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Trust Board Papers

Isle of Wight NHS Trust

Board Meeting in Public

to be held on

Thursday 10 December 2020

at

1.00pm

The meeting will be held virtually via Microsoft Teams

See our website for details on how to join the meeting

via the Live Event link:

https://www.iow.nhs.uk/about-us/our-trust-board/2020-

board-papers.htm

Trust Board in PublicThu 10 December 2020, 13:00 - 15:30

To be held via Microsoft Teams and Live Event

Agenda

Meeting Notice

Opening Matters

1. Chair's Welcome and Apologies

Receive Chair

2. Declarations of Interest relating to agenda Items

Receive Chair

Declarations of interest for Board Members are recorded on the Register of Declarations and do not need to be restatedunless there is a specific item on the agenda and which is pertinent to the declared interest.

3. Minutes of previous meeting

Approve Chair

Meeting held on 12 November 2020

Item 3 - 2020-11-12 - Minutes of the Meeting in Public - v2 - 241120.pdf (10 pages)

4. Matters Arising and Schedule of Actions

Receive Chair

Item 4 - Schedule of Actions - Board in Public as at 031220.pdf (1 pages)

5. Patient Voices

Presentation/Video Kirk Millis-Ward

Item 5 - PRESENTATION - Patient Voices.pdf (1 pages)

6. Chair's Update

Verbal-Receive Chair

Item 6 - VERBAL - Chair's Update.pdf (1 pages)

13:00 - 13:01

13:01 - 13:02

13:02 - 13:04

13:04 - 13:05

13:05 - 13:20

13:20 - 13:25

7. Chief Executive's Update

Receive Maggie Oldham

Report Author: Kirk Millis-Ward/Eloise Shavelar

Item 7 - Chief Executive's Report December 2020.pdf (6 pages)

Strategy

8. Transformation Update on Partnerships

Assurance Nikki Turner/Lesley Stevens

Item 8 - Transformation Update on Partnerships Report.pdf (10 pages)

9. Winter Resilience Update

Assurance Joe Smyth

Item 9 - Winter Resilience 2020 21 Update.pdf (3 pages)

Quality & Performance

10. Quality & Performance Committee Feedback

Assurance Tim Peachey


For information : Report10a - Learning from Deaths/Mortality Report

Item 10 - Quality & Performance Committee Feedback to Board - v2 011220 final.pdf (8 pages) Item 10a - Q&PC Report - Learning From Deaths and Mortality Report.pdf (7 pages)

11. Analysis of Quality & Performance section of the Integrated PerformanceReport

Verbal Lois Howell

Item 11 - VERBAL - Analysis of IPR Quality & Performance.pdf (1 pages)

12. Key actions in infection prevention and control testing

Verbal Alice Webster

Item 12 - VERBAL - Key Actions in IPC testing.pdf (1 pages)

13. Emergency Preparedness, Resilience and Response (EPRR) NHSEAnnual Assurance Process

Assurance Joe Smyth

13:25 - 13:55

13:55 - 14:05

14:05 - 14:15

14:15 - 14:20

14:20 - 14:30

14:30 - 14:35

14:35 - 14:40

Item 13 - EPRR NHSE Annual Assurance Update for Trust Board.pdf (3 pages)

14. Emergency Planning re EU Exit

Assurance Steve Parker

Report Author: Steve Parker

Item 14 - EU Exit Board Report 10.12.2020.pdf (3 pages)

Finance & Infrastructure

15. Finance & Infrastructure Committee Feedback

Assurance Caroline Spicer


Report Author: Caroline Spicer, Darren Cattell

Item 15 - Finance Infrastructure Committee Feedback to Dec Board -v3 final.pdf (6 pages)

16. Analysis of Finance section of the Integrated Performance Report

Verbal Darren Cattell

Item 16 - VERBAL - Analysis of IPR FinanceSection.pdf (1 pages)

17. Operating Plan 2021/22 Forward Look

Assurance Darren Cattell

Item 17 - Operating Plan 2021-22 Forward Look v3.1.pdf (2 pages)

People & Organisational Development

18. Analysis of Workforce section of the Integrated Performance Report

Verbal Julie Pennycook

Item 18 - VERBAL - Analysis of IPR Workforce Section.pdf (1 pages)

Digital Transformation

19. Digital Transformation Committee Feedback

Assurance Kemi Adenubi


Item 19 - Digital Transformation Committee Feedback to Board Dec v1.4 - final.pdf (5 pages)

14:40 - 14:45

14:45 - 14:50

14:50 - 15:00

15:00 - 15:05

15:05 - 15:15

15:15 - 15:20

Governance & Risk

20. Audit Committee Committee Feedback

Assurance Phil Berrington


Item 20 - Audit Committee Report for 26 November 2020 - final.pdf (4 pages)

Closing Matters

21. Additions to the Board Assurance Framework (BAF) and/or CorporateRisk Register (CRR)

Verbal Lois Howell

The Board is asked to consider whether any amendments or additions are required to the BAF or CRR

22. Questions from the public on issues raised and covered on this agenda

Receive Chair

23. Any Other Business

Receive Chair

24. The next meeting in Public of the IW NHS Trust Board will be

Information Chair

Date: Thursday 11 February 2021 and will be held via Microsoft Teams and Live Event

25. Supporting Documents for Information

Information

Integrated Performance Report

Item 25 - Integrated Performance Report - 10 December 2020 final.pdf (62 pages)

15:20 - 15:25

15:25 - 15:27

15:27 - 15:29

15:29 - 15:30

15:30 - 15:30

15:30 - 15:30

Trust Board in Public – 12 November 2020 Page 1 of 10

Minutes of the meeting of the Isle of Wight NHS Trust Board

held in public on Thursday 12 November 2020 Due to the current Covid-19 incident and the Government’s requirements for citizens to undertake no non-essential travel and maintain a safe social distance, the meeting took place over Microsoft Teams. All members were able to communicate interactively and simultaneously with all parties for the whole duration of the meeting.

Present Members Non-Executive Directors

Melloney Poole Chair Kemi Adenubi Non-Executive Director Phil Berrington Non-Executive Director

Paul Evans Non-Executive Director Tim Peachey Non-Executive Director Julia Ross Non-Executive Director Caroline Spicer Non-Executive Director Anne Stoneham Non-Executive Director Sara Weech Non-Executive Director Executive Directors Maggie Oldham Chief Executive Darren Cattell Deputy Chief Executive/Director of Finance,

Estates and IM&T Steve Parker Medical Director Lois Howell Director of Governance & Risk Kirk Millis-Ward Director of Communications & Engagement Julie Pennycook Director of People & Organisational

Development (DHROD) Joe Smyth Chief Operating Officer – Acute & Ambulance Lesley Stevens Director of Mental Health & Learning Disabilities Nikki Turner Director of Transformation (DoT) Alice Webster Director of Nursing, Midwifery, AHPs1 &

Community Services Attendees Sarah Anderson Associate Director of Corporate Affairs (ADoCA) Eloise Shavelar Head of Communications & Engagement Isobel Wroe Director of Partnerships & Strategic

Development – South Central Ambulance Service (SCAS)

Observers Pam Fenna Chair of Patient Council (via live event) Laura Cook Care Quality Commission Chris Orchin Chair of Healthwatch Minuted by Lynn Cave Board Governance Officer Members of Staff and Public in attendance:

There were 11 members of the public present according to the Microsoft Live Event link which included members of staff and representatives from the IW Council

These minutes reflect the order items were discussed at the meeting and it should be noted that this may differ from the set agenda.

1 Allied Health Professionals

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The meeting commenced at 1.00pm and closed at 3.35pm Minute No.

PROCEDURAL 20/T/113 APOLOGIES FOR ABSENCE, CONFIRMATION THAT THE MEETING IS

QUORATE AND CHAIR’S OPENING REMARKS The Chair welcomed everyone to the meeting including those members of the public

attending via the Live Event. She requested that all attendees did identify themselves in order to replicate the openness and transparency that would be had as to attendance if the meeting was in person. She also welcomed Laura Cook from the Care Quality Commission who was observing the meeting. Apologies for absence were received from:

• Jay Chappell, Staff Side Representative • Anne New, Staff Side Representative

The Chair confirmed that the meeting was quorate.

20/T/114 DECLARATIONS OF INTEREST The Register of Declarations of Interests holds the various Board members’

interests and is available on the Trust website.

20/T/115 MINUTES OF PREVIOUS MEETING The minutes of the meeting of the Isle of Wight NHS Trust Board held on 8 October

2020 were approved with the following minor amendments:

i. 20/T/1018a) – 2nd paragraph amended to read: ‘He also highlighted that cancer referrals had been impacted ........’

ii. 20/T/104 – 2nd paragraph amended to read: ‘He confirmed that during Covid-19 crisis the Trust Board in Public and Private have been ……..’

iii. 20/T/105 – 2nd paragraph amended to read: ‘Anne Stoneham, Non-Executive Director, also confirmed that the meeting had agreed that limited assurance be assigned to the Estates and Facilities Sub Committee as the subcommittee meeting had not been quorate but had noted that work is continuing across the organisation at pace.

Resolution The Isle of Wight NHS Trust Board Approved the minutes of the meeting held on 8 October 2020 subject to the agreed amendments.

20/T116 MATTERS ARISING AND SCHEDULE OF ACTIONS a) Matters Arising: There were no matters arising.

b) Schedule of Actions:

There were no open actions although

The Chair highlighted that the request was made at the last Board meeting for the data for pre and post Covid-19 attendance was to have been included within the Integrated Performance Report and requested that this be included in the next submission of the report.

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Action Future Integrated Performance Report data to included pre and post Covid-19 data.

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

20/T/117 CHAIRS UPDATE The Chair advised that the risks presented by the 2nd wave of Covid-19

(and the restrictions which needed to be in place) together with winter pressures, the plans for maintaining elective admissions and Brexit would have a significant impact on the organisation and on its ability to implement its recovery plans. She advised that members of the Board recognise the severity of this situation and that this will add to the considerable workloads of the staff throughout the organisation and for the Executive Management team She reminded the meeting that consideration of these risks and the likely impact upon patient safety and the quality of care must remain the priority both for the Board discussions today while also ensuring that the Trust was able to deliver its services in line with its strategy and recovery plans. Resolution The Isle of Wight NHS Trust Board received the Chair’s Update.

20/T/118 CHIEF EXECUTIVE’S UPDATE The Chief Executive presented the report which was taken as read and highlighted

the following:

a) Covid-19 Recovery: She advised that the number of Covid-19 positive in-patients is low and that infection prevention and control measures would continue. These measures include restricting access to the hospital and unfortunately would include reducing visitors’ access in line with best practice and to ensure the safety of patients.

b) 2nd Wave of Covid-19: Following the 1st wave of Covid-19 a recovery plan was implemented and this is now being reviewed against the impact of the 2nd wave and winter pressures.

c) Covid-19 Vaccine: She highlighted that good news had been reported in

the media regarding the vaccine and advised that the team are looking at how this can be rolled out when it becomes available. This work is being undertaken in conjunction with system partners and the third sector.

d) EU Exit: She confirmed that measures are in place to support all staff who

are affected by this with the Medical Director taking the lead.

e) Awards: She highlighted that a number of staff had been nominated for national awards.

• The Trust’s Technology Enabled Care (TEC) Team, alongside project management colleagues and the Care Home Support Team won an award for Best COVID-19 Remote Monitoring Solution at the 2020 Health Tech Digital Awards.

• The Trust has also been shortlisted for a Nursing Times Award in two categories:

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Enhancing Patient Dignity for the opening of the Wellow Unit and the end of life care provided.

Nurse Leader of the Year for Shane Moody, Clinical Director and Consultant Nurse for End of Life Care

f) Flu Campaign: It was confirmed that good progress has been achieved so

far in vaccinating all staff and that current uptake is ahead of the same period last year. She stressed the importance of everyone receiving the vaccine to protect themselves and their families as well as patients and colleagues.

The Chair extended the Board’s congratulations those members of staff who had received or were nominated for national awards. Members of the Board had a robust discussion concerning the various aspects of the report during which the Non-Executive Directors requested further clarity on a number of issues. The Chief Executive and other relevant Executive Directors responded providing additional context and clarity on the various issues raised. Resolution The Isle of Wight NHS Trust Board received the Chief Executive’s Update.

20/T/119 STAFF STORY Members of the Board viewed a video interview concerning Transforming our care

for people living with dementia. This was also viewed by those attending via the Live Event link although it was noted subsequently that there had been issues with the sound link. The Chair thanked the Dementia Team for an excellent video and also the Dementia Champions who will make a significant contribution. Members of the Board noted the progress being made by the team and queried what the next steps would look like. The Director of Nursing, Midwifery, AHPs & Community Services advised it was important to look beyond the patient and to view their wider support system which may include both carers and family to ensure that they are also supported. She confirmed that this approach is being shared across the island wide network to ensure that support is available where it is required. She also advised that there is now a Dementia Steering Group where progress will be monitored. Mandatory training for all staff is in place and work is taking place with the mental health team to ensure that this support is also available in the community. Resolution The Isle of Wight NHS Trust Board noted the Staff Story

STRATEGY 20/T/120 TRANSFORMATION UPDATE ON PARTNERSHIPS The Director of Transformation presented the report which was taken as read and

highlighted the following:

a) Acute: She was pleased to welcome three members to the core programme team who will be supporting the implementation of the plan and providing support to the clinical teams. The partnership plans have been reviewed by NHSE/I who are supportive of the plan and who have offered financial

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support to backfill posts. The plans are now moving into the delivery phase with a key milestone in place for October 2021.

b) Ambulance: The Patient Transport Service Computer Aided Despatch (PTS CAD) system is now live and will enable more effective support for patients. Phase 1 of the new South Central Ambulance Service (SCAS) telephony system will be rolled out across both organisations by the end of February 2021 and work is underway to support the delivery programme to enable phase 2 to commence in Quarter 1 of the 2021/22 financial year.

c) Community: The partner has now been confirmed as Solent NHS Trust which will enable a combined approach to community and mental health and learning disabilities services. The teams are working together to develop a strong relationship with good practices and learning being shared from both organisations.

d) Mental Health & Learning Disabilities: The Mental Health & Learning Disabilities Strategy has now been signed off by the Board. There has been very positive engagement to the strategy and work continues with service user involvement to roll out the programme of work.

The Director of Mental Health & Learning Disabilities provided an overview of the work being undertaken within the mental health & learning disabilities teams to support the strategy and enable the implementation plan to be delivered. Members of the Board discussed the report during which the Non-Executive Directors raised concerns regarding the risks to delivery of the various transformation and partnership plans and requested that these be included within a regular update which includes the risks, mitigations, outcomes and progress within the partnerships. Action The Transformation Update on Partnerships report to included details of the risks and mitigations to delivery of the various transformation and partnership plans together with the outcomes and progress within the partnerships.

Action by: DoT Resolution The Isle of Wight NHS Trust Board received the Transformation Update on Partnerships

20/T/021 ISLE OF WIGHT WINTER PLANNING 2020/21 The Chief Operating Officer – Acute & Ambulance advised that the Isle of Wight

winter plan is a live document which covers the usual measures for winter. It includes surge scenarios for patient flow both within the acute hospital and the wider community and impacts on ambulance transfers and the emergency department. Isobel Wroe, Director of Partnerships & Strategic Development – South Central Ambulance Service (SCAS), outlined the challenges and mitigating measures being undertaken by SCAS but stressed that a similar issues are being seen across the country. She confirmed that the integrated working arrangements seen on the island mean that the Isle of Wight is well placed to manage these issues. Members of the Board discussed the plans with a number of members raising concerns about the potential risks to patient flow within the hospital and the level of support from the wider system to enable effective discharges to take place.

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The Director of Communications & Engagement provided an overview of the range of communication being rolled out to support the health and wellbeing message to the public during Covid-19, Recovery and Winter plans. These include stressing the need for those people who need help to contact 111 First service or their local GP’s before they are too poorly. The Chief Operating Officer – Acute & Ambulance also outlined the measures which continue to be refined as the situation develops and include the integrated discharge team which is a multi-disciplinary team working across the system to facilitate patient flow from hospital to home. He also advised that there would be a focus on how to support frail and elderly people at home The Chair requested that the Board be kept updated to ensure that it is aware of the challenges. Members of the Board noted that this is a live document and supported the approach being taken. Resolution The Isle of Wight NHS Trust Board supported the Isle of Wight Winter Plan 2020/21

QUALITY & PERFORMANCE 20/T/122 COMMITTEE REPORT FROM THE QUALITY & PERFORMANCE COMMITTEE Tim Peachey, as Chair of the Quality & Performance Committee, presented the

report of the meeting held on 30 October 2020 outlining the issues discussed. In particular he highlighted the following: Quality Account 2019/20: He advised that the Committee had discussed the Quality Account and noted the enormous progress which has been achieved in the year. He also confirmed that the Committee were pleased to see the exceptional stakeholder feedback included within the report which was the best set of supporting statements he has ever seen. The Committee are therefore very pleased to recommend that the Board approve the Quality Account for 2019/20. Care Quality Commission (CQC) Preparation: The Committee had also received a detailed report on the Trust preparation for the CQC inspection which outlined the excellent progress which has been made across the organisation. It was confirmed that a risk assessment undertaken to assess the likelihood of not achieving an improved rating had a positive outcome which is encouraging. It is disappointing that the planned inspection has been cancelled but this is understandable under the current national restrictions. Quality Heat Map: An overview of the model was received by the Committee where it was acknowledged that this was a ‘live’ document and that further development is planned. Infection Prevention & Control Board Assurance Framework: He explained that the template for this is provided by NHSE/I with the aim of preventing the spread of Covid-19, and advised that significant progress has been achieved since it went live. Visual Consultations: An excellent presentation was delivered to the Committee on the application and benefits of video and telephone consultations within healthcare provision. Mental Health Act (MHA) Quarterly Report: The Committee has delegated responsibility to monitor the application of the MHA on behalf of the Board and this

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report provided assurance that it is being applied appropriately. Divisional Performance Reports; The Committee received the performance reports from each of the four divisions and which are also included within the Integrated Performance Report attached to the Board papers. Referral to Treatment Times Analysis: The Committee received an analysis of the current waiting list which provided assurance that there were no unknown factors to report, and that good progress was being achieved. Resolution The Isle of Wight NHS Trust Board received the Committee Report from the Quality & Performance Committee

20/T/123 QUALITY ACCOUNT 2019/20 The Director of Governance & Risk advised that in addition to the points just raised

by the Chair of the Quality & Performance Committee, the key themes have continued with significant achievement of the objectives set for the year. Members of the Board discussed the report and it was noted by Caroline Spicer, Non-Executive Director, that within section 1.3.1 of the report that the implementation of an electronic observation system had not been achieved and she queried how this would now be taken forward. The Director of Nursing, Midwifery, AHPs & Community Services confirmed that this is part of the wider digital transformation programme as the Trust had not wanted to introduce a system which would be unable to link with the wider digital platform. The Director of Governance & Risk advised that subject to minor amendments and the inclusion of the management response to stakeholder statements (annex 2) that the Quality Account was here for formal approval prior to submission to NHSE/I. Resolution The Isle of Wight NHS Trust Board Approved the Quality Account 2019/20 and agreed its submission to NHSE/I subject to final amendments and inclusions

FINANCE & INFRASTRUCTURE 20/T/124 COMMITTEE REPORT FROM THE FINANCE & INFRASTRUCTURE

COMMITTEE As the Finance & Infrastructure Committee had not met during October the Deputy

Chief Executive/Director of Finance, Estates and IM&T provided a verbal update on the data included within the Integrated Performance Report which is provided within the Board papers for information. He advised that up to Month 6 funding and excess costs had been received from central government and from Month 7 the Trust would manage its own budget, would receive no retrospective refunds for costs and would be measured against the forecast submitted to NHSE/I for the remainder of the year. For Months 7 – 12 he advised that staffing and agency cost would be a risk to the live budget and could lead to an adverse income/expenditure position. There are mitigations and controls in place at divisional level which would be reported to the Finance & Infrastructure Committee. He reported that creditors were currently being paid to terms which was a huge benefit to local suppliers. He confirmed that all revenue Covid-19 costs had been

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reimbursed however to date not all capital Covid costs had not yet been reimbursed, this presented a risk for the achievement of our Capital Resource Limit and mitigations were in place Additional funding has also been secured for digital outpatient developments and was both capital and revenue funding. Business as usual and Strategic Capital plans were being developed at pace and work within the Investing in our Future (£48m) programme was on track and covered a range of capital programmes. Caroline Spicer, Chair of the Finance & Infrastructure Committee, confirmed that although the Committee had not met that she had discussed the current position with the Deputy Chief Executive/Director of Finance, Estates and IM&T and was reassured that measures were in place moving forward towards year end. Resolution The Isle of Wight NHS Trust Board received the verbal financial update from the Deputy Chief Executive/Director of Finance, Estates and IM&T.

PEOPLE & ORGANISATIONAL DEVELOPMENT 20/T/125 COMMITTEE REPORT FROM THE PEOPLE & ORGANISATIONAL

DEVELOPMENT COMMITTEE Anne Stoneham, Chair of the People & Organisational Development Committee

presented the report of the meeting held on 29 October outlining the issues discussed. In particular she highlighted the following:

a) Integrated Finance & Workforce Performance Report: She confirmed that this is a new format for the report which ensures alignment of the data particularly around workforce capacity and pay, and which is also included within the Integrated Performance Report attached to the Board papers. She summarised the key aspects of the report including risks to recruitment and retention including overseas nurse recruitment, medical appointments, staff sickness and updates on the staff survey.

b) Staff Story: She also reported that there will be a regular presentation by a

member of staff to share their story with the committee.

c) Deep Dive into Exit Interviews: It was reported that an interim report was received due to the impact of the suspension of work during the first wave of Covid-19 and the small sample of data available. A more in-depth deep dive was now being undertaken which would also look at alternative ‘stay’ options to encourage staff to remain within the organisation.

d) Allied Health Professionals (AHPs) E-Job Planning Software Business

Case: It was advised that the Committee had received an update on the business and noted the next stage is an application for funding from NHSE/I. Future governance of this business case would fall within the remit of the Finance & Infrastructure Committee.

e) Medical Directors Report: She advised that the reporting included updates

concerning the General Medical Council (GMC) and Health Education England (HEE) Visit, medical appraisal, medical recruitment and the annual organisational report for revalidation.

f) Junior Doctors Guardian of Safe Working Report: She confirmed that the

report included data for the period April – September 2020 which showed a

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huge improvement in the level of positive feedback received from the junior doctors and acknowledged that there remain challenges during the Covid-19 crisis. She also advised that the Junior Doctors Guardian of Safe Working had expressed his gratitude to the committee for its on-going support. The report presented to the People & Organisational Development Committee is included within the Board papers for information.

g) Director of Nursing Report: She advised that the report includes updates

from corporate nursing, AHPs, midwifery, nursing education and overseas recruitment. She reported that there were challenges within maternity with staff sickness, annual leave and unfilled vacancies but that mitigation measures were in place to support the unit to ensure it remains appropriately staffed.

h) Freedom to Speak Up Guardian Report: She confirmed that the report

included data for the period April – September 2020 which included an update on the changes and measures being implemented to support staff during Covid-19. It also noted a decline in cases of bullying/harassment although an increase in cases within the ‘other’ category was seen. An analysis of the ‘other’ category is being undertaken to break down the nature of the behaviours included. The report presented to the People & Organisational Development Committee is included within the Board papers for information.

The Non-Executive Directors sought clarification around the challenges highlighted by the junior doctors regarding the rotas and how do the issues raised with the Freedom to Speak Up Guardian directly affect change? It was also noted the positive approach taken to ensure the BAME2 Covid assessments were completed. The Director of People & Organisational Development and the Medical Director provided added reassurance on the measures being taken to address these areas. The Director of People & Organisational Development also advised that in terms of the EU Exit measures to support staff, that there was a cohort of 130 who were affected by the measures and were being actively supported by the HR team. Resolution The Isle of Wight NHS Trust Board received the Committee Report from the People & Organisational Development Committee

DIGITAL TRANSFORMATION 20/T/126 COMMITTEE REPORT FROM THE DIGITAL TRANSFORMATION COMMITTEE Kemi Adenubi, Chair of the Digital Transformation Committee presented the report

of the meeting held on 22 October which was taken as read. She outlined that as a new Board Committee it would be monitoring closely the digital transformation programme of work on behalf of the Board. This would include the development of a Digital Strategy, which was favourably viewed by the regulators who agreed with the direction of travel. The Digital Strategy is aimed to be in place by February 2021. She advised that the Chief Digital & Information Officer position has been appointed to with the successful applicant providing support in a joint role between Portsmouth University Hospitals NHS Trust and the Isle of Wight NHS Trust.

2 Black, Asian and Minority Ethnic

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She provided a brief update on the clinical system review and cyber security audit which would be presented to future Committee meetings for review. Resolution The Isle of Wight NHS Trust Board received the Committee Report from the Digital Transformation Committee.

GOVERNANCE & RISK 20/T/127 BOARD FIT & PROPER PERSON RETURN The Director of Governance & Risk confirmed that all Fit and Proper Person returns

for the Board members had been completed and that for governance and procedural purposes the report was submitted for information. Resolution The Isle of Wight NHS Trust Board received the Board Fit & Proper Person Return

20/T/128 BOARD DECLARATION OF INTEREST REGISTER The Director of Governance & Risk confirmed that all declarations of interest for the

Board members were up to date and that for governance and procedural purposes the report was submitted for information. Resolution The Isle of Wight NHS Trust Board received the Board Declaration of Interest Register

CLOSING MATTERS 20/T/129 QUESTIONS FROM THE PUBLIC There were no questions raised in connection with this agenda

20/T/130 ANY OTHER BUSINESS There was no other business.

20/T/131 Supporting Documents for Information The Board received the following documents for information:

• Integrated Performance Report • Reports submitted to the People & Organisational Development Committee

held on 29 October: o Freedom to Speak Up Guardian Report Quarter 1 & 2 o Junior Doctors Guardian of Safe Working Report Quarter 1 & 2

20/T/132 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 10 December 2020 This meeting will take place virtually via Microsoft Teams with the public able to attend via a Live Event link.

Signed: Melloney Poole, Chair Date: 10 December 2020

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03/12/2020

Action due for this meetingAction not yet due

Action OverdueAction Closed

Date of Meeting Minute No. Action No. Action Exec Lead Update & Evidence of Completion Due Date Progress RAG

12-Nov-20 20/T/166 TB/394 Future Integrated Performance Report data to included pre and post Covid-19 data.

Joe Smyth 02/12/20 - The December report includes detail of the pre & post covid analysis data.Propose action is closed

10-Dec-20 Due

12-Nov-20 20/T/120 TB/395 The Transformation Update on Partnerships report to included details of the risks to delivery of the various transformation and partnership plans together with the outcomes and progress within the partnerships.

Nikki Turner 03/12/20 - Top partnership risks are included within the report going to the December Board.Propose action is closed

10-Dec-20 Due

KEY TO RAG STATUS SCHEDULE OF ACTIONS TAKEN FROM THE MINUTES

Trust Board in Public

1/1 11/136

Presentation

Item 5

Patient Voices

1/1 12/136

Verbal

Item 6

Chair’s Update

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of 1

Agenda Item No 7 Meeting Trust Board in Public Meeting Date 10 December 2020 Title Chief Executive Report

Sponsoring Executive Director

Maggie Oldham, Chief Executive Officer

Author(s) Kirk Millis-Ward – Director of Communication & Engagement Report previously considered by including date

N/A

Purpose of the Report Reason for submission to Trust Board in

Private only (please indicate below) Link to CQC

Domain Link to Trust Strategic Objectives 2020-2025

Trust Board Approval Commercial Confidentiality Effective X SO 01: Make our Trust a great place to work and receive care

X

Committee Agreement Patient Confidentiality Caring X SO 02: Work with our partners and our community to improve services

X

Assurance X Staff Confidentiality Safe X SO 03: Deliver high quality compassionate care X Information Only Other Exceptional Circumstance Responsive X SO 04: Make sure our services are clinically and financially

sustainable X

Well-led X SO 05: Join up health and care services by working more closely with our partners

X

SO 06: Invest in building and IT that helps our teams make a positive difference to our island community

X

Key Recommendations to be considered: The Trust Board is asked to receive this update

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Chief Executive’s Board Report December 2020 Each month I will focus on key themes to demonstrate the progress we are making against important priorities for our patients, staff and community.

I will also highlight a number of risks for our organisation as we seek to respond to multiple challenges, including winter, the second wave of COVID-19 and our recovery from the impact that coronavirus has had on our services.

The relatively low level of transmission of COVID-19 in our local community was reflected in the Government’s announcement that the Isle of Wight is in Tier 1 restrictions following the end of national lockdown on 2 December.

We are grateful to the local community and to our staff for the way they have responded to the pandemic - we have all played our part in keeping people safe. Being in Tier 1 is welcome good news for people and recognises the sacrifices that islanders have made to keep infection rates down.

But we are not out of the woods yet, we all need to remain alert and to follow the rules that are in place so that we can continue to keep the number of cases down. Recent events in Jersey show how vulnerable island communities can be. The authorities in Jersey has powers to take action which the Isle of Wight does not, so it provides a reminder of how vigilant we need to be in the months ahead.

The nation received further good news last week as the Medicines and Healthcare Products Regulatory Agency (MHRA) approved the first COVID-19 vaccine for use. At the time of writing this report the Trust is still working through the details but we will work with our partners on the island and the mainland to ensure that every support is given to the roll out.

COVID-19 continues to have a significant impact on our services. There are still people needing hospital treatment who have the virus, we still need stringent infection, prevention and control measures in place and we must all follow social distancing guidelines. This makes delivering non-COVID services more challenging.

1. COVID-19 recovery

The Trust continues with the recovery of services to pre-COVID levels as illustrated by the table below. There is good progress in many areas with activity levels above 100% of what we saw in 2019.

Diagnostic services are recovering well and we continue to address the backlog from Wave 1.

This month’s Integrated Performance Report sets out in detail our progress in delivering the organisation’s recovery plans.

Recovery 08-Nov 15-Nov 22-Nov 29-Nov Outpatients 4 week average

(acute) 91% 81% 97% 91%

MRI 93% 97% 106% 99% CT 123% 117% 116% 119%

Ultrasound 116% 104% 116% 106% Endoscopy 92% 87% 106% 90% Day Case 77% 94% 85% 87% Inpatient 111% 76% 122% 60%

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https://www.bbc.co.uk/news/world-europe-jersey-55161923

Chief Executive’s Board Report December 2020 The area of main concern in the recovery programme is 52 week breaches – people waiting longer than a year for treatment. Progress is being made but there are still over 500 patients who have waited over a year for their procedure. Additional lists are being run at the weekends and delays are coming down. However given the size of the backlog that built up in the first wave of COVID-19, when the NHS nationally instructed hospitals to pause services, will take time to get back to pre-COVID levels.

2. Responding to COVID-19 wave 2

The Integrated Performance Report (IPR) shows that we have seen an in increase in the number of people with a COVID-19 diagnosis in hospital and in our Intensive Care Unit compared to recent months.

My thanks go to the teams across the hospital and in particular on Isolation 1 and in both our Hot and Cold ICUs for their continued hard work. Our escalation plans remain in place to create more bed capacity if the rate of COVID-19 admissions increases.

With our local community in Tier 1 local restrictions it is as important as ever that we control the spread of the virus. This is crucial to maintaining the non-COVID services that we have restored in recent months and we ask staff, volunteers and the public to follow the new local restrictions.

2.1 NHS staff testing for COVID-19

COVID-19 tests for NHS staff without symptoms of the virus (lateral flow tests) are now being made available.

These are being given in batches to patient-facing staff, who then test themselves twice a week at home before coming to work. They are asked to register the results online so that the Trust can report back to NHS England.

These tests are voluntary but we thank everyone who is taking the opportunity to keep themselves, our patients and the community safe.

This testing system was set up and rolled out quickly and effectively thanks to a good deal of hard work from colleagues in Infection, Prevention and Control, nursing, IT, and communications.

2.2 COVID-19 vaccinations

At the time of writing this paper news had just broken that regulators had approved the first COVID-19 vaccine for mass vaccination across the country.

Details of the programme, which is a huge logistical undertaking, are still emerging so we are not in a position to give a detailed update at this stage.

We will however commit to doing everything we possibly can to support this crucial work and will collaborate with our partners on the island and across the Solent to ensure that it is a success.

More information about staff testing and vaccinations will be available in an update from our Director of Infection Prevention and Control (DIPC).

3. Winter preparation

The System Wide Winter Plan for 2020/21 was approved at the November Trust Board.

This plan is a live document that will continue to be developed throughout the early winter period as further information and guidance is received.

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Chief Executive’s Board Report December 2020 Any risk to the delivery of the plan will be monitored through the A&E Delivery Board and Isle of Wight System Silver and Gold escalation groups.

I am particularly pleased about the strengthening of mental health liaison cover in our Emergency Department and the extended opening hours of our discharge lounge to support people to get home as soon as they are able.

Responding to the challenges of winter remains a significant risk for this organisation but a great deal of work has already been done to ensure we are ready for the challenges ahead.

More detailed information about winter resilience will be presented by our Chief Operating Officer (COO).

4. Strategy and partnerships

Our Trust strategy makes clear our commitment to partnership working as one of our four strategic objectives.

Work to strengthen partnerships for Acute, Ambulance, Community and Mental Health and Learning Disabilities Services continues.

An update from our Director of Transformation will outline developments and risks associate with our partnership work in more detail.

However, I would like to add that even with the improvements we have seen to date we have not yet managed to address all of the challenges that have made Isle of Wight NHS Trust clinically and financially unsustainable. Given the scale of challenge we face we continue to work with our partners to find ways to make our services sustainable.

Alongside working with these partners, it is essential that there are strong arrangements for integrated planning and service delivery on the Isle of Wight through our Integrated Care Partnership (ICP).

5. Operational performance

Each month I will provide summary of the Isle of Wight NHS Trust and the Isle of Wight health system’s Operational Pressures Escalation Levels (OPEL) status.

To learn more about what OPEL status means on the NHS England and Improvement website via this link.

Isle of Wight NHS Trust

Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20

OPEL 1 28 31 28 30 24 14 7 7

OPEL 2 2 0 2 1 7 15 21 18

OPEL 3 0 0 0 0 0 1 0 5

OPEL 4 0 0 0 0 0 0 3 0

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https://www.england.nhs.uk/publication/operational-pressures-escalation-levels-framework/

Chief Executive’s Board Report December 2020

Isle of Wight System

Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20

OPEL 1 4 0 8 1 0 0 0 0

OPEL 2 26 31 22 30 31 30 31 30

OPEL 3 0 0 0 0 0 0 0 0

OPEL 4 0 0 0 0 0 0 0 0

I’m pleased to say that our emergency care performance has improved month on month. We saw significant improvement in ED performance for several months during Wave 1 of the pandemic. Pressure increased during September and October but the latest figures show an improvement.

Similarly, our 18 week referral to treatment (RTT) performance has improved with 57.7% in October against 53% in September and 44% in August.

I remain concerned about people who may not be accessing cancer services on the island. We are working with colleagues in primary care to try to encourage people to seek help sooner.

I commend the national NHS campaign aimed at encouraging people to have cancer symptoms checked. The first TV adverts are available online here.

You can find more detailed performance information from our Chief Operating Officer (COO) in this month’s Integrated Performance Report (IPR).

6. Good news 6.1 External awards

Nursing Times Awards

Congratulations to the team on Wellow Unit and Shane Moody, our Clinical Lead for End of Life Care, who were both shortlisted at this year’s Nursing Times Award. Wellow Unit was shortlisted in the Improving Patient Dignity category and Shane Moody was a finalist in the Nurse Leader of the Year category.

HSJ Awards

The Trust’s work with Isle of Wight NHS Clinical Commissioning Group (CCG), Lighthouse Medical, Wessex Academic Health Science Network (AHSN) and Gnosco, has been shortlisted in the Primary Care Innovation of the Year category at the Health Service Journal (HSJ) Awards. The Dermicus App featured helps speed-up skin cancer diagnosis.

Health Business Awards

Our teams involved in an innovative trial of drone technology to deliver PPE and other medical supplies have been shortlisted at the 2020 Health Business Awards. The Transport and Logistics category recognises trusts that have seen improvements in operational logistics and the supply of materials and goods.

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https://www.england.nhs.uk/2020/10/celebs-and-lockdown-heroes-urge-public-to-get-cancer-symptoms-checked-and-attend-routine-appointments/

https://app.frame.io/presentations/4e9f445e-a2a2-46c1-b6a4-4f2e838a6bac

Chief Executive’s Board Report December 2020

NHS Parliamentary Awards

Two people have been named South East regional winners and shortlisted for national prizes. Brian Martin, part of the Technology Enabled Care (TEC) Team, was nominated in the Lifetime Achievement category after 40 years of NHS service. Carolina Lamb was nominated in the NHS Rising Star category for her work as a volunteer at St Mary’s. They go through to the national awards which will be announced in 2021.

Public Service Communications Awards

The work of our Communications and Engagement Team, in partnership with Isle of Wight Council and other local stakeholders has been recognised by the Local Government Association (LGA). The Public Service Communications Awards examine how organisations reach out to their local communities to provide support or improve public services. The Bronze Award in the Unified category was given to recognise the work of a wide range of Isle of Wight stakeholders to support the roll out of the NHS COVID-19 App.

6.2 Record response rate for 2020 NHS Staff Survey

At the time of writing this report, our overall response rate to the 2020 NHS Staff Survey was already the highest it has ever been.

The response rate at the time of writing the report is 58%. I am grateful to everyone who took the time to feedback on what their experience of work has been during these most challenging of months.

I hope to be able to update the Board verbally on our final response rate but the signs are that we will have seen an improvement on last year.

My thanks go to colleagues in Organisational Development who coordinated this year’s campaign and to everyone around the organisation who supported and responded.

There is however still a long way to go to make sure everyone’s voice is heard next year.

We will analyse the feedback we receive and continue to demonstrate to our staff that we will take action to improve things.

6.3 Big improvement in flu vaccination uptake

My thanks go to our vaccinators who have helped to deliver a significant year on year increase in the number of staff having the flu vaccination. There has never been a more important time for us all to help protect our patients and our community by getting vaccinated.

At the time of writing this report we have seen:

• 70% of frontline staff vaccinated • 67% of all Trust staff vaccinated • 4% of staff declined the vaccine

Drop-in clinics are still taking place so we expect this figure to rise further and we are aiming for 90% by 11 December.

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Agenda Item No Meeting Trust Board in Public Meeting Date 10 December 2020

Title Transformation Update on Partnerships for November 2020

Sponsoring Executive Director Dr Nikki Turner, Director of Transformation and Dr Lesley Stevens, Director of MH/LD

Author(s) Dr Nikki Turner, Director of Transformation, Alice Webster, Director of Nursing, Midwifery, AHP and Community Service, and Dr Lesley

Stevens, Director of MH/LD

Report previously considered

by:(including dates)

N/A

Key Recommendations to be considered:

Trust Board is asked to consider the following recommendations:

To receive this report on behalf of the Acute, Ambulance, Community and Mental Health Partnerships.

To note the progress made within all the partnerships in November.

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

Link to CQC Domain

Link to Trust Strategic Objectives 2020-2025

Trust Board Approval Commercial Confidentiality Effective X SO 01: Make our Trust a great place to work and receive care X


X

Assurance X Staff Confidentiality Safe X SO 03: Deliver high quality compassionate care X

Information Only Other Exceptional Circumstance Responsive X SO 04: Make sure our services are clinically and financially sustainable

X


X

SO 06: Invest in building and IT that helps our teams make a positive difference to our island community X

1

8

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Executive Summary

The report below covers all aspects of the partnership work that has been undertaken in November. Partnerships is one of the four strategic priorities outlined in the Trust

Strategy. Progress continues to be made in all four areas.

The Acute Partnership with Portsmouth Hospitals University Trust has focussed this month on:

• Introduction of a programme management structure to drive delivery of programme outcomes

• Progression of stroke priorities into deliverables such as 2 stroke consultants and development of nurse specialist business case

• Engagement of new programme team with service leads

• Appointing a clinical lead for the partnership

The Ambulance Partnership with South Central Ambulance Service has delivered:

• A new booking system for hospital wards, 40% of which are now live

• Review of the governance and contractual arrangements around patients being transferred by hovercraft.

The senior team of Community Services have met with their colleagues from Solent NHS Trust and scoped a high level work plan. This group has also drafted the terms of

reference of the Community Partnership Board which will hold a planning session in December. We must also note the wider work with all partners out in our local

communities that is being directed through the ICP who will help shape the priorities in the next 12 months.

The Mental Health and Learning Disability (MH&LD) partnership is gaining momentum, it has:

• Undertaken a workshop to develop a locality prototype that is being co- produced with community, PC, third sector and local authority.

• Relocated the Integrated Mental Health Hub (IMHH) in partnership with Solent to develop South Block as a location.

• Circulated the new leadership structure and an engagement process in place. This is supported by a Workforce development programme.

• Begun the recruitment process into the Children and Young People’s Mental Health Support Teams.

Looking across the partnerships, the 4 top risks remain the same, but current pressures associated with the second wave of COVID are impacting on the pace of delivery.

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3

• Our partners, both on and off the island have been working with us to

address the challenges of delivering sub-scale services for the Island

population

• The support and contribution being made by SCAS, Solent and

Portsmouth Hospitals is significant and recognised by the Board

• Even with the improvements seen so far, the Isle of Wight NHS Trust still

remains unsustainable clinically and financially in the medium term

• Given the scale of transformation needed, and the underlying

sustainability challenge, further evolution and strengthening of the

partnerships is now needed.

• Alongside working with these partners to develop sustainable solutions, it

is essential that there are strong arrangements for integrated planning

and service delivery on the Isle of Wight through the ICP

• This aligns with the commitment given by the Hampshire and Isle of

Wight ICS to the Island’s partnerships and the national direction of travel

for ICP’s to become statutory bodies by 2022

Development of our partnerships

The goal is for people living on the Island to have

access to high quality, clinically and financially

sustainable services, and for partners in the Isle of

Wight system (through the Isle of Wight Integrated Care

Partnership) to work together to plan and co-ordinate

care for the Island, on the Island.

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4

• Programme Director and PMO team in post, introducing a

programme management structure to drive delivery of programme

outcomes

• Joint ‘Senior Responsible Owners’ SROs to be appointed for each

workstream, responsible for delivering programme objectives

• Draft project plans and project briefs in progress

Acute services – delivery plan

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5

• Job plans and job descriptions completed for joint stroke

consultant posts

• Business plan complete for Stroke Specialist Nursing team

• Partnership board approval to commence recruitment activity for

medical and nursing recruitment in the Stroke Service

• Introductory partnership meetings for 5 x clinical services and 3

x enabling groups

• Partnership approach to locum roles / shifts being explored in

Stroke and General & Acute Medicine

Acute services – achievements

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6

Ambulance services

• Patient Transport Services – system support continues post go live of the

PTS Computer Aided Dispatch System. 40% of hospital wards are now live

with the new booking system.

• A meeting took place in October to review the Urgent and Emergency care

activity of frontline 999 ambulances transferring patients from the IOW to

the mainland using the Hovercraft. SCAS will continue to support pick up

from the Hovercraft in Southsea whilst a contractual review takes place.

• The business case for ambulance digital transformation has been drafted.

Next steps are to complete the full business case for submission to NHSEI

in December. This is on target.

• Further discussions have taken place regarding the requirement for robust

service level agreements, data privacy impact assessments and data

mapping to support the digital programme.

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• Senior teams from the Solent and Isle of Wight have met and a

schedule of meetings are being agreed

• Community Partnership Board terms of reference are in draft for

review at first meeting planned in December

• Co-production of a high level work plan has started

• Interview for Project lead in place for December

• The Community Division continue working with Adult Social Care

and the Primary Care Network

• Wider work with all partners out in our local communities is being

directed through the ICP who will help shape the priorities in the

next 12 months

Community services

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Mental health and learning disabilities – November update

Headlines

• New MH&LD Strategy signed off by Trust Board in October 2020

• Implementation of new model and improvements during 2020/21 and 2021/22

• Solent partnership support with preparation for CQC inspection

• Peer support worker funding - submitted

• LTP Estates workshops underway- Milestone December

• A workshop has taken place to develop a locality/ foot print prototype that is co- produced with community, PC, third sector and Local authority. • The transformation programme has relocated the Integrated Mental Health Hub (IMHH) in partnership with Solent to develop South block as a

location. Quality Impact Assessment has been completed with service users with a mitigating action plan, which is currently under review; further estates work progress on the South block site.

• CQC preparation continues with self-assessment tool and must do’s from last inspection.

• Rehab received final approval to proceed with new model on the 30th September Via Health Overview and Scrutiny Committee

• MH&LD strategy developed, ratified and communicated to all stakeholders and partners

• Transformation acute pathway is reviewing need, demand and capacity- future bed modelling

• Transformation- supporting the LT Estates plan (milestone December) for initial outcome

• Leadership- new structure has been circulated and an engagement process is in place. Workforce development- implementation & OD programme underway

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Mental health and learning disabilities – next steps

What is coming up in the next period: • Further developing a foot print model in the South Locality to implement our ‘No wrong door’ strategy in

conjunction with the local authority, third sector and Primary care. • Finalise work plan on IMHH - immediate estates actions in progress. Short, medium and long term plan is

being developed for the IMHH - linked to interim Estates options. • Implementation of our rehab model and deregister Woodlands. • Currently recruiting to the Children and Young People’s Mental Health Support Teams. CYP development of

visual pathway and finalise development of the website.

• Peer support worker task and finish group development- implementation of trust based model. • Continue to support the implementation of the new leadership structure and the workforce and OD plans.

• Second live engagement event February 2021.

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Risk Mitigation RAG

Probability

RAG

Impact

Current partnerships aren’t able to

demonstrate clinical and financial

sustainable solutions

• Analysis of financial performance, cost drivers and savings opportunities [Jan 2021]

• Discussions with commissioner/regulators on ‘island premium’ [on-going]

Partnerships are not able to address all of

the workforce gaps

• Joint recruitment of posts being planned with PHU [on-going]

• Innovative role design (QI / Education /Strategy / Leadership) [on-going]

• Rotation of staff underway across IWT & PHU [on-going]

• Joint training and development [on-going], Acute, MHLD

• Travel and transport options (helicopter / taxi / accommodation) [Discussion Paper Dec’ 2020]

• Review clinical models / strategy [Post recruitment cycle one March 2020]

• SLA with SCAS for specialist advice where we don’t have staff in place e.g. EPRR

Managing second surge of Covid and/or

winter demand impacts on our ability to

deliver service delivery plans

• Proactively seeking opportunities for short term clinical resourcing [Acute, Nov 2020]

• Additional programme resources have been secured [Acute, Nov 2020]

• Programme design accounting for teams facing winter pressure [on-going, all partnerships]

• Operational and clinical capacity will need to be monitored [on-going, all partnerships]

Delay in access to capital funding to

support service redesign

• The Trust continues to work with NHSE/I to secure timely draw-down of the funding that has been

allocated [on-going]

• Assess clinical redesign within existing footprint [Dec 2020]

• Trust approval to draw down for implementation of telephony project for Ambulance [on-going]

10

Top Partnership Risks

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Agenda Item No 9 Meeting Trust Board in Public Meeting Date 10 December 2020 Title Winter Resilience Update 2020/21

Sponsoring Executive Director

Joe Smyth, Chief Operating Officer, Acute and Ambulance

Author(s) Jo Ferguson, Business Support Acute Report previously considered by including date

n/a




Trust Board Approval Commercial Confidentiality Effective x SO 01: Make our Trust a great place to work and receive care

x

Committee Agreement Patient Confidentiality Caring x SO 02: Work with our partners and our community to improve services

x

Assurance x Staff Confidentiality Safe x SO 03: Deliver high quality compassionate care x Information Only Other Exceptional Circumstance Responsive x SO 04: Make sure our services are clinically and financially

sustainable x

Well-led x SO 05: Join up health and care services by working more closely with our partners

x



The Trust Board is asked to receive this Winter Resilience Plan 2020/21 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. System level monitoring of the plan locally will take place through the Accident and Emergency Delivery Operational Board escalating to the A&E Delivery Board. Oversight of whole health system planning will be led by the Hampshire and IOW Incident Coordination Cell.

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Executive Summary

The Winter Plan 2020/21 was presented to the November Trust Board and approved with the requirement of updates against progress 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. The planning process is based on historical knowledge and experience together with aligning itself to existing transformation programmes and the ongoing delivery of the Response, Recovery and Restoration plan. The Plan incorporates any specific actions within our control to improve during the period and reflects the requirements for services that may be affected by severe weather, surges in activity, including Covid, flu, norovirus outbreaks, as well as managing EU exit. Review of the plans and 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. Key progress against the plan to date are;

• Established a Winter Support team to liaise with operational teams and support • Mental Health Liaison cover in the Emergency Department (ED) increased to seven-days-a-week • Introduction of point of care testing in ED for COVID-19 and flu • Joint appointment with Adult Social Care of Weekend Director in place until 31 March 2021 – strengthening seven day services • Implementation of NHS 111 First on 1 December 2020 • Embedded COVID and non-COVID clinical pathways • Extended opening hours of Discharge Lounge • Ring-fenced beds to protect elective activity • Breaking the Cycle Week held 16 Nov 2020 - to effectively manage flows through the hospital to reduce Length of Stay and congestion in

ED and proactively manage discharges adapting lessons learnt to support winter

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Next steps will be to continue;

• Working with system partners to monitor performance and take action as necessary to address winter pressures • Continue efforts to secure and deliver multi-disciplinary services seven-days-a-week • Increase Patient Transport capacity to improve discharge from hospital • Extend direct access pathways to acute services, which will improve ‘flow’ of patients through hospital • Continued support for staff health and wellbeing • Continued focus on staffing levels throughout the Trust

This plan will be a live working document and will continue to be developed throughout the early winter period as further information and guidance is received. Any risk to the delivery of the plan will be monitored through the Operational Winter team and escalated to the A&E Delivery Board and Isle of Wight System Silver and Gold escalation groups. Oversight of whole health system planning will be led by the Hampshire and IOW Incident Coordination Cell. 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 • Ongoing delivery of the Response, Recovery and Restoration plan • 18 week Referral to Treatment • 31 and 62 Day Cancer Waiting Times • Measuring levels of patients residing in non-appropriate beds/location • Bed Occupancy compared to local modelling of 85-90%

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Agenda Item No 10 Meeting Trust Board in Public Meeting Date 10 December 2020 Title Committee Report from Quality & Performance Committee Sponsoring Executive Director

Tim Peachey, Chair of Quality & Performance Committee

Author(s) Lois Howell, Director of Governance & Risk Report previously considered by including date

Quality & Performance Committee – 27 November 2020






X


sustainable

Well-led SO 05: Join up health and care services by working more closely with our partners

X


X

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

• Receive report and recommendations from the Committee

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Executive Summary

The Committee discussed the following items at its meeting on 27 November 2020 which are covered within the report:

• Preparation for CQC Inspection • Quality Dashboard • Patient Experience and Patient Safety Sub Committee report • Infection Prevention and Control Board Assurance Framework • System Resilience – Winter Plan • Flu Programme Update • Safer staffing – Nursing and Allied Health Professionals (AHPs) • Clinical Effectiveness Sub Committee report • Learning From Deaths and Mortality Report • Research and Development Report • Community Technology Enabled Care (TEC) Strategy • Transformation Update on Partnerships • Acute Hospital Performance Report • Ambulance Performance Report • Mental Health & Learning Disabilities Performance Report • Community Services Performance Report • Corporate Risk Register • Additions to the Board Assurance Framework and/or Corporate Risk Register

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Quality & Performance Committee Feedback – 27 November 2020

Report to the Board in Public Item: Preparation for CQC inspection Level of assurance gained: Reasonable

• The Committee noted that the CQC has suspended its plan to inspect the Trust, and has no alternative date on the horizon • A revised approach to monitoring compliance with the CQC’s expectations is in development and will be presented to the next meeting of the

Committee • The proposal will also reflect plans to embed formal improvement methodologies as an essential element of clinical governance • The Committee took reasonable assurance from the report on the basis of the progress reported against delivery of the CQC action plan, and

the plans in development to ensure continuous improvement in future

Item: Quality dashboard Level of assurance gained: Reasonable • The Committee noted the data presented and found reasonable assurance that most aspects of patient safety and experience are well managed • A planned focus on improved assurance and practice in respect of duty of candour was welcomed, and the Committee has requested a detailed

report on the subject at a future meeting

Item: Patient Experience and Patient Safety Sub Committee Report Level of assurance gained: Substantial • The Committee acknowledged the assurance provided by the Patient Experience and Patient Safety Sub-Committee • The need for improved support for patients at the end of their life (and their families) in some areas has been noted and is being considered with

a view to developing better services • It was noted that maintaining high standards of care during the pandemic, when staff are under prolonged additional pressure and tired, is a

challenge, but that governance systems are helping to monitor and address this • The Committee took substantial assurance from the depth of the data presented, and the detail of the plans in place to address sub-optimal

performance

Item: Infection Prevention and Control Board Assurance Framework Level of assurance gained: Substantial • The Committee noted the updates to the content which have been scrutinised by the Infection prevention and Control Committee, and welcomed

the assurance provided by the depth and range of data available to demonstrate compliance with best practice, and by the low rates of in-hospital infection

• It was noted that the format has been revised and a new version will be presented to the next committee • A key challenge remains maintain flow through the hospital and beyond while maintaining appropriate social distancing / isolation

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o The limited number of on-site tests available each day (35) is a factor in this issue o The number of available tests will increase to 65 per day in the next week or so

• The rate of nosocomial infection remains low, but is kept under constant review – this will be supported by an increased rate of swab testing for patients

• The Committee sought and received assurance that the Trust and IPC team has all the support is requires from other parts of the hospital and system partners

• Lateral flow testing of staff has commenced, but the Trust has not been sent as many test kits as it has requested to ensure that all “frontline” staff are regularly tested. Prioritisation of allocation of the tests is underway and alternative approaches to staff testing are being pursued

o The complexity of the testing regime was noted • The updated IPC BAF is commended to the Trust Board by the Committee, and attached for information

Item: System Resilience – Winter Plan Level of assurance gained: Reasonable • The Committee noted further iteration of the winter plan, previously scrutinised by the Trust Board • The value added to the plan by the improved system-wide collaboration arising from the pandemic was commended • Current pressures in the ICU service in the Trust presents a challenge to delivery of the planned activity programme, including recovery activity

o ICU resources and demand are kept under regular review to help reduce the risk of impact on planned activity o Escalation and mutual aid plans also exist to support the Trust if demand exceeds capacity and planned activity is threatened

• The Committee was assured that the plan is robust, but that delivery presents a significant challenge, and for this reason took a reasonable level of assurance that the Trust is protected by the plan’s provisions

Item: Flu Programme Update Level of assurance gained: Reasonable

• The Committee noted that the current rate of vaccination is 63%, but a further increase is expected when latest data is added • A national target of 90% remains in place, and the Trust continues to pursue this • The improvement on the position against the same point in 2019/20 was commended • It was noted that there needs to be an interval of seven days between any flu vaccination and a COVID vaccination • The COVID vaccination programme is expected to start in early December • The Committee found the report to offer reasonable assurance on the basis of the improvement on previous years’ performance, tempered by

the remaining challenge to meet the national target Item: Safer staffing – Nursing and AHPs Level of assurance gained: Substantial

• The Committee sought assurance from the Chief Nurse that the Trust is safely staffed and was advised that the challenges presented by usual winter sickness levels and the additional challenges of the pandemic are generally being met, albeit with some occasional short term difficulties

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• The delivery of safe staffing levels can be attributed to detailed scrutiny of rostering and shift fill rates, and the agility and willingness of staff across the Trust

• Reduced numbers of vacancies have supported this position • The committee took substantial assurance form the fact that there have been no significant safety incidents associated with lack of staff

Item: Clinical Effectiveness Sub-Committee report Level of assurance gained: Reasonable

• A number of audits and assessment had been scrutinised by the Clinical Effectiveness Sub-Committee. The majority provided assurance of good practice and achievement

• The Committee welcomed details of the actions in place to address concerns identified as a result of audit of antibiotic allergy recording, and other noted non-compliances with best practice standards

• It was noted that the Clinical Ethics Advisory Group will report in to the Clinical Effectiveness Sub-Committee en route to the Quality & Performance Committee

• The importance of patient involvement in the group and plans to deliver this were discussed

Item: Learning From Deaths & Mortality Report Level of assurance gained: Substantial • The number of deaths reported in Q2 was noted to be very similar to those in Q1 • The Committee welcomed news that the backlog of structured judgment reviews is reducing • The Medical Examiner role is working well • Adjusted mortality rates remain stable • The Committee also welcomed inclusion of mental health, community and ambulance data in assessments • Summary of some cases of interest will be included in future reports

Item: Research And Development Report Level of assurance gained: Substantial

• The Medical Director advised the Committee that a significant proportion at R&D activity had been re-directed to COVID related research during the pandemic

o As a result the Trust has contributed significantly to COVID research programmes, to the benefit of those patients and the community o The committee commended the research team’s contribution and efforts in this regard

Item: Community Technology Enabled Care (TEC) Strategy Level of assurance gained: Substantial

• The Committee welcomed news that the Trust has won a national award for this work • The TEC strategy is a key enabler to delivery of the wider Community Services three year strategy

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• The strategy helps to promote enhanced self-management by patients of their own help • Implementation of many of the initiatives proposed was escalated during the pandemic to help support the reduce of transmission of COVID • The Committee received assurance that there will be further digital developments which build on progress made thus far, and that service users

have welcomed the opportunities and benefits they present • An increased focus on / reference to Learning Disabilities was requested by the Committee, together with an enhanced link to the Trust’s

corporate strategy Item: Transformation Update on Partnerships Level of assurance gained: Reasonable

• The Committee welcomed information about the progress being made to secure effective partnerships in all parts of the Trust’s services • A number of key appointments have been made, including a clinical lead for the partnership with Portsmouth Hospitals University NHS Trust • Joint appointments have also been made to the stroke services • The first meeting of the Ambulance partnership board will take place in January • The risks to delivery of the partnership presented by COVID were noted

Item: Acute Hospital Performance Report Level of assurance gained: Substantial

• The Committee heard that transformation work in the ED has taken good effect, and will continue to address previous problems with meeting the access standards as long as flow through the department can be maintained. The Committee was aware, however, that effective flow is threatened by the challenges presented by IPC practice during the pandemic

• Performance against national cancer access standards has been affected by the decision made by two patients not to accept treatment within the prescribed timeframe, along with failure to escalate the position of two other patients – it was noted that in the context of a percentage indicator, small numbers of non-compliances make a very significant impact

• Delivery against the RTT recovery plan is going well, as is work in the diagnostic pathways, although the national access standards have not yet been fully recovered.

• The Committee commended the rate of recovery in a number of areas, particularly in diagnostic pathways • The Committee took substantial assurance from the fact that performance data are clearly well-understood and being addressed

Item: Ambulance Performance Report Level of assurance gained: Reasonable • Demand rates have continued to rise for all aspects of the service • The impact of IPC practice (donning and doffing of PPE1, cleaning etc) has been assessed and is having a material impact on performance

against required standards

1 Personal protective equipment

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• Despite these factors, performance against the national standards has improved, although not yet quite at the required level • The committee took reasonable assurance from the fact of that improvement and the level of insight into the causes of, and risks associated

with, delays to service

Item: Mental Health & Learning Disabilities Performance Report Level of assurance gained: Limited • Demand for services amongst adults, and particularly children, continues to increase • The increase is not out of step with the picture on other areas, and is thought to be associated with the pandemic • Additional regional funding for CAMHS has been agreed, but only in the last few days, and the impact is yet to be felt • The Trust has sought to mitigate risks associated with the current mismatch between demand and the services available by deployment of

registered mental health nurses in the children’s department, and a focus on addressing crisis needs on a community basis • The Trust is also seeking to take innovative approaches to meeting recruitment challenges • Given the complexity and scale of the challenges facing the service and the increasing demand, the Committee felt that it could take only limited

assurance that the Trust’s position in this regard is strong, particularly in regard to the CAMHS position. • The Committee did note however, that there is insight into the key areas of concern and that plans to improve the position are in development,

and anticipates an early improvement in the levels of assurance available

Item: Community Services Performance Report Level of assurance gained: Reasonable The Community Service division has seen increased demand, apparently associated with the pandemic • Waiting lists are increasing in many parts of the service, and the causes and potential solutions are being investigated • Support to care homes is being increased to help prevent patient deterioration and hospital admission • A gap in the tissue viability service is known and is being addressed through liaison with Acute colleagues • The Committee took reasonable assurance from the fact that there is generally insight into the areas of risk in the service and that plans to

address them are being implemented

Item: Corporate Risk Register Level of assurance gained: Reasonable • The Committee welcomed the proposals to review and revise the Corporate risk register and to increase the profile of corporate level operational

risks • It was noted and acknowledged that the new process will take some time to embed effectively, and for this reason the Committee found that the

document currently offers only reasonable assurance that such risks are being managed effectively • The Committee agreed to recommend the draft corporate risk register to the Trust Board subject to the inclusion of a risk of patient harm arising

from inconsistent communication within and beyond the hospital

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Item: Additions to the BAF and/or Corporate Risk Register Level of assurance gained: N/A

• The Committee sought and received assurance that the strategic risks associated with exit from the EU will be added to the Board Assurance Framework

3 = Substantial Assurance There is a robust series of suitably designed internal controls in place upon which the organisation relies to manage the risk of failure of the continuous and effective

achievement of the objectives of the process, which at the time of our review were being consistently applied. 2 = Reasonable Assurance There is a series of controls in place, however there are potential risks that they may not be sufficient to ensure that the individual objectives of the process are achieved in

a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. 1 = Limited Assurance Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of

the process. Significant improvements are required to improve the adequacy and effectiveness of the controls. 0 = No Assurance There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and

effective achievement the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls.

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Agenda Item No 13 Meeting Quality and Performance Committee Meeting Date 27th November 2020 Title Learning from Deaths/Mortality Report Q2 2020/21 Sponsoring Executive Director

Alistair Flowerdew Executive Medical Director/ Steve Parker Executive Medical Director(from 1.11.2020)

Author(s) Lisa Reed Associate Director Clinical Effectiveness, Clinical & Corporate Mortality Lead Report previously considered by including date

Trust Mortality Review Group – 14 October 2020 Clinical Effectiveness sub Committee – 29 October 2020





X


X


sustainable


X


Key Recommendations to be considered: Since April 2017, it’s been a requirement that Hospital Trusts publish information on deaths of patients in their care in line with the Learning from Deaths Framework (LfDF) on a quarterly basis via the Trust Board (public) and in the Quality Account annually. From April 2020 it also became a requirement that Ambulance Trusts implement the Ambulance LfDF and report quarterly at their Trust Boards. As an integrated trust the decision was made to combine the Ambulance Service reporting into one overarching trust report.

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Executive Summary This is the Quarter 2 (Q2) 2020/21 report on Learning from Deaths/Mortality and covers the reporting period June – September 2020/21 and the numbers relate to adult ‘in patient’ deaths as mandated. In Q2 there were 160 (Q1 =162) acute ‘in patient’ deaths this remains as expected. The Medical Examiners (ME) Advice and Scrutiny process is established and all deaths in Q2 as per Q1 were independently scrutinised. During Q2, 2 deaths (inclusive of ED and ITU deaths) were referred for Structured Judgment Review (SJR) and 1 has been referred for investigation in line with Serious Incident Framework. The overall referral for SJR remains stable although as predicted since the establishment of the ME’s the number of SJR’s has reduced. Overall there are currently 7 SJR’s on hold (rolling year) due to on-going Serious Incident (SI) Review Process and 32 SJR’s (rolling year) in progress. The Trusts Mortality Review Group continues to review all SJR’s and any SI’s that involve the death of a patient and in Q2 no deaths met the threshold for reporting. The Hospital Standardised Mortality Ratio (HSMR) is at 76.8 (CI: 69.9-84.3), the Standardised Mortality Ratio (SMR) 80.3 (CI: 73.8-87.2) and the Standardised Hospital Mortality Index (SHMI) 0.99 (CI: 87.60-114.15) both remain well within acceptable range. The Trust continues to compare very favourably to peers in region and against similarly sized trusts nationally. The trust is an outlier for crude mortality Covid admissions, this is because of low numbers overall, demographics and improvements in how end of life care has been managed. The overall deaths from COVID-19 remain low. There are no new major ‘themes’ identified from SI’s, SJR’s or ME Scrutiny. There was 1 death in Q2 (September) that was reported as having COVID 19 positive swab result. NB: NHS Digital will be excluding COVID-19 activity from the SHMI

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Learning from Deaths Mortality Report Quarter 2 2020/21 The mortality data (HSMR/SMR) and NHS Digital (SHMI) relates to the most recent which is July 2019 – June 2020 and April 2019 – March 2020 respectively as a rolling year. This report contains figures pertaining to Quarter 2 (July – September 2020/21) for actual deaths (inpatient adult over age 18), all deaths within 30 days of discharge are now reviewed. 1.0 Update on Learning from Deaths Framework, SJR Outcomes and Deaths in our care

1.1 In Q2 there were 160 acute ‘in patient’ deaths (162 Q1). This remains as expected although is slightly higher than the same time period in

the previous year, nationally deaths are calculated on a rolling 5 year average and to date the trust has had no ‘excess’ deaths . All deaths were scrutinised by the Medical Examiner (ME). One death during Q2 was reported as per the NHSE guidance as COVID19.

1.2 3 of these deaths (inclusive of ED and ITU deaths) were referred for Structured Judgment Review (SJR) or Serious Incident (SI)

Number of deaths Number referred for SJR Number declared as SI July 56 0 0 August 57 0 1 September 47 2 0

1.3 As the Medical Examiner (ME) role has become more established the referral for SJR has continued to reduce as was expected.

1.4 SJR’s and all deaths that are investigated in line with the Serious Incident Framework (SI) are also reviewed by the Trusts Mortality Review

Group (TMRG). During Q2 here have been no deaths that meet the threshold for reporting (deaths that were reviewed/investigated and as a result considered more likely than not to be due to problems in care (CESDI grading applied as per detail in previous reports) that’s not to say there is no learning and those investigations will also have been reviewed at the Serious Incident Review Oversight Group (SIROG) and in Care Groups and Specialties. In some circumstances they will also have been part of a Coronial or Complaints process.

2.0 Mortality indicators for the Isle of Wight NHS Trust

2.1 HSMR – The Hospital Standardised Mortality Ratio (HSMR) reporting period July 2019 – June 2020 is 76.8 (CI: 69.9-84.3) compared to 78.8 reported in Q1 and is still ‘statistically lower than expected’ as is the Standardised Mortality Ratio (SMR) at 80.3 (CI: 73.8-87.2) with a tiny increase on the figure of 79.0 which was reported in Q1.

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2.2 SHMI – The Standardised Hospital Mortality Indicator (SHMI) reporting period April 2019 – March 2020 is at 0.99 (CI: 87.60-114.15) previously reported in Q1 as 1.05 so this remains well within acceptable ranges (band 2).

2.3 The Trust is one of 3 trusts in the peer group with an HSMR which is lower than expected and the trust continues to compare well to both

trusts in the region and trusts with similar ‘spell sizes’. These remain consistent with no cause for concern. The trust is an outlier for crude mortality Covid admissions, this is because of low numbers overall, demographics and improvements in how end of life care has been managed. The overall deaths from COVID-19 remain low.

2.4 As reported with full detail in Q1 COVID-19 activity is excluded from the SHMI – this is to make the indicator values as consistent as

possible with those from previous reporting periods. 3.0 Learning Lessons, Themes and Information Sharing

3.1 No new concerns or themes have been identified in Q2. Work is still ongoing and focused in relation to end of life care, deteriorating patients, dementia and is monitored at Patient Safety and Experience sub Committee.

3.2 Work is ongoing to align the LfD work to the new Patient Safety Incident Response Framework (PSIRF) of which the trust is an an early

adopter.

4.0 Ambulance Learning from Deaths

4.1 All ‘ambulance deaths for Q2 were screened and deaths included in the manadated reporting are the following:

• All deaths including those where patient was in cardiac arrest at receipt of 999 call. • Died in ED is the total of deaths screened that were deaths in 24hrs of admission • Deaths screened are deaths where the patient was NOT in cardiac arrest at receipt of 999 call and has died whilst under the care of the

Ambulance Service or has died within 24hrs of handover from Ambulance to ED

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Table 1:

* Deaths are all deaths including those where patient was in cardiac arrest at receipt of 999 call. **Died in ED is the total of deaths screened that were deaths in 24hrs of admission ** Deaths screened are deaths where the patient was NOT in cardiac arrest at receipt of 999 call and has died whilst under the care of the Ambulance Service or has died within 24hrs of handover from Ambulance to ED

4.2 The Ambulance Service continues to report to TMRG where more detail on the cases are shared there have been no specific themes identified in any deaths reviewed in Q2 with regard to ‘care concerns but not attributable to death’ but some examples of learning have been around the ‘sign off’ of a DNACPR form, end of life care in the community and access to medication.

4.3 Further reviews are undertaken by senior clinicians not involved in the care of the patient, as this report evolves it will start to include

examples of learning where applicable.

5.0 MH&LD

5.1 The Division has a very robust system that reports on a regular basis to the TMRG. They follow a prescribed process that also includes a RCPsych SJR or SI when applicable and report on a rolling basis. Any person who dies and has had contact with a MH service within 12 months of their death is reviewed. The largest majority of deaths reviewed are linked to ‘Memory Services’, there have been no new themes or concerns.

July Sep-202020

Total Deaths * 22 31 25Died in ED ** 2 3 4

No of deaths meeting screening criteria ***

7 11 15

Percentage of Deaths Screened

100% 100% 100%

0 0

Ambulance SJR’s/SI’s

Completed0

Aug-20

0Ambulance SJR’s/SI’s

0 0

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5.2 All deaths of patients that have a diagnosed Learning Disability (LD) are also reviewed and referred to the national Learning from Disability

Mortality Review Programme (LeDeR). As reported previously there was a national issue in respect of this for which the CCG has been working to resolve. The Trust has started to now recieve outcomes from these processes however there has been an acknowledgemnet that some of them are over 3 years old. The SHIP annual report has now been recieved and has been shared in the organisation.

5.2 The situation with Covid 19 and the restrictions placed on the poplulation was recognised early by the team during the last few months there

has been close monitoring of numbers and possible trends as there was a potential to see numbers go up in the Pandemic given the demographics of the patients numbers at present have changed and monitoring will continue.

5.3 The table below reflects the activity in respect of MH&LD mortality reviews rolling year. Please note SJR’s referred to below are MH SJR’s

not ‘acute in patient’s so do not sit in the number reported at the outset of the report.

0

20

40

60

80

100

120

140

160

180

200

Deaths Registered on IOW

Number of Registered Deathsknown to MH & LD

Hospital Deaths Reported

Number of Hospital DeathsKnown to MH & LD

Number of SJR's Required

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6.0 Community Nursing Team

The team have embedded the LfDF and report regularily at the Trust Mortality Group (TMG). When applicable the team utilise the SJR methodology and report accordingly to the TMG. There was a dip in numbers for March and April 2020 for deaths on the communty case load and there was a slight difference in April for the normal cancer / non-cancer ratio of patients this increased again during July and is being monitored. Focus has been on ‘end of life’ patient care and the use of the Priorities of Care document. (POC) and its noted that there has been considerable improvement and they are achieving 100% in most of the KPIs in terms of recognition, discussion, identification and achievement of preferred place of care, there is still work to do re the use of the POC but progress is encouraging. This is monitored by the End of Life Group.

7.0 Conclusion

The first 2 quarters of the year has brought new challenges but also consolidated the LfDF and a good test for the Trusts mortality processes. Work will continue to focus on identifying themes and learning where applicable. This in turn will align with the PSIRF and support the organisation in identifying where to concentrate efforts. The ME Scrutiny is developing and becoming more estalished significant improvements have been made to the timliness of death certification paperwork and proactive support of doctors completeing this and dealing with deaths. The robust mortality processes continue in the Community and MH&LD Services. The Ambulance Service despite the recent challenges has still managed to continue with LfD and report as mandated. There are no new themes or concerns identified in Q2 and work across the trust is concentrating still on recognition of deteriorating patients, patients approaching the end of their life, dementia and documentation to ensure that our patients get the best care possible. The HSMR and SHMI remain consistent and stable. Overall our in patient deaths remain stable and numerically as expected.

Lisa Reed Associate Director of Medical/Clinical Effectiveness and Corporate/Clinical Lead for Mortality October 2020

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Verbal

Item 11

Analysis of Quality & Performance section of

the Integrated Performance Report

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Verbal

Item 12

Key Actions in IPC testing

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Agenda Item No 13 Meeting Trust Board in Public Meeting Date 10 December 2020 Title Emergency Preparedness, Resilience and Response NHSE Annual Assurance Process Sponsoring Executive Director

Joe Smyth, Chief Operating Officer and Accountable Emergency Officer

Author(s) Tricia Smith, Head of Emergency Preparedness, Resilience and Response (EPRR) Report previously considered by including date

Emergency Preparedness and Business continuity sub-committee, 15th September




Trust Board Approval Commercial Confidentiality Effective x SO 01: Make our Trust a great place to work and receive care

x

Committee Agreement Patient Confidentiality Caring x SO 02: Work with our partners and our community to improve services

x

Assurance x Staff Confidentiality Safe x SO 03: Deliver high quality compassionate care x Information Only Other Exceptional Circumstance Responsive x SO 04: Make sure our services are clinically and financially

sustainable


x



• This report is provide assurance to the Trust Board on compliance against the NHSE Annual Emergency Preparedness, Resilience and Response (EPRR) Assurance Process

• The IOW Trust has continued to make significant progress in meeting the EPRR core standards and the self-assessment, which was completed in discussion with the IOW CCG EPPR lead, shows that the Trust has improved its position from partially to substantially compliant.

• The Head of EPRR presented a summary of the Trusts Compliance at the ICS meeting with all the other HIOW NHS providers and the ICS/STP will present a combined picture of the HIOW EPRR assurance levels to NHS E/I

• The EPRR Core Standards action plan, which sets out actions against core standards where full compliance has yet to be achieved, will be monitored through the Emergency Preparedness and Business Continuity Sub -committee

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Executive Summary

Isle of Wight NHS Trust EPRR Core Standards Compliance – 2020/2021 Assurance Process The NHS needs to plan for, and respond to, a wide range of incidents and emergencies that could affect health or patient care. These could be anything from extreme weather conditions to an outbreak of an infectious disease or a major transport accident. The Civil Contingencies Act (2004) requires NHS organisations, and providers of NHS-funded care, to show that they can deal with such incidents while maintaining services. NHS England and Improvement has published NHS Core Standards for Emergency Preparedness, Resilience and Response arrangements. These are the minimum standards which NHS organisations and providers of NHS funded care must meet. The Accountable Emergency Officer in each organisation is responsible for making sure these standards are met. The Trust has continued to make significant progress in meeting the EPRR core standard’s and has improved its position from partial to substantial compliance for both the Acute Trust and the Ambulance Service

Against 64 of the core standards which are applicable to the organisation, the IOW NHS Trust is now fully compliant with 61 of these core standards; and will become fully compliant with the remaining three by September 2021. These are completing the Mass Countermeasures Distribution Plan, embedding the strategic and tactical training and portfolios and completing a Live Exercise. Key outstanding emergency plans have been completed and signed off, including the Trust Pandemic Flu plan and Incident Co-ordinating Centre Plan. A Comprehensive Training and Exercising plan was developed and strategic leadership training provided but progress on training and exercising has been slow due the COVID-19 response. However, training delivery options are being reassessed and a plan developed to ensure the annual training and exercise plan is back up and running, so that relevant staff such as on call directors and managers are able to meet their EPRR core competencies The planned ‘Live exercise’ had to be postponed but the real-life response to COVID has certainly tested our response to a pandemic. A Live exercise will be arranged for 2021, focussing on a ‘big bang’ incident, and we will use the after event review report to update the Incident Response Plan and action cards, also taking into account any lessons identified from the COVID response. An audit of the Emergency Department CBRNe (Chemical, Biological, Radiological, Nuclear, explosive) capability was undertaken by South Central Ambulance Service and outstanding CBRNe actions have been completed. The outcome of the self-assessment for the Ambulance Interoperable capabilities also shows an improvement to substantial compliance. Against 163 of the core standards which are applicable to the organisation, the IOW Ambulance Service is fully compliant with 146 of these core standards

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The IOW Trust and South Central Ambulance Service EPRR Memorandum of Understanding has now been agreed which has enabled the relevant support to be provided to ensure compliance in those areas such as command and control where the ambulance service was showing partial compliance. The Head of EPRR presented the Assurance statement at an STP/ICS EPRR meeting on 14th October for agreement and sign off. The EPRR Team will continue to work to the Core Standards Action Plan and report to the Emergency Planning and Business Continuity Sub- committee on core standards’ progress

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Agenda Item No 14 Meeting Trust Board in Public Meeting Date 10 December 2020

Title EU Exit

Sponsoring Executive Director Stephen Parker, Medial Director

Author(s) Tricia Smith, Head of Emergency Preparedness, Resilience and Response.

Report previously considered by:(including dates)

Nil


The board is requested to note the arrangements put in place for EU Exit

Key areas of risk for the NHS in general remain • Continuity of supply (including medicines, consumables and medical devices) • Workforce (settled status, mutual recognition of qualifications • Data (transfer, storage and protection) • Reciprocal Healthcare and cost recovery


Link to CQC Domain


Trust Board Approval Commercial Confidentiality Effective x SO 01: Make our Trust a great place to work and receive care Committee Agreement Patient Confidentiality Caring x SO 02: Work with our partners and our community to improve

services

Assurance Staff Confidentiality Safe x SO 03: Deliver high quality compassionate care Information Only X Other Exceptional Circumstance Responsive x SO 04: Make sure our services are clinically and financially

sustainable



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The Isle of Wight NHS Trust has reviewed its plans to ensure it is prepared for the forthcoming departure of the United Kingdom (UK) from the European Union (EU) on the 31st December 2020 and any potential issues that may impact upon various areas of the Trust’s service delivery. The EU Exit Senior Responsible Officer (SRO) is Steve Parker, Medical Director and the EU Exit Lead is Tricia Smith, Head of Emergency Preparedness, Resilience and Response (EPRR). The Head of EPRR has linked into the relevant Trust ‘Subject Matter experts’ to ensure local awareness and assurance. Key areas of risk for the NHS in general remain • Continuity of supply (including medicines, consumables and medical devices) • Workforce (settled status, mutual recognition of qualifications) • Data (transfer, storage and protection) • Reciprocal healthcare and cost recovery.

The Trust EU Exit Risk Assessment has been updated accordingly and is subject to regular and ongoing review. An EU Transition Assurance Return will be submitted NHSE/I by 4 December 2020. The Department of Health and Social Care (DHSC) has put in a multi-layered approach to mitigate the supply risks with freight options for NHS supplies through alternative ports. There has also been engagement with key suppliers to ensure continuity of supplies with buffer supplies in place and additional warehouse capacity.

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The Trust Business continuity plans have been well tested this year as a result of the Covid-19 response and key plans have been reviewed and updated as required. An EU Exit exercise was held in 2019 and relevant learning implemented. There will be a common operating model for COVID-19, Winter and EU Exit through the Trust Covid / Winter response command and control structure. Any impacts will be reported through this structure with the escalation process through the HIOW Integrated Care System incident co-ordinating centre to Region and to NHSE/I. The Trust EPRR team works closely with the Hampshire & IW Local Resilience Forum to ensure that the island is considered in mainland arrangements to mitigate congestion on the mainland highways network and to ensure we have a plan in place if there is disruption to essential supplies to IOW.

The Human Resources team are making sure that we have done everything possible to support our workforce. They are reviewing the number of staff from the EU that have applied for the Government’s settlement scheme and the will be sending updates to any staff that are affected and supporting them through the process. An important point to reiterate is that under UK legislation, EU medical qualifications will still be valid.

The Trust’s Communications Team will link with the CCG and local authority, as well as our colleagues in the regional and national NHS to ensure that we share information effectively. The Trust will continue to share information with the Board, staff and partners as it becomes available.

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Agenda Item No 15 Meeting Trust Board in Public Meeting Date 10 December 2020 Title Finance & Infrastructure Committee Feedback Sponsoring Executive Director

Caroline Spicer, Chair of the Finance & Infrastructure Committee

Author(s) Sarah Anderson, Associate Director of Corporate Affairs

Report previously considered by including date

Finance & Infrastructure Committee – 26 November 2020






X


sustainable


X


X


• Receive the report and assurance from the Committee

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Executive Summary


• Integrated Finance and Workforce Performance Report – Month 7 2020/21 • Financial Controls & Governance assurance update • National Cost Collection/PLICS (Patient Level Information Costing) Submission 19/20 – Paper 2 of 3 • Reports from Sub- Committees:

o Financial Recovery Board (FRB) Report – 23 October 2020 o Progress Report – Investing in Our Future (£48m o Capital Investment Group Report – 15 October 2020 o Estates and Facilities Sub-committee Update and Assurance Report – 26 November 2020

• Financial Strategy and Planning • Operating Plan 2021/22 Forward Look • Divisional Business Cases

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Finance & Infrastructure Committee Feedback – 26 November 2020 Board in Public

The Finance and Infrastructure Committee noted that meetings will be held monthly from this meeting forward to enable a timely review of financial and infrastructure issues. Item: Integrated Finance and Workforce Performance Report – Month 7 2020/21 Level of Assurance Gained: Reasonable

Note the risks with operational and workforce issues The Committee received the Month 7 Trust Integrated Finance and Workforce Performance Report. The Trust had reported break even against the revised financial plan for M7 and YTD. Staffing costs remain a challenge and the Committee considered the impact on staffing of the increased testing regime and how the Covid vaccine will be administered, particularly the financial impact on the workforce. Options to address include staffing over establishment or at establishment with the use of agency etc to cover absence and vacancies. The Committee was informed that based on what the Trust knows and can predict tit has planned for the impact of the second wave of Covid The Committee noted that actuality could be a positive or negative impact on the financial plan but were assured that any unplanned for risk would be factored into forecasts. Vacancies in the Acute Division are impacting on flow through the hospital. In particular the Medical workforce has a vacancy factor of 48% which has been filled through medical agency, which has a financial impact on the budget. This was the significant operational risk for the Acute division in terms of performance, quality and on the use of Agency/Locum staff on the budget. Plans were in place to address this risk which were outlined to the Committee by the COO. Mental Health has also experienced pressures around doctors with a 50% vacancy level covered by agency spend. It is also considering over-recruiting as a model to address this issue. There is a national shortage in some staff groups and, although funding is available, it can represent a disproportionate investment of time to obtain given the size of organisation. Item: Financial Controls & Governance Level of Assurance Gained: Reasonable

The Committee noted that the financial and budgetary control arrangements for Divisions have reverted from the Covid arrangements to a plan agreed by Board with accountability at budget holder level. Retrospective waivers often arise from no foresight on contracts expiring. New arrangements have been put in place to seek to be compliant with SFIs etc. In addition, the procurement process has been updated and all Estates and IT procurement and contracts now go through the Procurement agency. This issue was also reported to the Audit Committee.

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Item: National Cost Collection/PLICS (Patient Level Information Costing) Submission 19/20 – Paper 2 of 3

Level of Assurance Gained: Reasonable

The Committee received the second paper in a series of steps in the process of submitting this data as part of the national process of the National Cost Collection / PLICS that is required. The submission of the Trust’s National Cost Collection / PLICS submission was made in November and reported to this meeting. Service Line Reporting and the use of this information is developing and will be needed to identify future efficiencies. Item: Financial Recovery Board (FRB) Report – 23 October 2020 Level of Assurance Gained: Reasonable

The Committee received a report from the FRB and noted:

• financial planning for 2021/22 is commencing and there are expected benefits from the on-going transformation work • Significant cash releasing benefits from the N365 business case were reported through a strong benefits realisation case presented to FRB • improvements in financial controls around Single Tender Waivers and business cases were reported as now in place within the Trust • financial planning will return to fully devolved budgetary responsibility from Month 7 with the risk that costs may exceed income and create a

larger than expected financial deficit. • Expectations of Budget Managers continue to be outlined in relation to the actions that need to be taken within our financial recovery.

Item: Progress Report – Investing in Our Future (£48m) Level of Assurance Gained: Reasonable

The Committee received the report from the sub-group and noted:

• overall good progress is being made by the programme with the Strategic Outline Case (SOC) being submitted to Regulators to the deadline. • funding is being drawn down to fund ongoing planning and programme management costs. The risk is that not all funding will be recovered from

the Dept of Health,this has been highlighted and mitigations were reported as in place. • three risks to delivery have been developed for the BAF (not securing the £48m, Benefits Realisation, Capacity and Capability of resources) • an independent review of the programme will be undertaken in the new year by 40C . This approach will be used for periodic checks at key

milestones. • development of the Digital Transformation Strategy and the Estates Strategy is on track for February 2021 Trust Board.

The Committee approved changes in the programme (with links to the Trust enabling strategies and Island Health and Care Plan transformation work) that have evolved over the past few months The Committee had a discussion about the assumptions for CIP as part of the Regulators’ assessment of the SOC and whether this is achievable. It was assured that these have been risk assessed and are not over-optimistic. In addition it was noted that the £48m is only part of the funding source for the delivery of Trust and any enabling Strategies.

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Item: Capital Investment Group Report – 15 October 2020 Level of Assurance Gained: Reasonable

The Committee received the report from the Capital Investment Group and was assured that all actions are being delivered on the plan and all risks are identified and mitigated. A spending forecast has been produced and is within the capital limit. Item: Estates and Facilities Sub-Committee Update and Assurance Report – 26 November 2020


The Committee received the report on activity in Estates and Facilities that is reported through the Sub-Committee. The Committee noted that the Estates Strategy will be presented to Board in February. The Committee approved the Estates and Facilities Sub-Committee Terms of Reference and noted the commitment from operational divisions to participate in the Sub-Committee. It recommended that the workplan was further developed around Divisional activity to support this. Item: Financial Strategy and Planning Level of Assurance Gained: N/A - Not applicable

The Committee noted the update on developing the Finance Strategy and financial plan and noted that, although this needs to come after some of the other enabling strategies that are being developed, progress is on plan. Item: Operating Plan 2021/22 Forward Look Level of Assurance Gained: N/A - Not applicable

The Committee received a briefing on the Operating Plan 2021/22 and noted that it and Board will be updated as plans develop. Item: Review of Business Cases Level of Assurance Gained: N/A - Not applicable

The Finance and Infrastructure Committee reviewed and will recommend a number of business cases to the Board for approval. Business cases reviewed were:

• 18 Week Support RTT Insourcing: Part of the funding envelope approved by Board in October • Elsmore Healthcare Endoscopy Insourcing to deliver Recovery Plans: Part of the funding envelope approved at October Board and coming for

retrospective approval as the organisation needed to move at pace • FestiMed Single Tender Waiver Extension: For ambulances to provide the required cover during the pandemic • CT scanner Replacement: Funded through a capital award from the STP Adapt and Adopt diagnostic recovery programme

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Finally, the Finance and Infrastructure Committee reiterated the risks around the delivery of the capital programme that need to be included in the Board Assurance Framework and Corporate Risk Register. 3 = Substantial Assurance There is a robust series of suitably designed internal controls in place upon which the organisation relies to manage the risk of failure of the continuous and effective

achievement of the objectives of the process, which at the time of our review were being consistently applied. 2 = Reasonable Assurance There is a series of controls in place, however there are potential risks that they may not be sufficient to ensure that the individual objectives of the process are achieved in a

continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. 1 = Limited Assurance Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the

process. Significant improvements are required to improve the adequacy and effectiveness of the controls. 0 = No Assurance There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective

achievement the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls.

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Verbal

Item 16

Analysis of Finance section of the


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Agenda Item No 17 Meeting Trust Board in Public Meeting Date 10 December 2020

Title Operating Plan 2021/22 Forward Look

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

Author(s) Gary Edgson, Deputy Director of Finance

Report previously considered by inc date Finance and Infrastructure Committee 26 November 2020

Key Recommendation

To update the Board on the development and timeline of the Operating and Financial plan for 2021/22.

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 2020 - 2025

Trust Board Approval Commercial Confidentiality Effective X SO 01: Make our Trust a great place to work and receive care X

Committee Agreement Patient Confidentiality Caring X SO 02: Work with our partners and our community to improve services X

Assurance X Staff Confidentiality Safe X SO 03: Deliver high quality compassionate care X

Information Only Other Exception Circumstances Responsive X SO 04: Make sure our services are clinically and financially sustainable X

Well-Led X SO 05: Join up health and care services by working more closely with our partners

X

SO6: Invest in building and IT that helps our teams make a positive difference to our island community

X

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Executive Summary

A 6-month financial plan for 2020/21 was approved by the Trust Board, and submitted to NHSE/I on 22 October 2020. A financial plan forecast of £3.7m gross deficit was submitted. The STP, in discussion with regional and national teams, have indicated that organisations will have an ‘allowable’ deficit relating to under recovery of external non-NHS income and increased annual leave costs. This resulted in a residual financial deficit of £3.0m for the Trust. This has been approved by the STP and the Region and is the deficit plan we are now working to for the remainder of 2020/21.

The details of the financial regime that will be adopted in 2021/22 are not yet published, however early indications imply that there will be an expectation for the Trust and STP to recover lost efficiencies throughout 2020/21. We are starting to plan for this and our new year efficiencies through Financial Recovery Board and progress will be reported to F&IC.

Nationally the planning process for 2021/22 is anticipated to be launched at the earliest in late January 2021, until such time the STP will be unlikely to be in a position where it can conclusively confirm the resource available, the impact of any changes to the national contracting framework or tariff adjustments to be applied to our contracts and income. We cannot wait entirely for this and we plan to work on expenditure levels and efficiencies in advance of income being known. Early indications are we will be expected to develop 21/22 financial plans from a run rate baseline rather than a Long Term Financial Plan baseline. This is helpful but requires confirmation.

To manage the Trust and STP financial position beyond Phase III Recovery and Covid, understanding the long term implications of those decisions taken during Covid will be key to enable the system and the Trust to proactively plan the winding down of the short term response to return to a business as usual model of operation that is financially sustainable. These will the operating framework assumptions and these will be developed and agreed as part of our planning response.

All Board Committees will need to receive assurance (we will agree this process) in the development of the plan and the Trust Board will need to approve final submission (date tbc).A three step financial planning process is proposed to prepare the Trust (within the STP footprint) for 2021/22 planning:

As part of our Strategy implementation, we will be updating the Health and Care Plan financial and Structural Deficit position to incorporate progress since the base position was set, this will include expected efficiencies delivered versus actual efficiencies delivered under year 2 of the Plan. In Q4 we will also identify Partnership efficiency opportunities going forward and build into 2021-22 planning.

2

Requirement Initial Timeline

Step 1 Thorough analysis of 2020/21 exit run rate to identify recurrent, non recurrent and temporary expenditure associated with current COVID protocols and any longer term recovery activities. 30 November 2020

Step 2 Application of system/Trust service change impacts, prior planned investments and system efficiencies 31 December 2020

Step 3 Application of mandatory national guidance impacts February 2021

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Verbal

Item 18

Analysis of Workforce section of the


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Agenda Item No 19 Meeting Trust Board in Public Meeting Date 10 December 2020 Title Digital Transformation Committee Feedback Sponsoring Executive Director

Kemi Adenubi, Chair of the Digital Transformation Committee

Author(s) Darren Cattell, Director of Finance, Estates and IM&T/Deputy CEO

Report previously considered by including date

Digital Transformation Committee – 25 November 2020





Committee Agreement Patient Confidentiality Caring SO 02: Work with our partners and our community to improve services

Assurance X Staff Confidentiality Safe SO 03: Deliver high quality compassionate care Information Only Other Exceptional Circumstance Responsive X SO 04: Make sure our services are clinically and financially

sustainable



X


• Receive the report with the assurance levels as stated.

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Executive Summary


• Digital Transformation Strategy – Draft version 0.8 • Clinical Systems Strategy - Phased Procurement and Implementation Planning - Update Report • Strategic and Other Projects Update • Agile Working (N365) Statement of Benefits • Information Management & Technology Operational report and Deep Dive • Update on progress with Cyber Security • The Board Assurance Framework – Digital Risks inc Corporate Risk Register - Agenda item was deferred. • Draft Digital Transformation Delivery Group Terms of Reference

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Digital Transformation Committee Feedback – 25 November 2020 Board in Public

This was the second meeting of the Digital Transformation Committee and some issues on the transition to a Board level committee were still being worked through including reporting and detail of minutes. The meeting was attended by the incoming Chief Information Officer who was able to provide some thoughtful insights into how our committee could operate. Item: Digital Transformation Strategy – Draft version 0.8 Level of Assurance Gained: Reasonable

The Committee welcomed the detail provided and were excited by the potential transformation that could be achieved. The Committee noted that this is still developing and requested that the final document would need to: • Be more accessible to staff and services users (no technical jargon) • Be more people and patient focussed

Be more information focussed • Demonstrate links with our partners on and off the island • Demonstrate how we will take advantage of innovative technologies over time The Committee were pleased with the work to date, they recognised this draft was a work-in-progress and welcomed seeing updated versions at future meetings. It was noted that the final document will come to the February Trust Board and will respond to the need for a public facing document of the vision and a more detailed plan for internal use. Item: Clinical Systems Strategy - Phased Procurement and Implementation Planning - Update Report


This agenda item was triggered by the desire to start to implement and deliver benefit in advance of the full strategy and business case for the £48m being approved, which may require internal business cases and other sources of funding to be identified. It provided feedback on the proposed phased approach to clinical systems procurement and implementation. Specific systems such as TPP SystmOne for Mental Health were discussed. An options appraisal is being completed and any replacement system would need to meet suitability and any procurement tests. Interoperability of systems will be even more important as we further develop our partnership approaches. In addition, the committee discussed the current pressures, financial and operational, relating to the continued use of e-care logic for acute services and the need to understand any key future decision points including any migration path. The Executive will need to ensure that any choice made for any replacement will have the capability to integrate with acute systems selected within the strategic solution under the Partnership arrangement with PHU. In terms of risk, Clinicians report that e-care logic works for their needs and the Trust will need to consider the

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risks associated with any migration and any transition. Item: Strategic & Other Projects Update… Level of Assurance Gained: Limited

The project status includes priority ranking, but there still remains a need to identify Senior Responsible Officers (SROs) and make decisions about how resources will be allocated to address the challenges around high priority projects where progress is slipping against plan. Discussions are underway with suppliers, operational staff and NHSE/I (as appropriate) to ensure that all possible mitigations are considered. Where appropriate, corporate risks will be raised and escalated through the appropriate process. Item: Agile Working (N365) Statement of Benefits Level of Assurance Gained: Substantial

The Committee agreed it was very positive to see the use of the methodology as described and to see that cash releasing benefits are higher than originally predicted. It noted that significant operational (corporate and clinical) benefits are to be gained and there are plans to start the engagement with operational staff are subject to recruiting a project manager. This is an important test to see if we are able to genuinely engage the business in actively managing and ensuring the delivery of predicted benefits. Item: IM&T1 Operational report and Deep Dive Level of Assurance Gained: Substantial

The Committee welcomed our first sight of this report and were impressed by the level of activity underway. It requested some more tangible, outcome based descriptions so that these can be used for the Board, staff and more generally. The Committee also requested for an update on IM&T recruitment to address the challenges, particularly where teams are experiencing work pressures. The Committee noted that the IT helpdesk was under significant demand pressure and additional capacity was planned to resolve this. Item: Update with progress with Cyber Security Level of Assurance Gained: Reasonable

The Committee were pleased to see the report from TIAA which confirmed that the majority of previous actions had been closed. In addition this area has been subject to an independent assessment which reflected good progress and some improvements. The Interim Chief Information Officer will provide a summary ranking and month by month forward look on actions to address outstanding issues. It was acknowledged that the residual issues require infrastructure investment and would take some time to implement. The committee will monitor progress. Item: Board Assurance Framework –Digital Risks inc Corporate Risk Register Level of Assurance Gained: Not applicable

1 Information Management & Technology

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A full consideration was deferred to the next meeting. The Interim Chief Information Officer updated on proposed amendments to the risks and the Committee supported the review. Item: Draft Terms of Reference for Digital Transformation Delivery Group Level of Assurance Gained: Not applicable

The Committee considered the draft terms of reference for the Digital Transformation Delivery Group, which will act in the role as Digital Transformation Programme Board. It noted that further work on the desired membership and fit with wider governance is still required. Finally, the Digital Transformation Committee thanked the outgoing Interim Chief Information Officer and noted that there has been significant progress in the work undertaken around the digital agenda. The Committee recognises that some of the risks in its area are reducing and anticipates being able to reflect this in its review of the Board Assurance Framework at its next meeting. 3 = Substantial Assurance There is a robust series of suitably designed internal controls in place upon which the organisation relies to manage the risk of failure of the continuous and effective achievement of the objectives of the process, which at the time of our review were being

consistently applied.

2 = Reasonable Assurance There is a series of controls in place, however there are potential risks that they may not be sufficient to ensure that the individual objectives of the process are achieved in a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks.

1 = Limited Assurance Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Significant improvements are required to improve the adequacy and effectiveness of the controls.

0 = No Assurance There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective achievement the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls.

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Agenda Item No 20 Meeting Trust Board in Public Meeting Date 10 December 2020 Title Audit Committee Feedback Report Sponsoring Executive Director

Phi Berrington, Chair of Audit Committee

Author(s) Phi Berrington, Chair of Audit Committee Report previously considered by including date

Audit Committee – 26 November 2020






X


sustainable


X


X


• Receive report and recommendations from the Committee

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Executive Summary

The Committee discussed the following items at its meeting on 26 November 2020 which are covered within the report: • Internal Audit – Summary Internal Controls Assurance (SICA) Report • Internal Audit Plan 2021/22 • Review Single Tender Waivers to Standing Financial Instructions • Quarter 2 Board Assurance Framework

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Audit Committee Feedback Report – 26 November 2020 Board in Public

The Audit Committee held this intermediate meeting to receive Internal Audit Review reports that have been completed since the last meeting in September and discuss other key issues. This intermediate meeting was held to gauge progress and avoid a large number of Internal Audit Review reports being presented at the January 2021 meeting. Item: Internal Audit – Summary Internal Controls Assurance (SICA) Report Level of Assurance Gained: Reasonable

The Audit Committee reviewed five full Internal Audit Reviews and one Advisory Review that had been completed since the last Audit Committee meeting. Members of the Trust leadership responsible the areas under consideration were present to respond to Audit Committee member questions. Classification of the Reviews completed was as follows:

Reasonable Assurance: • Payroll Review • Finance including non-pay expenditure • Financial Governance / New Ways of Working

Substantial Assurance:

• Claims Management • Coronial Process

No assessment made:

• Advisory review - Cyber Security The indicative overall rating provided by the Internal Auditors for work performed to date was Reasonable Assurance. This compares favourably against last year’s overall rating of Limited Assurance, although we need to recognise there remains a large number of Reviews yet to be completed. Whilst recognising the number of outstanding recommendations and actions has been diminishing the Committee noted a number of these are old and need closing. These recommendations and actions will be revisited by Trust leadership and Internal Audit during December to ensure recommendations remain relevant and can be actioned. An updated schedule will be circulated to the Committee. It was agreed that the status of outstanding actions will be given more prominence in forthcoming Audit Committee meetings. The Committee thanked the Trust leadership for being responsive to the demands placed on them with regard to Internal Audit Reviews and wanted to recognise in particular Rowena Welsford, Rebecca Agnew, Gary Edgson, Neil Stevens and the teams of individuals working with them.

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Item: Internal Audit Plan 2021/22 – for discussion Level of Assurance Gained: Not applicable

A draft Internal Audit plan for 2020/21, which includes an additional review to cover Contract Management, was presented to the Committee. Committee members were asked for any considerations to be taken into account when Internal Audit and Trust leadership refine the outline plan for 2021/22. The refined Internal Audit plan will be presented at the next Audit Committee. The Committee noted that we are further ahead in planning than at a similar stage for preparing this year’s Internal Audit plan. Item: Review Single Tender Waivers to Standing Financial Instructions Level of Assurance Gained: Reasonable

The Committee received details of procurements related to Single Tender Waivers which have been raised since the last Audit Committee meeting. The Audit Committee again noted the prioritisation that Trust leadership had made in improving the application of the Single Tender Waiver process. Despite the focus on improving the process 13 Single Tender Waivers were deemed to be retrospective. The Trust leadership agreed that more action, including education, needs to be taken with regard to complying with Standing Financial Instructions. Item: Quarter 2 Board Assurance Framework Level of Assurance Gained: Reasonable

A discussion on the Board Assurance Framework process was held. The Trust leadership welcomed the suggested improvements to the running of the Board Assurance Framework made by the Committee members. It was noted that the process is evolving and improvements will be incorporated into the process as they arise. It was further noted that the high scoring operational risks element of the Corporate Risk Register will be reviewed to ensure that the risk scores are reflective of the actual risk. In addition the Committee was informed that a further element of the Corporate Risk Register covering corporate level risks has been developed and will be brought to the December Board for approval. Finally, the Audit Committee noted the significant progress that had been made by Trust leadership in the areas reviewed despite high operational pressures. 3 = Substantial Assurance There is a robust series of suitably designed internal controls in place upon which the organisation relies to manage the risk of failure of the continuous and effective

achievement of the objectives of the process, which at the time of our review were being consistently applied. 2 = Reasonable Assurance There is a series of controls in place, however there are potential risks that they may not be sufficient to ensure that the individual objectives of the process are achieved in a

continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. 1 = Limited Assurance Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the

process. Significant improvements are required to improve the adequacy and effectiveness of the controls. 0 = No Assurance There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective

achievement the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls.

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Agenda Item No 25 Meeting Trust Board in Public 10 December 2020

Title Integrated Performance Report

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

Author(s) Gary Edgson - Deputy Director of Finance; Rowena Welsford - Deputy Director of Human Resources; Ricky Somal – Deputy Director of Organisational Development; Vanessa Flower - Head of Quality, Iain Hendey – Deputy Director of Information; Rebecca Agnew – Head of Legal Services; Rob Jubb – Head of Health, Safety & Security.

Report previously considered by:(including dates)

Executive Team and Divisional Boards Workforce and Finance report presented at the Finance & Infrastructure Committee 26 November 2020

Key Recommendations to be considered: This Integrated Performance Report is an evolving report, following feedback we are working to a completed revision by the February Board. There is an Executive summary outlining headlines and risks at the front of each performance domain and Service and more detailed information in the rest of this Report. The Chair of each Board Committee will report to the Trust Board on the level of assurance received and that level of assurance will be largely based on the detail contained within this report. The Board are asked to receive the following Integrated Performance Report for information.


Link to CQC Domain


Trust Board Approval Commercial Confidentiality Effective X SO 01: Make our Trust a great place to work and receive care x Committee Agreement Patient Confidentiality Caring SO 02: Work with our partners and our community to improve

services

Assurance X Staff Confidentiality Safe SO 03: Deliver high quality compassionate care Information Only Other Exceptional Circumstance Responsive X SO 04: Make sure our services are clinically and financially

sustainable x



x

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Trust Integrated Performance Report

10 December 2020

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3

Contents Pg. 4 Quality Information

Pg. 5 - Headlines Pg. 6 - Divisional Summaries Pg.14 - Flu update

Pg. 18 Performance Information

Pg. 19 - Recovery Pg. 22 - Covid response Pg. 27 – Acute Performance

Pg. 32 – Ambulance Performance Pg. 37 – Mental Health & Learning Disabilities Performance Pg. 41 – Community Performance Pg. 46 Workforce & Finance Information Pg. 47 - Headlines Pg. 49 – Summary Financial Performance Pg. 52 – Divisional Financial Performance Pg. 53 – Key Workforce KPIs Pg. 58 – Staff Survey Headlines Pg. 59 – Organisational Development Pg. 61 Governance Updates Pg. 62 - Headlines

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Quality

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Quality Headlines

Key Risks Controlling actions 1 Recruitment of substantive GP’s in Urgent Treatment Centre (UTC).

Recruitment of Emergency Department (ED) Consultant. High usage of Agency Nurses in ED.

• Continue to recruit bank GP’s and Associate Clinical Practitioner’s in the absence of available substantive GP’s in UTC.

• Nursing establishment being reviewed in ED.

2 Poor audit results related to hydration assessment. • Hydration assessment form reviewed and simplified. • Targeted focus on training staff on the completion of the hydration assessment form. • Spot check audits undertaken and non-compliance addressed with individual staff to

improve standards of practice.

3 The current issue impacting on Outpatients is the reduced waiting area due to social distancing. It is difficult to return activity to 100% when we have taken over half the chairs out of the waiting rooms.

• Use devices that individuals can take with them that will notify the patient when to return to clinic whilst waiting in the car or in Costa etc.

• Reconfiguring the waiting area for patients putting in place COVID Secure barriers so that we can increase the number of chairs in waiting areas.

• Posters displayed promoting ‘no waiting’ or no congregation outside clinic areas. Create shelters outside.

4 Patient Transport Services (PTS) patient capacity still a challenge despite being able to convey 2 patients on some journeys

• Where possible trying to convey two patients on some journeys • Reviewing the feasibility of extending the PTS hours to 22:00pm which will also aid late

discharges of patients requiring assistance to be transported home.

Key achievements this period 1. Achieved an uptake of 54% of all frontline staff having the flu vaccination as at 18 November 2020 which is an increase compared to 43% uptake in 2019 for the same time period.

Flu vaccination given to all staff is also 54%. 2. Cellular Pathology has had a very successful ISO accreditation visit. 3. Mental health Inpatient services are now smoke free. 4. Reduction in the total number of Clostridium Difficile cases in month. 5. Audit by the MHA Office shows a reduction in the use of nurses holding powers Section 5 (4). The service was an outlier due to large numbers but is now performing better than the

national average. 6. NEWS2 compliance sustained for last 6 months in the Community Unit 7. NHS Resolution (NHSR) benchmark data in relation to all claims reported and indemnified by NHSR notably shows that the Trust is reducing it’s time to resolution.

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Divisional Quality Updates

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Unplanned Care (Acute – Medicine) Quality Successes – November 2020

• Approved funding for Inpatient Heart Failure Nurse which will enable us to be compliant with Heart Failure NICE guidance and improve patient experience.

• Funding approved for 24/7 Stroke Nurse service to fall in line with partner organisations and continue to improve SNAPP compliance and patient safety.

• Two more cohorts of overseas nurses have joined

the Division and integrating well into their teams.

• 100% OSCE pass rate for new overseas team.

• Successful recruitment into our HCA vacancies across our medical wards.

• New ADON in post improving senior nursing structure for the division.

• Improved oversight and actions implemented for Dermatology service regarding prescribing concerns promoting patient safety.

• Stroke Gym relocated to a larger area on the ward.

Quality Challenges/Risks – November 2020

• Following the amalgamation of care groups to unplanned care, there is now an overall increase in overdue incidents which will be managed through division Quality, Risk and Patient Safety group

• Currently no substantive Sister on Colwell Ward.

Position currently out to advert. • Continue to improve communication within Acute

Medicine with both patients/relatives and professionally.

• Difficulties maintaining correct staffing establishment with ongoing COVID-19 related absence.

• Poor audit results related to hydration assessment and PVAD.

• Medical recruitment an ongoing challenge.

• Re-invigorating PJ paralysis initiative in order to encourage whole MDT to be able to offer drinks to the patients and ensure they have their tables and call bells to hand and that this is clearly and appropriately documented.

• Sustaining progress with Medicine Ward

Improvement Strategy and 3Ds with ward teams

• Extending ward clerk hours to support with efforts to improve communication and responsiveness on the wards.

• Looking into new ‘ward orderly’ role to release the HCA’s and nurses to provide more time to care

• Engaging with practise educators to facilitate leadership training and continued competency completion.

Quality Plan for December 2020

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Unplanned Care (Acute – CSCD) Quality Successes – August 2020

September 2020: • Low number of complaints and serious

incidents across Care Group. • Reintroduction of ‘Straight to Test’ for

Endoscopy • HDU planning developed • Developed plans for sustainable

integrated critical care service • New model of supplying chemotherapy

introduced

New achievements for September 2020 including:

• HCA Training nearly completed to maximise Endoscopy theatre capacity

• Mobile MRI in situ and second MRI building works have started

• Phlebotomy in community now commenced

• Consultant Critical Care Outreach Post now permanent

• CT POD being delivered 26.09.20


• Significant backlog of referrals in

Diagnostics. • Challenges in Diagnostic Capacity • Challenges around Diagnostic waiting

facilities • Lack of Senior Nurse Leadership

within Care Group

• Planning to increase capacity in

Diagnostics • High Dependency Unit Project is

progressing. • Medefer ‘Virtual Hospital’ for 6 initial

specialities – business case being developed.


8

Quality Successes – November 2020

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Unplanned Care (Acute – IUEC) Quality Successes – November 2020

Urgent Treatment Centre • No overdue complaints/concerns/incidents • Appraisals 92% • 111 ED validation has gone live with UTC • GP’s validating the 111 ED dispositions Emergency Department • Reduction of internal ED breach reasons by

70% • Increase of patient feedback cards,all good

or excellent. • More compliments received than complaints Medical Assessment Unit & SDEC • Completed Acute medical rapid

improvement event to streamline emergency floor patient experience

• Renaming of SSU and AAU • NHS111 ED dispositions went live.(allowing

patients to book a time slot in ED) • Recruited to band 7 post to have 4 full time

to cover 7 days a week cover


Urgent Treatment Centre • Recruitment of substantive GP’s • Tender process for Definitive Clinical

Assessment is on hold • Lack of Adastra continuity tracker patient

information in department Emergency Department • Recruitment of consultant • High usage of agency nurses – nursing

establishment being reviewed • Bed capacity has impacted on poor patient

flow with patients remaining in corridor. Increase in activity.

• Medical Mandatory training compliance still below 90%

Medical Assessment Unit & SDEC • No funding for SDEC activity – business

case underway • Improving pull flow from ED to SDEC using

a pull model rather than push • Medical staffing

Urgent Treatment Centre • Continue to recruit bank GP’s and ACP’s in

the absence of available substantive GP’s • Work with procurement to start the

Definitive Clinical Assessment tender process

• Complete outstanding appraisals Emergency Department • NHS111 MH patients to book slots in ED

once pathway established • Children’s ED area agreed date to open 5-18 December • ED presence at Hospital at night and

morning trust huddle Medical Assessment Unit and SDEC • Acute Assessment Unit plans • HISUG being launched • SDEC business case


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Planned Care (Acute – Surgery, Women’s & Children’s) Quality Successes – August 2020

Surgery Luccombe and Alverstone • Shelving installed in sluice on Luccombe • Shelving installed in cupboard next to kitchen for food items for Luccombe • Shelving installed in joint treatment room for IV fluids etc. • Decoration in progress on Luccombe e.g. dementia friendly yellow toilet

doors etc. • Overseas nurse allocation • 2 new starters interviewed (one for each side) • Band 5 seconded to Deputy Sister on Luccombe to cover maternity leave • Engagement with 10.00 and 15.30 site team meetings Pathology • Cellular Pathology has had a very successful ISO accreditation visit. • There has been increased testing in Microbiology as well as antibody testing

in Blood Sciences and this has been implemented successfully. • New equipment has been installed in Blood Sciences. Maternity • COC teams planned as part of national ambition and safety collaborative • Caesarean section rate is decreasing from the initial peak in May • Partners able to attend 1st trimester and anomaly scans • MVP focus groups in community antenatal clinics • Successful bank contract of lactation consultant and tongue tie division Paediatrics • Appointed to following vacant roles:

• Band 6 for Ward • Diabetes Band 6 PDSN • Healthcare Assistant Role for Outpatients

• End of life patient discharged home with Nursing and Medical plan in place • Booking long waiting ADHD patients Radiology • Ultrasound recruitment – appointment of Sonographer, Radiographic Helper

and Trainee Sonographer • Install of new CRIS (Computer Radiology Information System)


Surgery Luccombe and Alverstone • Patients arriving on ward from ED with unclear or unknown Covid-19 status

meaning isolation of patients/bay closures • Staff leavers & sickness – Alverstone • Challenges of Covid on going and winter pressures • Relentless pace and staff tiredness & anxieties surrounding Covid increases

(all areas) • Increase in Ortho elective surgery to Level C and demand on staffing

resources

Outpatients • The current issue impacting on Outpatients is the reduced waiting area due

to social distancing. It is difficult to return activity to 100% when you have taken over half the chairs out of the waiting rooms.

Pathology • Running the current Pathology service whilst increasing Covid testing and

absorbing the backlog work from cancer and screening services. • Microbiology is Setting up a new PCR Lab, however staffing is a challenge. • The lack of provision of ‘out of hours’ cell counts is also an on-going issue for

Microbiology. • The requirement for the Refurbishment of Cellular Pathology as well as

implementing the South 6 MES. • Introduction of new equipment in Blood Sciences has been difficult and

staffing in Blood sciences is also an issue. The lack of Haematology Accreditation is on-going.

• IT connectivity for NPEx to send and receive pathology test results between us and referral labs. Especially for Covid results

Maternity • COC teams planned as part of national ambition and safety collaborative • Caesarean section rate is decreasing from the initial peak in May • Partners able to attend 1st trimester and anomaly scans • MVP focus groups in community antenatal clinics • Successful bank contract of lactation consultant and tongue tie specialist

Paediatrics: • Increase in acuity and number of CAMHS patients • Long term sickness in Diabetes team.

Radiology • Radiographer recruitment for substantive and agency staff • CT, MRI and Ultrasound capacity and demand – existing equipment

at saturation point, additional units required

Surgery Luccombe and Alverstone • 3rd Deputy Head of Nursing starting at end of November – March

2021 to support 2 Deputies in post due to No HoN and ADoN • Portfolios of Heads of Nursing changing to cover areas

Outpatients: • Create shelters outside. • Use devices that individuals can take with them that will notify the

patient when to return to clinic. • COVID Secure barriers so that we can increase the number of chairs

in waiting areas.

Pathology • There is a need to increase the testing capacity across Pathology as

the Trust begins to implement measures to address their backlogs as well as continuing to perform the additional Covid workload.

• We need to support POCT for ED. • Training of staff to perform cell counts out of hours needs to begin. • We will be preparing for the Microbiology UKAS visit in January. • The ICE v7 upgrade testing needs to be completed and then we

need to start the ARES testing in Tpath.

Maternity • Continual review of maternity visiting • Increase Gynae outpatient clinics to address waiting lists and review

nursing requirements • Antenatal plans to be submitted for financial agreement • COC plans to be staffed and implemented

Paediatrics: • 24 hr Mental Health cover for Children’s Ward • Appointment to Interim Ward Sister for a period of 6 months • Bank PDSM to cover long term in the Diabetes team.

Radiology • Head & Neck Ultrasound training for Sonographer to support

Radiologist • Changeover of PACS (Picture Archiving Communication System) • New MRI scanner installation


10

Quality Successes – November 2020

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Mental Health & Learning Disabilities Division

Quality Successes – August 2020

Over the past 7 concurrent months all SI’s have been completed in time. This is a marked improvement in responsiveness within the Division. Mental Health Inpatient services are now smokefree . Good progress in month for assurance and validation of CQC actions (none remain at red – reduction of 20 red in the month) Audit by the MHA Office shows a reduction in the use of nurses holding powers Section 5 (4). The service was an outlier due to large numbers but is now performing better than the national average. Inpatient physical health screening document has been completed in draft for review and comment. Greenlight toolkit working group expanded to include external partners and service users – the group has commenced the first audit using the national audit tool. Positive feedback received from care homes to the Learning disability services regarding training they provided resulting in improved client experience. Substantive recruitment into interim posts in several teams. Team leader and clinical lead recruited for MHST Service User Reference Group formed to ensure co-production in developing and transforming services Risk assessments for those on CPA in the CMHT has exceeded target and in the month reached 100% for the first time. Positive feedback following release of MHLD Strategy

Quality Challenges/Risks – August 2020

Inpatient services did not win the bid for national funding to be used for privacy and dignity issues on Afton Ward. The funding was also going to be used to address dementia bed capacity. An alternative plan now needs to be agreed. Gaps in medical workforce continue to impact on the responsiveness of many teams . Estate changes to the ECT suite linked to covid19 have impacted on Osborne ward which does not now have a physical health clinic area for examination of patients. This will need addressing through repurposing other area of the ward.

Finalise the inpatient physical risk assessment booklet and roll out within all MH wards. Safety huddles/boards being rolled out in MH Inpatients Knowing how we are doing boards rolled out to all Division clinical teams. Commence medi-audits after the appropriate training of staff. Workforce skill mix planning commencing for transformation of services . Improved service user feedback reporting into Division Board. Assessment and Discharge team recruitment within inpatient services Draft carer strategy out for comment Further recruitment to MHLD Liaison team to ensure 7 day cover. MHLD Charitable funds process communicated to stakeholders . Further MADE event within MH inpatient service to address patient flow


Quality Successes – November 2020 Quality Challenges/Risks – November 2020

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Ambulance Service Division Quality Successes – October 2020

• Pelvic binder trial complete and new kit agreed for purchase and awaiting kit, improved ease of use, consistency across services and cost saving.

• Ambulance Service Quality Strategy approved and available on the intranet for staff to access

• Frontline staff meetings frequency increased to monthly and now held by MS Teams which is working well

• Chaplaincy service continue supporting staff health and wellbeing and debriefs.

• Attend anywhere available to Community Practitioners • 6 more computer tablets available for road staff to book out for

shift, enables remote access to e-mail, intranet, JRCALC and this is benefiting staff

• New replacement hard hats continue being rolled out to frontline staff.

• New cohort of volunteer Community First Responders continue being trained

• 2 newly qualified Paramedics (NQP’s) completed training. • Recognition of life extinct (ROLE) procedure reviewed and

updated and available for staff to access • Community Practitioner training portfolio signed off ready for

use by staff • Greatex for whole 111 team for the management of excessive

demand during Covid • 111 call abandonment rate <5% • Approved business case to progress implementation of new

999/111 telephony system • Rotating role for call handling to support quality of calls and

improve outcomes • 3 further CSD clinicians in training • Business case for ambulance station supported in principle • Additional PTS bank staff recruited • ED ambulance hand over average times improving • Continue to update clinical and operational SOPS.


• Patient Transport Services (PTS) patient capacity still a challenge despite being able to convey 2 patients on some journeys

• MOU with UHS for them to accept patients for PPCI direct from the community where QA cardiac lab is not available, not complete due to sickness

• Community Practitioner in the Hub clinical trial. • Continue to explore ceasing the use of cervical

collars for trauma patients, now delayed due to national programmes of work

• PTS computer aided dispatch go live and working well

• Face to face mandatory training days to recommence and training compliance monitored

• Trail of device for needle thoracostomy continues • Update/ agree maternity direct admission pathway • Commence use of Medical Audits for hand hygiene

and H&S audits. • Officer responder rota go live to support responses

to life threatening incidents. • Paramedic apprenticeship bridging course to be

advertised.


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Community Division Quality Successes – November 2020

• Wessex Activation Self Management Programme

(WASP) commenced on community unit as planned- first training session completed

• EOL training commenced as planned- positive feedback

but put on hold due to Lockdown

• Initiated detailed report of overdue incidents against Trust policy- zero tolerance approach

• NEWS2 compliance sustained for last 6 months • All actions in the Divisions 3 CQC improvement plans-

Dementia, Documentation and Deteriorating patient achieved on time and in line with expectations

• Peer reviewed article, COVID-19: the experiences of a

frailty specialist community rapid response team written by James Rushton et al and published on line in Nursing Older People

• 100% success rate with new Falls pathway triage pilot • Positive partnership discussions with Solent re: Rehab

consultant and clinical mentorship


• Competencies outstanding for Mid-line insertion • Work continues to understand the waiting lists

across the Division and identify/implement mitigation for the following areas:

-Rehab -Podiatry -Orthotics and Prosthetics -Paediatric Physiotherapy -Paediatric OT • Staffing resilience and capacity continues to be a

challenge to meet increased demand across Community services

• Sustainability of Tissue Viability and Nutrition

provision- sole practitioners (working with CCG/Trust on way forward)

• Continuing to review challenges posed through IT hardware and Divisional IT systems to ensure sustainable way forward

• Plan in place to address Mid-line competencies

• Continue to implement mitigations to support waiting list • Flu - 86.96%, push to achieve 90% • TEC plan to continue to work with services across the

Division e.g. Falls team to devise pathway from fracture liaison clinic

• Inaugural audit in the use of rehab and community beds- ensuring appropriateness to meet patient needs

• Division wide services to provide assurance regarding Documentation Audit via monthly report

• Division wide services to provide assurance regarding Supervision figures via monthly report

• Further work with Primary Care and Care Home team

successful trial for Comprehensive Geriatric Assessment - roll out in care homes


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Flu Programme Update Positives:

• Uptake has been positive overall from staff who are eager to get their vaccination

• Vaccinators have been very proactive in most areas and got off to a good start

• Staff have been asking about COVID-19 vaccines and it has given opportunity to start some of those discussions

• On track for achieving 60% immunisation into November, a trajectory to get to 90% is in place

• Further 1000 vaccines received Challenges:

• Vaccines arrival in batches and we ran out in OCC health on occasions

• Late return of forms by vaccinators needed chasing

• Large amounts of vaccines in some areas audited to track whereabouts

Next steps:

• Nov 26th 27th drop-in clinics and continue through December 2020 to optimise opportunities

• All staff being offered flu jab to maximise coverage in preparation for COVID vaccines

• All staff 90% to be offered accepted or refused vaccine by 1st Dec in preparation for COVID vaccines

• Data currently being updated to reflect position

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88%

70%

64%

64%

56%

50%

49%

49%

48%

37%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Quality Governance

Corporate Nursing

Community Division

Acute Services - Unplanned

Acute Services - Planned

Finance & Performance Mgt

Ambulance & Patient Transport Service

Mental Health & Learning Disabilities

Medical Directorate

HR & Organisational Development

Flu Jabs Given to Frontline Staff at 18 November 2020

Flu Programme Update

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35%

36%

39%

47%

50%

55%

59%

62%

66%

70%

74%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Trust Administration

HR & Organisational Development

Finance & Performance Mgt

Medical Directorate


Acute Services - Planned

Ambulance & Patient Transport Service

Acute Services - Unplanned

Community Division

Corporate Nursing

Quality Governance

Flu Jabs Given to All Staff at 18 November 2020


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Performance Information Organisational - Recovery - Covid Divisional - Acute - Ambulance - Mental Health and Learning Disabilities - Community

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Recovery - Update on Position

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Recovery Summary as at w/e 29.11.2020

20

Service Restoration 4 Week Av

Comments

Outpatient Appointments 91% Continuing to be impacted by Social Distancing

MRI 99% Both scanners work long days – Clearing backlog

CT 119% Third CT Scanner – Clearing backlog

Endoscopy 90% Additional weekend lists continuing

Day case 87% Continuing to be impacted by enhanced IPC measures – additional weekend list commencing

Inpatient 60% Continuing to be impacted by enhanced IPC measures – additional weekend list commencing

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Patient Waiting Lists

21

Total List size is now 9,639, 895 lower than at the start of 20/21. Non-Admitted List size is now 935 lower than at the start of 20/21. Admitted list size is now 40 higher than at the start of 20/21. 52 week breaches – there are now 522 patients who have waited more then 52 weeks for their procedure, 519 higher than at the start of 20/21. Challenge utilising Independent Sector

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Covid - Update on Position

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Isle of Wight Community Testing Activity Bed Capacity Modelling

Weekly Infection Rate (Cases per 100,000 population

COVID Update – Data as at 9.11.20

23

• Data taken from Daily COVID Dashboard, National Forecasts and Community Services Testing Group Update.

Data as at 9th November

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System COVID-19 Data As at 30th November 2020:

Southampton, Hampshire & the IW compared with IW - graphs normalised using by population size

11-Mar 11-Apr 11-May 11-Jun 11-Jul 11-Aug 11-Sep 11-Oct 11-Nov

Number of beds occupied by confirmed COVID-19 cases in hopital setting as of 8am Per 100,000 population

Isle of Wight

Southampton,Hampshire & IOW


Number of ITU beds occupied by confirmed COVID-19 cases as of 8am Per 100,000 population

Isle of Wight

Southampton, Hampshire &IOW


Number of COVID-19 discharges in the past 24 hours Per 100,000 Population

Isle of Wight

Southampton, Hampshire & IOW


Number Inpatients diagnosed with COVID-19 in past 24 hours Per 100,000 population

Isle of Wight

Confirmed diagnoses with

COVID-19 in past 24 hours

New admissions with COVID-19 in

past 24 Hours

Patients currently awaiting swab

results as of 8am

All Discharges from hospital in the last

24 hours

Of these discharges to usual place of

residence

S'oton, Hants & IW 14 6 333 25 17 709 38%Isle of Wight 1 1 21 0 0 58 32%

Of these COVID-19 related absences

290 376 2

1885184

Number of beds occupied by

confirmed COVID-19 cases as of 8am

Number of HDU/ITU beds occupied by confirmed COVID-19 cases as of 8am

Staff - All Absences

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Pre & Post Covid Analysis Other Emergency Activity Attendances

25

51.4% 55.2% 66.6% 83.0% 92.4% 92.3% 92.8% 81.0% 70.8% 74.0%

100.0% 100.0% 99.8% 100.0% 99.9% 99.9% 99.9% 100.0% 99.8% 99.8%

74.4% 75.5% 80.8%

88.0% 95.1% 95.0% 95.5%

89.3% 83.0% 84.4%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

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

ED Attendances by % Type 1 & 3

Type 1 % Type 3 % All Attendances %

Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Number of A&E Attendances - Type 1 2501 2442 2117 1557 1836 2197 2612 2868 2628 2385 4 Hour Wait Breaches - Type 1 1215 1095 708 264 140 170 188 544 767 620 Type 1 % 51.4% 55.2% 66.6% 83.0% 92.4% 92.3% 92.8% 81.0% 70.8% 74.0%

Number of A&E Attendances - Type 3 2248 2030 1580 652 1069 1228 1615 2207 1896 1607 4 Hour Wait Breaches - Type 3 0 0 3 0 1 1 1 1 4 3 Type 3 % 100.0% 100.0% 99.8% 100.0% 99.9% 99.9% 99.9% 100.0% 99.8% 99.8% Total Attendances Total Number of Attendances - ALL 4749 4472 3697 2209 2905 3425 4227 5075 4524 3992 4 hour Wait Breaches - ALL 1215 1095 711 264 141 171 189 545 771 623 All Attendances % 74.4% 75.5% 80.8% 88.0% 95.1% 95.0% 95.5% 89.3% 83.0% 84.4%

0

1000

2000

3000

4000

5000

6000

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

ED Attendances Activity Type 1 & 3

Type 1 Attendances Type 3 Attendances All Attendances

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Pre & Post Covid Analysis Other Emergency Activity Admissions

26

0

200

400

600

800

1000

1200

1400

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

Num

ber o

f Adm

issi

ons

Admission Month

Emergency Admissions - All Acute Care Groups 2020 2019 Pre Covid emergency

admissions were similar to that seen for the same period in 2019 During Covid Wave 1 emergency admissions reduced month on month by 15-17% YTD emergency admissions have increased by 4.1%

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Acute Division Performance Update

(October Data)

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Acute Performance Headlines

Key Risks Controlling actions 1 On-site COVID testing does not meet demand leading to delays in admission

/ discharge compromising performance and increased risk of outbreak • New point of care testing equipment purchased for ED – currently in testing phase • New platform in testing phase when complete will increase on-site testing by 200%

2 Emergency admissions continue above last year (3 – 8%). Impacting bed availability creating congestion in the ED department as patients wait for a bed to become available. Congestion is compromising performance and increases the risk of an outbreak

• Working with the CCG to develop primary care strategies to support patients outside hospital avoiding attendance and admission

• Work continues with ECIST to improve flow through the organisation embedding red to green and SAFER methodologies

• Continued development of the Integrated Discharge Team – to improve discharge planning reducing LOS.

• Breaking the Cycle Week event held 16 Nov 2020 - to effectively manage flows through the hospital to reduce Length of Stay and congestion in ED and proactively manage discharges adapting lessons learnt to support winter

3 48% vacancy factor in acute medic rota, slowing patients journey further compromising flow and leading to a breakdown of the medical model.

• Full time recruitment manager employed to source short term agency/bank staff to secure the rota

• Working with recruitment agency to do a focused campaign to attract permeant staff to provide consistency of care.

4 There are still 522 patients waiting more than 52 weeks down from 552 last week. While progress is being made this remains a significant risk. The focus on the longest waiters patients will continue however with significant number of patients waiting between 40-51 weeks, 52 week waits will continue to be an issue for some time to come.

• Utilisation of insourcing through 18 weeks to run additional weekend clinics • Using the Independent sector – continue working with the CCG and IS directly to try to

encourage uptake – has not met expectations • Extended days and additional theatres • The combined impact of all the schemes, including those such as extended working that we

are already introducing, would be to reduce the forecast 52 week breaches by 882, to 489 by the end of the year.

Key achievements this period • ED performance improving due to actions taken above to improve flow • Diagnostic services fully recovered and clearing backlogs • Outpatient 4 week average now above 90% • Day case activity above 90% (if exclude chemo) • Insourcing at weekend supporting Endoscopy (over 90%) and inpatient (85%) • Reduction in the total number of patients over 52 weeks.

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Preparation for COVID-19 Impact and Actions The Trust has been working closely with system partners and in line with national guidance and best practice responding to the Covid-19 pandemic and implementing delivery of a phased increase of routine activity as part of the Trust’s recovery plans. Phase 3 Response and Recovery includes the Winter Plan and the Covid-19 response.

Emergency Care Performance for October was 84.4% an improvement on the previous month of 83%. The Trust and System partners remain committed to managing demand ensuring patients are seen in the right place and the at right time. Slide 14 provides further details on drivers and improvement actions.

Cancer (provisional) Delivery of the national cancer standards continues with 2 week GP referral to 1st outpatient for Cancer, 2 week to first appointment for breast and the 31 day wait for diagnostics all achieving above target in month. The 62 day performance has seen a drop in performance from 83.1% to 68.3%. Patient choice has resulted in some delays to pathways and the Trust are liaising with primary care regarding targeted communications for patients to encourage attendance. CNS team are also contacting patients wishing to defer. There continues to be an improved re-allocation of theatre capacity for cancer procedures.

Improved escalation process through weekly performance reviews with Cancer MDT to be implemented and a new structure from 1st December to align surgery and cancer teams more closely.

18 Week RTT (provisional) RTT continues to see an improved performance position with October at 57.7% (53% in September and 44% in August). Full roll out of Medefer will help improve our non-admitted position, along with continuation of the restoration of outpatient and diagnostic activity. Admitted performance continues to improve with the addition of designated orthopaedic beds on Level C. The admitted waiting list size (reduced by 184 over the last 4 weeks) continues to reduce along with the backlog. This has been achieved through the utilisation of insourcing and improving theatre utilisation in-hours for cancers, urgents and long waiters. Use of the independent sector for the Island has been disappointing due to uptake.

Diagnostics (provisional) October provisional position is 72.5% which is a slight improvement on the previous month. Whilst CT/MRI activity has been above 100% on last year, the Trust is still continuing to clear the backlog from the Covid period. Capacity has been expanded to improve responsiveness for routine patients. A new mobile CT scanner online. This currently adds 50 patients/wk which brings capacity and demand to equilibrium, and we plan to increase this to 75/wk in the next month. Performance for next month should see an improved position.

Stroke (provisional) Compared to last quarter the quality markers have remained quite consistent with us being above national average on nearly all of them. The stroke unit 4hr target has improved from 57.6% to 65% which is a great improvement and we predict this to be similar for next quarter. We have kept the national average figures the same as last quarter as SSNAP didn’t provide them with these results. LOS is down by an average of two days and the other quality markers have kept to the same range as the Jan-March results.

The 4hour standard deterioration seen during September was due to bed capacity issues alongside the increase in the number of stroke patients in the previous 2 consecutive months.

Acute Spotlight Report Operational Performance - M7 October

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Acute Operational Performance Overview M7 October

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GP Referrals as at 29.11.2020

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Ambulance Division - Performance update

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Ambulance Performance Headlines

Key Risks Controlling actions 1 Continued increased demand against last years activity. • Additional private provider cover agreed until end of March 2021

• Community Practitioner in the hub trialled to increase see and treat rates • Improved working with ED to reduce handover delays • Additional call handler recruitment and training on going • Community First Responder training commenced • Increased use of attend anywhere within the hub

2 Increased number of Mainland Transfers • Continuing to work with SCAS to scope reciprocal transport arrangements using the Hovercraft

Key achievements this period • Improvement in response times compared to last month • Sustained improvement in recording of handover times 91% recorded this month in comparison to 41% in April 2020 • 111 First Programme gain national approval for go live in November ahead of national go live on 1st December

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• Further Officer responders to come on

line November and December • Frontline to participate in monthly quality

performance reviews • Paramedic recruitment • Results/ analysis from CP in Hub trial • Further roll out of the use of Corsium for

remote reviewing of EGG’s and obs. • Short audit on the outcome of patients

triaged and dispatched to as a sepsis.

Quality Plan for November 2020

Quality Successes – October 2020

• Community Practitioner in the Hub clinical trial undertaken, 6 days, including the use of attend anywhere

• PTS Cleric Computer Aided Dispatch live

• Face to face mandatory training days for frontline staff recommenced

• Medical Audit training for staff undertaken

• Paramedic apprenticeship bridging course, successful applicants have commenced training

• AED’s installed on Hovercrafts • New needle thoracostomy device

agreed • First officer responder shifts have gone

live • 48% of staff have received flu jabs • New personal issue helmets for frontline

PPE to all frontline staff. • Newly Qualified Paramedic portfolio live

on ESR • Death in Service protocol approved at

Divisional Board • Successful recruitment to Performance

Support Officer role for CFR’s • 111 first project has passed the regional

assurance process

Quality Challenges/Risks – October 2020

• Update/ agree maternity direct admission pathway, delayed due to workload

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Performance Summary

ImprovedSameWorse

Trajectory Key

Ambulance: 999: October activity was 9% higher than October 2019. Q1 and Q2 have seen a 21% growth in activity compared to 2019 Whilst increased resource has been deployed to support the

COVID-19 pandemic, demand outstrips capacity resulting in the failure of the standards and patients waiting longer for an ambulance.

October saw a reduction in activity compared to both August and September along with an associated improvement in response times compared to last month

Average number of ambulances in October per day was 71.6 compared to 78 in September, and 81 in August

Hospital handover times continue to improve 111: Call demand has reduced in October compared to previous

months August and September, although 2020 activity remains higher than 2019

Performance has risen as a consequence from 87.1% of calls being answered within 60 seconds to 90.43% which is still not meeting the standard (95%)

Recruitment and training of call handlers is on going PTS: Additional crews having been operating at weekend to assist

increased demand of hospital discharges Transporting more than one patient to assist with OP demand

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Hospital Journey's 785 991 1,176 1,280 1,336 1,333 1,259

Turnaround% > 30 Minutes 58.2% 58.0% 56.0% 47.8% 50.0% 54.4% 42.4%% > 60 Minutes 11.3% 7.6% 6.5% 5.0% 3.4% 5.5% 4.8%

Mean Turnaround Time 00:41:12 00:42:31 00:37:35 00:36:16 00:34:25 00:36:11 00:32:32

Time Lost Per Journey (Turnaround >30 Mins)

00:14:56 00:15:54 00:10:54 00:09:58 00:08:20 00:09:14 00:07:30

HandoverHandovers Recorded 384 680 930 1,079 1,199 1,213 1,155

% Recorded 48.9% 68.6% 79.1% 84.3% 89.7% 91.0% 91.7%

% Handovers > 15 Mins 67.2% 63.5% 61.4% 67.6% 71.6% 74.3% 42.1%% Handovers > 30 Mins 7.0% 8.2% 5.9% 7.4% 8.2% 9.8% 6.4%% Handovers > 60 Mins 1.3% 1.0% 0.6% 0.8% 0.4% 1.6% 1.3%

Mean Handover Time 00:19:46 00:19:44 00:18:10 00:19:35 00:19:52 00:21:01 00:16:58

Time Lost Per Journey (Handover >15 Mins)

00:05:51 00:06:01 00:04:34 00:05:41 00:05:46 00:06:45 00:04:21

Metric Sep-20 TrajectoryApr-20 May-20 Jun-20 Jul-20 Aug-20 Oct-20

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Division – Performance update

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MH & LD Headlines

Key Risks Controlling actions 1 Consultant vacancies across

the Division resulting in lack of medical capacity.

• Work continues through the Partnership to review the medical model in line with the strategy and HR offering proactive support to consider options for temporary cover and filling vacancies in the longer term.

2 Continued high vacancy rates across inpatient services and increasing vacancies in the Community Mental Health Team. Lack of Band 5/6 temporary staff via the agency framework.

• The Division is exploring options for overseas recruitment.

3 Increased demand in Children’s and Young People’s services, resulting in increase in mental health admissions to the Children’s ward

• Recruitment of agency RMN staff in the Children’s ward

• Recruitment of CYP nurses in the crisis services • Working with commissioners to grow the CAMHS

crisis service • Recruiting to the schools Mental Health Support

team

Key achievements this period • Consultation on new leadership structure completed. Recruitment to the Director of

Operations and Commissioning is in progress. • Recruitment underway for the school’s mental health support teams (MHST) with the Team

Leader and Clinical Lead appointed

38

• The Division is continuing to experience an increase in demand across services, linked to the Covid impacts on mental health. This is particularly acute in services for Children and Young People, and in inpatient services

• Lack of medical capacity across the Division continues to be a significant risk, and work continues through the Partnership to review the medical model in line with the strategy, and to consider options for filling vacancies.

. • The Division is progressing implementation of the MH&LD

Strategy ‘No Wrong Door’. A new leadership structure has been agreed, in line with the strategy. This increases leadership capacity, and also introduces a new joint role with the CCG – Director of Operations and Commissioning.

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Performance

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Operational Challenges

• We are experiencing pressure on mainland specialist inpatient dementia beds.

• The significant increase in the number of Children and Young People (CYP) presenting in crisis and admitted to the Children’s Ward is continuing, and is in line with the national picture. We are recruiting additional CYP staff to the Integrated Mental Health Hub, and employing RMN staff to support the Children’s wards, and working with Commissioners to develop medium term plans to increase CAMHS capacity in the community.

• CMHT staffing retention is becoming an issue again after a period of stability which will impact on service capacity. Recruitment is in progress, and we are seeking

agency staff to fill gaps. ‘Team Care’ programme to start in month to support staff retention.

Good news

• Winter pressures funding agreed for:- MH&LD Liaison team to extend operating hours to include Saturday & Sunday 7am until 9pm, recruitment is currently in progress, aiming to go live by the

beginning of December. ��Extension of Safe Haven into MH Hub at hospital. Commences 16/11/20�

• 3 Children and Young People (CYP) Practitioner posts recruited in Single Point of Access to provide assessment and liaison at weekends for CYP in crisis • � Liaison & Dementia Outreach teams now building links for complex case transitions from acute inpatient care to a care facility/home by using trusted

assessments � • �Lockdown restrictions have led to positive innovations in recruitment for the school’s mental health support teams (MHST) - applicants for roles have been invited

to submit 3 minute videos with their application, and this has enabled applicants to be shortlisted for interview by volunteer young people. �� • PHL Ltd have been commissioned to start taking referrals for ADHD assessment from 23rd Nov �

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Community Division – Performance update

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Quality Headlines

Key Risks Controlling actions 1 Central Rehab Service - cessation

of Botox clinics; these are yet to resume due to lack of mentorship for the Extended Scope Clinician, 24 patients are now waiting. has contacted all clients to review their needs.

• Discussions are underway with Solent NHS Trust to seek a joined up resolution. In the interim, the Physiotherapy service

2 Dietetic Service have flagged an increase in paediatric and adult mental health cases in the last 2 months. The impact of this increased demand is a reduction in time available for lower priority work and increases the waiting list for routine outpatients.

• The Mental Health Division are considering funding for an additional 0.2wte of a Dietitian which will partially address this risk.

3 There is currently a limited Tissue Viability service provided across the Trust (due to long-term sickness)

• The Division is working closely with Acute colleagues to find alternative solutions to support this gap in service.

Key achievements this period • The 0-19 Service transferred to Solent NHS on 1st November 2020. The

demobilisation project received excellent support from corporate teams and implementation went to plan, no items to escalate. The Child Health Information Systems (CHIS) team is transferring to Southern NHS on 1st April 2021 and demobilisation work is ongoing.

• There were no serious incidents declared in September. A full Root Cause Analysis (RCA) investigation has been carried out across Quarter 2 serious incidents and support learning from outcomes.

• Overdue incident management – following clarification of the Trust’s policy standard, the Division have implemented changes to oversight and will be closely monitoring performance on a weekly basis (All Datix’s logged must be reviewed within 5 working days; all investigations to be closed with appropriate lessons learnt within 20 working days).

• The mandatory training compliance across the Division is currently reported at 88% against a 95% target. The Division is checking and reviewing associated processes with HR colleagues to drive achievement across the division.

• Flu vaccination uptake across the Division is currently at 50.66% with a further 5.31% of staff formally declining to have the vaccination. Work is continuing to promote flu vacs to all staff and monitor uptake weekly through Divisional governance.

• The Youla project is now gathering patient behaviour data from within the Community Unit and from patients homes following discharge to enable us to monitor the increased independence of patients and post discharge monitor changes remotely, the following performance has been recorded for September 2020. Out of Bed – 97% Been to the day room – 73% Happy about activity level – 85% Improvement in condition – 64%

• The staff on the Community Unit have now completed the first stage of the Wessex Activation Self Management/Personalised Care programme which saw managers, Commissioners and patients complete a questionnaire around personalised care. The feedback from this has informed a Quality Improvement Plan for the Unit.

• The Care Home Support team are working with Primary Care Networks to develop and undertake Comprehensive Geriatric Assessments on care home residents. This has resulted in medication being stopped to reduce risk of falls and onward referrals for investigation of weight loss. The team will measure outcomes, for example - their impact on ED attendances.

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Performance Headlines Key Risks Controlling actions 1 The long-standing risk that Year 1

children with Speech & Language Therapy needs are not able to access therapy following a change to commissioned care has now been resolved with a new Service Level Agreement and additional funding being offered by Commissioners.

• Risk now mitigated

Key achievements this period • The Covid Testing site service is now well embedded within the Division with robust governance and

reporting in place. • Falls Prevention Pathway - the September Community Divisional Board approved the falls pathway

for implementation as part of restoration work post COVID to make adjustments to service delivery model and align with frailty plans. Refer to slide 6 for the Falls pathway ‘Plan on a Page’. The falls data for September for Community Rehab beds is showing a reduction in falls since June 2020. Further work continues across the Division to drive this work forwards.

43

• Following the implementation of the Integrated Discharge team, both the Care Health and Improvement Partnership and ECIST have undertaken reviews to identify areas for development. Feedback from both organisations has been very positive and recognised the great progress made across the Trust in discharge processes.

• Following close monitoring of increased Podiatry waiting times, the performance of high risk podiatry clinics is an improving picture with some clinics now achieving a 12 week waiting time. Clinic Co-ordinators are now rebooking patients to attend at different clinics to ensure targets are met across all areas. Informal discussions with peers have indicated the IW are in a good position in comparison to other areas.

• The increase in remote consultations throughout the pandemic is being actively monitored by the Division with an audit being undertaken across services.

• The length of stay data for the Community Unit has seen an improvement with 9.9 days reported in August, reducing to 7.5 days in September.

• The Community Paperless Programme is picking up pace again following a COVID pause and continuing to make good progress. Via a business partner relationship, colleagues in Information Management &Technology are supporting efforts to ensure electronic solutions are in place for services. A focus on Community Rehabilitation is planned next.

• The Crisis Team has had a peer review paper published in the Royal College of Nursing covering the experiences of a frailty specialist community rapid response team during the pandemic.

• The Continence Service is trialling a ‘Continence Champion’ role within the West & Central Locality Nursing team.

• The Orthotics and Prosthetic service are offering evening clinics to patients twice a week to maximise estate usage and implementing a triage approach to meet additional Covid demands.

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Key achievements this period • The Technology Enabled Care team continue to progress transformational

work and showcase the IW Trust. The team have reported the completion of 10 virtual clinics at Ryde Health & Well-Being Centre during September in conjunction with their Acute colleagues and an evaluation of the droplet cup (to support hydration of patients) has been published by the Academic Health Science Network (AHSN). The team have also won a national Health Tech Digital award for ‘Best COVID-19 Remote Monitoring Solution’ which received good publicity on IW Radio.

Workforce Headlines

• The Division continues to see good performance with sickness absence – currently reporting 3.42% against a target of 3.5%. Graphical representation of performance over the last 3 years is detailed on slide 7.

• The Community Division continues to make great progress with Appraisal compliance (Well Being Checks for 2020) with a majority of teams having achieved their target of 100%, overall compliance is 90.66%. All Service Leads tasked to complete checks by end of October, pre any winter surge. The Community Unit has a number of new staff to complete Well-Being Checks with and these are being progressed at pace. A breakdown of individual service compliance is detailed on slide 8.

• In addition to the corporate and divisional staff support offered throughout Covid-19, work has resumed to improve staff engagement levels across the Division. The first online ‘Community Conversation’ was conducted in October via MS Teams and focused on staff health and well-being. The Division plans to hold a ‘Community Conversation’ each month with topics selected by the staff and guest speakers introduced as appropriate.

• At the time of writing this report, the Division has achieved 63.20% of staff responding to the national NHS staff survey. All Community Service Leads are encouraging their staff to participate and ensuring they are given time within their working week to complete the survey.

• Work has recently completed following an organisational change to create an integrated admin team in each locality to support implementation of integrated community services, aligned with Island Health & Care Plan and STP plans.

• Two of our three Island-wide Health & Social Care Locality teams are now are now co-located following the North East Locality staff moving to Ryde Health & Well-Being Centre. Work now underway, with support of Estates, to co-locate the Central & West team .

• The Integrated Discharge team continue to develop to support discharges and further funding from Hospital Discharge Support Scheme has been received. Recruitment is currently underway.

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• The Division continues to closely monitor of clinic space utilisation with the establishment of a monitoring tool for the Ryde Health & Well Being Centre. Roll-out of this tool to other areas of the Community estate is planned over future months which will help improve a Value For Money focus on estate utilisation.

• The divisional budget position has been agreed and there is a high degree of confidence that service delivery can be maintained within the financial envelope.

• Community has received the Hospital Discharge Service (Scheme 2) investment to support Phase 3 Covid recovery.

• The Care Home Support team have secured funding from Primary Care Networks (PCN’s) for additional posts to support PCN’s in delivery of their new contracts which include the completion of Comprehensive Geriatric Assessments and training of Care Home staff to avoid hospital admissions.

Finance Headlines

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Integrated Workforce & Financial performance

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• Substantive staffing has increased by 34 FTE since Month 6, but remains 130 FTE below the substantive plan of 3092 at Month 7.

• Overall Bank & Agency usage increased on Month 6 at 344 FTE.

• Sickness absence has seen a further increase against month 6 position and is at 4.72%.

• Issues with ESR BI have prevented us from running Turnover reports for this month and divisional level detail for sickness absence

• Appraisal rate as at 31 October 20 has increased to 65% this represents an increase of 7% on month 6

• Statutory training decreased by 1% in month to 82% as at 30 October 20

• Response rate for the staff survey is 54%

Key Risks Controlling actions 1 Medical workforce

vacancies

• Business case being prepared for international recruitment; looking at option of joint process with PHT

2 Covid-19 Wave 2 – staff capacity

• Continued recruitment to Bank • Regular health and wellbeing checks • Working with divisions on staff

redeployment plan

3 EU Exit • Refreshed communication to staff with guidance and reassurance

4 Staff health and well being

• Additional OH Consultant resourced to support increased capacity

Key achievements this period • Long term locums booked to March 21 for General Medicine • Established new relationships with partner organisations to secure

additional international recruitment • Working with partner to secure mental health nurses

Workforce Headlines

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• Board approved financial plan in place from October to March, replacing the interim national financial framework in place until September

• Divisional ownership of the plans mean we now have full devolved budgetary responsibility from M7.

• Overall financial performance as at M7 is a £22k positive variance against plan

• The risk is under a new financial regime in M7-12, our costs exceed our income and create a larger than expected deficit. In mitigation, Financial Controls have been reviewed and communicated, the board has agreed a net £3m deficit plan for M7-12.

• Regional approval has been given for all Covid revenue reimbursement claims in M1-6. From October, the financial plan includes a budget allocation for Covid-19 related costs, excluding costs of testing. Testing costs continue to be reclaimed from NHS England on a cost incurred basis. Costs for October were £262k.

• The Trust is however waiting on national approval for some of the Covid capital claims we preceded at risk on during Covid phase 1 response.

• Recurrent/non-recurrent additions to our cost base, Covid or otherwise are being worked as a start to our planning for 2021-22. This presents a further medium term risk to our financial viability. Initial draft of this will be completed by the end of November.

Key Risks Controlling actions 1 Covid wave 1 capital

reimbursement still awaiting national approval – maximum risk £1.8m

• Identification of any potential Q4 slippage in Trust capital programme to offset

• Supporting information supplied to NHSE to support investment reimbursement

2 Covid-19 Wave 2 staff absences lead to higher than expected high cost Agency staff and/or insufficient capacity to deliver our Recovery targets, this leads to a cost in excess of budget

• Approval process in place to approve additional staff over rotas

• Approval process in place to approve rates outside of agreed limits

• Recruitment to Bank, replacing Agency • Continued work on Agency pricing regime • Business case and contracts in place outlining

benefits within agreed funding envelope

3 Risk for Longer term financial plans due to higher recurrent cost base incurred in response to Covid and Recovery

• Current validation of recurrent/non recurrent cost and income baseline for 2021/22 planning

Key achievements this period • New budget allocations issued to all budget holders from Month 7, in line with approved

plan • M7 and YTD financial positive marginally better than plan y £22k • Enhanced financial controls in place, STWs and revised Business Case process • Further capital funding received for replacement CT Scanner under national Adopt and

Adapt Programme • Financial Recovery Board messages agreed and disseminated to the Organisation

Finance Headlines

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Finance - Month 7 Summary

Area Key issues Current month (ytd)

Previous month (ytd)

Overall Plan Board approved financial plan in place from October to March, replacing the interim national financial framework in place until September. The gross reported planned deficit for the Trust is £3.7m. This includes ‘allowable’ variances of £0.7m, leaving a net £3m deficit gap. To date, the financial performance is ahead of plan by £22k.

£22k positive variance to plan

Break even

Pay and Non Pay Expenditure

This is the first month of the revised financial framework and plan. Performance is on plan to date.

On plan £0.5m fav to plan

External Income This is the first month of the revised financial framework and plan. Performance is on plan to date.

On plan £0.5m adv to plan

Capital Capital plan for 2020/21 is now split into 6 programmes. The main Trust capital programme plan was reviewed at the Capital Investment Group meeting on 15 October. The Trust is awaiting national approval for some Covid reimbursement claims, and this represents a risk to delivery of the overall capital plan within funding allocation.

On plan On Plan

Cash The revised financial framework funds cash in advance for 2020/21. This enables the Trust to maintain a positive cash balance without the need for external support cash. For comparison, month end cash balances during 2019/20 were typically around £2m. With this advance cash comes a requirement to pay supplier invoices in advance of due dates once approved, in order to aid the local and national economy.

£29.3m Cash

Balance

£27.7m Cash

Balance

Cumulative monthly supplier payment performance

Trusts are expected to pay 95% of all suppliers within 30 days. As at the end of October the supplier payment performance was 93.0% cumulatively for 20/21. The in-month performance for October was 97.2%.

93.0% 92.1%

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Pay versus workforce capacity

Summary • Overall pay spend to date is £95.6m,

of which £5.1m relates to COVID-19.

• The net pay spend is a £0.2m positive variance against plan

Summary • Overall FTE capacity utilisation was

74 FTE below plan for Month 7, but was an increase of 59 FTE above the Month 6 position.

• Temporary staffing utilisation was 29 FTE greater than M6, overall usage is 69 FTE above plan to compensate for substantive vacancies.

• Agency usage for M7 is on plan (115 FTE) and is predominantly covering nursing and medical vacancies

Plan Actual Var Plan Actual Var Estab ActualSubstantive 12.1 11.6 -0.4 81.4 81.0 -0.4 3,380 2,962Bank 1.0 0.9 -0.1 6.3 6.2 -0.1 229Agency 1.3 1.5 0.2 8.2 8.4 0.2 115

Total 14.3 14.1 -0.3 95.9 95.6 -0.3 3,380 3,306

Plan Actual Var Plan Actual VarSubstantive 0.2 2.2Bank 0.2 1.7Agency 0.2 1.2

Total 0.5 5.1

Workforce wteTotal Pay

In Month (£m) Year to Date (£m)

Of which COVID-19 cost

In Month (£m) Year to Date (£m)

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Trust has reported a positive variance of £22k against the planned position to date. The forecast position remains to achieve the financial plan.

Board approved financial plan in place from October to March, replacing the interim national financial framework in place until September. The gross reported planned deficit for the Trust is £3.7m. This includes ‘allowable’ variances of £0.7m, leaving a net £3m deficit gap (£2.4m to deliver elective care recovery plan, and £0.6m recognising additional costs of delivering services and Covid response to Island). This plan excludes any potential Covid wave 2 impact.

Funded plan

Actual Variance to plan

Year end forecast

£m £m £m £mPay -95.9 -95.6 0.3 -166.5 Non Pay -45.8 -46.0 -0.2 -77.2 Other external income 7.6 7.7 0.1 13.4

Sub Total -134.1 -133.9 0.1 -230.2 Contract income 133.2 133.1 -0.1 226.5

Surplus / (Deficit) -0.9 -0.8 0.0 -3.7

Year to date (YTD)

Finance - Month 7 Overall Financial Performance

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Updated 2020/21 budget allocations have been given to all budget holders across the Trust. These are based on: • April – September allocation matched to actuals incurred (i.e. zero variance) • October – March allocation as per plan submission

This will ensure that delivery of the operational and financial plan can be managed at a Divisional and departmental level for the remainder of the year.

Trust has reported a positive variance of £22k against the planned position to date. In addition to financial performance being managed at a Divisional level, the following specific elements of the financial plan will be monitored:

• Progress against recovery plan • Covid direct costs incurred • Achievement of overall financial plan • Recovery of external income

There are clearly risks to the delivery of this plan and these will be managed/mitigated through the Executive and assurance will be provided to the Board assurance Committees on behalf of the Board.

Plan£m

Actual£m

Variance£m

Plan£m

Actual£m

Variance£m

Acute & Ambulance Division -11.7 -11.9 -0.2 -74.0 -74.2 -0.2Mental Health & LD Division -1.9 -1.9 0.0 -12.6 -12.6 0.0Community Division -1.7 -1.6 0.1 -11.2 -11.1 0.1Non Clinical Division & Covid -3.6 -3.3 0.2 -31.1 -30.9 0.2Capital Charges & Financing -0.6 -0.6 0.0 -5.2 -5.2 0.0

Sub-Total -19.5 -19.4 0.1 -134.1 -133.9 0.1Contract income 18.7 18.5 -0.1 133.2 133.1 -0.1Surplus / (Deficit) -0.9 -0.8 0.0 -0.9 -0.8 0.0

In month Year to date

Finance - Month 7 Financial Performance (by division)

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Summary • Sickness absence has seen a general decrease within the COVID period from April 20 onwards. There has been

a continued increase between Month 5 and Month 7 driven by an upward trend in Registered Nursing and AHP sickness absence.

• “Stress, anxiety, depression” remains the highest cause of sickness absence. Specialist mental health support is being provided by Occupational Health as part of the Trust’s Health and Wellbeing offer.

• The new Covid lateral testing process may result in increased levels of absence.

Month 7 staff absence - performance by division Division Target Actual VarianceAcute Services 3.50% 4.88% 1.38%Ambulance & Patient Transport 5.50% 7.48% 1.98%Community Division 3.50% 3.28% -0.22%Corporate Nursing 3.50% 1.98% -1.52%Finance & Performance Mgt 3.50% 4.04% 0.54%HR & Organisational Developmen 3.50% 2.93% -0.57%Medical Directorate 3.50% 0.49% -3.01%Mental Health & Learning Disab 4.50% 5.93% 1.43%Quality Governance 3.50% 3.99% 0.49%Trust Administration 3.50% 2.75% -0.75%Trust 3.50% 4.72% 1.22%

Staff Sickness Absence

Data not yet available due to ESR technical

issue

Data not yet available due to ESR technical

issue

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Summary The Trust still relies on significant levels of temporary staffing. Requests for bank staffing have seen an increase of approximately 30% since November 2019, this is due to our response to COVID-19 and preparation for winter against a shortfall in our substantive staffing. Increased bank usage has addressed shortfalls in substantive staffing but has not impacted on agency usage, which is on plan at M7. The declining fill rate reflects this recent growth in demand. Recruitment activity to the bank continues to be a priority focus.

86%

82%

88%

85%

87%

85%

87%

81%

81%

80%

82%

85%

86%

87%

83%

80%

75%

74%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% Bank Fill Rate

Temporary staffing

Overseas Nurses 20/21 Trajectory Overseas nurses revised deployment trajectory following Covid-19 pandemic • There is a revised deployment plan for the remaining 64 registered nurses. The most recent

cohort of nurses arrived on 30 October and have commenced their online learning while isolating.

• We have succeeded in being awarded additional funding from central NHSI/E to support the deployment of the remaining nurses is complete by 31 Jan 21.

• Deployment will have a significant impact on the current levels of agency nursing staffing. • The Trust has undertaken interviews with prospective international nurses provided by Yeovil.

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Summary • Overseas recruitment will see a rise in our substantive RN workforce, and a decrease in agency utilisation – the latter requiring commitment from the divisions • £2.9m full year savings have been achieved as a result of the 2020-21 overseas recruitment. • Further work is underway to extend our international recruitment programme to improve our 66 FTE vacancies

• Despite additional RN agency hours being used for the recovery plan, overall usage has reduced.

• A further reduction of ~9000 hours is expected in the last quarter of 2020-21 due to the employment of overseas nurses

• This has resulted in a forecast RN vacancy position of c66 FTE at the end of 2020-21, an reduction of c71fte vacancies since Apr20

• Forecast is based upon average natural attrition and anticipated student and overseas recruitment, which is all subject to change

RN agency trajectory

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Executive Summary

Our organisational development journey aims to create an environment where staff are valued and able to take responsibility; where career development and progression is enabled; a learning culture embedded; where we make things simple for staff to have their say and feel engaged; and work in partnership across the health and social care economy as part of a system. Key action highlights in October 2020 include: Education • Overall Statutory Training Compliance at 31/10/20 = 82% Staff Engagement • NHS Staff Survey 2020 launched w/c 28 September 2020; • NHS Staff Survey 2020 Communication and Engagement campaign being delivered 28 September – 30 December 2020 • Response Rate as at 16 November 2020: 54%

Health and Wellbeing • Continued delivery of health and wellbeing service offer from January 2020 – October 2020; • 64.95% completion of Health and Wellbeing Check-in (Appraisal) as at 31 October 2020. Collective Leadership • Leadership Essentials is available for staff booking launching on w/c 16 November2020 • Launch of PERMAteams and TeamCARE as an intervention to review, reflect and re-focus leadership culture at team level • Launch of Leadership Design Labs w/c 16 November 2020. Diversity and Inclusion • Delivery of Race, Disability and LGBT+ Equality Networks • Celebration of Black History Month with a focus on HIOW collaboration events and • Presentation by the Estate and Facilities Service to the Disability Network to implement a Trust Disability Access Audit • Social media activity promoting International Coming Out Day to support LGBT+ Network

Organisational Development Summary

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Statutory Mandatory Training Compliance – 30/10/20

Action • Corporate directorates all below 85% compliance • Manual Handling refresher to be delivered at departmental level and new process has been

shared with all Clinical Managers • Virtual Mental Capacity Act sessions planned to deliver training to large groups of staff

currently or due to be out of date. • The migration of data from Pro4 to ESR is still currently being implemented. Additional IT

support is required to move on to the second phase of the implementation (import of mandatory training data into ESR).

• Currently all mandatory training data and bookings still sit within Pro4 for data accuracy. • Training Tracker and ESR remain available for staff to complete online training modules.

Impact • Overall Statutory Training Compliance at 30/10/20 = 82% • This is a 1% reduction on last month

Mandatory Training Compliance

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Staff engagement – NHS Staff Survey

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1. Health and Wellbeing Journey (as at 31 October 2020)

Health and Wellbeing • Coordinated, accessible wellbeing offer • Happy, healthy, resilient people • Flexibility and work life balance

1. Wellbeing Hub with up to date information and resources for staff on staff intranet 2. Health and Wellbeing Newsletter promoting staff stories and wellbeing information on

services available inside and outside the organization 3. Occupational Health offering a 24 hour phone line and management of Covid-19 Risk

Assessments 4. ‘Listening Ear’ service for staff to have a safe and confidential place to have a wellbeing

check-in with a trained coach. 5. Health and Wellbeing Check-in/Appraisal template and manager resources 6. Psychological formulation of support via ‘Care Spaces’ and ‘Taking Care to Give Care’

to teams working throughout the pandemic 7. ‘Mindful Monday’ delivered by our Consultant Clinical Psychologist via our staff Facebook

page 8. Promotion of NHS England/Improvement and system wide offers 9. Working from Home health tips resources 10. Physical health interventions including yoga and fitness

The trust is building a well-led architecture for workplace health and well-being with a specific focus on developing (i) organisational enablers such as leadership and a data driven response; and (ii) mental and physical health interventions that promote the health, safety and wellbeing of our people.

Health and Wellbeing Check-in performance as at 31 October 2020 Health and Wellbeing Service Offer

Building a Well-Led Architecture for Organisational Development

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Collective Leadership • Developing leaders at every level • Empowering managers • Identifying and nurturing talent

Service Offer 1. Career Coaching Delivery of Individual Career Coaching sessions are underway supporting people in their career development and progression. 2. TeamCARE TeamCARE aims to integrate a structured approach to staff engagement at team level. More specifically, offering a multi-methods approach to build insight into team culture and offering staff the opportunity to co-design an team culture action plan via team development away time. A programme of leadership essentials is also delivered via bitesize seminars. 3. PERMAteams This 2 hour intervention introduces teams to Positive Psychology with a focus on understanding the PERMA model and enhancing team morale and motivation. An audit will be kept on teams accessing this service and impact measured through the development of a new Pulse Survey in 2021.

Diversity and Inclusion • Celebrating diversity • Tackling inequality • Promoting Inclusion

Service Offer 1. Conferences The People and Organisational Development team have presented at national and international conferences to put a positive spotlight on the diversity and Inclusion journey at Isle of Wight NHS Trust

2. Black History Month Celebration of Black History Month in October 2020. This includes working in partnership across HIOW to deliver a coordinated response and engagement/communication campaign within the trust. 3. Staff Equality Networks The Equality Networks offer staff a support network and opportunities to co-design solutions to improve diversity and inclusion performance. The focus in October has been tackling bullying and harassment with design opportunities to create a #Respect campaign.

2. Collective Leadership Journey (as at 31 October 2020) 3. Diversity and Inclusion Journey (as at 31 October 2020)

Building a Well-Led Architecture for Organisational Development

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Governance Updates

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Governance Headlines

• The Risk Management team is in the process of reviewing the Corporate Risk Register to ensure all risks are accurately described, still current, and accurately scored. There will also be increased emphasis on identifying, recording and managing risks which need to be addressed at a corporate level, rather than focusing only on the highest level divisional risks

• A further review of the allocation of all corporate risks is underway

• There is a comprehensive review planned for all policies to determine their relevance in line with national guidelines – it is expected that an outcome of the review will be a reduction in the total number of policies

Key Risks Controlling actions 1 Corporate risk register

has not previously included Trust-wide, corporate risks

• Interim revised corporate risk register presented to the Board for approval, on recommendation of Q&P Committee

2 Highest scoring divisional risks require review

• The description and rating of all divisional risks will be reviewed over the coming three months

3 The Trust’s bank of policies includes several which are considerably out of date

• All policies will be reviewed for currency, with the expectation that a significant number can be withdrawn. Those still required will be allocated for update

Key achievements this period • Key current corporate level risks have been identified and captured on

the revised Corporate Risk Register • Internal Audit reviews of the Coronial process and claims management

process have both found ‘substantial assurance’

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