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AGENDA

Meeting Board of Directors

Time of meeting 14:00

Date of meeting Tuesday, 26 May 2015

Meeting Room Dulwich Room, Hambledon Wing

Site King’s College Hospital, PRUH

Members:

Lord Kerslake (BK) Trust Chair

Graham Meek (GM) Non-Executive Director, Vice Chair

Christopher Stooke (CS) Non-Executive Director

Faith Boardman (FB) Non-Executive Director

Sue Slipman (SS) Non-Executive Director

Prof. Ghulam Mufti (GM1) Non-Executive Director

Angela Huxham (AH) Director of Workforce Development

Trudi Kemp (TK) - Non-voting Director Director of Strategy

Steve Leivers (SL) – Non-voting Director Director of Transformation and Turnaround

Dr. Michael Marrinan (MM) Medical Director

Simon Taylor (ST) Chief Financial Officer

Ahmad Toumadj (AT) - Non-voting Director Interim Director of Capital, Estates and Facilities

Dr. Geraldine Walters (GW) Director of Nursing & Midwifery

Jane Walters (JW) - Non-voting Director Director of Corporate Affairs

Attendees:

Tamara Cowan (TC) Board Secretary (Minutes)

Sally Lingard (SL) Associate Director of Communications

Linda Smith (LS) Charity Representative

Kath Dean (KD) Operational Site Lead - PRUH

Zebina Ratansi (ZR) Divisional Manager Critical Care, Theatres and Diagnostics

PwC Observers Governance Review

Apologies:

Roland Sinker (RS) Acting Chief Executive

Jeremy Tozer (JT) Interim Chief Operating Officer

Circulation List:

Board of Directors & Attendees

Enclosure Lead Time

1. . STANDING ITEMS Chair 14:00

1.1. Apologies

1.2. Declarations of Interest

1.3. Chair’s Action

1.4. Minutes of Previous Meeting – 28/04/2015 Enc. 1.4

1.5. Matters Arising (no tracker) Verbal

2. FOR REPORT

2.1. Move to Operational Sustainability

2.1.1. Chief Executive’s Report Enc. 2.1.1 J Walters

14:05

2.1.2. Consolidated Finance Report (Month 01) Enc. 2.1.2 S Taylor 14:20

2.1.3. Performance Reports (Month 01) Enc. 2.1.3 K Dean/ Z Ratansi

14:35

2.2. Updates from Board Committee and Council 14:50

2.2.1. Audit Committee Verbal C Stooke

2.2.2. Finance & Performance Committee Verbal G Meek

2.2.3. Quality & Governance Committee Verbal G Mufti

2.2.4. Council of Governors Activities Verbal Chair

2.3. Improving Quality of Care for Patients

2.3.1. Quarterly Patient Safety Report Enc. 2.3.1 M Marrinan 15:10

2.3.2. Monthly Nursing Staff Levels Report Enc. 2.3.2 G Walters 15:20

2.4. King’s College Hospital Charity – Monthly Update Verbal L Smith 15:30

3. FOR APPROVAL

3.1. Draft Annual Reports & Accounts 2014-15 15:45

3.1.1. Annual Report Reports available at the meeting

J Walters

3.1.2. Quality Report & External Auditors Report G Walters

3.1.3. Annual Accounts & External Auditors Report S Taylor

3.1.4. Draft Letter of Representation S Taylor

3.2. Board Annual Self Certifications Enc. 3.2 J Walters 16:05

4. FOR INFORMATION Chair 16:15

4.1. Chair’s and Non-Executive Directors’ Activity Report Enc. 4.1

4.2. Confirmed Board Committee Minutes

4.2.1. Finance & Performance Committee – 31/03/15 Enc. 4.2.1

5. . ANY OTHER BUSINESS

Chair 16:20

6. 7.

DATE OF NEXT MEETING Tuesday, 30 June, 14:00 in the PRUH

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King’s College Hospital NHS Foundation Trust Board of Directors - PUBLIC

Minutes of the meeting of the Board of Directors held at 14:00 on Tuesday, 28 April 2015 in the Boardroom, Princess Royal University Hospital

Members: Lord Kerslake (BK) Trust Chair Graham Meek (GM) Non-Executive Director, Vice Chair Chris Stooke (CS) Non-Executive Director Sue Slipman (SS) Non-Executive Director Faith Boardman (FB) Non-Executive Director Prof. Ghulam Mufti (GM1) Non-Executive Director Roland Sinker (RS) Acting Chief Executive Officer Angela Huxham (AH) Director of Workforce Development Dr Trudi Kemp (TK) – Non-voting Director Director of Strategic Development Dr. Michael Marrinan (MM) Medical Director Simon Taylor (ST) Chief Financial Officer Jeremy Tozer (JT) Interim Chief Operating Officer Dr. Geraldine Walters (GW) Director of Nursing & Midwifery Jane Walters (JW) – Non-voting Director Director of Corporate Affairs Ahmad Toumadj (AT) – Non-voting Director Interim Director of Capital, Estates & Facilities In attendance: Tooba Ahmadi (TA) Corporate Governance Officer (Minutes) Chris Rolf (CR) Deputy Director of Communications Robert Lechler (RL) KHP Executive Director Caroline Hewitt (CH) Trust Charity Representative Eniko Benfield (EB) Public Governor Ross Lydall (RL2) Evening Standard Ryan Reed (RR) Xerox Representative Richard Boys-Stones (RBS) PwC – Governance Review John Morris (JM) PwC – Governance - Review Apologies: Tim Smart (TS) Chief Executive Steve Leivers (SL1) – Non-voting Director Director of Transformation & Turnaround

Item Subject Action

15/34 Apologies Apologies for absence were noted.

15/35 Declarations of Interest There were no declarations of interest reported.

15/36 Chair’s Action There were no Chair’s actions to report.

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Item Subject Action

15/37 Minutes of Previous Meeting The minutes of the meeting held on 31 March 2015 were approved subject to a minor typographical error on page 3.

15/38 Matters Arising/Action Tracking There were no actions recorded on the action tracker.

15/39 King’s Health Partners’ (KHP) The Board welcomed Robert Lechler (RL) to the meeting.

RL provided the following update on KHP activity: Mental & Physical Health – There are a number of well-developed outpatient

services that are exemplars of integrating mental and physical healthcare;

Public health – Numerous initiatives are being developed, including the smoke free and comprehensive alcohol strategies;

Outcomes Books – The last CAG book – on Cancer - was launched at the

Annual KHP Conference on 15 April 2015;

Informatics – ‘KHP online’ is progressing well with plans in place to roll out the portal to primary and secondary care. The Informatics Group will be holding a workshop on software that supports improvement programmes for hospitals;

Local healthcare - There is now a pressing need to make some decisions about

delivering integrated healthcare solutions;

Global Health - KHP played an extraordinary central role in recent Ebola outbreak and the team is continuing to focus on rebuilding a sustainable health system in the countries affected. KHP also presented at the launch of the Lancet Global Surgery Commission on 26 April 2015, where the key focus was on access to safe surgery;

Income Generation – Work is ongoing in relation to the production of a KHP

brochure, which will set out the education and training opportunities; and Institute Development Plans –There has been positive progress with the key

focus on institute working and development in relation to cardiovascular, transplantation and child health.

The following key points were raised in discussion: The Trust Board in its earlier meeting discussed the emerging KHP picture. The

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Item Subject Action

Trust is pleased with KHP progress. However, the Board is keen to have sight of the total package for the development of the institutes;

Crystallising the debate around cardiovascular, paediatrics, transplantation and Haemato-oncology are important and how agreements would be achieved between partners by mid-June also requires consideration;

It is vital that integrated care is in the first phase of the deal;

The fundraising issues illustrate the importance of sustaining momentum and providing clear recommendations around institute working; and

RL highlighted that there needs to be discussion and interaction between KHP

Chairs and CEOs on processes to obtain clarity on institute issues and the whole plan going forward.

15/40 Update from Board Committees and Council of Governors Audit Committee CS advised that the Audit Committee had not met since the last meeting of the Board. Education & Workforce Development Committee (EWDC) FB advised that the Education & Workforce Development Committee had not met since the last meeting of the Board. Finance & Performance Committee GM reported that the Committee met earlier today and discussed the one year forward plan in depth. Improving RTT and ED performance remains a key area of focus. More detail about the operational and financial performance of the Trust will be provided under agenda items 2.3.3 and 2.3.4. Quality & Governance Committee (QGC) GM1 advised that the Quality & Governance Committee had not met since the last meeting of the Board and that the next meeting will be held on Wednesday, 13 May 2015. Strategy Committee (SC) SS advised that the Strategy Committee had not met since the last meeting of the Board. Council of Governors Activities The Board noted the report on Council of Governors activities since the last meeting and BK advised that his first meeting as Chair of the Council of Governors will be held on 14 May 2015.

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Item Subject Action

15/41 Capacity & Resources

15/41.1 Monitor – Enforcement Action The outcome of the Monitor investigation was announced at the beginning of April. The key requirements for the Trust are to produce a one year and a two year financial recovery plan, and a five year sustainability plan. The Trust is required to submit the one year plan to Monitor by the end of May and the two year plan the end of October 2015. The Board noted that work is underway to produce the one, two and five year financial plans, which covers the steps needed to reach financial sustainability and achieve the Cost Improvement Plan (CIP) savings targets.

15/41.2 Chief Executive’s Report The Board noted the Chief Executive’s report presented by RS. The new report structure focuses on the seven key areas in the forward plan. The following key points were noted: RS thanked all the staff for their work in preparation for and during the CQC

inspection week, which took place from 13 -17 April 2015. The initial feedback from the CQC has identified some strong areas of performance as well as some areas of improvement;

The Trust is on track to deliver on the required one year and two year financial

plans as well as the five year sustainability plan;

A savings target of £86m (8%) has been identified as the 2015/16 CIP. All the CIPs will undergo a rigorous quality impact assessment process to ensure decisions will not affect quality of care;

Improvements continued to be progressed in all areas of quality, access

targets, staffing, finance and productivity. The key priority area will be the emergency pathways at both DH and PRUH sites and the referral to treatment times (RTT);

The evolution of King’s Values to ‘my promise’ , and the ‘senior leaders’ away

day’ on 11 May 2015 are current key initiatives to provide staff the opportunity to reflect on the challenges and plan for the future;

The Board will consider a comprehensive plan in relation to organisational

development and leadership in due course;

Work continues with KHP and the development of key institutes. A memorandum of understanding will be considered and discussed at the KHP Board meeting on 16 June 2015;

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Item Subject Action

The Trust has commissioned PwC to undertake a governance review to ensure arrangements continue to be fit for purpose given the current regulatory challenges facing the trust;

Meetings with a wide range of stakeholders have commenced and there are

positive interactions to help deliver the emergency care pathway at the PRUH;

The Trust, Bromley CCG, NHSE and Monitor have commissioned a six week diagnostic called ‘one-version of truth’. A Steering Group has been established to deliver the diagnostic transformation initiatives; and

The Board noted that the CIP planning and delivery is robust and there is

reasonable degree of comfort to achieve the deliverables. However, the Trust may consider the high risk and intense options to improve financial performance of the organisation but these may be subject to commissioner agreement.

15/41.3 Consolidated Finance Report (month 12)

The Board received the month 12 finance report presented by ST which was discussed at length at the Finance & Performance Committee, held earlier. The following key points were noted: The Trust ended financial year 2014/15 with a deficit of £47.5m;

The deficit position was in part driven by the need to invest more heavily at the

PRUH to meet the demands in the ED as well as to manage the large vacancy factor;

During the second half of the year the increase in ED activities at both sites and the difficulty in repatriation of patients required additional investment in capacity;

Due to new systems put in place during 2014, a downward trend in the run rate of temporary staff has been noted since December 2014;

The Trust has agreed a working capital facility with the Department of Health for

the first quarter of 2015/16 to manage the Trust’s cash position; and The second half of the 2015/16 cash position will depend on the Trust’s ability

to deliver its savings target and managing the ran rates to reflect in cash flows; Recovery Plan The Trust will be submitting the year one recovery plan to Monitor this week;

Majority of the CIPs for the year has been identified and progressing through

the process to identify any potential implications on quality and safety before they are finally implemented in July-August 2015; and

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Item Subject Action

Agreements have been reached with majority of the Commissioners and NHSE in relation to contracts position for specialised services.

The Board noted the finance report and recognised the scale of challenge faced by the Trust.

15/41.4 Performance Reports (Month 12)

The Board received the month 12 performance report presented by JT which was discussed at length at the Finance & Performance Committee held earlier. The following key points were noted for other Trust sites and services: The Trust has generally performed well against the cancer wait targets but not

to the extent to reduce the 62 day cancer wait position for Q4;

There were some improvements in the 18 week RTT backlog, but challenges remain due to pressures on capacity and the cost of offsite working;

Improved performance in 4-Hour access target both at DH and PRUH during

March; The overall Trust performance for Q4 remains in line with the annual

self-certification for Monitor; The three key area of focus remain the DH ED, PRUH ED and the RTT targets.

Improvement plans in relation to these areas were discussed in depth at the Finance & Performance Committee meeting earlier today;

The C.difficile target has been breached by 19 cases across both sites with the

only definable trend being the increase in intensive care cases;

The Trust had a very tight c.difficile target of 58 cases last year and this year’s target is set at 72 cases;

The Board noted that separate reporting for both sites will continue for the rest

of this financial year; and

The performance report will provide more information on some of the operational KPIs that are leading indicators of financial issues.

15/42 Improving Quality of Care for Patients

15/42.1 Quarterly Patient Experience Report

The Board noted and received the quarterly patient experience report. The following key points were raised and noted: Overall, good performance in patient experience scores in Q4;

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Item Subject Action

The downward trend in patient complaints has continued with a reduction of over 10% in the number of complaints for Q4;

There has been improvement in the response rate to complaints but further

improvement is required to achieve the targets. A number of initiatives such as the introduction of the twin tracking system to respond to less serious or complex complaints are in place. FB is also overseeing a programme of work in her capacity as the Chair of Serious Complaints Committee;

The Trusts ‘how are we doing?’ scores improved at DH, meeting or exceeding

the benchmark but the PRUH scores dipped for months two and three; Friends and Family Test (FFT) results were positive for inpatients, with the Trust

scoring at or above the averages for both London and England but less positive scores for emergency FFT. Action plans are in place to address patient concerns; and

The volunteering service is continuing to develop and support patients both

within the hospital and at home. A new volunteering initiative, ‘the Saturday Social Club’ was launched in December 2014.

15/42.2 Monthly Nursing Staff Levels Report

The Board noted and received the monthly nurse staffing levels and agreed that the nursing staff level data should be publicised in line with guidance.

15/43 King’s College Hospital Charity – Monthly Update

The Board welcomed Caroline Hewitt (CH) to the meeting and thanked the Charity for organising the Long-Service Award ceremony, which was held recently. CH provided a short update on the Charity’s activities. The following key points were noted: CH thanked the Estates and Facilities team for the move of the Fundraising

Team to the new office; The key focus this month has been on the soft launch of the charity champions

initiative, with the aim of encouraging staff to be advocates and champions for the Charity;

The second Charity Futures Steering Group meeting will be chaired by CS and

a recommendation presented to the Board in July 2015;

In May, there will be a number of engagement opportunities with various stakeholders; and

The Charity is now working more closely with the Trust’s Communication Team

to promote and advertise its initiatives more widely.

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Item Subject Action

15/44 FOR APPROVAL

15/44.1 Monitor Submission Quarter 4, 2014/2015 The Board received and approved the Quarter 4 submission to Monitor.

15/45 FOR INFORMATION

15/45.1 Chair’s and Non-Executive Directors’ Activity Report The Board noted the Chair’s and NEDs activity report for the period.

15/45.2 Confirmed Board Committee Minutes The Board noted the confirmed minutes of the Finance & Performance Committee (24/02/2015).

15/46 Any Other Business There were no matters of any other business raised for discussion.

15/47 Date of Next Meeting Tuesday, 26 May 2015, Dulwich Room, Denmark Hill site.

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Report to: Board of Directors Date of meeting: 26 May 2015 By: Roland Sinker, Acting Chief Executive Officer Presented by: Jane Walters, Director of Corporate Affairs & Trust Secretary

Subject: Chief Executive’s Board Report

Introduction

This month the Board has given its focus to developing and approving the Trust’s two-year financial recovery plan in addition to completing its year-end processes, which involve reviewing, and finalising the annual report, quality report and annual accounts.

As part of this process the Board has been asked to make relevant self-certifications on the Trust’s ability to remain a going concern, its operational, financial and clinical sustainability, availability of resources to meet the continuity of services condition and how it will continue to meet the requirements under the licence issued by Monitor.

In parallel with the year-end processes, the Board will today consider month 1 performance reports.

The major themes of the forward plan for the organisation continue to be the driving force for delivering the financial turnaround and improving the sustainability and quality of our services.

1. Improving the Quality of Care for our Patients

Improving quality of care for our patients remains the core of all the Trust’s plan. Following initial feedback from the CQC when they visited us in April, the Trust has been focussing on seven initial areas for improvement , and also on quality assessment of the development of the Trust’s Cost Improvement Plans (CIPs) which are subject to rigorous quality impact assessment . CQC unannounced inspections took place in the two weeks following the formal inspection in mid April. There has been no further feedback from the CQC since these last visits , and we now await their formal report , which will also be discussed with all key stakeholders at a quality summit. Later in the agenda the Board will consider quality report which details the key improvements made during the last financial year and our plans for 2015-16. 2. Delivering the Financial Plan

The Trust has agreed formal undertakings with Monitor to deliver one year and two year financial plans, as well as a five year sustainability plan. The Trust completed and submitted the one year financial recovery plan and on track to deliver the other two plans within the required timeframes. Steve Leivers, the Director of Turnaround and Transformation, supported by PwC are working with all Divisions and Corporate Departments to consolidate

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the Trust’s savings plans and to develop new initiatives to ensure that the challenging 2015/16 target of £86m is delivered. In addition, the Trust is working with commissioners and Monitor to articulate strategic choices to enable the health economy to function more sustainably. The divisions and corporate departments continue to receive significant support to develop the savings programme. Clinicians are actively involved in the programme to ensure that the programme takes cognisance of the requirement to safeguard quality and patient care. The process is on-going and the teams are continuing to explore new opportunities and develop additional schemes. 3. Moving to Operational Sustainability

The Trust continues to drive improvements in all areas of performance , quality, access targets, staffing, finance and productivity. Working with Commissioners and Regulators, there is a particular focus on improvement in three areas: the PRUH emergency pathway; the Denmark Hill emergency pathway; and referral to treatment times. On the PRUH emergency pathway, the Trust is looking at internal improvements and also working with partners in the local health economy to develop a shared understanding of the system wide pressures. We have worked closely with commissioners and provider partners on scoping how best to meet the future health and social care needs of the population. The stakeholders are now reviewing the first iteration of this work and we are confident it will lead to improvements which will benefit the patient populations served by the Trust. Similar work is developing at Denmark Hill with work on the development of Local Care Networks in Lambeth and Southwark; the establishment of five federations of GPs; and work on future models of community based services. We are introducing a new format for reporting performance across our sites and you will hear more about how we are doing in month 1. 4. Investment in Organisational Development and Leadership

The investment in our organisational development and leadership is key to ensuring that the organisation will remain sustainable and deliver its plans.

On the 11th May, the Trust held a very successful workshop for 150 of our senior leaders across the Trust. This was an opportunity to reflect on the status of the Trust, shape the seven point forward plan, understand the strategic context and hear from some of our outstanding clinical areas. The workshop will be repeated in September as part of a broader programme of organisational development.

5. Negotiation of a KHP Strategy and further development of the King’s strategy

Work continues with our colleagues in King’s Health Partners to scope how best to continue to develop clinical and academic excellence. Following initial scoping work on the priority institute areas, work is now underway looking at cardiovascular, integrated care, transplantation, cancers of the blood and lymphatic systems and some aspects of child health in order to be able to describe clearly the vision for the future. KHP will be a key plank of our forward strategy and will sit alongside plans in numerous other areas.

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6. Board Working

In April, Tim Smart, Chief Executive of King’s College Hospital NHS Foundation Trust announced he was retiring from the position he had held for seven years. Tim joined King’s in 2008, and has played a key role to establish King’s as one of the largest and most prestigious Foundation Trusts in the country. During his time as Chief Executive, Tim was instrumental in the formation of King’s Health Partners Academic Health Science Centre (AHSC), and leading the Trust in the acquisition of the Princess Royal University Hospital (PRUH) in 2013. He was also one of the driving forces behind the development of the Trust’s Values, which are a key part of his legacy. Tim’s contribution over the last seven years have been significant and the Trust thanks him for his hard work and strong commitment to patient care. Roland Sinker continues in his role as Acting Chief Executive, and will do so until a permanent appointment to the position is made. During the summer appointments are expected to the roles of Executive Director of Workforce and Director of Capital, Estates and Facilities. Recruitment is also underway for the posts of Medical Director and Director of Corporate Affairs. As incoming Chair, Lord Kerslake has commissioned a Board governance review, which commenced on 28 April and being carried out by PwC. It will review how the Board and organisation is positioned to address the challenges and opportunities it faces going forward. It will also include a high-level review of governance arrangements for the Council of Governors. The review will conclude at the end of June 2015. In parallel with this review a great deal of work is ongoing considering how the Trust can streamline reporting and meeting structures.

7. Developing relationships with our stakeholders

We continue to engage with a wide range of stakeholders, as outlined elsewhere in this report, and remain committed to developing our relationship with them. Further progress has been made on the stakeholder engagement programme led by the Chief Executive and the Chairman. Meetings with over 20 individuals have already been taken place or have been scheduled for the coming weeks spanning the NHS, local authority and wider partner landscape. Now that the general election has taken place, meetings with local MPs are being arranged. In addition, site tours are being arranged for elected members of Health Overview and Scrutiny Committees and Health and Wellbeing Boards. Two tours are taking place in June with Bromley and Southwark members. The increase in senior representation at key stakeholder meetings is moving forward at pace and positive feedback has already been received from stakeholders. Dedicated stakeholder events will take place this summer focusing on our emerging strategy. The events will provide an opportunity for comprehensive feedback from our stakeholders and input into our strategic plans.

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8. Media Highlights and Visits

New and events can be found on the Trust’s website https://www.kch.nhs.uk/news

Some noteworthy media coverage and events include:

Medium Summary

BBC2 Horizon The Trust was featured in a programme about binge drinking. Professor Nigel Heaton talked about the regenerative powers of the liver, but also the importance of moderation when it comes to alcohol.

Evening

Standard

BBC London

Southwark

News

Media coverage about Nanoknife, a new treatment we are offering that

‘kills’ liver and pancreatic tumours using high-voltage electricity. King’s is

the first NHS hospital in London to use the technology that can treat

people with formerly inoperable cancers. Dr Praveen Peddu, Consultant

Radiologist at King’s, is quoted in the article.

BBC News Mr Lyndon Meehan, Speciality Endodontist at King’s and Board Member

for charity Dental Trauma UK, was featured advocating the compulsory

wearing of mouthguards during sport to protect teeth from damage.

Evening

Standard

A feature story about Professor Nigel Heaton and James Lane, the son of

one of Prof Heaton’s former patients, who is cycling for ten days from

London to Barcelona to raise money for the Institute of Liver Studies at

King’s. They will be joined by 33 other cyclists from King’s and technology

company Ricoh, where James works.

Daily Mail Article about a new cardiac implant to help patients with chronic angina

pain, includes an interview with Dr Jonathan Hill, King’s Consultant

Cardiologist.

ITV’s Good

Morning Britain

Interview with the parents of King’s three-year-old Georgia Fieldsend, who

sadly died at King’s in 2013 after suffering a brain aneurysm on holiday. A

song is to be released in her memory by two close friends of Georgia’s

family money raised from sales of the song will be donated to the Thomas

Cook Children’s Critical Care Unit at King’s.

The Trust will also be featured in BBC One two-part documentary – ‘The Truth About Teeth’. The programmes air on Thursday 4 June and Thursday 11 June on BBC One at 9pm. They will feature Dr Serpil Djemal, Clinical Lead for Restorative Dentistry at King’s, and her team exploring the nature of modern dentistry.

https://www.kch.nhs.uk/news

Finance Report

Month 1 (April) 2015/16

Board of Directors

26th May 2015

Enc. 2.1.2

Report to: Board of Directors

Date of meeting: 26th May 2015

Subject: Finance Report – Month 1 (April 2015)

Author(s): Simon Dixon, Nicola Hoeksema

Presented by: Simon Taylor, Chief Financial Officer

Sponsor: Simon Taylor, Chief Financial Officer

History: First submission to Finance and Performance Committee

Status: Decision/Discussion/Information

1. Purpose The Finance Reports includes information on the Trust’s financial performance and position which

support the in-year submissions to Monitor on a quarterly basis.

This report covers the Income & Expenditure position, Cost Improvement Programme, Capital and

Working Capital Plans.

2. Action required The Board is asked to approve the Finance Report

Enc. 2.1.2

Legal: Reporting to Monitor and Commercial Bank

Financial: Trust reports financial performance and position against published plan and notifies the

committee of financial risks, cost pressures and action plans to mitigate any material variance

from financial targets.

Assurance: The summary and appendices provide assurance that the Trust is meeting Financial targets

(internal and those set by Monitor) and is compliant with its terms of authorisation.

Clinical: There is no direct impact on clinical issues

Equality & Diversity: There is no direct impact on E&D

Performance: Financial Performance against annual plan, budgets, CIPs and Monitor Risk Ratings and

Limits.

Strategy: Performance against the Trust’s Annual Plan including Risk Ratings

Workforce: There are implications for workforce recruitment in respect to service developments and

vacancies.

Estates: There are implication on the Trust’s estates strategy.

Reputation: Finance Committee Report is provided to Monitor and Commercial Bankers as additional

information to support the quarterly Monitor Return.

Other:(please specify) None.

3. Key implications

Page 3

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Contents

Page(s)

Executive Financial Summary 5 - 6

Continuity of Service Risk Ratings 7

Annual Plan Budget Control Totals 8 - 9

Income & Expenditure Analysis

Clinical & Corporate Departments 10 - 20

Temporary Pay 21 - 22

Trust Clinical Income 23 - 25

Cost Improvement Plans (CIP) 26 - 29

Cash Flow Forecast 30

Capital Plan 31

Working Capital Summary 32 - 34

Glossary 35

Enc. 2.1.2

Executive Financial Summary

Income and expenditure summary

1. The Trust is reporting an favourable variance to plan of £984k to date excluding the asset impairment (non-operating cost). The Continuity of

Service Risk Rating is 1 (page 7). The actual operational income and expenditure deficit for the month is £12.6m.

2. The Trust’s annual budgets were based on last year’s outturn expenditure excluding national resilience income and expenditure for

emergency pressures (tranche 2) and RTT backlog cost pressures. The underlying deficit for 2014/15 was £147m and therefore the month 1

deficit was expected to be circa £12.25m. The normalised run rate for month 1 is circa £10m excluding prior year costs. No cost

improvement plans have been allocated in month 1 and they will be phased into the budgets from month 2.

3. The financial plan requires the delivery of £86m (c.8%) CIP on expenditure baselines. The divisional and corporate targets are presented on

page 8. Progress has been made over a short period of time, with £20m of schemes being green rated (agreed and budget to be taken out)

by the end of May. The Trust is seeking to achieve over 75% of schemes to be green rated by the end of June and targeting 100% by end of

July. A summary of the CIP target progress is reported on pages 26 to 29.

4. The Clinical Divisions and Corporate Department detailed budgetary movements are reported on pages 10 to 20.

• The positive income variance reflects accrued income for off-tariff drug usage and funding for RTT backlog costs in respect to the

use of the independent sector. No contract activity information was available at the time of this report and all contract income for

CCGs and NHSE was reported in line with contract values. It should be noted that 45.4% of clinical income (£391m) is now under

block contract (see page 24).

• The pay costs are below budget due to an increase in substantive appointments and a reduction in agency costs. See pages 21 - 22.

• Non-pay costs were overspent due to drug costs and the use of the independent sector to meet RTT backlog activity targets.

Annual

Budget YTD Budget YTD Actual YTD Variance

Last Month

Variance

Movement in

Month

£'000 £'000 £'000 £'000 £'000 £'000

1,025,195 84,922 85,872 951 0 951

(628,355) (55,390) (55,125) 265 0 265

(399,414) (38,164) (38,541) (376) 0 (376)

(67,929) (5,479) (5,335) 145 0 145

(70,503) (14,112) (13,127) 984 0 984

(5,500) (458) (458) 0 0 0

(65,003) (13,653) (12,669) 984 0 984Operating Surplus / (Deficit)

Income and Expenditure

Income

Pay Expenditure

Non-pay Expenditure

Capital Charges, Interest & Dividends

Surplus / (Deficit)

Impairment Expense

Enc. 2.1.2

Executive Financial Summary

Cash Flow Summary

1. Based on the 13-week cash forecast, the Trust has a cash overdraft position at mid-June, as well as in July. See page 30.

2. The Trust quarter one FY16 cash position has improved in recent weeks owing to agreement of short-term funding from local CCGs (£10m).

3. A working capital facility of £59.7m has been agreed with ITFF through Monitor, which the Trust is using, alongside ongoing cash management

initiatives, to manage its cash low points. However, in-line with the terms of the agreement, the Trust cannot use the facility to un-wind its

payables, which puts pressure on supplier relationship and price negotiations.

4. The full year cash requirement, supported by a monthly cash flow forecast, is £77.9m, predicated on the Trust delivering £86m of CIPs in year.

The cash flow forecast is prudent and assumes a time lag between CIP delivery and cash release given the phasing of CIPs towards the end of

the year.

5. Areas of risk within the 13 week forecast include:

NHSE income contract is still to be agreed

Further suppliers demanding payment in addition to what is currently forecast, as witnessed in recent weeks.

The expected reduction in bank and agency usage is reflected in reduced weekly forecast payments from July 2015. There is a risk that

the bank and agency usage will not have decreased adequately for this level of payment to suffice.

Trade Creditor payments have been reduced by £200k per week until mid-June in order to ensure that the Trust is able to retain a cash

balance of £3m in the week ending 12 June 2015

Capital Summary

1. FY16 capital expenditure plan includes £38.9m of planned expenditure, this has been reduced from £89.7m as at October 2014. This reduction

reflects cancellation/postponement of projects not related to patient safety, enablers to CIPs or for which the expenditure is contractually

committed.

2. The majority of the planned capital spend relates to the Phase 1 and 2 of the Critical Care Unit development, £20.3m (52%). This project is

deemed as critical to meeting patient safety requirements;

3. £4.9m (12.6%) relates to the construction of the Helideck, which will reduce the time taken for air ambulance patients to reach the hospital.

4. The remaining £17.5m of expenditure relates to essential works also deemed critical to patient safety.

5. £23.9m of the capital plan is funded through depreciation with the remainder funded by IFTFF loan, donations and DoH specific funding. The

capital plan is presented on page 31.

Enc. 2.1.2

Continuity of Service Risk Rating

Page 7

Debt Service Cover

Revenue available for Debt Service £'000 (7,794) key to scoringDebt Service £'000 (3,163) Debt Service Cover 50%

Debt Service Cover metric -2.46x 4 3 2 1

Debt Service Cover rating 1 2.5 1.75 1.25 <1.25

Liquidity

Cash for CoS liquidity purposes £'000 (782) key to scoringOperating Expenses within EBITDA, Total £'000 (12,688) Liquidity 50%

Liquidity metric days -0.06x 4 3 2 1

Liquidity rating 1 0 -7 -14 <-14

Continuity of Service Risk Rating 1

Enc. 2.1.2

15/16 Annual Plan Budget Control Totals

Page 8

Enc. 2.1.2

15/16 Budget Principles

Page 9

INCOME

Trust income is based on 15/16 contract proposals - outturn plus 2% growth

Division/department Income targets are based on 14/15 outturn

UNDERLYING OPERATING OUTTURN EXPENDITURE

Includes

Posts relating to the PRUH transaction that were unfunded in 14/15

Posts that were approved by BRSG or the trust executive that were unfunded in 14/15.

Recurrent non-pay overspends from 14/15

Business cases that were approved in 14/15 but not funded.

Historical negative 'unmet CIP' budgets have been removed

An uplift for vacant posts current being filled by agency staff (agency additional cost of 25% to 30%)

Agency/Bank costs relating to over-established nursing posts. Once the nursing establishment review has been completed

and approved these will be converted into established posts.

Nursing replacement costs for annual leave, sickness and training are built into budgets at 21% of cost.

Excludes

RTT costs from 14/15

Costs relating to tranche 2 ED/Resilience funding (N/R national monies)

15/16 COST PRESSURES

Full year effect of 14/15 business cases

Full year effect of costs relating to tranche 1 ED/Resilience funding

Incremental pay and 1% pay uplifts

NHSLA increase in CNST premiums

Increase in Viapath contract prices

Increase in depreciation charges

Integration and restructuring support costs

Transformation costs to achieve QIPPs

Enc. 2.1.2

Trustwide Expenditure By Type

Page 10

The table above is an unconsolidated expenditure analysis, excluding Trust subsidiaries.

Subjective Summary

Annual

Budget

£'000

YTD Budget

£'000

YTD Actual

£'000

YTD

Variance

£'000

Last Month

Variance

£'000

In Month

Movement

£'000

Income Income 1,025,195 84,922 85,872 951 0 951

Income Total 1,025,195 84,922 85,872 951 0 951

Pay Nursing Staff (257,677) (22,647) (22,437) 210 0 210

Medical Staff (200,416) (17,138) (16,889) 249 0 249

A&C Staff/Senior Managers (100,160) (8,687) (8,871) (183) 0 (183)

PAMS/Scientific/Professional (70,102) (6,917) (6,928) (11) 0 (11)

Pay Total (628,355) (55,390) (55,125) 265 0 265

Non-Pay Drugs (116,535) (9,711) (10,294) (583) 0 (583)

Clinical Supplies (96,359) (8,030) (7,866) 164 0 164

Non-Clinical Supplies (58,898) (4,908) (4,533) 375 0 375

Sub Contracted Healthcare - NHS bodies (54,926) (4,577) (4,498) 80 0 80

Misc. Other Operating Exependiture (47,948) (8,876) (8,937) (61) 0 (61)

Interest & Dividends (38,887) (3,059) (2,893) 165 0 165

Capital Charges (29,042) (2,420) (2,441) (21) 0 (21)

Services Provided by non-NHS bodies (24,749) (2,062) (2,413) (351) 0 (351)

Non-Pay Total (467,343) (43,644) (43,875) (232) 0 (232)

Surplus / (Deficit) (70,503) (14,112) (13,127) 984 0 984

(5,500) (458) (458) 0 0 0

(65,003) (13,653) (12,669) 984 0 984

Impairment Expense

Operating Surplus / (Deficit)

Income

Income over-performance relates to an estimate for off-tariff drugs over and above last years outturn (£250k). This is partly offsetting the non-pay drug

overspend. The off-site activity costs have been offset by an income accrual (£500k) on agreement that commissioners will support the Trust to meet the

RTT backlog demand by October. The Trust is confirming the RTT activity backlog figures during the reporting holiday. No clinical activity data was

available at the time of reporting and all contract income budgets with commissioners have been reported as break-even.

Pay

Favourable position in month is due to improved bank and agency controls and the increase in substantive appointments throughout the trust.

Non-pay

Overspend is primarily due to drugs and off-site working which is being offset by income over performance.

Month 1 budget phasing

In order to cover additional prior year agency costs the month 1 pay budgets were increased from central reserves. The income and non-pay (drugs and

clinical supplies) budgets have not been phased in month 1 and the phasing will be completed from month 2.

Enc. 2.1.2

Ambulatory Care and Local Networks

Page 11


Subjective Summary

Annual

Budget

£'000

YTD Budget

£'000

YTD Actual

£'000

YTD Variance

£'000

Last Month

Variance

£'000

In Month

Movement

£'000

Income Income 143,000 11,917 12,158 241 0 241

Income Total 143,000 11,917 12,158 241 0 241

Pay Medical Staff (31,446) (2,661) (2,599) 62 0 62

A&C Staff/Senior Managers (15,414) (1,345) (1,208) 138 0 138

PAMS/Scientific/Professional (13,614) (1,151) (1,043) 108 0 108

Nursing Staff (11,636) (999) (907) 92 0 92

Pay Total (72,110) (6,156) (5,756) 400 0 400

Non-Pay Drugs (31,531) (2,628) (2,920) (292) 0 (292)

Clinical Supplies (6,556) (546) (537) 9 0 9

Non-Clinical Supplies (3,495) (291) (230) 61 0 61

Sub Contracted Healthcare - NHS bodies (1,177) (98) (93) 5 0 5

Services Provided by non-NHS bodies (94) (8) (2) 6 0 6

Misc. Other Operating Exependiture 6,173 (180) (129) 51 0 51

Non-Pay Total (36,680) (3,751) (3,910) (159) 0 (159)

Grand Total 34,210 2,009 2,492 482 0 482

Income

Income over-performance relates to off tariff drugs over and above last years outturn, this is partly offsetting the non-pay drug overspend

Pay

Favourable position in month is due to vacancies across all staffing categories. Underspend is partially being offset against bank and agency usage

costs. Recruitment is ongoing and should result in a reduction in non-substantive staff costs towards the end of Q1.

Non-pay

Overspend is primarily due to drugs overspend within Rheumatology, Dermatology, Medical Oncology and Endocrinology. This is offset by off tariff drug

income overperformance

The unfavourable misc.other operating expenditure budget relates to unallocated CIPs. This will reduce as CIPs are identified and moved to the correct

pay/nonpay categories

Enc. 2.1.2

Critical Care, Theatres and Diagnostic Services

Page 12


Subjective Summary

Annual

Budget

£'000

YTD Budget

£'000

YTD Actual

£'000

YTD Variance

£'000

Last Month

Variance

£'000

In Month

Movement

£'000

Income Income 61,991 5,166 5,011 (155) 0 (155)

Income Total 61,991 5,166 5,011 (155) 0 (155)


Medical Staff (39,249) (3,319) (3,215) 104 0 104

PAMS/Scientific/Professional (31,895) (2,741) (2,931) (190) 0 (190)

A&C Staff/Senior Managers (6,894) (597) (587) 10 0 10

Pay Total (121,870) (10,415) (10,234) 181 0 181

Non-Pay Clinical Supplies (43,464) (3,622) (3,390) 232 0 232

Drugs (5,709) (476) (429) 47 0 47

Non-Clinical Supplies (4,937) (411) (488) (77) 0 (77)


Services Provided by non-NHS bodies (4) (0) (3) (2) 0 (2)


Non-Pay Total (46,574) (5,063) (4,576) 487 0 487

Grand Total (106,454) (10,312) (9,799) 513 0 513

Income

Breast Screening had a shutdown over 4 days due to building works creating a reduction in income, CSSD underperformed in non-operating income NHS

and Imaging underperformed in other operating income NHS.

Pay

Vacancies in Pathology and Imaging Medical staff have created a positive variance to the current budget. Critical Care at DH and the PRUH have a

vacancy rate of 35 WTE which currently replaced with bank and agency this is 25 WTE less than at the same time last year. Theatres currently have a

vacancy rate of 70 WTE and both these areas have a target reduction to 10 WTE with July and October recruitment intakes being the main drivers.

Non-Pay

Critical Care run rate has reduced considerably compared to the 2014-15 average. In April there was a reduction in acuity in Christine Brown and Frank

Stansil.

Pharmacy is also favourable in drugs based on 2014-15 flow through cost efficiencies being realised.

The unfavourable misc. other operating expenditure budget relates to unallocated CIPs. This will reduce as CIPs are identified and moved to the correct

pay/non-pay categories

Enc. 2.1.2

Liver, Renal and Surgery

Page 13


Subjective Summary

Annual

Budget

£'000

YTD Budget

£'000

YTD Actual

£'000

YTD Variance

£'000

Last Month

Variance

£'000

In Month

Movement

£'000

Income Income 208,711 17,393 17,499 107 0 107

Income Total 208,711 17,393 17,499 107 0 107

Pay Nursing Staff (46,136) (4,100) (4,118) (18) 0 (18)

Medical Staff (37,608) (3,296) (3,189) 106 0 106

A&C Staff/Senior Managers (7,794) (677) (708) (32) 0 (32)

PAMS/Scientific/Professional (6,367) (327) (340) (13) 0 (13)

Pay Total (97,905) (8,399) (8,355) 44 0 44

Non-Pay Drugs (17,298) (1,441) (1,492) (51) 0 (51)

Clinical Supplies (12,662) (1,055) (1,032) 24 0 24


Sub Contracted Healthcare - NHS bodies (732) (61) (54) 7 0 7


Misc. Other Operating Exependiture 6,766 (152) (160) (8) 0 (8)

Non-Pay Total (26,248) (2,903) (3,093) (190) 0 (190)

Grand Total 84,558 6,091 6,052 (39) 0 (39)

Income

Overall Income, has over performed in month by £107k, mainly due to provision for activity carried out by private providers.

Pay

Underspent by £44k in month, mainly due to the budget been set at last year outturn. The normalised in-month run rate has slightly (£75k) decreased as

compare to last year's average, due to tightened controls over temporary staff usage and recruitment. Overall, the underlying cost drivers remain the same,

a) temporary Nursing staff usage to cover over 85wte qualified nursing vacancies & (b) to backfill over 23wte overseas nurses whilst staff are going

through training and NMC registration process, c) specialising of patients. d) temporary medical staff usage to cover 31.6wte vacancies. The division is

working on fast track recruitment plans to recruit substantively which includes the overseas recruitment strategy.

Non-Pay

Across categories is with in budget with the exception of services provided by non-NHS bodies (£178k) due to patient referred to private sector to manage

the RTT targets. The drugs is also overspent by £51k that relate to pass through drugs and is off set by corresponding income.



Enc. 2.1.2

Networked Services

Page 14


Subjective Summary

Annual

Budget

£'000

YTD Budget

£'000

YTD Actual

£'000

YTD Variance

£'000

Last Month

Variance

£'000

In Month

Movement

£'000

Income Income 196,155 16,346 16,895 549 0 549

Income Total 196,155 16,346 16,895 549 0 549

Pay A&C Staff/Senior Managers (8,363) (701) (663) 38 0 38

Medical Staff (30,127) (2,666) (2,453) 213 0 213

Nursing Staff (41,238) (3,541) (3,450) 90 0 90

PAMS/Scientific/Professional (9,492) (791) (738) 53 0 53

Pay Total (89,219) (7,698) (7,304) 395 0 395

Non-Pay Clinical Supplies (25,174) (2,098) (1,964) 133 0 133

Drugs (48,238) (4,020) (4,246) (226) 0 (226)




Sub Contracted Healthcare - NHS bodies (1,233) (103) (121) (18) 0 (18)

Non-Pay Total (65,897) (6,492) (6,914) (422) 0 (422)

Grand Total 41,039 2,156 2,678 522 0 522

Income

Over-performance of £549k almost exclusively related to income expected for RTT offsite work (£321), £109k off-tariff drug over-performance, and £82k

income billed to other Trusts for services provided.

Pay

£394k under-spent, mainly around Medical pay (£213k under-spend), where funded positions haven’t been filled in yet (e.g.: sickle cell post, etc.) and

better use of temp staffing. Temp Staffing usage downward trend (or at least within budgeted levels) is evident in all other areas as well, with nursing

under-spending by £90k, and PAMS and Scientific Staff by a combined £51k.

Non-Pay

Over-spent by £394k, but with a combined over-spend in drugs and external contract staffing (included in Misc. Other Operating Expenditure and partly on

Services Provided by other non-NHS bodies) of £538k (226k in drugs and £321k in external contractors relating to the offsite RTT work). RTT offsite work

is fully funded by the over-performance in income, as is a large amount of the drugs. Clinical Supplies and Services under-spent by £133k, explained by a

comparatively slow month in the use of high cost consumables (e.g.: ICDs in Cardiothoracic).



Enc. 2.1.2

Trauma, Emergency and Medicine

Page 15


Subjective Summary

Annual

Budget

£'000

YTD Budget

£'000

YTD Actual

£'000

YTD Variance

£'000

Last Month

Variance

£'000

In Month

Movement

£'000

Income Income 128,914 10,743 10,846 103 0 103

Income Total 128,914 10,743 10,846 103 0 103

Pay Nursing Staff (50,539) (4,803) (4,920) (118) 0 (118)

Medical Staff (32,180) (2,682) (2,749) (67) 0 (67)

PAMS/Scientific/Professional (18,235) (1,520) (1,462) 57 0 57


Pay Total (108,474) (9,634) (9,804) (171) 0 (171)

Non-Pay Drugs (6,138) (512) (548) (37) 0 (37)



Sub Contracted Healthcare - NHS bodies (253) (21) (28) (7) 0 (7)


Non-Pay Total (5,162) (1,112) (1,121) (9) 0 (9)

Grand Total 15,278 (3) (79) (77) 0 (77)

Income

Additional income received in month against compensatory recovery unit income to cover treatment for successful RTA & personal injury claims.

Contract income based on planned level of activity for April 2015.

Pay

Medical staff £67k overspent: DH site 26% reduction in agency compared to 14/15 run rate due to successful junior doctor and Consultant recruitment. PRUH site

15% increase in agency compared to 14/15 run rate due to continuation of Ortho Geriatric Consultant to address service delivery/ patient safety concerns previously

funded by winter resilience money; review of job plans and junior doctors rotas to ensure they are in line with service needs with intention of realigning resource to

cover the Consultant. Substantive spend has increased by 8% at the PRUH due to successful junior doctor recruitment. Registrar and Consultant vacancies are out to

advert.

Nursing staff £118k overspent: DH site 67% reduction in agency compared to 14/15 run rate to due to reduction of use of specials since introduction of specialing

tool in November14 and successful overseas recruitment. PRUH site has had similar success from reduction in specialing and overseas recruitment, however agency

has increased by 15% due to 4 additional specials added to the AMU in response to an adverse incident in order to reduce falls from December 14 recommended at

the safer, faster care forum. There are also 4 additional night shifts added to the rota in ED from December 14 due to patient safety concerns; 1 will be removed from

rota and others are are being reviewed to shorten length in response to peak demands, a summary document is being produced w/c 25/05/15 to highlight risks of

withdrawal. Interviews are being held for ward and ED nurses w/c 25/05/15.

Non-Pay £9k overspent

Month 1 spend in line with 14/15 run rate.

The unfavourable misc. other operating expenditure budget relates to unallocated CIPs. This will reduce as CIPs are identified and moved to the correct pay/non-pay

categories

Enc. 2.1.2

Women’s and Children’s

Page 16


Subjective Summary

Annual

Budget

£'000

YTD Budget

£'000

YTD Actual

£'000

YTD Variance

£'000

Last Month

Variance

£'000

In Month

Movement

£'000

Income Income 130,277 10,856 10,733 (123) 0 (123)

Income Total 130,277 10,856 10,733 (123) 0 (123)


Medical Staff (26,994) (2,279) (2,321) (43) 0 (43)

A&C Staff/Senior Managers (5,739) (496) (448) 48 0 48

PAMS/Scientific/Professional (1,358) (113) (107) 6 0 6

Pay Total (84,457) (7,178) (7,109) 69 0 69

Non-Pay Drugs (6,291) (524) (475) 49 0 49






Non-Pay Total (8,320) (1,278) (1,160) 117 0 117

Grand Total 37,499 2,401 2,465 64 0 64

Income

Underperformance due to delays in invoicing for some non CCG activity due to lack of data, this will be recovered in M2

Pay

There are currently 122wte nursing vacancies across the division which are being covered by bank and agency staff. These are ongoing recruitment

drives to fill these posts. Medical Staffing is £13k overspent, there are currently 3.2wte junior doctors over established at Denmark Hill. This anomaly of the

rotation will be investigated with the Division. Admin & Clerical is £38k underspent. Admin & Clerical spend is above the trend of 14/15, not all vacancies

are being fully backfilled with Bank or Agency. Vacancies are reducing compared to last in the year, the remaining posts are either - out to advert, pending

VAP or on hold pending overall review on admin. Admin vacancies are currently not being filled unless critical.

Professional and Technical is £32k adverse in month, due to part year cost for Sonographers (£400k total value) to support the delivery of Fetal medicine

services at PRUH. This is the biggest pay over spend within the Division.

Non-pay

Drugs are £49k underspent due to a reduction in CF drug spend

External (BMI) Gynaecology charges have caused £15k adverse variance in Month 1. Ad hoc invoice for replacement probes has caused a £9k adverse

variance for Establishment expenses in month. Other items remain on trend.



Enc. 2.1.2

Private Patients and Overseas Visitors

Page 17


Subjective Summary

Annual

Budget

£'000

YTD Budget

£'000

YTD Actual

£'000

YTD Variance

£'000

Last Month

Variance

£'000

In Month

Movement

£'000

Income Income 18,351 1,529 1,198 (331) 0 (331)

Income Total 18,351 1,529 1,198 (331) 0 (331)

Pay Nursing Staff (1,910) (159) (166) (7) 0 (7)


PAMS/Scientific/Professional (77) (6) (13) (6) 0 (6)

Medical Staff 1 0 (4) (4) 0 (4)

Pay Total (3,314) (276) (329) (52) 0 (52)

Non-Pay Misc. Other Operating Exependiture (2,867) (296) (233) 63 0 63

Drugs (1,269) (106) (154) (48) 0 (48)

Non-Clinical Supplies (266) (22) (4) 18 0 18

Clinical Supplies (118) (10) (5) 4 0 4

Non-Pay Total (4,520) (433) (396) 38 0 38

Grand Total 10,518 820 474 (346) 0 (346)

Income

The Income shortfall is due to the continuing loss of activity from the Cyprus high commission. The Trust is looking to capture additional activity from the

middle-east market. No income has been recorded for non-reciprocal overseas visitors in respect to the new billing process. The Trust will bill the patient

directly at 150% of tariff and if this income is not recovered the Trust will be reimbursed by the commissioner at 75% of tariff. This should generate an

additional £3-4m which has been built into the income target.

Pay

Overspend on A&C staff due to additional staff over and above 14/15 outturn

Non-pay

High cost drugs (fully recoverable via income) accounting for £48k of overspend

The remaining non-pay underspend is as a result of chargeable ad hoc outlier activity to LRS and NWS

Enc. 2.1.2

Contract Services

Page 18


Subjective Summary

Annual

Budget

£'000

YTD Budget

£'000

YTD Actual

£'000

YTD Variance

£'000

Last Month

Variance

£'000

In Month

Movement

£'000

Income Income 21,416 1,785 1,829 44 0 44

Income Total 21,416 1,785 1,829 44 0 44

Pay A&C Staff/Senior Managers (846) (70) (79) (9) 0 (9)

Medical Staff (774) (64) (58) 7 0 7

Nursing Staff (235) (20) (19) 0 0 0

PAMS/Scientific/Professional (143) (12) (9) 3 0 3

Pay Total (1,997) (166) (165) 1 0 1

Non-Pay Services Provided by non-NHS bodies (24,133) (2,011) (2,115) (104) 0 (104)

Sub Contracted Healthcare - NHS bodies (11,595) (966) (994) (28) 0 (28)

Non-Clinical Supplies (105) (9) (25) (16) 0 (16)

Drugs (3) (0) (4) (4) 0 (4)

Misc. Other Operating Exependiture 854 (15) (60) (45) 0 (45)

Clinical Supplies 869 72 (68) (141) 0 (141)

Non-Pay Total (34,111) (2,929) (3,266) (337) 0 (337)

Grand Total (14,692) (1,310) (1,602) (291) 0 (291)

Non-pay

A VAT refund of £95k relating to 14/15 was repaid to Viapath this month.

Bexley MSK is overspent by £43k but this is being recovered from income which is showing a small over-performance.

ACU is overspent by £57k, the income received is not covering all costs due to a reduction in activity.

Enc. 2.1.2

Corporate Departments

Page 19

See page 20 for commentary.

Subjective Summary

Annual

Budget

£'000

YTD Budget

£'000

YTD Actual

£'000

YTD Variance

£'000

Last Month

Variance

£'000

In Month

Movement

£'000

Income Income 116,379 9,187 9,703 516 0 516

Income Total 116,379 9,187 9,703 516 0 516

Pay A&C Staff/Senior Managers (46,264) (4,060) (4,359) (298) 0 (298)

Nursing Staff (11,783) (978) (1,122) (145) 0 (145)

Medical Staff (2,039) (172) (301) (129) 0 (129)

PAMS/Scientific/Professional 11,078 (257) (287) (30) 0 (30)

Pay Total (49,008) (5,467) (6,069) (602) 0 (602)

Non-Pay Misc. Other Operating Exependiture (92,910) (7,622) (7,637) (15) 0 (15)

Non-Clinical Supplies (43,215) (3,601) (3,290) 311 0 311

Interest & Dividends (38,887) (3,059) (2,893) 165 0 165

Sub Contracted Healthcare - NHS bodies (34,898) (2,908) (2,891) 17 0 17

Capital Charges (29,042) (2,420) (2,441) (21) 0 (21)

Clinical Supplies (820) (68) (263) (194) 0 (194)

Drugs (57) (5) (25) (20) 0 (20)

Services Provided by non-NHS bodies (0) (0) 0 (0)

Non-Pay Total (239,830) (19,683) (19,441) 243 0 243

Grand Total (172,459) (15,963) (15,807) 156 0 156

Enc. 2.1.2

Corporate Departments

Page 20

Description of Variance Explanation of Variance

Corporate Services -

£18k overspent Non-pay: £45k overspent, mainly due to new contributions to the Shelford Group (£20k) and Election costs (£25k) incurred in month 1.

Executive Nursing - £3k

overspent

Pay: £85k overspent, with £20k of costs relating to talent pool recruits to be transferred to divisions & £66k relating to the Specials Team. Funding

is currently within divisional budget but will be centralised in M02.

Finance - £98k

underspent

Pay: £62k underspent, due to vacancies where no agency is being used, recruitment is taking place to fill these posts. Non-pay: £36k

underspent, due to less consultancy charges.

Information - £40k

underspent

Pay: £14k underspent due to vacancies where no agency is being used, recruitment is taking place to fill these posts. Non-pay: £41k

underspend mainly relates to computer & switchboard maintenance contracts and leasing.

Procurement - £21k

underspent Pay: £30k underspent, mainly due to vacancies filled by Agency.

Workforce (HR & OH) -

£158k overspent

Income: £49k overachieving due to Apprentice & OH income offset in pay & non-pay. Pay: £88k overspend relates to staff over-establishment

mainly concerning Apprenticeship posts & Occupational Health's TUPEd SLAM staff costs (which is being offset by income). Non-pay: £120k

overspent. This relates to recruitment for Exec posts £25k, £59k for previously unknown Capita expenses relating to 14/15 & £45k for a staff

awards event.

Operations - £218k

overspent

Pay: £117k overspent, mainly due to Patient Records PRUH high agency spend Clinic Prep staff. Non-pay: £36k overspent due to additional

system maintenance renewal.

Strategic Development -

£7k overspent

Pay: £16k overspend Dis-banded transformation team have been redeployed to other departments but costs still remains within strategic

development. These costs will be moved in M2.. Non-pay: £9k underspent principally relates to reduced Consultancy costs.

Facilities (Estates) -

£355k underspent There has been a significant reduction in maintenance expenditure in month 1.

PFI £185k Overspent

PFI @ Denmark Hill - £197k overspent. There has been additional costs for deep cleaning and fogging on the main site together with further costs

in relation to CQC requirements. Additional cleaning costs for 161 DH & Jennie Lee House fall outside of the main Medirest contract and were a

cost pressure in month 1.

PFI @ PRUH - £12k underspent.

Enc. 2.1.2

Divisional Pay Compared to 14/15 Average

Page 21

Enc. 2.1.2

Corporate Pay Compared to 14/15 Average

Page 22

Enc. 2.1.2

Trust Clinical Income

Page 23

Planning Assumptions

The 15/16 income baseline is based on Month 12 Flex (excluding CQUIN) + 2% growth to reflect increased demographic change,

such as changes in population growth, age and sex. This is in line with CCG assumptions.

Internal baseline will be set to agreed commissioner plans, phased across historical income trends (NHS Clinical Contract Income

& Other Non-NHS Clinical Revenue). This will be set in month 2 as all contract negotiations have not been completed to date, in

particular NHSE specialised services.

Single (blended) MFF (21.32%) across both sites.

Contracts, Terms & Conditions

Block Contracts – The Trust has agreed these contracts with the majority of London CCGs (including Lambeth, Southwark and

Bromley), Kent CCGs and Surrey CCGs for a one year period, 1st April 2015 to 31st March 2016. The block contract value income

is therefore fixed, together with the agreed terms and conditions for the year. Any other mandated national guidance or policy

issues will be reviewed in the context of the contract agreement.

A block type contract has been agreed with contractual reopeners in the event of variance above or below 2.5% of the start

agreement value. The contract includes additional reopeners for RTT backlog investment, ED pathway at the PRUH (One Version

of the Truth), funding for best practice tariffs, system-wide issues affecting patient throughput (repatriation at Denmark Hill and

delayed discharges at PRUH), and the funding of patient quality services which may fall outside of normal PbR regulation.

The following adjustments will apply to the default tariff carried forward:

No deflator and no CQUIN will be applied.

For CCGs agreeing a block contract, a Local Incentive Premium (LIP) has been applied to the agreed contract value of

1.5% (Excluding Drugs & Devices and Patient Transport), together with an additional 1% growth.

Cost and Volume (C&V) - fixed sum is paid for access to a defined range and volume of services. If there is a variation

from the planned level of activity there is a variation in payment according to a variation or threshold agreement clause.

This sets the marginal (or per unit) payment higher/lower than the agreed target performance (baseline contract value).

Enc. 2.1.2



Page 24

Contract Income Proposals

CCG & NHSE Contracts Contract Type Trust Contract Proposal

2015/16

NHS England Specialised (e.g. NICU, PICU, Liver, BMT) C&V £308,777,997

London Area Team_Dental C&V £25,013,241

London Area Team_Screening C&V £5,403,820

London Area Team_Health & Justice Block £4,342,704

NHS BROMLEY CCG Block £157,360,000

NHS SOUTHWARK CCG Block £84,902,000

NHS LAMBETH CCG Block £71,361,000

NHS LEWISHAM CCG Block £33,450,000

NHS BEXLEY CCG Block £22,372,000

NHS CROYDON CCG C&V £20,271,069

NHS GREENWICH CCG C&V £19,177,169

NHS DARTFORD, GRAVESHAM AND SWANLEY CCG C&V £10,465,870

NHS WEST KENT CCG Block £9,837,000

NHS WANDSWORTH CCG Block £2,647,000

NHS SOUTH KENT COAST CCG Block £1,789,000

NHS MERTON CCG Block £1,208,000

NHS SURREY DOWNS CCG Block £680,000

NHS KINGSTON CCG Block £459,000

NHS RICHMOND CCG Block £395,000

NHS GUILDFORD AND WAVERLEY CCG Block £169,477

NHS SURREY HEATH CCG Block £153,821

Other CCGs/ Local Authority/ LATs C&V £81,663,873

Total Clinical Income Contract £861,899,041 %

Block £391,126,002 45.4

C&V £470,773,039 54.6

Enc. 2.1.2


Page 25


Trust/Divisional Baseline

Total Trust Income

Summary Total Trust Income

NHS CLINICAL CONTRACT INCOME 855,054,872

OTHER NHS CLINICAL 5,099,784

OTHER NON-NHS CLINICAL REVENUE 12,683,256

MISC OTHER OPERATING INCOME 74,251,668

EDUCATION & TRAINING INCOME 50,620,304

PRIVATE PATIENT INCOME 18,353,376

RESEARCH & DEVELOPMENT INCOME 9,131,330

Grand Total 1,025,194,590

NHS Clinical Contract Income by Division – Indicative values apportioned on last years outturn (figures to be revised on completion of contract negotiations)

Row Labels ASLN Dental CSDS CCTD Facilities/ Contracts LRS NWS TeAM W&C Total

NHS Acute: A&E - NON TARIFF 758 0 0 0 0 758 0 404,113 758 406,388

NHS Acute: A&E - TARIFF 0 0 0 0 0 0 0 27,740,455 0 27,740,455

NHS Acute: Critical Care - NON TARIFF 0 0 0 31,871,977 0 11,640,282 11,629,246 0 20,919,058 76,060,563

NHS Acute: DC - NON TARIFF 1,778,224 90,168 617 28,994 0 440,967 2,570,513 29,251 387,329 5,326,064

NHS Acute: DC - TARIFF 16,354,775 7,171,597 269,688 1,581,485 0 25,367,188 14,769,573 1,435,016 6,323,560 73,272,883

NHS Acute: Devices - NON TARIFF 1,542,273 93,384 620,773 0 0 1,818,171 8,925,983 976,944 105,997 14,083,524

NHS Acute: Drugs - NON TARIFF 8,154,448 8,871 1,553,328 651,800 0 16,712,325 37,667,562 4,063,584 3,133,394 71,945,312

NHS Acute: EL - NON TARIFF 67,899 9,254 0 9,254 0 625,282 2,112,123 16,624 92,217 2,932,653

NHS Acute: EL - TARIFF 692,139 1,870,874 68,252 3,920 0 33,635,545 23,112,461 1,080,652 5,617,009 66,080,851

NHS Acute: NEL - NON TARIFF 11,264 1,191 0 2,383 0 115,257 216,563 2,223,671 252,683 2,823,012

NHS Acute: NEL - TARIFF 2,469,392 1,735,481 72,814 80,229 0 45,434,739 46,826,429 66,488,193 16,838,198 179,945,475

NHS Acute: OP - NON TARIFF 16,913,753 710,734 48,689 94 0 266,456 7,572,689 4,098,354 1,942,385 31,553,153

NHS Acute: OP - TARIFF 27,803,798 15,971,391 418,283 1,206,034 0 29,614,402 11,414,243 7,555,466 11,472,810 105,456,427

NHS Acute: OTHER - NON TARIFF 24,722,942 8,996,849 19,406,409 -256 7,439,935 18,707,281 22,774,849 -501,182 14,317,558 115,864,384

NHS Acute: OTHER - TARIFF 745,136 52,605 4,392,810 112,047 5,288,862 20,087,531 2,573,553 8,931,392 46,223,963 88,407,898

Grand Total 101,256,801 36,712,399 26,851,662 35,547,961

12,728,797 204,466,182 192,165,787 124,542,534 127,626,919 861,899,041

Enc. 2.1.2

2015/16 CIP Overview

Page 26

Additions to the programme – Top 10 key movements

CCTD - Standardise elective prosthesis FY £759K, IY £563K

CCTD - Outsourcing the Outpatient Dispensing Service at the

PRUH Pharmacy FY £534K, IY £407K

LRS - Digestive Diseases Unit FY £467k, IY £116k

CCTD - Additional ICD implants at PRUH (increase of values)

FY £374k, IY £218k

HR - Capita Contract (new scheme) FY £368k, IY £123k

CCTD - blood conservation (increase of existing values) FY

£250k, IY £187k

CCTD - Close a main theatre at PRUH FY £247k, IY £185k

CCTD - Close a main theatre at PRUH (10 sessions)

(anesthatists) FY £213k, IY £160k

W&CH - Newborn hearing screening FY £200k, IY £150k

W&CH - PICU - Nursing Bank & Agency spend reduction FY

£162k, IY £108k

Subtractions to the programme – Top 10 key movements

CCTD - Drug Expenditure Project (POD value submitted lower

than pre-POD estimate) FY £500k, IY £375k

Procurement - Stretch target by £500k to cover staff budget FY

£500k, IY £125k

CCTD – B&A reduction post service reviews FY £328k, IY £246k

ACLN - Space/Lease Costs (POD value submitted lower than

pre-POD estimate) FY £300k, IY £75k

CCTD - Outsourcing the outpatient (POD value submitted lower

than pre-POD estimate) FY £300k, IY £175k

HR – SHLT FY £290k, IY £169k (POD value submitted lower

than pre-POD estimate)

HR - E rostering change in cloud contract (POD value submitted

lower than pre-POD estimate) FY £250k, IY £188k

HR - DBS FY £229k, IY £172k (POD value submitted lower than

pre-POD estimate)

LRS - Transfer of activity from IP to DC (marked as do not

proceed) FY £150k, IY £112k

CCTD - Omnicell Delivery charges FY £123k, IY £92k (POD

value submitted lower than pre-POD estimate)

Full Year 15/16

Category

£'000's

Recurrent Non-recurrent Total Total %

Pay 16,552 - 16,552 23%

Non-Pay 39,943 260 40,203 57%

Income 12,552 - 12,552 18%

Est of unquantified 1,800 3%

Total 69,047 260 71,107 100%

In Year 15/16

Category

£'000's

Recurrent Non-recurrent Total Total %

Pay 11,570 140 11,710 23%

Non-Pay 28,384 161 28,545 57%

Income 7,967 277 8,243 17%

Est of unquantified 1,350 3%

Total 47,920 578 49,848 100%

Full Year 16/17

Category

£'000's

Recurrent Non-

recurrent

Total Total %

Pay - - - 0%

Non-Pay 134 - 134 0%

Income 200 - 200 0%

Est of unquantified - 0%

Total 334 - 334 0%

Source: PMO/PwC

Enc. 2.1.2

CIP Weekly position

Page 27

❶ TEAM reduction of £258k across “pharmacy 77”, “mental health nurses” and “disestablishment of paediatric health care assistants” ❷ WCH increase of £367k. Main contributors; “new-born hearing screening” and “PICU – Nursing bank and agency spend reduction. ❸ CCTD net increase of £467k made up of 16 lines. 9 additions totalling £1.4m, of which £1.2m: “Standardise elective prosthesis” and “blood conservation”. Deductions of £933k: “Reduction in Omnicell Delivery charges”, and “reduce bank and agency spend” ❹ HR increase of £522k. Additions of £628k ( “capita contract”, “DBS update service” and “Administration charge for honorary contracts and observerships”) and subtractions of £106k (“2 year duration of excess travel for ex SHLT employees”). ❺Removed “Medical records” £300k. Remainder made up across LoS, commercial and estates and facilities. ❻ Multiple small adjustments ❼+❽ In year value exceeds full year value due to late notification of in year value. Full year value recorded in prior week Moving “pipeline” to “Green”/ “implementation”. To date, 44 schemes have been converted from pipeline to ‘workbooks’ with a total value of £6,483k. 22 of these workbooks with a value of £897k are approved by Divisions and are pending QIA sign off.

Divisions 15/16 Target

Schemes

identified

(pipeline)

To Identify

(Headline)Total

Schemes

identified

(pipeline)

To Identify

(Headline)Total Change Divisions 15/16 Target

Schemes

identified

(pipeline)

To Identify

(Headline)Total

Schemes

identified

(pipeline)

To Identify

(Headline)Total Change

TEAM 9,744 5,066 0 5,066 5,324 0 5,324 -258 ❶ TEAM 9,744 3,788 0 3,788 3,982 0 3,982 -194

ACLN 9,302 3,484 0 3,484 3,381 56 3,437 47 ACLN 9,302 2,661 0 2,661 2,583 42 2,625 36

WCH 7,961 2,171 318 2,489 1,629 493 2,122 367 ❷ WCH 7,961 1,456 187 1,643 1,063 318 1,381 262

LRS 10,644 6,211 0 6,211 6,291 0 6,291 -80 LRS 10,644 4,397 0 4,397 4,440 0 4,440 -43

NWS 13,343 6,231 683 6,914 5,968 1,043 7,011 -97 NWS 13,343 3,416 393 3,810 3,296 615 3,911 -101 ❻

CCTD 14,614 8,143 5,695 13,838 8,376 4,991 13,367 471 ❸ CCTD 14,614 6,267 3,921 10,188 6,435 3,243 9,678 510 ❼

Corporate Corporate

Contract Services 3,503 0 0 - 0 0 - 0 Contract Services 3,503 0 0 - - 0 - 0

Corporate Services 589 232 0 232 232 0 232 0 Corporate Services 589 193 0 193 193 0 193 -1

EN / PDT 664 0 0 - 0 0 - 0 EN / PDT 664 0 0 - - 0 - 0

Facilities (Estates) 3,689 4,022 400 4,422 767 3,675 4,442 -20 Facilities (Estates) 3,689 2,949 300 3,249 508 1,323 1,831 1418 ❽

Finance 661 0 800 800 0 800 800 0 Finance 661 0 600 600 - 600 600 0

Information 661 1,783 128 1,911 1,783 128 1,911 0 Information 661 1,155 88 1,243 1,155 88 1,243 0

Procurement 661 9,198 0 9,198 8,948 250 9,198 0 Procurement 661 6,348 0 6,348 6,160 188 6,348 0

Guthrie Clinic 681 0 0 - 0 0 - 0 Guthrie Clinic 681 0 0 - - 0 - 0

Human Resources 551 1,520 273 1,793 661 610 1,271 522 ❹ Human Resources 551 983 180 1,163 496 433 929 234

Kings Hewitt ACU 4,391 0 0 - 0 0 - 0 Kings Hewitt ACU 4,391 0 0 - - 0 - 0

Medical Director 35 0 0 - 0 0 - 0 Medical Director 35 0 0 - - 0 - 0

Operations Directorate 1,192 29 0 29 29 0 29 0 Operations Directorate 1,192 22 0 22 22 0 22 0

PRUH Integration 2,973 0 0 - 0 0 - 0 PRUH Integration 2,973 0 0 - - 0 - 0

R&D 290 0 0 - 0 0 - 0 R&D 290 0 0 - - 0 - 0

Strategic Development 150 0 0 - 0 0 - 0 Strategic Development 150 0 0 - - 0 - 0

Cross cutting 1,588 11,332 12,920 1,838 11,632 13,470 -550 ❺ Cross cutting 1,104 8,089 9,193 1,292 8,264 9,556 -363

Est not unquantified 1,800 1,800 1,800 1,800 Est not unquantified 1,350 1,350 1,350 1,350

Total 86,298 49,678 21,429 71,107 45,227 25,478 70,705 402 Total 86,298 34,739 15,109 49,848 31,625 16,464 48,089 1,759

This week Last Week

Full Year In Year

This week Last Week

Source: PMO/PwC

Enc. 2.1.2

15/16 FY CIP targets and overview

Page 28

15/16

15/16

Value

Divisional lead 15/16

TargetsPipeline pre

POD

Pipeline

PODGreen Amber Red

Total

identified

including

pipeline +

Headlines

Total

unidentified /

(surplus)

Pay Non-Pay Income Recurrent non-recurrent No. of

schemes,

Green,

Amber & Red

No. of

pipeline

schemes

No. of

schemes

(incl

pipeline)

Full Year

WTEs

Removed

WTEs

calcualted

for total

identified

including

pipelineDivisions

TEAM Helen Sirs 9,744 0 5,066 0 0 0 5,066 4,678 1,826 763 2,477 5,066 0 0 17 17 0.0 36

ACLN Ann Wood 9,302 0 3,484 0 0 0 3,484 5,818 1,186 971 1,327 3,474 10 0 50 50 4.1 23

WCH Julie Stevenson 7,961 318 2,171 0 0 0 2,489 5,472 864 991 635 2,489 0 0 32 32 0.0 12

LRS Dan Gibbs 10,644 0 6,211 0 0 0 6,211 4,433 1,667 2,534 2,010 6,211 0 0 38 38 4.5 32

NWS Jan Beynon 13,343 683 6,231 0 0 0 6,914 6,429 665 1,720 4,529 6,914 0 0 37 37 0.0 5

CCTD Zebina Ratansi 14,614 5,695 8,143 0 0 0 13,838 776 5,258 8,049 531 13,838 0 0 74 74 0.0 8

Corporate 0

Contract Services 3,503 0 0 0 0 0 0 3,503 0 0 0 0 0 0 0 0 0.0 0

Corporate Services Jane Walters 589 0 232 0 0 0 232 357 232 0 0 232 0 0 3 3 0.0 5

EN / PDT Geraldine Walters 664 0 0 0 0 0 0 664 0 0 0 0 0 0 0 0 0.0 0

Facilities (Estates) Simon

Taylor/Ahmad

Toumadj

3,689 400 4,022 0 0 0 4,422 (733) 400 4,022 0 4,422 0 0 12 12 0.0 0

Finance 661 800 0 0 0 0 800 (139) 400 400 0 800 0 0 0

Information 661 128 1,783 0 0 0 1,911 (1,250) 100 1,811 0 1,911 0 0 8

Procurement Simon Dixon /

Simon Taylor /

Colin Sweeny

661 0 9,198 0 0 0 9,198 (8,538) 500 8,698 0 9,198 0 0 0 0 0.0 10

Guthrie Clinic 681 0 0 0 0 0 0 681 0 0 0 0 0 0 0 0 0.0 0

Human Resources Mark Preston 551 273 1,520 0 0 0 1,793 (1,242) 749 1,019 25 1,793 0 0 13 13 0.0 13

Kings Hewitt ACU 4,391 0 0 0 0 0 0 4,391 0 0 0 0 0 0 0 0 0.0 0

Medical Director Mike Marrinan 35 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0.0 0

Operations Directorate Peter Fry / Steve

Coakley

1,192 0 29 0 0 0 29 1,163 0 29 0 29 0 0 1 1 0.0 0

PRUH Integration 2,973 0 0 0 0 0 0 2,973 0 0 0 0 0 0 0 0 0.0 0

R&D 290 0 0 0 0 0 0 290 0 0 0 0 0 0 0 0 0.0 0

Strategic Development Trudi Kemp 150 0 0 0 0 0 0 150 0 0 0 0 0 0 0 0 0.0 0

Cross cutting 11,332 1,588 0 0 0 12,920 (12,920) 2,705 9,196 1,019 12,670 250 0 0 0 0.0 10

Est not unquantified 1,800 1,800 (1,800) 1,800 1,800

Total 86,298 21,429 49,678 0 0 0 71,107 15,191 18,352 40,203 12,552 70,847 260 0 285 277 9 153

15/16

People Number WTE numbers

Source: PMO/PwC

Enc. 2.1.2

15/16 IY CIP targets and overview

Page 29

15/16

15/16

Value

Divisional lead 15/16

TargetsPipeline

pre POD

Pipeline

PODGreen Amber Red

Total

identified

including

pipeline +

Headlines

Total

unidentified /

(surplus)

Pay Non-Pay Income Recurrent non-recurrent No. of

schemes,

Green, Amber

& Red

No. of

pipeline

schemes

No. of

schemes

(incl

pipeline)

In Year WTEs

Removed

WTEs calcualted

for total

identified

including

pipeline

Divisions

TEAM Helen Sirs 9,744 0 3,788 0 0 0 3,788 5,956 1,358 572 1,858 3,788 0 0 17 17 0 26

ACLN Ann Wood 9,302 0 2,661 0 0 0 2,661 6,641 921 632 1,107 2,453 207 0 50 50 3 18

WCH Julie Stevenson 7,961 187 1,456 0 0 0 1,643 6,318 591 658 394 1,643 0 0 32 32 0 8

LRS Dan Gibbs 10,644 0 4,397 0 0 0 4,397 6,247 1,257 1,667 1,474 4,397 0 0 38 38 5 24

NWS Jan Beynon 13,343 393 3,416 0 0 0 3,810 9,533 467 1,215 2,127 3,806 4 0 37 37 0 3

CCTD Zebina Ratansi 14,614 3,921 6,267 0 0 0 10,188 4,426 3,984 5,659 545 9,986 202 0 74 74 2 8

Corporate 0 0

Contract Services 3,503 0 0 0 0 0 0 3,503 0 0 0 0 0 0 0 0 0 0

Corporate Services Jane Walters 589 0 193 0 0 0 193 397 189 4 0 174 19 0 3 3 0 4

EN / PDT Geraldine Walters 664 0 0 0 0 0 0 664 0 0 0 0 0 0 0 0 0 0

Facilities (Estates) Simon

Taylor/Ahmad

Toumadj

3,689 300 2,949 0 0 0 3,249 440 300 2,949 0 3,249 0 0 12 12 0 0

Finance 661 600 0 0 0 0 600 61 300 300 0 600 0 0 0 0 0 0

Information 661 88 1,155 0 0 0 1,243 (583) 75 1,168 0 1,243 0 0 8 8 0 0

Procurement Simon Dixon /

Simon Taylor /

Colin Sweeny

661 0 6,348 0 0 0 6,348 (5,688) 375 5,973 0 6,348 0 0 0 0 0 0

Guthrie Clinic 681 0 0 0 0 0 0 681 0 0 0 0 0 0 0 0 0 0

Human Resources Mark Preston 551 180 983 0 0 0 1,163 (612) 540 604 19 1,163 0 0 13 13 0 10

PFI 4,391 0 0 0 0 0 0 4,391 0 0 0 0 0 0 0 0 0 0

Medical Director Mike Marrinan 35 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0 0

Operations Directorate Peter Fry / Steve

Coakley

1,192 0 22 0 0 0 22 1,170 0 22 0 22 0 0 1 1 0 0

PRUH Integration 2,973 0 0 0 0 0 0 2,973 0 0 0 0 0 0 0 0 0 0

R&D 290 0 0 0 0 0 0 290 0 0 0 0 0 0 0 0 0 0

Strategic Development Trudi Kemp 150 0 0 0 0 0 0 150 0 0 0 0 0 0 0 0 0 0

Cross cutting 8,089 1,104 0 0 0 9,193 (9,193) 1,353 7,122 719 9,047 146 0 0 0 0 0

Est not unquantified 1,350 1,350 (1,350) 1,350 1,350

Total 86,298 15,109 34,739 0 0 0 49,848 36,450 13,060 28,545 8,243 49,270 578 0 285 285 9 102

People Number WTE numbers

15/16

Source: PMO/PwC

Enc. 2.1.2

Short-term Cash Flow Forecast

13 week short term cash forecast – baseline position

May-15 Jun-15 Jul-15 Aug-15

Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast

01 May 08 May 15 May 22 May 29 May 05 Jun 12 Jun 19 Jun 26 Jun 03 Jul 10 Jul 17 Jul 24 Jul 31 Jul 07 Aug

Balance B/F 43,265 32,427 23,996 94,718 33,427 26,317 13,621 3,893 25,876 (8,118) (20,466) (28,182) 18,670 (16,308) (20,178)

Receipts (inflows)

1 LSB receipts 0 0 26,635 0 0 0 0 26,635 0 0 0 26,635 0 0 0

2 SLA receipts 179 3,302 7,200 0 0 141 0 11,500 0 141 0 12,500 0 0 0

3 Patient SLA Overperformance 2014/2015 755 0 1,000 0 0 0 0 1,000 0 0 0 2,500 0 0 0

4 LSB - Financial Investment 2014/2015 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Patient SLA Overperformance 2013/2014 0 39 0 0 0 0 0 0 0 0 0 0 0 0 0

6 Private Patients receipts 292 324 102 232 347 465 252 504 335 184 175 624 234 347 195

7 Training & Education receipts 219 0 0 0 0 0 0 0 0 0 0 10,500 0 0 0

8 NHSE Inflows 1 0 28,283 100 0 0 0 32,764 0 0 0 31,783 0 0 0

9 DoH - National RTT, ED Monies & Project Diamond 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 VAT reclaims 0 3,465 0 0 3,000 0 0 0 3,000 0 0 0 0 3,000 0

11 Other 1,282 824 4,337 735 539 830 614 3,158 691 863 614 3,983 1,359 517 716

2,728 7,954 67,557 1,067 3,886 1,437 866 75,561 4,026 1,189 789 88,525 1,593 3,864 911

Payments (outflows)

12 Pay monthly (incl Pay Awards) 44 137 0 25,655 0 70 0 0 28,200 0 70 0 28,200 0 70

13 PAYE/NIC/SUPER (CHAPS) 0 0 0 19,571 0 0 0 20,531 0 0 0 20,531 0 0 0

14 Agency Spend 3,178 1,809 1,376 2,887 2,389 1,259 1,800 1,800 1,800 936 936 936 936 936 936

15 PFI project 0 4,447 0 4,153 0 4,200 0 4,000 0 4,200 0 4,000 0 0 0

16 Trade Creditors 8,210 6,292 6,400 6,400 6,400 6,400 6,400 6,600 6,600 6,600 6,600 6,600 6,600 6,600 6,600

17 Other 1,986 205 6,948 3,325 634 1,840 713 8,974 1,275 1,800 100 8,098 750 200 1,200

13,418 12,890 14,724 61,991 9,423 13,769 8,913 41,905 37,875 13,536 7,706 40,165 36,486 7,736 8,806

Cash from operations (10,690) (4,936) 52,833 (60,924) (5,537) (12,332) (8,047) 33,656 (33,849) (12,347) (6,917) 48,360 (34,893) (3,872) (7,895)

Capital & Financing Items

18 Capital expenditure (outflow) 150 3,500 178 367 1,575 364 1,686 728 145 2 805 1,507 85 0 50

19 PDC Dividends (TDR) (outflow) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

20 Indemnity Funding (inflow) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 LSB CCGs - Financial Advance 15/16 (inflow) 0 0 (2,500) 0 0 0 0 (7,500) 0 0 0 0 0 0 0

22 Revolving Working Capital Facility 0 0 (15,567) 0 0 0 0 15,567 0 0 0 0 0 0 0

23 Loans Repaid (outflow) 0 0 0 0 0 0 0 1,934 0 0 0 0 0 0 0

24 Interest on Loans (outflow) 0 0 0 0 0 0 0 944 0 0 0 0 0 0 0

25 Other (inflow) (2) (5) 0 0 (2) 0 (5) 0 0 (2) (5) 0 0 (2) (5)

148 3,495 (17,889) 367 1,573 364 1,681 11,673 145 0 800 1,507 85 (2) 45

Net Inflow / Outflow (10,838) (8,431) 70,722 (61,291) (7,110) (12,696) (9,728) 21,983 (33,994) (12,347) (7,717) 46,853 (34,978) (3,870) (7,940)

Forecast Balance C/F 32,427 23,996 94,718 33,427 26,317 13,621 3,893 25,876 (8,118) (20,466) (28,182) 18,670 (16,308) (20,178) (28,118)

Consolidated 13 week short term cash

forecast

Enc. 2.1.2

Capital Plan 2015-2016

Page 31

Schemes

2015/16

£'000

Critical Care Unit 20,262

Cathlab Developments 925

Site Wide Infrastructure 2,000

Helideck 4,900

Other Major Works - Denmark Hill 1,320

Orpington Hospital 55

PRUH Hospital 2,825

Minor Works 1,673

ICT Projects 2,900

Medical Equipment 650

Integration Projects 1,400

Total Capital Budget Expenditure 38,910

External Funding

Critical Care Unit Loan (20,262)

Total External Funding (20,262)

Net Spend after External Funding 18,648

Internal Funding Donated - Equipment (250)

Donated - Adult Cystic Fibrosis -

Donated - Helideck (London Air Ambulance) (500)

Donated - Helideck - Charity donations -

Friends of Orpington - Orpington MRI (400)

Integration Funding per Transaction Agreement (900)

PDC to fund CCU IT Purchases (584)

NHS England to fund 100k Genomes (540)

NHS England funding for Havens project (500)

Chartwell Cancer Trust funding for PRUH chemo -

Funding for Eye Stereostatic Xray machine (14)

Depreciation (Incl PRUH & ORP) (23,971)

Total Internal Funding (27,659)

Additional Internal Funding (Available) / Required (9,011)

Enc. 2.1.2

Working Capital Summary

Trade Debtors

As at the end of Month 1, outstanding trade debtors totalled £64.898m. Significant balances were as follows:

Trade Creditors

As at Month 1, outstanding trade creditors totalled £41.264m. This total includes the following outstanding amounts:

King’s College London £4.8m

Guy’s & St Thomas’ NHS Foundation Trust £2.8m

FT Borrowing

The Trust currently holds loans with the Foundation Trust Financing Facility totalling £69.8m as at 3 April 2015 and PFI Liabilities

of £158.363m.

Organisation Debt Type £000

Private Patients and Overseas Visitors Private Patients and Overseas Visitors 8,976

NHS England Over-Performance 167

NHS England Drugs invoiced outside contract e.g. CDF 2,002

CCGs CCGs Overperformance 2014/15 5,236

CCGs Monthly SLAs 1,600

CCGs NCAs 3,580

NHS Trust Development Authority SLHT Support 7,647

Oxleas NHS Foundation Trust Various 244

Guy's and St Thomas' NHS Foundation Trust Various 2,692

Lewisham and Greenwich Various 3,570

King's College London Various 4,387

South London and Maudsley NHS FT Various 1,645

Various Pathology 2,891

Provider Trusts Various 1,912

Other Non NHS Bodies Various 9,426

Enc. 2.1.2

Working Capital - Debtors

Page 33

Provision for Bad Debts is based on debts outstanding over 6 months. The NHS Provision has been adjusted for debts

which are not contested and are considered recoverable.

Total Outstanding 0-30 days 31-60 days 61-90 days Over 90 days

£'000 £'000 £'000 £'000 £'000

NHS Bodies

CCGs 12,486 371 7,906 594 3,615

NHS England 6,658 5,117 569 164 808

Provider Trusts 10,067 655 3,081 273 6,058

Other NHS Bodies 8,884 50 7,937 18 879

NHS Trade Debtors 38,095 6,193 19,493 1,049 11,360

Provision for Bad Debts (12,492) - (7,646) - (4,846)

NHS Bodies Total 25,603 6,193 11,847 1,049 6,514

Non NHS Bodies

Scottish, Welsh & Irish Health Bodies 578 7 76 136 359

King's College London University 4,387 582 550 386 2,869

King's Charitable Trust 421 300 34 2 85

Other Non NHS Bodies 12,441 1,705 4,115 1,331 5,290

Non NHS Trade Debtors 17,827 2,594 4,775 1,855 8,603

Provision for Bad Debts (471) - - - (471)

Non NHS Bodies Total 17,356 2,594 4,775 1,855 8,132

Total Accounts Receivable 55,922 8,787 24,268 2,904 19,963

% of Total Outstanding - Month 1 100% 16% 43% 5% 36%

Month 12 - 31 March 2015 100% 53% 7% 8% 32%

Private Patients Accounts Receivable 3,172 710 883 766 813

Provision for Bad Debts (132) - - - (132)

Private Patients Accounts Receivable Total 3,040 710 883 766 681

Overseas Visitors Accounts Receivable 5,804 356 97 207 5,144

Provision for Bad Debts (2,309) (249) (78) (166) (1,816)

Overseas Visitors Accounts Receivable Total 3,495 107 19 41 3,328

Total PP & Overseas Visitors Accounts Receivable 8,976 1,066 980 973 5,957

Aged Debt Analysis Summary as at 30 April 2015

Enc. 2.1.2

Working Capital - Creditors

Page 34

Total Outstanding 0-30 days 31-60 days 61-90 days Over 90 days

£000 £000 £000 £000 £000

NHS Bodies

Guy's and St Thomas' NHS Foundation Trust 2,850 153 191 356 2,150

Others 8,515 645 2,523 1,619 3,728

NHS Bodies Total 11,365 798 2,714 1,975 5,878

Non NHS Bodies

King's College London 4,817 3 375 1,204 3,235

Others 25,082 3,183 13,100 4,819 3,980

Non-NHS Bodies Total 29,899 3,186 13,475 6,023 7,215

Total Accounts Payable 41,264 3,984 16,189 7,998 13,093

% of Total Outstanding - Month 1 100% 9.7% 39.2% 19.4% 31.7%

Month 12 - 31 March 2015 100% 12.4% 47.8% 18.1% 21.7%

Aged Creditors Analysis Summary as at 30 April 2015

Enc. 2.1.2

Glossary

Page 35

CIP – Cost Improvement Plan

SLA – Service Level Agreement

PDC – Public Dividend Capital

PSPP – Public Sector Payment Policy

Working Capital Facility - represents a sum of money reserved by the relevant bank for potential use

by the Foundation Trust

Asset - An asset is a resource controlled by the enterprise as a result of past events and from which

future economic benefits are expected to flow to the enterprise

Liability - an entity's present obligation arising from a past event, the settlement of which will result in

an outflow of economic benefits from the entity

Equity - the residual interest in the entity's assets after deducting its liabilities

EBITDA – Earnings before Interest, Taxation, Depreciation and Amortisation

EBITDA Achieved (% of Plan) – measures the achievement of earnings against plan

EBITDA Margin (%) – Measures Earnings as a percentage of total income indicating underlying

performance

Return on Assets excluding Dividends – Net surplus before Dividends as a percentage of average

assets indicating financial efficiency

I & E Surplus margin net of dividends – Net surplus as a percentage of total income indicating

financial efficiency

Liquidity Ratio (days) - The liquidity ratio (days) indicates the number of days that net liquid assets

can cover operating expenses without further cash coming from cash sales of fixed or long-term

assets.

Enc. 2.1.2

This page has been left blank

Enc. 2.1.3

1



Subject: Trust Performance Report 2015/16 Month 1

Author(s): Steve Coakley, Acting Assistant Director of Performance & Contracts

Presented by: Kath Dean, Associate Director of Operations – PRUH;

Zebina Ratansi, Divisional Manager for CCTD

Sponsor: Jeremy Tozer, Interim Chief Operating Officer

Status: For Information

1. Summary of Report This report provides the details of performance achieved against key national performance and quality indicators, and governance indicators defined in the Monitor Risk Assessment framework for the April position in 2015/16. 2. Action required The Board is asked to approve the M1 performance reported against the governance indicators defined in the Monitor Risk Assessment framework for the April 2015 position. 3. Key implications Legal: Statutory reporting to Monitor and the DoH.

Financial: Trust reports financial performance against published plan.

Assurance: The summary report provides assurance that the Trust has met the performance targets as defined within the Monitor Risk Assessment framework (RAF) for the April position with the exception of the A&E 4-hour target, the c-difficile threshold and 62 day cancer – all cancer target.

Clinical: There is no direct impact on clinical issues.

Equality & Diversity: There is no impact on equality & diversity issues.

Performance: The summary report demonstrates that the Trust has achieved the performance indicators for the April position as defined in the RAF with the exception of the A&E 4-hour target, the c-difficile threshold and 62 day cancer – all cancers target. Referral to Treatment indicator performance is not being reported now that commissioners have approved the Trust’s proposal for an RTT reporting break for a 6-month period.

Strategy: Performance against the Trust’s annual plan forecasts and key objectives.

Workforce: None.

Estates: There is no direct impact on Estates.

Reputation: Trust’s quarterly and monthly results will be published by Monitor and the DoH.

Other:(please specify)

This is the first version of the revised format for the performance report that will be presented to the F&P and Board committees.

Enc. 2.1.3

2

Key Messages of this Report

Emergency 4-hour performance improved slightly from March 2015 performance to 87.6% but remains below the national target of 95%. Performance against the 3 national Referral to Treatment (RTT) indicators is not being reported until October 2015 based on the reporting suspension agreed with commissioners. Cancer waiting time targets are being achieved for the in-month April position with the exception of the 62-day target. 10 c-difficile cases which is above the internal quota of 7 cases, and zero MRSA cases reported for April. One never event reported on the DH site in Radiology.

Introduction/Background

In Q4 2014/15, we committed to reviewing the format and content of the Trust performance report. This document represents the first version of the revised performance report which reflects Trust as well as site-based performance against national, Monitor, contractual and internal quality standards for April 2015.

Trust Priorities

Emergency 4-hour performance at Princess Royal Hospital (PRUH): Emergency 4-hour all types attendance performance improved from 82.2% in March to 85.6% in April. Type 1 performance also improved from 67.1% to 72.8%. The average number of patients seen within the Emergency Department (ED) remains relatively static with circa 175 patients seen per day. April was the first month in which there were slightly more patients seen in the Urgent Care Centre at PRUH as opposed to patients seen within the ED. There were 23 breaches of the 12-hour trolley standard on the PRUH site during April, with 15 breaches reported in the first week of the month.

Emergency 4-hour performance at Denmark Hill (DH): Emergency 4-hour all types attendance performance worsened slightly from 90.9% in March to 89.3% in April. The average number of patients seen within the Emergency Department remains high at circa 385 attendances per day compared to an average of 365 seen per day during January and February. There was also 1 breach of the 12-hour trolley standard on the DH site during April.

Referral to Treatment (RTT) 18 Weeks performance: The Trust request for an RTT reporting suspension period for April to September 2015 performance has been approved by local commissioners, NHS England and Monitor. A number of metrics have been agreed with NHS England for the Trust to provide on a weekly and monthly basis.

Admitted Backlog position: There were just under 2,600 patients waiting over 18 weeks on admitted incomplete pathways at the end of April which is 23 patients above plan. This backlog of patients has reduced further in May and is ahead of the planned trajectory for May.

52-week position: There were 33 patients waiting over 52-weeks at the end of April – 28 patients at DH and 10 patients at PRUH. 18 of these patients have treatment plans for May and 5 with plans for June. Plans are still to be confirmed for 10 of these patients.

Enc. 2.1.3

3

Key Issues

Clinical Effectiveness:

The 62-day cancer 85% target has not been achieved at 84.2% for the April position and is at risk of not being achieved for Q1.

The number of diagnostic 6-week waiting time breaches increased from 193 reported in March to 347 in April. The national target of 1% has not been achieved with 3.2% waiting over 6 weeks at the end of April. The number of non-obstetric ultrasound breaches at the PRUH increased by over 100 cases.

Safety:

10 c-difficile cases attributed to the Trust in April which is above the quota of 7 cases.

There was 1 never event reported in April for a wrong implant in Radiology. The case will be subject to formal review and the findings taken to the Serious Incidents Committee.

Red shifts on wards reduced from 85 instances reported in March to 58 instances in April but remain a concern.

There were 34 pressures sores reported in April. 26 cases were reported at the DH site, all of which were grade 2 cases. 18 of these cases were reported on intensive care units. There were 8 cases reported at the PRUH site, of which 7 cases were grade 2 and one case was rated as a grade 3 on Medical 8 ward.

Patient Experience:

New HRWD inpatient surveys were sent out for April with a reduced set of patient questions. The responder score target of 89 was achieved for PRUH wards with a score of 91, but was not achieved on the DH site with a score of 87 for April.

The national Friends & Family test (FFT) for April now includes day case as well as inpatients. The Inpatient/Daycase FFT score was 94 on the DH site and 93 on the PRUH site, both scores better than the internal target. The FFT scores for the Emergency Department are also better than target at 82 for DH and 80 for PRUH.

Complaints received have reduced further to their lowest level with 44 cases in April, although 10 cases were rated as high or severe.

There were 16 breaches of the mixed sex accommodation standard at the PRUH site, all delayed discharges from the intensive care unit, which we are not required to report on national returns.

Finance & Operational Efficiency:

Financial position - please see the Finance report for further details.

Overall theatre utilisation target of 80% has been achieved on the DH site for April which is the first time that this indicator has been met since November 2014. Despite an improving trend reported from January 2015, theatre utilisation at the PRUH reduced slightly from 67% in March to 66% in April, remaining below the internal target.

Staffing:

Vacancy rate worsened from 5.9% in March to 7.4% in April but remains within the 5-8% target. The vacancy rate at PRUH remains relatively static at just under 12%, above the internal target.

Sickness & absence and Appraisals data is not available and unable to be published into the performance scorecards for April.

Compliance against mandatory and statutory training and induction courses improved by 2 points to 76 in April, and is 4 point below the 80 target for the DH site. Data is not currently available for the PRUH sites.

Enc. 2.1.3

4

Regulatory Performance/Monitor compliance (1/2)

Monitor Month 1 position:

The Trust has achieved the performance indicators in the Monitor Risk Assessment Framework for April with the exception of the c-difficile target, 62 day all-cancers target and the A&E 4-hour performance target.

RTT performance indicators are not being reported, consistent with the RTT reporting suspension that has been agreed with local and national commissioners.

We currently have a score of 6.0 incorporating the non-submission of RTT data.

Enc. 2.1.3

5

Regulatory Performance/Monitor compliance (2/2)

Monitor 2015-16 Self Certification The table below summarises the Trust’s proposed self-certification against the key healthcare performance targets in the Monitor Risk Assessment Framework for 2015-16. We are proposing that we self-certify non-compliance against the following indicators:

RTT admitted-completed, non-admitted completed and Incomplete pathways pathways: the Trust will not be providing a performance position for April-September 2015 consistent with the RTT reporting suspension period.

Total time in A&E under 4 hours: Trust position would not become compliant until after Q2 when PRUH achieves the 95% target.

Cancer 62 day waits for first treatment: this target will not be achieved until after Q1.

Clostridium-difficile: we are at risk of breaching the quota for Q1 and achievement of the 72 patient quota for the year remains a challenge.

This would give the Trust a score of 5.0 in the Risk Assessment Framework for 2015-16. FOR ACTION: The Committee is asked to approve the Trust’s self-certification proposal to Monitor for 2015-16.

Enc. 2.1.3

6

Trust Performance Scorecard – DH site

Enc. 2.1.3

7

Trust Performance Scorecard – PRUH sites

Enc. 2.1.3

8

ED Action Plan Update @PRUH

ED Breaches: For the 5 weeks ending in April, nearly 39% of breaches were due to reasons relating to bed management, over 36% of breaches due to waits for specialist review and 10% due to ED processes. ED Action Recovery Plan: It has been recognised that the non-achievement of the emergency pathway 4-hour target is both an acute care and a community-wide system problem. McKinsey have been commissioned to undertake a 6-week piece of work to determine ‘One Version of the Truth’ which we are supporting. In parallel, the Trust has been working with clinical and managerial leads to develop and sign-off an ED action plan. As planned, the first draft of this plan has been submitted for commissioner review and their responses have been received. The final action plan will be submitted to the tri-partite panel together with the commissioner risk assessment for 1 July 2015, pending the outcome of the ‘One Version of the Trust’ work. There are 8 work-streams and action plan details and key objectives have been completed for 5 of the areas as defined below:

Ambulatory & admission avoidance: To develop admission avoidance pathways through increased specialty in-reach (including hot clinics) into the acute care hub and ambulatory and ensure the patient is assessed by the right specialty.

Emergency Department internal pathways: To review, develop and implement new models for assessment, clinical decision-making and treatment planning to enable ‘right patient, right pathway, right clinical, right time’;

Patient flow across the PRUH: To provide an efficient bed management model ensure patients are in the right place, at the right time; and to establish the roles and responsibilities within the site management team and specialty multi-disciplinary teams to increase patient flow.

Frailty pathway: To improve recognition of frailty syndromes; and to get frail medical patients to specialist wards in one move thereby reducing the number of ward moves.

Transfer of Care: To reduce the number of delated transfer of care patients; and to reduce the number of beddays lost for these patients as well as those who are medically fit for discharge.

Paediatrics: clinical lead and key objectives to be confirmed.

Internal Professional Standards (including interfaces ED-specialties and stroke): clinical lead and key objectives to be confirmed.

Diagnostics: clinical lead and key objectives to be confirmed. The latest draft version of the ED Action recovery plan for PRUH can be found in the separate attachment ‘Appendix 1’. Sara Coles has also been appointed as the System Delivery Programme Director, responsible to the Chief Executive of Bromley CCG and Kings. Governance: The ED Action Recovery Plan will be reviewed at the Emergency Care Board (ECB). This meeting is due to be re-launched on 11 June and will take place fortnightly, chaired by the interim Chief Operating Officer.

Enc. 2.1.3

9

ED Action Plan Update @DH

ED Breaches: For the 5 weeks ending in April, 24% of ED breaches were due reasons relating to bed management including CDU beds, nearly 23% of breaches due to waits for specialist review and nearly 19% due to waits to be seen by first clinician in ED. Performance in April has been further compounded with the loss of circa 20 medical beds as a result of managing the outbreak of norovirus on our wards. ED Action Recovery Plan: Implementation of point of care testing is the main action outstanding action from last year’s recovery plan which remains to be delivered in 2015-16. The additional schemes identified in the DH action recovery plan for 2015-16 are being worked-up with each division, including schemes attributed to the Integrated Care division and Facilities. As planned, the final draft of the ED Action Recovery Plan was submitted to last month’s F&P and Board Committees incorporating commissioner feedback. The final plan containing the detailed actions is currently being developed and is due to be submitted to the local area tri-partite member organisations by 8 June 2015. The final plan will incorporate a revision to originally-proposed capacity solutions relating to feedback received on catchment area restrictions, a further review on repatriation bedday delays and additional internal schemes developed by the Internal Care division leads. The plan will get clinical sign-off by ECB and the key actions fall into the following themes:

Emergency Department Minors Flow: To re-direct appropriate patients from ED and improve flow from ED at peak times; and to reduce the wait to first clinician in minors by extending emergency nurse practitioner and GP cover overnight.

Emergency Department pathways: To implement point of care testing to enable rapid access to blood results in ED; to develop, launch and audit standard operating procedures between ED and the clinical site management team out of hours, and to improve internal issue escalation process and response for specialty waits.

Medicine Emergency Pathway: To standardise pathways into and out of medicine’s bed-base; establish and implement processes at ward level to ensure adherence to internal professional standards; change Thursday morning ward round to focus on weekend discharge planning and create assessment space in the Medical Ambulatory Centre to increase the throughput of clinic patients.

Emergency Specialty Pathways: To improve specialty response to ED within 60 minutes across all divisions; to combine the surgical and medical ambulatory unit and clarify the role of the unit; to increase the focus on Thursday ward round planning for weekend discharges; to develop a plan with Medihome to increase their input at the front of the hospital.

Governance: The ED Action Recovery Plan will be reviewed at the Emergency Care Board (ECB). This meeting will take place fortnightly, taking place on alternate weeks to the ECB meeting held at PRUH.

Enc. 2.1.3

10

RTT Update

Reporting arrangements The Trust has agreed revised RTT reporting arrangements with commissioners, Monitor and NHSE for the period April to September 2015. During this period the Trust will not upload weekly and monthly data to Unify and will be excluded from national RTT reporting figures. This decision reflects the common understanding between all parties that data quality and underlying informatics processes need to be improved to enable a stronger degree of confidence in RTT reporting. The Trust will continue to provide a subset of RTT data reports to external stakeholders as well as progress reports against our key recovery milestones.

RTT Recovery Program The program of work planned over the next 6 months seeks to establish firm foundational policies and processes alongside the development of informatics and operational capabilities designed to deliver sustainable RTT performance (achieving all 3 targets) from October 2015.

Work-stream Key milestone Start date Complete Date Progress

RTT Policies and Procedures

Publish Planned Access Policy

Standing Operating Procedures (SOPs) to support policy

Action cards to guide staff through SOP process steps

Review and re-launch standard documentation including clinic outcome forms

1st Sept

1st May

1

st May

1

st May

31st May

31st May

12

th June

12

th June

On track On track On track On track

RTT Systems and reporting

Establish Trust-wide PTL to enable effective management of all pathways

Review reporting rules to ensure compliance with national guidelines and data

1st May

1

st May

1st June

1

st June

On track On track

Education and Training

Establish training strategy matrix identifying training requirements and competency measures for all relevant staff groups

RTT summary guide with FAQs

RTT guidance to specific groups –outpatients, admissions, clinicians, operational teams etc.

Roll-out trust-wide training programme

18th May

18

th May

18th May

15

th June

31st May

31

st May

On-going 11

th September

On track Complete On track On Track

RTT Pathway Validation

Validation of all admitted and non-admitted pathways

Re-establish data quality audit process

Monitor data quality of RTT data fields addressing issues through training

1st May

18

th May

1

st June

30th September

31

st May

Ongoing

On track On track On track

Backlog Clearance

Deliver backlog reductions through undertaking a range of initiatives to increase activity on and offsite, including addressing outpatient and diagnostic pressures.

1st May 30

th September On track

Demand & Capacity

Identify outpatient, diagnostic & inpatient capacity requirements for each specialty based on validated PTL & achieving agreed pathway milestones.

18th May 30

th June On track

Enc. 2.1.3

11

RTT Recovery Program Governance / Assurance Framework A program lead has been appointed and will be accountable through the agreed assurance framework to the Trust Access Board for the delivery of the RTT recovery program.

Scale of the challenge

RTT Pathway validation - An organisation the size of King’s could expect to have

between 45,000 and 50,000 patients on live RTT pathways. There are currently circa

300,000 patients in the KCH validation cohort. This number will reduce over the coming

Trust Board

Finance & Performance

Committee

RTT Steering Group

COO (Chair), D/Ops, Head of Capacity Planning, RTT Programme Lead, RTT Performance Manager

RTT Recovery Working Group

D/Ops (Chair), RTT Programme Lead, RTT Performance Manager, Divisional Managers

Divisional PTL

meetings

Validation, Data Quality &

Reporting

Training Delivery

Group

Policies and

Processes

Trust Access Board

Enc. 2.1.3

12

weeks as agreed RTT rules exclusions are applied. The remaining patients (circa

150,000) will require full validation between now and the end of September 2015.

Backlog Clearance - To achieve a sustainable incomplete position the Trust plans to

reduce the number of patients on an admitted pathway waiting more than 18 weeks by

circa 1,300 patients (50%) before the end of September, this includes reducing the

maximum waits to less than 40 weeks. This can only be achieved by increasing internal

capacity in the large majority of admitting specialties and by procuring additional capacity

in the private sector. Delivery of the planned reduction in backlog rests on increasing our

admitted RTT activity by 8% above our historical run-rate for the first 6 months of the year.

This will be achieved through a combination of improved productivity, additional weekend

and/or evening sessions and outsourcing to the Independent Sector.

Training & Education - All staff involved in the delivery of planned patient care will

receive RTT training. This will involve group sessions away from the work-place,

workplace sessions and in some cases 1:1 support. The number of staff requiring training

is expected to be over 2000.

Program Risk Matrix Risk Identified Work-stream Impact Mitigation

Procure specialist skills non-medical

Training, Validation Recruitment of Validation team, Procurement of RTT training resource, Appointment of Program lead

Procure specialist skills clinical

Backlog, Demand & Capacity

Capacity gaps identified and procurement plans in place for “at risk” services

Independent sector capacity

Backlog Early communication to identify and expedite opportunities. Additional resources in place to manage process of out-sourcing

Emergency & Cancer Pressures

Training, Backlog, Demand & Capacity

Optimise use of Orpington and DSU services

Work force resilience Training, Validation, Backlog, Demand &

Capacity

Central support for clinical & operational teams to reduce waste and improve efficiency

Systems Functions Policy & Procedures, Reporting, Validation, Demand & Capacity

PiMs & Informatics development plans

Operational grip Training, Validation, Backlog, Demand &

Capacity

Assurance framework

PRUH Emergency Pathway Recovery Plan

2015/16

1

Appendix 1 Enc. 2.1.3 - Appendix 1

2

Q4 Breach Analysis

Breach Categories have been derived from the 'Main Reason for Breach' in the Symphony ED Dataset and applied as follows: when a.main_reason_for_breach in ('ED Cubicle Capacity','SR/Critical care/Monitored bed','Waiting for a bed') then 'Bed Flow' when a.main_reason_for_breach in ('Waiting 1st Clinician', 'Late Referral by ED', 'ED Triage') then 'Ed processes' when a.main_reason_for_breach in ('Mutliple Specialties','Paeds Treat and Transfer','Waiting Specialty Decision', 'Delay in Treatment Decision') then 'Spec Review' when a.main_reason_for_breach = 'Delay Diagnostics' then 'Delay Diagnostics' when a.main_reason_for_breach = 'Clinical Deterioration' then 'Clinical Excep' when a.main_reason_for_breach in ('Waiting Transport','Delay Mental Pathway','Delay Social Services','Late click off - Did not breach', 'Late UCC Handover') then 'Other' else 'Other'

end as Breach_Category,

Enc. 2.1.3 - Appendix 1

Bed Demand & Capacity Waterfall Chart - Based on demand in Q4 14/15 + 1% emergency growth

3

Bed Demand & Capacity Waterfall Chart - schemes to date release 17 beds

3

6

5

3

-28 TBC** TBC** 3 5 ?6 3

Current

Shortfall

*

Expanding

Medical

Assessment

Centre

Expanding

Surgical

Assessment

Unit

Managing Demand

** To be finalised forllowing 'OVT' One version of the trust (McKinsey)

* Modelled on 90% occupancy rate

Internal Initiatives Joint Initiatives

-28

TBC

Transferring

electives from main

theatres to DSU -

BADS analysis

currently being

agreed with

specialties

LOS

improvements -

PWC currently

compiling

schemes

Establish a

King's Older

Person

Assessment

Unit

Transfer of

Care

initiatives -

work started

in 14/15 is

50%

complete

Care Home

Selection

Service

(CHS)

started in

April'15

Discharge to

Access

Schemes

due to start

in Oct'15

Stop Urology

elective and

emergency service

for QEH

Relocate both areas next to ED

Productivity improvements Increased Ambulatory Integrated Care Initiatives


Methodology For each specialty, identified the occupied general acute beds required to deliver the 14/15 activity

levels at Princess Royal each quarter at (i) 100%, (ii) 90% and (iii) 85% occupancy levels

For each division calculated the difference between the level of beds required and the beds available each quarter at (i) 100%, (ii) 90% and (iii) 85% occupancy levels

Calculated the Trust overall bed position for (i) 100%, (ii) 90% and (iii) 85% occupancy levels

Calculated the change in bed requirement if emergency demand increased by 1% based on the increase between Q4 13/14 and Q4 14/15 , which equates to an additional 4 beds

The following activity was excluded from the analysis – day cases, obstetrics, neonatology and activity undertaken in the Independent Sector

Undertook the same process to calculate the bed position for (i) Critical Care and (ii) Paediatrics

Bed Capacity Shortfall Based on Q4 demand the following additional general acute adult beds are required:

The waterfall chart shows a shortfall of 28 beds based on 90% occupancy + 1% growth.

Critical care bed pressures rose to 87% bed occupancy

Paediatric bed occupancy is below 80%

Bed Demand & Capacity

4


Shortfall in adult general beds during 2015/16 - Work in Progress

5


6

Summary of workstreams and RAG tracking

PRUH Emergency Care Recovery Plan - Summary Date Updated

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

Ambulatory & admission avoidance Dr Joble Joseph / Dr Prakash Sinha

Emergency Department internal pathways Dr Andrew Hobart

Patient flow across the PRUH Liz Wells

Frailty pathway Dr Wendy Hildick-Smith

Transfer of Care Paran Govender

Paeds TBD

Internal Professional Standards (including

interfaces ED-specialties and stroke)

TBD

Diagnostics TBD

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

Ambulatory & admission avoidance Dr Joble Joseph / Dr Prakash Sinha

Emergency Department internal pathways Dr Andrew Hobart

Patient flow across the PRUH Liz Wells

Frailty pathway Dr Wendy Hildick-Smith

Transfer of Care Paran Govender

Paeds TBD

Internal Professional Standards (including

interfaces ED-specialties and stroke)

TBD

Diagnostics TBD

11/05/2015

KPIs status

Workstream LeadActions status

LeadWorkstream


In Progress

7

KPI Scorecard Enc. 2.1.3 - Appendix 1

8

Patient Flow across PRUH (1 of 3)

Performance summary

Status commentary (copied to summary sheet)

May Jun Status commentary

KPIs

Actions

KPIs:

KPI May Jun Status commentary

Number of discharges

Number of discharges < 1pm

Number of outliers

Number of cancelled elective patients

Number of patients place within 1 hour of DTA

Number of admissions

Number of ward moves

Actions

# Action Responsible Date created Planned Due Date Revised due date Update/remediation/support required May Jun Status commentary

1

Identify and provide project

management resource to support

development and implementation

Kath Dean TBD

2Confirm new site/bed management

structureSimon Dixon TBD

3

Define draft standardised role and

responsibilities of discharge

coordinator (simple and complex

discharge) supporting:

. ED to wards move

. ward to ward moves

. ward to community services

. Repatriation

Paran Govender TBD

4

Define draft standardised role and

responsibilities of ward clinical teams

(Dr, nurse)

. ED to wards move



. Repatriation

Paula Townsend

Jack Barker05/06/2015

5

Define draft standardised roles and

responsibilities of site/bed mgt team

supporting:

. ED to wards move



. Repatriation

Liz Wells 15/05/2015

Action status

KPI Status

Lead

Last updated

Workstream

Status (copied to summary sheet)

Patient flow across the PRUH

Objectives

To provide an efficient bed management model to

ensure patients are in the right place at the right time

To establish roles and responsibilities both within the

team and the speciality multidisciplinary teams to

increase patient flow

To provide consistency of service 24/7

Liz Wells

08/05/15

0

0.2

0.4

0.6

0.8

1

1.2

May Jun

No. of breaches

Number ofdischarges

Number ofdischarges < 1pm


9



6

Test and refine all roles and

responsibilities against patient

pathway (simulation workshop)


7

Get sign-off from PRUH tripartite

leadership for all roles and

responsibilities

P. Govender

P. Townsend

J. Barker

L. Wells

1 week

8Communicate and implement changes

in roles of site/bed mgt teamLiz Wells

3 months (from

sign-off)


in discharge coordinator roleParan Govender TBD


in roles of ward clinical teams

P. Townsend

J. Barker10/07/2015

11

Define standardised ward processes

(through white board management)

and get sign-off from PRUH tripartite

leadership

P. Townsend

J. Barker10/07/2015

12

Communicate and implement changes

in ward processes (white board

management)

P. Townsend

J. Barker14/08/2015

13Define beta model for bed

management meetingsLiz Wells 12/06/2015

14Communicate and implement beta

model for bed management meetingsLiz Wells 12/06/2015

15

Define final model for bed

management meetings (w/ output from

workshop) and get sign-off from PRUH

tripartite leadership

Liz Wells1 month (from

sign-off)

16Communicate and implement new

model for bed management meetingsLiz Wells

3 months (from

sign-off)


10



17

Establish requirements for information

collected and provided for the bed

management meeting (beta model)


18

Establish requirements for information

collected and provided for the bed

management meeting (final model)

Liz Wells3 months (from

sign-off)

19

Develop escalation plan (including

trigger recognition and information to

relevant parties) to support problem

solving (beta model)


20

Develop escalation plan (including

trigger recognition and information to

relevant parties) to support problem

solving (fianl model)

Liz Wells3 months (from

sign-off)

21

Refine data requirements and

implement data collection to ensure on-

going performance monitoring

C. Fry

J. Barker31/07/2015 - TBC


11

Ambulatory Admission Avoidance (1 of 2)

Performance summary



KPIs

Actions

KPIs:


Number of ambulatory attendances

Number of admissions

Actions


1



change

Kath Dean TBD

2

Undertake data modelling and analysis

to formalise need for ambulatory

and/or assessment centre:

. Overall modelling

. Snapshot of ED cards

. Cinical audit surgery

. Diagnostics modelling

Strategy dept

A. Hobart

P. Sinha

Strategy dept

22/05/2015

3

Review and draw conclusions on best

practices: Homerton, Whittington, Bath,

Oxford and Future Hospital Programme

(RCP)

A. Abba

E. Garbelli

P. Sinha

S. Karamanakos

22/05/2015

4

scope and identify pros and cons of

different models given current space

constraints:

. ambulatory unit for medical and/or

surgical

. assessment unit/decision making hub

only, for medical and/or surgical

A. Abba

E. Garbelli

P. Sinha

S. Karamanakos

29/05/2015

(subject to project

mgt support)

requires to look at space blueprint and at

potential extension of 4h target to new

service

Workstream


Ambulatory and admission avoidance (medical and surgical)To ensure the right patient is at the right place and the

right time to be assessed by the right specialty (best

practice)

To improve patient safety and quality of care by

improving flow through ED and acute care hub and also

reduce number of ED breaches

To develop admission avoidance pathways through

increased specialty inreach (including hot clinics) into the

ObjectivesDr Joble Joseph (medicine) / Dr Prakash Sinha (surgery)

08/05/2015

Action status

KPI Status

Lead

Last updated


12

Ambulatory Admission Avoidance (2 of 2)


5

Define operational model:

. Pathways (inclusions/ exclusions)

. Develop draft SOPs

A. Abba

E. Garbelli

P. Sinha

S. Karamanakos

05/06/2015

(subject to project

mgt support)

6

Refine and validate operational model

w/ wider clinical group within PRUH:

. Interface with UCC streaming and ED

triage

. Interface with frailty pathway

. Interface with other specialties

. Interface with rapid access clinics / hot

clinics (gastro, neuro, cardio,

dermatology, resp)

A. Abba

E. Garbelli

P. Sinha

S. Karamanakos

19/06/2015

(subject to project

mgt support)

7Refine and validate operational model

w/ community services

A. Abba

E. Garbelli

P. Sinha

S. Karamanakos

05/07/2015

(subject to project

mgt support)

8Test operational model w/in existing

capacity

A. Abba

E. Garbelli

P. Sinha

S. Karamanakos

19/06/2015

(subject to project

mgt support)

9 Finalise SOPs and get sign-off ?

A. Abba

E. Garbelli

P. Sinha

S. Karamanakos

26/06/2015

(subject to project

mgt support)

10 Vacate space for future service Sue Field 15/07/2015

11 Define new tariff with CCGs TBD TBD

12

Undertake detailed planning of new

service

. Identify resource requirements

. Get quote from Vinci

. Develop business case and submit to

BRSG

. Develop implementation plan

A. Abba

E. Garbelli

P. Sinha

S. Karamanakos

31/07/2015

13 Get BRSG approval N/A 21/08/2015

14

Implement new service:

. Initiate staff recruitement

. Building work

. Order equipment

. Communication

. Training

A. Abba

E. Garbelli

P. Sinha

S. Karamanakos

31/10/2015


13

Frailty Pathway (1 of 3)

Performance summary



KPIs

Actions

KPIs:


No. of patient moves (target is 1)

Pre-admission time (from ED to specialty ward)

No. of discharges per day from M7

Actions


1




Kath Dean TBD

2

Be informed of current best practices

and how relevant ones could be

adapted to the PRUH. Organise site

visits subsequently

W. Hildick-Smith

J. Evans

C. Turner

08/05/2015

Wendy Hildick-Smith

08/05/2015

Action status

KPI Status

Lead

Last updated

Objectives

Workstream


Frailty Pathway To improve recognition of frailty syndromes

To get frail medical patients to specialist wards in one move

To reduce the number of ward moves for frail medical patients

To target up to 5 frail medical patients a day for M7 ward team

management and discharge to treat

0

0.2

0.4

0.6

0.8

1

1.2

May Jun

No. of patient moves(target is 1)

Pre-admission time(from ED to specialty

ward)


14



Overall short to mid-term objective: to move ~5patients a day from ED to M7 + discharge the same => trial for 6 months

3

Frailty syndromes identification -

develop checklist to use in ED/triage so

patient can be sent directly to M7 after

senior review in ED

W. Hildick-Smith 08/05/2015

4

Develop frailty pathway in co-

ordination with ED and acute medicine,

including discussion with ED team,

development of algorithm for M7,

development of SOP

W. Hildick-Smith

J. Evans4-6 weeks

5

Undertake data collection:

. No. of patients (snapshot audit ED

cards)

. Baseline pre-admission time from ED

to M7/S1/S2 (snapshot audit by ward

clerk)

. LOS M7 over 1 month (average, No. of

discharges per day of the week, etc) to

see if realistic to discharge 5 pts a day

. Consultants PA + MDT

C. Turner

W. Hildick-Smith

P. Govender

4 weeks

6

Comprehensive Geriatric Assessment -

as close to front door as possible. Adapt

current resources (M7 consultants +

extra SHO and FY1 from AMU or Take

Teams)

W. Hildick-Smith J

Evans

C. Turner

4 weeks?Risk: M7 consultants are locums + extra SHO

and FY1 to move from Acute medical unit

7

Develop Community Services links (e.g.

MRT, BHCP, etc) to encourage Discharge

to Treat where appropriate

P. Govender 8 weeks

8

Re-launch mobile phone hotline for

GPs (advice) - undertake monitoring of

No. of calls and outcomes

W. Hildick-Smith (w/

support from J.

Evans)

6 weeks

9 Data monitoring and analysis of trial TBD 6 months


15



Confirm and implement longer term needs

10

Assess staffing requirements and

develop M7 team:

. appropriate multi-disciplinary staffing

. 5+2 working week

W. Hildick-Smith (w/

support from J.

Evans)

P. Govender (MDT)

C. Turner

TBC post 'One

Version of the

Truth'

11

Assess requirements and develop

Frailty Liaison Team:

. part of M7

. appropriate multi-disciplinary staffing

(medical, therapy, nursing, Social

services)

. 5+2 working week

W. Hildick-Smith

J. Evans

P. Govender

C. Turner

TBC post 'One

Version of the

Truth'

12

Develop HOT Clinics / Rapid Follow-up

clinics / Ambulatory:

. Learnings from GP hotline

. Benefits/risks analysis

. Review definitions and models

. Undertake data modelling

. Identify staffing requirements

C. Turner (w/

support from clinical

leads and Dr

Garbelli)

TBC post 'One

Version of the

Truth'

13

Review current Outpatients clinics,

assess pros and cons of relocating to

PRUH to possible unified "Betty

Alexander suite equivalent" at PRUH

C. Turner (w/

support from clinical

leads and Dr

Garbelli)

TBC post 'One

Version of the

Truth'


16

Transfer of Care (1 of 2)

Performance summary



KPIs

Actions

KPIs:


Number of bed days lost for MSFD patients

Number of patients listed as MSFD

Average bed days lost per MSFD patient

Number of bed days lost for DTOCs patients

Number of patients listed as DTOC

Average bed days lost per DTOC patient

Actions


1




Kath Dean 15/05/2015 TBC

2

Develop comprehensive service

directory to support admission

avoidance and short stay

Louise Duffell 15/05/2015

30/06/2015

(subject to project

mgt support)

3

Develop and deliver 7 day admission

avoidance / short stay services:

. Establish 7 day working for OT and PT

within ED, CDU and AMU by recruiting

relevant staff

. Investigate the demand for and

establish 7 day working amongst

DISCO's if indicated

Louise Duffell

Celia Rickwood15/05/2015 30/09/2015

Paran Govender

18/05/2015

Action status

KPI Status

Lead

Last updated

Objectives

Workstream


Admission/ Discharge Management: Transfer of Care Reduce the number of bed days lost on the SITREP for

patients who are medically safe for discharge

Reduce the number of Delayed Transfers of Care patients

(and associated bed days) reported (NHS and/ or social

care delays)


17

Transfer of Care (2of 2)


6

Develop and deliver system wide

programme to access NHSE specialised

rehab in a timely manner:

. Develop Demand & Capacity

modelling for specialist commissioned

neuro-rehab

. Establish / review pathways and

processes with commissioners and out

of hospital providers

Jacqui Wakefield15/05/2015

31/07/2015

(subject to project

mgt support)

requires access to data from community

partners?

7

Deliver timely access to environmental

adaptations including equipment

provision for patients who require this

type of support within the community:

. Establish / review process with each of

the 3 boroughs

. Review commissioning agreements

(incl. w/ Medequip)

Matt Bourne 15/05/2015

31/08/2015

(subject to project

mgt support)

involves agreement with community partners

8

Develop and deliver system wide

programme to access out of hospital

care in a timely manner:

. Develop Demand & Capacity

modelling

. Establish / review pathways and

processes with commissioners and out

of hospital providers

. In discussion with community

partners, establish 7 day access to

service for all boroughs for all types of

placements/ packages of care (self-

funded, social care funded, health

funded)

Paran Govender

Sue Bowler15/05/2015

30/09/2015

(subject to project

mgt support)


9

Develop and influence system wide

programme to access out of hospital

rehab and care in a timely manner:

. Initiate work with commissioners and

out of hospital providers to support

effective use of available capacity and

expansion of services for changing

needs of population

Paran Govender

Sue Bowler

Trudi Kemp

15/05/2015

30/09/2015

(subject to project

mgt support)


10

Develop and sustain accurate

performance monitoring and

management of key data via an

effective clinical performance and

governance framework

Paran Govender

Sue Bowler15/05/2015

30/06/2015

(subject to project

mgt support)

needs effective BIU support


18

Emergency Department Internal pathways (1 of 4)

Performance summary



KPIs

Actions

KPIs:


Time to 1st clinician (median)

Time to referral ED to Inpatient team (median)

Time from arrival to see Dr for T2 patients who walk-in

Proportion of nursing shifts covered by agency staff (out of total No. of nursing shifts)

Compare consultants staffing establishment with standards

Additional KPIs identified (separate list)

Actions

# Project Responsible Date created Planned Due Date Revised due date Update/remediation/support required May Jun Status commentary

1


management resource to support ED in

process change

Kath Dean TBD

2

Undertake data modelling and analysis

to inform process change:

. Overall modelling

. Snapshot of ED cards

Strategy dept

A. Hobart22/05/2015

3

Streaming, walk-in triage and initial

assessment - Review current model:

. As Is model and issues

. Observations and value step analysis

A. Hobart

D. Swaby-Larsen30/04/2015

Completed

/On-track

4


assessment - Define new operational

model for ED patients:

. Identify new potential models to test

. Test potential models and evaluate

. Develop SOP for preferred model

A. Hobart

D. Swaby-Larsen

12/06/2015

(subject to project

mgt support)

Emergency Department internal pathways

Andrew Hobart

07/05/2015

Action status

KPI Status

Lead

Last updated

Workstream


Objectives

- "Right patient, right pathway, right clinician, right time"

- Initial assessment process ensures that time critical conditions

are treated promptly and patients are put on the optimal pathway

straight away

- the right number of staff with the right skills to meet patient

needs are on duty

- Early decision making and definitive treatment planning by

involving a senior clinician early in the patient pathway

- Fewer more focused blood tests with more rapid results

- Referrals to admitting speciality teams are as early as possible

- Admission or discharge rapidly follows the clincal decision

0

0.2

0.4

0.6

0.8

1

1.2

May Jun

No. of breaches

Time to 1st clinician(median)

Time to referral ED toInpatient team

(median)


19



5


assessment - Define new operational

model for interfaces w/ ambulatory,

frailty pathway, hot clinics, community

services

. Discuss and define model w/ key

stakeholders

. Test potential models and evaluate

. Develop SOP for preferred model

A. Hobart

D. Swaby-Larsen

26/06/2015

(subject to project

mgt support)

6


assessment - Discuss and agree new

model w/ Greenbrook and CCG

A. Hobart

Angela Bahn

15/07/2015

(subject to project

mgt support)

7Streaming, walk-in triage and initial

assessment - Implement new model

A. Hobart

D. Swaby-Larsen

20/07/2015

(subject to project

mgt support)

8

Ambulance triage - Review current

model:

. As Is model and issues

. Observations

A. Hobart


9

Ambulance triage - Define draft new

model:

. Identify potential models (incl. links w/

ACH)

. Develop draft SOP

. Test and evaluate

A. Hobart


10

Ambulance triage - Implement new

modelA. Hobart


11

Staffing establishment (nurses, ED

Consultants, ED Middle Grade/ Jr Drs):

. Benchmarking + review requirements

to match demand and meet standards

. Understand current budget

. Develop business case if required

A. Hobart

D. Swaby-Larsen

J. Sleater

31/05/2015

12

Staffing establishment (nurses, ED

Consultants, ED Middle Grade/ Jr Drs):

. Get BRSG approval

. Initiate recruitment

A. Hobart

D. Swaby-Larsen

J. Sleater

TBC

13

Pathology and point of care testing:

. As Is processes and issues

. Review current performance (TAT)

. Test improvements (new chute) and

quick wins / Evaluate

A. Hobart

D. Swaby-Larsen

J. Sleater

15/05/2015


20



14


. Collect information and data from DH

. Investigate potential to share w/ AMU,

ASU, ambulatory unit

. Get quotes

J. Sleater 31/05/2015

15


. Build options appraisal (do nothing /

continuous improvt of current process /

ED POCT / shared POCT (incl. location)

. Submit for decision

. Write business case for BRSG approval

if relevant

J. Sleater 30/06/2015

16


If relevant:

. Get BRSG approval

. Develop detailed plan

. Initiate implementation

J. Sleater 31/07/2015

17

Develop appropriate data collection and

reporting system to enable performance

monitoring

TBD TBD

18 Review ED interface with Ambulatory

pathways

A. Hobart

D. Swaby-Larsen

Linked to

ambulatory and

admission

avoidance

workstream


21



19Review ED interface with Admissions

pathways

A. Hobart

D. Swaby-Larsen

Linked to

ambulatory and

admission

avoidance

workstream

20 Review ED interface with Frailty pathwayA. Hobart

D. Swaby-Larsen

Linked to

ambulatory and

admission

avoidance

workstream

21 Review ED interface with TherapiesA. Hobart

D. Swaby-LarsenTBD

Surge, escalation actions & visual

management plan:

. Define draft roles & responsibilities

. Define triggers and escalation actions

. Developed and tested 'Status at a

glance' visual management board

. Develop safety checklist

. Develop draft SOP

A. Hobart


Surge, escalation actions & visual

management plan:

. Align w/ Trust-wide escalation plan

. Implement

A. Hobart

D. Swaby-Larsen30/06/2015 - TBC

22

Improve support services: imaging,

pharmacy, portering


A. Hobart


22

Improve support services: imaging,

pharmacy, portering

. Pb-solve, test improvements, evaluate

and refine

. Implement changes

A. Hobart

D. Swaby-LarsenTBD

23

Improve other internal ED processes:

Majors, CDU, sub-acute, resus


A. Hobart


23


Majors, CDU, sub-acute, resus


and refine

. Implement changes

A. Hobart

D. Swaby-LarsenTBD

23


Well organised work environment,

house-keeping, paperwork, ICT systems



and refine

. Implement changes

A. Hobart

D. Swaby-LarsenTBD


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Enc. 2.3.1

1


Date of meeting: 26 May 2015

Subject: Quarterly Patient Safety Report

Author(s): Mr Michael Marrinan (Medical Director) & Richard

Hinckley (Head of Patient Safety & Risk)

Presented by: Mr Michael Marrinan (Medical Director)

Sponsor: Mr Michael Marrinan (Medical Director)

Status: For discussion

1. Summary of Report

The purpose of the report is to present an overview of patient safety issues to the Board of Directors highlighting areas of concern.

2. Action required The Board of Directors is asked to review the report and make any recommendations as required.

3. Key Implications

Enc. 2.3.1

2

1. Executive Summary

2 Never Events have been reported since the last report to the Board of Directors in February 2015. These are summarised below:

o Wrong site surgery (Denmark Hill, Day Surgery Unit). There was no significant harm to the patient and this incident is being fully investigated in line with Trust Policy

o Wrong implant (Denmark Hill, Radiology). There was no significant harm to the patient and this incident is being fully investigated in line with Trust Policy

9 serious falls occurred (6 at DH, 2 at PRUH and 1 at Orpington) in the last quarter, down from 11 the previous quarter

15 grade 3 pressure ulcers were reported in the last quarter (Jan-Mar 15), up from 9 in the previous quarter. This increase is accounted for by a rise in grade 3 pressure ulcers at the PRUH (from 1 to 6) over the same period

An analysis of medication errors for 2014-15 has highlighted some areas where safety can be improved and medication safety has been selected as a safety quality priority for 2015-16

In a recent Biopatch audit of IV line care KCH performed the best out of 26 other Trusts in the sample

Important Patient Safety Issues

2. Safety Quality Priority: Medication Safety An analysis of medication errors from 2014/15 indicated three areas where safety can be improved:

Errors of magnitude (for example tenfold overdoses, especially in paediatrics)

Drug omissions

Incidents involving drugs deemed to be “high risk” (11% of reported incidents involved opioids, 8% anticoagulants and 4.6% insulin)

Actions that have been put in place to address these issues include:

Set-up of an Insulin Safety Group & Opioid Safety Group to review issues relating to the prescription and administration of these high-risk drugs

The “Rule of One” has been launched in paediatrics (a campaign that reminds staff to query a preparation if they open more than one vial) to help prevent errors of magnitude

Extension of the skills programme for drug dose calculations

Ongoing review of all medication incidents by the medication safety team Further work streams that are planned in 2015-16 include:

Development of a policy to escalate decisions to omit drugs (administration)

Incorporation of observational patient identification audit into audit tools to monitor positive patient identification and target areas of non-compliance

Continue roll-out of EPMA to ED and implement e-systems in Critical Care to reduce chance of drug administration to patients with documented allergies

Review drug calculation competency testing regime for nurses The Medication Safety Committee monitors these work streams and reports into the Patient Safety Committee.

Enc. 2.3.1

3

3. Safety Quality Priority: Improving Safety in Surgery through use of the Safer Surgery Checklist (SSC)

As noted in section 1 there have been 2 further Never Events reported since the last report, one in Surgery and one in Radiology. Neither of these Never Events resulted in significant patient harm although the breast surgery patient had additional surgery which was not clinically indicated at the time. Both of these incidents are being fully investigated and will be reviewed at the Trust Serious Incident Committee. As surgical Never Events have not been eliminated in 2014-15 the Trust has retained surgical safety as a safety quality priority for 2015-16. The current focus of improvement work has shifted toward interventions that are carried out in non-theatre settings. A progress update on current work streams is provided below:

A formal Surgical Safety Policy has been developed and was ratified at the Surgical Safety Improvement Group (SSIG) in May. This policy brings together in one place policies and practices relevant to interventional procedures (with references to the Surgical Count Policy, Surgical Marking Policy, etc) An educational programme (for all surgical, anaesthetic and theatre staff) to accompany the policy is being developed. The focus of education will be on the empowerment of staff to challenge non-compliance with the policy.

A cross-site observational audit of SSC use in all interventional settings will take place in July and August 2015 with the results fed back to the SSIG

A re-audit of the anonymous culture survey on all sites (particularly in non-traditional theatre areas) will take place in the Summer

Speciality specific checklists at the PRUH, Orpington and QMS are still in development in some areas (although those for ophthalmology procedures have been implemented across all sites)

The SSIG is overseeing a project to improve timely addition of operation notes to the Electronic Patient Record (EPR) on the Denmark Hill site

Implementation of the SSC is monitored by the Surgical Safety Improvement Group (SSIG - chaired by a Consultant Neurosurgeon) which reports to the Patient Safety Committee chaired by the Medical Director.

4. Improving the identification and escalation of acutely ill patients

Work to improve the management of acutely ill-patients is led by the Director of Nursing and Midwifery. Safety improvement work in this area is summarised below:

• The upgrade of the electronic vital signs software (Wardware) at DH (to align it with the National Early Warning Score) which was delayed (due to technical issues) has now been implemented. An education drive around the use of Wardware accompanied the launch

• Acute Kidney Injury (AKI) workstream – the notification of AKI will become electronic via the results system in EPR pending further pathology IT upgrades

• iMobile are now more active at the PRUH and are providing excellent support to wards with feedback and teaching

• The electronic Do Not Attempt Resuscitation (DNAR) form which is available in EPR has been piloted in Medicine in parallel with an electronic Treatment Escalation Plan (TEP). A TEP project plan (led by the Matron for Palliative Care) is in development

• As noted in previous reports, plans are underway to increase critical care capacity (with a new 60-bedded ICU coming on stream later in 2015)

Enc. 2.3.1

4

The Deteriorating Patient Group monitors these workstreams and reports into the Patient Safety Committee.

5. Pressure Ulcers & Falls The incidence of hospital acquired pressure ulcers and patient falls across all sites are monitored closely by the respective Tissue Viability and Falls Teams. All serious falls and pressure ulcers (grade 3 or 4) are reviewed by the Safer Care Fora at DH or PRUH. The Safer Care Fora report to the Patient Safety Committee.

5.1 Falls

9 serious falls occurred (6 at DH, 2 at PRUH and 1 at Orpington) in the last quarter, down from 11 the previous quarter (2 at DH, 9 at PRUH)

Falls with significant harm have reduced from 36 cases in 2013 to 25 cases in 2014

The overall rate of falls increased slightly at DH (from 5 to 5.5 per 1000 bed days) but reduced at PRUH (from 6.6 to 6.2) in the last quarter

5.2 Pressure Ulcers

15 grade 3 pressure ulcers were reported in the last quarter (Jan-Mar 15), up from 9 in the previous quarter. This increase is accounted for by a rise in grade 3 pressure ulcers at the PRUH (from 1 to 6) over the same period. However the number of grade 3 pressure ulcers at PRUH remains well below the numbers that were reported prior to acquisition

The current focus of work to reduce avoidable falls and pressure ulcers is provided below:

• Continue with recruitment of the “specials” team at DH which will better enable prompt 1:1 care to be delivered to patient’s at risk of falls and pressure ulcers (now in phase 3 of recruitment)

• Continue with recruitment plans to increase nursing establishment across sites • The numbers of HCAs have been increased by two on each shift on AMU at PRUH

to ensure that those at risk are supervised when mobilising • An additional TVN started at PRUH in April 2015 and more pressure relieving

mattresses have been made available • Documentation steering group setup to review nursing documentation (incl. falls risk

assessments) & explore options for electronic capture of this information • Rollout of Patient Falls & Pressure Ulcer Passports across sites • Extend Executive Nursing leadership & engagement (through the “engage” tool) to

additional wards in 2015/16 • Benchmarking data from Shelford colleagues has been obtained – the rate of falls

per 1000 bed days is comparable (5.6) considering we are an MTC and neuro centre • Embed the ward accreditation scheme (Commit to Care) at PRUH and extend

implementation at DH • A ‘frailty pathway’ to be developed to ensure a more seamless transition from the ED

to ward of admission • Development of an ‘admission avoidance’ unit at PRUH (similar to the Betty

Alexander Suite at DH) to optimise individualised care • The Trust continues to work with Commissioners and community care providers to

ensure pressure ulcers that are acquired by patients who pass between community and acute care providers are fully investigated

Recommendation The Board of Directors is asked to note the content of this report.

1

Report to: Board Directors


Subject: Monthly Unify Staffing Report (April 2015)

Author(s): Maria Donbavand

Presented by: Geraldine Walters

Sponsor: Geraldine Walters

History: Monthly Nursing, Midwifery and Care staff numbers to the Board

Status: For Information

1. Summary of Report This report provides the Board of Directors with information on the details of the actual hours of Nursing, Midwifery and Care Staff time on ward day shifts and night shifts versus planned staffing levels for April 2015. KEY POINTS

For each of the 77 clinical inpatient areas, the optimal number of hours of nursing or midwifery staff time required for day shifts and night shifts has been calculated for the month and the actual fill rate has been recorded.

Overall the actual fill rate for shifts for Registered Nurses was 95% which hasn’t changed from last month and for other care staff against planned levels was 132% which is 2% lower than last month during day shifts. Overall the actual fill rate for shifts for Registered Nurses against planned levels was 98% which is 1% lower than last month during night shifts and for other care staff the actual fill rate was 182% which is 40% higher than last month.

This report details those areas where there was a variance of greater than 15% between actual fill rates and planned staffing levels. The reasons for the variance are given and any actions that were taken are detailed.

It is important to note that where the variances are a lot higher than the expected planned there will be contributing factors such as;

o Actual Budgets haven’t been formalised yet so some areas will show over established until budgets are uploaded

o They would have been a requirement to use Specials

o Overseas Nurses awaiting their Pin number so recorded as a HCA

o Acuity higher than expected

Enc. 2.3.2

April 2015 Safer Staffing Board Report Cover Note 2 of 2

0%

20%

40%

60%

80%

100%

120%

140%

160%

180%

200%

% Average fill rateRN

% Average Fill rateHCA

% Average fill rateRN

% Average Fill rateHCA

DAY NIGHT

January

Feb

Mar

Apr

% Difference of planned versus actual nursing hours: Jan 2015 ‐ Apr 2015

2. Action required The Board is asked to note the report. 3. Key implications

Legal:

Patients have a right to be cared for by appropriately qualified and experienced staff in safe environments. This right is enshrined within the national Health Service (NHS) Constitution, and the NHS Act 1999 makes explicit the board’s corporate accountability for quality. Nurses’ responsibilities regarding safe staffing are stipulated by the Nursing and Midwifery council (NMC).

Financial: Nursing is the largest professional group in the Trust and consumes a large amount of resource. Cost efficiency is therefore paramount

Assurance:

This report provides assurance and evidence on nursing workforce.

Clinical: Nursing is a key component in provision of good patient experience and harm free care

Equality & Diversity: There are no issues or implications relating to equality and diversity within this report

Performance: This report highlights achievements against national and local key performance indicators

Strategy: The contents of this report is directly aligned to the Trust Nursing and Midwifery Objectives

Workforce:

This report will inform Trust’s Nursing and Midwifery Workforce Strategy.

Estates:

There are no implications

Reputation:

Poor nursing care would have a deleterious effect on the reputation of the Trust

Other:(please specify)

n/a

Enc. 2.3.2

April 2015 Safer Staffing – Board Report

EXECUTIVE SUMMARY

REPORT TO THE BOARD OF DIRECTORS

HELD ON 26th MAY 2015

At Kings College NHS Foundation Trust we aim to provide safe, high quality care to our patients and our staffing levels are continually assessed to ensure we meet this aim. For most wards, there will be a difference between the planned and actual staffing hours. In some cases, departments will have used more hours than they planned to use and in other cases they will have used less hours than they planned. The reasons for using more staff hours than planned could include needing to open and staff additional beds, or needing to care for patients who are either more unwell or who have greater care needs than those patients usually cared for on that ward. The reasons for using less staff hours than planned could include using fewer beds than planned, or caring for patients who are less unwell or with fewer care needs than those patients usually cared for on that ward. The planned staffing level is based on optimal staffing levels and where actual staff is below this on a shift, the Trust has a number of mechanisms to ensure the staffing on that shift remains at a safe and appropriate level. The average fill rate for the Trust and individual hospital inpatient sites in April 2015 was as follows:

Site

DAY NIGHT

% Average fill rate RN

% Average Fill rate HCA

% Average fill rate RN

% Average Fill rate HCA

Denmark Hill 95% 169% 97% 195%

PRUH 95% 121% 99% 170%

Appendices:

Variance report by ward/department (Appendix I) Unify upload (Appendix II)

April 2015 unify return.pdf

Enc. 2.3.2


APPENDIX I VARIANCE REPORT BY WARD / DIVISION The following wards have been identified as having a variance of greater than 15% against either their day or night staffing for either Nursing, Midwifery and Care staff during April 2015. The Trust website lists the results for all the inpatient wards or departments and details whether there was a deficit or surplus between the planned and actual staffing.

PRUH/Orpington

Division Ward Name Day Planned

RN

Day Actual

RN %

Day Planned

HCA

Day Actual HCA %

Night Planned

RN

Night Actual

RN %

Night Planned

HCA

Night Actual HCA %

Review by HON/Matron/Ward where 15% or more of nursing hours did not meet agreed staffing levels (Highlighted in red)

Children's Children's Ward 1012 1231 122% 265 345 130% 1116 1254 112% 23 58 250%Additional staff booked via winter pressure agreement to keep beds open to 15 until end of April

Children's Special Care Baby Unit 966 897 93% 104 184 178% 978 978 100% 23 104 450% Additional HCAs booked to cover milk bank and open additional 2 cots as needed


RN

Day Actual

RN %

Day Planned

HCA

Day Actual HCA %

Night Planned

RN

Night Actual

RN %

Night Planned

HCA

Night Actual HCA %


Surgery Boddington (ORP) 2024 1300 64% 1035 932 90% 1024 805 79% 656 472 72%We adjust staffing due to patient numbers and generally the reduced staffing is because we have a lower number of patients on the ward.

Surgery Surgical Ward 5 1725 1679 97% 1070 1323 124% 1403 1392 99% 725 1081 149%

Ward's acuity has increased. HCA booked instead of RN. Extra staff needed during outbreak. There has been a lot of ITU step down patients and confused high risk patients.


RN

Day Actual

RN %

Day Planned

HCA

Day Actual HCA %

Night Planned

RN

Night Actual

RN %

Night Planned

HCA

Night Actual HCA %


NetworkCoronary Care Unit (CCU) 1380 1380 100% 35 12 33% 1058 1035 98% 276 265 96%

No HCAs in the day shift est. These are specials only and increased acuity during the month.

Enc. 2.3.2



RN

Day Actual

RN %

Day Planned

HCA

Day Actual HCA %

Night Planned

RN

Night Actual

RN %

Night Planned

HCA

Night Actual HCA %


TEAM Darwin 1 (S1) 1323 1150 87% 1012 1886 186% 1035 1047 101% 368 1150 313%D1&2 are the dementia focus wards and as such have a regular and ongoing need for HCA specials in line with patient needs

TEAM Darwin 2 (S2) 1035 995 96% 1035 1714 166% 1035 1024 99% 345 1035 300%D1&2 are the dementia focus wards and as such have a regular and ongoing need for HCA specials in line with patient needs

TEAM Emergency Assessment Unit (EAU) 2070 2013 97% 713 1357 190% 1725 1691 98% 345 1449 420% December SCF agreed 2 additional HCA's per shift to reduce inpatient falls/harm

TEAM Farnborough Ward 1737 1432 82% 1357 1760 130% 1277 1288 101% 771 1265 164%FW has single side room accommodation and as such specialling requirements for patients have resulted in additional HCA staffing

TEAM Medical Ward 2 1277 1139 89% 1024 1277 125% 1024 955 93% 345 575 167%Additional HCA's required to provide 1:1 specialling and/or cohort nursing of patients assessed to be at risk





TEAM Medical Ward 9 2070 2013 97% 782 1300 166% 1737 1656 95% 460 1357 295% December SCF agreed 2 additional HCA's per shift to reduce inpatient falls/harm


RN

Day Actual

RN %

Day Planned

HCA

Day Actual HCA %

Night Planned

RN

Night Actual

RN %

Night Planned

HCA

Night Actual HCA %


Women's Maternity Unit (PRU) 1403 1461 104% 1024 736 72% 1035 1035 100% 667 564 84%

There was a high sickness and maternity leave factor this month and senior staff worked with the department to ensure patient safety was not compromised as Kings Bank were unable to fill the shifts”


RN

Day Actual

RN %

Day Planned

HCA

Day Actual HCA %

Night Planned

RN

Night Actual

RN %

Night Planned

HCA

Night Actual HCA %


CCTD Intensive Care Unit 3209 3324 104% 345 276 80% 3209 3220 100% 357 253 71%

Small vacancy in establishment for HCA, now filled. Some shifts were not filled by NHSP which was escalated to Matron who helped to ensure that patient care was not compromised.

Enc. 2.3.2


Denmark Hill

Division Ward NameShift

pattern

Planned RN/RMW

Day

Actual RN/RMW

Day

% Average fill rate

RN - Day

Planned HCA/MSW

Day

Actual HCA/MSW

Day

% Average Fill rate HCA - Day

Planned RN/RMW

Night

Actual RN/RMW

Night

% Average fill rate

RN - Night

Planned HCA/MSW

Night

Actual HCA/MSW

Night

% Average Fill rate HCA - Night


Cardiac Coronary Care Unit (Sam Oram) 2 1035 1035 100% 311 357 115% 1035 1035 100% 46 150 325% The high HCA fill rate relates to specialling of at risk/confused patientsCardiac Cotton 2 1691 1668 99% 978 1369 140% 1415 1369 97% 437 886 203% The high HCA fill rate relates to specialling of at risk/confused patients

Cardiac Recovery Ward 2 1254 1185 95% 35 58 167% 1035 1035 100% 58 69 120%Difficulty closing CRU on a Saturday afternoon. HCA used to facilitate moves. Some specialling required in early April due to confusion.

Cardiac Victoria & Albert 2 1392 1426 102% 357 598 168% 1047 1035 99% 23 207 900% The high HCA fill rate relates to specialling of at risk/confused patients


pattern

Planned RN/RMW

Day

Actual RN/RMW

Day

% Average fill rate

RN - Day

Planned HCA/MSW

Day

Actual HCA/MSW

Day


Planned RN/RMW

Night

Actual RN/RMW

Night

% Average fill rate

RN - Night

Planned HCA/MSW

Night

Actual HCA/MSW

Night



Children's Frederick Still (Newborn Unit) 2 5003 5198 104% 0 334 2900% 5083 5244 103% 0 288 2500% Additional HCAs are the overseas nurses awaiting registrationChildren's Lion 2 1035 1001 97% 345 334 97% 1035 989 96% 0 46 400% Additional HCAs booked to make ward safe when RN shifts not filled

Children's Princess Elizabeth 2 1035 1058 102% 334 322 97% 1012 1012 100% 196 161 82%Managed without HCA for some shifts as Lion ward covered with PE and Lion working together

Children's Rays Of Sunshine 2 2415 2093 87% 357 230 65% 2082 1978 95% 345 230 67%Not enough HCA in post to cover all shifts. Rostered for busiest days in order to ensure patient care is not effected.

Children's Thomas Cook CCCC 2 3853 4301 112% 345 265 77% 3853 4221 110% 345 322 93% When HCA not available filled with RN as acuity very highChildren's Toni & Guy 2 1921 1725 90% 311 334 107% 1748 1518 87% 104 173 167% Overfill on HCA due to unavailability of bank reg child nurses


pattern

Planned RN/RMW

Day

Actual RN/RMW

Day

% Average fill rate

RN - Day

Planned HCA/MSW

Day

Actual HCA/MSW

Day


Planned RN/RMW

Night

Actual RN/RMW

Night

% Average fill rate

RN - Night

Planned HCA/MSW

Night

Actual HCA/MSW

Night



Haematology Davidson 2 1725 1673 97% 679 656 97% 1380 1334 97% 345 679 197%Increased use of HCA due to an increase in ward establishment and special to maintain patient safety.

Haematology Derek Mitchell Unit 2 1725 1783 103% 368 541 147% 1047 1058 101% 345 633 183%Increased use of HCA to support bedside care as patients required special.

Enc. 2.3.2



pattern

Planned RN/RMW

Day

Actual RN/RMW

Day

% Average fill rate

RN - Day

Planned HCA/MSW

Day

Actual HCA/MSW

Day


Planned RN/RMW

Night

Actual RN/RMW

Night

% Average fill rate

RN - Night

Planned HCA/MSW

Night

Actual HCA/MSW

Night



Liver and Renal Cheere Ward 2 1208 1024 85% 368 552 150% 771 725 94% 345 495 143%The increased use of HCA reflects the need for specials on both day and night shift.

Liver and Renal Fisk Ward 2 1426 1369 96% 575 817 142% 1380 1369 99% 414 805 194%The increased use of HCA reflects the need for specials on both day and night shift.

Liver and Renal Liver ICU 2 6130 6273 102% 138 0 8% 6210 6360 102% 138 0 8% 12 ONP nurses awaiting nmc reg hence not staffed for HCA.Liver and Renal Howard Ward 2 1219 1162 95% 564 978 173% 1047 1035 99% 380 713 188%Liver and Renal Todd 2 1955 1863 95% 1012 1081 107% 2254 1702 76% 702 794 113%


pattern

Planned RN/RMW

Day

Actual RN/RMW

Day

% Average fill rate

RN - Day

Planned HCA/MSW

Day

Actual HCA/MSW

Day


Planned RN/RMW

Night

Actual RN/RMW

Night

% Average fill rate

RN - Night

Planned HCA/MSW

Night

Actual HCA/MSW

Night



Neuro David Marsden 2 2093 1817 87% 897 1955 218% 2093 1783 85% 897 1863 208%

The increased use of HCA reflects the need for specials on both day and night shift. Also we currently cover the majority of our RN vacancies with HCA. Even short notice RN sickness we will cover with HCA if we feel the shift is safe. Also included in the HCA numbers are our ONP nurses. For the month of April this increased from 6 to 7.

Neuro Kinnier Wilson HDU 2 2070 2070 100% 345 414 120% 2070 2024 98% 150 230 154% ONP's awaiting registration who work as HCA Neuro Murray Falconer 2 2473 2404 97% 794 978 123% 2024 1921 95% 771 1093 142% ONP Nurses awaiting registration


pattern

Planned RN/RMW

Day

Actual RN/RMW

Day

% Average fill rate

RN - Day

Planned HCA/MSW

Day

Actual HCA/MSW

Day


Planned RN/RMW

Night

Actual RN/RMW

Night

% Average fill rate

RN - Night

Planned HCA/MSW

Night

Actual HCA/MSW

Night



Surgery Matthew Whiting 2 1944 1875 96% 1415 1633 115% 1380 1369 99% 690 1012 147%Working to establishment with additional HCA specials to care for dementia/confused patients at risk of falling

Enc. 2.3.2



pattern

Planned RN/RMW

Day

Actual RN/RMW

Day

% Average fill rate

RN - Day

Planned HCA/MSW

Day

Actual HCA/MSW

Day


Planned RN/RMW

Night

Actual RN/RMW

Night

% Average fill rate

RN - Night

Planned HCA/MSW

Night

Actual HCA/MSW

Night



TEAM Byron 3 2565 2175 85% 1350 1545 114% 1392 1380 99% 1035 1173 113%RN nursing numbers within safe level (1:6 RN / patient ratio); additional HCAs during day and night shifts to support bedside care

TEAM Donne 3 2475 2070 84% 1800 2490 138% 1426 1334 94% 1104 1645 149%

RN establishment working within safe nursing levels to meet patient needs (1:7 day; 1:8 night). Additional HCAs on day shifts to support bedside care. Additional HCA at night to support bedside care and addition 1:1 care (2 patients needed 1:1 supervision for an extended period to prevent risk of harm)

TEAM Lonsdale 3 2543 2213 87% 1350 1283 95% 1725 1380 80% 690 690 100%RN establishment working within safe nursing levels (1:5 day; 1:6 night). Decreased acuity (respiratory patients) compared to previous 2 months.

TEAM Mary Ray 3 2700 2265 84% 1350 1560 116% 1737 1518 87% 1035 1196 116%RN establishment working within safe nursing levels. Additional daily support by the Matron (not allocated within the nursing numbers)

TEAM Oliver 3 3150 2693 85% 900 1073 119% 2116 1691 80% 690 725 105%

RN establishment working within safe nursing levels to meet patient needs at night (1:6 ratio). Monitored daily by Ward Matron and Lead Matron for AMU.

TEAM R D Lawrence 3 3255 2723 84% 930 1125 121% 2197 1852 84% 713 794 111%

RN establishment working within safe nursing levels to meet patient needs at night (1:6 ratio). Monitored daily by Lead Matron for AMU who additional provides daily support for this AMU ward as Ward Matron.

TEAM Twining 3 2670 2160 81% 1350 1440 107% 1633 1369 84% 1012 1058 105% RN establishment within safe nursing levels (1:6 day; 1:7 night).

Enc. 2.3.2

FT Name:

Organisation Name:

1 & 2

3

4

5

6 Certification on training of Governors - in accordance with s151(5) of the Health and Social Care Act

Declaration 3 is included in the APR 2015/16 Final Financial Template, which is required to be returned to Monitor per communications on final operational plan submissions.

1) Copy this file to your Local Network or Computer.

2) Select the name of your organisation from the drop-down box at the top of this worksheet.

3) In the Certifications G6 worksheet, enter responses and information into the yellow data-entry cells as appropriate.

4) Once the data has been entered, add signatures to the document, as described below.

5) Use the Save File button at the top of this worksheet to save the file to your Network or Computer - note that the name of the saved file is set automatically - please do not change this name.

6) Copy the saved file to your outbox in your Monitor Portal.

Notes:

In the event than an NHS foundation trust is unable to fully self certify, it should NOT select 'Confirmed’ in the relevant box. It must provide commentary (using the

section provided at the end of this declaration) explaining the reasons for the absence of a full self certification and the action it proposes to take to address it.

Self-Certification Template

NHS Foundation Trusts are required to make the following declarations to Monitor:

Systems for compliance with licence conditions - in accordance with General condition 6 of the NHS provider licence

Availability of resources and accompanying statement - in accordance with Continuity of Services condition 7 of the NHS provider licence

Corporate Governance Statement - in accordance with the Risk Assessment Framework

Certification on AHSCs and governance - in accordance with Appendix E of the Risk Assessment Framework

Declarations 1 and 2 above are set out this template, which is required to be returned to Monitor by 29 May 2015.

Declarations 4, 5 and 6 above are set out in a separate template, which is required to be returned to Monitor by 30 June 2015.

Templates should be returned via the Trust portal, marked as a Trust Return with the activity type set to Annual Plan Review.

How to use this template

Monitor will accept either:

1) electronic signatures pasted into this worksheet (always use Paste-Special to do this) or

2) hand written signatures on a paper printout of this declaration posted to Monitor to arrive by the submission deadline.

Enc. 3.2

Worksheet "Certification G6"

1 & 2 General condition 6 - Systems for compliance with license conditions

1

2

Signed on behalf of the board of directors, and having regard to the views of the governors

Signature Signature

Name Name

Capacity [job title here] Capacity [job title here]

Date Date

A

B

Further explanatory information should be provided below where the Board has been unable to confirm declarations 1 or 2

above.

The board are required to respond "Confirmed" or "Not confirmed" to the following statements (please select 'not confirmed' if confirming

another option). Explanatory information should be provided where required.

Following a review for the purpose of paragraph 2(b) of licence condition G6, the Directors of the Licensee

are satisfied, as the case may be that, in the Financial Year most recently ended, the Licensee took all such

precautions as were necessary in order to comply with the conditions of the licence, any requirements

imposed on it under the NHS Acts and have had regard to the NHS Constitution.

AND

The board declares that the Licensee continues to meet the criteria for holding a licence.

Declarations required by General condition 6 of the NHS provider licence

Enc. 3.2

Enc. 4.1

1


Date of report: 26th May 2015

Subject: Chair’s and Non-Executive Directors’ Activity Report

Presented by: Lord Kerslake, Chairman

Status: For information

1. Background/ Purpose

This report details the activities undertaken by the Non-Executive Directors of the Board for the period from Monday 13 April to Friday 8 May 2015.

2. Action required The Board of Directors is asked to note the contents of this report.

Lord Kerslake - Chairman

Date Activity

14 April 1:1 with Faith Boardman, Non-Executive Director

Attended KCH Private Board Meeting

16 April Attended KCH Board Agenda Planning Meeting

27 April Carried out Graham Meek’s (Vice Chair) Appraisal

28 April

Chaired Remunerations Committee

Attended Audit Planning Meeting with Non-Executive Directors

Attended Finance & Performance Committee Meeting

Chaired KCH Private Board Meeting

Chaired Non Executive Directors’ Lunch Meeting

Chaired KCH Public Board Meeting

Enc. 4.1

2

29 April Attended Nominations Committee Agenda Planning Meeting

5 May Chaired Nominations Committee (recruitment of Non-Executive Director)

6 May Attended KHP Acute Chairs and Chief Executives Meeting

7 May Attended KCH Board Agenda Planning Meeting

Undertook interviews for recruitment to Non-Executive Director post

Graham Meek – Vice Chairman, Chair of Finance & Performance Committee

Date Activity

14 April


16 April Co-chaired KCH Long Service Awards

28 April

Attended KCH Remuneration & Appointments Committee Chaired KCH Finance & Performance Committee Attended KCH Private Board Meeting Attended Non Executive Directors’ Lunch Meeting Attended KCH Public Board Meeting

Chris Stooke – Chair of Audit and Board Integration Committees

Date Activity

14 April Attended KCH Private Board Meeting

15 April Met with Steve Leivers

Attended KCH Delivery Board Meeting

21 April Chaired KCH Charity Meeting

27 April

Chaired interview panel – Consultant Obstetrician and Gynaecologist

28 April Attended KCH Remunerations Committee

Enc. 4.1

3

Attended Audit Planning Meeting with Chair and Non-Executive Directors

Attended Finance & Performance Committee Meeting


Attended Non Executive Directors’ Lunch Meeting

Attended KCH Public Board Meeting

29 April Attended KCH Delivery Board Meeting

Chaired interview panel, Consultant Intensive Care

Attended NHS FT Audit Chairs Dinner

6 May Attended meeting with Simon Taylor and Deloitte

Attended meeting with PWC

7 May Conference call with KPMG Internal Auditors

Faith Boardman – Non-Executive Director Lead for Quality

Date Activity

13 April

Met with Chair Attended KCH Private Board Meeting Attended interview with CQC Attended KCH Quality & Governance Committee

16 April

Advised on Director of Workforce Development position Conference call with KCH Charity and advised on review

28 April

Attended KCH Remunerations Committee Attended KCH Finance & Performance Committee Attended KCH Private Board Meeting



Enc. 4.1

4

Met with CEO of KCH Charity

30 April

Conference call with KCH Charity

6 May

Advised on short-listing for Director of Workforce Development post

Sue Slipman – Chair of KCH Board Strategy Committee

Date Activity


15 April Attended KHP Annual Conference

22 April

Undertook 2 Go See Visits at Denmark Hill site Attended farewell event for Sir George Alberti

23 April Discussion with Trudi Kemp

28 April

Attended KCH Finance & Performance Committee Meeting Attended KCH Private Board Meeting



Professor Ghulam Mufti – Chair of Quality and Governance Committee

Date Activity


28 April

Attended KCH Finance & Performance Committee Meeting Attended KCH Private Board Meeting



Enc.

1

King’s College Hospital Board of Directors Finance & Performance Committee Minutes of the meeting of the Finance & Performance Committee held at 09:00 on Tuesday 31 March 2015 in the Trust Head Quarters, Board Room, Princess Royal University Hospital, Kings College Hospital NHS Foundation Trust

Present: Graham Meek (GM) Committee Chair/ Non-Executive Director

Prof Sir George Alberti (GA) Trust Chair/ Non-Executive Director

Sue Slipman (SS) Non-Executive Director

Chris Stooke (CS) Non-Executive Director

Angela Huxham (AH) Director of Workforce Development

Trudi Kemp (TK) Director of Strategic Development

Dr Michael Marrinan (MM) Medical Director

Dr Geraldine Walters (GW) Director of Nursing and Midwifery

Prof Ghulam Mufti (GM1) Non-Executive Director

Marc Meryon (MM1) Non-Executive Director

Faith Boardman (FB) Non-Executive Director

Roland Sinker (RS) Acting Chief Executive Officer

Simon Taylor (ST) Chief Financial Officer

Jane Walters (JW) Director of Corporate Affairs

Ahmad Toumadj (AT) Interim Director of Capital Estates and Facilities

Steve Leivers (SL1) Interim Director of Transformation and Turnaround

In attendance:

Lord Kerslake (BK) Shadow Trust Chair

Simon Dixon (SD) Director of Finance

James Pring (JP) PwC LLP (Item 2.1)

Quentin Cole (QC) PwC LLP (Item 2.1)

Brian Pomering (BP) PwC LLP ( Item 2.1)

Non Owen (NO) Corporate Governance Officer - minutes

Apologies:

Tim Smart (TS) Chief Executive Officer

Jeremy Tozer (JT) Interim Chief Operating Officer

Peter Fry (PF) Director of Operations

Kath Dean (KD) Operational Site Lead (PRUH)

Item Subject Action

15/27 Welcome & Apologies

Enc.

2

Item Subject Action

The apologies for absence were noted.

15/28 Declarations of Interest MM1 advised of his interest with BMI Healthcare.

15/29 Minutes of the Previous Meeting The minutes of the meeting held on 24 February 2015 were approved as a correct record subject to the following amendments: Page 2, Item 15/17, Minutes of the Previous Meeting, the second corrected item, item 15/11 should have been a correction to item 15/10 and be as follows: change “The forecast continues to April 2016 and indicates that if the predictions in starters and leavers remains on trajectory the Trust would benefit from cumulative bank and agency spend reduction of circa £17m” to “The forecast continues to April 2016 and indicates that if the predictions in starters and leavers remains on trajectory the Trust would benefit from cumulative bank and agency spend reduction of circa £17m and a saving to the Trust of circa £3m” Page 7, Item 15/23, Recruitment – Month 10, bullet 5 delete: “and it is key to have quality and reliable information”; and Page 7, Item 15/23, Recruitment – Month 10 – delete bullet 6

15/30 Actions Tracking/Matters Arising The action tracker was noted. Item 24022015 – 15/20 - Finance Report – Month 10– SD updated that the totals have been corrected in the Month 11 report and that there is a downward trend overall.

15/31 Finance and Sustainability Review Update – PwC James Pring (JP), Quentin Cole (QC) and Brian Pomering (BP) of PwC attended the Committee to provide a progress update and inform the Committee of actions which have been taken since the previous meeting. The Committee received the tabled recovery plan. The following key points were raised and noted: The Trust will be submitting 3 key plans over the coming months;

The one year plan will be aimed at expectations and developing a

document to build trust on the financial information being submitted;

The document will demonstrate good processes and provide credibility;

Monitor will be looking for information on cash, forecasting, working capital, cost improvement programmes (CIPs) and workforce in all of the plans which are submitted;

Enc.

3

Item Subject Action

More clarity is needed for Monitor to be informed on the numbers and finances of the Trust from the Princess Royal University Hospital (PRUH) site acquisition to date;

The plan will be scrutinised mainly in terms of quality, robustness, ambition and rigour of the plans rather than on strategic issues;

The one year plan will signpost the areas where the Trust will be making choices and will be crystallised in the two year plan;

The NHS financial climate has changed and there are a lot of other Trusts

in financial difficulty. Negotiation and firm discussions with Clinical Commissioning Groups (CCGs) is therefore key;

The one and two year plans will be viewed as to how they will link in with

the five year plan and how the strategies stretch and cross into five year planning;

One of the main areas of focus for the one year plan will be on improving

the financial situation of the Trust but this will not come over importance of quality;

In order for the Board to be clear on the internal savings which could be

made there will be a waterfall chart developed presenting choices for commissioners;

The more ambition and focus the Trust can place on the one year plan the

more credibility will develop and draw dialogue away from King’s and onto the system, where it needs to be;

The Committee were updated on the productivity improvements. Theatre

productivity remains more efficient since PwC introduced new processes and practices;

Improvements to the acute medical unit (AMU) and acute stroke unit

(ASU) are now being developed together with quality improvements in fractured neck of femur;

PwC will add capacity help improve estimated date of discharge (EDD)

flow in theatres at the Denmark Hill (DH) site;

There is work to be done in the system with regard to the discharge process and ability/capacity to move patients medically fit for discharge;

The Trust are working to link this in with social services and local councils;

The Committee noted the cash flow forecasting and that accuracy of this

has become better and more robust;

The cash “low point” is forecast to hit in June and timing is going to be very important to manage this and other measures which could be taken near this time;

Enc.

4

Item Subject Action

The Committee noted the CIP identification which SL1 is driving;

Every division has been issued with a target based on turnover as a percentage and are being supported in making plans;

Circa £28m of schemes have been identified and worked through but have

not been risk rated; Total CIP identification currently stands at circa £51m and whilst this is

good progress so soon into the project there is still a considerable way to go;

There needs to be an element of caution on the CIP amounts predicted.

Many of the schemes being looked at were identified in the initial business case;

There should be demonstration of capability and capacity to deliver; There has been a refreshed delivery structure with Thursday morning

divisional meetings. NEDs were encouraged by SL1 to attend these for their assurance;

A CIP delivery forecast is being developed currently; and

At the May Board of Directors meeting there will be much more clarity and

a higher degree of certainty on what can be achieved.

15/32 Finance Report – Month 11 ST presented a summary of the financial position at the end of month 11 (February). The Committee noted the month 11 financial report and the following key points: As the Trust approaches the end of the financial year it is clear that the

negative run rate has effectively not changed all year;

Core issues around this range from emergency department (ED) pressures, referral to treatment (RTT) target pressures and capacity pressures to temporary agency costs;

Coding of the operational targets is a key area where the Trust can make

improvements to ensure that there is a payment made on all qualifying activity;

Issues which have resulted in incorrect coding are lack of expertise

through to the inherited systems being incompatible and incorrect;

The recovery plan performance has also been patchy since its implementation back in summer 2014; and

Cash is the most pressing issue at the moment with the low point forecast

to hit in June.

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Item Subject Action

The Committee noted the draft report for Monitor and the following key points: The report covers explanatory information of why the Trust is in the current

position, providing context of the acquisition and why the Trust has not been able to implement the full business case (FBC);

There were a range of pathway issues, quality concerns and lacking services at the Princess Royal University Hospital (PRUH) site on acquisition and the Trust is now at a stage where decisions on either being paid for these or stopping them, are being considered;

There should be a developed matrix of options for key areas of importance

for both the Trust and commissioners to inform discussions and decisions; and

RS would explore the point raised with regard to diabetic care and

the possible expansion of this to the Croydon area; The Committee noted the proposed management and governance report and the following key points: There is a 3 tier management structure comprised of a monthly

programme board which holds divisions to account, a delivery board at divisional management level to drive the structure and then the Thursday morning meetings at divisional levels;

There is additionally a lot of work continuing outside of this governance structure;

All of the Cost Improvement Programmes (CIPs) will be approved by

divisional managers and if the risk score of any scheme is over 15 it will require approval from MM or GW;

There are circa 800-1000 CIP schemes in consideration for the Trust;

Whilst this seems like an ambitious target, it is more so as this is the

beginning of the process which will in time become a culture;

The correct focus and resources are required for this and at all times the quality of care should be at the forefront of activity; and

The Committee noted that whilst discussing the required focus on CIPs,

the Board is very aware of all of the hard work which is ongoing from Trust staff on a daily basis in spite of the challenges they are faced with.

15/33 Treasury Management Report – Month 11 The Committee noted the Treasury Management report for month 11 (February).

15/34 Performance Reports – Month 11 RS presented summaries of the month 11 (February) performance at the Denmark Hill (DH) and Princess Royal University Hospital (PRUH) sites.

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Item Subject Action

The Committee noted the reports and the following key points: Denmark Hill (DH) site Strong areas of performance at the DH site are cancer waiting times and

“how are we doing” (HRWD) patient experience surveys;

There are continued levels of high attendance in the emergency department (ED) with high acuity and mental health illness attendance;

The “one version of the truth” piece which will be implemented at the

Princess Royal University Hospital (PRUH) site will be mirrored at the DH site but will be an in house exercise; and

The Committee noted the specific performance reports for:

o ED Action Plan Update; o RTT Action Plan Update; o Infection Control Update; and o Key Areas of Concern.

Princess Royal University Hospital (PRUH) site There have been some notable areas of improvement and development to

report for the PRUH site including the reduction in level of complaints and improved response times, improved stroke service and better pathways have been developed;

Obstetric improvements to nursing and consultancy culture was noted;

A number of other areas of improvements were noted from the executive

summary;

Emergency department (ED) performance has improved but is a long way from where it needs to be and there are a lot of patients who are fit for discharge;

Further to attempts to try and improve ED performance processes in

“business as usual” there will now be a full review of in and out of hospital care;

The “one version of the truth” piece will be funded by Bromley Clinical

Commissioning Group (CCG) and Mckinsey will conduct a 4 to 6 week diagnostic;

Referral to treatment (RTT) remains a key area of focus for the Trust and

the backlog stands at circa 1400 patients;

Following review there is circa 8% of elective activity offsite or out of hours and there needs to now be a sourced long term sustainable solution;

Medical records for the PRUH site are improving but are an area of

continuing concern;

Cancer targets were almost all achieved in quarter 3 at the PRUH site but have since fallen;

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Item Subject Action

Clostridium difficile targets have not been met;

Diagnostic waits are linked to capacity issues and there should be strong communication with commissioners regarding payments which are required; and

The Committee noted the specific performance reports for:

o ED Action Plan; o RTT Action Plan; o Cancer Action Plan; o HCAI Action Plan; o Medical Records Action Plan; and o Key Areas of Concern.

It was agreed that: An analysis of where the delays with ED discharge are occurring and

this would be brought back to a future meeting; and The Committee approved a 6-month reporting holiday in its

submission of 18-week referral to treatment (RTT) performance indicators via Unify to the Department of Health following the patient information management service (PiMS) implementation so that patient lists can be cleansed.

RS/JT/ SC

15/35 Health Records The Committee noted the health records report. The following key points were noted: An earlier version of this report has appeared at the Quality and

Governance Committee;

The South London Healthcare Trust (SLHT) disbandment created an inherited challenge at the Princess Royal University Hospital (PRUH) site in terms of patient records;

The implementation of the patient information management system (PiMS)

added pressure to an already fragile position and led to a required substantive review of the records and focus on patient safety;

During the review there was no evidence of patient harm although the

Trust acknowledges that there is no solid way of quantifying this;

There has subsequently been a lot of work to improve the record availability which is still under review; and

The progress and any issues are being tracked in a weekly steering group.

15/36 Recruitment Update

The Committee noted vacancy update and improving recruitment reports. The following key points were raised and noted:

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Item Subject Action

PwC have been working with the workforce directorate to improve recruitment and ensure that local managers across divisions have clear understanding on vacancies;

There are significant differences between the actual staff in post and the trail balance and the commitment to the financial trial balance and managers reporting effectively must be sustained;

There is now a King’s recruitment managed service which must be engaged with by divisions;

Areas of improvement include reduction in time to hire and quicker safer

employment checks being conducted;

Moving forward the workforce directorate are now requesting approval for a further £130k for the 15/16 financial year to continue with the service delivery and embed this in the Trust;

Vacancy rates by staff group will be investigated to establish trends and

issues and provide a focus and target; and

The progress made over the last 6 months with recruitment and in the face of a national shortage of nursing staff has been very positive.

15/37 Monitor Monthly Report The Committee noted the Monitor month 11 (February) report.

15/38 Any Other Business There were no additional items raised for discussion.

15/39 Date of next meeting

Tuesday 28 April 2015, 10:00-12:00 in the Dulwich Committee Room, Denmark Hill

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