agenda - kmpt.nhs.uk · 6/25/2020 · key: dl: diligent reference fa- for approval, fd - for...

Key: DL: Diligent Reference FA- For Approval, FD - For Discussion, FN – For Noting, FI – For Information

AGENDA

Title of Meeting Trust Board Meeting (Public)

Date 25th June 2020

Time 9.30am – 12.45pm (including 15 minute break)

Venue Boardrooms, Farm Villa and via Video Conferencing

Agenda Item DL Description FOR Format Lead Time

TB/20-21/37 1. Welcome, Introductions & Apologies Chair 09:30

TB/20-21/38 2. Declaration of Interest Chair

PERSONAL STORY

TB/20-21/39 3. Why black lives matter in KMPT FD verbal SC 9.35

STANDING ITEMS

TB/20-21/40 4. Minutes of the previous meeting – 28/05/2020 FA paper Chair 10.15

TB/20-21/41 5. Action Log & Matters Arising FN paper Chair

TB/20-21/42 6. Chair’s Report FN paper JC 10.25

TB/20-21/43 7. Chief Executive Officer’s Report FN paper HG

INTEGRATED CARE SYSTEM

TB/20-21/44 8. MOU – KCHT & KMPT FA paper HG 10.40

OPERATIONAL ASSURANCE

TB/20-21/45 9. Integrated Quality and Performance Report FD paper HG 10.50

TB/20-21/46 10. Finance Report: Month 2 FD paper SS

TB/20-21/47 11. Chief Operating Officer’s Report FD paper JMG

TB/20-21/48 12. Workforce Report FD paper SG 11.50

TB/20-21/49 13. Quality Committee Chair Report FD paper JC 12.20

TB/20-21/50 14. Integrated Audit and Risk Committee Chair Report FD paper TP

TB/20-21/51 15. Finance and Performance Committee Chair Report FD paper MB

CONSENT ITEMS

TB/20-21/52 16. Any Other Business Chair 12.35

TB/20-21/53 17. Questions from Public Chair 12.40

Date of Next Meeting: Thursday, 30th July 2020 via Video Conferencing

Agenda

1 of 126Trust Board - Public-25/06/20

Key: DL: Diligent Reference FA- For Approval, FD - For Discussion, FN – For Noting, FI – For Information

Members:

Dr Jackie Craissati JC Non-Executive Director (Vice Chair)

Anne-Marie Dean A-MD Non-Executive Director

Mark Bryant MB Non-Executive Director

Tom Phillips TP Non-Executive Director (Senior Independent Director)

Rod Ashurst RA Non-Executive Director

Venu Branch VB Non-Executive Director

Catherine Walker CW Non-Executive Director

Helen Greatorex HG Chief Executive Officer (CEO)

Vincent Badu VB2 Executive Director of Partnership and Strategy/(Deputy CEO)

Dr Afifa Qazi AQ Executive Medical Director

Jacquie Mowbray-Gould JMG Chief Operating Officer

Mary Mumvuri MM Executive Director of Nursing & Quality

Sheila Stenson SS Executive Director of Finance & Performance

Sandra Goatley SG Director of Workforce & Communication

Kelly August KA Assistant Director of Communications

In attendance:

Tony Saroy TS Trust Secretary (Minutes)

Simon Cook SC Service Manager - LD & Low Secure

Apologies:

Julie Nerney Chair Trust Chair

Agenda

2 of 126 Trust Board - Public-25/06/20

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Kent and Medway NHS and Social Care Partnership Trust Board of Directors (Public) Minutes of the meeting held at 0930 – 1150hrs on Thursday 28th May 2020

via video conferencing.

Members:

Dr Jackie Craissati JC Non-Executive Director (Deputy Chair)

Mark Bryant MB Non-Executive Director

Catherine Walker CW Non-Executive Director

Tom Phillips TP Non-Executive Director (Senior Independent Director)

Anne-Marie Dean A-MD Non-Executive Director

Rod Ashurst RA Non-Executive Director

Venu Branch VB Non-Executive Director

Helen Greatorex HG Chief Executive (CEO)

Vincent Badu VB2 Executive Director Partnerships & Strategy/Deputy CEO

Mary Mumvuri MM Executive Director of Nursing and Quality

Dr Afifa Qazi AQ Executive Medical Director

Jacquie Mowbray-Gould JMG Chief Operating Officer (COO)

Sandra Goatley SG Director of Workforce and Communications

Sheila Stenson SS Executive Director of Finance and Performance

Attendees:

Tony Saroy TS Trust Secretary (Minutes)

Observers:

Apologies

Julie Nerney Chair Trust Chair

Kelly August KA Head of Communications

Item Subject Action

TB/20-21/16 Welcome, Introduction and Apologies The Chair welcome all to the meeting, noting that AQ would be joining the meeting at 10am.

TB/20-21/17 Declarations of Interest No declarations of interest were made.

TB/20-21/18 Minutes of Previous Meeting The Board was informed that comments had been received with suggested amendments to the previous minutes:

The third bullet point under the Safe section – The words ‘Due to social distancing’ should be replaced with ‘Due to case mix’;

Trust Board had agreed the Delivery Plan at the last meeting and the minutes need to make this clearer.

Minutes of the previous meeting 28th May 2020


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Item Subject Action

TB/20-21/19 Action Log & Matters Arising The Board agreed that the Action Log as it stood, save that two actions that were generated in the meeting need to be captured within the Action Log. As a Matter Arising, the Board discussed the Thank You Card which staff members will be receiving from the Board. Each Thank You Card in turn contains five individual thank you postcards so that the member of staff can in turn thank people of their choice. Action: A copy of the Thank You Card for staff shall be circulated to Trust Board.

SG

TB/20-21/20 Chair’s Report The Trust Chair’s Report was received. The Board’s attention was brought to a typographical error regarding stock control, which erroneously stated ‘sock control’. VB also confirmed to the Board that she will be attending the next Trust BAME meeting in June. The Board NOTED the Chair’s Report.

TB/20-21/21 Chief Executive Officer’s Report The Chief Executive Officer’s Report was received by the Board, with the CEO highlighting:

The nation is now moving to the next stage of recovery through the Trace and Track system;

The Trust is retaining all the positive changes that have been made, with a reconfiguration of buildings and working patterns taking place. Clinical services remain the priority for that reconfiguration. The Trust is ensuring that staff are being kept fully informed of the changes.

Integrated Care System Meetings have re-commenced and KMPT is taking a strategic approach to ensure that mental health is appropriately reflected in the discussions.

KMPT had recently hosted the Mental Health Collective, which brings together both local statutory and third sector organisations from across the county. These conversations have been constructive and solution focussed and Trust Board will be updated regarding progress over the year.

The Board discussed the risk of not taking advantage of the new methods of working and delivering services to patients. There is now an opportunity to benefit from skill sets of the new people joining KMPT. The CEO is leading this work through her team. Further updates will be provided as the work continues. The Board noted the Chief Executive Officer’s Report.

TB/20-21/22 Recovery and Transform Update The purpose of the paper was to provide assurance to the Board about the work



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Item Subject Action

that is occurring as the NHS moves through to a different Covid-19 stage. The Recovery and Transform plan sets out where the Trust currently is and how services coped with the pandemic. The Trust is also reviewing services to reflect the likely increase in mental health service demand, as service users become more willing and/or able to seek help from our services. The Board discussed the opportunities presented by joint working with Acute Hospital Trusts through the Integrated Care System and Integrated Care Partnerships. Whilst these presented opportunities, the Board reflected that there was greater opportunity by working in partnership with with Primary Care Networks given the work that is done with GPs, such as use of their surgeries for the delivery of some mental health services. KMPT has provided support to staff across the system and this will help others within the system understand how physical health services and mental health services interact. The Mental Health Collective would be a key forum in which the third sector can work better with KMPT and the wider mental health system. The Board discussed how resources can be used to support the third sector and this will be further explored in an informal Board Seminar in July. Action: TS to arrange an informal Board Seminar following Trust Board’s meeting in July. The Board discussed bed occupancy levels and the Trust’s effective work with Kent County Council to ensure that patients were discharged appropriately. With the implementation of the testing regime, there is much better patient flow although there will still be an overall increase in the number of Delayed Transfer of Care cases. The Board reflected on the efficient use of its Estate and how the use of Littlestone Lodge by the local acute trust as a way of stepping down patients could be used as a model for future working. Discussions with commissioners will be had in terms of the sharing of estates across the health and social care sector. The Board provided some feedback on the Recovery and Transform Programme, with a suggestion that the wording should be clearer, and the programme should be clinically led whilst supported by Operations and Management. This can be made clearer by including the names of key individuals within the Programme. The Executive Management Team was confident that it has the right resources and would bring in additional capacity if required. The Board noted the Recovery and Transform Programme Update.

TS

TB/20-21/23 Integrated Quality & Performance Report (IQPR) The Board received the IQPR and the Board considered each of the IQPRs sections.



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Item Subject Action

Safe

The Trust’s operations performance is stable at present. There is a Community Mental Health Team (CMHT) leadership team meeting every Friday and this has continued throughout Coivid-19. If there is a dip in operational performance, this is likely to be revealed in July and August.

The Board reflected on the restrictive interventions data, which has reduced this month. However, the use of forced administration of intra-muscular medication has increased, which is a concern, and the Executive Management Team will deal with this issue during the next few months.

There has been a reduction in the number of AWOL incidents, which could be due to the reduced amount of leave being given to patients due to Covid-19. There has been an increase in OT activity within the ward.

In terms of Mortality incidents, Board was informed that there is likely to be an increase in the number of incidents within the Q1 Mortality Report due to the number of older adults who were open to services at the time of death.

Effective

The Board was provided with an update regarding the PICU contract, which has now been signed. The Operational Procedure has been agreed with the PICU provider and the first contract meeting will be taking place in June. Jacquie Wilson will be supporting JMG to embed the contract regarding Quality and Safety. There was higher than average use of Out of Area PICU and unusually there was a higher proportion of men requiring Out of Area PICU beds. This is likely due to the national picture of an increase in the incidence of people with acute psychotic illness. Similarly, although there was a reduction in the number of referrals from GPs, the number of patients with acute mental health needs was higher.

The number of home treatment episodes decreased, so staff within the Home Treatment teams and CMHT staff were reallocated to support the 24/7 service.

Workforce

The Board was updated regarding the staff sickness rate, which stood at 5.8%, noting that without Covid-19 sickness, the rate would 4.44%.

Since the last Board meeting, 125 new members of staff were brought into KMPT, with inductions being carried out virtually. There had also been 56 students brought in, with 10 more joining in June. The Trust is looking to retain those students once studies completed

The effect of Covid-19 on staffing levels was that 164 staff members were out of the business, 103 were shielding and 61 were self-isolating. The majority of those staff members are working from home.

In terms of the summer period, KMPT is asking local councils what childcare support will be provided over the summer holidays. The Trust is also working on the matter of booked foreign holidays that staff may go on and would then need to self-isolate for two-weeks upon their return.

The Executive Assurance Committee is due to receive a paper as to how the Trust will be re-introducing face-to-face training after a period of virtual video learning – including leadership videos.

The Trust is re-evaluating medical posts and how much of the role can be



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Item Subject Action

done remotely, particularly consultant roles. Work is ongoing to see how consultant roles can be adjusted.

The Board discussed the Freedom to Speak Up commentary within the IQPR and reflected on the level of oversight it would like to see regarding Freedom to Speak Up. It was agreed that a three-pronged approach would be helpful. First, safety issues will be brought to the Trust-Wide Patient Safety and Mortality Group. Second, there will be regular meetings between the Freedom to Speak Up Guardian, Chief Executive and Trust Chair. Third, the Chair of Workforce and Organisational Development Committee will include Freedom to Speak Up matters in the board report, for discussion – if need be - in the private board sessions.

Action: TS to advise Freedom to Speak Up Guardian regarding: (1) the taking of safety matters to the Trust-Wide Patient Safety and Mortality Group and (2) to arrange a regular meeting with the Chief Executive and Trust Chair. Action: Chair of WFODC to include Freedom to Speak Up matters within Chair Report to Board, which may be discussed within private Board sessions. Finance

Dealt with in Finance Report section. Caring

There has been a decrease in the number of complaints, which continues the trend established over the last seven months. There were however two outliers: Medway CMHT and Boughton Ward. The Quality Committee will continue to monitor those matters, but it was important to note that no complaints were received regarding Boughton Ward in May.

Patient Reported Experience Measure continues to be suspended nationally, but as soon as the suspension is lifted, the Trust will be ready to restart.

The centralisation of the Serious Incident (SI) team is working well, with investigations happening on time and with a reduced burden on operational managers.. Quality Committee continues to monitor progress of SI reports. The board were pleased that AQ, MM and JMG are jointly evaluating some of the SI Reports to ensure that the scope of actions are broadened to a Trust-wide, systems level.

Responsive

The Board discussed the opportunity that is available by using video calls/telephone calls for consultations. Presently these are being used for the delivery of services, but activity is not being captured in performance metrics; the Trust is establishing the clinical criteria to enable this to happen. Dr James Osborne is leading the patient feedback work regarding video-conferencing/telephone conferencing, with the Board noting that for patients with personality disorder, the anecdotal feedback was very good.

The Board NOTED the Integrated Quality and Performance Report.

TS

Chair of WFODC



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Item Subject Action

TB/20-21/24 Finance Report: Month 1 Finance Report The Board received the Finance Report (Month 1), with the following matters highlighted:

The Finance Report is on the basis of an internal plan. There is an external plan as per NHSE requirement, but as of yet, the date by which to submit the external plan has not been set. There is an expectation that the current finance block, due to end in October 2020, will be further extended to summer next year. The Trust is expecting to receive clarity on that point within the next four weeks.

Financial Forecast: For April KMPT is reporting a breakeven position, in line with national expectations. Additional costs for COVID-19 have been recognised in line with national guidance. Funding will be confirmed in arrears, so this may alter in future reporting periods. For KMPT these additional costs totalled £552k in April. Other pressures include PICU placements, with much higher numbers sent to private placements in April, exceeding budget by £64k, and an increase in the community teams' drug spend of £48k above budget.

Agency: Agency spend in month has been consistent with the trend over the last three months, with a marginal increase as a result of covering shifts for those self isolating or shielding. The Agency Cap is yet to be confirmed.

Cost Improvement Programme: The programme for this year totals £5.6m, and at the end of April £3.4m of this remains unidentified. The Trust is forecasting to deliver the full programme, but this may be subject to change if guidance is received from the Centre. The Trust’s Opening position will change subject to the finalised accounts for 2019/20.

Capital - There has been a 14% reduction in the amount that the Integrated Care System (ICS) will be receiving this Financial Year. This has a knock-on effect, with the Trusts within the ICS finding savings although some are finding more than 14% savings and others are finding less. The 14% reduction for KMPT is manageable in terms of quality and safety.

The Board shall continue to seek assurance that the ICS is ensuring that all of its members help each other to deliver the required 14% reduction. The Board noted the Finance Report for Month 1 and authorised SS to submit the Capital Plan with its 14% reduction.

TB/20-21/25 Workforce and Organisational Development Committee (WFODC) Report The Board received and noted the content of the WFODC report

TB/20-21/26 Quality Committee (QC) Report The Board received and noted the content of the QC report

TB/20-21/27 Integrated Audit and Risk Committee



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Item Subject Action

The Board received and noted the content of the IARC report.

TB/20-21/28 Finance and Performance Committee (FPC) Report The Board received and noted the content of the FPC report.

TB/20-21/29 Delivering Same Sex Accommodation (DSSA) Declaration The Board received the DSSA Declaration for assurance regarding the systems in place to ensure patients’ privacy, dignity and safety on inpatient units.

The Trust DSSA policy has been updated in line with refreshed DSSA Guidance published in September 2019.

There were no breaches reported between April 2019 and March 2020.

Refurbishments carried out in the same period maintained DSSA compliance.

In April and May 2020 the Trust had a Covid19 Cohort ward Jasmine Ward, DSSA compliance was maintained in response to the pandemic.

The Board received the assurance it was seeking and noted the DSSA Declaration.

TB/20-21/30 Any Other Business

The Board discussed the high rate of asymptomatic Covid-19 cases in the general population and the likelihood that this is replicated within KMPT. It was confirmed that patients are tested on arrival and on transfer. In terms of staff, KMPT’s position is that all staff must act as if they have Covid-19 and so make appropriate use of Personal Protection Equipment.

Technology permitting, the Trust is anticipating livestreaming Trust Board meeting in June, with moderated access to the public. Discussions are ongoing regarding in-person Trust Board meetings in summer.

TB/20-21/31 Questions from Public None received

Date of Next Meeting The next meeting of the Board would be held on Thursday 25th June 2020 at Farm Villa and Video-Conferencing. Trust Board meeting ended at 11.50am.

Signed ………………………………………………………….. (Chair)

Date ……………………………………………………………..



BOARD OF DIRECTORS ACTION LOG UPDATED AS AT: 09/06/2020

Key DUE IN

PROGRESS NOT DUE CLOSED

1 Action Log v4

Meeting Date

Minute Reference

Agenda Item Action Point Lead Date Revised Date Comments Status

ACTIONS DUE JUNE 2020

27/02/2020 TB/19-20/161 Integrated Quality & Performance Report

TS to invite Joanne Hand to give a presentation to Board

regarding the. TS June 2020 On agenda

30/04/2020 TB/20-21/07

Trust Strategy

The Board agreed to have a development session to

discuss the plan and how to work with third parties. TS to

work with the Executive Management Team to arrange

that Board Development Session.

TS June 2020 September

2020

Covid-19 reset date: This also allows new Non-Executive Directors to be involved

27/02/2020 TB/19-20/160

KMPT Quality

Improvement

Strategy

JC, CEO and TS to create a Quality Improvement

workshop as part of the Board Development Day, which

is to be held in April 2020. JC/HG/TS April 2020

June 2020 July 2020

Covid-19 reset date: Board seminar to take place in July 2020 immediately after Board meeting

28/05/2020 TB/20-21/19

Action Log & Matters

arising

A copy of the Thank You Card for staff shall be circulated

to Trust Board. SG June 2020 Action completed on 28/05/2020

28/05/2020 TB/20-21/23

Integrated Quality &

Performance Report

TS to advise Freedom to Speak Up Guardian regarding:

(1) the taking of safety matters to the Trust-Wide Patient

Safety and Mortality Group and (2) to arrange a regular

meeting with the Chief Executive and Trust Chair.

TS June 2020 Action completed: E-mail sent to Freedom to Speak Up Guardian on 04.06.2020

27/02/2020 TB/19-20/160

KMPT Quality

Improvement

Strategy

VB2 and AQ to present to Quality Committee in April

2020 an implementation plan for the Quality

Improvement Strategy. The implementation plan will be

appended to the QC Chair report.

VB2 & AQ April 2020 June 2020

Covid-19 reset date: Implementation plan taken to QC in May 2020, which is attached to QC Chair report for this month’s Board meeting

ACTIONS NOT DUE OR IN PROGRESS

27/11/19 TB/19-20/117

Integrated Quality

and Performance

Report

DN&Q to provide Board in January 2020 with suggested

metrics for customer service. DN&Q Jan 2020 April 2020 May 2020 July 2020

Update 21.05.2020 – SS: Full review of IQPR Metric s to be presented in July 2020,

In Progress

Action Log &

Matters A

rising

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BOARD OF DIRECTORS ACTION LOG UPDATED AS AT: 09/06/2020

Key DUE IN

PROGRESS NOT DUE CLOSED

2 Action Log v4

Meeting Date

Minute Reference

Agenda Item Action Point Lead Date Revised Date Comments Status

28/05/2020 TB/20-21/23 IQPR

Chair of WFODC to include Freedom to Speak Up

matters within Chair Report to Board, which may be

discussed within private Board sessions

Chair of WFODC

July 2020 Not due

30/01/20 TB/19-20/138 IQPR

CEO to produce a refined set of local targets within the

IQPR by April Board. CEO April 2020 July 2020

Update 21.05.2020 – SS: Full review of IQPR Metric s to be presented in July 2020, which will include customer service

In Progress

30/01/20 TB/19-20/141

Annual Inpatient

Establishment

Review Paper on HCA retention to return to Board in May 2020. MM May 2020 July 2020

Not Due

28/05/2020 TB/20-21/122

Recovery and

Transform Update

TS to arrange an informal Board Seminar following Trust

Board’s meeting in July. TS July 2020

30/01/2020 TB/19-20/146 WFODC Report

CEO, SG and TS to allocate Board time for self-

assessment in relation to Freedom To Speak Up TS Mar 2020 October 2020

TS has discussed with the Freedom To Speak Up Guardian the logistics of the self-assessment. As a result of that discussion, TS will liaise with the Freedom to Speak Up Guardian and contact some of the Board Members to discuss and arrange the self-assessment process to take place in Autumn.

Not due

CLOSED AT LAST MEETING OR COMPLETED BETWEEN MEETINGS

30/04/2020 TB/20-21/04

Action Log & Matters

Arising

Executive Management Team to review action log and

provide the Trust Secretary with new dates for actions

(extensions up to 3 months permitted) by May 2020. TS May 2020

Revised dates for actions received and Action Log amended

Complete

Action Log &

Matters A

rising

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Title of Meeting Board of Directors (Public)

Meeting Date Thursday 25th June 2020

Title Chair’s Report

Author Dr Jackie Craissati, Deputy Trust Chair

Presenter Dr Jackie Craissati, Deputy Trust Chair

Purpose For Information

1. Introduction

In the Trust Chair’s absence, I continue to cover the role and provide this report,

addressing three key areas;

Recover and Transform Programme

Non-Executive Director (NED) recruitment; and

NED communications with clinical staff.

2. Recover and Transform Programme

We continue to work together as a Board to ensure that we move forward into a new phase of service delivery as we gradually emerge from the Covid-19 crisis; we are keen to ensure that we maintain some of the benefits of remote working and agile decision-making that were so striking during this difficult period. However this will need to be balanced against the need to ensure that our services are accessible to all who need them and that no one is disadvantaged by new ways of working. To this end, I have been predominantly engaged in networking with other Chairs in Kent, with the Integrated Care System, and across the country. The focus has been in sharing - both in terms of solutions to problems, and learning from innovative practice. For example, Helen and I met with our counterparts in Kent Community Foundation Trust, to start a conversation about future opportunities for collaboration, and I have encouraged the Executive team to forge ahead with building local partnerships.

3. Non-Executive Director Induction

I am pleased to announce that we have appointed - subject to NHS England

approval - three new non-executive directors and two associate directors.

We are working hard - with the able support of the Trust Secretary and Director of Workforce - to put together a first class induction for our new NEDs who will be joining the Trust in August. This will provide a strong, values-led introduction for the new board members, and enable a smooth transition in the team as we move towards 2021.

Chair’s Report


Front Sheet

Title of Meeting Trust Board meeting Date 25 June 2020

Title of Paper Chief Executive’s Report

Author Helen Greatorex, Chief Executive

Executive Director

Purpose: the paper is for: Delete as applicable

Discussion

Recommendation:

The Board is asked to consider the content of the report, asking any questions of the Chief Executive and her team.

Summary of Key Issues: No more than five bullet points

This is the Chief Executive’s thirty second report to the Board. Key Items include

An address from our Black and Minority Ethnic (BAME) Network Chair

A strategic system wide approach to restarting acute trusts’ business

Strategic Objectives: Select as applicable

☒ Consistently deliver an outstanding quality of care

☒ Recruit retain and develop the best staff making KMPT a great place to work

☒ Put continuous improvement at the heart of what we do

☒ Develop and extend our research and innovation work

☒ Maximise the use of digital technology

☒ Meet or exceed requirements set out in the Five Year Forward View

☒ Deliver financial balance and organisational sustainability

☒ Develop our core business and enter new markets through increased

Chief Executive’s Officer's Report


partnership working

☒ Ensure success of our system-wide sustainability plans through active

participation, partnership and leadership

Implications / Impact:

Patient Safety: N/A.

Identified Risks and Risk Management Action: N/A

Resource and Financial Implications: N/A

Legal/ Regulatory: N/A

Engagement and Consultation: N/A

Equality: N/A

Quality Impact Assessment Form Completed: Yes/ No

1. Introduction

Whilst we remain alert and focused on keeping everybody safe, it has been good to see the

week on week reduction in the numbers of staff and service users affected by the global

pandemic.

Since the last board meeting, a thank you card from the board has been sent to every

member of staff. Included in each envelope were five thank you postcards for the member of

staff to use to say thank you to whoever they would like to. Multiple positive comments,

tweets and emails have been received from members of staff who liked the initiative and the

sentiment.

As we continue to move in to the next phase of responding to Covid-19 and its impact, our

focus on retaining the positive changes we made in response to it is sharpened. The board

agreed at its last meeting that a regular brief update on this work would be helpful. The first

of these is attached.

Since the last board meeting, the Executive Assurance Committee considered in detail, how

to agree the benchmarks for retaining the new and improved ways of working. The

Committee also agreed that re-establishing the Clinical Senate would be key in ensuring that

senior clinical leaders shape and inform the standards agreed by each Care Group. Further

regular updates on this work will be shared with the board as it unfolds.



One of the most important areas of conversation across the Trust since the last board

meeting has been the discussion about the experience of staff who come from a Black and

Minority Ethnic (BAME) background. A combination of two recent and significant events

precipitated our discussion; The appalling killing of George Floyd on May 25th, and the

national response to the long awaited Public Health England report in to the disproportionate

risks posed by Covid-19 to people from a BAME background. I am pleased to say that

today’s board meeting will be addressed by Simon Cook, in his role as Chair of our BAME

network. It was Simon’s open letter to us as a board (attached for information) that started a

debate that has every day, gathered more momentum. I know that the board will join me in

welcoming Simon and the challenge that he offers us, and I look forward to our discussion

and shared commitment that as a unitary board, this is absolutely a priority for us all.

2. National, Strategic

NHS Providers shared with trusts a letter that they sent Matt Hancock, Secretary of State for

Health and Social Care. The letter was borne of the concern for patient and staff safety

expressed by trusts across the country caused by the lack of consultation or notice of key

changes in guidance relating to Covid-19.

The letter asked Mr Hancock to confirm that from now on he will :

appropriately consult trust chief executives before finalising the details of any

announcement, including announcement and implementation date timing

give all trust chief executives as much notice as possible of any announcement and,

as a bare minimum, provide them with a copy of the announcement at the same time

it is made public, for example by putting it on a website

provide all trust chief executives with Frequently Asked Questions and other

supporting material as quickly as possible after any announcement to enable them to

answer legitimate questions from staff, patients and local stakeholders

make available any detailed guidance in a sufficiently timely way to enable effective

implementation within the announced implementation deadline.

3. County Wide

The regional office is hosting a series of meetings to check and challenge local systems’

activity and progress in re-establishing pre Covid levels of activity. The Kent and Medway

system was the first to be virtually visited and six places for system leaders were available.

The Chief Executive took a place and represented mental health, learning disability and

substance misuse services. It was notable that whilst the acute trusts and primary care in

order to respond to the pandemic, had needed to stop or reduce some areas of routine work,

our services had done the opposite and had created new ways of working, broadening

access and improving our offer. The region welcomed the system’s endorsement of

establishing a System Integrator and a Mental Health Collective or Community of Practice

noting the good news that for the first time in the county’s history, we now have Core 24

Liaison Psychiatry in our acute hospitals; a strong example of system integration delivering

better care for patients.



Building on the theme of interagency working, the board will today receive a paper, jointly

written by both the Chief Executive of KMPT and the Chief Executive of Kent County

Healthcare Foundation Trust. The paper seeks the endorsement of the board for the signing

of a Memorandum of Understanding between the two organisations, marking the

strengthening of our mutual commitment to improve the quality of services we offer our

patients.

4. In House

Change of Name to Personality Disorder Pathway

I am pleased to update the Board that following very substantial discussions with people

who have a diagnosis of what was previously referred to as Personality Disorder,it has been

agreed that it will from now on be known as The Pathway for Complex Emotional Difficulties.

Appraisals

The annual appraisal window opened on 1st June and has been extended until the end of

September in light of the pandemic’s impact on our capacity. We would usually close the

window at the end of July. Take up to date has been good, with positive feedback received

on the improved e-appraisal form.

A Gradual Return to Visits in Person

A key element of our management of the virus has been to limit to the barest minimum, non

essential visits across the Trust. These included visits from members of the board. As the

grip of the pandemic eases and the numbers of Covid positive patients reduces we are now

reviewing the measures that we need to have in place to ensure that a gradual return to

visits in person is safe. We will be advised by Director of Infection Prevention and Control

about our phased return and the requirements of each of us to undertake visits that protect

those we are visiting and anticipate that in July, it will be possible to gradually reintroduce

visits in person to complement the programme of virtual visits made over recent months.



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Phase One Recover and Transform Priorities – June 2020

National Task

Action Taken / Required Delivery

Timescale Action Owner RAG

Establish clear plans for system restart, restoration and recovery phases

1. System restart framework established with assurance reporting to NHS England / Improvement (NHSE/I).

2. Integrated Care Partnership (ICP) collaboration on integrated plans to sustain new normal.

3. KMPT Lead Recovery Director in place with programme board, framework and phase timelines established.

April 2020 – June 2020

Executive Director Partnerships and Strategy

Complete

Open access crisis services with partners such as local authorities, voluntary sector and 111 services

1. Open Access Crisis Care project established. Scoping work underway (due to complete by end June 2020); this will include clear timeline, interdependencies and risks.

2. Develop 111 / Clinical Assessment Service (CAS) Single Point of Access (SPoA) response for mental health crisis.

3. SPoA crisis response in place as an extended 24/7 helpline in response to national request for service. Agreed three month operational delivery from April 2020; currently being monitored to assess its performance.

4. Assess ability to provide additional service past June 2020 - model currently resourced by shielding / isolating staff.

5. Further review long term plan requirements using available data to assess option to extend past July 2020.

6. Demand and capacity modelling to be developed to determine longer term requirements for the service.

7. Develop business plan for additional commissioning requirements – build into the Mental Health Investment Standard (MHIS) as part of Long Term Plan (LTP) requirements.

8. Develop, with Clinical Commissioning Groups (CCGs), the mental health CAS to assess option to add KMPT SPoA to the 111 Directory of Services (DoS) profile.

9. Review helpline outcomes to ensure efficiency – reporting being established. 10. Helpline provides front door for 24/7 crisis services – need to align Mental

Health Matters crisis line and CAS mental health response.

June 2020 – October 2020

Chief Operating Officer On track

1. Digitally Enabled Care workstream established to develop standards that support clinicians to undertake telephone contacts and video conferencing safely.

2. Initial scoping work complete (17 June 2020); further work to refine scoping underway (due to complete by mid-July 2020).

3. Task and Finish Group to be established and clinically led with full multi-disciplinary team input encouraged from frontline junior staff.

June 2020 – December 2020

Executive Director Nursing and Quality

On track

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Offer improved access to services in the community across 7 days (community framework)

1. Improving Community Provision (was Agile Working) project established. 2. Scoping work complete / project initiation document (PID) developed (Jun20). 3. Work underway to identify, retain and build on COVID innovations relating to

agile working, use of technology (Lifesize / Attend Anywhere video-conferencing tools to increase attendance at meetings / reduce travel time and expense, and need for large meeting rooms) and estate going forward where they add value.

4. Work underway to cease or change those working practices which do not add value where this can be evidenced.

5. Work underway to embed flexible working hours, access to services and working practices where this is justified across the organisation (corporate, community and inpatient if applicable) through engaging and consulting with staff, patients and carers.

6. Work underway to ensure the provision of a high level of patient safety by embedding 72 hour follow up across the organisation for those recently discharged and operating a red board system

7. Work underway to embed effective data capture and reporting of new ways of working.

June 2020 – December 2020

Chief Operating Officer / Executive Director Finance

On track

Prepare for long term demand increase due to COVID19, including active recruiting in line with the NHS Long Term Plan

1. Demand and Capacity workstream established. Scoping work underway (due to complete by end June 2020); this will include clear timeline, interdependencies (internal / external) and risks. a. Demand model to be built. b. Capacity model built for Older Adult Care Group to be refined and rolled

out to Community Recovery Care Group. c. Focus on short term demand and capacity risks, as well as long term

‘business as usual’. d. Support continued implementation of good patient flow practice, linking

with the police and local authorities to reduce use of Section 136. 2. Increasing recruitment in line with the NHS Long Term Plan workstream

established. Scoping work underway (due to complete by mid July 2020); this will include clear timeline, interdependencies and risks.

3. Continue business as usual activities: a. Implementation of good patient flow practice, linking with the police and

local authorities to reduce use of Section 136. b. Improved community discharge planning to reduce readmissions. c. Working positively with primary care / general practitioners (GPs) to

understand any change in anti-depressant medication prescribing, increase in people with psychotic presentations and study into number of new service users since COVID-19.

d. Routine review of caseloads to identify urgent and routine work using

June 2020 – March 2022

Executive Director Finance and Performance / Director of Workforce, Organisational Development

On track

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established processes such as red board meetings. e. Ongoing development of clinical care pathways. f. Delivery of the Mental Health Community Framework bringing providers

together to deliver joined up Kent wide mental health care and support.

Estates and facilities review to support safe reopening of clinical and community services taking account of new requirement e.g. Social Distancing, Health & Safety

1. Safer Better Buildings project established. 2. Scoping work complete (Jun20). 3. Building capacity planning process and tool developed, and used by multi-

disciplinary team (estates, operations, human resources) to assess buildings. 4. Initial focus on community buildings; emerging themes identified – to be

reported to Recover Transform Board mid-Jun20. 5. Second area of focus on corporate buildings; emerging themes identified – to

be reported to Recover Transform Board mid-Jun20. 6. Building risk assessments (social distancing) complete for majority of buildings

(32 of 41); estate teams meeting with assessors from 08Jun20 to complete action plans.

7. Findings to be triangulated with Agile Working survey results, and other potential surveys linked with Improving Community Provision project.

8. Actions plans to be implemented.

April 2020 – September 2020

Executive Director Finance and Performance / Director of Estates and Capital Planning

On track

Annual Health Checks (AHC) for people with learning disabilities should continue to be completed

1. As off 12 May 2020 (C19 cell) nationally AHC have been on hold and NHSE/I are working to produce guidance for GPs although this will need to be signed off by the General Practitioners Committee (GPC) before shared with GPs.

2. Locally Kent Community Health NHS Foundation Trust (KCHFT) is commissioned to support the GP practices across Kent and Medway to carry out AHC and 1) offer regular GP training, 2) validate the GP Learning Disability register annually and 3) provide a named learning disability nurse for each GP practice.

3. There is a mental health element in the AHC although KMPT do not currently have any regular involvement in this particular GP enhanced service at the moment.

4. KMPT’s Learning Disability and Autism Lead has contacted the Senior Responsible Officer (SRO) for the Learning Disabilities and Autism Programme asking for a local update including any additional support from KMPT required. Practices are reminded that the ‘DES’ has not been suspended and that they should continue to offer this proactive service to their patients and healthcare professionals should continue to discuss on a face to face basis if safe with the patient (if considered to have mental capacity), their carer or their advocate the most suitable and safe way to conduct a health check.

Ongoing Executive Medical Director

Enhanced psychological support is available for

1. Psychological Support / Staff Health and Wellbeing programme established with three core projects:

April 2020 – September

Director of Workforce, Organisational Development

On track

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NHS staff who need it

a) Enhanced Psychological Support for NHS / Healthcare Staff: Project delivery group (PDG) established and met (08Jun20). Commissioners procured external agency, ‘Health Assured’, to support delivery. KMPT oversight of governance and coordination of support. Work to develop links with local authority and third sector Debrief support available to Acute Trust partners across Kent and Medway.

b) Psychological Support for the General Population: PDG established and met 09Jun20. Specific cohorts agreed (those who have had COVID-19 and been treated in hospital, and those with bereavement as a result of COVID-19). Work underway with other agencies to define offer. System agreed to contribute to funding provision of support. The PDG met for the first time on 9 June 2020.

c) KMPT Staff Psychological Support: PDG established and met w/c 15Jun20 to commence scoping work. Staff Helpline established and resilience coaching offer available. Other areas of focus informed by feedback gathered by Health and Wellbeing Group during COVID Active Phase, agreed as webinars for managers and staff and ‘reflective space’ for all staff (dedicated sessions facilitated by psychology and organisational development teams as well as dedicated physical space for reflection, for example, staff rooms / rest rooms / outdoor space). Research and development team will undertake research on the staff experience of crisis / trauma to understand impact on staff within a trauma informed contact. Regular touch bases with whole teams. Proportionate, direct, and effective communication with staff to raise awareness of Trust / system objective and develop relationships between all levels of staff

2020

and Communications / Head of Psychology and Psychological Services

Emerging COVID19 implications review including focus on inequalities and wider determinants of health for

Patients

Workforce

Local Communities

1. Workforce COVID-19 daily reporting structures in place including shielding, self-isolation, testing / swabbing and fitness to return to work.

2. Black Asian Minority Ethnic (BAME) workforce monitoring and support in place. Risk assessment tool kit operational.

3. Considering messaging that can support staff in these groups as there may be a possible escalation of racism.

4. Engagement with Healthwatch, patient and carer forums supported by increased use of virtual technology.

5. Review of consultative committees commenced to broaden participation and involvement.

6. COVID-19 volunteer support service - volunteer service has launched an emergency COVID-19 volunteer support service. This offers shopping / collection of prescriptions / befriending service for vulnerable / isolated / shielding clients without support.

April 2020 – September 2020

Chief Executive / Executive Management Team

On track

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Dear All In my capacity as BAME Chair, and as a member of the Black community as well as the NHS for 36 years, I feel qualified to comment on current issues around race and ethnicity. I am pleased to acknowledge the support I have had from many individuals and groups, that have helped me grow and become who I am today; and I am proud, extremely proud to have been associated and nurtured in this way. My work in both the BAME community and the NHS is not yet complete and I am more convinced there is a need to continue to do the best I can for what I believe is right, just and fair. I do hope that you as senior colleagues can agree with my sentiments, frustration and upset at this particularly poignant time in our history. I have spoken with many BAME staff within the Trust over the past few weeks, as well as white colleagues (some of which have been in tears), not only about the disproportionate impact of COVID-19 on the workforce but about the levels of subtle racial abuse they face on a daily basis, working in and for the NHS. These concerns are not only about the behaviour of patients but unfortunately, from colleagues including peers and senior staff. They continue to work and provide the best possible service they can. I respectfully request that the executive and other senior colleagues, across all care groups, counter this pandemic of racism with the same vigour, intelligence and professionalism with which we have together, tackled COVID-19. It is reassuring to know that we have on the Board a good BAME representation, but I feel we still need your help to move this issue on and look for true equality, respect as well as challenge intolerance. I think it is now timely and important, that our White colleagues (I truly hate going down the lines of colour) stand with us and put a ‘mark in the sand’ and say these abuses need to stop and will not be tolerated; this will increase the respect and admiration to the Board and it will send out a clear message that enough is enough. I would love to see the next BAME conference led by my White colleagues, and race equality promoted loudly throughout the Trust and wider society. This is such an important matter that it requires strong and visible leadership as well as grass roots engagement. My mother and father came to the UK in the early 50’s to help rebuild the infrastructure of the UK. Dad was a carpenter whilst my mother was a nurse in our NHS. They tolerated years of abuse yet were always polite towards others in public whilst crying angry tears at home. I have also faced racist abuse throughout my life but have had the opportunity to challenge and question this. When I consider my grandchild’s future and development, I hope with all my heart that he will not have to experience the hurtful misery of racist abuse. I consider the Trust’s ambition is to commit to causing every individual to feel included, valued and respected through the efforts we all make on a daily basis. No one is asking for exclusivity, together we should look to develop a level playing field which I believe should be afforded to all staff and service users. I for one have tried to support, nurture, guide not only my children but family, friends and colleagues through challenging times and it is always easier to work at something collectively rather than alone. With the above backdrop, can I suggest that consideration is given to the following suggestions for the further development of our Trust and its individual leaders and other employees. Non BAME colleagues more involved in the BAME Network and forthcoming conference Elevate training around Race, Ethnicity and Respect to a more prominent position To support staff to feel sure that we will support them to report racist incidents to the police



To actively support all staff to challenge any racial incident that makes them feel uncomfortable whether it was directed at them or not To insist that Race and Diversity is included on all meeting and supervision agendas To consider developing a champion network for BAME staff To educate yourselves and how you can be part of the solutions for change. Here are some suggestions: Books to read: Why I’m no longer talking to white people about race – Reni Eddo-Lodge So you want to talk about Race – Ijeoma Oluo White Privilege: The myth of a post-racial society – Kalwant Bhopal White Privilege unmasked: How to be part of the solution – Judy Ryde YouTube: Deconstructing white privilege – Robin DiAngelo https://www.youtube.com/watch?edufilter=NULL&v=DwIx3KQer54 Akala on Racism and the British Emprire https://www.youtube.com/watch?edufilter=NULL&v=prn7sE9K-tQ I would be more than happy to discuss any of the above with my senior colleagues, and wider staff groups and look forward from hearing further from the executives. I remain yours accountably Simon Cook Service manager, forensic and specialist BAME Chair



https://www.youtube.com/watch?edufilter=NULL&v=DwIx3KQer54

https://www.youtube.com/watch?edufilter=NULL&v=prn7sE9K-tQ

Front Sheet

Title of Meeting Trust Board meeting Date 25th June 2020

Title of Paper KMPT / KCHFT : Moving to a Memorandum of Understanding

Author Helen Greatorex, Chief Executive

Executive Director


Discussion

Recommendation:

The Board is asked to consider the content of the report, asking any questions of the Chief Executive and endorse the development of a Memorandum of Understanding with Kent Community Health Foundation Trust (KCHFT).


Delivering improved care as a result of strengthened working

Improved outcomes for our service users in common

Greater efficiencies in sharing resources

Improved flow of patients to enhance performance and reach of services

Formally recognise our joint working through a Memorandum of Understanding



☒ Recruit retain and develop the best staff making KMPT a great place to work


☒ Develop and extend our research and innovation work


☒ Meet or exceed requirements set out in the Five Year Forward View


☒ Develop our core business and enter new markets through increased

partnership working

☒ Ensure success of our system-wide sustainability plans through active

MOU - KCHT & KMPT




Patient Safety: N/A.

Identified Risks and Risk Management Action: N/A

Resource and Financial Implications: N/A

Legal/ Regulatory: N/A

Engagement and Consultation: N/A

Equality: N/A

Quality Impact Assessment Form Completed: Yes/ No

The board are asked to consider the attached document which has been written jointly by

myself as Chief Executive and the Chief Executive of KCHFT.

There is a strong connection between the two organisations both in the way that we work

and we share service users.

It is noted that we have previously looked at this back in 2018 and the idea was revisited

during a recent 2:2 meeting. During this global pandemic it has become clear and

imperative that the system must work as a whole and work differently. KMPT and KCHFT

having the makings of a very strong partnership.

The paper attached is a brief overview of what we believe we can achieve together to the

benefit of all that use our services and will also benefit our staff.

MOU - KCHT & KMPT


Background and Introduction Kent Community Health Foundation Trust (KCHFT) and Kent and Medway Partnership Trust (KMPT) have many things in common and over recent years especially, have established strong and positive working relationships. We also hold dear in our respective trusts, the same belief and commitment; that anything we do, should be in the best interests of our patients or service users and their loved ones. This brief paper has been jointly written by the Chief Executive of each Trust, and marks a moment in time when we believe even greater benefit for those we serve could be derived from formally recognising through a Memorandum of Understanding, our joint working and in particular, explore opportunities for innovation and collaboration that facilitate :

a) Improved outcomes for our service users in common b) Greater efficiencies in sharing resources c) Improved flow of patients to enhance performance and reach of services

With the advent of a global pandemic, came the imperative for the system as a whole to work differently. It has been clear that better joint working, more proactive collaboration and the removal of non-value adding activity creates capacity to think and act differently. KMPT and KCHFT have previously considered areas for potential joint working, and to that end a Non Executive and Executive pair from each trust met to discuss this in 2018. The sense was that there were areas of overlap and potential joint working but at that time, it felt reasonable to continue as we were. The pandemic and our learning from it has made us think again. In many instances staff, from our respective organisations, already collaborate in the interests of patient care, and we have of course, many patients in common. At a recent Chair and Chief Executive 2:2 meeting, the idea of areas of synergy and overlap were revisited and the potential benefits to patients explored. It was agreed that in order to maximise the opportunity, the importance of collaboration should be made formal and public. To this end, the possibility of a Memorandum of Understanding was discussed. Potential Benefits to Patients and Service Users The thinking about potential benefits is in its earliest stage but it is easy to see that for some of our most vulnerable populations, together, KCHFT and KMPT could make a significant difference. People who have a dementia, autistic people and those who live with long term mental illness all use the services of both organisations and sadly, their experience is not universally excellent, the Trusts collaborate in the provision to people with learning difficulties Formally committing to joint working on a particular care pathway could significantly improve the experience of those we serve, and at the same time improve our efficiency and staff satisfaction. For some it could be as simple as not having to see two health workers and instead just see one. For others, it could be the behind the scenes improvements that together we could make to the entire care pathway; much more difficult to do on our own, so much easier to deliver together. These are unworked examples that might lend themselves to testing the concept. Our respective Executive Medical Directors have been tasked with thinking about what could make the biggest difference to the greatest number of people. They will report back to us in July.

MOU - KCHT & KMPT


The estates challenges arising from the pandemic are significant and need creative solutions; both Trusts have been hampered by the relationship of tenant and landlord with NHS Property Co. The acceleration of the digital solutions enabling our teams to work with each other and with the people we serve are profound and significant, offering further potential areas of shared benefit. Summary and Conclusions We already have good working relationships at all levels of the two trusts. We have an established interest in improving the quality of care that we offer, through joint working but the pandemic, and our learning from it has created the drive to further strengthen this commitment and to signal to both the wider system and the public that we want to make a step change and set ourselves some ambitious targets to drive up the quality of what we offer. Next Steps If the board endorses the direction of travel, the next steps would be for the two Chief Executives to formally sign a Memorandum of Understanding. Whilst not a legally binding document or contract, the signing of such an agreement between the two trusts, makes a strong statement about working in the interests of our patients and signals that we want to do things in a more joined up way. In order to support the work, re-establishing a Non Executive and Executive pair from each trust would ensure that the work was sponsored at the highest level with a clear line of sight from both boards to the work as it unfolds. The starting point for this and any changes that the two trusts make, is always to improve the quality of what we offer those we serve. This simple change, could be the start of some significant improvements, in particular, for our most vulnerable patients.

MOU - KCHT & KMPT


1

Title of Meeting Trust Board Date 25/06/2020

Title of Paper: Integrated Performance and Quality Report (IQPR) Performance Update as of: May 2020

Author: All Executive Directors

Presenter: Helen Greatorex, Chief Executive

Executive Director:

Sheila Stenson – Executive Director of Finance


Discussion and information.

Recommendation:

The Board is asked to consider May’s Integrated Quality and Performance Report (IQPR) noting the key areas of focus.


Each section has been written by the executive lead for the domain. The report

provides Trust-wide performance data, with Care Group and locality data monitored

by the Executive and their teams.

The report highlights performance that has improved, is on track and has declined.

Despite the ongoing impact of COVID 19 there has not been a significant impact on

the levels of performance within this report. Key elements of service delivery have

been maintained ensuring patients receive the best care possible through the

adoption of different ways of working. Due to social distancing requirements the

amount of referrals received continues to be approximately 10% lower than average

but May did see a 25% increase compared to April. A reduction in assessments via

the usual face to face consultation continues to be reflected in this report,

alternatives methods have been deployed (telephone contacts) to ensure patients

are safe and are in contact with our services. Discussions are concluding on how

best to reflect such service changes within the IQPR going forward.

Report History:

None


Integrated Quality & Performance Report (IQPR)


2


☐ Recruit retain and develop the best staff making KMPT a great place to work


☐ Develop and extend our research and innovation work

☐ Maximise the use of digital technology

☐ Meet or exceed requirements set out in the Five Year Forward View

☐ Deliver financial balance and organisational sustainability

☐ Develop our core business and enter new markets through increased

partnership working

☐ Ensure success of our system-wide sustainability plans through active



Patient Safety: Patient safety is a key priority and issues that may affect this, are highlighted in the report and considered by the Board.

Identified Risks and Risk Management Action: Risks set out in the report are all reflected in the Trust’s risk register or BAF. All risks are outlined within the paper below

Resource and Financial Implications: Failure to achieve some of the regulatory, performance or data quality metrics could result in a financial penalty under the NHS Standard Contract and importantly, to a poor quality service for patients potentially leading to claims.

Legal/ Regulatory: None

Engagement and Consultation: Not applicable

Equality: None

Quality Impact Assessment Form Completed: No



3

The Integrated Quality and Performance Report (IQPR) is a key document in ensuring that the Board

is sighted on key areas of concern in relation to a range of internally and externally set Key

Performance Indicators (KPIs).

Good examples of IQPRs from high performing organisations change and improve over time. KMPT’s

is no different, and continues to be adjusted and improved in the light of feedback from internal and

external stakeholders. Any changes to indicators will be clearly documented and the report will

include the rationale for any change.

Each member of the Chief Executive’s team provides the commentary to the area for which they are

the lead. This adds a further strengthening to the actions outlined, and ownership and accountability

where improvements are required.

Importantly the IQPR now includes a dedicated section on workforce. This is an extremely important

area of focus for us because without brilliant people, we cannot deliver brilliant care. Reducing our

turnover rate, improving the robustness of our appraisal and supervision, and helping our workforce

stay fit and at work, are all essential in meeting our strategic objectives.

Because this report brings together in one place, all the key work streams that the Chief Executive’s

team lead, the overarching paper is presented to the Board by the Chief Executive.

Our nine Strategic Objectives (for 2016-19) are set out at the start of the report under our aim of

Brilliant Care Through Brilliant People, along with the Care Quality Commission’s five Domains (Safe,

Caring, Effective, Responsive and Well Led) helps focus the report on both the national and local

context.

Introduction



4



5

Executive Commentary

The data provided to the Board is drawn from performance in May and is shown at Trust-wide level.

It is positive to observe that despite the challenges faced in the light of the pandemic, the Trust

exceeded the target for people subject to the Care Programme Approach (CPA) receiving a formal 12

month review (95.6%). All care groups were compliant as at the end of May 2020. The proportion of

discharges from hospital under CPA followed up within 7 days was also at its highest level in the last

12 months at 98.9%.

The overall sickness rate decreased by 1.3% this month to 4.5%, against the 2020/21 target of

4.22%. However, this is due to recording of staff having reported as sickness due to Covid-19.

(0.58%), without this, sickness for May would be within target at 3.92%. Staff Turnover reduced by

0.6% in month to the lowest position within the last 12 months of 10.6%, 0.1% from the trust target of

10.5%.

A trend line over twelve months is provided after each section enabling the reader to see a year’s

performance at a glance. Trust-wide data is drawn from a range of sources and includes individual,

team, Care Group and locality information. That data is reviewed and explored by members of the

Executive Team with every Care Group at the monthly Quality Performance Review meetings. In

addition, where an area is receiving additional attention as a result of concerns, special reporting and

monitoring mechanisms are implemented, supported by trajectories for improvement.

Not all areas of performance (including those nationally set) have a target set against them. This is an

area for further consideration with the board as the report evolves. It is helpful to note that in the

absence of a national waiting time target for mental health service users, the Trust has set its own

local target for two key indicators. We have made a number of changes to the report this month and

they are detailed in the change table below.

As lockdown eased in May referral rates increased by approximately 25% in May compared to April

but remain over 10% lower than in pre COVID months. The Trust is planning for the impact on the

lower referral rates we have seen in the past 12 weeks, as it is likely to lead to an increase in demand

for our services in the coming months, due to different social and economic circumstances faced by

many. There is close monitoring of the levels of referrals and changing means of clinical delivery to

inform the effective planning of delivering sufficient assessment capacity.



6

Underpinning the IQPR is a series of Executive chaired meetings. They bring together KMPT experts

in their field in order to understand the data at a granular level and test that actions in hand to resolve

concerns are strong enough and delivering improvements in a timely way.

Supporting the work of the board, are its sub-committees each of which considers in detail, aspects of

the IQPR. This report, when working as we expect it to, will enable the board to operate at strategic

level, confident in the work of the sub-committees in testing assurance and understanding further

detail provided by the executive and their teams.

The report is now a familiar tool and point of reference in the Trust and as we had hoped, further

strengthening our ability to triangulate information and explore in detail areas of concern. My team will

provide detail on the work being done to understand and address these areas of concern whilst

maintaining improved performance across a range of other areas.

Helen Greatorex

Chief Executive



7

IQPR Change Tracker Date Change Report

Reference

June 2019 Additional measures added to Responsiveness Domain: Referrals per

working day & Referrals per 10,000 registered Kent and Medway GP

population

014.R & 015.R

July 2019 Data Quality Maturity Index (DQMI) updated to reflect new definition 004.E

November 2019 Splitting of OPMH LoS to reflect Acute wards and Continuing Care Wards

separately

013.E a & b

November 2019 Amber has been included within the tables when the reported position is

within 10% of the identified target.

All Domains

January 2020 Data Quality Maturity Index (DQMI) updated to reflect new definition –

expanded to 30 items

Additional Finance Measure: Distance From Financial Plan YTD (%)

004.E

006a.W-F

February 2020 Settled accomodation and employment indicators retired 002.E & 003.E

March 2020 Additional measures added to Responsiveness Domain:

Patient cancellations- 1st Appointments

Patient cancellations- Follow Up Appointments

Trust cancellations- 1st Appointments

Trust cancellations- Follow Up Appointments

009.R

010.R

011.R

012.R

April 2020 Removed safety thermometer as retired as a measure nationally. 014.S

May 2020 Removed clustering measures as no longer part of contract monitoring: %

Reviews Undertaken Within The Maximum Cluster Review Period & % Of

Service Users Assessed With Cluster Assigned

Removed staff survey measures as only reported annual and will be

detailed in narrative once available

Amended Emergency Readmission Within 28 Days target to reflect mean

of national benchmarking

Workforce metric targets updated:

009.E & 010.E

010& 011.WW

004.S



8

Regulatory Targets – Single Oversight Framework (SoF) Overview The Single Oversight Framework (SOF) sets out how NHS Improvement (NHSI) oversees NHS trusts

and NHS foundation trusts, using one consistent approach. It helps to determine the type and level of

support needed. The first version of the SOF was published in September 2016 with small

amendments made in 2017.

The Framework aims to help NHSI to identify NHS providers' support needs across five themes:

quality of care

finance and use of resources

operational performance

strategic change

leadership and improvement capability

NHSI monitor providers’ performance under each of these themes and consider whether they require

support to meet the standards required in each area. Individual trusts are segmented into four

categories according to the level of support each trust needs. KMPT’s current segmentation is 1 as

highlighted below

Segment/ category Description of support needs

1 (Maximum autonomy) No actual support needs identified across the five themes described in the provider annex. Maximum autonomy and lowest level of oversight appropriate. Expectation that provider supports providers in other segments.

2 (Targeted support) Support needed in one or more of the five themes, but not in breach of licence (or equivalent for NHS trusts) and/or formal action is not considered needed.

3 (Mandated support) The provider has significant support needs and is in actual or suspected breach of the licence (or equivalent for NHS trusts) but is not in special measures.

4 (Special measures for providers; legal directions for CCGs)

The provider is in actual or suspected breach of its licence (or equivalent for NHS trusts) with very serious/complex issues that mean it is in special measures.

NHSI segment providers based on information collected under the SOF, existing relationship

knowledge, information from system partners (e.g. CQC, NHS England, clinical commissioning

groups) and evidence from formal or informal investigations. The process is not one-off or annual.

NHSI will monitor and engage with providers on an ongoing basis and, where in-year, annual or

exceptional monitoring flags a potential support need a provider’s situation will be reviewed.

A breakdown of measures reported against the Single Oversight Framework can be found in

appendix A. This shows that currently the trusts biggest challenge is achievement of the agency cap

against the national target. It also reports staff turnover as non compliant. This is against a target

that is set by the Trust as no target has been set in the SoF.



9

IQPR Dashboard Guide The IQPR is structured by domains with executive commentary followed by the domains dashboard

and a page in which up to three indicators are brought into focus with additional information on current

actions in place.

The diagram below provides a guide for each of the columns with the domain dashboards; this is

followed by further information on the application of Statistical Process Control charts which are

applied within the ‘Domain Indicators in Focus’ sections.

Statistical Process Control (SPC) Charts Explainer

SPC Charts are used to study how a process changes over time. Data is plotted in time order.

A control chart always has a central line for the average, an upper line for the upper control

limit and a lower line for the lower control limit. These lines are determined from historical

data, usually over 12 months within this report. By comparing current data to these lines, you

can draw conclusions about whether the process variation is consistent (in control) or is

unpredictable (out of control, affected by special causes of variation).

Upper and Lower control limits are set by calculating the average +/- 2 standard deviation (a

quantity expressing by how much the members of a group differ from the mean value for the

group.)

Where significant process change is implemented you may recalculate the mean and control

limits to reflect this change.

The SPC charts within this document only apply the basic rule set of identifying breaches of

control limits, charts can however be developed further to identify additional triggers for

investigation, such as a succession of 9 or more data points on the same side of the mean.

IQPR Dashboard: Safe

Ref Measure

SoF Target

Local /

National

Target

Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18

001.S 0 N 0 0 0 0 0 0 0 0 0 0 0 0

002.S 95% N 82.1% 84.4% 88.6% 93.0% 93.6% 90.1% 90.5% 91.7% 93.0% 93.2% 92.9% 92.4%

003.S 90% L 94.3% 93.1% 95.4% 94.7% 95.3% 94.9% 95.2% 96.7% 95.2% 96.1% 97.3% 93.7%

004.S 5% L 11.2% 6.9% 6.9% 6.2% 5.3% 15.0% 12.4% 11.0% 14.9% 9.1% 10.5% 5.8%

Indicates if the measure is contained within the SingleOversight Framework as measured by NHS Improvement

to inform segmentation of providers: https://improvement.nhs.uk/resources/single-oversight-framework/

Targets: Determine by regulatory bodies where stated (N). In absence of national

target a local target has been set (L) for some indicators.

Domain: The report is presented in sections consistent with the 5 domains set out by the

CQC.

Monthly performance: performance for a given month, usually reflective of performance for the

stated period but may reflect a rolling 12 months for some indicators.Grey boxes show where indicator is reported at a frequency less that monthly.

Ref: Individual indicator ID's, refrenced in supporting

narrative within report



10

Trust IQPR by CQC Domains, Trust Strategic Objectives & Board Assurance Framework

CQC Domain Safe Trust Strategic Objective & Board Assurance Framework

Consistently deliver an outstanding quality of care

Executive Lead(s): Executive Director of Nursing & Quality Lead Board Committee: Quality Committee


CPA Patients Receiving Formal 12 Month Review (002.S)

Despite current challenges to service delivery it is positive to note that the trust has exceeded target

for only the second time in the last 12 months for people subject to CPA receiving a formal 12 month

review. All care groups were compliant as at the end of May 2020.

Restrictive Practice (011.S – 013.S)

The Trust’s approach to the use of restraint is carefully monitored and reviewed in line with national

best practice. The use of restraint is always a last resort and staff are trained in de-escalation

techniques which are always considered before restraint is implemented.

There were 105 reported incidents of restraint needing to be used in May 2020, a reduction by 26

from the previous month. All care groups have shown a reduction. The majority of restraints occurred

in the Acute Care Group (ACG) with 81 reported in May. The data indicates that Chartwell Ward had

the highest reduction of over 50%, from 30 restraints in April to 14 restraints in May. As indicated in

the IQPR presented to the Board in May, most of the restraints in April were attributable to a single

patient with a complex presentation. The patient was transferred to a specialist placement at the end

of April. All use of restrictive interventions are monitored in line with Trust policy with, strategic

oversight at Promoting Safe Care group meeting which has membership from all care groups and

subject matter experts.

Prone restraints have remained static from last month at five reported incidents. Three prone

restraints were used to administer IM medication and two were due to the team being overpowered

and therefore unable to hold the patient in a supine position.

2020-03 2020-04 2020-05 Latest Denominator Total CPA Caseload

Acute Service 100.0% 100.0% 100.0% 7 8

Community Recovery Service 94.3% 93.4% 95.1% 1,437 2,162

Forensic and Specialist 98.7% 98.0% 98.0% 151 220

Older Adult 96.8% 96.9% 97.9% 95 329

Grand Total 94.9% 94.0% 95.6% 1,690 2,719



11

The use of seclusion has increased slightly from 26 instances in April to 28 in May 2020. The majority

of these occurred in the ACG (23) with the remaining five in the Forensic & Specialist Care Group. All

instances of seclusion are reviewed and an overview retained in order to identify outliers or patterns.

No outliers or patterns were identified.

There have been no incidents of patients with a confirmed diagnosis of Covid being subject to

restraint. There were however six instances where restraint was used in order to keep people safe;

patients who had been swabbed on admission declined to follow infection control measures and had

to be prevented from mixing with other patients whilst waiting for their Covid status results.

Number of Grade 1 &2 Serious Incidents confirmed breached over 60 days (008.S)

We have seen an improvement not only in the quality, but the timeliness of Serious Incident (SI)

Investigation reports since the launch of the centralised SI and complaints investigation team. The

team commenced in January this year in response to feedback from operational managers about lack

of capacity to respond to serious incidents investigations. The pilot is showing encouraging results

and a full review will be completed in August and shared with Executive Management Team and also

the Quality Committee before a way forward is agreed.

Number of unplanned Absences and Absence (005.S)

There was an overall increase in patients Absent Without Leave (AWOL) reported across the Trust in

May, with 14 of the 19 originating from Acute wards. All incidents involved different patients and no

harm was reported as a result. Some patients returned of their own accord while others were returned

with assistance from the Police. The AWOLs occurred when the patients were on agreed Section 17

leave, either running away from escorting staff member or not returning at the agreed time. None of

these patients were diagnosed with Covid. In line with national guidance, patients who go AWOL now,

will be subject to the same infection prevention and control standards as new hospital admissions.

There were no AWOLS from Forensic or Specialist services.



IQPR Dashboard: Safe

Ref Measure

SoF Target

Local /

National

Target

Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20

001.S Occurrence Of Any Never Event 0 N 0 0 0 0 0 0 0 0 0 0 0 0

002.S CPA Patients Receiving Formal 12 Month Review 95% N 89.5% 89.1% 89.4% 92.0% 93.0% 93.6% 94.9% 95.0% 96.0% 94.9% 94.0% 95.6%

003.S % Inpatients With A Physical Health Check

Within 72 Hours 90% L 96.7% 94.3% 96.8% 95.6% 94.0% 96.1% 98.1% 93.4% 94.7% 95.8% 95.1% 95.2%

004.S Emergency Readmission Within 28 Days 8.8% L 9.3% 9.1% 11.3% 11.4% 12.5% 13.6% 12.1% 9.9% 9.8% 8.5% 10.9% 9.6%

005.S Number Of Unplanned Absences (AWOL and

Absconds on MHA)- - 17 18 14 18 12 19 16 17 24 25 6 19

006.S Serious Incidents Declared To STEIS - - 7 13 9 6 20 7 11 10 8 18 11 8

007.S % Serious Incidents Declared To STEIS within 48

hours- - 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

008.S Number Of Grade 1&2 Sis Confirmed Breached

Over 60 Days0 L 10 10 3 9 9 8 7 16 8 12 8 4

010.S All Deaths Reported On Datix And Suspected

Suicide- - 80 81 223 353 270 271 205 319 235 172 375 206

011.S Restrictive Practice - All Restraints - - 100 142 90 139 108 94 172 135 111 159 131 105

012.S Restrictive Practice - No. Of Prone Incidents 0 L 4 1 1 8 8 3 2 3 4 11 5 5

013.S Restrictive Practice - No. Of Seclusions - - 10 22 14 33 41 38 49 28 25 38 25 28

015.S Ligature Incidents - Ligature With Fixed Points

(moderate to severe harm)0 L 0 0 0 0 0 0 0 0 0 0 0 0

016.S Ligature Incidents - Ligature With No Fixed

Points (moderate to severe harm)- - 2 1 0 0 0 0 0 0 0 0 0 0

017.S RIDDOR Incidents - - 1 2 0 1 2 2 3 3 1 3 1 1

018.Sa Infection Control - MRSA bacteraemia 0 N 0 0 0 0 0 0 0 0 0 0 0 0

018.Sb Infection Control - Clostridium difficile 0 0 0 0 0 0 0 0 0 0 0 0

019.S Safer staffing fill rates 80% L 91.4% 99.4% 95.9% 101.0% 94.7% 97.6% 100.5% 95.8% 97.3% 102.9% 108.9% 114.7%


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Domain Indicators in Focus The graphs below provide a 12 month trend on areas of focus from the IQPR dashboard

Weekly tracking of progress and

escalation to managers as

appropriate

Pilot of a centralised SI and

complaints underway

Root Cause Analysis (RCA)

training to staff in management and

leadership roles

Actions in place:

CMHT actions plans to be produced

Administrative staff to support

process for scheduling reviews

within required time period

Additional staffing agreed to

support safe transition of cases



14

CQC Domain Effective Trust Strategic Objective & Board Assurance Framework

Make continuous improvement at the heart of what we do

Develop and extend our research and innovation work Executive Lead(s): Chief Operating Officer Lead Board Committee: Finance and Performance Committee


Inappropriate out of area placements for adult mental health services (005.E)

The Trust is committed to ensuring that local people can be admitted to a local Kent and Medway

bed. The exception is for specialist beds, where the person’s needs cannot be met locally and a

national specialist bed is sought. Historically, women who needed a Psychiatric Intensive Care Unit

(PICU) bed also needed to be placed out of county. KMPT in partnership with commissioners has led

the way in establishing local access to PICU beds for women.

May saw a further increase in the number of bed days used in a month (379), the highest since June

2019.

The contract for a single female PICU provider commenced in May 2020; the contract is for 5 blocks

booked beds and 2 cost and volume beds allowing some additional capacity if needed. A weekly

review of patients placed out of area is ongoing with repatriation of any clinically appropriate patient

being actively pursued.

% of Patients with Valid CPA Care Plan or Plan of Care & Crisis Plans (All Patients) (007.E &

008.E)

Both indicators have remained stable in month across all pathway groups. The work to further to

streamline CMHT processes has restarted and an update will be presented to the Clinical Operational

Group in due course.

Patients subject to CPA continue to meet both targets across all care groups as demonstrated by the

tables below:

Table 1: % of Patients with Valid CPA Care Plan or Plan of Care - CPA only

2020-03 2020-04 2020-05 Latest Denominator (CPA)

Community Recovery Service 97.2% 97.9% 98.2% 2,162

Forensic and Specialist 99.5% 99.5% 99.1% 220

Older Adult 99.7% 99.7% 99.4% 330

Grand Total 97.7% 98.3% 98.4% 2,712



15

Table 2: Crisis Plans - CPA only

2020-03 2020-04 2020-05 Latest Denominator (CPA)

Acute Service 81.8% 87.5% 100.0% 7

Community Recovery Service 95.2% 97.2% 97.2% 2,160


Older Adult 97.3% 96.9% 94.2% 330

Grand Total 95.1% 97.0% 96.7% 2,713



New methodology introduced and target for DQMI (004.E) in June 2019 and further methodology update reflected in figures from August 2019 onwards

IQPR Dashboard: Effective

Ref Measure

SoF Target

Local /

National

Target


001.E Care Programme Approach (CPA) Follow-Up –

Proportion Of Discharges From Hospital

Followed Up Within Seven Days 95% N 96.0% 96.1% 94.1% 94.5% 97.8% 94.4% 94.1% 98.4% 95.9% 95.6% 95.3% 98.9%

004.E Data Quality Maturity Index (DQMI) – MHSDS

Dataset Score 95% - 89.8% 89.6% 92.9% 93.2% 94.0% 94.1% 94.4% 94.7% 94.7% 91.1% 95.6% 95.2%

005.E Inappropriate Out-Of-Area Placements For Adult

Mental Health Services. (bed days) - - 418 287 270 255 271 254 208 219 201 292 318 379

006.E Delayed Transfers Of Care 7.5% N 7.6% 5.8% 4.7% 6.5% 7.5% 8.5% 10.0% 9.3% 8.6% 9.4% 10.7% 9.8%

007.E % Of Patients With Valid CPA Care Plan Or Plan

Of Care95% L 90.6% 89.8% 88.7% 87.4% 87.7% 88.5% 88.2% 87.5% 87.3% 87.5% 88.1% 87.8%

008.E Crisis Plans (All Patients) 95% L 91.9% 91.4% 91.3% 89.9% 89.6% 89.2% 88.6% 87.8% 87.6% 87.1% 88.6% 88.2%

011.E Number Of Home Treatment Episodes 224 L 224 230 200 199 220 171 183 195 218 164 128 159

012.E Average Length Of Stay(Younger Adults) 25 L 28.01 22.14 23.98 25.10 26.26 26.11 25.27 29.01 31.66 26.78 36.38 26.64

013a.E Average Length Of Stay(Older Adults - Acute) 52 L 81.15 73.78 53.42 54.24 77.97 69.28 70.44 92.80 73.32 69.50 62.11 82.25

013b.E Average Length Of Stay(Older Adults -

Continuing Care)- - 1385.50 1419.00 1485.00 2003.00 437.00

014.E Care Plans Distributed To Service User 75% L 65.0% 67.1% 66.3% 65.9% 65.3% 65.2% 65.9% 65.9% 66.2% 64.4% 68.2% 67.0%


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Weekly PICU clinical review

group

Business Case for PICU

completed for approval by Trust

Board – procurement undertaken

All information triangulated

through quality performance

reviews to maintain Executive

scrutiny, ascertain areas of

concern and ensure key issues

are actioned planned

The Community Recovery Care

Group leadership required to

ensure all persons on CPA

remain prioritised for review of

care and risk

Pilot of Personal Support Plan

underway for those not subject to

CPA in East Kent CMHTs



18

CQC Domain Well led – Workforce Trust Strategic Objective & Board Assurance Framework

Recruit, retain and develop the best staff making KMPT a great place to work

Executive Lead(s): Director of Workforce and Communications Lead Board Committee: Workforce Committee


Staff Sickness (001.W-W)

The overall sickness rate decreased by 1.3% this month to 4.5% (5.15% 2020/21 year to date),

compared to the target of 4.22%. The short term sickness is 1.6%, a decrease of 1.5% since

previous month and long term sickness is 2.8%, an increase of 0.1% since previous month.

However, this is due to recording of staff having reported as sickness due to coronavirus (0.58%), so

without this sickness for May would be 3.92%. Therefore without Covid-19 this would be 3.98%

2020/21 year to date.

Activities in place to reduce sickness absence include:

Health and Wellbeing Advisor has started (15/6/20)

Monthly case management reviews looking at individual cases and plans to return to work.

Successfully closed 18 long term sickness absence cases in May 2020

Supporting management of Covid sickness absence through managing self-isolation, obtaining

swab testing and support helplines

Staff Turnover (004.W-W)

The 12 month rolling turnover for this reporting period is 10.6% which is a 0.6% decrease compared

to previous month. This compares to the target of 10.5%.

There are decreases within all Care Groups except a 0.1% increase in Acute Care Group.

Activities to reduce turnover:

Work on the just and learning culture – ‘BluePrint for our cultural heart developed’ and

included in new People Strategy

NHS Improvement Retention Programme currently on hold

Specific work on nursing and healthcare support workers

Vacancy Gap (006.W-W)

The reported in month rate has increased from 14.3% to 14.7%. This is against the target of 11.85%

and is 14.5% for 2020/21 year to date.



19

Activities to reduce vacancy levels:

Task and finish groups established as output of medical staff workshop. Workstream restarted

projects.

Innovative interim solutions to locality based, ‘virtual’ Open Day recruitment events

Recruitment of final year nursing students – 70 started to date (12th June 2020)

We have welcomed 229 new starters since 1st April 2020

Freedom to Speak Up (FTSU) (013.W-W)

For May 2020, 12 concerns have been handled by the Freedom To Speak Up Guardian (FTSUG). 7

of these concerns were received via the Green Button. 5 of these concerns (42%), if accurate, would

raise concerns around patient safety and safety of staff. The concerns are categorised and the

FTSUG develops a plan of action according to the issue.

Also to note the HR Business Partners are developing their People Plans to support achievement of

the 2020/21 targets.



New targets were introduced April 2020; historic data RAG rated against the new targets however may have previously been compliant against old targets.

IQPR Dashboard: Well Led (Workforce)

Ref Measure

SoF Target

Local /

National

Target


001.W-W Staff Sickness - Overall 4.22% L 4.1% 4.1% 4.0% 4.4% 4.4% 5.3% 5.1% 4.8% 4.4% 5.2% 5.8% 4.5%

002.W-W Staff Sickness - Short term 1.65% L 1.8% 1.7% 1.6% 1.8% 2.1% 2.6% 2.1% 2.2% 2.0% 3.0% 3.1% 1.6%

003.W-W Staff Sickness - Long term 2.57% L 2.3% 2.4% 2.5% 2.5% 2.3% 2.7% 3.0% 2.6% 2.4% 2.2% 2.7% 2.8%

004.W-W Staff Turnover 10.5% L 12.7% 14.3% 11.6% 12.2% 12.3% 11.8% 11.8% 11.9% 11.7% 11.5% 11.2% 10.6%

005.W-W Appraisals And Personal Development Plans 95% L 97.9% 98.5% 98.5% 98.5% 98.5% 98.5% 98.5% 98.5% 98.5% 98.5%

006.W-W Vacancy Gap - Overall 11.85% L 13.7% 14.3% 13.4% 14.3% 15.1% 15.1% 16.6% 17.5% 14.5% 13.7% 14.3% 14.7%

007.W-W Vacancy Gap - Medical - - 28.4% 30.2% 26.8% 31.2% 31.9% 48.3% 27.8% 29.1% 21.4% 21.9% 22.6% 15.5%

008.W-W Vacancy Gap - Nursing - - 13.2% 14.6% 13.3% 15.0% 15.9% 14.3% 14.8% 14.6% 13.2% 12.7% 13.5% 15.2%

009.W-W Vacancy Gap - Other - - 11.5% 12.6% 11.2% 12.2% 12.8% 15.7% 16.2% 16.3% 14.5% 12.1% 12.9% 14.3%

012.W-W Essential Training For Role 90% L 86.5% 87.3% 89.4% 90.2% 91.4% 92.5% 93.0% 92.7% 93.3% 92.4% 91.4% 90.4%

013.W-W Freedom to speak up issues - - 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 35.0% 0.2% 1.1% 1.5% 0.6% 0.4%


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Activities to reduce Staff Turnover

include:

‘Brilliant People Group’

established to look at retention

initiatives

Continue to build on the NHS

Improvement Retention

programme workstream

Deputies group initiated to review

workforce model

Activities to support sickness absence

include:

Involvement in the NHS

Improvement Health and Wellbeing

Programme

Monthly case review meetings

Monthly Health and Wellbeing

meetings

Ongoing support for managers.



22

CQC Domain Well led – Finance Trust Strategic Objective & Board Assurance Framework

Deliver financial balance and organisational sustainability

Develop our core business and enter new markets through increased partnership working

Executive Lead(s): Executive Director of Finance Lead Board Committee: Finance and Performance Committee


Please see the financial performance report included as a separate agenda item for the detailed

financial performance.

It is important to note that the current financial architecture has changed due to the pandemic. This

has included the suspension of Financial Recovery Funding, which would have been £5.4m this year

for KMPT but has been replaced in the short term by top up funding mechanism that ensures all

providers breakeven based on their reported spend.

Our financial reporting for May has been produced with this in mind, and as a result there are number

of factors to acknowledge:

- The funding arrangements in place support providers to report a breakeven position for at least the

first four months of the year, and this is being achieved through top up income

- Projecting cashflow is challenging due to the upfront payment of two months' contract income in

April. It is not clear as yet when this will be unwound so we have continued with the same assumption

as last month, and projected this for October.

- Capital discussions have concluded to reprioritise and reduce spend across Kent and Medway in

line with a nationally set target. A resubmission was completed in May and a final submission will be

made on 18 June.

As these elements become clearer, our reporting will adjust appropriately. We are continuing to focus

internally on sound financial controls and budget management.

Our financial rating for use of resources is not currently being measured formally by NHS

Improvement due to changes in the financial architecture.

Income and Expenditure Margin YTD (%) (003.W-F)

In light of the financial architecture, KMPT is continuing to report a breakeven position. Patient Care

Income is included as advised nationally, with an additional £1.3m year to date to reflect additional

COVID-19 related costs.

These additional costs for COVID-19 have been recognised in line with national guidance and include

additional IT licences for remote working, and staffing costs for covering sickness absence and

isolating staff.



23

Other pressures separate to COVID include PICU placements, with private bed days remaining high

in May, an increase in patients requiring specialist care within LD and autism services, and agency

costs to cover vacancies.

Agency Spend (008.W-F - 010.W-F)

Agency spend has increased from April, reflective of staffing pressures experienced due to vacancies

and COVID-19, with spent this year totalling £1.2m. The draft plan indicated from NHS Improvement

that the ceiling set for the Trust in 2020/21 was a reduced total of £5m (£6.1m last year), so against

this target we have exceeded in May.

The final ceiling is still to be confirmed, noting the changed financial landscape we are now in, and will

be discussed in future reporting periods once that confirmation has been received.

CIPs (011.W-F - 013.W-F)

The programme for this year is £5.9m, and at the end of May £2.5m of this remains unidentified.

National guidance removed the efficiency expectation from block contract payments for the first four

months of this financial year, likely to be now extended to the first seven months. However KMPT is

continuing to work on productivity and efficiency initiatives where possible, and is progressing plans

that were already under development in the draft submission.

We are forecasting to deliver the full programme this year, but this is subject to change if the

efficiency agenda is not a national priority over coming months.

Long Term Financial Sustainability

National planning has been suspended, so internally KMPT continues to focus on sound financial

management and controls. This has included ongoing budget meetings, a renewed focus on

efficiency opportunities where appropriate, and expanding our monthly performance reviews to

include Support Services. It remains the focus for KMPT to continue progressing towards a breakeven

position independent of support funding, and once the financial architecture post-Covid becomes

clearer this will develop into a more structured plan.

Mental Health Investment

It has been made clear that additional investment in Mental Health should not be compromised and

plans are progressing to develop cases for required funding for 2020/21 to satisfy the Mental Health

Investment Standard. Conversations are expected to commence with local commissioners in the

coming weeks to consider how this is delivered this financial year.



Some targets are variable in year; historic data RAG rated against the new targets however may have previously been compliant against old targets.

IQPR Dashboard: Well Led (Finance)

Ref Measure

SoF Target

Local /

National

Target


001.W-F Capital Service Capacity 1.58 N 1.30 1.30 1.60 1.80 1.45 1.80 1.66 1.87 1.86 2.27 0.80 2.10

002.W-F Liquidity (Days) -11.1 N -4.4 -2.8 -2.1 -3.8 -5.0 -1.8 -1.4 -1.1 -2.1 -0.1 1.7 0.8

003.W-F Income And Expenditure Margin YTD (%) -0.7% N -0.70% -0.60% -0.60% -0.50% -0.50% -0.46% -0.44% 0.35% 1.00% 2.00% 0.00% 0.00%

004.W-F In Month Budget (£000) 0.0 N (93) (69) (68) (73) (20) (10) (7) 212 206 153 0 0

005.W-F In Month Actual (£000) - - (90) (66) (67) (74) (22) (10) (6) 1,212 1,203 2,177 0 0

006.W-F In Month Variance (£000) - - 3 3 1 (1) (2) 0 1 1,000 997 2,024 0 0

006a.W-F Distance From Financial Plan YTD (%) 0.0% N 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.64% 1.10% 2.00% 0.00% 0.00%

007.W-F Agency - In Month Budget (£000) - N 512 514 514 514 520 510 514 520 510 512 427 427

008.W-F Agency - In Month Actual (£000) - - 476 522 509 549 578 501 437 576 571 568 596 637

009.W-F Agency - In Month Variance from budget (£000) - - (31) 7 (6) 29 58 (9) (77) 56 61 56 169 210

010.W-F Agency Spend Against Cap YTD (%) 0.0% N 2.32% 2.08% 1.43% 2.15% 3.44% 2.79% 1.96% 1.80% 2.70% 3.40% 39.58% 44.38%

011.W-F CIP Plan (£000) 6m L 329 482 494 494 570 570 587 708 710 702 282 282

012.W-F CIP Actual (£000) - - 273 324 693 868 666 418 645 571 398 458 64 187

013.W-F CIP Variance (£000) - - (56) (159) 199 374 96 (152) 57 (137) (312) (244) (218) (95)


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Fortnightly CIP meetings as part of

CIP governance process

2020/21 Financial Planning

underway.

Non recurrent CIPs will need to be delivered recurrently in 20/21

STP temporary staffing group is

working to switch rates for

medical and nursing agency

which will impact positively on

prices paid for agency staff in

2019/20

Alternative workforce models are

being discussed within Care

Groups to recruit to different staff

groups where vacancies have

previously been hard to fill,

introducing new roles such as

Advanced Clinical Practitioners

and Nurse Prescribers



26

CQC Domain Caring Trust Strategic Objective & Board Assurance Framework

Consistently deliver an outstanding quality of care

Executive Lead(s): Executive Director of Nursing & Quality Lead Board Committee: Quality Committee

Executive Commentary Complaints (004-6.C)

Our performance on reported complaints as well as handling has been positive this month.

Reportable complaints reduced to 19 in May compared to 22 in April. This has been the lowest

number of complaints year to date and we have seen a steady decrease from beginning of the year

whereby 42 complaints were recorded. There was one PALS enquiry related to visiting arrangements

during Covid and appropriate advice and support was provided. There were no complaints in relation

to the current Covid crisis.

There were no complaints were re-opened in May.

Acknowledgement timeframes - 100% of Complaints and PALS were acknowledged within 3 days,

all enabled by staff current working arrangements which is offering flexibility, greater productivity

through reduced travel time and reduced interruptions for the central complaints team and also

investigators who have been working remotely primarily.

Response time frames - 100% complaints and PALS were completed within the agreed

timeframe. The renegotiated and extended time frames have also helped with completion of

investigations within a realistic timeframe for the level of complexity and taking into account other

Covid related duties for staff. No dissatisfaction has been noted or expressed from complainants in

regards to the nationally relaxed timeframes.

PHSO - no new cases were received from PHSO in May and none were closed. We are awaiting an

update as to when the PHSO anticipate they will be in a position to resume investigations.

The complaints annual report detailing performance, findings from complaints investigations, themes

and learning was presented to the Quality Committee at their meeting in June and will be provided to

the Board in July.

86 compliments were received with Forensic &Specialist services receiving the highest number (51)

followed closely by Acute Care Group with 20. Six compliments were reviewed specifically in relation

to Covid and below are some examples:



27

Brookfield Ward

Patients wanted to say thank you to the staff who looked after them during COVID-19.

Staff member complimented for their hard work during COVID-19, getting drinks for patients and

keeping the kitchen clean and tidy.

Patients thanked staff at the Brookfield for sorting the garden out and getting new furniture.

Patients said that it is nice to spend time in the garden whilst we are on lockdown.

Trevor Gibbens Unit

Comments received from inpatients expressing their gratitude for the café opening up during Covid19

and bank holiday Friday. "Thanks - it’s nice that you have opened up. Thank you - it was very nice of

you ladies to open up today".

Patient Reported Experience Measures (013-15.C)

In line with national guidance to pause gathering patient feedback, we have not gathered feedback via

the PREM. Preparatory work is underway to ensure we are able to resume PREM surveys as soon as

we get the approval from NHSE/I.

The annual national Community Mental Health Survey undertaken by the Care Quality Commission

(CQC) is ongoing and field work is due to close by the 19 June. We can see from the benchmarking

data shared by Quality Health who conduct this survey on our behalf that our response rate is within

the top mental health trusts. This data is yet to be validated, nonetheless is an encouraging position.

We await the draft report from Quality Health and initial findings will be shared through Quality

Committee before the final CQC report is published which should be towards the end of the year.



IQPR Dashboard: Caring

Ref Measure

SoF Target

Local /

National

Target


003.C Complaints - actuals - - 30 51 40 38 47 45 38 42 29 28 22 19

004.C Complaints - per 10,000 contacts - - 9.96 15.25 13.65 12.59 14.55 15.06 14.99 13.40 9.97 9.54 7.25 5.86

005.C Complaints acknowledged within 3 days (or

agreed timeframe)100% L 97.0% 100.0% 95.0% 100.0% 96.0% 96.0% 100.0% 98.0% 100.0% 100.0% 100.0% 100.0%

006.C Complaints responded to within 25 days (or

agreed timeframe)100% L 91.0% 83.0% 98.0% 90.0% 84.0% 97.0% 93.0% 96.0% 97.0% 95.0% 97.0% 100.0%

007.C Compliments - actuals - - 105 158 92 142 115 132 133 125 96 78 84 86

008.C Compliments - per 10,000 contacts - - 34.86 47.25 31.39 47.04 35.60 44.18 52.46 39.89 33.01 26.59 27.67 26.54

010.C PALS acknowledged within 3 days (or agreed

timeframe)- - 100% 99% 100% 99% 100% 100% 100% 100% 100% 100% 100% 100%

011.C PALS responded to within 25 days (or agreed

timeframe)- - 99% 94% 90% 98% 96% 95% 100% 98% 97% 98% 100% 100%

012.C PALS - actuals - - 94 70 64 99 101 86 73 66 73 75 64 67


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A new complaints thematic

review has been scheduled at

regular intervals at the Quality

Committee

New complaints and feedback

form launched on the trust

website

Continuation of analysis of

complaints for any outliers in

order to target specific support.



30

CQC Domain Responsive Trust Strategic Objective & Board Assurance Framework

Maximise the use of digital technology

Meet or exceed the requirements set out in the Five Year Forward View

Ensure success of STP through active participation and leadership

Executive Lead(s): Chief Operating Officer Lead Board Committee: Finance and Performance Committee


People with first episode psychosis (001.R)

In 2020/21 the national standard has increased from 56% to 60%. Based on the past 12 month’s

performance the services have met the new standard every month with an annual high of 90% in May

2020.

Referral to Assessment within 4 Weeks & 18 Weeks Referral to Treatment (002.R & 003.R)

Performance against the 4 week and 18 week standards has increased in month, however due to the

impact of COVID pandemic the numbers of people recorded as having their initial assessment or

commencement of treatment has dropped significantly.

The denominator, which is for a face to face contact, for May 2020 trust wide increased by 30%

compared to April but remains 39% lower than February 2020 pre Covid. The 18 week wait

denominator increased by 38% compared to April but remains 56% lower than in February. As a

locally defined measure requiring a face to face contact, the report is limited due to current

circumstances as it does not include telephone contacts, assessment or treatment. Telephone

contacts do not currently count against the performance standard. The reduction is most significant in

OPMH services; we expected to see a reduction in the number of face to face contacts in OPMH

services given that majority of the patients seen by this service are older and therefore met the

vulnerable category required to self-isolate (as defined by the government guidance). The services

took steps to stop all routine memory assessment referrals which constitute 80% of the workload to

focus on urgent cases with some CMHSOPs staff redeployed to work on wards.

Whilst a telephone contact or assessment is not yet a clearly defined measure, the CMHTs have been

using this medium to provide an assessment service to patients who are unable to attend in person

during the COVID pandemic. Of the referred people waiting for a first face to face contact 55.7% have

received a telephone contact/ assessment. The average duration of this contact was 45 minutes and

whilst this is not a sole indicator of quality it is a demonstration that a robust assessment has taken

place. Of the remaining 45% of people who have not received a telephone contact/assessment 80%



31

of these people have been waiting less than 28 days; with 42% less than 7 days and 73% less than

14 days, showing those without contact to date are predominantly recent referrals.

During Covid CRCG clinicians were able to assess patients whilst working more flexibly, such as at

home or during the extended hours of weekends and evenings. The development of more agile

working is part of the Restoration and Recovery Programme. This approach means that if telephone

assessments of 45 minutes or longer duration had been included in the performance the compliance

against the referral to assessment target for the CMHTs would have likely increased as there was a

greater focus on waiting list clearance.

Similarly telephone assessments have been implemented where appropriate in Older Adults but the

majority of memory assessments have been paused. Recent telephone contacts data shows

significant progress in the last month, 43.7% of patients on the waiting list showing as having had

telephone contacts compared to 25.6% a month ago. These calls show an average telephone contact

duration of 28 minutes thus demonstrating an insight into the level of engagement with patients which

could be a proxy for quality. The care group expects to see further improvements to the 43.7%

throughout June as the team and patients grown in confidence with the new way of working.

18ww breaches have increased owing to the reduction in face to face contact, the position should

change once face to face clinics commence in July /August.

There is a review underway to establish how to capture all clinical meaningful activity for these

indicators; face to face, video and telephone. Currently face to face and some video conferencing

can be recorded and therefore reported on. EMT has agreed that a video consultation will be counted

against the performance standard. It is known during the COVID pandemic the community teams

used telephone contacts for completion of clinical work where video was not appropriate or available

however this currently does not impact on the performance standard. The standard of the quality of

telephone assessments will be measured through the CLiQ check process.

Referral rates in May were approx. 25% Higher than in April but remain over 10% lower than in pre

COVID months. This will help maintain lower waiting lists in the short term, notwithstanding the pre-

COVID backlog. Both of which will likely cause significant pressures later in the year assuming most

referrals are delayed along with the additional potential of increased referrals due to different social

and economic circumstances faced by many. As part of our recovery planning use of digital and ability

to collect the data, report on the use and ensure the use is clinically safe and of high quality is

imperative, this is key factor in the recovery plans.



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Referral to Assessment within 4 Weeks

18 Weeks Referral to Treatment

2020-03 2020-04 2020-05 Latest Denominator

Acute Service 99.2% 98.4% 97.7% 795

Community Recovery Service 81.6% 74.1% 73.8% 233

Forensic and Specialist 95.2% 94.6% 97.2% 1,057

Older Adult 66.3% 83.3% 67.7% 93

Grand Total 87.7% 93.0% 93.6% 2,178

2020-03 2020-04 2020-05 Latest Denominator

Acute Service 99.1% 100.0% 98.4% 379

Community Recovery Service 88.9% 88.9% 89.1% 129


Older Adult 75.1% 81.3% 71.4% 49

Grand Total 86.5% 93.7% 93.8% 640



IQPR Dashboard: Responsive

Ref Measure

SoF Target

Local /

National

Target


001.R People With A First Episode Of Psychosis Begin

Treatment With A Nice-Recommended Care

Package Within Two Weeks Of Referral 60% N 82.6% 70.0% 75.0% 72.2% 88.9% 78.9% 76.5% 78.9% 85.7% 75.0% 86.4% 90.0%

002.R Referral To Assessment Within 4 Weeks 95% L 82.5% 84.5% 86.2% 82.8% 84.6% 83.6% 86.6% 79.8% 85.8% 87.7% 93.0% 93.6%

003.R 18 Weeks Referral To Treatment 95% L 87.9% 87.5% 90.0% 87.2% 86.9% 88.4% 89.9% 85.4% 87.1% 86.5% 93.7% 93.8%

004.R % Of Waiting List Over 28 Days - - 49.2% 47.3% 52.1% 48.7% 46.7% 49.2% 51.6% 42.1% 42.0% 54.0% 72.1% 66.7%

005.R % of Liaison (urgent) referrals seen within 1

hour- - 93.6% 92.1% 91.8% 92.2% 87.4% 91.8% 82.6% 88.6% 75.9% 85.8% 91.9% 84.8%

006.R % of Liaison (urgent) referrals seen within 2

hours- - 70.4% 78.0% 77.5% 77.1% 79.0% 81.2% 85.7% 74.7% 74.0% 75.6% 86.3% 87.7%

007.R DNAs - 1st Appointments - - 6.1% 7.0% 5.9% 7.4% 7.1% 8.2% 7.6% 8.3% 7.1% 7.5% 6.0% 6.8%

008.R DNAs - Follow Up Appointments - - 8.6% 8.5% 7.8% 8.3% 8.9% 9.0% 8.3% 8.2% 7.7% 6.4% 4.3% 4.8%

009.R Patient cancellations- 1st Appointments - - 2.2% 2.4% 2.4% 2.6% 2.5% 2.0% 2.6% 2.6% 2.8% 3.3% 0.4% 0.2%

010.R Patient cancellations- Follow Up Appointments - - 5.4% 5.9% 5.6% 5.4% 5.7% 5.9% 6.7% 6.0% 6.7% 6.2% 2.1% 2.0%

011.R Trust cancellations- 1st Appointments - - 9.8% 10.4% 10.9% 11.9% 12.0% 11.7% 10.5% 10.2% 12.0% 18.1% 14.7% 11.3%

012.R Trust cancellations- Follow Up Appointments - - 10.9% 10.4% 11.3% 10.5% 10.4% 10.7% 11.8% 10.5% 10.9% 16.6% 16.3% 11.1%

013.R Referrals Received (ave per calendar day) - - 293.7 322.3 293.6 303.6 339.6 314.8 274.7 326.2 379.9 319.1 221.8 283.3

014.R Referrals Received (ave per working day) - - 370.6 385.5 364.0 368.4 400.2 384.8 351.9 395.8 462.7 378.5 260.7 352.1

015.R Referrals Received (per 10,000 Kent and Medway

Registered GP population))- - 544.0 657.1 562.8 568.4 669.6 589.7 520.0 631.8 672.8 589.8 370.4 484.5


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Actions in place:

The standard operating model

CAPA in place across both older

adult and adult CMHTs

Demand and Capacity review

underway

Active vacancy management

and use of additional staff as

required

Improved use of Primary Care

mental health services

All information triangulated

through quality performance

reviews to maintain Executive

scrutiny, ascertain areas of

concern and ensure key issues

are actioned planned

Clinical leaders are currently

redefining the assessment

process in line with the clinical

care pathways



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Appendices Appendices Appendix A *The above tables includes those SoF measures that are reportable and supported by clear national guidance but is not inclusive of all indicators within the SoF. Full details available here

IQPR Dashboard: Single Oversight Framework

RefMeasure Target Apr-20 May-20

Trend(Last 12 months where available, left to right)

001.S Occurrence Of Any Never Event 0 0 0

001.E

Care Programme Approach (CPA) Follow-Up –

Proportion Of Discharges From Hospital

Followed Up Within Seven Days

95% 95.3% 98.9%

004.EData Quality Maturity Index (DQMI) – MHSDS

Dataset Score95% 95.6% 95.2%

005.EInappropriate Out-Of-Area Placements For

Adult Mental Health Services. (bed days)318 379

001.W-W Staff Sickness - Overall 4.2% 5.8% 4.5%

002.W-W Staff Sickness - Short term 1.7% 3.1% 1.6%

003.W-W Staff Sickness - Long term 4.2% 2.7% 2.8%

004.W-W Staff Turnover 1.7% 11.2% 10.6%

001.CStaff Friends And Family Test %

Recommended – Care2.49% #N/A #N/A

002.CMental Health Scores From Friends And

Family Test – % Positive93% Qtly, Last results Sep 19: 73.4%

001.R

People With A First Episode Of Psychosis

Begin Treatment With A Nice-Recommended

Care Package Within Two Weeks Of Referral

60% 86.4% 90.0%

001.W-F Capital Service Capacity 158% 80.0% 210.0%

002.W-F Liquidity (Days) -11.10 1.65 0.80

003.W-F Income And Expenditure Margin YTD (%) 0.0 0.0 0.0

006a.W-F Distance From Financial Plan YTD (%) 0.0% 0.00% 0.00%

010.W-F Agency Spend Against Cap YTD (%) 0% 39.58% 44.38%



https://improvement.nhs.uk/documents/400/SOF_Framework_November_2017_July_2018_update.pdf

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Front Sheet

Title of Meeting Trust Board Date 25th June 2020

Title of Paper Finance Report for May 2020 (Month 2)

Author Victoria French, Deputy Director of Finance

Executive Director

Sheila Stenson, Executive Director of Finance


Consideration: A report containing a positional statement relating to the delivery of the Trust’s functions for which the Board has a corporate responsibility but is not explicitly required to make a decision

Recommendation:

The Board is asked to consider the financial position for month 2 (May 2020). This is consistent with the position submitted to NHS Improvement in the Month 2 Financial Performance Return.


Whilst this report has been compiled in the usual manner, there are number of factors to acknowledge:

The new block contract structure includes final top up reimbursement to ensure that all providers report a breakeven position for at least the first four months of the year. The value for April has been received, and May has been submitted on the same basis. In line with this KMPT has reported a breakeven position year to date.

Projecting cashflow is challenging due to the upfront payment of two months' contract income in April. It is not clear as yet when this will be unwound. Current assumption is that no block contract payment will be made in October.

Capital discussions have concluded to reprioritise and reduce spend across Kent and Medway in line with the nationally set target. KMPT has contributed to this, and will be resubmitted the final capital plan on 18th June.

As these elements become clearer, our reporting will be adjusted appropriately. We are continuing to focus internally on sound financial controls and budget management. COVID cost reimbursement has been included at £1.3m year to date, based on costs for converting Jasmine Ward to the cohort ward, additional bank cover for

Finance Report: Month 2


absent staff and costs such as IT licences and equipment to support home working.

Report History:

N/A


☐ Consistently deliver an outstanding quality of care

☐ Recruit retain and develop the best staff making KMPT a great place to work


☐ Develop and extend our research and innovation work


☐ Meet or exceed requirements set out in the Five Year Forward View


☐ Develop our core business and enter new markets through increased

partnership working

☐ Ensure success of our system-wide sustainability plans through active



Patient Safety: None

Identified Risks and Risk Management Action: Control total of breakeven set for 2020/21 CRL and EFL limits set that can be under shot but not over shot.

Resource and Financial Implications: Loss of FRF funding if the control total is not delivered

Legal/ Regulatory: Reconciles to NHS Improvement in the Key Data return Delivery of statutory targets

Engagement and Consultation: None

Equality: None

Quality Impact Assessment Form Completed: Yes/ No N/A

Finance Report: Month 2


Finance ReportTrust Board

May 2020

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Contents

Executive Summary 3

Board Report

Key Financial Statements

- Statement of Comprehensive Income 4

- Statement of Financial Position 5

- Statement of Cash flow 6

- Capital 7

Key Financial Performance and Monitoring

- Cost Improvement Programme 8

- Care Group Analysis 9-13

- Contracts and Income 14

Appendices

- Comparison to NHS Improvement Plan 16

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Executive Summary

Executive Summary for May 2020 Single Oversight Framework - Use of Resources

Definition

Year To Date

Actual

Degree to which the provider's generated income covers its

financial obligationsTBC

Days of operating costs held in cash or cash-equivalent forms,

including wholly committed lines of credit available for drawdownTBC

Income and Expenditure I&E surplus or deficit as a proportion of total revenue TBC

Year to date I&E surplus/deficit compared to year to date plan TBC

Distance from provider's cap TBC

TBC

Agency Spend Capital Programme

Cost Improvement Programme Cash

The programme for this year is £5.9m, and at the end of May £2.5m of this remains unidentified. National

guidance removed the effeciency expectation from block contract payments for the first four months of this

financial year, likely to be now extended to the first seven months. However KMPT is continuing to work

on productivity and efficiency initiatives where possible, and is progressing plans that were already under

development in the draft submission.

We are forecasting to deliver the full programme this year, but this is subject to change if the efficiency

agenda is not a national priority over coming months.

The new cash regime has seen the monthly block income paid one month in advance. This has

resulted in the Trust holding an average of £30m cash in the bank since April. The latest information

suggests that this regime will finish in October 2020, therefore for cashflow purposes it is assumed

that the Trust will not receive any block income in October. The forecast is a £8m cash balance at

March 2021. Support funding has been assumed as £4m at this stage, based on three quarters of the

£5.4m included at draft planning stage. Once we know what the architecture will be from August

onwards this assumption could change.

The cash forecast includes assumed spend in line with the full £17m capital plan. Of this, £8m is

funded from existing cash reserves, carried forward from incentive funding received in prior years.

Agency spend has increased from April, reflective of staffing pressures experienced due to vacancies and

COVID-19, with spent this year totalling £1.2m. The draft plan indicated from NHS Improvement that the

ceiling set for the Trust in 2020/21 was a reduced total of £5m (£6.1m last year), so against this target we

have exceeded in May.

The final ceiling is still to be confirmed, noting the changed financial landscape we are now in, and will be

discussed in future reporting periods once that confirmation has been received.

Agency spend

Due to changes in the financial architecture nationally, no risk ratings are being reported nationally for

any trust. KMPT has therefore suspended its own reporting until it is clear what plan we are being

measured against. We finished 2019-20 with a rating of "2" and it is anticipated that this will be

maintained in 2020-21.

Metric

Capital Service

Capacity

Liquidity (days)

During May the Trust has continued to manage its response to the global pandemic, embracing new ways

of working and beginning to discuss recovery over the coming months. The new financial architecture is

still emerging so this report has been compiled reflective of the latest intelligence as at the end of May.

This includes the following key aspects:

- The funding arrangements in place support providers to report a breakeven position for at least the first

four months of the year, and this is being achieved through top up income

- Projecting cashflow is challenging due to the upfront payment of two months' contract income in April. It

is not clear as yet when this will be unwound so we have continued with the same assumption as last

month, and projected this for October.

- Capital discussions have concluded to reprioritise and reduce spend across Kent and Medway in line

with a nationally set target. A resubmission was completed in May and a final submission will be made on

18 June.

As these elements become clearer, our reporting will adjust appropriately. We are continuing to focus

internally on sound financial controls and budget management.

I&E Margin

Variance from

control total

The capital programme spent £539k in May, which is £131k less than the revised plan submitted in

May. This brings the year to date performance to an underspend of £131k.

The overall programme for 2020/21 has been reprioritised, working with the wider Kent and Medway

system to deliver our overall control total. A resubmission was made in May, and will be finalised in

June following feedback from the national team.

Rating for Use of Financial Resources

In light of the financial architecture, KMPT is continuing to report a breakeven position. Patient Care

Income is included as advised nationally, with an additional £1.3m year to date to reflect additional COVID-

19 related costs.

These additional costs for COVID-19 have been recognised in line with national guidance and include

additional IT licences for remote working, and staffing costs for covering sickness absence and isolating

staff.

Other pressures separate to COVID include PICU placements, with private bed days remaining high in

May, an increase in patients requiring specialist care within LD and autism services, and agency costs to

cover vacancies.The scale is 1 to 4, with 1 being best performing and 4 financial special measures.

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Statement of Comprehensive Income

Commentary

Budget Actual Variance Budget Actual Variance Budget Forecast Variance

£000 £000 £000 £000 £000 £000 £000 £000 £000

Income

Income from Activities (15,576) (16,340) (764) (31,152) (32,934) (1,782) (192,253) (192,253) 0

Other Operating Income (642) (1,009) (367) (1,294) (1,641) (347) (11,717) (11,717) 0

Total Income (16,218) (17,349) (1,131) (32,446) (34,575) (2,129) (203,970) (203,970) 0

Expenditure

Substantive 11,360 11,157 (203) 22,693 22,094 (599) 144,684 144,684 0

Bank 594 1,337 742 1,184 2,679 1,495 6,888 6,888 0

Agency 274 638 363 536 1,234 698 5,040 5,040 0

Total Employee Expenses 12,229 13,132 902 24,413 26,007 1,594 156,612 156,612 0

Clinical supplies 161 166 5 322 309 (14) 1,934 1,934 0

Drugs 245 256 10 491 549 58 2,964 2,964 0

Other non pay 2,595 2,803 208 5,245 5,715 470 29,426 29,426 0

Non Exec Director 12 12 0 24 22 (2) 142 142 0

Redundancy Costs - staff costs 2 0 (2) 4 30 27 0 0 0

Depreciation 562 567 5 1,124 1,129 5 8,046 8,046 0

Total Non Pay 3,577 3,804 227 7,209 7,754 545 42,513 42,513 0

Total Expenditure 15,806 16,936 1,129 31,622 33,761 2,139 199,125 199,125 0

Operating (Surplus) / Deficit (412) (413) (2) (824) (814) 10 (4,845) (4,845) 0

Finance Costs 412 413 1 824 814 (10) 5,912 5,912 0

(Surplus) / Deficit 0 0 (0) 0 0 (0) 1,067 1,067 0

Depreciation (Technical Adjustment)Technical Adjustments 0 0 (0) 0 0 0 0 0 0

Total (Surplus) / Deficit 0 0 (0) 0 0 (0) 1,067 1,067 0

Current Month Year to Date Year End ForecastThe May position has been reported based on information

known at this time. This includes the areas highlighted

below, and an adjustment of income to ensure that the

Trust reports a breakeven position, in line with national

guidance.

The budget for comparison is the internal plan developed

with budget holders and managers. An appendix has been

included for information to highlight what NHS Improvement

are reporting against externally, which is consistent in terms

of the monthly breakeven, but varies in categories of

income and expenditure. As this is a top down plan, it is

more meaningful for this report for us to use our internally

generated budgets.

At this stage, we are expecting to deliver a year end

position of breakeven based on the new national funding

regime.

Income

Income from Activities includes nationally provided contract

values for the main commissioners. The key variances

include an assumed £1.3m of income for COVID-19 related

costs (to be confirmed after the reporting period); and

additional £0.5m for specialist placements and the Mother

and Baby Unit for a Guernsey patient.

Pay

Substantive pay includes vacancies where there have been

delays to recruitment or new staff coming in to the Trust.

This has been offset by bank costs, which are higher due to

additional shifts to cover staff affected by COVID-19.

Income for these is recognised above.

The agency budget is not reflective of the draft plan

submission cap, which would have been £854k year to

date. This will be adjusted once any agency ceiling is

communicated out from NHS England and NHS

Improvement.

Non-pay

Other non pay includes additional IT licences due to

increased homeworking, which has been included within the

COVID cost recovery.*NOTE: the forecast has been set to budget, whilst the changing financial architecture is still being finalised. More detailed work on this will start in Q2

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Statement of Financial Position

Opening Commentary

2020-21 Actual Forecast

£000 £000 £000

Non-current assets

SFP0110SFP0130Property Plant and Equipment 124,791 123,602 129,302

SFP0100Intangible Assets 461 411 463

SFP0180Other non-current receivables 403 345 275

Total non-current assets 125,655 124,358 130,040

Current Assets

SFP0230SFP0240Trade and other receivables 8,510 6,006 6,985

SFP0280SFP0290Cash and cash equivalents 15,678 32,390 8,082

Total current assets 24,188 38,396 15,067

Current Liabilities

SFP0310SFP0320Trade and other payables (20,436) (33,646) (13,718)

SFP0350Provisions (1,208) (610) (610)

SFP0330Borrowings (2,576) (3,219) (3,203)

Total current liabilities (24,220) (37,475) (17,531) Aged Debt Analysis

Non-current Liabilities

SFP0440Provisions (1,492) (2,057) (2,057)

SFP0420Borrowings (10,941) (10,765) (10,765)

Total non current liabilities (12,433) (12,822) (12,822)

Total Net Assets Employed 113,190 112,458 114,754

Total Taxpayers Equity 113,190 112,458 114,754

Year to

Date

Year End

ForecastThe Statement of Financial Position plan requires reforecasting due to the closing 2019-

20 position, the deferral of the change due to the implementation of IFRS 16 and the

resubmission of the capital programme. The plan has not been included for May reporting

by NHS Improvement. It has therefore been excluded for this report and will be updated in

future months. The year end forecast has been left in line with the draft submission and

again will be updated in future months.

Key areas to note in terms of actual performance are highlighted below.

Non-current assets

There is small movement in Non Current Assets from Opening to Year to Date due to

capital spend and one month's deprecation. Variances to the capital expenditure plan are

detailed on page 7 of this report.

Current Assets

The increased cash balance is a result of the COVID-19 financial regime whereby block

contract sums are being paid a month in advance. This means two months' contract were

paid in April, and have been retained in May.

Current Liabilities

Trade and other payables includes £15m of deferred income, in relation to the advance

contract payments.

Current >30 days 31-60 days 61-90 days >90 days

0

20

40

60

80

100

120

140

160

180

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12 Month Cashflow

Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21

Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast

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

Cash brought forward 15,678 32,223 32,390 30,853 29,338 28,501 26,569 25,683 8,194 8,272 7,963 7,979

Receipts

STC1300Revenue Receipts 33,811 16,444 16,604 16,604 16,604 16,604 16,604 - 16,604 16,604 16,604 16,604

STC1170PSF / FRF Funding - 2,028 - - - 1,014 - - 1,014 - - 1,014

Total Receipts 33,811 18,472 16,604 16,604 16,604 17,618 16,604 - 17,618 16,604 16,604 17,618

PaymentsSTC1500Pay (10,707) (10,872) (10,823) (10,800) (10,794) (10,914) (11,008) (10,508) (10,508) (10,508) (10,508) (10,508)

STC1510Non-Pay (6,559) (7,433) (7,450) (7,455) (7,517) (6,981) (6,481) (6,981) (7,031) (7,905) (7,580) (7,399)

STC1638Loan repayment - - - - - - - - - - - -

STC1639Dividend payment - - - - - (1,656) - - - - - (1,656)

Total Payments (17,266) (18,305) (18,273) (18,255) (18,311) (19,551) (17,489) (17,489) (17,539) (18,413) (18,088) (19,563)

Financing Transactions

STC1350Capital Sale Proceeds - - - - 870 - - - - - - -

STC1350PDC received - - 132 136 - - - - - 1,500 1,500 2,000

STC1484Total Financing Transactions - - 132 136 870 - - - - 1,500 1,500 2,000

Net Cash Inflow/Outflow 16,545 167 (1,537) (1,515) (837) (1,933) (885) (17,489) 79 (309) 16 55

Cash carried forward 32,223 32,390 30,853 29,338 28,501 26,569 25,683 8,194 8,272 7,963 7,979 8,033

NHSI Plan 11,178 10,736 10,089 12,520 13,995 10,810 9,853 10,169 8,301 8,154 9,091 7,018

Variance 21,045 21,654 20,764 16,818 14,506 15,759 15,830 (1,975) (29) (191) (1,112) 1,015

Commentary

The new cash regime has seen the monthly block income paid one month in advance. This has resulted in the Trust holding an average of £30m cash in the bank since April. The latest information

suggests that this regime will finish in October 2020, therefore for cashflow purposes it is assumed that the Trust will not receive any block income in October. With support funding to deliver a break-

even position in line with the draft plan submission (£5m in total, £4m of which is received in year, and the final quarter due in 2021-22), the forecast is a £8m cash balance at March 2021.

The cash forecast includes assumed spend in line with the full £17m capital plan. Of this, £6m is funded from existing cash reserves, carried forward from incentive funding received in prior years.

£5m is requested to be financed via PDC.

It is currenty not possible to illustrate the performance against the External Financing Limit as the Trust has not yet received confirmation of the limit from NHS England and NHS Improvement.

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Capital Expenditure

Plan Actual Variance Plan Actual Variance Plan Forecast Variance

£000 £000 £000 £000 £000 £000 £000 £000 £000

Information Management and Technology 38 24 (14) 22 8 (14) 5,015 5,015 0

Informatics - Phase 2 0 0 0 0 0 0 250 250 0

Capital Maintenance and Minor Schemes from 2019/20 51 1 (50) 51 1 (50) 3,771 3,771 0

Strategic Schemes 0 0 0 0 0 0 2,000 2,000 0

STP Wave 4 - Bid PICU S136 Locked Rehab 0 0 0 0 0 0 5,000 5,000 0

PFI 2020/21 9 9 0 18 18 0 109 109 0

COVID-19 Schemes 571 504 (67) 658 592 (67) 827 827 0

Total Capital Expenditure 670 539 (131) 750 619 (131) 16,973 16,973 0

Cumulative Performance against Plan Commentary

Current Month Year to Date Year End Forecast

During May the Trust has spent £539k on the capital programme against

the revised plan of £670k. The key items of spend relate to £409k on

devices to enable working from home and £11k on conversion of Jasmine

Ward to the COVID Cohort ward.

The majority of the other schemes originally planned for April and May

have been delayed due to the pandemic.

The forecast position for 2020/21 is based on a revised plan submitted to

NHSI in May 2020.

The Trust Capital Group met in May and agreed the priortisation of

schemes which enabled the revised capital plan to be submitted to NHSI.

The Trust has received initial feedback on the COVID-19 schemes, and is

awaiting a discussion with the NHS Digital team regarding some of the

details in our submission to confirm whether funding will be granted.

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

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

Plan

Actual

Forecast

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Cost Improvement ProgrammeFull

Year

Effect Commentary

Plan Actual Variance Plan Actual Variance Plan Actual Variance Actual

Care Group £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Acute (112) (118) (6) (224) (118) 105 (1,341) (1,341) 0 (1,424)

Older People (22) (25) (3) (44) (44) 1 (555) (555) (0) (728)

Community Recovery (97) 0 97 (194) 0 194 (1,164) (1,164) 0 (1,164)

Forensic & Specialist Services (4) 0 4 (8) 0 8 (1,106) (1,082) 23 (1,231)

Support Services (24) (24) 0 (48) (48) 0 (1,472) (1,472) 0 (976)

Trustwide (23) (21) 3 (47) (42) 5 (280) (250) 30 (250)

Total (282) (187) 94 (564) (251) 313 (5,917) (5,864) 53 (5,773)

Scheme Category

Recurrent (275) (172) 103 (551) (229) 321 (5,777) (4,186) 1,591 (4,002)

Non Recurrent (6) (15) (9) (13) (22) (9) (140) (1,678) (1,538) (1,771)

Total (282) (187) 94 (564) (251) 313 (5,917) (5,864) 53 (5,773)

RAG Breakdown of Plan

Green (114) (142) (28) (228) (175) 53 (1,367) (1,305) 62 (1,377)

Amber (26) (45) (19) (52) (76) (24) (749) (824) (76) (888)

Red (15) 0 15 18 0 (18) (373) (1,226) (853) (1,279)

Pipeline 0 0 0 0 0 0 0 0 0 0

Unidentified (127) 0 127 (266) 0 266 (3,429) (2,509) 920 (2,230)

Total (282) (187) 94 (528) (251) 277 (5,917) (5,864) 53 (5,773)

Top 5 Approved Schemes (by Value) Risk Adjusted Profile of Schemes

Scheme Title Annual Plan Forecast Risk Rating

1 PICU Placement reduction 973 892

2 Tarentfort Staffing Review 375 375

3 Urgent & Emergency Care Pathway 182 182

4 North Kent Place of Safety review 143 143

5 Servelec Contract 80 80

Year to date we are reporting £0.3m behind

plan. The two main areas for this are the Acute

and Community Recovery Care Groups where

planning has been paused to respond to the

pandemic. However during May a number of

discussions took place with Care Group

management to develop ideas further and this

has moved the unidentified gap from £3.3m last

month to £2.5m now.

At this stage in the year, all Care Groups are

forecasting to deliver their savings target. Some

of this is currently shown as non recurrent, in

areas such as Older People where further

workforce redesign is being considered so until

that is approved and finalised, savings won't be

made permanent.

The ideas in progress that will reduce the

unidentified balance and are being worked on

include:

- a review of travel in response to the increased

use of video conferencing facilities across the

Trust

- further development of care pathways across

the Trust

- maximising the opportunities identified

through Model Mental Health Trust

- procurement savings being developed by our

newly recruited to procurement function, which

will include improved contract management and

the introduction of catalogues for key areas of

supplies

We are continuing to focus on efficiency and

productivity as far as is appropriate, but this

programme may be updated as more

information is shared about the financial

architecture for this year.

In Month Year to Date Year End Forecast

Green 22%

Amber 8%

Red 11%

Unidentified

59%

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Care GroupForensic & Specialist Services

Forensic and Specialist ServicesExecutive Summary Financial Position

Budget Actual Variance Budget Forecast Variance

£000 £000 £000 £000 £000 £000

Income (197) (142) 55 (1,184) (1,184) 0

Pay 5,027 5,000 (27) 30,793 30,793 0

Non Pay 683 658 (25) 4,171 4,171 0

5,513 5,516 3 33,781 33,781 0

Plan Actual Variance Forecast Actual Variance

£000 £000 £000 £000 £000 £000

(8) 0 8 (1,106) (1,106) 23

Income and Expenditure Agency

Cost Improvement Plans Forecast

The plans for 2020/21 have been effected by the pandemic and scheme developments are running

behind the original plan. The budget has been phased to reflect this, with an increase in target in latter

months of the year.

The scheme set to achieve the most is the Marle and Riverhill ward merger at Tarentfort in Dartford, the

unit supporting learning disability patients. This merging of rotas is awaiting quality impact assessment

sign off from the Executive Director of Nursing and Medical Director and should be able to start as soon

as it has been, as long as it is safe to do so.

There is a large unidenified element of £0.6m that requires futher work from the team and is being actively

discussed in Care Group meetings.

The Addictions service at Bridge House should continue to improve financially into 2020-21 as prices

are increased to more closely reflect costs, and planned work with BUPA begins.

Looking forward there is a large amount of growth expected in the perinatal (Mothers and Infants

Mental Health Service) due to the Mental Health Investment Standards and LDFOLS (Learning

Disability Forensic Outreach) teams due to expansion and investment in the service via the

Transforming Care Pathways funding for Learning Disability and Autism. There will also be savings

made in our low secure services at Dartford.

The Care Group is forecasting to deliver in line with its budget at this stage in the year.

Non-pay in month is underspent due to a below funded level of activity in the Disablement Service. This

has been largely due to COVID-19. There has been an offsetting reduction in income to match this

position.

Overall the Care Group is delivering within its expected budget after two months of this financial year.

There continues to be two agency consultants in perinatal services, and neuropsychology, and a

medical career grade agency in MHLD (Mental Health of Learning Disability).

Agency use is minimal in the Care Group, with much more reliance on bank workers for temporary

staffing, however there has been a small element of nursing agency in May on the Forensic wards and

in MHLD due to there not always being available bank staff available to cover shifts.

Net Position

CIP Summary

The net position for the Care Group at the end of May is a £3k overspend.

Alongside Trust colleagues, Forensic and Specialist Services staff continue to work hard to cover

sickness and absence to ensure continuity of service during COVID-19. Additional costs for this cover are

not shown in the Care Group position, as revenue funding is being allocated nationally for this.

Recruitment is still ongoing, with the care group welcoming several new colleagues in month, and

successfully interviewing several more.

A large investment in perinatal services is pending approval with commissioners. This will continue to

enhance and develop services across the county for families during the perinatal and postnatal period

and is identified in the Long Term Plan for the NHS. Both commissioners and the Trust are supportive of

this development but the financial architecture needs to be finalised for funding to be agreed.

Year to Date Year End Forecast

Income

Employee Expenses

Operating Expenses

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Care GroupAcute

AcuteExecutive Summary Financial Position


£000 £000 £000 £000 £000 £000

Income (13) 0 13 (80) (80) 0

Pay 5,811 5,712 (99) 37,865 37,865 0

Non Pay 819 878 59 4,917 4,917 0

6,616 6,590 (26) 42,702 42,702 0


£000 £000 £000 £000 £000 £000

(224) (118) 105 (1,341) (1,341) 0



The underspend is driven by employee expenses. A significant level of vacancies remain within the Care

Group and recruitment continues.

Non Pay is mainly overspent due to the private female PICU placements, which amounted to £53k of the

variance. This is due to higher numbers than planned, where we are experiencing a higher acuity of

patients during the pandemic. There are two areas of potential overspend emerging in relation to drug

costs and taxi usage which the Care Group are looking into.

There is a small element of income in relation to funding for family therapies training which is not

happening due to the pandemic. The Care Group has the expenditure budget and income target therefore

these predominantly offset.

The Care Group continues to use agency mainly in medical and nursing. The Trust is working on

projects to aid an increase in staff retention which should negate the reasons for extensive agency

usage.

There is now only one consultant vacancy where agency has been used. There has been difficulties

recruiting to this post so alternative options are being considered. The remaining vacancies within the

Care Group are specialty doctor posts which are being recruited to or agency is in place.

The medical business case reviewing the resource for Acute Inpatient Units continues to be developed

into a full business case which will be presented at the Business Case Review Group in July. The aim is

to redesign the workforce model to cope with increasing pressures in the inpatient wards.

Nursing agency continues to be used where there is insufficient bank staff available and there are a

couple of business cases being developed to in order to help increase and retain ward staff.

The Care Group has ideas to achieve the target for 2020-21 however the pandemic could cause plans to

be delayed in implementation.

The increase in PICU private bed usage is of concern as bed days have increased alongside travel.

Currently the budget is £53k overspent. The Care Group are actively working to understand the numbers

and associated costs.

The North Kent Place of Safety delivered a non recurrent CIP in month due to staff being redeployed to

support on the Extra Care area in Cherrywood.

There was a slight reduction in travel in month but it is too early to tell whether there is a downward trend in

costs due to timing differences in claim submissions. It is anticipated that the Care Group will have some

recurrent savings as the Trust continues to support home working and video conferencing.

The Care Group is expected to stay within its budget for 2020-21. Current vacancies that are not

backfilled have been phased into the budgets to provide a more realistic plan.

The risks to achieving financial balance at the end of the year are

- private bed usage in excess of contract levels

- achieving the CIP target

The Care Group is also developing a number of business cases which, if approved will impact on the

Care Group's spend.

The Acute Care Group underspent in May by £57k and is cumulatively £26k underspent.

A review of the patients against the external placements budget happened in month and costs were

realigned into two categories of patients; female PICU placements remain within the Acute Care Group,

whilst specialist placements for those with more complex needs are being managed centrally under the

Chief Operating Officer. The transfer of costs was partly offset by an increase in bed days and increased

travel costs.

The Care Group continues to underspend on pay due to high vacancies following recent investments.


Income

Employee Expenses

Operating Expenses

Net Position

CIP Summary

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Care GroupOlder People

Older Peoples ServicesExecutive Summary Financial Position


£000 £000 £000 £000 £000 £000

Income 0 0 0 0 0 0

Pay 4,036 3,913 (124) 24,759 24,759 0

Non Pay 229 266 37 1,386 1,386 0

4,265 4,178 (86) 26,145 26,145 0


£000 £000 £000 £000 £000 £000

(224) (118) 105 (1,341) (1,341) 0



The Care Group are underspent in month, with vacancies exceeding expected levels in the community

teams, both in admin and nursing roles.

Pay has also increased due to higher use of unqualified bank staff on the wards. Work is continuing with

the Care Group to monitor inpatient staffing levels on a weekly basis and understand the pressures,

both operational and in recruitment, which create variance to budget in the staffing used on wards.

Variances in non pay are all minor with no trends that suggest underlying pressures.

Nursing agency has reduced by £23k with reductions on Orchards ward, Ruby ward, Tunbridge Wells and

Maidstone Community Teams. Agency continues on Orchards ward and Thanet Community Team.

Medical agency costs for two posts are also included in the position and recruitment to vacancies

continues alongside work to confirm efficient use of medical time.

The unidentified balance of £260k from 2019-20 has been phased equally across the year, with 1/12th of

the target (£22k) to achieve in May. £25k savings have been achieved in month through reduction of

posts and reduction of travel costs.

The 2020-21 target of £290k has been phased July-March and plans are being developed to meet this,

including workforce reviews, procurement savings and review of SLAs.

At this stage the Care Group is expecting to remain within budget for this financial year, and has forecast

accordingly. This will be reviewed in coming months as the impact of the pandemic is clearer and demand

for older adult services emerges. The Care Group has been engaging actively in conversations about

dementia pathways across the county to ensure we can respond to increasing demand for diagnosis and

support.

The Older People's Care Group is underspent against plan in May, reflecting vacancies above expected

levels.

Jasmine ward costs and budget have reverted back to the Care Group from the 12th May following the

closure of the COVID cohort ward.

The run rate for the Care Group has increased in month, so the underspend in month is lower than in

April. This is due to increases in medical spend and use of unqualified bank staff on wards.

Several new and additional posts have been requested during budget setting from contingency funding.


Income

Employee Expenses

Operating Expenses

Net Position

CIP Summary

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Care GroupCommunity RecoveryCommunity Recovery

Executive Summary Financial Position


£000 £000 £000 £000 £000 £000

Income (1) (3) (2) (7) (7) 0

Pay 5,411 5,501 90 33,245 33,245 0

Non Pay 543 540 (3) 3,432 3,432 0

5,953 6,037 84 36,670 36,670 0


£000 £000 £000 £000 £000 £000

(194) 0 194 (1,164) (1,164) 0



The year to date over spend is within employee expenses and is largely due to the vacancy factor element

of the plan and a year to date budget adjustment relating to CCG funding.

Without this, employee expenses would be significantly underspent due to the level of vacancies within the

Care Group, particularly within the nursing staff group. Operating expenses are close to plan and is

expected to remain so as the year progresses.

Temporary staffing spend continues to be high within the Care Group as expected, particularly within the

CMHTs.

Nurse agency has increased in comparison to April, which was lower than previous months. This is

not expected to reduce just yet due to COVID-19 and the level of vacancies within the Care Group.

However, recruitment has been (and continues to be) successful so the expectation is that agency

use will reduce gradually as posts are filled.

Medical agency has remained consistent, and should continue to be for the next month or so.

Recruitment is ongoing.

The Care Group continues 2020-21 with one partial medical post identified for recurrent savings.

Recurrent cost improvement schemes for the remainder of the 2020-21 target are currently under

development and are expected to be finalised soon following a workshop to be held mid-June. These

schemes include a review of the screening process and transfer to Primary Care, efficiency savings as a

result of the Clinical Care Pathways being implemented and a saving on travel expenses following the

increased use in video conferencing for patient appointments.

Bottom up forecasting will begin as of June reporting and the Care Group is expected to stay fairly

close to plan throughout the year.

Key areas of focus within forecasting will continue to be employee expenses, specifically substantive

recruitment and the use of temporary staff as the year goes on.

Medical agency is not expected to vary too much over the next several months, though this will be

monitored closely as we move through the year and reflected in the forecast.

The Community Recovery Care Group has overspent against plan year to date.

The Maidstone Rough Sleeper project is progressing, with costings now finalised and a contract being

drawn up. The running of the service will involve recruitment of two band 6 nurses as well as a part time

consultant. Similar discussions are now being held regarding the Medway Rough Sleeper project and is

expected to progress further over the coming month.

The expansion of Individual Placement Support within the Vocational Rehabilitation service is also

progessing and nearing final sign off. This is a collaboration between KMPT, Porchlight and Shaw Trust

which has been funded through national monies.

The Community Mental Health Teams (CMHTs) are operating over seven days in light of the pandemic,

and are in discussions about flexible working moving forward in the future.


Income

Employee Expenses

Operating Expenses

Net Position

CIP Summary

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Care GroupSupport ServicesSupport Services

Executive Summary Financial Position


£000 £000 £000 £000 £000 £000

Income (1,020) (1,049) (29) (6,066) (6,066) 0

Pay 4,573 4,598 25 26,606 26,606 0

Non Pay 3,380 3,451 70 20,300 20,300 0

Post EBITDA Financing Costs 134 115 (19) 803 803 0

7,067 7,113 47 41,643 41,643 0


£000 £000 £000 £000 £000 £000

(47) (42) 5 (280) (250) 30



Employee Expenses are overspent year to date due to an additional Clinical Excellence Awards payment

relating to 2019-20.

Operating Expenses is reflecting an overspend. £315k is the cost of the Bed Overspills relating to the

high dependency female patients that do not fall under the PICU criteria. This is reduced by large

underspends on the central training budget, conferences and SIFT, where due to COVID-19, most

training and events have been cancelled. There has been a significant reduction in travel, where staff are

making use of remote working facilities and video conferencing, and we are currently working on a

trustwide CIP around this, as we move to better ways of working going forward.

Income is overachieved as we are now receiving funding from HEE to support Nurses CPD. There is

expenditure to match the income.

Agency costs have reduced slightly in May within the ancillary workforce. This is due to the pressures

around COVID-19 reducing slightly. There is a still an on-going element of use within Facilities and

Estates to reflect levels that we would be using to cover vacancies, leave and sickness on a normal

basis.

There is a fixed term agency worker supporting the work around the PICU private beds, who has been

extended until August 2020. This will be part funded by the CCGs to support work around OATs (Out of

Area Treatment) as well as supporting the Trust with PICU.

All of the CIPs schemes allocated against month 2 have delivered in month, and year to date.

Support Services held its first Quality and Performance Review (QPR) meeting with the executive team

in May where CIPs was a key focus. Even though most CIP targets have been phased from month 4,

this is still a large unidentified balance of £1.2m across all Support Services.

Work has commenced to start looking at pipeline ideas, such as savings around travel reductions, due to

remote working and soft facilities management contract reviews. Quarterly QPR meetings have been

booked in with Support Services to review the CIP position which should reduce this unidentified balance

in the coming months.

The Finance department has started to create and test the forecasting spreadsheets, ready for reporting

from month 3. Several changes and improvements are being implemented over the next few months, and

will incorporate a more detailed two year forecast.

The budget for PICU Private Beds moved under the Acute Care Group in April, however we have

identified the need for 5 beds for high dependency, long term female patients, who do not fall under the

PICU criteria funded by the commissioners. The cost of these has been moved under the Operations

Directorate in month 2, and is being overseen by the Chief Operating Officer.

The workforce team has worked alongside HEE (Health Education England) to fast track 76 students into

the trust. As at the end of May, 66 of these are now in post, and the remainder should be ready for a

start date on the 15th June.

The first cohort of 10 RGN students are being considered for a September 2020 intake, as part of the

business case for the Trust's Nurse Degree Apprenticeship scheme. There is an aim to recruit a further

10 Nurse Associates in February 2021. This will support the Care Groups where we have a high number

of nurse vacancies.


Income

Employee Expenses

Operating Expenses

Net Position

CIP Summary

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Contracts and Income

Clinical Income by Type

Budget Actual Variance Budget Actual Variance Budget Forecast Variance

£000 £000 £000 £000 £000 £000 £000 £000 £000

(15,379) (16,150) (771) (30,758) (32,481) (1,723) (188,107) (188,107) 0

(81) (48) 33 (163) (163) (1) (977) (977) 0

(116) (141) (25) (231) (290) (59) (2,451) (2,451) 0

(15,576) (16,340) (764) (31,152) (32,934) (1,782) (191,535) (191,535) 0

CommentaryBlock contracts: All block contracts reflect the figures advised by NHS England and NHS Improvement as those deemed necessary to support providers during the current pandemic. These blocks are

currently set to continue until the end of October but could be extended further. The variance reflects ongoing pilots for which funding has rolled over from 2019-20, outside of the current block

arrangements.

Cost and volume contract: Current arrangements are that cost and volume recharging (such as Out of Area Treatment (OATs) charged to CCGs outside Kent) is suspended between providers and

CCGs. All income shown here is with non-NHS providers or is for one particular case which is outside of the current arrangements. Also included here is the recharge for additional costs associated with

Covid (£1.4m).

Other: NHS England and NHS Improvement are continuing to provide information on how the financial architecture will move forward in this financial year. It has been made clear that additional

investment in Mental Health should not be compromised and plans are progressing to develop cases for required funding for 2020/21 to satisfy the Mental Health Investment Standard (MHIS).

Bottom up forecasting has not commenced in the Trust so at this point in the year, we are assuming to deliver against budget.

Cost and volume contract

Current Month Year to Date Year End Forecast

Block contracts

Clinical Partnerships

Total Patient Care Income

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NHSI COVID Plan compared to internal plan and actual spend

Actual VarianceDraft

Plan

Internal

PlanVariance

Commentary

£000 £000 £000 £000 £000 £000

Income

Income from Activities (31,172) (32,934) (1,762) (32,043) (31,152) 891

Other Operating Income (1,330) (1,641) (311) (1,290) (1,294) (4)

Total Income (32,502) (34,575) (2,073) (33,333) (32,446) 887

Expenditure

Substantive 21,388 22,094 706 24,227 22,693 (1,534)

Bank 2,310 2,679 369 1,148 1,184 36

Agency 1,028 1,234 206 840 536 (304)

Total Employee Expenses 24,726 26,007 1,281 26,215 24,413 (1,802)

Clinical supplies 310 309 (1) 322 322 (0)

Drugs 530 549 19 494 491 (3)

Other non pay 4,992 5,715 723 4,910 5,245 335

Non Exec Director 26 22 (4) 24 24 0

Redundancy Costs - staff costs 0 30 30 0 4 4

Depreciation 982 1,129 147 1,342 1,124 (218)

Total Non Pay 6,840 7,754 914 7,092 7,209 117

Total Expenditure 31,566 33,761 2,195 33,307 31,622 (1,685)

Operating (Surplus) / Deficit (936) (814) 122 (26) (824) (798)

Finance Costs 910 814 (96) 986 824 (162)

(Surplus) / Deficit (26) 0 26 960 0 (960)

This page has been included for Board oversight of what is being reported to NHS

Improvement as variances to a centrally set plan. This is not reflective of the draft

plan KMPT set and the expectation is that this will be updated in our final plan

submission, date as yet unconfirmed. There is minimal information available on the

NHSI Covid Plan other than each category has been reduced compared to our draft

figures. The high level variances that have been communicated to NHS

Improvement are consistent with those reported earlier in this document, namely:

1. COVID-19 income and costs totalling £1.3m year to date

2. Additional income for specialist placement being confirmed with commissioners

3. Overspend on PICU placements

There are some key differences between our draft plan and our latest internal plan

due to changes in circumstances:

1. Mental Health Investment Standard has been removed from our internal plans.

This will be adjusted as and when commissioners agree which areas of priority will

be invested in. This has moved income by £1m year to date, and employee

expenses by a corresponding amount

2. The decision to defer implementation of IFRS 16, which has impacted the split

between depreciation and other non pay relating to leases

3. Vacancies and establishment changes to reflect further conversations with

Care Groups after Check and Challenge sessions where recruitment timelines have

been delayed. A vacancy factor has been included within the internal plan to reflect

turnover, and will be amended as posts become fully recruited and/or decisions are

being made regarding revised establishments.

4. Phasing of support funding - in the draft plan we had followed national planning

guidance that stated support funding was received quarterly (£5.4m in total for

2020/21, 4 payments of £1.35m). This meant that April and May delivered a planned

deficit, which would have been recovered in June on receipt of £1.35m. Now, with

the changes to the financial architecture, we are receiving monthly support funding

which enables us to breakeven.

NHSI

Plan

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1


Meeting Date 25th June 2020

Title Chief Operating Officer’s Report

Author Jacquie Mowbray-Gould, Chief Operating Officer

Presenter Jacquie Mowbray-Gould

Executive Director Sponsor

N/A

Purpose For Information

1 Introduction

The report will cover key actions as required by the Board, highlight areas of strategic operational development and give an overview on any particular areas of interest the Board requests. Due to Covid there has been no Chief Operating Officer report for the past two board meetings, this report highlights the operational response to Covid-19 including changes made during the pandemic that will form part of the recovery and transform delivery programme

2 Updates from March Board report

2.1 Psychiatric intensive care unit (PICU)

KMPT have procured 5 female PICU beds at Godden Green Hospital, Kent,

operated by Cygnet Healthcare. Within the same contract the trust has also

procured two cost and volume beds to allow for flexibility in terms of admission

numbers. These two beds may not be always be available in Kent however will

be as near to Kent as is possible. Monthly contract meetings are in place and

updates will be provided to board on safe staffing and quality via the Chief

Operating Officer’s board paper.

2.2 Police Street Triage

The police street triage service has now ceased; staff have been redeployed in

line with trust workforce policy and the Acute Care Group leadership is

continuing with the development of an improved telephone triage service for the

police (the 836 number) alongside developing a more comprehensive training

package for the police.

In terms of use of Section 136 of the Mental Health Act the STP mental health

work stream delivered a final report on use of Section 136 in the county. Firstly

it acknowledges being detained under the mental health act is serious and

every effort by all partner agencies should be made to engage people in their

care first, so detention can be used as a last resort. The deep dive analysis did

not support any conclusive findings however is a helpful scene setting

document for all partner organisations to commit to a multiagency development

Chief Operating Officer's Report


2

improvement plan. The report requires sign off at the Kent Mental Health crisis

board in July 2020 to take forward 17 recommendations.

To ensure pace and organisational grip the Chief Operating Officer (COO) has

maintained good links with the police during COVID and there is commitment

from both organisations to maintain improvements made during COVID which

saw a significant reduction in the use of Section 136.

2.3 Community Mental Health Framework

As part of the local recovery planning Integrated Care Partnerships (ICP) are

interested in understanding the broader mental health response. COVID

recovery offers an opportunity to build many of the key aspects of the

community mental health framework into local ICP recovery planning.

The Integrated Care System (ICS) has allocated a health improvement lead for

this work, Andy Oldfield, who is working with the COO to develop a high level

scoping document for the consideration by the ICPs with the aim to build in a

number of local mental health plans into the programme of work. This is a

significant piece of work, requiring full system engagement and likely to take 24

months to fully embed change. COVID, however, has offered the opportunity to

build on new ways of working and to work more effectively with the ICPs. Key

to success is the work in development for a system mental health integrator

and provider collaborative led by the KMPT Chief Executive, Helen Greatorex

3 Autism and Learning Disability The COO is the KMPT Executive Lead for Autism and Learning Disability. Work

remains on-going at a system wide and national level to ensure people placed

out of area with these conditions have the opportunity to consider moving back

to the county from which they originated from. It is important to note some

people placed out of area have made their lives in different parts of the country

and do not want to return.

A key area of this work will be the development of local provision for people

with an autism diagnosis who experience significant challenges in finding the

right care solutions. There are a number of providers able to provide the right

care however the lack of estate and buildings is the main barrier. This has

proved a significant challenge for KMPT. Currently this group of people can be

admitted to general psychiatric in-patient wards rather than receiving the more

specialist care they need as it is unavailable. Positively media interest and

escalations outlining gaps from the mental health system has helped move the

discussion and there is improved engagement both locally and nationally. This

is a key improvement area for KMPT in the next year.



3

4 Covid-19 response Clinical services and operational leaders worked tirelessly throughout the peak

of the COVID pandemic to maintain effective care over the last two months.

Clinical services adapted quickly and to their merit no service ceased with most

prioritising urgent work; it was acknowledged early on there would be a likely

increase in June and July of routine work once the peak of the pandemic

passed.

The teams implemented a number of new ways of working and changes to

operational delivery functions:

CMHT and CMHSOP introduced 7 day working; many staff welcomed the

option to work in a more agile and flexible way. The Executive

Management team (EMT) has agreed to maintain a more agile workforce

willing to work differently; this is a key element of the Trust recovery and

transform plans with this element led by the COO

Homeworking – large numbers of staff have been able to work from home

including people self-isolating, shielding and clinical staff. The COO and

Director of workforce and communications quickly develop a standard

operating procedure (SOP) ensuring clarity of expectation, roles and

assessment of risk re: home working.

Staff willing and able to cross-cover services especially the crisis teams,

community teams and in-patient wards – the can do attitude was palpable

and to be included in the learning as part of the on-going cultural work

Set up of a COVID cohort ward within a matter of two weeks – led by the

Head of Service for Acute services, KMPT was one of the first mental

health trusts to have both the ward and comprehensive standard

operating procedure in place.

Patients of the specialist personality disorder services accessed video

group work within the first week of lockdown – work is underway to review

experience by both staff and people using the service to be built into the

development of the Trust digital offer

Expanded the single point of access to function as a 24/7 crisis response

in line with national requirements. The service has operated with staff

homeworking and as they return to work consideration of sustainable

change is part of recovery planning.

The safety and quality of service will continue to be the main driver and to

fully embed extended hours it is accepted investment is required. The

Director of Finance and COO are working together to ensure

consideration for new investment is fully considered as part of the mental

health investment standard contract negotiations.



4

Taps Mutakati, Deputy COO, is leading the work operationally to align this

development with the expansion of NHS 111 and clinical assessment

services.

Use of digital and telephone for clinical contacts and team meetings. In

line with many other NHS organisations KMPT quickly scaled up the

options for use of digital and telephony to ensure business continuity. The

use of this new way of working is again part of the recovery planning with

work in place to garner the experience of both staff and patients. The

absolute requirement for developing this work is to ensure it is safe and

able to be quality checked alongside staff trained in its use, accurate

recording on RiO and ability to report both performance and outcomes

into the integrated quality performance review board report.

Development of operational business continuity planning. The COVID

pandemic has required real time use of the organisational emergency

plans down to team level. The daily tactical, Silver and EMT COVID

meetings, the weekly standard operating procedure meeting with the

COO, director of nursing and medical director and the ability to meet

virtually has meant quick, clear decision making has been the order of the

day with a number of SOPs now fully tested, robust and built into our new

ways of working. It suggests a greatly improved ability to scale up and

down as required over the next 12 months whilst COVID remains an on-

going threat to the population

5 Conclusion Board are asked to note this paper



Brilliant care through brilliant people

Workforce, Organisational

Development and Communications

June 2020

Sandra Goatley

Director of Workforce and

Communications

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OUR KMPT PEOPLE STRATEGY

‘OUR CULTURAL HEART’ 2020-2023

Finalised from feedback received & approved

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A look back…People Plan 2019/20 Strategic Objective:

Recruit retain and develop the best staff making KMPT a great place to work

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Look back on 2019/20

KPI Actual 2018/19 Target 2019/20 Actual 2019/20

Turnover 15% 12% 11.5%

Sickness 4.44% 4.17% 4.43%

Appraisal 98% 95% 99%

Staff Survey – response rate 59.5% 62% 69.5%

Staff Survey – engagement score 6.9 7.06 7.1

Essential training for the role 93.6% 90% 90%

Vacancy rate 12.59% 14% 14.7%

NB: Essential Training increased in year from 85% target to 90% target

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KPI’s achievements

August 2019 – all KPI’s were ‘green’

March 2020 – all KPI’s were ‘green’ when excluding Covid sickness from %

IQPR Dashboard: Well Led (Workforce)

Ref Measure

SoF Target

Local /

National

Target

Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19

001.W-W Staff Sickness - Overall 4.17% L 4.2% 4.0% 4.8% 4.5% 4.9% 4.3% 3.9% 4.2% 4.1% 4.1% 4.1% 4.0%

002.W-W Staff Sickness - Short term 1.68% L 1.7% 2.2% 2.4% 2.2% 2.7% 2.4% 1.8% 1.8% 1.4% 1.8% 1.7% 1.6%

003.W-W Staff Sickness - Long term 2.49% L 2.5% 1.8% 2.3% 2.4% 2.2% 2.3% 2.2% 2.4% 2.7% 2.3% 2.4% 2.5%

004.W-W Staff Turnover 12.0% L 12.1% 12.1% 12.4% 12.6% 12.7% 12.6% 12.7% 12.0% 14.7% 12.7% 14.3% 11.6%

005.W-W Appraisals And Personal Development Plans 95% L 96.7% 98.1% 98.6% 98.6% 98.6% 98.6% 98.6% 97.9%

006.W-W Vacancy Gap - Overall 14% L 12.4% 12.3% 12.9% 13.6% 13.4% 12.6% 12.6% 12.9% 13.4% 13.7% 14.3% 13.4%

007.W-W Vacancy Gap - Medical 28.8% 28.8% 28.8% 26.9% 29.9% 26.5% 26.5% 25.6% 26.8% 28.4% 30.2% 26.8%

008.W-W Vacancy Gap - Nursing 12.4% 11.5% 12.6% 13.5% 13.2% 12.8% 12.8% 13.4% 13.3% 13.2% 14.6% 13.3%

009.W-W Vacancy Gap - Other 10.7% 10.9% 11.3% 12.2% 11.9% 11.1% 11.1% 10.5% 11.2% 11.5% 12.6% 11.2%

010.W-W Staff Survey Response Rate 53.5% 53.5% 59.5% 59.5% 59.5% 59.5% 59.5% 59.5% 59.5% 59.5% 59.5%

011.W-W Staff Survey Engagement Score 6.9% 6.9% 6.9% 6.9% 6.9% 6.9% 6.9% 6.9% 6.9% 6.9% 6.9%

012.W-W Essential Training For Role 85% L 91.7% 93.0% 93.0% 93.1% 93.4% 93.4% 93.6% 86.5% 83.8% 86.5% 87.3% 89.4%

013.W-W Freedom to speak up issues 0.0% 0.1% 0.0% 0.1% 0.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

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2020-2023 (including KPI’s)

KPI Target 2020/21

Turnover 10.5%

Sickness 4.22%

Appraisal 95%

Staff Survey – response rate TBC

Staff Survey – engagement score TBC

Essential training for the role 90%

Vacancy 11.85%

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The Strategy is a 3 year plan

Next slides cover our aspirations……

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Recruitment and retention

• We will attract diverse and talented candidates

• We will open our doors to enable potential employees to

meet us

• We will have pro-active approaches to retaining our

people

• We will ensure we create innovative workforce models for

the future

• We will support employees through their time with us

• We will develop clear career pathways

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Team, management & leadership development

• We will support access to learning and development

opportunities

• We will focus support to under-represented areas

• We will enhance technological opportunities

• We will support through a Quality Improvement approach

• We will have clear management and leadership career

pathways

• We will have future fit Leadership Development

Programmes

• We will develop our coaching culture

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Culture and

employee engagement • We will develop and embed our cultural heart

• We will measure our progress and gain feedback

• We will embed our Just and Learning approach

• We will enable employees to be accountable and part of

empowered teams

• We will ensure the KMPT values are in all our people

practices

• We will engage all employees in the Freedom to Speak

Up Guardian agenda

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Health and wellbeing

• We will develop and evolve our ‘Thrive @KMPT’

wellbeing strategy

• We will be an exemplar in Mental Health First Aider

practice

• We will involve and engage people

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Diversity and

Inclusion

• We will be open about our priorities and progress

• We will work together

• We will work towards a zero tolerance of Bullying and

Harassment

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Covid – 19 KMPT Overview Actions taken: - Amended Business Continuity Plan and key policies

- Working from Home protocol

- Daily reporting of key workforce data

- Amended interview and employee relations processes to Lifesize

- Supported decision making on essential training and other training interventions

- Introduced on-line KMPT Induction processes

- Established central helpline to support staff

- Established central temporary staffing booking team

- Established central helpline to enable staff to confirm if self-isolating or with symptoms and

unable to work

- Rapid Response (fast track) NHSP application process

- Weekly JNF calls

- Increased number of temporary staffing agencies

- Daily communication messages

- Source benefits for staff

- Swabbing results calls to staff & letters to staff testing positive

- Psychology support

- Action plan for BAME staff

- Thank you cards (plus bespoke WF, OD and Comms approach)

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Covid – 19 KMPT Overview Achievements: - Number out of business – worked to reduce (at peak over 400 staff out of KMPT) to 155 (as at

15/6/20)

- Helpline received 171 calls (as at 11/6/20)

- Supported 185 staff to receive swab test & 126 members of staffs’ households (as at 14/6/20)

- Welcomed 229 new starters, of which 66 recruited as final year nursing students

- As a team, we have increased contact, including Rod and Sandra attending individual team

meetings

- Good relationships with staff side colleagues

- Quick development of policies and Standard Operating Procedures

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Diversity and Inclusion - Update

• New Hate Crime Strategy published.

• New Equality Impact Assessment (EIA) process rolled out. Support given for

completing assessments from D&I team.

• Share and Learn event held for LGBTQ+ progress with other organisations in

Kent.

• Pride events cancelled but will still celebrate PRIDE month internally with

Communications team supporting through online video/photo stories.

• Opening Doors Programme commenced

• Reviewed and amended patient data collection to commence accurate

reporting.

• Two patient focussed projects commenced:

•Management of Trans Patients in Adult Secure Settings

•Supporting religious and cultural needs in Rosewood Mother and Baby Unit

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Freedom to Speak Up Guardian –

quarter 4

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Workforce, OD and Comms

Thank you….

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KMPT Thank you….

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WFODC Report


CONTENTS

Welcome from our Chief Executive, Helen Greatorex .................................................... 3

Welcome from our Director of Workforce and Communications, Sandra Goatley...... 4

Developing our strategy ................................................................................................... 5

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Welcome from our Chief Executive, Helen Greatorex

Our simple aim at KMPT is to deliver brilliant care through brilliant people. That is why our people are so important. Making the most of our talent is a key part of our strategy and culture which is why diversity and inclusion is a priority. We recognise we need to have a diverse workforce to deliver brilliant care As a specialist trust, we provide care and treatment to people when they are at their most vulnerable, twenty-four hours a day, three hundred and sixty five days a year. We value our people and the contribution they make, whether they work in support services, enabling front line employees to deliver high quality care, or directly with the people who use our services and their loved ones, they need to be the very best they can be, all the time, every day.

It is because of this, that I am so pleased to be introducing our People Strategy which is designed to create the right environment for our staff to thrive. If we are to recruit and retain the very best employees, we need to have a clear strategy in order to do it. This in turn, leads to brilliant care and high quality services, consistently.

I hope you feel, as I do, that this strategy it is easy to read, and that you can understand and commit to it. Importantly, it needs to be a document that lives and breathes our values and they can be seen everywhere, in every situation at KMPT. To help us do this, the strategy is supported by a plan. The plan is structured around our ‘cultural heart’ which has three pillars:

The pillars set out the framework by which we can make sure we are delivering the improvements we need to, whilst continuing to learn and reflect. We will be reporting our progress regularly to everyone across KMPT and everyone who would like to join us in continuing to implement our plan will be warmly welcomed. We need all the talents to help us to make this a reality. Achieving our vision of a truly high quality organisation, staffed by brilliant people, whose talents are released to create even better services makes this strategy vital, and everyone’s commitment is essential.

With Best Wishes

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Welcome from our Director of Workforce and Communications, Sandra Goatley

This is an exciting time for us in KMPT. This strategy sets out our vision for our people.

By delivering the three elements of our cultural heart together we’ll create the environment where you feel you want to come to work and feel valued, developed and heard, believe you add value each time you are at work, have an opprotunity reflect on what went well and what could be improved and then when you go home you are able to switch off and recharge. We’ll do this by:

Maximising the potential of all our employees and deliver amazing results through positive

employee engagement.

Ensuring our workplace is inclusive and everyone can come to work and be themselves.

Encouraging our people to raise concerns openly to continually improve our services and

working environments.

Ensuring our people have the tools to do their jobs and be their best.

#KMPTProud? I am!

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Developing our strategy In developing our people strategy we have ensured that it aligns with the national strategies and the KMPT strategy: NHS People Plan – https://www.longtermplan.nhs.uk/ NHS Long Term Plan – https://www.longtermplan.nhs.uk/

KMPT Strategy 2020-2023

The KMPT strategy sets out our vision, three main aims and five enabling capabilities:

WFODC Report


https://www.longtermplan.nhs.uk/

https://www.longtermplan.nhs.uk/

6

Our KMPT People Strategy - Our cultural heart Our KMPT People Strategy links all of the above to meet the national and KMPT priorities. We

believe our cultural heart, made up of three pillars, will enable to us to be an Outstanding

organisation and a brilliant place to work and learn.

We will embed a just and learning approach across KMPT; ‘just’ meaning fair and ‘learning’ to enable reflection. This will underpin all of our workforce practices and support employees and managers to embed the cultural heart. We will continuously strive to improve our services. We accept everyone make mistakes, especially in pressured environments and situations. We will review our systems and our processes and focus on safety and quality not blame. We will learn from experience and share this with others. We will ask what we should do differently.

We will be one team with a shared purpose and vision. To operate effectively and remain agile we will organise ourselves into smaller teams with clear roles and responsibilities. These teams are empowered to make decisions and work together, always with service users at the heart of what we do. We will grow strong networks with other teams and align our goals and efforts to deliver the KMPT objectives.

We will act according to our shared values. We will recruit, develop, reward and manage by them. We respect the contribution of everyone, openly working together and we value people for their individuality and the difference they bring. We do not tolerate poor or disrespectful behaviours. We seek, listen and act on feedback to help us work together more effectively. Everyone counts, everyone has a voice.

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Embedding our cultural heart is a transformational journey and we anticipate this will take three years to fully develop, we aim to take a quality improvement (QI) approach to delivering this, listening to feedback and adapting to meet the needs of our people and services. We will measure our progress annually through employee engagement results, our key performance indicators and delivery of our people objectives.

People Delivery Plan

Our people delivery plan is agreed annually and reviewed by the Workforce and Organisational Development Committee, a sub-committee of the Board. These detail how we aim to achieve our strategy, but have the following broad aims:

Recruitment and retention

We will attract diverse and talented candidates through recruitment events here and internationally, and by developing our employer brand

We will open our doors to enable potential employees to meet us and understand our services

We will have pro-active approaches to retaining our people throughout their careers

We will ensure we challenge our thinking to create innovative workforce models for the future

We will support employees through their time with us; from Induction, through supervision, appraisal, career conversations and personal development planning

We will develop clear career pathways across all employee groups.

Team, management and leadership development

We will support all employees in their strive for excellence, by enabling access to learning

and development opportunities

We will focus support to under-represented areas or teams who have identified specific

needs

We will enhance technological opportunities for learning and development delivery

We will support employees through QI approach to learning

We will have clear management and leadership career pathways and profiles

We will have future fit leadership development programmes

We will develop our coaching culture across KMPT.

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Culture and employee engagement

We will work together to develop and embed our new culture

We will pro-actively measure our progress and gain feedback from our people

We will embed our just and learning approach across all areas

We will enable a culture which allows employees to be accountable and part of

empowered teams

We will clearly communicate and ensure the KMPT values our in all our people practices

We will engage all employees in the Freedom to Speak Up Guardian agenda.

Health and wellbeing

We will develop and evolve our ‘Thrive @KMPT’ wellbeing strategy

We will be an exemplar in Mental Health First Aider practice in the NHS

We will introduce innovative approaches to involve and engage people in their own health

and wellbeing.

Diversity and inclusion

We will be open about our Workforce Race and Disability Equalities Standard priorities

and progress

We will work together to introduce a range of opportunities for employees to be involved in

this work, including through our staff networks, training and development

We will work towards a zero tolerance of bullying and harassment at work through the

implementation of our Staff Charter and Hate Crime Policy

As an employee or prospective employee of KMPT, we hope this strategy conveys the passion and dedication of our organisation to achieving Brilliant care through brilliant people.

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Document Reference No. KMPT.HR.65.01

Replacing document N/A

Target audience All employees

Author Director of Workforce, OD and Communications

Group responsible for developing document

Workforce and Organisational Development Committee

Status Approved

Authorised/Ratified By Trust Board

Authorised/Ratified On TBC

Date of Implementation TBC

Review Date March 2023

Review This document will be reviewed prior to review date if a legislative change or other event otherwise dictates.

Distribution date TBC

Number of Pages 7

Contact Point for Queries [email protected]

Copyright Kent and Medway NHS and Social Care Partnership Trust 2020

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mailto:[email protected]

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DOCUMENT TRACKING SHEET

PEOPLE STRATEGY

Version Status Date Issued to/approved by Comments

1.0 Approved 24/11/2016 Trust Board Ratified

REFERENCES

RELATED POLICIES/PROCEDURES/protocols/forms/leaflets

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Meeting Date 25 June 2020

Title Quality Committee Report

Author Jackie Craissati, Non-Executive Director & Committee Chair

Presenter Jackie Craissati, Non-Executive Director & Committee Chair

Executive Director Sponsor N/A

Purpose For Information/Assurance

Executive Summary The Quality Committee met on 16 June 2020. In line with the Committee work plan, this was a shorted meeting to allow time for clinical and site visits which were facilitated through use of video conferencing session in view of social distancing. The following items were discussed and scrutinised:

1. CQC Quality improvement Plan (Q4 report)

2. 2019/20 Annual Complaints report

3. 2019/20 Clinical Audit Annual Report including National Audits and

Accreditation

4. Medicines Optimization Strategy

5. Quality Committee Annual Review and Committee Effectiveness Survey

6. Included in this report, is a brief summary of feedback from the Quality

Committee “ Beam in” visits

The committee would like to bring the following items to the attention of the Board:

Quality Improvement Strategy

The board are asked to note that sign off of the implementation plan for the Quality

Improvement Strategy took place at the May meeting and is appended to this report

for reference.

CQC QIP

The Committee discussed the report and action plan and noted the significant

progress made. There are a few areas still in progress for which completion has

been delayed due to Covid-19. The targets dates have been to reflect this delay.

There are no risks associated with the actions still in progress. .

Key progress made is highlighted below:

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- Clinical technology, informatics and Quality Improvement strategies have all

been approved by the board

- Psychology provision for Acute wards has improved

- Workforce Race Equalities System priorities are now published on the trust

website

- Participation and Involvement strategy has been approved by the board

- Referral to assessment target had shown improvement, but has dipped

slightly due to Covid-19

- Clinical Commissioning Groups have been providing positive feedback on the

quality of Serious Incident Root Cause Analysis

- (RCA) investigation reports. The pilot of a centralised investigation team who

are leading on these RCAs has made an impact on the quality of the reports.

- Supervision for all staff is recorded centrally on i-learn, with performance

notably improved. In addition there is oversight and scrutiny at Trust wide

governance meetings

Areas for improvement were highlighted to the Committee:

- Fully evidencing care provided in Rio

- Ensuring that Trust policies and procedures are consistently implemented

- System gap in Learning Disability and Autism pathway which impacts on

KMPT’s patient flow and ability to provide speciality care for individuals

2019/20 Annual Complaints Record

Key headlines for noting:

- Complaints have increased in the last 3 years, which could be as a result of

more accessible complaint reporting processes

- Trust acknowledgement and response times have improved

- 4 Parliamentary and Health Service Ombudsman referrals were reported at

the year end and this is a reduced from previous years

- Patients have personally raised concerns rather than others doing so on their

behalf, which could be as a result of more accessible complaints processes

- MP complaints have reduced, likely to be as a result of improved working

relationships between the Chief Executive’s and local MPs.

- Feedback posters and leaflets containing information on complaints and

PALS are available on all KMPT sites including the KMPT website

- Included in this report was the number of compliments. The Committee requested that this section is expanded in future reports to show how this learning is shared, celebrated and reinforced.

Areas of further focus:

Improving customer care and communication with patients and referring agencies in

instances were decisions are pending or the referral has been rejected or signpost to

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other agencies. The Committee discussed and reflected on possible customer

satisfaction feedback measures, and what steps could be taken to improve this. A

Quality Improvement pilot project is underway with GP colleagues in Medway, to

assess the process around engagement and assessment, with the aim that this will

be implemented trust wide in the coming months. The evaluation of the pilot will be

presented to the Committee in July, with a view to revise and roll out trust-wide.

The Committee would like to recommend this to the board for approval.

Medicines Optimization Strategy

The Committee welcomed this strategy which sets out the vision and ambition of the

pharmacy service for ensuring safe and effective medicines management. The

strategy is also in keeping with Regulators expectation for a medicine optimisation

strategy.

Key headlines were noted by the Committee:

- 12 Pharmacists, and 13 Technicians in the team

- Two business cases are already underway to support new ways of working

- There is strong recruitment retention within the Pharmacy team

- Work is underway with external agencies to work collaboratively with other

system partners on this agenda

Strategy objectives were highlighted as:

- Implement E-Meds

- Improve working relationships with Acute trusts

- Support nursing associates and medical school

- Development of in-house referral service

- Extend the team function to include ‘meet the Pharmacist’ clinics

The Committee discussed some minor amendments to the paper, to ensure key

objectives are highlighted as an Executive summary at the start of the report, linked

to outcomes. The strategy will be presented to Workforce and Organisational

Development committee in due course.

Quality Committee Annual Review and Committee Effectiveness Survey

The committee effectiveness questionnaire suggested QC is operating as it should,

with considerable agreement on most items. The area for improvement is the

communication of actions from the committee to the relevant staff members or

teams, and the executive will lead on improving this during the forthcoming year.

QC Visits “Beam in sessions”

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This is the first time that the QC has trialled team visits as part of the QC agenda

which have been established to expand the involvement of the committee from a

reliance on a centralised meeting structure and two annual workshops, to at least

one month devoted to targeted visits. The committee broke into three teams, each

of which 'beamed' (virtually) into two teams. The visits were well received and the

committee will review the teams’ visiting model going forward.

The six visits were to the following teams:

Chartwell ward

Maidstone CMHT

Neuropsychology team

Cherrywood ward

Place of Safety (Section 136 Suite)

Trust wide Safeguarding team

The Board is asked to: 1) Note the content of this report.

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Quality Improvement

Background

The inaugural Quality Improvement Working Group was held on 24th July 2019 and has

been established to drive forward and deliver the Trust’s ambition of enabling those closest

to the complex problem to develop and deliver solutions through the art and science of

quality improvement.

The Quality Improvement Working Group is co-chaired by the Executive Medical Director

and Executive Director of Nursing and Quality. Attendees include a person with Lived

Experience; Assistant Medical Director – Acute Care Group; Consultant Nursing and

practise, Head of Research Clinical Effectiveness Manager and representatives from each

Care Group and corporate services including Learning and Development and

Communications team.

Trust Board approved the QI strategy in February 2020 and the table below articulates the

2019/20 key deliverables for quality improvement and the recommended 2020/21 strategic

objectives, KPIs and outcomes;

Objectives 2020/21 Key deliverables 2019/20 KPIs 2020/21 Outcome 2020/21

Further engagement

with the Board with

regards to Quality

Improvement

A Board development day

was planned for 30th April

2020 which would have

included QI (due to the

COVID 19 pandemic the

Board development day has

been postponed)

A Board development

day including QI; one

Board seminar including

QI, three presentations

of QI projects to the

Board

The Executive team are

accountable for delivering the

Quality Improvement strategy

There is alignment with

Board subcommittee’s remits

and QI

Engagement with

Quality Improvement

sponsors

15/30 sponsors have been

actively engaged with QI

projects across KMPT

All 30 sponsors to be

actively engaged with QI

projects across KMPT

Sponsors fulfil a leadership

role and empower those

closest to the complex

problem to develop, test and

evolve solutions

To further build the

infrastructure across

KMPT including a

coherent QI offer

which includes the

KMPT way

The KMPT QI logo has

been developed

We have been

socialising KMPT’s draft

QI approach (please see

appendix one)

We have a KMPT QI i-

connect page http://i-

connect.kmpt.nhs.uk/iconnect/pages

/trust-

departments/operations/quality-

improvement.htm

We have developed QI

90% of QI projects

are using QI life

Staff accessing the

QI i-connect page

QI marketing

material printed and

cascaded including

posters, banners

A clear and consistent KMPT

QI approach which is easily

accessed by staff across the

Trust

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tools and templates

which are available on

the above page

We have drafted a QI

poster

We are using QI life for

some QI projects

We have two QI selfie

frames

Starting to build the

culture of QI across

the Trust

We have been working in

collaboration with heads of

nursing and quality leads to

explore how we will use

existing networks for QI

15 QI coaches within

KMPT offering

support across the

Trust

10 action learning

sets held with good

attendance

Increasing awareness,

confidence and application of

QI through aligning with

existing networks and people

responsible for quality

Starting to build QI

capacity and

capability across the

Trust including a

menu of training

We have been co-

delivering 1 and 5 day QI

training with KCHFT

140 KMPT staff have completed QI awareness (due to COVID-19 160 people have had to cancel their training so this would have been 300)

21 KMPT staff have completed QI Fundamentals (due to COVID-19 76 people have had to cancel their training so this would have been 97)

13 KMPT staff have completed QI Practitioners and 9 staff are currently being trained (due to COVID-19 the training has been paused)

We have met with East

Kent consultants at their

CPD day

We delivered QI training

at the HEE KSS eCLiPS

for Psychiatrist

development day 2

We attended the Liaison

psychiatry SMT

Meet our cumulative ambitions within the dosing plan (please see appendix two)

Co-deliver 1 and 5 day QI training sessions with KCHFT

Deliver 10 internal QI training sessions such as consultant CPD days

Deliver the innovation and QI modules within the Leading the way programme

Completion of a training options for QI

QI included in CPD days, junior doctor’s induction and job planning

Progress business case to secure resource to build a QI team to support implementation of strategy

Working in collaboration with

learning and development

and organisational

development to scope and

coordinate the QI work which

is currently happening across

the Trust

Development of a

sustainable and effective QI

training approach

QI facilitators, Data analyst

and communications

resource in place

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We have identified QI e-learning which KMPT can access

We have developed the resources for the innovation and QI module within the Leading the way programme

Development and

delivery of a robust

and proactive

communication plan

through multiple

channels.

We have agreed a QI

communications plan

We have presented at

the leaders event

We have undertaken

interviews with QI

champions

We are starting to use social media for QI #Qikmpt

Interviews with QI champions

Using social media 2 times a week for QI

Delivery of a robust QI communications plan

Hold one conference of celebration including QI projects

A quarterly ward to Board QI story (quarters 3 and 4)

Twitter KPIs;

Twitter mentions (i.e – every time your twitter account is mentioned)

Number of followers – define the baseline and target over 12 months’ to evidence improved engagement.

Number of tweets sent from KMPT account

QI will be part of our induction for new starters and to pre Reg students

Working in collaboration with

communications sharing

learning internally and

externally - coordinating

opportunities for this to

happen and developing

stories which inspire people’s

hearts and minds and

celebrating at a local and

strategic level. Outcomes

include raising awareness,

sharing best practice and

motivating people

Development and

delivery of a

coordinated

approach to QI

projects

We have supported 11 QI

projects across the Trust

(please see appendix three)

We have submitted an outline business case for additional resource to support more QI projects

25 QI projects across the Trust- focusing on SMART improvement aims and qualitative and quantitative measures Each QI project to include a person with lived experience Each QI project to evidence efficiencies made including reducing time and money

Alignment with strategic

priorities and our Just and

Learning Culture

Work in collaboration with the

CASE and Research teams

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Each QI project to evidence the positive impact on staff and patient experience

Next steps

In consideration of the COVID-19 pandemic during quarter one of 2020/21 the

Transformation Team will continue to drive forward the following elements of the QI

programme;

Further scoping of the resources required to deliver our QI strategy and objectives

Finalisation of KMPT’s QI approach

Finalisation of KMPT’s QI marketing material

Further understanding of the functionality of QI life

Support colleagues to drive forward the QI projects which are in progress

The priorities of the programme will be reviewed in July 2020 in consideration of the COVID-

19 pandemic.

Recommendation

Quality committee is asked to acknowledge the 2019/20 key deliverables for quality

improvement and to support the recommended 2020/21 strategic objectives, KPIs and

outcomes.

Quality committee is also asked to consider and feedback on the DRAFT KMPT QI approach

in Appendix one

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Appendix one - DRAFT KMPT’s QI approach

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Appendix two

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Appendix three - KMPT QI projects 2019/20

Title Care group/team Leads and tile QI project status 17/04/20

Violence and

aggression

Acute care group TBC In progress

Patient experience Acute care group TBC Closed

Sexual safety

collaborative

(Royal College of

Psychiatry)

Acute care group Carrie King, Ward Manager and

Sojan Joseph, Matron

Currently paused due to COVID-19

Personal care and

support plan

Community recovery CG Ed Kanu, head of nursing and Grace

O‘Driscoll

Closed

Medway referrals Community recovery CG Dr Mo Eyeoyibo, Associate Medical

Director and Priya Gurung

In progress

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Blood glucose

monitoring

Physical health team Gill Leighton, Senior Physical Health

Nurse and David Cousins

Paused

Person centred

care planning

Older adults care group Madelaine Lambie and David Cousins Paused

Therapeutic leave Acute care group Cheryl Lee and Michael Relf Paused

Ward

documentation

Older adults care group Grace O‘Driscoll and Tanya Parker Paused

Medway caseloads Community recovery CG Dr Anoop Saraf, clinical lead Medway

CHMT and Holly Till

Paused

Adherence to anti-

depressants

Community recovery CG Albert Botchway, Trainee Advance

Nurse Practitioner

In progress

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Meeting Date 25th June 2020

Title Integrated Audit and Risk Committee (IARC) Report

Author Tom Phillips, Non-Executive Director & Chair of IARC

Presenter Tom Phillips, Non-Executive Director & Chair of IARC

Executive Director Sponsor N/A

Purpose For Information/Assurance

Executive Summary The Integrated Audit and Risk Committee (IARC) met on 18th June 2020 to discuss the following:

External Audit Report

o Audit Report

o Letter of Representation

Year-End matters:

o Draft Annual Account

o Draft Annual Governance Statement

o Draft KMPT Annual Report

The Committee would like to bring the following matters to the attention of the Board:

1 External Audit Report The External Auditors had produced an Addendum Report for the Committee’s

consideration. The Committee reviewed the Addendum Report in tandem with the main

Audit Report.

The Committee explored a variety of matters, including the unadjusted misstatement. The

Committee noted that this was a technical matter rather than a substantive issue that

needed further exploration. Due to the value of the unadjusted misstatement, there is no

requirement on the Trust’s part to have it adjusted within the Accounts.

The Committee considered and approved the Letter of Representation.

2 Year End Matters

The Committee received the finalised versions of the Annual Accounts, Annual Governance

Statement and Trust Annual Report with those documents having been adjusted following

the Committee’s previous comments.

Trust Board shall receive a copy of those documents at its meeting on 24th June 2020.

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3 Recommendation The Board is asked to:

1) Note the content of this report.

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agenda - kmpt.nhs.uk · 6/25/2020 · key: dl: diligent reference fa- for approval, fd - for...

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