nlg(19)005a · working through clinical standards, mental health standards and paediatric standards...

NLG(19)005a

DATE OF MEETING 08 January 2019

REPORT FOR Trust Board of Directors – Public

REPORT FROM Kate Wood, Acting Medical Director Shaun Stacey, Chief Operating Officer Jayne Adamson, Director of People and Organisational Effectiveness Richard Eley, Director of Finance Pam Clipson, Director of Strategy and Planning Kathryn Helley, Deputy Chief Operating Officer – Improvement and Productivity

CONTACT OFFICER Kathryn Helley, Deputy Chief Operating Officer – Improvement and Productivity

SUBJECT Improving Together Update

BACKGROUND DOCUMENT (IF ANY) Project Highlight Reports

PURPOSE OF THE REPORT: For Information

EXECUTIVE SUMMARY (PLEASE INCLUDE: A SUMMARY OF THE REPORT, KEY POINTS & / OR ANY RISKS WHICH NEED TO BE BROUGHT TO THE ATTENTION OF THE TRUST BOARD AND ANY MITIGATING ACTIONS, WHERE APPROPRIATE)

The attached paper outlines the progress made and the current risks identified in respect of the Improving Together Programme.

TRUST BOARD ACTION REQUIRED The Board is asked to note the content of the report

Improving Together Programme Summary

As at 18 December 2018

1

Contents

Page 1 - 4 – Quality and Safety Page 5 - 7 – Workforce and Safe Staffing Page 8 - 11 – Leadership and Culture Page 12 - 16 – Finance Page 17 - 24 – Access and Flow Page 25 - 30 – Service Strategy

2

Likelihood Impact Risk Score Category 1 Rare 1 Negligible Low Risk 1-3 2 Unlikely 2 Minor Moderate Risk 4-6 3 Possible 3 Moderate High Risk 8-12 4 Likely 4 Major Extreme Risk 15-25 5 Almost Certain 5 Catastrophic

Risk Matrix Key Workstream RAG Key Green On track for delivery milestones and KPIsAmber At risk but recoverableRed At risk and non recoverable

WORKSTREAM HIGHLIGHT REPORT Workstream: Quality and Safety Senior Responsible Officer: Kate Wood Reporting Month: November 2018

1

Improving Together Workstream Highlight Report

** This is subject to change**

Project Title Previous

RAG

Current RAG

Next RAG

Comments (explanation of RAG, progress update etc.)

Patient Safety Maternity

A A A

Divisional Clinical Director currently sitting on the board as the ward to board champion. Tablets to be purchased by the end of December 2018 to enable patient feedback to be more interactive and exploring the use of volunteers. Division currently working with Associate Director of Communications looking at improving patient information in clinical areas. Looking at the gap analysis of training for Cardiotachograph (CTG) and working on standardisation for a study day in January 2019.

Community A A A

Standard Operating Procedure being approved at Governance in December 2018 for Hand Scrubbing instruments. Clinical Risk Assessment to be undertaken for repeat use vs disposable dental burs and discuss results in December 2018 Governance Meeting for clinical opinion.

Critical Care

A A A

Reduction in incidents relating to air mattresses on critical care since 3 Hybrid Mattresses purchased and now on the unit, numbers are small and recorded on a monthly basis so need to continue monitoring to see if a sustained improvement and what is variation.

When applicable has a patient diary been commenced = Scunthorpe General Hospital (SGH) Compliance 100%, Diana Princess of Wales (DPoW) 87.50% relaunch has been undertaken at DPoW. Concerns raised regarding support for mental health services on the unit, this will be escalated at next oversight meeting.

Project Risk Rating Blue Complete and embedded. Green Completed. Not yet fully embedded/evidenced. Amber In progress/ on track. Red Not yet completed/ significantly behind agreed timescales.

Quality and Safety Workstream: Quality and Safety Number of Projects in Total (20) 13 currently live Number of Project Milestones 242 Number of Project Milestones Complete in Month

0

Number of Project Milestones on Track 242 Number of Project Milestones Overdue

0

Number of Projects Closed in Month 0


2

Emergency Department

A A A

Working through clinical standards, mental health standards and paediatric standards for the Emergency Department (ED) out for discussion with project team on short, medium and long term priorities for decision at meeting on 11 December 2018. Joint working taking place with Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH) to assist the Trust with Mental Health Risk Assessments with agreement to undertake annual risk assessments. MIND (mental health charity) are working with the CRISIS team and are opening before Christmas a “Sanctuary” that will have support from many other agencies such as social care etc. and they have also received £ ½ million funding to implement an Adult Liaison Service that will support the Emergency Department’s with assessing patients. Exploring Paediatric competency training for Adult Nursing with Lincoln University, meeting hopefully before the end of December 2018.

Children’s Services

A A A

Mental Health Risk Assessment completed with Child and Adolescent Mental Health Services (CAMHS). Matron working on cross site documentation for individual assessment to assess young people at risk. Paediatric Assessment unit has purchased its own resus trolley. WEB V to produce draft for one age group and then clinicians can agree format, then further versions for different age groups can be developed – WEB V have confirmed that this will be available for demonstration by January 2019. Surgical and Anaesthetic Representatives still to be appointed to attend Children’s Advisory Group (CAG) completion date is dependent on clinical staff coming forward.

Medical Record Keeping Project brief written, project group to be set up Safe Use and Storage of Medicines

A A A

Have actively sought engagement with attendance at the monthly safer medications group. Project plan to be signed off at Quality and Safety Oversight Meeting on 13th December 2018. Medication errors pulled by speciality to compare trends presented at safer medication group on 27 November 2018. First priority is to look at getting this information to be owned by the specialty.

Deteriorating Patient, including AKI, Sepsis and CQUIN 2

A A A

Gone live with Sepsis tool on handheld devices. All staff trained now trained either by Sepsis Nurse or Ward Managers. Use of Sepsis tool has been less than expected. Exploration of this week commencing 10 December 2018. Sought feedback from group of junior doctors, and in discussion with senior doctors have decided on a Single pathway for Acute Kidney Infection for use trust wide. This will be now on the governance agendas throughout December for all divisions for full ratification. There is a significant piece of work to drill down and understand the differences between different wards and sites in the timeliness of reporting NEWs 2. Initial discussions have revealed a variety of reasons around ward processes, connectivity and the e-obs package. Plan to tie in further work with the new matron structure to understand these fully and make the appropriate improvements. Maternity have worked with WEB V on the sensitivity to record Maternity Early Warning Score (MEWS) appropriately within the service. For example – a woman may be admitted to the unit and have a raised MEWS score which as part of the admission process is recorded onto Web V. This is duly escalated (as would be expected) but she may also be in established labour and therefore all the following observations are not put onto Web V but onto the partogram as part of the labour documentation. In respect of the Scorecard, we would be highlighted as having failed as there does not appear to be any further observations on Web V but all obstetric related guidelines and policies have been followed appropriately. Needs discussion at Quality and Safety Oversight whether e-obs are stopped in labour areas.

Pressure Ulcers A A A

Acute and Community Pressure Ulcer Project Group being set up and plan written to be agreed by mid December 2018. On the ward training in the hospital for pressure ulcer care continues. Project as part of patient safety collaborative on pressure ulcers will also be included in the plan.

Positive Identification of Patients Project brief written. Meeting arranged with Head of Risk Management to progress further. Equipment, including training Project plan being written and to be agreed 13 December 2018. Will build on ward inventory work that is been undertaken. Clinical Effectiveness


3

Evidence Based Practice Project brief written and project group to be set up. Mental Capacity/Vulnerability/Dementia and Learning Disabilities

A A A

35 Patients notes with a confirmed diagnosis of Dementia audited to ensure that patients are managed appropriately in line with the mental health act. 20% improvement from last audit undertaken. Paper going to Safeguarding Adults Forum on 5 December 2018 to discuss actions required from audit to further improve. Tender to be released for the delivery of Restraint/Clinical holding training, meeting with procurement in December 2018 to arrange.

Nutrition and Hydration A A A Draft position paper written for discussion with project team and chief nurse on the 10 December 2018. SI Process/Governance Project brief written, meeting arranged with Head of Risk Management to progress further. Mortality and Learning from Deaths

A A A

60.6% Mortality Structured Judgement Review’s (SJR) distributed 17.4% Completed SJR Reviews 34.4% SJR’s returned Incomplete 8.8% SJR’s In Progress

Ward Assurance and Excellence Processes A A A Ward assurance visits currently suspended. Patient Experience End of Life

A A A Service provision not all provided by NLAG. Currently working with other local service providers to understand service provision and service specifications for both sites along with performance data.

Way Finding Project to commence once other priority projects have fully commenced. Pride and Respect Experience of staff Behaviours Project brief written to support work around IT system to collate patient feedback and the work of the Patient Experience Group


4

Risks Ref Date Risk

Added Risk Description RAG Mitigation/Controls Date

Mitigation Occurred

RAG

17/10/18 Matron currently leading Ward excellence programme left in November 2018 and no replacement in post. Awaiting matron consultation to complete to identify new lead, potentially this process will be suspended for a while however the ward assurance and excellence programmes provide assurance for the organisation.

15 (R)

Some cover has been arranged to minimise cancelled assurance visits 17/10/18

R

Issues for Escalation

• No resource identified to collate scorecards for deteriorating patient • Sepsis data for competency not currently being pulled • Quality of the data being pulled for the score cards needs further interrogation • Clinical lead not appointed for Nutrition and Hydration work stream • Surgical and Anaesthetic (SGH) reps still to be identified to support the Children’s advisory group

Risk Rating Matrix Severity / Impact /Consequence

Likelihood of recurrence

None/Near Miss (1) Low (2)

Moderate (3)

Severe (4)

Catastrophic (5)

Rare (1) 1 2 3 4 5

Unlike (2) 2 4 6 8 10

Possible (3) 3 6 9 12 15

Likely (4) 4 8 12 16 20

Certain (5) 5 10 15 20 25

WORKSTREAM HIGHLIGHT REPORT Workstream: Workforce and Safe Staffing Senior Responsible Officer: Shaun Stacey Reporting Month: November 2018

5


Project Title Previous RAG

Current RAG

Next RAG


Establishment of Resource Centre

R A

• First Workforce Oversight meeting held in December 2018 and agreed priorities for Q4 and a plan for Q1 2019 • A Resource Centre workshop is being organised for January 2019 • Deputy Chief Nurse has been awarded a place on the National Safe Nursing Care Faculty to work with the Shelford Group to embed

and sustain the ethos and methodology of the Safer Care Nursing Tool. Commences February 2019 • Intensive Support Team established to provide weekly senior focus on grip and controls of the temporary staffing agency spend.

Plan in development to support grip and control in Q4 and support the development of Cost Improvement Plans for 2019/20 Medical Staffing • Post by post review on each rota to map new recruitment against locum spend • Development of an agency rate card – commencing with Accident and Emergency Department • Proposals to standardise internal rates through Local Negotiating Committee • Local collaborative rate reduction work continues (3,2,1 principle) Nursing • Review process for “allocate on arrival” to ensure staff are used/needed • Removed access for ward managers to request additional duties • Review f sign-off process for “Additional Duties” by Matrons and Heads of Nursing taking place • Developing divisional process to flex substantive staff across other wards • Challenge meetings taking place with Head of Nursing to ensure rotas meet Key Performance Indicator’s and governance

requirements using Safer Care Nursing Tool • Rota approvals process to be reviewed by Deputy Chief Nurse • Agree standardisation of nursing agency rates, reduce number of suppliers and gearing across suppliers – initial agreements aims to

deliver approximately 43 Whole Time Equivalent staff available December 2018/January 2019


Workforce and Safe Staffing Workstream: Workforce and Safe Staffing Number of Projects in Total 6 Number of Project Milestones 20 Number of Project Milestones Complete in Month

4


12



6

Allocate Software Implementation

A A

• Doctor’s Rostering Project - Training for Medical Staffing Mangers and E-roster team commences in December 2018. Cut over planned for end of Q4

• Meeting in December 2018 with Allocate to initiate the implementation of the Medical Optima software platform in Q1 2019/20 • Webinar to introduce Allocate job planning software for non-medical staff planned in January 2019

ESR – Self Service modules A A

• Business case submitted to Trust Management Board on 17 December 2018 for approval of non-recurrent funding to support data cleanse and project management

• Project Planning meeting scheduled for January 2019 Job Planning Medical Staffing

R A

• Action plan sent to Group Managers and General Manager to provide update on current position • Urology job plans now ready for publication – meeting will require scheduling with Clinical Leader in January to agree publication • Job planning training required as an on-going process • New reports are available and await confirmation from Medical Director for publication • Divisional Clinical Director job plans now published – a number are signed off and agreed, others are work in progress with an aim

to complete by December 2018 Establishment Reviews

R A

• Agreed at Workforce Oversight meeting that establishment reviews will be owned by the Medical Director and Chief Nurse and reported through Performance Improvement meetings

• When establishment changes are approved through formal channels eg Trust Management Board this is communicated to Financial Management teams to adjust budget lines to reflect approved changes

Recruitment

A A

• Medical Recruitment – The current medical vacancy rate is 16.89% which is equivalent to 106.98 Whole Time Equivalents. This is higher than the previous month due to the establishment increasing by 12.5 Whole Time Equivalent (WTE) staff. Increase in the Medical and Dental vacancy position due to increase in consultant radiology establishment in Clinical Support Services. Current trainee vacancy factor of 18.42% (39.75 WTE), offset by locally recruited Trust Grade posts, currently 9.09 WTE over established, resulting in an overall junior vacancy of 30.66 WTE. The pipeline across all grades awaiting start between December 2018 and March 2019 is 49.

• Overseas Nursing Recruitment - Planned recruitment of 20 nurses from the Philippines is expected in March 2019 with registration anticipated circa June 2019. A tender process for further 4 cohorts in 2019-20, subject to the procurement process, with arrival of the second cohort circa August 2019. A pilot to recruit 10 nurses from India via the Talent Acquisition Team has commenced resulting in 17 Curriculum Vitae’s to date. This is a direct initiative without the use of a recruitment agency. A social media campaign has commenced to advertise in Australia and New Zealand. The first nurse through our other overseas nurse initiatives has now passed all relevant examinations and received their pin number. An Occupational English Test (OET) programme to support our current 7 overseas nurses who have been unable to pass International English Language Testing System (IELTS), will be presented to Trust Management Board.

• Nurse Recruitment – Nursing vacancy rate reduced to 7%, previously 11%. Non-registered vacancies have risen slightly in month due to Newly Qualified Nurses moving to Band 5 roles from Band 2, a pipeline is in place to mitigate this with start dates booked for January 2019. 2019/20 Newly Qualified Nurse campaign commenced in December 2019 aimed at third year students, visits to Nottingham and Hull University over the past few weeks has resulted in over 100 applications so far. Interviews commence in January 2019.

• Allied Health Professionals - The Talent Acquisition team have commenced pilot recruitment campaigns in multiple English speaking countries with a good early response from potential candidates. The main focus initially has been dieticians but will expand beyond to all Allied Health Professional roles once a proof of concept is established. The Allied Health Professional vacancy level reduced slightly in month 8.


7

Risks (High Risk only 15>) Ref Date Risk


Mitigation Occurred by

RAG

1 19/07/18 Projected job plan savings are not being delivered 16 (R) Action plans per speciality available to audit explanations as to why identified efficiencies cannot be met

Ongoing 16 (R)

2 17/10/18 Clinical and operational resistance to the creation of a resource centre may

lead to operational and financial benefits not being delivered 15 (R)

NHSI have provided funding to support a project management role to develop the resource centre

14/12/18 9 (A)

3 1/11/18 As a result of the Job Planning Lead leaving post there is a risk of lack of

knowledge and expertise and capacity to maintain the level of input to drive forward the job planning agenda

15 (R)

Escalate to Programme Director. Project plan requires review with the Senior Responsible Officer and Operational Lead

4

14/11/18 As a result of the ongoing retention issues affecting the net vacancy position there is a risk that the requirement for increased recruitment will continue.

12 (A)

Retention workstreams developing plans to mitigate risk. Ongoing 9 (A)


None.

KPI’s/Trajectories (including quality and finance)

To be agreed.




Moderate (3)

Severe (4)

Catastrophic (5)

Rare (1) 1 2 3 4 5

Unlike (2) 2 4 6 8 10

Possible (3) 3 6 9 12 15

Likely (4) 4 8 12 16 20

Certain (5) 5 10 15 20 25

WORKSTREAM HIGHLIGHT REPORT Workstream: Leadership and Culture Senior Responsible Officer: Jayne Adamson Reporting Month: November 2018

8


*Will increase with development of two projects (Safety Culture and Organisational Redesign) and refresh/expansion of existing projects. Project Title Previous

RAG

Current RAG

Next RAG


Pride & Respect (including Listening to Improve)

A A A

Pride and Respect training delivered to over 400 staff since launch, including 52 as part of second Leadership Conference Day. Let’s Talk Mediation Service promoted at Leadership Conference Day – all referrals into service so far have produced successful outcomes. Review of Champions list undertaken to ensure those on the list are still engaged and ready to ‘champion’ the programme. 90 Champions remain engaged. Champions Pledge Certificate to be distributed to all Champions. Actual pledge will be down to the individual champion but ideas and examples will be distributed. Pride and Respect training to continue through the coming months, including at a third Leadership Conference Day in January 2019.

Supporting the Junior Doctors

R R R

Agreement between departing Director of Medical Education, Post Graduate Medication Education and Improvement Team for a deep-dive into the presenting issues for Supporting the Junior Doctors. Focus to be on what has held up progress, especially in relation to delivering against internal and external reviews held previously.


Leadership and Culture Workstream: Leadership and Culture Number of Projects in Total 8 Number of Project Milestones 43* Number of Project Milestones Complete in Month

0


4



9

Engagement and Retention

A A A

Slight increase of 0.09% for Trust Turnover Rate but the monthly figure of 9.92% remains under the Trust target of 10.40%. Statistical Process Control (SPC) Charts developed for Nursing turnover to help deliver message of control limits and move away from reaction to natural ups and downs on a month-to-month basis. Second engagement session delivered as part of Leadership Conference, where same message from October 2018 session delivered and with divisions tasked with bringing back engagement plans before Christmas. Baseline results to be established in the New Year as part of the Staff Survey 2018 results, with an internal measurement tool built to monitor against moving forward, results and plans to be challenged as part of the Performance Improvement Meetings. Final engagement session to be held in January 2019. Exploration underway with Nursing colleagues on further improve overall retention, examples of:

♦ Sabbaticals ♦ Flexible working/shift allocations ♦ Retire and Return/Mentorship roles.

Task groups to be established to support the above initiatives. Leadership Development

A A A

Second cohort of Ward Leadership programme commenced 5 November 2018 with initial positive feedback. Review to take place with Chief Nurses Office. Feedback has been positive but review required to determine future scope and output. Initial conversations held with external provider for Clinical Leadership programme. Provider is a former Medical Director with direct experience of leading on such programme. Existing Level 3, 5 & 6 programmes and Ward Leadership programmes continue.

Quality Improvement

A A A

Trust wide decision made for Quality Service Innovation & Redesign (QSIR) to be the standardised Quality Improvement package. Meeting with NHS Improvement ACT Academy Associate to discuss and showcase Quality Improvement plans for the Trust, met with a positive response and encouragement. Applications from cohort of staff to become the second wave to enrol in the QSIR College and become QSIR Associates. Establishment of Task and Finish group to progress with actions. Quality Improvement Workshop with Endoscopy Staff (cross-site) held with a positive response from a group engaged with the Quality Improvement principles. Continuous Improvement Strategy to be developed in December 2018/January 2019 for ratification by end of March 2019.

Safety Culture

N/A N/A A

Review of Manchester Patient Safety Framework and establishment of how it could be used within the Trust taking place. Project team agreement to roll-out across the Trust on a division-by-division basis to address key issues within each area. Tool to serve as a stocktake on where areas/teams/divisions are in terms of a safety culture against where staff feel they are, utilising both staff opinions (via Manchester Patient Safety Framework) and available safety related data (Incidents, Serious Incident’s etc.) Agreement to present framework and toolset to Chief Operating Officer for approval and support to take to divisions. Project team to present framework at Operational Management Group sessions in January and February 2019, including a taster exercise before getting divisional sign-up to roll-out across Trust. Exploration of potential link-up with organisations that have rolled out similar frameworks to take place in December/January.

Career Pathways N/A N/A A

Project plan produced following initial project team forming/storming session. Milestones established with key actions, accountable parties and dates to be established in December along with confirmation of governance arrangements.

Organisational Re-design (Operational Model) N/A N/A N/A

New addition to Programme. Project plan and development to be scoped.

Risks


10

Ref Date Risk Added

Risk Description RAG Mitigation/Controls Date Mitigation Occurred

RAG

ODC1 January 2018 Low training scores for junior doctor which is impacting future takes. Lack of engagement from junior doctors in being part of improvement action plan to address issues.

12 (A)

• Increased pace and focus on reviewing junior doctor scores and surveys and agreeing responsive actions/interventions to improve target areas

• Development of project plan in conjunction with Post Graduate Medical Education to work alongside deanery ‘Rescue Plan’.

• Regain confidence and gain traction with series of ‘quick wins’ of issues affecting Junior Doctors.

Ongoing Mitigation

3 (G)

ODC2 January 2018 Danger of duplication of work with many work-streams within Leadership & Culture (and across Improving Together) having close links or cross-working. Not only potential of duplication but also contradicting work taking place, placing at risk not only the projects but the credibility of the programme overall. 6 (Y)

• Establishment of project support and appropriate governance arrangements within Leadership and Culture programme.

• Establishment of checks and balances to ensure duplication is avoided/mitigated but also to build a repository of evidence for future reference and guidance.

• Ongoing dialogue between project leads and with project support.

Ongoing Mitigation

2 (G)

ODC3 January 2018 Work stream quite embryonic in terms of Improving Together Programme. Measures of success for the programme are qualitative rather than quantitative, making KPI’s difficult to evidence – especially for plans which will see benefit in the long term.

6 (Y)

• Good work being delivered against a number of areas e.g. Listening to Improve and development programme

• Continued engagement with Project Management Office resource to enable plan development and progress.

• Project support embedded with all work stream leads to enable project fulfilment.

• Strong communications and engagement work on-going and planned in addition to success stories, for example Listening to Improve, but also future developments.

• Ongoing development of hotspot dashboard to give snapshot of impact of Leadership & Culture overall as opposed to specific work streams.

• Continual review and challenge of the project plans from both peers and Improvement Team support but also a degree of flexibility within the plans to account for the differing issues that the projects present, whilst still staying within the Governance arrangements of the Improving Together programme.

Ongoing Mitigation

2 (G)


11


• Forthcoming information of staff attending training sessions when on Annual Leave, clarification needed to see if this time is taken back although initially it appears this is not the case. As detailed in the project update, this has an impact greater than that of the specific project and is escalated as an issue for observation due to the wider impact on staff morale, safety of both staff and patients and retention.

• It appears there are numerous dashboards in development and in use across the Trust. As a result there is a risk of conflicting information but also of duplication from this. A standardised approach and ownership of this information is required.

• Leadership and Culture oversight meeting has seen core members (as per Terms of Reference) neither attending nor sending representatives. This presents an issue for the meeting in terms of monitoring the implementation of project plans to ensure necessary improvements are being made.




Moderate (3)

Severe (4)

Catastrophic (5)

Rare (1) 1 2 3 4 5

Unlike (2) 2 4 6 8 10

Possible (3) 3 6 9 12 15

Likely (4) 4 8 12 16 20

Certain (5) 5 10 15 20 25

WORKSTREAM HIGHLIGHT REPORT Workstream: Finance Senior Responsible Officer: Marcus Hassall Reporting Month: November 2018

12


Project Title Previous RAG

Current RAG

Next RAG


18/ 19 financial recovery plan A A A

Progress update: • £7.40m delivered against a plan £8.40m a shortfall of £1.0m • The risk adjusted forecast is £12.71m a reduction on October’s position due to a lowering of expectations on the orthopaedic

tender and Lucentis and an in-month under delivery on nursing new deal Deliverables next Month :

• Development of pipeline schemes/recovery actions to mitigate the £2.3m risk identified

Grip & control G G G

Progress update: • Currently under delivering by £12k • Forecast position is a shortfall of £31k with small under deliveries across the board

Deliverables next month :

Medical workforce A A R

Progress update: • Delivery of £1.80m against a plan of £2.26m • The forecast position is £2.72m against a plan of £3.92m. Recruitment remains positive there was a small improvement on

agency usage and rate. • The main area of shortfall has been on reduction to the agency rate.

Deliverables next month: • Contract meeting with Holt to discuss rates


Finance Workstream Workstream: Finance Number of Projects in Total Number of Project Milestones Number of Project Milestones Complete in Month

Number of Project Milestones on Track Number of Project Milestones Overdue

Number of Projects Closed in Month


13

Nursing & midwifery workforce R R R

Progress Update: • Delivery at £607k was £453k down against the plan of £1.06m. In-month savings for new deal were nearly £100k less than

initially anticipated. • Delivery of £1.66m is forecast against the plan of £2.30m a shortfall of £0.64m. • Block booking of agency shifts to secure a better rate and a number of recruitment initiatives are on-going which are

described in the Safe Staffing Workstream Highlight Report Deliverables for next month:

• New deal establishments need to be put in place over the remainder of the year.

AHP workforce G G G

Progress update: • £841k delivered against a plan of £697k, however the majority of this is non-recurrent savings. • Forecast over delivery at year-end of £107k.

Deliverables next month: • An AHP (Allied Health Professionals) Workforce plan to meet service needs in Community & Therapy Services has been

completed. The actions from this need to commence delivery next month.

Clinical productivity G G G

Progress update: • Delivery of £798k against a plan of £782k • Forecast £1.32m based on all additional sessions being agreed through a business case process

Deliverables next month: • Assessment of additional sessions year to date

Non pay and procurement R R R

Progress update: • £1.09m delivered against a plan of £1.4m, £726k shortfall. • Orthopaedic tender savings have been reduced further following review and all savings relating to Lucentis have now been

deferred until 2019/20 • Forecast delivery is a shortfall of £1.03m due to the orthopaedic tender as well as Purchase Price Index and Benchmarking tool

(PPIB) led supplier negotiations Deliverables next month:

•

Estates and facilities G G G

Progress update: • £472k delivered against a plan of £448k, an over delivery of £24k • Forecast of £784k against plan of £737k

Deliverables next month: •

Income A A A

Progress update: • Delivery of £171k against a plan of £205k • Forecast Delivery is only £262k against plan of £308k with some of the income shortfall mitigated by reduced expenditure

Deliverables next month: • Assessment required of when the scheme is likely to commence


14

Corporate G G G

Progress update: • Vacancies have enabled a £291k over delivery year to date • Current vacancy levels would allow for the Cost Improvement Plan (CIP) to be delivered in whole. However current

assessment assumes some fill so forecast delivery is only £211k above the £1,333 plan. Deliverables next month:

• Vacancy assumptions need to be replaced with full schemes in the Corporate Directorates Risks Ref Date Risk


Mitigation Occurred

RAG

1.

Current forecast delivery is £12.71m against the £15m plan. However, a shortfall of £2.29m against plan remains for which mitigation schemes/recovery actions are needed urgently.

A (12)

The development of a CIP pipeline has been ongoing and will be continuous throughout the year. Currently potential schemes in excess of £1.9 million have been identified.

A

(12)

2.

The Trust is required to maintain their elective backlog levels and is committed to reducing their 52 week waiting patients. There is a risk to WLI (Waiting List Initiatives) reduction if productivity levels do not increase rapidly enough to increase numbers of patients seen.

A (12)

Discussions commenced with commissioners on any waiting list position improvements required for 18/19 and negotiate activity funding within contract to cover costs.

A (12)

3.

18/19 nursing agency savings are based on current nursing establishments. Recruitment challenges, and vacancies, effectiveness of roster controls, and ability to reduce agency rates continue to present high risk despite concerted effort to overcome.

R (20)

Tightened agency controls and spend monitoring through Executive/COO (Chief Operating Officer) sign-off and nursing oversight group New deal for nursing developed as mitigation schemes £0.6m (PYE)

R (16)

4.

Significant progress has been made on Medical staffing recruitment with a healthy pipeline in place. However there needs to be a reciprocal drop off in the use of agency staff in order to deliver the associated CIP

R (16)

Tight roster control as well as close monitoring of dual running. Assessment of the impact of additional shifts.

A

(12)


None.


15

Financial Performance M7


0

500

1000

1500

2000

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

£000

's

2018-19 CIP Delivery

Forecast Recurrent Forecast Non-recurrent Actual Recurrent Actual Non-recurrent Plan


16




Moderate (3)

Severe (4)

Catastrophic (5)

Rare (1) 1 2 3 4 5

Unlike (2) 2 4 6 8 10

Possible (3) 3 6 9 12 15

Likely (4) 4 8 12 16 20

Certain (5) 5 10 15 20 25

WORKSTREAM HIGHLIGHT REPORT Workstream: Access and Flow Senior Responsible Officer: Shaun Stacey Reporting Month: November 2018

17


Unplanned Care

Programme: Access & Flow Workstream: Unplanned Care Planned Care Number of Projects in Total 5 4 Number of Project Milestones 30 39 Number of Project Milestones Complete in Month 1 3 Number of Project Milestones on Track 25 24 Number of Project Milestones Overdue 4 12 Number of Projects Closed in Month 0 0


RAG

Current RAG

Next RAG


Frailty

A A A

Initial pilot completed 3 October 2018. Review report received from Emergency Care Improvement Support Team, some further work to do regarding the assessment criteria and the way in which the Multi-Disciplinary Team works. The pilot will continue until such time as the final business case is agreed across the system, this is due to go to Trust Management Board on 17 December 2018. Service currently remains amber as the strategy required needs to be system wide rather than Trust focused so this will need to be developed in line with the system wide business case.

SAFER patient Flow Bundle

R R A

SAFER refers to a senior review of all patients, consideration of the flow of patients, discharge at the earliest opportunity before midday, with a systematic review of all patients in hospital over 7 days. The roll out of SAFER is behind plan due insufficient clinical input at board rounds. The Trust has commenced work as part of a SAFER collaborative and a peer review visits have taken place. A roadshow is being held on the wards to gain staff engagement with the SAFER principles and understanding the impact on length of stay and stranded patients. Performance at ward level is being reviewed by the Divisional Head of Nursing, Medicine with each of the ward managers.

Discharge to Assess/Virtual Ward

A A A

An Integrated Discharge Team has been created at Scunthorpe which combines existing resources and functions across health and social care (North Lincolnshire) to take responsibility for the management of inpatients who have new or significantly altered care and/or support needs following discharge. A virtual ward has been established where patients who do not require acute medical inpatient support and are clinically fit for discharge (step-down) and where admission to an acute bed can be avoided through the provision of nursing interventions appropriate for an advanced clinical practitioner and/or intensive therapy (step-up). There have been two patients move through the service to date and case studies regarding their experiences are being developed to ensure any learning is shared.

Project Risk Rating Blue Complete and embedded. Green Completed. Not yet fully embedded/evidenced. Amber In progress/on track. Red Not yet completed/significantly behind agreed

timescales.


18

Urgent Treatment Centre (UTC)

A A A

Both Urgent Treatment Centre trial weeks have been completed for North Lincolnshire and North East Lincolnshire, which were successful and assured that the model trialled suited the needs of the patient population and the Trust. Two different procurement models are proposed. Scunthorpe site model to be tendered, specification prepared by North Lincolnshire Clinical Commissioning Group whilst Grimsby model is based upon an alliance between all agencies in the North East Lincolnshire system. It is anticipated that the introduction of the urgent care facility will have a positive impact on the Emergency Department performance as patients are reviewed and treated by the most appropriate staff group, leaving only those patients requiring emergency care to be treated in the Emergency Department. The model will be delivered in 2 phases, Phase 1 December 2018 both sites have started to deliver the concept model of the Urgent Treatment Centre however the workforce will not be fully established. The aim is to have the Urgent Treatment Centre model fully implemented by June 2019 at North East Lincolnshire and October 2019 at North Lincolnshire (due to procurement).

Ambulatory Care

A A A

This is a two part project which has initially focussed on the implementation of surgical pathways which are assessed in the Emergency Department and directly streamed to a Surgical Ambulatory Ward. Numbers on the Grimsby site are increasing month on month as pathways for General Surgery however there are some pathways for Urology and Ear Nose & Throat still being introduced. Work is still underway to find a suitable location for an ambulatory care unit on the Scunthorpe site and is part of the site development work. Once Surgical Ambulatory Care is fully functioning a review of the medical pathways will be undertaken. There is no further update this month.

Risks Ref Date Risk


Mitigation Occurred

RAG

03/10/18 Financial Risks associated with continuing to run frailty the pilot R To produce the business case promptly to maintain the financial risk to a minimum, to be presented to Trust Management Board on 17/12/18.

A

01/10/18 Risk that lack of clinical engagement for morning board rounds will mean there will be no

clinical decision maker as part of the Multi-Disciplinary Team therefore delayed discharges

R To work with clinical teams during implementation of SAFER principles and Red2Green tool, any issues to be escalated.

A


• Key issues for escalation are: insufficient clinical engagement to facilitate the implementation of the SAFER principles across the wards which will have a negative impact on length of stay as a result of key decisions not being made in a timely manner.

• Improved attendance from external partners would enhance the outcomes of the Multi Agency Discharge Events that will be held at each site throughout winter.


19


KPI Lvl

Key Performance Indicator Secondary Indicator

Target Site Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 12 Months Total

Perf TrendUnplanned Care KPI Dashboard

Nov-18 Current Month & Movement


20


KPI Lvl

Key Performance Indicator Secondary Indicator

Target Site Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 12 Months Total

Perf TrendUnplanned Care KPI Dashboard

Nov-18 Current Month & Movement


21

Improving Together Workstream Highlight Report Planned Care


RAG

Current RAG

Next RAG


Performance standards and waiting lists

A A A

The project covers a number of areas that will enable the Trust to respond to the Care Quality Commission (CQC) requirements and deliver recovery of performance standards and waiting lists. Key themes include:

• Elimination of 52 week wait patients • Documented approach and specialty plans for review of overdue follow-up patients • Floor to Board understanding of waiting lists • Improvement of referral to treatment (RTT) performance • Improvement of cancer performance and cancer timed pathway delivery • Improved radiology reporting turnaround times and reduction in waiting times • Review of clinical administration provision

Further work within the programme to support this goal is to ensure we strive to get it right first time in terms of administration which the trust aims to do by training staff in referral to treatment and regularly reviewing our patients. In addition, the programme aims to provide improved access for patients and GPs to the trust via improvements in booking and access. RTT:

• Daily huddles in place for all specialities with Specialty Admin Team members, Team Leaders and Service Managers to review clinical priorities 52 week waits and manage patient booking priorities – review of effectiveness to be undertaken and changes implemented if required.

• Divisional weekly Patient Tracking List (PTL) meetings linked to the Chief Operating Officer’s Patient Tracking List weekly meetings to review and scrutinise patient level detail and manage the 52 week wait position with some speciality reviewing down to 40 weeks and preventing “tip overs”

• Division/Specialty 52 week waits reviewed daily and “tip overs” managed • CQC high level milestone plan converted to a working document and Task and Finish Group established

Outpatients: • Dynamic Outpatient Data Collection Form being implemented Trustwide following pilot in Ophthalmology (currently 56% of specialties in

place) • Central Referral to Treatment validation team business case underway

Theatres: • Theatre session uptake and scheduling severely compromised by the closure of the Coronation Block F&G theatres and wards 10 and 11.

Cancer

A A A

The cancer project is focused on ensuring that all those patients suspected of, or diagnosed with, cancer receive diagnosis and treatment within the cancer RTT pathway. This includes introduction of timed cancer pathways and straight to test diagnostics, commencing with lung, colorectal and prostate.

• Work ongoing with Divisions to complete timed cancer pathways commencing with Lung, Colorectal and Prostate – Referral to diagnostics determined and measured against currently

• Increase in ‘straight-to-test’ diagnostics underway – colorectal due to commence early January 2019


22

Diagnostics

A A A

The diagnostics project is primarily focused on the provision of timely and high quality diagnostics in support of the patient RTT pathway. To achieve this, the project focuses on increasing core capacity through recruitment, reducing waste, service improvements and new models of working. In addition the project supports the Trust aspiration for a Joint Advisory Group (JAG) accredited endoscopy service, which demonstrates a high quality service.

• Global Rating Score (GRS) submitted for Scunthorpe – JAG accreditation visit expected April 2019 • Call reminding to reduce DNAs – continue to monitor impact • Feedback utilisation of bronchoscopy lists to medicine, and if underutilised consider options • Ongoing monitoring of short notice cancellations with medicine, surgery and Clinical Support Services to maximise capacity • Review of trainees underway to map when full capacity will be achieved

Preoperative assessment (POA)

A A A

Effective preoperative assessment ensures a quality service and reduces risk to patients by ensuring they are fit for their procedure. Preoperative assessment also allows for the identification of any potential issues that may lead to the delay or cancellation of the procedure on the day; a lost opportunity to the Trust to treat a patient and ultimately has a financial implication. Through this work this project aims to reduce risk to patients and ensure that theatre slots are not lost that could have been avoided.

• POA and Anticoagulation Standard Operating Procedures (SOP) drafted and out for consultation – closing date for comments is 14 December 2018

• Booking processes for each specialty administration team (SAT) have been collated with a view to streamlining processes Trustwide. This is to be discussed at the Task and Finish Group in Dec ember 2018.

• Trust visit to Northumbria to review process for Orthopaedic elective surgery and understand enhanced recovery pre-assessment took place on 9 November 2018. Next steps are to be discussed at the Task and Finish Group in December 2018. Work also considering how the trust can use Goole more effectively

• Clinical pre-assessment training sessions scheduled in monthly for 2019 Risks Ref Date Risk


Mitigation Occurred

RAG

1 01/08/18 Specialty performance recovery plans may be limited by the ability to provide additional theatres, outpatients and diagnostic capacity R

Specialty teams to work with Theatre Transformation Board and link with outpatient and diagnostic teams to understand specialty capacity requirements and improve efficiencies in core capacity to deliver increased activity

A

2 20/11/18 Difficulty in meeting with lead clinician for anticoagulation guidance sign off R Guidance currently in place can still be utilised, though this is outdated A

Issues for Escalation • Specialty performance recovery plans not linked to waiting lists – Information Services currently reviewing to align recovery plans with impact on waiting list • Theatre dashboard now available but accuracy of data questioned – discussed at PIMs and raised with executive team


23

KPIs/Trajectories (including quality and finance)


24

Financial Delivery Month 8




Moderate (3)

Severe (4)

Catastrophic (5)

Rare (1) 1 2 3 4 5

Unlike (2) 2 4 6 8 10

Possible (3) 3 6 9 12 15

Likely (4) 4 8 12 16 20

Certain (5) 5 10 15 20 25

WORKSTREAM HIGHLIGHT REPORT Workstream: Service Strategy Senior Responsible Officer: Pam Clipson Reporting Month: November 2018

25

Improving Together Board Update

Workstream Element Previous RAG

Current RAG

Next RAG

Planned Finish Date

Revised Finish Date


Strategic Oversight Group established B B

27 November

2017

n/a Scheduled into diaries on a monthly basis. Following stocktake and relaunch of Improving Together Programme to involve wider stakeholders, the monthly meeting transferred into breakfast meetings.

Humber Acute Services Review Programme agreed B B

24 January 2017

n/a Continuous comms needed. First Clinical Design Group met 27th June providing joint clinical leadership between HEY/NLaG

South bank principles agreed B B 19 January

2018 n/a Built into the proposed service changes

Bring Wave 1, Fragile services to a conclusion

A A

NLaG 31 March 2018

HASR September

2018 HASR May

2019

n/a Trust Board received Ear’s Nose and Throat (ENT) and Urology proposals 27th March and agreed with the clinical leaders preferred scenario. Clinical Commissioning Group leaders meeting OSC chairs (joint approach still being established). Clinical Leads to attend for ENT, Urology & Haematology to provide update on service position as per briefings provided to OSC chairs. North East Lincolnshire OSC 12/9/18, NL OSC 17/9/18. Will be factored into any wider engagement and consultation due post May 2019. To form part of the full engagement and communication from Jan 19 through to potential public consultation as part of HASR programme.

Governance Structure for Wave 2 of HASR Programme

G G

02 May 2018 n/a Northern Lincolnshire and Goole (NLAG) Chief Executive Officer, HEY CEO and Chair of HCV STP have proposed a governance structure for confirm and challenge at the next HASR Steering Group 2nd May – approved and in place. Feeding into breakfast meetings. Next 6 specialities agreed (Cardiology, Oncology, Neurology, Stroke, Critical Care, Complex Rehab). Will be aligned with the Emerging Clinical Strategy presentation to TB 18 December 2018



26

Detailed evidence and service planning which forms the foundations of the emerging clinical strategy

A A

25 September

2018 18 December

2018

Tbc Trust Board agreed Emerging Strategic headlines 27th February HASR Steering Group agreed Emerging Strategic headlines 14th March Presented Emerging Strategic headlines to NHS Improvement 28th March Secretary of State meeting regarding strategic headlines 24th April Nuffield workshop held 22nd/23rd June Trust Board agreed scenarios for modelling 26th June Humber Acute Steering Group presentation 4th July Breakfast meetings with clinical and system leaders to work through detail of scenarios in place during July. Further breakfast meetings arranged throughout September, October and November to continue scenario modelling and development of Current State (Case for Change) through to draft Future State. Attain appointed with effect from October 2018 through agreed CEO oversight. Presenting at Trust Board 18Dec18

STP Capital submission aligned to emerging clinical strategy B B

July 2018 July 2018 First submission through the STP achieved, awaiting feedback from regulators Group established to co-ordinate detailed submission by Jul18. Executive Director representation PC/JJ Capital submission deadline of 16th July met, £71.5m submission for NLaG. Awaiting feedback

Nuffield Facilitated Workshop G G

09 February 2017

Tbc through terms of

engagement

Workshops completed. Verbal agreement to provide confirm and challenge following the detailed scenario work up. Nuffield Trust document on ‘Smaller Hospitals’ shared with Divisions. To be referenced in the Emerging Clinical Strategy.

NHS Improvement support confirmed G G

31 March 2018

02 May 2018

Confirmed and included within the HASR Governance structure highlighted above

Clinical co-dependency grid in place

G G

28 February 2018

In draft through full

ASR

Draft shared for confirm and challenge with Strategic Oversight group. One methodology to ensure co-dependencies is front and centre of all decisions. Oversight 28 February cancelled due to Opel4 from Snow. Has been shared as part of the Trust Board briefing 27th Feb. Will remain in draft whilst all key specialties are worked through. Live document. Linking into HASR for consistency across the wider system. Will be linked into the strategy documents.

Pan STP working group B B

17 January 2017

Ongoing Any service change has the potential to impact upon ULHT and Doncaster. Likewise any changes proposed from their acute service review may impact upon NLaG. Regular meetings established with agreement to build sensitivity analysis into strategies.

Specialty specific transformation groups in place – Surgery G G

31 December 2018

In place with Commissioner and GP reps as members. 4 patient representatives recruited and supporting Urology, ENT, Ophthalmology and Orthopaedics. General Surgery commenced. Breast in development

Specialty specific transformation groups in place – Medicine A A

28 February 2018

Structure in place but not yet facilitating Commissioner and GP reps as members. Rep with potential for dual role but need formal structure for rep to be part of. Alternative specialty based groups in place and will be documented for clarity.

Specialty specific transformation groups in place – Women & Children’s A A

28 February 2018

Maternity in place. Paediatrics tbc as per comments below (NHSI coordinating)


27

Maternity Strategy G G

31 March 2018

Maternity strategy taken as far as can go without paediatrics review. Agreed through HASR Exec, not a priority for us for radical change Feeding into LMS as part of wider Humber Strategy longer term. Maternity appendix being refreshed with triumvirate.

Please note: Planned finished date for the following represents the date for completion of draft for wider sharing and engagement. This is to ensure no decisions are made without full knowledge and understanding of all clinical interdependencies. The 3mth timescale referred to above covers the 6 priority specialties In wave 2.

Paediatric Strategy (wave 2)

R R

31 March 2018

Maternity decisions cannot be made without reviewing paediatric and neonatal services. Resources not available to meet turnaround timescales hence red rating. NHSi support offered, NLaG accepted. PC requested review to include HEY and Sheffield Children’s, NHSi agreed in principle. NHSi have sourced external support, terms of engagement being worked through. Awaiting confirmation of who and when. Escalated to HASR programme leads. External support not secured. NLaG anaesthetic paediatric lead completed Paediatric pathway document. Paediatric appendix in progress to support the strategy.

Critical Care Strategy (wave 2)

G G

31 March 2018

Scenarios fully documented critical care presence on both sites. Clinical interdependencies resulting from Scenarios being worked through as part of breakfast meetings. ODN strengthened with a focus on workforce and technology developments. Critical Care appendix being refreshed with the triumvirate and clinical leads.

Urgent and Emergency Care Strategy (Wave 2) A A

31 March 2018

Two urgent and emergency care front doors agreed through HASR Exec. Clinical interdependencies resulting from Scenarios being worked through as part of breakfast meetings including the quantification of an UTC on site. Pilots complete. NL tender released. Tender delayed.

Acute Medicine Strategy (inc Frailty, ambulatory care) (Wave 2)

A A 31 March

2018 Scenarios focussing on a multi-disciplinary assessment unit on each of the main sites. First

breakfast meeting explored potential to join this unit to UTC to align staffing and reduce potential duplication. Integrating discussions into UTC models continue with CCG leads

Acute Surgical Strategy (Wave 2) A A

31 March 2018

As above

ENT Strategy (wave 1) G G

31 March 2018

Timescale to share preliminary modelling of scenarios of future Acute hospital service provision including facilitated clinical discussions. Requested this be looked at PAN STP – requested support from HCV STP at Jan HASR Executive. Board received and agreed strategy March18. Due to NEL/NL OSC’s sept 18.

Urology Strategy (wave 1) G G

31 March 2018

Timescale to share preliminary modelling of scenarios of future acute hospital service provision including facilitated clinical discussions. Headlines went to Trust Board briefing 27Feb18. Board received and agreed strategy March18. Due to NEL/NL OSC’s Sept 18

Haematology Strategy

A A

31 March 2018

May Board Timescale to share preliminary modelling of scenarios of future acute hospital service provision including facilitated clinical discussions. NLaG/HEY working through to 28th March for headlines. Actions to address in train, Board to receive progress (timescale TBC). NHSE leading, updated provided for OSC. Due to NEL/NL OSC’s Sept 18. Full business case in development, to be approved through internal structure. Clinical Senate invite to attend to update.


28

Immunology Strategy

A A

Priority following resignation of single handed immunologist. Red rated as HEY cannot support due to workforce shortages. Division seeking locum. Majority of allergy care is delivered in primary care in other areas; view of outgoing clinician is 90% can transfer. HEY already implemented shift. Linking into HASR. Joint support in place with HEY. Comms being worked through in terms of holding position. Paper due at TMB 17/9/18 for future decision of service. Network support in place from HEY whilst working on longer term strategy.

Cardiology Strategy A A

31 March 2018

ODN launched 12/6/18. Exploring potential change in 2018/19 as a result of long lengths of stay. Focus of breakfast meetings. Community cardiology going live Nov 18. ODN established. HASR speciality design workshop 21/11/18 – output disseminated for comment. Next review workshop scheduled for Jan19

Respiratory Strategy

A A

Linked to the acute medicine debate given the acute medical rotas. Right Care Programme also underway. NL and NE Lincs have supported a shift to community services for Resp with the potential investment of a consultant in each patch. This would provide better care for long term conditions working with specialist nurses.

Gastroenterology Strategy A A

Linked to the acute medicine debate given the acute medical and GI bleed rotas. Right Care Programme also underway indicating potential material shift away from acute care reducing demand. Three pathways agreed, implementation phasing to Jan 19.

Neurology

A A

Single handed service with no capacity to support any further from HEY. Requested this be looked at PAN STP – requested support from HCV STP at Jan HASR Executive. Network links in place, working through recovery plan. CNS MS funding secured. Significant progress made with RTT performance position and reduction in waiting lists. Network links continue.

Oral and Maxillofacial Surgery R R

Being driven as a HCV STP footprint due to scale needed to attract workforce. Based upon the West Yorkshire model. Builds upon relations built during orthodontic move, a HCV work stream. Strategy is wider than HCV STP, structure and timescales in discussion through STP led by York. NB immediate 18/19 issue due to limited capacity at HEY.

Trauma & Orthopaedics A A

Transformation Board in place. GIRFT programme. HCV principle of Goole and Bridlington as elective orthopaedic centres. 70% of elective ortho now being cared for in Goole. Demand & capacity plans in progress. Links to MSK service provision and ability to reduce demand.

Radiology

A A

Strategy in place however investment stream to deliver is not in place. Imaging Group with task & finish groups established to oversee CT and MRI developments. HCV STP taking forward agreed acute network actions including implementation of imaging equipment across the STP.

Ophthalmology A A

Transformation Board in place. Plan agreed with commissioners. Recovery plan continues, significant progress made with RTT at DPoW and GDH, SGH back on track.

Community services A A

North Lincs agreed to additional time to work through service need and structure therefore postponed tendering for 9mths. Transformation Board with task & finish groups structures in place with a clear direction of travel. Jan 19 next milestone review.


29

Risks Ref

Date Risk Added

Risk Description RAG Mitigation/Controls Date Mitigation Occurred

RAG

1

Dependency of core specialty strategy (timescale) on other specialty strategies. Specifically, the ED/CC/Maternity strategies will impact the category 1,2,3 strategies and therefore the risk is timescales and sequencing. A

(12)

Category 1 (Cardiology, Respiratory, Gastro, General Surgery, Acute Medicine) and Category 2 specialties (Urology, ENT, Haematology/Oncology), CT/MRI, Immunology) specialty strategies may need to remain temporary until Core specialty strategies are finalised. The risk will always be present however the strategy oversight group is now established to manage the interdependencies

A (8)

2 Threat of service tendering present for community services and

ophthalmology. UTC NLCCG published October 18. R (16)

RAG improved following recent decision by NL CCG to delay community services tendering by 9mths. Keep progress through the transformation board under review

Y (6)

3

Workforce strategies for 13 priority specialties are quite reactive to the immediate fix requirements. This is not necessarily providing a sustainable/long term solution.

A (12)

Workforce present at the breakfast meetings to support with service redesign. Linkages into HASR / STP workforce strategies for joint potentials

A (9)

4

Heat map work may identify additional specialties classified as ‘fragile’ for example; Immunology has been identified through the work. Eg we don’t know, what we don’t know. Following completion of demand and capacity across all specialties, NLaG have greater transparency and understanding of challenges and actions in place. The larger risk now, is lack of visibility of the capacity constraints in other organisations in particular our adult tertiary provider.

R (16)

TP Board to note risk Work stream to complete heat map exercise to confirm any additional specialties No new specialty has been highlighted through the technical development. To remain a risk as we shift from technical to clinically owned indicator. Demand and capacity work for priority 8 completed. All other specialties due for completion end Sept 18 – completed (all 22 for NLaG). Meeting being established between

A (9)

5

Haematology service has escalated a potential issue in delivering the 3 step plan to stabilise the service with support from HEY. HEY has no capacity to take Grimsby inpatients or any patients from Scunthorpe.

R (16)

Work progressed with HEY actions in place 3rd April to expand their inpatient capacity to enable inpatient transfers. Transfer on schedule for September 2018. Full business case to be approved. Still in development

Y

(6)

6 Oral Surgery – service impact due to limited capacity at HEY.

Rated severe due to the length of time patients have already waited (3 x over 52 week breaches)

R (16)

Discussions in progress

7 Engagement and communications (governance timeline) internal and external; resource to achieve.

R (16)

Discussions in progress to reassess (12Dec18)


Oral Surgery, refer to risk below.


30

Financial Delivery

No financial target


Ref KPI Target Aug Sep Oct Nov Dec Jan Feb Mar Apr YTD Baseline Comments

S1 Specialties that have an agreed heat map assessment 34 0 0 0 0 0 0 0 0 0

Live document, agreement through the 18-19 planning round.

S2 Specialities with a Board approved sustainability strategy 13* 0 0 0 0 0 0 0 2 0

ENT and Urology

S3 Specialities with a commissioner approved sustainability strategy 13 0 0 0 0 0 0 0 0 0 Target will be one month post NLAG Board date



None/Near Miss (1)

Low (2)

Moderate (3)

Severe (4)

Catastrophic (5)

Rare (1) 1 2 3 4 5

Unlike (2) 2 4 6 8 10

Possible (3) 3 6 9 12 15

Likely (4) 4 8 12 16 20

Certain (5) 5 10 15 20 25

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