agenda · g/16/01/11 governor elections – the deadline for nominations was 1 february 2016....

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A Meeting of the Board of Governors of

Doncaster and Bassetlaw Hospitals NHS Foundation Trust (‘the Trust’) on

Tuesday 19 April 2016 at 6.00 pm at

Lecture Theatre, Education Centre, Doncaster Royal Infirmary

AGENDA

No Item Action Enclosures

1. Welcome and Apologies

Note (Verbal)

2. Declaration of Governors’ Interests Maria Dixon, Head of Corporate Affairs

Note Enclosure A

3. Minutes of the meeting held on 19 January 2016 Approve

Enclosure B

4. Matters Arising from the Minutes

Note

Enclosure C

5. Chairman’s Report and Correspondence Chris Scholey, Chair

Note

(Verbal)

EXECUTIVE REPORTS

6. Chief Executive’s Report Mike Pinkerton, Chief Executive

Note Enclosure D

7. Matters Arising from Board of Directors minutes All Governors

To take questions

Enclosure E

8. Finance Report Jeremy Cook, Interim Director of Finance

Discuss Enclosure F

9. Business Intelligence Report Richard Parker, Director of Nursing, Midwifery & Quality David Purdue, Chief Operating Officer Sewa Singh, Medical Director

To take questions

Enclosure G

10. People & OD Quarterly Report Ruth Cooper, Head of HR Services

To take questions

Enclosure H

11. Annual Plan Update Jeremy Cook, Interim Director of Finance Marie Purdue, Deputy Director Strategy & Improvement

Note Enclosure I

12. Strategy & Improvement Report Dawn Jarvis, Director of Strategy & Improvement

Discuss Enclosure J

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GOVERNANCE

13. Governor Appointments

Vice Chair

Lead Governor Chris Scholey, Chair

Approve

Enclosure K

SUB-COMMITTEES OF THE BOARD OF GOVERNORS

14. Minutes of the Agenda Planning meeting held on 4 March 2016

Note

Enclosure L

15. Minutes of the Appointments & Remuneration meeting held on 14 March 2016

Note Enclosure M

16. Minutes of the Communications, Engagement & Membership meeting held on 9 February 2016

Note

Enclosure N

17. Minutes of the Health and Care of Adults meeting held on 8 March 2016

Note

Enclosure O

18. Minutes of the Health and Care of Young People meeting held on 5 April 2016

Note

Enclosure P

MEMBERSHIP

19. Feedback from members All governors

Note

(Verbal)

GOVERNOR REPORTS

20. Governor reports from committees and other activities Finance Oversight Committee – Bev Marshall

All governors

Note

(Verbal)

INFORMATION ITEMS

21. Any Other Business Resolution : Members are invited to RESOLVE that the meeting of the Board of Governors be adjourned to take any informal questions relating to the business of the meeting. Chris Scholey, Chairman

Note

(Verbal)

22. Date of Next Meeting : Date: 30 June 2016 Time: 6 pm Venue: Lecture Theatre, Postgraduate Centre, Bassetlaw Hospital

Note (Verbal)

Register of Governors’ Interests as at 19 April 2016 The current details of Governors’ Interests held by the Trust are as follows: Ruth Allarton, Partner Governor School Governor, Tuxford Academy Parish Councillor, Weston Parish Dr Utpal Barua, Public Governor Retired member, British Medical Association Senior medical member, Court and Tribunal Services, Leeds Philip Beavers, Public Governor Judge, The Single Family Court Magistrate (and previously Chairman), Doncaster Bench

Independent Person under the Localism Act, Doncaster MBC; Rotherham MBC; & North

Yorkshire Fire and Rescue Service Shelley Brailsford, Public Governor Independent Custody Visitor, South Yorkshire Police and Crime Commissioner Volunteer, British Red Cross Charity Shop, Doncaster Hazel Brand, Public Governor Member, Bassetlaw District Council David Cuckson, Public Governor Justice of the Peace, Scunthorpe Member, Worksop 41 Club Vivek Desai, Staff Governor DBH Consultant Representative, BMA Trent Regional Consultant Committee Advisor and Negotiator, DBH Local Negotiating Committee Eddie Dobbs, Public Governor Councillor, DMBC Magistrate, Doncaster Nicola Hogarth, Public Governor Employee, BT Health (BT PLC) Peter Husselbee, Public Governor School Governor, Redlands School, Worksop Member, Rotary Club of Worksop Member, Worksop 41 Club Pat Knight, Partner Governor Member, Labour Party

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Chair, Doncaster Health and Wellbeing Board DMBC Cabinet Member for DMBC Public Health and Wellbeing Member, DN7 Community Food Bank Trustee, East Doncaster Development Trust Bev Marshall, Public Governor Member, Labour Party Governor, Hall Cross Academy Member, Yorkshire Ambulance Service NHS Trust Jackie Pederson, Partner Governor Employee and Representative of NHS Doncaster Clinical Commissioning Group Rupert Suckling, Partner Governor Director of Public Health, DMBC Non-executive Director, Doncaster Children’s Services Trust Trustee, Club Doncaster Foundation Clive Tattley, Partner Governor Member, Worksop Rotary Club The following have no relevant interests to declare: Mike Addenbrooke, Public Governor Oliver Bandmann, Partner Governor Dev Das, Public Governor Lynn Goy, Staff Governor Shahida Khalele, Staff Governor Susan Overend, Public Governor John Plant, Public Governor Patricia Ricketts, Public Governor Lorraine Robinson, Staff Governor Denise Strydom, Public Governor Roy Underwood, Staff Governor George Webb, Public Governor Maureen Young, Public Governor The following have not yet declared their interests: Dennis Benfold, Public Governor Lisa Bromley, Partner Governor Ainsley MacDonnell, Partner Governor Brenda Maslen, Public Governor Susan Shaw, Partner Governor Andrew Swift, Staff Governor Governors are requested to note the above and to declare any amendments as appropriate in order to keep the register up to date. Maria Dixon Head of Corporate Affairs

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Minutes of the meeting of the Board of Governors held on Tuesday 19 January 2016

Ivanhoe Centre, Gardens Lane, Conisbrough, DN12 3JX

Present: Apologies: Chairman Chris Scholey Public Governors Mike Addenbrooke Philip Beavers Utpal Barua Dennis Benfold Hazel Brand John Humphrey David Cuckson Howard Taylor Dev Das Eddie Dobbs Nicola Hogarth Peter Husselbee Bev Marshall Susan Overend John Plant Patricia Ricketts Denise Strydom George Webb Maureen Young Staff Governors Vivek Desai Shahida Khalele Lynn Goy Lorraine Robinson Andrew Swift Roy Underwood Partner Governors Ruth Allarton Oliver Bandmann Lisa Bromley Jackie Pederson Cllr Pat Knight Susan Shaw Dr Rupert Suckling Clive Tattley In Attendance: Alan Armstrong Non-executive Director Emma Bodley Head of Communications & Engagement Geraldine Broderick Non-executive Director Jeremy Cook Interim Director of Finance David Crowe Non-executive Director Maria Dixon Head of Corporate Affairs Dawn Jarvis Director of Strategy & Improvement Alison Luscombe Foundation Trust Office Coordinator Martin McAreavey Non-executive Director John Parker Non-executive Director Richard Parker Director of Nursing, Midwifery and Quality Mike Pinkerton Chief Executive David Purdue Chief Operating Officer

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Philippe Serna Non-executive Director Kate Sullivan Trust Minute Secretary Apologies: Sewa Singh Medical Director Public: 6 members of the public were in attendance

Action Welcome and apologies

G/16/01/1 Chris Scholey welcomed those present to the meeting, including Pat Knight, Ainsley MacDonnell and Rupert Suckling who were attending their first meeting. Apologies as recorded above were noted.

Declaration of governors’ interests

G/16/01/2 No changes were noted.

Minutes of the meeting held on 29 September 2015

G/16/01/3 The minutes of the meeting held on 29 September 2015 were APPROVED as a correct record of the meeting subject to following amendment:

G/16/01/4 G/05/04/24 – “with” to be removed.

Matters arising and action notes

G/16/01/5 Actions from the previous meetings were reviewed and updated. No further matters arising raised.

Chairman’s report and correspondence

G/16/01/6 Chris Scholey reported the following:

G/16/01/7 Financial position - Since the last meeting, the Trust had engaged KPMG to investigate the misreporting of the Trust’s financial position. KPMG’s work was now complete and the final report was awaited. Once received, governors would have the opportunity to meet with KPMG to discuss the investigation outcome.

MD/JC

G/16/01/8 December had shown a reduction in costs, and this was welcomed. A detailed cost savings plan was to be submitted to Monitor in February. It was agreed for CIP plans to be shared with Governors at the next timeout session.

DJ

G/16/01/9 If the month 9 position was extrapolated to the end of the year, revenue would be down by approximately £10m. This was in part due to a reduction in tariff and was a position shared by many other trusts. There would be a further reduction in tariff in 2016/17

G/16/01/10 A robust savings plan would enable access to Sustainability & Transformation funding, and this was being taken forward.

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G/16/01/11 Governor elections – The deadline for nominations was 1 February 2016.

G/16/01/12 Governor timeout – The next session would be held on 7 March 2016. The agenda included the 2016/17 annual plan.

The Chairman’s Report was NOTED.

Chief Executive’s Report

Mike Pinkerton presented the report, highlighting the following:

G/16/01/13 Performance overview – The 4hr access target had been achieved for Q2 and performance remained strong in December at 95.5%. In November, the Trust had been 33rd best in England out of 138 trusts, and had been the only Trust in South Yorkshire to achieve the target for Q2.

G/16/01/14 The new FDASS service and Unplanned Care Centre had commenced at DRI. The former was having a positive effect on streaming primary care patients away from the ED.

G/16/01/15 Cancer performance had been strong in September, RTT was compliant and there had been a significant improvement in stroke performance. Performance for HAPU, Falls and C.Diff all remained under trajectory and there had been continued improvement in HSMR.

G/16/01/16 Mike Pinkerton emphasised that although the Trust faced significant financial issues, performance was very strong in the context of other trusts.

G/16/01/17 Financial position – A detailed update on actions being taken was provided. Monitor was yet to reach its official judgement with regard to a breach of licence. This decision would be taken after the M9 position had been submitted.

G/16/01/18 Announcements had been made regarding the establishment of a strategy and improvement team to be led by Dawn Jarvis. Dawn Jarvis would, as Director of Strategy and Improvement, deliver comprehensive PMO support to CIP and longer term recovery plans as agreed by Monitor. The project management team would be strengthened and would be resourced to ensure its ability to deliver the work required.

G/16/01/19 It was important to continue to support staff and there would be continued communication and engagement with staff side.

G/16/01/20 Executive director recruitment – Interviews for a substantive Director of Finance were due to take place later in the month and the recruitment process for a Director of People and Organisational Development had commenced.

G/16/01/21 In response to a query from David Cuckson, Mike Pinkerton advised that

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the Director of Strategy and Improvement role was likely to be required long term, in order to strengthen long term strategic actions.

G/16/01/22 In response to a query from George Webb it was noted that the new Director of People & Organisational Development would not hold a vote on the Board of Directors and would not therefore need to be balanced out by the appointment of another non-executive director.

G/16/01/23 Parliamentary Health Service Ombudsman (PHSO) – In a recent report the Trust had been ranked 10th best out of 158 trusts for the number of complaints received by the PHSO in 2014/15.

G/16/01/24 GMC training survey – DBH had been rated 10th best nationally for F2 educational supervision. This was an excellent result and a significant improvement on the previous year.

G/16/01/25 Q2 Friends & Family Test – The Trust was 1st in the Yorkshire and Humber region for the ‘work’ question, with 77% of respondents stating that they would recommend the Trust to friends and family as a place to work.

G/16/01/26 Junior doctors – Junior doctors had undertaken industrial action on 12 January for 24 hours. This had been well managed by Trust staff and there had been no clinical incidents as a result of the strike action. However some activity had been lost and the financial impact of this was now being evaluated.

G/16/01/27 Vivek Desai asked whether the Trust had considered applying for part of the £1.8bn Sustainability and Transformation funding and this was discussed. The Board had only recently received the details of the funding and this was being considered. Trusts needed to meet strict conditions to access the funding, including performance conditions. The Trust would also need to demonstrate cost reduction to the maximum possible extent for the remainder of 2015/16.

The Chief Executive’s Report was NOTED.

Matters arising from the Board of Directors minutes

G/16/01/28 No matters were raised. The minutes of the Board of Directors meetings held on 25 August 2015, 22 September 2015, 27 October 2015 and 24 November 2015 were NOTED.

Finance Report

G/16/01/29 The papers included the M8 Financial Performance Report and Jeremy Cook provided a verbal update on the M9 position as follows:

G/16/01/30 Previously it had not been possible to provide assurance regarding the reliability of the reported financial position because a number of key control accounts and supplier statements had not been reconciled. This

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work had now been completed and the adjustments would be reflected in the M9 report to be taken to the Board of Directors later in January

G/16/01/31 The audited accounts for 2014/15 had been misstated. Adjustments totalling £15.3m had been identified to date, changing the reported 2014/15 position from a £1.6m surplus to a deficit of £13.6m. The external auditors had been briefed and an audit of the restated accounts would be required.

G/16/01/32 Financial overview – There was a £27.1m deficit to the end of month 9. This included an in month deficit of £6.1m for December and incorporated the impact of required adjustments. Work was underway to produce a forecast year end position which would be provided to the Board in February.

G/16/01/33 Expenditure - The run rate had reduced by approximately £0.6m in month, reflecting that control measures were now taking effect. The reduction was primarily due to a reduction in the use of agency staff.

G/16/01/34 Cash – Significant cash problems had been experienced due to the deficit and it had previously been reported that this had been managed by stretching the payment terms for creditors. The creditor position had now been addressed but external cash support would be required during 2015/16 and beyond. Details of the temporary working capital facility secured through Monitor were provided, along with an overview of the level of loans that would be required to support the cash position for the remainder of 2015/16.

G/16/01/35 Due to the financial pressures, it had been necessary to review the capital plan. The Trust’s ability to invest in capital would be severely restricted.

G/16/01/36 David Cuckson asked for assurance that future plans would be realistic. Jeremy Cook advised that there had been a number of deficiencies in the 2015/16 plan and he gave assurance that a realistic deliverable plan would be developed for 2016/17.

G/16/01/37 Hazel Brand asked for assurance that plans were in place to address all identified issues. This was being taken forward by Dawn Jarvis and work was underway to ensure that sufficient resources were in place to undertake the work required.

G/16/01/38 CIP – CIP plans would be presented to governors at a future date and would be taken through the Financial Oversight Committee.

G/16/01/39 Chris Scholey highlighted the costs associated with 7 day working and increased nurse staffing, and commented that it was important that the Trust continued to focus on quality and that the improvements that had been seen in many areas continued. All savings plans would be signed off by the Medical Director and Director of Nursing, Midwifery & Quality.

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G/16/01/40 In response to several queries, Dawn Jarvis provided an overview of how

the ‘grip and control’ work was being taken forward. It was noted that Dawn Jarvis would be assisted by external support, as agreed with Monitor.

G/16/01/41 Fred and Ann Green Legacy – John Plant expressed concern about the decision to use the legacy to support the Trust’s ophthalmology development. He commented that this was an inappropriate use of the legacy as it was essential work. He emphasised that the legacy advisory committee fully supported the project, which would be of significant benefit to patients, but stated that he felt strongly that the funds were being used to bridge a financial gap which was the responsibility of the government. This view was supported by several governors and the matter was discussed at length.

G/16/01/42 Jeremy Cook reiterated that the ability of the Trust to invest in capital would be severely restricted. This meant that the Trust needed consider alternative routes to fund capital projects. He undertook to take this away and consider alternatives where possible.

JC

G/16/01/43 Mike Pinkerton stated that charitable funds were there to provide what the NHS could not but he acknowledged the concerns expressed and undertook to reflect on the points raised and report back at a later date.

MP

G/16/01/44 David Cuckson requested that the balance sheet report included some narrative in future, and this was agreed.

JC

G/16/01/45 Maureen Young asked for assurance that cost improvement plans would not impact on the quality of products used, such as prostheses, and this was discussed. Richard Parker advised that the Trust would continue to source the best quality products at the lowest possible price. Richard Parker and Sewa Singh signed off all plans and clinicians and nurses were be engaged in setting quality standards. Pat Knight stated that patient needs should also be taken in to consideration, and it was agreed to consider how patients were involved in these decisions in the future.

G/16/01/46 In response to similar concerns raised by Clive Tattley, David Crowe stated that maintaining quality and standards of patient care was a key concern and area of scrutiny for the non-executive directors.

G/16/01/47 Utpal Barua noted that a recent news report suggested that there was an overall surplus of doctors and he asked for an explanation of this. David Purdue advised that some wards only appeared to be overstaffed because additional beds had been opened in those areas, and confirmed that the Trust did not have a surplus of medical staff.

The Finance Report was NOTED.

Business Intelligence Report

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G/16/01/48 David Purdue, and Richard Parker presented the report and drew attention to the following:

G/16/01/49 ED 4hr access target – Q3 had been achieved. The Trust has been asked to achieve 20% bed capacity by Christmas Eve and this had been achieved at DRI and Bassetlaw. This had significantly helped with patient flow over the Christmas period. David Purdue thanked local healthcare partners for their support to achieve this.

G/16/01/50 In response to a query from Mike Addenbrooke it was agreed to consider providing more detailed information on stroke and ED 4hr access times in future reports. David Purdue advised that the Trust was very stringent about recording target achievement, if a patient waited 4hrs and 1 minute in the ED this was recorded as a fail. The Trust would look at how other trusts in the region were recording this information

G/16/01/51 Ambulance handover times - Mike Addenbrooke noted that although performance targets for ambulance handover times were shown to be red, this had improved significantly since September 2015.

G/16/01/52 CaMIS - new Patient Administration System – The system had gone live in November and had been working very well in terms of reporting and income. However, there had been some issues relating to medical records and bookings. In response to concerns raised by Clive Tattley, David Purdue provided an overview and gave assurance that action plans to address the issues had been put in place. An update on the CaMIS implementation would be provided at the next governor timeout.

DP

G/16/01/53 DNAs – Vivek Desai suggested that the Trust should consider setting internal benchmarks for DNA rates and hospital cancellation rates. David Purdue undertook to take this forward.

DP

G/16/01/54 Cancer – All targets had been achieved, with the exception of the 62 day target.

G/16/01/55 Stroke – In response to a query from Utpal Barua, David Purdue advised that the Trust did not provide neurology services and therefore had not applied for funding that had been made available for this. Rupert Suckling highlighted that a lot of strokes were preventable and the healthcare community should be doing all it could to help prevent stroke. It was noted that, in terms of outcomes for stroke patients, the Trust was one of the best performing trusts in the region.

G/16/01/56 Safety & quality – The quality report had not been included in the papers and would be circulated outside of the meeting. A verbal update was provided, reporting that C.Diff performance remained below trajectory at 33% better than performance at the same time the previous year. There had been a significant improvement in HAPU performance, with 49.4% fewer cases than at the same time the previous year. Falls were under trajectory and on track to meet the annual target.

MD

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G/16/01/57 Complaints – There had been a slight increase in the level of complaints,

but there had been a significant improvement in response rates.

G/16/01/58 Friends and Family Test – Emergency Department response rates remained a key concern, and work had been undertaken to increase the availability of response cards in the FDASS.

G/16/01/59 HSMR – The rolling 12 month HSMR was 101.27, showing sustained improvement.

G/16/01/60 SIs – Despite increased incident reporting overall, the number of SIs continued to be below the level reported at the same time in the previous year. This reflected an improvement in openness and transparency.

The Business Intelligence Report was NOTED.

People and Organisational Development Report

Dawn Jarvis presented the Q2 report and highlighted the following:

G/16/01/61 Absence and wellbeing – 3.79% in December.

G/16/01/62 Turnover – The Trust was now able to monitor voluntary turnover which stood at a rolling figure of approximately 7.5%.

G/16/01/63 Staff Survey engagement – The most recent staff survey results were currently under embargo, and would be shared with governors at a future date.

G/16/01/64 Appraisals – The appraisal rate stood at 80%, a significant improvement since 2012 when appraisal rates had stood at 20%.

G/16/01/65 Training – A similar project to that undertaken to improve appraisal rates was now being taken forward with regard to training, and there had been early signs of improvement in training rates.

G/16/01/66 Vacancy rates – Jeremy Cook and Dawn Jarvis would work to align information reported in the People and Organisational Report with the Finance Report.

G/16/01/67 In response to a query from Ruth Allarton about when the final report would be available from the Health Education England Multi-disciplinary Review, Dawn Jarvis advised that the report had been received and the Trust was currently responding to points of factual accuracy. It was agreed to consider Alasdair Strachan presenting the report at a future timeout session.

DJ

The People & Organisational Development Report was NOTED.

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CQC Report

G/16/01/68 Richard Parker presented the report, which provided a detailed briefing on actions planned following the CQC inspection and an overview of the action plan. There had been a meeting in January with the local CQC inspection team to discuss the action plan and no specific concerns had been raised.

G/16/01/69 In response to a query from David Cuckson, Richard Parker clarified that action 97, to ensure medical staff had appropriate intensive care qualifications, was an action to drive improvements in quality and related to specialised training for anaesthetists.

G/16/01/70 In response concern raised by Utpal Barua with regard to some of the target dates, Richard Parker advised that the Trust had completed all actions it had been required to take within agreed timeframes. Progress had been fed back to the CQC and no concerns had been raised.

The CQC Report was NOTED.

Chair appointment: Job Description & Person Specification

G/16/01/71 Geraldine Broderick presented the Chair Job Description & Person Specification and this was APPROVED.

[Geraldine Broderick and John Parker left the room]

Non-executive Director Appointments

G/16/01/72 Chris Scholey presented the paper, which sought Board of Governor’s approval for the re-appointment of Geraldine Broderick and John Parker as non-executive directors for terms of office of two years commencing 1 April 2016 and this was APPROVED.

[Geraldine Broderick and John Parker rejoined the meeting]

Vice-Chair Appointment

G/16/01/73 It was reported that George Webb would come to the end of his term of office as vice-chair on 31 March 2016. Nominations had been sought but there were currently no eligible nominees. The Board of Governors therefor needed to consider a way forward.

G/16/01/74 This had been raised at the Board of Governors pre-meeting where it had been proposed that the role of vice-chair and lead governor be split into two roles, and this was discussed.

G/16/01/75 It was AGREED to split the role of lead governor and vice-chair. Role descriptions would be circulated outside of the meeting. Appointments to these positions would be deferred until the meeting due to be held on 19 April 2016. It was proposed that George Webb continue as vice-chair until this time and this was APPROVED.

MD

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Governance processes

G/16/01/76 Maria Dixon presented the paper, which provided governors with information to enable them to consider what improvements could be made to governance processes. This had stemmed from governor timeout during which governors had asked whether, in light of the Trust’s financial position, any improvements could be made.

G/16/01/77 Key areas of focus included holding NEDs to account, the appointment and removal of external auditors, assurance and processes for governors to feed back issues to the wider governing body.

G/16/01/78 This was discussed and it was noted that the ongoing KPMG investigation in to the Trust’s financial position would highlight any relevant governance issues.

G/16/01/79 It was agreed for actions regarding ‘holding to account’ processes to be taken forward and for the matter to be discussed in more detail once the final KPMG report was available.

NEDs

Governance processes were DISCUSSED.

Agenda Planning Group minutes

G/16/01/80 The minutes of the Agenda Planning Meeting held on 27 November 2015 were NOTED.

Health and Care of Adults Committee minutes

G/16/01/81 The minutes of the Health and Care of Adults Committee meeting held on 1 December 2015 were NOTED.

Health and Care of Young People Committee minutes

G/16/01/82 Maureen Young raised concern about the level of attendance at the meeting. This had resulted in the last two meetings not being quorate and if the lack of engagement continued the committee would no longer to be able to function effectively.

G/16/01/83 She added that presenters often chose to provide verbal reports to the committee and due to this members did not always have the opportunity to prepare considered questions. It was agreed to stress to presenters the requirement for papers to be circulated in advance of the meeting wherever possible.

MD

G/16/01/84 After further discussion it was agreed to review of sub-committee membership in April, after new governors had been appointed, as part of the process to replace those who had retired or stepped down.

Govs

G/16/01/85 The minutes of the Health and Care of Young People Committee meeting held on 15 September 2015 and 14 December 2015 were NOTED.

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Feedback from members

G/16/01/86 Hazel Brand asked if the proposed Bassetlaw Hospital site development plan was still expected to go ahead. Mike Pinkerton advised that the Trust could not proceed with discretionary capital developments until it was in a better financial position, and this included the Bassetlaw site development plans. The Trust needed to explore outside opportunities and potential support from partners.

G/16/01/87 Hazel Brand raised concern about staff and patients parking in residential areas near Bassetlaw Hospital. Richard Parker advised the Trust was looking at car parking issues, including parking rates and regulations and work was underway to take this forward.

G/16/01/88 Maureen Young commented that some information on the Trust website was out of date. Emma Bodley undertook to look into this and address any issues.

EB

G/16/01/89 Pat Ricketts advised that a patient had received two hospital appointments on the same day at the same time. David Purdue undertook to look in to the matter outside of the meeting.

DP

Governor reports

G/16/01/90 Patient Experience Committee – David Cuckson commended the work of the patient experience committee, particularly with regard to reports received about dealing with complaints, which had been very useful.

Any other business

G/16/01/91 Communications – George Webb raised concern that members had not received an update on the Trust’s financial position since early December 2015 and stated that the Trust had an obligation to communicate with members. Mike Pinkerton reported that an update would be provided once the KPMG investigation report had been received. It was agreed that the level of communication regarding the financial position would be reviewed.

EB/MP

Any other business

G/16/01/92 In response to concerns raised by Pat Ricketts, Richard Parker undertook to feedback to Heads of Nursing clarifying advice to wards regarding carrying out all audits on the same day.

RP

Member questions

G/16/01/93 Mr Sprakes stated that he had experienced difficulty on several occasions getting through to the eye clinic at DRI to rearrange an appointment. He had also experienced problems claiming travel expenses; amongst other things the cashiers office had not been open on the day of the clinic (Saturday) which had meant he had to return to the hospital. Travel expenses claim forms had not been available in the

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clinic and there had not been anyone available to assist him completing the form. David Purdue undertook to look into this outside of the meeting.

DP

G/16/01/94 In response to a query from Mr Sprakes, Chris Scholey advised that governors meeting with KPMG would be held in private.

G/16/01/95 Mr Sprakes asked who would sit on the new Financial Oversight Committee. It was reported that the committee was chaired by John Parker and the membership included two other non-executive directors. The Interim Director of Finance, Director of Strategy & Improvement and a Governor Observer were also in attendance.

G/16/01/96 Mr Sprakes asked for assurance that the financial misreporting issues that had been uncovered went back no more than two years. He also asked how it had been possible for financial issues not to have come to light sooner, given the assurance from sub-committees of the Board and the external auditors. George Webb echoed this. Chris Scholey advised that KPMG had been considering these questions as part of their investigation.

Date and time of the next meeting:

G/16/01/97 .

Date: Time: Location:

Tuesday, 19 April 2015 6pm Lecture Theatre, Doncaster Royal Infirmary

Date of next Meeting: 19 April 2016

Action Notes prepared by: Maria Dixon

Circulation: Chair, Governors, NEDs, EDs

Action Notes

Meeting: Board of Governors

Date of meeting: 19 January 2016

Location: Ivanhoe Centre, Conisbrough

No. Minute No Action Responsibility Target Date

1. G/15/06/12 National policy agenda update at future timeout session.

MP Timeout Mar / Jun 2016

2. G/15/09/34 BIR / RTT reporting - Consider including the number of patients who had not been seen within the target times alongside the percentages.

DP

3. G/16/01/7

Schedule meeting for KPMG to report to governors regarding investigation outcome, and for discussion regarding relevant governance processes.

MD / JC February 2016

4. G/16/01/8

Present CIPs to governors. DJ Timeout March 2016

5. G/16/01/42 G/16/01/43

Look into whether other charitable funds may be used to fund ophthalmology business case, and report back to governors.

JC MP

BoG April 2016

6. G/16/01/44

Provide explanatory notes to go with balance sheets in finance reports

JC BoG April 2016 onwards

7. G/16/01/52

Provide update on CaMIS implementation and impact on appointments, medical records etc.

DP Timeout March 2016





8. G/16/01/56

Circulate quality section of business intelligence report.

MD Immediate

9. G/16/01/67 Consider reporting outcomes of Health Education England Multi-disciplinary Review at a future timeout session.

DJ Timeout

10. G/16/01/75

Split vice-chair and lead governor role descriptions, and circulate.

Schedule election of vice-chair and lead governor for next meeting.

MD Immediate

BoG April 2016

11. G/16/01/79

Take forward proposed actions regarding ‘holding to account’ processes.

NEDs Immediate

12. G/16/01/83

Ensure presenters at sub-committees provide a written paper in advance of meetings where possible

MD Ongoing

13. G/16/01/84

Review sub-committee memberships. Govs Timeout Mar / Jun 2016

14. G/16/01/88

Consider way forward with regard to improving the Trust website.

EB Immediate

15. G/16/01/91 Review frequency of communication with staff and members regarding financial position.

MP / EB

Immediate

16. G/16/01/89 G/16/01/93

Member queries:

Follow up member query regarding appointment booking systems (via Pat Ricketts)

Follow up member query regarding eye clinic appointment booking etc. (Mr Sprakes)

DP Immediate





17. G/16/01/92

Feedback to HoNs regarding communication to wards regarding carrying out all audits on the same day.

RP Immediate

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Chief Executive’s Report 19th April 2016

Executive Summary

The last three months have been very difficult in many ways, as the Organization has learned in outline of the events surrounding the financial misreporting over two years, as Monitor has concluded its investigation and specified the nature of the license breach and its consequences and as we have moved to start to turnaround the financial position, which has necessitated quick and challenging decisions.

However, as we turn the financial year end and look forward to our future, we now have a clear and achievable plan for next year shared with Monitor, our Partners, our Governors and Staff. That plan is based on a financial framework and balance sheet that is as clean and as clear as it is possible to be. As we start to deliver that plan, we must also consider in detail the plan for the 17/18 financial year and also our longer term five year financial plan. In parallel with that, we must also play our part in the sustainability and transformation plans (STP) of the Bassetlaw and Doncaster “Places” and also more visibly from a national perspective, the Working Together “Footprint” as one of 44 STPs making up the overall plan for NHS England. Alongside that, we must also continue to play our part in the Acute Care Vanguard. So overall, a crowded planning environment and one in which the current organizational focus is moving for the first time in decades to a whole system approach, yet our accountabilities remain primarily at an organizational level. Another way of looking at things is that we will over the period move from shorter term tactical measure to longer term review of services and where they are delivered from, as Lord Carter and others point to more structural reasons for parts of the deficit in this and other acute NHS organizations.

However, finance is only one of the areas where the organization has to deliver for its patients. We are here primarily to provide safe and effective care and in these areas the performance of the Trust has been strong over the last year, with the majority of quality and performance targets achieved or outperformed and 15/16 will also be remembered as the year the Trust for the first time delivered a sub 100 mortality level for our public, which includes communities with some of England’s highest rates of deprivation and morbidity and hence reliance on local health and social care services. Other organizations will in future be obliged to support areas where we already invested in strong services, such as seven day care.

So in summary, it’s not finance or quality, it has to be both and many of the measures we will take to improve efficiency will also positively impact on quality overall and/or individual patient experience. Equally, we will ensure that relevant efficiency business cases are carefully assessed for impacts to quality and risks eliminated or mitigated to the maximum extent possible. Finally, we also need to continue to take care of our staff and bring them with us on the difficult journey to recovery and then emerging fitter and stronger for the future.

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Corporate Objectives

Objectives for the current year will be considered by the Board of Directors at the April meeting and will reflect the balance between finance and quality and performance alluded to above.

Performance Overview

The BIR and Finance reports for March 2016 were not available at the time of writing. A major performance headline in Q4 is always four hour wait. The top 30 Trusts in the country who achieved the target in the year to date including December are not subject to weekly monitoring and DBH is within the top 30 trusts, being 17th best out of 138 Trusts in England at that point. Increasing conversion rate to inpatient admissions is however one of a number of factors that have impacted on our ability to maintain the standard through Q4 which will be explained further in the BIR report. Our financial position is expected to outturn better than recent forecast, due to a combination of factors including reduced expenditure.

Turnaround

A detailed Buzz Special has been issued around the Organisation, setting out the key features and ambitions of the Turnaround approach, including some examples of early progress. This is a small part of a wider programme of engagement with staff both directly and indirectly, now it has a defined content. The Special also announced to the Organisation the net impact of the MARs scheme,

and ended with a thank you for staff suggestions that is helping to inform and develop the work streams.

Monitor

On Tuesday 1 March, Monitor announced the outcome of its investigation into the potential breach of license relating to finance and governance matters, reaching the conclusion that there had been a breach of license and therefore enforcement action to remedy the breach was in order. Monitor has decided to accept undertakings from the Trust under Section 106 of the Health and Social Care Act 2012 in the following areas:

Sustainability

Financial Governance

Distressed Financing and Sustainability and Transformation Fund

General

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In parallel, Monitor has added an additional license requirement under section 111 of the Act requiring the Trust as Licensee to ensure it has sufficient and effective Board, Management and Clinical Leadership capacity and capability as well as appropriate governance systems and process to enable it to address breaches of its license and comply with section 106 undertakings. Monitor will now also hold regular progress meetings with the Trust, the first of which was on 31 March 2016, where the visiting Monitor team also met directly with a number of Governors. KPMG Report On the day of publication of the Monitor investigation, the KPMG report was published on the Trust website. The aim was to be as open and transparent as possible, commensurate with protecting the confidentiality of individuals during the conduct of disciplinary processes, thereby necessitating a redaction for that purpose, undertaken by KPMG. Several well attended staff briefings have been held on all three sites to explain the KPMG conclusions and what the Trust is doing to respond to the recommendations. Following discussions regarding how the Board could provide further assurance to staff and governors that the reason for the redactions was accurate, it was agreed that the Staff Governors and the Governor Observer on the Financial Oversight Committee and TMC Chair would be offered opportunities in April to view the unredacted report for that verification. MARS Scheme As part of the Trust wide Turnaround projects programme the Board agreed to introduce a Mutually Agreed Resignation Scheme (MARS). MARS is a form of voluntary severance which enables individual employees, in agreement with the Trust, to choose to leave their employment voluntarily in return for a severance payment. This is designed to create vacancies in the Trust that can be filled with staff redeployed from other jobs or as a suitable alternative job for those at risk of redundancy or provide opportunities for posts to not be replaced following work redesign.

The scheme ran to March 2016 and although the majority of applicants were from staff in positions that could not be released (as is usual for such schemes) 29 posts were identified for release, which will see an overall pay cost reduction of £730K recurrent after allowing for a small investment in compensating staff, giving a return on investment of < 1 year.

NHS Improvement On 1 April 2016, NHS Improvement launched, bringing together Monitor, NHS TDA, the Patient Safety Team, the National Reporting and Learning System, the Advancing Change Team and the Intensive Support Teams. The Trust has responded to an invitation under NHSI cover to receive external support with its turnaround activities as part of a national programme. This is being centrally procured by NHSI with definition of the outcomes in April. Whilst the costs of this will be borne by the Trust, projects will be required to deliver a significant return on investment,

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GPs have referred an additional 2,700 (38%) patients to hospital with suspected cancer, which has led to an additional 555 people (26%) having their first treatment to battle the disease.

drawn from areas not currently included within Cost Improvement Plans, potentially accelerating savings. The Carter Report The long awaited Carter Report was published in February. Synopsis is as follows:

Focus of the Report is ‘Unwarranted Variation’ and moving to the ‘Model Hospital’.

Used benchmark data from 136 non-specialist Trusts

If NHS Trusts addressed unwarranted variations it would save the NHS £5bn by 2020

Report makes 15 recommendations, in rank order the areas of greatest opportunity for savings are:

o Clinical Workforce Optimisation £2bn o Estates & Facilities Management £1bn o Pharmacy & Medicines Management £0.8bn o Procurement £0.7bn o Corporate back office and admin £0.3bn o Diagnostics – path and radiology £0.2bn

NHS Improvement will be responsible for working with Trusts to achieve the savings

CQC will have additional criteria to assess Trusts performance on linked to Carter and NHS Improvement.

Cancer Improvement Plans and “Catch Cancer” Early Success

The Trust’s Cancer Improvement Plan, focused on improving performance on the 62 day pathway and its shared care element, received a Regional Tripartite Assurance Rating of ‘Assured’ on 18/01.

Doncaster CCG believe that 370 people are alive today who probably would not be, had there not been a major local focus on catching and treating cancer early. Overall the number of patients who have had their first treatment for cancer in Doncaster is now more than twice the national average (5.5%). This is an undoubted success in health outcome terms, but has placed operational and financial pressures on the local diagnostic and treatment services to deliver this significant additional capacity.

Award of JAG Accreditation for 2016 – Doncaster Royal Infirmary Following the successful submission of a satisfactory GRS census and the review of the Annual Report Card by the Endoscopy Unit at Doncaster Royal Infirmary, the Endoscopy Unit has met all of the requirements to be

awarded JAG Accreditation for 2016.

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Picker Inpatient Survey 2015

The Picker Institute includes 65 questions and the report shows the percentage of patients for each question who, by their responses, have indicated that this particular aspect of their care that could have been improved. Below is a summary outlining whether the Trusts scores have improved since the 2014 survey and how the Trust compares with other Trusts. Overall, the position is positive in comparison to other trusts.

The follow up to all surveys of such nature is picked up by the Patient Experience Committee where the opportunity to improve highlighted by the survey will be examined, in particular the question highlighted above where the Trust has worsend significantly since the last survey. The Trust will shortly be piloting a new integrated and specifically trained team to provide “specialing” to patients, where the aim will be to provide a higher quality more consistent service at lower overall cost, and there is some reasonable prospect that this team will improve both care and perceptions of safety in ward environments. Maternity Services ‘Better Births – Improving outcomes of maternity services in England’ has recently been published. The review was led by Baroness Julia Cumberlege and set out the vision for maternity services across England to become safer, more personalised, kinder, professional and more family friendly. The Board may recall Baroness Cumberlege visited the Trust to open new birth pool facilities some months ago.

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The report will be considered by the Children and Families care group and our commissioners. We are in current discussion with local CCGs about how we can progress financial support for the CQC recommendations in terms of improving midwife to birth ratios. The Trust has been successful in securing funding of £25k from the Department of Health from the Preventing avoidable harm in maternity care - Capital Fund for Improving Resources to Assess Foetal Growth and Wellbeing during pregnancy and improving the perinatal morbidly and mortality for the population of Doncaster and Bassetlaw. The funds will be used to purchase new Cardiotocograph monitors Health Education Yorkshire & Humber – Multi-professional Quality Review Final Report The final report has been received following the inaugural Multi-professional Quality visit which took place on 10 November in the Education Centre at DRI. The Education and Training Department team and its leadership were highlighted for praise on several occasions during the interviews with learners and educators. The value placed on Education & Training is appreciated by both educators and learners and the fact that challenges raised are acted upon. The multiprofessional ethos is welcomed, but it is felt there are many further opportunities to capitalise on the progress made to widen participation. There was general agreement that the multiprofessional review was an additional catalyst for this. Annual Operational Plan 2016/2017 The Trust has submitted its annual operational plan for 16/17 on 8th February setting out our key actions and based on the core requirements associated with delivering the Control Total for 2016/2017 which the Trust will accept as a “budget” of £-27.1M. It is important to note that the Trust intends to exceed (do better than) the control total as a “target”, but equally it is important the target is informed bottom up with real schemes with clear timetables and appropriate risk assessment. Fire Improvement Notices Good progress has been made, as assessed by South Yorkshire Fire and Rescue Service, in terms of the post CQC report requirements for Montagu and DRI (Bassetlaw remains assessed as compliant). The DRI work in particular is complex to execute whilst maintaining access to critical and non-critical care and will be delivered in a planned programme over the next two years and provision has been made in the 16/17 capital plan.

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Friends & Family Test A huge thank you and congratulations to all staff involved in achieving excellent response rates, positivity and negativity of experience in the January FFT returns. Moira Hardy, Deputy Director Nursing & Quality has driven work to share learning across the Trust from those areas that had achieved the highest response rates.

Ward Friends and Family response rate %

Friends and Family positivity rate

Friends and Family unlikely to recommend

ITU DRI 57.1 100 0

Mallard 65 100 0

Gresley 62.1 100 0

16 114.6 100 0

CCU/C2 95 100 0

25 78.6 100 0

A2L 85.5 99.11 0

Training Feedback The overall placement satisfaction of students at the Trust in the Sheffield Hallam University student nurse feedback report was 97%, the most positive of all the SHU acute placements. This builds on a similar outcome last year and continues to develop the platform for our teaching and training quality to be formally recognized in the future. DBH Library Service – NHS Library QA Framework Compliance 2015 As part of the Trust’s Learning and Development Agreement (LDA) with Health Education England Yorkshire and the Humber, the library and knowledge service (LKS) is required to submit a moderated self-assessment against the national standards. The Trust’s library and knowledge service is 98% compliant with the national standards and therefore is rated as a green service. As the second best result in the Yorkshire and Humber Region (range 99 – 76%) it is a safe assumption that this is a top 10% national result in line with the Strategic Direction. The staff have been congratulated for their enduring achievement, building on similar results last year and previous, but now with a more rigorous assessment. Tour de Yorkshire 2016 - Otley to Doncaster 30 April 2016 The Tour de Yorkshire will be run again this year with the second stage finishing in Doncaster. This year there will be two races – the women’s race finishes at 13.00 or thereabouts, and the men’s race finishes around 18.00. The race falls on a Saturday, and also the Bank Holiday weekend. Each Care Group and Department have been asked to submit a statement of readiness to demonstrate assurance in preparation and planning for Stage 2 of the event which

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finishes in Doncaster, addressing those risks highlighted on the risk register, and any others identified by the Care Group/Department during the process. “Building on the Best” - Improve End of Life Hospital Care across the UK DBH has been selected as one of just 10 hospital trusts to take part in the ‘Building on the Best’ programme to support improvements in the quality and experience of palliative and end of life care across the UK. The programme is funded by Macmillan and supported by a partnership between the National

Council for Palliative Care, Macmillan, NHS England and the NHS TDA. Stacey Nutt, Lead Nurse for Cancer and End of Life Care, led our bid which acknowledges the Trust as one that delivers outstanding end of life care. We are looking forward to being part of this exciting work to transform end of life care, not only for our own patients, but also for the UK as a whole. DBH Palliative Care Services were highlighted recently in a national report as being of only 16 Trusts operating a seven day service as required by national care standards post the Liverpool Care Pathway withdrawal.

Merging oncology letters with Medisec The automatic merger of oncology letters from Weston Park Hospital with the Trust’s Medisec system has been successfully implemented. This is great news which will be will be invaluable from a clinical perspective and will have a real impact on administration and pathway validation time. This holds real potential for the future and could potentially be rolled out to other specialities. Genomic Medicine Centre (GMC). The Yorkshire and Humber region has been given NHS England approval to establish a Genomic Medicine Centre (GMC). The new centre, which will support with the delivery of the national 100,000 Genomes Project, is an opportunity to transform how we diagnose and treat patients. The successful bid was led by Sheffield Children’s NHS Foundation Trust, Sheffield Teaching Hospitals and Leeds Teaching Hospitals. It was supported by DBH and the other 10 acute trusts in the region along with the Yorkshire & Humber Academic Health Science Network and our major Universities. National Institute for Health Research (NIHR) Two of our Principal Investigators for research have received national recognition by the NIHR. Dr Chee Seng Yee, Consultant Rheumatologist and Mr Sanjeev Madan, Orthopaedic Surgeon are among a selected group of just 100 investigators nationally to have received a personal invitation from Dame Sally Davis, Chief Medical Officer for England to an event formally recognising their personal contributions to research.

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UK first for keyhole surgery that leaves virtually invisible scars

A DBH team at has performed the UKs first hernia repair surgery using a pioneering new technique that leaves virtually no scars for patients.

Called Micro-Incision Laparoscopic Surgery, it is the latest development in Laparoscopic ‘keyhole’ surgery which allows the surgeon to operate through tiny incisions or cuts in the abdomen, of less than 3mm; up to five times smaller than other standard keyhole surgery procedures.

Unlike traditional keyhole surgery, Mr. Balchandra and his team used specially developed ultra-thin instruments that do not need a ‘port’ to hold them in place during the operation.

Staff & Appointments Director of People and Organisational Development The appointment process run on 01/02/2016 was successful and Karen Barnard, currently Deputy Director of Human Resources at Sheffield Teaching Hospitals will start on 2 May 2016. Mr. Shahed Quraishi, Consultant Ear Nose and Throat (ENT) Surgeon has received a prestigious national award as a public acknowledgement of his expertise and high quality work. He is the first surgeon in Doncaster and the first ENT surgeon in South Yorkshire to receive the Silver National Award for Clinical Excellence, by the Advisory Committee on Clinical Excellence Awards. Further to this, Mr. Quraishi has now been elected as President at the Royal Society of Medicine, London, Head and Neck Section, a unique achievement for a non-teaching hospital Consultant.

Mike Pinkerton Chief Executive

Minutes of the meeting of the Board of Directors

held on Tuesday 22 December 2015

in the Boardroom, DRI

Present: Chris Scholey Chairman Alan Armstrong Non-executive Director Geraldine Broderick Non-executive Director Jeremy Cook Interim Director of Finance Dawn Jarvis Director of Strategy & Improvement Martin McAreavey Non-executive Director John Parker Non-executive Director Richard Parker Director of Nursing, Midwifery & Quality Mike Pinkerton Chief Executive David Purdue Chief Operating Officer Sewa Singh Medical Director In attendance: Emma Bodley Head of Communications & Engagement Maria Dixon Head of Corporate Affairs Kate Sullivan Corporate Secretariat Manager Dino Tedaldi Ophthalmology Service Manager [15/12/66 – 15/12/73] Public: Mike Addenbrooke Public Governor Hazel Brand Partner Governor ACTION

Apologies for absence

15/12/1 Apologies were received from David Crowe and Philippe Serna.

Register of directors’ interests and ‘Fit and Proper Person’ declarations

15/12/2 No amendments were noted.

Minutes of the meeting held on 24 November 2015

15/12/3 The minutes of the meeting held on 24 November 2015 were APPROVED as a correct record of the meeting, subject to the correction of 2 typographical corrections and the following amendments:

15/12/4 15/11/27 – “and the Trust had recommended KPMG” to be amended to “and KPMG had been identified as the preferred bidder”.

15/12/5 15/11/33 – “Recovery plans” to be amended to “Initial recovery plans”.

15/12/6 15/11/47 – “and this was discussed” to be replaced with “but that the ANCR committee had only received the summary report without the underlying detail. This was discussed.”

15/12/7 15/11/49 - “An experienced accountant had been appointed to lead on reconciling supplier statements and would commence in post on 30

November. The individual had significant experience implementing controls and troubleshooting in the NHS.” to be replaced with “An experienced accountant with significant experience implementing controls and troubleshooting in the NHS had been appointed to lead on reconciling supplier statements and would commence in post on 30 November.”

15/12/8 15/11/53 – “at site level” to be replaced with “at care group, specialty and site level”

15/12/9 15/11/67 – “SCFS” to be replaced with “FCMS”

15/12/10 15/11/69 – “for data accuracy following the validation exercise.” to be added to the last sentence.

15/12/11 15/11/73 – “for cancer” to be amended to “for early cancer”.

15/12/12 15/11/83 – “75%” to be amended to “25%”.

15/12/13 15/11/95 – “The Trust was” to be amended to “The Trust assessed the outcome as being”.

Actions from the previous minutes

15/12/14 The action notes from the meeting held on 24 November 2015 were reviewed and updated.

Matters arising

15/12/15 15/11/22 – In light of the misreporting of the Trust’s financial position it had been agreed that executives needed to seek additional assurance regarding reported information within their areas of responsibility. On behalf of David Crowe, John Parker requested further assurance in this regard and this was discussed in detail. It was noted that the Trust’s financial controls had been subject to internal audit and the financial position had been independently audited by external auditors. KPMG would make recommendations with regard to governance following conclusion of the investigation.

15/12/16 Sewa Singh advised that quality and performance reports were based on exported patient level data. The majority of this was externally analysed and/or audited by HSCIC, Dr Foster or other agencies. Data quality wheels had previously been provided in the business intelligence report, which indicated the level of assurance that could be taken from the data reported. It was resolved to provide clarification regarding which data presented to the Board was externally audited or validated.

DP, SS, RP, RC

15/12/17 15/11/44-45 - CaMIS – Geraldine Broderick reported that she was aware of significant issues relating to CaMIS, but that this had not been raised at Board. It was noted that issues had been reported in the Chief Executive’s Board report in previous months, and agreed that more information would be provided in future.

15/12/18 Martin McAreavey asked whether an action plan with timescales was in

place for CaMIS. David Purdue advised that 3 action plans were in place and provided an overview of the issues and plans to address them.

15/12/19 Martin McAreavey stated that it was important to get maximum feedback in order to take learning forward and Mike Pinkerton concurred. Clinicians had been asked to escalate any issues and had been reminded to manage ongoing risks. The CaMIS implementation would be subject to a 6-month post-implementation review and this would include lessons learned.

15/12/20 Richard Parker advised that some issues were due to the need for changes to ways of working rather than the system itself.

15/12/21 15/11/70 – Philippe Serna had raised a query outside of the meeting with regard to the reported increase in ENT referrals and how this triangulated to financial information. It was agreed to answer this outside the meeting.

DP/JC

Chairman’s correspondence

Chris Scholey reported the following:

15/12/22 Governor Timeout – Jeremy Cook’s report regarding the financial position had been well received and his clarity and grip of the situation had been appreciated.

15/12/23 Board of Governors – A governor election would commence on 4 January 2016. David Hamilton, Partner Governor, would be stepping down as he would be leaving DMBC. Chris Scholey expressed his appreciation for David Hamilton’s significant contribution, particularly his work on the Appointments and Remuneration Committee.

15/12/24 Trust Seal – A new process had been approved by the Audit and Non-clinical Risk Committee and was now in place.

15/12/25 Working Together Programme (WTP) – Chris Scholey had met with the Chairs of the WTP. The Chief Executive of Sheffield Teaching Hospitals would take over as Chair of the WTP Chief Executives Steering Group.

The Chairman’s correspondence was NOTED.


Mike Pinkerton presented the report.

15/12/26 KPMG investigation - John Parker noted that the Audit and Non-clinical Risk Committee had received the interim KPMG investigation report and Mike Pinkerton updated the board on the findings to date. The final report was expected in January following conclusion of interviews.

15/12/27 Working Together Vanguard – Business cases totalling just over £1m to

cover key agreed programmes for 2016/17 had been submitted.

15/12/28 Carter Report – The first draft of the Carter Report had been received. The report showed an adjusted treatment index of 0.91 for the Trust and a maximum best case savings opportunity of £13m. Next steps included validation of the report and a meeting with the Carter team to discuss the Trust’s initial response.

15/12/29 Acute Medical Unit DRI – Phase 2 of the unit had been completed and handed over to staff at the end of November. The patient environment and patient flow had been significantly improved.

15/12/30 Q2 Friends and Family Test – There had been some very positive results. The Trust had rated highest in the region in relation to the number of staff who would recommend the trust as a place to work.

15/12/31 Martin McAreavey suggested that the report should include a comparative response rate column. Dawn Jarvis advised that trusts had targeted different groups of staff so response rates were not comparable.

15/12/32 Educational investment – Health Education Yorkshire and the Humber (HEYH) had allocated £200k to the Trust for non-recurrent investment in education infrastructure and development. The Trust was developing proposals setting out how it intended to use the funding.

15/12/33 National Staff Survey – There had been a 2% improvement in the overall response rate against the previous year.

15/12/34 NHS Innovator of the Year – The board congratulated Rod Kersh, who had received the NHS Innovator of the Year award from the Leadership Academy for his work in improving patient care.

The Chief Executive’s Report was NOTED

Finance Report as at 30 November 2015

15/12/35 Jeremy Cook reported that work to reconcile control accounts and supplier statements was progressing well and the Trust was on track to report an accurate month 9 position and CIP. Until this work was complete, confidence in the reliability of the reported financial position was low. Work to provide a reliable forecast position was also on track. The report now included an aged creditor graph and balance sheet.

15/12/36 Financial overview – Performance was £20.5m behind the planned position and the deficit had increased by £3.5m during November.

15/12/37 Income – £0.961m behind plan. Outpatient performance continued to be below plan and the impact of the outpatient cap continued to contribute to income underperformance.

15/12/38 Expenditure - £20.688m above plan at month 8. The pay variance of

£5.467m continued to be a key concern as the deficit run rate was increasing. Pay overspends were primarily driven by medical expenditure pressures.

15/12/39 John Parker raised concern about the increase in run rate and queried the accuracy of this. Jeremy Cook advised that this would be better understood once an accurate position was available. In response to a query from Chris Scholey, Jeremy Cook advised that he was not aware of any carry-over of agency costs from previous months; reported figures related to month 8.

15/12/40 The pay variance was discussed and David Purdue provided an update on work being undertaken. Shifts had been taken out from the beginning of November and new processes for the authorisation of agency staff were in place. Chris Scholey noted that November had seen the highest ever nursing cost. Dawn Jarvis reported that since October there had been a reduction in demand and fill rates for agency nurses. She undertook to circulate information to illustrate this outside of the meeting.

DJ

15/12/41 Richard Parker noted that adhering to the restrictions placed on the use of nursing agency staff by Monitor could lead to significant pressure.

15/12/42 David Purdue stated that there was up to a 3-month lag in the Trust receiving invoices for some agency shifts and John Parker raised concern that costs were not being accurately reflected. The lag in invoicing and accuracy of the accruals was discussed. Agency shifts were accrued for, but Richard Parker commented that the rate to be accrued was not always known to the management accountants until the point of invoice. Jeremy Cook stated that there should not be a lag in accruals and work was needed to understand this.

JC

15/12/43 During further discussion, Dawn Jarvis advised that work was being undertaken to ensure that all agency rates were below the cap.

15/12/44 Further concern was raised with regard to the increase in run rate and this was discussed. CIP performance, vacancy rates, medical agency rates, the cost impact of replacing agency staff with substantive staff, and plans to change skill mix were discussed. Dawn Jarvis advised that cost savings projects were being evaluated. It was confirmed that work would be undertaken to analyse the run rate and establish why it had increased.

JC

15/12/45 Sewa Singh stated that in some areas over a third of clinical staff were non-substantive and this needed to be addressed. The solutions included changing the way services were delivered and would take time.

15/12/46 CIP – Performance remained disappointing, with the majority of schemes not delivering planned savings. John Parker expressed concern that the Trust would not achieve the level of savings expected by Monitor and this was discussed. Further information would be provided once work to validate savings plans and assess confidence levels was complete. Work

was underway to review every savings plan in detail. Resources had been put in place and an accurate position was expected by mid-January.

15/12/47 Capital expenditure - £10m at month 8 (£2.2m behind plan). Capital scheme commitments were higher than anticipated, and c. £5m higher than that previously reported. Executive leads had been asked to review what spend could be stopped. Issues relating to iHospital overspend were being addressed.

15/12/48 In response to a query from Alan Armstrong about the iHospital spend, Jeremy Cook and Dawn Jarvis advised that the position would be better understood in January. The Financial Oversight committee had agreed for capital commitments to be evaluated from the bottom up.

15/12/49 Cash – The supplier ‘watch list’ was up to date and over 200 local suppliers had been paid. Chris Scholey welcomed this. The business case to appoint KPMG to develop a cash forecast was expected to be approved by mid-January.

The Finance Report was REVIEWED and NOTED.

Business Intelligence Report as at 30 November 2015

15/12/50 David Purdue, Richard Parker and Sewa Singh presented the report. It was noted that some of the data reported on the ‘at a glance’ page of the report was incorrect; the correct data was shown elsewhere in the report.

15/12/51 ED 4hr access target – November attendance had been the highest for 4 years. Performance stood at 95.12% to date for Q3 and 95.18% for the year to date. With the exception of Sheffield Children’s Hospital, the Trust was the only Trust in South Yorkshire achieving the target for the quarter and year to date.

15/12/52 Ambulance handover times – There continued to be significant improvement following the delivery of the action plan.

15/12/53 RTT – The target had been achieved at 92.6%. Three specialties had failed the target, with key issues in ENT. An action plan was in place.

15/12/54 Cancer – With the exception of the 62 day wait target, all cancer targets had been achieved.

15/12/55 Chris Scholey noted that the number of target referrals received was circa 50% higher than the same month 2 years ago and he queried the income relating to this. David Purdue advised that income was received for all referrals.

15/12/56 Stroke – Over the past six months, the Acute Stroke Unit overall SSNAP level had moved from a D to a B, which was an exceptional achievement. This indicated that the Trust was one of the best performing trusts in the region for its quality of stroke services.

15/12/57 In response to a query from Martin McAreavey regarding performance

trajectory, it was agreed to provide more detailed information in future reports.

DP

15/12/58 DNA – In response to a query from Alan Armstrong, David Purdue advised that DNA rates were expected to improve once issues relating to the text message reminder service had been resolved.

15/12/59 Outpatient cancellation rate – Geraldine Broderick stated that it had been reported at the Patient Experience Committee that the implementation of CaMIS had impacted on the availability of patient notes for outpatient clinics and that this had resulted in some clinic cancellations. The issues were being addressed, including issues related to ways of working.

15/12/60 HSMR – Continued improvement in HSMR, with the rolling 12 month HSMR at 102.5 at the end of August. Crude mortality was also gradually improving.

15/12/61 Elective HSMR had deteriorated. A review of every elective death from April to October 2015 had been conducted and an overview of the findings was provided. All cases had been categorised as unavoidable. The deterioration was due to a combination of an increase in day cases and coding issues, and these were being addressed.

15/12/62 Fractured neck of femur – There had been gradual sustained improvement and best practice tariff had reached 80%. Sewa Singh commended the hard work of the team to achieve this.

15/12/63 SIs - There had been 7 SIs relating to care issues in November. All cases had been reviewed and no significant concerns had been raised; the final reports were awaited.

15/12/64 Quality – There had been continued good performance in most areas with the exception of falls, where performance was below trajectory but worse than at the same point last year. Performance for HAPUs remained significantly under trajectory, at 43% better than the same time last year.

15/12/65 Complaints and concerns – Response times continued to improve. Performance had stabilised at around 90 complaints received per month.

The Business Intelligence Report was REVIEWED and NOTED.

Ophthalmology Business Case

15/12/66 David Purdue and Dino Tedaldi presented the business case which set out the investment needed to enable sustainable delivery of contract ophthalmology activity.

15/12/67 The Board was asked to support the business case and endorse its submission to the Fred and Ann Green Legacy Committee (F&AGLC) for a

decision regarding funding. The business case had been supported by the Corporate Investment Committee and had been discussed at the Fred and Ann Green Legacy Advisory Group.

15/12/68 In the context of the Trust’s current financial position, it was not possible for the Trust to fund the proposals. Alan Armstrong advised that the Advisory Group had not supported the proposal for the legacy to fund the business case. This was discussed. Geraldine Broderick stated she felt that, under current financial circumstances, the case was in line with the spirit of the Fred and Ann Green will.

15/12/69 David Purdue advised that the business case was currently the Trust’s highest priority with regard to service delivery. The proposals covered the whole ophthalmology service across the Trust and would benefit patients. Dino Tedaldi gave an overview of environmental and patient experience issues, safety issues and workforce plans. He highlighted the limitations of the existing service model and outpatient department, noting that the continued use of locum staff and additional sessions was unsustainable.

15/12/70 In response to a query from Chris Scholey with regard to confidence levels in proposed savings, Jeremy Cook stated that confidence in the savings outlined in respect of additional sessions, outsourcing and locum costs was good. Mike Pinkerton stated that ability to recruit consultant staff would be considerably improved by the new development.

15/12/71 Sewa Singh stated that the funding would be transformational in terms of service change and this was echoed by Mike Pinkerton.

15/12/72 Alan Armstrong asked why the proposals had not been included in the capital plan. David Purdue advised that progress had been halted due to a delay developing the business case.

15/12/73 The ophthalmology business case was DISCUSSED and SUPPORTED. The Board SUPPORTED the submission of the case to the Fred and Ann Green Legacy Committee to seek funding.

Nursing Workforce Update

15/12/74 Richard Parker reported that overall planned versus actual hours worked in November had been 100%. This was very positive in the context of the national average fill rate, which was below 98%.

15/12/75 51 nurse staffing incidents had been reported during November, fifty of which were ‘no harm’ and one which reported low harm. HoN and Matron clinical and supervisory time targets had not been met for Children and Families in November. This had been due to annual leave.

15/12/76 The Trust continued to collate E-PANDA data; paediatric ward staffing requirements would be available to the Board in January 2016.

15/12/77 There would be continual monitoring of e-Roster efficiency, with quarterly

follow-up meetings and QAT.

15/12/78 Chris Scholey queried the variance between planned versus actual hours worked on Mallard ward and ward 17, which stood at 119% and 131% respectively. Richard Parker advised that additional beds had been opened on ward 17 and there had been increased costs on Mallard ward due to the need to ‘special’ patients. This was being reviewed. Chris Scholey stated that the Trust needed to ensure that patients were on the appropriate wards. It was agreed to circulate information regarding nursing costs, to enable an understanding of why costs had increased.

RP

The Nursing Workforce Update was DISCUSSED and NOTED.

Development of Turnaround Plans

15/12/79 Dawn Jarvis presented an update on the new Directorate of Strategy and Improvement and progress to develop and activate a turnaround plan.

15/12/80 Processes - Conventions for savings schemes, projects and approaches were inconsistent across the Trust, as were reporting methods. It was vital to work to trust-wide definitions and for reporting to be consistent across the whole Trust and action was underway to achieve this.

15/12/81 Governance – There would be a need for formal decision making forums escalating directly or indirectly to the board. Changes to governance and operational meetings were being considered to ensure pace, flexibility and speed of decision-making. The changes would be proposed to the board in January 2016.

DJ

15/12/82 Chris Scholey asked whether principles to be incorporated into CIPs had been discussed at the Financial Oversight Committee. Dawn Jarvis confirmed that she had discussed the proposals with Philippe Serna, audit committee chair.

15/12/83 Martin McAreavey asked how the board would link to the Directorate of Strategy and Improvement and this was discussed.

The Development of Turnaround Plans report was DISCUSSED and NOTED.

Register of Sealing

15/12/84 Maria Dixon presented the Register of Sealing, detailing sealing numbers 68, 69 and 70. The register was RECEIVED and NOTED

Board Assurance Framework

15/12/85 Maria Dixon presented the report, highlighting a summary of all recent audits reported to the Clinical Governance Oversight Committee and Audit and Non-clinical Risk Committee, none of which had identified any high risk issues. It had been agreed that the audit committee would receive full audit reports going forwards.

15/12/86 In light of the change in the Trust’s financial position, significant changes had been made to the assurance summary report.

15/12/87 The Board Assurance Framework was NOTED.

Minutes of the Management Board meeting held on 30 November 2015

15/12/88 The minutes of the Management Board meeting held on 30 November 2015 were NOTED.

Items for escalation from sub-committees

15/12/89 None raised.

Board of Directors and Board Briefing Agenda Calendars

15/12/90 The agenda calendars were NOTED.

Q2 Monitor Feedback

15/12/91 The Q2 Monitor Feedback was NOTED. Feedback from Monitor regarding the Trust’s breach of licence and any consequences or regulatory action to be taken was expected by mid-January.

Health and Wellbeing Board Decision Summary

15/12/92 The Health and Wellbeing Board Decision Summary was NOTED.

Any other business


Governor questions

15/12/94 Overseas nurse recruitment – Mike Addenbrooke asked whether the Trust had anticipated the difficulties regarding visas and changes to the English language test. Richard Parker advised that the Trust had no prior knowledge of these issues and provided an update on the current position. Face-to-face interviews had been conducted with each candidate to determine their English language competence; all of the candidates selected were considered to have appropriate language skills on that basis.

15/12/95 Switchboards – Mike Addenbrooke reported that a patient had experienced difficulty contacting the Trust on the telephone over several days. David Purdue undertook to investigate the matter. It was noted that other than this, the patient had experienced excellent service.

DP

15/12/96 Parking – In response to a query from Mike Addenbrooke regarding charging for the Park & Ride service, it was noted that this was being considered as part of the turnaround plans.

15/12/97 Patient Transport – Mike Addenbrooke reported that he was aware of cases where Medicars had arrived at the home of patient to take them to

Montagu Hospital for an appointment when they had not been requested. He noted that this was a waste of NHS funds. David Purdue undertook to investigate the matter.

DP

15/12/98 Ophthalmology - Hazel Brand endorsed the ophthalmology business case, commenting that the proposed work would also benefit patients of the Dearne Valley area.

Date and time of next meeting

15/12/99 It was confirmed that the next meeting of the Board of Directors would be held at 9am on Tuesday 26 January 2016 in the Boardroom at DRI.

………………………………………………… ………………………………………………

Chris Scholey Date Chairman


held on Tuesday 26 January 2016


Present: Chris Scholey Chairman Alan Armstrong Non-executive Director Geraldine Broderick Non-executive Director Jeremy Cook Interim Director of Finance David Crowe Non-executive Director Dawn Jarvis Director of People & Organisational Development Martin McAreavey Non-executive Director John Parker Non-executive Director Richard Parker Director of Nursing, Midwifery & Quality Mike Pinkerton Chief Executive David Purdue Chief Operating Officer Philippe Serna Non-executive Director Sewa Singh Medical Director In attendance: Emma Bodley Head of Communications & Engagement Maria Dixon Head of Corporate Affairs Kate Sullivan Corporate Secretariat Manager Public: Mike Addenbrooke Public Governor David Cuckson Public Governor Marie Fawcett Information Analyst Duncan Garratt Care Group Information Manager George Webb Public Governor ACTION


16/1/1 None



Minutes of the meeting held on 22 December 2015

16/1/3 The minutes of the meeting held on 22 December 2015 were APPROVED as a correct record of the meeting, subject to the correction of 2 typographical corrections and the following amendments:

16/1/4 15/12/15 – Final sentence to be amended to “It was noted that the Trust’s financial controls had been subject to internal audit and the financial position had been independently audited by external auditors. KPMG would make recommendations with regard to governance following conclusion of the investigation.”

16/1/5 15/12/22 – “and his clarity and grip of the situation had been appreciated”

to be added.

16/1/6 15/12/41 – To be replaced by “Richard Parker noted that adhering to the restrictions placed on the use of nursing agency staff by Monitor could lead to significant pressure.”

16/1/7 15/12/91 – “licence was” to be amended to “licence and any consequences or regulatory action to be taken was”.


16/1/8 The action notes from the meeting held on 22 December 2015 were reviewed and updated.

Matters arising

16/1/9 15/12/15 & 15/11/22 – David Crowe commented that there needed to be emphasis on what was to be learnt from the investigation in terms of ensuring the quality of audit processes going forwards, and this was discussed. It was noted that KPMG would be making recommendations with regard to governance, and the board would respond to these.



16/1/10 NHS Planning Guidance 2016/17 – 2020/21 – An update on access to Sustainability and Transformation funding would be provided in the part 2 meeting.

16/1/11 Non-Executive Directors – The Board of Governors had re-appointed Geraldine Broderick and John Parker as Non-executive Directors for a further two years.

16/1/12 Board of Governors – The Board of Governors had agreed to separate the roles of Lead Governor and Vice Chair and this was being taken forward.

16/1/13 Executive director recruitment - Interviews for a new Director of Finance had been cancelled and the Trust was considering a way forward. Recruitment plans would be paused to allow time to achieve greater stability in order to attract a large pool of candidates. Recruitment for a new Director of People & Organisational Development was underway and there were currently three candidates.

16/1/14 Turnaround – Arrangements were being made for non-executive directors to meet with Steve Swayne, Turnaround Director.

16/1/15 Governors – Rupert Suckling, DMBC Director of Public Health, had replaced David Hamilton as Partner Governor for DMBC. Chris Scholey expressed his appreciation for David Hamilton’s significant contribution during his time as a governor.

16/1/16 KPMG investigation – The final report was expected soon. A meeting had been scheduled to share the findings with governors on 12 February.




16/1/17 Performance – There had been positive progress in a number of areas, particularly in terms of the resilience of the emergency care system which had seen a significant number of attendances. In November the Trust had been ranked 33rd best out of 138 acute trusts for ED performance for type 1 attendances.

16/1/18 David Crowe stated that it was important to maintain momentum in terms of work needed to drive cost improvement and turnaround plans. He asked what was being done to counter the risk of complacency amongst staff, whether the Trust had followed up on cost saving ideas put forward by staff, and what was being done to focus local leaders. Mike Pinkerton stated that he had seen no sign of complacency amongst staff in this regard.

16/1/19 Executives had met with the top 100 managers on 25 January to report on events from October 2015 to present. Key messages had included the need for continued focus on grip and control plans and staff engagement. Departmental leaders were ready to push forward, and there would be ongoing communication with all staff, including further information following the final KPMG Report.

16/1/20 Mutually Agreed Resignation Scheme (MARS) – 153 applications had been received were being reviewed.

16/1/21 David Crowe asked for assurance that the Trust would not re-employ staff who had resigned through MARS and this was discussed. Dawn Jarvis advised that the terms of the scheme stated that staff would not be able to return to work for the Trust. They would also not be able to work for another Trust within 6 months.

16/1/22 NHS Planning Guidance 2016/17 – 2020/21 – The timetable for the submission of plans was noted.

16/1/23 JAG accreditation – The endoscopy unit at DRI had met the requirements to be awarded JAG Accreditation for 2016. The continued hard work of the endoscopy team to achieve this was commended.

16/1/24 Fire Improvement Notice – An appendix which provided a detailed update on ongoing fire improvement actions was attached to the report.

16/1/25 In response to queries from Chris Scholey and Alan Armstrong, Richard Parker provided an update on the expected overall cost of the fire

improvement actions and on the issues, including those relating to the lateral evacuation of the ICU. There was to be further discussion with the fire service and an update on this and the expenditure which the Trust was already committed to would be provided outside of the meeting. Regular reports were being provided to the Audit and Non-clinical Risk Committee and any issues would be escalated to the Board.

RP

16/1/26 Catch Cancer Early Success – GPs in Doncaster had referred an additional 2,700 patients to hospital with suspected cancer, which had led to an additional 555 having their first cancer treatment. Mike Pinkerton noted that this highlighted the positive outputs and outcomes of the increased referrals previously reported.

16/1/27 Health Education Yorkshire & Humber (HEE Y&H) – The final report had been received following the HEE Y&H Multi Professional Quality Visit. A number of good practices and achievements had been noted.

16/1/28 Mr Quraishi, ENT Consultant - The Board congratulated Mr Shahed Quraishi on the exceptional achievement of being the first ENT Surgeon in South Yorkshire to be awarded the prestigious Silver National Award for Clinical Excellence by the Clinical Excellence Awards Advisory Committee.

16/1/29 Corporate objectives – Martin McAreavey asked how the delivery of the objective to ensure that 90% of consultant job plans were agreed by Care Group Directors would be monitored. It was confirmed that this would be reported via the Financial Oversight Committee as part of the relevant workstream.

16/1/30 With regard to workforce planning, Martin McAreavey asked how the Trust would ensure that it retained the appropriate staff, and this was discussed. The objective was to develop a Trust wide workforce planning strategy and this work was underway.

16/1/31 In response to a query from Martin McAreavey, Dawn Jarvis provided an update on progress to deliver the iHospital Programme workstreams. There had been overspending in some areas. The executive team had reviewed each line of the programme; some areas were being reassessed and work would be done to support workstreams where there was no clear path for delivery. Progress would be reported through Financial Oversight Committee.

16/1/32 Dr Steve Kell was to step down as Chair of Bassetlaw CCG. Mike Pinkerton expressed his gratitude for Dr Kell’s extraordinary work and for his personal support; this was echoed by David Crowe. Stephen Eames, Chief Executive of The Mid Yorkshire Hospitals NHS Trust had taken up a new role as Chief Executive of North Cumbria University Hospitals NHS Trust.


Finance Report as at 31 December 2015

16/1/33 Two errors in the report were noted: column headers on table 1 should state M9 and not M10; and the graphs illustrating activity and income variance by CCG were incorrect. A replacement page had been tabled and Jeremy Cook confirmed that steps had been taken to ensure that reporting errors did not occur in future.

16/1/34 Work to reconcile key control accounts and supplier statements was now complete and the adjustments were reflected in the report. The audited accounts for 2014/15 had been misstated; adjustments totalling £15.2m had been identified, changing the reported 2014/15 position from a £1.6m surplus to a deficit of £13.6m. The external auditors had been briefed and a re-audit of the 2014/15 financial accounts would be required.

16/1/35 Financial overview – There was a £27.1m deficit to the end of month 9. This included an in month deficit for December of £6.1m and incorporated the impact of required adjustments.

16/1/36 Work was underway to produce a reliable forecast year end position. This would be provided in February. A bottom up approach would be taken, with each care group providing a forecast of costs. This would be triangulated with the top down forecast. This approach was endorsed.

16/1/37 Meetings were scheduled to agree nursing budgets for the following year. A zero based approach would be taken for setting 16/17 budgets and this was endorsed.

16/1/38 During further discussion, Geraldine Broderick requested that care groups present their budgets to the board in order to provide assurance regarding sign up to budgets. It was agreed that this would be considered.

DJ/JC

16/1/39 Income – NHS clinical income was underperforming by £327k for the year to date. This was mainly due to emergency activity.

16/1/40 In response to a query from Alan Armstrong, Jeremy Cook confirmed that there were opportunities in terms of the outpatient cap. A key issue was that not enough patients were being seen in primary care and work to ensure this was considered in relation to the 2016/17 contract was being taken forward.

16/1/41 Expenditure - £24.374m above plan for month 9. The run rate for expenditure had reduced by approximately £0.6m in month reflecting that control measures were now taking effect. In response to a query from Chris Scholey, it was noted that no assumptions would be made for the remainder of the year on this basis.

16/1/42 As in previous months, pay overspends of £6.459m in month had been primarily driven by medical expenditure and the use of non-substantive staff. Overspends largely related to non-elective services where agency staff had been used to cover gaps in rotas due to annual leave in December. Jeremy Cook and Sewa Singh had met to discuss this.

16/1/43 Martin McAreavey asked whether opportunities to reduce medical

overspends would be provided through the consultant job planning review. Sewa Singh stated that the review of consultant job planning was a key work stream for the Turnaround team. Steve Swayne had undertaken similar work at other trusts and would share learning from elsewhere.

16/1/44 CIP – It had previously been reported that the CIP target for 2015/16 was £14m. However, when included the carry forward of non-recurrent 2014/15 CIPs and duplicated schemes. The deliverable plans for 2015/16 had therefore been £8.8m, and this was discussed. The year-end forecast would assume that no further CIP schemes would be delivered; this approach was endorsed by Philippe Serna.

16/1/45 Further work would be undertaken to provide an explanation of the contributory factors relating to the non-delivery 2014/15 and 2015/16 CIP budgets, and reconciliations would be undertaken to ensure that the unallocated retracted budget agreed to the retracted budget less CIP.

16/1/46 David Crowe stated that greater and more reliable assurance regarding the deliverability and robustness of CIP plans was needed in future. This was discussed and it was noted that there had been key failings in the accounting processes which were now understood. Significant assurance had been provided by internal audit based on a 25% CIP plan sample and there were also lessons to be learnt from this.

16/1/47 Ways of providing greater assurance to the Board were discussed, and it was agreed to circulate the timetable for financial and delivery accountability meetings, to enable non-executive directors to attend and observe the meetings.

DJ

16/1/48 David Crowe asked what lessons the Trust had learnt and this was discussed. The Trust now understood the level of resourcing required to drive CIP plans, and action had been taken to address this. The Trust now had a dedicated Turnaround Director and turnaround team.

16/1/49 Creditors – The aged creditors graph illustrated a significant decrease in aged debt for both NHS and non-NHS creditors.

16/1/50 Capital expenditure - £3.5m behind plan at £10.8m. The variance was outside Monitor’s tolerance level but was an integral part of the Trust’s recovery plan.

16/1/51 Cash – £1.9m at month 9, £4.9m below plan.

16/1/52 As a result of the financial position, external cash support would be required during 2015/16 and beyond. Jeremy Cook provided details of the temporary working capital facility secured through Monitor.

16/1/53 Monitor had approved the business case for KPMG to support the

production of robust cash flow forecasts. This work would commence in January.

16/1/54 Restated income and expenditure – John Parker expressed concern that, following the introduction of grip and control measures in October 2015, November and December had been the two worst months in terms of expenditure. This was discussed and it was noted that additional grip and control measures had not come into play until late November.

16/1/55 In response to a query from Martin McAreavey with regard to movement in patient activity, David Purdue and Sewa Singh advised that the data was being reviewed to ensure that activity had not been missed, as it did not triangulate with referral data. More work needed to be done to align the business intelligence report with the finance report. This would be taken forward but would take time.

Execs

16/1/56 Care Group performance – Philippe Serna queried the reasons for under-recovery of income in the surgical care group, and this was discussed. David Purdue advised that there had been significant spending on additional sessions for radiologists and that how this would be managed in the future was being reviewed.


Business Intelligence Report as at 31 December 2015

16/1/57 David Purdue, Richard Parker and Sewa Singh presented the report and drew attention to the following:

16/1/58 Reporting - The report again included information on data quality and where data was externally validated. The health records, booking and reconciliation recovery plans were included as appendices.

16/1/59 ED 4hr access target – Q3 had been achieved at 95.47%. With the exception of Sheffield Children’s Hospital, the Trust was the only Trust in South Yorkshire to achieve the target for the quarter. Geraldine Broderick commended this. Nationally, Q3 performance had been circa 91.6%.

16/1/60 RTT – The target had been achieved at 92.1% for December. Four specialties had failed the target and key issues related to ENT referrals. The target for Trauma and Orthopaedics had been failed nationally. In response to a query from John Parker, David Purdue provided an overview of issues and actions.

16/1/61 Diagnostic waits – The target had been failed at 96.5%. Key issues related to non-obstetric ultrasound; more work was required to ensure the service was sustainable and this was discussed.

16/1/62 Geraldine Broderick noted that assurance had previously been provided that improvements were on track and she queried why they had not been delivered. David Purdue advised that there had been improvements in

most areas but there had been significant capacity issues in some areas, which had affected overall performance. It was agreed to provide an update on the cost of penalties outside the meeting.

DP

16/1/63 Hospital cancellation rates – Martin McAreavey noted that cancelled operations, DNAs and cancelled outpatient appointments were all higher in December than in the same month the previous year and this was discussed. David Purdue had met with Steve Swayne who had been able to share learning from other organisation regarding actions that might be taken. Although it was felt that little could be done to address DNAs, improvements could be made to the hospital cancellation rate in terms of better planning of consultant capacity, and taking better account of consultant annual leave. This would be taken forward.

16/1/64 HSMR – The rolling 12 month HSMR was 101.27, showing sustained improvement. This was in line with the performance of Sheffield Teaching Hospitals. The Trust had previously been an outlier for SHMI, and the latest figures for June 2015 showed that performance was now within the expected range. David Crowe commended the work of all staff to improve HSMR performance.

16/1/65 SIs - Despite increased incident reporting, the number of SIs continued to be below the level reported at the same time in the previous year. This reflected an improvement in openness and transparency.

16/1/66 John Parker raised concern that although SIs were reported to the Board, details of cases which had progressed to inquest stage were not shared at an early enough stage. He requested that this information be provided to the board as routine. This was discussed and Sewa Singh provided details of current inquests. It was agreed for the CGOC to consider reporting and triangulation of SI and inquest information.

SS

16/1/67 Quality – C.Diff performance remained below trajectory, and better than performance at the same time the previous year. There had been a significant improvement in HAPU performance with 49.4% fewer cases than at the same time the previous year. Falls were under trajectory and on track to meet the annual target.

16/1/68 Friends and Family Test – Emergency Department response rates remained a key concern and work to increase the availability of Friends and Family response cards in the FDASS had been undertaken.


Q3 People & Organisational Development (P&OD) Report

16/1/69 Dawn Jarvis presented the update on progress to deliver the P&OD Strategy, the annual KPIs, corporate objectives and P&OD led projects. She drew attention to the following:

16/1/70 Staff Flu immunisation – Nationally there had been a decline in flu

immunisation uptake of around 20%. The trust had failed the internal target of 81%, with 63.6% of staff immunised up to December 2015. However, the Trust was in the top 10% of organisations nationally (27th out of 270) and performance was expected to improve in January 2016. A review of processes would be undertaken and the Trust would consider what could be improved.

16/1/71 Staff turnover – Chris Scholey raised concern about the accuracy of the turnover data for leavers and starters, noting that the report illustrated a month on month increase in headcount. This was discussed and it was agreed to provide clarification on turnover data to the Financial Oversight Committee.

DJ

16/1/72 Staff Survey – The response rate had increased to 44% against an average of 38%. 86% of staff had reported in the staff survey that they had received an appraisal, above the national average of 85%. This was a significant improvement on the 27% reported at the beginning of 2014/15.

16/1/73 In response to a query from Martin McAreavey, Dawn Jarvis advised that the staff survey engagement score could not be updated yet.

16/1/74 Training – Following work to address issues relating to the system for recording SET training, the recorded level had improved and stood at 59%.

The Q3 People & Organisational Development Report was DISCUSSED and NOTED.


16/1/75 Richard Parker reported that overall planned versus actual hours worked in December had been 97%. The decrease was attributed to vacancies and significant sickness absence, which could not be fully covered by temporary staffing. This was partly due to the implementation of the grip and control plan and it was expected that the fill rate would continue to decrease over the coming months. A query was raised regarding wards that appeared to be overestablished, and it was agreed to provide contextual information regarding this.

RP

16/1/76 Nurse manager ward supervisor time - The target had not been achieved for paediatrics due to significant long term sickness absence. The department had been supported by both the Matron and Head of Nursing.

16/1/77 Safer Nursing Care / AUKUH assessments – A further assessment had taken place in November 2015 and the results were broadly in line with previous results.

16/1/78 Paediatric Acuity and Nurse Dependency Assessment (PANDA) – ePanda work continued to progress. The variances between establishment WTEs and the required WTEs identified by the ePanda data collection were explained. Work was being undertaken by Matrons to review the results against the exact patterns of time children were on the ward and

minimum safe staffing levels.

16/1/79 Hard Truths - Alan Armstrong asked whether learning and best practice were being shared in relation to quality and safety metrics for each area. Richard Parker advised that another ‘sharing event’ was planned.


Q3 Complaints, Compliments, Concerns and Comments Report

16/1/80 Richard Parker reported that the overall number of complaints and concerns received was at approximately 90 to 100 complaints per month. He provided an overview of complaints by management team, the top 10 reasons cited in complaints, complaint themes, care group breakdown, high risk complaints and complaint reply performance.

16/1/81 Martin McAreavey noted that there had been an increase in complaints about orthopaedic consultants and asked for more information about this. Richard Parker provided an overview of the cases. Some issues related to variances between patient perceptions and actual outcomes. It was important that there be good communication between consultants and patients in this regard. Actual outcomes were comparable with other Trusts. A patient was to be invited to tell their story at the next orthopaedic consultant audit meeting and this approach had been very powerful in the past. Issues relating to communication between consultants and patients had been recognised and issues raised were being fed back to consultants through their appraisals.

16/1/82 The report had been taken through the Patient Experience Committee. Geraldine Broderick commented that good examples of learning from complaints and picking up themes had been provided. Richard Parker advised that each care groups would present on learning from complaints in 2016.

The Q3 Complaints, Compliments, Concerns and Comments Report was DISCUSSED and NOTED.

Strategy & Improvement Report / Development of Turnaround Plans

16/1/83 Dawn Jarvis presented the report, which set out the progress towards readiness for Turnaround, including the immediate turnaround plan and high level workstreams. An overview of work to set roles and responsibilities and standardise project management processes was provided, alongside an update on the work to assess what would be delivered by each care group.

16/1/84 Implementing accountability arrangements – The delivery of turnaround plans was currently being overseen by the Financial Oversight Committee. Dawn Jarvis advised that a permanent sub-committee of the Board to oversee Turnaround delivery would be required, and this was discussed. It was agreed that draft terms of reference would be considered at the next

DJ

meeting.

16/1/85 Non-executives queried the level of staff engagement with the turnaround plans and this was discussed. Key forums for engagement were being considered, as well as bringing staff together in smaller professional groups to discuss the plans. Work was underway to establish communications and regular workshops with staff to ensure engagement and understanding

The Strategy & Improvement Report / Development Turnaround Plans were DISCUSSED and NOTED.

Business Planning 2016/17

16/1/86 Dawn Jarvis presented the paper, which highlighted the requirement for NHS organisations to produce two plans: a Sustainability and Transformation Plan (STP) and an Operational Plan. The paper provided an outline of the planning process and timescales and this was APPROVED.

Register of Sealing

16/1/87 Maria Dixon presented the Register of Sealing, detailing sealing numbers 71, 72 and 73. The register was NOTED

Minutes of the Management Board meeting held on 11 January 2016

16/1/88 It was noted that there would be a revised agenda for Management Board going forwards. Mike Pinkerton commented that it was important to maintain engagement with clinical leaders.

16/1/89 The minutes of the Management Board meeting held on 11 January 2016 were NOTED.


16/1/90 Issues relating to medical records and the CaMIS implementation had been reported at the Clinical Governance Oversight Committee and Martin McAreavey asked for an update. It was noted that three action plans to address the issues were included with the Business Intelligence Report. It was agreed that updates from the weekly action plan meetings would be provided to the Board.

DP



Health and Wellbeing Board Decision Summary

16/1/92 The Health and Wellbeing Board Decision Summary was NOTED.

Any other business

16/1/93 Telecommunications – In response to a query from John Parker, Richard Parker advised that some elements of the work to upgrade the

telecommunications system had been completed. The telecommunications workstream was being evaluated and the Trust would consider alternatives, such as a managed system.

Governor questions

16/1/94 Agency staff - Mike Addenbrooke asked whether the level of agency staff used by the Trust could be reduced. It was noted that the level of agency staff had reduced and was one of the lowest in the region. David Purdue provided an overview of the new rules relating to medical and nursing agency caps.

16/1/95 Stroke - In response to a query from Mike Addenbrooke about stroke performance, it was noted that outcomes for stroke patients at the Trust was the best in the region and one of the best in the country.

16/1/96 iHospital - In response to a query from Mike Addenbrooke about the progress of the iHospital Programme, it was noted than an update would be provided at a future board meeting.

DJ

16/1/97 External audit - David Cuckson stated that the Trust should ensure a robust negotiation with external audit with regard to the cost of re-auditing the 2014/15 financial accounts, given their role in the original audit.

16/1/98 Fire Improvement Notice - David Cuckson commented that the estimated overall cost of fire improvement actions was higher than he had expected. Richard Parker advised that this was due to work required to address issues relating to the lateral evacuation of ICU, an issue raised by the CQC.

16/1/99 Patient feedback - George Webb relayed comments from a patient who had attended the Jasmine Centre. The patient had praised the staff highly, particularly the care they had received from Dr Riley.


16/1/100 It was confirmed that the next meeting of the Board of Directors would be held at 9am on Tuesday 23 February 2016 in the Boardroom at Bassetlaw Hospital.

………………………………………………… ………………………………………………



held on Tuesday 22 February 2016


Present: Chris Scholey Chairman Alan Armstrong Non-executive Director Geraldine Broderick Non-executive Director Jeremy Cook Interim Director of Finance David Crowe Non-executive Director Dawn Jarvis Director of Strategy & Improvement Martin McAreavey Non-executive Director John Parker Non-executive Director Richard Parker Director of Nursing, Midwifery & Quality Mike Pinkerton Chief Executive David Purdue Chief Operating Officer Philippe Serna Non-executive Director Sewa Singh Medical Director In attendance: Emma Bodley Head of Communications & Engagement Kate Sullivan Corporate Secretariat Manager Public: Lauren Mugridge Member of the public George Webb Public Governor ACTION


16/2/1 Apologies were received from Maria Dixon.



Minutes of the meeting held on 26 January 2016

16/2/3 The minutes of the meeting held on 26 January 2016 were APPROVED as a correct record of the meeting, subject to the correction of one typographical corrections and the following amendments:

16/2/4 16/1/13 – “due to lack of candidates” to be removed

16/2/5 16/1/37 – “taken and” to be amended to “taken for setting 16/17 budgets and”

16/2/6 16/1/44 – “however, this had” to be amended to “however, when” and the third sentence to be removed.

16/2/7 16/1/54 – “that grip” to be amended to “that additional grip”

16/2/8 16/1/58 – “now included” to be amended to “again included”

16/2/9 16/1/66 – Last sentence to be replaced with “it was agreed for the CGOC

to consider reporting and triangulation of SI and inquest information.”


16/2/10 The action notes from the meeting held on 26 January 2016 were reviewed and updated.

Matters arising

16/2/11 None



16/2/12 National position – The national NHS providers financial position was worsening, standing at a deficit of circa £2.26bn at Q3. Over 1/3 of providers had rejected control totals linked to Sustainability and Transformation (S&T) funding. Philippe Serna queried whether this would result in a review and whether it would impact on the Trust’s control total, which had been accepted by the Trust. This was discussed and it was not known whether a revision was likely.

16/2/13 NHS Improvement Provider Conference – Chris Scholey had recently attended the NHS Improvement Provider Conference hosted by Monitor and the Trust Development Authority (TDA). Keynote speakers had included Jeremy Hunt MP, Secretary of State for Health, Simon Stevens, Chief Executive of NHS England, and Professor Lord Ara Darzi. Over 500 Chairs and Chief Executives had attended the conference. Chris Scholey gave an overview of key messages.

16/2/14 Governors – John Humphrey, Public Governor, had sadly passed away following a period of ill health. John Humphrey had been an active Governor and Chris Scholey had expressed his condolences to John’s family on behalf of the Trust and the board.

16/2/15 Governor meeting with KPMG – The meeting with KPMG to discuss the investigation report had been well attended and there had been positive feedback from Governors.

16/2/16 Timeout – There was a good agenda for the next timeout session, due to be held on 7 March 2016.

16/2/17 Quarterly Meeting with Sheffield Teaching Hospitals – Chris Scholey provided an overview of key issues discussed at the recent meeting.

16/2/18 In response to a query from David Crowe with regard to communications with MPs, Mike Pinkerton advised that he and Chris Scholey had recently met with Rosie Winterton, Caroline Flint and Ed Miliband. Mike Pinkerton had also spoken with John Mann and a meeting was being arranged.




16/2/19 Performance overview – The Trust continued to deliver well above England national averages in most areas.

16/2/20 Regulator matters - An update on the extent to which Monitor would provide support to the Trust’s turnaround plans would be discussed later in the meeting.

16/2/21 KPMG – The Board had received the final KPMG Financial Misreporting Investigation Report and an update would be provided in part 2 of the meeting. KPMG had provided an update to Governors and the Financial Oversight Committee.

16/2/22 Staff engagement - Mike Pinkerton had started to meet regularly with small groups of consultants to personally brief them on the financial position. It was hoped that some good ideas could be developed from the meetings. This approach was endorsed by David Crowe, although he raised concern that it would take time to see all consultants and this was discussed.

16/2/23 Consultant engagement was critical to future progress, particularly in areas involving the consultant body. Engagement was highly variable and the new meetings had been introduced to help address this. Mike Pinkerton also attended the Trust Medical Committee (TMC) meetings and TMC attendance had increased significantly in recent months.

16/2/24 There was further discussion about consultant engagement and Sewa Singh provided an overview of issues raised at recent TMC meetings. Consultants had requested details of the KPMG investigation and this was discussed. The Trust had taken the decision to share the KPMG investigation report publicly, providing the maximum disclosure possible whilst protecting the identity of individuals and this was endorsed. KPMG were to provide a redacted version of the report for this purpose.

16/2/25 Mutually Agreed Resignation Scheme (MARS) – The Scheme had closed. Circa 30 applications had been accepted and letters had gone out to applicants. In response to a query from Philippe Serna, Dawn Jarvis undertook to provide an update on the financial impact of the MARS scheme outside of the meeting.

DJ

16/2/26 Carter Report - A detailed overview of recommendations and key dates was included in the report. Any recommendations that were not already in the existing programme of workstreams would need to be incorporated, and work to do this was underway. This was endorsed by Geraldine Broderick. In response to a query Dawn Jarvis advised that this work

would be complete by 1 April 2016.

16/2/27 Annual Operational Plan 2016/17 – The plan had been submitted on 8 February 2016. Geraldine Broderick queried whether this had been developed using a bottom-up process and this was discussed. Jeremy Cook advised that a key issue was to ensure that budgets were realistic and not based on prior year roll over; new processes were in place to ensure this.

16/2/28 Fire improvement notice – Progress was outlined in the report. The fire and rescue service were considering whether the process could be managed by ongoing 3 monthly extensions with regular meetings until the work was complete, confirmation of this was awaited.

16/2/29 Library services – A self-assessment against the NHS Library Quality Assurance Framework had shown the Trust to be 98% compliant, placing the Trust in the top 10% nationally.

16/2/30 UK first for keyhole surgery – The Board commended the DBH team that had performed the UK’s first hernia repair surgery using a pioneering new technique that left no scars for patients.

16/2/31 Executive director appointment – Karen Barnard had been appointed as Director of People & Organisational Development and was due to commence in post on 2 May 2016. On behalf of the board, Mike Pinkerton thanked Dawn Jarvis, Director of Strategy and Improvement, for her work in this role prior to taking up her new position.

16/2/32 Martin McAreavey endorsed the celebration of staff successes in the report. He stated that it was important that this continued and queried how future successes would be picked up. This was discussed and it was agreed that the executive team would continue to focus on highlighting innovation and success across the Trust.


Finance Report as at 31 January 2016

16/2/33 Jeremy Cook presented the report and apologised for its lateness. A major contributing factor had been that two members the senior finance team had been off work. This highlighted the lack of resilience within the team and he noted that other staff had worked over the weekend to prepare the Monitor Q3 return. Five new members of the finance team had been recruited to provide greater resilience and to strengthen the team’s skillset. This was in line with KPMG recommendations.

16/2/34 Performance overview - At the time of reporting the trial balance had not been reconciled to the board report and this had meant there had been a risk that the reported position was not as stated. This reconciliation had now been undertaken and the year to date position was as reported.

16/2/35 However, there was an error in the reported planned deficit of £2.2m,

which was overstated by £1.2m and should have been a planned deficit of £1m. The negative variance against plan should therefore have been £28.6m and not £27.4m. A revised report would be issued. Philippe Serna endorsed work to ensure the trial balance reconciled to the Board report.

JC

16/2/36 Run rate - There had been a reduction in the run rate for the second consecutive month and this was welcomed.

16/2/37 Forecast – Work had been undertaken to complete a bottom-up forecast of income and expenditure. This showed a forecast deficit of £38.4m, which was consistent with the top down forecast.

16/2/38 There were ongoing risks connected with the iHospital Programme relating to both revenue and capital and there was more work to do to understand this. This would be undertaken by one of the new interim members of staff.

16/2/39 Alan Armstrong requested that, once this work had been undertaken, assurance be provided to the Board with regard to the benefits delivered by iHospital programme. This was discussed. Dawn Jarvis advised that work was underway to separate the iHospital programme so that each element sat within the relevant work stream, and a more details review each business case was underway.

16/2/40 There was further discussion about the delivery of individual iHospital projects including the Electronic Patient Record. Sewa Singh provided an update on progress, commenting that clinical engagement was key and meetings had been arranged to take this forward. It was noted that, as with previous IT projects, all elements of the IHospital Programme would be subject to a post implementation review.

16/2/41 Income – Below plan at £3.9m (M9 £3.4m). The underperformance of other non-NHS income had increased from £2.5m to £2.8m.

16/2/42 Expenditure - £24.9m above plan, with the pay variance continuing to be the key area of concern at £6.7m. As in previous months, pay overspends were primarily driven by medical expenditure pressures. However, medical agency costs had fallen again and were still well below the average for months 6 to 8. This was commended by Chris Scholey.

16/2/43 In response to a query from Alan Armstrong about non-clinical staffing overspends, Dawn Jarvis advised that these had primarily been due to medical records and were connected with high levels of staff sickness and support required for the CaMIS implementation, which had resulted in high use of agency staff in this and other areas. There had been a significant improvement in this department recently and work to improve the position was ongoing.

16/2/44 x 15/16 CIP - It was noted that there were minor errors in table 1 of the report, which would be corrected in a revised report. Work was

progressing in relation to the 2016/17 CIP plan with work streams being set up for the overarching schemes.

JC

16/2/45 Alan Armstrong asked why there had only been a retraction of the CIP budgets to M12 of £4.9m. Jeremy Cook advised that, as previously reported, a significant element of the CIP plan had not had any substance and there would be no point allocating additional CIP targets to care groups and divisions following the misreporting of CIPs in months 1 to 6. As a result, only £4.9m of budget had been retracted from care groups.

16/2/46 Cash - £4.1m below plan at £2.7m. The balance was above the minimum £1.9m as required by Monitor, as a £0.8m direct debit had not been drawn down as a result of national changes to banking arrangements in month. The Trust’s working capital facility had been increased from £32.9m to £33.5m during February, of which £22.4m had been drawn down in January and a further £10.6m drawn down in February.

16/2/47 The expectation was that the total working capital facility drawn down at year end would be converted into a loan, which would carry a lower rate of interest. John Parker asked whether this would be repayable and this was discussed. This would be reviewed in due course once the extent of the loan and repayment terms were known.

16/2/48 Creditors – Aged creditors had reduced and this was welcomed.

16/2/49 Capital expenditure - £4.9m behind plan at £11.5m.

16/2/50 Outsourcing – In response to a query from Alan Armstrong about reported cost pressures generated by clinical outsourcing, Jeremy Cook advised that a review of the SLA with Park Hill Hospital would be undertaken as part of a workstream. John Parker noted that the ANCR had received previous assurance about this and this was discussed. It was agreed that previous assurance should be disregarded.

16/2/51 Care Group performance - The use of mobile scanners was discussed. A business case to appoint substantive staff to the team was being taken forward. The use of mobile CT had reduced and would cease in March 2016. The Trust had been encouraged by work undertaken with the diagnostics team by the Birch Group and would consider how this type of work could be rolled out in other departments.

16/2/52 Martin McAreavey queried whether there was a risk to quality of patient care due to vacancies in therapies. Richard Parker advised that a review of therapies was being undertaken as part of the non-medical workforce review workstream to understand workforce needs going forward. National benchmarking showed that the Trust had a richer skill mix than the national average and he gave assurance that there was nothing to indicate that the service was anything other than good.

16/2/53 Teaching Hospital Status - In response to a query from Martin McAreavey,

Mike Pinkerton advised that this would be picked up by Karen Barnard, the new Director of P&OD, when she commenced in post in May.

16/2/54 The Surgical Care Group deficit had doubled and concern was raised about this. David Purdue advised that this was a phasing issue that related to income variances; it was noted that expenditure had reduced.

16/2/55 Philippe Serna asked for assurance with regard to how the budget was phased. Jeremy Cook advised that all phasing should be based on the number of days in the month but that there had been an error in the phasing which had subsequently been corrected. The issue was that this had been corrected as a bottom line adjustment and not against the points of delivery, which made it difficult to identify the true performance by point of delivery. It was agreed that this would be corrected for the 2016/17 plan and correctly reported in 2016/17.

JC


Business Intelligence Report as at 31 January 2016

16/2/56 David Purdue, Richard Parker and Sewa Singh presented the report and drew attention to the following:

16/2/57 4hr Access – 92.06% as a Trust for January. Although the target had been failed, the Trust remained the best performing Trust locally, and was above the national position.

16/2/58 Attendances in month had been the highest since 2011 at 13,735. Attendances at Doncaster had been 636 higher than in December 2015. David Purdue gave an overview of action being taken to address the issues. One key issue had been the agency cap, which had affected the ability to cover shifts.

16/2/59 The Trust had met with Doncaster CCG to discuss increased ED attendance. An investigation was to be undertaken to understand the issues outside of the hospital.

16/2/60 RTT – Achieved as a Trust at 92.3%.

16/2/61 Cancer – All targets were achieved for Q3, including the 62 day target.

16/2/62 Stroke – Performance had not improved and David Purdue explained the reasons for failure to meet the admission target and the work being undertaken to address this. Stroke nurses attended to patients in the ED and, although patients were not always admitted to the stroke unit within the targeted timeframe, care commenced early within the ED. Outcomes for stroke patients at the Trust were the best in the region.

16/2/63 Diagnostic Waits – Achieved at 99.48%. This was commended by Alan Armstrong.

16/2/64 DNAs – In response to a query from Alan Armstrong about work to address DNA rates, David Purdue advised that DNA rates were better than they had been for some time. Patients were being sent appointment reminders, including text reminders that highlighted the cost to the Trust of missed appointments.

16/2/65 Cancelled operations – In response to a query from Martin McAreavey about the number of cancellations and reasons for cancelled operations, David Purdue and Sewa Singh provided a detailed overview of the process for admission and reasons for cancellation.

16/2/66 54 operations had been cancelled in January. The figure reported related to cancellations on the day of the operation; where in many cases elective procedures were cancelled to allow for people with urgent life threatening conditions to be treated. The availability of ITU and CCU beds was also a factor and this would be considered in the bed plan. Theatre utilisation was being picked up as part of a work stream.

16/2/67 In the context of turnaround, Martin McAreavey asked whether risk had increased in relation to re-admissions. It was reported that this was reviewed by speciality; the Trust was not an outlier and was below the CCG trajectory.

16/2/68 HSMR – There had been continued improvement. The rolling 12 month HSMR to November 2015 stood at 98 and the un-validated HSMR for the month of November had been 70. Martin McAreavey thanked Sewa Singh and all staff who had worked to improve HSMR performance. [Post meeting note – It was later reported that the validated HSMR for November 2015 was 80]

16/2/69 Never event – Sewa Singh provided details of a never event. A retained swab had now been removed and there had been no harm to the patient. An investigation was underway and the case had been discussed with the CQC.

16/2/70 SIs – The Trust was on trajectory to significantly improve on the previous year’s SI rate.

16/2/71 Quality – C.diff performance continued under trajectory at 27% better than the same time the previous year. HAPU performance was 50% better than the same time the previous year.

16/2/72 Friends & Family – A key issue continued to be ED response rates. Richard Parker would meet with the Care Group to discuss how this could be improved.

16/2/73 Complaints – A key issue was response times due to the Care Groups undertaking work in other areas. Rick Dickinson, Deputy Director of Quality & Governance, was developing an action plan. Alan Armstrong

raised concern around the increase in overall complaints and this was discussed. The rise in complaints was proportional to activity levels. Richard Parker advised that part of the Trust’s strategy was to learn as much as possible from complaints and to resolve them early. Although the overall level of complaints had increased, the number of formal complaints had reduced.



16/2/74 Richard Parker reported that overall planned versus actual hours worked in December had been 99% in January (97% in December). This included staff for additional escalation beds opened on a number of wards for most of January.

16/2/75 John Parker asked whether it had been appropriate to take beds out of the bed plan as part the savings plan, given the number of escalation beds opened and this was discussed. It was key to ensure that quality of care was maintained and that patients were on the right wards and this required flexibility in the bed plan. It was also key to ensure that opening of escalation beds was supported by an active plan and business case.

16/2/76 Nurse Manager Clinical Time – HoN and Matron clinical time had not been achieved in January for the Children and Families Care Group due to sickness absence.


Development of Turnaround Plans / CIP

16/2/77 Dawn Jarvis presented the report, which set out the progress towards readiness for turnaround, progress to deliver Grip & Control and turnaround and progress to deliver the high level CIP plan for 2016/17 and beyond. She reported that since the publication of the papers the number of CIP workstreams rated ‘red’ had reduced from 8 to 3.

16/2/78 David Crowe welcomed the report but raised concern about whether inputs from the Carter Report and other external recommendations had been incorporated into plans. This was discussed and Dawn Jarvis advised that this would be reported through the Financial Oversight Committee. The Financial Oversight Committee agenda would also cover reviews of failing workstreams, and this was welcomed.

16/2/79 Alan Armstrong asked whether there were lessons to be learnt from other trusts and this was discussed. Dawn Jarvis provided an update on issues discussed at Grip & Control meetings and it was noted that there would be a DBH Buzz special update on turnaround.

The Development of Turnaround Plans / CIP Report was DISCUSSED and APPROVED.

Board of Directors sub-committee structure

16/2/80 Dawn Jarvis presented the paper outlining the proposed committee and reporting structure for the operational management of the Trust and delivery of the Turnaround programme. The Board was asked to consider and approve draft revised terms of reference for the Management Board and Financial Oversight Committee.

16/2/81 Care Group performance and quality accountability meetings / financial accountability meetings - Martin McAreavey queried what triggers, in terms of quality, were required in order for Care Groups to move forward through each gateway. This decision was taken by Sewa Singh and Richard Parker; Dawn Jarvis undertook to provide further information on the process outside of the meeting.

DJ

16/2/82 Financial Oversight Committee ToR – It was proposed that the Financial Oversight committee become a permanent sub-committee of the board, reporting directly to the board rather than through the Audit and Non-clinical Risk Committee. The duties and work programme were discussed. It was noted that it had been agreed that the KPMG action plan would be taken to the committee and it was agreed that the committee should also review and monitor the management response to recommendations of other externally commissioned reports relating to the its area of work.

MD

16/2/83 It was noted that the Chief Operating Officer should be removed from the list of attendees as in terms of the committee the role had been superseded by the Turnaround director

MD

16/2/84 Management Board ToR – It was agreed that the purpose should include a reference to delivery of quality of care.

MD

The Board of Directors sub-committee structure was DISCUSSED and APPROVED subject to the agreed amendments to the ToRs.

Doncaster & Bassetlaw NHS Foundation Trust Charitable Funds Annual Report and Financial Statements 2014/15

16/2/85 Jeremy Cook presented the report and noted that a formula error on the first table on page 21 would be corrected. He also drew attention to the following:

JC

16/2/86 The Charitable Fund Financial Statements 2014/15 had been audited by PwC. The ISA 260 report had been received after the publication of the papers and would be circulated outside of the meeting. PwC had made minor changes and the report was to be amended accordingly. The paper included a copy of the letter of representation

JC

16/2/87 In response to a query from Martin McAreavey with regard to how charitable funds would be managed in the future, Jeremy Cook advised that a paper to include initiatives to spend charitable funds and how the

fund should be managed would be brought to a future meeting. Board comments and concerns would be fed back outside of the meeting.

16/2/88 The Doncaster & Bassetlaw NHS Foundation Trust Charitable Fund Annual Report, Financial Statements 2014/15 and letter of representation were APPROVED subject to the reflection of minor changes as set out by PwC in the ISA 260 report.

Minutes of the Clinical Governance Oversight Committee meeting held on 18 January 2016

16/2/89 16/44 – Medical records – Martin McAreavey noted that concerns relating to issues with the availability of medical records following the implementation of CaMIS had been escalated to the CGOC from the Clinical Governance and Quality Committee. He asked for an update on actions taken to address the issues and this was discussed. David Purdue provided a detailed update: all action plans had been updated, there had been a change of leadership in bookings and records, and the percentage of notes delivered to clinics continued to be monitored. It was noted that all clinic notes had been delivered the previous week.

16/2/90 In response to further query, David Purdue advised that a work stream was in place to consider how booking rules could take into account DNA rates.

16/2/91 16/15 to 16/19 – Medicines management - John Parker and Geraldine Broderick raised concern that issues relating to medicines reconciliation and junior doctors were not always fed back to doctors and this was discussed. It was clarified that wherever it was possible to do so issues were fed back at the time, however there were occasions where this was not always possible, for example during a night shift. Sewa Singh undertook to seek assurance from Andrew Barker, Care Group Director, that systems were robust and it was agreed that assurance be provided to the Clinical Governance Oversight Committee.

SS

16/2/92 The minutes of the Clinical Governance Oversight Committee meeting held on 18 January 2016 were NOTED.

Minutes of the Management Board meeting held on 1 February 2016

16/2/93 MB/16/02/21 – The future of Board Briefing sessions had been discussed. It had been queried whether they were a productive use of time and it had been suggested that non-executive directors could attend accountability and management team meetings instead. This was discussed and it was agreed that non-executive directors would consider this further outside of the meeting.

NEDS

16/2/94 MB/16/2/67 – Agency Caps – In response to a query from Philippe Serna, David Purdue advised that all Care Groups had identified staff paid above the agency caps and were taking steps to reduce reliance on agency staff

16/2/95 The minutes of the Management Board meeting held on 1 February 2016 were NOTED.


16/2/96 CGOC 16/15 - 16/19 - Medicines management, as reported above.

Q3 Monitor Declaration

16/2/97 It was noted that the report related to in year financial reporting to December 2015 only. Due to the size and level of detail in the report it agreed not to include hard copies of the declaration in future papers. Comments would be fed back outside of the meeting.

ALL

16/2/98 The Q3 Monitor Declaration was NOTED.

Annual Operational Plan 2016/17 (submitted to Monitor)

The Annual Operational Plan 2016/17 (submitted to Monitor) was NOTED.



Any other business

16/2/100 None.

Governor questions

16/2/101 George Webb endorsed the celebration of successes across the Trust in the Chief Executive’s report.

16/2/102 George Webb commented that one of the Public Governors who had recently suffered from a stroke had highly commended the care they had received at the Trust.


16/2/103 It was confirmed that the next meeting of the Board of Directors would be held at 9am on Tuesday 22 March 2016 in the Fred and Ann Green Board Room at Montagu Hospital.

………………………………………………… ………………………………………………


1

Title Financial Performance – February 2016 – M11

Report to: Board of Governors Date: 19 April 2016

Author: Jeremy Cook (Interim Director of Finance)

For: Note

Purpose of Paper: Executive Summary containing key messages and issues

To update governors on the financial position for the 10 months to 29 February.

Recommendation(s)

Governors are asked to NOTE that the reported financial position is a deficit of £31.2m which is £30.3m behind the planned deficit to date of a £0.9m. Governors are asked to note the improvement in the forecast from £38.4m to £36.4m

Delivering the Values – We Care

Not applicable

Related Strategic Objectives

Provide the safest, most effective care possible

Control and reduce the cost of healthcare

Focus on innovation for improvement

Develop responsibly, delivering the right services with the right staff

Analysis of risks

Due to the deficit the Trust is in breach of its license with Monitor

Board Assurance Framework

1 Failure to comply with the Monitor Risk Assessment Framework, CQC and other regulatory standards, triggering regulatory action.

5 x 4 = 20

2 Failure to deliver the financial plan 5 x 5 = 25

3 Failure to deliver the cost improvement plan 4 x 5 = 20

1

FINANCIAL PERFORMANCE – FEBRUARY 2016 1. Overview 1.1 As at Month 11 the Trust deficit is £31.2m which is £30.3m behind the planned deficit of £0.9m.

As in previous months medical staff costs continue to be a main area of concern, with adverse variances in a number of specialties with particular focus on the Surgical, Emergency and Children & Families Care Groups who continue to be over established against funded levels. In addition there are large overspends on other non-pay costs and non-delivery of efficiency savings.

1.2 Expenditure in month has remained at the same level as Month 10 of £29.9m. This represents a

reduction of £1.5m since November expenditure of £31.4m 1.3 The forecast for the year has improved by £2m from £38.4m to £36.4m as a result of penalties

for readmissions being waived in Q4, reduced payments under the MARS scheme and improved run rate.

1.4 A disputed debt with NHS England was resolved in the month in the Trust’s favour. At month 9 an accrual of £0.54m was posted as a prior period adjustment and £0.22m accrued for the current year. As these transactions were being concluded it was noticed that the accrual the Trust had made for these transactions (£1.46m) had been moved from accruals to general provisions. The general provision account should only be used where there is an under or over accrual and the net balance is added to or deducted from expenditure at the year end. This has resulted in an additional prior year adjustment of £0.61m which was net of the write back of £0.54m no longer required. In addition a further prior year adjustment has been identified whereby cardiology stock was double counted as a prepayment at last year end resulting in a further adjustment of £0.21m. Therefore the total adjustment to prior years is a further write off of £0.82m.

1.5 There are a further £1.4m of credit balances which have been written off to general provision for which an exercise is being undertaken to identify whether any of the balances are valid which will add to the prior year adjustment.

2. Income 2.1 Income at the end of month 11 (inclusive of Recharges, Education and Outsourcing income) is

£3.837m below plan (£3.856m at month 10) a deterioration of £19k in month. 2.2 NHS clinical income has over-performed by £293k during February, giving a £105k under-

performance for the year to date. This is mainly due to Emergency activity (£2.165k) and other income (£2,668k) which is partly offset by an underperformance on Elective & Daycase activity (£2,593k), both of which under-performed against plan in February. Other areas contributing to the underperformance is the impact of the Outpatient Cap (£886k). NHS clinical income has benefitted in month from an adjustment to reflect no fines for readmissions in Q4 of £787k relating to M10 and M11.

2

2.3 Outpatient performance in month continues to be behind plan cumulatively, however February’s performance was ahead of plan, with First activity year to date underperformance reducing to £295k and Follow Up performance now £1,316k below plan due to the application of the Outpatient Cap. The total Outpatient Cap as at month 10 is £886k (£894k at month 10); this is across most specialties with the main ones being Urology £242k, Gynaecology £117k, Dermatology £43k and Respiratory £23k. Valuable capacity continues to be used to deliver unfunded follow up work, whilst pressure remains on both waiting lists and medical staffing to deliver this capacity often at premium rates due to non-substantive cover. This will be a key element of the Trust’s recovery plan.

2.4 The under-performance on other non-NHS clinical income has increased in month to £1,018k,

with £379k of the variance being due to the Trust reverting to its previous method of accounting for income receivable from the NHS injury cost recovery scheme. Education and training has improved from an adverse variance of £368k to an adverse variance of £208k due to confirmed student numbers. Other income is under-performing (£1,643k) due to changes in reporting asset sales and donated & government granted assets income; in addition internally generated income continues to under-perform, this is partly offset by over-performance on provider to provider contracts.

3. Expenditure 3.1 Expenditure at month 11 is £28.24m worse than plan (£24.87m at month 10). The pay variance

of £7.31m (last month £6.66m) continues to be the single largest contributory factor. As has been the recent trend pay overspends are primarily driven by medical expenditure pressures of £7.81m (last month £7.22m), due to the use of non-substantive staff. Medical agency costs have fallen further to £1.04m in February, a reduction of £134k on January and are still well below the average for months

six to eight of £1.5m per month. The overspend is inclusive of over-establishment against funded levels, with significant overspends still being reported in; Children’s, Women’s & Maternity, Medical Imaging, A&E, Medical Gastroenterology, T&O, Ophthalmology, GI, Stroke, Diabetes & Endocrinology, Urology, ENT and Anaesthetics.

The run rate across medical staff costs has once again fallen this month this and is £160k better in February than the year to month 10. Headcount over establishment has once again reduced from 35.1 wte in January to 27.1 wte in February.

In addition to over expenditure on medical staff there are also significant overspends on

non-medical staff within; Estates (£243k), Medical Imaging (£283k), Outpatients & Clinical Admin (£224k) and Theatres Day Surgery (£499k).

3.2 There are six material areas of year to date overspends on non-pay categories.

Medical Supplies & Equipment £690k - more than half this value resides within Estates, the majority of it relates to maintenance contracts. Overspends are also present in Cardiology, Surgery & Women’s & Children’s.

Prosthesis £651k - the majority in Trauma & Orthopaedics.

Building costs £428k

3

Outsourcing £5,305k - £2.26m in Trauma & Orthopaedics, £1.383m in Surgery and £950k in Diagnostic & Pharmacy.

Facilities related expenditure £644k

Office expenses £889k

The variance on Drugs continues to be inclusive of Non PbR drugs underspend together with PbR drugs pressures in several specialities. The continued under performance on CIP schemes also has a significant impact on nther non pay variances. The reported variance on contingencies and reserves continues to reflect both the planned release of general contingency and the impact of the efficiency reserve that hadn’t been retracted from budget.

4. Efficiency

Table 1: CIP delivery to M11 and forecast

4.1 The reported CIP achieved to month 11 is £1,674k, a shortfall to retracted budget of £1,866k.

£1,142k of the reported figures relate to procurement savings.

4.2 The current forecast out turn for 2015/16 of £1,850K has a FYE (Full Year Effect) of £2,732k, however £583k of these has been deemed non-recurrent.

4.3 Work is progressing in relation to the 2016/17 CIP plan with project groups for the overarching

schemes now live and ’local’ schemes being worked up in the individual delivery areas. The

target number is now £11m with an internal stretch target of £13m.

Original

Plan

Budget

Retracted

to M11

Actual to

M11

Variance

to M11

Budget

retracted

to M12

Forecast to

M12

Forecast

Variance

Forecast

FYE

Forecast

Non

Recurrent

Care groups £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

MSK and Frailty 1,776 601 279 -322 1,121 301 -820 697 79

Emergency care 730 347 74 -273 417 91 -326 202 0

Specialty services 602 182 52 -129 215 56 -159 62 18

Children's and Families 846 498 7 -492 608 7 -601 8 0

Diagnostic and Pharmacy 1,064 498 525 28 575 634 59 926 119

Surgical 2,183 845 113 -732 1,014 121 -892 134 11

Corporate

Chief Executive 74 68 68 0 74 74 0 74 0

Facilities, Estates and Hotel services 812 358 84 -274 426 94 -332 83 6

Finance 126 115 313 198 126 324 198 324 324

medical Director 4 3 3 0 3 3 0 3 0

Property 880 0 0 0 0 0 0 0 0

Cross organisational 10,005 25 155 130 0 145 145 218 27

Totals 19,101 3,540 1,674 -1,866 4,579 1,850 -2,729 2,732 583

4

5. Care Group Performance 5.1 Children & Families Care Group - £2,588k net deficit to plan for the year to date. The Care

Group has seen an improvement in income in month along with a continued overspend against expenditure in line with the monthly run rate. The over-spend on pay of £538k is mainly driven by medical agency and additional sessions premiums (£1,481k) due to the backfill of medical vacancies (16.21wte at February). These overspends are currently offset by the large number of nursing and midwife vacancies (28.34wte). Non-pay continues to overspend mainly due to increased activity referred to other NHS trusts £427k (Women’s, Maternity, and Children’s), unachieved CIP’s £492k, volume funding retraction £319k, and drugs and consumables £411k. Income is £36k above plan as at the end of February. This is mainly driven by an over performance against the maternity contract (£259k), offset with a continued underperformance against Paediatric emergency contract (£360k). The outpatient CAP continues to cause a pressure in Gynaecology (£126k) which is currently offset by and over performance on outpatient activity (£385k).

5.2 Diagnostics and Pharmacy Care Group - £1,137k net deficit to plan for the year to date. The net

budgetary position deteriorated by £209k month on month. The most significant cost pressure is the Medical Imaging specialty; where over £678k has been spent year to date on mobile scanning support to meet activity levels. The specialty has plans to employ lean principles to increase the capacity on their in-house scanning. The Outpatients specialty is also underperforming, due to an unachieved CIP from previous years of £218k. These cost pressures are offset by a high performing Pathology specialty which has a net budgetary position of £748k.

5.3 Emergency Care Group - £2,458k net deficit to plan for the year to date. This is mainly driven by

an over-spend on medical staffing equating to £2,635k. There are currently 36.50wte medical vacancies as at February which are being covered by additional sessions and agency staffing. Also, within A & E medical rotas have previously been over recruited to by non-substantive staff. This issue has been rectified in part by removal of consultant and middle grade shifts. Nursing staff are £918k overspent due to bank and agency usage to cover the high number of vacancies (81.08wte at February). Within the Care Group there is £692k of expenditure for Sleepers in/out. The income over performance of £3,286k is partly due to £1,194k over performance on non PbR drug income which is balanced out by a corresponding expenditure over-spend. Acute Medicine emergency activity is over performing by £956k and elective activity by £368k. Accident and Emergency is over performing by £680k which has occurred since the reduction of activity in relation to the Front Door Signposting project. This position is masked by Outpatient CAP (£37k) and under performance against cost per case income targets (£202k) across Respiratory and Acute Medicine.

5.4 MSK Care Group - £2,598k net deficit to plan for the year to date. This is mainly driven by

expenditure overspends across the Care Group. Pay overspends on medical and nursing staff exist across Orthopaedics and Care of the Elderly which are masked by vacancies in Therapies leaving a net pay overspend of £273k. PbR drugs are overspent by £414k and there is an underachievement on CIP of £322k year to date. Prosthesis, implants and patient appliances

5

are overspent by £568k, outsourcing of activity is overspent by £2,232k but covered by the volume funding allocation of £2,655k. Income is under delivering by £936k which is partly due to a variance on non PbR drugs of £420k which is balanced out by a corresponding underspend on expenditure. The main underperformances against contract exist within Trauma & Orthopaedics with a variance on elective of £818k, day case of £385k, outpatient’s of £93k together with activity penalties of £201k.

5.5 Specialty Services Care Group – £2,799k net deficit to plan for the year to date. The Care Group

has seen a significant improvement in income in the month of February along with a reduction in expenditure. The main specialties of concern driving the deficit within the Care Group are Dermatology £417k deficit against plan, Cardiology £466k deficit against plan, Stroke £215k deficit against plan, Diabetes £608k deficit against plan, Breast £384k deficit against plan and Urology £614k deficit against plan.

The Care Group has a pay overspend as at February of £522k, which is spread across the specialities and is mainly driven by medical agency and additional sessions premiums to backfill vacancies. Volume retractions for the care group amount to a cost pressure of £833k as at February. Dermatology is currently behind income plan by £211k (outpatient activity) and significantly overspending against drugs at £115k worse than budget. Stroke and Diabetes continue to overspend in month which is mainly driven by nursing and medical staff vacancies. Breast underperformance against income plan continues in February at £414k worse than budget. The expected increase in activity to be delivered by new consultants has not been realised due to the extra capacity needed from pathology and medical imaging not being available. The Urology deficit is due to expenditure, outsourced activity is £206k worse than budget and additional sessions paid make the position £172k worse than budget.

5.6 Surgical Care Group - £7,406k net deficit to plan for the year to date. The position deteriorated by a further £476k in February. The deficit position is caused by four main pressures; Medical expenditure is £2,778k worse than plan, with the care group having carried 20-25 medical vacancies per month over the past two years a high amount of additional sessions and locums have been required to cover this. The care group is currently focusing on reducing long-term locum placements, and this again had a positive impact in February against run rate, as it had for the previous three months. Income, which is £3,605k worse than plan. The care group is significantly under-recovering on elective, day case and outpatient work while over performing on non-elective. The income position deteriorated by a further £298k in-month but this was an improvement compared to recent months. Outsourcing is £1,258k worse than plan; there has been high usage in both GI and ENT. Underachieving on CIP which is currently £732k worse than budget. The Care Group’s main CIP was to increase income through a new Bowel Scoping programme but so far this has underperformed.

6

5.7 Estates, Facilities & General Operations - £2,672k net deficit to plan for the year to date. The

Estates position worsened to a £1,766k deficit and Hotels services to a £631k deficit, with General operations making up the balance.

Within expenditure previously reported cost pressures continue to be the main contributory factors in the current combined position of £2,300k deficit to date. Estates have a £122k negative variance against unidentified pay efficiencies at month 11, along with year to date overspends on ancillary staff of £94k, which has been mainly caused by unfunded overtime and enhanced hour payments. Utilities are overspent by £337k and building maintenance and repair costs (including medical equipment contracts) by £636k. Hotel services continue to underspend on staff due to a number of vacancies within the catering and service assistant plans, an overall pay under-spend of £186k year to date. Postage costs are significantly overspent at £496k worse than plan, and are currently under review. Cleaning equipment and materials are also contributing towards the position and show a deficit of £102k to date. The combined income position is £372k worse than plan with internally generated income underachieving by £419k. This is due to an under recovery of car parking income of £467k, which is being offset by catering facilities income overachieving by £143k year to date.

6. Capital Expenditure 6.1 Capital expenditure at month 11 of £11.8m is £7.1m behind plan (£4.9m at month 10). The

variance continues to be due to planned slippage on property and replacement medical equipment expenditure partly offset by information technology schemes. The variance above 30% is outside Monitor’s tolerance level but is an integral part of the Trust’s cash recovery plan. The key area of concern is spend on the iHospital projects.

7. Financial Performance 7.1 The aggregated Financial Sustainability Risk Rating (FSRR) rating is a 1 against a plan of 2. All

four of the elements (liquidity, capital servicing capacity, I&E margin and variance from plan)

are rated as 1, reflecting the variance in the overall I&E position.

7.2 The cash position at month 11 is £1.9m which is £5.6m below the plan to date of £7.5m. The variance is due to the significant I&E overspend against plan and slippage on land disposals, partly offset by the early drawdown of the approved ITFF loan and access to Monitor approved temporary working capital facility.

7.3 As a result of the Trust’s financial position external cash support is required during 2015/16 and

beyond. The Trust has secured through Monitor a temporary working capital facility of £33.5m of which £33m has been drawn down by the end of February. Due to improved cash flows fore income no draw down was made during March. The Trust has been granted a loan facility of £7.2m for drawdown in April. Funding will be agreed on a monthly basis until DoH/Monitor agree a more permanent solution for Trust’s receiving distress funding.

7

8 Budgets 2016/17 8.1 A draft financial plan was submitted to Monitor on 8 February which showed that the Trust

achieved a control total of £27m. A budget setting principles and process paper was approved at the March Financial Oversight Committee which due to the delay in starting budget setting has a final sign off of budgets with budget holders in May. Monitor has provisionally agreed to the Trust submitting a final Monitor plan on conclusion of this process.

Jeremy Cook – Interim Director of Finance

Statement of Comprehensive Income Variance January 2015

Plan Actual Variance VarianceIncome £000 £000 £000 £000

NHS Clinical Income

Elective 26,761 25,262 -1,499 -1,434Daycase 26,881 25,786 -1,095 -1,075Emergency and Non-Elective 68,987 71,574 2,587 2,066Emergency Threshold Reduction -1,068 -1,489 -422 -304First Outpatients 20,380 20,084 -295 -522FU Outpatients 27,472 26,157 -1,316 -1,338Other (inc A&E) 98,357 101,024 2,668 2,580

Contract Penalties -1,788 -1,430 358 445

CQUINS 6,238 5,614 -624 -567Non PbR Drugs 21,722 21,255 -467 -249

Total 293,941 293,837 -105 -398-105

Non NHS Clinical IncomePrivate Patient Income 760 842 82 76Other Clinical Income 2,523 1,423 -1,100 -752

Total 3,283 2,265 -1,018 -676

Other IncomeEducation and Training 7,362 7,154 -208 -368Other Income 16,121 14,479 -1,643 -1,658Income Recharges 9,905 9,042 -862 -755

Total 33,388 30,675 -2,713 -2,781

Total Income 330,613 326,777 -3,837 -3,856

Expenditure

Pay Costs -219,579 -226,889 -7,310 -6,656Drug Costs -28,442 -29,692 -1,250 -1,405Clinical Supplies and Services -24,941 -27,190 -2,248 -2,253Other Costs -42,199 -51,171 -8,972 -7,701

Total -315,161 -334,942 -19,781 -18,015

Contingency and Reserves 8,539 -785 -9,324 -7,609

Recharges -9,905 -9,042 862 755

Total Expenditure -316,527 -344,769 -28,243 -24,869

EBITDA 14,086 -17,992 -32,078 -28,726

Depreciation -9,037 -8,471 567 532PDC Dividend -5,587 -5,538 49 39Other Finance Costs -352 755 1,107 794

Net Surplus/Deficit (-) -891 -31,245 -30,354 -27,360

Financial Performance - February 2016 - Statement of Comprehensive Income and Risk Rating

As at 29 February 2016

Daycase and Elective activity combined was 1,237 cases under plan in month 11, driven by an under

performance in the majority of specialties due to cancellations for both the strike and bed pressures.

Outpatient first and follow up attendances are also behind plan by 3,976 predominantly whihc has

improved in month due to increased workloads. Emergency activity is 4060 cases above plan, this

increase in month 11 has had an impact on planned work.

Outpatient overperformance against Doncaster CCG plan has increasd in month 11, they are still

over-performing YTD. Daycase and Elective activity continue to show a net overperformance,

which has increased slightly in month with a increase in both daycase and elective activity.

The Q3 position for CQUIN's has now been agreed with Commissioners, the actual performance has

deteriorated more than expected on some specific schemes. These included Paediatric Assessment Tariff,

Mental & Physical Health and both the National AKI & Sepsis. From the results of the Q3 performance the

forecast Q4 performance has been adjusted accordingly to predict a year end under-performance of £1.7

million.

Financial Performance - February 2016 - Income & Activity Analysis

2015/16 Cumulative Activity Variance Activity Variance by CCG - Cumulative to February 2016 CQUINs Forecast 2015/16 Performance

Inpatient activity has increased slightly in month 11 reducing the under-performance, Daycase and

Elective remains behind plan. The over-performance in Emergency income has again increased in

month as a result of activity over-performance and increased casemix.

Doncaster CCG income has overperformed in month with the variance to date of -£0.5m behind

plan. The significant movement is on outpatient & Planned income. Bassetlaw CCG also

overperformed in month 11 giving a YTD overperformance of £192k. NHS England's position has

declined in month 11 due to an reduction in Non PbR drugs.

The contract penalties have been restated for April and May due to national changes in RTT penalties and are

now based on the new guidance. A&E performance has fallen significantly in month 10. RTT has continued at

the increased level seen in month 7 - 11 due to ENT performance and the impact of CaMIS and also due to the

increase in the unit penalty charge.

2015/16 Cumulative Income Variance Income Variance by CCG - Cumulative to February 2016 2015/16 Contract Penalties Performance

-6,000

-5,000

-4,000

-3,000

-2,000

-1,000

0

1,000

2,000

3,000

4,000

5,000

Inp

atie

nt

& O

utp

atie

nt

Act

ivit

y

Daycase & Elective Emergency Outpatient First Outpatient Follow Up

(-1,237) (-3,612) (1,061) (-£1,672) -10,000 -8,000 -6,000 -4,000 -2,000 0 2,000 4,000

Do

nca

ster

Bas

setl

awN

HS

Engl

and

Oth

erA

sso

ciat

es &

NC

A's

Daycase

Elective

Emergency

Outpatient

(£2,500) (£2,000) (£1,500) (£1,000) (£500) £0 £500 £1,000 £1,500 £2,000

Do

nca

ster

Bas

setl

awN

HS

Engl

and

Oth

erA

sso

ciat

es &

NC

A's

£'000's

Daycase

Elective

Emergency

Outpatient

Drugs

Other

-£586,335

£561,488

£192,406

-£272,421

-1,000,000

-800,000

-600,000

-400,000

-200,000

0

200,000

400,000

600,000

-3,000

-2,000

-1,000

0

1,000

2,000

3,000

Ap

ril

May

Jun

e

July

Au

gust

Sep

tem

ber

Oct

ob

er

No

vem

ber

Dec

emb

er

Jan

uar

y

Feb

ruar

y

Mar

ch

Ou

tpat

ien

t In

com

e

Inp

atie

nt

Inco

me

Daycase & Elective Emergency excl threshold adj

Outpatient First Outpatient Follow Up

(-£2,593,368)

(-£531,498)

(£2,563,508)

(-£151,039)

0 200 400 600 800 1000 1200

End of Life Care

Discharge Pathway

Pressure Ulcers

Paediatric Assessment Tariff

Patient Safety

Customer Care & Patient Experience

Mental & Physical Health

Mgt. of Complex Frequent Flyers

National: AKI

National: Sepsis

National: Dermentia

National: UEC

NHS E: QIPP Plans

NHS E: Vascular Services

NHS E: Neonatal Critical Care

NHS E: Dental

NHS E: Public Health

£000's

CQ

UIN

Sch

em

e

CQUINs Performance 2015/16

Expected to Achieve

At RiskLost

-163 -163 163 163 163 163 163 163 163 163 163

16 10 9 1 9

45 37

72

79 105

47

95

12 13 13

21

19

129

34

35

36

26

23

15

93 96 69

77

74

0

50

100

150

200

Pla

n

Act

ual

Pla

n

Act

ual

Pla

n

Act

ual

Pla

n

Act

ual

Pla

n

Act

ual

Pla

n

Act

ual

Pla

n

Act

ual

Pla

n

Act

ual

Pla

n

Act

ual

Pla

n

Act

ual

Pla

n

Act

ual

Apr May Jun July Aug Sept October NovemberDecember January February

£0

00

's

Diagnostic Waits RTT Penalties Ambulance Handover

A&E 4 Hour Waits 2015/16 Plan

-

Care Group Specialties

Contract

Ratio

2015/16

Actual Ratio -

April 15

Actual Ratio -

May 15

Actual Ratio -

June 15

Average

Ratio -

Quarter 1

Actual Ratio -

July 15

Actual Ratio -

August 15

Actual Ratio -

Sept 15

Average

Ratio -

Quarter 2

Actual Ratio -

Oct 15

Actual Ratio -

Nov 15

Actual Ratio -

Dec 15

Average

Ratio -

Quarter 3

Actual Ratio -

Jan 16

Actual Ratio -

Feb 16

Actual Ratio -

YTD

Outpatient

Cap £ - YTD

Children & Families Care Group Womens & Maternity 3.0 3.0 3.4 3.7 3.4 3.6 4.0 3.4 3.7 2.3 5.5 2.6 3.5 3.3 3.0 3.2 (£116,529)Paediatrics 1.6 1.3 1.5 1.5 1.4 1.6 1.5 1.9 1.7 1.8 1.6 1.5 1.6 1.6 1.6 1.6 (£9,774)

Children & Families Care Group Total (£126,303)

Emergency Care Group Emergency Medicine 2.2 2.5 2.8 2.5 2.6 2.3 2.2 2.3 2.3 2.3 2.3 2.1 2.2 1.8 1.8 2.2 (£14,119)

Respiratory Medicine 2.9 2.9 3.4 2.8 3.0 3.7 6.0 3.8 4.5 3.0 3.1 2.8 3.0 2.5 2.3 2.9 (£23,225)

Emergency Care Group Total (£37,344)

MSK & Frailty Care Group Trauma & Orthopaedics 2.2 2.1 2.0 2.0 2.0 2.1 2.0 2.1 2.1 2.4 2.2 1.8 2.1 2.1 1.9 2.1 (£9,717)

T&O - Fracture Clinic 1.6 1.5 1.6 1.5 1.5 1.7 1.6 1.5 1.6 1.6 3.3 1.4 2.1 1.4 1.2 1.5 £0

Care of the Elderly, Rehab, End of Life Care 1.7 1.7 1.7 1.8 1.7 2.3 1.9 2.0 2.1 2.8 2.0 1.8 2.2 1.8 1.7 1.9 (£2,108)

Rheumatology 5.2 5.7 5.3 6.1 5.7 5.4 5.7 4.9 5.3 6.5 5.5 5.2 5.8 5.4 4.9 5.4 (£85,352)

MSK & Frailty Care Group Total (£97,177)

Specialty Services Care Group Haematology 6.2 7.3 6.5 5.1 6.3 5.8 5.7 8.1 6.5 7.1 6.5 7.7 7.1 7.5 6.5 6.6 £0

Dermatology 2.5 3.3 2.6 2.8 2.9 3.1 3.3 2.5 3.0 2.5 2.8 2.5 2.6 2.4 2.3 2.7 (£46,559)

Renal 7.1 8.4 8.7 6.8 8.0 8.2 6.2 8.0 7.5 13.0 7.8 5.7 8.8 14.0 5.9 8.0 (£38,355)

Cardiology 0.9 1.2 1.1 1.0 1.1 0.9 0.9 0.8 0.9 1.3 1.0 1.0 1.1 0.9 0.9 1.0 (£60,936)

Stroke / TIA's 1.6 1.1 2.6 2.9 2.2 2.3 2.7 2.7 2.6 4.4 2.6 1.7 2.9 1.7 1.8 2.4 (£11,483)

Diabetes & Endocrinology 3.6 4.4 4.1 3.9 4.1 3.9 3.3 3.4 3.5 3.6 3.7 4.1 3.8 3.8 3.6 3.7 (£12,339)

Vascular 0.8 0.0 1.3 1.5 0.9 1.6 1.3 1.6 1.5 1.3 1.5 1.5 1.4 1.2 1.7 1.5 (£1,293)

Breast 1.2 1.1 1.0 1.1 1.1 1.1 0.9 1.3 1.1 1.0 1.1 1.2 1.1 1.2 1.1 1.1 (£857)

Urology 2.4 3.2 3.3 3.2 3.2 3.0 3.8 3.4 3.4 3.9 3.3 2.7 3.3 2.9 2.8 3.2 (£241,760)

Specialty Services Care Group Total (£413,582)

Surgical Care Group Ophthalmology 3.0 3.6 2.7 3.3 3.2 2.9 3.3 3.0 3.1 3.2 3.1 3.1 3.1 2.5 2.5 3.0 (£5,907)

Medical Ophthalmology 7.1 4.0 2.2 8.1 4.8 10.1 6.5 7.2 7.9 16.8 6.2 15.8 12.9 6.9 6.6 6.3 (£474)

ENT 2.0 2.2 1.9 2.2 2.1 2.1 2.3 2.1 2.2 1.8 2.0 2.2 2.0 2.2 2.2 2.2 (£70,303)

Anaesthetics, Critical Care & Pain Management 2.7 2.6 2.4 2.3 2.4 2.7 2.6 2.6 2.6 3.1 2.8 3.0 3.0 3.3 3.3 2.9 (£62,800)

Gastro Intestinal Surgery 2.7 2.9 2.5 2.5 2.6 2.6 2.5 2.3 2.5 2.4 2.5 1.9 2.3 2.5 2.3 2.5 £0

Surgical Care Group Total (£139,484)

Corporate Other Other Minor Adjustments

Phasing adjustment in Board position to reflect gradual improvement in ratio's (£107,703)

Corporate Other Total (£107,703)

Trust Total (£921,593)

Outpatient First to Follow Up Ratio & CAP February 2016

Medical -7,813

Nursing -60

Other Staff 564 -7,310

Drugs -1,250 -1,250

Clinical Supplies and Services

MSSE -690

Prosthetics -651

Other -908 -2,248

Efficiency -2,096

Other -1,571 -8,972

Total -19,781

Medical staff expenditure has once again seen a reduction in expenditure month on month (M10 to

Financial Performance - February 2016 - Expenditure Analysis

Expenditure Subjective Variance Analysis (£000s) Nursing Expenditure Nursing Expenditure Analysis (£000s)

Nursing costs have underspent against budgets in month although untrained posts are continuing

to be significantly overspent currently of £2,162k year to date due to over-establishment and non-

substantive costs. MSK (£821k), Emergency (£649k), Specialties (£375k) and Surgical (£364k) are

the key adverse variances within untrained nursing. It should be noted that there are significant

trained vacancies that do offset the cumulative position to an extent resulting in the reported

variance of £60k cost pressure for nursing staff after the first 11 months of the financial year.

Performance in February against Monitor's 3% spending cap on registered nurses was 1.7% and a

cumulative position for October to January of 2.96%, mainly as a result of providing safe and

appropriate cover in A&E.

Pay £000s £000s

Other Employed Nursing Expenditure Analysis (£000s) Total Nursing Expenditure Analysis (£000s)

External

Contracts-5,305

M11 a reduction of£42k), although this remains the single largest area of overspend.At month 11 we were over established by 27.1 wte, a reduction in variance on last month of 8.0 wte.

Medical agency costs have also seen a further month on month reduction of £134k.

last month's level of expenditure.Lastly outsourcing of services to Parkhill, Barlborough and Medinet continues to pose a cost pressurewith income still partially off-setting the impact. CIP continues to under deliver but the focus is now around working up detailed and deliverable schemes for 2016/17.

Nursing expenditure continues to be broadly in line with budget whilst the variance on other staff

although still positive, has diminished in month by £223k.The overspend on drugs had once again reduced, by £119k month on month to £1.25m.

Clinical supplies & services continue to be adverse to budget and have remained consistent with6,600

6,800

7,000

7,200

7,400

7,600

7,800

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

2015/16 2014/15

6,400

6,600

6,800

7,000

7,200

7,400

7,600

7,800

8,000


2015/16 2014/15

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

Mar Apr May June July Aug Sep Oct Nov Dec Jan Feb

External Non-Substantive

Internal Non-Substantive

Substantive

Financial Performance - February 2016 - Expenditure Analysis

Medical Staff Analysis Medical Staff Expenditure Analysis (£000s) March 15 - February 16 Additional Session & Overtime Expenditure Analysis (£000s)

Agency Expenditure (£000s) March 15 - February 16 Additional Session Reason February 2016

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000


Internal Non-Substantive

External Non-Substantive

Substantive

0

500

1,000

1,500

2,000

2,500


Other Agency

Nursing Agency

Medical Agency

0

50

100

150

200

250

300

350

400

450

500


2015/16 Overtime 2015/16 Additional Sessions

2014/15 Overtime 2014/15 Additional Sessions

Capacity Gap (Vacancy)

Dental

ENT

GI

Ophthalmology

Orthopaedics

Respiratory

Urology

Anaesthetics

Children's

General Medicine

Gastroenterology

Rheumatology

COTE

Total : £241,591

Specialty Budget (£) WTE

Total WTE

Non-

Substantive

%

Womens & Maternity 4,012,152 43.30 -517,766 -2.16 17.05%

GU Medicine 537,557 6.59 87,543 0.88 4.24%

Childrens 5,202,598 56.76 -938,967 -3.92 35.53%

9,752,307 106.65 -1,369,190 -5.19 26.74%

Pathology 1,574,415 13.61 278,600 3.67 17.68%

Medical Imaging 2,264,270 18.06 -315,352 -3.35 10.40%

3,838,685 31.68 -36,752 0.32 12.84%

Accident and Emergency Department 5,336,565 59.34 -2,169,577 -11.75 60.79%

Emergency Medicine 4,184,453 57.36 -129,424 -1.41 34.23%

Medical Gastroenterology 1,916,647 18.80 -198,436 0.38 29.36%

Respiratory Medicine 2,011,209 21.65 -137,922 -1.29 18.91%

13,448,874 157.15 -2,635,359 -14.07 43.94%

Trauma & Orthopaedics 4,764,356 48.70 -528,248 -1.78 23.84%

Clinical Therapies 6,963 0.06 -2,234 0.00 0.00%

Care of the Elderly/Rehabilitation 1,928,319 20.81 -77,994 -2.25 23.16%

Rheumatology 711,307 6.65 32,751 1.15 3.46%

7,410,945 76.22 -575,725 -2.88 21.91%

Haematology 885,472 7.60 130,523 0.14 3.08%

Dermatology 812,338 7.23 -72,677 -1.95 35.89%

Renal 977,392 12.00 35,755 -0.35 3.76%

Pallative Care 232,142 2.49 -7,186 0.00 0.00%

Cardiology 1,442,829 15.00 54,898 2.42 16.05%

Stroke 667,787 7.00 -213,972 -1.37 49.49%

Diabetes & Endocrinology 1,163,593 12.00 -236,616 -0.84 35.36%

Breast 993,925 9.68 26,514 -0.09 20.09%

Vascular 1,264,234 12.50 -13,882 0.66 3.02%

Urology 1,268,819 12.00 -171,548 -6.74 14.48%

9,708,531 97.50 -468,191 -8.12 19.38%

Ophthalmology 1,977,435 19.50 -594,583 1.17 35.94%

Dental 750,989 8.11 -56,304 -0.32 11.35%

ENT 2,018,129 20.15 -332,150 -0.42 21.81%

Theatres & Day Surgery 12,975 0.00 12,975 0.00 0.00%

Anaesthetics, Critical Care & Pain Management 8,565,506 81.74 -903,835 2.80 18.32%

Gastro Intestinal Surgery 3,434,593 39.99 -904,128 -0.66 27.87%

16,759,627 169.49 -2,778,062 2.57 22.89%

Research 9,177 0.11 176 0.11 0.00%

PGME 155,975 1.92 17,603 0.00 0.00%

Medical Director 339,098 2.30 32,096 0.15 0.00%

504,250 4.33 49,875 0.27 0.00%

61,423,220 643.02 -7,813,403 -27.10 27.06%

Variance

WTE Net Budgetary Position

Children & Families Care Group £000s £000s £000s £000s £000s £000s £000s

Children & Family Services Care Group - Management 8.87 0 0 0 -97 521 -618 -618 Womens & Maternity 328.54 26,769 27,090 321 20,576 21,757 -1,181 -860

GU Medicine 33.10 5,048 4,913 -135 3,878 3,880 -2 -137

Childrens 249.50 14,851 14,702 -149 13,337 14,161 -824 -973

Total Children & Families Care Group 620.01 46,668 46,705 36 37,694 40,319 -2,625 -2,588

Diagnostic & Pharmacy Care Group

Diagnostic & Pharmacy Care Group - Management 3.72 0 0 0 280 262 18 18Pathology 192.33 6,126 6,479 353 11,620 11,225 395 748

Medical Imaging 209.66 5,222 5,280 58 11,483 13,000 -1,517 -1,459 Outpatient & Clinical Admin 233.35 132 128 -4 4,754 5,187 -433 -437 Pharmacy & Medicines Management 112.31 717 726 9 4,066 4,083 -17 -7

Total Diagnostic & Pharmacy Care Group 751.37 12,197 12,613 416 32,203 33,757 -1,553 -1,137

Emergency Care Group

Emergency Care Group - Management 6.96 0 0 0 209 416 -207 -207 Accident and Emergency Department 290.46 18,302 18,949 647 17,320 19,729 -2,409 -1,762 Emergency Medicine 303.32 33,821 36,292 2,471 13,675 16,380 -2,706 -234

Medical Gastroenterology 94.66 0 0 0 4,824 4,805 19 19

Respiratory Medicine 145.43 2,481 2,648 168 6,452 6,894 -442 -274

Total Emergency Care Group 840.84 54,603 57,889 3,286 42,480 48,225 -5,745 -2,458

MSK & Frailty Care Group

MSK & Frailty Care Group - Management 8.06 0 0 0 546 512 35 35

Trauma & Orthopaedics 265.11 34,851 34,113 -738 21,873 23,278 -1,404 -2,143

Clinical Therapies 332.42 8,216 8,183 -33 12,304 12,022 282 249

Care of the Elderly/Rehabilitation 247.09 12,015 12,277 262 9,317 10,316 -999 -738

Rheumatology 15.78 9,751 9,325 -426 8,501 8,077 424 -1

Total MSK & Failty Care Group 868.46 64,833 63,897 -936 52,542 54,205 -1,663 -2,598

Specialty Services Care Group

Specialty Services Care Group - Management 26.43 0 0 0 887 848 39 39

Neurology 7.63 465 466 2 155 171 -17 -15

Haematology 31.74 10,922 10,276 -647 7,603 7,225 378 -269

Dermatology 29.63 3,233 3,022 -211 1,708 1,914 -206 -417

Renal 75.23 7,200 7,216 16 6,116 5,997 118 134

Pallative Care 15.71 127 142 15 918 872 46 61

Cardiology 145.65 7,732 7,728 -5 7,732 8,192 -461 -466 Corporate Cancer 3.67 0 0 0 87 87 -0 -0 Stroke 56.82 2,944 3,327 382 2,146 2,743 -597 -215

Actual to

date Variance Variance

Income Expenditure

Specialties

Average

Actual

Worked 15/16

Budget to

date

Actual to

date Variance

Budget to

date

Financial Performance - February 2016 - Specialty Performance Summary (+ Favourable / - Unfavourable)

WTE Net Budgetary Position

Actual to

date Variance Variance

Income Expenditure

Specialties

Average

Actual

Worked 15/16

Budget to

date

Actual to

date Variance

Budget to

date

Diabetes & Endocrinology 74.09 6,582 6,471 -111 3,325 3,822 -497 -608 Breast 29.73 4,235 3,821 -414 2,205 2,174 31 -384 Vascular 47.50 4,777 4,984 207 3,281 3,534 -252 -46 Urology 62.64 8,065 7,789 -276 3,391 3,729 -338 -614

Total Specialty Services Care Group 606.47 56,284 55,241 -1,042 39,551 41,308 -1,757 -2,799

Surgical Care Group

Surgical Care Group - Management 18.44 0 0 0 787 1,005 -218 -218

Ophthalmology 81.22 13,225 12,069 -1,156 8,156 8,375 -219 -1,375

Dental 27.76 2,936 2,584 -352 1,973 2,138 -165 -517

ENT 63.42 7,848 7,355 -493 3,620 3,932 -312 -805

Audiology 29.65 2,043 2,080 37 2,042 2,138 -96 -59

Theatres & Day Surgery 262.80 77 73 -4 12,171 12,266 -95 -99

Anaesthetics, Critical Care & Pain Management 297.92 12,558 12,331 -227 18,486 19,336 -850 -1,077

Gastro Intestinal Surgery 215.30 24,642 23,232 -1,410 11,688 13,317 -1,629 -3,039

Endoscopy 79.17 0 0 0 3,126 3,344 -218 -218

Total Surgical Care Group 1,075.67 63,330 59,725 -3,605 62,049 65,849 -3,801 -7,406

Corporate Directorates & RechargesNursing Services 46.31 44 44 0 2,117 2,068 50 50Research 6.53 213 193 -20 229 242 -12 -33 PGME 42.42 78 57 -22 2,244 2,242 2 -20 Hotel Services, Estates & General Operations 714.49 4,983 4,612 -372 27,938 30,238 -2,300 -2,672 People and Organisational Development 56.58 1,936 2,108 173 2,158 2,101 57 230Legal 7.35 0 0 0 2,400 2,441 -41 -41 Chief Executive 18.60 461 461 -0 1,782 1,959 -177 -178 Medical Director 5.24 0 0 0 447 433 13 13Performance Management 56.86 44 41 -3 1,920 1,971 -51 -54 Finance & Healthcare Contracting 162.23 131 179 48 7,219 7,514 -294 -246 Strategy and Improvement 3.10 0 0 0 190 290 -101 -101

Total Corporate Directorates & Recharges 1,119.68 7,891 7,695 -196 48,644 51,498 -2,854 -3,050

24,807 22,898 -1,909 1,366 9,610 -8,245 -10,154

32,699 30,593 -2,105 50,009 61,108 -11,099 -13,204

5,882.50 330,613 326,663 -3,950 316,527 344,769 -28,243 -32,192 Trust Total

Plan phasing adjustment (Monitor plan) and

Total Corporate Directorates, Recharges and Contingency

Recharges and Contingency

Plan Actual The key risks identified in the 2015/16 Business Plan were;

3 1

3 1 - Care Group and Specialty Overspends Care Group and Specialty financial performance is set out on the previous page. Plan Actual

3 1 The Care Group and Specialty financial performance is inclusive of funding adjustments for;

activity and drug growth in line with the Trusts clinical activity projections, pay and non pay - Stock Days 18.1 15.8

3 1 inflation, historic cost pressures, CIP and CCG and Trust developments which are

consistent with the income plans for each Specialty. The performance to date is poor.

3 1 - NHS Trade Debtor Days 13.4 6.1 - CIP Performance

The CIP plans were generated as part of the 2015/16 Business Planning process and the

detailed plans have been reviewed and signed off by the Board. - Non NHS Trade Debtor Days 4.0 2.8 The CIP schemes have been phased as per the agreed projections with Care Group Managers.

CIP performance to date has been very disappointing with the majority of schemes not

delivering the planned level of savings. - Trade Debtor Days 17.4 8.9

- CCG Affordability Doncaster CCG is £198k ahead of plan to date (inclusive of 2015/16 assumed activity) primarily - Trade Creditor Days 60.2 29.5 driven by the Outpatient and offset by Non PbR drugs underperformance.

Bassetlaw CCG are now £307k ahead of plan. This has increased mainly due to Emergency.

Liquidity ratio

Financial Performance - February 2016 - Key Financial Indicators

Capital Spend Profile Against Plan (£000s) 2015/16 Cash Profile Against Plan (£000s) 2015/16 Daily Actual Cash Balances - February 2016

Capital expenditure at month 11 of £11.8m is £7.1m behind plan (£4.9m at month 10). The variance

continues to be due to planned slippage on property and replacement medical equipment expenditure

partly offset by information technology schemes. The variance above 30% is outside Monitor’s

tolerance level but is an integral part of the Trust’s cash recovery plan.

The cash position at month 11 is £1.9m which is £5.6m below the plan to date of £7.5m. The variance is due to

the significant I&E overspend against plan and slippage on land disposals, partly offset by the early drawdown of

the approved ITFF loan and access to Monitor approved temporary working capital facility.

Financial Sustainability Risk Rating (FSRR) to 31st March 2016) Key Financial Risks to February 2016

Financial Sustainability Risk Rating

Key Financial Metrics to February 2016

Capital servicing capacity

I&E Margin

The aggregated Financial Sustainability Risk Rating (FSRR) rating is a 1 against a plan of 3. All four of the

elements (liquidity, capital servicing capacity, I&E margin and variance from plan) are rated as 1,

reflecting the variance in the overall I&E position.

Variance from Plan

Overall FSRR

31 March 31 March

2015 2015 CommentaryActual Actual (Restated) Plan Actual Variance£000 £000 £000 £000 £000

Non-current assets

Intangible assets 3,498 3,498 2,948 2,750 (198)

Property, plant and equipment 201,632 201,632 208,407 206,658 (1,749)

Trade and other receivables 1,993 1,993 1,968 1,976 8

Total non-current assets 207,123 207,123 213,323 211,384 (1,939)

Current assets

Inventories 5,476 5,476 5,501 5,556 55

Trade and other receivables 16,562 14,602 23,399 19,732 (3,667)

Cash and cash equivalents 11,706 11,706 7,535 1,897 (5,638)

Total current assets 33,744 31,784 36,435 27,185 (9,250)

Non-current assets held for sale 350 350 - - -

Current liabilities

Trade and other payables (31,579) (45,892) (28,929) (32,047) (3,118)

Borrowings (2,483) (2,483) (2,483) (2,860) (377)

Provisions (442) (442) (142) (404) (262)

Total current liabilities (34,504) (48,817) (31,554) (35,311) (3,757)

Total assets less current liabilities 206,713 190,440 218,204 203,258 (14,946)

Non-current liabilities

Borrowings (15,460) (15,460) (24,970) (59,651) (34,681)

Provisions (590) (590) (590) (462) 128

Total non-current liabilities (16,050) (16,050) (25,560) (60,113) (34,553)

Total assets employed 190,663 174,390 192,644 143,145 (49,499)

Financed by (taxpayers equity)

Public dividend capital 128,755 128,755 128,755 128,755 -

Income and expenditure reserve 25,555 9,282 27,536 (21,763) (49,299)

Revaluation reserve 36,353 36,353 36,353 36,153 (200)

Total taxpayers equity 190,663 174,390 192,644 143,145 (49,499)

As at 29th February 2016

Statement of Financial Position

Balance Sheet - February 2016

Tangible assets are below plan due to the reduced capital expenditure programme and cash restriction.

Trade and other receivables are lower than plan due to prior year adjustments, the prompt payment of monies

by NHS Trusts and CCGs; and prepayments being lower than expected as a result of a revised payment schedule

with NHS Litigation Authority.

Cash is below plan due to the significant I&E overspend against plan and slippage on land disposals, partly offset

by the early drawdown of the approved ITFF loan and access to Monitorapproved temporary working capital

facility.

Trade and other payables are above plan due to prior year adjustments to trade payables and accruals,the

extension of trade creditors, which is slightly offset by lower than expected capital creditors due to the slippage in

the capital programme.

Borrowings are above plan due to the earlier drawdown of the approved ITFF loan and loans provided as the

temporary working capital facility.

Income and expenditure reserve variance reflects the prior year adjustments and significant in-year overspend

against the planned surplus position.

The level of trade creditors reduced in August (month 5) following receipt of the ITFF loan.

Aged Creditor Analysis - February 2016

NHS - Creditor Analysis Non NHS - Creditor Analysis

0

1500000

3000000

4500000

6000000

7500000

9000000

10500000

12000000

0

500000

1000000

1500000

2000000

2500000

3000000

3500000

4000000

201601 201602 201603 201604 201605 201606 201607 201608 201609 201610 201611

Not Yet Due/Data Quality

0-29

30-59

60-89

90-120

>120

Grand Total

-2000000

0

2000000

4000000

6000000

8000000

10000000

12000000

14000000

16000000

-1000000

0

1000000

2000000

3000000

4000000

5000000

6000000

7000000

8000000

201601 201602 201603 201604 201605 201606 201607 201608 201609 201610 201611

Not Yet Due/Data Quality

0-29

30-59

60-89

90-120

>120

Grand Total

1

Title Business Intelligence Report


Author: David Purdue, Chief Operating officer

Sewa Singh, Medical Director

Richard Parker, Director of Nursing, Midwifery and Quality

For: Note


The Business intelligence report highlights the key performance and financial targets required by the Trust to maintain Monitor compliance. The report gives insight into current issues and pressures faced during the current increase of emergency activity.

Recommendation(s)

To note

Delivering the Values – We Care (how the values are exemplified by the work in this paper)

We always put the patient first

By ensuring the correct capacity and pathways are in place to allow for treatment in the right place, first time. To ensure quality care is at the centre of all we do to provide the most efficient service.

Everyone counts – we treat each other with courtesy, honesty, respect and dignity

By ensuring that all parties have contributed to the planning and delivery of services Committed to quality and continuously improving patient experience

By delivering new ways of working across health and social care to ensure compliance withal quality indicators

Always caring and compassionate

By ensuring staff are committed to working with partners to improve services. Responsible and accountable for our actions – taking pride in our work

By being accountable for delivery of the efficient and effective services Encouraging and valuing our diverse staff and rewarding ability and innovation

By ensuring engagement in planning and delivery of services



2




Analysis of risks

Resource – Key financial issues related to additional funding streams to support planning for surge capacity.

Governance – The Trust needs to maintain compliance framework with monitor

Equality and Diversity – No known issues or risks.

PR and Communications – Need for continued appropriate communication to ensure ongoing performance

Patient, Public and Member Involvement – Public attendance at System Resilience Groups

Risk Assessment – The risks to the Trust’s performance are very high 2015/16, at this stage especially in relation to 4hr access

NHS Constitution - Rights and Pledges – No known issues or risks.

Indicator December January February Comments

31 day wait for second or subsequent treatment: surgery 94.0% 100.0% 100.0% 100.0%

31 day wait for second or subsequent treatment: anti cancer drug treatments 98.0% 100.0% 100.0% 100.0%

31 day wait for second or subsequent treatment: radiotherapy 94.0% 100.0% 100.0% 100.0%

62 day wait for first treatment from urgent GP referral to treatment 85.0% 89.3% 76.3% 85.2%

62 day wait for first treatment from consultant screening service referral 90.0% 95.8% 82.4% 91.9%

31 day wait for diagnosis to first treatment- all cancers 96.0% 99.4% 97.6% 97.6%Two week wait from referral to date first seen: all urgent cancer referrals (cancer suspected)

93.0% 95.0% 93.5% 96.6%

Two week wait from referral to date first seen: symptomatic breast patients (cancer not initially suspected)

93.0% 93.3% 94.9% 97.4%

A&E: Maximum waiting time of four hours from arrival / admission / transfer / discharge (Trust)

95.0% 95.5% 92.1% 92.5%

DRI performance dropped to 89.24%, including MMH, 90.32%. 836 patients failed

to be treated within 4hrsBassetlaw CCG performance 96.02%, 155

patients breached the target. Trust performance continues to be in the upper

quartile of national performance.Maximum time of 18 weeks from point of referral to treatment- incomplete pathway

92.0% 92.1% 92.3% 92.1%

% of Patients waiting less than 6 weeks from referral for a diagnostics test 99.0% N 96.5% 99.5% 99.7%

Total time in A&E: 4 hours (95th percentile) HH:MM 04:00 04:00 06:11 06:16A&E Admitted patients total time in A&E (95th percentile) HH:MM 04:00 07:48 10:20 10:49A&E Non-admitted patients total time in A&E (95th percentile) HH:MM 04:00 03:56 03:58 03:58A&E: Time to treatment decision (median) HH:MM 01:00 00:53 00:57 01:00A&E unplanned re-attendance rate % 5.0% 0.30% 0.4% 0.40%A&E: Left without being seen % 5.0% 3.00% 3.0% 3.60%

Ambulance Handovers Breaches -Number waited over 15 & Under 30 Minutes 743 821 717

Ambulance Handovers Breaches-Number waited over 30 & under 60 Minutes 72 239 229

Ambulance Handovers Breaches -Number waited over 60 Minutes 4 40 50Proportion of patients admitted to an acute Stroke unit within 4 hours of arrival

90.0% 60.0%

Proportion of Stroke patients scanned within one hour of arrival at hospital 50.0% 51.1%

Proportion of Stroke patients scanned within 24 hours of arrival at hospital 100.0% 93.3%

Proportion of high-risk TIA patients investigated and treated within 24 hours of first contact with a health professional

60.0% 72.2%

Cancelled Operations 0.8% 2.0% 2.9% 2.1%Cancelled Operations-28 Day Standard 0 2 5 2Out Patients: DNA Rate 9.5% 7.9% 7.6%Out Patients: Hospital Cancellation Rate 17.5% 16.3% 16.6%Total Number of DNAsTotal Number of DNWDid Not Wait Rate

Effe

ctiv

e

Emergency Readmissions within 30 days (PbR Methodology) L 6.2% 6.7%Data

Unavailable

% of patients achieving Best Practice Tariff Criteria 82.90% 59% 42.20%36 hours to surgery Performance 82.90% 70.40% 66.60%72 hours to geriatrician assessment Performance 100% 93.10% 90.90%

% of patients who underwent an MDT assessment 97.60% 100% 93.30%

% of patients who underwent a falls assessment 100% 100% 86.70%

% of patients receiving a bone protection medication assessment 100% 100% 95.6

Mortality-Deaths within 30 days of procedure 3.05% 1.81% 2%

Infection Control C.Diff

4 Per Month for Qtr 2 - 45 full year

M 1 1 2

Infection Control MRSA 0 L 0 0 0

HSMR (rolling 12 Months) 100 N 101.53(Oct 14 - Sep 15)

100.18(Nov 14 - Oct

15)

98.94(Dec 14 - Nov 15)

Never Events 0 L 0 0 1 Currently under investigation.VTE 95.0% N 95% 95% 95%

Pressure Ulcers12 Per

Month 144 full Year

L 2 4 2

Falls that result in a serious Fracture 2 Per

Month 23 full Year

L 2 1 2

Catheter UTI 0.82% 0.69% 0.23%

Complaints received 42 49 54Concerns Received 63 84 71Complaints Performance 65.2 38.6 19.8Clinical Negligence Scheme for Trusts (CNST) 6 4 4Liabilities to Third Parties Scheme (LTPS) 1 0 5

Total number of open and active claims with the NHSLA (as at 31 May 2015) 257 256 267

Claims per 1000 occupied bed days 0.27 0.14 0.36

Performance over 3 monthsSt

roke

N

Thea

tres

&

Out

patie

nts

N

L

Standard (Local,

National Or Monitor)

Mon

itor C

ompl

ianc

e Fr

amew

ork

M

A&E

Perf

orm

ance

Indi

cato

rs

N

62 day pathways failed in January due to continued capacity and pathway issues

primarily with urology.

As above.

Com

plai

nts &

Cla

ims

Snap shot audit

Data Not available, stroke is reported 2 Months

behind

The key pathway remains direct admission to a hyper acute stroke bed. The reporting of SSNAP data is refreshed each month up to 3 months so the latest figures are from December, of the 45 discharged, only 60% were admitted in 4hrs, 76% were admitted

within 5hrs.

Performance is affected by Winter pressures. Improvement work is underway

as part of the turnaround projects.Data is unavailable, unable to report

Frac

ture

d N

eck

of F

emur

Performance is recorded by the Ambulance services and is affected by both Winter pressures and the accuracy of recorded

data.

Safe

Draft - for discussion at Board of Governors meeting

Title 15/16 Q3 People and Organisational Development Delivery Report; and

2015 Staff Survey outcomes


Author: Dawn Jarvis, Director of People & Organisational Development (P&OD) – for the period being reported (Q3) and Ruth Cooper for 2015 Staff Survey outcomes

For: Note and Approve


This paper seeks to update Board of Governors on the progress made in Q3 15/16 to deliver the P&OD Strategy, the annual KPIs (page 10), corporate objectives and P&OD led projects. The paper also highlights outcomes and agreed areas for action from the 2015 Staff Survey.

Recommendation(s)

The Board is asked to NOTE the content of the update and COMMENT on progress. The first three quarters of 15/16 has been generally positive from a P&OD perspective, with good progress made in several areas. Such as engagement, sickness absence and the beginnings of progress in training statistics. P&OD produce data each month for the Care Groups and the Corporate Directorates which gives them full staffing lists for their cohort and reports on all the KPIs at team and individual levels, (see page 11 for the one page overview). Each area for each month is marked red, amber or green:-

Red missed the target and worse than Trust average

Amber missed the target but better than Trust average

Green reached target This focus is leading to improvements in all areas overall. As the Board will be aware the main priority for P&OD in 15/16 is appraisals, closely followed by Statutory & Essential Training (SET), both of which are corporate objectives, along with several others delegated to the Director of P&OD for implementation. These corporate objectives, P&OD Strategy KPIs and P&OD led projects are all reported within this report. Of particular note in Q3 15/16, the Board’s attention is drawn to the following sections of the report:-

1. Absence and wellbeing – with a cumulative total of 3.89%, above our target of 3.5%; 2. Turnover, deployment and registration – now we are able to monitor voluntary turnover which

averages around 7.5% 3. Appraisals - huge improvements from the 2012 low of 20% up to a peak of 82% by the end of

September. Staff survey 2015 outcomes show a response to this question of 86%.

4. Training, education and development - rates for SET are still much lower but a project mirroring the approach used for appraisals will see us achieve the same outcomes for year end and Q3 outcomes show a rise to just under 60%.

5. Vacancy rates and recruitment – for the first time we are reporting Trust wide vacancy % which cumulatively YTD average is at 7.9% this figure is derived from the difference between the budgeted establishment and the filled and paid for posts. We are working on aligning the descriptors used and the way gaps are reported between finance, HR and Care Groups and will reach a more sophisticated level of reporting, though this will take several months.

2

6. Casework – a steady downturn in discipline and conduct dismissals, a sharp rise in capability

dismissals, a big reduction in appeals and no employment tribunals. This shows a heightening level

of grip and competence by managers being well supported by the Casework and HR Business Partner

teams.

7. Staff survey and engagement – during Q3 we saw good outcomes from the Q2 staff FFT in Estates

and Facilities, with an ongoing upward trajectory for a good place to work and receive care, and a

rise in their response rate to 44%. Outcomes from 2015 NHS Staff Survey show a broadly stable

picture - improved response rate 42% (NHS acute rate 41%). Compared to all acute Trusts, of the 32

key findings areas this year (2014 results in brackets, when only 29 key findings were reported):-

o 1 (1) issue in the best 20%

o 8 (8) issues better than average

o 9 (5) issues at the average

o 10 (10) issues worse than average

o 4 (5) issues in the worst 20%.

Compared with 2014 results, 6 issues improved, 15 stayed the same and 1 issue deteriorated. These

results offer some encouragement given the broader context and although ourfocus must be on

turnaround, we agreed with Board of Directors (March 2016) to continue with current priorities of

appraisal; Statutory & Essential to Role training (SET); Management Skills/Leadership; and Health and

Wellbeing. We will support Care Groups/Directorates with their local survey outcomes and to

develop actions to address issues. Annex 3 shows the differences that merit additional local action.

Annex 1 shows the original KPIs from the P&OD strategy; Annex 2 shows the Care Group and Corporate comparison document. Annex 3 shows the 2015 NHS Staff Survey outcomes for DBH

Delivering the Values – We Care (how the values are exemplified by the work in this paper)

We always put the patient first

By focusing on improving staff presence, well-being, engagement and skill level Everyone counts – we treat each other with courtesy, honesty, respect and dignity

By having clear and transparent processes and policies and by living our values Committed to quality and continuously improving patient experience

By ensuring we are continuously improving against our KPIs and objectives Always caring and compassionate

By recruiting, retaining and engaging the right staff who demonstrate our values Responsible and accountable for our actions – taking pride in our work

By having clear objectives and actions to improve our performance and quality Encouraging and valuing our diverse staff and rewarding ability and innovation

By ensuring the right people with the right skills are involved in delivering our progress






Analysis of risks

There are two Trust wide risks on the Corporate Risk Register and the Board Assurance Framework that will be directly improved or mitigated by the delivery of the P&OD Strategy through successful delivery will help to support the delivery or mitigation of most corporate risks. Board Assurance Framework

10 Inability to recruit right staff and ensure staff have the right skills to meet operational needs 3x4=12

15 Failure to engage and communicate with staff and representatives 2x3=6

3

1. Absence and Wellbeing

Corporate Objectives 15/16 Q1 15/16

Comprehensively implement and maintain processes and procedures to reduce and then maintain staff sickness to <3.5% measured as an annual position. Hold corporate directorate and care groups to account by escalating performance issues or failure to use corporate tools and processes designed to manage sickness.

Q4 annual

Develop a comprehensive BoD approved Strategy for Staff Health and Wellbeing by Q2 that will be supported by staff side, set measurable goals for improvement and will radically impact the health and wellbeing of our staff, helping us over time to become role models for healthy living

Q2

People and Organisational Development Strategy KPIs

Staff sickness <3.5% Q4 annual

Flu immunisation >81% - 63.6% outcome in December. Most NHS organisations saw a decline, many of around 20% we were just in the top 10% being 27

th out of 270. In comparison with other local or benchmark organisations we did relatively

week as follows:- Chesterfield – 76.6%; Barnsley – 66.1%; SCH – 46.6%; STH – 44.3%; MYorks 35.7%; TRT 55.4% York – 40.4%; WWL 50.4%; Salford 25.8%

Q3

Year on year the absence levels are dropping nearer to our target and our relative position regionally

and nationally continues to be good with us regularly in the top 3 regionally.

Our cumulative position at Q3 is only marginally above our target at 3.89% despite the year starting

with higher than target outcomes (April 4.25%, May 4.07%, June 3.95%, July 3.01%, August 3.71%,

September 3.82% October 3.08%, November 3.44%, December 3.79%). Three out of nine months

have been under target. We build in the 3.5% absence rate to our staffing plans but anything over

this may affect care and costs if we directly backfill. Our cumulative annual absence for Q3 of 3.89%

represents 58,879.69 days lost (£112 per day using average salary and whole pay bill = £6.6m so far

this year which is over by .39% or £700k). Greater focus and ownership by the Care Groups is

proving to be successful, though there are pockets of excellence and areas that need to do more as

outlined in appendix 2. Our continued focus on the use of the Bradford Factor (S²xD=BF – S=spells,

D=days lost, BF=Bradford Factor) is showing positive results from a 14/15 high of 235 people with a

BF over 1000 to 172 in December.

We are also monitoring the length of absences over 12 (3 cases), 6 months (worrying rise from 12 to

24 which is being picked up) and 28 days (slight rise to 203).

4.70% 3.98% 3.92% 3.89% 3.50%

12/13 cum 13/14 cum 14/15 cum 15/16 Q cum Target

0

100

200

300

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

BF +1000 BF +1000 14/15

4

2. Turnover, deployment and registration

Corporate Objectives Q1

N/A

People and Organisational Development Strategy KIPs

Voluntary turnover <10% annually Q4 annual

Additional P&OD led projects

E-roster roll out (DBH2020 project on embedding and handover to be a separate project) Further roll

out moving

to CIP

Programme

Deliver voluntary turnover levels by taking out areas for purposeful turnover from the statistics.

Q3

NHS Professionals Phase2 Moving to CIP Programme

We can now report voluntary turnover which shows around a 7% annual turnover rate.

Dec 2015 Voluntary Reasons

11% 11.7% 12.40% 10.67% 10%

0%

5%

10%

15%

% Rolling Turnover Rates

12/13 Baseline Cum 13/14 Cum 14/15 15/16 Q3 Cum 2017 Target

Monthly Turnover 2015 / 04 2015 / 05 2015 / 06 2015 / 07 2015 / 08 2015 / 09 2015 / 10 2015 / 11 2015 / 12

Average Headcount 6,675 6,652 6,592 6,574 6,624 6,698 6,646 6,649 6,696

Average FTE 5,493.45 5,474.19 5,429.95 5,416.22 5,459.40 5,526.33 5,483.22 5,483.18 5,526.08

Average Leavers Headcount 42 45 52 53 43 43 40 37 38

Average Leavers FTE 34.23 35.08 41.11 46.70 36.97 34.02 29.63 32.10 28.92

Average Starters Headcount 59 31 67 65 186 132 93 53 61

Average Starters FTE 47.97 23.75 50.72 51.87 165.05 116.39 78.67 40.75 49.73

Maternity 137 135 130 139 136 140 144 133 131

Annual Turnover 2015 / 04 2015 / 05 2015 / 06 2015 / 07 2015 / 08 2015 / 09 2015 / 10 2015 / 11 2015 / 12

Turnover Rate (Headcount) 0.63% 0.68% 0.79% 0.81% 0.65% 0.64% 0.60% 0.56% 0.57%

Turnover Rate (FTE) 0.62% 0.64% 0.76% 0.86% 0.68% 0.62% 0.54% 0.59% 0.52%

Leavers (12m) 468 478 498 527 524 516 523 520 527

Turnover Rate (12m) 7.11% 7.25% 7.54% 7.97% 7.92% 7.78% 7.87% 7.82% 7.92%

Leavers FTE (12m) 374.66 379.54 395.79 424.17 423.64 416.11 416.05 416.00 421.03

Turnover Rate FTE (12m) 6.92% 7.00% 7.29% 7.80% 7.78% 7.62% 7.61% 7.60% 7.68%

5

3. Staff Survey and Engagement


Develop and agree a clearly defined and branded staff engagement programme to deliver P&OD Strategy, communication and engagement ambitions.

Q3

Implement the key actions arising from the Staff Survey 14/15 and quarterly Staff FFTs. Ensure each care group and corporate directorate has developed a local action plan by the end of Q1 to take forward local issues identified in the staff survey

Q1 & Q3

People and Organisational Development Strategy KPIs Q1

Engagement scores at 4.00 by 2017 2017

Staff survey response rates at 55% in the annual staff survey by 2017 Our response rate for annual staff survey increased to 44% against an average of 38% (not yet adjusted)

2017


Internet/Intranet Procurement and Implementation Q2 & Q4

Quarterly Staff Friends and Family Test (FFT). Q1,2,3,4

3.51

3.72 3.72

4

3.2

3.4

3.6

3.8

4

4.2

Annual Staff Engagement Score

12/13 Baseline 13/14 14/15 2017 Target

57%

34% 42% 44%

55%

0%

20%

40%

60%

Annual Survey Response Rates

12/13 Baseline* last paper based 2013* online 2014 2015 2017 Target

6

4. Appraisals


Ensure that at least 90% of staff are recorded on ESR by September 2015 as having had an appraisal in the last year through delivery of the first stage of a longer term project covering uptake, information and systems and quality assured content. Dawn Jarvis will be responsible for the corporate systems and policy. Each executive director will be held individually accountable for the staff under his/her leadership as demonstrated by the September ESR report

80% by September 90% by Q4

People and Organisational Development Strategy KIPs

Appraisal completion >90% by 2017 2017

There is a 3 phase project underway with phase 1 completed to ensure we have the right quantity

and quality of appraisals completed for all staff across DBH. We began 14/15 reporting only 27%

(20% in 2012) of staff logged as having an appraisal and are currently reporting 79% against a

national standard of 85% and an internal target of 90%. In the 2014 full staff survey, 63% of staff

said they had received an appraisal in the last year, with a rise to 73% in Q1 FFT. Early, unverified

outcomes of the 2015 staff survey show this has risen to 86%, above the national average.

This is excellent progress, and our engagement with the project board continues to be high, with the

project moving into phase two focusing on quality of conversations as well as quantity of appraisals.

20% 20%

63%

42%

73%

55%

73% 81%

86% 79%

90% 90%

0%

20%

40%

60%

80%

100%

% Appraisal Completion by staff survey (left) and by data from ESR (right)

12/13 Baseline 14/15 Q1 15/16 Q2 15/16 Q3 15/16 2017 Target

7

Training, education and development


Deliver the Statutory and Essential to role (SET) training project to ensure that at least 90% of staff accesses the full programme appropriate to their role, including safeguarding training, by year end

Q4

Develop a clear understanding and forward programme covering the next three years with the University of Sheffield Medical School by Q3, describing how the two organisations will work together to increase student numbers and deliver excellent medical education at DBH

Q3

People and Organisational Development Strategy KPIs and deliverables

SET training completed for >85% of staff by 2017 2017


Future Leaders – first pilot cohort working well with all 15 through first stages Q3

Coaching – delivery in Q3 procured training provider dates for October Q3

Training and Education Restructure – delivery in Q3 Q3

Management Skills Programme – Module 1, 2 and 3 up and running over 200 attended Q4

We have delayed the planned launch over the summer on our much simplified SET training

programme. However we have been following the same pattern of action as with the appraisal

project and this is already showing an increase in the internal Trust systems of recording as

shown below we are currently at 59%. The issues that led us to report such low rates are very

similar to that of appraisal and the two are mutually supportive as the essentials of good people

management. We are also making excellent progress in our work and relationship with Sheffield

Medical School and Sheffield Hallam University.

More widely in the education and development area we are making good progress across a

number of development interventions with excellent attendance and engagement in coaching,

Management Skills Programme and our innovative Future Leaders Programme.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


14/15 % Target - 90%

Staff Suvey 2014 Prediction

SET Training rates

drawn from

Employee Staff

Record system (ESR)

8

5. Vacancy Rates and Recruitment

Corporate Objectives Q1 15/16

To Produce a Workforce Planning Strategy for all professions and staff groups by Q2 15/16 with clear plans to deliver on over and under supply issues for each profession or staff group by Q4 15/16; the overall Trust wide strategy will be developed and delivered by Dawn Jarvis, and each profession or staff groups’ plans will in turn be led by the relevant Executive Director

Q2


Vacancy rates less than 5% 2017


Recruitment and Workforce Planning Project Q4 & 2016

International Recruitment Project Q3 & Q4

For this report we have widened the focus onto all gaps across the Trust, which may then translate

into a vacancy.

Currently, we can report the difference between the budgeted for, whole time equivalent (WTE) in a

Care Group or Corporate Directorate and the fill rate of those roles which the cumulative average for

the year is 7.4%. We have two pieces of work underway though these are currently of a lower

priority within Finance and Employee Services:

one to align the budget data with people in post data e.g. staff on maternity leave who

are not here but are being paid which may show as an oversupply issue; and

a second, which is part of the Recruitment and Workforce Planning Project to report by

staff group what gaps translate into actual vacancies that are or are not being recruited

to and what stage that recruitment is at.

While I am satisfied that the reported % is currently an overestimation of our vacancy position it is

likely to be some months before we can report a fully accurate position, as we have yet to remove

examples like the maternity one or gaps where the choice has been made not to fill it, from the

calculations.

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%


Target - 5%

Overall Trust gap % drawn from Employee

Staff Record system (ESR)

9

6. Casework

Corporate Objectives 15/16 Q1

N/A


N/A


Employee Relations Casework review Q4

Case Type 12/13 13/14 14/15 15/16

Grievance (17/19/10) 2 9 1 Grievance Upheld

12 7 3 Grievance Not Upheld

3 3 4 Part/Informal

2 Withdrawn

Conduct/Discipline (176/160/52)

66 73 19 No Action/Informal Action

87 72 23 Formal Action not Dismissal

23 15 6 Dismissal

4 Resigned

Capability (26/67/131) 4 11 19 No Action/Informal Action


4 23 18 Dismissal

7 Resigned

Harassment & Bullying (4/4/4)

4 3 4 No Action/Informal Action


3 0 0 Dismissal

Appeals # (21/9/6) 1 1 0 Appeal Successful

20 9 4 Appeal Unsuccessful

2 Withdrawn

Employment Tribunals # (4/0/3)

0 0 0 ET Successful for claimant

4 0 1 ET Unsuccessful for claimant

0 3 2 ET Withdrawn

Whistleblowing (0/1/1) 0 1 2

Suspensions *&** (6/6) 16 paid 2 unpaid

6 paid 5 paid 1 unpaid

6 paid

Calculated as a cumulative total year to date – i.e., there are currently (15.01.16) just 4 ongoing suspensions and no alternatives to suspension.

Alternatives to Suspensions (8/7)

8 paid 7 paid 3 paid 2014/15 includes 1 individual who was initially suspended on full pay for two weeks and this was then commuted to alt. to suspension.

Capability - failure of sickness targets

5 2 103

Ill Health Capability 3 23 24

Capability - Performance 1 1 4

# No. of Appeals/ET cases concluded in period (case included only if also concluded in same period)

* These will be included in the above figures; ** With and without pay;

10

Annex 1 – P&OD Strategy KPI tracker 2012 – 2017

KPI 2017 Target

12/13

14/15 Q3 15/16 Descriptor

Vacancies 5%* 9-12% 4.89% 7.47% From Q1 15/16 reports all gaps across Trust, more work to do to translate into actual vacancy numbers

Absence 3.5%** 4.7% 3.97% 3.89% Cumulative YTD taken directly from eWin workforce data source

Turnover <10% 11% 11.4% 10.67% Rolling annual % includes voluntary turnover taken directly from eWin data source

Engagement 4.00 3.51 3.72 N/A Calculated by taking the scores for 9 questions (scored 1-5) and averaging them scoring 4 for 5 of the questions and 3 for 4 of the questions means (4x5)+(3x4)=32÷9=3.5 giving an engagement score of 3.5

Flu immunisation

>81% 80% 82.5% - including 71.2% nursing

63.6 % of clinical, front line staff immunized, our denominator group as determined by NHS England is around 4300 results are a % of that figure. Other staff cannot count towards results

Staff Survey response rates

>55%*** 57% 42% (2014) 44% % of staff responding – based on full annual on line survey 2012 was paper based.

Appraisal >90% 20% 63% (2014) 86% (2015) % of staff in staff survey saying they have had an appraisal in the last 12 months

Training >85% 20% 80% (2014)

TBC % of staff saying they have had training that has helped them do their job more effectively in the staff survey

*4.5% raised to 5% by Board of Directors following nurse staffing paper June 2014

**absence target is 3.5% not 3% as stated in the printed copy of P&OD Strategy

***reduced from 70% by Board of Directors following March 2015 Board paper on staff survey after reviewing

performance of top decile Trusts.

11

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8.4

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9.5

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2.4

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3.7

546.3

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8%

31.6

4%

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2015 RAG Percentage Difference from Acute Average 3 52 10 5 18 12 28 43 33 45 16 64 15

National Staff Survey 18 47 25 49 24 30 38 27 21 21 19 61

10 29 56 19 50 27 5 22 18 46 3 10

6 1 4 2 3

Question Topic Q Positive Score Text

Organisation

Average %

Chief Executive

Directorate

Children &

Family Care

Group

Diagnostic &

Pharmacy Care

Group

Emergency Care

Group

Estates &

Facilities

Finance &

Healthcare

Contracting

MSK & Frailty

Care GroupNursing Services

People &

Organisational

Development

Performance

Speciality

Services Care

Group

Surgical Care

Group

2a Often/always look forward to going to work 58 74 53 49 65 56 44 61 76 61 46 64 61

2b Often/always enthusiastic about my job 76 78 78 65 82 69 69 77 77 75 70 85 77

2c Time often/always passes quickly when I am working 78 78 76 70 78 75 72 82 71 80 68 87 78

3a Always know what work responsibilities are 87 87 90 83 89 78 86 88 78 73 74 95 91

3b Feel trusted to do my job 92 91 91 89 95 85 91 93 93 81 82 96 93

3c Able to do my job to a standard am pleased with 79 91 65 80 75 78 77 78 87 81 82 86 85

4a Opportunities to show initiative frequent in my role 71 87 72 60 74 62 70 76 76 74 64 79 70

4b Able to make suggestions to improve the work of my team/dept 71 100 70 61 71 59 74 78 84 75 67 77 70

4c Involved in deciding changes that affect work 50 91 46 36 49 43 52 55 59 62 41 56 50

4d Able to make improvements in my area of work 51 87 48 39 51 43 61 53 71 68 51 59 49

4e* Able to meet conflicting demands on my time at work 44 65 31 38 45 49 48 43 42 51 51 49 50

4f Have adequate materials, supplies and equipment to do my work 57 87 47 58 50 51 65 51 59 74 50 72 59

4g Enough staff at organisation to do my job properly 29 61 19 27 24 25 39 25 33 40 31 36 33

4h* Team members have a set of shared objectives 70 82 70 65 67 56 75 70 73 74 69 76 75

4i* Team members often meet to discuss the team's effectiveness 52 77 38 37 47 49 56 64 69 66 62 56 53

4j* Team members have to communicate closely with each other to achieve the team's objectives 77 91 73 69 81 67 78 80 73 81 72 82 78

5a Satisfied with recognition for good work 48 77 39 32 48 53 56 54 51 60 44 56 45

5b Satisfied with support from immediate manager 64 71 60 51 67 61 71 67 57 73 53 74 65

5c Satisfied with support from colleagues 79 74 79 75 75 69 86 84 80 75 72 84 80

5d Satisfied with amount of responsibility given 73 78 71 65 71 62 76 79 64 68 53 82 75

5e Satisfied with opportunities to use skills 69 61 72 60 70 52 70 73 66 70 62 80 72

5f Satisfied with extent organisation values my work 42 65 33 30 43 42 47 43 47 58 31 51 42

5g Satisfied with my level of pay 34 61 31 34 31 31 37 36 27 46 26 38 32

5h* Satisfied with opportunities for flexible working patterns 47 87 41 37 50 37 67 46 60 67 38 53 43

6a Satisfied with quality of care I give 70 52 61 76 67 59 27 77 58 42 74 84 84

6b Feel my role makes a difference to patients/service users 82 74 83 85 84 73 44 88 60 59 87 88 90

6c Able to provide the care I aspire to 58 48 49 61 54 43 21 62 49 34 56 74 72

7a Immediate manager encourages team working 72 87 72 59 80 60 72 80 70 79 64 76 71

7b Immediate manager can be counted upon to help with difficult tasks 69 83 67 59 73 61 77 75 64 78 59 74 66

7c Immediate manager gives clear feedback 57 71 57 42 60 50 64 62 57 69 56 65 55

7d Immediate manager asks for my opinion before making decisions that affect my work 52 55 51 39 52 45 54 58 52 64 50 61 49

7e Immediate manager supportive in personal crisis 71 78 72 64 69 64 72 76 75 81 49 80 68

7f Immediate manager takes a positive interest in my health & well-being 62 74 61 48 64 59 71 67 67 74 49 69 58

7g* Immediate manager values my work 66 77 63 55 66 56 70 73 64 70 51 74 67

8a I know who senior managers are 82 91 86 76 82 75 89 87 84 93 85 84 78

8b Communication between senior management and staff is effective 41 74 31 26 49 38 39 49 39 58 38 55 35

8c Senior managers try to involve staff in important decisions 32 61 23 23 35 26 35 39 41 53 31 42 25

8d Senior managers act on staff feedback 32 64 27 20 36 27 38 38 39 57 26 39 24

9a* Organisation takes positive action on health and well-being 88 100 86 82 83 91 92 91 95 93 97 93 85

9b* In last 12 months, have not experienced musculoskeletal (MSK) problems as a result of work activities72 70 72 69 68 77 81 68 89 85 79 73 71

9c Not felt unwell due to work related stress in last 12 months 62 87 49 60 61 66 66 63 64 71 50 65 63

9d In last 3 months, have not come to work when not feeling well enough to perform duties 39 35 32 40 31 45 39 40 47 44 24 40 41

9e Not felt pressure from manager to come to work when not feeling well enough 64 87 61 52 66 67 62 67 78 73 64 74 57

9f Not felt pressure from colleagues to come to work when not feeling well enough 76 73 72 73 66 84 87 81 83 85 86 75 73

9g Not put myself under pressure to come to work when not feeling well enough 7 13 6 3 8 12 10 7 4 3 11 11 5

11a In last month, not seen errors/near misses/incidents that could hurt staff 82 86 83 88 65 74 90 83 88 95 94 84 83

11b In last month, not seen errors/near misses/incidents that could hurt patients 75 82 74 73 58 87 95 78 80 94 85 75 70

11c Last error/near miss/incident seen that could hurt staff and/or patients/service users reported 88 * 89 87 91 71 53 89 * * * 91 90

12a* Organisation treats fairly staff involved in errors 42 55 28 44 47 40 32 47 30 50 32 49 41

12b* Organisation encourages reporting of errors 88 95 88 84 87 77 81 91 95 85 97 96 88

12c* Organisation takes action to ensure errors not repeated 65 55 69 65 67 56 54 65 64 58 68 73 67

12d* Staff given feedback about changes made in response to reported errors 49 33 52 46 50 34 33 52 43 45 34 60 56

Your job

Management

Health, Well-being

and Safety

14

2015 RAG Percentage Difference from Acute Average 3 52 10 5 18 12 28 43 33 45 16 64 15

National Staff Survey 18 47 25 49 24 30 38 27 21 21 19 61

10 29 56 19 50 27 5 22 18 46 3 10

6 1 4 2 3

Question Topic Q Positive Score Text

Organisation

Average %

Chief Executive

Directorate

Children &

Family Care

Group

Diagnostic &

Pharmacy Care

Group

Emergency Care

Group

Estates &

Facilities

Finance &

Healthcare

Contracting

MSK & Frailty

Care GroupNursing Services

People &

Organisational

Development

Performance

Speciality

Services Care

Group

Surgical Care

Group

13a Know how to report unsafe clinical practice 86 91 92 83 88 64 69 91 77 80 89 90 92

13b Would feel secure raising concerns about unsafe clinical practice 70 77 72 64 72 56 47 75 75 73 70 79 73

13c Would feel confident that organisation would address concerns about unsafe clinical practice 58 68 54 53 59 49 54 62 64 70 62 68 55

14a Not experienced physical violence from patients/service users, their relatives or other members of the public83 100 94 94 53 94 99 74 98 99 79 80 85

14b* Not experienced physical violence from managers 100 100 100 100 99 99 100 99 100 99 97 100 100

14c* Not experienced physical violence from other colleagues 98 100 99 100 95 97 100 97 100 99 97 99 99

14d+ Last experience of physical violence reported 58 * 71 37 62 54 * 70 * * * 48 39

15a Not experienced harassment, bullying or abuse from patients/service users, their relatives or members of the public74 86 65 79 53 87 93 70 95 94 74 74 76

15b* Not experienced harassment, bullying or abuse from managers 88 90 88 83 89 86 87 93 86 92 81 89 87

15c* Not experienced harassment, bullying or abuse from other colleagues 83 86 83 83 78 82 85 88 85 87 73 85 78

15d+ Last experience of harassment/bullying/abuse reported 40 * 43 23 46 41 29 38 * 30 64 48 43

16 Organisation acts fairly: career progression 60 73 59 53 62 52 68 63 51 59 43 71 57

17a Not experienced discrimination from patients/service users, their relatives or other members of the public96 100 98 98 90 100 99 95 100 99 95 96 96

17b Not experienced discrimination from manager/team leader or other colleagues 94 95 94 95 93 94 96 96 93 93 100 96 91

18a* Had training, learning or development in the last 12 months 72 68 74 64 81 56 64 79 68 73 74 72 75

18b* Training helped me do job more effectively 81 93 77 76 83 73 72 87 83 82 75 89 80

18c* Training helped me stay up-to-date with prof. requirements 84 87 86 80 89 67 64 87 83 75 71 90 89

18d* Training helped me deliver a better patient / service user experience 78 80 77 73 83 58 45 86 77 62 57 88 83

19* Had mandatory training in the last 12 months 91 91 96 92 84 87 97 94 86 93 92 90 88

20a Had appraisal/KSF review in last 12 months 86 95 85 91 84 76 92 86 77 95 95 78 91

20b* Appraisal/review helpful in improving how do job 71 80 67 56 78 68 62 80 76 73 58 83 70

20c* Clear work objectives agreed during appraisal 83 85 82 75 86 75 79 88 79 82 72 91 84

20d* Appraisal/performance review: left feeling work valued 70 95 65 59 75 65 68 77 68 72 61 85 68

20e* Appraisal/performance review: organisational values discussed 73 85 72 65 73 70 66 78 62 82 60 83 71

20f Appraisal/performance review: training, learning or development needs identified 68 74 68 64 73 48 67 77 61 60 59 72 69

20g* Supported by manager to receive training, learning or development identified in appraisal 91 92 90 81 91 92 92 95 95 91 74 93 91

21a Care of patients/service users is organisation's top priority 75 95 70 74 73 68 73 79 93 90 61 79 75

21b Organisation acts on concerns raised by patients/service users 74 76 75 65 76 64 61 76 82 88 76 80 74

21c Would recommend organisation as place to work 60 77 49 48 64 59 58 63 57 70 55 70 61

21d If friend/relative needed treatment would be happy with standard of care provided by organisation64 82 58 56 63 56 59 63 59 71 68 75 69

22a Patient/service user feedback collected within directorate/department 65 27 88 41 81 39 11 84 27 34 58 85 68

22b Receive regular updates on patient/service user feedback in my directorate/department 53 * 58 39 43 52 40 54 67 49 41 59 59

22c Feedback from patients/service users is used to make informed decisions within directorate/department47 * 53 37 44 51 13 47 58 49 41 52 47

Disability 27b Disability: organisation made adequate adjustments(s) to enable employee to carry out work 34 * 52 35 30 34 33 41 * 19 * 24 31

3.77 4.24 3.68 3.56 3.79 3.65 3.66 3.84 3.99 3.95 3.68 3.95 3.79

Response Rate 44% 77% 47% 40% 42% 24% 67% 50% 75% 92% 55% 49% 41%

* = Not comparable to 2014 or earlier scores

Overall Staff Engagement

Training

Appraisals

Organisation

Bullying,

Harassment and

Whistleblowing

Doncaster and Bassetlaw

Hospitals

Annual Plan 2016/17

Forecast outturn 2015/16

• The year to date deficit at M11 is £31.2m

• Valuation has come in at reduction of £20m or 11%

• The forecast outturn position is a deficit of £36.4m which is made up as follows

£m Comments

Forecast deficit at M11 31.2

March forecast deficit 2.6 As per management accounts

MARS 0.6 As per final settlement

Reverse impairment gain 1.2 Reverse as uncertain

DCCG readmissions penalty 0.6 Disputed by DCCG. Gain taken in M11

DCCG year end settlement -0.5 Year end settlement with DCCG

Contingency 0.7

36.4

Prior year adjustment

• The prior year adjustment has been finalised at £16.4m

• Restated accounts were submitted to PWC on 1 April

• The prior year adjustment is made up as follows: – As informed to Board following reconciliation of

control accounts and supplier statement reconciliations at Month 9 = £15.2m

– Adjustment at M11 reported to FOC in March = £0.8m

– Final adjustment in M12 = £0.4m

Planning assumptions 16/17

• The inflation uplift applied in the plan uses the governments published assumptions – Pay 3.3% (including incremental drift and 1.75% for

pension reform)

– Drugs 4.5%

– Capital costs 3.1%

– Other operating costs 1.7%

– TOTAL = 3.1%

– Tariff uplift = 1.1%

– CIP built into tariff = 2%

NHS Litigation Authority

• Premium built into tariff in excess of the 1.1% uplift • National contribution up from £1,418m to £1,659m an

increase of 17% • DBH NHSFT premium increased from £15.3m to

£16.8m an increase of 9.8% • Premium is £0.4m overstated as includes activity for

private providers. Net increase should be £1.1m or 7.3% increase

• The lower than national average premium uplift reflects lower than national average claim settlement and outstanding claims

• Tariff uplift £1.7m therefore £0.6m gain

Contract negotiations - DCCG

• Outturn 15/16 £187.5m • D&D FT 16/17 £189.3m • DCCG offer £186.8m • Difference of £2.5m

– Block transition £1.3m – Clinical decision unit £1.3m – Outpatient cap £0.7m – Midwifery ratios 1:28 £0.4m – C-PAP consumables £0.3m – Paediatric assessment tariff £0.2m – Other (£1m) – Revised offer (£0.7m)

• Potential additional £0.4m for demographic growth • Need to agree a way forward for non tariff income and payment for over

performance against plan

Contract negotiations - BCCG

• Outturn 15/16 £63.2m

• D&B FT 16/17 £63.8m

• DCCG offer 16/17 £62.4m

• Difference of £1.4m

– QIPP £1.5m

– Other (£0.1m)

• Next meeting 5 April

• Aim to negotiate QIPP down to £0.75m

Contract negotiations – Specialist Commissioning

• Outturn 15/16 £21.3m

• D&B FT 16.17 £21.8m

• Specialist Commissioning offer £21.2m

• Difference of £0.6m

– QIPP £0.5m

– Other £0.1m

16/17 plan

• Progress with 16/17 plan – Plan reflects income offers from commissioners – Pay is recurrent forecast outturn – Non pay is recurrent M9 to M11 annualised – Improved run rate gives £3.6m benefit on non pay

compared to recurrent forecast outturn – CIP target £11m (3%) – Assumes full S&T funding of £11.8m is earned – Inflation at 3.1% and tariff uplift 1.1% plus CNST uplift

(0.54%) – Allows for budget setting cost pressures of £11.7m – Allows Trust to achieve control total of £27.1m

Bridge analysis - 16/17 plan

• Bridge analysis

Summary £m

Forecast outturn -36.4

Non recurrent 14/15 1.3

Full year effect CIP 0.9

Specialist commissioning marginal rate 0.2

Income adjustments -1.2

Run rate improvement 3.6

Budget setting cost pressures -11.7

Baseline budgets -43.4

Pay inflation -8.4

Non pay inflation -3.7

Tariff uplift 5.6

CIP 11.0

Sustainability & transformation funding 11.8

Control total -27.1

Bridge analysis – 16/17 plan

• Reconciliation to plan discussed with Monitor on 31 March

Reconciliation to Monitor meeting plan £m

Improved offer DCCG 0.7

Increased pay uplift -0.5

Increased non pay uplift -0.2

Adjustment to income CIP -0.2

Adjustment to cost pressures (balancing figure) -0.2

Budget setting cost pressures

• Non recurrent £3m and £3.8m recurrent pressures

• This leaves general contingency of £4.9m

• £6.9m of cost pressures not supported

• Key risks are as follows:

– Capitalisation of IM&T staff (£0.85m)

– Growth in mobile CT scanning (£0.98m)

– Take out vacant posts in Clinical Therapies £0.65m, Children’s services nursing £0.58m

– Pathology £0.81m of cost pressures to be validated

Budget setting cost pressures

£'000

Recurrant cost pressures

CNST 1,127

Finance staff 250

AMU only open for part of the year in 15/16 387

Midwifes 1:28 compliance 580

Director of HR&OD 165

Coding 100

Other 1,152

3,761

£'000

Non recurrant cost pressures

Consultancy support 2,000

PMO 299

Finance staff 595

Other 152

3,046

CIP risk analysis 16/17

• CIP analysis

£'000

Fully developed 3,852

Plans in progress 3,812

Opportunity 3,086

Unidentified 250

11,000

Green 4,300

Amber 5,357

Red 1,343

11,000

CIP analysis 16/17

£'000

Theatres 443

Outpatient productivity 287

Medical productivity 413

Non medical productivity 261

Management review 261

Corporate directory review 500

Bed plan/LOS 2,292

Procurement 1,900

Clinical admin review 250

Infrastructure 968

Corporate and Care groups 1,700

Income 500

Grip and control 1,225

11,000

CIP phasing

• Savings are 33:67

454

557 563

682 687 725

1,043

1,180 1,187

1,295 1,311 1,316

0

200

400

600

800

1000

1200

1400

April May June July August September October November December January February March

Downside Base Upside

case case case

£m £m £m Comment

Forecast outturn -36.4 -36.4 -36.4

Non recurrent and full year effects 2.2 2.2 2.2

Income adjustments -0.9 -0.9 -0.5 £0.4m DCCG

Run rate improvement 2.6 3.6 3.6 Non pay increases in M12 by £1m

Budget setting cost pressures -12.8 -11.8 -8.8 Downside -£1m, upside +£3m

Baseline budgets -45.3 -43.3 -39.9

Pay inflation -8.4 -8.4 -7.4 Upside +£1m

Non pay inflation -3.8 -3.8 -3.3 Upside +£0.5m

Tariff uplift 5.6 5.6 5.6

CIP 9.0 11.0 13.0 Downside -£2m, upside +£2m

Sustainability and transformation funding 9.8 11.8 11.8 Downside -£2m

Deficit -33.1 -27.1 -20.2

Sensitivity analysis

Capital plan 16/17

• The capital plan for 16/17 is £9.3m

• This is funded from depreciation (£9m), asset sales (£0.7m) , donated assets (£2.4m) less repayment of loans £2.8m

• Key projects are the works on fire, water and electricity (£3.6m) and completion of the ophthalmology development funded by Fred & Ann Green and Charitable Funds (£2.4m)

• Medical equipment includes current committed orders (£0.60m) and all high priority items (£1.46m) and a (£0.3m) contingency. Medium priority are £0.46m and low priority £0.09m

• Asset sales comprise 5 Highland Grove(£0.20m), Montagu Nurses Home land (£0.27m) and 9/19/21 St David’s Close (£0.25m)

• IM&T spend is limited to £0.99m pending development of an IM&T strategy and recognition that the infrastructure is good

Capital plan 16/17

£000

Property

Fire safety 1300

Water safety 450

Capital Design Team 350

Contingency (Incl. DSA1 building work) 1500

3,600

Equipment

Medical equipment replacement 1,676

Medical imaging replacement / DSA 1 391

Contingency 300

2,366

IT

iHospital 540

Other IT 527

Switchboard 300

Adjustment -378

989

Ophthalmology development 2,414

Gross capex 9,369

Sources of fundingDepreciation - Forecast 9,032

Loan principal repayments -2,799

Asset Sales 727

Donated assets 2,414

Financing -5

9,369

Cost Improvement Plans

Dawn Jarvis

Director of Strategy & Improvement

Strategy & Improvement Team Operates in line with the Trust’s “We Care” values.

• We always put the patient first – without financial stability we cannot provide safe and effective service for patients

• Everyone counts – staff and stakeholder have ideas for savings and efficiency we need to harvest them and keep everyone engaged and enthused about the recovery path

• Committed to quality - and continuously improving patient and staff experience is the most efficient way of working

• Always caring and compassionate – savings, cuts and difficult messages will be delivered with compassion and support AND we will be uncompromising in expecting delivery from everyone across the Trust to agreed standards and deadlines.

• Responsible and accountable for our actions – we will take pride in our role in supporting the recovery of the organisation’s finances for the benefit of patients and staff

• Encouraging and valuing our diverse staff and rewarding ability, creativity and innovation – we will appreciate the different strengths and experiences we will all bring to support our core purpose.

• Safety regulation

• Performance targets

• Finance regulation

• Quality

• Staff Engagement

• Public confidence

Readiness for Turnaround • Setting Turnaround principles and culture

• Introducing standard governance and accountability

• Setting roles and responsibilities

• Standardising project management

• Implementing accountability arrangements

• Enhancing Quality and Performance Impact Assessment processes

• Introducing the Gateway Process, and

• Securing enough resources to ensure successful delivery

Planning Context

1. Recovery Plan 16/17 – end April

2. Recovery Plan 17/18 – July

3. 5 year plan - September

4. Sustainability & Transformation plan (STP) to 2020/21

Cost Improvement Programme

Work Streams

1. Theatres

2. Outpatient Productivity

3. Medical Workforce Productivity

4. Non-medical Clinical Productivity

5. Management Review

6. Corporate Directorates Review (back office)

7. Bed Plan/Length of Stay

8. Procurement

9. Clerical/Admin Review (clinical and non-clinical)

10. Infrastructure – Estates and IT enabled change

11. Income

12. Care Group Schemes/corporate Directorate Schemes

Cash Stabilisation

Capital Planning

Grip and Control

Communications, Engagement and Education

PMO

Grip & Control

• Review of budgets – line by line

• Review of overspends/underspends

• Agency use

• Cost pressure issues

• Ownership of actions

• Identification of cross cutting themes

Grip & Control

• In December (M9) we spent over £600k less

• In January (M10) this position has continued to improve

• We are applying the same level of controls

• G&C meetings continue and frequency is based on level of improvement

Plans

Incorporate

• National guidance

• Staff ideas

• Carter report

• Benchmarking – HED data, BCBV, external sources

• Working Together Partnership

• Part of 16/17, 17/18 and five year plan

Matrix Approach

QPIA Process Key Questions/Decisions Inputs required from Work stream/Project Leads Outputs

Gateway 0 Does the idea contribute to meeting our

strategic and financial objectives?

Should we apply resources to develop it

further?

Is the scheme included in another work

stream?

Completed PID

PID to include; project overview, roles and

responsibilities, high level project plan and

finance plan with phasing

Agreement from Director of Finance to

proceed

Agreement from COO to proceed

Agreement from Director of Nursing to

proceed

Only move to next Gateway once full signed agreement reached

Gateway 1 Is the idea robust, risk assessed and

achievable?

Does the idea still to contribute to our

strategic and financial objectives?

Do we have, or can we secure the

resources to deliver it?

Impact assessment completed

Equality impact assessment completed

Savings calculated

Agreement from Director of Finance to

proceed

Agreement from COO to proceed

Agreement from Director of Nursing to

proceed


Gateway 2 Who will do what, by when and what will

delivered by when?

Is there a clear critical path?

Have stakeholders been identified?

Has consultation been planned for

affected staff?

Have the project savings been phased and

signed off by the relevant MA?

Project plan completed (PMO template)

Baseline measurement taken

KPIs agreed

Weekly highlight reports

Project signed off for delivery

Implementation starts


Gateway 3 Has the project achieved its objectives?

Have the KPIs been achieved?

Have the savings been removed from the

relevant budgets?

Milestone tracker shows actions completed

KPI monitoring shows KPIs met

Project Closure report completed

Director of Finance agrees savings delivered

COO agrees savings delivered

Director of Nursing agrees savings delivered

DBH Financial Accountability Board of Directors

Finance Oversight

Committee

CEO

Delivery Accountability

Meetings

Management Board

Finance Accountability

Meetings

Governors

Information & Engagement

Accountability

1

Board of Governors Meeting – Tuesday 19 April 2016

Election of the Vice-Chair and Lead Governor of the Board of Governors 1. Purpose The purpose of this paper is to enable the Board of Governors to elect two governors to serve as vice-chair and lead governor of the Board of Governors, for a term of office of up to 3 years, commencing 20 April 2016 and ending 19 April 2019 or when the individuals’ terms of office expire, whichever is the sooner.

2. Nominations

Nominations have been received from the following governors: Vice-chair nominations

Mike Addenbrooke

David Cuckson Lead governor nominations

Utpal Barua

Hazel Brand Candidate statements are shown at appendices I and II. Further nominations may be submitted at any point prior to the election during the meeting on 19 April 2016. It is requested that any Governors who intend to self-nominate in the meeting make the Head of Corporate Affairs aware of this, to enable ballot papers containing the names of nominees to be prepared in advance. 3. Elections Following receipt of nominations, the Board of Governors is invited to elect a Vice-Chair and a Lead Governor. For each post, in order for a successful candidate to be elected, they will need a simple majority (a minimum of 50%) of the votes of those present and voting at the meeting. Proxy voting is not permitted. In accordance with the Standing Orders of the Board of Governors, the elections may be conducted by oral expression; by a show of hands; or by a paper ballot. In line with the procedure followed previously for this appointment, it is expected that the decisions will be made using a paper ballot during the meeting and ballot papers will be prepared.

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In the event that more than two candidates are nominated for either post (i.e. further nominations are received), and no one individual receives more than 50% of the votes:

a. The votes of the candidate with the least votes will be discounted, and that candidate removed from the running;

b. Those Governors who voted for the candidate with the least votes will be asked to make a

second choice from among the remaining candidates;

c. This process will be repeated until one candidate has a majority of the votes. In the event that a paper ballot is requested, ballot forms shall enable Governors to nominate second, and if necessary third, choice candidates in the first instance, in order to expedite the process outlined above. The process outlined above is consistent with the Single Transferable Vote system used when conducting elections to the Board of Governors. Maria Dixon Head of Corporate Affairs April 2016

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APPENDIX I Candidate Statements – Vice Chair

Mike Addenbrooke I would like to nominate myself for the position of vice chair. Having completed my first three years as a public governor for Doncaster and having been re-elected for a further three years, I feel that now is the appropriate time for me to put myself forward for this position I am an active member of the B.O.G. attending as many meetings as possible. I am present at monthly B.O.D. meetings and time out sessions on a regular basis. I pay frequent visits to the two wards that I sponsor as part of the fifteen steps challenge and serve on the H.C.A., H.C.Y.P and patient experience committees. I would consider it a privilege to be elected and would use my best endeavours to ensure that we work together to challenge the B.O.D. and hold the N.E.D. to account for the performance of the Board.

David Cuckson The Role Description of the Vice Chairman specifies four responsibilities. Two of these involve the statutory duty of presiding at meetings when called upon. I have considerable experience of acting in this role in other organisations and I am confident that I can perform this function to the Governor's satisfaction. Another role is to participate in the process for the removal of Governors. It is important that a clear and analytical mind is essential in this process. My experience and training as a Magistrate will stand me in good stead should the unfortunate need arise. Lastly, I could be required to act as a conduit for the Governors if our views need to be formally reported to the Board of Directors. I believe my communication skills are well adequate for this purpose. Many of you will know that I take a full part in my Governor responsibilities, including attending and asking questions of the Executive, both at our Governor and Board of Directors meetings. I am confident I can perform the role to your satisfaction and I hope you will have the confidence in me to give me your vote.

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APPENDIX II Candidate Statements - Lead Governor

Utpal Barua I welcome the opportunity to contribute to the work of the Board of Governors of Doncaster and Bassetlaw Hospital trust at a leadership position. I have been a dedicated participant of delivering local patient care for the last 39 years, including as a governor at DBH FT for the last three years. As a governor I attended multiple conferences and training sessions both at national and local level. In addition to my extensive involvement with clinical care as a local General Medical Practitioner, I also worked in Victoria hospital Worksop, HMP Prison Medical service, DWP, HM Court & Tribunal Service and for a short period as a Specialist adviser for the Care Quality Commission. I also worked as a clinical researcher in local university and The State University of New York, Buffalo, USA. I campaigned for improved Dementia & Geriatric care at BDH, for advanced prostate cancer surgical treatment, encouraged the Trust to appoint a Clinical NED with clinical expertise. I was a local Magistrate in North Nottinghamshire, a founder member of Worksop Dukeries Rotary club. If elected, I believe in working together to achieve our long term objectives of improved patient care by:

- Supporting and ensuring that clinical and financial reviews are efficient and robust, being committed to be the eyes and ears for common good.

My vision: To be proud of our Hospital and the care we provide for our patients and our staff.

Hazel Brand Due to its financial position, the Trust is currently in breach of its licence. Although there has been little or no contact by Monitor with the Lead Governor hitherto, current circumstances mean this should change. Monitor needs to keep the Board of Governors informed, as it did last month. There was a commitment to further meetings. If this doesn't happen, and if elected, I will pursue this and ensure that the Board of Governors is briefed and can play its part in the Trust's recovery. I am committed to being the first point of contact with Monitor and will carry this out diligently on behalf of governors. Of course, it's not just breach of the Trust's licence that concerns governors. If there are other legitimate areas that exercise governors, I will be proactive in raising such issues with Monitor. I worked for the Trust until 2012. It's disappointing to see such a successful organisation 'fall from grace' but directors and Monitor have been open about the cause of the financial problem. I have recently been elected for a further 3-year term. In my election statement, I promised to be a do-er, not an armchair critic. Never has that been more necessary. I stood for re-election to give

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something back to the hospitals that were such a large part of my life for so long. I will continue to bring this same enthusiasm for, and commitment to, the Trust's revival in the role of Lead Governor.

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APPENDIX III

Vice-Chair of the Board of Governors

Role Description Eligibility 1. The Vice-Chair shall be a Public Governor of Doncaster and Bassetlaw Hospitals NHS

Foundation Trust. 2. A person appointed as the Vice-Chair shall cease to be eligible to continue serving as the

Vice-Chair if he ceases to be a Governor or Member Appointment and Removal 3. The Vice-Chair shall be elected by a majority of the Board of Governors in a general meeting. 4. The Vice-Chair’s term of office may be terminated by a majority of not less than 75% of the

Governors present and voting at a meeting of the Board of Governors. Term of Office 5. The Vice-Chair shall be elected for a term of office of up to 3 years. 6. No person may serve as the Vice-Chair for more than a total of six years. Responsibilities 7. If the Chair and Deputy Chair are unable to preside at meetings of the Board of Governors

whether for reasons of absence, conflict of interest or otherwise the Vice Chair shall preside. 8. The Vice-Chair is to preside at meetings of the Board of Governors in respect of votes of the

Board of Governors concerning Non-Executive Directors, including the Chair. 9. The Vice-Chair shall, alongside the Chair and Senior Independent Director, participate in the

process for the removal of Governors outlined in sections 3.1.3 and 3.1.4 of Annex 5 to the Constitution.

10. The Vice-Chair shall act as a conduit through which the views of the Board of Governors may

be reported to the Board of Directors as detailed in 7.3.5(d) of Annex 6 to the Constitution.

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APPENDIX IV

Lead Governor of the Board of Governors

Role Description Eligibility 11. The Lead Governor shall be a Governor of Doncaster and Bassetlaw Hospitals NHS

Foundation Trust. 12. A person appointed as the Lead Governor shall cease to be eligible to continue serving as the

Lead Governor if he ceases to be a Governor or Member Appointment and Removal 13. The Lead Governor shall be elected by a majority of the Board of Governors in a general

meeting. 14. The Lead Governor term of office may be terminated by a majority of not less than 75% of

the Governors present and voting at a meeting of the Board of Governors. Term of Office 15. The Lead Governor shall be elected for a term of office of 3 years. Responsibilities 16. To act as the first point of contact in the event that Monitor need to communicate with the

Board of Governors, without going through the Chair or Trust Board Secretary. Examples of circumstances in which Monitor would contact the Lead Governor are as follows:

a. Where there are concerns regarding the leadership of the Trust, and a real risk that

the Trust may be in significant breach of its Terms of Authorisation.

b. Where Monitor has been made aware that the appointment of a Board member, Governor Election, or other material decision has not complied with the Trust’s constitution, or has been inappropriate.

17. To contact Monitor directly when the Board of Governors wishes to raise concerns regarding

the Trust’s adherence to its Licence.

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Meeting of the Agenda Planning Sub-committee of the Board of Governors held on 4 March 2016 at 10 am

in the Members Room, DRI

Present: Chris Scholey Chairman Bev Marshall Public Governor Susan Overend Public Governor John Plant Public Governor Clive Tattley Partner Governor Maureen Young Public Governor

In attendance: Maria Dixon Head of Corporate Affairs

Action Apologies for Absence

16/03/1 1 Apologies were received from George Webb and Pat Ricketts.

Minutes of the meeting held on 27 November 2015

16/03/2 1 The minutes of the meeting held on 27 November 2015 were APPROVED as an accurate record.

Matters arising

16/03/3 1 None.

Review of Previous Board of Governors Meeting

16/03/4 Chris Scholey discussed the previous meeting, noting that it had gone well, with some questions from the public attendees regarding the Trust’s financial position. He stated that the KPMG report had now been shared publicly and provided a detailed update on the financial position and the work to deliver turnaround. He noted the importance of maintaining good performance on quality while delivering the savings required.

16/03/5 Chris Scholey and Mike Pinkerton had met with the Doncaster MPs, who had been supportive. They had reported a reduction in complaints from constituents due to the improvements in quality in recent years.

Draft Board of Governors Agenda: 19 April 2016

The following reports were agreed for inclusion on the agenda:

16/03/6 Standing Items - The usual standing items, including Chairman's Report and Correspondence, and matters arising from Board of Directors minutes, were agreed.

16/03/7 Executive Reports

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Chief Executive’s Report (to include summary of position following KPMG report and Monitor intervention)

Finance Report

Business Intelligence Report (summary version, with executive commentary)

People and OD Report

Strategy and Improvement Report

Annual Plan Update

16/03/8 It was agreed that, in general, the Chair should continue to take papers as read, with executives only verbally reporting on items by exception. It was agreed that it was important to ensure that discussion focused on quality as well as finance.

16/03/9 It was agreed that the Chair’s or Chief Executive’s report should include a summary of the position following publication the KPMG report and Monitor enforcement action.

16/03/10 Governance & Statutory Compliance

Vice-Chair appointment

16/03/11 It was agreed to provisionally add the external auditors’ appointment to the agenda, to be deferred to the next meeting if appropriate.

16/03/12 Governor/Member matters

Feedback from members

Minutes of the sub-committees

Governor reports from committees and other activities

16/03/13 It was agreed that Bev Marshall would provide a verbal report on the activities of the Financial Oversight Committee. It was also agreed that Susan Overend would report on the changes to member communications.

16/03/14 The seating arrangements in the Lecture Theatre were discussed, and it was agreed to try to seat governors in a square at the front of the room as far as possible.

Any Other Business


Date & Time of Next Meeting

16/03/16 10 am, 19 May 2016 Boardroom, DRI

1

Minutes of the Appointments and Remuneration Sub-committee Meeting

Held at 2pm on Monday 14 March 2016

in Members Room 1, DRI Present: Geraldine Broderick Senior Independent Director David Cuckson Public Governor Dev Das Public Governor Peter Husselbee Public Governor John Plant Public Governor George Webb Public Governor In attendance: Maria Dixon Head of Corporate Affairs Alison Luscombe Foundation Trust Office Coordinator Susan Shaw Partner Governor

Action

Apologies for Absence

16/03/1 1 No apologies for absence received.

Minutes of the previous meeting

16/03/2 D The minutes of the meeting held on 20 October 2015 were APPROVED.

Matters Arising

16/03/3 None.

Chair Appointment

16/03/4 Maria Dixon asked for feedback on the draft candidate pack including the job description and person specification and advised that the two key points to be agreed were the advertisement wording and advertisement methods.

16/03/5 Following a discussion on the draft job description and person specification, these were AGREED.

MD

16/03/6 Maria Dixon gave an overview of the advertisement quotations that had been obtained for The Guardian and the HSJ online. A quotation from the Sunday Times was awaited.

16/03/7 George Webb referred to past experience and stated that he would not recommend the HSJ.

16/03/8 Geraldine Broderick discussed the expense of using head-hunters and advised approaching the TDA / NHS Improvement.

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16/03/9 In answer to a question on the cost of advertising in the Worksop

Guardian and Doncaster Free Press, Maria Dixon stated that previously these had been expensive and noted that recruitment expenditure should be proportionate to executive recruitment costs.

16/03/10 David Cuckson echoed this, stating that spending a lot of money could not be justified at this time.

16/03/11 Maria Dixon advised that a press release would be sent out and copied to local networks such as the Chamber of Commerce.

MD/EB

16/03/12 It was AGREED to place advertisements in two national newspapers, The Guardian and Sunday Times, and two regional newspapers, the Yorkshire Post and Sheffield Star. It was AGREED to approach the TDA / NHS Improvement regarding publicising the role.

MD

16/03/13 Following a comment regarding the salary to be shown in the advertisement, and whether the remuneration should be reviewed, Maria Dixon stated that the current level was around average when compared against similar Foundation Trusts. It was agreed that the advert should state that the remuneration was ‘circa £45k’.

MD

16/03/14 In answer to a query that the job advertisement stated 2-3 days per week and the candidate pack stated 3 days per week, it was agreed that these should be consistent and amended to read 3 days per week.

MD

[Susan Shaw left the meeting]

16/03/15 Maria Dixon discussed the proposed timescale for shortlisting and interviews and advised that approval of the appointment would be at the Board of Governors meeting on the 30 June.

16/03/16 Following a discussion around availability it was agreed to hold the shortlisting meeting on 23 May and for shortlisted candidates to be invited to meet the Chief Executive and other executives (which ones to be determined by the CE) and Chair prior to formal interview.

MD

16/03/17 A detailed discussion took place on the interview process and it was agreed that the main interview panel would include three/four governors, the Senior Independent Director and an external advisor – an experienced Chair from an acute trust of similar size to DBH, preferably not an immediate neighbouring trust. Maria Dixon agreed to make enquiries and identify a suitable external individual.

MD

16/03/18 Maria Dixon advised that the appointment timetable would be updated and emailed after the meeting.

MD

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Any other business

16/03/19 In answer to the query regarding any feedback received from Monitor the previous week, Maria Dixon advised that Monitor had mandated that the Trust appoint a Board Advisor, Chris Mellor, who would be working at the Trust approximately two days per week.

16/03/20 Following a comment regarding Jeremy Cook’s interim appointment, Maria Dixon advised that the Director of Finance post would go back out to advert in future but that she was not currently aware of any timetable for this.

16/03/21 George Webb commented on Monitor’s lack of engagement with governors, and stated that any changes to the licence should have been notified to the lead governor and Board of Governors.

Date of the Next Meeting

16/03/22 1 Chair shortlisting meeting 10 am, Monday 23 May 2016 Kilton Meeting Room, BDGH

1

Minutes of the Health and Care of Adults Sub-committee Meeting Held at 10am on 8 March 2016

in the Kilton Room, Bassetlaw Hospital

Present: Patricia Ricketts Public Governor (Chair) Mike Addenbrooke Public Governor Utpal Barua Public Governor

Hazel Brand Public Governor Peter Husselbee Public Governor

In attendance: Maria Dixon Head of Corporate Affairs Pat Johnson Safeguarding Adults Lead Deborah Oughtibridge Head of Safeguarding

Action Welcome and Apologies

15/12/1 Apologies were received from Clive Tattley.


15/12/2 The committee approved the minutes of the meeting held on 8 September 2015 were APPROVED subject to the following amendments:

15/12/3 15/12/10 – “and North Nottinghamshire Councils” to be amended to “and Nottinghamshire County Councils”.

Matters Arising

15/12/4 15/12/5 & 15/09/19 – Maria Dixon agreed to ensure a visit to CDU was organized.

MD/AL

15/12/5 15/12/28 – Maria Dixon undertook to request an update from Moira Hardy regarding the review of the 15-step process, and when a meeting could be scheduled to discuss it with governors.

MD

15/12/6 15/12/29 – An update on this matter had been provided at the recent governor timeout.

15/12/7 15/12/30 – Mike Addenbrooke reported that the privacy screens seemed to have improved and that there were now more volunteers present to assist patients in using the kiosks.

Safeguarding – Annual Update

15/12/8 Deborah Oughtibridge provided a detailed update on the work of the safeguarding team. She advised that there was a central safeguarding team, but that safeguarding work was also undertaken by individuals working within the Care Groups. She noted that Doncaster and Bassetlaw

2

had undergone CQC safeguarding inspections in 2014 and 2015, the outcomes of which had been positive.

15/12/9 Deborah Oughtibridge reported that there was good awareness among staff of the safeguarding newsletter and policies, but that recording of mandatory training was still an issue. Training needed to be recorded centrally so it could be evidenced.

15/12/10 Staff were aware of the requirements with regard to the Mental Capacity Act and Deprivation of Liberty (DoL) rules, but the number of DoL applications remained low.

15/12/11 Hazel Brand asked whether there was information available regarding exactly which areas the assessors looked at, as this could help identify areas of good performance and those in need of improvement. Deborah Oughtibridge advised that unfortunately this information wasn’t available. It also wasn’t known exactly what questions staff were asked, and how they were worded.

15/12/12 In addition to training records, the fact that the Trust had not had a named nurse for safeguarding children for 9 months had been highlighted, although, the 2014 review had not flagged this as a concern. The main actions resulting from the review were to update the domestic abuse policy and improve training recording.

15/12/13 Lots had been done to improve DoL awareness among staff, and improvements had been demonstrated, but further work remained.

15/12/14 Pat Johnson reported that the last audit, undertaken in January 2016, had shown an improvement in understanding of both the Mental Capacity Act and DoL. 12 areas, across different sites and specialties had been looked at. The criteria for making a DoL referral had widened, so referrals were increasing, but it was thought that the numbers needed to increase further. There were 2 criteria: was the patient subject to supervision and control, and could the patient be discharged if they asked? Patients therefore didn’t need to be actively attempting to leave to require a referral.

15/12/15 In response to a query from Hazel Brand, Pat Johnson advised that many of the patients lacked capacity due to dementia, some due to brain injuries, and some had temporarily lost capacity. Deborah Oughtibridge advised that the main challenge was completing documentation and making referrals.

15/12/16 Peter Husselbee highlighted that patients who lacked capacity could impact on the experience of other patients. Deborah Oughtibridge acknowledged this and noted that an enhanced care team was being established. This would provide staff who could provide targeted extra support where needed, moving between wards.

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15/12/17 Deborah Oughtibridge reported that training had been enhanced, and covered the Mental Capacity Act and DoL.

15/12/18 Work had been carried out with the complaints team to look at how safeguarding issues were picked up. There was now a process whereby the safeguarding team provided advice about any safeguarding issues that were identified in complaints, and helped to ensure an appropriate response. The complaints team would be provided with training to help them identify safeguarding issues.

15/12/19 The importance of documenting safeguarding concerns was discussed in detail.

15/12/20 Deborah Oughtibridge reported that 2315 staff had received the new training in the first year since it had been rolled out, and combining all safeguarding training into a single session had made recording attendance much easier. An e-book had also been developed for use at induction, and there was also a regular safeguarding newsletter. Staff who attended were given feedback forms, and the course was updated in response to feedback received.

15/12/21 A domestic abuse caseworker had been seconded to work in Doncaster, and the Trust was trialling having health caseworkers as well as social care. The main input to date had been in A&E, where the post was very useful.

15/12/22 The safeguarding team received a wide range of types of contacts and referrals from a variety of sources, some of which required immediate action while others were resolved over time. There had been 35 referrals to the team to date during Q4, compared to 28 referrals in Q1.

15/12/23 Current challenges included supporting partnership working with the councils and other organisations. The local safeguarding boards had a complex sub-committee structure and the Trust aimed to input into these. The boards were currently being reviewed to work was appropriately focused and resourced.

15/12/24 A further challenge was ensuring that all staff got the message regarding flagging up concerns, including staff groups such as service assistants.

15/12/25 Peter Husselbee asked how volunteer training records were recorded, and noted the importance of ensuring that volunteers were trained and checked appropriately. Deborah Oughtibridge advised that volunteers were not on ESR, therefore these records were kept on a different system, within the safeguarding team.

15/12/26 In response to a query from Utpal Barua, Deborah Oughtibridge advised that local social services were generally the best contact for over 16s who were not in school. She acknowledged that the transition between child and adult mental health services could be an issue.

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15/12/27 Mike Addenbrooke asked who would make decisions regarding the care of patients who lacked capacity. Deborah Oughtibridge advised that the consultant in charge would make the decision.

15/12/28 Mike Addenbrooke gave an example of case involving an assault on a patient by a staff member and this was discussed. Deborah Oughtibridge advised that judgments in cases like this were often complex, but all such incidents would be taken through the serious incident process and disciplinary process. Suspension was used to ensure patients were protected.

15/12/29 The question of patients refusing treatment was discussed, and Pat Johnson confirmed that providing a patient was assessed as having capacity, they could decide to refuse treatment. However, it was important that staff documented the process.

The annual safeguarding update was NOTED.

Any Other Business

15/12/30 Utpal Barua drew the committee’s attention to the Parkinson’s Society campaign called “Get it on time”, which aimed to ensure that patients always get their medication on time, due to the importance of Parkinson’s medication being taken on time. It was agreed that this should be flagged up to Richard Parker and Sewa Singh.

MD

Date and Time of Next Meeting

15/12/31 10 am, Tuesday 14 June 2016 Members Room 1, DRI

1

Health and Care of Young People Sub-committee Meeting held at 10 am on Tuesday 5 April 2016


Present: Maureen Young Public Governor (Chair) Mike Addenbrooke Public Governor Dev Das Public Governor Eddie Dobbs Public Governor Patricia Ricketts Public Governor Roy Underwood Staff Governor In attendance: Andrea Bliss Matron, Children’s Services Sharon Dickinson Head of Midwifery Lib Jones Head of Workforce Design

Maria Dixon Head of Corporate Affairs Alison Luscombe FT Office Coordinator

Action Welcome and apologies

16/04/1 Apologies were received from Lynn Goy.

16/04/2 Sub-committee membership and chair appointment – It was noted that, following the recent governor elections, an email would be circulated to governors requesting nominations to the vacant seats on sub-committees. Until that process was completed, the membership would be assumed to stay the same and Maureen Young would remain chair.


16/04/3 The committee APPROVED the minutes of the meeting held on 14 December 2015 as an accurate record.

Matters arising

16/04/4 Overseas recruitment – Following a comment on the standard of education required, Maria Dixon confirmed that Richard Parker had stated it was a national requirement that overseas candidates for nursing roles had to pass a Masters level English language examination.

Midwifery Staffing Update

16/04/5 Sharon Dickinson delivered a presentation on the Trust’s maternity services and advised that the birth rates at Doncaster and Bassetlaw had remained roughly static over the last three years. Stillbirth rates had slightly increased for 2014. Although national data was currently unavailable for 2015, the stillbirth rate at DBH had decreased and performance was considered to be good, although there was still work to be undertaken to deliver

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improvements.

16/04/6 NHS England had commissioned a national maternity review led by Baroness Cumberlege which was published in February 2016. The review looked at collaboration and bespoke maternity hubs with a more patient centred service and evidence was currently awaited from pilot sites.

16/04/7 The national stillbirth bundle had been launched to implement four strands/interventions around smoking cessation, routine screening to enable the growth of babies to be monitored and recorded on growth charts and an algorithm to indicate the level of monitoring required, improving awareness of fetal movement and improved fetal monitoring during labour. Although the CTG assessing tool was not yet available a successful bid for funding of £25k had allowed the Trust to purchase electronic heart monitoring equipment.

16/04/8 Sharon Dickinson advised that there had been an increase in the overall acuity and dependency and the current establishment for Doncaster & Bassetlaw Maternity Service was 1:32 against the national benchmark birth to midwife ratio 1:28. She noted that the maternity tariff had been set by commissioners four/five years ago and no longer reflected current practice.

16/04/9 Suspending / diverting services was a last resort decision used to support the provision of safe care for women with complex needs. The average suspension between September 2015 and March 2016 had been twelve hours. Although neighbouring trusts did not explicitly suspend services, on an occasion when DBH staff rang, only two out of eleven trusts had capacity. This had been challenged and the CCG and NHS England were currently undertaking a review.

16/04/10 Following a comment on homebirths and suspension of services, Sharon Dickinson stated that if the delivery suite was full of complex births and the homebirth had been determined low risk a paramedic could attend. In order to guarantee a homebirth an independent midwife could be booked.

16/04/11 In answer to the question regarding national policy and homebirths, Sharon Dickinson advised that NICE guidelines stated that the safest place to have a baby was in a midwifery led unit.

16/04/12 Sharon Dickinson stated that the executive team had been extremely supportive around recruitment and an advert would be going out in good time for the September cohort of newly qualified nurses. There was currently a review underway with People & OD around shift patterns. There was also a paediatric review at Bassetlaw, with no current plans to change maternity services at BDGH. Going forward, the Trust may need to look at the needs of the service and there may be an independent unit at Bassetlaw and patients being informed which unit to attend.

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16/04/13 Roy Underwood commented on the smoking cessation service and the

challenges around data protection and sharing patient information with other providers when making referrals.

16/04/14 Maureen Young asked about the number of babies born with cleft palette, Sharon Dickinson agreed to find this out and report back to the committee.

SD

16/04/15 Dev Das asked about the stillbirth rate. Sharon Dickinson advised that the

numbers were on the decline but remained much slower than in other countries.

16/04/16 Mike Addenbrooke asked about the number of induced births. Sharon Dickinson advised that an audit had been undertaken and the Trust was 2-3% higher that neighbouring Trusts and 5-6% percent higher than the national average. She advised that a lot of work had been done around morbidity, complex health needs and obese women.

16/04/17 In answer to a comment on the review of paper and electronic notes, Sharon Dickinson referred to the ‘Saving Babies’ Lives Care Bundle’ and a piece of work undertaken by Jason Gardosi from The Perinatal Institute in relation to the consistent use of the perinatal chart when plotting data. The Trust used the electronic K2 chart, as this was more accurate and lower risk than using paper charts, and ensured the information available to all relevant staff.

16/04/18 Maureen Young thanked Sharon Dickinson and the presentation was NOTED.

Children’s Nursing Staffing Update

16/04/19 Andrea Bliss reported the CQC Report in August 2015 had concluded that nurse staffing was considerably under establishment at the time of the visit. The DRI Children’s Ward, DRI Children’s Observation Unit, BDGH Ward A3, and Children’s Outpatient Departments at both DRI and BDGH had vacancies at the time which were exacerbated by sickness and maternity leave. The CQC did recognise that staff were moved across sites/areas whilst looking at activity, and that the issue was managed through the risk register and monitored via clinical governance.

16/04/20 In answer to a question on children’s services sickness levels, Andrea Bliss sickness had significantly improved at 3.5%.

16/04/21 Maureen Young asked if there was funding or training available to support nurses who wished to return to practice. Lib Jones advised that funding was available via Health Education Yorkshire & the Humber, although this was not currently taken up in relation to paediatrics.

16/04/22 Following a comment on support for staff on long term sick, Andrea Bliss stated that this was managed using the Trust policies and procedures with

4

ongoing support from Occupation Health and advised that counselling services were available.

16/04/23 Lib Jones commented that paediatric nurses worked extremely flexibly and effectively working across all sites. Dashboards were currently being piloted in two areas with key metrics including study time and sickness. This would enable the overall picture to be shared and the process to be rolled out across the organisation.

16/04/24 Going forward with ongoing monitoring and review of staffing levels, the Trust would be advertising for newly qualified staff from the September cohort.

16/04/25 The Children’s Nursing Staffing Update was NOTED.

ePANDA – Nurse Dependency Acuity Tool

16/04/26 Andrea Bliss gave a brief overview of the ePANDA (electronic Paediatric Acuity and Nurse Dependency Assessment) tool. The analysis of the information provided calculated the appropriate dependency and staffing for each child on each shift based on patient acuity. Going forward, the data would allow the Trust to plan and provide appropriate staffing levels and skill mixes and also provide easy access to data for monthly reports. Sub-committee members were invited to visit the ward to view how it worked in practice.

16/04/27 Maureen Young thanked Andrea Bliss and the ePANDA report was NOTED.

Any Other Business

16/04/28 Maureen Young commented on the temporary Ophthalmology Outpatient play area and lack of space for toys being a trip hazard. Lib Jones agreed to follow this up and speak to the appropriate person.

LJ

Date and Time of Next Meeting

16/04/29 10 am, Tuesday 12 July 2016 Kilton Meeting Room, BDGH

agenda · g/16/01/11 governor elections – the deadline for nominations was 1 february 2016....

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