part ne -- ppubblliicc mmeetin et ng...october 2014. paper 08 . business risk and investment...

U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Agenda - 27th November 2014.doc

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PPAARRTT OONNEE -- PPUUBBLLIICC MMEEEETTIINNGG 1.0 Apologies: None 2.0 Minutes of the previous meeting held on 30

th October 2014 Paper 01

3.0 Matters Arising

4.0 Declarations of Interest

PPRREESSEENNTTAATTIIOONN 5.0 Patient-led assessments of the care environment – Presentation by Phil Davies,

Facilities Manager

Presentation

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6.0 Monitor Guidance on Strategy Development Paper 02

7.0 2015-16 Planning Process Presentation

8.0 2015-16 Tariff Update Paper 03

PPEERRFFOORRMMAANNCCEE 9.0 Month 07 Integrated Performance Report Paper 04

10.0 Capital Programme Update and Plan Review Paper 05

GGOOVVEERRNNAANNCCEE,, QQUUAALLIITTYY AANNDD SSAAFFEETTYY 11.0 Monitor Feedback on 5-Year Strategic Plan Paper 06

12.0 Quarter 2 Infection Prevention Control and Cleanliness Report Paper 07

13.0 Reports from Board Committees:

Audit Committee – 7th October 2014 Paper 08

Business Risk and Investment Committee – 8th October 2014 Paper 09

Quality and Safety Committee – 16th October 2014 Paper 10

14.0 2015-16 Board Committee Timetable Paper 11

15.0 Any Other Business: None notified

16.0 Questions from the Public

17.0 Date and time of next meeting: 9.30 a.m. on 29th January 2015, The Board Room,

RJAH Orthopaedic Hospital NHS Foundation Trust, Oswestry

Questions from the Public on Agenda items – time limit of 15 minutes There will be an opportunity for the public to ask questions on agenda items. These should be limited to two questions per person and the time in total for each person should be limited to five minutes. If topics are likely to exceed this, they should be the subject of discussions between the hospital management and the individual concerned or there should be a formal request agreed by the Trust Board for the item to be included on the next agenda. If questions are detailed and require information that is not instantly available, the hospital will respond to the question within ten working days.

To resolve, in accordance with Trust Standing Orders, that representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.

(Section 1(2) Public Bodies (Admission to Meeting) Act 1960)

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18.0 Minutes of the previous meeting held on 30th October 2014 Paper 12

19.0 Matters Arising

20.0 Chief Executive’s Update Verbal

21.0 Board Governance Review – Presentation of Final Report from CV4 Consulting Paper 13/

Presentation

22.0 Minutes from Board Committees:

Audit Committee – 7th October 2014 Paper 14

Business Risk and Investment Committee – 8th October 2014 Paper 15

Quality and Safety Committee – 16th October 2014 Paper 16

23.0 Appointment of Chairman – Deputy Chairman to Chair for this item Verbal

24.0 Any Other Business

25.0 Date and Time of Next Meeting: 29th January 2015 following the Public Board of

Directors meeting

Paper 1

U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Paper 01 Draft Minutes of the meeting held on 30th October 2014.doc

1

Russell Hardy 4358 Chairman


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PPRREESSEENNTT:: Russell Hardy, Chairman Wendy Farrington Chadd, Chief Executive Jayne Downey, Director of Nursing and Service Delivery Steve White, Medical Director Richard Clarke, Non-Executive Director Ian Davis, Non-Executive Director Alastair Findlay, Non-Executive Director Peter Jones, Non-Executive Director Hilary Pepler, Non-Executive Director

IINN AATTTTEENNDDAANNCCEE:: Ruth Tyrrell, Associate Director of HR

Craig Macbeth, Deputy Director of Finance

Margaret Surrage, Head of Board Governance (Trust Secretary) Emma Pickles, Communications and Engagement Manager Janet Cox, Minutes Secretary

MMEEMMBBEERRSS OOFF TTHHEE PPUUBBLLIICC:: Gareth Pritchard, Public Governor Jan Greasley, Public Governor Julie Roberts, Assistant Director of Nursing

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30/10/1.0 AAPPOOLLOOGGIIEESS Apologies were noted from John Grinnell, Director of Finance.

30/10/2.0 MMIINNUUTTEESS OOFF TTHHEE PPRREEVVIIOOUUSS MMEEEETTIINNGG The following amendment was agreed: 25/09/11.0 Shropshire CCG 5-Year Strategic Plan Page 9, second paragraph, first sentence to be amended to read: “The Board of Directors discussed whether work had been undertaken on the patient pathway for those patients with multiple long term conditions”. Following this amendment, the minutes were agreed as an accurate record.

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30/10/3.0 MMAATTTTEERRSS AARRIISSIINNGG The Chairman went through the actions which had all been completed.

30/10/4.0 DDEECCLLAARRAATTIIOONNSS OOFF IINNTTEERREESSTT There were no new declarations of interest to record.

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30/10/5.0 AAPPPPRREENNTTIICCEESSHHIIPPSS//TTRRAAIINNIINNGG The Associate Director of Human Resources introduced Allen Edwards, Training Advisor who gave a presentation on Apprenticeships and Training. The presentation can be accessed here. He explained that the organisation had been nominated for an award at the Health Education England West Midlands awards evening in the Small Apprenticeship Employer of the Year category and had received a commendation for the work which it undertakes. The Board of Directors discussed the number of applicants for the apprentice vacancies. The Director of Nursing and Service Delivery commented that she would like to see the numbers of health and social care apprentices increase and this was agreed. A question was asked regarding whether the Trust has an outreach programme to link in with local schools and colleges and it was noted that the Training Advisor attends school career events during the year and as a result of this, there is a 12-month waiting list for young people to participate in the Trust’s work experience scheme. A suggestion was made regarding the use of apprentices to fill vacancies and it was agreed that the default position in future would be to review this as an option where appropriate. The Chairman thanked the Training Advisor for the excellent work that he is doing and congratulated him on the external recognition that he had been given and which was well deserved. The Board of Directors noted the presentation.

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30/10/6.0 LEADERSHIP STRATEGY DEVELOPMENT The Chief Executive introduced the presentation by explaining that discussions had begun with staff groups regarding development of the leadership strategy and a number of themes had been identified. She reinforced that leadership is not just about the Board of Directors and is underpinned by the organisation’s values which influences culture and behaviour. She explained that the idea of ‘collective leadership’ was gathering pace; for example as part of the CQC inspections they test whether an organisation is well-led and how the leadership and culture of an organisation reflects its visions and values. She said that this was something which the Executive Team was keen to progress and she was seeking support from the Board of Directors that it agreed with this direction of travel. The Associate Director of Human Resources then gave the presentation which is available here. A discussion took place on the need for everyone to understand when ‘command and control’ leadership is appropriate and when ‘collective’ leadership is appropriate and it was agreed that it was important that staff are empowered to take responsibility. It was agreed that embracing the collective leadership ethos will be a challenge in this regard, but the need for this to be to the benefit of patient safety overrides any perception of hierarchy.

http://www.rjah.nhs.uk/getattachment/About-Us/Publications/Minutes/2014-2015-Trust-Board-Meeting-Papers/2014-10-30-Board-of-Directors-Public-Presentation-Apprenticeships-Training.pdf.aspx

http://www.rjah.nhs.uk/getattachment/About-Us/Publications/Minutes/2014-2015-Trust-Board-Meeting-Papers/2014-10-30-Board-of-Directors-Public-Presentation-Leadership-Strategy-Development.pdf.aspx

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The Chairman commented that it was important that the reason for the Board of Directors discussing the issue of collective leadership was because it believed that this was a way to deliver better outcomes for patients and to support delivering the vision of delivering outstanding patient care to every patient every day. The Associate Director of Human Resources confirmed that the Kings Fund research indicated a clear link between high quality care and collective leadership. It was agreed that the evidence demonstrating this would be included in the strategy. The Board of Directors agreed with the ethos of collective leadership and approved the continued development of the leadership strategy.

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30/10/7.0 MONTH 06 INTEGRATED PERFORMANCE REPORT The Chief Executive introduced the Month 06 integrated performance report which represents the half-year point in the organisation’s performance and showed a much improved position around the areas of resources and operational delivery. She confirmed that these areas have been a key focus and it was encouraging to note the organisation’s return to its planned position in terms of overall surplus required. She reiterated the need for continued focus for the remainder of the year in maintaining this overall improved position. Domain 1 Patient Safety The Medical Director reported that there had been strong overall performance within this domain. He highlighted that:

There were no cases of hospital acquired Clostridium Difficile or MRSA Bacteraemia in month.

There were no hospital acquired venous thrombosis embolism in month.

The Trust’s performance for national VTE risk assessment completion was above target.

There was one serious incident involving a patient who fell in the hydrotherapy pool changing area. This will be fully investigated although initial indications are that there was no lapse in patient care.

There was one patient death in month which was not unexpected.

There were 16 patient falls in month; 3 patients were deemed to have suffered harm as a result of their falls and whilst this figure is above the target it is within expected normal variation level.

There were no hospital acquired grade 2 pressure ulcers in month.

The Trust scored 100% in providing harm-free care using the safety thermometer tool.

There were 13 medication incidents with 4 patients classed as having low level harm. This is the first time this metric has been outside the target but performance remains within normal variation levels.

4 patients were readmitted as an emergency which was within target levels.

Progress is on target against plan for the CQUIN metrics.

A question was asked concerning the number of patient falls where the patient was not following advice and it was agreed

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that this detail would be included in the report in the future. A discussion then took place on the harms suffered by patients as a result of medication errors and falls and the Chairman requested that more detailed discussion on these issues takes place at the next Quality and Safety Committee. Domain 2 Patient Experience The Director of Nursing and Service Delivery reported that overall performance within the domain remains strong with all domains classed as ‘green’ at the end of September. She highlighted that:

The net promoter score was 92.27 which is above the national performance rate of 73.

148 compliments had been received.

There had been 6 complaints, all of which are being investigated in line with the complaints policy.

3 patients were recorded as delayed discharges.

Access to bone tumour service targets had been achieved.

Access targets relating to diagnostics and English referral to treatment targets had been maintained.

Work is continuing in meeting the 36-week access targets for Welsh patients.

A comment was made concerning the numbers of delayed discharge patients who are awaiting care packages which have reduced. It was noted that support from Shropshire CCG was acknowledged and close working with Welsh care partners is continuing. Domain 3 Efficiency The Director of Nursing and Service Delivery reported that there was improvement in a number of the efficiency metrics in month. She highlighted that:

The growth in demand for services locally has meant that patients are choosing RJAH rather than other providers. The CCG have recognised this and issued a contract variation to support this increase in referrals.

Surgical Inpatient activity was behind plan in month although more complex cases were treated than planned.

The British Association of Day Case (BADS) rate was below target at 83.39%. The overall daycase rate was also below target and this remains a key focus of the finance and productivity task and finish group to ensure the year-end target is achieved.

The average length of stay has been decreasing since the start of the financial year and the September performance was 4.05 days, slightly above the target of 4 days.

Bed occupancy was below target levels although it was noted that staffing levels are adjusted to take account of weekend fluctuations.

The Outpatient Did Not Attend (DNA) rate reduced in month and was within target at 6.48%. Following introduction of the text messaging reminder service, this will be evaluated over the coming months with potential for this to be introduced to other services if successful.


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A question was asked regarding whether the targets were realistic for the average length of stay (elective) and daycase as they had not been achieved for a couple of months. The Director of Nursing and Service Delivery confirmed that she believed that they were realistic but work was required on understanding why patients were not achieving the expected date of discharge. She added that more complex patients had been treated in month and this could have an impact on the length of stay. It was noted that the narrative regarding theatres performance had been omitted from the report and it was agreed that this would be reinstated next month. The Chairman thanked the Director of Finance and Director of Nursing and Service Delivery for the work that they had undertaken in identifying the underlying issues which had resulted in improved performance. Domain 4 Resources The Deputy Director of Finance reported that strong performance in month meant that the financial shortfall from the first quarter had been fully recovered. He highlighted that:

A surplus of £260k had been delivered which exceeded plan by £150k.

Cumulatively the surplus is £350k which is on plan.

The EBITDA margin was 7.3% and cumulatively is 4.8%.

The pay bill was under budget which was driven by lower levels of out of job plan working supported by improved controls on how the sessions are allocated.

The Continuity of Services Risk Rating remains at level 4 (lowest risk).

The forecast remains of a £1m year-end surplus subject to delivery of the remaining efficiency programme.

Cash balances were £700k behind plan which relates to contract over-performance. Settlements have now been agreed which total £1m.

The Chairman congratulated the team on a successful month with regards to performance and it was acknowledged that the elements which had combined to produce this success needed to be replicated in future months. It was noted that the figures relate to activity which has been completed rather than forecasted activity. It was also noted that the narrative in paragraph 3.4.1 should refer to the Continuity of Services Risk Rating and it was agreed that the correct terminology would be used in future. The Associate Director of Human Resources reported that:

Sickness absence had increased to 3.76% as a result of continued long term absence in Diagnostics and Theatres and an increase in short term absence across the Trust.

For the third month, musculo-skeletal disorders absence increased in spite of the fast track access to physiotherapy.


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The Trust is third lowest in the region for absence and has the lowest rolling absence in the West Midlands.

The annual health and wellbeing day had been very well attended by staff.

The promotion of flu vaccination continues.

The staff stability index remained static at 91.94%.

Staff appraisals were at 92.58% which was above the 90% target.

There were no incidents relating to staffing levels or ‘red flag’ events reported.

It was noted that absence as a result of musculo-skeletal disorders is discussed at the health and safety committee and this is triangulated to see if there are work-related issues or whether the individual has completed statutory training. Domain 5 External perception The Trust maintained its ‘green’ rating for the governance rating and Level 4 continuity of services risk rating. The Board of Directors noted the Month 06 integrated performance report.

30/10/8.0 MID-YEAR REVIEW The Chief Executive presented a paper which evaluated the progress made in delivering the organisation’s strategic aims and objectives which had been agreed previously as part of the operational plan and 5-year strategy. She explained that the review focussed on the key objectives and progress to date providing a risk rating for each area. She said that overall progress was very encouraging and focus would continue to improve the patient pathway; change management and service redesign to ensure that new ways of working deliver the required benefits prior to the introduction of the new facilities all of which will be underpinned by the development of the leadership/talent management/succession planning agenda. It was noted that whilst staff engagement in service redevelopment initiatives or projects was very good, engaging staff in delivering change to underpin this was not as successful. A discussion then took place on the usefulness of the update and it was agreed that a quarterly update would be provided which would inform the submissions to Monitor. The Board of Directors noted the Mid-Year Review position.

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30/10/9.0 NURSE STAFFING UPDATE The Director of Nursing and Service Delivery presented an update on the progress in managing safe nurse staffing levels within the inpatient wards which was a requirement of the response to the Francis report. She highlighted the following:

Staffing investment of £414k had been agreed at the March Board of Directors meeting which resulted in an increase of 17.4 wte registered nurses and movement of 5.46 wte unregistered nurses to meet the agreed ratio of 1:8 for safe daytime care and 1:11 for safe night time care. Positive engagement between the senior nursing team and HCAs had

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resulted in the changes being effected with different ways of working being implemented to ensure staff are retained and in some instances gain experience in other areas.

‘Fill’ rates are very good with some areas having above 100% to ensure patient safety is maintained.

There had been no patient safety incidents as a result of reduced staffing.

The NICE guidance has been reviewed and a number of ‘red flags’ which should be monitored will be built into the integrated Patient Acuity Monitoring System (iPAMS).

A number of recommendations will be progressed including utilising beds efficiently; different ways of working; increasing data capture using the iPAMS; building bank staff reliability and staff better understanding the acuity of patients and how this impacts on the ward.

A discussion took place on whether the £414k investment agreed in March 2014 was sufficient to meet the organisation’s recruitment needs. It was confirmed that this was sufficient at the moment but the iPAMS staffing tool will enable the organisation to monitor and understand what staffing is required when the new theatre development becomes operational. It was noted that whilst it had taken longer than expected to recruit the new staff, some were working as HCAs whilst waiting for their registration to be confirmed. The Board of Directors then discussed the valuable contribution which experienced HCAs bring to overall nursing care and whether there had been any issues between registered nurses and HCAs with the changes which had to be made to ensure the correct ratios. It was noted that there had been clear engagement between the senior nursing team and the affected staff and they had worked together to come up with solutions which meant that this valuable pool of staff was not ‘lost’ to the organisation. This had also given opportunities for staff to gain experience on other wards which has benefitted their personal development. A comment was made regarding the assurance which the Board of Directors can take from this and it was agreed that it would be helpful for the hospital to analyse the data which has been collected nationally since May 2014 to understand where it is in comparison to other organisations. A question was then asked whether acuity was affected by patients who suffer from dementia and it was noted that there are a number of support mechanisms in place to help dementia sufferers. It was also noted that as part of the new theatres development one of the key questions asked during the appointment of the preferred partners was their experience of designing dementia-friendly buildings. The Board of Directors approved the report.


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30/10/10.0 QUARTER 2 MONITOR SUBMISSION The Chief Executive presented the 2014-15 Quarter 2

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submission which provides assurance to the Board in relation to the key targets and declarations required by Monitor. She explained that overall compliance is shown as ‘green’ with a continuity of service risk rating of Level 4. The Board of Directors approved the content of the Quarter 2 submission to Monitor.

30/10/11.0 QQUUAARRTTEERR 22 BBOOAARRDD AASSSSUURRAANNCCEE FFRRAAMMEEWWOORRKK The Head of Board Governance (Trust Secretary) presented the Quarter 2 Board Assurance Framework which had been reviewed and updated by the Executive Team prior to its presentation to the Board of Directors. She explained the changes as follows:

One new risk Risk 1189 – Workforce culture – resistance to change. Elements that were previously in risk 1049 have now been captured in this new risk.

Two risks have had their level increased: Risk 890 - Impact of new specialised commissioning arrangements - residual risk increased to reflect impact of new specialised commissioning arrangements. Risk 888 - The risk of instability arising from fluctuations in the annual tariff - residual risk increased to reflect ongoing fluctuations in annual tariff.

One risk has been removed: Risk 1049 – this has been revised, following the removal of elements relating to resistance to change and the inherent risk level has been reduced to below 15. The Board of Directors noted that there had been a detailed discussion at the Business Risk and Investment Committee regarding the Tariff and whilst this had been ‘red’ rated at the time of production, it was acknowledged that the risk may well be mitigated down pending the outcome of Monitor’s further review. The Board of Directors approved the Quarter 2 Board Assurance Framework.

30/10/12.0 BBOOAARRDD GGOOVVEERRNNAANNCCEE RREEVVIIEEWW SSEELLFF--AASSSSEESSSSMMEENNTT The Director of Nursing and Service Delivery presented the self-assessment which had been developed initially by the Executive Directors and was then subject to a ‘challenge and confirm’ informal Board session on 8

th October 2014. She

explained that following this detailed challenge and confirm session a number of additional examples of good practice were suggested and included in the final self-assessment. The Board of Directors approved the self-assessment.

30/10/13.0 QQUUAARRTTEERRLLYY AAPPPPRRAAIISSAALL RREEPPOORRTT FFOORR FFRRAAMMEEWWOORRKK OOFF QQUUAALLIITTYY

AASSSSUURRAANNCCEE The Medical Director presented his report which provided an update to the Board of Directors on the appraisal of medical practitioners at the hospital for 2014-15. He explained that it included details of the quarterly submission to NHS England called the Annual Organisation Audit (AOA) and that in future

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this will be presented to the Board quarterly instead of annually. He gave details of the actions which had been undertaken during quarters 1 and 2; the detail which would be provided to NHS England and the number of revalidations which had been completed. He concluded that quarter 3 would concentrate on providing further support for appraisers and preparing the remaining doctors for year 3 of revalidation. The Board of Directors discussed the reasons why some doctors had not undertaken their appraisal and it was noted that there was no deliberate attempt to avoid the appraisal but there had been a need to reinforce the importance of this being undertaken within the required timescale. The Board of Directors then discussed the availability of the information provided and whether this would be included on the NHS Choices website as it was noted that the information regarding nurse staffing was available. The Medical Director confirmed that he was awaiting a response to this question from NHS England. A comment was made regarding 360

o appraisal and it was

noted that the Medical Director and Associate Director of Human Resources would use this to inform the revalidation process. The Board of Directors noted the report.

30/10/14.0 BBOOAARRDD OOFF DDIIRREECCTTOORRSS MMEEEETTIINNGG DDAATTEESS 22001155--1166 The Chairman presented the proposed dates for the Board of Directors meetings for 2015-16. It was noted that the provisional date for the meeting in May was Wednesday 27

th

to allow for the annual report and accounts to be formally approved prior to submission. The Board of Directors approved the proposed meeting dates for 2015-16.

30/10/15.0 AANNYY OOTTHHEERR BBUUSSIINNEESSSS There was no additional business to discuss.

30/10/16.0 QQUUEESSTTIIOONNSS FFRROOMM TTHHEE PPUUBBLLIICC There were no questions from the public.

30/10/17.0 DDAATTEE OOFF NNEEXXTT MMEEEETTIINNGG:: Thursday 27

th November 2014 at 9.30 a.m. in the Board

Room.

CCHHAAIIRRMMAANN’’SS CCLLOOSSIINNGG RREEMMAARRKKSS The Chairman thanked everyone for their contribution and closed the public session of the meeting.

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Action Lead Responsibility

Progress

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Minutes to be corrected.

Minutes Secretary

Completed.

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Director of Nursing and Service Delivery to meet with Training Advisor re increasing health and social care apprentices.

Director of Nursing and Service Delivery

In progress.

30/10/7.0 MONTH 06 INTEGRATED PERFORMANCE REPORT

Quality and Safety Committee to discuss patient harms as a result of medication errors and falls.

Performance report to include narrative around Theatres performance.

Report to include correct terminology.

Director of Nursing and Service Delivery Director of Finance Minutes Secretary

Included on January agenda. Completed. Completed.

30/10/8.0 MID-YEAR REVIEW

Quarterly review to be presented to Board of Directors to inform the Monitor submission.

Chief Executive

Included on Board of Directors agenda quarterly.

30/10/9.0 NURSE STAFFING UPDATE

Analysis of national data to be undertaken.

Director of Nursing and Service Delivery

In progress.

Paper 02

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Executive Responsible Wendy Farrington Chadd, Chief Executive

Paper prepared by (if different

from above)

Margaret Surrage, Head of Board Governance (Trust Secretary)

Category of Item Strategic Direction and

Development

Performance and Governance �

Context Previous Board discussion Link to National Policy Link to Trust’s Strategic

Objectives

Risk if no action taken

Executive Summary

Monitor have issued two documents on Strategic Planning, one gives the results of a study by PwC which highlights weaknesses in the development of Foundation Trust’s strategic plans, and the other is a toolkit to assist Foundation Trusts in strategic planning.

Subject/Title Monitor Guidance on Strategy Development

Nature of Report For Information �

For Discussion For Approval

Received or approved by

Legal Implications

Recommendation That the Trust Board notes the Monitor report and the strategic planning toolkit.

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BOARD OF DIRECTORS

27TH

NOVEMBER 2014

MONITOR GUIDANCE ON STRATEGY DEVELOPMENT

1. Introduction

Monitor have recently issued two documents on strategic planning.

• Meeting the needs of patients: Improving Strategic in planning NHS Foundation Trusts.

• A strategy development toolkit

1.1 Meeting the needs of patients: Improving Strategic planning in NHS Foundation Trusts

In this document Monitor sets out the importance of strategic planning, particularly in the context of “future pressures which threaten to overwhelm the NHS”. Against this backdrop Monitor commissioned PwC to carry out research into the quality of strategic plans and planning capabilities at NHS foundation trusts. This was based on a sample of 30 Foundation Trusts. This report concluded that the “current quality of strategic planning in the majority of NHS foundation trusts is inadequate to respond to the significant challenges facing the health care sector”. In particular it was noted that:

• there is significant scope for the sector to improve service-level thinking based on better analysis and forecasting of trends in local health economies;

• the long-term goals of many NHS foundation trusts are too general to be strategically useful or provide a meaningful framework for decision-making;

• few trusts are proactively developing longer term initiatives in response to the changing health care environment; and

• many NHS foundation trusts lack the processes to review and adapt their plans and strategies to make sure they remain relevant and achievable. In response to this Monitor have issued a Strategy Development toolkit which is described overleaf.

1.2 Strategy Development Toolkit

The toolkit splits strategy development into seven stages and gives detailed advice and examples for each stage. Their framework is set out overleaf. The seven-stage framework of strategy development for foundation trusts

Frame: (What questions do you need to answer?) establishes the scope of the strategy development process by identifying the important strategic choices and decisions to be made and the criteria for making them. In this stage FTs may ask, what are our greatest challenges in delivering quality care affordably? Will we face an uncertain financial future if we make no changes? What will success look like?

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Diagnose: (What determines your performance?) assesses the FT’s current performance in detail and provides insights into what lies behind it. Performance is compared to national and local standards, peers, and ‘best in class’ providers in the NHS and beyond. All aspects of performance are included: quality, operational, financial and workforce. If poor performance is identified, the FT carries out detailed diagnostic work to understand the causes. Forecast: (What futures do you need to plan for?) creates a clear view of what the future might look like. Projecting what will happen if current trends continue – often known as the baseline forecast – is critical here. This involves forecasting demand for services based on future patient needs and expectations as well as commissioner and provider plans; forecasting the corresponding income; and forecasting costs based on predicted activity levels, inflation and any additional factors such as plans to improve quality or introduce new technology. Generate Options: (Where and how could the FT change?) exploring alternative ideas about what services the FT could provide and how it could provide them to best meet patients’ needs. Important questions can include: what services might we begin to provide or stop providing? How could we radically improve care quality or productivity? What technology innovations and new practices could we adopt? How can we collaborate with other providers and our commissioners to redesign services to better meet patients’ needs? Prioritise: (What is the best strategy for your FT?) What is the best

choosing which strategic initiatives to pursue and building them into a coherent strategy. These initiatives should create a strategy that combines quality care for patients with financial viability, resulting in sustainable clinical services. Deliver: (How can you support making your strategy a reality?) creating and publicising the implementation plan, as well as allocating resources to achieve the strategy. This involves setting out the activities, milestones, measurements and key performance indicators, being clear about who will deliver what by when. Now is the time to identify gaps in resources or systems – and to take action to fill them. Evolve: (How can your FT learn and adapt when the world changes?) monitoring delivery to ensure the strategy is effective. This involves re-evaluating the strategy regularly, or when unexpected changes occur, to recommit to the existing direction, refresh or recreate if necessary.

2. Recommendation

That the Trust Board notes the Monitor report and the strategic planning toolkit. Wendy Farrington Chadd

Chief Executive

www.gov.uk/monitor

Developing strategy What every trust board member should know

Introduction Contents

Introduction 1

Why strategy development matters 3

What makes a good strategy? 4

Monitor’s toolkit to support strategy development 6

Your role in strategy development 7

www.gov.uk/monitor 1

A clear and well thought out strategy will help achieve the vision, principles and values of the NHS by sustaining safe, effective patient care. A sound strategy will help to ensure the clinical, financial and operational sustainability of the services that trusts, local health economies and the wider NHS provide for their populations.

This guide explains your role as a board member in leading the strategy development process. It describes what to look for when assuring your trust’s strategy, and points out common pitfalls. It helps you in raising critical questions such as:

• How can strategy development help us make informed choices about the services we provide?

• How can I be sure our strategy will meet patients’ future needs?

• What is my role as a trust board member in the local health economy’s strategy development, and how can we align our plans?

1. See ‘The NHS Constitution’, available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/170656/NHS_Constitution.pdf

The NHS belongs to the people.

It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most.

‘The NHS Constitution’1

Supporting foundation trusts to improve strategy development is one of Monitor’s strategic initiatives for 2014/15, and this document forms part of this programme of work.

For more information about our support in this area, please email [email protected]

www.gov.uk/monitor 3www.gov.uk/monitor2

Why strategy development matters

Effective strategy development benefits patients

Strategy development is an essential step towards improving care and patient experience within available resources. Effective strategies, successfully implemented, can lead to:

• satisfied patients

• improved outcomes

• reduced health inequalities

• motivated staff

• safe, sustainable services

• robust finances.

Thriving clinical services that take full advantage of new treatments and technologies for their patients are the result of astute strategies developed by leaders of trusts who have taken bold steps to grasp opportunities available to them.

Who is this guide for?

This guide to the board member’s role in developing strategy was written for NHS foundation trusts, but is relevant to board members in both foundation trusts and NHS trusts, whether they provide acute, community, mental health or ambulance services.

It contains summary guidance tailored to the board role in strategy development, which is underpinned by a more detailed toolkit Monitor has developed for foundation trusts. Both are intended to be a helpful contribution to the resources at your disposal for developing strong strategies for your trust. It is not prescriptive or regulatory guidance.

It does not aim to replace existing practice but provides a framework which will help you to:

• assess what you are already doing and compare it with the characteristics of successful strategy development

• prepare your organisation for strategy development, taking account of any gaps in resources and skills that may need to be addressed

• recognise a good strategy and identify the signs of a poor one.

Strategy is a set of choices designed to work together to deliver the long-term goals of an organisation in the face of uncertainty

Trusts face challenges in meeting patients’ future needs

Improving patient safety and care quality while facing financial challenge is a demanding task. Now, more than ever, trusts need a strategy to guide them through future uncertainties.

The strategy will influence how resources are allocated and how staff prioritise their time. If leaders communicate their strategy successfully, it will help employees understand the organisation’s direction. Whether or not the organisation achieves its aims will depend on the quality of the strategy.

What makes a good strategy?

A good strategy development process

The following pages set out in more detail the board’s role in assuring the quality of the strategy throughout its development. However, three simple underpinning principles run through a good strategy development process:


• Improving quality, safety and patient experience:

through a rigorous strategy development process, you will be better placed to ask the right questions about your trust’s commitment to improving quality, safety and patient experience.

• System-wide leadership:

strategy development represents a significant leadership challenge which goes beyond just one organisation or one leader. Everyone has a part to play and trust board members are at the centre of this.

• Flexibility:

no trust ever entirely implements the strategy it intends to. The ability to continually adapt and learn is a fundamental skill for board members to develop in order to manage their organisation well and deliver for patients.

The output of a good strategy development process

Once the strategy is written, board members will want to assure themselves that it reflects their vision and is realistic.

How do I know if we have a good strategy?

Good strategies:

evaluate where the organisation is now, and then state realistic, evidence-based goals expressed in a way that allows progress to be monitored

are patient-focused, designed to improve care quality and patient experience

set out a clear vision for improving quality and safety

are based on forecasting and analysing trends in local health economies, not just at the level of a single organisation

prioritise initiatives on the basis of coherence, impact and feasibility

clearly set out milestones for achieving specific aims

clearly describe current problems (both financial and quality)

consider the current and future organisational culture required to support implementation of the strategy.

What are the common pitfalls of a strategy?

Poor strategies may be:

vague: strategies are complex documents but a good structure and clear messages should guide you through

inflexible: your strategy can soon become outdated, irrelevant and unachievable if you cannot review and adapt it to incorporate new information

unfocused: concentrating on too many decisions, rather than prioritising, can distract from those that demand immediate discussion and commitment

not ambitious enough: insufficient experimentation will limit your ambition and restrict potential for quality improvement

impossible to achieve: insufficient time and effort to build ownership, identify changes and set up infrastructure can render ambitions unrealistic

poorly communicated: if staff at all levels do not understand and own the ambitions expressed in the strategy, implementing it will be difficult.

www.gov.uk/monitor 7

Monitor’s toolkit to support strategy development

Monitor’s strategy development toolkit describes a seven-stage framework for trust directors and their teams. It will help trusts to work through the strategy development process and ensure the right people within the trust and across the local health economy are engaged at the right time.

The toolkit contains guidance on each stage of developing a strategy as well as many illustrations of possible analyses and case studies of strategic changes that some NHS providers have already implemented. It is intended to help you develop a strong strategy for your trust, but it is not prescriptive guidance. Its examples of analyses, frameworks and sources of ideas are all intended to provide useful direction and inspiration rather than a set of rules.

The toolkit can be accessed at www.gov.uk/monitor or by emailing [email protected]

www.gov.uk/monitor6

Your role in strategy development

Leading strategy development

Effective strategies will draw on expertise from clinical colleagues, other staff across the organisation and the wider health economy, but board members have the central role in leading the strategy-making process. In developing its strategy, an organisation will encounter debate, challenge and dissenting views while exploring new possibilities. Dealing with uncertainty is at the heart of strategy development, but by making clear and explicit decisions board members can address the challenges facing the NHS.

Your role includes articulating ambitions, gauging possibilities and assessing risks. While developing your strategy you should take advantage of opportunities for innovation and challenge the status quo. This may mean testing ideas or setting out in unfamiliar directions that could radically improve outcomes for patients by adopting new treatments, technologies or ways of working. Board members must deploy their judgement, knowledge and experience in leading discussions and making decisions.

Many boards are doing this already, but an independent review2 concluded that most NHS foundation trusts could do better at strategy development. This toolkit is a contribution to helping them do that.

Testing your organisation’s strategy

The ultimate test of a trust strategy is that it sets out a realistic path to achieving or maintaining clinical, operational and financial sustainability of services.

The three fundamental review questions set out on page 9 underpin this and are the areas which benefit most from board members directing the discussions and assuring their organisations’ strategic choices.

The following pages suggest critical questions that the board can ask to make sure that each stage of the strategy development process has been carried out effectively.

2. See ‘Meeting the needs of patients: Improving strategic planning in NHS foundation trusts’, available at http://www.gov.uk/nhs-foundation-trusts-planning-and-reporting-requirements

Questions to ask as your trust develops its strategy

FUN

DA

ME

NTA

L R

EV

IEW

QU

ES

TIO

NS

RE

LEVA

NT

STA

GE

Does your trust understand its

external opportunities and challenges and its internal strengths and weaknesses?

Does your trust have robust solutions to

address the opportunities and challenges in light

of its strengths and weaknesses?

Does your trust have the capability

and a credible plan to deliver the

strategy?

What is the right set of questions?

What drives our performance?

What scenarios do we need to plan for?

What are the potential strategic options?

How do we deliver changes?

What is our combined strategy?

How do we adapt and learn?

Forecast PrioritiseFrame DiagnoseGenerate Options

Deliver EvolveU

LTIM

ATE

TE

ST

Does the strategy set out a realistic path to achieving or maintaining clinical, financial and operational sustainability?


• Recommit

If your strategy’s underpinning assumptions are still accurate and implementation is on track, you will want to recommit to the strategy. This means briefly revisiting its delivery and ongoing development.

• Refresh

If you are happy with your strategy but the external environment has changed, you may want to refresh the strategy. This will involve checking whether you need to change any assumptions or outputs.

• Create or recreate

If you do not have a strategy to meet your goals – perhaps because the local health economy has changed or your trust has identified new performance issues – you will want to recreate your strategy.

Three situations may prompt you to undertake strategy development work and use this guide and the accompanying strategy development toolkit.

Does your trust understand its external opportunities and challenges and its internal strengths and weaknesses?

ForecastDeciding which future scenarios the trust needs to plan for

What is the board’s main responsibility?

• Closely working with commissioners and the rest of the health economy to understand the potential future scenarios that the area faces.

What should the board ask to assure itself at this stage?

• Rather than having just one view of the future, can we see how the trust would look in a variety of scenarios and can we as a board adapt to them as required?


FrameAgreeing the scope of the strategy-making process


• Identifying the most important strategic questions facing the trust and ensuring the required people have the capacity to participate in answering them.


• Have we set aside enough dedicated time to ensuring we have an agreed view of what our strategy must achieve?

DiagnoseUnderstanding the internal and external landscape driving current performance


• Setting the right level of ambition for the trust.


• Do we have a shared understanding of which services are performing well and which particularly need improving?

• Do we truly understand the current perspective and anticipated future needs of patients?

Your role summed up in three questions

Does your trust have robust solutions to address opportunities and challenges in light of its strengths and weaknesses?

Does your trust have the capability and a credible plan to deliver the strategy?

Further detail and insights into each of the seven steps and the questions boards should consider at each stage can be found in the detailed toolkit underpinning this guide, which is available at www.gov.uk/monitor


Generate OptionsWhat are the potential strategic options available to us?


• Challenging levels of ambition and existing perspectives.


• Have we sought inspiration from as wide a range as possible of sources in healthcare and other industries to identify our strategic options?

PrioritiseWhat is our combined strategy?


• Agreeing how to form its chosen options into a coherent strategy.


• Is the board confident that the choices we have made will mean the trust is clinically, operationally and financially sustainable, while addressing the needs of patients?

DeliverDelivering changes


• Communicating the trust’s goals widely and effectively to ensure shared responsibility and ownership across all levels of the organisation.


• How will we hold each other to account for delivery?

• Can leaders and teams at all levels explain the link between what they have to do and delivery of the strategy?

• What resources are required to support implementation of the strategy?

EvolveHow do we adapt and learn?


• Monitoring the delivery of the plan and ensuring the plan is revised as necessary in the future.


• How will we know whether the delivery of our strategy is successful and under what circumstances will we need to revisit it?

© Monitor October 2014. Publication code: IRG 27/14

Contact usMonitor, Wellington House,133-155 Waterloo Road,London, SE1 8UG

Telephone: 020 3747 0000Email: [email protected]: www.gov.uk/monitor

This publication can be made available in a number of other formats on request. Application for reproduction of any material in this publication should be made in writing to [email protected] or to the address above.

Paper 03

U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Paper 03 2015-16 Tariff Update.docx Page 1 of 2

BOARD OF DIRECTORS

27TH

NOVEMBER 2014

Executive Responsible John Grinnell, Director of Finance Paper prepared by (if

different from above)


Development �

Performance and Governance

Context Previous Board discussion

Link to National Policy

Link to Trust’s Strategic Objectives


Executive Summary

Further to the last update at the Trust Board the final tariff consultation is expected on 20

th November. Assuming this

timetable is met a further update will be provided at the Board meeting. As an interim position the paper outlines the latest understanding of key proposals per the FTN.

Subject/Title 2015-16 Tariff Update


For Discussion �

For Approval


Legal Implications

Recommendation The Board of Directors are asked to note the update.

Acronyms and

Abbreviations

Paper 03

U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Paper 03 2015-16 Tariff Update.docx Page 2 of 2

BOARD OF DIRECTORS

27TH

NOVEMBER 2014

2015/16 TARIFF UPDATE

1.0 Background

The Board has been kept abreast of progress made in working with Monitor on the potential impact of the draft 2015/16 tariff originally released in July 2014. For context the latest iteration of the draft tariff showed a net reduction of £2.6m (7%) for RJAH prior to any efficiency related deflator. Given this level of reduction the SOA were assured by Monitor that some form of transitional relief would be applied reducing the net impact to £500k to £750k (1% to 1.5%). The Board agreed to await the formal consultation on the tariff and its impact on our wider plans before deciding on any further steps. 2.0 Current Update

It is now anticipated that the formal consultation on the 2015/2016 tariff will be released on 20

th November. Assuming this timeline a more detailed impact assessment will be available

for the Trust Board meeting. The FTN have been active in working with Monitor and NHS England on the tariff and have the following understanding of key areas that will be covered in the consultation: Expected Proposals in the National Tariff

• An efficiency factor towards the lower end of the proposed 3-5% range. It had been suggested that the efficiency factor, taking ‘tariff leakage’ in to consideration, might have been as high as 4.5-5%.

• A major squeeze on specialised services and an attempt to manage the budget through proposals such as marginal rates over the previous year’s contract value, for the vast majority of services. NHS England included some early information on this in their commissioning intentions.

• Changes on some HRG chapters since proposals put forward in the tariff engagement document, including increased A&E and outpatient tariffs, as well as smoothing of the volatility proposed to the trauma and orthopaedic chapter.

• Some movement on the punitive payment arrangements in urgent and emergency care.

• A number of new national CQUINs including on management of kidney injury and sepsis for the acute sector and dementia care for mental health trusts.

Once we receive the consultation we will be able to carry out an impact assessment and the implications of any guidance against our planning assumptions and key risks of delivery. John Grinnell

Director of Finance


2277 NNOOVVEEMMBBEERR 22001144

Executive Responsible John Grinnell, Director of Finance

Paper prepared by (if


Executive Directors


Development


Context Previous Board discussion Link to National Policy �


�


Executive Summary

The Trust’s Month 7 Performance Report is detailed in the attached paper.


Legal Implications None

Recommendation It is recommended that the Board note:

• The performance during October 2014 (Month 7).

Acronyms and

Abbreviations VTE – Venous Thromboembolism CQUIN – Commissioning for Quality and Innovation Payment Programme RTT – Referral to Treatment BRIC - Business, Risk and Investment Committee UCL – Upper Confidence Limit LCL – Lower Confidence Limit UTI – Urinary Tract Infection BADS - British Association of Daycase Surgery MSD – Musculoskeletal Disorders C. difficile – Clostridium difficile (bacterial infection) MRSA – Methicillin-resistant Staphylococcus aureus (bacterial infection)

Subject/Title October (Month 7) Integrated Performance Report

Nature of Report For Information For Discussion �

For Approval �

Paper 04

U:\Trust Board & Committees\Public Trust Board\2014-15\November 2014\Paper 04 Month 07 Integrated Performance Report

1

BOARD OF DIRECTORS

INTEGRATED PERFORMANCE REPORT

OCTOBER 2014

1. Introduction

1.1 The integrated performance report has been developed in order to assist the Board to monitor the delivery of key performance metrics against local and national targets.

1.2 The report covers five key domains of Patient Safety, Patient Experience, Resources, Efficiency and External Perception.

1.3 Performance measurement targets within these domains are based on:-

• Core standards set nationally by Monitor, NHS England, Welsh Assembly Government and the Care Quality Commission

• Locally agreed Commissioner driven targets including CQUIN quality improvement

• Internal development targets in line with the Trust’s Annual Operating Plan 1.4 The scorecard format provides an overview of the performance within each domain

with further detail of specific metrics in graphical and tabular format.

1.5 The scorecard utilises two graphical presentation methods; line graphs and statistical process control (SPC) charts. SPC charts enable the analysis of the variability of a metric relative to average performance. Data points within the upper and lower limits are linked to natural variation in performance levels.

1.6 The narrative section places focus on exception reporting and trend analysis.

2. Chief Executive’s Overview

2.1 The overall Month 7 position shows a continued improvement on last month particularly in the domains of resources and efficiency.

2.2 The report shows strong performance in the resources domain and overall surplus is now slightly ahead of plan year to date. Activity has also returned to planned levels. Focus will need to continue for the remainder of the year in maintaining this improved overall position

3. Performance Overview

3.1 Domain 1 – Patient Safety

3.1.1 Overview – Seven of the nine key metrics within this domain are green rated at the end of the month.

There were no cases of hospital acquired C. difficile infections in month and no cases of hospital acquired MRSA bacteraemias since 2006. As part of the Trust’s continued commitment to minimise hospital acquired infections, 100% of eligible patients had been screened for MRSA bacteraemias prior to admission in October. There were no hospital acquired pressure ulcers during October, with 100% of elective inpatients being risk assessed for pressure ulcers on admission during the month. The following exceptions are noted.

3.1.2 Serious Incidents / Never Events – During October it was identified that a patient had undergone spinal surgery at the wrong level. This has been reported as both a

Paper 04


2

serious incident and a never event. All relevant authorities have been notified and have approved our initial actions to deal with the issues.

This incident is currently under investigation and a full root cause analysis will be reported to the Quality and Safety Committee.

3.1.3 Mortality Rates – There was one patient death on the Care of the Elderly Ward during October. The death was not unexpected.

3.1.4 Clinical Quality – Hospital Acquired VTE (DVT or PE) – There were four cases of hospital acquired venous thromboembolism during October. Three patients developed pulmonary embolism post operatively and one rehabilitation patient developed a pulmonary embolism five days after admission. Each patient had been risk assessed on admission and were commenced on appropriate anti-coagulation therapy post diagnosis. Whilst four cases is above the monthly tolerance of three cases, it remains within the upper confidence limit.

3.1.5 Clinical Quality – Falls with harm – Of the nine inpatient falls recorded during October, three patients weren’t complying with medical advice at the time of their fall. One patient developed a small bruise as a result of their fall but did not require any additional treatment. No other patient harm was noted. One fall with harm is within the tolerance level of two incidents per month.

3.1.6 Clinical Quality – Safety Thermometer – During the latest monthly snapshot on patient “harms”, 98.78% of patients did not suffer any new harms following admission to RJAH. In the context of the Safety Thermometer, harms are defined as falls, pressure ulcers of any grade, catheter associated UTI’s and VTE. This remains above the latest national published performance of 97.58%.

3.1.7 Medication Errors (Harms) – Seventeen medication incidents relating to patient care were recorded during October which were categorised as Prescribing (7), Administration (3), Supply (3) Storage (1) and near miss medication (3).

One patient required increased supervision following a fall which was potentially attributable to incorrect medication dosage. A second patient experienced headaches due to omission of medication. Two incidents resulting in harm is within the tolerance level of three incidents per month.

3.1.8 28 day Readmission Rates to RJAH – Six patients were readmitted as an emergency within 28 day of initial discharge in September 2014. Reasons for readmission were pain control (1), wound issues (5).

Compared to activity levels, this provides a readmission rate of 0.99% which is within the target level of 1.05%

3.2 Domain 2 - Patient Experience

3.2.1 Overview – Overall performance remains strong within this domain.

3.2.2 Patient Satisfaction – Net Promoter Question - The net promoter score of 96.55 in month remains above the target of 71. NHS England have replaced the net promoter score as a headline measure for patient satisfaction with a score calculating the percentage of respondents who

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3

would recommend the service. Compared to other acute Trusts, RJAH scored the 4th

highest percentage nationally during September.

3.2.3 Compliments & Complaints – One hundred and nineteen formal compliments were received during October with particular praise given to the professionalism of staff. No additional comments were logged on the NHS choices website this month. Fourteen complaints were received during October (0.15% of activity). Whilst this is above the target level of nine per month, the number remains within the normal variation range. Nine complaints have been categorised as clinical care and were related to care on the wards (3), outcome of surgery (2), physiotherapy provision (1), pain injection procedure (1), consultant attitude (1) and a patient not being given assistance to reach the Oswestry Minor Injuries Unit (1). A further five complaints were logged relating to the operational issues of waiting times (2), changes to appointment dates (1), cancellation of surgery (1) and Trust signage (1). Each complaint is being investigated by the Clinical Governance Team in line with Trust Policy.

3.2.4 Delayed Discharges – Three patients were classed as delayed discharges at the end of October. This correlates to 1.99% of patients in hospital on the last Thursday of the month which is within the target level of 3.50%.

Two of the patients are waiting for the completion of appropriate care packages following a period of care on the Spinal Injuries Unit. The third patient is waiting for a care package following rehabilitation on the care of the Elderly Ward. The longest period a patient had been delayed at the end of the month was 4 days.

3.2.5 Access to Bone Tumour Services – All cancer targets have been achieved during October.

3.2.6 Access to Services - English - The target of 99% of patients waiting less than 6 weeks for a diagnostic appointment was maintained with a performance of 99.27% at the end of October. Performance against all three English RTT targets was maintained at the end of October. In month, the admitted target of 90% was achieved with 91.21% of patients completing their pathways within 18 weeks. Against the non-admitted target of 95%, 97.77% of patients completed their pathways within 18 weeks. At the end of the month, 92.29% of patients on an open pathway were waiting less than 18 weeks to commence their treatment maintaining the performance level above the target of 92%.

3.2.7 Access to Services – Welsh – During October 91.80% of Welsh patients completed their RTT pathways within 36 weeks. At the end of the month 87.99% of Welsh patients were waiting within 36 weeks to start their treatment.

3.3 Domain 3 – Efficiency

3.3.1 Overview – The admission on day of surgery rate of 93.16% remains above the target of 90%. Theatre utilisation rates were also within target levels during October with 95.46% of lists utilised compared to a target of 95%. The following exceptions to planned performance are noted during October.

3.3.2 Demand for Services – Discussions are continuing with a number of our Commissioners regarding the trend increase in referrals during the year. As well as the impact on contract outturn during 2014/15, an understanding of future commissioner intentions will be factored into the contract planning round for 2015/16.

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4

October referral figures are distorted by an additional batch transfer of patients from BCU as part of the contract agreement. Given a current trendline increase in English GP referrals to our Spinal Disorders team, further analysis will be carried out within the Surgical Division in order to understand the drivers for increase.

3.3.3 Activity – Within the surgical division, both inpatient and outpatient activity levels were on target during the month with year to date outpatient activity now ahead of annual delivery plan. Year to date performance within the medicine division also remains on plan. Continued focus is required over the coming months to ensure delivery of contracted activity levels.

3.3.4 Daycase Performance – Reflective of the casemix of patients treated during the month, there was a dip in in the daycase rate during October with 46.18% of patients treated as daycase compared to a monthly target of 50%. With a trendline decrease in the overall daycase rate over the last four months, it is imperative that regular analysis of theatre bookings continues over the coming months in order to maximise daycase theatre throughput.

The BADS rate of 81.96% remains below the target of 87% but within normal variation rate

3.3.5 Average Length of Stay – There continues to be a reduction in the average length of stay, with the rate of 3.95 days in October being within the target of less than 4 days. There was a corresponding increase in the number of patients discharged within 3 days following a primary hip or knee replacement during October with a performance of 53.33% against a target of 45%. A new daily report is now in place which flags patients who have breached their estimated discharge dates. Monitoring reasons for longer than expected length of stay assists with highlighting any pressure points within the system.

3.3.6 Bed Occupancy – Adult Orthopaedic Wards – Overnight occupancy levels on the adult orthopaedic wards during October was 79.31%. Whilst this remains below the target, it remains within the normal performance range.

3.3.7 Outpatient Productivity – The Outpatient DNA rate stayed constant in October with a rate of 6.47% in month. As there is a stepped reduction in the target to 6.40% during quarter 3 this is reported as amber in month. A text reminder system which was launched in two areas during October is now being extended further within the Trust. The impact of this system will be monitored over the coming months but it is hoped that this will reduce DNA rates. The outpatients per session rate of 8.30 in October remains below the target rate of 8.80. With an increase in referrals over the last few months, it is imperative that focus continues on ensuring clinic slots are utilised going forward.

3.4 Domain 4 – Resources

3.4.1 Overview – The Month 7 position overall was a surplus of £0.314m which exceeded plan by £0.04m. This represents our strongest month of the year to date and increases our year to date surplus to £0.659m as we continue to progress towards our agreed £1m plan. Our EBITDA margin for the month was 7.53% and on a cumulative basis is now 5.24%. We continue to deliver a Continuity of Service Risk Rating of 4, the lowest risk under Monitor’s framework.

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3.4.2 Income – Clinical income levels for the month were £0.230m above plan driven by a

rich case mix of inpatient activity and further progress against the outpatient recovery plan. Income from private patients was once again strong and exceeded the target by £0.054m.This offset shortfalls from other income sources that continue to be impacted by reduced education and training funding.

3.4.3 Expenditure – Whilst pay costs were £0.05m higher than plan in month, half of this related to pass through costs associated with research projects. The remainder related to agency pressures in covering gaps on our specialist registrar rota and to cover Orthotist sickness. Both of these areas of pressure are being overseen by the Finance and Productivity Group.

Non-Pay was £0.218m overspent in month. Half of this related to pass through costs associated with drugs and the remainder was driven by increased implant costs associated with the rich case mix of work delivered and increased volumes of private activity.

3.4.4 Cost Improvements – Cost improvements of £0.404m were achieved in month, which was £0.135m above plan. This strong in month performance was driven by the recognition of contribution earned from additional activity delivered, procurement savings and the introduction of a sustainable clinical model to manage spinal outpatients.

Year to date savings now stand at £1.655m and we are forecasting delivery of the full £3m programme by the end of the year following the agreement of a number of mitigating schemes.

3.4.5 Cash Balances –Cash balances reduced by £0.87m in month to £2.57m driven by high in month capital expenditure and the continued over performance of our clinical income against contracted cash profiles. An additional £1m of interim over performance has been secured and cash settled during November.

Once the November settlements have been taken into account our cash balances are £0.6m behind plan. The primary driver for this is the recovery of grant income in respect of our IT capital developments that has been delayed pending delivery of schemes.

The forecast end of year cash balance is per the plan at £5.4m.

3.4.6 Capital Expenditure – Capital expenditure for the month was £0.68m which was £0.02m behind plan. On a cumulative basis we have now spent £2.674m against an annual plan of £6.381m. The main drivers of expenditure in month were the pre-op relocation scheme and progression of the design for our new Theatre and Tumour unit for which a GMP will be presented to the Board in January 2015. Although the IT investment has slipped from the original plan profile, we anticipate all schemes being completed by the end of the financial year and on this basis the overall capital programme is still forecast to meet the planned spend of £6.4m.

3.4.7 Financial Forecast – A second successive month of strong financial performance sees us ahead of both our original financial plan and recovery plan.

The revised profile for delivery of our £1m surplus target is shown in the table below.

Quarter Q1 (Actual) Q2 (Actual) Q3 Q4

Surplus/(Deficit) -£30k £375k £300k £355k

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November will require another strong surplus to offset the seasonal losses we expect to incur during December.

3.4.8 Sickness Absence – Sickness absence for October increased to 4.15%, due to increased & continued long term sickness however short term absences have remained static from the previous month. Unfortunately cardiac/coronary related absence have significantly increased; absence due to MSD’s increased for the fourth month, but remains within control limits and absence due to stress/anxiety remained static. Benchmarking ranked the trust with the 3

rd lowest in month sickness and the lowest

12 month rolling absence rates for the West Midlands region.

3.4.9 Staff Stability Index – The stability index for October increased at 92.21% which remains above (better than) the 90% target.

3.4.10 Staff Appraisal – Staff appraisals decreased in October to 88.58% of staffing having undertaken an appraisal within the past 12 months. This is slightly below the 90% target but remains within normal variation.

3.4.11 Staffing Establishment – The Trust monitor staffing levels twice daily and this is reported to NHS England monthly. All escalation processes have been followed to ensure patient safety is maintained.

Total

monthly

planned

staff

hours

Total

monthly

actual

staff

hours

Total

monthly

planned

staff

hours

Total

monthly

actual

staff

hours

Total

monthly

planned

staff

hours

Total

monthly

actual

staff

hours

Total

monthly

planned

staff

hours

Total

monthly

actual

staff

hours

Alice 906 906.75 322.5 322.5 708 708 132 132 100.1% 100.0% 100.0% 100.0%

Clwyd 1223 1222 1074 1074 744 756 456 444 99.9% 100.0% 101.6% 97.4%

Gladstone 1372.5 1349 1375.5 1369.5 720 720 720 699 98.3% 99.6% 100.0% 97.1%

Wrekin 1274 1262 1330 1354 744 744 372 372 99.1% 101.8% 100.0% 100.0%

Kenyon 1403 1397 1038 1016 744 744 372 372 99.6% 97.9% 100.0% 100.0%

Ludlow 902.5 895 744 703.5 744 744 288 288 99.2% 94.6% 100.0% 100.0%

Powys 1296 1262 935 933.5 744 756 384 384 97.4% 99.8% 101.6% 100.0%

Sheldon 1134 1026 900 1241.5 744 744 720 652 90.5% 137.9% 100.0% 90.6%

HDU 1240 1215 120 120 1050 1012.5 0 0 98.0% 100.0% 96.4% N/A

Average fill

rate -

registered

nurses/

midwives

(%)

Average fill

rate - care

staff (%)

Average fill

rate -

registered

nurses/

midwives

(%)

Average fill

rate - care

staff (%)

Ward

name

Day Night Day Night

Registered

midwives/nursesCare Staff

Registered

midwives/nursesCare Staff

3.5 Domain 5 – External Perception

3.5.1 At the end of October, the Trust continues to deliver a level 4 continuity of service risk rating and a ‘green’ governance rating.

4. Recommendation

4.1 It is recommended that the Board:

Note the performance for October (Month 7)

John Grinnell

Director of Finance, Contracting and Performance

Paper 04


7

Balanced Scorecard - Trust

October 2014 - Month 7

Month Key Metric Actual YTD Change Forecast Month Key Metric Actual YTD Change Forecast

Oct-14 Infection Control g r same r Oct-14 Patient Satisfaction - Net Promoter Question g g same gOct-14 Serious Incidents a a same g Oct-14 Number of Complaints a g worse gOct-14 Never Events r r worse r Oct-14 Theatre Cancellations g g same gOct-14 Unexpected Deaths g r same r Oct-14 Delayed Discharges g g same aOct-14 Clinical Quality g a better g Oct-14 Access to Bone Tumour Services g a same gOct-14 Medication Errors (Harms) g g better g Oct-14 Access to Services - English g g same gOct-14 Pressure Ulcer Assessments g g same g Oct-14 Access to Services - Welsh g g same gOct-14 28 Days Readmission Rates to RJAH for all Specialties g g same gOct-14 CQUIN g g same g

↑

← →

↓

Month Key Metric Actual YTD Change Forecast Month Key Metric Actual YTD Change Forecast

Oct-14 Sickness Absence r a same a Oct-14 Demand for Services g g same gOct-14 Staff Stability Index g g same g Oct-14 Activity - Surgery g g better gOct-14 Staff Appraisal a a worse g Oct-14 Activity - Medicine g g worse gOct-14 EBITDA Margin g g same g Oct-14 Daycase Performance a a same aOct-14 Net Surplus g g same g Oct-14 Admission on Day of Surgery g g same gOct-14 CIP Delivery g g better g Oct-14 Theatre Efficiency g g same gOct-14 Capital Expenditure g a same g Oct-14 Average Length of Stay g g better gOct-14 PSPP g g same g Oct-14 Bed Utilisation r r same aOct-14 Cash Balance a a worse g Oct-14 Outpatient Productivity a g worse g

Oct-14 New to Follow Up Ratio (Consultant Led Activity) g g same g

Resources EfficiencyOverall Performance Overall Performance

Patient Safety Patient ExperienceOverall Performance Overall Performance

VISION

To be the leading centre for high quality, sustainable Orthopaedic and related care, achieving excellence in both experience and outcomes for our

patients

Month Key Metric Actual YTD Change Forecast

Oct-14 Monitor Risk Rating - Finance g g same g

Oct-14 Monitor Risk Rating - Quality Governance g g better g

External PerceptionOverall Performance

Paper 04


8



Patient Safety

Infection Control

Period Target Actual PerformanceApr-14 0.00 0.00 gMay-14 0.00 0.00 gJun-14 0.00 0.00 gJul-14 0.00 0.00 g

Aug-14 0.00 0.00 gSep-14 0.00 0.00 gOct-14 0.00 0.00 gNov-14 0.00Dec-14 0.00Jan-15 0.00Feb-15 0.00Mar-15 0.00

Hospital Acquired MRSA Bacteraemia

0.00

1.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Patient Safety

Infection Control

Period Target Actual PerformanceApr-14 0.00 0.00 gMay-14 0.00 1.00 rJun-14 0.00 1.00 rJul-14 0.00 0.00 g


Hospital Acquired C.Difficile

0.00

1.00

2.00

3.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Patient Safety

Period Target Actual PerformanceApr-14 0.00 2.00 aMay-14 0.00 0.00 gJun-14 0.00 1.00 aJul-14 0.00 0.00 g

Aug-14 0.00 0.00 gSep-14 0.00 1.00 aOct-14 0.00 1.00 aNov-14 0.00Dec-14 0.00Jan-15 0.00Feb-15 0.00Mar-15 0.00

Serious Incidents

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Patient Safety


Aug-14 0.00 0.00 gSep-14 0.00 0.00 gOct-14 0.00 1.00 rNov-14 0.00Dec-14 0.00Jan-15 0.00Feb-15 0.00Mar-15 0.00

Never Events

0.00

1.00

2.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Paper 04


9



Patient Safety


Aug-14 0.00 0.00 gSep-14 0.00 0.00 gOct-14 0.00 1.00 rNov-14 0.00Dec-14 0.00Jan-15 0.00Feb-15 0.00Mar-15 0.00

Never Events

0.00

1.00

2.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Patient Safety

Period Target Actual PerformanceApr-14 0.00 1.00 rMay-14 0.00 1.00 rJun-14 0.00 1.00 rJul-14 0.00 0.00 g


Unexpected Deaths

0.00

1.00

2.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Patient Safety

Clinical Quality

Period Target Actual PerformanceApr-14 3.00 3.00 gMay-14 3.00 4.00 aJun-14 3.00 2.00 gJul-14 3.00 1.00 g

Aug-14 3.00 0.00 gSep-14 3.00 1.00 gOct-14 3.00 4.00 aNov-14 3.00Dec-14 3.00Jan-15 3.00Feb-15 3.00Mar-15 3.00

Hospital Acquired VTE (DVT or PE)

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Mean UCL LCL Actual

Patient Safety

Clinical Quality


Aug-14 2.00 6.00 rSep-14 2.00 3.00 aOct-14 2.00 1.00 gNov-14 2.00Dec-14 2.00Jan-15 2.00Feb-15 2.00Mar-15 2.00

Inpatient Falls (Harms)

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er


Paper 04


10



Patient Safety

Clinical Quality



Inpatient Falls (Harms)

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er


Patient Safety

Clinical Quality

Period Target Actual PerformanceApr-14 1.00 2.00 aMay-14 1.00 2.00 aJun-14 1.00 3.00 aJul-14 1.00 0.00 g

Aug-14 1.00 4.00 rSep-14 1.00 0.00 gOct-14 1.00 0.00 gNov-14 1.00Dec-14 1.00Jan-15 1.00Feb-15 1.00Mar-15 1.00

Hospital Acquired Pressure Ulcers - Grade 2 or Above

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er


Patient Safety

Clinical Quality



Safety Thermometer - % with no new harms

92.00

93.00

94.00

95.00

96.00

97.00

98.00

99.00

100.00

101.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er


92.00

93.00

94.00

95.00

96.00

97.00

98.00

99.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%


Patient Safety


Aug-14 3.00 0.00 gSep-14 3.00 4.00 aOct-14 3.00 2.00 gNov-14 3.00Dec-14 3.00Jan-15 3.00Feb-15 3.00Mar-15 3.00

Medication Errors (Harms)

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er


Paper 04


11



Patient Safety



Medication Errors (Harms)

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er


Patient Safety



Pressure Ulcer Assessments

98.40

98.60

98.80

99.00

99.20

99.40

99.60

99.80

100.00

100.20

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Patient Safety


Aug-14 1.05 0.65 gSep-14 1.05 0.99 gOct-14 1.05 No Data gNov-14 1.05Dec-14 1.05Jan-15 1.05Feb-15 1.05Mar-15 1.05

28 Days Readmission Rates to RJAH for all Specialties

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

2.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%


Patient Safety

CQUIN



VTE Risk Assessments

84.00

86.00

88.00

90.00

92.00

94.00

96.00

98.00

100.00

102.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Paper 04


12



Patient Safety

CQUIN



VTE Risk Assessments

84.00

86.00

88.00

90.00

92.00

94.00

96.00

98.00

100.00

102.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Paper 04


13



Patient Experience



Patient Satisfaction - Net Promoter Question

0.00

20.00

40.00

60.00

80.00

100.00

120.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er


0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%


Patient Experience

Period Target Actual PerformanceApr-14 9.00 8.00 gMay-14 9.00 8.00 gJun-14 9.00 7.00 gJul-14 9.00 10.00 a


Number of Complaints

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.00

18.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er


Patient Experience

Theatre Cancellations



% Reportable Cancellations

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Patient Experience




Cancellations Not Rebooked within 28 Days

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Paper 04


14



Patient Experience




Cancellations Not Rebooked within 28 Days

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Patient Experience

Delayed Discharges

Period Target Actual PerformanceApr-14 3.50 3.55 aMay-14 3.50 2.24 gJun-14 3.50 0.62 gJul-14 3.50 3.90 a


% Delayed Discharges Against Occupied Beds on last

Thursday of Month

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%


Patient Experience

Access to Bone Tumour Services

Period Target Actual PerformanceApr-14 93.00 100.00 gMay-14 93.00 90.00 rJun-14 93.00 100.00 gJul-14 93.00 100.00 g


Cancer Two Week Wait

84.00

86.00

88.00

90.00

92.00

94.00

96.00

98.00

100.00

102.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Patient Experience




31 Day First Treatment (Tumour)

94.00

95.00

96.00

97.00

98.00

99.00

100.00

101.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Paper 04


15



Patient Experience




31 Day First Treatment (Tumour)

94.00

95.00

96.00

97.00

98.00

99.00

100.00

101.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Patient Experience


Period Target Actual PerformanceApr-14 85.00 75.00 rMay-14 85.00 100.00 gJun-14 85.00 100.00 gJul-14 85.00 0.00 r


Cancer Plan 62 Day Standard (Tumour)

0.00

20.00

40.00

60.00

80.00

100.00

120.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Patient Experience

Access to Services - English



18 Weeks RTT Admitted

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Patient Experience




18 Weeks RTT Non Admitted

93.50

94.00

94.50

95.00

95.50

96.00

96.50

97.00

97.50

98.00

98.50

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Paper 04


16



Patient Experience




18 Weeks RTT Non Admitted

93.50

94.00

94.50

95.00

95.50

96.00

96.50

97.00

97.50

98.00

98.50

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Patient Experience




18 Weeks RTT Open Pathways

65.00

70.00

75.00

80.00

85.00

90.00

95.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Patient Experience




Patients Waiting Over 52 Weeks

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Patient Experience




6 Week Wait for Diagnostics - English Patients

98.40

98.60

98.80

99.00

99.20

99.40

99.60

99.80

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Paper 04


17



Patient Experience




6 Week Wait for Diagnostics - English Patients

98.40

98.60

98.80

99.00

99.20

99.40

99.60

99.80

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Patient Experience

Access to Services - Welsh



36 Weeks RTT Completed Pathways

0.00

20.00

40.00

60.00

80.00

100.00

120.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Patient Experience




36 Weeks RTT Open Pathways All Wales

0.00

20.00

40.00

60.00

80.00

100.00

120.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Patient Experience





0.00

100.00

200.00

300.00

400.00

500.00

600.00

700.00

800.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Paper 04


18



Patient Experience





0.00

100.00

200.00

300.00

400.00

500.00

600.00

700.00

800.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Paper 04


19



Resources

Period Target Actual PerformanceApr-14 2.70 2.39 gMay-14 2.70 2.21 gJun-14 2.70 2.46 gJul-14 2.70 3.00 a

Aug-14 2.70 3.32 aSep-14 2.70 3.76 rOct-14 2.70 4.15 rNov-14 2.70Dec-14 2.70Jan-15 2.70Feb-15 2.70Mar-15 2.70

Sickness Absence

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%


Resources



Staff Stability Index

88.50

89.00

89.50

90.00

90.50

91.00

91.50

92.00

92.50

93.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Resources

Period Target Actual PerformanceApr-14 90.00 85.48 aMay-14 90.00 85.13 aJun-14 90.00 90.46 gJul-14 90.00 92.59 g


Staff Appraisal

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Paper 04


20



Efficiency

Demand for Services

Period Target Actual PerformanceApr-14 8500.00 8276.00 gMay-14 8500.00 8913.00 gJun-14 8500.00 9105.00 aJul-14 8500.00 9455.00 a

Aug-14 8500.00 9353.00 aSep-14 8500.00 9058.00 gOct-14 8500.00 9257.00 aNov-14 8500.00Dec-14 8500.00Jan-15 8500.00Feb-15 8500.00Mar-15 8500.00

Total Open Pathways

0.00

1000.00

2000.00

3000.00

4000.00

5000.00

6000.00

7000.00

8000.00

9000.00

10000.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

0.0

1000.0

2000.0

3000.0

4000.0

5000.0

6000.0

7000.0

8000.0

9000.0

10000.0

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Efficiency

Demand for Services



Referrals Received for Consultant Led Services

0.00

500.00

1000.00

1500.00

2000.00

2500.00

3000.00

3500.00

4000.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

-159.00

341.00

841.00

1341.00

1841.00

2341.00

2841.00

3341.00

3841.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Efficiency

Activity - Surgery

Period Target Actual PerformanceApr-14 1010.00 1017.00 gMay-14 1059.00 1077.00 gJun-14 1108.00 1098.00 aJul-14 1108.00 1108.00 g

Aug-14 1010.00 1005.00 aSep-14 1089.00 986.00 aOct-14 1128.00 1123.00 aNov-14 1128.00Dec-14 962.00Jan-15 1129.00Feb-15 1099.00Mar-15 1129.00

Surgical Division Activity - Inpatient Contract

0.00

200.00

400.00

600.00

800.00

1000.00

1200.00

1400.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

1400.0

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Efficiency

Activity - Surgery

Period Target Actual PerformanceApr-14 5986.00 6147.00 gMay-14 6275.00 6167.00 aJun-14 6564.00 6705.00 gJul-14 6564.00 6365.00 a


Surgical Division Activity - Outpatient Contract

0.00

1000.00

2000.00

3000.00

4000.00

5000.00

6000.00

7000.00

8000.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

0.0

1000.0

2000.0

3000.0

4000.0

5000.0

6000.0

7000.0

8000.0

9000.0

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Paper 04


21



Efficiency

Activity - Surgery



Surgical Division Activity - Outpatient Contract

0.00

1000.00

2000.00

3000.00

4000.00

5000.00

6000.00

7000.00

8000.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

0.0

1000.0

2000.0

3000.0

4000.0

5000.0

6000.0

7000.0

8000.0

9000.0

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Efficiency

Activity - Medicine

Period Target Actual PerformanceApr-14 134.00 155.00 gMay-14 140.00 121.00 rJun-14 147.00 153.00 gJul-14 147.00 170.00 g

Aug-14 134.00 111.00 rSep-14 140.00 155.00 aOct-14 147.00 163.00 aNov-14 147.00Dec-14 127.00Jan-15 140.00Feb-15 140.00Mar-15 140.00

Medicine Division Activity - Inpatient Contract

0.00

20.00

40.00

60.00

80.00

100.00

120.00

140.00

160.00

180.00

200.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

200.0

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Efficiency

Activity - Medicine

Period Target Actual PerformanceApr-14 1236.00 1166.00 aMay-14 1296.00 1203.00 aJun-14 1355.00 1354.00 gJul-14 1355.00 1580.00 g

Aug-14 1236.00 1052.00 rSep-14 1296.00 1424.00 gOct-14 1355.00 1506.00 aNov-14 1355.00Dec-14 1176.00Jan-15 1296.00Feb-15 1296.00Mar-15 1296.00

Medicine Division Activity - Outpatient Contract

0.00

200.00

400.00

600.00

800.00

1000.00

1200.00

1400.00

1600.00

1800.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

1400.0

1600.0

1800.0

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Efficiency

Daycase Performance

Period Target Actual PerformanceApr-14 87.00 83.07 aMay-14 87.00 82.42 aJun-14 87.00 85.00 aJul-14 87.00 83.33 a


BADS Activity

68.00

70.00

72.00

74.00

76.00

78.00

80.00

82.00

84.00

86.00

88.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Paper 04


22



Efficiency

Daycase Performance



BADS Activity

68.00

70.00

72.00

74.00

76.00

78.00

80.00

82.00

84.00

86.00

88.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Efficiency

Daycase Performance

Period Target Actual PerformanceApr-14 49.00 49.31 gMay-14 49.00 50.83 gJun-14 49.50 48.98 aJul-14 49.50 49.56 g


Overall Daycase Rate

43.00

44.00

45.00

46.00

47.00

48.00

49.00

50.00

51.00

52.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

-1.00

9.00

19.00

29.00

39.00

49.00

59.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Efficiency

Admission on Day of Surgery

Period Target Actual PerformanceApr-14 90.00 84.70 rMay-14 90.00 87.58 aJun-14 90.00 90.20 gJul-14 90.00 90.99 g


% of Elective NHS Inpatients Admitted on Day of Surgery

78.00

80.00

82.00

84.00

86.00

88.00

90.00

92.00

94.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Efficiency

Theatre Efficiency



% Staffed Theatre Lists Utilised

82.00

84.00

86.00

88.00

90.00

92.00

94.00

96.00

98.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Paper 04


23



Efficiency

Theatre Efficiency



% Staffed Theatre Lists Utilised

82.00

84.00

86.00

88.00

90.00

92.00

94.00

96.00

98.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Efficiency

Average Length of Stay

Period Target Actual PerformanceApr-14 4.00 4.72 rMay-14 4.00 4.50 rJun-14 4.00 4.36 rJul-14 4.00 4.22 a

Aug-14 4.00 4.23 aSep-14 4.00 4.09 aOct-14 4.00 3.95 gNov-14 4.00Dec-14 4.00Jan-15 4.00Feb-15 4.00Mar-15 4.00

Average Length of Stay - Elective Excluding Daycase

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Efficiency

Average Length of Stay

Period Target Actual PerformanceApr-14 45.00 45.99 gMay-14 45.00 41.52 aJun-14 45.00 43.11 aJul-14 45.00 45.77 g


% of Primary Hip and Knee Patients Discharged in 3 days or

less

0.00

10.00

20.00

30.00

40.00

50.00

60.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

28.00

33.00

38.00

43.00

48.00

53.00

58.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Efficiency

Bed Utilisation

Period Target Actual PerformanceApr-14 87.00 81.56 gMay-14 87.00 78.12 rJun-14 87.00 83.72 gJul-14 87.00 76.81 r

Aug-14 87.00 79.05 rSep-14 87.00 77.20 rOct-14 87.00 79.31 rNov-14 87.00Dec-14 87.00Jan-15 87.00Feb-15 87.00Mar-15 87.00

Bed Occupancy - Adult Orthopaedic Wards

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

70.0

75.0

80.0

85.0

90.0

95.0

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Paper 04


24



Efficiency

Bed Utilisation

Period Target Actual PerformanceApr-14 87.00 81.56 gMay-14 87.00 78.12 rJun-14 87.00 83.72 gJul-14 87.00 76.81 r

Aug-14 87.00 79.05 rSep-14 87.00 77.20 rOct-14 87.00 79.31 rNov-14 87.00Dec-14 87.00Jan-15 87.00Feb-15 87.00Mar-15 87.00

Bed Occupancy - Adult Orthopaedic Wards

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

70.0

75.0

80.0

85.0

90.0

95.0

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

%

Target Actual

Efficiency

Outpatient Productivity

Period Target Actual PerformanceApr-14 6.60 6.49 gMay-14 6.60 7.08 rJun-14 6.60 7.06 rJul-14 6.50 6.83 r

Aug-14 6.50 7.34 rSep-14 6.50 6.46 gOct-14 6.40 6.47 aNov-14 6.40Dec-14 6.40Jan-15 6.30Feb-15 6.30Mar-15 6.30

Outpatient DNA Rate

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Efficiency

Outpatient Productivity



Outpatients Per Session

7.20

7.40

7.60

7.80

8.00

8.20

8.40

8.60

8.80

9.00

9.20

9.40

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

0.00

2.00

4.00

6.00

8.00

10.00

12.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Efficiency

Period Target Actual PerformanceApr-14 2.18 2.30 rMay-14 2.18 2.03 gJun-14 2.18 2.14 gJul-14 2.15 2.11 g


New to Follow Up Ratio (Consultant Led Activity)

0.00

0.50

1.00

1.50

2.00

2.50

3.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Paper 04


25



Efficiency

Period Target Actual PerformanceApr-14 2.18 2.30 rMay-14 2.18 2.03 gJun-14 2.18 2.14 gJul-14 2.15 2.11 g


New to Follow Up Ratio (Consultant Led Activity)

0.00

0.50

1.00

1.50

2.00

2.50

3.00

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Nu

mb

er

Target Actual

Paper 04


26

C) Cashflow Statement £'000

Original

Plan Plan Actual Variance Original Plan Plan Actual Variance Plan Actual Plan Actual

600 634 2,913 2,921

0 0

110 (837) 338 (642)

710 (203) 3,251 2,279

(700) (685) (2,792) (3,336)

0 0

10 (888) 459 (1,057)

(1) (1) (7) (20)

0 16 0 (78)

0 0 0 0

0 0 (25) (25)

0 0 (12) 0

0 0 0 0

0 0 (723) (694)

9 (872) (308) (1,874)

*Excludes variance on Anti TNF as pass through cost4,130 3,445 4,447 4,447

4,139 2,573 4,139 2,573

B) Statement of Financial Position £'000 D) Predicted Monitor Risk Assessment/Ratio's

Sep-14 Oct-14 Movement Movement Notes Continuity of Services Risk Rating:

51,219 51,694 475 Capital additions offset by depreciation Plan YTD Actual

493 482 (11) Debt Service Cover 3.18x 3.47x 4

51,711 52,176 464 Liquidity (Days) 6.81 4.66 4

1,130 1,140 10 4

7,092 7,950 858Annual

PlanYTD Actual M7 Plan

M7

Actual

3,445 2,573 (872) EBITDA margin 5.19% 5.25% 7.59% 7.53%

11,666 11,662 (4)

(7,723) (7,854) (131)

Executive Commentary(82) (82) 0

(76) (103) (26)

(7,881) (8,038) (157)

55,496 55,800 303

(117) (116) 1

(294) (284) 10

(411) (400) 11

55,085 55,399 314

31,752 31,752 0

345 659 314 In month surplus

6,517 6,517 0

16,472 16,472 0

55,085 55,399 314

Original

Plan

Flexed

Plan

76.84

3.97

6.18

(51.47)

(30.61)

4.91

(3.91)

1.00

0.03

0.01

0.04

Clinical Income from

activity*

Private Patient

income

Other income

Pay

Non-pay*

EBITDA

Finance Costs

Operational Surplus

75.92

3.97

6.18

(50.91)

(30.24)

4.91

(3.91)

1.00

6.92

0.43

0.45

(4.36)

45.23

2.48

3.41

(30.12)

(18.07)

2.92

(2.26)

0.66

Year To Date Position

(17.74) (0.33)

0.03

0.62

(2.29)

0.040.62

(2.29)

In Month

6.62

0.38

0.50

(4.26)

(2.63)

0.60

(0.33)

0.27

(0.15)

0.50

0.05

Continuity of Services Risk Rating

PDC dividend accrual

Increased Clinical Income debt.

Cash reduction attributable to capital investment and receivables.

PDC Received

PDC Dividend Paid

Closing Cash Balance

Capital Expenditure

Proceeds from sale of assets

Operating Cash Flow after Capital

Loan Repayment

Lease Payment

Fixed Assets

Opening Cash Balance

(0.09)

2.26

Net Interest Paid / Received

Provisions Movement

(4.31) (0.26)

(2.66)

Total Taxpayers Equity

Non Current Borrowings

Non Current Provisions

Total Current Liabilities

Total Current Assets

Payables (Creditors)

Non current receivables

Borrowings

Retained Earnings

Revaluation Reserve

Public Dividend Capital

Revenue Position

Total Non Current Assets

Total Assets Employed

Creditors due after more than one year

Total Assets less Current Liabilities

Inventories (Stocks)

Receivables

Current Provisions

Cash at Bank and in hand

0.60

(0.33)

0.27

(0.05)

Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustFinance Report for period ending 31st October 2014

Year To Date

2.91

44.57 44.76 0.47

Operating Cash Flow

EBITDA

Impairments

Adjustment for Working Capital

0.23

(29.75)

A) Income and Expenditure Account £m

2.91 0.01

Loans Received

In Month

Cash Flow for Period

0.22

6.69

(29.86)

(0.05) 3.503.50

0.38 2.26

(2.81)

0.63

(0.32)

0.31

(17.67)

The Month 7 position overall was a surplus of £314k which exceeded plan by £40k. This represents our strongest month of the year to date and increases our year to date surplus to £659k as we continue to progress towards our agreed £1m plan. Our EBITDA margin for the month was 7.53% and on a cumulative basis is now 5.25%. We continue to deliver a Continuity of Service rating of 4, the lowest risk under Monitor’s framework.

Paper 04


27

Surgical In-patient Income £m Surgical In-patient income per spell £ Medicine Income £m Surgical Out-patient Income £m

YTD Total Income Against Plan £m

Private Patients Income £m Other Income £m

Year To Date Commissioner Income against Plan £m

Oth

er

Inco

me

Co

mm

issio

ne

r P

erf

orm

an

ce

Clinical Income (exc Anti TNF) £m


E) Income and activity analysis

Cli

nic

al

Inco

me

5.00

5.50

6.00

6.50

7.00

7.50

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar

1415 Target £m1415 Actual £m1314 Actual £m

Contract performance exceeded plan by £298k in month . The most material area of over performance continues to be Shropshire; it is forecast that there will be c£1.4m of over performance in excess of the uplifted contract value agreed to date. Further contract variations are being pursued to reflect an increase in referrals and reduction in waiting list.

Income from private patients continued to be strong, exceeding plan by £54k. This offset shortfalls from other income sources that continue to be impacted by reduced education and training funding.

2,750

2,850

2,950

3,050

3,150

3,250

3,350

3,450

3,550

3,650

3,750

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar

1415 Income per Spell Plan £1314 Income per Spell £1415 Income per Spell £

0.00

0.10

0.20

0.30

0.40

0.50

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar

1415 Plan £m 1314 Actual £m 1415 Actual £m

0

0.2

0.4

0.6

0.8

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar

1415 Plan £m 1314 Actual £m 1415 Actual £m

- 2.00 4.00 6.00 8.00 10.00 12.00 14.00 16.00 18.00 20.00

Shropshire

BCU

Specialist

Other English Contracted

Powys

Telford

Other

YTD plan YTD actual

30.00

35.00

40.00

45.00

50.00

Total performance *YTD plan YTD actual

2.000

3.000

4.000

5.000

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar

1415 Income £m Plan1314 Income £m1415 Income £m

0.400

0.450

0.500

0.550

0.600

0.650

0.700

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar


0.000

0.100

0.200

0.300

0.400

0.500

0.600

0.700

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar


Paper 04


28

CIP Monitoring FY1415

In

Month

Plan

£'000s

In Month

Actual

£'000s

In Month

Variance

£'000s

YTD Plan

£'000s

YTD

Actual

£'000s

YTD

Variance

£'000s

Forecast

Plan

£'000s

Forecast

Actual

£'000s

Mitigating

Schemes

£'000s

Forecast

Variance

£'000s

18 60 42 127 297 170 218 224 200 206

35 44 9 212 302 90 383 359 156 132

0 -1 -1 0 18 18 0 20 0 20

8 0 -7 31 2 -29 70 5 0 -65

95 185 90 539 379 -160 1033 387 436 -210

156 288 132 909 998 88 1704 994 792 83

0 0 0 3 0 -3 5 5 0 0

14 -14 -28 59 75 16 130 150 27 47

16 60 45 109 195 87 179 394 69 284

13 3 -10 80 25 -56 143 65 0 -78

43 49 6 251 295 44 457 614 96 253

2 0 -2 13 0 -13 23 7 0 -16

5 11 6 34 30 -4 58 33 30 5

3 2 -1 18 12 -5 30 50 0 20

1 0 -1 80 72 -8 86 79 0 -7

9 0 -9 64 0 -64 110 50 0 -60

20 13 -7 209 114 -95 307 219 30 -58

1 10 9 6 21 15 11 29 0 18

26 19 -8 146 92 -54 278 135 42 -101

3 1 -2 10 4 -6 23 9 0 -14

30 29 -1 162 117 -45 312 173 42 -97

1 2 1 1 2 1 5 5 0 0

19 23 4 119 130 11 215 260 0 45

20 25 4 120 132 12 221 265 0 45

269 404 135 1651 1655 4 3000 2266 960 226

Deliverability RAG

2,675 83% g276 9% a275 9% r

3,226 100%

Key Theme

Commercial/Trading Opportunities

Stepped Operational Efficiency


Corporate Functions

Service redesign/use of Technology



Corporate Functions

Diagnostics

Estates & Facilities

Grand Total


Corporate Functions

Improved service line performance


Corporate Functions




Corporate Functions

Surgical Services

Medicine

CIP

by T

he

me

in

mo

nth

Division

CIP

by T

he

me

In Month CIP Achievement £000's


Year To Date CIP Achievement £000's Trust YTD Achievement Against YTD Plan £000's

F) Cost Improvement Programme

Corporate



0 50 100 150 200





Corporate Functions

Oct Plan Oct Actual

0.00

200.00

400.00

600.00

800.00

1,000.00

1,200.00

1,400.00

1,600.00

1,800.00

Total

YTD Plan YTD Actual

0 100 200 300 400 500 600 700 800





Corporate Functions

YTD Plan YTD Actual

Cost improvements of £404k were achieved in month, which was £135k above plan. This strong in month performance was driven by the recognition of contribution earned from additional activity delivered, procurement savings and the introduction of a sustainable clinical model to manage spinal outpatients.

Year to date savings now stand at £1.655m and we are forecasting delivery of the full £3m programme by the end of the year fo llowing the agreement of a number of mitigating schemes.

Paper 04


29

-110


G) Pay Expenditure related Key Drivers/Financial Assumptions

To

tal

Pa

yB

an

k &

Ag

en

cy E

xp

en

dit

ure

Six Months Out of Job Plan Expenditure By Area (£,000)

Trust Pay Cost Per In-patient Spell (£)

Non-Clinical Bank & Agency Expenditure (£,000)

Total Pay Expenditure (£m)

Out of Job Plan Expenditure (£m)

Clinical Bank & Agency Expenditure (£,000)

Ou

t o

f Jo

b P

lan

Ex

pe

nd

itu

re

Pay costs in month were £54k higher than plan mainly relating to pass through costs associated with research projects and agency SPR pressures.

Out of Job plan expenditure was on plan.

The Clinical bank and agency spend continued at the same level as last month due to the employment of agency SPR's linked to rota cover and Orthotist sickness.

3.800

3.900

4.000

4.100

4.200

4.300

4.400

4.500

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

1415 Plan 1314 Actual 1415 Actual

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500



0.000

0.050

0.100

0.150

0.200

0.250

0.300

0.350

0.400



0

20

40

60

80

100

120

140

160

180

May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14

Radiology Anaesthetics In-patients Out-patients

0

20

40

60

80

100

120

140


1314 Actual 1415 Actual

0

20

40

60

80

100

120


1314 Actual 1415 Actual

Paper 04


30

-110


H) Non-Pay Expenditure related Key Drivers/Financial Assumptions

To

tal

No

n-p

ay

Dru

gs E

xp

en

dit

ure

Average Drugs Cost Per In-patient Spell (£)

Average Implant Cost Per Surgical In-patient Spell (£)

Trust Average Non-pay Cost Per In-patient Spell (£) (Exc Anti TNF)Total Non-pay Expenditure (£m) (Exc Anti TNF)

Implant Expenditure (£m)

Drugs Expenditure (£m)

Im

pla

nts

Ex

pe

nd

itu

re

Non-Pay was £218k overspent in month . Half of this related to pass through costs associated with drugs and the remainder has been driven by high implant costs associated with the rich case mix of work delivered and increased volumes of private activity.

Implant expenditure came in above plan due to the rich case mix of activity delivered.

Drugs expenditure exceeded plan by £41k in month which is mainly related to pass through costs

1.000

1.200

1.400

1.600

1.800

2.000

2.200

2.400

2.600

2.800

3.000



1,000

1,500

2,000

2,500



0.000

0.100

0.200

0.300

0.400

0.500

0.600

0.700

0.800

0.900

1.000



0

100

200

300

400

500

600

700

800

900



0.000

0.020

0.040

0.060

0.080

0.100

0.120

0.140

0.160

0.180

0.200



0

20

40

60

80

100

120

140

160

180



Paper 04


31

-110

Cash Plan v Actual

Ca

sh

De

bto

rs

Creditors over 90 Days

Cre

dit

ors

Public Sector Payments Policy


I) Balance Sheet Items Analysis

Receivables over 90 Days

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

AR Debtors

Sep Oct

0.00%

2.50%

Current Invoices over 90 days %

Sep Oct

The percentage of receivables over 90 days has decreased to 10.53%. This was as a result of an overall increase in the invoiced debt .

Creditors over 90 days dropped to 0.64% following a successful resolution with implant suppliers of a large number of over 90 day invoices . This keeps us well under the Monitor target 5% threshold. Invoices paid within 30 days performance remained within targets at 95.63%.

Cash balances reduced by £0.87m in month to £2.57m driven by high in month capital expenditure and the continued over performance of our clinical income against contracted cash profiles. An additional £1m of interim over performance has been secured and cash settled during November.

Once the November settlements have been taken into account our cash balances are £0.6m behind plan. The primary driver for this is the recovery of grant income in respect of our IT capital developments that has been delayed pending delivery of schemes. The forecast end of year cash balance is per the plan at £5.4m.

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00


Cash Plan £m Cash Actual £m

80.00%

82.00%

84.00%

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

PSPP

Sep Oct

Paper 04


32

ProjectAnnual Plan

£000s

In

Month

Plan

£000s

In Month

Completed

£000s

In

Month

Variance

£000s

Year to

date

Plan

£000s

Year to

date

Complet

ed £000s

Year to

date

Variance

£000s

Forecast

Outturn

£000s

Estates Backlog Maintenance 998 175 90 -85 574 597 23 1,023

Medical Equipment replacement 755 40 93 53 285 701 416 755

IT Investment Programme 300 22 24 2 137 101 -36 300

X-Ray room 3 upgrade 245 0 0 0 245 242 -3 245

Outpatients Refurbishment 200 0 0 0 0 0 0 200

Pre-Op 250 50 161 111 250 272 22 425

Wayfinding 80 0 51 51 0 73 73 80

Tumour Unit & Theatre Modernisation

Programme1,868 300 202 -98 490 471 -19 1,868

Scheme Project Management 150 13 8 -5 82 67 -15 150

IT Tech Fund 1,335 100 51 -49 804 150 -654 1,335

Contingency 200 0 0 0 0 0 0 0

NHS Capital Expenditure 6,381 700 680 -20 2,867 2,674 -193 6,381

K) Service Line Performance L) Key Financial Risks

Resulting

Risk

Rating

Risk

RatingMitigating Action

Increased controls to be introduced.

Close tracking of delivery as part of

performance framework. Total schemes

identified in excess of target.

Formal review group established to review

progress. Risk reserve held.

Se

rvic

e L

eve

l R

ep

ort

ing


J) Capital Programme

Ca

pit

al

In Month Capital Expenditure £'000s Cumulative Capital Expenditure £'000s Capital Projects Listing

Capital Projects 2014/15

Contingency allocated as part of plan.

Service Line Reporting - Quarter 2 Update

• Excessive premium cost working to deliver activity e.g. OJP

• Delivery of 2014/15 CIP

• Over performance against Shropshire Contract, driven by unidentified QIPP

Key Risk Description

• In year cost pressures

0

100

200

300

400

500

600

700

800

October

In Month Plan £000s In Month Completed £000s

0

500

1,000

1,500

2,000

2,500

3,000

3,500

October

Year to date Plan £000sYear to date Completed £000s

Capital expenditure for the month was £0.68m which was £0.02m behind plan. On a cumulative basis we have now spent £2.674m against an annual plan of £6.381m.

The main drivers of expenditure in month were the pre-op relocation scheme and progression of the design for our new Theatre and Tumour unit for which a GMP will be presented to the Board in January 2015. Although the IT investment has slipped from the original plan profile, we anticipate all schemes being completed by the end of the financial year

The financial risks to the delivery of our financial plan have been captured in the table above. Also included are the mitigating actions in place from which a residual risk position has been assessed.

The table above tracks the margins made by our Service Lines at Q2. Whilst all areas are making a positive contribution, three service lines are falling short of the return required to recover their overheads. The drivers for this will be addressed as part of future business planning and through our efficiency programme.

Paper 04


33

Rolling Cashflow Forecast Oct-14

INCOME

Nov Dec Jan Feb Mar Apr May June July August Sept Oct Nov Dec Jan Feb Mar Apr May June July August Sept Oct

2013 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2015 2015 2015 2015 2015 2015 2015 2015 2015 2015

Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan

INCOME

Clinical SLA Income 6,243 5,697 5,882 5,844 5,931 6,175 6,089 6,326 6,354 6,149 6,607 6,284 7,300 6,250 6,250 6,250 6,290 6,330 6,330 6,330 6,330 6,330 6,330 6,330

Other Clinical Income 105 548 178 243 390 217 123 139 251 425 141 234 380 380 380 380 380 275 275 275 275 275 275 275

Clinical SLA Overperformance 1,100 0 2,144 1,325 527 197 438 25 1,000

Clinical SLA Underperformance refunds 0 0 0 -117 -153 -123

Other NHS Income 214 336 690 232 558 151 808 216 174 528 136 496 230 230 550 230 230 550 230 230 550 230 230 550

Non NHS Income 700 394 682 725 827 725 751 680 896 605 661 685 675 675 675 675 675 675 675 675 675 675 675 675

Loan 1,000

PDC Drawdown 600 750

Donated Capital 0 532 100

Total Cash receipts 7,262 8,075 7,432 7,044 10,382 8,593 8,181 7,405 7,990 7,732 7,545 7,699 8,585 7,535 9,555 7,535 9,325 7,830 7,510 7,510 7,830 7,510 7,510 7,830

EXPENDITURE

Payroll 2,300 2,346 2,302 2,305 2,335 2,300 2,334 2,357 2,376 2,336 2,313 2,379 2,320 2,320 2,320 2,320 2,320 2,320 2,320 2,320 2,320 2,320 2,320 2,320

Tax,NI,SPN 1,635 1,601 1,657 1,641 1,626 1,642 1,662 1,682 1,685 1,704 1,656 1,629 1,660 1,660 1,660 1,660 1,660 1,660 1,660 1,660 1,660 1,660 1,660 1,660

Annual Rentals 0 0 0 33 33 33 33 807 33 33 33 33 33

Non-Pay via Accs Payable (Trade) 2,510 2,531 3,185 2,427 3,376 3,468 2,849 2,414 2,853 2,092 2,700 3,234 2,550 2,550 2,550 2,550 2,550 2,575 2,575 2,575 2,575 2,575 2,575 2,575

Non-Pay via Accs Payable (NHS) 765 805 513 325 259 170 884 659 934 1,275 454 609 500 500 500 500 500 550 550 550 550 550 550 550

Capital (NHS) 118 403 169 275 833 261 41 324 216 527 625 681 695 1,241 505 502 763 400 400 400 400 400 400 400

Investments

Loan Repayment 25 25 25 25

Loan Interest 5 4 6 6

PDC Dividend 610 694 682 682

Total Cash Payments 7,328 7,686 7,826 6,973 9,069 7,841 7,803 7,469 8,097 7,967 9,278 8,565 7,758 8,304 7,568 7,565 8,506 7,505 7,505 7,505 7,505 7,505 8,218 7,505

CASH BALANCE

Opening Balance 3,134 3,068 3,457 3,063 3,134 4,447 5,199 5,577 5,513 5,406 5,171 3,438 2,572 3,399 2,630 4,617 4,587 5,406 5,731 5,736 5,741 6,066 6,071 5,363

Cash Movement -66 389 -394 71 1,313 752 378 -64 -107 -235 -1,733 -866 827 -769 1,987 -30 819 325 5 5 325 5 -708 325

Closing Balance 3,068 3,457 3,063 3,134 4,447 5,199 5,577 5,513 5,406 5,171 3,438 2,572 3,399 2,630 4,617 4,587 5,406 5,731 5,736 5,741 6,066 6,071 5,363 5,688

TOTAL CASH INCLUDING INVESTMENTS

Add short term investments

Total Cash Holding 3,068 3,457 3,063 3,134 4,447 5,199 5,577 5,513 5,406 5,171 3,438 2,572 3,399 2,630 4,617 4,587 5,406 5,731 5,736 5,741 6,066 6,071 5,363 5,688

As per Monitor Plan 4,146 3,794 3,900 3,913 5,800 5,384 4,863 4,750 5,291 4,263 3,640 3,932 4,154 2,943 6,198 5,310 5,400 5,731 5,736 5,741 6,066 6,071 5,363 5,688

Variance -1,078 -337 -837 -779 -1,353 -185 714 763 115 908 -202 -1,360 -755 -313 -1,581 -723 6 0 0 0 0 0 0 0

Actual Forecast

Paper 04


34

Month 7

Achieved / Not Met

Referral to treatment time, 18 weeks in aggregate, admitted patients 90% 1.0 No Achieved

Referral to treatment time, 18 weeks in aggregate, non-admitted patients 95% 1.0 No Achieved

Referral to treatment time, 18 weeks in aggregate, incomplete pathways 92% 1.0 No Achieved

Cancer 62 Day Waits for first treatment (from urgent GP referral) 85% 1.0 No Not relevant

Cancer 62 Day Waits for first treatment (from NHS Cancer Screening Service

referral)90% 1.0 No Not relevant

Cancer 31 day wait for second or subsequent treatment - surgery 94% 1.0 No Not relevant

Cancer 31 day wait for second or subsequent treatment - drug treatments 98% 1.0 No Not relevant

Cancer 31 day wait for second or subsequent treatment - radiotherapy 94% 1.0 No Not relevant

Cancer 31 day wait from diagnosis to first treatment 96% 0.5 No Achieved

Cancer 2 week (all cancers) 93% 0.5 No Achieved

Clostridium Difficile -meeting the C.Diff objective 0 1.0 No Not met

Risk of, or actual, failure to deliver Commissioner Requested Services N/A 4.0 No No

CQC compliance action outstanding (as at 30 Sep 2013) N/A special No No

CQC enforcement action within last 12 months N/A special No No

CQC enforcement action (including notices) currently in effect N/A 4.0 No No

Moderate CQC concerns or impacts regarding the safety of healthcare provision N/A special No No

Major CQC concerns or impacts regarding the safety of healthcare provision N/A 2.0 No No

Trust unable to declare ongoing compliance with minimum standards of CQC

registrationN/A special No No

0

GREEN

Appendix 1

Indicative Risk Rating

Declaration of risks against healthcare targets and indicators for 2014/15

Target or Indicator (per Risk Assessment Framework)

Threshold

or target

YTD

Scoring

Risk

declared at

Annual Plan

Overall Score

Paper 04


35

Paper 05

Page 1 of 3

U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Paper 05 Capital Programme Update and Plan Review.doc

BOARD OF DIRECTORS

27TH

NOVEMBER 2014

Executive Responsible John Grinnell, Director of Finance Paper prepared by (if different

from above)


Development




�


Executive Summary

A mid year review of the capital plan has been undertaken and a forecast to the year end. This has highlighted that, whilst the overall plan is on track, there are two risks that have been identified and an invest to save opportunity. The Board are being asked to ring-fence a cash flow improvement that is available following a re-profiling of the theatre loan repayment to cover these potential risks and opportunities to invest in a CHP. All are subject to further Board approval

Subject/Title Capital Programme Update and Plan Review


For Discussion �

For Approval


Legal Implications

Recommendation The Board of Directors are asked to note the update and the recommendation to ring-fence the increased cash balance to manage in year risks and a potential investment in a CHP, all of which will be subject to individual business case approval.

Acronyms and Abbreviations CHP – Combined Heat and Power GMP – Guaranteed Maximum Price

Paper 05

Page 2 of 3


BOARD OF DIRECTORS

27TH

NOVEMBER 2014

CAPITAL PROGRAMME UPDATE AND PLAN REVIEW

Background

Given that we are just past the half-way point of the year a further review of the capital programme has been undertaken to capture any emerging issues. A more strategic review of the programme will take place as part of the planning round early in the new calendar year. As a reminder at the July Trust Board meeting a revised capital programme was approved at £6.32m and £29.7m over the 5 year planning period 2014/15 to 2018/19.

Latest Position

At the half way point of the year we are on track to deliver our capital programme as previously agreed by the Board at Q1. The profile of delivery means that some schemes are further ahead than others. There has been excellent progress on a number of key schemes including:

• Refreshing our entire asset base of power tool equipment in theatres and other equipment

replacements.

• Completion of a major corridor upgrade.

• Enhanced wayfinding.

• Completion of x ray room 3 upgrade.

We have gone on to assess the deliverability of our remaining schemes. At an overview level the 14/15 programmes forecast out turn is £6.38m which is in line with plan. The key assumptions within this are:

• Theatres modernisation – the plan assumes GMP is signed off in January per the business

case and construction starts early in the new year.

• Tech Fund investments – the current spend profile is behind that originally planned leaving

significant expenditure in the final 5 months of the year however we continue to forecast full

delivery of the programme. This is overseen by the IM & T Programme Board.

• A feature of this year has been the full utilisation of the contingency in managing cost

pressures associated with the relocation of Pre Op and medical equipment requirements. The

forecast assumes no further call on contingency funds which carries a level of risk.

Emerging Issues/Opportunities

In reviewing the capital plan we have assessed any risks to the plan and any other issues or opportunities that have been raised. The key areas to highlight are:

• Contingency – the capital programme is fully committed with little contingency for unforeseen expenditure.

• Theatres Development – whilst we are progressing towards GMP, our P21+ partner has highlighted a cost pressure against our budget of c£300k due to the increased costs caused by the buoyant construction sector. We are continuing to work on the GMP however at this stage think it is likely that this level of pressure will not be able to be managed within the original budget.

Paper 05

Page 3 of 3


• CHP – since we breached the Carbon Credit Limit we have been developing an energy strategy to reduce our energy costs and to lower our carbon usage beneath the Credit Limit requirement. In addition changes to the application of building control regulations means that the Trust is required to demonstrate further investment in sustainability should it wish to update the site further. To address these issues we have been developing proposals to install a Combined Heat and Power (CHP) electricity generator. This would deliver a strong return on investment by significantly reducing our energy costs, bring our carbon footprint down and meet regulatory requirements. The business case is assessing the most attractive funding solution that could be either capital (c£400k) or some form of managed service. A business case will be presented to the BRIC meeting in January.

Based on this assessment there are pressures on the capital programme that cannot be accommodated within our original funding plans for 2015/16 and an opportunity to invest to save in a CHP. Funding Envelope

The parameters of our capital funding envelope were set using the following principles:

• Reinvestment of annual depreciation.

• Reinvestment of annual surpluses net of loan repayments.

• Any donations and grants received.

The original plan had anticipated that the loan repayment for the theatres scheme would commence on initial drawdown from 2015/16 and therefore our full surplus was not made available for capital investment. It has subsequently been confirmed that the loan repayment will only commence upon full draw down of the loan. This means that our repayments will be deferred until 2016/17, which means an additional £1m of cashflow is available for the Trust Board to support the capital programme. Recommendations

Having reviewed the 2014/15 capital forecast and the 2015/16 plans the risk areas highlighted could not be accommodated within the identified funding. Against our 5 year capital programme a further £1m of cash funding is available that it is proposed to ring-fence for the capital programme to cover the following risks or investment opportunities:

• Contingency for any unforeseen capital requirements in the last 4/5 months of the year.

• The risk of an increase in the GMP for the Theatres development of c£300k relating to the

market conditions of the construction industry.

• Subject to business case approval and testing of the best source of funding an investment in a

CHP.

Both the GMP for the Theatres scheme and CHP business case will be subject to final approval prior to proceeding. John Grinnell

Director of Finance

Paper 06

U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Paper 06 Monitor Feedback on 5-Year Strategic Plan.doc


2277TTHH


Executive Responsible Wendy Farrington Chadd, Chief Executive Paper prepared by (if different

from above)

Jay Mistry, Senior Regional Manager, Monitor


Development




�


Executive Summary

The Trust submitted its 5-Year Strategic Plan in June 2014. The feedback from this submission is attached.

Subject/Title Feedback from Monitor on 5-Year Strategic Plan


For Discussion �

For Approval �


Legal Implications

Recommendation The Board of Directors is asked to note the feedback.

Acronyms and Abbreviations

31st October 2014 Wendy Farrington-Chadd Trust Headquarters The Roberts Jones and Agnes Hunt Orthopaedic Hospital NHS FT Oswestry Shropshire SY10 7AG

Dear Wendy

Your foundation trust’s five-year strategic plans

Thank you for the significant efforts of your foundation trust during this planning round to address the major challenges faced by the healthcare sector. Below I have summarised key findings from our review of the five year plans and next steps.

Background

Our review of last year’s strategic planning concluded that there were significant opportunities for the majority of foundation trusts to improve1. This is important as a clear and well thought-out strategy helps foundation trusts achieve the vision and values of the NHS by sustaining safe, effective care for patients in the medium term. Supporting the sector to improve was therefore a key objective of the 2014/15 planning round and why we added the five-year strategic plan to the process. More recently, we launched the Strategy Development Toolkit with guidance for foundation trust boards and their teams on every stage of the strategy development process.

In our letter of 16 May 2014, we stressed the importance of foundation trusts having a realistic view of the scale of the financial challenge over the next few years. Furthermore, we reassured you that we want to engage with you in a supportive manner if risks to sustainability are identified. Our approach to reviewing this year’s five-year plans has been governed by these principles.

Overview

Our review of the five-year plans has highlighted a number of improvements:

the “optimism bias” identified in previous plans has become less pronounced

there is a higher quality of diagnosis and analysis of the various issues facing foundation trusts

there is evidence of providers and commissioners working more closely together to identify and confront emerging pressures

some truly innovative transformational initiatives are being developed and implemented across local health economies.

However, our analysis shows that there are still some key issues in strategic planning at many foundation trusts:

1 See Meeting the needs of patients: Improving strategic planning in NHS foundation trusts, available

at https://www.gov.uk/government/publications/nhs-foundation-trusts-improving-strategic-planning

Wellington House 133-155 Waterloo Road London SE1 8UG T: 020 3747 0000 E: [email protected] W: www.GOV.UK/monitor

https://www.gov.uk/government/publications/strategy-development-a-toolkit-for-nhs-providers


https://www.gov.uk/government/publications/nhs-foundation-trusts-improving-strategic-planning

http://www.gov.uk/monitor

overall cost improvement programmes (CIPs) appear insufficient to offset the financial pressures facing the system

transformational changes are not yet widespread enough across the sector

there is evidence of poor alignment between provider and commissioner plans

in aggregate, financial pressures continue to be under-modelled in plans. As a result, there are concerns about the robustness of foundation trusts’ plans to deliver quality care on a sustainable basis.

Our approach to the assessment of your strategic plan

We have not undertaken an in-depth review of foundation trusts’ strategies and plans. Instead, we have tested the robustness of the financial projections which describe those plans. We did this by applying a limited number of sensitivities to foundation trusts’ own financial projections to adjust for parameters generally known to be poorly modelled2.

We have used a RAG rating to categorise our assessment of the level of risk in each case:

Green No undue concerns were raised from review of the strategic plan. We will continue to monitor ongoing delivery as normal.

Amber The sensitisation of the projections identifies that the foundation trust’s sustainability may be marginal. We therefore ask the trust to review its plans in light of our findings, and to consider what improvements in strategic planning may be required.

Red There appears to be a high risk to sustainability. Where appropriate, we will invite foundation trusts in this category to a meeting with Monitor so we can reach a shared understanding of possible gaps and agree what is required to close these in terms of resources, support and milestones.

We recognise that there may be limitations in some cases to using top-down sensitivities and will not base any response on this alone. We are of course happy to discuss the outcome and approach applied for your foundation trust with you.

Outcome of the assessment of your strategic plan and next steps

Your strategic plan has been rated as Amber.

The sensitisation of the projections identifies that your foundation trust’s sustainability may be marginal and we have an area of concern which we wish to raise with you:

The financial projections have potentially under-modelled financial pressures (efficiency factor) compared to national guidance. Whilst you should form your own view on local inflation, we ask you to review the assumptions in your plans in future.

2 The following adjustments to trusts’ assumptions were made:

i. expected CIP delivery was adjusted in light of past performance and delivery against

plan

ii. anticipated pressures to tariff and costs were uplifted in line with Monitor guidance

iii. contingencies in plans were released (this mitigates against the above adjustments)

iv. capital expenditure forecasts were reduced to reflect the historical underspend in the

sector against plan.

Should you wish to discuss our findings in more detail, please contact your Regional Team at Monitor.

Further information

In early November you will receive a letter from Monitor, NHS England and the NHS Trust Development Authority which sets out the timetable and high level principles for the 2015/16 planning round. Monitor’s full guidance will be published in early December.

The summarised version of your strategic plan will be published on our website shortly.

As referred to earlier, we recently published our Strategy Development Toolkit. The toolkit describes a seven-stage framework for boards and their teams, and offers practical guidance at every step of the process together with case studies from other NHS providers. It is a series of frameworks, analyses and ideas intended to provide direction and inspiration, rather than to be prescriptive. Please download the toolkit here3; you can also find a link to the landing page, together with further information, here4. We hope you find it helpful.

If you have any queries, please feel free to contact me.

Yours sincerely

Jay Mistry

Senior Regional Manager

Direct line: 02037470166

Cc: Mr Russell Hardy, Chair

3 Available at

https://drive.google.com/uc?export=download&id=0B8FRBEcO1QyULXYxRWlza0xSRjQ 4 Available at



https://drive.google.com/uc?export=download&id=0B8FRBEcO1QyULXYxRWlza0xSRjQ


https://drive.google.com/uc?export=download&id=0B8FRBEcO1QyULXYxRWlza0xSRjQ


Paper 07

Page | 1 U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Paper 07 Quarter 2 Infection Prevention Control and Cleanliness Report.docx

BOARD OF DIRECTORS

27TH

NOVEMBER 2014

Executive Responsible Jayne Downey Director of Nursing and Service Delivery Paper prepared by (if different

from above)

Sue Sayles Infection Prevention and Control Nurse


Development


�

Context Previous Board discussion Link to National Policy National Requirement Link to Trust’s Strategic

Objectives


Executive Summary

Quarter 2 infection prevention and control and cleanliness report outlines the performance of the Trust against the registration requirements. Activity to support these requirements is outlined in the report, and is on trajectory against the annual work programme.

Subject/Title Quarter 2 Infection Prevention, Control and Cleanliness Report



Received or approved by Quality and Safety Committee – 16 October 2014

Legal Implications

Recommendation The Board of Directors note the attached report.

Paper 07


Quarter2

ReportforInfectionPrevention,Control

andCleanliness

Executive Summary Through the monthly Board performance report, the Board are briefed on the mandatory bacteraemia and any key issues emerging from those results. Over and above the mandatory

reporting, the Quality and Safety Committee receive a report at least four times per year

from the Director of Infection Prevention and Control (Director of Nursing). This report includes a high level summary of the key issues in Infection prevention and control as well as

cleanliness.

Key Issues

MRSA Bacteraemia RJAH Acquired

MSSA Bacteraemia RJAH Acquired

E .coli Bacteraemia

RJAH Acquired

C. difficile

Month No. of Cases No. of Cases No. of Cases No. of Cases

July 0 0 1 0

August 0 0 0 0

September 0 0 0 0

Quarter 0 0 1 0

The Board of Directors will have seen through the Board performance papers that there have

been no cases of reportable MRSA bacteraemia since 2006. There was one case of E .Coli Bacteraemia which was reported as an RJAH acquisition.

Annual Infection prevention and Control work plan Summary in the main report shows current performance in cleanliness and infection control

against the work plan.

Recommendation

The Board of Directors are asked to note the progress report against the annual plan for: Infection Prevention and Control and Cleanliness report

Paper 07


1.0 Introduction This report provides an update on progress made within quarter 2, 2014/15 to the Quality and Safety Committee, to ensure that the Board are briefed at a high level on any trends or

issues that identify best practice or any gaps in assurance from which further work or actions are required.

2.0 Infection Control Committee The Board agreed the Infection Prevention and Control programme of work for 2013 – 15.

To date progress is on target.

3.0 Cleanliness

Cleanliness – RJAH National Cleaning Score Measured cleanliness has been maintained above the National calculated target (85.0%) and Trust target (94.0%) over the first quarter period, achieving an overall average for the

quarter of 97.9%, which is consistent with recent quarters. The below chart demonstrates the position for the last 2 quarters.

Paper 07


Cleanliness – High Risk Areas Measured standards in the Very High Risk areas including Main Theatres, HDU and Menzies

consistently exceeded the National Target of 98%. The average standard achieved over the

most recent quarter was as follows: HDU – 99.7%

Menzies – 99.4% Main Theatres – 98.8%

Cleanliness – Staff Training

Training remains on target for 100% completion by year end, demonstrating our commitment to the highest level of staff competency. The rolling year position is

demonstrated below:

Infection control training position: 85% Statutory training position: 91%

Less than 70%

70%-89% 90% or greater

Less than

70%

70%-89% 90% or

greater

Paper 07


Cleanliness – Spend on Cleaning

Year to date spend is being controlled under budget.

Cleanliness – Patient Satisfaction Patient satisfaction is sustaining its very high level, reflecting the feedback from the CQC

Inpatient survey and the net promoter score.

• 99.7% of those asked found the ward environment to be always or mostly clean

• The one feedback of “sometimes” had no cleaning related comment, but stated that

“Lockers difficult to use” • The one feedback of “never” had no comment

• 10 compliments relating to cleanliness were recorded in the written comments

Did you feel the Ward environment was clean?

Month Always Mostly Sometimes Never N/A

July-14 263 11 1 0 7

Aug-14 230 8 0 0 1

Sept-14 187 9 0 1 4

Paper 07


4.0 Infection Control Training

The infection control team attended ‘The New National Quality Standard for Surgical Site

Infection’ Conference.

The New National Quality Standard for Surgical Site Infection was recently released by the

National Institute for Health and Clinical Excellence (NICE ).

This conference included presentations from members of the Topic Expert Group on the

Surgical Site Infection Quality Standard through expert sessions and case studies focusing on

implementing the new standard in practice. Attendance has enabled the Infection

Prevention control team to provide strong leadership and multidisciplinary team working,

alongside the auditing of the implementation of the quality standards enabling early

recognition of problems to maintain our low surgical site infection rates throughout the

Trust.

5.0 Link Meetings

1023,

78%

289, 22%

Infection Control Training

Staff Completed Staff Yet To Complete

July

• Attendance 8

• Discussed a second case of C.difficle and lessons

learnt from the RCA.

• the outcomes following the root cause analysis into

RJAH acquired CPE and the infection control protocol.

August

• Attendance 10

• Discussed the Decontamination of air flow matresses,

High Impact Intervention No:4 Preventing surgical site

infections, MRSA Screening Incident and D&V The

48hr rule

September

• Attendance 6

• Discussed Audit returns,and the new quality standard

NICE 49: Surgical Site Infections

Paper 07


Attendance figures are reflected in the low performance across the trust during the summer

period. The importance of attendance is monitored through the STAR programme and reinforced by the Matron for Quality & Safety. The dates for 2015 have been disseminated to

encourage forward planning by ward managers.

6.0 Audit In Quarter 2, the identified planned clinical audits have been undertaken. These include audit

tools from:

ICNA (Infection control nursing association) which include: � Departmental waste handling and disposal,

� Safe handling and disposal of sharps,

� Environment, � Ward/departmental kitchens,

� Management of patient equipment � Isolation precautions

High Impact Intervention audit tool kit

Hand hygiene audits

These audit results are displayed on ward STAR Boards.

Audit Results Hand Hygiene

The hand hygiene audit categorises personnel into Doctor, Nurse, Health Care Assistant or

‘Other’.

Paper 07


ICNA

An isolation audit demonstrated that infection control signage is not always used on barrier

nursing rooms. This will be discussed with Link staff and SNAHP meetings.

Saving Lives: High Impact Interventions

Paper 07


Quarter two remain consistent. The care bundle to prevent surgical site infection has been

rolled out to be included in the next quarter’s results. This will incorporate pre, intra and post-operative actions.

7.0 Surgical Site Surveillance Providing data to the national SSI process enables the Trust to benchmark on a national basis with other Trusts and promote the low infection rates within the Trust. The process

uses nationally agreed criteria from which the definition of a Surgical Site Infection is formed.

The national requirement for the auditing of SSI in arthroplasty patients is one quarter per calendar year. In recent years audits had been carried out to meet the minimum national

standard but the Trust has the resources to compile a full complement of quarterly audits.

The Infection Control Nurse liaises with Consultants concerning any wound infections. The

data for Quarter 1 (April-June), 2014 has been verified and these results have been published.

8.0 MRSA Swabbing and New Isolates MRSA swabbing for all admissions continues and is monitored internally to ensure that the Trust remains compliant to the national requirement for reducing preventable Hospital

Acquired Infections.

July 14 Aug 14 Sept 14

Eligible patients 1078 1002 1006

Screened for

MRSA

1078 1002 1006

% achieved 100.00% 100.00% 100.00%

Target 100% 100% 100%

4 Infections

from 354

Procedures

Quarter 1

1.1 %

National

Average

1.1%

Total Knee

Replacements

1 Infection

from 398

Procedures

Quarter 1

0.25%

National

Average

1.0%

Total Hip

Replacements

0 Infections

from 145

Procedures

Quarter 1

0%

National

Average

1.5%

Spinal

Surgery

Paper 07


MRSA screening compliance remains excellent. The figures are shared externally at the

monthly DIPC LIT meetings with Shropshire Infection Control teams

9.0 Alert Organisms

E Coli Bacteraemia The patient that acquired E Coli bacteraemia had previously been diagnosed with an E .Coli urinary tract infection; this was the probable source of the bacteraemia.

10.0 Serious Incidents There have been no outbreaks or serious incidents recorded during quarter 2

11.0 Conclusion RJAH Orthopaedic Hospital is consistently striving for low infection rates. The audit findings

provide a positive assurance that clinical practice is at a high standard and support for specific areas given to assure that improvements are maximised.

12.0 Recommendations The Board of Directors are asked to note the progress outlined in the Quarter 2 report and approve the report.

Jayne Downey Director of Infection Prevention and Control (DIPC) October 2014

U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Paper 08 Audit Committee Chairmans Report - 7

October 14.docx

Paper 08

BOARD OF DIRECTORS

27TH

NOVEMBER 2014

Executive Responsible Richard Clarke, Non Executive Director Paper prepared by (if different

from above)


Development

Performance and Governance Context Previous Board discussion Link to National Policy Link to Trust’s Strategic

Objectives


Executive Summary

This report highlights the key business undertaken by the Audit Committee at its meeting on 7

th October 2014.

Subject/Title Report from the Chair of the Audit Committee




Legal Implications

Recommendation The Board of Directors are asked to note the Chairman’s Report


U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Paper 08 Audit Committee Chairmans Report - 7

October 14.docx

BOARD OF DIRECTORS

27TH

NOVEMBER 2014

AUDIT COMMITTEE MEETING 7TH

OCTOBER 2014 CHAIRMAN’S REPORT

Governance

The Committee:

• Received an update on Data Quality audits undertaken in the first six months of 2014-15;

• Received a copy of the Finance Governance Pack, including a report on debtors, waivers, and losses and special payments;

• Reviewed the section of the corporate risk register assigned to the Audit Committee;

• Received a review of the Register of Interests and Hospitality Register; and

• Approved an updated Audit Committee Terms of Reference.

External Audit Matters

The Committee:

• Approved the 2014/15 External Audit Plan;

• Noted Deloitte LLP’s Update Report; and

• Concluded the Trust had an effective external audit service following a review of the effectiveness of the service provided.

Internal Audit Matters

The Committee:

• Noted KPMG’s progress against the 2014/15 Internal Audit Plan;

• Received final reports on the 18 Weeks Referral to Treatment Process, Cost Improvement Programmes and IM&T Risk Assessment - all of which had been awarded significant assurance with minor improvement opportunities; and

• Concluded the Trust had an effective internal audit service following a review of the effectiveness of the service provided.

Counter Fraud Matters

The Committee:

• Received the LCFS progress report; and

• Requested the Local Counter Fraud Specialist review the Fraud Bulletins issued in the last 18 months and ensure appropriate controls were in place to prevent fraud occurring within the Trust.

Routine Matters

The Committee reviewed its work plan for 2014/15. Richard Clarke Non Executive Director

Paper 09

U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Paper 09 BRIC Chairmans Report.doc 1


2277TTHH

NNOOVVEEMMBBEERR 22001144 Russell Hardy �� 4358

Chairman

Executive Responsible Alastair Findlay, Non-Executive Director Paper prepared by (if different

from above)


Development



Objectives


Executive Summary

This report highlights the key business undertaken by the BRIC at its meeting on 8th October 2014.

Subject/Title Report from the Chairman of the Business Risk and Investment Committee (BRIC)


For Discussion �

For Approval


Legal Implications

Recommendation The Trust Board are asked to note the BRIC Chairman’s Report.


Paper 09

U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Paper 09 BRIC Chairmans Report.doc 2

Alastair Findlay

Non-Executive Director


2277TTHH

NNOOVVEEMMBBEERR 22001144 BBUUSSIINNEESSSS RRIISSKK AANNDD IINNVVEESSTTMMEENNTT CCOOMMMMIITTTTEEEE

CCHHAAIIRRMMAANN’’SS RREEPPOORRTT OOFF TTHHEE MMEEEETTIINNGG OOFF 88TTHH OOCCTTOOBBEERR 22001144

Risk

• The Committee reviewed the corporate risks which had been allocated to it, they o They noted that Risk 1139: Cancer Access Targets had been removed following the

reinstatement of the de minimis rule. o The Associate Director of HR updated on the risk of industrial action & it was agreed

to reduce the impact score of this risk o “Future fit” programme

• The Committee undertook a “deep dive” into the workforce age profile, noting the potential for retirements to spike in 2025.

Strategy

• The Committee reviewed the draft Sustainable Development Strategy. They commended the work to date but agreed that further work was required, to clarify the strategy and emphasise individual responsibility.

Governance

• The Committee received three Internal Audit reports, all of which gave significant assurance. o 2014-15 IM&T Risk Assessment. This report was discussed in some detail and the

Committee noted the risk areas (remote access, disaster recovery, password security and risk management) which had been highlighted and that action was being taken to mitigate them as a matter of priority

o 2014-15 Review of 18 Week Referral to Treatment Processes

o 2014-15: CIP Review

Review of Business cases

• The committee were updated on the new theatre project

• The Committee received a report which followed up on an earlier report into the PACs implementation to determine if the outstanding issues had been resolved by the PACs upgrade. They expressed concern that “voice recognition” still hadn’t been implemented across the department.

Regular Reports

The Committee received the following reports:

• The Health and Safety report

• The IM&T report, noting progress on the key projects. o Integrated Health Care Records Programme o Electronic Prescribing and Medicine Administration (EPMA) system o Digital Pre-Operative Assessment System

• Capital Update

• Human Resources report, which included an update on the implementation of Appraisal, Performance Related Pay and Probationary Period Policy and on the work of the Equality and Diversity group.

• The Work Plan was reviewed .Alastair Findlay

Non-Executive Director

Paper 10

U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Paper 10 QandS Chairmans Report - 16 October 2014.doc


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Executive Responsible Peter Jones, Non-Executive Director/Chairman of Quality and Safety Committee

Paper prepared by (if


Julia Palmer, Governance Manager


Development


�


Objectives


Executive Summary

The Quality and Safety Committee met on 16

th October

2014. A summary of the key issues discussed is given in the Chairman’s report.

Subject/Title Quality and Safety Committee Chairman’s Report




Legal Implications

Recommendation That the Trust Board note the Chairman’s report.

Acronyms and

Abbreviations CQUIN – Commissioning for Quality and Innovation PALS – Patient Advice & Liaision Service PROMS – Patient Reported Outcome Measures

Paper 10

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CCHHAAIIRRMMAANN’’SS RREEPPOORRTT FFRROOMM TTHHEE QQUUAALLIITTYY AANNDD SSAAFFEETTYY CCOOMMMMIITTTTEEEE

MMEEEETTIINNGG

1166TTHH

OOCCTTOOBBEERR 22001144 Patient Story

• A patient story was read from a patient who was on Sheldon Ward. The patient had an excellent experience.

Quality and Safety

• The Committee received the CQUIN report and noted that there was one element that remained at amber, as the improvement target was still being agreed.

• The Committee noted the Patient Experience report which showed a slight increase in complaints and PALS concerns, with the main reasons for patient raising complaints and concerns remaining the same, namely waiting times and dissatisfaction with the treatment.

• The Committee received the Safety Thermometer report and noted that there were no new harms in quarter two.

• The Committee received the Legal Claims update report and noted that the Trust will be participating in the Sign up to Safety campaign which aims to reduce the number of claims.

• The Committee approved the infection control report for quarter two.

• The Committee noted the Quality Governance Framework Update, which has been reviewed in line with the current review of Board Governance.

• The Committee received an update of progress against the Francis Report recommendations.

• The Committee received an update on Safer Staffing and noted that the Trust has not experienced any problems recruiting additional staff.

Risk and Assurance

• The Committee noted the risk register and agreed that a risk assessment was needed in relation to medical devices.

Clinical Effectiveness

• The Committee approved the Clinical Audit Report for quarter two.

• The Committee noted the Clinical Audit Annual Report for 2013/14

• The Committee noted the PROMS report; this currently only includes data for English patients, but will include Welsh patients in the future.

Routine Matters

• The Committee reviewed and approved the work plan for 2014/15 and noted that the workplan for 2015/16 would be brought to the next meeting.

Any Other Business

• There was no other business.

Peter Jones

Non-Executive Director / Chair of the Quality and Safety Committee

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U:\Trust Board & Committees\Public Trust Board\2014-2015\November 2014\Paper 11 2015-16 Board Committee Timetable.doc


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Executive Responsible Paper prepared by (if different

from above) Margaret Surrage, Head of Board Governance (Trust Secretary)


Development



Objectives


Executive Summary

The Draft Board Committee timetable for 2014/15 is attached.

Subject/Title 2015-16 Board Committee Timetable




Legal Implications

Recommendation That the Board approves the Committee Timetable

Paper 11



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CCOOMMMMIITTTTEEEE TTIIMMEETTAABBLLEE 22001144//1155

The three Board Committees meet on a quarterly basis. They normally meet in the month following the quarter end, ie April, July, October and January. This is to allow for timely reporting of the previous quarter’s performance and for the committees to review their sections of the corporate risk register in preparation for the Board consideration of the BAF. The timing of the committees within those months is influenced by a number of factors.

• The Q&S committee receives a number of quarterly reports and sufficient time most be allowed for their preparation (eg CQIN performance, medical claims, safety thermometer, Infection control). This will be particularly important in April, when full year reports will be due and Easter falls over the first weekend.

• There must be sufficient time for feedback on corporate risks to be reflected in the BAF

• Consideration of workload on members attending the meetings and staff preparing the papers, given that there will also be a board meeting in those months.

• Accommodation of NEDs commitments outside of the Trust where practical.

• Avoidance of Audit Reports being considered by the Audit Committee (in summary) prior to them going to the responsible committee (in full)

• For the April/May Committees the Audit Committee must be the final committee as it will receive reports from the other committees on their risk management for the year (now done through their annual reports) which feed into the annual risk assurance process.

The final timetable is inevitably a compromise, with not all of the factors noted above being able to be achieved. The timetable for the April /May committees is particularly constrained given that Easter weekend is 3

rd-6

th

of April and the Board is scheduled for April 23rd

. RREECCOOMMMMEENNDDAATTIIOONN

That The Board approves the Committee Timetable

Paper 11


BOARD BUSINESS PROGRAMME 2015/16


2015 2015 2015 2015 2015 2015 2015 2015 2015 2016 2016 2016

FORMAL TRUST BOARD (monthly) 23rd 27th 25th 30th - 24th 29th 26th - 28th 25th 24th

ANNUAL GENERAL MEETING (annual) 30th

Board Committees

Audit Committee - Regular (Friday) 5th 17th 16th 22nd

Audit Committee - Extraordinary ( final accounts) 26th

Quality & Safety - Regular (Thursday) 30th 16th 15th 21st

Quality & Safety - Extraordinary (quality accounts ) 26th

BRIC Tuesday 28th 7th 6th 12th

Nomination & Remuneration committee as & when required

part ne -- ppubblliicc mmeetin et ng...october 2014. paper 08 . business risk and investment...

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