board of directors...– part 1. topic lead time 1. opening and apologies for absence graham sims -...

Board of Directors Wednesday 30 January 2019, 9.30 – 11.35 Seminar Room, Trust Education Centre, Royal Berkshire Hospital We provide a comprehensive service, based on clinical need, not an individual’s ability to pay. We aspire to the highest standards of excellence and professionalism and to put patients at the heart of everything we do. We are accountable to the public, communities and patients that we serve.

Board Meeting – Part 1 Topic Lead Time 1. Opening and Apologies for Absence

Graham Sims

-

2. Staff Story*

Caroline Ainslie 9.30

3. Patient Story*

Caroline Ainslie 9.40

4. Minutes of 28 November 2018 and Outstanding Actions Schedule and Declarations of Interest

Graham Sims 9.50

Executive Team Performance update 5. a) Chief Executive’s Report

b) Integrated Performance Report c) Integrated Care System Update

Steve McManus Lindsey Barker Andrew Statham

9.55 10.05

Minutes of Board Committee Meetings and Committee updates 6. a) Finance & Investment Committee 19 November

2018, 19 December 2018, 21 January 2019* b) Quality Committee 4 December 2018 c) Audit & Risk Committee 16 January 2019 d) Charity Committee 18 December 2018, 23 January

2019*

Sue Hunt Julian Dixon John Petitt Graham Sims

11.05

7. Board Work Plan

Caroline Lynch -

8. Date of Next Meeting and Close Wednesday 27 March 2019 9.30 -13.00

Graham Sims 11.20

Agenda

* verbal

‘Working together to provide outstanding care for our community’ Our Values: Compassionate | Aspirational | Resourceful | Excellent

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Agenda Item 4

Board Wednesday 28 November 2018 9.30 – 13.30 Boardroom, Level 4, Royal Berkshire Hospital Members Present Mr. Graham Sims (Chair) Mr. Steve McManus (Chief Executive) Ms. Caroline Ainslie (Director of Nursing) Mr. Craig Anderson (Director of Finance) Dr. Lindsey Barker (Medical Director) Mr. Julian Dixon (Non-Executive Director) Mr. Brian Hendon (Non-Executive Director) Mrs. Sue Hunt (Non-Executive Director) Dr. Alison Hill (Non-Executive Director) Mr. John Petitt (Non-Executive Director) Ms. Mary Sherry (Chief Operating Officer and Deputy Chief Executive) In attendance Mrs. Heather Allen (Director of IM&T) (for minutes 156/18 and 157/18) Mr. Don Fairley (Director of Workforce) Mrs. Caroline Lynch (Trust Secretary) Mrs. Victoria Parker (Director of Communications & Engagement) Mr. Andrew Statham (Director of Strategy) Apologies There were five governors, one member of staff and one member of the public present. The meeting commenced with a patient story. The Medical Director read a letter from a patient, who, following an appointment at Bracknell Healthspace, had been referred to the Trust for further investigation. The patient was found to have a bladder tumour and options for his treatment had been discussed with his consultant. The patient highlighted that he had also joined the bladder cancer support group and had found this to be a great help. The patient had walked to theatre accompanied by his consultant which he found comforting. Following surgery, the patient had been admitted to the Intensive Care Unit followed by six days on Hopkins Ward. The patient highlighted that overall care had been excellent. The patient highlighted that once he had been discharged he had found little community support available. The patient would be undertaking annual CT scans and highlighted that communications from the Trust were sometimes slow and he recommended faster feedback for patients. The Director of Nursing introduced the team from Hopkins Ward and explained that, following a rigorous process including ward visits and review of portfolio evidence, Hopkins Ward had successfully achieved their ward accreditation. The Director of Nursing highlighted that a week after the accreditation process, local commissioners had carried out a quality assurance visit to Hopkins Ward. Commissioners had highlighted the excellent leadership of the ward and stated

Minutes

Minutes of the Board – 28 November 2018 1

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that all the team felt comfortable raising any issues. The ward team shared good practice and staff were engaged in audit and research. The Director of Nursing advised that three years ago the ward had a vacancy rate of 50% and the team had worked hard to recruit and retain staff. Currently the ward had only one vacancy. The Director of Nursing highlighted that a buddy system to link accredited wards with other wards was in place. The Board congratulated the team. 145/18 Minutes: 26 September 2018 and Matters Arising Schedule The minutes of the meeting held on 26 September 2018 were approved as a correct record

and signed by the Chair.

There were no declarations of interest. The matters arising schedule was noted. Minute 117/18 (91/18): Minutes 30 May 2018 and Matters Arising Schedule: Integrated Performance Report: The Director of Finance advised that the Health & Safety update had been deferred to the January meeting in order to incorporate feedback from the internal audit review. Action: C Anderson

146/18 Chief Executive’s Report The Chief Executive introduced the report and highlighted that the second cohort of 33 staff

had started the Applied Management & Leadership Programme at Henley Business School. The first cohort had also completed their first year of the programme and was due to start the second year. Staff undertaking the programme were from a range of multi-professional groups across the organisation. The Board noted that business and financial management formed part of this programme. The Director of Workforce confirmed that assignments were work based and in Year 3 of the programme staff would need to undertake a major project and work was on-going to link these projects with the Transformation Strategy.

The Chief Executive advised that the Trust had recently received the Armed Forces

Covenant Silver Award for employer recognition and the support provided to our reservists. The Board noted that the Behaviours Framework had been launched during September 2018 and 50 to 60 events had been held including team facilitated discussions with support from the Organisational Development team.

The Chief Executive advised that the digital ‘go-live’ implementation had been completed in

mid-October with the Chief Operating Officer as Senior Responsible Officer (SRO) for this. The implementation had been a success with good engagement from operational, IT and clinical teams. There had been some challenges in relation to the Emergency Department (ED) but these were being worked through with the team.

The Chief Executive highlighted that 10 new graduates from the Physicians Associate

programme had just been recruited. These roles supported on-going work in relation to workforce transformation. The Chief Executive advised that his ‘back to the floor’ visits continued and, as part of these visits, he had seen both administrative and clinical teams embracing and enthusiastic in relation to the digital programme which presented a major change for their areas of work.

The Chief Executive advised that the dermatology service had been significantly challenged

in relation to consultant staffing. This was also an issue nationally. Work with the team


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was on-going in relation to service access and safe care and it had been agreed with local commissioners and GP Alliances that the Trust would limit referrals to urgent cases only. The Board noted that a system review of the dermatology service across Berkshire West was due to be completed by the end of the financial year.

The Chief Executive highlighted that the Trust continued to support the Project SEARCH

programme and ten young adults with a range of learning disabilities had joined the Trust in September 2018. The Board noted that number of areas within the Trust where students were placed had been increased.

147/18 Integrated Performance Report (IPR) The Chief Operating Officer introduced the report and advised that three avoidable

pressure ulcers had been reported in October and investigations were on-going in relation to these. It was considered that high use of temporary staff, bed capacity issues and the Digital ‘go-live’ had impacted on this area of performance. The Tissue Viability team had provided targeted training. However, there had been no Grade 3 or Grade 3 Pressure ulcers during November.

The Chief Operating Officer advised that, despite immediate action taken in relation to a

Never Event in October 2018, there had been a second Never Event of a similar nature that had taken place during a night shift. This related to ‘unintentional connection to an airflow meter instead of oxygen flow meter’. It was considered that the messaging from the first Never Event had not reached staff in a timely way due to the closeness of the two incidents. The Board noted that short term actions included the purchase of nebulizer boxes prior to piped air being capped in ward areas. The Director of Nursing advised that medical air was normally found in the Intensive Care Unit (ICU) and respiratory wards. However, there were a number of wards with medical air and these were clearly marked. All flow meters would be removed in due course from ward areas. The Director of Nursing advised that the Never Event list had increased earlier in 2018 to include ‘unintentional connection to airflow meter instead of oxygen flow meter’. Never Events would be discussed in detail at the next Quality Committee. Action: C Ainslie

The Chief Operating Officer advised that mortality rates were as expected. However, there

had been one possible avoidable death that related to a patient who experienced a delay in transfer to a tertiary centre for acute coronary intervention. The Chief Operating Officer advised that fractured neck of femur performance continued to present a challenge and a detailed review on this topic had been scheduled for the next Quality Committee.

Action: M Sherry The Board noted that there had been a birth increase in the month and the maternity unit

had diverted patients on three occasions during October 2018. This area of performance had been discussed by the Executive Management Committee as there had been diversions yet there had been an improvement in the staff ratio. It was considered that this was as a result of the flow of patients and there had been some staff sickness in the unit.

The Chief Operating Officer advised that there had been an improvement in cancer

performance and it was anticipated that the 62 day standard would be achieved for Quarter 2. The Board noted that ED performance had deteriorated during September and October and this had continued into November. Digital ‘go-live’ had been a contributory factor and particular issues for the ED system had been made a high priority following ‘go-live’. The Chief Operating Officer highlighted the workforce indicators and advised that appraisal rates and mandatory training compliance had also been affected by the digital ‘go-live’.


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The Director of Finance advised that there had been six Reporting of Injuries, Diseases and

Dangerous Occurrences Regulations (RIDDORs) during October 2018. These related to exposure to fluid and injuries to employees. A review would be undertaken as a result of this increase in RIDDORs. Action: C Anderson

The Chief Operating Officer advised that the Trust did not achieve its forecast or budget for

October 2018. The overall position was £0.08m behind forecast and £1.08m behind budget. PSF monies had not been accrued for ED performance. Care Groups were £0.86m behind budget. Cash was strong at £31.1m. The Director of Finance highlighted the increased risk to deliver the financial control total. Mitigating actions were being reviewed and the Trust’s financial position had been formally recorded with NHS Improvement (NHSI). The Board noted that NHSI could request a formal forecast from the Trust. The Board noted that an additional Finance & Investment Committee had been scheduled for December 2018 to discuss the financial position. The Chief Executive confirmed that the Trust’s financial position had been discussed with both finance directors and accountable officers within the Integrated Care System (ICS).

The Board queried whether lack of GP availability had impacted on ED performance. The

Chief Operating Officer considered that this was not an issue as there was a robust Westcall service that supported the GP streaming facility. The Chief Operating Officer advised that there had been discussion at the A&E Delivery Board in relation to the national requirement for the 7 day service as a number of patients had not taken up the option of a Sunday service. Therefore, this was being kept under close review. The Chief Operating Officer advised that staffing in ED presented a challenge as per other areas of the Trust. There were significant nursing vacancies and a number of staff were retiring. The Medical Director confirmed that Physician Associates had been placed in ED. The Chief Executive advised that ED would be an area of focus in relation to workforce transformation. The Board discussed whether the ED trajectory would be achieved over the Winter period and noted the challenge in relation to high number of attendances. The Chief Executive highlighted that colleagues within the Sustainability Transformation Plan (STP) had also reported a percentage increase in ED attendances in line with that seen by the Trust.

The Board discussed cancer performance in relation to 104 day waits. The Chief

Operating Officer advised that this was a standard national key performance indicator (KPI) and these patients were reviewed on a monthly basis. A number of these related to tertiary referral and the Trust’s performance was in line with other trusts. This related to the complexity of patients on this particular pathway. The Medical Director confirmed that these patients were scrutinised in detail and no patient harm had occurred. However, the number of cancer patients was increasing as well as their complexity. This area would be reviewed further by the Medical Director and Chief Operating Officer.

Action: M Sherry/L Barker 148/18 Integrated Care System (ICS) Update The Director of Strategy introduced the report and highlighted that final arrangements for

the commencement of the 7 day Primary Care model had been finalised during Quarter 2. An ICS communication and engagement plan had been developed and a public engagement event was scheduled for early December 2018.

The Director of Strategy drew attention to the ICS delivery report and highlighted that the

ICS had discussed the need to focus and prioritise work programmes. Discussions were


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currently on-going in relation to reducing areas of focus to those areas where material difference could be achieved and finances presented a challenge at system level. The Director of Finance advised that a meeting was planned to explore whether shared services was an area of future focus. However, if it transpired that this would not be progressed at ICS level, the Trust could look to progress this independently.

149/18 Winter Plan The Chief Operating Officer introduced the Winter Plan and advised that some dates within

the plan were subject to amendment. The final draft would be published on 1 December 2018. The Board noted that, as part of the Winter funding, 16 beds would be made available for use by 24 December 2018. The Chief Operating Officer highlighted that, as part of the Winter Plan, Redlands Ward would be used for emergency patients for a three week period in January 2019. Redlands had been used in the previous year but this had been at short notice. As part of the learning from the previous year the use of Redlands had now been incorporated in the Winter Plan. The Board noted that the Winter Plan had been developed with various teams and a launch event was planned.

It was agreed that a copy of the final Winter Plan would be circulated to the Board. Action: M Sherry 150/18 Finance Strategy and Estates Strategy The Director of Finance introduced the Finance and Estates strategies and highlighted that

work was on-going in relation to the Long Term Financial Model (LTFM). The Director of Finance highlighted the link between the LFTM and the Transformation strategy. The Board discussed the investment required as set out in the supporting strategies. The Director of Strategy advised that work was on-going with Care Groups and corporate departments in relation to the Operating Plan 2019/20.

It was agreed that there would be a soft launch in relation to the development of the

supporting strategies. Action: V Parker/A Statham 151/18 Corporate Risk Register (CRR) The Director of Nursing introduced the Corporate Risk Register (CRR) and advised that this

had been recently reviewed by the Audit & Risk Committee. The Director of Nursing highlighted that the two risks related to ED had been maintained as separate entries on the CRR and the Audit & Risk Committee had approved this decision. The Board noted that the cancer performance and finance risk scores would be reviewed as part of the next review cycle.

152/18 Standing Orders The Trust Secretary introduced the Standing Orders that were due for review as part of the

annual cycle. The Standing Orders had been reviewed by the Audit & Risk Committee. The Board considered that a role description for the Senior Independent Director should be

included in the document as well as reference to the Trust’s other sites. Subject to these amendments, the Board approved the Standing Orders. Action: C Lynch


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153/18 Minutes of Board Committee Meetings The Board received the minutes of the Finance & Investment Committee held on 17

September and 22 October 2018 and the Quality Committee held on 9 October 2018.

The Board received the minutes of the Workforce Committee held on 29 October 2018. The Chair of the Workforce Committee highlighted that the Committee had reviewed the skill mix review in detail and recommendations from this review would be considered as part of the budget setting process. The Committee had noted the reduction in appraisal and mandatory training due to ‘go-live’. The Board received the minutes of the Audit & Risk Committee held on 19 September and 8 November 2018. The Chair of the Audit & Risk Committee highlighted that the Committee had received a detailed update on ‘go-live’ at both meetings.

154/18 Information Item: Board Work Plan The Board received the work plan. The Trust Secretary highlighted that a full year work

plan would be submitted to the January meeting. Action: C Lynch

155/18 Date of Next Meeting

It was agreed that the next meeting would be held at 9.30am on Wednesday 30 January 2019. The Chair highlighted that all meetings scheduled for 2019 would be held in the Seminar Room at the Trust Education Centre.

Chairman Date


Board Schedule of Matters Arising and Outstanding Actions Agenda Item 4

Board Date Board Minute

Subject Decision Owner Expected Submission

Update

28 November 2018

145/18 (117/18 (91/18)

Minutes: 26 September 2018 and Matters Arising Schedule: Minute: Minutes 30 May 2018 and Matters Arising Schedule: Integrated Performance Report:

The Director of Finance advised that the Health & Safety update had been deferred to the January meeting in order to incorporate feedback from the internal audit review.

C Anderson Completed. Update provided to January Audit & Risk Committee.

28 November 2018

147/18 Integrated Performance Report (IPR)

Never Events would be discussed in detail at the next Quality Committee. The Chief Operating Officer advised that fractured neck of femur performance continued to present a challenge and a detailed review on this topic had been scheduled for the next Quality Committee. A review would be undertaken as a result of this increase in RIDDORs. The Board discussed cancer performance in relation to 104 day waits. The Medical Director confirmed that these patients were scrutinised in detail and no patient harm had occurred. However, the number of cancer patients was increasing as well as their complexity. This

C Ainslie M Sherry C Anderson M Sherry / L Barker

Completed. Completed. Completed. No discernable pattern to RIDDORs but concern about the time delay that sometimes exists between incident and reporting to be followed up on. Completed.

January 2019

Board Schedule of Matters Arising and Outstanding Actions Agenda Item 4

area would be reviewed further by the Medical Director and Chief Operating Officer.

28 November 2018

149/18 Winter Plan It was agreed that a copy of the final Winter Plan would be circulated to the Board.

M Sherry There were no material changes made to the version presented to the Board in December. The final version has been published on the Trust intranet.

28 November 2018

150/18 Finance Strategy and Estates Strategy

It was agreed that there would be a soft launch in relation to the development of the supporting strategies.

V Parker / A Statham

The Director of Communications and Engagement will be meeting with the leads of the supporting strategies to discuss a robust engagement and communication plan. An update will also be provided at the March Team Brief.

28 November 2018

152/18 Standing Orders The Board considered that a role description for the Senior Independent Director should be included in the document as well as reference to the Trust’s other sites. Subject to these amendments, the Board approved the Standing Orders.

C Lynch Completed. The Standing Orders have been updated to include a role description for the Senior Independent Director and a reference to the other Trust’s sites.

28 November 2018

154/18 Information Item: Board Work Plan

The Trust Secretary highlighted that a full year work plan would be submitted to the January meeting.

C Lynch Item on the agenda.

January 2019

Title: Chief Executive’s Report Agenda item no: 5a Meeting: Board of Directors Date: 30 January 2019 Presented by: Steve McManus, Chief Executive Prepared by: Caroline Lynch, Trust Secretary Purpose of the Report • To update the Board with an overview of key issues since the

previous Board meeting. • To update the Board with an overview of key national and local

strategic environment and planning developments • This includes items that may impact on policy, quality and financial

risks to the Trust.

Report History None

What action is required?

For information and discussion: the Board is asked to note the report.

Assurance Information Discussion/input Decision/approval

Resource Impact: None Relationship to Risk in BAF:

Strategic objectives This report impacts on (tick all that apply):: Provide the highest quality care Invest in our staff and live out our values Drive the development of integrated services Cultivate innovation and transformation Achieve long-term financial sustainability Well Led Framework applicability: Not applicable

1. Leadership 2. Vision & Strategy 3. Culture 4. Governance

5. Risks, Issues & Performance

6. Information Management

7. Engagement 8. Learning & Innovation

Publication Published on website Confidentiality (FoI): Private Public

1

Key Issues 1. Provide the Highest Quality Care 1.1 Over the last two months I have continued to meet a variety of teams during my ‘back to the floor’

sessions. In November I spent time with colleagues in the Ambulatory Emergency Care Unit (AECU) that celebrated their one year anniversary. The unit is staffed by a highly skilled and dedicated team of advanced nurse practitioners that work in partnership with the Acute Medicine and Emergency Medicine consultants. The team also support early discharges from the Acute Medical Unit and Short Stay Unit that allows patients to transition safely from an acute episode of ill health back to their own home.

1.2 I also spent some time with the Head and Neck team during November. It was impressive to see the staff and colleagues from local trusts holding a video conference at the MDT meeting. This enabled the team to discuss the complex history, diagnosis and treatment of our head and neck patients in order to provide them with the best possible advice and support regarding their clinical care.

1.3 I spent time with the Care Crew who are a dedicated team of Health Care Assistants. The Care Crew specialise in engaging patients across our elderly care wards as well as other areas, in group activities to encourage socialising and mental stimulation to break up the day and reduce the anxiety and uncertainty of being in hospital.

1.4 Ahead of Winter, our Chief Operating Officer, has chaired the Berkshire West Accident &

Emergency Delivery Board to ensure robust planning for this period. The collaborative work across community and mental health, social care, voluntary sector and the Trust has been really positive ensuring that the system as a whole was extremely well prepared. As part of this our teams within the Trust (clinical, operational, estates) were also able to deliver the additional bed capacity as part of our Winter Plan both on time and on budget. Our staff continued to work extremely hard to ensure that we are providing a safe and effective service to our community who required urgent and emergency care.

2. Invest in our staff and live out our values

2.1 The winner of the November StarCard was the Resuscitation and Clinical Skills team. The team were nominated for innovative and flexible approach in how they adapt their approach to training that meets the needs of staff in their working environment. The team also helped support and develop clinical champions when aseptic non-touch technique was introduced in the Trust. The courses facilitated by the team are also in great demand from external agencies.

2.2 The winner of the December StarCard was Michelle Doyle who works in the Radiotherapy service. Michelle was nominated for the November award for her compassion to patients that attend the service. Colleagues highlighted that Michelle takes away some of the uncertainty for new people attending the department and is a constant friendly face for patients that regularly attend.

2.3 We launched our Staff Excellence Awards in January 2019. These awards provide an opportunity

for the Trust to recognise and reward staff who not only deliver first class care but also demonstrate the Trust values. Our Staff Excellence Awards ceremony will be held on 23 May 2019.

2.4 2019 marks the 180th anniversary of the Royal Berkshire Hospital that opened its doors to the

community of Reading and Berkshire on 27 May 1839. In collaboration with the Royal Berks Charity a series of celebratory events will be held over the course of the year.

2.5 Jacobs the Jewellers committed to raise £70,000 for our Berkshire Cancer Centre as part of celebrating their 70th Anniversary and the NHS turning 70. The final total raised was £93,588.94.

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I would like to thank Adam Jacobs and all of his team for their efforts in raising this amazing amount of money for cancer services in Berkshire.

3. Drive the Development of Integrated Service

3.1 The Minister of State for Health visited Townlands Hospital in November 2018. The services provided at Townlands Hospital are an excellent example of where integrated, multi-disciplinary care is working well with 27 different clinical specialties now operating from that location.

3.2 The Berkshire West Integrated Care System (ICS) in collaboration with NHS England welcomed over 70 delegates to a public engagement workshop. The event brought together a range of local partners to review public involvement across the region. Attendees were provided with an overview of work that had taken place to date and discussed a number of ideas to create further opportunities for public involvement around shaping health and care services through 2019.

3.3 Our Safeguarding team hosted a ‘Join the Dots’ safeguarding conference that was held at the University of Reading in November 2018. Representatives from local voluntary services, police, social care and Clinical Commissioning Groups attended the event. It was a fantastic opportunity for staff to increase their knowledge as safeguarding champions and improve joint working to ensure patients receive the best possible care and outcomes.

4. Cultivate Innovation and Transformation

4.1 Colleagues from across the Trust hosted a Healthcare Science day in November 2018 that provided an opportunity for our healthcare scientists to showcase their work and share the achievements of their department. The event highlighted one of the Trust strategic objectives around cultivating innovation and transformation. Colleagues also had the opportunity to network, exchange service improvement ideas and explore avenues for research.

4.2 Our Urology team have recently been awarded the prestigious title of 'European Centre of Excellence for Robotic Surgery', by the European Association of Urology (EAU). Our training fellowship we offer in this field now has official EAU accreditation and will now be advertised internationally. There are only 27 other recognised EAU robotic centres of excellence across Europe.

4.3 The first wave of the innovation fund from the Joint Academic Board between the University of Reading and the Trust was awarded to 8 projects totalling £115,000. There were strong applications for 29 projects. The bids will be run twice a year and the next is planned in spring 2019.

4.4 The Trust and the University of Reading launched the academic department accreditation process in December 2018. This forms part of the on-going collaboration between both organisations in order to support and encourage academic excellence. Accreditation requires departments to demonstrate excellence in clinical outcomes, research and education with the ultimate aim of achieving outstanding patient care.

5. Achieve Long-Term Financial Sustainability

5.1 The 10 year Long Term Plan was launched in January 2019. Key areas of focus include,

improving care in the community, reducing pressure on emergency hospital services, becoming a digital NHS and focussing on health and local partnerships through the ICS.

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6. Brexit

6.1 The Trust received the EU Exit Operational Readiness Guidance (Department of Health and

Social Care (DHSC), which was developed and agreed with NHS England and Improvement, in December 2018. The document advises on the action the health care system in England should take to prepare for a ‘no deal’ scenario. Information has been sent in parallel to local authorities and adult social care providers to address specific adult social care issues.

6.2 The DHSC guidance focuses on seven areas of activity in the heath and care system in the event

of a ‘no deal’ Brexit. These are supply of medicines and vaccines; supply of medical devices and clinical consumables; workforce; reciprocal healthcare; research and clinical trials; and data sharing, processing and access.

6.3 The Trust continues to undertake its own self-assessment in line with the seven themes identified

above to ensure we are best placed to provide continuity of care to our community.

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Title: Integrated Performance Report Agenda item no: 5b Meeting: Board of Directors Date: 30 January 2019 Presented by: Lindsey Barker, Medical Director Prepared by: Performance Team Purpose of the Report The purpose of this paper is to provide the Board of Directors with an

analysis of quality performance to the end of December 2018.

Report History None

What action is required? The Board is asked to note the report.


Resource Impact: None

Relationship to Risk in BAF:







January 2019

Integrated Performance Report

The purpose of this paper is to provide the Board of Directors with an analysis of quality performance to the end of December 2018. The report covers performance against the NHS Improvement (NHSI) Risk Assessment Framework as well as national and local key performance indicators. Contact: Caroline Ainslie, Director of Nursing Lindsey Barker, Medical Director Mary Sherry, Chief Operating Officer Don Fairley, Director of Workforce Craig Anderson, Director of Finance

Contents

Integrated Performance Report Page 2

Introduction Page 3NHSI Compliance Page 4Summary Page 51. Patient Safety Page 6Harm Free Care Page 6Incidents Reporting Page 72. Patient Experience Page 103. Clinical Effectiveness Page 12Mortality Page 12Clinical Outcomes 4. Access Page 19Elective Waiting Times Page 19Emergency Waiting Times Page 22Admitted Patient Experience Page 26Theatres Patient Experience Page 27Outpatient Experience Page 285. Workforce Page 306. Staffing Data Page 317. Health and Safety Indicators Page 338. Finance Page 35

The purpose of this report is to provide assurance to the Board of Directors on compliance against the NHSI Risk Assessment Framework, national and local key performance indicators. It acknowledges significant and notable achievements, and highlights and discusses areas of concern or where performance has a less than favourable forecast.

Introduction


NHSI Compliance (Access)


CQC - Excellence CARE - Excellent

Accident & Emergency (A&E) o Performance against the A&E 4 hour standard in December reported at 86.1% combined (83.2% Type 1 only).

o Our December position is above our Provider Sustainability Fund (PSF) in month target. However does not recover the quarter.

o The Q3 PSF requirement at RBH level has ‘not achieved’. However at both Delivery Board and Footprint the expectations have been met.

o We continue to have a strong focus on breach management and improved bed capacity/flow.

o The key focus for the Trust remains on service improvement across the whole pathway to secure sustainable performance and improved patient experience. This includes measures to strengthen winter performance.

o Performance at the beginning of Q4 is above PSF expectations and significantly better than the same period last year.

Cancer Waiting Times o The Trust has achieved compliance against all core cancer access standards (November reporting).

o We will continue to work closely with local commissioners, NHS Improvement and the Thames Valley Cancer Network in relation to 62 day standard sustainability.

18 Weeks Referral To Treatment (RTT) o The Trust remains compliant against the RTT 92% standard for December 2018.

December 2018 Summary



23/01/2019 Page 5

Provide the highest quality care

• Friends and Family and Inpatient Survey: We continue to perform well against the Friends and Family test and Inpatient Survey. • CRAB Mortality and Morbidity Metrics now live. The Trust is within normal or better than expected ranges across medical and surgical mortality and morbidity. • Our diagnostic waiting times have deteriorated as a result of an equipment failure and our teams are working hard to recover the position. • Most Safety and Patient Experience metrics continue to perform well and show a stable trend. • The 62 Day Cancer access standard remains compliant in the November reporting. • Areas of on-going concern:

o A&E Access: Performance through December has deteriorated. However is above our trajectory (in month). Work to rapidly improve the position is underway as an immediate priority with January showing an improved position at the time of writing.

o A sixth Never Event has been reported in December. A number of immediate actions to prevent reoccurrence have taken place.

Invest in our staff and live out our values • Appraisal rates remain an area with a need for significant improvement. However have improved in December. • The Trust has recently launched its behaviour framework, supporting staff to live out our values. This shows staff that we are listening to what they are telling us and acting on

what’s important to them.

Drive the development of integrated services

• As part of the Trust Winter Plan we have been operating a ‘Silent Winter’ (minimal phone calls) in collaboration with our partners across the West Berkshire system, communicating information and required actions on a daily basis via email. The approach has proved itself to be both a more efficient use of peoples time and an effective way of communicating the systems needs to support safer patient flow.

Cultivate innovation and transformation

• Our Transformation Team has undergone training to ensure we are growing a local transformation skills base that is ready to support the design and delivery of both our local programmes but also as we begin to work closer as a health system that we have a skillset fit for the future. We are now supported by our LEAN/Six Sigma trained Transformation Team who will be working to share these skills with teams across the Trust as they work with us to deliver our transformation strategy.

Achieve long-term financial sustainability

• The Executive will continue to develop and implement mitigating actions and will work towards the completion of a financial forecast during mid-January. • PSF: A&E trajectory within Sustainability Fund (PSF) has not been achieved for the local target. However is achieved at a delivery board level. Discussions are taking place to

understand the impact of this. • QIPP: The YTD delivery is £9.7m against a budget of £10.4m. Month 9 delivered £1.2m against a budget of £1.75m and a forecast of £1.31m. As at 10 January 2019, for 18/19 the

Trust has identified £16.6m of schemes against an in year target of £16.08m. The risk adjusted figure stands at £13.7m.

1. Safety – Provide the highest quality care

Infection Control Zero Trust apportioned cases of Clostridium difficile (C.diff) were reported for December 2018. The total number of cases reported to date for 18/19 stands at 12, against an upper limit of 26 for the full year. 2 Trust apportioned Meticillin Sensitive Staphylococcus Aureus (MSSA) bacteraemia were reported in December 2018. No Trust apportioned Meticillin Resistant Staphylococcus aureus (MRSA) bacteraemia were reported. 4 Trust apportioned Escherichia coli (E.coli) bacteraemia were reported in December 2018. No common themes / lapses were identified with the E.coli Bacteraemia. Zero Trust apportioned Klebsiella bacteraemia and 1 Trust apportioned Pseudomonas bacteraemia were reported in December 2018. No common themes / lapses were identified for either the Klebsiella or Pseudomonas Bacteraemia. Sepsis remains compliant against standards.


CQC – Teamwork / Integrity CARE - Aspirational

Harm Free CareTarget

variance

Infection Control Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type

Month +/-

Meeting the C.Diff objective 1 0 3 0 4 2 2 1 1 1 1 0 ▼ N 2 -2C.Diff due to lapses in care 1 0 1 0 1 1 1 1 0 0 1 0 ▼ N 0 0C.Diff (Cummulative) 16 16 19 0 4 6 8 9 10 11 12 12 - N 26 -14MRSA 0 1 0 0 0 0 0 0 0 0 0 0 ◄► N 0 0MSSA surveillance (trust acquired) 4 2 5 3 1 0 0 3 0 3 1 2 ▲ - - -Ecoli (trust acquired) infections 6 2 7 5 5 4 3 4 7 2 5 4 ▼ - - -

Sepsis: % of the patients meeting the screening criteria should be screened for sepsis in ED

92.0% 90.0% 94.0% 94.0% 94.0% 92.0% 92.0% 94.0% 94.0% 96.0% 92.0% 94.0% ▲ - 90.0% 4.0%

Sepsis: 90% of patients with sepsis should receive antibiotics within one hour (Inpatients)

93.0% 92.0% 92.0% 92.0% 90.0% 93.0% 90.0% 92.0% 90.0% 90.0% 90.0% 91.0% ▲ - 90.0% 1.0%

Target Type: N - National / L - Local / H - Hospital

Target Actual

Hospital acquired Category 3 / 4 Pressure Ulcers: 2 Avoidable Category 3 / 4 pressure ulcers – Investigations are underway. Hospital acquired Category 2 Pressure Ulcers: Following review of the 11 confirmed Hospital Acquired Category 2 Pressure ulcers: 5 unavoidable. 2 avoidable. 4 not able to review. Nutrition risk assessment The drop in performance around completion of Malnutrition Universal Screening Tool (MUST) assessments coincides with the implementation of digital records. A deep dive is being done into each wards performance and ward sisters have been contacted to try and identify and understand what the issues are. There was a focus on MUST assessments at the Nutrition Champions workshop held on the 19th November and the champions were given additional training on how to complete the MUST assessments in EPR. It will be monitored through the Care Group performance meetings.


1. Safety – Provide the highest quality care CQC – Teamwork / Integrity CARE - Aspirational

Incidents ReportingTarget

variance

Falls and Ulcers Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

Pressure Ulcer Incidence per 1 000 bed days 1.05 0.74 0.85 0.85 0.72 0.44 0.89 0.36 0.53 0.76 0.55 0.64 ▲ N 1.00 -0.36Grade 2 Pressure Ulcers 17 11 15 16 14 8 17 7 10 11 10 11 ▲ N - -Grade 3 or 4 avoidable pressure ulcers (SI) 1 3 1 0 1 1 0 0 0 3 0 2 ▲ N 1 1Patient Falls per 1 000 bed days 5.7 5.0 4.6 4.2 3.7 3.5 5.0 3.6 4.0 4.6 4.3 4.3 ▲ N 5.0 -0.7Patient falls resulting in Harm (SI) Avoidable 4 1 1 2 0 0 0 0 0 0 1 0 ▼ - - -Patient falls resulting in Harm (SI) Unavoidable 0 0 0 0 0 0 0 0 0 0 0 0 ◄► - - -Nutrition risk assessment in 48 hours of Admission to Hospital

97.9% 98.2% 97.3% 98.4% 97.3% 98.2% 97.2% 97.8% 93.0% 90.4% 85.9% 92.7% ▲ N 95.0% -2.3%


Target Actual

23/01/2019 Integrated Performance Report Page 8

1. Safety – Provide the highest quality care

There was 1 Never Event in December relating to unintentional administration of medical air instead of oxygen. In order to prevent reoccurrence the following actions have been put in place: • Awareness sessions have taken place daily on all wards with piped air and at the daily bed meetings. • The air points in Battle block have been capped off and nebuliser machines distributed to all wards. All air flow meters have been removed from

these wards. • Kennet & Loddon (respiratory wards) have a high number of patients requiring nebulisers and will keep their access to piped air.


Incidents ReportingTarget

variance

Other Incidents Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

Patient safety incidents reported (approved) 682 588 624 620 688 686 752 677 611 701 682 719 ▲ - - -Number of incidents reported (unapproved) 103 85 103 74 56 77 94 61 59 65 71 81 ▲ - - -Patient Safety Incidents/1000 Bed days 39 36 34 35 36 38 45 34 35 36 38 39 ▲ - - -Patient Safety Incidents/100 Admissions 9.8% 9.5% 8.9% 8.1% 7.9% 8.4% 9.2% 8.3% 8.2% 7.9% 8.0% 9.7% ▲ N 7.0% 2.7%All serious incidents (SI) 11 8 9 8 5 7 4 3 6 6 7 4 ▼ - - -Duty of Candour breaches (SI) 0 0 0 0 0 0 0 0 0 0 0 0 ◄► N 0 0Never Events 0 0 0 0 1 0 0 1 1 1 1 1 ◄► N 0 1


Actual Target

• The numbers of mental health related attendances to the Emergency Department (ED) in December was 284 compared to 366 in November. • Children and young people’s (CYP) attendance has decreased from 52 to 44. • 7 new patients detained to the RBH under the Mental Health Act (MHA); 5 patients brought to ED under section 136. • 7 Deprivation of Liberty (DoLs) applied for, assessments on-going. • 64 of 89 child safeguarding concerns raised by the Trust (68%) were for CYP who presented with mental health issue or where there were parental mental health issues.

Of the 64, 44 were seen by Children & Adolescence Mental Health Services (CAMHS) and 20 were due to parental mental health disorder. • 100% increase in referral for parental mental health disorder from November. • Zero safeguarding concerns raised against the Trust. • Compliance for Level 1 child safeguarding training for non-clinical staff remains just below the agreed target has decreased. • There continues to be focus on circulating compliance figures to Care Group and Corporate Directors, exception reporting and data quality. • The ways that Level 1 CP training updates are delivered to hard to reach groups within the organisation will change during Q4.


1. Safety – Provide the highest quality care CQC – Teamwork / Integrity CARE - Aspirational

Health and Safety Indicators Target variance

Health and Safety IndicatorsJan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

Number of detentions under the Mental Health Act to the RBH 4 4 6 5 5 0 8 7 7 8 7 7 ◄► - - -

Number of DOLS (Deprivation of Liberty) applications applied for 7 3 4 2 1 4 3 3 1 8 11 7 ▼ - - -

Number of DOLS (Deprivation of Liberty) applications granted

0 0 0 0 0 0 1 0 1 0 0 0 ◄► - - -

Number of Child Safeguarding concerns raised by the Trust

79 71 74 60 79 86 62 63 103 71 89 94 ▲ - - -

Number of Adult Safeguarding concerns raised by the Trust

24 13 16 27 24 6 20 21 28 25 29 2 ▼ - - -

Number of Safeguarding concerns raised against the Trust3 2 3 3 1 6 5 1 5 3 4 0 ▼ - - -


Actual Target

SafeguardingTarget

variance

Safeguarding Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

Staff training in safeguarding of Adults (to incl introductory DoLS & MCA)

90.8% 90.2% 89.6% 91.7% 91.8% 92.4% 93.6% 91.2% 92.4% 93.5% 93.5% 93.5% ◄► L 90.0% 3.5%

% of relevant staff who have had Safeguarding Children Level 1 Training

94.1% 90.5% 88.2% 93.5% 93.7% 93.5% 93.3% 92.1% 92.6% 93.9% 93.4% 92.6% ▼ N 95.0% -2.4%


94.5% 95.1% 94.2% 85.6% 94.6% 94.5% 94.5% 93.5% 93.5% 92.7% 92.6% 92.6% ◄► N 85.0% 7.6%


88.5% 93.4% 91.0% 84.9% 89.4% 88.8% 86.9% 86.0% 86.0% 92.4% 88.1% 87.4% ▼ N 85.0% 2.4%

Mental Capacity Act (MCA) and Deprivation of Liberty (DoL)s enhanced training

82.3% 81.8% 81.1% 80.0% 80.5% 80.2% 83.1% 81.9% 84.5% 83.2% 83.9% 92.6% ▲ L 80.0% 12.6%

A&E staff with appropriate training in conflict resolution incl restraint training: ALL ED Staff

65.4% 65.4% 64.7% 73.1% 87.3% 88.9% 87.7% 82.2% 84.9% 85.5% 84.5% 93.5% ▲ N 80.0% 13.5%


Actual Target

21 complaints were received in December and 28 were closed (7 in Planned Care, 13 in Urgent Care, 6 in Networked Care 1 in Finance and 1 in Corporate Affairs). From closed complaints, for December 20 were recorded as green, 6 as amber and 2 as red. Analysis of the 21 complaints received has shown that Clinical Treatment (13) and Communication (4) were the top two themes. Of the complaints closed in December - 5 were well founded, 8 were partially well founded and 2 were unfounded. We are awaiting outcomes for 13 complaints; these are being actively chased up. PALS - Planned Care received the highest number of PALS, at a total of 62 (59 informal PALS concerns and 3 concerns originating from GP surgeries directly).


2. Patient Experience – Provide the highest quality care


Target

variance

Patient Complaints Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

Number of Complaints 23 18 9 23 26 13 25 20 23 19 28 21 ▼ - - -Complaints avg response (days) 23 21 27 23 22 25 27 22 25 30 27 24 ▼ L 25 -1Number of complaints returned for a second review

- - - - - - 5 5 4 2 0 6 ▲ - - -

Number of Patient Advisory Liaison Service (PALS) concerns

244 255 244 243 262 177 237 156 185 236 236 147 ▼ - - -

Number of Complaints to Ombudsman 0 0 0 1 0 1 0 0 0 1 0 0 ◄► - - -

Number of Complaints upheld by Ombudsman

0 0 0 0 1 0 0 0 0 0 0 0 ◄► - - -

Number of compliments recieved to Patient Relations Department

111 134 164 100 61 4 7 75 101 12 35 9 ▼ - - -


Actual Target

The increase in single sex accommodation breaches has been driven by demands on capacity, flu and patient acuity. Most of the breaches occur late evening and are compounded by not wanting to move patients/bays around after 10pm.


2. Patient Experience – Provide the highest quality care


Surveys and FeedbackTarget

variance

Trust Patient Survey Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type

Month +/-

Trust Inpatient Survey - overall rating 97.6% 98.0% 97.4% 98.6% 99.3% 99.2% 98.7% 97.9% 97.0% 95.9% 97.1% 98.6% ▲ N 97.0% 1.6%

Friends and Family Test (FFT) Response Inpatients

41.0% 41.1% 41.2% 45.1% 59.6% 52.4% 41.8% 47.0% 42.4% 52.0% 51.1% 40.3% ▼ N 30.0% 10.3%

FFT Recommendation Rates Inpatients 99.5% 99.7% 99.4% 99.0% 99.9% 99.7% 99.6% 99.6% 99.8% 99.7% 99.3% 99.6% ▲ N 98.0% 1.6%

FFT Recommendation Rates Maternity 97.1% 97.2% 98.0% 98.5% 96.9% 98.5% 95.8% 97.4% 96.6% 96.3% 97.0% 96.8% ▼ N 95.0% 1.8%

Single sex accommodation - breaches 167 408 279 220 74 15 49 - - - - - ▼ N - -

Single sex accommodation - breaches (Excluding Emergency Department Observation Bays)

- - - - - - - 67 41 62 64 105 ▲ N 0 105

Number of positive feedback posted on NHS choices

27 14 9 15 9 15 15 11 9 7 16 9 ▼ - - -

Number of negative feedback posted on NHS choices

8 0 4 3 0 3 6 1 2 11 1 1 ◄► - - -


Actual Target

Crude mortality has increased in December due to increased deaths as winter starts and reduced discharges due to Christmas; both the number of deaths and the crude mortality percentage are lower than the same time last year. Summary Hospital-level Mortality Indicator (SHMI) remains as expected however it is published 6 months in arrears – next publication is due at the end of February. The Clinical Data Quality Group (CDQ) and Clinical Outcomes and Effectiveness Committee (COEC) will continue to review any outlying variability in both the data and the clinical performance. The Mortality Surveillance Group (MSG) continues to monitor possible or probable avoidable harm related to hospital care and shares learning points across the Trust.

3. Clinical – Consistently Delivering Quality Care and Healthcare Outcomes


CQC - Effective CARE - Excellent

Trust Mortality

October 2018 In October there were 116 deaths; 41 of which triaged requiring full mortality review. Of the 31 cases reviewed to date all were considered to have delivered excellent care with no issues. A second possible avoidable death for September has come in more recently and has not yet been discussed at the Mortality Surveillance Group (MSG). The case highlighted the importance of ICU medical team review when the Critical Care Outreach Team identify a clear trajectory of deterioration in a ward patient recently discharged from ICU. There are no new significant themes within the reviews which have been completed in this period. The only recurring themes are related to Do Not Attempt Resuscitation (DNACPR) and Medical Advanced Planning (MAP) discussions and implementation. The continued roll out of the new RESPECT forms incorporating education and training should help to improve the frequency and quality of these discussions and plans with patients and their families. The following pages report CRAB mortality and morbidity.



CQC - Effective CARE - Excellent

Learning from Deaths



Surgical Risk Adjusted mortality for our own case-mix is better than expected. Risk Adjusted Surgical complications are lower than expected for our case-mix.

CQC – Excellence / Integrity CARE - Excellent

Surgical Mortality and Morbidity

Complications Overview - by Complication Category



CRAB methodology applies ‘trigger’ events – 4 or more triggers would highlight the acuity of patient or quality of care provided being an issue. The triggers are based upon morbidities such as AKI (Acute Kidney Injury), Pneumonia and Decubitus Ulcers. The Admissions graph on the left shows that the Trust has a high number of patients with 4 or more triggers from August to October. However, the Mortality graph shows that the Trust is well within normal range. This suggests that patients were high acuity but had good outcomes. As the supplier (CRAB) is new, we are validating the information.


Medical Mortality and Morbidity

3. Clinical – Provide the highest quality care

The number of Births in December was 394 and deliveries 400. Deliveries year to date extrapolated give a predicted number of births of 4900. Taking into account bookings by estimated delivery date, there is a drop in bookings from February onwards, which gives a predicted number of births closer to 4600. Work has been carried out with forecasts, which gives a more accurate estimated number of births for 18/19 of 4750. The number of term admissions to the neonatal unit has come down from 7.8% to 4.5% this month. The review of admissions has been completed and will be presented at the end of January. The percentage of births on the Midwifery Led Unit (MLU) has increased this month which has impacted on the overall spontaneous vaginal delivery (SVD) rate of 63% which is a much improved position.



Monitoring Clinical OutcomesTarget

variance

Maternity Care Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

Women giving birth: 1:1 delivery of care 100.0% 100.0% 99.0% 100.0% 100.0% 100.0% 100.0% 99.0% 100.0% 99.0% 100.0% 100.0% ◄► N 98.0% 2.0%

Midwife : birth ratio (utilised workforce) 1:32 1:30 1:30 1:30 1:29 1:28 1:29 1:29 1:28 1:27 1:27 1:27 - L 1:30

Caesarean Sections - Elective 12.7% 14.6% 14.1% 14.3% 13.0% 12.9% 16.1% 16.2% 12.9% 16.4% 17.6% 13.5% ▼ N 12.0% 1.5%MLU No of deliveries (proportion of total)

19.0% 20.0% 17.0% 20.0% 16.0% 14.0% 20.0% 17.0% 17.0% 13.0% 15.0% 22.0% ▲ N 20.0% 2.0%

No of times women diverted 1 0 3 0 0 0 0 0 2 4 0 0 ◄► N 0 0Percentage of Unexpected NICU admissions over 37 weeks

3.7% 2.6% 3.8% 2.8% 4.5% 2.5% 3.0% 3.3% 3.0% 5.1% 7.8% 4.5% ▼ N 6.0% -1.5%

Number of births 422 339 388 390 448 403 422 416 402 448 411 400 ▼ N - -Target Type: N - National / L - Local / H - Hospital

Actual Target





variance

Other Clinical Indicators Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

VTE Risk Assessment 95.6% 96.7% 95.4% 95.2% 98.3% 96.6% 96.8% 96.8% 95.9% 97.3% 96.5% 97.3% ▲ N 95.0% 2.3%VTE Incidence (Hospital & Community Acquired)

60 51 48 45 46 43 45 55 44 62 59 31 ▼ N - -

Datix: Number of VTE Incidence (Hospital Acquired)

0 0 0 0 1 0 0 0 0 1 0 0 ◄► N - -

Datix: % VTE Incidence (Hospital Acquired)

0.0% 0.0% 0.0% 0.0% 2.2% 0.0% 0.0% 0.0% 0.0% 1.6% 0.0% 0.0% ◄► N - -


Actual Target


Stroke Care: • Transient ischemic attack (TIA) assessments for high risk patients continues to fluctuate and dropped significantly below 95% for M09 at 72%. • Higher than normal levels of both high and low risk patients accessing the service. Physician assistant commenced in post November 2018 and to

commence supporting the TIA clinic in January. • There were 14 breaches of the 90% target for patients discharged in December 2018 where we saw the length of stay (LOS) increase to 17 days. 3

patients awaiting onward transfers, with a combined LOS of 85 days. Speech and Language Therapy (S&LT): • 72 hour assessment dropped below 95% target window in M9, 86% as a result of reducing staffing levels and support provided to the medical

wards. S&LT service review underway, looking to utilise S&LT assistant practitioner to support the team. Reduction in S&LT performance significantly effects overall SSNAP rating.

Cardiac Care: • MINAP figures provided 1 month in arrears due to validation. • RBFT performance remains way above national average.




variance

Stroke Care Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

Proportion of patients spending 90% of their inpatient stay on a specialist stroke unit (national target)

77.0% 70.0% 63.0% 73.0% 82.0% 84.0% 86.0% 85.0% 89.0% 82.0% 82.0% 72.0% ▼ N 80.0% -8.0%

Proportion of stroke patients scanned within 12 hours of hospital arrival

- - 97.0% 97.0% 97.0% 99.0% 93.0% 88.0% 95.0% 92.0% 96.0% 94.0% ▼ N 0.0% 94.0%

Proportion of people with high risk TIA fully investigated and treated within 24hrs (IPM national target)

89.0% 90.0% 91.0% 97.0% 86.0% 97.0% 92.0% 87.0% 94.0% 83.0% 71.0% 82.0% ▲ N 90.0% -8.0%

Average Length of Stay (LOS) from admission to discharge (days)

- - 15 20 22 14 12 11 15 15 14 17 ▲ N 14 3.0

Door to needle time <60mins - - 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% ◄► N 95.0% 5.0%

Proportion of S&LT communication assessments <72 hrs

- - 93.0% 77.0% 96.0% 97.0% 100.0% 100.0% 90.0% 90.0% 86.0% 86.0% ◄► N 95.0% -9.0%



variance

Cardiac Care Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

Myocardial Ischaemia National Audit Project (MINAP): Call to Balloon target less of than 150 minutes

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 89.0% ◄► N 82.0% 18.0%

Myocardial Ischaemia National Audit Project (MINAP): Call-to-Balloon target of less than 120 minutes

100.0% 100.0% 93.0% 100.0% 93.0% 100.0% 88.0% 100.0% 93.0% 100.0% 89.0% ▼ N 86.0% 5.7%

Myocardial Ischaemia National Audit Project (MINAP): Door-to-Balloon target of less than 90 minutes

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% ◄► N 97.0% 3.0%


Actual Target

Actual Target

18 weeks RTT The December RTT incomplete position remains compliant against the 92% standard. DM01 – The Trust remains non-compliant in December Performance against the 6 week waiting list target has been a significant challenge throughout 2018/19 with all but one month not meeting the 99% threshold. However the reasons for non compliance have been separate and relate to different areas within the Trust. - April to August. At the end of 2017/18 the Trust Echocardiography service experienced a significant drop in personnel/resource which began to

impact performance at the start of 2018/19. The Trust was non-compliant with the 99% standard for 5 months, driven by an increase in size of the echo waiting list, complicated by the reduction in overall (Trust) list size as a result of targeted additional work in MRI to support the cancer pathway (Urology). Through Apr-Jun the Trust successfully recruited into vacancies within echo, new staff were inducted and went through mandatory competency assessment. Over this period a backlog had built which took until Sept to bring back to maintainable levels.

- October/November. The dip in performance was not as significant as the issues earlier in the year. Oct – 98.8% (off by 0.2%), Nov – 98.5% (off by 0.5%). This dip is as a result of an increase in waits for routine Endoscopy. The number waiting over 6 weeks at month end had increased from a more usual 10-15 to c30. This is as a result of reduced capacity following discussions relating to an additional session which took place during October. Capacity has been made available again during November. However it has been necessary to prioritise cancer pathways for this period. At present this is an on-going risk that the department are working hard to mitigate but needs to be viewed in the context of cancer and urgent demand which must be prioritised by the Endoscopy department.

- December. The proportion of the diagnostic waiting list over 6 weeks has increased during December, unrelated to Echo and Endoscopy (whilst Endoscopy remains an on-going concern the performance in this area has not deteriorated). This is a result of a scanner breakdown within the MRI department, causing the necessary rescheduling of patients. The department are working hard to rebook displaced patients and reduce the backlog whilst continuing to manage the urgent demand.


4. Access – Provide the highest quality care.


18 weeks RTTTarget

variance

Waiting Times: 18 weeks RTT Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type

Month +/-

18 Weeks: incomplete pathways (%) 92.3% 92.1% 92.3% 92.5% 92.2% 93.1% 92.4% 92.6% 92.5% 93.2% 92.6% 92.5% ▼ N 92.0% 0.5%18 Weeks: incomplete pathways (number) 29589 30223 30930 31814 32417 32198 32738 32537 31408 30994 30105 29974 ▼ - - -18 weeks complete patients (Admitted clock stops)

1668 1373 1570 1649 1617 1805 1866 1934 2326 2418 2691 2427 ▼ - - -

18 weeks complete patients (Non Admitted clock stops)

6410 5624 5873 5741 6361 6182 6338 5266 5552 5634 6130 5234 ▼ - - -

52 Weeks - Admitted 0 0 0 0 0 0 0 0 0 0 0 0 ◄► - 0 052 Weeks - Non-admitted 0 0 0 0 0 0 0 0 0 0 0 0 ◄► - 0 052 Weeks - Incomplete 0 0 0 0 0 0 0 0 0 0 0 0 ◄► N 0 0Diagnostics Waiting < 6 weeks (DM01) (%) 98.0% 99.3% 99.1% 98.4% 97.5% 96.8% 97.6% 98.4% 99.1% 98.8% 98.5% 97.0% ▼ N 99.0% -2.0%Diagnostics in 6 weeks: active (number) 5613 5701 5494 5751 5816 5434 4934 4814 5027 4938 5373 5302 ▼ N - -


Target Actual



Cancer 104 days. At the end of December 10 patients have been reported to the Clinical Commissioning Group. 5 with a confirmed diagnosis of cancer. All pathways have plans in place with 5 of the 10 having treatment plans in place. Of the 5 without treatment plans in place 4 are expected either to commence conservative management or receive a non-cancer diagnosis. Long waits within the cancer pathway remain consistent with previous months with themes of tertiary centre delays and complex pathways. However patient fitness and patient choice have been a factor. The Trust continues to work closely with NHS Improvement and the Thames Valley Cancer Alliance to ensure reporting definitions are clearly identified for this complex standard.


Outpatient ExperienceTarget

variance

Cancer Pathways Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type

Month +/-

Cancer 2 week wait: cancer suspected 95.6% 96.6% 96.4% 95.7% 95.6% 92.7% 94.4% 95.0% 95.1% 95.9% 98.0% 96.6% ▼ N 93.0% 3.6%Cancer 2 week wait: cancer suspected - QTR 0.0% 0.0% 96.2% 0.0% 0.0% 94.7% 0.0% 0.0% 94.8% 0.0% 0.0% 96.8% ▲ N 93.0% -Cancer 2 week wait: breast patients 94.3% 100.0% 97.8% 96.1% 92.4% 94.0% 96.4% 96.8% 94.5% 97.4% 99.5% 98.6% ▼ N 93.0% 5.6%Cancer 2 week wait: breast patients - QTR 0.0% 0.0% 97.2% 0.0% 0.0% 94.4% 0.0% 0.0% 95.9% 0.0% 0.0% 98.5% ▲ N 93.0% -Cancer 31 day wait: to first treatment 95.5% 98.3% 98.2% 97.5% 97.8% 98.1% 94.5% 96.3% 98.7% 97.9% 98.5% 97.0% ▼ N 96.0% 1.0%Cancer 31 day wait: to first treatment - QTR 0.0% 0.0% 97.4% 0.0% 0.0% 97.8% 0.0% 0.0% 96.6% 0.0% 0.0% 97.9% ▼ N 96.0% -Cancer 31 day wait: drug treatments 98.4% 100.0% 100.0% 98.4% 98.5% 100.0% 98.9% 97.7% 100.0% 100.0% 100.0% 94.7% ▼ N 98.0% -3.3%Cancer 31 day wait: drug treatments - QTR 0.0% 0.0% 99.5% 0.0% 0.0% 98.9% 0.0% 0.0% 99.0% 0.0% 0.0% 99.0% ▲ N 98.0% -Cancer 31 day wait: surgery 100.0% 100.0% 100.0% 100.0% 89.5% 95.5% 94.4% 100.0% 96.4% 98.3% 97.7% 100.0% ▲ N 94.0% 6.0%Cancer 31 day wait: surgery - QTR 0.0% 0.0% 100.0% 0.0% 0.0% 94.9% 0.0% 0.0% 96.4% 0.0% 0.0% 98.2% ▲ N 94.0% -Cancer 31 day wait: radiotherapy 95.7% 96.4% 97.5% 94.7% 98.1% 96.2% 93.3% 96.8% 94.5% 95.6% 91.8% 94.4% ▲ N 94.0% 0.4%Cancer 31 day wait: radiotherapy - QTR 0.0% 0.0% 96.6% 0.0% 0.0% 96.3% 0.0% 0.0% 94.8% 0.0% 0.0% 93.9% ▼ N 94.0% -62 day consultant upgrade: all cancers 100.0% 85.7% 100.0% 40.0% 75.0% 100.0% 92.3% 77.8% 100.0% 50.0% 77.8% 25.0% ▼ - - -62 day consultant upgrade: all cancers - QTR 0.0% 0.0% 93.3% 0.0% 0.0% 66.7% 0.0% 0.0% 90.0% 0.0% 0.0% 57.1% ▲ - - -62 Day GP Ref 85.5% 85.1% 90.4% 85.5% 85.5% 87.7% 71.0% 71.4% 83.0% 86.5% 87.0% 72.8% ▼ N 85.0% -12.2%62 Day GP Ref - QTR 0.0% 0.0% 87.3% 0.0% 0.0% 86.2% 0.0% 0.0% 75.1% 0.0% 0.0% 83.3% ▼ N 85.0% -62 Day screen Ref 79.1% 100.0% 82.8% 68.4% 82.4% 100.0% 100.0% 93.3% 92.3% 81.3% 100.0% 82.6% ▼ N 80.0% 2.6%62 Day screen Ref - QTR 0.0% 0.0% 86.5% 0.0% 0.0% 84.8% 0.0% 0.0% 94.4% 0.0% 0.0% 86.0% ▲ N 80.0% -Incomplete 104 day waits 4 6 6 5 7 5 6 7 9 8 6 10 ▲ N 0 10


Actual Target


4. Access – Provide the highest quality care. CQC - Excellence CARE - Excellent

November Performance The Trust is compliant against all core cancer access standards with the exception of 31 day Subsequent Radiotherapy which has seen an increase in patient waiting beyond target. There is no one theme in December attributable to the increase with delays being seen for patient, hospital and complexity reasons. December Provisional The Trust anticipates December and January being very challenging months for all cancer performance standards. As has been the case in previous years, the impact of the Christmas holiday period is expected to reduce the number of patients seen/treated in December (as a result of patient choice) and for the number of >62 day patients treated to increase in January as a result of deferral from December. The in-month figures for December currently support this assessment. However December figures are not yet fully validated. Residual Risk – • Fragility of cancer waiting times and the need to carefully consider the Trust ability to respond to unexpected increases in demand. • Dermatology service challenges. • Christmas / Holiday Period – A high volume of seasonal choice is expected to impact the Trust ability to maintain compliance through December and

January. This is reflected in the Trust PSF trajectory.

Standard Seen / Treated Breaches Performance (%)Two Week Wait 93% 1576 31 98.0%2WW SBR 93% 190 1 99.5%31 Day FDT 96% 264 4 98.5%Subs - Chemo 98% 79 0 100.0%Subs - Surgery 94% 43 1 97.7%Subs - RT 94% 134 11 91.8%Subs - Other - 2 0 100.0%62 day FDT 85% 138 18 87.0%Upgrade - 4.5 1 77.8%Screening 90% 11 0 100.0%

November



The breach analysis undertaken in December shows a consistent number of ED related delays. Weekly 4 hour quality review meetings continue, with focus on processes improvement within the department to reduce ED related delays, as well as updates on actions to support the improvement of trust wide delays.

Performance for December has remained challenging at 83.16%. Admission conversion rate December was 33.3% compared to 31.7% in November 2018 although there is a sustained increase in attendances of the over 65yrs, coupled with an increase in paediatric attendances, on average a third of all attendances are now paediatric. Acuity of patients remains high and mental health patients remaining challenging.


A&E ExperienceTarget

variance

Waiting Times: A&E Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type

Month +/-

A&E 4hr Limit (RBH combined) 85.8% 79.2% 83.1% 93.3% 96.1% 96.5% 95.6% 95.8% 93.7% 87.9% 88.2% 86.1% ▼ N 95.0% -8.9%A&E 4hr Limit (RBH combined) - QTR 82.8% 95.3% 0.0% 0.0% 95.1% 0.0% 0.0% 87.4% ▼ N 95.0% -A&E 4hr Limit (Type 1 only) 82.3% 73.4% 78.9% 92.0% 95.4% 95.9% 95.0% 95.5% 92.9% 85.6% 86.1% 83.2% ▼ N 95.0% -11.8%A&E 4hr Limit (Type 1 only) - QTR 0.0% 78.3% 0.0% 94.5% 0.0% 0.0% 94.4% 0.0% 0.0% 85.0% ▼ N 95.0% -A&E Type 1 (number) 8826 8154 9119 8870 9346 9313 9881 8925 9263 9827 9741 9423 ▼ - - -

Trolley Waits: 12 hour decision to admit (DTA) 6 2 0 0 0 0 0 0 0 0 0 0 ◄► N 0 0

Ambulance Handover : 30 Minutes 113 125 98 32 2 29 32 37 105 91 91 ◄► N 0 91Ambulance Handover : 60 Minutes 29 20 32 1 0 0 1 2 3 9 9 ◄► N 0 9


Actual Target


CQC - Excellence CARE - Excellent 4. Access – Provide the highest quality care.

The A&E department continues to be seeing numbers above previous years of patients conveyed over the age of 70yrs.

The Trust position for stranded patients (patients staying longer than 7 days) has remained above our internal threshold during December and into January. This remains an area of strong focus for the Trust particularly as we move through the most challenging time of year. The level of ‘super stranded’ patients (>21 days) has slightly reduced as a proportion of the total level of stranded patients and the volume of patients above 21 days has remained fairly consistent (avg 77). However on comparison when comparing December 2018 with December 2017 we are showing a 25% reduction in the number of super stranded and a 10% reduction in stranded.

4. Access – A&E Performance Dashboard



- - 95%

89.51% 0.00% 0.00%

92.83% 0.00% 0.00%

91.5% 92.1% 95.5% 95.6% 91.4% 90.5% 92.6% 91.6% 86.0% 87.2% 81.2% 95.0%

93.29% 96.09% 96.54% 95.63% 95.81% 93.71% 87.89% 88.18% 86.03% 89.51% 0.00% 0.00%

95.53% 97.43% 97.73% 97.08% 97.19% 95.78% 91.83% 91.96% 90.44% 92.83% 0.00% 0.00%

92.4% 88.5% 95.2% 95.0% 90.0% 89.1% 91.2% 86.8% 79.5% 82.3% 73.4% 78.8%

92.0% 95.4% 95.9% 95.0% 95.5% 92.9% 85.6% 86.2% 83.1% 87.1% 0.0% 0.0%

Must be 95% in March 18

Q1

INFORMATION CORRECT AT 22/01/2019

Better than Q1 17/18 Better than Q2 17/18 90 % or better than Q3 17/18

Feb-18 Mar-18Q2 Q3 Jan-18

2017/18 Type 1

2018/19 Type 1

Monthly PERFORMANCE (ED-DB)

Quarterly PERFORMANCE (ED-DB)

Monthly PERFORMANCE (RBH)

87.40%

93.1% 92.5% 90%

Monthly TARGET

Quarterly TARGET

Quarterly PERFORMANCE (RBH) 95.34% 95.08%

96.91% 96.70% 91.10%

93.29% 96.09%96.54%

95.63% 95.81%

93.71%

87.89% 88.18%

86.03%

89.51%

95.53%97.43% 97.73%

97.08% 97.19%95.78%

91.83% 91.96%90.44%

92.83%

0

2000

4000

6000

8000

10000

12000

14000

70.00%

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

April May June July August September October November December January February March

A&E Performance Tracker

2017/18 Activity Projected Activity (Combined) 2018/19 Activity (RBH) 2017/18 Performance £££ STF Trajectory 2018/19 Performance (RBH) 2018/19 Performance (Delivery Board)


4. Access - Exception Report Emergency Department CQC - Excellence CARE - Excellent

Delayed Transfers of Care (DTOC) During December the proportion and number of patients formally reported as Delayed Transfer of Care (DTOC) has increased. Combined with a significant increase in the number of associated lost bed days. The Trust will continue to focus attention on working with our partners to drive improvements against this metric.


4. Access –Provide the highest quality care. CQC - Excellence CARE - Excellent

Admitted Patient ExperienceTarget

variance

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

Delayed Transfers of Care (%) 5.2% 5.2% 3.4% 4.8% 4.0% 4.2% 3.7% 4.8% 3.8% 3.6% 3.7% 4.2% ▲ N 3.5% 0.7%Number of Delayed Transfers of Care (No. of patients)

134 88 78 94 81 62 70 84 70 73 76 101 ▲ N - -

Number of Delayed Transfers of Care (Lost bed days)

938 686 640 775 605 608 617 741 592 612 652 926 ▲ N - -

Average elective length of stay - excluding 0 day LOS

2.6 2.7 2.8 2.7 2.7 2.5 2.7 2.6 2.9 2.9 2.6 2.7 ▲ N - -

Average non-elective length of stay - excluding 0 day LOS (Length of Stay)

6.1 6.7 6.0 6.7 6.1 5.9 5.5 5.5 5.7 5.5 5.5 5.9 ▲ N - -

Percent of Ambulatory Care of Non elective Admissions

23.0% 29.1% 28.7% 28.7% 30.0% 30.7% 30.1% 32.3% 31.0% 28.2% 23.4% 22.4% ▼ N - -


Actual Target

Hospital Cancellation on the day of surgery (non-clinical) There were no patients booked outside of 28 days following a hospital cancellation on the day of surgery. In list utilisation In list utilisation remains below target in December however when compared with the December 2017 figure (84.9%) we are showing a small improvement for the time of year. Delayed starts have improved to an average delay of 14 minutes per list. General Surgery has the best time with an average delay of 7 minutes per list.



Theatres Patient ExperienceTarget

variance

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

Month +/-

Hospital Cancelled Ops on day of surgery - non clinical (Numbers)

52 33 21 19 15 15 15 25 11 13 34 12 ▼ - - -

Hospital Cancelled Ops on day of surgery - non clinical (Percentage)

1.3% 0.9% 0.5% 0.5% 0.4% 0.4% 0.3% 0.6% 0.3% 0.3% 0.8% 0.4% ▼ - - -

Cancelled Ops not re-scheduled < 28 days 23.1% 0.0% 18.2% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 2.9% 0.0% ▼ N 5.0% -5.0%Urgent Operations Cancelled 2nd time 0 0 0 0 0 0 0 0 0 0 0 0 ◄► N 0 0In List Theatre Utilisation 85.8% 88.9% 87.2% 87.1% 88.0% 86.9% 86.6% 87.7% 86.5% 88.6% 86.9% 85.7% ▼ L 90.0% -4.3%Sessional Theatre Utilisation 88.0% 91.0% 92.0% 93.0% 93.0% 91.0% 88.0% 92.0% 96.0% 92.0% 93.0% 91.0% ▼ L 90.0% 1.0%


Actual Target

The Trust is continuing with its modernisation and data quality programme in outpatients. As reported in previous months Outpatient metrics remain under review as part of the Trust’s Data Quality Assurance Programme and we continue to interrogate the information capture, processing and assurance processes. Advice and Guidance (A&G) is an area that the Trust will be working with local commissioners and NHS England to increase utilisation over the next 12-24 months (CQUIN). The current measure used locally is to assess the proportion of requests through A&G that are responded to within 7 working days however this only includes requests for A&G through the e-Referral Service (eRS) system. Requests via other communication routes e.g. telephone are not included in this calculation. We are exploring the capability and development need of the national eRS system, to deliver a useable mobile platform that would enable ease of use for both primary care and hospital clinicians using a 24 hour turnaround as the aim. In the interim, the Trust will work with primary care to pilot new technologies to support advice and guidance.



Outpatient ExperienceTarget

variance

Waiting Times: Outpatient Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type

Month +/-

Appointments cancelled by RBFT (%) - - - - - - - - - - - - - - - -Appointments cancelled by patient (%) - - - - - - - - - - - - - - - -DNA Rate - - - - - - - - - - - - - - - -New to Follow Up Ratio 1.9 1.8 1.9 1.9 1.8 1.9 1.9 2.0 2.0 1.9 1.9 1.9 ◄► L - -% Advice and Guidance 78.6% 87.7% 84.1% 84.5% 92.3% 94.8% 82.3% 89.7% 89.2% 87.6% 75.2% 83.6% ▲ L 90.0% -6.4%% Appointments at Virtual clinic 3.6% 3.9% 3.9% 4.1% 4.1% 4.1% 4.2% 3.9% 3.8% 3.5% 3.5% 3.7% ▲ - - -


Actual Target


4. Access – CAT Dashboard

December 2018


5. Workforce – Invest in our staff and live out our values.

Appraisal Rate - Appraisal compliance recovered strongly over the month to finish at 87.1% - the highest level of compliance since June 2018. Improvements were seen across all clinical areas particularly Planned Care, which finished the month on 91.5 % compliance. Completed Mandatory Training - Mandatory and Statutory Training (MAST) Compliance reversed the recent downward drift to finish December on 87.9 % the third best ever achieved, just below the 88/88.1 achieved in June/July 2018. Again improvement was driven by all the clinical areas with Networked Care achieving their highest ever compliance (88.3%) and training grade medics improving compliance by 4 percentage points over the month. Rolling 12 month Sickness absence - The Employee Relations (ER) team continue to work closely with managers to ensure sickness is monitored and managed within the policy and we are looking to develop a more proactive approach to this over time. Currently the team is experiencing a large number of cases but this is being managed and the policy is applied by mangers with ER support. Training will remain a priority for the future and we will look to identify and redress any hotspots in absence levels where they are identified. Vacancy Rate – The Trust vacancy rate has increased by 0.3% from last month. With 82 external individuals currently undertaking pre-employment checks our recruitment pipeline remains consistent. Due to financial pressures we are reviewing admin and clerical vacancies and only proceeding this financial year with essential roles. This may have an impact on our future vacancy rates. Agency Spend - Agency Spend has reduced by 0.9%. The main reason for using agency is to cover vacancies therefore whilst our vacancy rate remains consistent our agency spends will also. Throughout the course of the financial year our agency spends has reduced. This is as a result of a number of initiatives including promoting our bank, engaging in a bank share with Berkshire Healthcare (BHFT) and tighter control processes. Rolling 12 month Turnover - The Trust has recently launched its behaviour framework, supporting staff to live out our values. This shows staff that we are listening to what they are telling us and acting on what’s important to them. Trust turnover has reduced by 1.1% from the same month last year. New starter report for December 2018 shows the Trust is effectively retaining 69 internal employees. Offering promotions or developing into new roles.


CQC - Integrity / Excellence CARE - Resourceful / Excellent

Caring CultureTarget

variance

Workforce Indicators Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

Appraisal rate 89.2% 89.0% 88.4% 87.5% 88.8% 87.2% 86.8% 86.9% 85.8% 85.1% 85.3% 87.1% ▲ L 90.0% -2.9%Completed Mandatory Training 87.1% 87.3% 86.1% 86.9% 87.7% 88.1% 88.0% 87.7% 86.7% 87.4% 87.4% 87.9% ▲ L 90.0% -2.1%Rolling 12 month Sickness absence 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% ◄► L 3.0% 0.3%Vacancy rate 6.6% 6.8% 6.8% 10.5% 6.8% 8.2% 7.0% 8.3% 8.3% 7.2% 7.1% 7.4% ▲ L 6.0% 1.4%Agency spend % of total staff cost 4.7% 3.5% 4.1% 4.2% 4.8% 3.9% 3.9% 4.1% 3.7% 3.8% 3.3% 2.4% ▼ L 5.0% -2.6%Rolling 12 month Workforce Turnover 15.1% 15.1% 15.2% 15.4% 14.9% 15.0% 14.6% 14.4% 14.9% 14.4% 14.2% 14.8% ▲ L 14.0% 0.8%


Target Actual


Nurse staffing levels are monitored daily at the Operational Meeting and Senior Nursing huddle. Risk assessment of any shortfall is carried out and staff movement and/or the use of temporary staff is undertaken to ensure that safe staffing levels are always maintained. The level of planned staffing levels change to reflect the needs of our patients. This may alter depending on the number of occupied beds on a ward, changes in patient acuity or any specific 1:1 care needs.

6. Staffing Data – Invest in our staff and live out our values.

CQC - Integrity / Excellence CARE - Resourceful / Excellent

Caring CultureTarget

variance

Staffing Data Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

% Fill rate of Registered Nurse Shifts (RN) 91.3% 89.8% 89.9% 91.0% 91.9% 91.4% 91.7% 90.3% 90.7% 92.7% 94.2% 90.5% ▼ N 90.0% 0.5%

% Fill rate of Care Support Worker Shifts (CSW) 106.0% 105.0% 105.8% 106.9% 108.3% 104.8% 107.1% 109.2% 108.1% 107.8% 106.8% 107.3% ▲ N 90.0% 17.3%


Target Actual

23/01/2019 Integrated Performance Report Page 32

The Lord Carter report recommends that all trusts record Care Hours Per Patient Day (CHPPD) as a single, consistent metric of nursing and healthcare support workers deployment on inpatient wards and units. The CHPPD is calculated by taking the actual hours worked (split into registered nurses/midwives and healthcare support workers) divided by the number of patients occupying beds on the ward at midnight. It should be noted that CHPPD does not take into account patient acuity, ward environmental issues, patient turn over or movement of staff for short periods. Benchmarking is available on the Model Hospital Portal but restricted to data from October 2018 - the national average for October 2018 was 8.0 and the average for RBH in Oct was also 8.2. The average score for RBH in December2018 is 7.97.

6. Staffing Data – Invest in our staff and live out our values.

CQC - Safe CARE - Excellent

RIDDOR: The two reportable incidents for December involved members of staff. The first incident resulted in a member of staff suffering a fractured bone through slipping on a staircase. The second incident led to a 7 plus day absence from work, through assisting in the movement of a patient. Total Health and safety (non clinical) incidents reported: Violence and aggression incidents remain the largest cause for non clinical reporting. The reporting of non clinical incidents especially near misses has become a focus in the refresher days training for 2019.


7. Health and Safety Indicators CQC – Teamwork / Integrity CARE - Aspirational

Health and Safety IndicatorsTarget

variance

Incidents Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

RIDDOR reportable Incidents 6 5 4 6 0 1 3 1 2 6 4 2 ▼ - -Total non clinical incidents reported 89 52 77 63 46 49 70 49 39 79 83 69 ▼ - -Abuse/V&A (Patient to staff) 35 25 36 26 12 14 24 18 10 28 47 38 ▼ - -Body fluid exposure/needle stick injury 14 10 16 19 20 8 16 5 8 24 15 16 ▲ - -Building works 14 9 13 9 6 6 57 21 6 45 24 15 ▼ - -Slips and Trips 10 3 4 2 4 1 5 9 4 2 4 3 ▼ - -Musculoskeletal - Inanimate object 4 0 2 0 0 0 0 3 4 2 5 2 ▼ - -

Staff receiving H&S related training Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Month +/-

Manual Handling non patient every 3 years 87.4% 86.8% 86.5% 89.0% 88.7% 89.6% 90.3% 88.9% 89.6% 83.4% 90.4% 90.7% ▲ > 90.0% 0.7%

Conflict Resolution 78.7% 79.0% 80.8% 82.6% 84.2% 85.0% 85.1% 85.3% 85.1% 83.4% 83.4% 82.5% ▼ > 90.0% -7.5%Fire (Annual) 84.6% 84.2% 83.5% 85.0% 85.1% 85.9% 86.0% 84.6% 84.2% 83.4% 85.4% 85.3% ▼ > 90.0% -4.7%Nursing and AHP Manual handling training every 3 years

92.8% 91.5% 90.8% 90.2% 90.1% 89.9% 90.4% 90.3% 90.1% 90.5% 90.3% 91.1% ▲ > 90.0% 1.1%

Doctors manual handling training every 3 years 61.0% 60.5% 61.4% 62.1% 62.0% 61.8% 60.9% 64.3% 65.5% 68.4% 71.3% 71.3% ◄► > 90.0% -18.7%

Civil and Enforcement Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Month +/-

Personal Injury claims 1 1 0 0 1 0 1 0 1 1 0 1 ▲ - -Interaction with Regulators 0 1 0 0 0 0 0 0 0 1 0 0 ◄► - -


Actual Target

The Overall RAG rating (Red, Amber, Green) is a subjective risk rating determined by the Head of Engineering. By using a variety of records and information, it is an agreed but subjective view of the key item as an overall risk view. The Datix risk assessment accounts for entries which highlight a particular risk in that key item category and using the Datix matrix for scoring.


7. Health and Safety Indicators CQC – Teamwork / Integrity CARE - Aspirational

8. Finance – Achieve long-term Financial Sustainability


Income from Activities (excluding Drugs income) – Income is £2.08m ahead of plan in month due £1.80m adjustment to risk share agreement in Berkshire West contract £1.50m.

Total Cost (excluding Drugs) – Total costs are £0.04m underspent against budget due to release of purchase order accruals for historic invoices £0.83m, and VAT recovery following quarterly review £0.66m. Cash (£M YTD) – The current £9.00m cash variance includes movement in working capital of £5.00m, cash-flows from operating activities of £(7.8)m, a delay in Capex spend and Charity grants of £9.00m and Agenda for Change funding of £2.7m. QIPP delivery – QIPP delivery of £1.23m is below the target by £(0.52)m for M09 (target of £1.75m). Full year risk adjusted programmes represent 85% of full year £16.08m target. Use of Resources - Score of 2.

CQC - Excellence / Integrity CARE - Resourceful

Financial ProficiencyTarget variance

(based on budget)

Financial Efficiency Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DoT Target Type Month +/-

Income from activities (excluding drugs income)

28.26 26.76 28.95 26.83 28.15 28.01 28.30 27.91 27.99 29.81 27.39 28.11 ▲ >= 26.04 2.08

Total cost, excluding drugs -30.33 -30.27 -34.55 -30.84 -30.97 -31.21 -31.58 -32.56 -30.38 -30.98 -31.69 -30.18 ▼ <= -29.40 -0.78Cash(YTD) £M 35.73 33.97 41.19 38.15 36.08 32.47 35.85 38.25 36.21 31.10 30.54 33.54 ▲ > 24.54 9.00QIPP Delivery (£M) 1.23 1.04 1.73 0.25 0.49 0.91 1.48 1.30 1.10 1.32 1.60 1.23 ▼ > 1.75 -0.53Use of Resources 2 2 2 3 3 3 3 3 2 2 2 2 ◄► <= 1 1


Actual Target

Title: December Financial Performance Summary Agenda item no: 5b Meeting: Board of Directors Date: 30 January 2019 Presented by: Nicky Lloyd, Chief Finance Officer Prepared by: Michael Clements, Deputy Director of Finance – Central Finance Purpose of the Report To update the Committee on the Financial Performance of the Trust in

December 2018.

Report History

What action is required? The Board of Directors is asked to NOTE the report



Relationship to Risk in BAF:







1 Summary

1.1 The Trust has reported results in line with adjusted NHS Improvement (NHSI) Control Total for the year to date at M09 2018/19.

(a) Operational financial performance remains behind plan with significant pressures across care groups in M09

(b) Prior to any adjustments the Trust financial performance was £(4.63)m off control total for the year to date and £(2.74)m behind Q2F

(c) For the month of December this represents a £(2.12)m variance to plan and £(2.75)m variance to Q2F, shown below

(i) Care Groups collectively £(1.32)m off budget split £(0.62)m pay and £(0.70)m non-pay

(a) Networked Care £(0.51)m

(b) Planned Care £(0.53)m

(c) Urgent Care (0.28)m

(ii) Corporates collectively £0.35m ahead of budget

(iii) Corporate – Other £(1.16)m driven by activity and drugs income

(d) Against Q2F the variances are as follows:

(i) Care Groups £(0.51)m, driven by non-pay. Pay is collectively £0.15m better than forecast due to a £0.42m underspend against Nursing, partially offset by £(0.14)m Medical and smaller variances against other staff groups

(a) Networked Care £(0.24)m

(b) Planned Care £(0.20)m

(c) Urgent Care £(0.07)m

(ii) Corporates collectively £0.35m ahead of forecast

Income and Expenditure - pre adjustmentPlan Actual Vs Q2F Vs Plan Plan Actual Vs Q2F Vs. Plan£m £m £m £m £m £m £m £m

Operating Income 33.50 34.72 (0.52) 1.22 313.00 316.39 (1.85) 3.39Pay costs (18.97) (20.01) 0.37 (1.04) (172.05) (180.20) (0.18) (8.15)Non Pay (12.34) (13.21) (0.99) (0.87) (117.24) (120.64) (2.26) (3.39)EBITDA 2.20 1.51 (1.14) (0.69) 23.70 15.55 (4.29) (8.15)Donations and GrantsDepreciation/Amortisation & loss of disposals (1.43) (1.24) 0.00 0.18 (12.68) (10.65) 0.02 2.03Net Interest, Finance & Tax (0.06) (0.11) (0.04) (0.05) (0.59) (0.65) (0.05) (0.06)PDC Dividend (0.55) (0.55) 0.00 0.00 (4.96) (4.96) 0.00 (0.01)Net Surplus/(Deficit) 0.16 (0.40) (1.18) (0.55) 5.48 (0.71) (4.31) (6.19)Remove: Donated Asset items (0.15) 0.03 0.18 0.18 (1.31) (0.53) 0.77 0.77Remove: PSF (1.27) (3.01) (1.75) (1.75) (8.24) (7.45) 0.79 0.79Control Total (1.26) (3.38) (2.75) (2.12) (4.07) (8.69) (2.74) (4.62)

M09 YTD M09

(e) M09 results benefit from the following one off items, which are non-recurrent:

(a) Release of accruals for Purchase Orders receipted more than six months ago for which no invoice has been matched £0.83m

(b) Recovery of VAT through quarterly review £0.66m

(c) Release of Income Provisions following re-assessment of required level of provision £1.00m

(d) Variation to risk share within the Berkshire West contract £1.5m

Income and ExpenditurePlan Actual Vs Q2F Vs Plan Plan Actual Vs Q2F Vs. Plan£m £m £m £m £m £m £m £m

Operating Income 33.50 37.22 1.98 3.72 313.00 318.89 0.66 5.89Pay costs (18.97) (20.01) 0.37 (1.04) (172.05) (180.20) (0.18) (8.15)Non Pay (12.34) (11.73) 0.49 0.61 (117.24) (119.16) (0.78) (1.91)EBITDA 2.20 5.49 2.84 3.30 23.70 19.53 (0.31) (4.17)Donations and GrantsDepreciation/Amortisation & loss of disposals (1.43) (1.24) 0.00 0.18 (12.68) (10.65) 0.02 2.03Net Interest, Finance & Tax (0.06) (0.11) (0.04) (0.05) (0.59) (0.65) (0.05) (0.06)PDC Dividend (0.55) (0.55) 0.00 0.00 (4.96) (4.96) 0.00 (0.01)Net Surplus/(Deficit) 0.16 3.58 2.80 3.43 5.48 3.27 (0.33) (2.21)Remove: Donated Asset items (0.15) 0.03 0.18 0.18 (1.31) (0.53) 0.77 0.77Remove: PSF (1.27) (3.01) (1.75) (1.75) (8.24) (7.45) 0.79 0.79Control Total (1.26) 0.60 1.23 1.86 (4.07) (4.71) 1.24 (0.64)

YTD M09M09

1.2 The Trust has achieved the adjusted Control Total as at December 2018 as a result of the

adjustments outlined above, the effect of the offset with Berkshire Healthcare FT being £0.68m reduction in year to date Control Total

(a) £7.45m Provider Sustainability Fund (PSF) has been recognised in the year to date, representing:

(i) Full achievement of Quarters 1 and 2 (£4.44m)

(ii) Achievement of Q3 A&E Trajectories on the basis that the Trust has achieved the year to date trajectory and the Footprint and A&E Delivery Board Q3 trajectories have been achieved (£1.14m)

(iii) Recognition of the Trust Q3 Financial element (£2.66m)

(iv) Non-recognition of the System PSF element (£(0.79)m)

1.3 Subsequent to the posting of M09 results it was confirmed that Berkshire West CCG had achieved Control Total and, as a result, the system has achieved. The Trust will accordingly recognise an additional £0.79m of income in M10 results, although this will not change performance against Control Total

2 Conclusion and Next Steps

2.1 The Board of Directors is asked to NOTE the report

3 Attachments

3.1 The following are attached to this report:

(a) Appendix 1 – Director of Finance Report

8. Finance - Achieving Financial Sustainability

Director of Finance Report Page 1

CQC - Excellence / Integrity CARE - Resourceful

Income from Activities (excluding Drugs income) – Income is £2.08m ahead of plan in month due £1.80m adjustment to risk share agreement in Berkshire West contract £1.50m

Total Cost (excluding Drugs) – Total costs are £0.04m underspent against budget due to release of purchase order accruals for historic invoices £0.83m, and VAT recovery following quarterly review £0.66m. Cash (£M YTD) – The current £9.00m cash variance includes movement in working capital of £5.00m, cash-flows from operating activities of £(7.8)m, a delay in Capex spend and Charity grants of £9.00m and Agenda for Change funding of £2.7m QIPP delivery – QIPP delivery of £1.23m is below the target by £(0.52)m for M09 (target of £1.75m). Full year risk adjusted programmes represent 85% of full year £16.08m target. Use of Resources - Score of 2.

2 2

Overall Financial Performance for December 2018 – Ahead of budget and forecast in month but behind budget and forecast year–to-date ( YTD), driven by adverse pay but favourable non-pay variances. YTD the Trust is in line with the adjusted control total.

Key Messages:

• Control total missed by £(0.64)m. This is in line with the adjusted control total as a result of offsetting adjustment of control total with Berkshire Healthcare FT

• As a result the Trust has recognised PSF income for the achievement of Q3 financial and A&E performance. At this stage the system PSF has not been achieved for Q3

• Care Groups £(0.74)m behind budget but £0.08m favourable to Q2F predominantly driven by £0.63m of reduction in historic purchase order accruals

• Income is £3.72m ahead of plan in month due to catch up in PSF income, £1.80m adjustment to risk share agreement in Berkshire West contract £1.50m and release of £1.00m contract income provisions no longer required

• Operational Corporate departments £0.59m ahead of budget and £0.65 ahead of Q2F partly driven by £0.20m of reduction in historic purchase order accruals and Estates cost

• Capital Charges and Corporate-Other £3.52m favourable to budget, £2.12m favourable to Q2F, driven by Income as described above and VAT recovery

• Use of Resources Rating: 2

Actions: • All care groups and corporate departments need to

accelerate delivery of QIPP programmes and actions to reduce run rate of expenditure

Results for Month 9£m

Actual £m Vs Q2F

Vs Budget £m

Actual £m Vs Q2F

Vs Budget £m

Income 37.22 1.98 3.72 318.89 0.65 5.89 Pay (20.01) 0.37 (0.84) (180.20) (0.18) (6.21)Drugs (3.46) 0.26 0.49 (35.24) 0.48 1.64 Non Pay ex Drugs (9.51) 0.23 0.04 (94.56) (1.24) (3.53)Other (0.66) (0.04) (0.05) (5.62) (0.04) (0.06)Exceptional Items (0.00) (0.00) (0.00) (0.00) (0.00) (0.00)Surplus/(Deficit) 3.58 2.80 3.37 3.27 (0.33) (2.27)Use of Resources 2 Control Total YTD (4.71) (0.64)

Actual £m Vs Q2F

Vs Budget £m

Actual £m Vs Q2F

Vs Budget £m

Cashflow from Operations 5.01 4.55 (1.37) 5.01 4.55 (1.37)

Cash 33.54 9.09 9.01 33.54 9.09 9.01

EBITDA 5.49 2.65 3.23 19.54 19.84 (4.30)

EBDITDA margin 14.7% 7.5% 8.00% 6.1% 6.2% (1.49%)

Net Surplus/(Deficit)Actual

£m Vs Q2FVs Budget

£mActual

£m Vs Q2FVs Budget

£mUrgent Care (7.50) 0.24 0.04 (71.00) (0.20) (1.52)Planned Care (9.29) 0.05 (0.29) (89.09) 0.08 (3.18)Networked Care (7.53) (0.21) (0.49) (66.66) (0.56) (2.41)E&F (1.74) 0.35 0.26 (17.86) (0.14) (0.18)Corporate Services 29.63 2.37 3.84 247.88 0.48 5.02 Total Trust 3.58 2.80 3.37 3.27 (0.33) (2.27)

IncomeActual

£m Vs Q2FVs Budget

£mActual

£m Vs Q2FVs Budget

£mIncome from Activities 28.11 0.65 2.08 252.50 1.68 3.96 Drug & Devices 3.09 (0.40) (0.63) 31.90 (0.28) (2.33)Other Patient Care Income 0.26 (0.23) (0.11) 3.44 (0.35) 0.24 Other Operating Income 6.65 4.12 4.54 25.35 1.75 6.56 PSF (0.89) (2.15) (2.15) 5.70 (2.15) (2.53)Total Income 37.22 1.98 3.72 318.89 0.65 5.89

MONTH YTD

MONTH YTD

MONTH YTD

MONTH YTD

3 3

Overall Financial Performance for December 2018 against Control Total – Behind Control Total year to date, driven by adverse variance in pay and non pay

Key Messages: • Trust YTD M09 actual deficit position is behind Plan by £(2.21)m. When donated items and PSF income are removed the variance against

Control Total is £(0.64)m

Income and Expenditure VariancePlan Actual Variance Plan Actual Vs. Plan£m £m £m £m £m £m

Operating Income 33.50 37.22 3.72 313.00 318.89 5.89Pay costs (18.97) (20.01) (1.04) (172.05) (180.20) (8.15)Non Pay (12.34) (11.73) 0.61 (117.24) (119.16) (1.91)EBITDA 2.20 5.49 3.30 23.70 19.53 (4.17)Donations and GrantsDepreciation/Amortisation & loss of disposals (1.43) (1.24) 0.18 (12.68) (10.65) 2.03Net Interest, Finance & Tax (0.06) (0.11) (0.05) (0.59) (0.65) (0.06)PDC Dividend (0.55) (0.55) 0.00 (4.96) (4.96) (0.01)Net Surplus/(Deficit) 0.16 3.58 3.43 5.48 3.27 (2.21)Remove: Donated Asset items (0.15) 0.03 0.18 (1.31) (0.53) 0.77Remove: PSF (1.27) (3.01) (1.75) (8.24) (7.45) 0.79Control Total (1.26) 0.60 1.86 (4.07) (4.71) (0.64)

M09 YTD M09

4

Income – Behind Q2F by £1.33m driven by non-accrual of PSF

Analysis of Income from Activities£m Actual vs Q2F vs Budget Actual vs Q2F vs BudgetA&E 1.70 0.02 0.06 15.39 0.14 (0.05)Non Elective 7.88 (0.39) 0.22 70.02 (0.52) (0.04)Elective (incl Daycase) 4.04 (0.39) (0.29) 41.39 (0.54) (1.82)Outpatient (incl Procedures) 5.24 (0.29) (0.48) 55.05 (0.42) (1.68)Maternity 2.43 0.28 0.11 21.47 0.45 (0.24)Critical Care 1.05 0.03 0.02 8.65 (0.23) (0.46)Renal Dialysis & Post Transplant 0.88 0.09 0.10 7.87 0.05 (0.01)Direct Access (Pathology & Radiology) 0.80 0.00 (0.00) 8.27 (0.01) 0.23CQUINs 0.58 0.00 0.00 5.18 (0.00) 0.00Other 3.51 1.29 2.34 19.21 2.76 8.02Total Income from Activities 28.11 0.65 2.08 252.50 1.68 3.96

Month YTD

IncomeActual

£m Vs Q2FVs Budget

£mActual

£m Vs Q2FVs Budget

£mIncome from Activities 28.11 0.65 2.08 252.50 1.68 3.96 Drug & Devices 3.09 (0.40) (0.63) 31.90 (0.28) (2.33)Other Patient Care Income 0.26 (0.23) (0.11) 3.44 (0.35) 0.24 Other Operating Income 2.75 0.22 0.64 23.61 0.01 4.82 PSF 3.01 1.74 1.74 7.45 (0.41) (0.79)Total Income 37.22 1.98 3.72 318.89 0.65 5.89

MONTH YTD

Key Messages: • Month 9 Income from Activities – £0.65m ahead of Q2F

with the main variances as follows: – Non Elective is £(0.39)m behind Q2F. This shortfall is

volume driven with a partial offset in the complexity. – Elective (including Daycase) is £(0.39)m behind Q2F.

Within this total, income from Daycases is £(0.26)m behind Q2F, across a wide range of specialties but most notably within Gastroenterology, Oncology and Ophthalmology. Elective overnight spells are behind Q2F by £(0.13)m.

– The Outpatient (including Procedures) shortfall vs Q2F is £(0.29)m. First Atts are £(0.20)m behind, with Follow Up Atts £(0.14)m behind, with both Procedures and Diagnostic Imaging slightly ahead of Q2F.

– The ‘Other’ favourable variance of £1.29m is largely due to agreed additional funding from Berkshire West CCG – a value of £1.50m at YTD M9 and £2.00m for the full year.

– PSF (Provider Sustainability Funding) income is £1.74m ahead of Q2F in the month, due to the inclusion this month of £3.01m relating to the whole of Q3 (none was included last month).

• Drug & Devices Income is behind Q2F by £(0.40)m. • Other Patient Care Income is behind Q2F by £(0.23)m,

due mainly to shortfalls in Private Patient and Overseas Visitors income of £(0.10)m and £(0.08)m respectively.

• Other Operating Income is £0.22m ahead of Q2F due to additional Training Income in respect of Non-Medical Placements & Upskilling Staff, received from Health Education England.

5

Pay costs – worse than YTD budget by £(6.21)m and Q2F by £(0.18)m Key Messages

• The adverse variance to Budget in

December of £(0.84)m is mainly representative of Care Group overspends of £(0.62)m and an adverse variance in Corporate Other of £(0.5)m (offset in income)

• Performance against Q2F was £0.37m favourable in December and this was driven by Care Group Nursing and Estates underspends

• Pay costs decreased by £0.31m from last month, due to one off CEA costs in prior month

• Care Groups reported M09 adverse variances against budget are driven by:

• PCG - Pay is £(0.12)m higher than budget. The main driver of this is Medical £(0.09)m and Admin £(0.06)m staffing costs

• UCG - Pay is £(0.31)m higher than budget. Budget variances are apparent in Medical staffing, £(0.11)m and Nursing £(0.11)m

• NCG – Pay is £(0.20)m higher than budget. Predominantly driven by Medical staffing’s £(0.11)m variance to budget.

• The reported variance against Q2F for the Care Groups was £0.15m favourable in month

Pay Costs £M

Group Description M04 2018/19

M05 2018/19

M06 2018/19

M07 2018/19

M08 2018/19

M09 2018/19

MoM varMonth vs. Forecast

YTD vs. Forecast

Month vs Budget

YTD vs Budget

Medical Staff 5.86 6.20 5.85 6.02 6.27 5.99 0.28 (0.20) (0.79) (0.33) (1.69)Nursing 7.77 8.05 7.64 7.58 7.64 7.56 0.08 0.43 0.68 (0.25) (2.35)PAMs 1.20 1.22 1.17 1.23 1.26 1.20 0.06 (0.04) (0.14) (0.11) (0.60)Scientist and PTBs 1.13 1.19 1.08 1.14 1.11 1.17 (0.06) (0.01) 0.04 (0.08) (0.23)Pharmacists 0.22 0.23 0.23 0.24 0.22 0.23 (0.01) (0.02) (0.04) (0.02) (0.07)Admin & Management 2.95 3.10 2.84 2.82 2.85 2.76 0.09 0.11 0.09 (0.00) (0.28)Ancil lary & Maintenance 0.88 1.01 0.92 0.83 0.83 0.84 (0.00) 0.18 0.25 0.14 0.18Other Pay 0.12 0.27 0.14 0.13 0.14 0.26 (0.12) (0.07) (0.27) (0.18) (1.17)Pay 20.13 21.28 19.85 19.99 20.32 20.01 0.31 0.37 (0.18) (0.84) (6.21)

By Care Group/DirectorateUCG 6.73 7.00 6.66 6.64 6.88 6.65 0.24 0.02 (0.31) (0.31) (2.03)PCG 6.00 6.40 6.16 6.06 6.17 5.95 0.22 0.05 (0.12) (0.12) (1.05)NCG 4.48 4.72 4.33 4.42 4.31 4.38 (0.06) 0.08 0.23 (0.20) (1.36)Total Care Group 17.21 18.12 17.16 17.12 17.37 16.97 0.40 0.15 (0.21) (0.62) (4.44)Chief Medical Officer 0.22 0.23 0.22 0.22 0.23 0.22 0.01 0.01 0.00 0.02 0.18Chief Nursing Officer 0.35 0.38 0.33 0.33 0.34 0.36 (0.02) (0.00) 0.02 (0.01) 0.06Chief Exec & Non-Execs 0.21 0.21 0.21 0.20 0.20 0.21 (0.00) (0.01) (0.01) (0.00) 0.02Chief Operating Officer 0.05 0.06 0.05 0.05 0.05 0.05 0.01 0.01 0.02 0.01 0.06Workforce and Organisational Development 0.27 0.31 0.29 0.29 0.30 0.29 0.01 0.01 0.00 0.01 0.13Finance 0.26 0.28 0.25 0.26 0.26 0.25 0.01 0.02 0.02 0.02 0.04IT 0.40 0.42 0.39 0.37 0.39 0.30 0.09 0.09 0.11 0.09 0.18Estates & Facil ities 0.95 1.12 0.98 0.90 0.91 0.90 0.00 0.19 0.24 0.16 0.31Corporate - Other 0.20 0.16 (0.05) 0.25 0.26 0.45 (0.20) (0.09) (0.38) (0.50) (2.74)TOTAL Other 2.92 3.16 2.69 2.87 2.95 3.03 (0.09) 0.22 0.03 (0.21) (1.77)Pay 20.13 21.28 19.85 19.99 20.32 20.01 0.31 0.37 (0.18) (0.84) (6.21)

Vs.Forecast VS BUDGET

6

Non Pay Costs – Drugs – Below budget for month 9 by £0.49m and forecast by £0.26m

Key Messages • Drugs income as a % of drugs

costs totalled 82.8% in December, which is below plan although prior year phasing suggests we will get an uplift in Q4

Non Pay - DrugsActual

£m Vs Q2FVs Budget

£mActual

£m Vs Q2FVs Budget

£mUrgent Care (0.34) (0.02) 0.02 (2.94) (0.03) 0.20 Planned Care (1.49) 0.15 0.17 (15.59) 0.69 1.04 Networked Care (1.66) 0.28 0.25 (16.63) 0.17 0.35 Other 0.03 (0.16) 0.04 (0.08) (0.35) 0.05 Total Drugs (3.46) 0.26 0.49 (35.24) 0.48 1.64

MONTH YTD

7

Non Pay Costs – Excluding Drugs – £(1.24)m worse than forecast and £(3.53)m worse than YTD budget

Key messages • December’s non-pay expenditure is

£0.04m favourable to budget and £0.23m favourable to forecast

• Within this there is £0.66m of VAT recovery following the quarter end review of invoices and £0.83m reduction in purchase order accruals where invoices have not been matched to orders that are over 6 months old

• An underlying overspend occurred within Care Groups predominantly due to non-delivery of QIPP

Non Pay ex DrugsActual

£m Vs Q2FVs Budget

£mActual

£m Vs Q2FVs Budget

£mClinical Service & Supplies (3.81) (0.19) (0.24) (34.18) (0.28) (0.61)General Supplies & Services (0.61) (0.08) (0.06) (5.24) (0.18) (0.12)Establishment Expenses (0.16) 0.14 0.17 (2.96) 0.12 (0.00)Other Establishment Expenses (1.61) (0.03) 0.10 (14.44) (0.10) 0.89 Prem, Trans & Fixed Plant (1.73) 0.26 0.20 (15.83) 0.29 0.55 Depreciation (1.24) 0.00 0.19 (10.64) 0.03 2.09 Leases (0.23) 0.03 0.03 (2.08) 0.04 0.26 Miscellaneous Services (0.13) 0.10 (0.35) (9.19) (1.15) (6.59)Total Non Pay ex Drugs (9.51) 0.23 0.04 (94.56) (1.24) (3.53)

Non Pay ex DrugsActual

£m Vs Q2FVs Budget

£mActual

£m Vs Q2FVs Budget

£mUrgent Care (0.88) 0.16 0.14 (10.44) (0.00) (0.55)Planned Care (2.10) (0.01) (0.30) (22.33) (0.27) (3.64)Networked Care (1.83) (0.52) (0.56) (13.40) (0.80) (1.62)Estates & Facilities (1.13) 0.14 0.10 (12.15) (0.36) (0.75)HFMS 0.17 0.13 0.09 1.09 0.17 0.36 Other Corporate (3.73) 0.33 0.57 (37.33) 0.02 2.67 Total Non Pay ex Drugs (9.51) 0.23 0.04 (94.56) (1.24) (3.53)

MONTH YTD

YTDMONTH

8

Point of Delivery – Month 9 December 2018

All CCGs (including NCAs)

POD Group POD Detail Activity Value (£'000) Activity Value

(£'000) Activity Value (£'000) Activity Value

(£'000)

A&E Accident & Emergency 129,843 20,134 10,936 1,683 11,519 1,698 583 15A&E Total 20,134 1,683 1,698 15

Outpatient Outpatient FA Multi Prof Cons Led 4,163 1,096 361 83 316 83 (45) (0)Outpatient FA Single Prof Cons Led 141,306 25,052 12,081 1,881 9,329 1,680 (2,752) (201)Outpatient FA Single Prof Non-Cons Led 2,522 124 233 10 167 9 (66) (1)Outpatient FUP Multi Prof Cons Led 8,309 1,135 727 87 505 72 (222) (15)Outpatient FUP Single Prof Cons Led 240,313 21,300 20,050 1,595 16,246 1,473 (3,804) (122)Outpatient FUP Single Prof Non-Cons Led 5,239 182 456 14 326 12 (130) (2)Outpatient Procedures 129,754 18,841 11,017 1,408 9,506 1,423 (1,511) 15Diagnostic Imaging whilst Outpatient (Unbundled) 62,222 5,983 4,047 388 4,473 424 426 36Non Face to Face 22,495 955 1,721 66 1,512 65 (209) (1)

Outpatient Total 74,668 5,532 5,241 (291)

Elective Elective Inpatients 6,752 21,844 587 1,722 496 1,585 (91) (137)Elective Inpatients - Change re Spells in Progress (vs M12 17-18) 21 45 0 0 1 (4) 1 (4)Elective Excess Bed Days 877 238 61 14 64 17 3 3Day Cases 41,052 32,495 3,694 2,593 2,838 2,351 (856) (242)Haematology - Regular Day Atts (Chemo & Other Infusions) 7,523 1,369 671 107 476 94 (195) (13)

Elective Total 55,989 4,437 4,043 (394)

Non Elective Emergency Inpatients (Excluding Maternity) 36,674 83,010 3,392 7,325 3,019 6,923 (373) (402)Emergency Inpatients - Change re Spells in Progress (vs M12 17-18) (31) 37 0 0 (8) (23) (8) (23)Emergency Same Day 4,823 4,088 406 331 416 341 10 10Emergency Short Stay 4,769 3,687 415 324 432 341 17 17Emergency Excess Bed Days 12,184 3,265 1,135 289 1,082 301 (53) 12

Non Elective Total 94,088 8,268 7,883 (385)

Maternity Maternity Pathway - Antenatal 7,284 10,899 488 721 339 966 (149) 245Maternity Pathway - Postnatal 5,270 1,672 352 111 477 150 125 39Non Elective Non Emergency (Maternity Admissions) 12,949 15,200 1,102 1,286 1,087 1,260 (15) (26)Maternity Excess Bed Days 927 346 82 29 151 56 69 27

Maternity Total 28,118 2,148 2,432 284

Critical Care Adult Critical Care 4,488 7,014 395 618 452 710 57 92Adult Critical Care - Change re Spells in Progress (vs M12 17-18) 117 210 0 0 0 (23) 0 (23)Neonatal Critical Care 7,680 4,187 655 352 525 277 (130) (75)Neonatal Critical Care - Change re Spells in Progress (vs M12 17-18) (223) (91) 0 0 27 11 27 11Paediatric High Dependency 512 500 45 43 72 70 27 27

Critical Care Total 11,819 1,014 1,045 (19) 31

Renal Renal Dialysis & Post Transplant 70,761 10,478 6,231 790 5,857 884 (374) 94Renal Total 10,478 790 884 94

Other Activity Pre-op Assessments 18,051 736 1,279 45 1,312 54 33 9Rehab Bed Days 5,102 1,521 482 126 298 91 (184) (35)Block Priced Items 17,849 1,457 1,491 34Pathology Direct Access 3,593,576 7,633 301,591 572 271,762 578 (29,829) 6Radiology Direct Access 79,988 3,418 5,265 225 5,287 223 22 (2)Orthotics Direct Access 4,462 934 396 71 213 55 (183) (16)Anti Coagulant Reviews 78,197 617 7,498 52 5,442 44 (2,056) (8)Heart Failure Pathway 37 47 3 3 2 2 (1) (1)Post Discharge Rehab 286 169 25 13 17 10 (8) (3)Other (DMARDs etc) 44,593 981 3,227 69 4,209 72 982 3

Other Activity Total 33,906 2,633 2,620 (13)

Drugs & Devices PbR Excluded Drugs 39,675 3,159 2,863 (297)PbR Excluded Devices 3,422 323 223 (100)

Drugs & Devices Total 43,097 3,483 3,086 (396)

Adjustments CQUINs 6,907 576 576 0Marginal Rate on Over Performance re BWCCGs 0 0 0 0MRET & 30 Day Readmits Deductions (Net of Reinvestment) (4,761) 0 (423) (423)Contingency Provision re Contract Deductions 547 358 594 236Adjust BWCCG Income to align with Baseline & Trust Cost profile 1,440 0 (190) (190)Agreed additional funding from Berkshire West CCG 0 0 1,500 1,500

Adjustments Total 4,133 934 2,057 1,123

Bowel Screening & Scoping 804 25 88 63Others 107 3 123 120

Other Income from Activities Total 911 28 211 183

TOTAL (= 'Income from Activities') 377,342 30,949 31,200 251

Other Income from Activites

*** TRUST TOTAL ***

ANNUAL PER Q2F MTH 09 PER Q2F MTH 09 ACTUAL MTH 09 VARIANCE

9

Point of Delivery – YTD April to Dec 2018

All CCGs (including NCAs)

POD Group POD Detail Activity Value (£'000) Activity Value

(£'000) Activity Value (£'000) Activity Value

(£'000)

A&E Accident & Emergency 129,843 20,134 97,950 15,249 99,379 15,390 1,429 141A&E Total 20,134 15,249 15,390 141

Outpatient Outpatient FA Multi Prof Cons Led 4,163 1,096 3,134 815 3,056 809 (78) (6)Outpatient FA Single Prof Cons Led 141,306 25,052 105,724 18,583 101,475 18,220 (4,249) (363)Outpatient FA Single Prof Non-Cons Led 2,522 124 1,875 92 1,792 91 (83) (1)Outpatient FUP Multi Prof Cons Led 8,309 1,135 6,250 844 6,003 831 (247) (13)Outpatient FUP Single Prof Cons Led 240,313 21,300 181,692 15,810 177,265 15,646 (4,427) (164)Outpatient FUP Single Prof Non-Cons Led 5,239 182 3,975 137 3,779 134 (196) (3)Outpatient Procedures 129,754 18,841 97,679 13,999 96,155 14,124 (1,524) 125Diagnostic Imaging whilst Outpatient (Unbundled) 62,222 5,983 46,286 4,454 46,574 4,461 288 7Non Face to Face 22,495 955 17,565 733 17,390 733 (175) (0)

Outpatient Total 74,668 55,468 55,049 (419)

Elective Elective Inpatients 6,752 21,844 5,177 16,444 5,120 16,399 (57) (45)Elective Inpatients - Change re Spells in Progress (vs M12 17-18) 21 45 21 45 18 31 (3) (14)Elective Excess Bed Days 877 238 708 191 682 186 (26) (5)Day Cases 41,052 32,495 31,018 24,239 29,786 23,782 (1,232) (457)Haematology - Regular Day Atts (Chemo & Other Infusions) 7,523 1,369 5,663 1,013 5,319 991 (344) (22)

Elective Total 55,989 41,931 41,389 (542)

Non Elective Emergency Inpatients (Excluding Maternity) 36,674 83,010 27,386 62,287 26,885 61,989 (501) (298)Emergency Inpatients - Change re Spells in Progress (vs M12 17-18) (31) 37 (31) 37 (23) 11 8 (26)Emergency Same Day 4,823 4,088 3,645 3,116 3,684 3,096 39 (20)Emergency Short Stay 4,769 3,687 3,564 2,730 3,547 2,725 (17) (5)Emergency Excess Bed Days 12,184 3,265 8,930 2,374 8,120 2,199 (810) (175)

Non Elective Total 94,088 70,544 70,020 (524)

Maternity Maternity Pathway - Antenatal 7,284 10,899 5,362 8,061 5,411 8,383 49 322Maternity Pathway - Postnatal 5,270 1,672 3,885 1,234 4,079 1,293 194 59Non Elective Non Emergency (Maternity Admissions) 12,949 15,200 9,750 11,465 9,815 11,493 65 28Maternity Excess Bed Days 927 346 691 261 775 297 84 36

Maternity Total 28,118 21,021 21,466 445

Critical Care Adult Critical Care 4,488 7,014 3,341 5,218 3,374 5,244 34 26Adult Critical Care - Change re Spells in Progress (vs M12 17-18) 117 210 117 210 (9) (11) (126) (221)Neonatal Critical Care 7,680 4,187 5,778 3,164 5,541 3,031 (237) (133)Neonatal Critical Care - Change re Spells in Progress (vs M12 17-18) (223) (91) (223) (91) (133) (59) 90 32Paediatric High Dependency 512 500 381 373 451 442 70 69

Critical Care Total 11,819 8,874 8,647 (170) (227)

Renal Renal Dialysis & Post Transplant 70,761 10,478 53,484 7,817 53,060 7,872 (424) 55Renal Total 10,478 7,817 7,872 55

Other Activity Pre-op Assessments 18,051 736 14,504 585 15,069 618 565 33Rehab Bed Days 5,102 1,521 3,738 1,114 3,450 1,059 (288) (55)Block Priced Items 17,849 13,391 13,414 23Pathology Direct Access 3,593,576 7,633 2,756,453 5,744 2,730,871 5,763 (25,582) 19Radiology Direct Access 79,988 3,418 59,257 2,532 58,973 2,505 (284) (27)Orthotics Direct Access 4,462 934 3,359 701 3,113 677 (246) (24)Anti Coagulant Reviews 78,197 617 57,408 446 53,271 424 (4,137) (22)Heart Failure Pathway 37 47 27 34 28 35 1 1Post Discharge Rehab 286 169 216 127 191 114 (25) (13)Other (DMARDs etc) 44,593 981 35,491 755 37,303 706 1,812 (49)

Other Activity Total 33,906 25,428 25,315 (113)

Drugs & Devices PbR Excluded Drugs 39,675 29,731 29,554 (177)PbR Excluded Devices 3,422 2,445 2,343 (102)

Drugs & Devices Total 43,097 32,176 31,898 (278)

Adjustments CQUINs 6,907 5,180 5,180 (0)Marginal Rate on Over Performance re BWCCGs 0 0 0 0MRET & 30 Day Readmits Deductions (Net of Reinvestment) (4,761) (2,695) (3,508) (813)Contingency Provision re Contract Deductions 547 (265) 353 618Adjust BWCCG Income to align with Baseline & Trust Cost profile 1,440 1,440 2,810 1,370Agreed additional funding from Berkshire West CCG 0 0 1,500 1,500

Adjustments Total 4,133 3,660 6,335 2,675

Bowel Screening & Scoping 804 726 869 144Others 107 98 143 45

Other Income from Activities Total 911 824 1,012 189

TOTAL (= 'Income from Activities') 377,342 282,993 284,393 1,401

Other Income from Activites

*** TRUST TOTAL ***

ANNUAL PER Q2F YTD PER Q2F YTD ACTUAL YTD VARIANCE

10

Price/Volume Income Variances

POD Detail Vol Value (£000) Vol

Value (£000) Vol

Value (£000)

Vol (£000)

Price (£000) Price %

Total (£000)

Accident & Emergency 97,950 £15,249 99,379 £15,390 1,429 £141 £222 (£81) -0.5% £141A&E Total £15,249 £15,390 £141 £222 (£81) £141

Outpatient FA Multi Prof Cons Led 3,134 £815 3,056 £809 (78) (£6) (£20) £14 1.8% (£6)Outpatient FA Single Prof Cons Led 105,724 £18,583 101,475 £18,220 (4,249) (£363) (£747) £383 2.2% (£363)Outpatient FA Single Prof Non-Cons Led 1,875 £92 1,792 £91 (83) (£1) (£4) £3 3.6% (£1)Outpatient FUP Multi Prof Cons Led 6,250 £844 6,003 £831 (247) (£13) (£33) £20 2.5% (£13)Outpatient FUP Single Prof Cons Led 181,692 £15,810 177,265 £15,646 (4,427) (£164) (£385) £221 1.4% (£164)Outpatient FUP Single Prof Non-Cons Led 3,975 £137 3,779 £134 (196) (£3) (£7) £4 2.7% (£3)Outpatient Procedures 97,679 £13,999 96,155 £14,124 (1,524) £125 (£218) £344 2.5% £125Diagnostic Imaging whilst Outpatient (Unbundled) 46,286 £4,454 46,574 £4,461 288 £7 £28 (£20) -0.5% £7Non Face to Face 17,565 £733 17,390 £733 (175) (£0) (£7) £7 0.9% (£0)Outpatient Total £55,468 £55,049 (£419) (£1,395) £975 (£419)

Elective Inpatients (incl Spells in Progress Change) 5,198 £16,489 5,138 £16,430 (60) (£59) (£189) £130 0.8% (£59)Elective Excess Bed Days 708 £191 682 £186 (26) (£5) (£7) £3 1.4% (£5)Day Cases 31,018 £24,239 29,786 £23,782 (1,232) (£457) (£963) £506 2.2% (£457)Haematology - Regular Day Atts (Chemo & Other Infusions) 5,663 £1,013 5,319 £991 (344) (£22) (£62) £39 4.1% (£22)Elective Total £41,931 £41,389 (£542) (£1,220) £678 (£542)

Emergency Inpatients (incl Spells in Progress Change) 27,355 £62,323 26,862 £62,000 (493) (£323) (£1,123) £800 1.3% (£323)Emergency Same Day 3,645 £3,116 3,684 £3,096 39 (£20) £33 (£54) -1.7% (£20)Emergency Short Stay 3,564 £2,730 3,547 £2,725 (17) (£5) (£13) £8 0.3% (£5)Emergency Excess Bed Days 8,930 £2,374 8,120 £2,199 (810) (£175) (£215) £40 1.9% (£175)Non Elective Total £70,544 £70,020 (£524) (£1,319) £795 (£524)

Maternity Pathway - Antenatal 5,362 £8,061 5,411 £8,383 49 £322 £74 £248 3.1% £322Maternity Pathway - Postnatal 3,885 £1,234 4,079 £1,293 194 £59 £62 (£2) -0.2% £59

Non Elective Non Emergency (Maternity Admissions) 9,750 £11,465 9,815 £11,493 65 £28 £76 (£48) -0.4% £28Maternity Excess Bed Days 691 £261 775 £297 84 £36 £32 £4 1.3% £36Maternity Total £21,021 £21,466 £445 £244 £201 £445

Adult Critical Care (incl Spells in Progress Change) 3,458 £5,428 3,365 £5,233 (93) (£195) (£145) (£50) -0.9% (£195)Neonatal Critical Care (incl Spells in Progress Change) 5,555 £3,073 5,408 £2,972 (147) (£101) (£81) (£19) -0.6% (£101)Paediatric High Dependency 381 £373 451 £442 70 £69 £69 £0 0.0% £69Critical Care Total £8,874 £8,647 (£227) (£158) (£69) (£227)

Renal Dialysis & Post Transplant 53,484 £7,817 53,060 £7,872 (424) £55 (£62) £117 1.5% £55Renal Total £7,817 £7,872 £55 (£62) £117 £55

Pre-op Assessments 14,504 £585 15,069 £618 565 £33 £23 £10 1.6% £33Rehab Bed Days 3,738 £1,114 3,450 £1,059 (288) (£55) (£86) £31 3.0% (£55)Pathology Direct Access 2,756,453 £5,744 2,730,871 £5,763 (25,582) £19 (£53) £72 1.3% £19Radiology Direct Access 59,257 £2,532 58,973 £2,505 (284) (£27) (£12) (£14) -0.6% (£27)Orthotics Direct Access 3,359 £701 3,113 £677 (246) (£24) (£51) £28 4.3% (£24)Anti Coagulant Reviews 57,408 £446 53,271 £424 (4,137) (£22) (£32) £10 2.5% (£22)Heart Failure Pathway 27 £34 28 £35 1 £1 £1 (£0) -1.3% £1Post Discharge Rehab 216 £127 191 £114 (25) (£13) (£15) £2 2.0% (£13)Other (DMARDs etc) 35,491 £755 37,303 £706 1,812 (£49) (£49)Other Activity Total £12,037 £11,901 (£136) (£226) £138 (£136)

Block Priced Items £13,391 £13,414 £23 £23PbR Excluded Drugs £29,731 £29,554 (£177) (£177)PbR Excluded Devices £2,445 £2,343 (£102) (£102)CQUINs £5,180 £5,180 (£0) (£0)Marginal Rate on Over Performance re BWCCGs £0 £0 £0 £0MRET & 30 Day Readmits Deductions (Net of Reinvestment) (£2,695) (£3,508) (£813) (£813)Contingency Provision re Contract Deductions (£265) £353 £618 £618Adjust BWCCG Income to align with Baseline & Trust Cost profile £1,440 £2,810 £1,370 £1,370Agreed additional funding from Berkshire West CCG £0 £1,500 £1,500 £1,500Bowel Screening Block Contract £726 £869 £144 £144Others £98 £143 £45 £45All Other Items Total £50,051 £52,659 £2,608 £2,608

TOTAL (= 'Income from Activities') £282,993 £284,393 £1,401 £1,401

YTD Mth 09Q1F ACTUAL VARIANCE VARIANCE ANALYSIS

11

Extract from November Monthly return to NHSI – included as information for the Board

Audited PY Plan Actual Variance Plan Forecast Variance31/03/2018 30/11/2018 30/11/2018 30/11/2018 31/03/2019 31/03/2019 31/03/2019

Expected Year ending YTD YTD YTD Year ending Year ending Year endingSign £'000 £'000 £'000 £'000 £'000 £'000 £'000

Performance against control totalSurplus/(deficit) before impairments and transfers +/- 8,538 5,320 (264) (5,584) 10,744 9,844 (900)Adjusted financial performance surplus/(deficit) including PSF +/- 7,734 4,161 (829) (4,990) 8,989 8,089 (900)Control total +/- 4,617 4,161 4,161 0 8,989 8,989 0

Performance against control total +/- 3,117 0 (4,990) (4,990) 0 (900) (900)Performance against control total excluding PSF

Adjusted financial performance surplus/(deficit) including PSF +/- 7,734 4,161 (829) (4,990) 8,989 8,089 (900)Less provider sustainability fund (PSF) +/- (11,950) (6,970) (4,436) 2,534 (12,673) (12,673) 0Adjusted financial performance surplus/(deficit) excluding PSF +/- (4,216) (2,809) (5,265) (2,456) (3,684) (4,584) (900)Control total excluding PSF +/- (4,395) (2,809) (2,809) 0 (3,684) (3,684) 0

Performance against control total excluding PSF +/- 179 0 (2,456) (2,456) 0 (900) (900)Adjusted financial performance as a % of Turnover (I&E Margin)

Including PSF % 1.89% 1.50% (0.30%) (1.79%) 2.16% 1.93% (0.23%)Excluding PSF % (1.06%) (1.04%) (1.91%) (0.87%) (0.91%) (1.13%) (0.21%)

EBITDAEBITDA value +/- 25,820 20,012 13,122 (6,890) 32,990 29,468 (3,522)as a percentage of related income % 6.31% 7.20% 4.67% (2.52%) 7.93% 7.03% (0.90%)

Efficiencies iTotal recurrent efficiencies i + 7,951 8,673 4,826 (3,847) 16,080 10,032 (6,048)High risk schemes + 1,704 2,156 0 (2,156) 3,997 96 (3,901)Total unidentified efficiencies i + 0 0 0 0 0 0 0Total identified efficiencies i + 15,346 8,673 8,427 (246) 16,080 16,140 60

Total efficiencies + 15,346 8,673 8,427 (246) 16,080 16,140 60Total efficiencies as a percentage of expenditure (before efficiencies) % 3.68% 3.07% 2.91% (0.16%) 3.80% 3.78% (0.02%)Capital

Gross capital expenditure + 20,583 21,993 12,130 9,863 40,000 34,170 5,830Disposals / other deductions - (4,511) 0 0 0 0 0 0

Charge after additions/deductions + 16,072 21,993 12,130 9,863 40,000 34,170 5,830Less donations and grants received - (1,334) (1,664) (965) (699) (2,500) (2,247) (253)Less PFI capital (IFRIC12) - 0 0 0 0 0 0 0Plus PFI residual interest + 0 0 0 0 0 0 0 g p p adjustments +/- 0 0 0 0 0 0 0

Total CDEL +/- 14,738 20,329 11,165 9,164 37,500 31,923 5,577Cash

Cash and cash equivalents at period end + 41,185 23,809 30,539 6,731 18,422 26,369 7,947DHSC capital financing i +/- 5,390 2,000 1,270 (730) 2,500 6,023 3,523DHSC interim revenue financing i +/- 0 0 0 0 0 0 0

Agency and contractTotal agency costs excluding outsourced bank + 9,725 5,832 6,380 (548) 8,748 9,448 (700)Updated agency ceiling + 10,320 6,336 6,336 0 9,502 9,502 0Agency costs as a percentage of gross payroll costs i % 4.28% 3.81% 3.99% 0.18% 3.83% 3.96% 0.13%

TurnoverTotal operating income + 410,660 279,497 281,664 2,167 418,234 421,496 3,262Less capital donations/grants income impact - (1,334) (1,496) (965) 531 (2,247) (2,247) 0Remove impact of prior year PSF post accounts reallocation - 0 0 0Total turnover + 409,326 278,001 280,698 2,697 415,987 419,249 3,262

12

Capital Expenditure Summary

Key messages: • The table to the left is the latest

view of the level of capital expenditure likely in 2018/19

• The table below shows expected phasing of projects spend and when it is anticipated Board approval will be sought.

2018/19 Original

Plan

2018/19 Revised Forecast

Spend to Date

Commit-ments

Orders to be raised

Sub Total

£m £m £m £m £m £m

Medical Equipment 11.00 11.00 (2.91) (5.38) (2.71) (11.00)

Major Estates Work 15.00 8.37 (3.11) (1.67) (3.59) (8.37)

Estates Compliance 5.00 4.13 (2.05) (0.70) (1.38) (4.13)

IM&T Department 7.50 9.42 (5.22) (2.29) (1.91) (9.42)

IM&T Other 0.75 0.75 (0.00) (0.00) (0.75) (0.75)

Transformation Fund 0.50 0.50 (0.02) (0.00) (0.48) (0.50)

Other 0.25 0.00 (0.00) (0.00) 0.00 0.00

Total 40.00 34.17 (13.31) (10.04) (10.82) (34.17)

Capital Expenditure Plan 18/19 - Accrual Basis

Line Type Description Funding 18/19 Capex Jan-19 Feb-19 Mar-196 Bldg North Block Hot Water Services - comprises a number of smaller projects B 1,000,000

34 Bldg Maternity HMA B 1,440,00041 Planned Care New LINAC Bunker @ RBH site - to house LA4 replacement B 2,622,000122 Planned Care Replacement of LA4 B 1,941,60042 Trustwide Additional Bed Capacity B 2,500,00044 Urgent Care Radiology Room 20 B 1,009,00047 Urgent Care Dingley Move B 900,00081 Planned - Replac Endoscopy C-Arm (likely completion 2019/20) L 960,000120 Planned Care AER and RO (likely completion 2019/20) B 1,440,000121 Urgent Care Mobile MRI scanner B 1,440,000

Trustwide Bed Replacement Programme B 1,062,000

Key: Finance & Investment Committee and Board of DirectorsTender/ProcureDelivery/Completion

13

Cash Flow Statement

Key messages • Year to date Cash of £33.54m is up on

plan due to the following:

– Movement in working capital £5.00m

– Agenda for Change funding £2.70m

– Cash flows from Operating Activities £(7.80)m

– Capital £9.00m

(As shown in the table below)

ROYAL BERKSHIRE NHS FOUNDATION TRUSTSTATEMENT OF CASH FLOW December 2018

NB - Against 18/19 APR Budget ForecastApril 2018 December 2018 December 2018 YTD December 2019

YTD Actual Month Actual YTD Actual 18-19 Q2 Forecast£000 £000 £000 £000

Opening cash Balance 41.19 30.54 41.19 41.19

Income 281.66 37.23 318.89 313.00Expenditure (incl Depr'n) (267.62) (31.73) (299.35) (288.31)

Cash generated 14.04 5.50 19.54 24.69

Working Capital(Increase)/decrease in inventories (0.08) 0.23 0.15 0.50(Increase)/decrease in receivables (5.00) 1.33 (3.67) (3.70)(Increase)/decrease in provisions (0.47) (0.59) (1.07) (1.49)Increase/(decrease) in payables 2.01 (1.34) 0.67 (6.92)

(3.54) (0.37) (3.92) (11.60)Investing ActivitiesCapex (Capital expenditure) (16.19) (0.74) (16.93) (24.13)Proceeds from sale of property, plant and equipment 0.00 0.00 0.00 0.00PDC receipt 1.27 0.54 1.81 0.00PDC paid (4.25) 0.00 (4.25) (3.79)

(19.17) (0.20) (19.38) (27.92)Financing ActivitiesInterest income/ (Expense) 0.16 0.02 0.18 0.01Interest expense (0.45) (0.36) (0.81) (0.75)Other (0.19) (0.08) (0.27) 1.93

(0.48) (0.42) (0.90) 1.19LoansLoan Drawdown 0.00 0.00 0.00 0.00Loan (Repayment) (1.50) (1.50) (3.00) (3.00)

Net increase/(decrease) in cash (10.65) 3.00 (7.65) (16.65)

Closing Cash Balance 30.54 33.54 33.54 24.54

£mDelay in Capex spend & charity grants 7.2Deficit movement against plan (7.8)Agenda for Change funding 2.7PDC - Capital 1.8Receivables movements 0.0Decrease in creditors, inc suppliers payment witheld 5.0Cash movement 9.0

14

Long term cash scenarios

Key message: the Trust’s cash balance is expected to remain positive across the next 12 months if mitigating action is taken.

Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20Scenario 1Month end cash as currently forecast / planned

36,210 31,100 30,539 33,544 20,071 18,489 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423

Mid-month low expected £2M lower than month end

(2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000)

Scenario 1 36,210 31,100 30,539 33,544 18,071 16,489 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423

Scenario 225% underdelivery of QIPPs in 18/19 and 19/20

(470) (939) (1,409) (1,623) (1,837) (2,051) (2,336) (2,621) (2,907) (3,335) (3,763) (4,191) (4,690) (5,190) (5,689) (5,903)

Activity income 1% below plan (326) (625) (944) (1,244) (1,544) (1,844) (2,144) (2,444) (2,744) (3,044) (3,344) (3,644) (3,944) (4,244) (4,544) (4,844)Underperformance results in loss of PSF

(4,410) (4,410) (12,600) (12,600) (12,600) (12,600) (12,600) (12,600) (12,600) (12,600) (12,600) (12,600) (12,600) (12,600) (12,600) (12,600)

Scenario 2 36,210 31,100 30,539 33,544 12,865 10,514 1,470 956 442 (72) (658) (1,243) (1,828) (2,556) (3,284) (4,012) (4,812) (5,611) (6,410) (6,924)

Scenario 3Earlier settlement of DXC payments

(5,000) (5,000)

Scenario 3 36,210 31,100 30,539 33,544 7,865 5,514 1,470 956 442 (72) (658) (1,243) (1,828) (2,556) (3,284) (4,012) (4,812) (5,611) (6,410) (6,924)

Scenario 4Delay in commissioner receipts for contract overperformance

(150) (300) (450) (600) (750) (900) (1,050) (1,200) (1,350) (1,500) (1,650) (1,800) (1,950) (2,100) (2,250) (2,400)

Scenario 4 36,210 31,100 30,539 33,544 7,715 5,214 1,020 356 (308) (972) (1,708) (2,443) (3,178) (4,056) (4,934) (5,812) (6,762) (7,711) (8,660) (9,324)

Mitigation AQ2 to Q4 capex spend halved 2,333 4,666 7,004 7,004 7,004 7,004 7,004 7,004 7,004 7,004 7,004 7,004 7,004 7,004 7,004 7,004

Mitigation B50% reduction in cost relating to activity income below plan - with 6 month delay

0 0 0 0 0 0 163 313 472 622 772 922 1,072 1,222 1,372 1,522

BW contract income unaffected by activity

212 407 614 809 1,004 1,199 1,394 1,589 1,784 1,979 2,174 2,369 2,564 2,759 2,954 3,149

Mitigated Mid Month Low Cash 36,210 31,100 30,539 33,544 10,260 10,287 8,637 8,168 7,699 7,230 6,853 6,462 6,081 5,548 5,015 4,482 3,878 3,274 2,669 2,350

Assume stays flatActual NHSI Monthly from Annual Plan

Title: Integrated Care System Update (ICS) Agenda item no: 5c Meeting: Board of Directors Date: 30 January 2019 Presented by: Andrew Statham, Director of Strategy Prepared by: Andrew Statham, Director of Strategy Purpose of the Report To provide the board with an update on the progress of the Berkshire

West Integrated Care System.

Report History Executive Management Committee – 28th January 2019 Board of Directors – 28th November 2018

What action is required? The Committee is asked to note the contents of the report.

Assurance Information ✓ Discussion/input Decision/approval


Relationship to Risk in BAF: Progress on ICS

Strategic objectives This report impacts on (tick all that apply):: Provide the highest quality care Invest in our staff and live out our values Drive the development of integrated services ✓ Cultivate innovation and transformation Achieve long-term financial sustainability Well Led Framework applicability: Not applicable

1. Leadership ✓ 2. Vision & Strategy ✓ 3. Culture 4. Governance ✓

5. Risks, Issues & ✓ Performance


7. Engagement ✓ 8. Learning & Innovation

Positive – supports boards understanding of progress of the ICS Publication Published on website Confidentiality (FoI): Private Public ✓

1 Background and purpose: 1.1 The Trust is part of the Berkshire West Integrated System, a collaboration between health

and social care organisations to improve services for our local population, delivering consistent high quality and safe care, ensuring the best possible outcome and experience for patients, whilst delivering financial stability across the system.

1.2 The BWICS is comprised of the following constituent members:

(a) Acute Hospital Provider – Royal Berkshire NHS Foundation Trust (RBFT);

(b) Community/Mental Health services Provider – Berkshire Healthcare Foundation Trust (BHFT);

(c) Primary Care Provider Alliances – covering four distinct localities – South Reading, Wokingham, Newbury and North and West Reading Alliances; and

(d) Clinical Commissioning Group – Berkshire West CCG.

1.3 Together with our Local Authority partners we are responsible for the health and wellbeing of 528,000 residents living across three Local Authority Areas:

(a) West Berkshire;

(b) Reading; and

(c) Wokingham.

1.4 Our collective aspiration is to deliver:

(a) An improvement in the health and wellbeing of our population;

(b) Enhancements to the experience of using health care services; and

(c) Value for money to local taxpayers and financial sustainability of services

1.5 Delivering on this agenda will require us to:

(a) Make fast and tangible progress in urgent and emergency care reform, strengthening general practice and improving mental health and cancer services;

(b) Manage these and other improvements within a shared financial control total and to maximise the system-wide efficiencies;

(c) Integrate services and funding, operating as an integrated health system, and progressively to build the capabilities to manage the health of the ICS’ defined population, keeping people healthier for longer and reducing avoidable demand for healthcare services; and

(d) Demonstrate to other parts of the health and care system what can be achieved with strong local leadership and increased freedoms and flexibilities.

1.6 The purpose of this paper is to update the board on the progress and activities of the ICS.

2 Key 2018/19 Q3 activities:

2.1 Key achievements during Q3 include:

(a) A number of patient and governor engagement events on the ICS and re-lauch of our ICS website

(b) Development of a Berkshire West Urgent Care Strategy for the next 5 years and completion of the demand and capacity modelling on the Berkshire West bed state

(c) Support from NHSE to be one of 4 systems to be part of the accelerated population health management development programme

(d) Strong performance against operational and finance standards;

(e) Commencement of operational planning for 19/20 and including identification of priority programmes

(f) Completion of the ICS organisation design programme

3 Summary of progress and forward look priorities:

3.1 In 2017/18 Berkshire West ICS was again recognised for its consistently strong performance clinically, operationally and financially, and for the alignment of its constituent organisations to the ICS vision.

3.2 Appended to this report is the latest ICS delivery report which highlights the progress made against each of the four areas NHSE and NHSI have identified as priority areas for ICS.

3.3 The ICS is currently looking to develop a system assurance report which will seek to integrate information from a number of existing reports in order to provide boards with a comprehensive view of quality, operational performance, delivery of commitments and finance. It is expected that the first of these reports will be available at the start of 19/20.

3.4 The summary delivery report highlights that while current and historic performance remains strong, the programme as a whole is rated as AMBER due to financial forward view and immaturity of ICS projects.

4 Recommendation to board:

4.1 The Board are asked to note the contents of this report.

5 Attachments:

5.1 Appendix 1: ICS delivery report

Berkshire West ICS Programme Delivery Report

DECEMBER 2018

1

Actions to improve ICS delivery

• ICS PROGRAMME REPORT: Following UE in November, the ICS Programme Report will be redesigned to provide a consolidated system view on FYFV delivery, quality and safety, finance, and delivery of the ICS Programme. A proposed report structure will be presented at February UE.

• ICS PROJECT METHODOLOGY: A joint ICS methodology and suite of reports which will support delivery of ICS projects needs to be developed. This will be particularly important for any closer working between transformation teams and flexibility with resourcing of projects.

• FINANCES: Planning needs to commence now on closing the financial gap for 19/20 with a fundamentally different approach to what was previously CCG QIPP. Directors of Strategy will work with Directors of Finance to refine the work required.

• WORKING CLOSELY WITH LOCAL AUTHORITIES: Feedback from Programme Boards have been that working closer with Local Authorities would benefit system transformation, such as for long term conditions.

• STAFF ENGAGEMENT: Staff focus sessions on the ICS are currently being planned. This will address the challenge that staff currently do not understand the ICS or do not feel they are part of the ICS.

• ICS ENABLERS: Enablers such as digital, workforce, communications & engagement and quality need to have a stronger link into the ICS governance structure so that there are clear paths of direction and escalation.

Key actions to improve system delivery

• ICS Strategic Priorities for 19/20 – A long list of ICS strategic priorities for next year is being developed by DoS. High level criteria for what constitutes an ICS project has been defined. This long list will be socialised with key stakeholders and Programme Boards during January with a proposal for 19/20 priorities to be presented at February UE.

• OD sessions – Mental Health Delivery Group, Digital and Plenary 2 are the remaining OD sessions. Feedback from all sessions will be collated and presented back at the Plenary 2 session. UE are asked to review the purpose and attendees for the Plenary 2 session.

• Patient experience discovery event – positive feedback on patient engagement discovery event on the 4th December. Action plans are being developed from the outputs of the session that will feed into the overall comms and engagement plan.

• UEC Strategy – Feedback has been sought from system partners and stakeholders to feed into the overall UEC Strategy. • Alcohol – A joint health and care system meeting was held to discuss the alcohol agenda, and it was proposed that the governance for this project would be shared

between both ICS and BW10 as an example of joint working and wider integration.

Items for Unified Exec attention

2

Berkshire West ICS: Performance scorecard for MoU Domains 1-4

Objective

1. Make tangible progress on urgent care, general practice, mental health and cancer services

2. Manage the finances within the system control total

3. Develop integrated pathways and build population health capability

4. Provide leadership at both local and national level

AG

G

In year status Commentary

• Challenge with achieving the A&E 4 hour target for Q3 due to increase in demand, high conversion rate and high acuity of patients.

• Outstanding challenges to address are presented in greater detail through the new FYFV Delivery Report

• System control total agreed. • Payment mechanisms and risk share agreed for 18/19 • Working with NHSI pricing team to secure additional support for the costing work stream • Further work required on system efficiency plan • Longer term plan required, DoFs to meet with DoS’

• New Care Models / national Vanguard clinical models extensively deployed in local system • Production of blueprint required for PHM in Berkshire West – roadmap with milestones for short term deliverables has been

developed • Communications and engagement strategy and plan for both public and staff in development. Strategy has been approved

by UE in November, with the plan being formally received by UE in December. • Significant local executive buy-in to ICS approach, meetings and delivery of priorities

• Berkshire West ICS MoU developed in conjunction with NHSE to reflect local priorities and deliverables. This has been signed off at UE and individual organisational Boards

• Demonstrating national leadership of specific focused workstreams and good CO level attendance at national ICS meetings • Organisational development sessions, facilitated by the King’s Fund, in place for UE, CDG, CFOs and Programme Boards to

support delivery of ICS objectives and priorities

AG

• The system is in a positive position re delivery of 5YFV priorities but is rated AMBER due to financial forward view and immaturity of ICS projects • Main elements of risk currently reside in Domain 2 – System Financial Position • Assessment of current FYFV delivery status is positive with some focus areas to resolve

Q3 2018/19

Overall System status

A

G

R

Forward status

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Agenda Item 6a

Finance and Investment Committee Monday 19 November 2018 10.05 – 12.00 Boardroom, Level 4, Royal Berkshire Hospital Members Mrs. Sue Hunt (Non-Executive Director) (Chair) Ms. Caroline Ainslie (Director of Nursing) Mr. Craig Anderson (Director of Finance) Mr. Brian Hendon (Non-Executive Director) Mr. Steve McManus (Chief Executive) Mr. John Petitt (Non-Executive Director) Mr. Graham Sims (Chair of the Trust) In Attendance Mrs. Mandy Claridge (Director of Operations, Urgent Care) Mr. Mike Clements (Deputy Director of Finance – Central Finance) Mr. Warren Fisher (Care Group Director, Planned Care) (for minute 138/18 to minute 139/18) Mrs. Caroline Lynch (Trust Secretary) Ms. Clara Purnell (Interim Head of Procurement) (from minute 138/18) Ms. Sarah Webster (Care Group Director of Operations, Planned Care)

(for minute 138/18 to minute 139/18) Apologies Ms. Mary Sherry (Chief Operating Officer) 135/18 Declarations of Interest There were no declarations of interest. 136/18 Minutes: 22 October 2018 & Matters Arising Schedule

The minutes of the meeting held on 22 October 2018 were approved as a correct record and signed by the Chair.

The Committee received the matters arising schedule and noted actions were completed or included as agenda items.

137/18 October Finance Update The Deputy Director of Finance introduced the report and advised that October financial

performance was £800k behind forecast, £1m behind budget and £180k behind the financial control total. Care Groups were £86k behind budget which was predominantly driven by pay and non-pay. Income was £3.3m ahead of plan due to the accrual of income in line with cost phasing rather than activity delivered.

The Deputy Director of Finance advised that non-elective activity was being reviewed as

there had been less complex activity and work was on-going with the informatics and

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Finance & Investment Committee November 2018

coding teams to ascertain if less detail was being captured on the digital record. The Director of Finance advised that there had been a high number of uncompleted Electronic Discharge Letters (EDLs) and a reminder had been issued to staff accordingly.

The Deputy Director of Finance advised that Provider Sustainability Fund (PSF) monies

had not been accrued as the ED trajectory was 86% against a target of 90%. The Director of Finance confirmed that there was a significant risk that the target for the quarter would not be achieved. However, the financial component of PSF monies had been accrued which was £800k for the month.

The Committee discussed the additional controls that had been put in place in relation to

pay. The Care Group Director of Operations, Urgent Care, advised that nursing spend was reviewed on a weekly basis by the Director of Nursing and medical spend required approval on a weekly basis by the Medical Director. The Medical Director advised that, in relation to medical spend, some additional sessions related to cancer waiting lists and/or areas that had seen an increase in activity or had difficulty recruiting such as dermatology. The Director of Nursing advised that, in relation to nursing spend, the premium for agency staff had had an impact. The Committee queried whether these issues had been considered as part of the budget setting. The Director of Finance advised that established staffing levels for wards were included in the budget setting. However, it had been anticipated that agency spend would reduce but as this had not reduced, use of agency had incurred the additional premium. The Director of Finance advised that pay and non-pay at specialty level was being reviewed.

The Committee noted that nursing pay was overspent by £60k in the previous month and

medical spend was £340k over budget therefore these were being reviewed. It was agreed that a briefing note would be prepared to set out the detail behind the medical spend and whether this was likely to continue. This would also include what decisions could be made in relation to this. Action: L Barker/C Anderson

The Director of Finance advised that, as part of the discussions with Care Groups, the

focus was on the run rate of cost. Work was currently on-going in relation to budget setting for 2019/20 as well as clarifying the cycle in relation to central provisions and QiPPs.

The Committee queried if there were any issues in relation to drug income. The Director

of Finance advised that drugs income as a percentage of drugs costs were monitored. This was currently being reviewed as more inter-month variance was being seen. A further update would be included in the report to the Committee in December.

Action: C Anderson 138/18 Quarter 2 Forecast The Director of Finance gave an overview of on-going actions in relation to the Quarter 2

Forecast. This included a weekly review with Care Groups and fortnightly review by the Executive team to ensure that the identified corrective actions were being progressed. Consideration to engaging a turnaround resource was also being considered. In addition, the consequence of not achieving the financial control total and the implication on both the cash position and the capital programme was also being prepared. Work was also on-going in relation to budget setting for 2019/20 with a key focus on the run rate of cost. Stakeholder management including Integrated Care System (ICS) partners and NHS Improvement (NHSI) was also being considered.

The Chief Executive confirmed that assurance was being sought from both Care Groups

and corporate areas regarding corrective actions. The Chief Executive confirmed that he was assured that there was a focus on the financial position but there was a need to increase the level of oversight therefore turnaround resource was being considered.

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The Committee noted that the Trust’s financial position had already been discussed with

finance directors within the ICS. The Chief Executive would also discuss the situation with his counterparts within the ICS. The Director of Finance was also due to meet with NHSI the following week. However, the financial position had also been highlighted with NHSI at the last oversight meeting. The Chief Executive advised that the capital programme would be re-phased and indicative budgets for 2019/20 had been issued.

The Committee agreed that the Board would need to consider the material risk of not achieving the financial control total. The Director of Finance highlighted that the Trust could receive formal notice from NHSI with a revised forecast that the Board would need to approve. The Director of Nursing highlighted the potential impact on the Trust’s CQC rating as a result of not achieving the financial control total.

139/18 Bed Management Business Case The Care Group Director of Operations, Planned Care, introduced the business case and

advised that approval was sought to replace the current fleet of 781 beds. The Care Group Director of Operations, Planned Care, confirmed that, operationally, it would be more beneficial to replace all beds. The Committee noted that there was a slight difference in cost in relation to outright purchase or financial lease. The Director of Finance confirmed that the Care Group team could explore this as part of the work to progress the Quarter 2 Forecast.

The Committee queried plans in relation to disposal of the current bed fleet. The Chief

Executive advised that charitable donation would be considered where possible. The Care Group Director of Operations, Planned Care, confirmed that training would be

delivered as part of the phased replacement roll-out. The Director of Finance confirmed that costs for the replacement were included in the capital programme.

The Committee noted that service and maintenance of beds was currently provided in-

house. The Care Group Director of Operations, Planned Care, advised that it was proposed that this was outsourced as part of the business case. A full tender process had been undertaken and Arjo had been selected as the preferred supplier. The Committee agreed that a recommendation should be submitted to the Board to approve the business case at a cost of £1.062m. Action: M Sherry

140/18 LINAC The Care Group Director, Planned Care introduced the report and advised that approval

was sought to construct an additional bunker at Bracknell Healthspace and to procure a LINAC with support from NHS England (NHSE). The total cost was circa £3.31m, £1.82m of which would be funded by NHSE.

The Care Group Director, Planned Care, highlighted that replacement options had been

considered. Currently there were 3 LINACs based at the Reading site and one based at Bracknell Healthspace. It was considered that an additional LINAC based at Bracknell Healthspace aligned with the Trust’s Vision 2025 in moving services to other sites. The Committee queried if an increase in activity was anticipated. The Care Group Director, Planned Care, advised that no increase in activity was expected. However, based on national studies, it was considered that there would be an increase of 25% in the number of treatments required.

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The Committee noted that, in order to secure funding, the Trust would need ensure the LINAC was operational by October 2019. The Committee agreed that a recommendation should be submitted to the Board to approve the proposal. Action: M Sherry

141/18 Procurement for the Provision of Orthopaedic Products

The Director of Finance introduced the report and advised that the Board had previously approved a 3 + 1 year contract to Smith & Nephew for orthopaedic hip and knee supply at a value of £3.46m excluding VAT. The Committee noted that, following further review of potential savings and advice from central procurement, a 4 year contract had been awarded. This would be reported to the Board for information. Action: C Anderson

142/18 Procurement for the Provision of Orthopaedic Sports Medicine

The Director of Finance advised that a tender process had been undertaken and approval was sought to award a 4 year contract to Smith & Nephew for Sports Medicine at a total contract value of £459,700 excluding VAT. The Committee noted that there had been good clinical engagement in relation to this procurement process. The Committee agreed that a recommendation should be submitted to the Board to approve the contract. Action: C Anderson

143/18 Legal Services Provision

The Director of Finance introduced the report. Following a tender process, approval was sought to award a 3 year contract to Capsticks LLP for the provision of the Trust’s Legal Services. The total contract value was circa £1m excluding VAT. The interim Head of Procurement advised that a ‘cap and collar’ arrangement was proposed for Year 1 with fixed pricing thereafter. Spend on legal services had been variable over the last 4 years and this arrangement would provide the Trust with flexibility. The Director of Finance confirmed that Capsticks LLP had been used previously by the Trust for commercial purposes. The Committee agreed that a recommendation should be submitted to the Board to approve the contract. Action: C Anderson

144/18 Security and Care Park Management Contract The Director of Finance advised that a tender process had been undertaken and approval

was sought to retain the current contractor, Kingdom Service Group Ltd for 3 years at a value of £3.8m excluding VAT effective from 1 December 2018. The Committee noted that car park management would be subcontracted by Kingdom Service Group Ltd. The Director of Finance highlighted that the Executive Management Committee had reviewed and supported the contract. However, the current level of security provision would be reviewed. The interim Head of Procurement confirmed that due diligence had been undertaken as part of the OJEU process.

The Committee discussed the proposed increase in the proportion of Penalty Notice

Charges received by the Trust. The Director of Finance confirmed that there was a need for a more robust process in relation to issuing Penalty Notice Charges including more visibility in relation to the appeals process and clear notice in relation to which areas were not available for parking. The Chief Executive advised that the Executive Management Committee had discussed the need to ensure clear communication to the organisation in relation to this as well as the Trust’s transport policy. The Committee agreed that a recommendation should be submitted to the Board to approve the contract.

Action: C Anderson 4


145/18 Replacement of Interventional Radiology Room 20 Business Case The Care Group Director of Operations, Urgent Care, introduced the report and advised

that approval was sought to replace imaging equipment for Intervention Radiology Room 20. Funding for the project had been included in the 2017/18 capital budget but this this had been deferred to 2018/19. The total cost including enabling works was £1.9m including VAT. Capital funding for 2018/19 was available due to the deferring the planned spend in ITU. The Committee noted that ITU spend had been deferred due to the need close the unit.

The Committee discussed the decision not to purchase a newer model. The Care Group

Director of Operations, Urgent Care, advised that it had been agreed that the same equipment would be purchased as that currently in use in Room 19 for clinical safety reasons. However, maintenance for the equipment would be available for the life of the asset. The Committee noted that majority of enabling works had been completed previously when equipment had been installed in Room 19.

The Committee agreed that a recommendation should be submitted to the Board to

approve the business case. Action: M Sherry 146/18 QiPPs Update It was agreed that this item would be deferred for discussion at the December meeting. 147/18 Procurement QiPP Programme It was agreed that this item would be deferred for discussion at the December meeting. 148/18 Model Hospital QiPP Programme It was agreed that this item would be deferred for discussion at the December meeting. 149/18 Work Plan Review The Committee received the work plan for 2018. 150/18 Key Messages for the Board Key issues to draw to the attention of the Board included:-

• October Finance performance discussed in detail • Work to develop the Quarter 2 Forecast discussed • Recommendation to the Board to approve business cases for Bed Management

and LINAc • Recommendation to the Board to award a 4 year contract for Orothpaedic

Products • Recommendation to the Board to approve the contract for Orthopaedic Sports

Medicine • Recommendation to the Board to approve the Legal Services, Car Park

Security & Management contracts, 151/18 Date of Next Meeting

It was agreed that an additional meeting would be scheduled for December 2018. Action: C Lynch

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SIGNED: DATE:

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Agenda Item 6a

Finance and Investment Committee Wednesday 19 December 2018 8.30 – 9.55 Boardroom, Level 4, Royal Berkshire Hospital Members Mrs. Sue Hunt (Non-Executive Director) (Chair) Ms. Caroline Ainslie (Director of Nursing) Mr. Craig Anderson (Director of Finance) Mr. Brian Hendon (Non-Executive Director) Mr. Steve McManus (Chief Executive) Mr. John Petitt (Non-Executive Director) Ms. Mary Sherry (Chief Operating Officer) Mr. Graham Sims (Chair of the Trust) In Attendance Mr. Mike Clements (Deputy Director of Finance – Central Finance) Mr. Julian Dixon (Non-Executive Director) Dr. Alison Hill (Non-Executive Director) Mrs. Caroline Lynch (Trust Secretary) Apologies 152/18 Declarations of Interest There were no declarations of interest. 153/18 Minutes: 19 November 2018 & Matters Arising Schedule

The minutes of the meeting held on 19 November 2018 were approved as a correct record and signed by the Chair.

The Committee received the matters arising schedule. Minute 137/18: October Finance Update: The Director of Finance advised that drug costs

had reduced in November and this was not an area of concern. However, quarterly reviews were routinely carried out and the next review was due in January/February 2019. The Committee noted that the implementation of e-prescribing provided greater oversight of drug usage but did not affect costs.

154/18 November Finance Update/Quarter 2 Forecast The Director of Finance advised that Provider Sustainability Fund (PSF) had not been

accrued in November and accrual for PSF in October had also been reversed. The Quarter 2 Forecast had also been updated in November.

The current position was £900k behind forecast and £2.5m behind budgeted control total. Variances in the month included £0.5m on pay largely due to medical staff pay, £400k of which related to one-time costs. The Director of Finance confirmed that part of the

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Finance & Investment Committee December 2018

overspend on medical staff pay related to the Clinical Excellence Awards (CEA), £200k, that had not been budgeted for. A further element related to back pay and locally agreed enhancements. The Chief Operating Officer advised that work was on-going to review the current process, for example, how payments had been authorised and how this had been communicated to the Care Group leads. Controls were in place but there was a need to review how locally made decisions were communicated to Care Group level. The Committee discussed the accountability of budget holders and the need for them to work to their budget. The Director of Finance highlighted that controls had been put in place and all additional payments or enhancements for medical staff pay would not be processed until appropriate checks had been made. The Director of Finance advised that one component of Care Group overspend in the month related to additional costs of £180k related to Berkshire Surrey Pathology Services (BSPS). This was currently being queried with BSPS. A further element related to cardiac devices. This related to higher usage in November than in the previous month. The Care Group had been asked to confirm figures and activity for December 2018. An update on these two issues would be provided to the next meeting Action: C Anderson The Committee noted that the QiPP tracker included higher delivery of QiPPs in the month. The Director of Finance advised that this was being reviewed and the outcome was expected in the next two weeks. An update on this issue would be provided to the next meeting. Action: C Anderson The Director of Finance confirmed that, overall, the current risk was between £1.5m to £3m compared with £2m risk that had been highlighted previously to the Committee. The Director of Finance highlighted the Care Group actions identified to deliver the Quarter 2 Forecast were reviewed with the Care Groups. It was anticipated that there would be an increase in costs for the Winter period. However, these had been included in the forecast. The list of actions was being reviewed on a weekly basis with Care Groups as to whether costs were recurrent or mitigating actions could be taken. The Committee noted the list of mitigating actions identified by the Executive team as well as NHS Improvement (NHSI) checklist of financial actions. The Director of Finance advised that these were subject to further discussion by the Executive team. Ahead of the forecast being formally approved by the Board and NHSI being contacted the Trust would need to evidence the actions it had taken including review of the NHSI checklist.

The Committee noted that an additional Chief Executive team meeting had been scheduled for early January in order to review Executive actions, the NHSI checklist as well as reviewing Month 9 results. It was agreed that the Director of Finance would circulate details of the process to be followed when submitting a revised forecast. Action: C Anderson

155/18 Replacement of Mobile MRI Scanner The Committee noted that approval was sought to replace the mobile MRI scanner at West

Berkshire Community Hospital with a new mobile facility. In addition, it was proposed that a further business case would be developed to replace the mobile unit with a permanent facility in the financial year 2019/20 relocating the mobile MRI unit to Bracknell Healthspace to replace the current rental unit.

An allocation of £1,440k for the replacement of the mobile of MRI scanner was included in

the 2018/19 capital plan and was not dependent on receipt of PSF monies The Committee queried whether charitable funding was available for the MRI scanner. The Director of Finance advised that this could be considered as part of the permanent solution.

The Committee noted the additional staffing that would be required once the mobile unit

moved to Bracknell Healthspace. The Chair of the Workforce Committee requested that 2

Finance & Investment Committee December 2018

this be reviewed at the Workforce Committee in relation to workforce reconfiguration.

The Committee considered that the proposal aligned with the Trust’s strategic direction. It was agreed that a recommendation should be submitted to the Board to approve the replacement of the mobile MRI scanner. Action: M Sherry

156/18 Interpretation and Translation Contract Extension The Director of Finance introduced the report and advised that approval was sought to

extend the current contract with Prestige Networks Ltd on a 2 + 1 + 1 year basis from 1 January 2019. The Director of Finance confirmed that the London Procurement Partnership (LLP) Framework had been used and appropriate procurement rules had been followed. The extension of the contract would enable savings to be achieved as well as operational efficiencies. The Committee noted that that there was a break clause included after two years. The Committee agreed that a recommendation should be submitted to the Board to approve the contract extension. Action: C Anderson

157/18 Procurement for the Provision of Theatre Procedure Packs The Director of Finance introduced the report and advised that approval was sought to

extend the existing agreement with Rochialle, via the NHS Supply Chain Framework, Category Tower 9, for two years for theatre procedure packs. The total value was circa £1.2m including VAT. The Committee agreed that a recommendation should be submitted to the Board to approve the extension of the existing agreement with Rochialle for two years Action: C Anderson


It was agreed that the next meeting would be held on Monday 21 January 2019 at 10.00am.

SIGNED: DATE:

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Agenda Item 6b

Quality Committee Tuesday 4 December 2018 14.00 – 15.35 Boardroom, Level 4, Royal Berkshire Hospital Members Dr. Alison Hill (Non-Executive Director) (Chair) Dr. Lindsey Barker (Medical Director) Mr. John Petitt (Non-Executive Director) Ms. Mary Sherry (Chief Operating Officer) In Attendance Mrs. Jane Chandler (Deputy Director of Nursing and Governance) Ms. Coralie Duff (Directorate Manager, Trauma and Orthopaedics)

(for minute 77/18) Dr. Janet Lippett (Care Group Director, Networked Care)

(from minute 77/18 to minute 78/18) Mrs. Caroline Lynch (Trust Secretary) Mr. Mark Robson (Director of Operations, Networked Care)

(from minute 77/18 to minute 78/18) Mrs. Hannah Travers (Deputy Trust Secretary) Apologies Ms. Caroline Ainslie (Director of Nursing) Mr. Julian Dixon (Non-Executive Director) Mr. Steve McManus (Chief Executive) 71/18 Declarations of Interest There were no declarations of interest.

72/18 Minutes: 9 October 2018 and Matters Arising Schedule

The minutes of the meeting held on 10 July 2018 were approved as a correct record and signed by the Chair subject to the following amendment:- Minute 57/18: End of Life Update: The second sentence of the fourth paragraph would be amended to read: ‘Carol highlighted processes in place in relation to the ‘caring’ domain that supported the team’s recent self-assessment rating as ‘outstanding’.

The Committee noted the matters arising schedule. 73/18 Inquest – Regulation 28 The Medical Director provided an update on the recent inquest held that related to a patient

admitted to the Emergency Department (ED) with suspected post-partum Pulmonary Embolism (PE) in January 2014. The patient had seen her GP several times prior to being admitted. Junior doctors in the ED had delayed anticoagulation due to concerns of safety

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Quality Committee December 2018

in breastfeeding. The patient had arrested four hours after admission, was thrombolysed during the second arrest but resuscitation had been unsuccessful.

The Coroner had issued a Regulation 28 relating to the Trust medical registrars staffing

levels at night. The Medical Director had discussed with the Coroner that Health Education England (HEE) defined the distribution of medical registrars across trusts. The Medical Director advised the Trust had 56 days to respond to the regulation 28 once received and the Trust’s response would be reviewed with the legal team.

Action: L Barker

74/18 Q2 Updates on Serious Incident (SI) Themes The Deputy Director of Nursing and Governance provided an update on the SI themes and

advised that six new SIs had been recorded in October 2018. There had been an increase in SIs being recorded. However, there was a good culture of reporting incidents across the Trust in order to share learning.

Of the 13 SIs reported in Quarter 2, two related to Never Events of a retained guide wire

and a retained swab that were currently being investigated. Common themes identified from the investigations included lack of documentation, patient assessment, decision making and training. In addition, staff factors that included failure to escalate; staffing and capacity factors were identified as a contributing factor in three of the SIs. Key actions to mitigate against these risks going forward included specific training, on-going education for ward staff and Trustwide education on job entry onto Nervecentre. The Deputy Director of Nursing and Governance highlighted that a failsafe officer had been also been recruited for the Prince Charles Eye Unit. This had been highlighted as an opportunity for improvement in existing working practices following a previous SI.

The Deputy Director of Nursing and Governance advised that the Trust had recently

reported a never event related to unintentional connection of a patient requiring oxygen to an airflow meter. The Patient Safety Team had contacted the Healthcare Safety Investigation Branch (HSIB). HSIB were carrying out a review following a number of organisations reporting similar incidents and the team had requested a copy of the outcome of their investigation to review if there was any additional learning for the Trust. The Deputy Director of Nursing and Governance advised the Trust planned to cap the piped air in ward areas in order to prevent similar future incidents. The Medical Director highlighted certain departments (predominantly respiratory) would still require access to medical air on clinical grounds.

75/18 Corporate Risk Register The Committee received the Corporate Risk Register and noted that there had been no

changes made to the current risk scores. The Integrated Risk Management Committee (IRMC) had recommended that dermatology

and cancer performance should be included on the Corporate Risk Register. In addition, the IRMC had suggested that Never Events from Urgent Care should be included on the Urgent Care Risk Register.

An additional IRMC meeting had also been scheduled in December to consider whether

Brexit should be included on the Corporate Risk Register as a separate item or incorporated within the other existing risks. The Deputy Director of Nursing and Governance advised that ED and workforce scoring would also be reviewed at the December meeting. Action: C Ainslie

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76/18 Executive Quality Assurance & Learning Committee Exception Report The Deputy Director of Nursing and Governance provided a detailed update on Never

Events. The learning from the retained guide wire was discussed. Safety pauses derived from the WHO checklist were also being considered for use in areas where procedures would take place outside operating theatres. It was agreed that the Deputy Director of Nursing and Governance would confirm if the retained guide wire Never Event had occurred within the Cardiology Care Unit (CCU). Action: J Chandler

The Committee noted that, following the retained vaginal swab Never Event, maternity had

purchased swab trays to enable staff to count in and count out all swabs for all procedures where swabs were used. The Committee recommended that the serious incident graph should include two years of data in future reports. Action: J Chandler

The Deputy Director of Nursing and Governance advised there had been three hospital

acquired Grade 3 pressure ulcers in October. These had been in the elderly care where there was a high nursing vacancy rate. Following review of all three incidents, there had been no evidence to suggest whether these pressure ulcers had been avoidable. The Deputy Director of Nursing and Governance advised the teams would receive targeted training. The Committee reviewed the clinical effectiveness and outcome reports and queried whether a more recent SSNAP organisational report had been published. The Deputy Director of Nursing and Governance would confirm the latest SSNAP report date. Action: J Chandler

77/18 Fractured Neck of Femur (NOF) Report The Care Group Director, Networked Care, introduced the report. The Committee noted

that a Best Practice Tariff (BPT) had been allocated to fractured NOF and the Trust received up to £1,335 if specific elements of care were achieved. These included time to surgery within 36 hours, delirium screening and assessment by a physiotherapist within a day of surgery.

The Committee noted that 30-45 patients had presented to the Trust each month. The Trust had set a target of meeting the BPT in at least 85% of these cases. The Trust benchmarked well against the national average performance for most of the elements that were required to achieve BPT. The Directorate Manager, Trauma and Orthopaedics advised 4-6 patients per month had not received surgery within 36 hours. These were attributed to either capacity or clinical reasons. A small number of patients did not receive delirium screening at the correct time or physiotherapy within one day. The Care Group Director, Networked Care, advised that following the digital ‘go live’ the team were in discussion with the EPR team to include a delirium screen prompt in order to mitigate the risk of delirium screening being missed. In addition, a detailed review had highlighted that these elements were occasionally missed when patients were on an orthopaedic ward instead of the hip fracture unit. Additional provision for patients requiring physiotherapy had been introduced on the trauma ward on Saturdays. The Trauma and Orthopaedics team had also considered whether additional surgery lists could be provided at the weekend. However, the cost of doing so would

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outweigh the potential gain from increased BPT achievement. All fractured NOF patients were monitored closely and prioritised at trauma meetings. The Committee acknowledged the improvements made for fractured NOF patients that included decreased length of stay. It was agreed that, going forward, quarterly updates on fractured NOF involving all the relevant metrics should be submitted to the Committee, instead of appearing in partial form in the Board IPR. Action: M Sherry

The Committee agreed that a letter of thanks should be prepared and distributed to the Trauma and orthopaedics team thanking them for all their work in this area.

Action: M Sherry

78/18 Dermatology Update The Care Group Director, Networked Care, introduced the report and highlighted that

substantive consultant provision had reduced to less than one whole time equivalent (WTE) post. Therefore, the service would only accept two week wait referrals, in the short term, until alternative provision could be negotiated or the non-cancer pathways redesigned. The Care Group Director, Networked Care, gave an overview of the work undertaken by the team in order to continue to provide a dermatology service. The Director of Operations, Networked Care, advised that recruiting staff to dermatology services was a national issue for the NHS as 60% of consultant posts had been vacant in the previous year.

The Care Group Director, Networked Care, advised that the Trust would look to maintain an

NHS service model. Discussions were on-going with Oxford University Hospitals NHS Foundation Trust in relation to possible joint working for dermatology service provision.

The Committee queried the percentage of patients that were diagnosed with cancer

following a two week wait referral. The Care Group Director, Networked Care, advised that less than 5% of referrals were diagnosed with cancer via the two week wait referral pathway, which was in line with NICE guidelines. There were approximately 400 to 500 patients currently on the minor operations waiting list. Therefore, any new referrals would not be actioned until April 2019.

The Care Group Director, Networked Care, advised that other options being reviewed

included nurse led services.

The Committee discussed the possible risk to medical training. The Medical Director recommended that discussions with the locum in the service could take place in order to gauge their interest in being trained as an educational supervisor for trainees. It was agreed that a further update would be provided to the next meeting. Action: J Lippett

79/18 Quality Account Update

The Committee received the Quality Account update. The Committee discussed the ‘improving patient experience of car parking’ priority and agreed the priority should be rated ‘red’ as there had not been any changes made since the last update. The Committee noted that an update on car parking would be submitted to the next meeting.

Action: T Middleton

The Deputy Director of Nursing and Governance confirmed that the ‘Reduction of Hospital-acquired, avoidable pressure ulcers had been rated amber as the Trust had met one of the targets to reduce grade 2 pressure ulcers by 10%. In addition, there had also been a

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reduction in falls following the ‘dignified throne’ campaign and the installation of falls alarms in patient toilets. The Committee queried whether digital implementation would impact on the National Warning Early Score (NEWS2). The Chief Operating Officer advised this had been included in the Electronic Patient Record (EPR) system following the rollout of ClinDocs in September 2018. The Committee agreed that the baseline for the number of avoidable cardiac arrest calls raised should be included as a figure in the Quality Report.

Action: J Chandler 80/18 Quality Impact Assessment Update The Chief Operating Officer provided an update on quality impact assessments. The

Committee noted that a decision had been made to restrict referrals for dermatology to two week wait patients whilst a longer term solution was developed. The impact assessment would be reviewed following the agreement of a longer term solution. Any impact on quality would be monitored through staff retention, access standards and staff and patient feedback. The Chief Operating Officer advised that the Transformation Strategy would support service changes going forward to ensure key services were sustained across the Trust.

81/18 Work Plan Review The Committee discussed the work plan. It was agreed that Integrated Care System (ICS)

Quality Governance would be included and reviewed bi-annually. The Clinical Services Strategy would also be reviewed bi-annually.

82/18 Key Messages for the Board It was agreed that key issues to draw to the attention of the Board included:

• Two Never Events that were being investigated under the Serious Incident Policy • Regulation 28 update discussed • Detailed updated received on fractured NOF with quarterly updates going forward • Detailed dermatology update received

The Committee expressed its thanks to Alison Hill for her work as Chair of the Quality Committee.


It was agreed the next meeting would be held on Tuesday 12 February 2019 at 14.00. SIGNED: DATE:

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Agenda Item 6c

Audit & Risk Committee Wednesday 16 January 2019 9.35 – 11.45 Boardroom, Level 4, Royal Berkshire Hospital Members Mr. John Petitt (Non-Executive Director) (Chair) Mr. Brian Hendon (Non-Executive Director) In attendance Advisors Ms. Anna Blackman (Partner, Pwc) Ms. Debbie Kinch (Local Counter Fraud Specialist) (up to minute 04/19) Mr. Ben Sherrif (Director, Deloitte) Ms. Alice Wainwright (Manager, PwC) Trust Staff Mr. Craig Anderson (Director of Finance) Mr. Mike Clements (Deputy Director of Finance – Central Finance) Mrs. Nicky Lloyd (Chief Finance Officer) Mrs. Caroline Lynch (Trust Secretary) Mr. Steve McManus (Chief Executive) Mr. Mike Robinson (Associate Director of Infrastructure) (for minute 03/19) Mrs. Hannah Travers (Deputy Trust Secretary) 01/19 Declarations of Interests There were no declarations of interests. 02/19 Minutes: 8 November 2018 and Matters Arising Schedule

The minutes of the meeting held on 8 November 2018 were agreed as a correct record and signed by the Chair. The Committee received the matters arising schedule. Minute 134/18: Counter Fraud Progress Report: The Director of Finance would liaise with the Local Counter Fraud Specialist (LCFS) to confirm that actions had been concluded to the Trust’s satisfaction. It was agreed that this action would be concluded ahead of the next meeting. Action: C Anderson

Minute 146/18: Losses & Special Payments: The Director of Finance would confirm the

details of the debt write off related to the Rainbow Nursery. Action: C Anderson

Audit & Risk Committee

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Audit & Risk Committee Minutes January 2019

03/19 Cyber Security Update The Associate Director of Infrastructure introduced the report and advised that all

outstanding actions for Quarter 3 had been completed. Further work in relation to patch management was required. However, there had been a slight delay due to additional storage solution required. In addition, there was also a need to be mindful of disruption in areas of the Trust.

[Section exempt under s43] The Committee noted that capital funds for 2018/19 had been re-allocated in order for IT to

support challenges in relation to storage and back-up. The Committee noted that good progress had been made in relation to the critical report

issued by PwC in 2017. It was agreed that the update to the next meeting would set out outstanding actions only and would include a general update on Cyber Security. Action: M Robinson

04/19 Counter Fraud Progress Report The LCFS introduced the report and highlighted that the Counter Fraud work plan for

2019/20 would be discussed with the Chief Finance Officer. The LCFS highlighted that the fraud awareness survey had been undertaken in October

2018 and overall, the survey results were positive and respondents had a high level of awareness. However, there had been a reduction in the response rate and other methods, such as face-to-face would be adopted for future surveys.

The LCFS advised that the draft report in relation to gambling had been issued to the Trust

was currently being considered. Discussions were also on-going in relation to a planned exercise to review processes in relation to consultants’ job plans. The Committee noted that safeguarding training was provided to Non Executives as part of the annual mandatory training session. Executives also attended the routine mandatory training sessions provided for staff.

05/19 Charity Accounts 2017/18 The Director, Deloitte, advised that the audit management letter had not yet been issued by

Deloitte. Following the merger of the Royal Berks Charity with Reading & District Hospitals Charity (RDHC) evidence to confirm restricted funds from the trustees of RDHC was required. The Director of Finance confirmed that, as part of the merger, a due diligence exercise had been undertaken in relation to the cash and property of RDHC. In relation to the property, a survey had been carried out to ascertain any repairs required and funds had been transferred. However, evidence of which funds were restricted had been requested by Deloitte and this was awaited from the trustees of RDHC.

It was agreed that the Chief Finance Officer would confirm the timeframe for the submission

of the accounts to the Charity Commission and an extension to submit the accounts would be sought from the Charity Commission. Action: N Lloyd

06/19 Internal Audit Programme Report The Partner, PwC, introduced the report and advised that reviews completed since the last

meeting included mortality, key financial systems, Health & Safety and IT controls.

Audit & Risk Committee Minutes 2


Fieldwork was on-going in relation to Corporate Governance and Risk Management, Follow-up and Information Governance. The Partner, PwC, highlighted that discussion were on-going with management in relation to the remainder of the audit plan for 2018/19.

The Manager, PwC, advised that, in relation to the mortality review, two medium and one low

risk finding had been issued. The review had identified that, whilst bereaved families were able to raise concerns regarding patient care via the bereavement or Patient Advice & Liaison Service (PALS) team there was no formal process for communicating and escalating these concerns to the Clinical Governance team. The Committee noted that a Medical Examiner was due to be appointed by the Trust and this would ensure a connection between the two areas. The Manager, PwC, advised that instances had been identified where case record reviews had not been included in the report to the Mortality Surveillance Group and in two instances the consultant completing the review was not independent of the patient’s care. The Committee noted that, often a patient’s care had been complex with a number of clinicians involved. Therefore, it was difficult to appoint a completely independent clinician to undertake the case record review. The Chief Executive clarified that there were safeguards in place in relation to case record reviews, for example, the Duty of Candour process. In addition, concerns highlighted by families were investigated and the findings were fed back to the family. This mortality review had highlighted instances when informal issues were raised with the PALS team. It was agreed that the management actions for each of the risk findings in the mortality would be circulated to the Committee. Action: N Lloyd

The Committee also requested that management actions should be included in future

internal audit reports submitted to the Committee. Action: A Blackman The Committee also recommended that the Quality Committee should review the mortality

audit findings and actions at its next meeting. Action: L Barker The Manager, PwC, advised that, in relation to the key financial systems review, good

practice had been noted. The Committee noted that, in relation to the overseas team, the Executive Management Committee had approved a request to increase the size of the team. The Deputy Director of Finance confirmed that the overseas team had also now been provided access to the finance systems in relation to invoicing for overseas debtors.

The Manager, PwC, advised that one low risk finding had been issued following the IT

general controls review that related to lack of evidence for system level backups. 07/19 Technical Update The Committee received the technical update. 08/19 External Audit Progress Report The Director, Deloitte advised that, in relation to the audit of Healthcare Facilities

Management Ltd (HFMS), work was still on-going in relation to the accruals and adjustments. The Director, Deloitte, advised that requirements for the Quality Report for 2018/19 had been

issued by NHS Improvement (NHSI). Mandated indicators had been changed for acute providers with 62 day cancer waiting times replacing the 18 week Referral to Treatment. NHSI had recommended that Summary Hospital-Level Morality Indicator (SHMI) should be selected as the local indicator by governors.

The Chair queried the delay in relation to the audit of HFMS Ltd. The Deputy Director of

Finance advised that the accruals process for HFMS Ltd was being reviewed. An element of



this was the inter-company transfer between the Trust and HFMS Ltd. A further update would be provided to the next meeting in relation to the changes made to these processes.

Action: N Lloyd The Committee noted the length of the Trust’s creditor versus debtor days and

recommended that the Chief Finance Officer review this. Action: N Lloyd 09/19 Audit Recommendations Update The Committee received the report and noted that there were eight reports with outstanding

audit actions. The Deputy Director of Finance advised that, in relation to the QiPP review and divisional review of Planned Care, actions had now been approved by the Executive lead. In relation to the key financial systems, three of four actions had now been approved and the actions in relation to the VAT return process was due for completion during January 2019.

The Committee recommended that the Chief Finance Officer confirm the timescale in relation

to the Code of Practice linked to the estate procurement audit action. Action: N Lloyd 10/19 Health & Safety Governance Review The Director of Finance advised that an independent review of Health & Safety was

commissioned a year ago. Internal audit had been asked to undertake the review to establish whether actions from the independent review had been implemented and to highlight any areas of focus.

The Manager, PwC, advised that, overall, a high risk finding had been issued following the

review. This included two high risk and four medium risk findings. Whilst the use of the Datix system for Health & Safety incidents was becoming increasingly embedded in the Trust, the timeliness of RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations) reporting and under-reporting of non-clinical incidents via Datix had been identified. The Director of Finance advised that there had been no adverse feedback received from the Health & Safety Executive. However, there was further work to be undertaken in relation to reporting of non-clinical incidents as well as raising Health & Safety awareness across the organisation. The Director of Finance confirmed that Health & Safety indicators were now included and discussed at Care Group performance meetings.

The Committee discussed incidents in relation to violence towards Trust staff. The Chief

Executive advised that the current Staff Survey results were due. However, a question could be included in the next survey. The Committee queried the target date in relation to raising awareness of reporting near misses and incidents. The Director of Finance confirmed that this was correct in relation to raising awareness.

The Director of Finance confirmed that the Board received a summary of compliance as part

of the Health & Safety indicators. However, further narrative would be added to this by the estates team.

The Committee discussed the medium rated recommendation. In relation to marking a

patient’s record when they had been violent towards staff. The Director of Finance advised that Data Protection legislation would have to be considered. However, work was on-going to review what process other trusts had in place in relation to this issue.

The Committee discussed the recommendation in relation to risk register ownership. The

Director of Finance advised that risk registers were also reviewed as part of the Care Group performance meetings.



The Committee noted that the review had established that the quality of minutes of the

Health & Safety Committee improved. However, there remained compliance issues in relation to mandatory training. The Chair requested that an update on this issue should be submitted to the next meeting. Action: N Lloyd

The Committee noted that the review had been commissioned by management and whilst

progress had been achieved in relation to Health & Safety there was further work to be undertaken to embed a Health & Safety culture in the organisation. . The Chair suggested that the report should be shared with the Board as a whole due to the overall high risk finding in the report. The Director of Finance highlighted that high risk findings were not normally submitted to the Board and suggested that the report could be shared with the Board as part of the scheduled annual Health & Safety update. The Committee agreed with this approach.

Action: N Lloyd 11/19 Bank Account Authorisations

The Committee noted that there had been one amendment to the Trust’s signatory panel for the Trust and the Royal Berks Charity since the last meeting of the Committee. This was the addition of a new member of staff that had joined the Trust.

12/19 Non-NHS Debt Report

The Deputy Director of Finance introduced the report and advised that latest actions in relation to debtors had now been added to the report as requested by the Committee. The Committee noted that the total non-NHS debt was £3.8m as at 30 December 2018. The Deputy Director of Finance advised that payment plans were dependent upon affordability of the individuals. Once this had been ascertained provisions were then considered. The Committee discussed the increase in outstanding debt. The Deputy Director of Finance advised that processes were in place but the level of debt was generally increasing.

13/19 Losses and Special Payments

The Committee noted that, since the last meeting, there had been three payments for loss of property to the value of £735. Other losses totalled £56,020 and included debt write off. The Committee noted that there had been two special payments to the value of £430.

14/19 Use of Single Tenders

The Committee noted that there had been one single tender awarded since the last meeting of the Committee. The Director of Finance confirmed that this related to a specialist bed for a patient. However, the bed could be used for other patients.

15/19 Schedule of Significant Contracts The Committee noted that there had been five significant contracts awarded since the last meeting of the Committee, all of which had been submitted to the Finance & Investment Committee and Board for approval.



16/19 Brexit Update The Chief Executive advised that there were three key areas being considered by the Trust

in relation to Brexit; staff, logistics and business continuity. The Director of Finance advised that the Trust was working, as advised by the Department of Health & Social Care, to identify its major suppliers. All local suppliers had been identified and clinical suppliers had been shared with the Medical Director for consideration. Non-clinical suppliers were being reviewed by the estates team. The Committee noted that an update on Brexit would be shared with the Board in January 2019. The Partner, PwC, advised that the approach taken by the Trust was in line with guidance issued by the Department of Health & Social Care.

The Chief Executive confirmed that the Trust had made the decision to support EU staff with

the cost of their settlement status applications. Drop-in sessions had been scheduled and one to one support provided to staff to complete their application process. A total of 45 staff had already been granted settlement status. The Chief Executive advised that, as part of business continuity, a named lead for Brexit was required. An update on business continuity in relation to Brexit was scheduled for discussion by the Executive Management Committee in February and this would then be submitted to the Board. Action: S McManus

The Committee noted that Brexit would be considered by the Integrated Risk Management

Committee in relation to whether this should be included on the Corporate Risk Register. Action: C Ainslie 17/19 Counter Fraud Annual Effectiveness Review

The Committee received the annual effectiveness review of Counter Fraud. The Trust Secretary advised that 77% of respondents had rated the service as strong. Comments provided by respondents would be provided to the Chief Finance Officer for discussion with the LCFS. Action: N Lloyd

18/19 Audit Committee Work Plan 2019

The Committee noted the work plan for 2019.

19/19 Key Messages for the Board It was agreed that key issues to draw to the attention of the Board included:-

• Cyber Security Update received • Charity Accounts 2017/18 update received • Health & Safety Governance review received and recommended for submission to

the Board as part of the annual Health & Safety update • Brexit update received • Annual Counter Fraud effectiveness review noted


It was agreed that the next meeting would be held on Wednesday 13 March 2019 at 9.30am. 21/19 Private Meeting with External Audit It was agreed that a meeting with Deloitte was not required as there were no specific issues

for discussion.



22/29 Private Meeting with Internal Audit It was agreed that a meeting with PwC was not required as there were no specific issues for

discussion. 23/19 Private Meeting of the Committee It was agreed that a meeting of the Committee was not required as there were no specific

issues for discussion. Chair: Date:


Agenda Item 6d

Charity Committee Tuesday 18 December 2018 12.30 – 13.30 Room 3, Level 4, Royal Berkshire Hospital Present Mr. Graham Sims (Chair of the Trust) (Chair) Mr. Craig Anderson (Director of Finance) Mr. Jonathan Barker (Public Governor, Reading) Dr. Sunila Lobo (Public Governor, Reading) Mr. Steve McManus (Chief Executive) (from minute 16/18) Ms. Aneta Saunders (Interim Charity Director) In attendance Mrs. Caroline Lynch (Trust Secretary) Mrs. Victoria Parker (Director of Communications and Engagement) Mrs. Hannah Travers (Deputy Trust Secretary) Apologies 14/18 Declarations of Interests

There were no declarations of interests. The Director of Finance highlighted the Charity Director, Ian Thomson, had not been in the Trust since October and was due to retire in December 2018. The Trust had recently appointed an Interim Charity Director in early December. However, due to the absence of the Charity Director there had been little progress made in relation to actions outstanding since the previous meeting.

15/18 Minutes for Approval: 12 June 2018 and Matters Arising Schedule

The minutes of the meeting held on 12 June 2018 were approved as a correct record and signed by the Chair. The Committee received the matters arising schedule and agreed that these would be deferred for discussion at the next meeting.

16/18 Charity Director’s Report

The Interim Charity Director introduced the report that provided an update on recent activities and priorities for the next three months. The Committee noted events that had taken place between July and November 2018. The current operating costs were 30%, including legacies against the total income. Excluding legacies, operating costs were approximately 42%. The Interim Charity Director highlighted key priorities that included consideration of the Charity’s strategic vision, clarity on the team’s roles and review of systems and processes. The Interim Charity Director advised that the team had been through a number of staff

Minutes

1

Minutes of the Charity Committee 18 December 2018

changes and clarity on individual roles and development opportunities would increase morale within the team. The Committee discussed individual funding plans and queried whether the number of individual plans had been reduced. The Director of Finance confirmed that there had been a reduction in the amount of plans. However, there was still further progress to be made. Discussions had taken place with Fund Advisors to look at their spending plans. However, when spending plans had not been provided, discussions would take place with the Fund Advisors to discuss the remit of their role and whether a new fund manager was required. The Director of Finance advised that an update on spending plans could be provided at the next meeting. Action: C Anderson The Interim Charity Director confirmed that a Funds Manager had been recently appointed and would arrange discussions with Fund Advisors to look at their plans in more detail. The Interim Charity Director highlighted that it was important that plans would impact positively on patient care. The Committee discussed the members that had been contacted in relation to the implementation of General Data Protection Regulation (GDPR). The Interim Charity Director advised that deceased members were held on the Charity records in cases where legacies were expected. The Trust Secretary recommended that the Information Governance Manager could be contacted to offer support and training to the Charity team in relation to GDPR. Action: A Saunders The Committee discussed a fundraising strategy that would provide a clear focus on the Charity objectives. However, it was agreed it would take time to prepare a strategy. The Chief Executive recommended that the Charity strategy would need to support Vision 2025. It was agreed that the Interim Charity Director would meet with members of the Committee to discuss their views and a framework would be developed for discussion at the next meeting. Action: A Saunders The Interim Charity Director advised that, in relation to a capital appeal, this would need to be sustainable in the long term. Consultation would need to take place prior to an appeal being launched. The Committee discussed the Trust’s supporting strategies and whether these could support the focus of a capital appeal. The Committee agreed that the capital appeal would need to be pertinent to members of the public that attended the hospital to encourage donations for the appeal.

17/18 Charity Risk Register

The Committee received the Charity Risk Register and noted that no updates had been provided following the previous meeting. The Committee discussed the risk in relation to the loss of key charity staff. The risk had increased with the retirement of the Charity Director. However, following the appointment of the Interim Charity Director this risk had been mitigated. The Committee recommended that the wording in the risk register should be reviewed and an update be provided at the next meeting. Action: A Saunders

18/18 Management Accounts

The Director of Finance introduced the report. The Committee noted that, in relation to spend, the value set out in the report would increase as, currently not all donations to purchase equipment had been captured. The Committee noted that, currently, the charity database did

Minutes of the Charity Committee – 18 December 2018 2

Minutes of the Charity Committee 18 December 2018

not directly link to the Trust’s finance systems. This would be reviewed following the appointment of a substantive Charity Director. The Interim Charity Director advised that the Trust would purchase equipment and recharge the cost to the Charity going forward. The Committee noted that accrual of legacies and donations was less than had been budgeted for 2018/19. The Director of Finance recommended that the operating costs be reviewed as part of the 2019/20 budget when this was presented to the Committee in March 2019. Action: C Anderson The Committee discussed the Knowledge and Training fund that was due to be set up and whether any progress had been made following this. The Director of Finance confirmed an update would be provided on the Knowledge and Training fund at the next meeting. Action: C Anderson The Director of Finance provided an overview of the income received from the three major events in 2018. The Soapbox Challenge had received less income than in the previous year. The Interim Charity Director advised that the activities taking place next year were being reviewed to ensure that the return on the event outweighed the set up costs.

19/18 Terms of Reference

The Committee received the terms of reference that were due for review as part of the annual review cycle. The Committee agreed that no changes were required at the present time. However, the terms of reference would be reviewed at the next meeting. Action: C Lynch

20/18 Charity Committee Work Plan

The Committee noted that the work plan would be reviewed for 2019. Action: C Lynch


It was agreed that the next meeting would be held on Wednesday 23 January 2018, 10:00.

SIGNED:

DATE:

Minutes of the Charity Committee – 18 December 2018 3

Charity Committee Terms of Reference Constitution and Membership The Royal Berkshire Hospital Trust Charitable Fund (Charity Registration Number 1052720) is governed by the Trust Deed which was approved by the Trustees. Under the terms of the deed the Charitable Fund is administered and managed by the Trustees, the members of the Royal Berkshire NHS Foundation Trust as a body corporate. The Trustees derive their authority to act from the Trust deed of the NHS Trust Charitable Fund, approved by the Trustees. The Committee will be chaired by the Chairman of the Trust. The membership will include the Chairman of the Trust, the Chief Executive, the Director of Finance, and two Governors nominated by the Council of Governors and the Charity Director. The quorum will be three members and include the Chairman and Director of Finance. Attendance The Charity Director is expected to attend all meetings. External advisers may attend as necessary at the request of members. The Trust Secretary (or their nominee) will act as secretary to the Committee. Frequency of meetings The Trustees will meet at least four times a year for no less than two hours and at such other times as may be required. Monitoring The work of the Committee will be kept under review by the Board. The Committee will conduct an annual review of its effectiveness with its terms of reference and submit any findings and proposals for changes to the Board of Directors for consideration.

Duties The Trustees are responsible for the overall management of the Charitable Funds. They are required to:

(a) satisfy themselves that best practice is followed in terms of guidance from the Charity Commission, National Audit Office, Department of Health and other relevant organisations;

(b) ensure that the appropriate policies and procedures are in place to support

the Charitable Funds Strategy and to advise Fund Managers on income and expenditure and that this is reviewed at regular intervals;

(c) develop and review the Foundation Trust’s Charitable Funds Strategy and

Trustees’ terms of reference on an annual basis and agree changes where appropriate;

(d) develop and review the Scheme of Delegation for charitable funds on a

regular basis and consider changes where appropriate;

(e) obtain assurance that a separate register of interests is compiled for both Trustees and Fund Managers, and that this is reviewed and updated on a regular basis;

(f) approve fundraising policies that comply with statutory requirements in

conjunction with the Director of Finance.

(g) on an annual basis, review and approve summary level income and expenditure plans, compiled from Fund Managers’ detailed plans, ensuring that they complement the strategy.

(h) seek assurance that an effective mechanism exists whereby equipment needs

are identified and satisfied, within resource constraints, through an equitable bidding process underpinned by business plans.

(i) oversee the management of investments. Where an investment manager is

used, the Trustees will ensure the investment strategy has been appropriately communicated, the information required is specified and received in a timely manner, and that the service is market tested at regular intervals;

(j) receive assurance that all research monies paid into charitable funds meet the

criteria for charitable status as specified by the Charity Commission;

(k) review the number of funds on an annual basis and undertake a programme of rationalization, where appropriate;

(l) undertake an annual risk assessment.

(m) keep the equivalent of one year’s running costs in reserves

(n) To formally appraise the performance of the Charity Director no less than once per year.

(o) Hold the Charity Director to account on principle matters of:

• Governance • Fund Raising • Financial Management • Resource Management • Investment Strategy

It should be expected that a full written report be submitted by the Charity Director monthly and discussed at each Committee following. Accountability The Trustees are accountable to the Charity Commission for the proper use of the charitable funds and to the public as a beneficiary of those funds. The Trust Secretary will therefore ensure that the Charitable Funds Strategy and Annual Report/Accounts are published on the Foundation Trust’s website. The Director of Finance will ensure that all necessary reports and returns are made to the Charity Commission on behalf of the Trustees. Reporting The minutes of Committee meetings will be formally recorded and submitted to the Board. The Committee will review these terms of reference on an annual basis and report to the Board accordingly. Reviewed by the Committee: January 2019 Approved by the Board:

Agenda Item 7

Focus Item Lead Freq Jan-19 Mar-19 May-19 Jul-19 Sep-19 Nov-19Chief Executive Report SM EveryCorporate Risk Register CAi QuarterlyBoard Assurance Framework CL Bi-annualIntegrated Performance Report Exec EveryIPR Metrics Review MS AnnuallyAnnual Report and Accounts and Quality Account

CL Annually

NHSI Annual Self-Certification CA/CL AnnuallyFreedom to Speak Up Annual Report JP AnnuallyWell Led Framework Action Plan Update SM Bi-AnnuallyN&R Committee Update CL QuarterlyStanding Orders Review CL AnnuallyHealth & Safety Annual Report CA AnnuallyReview of the meeting GS EveryBoard Work Plan CL EveryQuality Strategy CAi AnnuallySkill Mix Review CAi AnnuallyWinter Plan MS AnnuallyPathology LB/CAn OnceBalanced Strategy Scorecard AS Twice

Staff Survey Results DF Annually

Annual Revalidation Report LB AnnuallyDirector of Finance Report CAn EveryFinance Strategy Can onceQuarterly Forecast CAn Quarterly2019/20 Contract CAn Once2019/20 Budget CAn Once2019/20 Capital Plan CAn OnceOperating Plan AS TwiceCQC Use of Resources CAi OnceStanding Financial Instructions Review CA Annually

ICS Update AS Every

Transformation Strategy MS once

Achieve Long-Term Financial

Sustainability

Drive the Development of

Integrated Services

Cultive Innovation and Transformation

Board Work Plan

Other / Governance

Provide the Highest Quality Care

Invest in our Staff and live out our

Values

board of directors...– part 1. topic lead time 1. opening and apologies for absence graham sims -...

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