii. TB/388 – It was noted that this action was due for February 2020.

Resolution The Isle of Wight NHS Trust Board received the Matters Arising and Schedule of Actions Update.

STRATEGY 19/T/219 CHAIRS UPDATE The Chair presented his report which was taken as read and advised that

despite being in political purdah the Trust would continue its business as usual work and any announcements required would be made at the next Board meeting following the ending of purdah. Resolution The Isle of Wight NHS Trust Board received the Chair’s Update.

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19/T/220 CHIEF EXECUTIVE’S UPDATE The Chief Executive presented her report and highlighted the following areas:

a) Innovation in Volunteering Award: The Trust’s volunteer service had

been highly commended at the Helpforce Champions Awards for 2019, in recognition of their fantastic contribution to volunteering and their ability to attract students to volunteer schemes.

b) Restart a Heart Campaign: Following the success of last year’s

campaign an ambitious target had been set and she was pleased to confirm that this had been doubled. Credit was given to all those involved both within the Trust and the community.

c) Unsung Heroes Awards: Thanks were given to the Unison team for

their support in judging over 273 nominations down to the 42 shortlisted individuals.

d) Freedom to Speak Up Month: October was national Speak up October

month and good support has been seen across the organisation.

e) Mental Health & Learning Disabilities Partnership: The partnership arrangement with Solent NHS Trust has now been announced and confirmed that they would be providing support to deliver transformational services on the island for the benefit of residents.

f) Sustainability & Transformation Partnership: Work is taking place

across the country to make the long term plan a reality and in our region the Hampshire and Isle of Wight Sustainability & Transformation Partnership (HIOWSTP) has been linking with people across the region to ensure that the plan is developed to meet the needs of the people. She confirmed that the long term plan has now been formally submitted in line with the national deadline.

Resolution The Isle of Wight NHS Trust Board received the Chief Executive’s Update.

19/T/221 ISLE OF WIGHT HEALTH & CARE PLAN The Chief Executive presented the report which was taken as read and

highlighted that work is continuing to ensure that the system is now delivering against the milestones and is being monitored through the Local Care Board. She confirmed that this plan is incorporated within the wider regional long term plan and therefore she had confidence that there was visibility of the island’s needs which provided the confidence to sign off the HIOWSTP Strategic Delivery Plan. Caroline Spicer noted that it was beneficial to have a set programme in place but queried if the report was prepared specifically for the Trust. The Chief Executive advised that this report was prepared for the Board by the System Project Management Office and that it is consistent with reports provided to the IW CCG and Local Authority. Sara Weech expressed concern that mental health was not currently on line. The Director of Mental Health & Learning Disabilities confirmed that there is a definite plan to bring the mental health workstream on line and that this would feature in future reporting. The Director of Finance, Estates and IM&T/Deputy CEO confirmed that detailed

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reporting is undertaken by the team and is available to the Non-Executive Directors should they require further assurance. Resolution The Isle of Wight NHS Trust Board received the Isle of Wight Health & Care Plan Update

19/T/222 ACUTE, AMBULANCE & MENTAL HEALTH AND LEARNING DISABILITIES TRANSFORMATION REPORT

The Chair confirmed that Nikki Turner has now taken on the role of Director of Acute Transformation and that this report had been discussed at both Performance Committee and Board Seminar. The Director of Acute Transformation presented the report and provided an overview of the process and confirmed that a workplan has been developed and the team are now working on the cases for change and implementation plans which will take place over the next 24 months. She confirmed that this will require work across teams and she welcomed the support provided by South Central Ambulance Services over the past 12 months. The Director of Mental Health & Learning Disabilities confirmed that a memorandum of understanding to agree the scope of the partnership working is also been prepared and will come to the Board for approval. Resolution The Isle of Wight NHS Trust Board received the Acute, Ambulance & Mental Health and Learning Disabilities Transformation Report

19/T/223 WINTER PLAN The Chair advised that the report had been discussed at a joint session of the

Quality Committee and Performance Committee and was here for approval. The Clinical Director—Clinical Support, Cancer & Diagnostics who was deputising for the Chief Operating Officer, presented the report and advised that the plan has been developed as a system-wide winter plan for 2019/20 which has been produced in conjunction with the Operational Resilience Group. It has been based on historic data and predicted operational demand alongside the planned investment into capacity by system partners to create additional capability to allow flow through the acute inpatient settings during the winter period. The modelling demonstrates by high level specialty predicted peaks in demand for non-elective care. He confirmed that the system level monitoring of the plan will take place through the Local Care Board. Caroline Spicer, Chair of the Performance Committee, confirmed that the joint session noted that this is a live document and that there remains work to be undertaken to ensure the right financial and workforce resources are in place both within the Trust and the wider community, but that barring the addition of an effective dashboard to demonstrate progress, that this is a good plan. Phil Berrington highlighted the need to have effective governance in place. The Chief Executive confirmed that the Accident & Emergency Delivery Board would be monitoring and holding to account and would escalate any issues to the Local Care Board. She advised that this is her third winter on the island and noted that in that time she has witnessed significant improvements and confirmed that progress reports would be provided to the Performance Committee. Kemi Adenubi highlighted that some of the schemes required local authority funding and stated that clear milestones for completion should be indicated. The

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Director of Finance, Estates and IM&T/Deputy CEO confirmed that a suite of key performance indicators will be used to monitor the plan across the system. The Chief Executive confirmed that as this is a live document the Accident & Emergency Delivery Board will be updating and refining it according to demand developments. The Director of Finance, Estates and IM&T/Deputy CEO also confirmed that there are on-going discussions with NHSI/E for additional funding for activity not included within the operating plan. Resolution The Chair requested that the System Winter Plan 2019/20 be Approved. The motion was carried unanimously.

GOVERNANCE 19/T/224 BOARD ASSURANCE FRAMEWORK QUARTER 2 REPORT The Director of Quality Governance presented the report and confirmed that it

had been discussed at Board Committee level in October. As a result of Committee review a number of amendments were agreed as follows:

• Quality Committee requested that the proposed change in target risk score for SR01-1: Inability to achieve and maintain regulatory compliance (from a rating of 6 to 9) be approved.

• Performance Committee requested that the proposed change in current risk score for SR05-1: Pace of implementation of IoW Health and Care Sustainability Plan for achieving clinical and financial sustainability is not delivered (from a rating of 16 to 12) be approved.

The Board had a discussion about the timeliness of the BAF as at the end of Quarter 2 coming to the Board at this time. Assurance on the constant review of the BAF will be included in future reports. Resolution The Chair requested that the Board Assurance Framework for Quarter 2 subject to the changes requested by the Board Committees be Approved. The motion was carried unanimously.

19/T/225 EMERGENCY PREPAREDNESS, RESILIENCE & RESPONSE (EPRR) CORE STANDARDS ASSURANCE

The Medical Director presented the report which provided an update on the Trust compliance against the EPRR core standards. He confirmed that the Trust was fully compliant for 51 out of the 64 core standards which are applicable to the organisation and will be fully compliant with the remaining 13 core standards by July 2020. He advised that the outcome of the self-assessment for Ambulance Interoperable capabilities shows that against 163 of the core standards which are applicable to the organisation, the IOW Ambulance Service is fully compliant with 135 of these core standards; and will become fully compliant with all core standards by September 2020 He confirmed that the external assessors were pleased with progress. Sara Weech queried what the implications were for the Trust in only being partially compliant and were there any sanctions which would be applied. The Medical Director responded that the partial compliance status indicated that there are outstanding criteria to be met and included training which is being rolled out. He advised that significant progress has been made and advised that there were no specific sanctions or implications involved. The Chief Executive highlighted that the Trust is in a very different position compared with previous years and this has been due to the work of the Head of EPRR (Emergency Preparedness, Resilience and Response) who works across both the Trust and

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the Local Authority. The Medical Director also thanked South Central Ambulance Service for their support. Caroline Spicer, Chair of the Performance Committee, confirmed that the Committee had reviewed the report and were assured by level of progress being made. The Chair extended the Board’s formal thanks to the Board of South Central Ambulance Service. Resolution The Isle of Wight NHS Trust Board received the Emergency Preparedness, Resilience & Response (EPRR) Core Standards Assurance report

PERFORMANCE 19/T/226 COMMITTEE REPORT FROM QUALITY COMMITTEE Tim Peachey, Chair of the Quality Committee reported that following the meeting

held on 13 November 2019, that in addition to issues discussed elsewhere in the meeting, the following areas were to be brought to the Board’s attention:

a) Maternity Deep Dive: A very detailed and thorough report was presented and discussed. This topic is now on the regular workplan and will be reported quarterly.

Substantial Assurance b) Discharge Summaries Deep Dive: There has been little progress on

this matter in the last twelve months but a thorough diagnostic was presented and discussed. The Quality Committee will keep progress under review, however, it was noted that some IT solutions will take six months to deliver.

Limited Assurance c) Quarterly Safety Report: This was a helpful and encouraging report

with good level of assurance across all areas with the exception of duty of candour performance. A deep dive into duty of candour is planned.

Reasonable Assurance d) Safety Thermometer: This was a good report which demonstrated the

work undertaken to improve the utility of the toolkit. Substantial Assurance

e) Safe Staffing: It was noted that there has been good progress within nursing staffing although there remain challenges.

Limited Assurance f) 7 Day Services: The Committee noted that NHSI/E may review some of

the standards within the 7 Day Service BAF1 but that Trust compliance is reasonable in most areas.

Reasonable Assurance g) Patient Council: The Committee received concerns from the Patient

Council relating to the ophthalmology department communication systems which it agreed would be investigated by the Patient Experience team.

1 Board Assurance Framework (BAF)

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h) Quality Improvement Plan: The Committee noted that the risk of operational performance is reducing and approved the outline Quality Improvement Plan.

Reasonable Assurance The following report was taken as read and was confirmed to have been discussed at the committee meeting:

• Quality Performance Report including the Quality Improvement Plan

It was advised that formal Board approval was requested for the Quality Improvement Plan. Resolution The Isle of Wight NHS Trust Board received the Quality Committee’s report. The Chair requested that the Quality Improvement Plan be Approved. The motion was carried unanimously.

19/T/227 COMMITTEE REPORT FROM PERFORMANCE COMMITTEE Caroline Spicer , Chair of the Performance Committee reported that following the

meeting held on 13 November 2019, that in addition to issues discussed elsewhere in the meeting, the following areas were to be brought to the Board’s attention:

a) Acute, Ambulance and Mental Health & Learning Disabilities Transformation Report: The Committee reviewed the report which provided an overview of the progress to date and noted the areas where additional assurance could be gained.

Substantial Assurance b) Operating Plan: The Committee received an update which showed that

positive progress was being achieved against plan. Whilst there was limited assurance over the number of financial challenges, the Committee felt that overall it was a good representation of the current position. The Committee noted the risks moving forward to the financial forecast and noted that the mitigation plans were being reviewed. The Committee felt that these needed to be strengthen and would be reviewing again at the next meeting.

Limited Assurance c) Community Services: The Committee received the report which

demonstrated progress and a keen grip on challenges. It discussed the good practices used within the division on staff engagement and encouraged this to be shared with the other divisions.

Substantial Assurance d) Mental Health & Learning Disabilities Services: The Committee noted

that there were three key pressure areas - acute services, waiting times and waiting lists. The Committee noted the plans in place to improve these areas. It also noted that discussions were taking place to address supervision and CPA2 issues.

Limited Assurance

2 Care Programme Approach (CPA)

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e) Hospital Services: The Committee discussed the constitutional standards and confirmed that RTT3 targets continue to be a challenge, Cancer targets were achieved with the exception of the 62 day target, and diagnostic targets achieved in month. Accident and Emergency targets continue to be a challenge and a deep dive was planned to review this area. Agency costs continue to be a factor and it was noted that although nursing costs have reduced medical staff costs have increased.

Limited Assurance f) Ambulance Services: The Committee noted the strategic support being

provided by our partner organisation – South Central Ambulance Services, which together with the ‘perfect week’ and revised operating model has improved efficiency.

Reasonable Assurance The following reports were taken as read and were confirmed to have been discussed at the committee meeting:

• Finance Performance Report • Hospital Report including Hospital Improvement Programme • Ambulance Services Report • Community Services Report • Mental Health & Learning Disabilities Report

No issues were raised at the meeting concerning these reports. Resolution The Isle of Wight NHS Trust Board received the Performance Committee report.

19/T/228 COMMITTEE REPORT FROM HR & OD COMMITTEE Anne Stoneham, Chair of the HR&OD Committee, reported that following the

meeting held on 13 November 2019, that in addition to issues discussed elsewhere in the meeting, the following areas were to be brought to the Board’s attention:

a) Workforce Performance: The Committee noted that the staffing is below the budgeted establishment with the vacancy rate reducing with the successful recruitment of the new cohort of overseas nurses. Outliers around performance in relation to appraisals and mandatory training will be followed up. Feedback on pulse surveys suggest that this should be paused whilst the national survey takes place and will resume on a bi-monthly basis in January 2020. The focus going forward will be on improving engagement, especially around issues of communication between staff and senior management. The Committee have agreed to set up a task & finish group to look at this area and bring a proposal to the February meeting.

Reasonable Assurance b) Recruitment Deep Dive: The Committee received the report on the

work of the Nurse Retention Task and Finish Group. Key issues identified were training and development opportunities and access to

3 Referral to Treatment Time

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training and this should be the focus of future consideration. Other areas for consideration were more development of career coaching, promotion of rewards and staff benefits, flexible working. Similar task and finish groups are being established to cover other health professionals. A retention action plan will be delivered based on the outcome of these groups.

Reasonable Assurance c) Employee Relations: Discussions are continuing to agree the level of

information provided and how the report will develop. Therefore, at this time the Committee are not in a position to give assurance.

d) Strategy Priorities: Leadership and Cultural development strategy is on track with leadership programme for 2020 being reviewed currently. An update on retention initiatives has already been provided. Other areas of work are progressing. The major work going forward is development of the workforce strategy for 2020-23. This will need to take account of NHS People Plan and also consider priorities of partner organisations. Progress will be updated in February.

Reasonable Assurance e) Education, Learning & Development: The report presented on non-

medical education, learning and development activity. Apprenticeship provision is expanding following very successful ones for nursing and associate nurses. Excellent training results of overseas nurses recruited; an agreed review of appropriate level and content of mandatory training for all types of staff across the Trust. It was also agreed that an annual report on medical education and learning would be presented to the Committee and that the Medical Director and the Director of Human Resources & Organisational Development would review position for fully trained medics.

Reasonable Assurance f) Medical Workforce: Recruitment of certain medical positions remains

very challenging. Job planning intended to be complete by year end which will facilitate the process for 2020/21. Although GMC4 review recognised areas of improvement, concerns about experience of junior doctors remained in some areas. The master vendor contract has been reviewed. Awareness of risks around medical workforce remains.

Limited Assurance g) Director of Nursing Report: It was advised that this report was not

considered by the Committee.

Sara Weech confirmed that the task and finish groups would also be set up for ancillary staff as well as medical. The following reports were taken as read and were confirmed to have been discussed at the committee meeting:

• Workforce Performance Report • Medical Director Report

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No issues were raised at the meeting concerning these reports. Resolution The Isle of Wight NHS Trust Board received the HR&OD Committee report.

19/T/229 DIRECTOR OF NURSING REPORT The Director of Nursing, Midwifery, AHPs & Community Services presented the

report which was taken as read and advised that at present this report is not considered elsewhere. She confirmed that this was being discussed and would be addressed for future reports.

a) Nurse Agency: the Medical Assessment Unit has now cancelled a its agency requirement due to an improved vacancy position.

b) Mental Health Optimal Staffing Tool: This specialist tool is being explored and will be discussed further at the Quality Committee.

c) Dementia: The Creator of the Alzheimer Café programme and the Managing Director of Island Healthcare visited the Trust in October, and will be assisting in developing bespoke training.

d) Allied Health Professional Day: This was celebrated in October and a range of awards were presented to staff.

Resolution The Isle of Wight NHS Trust Board received the Director of Nursing Report.

CLOSING MATTERS 19/T/230 CHAIRS CLOSING COMMENTS AND ISSUES TO BE COVERED IN PRIVATE The Chair advised that the following items would be covered in a private meeting

of the Board: • Patient Safety matters • Commercial matters

19/T/231 QUESTIONS FROM THE PUBLIC The Chair opened the floor for questions from the observers. A number of

questions were asked to which the Executive Directors provided responses. The Chair also draw attention to a new questions form which is available at meetings which can be submitted by attendees and which will then allow time for a response to be provided.

19/T/232 ISSUES RAISE BY OBSERVERS a) Staff Side: No Issues raised

b) Patient Council: Pam Fenna, Chair of the Patient Council queried if there would be apprenticeships in other areas apart from nursing. The Director of Nursing, Midwifery, AHPs & Community Services confirmed that allied health professional apprenticeships across a range of specialties are being introduced. The Chair drew attention to the banner in the Full Circle Restaurant which detailed all the staff training successes

19/T/234 ANY OTHER BUSINESS There was no other business

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DATE OF NEXT MEETING The Chair confirmed that the next meeting of the Isle of Wight NHS Trust Board

to be held in public is on Thursday 12 December 2019. The venue for this meeting will be the Conference Room – Level B Main Hospital – opposite Full Circle Restaurant, St Mary’s Hospital, Newport, IW PO30 5TG

Signed: Vaughan Thomas, Chair Date: 12 December 2019

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Board & Board Committee KEY TO RAG STATUS

ROLLING SCHEDULE OF ACTIONS TAKEN FROM THE MINUTES Action overdue

Action not yet dueAction completePropose Action to be closed

Name of Meeting Date of Meeting

Minute No. Action No.

Item Action Exec Lead Update & Evidence of Completion Due Date Forecast Date

Progress RAG Date Closed

Board in Public 10-Oct-19 19/T/212 TB/388 Engagement opportunities with the community:

Opportunities to be sought to facilitate discussions and overcome barriers and common misconceptions and provide assurance to the public about the service they receive from the Trust.

Kirk Millis-Ward 14/11/19 - It was noted that this action was due for February 2020 13-Feb-20 13-Feb-20 Action not yet due

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Agenda Item No 6.1 Meeting Trust Board in Public Meeting Date 12 December 2019 Title Chair Report Sponsoring Executive Director

Vaughan Thomas, Chair

Author(s) Vaughan Thomas, Chair Report previously considered by inc date

N/A

Purpose of the report Reason for submission to Trust Board in Private only (please indicate below

Link to CQC Domains Link to Trust Strategic Objectives

Information only Commercial Confidentiality Effective X SO 01: Provide safe, effective, caring and responsive services – ‘Good’ by 2020

X

Review & discuss X Patient Confidentiality Caring X SO 02: Ensure efficient use of resources X

Assurance Staff Confidentiality Safe X SO 03: Achieve patient standards X

Committee Agreement

Other Exception Circumstances Responsive X SO 04: Achieve excellence in employment X

Trust Board Approval

Well-Led X SO 05: Implement the Isle of Wight Health & Care Sustainability Plan

X

Key Recommendations to be considered: The Board is recommended to receive the report.

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Executive Summary During the month, I have conducted and participated in meetings with, advisors, stakeholders, staff, and partners of the Trust. These have included:

o Meetings/calls with NHSI including: o Conference call with NHS Leadership Academy

o Meetings with partner organisations including:

o Meeting with Michelle Legg, CCG Executive Chair and Clinical Lead o Meeting with Melloney Poole, Chair PHT, Peter Hollins, Chair UHS, Steve Erskine, Chair HHFT o Board Development Day – NHS Leadership Academy o Wessex AHSN Board Strategic Session o Meeting with Lena Samuels, Chair SCAS o Hampshire & IOW Chairs Meeting o Meeting with Anne Eden, Regional Director, NHSI&E o NHS Providers Chairs & CEO Network Meeting

o Meetings with Individuals including Trust Executives and

o Meeting with Cllr. Clair Mosdell o Meeting with Kathy Marriott, Head of Strategy and Operations, IOW Local Authority o Telephone Call with Bill Gillespie, Wessex AHSN o Meeting with Cllr. Dave Stewart o Meeting at Ventnor Town Council o Meeting with John Metcalfe, Chief Executive, IOW Local Authority o Meeting with Cllr John Nicholson

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Agenda Item No 6.2 Meeting Isle of Wight NHS Trust Board Meeting Date 12 December 2019 Title Chief Executive’s Update Sponsoring Executive Director

Maggie Oldham, Chief Executive

Author(s) Kirk Millis-Ward, Associate Director of Communications and Engagement Report previously considered by inc date



Information only X Commercial Confidentiality Effective SO 01: Provide safe, effective, caring and responsive services – ‘Good’ by 2020

Review & discuss Patient Confidentiality Caring SO 02: Ensure efficient use of resources

Assurance Staff Confidentiality Safe SO 03: Achieve patient standards

Committee Agreement

Other Exception Circumstances Responsive SO 04: Achieve excellence in employment


Well-Led SO 05: Implement the Isle of Wight Health & Care Sustainability Plan

Key Recommendations to be considered: The Trust Board is asked to consider the enclosed update.

Executive Summary This month’s Chief Executive’s Update will cover three key areas: operational updates to the Board, employee engagement and progress delivering the Isle of Wight Health and Care Plan.

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1. New Urgent Treatment Centre We have been talking about making improvements to Urgent and Emergency Care for some time and we have seen significant pressure on our Emergency Department in recent months. That is why it is so pleasing to see our new Urgent Treatment Centre (UTC) up and running. The UTC will see and treat minor illnesses and injuries requiring immediate care, where patients do not need care in the Emergency Department. It is not an alternative to people's local GP practice. The Urgent Treatment Centre is open from 8am to 10pm throughout the year, but people should call ahead and make an appointment to be seen there via NHS 111. So far the UTC has had a positive impact on performance in our Emergency Department with waiting times reducing as people are being cared for in a much more appropriate place.

2. Relocated Outpatients Department

In preparation for the opening of the UTC, we relocated our Outpatients Department to a bigger, brighter part of the main hospital site. I would like to formally express my gratitude to all of the teams involved in the move because I know how challenging this sort of change can be, especially when you have a busy day job to attend to. We started informing patients well in advance of the move, to let then know that the North Car Park would be most convenient for them if they were attending the new department.

3. Inspirational project on Afton Ward

Vaughan Thomas and I were lucky enough to visit Afton Ward in Sevenacres this month to see first-hand the impact of some innovative work we are doing with a local primary school. Children from Lanes End Primary School are regularly visiting the people we care for on Afton Ward as part of an intergenerational project looking at the benefits of bringing young and older people together. We will have much more to say about the project next year once it is complete and the evidence is reviewed. But I saw for myself how much the children enjoyed spending time with different people, being creative and experiencing something new. I also saw the powerful impact this quality time had on the people staying with us on Afton Ward. It was wonderful to see people interacting and engaging much more than perhaps they normally would.

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I would like to place on record my sincere thanks to everyone at Lanesend Primary School for working with us on this and to all of the staff involved on Afton Ward. I could feel a really positive atmosphere when I visited and I was delighted to see how far we have come in the last two year.

4. Employee of the Month I am pleased to announce that the new Employee or Team of the Month programme has officially relaunched. The first winners will be announced in January and then monthly at Board via this update. The prizes will be presented to staff at in their place of work and the Communications and Engagement Team will make sure we celebrate their achievements. It’s also good to see that there have been more than 40 nominations in less than a month, for people in clinical and support roles all over our organisation. We look forward to seeing this programme evolve and I encourage people to take part. This is a part of a larger piece of work to celebrate staff, which will include a Trust-wide staff awards being held next year.

5. Greatix – recognising when things go well

As part of our Getting to Good in 2020 campaign we introduced Greatix – a mechanism by which people can report incidents whether things go well or where we can learn from positive outcomes. I spent an enjoyable hour or two earlier this month reading through submissions and writing thank you cards to go out to colleagues across the Trust. It was fantastic to see such enthusiasm for improvement across the Trust and reminded me of one of the really positive parts of my job. Thank you to everyone who submitted a Greatix this month, please keep them coming because it is a hugely important part of our improvement process. In the last three months we have awarded 30 certifcates and we will be sharing examples as part of our Getting to Good campaign over the coming weeks.

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6. Isle of Wight Health and Care Plan Update

6.1 Summary

The Isle of Wight Health and Care Plan sets out shared priorities for the future health and wellbeing of the Island’s population. The key objectives of the plan are summarised below:

• Improving services for our community • Making health and care sustainable for future generations • Closer working between the NHS, council, primary care and the voluntary sector • Finding partners to support some of our services

More information about the Isle of Wight Health and Care Plan, including the document, is available at www.iowhealthandcare.co.uk.

6.2 Workstream update

6.2.1 Onward Care and Independence (OCI)

• The OCI programme continues to be on track. An assesment is underway to determine the availability of wider domicillary

support within the system to enable the Integrated Recover Service to imporve flow from the acute setting into the community. • Challenges recruiting to three OCI-funded projects remain but action is being taken and support being provided by HR. • Integrated Care Discharge Team (ICDT) - The Discharge to Assess (D2A) form is now on E-CareLogic, electronic forms are now

being used appropriately. Pathway data is now built into the Patient Flow Dashboard and further development to enhance pathway data quality is in review. Approval given for Pathway Navigators to update D2A forms in E-CareLogic.

• Community Care Model – model and principles completed which will go to Local Care Board for approval. Phase 2 will be written alongside the CCG to ensure resources are used as effectively as possible and that duplication of work is avoided.

• Technology Enabled Care – an evaluation of Phase 1 was produced, which helped to scope the second phase of the work. This was tested with operational leads in November and will be presented to the OCI Steering Group.

http://www.iowhealthandcare.co.uk/

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6.2.2 Trust Productivity

• Good progress has been made uploading financial data for all of the Health and Care Plan programmes into PM3. All divisional and corporate plans are visible in PM3 as well.

• Hard to Fill Vacancies project is being refocused, with a deep dive carried out earlier this month. • Work has commenced to reconfigure the Allocate system to support e-rostering, with a view to begin a trial in MAU shortly. • Continuing review of unused hours in theatres, with additional support being given to Theatre Management

6.2.3 Urgent and Emergency Care

• The new Urgent Treatment Centre opening on November 19 • The Trust’s Outpatients Department relocated and opened in its new location on the North site on November 18

Next steps

Isle of Wight NHS Clinical Commissioning Group Managing Director Alison Smith is leading the Health and Care Plan work as Senior Responsible Officer (SRO), and fortnightly SRO meetings are now taking place where each of the key workstreams outlined above report. The Health and Care Plan, led by Alison Smith, will report into the Transformation Delivery Group from February 2020. This group will report to the Integrated Care Partnership (ICP) Board once it is established next year. The Transformation Delivery Group will be chaired by Maggie Oldham. Papers updating on progress in delivering the Health and Care Plan will in future be prepare for the CCG, Trust and Council governance structures. Timings made it impossible to aligh this month but we expect there to be a single paper produced for the various Boards in February.

Enc E Agenda Item No 6.3 Meeting Trust Board in Public Meeting Date 12 December 2019

Title Transformation Work plan November 2019

Sponsoring Executive Director Nikki Turner, Director of Acute Transformation Lesley Stevens, Director of Mental Health & Learning Disabilities

Author(s) Nikki Turner, Director of Acute Transformation and Lesley Stevens Director of MH/LD

Report previously considered by inc date

Key Recommendation The Trust Board is recommended to: Receive the report on the progress of Acute, Ambulance and Mental Health partnerships.



Information only Commercial Confidentiality

Effective X SO 01: Provide safe, effective, caring and responsive services – ‘Good’ by 2020

X

Review & discuss Patient Confidentiality Caring X SO 02: Ensure efficient use of resources X

Assurance X Staff Confidentiality Safe X SO 03: Achieve patient standards X

Committee Agreement

Other Exception Circumstances

Responsive X SO 04: Achieve excellence in employment X


X Well-Led X SO 05: Implement the Isle of Wight Health & Care Sustainability Plan

X

January - March November December

• Clinical model option development

• Clinical strategy development

• Set programme for developing clinical models and set up service specific working groups

• Trust Board approval for Case for Change and MOU

• Programme Manager in post • Use of Risk Stratification

Tool to produce a risk and sustainability assessment for each service

• Identify Project management resources

• Establishment of programme governance

Progress of Acute Partnership Work

Complete Not yet started

• Establish team and agree priorities

• Development of workplan for Partnership Operational Delivery Group

• Develop communications & engagement strategy

• Clinical model option development

• Identify clinical priorities and opportunities for alignment e.g. equipment, digital investments

Stakeholder Engagement

In progress

January - March November December

• Clinical strategy development

• Set programme for developing workplan priorities and set up service specific working groups

• Confirm SRO • Agree initial work plan

between IWT & SCAS • Draw up MOU • Establish governance for

programme

Progress of Ambulance Partnership Work

Complete Not yet started

• Seek Trust Board approval for MOU between IWT/SCAS

• Agree resourcing for work plan

• Identify quick wins and opportunities for alignment e.g. equipment, digital investments

• Establishment of programme governance


In progress

October November December

• Meetings with Solent exec team, and SRO for the partnership

• Immediate support offer agreed: - CMHT peer review

planned for 12 & 13 November 2019

- operational and transformation capacity to support the programme.

• Initial working groups established to support drafting MOU

• Partnership Board membership agreed in principle

• Establish Programme governance

• Establish detailed governance for work streams

• Establish scope for supporting partnership with SHFT

Progress of MH&LD Partnership

Complete In progress

• Seek Trust Board approval for MOU between IWT/Solent

• Agree resourcing for work plan

• Agree Transformation Programme work plan


In progress

PROPOSED MH & LD GOVERNANCE Overarching governance for the mental health sustainability plan will be aligned with the island system sustainability plan governance and

Hampshire and Isle of Wight STP - forming ICS

5

Isle of Wight Health and Wellbeing Board

IW Transformation Programme - Community MH well-being service - MH Recovery - Acute Provision - CAMHS &MH Provision 14-25 - Living well with dementia - Living well with learning disabilities*

Culture and leadership

IW Local Care Board

Delivery Group

IW Trust Board Solent Trust Board SHFT Board- TBC

Workforce and infrastructure opportunities

(including estates and IT reviews)

Quality Assurance

and compliance

Financial sustainability

review and due diligence

CCG Partnership Board

IW SRO meeting CQC- update

reports- received from partnership

board

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Agenda Item No 6.4 Meeting Trust Board in Public Meeting Date 12 December 2019 Title Winter Plan 2019/20 Sponsoring Executive Director

Joe Smyth, Chief Operating Officer, Hospital and Ambulance Services

Author(s) Charlise Cuthbert, Associate Director of Operations – Medicine Care Group Report previously considered by inc date

n/a



Information only Commercial Confidentiality Effective SO 01: Provide safe, effective, caring and responsive services – ‘Good’ by 2020

Review & discuss Patient Confidentiality Caring SO 02: Ensure efficient use of resources x

Assurance x Staff Confidentiality Safe x SO 03: Achieve patient standards x

Committee Agreement

Other Exception Circumstances Responsive x SO 04: Achieve excellence in employment


Well-Led x SO 05: Implement the Isle of Wight Health & Care Sustainability Plan

x

Key Recommendations to be considered: The Trust Board is asked to receive this Winter Plan 2019/20 update for assurance; this has been produced in conjunction with the activities of the A&E Delivery Board.

The plan details the predicted operational demand alongside the planned investment into capacity by system partners to create additional capability to allow flow through the acute inpatient settings during the winter period. The modelling demonstrates per high level specialty predicted peaks in demand for non-elective care. This has been remodeled in line with month 6 activity to ensure that the plan is as accurate as possible heading into the winter period.

System level monitoring of the plan will take place through the Accident and Emergency Delivery Board informing the Local Care Board.

Enc F

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Executive Summary The Winter Plan 2019/20 presented to the November Trust Board was approved with the requirement of an update for further assurance. Throughout the month of November the Accident & Emergency Delivery Board have been working across the Isle of Wight Health and Social Care system to update and refine the plan in accordance with demand developments. NHS England and NHS Improvement have provisionally awarded the Isle of Wight NHS Trust £1,192,000 of revenue funding to support the delivery of schemes for additional capacity which includes the provision of the following schemes:

• Care Home Support • Discharge Support at Home • Locum Community Geriatrician • Additional Domiciliary Care • Additional Social Worker based in the Emergency Department • Additional 21 general and acute beds

The impact of these schemes is highlighted in the updated bed model provided at Appendix 1. The Winter Plan incorporates any specific actions within our control to improve during the period and in particular reflects the requirements for services that may be affected by severe weather, surges in activity, including flu or norovirus outbreaks. Review and consideration of the potential schemes that could be undertaken by the Trust and its work with partners has been discussed in conjunction with the Local Authority, Clinical Commissioning Group, Volunteer Sector and other relevant stakeholders and has also been based on historical knowledge and learning from previous winters, whilst also aligning itself to any existing transformation programmes. Any risk to the delivery of these schemes will be monitored through the A&E Delivery Board and escalated to the Local Care Board. This plan will be a live working document and will continue to be developed throughout the autumn and early winter periods. Effectiveness of the plan and safe patient care will be measured by:- • The National Key Performance Triggers • Emergency Access Standard • Local and National Waiting Times Targets • 18 Weeks Referral to Treatment

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• 31 and 62 Day Cancer Waiting Times • No. Delayed Discharges over 72 hours • Bed Occupancy compared to local target of 90% (actual bed occupancy has been >95% for some time)

150

160

170

180

190

200

210

220

230

240

250

No.

of B

eds

Winter Bed Modelling - Bed Gap

CIP Target = 189 Beds

Current Bed Stock = 214 Beds

Capacity Gap

CIP Gap

No Gap

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Agenda Item No 7.1 Meeting Trust Board in Public Meeting Date 12th December 2019 Title Quality Report Sponsoring Executive Director

Suzanne Rostron, Director of Quality Governance

Author(s) Vanessa Flower, Head of Quality Governance Jo Case, Head of Service Improvement


The information within this report has been discussed at the Quality Committee and/or its subcommittees.




X

Review & discuss X Patient Confidentiality Caring SO 02: Ensure efficient use of resources X


Committee Agreement

X Other Exception Circumstances Responsive X SO 04: Achieve excellence in employment



Key Recommendations to be considered:

The Trust Board is asked to consider the following recommendations:

- To receive the report

Enc G1

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Executive Summary This report provides a summary of quality improvements, concerns, risks and the subsequent actions being taken to address these risks. Patient Safety 4 Serious Incidents were declared in October 2019 and as of the 18th November 2019, there are 52 cases under active management. A breakdown of these incidents and the lessons learnt from them is detailed within the Part 2 report. Claims & Inquests The Trust received 4 new clinical negligence claims in October 2019 relating to individual issues arising between January 2015 and February 2018. The Trust also received 14 notifications of investigations by the Coroner in October 2019 and 10 previously opened inquests were concluded. Once again, all details are enclosed within the private board report as this contains patient identifiable information.

Patient Experience The Trust has seen a rise of 47% in complaints received from September to October 2019. At the time of reporting, 34 new complaints had been received. However, returning complaints has remained low which indicates the improving quality of responses from the Trust. This report details that the number of managed concerns received in October was 122, compared to 68 in the same month last year, and 97 in September 2019, which is a 79% increase. The three main areas for concerns are:

I. Communication II. Clinical Treatment III. Waiting Times

This report also details the positive receipt of compliments across the organisation. These are now seeing an improved capture on the Datix system and this illustrates that 8 compliments have been received for every complaint received in October 2019. Equally, learning from feedback has been captured which illustrates developed practices as a result of complaints received. Health & Safety 1 RIDDOR has been reported in October and this case has since been resolved. Compliance This report provides an update against the Trusts compliance with CQC regulatory actions and highlights the mechanisms utilised for effective monitoring. Quality Improvement The Quality Improvement Board took place on the 22nd November 2019 and provided an opportunity for Divisions and Care Groups to present their CQC Regulatory Compliance and their progress against their Quality Strategies.

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Trust Board Report Quality Governance

Date: 12th December 2019

1. Purpose of the Paper

To inform the Board of any quality improvements, concerns or risks and advise of actions being taken.

2. Background The ‘Quality Report’ summarises key information that has been presented to the Quality Committee that the Board needs to be sighted on. The Quality Committee Sub-Committees receive more detailed information and interrogate thematic and trend analysis. The Quality Committee receives escalation and assurance reports and will investigate issues to seek assurance on behalf of the Trust Board. This report provides an overview of key issues or achievements and seeks approval when necessary

3. Patient Safety 3.1 Serious Incidents 4 serious incidents were declared to the Isle of Wight Clinical Commissioning Group (CCG) during October 2019; a detailed summary of these is included in the private board papers. In November, up to 18.11.19, 7 serious incidents have been declared so far. 3.1.1 Ongoing Serious Incident Management The current SI status, as of 18.11.19 is as follows: There are currently 52 cases being managed by the Trust; of those being managed – 9 have been returned from the CCG for further assurance; 12 are overdue (under investigation and not yet submitted to CCG) and 31 are under investigation within agreed timeframes. There are a further 19 cases currently with the CCG awaiting formal closure. 3.2 Key Performance Indicators The KPI below is set against the SI process, and in line with national requirements.

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Overview of SI cases submitted to CCG 3.3 Learning Lessons from Events 6 cases were closed in October 2019, all of which have lessons learned documented. A detailed summary of lessons learnt for each closed case is given in part 2 of the Trust Board report.

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4. Legal Services 4.1 Claims The Trust received 4 new clinical negligence claims in October 2019 relating to individual issues arising between January 2015 and February 2018. All claims are indemnified through the Trust’s membership of NHS Resolution’s Clinical Negligence Scheme for Trusts and are currently being reviewed. 4.2 Inquests The Trust received 14 notifications of investigations by the Coroner in October 2019 and 10 previously opened inquests were concluded. No regulations 28 reports have been issued since December 2018.

5. Patient Experience 5.1 Complaints, Compliments, Comments & Concerns During October the Trust received a total of 34 new complaints compared to 31 in the same month last year a decrease of 9%, but an increase of 47% in the number of new complaints received compared to September (23). Surgery, Women’s and Children’s Health received 12 complaints in October 2019, compared to 6 in September with Medicine receiving 4 compared to 0 in September. The Integrated Urgent and Emergency Care received similar numbers with 11 in October compared to12 in September 2019. For complaints received in October 2018 and 2019 there are similarities in the numbers of complaints for Surgery, Women and Child Health and Integrated, Emergency and Urgent Care. In October 2018 the top 5 areas / departments receiving the highest complaints were Emergency Department (4), Ambulance Emergency Services, pathology department, Diagnostic imaging, and St Helens Ward receiving 2 each. In October 2019 the top 5 areas / departments receiving the highest complaints were Emergency Department with (5), Orthopaedics (3), Osborne Ward (3), NHS 111 and Ophthalmology (2) Whilst it appears that October sees a slight peak in the number of complaints, from review of the data is not possible to identify why, as the remainder of the complaints for both years are spread across a number of departments / areas. Five complaints were withdrawn in October. 1 complainant was happy with the apology and explanation received by the Service; 3 complaints met

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the Serious Incident (SI) Framework, and are being managed via the SI process. In one further case following the Trust’s initial investigation it was identified that the concern sat with the GP practice. The chart below shows the number of complaints received by Division since April 2019 (please note this includes all new complaints received including those that were subsequently withdrawn)

The complaint lodged against the Operations division for October related to bed management, following delays in the patient receiving a bed on their transfer back from Southampton General Hospital. The Chart below shows the new and returning complaints received by the Trust since April 2018; this data includes all new complaints, including any complaints subsequently withdrawn.

0

5

10

15

20

Acute Division -CSCD

Acute Division -MED

Acute Division -SWCH

Acute Division -IUEC

CommunityDivision

Mental Health& LearningDisabilities

Division

Finance, Estatesand IM&TDivision

QualityGovernance

Division

OperationsDivision

Other Provider(Patient

ExperienceOnly)

Apr 2019 May 2019 Jun 2019 Jul 2019 Aug 2019 Sep 2019 Oct 2019

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As can be seen from above the number of formal complaints received fluctuates monthly and ranges from 22 – 51 per month. However the rate of returning complaints has remained low since October 2018 when we had 11 returned complaints, which indicates an improved quality of Trust responses. The number of managed concerns received in October was 122, compared to 68 in the same month last year, and 97 in September 2019, which is a 79% increase. Surgery, Women’s and Children’s Health saw the largest number of concerns this month with 44. Looking at the top 3 subjects and areas of the concerns; 43% related to Communication, 13% to clinical treatment, and 8% regarding waiting times. Ophthalmology and Orthopaedics each received 5 concerns and Urology 4. During October, 286 Compliments were recorded as being received on Datix; Integrated Urgent and Emergency Care saw an increase from 23 in September to 180 this month. The majority of these were related to the Urgent Care Service, who have started to capture the comments left in their Comments Book on Datix. Medicine however saw a reduction of compliments logged from 185 in September to just 4 in October, it is not clear at this why there has been a reduction in compliments this month, but in September there was a large number of compliments added by one member of staff that duplicated to the Patient Surveys from one service, which would have significantly increased the data for September. The graph below shows the numbers of complaints (including those subsequently withdrawn), comments and compliments from April 2018. As can be seen from the chart, there is steady improvement in the numbers of compliments now being captured on the Datix System; for the month of October we had 8 compliments for each complaint received.

0102030405060

Apr 2

018

May

201

8

Jun

2018

Jul 2

018

Aug

2018

Sep

2018

Oct

201

8

Nov

201

8

Dec

2018

Jan

2019

Feb

2019

Mar

201

9

Apr 2

019

May

201

9

Jun

2019

Jul 2

019

Aug

2019

Sep

2019

Oct

201

9

Total New complaints Returning complaints

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5.2 Returning Complaints: The Trust received one returning complaint in October compared to three in September, and a 90% decrease on the same month last year, when the Trust received 11 returning complaints. The returning complaint was in relation to Surgery, Women’s and Children’s Health, and the care received under Orthopaedics, the complainant was not satisfied with the response received. During the month of August the Trust closed a total of 35 complaints, this number includes complaints that have been awaiting response and have been overdue, forming the Trust backlog. 5.3 Ongoing Complaint Management

For those managed in month, at the time of reporting, 11 (37%) of the 30 complaints managed in October have been reported on Datix as having been managed within the timescale, it must be remembered that this is subject to change as the month progresses. The table below shows the current compliance for October by division, as well as September 2019 for received and managed in month compliance as at the time of reporting.

0

50

100

150

200

250

300

350

Apr2018

May2018

Jun2018

Jul2018

Aug2018

Sep2018

Oct2018

Nov2018

Dec2018

Jan2019

Feb2019

Mar2019

Apr2019

May2019

Jun2019

Jul2019

Aug2019

Sep2019

Oct2019

Total New complaints Total Concerns Compliments

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Division

Closed In time (October ) 11/30) =37%

September Percentage Compliance

Percentage compliance Closed in time (September) = 27% (7/26*)

Clinical Support, Cancer and Diagnostic Services

No complaints received

- 0/1 = 0%

Medicine 2/4 50% 0/1 = 0% (1 returner) Surgery, Women’s and Children’s Health

3/11 (1 returner) 28% 67% (4/6)

Integrated Urgent and Emergency Care

4/9 44% 16% (2/12) (incl. 2 returners)

Community 0/1 0% No complaints Mental Health and Learning Disabilities

2/4 50% 50% (1/4)

Operations Divisions 0/1 0% No complaints Finance No complaints - 0% (0/1) Other Provider (Dermatology) No complaints - 0% (0/1)

(*number of complaints received in month) At the time of reporting the Trust has seen an improvement in complaints closed within timescale this month, with 37% being closed within timescale. No division achieved the 75% target set as part of the Quality strategy measures. The September position for complaints managed in timescale was 27%, and at the time of reporting a further 9 complaints remain open. 2 within Mental Health and Learning Disabilities, and 7 within Integrated Urgent and Emergency Care. Information in respect of the backlog of complaints is included in Part 2 of the Board report. 5.4 Parliamentary Health Service Ombudsmen During October no new requests for information were received from the PHSO. At the time of reporting the Trust are working with the PHSO on the following cases:

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Case Ref

Date request received

Service Current status

14085 07/03/2018 Rheumatology Under investigation – still awaiting contact from PHSO 13760 18/09/2018 Alverstone Ward

(was also an SI) Report received 23rd August 2019 Partly upheld complaint – final recommendations given to division. Apology letter sent, cheque has been requested to be sent to the complainant.

13612 22/10/2018 Appley Ward Report received 21st June 2019 – Partially upheld – signed letter sent to complainant following recommendations. Signed response sent to the PHSO on 7 November 2019.

15372 15/11/2018 Medicine Following PHSO report received 21st June 2019 when complaint was upheld, PHSO have required evidence of recommendations and copy of this has been sent to PHSO on 10th September2019

14639 27/11/2018 Surgery Awaiting further contact from PHSO 13565 31/01/2019 MHLD The PHOS confirmed that the complainant does not wish to pursue the next stage of

the complaint and this is now closed 14580 08/03/2019 Colwell Ward Under investigation. Awaiting contact from PHSO 13827 02/05/2019 Medicine PHSO have requested copy of post mortem report, which was sent on 6th November

2019. Provisional report due to be sent to the Trust in next month. 15798 17/05/2019 Integrated Urgent

& Emergency Care Final report received by PHSO 5/9/19 – Complaint not upheld.

16698 30/07/2019 Surgery PHSO investigation underway, information has been shared as requested on 24

October 2019. 5.5 Learning from Feedback The following actions have been taken from complaints received in September and October 2019.

• Protocols and training for diving injuries has been updated; with multi-disciplinary teaching sessions being held in the department. • The Trusts Medical Director has instigated a zero tolerance for patients leaving the hospital without a full and robust discharge summary. • The Trust has developed local guidance for management of high risk TIAs to ensure staff work in line with national guidance utilising

resources available. • Poster notification displayed in prominent areas of the ED and Stroke Ward with reference to Carotid Doppler’s and the management of high

risk TIA admissions.

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• The Emergency Department nursing documentation has been updated and next of kin details are on the first page and all staff are expected to complete this.

• The Trust is reviewing the way certain medications are ordered to ensure procedures are in place to prevent issues when Locum doctors are covering clinics with regards to drug ordering.

5.6 National Patient Surveys The results of the Children and Young Persons Survey were published on 19th November, and the full results are available on the Care Quality Commission website at https://www.cqc.org.uk/cqc_survey/14 . The Trust received responses from 91 patients which is a 22% response rate against the national average of 25%. No overall scores were provided for each section and a number of questions marked not applicable, this was because too few respondents answered the question for the Trust. However the Trust faired about the same as all other Trusts for 38 questions and better in one question. This related to the type of ward stayed on, and the Trust achieved 10/10 for this question. Compared to the Trusts results from the 2016 survey there has been an improved score for 9 questions, and deterioration in 20 questions. The results will be shared with the Service and discussed at the Patient Experience Sub-Committee in December to ensure action is being taken in response to the recommendations. 5.7 Friends & Family Test The Trust continues to offer the FFT to patients, and is encouraging the use of volunteers to support in capturing patient feedback. Discussions are underway via Procurement to look at solutions to capture patient feedback, working in line with the revised guidance to be implemented from April 2020.

6. Health, Safety & Security 6.1 RIDDOR The following RIDDOR case was reported in the Trust during October 2019.

https://www.cqc.org.uk/cqc_survey/14

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Reported Date RIDDOR Reportable

RIDDOR Completed

Date of RIDDOR

RIDDOR NUMBER

Reason WHO Closed/Open?

22/10/2019 YES YES 01/11/2019 AAB9B08810 Injury to hip due to an assault from a patient on Seagrove ward

Member of Staff

CLOSED

7. Compliance 7.1 CQC The Trust is monitoring compliance with the CQC Must-Do and Should-Do Regulatory Actions through the Quality Improvement Board as updates are provided on a monthly basis. Through this, the Trust-wide regulatory actions were rated to determine those that are “At Risk” of not being delivered upon. All Divisional CQC Improvement Plans are being monitored through Divisional Quality Committee Meetings and summarised reports are provided to the Quality Improvement Board for assurance and review.

8. Quality Improvement Quality Improvement Board The Quality Improvement Board took place on the 22nd November 2019 and provided an opportunity for Divisions and Care Groups to present their CQC Regulatory Compliance and their progress against their Quality Strategies. It was noted from this meeting that dedicated support needs to be given to the Acute Division to support in meeting the regulatory compliance of their Warning Notice actions; this shall be provided through the Acute Warning Notice Task & Finish Group. In order to further support this and ensure assurance is appropriately provided, monthly assurance visits shall be scheduled to take place from December utilising external and internal teams on a rolling basis. Quality Improvement Plan The Quality Improvement Plan has identified leads for each priority and improvement plans are being developed with a clear ask of resource requirement to deliver. All improvement plans will be hyperlinked to a central document with clear outcomes and monitored through the Quality Improvement Board. PIDS are supporting the development of a dashboard. Communications and engagement with the Quality, Service Improvement Redesign (QSIR) Training has begun and a number of bookings have been taken from across all the divisions. Work is ongoing to ensure maximum staff engagement.

Ambulance, Community, Corporate, Hospital, Learning Disability & Mental Health Services - www.iow.nhs.uk 1

Enc H1

Agenda Item No 7.2 Meeting Trust Board in Public Meeting Date 12 December 2019

Title Financial Performance – Month 7 2019/20

Sponsoring Executive Director Darren Cattell – Director of Finance, Estates , IM&T and Deputy Chief Executive

Author(s) Gary Edgson – Deputy Director of Finance


Trust Leadership Committee, 28 November 2019 Performance Committee, 11 December 2019

Key Recommendation

To receive the Month 7 Trust performance against the 2019-20 financial plan.

The Board is asked to note the reasonable assurance on the Trusts overall financial performance to date but note the ongoing actions required to achieve current year plan and the inherent risks at Trust and Divisional level that require mitigation.


Link to CQC Domains

Link to Trust Strategic Objectives


Effective SO 01: Provide safe, effective, caring and responsive services – ‘Good’ by 2020 X

Review & discuss Patient Confidentiality Caring SO 02: Ensure efficient use of resources X Assurance X Staff Confidentiality Safe SO 03: Achieve patient standards

Committee Agreement


Responsive SO 04: Achieve excellence in employment



http://www.iow.nhs.uk/


Executive Summary

Income & Expenditure • The required financial position for October was a £1.4m deficit (in month) and a £14.6m deficit (year to date) • The Trust’s actual financial position for October was a £1.8m deficit (in month) and a £14.9m deficit (year to date) • This is off plan for the first month this year at +£0.3m • External support funding:

• £6.1m for achievement of Q1 & Q2 financial target – cash now received and is guaranteed • £1.8m assumed for Month 7, but will be only be realised if full Q3 plan achieved and variance to plan is recovered

• The reported year to date position is therefore £7.0m deficit including external support funding Year End Forecast (Q2) • A year end forecasting exercise at divisional level indicates a potential £7.1m shortfall against the Trust’s planned year end position • The most significant issues are:

• CIP risk of non or partial delivery (£2.5m) • ED/MAU (agency costs and non delivery of CIP) (£2.5m) • Nursing recruitment costs (£1.4m)

• Opportunities for reductions in run rate have been identified • These opportunities will be challenged and approved at Financial Recovery Board (FRB), to ensure all risks are mitigated • External support funding for Q3 and Q4 is at risk if the Trust does not achieve financial plan in the respective quarters • Opportunities that can be realised in Q3 are being prioritised to mitigate the risk of losing external support funding for that period



Executive Summary

Pay and Agency • Pay pressures continue in the Emergency Department and are also reflected in the expenditure year to date position as a result of

Compton Ward being open in Q1. Centrally held funds have been utilised to offset the former and additional income has been received from the CCG in respect of the latter

• M7 agency costs were £0.85m which is an increase of £56k compared to M6. Agency costs are continuing to show an overall downward trend over the last 12 months as a result of CIP initiatives however, they have not reduced to the extent anticipated in the plan. In October there were late bookings and an increase in hours for nursing, the benefit of recruitment of overseas nurses is yet to have a positive impact as registrations are in the process of being finalised.

• Efficiency plans for 2019/20 are focussed on improving productivity and reducing reliance on agency staff; the impact of these is reflected in the trend referenced above. Key enablers which support these plans include overseas recruitment, an increased focus on consultant job planning and improved rostering. The latter is enabling the Trust to pay lower rates for agency staff due to more pro-active workforce planning

Progress to date against CIP delivery • £3.4m planned delivery to date • £3.5m actual delivery to date • Delivery includes £1.4m of non-recurrent savings CIP Forecast • A risk based assessment of the forecast values of individual CIP schemes has been undertaken by the finance programme

management office. This indicates a likely shortfall of circa £2.5m (i.e. delivery will total £7.9m of the £10.5m baseline plan) • The FRB continues to drive performance delivery, to identify recovery actions, CIP mitigations and consider required investment

decisions which will support improved quality/financial sustainability • Closing the forecast shortfall in the CIP Programme through a CIP recovery plan will be the focus of the FRB



Executive Summary

FRB Update re key agreed actions • Further review of Quality investments and risks to be carried out by the fPMO • Agency positions to be challenged at divisional level through Integrated Performance Reviews (IPR) • Alignment of Onward Care and Independence work stream with the Acute Bed Programme • Review of the Community Q2 forecast outturn position (re deterioration from Q1) • Stationery amnesty (catalogue orders to be placed on ‘hold’) • Ongoing focus on the identification of savings to mitigate the £7.1m risk Mitigating Actions agreed at FRB The following high level actions, to mitigate the forecast year end shortfall, were agreed at the FRB: • ED/MAU – Establishment review • Review of investments (opportunities for slippage) and risk (opportunities for mitigation) held within central funding • Unfunded activity - Cease additional activity or secure additional funding for marginal costs to ensure net nil impact • Costs of financial recovery/transformation - Ensure financial benefits delivered exceed the costs incurred on a case by case basis,

seek to capitalise where possible. • CIP recovery plan and Divisional Control Totals • Post Q1 commitments – review of specific cost pressures that emerged during Q2 (identify potential mitigating actions)



Executive Summary

Capital Investment Update • The revised capital programme for 2019/20 now totals £8.2m • Following the return of the £1.2m previously ‘top sliced’ from the Trust’s allocation and an updated assessment of priorities the revised

capital programme has now been agreed • The £8.2m programme reflects the impact of additional allocations for NHS Digital and emergency care performance and the decision to re-

life some IM&T assets (which resulted in a revenue benefit but a reduction in available capital), this will be offset by the sale of the Gables now approval has been obtained from NHSI.

• The allocation for NHS Digital (HLSI) is £3.6m in total of which £1.4m will be received in this year. Plans are well developed to realise the benefits from this investment

• As at Month 7, capital investment year to date is £2m – ahead of plan (£0.7m) • The Trust will receive an additional £48m of capital to support the sustainability of acute services. This will be received over the next five

years. The Trust has recently submitted a high level template to NHSI which sets out key milestones and an indicative capital expenditure profile

Cash update • Loans of £9m for April-January have been secured from DHSC – this reflects the revised deficit plan (£4m) and cash in lieu of

PSF/FRF(£5m) • Remaining cash support will be in the form of further PSF & FRF funding, access to which is dependent on achieving the financial plan in

quarters 3 and 4 • Repayments of cash loans are expected to begin in April 2020 subject to national decisions regarding refinancing Use of Resources rating • The Trust’s Use of Resources Rating (UoR) has remained at a score 4 (1 being best and 4 being worst) • As the Trust is under Financial Special Measures the UoR rating will default to 4



Area Key issues Current month (ytd)

Previous month (ytd)

Overall Plan The Trust is reporting a deficit of £7m as at the end of October, which is £0.3m off plan. This position assumes the receipt of £7.9m PSF/FRF funding. A risk of £7.1m to the planned year end position has been highlighted, following the Q2 forecasting refresh exercise and high level mitigating actions have been developed (see Appendix F).

£0.3m adv to plan (ytd). FOT £7.1m risk to be mitigated

On plan (ytd). £7.1m

risk to be mitigated

Income At month 7 income is £2m favourable to plan (after in-year adjustments to the income plan). This is mainly as a result of ‘other income’ in excess of planned levels and an additional £0.6m for non elective activity above the planned SLA level.

£2.0m fav to plan

£0.9m fav to plan

Expenditure Expenditure is £2.4m adverse to plan at the end of October. This is mainly the result of additional staffing costs in the Emergency Department and the cost of additional non elective activity. This has been partially offset by the use of central funding.

£2.4m adv to plan

£0.9m adv to plan

CIP As at the end of the October the Trust has delivered £3.5m of CIP against a plan to deliver £3.3m (£1.9m of this is recurrent, £1.4m is non-recurrent). A scheme by scheme risk adjusted forecast indicates that £7.9m of the £10.5m CIP will be achieved.

£0.2m fav to plan

£0.2m fav to plan

Capital Capital expenditure is £0.7m ahead of the YTD planned position due to the expenditure incurred to relocate the Outpatients Department. The year end forecast is that capital expenditure will be in-line with the revised plan.

£0.7m adv to plan

£0.2m adv to plan

Cash At the end of October the Trust’s cash balance was £2.2m, a decrease on the previous month’s balance by £5.1m. The reduction is due to increase in working capital of £4.5m (3.1m Debtors) and increased capital expenditure.

£2.2m Cash

Balance

£7.3m Cash

Balance

Financial risk rating (UoR)

At the end of October the Trust’s Financial use of resources rating was ‘4’ as per the plan (as the Trust is in Financial Special Measures the risk rating will default to a ‘4’).

Overall score 4

Overall score 4

Month 7 Executive Summary



Month 7 Overall Financial Performance

Summary Service pressures continue to exert financial pressures, most significantly in ED & MAU. Additional non-elective activity (above the block contract value) and projects relating to delivering financial recovery and transformation have also impacted planned levels of expenditure. The use of centrally held funding, and recognition of future mitigating actions, has been required to minimise the adverse impact on the planned position. No loss of PSF/ FRF funding has been assumed.

The adverse financial impact of service pressures have been offset by non-recurrent actions up until M6. However expenditure exceeded income by £0.4m in M7, resulting in a year to date £0.3m adverse variance to plan.

NB – Variances may not sum exactly due to roundings

-3,005

-2,203 -2,082-1,962-1,874 -1,989

-1,428-1,745

-1,813

-1,157 -1,052-1,189

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

0Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

£'00

0

Underlying Deficit Run Rate £21.5m

Actual run rate Underlying Plan (£21.50m deficit)

Year (£m)

Plan Actual Variance Plan Actual Variance PlanIncome 15.0 15.4 0.4 105.2 107.1 2.0 178.9Pay -11.2 -12.3 -1.1 -81.6 -83.6 -2.0 -137.3Non Pay -4.5 -5.2 -0.6 -31.4 -34.0 -2.6 -53.6Centrally Held Funding 0.0 1.0 1.0 -1.3 0.9 2.2

EBITDA -0.7 -1.0 -0.3 -9.1 -9.6 -0.5 -12.1Post EBITDA -0.7 -0.8 -0.0 -5.5 -5.3 0.1 -9.4

Pre PSF/FRF -1.4 -1.8 -0.4 -14.6 -14.9 -0.3 -21.5PSF/FRF 1.8 1.8 0.0 7.9 7.9 0.0 17.5

Surplus/(Deficit) 0.3 -0.0 -0.4 -6.7 -7.0 -0.3 -4.0

In Month (£m) Year to Date (£m)



Month 7 Financial Performance (by division)

Pressures at divisional level are reflected in the table below, the key adverse variances are as follows: • Integrated Urgent & Emergency Care – agency staffing costs in the Emergency Department/MAU, CIP under

delivery and additional work to support patient flow • Acute Services – costs relating to additional activity and CIP under delivery

NB – Variances may not sum exactly due to roundings *See Appendix D

The overspends in Integrated Urgent & Emergency Care and Acute Services have been mitigated by small underspends in Community Services and Corporate areas and the use of centrally held funding. The latter will adversely impact on the amount that the Trust has available for investment priorities.

Year (£m)Plan Actual Var Plan Actual Var Plan

Acute Services -7.3 -7.9 -0.6 -52.7 -53.7 -1.0 -83.4Community Services -1.5 -1.4 0.0 -9.8 -9.6 0.2 -16.5Mental Health and Learning Disabilities -1.5 -1.6 -0.1 -11.0 -11.4 -0.4 -18.3Integrated Urgent & Emergency Care -1.7 -2.0 -0.4 -11.6 -13.6 -2.0 -19.4Finance, Information & Estates -1.4 -1.4 0.0 -10.3 -9.9 0.4 -16.9Trust Administration -0.5 -0.6 -0.1 -3.6 -4.0 -0.4 -6.1Human Resources and Organisational Development -0.1 -0.5 -0.3 -1.6 -2.2 -0.6 -2.6Nursing, Midwifery, AHP -0.1 -0.1 0.0 -1.0 -1.0 0.0 -1.7Medical Director 0.0 0.0 0.0 -0.3 -0.1 0.1 -0.4Quality Governance -0.2 -0.1 0.0 -1.2 -1.0 0.2 -2.0

Total (Divisions) -14.3 -15.7 -1.4 -103.0 -106.5 -3.5 -167.3

Non devolved income/expenditure/finance costs Plan Actual Var Plan Actual Var PlanIncome (not devolved) 15.3 15.4 0.1 103.0 103.3 0.3 179.4Capital Charges -0.6 -0.6 0.0 -4.2 -4.2 0.0 -7.2Finance Costs (inc donated asset income/depreciation) -0.2 -0.2 0.0 -1.3 -1.1 0.1 -2.2Centrally Held Funding* 0.0 1.0 1.0 -1.3 1.5 2.8 -6.7

Total 14.6 15.7 1.0 96.3 99.5 3.2 163.3

Trust Total 0.3 0.0 -0.4 -6.7 -7.0 -0.3 -4.0

DivisionIn Month (£m) Year to Date (£m)



Month 7 Financial Performance (by issue)

The table below summarises the YTD financial performance by the underlying issues which are driving the position. It highlights both areas of pressure and areas providing mitigation. The latter are ensuring that the Trust remains ‘on plan’ overall.

Cost pressures continued into M7

Balance sheet review / Mitigating actions: The use of funding and recognition of future mitigating actions has been required to minimise the adverse effect on the planned position

Plan Actual

Deficit Plan (14.59) (14.59)

Variances to planCost Improvement Programme 0.17 ED & MAU (1.80) Additional costs to deliver activity (0.28) Costs of financial recovery (0.09)

Costs to deliver transformation programme (0.76)

Shackleton Ward & mainland placements (0.35) Quality Investment funding 0.86 Medical staff pay award 0.28 NCA & RTA activity 0.07 Balance sheet review/ Mitigating actions 1.52 Financing & Capital Charges 0.15 Non elective activity over performance 0.16 Other (0.22)

Pre PSF/FRF (14.59) (14.91)

PSF/FRF 7.88 7.88

Surplus/(Deficit) (6.72) (7.03)

M7 YTD position(£m)



Plan Forecast Plan YtdActual

Ytd Plan Forecast Plan Forecast

Deficit Plan (21.5) (21.5) (13.1) (13.1) (5.1) (5.1) (3.4) (3.4)

Variances to planCIP in Divisional Forecast (0.6) 0.3 (0.5) (0.4) CIP Risk not in Divisional Forecast (1.9) 0.0 (1.0) (0.9) ED/MAU (2.5) (1.4) (0.7) (0.4) Shackleton / Mainland Placements (0.3) (0.1) (0.1) (0.1) Costs above budget to deliver activity (0.7) (0.1) (0.2) (0.4) Financial Recovery/Costs of Transformation (0.8) (0.4) (0.1) (0.3) Nursing Recruitment (1.4) (0.1) (0.6) (0.7) Quality Developments 1.0 0.6 0.3 0.1 Winter 0.0 0.0 0.0 0.0 Centrally Held Funding (excl Quality) 0.0 1.3 (0.7) (0.7) Post Q1 Prioritisation (0.8) 0.0 (0.2) (0.6) Financing/Capital Charges 0.3 0.1 0.1 0.1 Other 0.7 (0.2) 1.2 (0.2)

Pre PSF/FRF (21.5) (28.6) (13.1) (13.1) (5.1) (7.6) (3.4) (7.8)

Q4 Forecast(£m)

Year end Forecast (£m)

Q3 Forecast(£m)

Q2 Ytd (£m)

The Q2 year end reforecast modelled ‘bottom up’ by the finance team indicates a likely year end position of £7.1m adverse to the £21.5m deficit plan. The £7.1m would only be achieved after mitigating actions of £2m have been implemented (e.g. slippage on quality investments, saving on financing costs).

The most significant issues are as follows:

• CIP risk of non or

partial delivery (£2.5m)

• ED/MAU (agency costs and non delivery of CIP) (£2.5m)

• Nursing recruitment costs (£1.4m)

• Funding to support Quality Developments (not devolved to divisional budgets) provides £1.0m of partial mitigation to the above.

Q3 issue £2.5m off plan, impacting on external support

funding

Q4 Issue £4.5m off plan impacting on external support

funding

Year end forecast as at Q2 (by issue)



Month 7 CIP

CIP YTD DELIVERY & FORECAST YTD Delivery As at month 7 £3.5m of savings (£2.1m recurrent and £1.4m non recurrent) have been delivered against a phased plan of £3.4m (overall delivery is ahead of plan).

CIP Forecast The latest divisional level CIP forecast is that £7.9m of CIP will be delivered by the end of the financial year. This is against a target to deliver £10.5m (forecast is £2.5m below target). The table (bottom left) analyses forecast delivery by division and by risk rating. % of the £10.5m CIP target is now either rated ‘Blue’ (delivered) or ‘Green’ (will deliver). Actions are ongoing to improve this.

DIVISIONCIP Target

£'000RED AMBER GREEN BLUE

Total Recurrent

£'000

Non-Recurrent

Pipeline Est£'000

Acute 5,258 854 710 395 1,346 3,305 565 937 Ambulance 345 41 284 325 11 Community 613 237 32 45 364 678 75 Corporate Nursing 66 6 71 77 38 ED 1,231 - 32 - 32 212 Estates & Facilities 515 50 24 148 222 172 475 Finance 201 34 564 598 74 HR&OD 371 35 17 44 96 16 IM&T 152 52 23 60 135 38 Medical 21 12 12 19 Mental Health 1,202 20 456 476 120 Performance Info 97 5 8 21 12 46 13 100 Quality 114 3 125 128 134 170 SWTT 20 20 20Trust Admin 251 62 250 312TOTAL 10,458 1,096 887 723 3,756 6,462 1,487 1,682

Risk to deliveryRisk will be mitigatedProject will deliverDelivered



Month 7 Balance Sheet

Summary The key year to date balance sheets movements are as follows: • Reduction to Fixed Assets – Depreciation is

currently higher than the rate of capital additions

• Increase in Debtors* - mainly due to accrued in year non-tariff drugs and Acute activity over performance which is included as additional income above plan in the I&E position, and 4 months of PSF/FRF

• Increase in Creditors* - mainly invoiced creditors, reduced in month due to loan funding allowing payment of some overdue creditors

• Increase in Borrowings > 1 year – Because of delays in issuing the PSF/FRF short term loans equal to the amount due of £10.124m have been received, and £0.874m repaid due to Q1 PSF/FRF being received in September

• Retained Earnings - reduction reflects the deficit I&E position

*An analysis of the debtor and creditor movements can be found in Appendix B.

Balance SheetM12

18/19Month

6Month

7In Month

MovementFixed Assets 111.5 109.6 109.9 0.3

Stock 2.3 2.2 2.2 0.0Debtors 10.8 17.7 20.6 2.8Cash 4.5 7.3 2.2 -5.1

Creditors -16.9 -22.9 -21.3 1.6Capital creditors -2.2 -0.8 -1.2 -0.4PDC dividend creditor 0.0 -0.6 -0.7 -0.1Interest payable creditor -0.2 -0.3 -0.1 0.2Other Liabilities -1.9 -1.6 -1.9 -0.3Provisions < 1 year -0.2 -0.1 -0.1 0.0Borrowings < 1 year -0.1 -0.1 0.0 0.0

Net current assets/(liabilities) -4.1 0.9 -0.2 -1.2

Provisions > 1 year -0.2 -0.2 -0.2 0.0Borrowings > 1 year -68.2 -78.4 -77.5 0.9Long term liabilities -68.4 -78.5 -77.7 0.9

Net assets 39.0 32.0 32.0 0.0

Taxpayer's equityPublic dividend capital 7.9 7.9 7.9 0.0Retained earnings -2.4 -9.5 -9.5 0.0Revaluation reserve 33.6 33.6 33.6 0.0Other reserves 0.0 0.0 0.0 0.0Total tax payer's equity 39.0 32.0 32.0 0.0



Summary The cash balance held at the end of October is £2.2m, a £5.1m reduction on the previous month. The Month 7 cumulative I&E deficit of £7.0m is adjusted for depreciation (£3.6m) as it does not impact on cash. The charges for Interest Payable/Receivable (£1.1m) and PDC Dividend (£0.7m) are also added back as the amounts actually paid for these expenses are shown lower down for presentational purposes. This generates a YTD cash ‘Operating Deficit’ of £1.7m. The net impact of changes in working capital, payments for capital expenditure and an increase in working capital loans combine to generate the £5.1m overall decrease in the cash position since the previous month. The Trust paid back loan funding of net £0.9m in October due to receipt of Q1 PSF & FRF in September.

Month 7 Cash

Cash Analysis - Movement in Month

Actual M6

Actual M7

In Month

Cash Balance (19/20 Opening) 4.5 4.5

Income & Expenditure Surplus/(Deficit) -7.0 -7.0 0.0Depreciation 3.0 3.6 0.5Interest Payable/Receivable 1.0 1.1 0.2PDC Dividend 0.6 0.7 0.1Operating Surplus/(Deficit) -2.4 -1.7 0.8Change in Stock 0.1 0.1 0.0Change in Debtors -7.3 -10.4 -3.1Change in Creditors & Other Liabilities 6.1 4.9 -1.2Changes in Provisions 0.0 -0.1 -0.1Net Change in Working Capital -1.1 -5.5 -4.5Capital Spend -2.6 -3.0 -0.4Interest Paid/Received -0.9 -1.0 -0.1PDC Dividend Paid -0.2 -0.2 0.0Other 0.0 0.0 0.0Investing Activities -3.7 -4.2 -0.5Working Capital Loans 10.1 9.3 -0.9Loan/Finance Lease Repayments -0.1 -0.1 0.0Cash Balance 7.3 2.2 -5.1



Summary As at month 7 capital expenditure is £0.7m ahead of the year to date plan but is forecast to achieve plan by the year end. A decision to re-life IM&T Assets has the effect of reducing available capital spend by £0.3m. However the sale of The Gables should offset this now that approval has been received from NHSI. The Trust has recently submitted the high level milestones and capital expenditure profile for the £48m capital allocation as required by NHSI. This programme of work will extend over five years.

Month 7 Capital 2019/20 Capital Programme

Source of FundsOriginal Plan'£k

Revised Plan '£k

CRL based on depreciation 6,337 6,337Depreciation Re-Lifing (327)Emergency Care Performance 450NHS Digital 1,399Property Sale 285Donated Assets 50 50

Total Source of funds 6,387 8,194

Application of Funds £k £kIM&T RRP & New Schemes 500 916Equipment RRP 500 680Backlog Maintenance 651 430Shackleton interim 200 330Shackleton reprovision 800DSU 1,040ED Paediatrics 200 696Backup Generators 916 1,157Relocation CMHS 1,300Fire Compartment Remediation 230 231Urgent Care 300OPD Relocation 1,070Staff Capitalisation 200Emergency Care Performance 450NHS Digital 1,399Unallocated re Property Sale 285Donated Assets 50 50

Total Application of Funds 6,387 8,194



The Trust’s Use of Resources Rating is a ‘4’. This is against a score of 1 being best and 4 being worst. The Trust is currently achieving all UoR ratings as per its financial plan (table top left) however as the Trust is under Financial Special Measures the overall UoR rating will override to 4.

As the Trust is under Financial Special Measures the overall UoR rating will default to ‘4’.

Finance & Use of Resources Risk Rating

Use of resources risk rating summary Plan Rating

Actual Rating

Var

Capital Service Capacity 4 4 0Liquidity (days) 3 2 -1I&E Margin 4 4 0Distance from financial plan 1 2 1Agency spend 4 4 0

Overall Risk Rating 3.2 3.2

Risk rating after overrides 4.0 4.0


Enc H2 Agenda Item No 7.2 Meeting Trust Board in Public Meeting Date 12 December 2019

Title Hospital Performance Report for Month 7 - October 2019

Sponsoring Executive Director Joe Smyth, Chief Operating Officer for Hospital and Ambulance Services Author(s) Jo Ferguson, Business Support Acute Services


Acute Performance Committee 19th November 2019 Trust Performance Committee 11th December 2019

Key Recommendation

The Hospital Division Monthly Summary Report is set out in the attached presentation and provides an overview of activity and performance within the hospital for October 2019 (month 7) and now incorporates Integrated Urgent and Emergency Care (IUEC). This monthly Summary Report is produced from a number of data sources, which are all reported through the Hospital Care Groups Quality, Performance and Board meetings. The Committee will continue to receive a separate report for Ambulance.

The Trust Board is asked to receive this Month 7 report (October 2019) for assurance.


Link to CQC Domains




X

Review & discuss

Patient Confidentiality

Caring X SO 02: Ensure efficient use of resources X


Committee Agreement





Executive Summary RESPONSIVE – Constitutional Targets

Constitutional targets

Nat Target

%

Sept 18 %

Oct 18 %

Nov 18 %

Dec 18 %

Jan 19 %

Feb 19 %

Mar 19 %

April 19 %

May 19 %

June 19 %

July 19 %

Aug 19 %

Sept 19 %

Oct 19 %

RTT 92 80.65 80.8 81.0 81.5 80.6 79.3 77.2 75.7 73.3 71.4 71.7 70.4 70.4 71.7

Emergency Care Standard

95 81.8 80.7 72.8 82.7 81.8 76.3 84.6 76.7 79.1 77.9 77.6 67.72 71.9 70.9

Cancer 85 79.6 73.7 66.7 73.0 80.0 75.0

73.0

62.9 67.8 77.9 75.6 75.0 76.7 70.2 (74.4 *)

Diagnostics 99 96.15 98.6 98.8 98.0 92.0 92.0 94.0 95.4 94.9 96.8 97.9 98.4 98.8 99.4

Performance Summary 18/19

* = Potentially achieved but still needs to be fully validated once tertiary upload has been finalised

Executive Summary RESPONSIVE – Constitutional Targets RTT: Position at month 7 shows a continuation of our improvement trajectory on RTT incomplete performance. The achievement of planned levels of activity, combined with improvements in booking processes are delivering as anticipated. A plan has been agreed to increase activity in orthopaedics and urology over the next two months to reduce all waits to below 40 weeks. Additional support is being provided to improve performance in cardiology and gynaecology. Validation work continues. Actions: the Trust/CCG Executive led Planned Care Board continues to meet and has agreed a programme of work. Focus has been on identifying schemes, working up plans and diverting resources to deliver quick wins and higher impact schemes. The actions previously reported to improve the elective activity levels continue to be implemented, in particular: • Bed capacity remains ring fenced on Mottistone avoiding delays to orthopaedic surgery. Ring fenced elective surgery capacity will be created

at the start of December. • Urology insourcing weekend work will commence at the start of December. • The Trust will continue to work closely with its partners to expedite discharges of medically fit patients. • The plan for long waiting patients is reviewed at patient level on a weekly basis to monitor any variation to plan. • 6:4:2 theatre scheduling meeting to ensure optimal booking of lists in urgent and date order. Additional actions include: • Scheduled one day deep dive long waiting patient event with NHSI/E • Promoting choice for existing long waiting patients and new referrals • Ensuring improvements are made in booking patients in order for elective surgery • Working with the CCG to reconfigure pathways better utilising the independent sector and aligning with PHT pathways.

Executive Summary continued Emergency Care Standard (ECS) 4 hr standard The Emergency Care 4 hour Standard Performance was 70.9% resulting in the trajectory not being met for October ‘19. On the whole the performance was compromised by limited flow from the ED. The department commenced each day with a number of patients in the corridor waiting placement or review from speciality Consultants and therefore delays in discharging patients has impacted on the performance. This resulted in 26 x 12 hour breaches. There was a significant increase in the number of patients staying the hospital for more than 21 days, as well as an increase in the number of Delayed Transfer of Care (DTOC). Actions: • Opel 4 escalation status declared • Enhance bed meetings with escalation to all medical staff • Protection of Minors area to ensure flow through this area of the department and performance of >90%. • Additional HCA to ensure all care given to patients including nutritional support. • Senior attendance and support within the ED and at bed meetings. • Harm reviews undertaken for all 12 hour breaches - no harm found • Continuous review of patients waiting for beds. • System wide operational and executive level meeting to review flows from the hospital • Escalation and support from our system partners Additional actions include: Development of recovery plan and governance structure which includes work streams within programmes in the ED, UTC, SDEC and MAU to improve processes and procedures, tackle issues around leadership, capability and behaviour, expansion of footprint to enable growth in service need, equipment to ensure safety and quality. Plan to open Urgent Treatment Centre 19th November '19, this will bring together the minors workload from ED and the OOH service and provide assessment and treatment of Minor illness and injury. The unit will consist of GPs, ACPs, ENPs,HCAs and senior supervision from the ED. Requested support from ECIST discussed Rapid Process Improvement Workshop which will start on Tuesday 10th December 19’ and complete on Friday the13th December '19. This is a tried and tested programme which uses a PDSA methodology with nominated staff to undertake to change, with support, a process or area of practice across the urgent and emergency floor. Impact: Improvement performance trajectory through sustainable change and practice. Reductions in Long Length of Stay (LLoS) to enable flow through the hospital. Team building and working across services.

Executive Summary continued CANCER In October the Trust is provisionally achieving all measurable Cancer Waiting Times standards with the exception of 62 Day Referral as can be seen in the summary table below;. The number of 62 Day patients beyond 62 days was 102 in January 2019. This fell to 41 in June and had risen to 87 in September. The figure currently stands at 54 which represents a substantial improvement. The ongoing issues are: lack of local outpatient capacity and long waits for fusion biopsies and prostatectomies for prostate patients; and delays to colonoscopy and Consultant review of results for colorectal patients. Improved tracking and pathway management by site specific MDT Co-ordinators has contributed to the improvement. However, resolution of the issues remains the focus of our recovery plans. The recovery of performance against the 62 Day standard requires adequate capacity for investigations and treatments both locally and at the tertiary centres. The focus of the recovery plans on prostate and colorectal pathways will have a positive impact on the high number of breaches for these tumour sites and result in improved performance against the 62 day standard.

62 Day Referral Standard

Aug Sept Oct Actions to Recover

Performance 85%

75.0% 76.7% 74.4% Prostate • Friday morning Prostate clinics now reserved for 2ww patients. A second designated

clinic is to be implemented in December for post investigation/MDT patients. Appointments managed by MDT Co-ordinator

• Implementation of local Prostate fusion biopsy service to commence beginning of December 2019

• Improved collaboration with PHT: monthly strategy meetings and weekly telephone conversations to discuss long waiting times for Prostate investigations and treatments

• Colorectal • Additional capacity in Endoscopy to reduce pathway delays • Improved working practices between the Cancer Pathways Administration Team and

the Endoscopy team to ensure 2ww patients are proactively identified and prioritised • Deep Dive into Endoscopy capacity completed with NHSI support • Straight to Test Colorectal pathway to commence November 2019 Additional actions include: • Wessex Cancer Alliance Inter-Provider Transfer Policy to regulate waiting times for

investigations and treatments at tertiary centres. • Site Specific MDT Co-ordinators improving pathway management • Operational Manager, Cancer Services to work with the Breast team to ensure

appropriate identification and prioritisation of 2ww patients

Treated 58 58 52

Breaches 14.5 13.5 13.5

NB: These figures are provisional pending upload at the beginning of December and are subject to change based on the submission of the shared breaches by the tertiary centres.

Executive Summary Continued…………. DIAGNOSTIC WAITING TIMES: The Diagnostic Target has been achieved over the last 7 weeks reaching 99% and over. 6 week performance for October 2019 = 99.37%. This was last achieved in Feb 2018 and is due to significant hard work within the diagnostic services in all care groups. 1,592 total waiters (1,453 previous month) 10 breaches to be reported (18 previous month) Gynae cystoscopy - 3 Colonoscopy -7 Issues: Capacity issues within Endoscopy Annual leave and lack of cover for Gynae Cystoscopy’s Actions: Review of Endoscopy and additional lists being undertaken until additional resources can be actioned

Executive Summary Continued………….

FINANCE: The Division are overspent in month by £518k this is due to an increased CIP target and additional medinet costs Year-end Forecast to be remodelled with additional income and improved position of Acute Management Assumes CIP delivery of £5,354k against plan of £4,526k = £828k over delivery Areas of focus remain as; • Delivering operating plan of £21.5m • Remain within the Demand plan for Acute = Month 5 over performing acute activity due to emergency non elective spells • Robust CIP plans for 2019/20, to deliver the £5.2m • Robust recovery plan to mitigate financial risk of non delivery at year-end

WELL- LED Leadership Development Framework –

• Senior and Medical Leaders - Discussions underway for 2020 programmes. • Middle Leaders – planning for cohort 6 commencement underway. Evaluation of programme underway. • Team Leaders and Supervisors – cohort 2 to commence in October. Programme also embedded into Band 6 deputy Sister programme. • Fundamentals for Personal Growth at Work – workshops scheduled monthly. • Senior Nurse band 6 and 7 development programme – cohort 1 commenced.

• Human Factors Training -Monthly 1-day workshops scheduled to be facilitated by internal faculty of Terema accredited trainers. • Leadership Conference (19.03.20) – Focus on ‘Inclusive Leadership and Quality’ to be held at Northwood House, capacity 120.

SAFE Serious Incidents reported for the division there were a total of 49 SI’s open (including IUEC) and of these 10 were overdue. The care groups continue to focus on ensuring these incidents are responded to within the required timelines. There was an increase seen in the number of slip/trip/falls reported since last month with 48 incidents recorded. Of the 48 slips/trips/falls, 6 patients had more than 1 fall: 1 patient 1 x MAU, 1 x Colwell, 1 patient 4 x CCU, 1 patient 1 x MAU, 1 x Whippingham, 1 patient 2 x Colwell, 1 patient 2 x Stroke, 1 patient 1 x MAU, 1 x Appley. Deep dives are being undertaken to understand the reasons for this. There is live recruitment underway for a new Falls Co-ordinator.

No Grade 3 or 4 pressure ulcers were reported for the Division.

Duty of Candour compliance levels continue to increase with Clinical Support, Cancer and Diagnostics (CSCD) continuing to meet 100%, Medicine also achieving 100% and Surgery Women’s and Children’s Health (SWCH) have now hit 97% compared to 90% last month.

Complaints for the Division overall at the end of October were 23 received. Clinical treatment in Surgery received 7 complaints and A&E received 4 complaints with communication being the next theme to receive 4 complaints in month. This is a key area of focus for the Care Group Quality Managers and Heads of Nursing to ensure deadlines are met.

Divisional sickness rates for October has started to see an increase with overall reporting for the division at 4.72% compared to 3.78% last month and this still remains above the trust target. Hot spot areas and actions to support management plans in these areas continue with a focus on ward areas and a deep dive in IUEC in November.

Executive Summary Continued

WORKFORCE: Full recruitment activity by care group is now provided in monthly data packs and details the number of vacancies and impact to performance, quality and finance for the division. Discussions are taking place with Medical HR, care group leads, and sustainability group regarding long term plans to recruit to hard to fill posts. EFFECTIVE: Appraisal compliance – At the end of October the compliance rate was 91.72% and for IUEC remains at 54.63%. This performance continues to be closely monitored through the Divisional Board. There is a full action plan in place for IUEC appraisals and those that remain outstanding are booked in with the relevant managers. Mandatory training – Compliance rates remain above the 85% target across the division at 88%. Outlier staff groups are Junior doctors - Medical Education team working with the new cohort to ensure individuals are 85% compliant by 31.10.19. Bank staff – Weekly meetings taking place between Education & Training and Resourcing Team to improve compliance for bank staff to 85% by 31.10.19. Resuscitation – Issues with late cancellations, commonly attributed to staff levels/patient dependency. Alternative methods of delivery being explored. Manual Handling - Down by 10% overall on last month due to training expiring and not being refreshed. Lots of classroom capacity available ACUTE RISKS: There were 3 new risks rated 12 and above added for the Division for October 2019 and 3 risks closed in month. There are 5 top risks rated 15 and above for each of the care groups and these are listed below;

Acute Performance Summary

Acute Division Performance Report Review Month 7 October Data

* Rolling year ***Cancer figures for August are provisional. ** Appraisal Monitoring has changed from rolling 12 months to single quarter

Key Performance Indicator Data toTarget 19/20

Actual YTD

Actual Month 4 Month Trend

Exception Report

Required

Patients that develop a grade 4 pressure ulcer Oct-19 3 0 0 NO

Patients that develop an ungraded pressure ulcer Oct-19 0 14 4 YES

VTE (Assessment for risk of) Oct-19 >95% 98.3% 97.5% NO

MRSA (confirmed MRSA bacteraemia) Sep-19 0 0 0 NO

C.Diff (confirmed Clostridium Difficile infection - stretched target) Oct-19 7 12 2 NO

Clinical Incidents (Major) resulting in harm(all reported, actual & potential, includes falls & PU G4)

Oct-19 10 25 3 NO

Clinical Incidents (Catastrophic) resulting in harm(actual only - as confirmed by investigation)

Oct-19 - 19 5 NO

Falls - resulting in significant injury Oct-19 5 1 0 NO

Symptomatic Breast Referrals Seen <2 weeks*** Oct-19 93.0% 95.1% 95.1% YES

Cancer patients seen <14 days after urgent GP referral***

Oct-19 93.0% 94.5% 93.1% NO

Cancer Patients receiving subsequent Chemo/Drug <31 days***

Oct-19 98.0% 100.0% 100.0% NO

Cancer Patients receiving subsequent surgery <31 days***

Oct-19 94.0% 97.0% 92.3% YES

Cancer diagnosis to treatment <31 days*** Oct-19 96.0% 97.7% 94.7% NO

Cancer Patients treated after screening referral <62 days***

Oct-19 90.0% 93.0% 92.6% NO

Cancer Patients treated after consultant upgrade <62 days*** Oct-19

No measured operational

standard75.0% 0.0% NO

Cancer urgent referral to treatment <62 days*** (target) Oct-19 85.0% 73.1% 70.2% YES

Cancer urgent referral to treatment <62 days*** (trajectory)

Oct-19 79.3% 73.1% 70.2% YES

Never events Oct-19 0 0 0 NO

Stroke patients (90% of stay on Stroke Unit) Oct-19 80.0% 79.2% 87.9% NO

High risk TIA fully investigated & treated within 24 hours (National 60%)

Oct-19 60.0% 100.0% 100.0% YES

Total Workforce (inc flexible working) (FTE's) Oct-19 2,998.1 3,110.0

Total workforce SIP (FTEs) Oct-19 2,792.5 2,840.0

Variable Hours (FTE) Oct-19 205.6 1,306 270

Delayed Transfer of Care (lost bed days) - (Acute) Oct-19 115 1433 181 NO

LOS 7+ Patients Oct-19 127 836 116 NO

LOS 21+ Patients Oct-19 46 350 60 YES

Bed Occupancy - Acute Oct-19 0 - 98% NO

Excellent Patient Care

Acute Performance Summary

Acute Division – Performance Report Review Month 7 October Data

* Rolling year ***Cancer figures for August are provisional. ** Appraisal Monitoring has changed from rolling 12 months to single quarter

Key Performance Indicator Data to Target 19/20Actual YTD

Actual Month

4 Month Trend

Exception Report

Required

Emergency Care 4 hour Standards Oct-19 95% 76% 71% YES

Emergency Care 4 hour StandardsOct-19 Trajectory

88.0%76% 71% YES

Number of patients who have waited over 12 hours in A&E from decision to admit to admission

Oct-19 0 84 26 NO

All Cancelled Operations on/after day of admission Oct-19 - 371 40 NO

Cancelled operations on/after day of admission (not rebooked within 28 days) - including those not rebooked at the time of reporting

Oct-19 0 12 3 NO

Patient Satisfaction (Friends & Family test - Total response rate)

Oct-19 30.0% 3.1% 4.0% NO

Patient Satisfaction (Friends & Family test - A&E response rate)

Oct-19 95.0% 1.8% 1.1% NO

Mixed Sex Accommodation Breaches Oct-19 0 100 16 YES

Formal Complaints Oct-19 - 221 32 NO

RTT % of incomplete pathways within 18 weeks - IoW CCG

Oct-19 92.0% - 70.8% YES

RTT % of incomplete pathways within 18 weeks - NHS England

Oct-19 92.0% - 88.8% YES

Zero tolerance RTT waits over 52 weeks (Incomplete Return)

Oct-19 0 80 16 NO

RTT Incomplete Trust Combined Oct-19 92.0% - 71.7% YES

RTT Incomplete Trust Combined Oct-19 Trajectory84.5% - 71.7% YES

RTT waits over 52 weeks (Incomplete Return) - Total Oct-19 0 80 16 YES

No. Patients waiting > 6 weeks for diagnostics Oct-19 17 305 10 YES

% Patients waiting > 6 weeks for diagnostics Oct-19 99% 97.2% 99.4% YES

Theatre Utilisation - Audit Commission (NEW) Oct-19 - 73.1% 73.8% NO

Variable Hours (£000) (Trust Wide) Oct-19 244 9,644 1,630 YES

Staff absences - Acute Oct-19 3% - 4.72% YES

Staff absences - CSCD Oct-19 3% - 5.39% NO

Staff absences - GEN MED Oct-19 3% - 5.80% NO

Staff absences - SWCH Oct-19 3% - 3.69% NO

Appraisal Monitoring - Acute** Oct-19 100% - 91.7% YES

Appraisal Monitoring - CSCD** Oct-19 100% - 93.0% YES

Appraisal Monitoring - GEN MED** Oct-19 100% - 92.8% YES

Appraisal Monitoring - SWCH** Oct-19 100% - 89.9% YES

Mandatory Training* Oct-19 85% 84% 84% NO

Staff Turnover Oct-19 5% 10.95% 0.64% NO

Employee Relations Cases Oct-19 0 142 23 NO

Excellent Patient Care

Responsive - RTT Incomplete Performance Commentary:

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

18/19 84.1% 85.2% 85.1% 84.5% 82.0% 81.1% 80.8% 81.0% 81.6% 80.6% 79.3% 77.2%

19/20 75.7% 73.3% 71.4% 71.7% 70.4% 70.6% 71.7%

Target 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0%

Trajectory 78.5% 77.5% 79.1% 78.3% 77.7% 77.9% 77.4% 77.3% 74.6% 75.0% 75.9% 75.7%

Referral to Treatment Times

Position at month 7 shows a continuation of our improvement trajectory on RTT incomplete performance. The achievement of planned levels of activity, combined with improvements in booking processes are delivering as anticipated.

A plan has been agreed to over-perform in orthopaedics and urology over the next two months. Additional support is being provided to improve performance in cardiology and gynaecology. Validation work continues.

Actions: the Trust/CCG Executive led Planned Care Board continues to meet and has agreed a programme of work. Focus has been on identifying schemes, working up plans and diverting resources to deliver quick wins and higher impact schemes.

The actions previously reported to improve the elective activity levels continue to be implemented, in particular:• Bed capacity remains ring fenced on Mottistone avoiding delays to orthopaedic surgery. Ring fenced elective surgery capacity will be created at the start of December.• Urology insourcing weekend work will commence at the start of December.• The Trust will continue to work closely with its partners to expedite discharges of medically fit patients.• The plan for long waiting patients is reviewed at patient level on a weekly basis to monitor any variation to plan.• 6:4:2 theatre scheduling meeting to ensure optimal booking of lists in urgent and date order.

Additional actions include:Scheduled one day deep dive long waiting patient event with NHSI/EPromoting choice for existing long waiting patients and new referralsEnsuring improvements are made in booking patients in order for elective surgeryWorking with the CCG to reconfigure pathways better utilising the independent sector and aligning with PHT pathways.

Target - Within normal variation so may be achieved but not consistently

Trajectory - Within normal variation so may be achieved but not consistently

(4.0%)

(2.0%)

-

2.0%

4.0%

Perf

orm

ance

M

ovem

ent

Rese

t Usi

ng 1

7/18

as

base

line

Winter pressure

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Perf

orm

ance

Data Average Upper Lower Outside Relative to Average Movement Target Trajectory

71.7%

Responsive - RTT Activity Performance

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

Referral to Treatment Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12

Number of incomplete RTT pathways <=18 weeks i 8,240 8,034 8,522 8,565 8,362 8,541 8,536 8,517 8,022 8,055 8,449 8,642

Number of incomplete RTT pathways Total i

10,494

10,371

10,778

10,933

10,755

10,963

11,028

11,024

10,753

10,739

11,133

11,418

Referral to treatment Incompletes - Performance %

78.5% 77.5% 79.1% 78.3% 77.7% 77.9% 77.4% 77.3% 74.6% 75.0% 75.9% 75.7%

Number of incomplete RTT pathways >52 weeks i 0 0 0 0 0 0 0 0 0 0 0 0

Number of completed admitted RTT pathways i 458 500 735 511 687 547 530 707 447 550 550 525

Number of completed non-admitted RTT pathways i 2,566 2,625 3,512 2,702 3,428 2,728 2,724 3,497 2,500 2,637 2,659 2,666

Number of New RTT pathways (clock starts) i 3,212 3,002 4,654 3,368 3,937 3,483 3,319 4,200 2,676 3,173 3,603 3,476

Month 7 activity against plan

Trajectory 2019/20

Nb: produced January 2019 to be reviewed & updated for October

Commentary: Although year to date we have now declared 13 validated admitted 52 week breaches, there are a further 3 which have now been clinically validated which will be included in the month 3 returns and a further 2 anticipated following pathway review. There are currently 191 patients over 40 weeks on the admitted waiting list. An improvement of 58 since last month, mostly due to validation.

Plan Actual VarianceReferral to Treatment

Number of completed non-admitted RTT pathways 2,742 3,209 467

7,722 (678)

Number of incomplete RTT pathways Total 10,833 10,765 (68)

16 16

77.5% 71.7% (5.8%)

-

Number of completed admitted RTT pathways 530 650 120

Referral to treatment Incompletes - Performance %

Number of incomplete RTT pathways >52 weeks

Number of New RTT pathways (clock starts) 3,314 3,400 86

Number of incomplete RTT pathways <=18 weeks 8,400

Responsive – Emergency Care 4 hr Standard 70.9%

Commentary:


18/19 85.3% 89.9% 80.9% 82.4% 79.1% 81.8% 80.7% 72.8% 82.7% 81.8% 76.3% 84.6%

19/20 76.7% 79.1% 77.9% 77.6% 75.0% 71.9% 70.9%

Target 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%

Trajectory 87.7% 88.1% 88.6% 89.1% 89.5% 90.0% 90.8% 91.7% 92.5% 93.3% 94.2% 95.0%

Trajectory - Should be achieved unless performance consistently declines

Emergency Care 4 hour StandardsThe Emergency Care 4 hour Standard Performance was 70.9% resulting in the trajectory not being met for October ‘19. On the whole the performance was compromised by limited flow from the ED. The department commenced each day with a number of patients in the corridor waiting placement or review from speciality Consultants and therefore delays in discharging patients has impacted on the performance. This resulted in 26 x 12 hour breaches. There was a significant increase in the number of patients staying the hospital for more than 21 days, as well as an increase in the number of Delayed Transfer of Care (DTOC). Actions:Opel 4 escalation status declaredEnhance bed meetings with escalation to all medical staff Protection of Minors area to ensure flow through this area of the department and performance of >90%.Additional HCA to ensure all care given to patients including nutritional support. Senior attendance and support within the ED and at bed meetings.Harm reviews undertaken for all 12 hour breaches - no harm foundContinuous review of patients waiting for beds. System wide operational and executive level meeting to review flows from the hospital Escalation and support from our system partners Additional actions include:Development of recovery plan and governance structure which includes work streams within programmes in the ED, UTC, SDEC and MAU to improve processes and procedures, tackle issues around leadership, capability and behaviour, expansion of footprint to enable growth in service need, equipment to ensure safety and quality. Plan to open Urgent Treatment Centre 19th November '19, this will bring together the minors workload from ED and the OOH service and provide assessment and treatment of Minor illness and injury. The unit will consist of GPs, ACPs, ENPs,HCAs and senior supervision from the ED. Requested support from ECIST discussed Rapid Process Improvement Workshop which will start on Tuesday 10th December 19’ and complete on Friday the13th December '19. This is a tried and tested programme which uses a PDSA methodology with nominated staff to undertake to change, with support, a process or area of practice across the urgent and emergency floor.

Impact: Improvement performance trajectory through sustainable change and practice.Reductions in Long Length of Stay (LLoS) to enable flow through the hospital. Team building and working across services.

Target - Step Change required if required performance is to be achieved

(15.0%)(10.0%)

(5.0%)-

5.0%10.0%15.0%

Perfo

rman

ce

Mov

emen

t

Point above normal variation

Point below normal variation

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Perfo

rman

ceData Average Upper Lower Outside Relative to Average Movement Target Trajectory

Responsive – ED Recovery Plan Commentary: The Recovery Plan is being developed to provide one Operational Plan which will be owned and monitored through the system and hospital board structures. Draft Terms of Reference, membership and dates for this Hospital Acute Recovery Plan to provide assurance against this plan are in progress with the first meeting planned for 19th December. Elements of the plan will support the Emergency Care Standard and patient pathway through the Emergency Department, treatment and or follow up in the Same Day Emergency Care Unit (SDEC) or in patient treatment to discharge home or alternative care. Key objectives: • Recruitment and retention of staff. • Training of key personnel to provide the expertise to

assess, stream to most appropriate area of the emergency pathway or redirect to system wide services.

• Leadership support for Medical and Nursing staff • Provide alternative pathways other than the Emergency

Department (ED). • Development of process and procedure to support

decision making and sign posting. • Open an Urgent Treatment Centre to alleviate crowding in

the ED for minor illness and injury. UTC has now opened since 17 November 2019.

• Expand the SDEC service to include medicine and surgery.

• Install Point of Care testing within the ED to support diagnosis and decision making.

Responsive - Cancer Targets 70.2%

Commentary:

* Last month is provisional data

Issue - In October the Trust is provisionally achieving all measurable Cancer Waiting Times standards with the exception of 62 and 31 day. 62 Day: 51 treatments have been recorded with 9 local breaches (potentially 13.5 including those shared with the tertiary centres). 70.2% is currently being achieved against the trajectory of 71% and the 85% standard. Of the 9 local breaches 3 are colorectal and 4 urology. Breach reasons are yet to be determined.31 Day: 57 treatments recorded with 3 breaches. 95% provisionally achieved against the standard of 96%. The three breaches are breast patients who breached by one day due to inadequate capacity for wire guided excision.

These figures are provisional pending upload at the beginning of December and are subject to change based on the submission of the shared breaches by the tertiary centres.

In September the Trust achieved all measurable Cancer Waiting Times standards with the exception of 62 day. 58 treatments were recorded for September with 13.5 breaches: 11 local and 2.5 shared with tertiary centres. 77% was achieved against the trajectory of 83% and the 85% standard. Of the 11 local breaches, 3 were colorectal due to lack of capacity for colonoscopy and 4 were prostate due to lack of outpatient capacity. Our recovery schemes focus on these tumour sites.

The number of 62 Day patients beyond 62 days was 102 in January 2019. This fell to 41 in June and had risen to 87 in September. The figure currently stands at 54 which represents a substantial improvement. The ongoing issues are: lack of local outpatient capacity and long waits for fusion biopsies and prostatectomies for prostate patients; and delays to colonoscopy and Consultant review of results for colorectal patients. Improved tracking and pathway management by site specific MDT Co-ordinators has contributed to the improvement. However, resolution of the issues remains the focus of our recovery plans.

The 62 Day standard is recognised as a huge challenge across the Wessex Region and

Actions: Prostate• Friday morning Prostate clinics now reserved for 2ww patients. A second designated clinic is to be implemented in December for post investigation/MDT patients. Appointments managed by MDT Co-ordinator• Implementation of local Prostate fusion biopsy service to commence beginning of December 2019• Improved collaboration with PHT: monthly strategy meetings and weekly telephone conversations to discuss long waiting times for Prostate investigations and treatmentsColorectal• Additional capacity in Endoscopy to reduce pathway delays• Improved working practices between the Cancer Pathways Administration Team and the Endoscopy team to ensure 2ww patients are proactively identified and prioritised• Deep Dive into Endoscopy capacity completed with NHSI support• Straight to Test Colorectal pathway to commence November 2019

Additional actions include:• Wessex Cancer Alliance Inter-Provider Transfer Policy to regulate waiting times for investigations and treatments at tertiary centres. • Site Specific MDT Co-ordinators improving pathway management • Operational Manager, Cancer Services to work with the Breast team to ensure appropriate identification and prioritisation of 2ww patients

Impact:The recovery of performance against the 62 Day standard requires adequate capacity for investigations and treatments both locally and at the tertiary centres. The focus of the recovery plans on prostate and colorectal pathways will have a positive impact on the high number of breaches for these tumour sites and result in improved performance against the 62 day standard.

Cancer 62 Day Performance

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19Breast 9 7 9 6 10 7 67% 100% 67% 83% 90% 86%Lung 4.5 2.5 4 2 3 4 33% 40% 100% 75% 83% 100%Skin 6 12 11 8 16 10 100% 100% 100% 100% 100% 100%Urological (Excluding Testicular) 7.5 14.5 18 11.5 16 21 53% 41% 75% 61% 69% 76%Colorectal 8.5 4 4 2 3 5 35% 13% 25% 0% 0% 40%Gynaecology 2.5 2 2.5 1 4 5.5 100% 0% 60% 0% 38% 55%UGI 0 0 2.5 2 2 4.5 - 0% 100% 100% 100.0% 56%Haematology - 1 1.5 1 2 - 0% 0% - 100% 50% -

Total Seen Performance %

Responsive - Diagnostic Waiting Times Commentary:


18/19 97.9% 97.5% 95.2% 90.3% 91.5% 96.1% 98.6% 98.8% 98.0% 92.0% 92.0% 93.8%

19/20 95.4% 94.9% 96.8% 97.9% 98.4% 98.8% 99.4%

Target 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0%

Trajectory 89.2% 90.5% 93.5% 97.6% 98.3% 98.7% 99.0% 99.4% 99.6% 99.2% 99.6% 99.1%

Target - Within normal variation so may be achieved but not consistently

Trajectory - Within normal variation so may be achieved but not consistently

Patients waiting > 6 weeks for diagnostics

The Diagnostic Target has been achieved over the last 7 weeks reaching 99% and over.

6 week performance for October 2019 = 99.37%. This was last achieved in Feb 2018 and is due to significant hard work within the diagnostic services in all care groups.

1,592 total waiters (1,453 previous month)10 breaches to be reported (18 previous month)Gynae cystoscopy - 3Colonoscopy -7

IssuesCapacity issues within EndoscopyAnnual leave and lack of cover for Gynae Cystoscopys

ActionsReview of Endoscopy and additional lists being undertaken until additional resources can be actioned

(8.0%)(6.0%)(4.0%)(2.0%)

-2.0%4.0%6.0%

Perf

orm

ance

M

ovem

ent

80.0%

85.0%

90.0%

95.0%

100.0%

105.0%

Perf

orm

ance

Data Average Upper Lower Outside Relative to Average Movement Target Trajectory

WL 6+ Wks % <6 WksMagnetic Resonance Imaging 271 0 100.0%Computed Tomography 225 0 100.0%Non-obstetric ultrasound 668 0 100.0%Barium Enema 0 0DEXA Scan 0 0Cardiology - echocardiography 36 0 100.0%Neurophysiology - Nerve conduction studies 25 0 100.0%Respiratory physiology - sleep studies 36 0 100.0%Urodynamics - pressures & flows - Urology 2 0 100.0%Urodynamics - pressures & flows - Gynae 5 3 40.0%Colonoscopy 167 7 95.8%Flexi sigmoidoscopy 56 0 100.0%Cystoscopy 21 0 100.0%Gastroscopy 80 0 100.0%Total 1592 10 0.9937

Oct-19Area Service

Imaging

Physiological Measurement

Endoscopy

99.4%

Use of Resources – Hospital Division – Month 7 Please note these figures do not currently include IUEC but is being developed to include for future so IUEC data is present at slide 17

Next Steps and Areas of Focus: Delivering operating plan of £21.5m Remain within the Demand plan for Acute = Month 5 over performing acute activity due to emergency non elective spells Robust CIP plans for 2019/20, to deliver the £5.2m Robust recovery plan to mitigate financial risk of non delivery at year-end

HEADLINES:

• The Division are overspent in month by £518k this is due to an increased CIP target and additional medinet costs

• Year-end Forecast to be remodelled with additional income and improved position of Acute Management

• Assumes CIP delivery of £5,354k against plan of £4,526k = £828k over delivery

Increased CIP target, additional medinet costs

Use of Resources – IUEC Division – Month 7

Finance 19/20

The overall budget remains overspent as a result of high agency usage, external Consultancy fees, covering 7-day services and increased length of stay Action Plan: • Review and amend nursing and medical

cover for ED, MAU and Urgent Care Service • Gain support from HR with recruitment to

current vacancies • Under achieved contracts will be reviewed

with support from coding • Weekly finance check points meetings are

taking place to maintain grip and control of the financial position

Well-Led - Workforce Scorecard Summary Data based on M7 data

Appraisal compliance as at 30th October;

Sickness absence;

Actions taken to support management plans of absence;

Care Group % as at Oct

CSCD 92.99

Gen Med 92.82

SWCH 89.86

IUEC 54.63

Deep dives with the HR Business Partner into the management of absence continue across the division. • In November, deep dives will be offered for

Outpatients, OPARU and Phlebotomy. • Deep dives have been completed in Appley, Colwell

and Stroke. • Sickness Deep dive rearranged for ED on 6

November

IUEC

Acute

Vision: To Become a Centre of Excellence for Care of the Elderly

Acute Division ‘Operational Plan on a Page’

WORKFORCE

• Development of workforce model

• Workforce Structure

• Development of Staff Engagement Strategy

• Increasing staff morale to improve retention levels

• Recruitment of Overseas Nurses by July 2019

PERFORMANCE

• Operational Model to be agreed and implemented by 31.3.2020

• Systems Resilience through demand and capacity modelling

• Contract Negotiation to improve cancer services and demand growth

• Improve Sickness Absence levels to trust targets

IMPROVED FINANCIAL CONTROL

• Achievement of

financial recovery by Sept 2019 and reducing reliance on locums and agency

• Cost improvement plans fully realised and in place by September 2019

• System opportunities through redesign of service areas within Acute through system sustainability plans

• Capital plans improving productivity with planned improvements to service areas

PARTNERSHIP WORKING

• Integrated

service delivery with key stakeholders to improve patient flow

• Support the Island’s development of Primary Care Networks

• Work with Community to support out of hospital onwards care strategy

DRIVING DEVELOPMENT OF DIVISION AS PART OF INTEGRATED

TRUST • Reconfigured &

reduced inpatient bed base to meet patient demand and support transition to community

• Digital maturity in our back office functions

• Sustainable, locally developed workforce

• Centre of excellence for care of the elderly

We will achieve this through:

Measures of Success: • 30% reduction in Divisional vacancies • 40% reduction in use of Agency/Locum • Reduction in staff turnover • Improved utilisation of acute estate • IT strategy and implementation plan in place to improve IT support across Division • 10% improvement in staff survey results in key improvement areas • Effective financial management – operate within financial allocation in 2019/20

IMPROVING QUALITY

• Quality Improvement training for all staff

• Audit programme plan by end of Q1

• Acute Urgent & Emergency care improvement programmes

• Patient Engagement Strategy

• GIRFT engagement to support efficiencies and ongoing reviews of services

• Accreditation of Diagnostic Services

Page | 1

Agenda Item No 7.2 Meeting Trust Board in Public Meeting Date 12 December 2019 Title Ambulance Performance Report Sponsoring Executive Director

Joe Smyth, Chief Operating Officer, Ambulance and Acute Division

Author(s) Victoria White, Head of Ambulance Service Report previously considered by inc date

Ambulance Divisional Board, 25 November 2019



Information only x Commercial Confidentiality Effective x SO 01: Provide safe, effective, caring and responsive services – ‘Good’ by 2020

x

Review & discuss Patient Confidentiality Caring x SO 02: Ensure efficient use of resources

Assurance Staff Confidentiality Safe x SO 03: Achieve patient standards x

Committee Agreement

Other Exception Circumstances Responsive x SO 04: Achieve excellence in employment



Key Recommendations to be considered: The Trust Board is asked to consider the following recommendations:

• Executive sign off to the proposed service level agreement with South Central Ambulance Service relating to NHSE Core Standards

Enc H3

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Executive Summary Context

• The ambulance service comprises the Urgent and Emergency Service (U+E), Emergency Operations Centre (EOC), NHS 111 service, Patient Transport Service (PTS) and Non patient Transport service, Commercial training and Community Responders, and Emergency Preparedness, Response and Resilience (EPRR).

Key Messages • The service remains at 88% compliant with the Ambulance NHSE core standards for EPRR • The service is not meeting the ambulance response programme standards – the service trialed a perfect week in October implementing capacity to

meet demand. C2-4 performance was met, and C1 response times were significantly reduced. Long waits for ambulance were considerably reduced. The performance was discussed in detail at the November Ambulance performance committee and divisional Board, a workshop was held with SCAS to review urgent care pathways and the service will be working with SCAS to review forecasting and roster compliance before presenting further recommendations

• The programme to implement the new PTS Computer Aided Dispatch (CAD) system has now commenced • A business case is being written to replace the 999/111 telephony system in conjunction with SCAS. An initial meeting between the 2 services is

being planned to review the specification • The National Programme to replace use of radio communications used by ambulance, police and fire is underway. The IOW will be the first

ambulance service in the country to go live. First step in the programme is the implementation of a new control room solution which will take place before December 2019

• The Ambulance Quality Improvement Programme has been reset, and consists of 6 work streams including EPRR, CQC, Carter review recommendations, workforce, training and development plan, divisional/staff communications. First workshop relating to communications took place on 3rd October. Weekly huddles have now been introduced to keep the programme moving along

• The service has completed 71% of the CQC action plan and 79% of the quality strategy and is on trajectory Key Risks

• IT capacity to support the significant upcoming ambulance programmes and day to day operations • 999/111 performance • PTS capacity to support increased in mainland transfers/ timely discharges • Sickness Levels across the front line staff and subsequent impact on resilience, performance and staff capacity • Appraisal rates for frontline staff, and Basic Life Support training compliance for front line staff • Lack of assurance regarding cleanliness of PTS vehicle

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Ambulance Trust Board Report The division’s Quality, Performance and Divisional Board Meetings took place by 28th October 2019. The purpose of this report is to provide an overview of the key current opportunities, issues, challenges or risks affecting the division. Key Items of Information for Trust Board: Quality and Safety: The service remains non-compliant with some NARU cores standards. (88% compliant) The ambulance service and trust EPPR lead have met with

NHSE to review the 167 re-written core standards. A draft SLA has been received by SCAS which will address a number of the remaining non-compliant areas. Areas outside of the SLA that remain unresolved are numbers of trained staff required for MTA and the medical forward plan

Ambulance Appraisal at 72.02% Mandatory training at 85% 1 new SI’s declared in October, No new risks over 12 opened, 1 risk closed, 2 new complaints received in October The service has experienced continued issues with the telephony and connectivity of the electronic patient care record. The current telephony system

does not support the requirements of a modern 999/111 control room. A business case is being written to replace the system, and the service will work with SCAS to achieve this

CQC Inspection Report - Actions plans regarding the 2 must do and the 11 should do’s have been put in place with progress being monitored through the ambulance quality sub committee and divisional board. Currently the service has completed 71% of the CQC action plan however there is still a lack of assurance relating to the cleanliness of the PTS vehicles which was escalated through to the ambulance divisional board. Plans have been put in place to improve the systems and processe, along with robust auditing to assure compliance

Operational Performance: The October performance for the 999 Ambulance Response Programme (ARP) standards and NHS111 standards are attached below and were

discussed in detail at the Ambulance Divisional Performance subcommittee and Ambulance Divisional Board Performance for 999 has deteriorated over the summer, and whilst August saw a slight improvement across all standards, the performance

deteriorated in September. However performance in October improved slightly. Standards are not being met consistently across the service. The service commissioned a capacity modelling report through SCAS which demonstrates that the service is under capacity in relation to fleet/crews

in order to meet the national standards consistently. The service implemented a perfect week w/b 5th October which modelled the resourcing advised in the report and measured the impact on

performance and business as usual during this week. High level results demonstrated the service achieving C2, C3 and C4 standards, and whilst C1 standards were not met (the report predicted this), there was a significant reduction in the response times for life treatening calls. The was a big reduction in long waits with long waits almost being eliminiated. Initial staff feed back was that that they felt safe.

The service has conduced a review of the perfect week, and has subsequently undertaken a joint workshop with partners in SCAS to review ambulance urgent care pathways which would reduce ambulance conveyance to the emergency department. The outputs from the workshop will form

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an action/implementation plan and the final operational model to sustainably meet the ambulance response times standards, improve the patient anfd staff experience and reduce avoidable hard from long waits willl need to be finalised and agreed within the trust and with commissioners

The service also has plans to review roster and forecasting compliance for the frontline with SCAS to determine any oppurtunities to increase resources on each shift

The NHS111 performance standards are also attached in appendix 1 and demonstrate a slight improvement in the call handling standards. The service has further vacancies which will impact on performance. Recruitment is underway to fill these positions

The Patient Transport Service continues to operate with a manual workaround for their CAD which has been in place since October 2018 in place since the 999 CAD implementation and has now implemented a manual collection of reporting data. Progress is underway to implement the PTS CAD. Performance information will be submitted to future trust board meeting

Programme items: The programme to implement the new PTS Computer Aided Dispatch (CAD) system has now commenced – this is being implemented in conjunction

with SCAS. Integration of Electronic Patient Care Record to the CAD is now complete although there have been significant connectivity issues recently. A review

is underway to determine cause and sustainability. The contract runs out with the existing supplier on the 31st March 2020. A business case is being written to replace the 999/111 telephony system in conjunction with SCAS. An initial meeting between the 2 services is

being planned to review the specification. This is a critical system within the trust. The National Programme to replace use of radio communications used by ambulance, police and fire is underway. The IOW will be the first

ambulance service in the country to go live. First step in the programme is the implementation of a new control room solution which will take place before December 2019

The Quality Improvement Programme has been reset, and consists of 6 work streams including NARU, CQC, Carter review recommendations. Workforce, training and development plan, divisional/staff communications. First workshop relating to communications is planned for 3rd October

Key Items of Risk:

• IT capacity to support the significant upcoming ambulance programmes and day to day operations • 999/111 performance • PTS capacity to support increased in mainland transfers/ timely discharges and future operational model for conveying appropriate Category 3 and 4

non urgent, non bluelight patients • Sickness Levels across the service and subsequent impact on resilience, performance and staff capacity • IP+C compliance • Appraisal rates • Resussitation rates

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Performance Summary

Initial Performance report October 2019

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WORKFORCE SCORECARD – Ambulance Division Summary

* Sickness data – Oct 2019 **Appraisal data –Oct 2019 *** Mandatory Training –Oct 2019

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Overall Financial Position – M7 2019/20

Subjective

Class Budget Actual Variance Budget Actual Variance

PAY 695,884 657,178 (38,706) 4,535,852 4,568,816 32,964

NON-PAY 191,894 198,606 6,712 1,309,930 1,291,490 (18,441)

INCOME (26,973) (32,879) (5,906) (188,811) (193,932) (5,121)

Grand Total 860,806 822,906 (37,900) 5,656,971 5,666,374 9,402

In month (£000s) YTD (£000s)

CIP Progress 2019/20

DivisionCIP Plan

£'000BLACK (Gap)

RED AMBER GREENTOTAL

Recurrent planForecast Rec. Achievement

Plan to date

Delivered to date

Ambulance 345 32 0 0 313 313 336 68 145

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CQC action plan

Enc H4


Title Community Division Performance Report

Sponsoring Executive Director Alice Webster, Director of Nursing, Midwifery, AHP’s & Community Services

Author(s) Nicola Longson, Deputy Director of Out of Hospital Services


Community Divisional Board (19.11.19) Community Quality and Performance Meeting (19.11.19)

Key Recommendation

The Trust Board is asked to: • Note the update provided• Receive assurance on performance in relation to CQC key lines of enquiry





X



Committee Agreement





X

Executive Summary SAFE • Mandatory training compliance rates are reported at 91% . The Division continues to perform above the target of 85%. • In support of the above point, Community Nursing staff have all received the following training, showing significant progress:

o Leg Ulcer & Doppler training o 2 day diabetic training o Refresher SystmOne training o Refresher training given for Chest Drains, EOL care

• Following previous concerns raised regarding 125 overdue incidents, a divisional zero tolerance approach has led to a very significant reduction, only 28 remain all of which are appropriate to hold open. This has been achieved with concerted effort from staff across the Division and direct support from the Datix team to achieve this. Details are set out in Appendix A.

• Appendix B shows how the Division continues to maintain excellent performance on pressure ulcers with over 1 year of no Category 4 pressure ulcers developed under our care, and over 2 years with no reports of a Category 3 pressure ulcer developed under our care.

RESPONSIVE • A Community Division proposal for the Winter plan was submitted to Execs/CCG/Council for funding consideration in September, these

opportunities to support Urgent Care pressure are under consideration by the A&E Delivery Board. • The Physiotherapy Service delay in inputting activity data is being addressed and good progress has been made - a plan is in place

and the position has already reduced from 71% (July) to 48% (Oct). In addition, the Physiotherapy leadership are working with HR to help address recruitment shortages.

• Community Nursing are reporting an increasing caseload for Phlebotomy with referrals coming through Primary Care (359 visits in October). Last month it was reported that the service was deferring high levels of visits to cope with current demand and Phlebotomy referrals will be adding to this pressure. Work is underway to review this and identify required mitigation.

• The Sexual Health service have addressed the HIV consultant gap. This is being provided in partnership with NHS Solent.

2

Executive Summary

CARING • The Community Division has a flu plan in place with 47.74% of staff recorded as having received the flu jab by the end of November.

Rigorous monitoring and reporting now in place across all services. • Last month it was reported that divisional MES response rates were low and a focused piece of work is underway to improve patient

engagement and reporting of outputs. This is being supported with a volunteer working across Community Nursing, Continence and Orthotics & Prosthetics to improve MES responses.

• Community Nursing reported excellent performance on the outputs of 24 Mortality Reviews, as set out in Appendix C. EFFECTIVE • Of the 20,620 contacts made in September 2019, there were no complaints received. Following effective use of the ‘SWARM’ process

to unpick recent issues identified with Regaining Independence beds, the Division is looking to embed the process to further improve compliance with managing complaints.

• The Clinical Effectiveness Committee gave positive feedback to the Community Division regarding its input - ‘Steph was very good today and gave a really good account of community as a whole and considering where you started you are now starting to lead the way’.

• The Community Division are working to understand the impact of the Acute Outpatients Programme. Any decisions to shift clinics in to Community settings may lead to increased workload in Community Clinics and a shift in resource may be required as a result.

3

Executive Summary

WELL-LED • The monthly Pulse Survey response rates were previously reported as low, however the Division has seen a steady increase in

positive responses to ‘Communication is effective between senior managers and staff’. • Positive progress is being made with the implementation of the Division’s staff engagement strategy - 3 successful ‘Community

Conversation’ events were held in November engaging 150+ staff in development of Divisional strategies/plans and future approach to staff engagement. Great feedback received eg. “I feel the group work was a great way to meet other members of the community team and to relay our views and opinions on to the senior team”.

• Excellent risk management performance has been reported in month with 96% of risks reviewed within timeframe and only 4.5% of risk actions overdue. The division is fully compliant with corporate targets, see Appendix D for graphical representation.

• The Division is leading the Trust’s participation in the following collaboratives: o Act Now Home First o Pressure Ulcers o QI (Orthotics & Prosthetics)

WORKFORCE & INNOVATION • Appraisal compliance rates remain above target at 97.31%. Work with the corporate team to understand and address data anomalies

is ongoing and data sets are now more aligned (corporate figures reporting 90.21% compliance as at 31/10/19). • As part of the development of the Island’s locality working, the 0-19 service working across the south of the Island are now co-located

in the Barracks Locality Hub in Sandown. Good engagement and support experienced from partner organisations during the move. • The Division has been actively promoting the Annual Staff Survey to all staff via series of messages/posters showing progress over the

last 12 months in the areas highlighted in the 2018 survey. Current take up as of the 25th November was 44%. • The Divisional vacancy level has been halved in last 12 months, meeting the recruitment related target in the Divisional Strategy. In

December 2018 the Division had 72 vacancies, and in October 2019 this has reduced to 22 vacancies. • Following concerns raised by the Acute Division on vacancies in the Occupational Therapy service, investigation has identified there

are currently 4 vacancies across Acute & Stroke OT team out of 18.35 staff. Staff are working extra hours to meet current demand. • Demonstrating excellent workforce management, the Orthotics & Prosthetics service have implemented an improved skill mix to the

team, to enable a Trainee and Extended role Assistant Practitioners to hold their own clinics for simple orthoses.

4

Executive Summary

FINANCES • The month 7 financial position of the Division sees a small underspend of £48k against the forecast and the division are on track with

delivery of CIP. The end of year forecasting exercise based on year end run rate leaves the Division with a £608K deficit and work is ongoing to review and address this.

• The Continence Service have conducted a Value for Money review on product costs compared to last year, identifying % decreases as follows: o Residential Homes 6.7% o Nursing Homes 5% o Own home 4%

COMMUNITY RISK The Division currently has no high scoring risks to escalate.

5

Appendix A Extract of Community Division Quality Report

Live issues/concerns • As of 15 November 2019 there were 29 overdue incidents compared to 125

overdue incidents outstanding as of 17 September 2019 • Of the 29 incidents 28 have mitigating circumstances: • 4 x SI’s • 11 unstageable pressure ulcers • 6 x with line handlers in other division’s • 2 x were due on the day of this report being pulled • 2 x open due to SWARM investigation • 1 x being managed as a CCG SI • 1 x safeguarding referral • 1 x cannot be closed as notes have gone missing

The 1 that does not is:

• 1 x pressure area category 2 – all information added to Datix but needs closing down.

Appendix B Extract of Community Division Quality Report

Safe

Safe Service Provision

Key Performance Indicator 2018/19 Actual YTD

Actual Month

Patient Falls

Patient falls per 1000 contacts 0.68 0.56 0.17

Patient falls - Community 143 58 3

Pressure Ulcers

Pressure Ulcers Grade 1 11 1

Pressure Ulcers Grade 2 147 56 4



Category 2: • 2 developed - 1 x in rehab setting, all appropriate management put in place. 1 x patients home under DN care, all

appropriate management put in place. • 2 deteriorated – 1 x ulcer deteriorated, all appropriate action taken. 1 x was unstageable, following review it was

cat 2. all appropriate action was taken, Category 3 – deteriorated to 3 from 2. Patient knows the risk but chooses to live in their chair. They are known to have MS. Cluster review next month to be able to give assurance and plan of action. This will be fed into this report form December. Good News: • The division is still maintaining our position of over a year since reporting a category 4 developed under our care

and 2 years without reporting a category 3 developed under our care.

Appendix C Extract of Community Division Quality Report KPIs (taken from Mortality Reviews and therefore 2 months prior)

SEPTEMBER Community Nursing Service Totals

NE SW W&C Number of deaths reviewed

6 (involved with 4) 9 (Involved with 8) 9 (Involved with 7) 24 (19) - % figures from lower total

Evidence of recognition 4 8 7 19 (100%) PoC in place 4 6 4 14 (74%) PPC identified 4 8 7 19 (100%) PPC met 4 8 7 19 (100%) Communication with patient

4 8 7 19 (100%)

Communication with family / important other

3 6 6 15 (79%)

Appendix D Community Risk Management position @ 12/11/19

Performance since introduction of Community risk management process

Risks reviewed within timeframe Target 90% Actual 96% Best performance to date

Risks actions overdue Target <10% Actual 4.5% Best performance to date

0%

5%

10%

15%

20%

25%

30%

35%

0%

20%

40%

60%

80%

100%

120%

Enc H5


Title Performance Report - Mental Health & Learning Disabilities Services

Sponsoring Executive Director Dr. Lesley Stevens, Director of Mental Health and Learning Disabilities

Author(s) Sue Nelson, Business Manager Mental Health and Learning Disabilities Report previously considered by inc date

Based on data and reports considered in the Mental Health and Learning Disabilities Board 27th November2019

Key Recommendation

The Trust Board is asked to take assurance from the current performance position of the Mental Health & Learning Disabilities Service.




Effective x SO 01: Provide safe, effective, caring and responsive services – ‘Good’ by 2020 x

Review & discuss Patient Confidentiality Caring x SO 02: Ensure efficient use of resources x Assurance x Staff Confidentiality Safe x SO 03: Achieve patient standards x Committee Agreement


Responsive X SO 04: Achieve excellence in employment x Trust Board Approval

Well-Led x SO 05: Implement the Isle of Wight Health & Care Sustainability Plan x

1

Executive Summary

• Partnership work with Solent NHS Trust is progressing well, with the development of a Memorandum of Understanding. A draft will go

to private Trust Board this month. As part of the partnership arrangements Gordon Muvuti (Operations Director, Mental Health) is now working alongside our senior leadership team on the Isle of Wight. His role is to support the partnership, share learning and clinical practice across the two trusts.

• Pressures on beds and acute services continues.

• RTT performance for OPMH remains a challenge. The action plan developed to address the issues is being taken forward by the Service Lead and will be monitored weekly by the Senior Leadership Team.

• Progress continues with work towards completion of actions on the CMHS Warning Notice. Solent NHS Trust have completed a Peer Review, and the Mental Health Safety Improvement Programme (MHSIP) have supported a team away day in November.

• The MH&LD Board signed off a Coproduction Strategy, and associated action plan for the Division – this sets out our intention to adopt

the Coalition for Collaborative Care’s co-production model. • The MH&LD Board agreed a plan for the development and implementation of Clinical Pathways in services. This work will begin with

the mood and anxiety pathway, which has been agreed, and will be implemented in December 2019.

2

Performance Summary – Effective

sabbatical – plans for some cover in place. Need to review. • Improved performance against CPA 7-day follow-up in month at 100%. Year to date position expected to improve if current

performance maintained. • One breach in October has resulted in performance below target. This was a patient under section 135 of the Mental

Health Act who was assessed and admitted without Home Treatment team involvement in the assessment. • IAPT recovery performance has slipped below target in month. This has partly been due to a focus of booking in new

patients to improve the access rate. This is expected to improve as Psychological Wellbeing Practitioners move on to carrying out treatments as well as assessments.

Performance Summary - Safe

• Percentage of people on CPA with an updated risk assessment within last twelve months is below trajectory . In early

November a change was implemented to the caseload report sent to Care Co-ordinators to identify risk assessment expiring within 4 weeks is improving compliance and latest figures show 82.9%.

• Continued issues in some areas with supervision not being recorded correctly or within required timescale. Work is ongoing to improve recording and the Senior Leadership Team are monitoring closely. Performance is continuing to show improvement.

Performance Summary - Caring

• The Divisional Board has recognised the continued difficulties in getting service users and carers to engage in

feedback questionnaires. The Division is exploring other options for collecting feedback and the most appropriate tools implemented for each service, through engagement with the Service User and Carer forum, and in discussion with Solent NHS Trust.

Performance Summary – Well-Led

• Appraisal performance is improving but rate of improvement remains a concern. Performance is being closely monitored at team level and Divisional Board and a zero tolerance approach has been implemented.

• Sickness absence has increased in October. The highest reason for sickness absence continues to be

Stress/Anxiety/Depression – (25.5%). Split between short-term and long-term sickness is almost even. HR partner will undertake some work to ensure adherence to sickness management policy.

• Completion of appraisals continues to be particularly challenging in some areas which has negatively impacted on overall

compliance. A high number of new starters and imminent leavers is also reflected in the low compliance.

Performance Summary – Responsive

• Children and Young People (CYP) Eating Disorders - there were 2 completed Urgent Pathways within the quarter 2. One on these was outside of the target time resulting 50% achievement.

• The dip in performance against the IAPT access rate target was expected due to staff leaving and new trainees starting. This is beginning to improve as trainees are taking on caseloads for assessment and treatment.

Performance Summary – Responsive

• One CAMHS long wait impacted on RTT performance. Validation has identified that this is an administrative error and this

has been corrected on the system.

• One long wait for a patient on an RTT pathway in July for Adult MH has impacted on YTD performance. Currently there are no Adult MH patients on RTT pathways.

• RTT performance for OPMH remains a challenge. An action plan has been developed to address the current long waits and will be monitored by the Senior Leadership Team.

Community Mental Health Team Warning Notice Progress

• 93% of actions on the CQC warning notice action plan were complete at the end of October, and progress against this continues to be monitored weekly by the Division Senior Leadership Team.

• Total caseload continues to reduce in line with trajectory . • There was some slippage in compliance with Risk Assessments

for patients on CPA. A change has been made to the caseload report for Care Co-ordinators (CCO) to identify risk assessments due to expire within 4 weeks which has enabled staff to plan in a timely way. There has been significant improvement in CCO compliance during November and this will be reflected in the overall figures next month.

• Solent NHS Trust have completed a Peer Review, and the Mental Health Safety Improvement Programme (MHSIP) have supported team away days. Feedback from both was similar:

• Rapid and significant progress has been made in reducing overall team and individual care co-ordinator caseloads and waiting lists

• Good practice in the Nurse Led Clinic • Caring and compassionate staff, but they are feeling tired,

and confused about the changes, which have been driven from the top down.

• Staff feel distant from the senior leadership in the division and trust.

• Wellbeing service is a positive improvement, but more work needed to build relationships across services.

• One Consultant Psychiatrist post within CMHS is currently vacant and without agency cover in place. This together with sickness in the medical team has impacted on capacity to review Consultant caseloads.

9

Workforce Summary

October 2019 MHLD Divisional Board 10

Finance – Month 7 position

11

Risks

• The Divisional Risk Committee met in November, it was agreed to add one new risk in relation to the Procurement of the Community Wellbeing Service. No risk were closed.

• The MH&LD currently has a total of 45 risks on the register, 9 of which are rated as high. • It was identified that a number of risks had not been updated. Plans were agreed to ensure risks are reviewed in line with

policy and this will be closely monitored.

12

Strategic Developments and Service Transformation • Work to progress transfer of Mental Health Crisis Calls to the mainland 111 Hub continues. There may be some delay in

planned go-live as Paris training for mainland 111 Hub staff has not yet been delivered. The Paris Team is waiting for SCAS to confirm their availability for training.

• A full review of the mental health electronic patient record has been agreed to consider future use of Paris or possible

change to another system, for example, System One which is used by Solent. • Work has begun to consider and develop a new medical model across the Division. A diary exercise has been completed

by medical staff in the Division in November. This will be taken forward as quickly as possible in order to address continued recruitment difficulties to Consultant Psychiatrist posts across all services and reduce reliance on agency Consultants.

• Learning Disability Integrated service strategy update was presented to the Learning Disability Programme Group and was well received. The Learning Disability Integrated team are planning a “meet and greet” in December.

• The future service development of Woodlands continues to be progressed via the fortnightly meetings Mental Health Recovery Pathway Meetings involving both the CCG and local authority.

• Work has commenced on reprovision of acute dementia service. Work is in early stage of development for new dementia

outreach service with support of NHSE/I expert. Carers are engaged in planning.

• The MH&LD Board agreed to implement a Smoke-free policy in Sevenacres in 2020. The physical health working group will lead the implementation.

13

Strategic Developments and Service Transformation • The MH&LD Board signed off a Coproduction Strategy, and associated action plan for the Division – this sets out our

intention to adopt the Coalition for Collaborative Care’s co-production model:

We will involve service users and their families from the earliest stages of service redesign, and at all stages of care and planning. We will know we have achieved this when: • All services can evidence that they take a collaborative approach to risk assessment and care planning. • All services can demonstrate that they actively seek to understand and improve the experience of people who use

our services. • All service transformation work has been undertaken in collaboration with people who use the service, from the

outset and throughout.

• The MH&LD Board agreed a plan for the development and implementation of Clinical Pathways in services. This work will begin with the mood and anxiety pathway, which has been agreed, and will be implemented in December 2019.

14

“Co-production is a way of working that involves people who use health and care services, carers and communities in equal partnership; and which engages groups of people at the earliest stages of service design, development and evaluation. Co-production acknowledges that people with ‘lived experience’ of a particular condition are often best placed to advise on what support and services will make a positive difference to their lives.” (Coalition for Collaborative Care - A Co-production Model)

Page | 1

Agenda Item No 7.3 Meeting Trust Board in Public Meeting Date 12 December 2019 Title Workforce Performance Report Sponsoring Executive Director

Julie Pennycook, Director of HR & OD

Author(s) Rowena Welsford, Deputy Director of HR Donna Parkinson, Head of Practice Education & Development


HR & OD Committee – 11 December 2019 Performance Committee – 11 December 2019




X


Assurance x Staff Confidentiality Safe X SO 03: Achieve patient standards

Committee Agreement

Other Exception Circumstances Responsive X SO 04: Achieve excellence in employment X



X

Key Recommendations to be considered: The Trust Board is asked to receive the report

Enc I1

Page | 2

Executive Summary Headlines from this report are: • Turnover 10.95% is below regional average – revised exit interview underway to understand reasons for leaving • Rostering compliance has showed significant improvement at ward level • Reduction in agency spend £48k in M7 • 72.3% of temporary staff utilisation (bank& agency) is within the Nursing staff group, this level is maintained against 72.3% in Month 6. • Overseas RN recruitment is 119 FTE; 69 currently being processed; 41 Deployed; 9 conditional offers (pending ILETS) • Bank usage decreased and agency usage increased in month and this is reflective of the increase in sickness absence. • Trust sickness absence rate: 5.50% in month (decrease from 4.69% M6). Impact BP’s of sickness deep dive. Highest reasons for absence:

Anxiety, Stress & Depression – action to address in place • Mandatory Training compliance – 84% • Appraisal rate reset from 1st April 2019, currently YTD 78%.


Workforce Performance Report Board

11 December 2019 (October Data)



Headlines: M7 Data

HEADCOUNT: 3316 (2841 FTE)

VACANCY RATE: 8.6 % SICKNESS

ABSENCE: 5.5% FTE days lost 4814

APPRAISAL: 78% TURNOVER RATE: 10.95%

TEMPORARY STAFFING USAGE FTE: BANK 165 / AGENCY 105

MANDATORY TRAINING : 84%



Workforce FTE Budget Establishment: 3115

In-post : 2841 (2756 M6)

Bank Usage: 165 (173 M6)

Agency Usage: 105 (88 M6)

TOTAL: 3111 (3017 M6)

Variance: -4 (-84 M6)

Sickness Absence:

5.5% (4.69% M6)

5.27% YTD 4% Target

Turnover: 10.95%

(Rolling 12 months)

Appraisal Compliance:

78% 95% Target

Mandatory Training:

84% 85% Target

Vacancy Factor:

8.6% (10.3% M6)

October 2019 data (Finance data includes CIP within establishment)

• The Trust employs 3316 (headcount) substantive full

and part time staff, 400 bank workers with additional support provided by 300 volunteers. Corrective adjustment to substantive staff reported in M6 (with a positive impact M7)

• Clinical substantive staffing has increased in month due to the continued transition of overseas nurses from supernumerary HCA’s to substantive RNs

• Sickness absence rate: 5.5%. 4814 FTE Days Lost (4.69% M6). Stress Anxiety & Depression remains the highest cause of absence, with 31% of total Trust sickness (29.3% M6)

• Mandatory training currently at 84% • 72.3% of temporary staff utilisation (bank& agency) is

within the Nursing staff group (same as M6) • Saving Nursing Master Vend £48k in M7 • Overseas RN recruitment is 119 wte; 69 currently

being processed; 41 Deployed; 9 conditional offers • Turnover decreased to 10.95% remains lower than

regional average of 14%, revised exit review underway to understand reasons for leaving

• Vacancy Factor: 8.6% a reduction against M6 (10.3%)

Workforce Trust level Metrics: M7




Overall organisational compliance: • below target at 78.25% albeit areas of

good practice in Acute, Community Services & Corporate Nursing. Outliers, particularly Ambulance, Mental Health and Finance/Estates & Facilities in focus for remedial action

• MH/LD and Ambulance showing steady improvement.

Medical & Dental compliance: • Appraisals due for completion and

completed July 2019 – September 88% • Appraisals completed for appraisal

period (1 Apr 2019–31 Mar 2020) = 82% Evaluation of appraisal quality & process underway in advance of 2020-21 round

Training & Development: Appraisal

Trust compliance at 31.10.19 (excl. medical/dental)



Outliers – Staff Group: • BANK - Staff actively working but with low compliance to be contacted and given 2 weeks to achieve 85% or will be

unable to book shifts via Allocate ME app • Estates and Ancillary - Compliance remains below target (11%) • Medical/Dental – slight reduction to 75% • Junior Drs – Increase of 12% in the past 2 months Outliers – Course: • Moving and Handling – All provision is under review • Resuscitation - Compliance up 1% from last month. Enough spaces have been provided throughout the year to

achieve compliance and course bookings are very high for the rest of the year and into 2020

Training & Development: Mandatory Training



Summary

• Month 7 sickness rate is 5.5%. This is an increase compared to M6 (4.69%).

• Mental Health First Aid Training; The Occupational Health Mental Health Practitioner is undertaking ‘train the trainer’ training during December 2019 and January 2020 to enable cascade of this training across the organisation in the new year

• Line manager workshop to support staff with their mental fitness and wellbeing is being piloted in December 2019 with plans to roll this out in 2020 to help managers build confidence to support individuals who may experience stress, anxiety and depression.

• Health and Wellbeing Campaign to be launched in January 2020 using the hashtag #thrive. The Communications Team are working with Occupational Health and HR on a campaign to promote the organisations commitment to improving staff health and wellbeing.

• Health and Wellbeing open day planned for Wednesday 27th November 2019. The day will include promotion of the Protect Flu campaign and a focus on the Menopause at Work.

Workforce Metrics – Sickness Workforce Metrics - Sickness



Workforce Metrics – M1 Plan

• Agency utilisation is 105 wte in M7 and has increased against M6 88wte. This is due to opening additional beds in Day Surgery and additional staffing for ED.

• Bank use is consistent month on month and we have seen an increase in fill rate.

• Substantive staffing has increased in month due to the on boarding of the second cohort of overseas RNs as per the plan and also a further 10 RN appointments

Workforce Metrics: M7



• Benefit realisation of Nursing Master Vendor Agency Spend M7 = £48k Nursing: • Registered Agency Nurses fill rate October 19 = 97%

• Agency nurse spend has increased in M7 and this is due to delays in accrual of invoices and the use of pool nurses to open the Discharge lounge and there was increased requests for ED

Medics: • Spend has decreased in M7 due to a reduction of requests in ED and an alignment of invoice accruals . • We have secured Locums for Consultants in Stroke and Gastro and this will increase spend in November due to high pay rates for these

specialities

Workforce Metrics – Agency/Bank Headlines

0

200

400

600

800

1,000

1,200

1,400

Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19

£'00

0

Monthly Agency spend per month Medical Nursing Clinical Administration



• RN plan takes into account the overseas RN recruitment is 119 wte; 69 currently being processed; 41 Deployed; 9 conditional offers

• RN retention in the month is better with fewer RN leavers than plan and recruitment of RN is better in month than plan. RN recruitment is slightly behind year to date by 3 wte. Deep dive into RN leavers required to understand reasons for leaving and actions required to improve retention

• The gap is still being mitigated through the continued use of temporary staffing and we will continue to see a reduction as the overseas nurses are deployed.

RN recruitment and retention Performance against 2019/20 plan



• Reduction in month due to over inflation of in post figures for M6.

• Offers made to: Specialty Doctor in Anaesthetics & ICU, LAS ST3 Cardiology, Specialty Doctor Urology, LAS FY2

• New starters: LAS Core Trainee in Psychiatry, LAS Core Trainee in Medicine, Locum Consultant Paediatrician, Consultant Ophthalmologist

• Interviews planned for Trust FY2 General Medicine and Specialty Doctor General Medicine

• Recruitment to gaps has been very successful, with further plans to reduce vacancies. As at M7, there are now 4 trainee gaps in Medicine due to withdrawal of offer.

Medic recruitment and retention Performance against 2019/20 plan


Enc I2


Title Director of Nursing, Midwifery, AHPs and Community Services report to Trust Board

Sponsoring Executive Director Alice Webster

Author(s) Judy Dyos Deputy Director of Nursing Report previously considered by inc date

HR&OD Committee 11 December 2019

Key Recommendation The Board is asked to consider the following recommendations:

Receive this report and consider its contents


Link to CQC Domains



Effective x SO 01: Provide safe, effective, caring and responsive services – ‘Good’ by 2020 x

Review & discuss x Patient Confidentiality Caring x SO 02: Ensure efficient use of resources x Assurance x Staff Confidentiality Safe x SO 03: Achieve patient standards

Committee Agreement


Responsive x SO 04: Achieve excellence in employment x Trust Board Approval


Executive Summary The purpose of this paper is to inform the Board of activities within the Corporate Nursing The purpose of this paper is to inform the Board of activities within the Corporate Nursing Directorate over the month of November 2019 ross the organisation. Corporate Nursing has overarching responsibility for the nursing workforce of the organisation. It is a small but diverse area of the organisation that embraces several services alongside its corporate responsibilities; including Medical Electronics, Adult and Children’s Safeguarding, Children in Care Team, Infection Prevention and Control, Dementia and End of Life Care. It has corporate responsibility for the nursing workforce across the organisation

Workforce stabilisation –

• Cohort 5 of overseas arrived in the UK on the 22nd November brining a further 11 RNS staff to trust. This table demonstrates the impact this is having on each ward vacancy levels , with further staff joining us from January through till March 2020.

• Following improvement in rostering overall as demonstrated in agency spend reduction, our roster expert is now focused on improving rostering KPI reporting, utilising SafeCare to full potential and assisting with the implementation of MHOST staffing system for inpatient mental health wards.

• There is a continued issue with band 7 midwives not be added to the roster despite being post , this has been escalated to finance and HR . This make them appear over established

Funded RN

(WTE)

Contracted RN

(WTE)

Nov Overseas Vacancy

ALVERSTONE 11.39 9.4 1 0.99

LUCCOMBE 16.51 12.96 1 2.55

MOTTISTONE 11.39 9.29 0 0.76

ST HELENS 13.66 10.63 0 3.03

WHIPPINGHAM 21.63 12.6 2 7.03

PAEDIATRIC WARD 23.59 19.55 0 4.04

MATERNITY 32.41 37.21 0 Band 7’s not added

SPECIAL CARE UNIT 14.34 11.29 0 3.05

STROKE 21.72 16.93 1 3.79

COLWELL 16.51 12.27 1 3.24

APPLEY 17.79 11 1 5.79

INTENSIVE CARE UNIT 42.29 38.07 0 3.59

CORONARY CARE UNIT 28.46 26.82 0 1.64

EMERGENCY DEPARTMENT 30.8 24.53 1 5.27

MEDICAL ASSESSMENT UNIT 26.79 17.84 2 6.95

Safety thermometer • Our improved levels of harm free

care have been maintained for a second month following the data inputting issue being corrected . 91.3 % against a national average of 94%.

• October falls data put us below national average

• Pressure ulcers is an area of concern however this data includes ulcers that are reported as present on admission.

• We were below average of patient with a new VTE for October

Model hospital • CAS alerts compliance escalated

at Quality Committee in September. 1 now closed

• E- Coli and MSSA following rising national trajectory

• Positive position for C section rates, MRSA cases , C Difficile infection rates and VTE risk assessment

AHP Update

AHPs are making good progress with demonstrating effectiveness. There is much better engagement with clinical audit and we are seeing better reporting against clinical outcomes. Dietetics: Audit of patients on low Kcal (Newcastle) diet trial demonstrate positive outcomes with weight loss, improved control of blood sugar and reduced medications in patients with Type 2 diabetes. We have reviewed AHP capacity and demand against national benchmark in most areas to establish an accurate baseline and to inform service development and improvement. We compare well against national benchmarks with productivity generally higher than the national median, with less staff and better use of support staff. Some areas like Podiatry have high activity levels for the population and we are working with partners to review the pathway to manage demand better. We anticipate future progress from our Orthotics and Prosthetics service on this subject via their participation in an NHSI national improvement collaborative. We are planning to build e-job plans on health roster for acute Physiotherapy and Dietetics over the next couple of months in preparation for this becoming mandatory across all AHPs in April 2021.

Maternity Update

• Gap analysis for Saving Babies Lives 2 completed, staffing recommendation to be reviewed once final report is provided.

• Business case completed for the procurement of two antenatal Dawes Redman computerised cardiotocograph machines (CTG) although an initial cost pressure as part of the rolling replacement on existing machines we can reduce by two. Non compliance will require us to then offer a scan to every woman on her first presentation of reduced fetal movements which we do not have capacity. The Dawes Redman machines will bring us in line with SHIP and Wessex and compliance with both SBL v2 and NHSLA standards.

• Term admission to the neonatal unit in October 1% and an increase to 4.5% November (this should less than 5 %). This is significant improvement on previous months and due to nursery nurses working extremely hard on transitional care and both Maternity and Special Care have presented at the recent maternal and neonatal safety collaborative.

15 Steps

Special Care Baby Unit Very welcoming team with a positive message, evidence of good documentation, resus trolley checks 100%, excellent patient feedback , Support networks for the father being developed after feedback they feel forgotten. Partial accreditation due an door unlocked, Haz tabs not locked away and cleaning schedule documentation not maintained. Intensive Care Unit Patient representative was very impressed . High ordered , very clean . Excellent shared learning board in staff room and well thought out Partial Accreditation 2 days missed on resus trolley checks . Zero tolerance so partial accreditation if this was not found it would have been a full accreditation Planned re-inspections booked in next 8 weeks

Awards and Thanks Congratulations to Christina Ginsburg who won gold in Our Health Heroes outstanding contribution award. Christina works across the Mountbatten Hospice and the Trust to improve the discharge of palliative and end of life care patients Many thanks to Niton Knit and Natter who have made beautiful dementia friendly blankets. These blankets are gifted to patients , and help them to recognise their bed if they wander away from it . The added benefit is that it also helps these patients see the edge of the bed more easily to reduce the risk of falls

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Agenda Item No 8.3 Meeting Trust Board in Public Meeting Date 12 December 2019 Title Medical Directors Report Sponsoring Executive Director

Mr Alistair Flowerdew, Medical Director

Author(s) Dr Jugnu Mahajan, Deputy Medical Director


N/A




X

Review & discuss X Patient Confidentiality Caring SO 02: Ensure efficient use of resources X


Committee Agreement

Other Exception Circumstances Responsive SO 04: Achieve excellence in employment X


Well-Led SO 05: Implement the Isle of Wight Health & Care Sustainability Plan

X

Key Recommendations to be considered: The HR & OD Committee is asked to consider the following recommendations:

To receive the update from previous months Medical Directors report with regard to the GMC/HEE inspection, recruitment, job planning and partnership working with partner trust

Enc L3

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Executive Report 1. Introduction The report highlights the activities undertaken by the Medical Director and his team. Significant focus has been on improving training experience of the doctors in training and also ensuring that safe care is provided at all times including out of hours. The Medical Director has also been leading the clinical partnerships with Portsmouth and other external stakeholders. 2. Recruitment A new management group has been established as a forum to discuss medical recruitment, particularly difficult to fill vacancies. International recruitment company Drake have been commissioned to work on overseas recruitment for medical hard to fill vacancies, with a focus on consultants. Drake were used for the nursing recruitment in the Philippines. Accounts have been created for Doctors.net and the Royal College of Physicians for targeted speciality recruitment Recruitment is a standing agenda item on the weekly Medical Directors Meeting and a new report has been created highlighting the difficult to recruit areas, which is taken forward by the Care Group Directors. 3. Job Planning Our Interim Medical Workforce Lead is working with the PMO to develop a job planning plan to work towards finishing this year’s round by the end of March 2020. This plan will be finalised over the next week. The Allocate Job Planning System needs some housekeeping and Jonathan Shoebridge will meet with the Care Group Directors to help with this so that the system can then be used to report Job Planning status accurately. This will be included in the project plan. 4. GMC/HEE Review GMC/HEE visited the trust on 8th October 2019. Although improvements made since the previous visit were acknowledged there still remained a number of concerns which were highlighted in a letter to the CEO by Dr Paul Sadler. An action plan has been produced and submitted to the HEE on 28th November2019. The action plan outlines firm commitment to commence immediate appointment of extra doctors to provide a second decision maker on call over night and weekends to meet the acknowledged excess workload for the current medical ST doctors. This is targeted to be fully in place by 31 January 2020, but will be implemented sooner if at all possible. GMC has written to the trust updating on their concerns and decision to maintain the current special measures relating to clinical supervision and handover. The Executive team will monitor the action plan closely along with James Adams (Associate Dean) and report progress regularly to the Board and HEE/GMC.

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The trust is very mindful of the potential risk of not meeting the requirement of filling the posts and having trainees removed from the trust in January. On account of the risk, the Medical Director has been tasked to draw up a plan that will have the affected departments employing non-trainees in those posts that the Deanery have indicated will withdraw trainees. The CEO has written to the Postgraduate Dean to seek specific clarification of specialties that will be affected by the withdrawal of trainees as currently it is understood to relate to medical registrars. 5. Clinical Fellow / Trust Doctor Training All our Clinical Fellow/Trust Doctors are given access to Allocate and are required to participate in annual Appraisals. They are also required to complete mandatory training. During their appraisals they will develop a Personal Development Plan for the following year, this is the same for our Permanent Career Grade doctors. 6. Partnership Working The CEO’s of PTH and IOW trusts have endorsed the agreement to recruit with immediate effect a consultant post as Lead for Stroke Services for both Portsmouth and Isle of Wight. The Job Description and recruitment will be led by IOW trust and the respective departments are targeted to go out for recruitment by the end of December/ first week of January. There are a number of other departments that are felt to be key priorities for partnership solutions and these will be actively considered by PTH for acute specialities and Solent for mental health specialties. A group of senior clinicians will be attending alongside PTH senior clinicians at Queen Alexandra Hospital on 9 December for a programme provided by the GMC regarding the management of poor behaviour of doctors. This is a pilot study by the GMC and it is an opportunity for the two trusts to develop a joint learning and development framework for professional matters. There is an intention to have a further session with PPA (Practitioner Performance Advice) which has replaced NCAS (National Clinical Assessment Service). 7. Service development The Urgent treatment centre opened successfully last month and the relocation of Outpatient services went ahead as planned. This will improve patient flow and enhance safe care. The feedback from surgeons attending the new outpatients has been complimentary. 8. Medical Examiner Acute Trusts in England have been asked to set up medical examiner offices to initially focus on the certification of all deaths that occur in their own organisation. The system will also offer a point of contact for bereaved families to raise concerns about the care provided prior to the death of a loved one. The purpose of the medical examiner system is to:

• provide greater safeguards for the public by ensuring proper scrutiny of all non-coronial deaths • ensure the appropriate direction of deaths to the coroner

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• provide a better service for the bereaved and an opportunity for them to raise any concerns to a doctor not involved in the care of the deceased • improve the quality of death certification • Improve the quality of mortality data

The Medical Examiner System is being developed at Isle of Wight NHS and three Medical Examiners (all of whom are experienced Consultants from different specialties) have been recruited with one of them taking a lead role. The Medical Examiners (ME’s) will work flexibly across a 5 day week (Monday – Friday) and the ‘soft launch’ of the system went live 4th November 2019 with the expectation that by the end of January 2020 the system will be operational. This is an update on progress and the first month of the ME system.

8.1 Activity There were 51 deaths in the Trust in November 2019. 48 were scrutinised by ME’s – all since the soft launch on 4th November. There have been 24 referrals to coroner. 17 ‘form 5’ cremation forms have been completed to date – more may be completed retrospectively. NB by January 2020 all ‘part 5 forms’ will be completed by the ME’s and the fee for this will be paid to the Trust which in part this will offset the cost of funding.

8.2 Progress • National templates are used for scrutiny. • Trust mortality/Learning from Deaths screening requirements have been incorporated into scrutiny paperwork to reduce duplication. • Regular communication with regional ME and planned visit from her in January (TBC) • Meetings with the Coroner and Registrars have taken places which were very productive and positive. • Communication sent to Island Funeral Directors introducing ME’s and updating them on the need for payment for part 5 cremation forms to be made

to IOWNHS Trust.

8.3 Current challenges • Awaiting confirmation that Trust indemnity covers ME work. • Ensuring working week cover over holiday period as all the MEs cross-cover with clinical colleagues already - very challenging to then additionally

cross-cover with another group. • Ensuring a consistent Trust-wide process for when to communicate the declaration of an SI with Coroner, we believe there are some occasions when

this is not indicated. A meeting is planned with relevant stakeholders within next two weeks.

8.4 Future challenges • National roll out of ME system across community and primary care– no clarity on funding and organisational responsibility.

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