October - Dartford and Gravesham NHS Trust

Transcription

DARTFORD AND GRAVESHAM NHS TRUST
TRUST BOARD MEETING
29 October 2015 at 9.00 a.m.
Boardroom, 4th Floor, Trust Headquarters
A G E N D A – PART 1
Item
Lead
Enclosure
10-1
Apologies for absence
Chairman
Verbal
10-2
Declarations of Interest
Chairman
Verbal
10-3
Questions from members of the public relating
to agenda items
Minutes of the meeting held on 24 September
2015
Chairman
Verbal
Chairman
A
10-5
Chief Executive’s Report
10-6
Bid for Community Services
Chief Executive
B
Susan Acott
Helen Martin
Presentation
Assistant Director Community
Services
10-4
QUALITY
10-7
Nursing workforce and quality metrics
10-8
Quality and Safety Summary Report from 15
October 2015
Director of Nursing and
Quality
Vikki Leivers-Carruth
Committee Chairman
Karen Taylor
Minutes from meeting held on 17 September
2015
C
D
E
10-9
Board Member Quality Assurance Activity
Chairman
Verbal
10-10
Quarterly Combined Complaints, PALS and
Patient Experience Report
Director of Nursing and
Quality
F1
Combined Safeguarding Annual Report
STRATEGY
10-11
Vanguard Update
10-12
Physician Associates
10-13
Capacity Plan Update
10-14
PRODUCTIVITY
Performance Report (Month 6 2015-16)
10-15
5 Year QIPP Program Summary (Investment
and Improvement)
F2
Chief Executive
Susan Acott
Medical Director
Annette Schreiner
Director of Operations
Pam Dhesi
Presentation
Pam Dhesi
Chief Executive
Susan Acott
I
G
H
J
Item
10-16
Finance and QIPP Report (Month 6 2015-16)
10-17
ASSURANCE
Charitable Funds Committee
• Minutes 20 October 2015 meeting (draft)
Lead
Enclosure
Director of Finance &
Performance
Mick Bull
K
Committee Chairman
David Findley
• Charitable Funds Committee Annual Report
• Charitable Funds Committee Accounts
• Letter of Representation
10-18
10-19
10-20
10-21
L
M1
M2
M3
Workforce Committee Minutes – 22 September
2015
Remuneration Committee Report – 24
September 2015
Finance Committee
• Summary Report - 27 October 2015
• Minutes - 22 September 2015
Committee Chairman
N
Committee Chairman
O
Approve TOR for Partnership Board
Director of Finance and
Performance
ANY OTHER BUSINESS
Chairman
Committee Chairman
Peter Coles
10-22
QUESTIONS FROM MEMBERS OF THE PUBLIC
10-23
EXCLUSION OF THE PUBLIC AND PRESS
Motion to exclude the public and press by Chairman
reason of the confidential nature of the
business to be transacted
DATES OF FUTURE MEETINGS:
• Thursday 26 November 2015, Boardroom, Darent Valley Hospital
• Thursday 17 December 2015, Boardroom, Darent Valley Hospital
C
Janardan Sofat
Chairman
Verbal
P
Q
Verbal
Item 10-4. Attachment A – Part 1 Trust Board Minutes 24/09/2015 (draft)
MINUTES
Dartford and Gravesham NHS Trust Board (Part 1)
Thursday 24 September 2015
Darent Valley Hospital
Present:
Janardan Sofat
Susan Acott
Karen Taylor OBE
David Findley
Steve Wilmshurst
Gerrard Sammon
Pam Dhesi
Mick Bull
Annette Schreiner
Peter Coles
David Warwick
Andy Brown
In attendance:
Russell Davies
Ali Strowman
Gill Jinks
Chairman
Chief Executive
Non-Executive Director
Director of Strategy and Planning
Director of Finance & Performance
Medical Director
Director of Nursing and Quality
Director of Human Resources
Trust Secretary
Deputy Director of Nursing
Acting SPC Manager
(JS)
(SA)
(KT)
(DF)
(SW)
(GS)
(PD)
(MB)
(AS)
(PC)
(VLC)
(DW)
(AB)
(RD)
(ASt)
(GJ)
9-1
Apologies for absence
None received.
9-2
Declarations of Interest
There were no Declarations of Interest.
9-3
Questions from members of the public relating to agenda items
No members of the public present.
9-4
Minutes of meeting held on 27 August 2015
Following amendments were made:
8-12 Performance Report: The DoN explained the background to the recent changes
in monitoring and reporting [mixed sex accommodation] as discussed with the CCG.
There has been national guidance regarding mixed sex accommodation since 2009.
There was a local agreement in place until recently but this has changed and the
national guidance is now being applied hence the step change. The CCG also
wanted to apply the same guidance across all of Kent as various agreements were in
place so there was a lack in consistency. The DoN explained how this is monitored
and reported and what constitutes an unjustified breach. Currently there is no
financial penalty applied by the CCG.
This issue is addressed at every site safety meeting. There is also RCA sent to the
DoN which will be monitored through the Patient Experience Committee. This is not
a safety issue and in terms of quality there are almost no complaints regarding mixed
sex accommodation. Patients may be mixed when it is clinically appropriate for
specialist treatment e.g. CCU or Acute Stroke. The DoN Does not envisage negative
feedback from the CQC as the Trust has robust and transparent processes in place
albeit not ideal. Until occupancy reduces (to 95% or below) and delayed transfers of
care also reduce significantly it will be very difficult to significantly reduce this. The
board was assured that general ward areas do not mix and the challenges are in
assessment areas and critical care. The DoN stressed that the priority must remain
that patients receive the appropriate clinical care in a timely way, even if in extremis
(Black status , infection control outbreak etc) this may mean mixing.
Delayed Transfer of Care is at 6.9% which equates to 18 patients.
8-10 GS had visited the A&E reception area out of ours.
improvement and calm which is as a result of the rebuild.
There is a sense of
8-11 Stroke services – there is a limited number of HASU’s in London.
Action Log – 7-6 will be moved to Quality and Safety. 6-9 is also now closed.
Chairman announced that this is the last Trust Board that RD will be attending.
9-5
9-6
9-7
Chief Executive’s Report
Chief Exec presented the report. There have been requests from NHS England for
DGT to take on several diverts from Medway FT following a critical CQC report.
There have been two mornings of diverts. In addition, staff from DGT have been
requested to attend Medway. Canterbury, Maidstone and DGT are the three main
Trusts that have been approached to help. London Ambulance have avoided the
Trust during divert mornings which has assisted. Patients that are medically fit for
discharge occupying acute beds appears to be endemic across Kent. Kent
Community and Mental Health are trying to assist in providing care for patients that
do not require acute care. Kent County Council assistance has not been that visible..
The Trust has achieved its Vanguard status and NHS England would like the Trust to
take the lead [as opposed to GSTT].
Leadership Update – presentation
Presentations available from Trust Secretary upon request. The volume of activity
which is clinician based was congratulated. The Trust is working with its Primary
Care Colleagues and the frail and elderly pathway has been worked on in detail in a
collaborative approach. In terms of measuring outcomes it has been difficult, there is
no qualitative methodology of achieving this. General outcomes can be measured
such as service improvement. Generally, self-assessment is an excellent tool in
monitoring how effective the Leadership Programs are at DGT.
Nursing workforce and quality metrics
DoN presented the headlines from the reports. The last two months have been
extremely busy operationally. There are no substantive changes at Elm Court
however there have been negative comments namely the noise levels, food and the
call out system. An action plan has been put together and there will be an audit
undertaken on the call-out system. The timing of mealtimes and falls will also be
looked into. The chair requested that Elm Court is reported separately in the October
metrics. The mock-quality inspections will also be undertaken at Elm Court.
9-8
Quality and Safety Report Summary Report from 17 September 2015
The first report is the Directorate Report for Cancer Services. The committee
chairman highlighted the positives in the report. One criticism was that the report
read like a nursing report as a result there is a Cancer Board which produces a report
resulting in a more holistic view. An update on the initiative around the Ambulatory
Care Pathway has been requested. The Adult Medicine Report in general was very
comprehensive and illustrated what a busy directorate Adult Medicine is.
There has been a lot of discussion around the Point of Care Testing (POCT) and the
committee would like assurance that the training and assurance over the quality of
equipment is in place.
The board were asked if they had any opinions on the structure and running of the
Quality and Safety Committee and in particular its remit. Any suggestions or queries
should be directed toward Sue Craven.
VLC confirmed that a quarterly combined complaints, PALS and Patient Experience
Report will be submitted at the October Trust Board.
Minutes from the August meeting were noted.
9-9
PLACE Board Report
Annual self-assessment. An action plan is now in place to improve patient’s privacy,
dignity and well-being which will be reported to the Quality and Safety Committee.
9-10
Revalidation Update
Revalidation for Nurses and Midwives takes place April 2016. The update provided
the board with assurance that there is a robust action plan with deadlines in place.
The NMC is the sole arbitrator with regards to whether a nurse / midwife meets the
revalidation criteria. Due to a low turnover staff from overseas and newly recruited
staff there will always be a challenge to ensure all relevant validation is up-to-date
but this will not be too great. There is a final risk assessment currently underway.
9-11
Quality Inspections Board Report
This paper was presented at the Quality and Safety Committee. Any of the Execs or
NEDS who want to volunteer to be part of the mock quality inspections should
contact Ali Strowman.
Reds and ambers should be considered as a learning tool and staff can use them to
strive to become better as a Trust. A complex area of weakness is the
understanding of the Mental Capacity Act. Additional training has been implemented
and sessions are being well attended.
Wards are being concentrated on currently, however, once all clinical areas have
been inspected then out-patients and non-clinical areas that are subject to the CQC
inspections will also have mock inspections.
By mid-October all wards should have been inspected and once this process has
been completed a copy of the Inspection Tool will be circulated accordingly. By this
time there will be actions that the Trust will be able to execute to ensure the official
Quality Inspections run smoothly and will be an accurate reflection of a good
performing and continuously improving Trust.
9-12
Board Member Quality Assurance Activity
SW met with the GM of radiology. There needs to be a clear strategy for moving
forward that should have Exec involvement.
The Chair attended the Schwartz round which focused on staff members being
treated at in hospital. There was a overall perception by some of the patients that
those that work for the Trust receive better treatment. In addition, staff members
being treated generally preferred it when other patients on the ward did not know
they were staff members because there was more friendly dialogue between all
patients.
9-13
Resilience plan for winter pressures (including capacity plan)
Director of Operations presents the paper. The first dashboard has been presented
which is designed to show whether there is flow for patients in the health economy
and where the pressure points are. The issue is then what is done strategically and
operationally. The TDA have expressed concerns around the number of window
beds the Trust has and whether the CCG are sighted of this issue. The information
shows that the community have responded and community beds are close to
capacity. Ambulance delays have also occoured due to the number of patients
presenting at A&E and also capacity as discussed. There is a lot of focus on DTOC
and pressure on social services. The CCG have confirmed that Ambulatory Care is
supported in an attempt to ease winter pressures. Due to losing beds at QMH the
numbers that DVH can cope with is less. The board suggested a more detailed
demand and capacity plan with thresholds outlined with a view to providing a clear
benchmark. Expected demand should be modelled qualitatively. If these parameters
are not met the Health Economy should be prepared to assist the Trust. The
awareness should be shared and highlighted. There is an increased pressure on
care/nursing homes who are unable to cope with current demands. KCC have a
contractual position on approximately 30% of residents in nursing homes which are
at risk of being inadequate. There is also an absence of Advanced Care Plans which
has a direct impact on the Trust and this is an issue that KCC could address directly
and influence through their contracts. KCC are having a provider home meeting this
October which has not happened for over 12 months, in addition a member of the
Integrated Discharge Team is attending the nursing home provider meeting to
improve relationships and to provide information on alternatives to A/E in an attempt
to establish relationships. There will also be an attempt to establish a point of
contact where advice can be given as opposed to ringing 999. There is also ongoing dialogue with CCAM in an attempt to establish these joint relationships. During
Christmas and New Year 2014 the Trust struggled to cope with the increase in
demand and 111 functioned poorly. There are other walk in centres that could cope
with and share the additional demand. As a result what has been requested through
the Urgent Care Overview Group is a GP presence rather than diverting patients into
A&E offering support to the 111 service. KCHT have agreed to manage this and the
Director of Operations has also requested this communication starts as early as
possible during this period. This year’s Christmas period is likely to be more tough
than 2014 due to the way the bank holidays between Christmas and New Year fall
therefore its imperative that there are staff available to cope with this demand. There
is also an insurance issue with respect to ensuring GP out-of-hours rotas are covered
although there is currently no more details available on this. There are a number of
high risks in the system due to staff population and availability, the ability of the
system to learn from last year from the impact of a four day weekend and other less
resilient aspects of the system. Next month the risk highlights across the national
health economy will also be available for the Trust Board to have site of.
Can Pam please review these
9-14
LTFM Update
The LTFM will be submitted to the TDA to support the Endoscopy Business Case.
The LTFM long-term model is for 5 years to 2021. This assumes for 2016/17 a 3m
deficit against the Trust’s break even duty and that the Trust recovers its break even
duty of the further 2 years to 2018/19. Within the position for 2016/17 going forward
for the first 3 years of the plan there is approximately a 10m improvement
requirement to generate the deficit. This takes into account the 5.8m deficit in the
current financial year and rolled forward recurrently. There is also an assumption
that other changes moving forward around inflation, reforms to pensions and so on
including any business cases are included. Risks are also included such as the local
health economy with respect to the CCG. Contingencies are incorporated moving
forward. The finance committee supported the LTFM plan however, this is not
necessarily the final plan. The finance committee have requested a stretch target in
order to balance the finances.
The Finance Committee had reviewed and supported the requirement for £3m
revenue support based on the cash flow forecasts undertaken. The request for
revenue support of £3m was approved by the Board with delegated authority given to
the Finance Director to sign the application off on behalf of the Trust.
9-15
Performance Report (Month 5 2015-16)
Director of Operations presents the Performance Report. Mixed sex accommodation
breaches are higher due to the way they are reported. . Now there is a standardised
method and a change in reporting which is why the figures look different from
previous months. There are no safety issues or quality issues.
Threshold of 3.5% in Delayed Transfer of Care is between 12 and 18 patients.
9-16
Finance and QIPP Report (Month 5 2015-16)
The DoF presents the comprehensive report which has also been presented to the
Finance Committee.
9-17
Council of Governors Minutes
Trust Secretary confirmed that the database of members has been cleansed. The
Electoral Reform Society have details of all constituencies and members and will
start Communication around this area making members aware of the Council of
Governors and upcoming elections. Comms will take a period of time 1 – 2 months
with elections following. Either December or January. The minutes were noted by
the board and the Non-Execs were reminded that they are welcome to attend a
Council of Governors meeting.
9-18
Summary Report – Finance Committee held on 22 September 2015
The radiology directorate has received attention. Philips have been commissioned to
conduct a review with potential savings that directorate can make. There is an ongoing issue with OXLEAS around the facility charges with QMS and the committee
are supporting the negotiations with the Execs. Also unresolved are the debts owed
to the Trust by KCH. Currently the money that comes through does not reduce the
overall debt. PC and DoF have now set a deadline with KCH, should this deadline
not be then PC will contact MONITOR directly. The cash support issue in terms of
working capital is being monitored. The latest versions of procurement strategy and
finance strategy has been looked at with an emphasis on benchmarking and best
practice. The finance strategy will go to the October board. This is to match the
clinical strategy and capital plans about how the Trust resources what needs to be
done and how the service is managed financially. The capital business case to the
TDA for an additional 3m was approved by the committee. Budget setting proposals
for 2016/17 were looked into with the stretched target.
No penalties will be issued in line with breached agency spend constraints. The
Trust is around 4% and all Trust’s have to move to 3% [of agency staff] within the
next 5 years. Once again the 3m bid for working capital was ratified by the board.
9-19
The Hospital Company Annual Legal Statement of Compliance
Caroline Copping from UCLH will be taking Terry McCartney’s position [that is
currently being filled by GJ] from 12 October 2015. The document is a revised
version from the inadequate document that has previously come to the Trust board.
The document provides assurance that the hospital is being managed in a safe and
compliant manner and that THC are ensuring that Carillion are maintaining the site in
a safe and efficient manner. This document will be sited by the Partnership Group,
then the Partnership Board, then finally the Trust Board.
Legionella and
pseudomonas is regularly monitored however, pseudomonas is not reflected in the
appendices and will be in future reports. Spare parts for the generators and the
acquisition thereof will also be reflected in the compliance statement. A question was
raised regarding the audit under the Disability and Discrimination Act. The board
requested a plan and a timeframe accompanying the plan. Carillion have supplied a
report for the potential of more buried asbestos around the Heart centre as a result of
this there is now an Asbestos Management Plan in place.
9-20
Audit Committee – Minutes from 11 September 2015
Audit Committee Minutes were noted.
Any other business
Workforce committee report from Tuesday 22 September 2015. Radiology is in a
state of flux on the improvement pathway. Work on filling vacancies is going well.
Appraisal rate is being tracked closely and work is still needed to be done. There is a
workforce review currently underway. Trauma Orthopaedics have no issues with
regards to vacancy rate and turnover. The staff survey 2015 is currently being
launched. There is an action plan in investing in people. There is anecdotal
evidence that there is a feeling of two sites with QMH and DVH as opposed to one
Trust in DGT. The GMC survey action plan was focused on in particular how trainee
and junior doctors are handled.
Item 10-5. Attachment B – Chief Executive’s Report
TRUST BOARD MEETING – OCTOBER 2015
CHIEF EXECUTIVE’S REPORT
CHIEF EXECUTIVE
The Trust’s proposal to become an acute care collaboration (ACC) vanguard with GSTT
has been accepted. This followed a selection process involving input from clinicians,
patients, national experts, representatives of all seven of the NHS arm’s length bodies and
other shortlisted ACC applicants. In total thirteen proposals were selected. An ambitious
timetable has already been set with a workshop with the ACC Vanguard Team regarding
next steps already being held. By November, we need to develop a ‘value proposition’
which is effectively a way of describing the link from the support we want to the outcomes
we are aiming to achieve for patients. It is also required in order to go into more detail
about our proposal and to secure any financial support required from the NHS
transformation fund. A launch event specifically for ACC vanguards is scheduled for the
13th November and a national vanguard event is scheduled for the 18th November.
Since my last report to the Board, the work regarding the Community bid has intensified
with our presentation to the CCG regarding the Community Clinical Model and the
development of the partnership with Medway Community Health regarding the contractual
joint venture into which we wish to enter. The opportunities for better service integration
remain although the financial envelope available at the Dartford end is a concern.
Our teams have also continued to prepare for the transport tender which is reaching a key
point in the tender process. This is an opportunity for us to provide a more reliable service
than the offer we currently experience.
The Trust has been very pressurised operationally and we have been on black status on
one occasion in the month and spent much of it on red. Our A+E performance is under
stress but it is important that our clinical and managerial teams focus is on ensuring
patients safety at all times.
The Board are reminded that we are hosting a European Exchange Study Visit along with
the European Hospital and Healthcare Federation (HOPE). Ali Strowman has been central
to bringing this study tour here and we trust it will be successful and create longer term
learning opportunities for colleagues.
This week marks the first anniversary of the launch of the NHS Five Year Forward View (5YFV)
and progress on its delivery and featured as part of NHS England’s Annual General
Meeting. http://www.england.nhs.uk/2015/10/20/delivering-a-safe-haven/
Dr Donald Berwick, the renowned international authority on health care quality and improvement
management, is today appointed by The King’s Fund with NHS England and national partners to
help support vanguard sites in developing the new models of care set out in the NHS Five Year
Item 10-5. Attachment B – Chief Executive’s Report
Forward View. http://www.england.nhs.uk/2015/10/19/don-berwick-vanguard-sites/
The NHS Trust Development Authority has today published the overarching financial position of
NHS Trusts for the first quarter of 2015/16. http://www.ntda.nhs.uk/blog/2015/10/09/nhs-trustsfinancial-position-for-q1-of-201516/
Jim Mackey, Chief Executive of Northumbria Healthcare NHS Foundation Trust, has been
appointed as the Chief Executive of NHS
Improvement. http://www.ntda.nhs.uk/blog/2015/10/05/chief-executive-of-nhs-improvementannounced/
National price caps for agency staff working in the
NHS. https://www.gov.uk/government/consultations/national-price-caps-for-agency-staff-workingin-the-nhs
At its public board meeting on Thursday 22 October 2015, CQC’s chief executive, David Behan
confirmed that CQC still expects to inspect every acute NHS trust in England by the end of March
2016, as well as every acute specialist, mental health, community healthcare and ambulance trust
by the end of June 2016, using its robust, expert-led, and person-focused
regime. http://www.cqc.org.uk/content/inspection-programme-update
Hospitals can save around £5 billion by reducing variation in care and improving the way they care
for patients, Lord Carter said last week. https://www.gov.uk/government/news/lord-carterreducing-variation-in-care-could-save-nhs-5-billion
Reason for receipt at the Board (decision, discussion, information, assurance etc.)
Information & assurance
This report provides information on the following corporate objectives:
•
•
•
•
•
Provide excellent, safe patient services
Deliver financial sustainability and efficiency
Strengthen operational efficiency and effectiveness
Promote staff development and growth
Proactive community engagement
Item 10-7. Attachment C - Nursing workforce and quality metrics October FINAL
TRUST BOARD MEETING – October 2015
NURSING WORKFORCE AND QUALITY METRICS
DIRECTOR OF NURSING &
QUALITY
This paper contains the monthly UNIFY submission data regarding fill rates for ward areas
supported by a number of quality metrics with an accompanying narrative. This data remains
publically available on the NHS Choices platform. The Trust continues to display this information
on its public facing webpage as well as displaying planned versus actual staffing numbers in
clinical areas.
Key risks identified:
Fill rates were slightly lower in September and commentary is included in the report regarding any
area lower than 95%.
There were 2 falls resulting in a fracture in September. The overall number of falls in the Trust has
increased in September to 122 from 90 in August which is disappointing considering work invested
in falls reductions. The Trust falls training programme commenced in September and this should
assist in the reduction in falls. There is no obvious reason for the increase but this may be related
to a higher number of unfilled shifts, especially the use of specials.
Recommendations
The board is asked to receive and note the contents of the report which is for information,
assurance and discussion.
Discussion and assurance
•
•
Quality at our Core
Business sustainability and compliance
1
Workforce Data and Quality Metrics
The information below relates to September fill rates per ward broken down by day and night
for registered and unregistered staff.
In general the average fill rate for both registered and care staff has been more challenging
in September with a number of areas unable to fill all required shifts. There is no agreed
national rating system yet, so the Director of Nursing will provide commentary on any areas
less than 95%, albeit this may be relatively small numbers of shifts/hours depending on the
template. The reasons for dips relate to requests for additional staff and include vacancies,
sickness, and some requests for enhanced observation (specials) in that order which is the
same as in August.
Areas under 95% fill rate in September were Spruce (54 unfilled shifts), Beech (32), Juniper
(30), ITU (29), Ebony (29), Oak 27 (2), Rowan (22), Elm Court (18), Palm (18), Rosewood
(18), Willow (18), Chestnut (13), Laurel (13), Linden (13), Redwood (8), Aspen (7) and Short
Stay (6).
The main reason for requests to fill shifts amongst all wards for registered nurses was
primarily to cover sickness and vacancy, and amongst the HCA shifts, this was to cover
sickness, vacancies and to provide enhanced observation (specials) to patients.
The new policies for use of specials and enhanced observation have been ratified and
launched. The new form for requesting additional temporary staff is now in use and is being
audited.
2
The use of a new daily safe staffing monitoring system with a simple Red, Amber Green
approach as well as a log of actions taken and re-assessment of the risk is planned for all
wards using an electronic method of data capture with a pilot on Chestnut completed. Roll
out to all wards is now underway.
Safety
Below is a screen shot from the Safety Thermometer (ST) website which demonstrates that
94.88% of our patients were harm free in September on the day of the snapshot audit. The
ST looks at all patients on one day every month in relation to a number of harms. This
includes old and new harms such as pressure ulcers, falls, catheter associated Urinary Tract
Infections (UTIs) and new blood clots (VTEs). There will be a mixture of avoidable and
unavoidable harms.
In September, on the day of the audit, 469 patients were surveyed with 445 being harm free.
There were 14 old (pre-existing) harms and 10 new ones. There were 15 old (inherited)
pressure ulcers and 4 new, 1 fall which caused harm to the patient, 4 old UTIs and 3 newly
diagnosed ones and finally 2 newly diagnosed VTE. It should be noted that even though
some harms were new or acquired whilst in our care, not all will have been avoidable due to
underlying clinical conditions or patient choice.
The chart above shows the monthly performance (% of patients harm free) and the numbers
of patients surveyed. For falls and pressure ulcers, there are a number that are deemed
unavoidable either because of patients’ choice/resistance to care or their underlying medical
or end of life condition(s). This number includes all harms so those that were old/inherited
and therefore not caused whilst an inpatient with the trust.
3
The chart overleaf shows the breakdown of harms by type.
Pressure Ulcers
All of the Root Cause Analysis (RCA) reports for grade 3 and 4’s continue to be signed off by
the Director of Nursing & Quality. The RCA tool has been amended considerably to reflect
the recent changes to Duty of Candour and will enable greater sharing of the reports
externally. Training now underway for key staff due to the significant changes and it is
anticipated that this will generate additional work divisionally but is an important part of the
trust learning lessons and being transparent.
In September there was one hospital acquired grade 3 pressure ulcer, 1 deep tissue injury
and 1 unstageable pressure ulcer. RCA’s are underway for these. Plans are in place for
closer monitoring and reporting of grade 2 ulcers going forward in Q4.
Falls
There were 122 falls in September, which is a disappointing increase from the 90 falls in
August. Two of these falls resulted in a fracture. Both occurred on CDU and both were
unwitnessed. Root Cause Analyses are currently underway to determine if the falls were
avoidable or unavoidable, and to identify any learning.
Of the 122 falls, 52 of these were unwitnessed or the patient was found on the floor by staff
(there were 39 in August). In September, Elm Court, Linden, Redwood and Spruce ward had
a higher number of falls than usual. Elm Court had 9 falls with one patient falling twice.
Linden ward had 12 falls from 6 patients- one patient fell 4 times whilst on the ward.
Redwood had 10 falls from three patients- one patient fell eight times (this patient was very
confused, aggressive and had a 1:1 nurse at the time), and Spruce had 18 falls from 12
patients; one patient fell three times and four patients fell twice. Additional care staff are
4
requested for 1:1 care for patients at risk of falls but these additional shifts are not always
filled due to lack of availability.
The fill rates were lower than expected and below 95% on all four wards with higher numbers
of falls. There may be a correlation in fill rates and falls although this is difficult to say for
certain. The Falls group will continue to monitor falls closely to see if there any concerns or
trends and if any interventions could help to reduce this further.
There has been a robust review of the Falls Policy, with new care plans included and a
significant review of the post falls protocol ensuring NICE guidance is included in both. There
is good multi-professional engagement in this agenda and a training needs analysis is
complete with training that started in September.
5
Patient Experience (Friends & Family Test)
1Extremely
Likely
2Likely
3Neither
likely
nor
unlikely
4Unlikely
5Extremely
unlikely
6 - Don't
Know
Response
rate
620
510
94
8
2
2
4
A&E
56
31
15
2
3
5
0
Maternity
214
176
34
3
0
1
0
Out Patients
444
339
90
10
0
2
3
35%
1%
55%
2%
1,334
1,056
233
23
5
10
7
Sept 15
Inpatient
Total
Total
collected
The results for FFT in September for inpatient areas had a reduced response rate of 35%
(48% in August) with an overall 97% of patients extremely likely or likely to recommend us
(97% in August).
The response rate remained very low in A&E at just 1% with 90% of patients extremely likely
or likely to recommend us (96% in August). This was a particularly busy month with
occupancy at 99-100% and a Black Status Serious Incident declared.
For Outpatients the response rate also remained low at 2% (also 2% in August) with 96% of
patients extremely likely or likely to recommend us (96% in August).
In Maternity the response rate overall was 55% which is the same response rate as in
August, albeit as usual, and as is the case nationally, community surveys were very low.
However, 98% of patients were extremely likely or likely to recommend us (the same as in
August).
Reasons given by patients for negative replies were as follows;
ED- Extremely unlikely
Long uncomfortable boring wait. Need heating and comfy seats and plug sockets to charge
phones.
My elderly parents up here with me. My mum had kidney failure. We came at 2 and are still
waiting at 9. It is disgusting and uncomfortable.
Waited 41/2 hours for my mum to be seen. She is sitting in her own urine and we are unable
to move her. Vomiting for 41/2 hours still not seen and no bed for her to lie down disgusting.
6
Long wait with no communication. No assessment required all information to hand from : 1)
Erith U.C.C. 2) Queen Mary U.C.C. 3) Queen Elizabeth U.C.C. Get rid of computers get back
to compassion and common sense.
It is long waiting time for patients
ED- Unlikely
3 visits to hospital, starting Friday evening. Husband with abscess, given tablets. Worse here
at Darent 3pm left 8.30, still no one came after A & E tests done to see him. Because of
Dementia he got very agitated so we left. Here again at 9 on Mon now 11.45 waiting for
surgical team to see us. Don't know how much longer this visit will be or surgery applied.
ED- Unlikely
I have refrained from suggesting "extremely unlikely" to recommend purely because of the
actual service received from the Doctor once seen. He was very inquisitive and
demonstrated a real interest in my concerns, however having to wait for over 5 hours is very
frustrating and uncomfortable. Dr Badmus well done !!
Aspen- Unlikely
Very understaffed to cope with demand therefore effects service and delays inevitable.
Makes the whole experience traumatic, rushed and means you cannot build a close bond
with your carers. Staff show their frustrations, quite rightly. Resources need to be sorted.
Rosewood- Extremely unlikely
I was put in an overflow bed in the bay window it was very drafty at night. Also being
opposite toilet people were constantly in and out and the door needs closure so it closes
quietly. There was no light or T.V. no emergency buzzer. Patient next to me was pouring with
blood from his arm had to wake patient opposite to press buzzer for attention.
Areas of low numbers of surveys have been asked to present their improvement plans and
any actions going forward to the Quality & Safety Committee and will also be discussed at
the Patient Experience Committee chaired by the Director of Nursing.
Vikki Leivers- Carruth, Director of Nursing & Quality
Ali Strowman, Deputy Director of Nursing
October 2015
7
Item 10-8. Attachment D – QS Summary Report October 2015
10-8
SUMMARY OF QUALITY AND SAFETY
COMMITTEE MEETING, OCTOBER 2015
COMMITTEE CHAIRMAN: NONEXECUTIVE DIRECTOR
Key discussion points:
Action points from previous meetings:
Action point 117: The Medical Director reported that for suspected cancer reporting there is a now a
system where results are reported to the MDM coordinator, consultant and the GP to ensure that
reports are acted upon. There is, however, the need for a new process for non-cancer findings.
Action point 118: The Head of Midwifery presented the nine point action plan that aimed to reduce the
rates of elective Caesareans sections at the Trust. Maternity Services have worked throughout 2015 to
reduce this rate to 11.6% in October 2015. There are still some challenges associated with the aims of
the project with the need for consistent decision making from clinicians and the need for the
improvements to be sustainable.
Action point 123: The re-audit of the service users survey, including triangulation with the staff survey,
will be presented in November 2015
Action point 134: The non-medical prescriber’s policy has been produced. All changes will be agreed
outside of the meeting and Q&SC will ratify the policy.
Action point 136: The Medical Director reported that the weekly SI meetings have begun to address this
issue however the need for Duty of Candour has led to a number RCA’s having to be re-drafted and this
has led to delays. The Q&SC wanted reassurance that there is robust action plans and learning from
serious incidents and should be reviewed in December 2015.
Action point 139: General Manager presented the new guidance that has been produced regarding the
use of cemented, hybrid and un-cemented total hip replacement. It also realises a £400K saving on the
use of prosthesis.
Action point 140: Consultant microbiologist confirmed he has met with Trauma and Orthopaedics
regarding SSI audit.
Action point 141: SSIs will be reported within the next annual report – June 2016
Action point 145: The Clinical Director asked that the impact of violence and aggression be reviewed
after the new A&E build is completed. The Q&SC agreed to defer the details on verbal and physical
assault when the next report is presented - April 2016
Action point 147: The CQC quality teams and mock inspections were presented in the meeting.
Action point 148: The annual effectiveness of the Q&SC was presented in the meeting.
Directorate Report – Paediatrics: The report was presented by the Matron, General Manager (GM)
and Clinical Director who said that complaints remain low but the Directorate does actively encourage
feedback. To that end, a mother of one of the patients has shared her experiences with the band 6
nurses and this was a very powerful learning tool for the directorate.
There have been three serious incidents; one involving a wrong dose of insulin to a child; another
regarding a child given the wrong breast milk and the third regarding a mis-identification of siblings for
an allergy test. These have all been subject to investigation and actions plans produced.
Recruitment and retention of staff is an on-going issue and there are 11 members of staff on maternity
leave. This is being addressed by appointment of staff on fixed term contracts to cover this absence.
The Matron assured the Q&SC that staff would have their contract extended if they were considered an
asset to the directorate.
Q&SC asked for assurance regarding the paediatric advanced nurse practitioner. The matron stated
that there are now two senior members of staff in training with the third to start in January 2016.
1
Audit meetings are conducted once a month; the Feverish illness in children audit was originally
reported as an ICE 1 audit but this has showed significant improvement and is now rated as an ICE 4.
The re-audit of the service users survey, including triangulation with the staff survey, will be presented
in November 2015
Action: It was agreed that the Ward Manager, Willow Ward, will present the re-audit of the
service user’s survey at the next Q&SC meeting.
Directorate Report – Obstetrics and Gynaecology: The report was presented by the Head of
Midwifery and the Clinical Director (CD) who said that the Maternity services continue to show an
increase in activity with 474 women giving birth in September 2015. The stillbirth rate continues to be
low at 3.9 per 1000 births compare to national figures of 5.3 per 1000 births.
Umbilical cord complications for 2014 were reported as high (7% compared with 1.5% for peer). The
Head of Midwifery reviewed 133 cases and found that minor cord problems (e.g. cord entanglement,
short cord, true knot in the cord) had been misinterpreted as cord complication. The true cord prolapse
complication rate was found to be 2.26% or the reviewed dataset.
The Q&SC asked for reassurance that the elective Caesareans section rate should continue to be
monitored and should be included in the next report.
Action: It was agreed that the GM would provide information on the elective caesarean rate
when the directorate report is next presented.
Directorate Report – Emergency Department: The report was presented by the interim General
Manager and Clinical Director who said that one of the main challenges in the department was that
recruitment remained an issue. There had been a successful business case for two new consultants
with interviews in December 2015. However, the number substantive middle grades had slipped back
from 12 to eight. A business case will be presented to increase this to 23 positions. The Clinical
Director highlighted the Caesar Fellowship programmes that may help to address the recruitment to
these posts. Nursing vacancies is also an issue with 20 vacancies.
The A&E rebuild is progressing well with the minors Unit planned to handed over on the 29 October and
re-open on the 30 October 2015.
It was highlighted that the lack of substantive middle grades was hampering the completion of audits
within the department. The Q&SC asked that the Clinical Director present a more realistic and robust
plan for audit to take into account the number of substantive middle grades and the capacity for audit.
Action: It was agreed that the Clinical Director will present an updated audit plan and report
back to Q&SC in January 2016.
Quality and Safety Committee Committee Annual Review: The acting Chairman of the Q&SC
presented the results of the questionnaire but also highlighted the following concerns:
Directorate reports need to focus more on assurance with increased emphasis on self-assessment of
the impact of issues and risks
There needs to be specific action plans as too many action plans were ill thought through and/or nonspecific. Accountability within the Directorate needs to be clearer to allow follow-up and monitoring.
Reports should be presented as per the Q&SC reporting timetable. If this was not possible the General
Manager (or equivalent) must present themselves to explain why the report is not prepared.
Report data should be consistent and must be checked against Trust data sources.
Action: It was agreed that the acting Chairman of the Q&SC will meet with the Chairman of the
Q&SC and the AD Governance to review the report and produce robust actions to address the
concerns of the review.
2
Infection Control Report and Antimicrobial Update Report: The report was presented by the
Medical Director who said there have now been four MRSA case in the year to date. The Trust is above
its trajectory for MRSA. There have also been three C. difficle cases in September giving a total of 12
for the year to date. This is in line with the trajectory. In addition there have been 18 E.coli cases in the
year to date and this is also above trajectory
The Happi audit has had another good score this month with all areas above 80%.
The Q&SC asked if there was any reason for the increase in MRSA, C. difficle and E.coli infections. The
Medical Director highlighted that one member of the Infection Control team (out of three) was on long
term sick and this affected the efficiency of the team. In addition the increase in training frequency had
put additional pressure on the Infection Control team. A decision had been taken to buy in extra
training from external contractors to address this and will aim to get as many staff trained in November.
Q&SC asked if there should be executive endorsement of the training programme via short video
introduction. The Medical Director will discuss this with the Director of Nursing.
Dementia Carers Survey Report: The report was presented by the Deputy Director of Nursing (DoN)
stating that the report evaluated carer support provision with the Trust against the national standards.
Overall the results were very positive with excellent achievement around supporting carers.
Patient Safety Committee (PSC) Report including Mortality Working Group: The report was given
by the Patient Safety Committee Chair who said that the PSC has reviewed 35 incidents this month of
which 19 were inside the internal 45 day target, and 16 (46%) have breached the 45 day internal target.
Nine cases had been closed this month and five previously closed cases brought back for review of
action plan progress.
The PSC Chairman said that there is still a delay in closing pressure ulcer cases on the STEIS but that
the situation has started to improve.
The Serious Incident Declaration (SID) Group has been meeting weekly and reviews all new potential
SI cases. Q&SC asked how learning between departments and directorates was disseminated and the
Chairman of the PSC stated that there was a regular newsletter that was disseminated across the entire
hospital that included examples of recent cases. The Newsletter this month is a briefing on two patient
safety incidents and was circulated with the papers.
The Mortality Working Group was presented by the Medical Director who highlighted that the latest
standardised mortality rate was now 74.2 even though the SHMI data was still slightly elevated at 105.
This was explained in that it included the high mortality rate seen in January 2015.
The Mortality Review group had looked at 14 patients and in all but one case the care was considered
to be of a good standard. The Medical Director reported that the TDA had attended the last Mortality
Review Group meeting but wanted further reassurance regarding reporting to the Board. Therefore, the
TDA may wish to attend a Q&SC meeting to gain further assurance regarding the mortality reporting
process.
NICE Guidances and NICE Quality Standards Report: The report was presented by the Medical
Director who said that 27 guidances have been issued for the first quarter in 2015/16. Of these
guidance’s 6 had not received confirmation of review yet but there was a robust method to follow up
those guidance’s awaiting review. This was demonstrated by that in the last quarter there were no
guidance’s awaiting review. Compliance with NICE guidance is also generally good. There were no
questions.
Quarterly Patient Experience Report : The Deputy DoN presented the report noting that 69 formal
complaints have been received for the month. Five complaints were for Queen Mary’s and one for Elm
Court. The complaint acknowledgment rate is 100% within three days.
The main themes of complaints are clinical treatment, communication and attitude, and care.
PALS have received 376 informal enquiries for the month compared to 333 the previous month. Most of
these were by telephone with the main focus being on waiting times and communication issues.
Three enquiries were forwarded to be managed within the formal complaints process.
3
The complaints response rate was reported as less than 50% answered within 25 working days and the
Q&SC considered that this level of response rate was unacceptable. It was requested that an action
plan to address the response rate be included in the next report.
The report also highlighted the Friends and Family Test and social media concerns. The Q&SC asked
why the report covered two different reporting periods, April – June for complaints/PALs and April –
August for Friends and Family. The Deputy DoN will ensure that the next report ensures that the
reporting period is the same for all parts of the report
Action: It was agreed that the DoN will (a) revise the next report so that all sections of the report
cover the same time period and (b) there will be a robust action plan to address the complaints
response times.
Maternity Safeguarding Report: The report was presented by the Head of Midwifery who highlighted
that the team manage over 270 active cases at any one time. The link with mental health is the most
common and challenging. Other significant features of note are the rise in reported cases of
domestic violence and female genital mutilation.
Q&SC were concerned regarding the level of activity and whether there was the resource to maintain
the level of service. The Head of Midwifery agreed that this should be addressed via a business case
Trust Risk Register Update: The Senior Governance Manager presented the report stating that one
new risk had been added to the Risk Register associated with the autoclaves/sterilizers in the Sterile
Service Unit. This risk was assessed as a 16. The Trust has two other risks at 16+; which are the
imbalance between admission and discharge and the financial risk making together 16 open risks.
Internal Quality Inspection Reports: These reports were presented by the Deputy Director of Nursing
(DoN) who said that 13 wards had been inspected up to the end of September. Feedback has been
given to the wards and action plans are being devised to address any concerns.
The reports are based on teams of three people and look at records and interview patients and staff
and are based on CQC standards. The Q&SC complemented the Deputy Do N on the work.
National Joint Registry Report: The report deferred until November 2015
Reports received:
 Directorate Report – Paediatrics
 Directorate Report – Obstetrics and Gynaecology
 Directorate Report – Emergency Department
 Infection Prevention and Control Report
 Dementia Carers Survey Report
 Patient Safety Committee Report including Mortality Working Group Report
 NICE Guidances and NICE Quality Standards Report
 Quarterly Patient Experience Update
 Maternity Safeguarding Report
 Trust Risk Register Report
 Internal Quality Inspection Reports
 National Joint Registry Report
Agenda items
 New Guidances – none
 New National Confidential Enquiries - none
 New Interventional Procedures – none
 Policies for ratification: none
4
Actions for the Board: To note the report
Reason for receipt at the Board (decision, discussion, information, assurance etc.) 1
Information and assurance
Board members are also invited to consider whether they wish for any items to be subject to further
discussion within the Board meeting, and if so, to make such a request, either via the Chair of the
Quality & Safety Committee, or via the Board Chairman.
This report provides information on the following annual objective themes:
 Quality of care and patient safety;
 Organisational capability (investing in our staff and infrastructure); and
 Partnership and engagement (working with patients, community representatives, the Local Authority and the new Clinical
Commissioners)
1
All information received by the Board should pass at least one of the tests from ‘The Intelligent Board’ & ‘Safe in the knowledge: How
do NHS Trust Boards ensure safe care for their patients’: the information prompts relevant & constructive challenge; the information
supports informed decision-making; the information is effective in providing early warning of potential problems; the information reflects
the experiences of users & services; the information develops Directors understanding of the Trust & its performance
5
Item 10-8. Attachment E – QS Minutes 17.09.15 Final
MINUTES OF QUALITY & SAFETY COMMITTEE MEETING
HELD ON THURSDAY 17 SEPTEMBER 2015
Present:
Ms Karen Taylor, Non-Executive Director (Chair) (KT)
Mr David Findley, Non-Executive Director (DF)
Mr Janardan Sofat, Trust Chairman (JS)
Ms Susan Acott, Chief Executive (SA)
Ms Annette Schreiner, Medical Director (AS)
Ms Vikki Leivers-Carruth, Director of Nursing (VLC)
Dr Darshinder Sethi, Chair of Patient Safety Committee (DS)
Ms Deborah McAllion, Head of Midwifery (DMcA)
Ms Sue Craven, Assistant Director of Governance (SC)
Mr Peter Coles, Non- Executive Director (PC)
Mr Steve Wilmshurst, Non-Executive Director (SW)
Mr Stuart Jeffery, Director of Information (SJ)
Apologies:
Ms Eileen Brookson, Head of Nutrition & Dietetics (EB)
Invitees present:
Dr Kevin Kelleher, Clinical Director, Adult Medicine (KK)
Ms Sarah Collins, General Manager, Adult Medicine (SCo)
Mr Clive Aubrey, Interim General Manager, Pathology (CA)
Ms Julia Scott, Deputy Chief Pharmacist (JSc)
Dr Happy Hoque, Clinical Lead, QMS (HH)
Ms Gail Locock, Deputy Chief Nurse/Infection Prevention & Control Lead, North Kent CCGs (GL)
Mr Ben Day, Audit Manager, TIAA (BD)
Ms Kay Clarke, Palliative Care Lead Nurse, (KC)
Ms Ali Strowman, Deputy Director of Nursing (ASt)
2.
MINUTES OF THE MEETING HELD ON 20 AUGUST 2015
The Minutes were agreed as a true record.
3.
OUTSTANDING ACTIONS AND ACTIONS FROM MEETING OF
20 AUGUST 2015
As recorded on Action Log.
4.
AUGUST Q&S COMMITTEE REPORT TO TRUST BOARD
The report was noted. No questions were raised.
5.
QUALITY GOVERNANCE REPORT Q1
AS briefed the meeting on the report noting the following:
• Complaints received in surgery, Obs & Gynae and Emergency
Department have reduced this quarter.
• Incident reporting in Adult Medicine has increased.
Q&SC – 17/9/15 – EA
-1
Action
•
•
•
Recording of Duty of Candour has improved verbally, but written
information is not so well documented.
The outstanding NICE guidances reported last time have all been
completed.
Clinical Alert System (CAS) is up to date.
AS added that although under section 6, ICE 1 Audits, of the report there
are 7 reds and 2 green, ICE scores have improved and with the new
leadership in Clinical Audit she feels that this will diminish in future.
DF felt that the statistics at the beginning of report in incident reporting per
1,000 beds was very useful and would like to see that same form of
reporting in other Directorates’ reports. He also enquired whether
Directorates report actions against ICE audits. AS confirmed that this was
the case. SW asked what happens if there is no improvement. AS stated
that it is then brought to the Trust Risk Register.
KT enquired how the Trust is performing in mortality. AS stated that crude
mortality is good we are below national peer for the last 12 months with the
exception of January 2015. She explained that CHKS Summary Hospital
Mortality Indicator (SHMI) only report deaths in hospitals but the National
SHMI differs because they report deaths in hospitals and up to 30 days after
discharge. Since January the National Data shows an improvement.
DF expressed concern at the increase in attacks on staff in A&E. VLC
explained that she was in discussions with the Police on how to deal with
aggressive patients. DF felt that this should be reported in the next A&E
report to the committee. KT added that the Emergency Department will be
reporting to the committee next month and will ensure that this is in the
report.
ACTION: Emergency Department to ensure that increase in
aggressive patients and how the department is dealing with this to be
in the report.
6.
DIRECTORATE REPORTS
(a) Cancer Services
SCo updated the meeting on the report informing the committee that the
Trust is the only Trust in Kent to be achieving 62 day cancer GP Referral to
Treatment target. She added that meeting the screening target is still a
challenge but is in regular weekly meetings with the Bowel Screening team
in order to address the issue.
The Rapid Access 2 week wait referrals has also proved a challenge in
endoscopy, radiology, chemotherapy and clinic capacity she explained how
the department was implementing extra lists, evening clinics, Saturday lists.
The Endoscopy business cases has been presented and agreed this will
increase capacity once the new build is completed.
KT noted that there had been an increase in the number of falls and
wondered if this was avoidable. SCo felt that this was due to the number of
patients coming through the department, but they are monitoring more
closely to ensure that the number do not rise and the they are trying to
manage frail elderly patients in a better way.
KT enquired what the activity levels were as these were not recorded in the
Q&SC – 17/9/15 – EA
-2
AT/WM
report. SCo stated that there had been a huge increase in activity.
Discussions took place about the type of content required in the report. SA
said that the report as presented was focussed towards the nursing side of
cancer care and that a report from the Cancer Committee would provide
information on the medical care issues in a more rounded report. SCo
commented that the Cancer Committee will be meeting this Friday (19th
September) and bring it to the committee’s attention. She added she will
provide a copy of the report to the Quality & Safety committee for review to
ensure it is what is required.
ACTION: SCo to send copy of the Cancer Committee’s report to SA &
VLC and the Q&SC workplan be amended to include a report from the
Cancer Committee in place of the current Directorate report. Reporting
of quality and safety metrics to continue with actions and learning
from complaints and incidents.
PC enquired how the chemotherapy E-prescribing issue was progressing as
this has been highlighted as a risk in the report. SCo responded by
updating the committee that the ‘Go Live’ date had been delayed due to
issues raised with process and training that is being addressed by the
network team.
DF enquired how the relationship between pathology and MTW was
progressing. SCo stated that Chris Gunn (former General Manager in
Pathology) had worked closely with MTW and both now have a good
relationship but continues to be monitored closely.
DF asked how any staff related issues are addressed. SCo confirmed that
these were discussed at directorate meetings.
(b) Adult Medicine
SCo informed the meeting that the department have been working hard to
improve and strengthen governance arrangements by making each lead
accountable for the new structure. The directorate continues to work to
reduce the number of falls; the work plan from the recent JAG accreditations
visit for Endoscopy is progressing; a fifth cardiologist consultant has been
appointed and will join the department in December; the new Ageing and
Health Frailty and Ambulatory Care Service is proving a challenge but is
progressing.
SW enquired if there was any news on the recent JAG visit. KK stated that
the Trust have achieved JAG but are awaiting written confirmation. SA &
SW congratulated KK and the department.
DF noted that the ambulatory care target was set at 700 but last year only
achieved 400 which seems way below target. SCo explained that currently
there are only three couches but when the new ward is opened and running
at full capacity with 8 couches and 4 chairs then the numbers should
improve. She added that those who have used the facility have responded
positively.
JS asked whether the ambulatory care unit has an impact on the
department’s readmission rates and how this is reflected. SCo stated that
yesterday she had a meeting to discuss this very issue and that the
department is working closely with the Coding Department to ensure
appropriate coding.
Q&SC – 17/9/15 – EA
-3
SCo/SC
SA recent presentation from Philips stated that level of community provision
is very low by GP compared with other counties and they felt that for new
patients in the area the navigation is not good because of this.
KT requested that a report dedicated to the progress made on the
Ambulatory Care pathways initiative be brought to the meeting in 6 months’
time.
ACTION: SCo to provide a progress report on the Ambulatory Care
Pathways in 6 months’ time.
SCo
KT noted that although length of stay (LOS) patients continues to be a
challenge there was a reduction in July and questioned if anything
happened differently to achieve this. SCo stated that LOS differs from day
to day and that it continues to be a challenge.
DF requested that more information be made available in the next report in
relation to the Junior Doctors Morale section on Page 14 of the report.
ACTION: Further information to be included in next report on Junior
Doctors morale.
SCo
(c) Pathology
KT welcomed CA to the meeting. CA briefed the meeting on the report
highlighting the following:
• Point of Care (POC) Manager Darren Browne is to carry out audits
and will be setting up POC Committee and policy.
• The recruitment process to employ a POC assistant is slightly
behind but are hoping to appoint in a few months.
• UKAS pathology accreditation visits have taken place in
Microbiology and Biochemistry. Biochemistry has been
recommended for UKAS accreditation and Microbiology has
maintained CPA and will address the issues they need to achieve
UKAS accreditation.
• Haematology will not be assessed until next year.
• A trainee has been appointed to start mid-October in the Mortuary.
CA added that since the report has been written the Emergency Department
turnaround times has improved. He has also spoken to Mark Holland,
Pathology General Manager at Maidstone and Tunbridge Wells NHS Trust
in connection with the histology turnaround times and is happy that things
seem to be improving.
SW enquired that although a POC testing manager has been appointed
how confident is CA that there is no other POC testing going on within the
hospital. CA is not aware of any but this is the purpose of setting up the
POC committee and policy.
The service still needs an increase in staffing to move to a shift system of
working for Biomedical Scientists (BMS). Interviews are planned but there is
much competition from the private sector laboratories which are offering
significant recruitment incentives to staff.
ACTION: CA requested to include an update on BMS recruitment and
associated risks in the next report.
Q&SC – 17/9/15 – EA
-4
CA
7
INFECTION PREVENTION AND CONTROL REPORT
AS updated the meeting on the report, noting that there was 1 MRSA
bacteraemia which will be discussed at a PIR meeting after the QSC
meeting, there have been no C.Diff or MSSA and 3 E.coli’s. There has
been an outbreak of pseudomonas infections on ITU (2 patients).
SW enquired when the Trust last had a multi-resistant pseudomonas
outbreak. AS was unable to remember, she added that August was a good
month for pharmacy intervention the second lowest month. SA noted that
C.diff usually spikes in August and September which has been related to
the new junior doctor intake. AS added that regular 1½ hour training session
has been in operation since August last year in order to reduce these
figures.
The QSC heard that there appears to have been an end of summer MRSA
spike across other areas of Kent and the reasons for this are as yet unclear.
8
INFORMATION GOVERNANCE COMMITTEE
SJ informed the meeting that there has been on IG breach reported to the
Information Commissioner’s Office (ICO) in June and that 85% of freedom
of information requested has been responded to within 20 days.
DF enquired in connection with the Bexley incident what has been done to
avoid this happening again. SJ stated that it was just human error and that
the individual concerned was given personal training. Further discussions
took place on the rationale behind using faxes as opposed to sending via
email.
9.
(a) PATIENT SAFETY COMMITTEE REPORT
DS gave an overview of the report. There have been 33 incidents reviewed
this month of which 8 have been opened for more than 45 days and 10
which are new.
DS expressed concern that the Trust need to be more aware of patient
safety in view of the increase in patient activity due to closures. NJ stated
that the A&E department at Medway Foundation Trust will only divert two
days a week.
AS briefed the meeting on Appendix 1 of the report (Mortality Working
Group). 17 patients were discussed at a recent meeting held on 28th August
2015 and there was only one case where it was felt that care fell short but
did not contribute to the death. She added that after the spike in January
the Trust has returned at/below the national crude mortality rate since
February.
AS informed the meeting that the Trust Development Agency (TDA) are
very keen to attend the QSC meeting to discuss asked if the committee
would agree. KT confirmed that this was agreeable with the committee.
SA stated that she would like to look at ways to change the format of the
Mortality Report as the report looks back over previous months and feels
that the report should look forward and at ways to improve. AS explained
that TDA requested that the report be in this format. KT suggested that
when the TDA attend the QSC meeting the format of the report can be
Q&SC – 17/9/15 – EA
-5
discussed.
ACTION: AS to invite the TDA to attend a QSC meeting.
AS
(b) CASES CLOSED BY THE PATIENT SAFETY COMMITTEE
The paper was noted by the committee.
10.
SAFETY THERMOMETER UPDATE
DMcA briefed the meeting on the report explaining how the previous report
was on NHS Maternity Safety Thermometer, which is currently receiving
national attention. In April 2015 the Trust moved to a locally agreed
measurement tool for Medications Safety.
VLC congratulated DMcA on a well written report but felt that the safety
thermometer can sometimes be misleading for instance:
• It doesn’t record every pressure ulcer for every patients, i.e. patient
may have four pressure ulcers but will only be recorded as one.
• Records old and new harms not just new, i.e. does note separate.
• She felt it could make the chart look more dramatic
She added that the Patient Safety Committee look at all new harms. The
Clinical Nurse Board also reviews the Safety Thermometer data regularly
and has discussed the Falls with Harm (patients with harm from a fall) and
the progress of actions in place to reduce these.
11.
COMPLAINTS AND PALS REPORT
VLC informed the meeting that there were a total of 33 formal complaints for
the month of July.
• The volume of complaints increased slightly in July
• In adult medicine complaints have decreased
• There were 7 complaints for Surgery
• There has been a slight increase in complaints for Women’s &
Children and Emergency Department
• Trauma and Orthopaedics have now been separated from the
surgery directorate and this is the first time the complaints have
been recorded. When compared to the other directorates it became
apparent that they had the highest rate of complaints per 1000 bed
days. VLC and Professor Sriprasad are looking at ways to help the
Directorate.
• SA noted that a chart for Therapies is not included and suggested
that this should be in future reports.
• The information about the complaints process has been made more
visible on the wards and the QSC requested that any patient
feedback received by this route be included in the report.
ACTION: Therapies complaints information to be included in the report
and that the quarterly Patient Experience report should include a
section reviewing the impact of additional feedback received from the
wards.
Q&SC – 17/9/15 – EA
-6
VLC
12.
TRUST RISK REGISTER REPORT
SJ presented the report informing the meeting that no new risks were
discussed and out of the 15 open risks 4 were closed.
SW and DW both enquired about Risk1544 and whether SJ can assure the
Committee that just because the generator has been repaired what
procedures are in place to ensure that it doesn’t happen again. JS stated
that supply chain is trying to obtain enough parts to keep these available.
13.
SAFEGUARDING REPORT
VLC explained that on this occasion the report only contains reports from
adults and children and the maternity safeguarding report will be presented
to the committee next month and that the full Annual Report will be
presented to the Board in October.
JS enquired how the Deprivations of Liberty Safeguards (DOLS)
consultation paper, when completed, will work. VLC explained it is a very
complex process and the Trust will need to ensure that it works within the
guidelines. JS asked how it takes into account relatives and carers. VLC
explained that it involves them and it is also reassuring them that there is a
process in place.
DF asked whether 16-18 year olds with learning difficulties in A&E who are
on the social services risk register, if there is enough being done to support
them. VLC agreed that this is quite a complex group known to the social
services. AStr stated that there are regular meetings held with the Adult,
Maternity and Children Safeguarding team to address this.
14.
INTERNAL QUALITY INSPECTION
ASt explained how a number of unannounced quality inspections will be
taking weekly and that all clinical areas will be inspected. She informed the
meeting that these inspections commenced in August and all clinical areas
in the Trust should have been inspected by the end of October. The
inspection teams consist of three Trust Staff one of whom is a clinician. So
far four wards have been inspected these are Linden, CDU, Oak and
Juniper. The outcomes of Linden and CDU have been included in the
report submitted.
JS enquired how the patients received the inspection. ASt felt that they
were well received; one patient was interviewed twice each time on a
different ward. She added that the team check with the nurse in charge
who they should and shouldn’t talk too and she felt that it was a good way to
identify areas for improvement.
JS asked if the Non- Executive Directors could join the team. ASt stated that
an invite was extended to the Non- Executives at the last Board meeting.
JS are the Governors able to join. VLC confirmed that the Governors were
invited yesterday at the Patient Experience Committee and they are all very
interested. VLC and ASt will send out invites to Non-Executives and the
Governors.
It was also noted that the CCG walkabout inspections currently had a
separate timetable and GL asked if these could also amalgamated into the
trust programme – this was agreed.
Q&SC – 17/9/15 – EA
-7
ACTION: VLC and ASt to send out invitations to join the inspection
VLC/ASt
team to all Non-Executive Directors, Governors and the CCG Quality
team.
15.
ANNUAL LEARNING DISABILITIES REPORT
GT briefed the meeting on the report. She added that adjustments that
have been made within the Emergency Department with regards to
notification of patients attending with learning difficulties appear to be
working well. She gave an example of how a patient with learning
difficulties was seen, treated and given medication within an hour.
Unfortunately this does not appear to be working as well in the Community
and this is being targeted with additional education on the pathways and
services available for patients with learning disabilities.
16.
NATIONAL CARE OF THE DYING REPORT
KC explained how the palliative care team are developing end of life care
provision with the Trust. Phase two pilot of individualised care plans are to
start in September and then be rolled out across the Trust in December
2015. She added that lack of hospice beds and delays in transfer to nursing
homes for the end of life patients is a risk along with limited palliative care
consultant cover and bereavement support for families.
There has been an audit on quality of death for patients at the end of life
and a palliative care audit for patients attending A&E for which the results
are awaited.
SA enquired if lack of capacity is known to the CCG. NJ will check and get
back to her. KT requested that when Phase two of pilot is completed KC to
send report to QSC.
ACTION: KC to report back the findings from the A&E audit in the next
report.
KT also, on behalf of the Committee, congratulated the Palliative Care
Team on achieving 2nd place in the annual audit competition for ‘Home to
Die’ audit. Also KC in her nomination for excellence in leadership award.
17.
QUALITY ACCOUNT PRIORITIES 2015/16 UPDATE
VLC presented the report informing the meeting that indicators that were
being reported for all the priorities were very positive so far. No questions
were raised.
18.
QUALITY & SAFETY EFFECTIVENESS REVIEW
KT stated that as there has been insufficient time to discuss suggestions
given in the survey that this be brought back to the meeting in October but
higher up on the agenda.
ACTION: To be discussed again in October’s meeting.
19.
NEW INTERVENTIONAL PROCEDURES
There were no new interventional procedures for discussion.
20.
NEW GUIDANCE FOR INFORMATION
Q&SC – 17/9/15 – EA
-8
KC
There were no new guidances for discussion.
21.
ANY OTHER BUSINESS
No Any Other Business was received.
DATE OF NEXT MEETING
The next meeting will be held on Thursday 15 October 2015 at 12.303.30pm in the Boardroom, Level 4, DVH.
Q&SC – 17/9/15 – EA
-9
Item 10-10. Attachment F1 – Quarterly Patient Experience Report
QUALITY AND SAFETY COMMITTEE - OCTOBER 2015
Quarterly Patient Experience Report June - August 2015
RESPONSIBLE EXEC: Director of Nursing and Quality
Introduction:
This report details the Patient Experience report for June, July and August 2015, and the
complaints, Patient Advice and Liaison Service (PALS) report for Quarter One 2015-2016. As
an organisation, the Trust recognises that by responding well to complaints and feedback
from patients we improve the patient and carer experience and increase public confidence in
the services that we provide.
The report details feedback on the Friends and Family Test (FFT); feedback via Social Media
sources; the Trust award system of Every Thankyou Counts and complaints received in the
quarter. Due to the time lag with complaints (as they remain open for a minimum of 25 days)
the reporting period in this report is different for complaints and FFT & Social media feedback
which is much more real time.
Key risks identified:
The need for a continued focus on obtaining feedback from our patients via the Friends and
Family Test. In some clinical areas response rates are low.
There needs to be an improvement in the Directorate response times for formal complaints.
Sue Cox
Senior Clinical Governance Manager
Reason for submission of report to Quality and Safety Committee – discussion
and assurance.
1
Overview
The Trust is committed to improving patient experience, using complaints and other forms of
feedback to better understand the areas where we perform well and those areas where we
need to do better.
The Trust receives feedback through a variety of channels and this report outlines the main
themes from complaints during June - August 2015. Feedback routes now include online
communications, compliments, complaints, PALS and social media including NHS Choices
comments, Twitter feedback and Facebook postings.
This report details the complaints, Patient Advice and Liaison Service (PALS) and compliments
received by the Trust during the time frame (June – August 2015). As an organisation, the
Trust recognises that by responding well to complaints and feedback from patients we improve
the patient and carer experience and increase public confidence in the services that we
provide.
The report is intended to provide the Quality and Safety Committee and Trust Board with
assurance that patients accessing the Trust are receiving a high quality experience which
meets their individual needs.
The Friends and family Test (FFT)
The Friends and Family Test is a mandatory requirement for all acute Trusts. Patients are
asked whether they would recommend the Trust to their friends and family. This is an
important opportunity to receive feedback on the care and treatment patients experience and
to elicit information regarding trends in care which can be used to improve our services, where
needed.
Patients are asked whether they would recommend maternity services, hospital wards and
A&E departments to their friends and family if they needed similar care or treatment. In
addition to these areas, from March 2015, all outpatients and day care services at satellite sites
where Dartford and Gravesham NHS Trust provide services also have been included in the FFT
survey. It should be noted that there is not an evidence base for these figures, albeit the trust is
of course keen to canvass the views of as many patients as possible.
The data below demonstrates that of the patients who completed the FFT survey, high
percentages, consistently over 95% would recommend the service they used within the Trust to
their friends and family. This is a slight improvement on the previous three months.
Of note is the general slight decrease in satisfaction for July 2015, which is echoed in a raise in
complaints (n=33) for the same month.
2
Figure 1 FFT Recommended Results (by percentage)
Figure 2 FFT Not Recommended Results (by percentage)
Other than an increase in response rates for the Maternity Directorate, the response rate for
the Trust remains static. The online electronic kiosk system that is proposed for the Outpatient
Department is aimed to improve response rates further.
It should be noted that the Senior Nurse/ Matron role for the Emergency Department has been
vacant during this time. Active recruitment is underway for this role.
Figure 3 Response rate (by percentage)
3
The FFT survey also collects specific comments made by patients on the care they received.
Mostly these comments are positive, but occasionally they are negative. As the survey is
completed anonymously it is difficult to follow up with patient to gain further information if the
comment is negative. However, comments are fed back to the clinical area in order to drive
continuous improvement.
Some of the positive comments included:
Juniper ward
‘Everyone from doctors to porters have been excellent. The nurses work so hard and can't do
enough for you. I have watched them with the elderly being so kind and patient. I wanted to
know every detail of what I was taking, having done and why and it was all clearly explained.
The ward was constantly cleaned. I felt my treatment here was exceptional shame I can't say
the same about my doctor's surgery!’
Rosewood ward
‘They have been excellent in every way in catering for my needs. Nothing has been too much
trouble and always done with professionalism. I am very grateful for all the help they have
given me’.
Mulberry ward
‘Attentive, informative team. Friendly and sympathetic to all situations. Patient care was of the
highest calibre’.
The positive feedback is also represented below in a word cloud
4
Some of the negative comments included:
Emergency Department
‘Lack of patient care. Rude staff who treat patients like second class citizens.
Would not because all members of my family who have been treated here have been treated
badly’.
Out-patients
‘Very dissatisfied with service given. Doctors don't listen to patients concerns and issues.
Discharge patients even though they know there are issues. Feel very disappointed and
disheartened after the service I have had today’.
Day Care Unit
‘Surgeon was an hour late didn’t get into Theatre until 4.30pm wasn't allowed to eat from 6am.
I am extremely disappointed the way I have been treated and the system is slow’.
Ebony ward
Whilst 1 or 2 of the auxiliary staff went above and beyond and were more than helpful, they
were in a minority! The hospital regarding visitor's toilets & cleanliness leaves a lot to be
desired & the prices of parking is ridiculous when you have a family member in your care for a
long time. Unkindness in some nurses. They were very abrupt in their mannerisms especially
night staff. Apart from that everybody was more than compatible.
The negative feedback is also represented below in a word cloud.
5
Every Thank you Counts
The Every Thank You Counts Awards scheme has been running since October 2011. Patients
are able to nominate staff who have gone the extra mile in providing care and support to
patients. Patients are able to nominate staff via cards, emails, nomination forms and by using
the online form on the trust website.
Patients continue to send in compliments to the Trust via online nomination forms, NHS
Choices, Facebook, Twitter, thank you cards, letters and other general thank you emails.
The awards ceremony is held at regular intervals during the year. However, there has been no
awards ceremony during this reporting period.
Patient Feedback via Social Media
Patient feedback is actively sought by the trust through the friends and family test and patients
can actively feedback to the trust through NHS Choices, Patient Opinion, Facebook, PALs
twitter or email.
NHS Choices
6
Feedback Comments
August:
Positive: 7
Negative: 2
July:
Positive: 10 Negative: 1
June:
Positive 11
Negative: 2
7
Facebook and Twitter
The Trust has a very active Facebook page through wihich it provides updates regarding Trust
achivements and recives patient feedback. Below is a snapshot of some of the positive and
negative comments received via social media for this reporting time frame.
8
Patient Experience Committee (PEC)
This group meets bi-monthly and is chaired by the Director of Nursing and Quality and reports
to the Quality and Safety Committee.
Representatives from a variety of areas, including Governors, and a representative from
Healthwatch come together and share information, learning, actions and best practice. The
committee are currently focussing on the Patient Engagment Strategy and associated actions
with this, as well as devising a patient leaflet for information about discharge home.
The PEC are overseeing the latest national inpatient survey results and action plan.
Complaints and PALS
This is the complaints and PALS activity and performance for Quarter One (April, May and
June) 2015. The report includes information on PALS enquiries and formal complaints
received in relation to the services now managed by Dartford & Gravesham NHS Trust at
Queen Mary’s Sidcup site, Erith Hospital and Elm Court.
9
The data included within this report is captured through the DATIX risk management system
and highlights the following key points:
Complaints
A total of 69 formal complaints were received for Quarter One 2015-2016 compared to 98 for
quarter four 2014/15, (27 for April, 21 for May and 21 for June). 5 complaints relate to the
QMS site, 1 from Elm Court and no complaints from the Erith site.
Table 1 Formal complaints by Directorate
1. Complaints by ward/department area
Table 2 Trust complaints by Directorate and month
Directorate
Adult Medicine
(includes
Haematology)
Emergency
Medicine
Maternity
Paediatrics
Radiology
Surgery
(includes
urology)
Trauma and
Orthopaedics
Urology
Others
Total for
Quarter
23
April
May
June
9
6
8
9
2
2
5
9
2
8
6
3
0
2
6
3
1
4
0
3
1
2
0
3
1
1
1
3
6
1
4
2
2
0
0
2. Complaints by subject.
Figure 1 Trust complaints by Primary subject
10
Complaints Data
1. Volume of complaints by month
Complaints received for quarter one 2015-16 show a slight but steady decline when compared
to quarter four 2014-15. The Trust rate of 1.0 complaints per 1,000 bed days is within control
limits and below average.
Table 4 Trust complaints per 1000 bed days
Apr14
17
May14
14
33
Aug14
42
Sep14
40
Oct14
32
35
24166
24585
23188
33
25
32
35
27
27
21
21
24956
22834
23180
25032
22647
24077
24059
21848
23851
23314
23389
23710
0.7
0.6
1.2
1.2
1.5
1.3
1.8
1.7
1.3
1.5
1.0
1.3
1.6
1.1
1.2
1.0
1.0
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.61
1.61
1.2
1.61
1.61
1.61
1.61
1.61
1.61
1.61
1.61
1.61
1.61
1.61
1.61
1.61
Jun-14
Jul-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
11
0.89
0.89
0.89
0.89
0.89
0.89
0.89
0.89
0.89
0.89
0.89
0.89
0.89
0.89
0.89
2. Analysis of key themes and trends
Directorates – Top (highest) 3 for Quarter One 2015- 2016
Table 5 Trust complaints by Directorate and month
Adult Medicine
Emergency Medicine
Maternity
23
9
9
3. Adult Medicine
8
12
Aug14
13
9
11
5
11
12
7
9
7
7
9306
9507
8981
8668
9178
8065
9512
10322
9199
9498
9846
9131
9119
0.9
1.3
1.4
0.6
1.0
1.4
0.5
1.1
1.3
0.7
0.9
0.8
0.8
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.27
1.27
1.27
1.27
1.27
1.27
1.27
1.27
1.27
1.27
1.27
1.27
1.27
0.67
0.67
0.67
0.67
0.67
0.67
0.67
0.67
0.67
0.67
0.67
0.67
0.67
Jun-14
Jul-14
Sep14
5
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Complaints for Adult Medicine have decreased overall for the first quarter 2015-16 (other than
a slight increase in April), and for the first time appears to have plateaued. When compared to
the other directorates the directorate has the lowest rate per 1,000 beddays for the quarter at
0.83/ 1000.
Of the 23 complaints received in this quarter, 12 related to care, 5 to clinical treatment, and 5
to communication or attitiude.
12
The 12 complaints related to care are spread across the directorate, however 5 of the
complaints are related to issues related to grief or bereavement, and 3 complaints relate to the
Medical Short Stay area which has recenly reviewed the exclusion criteria implementing
learning from complaints and incidents. In addition this area will cease to exist in Nov and will
become the new Ambulance Receiving area.
4. Surgery
6
3
Aug14
10
10
12
7
2
0
1943
1897
2035
2328
2819
3887
3887
3631
3391
3462
3412
3550
4162
3.1
1.6
4.9
3.0
2.8
1.5
2.1
2.2
2.9
3.5
2.3
1.7
0.5
Jun-14
Jul-14
Sep14
7
Oct14
8
Nov14
6
Dec14
8
Jan15
8
Feb-15
Mar-15
Apr-15
May-15
Jun-15
2.3
2.3
2.3
2.3
2.3
2.3
2.3
2.3
2.3
2.3
2.3
2.3
2.3
3.45
3.45
3.45
3.45
3.45
3.45
3.45
3.45
3.45
3.45
3.45
3.45
3.45
1.17
1.17
1.17
1.17
1.17
1.17
1.17
1.17
1.17
1.17
1.17
1.17
1.17
Complaints for the Surgical directorate have decreased consistently for the quarter one 20152016. It should be noted that the Surgical figures include, General Surgery, and Urology. When
compared to the other directorates the directorate has the highest rate per 1,000 beddays for
the quarter at 4.5/ 1000.
The most dramatic reduction can be seen in General Surgical complaints across the quarter,
who had no complaints for June, and the directorate should be congratulated on their hard
work in achiveing this.
5. Emergency Department
13
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
6
7
9
9
5
7
3
5
5
2
2
2
5
8491
8727
7693
8064
8198
8040
8435
7611
7089
8279
7673
8033
8107
0.7
0.8
1.2
1.1
0.6
0.9
0.4
0.7
0.7
0.2
0.3
0.2
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.96
0.96
0.96
0.96
0.96
0.96
0.96
0.96
0.96
0.96
0.96
0.96
0.96
0.34
0.34
0.34
0.34
0.34
0.34
0.34
0.34
0.34
0.34
0.34
0.34
0.34
There has been an increase in the complaints per 1,000 attendancees for June 2015. The rate
remains within tolerance but is now just above average. It should be noted for this quarter the
directorate is currently recruitng to the vacant Lead Nurserole, and the directorate has had a
sustained period (3 consequtive months) of extremely low numbers of complaints. When
compared to the other directorates the directorate has the second lowest rate per 1,000
attendancees for the quarter at 1.2/ 1000. The department has been (and continues to be)
extremely busy over the summer and into the Autum with some days of record high
attendances. This is refoected in the unsually high numebr of negative FFT comments as well.
6. Women’s and Children’s
14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
6
3
10
7
8
5
6
1
1
1
3
3
3
1943
1897
2035
2328
2819
2655
2655
2494
2169
2612
2383
2675
2270
3.1
1.6
4.9
3.0
2.8
1.9
2.3
0.4
0.5
0.4
0.4
1.1
1.3
1.8
1.8
1.8
1.8
1.8
1.8
1.8
1.8
1.8
1.8
1.8
1.8
1.8
3.19
3.19
3.19
3.19
3.19
3.19
3.19
3.19
3.19
3.19
3.19
3.19
3.19
0.45
0.45
0.45
0.45
0.45
0.45
0.45
0.45
0.45
0.45
0.45
0.45
0.45
When compared to the other directorates the directorate has the second highest rate per 1,000
beddays for the quarter at 2.8/ 1000. Although there is a slight rise in the number of complaints
within the quarter for maternity this should be seen in context. The directorate has extremely
few formal complaints and should be congratulated on all the hard work that goes into in
achiveing this
7. Grading of complaints (RAG)
The Trust received 9 graded RED complaints for the quarter (4 for April, & 4 for May, and 1 for
June), compared to 11 for the previous quarter. Details as below.
RAG rating of complaints received for Quarter 1 2015-2016
No of Green
No of Amber
No of Red
LOW – no injury, or full recovery <3 days
MEDIUM – recovery >3 days, or minor impairment
HIGH – death, stillbirth, permanent damage including SUIs
49
18
9
RED complaints received for Quarter 1 2015-2016
Month Received
Total Severity
RED
Adult
Medicine
6
Emergency
Medicine
0
Surgery
1
Directorate/
Ward
No. of RED
Complaints
Beech
Juniper
Linden
Oak
Medical Short Stay
2
1
1
1
1
Theatres DVH
1
15
Radiology
2
2
Adult Medicine:
Beech ward
Although the complaint is listed for Beech ward it covers issues related to the patient’s time in
the Emergency Department and ITU. The patient felt that she was isolated because of the skin
condition that she was suffering from. The complaint was answered without the need for an
RCA and was not thought to be a patient safety issue.
Linden
The complaint raised concerns from the family that a patient died from aspiration pneumonia
which they feel occurred because the patient was eating and drinking when he should have
been nil by mouth due to fluctuating levels of consciousness and the ability to swallow. The
complaint was escalated via the SI declaration group and has been subject to a detailed
investigation and a full Root Cause Analysis (RCA) which is currently being overseen via the
Patient Safety Committee.
Oak
The patient’s sister’s raised concerns that they were not informed immediately about her death.
The complaint was answered without the need for an RCA. The patient had died following a
chronic illness and had been deemed to have capacity during her last admission. The patient
had provided the ward with contact numbers for her next of kin which turned out to be
incorrect. The ward made efforts via the GP and the police to make contact with the family
following her death.
Medical Short Stay
The patient sustained a tissue injury to his leg whilst confused and agitated following an
emergency admission. The case was escalated to a RCA which led to a review of the
exclusion criteria for the area and purchasing of padded protectors for beds to prevent injuries.
Juniper
This case is currently still under investigation via the Patient Safety Committee. The patient
was a medical outlier on a surgical ward and the complaint centres on care and communication
for a family whose mother was expected to die.
Theatres DVH
The patient was given the incorrect medication (intravenous antibiotics). The outcome of this
was no harm to the patient who was informed during his in-patient stay of the mistake. The
complaint raised the query that the patient had woken up during his operation. Investigation
revealed that this was not the case and the patient had woken up in recovery.
Radiology
16
The patient attended QMS radiology dept for a chest X-ray, which was reported as normal.
Subsequent CT scanning some months later at another NHS facility revealed a mass within
the lung, which on review of the original x-ray revealed that it should not have been reported
as normal. This case is currently still under investigation via the Patient Safety Committee.
The patient’s daughter contacted the Trust after her death at another hospital following routine
complications from neurological surgery. The complaint centres on the communication of
incidental findings from a previous brain CT scan.
8. Actions from Complaints
The following actions are examples of learning that has taken place from complaints received
in quarter one 2015 - 2016.
Adult Medicine
• Review and update of the exclusion criteria for patients being admitted to the Medical
Short Stay area
• Action plan for improved documentation for nursing staff on Beech ward
• A specific laminated sign to be placed on the side room door when a patient has died.
This will alert all health care professionals of a patient’s death as soon as it has
occurred.
Radiology
• Radiology manager at QMS has led a successful formal workshop with the reception
staff about communication and customer care in relation to a complaint about their
attitude
• A locum Radiologist has been stopped from working in the Trust due to communication
problems and not upholding Trust behaviours
9. Ombudsman update
No new cases have been referred to the Ombudsman in quarter one 2015-16.
There are currently three cases with the Ombudsman awaiting their review. One case following
the death of a patient from an coagulation related incident the board was made aware of that
led to a coroner’s case, a self-referral by the Trust on behalf of a family whose mother died
within the surgical directorate following surgery at King’s College Hospital, and a third case that
dates back to 2012 where a patient who attended the Emergency Department was discharged
and subsequently found to have suffered a pulmonary embolism. The patient has since been
successfully treated for this condition.
10. Independent Reviews
There were no cases referred for Independent review in quarter one 2015-2016.
11. Directorate turnaround time/performance
The internal response rates for quarter 1 2015-2016 46%. The breakdown by Directorate is
detailed below.
Directorate
Quarter 1 2014/15
17
Within less
than25 days
Adult Medicine
Surgery and Critical
Care
Trauma and
Orthopaedics
Obstetrics and
Gynaecology
Paediatrics
Emergency Department
Radiology
26-40 days
8/21
6/21
5/6
0
1/3
0
6/9
1/9
0/2
3/9
3/8
1/2
2/9
1/8
41-60 days
>61 days
1/21
0
5/21
1/6*
0/3
2/3
0
0
0/2
2/9
4/8
1/2
0/9
0
At the time of compiling this report, 8 complaints remain open for quarter 1 in 2015-16
(therefore the above table relates to responses for the Directorates regarding closed
complaints).
*This complaint involved patient post-natal care and required surgical input. Surgical aspect of
the complaint was delayed with Maternity component completed within 25 days.
PALS Report
There were 376 PALS referrals for Quarter 1 2015-2016 compared 333 for Quarter four 20142015
3 enquiries were forwarded to the Complaints Department to investigate as formal complaints.
There has been an increase of 43 enquiries in PALS activity in comparison to the previous
quarter. The mode of communication for PALS is unchanged with the majority of enquiries
made by telephone. Other than a slight decrease in enquiries related to Adult Medicince there
has been no change to the enquiries by directorate.
18
However, there has been a significant increase in the number of enquiries for ‘information and
advice’ and a slight increase in the enquiries related to care.
Drilling down into the request for information, shows that there has been an increase in
enquiries from patients and relatives making requests for medical records, four enquiries about
patients’ GP practices, and two enquiries for the Jasmine centre.
Themes/Trends
Waiting times Communication, Request for general information, and Clinical Treatment, are the
prominent themes for PALS for quarter one 2015-16
Top 3 concerns Quarter One 2015-2016
Waiting times
Request for general information
Clinical Treatment
70
68
51
Top 3 directorates Quarter One 2015-2016
Adult Medicine (includes ED)*
111
Surgical services (includes T+O and 109
Urology)
Operations
32
Surgery
The PALS team spend a lot of their time with the Scheduling and OPD teams helping patients
with appointments that have either been cancelled, rescheduled or at a time that is not
19
convenient for the patient. Work is currently underway to try and establish a system whereby a
change of appointment can be delivered by text message. Of the 111 surgical cases, 33 were
for General Surgery, 31 for Trauma and Orthopaedics, and 11 for Urology with no specific
trends or themes.
Adult Medicine
35 enquires relate to the Emergency Department, 14 issues relate to General Medicine, and 9
to Cardiology patients. There is no one particular trend for these areas, and the details have
been sent to the departments for their information.
Women and Children
14 of the enquiries relate to Gynaecology, 7 to Antenatal care and 7 to Maternity, with enquires
covering all aspects of care.
Outcome of PALS Enquiries.
There is a positive increase in the number of PALS enquiries that have been resolved
Forward Planning
The Senior Governance Manager leading the PALS department is working with the team to
continue to increase the number of issues that are resolved by the team, send information to
the directorates so that they may be aware of the enquiries related to their services.
Sue Cox
Senior Clinical Governance Manager
October 2015
20
21
Item 10-10. Attachment F2 – Safeguarding Report
SAFEGUARDING
PRESENTER:
DIRECTOR
NURSING AND QUALITY
OF
This report is a summary of safeguarding activity for adults, children and maternity
services.
Safeguarding Adults Team has been through a period of transition during 2014-2015
due to staff changes and vacancies; the safeguarding agenda continues to be supported
by the Learning Disability Nurse until the post has been recruited to.
The Care Act 2014 saw safeguarding introduced into a statutory framework and has
seen additional categories of abuse added. It also highlights six safeguarding principles.
Mental Capacity Act and Deprivation of Liberty Safeguards remains high on the agenda
of the safeguarding team, training continues to be offered throughout the trust.
PREVENT awareness continues to be covered in Core Induction and Mandatory
update; however this is currently being reviewed.
The Child Safeguarding Team remains busy and details of activity and training are
included.
The Maternity report identifies the team responsible for leading and coordinating
safeguarding issues within the Maternity Services and focuses on the activity for referral
of both unborn and newly delivered babies. In reporting, it is possible to see a trend from
February 2015 up to August 2015. Some comparisons have also been possible with that
of the previous six months.
The maternity safeguarding agenda continues to secure with the full time work of the
operational lead midwife for safeguarding who is supported with strategic overview by
the Head of Midwifery/Named Midwife. The Maternity Safeguarding Hub is successful in
providing a multiagency forum in which complex social care cases are discussed.
It is recognised that the team manage over 270 active cases at any one time and much
of this work involves the management of complex social factors. By far the link with
mental health is the most common and challenging. Other significant features of note
are the rise in reported cases of domestic violence and female genital mutilation. This
has standardised risk assessment in the antenatal period, pathways of care/ referral and
training for professional staff.
Close collaborative working continues with the Child and Adult Safeguarding Teams.
Reason for submission of report to Quality and Safety Committee (decision,
discussion, information, assurance)
For Information and Assurance
1
Safeguarding Adults report
The Adult Safeguarding Team has been in a period of transition in 2014 -15 with staff changes
and vacancies. The Safeguarding agenda continues to be supported by the Learning Disability
Nurse until the post of Safeguarding Lead has been recruited to. It is proving difficult to recruit to
this post and all avenues are being explored to attract the right candidate.
In April 2015 the Care Act 2014 (sections 42-46) introduced a statutory framework for
Safeguarding Adults in England. There is now a new definition for Safeguarding Adults at risk
and a number of legal duties for the Local Authority.
The Care Act 2014 also highlights six Safeguarding principles. (empowerment, protection,
prevention, proportionality, partnership and accountability). It has seen the introduction of new
categories of abuse which include self-neglect and modern slavery. The Care Act clearly sets
out individual responsibilities throughout the whole Safeguarding process. This new information
is shared via core induction and mandatory updates; this also available in the NHS England
Safeguarding Adults, Mental Capacity Act 2005 booklet that is handed out at these training
sessions.
Mental Capacity Act (MCA)
The Trust delivers a briefing on the Mental Capacity Act for all staff at core induction and
mandatory update sessions. A full day’s course is also delivered for relevant staff. This is not
currently classed as mandatory training within the Trust and therefore the uptake is variable.
The decision to recommend mandating this training is under review by the Education
Committee.
It was highlighted during a recent Safeguarding Adults Review (formally known as a Serious
Case Review) that the Trust must ensure that a Mental Capacity Assessment is undertaken in
appropriate cases and the results of the assessment are clearly recorded. The Trust has
devised an action plan to demonstrate how this will be achieved. This includes an audit of
patient records and assessing the understanding of the Mental Capacity Assessment process
and principles amongst staff.
Attendance figures for full days training delivered by Kent County Council
AprilSept 14
Feb-Mar
Oct-14
Nov-14 Dec-14
Jan-15
15
0
19
33
0
8
0
2
The training sessions for MCA had been cancelled or not booked between April 2014 and
September 2014. The uptake of training during the winter months is lower to due additional
strains within the departments.
Deprivation of Liberty Safeguards (DOLS)
Deprivation of Liberty Safeguards is also covered briefly during the core induction to all staff and
at mandatory update sessions. Additional full day training is also available for staff who are most
likely to need a deeper understanding of the DOLS process.
Attendance figures for the full days training delivered by Kent County Council
Apr-14
0
June- Aug
May-14 14
7
0
Sep-14
7
Nov - Dec
Oct-14 14
18
0
Jan-15
13
Feb-15
15
Mar15
0
The Law Commission consultation paper for Mental Capacity and Deprivation of Liberty is
currently open for comment until 2nd November 2015. The consultation paper is considering how
the law should regulate deprivation of liberty involving people who lack capacity to consent to
their care and treatment arrangements. The Consultation paper is proposing a separate
bespoke system for hospitals and palliative care.
The total number of DOLS that are applied for in the hospital is unknown. The wards are able to
send the applications directly to the DOLS office. They are encouraged to inform the
Safeguarding Team if they have sent these directly so that the numbers can be monitored for
the Clinical Commissioning Group. The ward is informed when a DOLS is approved but the
Safeguarding team may not always be aware that this has happened.
Known DOLS applications applied for during 2014-2015
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
2
2
3
0
1
Multi-Agency Working
Work continues with the Local Authorities in relation to the process of raising and investigating
safeguarding concerns. The Adult Protection Form (AP1) has now been replaced by the Kent
Safeguarding Adults form (KASAF).
3
There were a number of historical safeguarding alerts that had been raised by the Trust some
time ago where the investigation process had not been completed. These historical alerts were
jointly considered by the Trust and Social Services during the early part of 2015 and processed
accordingly. Some changes have been implemented with regard to raising alerts in respect of
grade three and four pressure ulcers, and this has been agreed with the Clinical Commissioning
Group, Kent County Council and NHS England. The process has changed and these are now
investigated prior to a safeguarding alert being completed to establish whether there has been a
form of neglect in the patients care.
In order to ensure all safeguarding and DOLS concerns are managed appropriately and in a
timely way in the Trust, a central email inbox has been established which is managed by the
Safeguarding team. safeguarding@dvh.nhs.net Safeguarding training is currently only covered
at level one and this is in the Core Induction and mandatory update. Level two training needs to
be established in line with NHS England, (the Intercollegiate Document: roles and competences
for health care staff, is currently in draft form) and Kent Safeguarding Board guidelines. This is
currently being discussed with the Clinical Commissioning Group lead for Safeguarding with
regard to how this can be taken forward.
Safeguarding concerns continue to be raised and reported by the wards, these are sent on to
the Local Authorities by the Safeguarding Team.
Safeguarding Alerts raised by the Trust
The number of Safeguarding alerts made in November 2014 increased dramatically, this was as
a result of the Safeguarding lead reporting all grade 3 & 4 pressure ulcers that had been
reported via Datix over a period of time. These were often historical reports from some time ago
and therefore do not show a true reflection for this month. This has been since addressed by
4
meeting with Social Services, an agreement has been made that all pressure ulcer safeguarding
concerns will be reported in a timely manner.
Safeguarding Adults Review (SAR) formally known as Serious Case Review
There has been one Safeguarding Adults Review reported on during 2014-2015. The multiagency review has now been produced in draft. It highlighted one recommendation that the
Trust needs to take forward and one that all agencies must take forward.
•
All agencies: It was recommended that the process for engaging with partner
agencies at practitioner level is robust enough to ensure meaningful outcomes can be
achieved.
•
The Trust must ensure that a Mental Capacity Assessment is undertaken in
appropriate cases and that this, together with the result of the assessment, is clearly
recorded.
PREVENT
PREVENT awareness is covered in the Core induction and Mandatory updates however it is
required to be delivered in a more extensive way. Training is required for all front line staff.
Ways in which this can be delivered is currently being explored with the Clinical Commissioning
Group.
There have been no reported cases in 2014-15 of potential radicalisation through the Channel
process.
Gina Tomlin
Learning Disability and Safeguarding Lead
September 2015
5
Safeguarding Children Report
Introduction
2015 has continued to be a challenging year for the safeguarding children team. The workload
continues to increase steadily and there has been sickness within the team. Ongoing review
continues in relation to the current capacity of the paediatric safeguarding children team in light
of previous business cases submitted, for safeguarding supervision and the Named Nurse
resource. Particular pressures are around the designated Named Nurse capacity, training
following the new Intercollegiate document which was published in March 2014, and the
requirement to provide safeguarding supervision to all Trust staff involved in safeguarding
children. This has resulted in an increase in training hours for the safeguarding team from135
per year currently, to at least 306 hours.
The current team consists of:
•
Lynn Brooks - Named Nurse for Safeguarding Children/Senior Nurse, Children’s
Services 1.0 WTE
•
Dr Khan – Named Doctor for Safeguarding Children/ Paediatric Consultant 1.0 WTE
•
Jackie Ayers – Senior Sister for Safeguarding Children 0.88 WTE
•
Sonya Cox – Paediatric Liaison Safeguarding Nurse – 0.69 WTE
•
Geri Colborne-Lilley – Senior Sister/Paediatric Liaison Safeguarding Nurse – 0.4 WTE
•
Sue Govier - Senior Sister for Safeguarding 0.6 WTE
A Practice Educator role within paediatrics has been introduced this summer from within the
existing nursing budget, with part of the role being to deliver safeguarding children training,
which will support the safeguarding team.
The new training programme commenced in January 2015 with level 1 training at induction and
4 times a year (2 hour sessions), level 2 training 20 times a year ( 4 hour sessions) and level 3
training 36 times per year (both 4 and 8 hour sessions). A piece of work was undertaken in 2014
with Stephen Mulvaney which maps all staff groups within the Trust into levels 1, 2 and 3.
Approximately 270 staff are in the level 1 group, 2090 in the level 2 group and 605 staff are in
the level 3 group. This TNA has been repeated in August 2015 to ensure staff are in the correct
groups.
There continues to be a considerable orthopaedic workload from fracture clinic and follow up of
DNA’s, in particular an increase in neonatal safeguarding issues has been noted. The
safeguarding team link regularly with the paediatric outpatient departments at Queen Mary’s
and Erith Hospital. There is a system in place for the identification of DNA’s and their
management and a policy has now been finalised.
Paediatric A&E attendances continue to increase 24,297 attendances between September 2014
and August 2015 and 2028 16-18 year olds. This equates to an average of 2024 attendances
per month and approx 77 A&E cards per day to read, assess and take action on. Paediatric
attendances to A&E make up approximately 25% of total A&E attendances. The safeguarding
team review the A&E attendance of any 16-18yr old, as they are now expected to be in full time
education until they are 18. The safeguarding team introduced weekend working in December
2013 with a half day at the weekend being covered on a rota basis, which continues to be well
received. This has enabled weekend support for A&E along with Willow/Walnut, and also
lightens the workload in terms of A&E cards and other safeguarding issues picked up on a
Monday. Due to the continued increase in children attending A&E, a member of safeguarding
visits the department on a daily basis.
6
A&E attendances 2013 to present
Year
Month
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2015
2015
2015
2015
2015
2015
2015
2015
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
0-3
Months
124
72
107
102
81
80
103
81
101
104
144
170
135
102
114
110
112
89
109
89
104
121
132
166
106
79
114
101
109
95
103
118
4-12
Months
Over 12
Months
159
181
280
229
191
154
168
138
126
159
201
272
174
163
201
218
154
158
158
127
141
172
204
277
193
169
194
172
152
156
146
139
1324
1467
1798
1785
1752
1699
1740
1307
1615
1652
1637
1619
1448
1434
1936
1716
1807
1864
1723
1229
1607
1625
1775
1750
1375
1400
1840
1490
1649
1611
1540
1114
16-18
199
192
196
165
198
194
177
163
188
182
176
153
158
184
220
178
201
172
168
165
177
170
187
177
180
140
190
151
150
180
190
136
TOTAL
PAEDS
<=16
1607
1720
2185
2116
2024
1933
2011
1526
1842
1915
1982
2061
1757
1699
2251
2044
2073
2111
1990
1445
1852
1918
2111
2193
1674
1648
2148
1793
1910
1862
1789
1371
PAEDS
TOTAL
ATTENDS PERCENTAGE
7795
7319
8631
8426
8320
8093
8615
7810
7746
8162
7756
8118
8032
7452
8915
8548
8688
8491
8727
7947
8064
8198
8040
8435
7611
7089
8279
7673
8033
8106
8350
7698
20.62
23.5
25.32
25.11
24.33
23.88
23.34
19.54
23.78
23.46
25.55
25.39
21.88
22.8
25.25
23.91
23.86
24.86
22.8
18.18
22.97
23.4
26.26
26
21.99
23.25
25.95
22.98
23.78
22.97
21.43
17.81
7
Paediatric Liaison report September 2015
Liaison
This refers to High Priority children and young people as per the West Kent policy. Health
visiting and school nursing services within Kent have reorganised their bases which has
resulted in less bases to be contacted.
•
•
•
•
•
•
•
•
January 2015 87
February
122
March
180
April
188
May
269
June
197
July
245
August
187
Social services referrals
There have been 26 referrals to Social Services for the period January 2015 to present.
16-18 year olds
In total there have been 1,317 16-18 year olds attend adult A&E from January 2015 to present:
•
•
•
•
•
•
•
•
January 2015 180
February
March
April
May
June
July
August
136
140
190
151
150
180
190
These young people remain an ongoing challenge for the safeguarding team, as the adult A&E
card does not have the same safeguarding information on it as the paediatric card, therefore
pertinent information is not recorded. The safeguarding team has attempted to progress this
problem with the adult team encouraged to document 16-18 yr olds about whom there are
safeguarding concerns in the safeguarding diary for follow up by the safeguarding team.
Regular reminders are given that 16-18 year olds can be booked in with a paediatric A&E card,
and it is being investigated as to whether a paediatric card can be automatically generated
according to date of birth.
Audit activity
•
•
Referrals to Social Services continue to be audited against the Laming
recommendations in relation to documentation. Audits are done on a spot check basis.
The safeguarding audit plan continues, which outlines the areas of practice which will be
audited by the safeguarding team. The reports will continue to be presented to the Trust
Safeguarding Committee on a rolling programme, with each audit being presented on an
annual basis. This will ensure that safeguarding audit is a standing agenda item and
robust action plans for each audit are developed and monitored.
8
•
•
•
•
•
•
Orthopaedic documentation remains under review in terms of ensuring
contemporaneous documentation on a daily basis in inpatient children notes, and
ensuring consultant documentation of review and a plan prior to discharge. This
continues to be monitored by the Named doctor who reports that this is improving.
Ongoing audit of A&E casualty cards continues for children attending with fractures. An
audit of children under 2 years of age presenting with long bone fractures has been
undertaken and presented at the Directorate audit meeting and at the March
Safeguarding Committee and Quality and Safety committee.
Orthopaedic audit of fracture clinic DNA’s continues.
Databases continue to be used to record referrals to Social Services, child deaths, child
protection medicals, frequent attenders, ring outs to HV/SN and children not in education
Paediatric DNA’s continue to be referred to the safeguarding team for follow up if there
are safeguarding concerns – audit is done on an ongoing basis.
An audit of 16-18 yr olds who attend A&E has commenced as this age group are now
expected to be in full time education until the age of 18.
An audit of safeguarding training requirements has been completed along with grouping
all Trust staff into relevant groups.
Audit reports due for this Safeguarding Committee:
•
•
•
•
Children and Adolescent Mental Health Services (CAMHS)
Fracture clinic DNA’s
Laming recommendations
Liaison report
Areas of good practice identified
•
•
•
•
•
•
A Safeguarding nurse continues to attend the medical handover on a daily basis, which
improves communication in relation to safeguarding issues.
The safeguarding team continue to gain favourable feedback in relation to their
relocation to an office on Willow ward, which has increased visibility, although space is a
challenge with an expanding team.
The safeguarding team continues to carry a bleep to provide one point of contact for all
staff (925), which has been very successful.
Orthopaedic follow up continues to be monitored with fracture clinic notifying the
safeguarding team of any DNA’s of children. A check is made to ensure that 2nd
appointments are routinely resent, and if 2 DNA’s occur then medical notes are reviewed
by the safeguarding team and any action or follow up required is identified. The
workload for this is considerable and there is some delay in assessing the medical
notes.
The safeguarding team are there to support medical staff in having difficult
conversations with parents, and this topic will be covered as one of the rolling level 3
training days.
Leads have been identified for Child Sexual Exploitation and trafficking.
CAF (Common Assessment Framework)
Kent has withdrawn the CAF process from use and has replaced it with an early intervention
assessment process. This was launched very quickly without user involvement (which has been
highlighted) in late 2014 so the usefulness of this new approach has yet to be assessed and
continues to be monitored.
9
Bexley has introduced a one stop assessment process which covers all referrals in to Social
Care, from early interventions, requests for family support and services to child protections
concerns. This replaces the previous separate referral processes of CAF/BEAN and child
protection. BEAN is the Bexley early intervention process.
Child deaths since December 2014
•
•
•
Feb 2015
June 2015
July 2015
17 month old brought into A&E unexpected death
23 month old brought into A&E having been found at home
baby born at 26/40, extreme prematurity
SI
No new SI’s since last report.
Training
Level 1
This is now delivered on day 2 of “Welcome to the Trust” in a stand alone 45 minute session.
Compliance is reported at 91.2%. There are approx 270 staff who will require level 1 training on
a 3 yearly basis.
Level 2
Delivery of level 2 training has changed from January 2015 to comply with the Intercollegiate
document 2014, which indicates that most Trust staff require 4 hours training every 3 years.
Sessions therefore have moved to being stand alone, and will run approx twice a month. There
are approx 2090 staff identified with the Trust who will require level 2 safeguarding training of 4
hours every 3 years. Compliance is reported at 57% at the end of June. 60 staff are booked
onto training for August/September with a further 115 booked between October and December.
Level 3
The requirements for Level 3 training changed in 2015 with the requirements being for all staff in
regular contact with children undertaking a whole day training within a year of coming into post,
then 12-16 hours every 3 years. It is hoped to develop a safeguarding training passport for staff
to record any training undertaken and one in use elsewhere is currently being assessed.
There are approx 605 staff identified with the Trust who will require level 3 safeguarding training
of 12-16 hours every 3 years from various specialist staff groups.
There is a requirement to report level 3 training figures to the CCG as a percentage, therefore
work has been undertaken to identify the groups of staff who require training at level 3 which will
be held by Nurse Education, so that attendance can be monitored and calculated. Attendance
figures for levels 1 and 2 will continue to be administered by Staff Development.
Current compliance for Level 3 training is reported at 62% with a further 111 staff booked on
training to the end of December.
Level 4
Level 4 whole day training for 2014 took place on 9th July, facilitated by University of Greenwich
which was attended by key members of staff including key safeguarding staff. A further date will
be planned for late 2015.
10
The Trust has produced an action plan to ensure that it reaches the standard of 85% of staff
trained at each level in relation to safeguarding children.
PREVENT training
There is a requirement for all clinical staff to receive PREVENT training according to their level
of clinical contact. This will involve a session at induction followed by a 3 yearly update. 4
members of the safeguarding team have been to a WRAP training session, and it is hoped that
further training dates will occur within the Trust in October. A meeting is planned for early
November to formulate a plan for Trust wide delivery to all staff. WRAP is Workshops to raise
awareness of PREVENT.
Serious Case Reviews
Outstanding actions in relation to SCR Baby K relate to a dedicated Named nurse resource, and
the need to provide safeguarding supervision for Trust staff who come into contact with children.
Flagging of children with CP plans
Work continues on a weekly basis to flag all children who are subject to a safeguarding plan on
PAS. Kent and Bexley Social Services provide a list of all children in Kent, children are identified
or entered on PAS and flagged in the special register section. This information is also cross
referenced with the midwifery safeguarding template and discussed at the midwifery monthly
safeguarding meetings. The Trust has signed up to the CP-Information Sharing project which
will be going live in 2016.
Bexley Safeguarding Children Board
DVH now have representatives attending the Bexley Safeguarding Children Board, the Serious
Case Review Panel and the Health Safeguarding Children Forum. In addition the Designated
Nurse for both Bexley and Kent now attends the Trust Safeguarding Committee.
Section 11 audit
Section 11 audit for Bexley in was completed in 2014, the Section 11 audit for Kent was
completed on 13th March 2015. Feedback has been given to both designated nurses that future
co-ordination of audits and information required would be useful.
KPI’s/Quality Indicators
Both Kent and Bexley have developed key performance indicators for safeguarding children
which are currently being agreed and circulated.
ACTIONS FOR THE COMMITTEE
Report for information only
Lynn Brooks
Senior Nurse, Children’s Services/Named Nurse Safeguarding Children
3rd September 2015
11
Safeguarding Children Audit Plan
Name Of Audit
Named Person
Date Last Completed
Audit Due Date
Under 2yrs With Fracture –
compliance with DVH
pathway
Paed OPD DNA’s
(Did Not Attend
Appointment) – compliance
with DVH policy
Overview of Safeguarding
Training at DVH
16-18yr Old’s Attending A&E
– outline of numbers and
issues/actions identified
Laming Documentation –
paediatric notes audit
CAMHS – numbers of
attendances and
Clinical Supervision –
progress report as per Trust
policy
Fracture Clinic DNA’s
(Did Not Attend
Appointment)
- outline of numbers and
Paed Liaison Activity
- outline of numbers and
Amanda Russell /
Sonya Cox
Aug 2013
Oct 2014
Oct 2015
Geri Colborne-Lilley
Sept 2013
June 2014
August 2015
Sue Govier
June 2014
June 2015
Geri Colborne-Lilley
Sept 2014
Sept 2015
Jackie Ayers
Aug 2013
Aug 2014
Sept 2014
Aug 2015
Sept 2015
Sep 2015
March / April 201March/April 2016
Sue Govier
Dec 2013
Oct 2014
Dec 2015
Dec 2015
Jackie Ayers
April 2014
July 2015
Dec 2015
Jackie Ayers
Amanda Russell / Geri
Colborne-Lilley
Trust Safeguarding Committee
Report Presenting Schedule
April 2015 / 2016
June 2015
June 2016
June
(Stats reported at each meeting)
Sept 2015
Each Meeting
12
Maternity Safeguarding Report
The Maternity Safeguarding Team
The above team comprises:
•
Named Midwife Safeguarding (1WTE) Deborah McAllion - Head of
Midwifery, Supervisor of Midwives,
•
Lead Midwife for Safeguarding (1WTE) Sarah Halsall – Band 7 Midwife
•
Support from:
3x Community Link Midwives for
Safeguarding
Specialist Substance Misuse Midwife
Specialist Mental health Midwife
The above team continues to be responsible for leading and co-ordinating safeguarding
issues within the department. They are responsible for the safe application of safeguarding
processes, advising staff, training, holding the maternity multi-agency Safeguarding Hub
attending Child Protection Conferences, MARAC, North West Kent Domestic Abuse Forum,
Dartford District Multi-agency Safeguarding Meeting and auditing of safeguarding practice
and procedures.
Activity and Referrals
The Maternity Safeguarding Team continues to provide referrals for both unborn and newly
delivered babies, predominately via the Kent Central Referral Unit in Ashford as well as
linking with Bexley MASH, Greenwich and Essex Social Care, Early Intervention Teams and
other support agencies.
We have further developed the ‘Maternity Safeguarding’ folder, which is accessible on the
shared drive. This contains the ‘Safeguarding Template’, the ‘Safeguarding Pathway’,
reports, agenda and minutes from the Safeguarding Hub, audits and data collection and
templates for referral forms. It is available on a twenty four hour basis for all midwives to
access. We have also updated hard copies of the folder for all maternity ward areas.
The tables below compares the safeguarding activity from February 2015 - July 2015 with
that of the previous six months. The data is linked to date of referral to the Safeguarding
Team.
13
Table 1 identifies that the safeguarding activity across the geographical areas for the last six
months has significantly increased in all of our geographic areas, although there has been
little change in the amount of activity from the out of area ladies, mainly from Essex, Medway
and outer London:
Table 1
Table 2 demonstrates that the average number of referrals per month to the Maternity
Safeguarding Team has risen to 81.8 for the last six months compared to 60.2 for the
previous six months:
Table 2
14
Table 3 shows the number of Early Help (EH) and Children’s Social Care (CSC) referrals we
have made compared to the previous six months. The vast majority of referrals to the
Maternity Safeguarding Team are Concern and Vulnerability (C&V) Forms. These women
will require extra support and monitoring, throughout their pregnancy and account for
approximately 83% of the women on our ‘Safeguarding Template’. Although there has been
an increase of the number of women that midwives have identified with maternity concerns,
in the last six months, the number of Early Help (2% - 4%) and Social Care (13% -15%)
referrals made have remained fairly consistent throughout the year.
Table 3
We currently have an average of 279.4 cases on the Safeguarding Template each month
(Table 4). This has risen significantly from an average of 233.8 for the previous six months,
an increase of approximately 46 cases per month. This demonstrates improved identification
of women with social complexities by the midwives. It has however put added pressure on
both the Maternity Safeguarding Team and the individual midwives co-ordinating the care for
these women.
Table 4
15
Maternity Safeguarding Hub
The monthly multi-agency Maternity Safeguarding Hub has been extremely successful. The
meeting runs over a three hour period. We split the meeting by area, so that visiting
agencies and community midwives only need only be present for an hour each.
Prior to the meeting, agencies are sent an agenda so that they can research the women
being discussed and bring relevant updates. At the start of the meeting a confidentiality
statement is read and it is made clear that the purpose of the meeting is for information
sharing only to improve care planning for the women and babies we look after. All women
are discussed from approximately twenty eight weeks of pregnancy. All women that have
been referred to the maternity safeguarding team are discussed at least once. As part of the
booking process women are asked if they are happy for us to share information with other
agencies.
Outcomes from the meeting may be to continue to support and monitor the women, support
via the mental health or FGM pathway, to develop a birth or postnatal plan or no further
action from the hub (if there are no current problems or concerns are historical). The
outcome will be recorded on the Safeguarding Template, available on the shared drive for all
midwives to access over a twenty four hour period. The minutes and agendas for all
meetings can also be accessed in the same way.
This meeting demonstrates excellent multi-agency collaboration, communication and
improves our cross boundary working. We have been asked by Designated Nurse Trish
Stewart if representatives from outside Trusts can attend the Hub as an example of ‘best
practice’.
Complex Social Factors
Table 5 demonstrates the complexity of social factors that our population of pregnant women
have presented with in the last six months compared to the previous six months. Women
may present with just one single complex social factor or many.
Table 5
16
Mental health continues to be a factor in the majority of referrals to the maternity
safeguarding team. The average is currently 42 women per month. We welcome Katie
Checkley as our new specialist Mental Health Midwife. She is responsible for co-ordinating
the care of women with enduring mental health problems. As not all of these women have
safeguarding concerns they can now be more appropriately monitored and supported on a
separate mental health pathway. We are still lacking full service provision from MIMHS,
however the Kent wide regional forum has now recommenced and we will be in attendance
in October 2015.
We have an average of 9 cases a month which feature domestic abuse. This has been a
factor in 14% of the concern and vulnerability referrals received by the maternity
safeguarding team this year. We continue to represent the Trust at the monthly MARAC,
held at North West Kent Police Station, there are on average 2 pregnant women discussed
each month and this remains consistent with the data for the previous six months. Overall
activity at this meeting has dropped to approximately 20-30 cases per month, compared to
30-40 cases per month for the previous six months.
MARAC Attendance requires an average of three to four hours preparation. In order to
reduce pressure on the meeting MARAC has developed criteria for ‘Cases for Mention’. This
applies to cases that are MARAC to MARAC transfers with no further reported incidents;
(where victims have moved into refuge and are not currently at risk of serious harm, cases
that have been heard within the last three months and are still open to agencies for on-going
actions and other case where risk of harm has greatly reduced). Cases cannot be for
mention on more than one consecutive occasion.
There are on average 7 women per month who disclose a history of substance misuse at
booking, accounting for 7.6% of women with complex social factors. This compares to 5
women per month for the previous six months. Our substance misuse midwife has
developed links with Kent Crime Reduction Initiative (CRI) and joint appointments are made
for the women who fall into this Criterion. CRI are also willing to see women in the
community, if required. Our Substance and Alcohol Misuse Midwife has participated in a
number of public health days in Dartford, discussing substance misuse and sexual health
issues with the public. These have been well attended.
We currently have on average 16.6 girls referred to the maternity safeguarding team per
month, with additional complex social factors. This accounts for 15.3% of our referrals being
from girls under the age of 20yrs. This compares to 10 per month for the previous six
months. We are engaging well with both the Gravesend and Bexley Family Nurse
Partnerships, which is proving to be a valuable resource for our young mothers. We are
hoping the service will be expanded to include the Dartford area in due course. Both the
Bexley and Kent FNP are engaging with our Safeguarding Hub. We are currently in the
process of developing Teenage Pregnancy Guidelines.
There is an average of 2-3 FGM cases disclosed each month, accounting for 4% of the
concerns reported to the maternity. This remains consistent with data from the last six
months. We report all of our FGM cases to the Department of Health on a monthly basis.
The FGM team continue to attend the Kent FGM Task and Finish group which has now
developed a draft Kent wide multi-agency FGM policy. Although we refer all women who
disclose FGM to Social Care via the Central Referral Unit we are getting little feedback on
the referrals we have made. It was highlighted at the September 2015 Named Nurse
meeting that this is also apparent in other Trusts. Designated Nurse, Trish Stewart will take
this for discussion at the next Quality and Effectiveness meeting.
17
Early Help
The aim of Early Help is to put in multi-agency community support for vulnerable families
that do not meet the threshold for Social Care intervention. We have made 11 Early Help
referrals over the last six month, compared to 14 in the previous six months, an average of
2-3 per month (Table 3). Kent Early Intervention Team has undergone a recent restructure.
Early Help referrals will now go to the Central Referral Unit (CRU) at Ashford. This is aimed
at improving liaison between Social Care and ‘Early Help’.
There have been difficulties with the Early Help referral system due to the central email
address provided by KCC not being secure and the unsuitability of the KCC SROW system
for use by other agencies. We have highlighted these difficulties at the February Early Help
Quality and Development meeting, the March Dartford Multi-agency Safeguarding meeting,
the August Dartford Early Help presentation and in personal correspondence with Mary
Burrell from KCC. We have not as yet been informed of any changes to the system.
Children’s Social Care
We have made 68 Child Protection referrals in the last six months (Table 3) an average of
11.3 per month. This is comparative to an average of 10.3 for the previous six months.
It was identified at the June Dartford Multi Agency Safeguarding Meeting that Kent
Safeguarding Children’s Board are monitoring all agencies attendance at Child Protection
Conferences via the Independent Chairman. We aim to represent maternity at all Child
Protection Conferences, Child in Need meetings and ‘Team around the Family’ meetings.
These are normally attended by the woman’s named community midwife.
For those women outside of our community boundaries the safeguarding midwife, substance
misuse midwife or mental health midwife will attend. Unfortunately attendance is not always
possible due to late notification or last minute changes to date or time by Social Care,
workload or staffing difficulties.
Table 6 demonstrates the number of case conferences and child in need meetings we have
been invited to and attended between March and August 2015. We do not have accurate
data prior to this as it is reliant in receiving a formal invitation from Social Care and a formal
report from the midwife. We now ask Social Care to copy the Safeguarding Midwife into all
conference invitations to ensure that a maternity representative attends wherever possible.
Midwives are encouraged to provide a post conference report and not rely on the conference
minutes.
Table 6
18
It is apparent that the more conferences we are invited to, the more difficult it is to guarantee
attendance. Each conference lasts approximately three to four hours, including travelling. In
addition to this a pre and post conference report is required which accounts for
approximately another two hours of the midwives time. Therefore each conference will take
a midwife out of her substantive role for approximately five to six hours. Attendance at six
conferences in a month is the equivalent to losing one whole time midwife for a week from
other.
There has been an increase in the number of babies, on child protection plans requiring a
pre-discharge planning meeting. Although we fully appreciate the importance of these
planning meetings and understand that this is part of Social Care Policy, it can be
problematic if women deliver at a weekend or bank holiday. We always try to accommodate
babies if Social Care are applying for a court order. However when the plan is for mother
and baby to be discharged home together, keeping a mother and baby in due to Social
Worker unavailability is unfair on the family and inevitably blocks beds. We would welcome
further discussion with the LSCB’s around the possibility of out of hour’s duty social workers
attending these meetings or for the meetings to take place in the home environment, in order
to relive the pressure it places on our service.
Training
We are working with the Children’s Safeguarding Team to deliver the Level 3 safeguarding
training program. So far the feedback from staff has been very positive. In order that
midwives do not lose midwifery specific training we are also delivering safeguarding training
as part of the midwives induction program and providing weekly 30 min sessions for band 5
antenatal clinic staff.
North West Kent police provide domestic abuse and MARAC training for all professionals
and details are periodically distributed around the Unit. CADDA DASH assessment and the
MARAC process is also included in our Level 3 Safeguarding Children Training, with staff
being encouraged to carry out a DASH risk assessment on any patient who discloses abuse
irrelevant of culture or gender, in line with the Trusts ‘Domestic Abuse Guidelines for
Maternity Staff’ - WAC132 and NICE public health guidance 50 (2014) ‘Domestic Violence
and Abuse: how health services, social care and the organisations they work for can
respond effectively’.
We are planning a joint meeting towards the end of September with the Children’s
Safeguarding Team, Substance Misuse Midwife and Steve Fearns from CRI to see how CRI
can help support our training program.
FGM training is also included in our Level 3 Safeguarding Children training and as part of the
band 5 orientation program for new midwives.
Supervision
The Maternity Department continues to provide adhoc supervision but still does not have a
program of supervision in place at this time.
Audit
We intend to re – audit maternity safeguarding documentation in April 2016. We continue to
audit safeguarding activity on a monthly basis and present to the quarterly Safeguarding
Committee Meetings.
19
Ongoing Areas for Development
•
Continue to work with the IMIT department in order to develop an electronic Concern
and Vulnerability form (on hold until the e-health records program moves forward)
•
Continue to develop and deliver the Level 3 training program with the Children’s
Safeguarding Team
•
Continue to audit safeguarding practice
In Conclusion
Over the last six months the Maternity Safeguarding Team has continued to support staff
working with approximately 279 vulnerable families. This number has significantly increased
in comparison to that of the previous six months. We have improved accessibility to the
maternity ‘Safeguarding Folder’ on the shared drive and have updated hard copies in all
ward areas.
We continue to collaborate with other agencies via the Safeguarding Hub and are extremely
pleased with its success. We are pleased that we have been identified as demonstrating
best practice in this area.
We have identified a trend in the increasing number of women needing pre-discharge
planning meetings and are concerned with potential problems this may cause by blocking
beds, we welcome discussion with the LSCB’s in order to ensure these meetings can take
place swiftly to prevent disruption to the women involved and the maternity service in
general.
Our specialist midwives play an important role in supporting the Safeguarding Team. by
collaborating with outside agencies for substance misuse, FGM and mental health services.
This leads to improved support networks for the women we care for.
We are pleased with the positive feedback the level 3 safeguarding training has received.
Despite a few teething problems we are now getting regular good attendance. We continue
to work closely with the Children’s Safeguarding Team in order to further develop and
evaluate this program.
Sarah Halsall
Lead Midwife for Safeguarding and Child Protection
22nd September 2015
Minor Contributions: Deborah McAllion, Head of Midwifery, Named Midwife for Safeguarding
20
Item 10-12. Attachment G – Physician Associates
TRUST BOARD - OCTOBER 2015
New Role in Healthcare - Physician Associates
RESPONSIBLE EXEC
Medical Director
Executive Summary
Physician Associates work to a Medical Model of Healthcare. They are a new role,
first championed in the USA, where well over 100 000 PAs are working in various
health care settings.
Reason for submission of report to Quality and Safety Committee (decision,
discussion, information, assurance)
For information
Physician Associates
PAs have a long tradition in the USA. Their role developed after the Vietnam war,
when many highly skilled paramedics returned to civilian life; they wanted to continue
in a healthcare role, but without having to go to medical school. Therefore, the
‘physician assistant’ was created who can work under the supervision of a doctor
and fulfil some, but not all, competencies of a doctor. The supervision can be
indirect. Over time the name has changed from ‘physician assistant’ to ‘physician
associate’ to identify their role as independent practitioners in their own right.
In January 2016 the 3 Universities in KSS (Kent & Canterbury, BSMS and BSU,
University of Surrey) will be offering courses for PA. Each is planning to offer 30
posts / year. The entry criteria for the PA courses are a 1:2 in a science degree.
The first year is mainly lecture based but at the end there is a 9 week attachments in
medicine. During their university based weeks, they will be 4 days / week at
university and 1 day / week attached to a GP surgery. The second year is mainly
practice based with 5 weeks in A&E, 5 weeks in mental health and 4 weeks each in
general surgery, O&G, paediatrics and acute medicine followed by another stint at
university before they sit their exams. The Students have to pass the course exams,
however, before they are allowed to practice as ‘physician associates’ they have to
pass a separate national exam. This national exam is valid only for 6 years and they
have to re-sit their exam every 6 years.
PAs work to a medical model of care.
Their competencies are around a set number of clinical conditions and procedures.
At the moment they are not a regulated profession and therefore cannot prescribe or
order radiology tests. However, their organisation has now been accepted as a
faculty of the RCP (Royal College of Physicians) and they are pushing very hard for
PAs to become a regulated profession. It is expected that this will happen within the
next 2 years. They then could become prescribers and order radiology imaging.
There is a set curriculum of conditions which they are competent to deal with and a
set number of procedures. However, further training in additional conditions or
procedures is common.
At the moment PAs can clerk, assess, examine and perform procedures, but it has to
be under supervision of a consultant (this may be indirect, the consultant may even
be on leave).
At SASH they have had PAs for several years and I met with 2 of their PAs and the
consultant in charge of them. They said that the PAs provide stability and continuity
on the wards, esp when junior doctors change over. They know ‘the ropes’ of a ward
and can help juniors. They are the people ‘to go to’. They are not rushing off to
clinics or theatres and can reliably review patients during the day and so improve
ward care.
In many ways they work like doctors, but with a limited field of expertise. They have
yearly appraisals, they need CPD (continuous professional development, 50 credits /
year) and, unlike doctors, they have to resit their exam every 6 years. At SASH they
are given one session in acute medicine each week to maintain generic skills which
they need for their repeat exam.
The level of stress of the consultants was reduced on the wards where there were
PAs (continuity) and their safety indicators has improved.
At the recent meeting, called by Kent & Canterbury University, there was
representation from the 7 Kent providers, but only 3 had signed up to provide
placements and take over trained staff. That may now have changed. The
University needs commitments for 30 students to be able to run the course. The
PAs at the meeting were clear that usually PAs go to where they trained. DGT has
offered placement for 8 PA students.
There is an additional chance for us to provide teaching during their course and raise
the profile of DGT. Two colleagues have already volunteered to lecture on the
course.
Physician Associates are seen to be one of the possible solutions addressing the
staff shortage in the coming years. The big advantage of PAs over other staffing
solutions is that:
• PAs come from a pool of science graduates who are usually in a lab or
industry and wish to have patient contact. They do not reduce the numbers of
other healthcare professionals. They are trained in 2 years and then ready to
work.
• Advance Nurse Practitioners take a similar time to obtain their additional
qualifications from routine nursing skills to ANP, but increasing the number of
ANPs reduces the numbers of nurses, who are already a recognised shortage
occupation.
• Training additional doctors takes too long and there are no further specialty
training numbers.
PAs therefore seem the best option to help with the impending staff shortage.
Annette Schreiner, October 2015
Item 10-13. Attachment H – Capacity Plan Update (cover)
CAPACITY PLAN 2015/16 – 2020/21
DIRECTOR OF
OPERATIONS
Summary
The total capacity has increased by 20 beds over the past three years and currently occupancy is
exceeding 100% requiring the regular use of escalation beds. Funding from NHS England for
significant further increases in capacity has not yet been identified.
Schemes to increase capacity and to reduce demand during Q3/4 2015/16 have been identified at
a level that will ensure the Trust does not exceed 100% occupancy.
.
• Provide excellent, safe patient services
• Deliver financial sustainability and efficiency
• Strengthen operational efficiency and effectiveness
• Promote excellent education
• Proactive community engagement
Item 10-13. Attachment H – Capacity Plan Update
Capacity Plan 2015/16 to 2020/21
Summary
The total capacity has increased by 20 beds over the past three years and currently occupancy is
exceeding 100% requiring the regular use of escalation beds. Funding from NHS England for
significant further increases in capacity has not yet been identified.
Schemes to increase capacity and to reduce demand during Q3/4 2015/16 have been identified at
a level that will ensure the Trust does not exceed 100% occupancy.
Demand for non-elective care is likely to rise by 12.5% over the period to 2020 and for elective
care by 24%. This is due to both population increases and disease / pathway changes.
Schemes to reduce bed demand by 55 beds by 2020 and capacity increases of 23 beds have been
identified for this period; however a shortfall of 35 adult medical and surgical beds and 7
maternity beds (to remain at 100% occupancy) is demonstrated, i.e. two wards. Should the Trust
wish to achieve 93% occupancy by 2020, 71 additional beds are likely to be required, i.e. an extra
36.
Last 3 years
The past three years have seen significant changes to the Trust’s bed base with the acquisition of
services at Queen Mary’s Hospital (QMH) which provided 24 beds of inpatient capacity for 15
months prior to elective surgery moving to Darent Valley Hospital (DVH), plus the opening of Elm
Court. There were a small number of other minor changes to the bed base, see Table 1 below
which shows these changes.
Although 24 beds were closed at QMH, on average 7 of these beds were in use by D&G patients
and therefore the impact at DVH was small.
Year
Adult
Medical
Adult
Surgical
Adult
M/S
Subtotal
Maternity
Childrens
ITU
Total
40
402
36
44
10
482
Q1
2013/14
Q2
Baseline
362
Vanguard closed
-10
-10
-10
Q2
MSS opened
6
6
6
Q3
Elm Court opened
31
31
31
Q3
Redwood
-1
-1
-1
Q3
Q1
2014/15
Q4
QMS Mottingham
24
24
24
64
452
-24
-24
-24
-6
-6
Q4
Q1
2015/16
Last year
QMS Mottingham
Prior Mews Virtual
ended
Current
388
-6
382
40
422
36
36
44
44
10
10
532
502
Table 1: Capacity changes 2013/14 to 2015/16 (Adult beds include Gynae beds and Children’s beds includes SCBU cots)
Page 1 of 4
Growth Assumptions
Modelling from Kent County Council suggests significant growth in the population for Dartford and
Gravesham over the next 5 years, with a 9.5% rise in population by 2020. This increase is similar to
the level predicted by Bexley CCG.
Year
2012
2013
2014
2015
2016
2017
2018
2019
2020
Dartford &
Gravesham
Population
199800
202500
206597
210397
215441
219841
224045
227263
230417
Growth
from
2015
-5.0%
-3.8%
-1.8%
0.0%
2.4%
4.5%
6.5%
8.0%
9.5%
Emergency spells
39950
41697
43350
43198
44386
45482
46581
47585
48590
-7.5%
-3.5%
0.4%
0.0%
2.8%
5.3%
7.8%
10.2%
12.5%
Elective Spells
25098
30597
37944
41580
44353
46248
48197
50176
51705
-39.6%
-26.4%
-8.7%
0.0%
6.7%
11.2%
15.9%
20.7%
24.4%
Table 2: Growth assumptions, 2012 to 2020
Growth in demand has been modelled based on the changes in both numbers and the age profile
of the population which provides a detailed view at specialty level of growth.
It has been well documented that population changes are not the only driver for increased
demand which has outstripped population growth by around 2.5% for elective activity and 1.0%
for emergency activity in previous years. This non-demographic growth is due to pathway changes,
new technologies, disease changes and other public health factors. Likely growth in emergency
care by 2020 will therefore be around 12.5% and elective care will grow by around 24%.
Pathway Assumptions
Four improvements have been assumed and modelled into the likely case: the Ambulatory Care
Unit reducing bed demand by 10 beds, the Frailty Unit reducing demand by 5 beds, length of stay
reductions through Right Time / Right Place reduce bed demand by 1% per annum cumulatively
and a reduction in the medically stable list of 10 patients. This equates to a reduction in bed
demand of 30 beds in 2015 rising to 55 beds in 2020 as shown in Table 3.
A further four schemes to increase physical capacity utilising beds away from DVH with other
providers have been identified and discussions are commencing to deliver this capacity which
equates to 23 beds.
Total capacity releasing schemes equate to 53 beds in Q3/Q4 have therefore been identified which
should ensure occupancy remains below 100%.
Page 2 of 4
Pathway Impacts
Ambulatory Care
Frailty Unit
Right time / right place
(LOS)
Medically stable list
Subtotal, demand
reduction
Capacity increases
Elm Ct to 39 beds
Elective @ Fawkham
Step down @ Fawkham
Virtual beds at NH's
Subtotal, capacity inc.
Total capacity freed
2015/16 2016/17 2017/18 2018/19 2019/20 2020/21
10
10
10
10
10
10
5
5
5
5
5
5
5
10
15
20
25
30
10
10
10
10
10
10
30
35
40
45
50
55
8
5
4
6
23
53
8
5
4
6
23
58
8
5
4
6
23
63
8
5
4
6
23
68
8
5
4
6
23
73
8
5
4
6
23
78
Table 3: Capacity impact of pathway improvements 2015 to 2020
Other scenarios that have been considered are shown in Table 4. These are deemed unlikely based
on current plans.
2015/16 2016/17 2017/18 2018/19 2019/20 2020/21
Demand
SEL Elective Plan
Kings MSK Collapse
Bridging Team ends
Urology cancer from Medway
IDT Reduction
GSTT PICU at DVH
Community Bed criteria review
Commissioner QIPP £2m p.a NEL
Community bid
0
5
3
3
5
4
-3
-30
-5
0
5
3
3
5
4
-3
-60
-5
0
5
3
3
5
4
-3
-90
-5
0
5
3
3
5
4
-3
-120
-5
0
5
3
3
5
4
-3
-150
-5
0
5
3
3
5
4
-3
-180
-5
Capacity
Hosp@Home ends
Close Elm Ct
-6
-31
-6
-31
-6
-31
-6
-31
-6
-31
-6
-31
Table 4: Potential impacts of other changes not included in capacity modelling, 2015 to 2020
Demand and Capacity
The schemes detailed in Table 3 plus assumed growth in Table 2 suggests a potential average
headroom of 17 beds during Q4 2015/16 for adult medical and surgical patients with occupancy
around 96% assuming all schemes deliver as planned.
By 2020/21 there is likely to be a shortfall of 35 beds for adult medical and surgical patients to
achieve 100% occupancy and 71 beds to achieve 93%, i.e. around three wards. Table 5 details this.
Page 3 of 4
Bed Demand (Q4)
Beds Used - Med/Surg
Elective
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
52
54
49
51
52
54
55
56
Beds Used - Med/Surg NEL
360
385
379
393
402
410
417
424
Bed Used - Total (Med/Surg)
412
439
428
444
454
464
472
480
Beds Available (Med/Surg)
402
452
445
445
445
445
445
445
Table 5: Adult medical and surgical bed demand and capacity 2015 to 2020
Table 6 shows the demand vs capacity modelling for maternity and paediatrics. Paediatrics is likely
to remain within reasonable levels of occupancy however maternity requires a maximum of 80%
average occupancy due to the day to day variability in demand. There will be a short fall of around
7 maternity beds by 2020.
Bed Demand (Q4)
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
Maternity beds used
28
30
32
32
33
33
34
34
Maternity beds available
36
36
36
36
36
36
36
36
Paed beds used
24
26
25
26
26
26
26
26
Paed beds available
44
44
44
44
44
44
44
44
Table 6: Maternity and Paediatric bed demand and capacity 2015 to 2020
Occupancy
The Trust has considered 93% adult medical / surgical occupancy as the optimum to provide
quality of care however this has not been achieved in the past few years and based on current
projections is unlikely to be achieved, see Table 2:
Occupancy (Q4)
Adult Med / Surg
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
103%
97%
96%
100%
102%
104%
106%
108%
Paeds
55%
60%
58%
58%
59%
60%
60%
61%
Maternity
79%
83%
89%
91%
93%
94%
96%
98%
Table 7: Occupancy 2013/14 to 2020/21
With only minor planned changes in capacity for the five years to 2020 and a 10% increase in
population plus further demand from non-demographic changes, adult medical / surgical
occupancy is likely to rise to around 108% with a requirement for 35 additional beds to reduce
occupancy to 100% and 71 beds needed to achieve 93%.
Stuart Jeffery
Director of Information and Performance
October 2015
Page 4 of 4
Item 10-14. Attachment I - Performance Report Month 06, 2015/16
PERFORMANCE REPORT, MONTH 06
DIRECTOR OF OPERATIONS
The attached report sets out performance against national and local targets to September 2015.
Monitor’s “Access and Outcomes” risk assessment framework remains at low risk concerns triggered under
their metrics.
The Board is asked to note:
Indicator
Mortality
A&E 4 hour target
18 week admitted
RTT Backlog (all)
Incomplete pathways
Narrative
Current
RAG
HSMR was 96 in the year to June 2015 and remains within
expected levels.
G
The A&E 4 hour target was missed in September at 91.4%
and for the quarter at 93.4%. Performance was 94.8% for
year to end of September. TDA
High day to day attendance variation, increases in both A&E
acuity and occupancy have impacted performance.
The 18 week admitted target was met in September at
92.1%.
There is no longer a requirement to monitor the actual
monthly achievement of admitted and non-admitted %.
The RTT total back-log remains low at 3.3% equating to 430
patients. 96.7% of patients on a GP referral to treatment
pathway have waited less than 18 weeks. TDA
The 6 week diagnostic The 6 week diagnostic waiting time target was met in
waiting time
September. TDA
Bed Occupancy
IG Training
C Diff
R
G
G
G
Occupancy remains the key issue impacting on performance
and quality metrics in September (101%).
B
87.8% staff completed IG training by September against a
trajectory of 85%.
G
Three cases of C Diff were reported in September. (12 YTD)
TDA
A
HCAI - MRSA bacteraemia
One MRSA bacteraemia case identified and attributed to
August and one reported for September (4 YTD). The
performance framework for August has been amended from
zero cases to one case within this report as a result. TDA
Family & Friends ( A&E) - 82% (46 out of 56) of respondents who would recommend
Recommend
services to their family and friends.
R
A
Page 1 of 18
14 day and 31 day cancer
The 14 day and 31 day cancer performance targets were met
in August. TDA
G
The 62 day GP cancer performance target was met at 89% in
August TDA.
G
TIA assessment within 24
hours
TIA assessment within 24 hours achieved in September at
69%.
G
Falls resulting in fracture
There were 2 falls resulting in a fracture in September. RCAs
have been completed and scheduled for review 21st
October.
62 day cancer
Mixed sex
accommodation
A
There were 109 reportable breaches in September against
the new monitoring system. Breaches occurred on CDU (38
on 8 occasions), MSS (26 on 9 occasions) and ITU (23
occasions), Laurel (20 on 7 occasions) and DCU (2 on 1
occasion)
R
Ambulance Handovers >
30 minutes
Concise RCAs will be completed and sent to the DoN for
review. TDA
Ambulance handover delays remain high with 183 reported
in September.
B
C--Section rate
(Elective)
The elective C-Section rate remains above target at 12% in
September.
R
Midwife to birth ratio
We met the Midwife to Birth ratio at 1:34 in September.
G
Appraisal (Trust)
The appraisal rate remains below target in September at
80%.
R
Delayed Transfers of Care
(DTOC)
4.0% of patients were deemed medically fit with delayed
transfers of care in September.
A
Hip Fracture 36 hours to
surgery
The percentage of hip fracture patients operated on within
36 hours was 77% in September.
G
Discussion and assurance





Provide excellent, safe patient services
Deliver financial sustainability and efficiency
Strengthen operational efficiency and effectiveness
Promote excellent education
Proactive community engagement
1
All information received by the Board should pass at least one of the tests from ‘The Intelligent Board’ & ‘Safe in the
knowledge: How do NHS Trust Boards ensure safe care for their patients’: the information prompts relevant & constructive
challenge; the information supports informed decision-making; the information is effective in providing early warning of potential
problems; the information reflects the experiences of users & services; the information develops Directors understanding of the
Trust & its performance
Page 2 of 18
1
Dartford & Gravesham NHS Trust
Month 06 2015/16
Board Performance Report
20th October 2015
Contents:
1. Executive Summary
2. Oversight and Escalation
3. Corporate Scorecard
Page 3 of 18
1. Executive Summary
The “Access and Outcome” metrics included in Monitor’s governance risk assessment framework are
shown below. Monitor collect data quarterly to assess performance against the selected national
standards. The Trust’s current service performance score for September (low is good) and the trigger
points that will initiate follow up investigation by Monitor are as follows:
Metric
C. Difficile
Referral to treatment waiting times
A&E indicator
Cancer waiting times
Access and Outcome total score
Q2 performance score
0/1
0/3
1/1
0/4
1/9
A governance concern would be triggered by:
•
•
•
Breaching pre-determined annual C.difficile threshold – either three-quarters breach of the
year-to-date or breaching the full year threshold at any time of the year.
Breaching the A&E waiting times target in two quarters over any four-quarter period and in
any additional quarter over the subsequent three quarters.
Three consecutive quarters’ breaches of a single metric or a service score of 4 or greater.
In relation to the Trust’s own scorecard and the TDA’s Accountability Framework:
Caring (Framework page 13):
•
•
•
109 mixed sex accommodation breaches reported in September. Breaches occurred on CDU
(8 occasions), MSS (9 occasions), (ITU 23 occasions), (Laurel 7 occasions) and DCU (1
occasion). Concise RCAs will be completed for review by the Director of Nursing.
The FFT percentage ratings of respondents who would recommend services to their family
and friends have reduced from 96.5% in August to 82.1% in September.
The complaints metric has been re-calculated using complaints per 1000 bed days as
requested by DoN to align with Quality Report metrics. All complaints reporting are being redesigned to allow for greater scrutiny and analysis.
Well-led (Framework page 14):
•
•
•
•
IG Training continues to make good progress in September with 87.8% of staff completing
the training against a target of 85%.
Sickness absence rate was 3.6%. TDA
The Trust appraisal rate remains steady but below target in September at 80% against a
target of 85%.
We met the Midwife to Birth ratio at 1:34 in September.
Effective (Framework page 15):
•
•
The number of inpatients staying greater than 30 days decreased in month from 57 to 54
patients.
Overall average non-elective length of stay has increased over the past year (surgical by
5.0% and medical by 2.0%).
Page 4 of 18
•
•
The Hospitalised Standard Mortality Ratio (HSMR) was 96 to the end of June 2015.
Weekend emergency standardised mortality remains slightly lower than for weekday
admissions.
Safe (Framework page 16):
•
•
•
•
•
•
One MRSA bacteraemia case identified and attributed to August and one reported for
September (4 YTD). TDA
Three cases of C Diff were reported in September (12 YTD). TDA
There were 2 falls resulting in a fracture in September. RCAs have been completed.
Hospital Acquired reported pressure sores have reduced in September to 15, with zero
grade 4, 1 grade 3 ulcer, 1 deep tissue injury and 1 unstageable. TDA
The percentage of hip fracture patients operated on within 36 hours was 77% in September.
The elective C-Section rate remains above target at 12% in September.
Responsive (Framework pages 17 & 18):
•
•
•
•
•
•
•
•
•
We missed the A&E 4 hour target in September at 91.4% and for the quarter at 93.4%.
Performance was 94.8% for year to end of September. A revised and detailed action plan
will be agreed with commissioners, however occupancy remains the key issue affecting A&E
performance. TDA
The overall RTT total back-log remains low at 3.3%. 96.7% of patients on a GP referral to
treatment pathway had been waiting less than 18 weeks at the end of September. TDA
No patients waited over 52 weeks for treatment in September. TDA
The 6 week diagnostic waiting time target was met in September. TDA
Ambulance handover delays remain high, increasing from 175 in August to 183 in September
and inpatient occupancy remains the key issue causing delays. The new ambulance
handover / RATTING area opens in November.
Occupancy increased for medical and surgical beds to 101% in September, the highest since
March 2015.
4.0% of patients had delayed transfers of care in September; a reduction from 5.5% in
August.
The 14 day and 31 day cancer performance targets were met in August. TDA
The 62 day GP cancer performance target was met at 89% in August TDA.
Page 5 of 18
2. Oversight and Escalation
2.1 BLACK
The following targets have been highlighted as being black and requiring additional attention.
Target:
Threshold:
Lead:
Performance:
Actions/
Controls:
Bed Occupancy
RAG: Current
Forecast
93%
Pam Dhesi
B
R
101%
• The whole system dashboard based on the principles agreed by the Executive
Programme Board is under development by the CCG. This will hold all providers
to account for delivery of patient flows across the health economy,
• Membership review of the Urgent Care Group has taken place and replaced with
an Executive Urgent Care Overview Group and an Urgent Care Operations Group
for middle managers has been set up as part of the UCB review.
• Set up a task force and multidisciplinary MDTs for a review of the medically
stable patient’s.
• Inpatient case mix continues to increase with 60% of the patients with 30 plus
days length of stay not medically fit.
• Reduced bed availability due to patients who occupy acute hospital beds whose
care should be provided elsewhere/home.
• Complex discharge meetings each week and proactive management of LOS
through the Integrated Discharge Team. 11% of the bed base is occupied by
patients that deemed medically stable, waiting for support /assessment by Kent
and Bexley Social Services.
• Proactive management of patients who no longer require acute care with daily
escalation on individual cases through three time daily bed meetings.
• 2 discharge work-shops for both internal and external partners have taken place
and facilitated by external support as an outcome from a medically stable list
audit.
Executive: Pam Dhesi
Manager: General Managers
Target:
Threshold:
Lead:
Performance:
Actions/
Controls:
Ambulance Handovers >30mins
RAG: Current
Forecast
0
Pam Dhesi
B
A
 183 in September
•
Ambulance handover delays increased in month to 183 from 175 in August.
•
Significant variability in arrival numbers with Mondays ranging from 259 to 337
– usually associated with winter months.
•
Limited space due to building work which is due for completion at the end of
October.
•
Short Stay area will be converted to the RATTING/ambulance handover area in
early November
•
High bed occupancy rate impacted handover delays in September.
•
Medical staff sickness had a key impact on performance in September.
•
Implementation of the HAS 2 Portal to capture real time ambulance offload
information - August 2014
th
•
RATTING commenced on 16 Sept, operating 8am to 4pm Monday to Friday. To
be gradually extended to a seven day service once Consultants are in post.
•
Early escalation of ambulance pressures in place
•
Direct admissions to CDU prior to clerking at pressure times
Manager: Alex Tan
Page 6 of 18
2.2 RED
The following targets have been highlighted as being red and requiring additional attention.
Target:
Threshold:
Lead:
Performance:
Actions/
Controls:
A&E 4 hour target
RAG: Current
Forecast
95% within 4 hours
Pam Dhesi
A
R
91.4% in September: YTD;94.8%
• Membership review of the Urgent Care group has taken place and replaced with
an Executive Urgent Care Overview Group Reference across the whole system.
• An Urgent Care Operations Group for middle managers has been set up as part
of the UCB review.
• Medical staff sickness had a key impact on performance in September.
• 60% middle grade posts covered by locums – recruited posts in the pipeline and
should start seeing benefits through November and December.
• Two additional Consultants planned for November and April 2016.
• Significant variability in arrival numbers with Mondays ranging from 259 to 337
– usually associated with winter months.
• Significant PTS delays and agency crews are regularly commissioned to reduce
delays. This has been escalated to the CCG for their contractual management.
• Elderly Frail Model commences in October.
• Ambulatory Care Unit phase 2 commences in December.
th
• Limited space due to building work which is due for completion on 29 October.
• Short Stay area will be converted to the RATTING/ambulance handover area in
early November, providing more space and should facilitate reductions in
handover delays.
th
• RATTING commenced on 16 Sept, operating 8am to 4pm Monday to Friday. To
be gradually extended to a seven day service once Consultants are in post.
• High bed occupancy rate impacted ambulance handover delays and transfer of
admitted patients to ward areas in September.
• The acuity of attendances continues to rise as avoidance measures for less ill
patients increase in effectiveness.
• 4.0% DTOC patients in September and difficulties in accessing community beds
have impacted bed availability.
• Inpatient case mix continues to increase with 60% of the patients with 30 plus
days length of stay not medically fit.
• Increasing pressures in ITU and Laurel ward with an increased number of MET
calls.
• Access to community beds and social services remains difficult.
• Emergency Care re-design programme.
Manager: Alex Tan
Page 7 of 18
Target:
Threshold:
Lead:
HCAI – MRSA Bacteraemia
RAG: Current
Forecast
0
Annette Schreiner
R
R
1 in August and 1 in September ( 4
Performance:
YTD)
• One MRSA bacteraemia case identified and attributed to August. This case
Actions/
required extended testing. One reported for September (4 YTD).
Controls:
• Both cases have been investigated, reviewed and key learning with actions
identified for follow up.
• The June case has been validated and allocated to the Trust.
Executive: Annette Schreiner
Manager: Amanda Clement
Target:
Threshold:
HCAI – E.coli
Internal target 24
Performance:
3 cases in September
Actions/
Controls:
•
R
YTD;16
Forecast
A
All cases reviewed at the weekly Infection Prevention Team meetings with the
Medical Director. Follow up actions and RCAs are completed as deemed
required.
Target:
Threshold:
Appraisals
85%
Performance:
80%
Actions/
Controls:
•
Executive: Andy Brown
RAG: Current
RAG: Current
R
Forecast
G
Plan to achieve 85% compliance is a focus of Directorate Q2 performance
meetings and the HR Director following up with Directorates with low rates.
Manager: All
Target:
Threshold:
Lead:
Performance:
Actions/
Controls:
Mixed Sex Accommodation Breaches
RAG: Current
Forecast
0
Vikki Leivers-Carruth / Pam Dhesi
R
A
109 in September
• New revised guidance and monitoring system agreed with CCG and is in now in
place. Reporting for Laurel and ICU is now in place and included in this report.
• 109 reportable breaches in September against new monitoring system.
• Breaches were on CDU (38 on 8 occasions), MSS (26 on 9 occasions) and ITU (23
occasions), Laurel (20 on 7 occasions) and DCU (2 on 1 occasion)
• Concise RCAs are completed and sent to the DoN for review. There were no
safety concerns and no experience issues or complaints.
• The reasons for the breaches were lack of capacity and to ensure patients were
in an appropriate clinical area. Occupancy was at 101% and Delayed Transfers of
Care were at 4.0%. A Black Status was also declared in month.
• Robust validation is in place as well as discussions at every site safety meeting.
Executive: Vikki Leivers-Carruth / Pam Dhesi
Manager: All
Page 8 of 18
Target:
Threshold:
Lead:
Performance:
Actions/
Controls:
Staff Turnover
RAG: Current
Forecast
<9%
Andy Brown
R
A
11.8%
• Turnover rate has remained stable. A range of measures are in place to analyse
turnover reasons and reduce the rate – these are discussed in more detail at the
Workforce Committee.
Target:
Threshold:
Lead:
Performance:
Actions/
Controls:
Family & Friends response rate
RAG: Current
Forecast
20%
R
A
1.5% (A&E); 1.6% (Outpatients)
•
On-going work looking at an electronic system to facilitate survey collection.
•
DoN is examining the use of the SNAP audit tool with the Trust audit team.
•
A&E is going through a transition period with staffing gaps in the senior team,
which is not facilitating an improvement drive in FFT.
•
Greater focus at divisional performance reviews.
Executive: Vikki Leivers-Carruth
Manager: Alex Tan / Karen Costello
Target:
Threshold:
Lead:
Performance:
Actions/
Controls:
C-Section - Elective
RAG: Current
Forecast
10%
R
A
12% in September
• The elective C-Section rate remains unchanged at 12% in September.
• The midwifery team presented their 10 point action plan to the LSA during their
th
annual supervisory meeting on 14 July.
Manager: Deborah McAllion
Page 9 of 18
2.3
AMBER
The following targets have been highlighted as being amber and requiring additional attention:
> 30 days Length of Stay and Delayed
RAG: Current
Forecast
Transfers of Care
< 50 and 3.5%
Threshold:
Pam Dhesi
Lead:
A
A
54
and
4.0%
Performance:
• Director of Operations regularly escalates to the CCG and long stayers and DTOC
Actions/
are discussed at the Urgent Care Operations Group.
Controls:
• 4.0% of patients were deemed medically fit with delayed transfers of care in
September, reduced from 5.5% in August.
• Inpatient acuity / case mix continues to increase with 60% of the patients with
30 plus days length of stay not medically fit.
• More complex patients, especially those with cognitive impairment.
• Access to community beds remains difficult with low community bed turnover
preventing patients accessing step down care.
• Complex discharge meetings each week and proactive management of LOS
through the Integrated Discharge Team.11% of the bed base is occupied by
patients that deemed medically stable, waiting for support /assessment by Kent
and Bexley Social Services.
• Proactive management of patients who no longer require acute care with daily
escalation on individual cases through three time daily bed meetings.
• Set up a task force and multidisciplinary MDTs for a review of the medically
stable patient’s.
• Weekly reporting at the executive meetings and monthly Executive Programme
Board.
• 2 discharge work-shops for both internal and external partners have taken place
and facilitated by external support.as an outcome from a medically stable list
audit.
Manager: Sarah Collins
Target:
Target:
Threshold:
Lead:
Performance:
Actions/
Controls:
Falls (resulting in fracture)
RAG: Current
Forecast
0
A
A
2 cases in September
YTD; 9
• There was 2 falls resulting in a fracture in August. RCAs have been completed
st
and scheduled for review on 21 October.
• Prevention agenda progressing and supported through the Falls group.
• Robust review of the Falls Policy has been completed with new care plans
included.
• Comprehensive Falls training Programme commences in September.
Target:
Threshold:
Lead:
Performance:
Actions/
Controls:
Outlier beds
RAG: Current
Forecast
Medical <2% Surgical <2%
Pam Dhesi
A
A
Surgical 2.4% Medical 7.4%
• Medical outliers have decreased from 8.2% in August to 7.4% in September.
• 4.0% DTOC patients in September, bed capacity and difficulties in accessing
community beds have impacted bed availability.
Page 10 of 18
Target:
Threshold:
Mandatory training
85%
Performance:
81%
Actions/
Controls:
•
•
•
RAG: Current
A
Forecast
G
Overall mandatory training rate remains unchanged in September 2015.
Mandatory training sessions for Medical staff have started in June 2015
Assurance on directorate plans has been a focus of the Q2 performance
meetings.
Manager: All
Target:
Threshold:
Lead:
Performance:
Actions/
Controls:
HCAI – C diff
RAG: Current
Forecast
24
Annette Schreiner
A
A
12 YTD against trajectory of 12
• 12 reported cases across eight clinical areas - all non-related.
• 9 of these cases have been reviewed with the CCG – 8 were deemed not due to
lapse of care.
Target:
Threshold:
Lead:
Performance:
Actions/
Controls:
Pressure Ulcers ( HA 2,3 & 4)
RAG: Current
Forecast
< 25 per month
G
A
 15 in September
• Hospital Acquired reported pressure sores have reduced in September to 15,
with zero grade 4, 1 grade 3 ulcer, 1 deep tissue injury and 1 unstageable. RCAs
are underway for these.
• Plans are in place for closer monitoring and reporting of grade 2 pressure ulcers.
• The RCA tool has been revised to reflect recent changes in the Duty of Candour.
• Full report within the DoN’s Nursing Framework and Quality Metrics report to
Trust Board.
Page 11 of 18
Target:
Threshold:
62 day GP Cancer
85%
Performance:
89% in August
Actions/
Controls:
•
•
•
•
•
RAG: Current
G
G
Five and a half breached patients allocated to the Trust (7 patients with 3 shared
breaches with other providers) out of fifty treated.
Three patients required further review and investigation by multiple speciality
clinical teams.
Three patients had elements of patient choice and 2 MRI post TRUS biopsy.
One lung patient with delay to follow up post diagnostic test – shared breach,
delay with other provider follow up. .
The Trust is performing significantly above the national average of 82.5%
Tumour Type
Breast
Gynaecological
Haematological (
Excluding Leukaemia)
Lower Gastrointestinal
Lung
Upper Gastrointestinal
Urological (Excluding
Testicular)
Total
Forecast
Patients
treated
within 62
days
28
1.5
2
Number 62
day
breaches
Performance
%
0
0
0
100%
100%
100%
2
2
1
8
3.5
0.5
0
1.5
36.4%
80%
100%
84.2%
44.5
5.5
89%
Manager: All
Page 12 of 18
3. Corporate Scorecard
2014
Indicator
Plan/
Target
Rating
109
0
R
96.5%
82.1%
95%
A
98.1%
99.2%
99.4%
96.9%
96.2%
94.8%
95.3%
95.3%
96.5%
95.7%
97.0%
96.6%
98.1%
TDA
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Mixed Sex Accom. Breaches - Wards
TDA
0
0
0
0
0
0
0
0
0
45
61
Family & Friends Test (A&E) - Recommend
TDA
94.9%
97.0%
95.6%
96.8%
97.8%
94.7%
98.4%
97.6%
98.5%
93.4%
Family & Friends Test (Daycases) - Recommend
TDA
99.1%
98.6%
98.9%
Family & Friends Test (Inpatient) - Recommend
TDA
97.1%
97.4%
Family & Friends Test (Outpatient) - Recommend
TDA
94.8%
Family & Friends Test (Maternity All Questions) Recommend
Caring
2015
95.9%
95.7%
95.3%
97.5%
96.8%
95.7%
12m Trend Line
YTD
Movement
YTD
G
95%
G
G
97.8%
96.5%
97.8%
99.5%
98.5%
98.6%
96.9%
100.0%
100.0%
99.0%
Family & Friends Test (A&E) - Recommend - Ranking
(Position / Out of 143)
17
9
15
8
2
15
3
5
2
30
15
G
Family & Friends Test (Inpatient) - Recommend Ranking (Position / Out of >170)
65
86
83
26
65
86
31
35
44
70
65
G
Family & Friends (Staff) - Recommend (Work)
TDA
Complaints/1,000 Bed Days
TDA
86%
95%
G
97.3%
83%

G
2.2
2.5
1.7
2.1
2.6
1.8
1.8
1.4
1.7
2.2
1.5
1.9
Movement 75+ moved > twice (at any time)
15
13
7
7
11
3
6
9
5
7
4
6
<5
A
Validated Overnight Discharges
0
0
0
0
0
0
0
0
0
0
0
0
0
G
Overnight Ward Movements
38
41
38
30
27
46
31
39
35
33
32
33
A
A
A
A
A
A
A
A
G
A
A
R
Overall Score
18.5%
Page 13 of 18
2014
Indicator
Plan/
Target
Rating
80%
85%
R
90%
94%
100%
G
94%
89%
84%
100%
A
80%
80%
81%
81%
85%
A
59.1%
75.3%
79.8%
85.0%
87.8%
95%
G
2668
2667
2678
2681
2697
2727
TDA
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
TDA
72%
70%
67%
66%
72%
74%
76%
76%
79%
80%
81%
Consultant Appraisal (exc. New Starters)
92%
92%
96%
90%
93%
88%
92%
92%
92%
89%
SAS and Trust Doctors Appraisal (exc New Starters)
89%
93%
89%
91%
99%
91%
95%
96%
94%
Mandatory Training (Overall Rating)
94%
95%
95%
95%
95%
80%
79%
46.7%
58.0%
62.7%
65.4%
76.3%
82.6%
39.6%
2620
2613
2623
2649
2657
2676
Appraisal (Trust)
IGT Training
Total Workforce (FTEs)
Well-Led
2015
12m Trend Line
YTD
Movement
YTD
Temporary Staff - Agency
TDA
1.7%
1.7%
1.9%
2.0%
1.9%
2.1%
1.8%
1.6%
1.5%
2.5%
1.6%
2.0%
Temporary Staff - Bank
TDA
6.4%
6.3%
7.8%
8.0%
6.1%
7.0%
6.0%
6.4%
6.4%
6.9%
6.5%
6.2%
Staff Absences (Sickness)
TDA
3.3%
3.7%
3.3%
3.9%
3.9%
3.6%
3.8%
4.2%
3.9%
3.7%
3.7%
3.6%
<3.5%
A
Vacancies
TDA
9.0%
9.5%
9.4%
8.5%
8.4%
7.8%
8.0%
8.5%
8.2%
8.0%
7.6%
7.0%
<9%
G
Turnover
TDA
13.0%
13.0%
12.9%
12.2%
11.9%
11.4%
11.4%
11.8%
11.8%
11.8%
11.7%
11.8%
<9%
R
34
34
35
35
36
36
36
35
35
35
35
34
34
G
2.39
2.42
2.42
2.37
2.34
2.36
2.38
2.37
2.42
2.41
2.38
2.39
Birth/Midwife Ratio
Nurse/(Available) Bed Ratio
35
Safe Staffing Fill Rate
TDA
97.0%
97.3%
96.5%
95.6%
95.7%
96.3%
97.1%
97.5%
97.3%
97.2%
97.0%
95.6%
Family & Friends Test (A&E) Response Rate
TDA
11.3%
7.8%
7.5%
3.5%
2.8%
4.4%
3.6%
7.9%
5.0%
5.2%
3.5%
1.5%
20%
R
Family & Friends Test (Inpatient) Response Rate
TDA
40.4%
25.1%
25.6%
21.1%
24.9%
27.5%
17.5%
20.7%
21.8%
23.1%
20.8%
14.5%
20%
A
1.3%
1.9%
1.1%
1.5%
2.2%
1.6%
20%
R
20%
G
Family & Friends Test (Outpatient) Response Rate
Family & Friends Test (Maternity Questions 2&3)
Response Rate
Overall Score
20.7%
16.0%
25.4%
13.2%
13.3%
10.2%
29.2%
27.9%
36.0%
34.3%
26.5%
27.1%
R
R
R
R
A
A
A
A
A
A
A
R
Page 14 of 18
2014
YTD
Plan/
Target
Rating
79%
89.0%
80%
G
63%
69%
71.8%
60%
G
96%
95%
95%
95.2%
95%
G
97%
93%
93%
96%
93.5%
90%
G
2.4%
2.2%
2.2%
2.5%
<100
A
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
90% Stay on Stroke Ward
87%
77%
78%
72%
96%
87%
89%
93%
93%
89%
91%
TIA Assess within 24 Hours
73%
50%
61%
77%
78%
61%
76%
77%
86%
60%
95%
97%
96%
96%
95%
96%
95%
95%
95%
91%
95%
93%
94%
93%
91%
91%
91%
3.3%
3.1%
5.0%
5.5%
3.7%
3.5%
3.1%
2.8%
Indicator
% Adults VTE Risk Assessed
TDA
TDA
Dementia Screen (Indicator 1)
Effective
2015
12m Trend Line
YTD
Movement
Mortality Rates - Crude (NEL)
TDA
Mortality Rates - SHMI
TDA
Mortality Rates - HSMR (12m)
TDA
89
89
89
89
89
98
98
98
96
<100
G
Mortality Rates - HSMR (Weekend)
TDA
99
97
100
100
100
108
108
105
102
<100
A
Mortality Rates - HSMR (Weekday)
TDA
103
104
110
110
110
109
109
108
109
<100
A
Deaths in Low-Risk Conditions (Score)
TDA
96
90
97
107
97
108
103
93
<100
G
Emergency Readmissions (< 30 Days)
TDA
4.2%
3.8%
3.7%
4.0%
3.0%
3.1%
3.6%
3.8%
3.6%
3.4%
4.6%
3.6%
<4.0%
G
LoS (NELIP) - Surgical - 12M vs Prev 12M
6.1
6.1
6.1
6.2
6.2
6.3
6.3
6.2
6.2
6.4
6.4
6.5

5.0%
3.5%
R
LoS (NELIP) - Medical - 12M vs Prev 12M
5.4
5.3
5.3
5.4
5.4
5.4
5.5
5.6
5.6
5.6
5.6
5.6

2.0%
3.5%
R
LoS (NELIP) - All - 12M vs Prev 12M
4.6
4.5
4.5
4.5
4.5
4.6
4.6
4.7
4.7
4.7
4.7
4.7

1.6%
3.5%
R
EM Beds (Average/Month)
404
404
414
423
429
425
422
419
412
417
411
428
30+ Day LoS
52
51
63
44
46
63
63
62
62
51
57
54

0%
<50
A
Follow-Up Ratio (FA : FU)
1.8
1.8
1.9
1.9
1.9
1.8
1.8
1.8
1.8
1.9
1.8
1.8
<2.0
G
G
A
G
A
G
G
A
A
A
A
A
A
104
105
3.8%
0.5
Page 15 of 18
2014
YTD
Plan/
Target
Rating
1
4
0
R
0
3
12
24
A
5
3
5
18
24
R
2
2
0
1
5
14
G
TDA
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
HCAI - MRSA bacteraemia
TDA
0
0
0
0
0
1
1
0
1
0
1
HCAI - CDI
TDA
2
1
0
2
0
1
3
4
0
2
HCAI - E.coli
1
2
1
3
5
3
3
2
0
HCAI - MSSA
1
0
0
2
0
3
0
0
Indicator
Safe
2015
12m Trend Line
YTD
Movement
Opened SI(RI)
TDA
9
5
3
7
6
6
16
5
5
12
3
2
43
<5
G
Open CAS Alerts (and relevant to Trust)
TDA
0
1
1
1
0
1
0
0
0
0
1
1
2
<2
G
Never Events
TDA
0
0
0
0
0
0
0
0
0
0
0
0
0
0
G
Falls (resulting in fracture)
TDA
2
4
0
2
1
2
0
0
2
4
1
2
9
95%
97%
90%
76%
94%
81%
86%
83%
73%
77%
92%
77%
1.5
1.8
1.2
2.2
1.5
1.7
2.1
1.4
1.7
1.5
1.6
1.0
22
27
18
33
22
27
32
24
25
23
25
15
1.5
2.0
1.3
2.2
1.6
1.7
2.1
1.5
1.7
1.5
1.7
1.1
12%
9%
12%
13%
15%
14%
12%
15%
15%
11%
12%
12%
10%
R
22%
16%
18%
16%
17%
17%
17%
18%
16%
14%
20%
17%
13%
R
Admissions to Neonatal Care
1%
4%
2%
3%
2%
3%
2%
4%
1%
3%
2%
2%
<10%
G
Overall Score
A
A
A
A
A
A
R
R
R
R
R
R
Hip Fracture 36hrs to Surgery (BPT)
HA Pressure Ulcers (2)/1,000 Bed Days
Pressure Ulcers (HA Grade 2,3 &4)
TDA
HA Pressure Ulcers (2,3,4)/1,000 Bed Days
Caesarean-Section Rate (Elective)
Caesarean-Section Rate (Non-Elective)
TDA
A
100%
A
G
<25
G
G
Page 16 of 18
2014
Indicator
YTD
Plan/
Target
92.1%
92.3%
90%
G
97.5%
97.5%
97.6%
95%
G
3.5%
3.1%
3.3%
<3.5%
G
0
0
0
0
0
0
G
0.1%
0.1%
0.1%
0.0%
0.0%
0.1%
<1.0%
G
96.1%
97.0%
94.3%
94.5%
91.4%
94.8%
95%
R
95%
R
0
G
0
B
TDA
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
18 Weeks Admitted %
TDA
94.2%
94.2%
94.0%
92.8%
92.2%
92.4%
92.1%
92.2%
93.3%
91.7%
92.5%
18 Weeks Non-Admitted %
TDA
97.8%
97.8%
97.6%
97.6%
97.6%
97.9%
97.4%
98.1%
97.8%
97.1%
RTT Waiting List (% Backlog)
TDA
2.9%
2.7%
3.3%
3.0%
3.0%
3.0%
2.3%
2.6%
2.7%
RTT Waiting > 52 Weeks
TDA
0
0
0
0
0
0
0
0
Diagnostic Waiting Time (>6 weeks)
Rate
TDA
0.9%
0.7%
1.1%
0.8%
0.0%
0.1%
0.2%
A&E 4 Hour Wait (Monthly)
TDA
95.1%
94.6%
93.8%
90.8%
93.8%
94.2%
95.5%
A&E 4 Hour Wait (Quarterly)
Responsive
2015
A&E 12 Hour Trolley Wait
94.5%
TDA
93.0%
96.2%
12m Trend Line
12 Month
Movement
93.4%
0
0
0
0
0
0
0
0
0
0
0
0
A&E Attendances
8198
8040
8435
7611
7089
8279
7673
8034
8107
8350
7698
7926

3%
47,788
A&E Ambulances
2072
2121
2247
2045
1888
2101
2047
2090
2029
2081
2061
2021

3.0%
12329
Ambulance H/O SECAmb >30mins
69
39
35
45
99
97
Ambulance H/O SECAmb >60mins
20
7
4
12
45
43
Ambulance H/O LAS >30mins
19
16
6
20
21
25
Ambulance H/O LAS >60mins
12
2
2
8
10
18
Total Ambulance Handovers >30 mins
A&E Conversion Rate
80
53
75
85
76
111
120
64
47
85
175
183
31.5%
30.9%
30.8%
30.1%
30.7%
28.0%
29.1%
29.0%
27.0%
27.9%
28.5%
28.1%
A
A
A
R
R
A
A
A
G
A
R
R
0
316
Rating
Page 17 of 18
2014
Responsive
Indicator
2015
Plan/
Target
Rating
93.2%
93%
G
93.8%
95.5%
93%
G
100%
98%
100%
96%
G
100%
94%
100%
100%
94%
G
100%
100%
100%
100%
98%
G
95.8%
90.8%
90.7%
84.6%
89.0%
85%
G
93%
78%
100%
86%
97%
100%
90%
G
100%
100%
-
-
100%
100%
100%
-
G
2.3%
1.6%
4.8%
9.0%
1.1%
3.7%
2.5%
<12%
G
0.9%
1.0%
0.9%
0.9%
0.5%
2.3%
0.4%
0.4%
0.4%
0.8%
0.8%
<0.8%
G
22
26
22
25
12
56
11
11
10
23
123
TDA
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
CWT - 2 Weeks - GP Referral
TDA
96.1%
93.8%
93.9%
93.3%
93.3%
93.2%
92.7%
94.2%
93.0%
93.3%
CWT - 2 Weeks - Breast
TDA
98.6%
93.2%
97.8%
93.5%
96.4%
94.6%
96.2%
95.9%
94.7%
CWT - 31 Days - First Seen
TDA
100%
98%
100%
100%
100%
100%
100%
100%
CWT - 31 Days - Subsequent (Surgery)
TDA
100%
100%
100%
100%
100%
100%
100%
CWT - 31 Days Subsequent
(Chemotherapy)
TDA
100%
100%
100%
100%
100%
100%
100%
CWT - 62 Days - GP
TDA
85.1%
85.1%
95.5%
90.9%
84.8%
87.8%
CWT - 62 Days - Screening
TDA
100%
92%
96%
100%
100%
CWT - 62 Days - Upgrade
TDA
100%
100%
100%
100%
CWT - 62 Days %Backlog
9.5%
5.2%
2.4%
Cancelled Operations Rate
0.7%
0.4%
21
11
Total (Cancelled Operations)
Sep
Not Rebooked 28 days
TDA
1
0
1
0
0
0
0
0
0
0
0
Urgent - Cancelled 2nd Time
TDA
0
0
0
0
0
0
0
0
0
0
0
0
Delayed Transfers of Care
TDA
12m Trend Line
YTD
Movement
YTD or
Avg
G
0
G
0
G
<3.5%
A
5.1%
3.4%
3.0%
3.8%
6.0%
7.9%
2.9%
6.3%
3.6%
6.9%
5.5%
4.0%
Bed Occupancy Rate (Adult Surgical,
Medical inc. ITU)
100%
99%
98%
100%
102%
101%
100%
100%
99%
99%
100%
101%
93%
B
Outlier Beds - Surgical
3.2%
3.0%
3.2%
1.4%
2.4%
2.4%
2.2%
2.5%
3.1%
2.6%
2.3%
2.4%
<2%
A
Outlier Beds - Medical
4.7%
4.8%
6.5%
11.1%
10.1%
10.7%
8.2%
8.2%
6.0%
6.6%
8.2%
7.4%
<2%
R
NELIP Spells
3425
3230
3294
3060
2878
3060
2945
3025
2944
3083
2892
2966

7%
4.9%
17855
ELIP Spells
627
560
513
522
517
591
605
615
654
641
537
701

14%
3753
DC Spells
2456
2295
2227
2529
2295
2553
2310
2374
2614
2626
2184
2527

6%
14635
Daycase Rate
80%
80%
81%
83%
82%
81%
79%
79%
80%
80%
80%
78%
Outpatient - FA
7941
7128
6643
7267
6657
7761
7096
6667
7916
7669
6537
7788
A
A
A
A
A
A
A
A
A
A
R
R
Overall Score
6%
>80%

2%
A
43673
Page 18 of 18
Item 10-15. Attachment J – 5 Year QIPP Program Summary (Investment & Improvement)
5 YEAR QIPP PROGRAM SUMMARY (INVESTMENT AND
IMPROVEMENT)
CHIEF EXECUTIVE
Summary
Over the past 5 years, admissions have increased; readmissions have reduced as has the Trust’s
crude mortality. Quality indicators such as pressure ulcers have remained static, hospital acquired
infections (HAI) and high severity complaints have reduced, however the number of falls has
increased. Pathways such as Stroke and #NOF have improved significantly over the last years,
and AKI and Sepsis have made small improvements.
.
• Provide excellent, safe patient services
• Deliver financial sustainability and efficiency
• Strengthen operational efficiency and effectiveness
• Promote excellent education
• Proactive community engagement
The QIPP Programme:
Mapping Investments & Improvements: Analysis
October 2015
Introduction
This report captures some of the quality improvements that have occurred between April 2010 and March 2015.
The data has been collected from a number of different sources, including the Patient Administration System, CHKS
benchmarking, DATIX, Electronic Staff Record, Dr Foster and the National Hip Fracture Database (NHFD). When
available, information has been taken from published reports, such as the Trust Board Report to ensure consistent
reporting.
Summary
Over the past 5 years, admissions have increased; readmissions have reduced as has the Trust’s crude mortality.
Quality indicators such as pressure ulcers have remained static, hospital acquired infections (HAI) and high severity
complaints have reduced, however the number of falls has increased. Pathways such as Stroke and #NOF have
improved significantly over the last years, and AKI and Sepsis have made small improvements.
Admissions
Chart 1 demonstrates the growth of non-elective and elective day case admissions to the Trust over the past five
years. There is a pronounced increase in elective day cases since the transfer of elective services at Queen Mary’s
hospital. Non-elective admissions have shown an increase since 2010. This is in part due to service changes at
Queen Mary’s Sidcup from October 2010 onwards. Table 1 shows the percentage increase by admission type
between 2010/11 and 2014/15.
Chart 1 Data Source – In-house PAS data
Table 1 Data Source – In-house PAS data
Non-Elective
% Increase
Actual
2010-15
2010/11
22395
2011/12
25420
2012/13
28690
2013/14
30910
2014/15
32008
30%
Elective IP
% Increase
Actual
2010-15
4422
4310
4243
4981
5039
12%
Elective DC
% Increase
Actual
2010-15
18076
20119
20614
25484
31674
43%
Average Length of Stay (LoS)
Chart 2 and Chart 3 show a reduction in average LoS for both non-elective and elective admissions over the five year
period. The average LoS for non-elective admissions has remained relatively static at around 4.5 days over the last 3
years. Although this has plateaued, innovations such as the Hospital@Home and Elm Court, mean that the length of
stay for the DVH site is reducing.
Elective admissions have seen a consistent reduction in the average LoS. Contributing factors may be pathway
developments, Enhanced Recovery Programme and also the service change with Queen Mary’s in October 2013,
expanding the day case rate. Table 2 summarises average length of stay by elective/non-elective admissions and
financial year.
Chart 4 clearly shows the difference between the Trust Length of Stay with and without QMH activity.
Table 2 Data Source – In-house PAS data
2010-11
Ave LoS Elective
0.72
Ave LoS Non-Elective
5.72
2011-12
0.58
4.85
2012-13
0.56
4.49
2013-14
0.52
4.45
2014-15
0.44
4.47
Readmissions
Chart 6 shows emergency readmissions within 30 days from April 10 – March 15. There is an improvement in
readmission rates with a reduction of 1.5% from July13 and March15. This may be influenced by the opening of Elm
Court, some whose patients may have previously been discharged to the community. The Ambulatory Care Unit
opened in June 2014, and after initial challenges recording the data appropriately, may have influenced a further
reduction in readmissions.
Mortality/HSMR
The crude mortality rate shows a steady decrease in Chart 7. The establishment of several quality improvement and
pathways over this period being a contributing factor. (See Charts 12-22.)
When reviewing the HSMR data it was apparent that there was a downward trend from Q4 2010 to Q3 2011, where
we remained below HSMR Relative Risk until Q1 2014 – see Chart 8. Since then there has been a slow incline in
mortality to date until the most currently reported quarter. Chart 9 demonstrates the same findings and are still
based on observed/expected percentage of mortality.
Chart 7 Data Source - CHKS
Chart 8 Data Source – Dr Foster reports
Chart 9 Data Source – Dr Foster reports
Acuity
Chart 10 demonstrates the acuity of the patients attending Dartford and Gravesham NHS Trust. It is clear that since
2010 the rate of both the high and low acuity patients has risen, although the medium level patients have remained
unchanged. This is interesting considering the age is relatively unchanged within this period, see Table4 and 5. It is
apparent that there is an increase with the number of DGT patients living with co-morbidities.
Chart 10 Data Source – PAS
Age
The average age of admitted patients to the Trust is unchanged since 2010, although this was based on spells – see
Table4 (excluding paediatrics and maternity). A more accurate way of calculating the average age of the patients
admitted can be seen in Table5 which is based on bed days occupied by age.
Table 4 Data Source – In House PAS Data
Based on Spells 2010/11 2011/12 2012/13 2013/14 2014/15
Average Age
60.1
59.9
59.6
59.1
58.6
Median Age
63
63
63
61
60
Based on Occupied
bed days
2010-11 2011-12 2012-13 2013-14 2014-15
Average Age
71.6
71.6
71.3
71.0
71.7
Median Age
76
76
76
76
77
Health Acquired Complications
The number of patients with health acquired complications has increased since 2010 as has the total number of
spells, this has meant that the overall percentage complication rate has reduced and is now <2%. Table6 clearly
shows the percentage of health acquired complications rates, which includes all surgical and medical care (all patient
spells inclusive of maternity and paediatrics).
2010-11 2011-12 2012-13 2013-14 2014-15
Complications
1159
1214
1372
1388
1553
All Spells
54533 61235 64955 72364 79998
Rates
2.1%
2.0%
2.1%
1.9%
1.9%
Workforce
Information on WTE’s and vacancy rates was requested from workforce. Below Table 7 shows the Trust has had an
increasing number of WTE’s in post with an increasing vacancy rate. The Clinical and Admin split in the tables
beneath show more clearly the increase in the vacancy rate each year with a particularly noticeable increase in
clinical vacancies in 2013-14 whilst clerical vacancies level out, however this is due to the increase in establishment.
The WTE in post shows a very similar trend, with clinical WTE’s increasing 10% from 2012-13 to 2013-14 another 9%
again to 2014-15.
Table 7 Data Source – ESR
2010-11 2011-12 2012-13 2013-14 2014-15
Average WTE in Post
1878.11 2005.58 2067.67 2306.88 2598.36
Average Vacancy Rate
7.24%
8.62%
9.19%
8.51%
9.57%
2010-11
2011-12 2012-13 2013-14 2014-15
Average Clinical/Medical Vacancy Rate
7.25%
7.52%
8.24% 10.61% 11.19%
Average Admin & Clerical Vacancy Rate
4.10%
6.63%
7.92%
7.99%
7.81%
Vacancy Rate by Staff Group
WTE in Post by Staff Group
Average Clinical/Medical
Average Admin & Clerical
2010-11
2011-12 2012-13 2013-14 2014-15
1477.33 1609.18 1688.70 1881.37 2067.62
400.36
397.84
395.21
449.17
530.75
Quality Indicators
Chart 11 indicates an increase in the number of inpatients having a fall. This trend requires some further
investigation. The number of Inpatient falls has increased slightly by 7% since 2010/11 to date, there is also been an
increase in the number of inpatient fractures from a fall, seeTable8.
Table 9 shows the hospital acquired pressure sores by grade. Grade 2 pressure sores data was only collated midway
through 2012, previously all grade 2 pressure ulcers (hospital and community) were collated as one. As a result only
grade 3 and 4 are comparable over five years, these show a reduction from 60 in 10/11 to 17 in 14/15, although as
previously stated the number of admissions has increased.
Health Acquired Infections have reduced over the last five years from 29 in 10/11 to 18 in 14/15 – See Table 10.
MRSA has reduced, from 8 episodes in 2010/11 to 1 14/15.
Chart 11 Data Source - Datix
Table 8 Data Source - Datix
Falls
Inpatient Falls
Inpatient Falls resulting in Fracture
% Falls with #
Pressure Sore
2010/11
2
3
39
4
21
3 and 4
60
2010/11
1127
11
0.98%
2011/12
1121
16
1.43%
2011/12
2012/13
22
13
35
12
11
23
2012/13
1038
9
0.87%
2013/14
202
30
4
34
2013/14
1162
16
1.38%
2014/15
1210
22
1.82%
2014/15
260
13
4
17
HAIs
2010/11 2011/12 2012/13 2013/14 2014/15
CDiff
21
26
23
21
17
MRSA
8
2
3
2
1
Complaints
Chart 12 demonstrates a steady number of complaints received in the Trust of around 320, however the more
severe complaints have reduced from 2012/13 to the point that only 7% of all complaints were classed as High
severity. This could be associated with the increased attention around quality and safety and the dissemination of
lessons learnt (e.g. Warfarin, antibiotic prescribing).
Chart 12 Data Source - Datix
Pathway Indicators – Stroke
Charts 13-15 demonstrate the quality improvements that have occurred in the Stroke pathway. Taken from the
Trust board papers it is apparent that there had been an increase in the percentage of patients staying on a specialist
unit for 90% of their stay, however this has plateaued at around 78% for the last year. The mortality and length of
stay have seen a reduction since the beginning of 2014. This period was accompanied by the appointment of a new
ward sister and period of focus on the clinical pathway and an introduction of ring-fenced beds on Spruce Ward and
stricter monitoring against NICE guidance. There was an in depth mortality review.
Pathway Indicators – #Neck Of Femur (NOF)
In 2011/12 DVH were issued an alert detailing the mortality rates and outcomes for #NOF patients were above the
National Average. Since this, the Trust analysed in detail the clinical pathway and made a variety of adjustments.
Key amongst these were quicker access to surgical intervention. More recently a further Orthogeriatrician was
appointed ensuring the patients are transferred to their care within 72 hours.
Charts 16 and 17 show a clear correlation and improvement between time to theatre and mortality since March
2013. These improvements have continued as the service improvement and #NOF team meet monthly, and review
their outcomes and objectives to ensure they remain aware of any discrepancies.
The dissemination of lessons learnt from the mortality review where every death was reviewed by the Orthopaedic
Consultant, Consultant Anaesthetist and the Consultant Orthogeriatrician. A new pathway pro-forma was devised to
ensure every patient met the same objectives and markers, this standardisation and ongoing review has led to the
work stream improving greatly, with the mortality now equalling peer.
Chart 16 Data Source - NHFD
Chart 18 shows the average LoS for the ward and Trust for all #NOF patients. In November 13 the ward LoS appears
to reduce and has continued to do so which could be a result of the pathway review at an Away Day. However, the
increase of the overall Trust LoS for these patients could be associated with the transferring of patients to Elm court,
rather than discharging directly to the community.
Pathway Indicator - Sepsis
Sepsis is on the national agenda for 2015/16 via CQUIN. There has previously been work around sepsis guidelines
and increasing awareness of septic patients. This has demonstrated a reduction in mortality over the five years from
30% to 23%, however the average LoS has remained relatively unchanged, see charts19-20.
Chart 19 Data Source – In House PAS Data
Pathway Indicator – Acute Kidney Injury (AKI)
Another national CQUIN for 2015/16 is AKI, which follows a very similar pattern to Sepsis where the mortality rate
has reduced from 31% to 24%. The average LoS has reduced from 17 to 15 days , see charts 21-22.
Conclusion
Since 2010 activity has increased by 35%, whilst the Trusts average LoS, mortality and readmission rates have
reduced. Interestingly with all of the quality indicators there is a noticeable improvement in LoS up until the end of
2013, since this time there has been an increase in LoS that coincides with the introduction of the service at Elm.
Table 11
2010/11 2011/12 2012/13 2013/14 2014/15
Admissions
44893
49849
53547
61375
68721
Average Length of Stay
3.2
2.8
2.7
2.5
2.3
Readmissions
5.2%
4.8%
5.5%
4.8%
4.1%
Mortality Rate
2.2%
1.7%
1.6%
1.5%
1.4%
Kerry Barrett and Hannah Rogers
October 2015
%Change
34.7%
0.9
1.1%
0.8%
Item 10-16. Attachment K – Finance Report Month 6 (cover)
TRUST BOARD OCTOBER 2015
MONTH 6 FINANCE REPORT
MICK BULL DIRECTOR OF FINANCE
1. Summary
The Finance Report attached shows the month 6 in month deficit of (£0.53m) against the
revised plan of a (£0.54m) deficit and a small favourable variance of £3k this month. This
resulted in a year to date deficit of (£3.42m) against the Trust’s break-even duty compared
to a revised plan deficit of (£3.46m). This represents a small favourable variance of £37k
YTD.
Within the year to date position:
•
•
•
•
•
•
•
Income was £0.2m above plan (£0.1m favourable in month)
Pay was £0.3m underspent ((£0.1m) overspent in month)
Non-pay was (£0.6m) overspent (£0.1m underspent in month)
QIPP delivery was £4.4m, which represented an adverse variance against the
internal phased plan of (£0.1m), a slight improvement in month
The cash balance at the end of August was £2.8m against a plan of £0.1m
The Continuity of Service Risk Rating (COSRR) was 2, which is better than planned
YTD
There was an underspend against the capital plan of £1m (up from £0.6m last
month) due to the Trust requiring confirmation from the TDA of the £1.9m additional
capital required above that which is internally generated.
The Finance Report is enclosed, together with the key tables. The Trust submitted a
revised plan in August, as requested by the TDA, which included an improvement of £2m.
This assumed that marginal rate threshold and penalties are reinvested plus inflation on
PFI invoices is paid to the Trust. To ensure the Finance Committee can track and review
performance against the TDA plan, a table showing actual performance versus the TDA
plan is included in the report. This is the original deficit plan, which has only a marginal
difference YTD from the revised submission. However, the year-end position is £2m less.
The revised plan has been included for the M6 Finance report.
Directorate Performance
The main overspending Directorates were;
•
•
•
•
1
Adult Medicine – YTD (£0.1m), no change in month (temporary nursing usage)
Radiology - YTD (£0.3m), (£0.1m) in month (outsourced MRI above plan, unmet
QIPP targets, agency radiographers plus consultant recruitment fees)
Cancer – YTD (£0.1m), no change in month – (nursing bank and agency usage,
unmet QIPP as well as other activity related pressures)
Women & Children – YTD (£0.3m), (£0.1m) adverse movement in month, due to
unmet QIPP targets, non-pay items and temporary staff usage for midwifery and
medical staff.
The QMH trading account in month was a £0.4m surplus (£0.2m favourable to plan) with a
£0.4m surplus position YTD (£0.1m favourable to plan). The in-month position moved
favourably this month due to increase activity levels above planned.
2. Income
Total year to date income was £0.2m better than plan to month 6, which was a £0.1m over
performance in the month. SLA income is £0.1m below the plan of £98.9m (an in month
adverse variance of (£0.2m). Within the SLA position:
•
•
•
•
Elective & Day Case activity is £0.7m over performing, ((£0.1m) underperformed in
month)
Non elective activity is £0.6m below plan, net of the threshold, ((£0.3m
underperformed in month).
Outpatients are over performing by £1.0m, ((£0.4m) underperformed in month).
A Penalty/Challenge provision has been included at £3.0m to account for likely
levels of penalties based on last year’s levels and in line with the 2015/16 outturn
challenge provision.
The increased levels of elective and day case activity will be causing overspends in
Directorate budgets on clinical supplies and services and drug expenditure.
Other income is now above the plan by £0.3m, a £0.3m favourable movement in the
month, mainly due to provider to provider SLA income for hosted services which has been
revised this month based on updated information.
Expenditure
The key issues are as follows:
•
•
Pay expenditure YTD was lower than plan by £0.3m ((£0.1m) adverse in month).
Total pay costs are higher than the average of the last 6 months of 2014/15, but are
slightly lower than Month 11 and 12 levels. Temporary staff costs have increased in
month 6 by £0.2m compared to August.
Non-pay – overspent YTD by £0.6m (£0.1m favourable in month) due to unmet
QIPP (£0.3m), (£0.1m) Bowel Screening activity at other NHS Trusts, outsourced
Pathology tests (£0.2m).
3. QIPP
All QIPP schemes have phased plans for the year. The QIPP delivered for the year to date
was £4.4m, £0.8m in month, which was below the internal plan by £0.1m (no change in
month). Key areas of slippage are on Adult Medicine (£0.2m) and Critical Care (£0.2m)
both no change in month. The Directorates have QIPP challenge meetings with the PMO
on a monthly basis. This is also an issue for discussion at the performance meetings. It
should be noted that the internal QIPP plan is more aggressive than the TDA plan
2
submitted resulting in the Trust slightly overachieving against the TDA plan of £4.2m. The
QIPP is forecast to deliver £10.3m.
4. Capital
Expenditure was £1m below plan (£0.4m further away from plan than last month), of which
£0.5m is on medical equipment. Buildings are £0.3m below plan to date and IM&T was
£0.2m below plan. A business case has been submitted to the TDA, due to the shortfall
between the capital requirements and the internally generated funds. The issue is now
creating operational difficulties as the Trust has committed the majority of the £3.4m
funding source from internally generated resources and £0.25m DH capital initiative
funding. Capital commitments are being prioritised so that a handling strategy can be
formulated. The TDA have confirmed that they will look to request emergency PDC if
required to avoid an immediate impact on service. The Trust is working on the assumption
that it will receive the £1.9m funding, which will enable the Trust to meet all the essential
capital requirements. The case has been submitted to DH by the TDA and the outcome
should be known imminently.
5. Cash
The Trust had a cash balance of £2.8m at the 30th September 2015 against the plan of
£0.1m. Since the period end the Trust has received the £3m interim revenue working
capital as planned and also the whole £4.5m PFI support income, of which, only £2.25m
was planned for in September. The capital programme is behind plan and therefore cash
balances are higher than expected at the month end. The cash balance is also higher than
plan due to a timing difference in payments planned for September, but in reality were not
due until October.
6. Forecast
The forecast for the Trust is a (£5.8m) deficit (please see the Finance Report for more
detail) before additional income is assumed to meet the stretch target – see below. Within
this, income is forecast to under achieve by £2.1m, an improvement of £0.3m from last
month, (this includes SLA income under achieving by £2.3m). Pay is forecast to
underspend by £0.2m, non-pay overspending £1.3m, most of which is unmet QIPP in
Directorates. This is however, offset by overachievement in other categories of income and
spend. There are central Trust reserves remaining of £0.9m, which are covering the
underperformance on income and some overspends in non-pay relating to QIPP
achievement. The central reserves have reduced by £2m this month to reflect the stretch
target of £2.0m requested by the TDA.
Key Assumptions included in the forecast changing the trend are:
•
•
•
•
3
ACU Business Case £0.3m
Endoscopy staffing £0.2m
Nursing Review £0.5m
Winter pressures £0.5m
• Back phased QIPP (£1.5m) – comprising CHP, PACS, Soft FM, annual Leave &
general pay QIPP
• SLA income (£3.2m) due to seasonality impact of emergency activity.
The key risks to achieving the original planned deficit of £5.8m are outlined in the report,
the most significant being over performance on the Dartford & Gravesham CCG contract
against the CCG plan of £3.3m up from £2.7m last month. The CCG have significant
financial pressures, which may put pressure on the Trust’s financial position. However, the
Trust would expect to be paid for activity undertaken in line with the agreed PbR contract.
The Trust is forecasting that it can meet the stretch target deficit of £3.8m if penalties
related to delayed discharges plus the marginal rate non-elective tariff adjustment were
reinvested back into the Trust and PFI support inflation was received. This additional
income has not been agreed and therefore represents a considerable risk, which has been
shared with the TDA. The position will be kept under close review.
Reason for receipt at the Finance Committee
This Trust Board is asked to:
•
4
Note, discuss and agree the month 6 Finance Report
Finance Board Report
Month 6
September 2015
Mick Bull
Director of Finance
Executive Summary - Dashboard
Financial Performance
Year to date compared with plan
Forecast Outturn compared with plan
Planned year to date
Surplus / (Deficit) £000s
Actual year to date Surplus / (Deficit) £000s
Year to Date
(3,423)
Variance between
actual and planned
year to date
£000s
(3,460)
38
Variance
£000s
Reason
Pay underspends YTD and income over-performance are being offset with non-pay overspends that include:
Unmet QIPP targets (£0.1m), Pathology outsourced tests (£0.2m),
Radiology outsourced MRI scans and consultant recruitment fees (£0.1m), Operations bowel screening
costs and surgical appliances expenditure (£0.3m) and Service Development IT and
consultancy costs (£0.1m).
Total
38
38
Efficiencies
Variance between
planned and
Forecast Outturn
Planned year end Surplus / (Deficit) £000s
current month
Forecast Outturn
£000s
(3,789)
(3,789)
0
Explanation required for forecast outturn variance to plan
No
Reasons for variance between current month
forecast and plan (to within 10% of variance)
Reason
Plan
£000s
Year End Forecast
Actual
£000s
10,019
10,297
The Trust is forecasting to over deliver on it's QIPP plan for 2015-16, by £0.3m.
Variance
£000s
he forecast includes £2m additional income from the reinvestment of the non-elective
T
marginal rate adjustment, reinvestment of fines and PFI support inflation.
This income has not been agreed and represents a significant risk to the
achievement of the stretch target.
Total
0
Fully Explained
Capital
Monitor Financial Metrics
Planned Charge against
CRL YTD
Charge against Capital Resource Limit
Year to Date
1,982
Plan
£000s
(955)
2,937
Year to Date
Q1 (2015-16)
Q2 (2015-16)
Q3 (2015-16)
Q4 (2015-16)
YES
Explanation required for Year End variance to plan
greater than 15% of plan (Year End)?
Capital expenditure is lower than planned due to delays in approval of
funding The Trust is still forecasting to achieve its CRL at 31/03/2015
Cash
Adjusted
Continuity of
Services Risk
Rating
Variance between
actual and planned
£000s
2.0
2.0
1.0
2.0
149
Variance between
actual and planned
2,791
2,642
The Trust has an external financing limit which sets the minimum amount of cash that the
Trust must hold at the end of the year. The Trust's is planning to meet its EFL at 31/03/2016.
(955)
The adjusted continuity of Services risk rating takes into consideration receipt of £4.5m PFI support.
The rating of '2' for Q1 & Q2 is based on actual performance and is better than plan for Q2.
The ratings for Q3 & Q4 are based on planned peformance for 2015-16.
Cash is higher than planned. This is due to the timing of receipts. The cash is planned to
be utilised in the coming months.
Receivables: Over 90 day debt
Liquidity Days
(955)
Fully Explained
Total
Better Payment Practice Code
Total Number
Total Value
Total
Non NHS
Receivables
NHS Receivables
Year to Date Performance
%
%
88
Year to Date %
%
86
Year to Date
%
28
%
26
59
Explanation required where over 90 day debt (for both NHS
YES
Explanation required for performance less than 95%
and non NHS debt) exceeds 5% of total balances
Actions being undertaken to
improve performance to 95%
Process in place to focus on EProcurement
Actual
£000s
Explanation required for low liquidity days and actions being
YES
taken to reduce
Reasons for high over 90 days debt and actions being
Variance (by %)
Variance (by %)
2.0
3.0
system turnaround times for queries
Targeting end users for prompt electronic GRNs
2.0
3.0
Kings on hold due to non payment
Total
3.0
7
3.0
Fully Explained
9
taken to reduce
Actively pursuing Non NHS Trade debt
NO
Reasons for low liquidity days
Variance
and actions being taken to reduce
Variance
Focus on improved working capital balances
(12.1)
54.0
material value relates to Overseas Visitors
which are lengthy in achieving success and delays
from Private Patient companies.
Outstanding debt with CCGs being actively
pursued. Material debt with Kings
Total
Fully Explained
Year to Date
Liquidity Days (excl
Working Capital
Facility)
Days
(12.1)
21.0
75
Fully Explained
Total
(12.1)
Fully Explained
Notes
The Explanation Required/Fully Explained mirror the metrics reported in the key data returns to the Trust Development Authority. The other metrics have been selected by the Trust to report to the Board.
2
Month 6 2015-16 (Published 20-10-15)
Income and Expenditure Position
Month 6 2015/16
Year to Date
Forecast Outturn
Budge t
Actual
Variance
Budge t
Actual
Variance
Ye ar End
Fore cas t I&E
Ye ar End
Variance
£'000
Ye ar End
Fore cas t
Budge t
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
16,408
16,167
(242)
98,912
1,384
1,813
429
8,448
98,859
(53)
203,285
200,960
(2,325)
8,650
202
16,862
17,011
Other Income
531
445
(86)
149
3,234
3,315
81
6,546
6,611
Direct Credits
0
0
65
0
0
0
0
0
0
0
18,323
18,425
101
110,594
110,824
230
226,693
224,582
(2,111)
Medical Staf f
Nursing
(3,072)
(3,125)
(54)
(18,459)
(18,612)
(153)
(37,443)
(37,640)
(197)
(4,821)
(4,897)
(77)
(28,853)
(28,970)
(117)
(58,008)
(58,639)
(631)
STT Staf f
(1,448)
(1,486)
(38)
(9,025)
(8,844)
181
(18,450)
(18,069)
382
A&C/Sen Man Staf f
(1,638)
(1,589)
49
(9,763)
(9,357)
406
(19,665)
(19,029)
635
0
0
0
0
0
0
0
0
0
(10,979)
(11,098)
(119)
(66,100)
(65,784)
316
(133,567)
(133,378)
189
Patient Care - Contract Income
Patient Care - Other Income (Inc. PFI Support)
Total Incom e
Ope ratingExpe nditure
Pay Cos ts
Support Staf f
Total Pay Cos ts
Total Non Pay Cos ts
Total Ope rating Expe ns e s
Reserves
EBITDA
(6,266)
(6,143)
123
(37,172)
(37,818)
(646)
(74,401)
(75,715)
(1,314)
(17,245)
(17,241)
4
(103,272)
(103,602)
(330)
(207,967)
(209,092)
(1,125)
179
0
(179)
(76)
0
76
(871)
0
871
1,257
1,184
(74)
7,246
7,222
(24)
17,855
15,490
(2,365)
0
9
9
0
23
23
0
23
23
(536)
(524)
12
(3,186)
(3,152)
34
(6,449)
(6,449)
(0)
Impairment of Fixed Assets
0
0
0
0
0
0
0
0
0
Interest Receivable
1
2
0
8
13
5
15
26
11
Prof it/Loss on Disposal
Depreciation
0
0
0
0
0
0
(30)
(49)
(19)
(1,249)
(1,205)
43
(7,339)
(7,209)
130
(14,850)
(14,534)
316
(182)
(182)
0
(1,091)
(1,091)
0
(2,231)
(2,182)
49
(1,965)
(1,901)
64
(11,609)
(11,416)
193
(23,545)
(23,165)
380
(708)
(717)
(10)
(4,362)
(4,193)
169
(5,690)
(7,675)
(1,985)
170
183
13
903
771
(132)
1,901
1,886
(15)
Surplus /(De ficit) Com pare d to B/E Duty
(538)
(534)
3
(3,459)
(3,423)
37
(3,789)
(5,789)
(2,000)
EBITDA Margin Calculation
6.86%
6.42%
6.55%
6.52%
7.88%
6.90%
Interest Payable
Other Finance Costs
Public Dividends Payable
Othe r Finance Cos ts Total
Surplus /(De ficit)
Technical Adjustments to Surplus/(Def icit)




The Trust delivered a deficit against breakeven duty of £534k in month 6, compared with a plan of £538k deficit in the month. This represents a £3k
favourable variance from plan.
The YTD position against breakeven duty is a £3,423k deficit, compared to a YTD plan of £3,459k deficit, representing a £37k favourable variance from plan
YTD.
The Reserves/Rephased Plan adjustment brings the Trust’s internal budget in line with the revised TDA, submitted in September 2015.
The Trust stretch target in the revised plan for 2015-16, of £3.8m deficit, is dependent upon the TDA confirming PFI indexation support funding of
£0.4m and the reinvestment of fines by the DGS CCG of £1.6m. At present this has not been confirmed and is not included in the figures reported
above.
Month 6 2015-16 (Published 20-10-15)
3
Directorate Expenditure Summary
Month 6 2015/16
Directorate
Budget
Central Incom e
Year to Date
Actual
Variance
£'000
£'000
£'000
18,205
18,308
103
(828)
(802)
25
(2,576)
(2,584)
(399)
(404)
(2,976)
(2,987)
(12)
(1,464)
(1,533)
(70)
(8,709)
(603)
(631)
(29)
(3,527)
Budget
Forecast Outturn
Year End
Forecast
I&E
£'000
Year End
Variance
£'000
Year End
Forecast
Budget
£'000
138
225,235
222,919
(2,316)
48
(10,035)
(10,061)
(26)
(15,348)
(84)
(31,487)
(31,742)
(255)
(2,492)
(112)
(4,842)
(5,014)
(171)
(17,840)
(196)
(36,329)
(36,756)
(426)
(8,798)
(90)
(17,487)
(17,790)
(303)
(3,669)
(142)
(6,811)
(7,286)
(476)
Actual
Variance
£'000
£'000
109,847
109,985
(5,058)
(5,011)
(7)
(15,264)
(4)
(2,380)
(17,644)
•
Adult Medicine reported a £7k overspend in month 6 and a
£84k overspend YTD. This YTD position is predominantly being
driven by nursing bank and agency usage, in particular relating
to specialing, as well as sickness and vacancy cover.
Temporary staff usage in some nursing areas are above the
funded nursing review levels.
•
Cancer Services is overspent by £4k in month 6 and £112k
overspent YTD. This YTD position is due to unmet QIPP
targets and pay overspends for nursing temporary staff usage
relating to sickness and maternity leave cover as well as
medical staff locum usage.
•
DVH Surgical Services is £33k overspent in month 6 and £20k
overspent YTD. The YTD position is due to various pay
underspends within Urology/Nephrology and Critical Care
relating to vacancies that are being recruited to. These pay
underspends are being partially offset by pay overspends in
General Surgery relating to nursing and medical temporary staff
usage. In addition there are some unmet QIPP targets YTD.
•
Women’s Services reported a £25k overspend in the month
and £110k overspend YTD. This YTD position is due to unmet
QIPP targets along with some non-pay pressures.
•
Paediatrics reported a £39k overspend in the month and £144k
overspend YTD. The adverse position is driven by medical and
nursing temporary staff usage, mostly at the DVH site.
•
Radiology is £108k overspent in month 6 and £267k overspent
YTD. This position is due to outsourced MRI scanning costs
across both sites as well as consultant recruitment fees and
radiographer agency usage.
•
Estates and Facilities reported a £89k underspend in the month
and £189k underspend YTD, driven by significant QIPP overperformance.
•
FM services reported a £24k underspend in the month and
£118k underspend YTD due to lower costs than planned for
additional projects.
•
The figures reported do not include the additional £2m
income required to deliver the stretch target of £3.8m.
£'000
Clinical Directorates
Accident & Em ergency
Adult Medicine, Cancer & Endoscopy
Adult Medicine
Cancer Services
Sub Total Adult Med, Cancer & Endoscopy
Surgical Services
Critical Care
General Surgery
Urology/Nephrology
(382)
(317)
65
(2,257)
(2,046)
211
(4,702)
(4,246)
456
QMH Surgical Services
(677)
(665)
12
(4,142)
(4,120)
21
(8,199)
(8,288)
(89)
(3,125)
(3,146)
(21)
(18,634)
(18,634)
1
(37,199)
(37,611)
(412)
(318)
Sub Total Surgical Services
Operations
Operations
(387)
(400)
(13)
(2,369)
(2,372)
(3)
(4,447)
(4,764)
Outpatient Services
(245)
(240)
4
(1,469)
(1,423)
46
(3,007)
(2,933)
74
(1,432)
(1,450)
(18)
(8,446)
(8,475)
(29)
(17,543)
(17,511)
33
Pharmacy
Therapy Services
Sub Total Operations
Orthopaedics
Wom en's
(417)
(419)
(2)
(2,541)
(2,551)
(10)
(5,247)
(5,103)
144
(2,480)
(2,508)
(29)
(14,825)
(14,821)
4
(30,244)
(30,311)
(67)
(680)
(665)
14
(4,162)
(4,191)
(29)
(8,368)
(8,367)
0
(1,267)
(1,292)
(25)
(7,413)
(7,522)
(110)
(14,983)
(15,034)
(51)
Children's
(617)
(655)
(39)
(3,775)
(3,919)
(144)
(7,609)
(7,818)
(209)
Pathology
(734)
(780)
(46)
(4,389)
(4,471)
(81)
(8,795)
(8,907)
(112)
Radiology
Total Clinical Directorates
(800)
(908)
(108)
(4,920)
(5,187)
(267)
(9,670)
(10,373)
(703)
(13,505)
(13,744)
(239)
(80,820)
(81,595)
(774)
(163,232)
(165,238)
(2,006)
(16)
Corporate Directorates
Chief Executive
(138)
(124)
14
(727)
(721)
5
(1,426)
(1,443)
Estates & Facilities
(818)
(729)
89
(4,790)
(4,602)
189
(9,888)
(9,048)
840
Finance
(280)
(250)
30
(1,672)
(1,643)
29
(3,022)
(3,162)
(141)
FM Services
(932)
(908)
24
(5,857)
(5,739)
118
(11,418)
(11,270)
148
Governance & Medical Education
(641)
(624)
16
(3,893)
(3,809)
85
(7,737)
(7,726)
11
HR
(143)
(145)
(1)
(859)
(817)
42
(1,718)
(1,718)
0
Nursing
(135)
(127)
9
(796)
(777)
19
(1,784)
(1,731)
53
Service Development
(431)
(402)
29
(2,561)
(2,558)
3
(5,175)
(5,160)
16
Strategy and Planning
(89)
(88)
1
(460)
(453)
7
(939)
(940)
(1)
Private Patients Expenditure
(15)
17
32
(89)
(49)
40
(170)
(90)
79
179
0
(179)
(76)
0
76
(871)
98
969
Total Corporate Directorates
(3,442)
(3,379)
63
(21,780)
(21,167)
613
(44,148)
(42,191)
1,957
Total Directorates
(16,947)
(17,124)
(176)
(102,601)
(102,762)
(161)
(207,380)
(207,429)
(49)
1,257
1,184
(74)
7,246
7,222
(23)
17,855
15,490
(2,365)
(1,965)
(1,901)
64
(11,609)
(11,416)
193
(23,545)
(23,165)
380
(708)
(717)
(10)
(4,363)
(4,193)
170
(5,690)
(7,675)
(1,985)
Reserves
EBITDA
Other Finance Costs Total
Surplus/(Deficit)
Technical Adjustments to Surplus/(Deficit)
Surplus/(Deficit) Com pared to B/E Duty
EBITDA Margin Calculation
170
183
13
903
771
(132)
1,901
1,886
(15)
(538)
(534)
3
(3,460)
(3,423)
38
(3,789)
(5,789)
(2,000)
-7.42%
-6.91%
-7.06%
-7.03%
-8.61%
-7.47%
Month 6 2015-16 (Published 20-10-15)
4
Financial Performance - Pay
Actual
Actual
Actual
Actual
Actual
Actual
Average
Actual
Actual
Actual
Actual
Actual
Actual
Movement
Oct
Nov
Dec
Jan
Feb
Mar
Oct to Mar
Apr
May
June
July
Aug
Sept
(Higher)/Lower
7
8
9
10
11
12
M7 to M12
1
2
3
4
5
6
M5 to M6
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
2,523
2,451
2,469
2,473
2,511
2,760
2,531
2,475
2,495
2,427
2,491
2,515
2,409
105
Locum
147
226
212
239
238
218
213
200
204
192
205
254
276
(23)
Agency
399
427
469
306
383
588
429
441
313
414
476
383
440
(56)
Sub Total Medical
3,069
3,104
3,150
3,018
3,132
3,567
3,173
3,115
3,012
3,034
3,173
3,152
3,125
26
Substantive
3,247
3,352
3,221
3,301
3,446
3,220
3,298
3,361
3,361
3,449
3,354
3,349
3,430
(81)
Bank
243
235
194
211
251
306
240
219
274
251
241
248
259
(10)
Agency
167
149
183
179
231
165
179
155
140
105
204
142
137
5
Sub Total Nursing
3,657
3,737
3,597
3,691
3,927
3,690
3,717
3,735
3,775
3,805
3,800
3,739
3,825
(86)
Substantive
1,030
1,030
1,034
1,042
1,044
1,140
1,053
1,056
1,075
1,076
1,023
1,068
1,076
(8)
Pay Group
Pay Expenditure
12,000
11,500
Pay
Substantive
Nursing
Scientific & Ther.
11,000
£000s
Medical
10,500
2015
-16
10,000
2014
-15
9,500
9,000
Bank
26
23
4
16
31
(58)
7
5
25
21
20
18
11
7
Agency
131
171
147
119
165
130
144
113
105
104
161
46
111
(65)
Sub Total STT
1,187
1,224
1,185
1,176
1,240
1,212
1,204
1,173
1,204
1,201
1,204
1,131
1,198
(66)
Substantive
1,021
1,039
1,027
1,042
1,109
1,046
1,047
1,108
1,108
1,153
1,128
1,115
1,152
(37)
159
163
151
172
170
217
172
190
205
180
215
216
199
17
1,800
1
-
-
-
-
-
0
-
-
-
-
-
-
-
1,600
1,180
1,202
1,178
1,214
1,278
1,263
1,219
1,298
1,313
1,333
1,343
1,331
1,351
(20)
1,400
Month
Funded Vacancies v Bank/Agency
Expenditure
HCAs/Support
Bank
Agency
Sub Total Support
Sen. Managers A&C Substantive
1,412
1,404
1,427
1,464
1,357
1,414
1,471
1,464
1,471
1,482
1,471
1,479
32
37
28
33
44
43
36
32
55
68
66
52
48
5
Agency
59
32
45
45
21
49
42
27
27
42
48
36
72
(36)
1,510
1,481
1,477
1,506
1,529
1,450
1,492
1,530
1,546
1,582
1,596
1,559
1,599
300
250
£000s
1,000
Locum
800
agency
(40)
600
bank
-
400
Vacany
Substantive
9,241
9,284
9,156
9,286
9,573
9,523
9,344
9,470
9,504
9,577
9,478
9,517
9,546
(29)
200
Bank/Locum
607
685
589
670
733
726
668
645
762
712
747
788
793
(5)
-
Agency
757
778
843
649
800
932
793
736
586
666
890
607
759
(152)
10,604
10,747
10,587
10,605
11,106
11,181
10,805
10,851
10,851
10,955
11,116
10,912
11,098
(185)
Total pay
350
1,200
(9)
Bank
Sub Total STT
Total
1,420
Vacant WTEs v Bank/Agency WTEs
Locum
200
WTE
agency
bank
150
Vacancy
100
50
1 3 5 7 9 11
Month
1 3 5 7 9 11
Month
Pay budgets were £119k overspent in month 6 and £316k underspent YTD (as shown on page 3).
QMH pay budgets reported a £47k underspend in the month and £4k overspend YTD. DVH pay budgets reported a £166k overspend in the month and £320k underspend YTD.
QMH pay underspends in the month were due to a correction for costs that were misallocated YTD.
DVH pay overspends of £166k in the month were due to Critical Care medical on call pressures and nursing agency usage, Paediatrics medical locum and agency expenditure, Radiology agency usage for radiographers and Pathology
agency expenditure for Haematologists.
DVH pay underspends of £320k YTD were driven by vacancies within Surgery (Critical Care & Urology/Nephrology), Pathology, Operations, Orthopaedics , Service Development, HR, Finance and Governance Directorates.
5
Month 6 2015-16 (Published 20-10-15)
Financial Performance – Non-Pay
Actual
Actual
Actual
Actual
Actual
Actual
Average
Actual
Actual
Actual
Actual
Actual
Actual
Movement
Oct
Nov
Dec
Jan
Feb
Mar
Oct to Mar
Apr
May
June
July
Aug
Sept
(Higher)/Lower
7
8
9
10
11
12
M7 to M12
01
2
3
4
5
6
M5 to M6
Non-Pay
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
Medical & Surgical Supplies
1,503
1,282
1,375
1,492
1,475
1,373
1,417
1,415
1,258
1,479
1,240
1,217
1,225
(7)
Laboratory Consumables
430
371
360
367
434
288
379
344
419
285
372
395
374
21
Travel & Training
66
125
94
109
83
228
114
136
83
102
103
77
92
(16)
Computer consumables
260
229
367
383
272
122
274
240
238
224
254
136
232
(97)
Hire & Maintenance of Equipment
393
423
355
372
418
610
415
376
397
446
387
336
392
(56)
Clinical Negligence Scheme & Consultancy Fees
534
503
526
518
580
462
518
511
519
530
464
511
495
17
Other
739
766
838
483
122
521
602
747
818
786
894
868
851
17
Energy, Rates & Insurance
426
449
433
477
467
351
425
422
472
447
469
403
391
12
Drugs
1,139
1,173
1,253
1,179
1,225
1,653
1,238
1,063
1,194
1,216
1,226
1,129
1,179
(51)
PFI
979
1,007
1,018
1,007
1,011
1,010
1,012
1,023
1,020
1,019
993
933
912
22
Total Non Pay
6,468
6,327
6,618
6,388
6,087
6,619
6,395
6,278
6,418
6,534
6,402
6,004
6,143
(139)
Non-pay expenditure (including drugs & PFI soft facilities) reported a
£123k underspend in month 6 and a £646k overspend YTD (as shown on
page 3).
Non-Pay Expenditure (inc. Drugs & PFI Soft Facilities)
7,500
QMH non-pay expenditure is £72k underspent YTD, while DVH non-pay
is £718k overspent YTD.
DVH YTD overspends are driven by the following key issues: Unmet
QIPP targets (£0.1m), Pathology outsourced tests (£0.2m), Radiology
outsourced MRI scans and consultant recruitment fees (£0.1m),
Operations bowel screening and surgical appliances expenditure (£0.3m)
and Service Development IT and consultancy costs (£0.1m). These
overspends are being partially offset by Estates & Facilities QIPP overperformance (£0.2m) and FM services projects underspends (£0.1m).
£000s
The month 6 underspend position is largely driven by Estates and
Facilities QIPP over-performance and FM services projects underspends.
7,000
2015-16
6,500
2014-15
6,000
5,500
5,000
Month 6 2015-16 (Published 20-10-15)
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Month
6
Financial Performance v TDA Plan
Category
Gross Employee Benefits
Other Operating Costs
Revenue from Patient Care Activities
Other Operating Revenue
TDA Plan YTD Actual YTD Variance
Key Issues
£000s
£000s
£000s
(65,753) (65,784)
(31)
(40,942) (40,969)
(27)
107,121
107,509
388 Contract income broadly inline with Plan favourable variance primarily relates to Lewisham Hosted services SLA and Direct Credits
3,473
3,315
(158) The adverse variance relates primarily to General income and the increased Bad Debt provision now provided for RTA income recovery
OPERATING SURPLUS/(DEFICIT)
3,899
4,071
172
Investment Revenue
Other Gains and Losses
9
(15)
13
23
4
38
Finance Costs (including interest on PFIs and
Finance Leases)
(7,232)
(7,209)
23
Dividends Payable on Public Dividend Capital (PDC)
(1,105)
(1,091)
14
RETAINED SURPLUS/(DEFICIT) FOR THE YEAR
(4,444)
(4,193)
251
984
770
(214)
(3,460)
(3,423)
37
4,169
4,381
212
IFRIC 12 adjustment including impairments
Adjusted Financial Performance Retained
Surplus/(Deficit)
Efficiency Programme (QIPP)
The phasing of IFRIC 12 adjustment is different to TDA plan, which had assumed equal 12ths phasing. Technical impact for donations is
-£153k YTD, with nothing included for this in the TDA plan.
QIPP schemes are currently forecast to overperform against plans for 2015-16
7
Month 6 2015-16 (Published 20-10-15)
QMH Income and Expenditure Summary
Category
Total Income
Cancer Services
Emergency Medicine
Finance
HR
Information
Governance
Operations
Pathology
QMH Surg Servs
Radiology
Service Development
Women & Children
Orthopaedics
Chief Executive Office
QMH Reserves
Total Expenditure
Grand Total




Budget
£000s
1,958
Month 6
Actual
£000s
2,130
Variance
£000s
172
Budget
£000s
11,175
Year to Date
Actual
£000s
11,203
28
Budget
£000s
22,896
Forecast Outturn
Actual
£000s
22,914
(21)
(115)
(338)
(8)
(6)
(47)
(210)
(27)
(677)
(190)
(39)
(67)
(36)
0
0
(1,783)
(22)
(108)
(330)
(8)
(6)
(47)
(215)
(27)
(631)
(223)
(35)
(78)
(15)
0
0
(1,745)
(1)
7
8
0
0
(0)
(4)
(0)
46
(33)
4
(11)
22
0
0
38
(129)
(624)
(2,025)
(49)
(36)
(282)
(1,413)
(135)
(4,142)
(1,243)
(227)
(404)
(206)
0
0
(10,914)
(151)
(608)
(2,033)
(49)
(36)
(280)
(1,316)
(136)
(4,120)
(1,293)
(229)
(419)
(175)
0
0
(10,846)
(23)
16
(8)
0
0
2
97
(1)
21
(49)
(2)
(15)
31
0
0
68
(258)
(1,244)
(4,073)
(97)
(71)
(563)
(2,979)
(244)
(8,199)
(2,394)
(463)
(807)
(424)
0
0
(21,818)
(281)
(1,257)
(4,067)
(97)
(71)
(561)
(2,666)
(247)
(8,231)
(2,500)
(452)
(846)
(368)
0
0
(21,642)
(23)
(13)
7
0
0
2
312
(2)
(31)
(107)
11
(39)
56
0
0
173
175
385
210
261
357
96
1,078
1,272
191
Variance
£000s
Variance
£000s
18
QMH income reported a £172k favourable variance in the month and a £28k favourable variance YTD. The favourable in month position is due to an overperformance on
the main contracts and Lewisham hosted services agreement.
QMH expenditure reported a £38k favourable variance in the month and the YTD position against plan is a £68k favourable variance. This favourable YTD expenditure
position is due to non-pay underspends within Surgical Services.
The overall month 6 position against plan is a £210k favourable variance in the month and a £96k favourable variance YTD. This YTD favourable variance is
predominantly due to non-pay underspends, particularly for Surgical Services and also income overperformance against plan.
The 2015-16 forecast position for QMH is a £1.3m surplus.
Month 6 2015-16 (Published 20-10-15)
8
Temporary Staffing Comparison Year on Year
• Total bank expenditure in month 6 was £516k, compared to month 5 which had a spend of 534k, this is a decrease of £18k in month 6. The variance consists of decreased bank spend
over a number of Directorates. Month 6 spend is significantly above the average monthly spend in 2014-15 of £476k. The average spend year to date is £520k.
• Total internal locum expenditure in month 6 was £276k, compared to month 5 this is an increase of £23k in month 6. This is above the monthly average locum expenditure in 2014-15 of
£214k. This gives an average of £222k for the first half of 2015-16.
• Non-Medical agency expenditure in month 6 was £319k, compared to month 5 this is an increase of £95k in month 6. However, this represents a decrease compared to the average
monthly spend in 2014-15 of £385k. This gives an average spend of £296k for the first half of 2015-16. Non-medical agency expenditure has increased rapidly this month mainly due to
expenditure within Pathology, Radiology and Service Development Directorates.
• Medical agency expenditure in month 6 was £440k, compared to month 5 this is a decrease of £56k in month 6. This is below the average monthly expenditure in 2014-15 of £472k. This
gives an average of £411k for the first half of 2015-16. Tighter pay controls are now in place to reduce the spend on medical agency and the benefits from engaging 247 time are starting
to materialise.
Month 6 2015-16 (Published 20-10-15)
9
Reserves
Month 6 Budgets and Reserve Balances
Month 5
Directorate
£'000
28,846
30,909
10,076
22,562
8,421
8,200
55,070
41,120
205,203
(74)
Business
Cases
£'000
14
212
Other
Month 6
£'000
(8)
95
34
£'000
28,860
31,046
10,076
22,562
8,368
8,200
55,080
41,215
205,407
(53)
18
(57)
226
Reserves Balance
14,000
12,000
10,000
£'000
Surgery
Emergency
A&E
Women & Childrens
Orthopaedics
QMS
Other Clinical Areas
Corporate
Activity
linked
£'000
PFI Financing Cost
PFI Depreciation
Depreciation Charge
Other Financing Costs
Dividend Payment
Capital Costs
14,797
3,077
3,372
15
2,231
23,492
0
0
0
14,797
3,077
3,372
15
2,231
23,492
Reserves
General
Contingency
3,256
957
57
(226)
7
(41)
3,093
916
Total Reserves
4,213
57
(226)
(34)
4,009
232,907
0
0
0
232,907
Total Budgets & Reserves
8,000
6,000
4,000
2,000
0
The reserve balance as at month 6 is £4.0m, which includes £0.9m of contingency reserve.
During month 6, £0.2m of reserve funding was allocated to Directorates. This included the following
significant items: ACU business case and costs relating to the community services bid.
10
Month 6 2015-16 (Published 20-10-15)
Income Analysis by Commissioner
Contract Income
Income & Activity Performance to the 30th September 2015
CONTRACTS
Annual
Plan
£000
124,082
YTD
Plan
£000
61,061
Medway CCG
3,503
1,721
1,786
65
West Kent CCG
1,113
547
591
44
31,899
15,662
15,588
-74
Greenwich CCG
5,043
2,479
2,439
-40
Bromley CCG
1,566
772
799
27
Thurrock CCG
1,631
802
1,060
258
20,571
10,152
9,878
-274
NCAs
2,958
1,452
1,670
218
Kings - MSK
3,700
1,821
1,344
-477
Guys - Cardiology
1,885
923
858
-65
Others (inc Public Health)
3,199
1,484
1,484
0
Technical and Seasonal phasing adjustment
2,135
36
0
-36
203,285
98,912
98,859
-53
Dartford, Gravesham & Swanley CCG
Bexley CCG
NHS England
Actual
Income Variance
£000
£000
61,362
301
The contract income for the 30th September 2015 is shown in the table opposite reflecting the month 6 contract
performance with each Commissioner for 2015/16.
The YTD Plan is based on an agreed phasing with Commissioners and reflects working days and seasonality and is
now included in SLAM. The variances are therefore more reflective of the individual Contract performances as at
M6.
The graphs below reflect the TDA Plan phasing which incorporates the impact of service developments and QIPP
income schemes commencing later in the finanancial year.
The gross SLAM income value has been reduced by £3,804k which represents a reduction of £786k relating to the
NEL Marginal Rate threshold penalty and £3018k for other challenges and contract penalties. (eg Readmissions,
New to Follow Up Ratios, Ambulance Handovers,CQUIN).
The DG&S CCG contract is £301k above the Trust's YTD Plan and is now forecast to be around £0.5m above the
Trust's Annual Plan by the year end. The Bexley, Greenwich and Bromley CCG contracts are broadly inline with the
YTD Plan after a provion for challenges. The Other commissioner contracts with significant over performances are
Thurrock CCG (£258k, 32%) and NCAs (£218k, 15%). The Thurrock CCG over performance continues to relate to
increased activity in most specialties particularly Orthopaedics and Obstetrics. The number of deliveries at the end
of M6 were 86 compared to a plan of 39, £107k additional income.
The MSK contract with Kings is still in negotiation. The offers made by Kings are unacceptable and therefore PbR
will apply until agreement is reached. The contract performance is still a significant 'Risk' to the Trust, underspent
by £477k, 26% at M6.
All Contracts have now been agreed and signed with the exception of the MSK Contract with Kings.
TOTAL (Contract Income - inc HCDs)
Summary
Overall there is an under performance against the Trust's Contract income of £53k at month 6 against the phased
YTD Plan. A revised forecast outturn for each Contract is provided in the SLA Update report.
The Trust's all Other income is now £282k over the plan year todate, primarily relating to the QMH Lewisham &
Greenwich Trust Hosted services SLA (£160k) and income from Donated Assets (£132k).
Overall the Trust's income is £229k ahead of the planned income at the end of September 2015.
Monthly Income - Other
Monthly Income from Contracts
2500
18,500
18,000
2000
1500
17,000
Plan
16,500
Actual
£000
Plan
Actual
1000
16,000
500
Month 6 2015-16 (Published 20-10-15)
March
Feb
Jan
Dec
Nov
Oct
Sept
August
July
0
June
15,000
May
15,500
April
£000
17,500
11
Income Analysis by Point of Delivery
The Table opposite details by POD the Trust's total contract income as at the
end of September 2015 after a total reduction to the gross SLAM income has
been made of £3,804k for the NEL Marginal rate threshold adjust ment (£786k)
and a provision for penalties and challenges (£3,018k).
Income Performance to the 30th September 2015
CONTRACTS
(By Point of Delivery)
Annual
Plan
£000
41,715
YTD
Plan
£000
19,615
Actual
Income
£000
20,311
Non Elective
NEL Marginal Rate Threshold penalty
79,953
39,469
39,682
-786
213
-786
First Outpatient Attendance
20,085
9,887
10,777
890
Follow Up Outpatient Attendance
15,176
8,125
8,263
138
A&E
12,454
7,063
6,489
-574
25,240
10,382
9,752
-630
8,662
4,371
4,371
0
203,285
98,912
98,859
Elective & Day Cases
Other (inc HCDs, Devices, Blood etc)
Block
TOTAL
Variance
£000
696
-53
The Point of Delivery (POD) Annual Plan and YTD Plan are now phased inline
with working days and seasonality as agreed with Commissioners and have
been input to the Trust's SLAM model.
All income and activity includes both DVH and QMH as there are no separate
contracts in 2015/16 for QMH.
A&E activity and income is significantly behind the Plan at the end of M6.
The other POD income has been reduced by £3,018k for the provision for
penalties and challenges as at M6 however a technical and seasonal
adjustment of £1,300k has been made to reflect the TDA YTD Plan. This is
expected to be corrected in the M7 actual activity/income performamce.
The Table below details the actual activity for September 2015 by POD and the
activity Plan is now phased in SLAM.
The Graphs below detail the 2015/16 income levels verses 2014/15 for A&E,
Outpatients and Elective and Non Elective Inpatient and Day Case activity.
Activity
Elective
Non Elective
First Outpatient
Follow Up Outpatients
A&E
YTD
Plan
19,399
24,498
76,328
86,829
50,497
Actual
Variance
20,873
23,612
75,979
103,160
47,785
1,474
-886
-349
16,331
-2,712
Variance
%
7.60%
-3.62%
-0.46%
18.81%
-5.37%
12
Month 6 2015-16 (Published 20-10-15)
Statement of Financial Position (Balance Sheet)
Opening as at
01/04/2015 Post
Audit
As at
30/09/2015
Forecast
31/03/2016
£000
£000
£000
•
Under IFRS the Trust is required to account for the
PFI asset as being on SoFP as a non current
asset with a corresponding liability.
Increase in cash is due to a higher level of receipts
than planned which will be utilised in the coming
months to meet obligations.
Cash includes £2,791 cash and £4k of cash
equivalents.
A desktop valuation was performed by the District
Valuation Office as at 31/03/2015 resulting in an
increase of £17.2m to property valuations.
Prepayments and accrued income has been
adjusted to reflect invoices raised in advance.
Non-Current Asset
Property, Plant & Equipment
149,654
148,656
150,901
Current Assets:
Inventories
Trade & Other receivables
Cash & Cash equivalents
Total Current Assets
Total Assets
2,526
16,754
3,504
22,784
172,438
2,385
13,241
2,795
18,421
167,077
2,717
15,918
1,182
19,817
170,718
Current Liabilities:
Trade & Other payables
Receipts in advance
Other Liabilities
DH Capital Loan
DH Working Capital Loan
Borrowings: PFI Liability
Current Provisions
Net Current Assets/Liabilities
Total Assets less current liabilities
(21,158)
0
(53)
0
0
(1,455)
(791)
(673)
148,981
(20,842)
0
(53)
0
0
(1,455)
(665)
(4,594)
144,062
(21,818)
0
(53)
0
Trade & Other Receivables
0
(1,622)
(342) NHS receivables less receipts in advance
(4,018) Trade receivables
146,883 Prepayments and accrued income
•
•
•
•
Non-Current Liabilities
Borrowings: PFI Liability
Interim Revolving Working Capital
Other borrowings Capital BAU
DH Capital Loan (Endoscopy & Communit
Non-Current Provisions
Other Liabilities
Total Assets Employed
(69,333)
0
0
0
(74)
(842)
78,732
(68,606)
0
0
0
(74)
(842)
74,540
Financed By:
Public dividend capital
Retained Earnings
Revaluation Reserve
Total Equity
56,652
(32,138)
54,218
78,732
56,652
(36,331)
54,219
74,540
Provision for the impairment of receivables
(67,711) VAT
(3,000) Other receivables
(1,937)
(2,137)
0
(789)
71,309
TOTAL
Trade & Other Payables
Trade payables
NHS payables
Non-NHS payables - capital
56,902 Non-NHS accruals and deferred income
(39,812)
PAYE/NI
54,219
71,309 Other payables
TOTAL
Month 6 2015-16 (Published 20-10-15)
As at
As at
01/04/2015
Month 6
£000
£000
10,435
2,975
2,628
(215)
931
16,754
12,098
812
(74)
(211)
616
13,241
As at
As at
01/04/2015
Month 6
4,040
3,118
1,825
10,490
96
1,589
21,158
1,194
1,071
790
14,382
2,706
699
20,842
13
Cash flow 2015/16
Forecast Forecast Forecast
Jan
Feb
Mar
£000
£000
£000
1,102
750
836
BALANCE B/F
Actual
Apr
£000
3,500
Actual
May
£000
9,113
Actual
Jun
£000
8,490
Actual
Jul
£000
4,889
Actual
Aug
£000
4,390
Actual
Sep
£000
3,802
Forecast
Oct
£000
2,791
Forecast
Nov
£000
2,025
Forecast
Dec
£000
1,362
RECEIPTS
21,765
19,172
16,702
19,917
19,639
19,494
26,904
18,887
21,402
19,827
18,887
21,441
PAYMENTS
(14,682)
(19,316)
(19,903)
(19,968)
(20,115)
(18,980)
(27,737)
(18,937)
(21,369)
(20,339) (18,909)
(21,400)
CASH FROM OPERATIONS
7,083
(145)
(3,201)
(51)
(476)
513
(833)
(50)
33
(512)
(22)
41
NON OPERATIONAL
RECEIPTS AND PAYMENTS
(1,471)
(479)
(400)
(448)
(112)
(1,525)
67
(613)
(293)
160
108
305
NET INFLOW/OUTFLOW
5,613
(623)
(3,601)
(498)
(588)
(1,011)
(766)
(663)
(260)
(352)
86
346
BALANCE C/F
Plan
9,113
9,113
8,490
3,821
4,889
3,821
4,390
1,954
3,802
1,169
2,791
149
2,025
2,025
1,362
1,361
1,102
1,101
750
749
836
835
1,182
1,182
•
•
•
Total at
Aged Receivables/Payables: Current Month
0-30 days
30 - 60 Days
•
•
The cash balance at the end of
September is £2.8m against a
plan of £0.1m.
NHS debtors are being actively
pursued by the Income team.
Material debts are with NHS
England £4,7m (PFI), Lewisham
& Greenwich NHST £1.6m,
Medway FT £0.6m, Kings £1.8m
and Dartford, Gravesham &
Swanley CCG £0.4m.
Trade creditors payments within
30 days (BPPC performance) is
90% by volume.
Non NHS debt over 90 days is
£812k of which £378k relates to
overseas patients. These are
proving lengthy in achieving
settlement. Of the £284k
overseas debt £52k is actively
reducing by instalments.
The Trust is planning to achieve
its External Financing Limit as at
31/03/2016.
60-90 Days
Over 90 Days
Sign Period End
Receivables Non NHS
Receivables NHS
+
+
Payables Non NHS
Payables NHS
(mc 01)
(mc 02)
(mc 03)
(mc 04)
(mc 05)
(mc 06)
(mc 07)
(mc 08)
(mc 09)
£000s
£000s
%
£000s
%
£000s
%
£000s
%
12,098
213
1,794
26
15
-
(1,194)
(1,098)
92
(30)
3
(34)
3
(32)
3
-
(1,071)
(398)
37
(188)
18
(237)
22
(248)
23
812
42
2,042
5
17
78
5,170
10
43
479
3,092
59
26
14
Month 6 2015-16 (Published 20-10-15)
Capital Programme
1
Capital expenditure
Month 6, Sept 2015
Category
Buildings
IM&T
Medical Equipment
Total
2
Allocation
£000
4,212
2,234
1,250
7,696
Plan year to
date
£000
1,607
510
820
2,937
Spend as at
30/09/15
£000
1,338
290
354
1,982
Variance
£000
269
220
466
955
•
The Trust submitted a plan to the TDA with a
capital resource limit (CRL) for capital expenditure
of £11,009k. A further £250k of PDC has been
received in respect of DH capital initiative funding.
•
The Trust has deferred capital spend of £3.5m
(£0.5m Community Services Loan, QMH loan
£1.5m and Endoscopy £1.6m). Therefore the
revised capital resource is £7,696m.
•
The spend as at month 6 is £1,982k against a plan
of £2,937k. This is due to the Trust awaiting
confirmation from the TDA of CRL before resource
can be committed. To date just £3,622k of the
£7,696k has been confirmed.
•
The Trust is planning to meet its CRL.
Source and Application
£000
Opening allocation internally generated (confirmed)
DH capital incentive funding (confirmed)
3,372
250
Community Tender IT Loan
1,000
Additional Support requested within plan loan
Endoscopy Loan
Total Resource
Buildings
IM &T
Equipment
Total Application
Resource Less Application
1,937
1,137
7,696
4,212
2,234
1,250
7,696
0
15
Month 6 2015-16 (Published 20-10-15)
QIPP Performance 2015-16
Table 1
Directorate
Target
£000s
Forecast
Delivery
£000s
A&E
Adult Medicine
Cancer Services
Chief Exec
Critical Care
Facilities
Finance
Governance
General Surgery
HR
Nursing
Operations
Pathology
Procurement
QMH Surgery
Radiology
Service Development
T&O
Urology/Nephrology
Strategy and Planning
Women & Children
Corporate
467
1,442
234
20
845
303
514
625
330
87
73
1,181
446
20
339
477
242
402
223
27
662
1,060
514
1,391
75
23
378
1,147
608
635
211
87
73
958
386
162
347
349
679
313
477
27
595
862
Total
10,019
10,297
Forecast
Forecast
Full Year
Variance
Recurrent
Recurring
from Target
Schemes
Schemes
£000s
£000s
£000s
47
(50)
(159)
2
(468)
844
94
10
(119)
(223)
(60)
142
8
(128)
437
(89)
254
(0)
(67)
(198)
278
164
1,218
23
264
1,147
232
635
188
87
38
621
386
98
300
299
679
237
444
21
206
116
7,404
290
1,556
23
264
1,212
252
645
203
87
38
687
379
69
424
357
1,279
308
480
21
116
8,690
YTD Plan YTD Achieved
£000s
£000s
YTD
Variance
% of
Target
Forecast
£000s
Budget
% Variance
Variance
to
£000s
Budget
196
721
117
10
411
111
46
312
157
44
13
525
223
9
165
147
97
176
94
14
331
530
264
543
75
11
226
359
86
316
93
44
50
429
198
112
140
108
55
135
191
15
330
602
68
(178)
(42)
1
(186)
248
40
4
(64)
36
(97)
(25)
103
(25)
(39)
(43)
(42)
97
1
(1)
72
110%
97%
32%
111%
45%
379%
118%
102%
64%
100%
100%
81%
86%
810%
102%
73%
281%
78%
214%
100%
90%
81%
48
(84)
(112)
5
(90)
307
106
85
(142)
42
19
4
(81)
53
21
(267)
3
(29)
211
7
(254)
0
4,450
4,381
(69)
103%
(148)
0%
0%
-2%
0%
-1%
3%
1%
1%
-2%
2%
1%
0%
1%
6%
0%
-3%
0%
0%
4%
1%
-3%
0
Table 1 details the position for QIPP schemes by Directorates against their plans. As at month 6, 98% of the YTD plan has been delivered. Full year
effect of recurrent QIPP schemes currently equate to 87% of the 2015-16 target. The overall QIPP performance for 2015-16 is forecasting to over perform
against targets by £278k.
16
Month 6 2015-16 (Published 20-10-15)
QIPP Performance 2015-16
Table 2
RAG rating
H
L
M
Grand Total
Table 3
Total
%
852
7,403
2,042
10,297
Analysis
Income
Savings - Pay (Skill Mix)
Savings - Pay (WTE reductions)
Savings Non Pay
Grand Total
8%
72%
20%
100%
Table 2 above shows RAG rating of the
schemes ( in terms of delivery and risk).
Value
3,136
1,864
1,535
3,761
10,297
%
30%
18%
15%
37%
100%
Table 3 shows QIPP schemes by
Pay, Non-Pay and Income
categories.
Table 4
Scheme Analysis by FIMS Category Total
Back office Efficiencies
1,151
Estates Optimisation
996
Medicines Management
543
Other Provider Efficiencies
3,330
Procurement | Contracting
1,720
Safe Care
754
Workforce Productivity
1,802
Grand Total
10,297
Table 4 shows QIPP schemes by
FIMS category.
17
Month 6 2015-16 (Published 20-10-15)
Service Line Report Summary
M onth 5⃰
M onth 6⃰
(De ficit) / Surplus
£217
-£111
£64
-£381
-£211
15-16
Contribution Contribution
(De ficit) / Surplus
£193
-£20
£70
-£404
-£161
M onth 6 ⃰ ⃰ ⃰
In m onth
pos ition
-£24
£91
£6
-£23
£50
Contribution
£3,390
£1,262
£253
£161
£5,066
YTD T/O
£11,865
£5,159
£486
£2,215
£19,725
%
1.6%
-0.4%
14.4%
-18.2%
-0.8%
%
28.6%
24.5%
52.1%
7.3%
25.7%
Targe t
38.3%
28.7%
36.6%
20.4%
M onth 6 ⃰ ⃰ ⃰ ⃰ ⃰
M onth 6 Surplus
General Surgery
Nephrology/Urology
Pain
ITU
TOTAL SURGERY
100
101
191
ITU
Accident & Emergency
TOTAL A&E
180
£98
£98
£112
£112
£14
£14
£2,704
£2,704
£10,104
£10,104
1.1%
1.1%
26.8%
26.8%
27.8%
Trauma & Orthopaedics
TOTAL T&O
110
-£107
-£107
£224
£224
£331
£331
£3,396
£3,396
£10,764
£10,764
2.1%
2.1%
31.5%
31.5%
34.4%
General & Elderly Medicine
Diabetic Medicine
Cardiology
Neurology
TOTAL EM ERGENCY M EDICINE
300
307
320
400
-£1,831
£83
-£125
-£54
-£1,927
-£2,164
£27
-£142
-£90
-£2,369
-£333
-£56
-£17
-£36
-£442
£3,390
£135
£1,112
£176
£4,813
£19,444
£366
£3,914
£1,198
£24,922
-11.1%
7.4%
-3.6%
-7.5%
-9.5%
17.4%
36.9%
28.4%
14.7%
19.3%
32.9%
50.2%
35.5%
-1.0%
In Sum m ary
Surgical Se rvice s
Turnover
Def icit
Contribution
£19,725
-£161
£5,066
A&E
Turnover
Surplus
£10,104
£112
1.1%
£2,704
26.8%
Turnover
Surplus
Contribution
£10,764
£224
£3,396
2.1%
31.5%
Em e rge ncy M e dicine
Turnover
£24,922
Def icit
Contribution
-£2,369
£4,813
Wom e n & Childre n
Turnover
Surplus
£21,281
-£30
-0.1%
£7,515
35.3%
Contribution
Paediatrics
Obstetrics
Gynaecology
SCBU
TOTAL WOM EN & CHILDRENS
420
501
502
SCBU
£291
£31
-£117
£32
£237
£343
-£187
-£144
-£42
-£30
£52
-£218
-£27
-£74
-£267
£1,724
£4,481
£829
£481
£7,515
£3,872
£11,843
£3,515
£2,051
£21,281
8.9%
-1.6%
-4.1%
-2.0%
-0.1%
44.5%
37.8%
23.6%
23.5%
35.3%
T&O
52.9%
41.9%
23.7%
22.2%
Contribution
Cancer Services
Rheumatology
ENT
Ophthalmology
Oral Surgery
Dermatology
Dietetics
Radiology
Direct Access
TOTAL OTHER
General Surgery QMH
Nephrology/Urology QMH
T&O QMH
Pain QMH
General & Elderly Medicine QMH
Cardiology QMH
Paediatrics QMH
Gynaecology QMH
Cancer Services QMH
Rheumatology QMH
Other Services QMH
Direct Access QMH
TOTAL QM H
TRUST TOTAL
370/303
410
120
130
140
330
654
810
DA
-£402
£90
-£163
£26
-£39
£1
-£26
£91
-£528
-£950
-£568
£131
-£208
£31
-£150
£5
-£30
£115
-£882
-£1,556
-£166
£41
-£45
£5
-£111
£4
-£4
£24
-£354
-£606
£1,179
£236
£72
£196
£86
£32
-£11
£435
-£146
£2,079
£7,496
£777
£471
£303
£470
£59
£8
£1,109
£2,132
£12,825
-7.6%
16.9%
-44.2%
10.2%
-31.9%
8.5%
-375.0%
10.4%
-41.4%
-12.1%
15.7%
30.4%
15.3%
64.7%
18.3%
54.2%
-137.5%
39.2%
-6.8%
16.2%
100QM
101QM
110QM
191QM
300QM
320QM
420QM
502QM
303QM
410QM
OTHERQM
DAQM
£183
-£24
-£172
£0
£169
£151
-£112
-£132
£21
£7
£28
-£147
-£28
£243
£2
£39
£40
£191
£192
-£95
-£232
£24
£2
£368
-£417
£357
£60
£26
£211
£40
£22
£41
£17
-£100
£3
-£5
£340
-£270
£385
£778
£72
£429
£120
£445
£310
-£50
-£40
£95
£2
£997
-£298
£2,860
£2,390
£309
£1,741
£359
£1,136
£527
£202
£857
£319
£42
£2,789
£532
£11,203
10.2%
0.6%
2.2%
11.1%
16.8%
36.4%
-47.0%
-27.1%
7.5%
4.8%
13.2%
-78.4%
3.2%
32.6%
23.3%
24.6%
33.4%
39.2%
58.8%
-24.8%
-4.7%
29.8%
4.8%
35.7%
-56.0%
25.5%
-£2,888
-£3,423
-£535
£28,433
£110,824
-3.1%
25.7%
-0.8%
25.7%
22.0%
43.3%
28.8%
67.2%
37.8%
46.5%
97.5%
90.2%
46.5%
-9.5%
19.3%
Othe r
Turnover
Def icit
Contribution
£12,825
-£1,556 -12.1%
£2,079 16.2%
QM H
Turnover
£11,203
Surplus
Contribution
£357
£2,860
3.2%
25.5%
Notes:
⃰ Month 5 and Month 6 position is total bottom
line Surplus or (Def icit) year to date. This
includes all income less direct, indirect and
overhead costs
⃰ ⃰ In month position is total bottom line f or
current month only
⃰ ⃰ ⃰ Contribution is Income less Direct and Indirect
costs bef ore overheads are deducted
• Dire ct Acce s s has s how n the large s t de ficit in the m onth of £354k for DVH. The Pathology e le m e nt of the s e rvice appe ars to be e xce e ding the incom e re ce ive d. This re quire s
a re vie w by Finance and the de partm e nt.
• In m onth the highe s t s urplus for DVH w as T&O at £331k . This w as due to incom e incre as ing in m onth by 21% w ith a dire ct cos t re duction of 9%
• The large s t de ficit in m onth for QM H w as Dire ct Acce s s at £270k . Again this re quire s a finance re vie w .
• The large s t in m onth s urplus for QM H w as Othe r Se rvice s due to a re vie w of incom e .
Month 6 2015-16 (Published 20-10-15)
18
SLR Bubble Chart - DVH
Notes:
• Profitability is measured by the surplus or deficit of the specialty compared to income. Ie if an area had £1m of income
and a surplus of £100k it would show as 10% profitable.
• Relative size is compared to that of the largest specialty - General Medicine.
19
Month 6 2015-16 (Published 20-10-15)
SLR Bubble Chart - QMH
Notes:
• Profitability is measured by the surplus or deficit of the specialty compared to income. Ie if an area had £1m of income
and a surplus of £100k it would show as 10% profitable.
• Relative size is compared to that of the largest specialty - Other Services.
Month 6 2015-16 (Published 20-10-15)
20
SLR Direction of Travel - DVH
Notes:
1. Profitability is measured by the surplus or deficit of the specialty compared to income. I.e. if an area had £1m of income and a surplus of
£100k it would show as 10% profitable.
2. The graph is showing the profitability of each service going from -50% to +50% compared to the size of each service. The further to the right
the services are, the more profitable they are. The higher dots are showing the largest services with Gen Med being the largest of all
3. Services which have improved their margin between 14-15 outturn and Month 6 15-16 are:
• General & Elderly Medicine
• Obstetrics
• General Surgery
• Accident & Emergency
4. Services which have reduced their margins between 14-15 outturn and Month 6 15-16 are:
• Cardiology
• Neurology
• Trauma & Orthopaedics
• Paediatrics
• Pain
• Radiology
• SCBU
• Gynaecology
• ITU
• Diabetic Medicine
• Urology/Nephrology
• Cancer Services
21
Month 6 2015-16 (Published 20-10-15)
SLR Direction of Travel - QMH
Notes:
1. Profitability is m easured by the surplus or deficit of the specialty com pared to incom e. I.e. if an area had £1m of incom e and a surplus of
£100k it w ould show as 10% profitable.
2. The graph is show ing the profitability of each service going from -50% to +50% com pared to the size of each service. The further to the right
the services are, the m ore profitable they are. The higher dots are show ing the largest services w ith Gen Med being the largest of all
3. Services w hich have im proved their m argin betw een 14-15 outturn and Month 6 15-16 are:
• Cancer Services
• Trauma & Orthopaedics
4. Services w hich have reduced their m argins betw een 14-15 outturn and Month 6 15-16 are:
• Gynaecology
• Cardiology
• Pain
• General & Elderly Medicine
• Paediatrics
• General Surgery
• Urology/Nephrology
22
Month 6 2015-16 (Published 20-10-15)
Key Financial Risks
KEY FINANCIAL RISKS as at MONT H 6 2015/16
Key Risk
Description
INCOME AND EXPENDITURE RISKS
Mth 6
Estimated
Forecast
Gross Risk
Likelihood 15 (5 high)
RAG
£m
Joint working with CCG - range of actions identified to im prove health
econom y pos ition. The funding gap m ay need TDA/NHS England
intervention.Reconciliation of year end forecas t and contract is s ues being
worked on with CCG.
1.86
A
PMO challenge m eetings are continuing with Directorates . The QIPP Board
reviews the QIPP pos ition m onthly. Executive Leads are allocated to the
works tream . Additional downs ide m itigations now being worked up and
brought into the program m e.
0.30
2
A
Contract will be clos ely m onitored over the com ing m onths and action will
need to be taken if activity does not continue to ris e - s eeking to reduce cos t
bas e. Kings have recently m ade new contract offer which will increas e
forecas t out-turn to £3m
0.04
0.30
1
G
Not expected
0.06
0.40
2.0
A
Central controls have been put in place to m anage potential expenditure
creep. Monthly perform ance review m eetings are in place to challenge
Directorate's financial pos itions . Additional QIPP would be required to achieve
the plan.
0.16
1.00
2.5
A
Flexing capacity to cope with operational pres s ures , incom e for non elective
work now at 70% not 30% will help fund the additional cos ts of tem porary
s taffing.
0.50
Funding received - ris k clos ed
0.00
No agreem ent with CCG regarding reinves tm ent - is s ue likley to require
es calation
1.80
CCG challenges higher than expected - overperform ance
challenged
3.10
3.0
Red
QIPP Delivery
£10m QIPP delivery required to achieve the plan
as s um ing that em erging pres s ures are not above the
£1m contingency. Currently £0.9m of high ris k s chem es
les s £0.3m expected over delivery
0.60
2.5
MSK contract (c.£1m advers e Trus t s till in negotiation with Kings Healthcare for MSK
varaince included within
contract. The plan is £3.7m , current projection bas ed on
forecas t)
current activity (not increas ing referalls ) is £2.7m
0.10
IDT Funding
Funding agreed with DG&S CCG for IDT @ £0.75m . The
expenditure has been reviewed and the cos ts aligned to
the which the Trus t believes is agreed.
Safer Staffing Initiative
Cos ts above current phas ed plan
PFI Incom e
£4.5m PFI incom e included in 2015/16 financial plan
s upported by TDA but incom e not received
4.50
0.0
G
Ris k to achieving s tretch
target of £2m im provem ent
Reinves tm ent of fines and m arginal rate funding targeted
plus inflationery increas e to PFI incom e
2.00
4.5
Red
Sub Total I&E Risk
Net risk
£m
CCG Increas ed Challenges ,
non paym ent of
overperform ance
Bed pres s ures em erge during the winter period ,
Operational/winter pres s ures increas ed agency cos ts and other cos t pres s ures that
can't be m anaged.
Mitigating Action/Update
12.00
4.72
Capital & Cash
Additional CRL approval
The TDA do not approve the £1.9m CRL increas e
reques ted
1.90
3.0
Red
Cas e has been s ubm itted to the TDA
1.14
Endos copy Bus ines s cas e
approval
The endos copy bus ines s cas e does not receive ITFF
approval in this financial year res ulting in additional fees
to m aintain SOC
0.50
3.0
Red
Cas e s ubm itted to TDA with s upporting docum ents
0.30
Working Capital Loan
TDA does not approve working capital loan of £3m
3.00
0.0
G
Loan received in full ris k clos ed
0.00
Note:
The as s es s m ent of the financial ris k value is agains t the forecas t £3.8m s tretch target deficit (agains t the break-even duty) bas ed on the as s um ptions included in the Trus t forecas t.
The net ris k is derived by taking the gros s ris k divided by 5 (highes t) divided by the liklihood of the ris k being realis ed.
Month 6 2015-16 (Published 20-10-15)
23
Item 10-17. Attachment L – Minutes of the Charitable Funds Committee 20.10.15 (draft)
CHARITABLE FUNDS COMMITTEE
20 October 2105
Darent Valley Hospital
MINUTES
Present:
David Findley
Susan Acott
Annette Schreiner
Mick Bull
Tracey Cummins
Jenny Still
Kathy Peache
Non-Executive Director (Committee Chairman)
Chief Executive
Medical Director
Director of Finance
Fundraising & Voluntary Services Manager
Assistant Director of Finance (from Item 10-5)
Finance Manager
(DF)
(SA)
(AS)
(MB)
(TC)
(JS)
(KP)
Mary Bradford
Corporate Development Assistant (for minutes)
(MBr)
In attendance:
10-1 APOLOGIES FOR ABSENCE
There were no apologies for absence.
10-2 MINUTES, MATTERS ARISING AND ACTION LOG
The minutes of the meeting held on 16 June 2015 were confirmed as a correct record.
The Committee noted the action log which was updated and is attached to these minutes.
10-3
ANNUAL REPORT 2014-15, ACCOUNTS & MANAGEMENT REPRESENTATION
LETTER
KP stated that the Annual Report and Accounts is an item on the Trust Board agenda for 29
October, when the representation letter will be signed off. A number of amendments were
agreed to the text to correct inaccuracies carried over from the previous year.
 Action:
MB to speak to JS re auditors and look at timing for February 2016.
10-4 CHARITABLE FUNDS BANKING ARRANGEMENTS
KP reported there is no change in the risk status of the Co-operative Bank and it was agreed
to take this item off the agenda/action log.
10-5 FINANCE PAPERS
JS presented the report. It was suggested it may be worth looking at Friends Fund and Little
Buds Fund in more detail to assess the availability of uncommitted funds.
MB asked whether we can use the funds for condemned/broken equipment, rather than the
expected £1.9m. It was agreed to use the Friends Fund with discretion at DVH and to use
QMH funds there. SA suggested assembling a list of equipment that is condemned/broken
or for urgent items and consider whether we can use any of the money now which can be
the contingency for the final quarter. The list is to be prioritised.
 Action:
AS to co-ordinate the list of condemned/broken equipment with MB.
Page 1 of 3
With regard to the outcome of Fund Survey, KP has sent letters and a questionnaire. This
survey will be finalised by the February meeting. It was agreed to add to the February
agenda.
10-6 FUNDRAISING UPDATE – MATERIAL MOVEMENTS
TC reported that since 30.6.15 there is £33,872 uncommitted funds.
Unfortunately the finance reports and the fundraising reports are not aligned with regard to
dates. It was therefore agreed that TC and KP will meet to align the documents and clarify
the position to ensure the reports can be synchronised. These reports will then be re-issued
to the Committee.
 Action:
TC/KP to synchronise reports and re-issue. Also
to
inform
Committee of the Friends Fund and Little Buds Fund uncommitted position.
the
10-7 DETAILED SCRUTINY OF FUNDS
There were no detailed scrutiny of funds for the meeting. It was agreed to look at any
Education Fund over £5k at the February meeting.
 Action:
JS/KP to provide details
10-8 FUNDRAISING STRATEGY
TC reported the fundraising administrative post is going through business support for
approval.
 Chair’s Action:
JS to follow up and obtain sign off.
10-9 FUNDRAISING POLICY
TC presented the policy with the amendments proposed from the last meeting. There was a
discussion over the ethical stance. SA stated we would not accept direct donations from an
industry that has directly proven it impacts on physical health; this was agreed as our overall
stance and appropriate wording will be included in the revised policy.
Item 4 – Duties:
(i) Roles and responsibilities of the Charitable Funds Committee need to be included.
(ii) Point of care testing - need to co-ordinate with appropriate departments and ensure
compatibility/incompatibility, e.g. IT and EMBE.
Supporters – need clear and transparent information on how their funds are used.
Refusals – reinforce ethics
Fundraising Activity – add a section regarding the process if an individual wants to do a ‘one
off’ event.
It was agreed that the policy needed some further work and that Committee members will
advise TC of proposed amendments.
 Action:
All Committee members
10-10 ITEMS FOR INFORMATION
TC reported that the Association of NHS Charities meetings continue to be very supportive.
10-11 ANY OTHER BUSINESS
(a)
New name of Charity – TC reported the new name is:
Your NHS Hospital Charity
Darent Valley, Queen Mary’s, Erith Hospitals
(b)
Recent requests – TC updated the group on recent requests, e.g. MSK Ultrasound,
which will need approval through AS.
Page 2 of 3
(c)
Update on Scope Appeal – TC reported there is a £66k legacy due. There is around
£200k in the Cancer Fighting Fund (including the legacy) and that this fund also
includes the Scope Appeal. A public appeal will commence in Spring 2016.
It was agreed that the February agenda should include an update on the Scope Appeal.
Next year’s Stride for Life will also raise funds for this.
TC showed the copies of The Valley and Fundraising leaflets, which she would like
incorporated into one document. SA agreed to speak to the Director of HR regarding this.
 Action:
SA to discuss with the Director of HR
DATE OF NEXT MEETING
Tuesday 16 February 2016 at 9.30 a.m. in the Chief Executive’s Office.
FURTHER MEETING DATES
Tuesday 14 June 2016, Tuesday 18 October 2016 and Tuesday 14 February 2017
Page 3 of 3
Item 10-17. Attachment M1 – Annual Report draft v1.1 23/07/2015
Dartford and Gravesham NHS Trust Charitable Fund –
Annual Report 2014/15
1. Introduction and background
The Trustees present their annual report and the accounts for the year ended 31 March 2015,
which have been prepared in accordance with the Charities Act 2011, and the Statement of
Recommended Practices, Accounting and Reporting by Charities 2005 (SORP 2005): Accounting
and Reporting by Charities.
Under the terms of the National Health Service Act 1977 and the National Health Service and
Community Care Act 1990, a health service Trust is able to administer a Charitable Fund. This
Fund is required to be registered and administered under the Charities Act 2011, and are now
under single accountability requirements. The revised Accounting and Reporting by Charities
Statement of Recommended Practice issued in March 2005 requires the NHS Trust to produce an
annual report and accounts.
Dartford and Gravesham NHS Trust was legally established on 1 November 1993. A Charitable
Fund was held and Charitable Trust records were maintained from 1 April 1994. Due to charitable
legislation requirements, the Dartford and Gravesham NHS Trust Charitable Fund was formed on
20 October 1995 and registered with the Charity Commission by Declaration of Trust Deed.
Dartford and Gravesham NHS Trust is based at Darent Valley Hospital in Dartford, Kent and offers
a comprehensive range of acute services to around 400,000 people in North Kent and South East
London. In October 2013 the Trust took on a number of services at Queen Mary’s Hospital, Sidcup
and Erith & District Hospital as part of the dissolution of the South London Healthcare Trust. As
part of the transfer Dartford and Gravesham NHS Trust became responsible with effect from 7 July
2014 for the related Queen Mary’s and Erith charitable funds and the transition of those funds
has been overseen by the Charitable Funds Committee.
2. The Dartford and Gravesham NHS Trust Charitable Fund
2.1
Charitable status - the Charitable Fund held by the Dartford and Gravesham NHS Trust is
registered under the following charity:
Name:
The Dartford and Gravesham NHS Trust Charitable Fund
Registration number: 1050861
Registered address: Darent Valley Hospital,
Darenth Wood Road,
Dartford,
Kent DA2 8DA
2.2
Trustees of the Charitable Fund - Dartford and Gravesham NHS Trust is the sole
Corporate Trustee. However, its Board of Directors acts as the agent of the Trust. Board
membership as at year-end 2014/15 is shown below, with in-year changes shown in italics below.
• Janardan Sofat, Chairman
• Susan Acott, Chief Executive(v)
• Michael Bull, Director of Finance1 (v)
• David Warwick, Non-Executive
Director
• Gerard Sammon, Deputy Chief Executive/Chief
Operating Officer (v)
• Steve Wilmshurst, NonExecutive Director2
• Annette Schreiner, Medical Director (v)
1
Michael Bull joined the Trust on 17 July 2014
2
Steve Wilmshurst joined the Board on 22 April 2014
Page 1
•
•
•
•
Vikki Carruth, Director of Nursing3
Stuart Jeffery, Director of Information
Andy Brown, Director of Human Resources
Pam Dhesi, Director of Operations4
•
•
•
Karen Taylor, Non-Executive Director
David Findley, Non-Executive
Director
Peter Coles, Non-Executive Director
In 2010, the Board of Directors of Dartford and Gravesham NHS Trust established and authorised
a committee, the Charitable Funds Committee, to oversee the management of the Charitable Fund
on its behalf. The Charitable Funds Committee met twice during 2013/14 (June 2014 and
October 2014). The Chairman of the Charitable Funds Committee reports the minutes of each
Charitable Funds Committee meeting to the Trust Board, highlighting any matters that require
Board attention or action.
The Charitable Funds Committee members as at year-end 2014/15 were:
 David Findley, Non-Executive Director (Chair)
 Susan Acott, Chief Executive
 Tracey Cummins, Fundraising & Voluntary Services Manager
 Kathy Peache, Finance Manager
 Russell Davies, Trust Secretary5
 Annette Schreiner, Medical Director (represented by the Director of Operations when unable to
attend)
 Michael Bull, Director of Finance
and Performance
In addition, the Charity Management Board, a sub-committee of the Charitable Funds Committee,
met every two months during the year. The minutes of the Charity Management Board and
received by the Charitable Funds Committee (and vice versa).
The Board of Directors, on behalf of the sole Corporate Trustee, employed the following
professional advisers during the year:
Bankers:
Co-operative Bank plc.
London and South East Business Centre,
PO Box 2790,
80 Cornhill,
London EC3V 3RD
Independent examiners:
Kevin Lowe, Director,
PricewaterhouseCoopers LLP,
1 Embankment Place
London WC2N 6RH
2.3
Appointment and induction of Trustees - the NHS Trust Development Authority appoints
Non-Executive Directors of the Trust Board. Executive Directors of the Board are appointed via the
NHS Trust’s recruitment procedures. Members of the Trust Board and the Charitable Funds
Committee are not individual trustees under Charity Law but act as agents on behalf of the
Corporate Trustee. As part of their induction programme, new Executive and Non-Executive
Directors of Dartford and Gravesham NHS Trust are made aware of their responsibilities as Board
members of the corporate trustee of Dartford and Gravesham NHS Trust Charitable Fund.
3
Vikki Carruth joined the Board on 10 June 2014
Pam Dhesi joined the Board on 19 May 2014
5
Susan Aylen-Peacock left the Trust in October 2014 and was replaced by Russell Davies.
4
Page 2
The accounting records and the day-to-day administration of the funds are held by the Finance
Department located at Darent Valley Hospital, Darenth Wood Road, Dartford DA2 8DA.
2.4
Strategic objectives and activities - the objects of this Fund empower Dartford and
Gravesham NHS Trust, as the Sole Corporate Trustee, to hold the Charitable Fund upon trust to
apply the income, and at their discretion, so far as may be permissible, the capital, for any
charitable purpose or purposes relating to the National Health Service.
There have been no changes of policy during 2014/15, which affect these objectives, nor are there
any plans to change these objectives.
The Charity is funded by donations and/or legacies received from patients, their relatives, and the
general public, staff and other organisations.
Whilst respecting the wishes of the donors, the Corporate Trustee has ultimate discretion to apply
the Charitable Fund, as the Fund is entirely unrestricted (though designated or restricted funds are
established where appropriate and necessary).
2.5
Governance and management - the Charitable Fund’s unrestricted fund status was
established using the Model declaration of trust and all funds held on trust as at the date of
registration were either part of this unrestricted fund or registered as separate restricted funds
under the main Charity. The funds registered separately have now been spent or dissolved with
Charity Commission approval and all funds are unrestricted. Subsequent donations and gifts
received by the Charitable Fund that are attributable to designated funds are added to those fund
balances within the existing Charitable Fund. The South London Healthcare Trust funds are
unrestricted with the exception of Heartbeat Fund which is registered separately and therefore
restricted.
The Corporate Trustee fulfils its legal duty by ensuring that funds are spent in accordance with the
objects of each fund and by designating funds the Trustee respects the wishes of our generous
donors to benefit patient care and advance the good health and welfare of patients, carers and
staff.
If funds were received which had specific restrictions imposed by the donor, then a restricted fund
would be registered. All monies received are receipted using the Charity Commission model
receipt therefore enabling all funds to be unrestricted. This includes a statement that the trustees
have ultimate discretion to apply the charitable funds as all funds are unrestricted in nature.
The Board of Dartford and Gravesham NHS Trust, on behalf of the Corporate Trustee, has
delegated the oversight of the management of the charitable funds to the Charitable Funds
Committee, which is chaired by a Non-Executive Director. The Director of Finance is responsible
for the day-to-day management and control of the administration of the charitable funds and
reports to the Charitable Funds Committee. The Director of Finance has particular responsibility to
ensure that spending is in accordance with the objects and priorities agreed by the Charitable
Funds Committee and the Board; that the criteria for spending charitable monies are fully met; that
full accounting records are maintained; and that devolved decision-making or delegated
arrangements are in accordance with the policies and procedures set out by the Board on behalf of
the Corporate Trustee.
Fundraising f o r t h e c h a r i t y i s s u p p o r t e d b y t h e F u n d r a i s i n g a n d V o l u n t e e r
M anager, a proportion of their costs are charged directly to the charity.
Page 3
The following funds were designated in the year:
Overseen by the Charitable Funds Committee:
‘Directorate-based’ fund
• Accident and Emergency Unit;
• Cancer;
• Children’s Fund (incorporating Paediatrics and
NICU);
• Diagnostics;
• Gynaecology;
• Maternity;
• Medicine;
• Outpatients; and
• Surgery
‘Separate’ funds:
• ALSO course fund;
• Anaesthesia Study Fund;
• Breast care library trust fund;
• Cardiology Training Fund;
• Diabetes Centre Education Fund;
• Haematology study Fund;
• Intensive Therapy Unit Education and Training
Fund;
• Lottery Fund
• Microbiology education fund;
• Neurology Trust Fund
• Pharmacy fund;
• Physiotherapy Department Training Fund;
• Resuscitation fund;
• Surgical Speciality Education Fund;
• Training income for dieticians; and
• Urology Education Fund
‘Special Funds’ (overseen by the Charity Management Board):
•
•
•
•
•
Friends Fund (formerly Fundraising & Voluntary Services Fund) - incorporating the 'brick fund'
Heartbeat Fund;
Little Buds Fund (for special care of babies);
The Cancer Fighting Fund; and
The Lollipop Fund (for sick children from babies to teens)
During 2013/14 Dartford and Gravesham NHS Trust became responsible for the Queen Mary’s
and Erith charitable funds listed below, with a value of £153k. Kings College Hospital NHS
Trust received all SLHT charitable funds and dealt with the onward transfer to other receiving
organisations:
•
•
•
•
•
•
•
•
•
•
•
•
•
Rheumatology department
Chislehurst ward
Pain relief
Avery Hill ward
Anaesthetic
Theatres
Newland fund
Heartbeat
Diabetes study fund
Digestive diseases
Diabetic fund
Gastroenterology fund
Cardiology
•
•
•
•
•
•
•
•
•
•
•
•
•
Dietetic
Outpatients
Geriatric day unit
Cardiac rehabilitation
Mottingham ward
Physiotherapy
Respiratory fund
Acorn (children’s fund)
Mammography
Ultrasound maternity
Gynaecology oncology
Paediatric
Infection control
On 17 February 2014 King’s College Hospital NHS Foundation transferred 95% of the value of the
funds to the Trust, retaining 5% as an ‘administration fee’. The Charitable Funds Committee was
clear it would expect 100% of the funds to be transferred. As at year-end formal Parliamentary
approval of the transfer had not been given. The funds therefore do not form part of the 2013/14
accounts and no funds were committed by the Trust during the year. Parliamentary approval was
granted on 7th July 2014 and funds of £153k were transferred to Charitable Fund at this point.
Page 4
In 2014/15 the Charitable Funds Committee continued to implement the agreed Investment
and Disbursement Strategy, and associated monitoring framework, for the Charitable Fund.
The Charitable Funds Committee at each reviews the overall position of all funds and
undertakes more detailed scrutiny of selected funds, inviting the Fund Manager to attend and
present an account of the fund activities, expenditure and future plans.
2.6
Public benefit - the Board of Dartford and Gravesham NHS Trust, acting as agents for
the corporate Trustee, confirms compliance with the duty in section 4 of the Charities Act
2006 (i.e. to have due regard to public benefit guidance published by the Commission). The
Board confirms that the Dartford and Gravesham NHS Trust Charitable Fund has expressed
aims which are for the public benefit, and that the charity is administered for the public benefit.
This can be demonstrated from the items and equipment purchased from the expenditure of
the Fund during 2014/15, which are described in the “Significant developments regarding the
‘Special Funds’” section below, and which are freely available to the public at large (dependent
on clinical need).
2.7
Risk management and internal control - aligned with the Trust’s own risk
management procedures, all areas of spend and commitments are reviewed regularly. There
are procedures in place to review the investment policy and to ensure that both spending and
firm financial commitments remain in line with income.
Guidance is provided to Fund Managers to support reporting on their funds to the Charitable
Funds Committee (which includes a declaration of compliance with the guidance).
2.8
Investment policy and performance - during 2014/15 funds were held with the
Co- operative Bank Plc. The performance of the fund held with the Co-operative bank was in
line with expectations. For investment purposes the balances of the charities are pooled in
order to gain maximum benefit from the investment. The Charity Commission has been
notified of this scheme.
2.9
Reserves policy - the Charity does not currently enter into future commitments and so
has not created any reserves for this. Activities are only authorised when full funding is
available.
3.
3.
3.1
‘Special Funds’ – significant developments and future plans
Significant developments
Cancer Fighting Fund
The annual Stride4Life sponsored walk and funday event raised £22,581 other donations were
made up of several small events, garden parties, in memory donations and individual and regular
giving. Total donated to the Cancer Fighting Fund £49,193
Approved Purchases: £95,000 for Urology Ultrasound, Plueral Ultrasound £26,000, Blue light
cystoscopy equipment £15,136, Equipment for Kidney Cancer £8,000. Other smaller requests
granted were for pumps, mobility aids, Camouflage service for facial deformities. Furniture, Items
for Pine Therapy Unit and garden, Respiratory equipment, ipads and Laptops for cancer nurse
specialists.
Little Buds Fund
Funds raised were from a variety of small community fundraising events some organised by our
staff; such as Elvis night; Dr Who Event and Buggy Push. Companies and Trusts applied to for
support gave approximately £30,000 (with £21,175 being given by M&S Bluewater). Together
with individual donations this amounted to a total of £61,424.
Page 5
Approved Purchases: Ultrasound scanner for babies hearts and brain £30,091, Techotherm to
cool babies brains to help reduce brain damage £13,028, Airvo kit to help babies breathing £9,000.
AVE delivery bed to enhance birth experience £ 4,543. Other smaller requests were for saturation
monitors, TV for family room, Warmers, nursing seats, Moses basket.
The Lollipop Fund
Received £7,647 in donations made up of individual donations, application to KCC for £1,500
and a few local companies and masonic lodges.
Approved purchases: DVD players £400 and a variety of play items
Fundraising & Voluntary Services Fund
£49,293 of donations received. The main contributors were: Mr. Hogg £3,000 from newsletter,
Rotary Clubs North Down and Ebbsfleet £2,500, Lions Club for patient packs £1,093,
Ladbrooks £1,000, Redeemed Christian Church £1,034. Individual donations and bankers
orders.
Approved purchases: A&E staff room project £10,255, Kidney Centre £7,278 room
configuration, Volumetric pumps for end of life care £4,500, Day-care Chairs £3,557,
Christmas cash to benefit patients on wards £2,250, Silver Song box for elderly care £1,680,
Ultrasonic Nebuliser £1,423, 2 bariatric wheelchairs £1,100, Specialist chair for plaster room
£1,760, and a variety of small items.
The Heartbeat Fund
£4,867 was received this year from donations.
Hospital Events raised:
British 10K Run £2,492, London to Brighton Cycle £2,472, Buggy Push £4,125, Santa Run
£1,238, Christmas Appeal £6,995 Christmas draw £4,305.
Fundraising Expenditure: Newsletters £3,725, Printing, reply paid envelopes etc £1,143,
Harlequin database annual fee £2,250, Events, places, Stride, £3,627, Merchandise £1,049,
Sundries £458. Advertising £107.
Gifts in Kind
Storage King donate storage lockup unit worth £3,000 a year
Gift Aid
An amount of £7,021 was collected through the gift aid scheme. Donors are always asked to
give using gift aid and pledge forms, where appropriate, are included with each thank you letter
with a reply paid envelope.
3.2
Future plans
The Mayor of Dartford has chosen the Lollipop Fund for sick children as his m a i n charity to
support during 2014/2015. The Winners Church has pledge support for the new Endoscopy Unit
recovery suite to the amount of £20,000.
A major capital appeal is planned for the next three years to help equip the new Endoscopy Unit.
Page 6
4. Financial performance
The accounts comply with the Statement of Recommended Practice on accounting and reporting
issued by the Charity Commission in March 2005.
Due to Dartford and Gravesham NHS Charitable Funds gross income being under £1m, and their
gross assets being less than £3.26m it has been decided to have an independent examination in
2014/15.
Income
During the year, income totalling £433,000 was received (£491,000 in 2013/14). £387,000 was
received in donations, compared with £437,000 in 2013/14.
Expenditure
Total expenditure was £314,000 in 2014/15 as compared to £402,000 in 2013/14.
Financial position at year end
The total Fund Balances at the end of the year were £536,000 (£417,000 in 2013/14). As all the
investments were realised during 2006/07 the cash is being held with the Co-operative Bank plc in
an interest bearing deposit account.
5. Thank you
On behalf of the patients and staff who have benefited from improved services due to donations
and legacies, the Corporate Trustee would like to thank all patients and relatives and staff who
have made charitable donations, and all our fundraisers who have made such valuable
contributions to the Charity in the last year.
Signed on behalf of the Corporate Trustee
Janardan Sofat, Chairman
Mick Bull, Director of Finance & Performance
The Annual Report has been approved, with the Financial Statements, by the Trust Board on the
29 October 2015.
Page 7
DARTFORD AND GRAVESHAM NHS TRUST CHARITABLE FUND 2014/2015
Statement of Trustees' Responsibilities
The Trustees are responsible for preparing the Trustees' Annual Report and the financial statements in
accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally
Accepted Accounting Practice).
The law applicable to charities in England & Wales requires the trustees to prepare financial statements
for each financial year which give a true and fair view of the state of affairs of the charity and of the
incoming resources and application of resources of the charity for that period. In preparing these
financial statements, the trustees are required to:
•
•
•
•
•
select suitable accounting policies and then apply them consistently;
observe the methods and principles in the Charities SORP;
make judgements and estimates that are reasonable and prudent;
state whether applicable accounting standards have been followed, subject to any material
departures disclosed and explained in the financial statements; and
prepare the financial statements on the going concern basis unless it is inappropriate to
presume that the charity will continue in business.
The Trustees are responsible for keeping proper accounting records that disclose with reasonable accuracy at any
time the financial position of the charity and enable them to ensure that the financial statements comply with the
Charities Act 2011 (Regulation 31 of The Charities (Accounts and Reports) Regulations 2008) and the provisions of
the trust deed. They are also responsible for safeguarding the assets of the charity and hence for taking reasonable
steps for the prevention and detection of fraud and other irregularities.
The Trustees are responsible for the maintenance and integrity of the charity and financial information included on
the charity's website. Legislation in the United Kingdom governing the preparation and dissemination of financial
statements may differ from legislation in other jurisdictions.
The Trustees also confirm that:
• steps have been taken to ensure that the auditors are aware of all information relevant to these
accounts
• there is no audit information relevant to the accounts of which the auditors are unaware
Within the year a resolution was passed to appoint PricewaterhouseCoopers LLP as independent examiners of the
charity.
By Order of the Trustees
Chairman.......................................................................Date ....................................... 2015
Trustee..........................................................................Date.........................................2015
8
Independent
Examiners' Report to the Trustees of Dartford and Gravesham NHS Trust Charitable Fund
I
We report on the accounts of Dartford and Gravesham NHS Trust Charitable Fund ("the Charity")for the year ended 31
March 2015 which are set out on pages 11 to 17.
Respective Responsibilities of trustees and examiners
The charity's trustees are responsiblefor the preparation of the accounts. The charity's trustees consider that an audit is not
required for this year under section 144 (2) of the Charities Act 2011 and that an independent examination is needed.
Having satisfied ourselves that the charity is not subject to audit and is eligible for independent examination , It is our
responsibilty to:
• examine the accounts under section 145 of the Charities Act 2011;
• follow the procedures laid down in the General Directions given by the Charity Commission under section
145(5)(b) of the Charities Act 2011; and
• to state whether particular matters have come to our attention.
This report has been prepared for and only for the trustees as a body in accordance with section 145 of The Charities Act
2011 and the regulations made under section 154 of the Charities Act 2011 (Regulation 31 of The Charities (Accounts and
Reports) Regulations 2008) and for no other purpose. We do not, in making this report, accept or assume responsibility for
any other purpose or to any other person to whom this report is shown or into whose hands it may come save where
expressly agreed by our prior consent in writing.
Basis of independent examiners' report
Our examination was carried out in accordance with the General Directions given by the Charity Commission. An
examination includes a review of the accounting records kept by the charity and a comparison of the financial statements
presented with those records. It also includes consideration of any unusual items or disclosures in the financial statements,
and seeking explanations from you as trustees concerning any such matters. The procedures undertaken do not provide all
the evidence that would be required in an audit, and consequently no opinion is given as to whether the accounts present a
'true and fair' view and the report is limited to those matters set out in the statement below.
Independent examiners' statement
in connection with our examination, no matter has come to our attention:
(1) which gives us reasonable cause to believe that in any material respect the requirements:
• to keep accounting records in accordance with section 130 of the Charities Act 2011: and
• to prepare accounts which accord with the accounting records and comply with the accounting
requirements of the Charities Act 2011 have not been met; or
(2) to which, in our opinion, attention should be drawn in order to enable a proper understanding of the accounts to be
reached.
Kevin Lowe, Director , ACA
For and on behalf of PricewaterhouseCoopers LLP
1 Embankment Place
London
WC2N 6RH
Signature:…………………......................................……………….. Date:………………………….
9
The accounts of the Dartford and Gravesham NHS Trust Charitable Fund.
FOREWORD
These Charitable Fund accounts have been prepared by the Trustees under the Charities Act 2011.
STATUTORY BACKGROUND
The NHS Trust is the corporate trustee of the Charitable Fund under paragraph 16c of Schedule 2 of the NHS and
Community Care Act 1990.
The Dartford and Gravesham NHS Trust Charitable Funds is registered with the Charity Commission and includes funds
in respect of Dartford and Gravesham NHS Trust's Hospital.
M AI N PURPOSE OF THE FUNDS HELD ON TRUST
The main purpose of the Charitable Fund held on trust is to apply income for any charitable purpose relating to the
National Health Service wholly or mainly for the services provided by the Dartford and Gravesham NHS Trust.
Chairman………………………………………….………
Date
Trustee…………………………………………………….
Date
10
Statement of Financial Activities for the year ended 31 M arch 2015
Unrestricted
Funds
Restricted
Funds
2014-15
Total
Funds
£000
2013-14
Total
Funds
£000
66
234
1
87
0
0
153
234
1
0
437
0
29
2
14
0
0
0
29
2
14
30
1
23
346
87
433
491
21
5
0
0
21
5
25
4
185
53
7
15
17
11
0
0
0
0
196
53
7
15
17
272
48
14
22
17
Total resources expended
303
11
314
402
Net movement in funds
43
76
119
89
Reconciliation of Funds
Total funds brought forward
417
0
417
328
Total Funds carried forward
460
76
536
417
Note
I ncoming Resources
Incoming Resource from generated funds
Voluntary income:
SLHT transfer of funds
Donations
Legacies
Activities for generating funds:
Fundraising Events
Fundraising Income
Investment Income
Incoming Resources from charitable activities
3
Total incoming resources
Resources Expended
Costs of Generating Funds:
Costs of Generating Voluntary Income
Costs of Fundraising Office
Costs of Fundraising Events
Charitable activities:
Purchase of New Equipment
Staff Education and Welfare
Patient Education and Welfare
Courses and Conference expenses
Governance Costs
5
5
5
4
The notes at pages 13 to 17 form part of these accounts.
There have been no transfers and no gains/losses on investment assets.
All incoming resources and resources expended are derived from continuing operations and are unrestricted.
The Trust received the full 100% transfer of funds from SLHT in cash of £153k following parliamentary approveal on 7th July 2014.
Restricted funds relate to Heartbeat Fund previously held by Queen Marys NHS Charitable Fund
11
Balance Sheet as at 31 M arch 2015
Notes
Unrestricted
£000
Restricted
£000
Total at 31
M arch 2015
Total at 31
March 2014
£000
Fixed Assets
1
1
0
0
1
1
3
3
9
9
9
7
0
498
505
0
0
76
76
7
0
574
581
5
4
683
692
10
46
0
46
278
Net Current Assets
460
76
536
417
Total Assets less Current Liabilities
460
76
536
417
460
0
0
76
460
76
417
0
460
76
536
417
Intangible assets
Total Fixed Assets
Current Assets
Debtors
Payment in advance
Cash at bank and in hand
Total Current Assets
Current Liabilities
Creditors: Amounts falling
due within one year
Funds of the Charity
Income Funds:
Unrestricted
Restricted
11
Total Funds
All funds are unrestricted.
The notes at pages 13 to 17 form part of this account.
The financial statements on pages 11 to 17 were approved by the Trustee on 29 October 2015 and signed
by:
Signed:
Chairman
Signed:
Trustee
Date:
12
Notes to the Accounts
1
Accounting Policies
(a)
Basis of preparation
The financial statements have been prepared under the historical
cost convention, but don't hold any legacies/investments.
The financial statements have been prepared in accordance with
Accounting and Reporting by Charities: Statement of Recommended
Practice (SORP 2005) issued in March 2005 and applicable UK Accounting
Standards and the Charities Act 2011.
(b)
Funds Structure
Unrestricted funds comprise those funds which the Trustee is free to
use for any purpose in furtherance of the charitable objects. Unrestricted funds
include designated funds, where the donor has made known their non binding
wishes or where the Trustees, at their discretion, have created a fund for a
specific purpose.
Restricted funds are funds which are to be used in accordance with specific
restrictions imposed by the donor. Where the restriction requires the gift to
be invested to produce income but the Trustees have the power to spend the
capital, it is classed as an expendable endowment.
(c)
I ncoming Resources
All incoming resources are recognised once the Charity has entitlement to the
resources, it is certain that the resources will be received and the monetary
value of incoming resources can be measured with sufficient reliability.
(d)
I ncoming resources from legacies
Legacies are accounted for as incoming resources once the receipt of
the legacy becomes reasonably certain. This will be once confirmation
has been received from the representatives of the estates that payment
of the legacy will be made or property transferred and once all
conditions attached to the legacy have been fulfilled.
(e)
Resources expended
The charity accounts are prepared in accordance with
the accruals concept. All expenditure is recognised once there is
a legal or constructive obligation to make a payment to a third party.
(f)
I rrecoverable VAT
Irrecoverable VAT is charged against the category of resources
expended for which it was incurred.
13
(g)
Allocation of overhead and support costs
Overhead and support costs have been allocated as a direct cost
or apportioned on an appropriate basis (refer to note 4) between
charitable activities and governance costs. Once allocation and/or
apportionment of overhead and support cost has been made between
charitable activities and governance costs, the cost attributable to
charitable activities is apportioned across those activities in proportion
to total spend.
(h)
Cost of generating funds
The costs of generating funds are the cost of running the fundraising
office and the cost of the fundraising events.
(i)
Charitable activities
Costs of charitable activities comprise all costs incurred in the pursuit
of the charitable objects of the charity. These costs comprise direct
costs and an apportionment of overhead and support costs as shown
in note 5.
(j)
Governance Costs
Governance costs comprise all costs incurred in the governance of the
charity. These costs include costs related to statutory audit together
with an apportionment of overhead and support costs.
(k)
Donated services and gifts in kind
The value of donated services and gifts in kind provided to the charity is
recognised in the statement of financial activities at their value to the
charity as determined by the trustee, in the period in which they are
receivable, and where the benefit is both quantifiable and material.
14
Donated assets
Impairments,
where
areincurred
capitalised
in theatyear
their
arevaluation
separatelyon
identified
full replacement
in Note 7 and
costcharged
basis on
to the
2
Related party transactions
The charity has made revenue and capital payments to the Dartford and Gravesham
NHS Trust, which is the Corporate Trustee of the charity (see note 5). The Directors
of the NHS Trust are responsible for managing the Charitable Funds and the names
of the directors are listed on page 1 of the Annual Report
Neither the Corporate Trustee nor any member of the NHS Trust Board has received
honoraria, emoluments or expenses in the year and the Corporate Trustee has not purchased
trustee indemnity insurance.
3
I ncoming resources from charitable activities
The income was primarily from the provision of training courses in furtherance of the charity's
objects in both the current and previous year.
Related party transactions
Income from the provision of education and training
Miscellaneous income
Total
4
2015
Total
£000
2014
Total
£000
14
0
14
23
0
23
Allocation of support costs and overheads
Once allocation and /or apportionment of overhead and support costs has been made to Governance Costs,
the balance is apportioned across charitable activities using the same apportionment basis. The value of
facilities provided to the charity free of charge, that would otherwise have had to be purchased, such as
the use of office equipment and office space, have not been recognised in the statement of financial
activities because their value is not easily quantifiable. Salaries relate to costs recharged by Dartford and
Gravesham NHS Trust in respect of support services provided.
Allocation and
apportionment to
Governance Costs
2015
Total
£000
Allocated to
Residual for
Governance apportionment
£000
£000
Salaries and related costs
Computer expenses
Depreciation
Independent examiners fee
18
2
2
4
9
2
2
4
9
0
0
0
Total
26
17
9
15
Basis of
apportionment
Allocated
based on time spent
Governance
Governance
4
Allocation of suppor t costs and over heads (contd)
Appor tionment of suppor t
Costs acr oss Char itable
Activities fund movements
5
Pur chase of Staff education
new equipment
and welfar e
£000
£000
Patient
education and
welfar e
£000
Total
allocated
Salaries and related costs
7
2
0
9
Total
7
2
0
9
£000
Analysis of char itable expenditur e
The charity undertook direct charitable activities and made available grant support to Dartford and Gravesham NHS
Trust in support of a range of charitable activities.
Purchase of new equipment
Staff Education and Welfare
Patient Education and Welfare
Total
6
Gr ant
funded
activity
£000
Suppor t
costs
Total
£000
£000
189
51
7
7
2
0
196
53
7
247
9
256
Analysis of gr ants
All grants are made to the Dartford and Gravesham NHS Trust and the Corporate Trustee operates a scheme of
delegation, through which all funded activity is managed by fund managers responsible for the day to day
disbursements of their funds, in accordance with the directions set out by the trustees in charity standing orders
and financial instructions. The charity does not make grants to individuals. The total cost of making grants is
disclosed in the activity analysis on the face of the Statement of Financial Activities. The grants received by the
beneficiaries for each category of charitable activity are disclosed in note 5.
7
Tr ansfer s between funds
There have been no transfers between funds .
8
Independent Examination
The independent examination fee of £4k (2013/14 £4k) related solely to the examination of the Trusts charitable accounts.
9
Analysis of cur r ent assets
Other debtors
Payments made in advance
Cash received re Queen Marys Charitable Funds
Cash at bank and in hand
Total
2015
Total
£000
2014
Total
£000
7
0
0
574
581
5
4
138
545
692
South London Healthcare Trust creditor (£138k 13/14) represented cash being held in respect of 95% of funds which
were received in advance due to transfer in September 2014 as described in note 10. The Trust received the full 100%
transfer of funds from SLHT in cash £153k following the parliamentary approval.
10
Analysis of cur r ent liabilities
Accruals
* South London creditor
Other creditors
Total
2015
Total
£000
2014
Total
£000
4
0
42
46
4
138
136
278
Other creditors represents sums owed at the year end by the charity to a related party,
Dartford and Gravesham NHS Trust, for costs incurred by the NHS Trust on behalf of the charity in
the furtherance of the charity's objects.
* South London Healthcare Trust creditor (£138k 13/14) represented cash being held in respect of 95% of funds which
were due to transfer in September 2014 as described in note 9. The Trust received the full 100% transfer of funds from SLHT
in cash of £153k following the parliamentary approval.
16
11
Analysis of char itable funds
The Trust has analysed material designated fund balances as set out below:
Fund Name
Fund Balance
brought forward
£
Incoming
Resources
£
Outgoing
Resources
£
Fund Balances
carried forward
£
Cancer Fighting Fund
Heart Beat Fund
Maternity Fund
Microbiology education
Friends Fund
Little buds
Resuscitation Fund
Pharmacy Fund
Queen Marys consolidated funds
Other Funds
157,614
19,367
25,646
15,938
49,119
68,053
10,824
7,469
62,958
49,193
4,867
9,757
750
49,294
61,424
10,150
15,968
148,898
82,153
58,476
3,412
20,635
1,252
43,830
70,859
3,310
7,729
35,781
68,951
148,331
20,822
14,768
15,436
54,583
58,618
17,664
15,708
113,117
76,160
Total designated Funds
416,988
432,453
314,235
535,206
QMH restricted
TOTAL FUNDS
-
416,988
87
11
76
432,540
314,246
535,282
Other funds are all less than £10k.
Cancer Fighting Fund - to benefit the diagnosis and treatment of cancer at Darent Valley Hospital
Heart Beat Fund - to benefit the Heart Centre.
Maternity Fund - donations held for benefit of staff and patients in Maternity department and wards.
Microbiology Education - sponsorship for staff to attend courses not provided by Dartford and
Gravesham NHS Trust.
Friends Fund - money held for wards, stroke or any other small appeals.
Darent Valley Hospital Fund - for all areas where there is no specific fund.
Little Buds Fund - for the special care of babies from conception to birth.
Resuscitation Fund - purchase of expensive training equipment for resuscitation department.
17
20 October 2015
PricewaterhouseCoopers LLP
1 Embankment Place
London
WC2N 6RH
Dear Sirs
This representation letter is provided in connection with your independent examination of the
financial statements of Dartford & Gravesham NHS Trust Charitable Fund (the “charity”) for the year
ended 31 March 2015.
Your independent examination is conducted for the purpose of carrying out a review of the accounting
records kept by the charity and a comparison of the financial statements presented with those records.
It also includes consideration of any unusual items or disclosures in the financial statements, and
seeking explanations from you as trustees concerning any such matters. The procedures undertaken do
not provide all the evidence that would be required in an independent examination, and consequently
you do not express an independent examination opinion on the view given by the financial statements.
We acknowledge as trustees our responsibilities under the Charities Act 2011 for preparing financial
statements of the charity which give a true and fair view, in accordance with International Financial
Reporting Standards (IFRSs), and for making accurate representations to you.
We confirm that the following representations are made on the basis of enquiries of management and
staff of the charity with relevant knowledge and experience and, where appropriate, of inspection of
supporting documentation sufficient to satisfy ourselves that we can properly make each of the
following representations to you.
We confirm, for all trustees at the time the trustees’ report is approved, to the best of our knowledge
and belief and having made the appropriate enquiries, the following representations:
Accounting records
All the accounting records have been made available to you for the purposes of your independent
examination and all the transactions undertaken have been properly reflected and recorded in the
accounting records. All other records and information which might affect the truth and fairness of, or
necessary disclosure in, the financial statements, including minutes of trustees’ and relevant
management meetings, have been made available to you and no such information has been withheld.
Accounting policies
We confirm that we have reviewed the charity’s accounting policies and estimation techniques and,
having regard to the possible alternative policies and techniques, the accounting policies and
estimation techniques selected for use in the preparation of the financial statements are the most
appropriate to give a true and fair view for the charity's particular circumstances, as required by FRS
18.
Related parties
We confirm that we have disclosed all related party transactions relevant to the charity and that we are
not aware of any other such matters required to be disclosed in the financial statements whether under
FRS 8, the Statement of Recommended Practice “Accounting and Reporting by Charities” or other
requirements.
Employee benefits
We confirm that we have made you aware of all employee benefit schemes in which employees of the
charity participate.
Contractual arrangements/agreements
All contractual arrangements (including side-letters to agreements) entered into by the charity with
third parties have been properly reflected in the accounting records or, where material (or potentially
material) to the financial statements, have been disclosed to you.
Laws and regulations
We are not aware of any instances of actual or potential breaches of or non-compliance with laws and
regulations which provide a legal framework within which the charity conducts its business and which
are central to the charity’s ability to conduct its business, to the retention of charitable status, or that
could have a material effect on the financial statements.
We are not aware of any irregularities, or allegations of irregularities including fraud, involving
management or employees who have a significant role in the accounting and internal control systems,
or that could have a material effect on the financial statements.
Fraud
We acknowledge our responsibility for the design and implementation of internal control to prevent
and detect fraud.
We have disclosed to you:
i) the results of our assessment of the risk that the financial statements may be materially misstated
as a result of fraud
ii)
•
•
•
our knowledge of fraud or suspected fraud affecting the charity involving:
Management
Employees who have significant roles in internal control, or
Others where the fraud could have a material effect on the financial statements;
iii) our knowledge of any allegations of fraud, or suspected fraud, affecting the charity's financial
statements communicated by employees, former employees, analysts, regulators or others.
Misstatements detected during the independent examination
We acknowledge our responsibility for the design and implementation of internal control to prevent
and detect error.
We confirm that the financial statements are free from material misstatement, including omissions.
Grants and donations
All grants, donations and other income have been notified to you and where the receipt is subject to
specific terms or conditions, we confirm that they have been recorded in restricted funds. There have
been no breaches of terms or conditions during the period in the application of such income.
Completeness of Income
We confirm that to the best of our knowledge all income receivable by the charity during the
accounting period has been included in the financial statements.
Taxation
We confirm that we have complied with the requirements of United Kingdom Corporation Tax Self
Assessment.
We confirm that to the best of our knowledge, throughout the year, the charity has acted within its
charitable objectives and therefore there are no activities on which the charity should be accounting for
direct taxes.
Subsequent events
There have been no circumstances or events subsequent to the period end which require adjustment of
or disclosure in the financial statements or in the notes thereto.
As minuted by the board of trustees at its meeting on 29 October 2015
........................................
(Trustee)
For and on behalf of Dartford & Gravesham NHS Trust Charitable Fund
Date:
Item 10-18. Attachment N – Workforce Committee Minutes 22.09.15 (draft)
MINUTES OF THE WORKFORCE COMMITTEE MEETING HELD
22ND September 2015
Present:
David Findley, Non-Executive Director, [Chair]
Andy Brown, Director of Human Resources
Annette Schreiner, Medical Director
Vikki Carruth, Director of Nursing and Quality
Peter Coles, Non- Executive Director
Steve Wilmshurst, Non-Executive Director
David Warwick, Non-Executive Director
Louise Lester, Deputy Director of HR
DF
AB
AS
VC
PC
SW
DW
LL
Attendance:
Avtar Verdee, General Manager (item 9.4)
Alex Tan, General Manager (item 9.5)
Lucy Gayle, HR Business Partner (items 9.4 and 9.5)
Jennifer Opare-Aryee, Interim HRBP for minutes
9.1
AV
AT
LG
JOA
Apologies
Apologises were received from Pam Dhesi and Dr Bikram Bhattacharjee (for item 9.4)
9.2
Declaration of Interest
None
9.3
Minutes of last meeting held on 28th July 2015
These were agreed as a true record.
Action Log
Medical Staffing Induction Update: AS gave an update and confirmed that post graduate
medical staffing have been booking medical staff on induction.
Action: AS to report progress on medical staff induction at the next Workforce
Committee
Local Pay Flexibilities: AB to provide update on development of options for senior
managers pay to the next Workforce Committee, following further discussion with executive
directors
Investors in People action plan: On the agenda for discussion.
GMC Survey Action Plan: On the agenda for discussion.
GM Structure / recruitment update: AB gave an update on the GM recruitment and
confirmed that Pam Dhesi appointed a Deputy Director of Operations from East Kent
Hospitals. He also advised the Committee that recruitment is also taking place for the
General Managers’ position for Adult Medicine, Pathology, QMH and Emergency Medicine.
9.4
Directorate Report - Radiology
AV supported by LG presented the Radiology workforce report. The main areas of the report
to note were recruitment challenges for consultant radiologists and sonographers. AV
reported that the department had recruited a number of consultants and there was some
interest in sonographer vacancies. A new superintendent in nuclear medicine had been
appointed from a London trust.
Temporary staffing: AV reported that the directorate is working with HR to reduce
temporary staffing usage and agency rates for consultants and radiographers. This forms
part of the revised directorate financial and operational plan.
Workforce Review: AV reported that the directorate was undertaking a workforce review,
and outlined some of the options available. The Committee encouraged AV to outline the
strategic options for the radiology directorate workforce and develop plans to progress the
preferred option, recognising that it may take time to implement it.
The Committee noted that AV was due to present to the Finance Committee on the
improved financial position for the directorate including realising the benefits of the recent
review undertaken by Philips consultancy.
VC asked how many wte nurses are in Radiology and stated that AV needs to ensure that
the three nurses in the directorate engaged with nursing revalidation.
DF commented that appraisal is a real issue for the Directorate and asked for assurance that
it has plans in place to be compliant by the end of October.
9.5
Directorate Report – Trauma and Orthopaedics
AT supported by LG provided an update on the Trauma and Orthopaedics workforce report.
He stated that vacancies and sickness absence rates are low and that the directorate is
keeping a good control on it. However, he confirmed that appraisal rates have dropped and
he has spoken to the managers and matrons to increase compliance to 85%. AT specified
that he anticipates compliance to be higher in October for the September figures.
DF encouraged AT to keep appraisal rates above 85%. AT advised that appraisal is high on
the directorate’s agenda.
SW asked whether there is clarity on who is responsible for completing appraisal when an
individual is split between directorates. AB advised that the default is the budget holder, but
that both managers would be expected to be involved in the discussion.
Service Development: AT also gave an update on service development, he stated that a
consultation paper been developed to disband the Orthopaedic bridging team but formal
consultation has not started. AT informed the committee that the reason for the consultation
was that the Trust received no income for this work and the Trust view was that it should be
undertaken by community health services.
DW stated that if we win the Adult Community Services (ACS) tender we will be responsible
for the bridging team. AB advised that this service was not included in the service
specification. It was recognised that the timing of the consultation was complex due to the
community services tender, and the AT and PD would review the timing of consultation.
Action: AT and PD to agree timing of consultation.
Staff Development: AT notified the committee that mandatory training compliance is not up
to 85% and that there are a few things that the directorate need to do better e.g. Infection
Prevention Level 2, Resuscitation Training and Safeguarding Level 2. He also informed the
committee that the plan is for his staff to complete the training. SW stated that the Trust is
not doing very well in these areas and DF also commented that the above training is
important for AT’s directorate.
AT also mentioned that his directorate has supported staff to attend managing leadership
training.
Staff Survey: AT advised the committee that there is an action plan in place to push the
staff survey forward. DF mentioned that physical violence for both staff and patients are in
the red. AT also informed the committee that Maple Ward has elderly and confused patients
which is challenging but that increase in staffing from the nursing review has helped to
improve the position. PC recommended comparing the before and after data to see if the
numbers have decrease. LG stated that the senior sisters felt that a lot has been done in
terms of training which has helped and the staff have also confirmed that they feel
supported. AT also stated that having a physician in place has helped the department. VC
asked whether job satisfaction is satisfactory and LG confirmed that this is green.
9.6
Workforce Report
LL presented an update on the workforce report which highlighted that overall workforce
metrics have improved since the last meeting. She reported that registered nurses vacancy
rate remains favourable compared to the Trust peers.
LL also informed the committee that the Trust is holding registered nurses and support
workers open days in October and 30 expressions of interest have been received for
registered nurses and 100 for support workers. Additionally, LL stated that there are a
number of posts in pathology due to the restructure, and the Trust will also be looking at
holding an open day for pathology to coincide with national pathology week in November.
Medical staffing: LL stated that the biggest medical staffing recruitment challenges are in A
& E and Paediatrics at middle grade level. However, she informed the committee that the
Trust has engaged a recruitment agency to assist with A&E recruitment and they have
recruited 9 candidates from overseas. 5 candidates have also been recruited from NHS
Jobs. AB stated that there are a few hurdles with the overseas recruitment e.g. English
language testing, Visa approval, which is likely to increase the time to hire. A proposal has
been submitted for a recruitment and retention premium to be approved for paediatrics
middle grades.
Sickness absence: LL reported that the Trust sickness absence is stable and flu campaign
will be launched in October. Furthermore, bank requirement was up in July for sickness
absence cover but this has not increase the rating for sickness absence. She suggested that
bank usage may have been used to cover annual leave.
DW asked what the Trust is doing specifically about the flu campaign. AS informed the
committed that the OH manager and his team are working on myth busting campaigns and
doing the junior doctors mandatory training rounds. She stated that the Trust uptake was
65% last year which was the highest in Kent by some distance. . AS also mentioned that the
OH team are very proactive and they visit different sites such as QMH, Erith and night
workers which makes it easier for staff to have the flu vaccination.
Turnover: LL highlighted that turnover remains stable and that the Trust’s stability rate
compares favourably with peers. She also confirmed that the Trust is making sure that it
support services where there is a transition e.g. Pathology to minimise any effects that the
current changes will have on staff decision to leave.
DW asked whether we are recruiting people from Medway. AB stated that some staff have
joined from Medway, through open adverts. AB advised that a recent analysis of source of
staff growth over the last three years indicated the Trust was gaining more staff from
neighbouring Trusts than were leaving to join them. DF acknowledged that the Trust is in a
good position and we need to leverage it.
Staff Survey: LL informed the committee that every member of staff will receive the survey
and they will have the opportunity to respond.
Mandatory Training: LL commented that there has been a slight increase in compliance
with a significant improvement seen in medical staff however, the plan is to maintain it.
The Trust is experiencing poor rating in infection prevention level 2, following the decision
last year to require attendance annually rather than every two years. AS informed the
committee that additional Infection Control training is being arranged. VC stated that
agreement needs to be reached with the areas to ensure that they don’t cancel training and
that staff will be released to attend the training.
Appraisal: The Trust appraisal rating is currently above 80% and moving in the right
direction. The black areas are Radiology, Nursing and Governance Directorates. VC advised
the committee that the latter is a small team so percentage in terms of compliance looks
bigger than the reality. She stated that there is a person on long term sick and another going
through the capability process. However, with the exception of the two all appraisals for the
team have been completed.
9.7
Assurance Review of Pre-employment checks
LL gave an update on the pre-employment check audit and informed the committee that
some refinements to processes were required but overall there was reasonable assurance
on the process. DF suggested that the main issue is the timeline of the checks. LL informed
the committee that 3 out of the 25 starter personnel files reviewed identified that either
registration checks took place on the day of employment or a couple of days after the
individual’s start date but the issue has now been addressed.
The other issues of note was agency booking for some clinical staff were made directly with
the supplying agency by some departments, and assurance on pre-employment checks
being completed was verbal. The Trust bank team completes a checklist for agency workers
and this practice is not consistent with direct agency bookings made by the departments but
this issue has now been resolved.
DF asked what checks have been put in place for volunteers. LL stated that while checklists
were been used for volunteers, ID was not being signed and dated. However, she confirmed
that the HR Officer has been made the secondary checker who will ensure that every
volunteer is checked before they begin working for the Trust. SW recommended that the
process is audited every 6 months.
9.8
Investors in People action plan update
AB provided an update on the IIP action plans and progress made since the last meeting.
PC asked whether we have done anything since July to address concerns at QMH. AS
mentioned that she had visited Erith twice recently. The appointment of a General Manager
for QMH was noted, but DW suggested further action made been needed between now and
the appointment of the GM, and whether executive directors should visit the site more often
to increase visibility.
SW highlighted that integration should be the key issue in the General Manager’s JD and he
also stated that the issue of QMH not having sufficient work should be resolved as soon as
possible.
Action:? PD/AS to advise the Committee on steps taken to improve QMH integration and
usage volumes
SW asked whether we share IIP action plan with the IIP assessors. AB confirmed that we do
but they do not formally review our progress against them, but will assess compliance
against the standard when they next visit.
9.9
GMC Survey action plan
AS gave an update on the GMC survey action plan and advised that the action plan will be
managed through the Local Academic Board. AS mentioned that the Trust will work on the
evidence before it goes to the GMC.
DF asked whether actions to address individual consultant concerns had been identified. He
also requested that timelines on the action plan should not be ‘ongoing’ but have a deadline.
AS informed him that the college tutor is clear about the individual concern and so that they
can be held to account. However, in terms of timeline, AS stated that some actions had been
classified as ongoing to ensure they remained as items for continuing improvement.
PC asked whether we know how the Trust compares with other places. AS informed the
committee that we are in the lower half. However, if the Trust had more trainees it should
help to improve our position. She mentioned that the new Dean thinks of the Trust positively
and the Trust is also linking in with the right people and making the right arguments. The
Dean Director talks about new trainees for the Trust and Ali Bokhari has also set up a group
to meet with the college tutors.
9.10
Revised Workforce Plan
AB gave an update on the revised workforce plan. He stated that the planned actions have
not changed, but the timing of the plan had been re-profiled, refreshed and resubmitted to
the TDA. The updated plan was noted.
9.11
2015/2016 Board Assurance Framework
DF provided an update on BAF and question what has changed. AB responded that
workforce metrics had been updated and the assessment on security had been updated. DF
asked to keep item on each agenda meeting.
9.12
Kent County Council Workforce Task and Finish Group
AB gave an update on KCC workforce task and finish group and stated that the first meeting
is in October and the purpose of the meeting is to develop actions to address short, medium
and long-term workforce challenges in Kent. AB presented a template showing the Trust’s
position on these issues.
DW stated that KCC may have aspirations for a more leading role in Health and Social Care.
He queried the type of workforce that we will need in the long term to run the services and
how we will get sufficient qualified workforce to support the delivery of the new models of
care.
Action: Committee members to provide comments on the draft template to AB. AB to
give an update at the next meeting.
9.13
National Workforce issues update
DF asked whether the right issues are there i.e. how big the challenge is in terms of the
Ebbsfleet numbers. AB stated that he will be delighted to receive comments. AB also gave
an update on the following:
Nurse agency controls;
Changes to national medical and dental terms and conditions;
Immigration rules.
Nurse agency controls: AB stated that Monitor and the TDA have issued Nursing Agency
rules in September to set targets for agency use of each Trust and requirement to use
framework agencies only. The Trust is already compliant with limits on use and will review
compliance with framework agency requirements when they are published. Guidance on
capping agency rates is expected to follow..
Changes to national medical and dental terms & conditions: AB informed the committee
that the BMA does not want to enter into negotiations on junior doctor terms and conditions.
However, the government has stated that new terms and conditions will be imposed on new
and rotating junior doctors from August 2016. The proposed changes states that junior
doctors will see an increase in their basic pay but they will lose automatic pay progression in
favour of a system based on their level of responsibility.
AB also informed the committee that the BMA have agreed to enter into negotiations on
consultants’ terms and conditions which may stir up the junior doctors to enter into
negotiation.
Immigration rules: AB gave an update on immigration rules and stated that the impact is
likely to affect c.5 Trust staff. However, he confirmed that the Trust will discuss with the
individuals when change in rules are finalised.
PC stated that we have some work to do on 7 days working and AB responded that progress
is being made. AS has done an assessment on where we are on 7 days working and we
seem to be doing better than most. DF said that it has been on the agenda for a long time
but we don’t seem to have got it fully implemented.
9.14
Our Values Implementation update
LL gave an update on our values and confirmed that the thank you postcard was launched
at the end of August 2015. The cards are readily available for all staff members to give to
one another at any time. It is inexpensive but it has been very well received. The idea is that
they are accessible to everybody who works for the Trust. It is an instant recognition which
also reinforces the Trust values. Part of the reason for introducing the thank you postcard is
to ensure that everyone is involve because the annual award programmes tends to focus on
frontline staff.
Value based recruitment for consultants – LL stated that a number of clinical and executive
Directors have been trained on structured interview technique and values based recruitment
approach for Consultants. LL is writing a paper for Trust wide roll out of consultant values
based recruitment which will go to the CD board. The training will be extended to the non–
executive Directors and The Chair.
DF asked how we attract high quality candidates in some areas and whether we can use
enhanced recruitment process to reinforce our attractiveness. AS stated that CD is using
personal relations trips to make recruitment effective.
PC asked whether thank you cards are used formally in appraisals. LL confirmed that it is an
informal arrangement but there is thinking around using the thank you postcard as part of
nursing revalidation.
9.15
Summary of complex and Contentious Employee Relations Issues
AB provided an update on the cases listed. There were no questions on the report.
9.16
Health Education Kent Surrey Sussex update
No notable issues to update the Committee on from HE KSS.
Any Other Business
AB highlighted that Janardan had sent David Findley and him a report on findings of a
review of bullying at Worcester Hospital to see whether there may be lessons learnt from the
report. AB stated that the document is being reviewed to see whether there are lessons to
be learnt.
Action: AB to report back to the committee at the next meeting.
9.17
Forward Planner
The date of the next meeting is 24 November 2015.
Item 10-19. Attachment O – Remuneration Committee Report 24.09.15
10-19
REPORT FROM REMUNERATION
COMMITTEE MEETING OF 24
SEPTEMBER 2015
PRESENTER COMMITTEE CHAIR
The Remuneration Committee met on 24 September 2015. The main items discussed were:
1) Remuneration for Director of Nursing and Quality maternity leave cover
2) Proposed remuneration range for new Medical Director due to planned retirement of current
medical director in summer 2016.
1
The Board is asked to note the report from the Remuneration Committee for information.
This report provides information on the following annual objective themes:
 Quality of care and patient safety;
 Organisational capability (investing in our staff and infrastructure);
 Sustained continuous business improvement (balancing the books and responding to change in an economically
viable manner); and
 Partnership and engagement (working with patients, community representatives, the Local Authority and the new
Clinical Commissioners)
1
All information received by the Board should pass at least one of the tests from ‘The Intelligent Board’ & ‘Safe in the knowledge: How
do NHS Trust Boards ensure safe care for their patients’: the information prompts relevant & constructive challenge; the information
supports informed decision-making; the information is effective in providing early warning of potential problems; the information reflects
the experiences of users & services; the information develops Directors’ understanding of the Trust & its performance
Page 1 of 1
Item 10-20. Attachment P – Finance Committee Minutes 22.09.15
MINUTES OF THE FINANCE COMMITTEE MEETING
Tuesday 22nd September 2015
Present:
Peter Coles
David Warwick
David Findlay
Susan Acott
Gerard Sammon
Mick Bull
Stuart Jeffery
Martin Chamberlain
In Attendance:
Avtar Verdee
Sara Cocklin
Non-Executive Director (Chair)
Chief Executive
Deputy Chief Executive
Director of Finance and Performance
Director of Information
Deputy Director of Finance
(PC)
(DW)
(DF)
(SA)
(GS)
(MB)
(SJ)
(MC)
General Manager, Radiology
PA to CEO/Director of Finance (Minute Taker)
(AV)
(SC)
1. Apologies for absence
Apologies were received from Janardan Sofat, John Brooker, Pam Dhesi and Giles Brown.
2. Declaration of interests
There were no declarations of interest.
3. Minutes of the meeting of 25th August 2015
The minutes were agreed as an accurate record of the meeting, subject to a small change
under item 4c. “Boarder controls” should read “border controls”.
4. Matters arising
All on agenda except reference costs. This will be circulated when John Brooker returns
from annual leave.
Action: Circulate reference costs to Finance Committee members (MB)
4a.
Radiology Directorate forecast outturn and QIPP position – Philips report
AV gave a presentation to the Committee in respect of the Directorates budget and QIPP
position for 2015/16. SA asked who does reporting for the MRI outsourcing. AV said the
Trust’s Consultants provide the reporting for Alliance Medical. AV stated part of the budget
overspend related to unbudgeted agency recruitment costs. The Directorate have a QIPP
target of £477K and forecast of £392K with a YTD plan of £109K and achieved £86K. QIPP
is being reviewed monthly. PC asked what areas are slipping, AV replied that QMH IT
savings were slipping. Work is ongoing to reduce costs for outsourced work.
AV reported on the actions taken in the Directorate, including AV and the CD only can
authorise additional payments, there are weekly payments between GM and CD and
monthly meetings with Superintendents. Also meeting with HR monthly. Pay rates are being
reviewed and training posts are being looked at. Direct Access has been suspended from 7th
September. PC asked if the Trust would lose income, MB replied yes but outsourcing costs
would reduce.
AV is developing a recovery plan and will examine what the Directorate is reporting. The
Directorate are looking to train radiographers to read plain film. The Directorate continue to
recruit 3 wte’s to replace agency staff. Key performance indicators are being developed with
information in order to better manage the Directorate overall performance. PC asked if
productivity by individual will be compared? AV replied that the Directorate have already
started to look at productivity by staff member and will extend to medical staff. PC asked if
the medical staff have job plans, AV stated that about 2/3rds do and the rest are being
worked on.
The capacity at QMH needs to be used - Reporting solution has been problematic – the 2
sites do not communicate – manual process current in place at the moment. PC asked if the
IT issues are being rectified, AV replied it relies on the supplier and there are meetings with
them on a weekly basis and a contractual meeting every 6 weeks. The next stage is to
review at the Philips report / work. The summary recovery plan will be presented at the
October Finance Committee meeting. DF stated there are lots of meetings but asked how
are actions tracked ? AV replied this is handled through weekly operational meeting. MB we have a discussion at exec meeting. There are some issues and some big pieces of work.
Philips has offered help around LEAN and will look at an improvement plan.
Action Summary recovery plan will come next month to FC. Add to action log
Philips Report
As part of a recent agreement, Philip used their management consultancy arm to look at the
service. They have done a detailed report and the full report is available on request. The way
the Trust undertakes scans needs to be reviewed as there is a large difference in efficiencies
between sites and costs, particularly where outsourcing is used. If we take this work inhouse we could justify the investment in another MRI scanner. The key is to understand
what model is to be adopted going forward and how best to address demand at different
times of the day.
PC explained the clinical leadership is key and hopefully the CD will be able to attend the FC
in October. AV said not everyone will be completely signed up to the changes, as it will need
to tie in with the service needs. DW asked what stage the Directorate are at - do the Senior
Team know what the requirements are. AV said he had only received the report last week,
but will be sharing with the superintendents shortly.
4b.
Oxleas proposed facility charge
MB reported that he had a meeting with the Oxleas Director of Finance two weeks ago.
The increase proposed by Oxleas was £1,030k. The Trust informed Oxleas that it would look
to remain under the current lease terms however it was accepted that this would need to
include areas outside the lease arrangements. Oxleas’ view was that 3 theatres, 1 ward and
F block is outside the lease and therefore the increase should be £965k. The Trusts view is
that only 1 theatre and F block increases are outside the lease and therefore the increase is
only £285k
DW highlighted the potential recurrent pressure based on the proposals. MB acknowledged
this and the recurrent position would need to be considered as part of the settlement but it
would be a pressure given transitional support would be withdrawn. SA said she was
confused regarding theatres. PC asked if it is possible to use less space to come in on
budget. MB said the Trust is occupying the space now but reducing the space requirement
could be looked at. If the Trust’s view is correct the cost will come down considerably. MB
will keep the committee informed.
5a.
Financial position M5 and Forecast Outturn
MB presented the Month 5 financial position. The Trust achieved the original plan year to
date and is forecasting to achieve the original £5.8m deficit. The Trust was required to
submit an improved plan of £3.8m on the assumption that PFI inflation would be funded and
fines/penalties reinvested into the Trust. This is yet to be agreed so the Trust is still
forecasting a £5.8m deficit. Income remains in line with forecast. Pay spend was similar to
the trend and down on last month due to a reduction in agency pay. Non pay trend is slightly
down, due to savings on PACS maintenance, soft FM reduction and also as activity was
lower this month due to the reduced number of working days and seasonality. QIPP was
slightly ahead of TDA plan and now only marginally behind the internal plan. Cash is above
where the Trust planned to be, due to the Capital programme being behind plan as a result
of holding back spending until the £1.9m funding has been agreed.
DW asked if CCG was to overspend because of our over performance by £5m what would
happen? MB said they will not achieve their control total and would go into formal
turnaround. Any local overspend would have to be balanced by NHS England across the
Country. The risk is that final balances are not agreed at the year end with the CCG
resulting in potential disputes that go into the new-year. In addition, additional growth funding
could be put at risk. The Trust wants to avoid any disputes at year end and get resolution by
March.
5b.
TDA Request (improve out-turn)
MB presented the paper on the revised plan submission of £3.8m deficit as requested by the
TDA. The Trust had now submitted a planned deficit of £3.8m incorporating a £2m
improvement as requested. The £2m improvement is based on the assumption that PFI
inflation would be funded and fines/penalties reinvested into the Trust. A letter has been
written to Paul Bennett at the TDA highlighting the Trust’s position and asking for support
from them to achieve the improved plan. There has been no response as yet.
DF asked about the impact on future years and should we be thinking about whether we can
get there any quicker? PC said we will come onto this under LTFM.
5c.
Service Level Agreements for 2015/16 and Month 5
SLA income is slightly overperforming to date - £0.2m. The forecast is a £1.9m
underperformance given the plan reflects income generation as part of the QIPP which is
unlikely to be delivered given the CCG financial position. Penalties have increased by
c£0.5m and are now £7.1m with the non-elective threshold reduction a further £1.6m.
There is a potential increase in emergency flows from Medway, which would impact on the
non-elective threshold. SJ said the Trust will make a case for full tariff for this work.
DW asked if there are any fines performances for extra Medway work? SA said if
unavailability of services elsewhere in the system, the Trust would had agreement for no
fines and the Trust will has to make sure the CCG don’t fine us. SJ explained the Trust had
corresponded with monitor / NHS England re fines reinvestment but had been referred back
to the local area office of NHS England to seek a resolution before they got involved
5d.
Aged Debtors/Creditors Report M5
MC reported that there had been very little movement – Kings are still paying us but debt
has increased by £93K. MB has written to Director of Finance at Kings giving a 2 week
timeline for a response. The Trust will write to Monitor if of a plan to reduce the debt is not
received from Kings.
5e.
Interim Working Capital Support
In order to apply for the interim revolving capital funding, the Trust needs Finance
Committee and Board approval. The Trust hasn’t received the PFI funding from NHS
England as per the plan. The Trust is expecting £4.5m in total with £2.25m in September.
SA stated that she had spoken to Philip Dodd (THC) to see if we can change our payment
date. He said if we give them a proposal they would consider this. PC asked what was the
interest on the working capital facility? MC said this would be £100k (3.5%) in a full year,
(c£50k this year) and a 1% arrangement fee is in the forecast, however did not expect to
have to pay this until if or when the funding is required permanently.
The Finance Committee agreed the request to go to Trust Board.
5f.
NHS Pensions – Acknowledgement and ‘Heat Map’
MB stated that this item was for assurance only. Still over 90% compliance.
5g.
Procurement Strategy and Business Case
MB presented two documents – a ‘Draft Strategy’ and draft ‘Business Case’
Strategy
•
•
•
•
Concept of single operating model to be clear now to procure - consistency across
the organisation.
Needs to be clinically led
Need more influence from procurement team
Number of objectives – use of technology / relationship with suppliers.
PC asked what is different about this version. MB said that the main changes were around
key target /objectives, a single operating model and the work plan.
MB added that further work is required and that he will work with Director of Procurement at
GSTT.
Business Case – potential options
1. Do nothing
2. Build team
3. Collaboration – keep team in place as is and buy in expertise around tendering
(GSTT / MTW / Medway)
Preference is to make sure there is a strong team and buy in expertise.
needs to be developed for next month. Any comments to be given to MB.
5h.
Business case
Finance Strategy
MB presented the updated Finance Strategy. The key changes were:
•
•
•
•
•
•
Ebbsfleet – ensuring revenue and capital funding to deliver clinical strategy
Refined financial targets
2% reduction in overhead costs targeted.
30% improvement programme delivered by contribution.
Target financial information better
Key milestone – PLICS – monitor requirement.
PC said Directorate / SLR to be better communicated in strategy and DF suggested the
requirement to specify the objectives of investments was captured - management to have
slick capital investment planning, which is not fully in the strategy. Investment needs to fit
clinical strategy.
MB would amend the strategy and bring it back to the next meeting for approval.
6. LTFM Update – TDA Commentary for review
MC report that the LFTM has been updated for submission to the TDA to support the
Endoscopy business case and the application for the £1.9m capital funding. This will go to
the September Board for approval. The overall position hasn’t changed, although the
baseline position has been updated to M4, with the forecast outturn still at £5.8m. The £2m
improvement requested by the TDA has not been included at this stage. The LTFM has
been updated to include the final Endoscopy business case impact the bottom line
contribution doesn’t change materially. The capital has been updated for the change in
phasing of Endoscopy and inclusion of £1m for the Community Tender IT requirements
should the Trust win the contract.
(the forecast out-turn for 2015/16 was subsequently changed to a £3.8m deficit following a
request from the TDA who indicated the capital bids would not be considered if the stretch
target was being worked to. This income assumed to achieve this was considered nonrecurrent)
SA said she is concerned regarding CNST pressure that had been removed from the LTFM
and this could cause the Trust a pressure in future years.
DW said the Trust should be planning on breakeven next year internally through stretch
QIPP targets even if it accepted that externally this is would be a very challenging to
achieve. PC asked if anything from Capita report would help deliver breakeven. MB said
procurement need to come up with some new ideas and deliver higher savings. GS asked
what percentage Monitor would consider as the maximum QIPP benchmark achievable in
any year?
MB confirmed this was 5% to 6% and the Trust is slightly below that. PC said if we achieve
£3.8m would it be recurrent? MC said it could be if the reinvestment of fines was agreed.
DW raised a point about safer staffing and any evidence that the investment has improved
outcomes? SA is trying to get information over a period of 3 years. There is an increase in
productivity and decrease in mortality.
PC recommended approval of the LTFM to the
Board for supporting Business Cases but to re-visit the forecast deficit in 2016/17 for the
purposes of setting balanced budget for next year.
7. Endoscopy Project Final Business Case
GS stated that the non-financial elements of the Business Case were presented at the last
Finance Committee. The Trust has got a CCG letter of support. The business case needs to
be sent to the TDA following Board approval with option 4 as the preferred option. MC
confirmed option 4 is now not the most financially beneficial due to the increase in build cost.
MB stated the capital build in option 4 has been reviewed in detail, but option 3 had not be
reviewed so could be higher. MC said the key changes from the OBC are the build capital
cost increase after scopes were removed. The baseline has been updated for revenue for
14/15 and from this base the same assumptions apply for options 1 and 2. The revenue in
options 3 and 4 have been updated to reflect the activity re-worked using 14/15 baseline,
which impacts on a lower workforce. The contribution remains similar to the OBC when the
unit is fully operational from 18/19. PC asked does this have to be approved by the CCG?
GS confirmed it doesn’t but the CCG have given us a letter to be included with the
submission to TDA.
PC asked does the JAG accreditation weaken the case?
GS
confirmed it doesn’t and we have it for another year on the assumption that a new unit will be
built. PC asked if business case scopes will come back here. GS said it will and be
purchased through fund raising.
The Finance Committee recommend approval of the case to the Board.
thanks to MC for his work on the Business Case.
GS noted his
8. Capital Business Case to TDA
MB presented the paper. The business case is required by TDA to support the capital
funding request of £1.9m to deliver urgent high priority capital schemes as part of the Trusts
capital programme for 2015/16.
The Finance Committee approved the business case.
9. Commercial update – CCG Tenders for services (inc Community Tender)
GS presented the update. The Trust is presenting the pitch on Thursday 24th September–
and will find out if the Trust has progressed on Friday 25th September.
The Trust are progressing the patient transport tender. The Trust has not received much
information. PC asked who are the other bidders? GS said he doesn’t know who they are.
DF expressed concern regarding staffing. GS said extra staff listed would TUPE; however
the Trust could challenge this.
As regards community services, DW asked to what extent have we been able to look at the
community services and how are they run?
GS said the Trust have seen community
services in action on a daily basis and information from GPs we are working with. The Trust
has not been allowed access to look at services to date. DW asked if the people the Trust
are working with have any knowledge of the services. GS confirmed they do.
10. Nursing Agency Rules – TDA/Monitor
MB presented the paper. There is a cap of 3% nurse agency spend against total pay to be
achieved by 18/19 – this will be challenging for some organisations. The Trust’s agency
spend is at about 5% now. There is a plan to make sure we meet the guidance.
11. Budget Setting
MC presented the paper. The proposed approach is similar to last year’s however, for
2016/17 taking the budget (and not spend) as the base and then agreeing in year pressures.
Directorates QIPP target will be informed by metrics and benchmarking, the Carter review,
LPP etc, and buy in be sought from the Directorate management teams.
12. Finance Committee Work Programme
The Committee noted the Work Programme and noted Information to bring the draft strategy
to the October meeting. Adult Medicine are required to return and present the financial
position in October. Women & Children are due to come to the November meeting. Surgery
are due to present in December. The Reference cost report and plan needs to be presented
at the October meeting. Radiology is due to return with an update in October.
13. Any other business
There was no other business to discuss.
Item 10-21. Attachment Q – TOR for Partnership Board
PARTNERSHIP BOARD – TERMS OF REFERENCE
Purpose
Membership
The Partnership Board has evolved from the PFI Project Board and is the
forum where representatives from the Trust, The Hospital Company (Dartford)
Limited and Carillion Health meet to discuss the Strategic development of the
site and its services together with PFI Contractual issues. To include strategic
vision of our partners and shared agenda.
Trust:
 Chairman of the Trust (or non-Executive Director)
 Chief Executive
 Director of Estates
 Director of Finance (or Director of Operations)
The Hospital Company (Dartford) Limited (THC):
 Chairman (or non-Executive Director)
 General Manager
Carillion Health:
 Managing Director
 Facilities General Manager
Vinci Park:
 Regional Manager
By invite.
Not applicable.
Attendees:
Members roles
and
responsibilities
Attendees
Other Members may be co-opted by the Partnership Board for either a fixed
period of time or for undertaking a specific project.
Frequency of
Meetings will be held 3 times a year (to consider strategic timeframes)
meetings
At the discretion of the chairman, other meetings may be held to fulfil its main
functions
To receive
The Committee will receive periodic reports from the Partnership Group and
reports from
may set up permanent groups or time limited working groups to deal with
specific issues. Precise terms of reference for these shall be determined by
the committee. However, Board committees are not entitled to further delegate
their powers to other bodies, unless expressly authorised by the Trust Board.
Public
Not open to the public.
admission
Reporting
 The minutes of the Committee will be reported to the non-public Trust
procedures
Board meeting
Quorum
The quorum will be two members and two attendees (one THC, one Carillion
Health). A deputy to attend when member not available.
Duties
The Committee has the following duties and functions:
 To consider proposals for the Strategic Development of the Site.
 To consider the impact on the services provided to the Trust by The
Hospital Company (Dartford) Limited and its sub-contractors from the
Strategic Development of the Site.
 To review the work of the Partnership Group and implications of this on the
Facilities Management service provisions.
 To discuss contractual issues that impact on the Concession Agreement.
 To oversee compliance and assurance issues on behalf of the Trust
Page 1 of 2
Item 10-21. Attachment Q – TOR for Partnership Board
Authority
Board.
 To support and participate in the Trust’s energy and efficiency initiatives
 Issues requiring urgent resolution will be communicated and resolved
immediately between all members. They will then be ratified at the next
meeting.
 Non urgent issues will have their resolution agreed at the next meeting.
As a committee of the Trust Board, it will make recommendations to the
Board, where necessary.
The Board delegates the above functions to the committee. The Board also
delegates decisions not of a significant nature. In practice what is significant
will depend on the judgement of members but committees must refer the
following types of issue to the full Board. Any matter which will:
 Change the strategic direction of the Trust.
 Conflict with statutory obligations.
 Contravene national policy decisions or governmental directives.
 Have significant revenue implications.
 Have significant governance implications.
 Be likely to arouse significant public or media interest.
Review
The Committee is authorised to investigate any activity within the terms of
reference and to seek any information it requires from any employee and all
employees are directed to co-operate with any request which in the opinion of
the Chairman of the Committee is properly made by the Committee.
The Terms of Reference will be reviewed annually.
General
matters
Any proposed changes to these Terms of Reference will need to be approved
by the Trust Board, The Hospital Company and Carillion.
 Agendas and papers shall be distributed in advance of the meeting.
 The Director of Finance secretary will take minutes of meetings.
February 2010
Reviewed and revised at Partnership Board, February 2011
Approved at Trust Board, February 2011
Reviewed and revised at Partnership Board, November 2011
Approved at Trust Board, January 2012
Revised June 2012 at Trust Board, to reflect the Trust’s appointment of a Non Executive
Director (Designate)
Reviewed and revised at Partnership Board, March 2013 (to remove Assistant General
Manager, THC, from list of attendees)
Approved at Trust Board, March 2013
Approved at Trust Board, August 2013
Reviewed at Partnership Board, October 2014
Reviewed at Partnership Board, March 2015
Page 2 of 2

October - Dartford and Gravesham NHS Trust

Transcription

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