quarterly quality report 2019 2020 quarter 3 · q1 2018/19 q2 2018/19 q3 2018/19 q4 2018/19 q1...

Quarterly Quality Report 2019 – 2020

Quarter 3

Innovative Caring Agile

Board 27th March 2020 Attachment K1

2

CONTENTS

Achievements and Challenges............................................................................................................... 3

Quality Dashboard ................................................................................................................................. 4

Quality Assurance

CQUINs/Quality Priorities ...................................................................................................................... 5

Risk Register ......................................................................................................................................... 6

Care Quality Commission ...................................................................................................................... 6

Quality Assurance Visits and staff engagement ..................................................................................... 6

Continuous Quality Improvement ........................................................................................................... 7

Patient Safety

Patient Safety Incidents ......................................................................................................................... 8

Serious Incidents and Local Investigations .......................................................................................... 12

Duty of Candour .................................................................................................................................. 13

Freedom To Speak Up......................................................................................................................... 13

Safer Care ........................................................................................................................................... 14

Learning from Deaths .......................................................................................................................... 19

Infection Prevention and Control .......................................................................................................... 19

Adult and Children Safeguarding ......................................................................................................... 20

Looked After Children and Care Leavers ............................................................................................. 21

Patient Experience

Patient Surveys ................................................................................................................................... 23

Patient Stories ..................................................................................................................................... 23

Friends and Family Test ...................................................................................................................... 24

Complaints and Compliments .............................................................................................................. 24

CCG/GP Hotline Enquiries ................................................................................................................... 26

Clinical Effectiveness

NICE Quality Standards and Guidance ................................................................................................ 27

Clinical Audit ........................................................................................................................................ 27

Medicines Management ....................................................................................................................... 27

Appendices

Appendix 1: External Quality Assurance Visits action plan ................................................................... 28

HCT Quality Report Q3 2019/20 / V3 / 090320 3

Achievements and Challenges

ACHIEVEMENTS The annual CQC Provider Information Request was completed and returned within required

timescales. Plans are now being developed to support the forthcoming CQC well-led and core service inspections expected during Q4.

The ‘Glimpses of Brilliance’ board provides an opportunity to recognise and celebrate individual and team achievements within HCT; Glimpses of Brilliance are shared via Noticeboard.

A mapping of Quality Wheels in use by services demonstrated that 71% of services are using the Quality Wheel to self-assess their team’s performance as part of the Continuous Quality Improvement Framework.

The number of patient safety incidents resulting in harm per 1000 patient contacts has reduced during Q3 when compared to Q1 and Q2.

The National Guardian’s Office Freedom To Speak Up Index rated HCT as the highest scoring trust in the STP based on staff survey results relating to speaking up and raising concerns.

The number of compliments received per 1000 patient contacts rose significantly in Q3, particularly in CYP services.

The Q3 Quality Report includes a summary position relating to clinical audits undertaken and actions in progress.

CHALLENGES The Q3 targets for two CQUINs and one Quality Priority have not been met. Actions are being

put in place to improve performance during Q4, although it is recognised that the target for CQUIN 2 relating to flu vaccination for 80% of frontline staff is not likely to be reached.

The overall Trust FFT score reduced in Q3; whilst there is no underlying trend to explain this, individual services scoring under 95% have been asked to review their feedback to identify any learning.

The number of complaints per 1000 patient contacts remained static in Q3 despite the transfer of a number of Adult services in the Herts Valleys area to another provider. There are no particular themes identified, and this will continue to be monitored in Q4.

The overall number of inpatient falls per 1000 Occupied Bed Days increased during Q3; however the number of inpatient falls resulting in harm per 1000 OBD reduced.

An internal peer review of QVM identified a number of areas requiring improvement. Feedback has been given to staff and a follow-up review will be undertaken during Q4.

The percentage of pressure ulcers acquired in HCT care rose during Q3. Analysis of data is underway to understand this trend, which could be due to an older age population in the east or a higher number of care home/social care use.


Quality Dashboard

Q1 2018/19 Q2 2018/19 Q3 2018/19 Q4 2018/19 Q1 2019/20 Q2 2019/20

Q3 2019/20

NB: A number of

Herts Valleys Adult

Services to

transferred another

provider on

01/10/2019

Number of patient safety incidents 1368 1233 1251 1343 1364 1035 765

Number of patient safety incidents resulting in harm 670 591 566 661 665 660 294

Number of Serious Incidents confirmed 2 2 2 3 7 2 3

Percentage of patients receiving harm-free care (national benchmark 95%) 97.96% 98.27% 97.74% 97.53% 97.38% 97.54% 97.51%

Number of pressure ulcers acquired in HCT care (as per Datix reporting, including mlutiple pressure

ulcers for the same patient)283 283 137

Number of pressure ulcers where lapses in care were found to be likely to have contributed to the pressure

ulcer39 43 18

Rate of inpatient falls per 1000 Occupied Bed Days 6.21 5.24 5.35 6.42 5.19 5.60 6.40

Rate of injurious inpatient falls per 1000 Occupied Bed Days 0.15 0.09 0.13 2.56 2.02 2.17 1.90

Number of HCT-attributed medication incidents resulting in harm 8 19 12 9 2 10 9

Percentage of moderate/severe harm incidents where appropriate actions were taken to meet duty of

candour requirements within expected timescales

Based on those incidents where the due date for the final letter occurs within the quarter

86% 83% 71%

Number of speaking up/raising concerns incidents 4 3 5 3 5 2 8

Number of deaths reported in quarter 12 8 8 16 21 14 1

Number of deaths judged more than likely to be due to problems in care (target 0) 0 0 0 0 0 0 0

Number of avoidable MRSA bloodstream infections (target 0) 0 0 0 1 0 0 0

Number of E.Coli bloodstream infections 0 0 0 0 1 0 1

Number of C.difficile cases attributable to HCT due to lapses in care identified (target <5 in year)

*Cases 1 to 5 successfully appealed as no lapses in care identified on RCA2 1 2 3 1* 7* 1

Safeguarding children training uptake percentage (Trust target 95%) 97% 87% 95% 94% 95% 97% 97%

Safeguarding Adult training uptake percentage (Trust target 95%)

*Compliance with Level 1 Safeguarding training was at 41% in Q4 2018/19 as all staff previously

requiring a ‘once only’ training session have been moved to 3-yearly refresher training programme to

ensure compliance with the new Safeguarding Adults Intercollegiate Document in 2019/20.

96% 96% 96% 69%* 93% 98% 96%

Percentage of inpatients treated with dignity and respect (Trust target 90%) 98% 100% 98.5% 99% 100% 99% 100%

Percentage of inpatients reporting overall quality of care good or better than good (Trust target 90%) 98% 98% 96% 99% 99% 98% 100%

Friends and Family Test score (Trust target 95%) 97% 94% 95% 96% 95% 95% 94%

Number of complaints 35 41 36 48 45 37 28

Percentage of complaints acknowledged responded to within agreed timescales (Trust target 80%) 83% 90% 92% 95% 87% 86% 98%

Number of PALS contacts 160 248 288 249 238 423 115

Number of enhanced contacts 42 31 41 55 48 47 36

Number of compliments 6326 4695 5280 4212 3501 5070 6763

Number of NICE guidance sets assessed 33 46 41 39 53 52 47

Number of NICE Quality Standards assessed 4 8 3 6 3 12 1

Number of NICE guidance sets applicable to HCT commissioned services 6 22 9 23 21 28 10

Number of NICE Quality Standards applicable to HCT commissioned services 3 3 2 4 1 8 1

Quality Dashboard 2019/20

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Reporting criteria changed 01/04/2019

Not previously reported


QUALITY ASSURANCE

CQUINs/Quality Priorities

CQUINs

Title of CQUIN Met / not met

Q1 Q2 Q3 Q4

CQUIN 2: Staff flu vaccines Met Met Met1

CQUIN 3: Alcohol and tobacco – screening and brief advice

Met Met Met

CQUIN 7: Three high impact actions to prevent hospital falls

Not met Partially met Partially met2

CQUIN 9: Six month reviews for stroke survivors

Met Met Met

Herts Valleys CYP services CQUIN – self management of child’s health condition

Met Met Met3

1 Whilst the Trust has met Q3 targets in completing its Flu Vaccination Action Plan, it is recognised that uptake of flu

vaccination by frontline staff is below trajectory. Actions are in place to improve uptake during Q4 although there is a risk that the Trust will not meet the 80% Q4 target. 2 Whilst the Q3 maximum target of 80% has not been reached, data demonstrates an improvement during Q3 to 77.72%

of inpatients having all three high impact actions documented. Work will continue towards achieving 80% in Q4. 3 Q3 targets for this CQUIN have been met. However, evaluation of the piloting of the PSFS as an outcome measure tool

has demonstrated that the PSFS is not appropriate to use for all patients within the CQUIN cohort. It is recommended that this workstream is carried forward into 2020/21, either as an extension of the CQUIN or as a Quality Priority, to ensure that appropriate outcome measurements for CYP services are in place, and that these align to the wider Trust strategy of ensuring consistent measuring of patient outcomes across its services.

Quality Priorities

Title of Quality Priority Met / partially met / not met

Q1 Q2 Q3 Q4

We will implement the guidance from NHS England to help staff recognise frailty and signpost patients and carers to relevant available help, and ensure actions are taken to support the patient’s needs. We will support our community to have active engagement in their health and wellbeing.

On trajectory Met Partially met1

We will aid recognition and management of a person whose health is deteriorating, including recognising and managing sepsis, in the inpatient and community setting.

On trajectory Met Met

We will ensure that carers, including staff, are recognised as carers. Carers will feel respected and heard as carers, and recognised as experts. This is year one of a two-year quality priority aligned with HCT’s Carers Strategy.

Baseline data confirmed

Met Met

1 Whilst Q3 targets relating to staff training, use of MyPlan and Cognitive Geriatric Assessment have been met, the Q3

target for the percentage of adult patients over the age of 65 having a Rockwood assessment at the first face-to-face assessment has not been met, although data shows a 49% improvement in the use of the Rockwood scale from Q1 to Q3. It is recognised that it is not always appropriate to undertake Rockwood assessment at first contact and that the assessment should take place at the most appropriate point in the clinical pathway.


Risk Register

Risks are routinely reviewed at Senior Management team meetings with key risks and their management brought to the attention of the Executive team following Business Unit Performance Reviews. Risk owners review and update their risks at least every month, and the High-Level Risk Register is reviewed by the Executive Group on a monthly basis. At the end of Q3 there are 11 risks on the High Level Risk Register; 8 operational risks and 3 corporate risks. Of the operational risks, 6 relate to Adult services and 2 relate to CYP services. Themes identified are risks relating to:

Workforce, including high nursing vacancy rates

Tendering for services

Insufficient capacity with services to meet increased demand

Robust assurance systems and processes

Contracts with GP practices

Data infrastructure issues

Care Quality Commission

Registration The current registration status is ‘good’. CQC Inspection

HCT received formal notification from the CQC in November 2019 of their intention to undertake the annual well-led inspection and inspection of core services within the next six months.

The Provider Information Request was received at the same time, and all required documentation was submitted within the timescale required.

A number of focus groups have been set up at the end of January 2020, providing HCT staff the opportunity to meet CQC inspectors and talk about their experiences of working in the Trust.

A programme of staff communication and engagement is in place, including the circulation of an updated CQC Booklet, to enable staff to prepare for the forthcoming inspection.

Quality Assurance Visits and staff engagement

Quality Assurance Visits External Quality Assurance Visits provide vital information about the quality of our services, identify any areas for improvement, and are an opportunity for external agencies to engage with our staff and patients. During Q3 1 external visit was undertaken:

Ofsted undertook a monitoring visit of the University of Hertfordshire’s Nursing Associate Programme, which included visits to Student Nurse Associates working within HCT services. Ofsted rated the University of Hertfordshire’s Nursing Associate Programme as having made “significant progress” (the highest grading) in all areas.

HCT was notified of a visit to its Prison Healthcare Service at HMP The Mount by NHS England’s Controlled Drug Accountable Officers Team on 9 January 2020; details of this visit will be included in the Q4 report. The completed Continuous Quality Improvement Plan for Danesbury, following the E&NCCG Quality Assurance Visit to Danesbury in Q1, is attached as Appendix 1. Glimpses of Brilliance HCT’s CEO implemented the ‘Glimpses of Brilliance’ Board during Q2 to provide an opportunity to recognise and celebrate individuals and services who provide outstanding care and support to patients, their families


and other staff members. Glimpses of Brilliance are shared each week via the staff Noticeboard. Glimpses of Brilliance have continued to be captured during Q3; some examples of these are below:

Outstanding care to a dying child and family by our Children’s Community Nursing team

Well done to the Analysis & Reporting team who, despite IT infrastructure issues, delivered required reports on time

Our first Staff Council has been launched

East & North Referral Hub – Winner of the HSJ Community/Primary Care Service Redesign award

Lots of positive feedback about Howard Court reception team

Formal review of a patient death at Herts & Essex Hospital showed that excellent care was provided to the patient and their family in the days before the patient’s death

Continuous Quality Improvement

Internal Peer Reviews:

During Q3, internal peer reviews were undertaken of all three community hospital sites and of Royston Integrated Community Team.

The scoring system for internal peer reviews was revised during Q3 to align with CQC ratings.

A summary of results can be seen below:

Internal Peer Review of Community Hospitals Q3 2019/20 Location HEH QVM Danesbury

% score % score % score

Safe 87 84 80

Effective 85 73 93

Caring / Responsive 96 67 84

Well-led 91 84 88

Overall score 90 77 86

Internal Peer Review of Integrated Community Teams Q3 2019/20 Location LLV North Herts Royston Stevenage SVV ULV WelHat

% score % score % score % score % score % score % score

Safe 98

Effective 100

Caring / Responsive 100

Well-led 96

Overall score 99

Key:

Outstanding - 95% or more

Good - 85-94%

Requires Improvement - 84% or less

A follow-up review is planned at QVM during Q4. Quality Wheels

The Quality Wheel is a self-assessment undertaken by services on a quarterly basis as part of HCT’s Continuous Quality Improvement Framework. The Quality Wheel has been refined during 2019 and was recently aligned with HCT’s CQC and ‘Good to Outstanding’ (G2O) work programme which will support the Trust working towards an Accreditation programme.

During Q3 a mapping exercise was undertaken to ascertain which services are using Quality Wheels. This found that, of the 52 Adult and CYP services which responded, 71% are using Quality Wheels, with a further 9% planning to implement their use during Q4.

HCT’s Assistant Director of Quality & Improvement, together with our Clinical Quality Leads, will continue to work with those services which have not as yet implemented the Quality Wheel.


CONSISTENT AND IMPROVING PATIENT SAFETY

A number of HCT Adult services within the Herts Valleys area, including five community hospitals, were transferred to other provider trusts on 1 October 2019; the reduction in services provided has resulted in a reduction in the number of incidents reported during Q3.

Patient Safety Incidents

Incidents

During Q3 there were 765 patient safety incidents reported, which represents 80% of all incidents reported.

471 incidents resulted in no harm (62% of patient safety incidents) and 294 incidents resulted in some level of harm (38% of patient safety incidents). These are broken down as follows:

Q1 Q2 Q3 Q4

Adult services

CYP services

Adult services

CYP services

Adult services

CYP services

No harm 699 474 171 311 160

Low harm 643 617 29 254 33

Moderate harm 16 9 2 6 0

Severe harm 5 3 0 1 0

Death 1 0 0 0 0

Total number of incidents resulting in harm

665 629 31 261 33

Total number of incidents reported

1364 1103 202 572 193

During Q3 a patient fell during transfer from wheelchair to bed using a hoist sling which was positioned incorrectly, resulting in a fractured right femur requiring surgery; the patient slid whilst staff were trying to reposition the hoist sling. This has been reported as a serious incident and will be investigated through the SI investigation process. A Statistical Process Control chart looking at data from April 2018 to date demonstrates that the number of incidents reported monthly remained within expected control limits until October 2019, when a number of Adult services in the Herts Valleys area transferred to another provider:


The total number of patient safety incidents and number of patient safety incidents resulting in harm per 1000 patient contacts (which is recognised as being a more sensitive tool when benchmarking rates) is shown below: Themes and trends of all incidents The 10 most-reported types of all incidents reported during Q3 are illustrated below for both Adult and CYP services: Review of Violence, Abuse and Aggression incidents towards patients There were 31 incidents of abuse towards patients in Q3 broken down as follows: Q1 Q2 Q3 Q4

Abuse towards patient by other person

(usually spouse or family member and escalated to safeguarding)

36 38 25

Abuse towards patient by patient 7 13 3

Abuse towards patient by staff 4 4 3

Total 47 55 31

3.42

1.66

3.42

1.73

2.5

0.96

Number of patient safety incidents per1000 patient contacts

Number of patient safety incidentsresulting in harm per 1000 patient

contacts

Patient safety incidents per 1000 patient contacts

Q1

Q2

Q3


There were no incidents of violence, abuse or aggression towards patients where moderate harm was caused, or where duty of candour was required to be applied.

One incident alleged financial abuse where a patient was excessively charged following a home visit from a Consultant that had been arranged by GP. This was reviewed by HCC Safeguarding Team and closed as not eligible for an S24 enquiry.

One incident alleged inappropriate behaviour by a carer. The Care Agency have removed the carer and have been requested to investigate and complete a risk management plan.

One incident alleged inappropriate behaviour by a member of staff at Herts & Essex Community Inpatient Unit. The incident is currently under investigation and the report will be reviewed by HCT Safeguarding Adults Team when complete.

Medication incidents During Q3 there were 65 medication-related incidents reported, 43 of which were attributable to HCT; 3 of these related to CYP services. A breakdown of resulting level of harm is detailed below: Insulin Incidents A breakdown of insulin-related medication incidents is seen below:

2017/18 2018/19 2019/20

Total Total Q1 Q2 Q3 Q4

Omitted dose due to missed visit

44 60 13 21 6

Incorrect dose/frequency 36 18 9 10 3

Lack of HCT prescription template

3 0 0 0 0

No supply at home 3 3 0 0 0

Misc. insulin incidents 45 20 1 9 2

Wrong quantity 2 7 0 0 0

Wrong patient 0 3 1 0 0

Total 133 111 24 40 11

Omitted insulin doses – missed visits

Omitted insulin doses as a result of missed visits have been caused by a number of reasons including incorrect use of SystmOne, staff not accessing an up-to-date task list for the day or failure of teams to allocate patients onto SystmOne.

Where it is identified that there is a possibility that a team is not utilising SystmOne correctly the SystmOne team has been requested to provide further training.

Work is also being undertaken on SystmOne to support the allocation of referrals.

45

2 0 0

68

9 1 0

34

9 0 0

Total number ofmedication incidentsresulting in no harm

Total number ofmedication incidentsresulting in low harm

Total number ofmedication incidentsresulting in moderate

harm

Total number ofmedication incidents

resulting in severe harm

HCT-attributable medication incidents - level of harm

Q1

Q2

Q3


Recommended actions for insulin incidents: It is encouraging to note the reduction in the number of incidents due to missed visits. However, insulin is frequently included in the list of top ten high alert medicines. It is a high risk medication in that it has the potential to cause significant harm even when used as intended. As a Trust we are taking the following actions:

We are providing monthly feedback to Clinical Quality Leads regarding incidents so that targeted teaching can be undertaken.

We have recently relaunched the Medication Review Group, attended by the Assistant Director of Quality and Improvement and Locality Managers. A review is carried out of all high risks areas and learning is identified for Locality Managers to share with their teams.

In 2020 further support is being offered to all nurses on prescribing, medicines management and CPD sessions.

Central Alert System During Q3 a total of 53 CAS alerts were received within HCT:

21 of these were not applicable to HCT

13 were applicable to HCT

18 were cascaded for information only

1 is currently being triaged

Q1 Q2 Q3 Q4

Total number of CAS alerts applicable to HCT

5 7 13

Number of CAS alerts disseminated, actions completed and alert closed

3 5 7

Number disseminated, actions on going and alert remains open

2 2 6

The CAS alerts applicable to HCT can be broken down as below:

5

4

2

1 1

Supply andDistribution

MHRA DrugAlert

Medical Devices Patient SafetyAlert

Estates andFacilities

CAS alerts breakdown


Serious Incidents and Local Investigations

Serious incidents During Q3 there were 3 serious incidents reported, all of which related to Adult services.

SIs are detailed by category below: Incident type Q1 Q2 Q3 Q4

Sub-optimal care 3 0 1

Fall 4 0 1

Infection prevention control 0 1 0

Death in custody 0 1 0

Screening incident 0 0 1

Total 7 2 3

A screening incident meeting serious incident criteria was reported after a member of the screening team was found to have given inappropriate advice to 2 patients. In line with Public Health England’s guidance ‘Managing safety incidents in NHS screening programmes’, a serious incident was reported.

To date there is no evidence of any harm having occurred to patients or of further incidents having occurred within the Diabetic Eye Screening Programme.

A patient slid from a hoist sling resulting in a fractured femur requiring surgery. Initial investigation shows that the hoist sling had not been placed correctly and staff were attempting to rectify this following appropriate procedures, unfortunately the patient slid whilst trying to rectify this.

A safeguarding concern was raised regarding the care of a community patient admitted to an acute hospital with suspected sepsis secondary to infected leg ulcers. The patient died 6 days later. The cause of death was recorded as 1a. Sepsis due to, 1b Infected leg ulcers.

On completion, each serious incident report will be reviewed at the Serious Incident Assurance Panel to provide assurance of evidence of actions taken to address concerns identified and that changes have been embedded in practice. Themes and learning from SIs

12 serious incidents have been reported in 2019/20. Of these 8 have been submitted to the commissioners and 4 remain under investigation. One serious incident report was submitted to the commissioners in Q3.

2 serious incidents have been reported at Danesbury Neurological unit in 2019/20; however no other patterns relating to the services or teams involved have been identified.

There have been 5 falls reported as serious incidents in 2019/20 (4 in Q1: the reasons for this were considered in Q1); however no further patterns have been identified in relation to serious incident type.

Teams, numbers and types of serious incident continue to be monitored and any areas of concern will be considered further.

The serious incident investigation report completed in Q3 identified no areas of poor care relating to the incident; however incidental learning was identified relating to enhanced documentation when using Patient Group Directives for provision of over the counter medication in HMP The Mount.

Actions are underway to address lessons learned from completed serious incident investigations.

Locally investigated incidents Some patient safety incidents are investigated using the local investigation process or local review: this includes incidents that do not meet the serious incident criteria but have resulted in significant harm or where some gaps in expected care delivery have been highlighted, so that learning can be identified and actions undertaken to address any concerns highlighted. A local investigation follows a full and formal investigation process. During Q3 there were no locally investigated incidents reported. Locally investigated incidents are detailed by category below:


Incident type Q1 Q2 Q3 Q4

Staff safety 1 0 0

Total 1 0 0

Where the level of harm may be lower or where additional information is required to ascertain whether a local or serious incident investigation may be required a case review may be undertaken. A case review involves a review of the clinical records to identify assurance/gaps and learning or next steps. Four case reviews have been commenced for incidents reported in Q3:

1 related to the care of a patient with a PEG feeding tube to identify if there were any gaps in the care delivered

1 related to a missed visit to understand if the missed visit contributed to admission to an acute hospital

1 related to concerns raised by the East of England Ambulance Service to understand the circumstances around the concern raised and whether care delivered by HCT caused any harm

1 related to the care of a patient with a category 4 pressure ulcer to understand if there were any gaps in the expected preventative care provided by HCT.

Themes and learning from locally investigated incidents No themes or trends have been identified to date as only one local investigation has been completed during 2019/20.

Duty of Candour

Q1 Q2 Q3 Q4

Percentage of moderate / severe harm incidents where appropriate actions were taken to meet duty of candour requirements, within expected timescales*

86% 83% 71%**

*CQC regulation 20, duty of candour, details actions but not timescales. Local timescales are in place to ensure timely communication with patient/family and are 1) verbal apology/written notification within 10 days of identification of incident; 2) investigation findings shared within 38 days of identification of incident. **Based on those incidents where the due date for the final letter occurs within the quarter

1 incident breached the expected timescales for sending an initial acknowledgment letter: The letter was sent 1 day late as the patient was in hospital and the staff wanted to deliver the letter in person. A verbal acknowledgement and apology had been given within the time frames and the letter also included an apology and outlined the next steps of the investigation.

1 incident breached the expected timescale for sharing the outcome of the investigation by 1 day due to a delay in senior management approval of the letter. The letter included a summary of the findings of the investigation and actions taken in response to the learning identified.

4 incidents remain open: 3 have been reported as a serious incident and one is being managed as a complaint so are therefore following timelines for these investigations.

Freedom To Speak Up

2018/19* Q1 Q2 Q3 Q4

Number of concerns raised 4 3 5 3

2019/20 Q1 Q2 Q3 Q4

Number of concerns raised 5 2 8

*2018/19 data is included above to provide comparison

In line with expectations of the National Guardian’s Office, a separate report is prepared half yearly and presented to the Trust board by the Freedom to Speak up Guardian.


During Q3 five contacts included suggestions being received for improving the working lives of staff, a matter concerning another provider and providing guidance to support a member of staff progress an individual area of concern.

The Director of Nursing and Quality offered to meet one person individually to more fully understand the points being raised.

Two concerns raised during Q3 were linked to areas recognised by the trust as being of concern and where reviews were underway and actions already being undertaken.

During Q3 the National Guardian’s Office published its first ‘Freedom to Speak Up Index report’ using information from the 2015 and 2018 National Staff Surveys to calculate an individual score, and rank, each trust. HCT is rated as the 11th highest scoring trust out of 220 trusts, as the joint 5th highest scoring community trust and as the top scoring trust in the Herts & West Essex STP. The results are extremely positive and provide helpful insight into how staff perceive HCT’s speaking up culture.

Safer Care

Safety Thermometer data During Q3 the average harm free care rate was 97.51%, benchmarked against the national benchmark of 95%.

A Statistical Process Control chart looking at data from April 2017 to date demonstrates that HCT’s harm free care rate has remained within expected control limits:

97.38 97.54 97.51

90

92

94

96

98

100

Safety Thermometer - harm free care (%)

Q1

Q2

Q3

National benchmark: 95%


The average rates of ‘harms’ for Q3 are shown below: Falls in community inpatient units Falls with moderate or severe harm: Severe harm- a patient sustained a fractured femur as a result of slipping out of her chair while being hoisted in Danesbury Neurological unit. This fall is currently being investigated as a serious incident. A Statistical Process Control chart looking at data from January 2017 to date demonstrates that the number of inpatient falls reported monthly has remained within expected control limits:

0.91

0.53 0.6

0.03

0.81

0.53

0.36

0.03

1.18

0.94

0.37

0

New pressure ulcers Falls with harm New catheter-associatedUTIs

New VTEs

Safety Thermometer - average 'new' harms (%)

Q1

Q2

Q3

82

32

2 3

91

35

1 2

39

12

0 1

Total number of falls incommunity inpatient units

(including assistedlowerings)

Total number of injuriousfalls in community inpatient

units

Number of falls categorisedas resulting in moderate

harm

Number of falls categorisedas resulting in severe harm

Falls in community inpatient units

Q1

Q2

Q3


It should be noted that the transfer of five HCT community inpatient units to a different provider from 1 October 2019 has resulted in a reduction in the number of falls reported. Levels of harm resulting from inpatient falls has also been monitored since September 2017: The number of inpatient falls per 1000 Occupied Bed Days (OBD), which is recognised as being a more sensitive tool when benchmarking falls rates, also continues to be monitored. Data recorded over the last two years demonstrates a marginally upward trend in the number of falls per 1000 OBD:

5.1

2.02

5.6

2.17

6.4

1.9

Number of inpatient falls per 1000Occupied Bed Days

Number of injurious falls per 1000Occupied Bed Days

Number of inpatient falls per 1000 Occupied Bed Days (OBD)

Q1

Q2

Q3


Achievements

Following the transition of services to CLCH we have reviewed our Falls Working Group and are relaunching the group in January 2020.

Compliance with the Falls policy continues to be monitored through daily spot checks, review of compliance reports by Ward Managers and falls discussed as part of the daily sweep.

Areas requiring improvement identified / actions taken

The system of chair and bed sensors is currently under review to ensure that they meet the needs of our inpatient units.

Compliance with completion of the two-hour assessment remains an issue, mainly due to nurses not accurately recording the time of completion of the assessment when entering their notes later during the shift. Nurses have been reminded of the importance of the assessment and accurate recording, and Ward Managers are ensuring that agency nurses are aware of and comply with the Falls policy.

Pressure ulcers

Q1 Q2 Q3 Q4

Number of patients with a pressure ulcer (as per S1 caseload report run on date indicated)

545 516 291

Number of pressure ulcers acquired in HCT care1 283 283 137

Number of category 2 pressure ulcers 108 117 53

Number of category 3, 4, unstageable and deep tissue injury pressure ulcers

175 166 84

Number of device-related pressure ulcers 9 5 3

Number pressure ulcers where lapses in care were found via investigation to be likely to have contributed to the pressure ulcer

39 43 18

1 As per Datix reporting, including multiple pressure ulcers for the same patient (therefore the number is higher than the number of Datix incident reports)

Q3 numbers are lower following the transfer of some of Herts Valleys Adult Services to another provider. Charts included are from October to allow for ENHCCG only data to be considered.

55% of pressure ulcer incidents were HCT acquired in Q3 as opposed to 46% prior to the transfer of the Herts Valleys services. Analysis of data is underway to understand this trend, which could be due to an older age population in the east or a higher number of care home/social care use.

During Q3 the Tissue Viability team has been able to recommence reviews of incident reports (a month in arrears) to identify lapses in expected care to support learning.

Common themes for lapses in care that have directly contributed to the pressure ulcer cause remain as previous quarters and are:

Delays in assessments (core, PURPOSE T, MUST, wound)

Delay in first visit when PU or risk of identified on referral

Heel protection not provided in timely fashion

Lack of clinical enquiry into cause of damage when occurs

Poor communication or leadership with carers when they are involved (80% of patients)


HCT acquired pressure ulcers – April 2017 to December 2019 (HVCCG included pre-October 2019)

Achievements

Development of work a plan to prioritise the key areas of focus to improve pressure ulcer prevention

A smaller clinical group is meeting regularly to focus on key actions needed to drive improvement. These centre around improving assessments, carer engagement and developing clinical curiosity.

Two facilitated ‘Will Training Help?’ workshops are planned for February and March to help understand the reasons why key actions to prevent pressure ulcers are not undertaken. These are being delivered by NHS Improvement’s PU Clinical Lead and follow their deep dive into over 4000 pressure ulcer Datix incidents.

React to Red training delivered two more ‘train the trainer’ sessions in November. In total 128 carers have attended these sessions with a further 49 attending ‘train the trainer’ sessions.

In partnership with, and being led by, the CCG and Herts County Council, a group will be set up to review how carer skills can be best enhanced to meet the need for pressure ulcer prevention within the system.

89% of pressure ulcer incidents have been investigated by the local team.

A joint working group with Herts Equipment Service and Central London Community Healthcare has been convened to support staff to make decisions about equipment appropriately and to develop a business case for funding for repositioning devices.

Areas requiring improvement and identified / actions taken

Key assessments being undertaken in a timely fashion – the change in the national guidelines removing the 72 hour rule has led to an increase in the number of pressure ulcers being determined as acquired in HCT care because pressure ulcer related assessments were not undertaken at the first visit. Identifying risk at point of triage and setting initial care plans and allocating the first visit in a timely fashion should help to reduce this.

Improvement with carer knowledge and engagement with pressure ulcer prevention is still required. There are challenges around providing the care agreement template for home carers due to inconsistency of carer staff and unsecure electronic mail addresses.

Staff do not appear from their documentation to enquire why a PU might have developed so they can better understand how to target prevention strategies. This behaviour will be explored further within the ‘Will Training Help?’ workshops.


Learning from Deaths

1 patient death was reported in Q3 meeting the criteria for undertaking case record review.

Q1 Q2 Q3 Q4

Number of inpatient deaths reported in quarter 16 12 0

Number of community deaths reported in quarter 5 2 1

Number of case record reviews undertaken in quarter 11 22 8

Number of deaths judged more likely to be due to problems in care

0 0 0

NB: Information in the above table reflects the reporting requirements within the annual Quality Account, that is, the number of deaths occurring each month/quarter is reported separately to the number of case reviews that are undertaken each month/quarter; this is in recognition that not all case note reviews are completed within the same quarter that the patient died.

As anticipated, the transfer of some HCT Adult services in the Herts Valleys area, including five community hospitals, has significantly reduced the number of deaths requiring review which is evidenced in the Q3 data above.

As required, more detailed information is published through a report to the public Board meeting each quarter.

Infection Prevention and Control

Healthcare Associated Infections (HCAI) Outbreaks of HCAI During Q3 there was 1 outbreak of HCAI reported; this is the ongoing iGAS outbreak in the community setting previously reported in Q2. 10 cases of iGAS with emm type 89 mostly in the Hatfield and Welwyn areas. The latest lab report is from June 2019 and cases are mainly elderly patients except one who is a 10 year old male. Achievements The iGAS cases are still at the investigation stage, however fast action was taken regarding the identified cases by PHE, community teams and Infection Prevention and Control. Areas requiring improvement identified / actions taken

High/low dusting issues identified

Hot Desking policy not in place

Minimal feedback on hand hygiene audits identified in certain clinical areas

1

0

1

7

0 0

1

0

1

Clostridium difficileinfections (CDI)

MRSA blood streaminfections (BSI)

E.coli blood streaminfections

Healthcare Associated Infections

Q1

Q2

Q3


Multi-use gel bottles being used for procedures

Adult and Children Safeguarding

Safeguarding Adults Achievements

There has been good joint working with new Herts Valley Provider Central London Community Healthcare Trust.

Six HCT front line staff attended the HSAB Self Neglect Forum in November.

HCT’s Named Nurse for Safeguarding Adults attended the Hertfordshire Annual Domestic Abuse Conference.

The new Health Education England MCA training modules have been launched.

Training compliance figures remain consistently high. Areas requiring improvement identified / actions taken

Following the TUPE of staff to CLCH, team capacity has been reduced to one clinician; this has been recorded on the risk register.

The Level 3 Safeguarding Champions cohort decreased following staff TUPE to CLCH. A review of the Level 3 cohort is underway with a proposal to increase these numbers.

Safeguarding Children Training and supervision

95% 95%

97%

95%

97%

98%

90%

95%

100%

Percentage of staff who are compliant with SGC trainingPercentage of staff who are compliant with SGC supervision

Safeguarding Children training and supervision

Q1

Q2

Q3

Trust target: 95%

93%

99% 99%

98% 99%

98%

96%

99%

96%

90%

95%

100%

Percentage of staff who arecompliant with safeguarding

adults training

Percentage of staff who arecompliant with MCA training

Percentage of staff who arecompliant with DoLS training

Safeguarding Adult training

Q1

Q2

Q3

Trust target: 95%


Achievements

A Safeguarding Children Nurse Manager has successfully been promoted and joins East & North Herts CCG as deputy Designated Nurse for Safeguarding Children.

The Safeguarding Children team has had a significantly higher number of rapid responses to a child’s deaths in this quarter and has managed to incorporate the additional work into the team’s diaries with limited impact on existing workloads.

The first HCT Fabricated Induced Illness (FII) training was delivered on 8/11/2019 by the Named Doctor and Safeguarding Children team. The evaluations were extremely positive and a further four training sessions have been arranged.

The Safeguarding Children team continues to work very closely with the Public Health Nurses during a period of transformation, providing specialist input to innovations and initiatives to improve outcomes for the service and children.

The Safeguarding Children team are supporting the Family Support Centres, in providing expertise and delivering domestic abuse and legal training to their teams.

Areas requiring improvement / actions taken

The Safeguarding Children team continues to progress through a comprehensive programme of competency development due to the high number of new staff in the team. This is a two-year programme.

The team also continues to upskill Public Health Nurses with report-writing competence. This will enable Public Health Nurses to finalise their own child protection reports and provide support to less experienced colleagues

There have been issues with the MASH email account inbox which the IT team is working to resolve. This has been declared a risk on the risk register and strategies have been put in place by the MASH nursing team to mitigate the risk.

Looked After Children and Care Leavers

Achievements

100% of out of county Review Health Assessments (RHAs) have been completed within timescale by Specialist Looked after Children (LAC) Nurses.

97.5% of RHAs in county have been completed within timescale by Specialist LAC Nurses.

96% of Initial Health Assessments (IHAs) completed within timescales by the HCT LAC GPs.

94% of RHAs completed by Public Health Nurses (PHNs) within timescales.

A teaching webinar for PHNs on how to complete an RHA on SystmOne has been produced.

Areas requiring improvement identified / actions taken

SMS feedback has been received from young people following their RHA. The team are looking at

92%

90%

83%

92%

86%

95%

80%

85%

90%

95%

100%

Percentage of all LAC Initial Health Assessmentsreferred to HCT staff completed within agreed

timescales

Percentage of all Review Health Assessments oflooked after children referred to HCT staff

completed with time scales

LAC completed Health Assessments Q1

Q2

Q3

Trust target: 90%


new ways of hearing the voice of the young people and working with the Head of Patient and Carer Experience to improve patient experience.

The return of out of county health assessments within timescales remains a challenge and the LAC team works closely with the Deputy Designated Nurse and escalates issues accordingly.


AN OUTSTANDING PATIENT EXPERIENCE

Patient Surveys

The information below summarises Q3 community hospital inpatient survey results. The following comments are taken from inpatient surveys and FFT cards: Areas of good practice

Service Areas of good practice

QVM It’s safe, good care, friendly and helpful staff, clean rooms, toilets, showers, beds etc. Helpful physio staff. Good food.

Danesbury Neurological Unit

I was consulted re discharge

Herts and Essex Hospital I was very satisfied with the service given by all

Areas requiring improvement

Service Areas requiring improvement

Danesbury Neurological Unit

Problems with transport did not turn up yesterday

Herts and Essex Hospital The food was obviously cooked elsewhere; it doesn't look like the description. The food was cold; it should come round on a heated trolley like other hospitals.

Patient Stories

There were no patient stories shared at Board during Q3.

100%

99% 99%

98%

100.0% 100%

Percentage of patients who told us they were treated withdignity and respect

Percentage of patients who told us that the overall quality ofcare was good or better than good

Community inpatient unit survey results

Q1

Q2

Q3


Friends and Family Test

NB: FFT scores were not reported separately for Adult and CYP Services in Q1. Overall FFT Trust performance for the quarter was below the 95% performance benchmark. Whilst there is no underlying trend to explain this under performance, individual services scoring under 95% have been asked to review their feedback to identify any learning where free text comment has been provided. An FFT performance report for Q3 will be shared at the ‘Good to Outstanding’ meeting each month to raise visibility and to identify how to better use FFT feedback to make improvements.

Complaints and Compliments

Complaints

Q1 Q2 Q3 Q4

Adult

Services CYP

Services Adult

Services CYP

Services Adult

Services CYP

Services

Number of complaints received

45 28 9 23 5

Number of complaints per 1000 patient contacts

0.11 0.09 0.09

Percentage of complaints acknowledged within agreed timescales

100% 100% 100% 100%

Percentage of complaints acknowledged responded to within agreed timescales

87% 86% 97% 100%

Number of complaints received graded as category 3 (Adult services only)

3 2 1

Number of complaints referred to the Parliamentary and Health Service Ombudsman (Adult services only)

1 0 0

Number of local resolution meetings held (Adult services only)

1 0 0

95% 95%

94%

96%

94%

97%

93%

90%

95%

100%

Overall Trust FFT score FFT score Adult services FFT score CYP services

FFT Score - percentage of patients who would recommend Trust services to friends and family if they needed similar care or treatment

Q1

Q2

Q3

Trust target: 95%


Trends and themes identified

97% of complaints were responded to within the agreed time frame which is an improvement on quarter two performance of 86%.

61% of all complaints received in Q3 were attributable to East & North Adult Services. Q4 reporting will help to identify if this is indicative of changes in service provision for Adult Services in Herts Valleys.

The top two issues raised were:

Standards of Care (25% of all complaints received)

Clinical treatment (21% of all complaints received) Examples of organisational learning and improvement from complaints

Theme Commentary Outcomes/Learning

Communication A complaint was raised regarding eligibility criteria for a community nursing team

All future decisions regarding eligibility reviewed by a senior member of the team before a conversation is held with the patients and their families.

Date for appointment

A mother raised a complaint regarding the time that had elapsed between her child’s appointments resulting in no diagnosis.

An appointment was subsequently arranged and booking ahead times reduced to 6 weeks to allow speedier follow up where required.

Compliments

Q1 Q2 Q3 Q4

Adult

Services CYP

Services Adult

Services CYP

Services Adult

Services CYP

Services

Number of compliments received

3501 3223 1847 1356 5407

Number of compliments per 1000 patient contacts

8.82 12.68 22.15

PALS contacts

Q1 Q2 Q3 Q4

Adult

Services CYP

Services Adult

Services CYP

Services Adult

Services CYP

Services

Number of PALS contacts received

238 423 76 39

Number of enhanced PALS contacts received

48 22 15 22 14

Number of PALS contacts received that were HCT-related

133 247 37 75 38

Number of MP enquiries received

2 0 0 0

Enhanced PALS contacts An enhanced PALS enquiry is one that cannot be answered immediately and requires further investigation or action by the Trust service/s concerned and the PALS team. A total of 36 enhanced PALS contacts were recorded within Q3. The top three themes of enhanced PALS contacts for Q3 are:

Communication (oral and written)



Standards of care

Examples of organisational learning and improvement from enhanced PALS

Theme Commentary Outcomes/Learning


Concerns raised about arrangements for wound care management.

The Locality Manager visited the patient to provide assurance that the Community Nursing Team will prioritise tasks and cancel visits where indicated. The locality administration team will also ensure that messages left with the referral hub about cancelled visits are acknowledged immediately and clinicians are informed of the same.


An Enhanced PALS contact was recorded following concerns raised by a parent regarding his daughter's wait for an Autistic Spectrum Disorder assessment with the Community Paediatrics Service

An apology was provided for the wait experienced which is being addressed by additional resources within the service.

CCG/GP Hotline Enquiries

Q1 Q2 Q3 Q4

Proportion of urgent ENHCCG hotline enquiries responded to within 5 working days

No urgent enquiries received

100% 100%

Proportion of routine ENHCCG hotline enquiries responded to within 20 working days

96.2% 93.75% 88.23%*

The above figures relate to ENHCCG hotline enquiries only as specified in the Quality Schedule 2019/20.

*2 out of 17 routine queries were not responded to within the expected timeframe


EXCELLENT CLINICAL EFFECTIVENESS

NICE Quality Standards and Guidance The NICE Working Group (NWG) reviews NICE guidance (NG) and quality standards (QS) released at the end of each month by the NICE. Where the guidance is found to be applicable to HCT commissioned services, action plans are reviewed at the NWG and an update is provided to the Clinical Effectiveness Group (CEG) meeting to provide assurance of clinical compliance of meeting evidenced-based practice standards.

Month Assessed Total NICE assessed

Applicable Total NICE applicable

Q3 NG QS NG QS

October 15 0 15 4 0 4

November 19 0 19 6 0 6

December 13 1 14 0 1 1

Total 47 1 48 10 1 11

Clinical Audit A fully updated report around clinical audit activity is presented to Clinical Governance Subcommittee to provide assurance around participation in, and actions undertaken following recommendations made as a result of, clinical audit. The Q3 summary position is detailed below:

National Audits 11 15% of Trust audit participation

Service Led Audits 61 85% of Trust audit participation

Completed audits with actions implemented 9 13%

Completed audits with actions ongoing 21 29%

Ongoing audits 20 28%

Delayed Audits 5 7%

No data/awaiting data on audit 6 8%

Abandoned/withdrawn/no data collection 11 15%

Total Audits 72 100%

Medicines Management Antibiotic prescribing audit - community inpatient units Point prevalence audit was undertaken in October 2019:

6 patients were prescribed oral/IV antibiotics/antifungals/antivirals.

In 4 of the patients prescribed antibiotics/antifungals/antivirals, the prescription was initiated by HCT doctors.

All 4 patients (100%) patients were prescribed antibiotics/antifungal/antiviral in line with pan-Herts or primary care guidance or HCT guidelines.

All 4 records had comprehensive information relating to the prescribing recorded.


Appendix 1: External Quality Assurance Visits action plan

HCT Continuous Quality Improvement Plan

Service: Danesbury Unit Date Reviewed: 20th September 2019/ 09.01.20

Action from:

Issue/Gap/Action Required Assigned Person

Date by:

Progress to Date/ Evidence of change KPI Sustained consistently

for 3/12 RAG

1. E&NH CCG 25/4/19

Staff to understand the process for medication charts when admitted in the evening whilst HCT medication chart not completed.

Ward Manager

16.6.19

29.5.19 all trained staff emailed. Discuss at ward meeting on 14.6.19 and include in minutes 20.09.19 No further incidents

09.01.20 no further incidents

2. E&NH CCG 25/4/19

Bathroom to be free of supplies and storage.

Inpatient Clinical Lead

30.6.19

29.5.19 waiting for estates to put shelving in cupboard to move supplies and put bathroom back in use 25.09.19 quote for shelving unit agreed work to commence week beginning 30.09.19. Stores can then be moved and bathroom will be back in use 09.01.20 shelving in new cupboard completed in December and stores removed from bathroom

09.01.20 bathroom back in use

3. E&NH CCG 25/4/19

Ensure notice boards data is up to date for example, SSNAP data

Ward Manager

29.5.19

29.5.19 Old data removed, current data in place

09.01.20 current data in place

4. E&NH CCG 25/4/19

Ensure intention rounding/comfort rounding consistently undertaken and documented Ensure stool charts completed daily

Ward Manager

30.6.19

29.5.19 Re-promote Daily ‘End of Bed Folder’ checks by RNs – to take place every afternoon 20.09.19 Daily ‘end of bed folder’ checks continue to take place. Frequency reduced over last 10 days - another push taking place 09.01.20 End of bed folder checks

09.01.20 spot


completed

checks on end of bed folders continue

5. E&NH CCG 25/4/19

Ensure staff aware of FFT

Ward Manager

29.5.19

29.5.19 FFT data made clearer on notice board

09.01.20 FFT data remains clear

6. E&NH CCG 25/4/19

O2 cylinders to be stored in appropriate brackets/storage rack

Ward Manager

30.6.19

29.5.19 Email sent to confirm with Eric Beach and Gerry Phee how oxygen on ward should be stored as we thought we were compliant 20.09.19 – bag holders for oxygen cylinders arrived and hooks on walls put in place by interserve

09.01.20 oxygen remains in bags, on hooks, in appropriately labelled room

Key:

New Action Action expected to be on target

Action not expected to hit target

Action has missed target

Action Completed Action Deferred / Cancelled

SRC FINANCE REPORT MONTH 11

FINANCE REPORT TO THE TRUST BOARD

Title: Month 11 Finance Report (February 2020)

Sponsoring Director: Director of Finance

Author(s): Finance Department

Purpose: The purpose of the report is to provide the Trust Board with HCT’s financial position as at Month 11 – 2019/20.

Action required by the Board:

The Board is asked to note the Trust’s financial position as at 29th February 2020.

Finance Strategy & Resources Report February 2020 (Month 11)

Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary

Contents

1. Director of Finance, Systems and Estates Key Messages

2. Clinical Income

3. Pay Expenditure

4. Non Pay Expenditure

5. Productivity Improvement and Efficiency Scheme (PIES)

6. Risk to achievement of Control Total

7. Financial Recovery

8. Statement of Financial Position

9. Cash Flow Statement

10. Capital Expenditure

11. Aged Receivables

12. Better Payments Practice Code (BPPC) Performance

13. Single Oversight Framework (SOF)

14. Glossary

1. Director of Finance, Systems and Estates Key Messages



The Trust performance against the control total is £196K behind plan year to date. Whilst this is an improvement in the Trust position of £350K behind plan in Month 10, thereis still an imperative to come back to balance by year end. The Trust's single oversight risk rating is still at 2, but the Trust is forecasting to achieve balance in the final monthin order to meet the control total of £1,213K as per the 19/20 Operating Plan submission. While the Trust's run rate has improved marginally since the board approved thefinancial recovery plan in November 2019, a number of additional cost pressures have arisen as part of the wider health economy which has impacted on the Trust's positionin month. Continued action in the final month will be required to bring the Trust back to plan and achieve the Control Total.

An accounting adjustment was made in Q3 relating to the transfer of buildings resulting from the HVCCG Adults contract loss. On discussions with regulators around theaccounting treatment of the transfer of these assets, the Trust has been required to present the loss on the assets of £22,631k within its Statement of ComprehensiveIncome and Expenditure (SOCIE) Statement as no funding was received from the NHS bodies the assets transferred to. Although this is reported in the trust position, thisnotional loss is not considered when assessing the Trust's performance against its agreed control total for 19/20 (please see narrative at Statement of Financial position,Table 13).

Year to date the Trust had a favourable position relating to

Revenue from Patient Care Activities of £4,003K ahead of

plan.

The overall Trust income position year to date at month 11 is £5,417K favourable. Patient Care income mainly consists of block income, and includes forecast pressures forCQUIN under achievement, increased winter pressures money and the variance to plan as a result of the changes to the Cambridge and Peterborough contract from block tocost per case, resulting in a positive variance of £1,772K year to date. The remaining revenue is higher than the annual plan due to invoicing of the HVCCG transition costs(£343K), and a portion of the Business Transfer Agreement (BTA) with Central London Community Health (CLCH). The BTA has now been signed with CLCH and the full fundsfrom the agreement will be recognised in the M12 position. Apart from the BTA funds, the additional income year to date is matched with additional expenditure incurred indelivering service activity. Further increases have also been obtained through additional rental income and pass through costs in Children's for the Continuing Care Service.

The year to date PIES delivery for the Trust as at month 11 is as

per plan year to date by £4,093K.

At the end of month 11, the Trust is showing delivered £4,093K of PIES year to date. In M11 both Adults and CYP business units were only slightly off their respective targets. There is expected to be some Corporate PIES improvement in M12 when the SLA contract between HCT and East & North Hertfordshire NHS Trust is agreed. A significant balance of the PIES has not been achieved through recurrent schemes. This balance will need to be made recurrent in 2020/21 if the Trust is to be in financial balance going forward.

In order to improve the PIES position the Trust has introduced a vacancy control panel to consider alternatives to recruitment where possible and plan minimise the use of contractors, agency staffing and/or bank staffing through a similar approach. As a result of the changes to recruitment and temporary staffing, the Trust PIES position is expected to achieve target by the end of the year, but it is expected for corporate that this will be non-recurrent contribution with the risk that this will be added to the target for 2020/21.

Risks to meeting the 19/20 Control Total

As per Table 11 later in this report the Trust could end the financial year off plan by £783K by year end; there is a risk of £350K Corporate PIES slippage (including the shortfall in the TCS savings), £169K at risk due to Public Health Nursing KPIs not being achieved, £80K at risk due to CQUIN targets not been met in full, as well as a few other savings targets and income streams not being achieved. Although some progress has been made with a marginal improvement in the run rate in M11, which has improved our overall position, significant work remains to ensure this upward trajectory continues to the year end.

Other AdjustmentsThe Trust's capital business case was approved by NHSE/I, increasing the Trust's Capital Resource Limit back up to the original plan of £5,356K. The Trust will now be ensuring this balance is fully spent by the end of the financial year, with updates provided by the Trust's Capital Investment Group.

The Trust performance against the control total (including

Prior Year PSF) is £196K behind plan year

to date.



Table 1: Income and Expenditure Summary

Income and Expenditure Summary Budget Actual Variance Budget Actual Variance Budget Forecast Variance

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Income 8,075 9,177 1,102 109,628 115,046 5,417 116,763 123,646 6,883

Pay Expenditure (6,279) (6,479) (199) (83,525) (85,073) (1,549) (87,776) (91,532) (3,756)

Non Pay Expenditure (1,478) (2,175) (697) (20,445) (23,861) (3,417) (23,007) (25,249) (2,242)

EBITDA 318 523 205 5,659 6,111 452 5,980 6,865 885

Depreciation (247) (286) (39) (3,121) (3,387) (267) (3,366) (3,873) (507)

Amortisation (22) (18) 3 (238) (203) 36 (264) (221) 43

Profit/Loss on Disposal (5) 0 5 (53) 0 53 (63) 0 63

Interest Receivable 10 9 (1) 110 126 16 120 126 6

Interest Payable (4) 0 4 (44) (18) 26 (48) (18) 30

PDC Dividend (63) (63) 0 (1,195) (1,191) 4 (1,254) (1,254) 0

Gains/losses from transfers by absorption 0 0 0 0 (22,631) (22,631) 0 (22,631) (22,631)

Retained Surplus (13) 165 179 1,118 (21,192) (22,311) 1,105 (21,006) (22,111)

Add back all I&E Impairments/ (reversals) 5 0 (5) 55 0 (55) 60 0 (60)

Remove capital donations/grants I&E impact 4 7 3 44 70 26 48 76 28

Adjust (gains)/losses on transfers by absorption 0 (18) (18) 0 22,631 22,631 0 22,631 22,631

Remove impact of prior year PSF reallocation 0 0 0 0 (488) (488) 0 (488) (488)

Control Total (incl PSF) (4) 154 159 1,217 1,021 (196) 1,213 1,213 0

In Month Year to Date Forecast



2 Clinical Income (Patient Care Activity)

Table 2: Income Breakdown

The Trust had a year to date favourable position relating to

Revenue from Patient Care Activities of £4,003K

The Trust has a year to date favourable position relating to Revenue from Patient Care Activities of £4,003K. Clinical income mainly consists of block income and therefore only small deviations frombudget are expected to materialise during the year. For the additional income received its directly offset by expenditure or additional costs. Despite receiving centralised funding to cover thePublic Health Nursing AfC cost increases for 2019/20, there remains a shortfall of £149K YTD. The Trust has appealed to NHSE/I for additional funding to cover this, which has added to the overall costpressure. The contract KPIs continue to be monitored closely in order to improve performance in future months. The £1,772K YTD of additional CCG income predominantly from HVCCG, includesadditional funds for Adults Diabetes Community Service West of £125K, and Continuing Care Carers pass through costs of £565K. While NCA income for Cambridgeshire & Peterborough has beenincreased, it is still off plan for the full year.Other operating income is ahead of plan by £1,301K year to date which includes £488K additional PSF income relating to 2018/19 which was allocated to the Trust in July 19 by NHSE/I. This will beexcluded from consideration for the 2019/20 Control Total, as will the additional HEE income which was not included in the plan.

Risks relating to the achievement of the income at year end have been identified in Table 11 which includes the £149K Funding for Public Health Nursing AfC, £350K Cambridge and PeterboroughCCG income lower than planned which is a significant concern. Additional funding for the demobilisation of the HV Adults contract has in principle been agreed, but is lower than expected. Of thisvalue, £315K HV transition recoverable income was recognised in M10. Non-contract activity (NCA) invoicing continues to be reviewed to ensure accuracy and there has been consideration for theBusiness Transfer Agreement (BTA) with CLCH; £289K has been recognised of the total balance of £675K and the remaining balance will be recognised in M12.

INCOME PERFORMANCE Budget Actual Variance Budget Actual Variance Budget Actual Variance

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Clinical Commissioning Groups 4,921 5,589 668 73,862 75,635 1,772 77,802 80,778 2,976

Injury Cost Recovery Scheme 2 0 (2) 19 8 (10) 24 8 (16)

Local Authorities 1,759 2,074 316 19,420 20,768 1,348 23,415 22,583 (832)

NHS England 732 685 (48) 8,057 8,727 671 7,536 9,590 2,054

NHS Foundation Trusts 4 2 (2) 234 172 (63) 240 170 (70)

NHS Trusts 284 362 78 4,269 4,219 (50) 4,358 4,508 150

DOH & SC 67 67 0 733 584 (149) 651 651

Non NHS: Other 29 73 44 445 902 457 474 1,021 547

Non HS: Private Patients 2 2 1 18 45 27 24 49 25

Operating Income - Patient Care Total 7,799 8,854 1,055 107,059 111,061 4,003 113,873 119,358 5,485

Education And Training 76 107 31 833 1,272 439 528 1,377 849

Non-Patient Care Income 37 52 15 405 743 338 444 794 350

Other 27 28 1 295 445 150 744 455 (289)

PSF (formely STF) 137 137 0 1,037 1,525 488 1,174 1,662 488

Other Operating Income Total 276 324 47 2,570 3,985 1,415 2,890 4,288 1,398

TOTAL Income 8,075 9,177 1,102 109,628 115,046 5,417 116,763 123,646 6,883

ForecastIn Month Year to Date



3 Pay Expenditure

Table 3: Total Pay Breakdown

The pay position in month 11 is £1,554K adverse year to date and £200K adverse

in month.

The Trust posted a pay expenditure overspend of £1,554K year to date which includes the use of temporary staff covering vacant posts.

The Trust had an under-establishment of 221 wte (12.2%) substantive posts in month 11 of which 103 wte was covered by temporary bank and agency staff. Vacancies continue within the Allied HealthProfessionals services particularly N&D and Podiatry in Adults services, and SALT within CYP which are partly driven by the wider reorganisational changes in the Trust.

Pay expenditure offset by income includes, Winter Pressures staffing extended into the summer for HVCCG ending with the contract termination in September 2019. Continuing Care Carers in CYP of £582K andtransition expenditure in Corporate of £79K which is at risk as this is still part of the Trust negotiation with the CCG over the reimbursement of the costs incurred.

Other pressures include, £242K Pay Service Reconfiguration target which is still to be distributed out within the Adults Business Unit.

Expenditure risks to the run rate include TUPE of staff transferred to CLCH being £800K per annum less than planned and the realisation of savings from the TCS scheme which had been identified as £150K andtherefore a shortfall to plan by £3,350K. In order to reduce the financial pressure, the Trust has introduced a vacancy control panel to consider alternatives to 'like for like' recruitment and where possibleminimise the use of contractors, agency staff and bank staff. This measure has resulted in slowing down staff recruitment and there is a reduction in bank and agency costs over the last few months. However theTrust pay spend is still forecast to overspend by £3,722K at the end of the year.

The year to date agency spend is £991K below the

NHSI threshold.

The NHSE/I agency ceiling for 2019/20 is £6,965K which has been phased and reduced from M7 onwards to a target of £376K in month 11 in line with the loss of the HVCCG Adults services. The Trust agency spendis below the NHSE/I Agency ceiling threshold by £991K year to date. Children and Young People's services continue to exceed their agency target by £784K year to date, predominantly due to nursing agency usagewithin Continuing Carers Service, which is a pass through cost and is offset by income. As a result of vacancy and agency controls implemented, the Trust is forecasting to underspend against the ceiling by £1,353Kat the year end.

Pay Budget Actual Variance Budget Actual Variance Budget Actual Variance Budget Actual VarianceWTE WTE WTE £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Substantive Staff 1,814 1,593 221 (6,241) (5,841) 401 (83,112) (75,515) 7,597 (87,326) (81,394) 5,932Bank Staff 56 (56) (258) (258) (4,042) (4,042) (4,216) (4,216)Agency (NHSI Target FYE £6,965K) 47 (47) (359) (359) (5,226) (5,226) (5,612) (5,612)Apprenticeship Levy 0 (38) (22) 16 (413) (291) 122 (450) (310) 140

Total Pay 1,814 1,696 118 (6,279) (6,480) (200) (83,525) (85,073) (1,549) (87,776) (91,532) (3,756)

In Month In Month Year to Date Forecast



Table 4: Agency Spend by Business Unit

Table 5: WTE Budget v Actual Table 6: Bank & Agency WTE

Table 7: Bank & Agency Total Spend

Agency Threshold by Business Unit Target Actual Variance Budget Actual Variance Budget Actual Variance

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Adult Services (266) (181) 85 (4,399) (3,287) 1,112 (4,931) (3,478) 1,453

Children & Young Persons' (45) (155) (110) (732) (1,516) (784) (822) (1,684) (862)

Corporate Services (65) (22) 43 (1,081) (418) 663 (1,212) (450) 762

Total Agency Pay (376) (358) 18 (6,212) (5,221) 991 (6,965) (5,612) 1,353

In Month Year to Date Forecast



4 Non Pay Expenditure

Table 8: Non Pay Breakdown

Non-pay recorded a £3,397K adverse

position year to date and £696K adverse in

month.

The Trust has delivered an adverse non-pay expenditure variance of £3,414K year to date and an adverse variance of £676K in month. In month there were increases in Estates charges (Business Rates and leasecosts - £260K), Purchase of clinical support for HMP the Mount, Skin Health, Nutrition & Dietetics (£284K), with the remainder being the release of funds to support PIES. The shortfall to date is significantlyattributable to the shortfall of Corporate PIES which were heavily dependent on the TCS scheme delivering a plan of £3,500K. In order to meet the shortfall of the TCS PIES scheme, funds were released fromcontingency reserves to offset the non-achievement. 2018/19 Year end accruals and provisions, identifying actual liabilities to those accrued were lower than expected. Further accruals have been released fromcontingency in months 7-11 to a total of £1.559K.

The year end forecast of £2,480K adverse does include an expected reduction to the run rate as a result of the additional scrutiny being placed on all orders and requests of non pay in future periods.

Non Pay Budget Actual Variance Budget Actual Variance Budget Actual Variance

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Drugs Costs (61) (97) (36) (762) (770) (8) (828) (837) (9)Supplies & Services - Clinical (339) (306) 32 (4,761) (4,590) 171 (5,020) (5,013) 7Supplies & Services - General (147) (196) (49) (1,666) (1,834) (168) (1,810) (1,937) (127)Establishment (275) (254) 20 (3,778) (4,085) (307) (4,198) (4,775) (577)Premises (incl. business rates) (275) (607) (332) (4,515) (5,712) (1,197) (5,505) (5,821) (316)Other (382) (714) (332) (4,963) (6,871) (1,909) (5,646) (7,104) (1,458)Grand Total (1,478) (2,174) (696) (20,444) (23,861) (3,417) (23,007) (25,487) (2,480)

ForecastIn Month Year to Date



5 Productivity Improvement and Efficiency Schemes (PIES)

Table 9: PIES Breakdown

The year to date PIES delivery for the Trust as at

month 11 is on plan year to date at £4,093K.

At month 11 the Trust position is showing a delivery of £4,093K year to date. Corporate PIES have only achieved £154K YTD recurrent savings against £1,085 YTD plan. In total Corporate PIES have been achieved non-recurrently by the release of provisions (prior year accruals, bad debt and reserves). Any identified non-recurrent schemes will need to convert to recurrent schemes as they are approved. The slippage against the Trust's non-recurrent plan in the first few months has been recovered via vacancy underspends within the various Business Units. As previously identified, a recovery action plan has been agreed and inacted, to reverse non-achievement of recurrent PIES. There is an expectation of a £200K contribution to the Corporate PIES from the SLA agreement with East & North Hertfordshire NHS Trust.

In order to improve the PIES position the Trust has introduced a vacancy control panel to consider alternatives to recruitment where possible and plan minimise the use of contractors, agency staffing / bank staffing through a similar approach. As a result of the changes to recruitment and temporary staffing, the Trust PIES position is expected to achieve target by the end of the year, though non-recurrent schemes will need to be converted to recurrent schemes for 2020/21.

HCT PIES Summary M1-M11Business Unit Saving Type FYE Plan Actual Variance

£'000 £'000 £'000 £'000

Children’s & Young People’s Recurrent 1059 971 948 (23)Non Recurrent 0 0

Children’s and Young People’s Total Non Recurrent 1,059 971 948 (23)Adult Services Recurrent 913 858 531 (327)

Non Recurrent 0 0 212 212Adults Services Total 913 858 743 (115)Corporate Services Recurrent 3,463 2,460 154 (2,306)

Non Recurrent 0 0 2,248 2,248Corporate Services Total 3,463 2,460 2,402 (58)Grand Total 5,434 4,289 4,093 (196)

Year to Date



6 Risk to achievement of Control Total

Table 10: Risk

Risk No.

Risk/Opportunity Identification ProcessRAG Rating/Risk

ScoreFinancial

Value£'000

Underlying Risk Assessed

Value £'000

M11-12 RAG Rating/Risk Score

Risk Assessed Value £'000

Basis for Financial AssessmentExec Lead

Actions to Mitigate

1PIES Slippage including shortfall in the TCS Scheme

PIES Tracker 25 (3,750) (3,750) 4 (350)PIES Project Tracker. TCS Consultation outcome paper

Trust Exec

TCS outcomes are now not expected to deliver the desired savings as expected. Action to mitigate the shortfall include:A review of all temporary staffThe introduction of a vacancy panel to review all requests for recruitment including essential and non-esstential posts The introduction of a formal establishment control processRequests for offsite meetings are also being approved by Execs in order to reduce non pay spend. Closer monitoring of budgets and forecasts by Budget Holders. All staff are being encouraged suggest further Trust wide efficiencies for consideration.2020/21 PIES planning has commenced

2Cambridge and Peterborough CCG income lower than planned

Block Contract 20 (600) (480) 9 (76) Activity Profile DB/STThis risk has changed significantly as NCA activity used by finance did not match activity supplied to C&B. Risk is thought to be diminished once activity invoiced between now and year end.

3100% of PHN KPIS targets are not achieved.

Monthly KPI Report 8 (1,110) (269) 8 (169) KPI Tracker MD Monthly review of agreed KPIS. Could Coronavirus affect activity levels

4Funding for demobilisation of the HV Adults contract is lower than expected.

Costing schedule 16 (600) (384) 3 (60) Expenditure incurred DB Regular negotiations with HV CCG & the STP.

5Funding for Public Health Nursing AfC is lower than expected.

Costing schedule 25 (149) (149) 25 (33) Contract Value DB Regular discussions with NHSI/NHSE & DoH.



Risk No.

Risk/Opportunity Identification ProcessRAG Rating/Risk

ScoreFinancial

Value£'000

Underlying Risk Assessed

Value £'000

M11-12 RAG Rating/Risk Score

Risk Assessed Value £'000

Basis for Financial AssessmentExec Lead

Actions to Mitigate

6 19/20 Unplanned Cost Pressures Business Case 2 (38) (3) 2 (3)Financial Evaluation from the Business Case

DB

Business Case Review on a case by case basis with Executive approval to incur additional cost. Approved Cases to date include:£38K HMP The Mount, staff retention to end of contract, to minimise temporary staff usage.

7100% of 19/20 CQUIN targets are not achieved.

Monthly KPI Report 12 (350) (140) 12 (80) CQUIN Tracker SB

Monthly review of CQUIN KPI'S. Due to the delays with the Flu vaccines, not enough staff are expected to be vaccinated to achieve this CQUIN. Also there is a reduction due to Hospital Fall prevention CQUIN not being achieved.

8 Annual Leave provisionPolicy - no leave to be carried forward

25 120 120 25 120No provision for annual leave required

DB N/A

9 Future use of Howard Court Recovery Plan 19/20 25 (240) (240) 9 (80) Recovery plan tracker ST Proposed as an income, but not for this financial year.

10 HVCCG Overhead for Children ServicesTransition working papers

25 (198) (198) 12 (18) Final transition review DB Proposed to HVCCG that the current rate required adjustment

11Estates recovery staffing costs with HPFT

Estates staffing working papers

9 (336) (121) 6 (34) Estates staffing calculation paper DBOngoing discussions with HPFT finance around recovery of staffing costs against changes in Estates share between the two Trusts

Total risk to Control Total achievement (7,251) (5,614) (783)

RAG Rating KeyRAG Rating Description Risk Score

Green 1-3Amber-Green 4-7Amber 8-13Amber-Red 14-17Red 18-25



7 Financial Recovery Plan

Table 11

As a result of the financial position in month 7 worsening (£700k off plan), the Executive developed a financial recovery plan, which was approved by the Trust Board on the 26th November 2019. This plan included a number of options which were not limited to:

• Corporate recruitment freeze • Vacancy control review for operational business units, • Escalation of PIES performance, including bringing forward 2020/21 PIES were possible • Slowing down spends • Identification of additional income • Review of all accruals and contingency balances in light of the loss of Herts Valleys Adult Services

As a result of these and other measures the Trust’s run rate has improved to be £159K ahead of plan and improved YTD position to £196K off plan in month 11. Trust management is planning for the Trust to achieve its control total through month on month improvement over future months with planned position £196K off plan in month 11, and then achieving year end planned position in month 12 of £39k.



8 Statement of Financial Position

Table 12: Statement of Financial Position

Statement of financial position Actual Forecast

YTD Year ending

£'000 £'000

Non-current assetsIntangible assets 608 504Property, plant and equipment: other 41,465 42,185Total non-current assets 42,073 42,689

Current assetsInventories 0 0Receivables: due from NHS and DHSC group bodies 9,664 4,094Receivables: due from non-NHS/DHSC group bodies 758 476Cash and cash equivalents: GBS/NLF 15,139 20,813Cash and cash equivalents: commercial / in hand / other 0 0Total current assets 25,561 25,383

Current liabilitiesTrade and other payables: capital (1,451) (1,800)Trade and other payables: non-capital (8,894) (11,613)Provisions (455) (497)Other liabilities: deferred income including contract liabilities 0 0Other liabilities: other (963) 0Total current liabilities (11,764) (13,910)Total assets less current liabilities 55,869 54,162

Non-current liabilitiesProvisions (937) (685)Total non-current liabilities (937) (3,685)Total net assets employed 54,932 53,477

Financed byPublic dividend capital 1,386 1,386Revaluation reserve 9,681 9,681Financial assets at FV through OCI reserve 0 0Other reserves 4,947 4,947Merger reserve 0 0Income and expenditure reserve 38,918 37,463Non-controlling interest 0 0Total taxpayers' and others' equity 54,932 53,477



9 Cash flow

Statement of cash flows Actual Forecast

31/10/2019 31/03/2020

YTD Year ending

£'000 £'000Cash flows from operating activitiesOperating surplus/(deficit) 2,521 2,771Non-cash income and expense:

Depreciation and amortisation 3,590 4,094Impairments and reversals 0 0Income recognised in respect of capital donations (cash and non-cash) 0 0Amortisation of PFI creditOn SoFP pension liability - employer contributions paid less net charge to the SOCI(Increase)/decrease in receivables (1,085) 6,286(Increase)/decrease in other current assets(Increase)/decrease in other assets(Increase)/decrease in inventories 0Increase/(decrease) in trade and other payables 280 (7,246)Increase/(decrease) in other liabilities 0Increase/(decrease) in provisions 0Tax (paid) / received 0Other movements in operating cash flows (6,533) 3,142

Net cash generated from / (used in) operations (1,227) 9,047Cash flows from investing activities

Interest received 126 126Purchase of financial assetsProceeds from sales of financial assetsPurchase of intangible assets (381) (381)Proceeds from sales of intangible assetsPurchase of property, plant and equipment and investment property (3,937) (4,975)Proceeds from sales of property, plant and equipment and investment propertyReceipt of cash donations to purchase capital assetsPFI lifecycle prepayments (cash outflow)Prepayment of PFI capital contributions (cash payments)Cash movement from acquisitions of business units and subsidiaries (not absorption transfers)Cash movement from disposals of business units and subsidiaries (not absorption transfers)

Net cash generated from/(used in) investing activities (4,192) (5,230)Cash flows from financing activities

Public dividend capital received 0 0Public dividend capital repaid 0 0Loans from Department of Health and Social Care - received 0 0Loans from Department of Health and Social Care - repaid (2,356) (2,356)Other loans received 0 0Other loans repaid 0 0Other capital receiptsCapital element of finance lease rental payments Capital element of PFI, LIFT and other service concession paymentsInterest paid (18) (18)Interest element of finance leaseInterest element of PFI, LIFT and other service concession obligationsPDC dividend (paid)/refunded (1,191) (1,254)Cash flows from (used in) other financing activities

Net cash generated from/(used in) financing activities (3,565) (3,628)Increase/(decrease) in cash and cash equivalents (8,984) (1,129)

Cash and cash equivalents at start of period 22,789 22,789Opening balance adjustment

Restated cash and cash equivalents at start of period 22,789 22,789Cash transferred to NHS foundation trust upon authorisation as FTCash and cash equivalents at start of period for new FTsCash and cash equivalents transferred by normal absorptionUnrealised gains/(losses) on foreign exchange

Cash and cash equivalents at end of period 15,139 20,813Cash balance per SOFP 15,139 20,813

The cash balance as at 29th February was £15,139K and the forecast for 31st March 2020 is £21,660K. The DHSC Capital loan repayment of £2,356K was paid on the 12th August 2019, allowing the Trust to save on interest that would have incurred on the loan. As result borrowings are forecasted to be zero at year end.



Table 13: Cash balances and Flow Statement

10 Capital Expenditure Table 14: Capital Expenditure



11 Aged Receivables Table 15: Receivables Age Analysis

Table 16: Age Analysis

TotalYTD YTD YTD YTD YTD YTD YTD YTD YTD

Aged receivables/ payables: current month £'000 £'000 % £'000 % £'000 % £'000 %

Receivables non NHS 1,083 627 57.9% 105 9.7% 1 0.1% 350 32.3%Receivables NHS 7,154 1,590 22.2% 3,443 48.1% 465 6.5% 1,656 23.1%Payables non NHS (1,091) (703) 64.4% (105) 9.6% (66) 6.0% (217) 19.9%Payables NHS (2,395) (944) 39.4% (585) 24.4% (87) 3.6% (779) 32.5%

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



12 Better Payment Practice Code Table 17: BPPC Performance



13 Single Oversight Framework

Table 18: Single Oversight Framework

The Single Oversight Framework Risk Rating for the Trust is a 2.

The Single Oversight Framework Risk Rating (SOF) is the NHS Improvement’s approach, to overseeing NHS providers. The SOF assesses the financial performance of providers via the “Use of Resources Metrics (UOR)” comprising the following five metrics:

• Liquidity Ratio• Capital Servicing Capacity• I&E Margin• I&E Distance from Plan• Agency

The overall metric is calculated by attaching a 20% weighting to each category.

The Single oversight risk rating for the Trust as at month 11 is at 2 as a result of the Capital service cover rating and the I&E margin (off plan). The year end rating will be 1 onachievement of both the Contol Total and completion of Capital spend for the year.

The capital service cover rating calculation of actual 3 and forecast 2 has been affected by the early repayment of the capital loan. We are still in discussion with NHSE/I about how thisanomaly.

The I&E margin to plan ratio calculation of actual 2 is as a result of the £196K variance against the Control Total. The forecast remains at 1 as it the Trust is still forecasting to meet theControl Total at year end.

Plan Actual Variance Plan Actual Variance

Forecast

Capital service cover rating 1 3 1 2

Liquidity rating 1 1 1 1

I&E margin rating1 2 1 1

I&E margin: distance from financial plan2 1

Agency rating 1 1 1 1

Overall Rating 2 1

YTD



DoLs - Deprivation of Liberty Safeguarding CQUIN - Commissioning for Quality and Innovation

IDAT - Integrated Discharge and Admissions Team CCG - Clinical Commissioning Group

MEN C - Meningococcal C PALMS - Positive Behaviour Autism Learning Disability and Mental Health Service

NHSI - National Health Service Improvement PIES - Productivity Improvement and Efficiency Scheme (PIES)

OT - Occupational Therapy PSF - Provider Sustainability Funding

PT - Physio Therapy ICT - Integrated Community Teams

CAPEX - Capital Expenditure Programme ENHT - East and North Herts Trust

BUPR - Business Unit Performance Review BPPC - Better Payment Practice Code

FP10 - Community Prescription H & WE - Herts & West Essex STP

SACH - St Alban's Community Hospital PIES - Productivity Improvement and Efficiency Schemes (formally CIPs)

14 Glossary

quarterly quality report 2019 2020 quarter 3 · q1 2018/19 q2 2018/19 q3 2018/19 q4 2018/19 q1...

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