agenda attached

CWM TAF UNIVERSITY HEALTH BOARD

FINANCE, PERFORMANCE & WORKFORCE COMMITTEE

The meeting of the Finance, Performance & Workforce Committee will be held on Thursday 19 April 2018 at 1pm in the Rhondda & Cynon Rooms,

Ynysmeurig House, Abercynon.

MR MEL JEHU

CHAIRMAN

AGENDA

ATTACHED

PART 1 - PRELIMINARY MATTERS

1.1 Apologies for absence

Oral

1.2 Welcome and Introductions

Oral

1.3 Declaration of Interests

Oral

1.4 To receive and confirm the Minutes of the meeting held on

22 March 2018

Paper

1.5

Action Log

Paper

1.6

Matters Arising

Oral

PART 2 – KEY ITEMS FOR DISCUSSION

2.1

To receive an annual update on Facilities Performance (John

Palmer) – Russell Hoare to attend for 1.30pm

Paper to

follow

2.2 To receive an annual update on Estates & Energy

Performance (Ruth Treharne) – Tim Burns to attend for 2.00pm

Paper

2.3 To receive an update on Primary Care CAMHS (Alan Lawrie)

Paper

2.4 To receive an update report on Medical Agency Expenditure

(Joanna Davies)

Paper

PART 3 – ITEMS FOR INFORMATION

3.1 To receive the confirmed Action Notes from the Efficiency, Productivity & Value Board meeting held on 5 February 2018

(Ruth Treharne/Mark Thomas)

Paper

1 Agenda

1 of 111Finance, Performance & Workforce Committee-19/04/18

PART 4 – OTHER MATTERS

4.1

4.2

4.3

4.4

To review the Forward Look for 2018/19 (Chairman)

To confirm any items to be referred to other Committees

(Chairman)

Any other Urgent Business (Chairman)

Date and time of next meeting

1pm, Thursday 24 May 2018, Ynysmeurig House, Navigation Park, Abercynon

Paper

Oral

Oral

1 Agenda

2 of 111 Finance, Performance & Workforce Committee-19/04/18

Agenda item 1.4

‘Unconfirmed’ Minutes of meeting held 22 March 2018

Page 1 of 13 Finance , Performance & Workforce Committee Meeting

19 April 2018

Finance, Performance & Workforce Committee Meeting

‘Unconfirmed’ Minutes of the meeting held on 22 March 2018

Ynysmeurig House, Abercynon

Present

Mr Mel Jehu - Independent Member (Chair) Mr Paul Griffiths - Independent Member

Mr Keiron Montague - Independent Member Cllr Robert Smith - Independent Member

In attendance

Ms Ruth Treharne - Director of Planning & Performance/Deputy Chief Executive

Mr Gareth Hardacre - Assistant Director of Workforce & Organisational Development (OD)

Mr John Palmer - ‘Interim’ Chief Operating Officer (in part)

Mr Mark Thomas - ‘Interim’ Director of Finance Miss Gwenan Roberts - Head of Corporate Services

Mr Alan Roderick - Assistant Director of Performance & Information

Mr Paul Dalton - Head of Internal Audit Mrs Clare Williams - Assistant Director of Planning &

Partnerships (In part) Miss Emma Walters - Corporate Governance / Committee

Secretariat Miss Jacqui Maunder - Head of Corporate Services (Shared

Services) Mrs Julie Keegan - Assistant Director of Commissioning (In

part) Mr Andrew Jones - Head of Finance Head of Finance (In part)

FPW/18/019

WELCOME AND INTRODUCTIONS

Mr Mel Jehu WELCOMED everyone to the meeting, particularly Miss Jacqui Maunder who would be based in the Health Board for 6 months

and would be shadowing Mr Robert Williams, Director of Corporate Services & Governance/Board Secretary.

FPW/18/019

APOLOGIES FOR ABSENCE

Apologies for absence were RECEIVED from Mrs Joanna Davies.

Members NOTED that Mr Alan Lawrie was also unable to attend the meeting at short notice due to an operational issue. Members NOTED

that Mr John Palmer would also be late arriving to the meeting.

1.4 Minutes of the Meeting held on 22 March 2018


Agenda item 1.4



19 April 2018

FPW/18/020

DECLARATIONS OF INTERESTS

There were no additional declarations of interests, to those already

declared.

FPW/18/021

MINUTES OF THE LAST MEETING

The minutes of the meeting held on 25 January 2018, were RECEIVED

and APPROVED as a true and accurate record, subject to the following amendment:

Page 9, Stay Well at Home Update – seventh sentence of the third paragraph to be amended to read ‘agreement between the

two Local Authorities and the Health Board’.

FPW/18/022 ACTION LOG

Members RECEIVED and REVIEWED the Finance, Performance & Workforce Committee Action Log.

Members NOTED that an update on Interventions Not Normally

Undertaken was now being discussed at the Efficiency, Productivity & Value Board (action log updated).

Members NOTED that an update on Stroke Mimics would now be included in the April Performance Dashboard update report (action

log updated).

FPW/18/023 MATTERS ARISING

Page 9, Stay Well at Home Update – Mr P Griffiths advised that he was confused by the wording of the third paragraph contained under this

section. Mr Griffiths advised that the update suggested that the service had not worked as well at one hospital compared to the other, as a

result of issues experienced with the Local Authority. Mr Griffiths questioned how this could happen within the same Local Authority.

Ms R Treharne explained that both areas were covered by two different

Local Authorities and advised that there were two separate issues that

had been experienced. The first issue experienced at Prince Charles Hospital was in relation to information systems which had now been

resolved.

Ms R Treharne advised that the second issue related to the development of a Medication at Home Policy which related to both

Local Authorities, Rhondda Cynon Taf and Merthyr Tydfil. Members NOTED that an agreed proposed policy had now been developed and

was currently being piloted in one area prior to further roll out.



Agenda item 1.4



19 April 2018

Ms R Treharne advised that she would be happy to send a note out to Members explaining this in more detail. Mr P Griffiths advised that he

was now content with the explanation provided.

Members REQUESTED that an amendment to the minutes was made

to reflect that there were issues with two Local Authorities.

FPW/18/024

INTEGRATED MEDIUM TERM PLAN (IMTP) 2018-2021

Mrs C Williams, Assistant Director of Planning & Partnerships, was in attendance for this item.

Ms R Treharne presented the report which presented the Committee

with the final Cwm Taf UHB IMTP 2018-21, for endorsement prior to Board approval and onward submission to Welsh Government (WG)

on 29 March 2018.

Members NOTED that the report included feedback received from

Welsh Government from the January submission of the plan and identified the changes made as a result. Members NOTED that the

key issues Welsh Government requested the Health Board to review included:

CAMHS – Further work was required to ensure challenges, risks and pressures were adequately articulated, addressed both

current and future arrangements and included alignment with Cardiff & Vale UHB IMTP;

Financial Plan and presentation – Concern was raised by Welsh Government in relation to some of the assumptions made;

Performance – Challenge was made in relation to the Health Board’s ambition in relation to some targets, particularly in

relation to Referral to Treatment, 26 week waits in particular.

Ms R Treharne advised the profile for 26 week waits had been set to

92% against a target of 95%. A discussion was held at Executive Board yesterday where it was agreed that the Health Board would

advise that the target of 92% would be achieved, with the exception of 3 specialty areas where this target would not be achieved (General

Surgery, Orthopaedics and Ophthalmology). Members NOTED that the Health Board would be advising Welsh Government that additional

funding would be required to assist in achieving the 95% target.

Mr P Griffiths questioned whether the Health Board would be in danger of being criticised by Welsh Government if the targets were not

achieved next year, even though additional funding had been provided this year. Mr M Thomas advised that the funding received for this year

was non-recurring. The same amount of funding was being requested for next year to help sustain performance.



Agenda item 1.4



19 April 2018

Members AGREED that regular updates on 26 week performance would need to be presented to the Committee moving forward to show

whether targets were being achieved and Ms R Treharne advised that

a specialty breakdown on 26 week performance would be included in the Performance Dashboard for next year (added to the action log).

Members NOTED that the areas who were unlikely to achieve the 92%

target were high users of theatres and this combined with the complexity of the pathways would make it difficult for the target to be

met. Members NOTED that the Health Board would need to make use of additional capacity elsewhere by outsourcing.

Mr M Thomas provided Members with an update on the key changes

made to the financial element of the plan following the January submission. Members NOTED the following key points:

The budget for delivery of RTT performance had been increased to £3.5m taking the total budget increases to £3.8m;

There had been an improvement in the underlying deficit from

£6m to £4m which was mainly as a result of an improvement in Ward & A&E nursing spend;

Shared Services have advised that they do not expect the Health Board to make any contributions to the Welsh Risk Pool

overspend so this cost pressure had been released; Investment priorities would need to be reviewed as at present

the fund was oversubscribed. Members NOTED that this did not present a risk to the plan;

Further work would be required to encourage Directorate’s to submit innovative Invest to Save proposals;

Members NOTED that the £6m cost pressure risks identified by Directorate’s had now been risk adjusted down to £1.2m;

Members NOTED there had been no change to the Welsh Government funding assumptions since the January submission

of the plan;

Members NOTED that Welsh Government had requested further clarity on some areas contained with the financial element of the

plan submitted in January and that the feedback was in the process of being considered and addressed;

Members NOTED that targets previously set for medical pay and ward nursing had been reduced given the significant overspends

in both areas; Members NOTED that Directorate’s were being asked to submit

fortnightly updates on progress being made against their savings plans. Mr M Thomas advised that the Efficiency,

Productivity & Value Board were scrutinising the position in addition to scrutinising delivery of the cross cutting themes.

Following discussion, Members NOTED that a further discussion on

the financial element of the plan would be discussed at In Committee

Board on the 29 March and Mr M Thomas advised that he would be



Agenda item 1.4



19 April 2018

circulating a report to Board Members for consideration prior to the 29 March.

Mr P Griffiths questioned whether there were any plans to reduce the size of the IMTP moving forward. Members NOTED that the plan had

actually increased in size as one of the annexes had been included in the overall plan. Ms R Treharne advised that given the amount of

information that needed to be included in the plan it would be difficult to produce a shorter document.

Ms R Treharne extended her thanks to Mrs C Williams for the work

undertaken in producing the plan.

Members RESOLVED to: NOTE the update provided;

ENDORSE the IMTP for onward submission to the Health Board on 29 March prior to submission to Welsh Government.

FPW/18/025

MONTH 11 FINANCE UPDATE

Mr M Thomas presented the report which provided Members with an update on the key messages in relation to the Month 11 financial

position.

Members NOTED the following key points: Revenue position – the Health Board reported a small deficit of

£11k for Month 11 with the year to date position reporting a small surplus of £16k. The Health Board was still forecasting a

break even financial position for 2017/18; Capital position – the Health Board reported a year to date

surplus of £1.6m and continued to forecast a breakeven position for 2017/18;

Public Sector Payment Policy – the Health Board reported a

compliance rate of 95.7% for the payment of non NHS invoices paid within 30 days. The year to date position was 95.2% and

the Health Board was forecasting to achieve the 95% target at year end;

Members NOTED that in relation to Non pay overspends, there would be no agreement made in relation to the funding of any

non-pay overspends until the outcome of the deep dives that were being undertaken was known.

Mr P Griffiths expressed his concern and surprise as to how little capital

had been spent throughout the year which meant that £10m needed to be spent within the last few days of the year. Ms R Treharne advised

that a discussion had been held at the Executive Capital Management Group where it was noted that a large proportion of the £10m related

to three large schemes, in addition to an accumulation of smaller

schemes which were the main cause for concern.



Agenda item 1.4



19 April 2018

Ms R Treharne advised that assurance was provided at the meeting that the Capital Resource Limit (CRL) would be achieved at year end

and Members NOTED that a lessons learnt report would be developed

as to why there was so much money left to spend at year end.

Mr M Jehu thanked Mr M Thomas for the update provided and the work undertaken to date.

Members RESOLVED to:

NOTE the update provided.

FPW/18/026

WORKFORCE DASHBOARD

Mr G Hardacre presented the report which provided an update on the new suite of workforce metrics.

Members NOTED that there had been five areas of improvement,

deterioration in three areas and one area remaining static.

The following key points were NOTED:

The Health Board was the biggest improving area across Wales in relation to performance against the staff survey, with 62% of

staff completing surveys which had increased from 54% in 2016; Since April, the Health Board successfully recruited 34

Consultants and 64 medics, a number of which had not yet commenced;

The Health Board had been shortlisted for a national award for the medical recruitment campaign;

The Health Board continued to actively target the next cohort of student nurses and would also be pursuing a cohort of

international nursing students who were currently studying for their MSc;

Nurse vacancies were predominant on the Royal Glamorgan

Hospital site and Members NOTED that recruitment would be targeted in this area;

An Allied Health Professionals campaign had been launched which had attracted some Radiographer students from

Birmingham University; Sickness levels currently stood at 5.46% and Members NOTED

that the Health Board was no longer an outlier compared to neighbouring Health Boards. Members NOTED that focus was

being placed on long term sickness as performance remained static;

Good progress was being made with ESR and E-Systems roll out and with the exception of Facilities staff paper pay slips were no

longer being provided; PDR compliance had deteriorated slightly but the Health Board

continued to compare favourably across Wales;



Agenda item 1.4



19 April 2018

Vacancies were driving the demand for Bank & Agency usage, although a positive position was reported in February in relation

to fill rates and no high cost off contract agency was being used.

Members NOTED that in relation to Medical Agency expenditure, the

main problem area was in relation to rotas in Accident & Emergency on the Royal Glamorgan Hospital site, which were heavily staffed by

Locums and was a unique issue to Cwm Taf. Members NOTED that a report on Medical Agency expenditure/pay caps would be presented to

the April meeting (added to the action log and forward look).

Members NOTED that in relation to the staff survey, some further work would be undertaken to develop an internal survey so that

further information could be obtained at a department level. Members NOTED that over 1800 returns had been received which was positive.

Mr G Hardacre added that the Health Board had recently been re-awarded the Gold and Platinum Corporate Health Standards.

In relation to the national performance dashboard, Mr P Griffiths expressed concern that the Health Board had only been the top

performing Health Board in one area despite all of the work being undertaken and questioned what more could be done to improve the

position further. Mr P Griffiths questioned whether there was anything different being undertaken by other Health Board’s that we could

adopt or whether any benchmarking could be undertaken.

Mr J Palmer arrived at 2.30pm.

A discussion was held in relation to Sickness Absence and Members NOTED that even though good progress had been made, Cwm Taf

UHB still remained in the bottom three within the All Wales position. Members NOTED that 80% of staff employed by the Health Board also

lived within Cwm Taf communities where you expect to see higher

levels of sickness. Stress remained one of the main reasons for sickness absence and work was being undertaken with the Clinical

Psychologist who was developing a plan to target the 4% of staff who were currently off sick with stress. Members NOTED that sickness

absence trends continued to be monitored with regular discussions taking place at Clinical Business meetings on sickness absence

performance. Mr G Hardacre advised that the new sickness absence policy was more stringent and the Health Board were now seeing more

staff being terminated at the third stage of the policy. Mr G Hardacre AGREED to share the new sickness absence policy with Members for

information and Mr J Palmer also AGREED to circulate the data discussed at Clinical Business meetings with Members for information

(added to the action log).

Mrs J Keegan and Mr A Jones arrived at 14.36pm.



Agenda item 1.4



19 April 2018

Members RESOLVED to: NOTE the update.

FPW/18/027

PERFORMANCE DASHBOARD

Ms R Treharne and Mr A Roderick presented the report which provided Members with a summary of current performance across a range of

indicators and key issues, particularly where there were current organisational challenges and achievement and/or the organisation

was under formal escalation with the Welsh Government.

The following key points were NOTED:

Unscheduled Care An initial review of the winter period had been undertaken where

it had been identified that there had been a significant increase in patients attending Accident & Emergency (900 in February)

with more patients being admitted;

Acuity levels had been greater and there were 4 occasions in February where there had been more than 450 attendances in

one day, which were all on a Monday. Members NOTED that this was 80 more attendances than average;

There had been an increase in influenza cases, particularly in the Merthyr Tydfil area, which contributed to unscheduled care

pressures. Members NOTED that a review would be undertaken as to why cases were higher within the Merthyr Tydfil area;

Members NOTED that this had an impact on elective activity; Mr J Palmer advised that the Health Board had experienced 7

weeks of gold command which was formally closed on Monday morning. Mr Palmer extended his thanks to Local Authority

colleagues for the support given during this challenging period.

Referral to Treatment

The final position for February in relation to 36 week waits was 514, 131 of which had been outsourced for treatment. Members

NOTED that there was confidence that a 0 position would be delivered end of March;

The confirmed position for 26 week waits was 91.3% and it was predicted that the 92% target would be achieved at year end

based on the current trajectory.

Diagnostic Waits The final position for February was 1071 patients waiting over 8

weeks for treatment; Additional capacity had now been secured for Non Obstetric

Ultrasound patients and it was hoped that a 0 position would be achieved at year end;

Issues remained within Endoscopy and even though an

alternative solution was being considered, it was unlikely that a



Agenda item 1.4



19 April 2018

0 position would be achieved. Mr J Palmer advised that it was likely that there would be 128 patients over the target and it

was hoped that the position would be improved from last year’s

performance.

A discussion was held in relation to performance within Endoscopy. Members NOTED that sickness absence within the department had

been a major contributory factor and that some of the planning assumptions made had not been realised. Consideration was now

being given to improving performance for next year. Ms R Treharne expressed concern that this had only recently come to fruition and

advised that this would now be the second year where performance would not be achieved. Ms R Treharne advised that more focus would

need to be placed on Demand & Capacity planning within Endoscopy for next year and this would need to be treated as a priority.

Mr K Montague recognised the significant amount of work being

undertaken to improve the year end position and questioned if targets

were not in place, would the Health Board be doing things differently, and were the targets taking away the Health Board’s ability to provide

a more sustained flow of patients throughout the year. Ms R Treharne welcomed the challenge and advised that the Health Board was

incrementally improving. Members NOTED that there would be a continued emphasis moving forward in relation to Demand & Capacity

planning.

Members NOTED that similar discussions had been held at the Medical Leadership Forum and Executive Board where it was agreed the year

needed to start with real clarity on what needed to be achieved on a daily and weekly basis. Members NOTED that discussions were taking

place with Welsh Government in relation to the possibility of an earlier release of finance to help sustain performance.

Cancer Performance Members NOTED that there had been 6 breaches against the 62

day target, 4 Urology, 1 Lung and 1 Dermatology.

GP Out of Hours Service Members NOTED that updates on GP Out of Hours Performance

would now be included in reports moving forward as two indicators had been given Tier 1 status.

Mr J Palmer advised that Out of Hours and Ambulance handover had

both played an important role during the gold command period. Members NOTED that every single handover delay had been

scrutinised and the Health Board had been vigorous in sharing our handover approach with other Health Board’s. In relation to Out of

Hours, Members NOTED that there was now a new Clinical Director in



Agenda item 1.4



19 April 2018

place for Out of Hours, and along with support from Locality Clinical Directors, a shift fill of around 80% had been achieved.

Members NOTED that a number of debriefs would now be held after the challenging winter period. Mr J Palmer AGREED to consider how

Non Officer members could be kept up to date on the outcome of discussions held (added to the action log).


NOTE the update provided.

FPW/18/028 COMMISSIONING & CONTRACTING UPDATE

Mrs J Keegan and Mr A Jones were in attendance for this item.

Mrs J Keegan and Mr A Jones presented the report which provided Members with an update on the performance of commissioned activity

to date in 2017/18 and provided and overview of the contracting and

commissioning plan for 2018/19.

Members NOTED that the Directorate managed to over achieve against their savings plan with a NET surplus of £392k against a £700k

target. Members NOTED that this recurring surplus would be built into the plan for next year.

Members NOTED that there had been concern in relation to LTA

performance with Cardiff & Vale which had seen high volatility during the year and work was being undertaken to understand the demand

pressures being seen in minor spinal procedures which had significantly increased. Members also NOTED that there was also

concern in relation to Haematology activity at Cardiff & Vale and a review was being undertaken to understand what was driving the

demand.

Members NOTED that significant investment had been made into the

Contracting & Commissioning team and that a £2m investment had been made into WHSSC commissioning contracts.

Members NOTED that there had been volatility within high cost

products, particularly in relation to NICE and that an additional £400k had been invested into Emergency Ambulance Services. Members

NOTED that there had been one risk, which was in relation to the introduction of HRG4 in England. Members NOTED that the tariff

mechanism had been introduced with the aim of being neutral across the health sector. Members NOTED that no volume changes had been

seen but there had been some price changes.

Mrs J Keegan advised that a number of service reviews had been

undertaken throughout the year, particularly in relation to Neurology



Agenda item 1.4



19 April 2018

and Community Dental services. Members NOTED that in relation to Community Dental services, the Executive Board supported the

transfer of services back into Cwm Taf and it was hoped that the

service would be repatriated within the next 12 months. Members NOTED that Cardiac CT had also been repatriated back into Cwm Taf

following the opening of the Diagnostic Hub.

Members NOTED that issues had been identified in relation to the general surgery waiting list position at ABMU where it was discovered

that non cancer pancreatic patients had been waiting over 2 years for treatment. The Health Board have expressed their concern to ABMU

and had requested that patients were outsourced as a matter of urgency.

Members NOTED that there were plans to undertake further reviews

during 2018/19 into other service areas and Members NOTED that reviews were being undertaken by a very small team. Members

NOTED that even though significant investment had been made into

the Directorate, if more resource was in place more reviews could be undertaken.

The following key points were NOTED in relation to 2018/19:

Significant risks had been identified in relation to Velindre. All commissioners had now agreed to abate their figures by 50%,

which equated to a £500k contribution for Cwm Taf; Welsh Government had ring fenced funding from Health Board’s

in relation to discrete services, which equated to £3.6m for Cwm Taf;

Members were reminded that even though the Health Board spends over £100m with other Health Board’s, £40m of income

was also being received; Members NOTED the regional service changes highlighted

within the report, particularly in relation to Paediatrics,

Obstetrics and Neonates which would require a definite commissioning arrangement with Cardiff & Vale in 2019/2020;

Members NOTED that discussions were ongoing in relation to available capacity within the Diagnostic Hub. Ms R Treharne

advised that Demand & Capacity planning had indicated that there was some additional capacity available to offer to other

Health Board’s; Mr J Palmer advised that consideration may need to be given to

focussing on the commissioning of Non-Emergency Patient Transport moving forward.


NOTE the update received.



Agenda item 1.4



19 April 2018

FPW/18/029 CANCER DIAGNOSTICS UPDATE

Mr J Palmer presented the report which provided an update on

progress made with the Health Board’s Cancer Diagnostics Work Programme.

Members NOTED that in July 2017, a pilot of Rapid Diagnostic Clinics

was undertaken, and that following success of the pilot the service had been rolled out to all four clusters. Members NOTED that 125 patients

had presented through the clinics and that the service was just about to diagnose its tenth cancer and that cancers were being diagnosed at

Stage 3 & 4 as opposed to Stage 1 & 2. Members NOTED that earlier diagnosis of chronic conditions were also being made as a result of the

establishment of this service and some further work was now being undertaken on the future model for chronic conditions.

Members NOTED that some challenges remained in relation to

patients presenting late and that work was being undertaken by Dr K

Nnoaham on cultural issues within the Cwm Taf communities. Members NOTED that work was also being undertaken on the

development of pathways and it was hoped that the Health Board could secure support from Bath University to help develop this further.

Members NOTED that discussions were also taking place with Cardiff University on what support they could provide.

A discussion was held in relation to culture and Mr P Griffiths

questioned whether there was a publicity campaign sitting alongside this project. Mr J Palmer advised that there was a communications

campaign in place which could be built upon further.

Ms R Treharne reminded Members that this was being reviewed by the Finance, Performance & Workforce Committee as the set-up of the

service should have a positive potential impact on improving cancer

performance, particularly in Urology. Ms R Treharne advised that a local target of 90% had been set and that it had been anticipated that

the number of breaches would reduce. Ms R Treharne questioned when the service was likely to have an impact on reducing the number

of breaches, particularly in Urology. Mr J Palmer advised that a Task & Finish Group was in the process of being set up in relation to Single

Cancer Pathways and Mr Palmer added that he would be happy to present the reformed pathway to Committee members at a future

meeting.

Mr M Jehu thanked Mr J Palmer for the update and asked for his thanks to be extended to the wider team for the work undertaken to date.


NOTE the update.



Agenda item 1.4



19 April 2018

FPW/18/030 CONFIRMED ACTION NOTES FROM THE EFFICIENCY, PRODUCTIVITY & VALUE BOARD HELD ON 5 FEBRUARY 2018

Members RECEIVED and NOTED the confirmed Action Notes from the Efficiency, Productivity & Value Board meeting held on 5 February

2018.

FPW/18/031 FORWARD LOOK FOR 2018/19

Members RECEIVED and NOTED the Forward Look for 2018/19. Members NOTED that the Forward Look would be amended following

the discussion held at Board Development on the structure of future meetings.

FPW/18/032 COMMITTEE REFERRALS

There were no Committee referrals made.

FPW/18/033 ANY OTHER BUSINESS

Mr M Jehu advised that following discussion at Board Development, it had been proposed to change the structure of Finance, Performance &

Workforce Committee meetings moving forward. Members NOTED that it had been proposed that 6 of the meetings would focus solely

on Finance, Performance and Workforce updates, which would coincide with Public Board meetings, with the other 4 meetings focussing on

Deep Dive reporting.

Mr M Jehu extended his thanks to Mr M Thomas who was attending his

last Finance, Performance & Workforce Committee as ‘Interim’ Director of Finance. Mr Jehu thanked Mr Thomas on a personal and

professional level and advised that Mr Thomas had brought a great level of clarity to the Committee.

Mr Jehu also extended his thanks to front line staff who had been

working under significant pressure over that last few weeks. Mr Jehu explained that it made him proud to be part of the Health Board.

FPW/18/018 DATE OF THE NEXT MEETING

The next meeting of the Finance, Performance & Workforce Committee

was scheduled to be held on Thursday 19 April 2018 at 1pm, in

Ynysmeurig House, Navigation Park, Abercynon.

Signed ………………………………………………. Mr Mel Jehu, Independent Member

Date …………………………………………………..



AGENDA ITEM 1.5

Action log Page 1 of 3

Finance, Performance and Workforce Committee Meeting 19 April 2018

Finance, Performance & Workforce Committee Action Log

MEETING

DATE

SUBJECT KEY ACTIONS/DECISIONS RESPONSIBLE

OFFICER

COMPLETED/

updated

24/09/15

31/03/16

Clinical efficiency

reports (FP15/098)

Develop an assurance mechanism to be

able to share information with clinical teams.

List to be developed by Miss G Roberts.

John Palmer

Kamal Asaad Deb Lewis

Ongoing

Quarterly reporting – on agenda

26/05/16 &

27/04/17 &

28/9/2017

INNU To receive an update on Interventions Not Normally Undertaken (INNU).

Progress report to be presented to a

future meeting.

Director of Public Health

Report received September

To be confirmed

Currently being

reviewed by the Efficiency,

Productivity & Value Board

6/12/2016

& 25/5/2017

& 27/7/2017

& 25/1/2018

Financial Deep Dive

into Pathology

Update required on the Financial Deep

Dive into Pathology.

Members requested that this matter was kept open on the action log and referred

to the Efficiency, Productivity & Value Board for ongoing monitoring of the

recovery plan. Agreed that an update report would be presented to the April

meeting and that Mr M Thomas would discuss further with Mrs K McGrath.

John Palmer

Mark Thomas

April 2018

Added to Forward Look

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AGENDA ITEM 1.5



MEETING

DATE


OFFICER

COMPLETED/

updated

6/12/2016 &

27/4/2017 &

27/7/2017

Assigned Organisational Risks

Quarterly updates on Committee assigned organisational risks, to be received by the

Committee.

Robert Williams May 2018 Added to Forward

Look

26/01/17 &

25/5/2017 &

30/11/2017

Follow up outpatient appointments not

booked

Report on progress to reduce the numbers in the top 9 areas to be received.

John Palmer Further update on progress

made required at a future

meeting. Timescale to be

agreed.

27/4/2017

& 28/9/2017

&

30/11/2017

Performance Dashboard

Stroke Performance - Mrs D Lewis (nee Evans) agreed to include reference to

mimics in future reports. Update to be presented at the November

meeting on the outcome of the analysis

being undertaken by the Delivery Unit on its assessment of the number of mimics

seen within Cwm Taf

Ruth Treharne In progress Update to be

included in the April Performance

Dashboard report.

25/5/2017 Performance

Dashboard

Members recommended that an

induction process was developed for new Independent Members joining the

Committee, in relation to the use of the Performance Dashboard.

Ruth Treharne/

Robert Williams

Ongoing

Being addressed on an individual /

bespoke basis.

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mittee-19/04/18

AGENDA ITEM 1.5



MEETING

DATE


OFFICER

COMPLETED/

updated

25/5/2017 Workforce Dashboard Proposal to be presented to the September meeting on how alignment and

triangulation between the Performance, Workforce and Finance Dashboards could

be developed further.

Ruth Treharne/ Jo Davies/

Mark Thomas

Now April 2018 Added to Forward

Look

27/7/2017 Workforce Dashboard Mrs J Davies to provide Members with an update on the Staff Survey at the January

meeting.

Jo Davies Completed

26/10/2017 Workforce Dashboard Mrs J Davies to undertake a review of the reasons behind the increase in Healthcare

Support Worker supply, despite the recruitment of additional Healthcare

Support Workers.

Jo Davies

Completed

30/11/2017 Finance Update Further consideration to be given to the format and style of the Finance report

moving forward following review undertaken by Wales Audit Office on best

practice reporting.

Mark Thomas In progress To inform

2018/19 reporting cycle.

30/11/2017

& 22/3/2018

Workforce Dashboard Analysis to be undertaken as to the

reasons behind the lack of reported improvement against the medical agency

spend.

Jo Davies April 2018

Report to be presented to the

April meeting – added to Forward

Look.

1.5 Action Log

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AGENDA ITEM 1.5



MEETING

DATE


OFFICER

COMPLETED/

updated

30/11/2017 Performance Dashboard

Follow up correspondence to be sent to Health Boards who had not yet responded

to the Health Board’s letter seeking assurance that Cwm Taf Patients would be

treated in turn.

Ruth Treharne In progress

30/11/2017 Pathology Financial Deep Dive

Consideration to be given to the development of a Service Level

Agreement (SLA) Schedule moving forward.

Directorate Manager

John Palmer

In progress

22/03/2018 IMTP 2018-2021 Updates on 26 week performance, specialty by specialty, to be included in

the Performance Dashboard moving forward.

Ruth Treharne In progress

22/03/2018 Workforce Dashboard New sickness absence policy to be shared

with Members for information along with the suite of sickness absence data

presented to Clinical Business meetings.

Joanna

Davies/John Palmer

In progress

22/03/2018 Performance Dashboard

Consideration to be given to how Independent Members could be kept

updated on the outcome of discussions held in relation to the analysis of winter

pressures

John Palmer In progress

1.5 Action Log

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Facilities Performance Update Page 1 of 9 Finance, Performance and

Workforce Committee 19 April 2018

AGENDA ITEM 4.4

19 April 2018

Finance, Performance and Workforce Committee Report

UPDATE ON FACILITIES PERFORMANCE

Executive Lead: Chief Operating Officer

Author: Interim Assistant Director of Facilities

Contact Details for further information: Russell Hoare 01685 728688 or email [email protected]

Purpose of the Finance, Performance and Workforce Committee Report

The purpose of this report is to provide an update to the Finance & Performance Committee on progress with the Facilities plan.

Governance

Link to Health

Board Strategic Objective(s)

The Board’s overarching role is to ensure its Strategy

outlined within ‘Cwm Taf Cares’ 3 Year Integrated Medium Term Plan 2018-2021 and the related

organisational objectives aligned with the Institute of Healthcare Improvement's (IHI) ‘Triple Aim’ are being

progressed, these in summary are:

To improve quality, safety and patient experience. To protect and improve population health.

To ensure that the services provided are accessible and sustainable into the future.

To provide strong governance and assurance. To ensure good value based care and treatment

for our patients in line with the resources made available to the Health Board.

The report focuses on improving quality, safety and

patient experience.

Supporting

evidence

N/A

Engagement – Who has been involved in this work?

The operational team and directorate has worked together with their Finance, procurement and WF&OD Business Partners to address any

issues identified and to develop the actions in this paper.

2.1 Annual Update on Facilities Performance


mailto:[email protected]



Finance, Performance and Workforce Committee Resolution to:

APPROVE ENDORSE DISCUSS √ NOTE √

Recommendation The Finance, Performance and Workforce Committee is asked to:

DISCUSS and NOTE the report.

Summarise the Impact of the Finance, Performance and Workforce

Committee Report

Equality and

diversity

No implications have been highlighted from an

equality and diversity perspective

Legal implications No known legal implications

Population Health There are no known population health implications

Quality, Safety & Patient Experience

The performance of the Facilities Unit can impact on the patient experience if quality and safety of

services is not maintained

Resources There are no further resource issues than those identified within the plan

Risks and Assurance Risks and Assurances are captured within Governance score cards and reported through to

the Corporate Risk Committee

Health and Care Standards

The 22 Health & Care Standards for NHS Wales are mapped into the 7 Quality Themes:

Staying Healthy; Safe Care; Effective Care; Dignified Care; Timely Care; Individual Care

Staff & Resources http://www.wales.nhs.uk/sitesplus/documents/1

064/24729_Health%20Standards%20Framework_2015_E1.pdf

Workforce There are no further resource issues than those

identified within the plan

Freedom of

information status

Open



http://www.wales.nhs.uk/sitesplus/documents/1064/24729_Health%20Standards%20Framework_2015_E1.pdf





UPDATE ON FACILITIES PERFORMANCE

1. SITUATION / PURPOSE OF REPORT

The purpose of the report is to provide the Finance, Performance and Workforce

Committee with the annual update on the Facilities performance.

The report presents the financial year 2017-18 Month 11 position for the Directorate and outline the further work to be undertaken against opportunities

reported in the Facilities Integrated Medium Term Plan (IMTP) 2018-21.

Members will be aware that there has recently been significant change within

the senior leadership of the Directorate at Director and Assistant Director level.

2. BACKGROUND / INTRODUCTION

Members should NOTED that since the financial year 2013/14, the Facilities

Directorate has been challenged and has delivered a combination of service transactional and transforming recurrent savings totalling £4.314m.

In March 2016, the Facilities Team commissioned an external consultancy to

conduct a benchmarking review of Cwm Taf Facilities costs against UK benchmarks both in the public and private sectors. The report analysed each of

the service areas against a number of known industry standard key performance indicators.

The report assessed twelve areas of operational delivery namely:

1. Administration & Helpdesk

2. Facilities Operational Management 3. Security

4. Linen

5. Catering - Patient Feeding 6. Catering – Restaurant/Barista

7. Catering - Central Production Unit (CPU) 8. Housekeeping

9. Porter Services 10. Grounds & Gardens

11. Waste 12. Transport.

The report identified the following areas of opportunity for further work and in

support of IMTP potential savings financial year 2017-18:

Facilities Operational Management Security

Catering - Patient Feeding

Catering – Restaurant/Barista Catering - Central Production Unit (CPU)





Housekeeping Porter services

Grounds & gardens Transport.

Facilities has taken forward and delivered on the following schemes associated with this report in financial year 2017-18:

Facilities operational management

Security services redesign Catering - patient feeding redesign

Housekeeping services redesign.

The following areas of work are in the financial year 2018-19 cash releasing efficiency savings (CRES) plan and are either in the latter stages of

implementation or require capital investment:

Catering – Restaurant/Barista rebrand and redesign Catering - Central Production Unit (CPU) outsource option

Portering services redesign Grounds & gardens service redesign

Transport redesign and support to the reduction of UHB

business mileage

It is anticipated that this further work will realise potential savings for the refreshed IMTP for 2018/21.

3. ASSESSMENT / GOVERNANCE AND RISK ISSUES

The month 11 position for Facilities is a cumulative variance (adverse) against budget of £1.065. This is forecast to be £1.230m at month 12 with a recurrent

position of £0.726m this is detailed in the table below.

Description

Annual

Budget

Month 11 Forecast Variance

Budget Actual Variance 2017/18 Recurrent

£000's £000's £000's £000's £000's £000's

Pay 17,204 15,780 16,163 382 424 0

Non-pay 8,859 7,735 7,735 0 124 19

CRES (637) (598) 0 598 602 670

Income and Trading 633 637 722 85 80 37

Grand Total 26,059 23,555 24,620 1,065 1,230 726

The main items which make up the over spend are shown in the following table

and are explained further below.





Month 11 Forecast Variance

Description Variance 2017/18 Recurrent

£000's £000's £000's

Porter services 318 342 0

Central Processing

Unit CPU 96 96 0

Undelivered CRES 598 602 670

Residential accommodation

20 37 37

Adverse weather 16 140 0

Porter Services Delivering Porter Services redesign across all sites has been challenging against

a push back from staff and trade union in agreeing service change and in particular acceptance of service change and introducing the new compliant rota.

The main reason being that changes to the rota impact on staff income from overtime payments.

The process for the consultation phase has proved to be challenging and

therefore it has been agreed that the rota element of the redesign scheme has been deferred to financial year 2018-19. However some progress has been

made over the last few weeks which is encouraging and it is hoped that consultation and the move to implementation will now pick up pace and

improve in the first quarter.

The over-spend in financial year 2017-18 has been incurred during the transformation phase of the scheme due to the individual departments having

to cover the vacancies on the non-compliant existing rota, particularly at

weekends at (premium cost) across the Royal Glamorgan (RGH), Prince Charles (PCH), Ysbyty Cwm Rhondda (YCR) and Ysbyty Cwm Cynon (YCC) sites. This

has been compounded by the length of time in the recruitment process in getting staff into the new service redesign roles and then repeating this process

to backfill the posts of internal staff. Overtime cover also had to be provided for staff suspended in line with the disciplinary process and also long term sickness

which has put further pressure on the service and the ability to cover the rotas required.

In addition, Members will be aware that the portering services support the

adverse weather plan when implemented and additional overtime cost has been incurred in support of the plan during this winter period.

It was agreed at the March Clinical Business Meeting with the Facilities

Directorate that once the service redesign was completed and the new rotas

were implemented, the portering services should breakeven for the financial year 2018/19; However, there would need to be a re-profiling of budget to

reflect the higher cost at the start of the year and reflecting lower costs from the implementation of the new rota from July 2018. This will also support the

delivery of recurrent savings from the lower cost base.





This is a priority scheme for the Facilities team and along with support from the

business partners and we are committed and working hard to bring to completion. The directorate continues to work with business partners to tackle

and mitigate the objections raised by the staff and trades unions; although this

has inevitably delayed the progress.

Central Production Unit (CPU) There have been some significant increases in the cost of provisions and

consumables for the CPU with some items increasing by as much as 55% over an eighteen month timeframe; this has also combined with some reduced

income from external customers leading to the current position. Members should NOTE that work is being undertaken with procurement business

partners to mitigate any further increases and some improvement has taken place to the overall position in the last quarter. More work is now needed to

improve our ability to forecast any increases in support of the CPU trading account. During the March Clinical Business Meeting (CBM) for Facilities these

significant increases have been identified as a financial risk in 2018/19 and this would be closely monitored during subsequent CBMs.

Residential Accommodation

The overspend on residential accommodation at the residences at Prince

Charles Hospital (PCH) is due to the poor general condition of fabric of the buildings resulting in fewer rooms being available to let. In addition, due to a

water leak in Block 4, a number of rooms were out of commission for 8 weeks. A report in relation to the residences at PCH and the backlog of maintenance

and need for major refurbishment work has been provided to the Assistant Director of Capital and Estates for further consideration. A decision is needed

on the future requirements for staff accommodation at PCH and the draw on the capital resourcing (estimated around £2m) to refurbish the facility and meet

current NHS Wales’s accommodation living standards.

Adverse Weather This reflects the extra cost of internal resources and additional external support

to undertake the necessary additional work resulting from the three episodes of severe adverse weather (snow) in December and March.

Royal Voluntary Service (RVS) Discussions have progressed well with the RVS regarding their payment of

outstanding lease rent and their agreement to the new leases. It is anticipated that the new leases will be signed off by RVS during April 2018.

NHS Wales Laundry Review

Members will be aware that the NHS Wales Shared Services Partnership (NHSWSSP) are facilitating a review of the five laundry production units in

Wales. The project commissioned is a two-part review, one to consider the required steps to comply with BS EN 14065 and the other in-line with estate

code building and equipment condition.





CASH RELEASING EFFICIENCY SAVINGS (CRES) PERFORMANCE FINANCIAL YEAR 2017-18

From the following table it can be seen that CRES savings of £0.460m is

forecast as delivered in 2017/18 with a recurrent impact of £1.010m. Although

the delivery is £0.602m and £0.670m this is significantly less than the target levels of £1.062m and £1.680m.

Description 2017/18 Recurrent

£000's £000's

Target 1,062 1680

Original plan 520 825

Initial

variance 542 855

Forecast delivery

460 1010

Forecast

variance 602 670

Coming into financial year 2017-18 the original IMTP in-year plan had a deficit

of £542k, £855k recurrent with no schemes identified to deliver the deficit. In addition, it transpired that the probability of delivering some of the planned

schemes and in the timescale was far lower than anticipated. This is because the schemes required additional capital investment or were only at the initial

opportunity stage as a potential idea which had not been fully thought through, or because of their scale and complexity it was realised that they were going to

take longer to deliver.

The Directorate reflection and lessons learned, particularly in the case of

schemes that impact on large service areas and groups of staff and involve engagement, consultation and agreement with staff and trade unions is that

these schemes require a lot of time and commitment. As a consequence, some schemes were identified to be ‘not deliverable’ or in the case of the larger

complex schemes required more time to deliver and have been deferred over into the next financial year 2018-19. Schemes that have been deferred for

delivery are as follows:

CPU bonus Porter Services service redesign – staff rota element

Restaurant new service model Bar Barista – Dewi Sant Health Park

Switchboard centralisation

CRES PLAN FINANCIAL YEAR 2018/19

The areas identified below are in various stages of outline planning, either waiting for capital investment or have an ongoing implementation plan. These

schemes are being progressed to meet the CRES target of £1.327m.





Two of the planned schemes namely the General Office rationalisation and the All Wales Laundry Review are in the initial stages of development and planning,

therefore any potential savings have not yet been identified.

In the development of three of these schemes namely:

CPU outsource Grounds and gardens outsource

Business mileage.

Decision papers were tabled and discussed at the recent CBM for a decision on the scheme options and consideration to the viability and sensitivity of the

schemes involved. The purpose was to provide an understanding of what each scheme involves and to ensure that the schemes would be supported so that

work could be commenced to take forward towards project implementation.

Project CRES 2018/19 - Scheme Title Amount

£000's

Fac 01 CPU outsourcing 250

Fac 02 Ysbyty Cwm Cynon shuttle bus 18

Fac 03 Non pay suppliers products volume and price 150

Fac 04

Grounds and Gardens Service -

Outsourcing 150

Fac 05

Restaurants - new service model

(capital investment required) 80

Fac 06 Ysbyty George Thomas Valley Life Service Redesign 80

Fac 07 Dewi Sant Health Park Barista (capital investment required) 8

Fac 08

Internal Transport

Community/Pathology review 40

Fac 09 UHB Business mileage cap - Shuttle Bus 150

Fac 10 Unscheduled Transport Spot Purchasing 30

Fac 11 CPU Bonus 90

Fac 12 General office rationalization TBC

Fac 13

NHS Wales Laundry production unit

service review TBC

Fac 14 Porter services 135

Fac 15 Switchboard 100

TOTAL 1281

Project Management Arrangements

The schemes identified now require a more innovative period of transformational change which requires careful balancing of strategic

development with the operational delivery.

The redesign of some key services is at the centre of this planning period and

the Directorate team acknowledge not only the importance of the leadership





skills of all of its management teams but also the support of our workforce and stakeholders in making our strategic plans become an operational reality.

In order to deliver such a challenging transformational change programme

robust project management arrangements required are being developed.

This programme utilises dedicated Project managers for each scheme who have

been utilised from the day-to-day operational roles and are also supported by a Facilities Senior Responsible Officer. The embedding of Workforce, Procurement

and Finance Business Partners together with a nominated Staff Side representative into the project team provides a core team able to deliver the

requirements of each scheme.

Conclusion The Facilities Directorate fully acknowledge that further work is needed to

improve the current financial position and to deliver on the IMTP and CRES plans. The Directorate team now have new focus and are committed to

ensuring financial sustainability. The team maintains a positive attitude and appetite for seeking opportunity and doing things differently whilst maintaining

a good reputation for high quality and standards of service delivery in support of clinical services and operations.

4. RECOMMENDATION

The Finance, Performance and Workforce Committee is asked to:

DISCUSS and NOTE the content of the report.

Freedom of

information status

Open



Energy and Operational Estates Performance Page 1 of 11 Finance, Performance &


AGENDA ITEM 2.2

19 April 2018

Finance, Performance & Workforce Committee Report

PART A - ENERGY PERFORMANCE - 2017/18

PART B – ESTATES OPERATIONAL PERFORMANCE -2017/18

Executive Lead: Director of Planning and Performance

Author: Tim Burns, Assistant Director of Planning (Capital and Estates)

Contact Details for further information: Tim Burns on 01443 443443 or [email protected]

Purpose of the Finance, Performance & Workforce Committee Report

The purpose of this paper is to update the Finance, Performance and Workforce Committee on the 2017/18 energy and operational estates

performance within Cwm Taf.

Governance

Link to Health Board Strategic

Objective(s)

The Board’s overarching role is to ensure its Strategy outlined within ‘Cwm Taf Cares’ 3 Year Integrated

Medium Term Plan 2015-2018 and the related organisational objectives aligned with the Institute of

Healthcare Improvement's (IHI) ‘Triple Aim’ are being progressed, these in summary are:

To improve quality, safety and patient experience. To protect and improve population health.



for our patients in line with the resources made

available to the Health Board. This report focuses on:

To improve quality, safety and patient experience. To reduce the cost of care in line with the resources

made available to the Health Board.

Supporting evidence

N/A

2.2 Annual Update on Estates & Energy Performance





Elements of the performance in this paper are routinely discussed at the

Estates and Capital Governance Board, the Estates Operational Management team meetings and the Energy Compliance Group meetings.

Finance, Performance & Workforce Committee Resolution to:

APPROVE ENDORSE DISCUSS √ NOTE √

Recommendation The Finance, Performance & Workforce

Committee is requested to: DISCUSS and NOTE the report.

Summarise the Impact of the Finance, Performance & Workforce Committee Report

Equality and diversity

There are no known equality and diversity issues

Legal implications All statutory requirements could lead to legal

implications. However, there are no known legal issues at this time.

Population Health No population health issues.

Quality, Safety &

Patient Experience

The Estates service is designed to improve the

Health Board’s estate and buildings in order to ensure the provision of safe quality services to

patients.

Resources Budgets are set against profiled expenditure

based on a three year average.

Risks and Assurance No risks identified

Health & Care

Standards

The 22 Health & Care Standards for NHS Wales

are mapped into the 7 Quality Themes:

Staying Healthy ; Safe Care; Effective Care; Dignified Care; Timely Care; Individual Care;



The work reported in this summary takes into account many of the related quality themes

Workforce No workforce issues

Freedom of

Information Status

Open








PART A ENERGY PERFORMANCE 2017/18


The purpose of this report is to provide the Finance, Performance & Workforce

Committee with the 2017/18 energy performance levels for Cwm Taf University Health Board’s estate against Welsh Government’s key performance indicators.


This report highlights Cwm Taf University Health Board’s performance against the Welsh Government’s key performance indicators relating to energy which

are: 90% of the estate to consume 410 kWh/m2 or less.

Reduce carbon emissions by 3% per annum. Reduce water consumption by 2% per annum.

The Health Board recognises that the consumption of energy and water is necessary for the provision of healthcare services, but it also has a

responsibility to be energy and resource efficient in minimising unnecessary usage. An Energy Policy has been implemented and a number of initiatives

aimed at reducing energy consumption, carbon emissions and cost have been progressed.

The reduction of energy usage will deliver benefits of: Reducing cost which enables savings made to be reinvested.

Minimising the impact on the environment. Complying with Legislation.

Monitoring

Cwm Taf utilises the Team Sigma software to monitor the consumption of

Energy & Water. Monthly data is input from meter reads or supplier invoices. The benefit of this software is that it will issue a warning when consumption is

greater than expected.

Energy cost information is calculated by Team Sigma which is used to inform the finance department on a monthly basis for budget reconciliation purposes.

The software is also used for producing Statutory Display Energy Certificates and the Annual Carbon Reduction Commitment Report.

Performance

Carbon

The target for Cwm Taf is to maintain a carbon reduction of 3% year on year as directed by Welsh Government. The trend graph below shows that the

emissions reduced in 2017/18 by 4.3% from the previous year, which is well within the Welsh Government Target.





Shared Services Partnership (Audit and Assurance Services) carried out an

audit of the CRC Energy Efficiency scheme to review operational procedures to ensure the Health Board is compliant with CRC scheme guidelines, including

both mandatory and best practice elements. The final report concluded that the

Health Board can take substantial assurance.

15,000

17,000

19,000

21,000

23,000

25,000

27,000

29,000

31,000

33,000

10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18

Total Emissions

TargetCO2 Emissions v Target

Energy

The table below shows that energy usage in 2017/18 has increased by 6.6% from the previous year. The increases in consumption are primarily due to the

installation of an energy intensive Diagnostic Hub at Royal Glamorgan Hospital, increased occupation at Dewi Sant Hospital compared to last year and 2 months

of poor performance of the Combined Heat and Power unit at Prince Charles Hospital.

The majority of other hospital sites have made a net energy reduction in

consumption during the past year which is due to the installation of low carbon technology fittings such as LED lighting and improved boiler controls.

The average KWh/m2 for Cwm Taf hospital sites is recording 426 KWh/m2 against the Welsh Government target which is 410KWh/m2. This is an increase

in consumption per m2 compared to last year.





Site Name

Net Energy Carbon Emissions

Net Hospital Energy

Consumption Site PI

Energy Change

on Previous

Year

Co2 Emissions

Co2 per sq. Metre

Change on

Previous Year

kWh kWh/m2 % Tonnes Kg/m2 %

Dewi Sant Hospital 1,796,948 200.4 +7.8% 399.28 44.5 -1.1%

Pinewood House 129,257 118.8 -4.0% 37 34.0 -29.3%

Pontypridd & District Hospital 777,202 312.5 +2.4% 167 67.1 -10.7%

Prince Charles Hospital 26,976,984 494.7 +12.3% 5,907 108.3 -7.3%

Royal Glamorgan Hospital 26,030,598 506.9 +7.7% 6351 123.7 -2.5%

Ysbyty Cwm Cynon 3,783,041 206.2 -26.9% 1089 59.3 -20.0%

Ysbyty Cwm Rhondda 2,945,667 209.8 -33.6% 860 61.3 -19.6%

Ysbyty George Thomas 1,917,564 357.3 -10.8% 429 79.9 -21.2%

Hospital Totals/Averages 64,357,261 426.7 +6.6% 15,239 101.1 -4.3%

The carbon factor issued by the Department of Environment, Food and Rural Affairs (DEFRA) for electricity purchased from the National Grid reduced

significantly in 2017-18 to that applied in 2016-17. This has been reduced by increasing the use of renewable fuel sources such as wind turbines when

producing electricity for the grid. This is a benefit to the Health Board.

The table below shows the average costs for energy for occupied floor area and relates to the total energy consumption by both hospitals and other Health

Board sites. There has been an overall reduction in £/m2 from £22.2 in 2016-17 to £21.2 in 2017-18. This absorbs an increase in electricity tariffs during the

last 6 months of the year.

Total Energy Cost per Occupied Floor Area

Data Unit 2015/2016 2016/2017 2017/2018

Total Energy Cost £ 3,810,037 4,087,231 3,920,580

Occupied floor area m² 172,608 184,432 184,682

Total Energy Cost per Occupied Floor Area £/m² 22.1 22.2 21.2

Water

In the same way as energy consumption, water is also monitored on a monthly

basis using the Team Sigma software.

A reduction target for water was set at 2% annually which has historically been achieved, however the Health Board has suffered significant underground water

leaks at Prince Charles Hospital and Dewi Sant Hospital which were only





detected when meters were manually read which as there is no automatic monitoring currently fitted to these meters.

A failed ball valve on a mains cold water storage tank at Keir Hardie Health

Park also increased the consumption. This was detected again from manual

monthly meter readings, reported and rectified.

The Health Board is expecting further rebates from Dwr Cymru to cover the cost of the underground leaks.

210,000

220,000

230,000

240,000

250,000

260,000

270,000

10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18

Total Consumed

TargetWater Consumed v Target

The water meter telemetry at Ysbyty Cwm Cynon & Ysbyty George Thomas has

been of great benefit to the Health Board which enables the Energy Manager to

monitor consumption from his office. The system also raises an alarm if there’s an excessive volume detected for a given period. The feasibility of fitting water

meter telemetry to other hospital sites will be considered.

The table below show the average costs for water per occupied floor area has reduced, which is primarily due to a reduction in sewage costs which are

forecast at the time of this report.

Total Water and Sewage Cost per Occupied Floor

Data Unit 2015/2016 2016/2017 2017/2018

Water Cost £ 289,702 302,146 306,622

Sewage Cost £ 273,518 284,604 279,026

Total Water & Sewage Cost £ 563,220 586,750 585,648

Occupied floor area m² 172,608 184,432 184,682

Total Water & Sewage Cost per Occupied Floor Area

£/m² 3.26 3.18 3.17





Energy Efficiency Investment Projects completed:

A number of energy efficiency projects have been completed in year which includes the installation of LED lighting, efficient boiler replacement and

Building management systems. Further LED lighting conversions have been

rolled out at the end of this financial year which will provide further reductions during 2018-19.

In addition the department is working with our utility suppliers to install smart

meters for electricity, gas and water on the majority of our sites. The benefit of these will be the availability of real time accurate data which is readily

accessible on the web. A schedule which is attached as Appendix 1 is in place to ensure the installation of smart meters to all major Health Board sites can be

monitored. Information provided by these systems will assist the Energy Manager in identifying potential savings, and highlight any areas of poor

performance.

Planned Developments

The Directorate has recently held a series of meetings with Re:fit Cymru, an organisation who supports public sector bodies in Wales to secure savings and

reduce carbon impacts through energy performance contracts. A project group

has been formed including representatives from Procurement, Management Accounts, Legal Services, Energy Management, Estates and Capital with the

task of exploring the potential opportunities relating to the project.

The Health Board has also been working in partnership with the Carbon Trust with surveys undertaken at Royal Glamorgan Hospital, Ysbyty George Thomas,

Ysbyty Cwm Rhondda and East Glamorgan Laundry. Survey recommendations include further investment in LED lighting, boilers rationalisation at East

Glamorgan, Royal Glamorgan Hospital and Ysbyty George Thomas, the potential installation of photovoltaic systems at Ysbyty George Thomas and Y

Ysbyty Cwm Rhondda and the improvement in building management systems across the Health Board. Funding has been requested within the Estates

Integrated Medium Term Plan to firm up these recommendations with an engineering evaluation suitable for tender and implementation. Capital funding

will be required to implement the projects.

Nationally evidence has shown that energy consumption can be reduced across

organisations simply through good housekeeping. The department is currently looking at ways to reinvigorate the energy awareness campaigns to further

improve efficiencies.

In addition work has been carried out with finance colleagues where data has been collected for each site and utility over the last 3 years and compared to

the 2017-18 consumption and cost figures. This exercise has identified savings for 2017-18, the figures are currently being checked against the Month 12

budget position and once confirmed the savings will be transferred to CRES.






The energy performance and water consumption levels measured against the national performance indicators and Welsh Government targets are

encouraging. Although energy consumption has increased due to poor CHP performance and increased consumption related to a new diagnostic hub, the

Health Board’s carbon emissions have reduced year on year. The Estates department under the direction of the Health Board’s water safety group have

been removing low use water outlets and water tanks in order to improve water flow and remove water safety risks. These modifications will over time make a

small contribution to reducing water consumption. The installation of water meter monitoring systems will assist the energy manager in identifying

potential water leaks quickly, and therefore assist in a faster response to such issues.





PART B ESTATES OPERATIONAL PERFORMANCE 2017/18


The purpose of this report is to update the Finance, Performance & Workforce Committee on the 2017/18 estates operational performance for Cwm Taf

University Health Board’s estate against key performance indicators.

Estate Service Quality Indicators

The Estates department has a ‘Planned and Reactive Maintenance Policy’ which

sets out best practice, roles and responsibilities with regards to estates maintenance services. The department provides an essential 24 hour, 365 days

a year service in the delivery of planned, reactive and help desk maintenance across the estate. Historically the estates department have measured and

monitored a range of indicators related to the quality of the service. These include:

% of statutory tasks undertaken each month. % of mandatory tasks undertaken each month.

% of helpdesk calls completed each month.

The maintenance programme is managed via the Tabs Facilities Management computer system, which enables the scheduling and operation of all planned

and reactive maintenance jobs and is reported bi-monthly to the Estates and Capital Governance Board, and monthly at the Estates Operational Management

team meetings. The department carry out on average 35,000 jobs per annum.

The table and graph below shows the performance levels over the last four

financial years.

Year Statutory PPM Jobs Mandatory PPM Jobs Response Desk Jobs

2014/15 82.2 76.5 78.0

2015/16 90.8 75.4 69.6

2016/17 95.7 80.9 72.7

2017/18 90.7 82.6 70.8





0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2012/13 2013/14 2014/15 2015/16 2016/17 2017/19

Performance - % of completed tasks each year

Statutory PPM Jobs Mandatory PPM Jobs Response Desk Jobs

There has been a decrease in the annual planned preventative maintenance (PPM) performance levels in 2017/18 for statutory and response desk jobs but

an increase in mandatory job performance. The Head of Estates has been tasked with improving statutory performance, the resource used on mandatory

and help desk jobs will be diverted from those areas so that statutory level

performance increases

For statutory jobs not completed the risk is minimized by ensuring that where a particular PPM is not undertaken as planned, then it is undertaken on the

following cyclical occasion. This is monitored by the Operational Head of Estates and senior operational estates managers at monthly operational management

meetings and reported to the Estates and Capital Governance Board.

Challenges

2017/18 has presented a considerable challenge within the directorate from a staffing perspective which has shown an approximate 15% staff turnover rate.

This is due to a number of factors such as age retirement and voluntary resignation. This has clearly had an impact on operational performance.

The Directorate has made every effort to recruit and retain suitably skilled staff in the positions but due to remunerations and external competition, this is

proving to be difficult. It is also clear that the Health Board recognises the future challenges that it will face due to the age profile of the staff within the

Department. This situation is gradually becoming worse. External remuneration between the Health Board and private sector is becoming greater, with

significantly higher wages being offered in the private sector. Benefits for employees within the private sector have significantly increased as well, and

Estates have found a number of employees taking up employment in the private sector, noting these issues as the main factors in leaving interviews.

Even with the addition of Recruitment Retention Payments (RRP) the gap can be as much as £10K per year plus a company vehicle. This gap is also making it

particularly difficult to recruit, with electrical engineer positions often going to advert 3 or 4 times, to attract minimal applications just to fill a single vacancy.





In order to help mitigate some of these risks, the Health Board approved a 5 year long term Recruitment and Retention Premium (RRP) for certain skilled

tradesmen, which commenced in 2016. However workforce planning and consideration of other mitigating actions are ongoing with the support of the

Human Resource Directorate.

During 2018-19 the Head of Estates will review the shift patterns of the Estates

team to establish whether or not increased hourly coverage can be achieved with the existing staffing resource. If it transpires that this is achievable then

there is a potential for performance to improve in statutory and mandatory levels as work in areas such as theatres, radiology, pharmacy laboratories

which are historically difficult to access during normal working could be carried out during nights or weekends when the departments have less use.

Sickness Management

Sickness levels have traditionally been high for this group of staff. However

considerable improvements have been made in managing sickness levels. Levels have fluctuated between 6% and 9% due to a number of long term

sickness issues but these levels are now reducing.

With the support of the Directorate Human Resources business partner the

levels of short term sickness have dropped due to the rigorous implementation of the sickness policy.

4. RECOMMENDATION

The Finance, Performance & Workforce Committee is asked to:

DISCUSS and NOTE the report.

Freedom of Information Status

Open



Appendix 1

Cwm Taf UHB Automatic Utilities Metering Sites Installation Gap Analysis Apr-2018

TOTALS ELECTRICAL GAS WATER GRAND TOTAL

Total AMR Meters Required 43 40 36 119

Total AMR Meters Installed 21 26 2 49

Total AMR Meters Outstanding 22 14 34 70

SITE AND METER NAME ELECTRICAL GAS WATER

Aberdare Health Centre REQUIRED REQUIRED REQUIRED

Aberfan Health Centre REQUIRED INSTALLED REQUIRED

Central Processing Unit (CPU) INSTALLED INSTALLED REQUIRED

Unit 22 CPU REQUIRED INSTALLED REQUIRED

Clinical Skills REQUIRED

Dewi Sant Hospital INSTALLED REQUIRED REQUIRED

Dewi Sant Bungalow REQUIRED

East Glamorgan INSTALLED INSTALLED REQUIRED

Hirwaun Medical Centre REQUIRED INSTALLED REQUIRED

Llwyn Yr Eos REQUIRED INSTALLED REQUIRED

Maritime Resource Centre INSTALLED INSTALLED REQUIRED

Merthyr Health Park INSTALLED INSTALLED REQUIRED

Merthyr Undergraduate Facility REQUIRED INSTALLED

Navigation Park INSTALLED INSTALLED REQUIRED

NIAD Pencoed INSTALLED REQUIRED REQUIRED

Noddfa REQUIRED INSTALLED REQUIRED

Pinewood House INSTALLED INSTALLED REQUIRED

Pontypridd & District Hospital INSTALLED

Pontypridd Hosp kitchen

Pontypridd Health Centre REQUIRED INSTALLED REQUIRED

Prince Charles Hospital (1) INSTALLED REQUIRED REQUIRED

Prince Charles Hospital (2) INSTALLED REQUIRED

Prince Charles Hospital (3) REQUIRED

Royal Glamorgan Hospital INSTALLED REQUIRED REQUIRED

Talbot Green REQUIRED INSTALLED REQUIRED

Tonteg Hospital INSTALLED INSTALLED REQUIRED

Tonypandy Health Centre REQUIRED INSTALLED REQUIRED

Trealaw Resource Centre INSTALLED INSTALLED REQUIRED

Trealaw (Carnegie) 1 REQUIRED INSTALLED REQUIRED

Trealaw (Carnegie) 2 REQUIRED

Trealaw (Carnegie) 3 REQUIRED

Tylorstown REQUIRED INSTALLED REQUIRED

Williamstown INSTALLED REQUIRED REQUIRED

Ynyswen Clinic REQUIRED INSTALLED REQUIRED

Ysbyty Cwm Cynon (1) INSTALLED REQUIRED INSTALLED

Ysbyty Cwm Cynon (2) INSTALLED

Ysbyty Cwm Rhondda INSTALLED INSTALLED REQUIRED

Ysbyty George Thomas INSTALLED INSTALLED INSTALLED

Ystrad Clinic REQUIRED INSTALLED REQUIRED

Ashgrove Surgery REQUIRED REQUIRED REQUIRED

Cwm Gwyrdd Medical Centre REQUIRED INSTALLED REQUIRED

Porth Dental (Leith House) INSTALLED INSTALLED REQUIRED

Porth Medical Centre (Ynyshir) REQUIRED REQUIRED REQUIRED

Treharris Primary Care Centre INSTALLED INSTALLED REQUIRED

Unit 1 Charnwood Court REQUIRED REQUIRED REQUIRED

Unit 3A Van Road Caerphilly REQUIRED REQUIRED REQUIRED

Printed 13/04/2018 Page 1 of 1

2.2.1 Appendix 1 AMR Sites Installation Gap Analysis Apr-2018 FPW 19 April 2018


CAMHS Performance Report Page 1 of 6 Finance, Performance &


AGENDA ITEM 2.3

19 April 2018

Finance, Workforce and Performance Committee Report

CAMHS PERFORMANCE REPORT

Executive Lead: Mr Alan Lawrie, Director of Primary Care, Community

and Mental Health

Author: Craige Wilson, Assistant Director of Primary Care, Children and Community Services

Contact Details for further information: [email protected] Tel 01685 351470

Purpose of the Finance, Performance & Workforce Committee Report

The CAMH Service has continued to work towards delivery the desired performance target of 28 days for Specialist CAMHS and 26 weeks for

Neurodevelopmental Disorder Services set by Welsh Government. The

purpose of this report provides the Cwm Taf University Health Board Finance, Workforce and Performance Committee the end of year

performance position of the Child and Adolescent Mental Health Service (CAMHS); including Primary CAMHS and details of the ongoing actions.

Governance

Link to Health





progressed, these in summary are: To improve quality, safety and patient

experience. To protect and improve population health.



for our patients in line with the resources made

available to the Health Board. This report focuses mainly on quality improvement and

providing governance and assurance.

Supporting

evidence


CAMHS management, Business Partners

2.3 Update on CAMHS Performance




Finance, Performance & Workforce Committee Resolution to:

APPROVE ENDORSE DISCUSS NOTE √

Recommendation The Finance, Performance & Workforce Committee

are requested to: NOTE the report

Summarise the Impact of the Finance, Performance & Workforce Committee Report

Equality and

diversity

Ensuring standards are equally applied within the

four locality regions is important

Legal implications The Mental Health (Wales) Measure (MHM) is a

legal requirement however the target is a mandatory requirement

Population Health Early access to mental health assessment and

intervention will positively affect the future prevalence of serious illness

Quality, Safety & Patient Experience

The achievement performance targets set by Welsh Government is a Board priority and has a

direct correlation to improving quality and experience

Resources Slippage on the new monies allocated by WG for

all 3 HB areas

Risks and Assurance In Summary - What are the Risk and Assurance

implications of the Report?

Health & Care Standards


Staying Healthy * Safe Care *

Effective Care * Dignified Care

Timely Care * Individual Care *



The work reported in this summary and related annexes take into account many of the related

quality themes (those marked *)

Workforce Identified within the report

Freedom of

information status

Open








CAMHS PERFORMANCE REPORT


The CAMH Service has continued to work towards delivery the desired

performance target of 28 days for Specialist CAMHS and 26 weeks for Neurodevelopmental Disorder Services set by Welsh Government. The purpose

of this report provides the Finance, Performance and Workforce Committee with the end of year performance position of the Child and Adolescent Mental Health

Service (CAMHS); including Primary CAMHS and details of the ongoing actions.


As the Committee will be aware, through the support of the clinical body

additional capacity was put into the service to ensure the 28 target for specialist CAMHS was met in 2016/17. The UHB has been unable to maintain this position

across the Network during 2017/18 and consequently this has been a focus for

attention for Welsh Government, Commissioners as well as within the UHB.

The CAMHS service has undergone a transition to a new model of working, the Choice and Partnership Approach (CAPA) which has help improve the

performance in the long term but there are also systems, productivity and efficiency improvements that are required. Funding was secured from Welsh

Government for short term waiting list initiatives to help improve the position and these focused both on new and follow up patients to ensure there was a

balanced approach to addressing the issue. The drive to meet the 28 day assessment target during February and March 2017 resulted in the Network

having to accommodate a large cohort of children requiring ongoing interventions; each patient on average has seven follow up appointments. This

coincided with an increase in the number of referrals across the Network.


The provisional year end waiting times position, March 2018, for specialist CAMHS

and Neurodevelopmental (ND) Services are shown below.

Specialist CAMHS ABMU C&V CT Total

Total Waiting List 196 165 59 421

Waiting 0-3 weeks 109 90 55 254 Waiting 4+ Weeks 87 75 4 167

% <4 weeks 55.6% 54.5% 93.2% 60.3% Longest Wait (in weeks) 21 20 6 21

As can be seen the 80% target was met in Cwm Taf and whilst the target was not met in Abertawe Bro Morgannwg University Health Board (ABMU) and Cardiff

& Vale (C&V) this represents a significant improvement from the 25.5% and 22.4% respectively reported to the Committee in September 2017. Also within

ABMU the 80% target was met in both the Bridgend and Neath Port Talbot localities.





Waiting list initiative are planned to continue through April and May which will

bring further improvement to the Network position and a demand and capacity analysis for each part of the Network is currently being undertaken. It is

anticipated that this will identify the need for additional resources to meet the

current demand and this has been highlighted in the directorate Integrated Medium Term Plan (IMTP).

The Neurodevelopmental target was also achieved.

Neurodevelopmental ABMU C&V CT Total

Total Waiting List 35 277 312

Waiting 0-11 weeks 24 135 159 Waiting 12-17 weeks 7 57 64

Waiting 18-25 weeks 3 84 87 Waiting 26-35 weeks 1 1 2

% <26 weeks 97.1% 99.6% 99.4% Longest Wait (in weeks) 28 45 45

Choice and Partnership Approach (CAPA)

As reported previously to Committee, a significant amount of work has been undertaken for the implementation of the Choice and Partnership Approach

(CAPA); a model that promotes collaborative practice and shared decision-making and enables the service to manage its demand and capacity.

Whilst we were able to introduce the CAPA Model in Cwm Taf from April 2017,

this change was delayed until September 2017 in both ABMU and Cardiff & Vale. However, as can be seen from the charts below, its introduction has had a

significant impact on reducing the total caseload in specialist CAMHS across the Network.

ABMU Total Caseload (Jan 17 to Mar 18)





C&V Total Caseload (Jan17 to Mar 18)

Cwm Taf Total Caseload (Jan17 to Mar 18)

Primary CAMHS

Whilst there has been a great deal of attention over the last two years on the specialist CAMHS waiting times position, this has not been the case with primary

CAMHS which also has a target of 80% of patient being seen within 28 days. The

main reason for this is that it is reported within Part 1a of the Mental Health Measure with Adult Mental Health and has therefore has been masked because

of the numbers relative to the adult service.

This has become an area of focus over the past two month, particularly since the waiting times were discussed at a Quality and Delivery meeting with Welsh

Government. As can be seen below, the current position is that some patients have waited over 12 months to be seen.





The waiting list is currently being validated and the longest waiting patients targeted through waiting list initiatives. Although there are long waiting patients,

they are relatively small in number with only 30 patients over 12 weeks. Therefore a significant improvement is anticipated over a short period of time.

As with specialist CAMHS a demand and capacity analysis will be undertaken to

determine the level of resource required to meet the ongoing demand. Primary CAMHS Waiting List (10 April 2018)

4. RECOMMENDATION

The Finance, Performance & Workforce Committee is requested to:

NOTE the report.

Freedom of information status

Open



Agency Locum Framework Page 1 of 11 Finance, Performance and


AGENDA ITEM 2.4

19 April 2018

Finance, Performance and Workforce Committee Report

ADDRESSING THE IMPACT OF NHS WALES MEDICAL AND DENTAL

AGENCY AND LOCUM DEPLOYMENT IN WALES – WELSH HEALTH CIRCULAR WHC/2017/042

Executive Lead: Mrs Joanna Davies, Director of Workforce & OD

Author: Ms Donna Hill, Medical Engagement Officer

Contact Details for further information: [email protected]

Purpose of the Finance, Performance and Workforce Committee Report

The Committee are asked to discuss and retrospectively approve the Agency Locum/Additional Duty Hours (ADH) reports submitted to Welsh

Government which sets out the progress made in CTUHB in December

2017, January 2018 and February 2018, against the agency locum framework. Appendix 1 provides a snapshot of data from each of the

three reports. The Committee will be informed that this report will now be prepared on a quarterly basis for consideration by Welsh Government,

and should be scrutinised through quarterly reports to the Finance and Performance and Workforce Committee throughout 2018.

Governance

Link to Health





progressed, these in summary are: To improve quality, safety and patient experience.

To protect and improve population health. To ensure that the services provided are accessible

and sustainable into the future. To provide strong governance and assurance.

To ensure good value based care and treatment

for our patients in line with the resources made available to the Health Board.

This report focuses on all of the above objectives.

Supporting

evidence

In particular, this report focuses on good value based

care and treatment with the aim of reducing agency locums - establishing a medical workforce that is

affordable, sustainable and supports patient pathways.

2.4 Update on Medical Agency Expenditure


mailto:[email protected]




The Agency Locum framework has been developed through the All Wales Medical Workforce Efficiency Group, in collaboration with Welsh Government

and Medical Directors.

Finance, Performance and Workforce Committee Resolution to:

APPROVE ENDORSE √ DISCUSS √ NOTE √

Recommendation The Finance, Performance & Workforce Committee is asked to:

NOTE the strategies taken by CTUHB to fully implement the new agency locum framework.

Retrospectively ENDORSE the attached performance reports for December 2017, January 2018 and

February 2018, submitted to Welsh Government. NOTE that the timetable for future reporting and F&PC

sign-off will need to be aligned with Welsh Government reporting.

NOTE the ongoing work of the Medical Workforce Efficiency Group to drive down the reliance of agency

locums.

Summarise the Impact of the Finance, Performance and Workforce Committee Report

Equality and diversity There are no directly related Equality and Diversity implications as a result of this report.

Legal implications There are no legal implications at this stage.

Population Health n/a

Quality, Safety &

Patient Experience

The Medical Director is responsible for ensuring

the quality, safety and patient experience is not

compromised as a result of the framework requirements.

Resources There are no directly related resource implications as a result of this report.

Risks and Assurance At a local level, CTUHB have established a scrutiny

committee, chaired by the Medical Director, to determine the level of risk against the withdrawal

of agency locums from fragile rotas. In addition, authorisation and escalation processes have been

clearly defined to ensure executive oversight and approval where necessary.

Health and Care Standards


Staying Healthy; Safe Care; Effective Care; Dignified Care; Timely Care; Individual Care

Staff & Resources

http://www.wales.nhs.uk/sitesplus/documents/1064/24729_Health%20Standards%20Framework_2

015_E1.pdf








Workforce This report focuses on a framework to help

develop a sustainable and affordable Medical Workforce.

Freedom of information status

Open





ADDRESSING THE IMPACT OF NHS WALES MEDICAL AND DENTAL AGENCY AND LOCUM DEPLOYMENT IN WALES – WELSH HEALTH

CIRCULAR WHC/2017/042


A new framework for agency worker/internal ad hoc locum pay caps was

implemented across NHS Wales in November 2017. As a result, all Health Boards and Trusts were required to report on progress for month 1 (December

2017) against this framework, followed by more detailed reports for the full month of December, and each month thereafter.

In November 2017, the Director of Workforce and OD presented to the Board,

the outline proposals for the planned agency locum framework and the

requirement for sign-off through the appropriate Committee. It was subsequently agreed that the mechanism for CTUHB’s sign-off would be

through the Finance, Performance and Workforce Committee.

The purpose of this report is to provide assurance to members of the Finance and Performance and Workforce Committee that CTUHB have fully

implemented the new framework and to provide detailed information on the strategies adopted locally, as confirmed in the attached reports to Welsh

Government (CTUHB – Agency Locum / ADH Report December 2017, January 2018 and February 2018).

The Committee are asked to note that whilst the framework has been fully

rolled out, it is important to highlight that the framework is not just about reporting on agency locum breaches. The introduction of this framework has

led to CTUHB taking a holistic approach to medical workforce which includes

assessing the workforce skill mix and designing an establishment which is affordable, sustainable and supports patient pathways.

It is acknowledged that the timing of this report to Finance, Performance and

Workforce Committee does not align to the monthly submission of reports to Welsh Government at this stage. However the reporting templates are still in

the early stages of being scrutinised, and as a result are likely to be further refined over the coming months. The Committee are asked to note the

standardised reporting arrangements for January and February 2018.


On 23 October 2017, Welsh Government wrote to all Health Boards and Trusts (WHC/2017/042 ‘Addressing the impact of NHS Wales Medical and Dental

Agency and Locum deployment in Wales’), setting out the requirement to introduce a control framework in order to support the reduction in medical and

dental agency and locum deployment and spend across Wales.

These new arrangements came into effect on 17 November 2017, when a price cap was applied for all medical and dental agency workers. In addition, the





framework confirmed that Internal Ad Hoc Locum cover could not be paid at a rate above the price cap rate from 27 November 2017, nor could locums be

paid more than they are currently paid.

In addition, the framework set out the requirement for all Health Boards and

Trusts to: make a reduction in external agency spend of 35% by the end of October

2018 prepare and deliver implementation plans, confirming internal escalation

and approval processes; set in place Board level scrutiny of performance against plans and

targets.

In return, Welsh Government confirmed that it would provide central capacity for scrutiny of plans, identifying and sharing effective practices, and targeted

interventions to tackle specific issues or priorities through the establishment of a Workforce Delivery Unit (Wales). Likewise, all Health Boards and Trust

signed-up to share information and reports with a view to learning lessons from each other and adopting best practice.

Progress to Date Data from Medacs (providers of the agency locum managed service) confirmed

that in December 2017 44.83% of agency locum hours booked in Wales were

below cap and 55.17% were above cap which points towards a promising start. At this stage it is not possible to benchmark against previous months but

comparisons will also be made with neighbouring Health Boards and England to understand the level of compliance at this early stage of implementation.

Strategies taken by CTUHB to reduce agency locum spend so far include:

Identifying a nominated Executive lead (Medical Director); Establishment of a weekly scrutiny committee chaired by the Medical

Director; Holding the line on the agency cap across Wales wherever possible;

Robust authorisation and escalation processes (daily and weekly); Encouraging agencies to vend through Medacs Managed Service;

Build-up of bank - internal locums; Communicating successes across the organisation – progress and quick

wins to date;

Concerted effort to attract agency locums to accept NHS roles; Introducing weekly pay for as and when locums;

Reviewing the workforce skill mix.

Issues/Risks that are taken into account when determining the utilisation of Agency Locums in Cwm Taf UHB

A sizeable percentage of agency locums shifts secured are in relation to rota gaps at Royal Glamorgan Hospital - A&E, requiring skills and knowledge at

Speciality and Consultant level. This is primarily due to the removal of trainees as per the South Wales Programme.





South Wales Programme - Following the announcement of the South Wales Programme there has been much anxiety amongst the obstetrics and

paediatrics workforce, which in turn has created additional vacancies, requiring agency locum appointments.

Likewise, the Deanery training reconfiguration programme has resulted in the removal of a number trainees posts in Paediatrics and Core Surgery. This in

turn is creating fragile rotas, resulting in a number of ongoing agency locum appointments.

Winter pressures - The timing of the Agency Locum programme has without

doubt been challenging for CTUHB as winter pressures have placed demands on the Medical Director to balance safe staffing levels against the requirement to

hold the line on locum pay caps. The severity of winter flu on both staff and patients has been yet a further pressure which has increased the requirement

to source agency locums, often at short notice.

Referral to Treatment Time (RTT) and Accident & Emergency (A&E) Performance/Targets - CTUHB have adopted a balanced approach to support

the principles of the medical locum spend caps without impacting on patient safety or compromising RTT and A&E performance. This has been a balancing

act which has required the Medical Director to consider shift requests on a case

by case basis considering a number of associated factors.

It has become evident that the data presented for Welsh Government provides a snapshot of committed (i.e. booked) agency locum usage, whilst the financial

data reports on actual expenditure for that particular month. Ordinarily the two sets of data should correlate however the recording of agency locum bookings

is still being further refined and for example, the financial expenditure for January includes the recoding of invoices which don’t necessarily relate to

activity for that given period. Fortunately it was always acknowledged from the outset that there will be discrepancies given the requirement to embed the

new reporting processes. As a result, finance are developing trackers to monitor spend and usage as part of the medical productivity cross cutting theme.

Progress in this respect is reported through the monthly Efficiency, Productivity and Value Board.

At this stage, there is some reduction in medicine, historically the largest problem, but this is being offset by agency usage elsewhere.

Finance have forecast that there would be no direct reduction in the agency

spend between November 2017 and January 2018 due to the pre-booked shifts necessitated by the delay in issuing the WHC and the proximity to Christmas.

Month 7 and 8 (Oct and Nov) suggests a slight reduction in agency spend but as anticipated at the outset, there are no obvious trends emerging in December

and January due to the fact that a considerable number of bookings were pre-booked (prior to 13 November) spanning well into February 2018. Attempts are

being made however to source cheaper agency locums and to renegotiate all future rates down, whilst targeting permanent recruitment.






Reporting and Implementation

Prior to the framework being introduced, medical (locum) expenditure and booking arrangements were largely unregulated with limited controls, approvals

and recording, resulting in varying pay rates and operating procedures across Health Boards and Trusts.

Whilst is was recognised that different issues exist in different organisations,

influenced by location of hospitals, distribution of junior doctors, impact of the South Wales programme and national shortages, it was critical to agree a

consistent approach to agency locum framework price caps.

The new controls and reporting regime introduced under the framework will

result in significantly improved data being available to both Welsh Government and Health Boards and Trusts, and will facilitate a better understanding of the

reasons for the high level of locum usage and identify short, medium and long term solutions to address these.

In December 2017, Welsh Government sought assurance that the framework

had been fully rolled out and that the appropriate escalation processes had been designed and implemented. A further report has since been

commissioned, confirming the actions taken to date and lessons learnt throughout December 2017. As part of this report, Health Boards and Trusts

were also asked to complete a detailed template setting out individual agency locum bookings and internal locum bookings above and below the price cap.

Next steps Taking this strategy forward, the Medical Workforce Efficiency Group still have a

challenging agenda ahead of them which includes the standardisation of internal locum rates likely to be from August 2018 onwards. In the absence of

standardised rates across Wales (apart from the locum rates currently set out in Welsh Government’s pay circular), Health Boards and Trusts will be

competing against each other for locums, which may in turn drive up rates. Moreover, this approach will set the foundations for the development of an all

Wales Medical Locum Bank which in turn will drive down agency locum usage.

There is however an dependency on finance colleagues designing and implementing consistent payroll coding (for ADHs) over the next few months,

but work is well underway to discuss proposed standardised rates at a local level with relevant parties.

The Committee may wish to note that the Wales Audit Office will be undertaking an audit in March focusing on a ‘Review of Locum Doctors in

CTUHB’.





4. RECOMMENDATION

The Finance, Performance & Workforce Committee is asked to:

NOTE the strategies taken by CTUHB to fully implement the new agency locum framework.

Retrospectively ENDORSE the attached performance reports for December 2017, January 2018 and February 2018, submitted to Welsh Government.

NOTE that the timetable for future reporting and F&PC sign-off will need to be aligned with Welsh Government reporting.

NOTE the ongoing work of the Medical Workforce Efficiency Group to drive

down the reliance of agency locums.

Freedom of

information status

Open





Appendix 1

Snapshot of data for December 2017, January 2018 and February 2019 Reports submitted to Welsh Government

A comparison of the actual savings compared to the projected savings and an assessment of the confidence in the accuracy of the data

The Welsh Health circular identifies 35% reduction in agency locum spend in

year 1 however CTUHB has developed trackers to monitor the spend across the whole medical paybill, and not just the agency locum spend in isolation.

For February 2018 the target spend set by the Health Board for Agency Spend

has been achieved as per the table below (Excludes Primary Care).

The actions implemented by the Health Board are starting to be reflected; with Agency spend down to 12.57% of the total medical expenditure.

The Health Board continues attempts to source cheaper agency locums and

to renegotiate all future rates down, as well as targeting permanent recruitment.

Medical Agency Expenditure vs CT Target

2016/17

Ave/Mth

Feb-18

Target

Feb-18

Actual

Variance to

target

£k £k £k £k

996 966 883 -83





Although there is no Welsh Government reduction in expenditure target for ADHs, we aim to track the impact of the rate reductions on a monthly basis

compared to 16/17 outturn, as per the table below.

Agency Usage

Whilst the Welsh Health Circular focuses on the impact of agency locum usage,

success in meeting the required targets can only be sustainable if complimentary activities are undertaken to address the demand to source a

locum. This work is being progressed through a number of work-streams

reporting through the Medical Productivity, Cross Cutting theme.

The component parts/work-streams are well defined and focus on the following areas:

i) e-Rostering: Healthroster and employee online have been rolled out to all directorates with the exception of ACT. The e-rostering system

will provide timely and accurate information around the management of all leave (sickness, annual, study and professional) and provides

the foundation for rota management to ensure safe and effective deployment of the medical workforce. If implemented properly, this

will eradicate poor rostering and will improve workforce planning around absences, resulting in less reliance on locums.

ii) e-job planning: rolled out to all directorates. Job planning metrics

will demonstrate productivity aligned to demand and capacity plans

and monitor working patterns to drive up productivity and meet the needs of the directorate.

iii) recruitment can be split into two themes 1) timely transactional

processing of approved medical vacancies, and 2) analysis of skill requirements and identifying methods of recruitment. The first

activity is undertaken by the medical workforce recruitment team who have well defined trackers and KPIs. The latter is work being

undertaken by HR Business Partners in conjunction with their respective directorates.

iv) alternative skills – this workstream will be taken forward following a

workshop scheduled on Friday, 27 April. Where repeated attempts have been made to recruit doctors with no success, alternative

practitioners must be a consideration. Typical roles may include

Physician Associates, Pharmacists, Physios, ANPs etc.

Medical ADH Expenditure

2016/17 Ave/Mth

Nov-17 Actual

Dec-17 Actual

Jan-18 Actual

Feb-18 Actual

£k £k £k £k £k

395 606 517 486 688





The Director of Workforce and OD and the Medical Engagement Manager

are also meeting with the directorates in April to explore scrutinise the local plans to address the locum usage and consider what additional

support needs to be given.

The following table sets out the number of locum hours booked

within each month, and the number of hours being paid above and below the price cap.

Month – Agency locum

bookings made

Total Hours booked

Total Hours booked

above cap (%)

Total Hours booked

below cap (%)

December 2017 13,486.38 10,609.24

(78.67%)

2,877.14

(21.33%)

January 2018

7,226.50 3,910

(54.10%)

3,316

(54.89%)

February 2018 9,909.50

8,871.50 (89.53%)

1,038 (10.47%)

Source: Medacs (data includes off-contract bookings)

Experience has shown that by offering shifts as a bundle for three or four months at a time will yield some success in securing the right skills at a lower

negotiated rate. This is because many of the locum are travelling long distances and need to plan their diaries well in advance. Also, locums have historically

been reimbursed for accommodation and travel, on top of the hourly rates. There have been small pockets where this has continued with pre-existing

bookings, but from April onwards, reimbursement will be refused

Off-Contract Agency Usage

A key strategy to help reduce agency locum costs is to channel all agency supply through Medacs managed service and their supply chain. This will also

provide assurance to the Health Board that all pre-employment checks (including mandatory training) have been completed and that all engagements

are adhering to IR35 compliance (PAYE or Limited status only). The most beneficial aspect of driving all supply through the managed service is the VAT

efficiency savings, even where engagements are through the supply chain.

Data Collection Considerations The data provided is a snapshot of agency locum bookings planned, as opposed

to actual hours worked. There is concern therefore that whilst the report sets out projected bookings/spend above and below cap, there is the risk that

bookings will be cancelled, rebooked, and potentially double counted the following month. Therefore the actual activity in month is not being recorded

which will create a mismatch between worked and paid activity in the reporting

mechanism.



s

Cwm Taf University Health Board

Agency Locum / ADH Report

Covering the period

December 2017

2.4.1 WG report Dec 2017 Agency Locum Framework FPW 19 April 2018


CONTENT:

1. Actions being taken in CTUHB to reduce the reliance on agency locum

2. Issues and risks taken into account when determining the utilisation of Agency Locums in Cwm Taf UHB

3. Summary of Agency Locums booked from 1-31 December 2017

4. An assessment of the effectiveness of the control framework and information about whether any changes have been made as a result of lessons learned during operation

5. A comparison of the actual savings compared to the projected savings and an assessment of the confidence in the accuracy of the data

6. Issues affecting the capturing of ADH requests

7. Summary of agreed ADHs for December 2017

8. Data collection considerations

Annex I – Agency Locum Data Return

- Summary of the reasons for Agency Locum usage - Summary of the speciality of Agency Locum usage - Summary of grade of Agency Locum usage - Summary of the location of Agency Locum usage - Ten highest paid Agency Locums - Ten longest serving Agency Locums - Increase in rate over previous 12 months - Names of off-contract usage

Annex II – ADH

- Summary of requests above and below cap covering reason, speciality, grade and location.



1 Actions being taken in CTUHB to reduce the reliance on agency locums 1.1 The internal escalation and daily authorisation process continues to be time

consuming for the Medical Director however it is helpful in exposing a number of workforce and operational issues. Moreover, the Medical Director’s role in taking the lead for this strategy has been important and continues to be critical where breaches are requested and need to be balanced against patient safety and health board performance.

1.2 Whilst the December figures confirm 78% of bookings are above cap, a number

of agency locum hourly rates have been successful reduced, albeit outside the cap rate which are difficult to capture. At the start of this journey, CTUHB identified 100% agency locums above cap for pre-existing bookings. Since then, discussions have taken place with all agencies supplying above cap to secure a reduction in rate, even if the rates is still above cap.

1.3 Likewise, discussions have been held with agency locums to entice them onto

NHS locum terms and conditions, permanent employment , or NHS ‘as and when’ terms. To date we have been successful in securing 4 individuals. A key feature of the package being offered to ‘as and when’ locums is the ability to offer a weekly payroll.

1.4 Where there are is high level of agency locum usage and cost, the workforce

establishment is being reviewed, alongside demand and capacity plans with a view to identifying alternative skill mix in hard to fill specialties.

1.5 Through the establishment of the CTUHB Medical Workforce Efficiency Group,

robust monitoring and reporting on medical workforce recruitment has resulted in an action plan against all vacancies setting out timeframes for either advertisement, skill mix change or alternative interim arrangements.

1.6 Successful appointments in high cost areas include 6 consultant anaesthetists, 2 locum consultants in Histopathology, 1 consultants in respiratory medicine, 1 consultant in sport and medicine, 2 clinical fellows in A&E and 1 specialty doctor in A&E. Whilst there has been some success in recruiting, the cost savings may not be realised until the individuals join and agency locums can be released.

1.7 Medacs are actively in discussion with the off-contract agencies who have to

date refused to supply locums through the managed service. Positive meetings have been held with Merco and Interact however written confirmation of their intent to form part of the supply chain is yet to be received. Discussions have also been held with Athona however, due to the high volume of supply to date, there is a reluctance for them to come on board. This matter is being dealt with through the Medical Workforce Efficiency Group to demonstrate to Athona there will be an all Wales approach.



1.8 The Health Board’s Scrutiny Committee continues to meet weekly to review progress against plans, during which Medacs provide weekly updates on the previous week’s activity and provide an all Wales overview.

2. Issues/Risks that are taken into account when determining the utilisation

of Agency Locums in Cwm Taf UHB

2.1 A&E

A sizeable percentage of shifts in A&E (Royal Glamorgan Hospital) require

Speciality and Consultant level locums. This is primarily due to the removal of

trainees as per the South Wales Programme. There are also vacancies in the

substantive middle grade and consultant rotas which we have been challenging

to fill over a number of years. At this stage, Royal Glamorgan Hospital will

continue to function as an A&E unit and is not ready for any major change at

the front door, particularly as Royal Glamorgan frequently accepts diverted

ambulance requests from Cardiff and Vale and ABMU. An additional pressure

is the fragility of filling GP out of hours shifts which it turn places additional

staffing requirements in A&E.

2.2 South Wale Programme Since the announcement of the South Wales Programme there has been some uncertainty and anxiety amongst the obstetrics and paediatrics workforce, which in turn has led to increased turnover initially and led to difficulty in recruiting to vacancies. This has resulted in the appointment of agency locums to provide business continuity.

Likewise, The Deanery training reconfiguration programme has resulted in the removal of a number trainees posts in Paediatrics and T&O (Core Surgical training) from the Royal Glamorgan. This has resulted in significant gaps in the rotas and has proved challenging to sustain safe rotas without the support of agency locum appointments.

2.3 Winter pressures

The timing of the planned implementation was always anticipated to be challenging, but the severity of winter flu on both staff and patients has been an additional pressure on medical workforce, increasing the requirement to source agency locums.

2.4 RTT and A&E Performance/Targets

As set out in the December report to Welsh Government, CTUHB have adopted

a balanced approach to support the principle of medical locum spend without

impacting on patient safety or compromising RTT and A&E performance. It will

be important to capture our performance with regard to RTT and A&E waiting

times to demonstrate a balanced and measured approach to maintain activity

and patient safety whilst implementing the caps during the winter months.



2.5 Hard to fill Specialties – National Shortages

All off-contract agency locum bookings breaching the rate cap and are located

in specialties where there is a national shortage, including Surgery (registrar),

A&E (specialty), Medicine (specialty), Histopathology (consultant) and ACT

(specialty). Medacs find it difficult to source suitable locums in these

specialties. Likewise, whether there is high spend on ADHs, this is due to

difficulties in recruiting including middle grades in ACT.

3. Summary of Agency Locums booked during December 2017

(Yellow cells represent off-contract bookings and Blue cells represent bookings

secured through Medacs managed service)

Individual Doctors Booked during

December for assignments either in

December or for shifts in 2018 37

Total hours booked 13,486.38

Total hours booked at or below Cap 2,877.14

Total hours booked at or below Cap % 21.33%

Total Hours booked above Cap 10,609.24

Total hours booked above Cap % 78.67%

Total assignments booked 72

Total assignments booked at or below Cap 13

Total assignments booked at or below Cap 18.06%

Total assignments booked above cap 59

Total assignments booked above Cap % 81.94%

Number of agency locums booked Off

Contract 8

Number agency locums booked Off

Contract % 21.62%

Number Of assignments booked off-

Contract 13

% Of assignments booked Off-Contract 18%



Number Of hours Booked off-Contract 190.50

% Of hours Booked Off-Contract 1.41%

Number agency locums Booked On

Contract 29

% Of agency locums Booked On Contract 78.37%

Number Of assignments Booked On

Contract 59

% Of assignments Booked On Contract 81.9%

Number Of Hours Booked On Contract 13,295.88

% Of Hours Booked On Contract 98.58%

4. An assessment of the effectiveness of the control framework and

information about whether any changes have been made as a result of

lessons learned during operation

4.1 The control framework is robustly adhered to in all Directorates where Agency

Locum requests are reviewed and authorised (and challenged) by the Medical

Director on a daily basis. This has proved challenging where directorates are

requesting authorisation for a large number of shifts (typically A&E Royal

Glamorgan). Moving forward, where there are block bookings requiring

authorisation (200+ shifts to be filled in A&E), it will be more prudent for the

Scrutiny Committee to review such requests as a batch.

4.2 Overall, the process has identified the need gain a better understanding of the

drivers for such high locum usage and where this is the case, reviews are

taking place to align demand and capacity within each directorate. This piece

of work will enable the Health Board to identify short, medium and long term

solutions to reduce locum expenditure without affecting the quality of services

and patient safety.

4.3 It is recognised that some specialties are faced with greater challenges with

regards to medical workforce availability and these areas continue to be

supported as necessary. In the spirit of healthy competition the health board

will consider how it communicates to colleagues the success of these

arrangements, potentially featuring some good news stories and featuring

“Directorate of the month” for the best managed leave and rota and fewest

medical locum requirements.

4.4 Learning from the process so far include:



Importance of Medical Director leading the process visibly

Training for operational managers and senior on call managers and executives is vital

Encourage agency locums to being sourced through Medacs Managed Service

Wherever possible, reduce the reliance on off-contract agency locums

Medium term, develop a Cwm Taf medical locum bank utilising the nurse bank software

Ensure a consistent payment rate within the University Health Board for the internal locum cover

Communicate successes to Directorates – progress and quick wins to date

Concerted effort to attract agency locums to accept NHS roles

Creation of an Innovative Workforce skill mix, whereby multi-professional clinical teams are developed

Offer weekly pay to as and when locums 4.5 As previously noted the high volume of agency locums bookings submitted for

A&E Royal Glamorgan is time consuming for both the Directorate staff and

Medical Director. As a result, two workshops have been held to agree the rota,

resource requirements, skill base (ANPs, ENPs etc) and general principles for

resourcing the department. This has resulted in an action plan which aims to

reduce the reliance on agency locums and associated risks of running the

department on temporary staff. As part of the action plan, directorates and

workforce colleagues are systematically working through the establishments in

ACT and A&E to fully understand the workforce skills and grades.

5. A comparison of the actual savings compared to the projected savings

and an assessment of the confidence in the accuracy of the data

5.1 The Welsh Health circular identifies 35% reduction in agency locum spend in

year 1 however CTUHB are also planning to track the whole medical paybill,

and not just the agency locum spend in isolation.

5.2 The UHB had forecast that there would be no direct reduction in the agency

spend between November 2017 and January 2018 due to the pre-boooked

shifts necessitated by the delay in issuing the WHC and the proximity to

Christmas. Month 7 and 8 (Oct and Nov) suggests a slight reduction in agency

spend but as anticipated at the outset, there are no obvious trends emerging in

December 2017 due to the fact that a considerable number of bookings were

pre-booked (prior to 13th November) spanning well into January and February

2018. Attempts are being made however to source cheaper agency locums

and to renegotiate all future rates down, whilst targeting permanent recruitment.

5.3 To help track the 35% reduction in agency locum spend, finance have profiled

the maximum desired spend from January 2018 onwards:



Month Maximum Agency locum spend

January 2018 (Starting point) £986k spend

February 2018 £966k

March 2018 £947k

April 2018 £897k

May 2018 £847K

June 2018 £797k

July 2018 £747k

August 2018 £797k

September 2018 £697k

October 2018 £648k

The above profile excludes Primary Care

5.4 A finance tracker which profiles the savings against target for each directorate

has been developed. This assesses the impact on agency spend, locum

(internal ADH spend and the total paybill to ensure that we are not reducing the

overall paybill.

6. Capturing of ADH requests

6.1 The Redcap Database has been an effective means of capturing planned ADH

and WLI activity for reporting purposes, however we are aware that the data

presented does not currently correspond with the totality of actual ADH claims

worked or processed through payroll. This is because some claims are still not

being processed through the approval mechanism.

6.2 Upon reviewing the data for December, it is clear that a number of consultants

and potentially specialty grade doctors are not complying with the requirement

to complete the Redcap database. As a result, a cross reference will be made

against the December and January payroll to identify where there is non-

compliance, and relevant discussions will be held with directorates if there is

found to be discrepancy or missing data.

6.3 CTUHB are also developing standard operating procedures to ensure the

appropriate authorisations are obtained prior to working a Waiting List Initiative

WLI). This will ensure that a clear distinction can be drawn for the payment of a

WLI or ADH.

7. Summary of agreed ADHs for December 2017 as recorded on Redcap

Total number of

assignments agreed over

cap

73 24.5%

Total number of

assignments agreed

below cap

225 75.5%



Overall Total 298

8. Data Collection Considerations 8.1 The data provided is a snapshot of agency locum bookings planned, as

opposed to actual hours worked. There is concern therefore that whilst the report sets out projected bookings/spend above and below cap, there is the risk that bookings will be cancelled, rebooked, and potentially double counted the following month. This scenario will need to be further explored with Medacs Managed Service who collating the data on our behalf.

8.2 A further concern is the lack of reporting on agency locum rates that have been

renegotiated down, but are still within cap. In particular, the Medical Director has made significant efforts to ensure that that hourly rates are reduced, particularly where the hourly rate breaches the cap. To date, these renegotiations are not recorded and whilst they count towards any savings going forward, it would be helpful to demonstrate the effort being made to ensure the best rate possible.

8.3 As noted in section 3, 18% of CTUHB assignments are booked off-contract (outside the managed service), details of which are noted in Annex I. It is important to note that all booking requests start with the Medacs Managed Service, and are only sourced to off-contract agencies where Medacs are unable to supply. Accordingly, there is a small risk that some agency locum bookings are not being recorded by Medacs for the monthly return. This is becoming less likely over time however there is a reliance on Medacs to capture any off-contract data being authorised by the Medical Director.

8.4 The ADH report for Welsh Government has requested Average Hourly costs.

Whilst it has been possible to calculate this cost, it would probably be more interesting to see the actual hourly rate paid.

8.5 The agency locum data request asks for the’10 longest serving’. To make this

data more meaningful the actual length of assignment has also been inserted for CTUHB.

8.6 The agency locum data request asks for the ’10 highest paid’ in December. It

may also be helpful to distinguish between the 10 highest hourly rates against the 10 highest paid (total pay).



s



Covering the period

January 2018

2.4.2 WG report Jan 18 Agency Locum Framework FPW 19 April 2018


CONTENT:



3. Summary of Agency Locums booked from 1-31 January 2018

4. An assessment of the effectiveness of the control framework and information about whether any changes have been made as a result of lessons learned during operation



7. Summary of agreed ADHs for January 2017


9. Agency Locum Data Return - Summary of the reasons for Agency Locum usage - Summary of the speciality of Agency Locum usage - Summary of grade of Agency Locum usage - Summary of the location of Agency Locum usage - Ten highest paid Agency Locums - Ten longest serving Agency Locums - Increase in rate over previous 12 months - Off Contract Agency usage

10. ADH - Summary of requests above and below cap covering reason, speciality,

grade and location.





1.2 Discussions continue with agency locums to entice them onto NHS locum

terms and conditions, permanent employment, or NHS ‘as and when’ terms. To date we have been successful in securing 4 individuals. A key feature of the package being offered to ‘as and when’ locums is the ability to offer a weekly payroll.






Progress made in renegotiating rates of agency workers who had

assignments booked prior to the 13th November 2017

Positive Outcome – Fully Compliant Decision taken at

Exec Director Panel

Directorate Complian

t as at

3.11.17

Left (or

date of

terminatio

n agreed)

Transfer

to NHS

being

processe

d

Agreed

reduction

to cap

Agreed

reductio

n but

not to

cap

Refused

reduction

– breach

authorise

d

General

Medicine

1 1

Paediatrics 2 2 5

Accident &

Emergency

1 3 1 1



Urology 2

T&O 1 4

Haematolog

y

1

General

Surgery

1 1

Adult

Psychiatry

1

Total – 28 9 3 2 3 11

% 0% 33% 11% 7% 11% 39%

2. Issues/Risks that are taken into account when determining the utilisation

of Agency Locums in Cwm Taf UHB

2.1 A&E

The Health Board has two A&E departments, one in Royal Glamorgan Hospital

(RGH) and the other in Prince Charles Hospital (PCH). The workforce in each

hospital is very different with RGH principally running on agency locums due to

the complete removal of training posts. Likewise, to date, there has not been

an agreed staffing establishment for medical and related (ANP and ENP) staff

in RGH.

As part of the Scrutiny Group discussions it has been important to understand

the workforce establishment across both hospitals and to ensure a programme

of recruitment activity is driven forward, which in turn will drive down the

reliance on agency locums. Since January, 7.0 WTE specialty doctors and 1

consultant locum have been advertised. To date 2 specialty doctors have been

offered posts. In addition 2 doctors, not yet appointable as specialty doctors,

have been offered clinical fellow posts and 1 clinical fellow has commended

employment. This recruitment process will continue until all the posts are filled.

In addition to advertising posts on NHS Jobs and TRAC, the department have

also been interviewing candidates introduced via recruitment agencies, one of

which is MEDACS our supplier of agency locums. Naturally the cost of the

introductory fee to an agency is quickly offset by the reduction in agency spend.



An innovative approach has also been taken in A&E to attract clinical fellows

which includes the offer of experience with the air Ambulance Service, Drug

Tank and Search and Rescue service (EMERTS), combined with the role of

junior doctor support within the A&E department. The level of interest in these

roles has been considerable and resulted in 4.0 WTE EMERTS clinical fellows

being appointed (one starting in March and three in August). One clinical fellow

will be based in PCH with the other 3 in RGH.

2.2 South Wale Programme Since the announcement of the South Wales Programme there has been some uncertainty and anxiety amongst the obstetrics and paediatrics workforce, which in turn has led to increased turnover initially and led to difficulty in recruiting to vacancies. This has resulted in the appointment of agency locums to provide business continuity.

Likewise, the Deanery training reconfiguration programme has resulted in the removal of a number trainees posts in Paediatrics and T&O (Core Surgical training) from the Royal Glamorgan. This has resulted in significant gaps in the rotas and has proved challenging to sustain safe rotas without the support of agency locum appointments.

2.3 Winter pressures

The timing of the planned implementation was always anticipated to be challenging, but the operational pressures on the whole system and severity of winter flu on both staff and patients has been an additional pressure on medical workforce, increasing the requirement to source agency locums.

2.4 RTT and A&E Performance/Targets

As set out in the December report to Welsh Government, CTUHB have adopted

a balanced approach to support the principle of medical locum spend without

impacting on patient safety or compromising RTT and A&E performance. It will

be important to capture our performance with regard to RTT and A&E waiting

times to demonstrate a balanced and measured approach to maintain activity

and patient safety whilst implementing the caps during the winter months.

2.5 Hard to fill Specialties – National Shortages

All off-contract agency locum bookings breaching the rate cap and are located

in specialties where there is a national shortage, including Surgery (registrar),

A&E (specialty), Medicine (specialty), Histopathology (consultant) and ACT

(specialty). Medacs find it difficult to source suitable locums in these

specialties. Likewise, whether there is high spend on ADHs, this is due to

difficulties in recruiting including middle grades in ACT.

3. Summary of Agency Locums booked during January 2018

(Yellow cells represent off-contract bookings and Blue cells represent bookings

secured through Medacs managed service)



Agency Locum Bookings –

Comparison December

2017/January 2018

December 2017

January 2018

Variance

Individual Doctors Booked during December for assignments either in December or for shifts in 2018 37 43 +6

Individual Doctors booked at or below Cap 7 13 +6

Individual Doctors booked at or below Cap% 23.33% 30.23% +6.9%

Individual Doctors booked above Cap 30 30 0

Individual Doctors booked above Cap% 81.08% 69.76% -11.32%

Total hours booked

13,486.38 7,226.50 -6,259.88

Total hours booked at or below Cap 2,877.1

4 3,316.0 +438.86

Total hours booked at or below Cap % 21.33% 45.89% +24.56

Total Hours booked above Cap

10,609.24 3,910.00 -6,699.24

Total hours booked above Cap % 78.67% 54.10% -24.57

Total assignments booked 72 144 +72

Total assignments booked at or below Cap 13 23 +10

Total assignments booked at or below Cap 18.06% 15.97% -2.09

Total assignments booked above cap 59 121 +62

Total assignments booked above Cap % 81.94% 84.02% +2.08

Number of agency locums booked Off Contract 8 8 0

Number agency locums booked Off Contract % 21.62% 18.60% -3.02

Number Of assignments booked off-Contract 13 11 -2



% Of assignments booked Off-Contract 18% 7.63% -10.37

Number Of hours Booked off-Contract 190.50 501.5

0 +311

% Of hours Booked Off-Contract 1.41% 6.93% +5.52

Number agency locums Booked On Contract 29 35 +6

% Of agency locums Booked On Contract 78.37% 79.06% +0.69%

Number Of assignments Booked On Contract 59 134 +75

% Of assignments Booked On Contract 81.9% 93.05% +11.15

Number Of Hours Booked On Contract

13,295.88 6,794 -6,501.88

% Of Hours Booked On Contract 98.58% 94.01% -4.57



In summary, the Health Board are seeing an increase in on-contract bookings

made throughout January, and this primarily due to rotas being submitted by

O&G and Surgery six weeks in advance. This in turn has provided Medacs

with an opportunity to fill gaps and therefore generated an increase in the

number of bookings made through the managed service.

4. An assessment of the effectiveness of the control framework and

information about whether any changes have been made as a result of

lessons learned during operation

4.1 The control framework is robustly adhered to in all Directorates where Agency

Locum requests are reviewed and authorised (and challenged) by the Medical

Director on a daily basis. This has proved challenging where directorates are

requesting authorisation for a large number of shifts (typically A&E Royal

Glamorgan). Moving forward, where there are block bookings requiring

authorisation (200+ shifts to be filled in A&E), the Scrutiny Committee will

review such requests as a batch on a weekly basis.

4.2 Overall, the process has identified the need gain a better understanding of the

drivers for such high locum usage and where this is the case, reviews are

taking place to align demand and capacity within each directorate. This piece

of work will enable the Health Board to identify short, medium and long term

solutions to reduce locum expenditure without affecting the quality of services

and patient safety.

4.3 It is recognised that some specialties are faced with greater challenges with

regards to medical workforce availability and these areas continue to be

supported as necessary. In the spirit of healthy competition the health board

will consider how it communicates to colleagues the success of these

arrangements, potentially featuring some good news stories and featuring

“Directorate of the month” for the best managed leave and rota and fewest

medical locum requirements.

4.4 Learning from the process so far include:

Importance of Medical Director leading the process visibly

Training for operational managers and senior on call managers and executives is vital

Encourage agency locums to being sourced through Medacs Managed Service

Wherever possible, reduce the reliance on off-contract agency locums

Medium term, develop a Cwm Taf medical locum bank utilising the nurse bank software

Ensure a consistent payment rate within the University Health Board for the internal locum cover

Communicate successes to Directorates – progress and quick wins to date

Concerted effort to attract agency locums to accept NHS roles



Creation of an Innovative Workforce skill mix, whereby multi-professional clinical teams are developed

Offer weekly pay to as and when locums 4.5 As previously noted the high volume of agency locums bookings submitted for

A&E Royal Glamorgan is time consuming for both the Directorate staff and

Medical Director. As a result, two workshops have been held to agree the rota,

resource requirements, skill base (ANPs, ENPs etc) and general principles for

resourcing the department. This has resulted in an action plan which aims to

reduce the reliance on agency locums and associated risks of running the

department on temporary staff. As part of the action plan, directorates and

workforce colleagues are systematically working through the establishments in

ACT and A&E to fully understand the workforce skills and grades.




year 1 however CTUHB has developed trackers to monitor the spend across

the whole medical paybill, and not just the agency locum spend in isolation.

5.2 The Agency spend for January 2018 has exceeded the target spend set by the

Health Board, as per the table below.

However, in January, a total of £270k of invoices, relating to April 2017 to

January 2018, were recoded to Medical Agency subjectives. This exercise

ensures the agency spend is captured correctly for future comparison.

As previously stated in the December report, there is unlikely to be a reduction

in the agency spending throughout January 2018 due to the pre-booked shifts

necessitated by the delay in issuing the WHC and proximity to Christmas.

However, the Health Board continues attempts to source cheaper agency

locums and to renegotiate all future rates down, as well as targeting permanent

recruitment.

5.3 Although there is no Welsh Government reduction in expenditure target for

ADHs, we aim to track the impact of the rate reductions on a monthly basis


Medical Agency Expenditure

2016/17 Ave/Mth Jan-18 Target Jan-18 Actual Variance to

target

£k £k £k £k

996 986 1,240 254



Whilst the monthly spend has not yet reduced to 2016/17 average, we are

starting to see a reduction in spend compared to the start of the year. The

volume of claims being recorded through the Redcap software suggests a

significant decrease in January by over 50% which may be reflected in the

February Actual expenditure. Whilst the volume has decreased, the

percentage of ADHs above cap are broadly the same.

5.4 There continue to be operational pressures in some directorates such as

Medicine, Pathology and ACT, therefore resulting in continued reliance on

Agency and ADHs.

5.5 From February the intention is for the Health Board to separately identify Winter

Pressure expenditure, to provide a true reflection of the existing cost reduction

measures.





worked or processed through payroll. It is clear that a number of claims are still

not being processed through the approval mechanism by the directorates .

6.2 Upon reviewing the data for December and January, it is clear that directorates

have failed to process the ADH bookings for a number of consultants and

specialty grade doctors via the Redcap database. As a result, a cross

reference will be made against the December and January payroll to identify

where there is non-compliance, and relevant discussions will be held with

directorates if there is found to be discrepancy or missing data.




WLI or ADH. A separate financial control procedure for booking ADHs is under

development and will be submitted for approval at the April Audit Committee


2016/17 Ave/Mth Nov-17 Actual Dec-17 Actual Jan-18 Actual

£k £k £k £k

395 606 517 486



7. Summary of agreed ADHs for January 2017 as recorded on Redcap

ADHs Planned

December 2017 January 2018

Total number of assignments over cap

73 (24.55) 40 (31%)

Total number of assignments below cap

225 (75.5%) 91 (69%)

Overall Total 298 131

8. Data Collection Considerations 8.1 The data provided is a snapshot of agency locum bookings planned, as

opposed to actual hours worked. There is concern therefore that whilst the report sets out projected bookings/spend above and below cap, there is the risk that bookings will be cancelled, rebooked, and potentially double counted the following month. This scenario is being explored with Medacs Managed Service who are collating the data on our behalf. Therefore the actual activity in month is not being recorded. There is therefore a mismatch between worked and paid activity in the reporting mechanism.

8.2 It is important to note that all booking requests are initially placed with the Medacs Managed Service, and are only sourced to off-contract agencies where Medacs are unable to supply. Accordingly, there is a small risk that some agency locum bookings are not being submitted to and therefore recorded by Medacs for the monthly return. This is becoming less likely over time however there is a reliance on Medacs to capture any off-contract data being authorised by the Medical Director.



9. The Welsh Health Circular requires Health Boards to provide anonymised data confirming the number of agency workers, including details about the number of hours/sessions they have delivered and their specialty. This data is broken down by reason for engagement, by specialty, by grade and by hospital location.

Summary by Reason

Reason For Job No of Individuals

No of Jobs Hours Booked

Charge Rate Total Charge

Medical Exclusion 1 1 20.00 £56.37 £1,127

Other 3 4 102.00 £99.79 £10,179

Paternity Leave 1 1 37.50 £97.22 £3,646

Sick Leave 13 19 1,218.50 £65.50 £79,816

Study Leave 2 2 60.00 £68.56 £4,114

Vacant Post 29 117 5,788.50 £76.06 £440,273

Total 49 144 7,226.50 £77.25 £558,247

Summary by Specialty

Speciality No of Individuals



Accident & Emergency 18 99 1,697.00 £78.40 £133,045

Adolescent/Child Psychiatry 1 1 166.00 £115.00 £19,090

Adult Psychiatry 5 7 1,141.00 £70.83 £80,817

Anaesthetics 1 8 110.50 £80.92 £8,942

General Surgery 7 7 1,505.00 £57.90 £87,133

Obstetrics & Gynaecology 6 15 1,070.00 £60.74 £64,992

Orthopaedics & Trauma 3 3 600.00 £61.03 £36,618

Paediatrics & Neonates 1 2 262.00 £51.86 £13,587

Urology 1 2 675.00 £97.04 £65,502

Total 43 144 7,226.50 £74.86 £540,976

Summary by Grade

Grade No of Individuals



Cons 4 5 1,028.50 £100.71 £103,576

SD 21 103 2,511.50 £78.34 £196,751

ST1 12 14 2,224.00 £53.98 £120,052

ST3+ 6 22 1,462.50 £68.57 £100,284

Total 43 144 7,226.50 £75.40 £544,878

Summary by Hospital location



Location Unit No of Individuals



Cwm Taf Health Board

Prince Charles Hospital 5 25 1,325.50 £69.94 £92,700

Royal Glamorgan Hospital 38 118 5,735.00 £75.81 £434,770

St Davids Hospital 1 1 166.00 £115.00 £19,090

Total 44 144 7,226.50 £86.92 £628,127

9.1 The following data is an anonymised summary which sets out the expenditure

made to each of the ten highest paid (ie. those paid the highest hourly rate)

agency workers including details of the hours/shifts worked and their specialty.

It also confirms any individual paid more than £120 per hour. The in the March

report, an update will be provided on actions being taken to eradicate the top

ten highest paid and longest serving by specialty.

Top 10 Highest Paid

Agency Reason For Job Speciality Grade Unit Total Hours Booked

Hourly Charge Rate

Total Pay

Medacs Healthcare

Vacant Post Ophthalmology Consultant

Royal Glamorgan Hospital

268.67 £122.63 £32,947

Interact Medical Vacant Post Haematology Consultant

Prince Charles Hospital

313.48 £121.20 £37,994

Medacs Healthcare

Sick Leave Adolescent/Child Psychiatry

Consultant

St Davids Hospital

191.5 £115.00 £22,023

Medacs Healthcare

Vacant Post Urology Consultant


174.38 £112.85 £19,679

Medacs Healthcare

Vacant Post Paediatrics & Neonates

Specialist Training Year 3


201.79 £71.72 £14,472

Medacs Healthcare




178.85 £73.67 £13,176

Medacs Healthcare




172.93 £72.66 £12,565

Medacs Healthcare

Vacant Post General Surgery Consultant


123.9 £97.19 £12,042

Medacs Healthcare

Vacant Post Accident & Emergency



130.83 £90.71 £11,868

Medacs Healthcare

Vacant Post General Surgery Specialist Training Year 3


165.59 £71.54 £11,846

Top 10 Highest Paid By Hour



Agency Reason For Job Speciality Grade Unit Total Hours Booked

Hourly Charge Rate

Total Pay

RIG Locums


SD

Royal Glamorgan Hospital 269.50 £121.80 £32,825.10

Medacs Healthcare

Vacant Post Urology Cons Prince Charles Hospital

500.00 £119.80

£59,900.00

Medacs Healthcare

Sick Leave Adolescent/Child Psychiatry

Cons St Davids Hospital

166.00 £115.00

£19,090.00

Total Assist


SD


Athona


SD


Total Assist


SD


Medacs Healthcare


SD Royal Glamorgan Hospital

8.00 £108.10

£864.80

Interact

Other Accident & Emergency

SD


Merco

Other Accident & Emergency

SD


Total Assist


SD


9.2 The following data is an anonymised summary of the ten longest serving agency workers ie. those working for the longest consecutive period, including their specialty, details of the hours/shifts worked and length of assignment.

Top 10 Longest Serving

Agency Reason For Job

Speciality Grade Unit Total Hours

Hourly Chrage

Rate

Total Pay

Length

Medacs Healthcare

Vacant Post

Orthopaedics & Trauma



7,432.54 £65.34 £485,642 2 Years 3 Months

Medacs Healthcare

Vacant Post




7,156.50 £56.65 £405,416 2 Years 3 Months

Medacs Healthcare

Vacant Post

Paediatrics & Neonates



6,240.93 £74.85 £467,134 2 Years 3 Months

Medacs Healthcare

Sick Leave Adult Psychiatry

Specialty Doctor St Tydfil`s Hospital

5,333.50 £66.43 £354,304 2 Years 2 Months

Interact Medical

Vacant Post

Haematology Consultant Prince Charles Hospital

5,049.15 £124.19 £627,054 2 Years 2 Months

Medacs Healthcare

Vacant Post




4,708.65 £73.87 £347,828 2 Years 5 Months



Medacs Healthcare

Vacant Post

Adult Psychiatry

Specialty Doctor Prince Charles Hospital

3,670.44 £65.70 £241,148 1 Year 4 Months

Medacs Healthcare

Vacant Post




2,971.98 £63.50 £188,721

1 Year 6 Months

Pathology Group

Vacant Post

Microbiology Consultant Royal Glamorgan Hospital

2,925.00 £148.56 £434,538

2 Years

Medacs Healthcare

Vacant Post




2,910.37 £77.26 £224,855

1 Year 11 Month


A key strategy to help reduce agency locum costs is to channel all agency supply

through Medacs managed service and their supply chain. This will also provide

assurance to the Health Board that all pre-employment checks (including mandatory

training) have been completed and that all engagements are adhering to IR35

compliance (PAYE or Limited status only). The most beneficial aspect of driving all

supply through the managed service is the VAT efficiency savings, even where

engagements are through the supply chain.

To date it has been challenging to eradicate off contract usage as agency locums in

some hard to fill specialties will favour agencies that allow umbrella status

engagements. Whilst the Health Board can refuse to offer shifts to such agencies

and umbrella status locums, there risk is significant that shifts in A&E, Pathology and

Surgery will not be filled, resulting in fragile rotas and unsafe levels of staffing.

As noted previously, Medacs are actively in discussion with the off-contract agencies

who have to date refused to supply locums through the managed service. Positive

meetings have been held with Merco and Interact however written confirmation of

their intent to form part of the supply chain is yet to be received. Discussions have

also been held with Athona however, due to the high volume of supply to date, there

is a reluctance for them to come on board. This matter is being dealt with through

the Medical Workforce Efficiency Group and a risk assessment has been undertaken

to consider withdrawal of all supply from Athona which is predominantly in Surgery

and A&E

Agency Number Of Locums

With Future Bookings

Number Of

Future Bookings

CCS RM3711

Framework

A&E Agency 1 1 Yes

Athona 6 11 Yes

Interact Medical 4 13 Yes

Mediteam 2 2 No



10. The following tables set out the number of ADHs requested (internal ad hoc locum usage). The tables detail ADH requests under cap and over cap by reason, specialty, grade and location.

Requests Under Cap No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Vacancy (Non-Deanery) 7 26 503 46.92 23395

Vacancy (Deanery Gap in rota) 2 2 17 42.5 705

Maternity/Paternity/Adoption Leave

Special Leave (Paid) – inc compassionate leave, interview

4 6 44.5 50.5 2172.35

Special Leave (Unpaid)

Study Leave/Examinations 4 5 56 47 2640

Additional Activity (Winter Pressures/Site Pressures)

Annual Leave 6 10 155 45.7 6817

Sickness 10 12 73.5 53.07 3934.92

Restricted Duties 10 14 124.5 48.1 5658.35

Jury Service

Exclusion(Suspension)


1 3 31 50 1550

ANP Cover

Target Provision

Staff Shortages 5 11 168 47.5 8000

Site Pressure

Health & Safety

Increased Capacity Need 1 1 5 60 300

No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Accident & Emergency 8 49 655 47.35 31130

Anaesthetics 15 28 197 51.92 9650.7

Merco 5 31 No

Pathology Group 3 3 No

RIG Locums 2 15 Yes

Total Assist 2 24 Yes



Dental

General Medicine * 3 4 56.5 48.01 2644.92

Obstetrics & Gynaecology

Paediatrics

Pathology

Psychiatry 2 2 20 40 800

Radiology

Surgical 6 9 316 44.67 14177

No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Foundation year 1 1 1 26 32 832

Foundation year 2

Registrar (SP1-2) / Core Medical Training 12 35 587

42.85 26266.85

Registrar (SP3+) 4 25 355.5 50.28 17834.92

Dental core training

Specialty Doctor / Staff Grade 5 9 81 49.5 3948

Associate Specialist

Consultant 11 21 152 51.85 7370.85

No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Princes Charles Hospital 15 47 729 50.41 34,123.00

Royal Glamorgan Hospital 19 41 424.5 49.07 19,969.62

Ysbyty Cwm Cynon 2 3 48 45 2160

ADH requests above Cap

Requests Above Cap No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Vacancy (Non-Deanery) 2 2 55 50 2750

Vacancy (Deanery Gap in rota)



3 9 37 135.49 5001.21


Study Leave/Examinations




Annual Leave

Sickness 1 1 4 138.92 555.69

Restricted Duties 12 27 193 95.73 15056.29

Jury Service



ANP Cover

Target Provision

Staff Shortages

Site Pressure

Health & Safety

Increased Capacity Need 1 1 4 138.92 555.69

No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Accident & Emergency

Anaesthetics 16 38 238 103.34 21168.88

Dental

General Medicine 1 1 12 50 600


Paediatrics

Pathology

Psychiatry

Radiology

Surgical 1 1 43 50 2150

No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Foundation year 1

Foundation year 2


52.5 8470

Registrar (SP3+)


Specialty Doctor / Staff Grade 6 12 66 131.05 1572.63


Consultant 7 13 68 126.11 7213.53



No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Princes Charles Hospital 7 14 113 93.33 10941

Royal Glamorgan Hospital 11 26 180 69.31 12977.8

Ysbyty Cwm Cynon



s



Covering the period

February 2018

2.4.3 WG report Feb 18 Agency Locum Framework FPW 19 April 2018


CONTENT:



3. Summary of Agency Locums booked throughout February 2018



6. Summary of agreed ADHs for February 2018


8. Agency Locum Data Return - Summary of the reasons for Agency Locum usage - Summary of the speciality of Agency Locum usage - Summary of grade of Agency Locum usage - Summary of the location of Agency Locum usage - Ten highest paid Agency Locums - Ten longest serving Agency Locums - Increase in rate over previous 12 months - Off Contract Agency usage

9. ADH - Summary of requests above and below cap covering reason, speciality,

grade and location.










1.5 Whilst the Welsh Health Circular focuses on the impact of agency locum usage,

success in meeting the required targets can only be sustainable if

complimentary activities are undertaken to address the demand to source a

locum. This work is being progressed through a number of workstreams

reporting through the Medical Productivity, Cross Cutting theme. The plan on

the page attached at Annex I sets out the various components that aim to

maximise medical productivity, which in theory will reduce the reliance on

agency and ad-hoc locums. The component parts/workstreams are well

defined and focus on the following areas:

i) e-Rostering: Healthroster and employee online have been rolled out to all directorates with the exception of ACT. The e-rostering system will provide timely and accurate information around the management of all leave (sickness, annual, study and professional) and provides the foundation for rota management to ensure safe and effective deployment of the medical workforce. If implemented properly, this will eradicate poor rostering and will improve workforce planning around absences, resulting in less reliance on locums.

ii) e-job planning: rolled out to all directorates. Job planning metrics will demonstrate productivity aligned to demand and capacity plans and



monitor working patterns to drive up productivity and meet the needs of the directorate.

iii) recruitment can be split into two themes 1) timely transactional processing

of approved medical vacancies, and 2) analysis of skill requirements and identifying methods of recruitment. The first activity is undertaken by the medical workforce recruitment team who have well defined trackers and KPIs. The latter is work being undertaken by HR Business Partners in conjunction with their respective directorates.

iv) alternative skills – this workstream will be taken forward following a

workshop scheduled on Friday, 27th April. Where repeated attempts have been made to recruit doctors with no success, alternative practitioners must be a consideration. Typical roles may include Physician Associates, Pharmacists, Physios, ANPs etc.

The Director of Workforce and OD and the Medical Engagement Manager are

meeting with the directorates in April to explore scrutinise the local plans to

address the locum usage and consider what additional support needs to be

given.


A&E

2.1 The workforce in A&E, Royal Glamorgan Hospital continues to be a challenge

in terms of sourcing suitable locums for monthly shifts and negotiating the best

rate possible. The challenges in this department have been well articulated in

December and January’s reports (ie.South Wales Programme resulting in no

junior doctors coupled with a high level of footfall 62k at the front door). As a

result, this department requires 21 WTEs to fill the week day shifts, of which we

recently secured 4 substantive appointments with a further 9 due to commence

by August 2018. If shifts are left vacant, it may be unsafe to keep the

department open and it will negatively impact on morale and retention of

recently appointment doctors.

2.2 More significantly, the time and effort being used to source locums is putting

considerable press on the management team, and is ultimately a distraction

from high value work looking at strategic workforce planning, contributing to the

strategic move to Prince Charles Hospital with regard to O&G and CYP as well

as thinking ahead with regard to the Bridgend issue.



2.3 Experience has shown that by offering shifts as a bundle for three or four

months at a time will yield some success in securing the right skills at a lower

negotiated rate. This is because many of the locum are travelling long

distances and need to plan their diaries well in advance. Also, locums have

historically been reimbursed for accommodation and travel, on top of the hourly

rates. There have been small pockets where this has continued with pre-

existing bookings, but from April onwards, reimbursement will be refused.

2.4 MEDACS have never been able to meet the locum demand in this department

partly due to the significant locum shifts required compounded by the shortage

of emergency medicine doctors nationally. This has resulted in shifts being

placed with off-contract agencies.

2.5 In summary, the Scrutiny Committee have been holding detailed conversations

to arrive at a proportionate decision to balance out adherence to the WG

circular expectation/ directive against the duty of care to patient safety,

especially with lack of regional readiness for any significant front door patient

flow alterations.

3. Summary of Agency Locums booked during February 2018






year 1 however CTUHB has developed trackers to monitor the spend across

the whole medical paybill, and not just the agency locum spend in isolation.

4.2 For February 2018 the target spend set by the Health Board for Agency Spend

has been achieved as per the table below (Excludes Primary Care).

The actions implemented by the Health Board are starting to be reflected; with

Agency spend down to 12.57% of the total medical expenditure.

The Health Board continues attempts to source cheaper agency locums and to

renegotiate all future rates down, as well as targeting permanent recruitment.

4.3 Although there is no Welsh Government reduction in expenditure target for

ADHs, we aim to track the impact of the rate reductions on a monthly basis


-

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

Nov-17 Dec-17 Jan-18 Feb-18

Actual Spend

Target Spend

Medical Agency Expenditure vs CT Target

2016/17 Ave/Mth Feb-18 Target Feb-18 Actual

Variance to target

£k £k £k £k

996 966 883 -83



The increase in ADH spend in February was primarily in ACT, Medicine,

CAMHS and Head & Neck Directorates. The majority of the increase in spend

has been due to ADHs not captured on directorate databases.

There were also ADHs in ACT that were over accrued (approx £14k) which will

be corrected in Month 12.

This highlights the importance of all directorates using the Redcap system for

all ADH requests. CTUHB are currently in the process of developing a

Financial Control Procedure which will address this issue once implemented.

An increase in spend in Head and Neck (£41k) relates to the backlog in

restorative dentistry being addressed in February.

4.4 There continue to be operational pressures in some directorates such as

Medicine, Pathology and ACT, therefore resulting in continued reliance on

Agency and ADHs.





worked or processed through payroll. It is clear that a number of claims are still

not being processed through the approval mechanism by the directorates .

5.2 Upon reviewing the data for December - February, it is clear that directorates

have failed to process the ADH bookings for a number of consultants and

specialty grade doctors via the Redcap database.




WLI or ADH. A separate financial control procedure for booking ADHs is under

development and will be submitted for approval at the April Audit Committee


2016/17 Ave/Mth

Nov-17 Actual

Dec-17 Actual

Jan-18 Actual

Feb-18 Actual

£k £k £k £k £k

395 606 517 486 688



6. Summary of agreed ADHs for January 2017 as recorded on Redcap

ADHs Planned

December 2017

January 2018

February 2018

Total number of assignments over cap

73 (24.55) 40 (31%) 34 (35%)

Total number of assignments below cap

225 (75.5%)

91 (69%) 63 (65%)

Overall Total 298 131 97

7. Data Collection Considerations

7.1 The data provided is a snapshot of agency locum bookings planned, as opposed to actual hours worked. There is concern therefore that whilst the report sets out projected bookings/spend above and below cap, there is the risk that bookings will be cancelled, rebooked, and potentially double counted the following month. Therefore the actual activity in month is not being recorded which will create a mismatch between worked and paid activity in the reporting mechanism.



8. The Welsh Health Circular requires Health Boards to provide anonymised data confirming the number of agency workers, including details about the number of hours/sessions they have delivered and their specialty. This data is broken down by reason for engagement, by specialty, by grade and by hospital location.

Summary by Reason

Reason For Job No of Individuals

No of Jobs Hours Worked

Hourly Charge Rate

Total Charge

Annual Leave 1 1 30.00 £62.11 £1,863

Deanary Gap 1 1 252.00 £69.74 £17,574

Maternity Leave 3 4 1,759.50 £101.68 £178,906

Other 5 5 142.00 £81.11 £11,518

Sick Leave 7 9 568.00 £108.90 £61,855

Study Leave 2 2 84.50 £75.79 £6,404

Vacant Post 38 91 7,061.50 £79.53 £561,601

Winter Pressures 1 1 12.00 £66.43 £797

Total 58 114 9,909.50 £80.66 £799,300

Summary by Specialty

Speciality No of Individuals


Hourly Charge Rate

Total Charge

Accident & Emergency 23 72 1,430.50 £79.98 £114,411

Adolescent/Child Psychiatry 1 5 30.50 £170.47 £5,199

Adult Psychiatry 3 3 532.50 £66.43 £35,374

General Medicine 2 2 349.00 £70.72 £24,681

General Surgery 3 5 2,602.50 £70.68 £183,934

Haematology 1 2 1,487.50 £106.11 £157,831

Obstetrics & Gynaecology 11 15 1,512.00 £68.49 £103,553

Paediatrics & Neonates 3 3 780.00 £56.65 £44,184

CAMHS 1 1 165.00 £107.40 £17,721

Histopathology 1 1 280.00 £156.00 £43,680

Trauma & Orthopaedics 4 4 740.00 £85.17 £63,026

Total 53 113 9,909.50 £94.37 £935,160



Summary by Grade

Grade No of Individuals


Hourly Charge Rate

Total Charge

Cons 5 10 2,045.50 £141.50 £289,438

SD 24 70 2,005.50 £81.05 £162,546

ST1 13 22 2,491.50 £70.00 £174,405

ST3+ 11 12 3,367.00 £70.31 £236,734

Total 53 114 9,909.50 £90.72 £898,990

Summary by Hospital location

Unit No of Individuals


Hourly Charge Rate

Total Charge

Prince Charles Hospital 18 32 6,113.50 £72.22 £441,517

Royal Glamorgan Hospital 33 76 3,600.50 £80.51 £289,876

St Davids Hospital 1 5 30.50 £170.47 £5,199

St Tydfils 1 1 165.00 £89.50 £14,768

53 114 9,909.50 £103.18 £1,022,462

The following data is an anonymised summary which sets out the expenditure made

to each of the ten highest paid (ie. those paid the highest hourly rate) agency

workers including details of the hours/shifts worked and their specialty. It also

confirms any individual paid more than £120 per hour. The in the March report, an

update will be provided on actions being taken to eradicate the top ten highest paid

and longest serving by specialty.

Top 10 Highest Paid (Total Pay)

Agency Reason For Job Speciality Grade Unit Total Hours

Hourly Charge

Rate

Total Pay

Medacs Healthcare

Vacant Post General Surgery ST3+ Prince Charles Hospital 2,340.00 £71.54 £167,403.60

Medacs Healthcare

Maternity Leave Haematology Cons Prince Charles Hospital 1,087.50 £125.00 £135,937.50

Pathology Group Vacant Post Histopathology Cons Royal Glamorgan Hospital

280.00 £156.00 £43,680.00

Medacs Healthcare

Maternity Leave Haematology Cons Prince Charles Hospital 400.00 £87.21 £34,884.00

Medacs Healthcare

Vacant Post Obstetrics & Gynaecology

ST1 Royal Glamorgan Hospital

525.00 £59.25 £31,106.25

Medacs Healthcare

Vacant Post Obstetrics & Gynaecology

ST1 Royal Glamorgan Hospital

494.00 £56.22 £27,772.68

Athona Maternity Leave Trauma &

Orthopaedics SD Prince Charles Hospital 224.00 £116.16

£26,019.84

Medacs Healthcare


ST3+ Prince Charles Hospital 360.00 £65.66 £23,637.60

Medacs Healthcare

Vacant Post General Medicine

SD Prince Charles Hospital 337.50 £66.44 £22,423.50



Top 10 Highest Paid (Hourly Charge Rate)

Agency Reason For Job Speciality Grade Unit Total Hours

Hourly Charge

Rate

Total Pay

Medacs Healthcare

Vacant Post Adolescent/Child Psychiatry

Cons St Davids Hospital 4.00 £170.47

£681.88

Pathology Group Vacant Post Histopathology Cons Royal Glamorgan Hospital

280.00 £156.00 £43,680.00

Medacs Healthcare

Maternity Leave Haematology Cons Prince Charles Hospital 1,087.50 £125.00 £135,937.50

Athona Maternity Leave Trauma &

Orthopaedics SD Prince Charles Hospital 224.00 £116.16

£26,019.84

RIG Vacant Post Accident & Emergency

SD Royal Glamorgan Hospital 199

£114.00 £22,686.00

RIG Vacant Post Accident & Emergency ST1


185.50 £114.00 £21,147.00

Total Assist Vacant Post Accident & Emergency SD


7.50 £114.00 £855.00

Total Assist Vacant Post Accident & Emergency

SD Royal Glamorgan Hospital 179.5

£111.60 £20,032.20

Total Assist Vacant Post Accident & Emergency

SD Royal Glamorgan Hospital 11.5

£111.60 £1,283.40

Merco Other Accident & Emergency SD


15.00 £107.98 £1,619.70

The following data is an anonymised summary of the ten longest serving agency

workers ie. those working for the longest consecutive period, including their

specialty, details of the hours/shifts worked and length of assignment.

Top 10 Longest Serving

Agency Reason For Job

Speciality Grade Total Hours

Hourly Charge

Rate

Total Pay

Length

Medacs Healthcare

Vacant Post Orthopaedics & Trauma


7,432.54 £65.34 £485,642 2 Years 3 Months

Medacs Healthcare



7,156.50 £56.65 £405,416 2 Years 3 Months

Medacs Healthcare



6,240.93 £74.85 £467,134 2 Years 3 Months

Medacs Healthcare

Sick Leave Adult Psychiatry Specialty Doctor 5,333.50 £66.43 £354,304 2 Years 2 Months

Interact Medical

Vacant Post Haematology Consultant 5,049.15 £124.19 £627,054 2 Years 2 Months

Medacs Healthcare



4,708.65 £73.87 £347,828 2 Years 5 Months

Medacs Healthcare

Vacant Post Adult Psychiatry Specialty Doctor 3,670.44 £65.70 £241,148 1 Year 4 Months

Medacs Healthcare



2,971.98 £63.50 £188,721 1 Year 6 Months

Pathology Group

Vacant Post Microbiology Consultant 2,925.00 £148.56 £434,538 2 Years

Medacs Healthcare



2,910.37 £77.26 £224,855 1 Year 11 Month




A key strategy to help reduce agency locum costs is to channel all agency supply

through Medacs managed service and their supply chain. This will also provide

assurance to the Health Board that all pre-employment checks (including mandatory

training) have been completed and that all engagements are adhering to IR35

compliance (PAYE or Limited status only). The most beneficial aspect of driving all

supply through the managed service is the VAT efficiency savings, even where

engagements are through the supply chain.

To date it has been challenging to eradicate off contract usage as agency locums in

some hard to fill specialties will favour agencies that allow umbrella status

engagements. Whilst the Health Board can refuse to offer shifts to such agencies

and umbrella status locums, there risk is significant that shifts in A&E, Pathology and

Surgery will not be filled, resulting in fragile rotas and unsafe levels of staffing.

As noted previously, Medacs are actively in discussion with the off-contract agencies

who have to date refused to supply locums through the managed service. Positive

meetings have been held with Merco and Interact however written confirmation of

their intent to form part of the supply chain is yet to be received. Discussions have

also been held with Athona however, due to the high volume of supply to date, there

is a reluctance for them to come on board. This matter is being dealt with through

the Medical Workforce Efficiency Group and a risk assessment has been undertaken

to consider withdrawal of all supply from Athona which is predominantly in Surgery

and A&E

Agency

Doctors On Call

Medacs Healthcare

Total Assist

RIG Locums

Athona

Interact

A&E Agency

Mediteam

Pulse

Pathology Group

Merco



9. The following tables set out the number of ADHs requested (internal ad hoc locum usage). The tables detail ADH requests under cap and over cap by reason, specialty, grade and location.

Requests Under Cap No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Vacancy (Non-Deanery) 7 26 503 46.92 23395

Vacancy (Deanery Gap in rota) 2 2 17 42.5 705



4 6 44.5 50.5 2172.35


Study Leave/Examinations 4 5 56 47 2640


Annual Leave 6 10 155 45.7 6817

Sickness 10 12 73.5 53.07 3934.92

Restricted Duties 10 14 124.5 48.1 5658.35

Jury Service



1 3 31 50 1550

ANP Cover

Target Provision

Staff Shortages 5 11 168 47.5 8000

Site Pressure

Health & Safety

Increased Capacity Need 1 1 5 60 300

No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Accident & Emergency 8 49 655 47.35 31130

Anaesthetics 15 28 197 51.92 9650.7

Dental

General Medicine * 3 4 56.5 48.01 2644.92


Paediatrics

Pathology

Psychiatry 2 2 20 40 800

Radiology

Surgical 6 9 316 44.67 14177



No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Foundation year 1 1 1 26 32 832

Foundation year 2


42.85 26266.85

Registrar (SP3+) 4 25 355.5 50.28 17834.92


Specialty Doctor / Staff Grade 5 9 81 49.5 3948


Consultant 11 21 152 51.85 7370.85

No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Princes Charles Hospital 15 47 729 50.41 34,123.00

Royal Glamorgan Hospital 19 41 424.5 49.07 19,969.62

Ysbyty Cwm Cynon 2 3 48 45 2160

ADH requests above Cap

Requests Above Cap No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Vacancy (Non-Deanery) 2 2 55 50 2750

Vacancy (Deanery Gap in rota)



3 9 37 135.49 5001.21


Study Leave/Examinations


Annual Leave

Sickness 1 1 4 138.92 555.69

Restricted Duties 12 27 193 95.73 15056.29

Jury Service



ANP Cover

Target Provision

Staff Shortages



Site Pressure

Health & Safety

Increased Capacity Need 1 1 4 138.92 555.69

No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Accident & Emergency

Anaesthetics 16 38 238 103.34 21168.88

Dental

General Medicine 1 1 12 50 600


Paediatrics

Pathology

Psychiatry

Radiology

Surgical 1 1 43 50 2150

No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Foundation year 1

Foundation year 2


52.5 8470

Registrar (SP3+)


Specialty Doctor / Staff Grade 6 12 66 131.05 1572.63


Consultant 7 13 68 126.11 7213.53

No of individuals

No of bookings

Hours worked

Avg hourly

rate

Total cost

Princes Charles Hospital 7 14 113 93.33 10941

Royal Glamorgan Hospital 11 26 180 69.31 12977.8

Ysbyty Cwm Cynon



Efficiency, Productivity and Value Board – 5th February 2018 – CONFIRMED P a g e | 1

Efficiency, Productivity and Value Board

Notes of the meeting held on 5th February 2018

Present: Allison Williams (AW), Craige Wilson (CW), Joanne Davies (JD), Kamal Asaad (KA), Kelechi Nhoaham (KN), Mark Thomas (MT), Rachel Marsh (RM), Robert Williams (RW), Ruth Alcolado (RA), Ruth Treharne (RT) and

Simon Wombwell (SW)

Apologies: Alan Lawrie (AL), Vijay Singh (VS), John Palmer (JP), Lynda Williams (LW)

In attendance: Susan McNamara and Heather Smith

Date Action

Recorded

Action Lead Update

1. PRELIMINARY MATTERS

1.2 To note and agree action log from meeting held on 18th December 2017

Feb 18 The action notes of the meeting held on 18th December 2017 were accepted as an accurate record.

-

Feb 18 Regarding the review of the T&O service (Page 4 – Unscheduled Care) it was noted that a clinical workshop would be held on 16th

February 2018. Consideration to be given to how this should be fed-back to EPVB.

RT /

RA -

2. KEY PERFORMANCE INDICATOR TRACKERS FOR THE PROGRAMME

Feb 18 All cross cutting themes required further work, particularly in relation

to confirmation of actions to be taken to deliver financial savings.

Consideration needed to be given to how the additional resources were used to ensure plans were as robust as possible.

ALL On agenda but progress remains slow.

2.1 Directorate Savings Tracker

Feb 18 The Directorate savings and cross cutting theme trackers were presented and discussed.

- -

Feb 18 Concern was raised about the Facilities position and further support was required to help deliver their plan. Feedback was required to ascertain whether the plan required further revision or additional

JP

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Efficiency, Productivity and Value Board Action Notes – 5th February 2018 – DRAFT P a g e | 2

Date Action

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Action Lead Update

support required to deliver the plan. Review position in Facilities CBM – how do we secure confidence in better delivery next year?

Feb 18 The current position and criticality of the next round of CBM’s was noted.

- -

2.2 Close-Down of Recovery Plan Process

Feb 18 The paper outlining the close-down of the recovery plan process for

2017/18 was noted. - -

2.3 Update on Cross Cutting Theme Targets and CRES 2018/19

Feb 18 Financial targets for 2018/19 were discussed including the CRES targets, risk-adjusted savings and the variance from target as at 31st

January 2018. It was noted that more traction was required relating to the cross cutting theme CRES.

ALL Work to apply KPI and financial data to cross cutting projects remains work in progress.

Feb 18 Updated plans should be received by exception for discussion at the next Executive Catch-up.

ALL No plans taken to Exec catch-up so far.

Feb 18 Invest to save was discussed and it was agreed that if this was a component of Directorate plans, clear understanding was required about where the investment and savings would be made.

ALL Agreed and will be part of planning process

Feb 18 It was agreed that the position would be shared with Executives on a two-weekly basis.

MT Updates for 14/2 and 28/2 completed. Risk abated plans remain below target mainly

due to slow progress of cross cutting themes.

3. CROSS CUTTING THEME UPDATES

3.1 Prevention and Improving VALUE from Healthcare

Feb 18 There was a lengthy discussion regarding INNU’s and whilst it was noted that the case note analysis should be completed within the next

few months, it was agreed that this timescale was too long.

The fundamental issue relating to INNU’s was whether it was capacity

or cash releasing and if potential savings were sufficient. Savings

KN

Exploration of the eight outlying INNUs has been undertaken. Cost savings have been

ruled out for six and they are thought to be unlikely for a seventh (varicose veins) but

may amount to £81,270 if realised. There

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should be identified by the end of February to determine whether alternative work-streams should be considered.

are potential cost savings of up to £198,135 attached to tonsillectomy and

further work around this INNU is recommended. It is still recommended that the INNU policy be updated and a

prospective monitoring system be put in place.

Feb 18 The population health management work would be awarded to Sollis which should be piloted by the end of February / beginning of March.

Potential financial savings would not be identified until the work had progressed further.

KN

Work is progressing well with this workstream: the contract was awarded to

Sollis in February 2018 and we are currently in the planning and GP recruitment stage. Phase I of the pilot is

still on track to be undertaken April-June. This will be followed by a period of

identifying effective interventions and implementing change, at which point potential cost savings can be estimated.

Feb 18 The national Evidence Based Procurement Board (EBPB) had been established but the final work-programme was unclear. Guidance

relating to hip prostheses had been released and this had been shared with the T&O Clinical Director. It was agreed that a process

would be put in place to take this work forward.

KN / PMO

Incorporating Hip & Knee Prioritisation

Tool, working with Lisa Williams, to take forward procedure guidance on hips.

Feb 18 Copies of EBPB papers would be forwarded to the PMO.

MT

Papers from Nov 17 EBPB forwarded to

PMO by Esther Price. To be discussed at next Value CCT Meeting.

Feb 18 The ICHOM work-stream was linked to a change in process / culture. It was suggested that work be undertaken to review outcomes of the in-sourcing work for cataracts. However, information was available

relating to those undertaken in 2017 and it was agreed that a conversation with clinical colleagues about anaesthesia would be

taken offline.

AW /

KA /

VS

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Action Lead Update

3.2 Integrated Unscheduled Care

Feb 18 The three work-streams proposed for 2018/19 were agreed as

follows:

1. Establishment of an Unscheduled Care dashboard

2. Stay Well @Home 2.0 3. Community Hospital Review

Dashboard being prepared by Info Team, 11 week project from 21 Feb concluding 9

May.

Feb 18 Stay Well@Home 2.0 relates to cost avoidance and a business case will be developed once Stay Well @Home 1 has been quantified and further resource requirements identified.

No specific actions agreed.

Feb 18 The Community Hospital Review was highlighted as the work-stream with greatest potential financial savings and there was

discussion regarding potential service model changes. A scope with clear objectives and timescales would be developed.

Consideration needed to be given to, for example, alternative staffing models within community hospitals and in-reach services into care homes.

AL/RT/

SW

Summary document outlining proposal on

agenda for feedback and sign-off.

Feb 18 Support for this theme was discussed and it was noted that the Business Support Manager to the Medical Director could be used as

a resource for this work-stream. It was also suggested that someone with experience in unscheduled care could be brought in

to review reports and benchmarking information to develop an evidence base and it was agreed that this would be progressed.

RT

Sue Beckman has been approached and

agreed to support.

Feb 18 Discussions were required with the Directorate Manager for Therapies to identify potential opportunities for Therapies relating to the community hospital model, and possible therapy led unit.

RT

3.3 Nursing Productivity

Feb 18 Due to operational issues there was no representative to present

the papers and it was agreed that this theme would be picked up off line.

AW Review meeting happened on 20th Feb. See

agreed actions below.

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Action Lead Update

Feb 18 It was felt that the benefits of the Enhanced Care Team (ECT) needed to be fully understood and the ECT paper would be taken

offline.

AW /

SW Agreed at 20 Feb meeting. See below.

Feb 18 20 Feb Meeting update:

1) Agreed for ECT to be rolled out with supports from Invest-to-Save Reserve.

2) Agreed to finalise detailed costings with Gareth H, Sue H on

18/19 premium cost reductions relating to sickness reduction and improved e-rostering

3) Plan required for “Other nursing savings”

LW

LW

LW

On agenda

Meeting on 8 March.

On agenda

3.4 Non-Pay

Feb 18 Highlight Report

It was forecast that the financial target would be significantly over-

achieved.

Feb 18 Risk was noted relating to the Pathology Managed Service Contract

but it was thought that issues relating to this would be resolved by the end of the week. Signature required from Allison.

AW

Feb 18 Plan on a Page

Capacity within the team was limited and therefore the cross cutting theme would focus on four specific areas for 2018/19 with

additional support provided to other areas of work when needed.

MT

Work has continued to develop plans to achieve £750k. On agenda.

3.5 Planned Care

Feb 18 There was no representative to present the papers and it was agreed that this theme would be picked up off line to include:

Priority order for actions Costing of opportunities (resource provided to support this)

AW / SW

Meeting held with Deb Lewis and Neil

Cooper (apologies from JP and Craige Wilson) on 20 Feb.

Feb 18 Regarding pre-operative assessment further clarity was required on whether the issue was the service model or a funding problem.

JP

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Action Lead Update

Feb 18 Actions for 20 Feb meeting:

1) Review dates on critical path as these have slipped

2) Increase clarity on the areas providing the major benefit to prioritise resource – requires costing to be completed

3) 2 weekly project meeting to be arranged to increase pace.

JP

JP

JP

JP to follow up progress with Deb Lewis &

Neil Cooper on actions agreed.

3.6 Medical Productivity

Feb 18 Further meetings were planned for job plan scrutiny. Links were being made between job planning and D&C planning.

KA/JD

Job Planning Assurance Committee met 6th March. Terms of reference agreed and monthly meetings have been scheduled to

assess compliance and quality of job plans. Quality indicators will include the

structure of a job plan to ensure activity is correctly coded to DCC/SPA, intensity banding, Measurable Objectives set, Lead

roles clearly identified, standardisation of tariffs for core duties.

Making links between the job plan and the D&C plans was discussed, but it was agreed that this should not be undertaken within

this work-stream as it duplicates work undertaken by the Planned Care work-

stream.

Feb 18 Consistency was required with the financial reporting. JD

Data being sourced through financial ledger

for KPI’s & dashboard.

Feb 18 There was some discussion regarding different roles including, for

example, consultant pharmacists, consultant therapists, etc and it was noted that a workshop was planned for March 2018 to consider the vacancy gaps driving agency usage and potential alternative

solutions.

JD

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4. OTHER MATTERS AND ITEMS FOR INFORMATION

4.1 Resource Requirements

Feb 18 The following resources were in place:

Sunny Adeusi supporting the Planned Care cross cutting

theme Jin Chahal supporting Deb Lewis on RTT (Jin has since left)

Ronald Jones undertaking financial modelling of the cross cutting themes

Feb 18 Analytical support was also required and options were being considered. SW

Unable to source suitable resources (three agencies consulted). Steve Haynes has been appointed part-time.

4.2 National Efficiency Board

Feb 18 Covered under 3.1 Prevention and Improving Value from Healthcare

cross cutting theme.

4.3 For information only

Feb 18 None

4.4 Date and Time of Next Meeting

Feb 18 Date of the next meeting was 13th March 2018 at 9am in the

Rhondda Room, YMH.

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Agenda item 6.1

Forward Look FP&W

Page 1 of 2 Finance, Performance & Workforce Committee Meeting 19 April 2018

Finance, Performance and Workforce Committee: Forward Look 2018/19

April 2018 1.00pm – YMH

To receive an update on the Financial Deep Dive into Pathology (now June 2018) John Palmer

To receive an annual update on Facilities Performance John Palmer

To receive an annual update on Estates & Energy Performance Ruth Treharne

To receive an update on Winter Pressures, lessons learnt and future plans – to include an update on Ambulance Performance and how the UHB was working with WAST to

improve systems

John Palmer/Stephen Harrhy

To receive an update report on Medical Agency Expenditure Joanna Davies

May 2018 1.00pm – YMH

Standard Items:

Finance Dashboard Steve Webster

Performance Dashboard Ruth Treharne

Workforce Dashboard Joanna Davies

To receive an update on the proposal in relation to the alignment and triangulation of

the performance, workforce and finance dashboards

Ruth Treharne/Mark

Thomas/Joanna Davies

June 2018 1.00pm – YMH

To receive a quarterly update on CAMHS Performance Alan Lawrie

To receive a quarterly update on the organisational risks assigned to the Committee Robert Williams

To receive a Clinical Efficiency Update report – Area to be Confirmed John Palmer/Kamal Asaad

To receive an update report on Follow Up Outpatients Not Booked John Palmer

To receive an update report on the Financial Deep Dives undertaken into Non Pay Expenditure

Steve Webster

To undertake scrutiny of the Demand & Capacity Plans for Ophthalmology (Glaucoma)

– Referred from Primary & Community Care Committee

Chief Operating Officer

To receive an update on Winter Pressures, lessons learnt and future plans – to include

an update on Ambulance Performance and how the UHB was working with WAST to improve systems

Chief Operating Officer

To receive an update on the Financial Deep Dive Undertaken into Pathology John Palmer

4.1 To review

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Agenda item 6.1

Forward Look FP&W

Page 2 of 2 Finance, Performance & Workforce Committee Meeting 19 April 2018

July 2018 1.00pm – YMH

Finance Dashboard Steve Webster

Performance Dashboard Ruth Treharne

Workforce Dashboard Jo Davies

2018/19

Detailed update on Delayed Transfers of Care – Operational Director (s) Committee Assigned Organisational Risks Quarterly Update - to be added to Forward Look for April 2018,

July 2018, October 2018, January 2019. Annual Report for 2017/2018 – to include Annual Self-Assessment and Updated Terms of Reference –

October 2017

To receive an update on Frequent Attenders – to be confirmed

NB - No meeting will be held

in August or December.

Urgent items will be accommodated as required

and the Forward Look is subject to change.

Quarterly items CAMHS Performance

Annual review of the Terms of Reference in line with the

Standing Orders – each October Principles

Anything that has improved for 3 months consecutively will be placed on the Agenda (Good news) for Info

Anything that has declined for 3 months consecutively will be placed on the Agenda (Improvement Plan)

Any area where we have DSU intervention will be reviewed at every meeting until intervention is

withdrawn

Dates for 2018

Thursday 19 April 2018 Thursday 24 May 2018

Thursday 21 June 2018

4.1 To review

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agenda attached

Documents