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Bolton NHS Foundation Trust – Board Meeting February 27th 2014

Location: Board Room Time: 0900 – 1230 hrs

Time Topic Lead Process Expected Outcome

0900 1. Patient Story Verbal Patient story and learning points noted

0920 2. Apologies for Absence – S Hodgson Trust Sec. Verbal Apologies noted

3. Declarations of Interest Chairman Verbal To note any declarations of interest in relation to items on the agenda

4. Minutes of meeting held 30th January 2014 Chairman Minutes To approve the previous minutes

5. Action sheet Chairman Action log To note progress on agreed actions

6. Matters arising Chairman Verbal To address any matters arising not covered on the agenda

0930 7.1 Chairman’s Report Chairman Verbal to receive a report on current issues

7.2 CEO Report including BAF Summary and reportable issues

CEO Report To receive a report on any reportable issues including but not limited to SUIs, never events, coroner reports and serious complaints

Safety Quality and Effectiveness

0945 8. Integrated Performance Report Exec team Report To note and receive the integrated performance report

9. Update on Keogh, Francis and Berwick DoN Report To receive an update on the actions taken to implement recommendations from national quality reviews

10. Update on implementation of Patient, family and carer experience strategy

DoN Report To receive an update on the implementation of the new patient experience strategy

11. Readmissions COO verbal To receive a verbal update on actions to analyse readmission rate

12. Mandatory Training Dir HR report To receive an update on actions to reach the target for mandatory training compliance.

Strategy

11.15 13. Draft Annual Plan To follow To review the first draft of the operational plan

2

Time Topic Lead Process Expected Outcome

Finance

11.45 14 Month 10 Finance Report DoF Report To receive an update on the current financial position.

For Information

Chair reports of the following sub-committees will be noted – if any member of the Board wishes to raise a question regarding one of these items they should indicate this before the start of the meeting.

12.00 17. Finance and Investment Committee – Chair Report 20th February 2014 (to be tabled)

18 Quality Assurance Committee – Chair Report 12th February 2014

19. Audit Committee – Chair report 24th Feb 2014 (to be tabled)

20. Council of Governor minutes 9th January 2014

21. Any other business

Questions from Members of the Public

1215 22. To respond to any questions from members of the public that had been received in writing 24 hours in advance of the meeting.

Resolution to Exclude the Press and Public

To consider a resolution to exclude the press and public from the remainder of the meeting because publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted

Lunch

Next meeting: Thursday March 27th 2014 - NB venue Breightmet Health Centre

Board of Directors minutes – January 30th 2014 Page 1 of 10

Meeting Board of Directors Meeting

Time 09.00 a.m.

Date 30th Jan 2014

Venue Boardroom

Present:- Abbv.

Mr D Wakefield Chair DW

Dr J Bene Chief Executive JB

Dr M Harrison Vice Chair MH

Mrs C Davies Non-Executive Director CD

Mrs G Ashworth Non-Executive Director GA

Dr E Adia Non-Executive Director EA

Mr A Duckworth Non-Executive Director AD

Mr S Worthington Director of Finance SCW

Mrs T Armstrong Child Director of Nursing TAC

Mr S Hodgson Acting Medical Director SH

Mr A Ennis COO AE

Ms S Woolridge Acting Director of Workforce and OD SW

In attendance:-

Mrs E Steel Trust Secretary ES

Five members of the Council of Governors, one member of staff and the local media in attendance as observers.

1. Patient Story

Mrs M attended with her husband to provide a patient story.

Mrs M fell in November 2012; she sustained a fractured hip however this was not picked

up at a GP appointment or a subsequent A&E appointment when she attended A&E on the

advice of her physiotherapist. The fracture was eventually diagnosed two weeks after the

fall and treated surgically.

Mrs M felt that she was not listened to or taken seriously and has since raised a formal

complaint.

The Medical Director apologised to Mrs M and undertook to ensure the learning from her

poor experience is used to educate and reinforce the message to A&E staff that a painful

hip might be broken even if the patient is managing to walk on the affected leg.

The Chairman thanked Mrs and Mr M for their time in attending the Board meeting and

formally apologised on behalf of the Trust for the experience.

Welcomes

The Chairman welcomed Mr A Ennis new Chief Operating Officer to his first formal

meeting and welcomed Dr Bene to her first meeting as the appointed Chief Executive

Officer of the Trust.


2. Apologies

None

3. Declarations of Interest

No additional interests declared

4. Minutes of The Board Of Directors Meeting Held on 19th December 2013

The minutes of the Board meeting held on 19th December 2013 were approved as an

accurate record subject to a change of wording on page 2 to read contest the alleged

issues.

5. Action Sheet

The action sheet was updated to reflect progress on agreed actions.

6. Matters Arising

No matters arising not covered elsewhere on the agenda.

7.1 Chairman’s Report

Quality

The integrated performance report shows improvement, although some areas are still red.

All red areas have shown improvement on the previous month’s performance, there were

no new cases of c. difficile and although January started busy with challenges to A & E

performance, A&E performance during the week beginning January 13th was the fifth

highest in England.

Finance - The Trust are on target to deliver the plan

Monitor - The routine monthly performance review meeting will be conducted by phone on

Friday 31st January 2014.

7.2 CEO report

Healthwatch Memorandum of Understanding -; the two organisations have established

a good relationship to build on to improve the experience of patients, carers and the public

of Bolton. The MoU sets out how the two organisations will work together to ensure public

views are taking into account about service delivery.

The reports generated through this joint initiative will be come to the PEIP group; a

quarterly forum will also be established with Healthwatch.

Resolved: The Board approved the signing of the Memorandum of Understanding with

Healthwatch Bolton

Reportable issues there were three red rated complaints, two regarding dignity and

attitude and one with mixed issues; the three were in different areas and are being

investigated.

BAF - The Board approved the proposed reduction to risks A1, A4, A6, A7 and D1 and


agreed that risk D2 which related to transitional post integration risks could be moved in

line with the recommendation of the workforce committee.

Board members were asked to note the other key risks to the Trust’s strategic objectives

and to raise questions regarding the on-going management of these risks.

A3 - timely response to the deteriorating patient - Board members noted that this risk had

remained unchanged for some time and requested an update. Board members were

advised that the majority of actions to address are with the mortality group. The main

action required is the upgrade of level one care, the business case for this investment is

now being worked up for inclusion in the 2014/15 financial plan. This business case is for

development of skills and monitoring outside of HDU and ICU. Responsibility for this risk is

shared between the Director of Nursing and Medical Director who agreed that they hoped

to be in a position to reduce the risk score in June 2104.

E2 - Implications of not achieving integrated care - Board members noted that this is

another risk where the score has remained constant and asked for further information on

the underlying progress and whether 12 was a fair assessment of the level of risk. The

CEO advised that integrated care is a central plank of our financial plan and although an

element of this is outside our control there is no reason to doubt the will to achieve and

nothing flagging to raise the risk.

C2 - Failure to ensure safe management and learning from incidents - Board members

expressed surprise that this risk had not reduced despite the recent focus on these areas;

the Director of Nursing agreed that a considerable amount of work had been undertaken

however this now needs to be embedded with the risk scored high until interventions

proved effective.

Board members endorsed the format for monthly BAF updates and asked for a

commentary to be included in future reports to advise why a risk has remained static for

longer than should be expected.

FT/14/01 BAF summary to include commentary on risks that have remained static ES

8 Performance update

C difficile - now seeing evidence of sustained improvement with no new cases in

December.

MRSA - The Trust reported one case in December - the first in the financial year which rca

shows was a high risk patient known to be colonised with the bacteraemia.

Pressure ulcers - decrease seen in December, now looking for this to be sustained as

evidence of the effectiveness of the new policy and associated interventions.

Complaints - sustained 100% timely response for all complaints. Board members asked if

the target Of 161 complaints in a year was realistic, the Director of Nursing advised that

she was looking at benchmarking with other organisations. Board members discussed the

importance of being open to complaints to identify themes and actions and continue to

raise standards.

A & E - as mentioned in the Chairman’s opening remarks performance is strong with all

members of the team working together to provide positive results for patient care.

18 weeks - performance for the aggregate target was achieved but there are still some

concerns around the orthopaedic pathway, there is still further work to undertake on the

capacity to delivery.


Board members expressed concern that orthopaedics failing to meet the 18 week target is

a perennial issue and asked what could be done in future years to avoid this. The COO

advised that the Trust must understand capacity and demand and must use this to inform

any business case to provide for increased demand.

Readmissions - still some concerns, working with divisional teams to strengthen

performance in this area. A Board action had previously been agreed to review the local

target, a larger piece of work is also required to ensure the pathways are right and

providing optimum management, this should include a case note review to provide

assurance that patients are not being discharged before they are ready.

Cancer - the 62 day target will be challenging for the month and for the quarter, the COO

advised that he could not give assurance that the Trust would achieve this target for Q3

although the independent support team have reported that processes are good, there is

still work to do on cancer.

Board members requested assurance that a systematic process was in place for referrals

for breast cancer; the COO advised that a review of capacity and demand is being

undertaken to close gaps in the system and to remove reliance on any one individual.

Board members requested a report back to the QA committee on cancer targets to provide

a full understanding of the allocation of breaches and to provide assurance that the right

actions are being taken.

Local induction - steady progress has been made to improve performance in line with the

target.

Staff turnover - the adjusted rate shows turnover around average although there are

some worry areas which are being looked at by the workforce committee,

Appraisals - above target

Mandatory Training - improvement seen - full report to next meeting.

FT/14/02 Report back on readmissions to include consideration of pathways and assurance that

patients are not being discharged too early AE

FT/14/03 Report on 62 day cancer target to provide full understanding of breach allocation and

pathways to March QA Committee

9. Pressure Ulcer update

The Director of Nursing provided an update on the implementation of the pressure ulcer

strategy approved by the Board in September 2013. In order to monitor the

implementation of the strategy a pressure ulcer prevention steering group has been

formed; this group is meeting on a monthly basis to ensure the strategy is fully

implemented.

A challenging trajectory has been agreed to ensure that all relevant staff receive

appropriate training with the aim of delivering on-going training twice a year once all staff

are trained.

Board members agreed that training was key and asked for assurance that the proposed

programme was sufficient to cope with staff turnover. The Director of Nursing advised that

the induction for nursing staff would be extended to four days and would include pressure

ulcer management. Monthly scrutiny of incidents would be used to focus and deliver


training to areas with high prevalence.

A question was raised as to any correlation between staff turnover and pressure ulcers, the

Director of Nursing confirmed that the heat map does show some correlation with high

vacancies and absence and that staffing levels were considered as a contributory factor in

root cause analysis.

Board members asked for an update on the installation of the better care boards and were

advised that these would be approved by the charitable funds committee.

Board members asked for assurance that the impact of the training would be sustained

and embedded; the Director of Nursing advised that the teams understand the importance

of pressure care and are asking the right questions. The intensive support will continue

into the summer and she has confidence that by then it would be embedded in every day

good practice.

The Board discussed the use of equipment and asked for assurance that the focus was on

the appropriate care rather than cost saving. The Director of Nursing advised that

spending additional money on specialist mattresses is not a replacement for good nursing

care and two hourly turns. The Director of Finance confirmed that an on-going dialogue

takes place to ensure that necessary expenditure on patient safety is protected.

Resolved: The Board noted the update and supported the approach taken.

10. Report on low harm incidents

Quality surveillance information highlighted that Bolton NHS FT is an outlier compared to

other Trusts in relation to the level of low harm reported through the current risk

management process.

A case note review was undertaken to validate this and understand the possible reasons,

this review of 50 sets of notes showed that in a high percentage of incidents reported as

low harm the patient did not experience any harm. Examples reviewed included a patient

who had a procedure cancelled because of not being properly fasted. Other examples

included patients who were observed after a fall, in accordance with the policy, but did not

suffer any harm however the NPSA guidance classifies increased observation as harm.

The Board agreed that it was important to record correctly and to be in a position to

benchmark with other trusts, the team are looking to address this with clinical engagement

and use of other fields within the incident reporting system. Divisions are to be asked to

conduct a weekly review of incidents to ensure all are followed up.

It was noted that if the results of the audit were applied to the overall results, with an

assumption that 66% of the cases reported as low harm were no harm, this would place

our reporting in line with other neighbouring trusts.

The Chair of the QA Committee advised that the Committee had included a six monthly

review of NPSA data within its workplan.

Resolved: The Board noted the report and agreed that the QA Committee should continue

to monitor this area and look for improved accuracy of benchmarking.

11. Sickness absence update

The acting Director of Workforce and OD presented an update on the management of

sickness absence. Charts within the report have been used to identify hotspots; all three

divisions will work closely with the Health and Wellbeing team and the Occupational Health

physician to target interventions as appropriate.


There was a significant increase in sickness absence in December, primarily as a result of

seasonal infections. A two pronged approach is being used for long and short term to

provide support for managers and to escalate when managers are not taking the

appropriate action.

Board members discussed the implications of the figures noting that 40 episodes were

more than six months with a significant number (204) between three and six months with

stress and anxiety a big area of concern.

Board members acknowledged the importance of HR interventions to support staff and

agreed that a robust process was also needed to consider sanctions if appropriate. The

Acting Director of Workforce advised that there is a robust policy for the management of

short term sickness with a prescribed process of triggers which must be followed in a

timely fashion; these are in line with those used in other Trusts.

A sickness intervention team is being created to work alongside managers and health and

wellbeing to provide additional support and knowledge.

Board members spent some time discussing interventions to address and to proactively

reduce sickness with interventions and conditions to prevent stress and anxiety and proper

applications of policies.

The Board discussed the proposal to reduce the target and agreed that the Trust should be

aiming for performance in the top quartile with sickness absence under 4%

Resolved: The Board noted the update and requested an update in three months’ time.

FT/14/04 Update on sickness absence to April 2014 Board meeting

12. End of life care

Dr Barbara Downes – Clinical Lead for Palliative and EOL Care and Carmel Wiseman –

Palliative and EOL Care Programme Manager attended to present on palliative and end of

life care to provide assurance that end of life patients were being appropriately managed.

The following points were noted:

The Liverpool Care Pathway (LCP) was implemented in Bolton in 2005/06 but in

line with national guidance following the more care less pathway report in July 2013

has now been withdrawn

A snap shot case note audit of 22 cases was conducted in September 2013 to

review the quality of care delivered in the Royal Bolton Hospital to the dying person.

Of the 22 patients 15 were identified as dying, 15 had consultant input either at the

time of diagnosis or afterwards and these 15 patients had discussions regarding the

ceiling of care and futility of medical escalation

Of the 15 recognised as dying:

o All had senior medical review

o All had discussion of DNAR and escalation of care

o 50% :LCP documentation was used

o 80%: Fluids/food were discussed

o All had EOL drugs prescribed if needed

o 33% had spiritual needs recorded


o 20%: the GP informed of the death

The audit will be repeated quarterly

Since the LCP report EOL care has been kept high on the agenda, any complaints

relating to EOL care are red rated and support and education is being provided to

the clinical team.

There will not be a replacement in terms of a document to replace the LCP. What

will be presented is a set of guiding principles that can be used as measurable

outcomes.

Board members thanked Barbara and Carmel for their presentation and asked further

questions to clarify their understanding of the survey results. Board members agreed that

this is a vitally important subject which should be a key issue in the integration agenda to

ensure patients are correctly identified as end of life to ensure their wishes are followed.

Resolved: the Board noted the update, regular updates are included on the QA Committee

workplan

FT/14/05 QA Committee to receive updates on End of Life audits TA

13. Risk Strategy

The Director of Nursing presented the Risk Management Strategy for Board approval.

The aim of the strategy is to reinforce and embed a culture in which risks are actively

identified and managed through explicit processes and systems.

A new Risk Management Committee has been established and the Trust now has a better

focus on processes through the BAF and risk register, this now needs to be embedded

with more proactive risk management.

Board members discussed the proposed strategy; a question was raised with regard to the

support being provided for senior managers; the Director of Nursing advised that the

divisional teams are attending risk management committee on a regular basis to discuss

their risk registers and the management of identified risks.

Some concern was expressed about the size of the document and its relevance for ward

and department based staff and after discussion Board members agreed that although the

full strategy provides assurance that the organisation has a strategy a shorter version

would help staff understand the processes that need to be activated.

Board members agreed the importance of cascading the strategy to ward and department

level to ensure responsibility for the management of risk is woven through the organisation.

Resolved: the Board approved the Risk Strategy subject to minor alterations to separate

the strategy from process and to incorporate communications.

FT/14/06 Risk strategy to be separated from process, document to be communicated TA

14 Quality Strategy

The Medical Director presented the Quality Strategy for Board approval, this strategy

previously discussed in the quality assurance committee builds on existing good work to


describe the vision for the organisation and set priorities for front line staff.

The strategy includes some ambitious aims and objectives which are supported by three

multidisciplinary enabling workstreams, the workstreams also include lay members who

are providing important challenge.

The strategy has been shared with the CCG and will now be communicated to all staff

through the communication strategy attached to the document.

Board members agreed it was pleasing to see an ambitious document produced with good

clinical engagement setting out good, concise and clear ambitions for the quality agenda.

Resolved: The Board approved the quality strategy; quarterly updates to the QA

Committee have been agreed and are included in the workplan.

15. Q3 Declaration to Monitor

The Trust Secretary presented the Q3 Monitor declaration for approval.

The Board agreed it could not confirm that the Trust would maintain a continuity of

service rating of at least 3 for the next 12 months

Having exceeded the c difficile trajectory, the Board agreed that it could not confirm

that plans were sufficient for on-going compliance with targets

The Board agreed that it could confirm that there were no matters arising in the

quarter requiring an exception report to Monitor which had not already been

reported.

Resolved: The Board approved the submission of the Q3 template to Monitor.

16. PwC report on response to governance recommendations

The Trust Secretary presented the outcome of the PwC review of actions taken in

response to the KPMG governance report (June 2012)

Of the 55 recommendations still felt to be relevant the Trust have completed 80%, 18%

have been partially implemented and just one is yet to be implemented.

The one outstanding recommendation is to complete an assurance mapping exercise;

PwC have agreed that this action should not be rushed and should be the final piece in the

plan. A target date of May 2014 has been agreed.

PwC have provided positive feedback to Monitor with regard to progress made.

Resolved: The Board noted the progress made to address the KPMG recommendations.

17. Month 9 Finance Report

The Director of Finance presented the month 9 finance report and highlighted the following

areas:

The financial position for month 9 was a deficit £ (0.2) m which is £0.2m better than

planned.

The year to date position is a £ (5.9) m deficit compared to the planned £ (7.0) m.

Income is (£0.6m) below budget this month comprised of favourable variances of

£0.7m on PbR income and adverse variances of (£0.3)m on income reductions and

(£1.0)m on other patient income.


Pay costs have fallen by £0.3m compared with November closer to the trend

experienced during the first 6 months of the year.

Non-pay underspend of £0.3m this month continues to support the overall position.

Income and cost improvement are £ (0.5m) below plan year to date. It is forecast

that there will be a shortfall in ICIP’s of £3.2m for this financial year.

The forecast shows that the Trust’s plan deficit of £7.8m is still achievable by

utilising the £2.2m risk reserve that was set aside in the plan and by using non

recurrent schemes to offset recurrent shortfalls. The Trust has a range of actions in

place to secure run rate balance by the year end but there is delivery risk

associated with these actions.

It was noted by one of the Board members that non recurrent exceptional expenditure was

above plan by £0.5m, the Director of Finance advised that this was for consultancy

expenditure and was non-recurrent.

Good progress has been made on the delivery of the plan; this is a credit to all staff in

divisions and corporate areas who have succeeded in delivering the financial plan and

delivering quality.

Resolved: The Board noted the month 9 and Q 3 financial position.

18. Finance and Investment Committee Chair report (21/01/14)

At the last meeting of the Finance and Investment Committee, the Committee focused on

planning for the broader aspects of 2014/15.

Resolved: The Board noted the Finance Committee Chair report

19. Quality Assurance Committee Chair report (15/01/14)

At their January meeting, the QA Committee:

Reviewed their terms of reference and approved the workplan for the coming 12

months.

Agreed that the Chief Pharmacist should be a regular attendee at future QA

meetings.

Received an update on the implementation of the clinical waste policy and were

advised that this will be independently assured.

Approved the proposed Exemplar Star System Accreditation

Resolved: The Board noted the QA Committee Chair report.

21. Charitable Funds committee (09/12/13)

Resolved: The board noted the minutes of the Charitable Funds Committee - the part two

agenda includes a further item on the Charitable Funds Committee

20. Any other business

None


22. Questions From Members of the Public

No questions were received in advance of the meeting

Date And Time Of Next Meeting

27th February 2014 0900

Resolved: to exclude the press and public from the remainder of the meeting because

publicity would be prejudicial to the public interest by reason of the confidential nature of

the business to be transacted.

December Board actionsCode Date Context Action Who Due CommentsFT/13/107 31/10/2013 mandatory training update in Jan 2014 on performance and any actions taken LL Feb-14 agenda item 12FT/13/90 26/09/2013 readmission report back to Board after audit with CCG JS Feb-14 verbal update to be provided agenda item 11FT/13/117 28/11/2013 Patient family and carer

experience strategy

report back on deployment of strategy and measures TA Feb-14 agenda item 10

FT/13/118 28/11/2013 Francis, Keogh and Berwick Quarterly updates - next Feb 2014 TA Feb-14 agenda item 9

FT/13/121 28/11/2013 Emergency preparedness report to Audit Committee to provide assurance on implementation of

actions

COO Feb-14 complete - breifing to Feb 24 Audit Committee

FT/14/01 30/01/2014 CEO report - BAF BAF summary to include commentary on risks that have remained

steady

ES/JB Feb-14 complete CEO report updated to reflect this

FT/14/02 30/01/2014 Performance report back on readmissions wider than FT/13/90, to include

consideration of pathways and assurance that patients are not being

discharged too early

AE Feb-14 verbal update to be provided agenda item 11

FT/14/06 30/01/2014 Risk strategy strategy to be separated from process, document to be communicated TA Feb-14

FT/13/122 28/11/2013 staff story complaints/PALS team to report back to QA Committee TA Mar-14 QA Committee FT/13/116 28/11/2013 Patient family and carer

experience strategy

review of complaints policy TA Mar-14

FT/13/124 19/12/2013 SUI Audit on follow up of abnormal test results to be reported to QA

committee

SH Mar-14

FT/13/111 28/11/2013 Equality and Diversity follow up report to be provided through the patient experience and

inclusion group to provide analysis of what the data means to the Trust

both as a provider of care and as an employer

TA Mar-14

FT/13/120 28/11/2013 revalidation update at end of Q4 with results for the year SH Mar-14FT/14/03 30/01/2014 Performance report on 62 day cancer target to provide full understanding of breach

allocation and pathways to March QA Committee

AE Mar-14

FT/13/103 31/10/2013 AHSN update in April 2014 AMS Apr-14FT/14/04 30/01/2014 sickness absence update report in three months SW Apr-14FT/14/05 30/01/2014 End of life care QA Committee to receive update on audits SH/TA Apr-14FT/14/07 30/01/2014 Charitable funds update on agreed actions for more strategic approach to funds SCW Apr-14FT/14/08 30/01/2014 overseas visitors update report in three months SCW Apr-14

All information provided in this written report was correct at the close of play 19/02/14 a verbal update will be provided during the meeting if required

Agenda Item No : 7.2

Meeting Board of Directors

Date 27th February 2014

Title Chief Executive Update

Executive Summary

The Chief Executive update includes a summary of key issues since the previous Board meeting, including but not limited to:

Monitor update

reportable issues log

o coroner communications

o Never events

o SUIs

o Red complaints

Board Assurance Framework summary

Next steps/future actions Clearly identify what will follow i.e. future KPI’s, assurance requirements

The Board are asked to note this update

Discuss Receive

Approve Note

This Report Covers (please tick relevant boxes)

Strategy Financial Implications

Performance Legal Implications

Quality Regulatory

Workforce Stakeholder implications

NHS constitution rights and pledges Equality Impact Assessed

For Information Confidential

Prepared by Esther Steel Trust Secretary

Presented by Dr J Bene Chief Executive


Chief Executive Update

1. Stakeholders

1.1 Bolton CCG

The Board to Board with the CCG is scheduled for March 14th 2014 1.30 pm - 4.00 pm

1.2 Monitor

The last progress review call on 31st January was very positive. Although it is likely that we

will remain in breach of our licence for some time yet, they recognise the progress we have

made.

By the time we have the Board meeting we will have had two visits from a team from Monitor

who are using this Trust to develop and pilot a new assessment tool; we anticipate receiving

feedback on this by the end of March.

1.3 Greater Manchester Cancer Services Provider Board

An MoU has been developed to provide a framework for the Greater Manchester Cancer

Services (GMCS) Provider Board and its member organisations to work together to inform

and implement the requirements of Greater Manchester and Cheshire cancer

commissioners.

This MoU was formally agreed at a meeting of the Greater Manchester Provider Services

Board on 21st February 2014 and is appended to this report for information

2. Reportable Issues Log

Issues occurring between 31st January and 19th February

These incidents will be discussed at the Quality Assurance Committee 12th March 2014

2.1 Serious Untoward Incidents

There has been one new Serious Untoward Incidents relating to a potential breach of

information governance, at the time of writing this had only just been reported, if appropriate

an update will be provided in the Board meeting

2.2 Never Events

There have been no never events since the last Board meeting.

2.3 Coroner Prevention of future Deaths (PFD) reports

There have been no coroner notices issued since the last report

2.4 Red Complaints


There have been 2 red rated complaints which are currently being investigate, further detail

will be provided to the Quality Assurance Committee

2.5 Reputational Issues

No issues to report at the time of writing

3 Board Assurance Framework

3.1. INTRODUCTION

The Board Assurance Framework (BAF) is a tool which sets out the significant risks for each

strategic objective, along with the controls in place and assurances on their operation. The

BAF is used by the Board of Directors to ensure that all significant risks have been identified;

information on control, performance and assurance is timely and relevant; and to provide

leadership on risk management.

The BAF is reviewed on a monthly basis by the Executive team who finalise the list of

strategic risks, confirm actions being taken and check assurances

3.2. 2013/14 ASSURANCE FRAMEWORK

The Risk Management Committee reviewed the BAF on 5th February 2014.

All risks were reviewed with peer challenge to facilitate further refinement particularly with

regard to ensuring actions had appropriate dates assigned to them.

E2 Failure to achieve integrated care Risk increased - the achievement of integrated

care is a key objective for the Trust in 2014

E3 Failure to address legacy community IT

issues

Risk reduced, funding has been identified to

progress the integration of community and

hospital IT.

At the January Board meeting Board members requested additional information in this report

on risks that have remained steady; executive members considered this in their review of the

BAF as below. For the majority of risks it has previously been recognised that the impact is

unlikely to change, risks are therefore likely to reduce when actions are complete or increase

when there is limited or no assurance regarding the impact of actions.

A2

Failure to provide appropriate skill mix –

remains a significant risk in terms of

recruitment

While the recruitment programme there are

still a number of vacancies to be recruited

to risk remains unchanged

12

A3 Failure to provide timely response to

deteriorating patient

This risk will remain at a high level until the

work detailed in the business case for level

one care has been implemented

16

B2 Failure to achieve run rate balance Remains a significant risk. 20


C1 Failure to address compliance

requirements

Having completed the majority of actions,

the likelihood of failing to address

compliance requirements is 2, risk

management committee members agreed

this should remain on the BAF on its

current score until the Board are assured

that actions have been completed. PwC

are currently assessing progress against

the Deloitte quality governance report.

10

C2 Failure to ensure safe management

and learning from incidents

Actions have been agreed to improve the

management of risks and learning from

incidents, the trust are recruiting for a new

Head of Governance - risk to remain at 16

16

C3 Failure to comply with information

governance

A key action to address this is the

implementation of EPR; likely to remain at

this level until this is achieved and the

number of IG incidents reduces.

9

D1 Failure to reduce sickness absence

The impact of the actions to address

sickness absence has not yet been

achieved - remains 16

16

E1 Healthier Together

The Trust continues to engage with

Healthier Together but has limited

influence on the outcome of the exercise.

15

E4 Failure to provide an efficient fit for

purpose estate

Whilst the position regarding funding for

the estates strategy remains uncertain this

risk remains at 16

16

3.3 NEXT STEPS

The BAF has now been placed on a shared drive to be accessed and updated by all

Directors.

The Risk Management Committee will continue to meet on a monthly basis and will report to

the QA Committee through a Chair’s report. The Risk Management Committee will continue

to review the BAF at each meeting.

The full BAF will be reviewed at the February Audit Committee; the COO will attend for

detailed scrutiny of the risks for which he is lead director


Summary of Risks February 2014

= risk increased = risk decreased = new risk = no change

lead

Octo

ber

Decem

ber

Janu

ary

Febru

ary

Ch

ange

A1 Failure to reduce the number of cases of CDT – current performance above target

DoN 20 20 12 12 -

A2 Failure to provide appropriate skill mix – remains a significant risk in terms of recruitment

DoN 12 12 12 12 -

A3 Failure to provide timely response to deteriorating patient DoN 16 16 16 16 -

A4 Failure to comply with CQC standards DoN 16 16 12 12 -

A6 Failure to continue to meet the A&E target COO 16 16 12 12 -

A7 Failure to continue to meet the 18 week RTT target COO 16 16 12 12 -

B1 Failure to achieve the planned deficit FD 15 10 15 15 -

B2 Failure to achieve run rate balance FD 20 20 20 20 -

C1 Failure to address compliance requirements CEO 10 10 10 10 -

C2 Failure to ensure safe management and learning from incidents DoN 16 16 16 16 -

C3 Failure to comply with information governance COO 9 9 9 9 -

D1 Failure to reduce sickness absence HR D 16 16 16 16 -

E1 Healthier Together CEO 15 15 15 15 -

E2 Failure to achieve integrated care CEO 12 12 12 15

E3 Failure to address legacy community IT issues COO 20 20 20 12

E4 Failure to provide an efficient fit for purpose estate COO 16 16 16 16 -

D2 Failure to strengthen communication and engagement HR D 16 16 Removed

Greater Manchester Cancer Services

part of Manchester Cancer

Greater Manchester Cancer Services Provider Board

MEMORANDUM OF UNDERSTANDING

February 2014

2

This Memorandum of Understanding is made on …………………………………………………………… between:

(1) Bolton NHS Foundation Trust;

(2) Central Manchester University Hospitals NHS Foundation Trust;

(3) East Cheshire NHS Trust;

(4) Pennine Acute NHS Trust;

(5) Salford Royal NHS Foundation Trust;

(6) Stockport NHS Foundation Trust;

(7) Tameside Hospital NHS Foundation Trust;

(8) The Christie NHS Foundation Trust;

(9) University Hospital of South Manchester NHS Foundation Trust;

(10) Wrightington, Wigan and Leigh NHS Foundation Trust;

(each a Party and together the Parties).

1. Introduction

1.1. This Memorandum of Understanding (this MoU) describes the NHS provider trust

arrangements that have been put in place to facilitate the delivery of the whole system

change necessary to achieve world-class cancer outcomes and experience in Greater

Manchester.

1.2. Greater Manchester has a history of relatively poor cancer outcomes and fragmented

services. There has also been a lack of progress in resolving longstanding issues in achieving

compliance with NICE improving outcomes guidance in hepato-pancreato-biliary,

oesophago-gastric, urology and gynaecological cancer services with specific reference to the

number of operating sites/centres.

1.3. The Greater Manchester Cancer Summit and Convention of September 2012 and January

2013 brought together provider, commissioner, clinician and patient representatives to seek

to address these historical issues. It was agreed that a Provider Board should be developed

to facilitate the development and ongoing delivery of single integrated cancer pathways and

thereby improve patient outcomes and experience.

3

1.4. It was agreed that the Provider Board should sit within the wider context of Manchester

Cancer. Manchester Cancer represents an integrated cancer system made up of three

strands: research, education and cancer services (see Appendix 1). It was agreed that the

Provider Board would be responsible for the cancer services element and it was therefore

formally named as the Greater Manchester Cancer Services Provider Board. It was agreed

that the Provider Board would seek to work with commissioners to deliver their

requirements for both local and specially-commissioned cancer services.

1.5. A Memorandum of Understanding was developed in January 2013. That document

acknowledged that it would need to be refined. This MoU supersedes the original

Memorandum of Understanding.

2. Purpose of the MoU

2.1. The purpose of this MoU is to provide a framework for how the Greater Manchester Cancer

Services (GMCS) Provider Board and its member organisations will work together to inform

and subsequently implement the requirements of Greater Manchester and Cheshire’s

cancer commissioners and thereby improve patient outcomes and experience.

2.2. In addition to the framework set out here, appropriate steps will be taken to ensure that the

Provider Board operates in relation to any given initiative in a manner consistent with all

legal requirements.

3. Effect of this MoU

3.1. The Parties acknowledge and agree that this MoU will take effect from the date set out

above and shall continue for an initial period of two years.

3.2. The Parties agree that the terms of this MoU are not intended to be legally binding and each

of the Parties expressly waives its right to enforce any breach of these provisions.

4. Role of the Provider Board

4.1. The GMCS Provider Board governs Greater Manchester Cancer Services, the service delivery

arm of Manchester Cancer.

4

4.2. Greater Manchester Cancer Services aspires to be accredited as an Operational Delivery

Network for cancer services within Greater Manchester and East Cheshire and the GMCS

Provider Board will work with commissioners with the aim of achieving this status in 2014

(see Appendix 2 for detail of Operational Delivery Networks).

4.3. The GMCS Provider Board will oversee and hold to account (via the Independent Chair) a

Medical Director who in turn will hold to account twenty dedicated Pathway Clinical

Directors who, with their multidisciplinary Pathway Boards, work together with

commissioners to develop and deliver single integrated pathways of care across

organisational boundaries that ensure the best outcomes for patients.

4.4. The GMCS Provider Board funds the appointment of the Independent Chair, Medical

Director, and dedicated Pathway Clinical Directors for Greater Manchester as well as the

core team necessary to support them.

4.5. The GMCS Provider Board provides a forum for all acute providers to discuss and agree the

delivery of care in line with commissioner requirements across organisational boundaries so

that patients from across Greater Manchester and Cheshire receive the same high quality

service, wherever they live.

4.6. To the extent that it is appropriate and consistent with members' legal obligations, the

GMCS Provider Board will seek to develop a unified acute hospital provider response to the

challenges of improving cancer patient outcomes and experience in Greater Manchester and

Cheshire.

4.7. The GMCS Provider Board will seek consensus between all acute providers of cancer care in

Greater Manchester and Cheshire where possible, in order to meet commissioner

requirements for the delivery of cancer services.

4.8. The GMCS Provider Board does not therefore take commissioning decisions but provides

views and recommendations in response to a request for these from commissioners.

4.9. For matters within its remit, the GMCS Provider Board will set clear objectives and time

frames for the development of cancer services in Greater Manchester, in particular to

ensure that the priorities of tumour-specific Pathway Boards contribute towards these wider

objectives.

5

4.10. In so doing, the Greater Manchester Cancer Services Provider Board will contribute to the

objectives of commissioners, Manchester Academic Health Science Centre, individual

provider trusts and Manchester Cancer.

4.11. The GMCS Provider Board will operate in compliance with the National Health Service

(Procurement, Patient Choice and Competition) (No. 2) Regulations 2013. The GMCS

Provider Board will seek advice from commissioners and Monitor prior to any discussions or

activities that may be contrary to these regulations.

4.12. Where the reconfiguration of services is required, for example to comply with NICE

Improving Outcomes Guidance, the GMCS Provider Board will, following a commissioner

request, take the following steps:

4.12.1. Contribute towards the development of the commissioning specification in an

advisory capacity.

4.12.2. Discuss the potential for a collegiate Board response to the final commissioner

specification, informing commissioners of the position reached by Providers.

4.12.3. If possible and appropriate, seek to agree a unanimous recommendation to

commissioners on the future configuration of services, advising on the operational

agenda, timescales and other implications of implementation.

4.12.4. Oversee the implementation of the reconfiguration if its recommendation is

accepted by commissioners following the required level of engagement and

consultation.

4.13. The Terms of Reference of the GMCS Provider Board are set out in Appendix 3.

Core functions of the Greater Manchester Cancer Services Provider Board & its support team

1. To provide views and recommendations to the commissioners (in an advisory capacity) on any aspect of cancer care

2. To encourage the operational delivery of all commissioners requirements for cancer patients with an initial focus on achieving IOG guidance for all cancer pathways across GM

3. To provide a forum to set and review cancer patient outcome and experience objectives; and to fund, oversee and hold to account the leadership of Greater Manchester Cancer Services and its support team in the achievement of these objectives

To carry out these core functions most effectively, Greater Manchester Cancer Services aspires to become accredited as an Operational Delivery Network for cancer in Greater Manchester in 2014.

6

5. Provider Board membership

5.1. In order to govern Greater Manchester Cancer Services, an aspiring Operational Delivery

Network for cancer services within Greater Manchester, the GMCS Provider Board must

have full representation and involvement of all ten acute provider trusts in the region.

5.2. The Chief Executive Officers of all Parties to this MoU are therefore core members of the

GMCS Provider Board.

5.3. Core members of the Provider Board may nominate deputies as appropriate.

5.4. The quorum shall be seven members of the GMCS Provider Board represented by their Chief

Executive Officer or their nominated deputy.

5.5. The GMCS Provider Board has an independent chair appointed by the unanimous decision of

the Parties to this MoU. The Parties acknowledge that the independent chair is selected for

their credibility and experience at managing complex NHS systems, as well as commitment

to the improvement of cancer services.

5.6. The following may be invited to attend meetings of the GMCS Provider Board as extended

members:

5.6.1. The Medical Director of Greater Manchester Cancer Services;

5.6.2. Nominated representatives of local and specialised commissioners;

5.6.3. Primary care provider expertise;

5.6.4. Patient/ user representation;

5.6.5. A representative from the third sector;

5.6.6. Cancer Pathway Directors or other clinical advisors as necessary for specific items;

5.6.7. The Director of Manchester Cancer

6. Provider Board meeting frequency

6.1. The GMCS Provider Board will meet every two months in the first year of this MoU, with the

frequency of future meetings being reviewed at the end of this period.

7

7. Expected behaviours

7.1. Each of the Parties recognises that they will be expected to co-operate and collaborate with

other partners across the pathway, where this is in patients’ best interest, in ways that have

not been achieved in the past. This will necessitate different ways of working and will be in

the form of:

7.1.1. Sharing reliable, complete and timely information with all the various components

of Manchester Cancer (with protocols in place to ensure that confidential

information is managed in an appropriate way);

7.1.2. Engaging fully and co-operating with all other parts of the pathway;

7.1.3. Sharing investment in appropriate and necessary equipment;

7.1.4. Co-operating and collaborating in key leadership appointments;

7.1.5. Ensuring the effective working of multidisciplinary teams as outlined in The

Characteristics of an Effective MDT published by the National Cancer Action Team

(2010); and

7.1.6. Reducing waiting times, reducing variation in care and improving the quality of the

patient experience across the entire patient pathway and thus delivering superior

outcomes.

7.2. The Parties are also expected to work in the spirit of the aims and objectives set out by

Manchester Cancer:

7.2.1. To work collaboratively across the integrated system to deliver safe and effective

care;

7.2.2. To improve access to screening and diagnostics such that diagnosis and treatment

occur at as early a stage as possible;

7.2.3. To increase the numbers of patients enrolled in clinical trials to improve cancer care

for all in our communities;

7.2.4. To localise expertise for cancer where appropriate and centralise expertise where

necessary to improve outcomes and ensure the best quality patient experience;

8

7.2.5. To combine the clinical and academic strengths across the region to drive up quality

and improve outcomes; and

7.2.6. To reduce the number of avoidable deaths in Greater Manchester and Cheshire.

8. Responsibilities of individual Parties

8.1. Individual provider organisations remain responsible for:

8.1.1. Meeting national and local quality standards, for example waiting times, patient

experience, complaints, incidents and peer review;

8.1.2. Day to day operational management of cancer care, including supporting

implementation of relevant recommendations emanating from the Pathway Boards;

8.1.3. Capture and timely submission of comprehensive and accurate data; and

8.1.4. Meeting statutory local responsibilities for consultation and engagement.

9. Provider Board costs

9.1. Parties will contribute an equal share to any Greater Manchester Cancer Services funding

commitment unanimously agreed by the GMCS Provider Board.

9.2. Each of the Parties will bear its own costs for entering into this MoU.

10. Third parties

10.1. It is agreed for the purposes of Contracts (Rights of Third Parties) Act 1999 that this MoU is

not intended to, and does not, give to any person who is not a party to this MoU any rights

to enforce any provisions contained in this MoU.

11. Confidentiality

11.1. The Parties agree that they will keep confidential any and all information disclosed for the

purposes of the operation of the GMCS Provider Board and that the Parties will not directly

or indirectly use or disclose any of such information in whole or in part save for the purpose

9

of the operation of the GMCS Provider Board in accordance with this MoU or any related

agreements.

11.2. Clause 12.1 will not apply to:

11.2.1. any matter which a party can demonstrate is already or becomes generally available

and in the public domain otherwise than as a result of a breach of Clause 12.1; or

11.2.2. any disclosure which is required by law; or

11.2.3. any disclosure of information which is already lawfully in the possession of the

receiving party prior to its disclosure by the disclosing party; or

11.2.4. any disclosure in compliance with the Freedom of Information Act 2000, as

amended from time to time; or

11.2.5. any information which the Parties agree in writing is not confidential.

11.3. In the event that any Party withdraws from the GMCS Provider Board they shall keep

confidential any information provided by other Parties in connection with the operation of

the GMCS Provider Board.

11.4. The full particulars and timing of any announcements relating to the GMCS Provider Board

shall be agreed in advance by the GMCS Provider Board on a unanimous basis.

10

Signed by the Parties or their duly authorised representatives on the date set out above.

Signed by Jackie Bene, Acting CEO

duly authorised for and on behalf of

Bolton NHS Foundation Trust

Signed by Mike Deegan, CEO

Duly authorised for and on behalf of

Central Manchester University Hospitals NHS Foundation Trust

Signed by John Wilbraham, CEO


East Cheshire NHS Trust

Signed by John Saxby, CEO


Pennine Acute NHS Trust

Signed by David Dalton, CEO


Salford Royal NHS Foundation Trust

Signed by Ann Barnes, CEO


Stockport NHS Foundation Trust

11

Signed by Karen James, Acting CEO


Tameside Hospital NHS Foundation Trust

Signed by Caroline Shaw, CEO


The Christie NHS Foundation Trust

Signed by Atilla Vegh, CEO


University Hospital of South Manchester NHS Foundation Trust

Signed by Andrew Foster, CEO


Wrightington, Wigan and Leigh NHS Foundation Trust

12

Appendix 1

Overall aimAchieving world-class outcomes and experience for patients with cancer in Greater Manchester and Cheshire through well led coordinated clinical services, innovation,

research and education

Manchester Cancer

ResearchGreater Manchester Cancer Services

Independent Chair

Associate Director and support team

20 Pathway Clinical

Directors and Pathway Boards

Education

Medical Director

Commissioners of cancer services

Strategic Clinical Networks

Provider BoardManchester

Academic Health Science Centre

Greater Manchester

Academic Health Science Network

Director

Independent Chair

Director

Independent Chair

1

Appendix 2

DEVELOPING OPERATIONAL DELIVERY NETWORKS

THE WAY FORWARD

December 2012

2

CONTENTS Foreword

Page

3

Introduction

4

Context

4

Current situation

5

Proposal

6

Operating Principles

7

Funding mechanisms

7

Accountability

8

HR

9

Communications and Engagement

10

Next steps

10

APPENDICES Appendix A: Purpose of Operational Delivery Networks

11

3

FOREWORD

Clinical networks are an NHS success story. Combining the experience of clinicians, the input of patients and the organisational vision of NHS staff they have supported and improved the way we deliver care to patients in distinct areas, delivering true integration across primary, secondary and often tertiary care.

In July 2012 we published The Way Forward: Strategic Clinical Networks; we are now delighted to announce the next step in this process: Developing Operational Delivery Networks: The Way Forward.

Operational Delivery Networks (ODNs) cover areas such as neonatal intensive care, adult critical care, burns and trauma and are focused on coordinating patient pathways between providers over a wide area to ensure access to specialist support. ODNs will need to work closely with Strategic Clinical Networks, commissioners, providers and patients.

Since July we have held a number of stakeholder events to explore how this model should develop and comments from these events have fed into this document. This document sets out the steps that need to be taken to transition current delivery networks into the new system and ensure that local clinicians continue to come together to improve care for patients.

The next stage is for regional specialised commissioning teams to agree with local providers who should host each ODN moving forward, and then commence consultation with staff about transfer to the new body, in line with the nationally determined service specification. CQUIN payments are confirmed as the source of transitional funding although over time the costs of these networks will be included in tariff.

This is a great opportunity to improve outcomes for patients across the country for some complex and specialist areas of care. Through the development of a national specification for ODN and implementation through these ODNS, patients will see the benefits of consistent standards of care and the use of the very latest evidence and technology to improve their lives.

Professor Sir Bruce Keogh Jane Cummings

NHS Medical Director Chief Nursing Officer

4

INTRODUCTION 1. The NHS Commissioning Board (NHS CB) has recognised that clinical networks

are an NHS success story and have been responsible for some significant and sustained improvements in the quality of patient care and the outcomes of their treatment.

2. The Way Forward: Strategic Clinical Networks (July 2012) outlined the range

and role of clinical networks in the new health system. There will be a range of networks performing different functions which include:

a small number of Strategic Clinical Networks (SCNs) that are established and supported by the NHS Commissioning Board (NHS CB) to advise commissioners, support strategic change projects and improve outcomes

Operational Delivery Networks (ODNs) that are focused on coordinating patient pathways between providers over a wide area to ensure access to specialist resources and expertise.

3. This paper sets out the way forward for Operational Delivery Networks.

CONTEXT 4. The NHS CB prescribed networks will be called Strategic Clinical Networks

(SCNs). SCNs will bring primary, secondary and tertiary care clinicians together, with partners from social care, the third sector and patients to define evidence based best practice pathways, which are implemented and assured through network relationships with commissioners and providers. SCNs will operate as ‘engines’ for change across complex systems of care maintaining and / or improving quality and outcomes.

5. ODNs will be determined by clinical need as agreed between providers and

commissioners.

6. Success factors for ODNs will be:

Improved access and egress to/from services at the right time

Improved operating consistency

Improved outcomes

Increased productivity

5

CURRENT SITUATION 7. Existing provider delivery networks with national coverage are:

Critical care – adult

Critical care - neonatal

Burns

Major trauma

8. The intention of this paper is to ensure safe transfer of existing provider delivery

networks so operational capacity is not lost during transition to the new system in 2013/14. In addition to those networks listed above with national coverage, there may be a small number of other existing delivery networks requiring transitional support. These will be determined on a case by case basis by the regional specialised commissioning teams of the NHS CB.

There is an acknowledged case for the development of additional ODNs, but this is outside the scope of this paper. Areas for early consideration by specialised commissioners will include: Adult Congenital Heart Disease, Paediatric Congenital Cardiac Surgery and Paediatric Neuroscience. Some of these already exist in developing form in some parts of the country.

9. Variable funding mechanisms are currently in place with no agreed standard.

Some operational networks receive funding from commissioning organisations, the Department of Health (DH) through the financial ‘bundle’ allocated to SHAs, and some from acute trusts.

10. Based on 2011/12 data, over £8.5m is currently being spent on provider delivery

networks. From this fund, just under £4m is spent on the running costs of adult critical care networks and £3m on neonatal networks. Funding for the majority of trauma networks at that time was being negotiated for 2012/13.

11. There is known disparity in individual network funding levels arising from

historical arrangements. To take critical care as an example, the lowest funding received by a network is £84K and the highest being £621K.

12. In The Way Forward: Strategic Clinical Networks (July 12), the NHS CB

recognised the vital importance of these delivery focused networks and committed to describe how they would be maintained both in transition and over the longer term. It also confirmed that it is not the direct responsibility of the NHS CB to support the running costs of ODNs. Therefore there needs to be consideration of the ways of retaining critical parts of these networks to maintain collaborative working between providers.

6

PROPOSAL

13. ODNs will be established across England within the 12 geographical areas of the

Clinical Senates. For 12/13 these will be based on existing geography. Over time it is anticipated that the number of similar networks within a Senate area will reduce to ensure optimal collaboration and effective use of resources. Each network will be aligned to a named Senate.

14. Outcomes and outputs of the ODNs will be included in commissioning service

specifications, commencing in 2013/14 contracts for the existing networks. Over time there will be a move from specification in contracts into tariff structures through identification in reference costs.

15. Subject to finalisation of national 2013/14 commissioning guidance, transitional

funding will be via specialised services CQUIN payments. An amount will be held back from all relevant specialised commissioning provider contracts and paid to the lead provider to cover the costs of running the network, aligned to specific quality improvements for which the host can reasonably be held to account. Some adult critical care is not commissioned by specialised commissioners and these providers will not have CQUIN payments retained in the same way. The arrangements will ensure that all critical care is delivered through an ODN environment, supported through specialised commissioning funds. This is a pragmatic transitional arrangement until the national tariff aligns.

16. There will need to be close collaboration between ODNs and other parts of the

system, notably SCNs, academic health science networks, senates and Health Education England. The new improvement body will provide support in improvement techniques and training.

17. Within the new national model for clinical networks, ODNs will focus on

operational delivery. Strategy will be set nationally. ODNs will ensure outcomes and quality standards are improved and evidence based, networked patient pathways are agreed. They will focus on an operational role, supporting the activity of Provider Trusts in service delivery, improvement and delivery of a commissioned pathway, with a key focus on the quality and equity of access to service provision. This will allow for more local determination, innovation and efficiency across the pathway. ODNs support the delivery of ‘Right Care’ principles by incentivising a system to manage the right patient in the right place.

18. Commissioners will clearly define pathway standards through a service

specification, articulating the requirement for a networked provision of services, and delivered through the contract delivery mechanism. For NHS CB directly commissioned services, these specifications will be nationally developed for consistency. This will determine that patients will receive the same standard of

7

care and treatment regardless of which hospital they are admitted to through a consistent approach to the application of national service standards and networked pathways. The ODN will provide an environment where clinicians work together to ‘do once’ where possible, to share best practice and promote best quality care to continually improve services.

19. ODNs will deliver a whole system work programme for a service across a defined

geographical area and within a specific area of care. They will align and work with established and evolving NHS organisations such as Senates and Clinical Reference Groups (CRGs). The ODN model will be reviewed and developed through the regional specialised commissioning bodies, coordinated through national ‘Programmes of Care’ as the delivery mechanism of the four regions, linked to CRGs, then out into the networks with delivery of the aligned pathways through the provider landscape. To improve joined up working to achieve better outcomes and service access, ODNs will collaborate with regional level Programme of Care (commissioning) leads, as well as commissioning quality teams and the leads for national outcomes.

OPERATING PRINCIPLES

20. These are the national operating principles on which the ODNs should be

founded:

The network will be hosted by an agreed lead provider within the geographical

area

The chair will be an appropriately experienced leader

There will be a clear link to the relevant national CRG, supporting the development of national contracting products, quality monitoring tools, and involvement in developing clinical innovations

The networks will work across a range of services in accordance with the specification drafted for that pathway.

FUNDING MECHANISMS

21. There is a clinically compelling case for retaining this way of working in the new

NHS architecture. The long term plan is for this to be included in tariff as reference costs catch up with the costs of service development.

22. CQUIN will be used as a source of transitional funding for a one year period to

allow time to include it in tariff mechanisms for associated specialised services. (This is subject to final confirmation within the NHS CB 2013/14 commissioning intentions).

8

23. NHS CB Area Teams (ATs) that have a specialised commissioning function will negotiate the actual financial amount with the host provider for a given network and include expectations in the contract. Each relevant service specification will state the requirement for providers to have networked pathways through an ODN approach and the quality outputs associated with the CQUIN payment.

24. Commissioners and clinicians will work in an integrated way at local and national

level to determine the outcome priorities for the year and how they will be monitored. It will be essential to use the wealth of experience in current network teams to inform this.

25. We anticipate that ODNs could function if each NHS CB AT retained c0.1% of

the total i.e. 2.5% CQUIN budget for relevant specialised commissioning areas for payment to host provider trusts for ODNs. However given the variation highlighted above, there will need to be some changes to ensure national consistency of approach.

ACCOUNTABILITY

26. The ODN will be hosted by a provider organisation, likely but not necessarily to

be a tertiary centre. The Chair will be an appropriately experienced leader, unlikely to be employed by the host, to underpin the collective nature of these arrangements. As part of the NHS drive to increase opportunities for clinicians in leadership roles, it is anticipated that clinicians will wish to hold the chair role. The individual will need to be credible across the whole network and evidence alignment to the needs of the network.

27. A governance framework underpinning the network will be fundamental for both

provider and commissioner assurance. This will encompass a governance structure including clear terms of reference and mechanisms for identifying, managing and escalating risks. This will need careful consideration by members to ensure that the network is effective and not seen to be dominated by one part.

Some model arrangements are being developed and commissioners will review this aspect carefully during the transition. The host provider will be responsible for ensuring that the Network Board is accountable to the organisations represented on its board. In addition, the standard contract that the NHS CB has with both the hub and the spokes will require all to operate within the protocols and procedures agreed by the Network Board.

9

28. The AT commissioners would expect to receive an annual account of network activities and achievements to demonstrate improvements towards the NHS Outcomes Framework, to support the achievement of the CQUIN payment.

HR

29. The individual existing networks are not employing bodies in their own right and

are all hosted with formal arrangements in place. Local circumstances will need to be taken into account.

30. A set of HR FAQs will be developed to ensure national consistency in key areas,

underpinned by the principles set out in the national People Transition Policy.

31. It is expected that providers will want to make best use of existing talent and

experience to ensure continuity of delivery.

32. The working assumption is that TUPE applies i.e. the ODN network function is

transferring with the associated staff. There will need to be local agreement about the detail of the function transferring and the associated staff.

33. Specialised commissioners will lead local discussions to agree the host provider,

the contract specification and to coordinate communication of these discussions with sender organisations, future host providers and the wider networks of providers.

34. The sender organisation, i.e. existing employer, will be responsible for

determining the local applicability of TUPE arrangements, communicating with existing staff and managing formal consultation where appropriate as well as managing the transfer of staff.

35. Where the sender is not a PCT, the HR team of the local PCT will provide

advice on the People Transition Policy.

36. National timescales apply which means PCT/SHA staff need to know their

destination by 31 December 2012 so they will know that they are part of the team associated with the transferring function. Given that contracts will not be agreed with providers until February/March 2013, this will require cooperation between providers and commissioners to retain the skills and talents of staff.

10

37. It may be appropriate for staff to continue to provide input to the network through a service level agreement or secondment to the host provider. Such arrangements have worked well in the past, particularly for clinical staff who provide a sessional contribution.

38. Staff currently employed by PCTs and SHAs will have the opportunity to apply

for posts in the Strategic Clinical Network and Senate Support teams, in line with the People Transition Policy. This is until such point as they are defined as being in a team associated with a function that is transferring.

.

COMMUNICATIONS AND ENGAGEMENT

39. A detailed communication and engagement plan will be drafted to ensure key

stakeholders are informed of the establishment of ODNs and the requirements that need to be put in place by 1st April 2013.

40. Communications will be published via the NHS CB website.

NEXT STEPS 41. These are as follows:

Publication of Developing ODNs: The Way Forward (this document)

Development of communication and engagement plan by NHS CB communications team, to be supported by local teams

Arrangements for management of risk during transition led by local senders,

working with specialised commissioners

Local negotiation between specialised commissioning teams and providers,

initially about host provider and then in relation to specification and TUPE arrangements

Development of national products to support local arrangements i.e. model

governance arrangements and model specification.

11

APPENDIX A PURPOSE OF OPERATIONAL DELIVERY NETWORKS

ODNs will respond to need through national, regional and local determination, depending on the identified challenge, for example, a local critical care bed crisis or a large scale mass incident.

An ODN will:

Ensure effective clinical flows through the provider system through clinical

collaboration for networked provision of services Take a whole system, collaborative provision approach to ensure the delivery

of safe and effective services across the patient pathway, adding value for all its stakeholders

Improve cross-organisational, multi-professional clinical engagement to improve pathways of care

Enable the development of consistent provider guidance and improved service standards, ensuring a consistent patient and family experience

Focus on quality and effectiveness through the facilitation of comparative benchmarking and auditing of services, with implementation of required improvements

Fulfill a key role in assuring providers and commissioners of all aspects of quality as well as coordinating provider resources to secure the best outcomes for patients across wide geographical areas

Support capacity planning and activity monitoring with collaborative forecasting of demand, and matching of demand and supply

The benefits of this will be improved outcomes, productivity and increasing efficiency through:

Stronger collaborative networked provision of services

Maintained and/or improved patient outcomes and quality of care and, where appropriate, standardisation of care.

New approaches associated with new hosts

Increased opportunities for risk sharing between providers

Opportunities to more accurately cost out the pathways of care and the utilisation of resources more efficiently

Sharing the benefit of QIPP opportunities

Opportunity to move to a ‘prime contracting focus’ i.e. a single contract for a pathway of care over several providers, though this has not yet been agreed

More effective utilisation of contract levers for commissioners

Increased speed of adoption of innovation

Rapid learning and development

Improved system resilience, including major incident planning

12

Members of ODNs will work collaboratively to share learning, experiences, knowledge, skills and best practice for the benefit of all within that specialist environment. The ODN will need to function based on a ‘compact’ between all parties which defines professional behaviour. To promote providers to do a good job, a network competency assessment would allow qualification to establish an inter- provider contract model.

The outcomes and indicators in the NHS Outcomes Framework were chosen with a view to measuring the outcomes resulting from treatment activity for which the NHS is largely responsible. Providers will be held to account for delivering improved outcomes. Providers will be supported by ODNs in achieving their critical contribution to the indicators within the NHS Outcomes Framework.

Appendix 3

Greater Manchester Cancer Services (GMCS) Provider Board Terms of Reference

1. Influence the design of clinical services and their configurations to improve quality, better meet patients’ needs, offer appropriate patient choice and improve efficiency of service delivery.

2. Contribute to the operational design and ensure the delivery of a cohesive vision for Greater

Manchester Cancer Services which is consistent with the overall vision of Manchester Cancer for an integrated system of clinical services, research and education.

3. With Commissioners ensure equitable and affordable access to excellence in clinical cancer

care through integrated pathways across primary, secondary, tertiary, community and third sectors.

4. Ensure wide organisational engagement and support from member organisations for the

vision and implementation plans of Greater Manchester Cancer Services.

5. Ensure that the behaviours and commitment from partners and participants along cancer pathways are consistent with the overall goals of Greater Manchester Cancer Services.

6. Receive and challenge recommendations from the Clinical Director and Clinical Pathway

Directors for prioritisation of clinical pathways and for the service configurations to support these pathways – if necessary commissioning expert external advice on pathway proposals.

7. Ensure agreement amongst members on collaborative service provision arrangements,

including responding to commissioner requirements for lead.

8. Agree national and international benchmarks against which to measure and promote improved performance and implement world class models of cancer care.

9. Influence and inform the development of national and international strategies for value based

healthcare.

10. Work with commissioners to ensure that commissioner specification requirements are met through the implementation of cancer pathway plans.

11. Ensure that the patients’ best interests are the main driver for any proposed change.

Safe, High Quality Care, Fit for the Future

Quality and Safety

Valued Provider

Financially viable and sustainable

Great place to work

Fit for the future

Well Governed

Subject Integrated Performance Report – February 2014

Prepared By Performance and Informatics

Approved By Executive Management Team

Presented By Chief Executive – Bolton NHS Foundation Trust

Executive Summary

Please see the High level Executive Summary section at the beginning of the report

Key Recommendations

The Board are asked to receive the report and give approval.

Acronyms/Terms used in Report

TRUST BOARD

Trust Objectives

Purpose

This report sets out the Trust’s integrated performance against leading national and local targets and draws attention to key areas for specific review by the Trust Board. Driven by the Trust’s strategic objectives this report is underpinned by a strong platform of integrated governance and assured data quality controls allowing the Trust Board to make effective decisions and demonstrate its commitment to delivering high quality healthcare for the people of Bolton.

Report

Appendix A

Appendix B

Report change log

1

1 All Report data correct and verified as of Friday 14th February 2014


Executive Apex Reports High Level Executive Summary High Level Executive Dashboard High Level Executive Report • Monitor Risk Assessment Framework

Section 1 Improving the Quality of Care and Safety of our patients • Quality and Governance Scorecard • Quality and Governance Charts • Quality and Governance Report • Acquired Infection • Falls • Pressure Damage

Section 2 Valued provider of Integrated Services • Operations Scorecard

• Operations Charts • Operations Report

Contents

2



Section 3 Financially viable and sustainable • Finance Scorecard • Finance Report Section 4 A great place to work • Workforce Scorecard • Workforce Charts • Workforce Report Section 5 Ward to Board Heat Map

Section 6 Fit for the Future Section 7 Well Governed

Appendix A Acronyms/Terms used in Report

Appendix B Dashboard Change log - in month

3


Risk Management Strategy

Patient Experience Strategy

Winter Plan

ICIP forecast is £2.1m above plan

Year to date deficit is £1.8m ahead of plan

January in month surplus of £0.8m above plan

Forecast in year deficit of £7.8m is on plan.

Cancer 62 day standard has failed to reach 85% target for the second consecutive month.

Natural Staff Turnover is 9.3% against a monthly target of 10%. .

Sickness % of days lost has increased to 5.68% against a target of 3.75%

Local Induction Attendance has improved to 82.2%. The target is 100%.

Mandatory training compliance remains at 84%.

Quality Strategy

48 formal complaints received. This is the highest number since June 2013.

There are 4 C.Diff cases and 1 MRSA reported in month.

There are 7 Acute Inpatient Acquired and 7 Community Acquired pressure damage cases. The severity rating has reduced for in-patients but increased for community patients.

Over the financial year the number of patient falls has significantly reduced.

A&E 4 hour target achieved at 96.3%

All 18 week pathways have achieved in month.

Diagnostic waiting times have increased. The 1.0% National target has been breached at 1.6%.

Executive Summary

This executive summary provides an integrated overview of the Trust Board Performance Report. Supporting the Trust's Strategic Objectives it orientates executives quickly to the areas that have been escalated, are of particular note or political significance. The accompanying High-Level Dashboard and narrative gives further analyses. Compliance levels with the Monitor Risk Assessment Framework and CQC (Care Quality Commission) are also shown.

Improving the Quality of Care and Safety of our patients A great place to work

Valued provider of Integrated Services Fit for the future

Financially viable and sustainable Well GovernedOur Patients

The Trust continues to be licensed to carry out regulated activities with no conditions imposed

on our registration status

Monitor Risk Assessment Framework

CQC

Governance Finance

All Report data correct and verified as of Friday 14th February 2014

The Trust is listed as a category 4 weighted Trust by the CQC.

4


Improving The Quality Of Care And Safety Of Our Patients Plan 13/14 Plan YTD

Actual YTD

Monthly Actual

Monthly Change

On Plan Off Plan Financially Viable And Sustainable

Plan 13/14

Plan YTD

Plan Actual YTD

Monthly Actual

Monthly Change

On Plan Off Plan Well Governed Status

Total number of new SUIs received within the month 0 0 13 0 Forecast year end deficit - FYE -7.8 -7.8 -7.8 -7.8 0.0 0.0

Monitor Risk Assessment Framework On Plan

Total number of patient incidents (Clinical and non-clinical) 5000 4170 6301 636 Forecast year end recurrent run rate - FYE 0.0 0.0 -8.8 -8.8 0.0 -8.8

CQC Intelligent Monitoring Report On Plan

Never Event 0 0 1 0 Forecast year end income and cost improvement - FYE 16.2 16.2 13.9 13.9 0.9 -2.3CQC Essential Healthcare Standards (5) On Plan

All Patient Falls (Safeguard) 1034 860 813 68 Actual position against plan - YTD -7.8 -6.7 -4.9 1.0 0.8 1.8CQUINS: National Clinical Quality Indicators (4) On Plan

Acute Inpatients acquiring pressure damage (grades 2+) 29 24 87 7 Actual Income and Cost Improvement -YTD 16.2 12.6 12.3 2.0 0.3 -0.3 Report to prevent future deaths On Plan

Community patients acquiring pressure damage 80 24 117 7 Capital Expenditure YTD -5.9 -5.0 -2.0 -0.2 0.3 3.0 Litigation On Plan

VTE Assessment Compliance 95.0% 95.0% 96.3% 96.7% Cash Position YTD 0.3 1.3 0.5 -0.2 -0.3 -0.8 Formal Contract Notices Off Plan

Catheter Associated Urinary Tract Infection 95.0% 95.0% 95.1% 95.4% Continuity of services rating 1.0 1.0 1.0 1.0 0.0 0.0 Formal Performance Notices On Plan

MRSA Bacteraemia Post 48 Hours admission 10 8 2 1 Contract Fines/Penalties Off Plan

C Diff Hospital aquired 28 20 33 4

CHKS RAMI (Rolling 12 months) 100 100 80 80

SHMI 1.000 1.000 1.022 1.048 Local Induction Attendance (starters in the last 12 months) 100% 100% 70.9% 82.2%

Surgical WHO Checklist compliance (Elective) 100.0% 100.0% 89.50% 93.20%

Substantive Staff Turnover Headcount (rolling average 12 months) <=10% 10% 10% 9.4% 9.3% Quality Improvement Strategy On Plan

Surgical WHO Checklist compliance (Emergency) 100.0% 100.0% 89.70% 89.70%

NewAppraisals completed % 80% 80% 82.2% 83.7% Risk Management Strategy On Plan

Formal complaints from patients 214 179 486 48 Sickness days % of days lost 3.75% 3.75% 4.97% 5.68% Patient Experience Strategy On PlanComplaints responded to within the time period % 95% 95% 84% 95% Mandatory Training Compliance % 100% 100% 81.1% 84.0% Winter Planning On Plan

Electronic Patient Record On Plan

Valued Provider Of Integrated Services Plan 13/14 Plan YTDActual YTD

Monthly Actual

Monthly Change

On Plan Off Plan Cancer Treatment Targets (7)

Plan 13/14

Plan YTD

Actual YTD

Monthly Actual

Monthly Change

On Plan Off Plan Monitor Escalation On Plan

A&E 4 hour target 95.0% 95.0% 96.5% 96.3% Patients 2 week wait (all cancers) % 93.0% 93.0% 94.8% 93.5%

RTT Admitted Clock Stops % 90.0% 90.0% 94.8% 93.7% Patients 2 week wait (breast symptomatic) % 93.0% 93.0% 96.5% 96.9%

RTT Non-Admitted Clock Stops % 95.0% 95.0% 96.5% 96.5% 31 days to first treatment % 96.0% 96.0% 98.5% 100.0%

RTT: Incomplete pathways within 18 weeks % 92.0% 92.0% N/A 95.9% 31 days subsequent treatment (surgery) % 94.0% 94.0% 100.0% 100.0%

Diagnostic waits >6 weeks % 1.0% 1.0% N/A 1.6% 31 days subsequent treatment (anti cancer drugs) % 98.0% 98.0% 100.0% 100.0%% of patients who spend 90% of their stay on the stroke unit 80.0% 80.0% 84.5% 88.6% 62 day standard % 85.0% 85.0% 87.5% 81.2%

% Readmissions within 30 days of discharge 8.0% 8.0% 12.4% 12.2% 62 day screening % 90.0% 90.0% 91.5% 100.0%

The On Plan / Off Plan Columns represent a projected Year End position. The status columns represents the current status of the initiative detailed

Status

High Level Executive Dashboard

Fit for the Future

Performance improved but off target in month

Performance deteriorated and off target in month

Monthly Change

On Plan Off PlanDeveloping Our Staff

Plan 13/14

Plan YTD

Actual YTD

Monthly Actual

Performance improved and on target in month

Performance deteriorated but on target in month

5


No. Area Indicator (All measured Quarterly) Threshold Weighting Oct-13 Nov-13 Dec-13Quarter 3 Actual Jan-14

2.05

Maximum time of 18 weeks from point of referral to treatment in aggregate – admitted 90% 1.0 94.3% 94.9% 94.3% 94.9% 93.7%

2.06

Maximum time of 18 weeks from point of referral to treatment in aggregate – non-admitted 95% 1.0 95.9% 96.1% 96.3% 96.6% 96.5%

2.07

Maximum time of 18 weeks from point of referral to treatment in aggregate – patients on an incomplete pathway 92% 1.0 95.3% 95.9% 95.4% 95.4% 95.9%

2.01

A&E: maximum waiting time of four hours from arrival to admission/ transfer/ discharge 95% 1.0 96.7% 96.1% 96.7% 96.5% 96.3%All cancers: 62-day wait for first treatment from:

2.23 Urgent GP referral for suspected cancer 85% 88.6% 84% 81% 84.6%2.24 NHS Cancer Screening Service referral 90% 95.0% 81% 100% 92.1%

All cancers: 31-day wait for second or subsequent treatment, comprising:

2.21 Surgery 94% 1.0 100.0% 100% 100% 100.0%2.22 Anti-cancer drug treatments 98% 1.0 100.0% 100% 100% 100.0%

2.20

All cancers: 31-day wait from diagnosis to first treatment 96% 1.0 97.1% 99% 100% 98.7%

Cancer: two week wait from referral to date first seen, comprising:

2.18 All urgent referrals (cancer suspected) 93% 94.7% 95% 94% 94.4%

2.19

For symptomatic breast patients (cancer not initially suspected) 93% 94.6% 91% 97% 94.0%

1.13

Clostridium (C.) difficile – meeting the C. difficile objective DM* 1.0 2 2 0 4 4

1.33

Certification against compliance with requirements regarding access to health care for people with a learning disability 100% 1.0 100% 100% 100% 100% 100%

Data completeness: community services, comprising:Referral to treatment information 50% 99% 99% 99% 99% 99%

Referral information 50% 100% 100% 100% 100% 100%Treatment activity information 50% 100% 100% 100% 100% 100%

Acc

ess

1.0

1.0

Monitor Risk Assessment Framework 2013/14

Out

com

es

1.0

6


High level Executive Report

Harm Free Care

• No Serious and Untoward Incidents and no Never Events in month.

• Patient Incidents – Following on from the report tabled at Board last month work is being undertaken to strengthen our internal governance processes. Benchmarking criteria is being established to ensure that we can compare ourselves with other providers. It is envisaged that this overall review will be completed by April 2014. A new weekly Incident Report Panel has commenced to review all incidents and subsequent grading decisions.

• The Falls Strategy continues to be implemented across all teams. The last two months have seen a lower return of patient falls occurring. From the beginning of the financial year the number of patient falls has reduced by 39.8%.

• Hospital and Community Acquired Pressure Damage is an area of high focus for the Trust and remains of concern. The “Effective Management of Pressure Area Care Strategy” has been implemented. There have been 7 in-patients acquiring pressure damage and 7 community patients.

Category Performance Indicator Nov-13 Dec-13 Jan-14

Patients acquiring pressure damage (grade 2) 8 3 4Patients acquiring pressure damage (grade 3) 4 4 3Patients acquiring pressure damage (grade 4) 0 0 0Patients acquiring pressure damage (Total) 12 7 7Patients acquiring pressure damage (grade 2) 13 6 2Patients acquiring pressure damage (grade 3) 4 1 3Patients acquiring pressure damage (grade 4) 4 0 2Patients acquiring pressure damage (Total) 21 7 7

Hos

pita

lC

omm

unity

7


Safety Thermometer (CQUIN)

• VTE Assessment and Catheter Associated Urinary Tract Infection targets show sustained achievement.

Acquired Infection

• One MRSA infection in January 2014 from a high risk patient who was known to have had MRSA previously. One of the lessons learned from the clinical review determined that all high risk patients should be treated immediately rather than wait for the results of initial tests. There has been a change in policy as a result of this learning.

• 4 C.Diff cases this month - 3 from the same area. An outbreak strategy meeting was convened with all teams. The root-cause-analysis determined that there was no contamination between the patients and no correlation with the cases. All patients were high risk and on antibiotics. As an added precaution the ward has been decanted and a full, deep clean is underway.

Mortality

• RAMI and SHMI are both within acceptable national thresholds. We are banded as expected. An intensive Mortality Review report is routinely tabled within the Quality and Safety Committee.

Surgical WHO Checklist

• Elective and Emergency Theatres are now shown separately owing to a full month’s data being available. Compliance is shown as 93.2% for elective and 89.7% for emergency.

8


Complaints

• Formal complaints have risen to 48 in month and response times show that 95% of complaints are being responded to within the given timescales. A full detailed analysis of complaints is tabled at the Quality Assurance Committee where the key themes and top 5 presenting complaints are reviewed.

Valued provider of Integrated Services National Targets

• A&E 4 hour target has achieved at 96.3%.

• All 18 week admitted, non-admitted and incomplete pathway targets are met in month.

• At the end of January there were 38 patients waiting over 6 weeks for diagnostic tests from a total of 2413 waiters, giving a position of 1.6% against the target of 1%. Of the 38, the biggest Diagnostic groups are Colonoscopy, Flexi-Sigmoidoscopy and CT scan. Within Endoscopy the delays are in the main due to the patient requiring more specialised input. A misalignment of the local reporting in radiology to the Trusts overall reporting processes resulted in the CT scan breaches. This problem has now been resolved.

• The National stroke target continues to achieve at 88.6%.

• The 8% target for re-admissions within 30 days of discharge is still scheduled for review with the CCG.

• The 62 day standard cancer target has failed to achieve for the second consecutive month. Cancer performance is reported one month retrospectively. In December 12 patients were treated outside the 62 day pathway. This was across most specialities: Colorectal x1, Haematology x1, Lung x3, Urology x3, Upper GI x3 and Skin x1. All specialities are working towards ensuring patients are offered a 1st appointment within 9 days and continue to closely monitor individual patients to avoid unnecessary delays.

9


Financially Viable and sustainable

• The Trust is ahead of plan year to date and is forecasting to deliver the planned deficit of £(7.8)m by the end of the year. The

underlying Trust deficit will be below the £ (7.8m). However, due to the requirement to reset our provisions for restructuring to deliver the 2014/15 ICIP’s we are still forecasting a £ (7.8m) deficit.

• The full year forecast for income and cost improvements is £16.1m v £18.3m plan.

• The Trust has reported a surplus financial position for month 10 of £1.0m against a planned surplus of £0.2m. The cumulative deficit of £ (4.9m) is better than planned by £ 1.9m. Income is £0.6m above budget this month. Non-pay underspend of £0.4m this month continues to support the overall position with a cumulative under spend of £1.8m. Pay costs have risen by £0.4m compared with last month and are £ (0.4m) over spent in the month.

• Income and cost improvements year to date at £12.3m are now £0.3m behind plan. This is due to the Board decision to reinvest nursing savings on the wards and the lower delivery rates than planned in some other work streams. This is being mitigated by additional ICIP plans which are in place in the divisions as part of their financial recovery plans.

• The Trust capital plan as submitted to Monitor is £6.0m as at the end of January capital was £3.0m underspent. The under spend is in a number of areas of replacements, maintenance and enhancements. It is forecast to spend the full capital budget by the end of the year. Plans are in place to spend all the Capital by the year end.

• Cash has been managed effectively with a £0.5m cash balance at the end of January. The year-end position assumes support of £17.25m from DoH.

10


Workforce

• Substantive Staff Turnover Headcount (rolling 12 months) has achieved at 9.3 % against a target of 10%.

• Local Induction - compliance has improved to 82.2%. A focused effort has been made this month to capture those non-compliant to return local induction documentation. The new streamlined documentation has been positively received.

• Mandatory Training - compliance remains at 84.0%. For new starters, corporate induction has been increased to four days to ensure new staff receive all mandatory training. For existing staff, work continues with hotspot areas to improve compliance. Where there have been only minor or no improvements this is being escalated to management teams.

• Sickness absence rates have increased in January 2014 to 5.68%. The Sickness Intervention Team (SIT) has started to

support reducing sickness absence rates by ensuring processes are in place to manage sickness absence, particularly in hotspot areas.

Fit for the Future

• The Quality Improvement Strategy has been approved at Board and a Communication Strategy is being developed to cascade the Quality Aims to teams.

• Following approval at Board of the Risk Management Strategy there is a cascade system being developed with key individuals nominated to drive work streams forward.

• A paper is tabled at February’s Board in relation to the Patient Experience Strategy. There is currently a work plan being developed to implement the key initiatives.

• The Winter Plan has been fully implemented.

11


Well Governed

• The Trust continues to monitor current performance against the CQC Intelligent Monitoring Report.

• There are 5 Essential Healthcare Standards which have 17 outcomes for delivery. The Trust remains compliant with all of the standards.

• The table below shows the fines and penalties for current performance for month 10 based on month 9 performance.

Plan Actual£'000 £'000

Penalties (417) (268)C-Diff 0 (465)TOTAL (417) (733)

• The Trust has received penalties for 18 weeks breaches in T&O. Due to improved trajectory on C-Diff the penalty has been

reduced significantly, as well as the re-admission penalty following discussions with commissioners. The NEL threshold adjustment has also improved in month due to a reduction in excess bed day activity.

12


Date Indicator Code Indicator Description Requested by Change Authorised by

19/11/13Monitor Compliance Governance 1013-14

Monitor Compliance Governance 1013-14 Report Esther Steel Remove from Report. No longer used. Esther Steel

27/11/13

1.07 - Total number of incidents (Clinical and non-clinical)

This metric is everything reported, patient, staff, visitors, contractors, non person. “Clinical & non clinical” infers just patient incidents. Eric Porter

Change to 1.07 - Total Incidents reported on Safeguard Trish Armstrong-Child

04/12/13

4.02 - Substantive Staff Turnover Headcount (rolling average 12 months)

Labour turnover of substantive contracted employees Kelly King

This metric previously included turnover relating to contrived reductions in workforce over the course of the year, relating to Turnaround schemes, redundancies (voluntary and compulsory) etc. The data for this metric should be based on “natural” turnover in order to demonstrate a representative picture of the workforce. Retrospective figures have replaced the previously reported figures for the current year (2013/14). The 2012/13 figures have not been adjusted. The target remains at 10%. The metric definition has also been changed. Louise Ludgrove

13/12/13 1.39 ‐ MRSA HA acquisitions N/A Julie Dziobon This is a duplicate of metric number 1.38 - MRSA Bacteraemia post-48 Hours admission Trish Armstrong-Child

13/12/131.37 - MRSA Bacteraemia pre-48 Hours admission

No of pts identified as having MRSA presenting complaint 48 hrs before admission Julie Dziobon

All pre cases are now the responsibility of the CCG, for both CDT & MRSA bacteraemia cases, so despite having 4 pre cases of MRSA bacteraemia for the current year– none of them have been attributed to the Foundation Trust. Action: To remove this metric . Trish Armstrong-Child

17/01/14 1.50 Infection Control Level 1 National Qualification David Wakefield Not Reportable David Wakefield

17/01/14 1.51 Infection Control Level 2 National Qualification David Wakefield Not Reportable David Wakefield

14/02/14

1.36 Surgical WHO Checklist compliance (Emergency)

Checklist to reduce surgical morbidity and mortality Mike Steele Metric added Jill Patterson

Report Change log

13


Agenda Item No: 9



Title Francis, Berwick, Keogh, Overview Update

Executive Summary

Why is this paper going to the Board

To summarise the main points and key issues that the Board should focus on including risk, compliance priorities, cost and penalty implications, KPI’s, Trends and Projections, conclusions and proposals

All healthcare providers are currently working in an unprecedented time of change. Challenges to demonstrate that services are patient focused, financially stable and well governed have never been as great. The Trust has continued to develop a number of initiatives in a direct response to the recommendations made by the reviews of Francis, Berwick and Keogh. This will assist the organisation in the preparation for the new CQC Hospital Inspection programme of visits.

At the November 2013 Trust Board, the Director of Nursing provided an overview of the recommendations made by three key reports Francis, Berwick and Keogh and the Trusts response to their recommendations. This briefing paper provides an overview of further progress made since then.

Next steps/future actions Clearly identify what will follow a Board decision i.e. future KPI’s, assurance requirements

Actions to be monitored via the Quality Assurance Committee

Discuss Receive

Approve Note

Assurance to be provided by:

Bev Tabernacle, Deputy Director of Nursing




Quality Regulatory




Prepared by Bev Tabernacle, Deputy Director of Nursing

Presented by Trish Armstrong-Child, Director of Nursing

Francis, Berwick, Keogh, Overview Update Introduction At the November 2013 Trust Board meeting the Director of Nursing presented an overview of the recommendations made by each of the above reviews and how these may impact on Bolton FT.

This paper is an update on progress following that initial presentation. Background

The Trust Integrated Performance Dashboard continues to be developed in order to ensure there is accurate and detailed oversight and scrutiny of performance across the organisation. In response to the performance highlighted within the dashboard the Trust has continued to respond to areas that require further development or support. The organisation has continued to implement new strategies and approaches to ensure patient quality and safety is at the centre of our services. Key Actions and Progress in Quarter 3

The new Quality Strategy and Patient Experience Strategy set out clear outcomes for achievement for the next year. Ensuring that the patient remains at the heart of what we do at Bolton FT. The Medical Director has begun to implement a series of ‘listening and learning’ events that include a wide range of staff from across the organisation

Governance processes have been fully reviewed and revised through the development of the new Risk Management Strategy. The Trusts current SUI process has been revised and a new policy drafted. Openness, honesty and candour is a key element of these strategies and policies moving forward.

The Ward to Board information included in the original Integrated Performance Dashboard has been developed further with the introduction of the ‘Heat Map’. This provides detailed information per ward that enables triangulation of information. Quality indicators are clearly highlighted in the context of staffing levels and training within each area.

The development of the new Exemplar Star System of Accreditation (ESSA) framework will ensure that wards and departments are continually improving their services to patients. When issues are identified a practice review process has been developed to support the areas to address any concerns.

A performance framework, including revised KPI’s have been developed for Ward Managers and Matrons to provide clarity in relation to roles and responsibility. A Leadership programme to further develop staff and identify talent is currently under development.

One of the 2014/15 local CQUIN’s that has been agreed with our Commissioners is the development of a learning cartel utilising the MAPSAF assessment of patient safety culture. This will enable the Trust to have a formal assessment of its attitude towards patient safety issues and learning.

The 290 recommendation made by Francis have now been fully examined and this analysis will be presented at the Quality Assurance Committee in March 2014 to provide assurance that each element of the recommendations made has been fully considered by the Trust.

Conclusion Since the last update to Trust Board In November 2013 good progress has been made in implementing many of the recommendations of these 3 key reports. However, the Executive team recognise that work will be ongoing to ensure continuous improvements can be demonstrated. The Francis Action Plan will be presented at the Quality Assurance Committee and will also be shared with commissioners to ensure the organisation has fully considered the impact of all the recommendations made. Recommendations The Trust Board are asked to note the progress made and agree that future monitoring of this should be undertaken by the Quality Assurance Committee.

Agenda Item No: 10



Title Patient Experience Strategy Implementation Plan

Executive Summary

Why is this paper going to the Board

To summarise the main points and key issues that the Board should focus on including risk, compliance priorities, cost and penalty implications, KPI’s, Trends and Projections, conclusions and proposals

The implementation of the Patient Experience Strategy, running parallel to the Quality Strategy has the potential to transform the experience of patients using the services that Bolton FT provides. The initial implementation work plan, for the first year will be monitored, amended and developed by the Patient Experience Sub Committee. The Quality Assurance Committee will undertake scrutiny and overview of this strategy implementation.


Outlined in Appendix 1

Discuss Receive

Approve Note


Bev Tabernacle, Deputy Director of Nursing




Quality Regulatory




Prepared by Bev Tabernacle, Deputy Director of Nursing

Presented by Trish Armstrong-Child, Director of Nursing

Patient Experience Strategy Implementation Plan 2014 Purpose To provide the Trust Board with the implementation work plan for year one of the Patient, Family and Carer Experience Strategy. Background In November 2013 the Trust Board received and approved the new Patient Experience Strategy which outlined the key seven outcomes to be achieved over the 3 year implementation programme. A communication programme is being developed to ensure that the strategy is publicised across the organisation. Key elements of the strategy document will be used to engage staff in the delivery of the outcomes. The Trusts new Patient Experience Manager will be responsible for overseeing the delivery of the Strategy. Support will be provided from the Deputy Director of Nursing and the newly developed role of the Patient Experience Assistant. The Patient Experience and Inclusion Group will be the committee monitoring its implementation. A CQUIN to accelerate the delivery of the strategy has been agreed locally with Bolton CCG, and this will focus on the delivery of a programme of collating real time patient experience information. Proposal It is recognised that the Strategy document is ambitious and some key priorities need to be set for the first year. This will ensure we can evidence clear tangible improvements. The work plan for the year one implementation of the strategy is included in Appendix 1. Conclusion The implementation of this strategy alongside the delivery of the recently launched Quality Strategy has the potential to transform the experience of patients using the services that Bolton FT provides. This initial implementation plan, which will be monitored, amended and developed by the patient experience group. The Quality Assurance Committee will undertake scrutiny and overview of this strategy implementation. Recommendations The Trust Board are asked to approve this implementation plan and agree that future monitoring of this should be undertaken by the Quality Assurance Committee.

Ma

r-14

Apr-

14

Ma

y-1

4

Jun-1

4

Jul-14

Aug-1

4

Sep-1

4

Oct-

14

Nov-1

4

Dec-1

4

We will improve the patients

experience from the start until

the finish of their journey

Communication Strategy in relation to

ensuring all staff have a knowledge and

understanding of what the strategy is

expected to achieve

Patient Experience

Manager

Mar-14 TBDDevelop further the Bedside Booklet for

patients and familiesDeputy Director of

Nursing

Head of

Communications Mar-14 TBDFull implementation of Safety Huddles

across the organisation Mar-14 TBD

Work with Health Watch to develop planned

programme of events and feeback Jun-14

Formalise action plans of patient board

stories and monitor lessons learnt via QA

Committee Mar-14 TBDEvaluate the Patient Safety Walkabout

process ensuring this develops in line with

staff feedback and experience Mar-14 TBD

We want to ensure that services

offered by the organisation are

accessible to all groups

Review the information available to patients

and their families on the external Trust Web

Site

Patient Experience

Manager Mar-14 TBD

Develop an engagement strategy and user

reference group to ensure that when

changes are made to services we have a

process of consultation and involvement

Head of

Communications

Deputy Director of

NursingJul-14 TBD

Continue to deliver work in relation to the

objectives agreed for Equality and Diversity Ongoing SWe will improve communication

with patients, families and their

carers

StatusOutcome/Action Owner/Lead Start Date

Review of the provision of patient

information.Patient Experience

Manager

Deputy Director of

Nursing Aug-14 TBDOpen Visiting will be examined across

appropriate areas Professional Leads Mar-14 TBD

Hospital Signage will be reviewed

Associate Director of

Estates Sep-14 TBD

FFT Dashboards will be developed for each

department ensuring the use of comments

and the 'You Said' 'We Did' framework Apr-14 TBDModule to be developed in line with key

themes identified in complaints Jul-14 TBDA Patient Experience module will be

developed in collaboration with the Learning

and Development department Sep-14 TBD

We will meet all the patients

physical comfort needsIntentional Rounding will be fully

implemented across the organisation Jul-14 TBDThe Harm Free Care Strategies will be fully

implemented evaluated and understood

across departments Jun-14 TBDAll ward baseline assessments for the

ESSA process will be completed Aug-14 TBDWe will meet the patients

emotional needs while using

Trust ServicesChaplaincy Volunteers will be further

developed Oct-14

The 'My name is' process will be

implemented across the Trust Jun-14

We will continually improve the

experience of patients families

and carersA process of real time patient experience

data caollection will be implemented

Jul-14 TBD

Started (S)

To be done (TBD)

Complete (C)

Agenda Item No : 12


Date 27 February 2014

Title Mandatory Training Report

Executive Summary

Why is this paper going to

the Board To summarise the main

points and key issues that the Board should focus on including risk, compliance priorities, cost and penalty implications, KPI’s, Trends and Projections, conclusions and proposals

The aim of this report is to provide information that will give an overall picture of mandatory training across the Trust. The report provides facts and figures based on the latest data and actions taken to support compliance. It also looks at suggestions for further measures based on practice from Trusts with higher training levels.


The Committee is asked to receive the report.

Discuss / Receive /

Approve Note


Workforce Committee


Strategy / Financial Implications

Performance / Legal Implications

Quality / Regulatory

Workforce / Stakeholder implications



Prepared by Carol Le Blanc - Head of Clinical & Professional Development

Presented by

Suzanne Woolridge – Acting Director of Workforce

BOARD OF DIRECTORS

Mandatory Training Report

1. Introduction This report contains data on the overall mandatory training position of the Trust and also describes the actions taken and further planned measures to improve compliance. Mandatory training is not easily benchmarked as it does not feature on the regional scorecards; however, we have contacted neighbouring Trusts to ask what their current position is in order to attempt to establish benchmark information. Caution must be taken because the training content is significantly variable and so comparisons may not be accurate. Verbal feedback of performance ranges between 70% and 95%. The report also makes suggestions for further areas to consider based on best practice seen at other Trusts.

2. Current situation – The facts and figures Our current mandatory training rate (as at January 2014) is 84%; this is based on a rolling 12 month period.

Divisional Table

Division Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14

Acute Adult 77.70% 78.30% 80.10% 82.40% 82.90% 83.20% 82.70% 82.10% 83.30% 83.40%

Elective Care 72.90% 73.90% 74.70% 75.80% 76.70% 78.60% 78.50% 79.30% 80.20% 80.10%

Families 76% 78% 80.10% 82.40% 84.60% 86% 86.70% 87.70% 88.40% 87.90%

Corporate 88.50% 87.20% 88.50% 88.90% 90.10% 88.50% 88.20% 89.30% 87.10% 87%

Mandatory training is delivered through a blended approach, which includes a combination of face to face training and e-learning. Six topics are delivered through face to face training and eight topics, including information governance, through e-learning. There is opportunity to attend some face to face training for e-learning topics, if this approach is preferred. The chart below shows the percentage compliance within each topic area for January 2014:

Conflict resolution and VTE are the lowest performing areas. Our capacity to deliver Conflict resolution training has increased over the past 12 months in order to improve compliance, which was 51% in January 2013, current performance for January 2014 stands at 77.7%. There is a focused effort to improve VTE compliance within the Trust as this is a once only e-learning package that takes a maximum of 30 minutes to complete. Senior divisional teams have received a list of staff who are showing as non-compliant with expected completion by the end of March 2014.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jan 14 Mandatory Training Topics Compliance

3. Divisional Compliance The tables below show the position within the Divisions. Managers in the hotspot areas are being supported by the mandatory training team, who offer bespoke training and advice to focus on the most critical mandatory training topics first. Corporate Divisions

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0%10%20%30%40%50%60%70%80%90%

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Family Division – Paediatrics (continued)

Family Division – Midwifery

4. Did Not Attends (DNAs) The current DNA rates for mandatory training are as follows:

Division Acute Adult Care Division 57

Elective Care Division 49

Family Division 11

Patient Safety & Experience Directorate 1

Total 118

0%10%20%30%40%50%60%70%80%90%

100%

Jan14

0%10%20%30%40%50%60%70%80%90%

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Jan-14

The main reason for DNAs continues to be the operational pressures of staffing problems. DNAs account for a third of the total places offered. It has been an unusual year with above average levels of vacancies, which are now being addressed. This means that the management of DNAs should move away from operational difficulties to an understanding of any individual non-compliance, which can be dealt with differently.

5. Recent Measures The team has recently introduced a number of new measures to enable the Trust to achieve its aim to have all available staff trained in the mandatory topics:

A review of capacity has been undertaken to ensure we have appropriate sessions to deliver the modules to the relevant workforce

Flexible methods of delivery have been employed so that staff who prefer an e-learning approach can opt for this where it is available

Extra capacity has been implemented to address the hot spot areas

Capacity has been increased to provide more face to face training and support is available for e-learning through the mandatory training team and library services

Advice is given to managers to prioritise the key topics for their areas and the most appropriate options for delivery in order to improve performance

When mandatory training is planned peak activity times are considered and 15% overbooking is used to account for DNAs

All DNAs are notified to the management team for follow up

Extension of the Trust induction from 1.5 days to 4 days to include mandatory training for all new starters is due to commence

Management of low compliance through the PAF has started

Partnership approach with Divisions with allocated training days so that attendance and DNAs can be managed directly

Automatic re-booking of staff onto programmes eleven months after their attendance

No ‘desirable’ training authorised until mandatory training is complete

6. Options for the future In order to understand how the Trust can make further improvement we contacted our peers who are sustaining a position of above 90%; the following areas represent measures the Trust may want to consider:

Individual real time data accessible from the Intranet so that staff can access their record to establish their current position and access electronic packages

Only measure staff available to undertake mandatory training and discount known long term absentees, for example, maternity leave, secondment and known long term sickness

Suspension with no pay or disciplinary action for individual non-attendance for ‘core’ subjects such as infection prevention and control. The operational pressures of staff vacancies and absenteeism would need to be resolved in order to start this practice

Robust performance management systems of attendance and DNAs for accountable managers

Text message alerts

7. Summary The Trust has made significant progress in the area of mandatory training working from a low baseline initially; however, the rate of progress has plateaued in view of operational pressures. Other urgent training requirements have limited progress in mandatory training, for example, tracheotomy, tissue viability, blood transfusion and medical devices training, which has reduced the available training time for the clinical staff. However, this should only be a short-term issue. Implementation of a more structured and bespoke package of mandatory training for each Division should support improvement by allowing managers to proactively manage mandatory training and DNAs within their areas and increase performance. It is evident that there is sufficient capacity, with flexible delivery options. New starters will now be captured at induction and there will also be the opportunity for existing staff to access this training. There will also be a more performance-led effort to ensure Divisional compliance. The Trust may wish to consider other best practice to support the drive to ensure all available staff are trained to mandatory requirements.

Agenda Item No : 14



Title Finance & Activity Report Month 10

Executive Summary

• Why is this paper going to the Board of Directors

• To summarise the main points and key issues that the Board of Directors should focus on including risk, compliance priorities, cost and penalty implications, KPI’s, Trends and Projections, conclusions and proposals

Please find attached the monthly Financial Board Reporting pack The key points to note are:-

• The financial position for month 10 was a surplus £1.0m which is £0.8m better than planned.

• The year to date position is a £(4.9)m deficit compared to the planned £(6.7)m.

• Income is £0.6m above budget this month, comprised of adverse variances of (£252k) on PbR income and positive variances of £816k on income reductions due mainly to an improved trajectory on C-Diff. There has also been an increase in income for our education contract with Health Education England of £755k.

• Pay costs have risen by £0.4m compared with December; marginally above the average for the year.

• Non-pay underspend of £0.4m this month continues to support the overall position.

• Income and cost improvement are forecast to be ahead of plan by £2.1m for this financial year.

• The Trust forecast shows that the Trust’s plan deficit of £7.8m will be achieved.


Discuss Receive

Approve Note





Quality Regulatory




Prepared by Andrea Bennett Deputy Director of Finance Presented by Simon Worthington

Director of Finance

Finance Report for the year to the end of January 2014 (Month 10)

1. Introduction

1.1 This report is intended to update the Board and provide more information on the financial position of the Trust as at month 10 and to provide further detail on the forecast for the remainder of the financial year.

1.2 The Trust is ahead of plan year to date and is forecasting to deliver the planned deficit of £(7.8)m by the end of the year. The underlying Trust deficit will be below the £(7.8)m. However, due to the requirement to reset our provisions for restructuring to deliver the 2014/15 ICIP’s we are still forecasting a £(7.8)m deficit.

2. Month 10 Financial position

2.1 The financial position for month 10 was a surplus of £1.0m which is £0.8m better than planned. The year to date position is a £(4.9)m deficit compared to the planned £(6.7)m.

2.2 Income is £0.6m above budget this month, comprised of adverse variances of (£252k) on PbR income and positive variances of £816k on income reductions due mainly to an improved trajectory on C-Diff. There has also been an increase in income for our education contract with Health Education England of £755k.

2.3 Pay costs have risen by £0.4m compared with December marginally above the average for the year.

2.4 The financial plan included PDC funding of £14.25m to the end of month

10 and £17.25m for the full year. It is intended to draw down the whole amount by year end. To date £3.25m of PDC funding has been utilised.

3. Income and Cost improvements Plans (ICIPs)

3.1 Due to the current underlying performance of the Trust, with improved Divisional positions and income over performance, the forecast ICIP delivery has been revised and shows an over-delivery of £2.1m on income and cost improvements as shown below.

Plan Forecast Difference £000s £000s £000sCIP Recurrent 14,600 11,736 ‐2,864CIP Non Recurrent 0 1,372 1,372Income 1,575 2,961 1,386Risk Reserve 2,200 2,200Total 16,175 18,269 2,094

3.3 The actual / forecast performance by work stream compared to plan is contained within the body of the report.

4. Forecast for the Financial Year 2013/14

4.1 The forecast deficit for the financial year 2013/14 remains unchanged from last month at £(7.8)m deficit. The forecast income position reflects discussion with Bolton CCG. Taking the risk reserve and non recurrent items into account the underlying deficit will be below the £(7.8)m. However, due to the requirement to reset our provisions for restructuring to deliver the 2014/15 ICIP’s we are still forecasting that the plan deficit of £7.8m will be achieved.

5. Recommendation

5.1 It is recommended that the Board notes the content of the report.

1. Executive Dashboard

1

(10.0)(9.0)(8.0)(7.0)(6.0)(5.0)(4.0)(3.0)(2.0)(1.0)

-

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

Surplus / (deficit) £m

Cumulative P lan Cumulative Actual / Forecast

0.0

5.0

10.0

15.0

20.0

02-F

eb

09-F

eb

16-F

eb

23-F

eb

02-M

ar

09-M

ar

16-M

ar

23-M

ar

30-M

ar

13 Week Cash Forecast(£m)

Cash forecast

0.0

1.0

2.0

3.0

4.0

5.0

6.0

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

Forecast month end cash balance (£m)

Forecast Actual

(25.0)

(20.0)

(15.0)

(10.0)

(5.0)

0.0


Net Current assets / (liabilities) (£m)

Actual Plan

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0


Cumulative capital expenditure (£m)

Actual spend Annual Budget

(0.5)

0.0

0.5

1.0

1.5

2.0


In-month ICIP delivery(£m)

Plan Actual

1. Executive Commentary

2

Income and Expenditure• This month shows a surplus of £1.0m (£0.8m favourable variance from plan) and a total deficit for the year of £4.9m which

is £1.9m favourable to plan.• Income is £0.6m above budget this month comprised of adverse variances of (£252k) on PbR income and positive

variances of £816k on income reductions due mainly to an improved trajectories on C-Diff. There has also been an increase in income for our education contract with Health Education England of £755k.

• Pay costs have increased by £429k compared with December ,which is marginally over the average for the year.• Non-pay underspend of £0.6m this month continues to support the overall position.• The monthly trend figures suggest that the divisions are strongly focussed on achieving the year end position and savings

are being made over and above those identified by the turnaround programme. At present the three clinical divisions show a net adverse variance of £1.2m on a budget of £184.1m (0.6%). The divisions have plans to bring most of the adverse variance back in line however Elective Care is forecasting a material overspend.

• The year end outturn position remains forecast to be £7.8m deficit as last month.

M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 YTDActual £m £m £m £m £m £m £m £m £m £m £mIncome 23.1 22.8 23.0 23.5 22.8 22.5 24.8 23.7 23.9 25.3 235.3 Pay ‐16.9 ‐16.7 ‐16.6 ‐16.6 ‐16.6 ‐16.6 ‐16.8 ‐16.9 ‐16.5 ‐17.0 ‐167.1 Non‐pay ‐7.4 ‐7.3 ‐7.1 ‐7.2 ‐7.6 ‐6.6 ‐8.0 ‐7.1 ‐7.6 ‐7.3 ‐73.0 Deficit ‐1.2 ‐1.2 ‐0.7 ‐0.3 ‐1.4 ‐0.7 ‐0.0 ‐0.3 ‐0.2 1.0 ‐4.9 Budget ‐1.8 ‐1.4 ‐1.9 0.0 ‐0.4 ‐0.6 0.2 ‐0.5 ‐0.5 0.2 ‐6.7 Variance 0.6 0.2 1.2 ‐0.3 ‐0.9 ‐0.1 ‐0.3 0.2 0.2 0.8 1.9

1. Executive Commentary

3

Cash and Capital

• Cash has been managed effectively with a £0.2m cash outflow and a £0.5m cash balance at the end of the month.

• PDC funding is currently forecast with the remaining requirement of £14m during Feb and Mar ‘14. This is subject to the phasing of the redundancy and capital payments.

• The year end position assumes support of £17.25m from DoH. The assumptions behind this is delivery of £7.8m deficit and full use of redundancy provision and full spend of capital.

• The Trust cash position at the end of January is £0.8m behind plan. However the Trust hasn’t drawn down £11m of PDC as planned. The reasons for this are:-

£m

Phasing of redundancy 3.2

Over achievement of plan to actual 1.9

Capital position 3.0

Working capital movements 2.9

11.0

• The capital budget for the year is £5.9m profiled equally by month. To date this is underspent by £3.0m. Historically capital expenditure accelerates through the year. Action is being taken to ensure full capital spend.

• Should the Trust fail to deliver full forecast expenditure on either the capital or redundancy programmes then alternative measures will be sought to ensure the cash expenditure is as forecast at year end.

2.1 Income & Expenditure

4

2.1.1 Summary I&E

• This month shows a £1.0m surplus which is £0.8m better than budget. YTD the Trust now has a deficit of £4.9m, £1.9m better than plan and the budgeted and forecast deficit for the whole year remains unchanged and on plan at £7.8m.

• Income shows a favourable variance of £0.6m in month and is now favourable by £1.4m YTD reflecting an increase in a number of different areas.

• The adverse variance on pay in month is driven by increased use of agency staff (see page 16)

• Non-pay is underspent this month as in previous months and reflects good cost control at divisional level.

2.1.1 I&E

Income and Expenditure M10Annual Budget Budget Actual Var.

Prior Year Budget Actual Var.

£m £m £m £m £m £m £m £mPatient income 252.4 22.0 22.4 0.4 208.4 211.2 212.1 0.9Other Income 28.1 2.7 2.9 0.2 23.0 22.7 23.1 0.5Total Income 280.5 24.7 25.3 0.6 231.4 233.9 235.3 1.4Pay (198.4) (16.5) (16.9) (0.4) (172.8) (165.9) (167.0) (1.1)Non-Pay (79.0) (7.1) (6.6) 0.4 (64.3) (65.6) (63.8) 1.8Total Expenses (277.3) (23.5) (23.5) 0.0 (237.1) (231.5) (230.9) 0.7EBITDA 3.1 1.1 1.8 0.6 (5.7) 2.3 4.4 2.1Depreciation, interest & dividends (9.6) (0.8) (0.8) 0.0 (8.0) (8.0) (7.7) 0.3Normalised Surplus/ (Deficit) (6.5) 0.3 1.0 0.7 (13.7) (5.7) (3.3) 2.4Non-recurrent & exceptional (1.3) (0.1) 0.0 0.1 - (1.1) (1.6) (0.5)Deficit (7.8) 0.2 1.0 0.8 (13.7) (6.7) (4.9) 1.9

Year To DateIn-Month

2.1 Income & Expenditure

5

(6.7)(4.9)

0.90.5

1.8

0.3

(1.1)

(0.5)

(9.0)

(8.0)

(7.0)

(6.0)

(5.0)

(4.0)

(3.0)

(2.0)

(1.0)

-

Budget deficit YTD Patient Income Other Income Pay Non-Pay Depreciation, interest& dividends

Non-recurrent andExceptional

Actual deficit YTD

2.1.2 YTD deficit bridge (£m)

(9.0)

(8.0)

(7.0)

(6.0)

(5.0)

(4.0)

(3.0)

(2.0)

(1.0)

-

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

2.1.3 Surplus / (deficit) £m

Cumulative Plan

Cumulative Actual / Forecast

2.2 Income

2.2.1 Income summary

• PbR income is £0.252m behind plan in January (M10).For the year to date there is a slight underperformanceof £0.016m.

• The adverse position in the month is driven by thecontinued underperformance in maternity and anunderperformance against plan of excess bed days inthe month.

• Year to date income reductions are £0.523 higher thanexpected mainly due to improvement in the C-Difftrajectory and improved re-admission position.

• The reductions in excess bad days has resulted in asmall year to date reduction in the NEL threshold,totalling £1.1m against a plan of £1.22m.

• The ledger timings differences is made up of severalcomponent parts (1) FP10 community prescribing (2)AQP (3) penalty reductions (4) risk reductions and (5)coding catch-up from the previous months

6

2.2.1 Income Summary

Plan Actual Var Plan Actual Var£'000 £'000 £'000 £'000 £'000 £'000

Gross PbR income (2.2.4) 13,737 13,485 (252) 134,869 134,852 (16)Income reductions (2.2.6) (309) 507 816 (3,089) (2,566) 523Other patient income (2.2.7) 8,538 8,828 290 79,316 79,817 500Ledger timing differences(1) 10 (451) (461) 100 11 (89)Total patient income 21,976 22,369 393 211,196 212,114 918Other income (2.2.8) 2,714 2,894 180 22,680 23,145 465Total income 24,690 25,263 573 233,876 235,259 1,384

Month 10 Year to date

(1) reflects impact of coding of prior month activity and in respect of the plan represents agreed contract variation

233.9235.3(1.5)

(0.3)+1.4+0.8

+0.5 +0.5

230.0231.0232.0233.0234.0235.0236.0237.0238.0239.0240.0

Budget Income YTD PbR - Volume PbR - Price Reductions - Contract Reductions - Other Other patient income Other income Actual Income YTD

2.2.3 YTD Income variance (£m)

2.2.2 Monthly IncomeApr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 YTD

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000Gross PbR income 13,748 13,516 12,817 13,981 12,807 13,162 14,056 13,763 13,518 13,485 134,852Income reductions (640) (354) 29 (641) (340) (217) (490) (170) (251) 507 (2,566)Other patient income 7,796 7,664 7,826 7,785 8,092 7,890 8,111 8,044 7,780 8,828 79,817Ledger timing differences(1) (298) (452) (100) 329 (252) (200) 963 (447) 919 (451) 11Total patient income 20,607 20,374 20,572 21,454 20,306 20,636 22,640 21,190 21,967 22,369 212,114Other Income 2,503 2,411 2,427 2,070 2,446 1,893 2,120 2,465 1,915 2,894 23,145Total income 23,109 22,786 23,000 23,523 22,753 22,529 24,760 23,655 23,882 25,263 235,259

2.2 Income

7

2.2.4 Gross PbR Income• PbR income is £0.252m (1.8%) behind plan in M10. Underperformance against maternity (£0.318m), Maternity Pathways (£0.412m) and excess

bed days (£0.230m).• Elective income and activity are both above plan in the month. Income over-recovery is noted in the month in Orthopaedics and Gastroenterology.• Day cases are slightly behind plan in the month, but remain above plan due to case mix year to date as activity remains generally on plan.• The Non Elective over-performance is predominantly in Medical specialties , this is offset in Trauma and Orthopaedics where activity is below plan. • Adult Acute Division reports income £0.111m above plan in January. Non elective over-performance is offset by Day Case and elective under-

performance.• The Elective Care Division is reporting an over-recovery of income against plan (£0.0435m) in the month. Day Case and outpatient over-recovery is

offset by Non Elective under-recovery. • Family Care Division is £0.099m above plan in January over-recovery of income for Gynaecology scheduled activity is offset by underperformance

in Delivery episodes and Ante / Postnatal pathways registrations & other Obstetric / Midwifery activity. Non-elective activity in Paediatrics is also starting to over perform following under performance earlier in the year.

2.2.4 Gross PbR Income

Plan Actual Var Var Plan Actual Var Var Plan Actual Var Var Plan Actual Var Var# # # % £'000 £'000 £'000 % # # # % £'000 £'000 £'000 %

A&E 9,715 8,863 (852) (8.8%) 988 953 (35) (3.6%) 95,799 93,566 (2,233) (2.3%) 9,741 9,673 (68) (0.7%)Day Cases 2,390 2,339 (52) (2.2%) 1,565 1,551 (14) (0.9%) 22,447 22,426 (22) (0.1%) 14,899 15,213 314 2.1%Elective IP 549 609 60 11.0% 1,320 1,327 7 0.6% 5,406 5,551 145 2.7% 12,972 13,325 353 2.7%Non-Elective IP 3,101 3,643 542 17.5% 5,060 5,660 600 11.9% 30,575 32,311 1,736 5.7% 49,898 51,222 1,324 2.7%Delivery Episodes 555 388 (168) (30.2%) 988 671 (317) (32.1%) 5,475 4,863 (613) (11.2%) 9,746 8,524 (1,222) (12.5%)Outpatients 23,167 23,949 782 3.4% 2,530 2,680 150 5.9% 228,441 226,579 (1,862) (0.8%) 24,951 25,243 292 1.2%Ante/Postnatal Pathw ays 1,004 738 (266) (26.5%) 928 516 (412) (44.4%) 9,899 9,481 (418) (4.2%) 9,147 8,495 (652) (7.1%)Excess Bed Days 1,500 546 (954) (63.6%) 356 126 (230) (64.6%) 14,784 13,581 (1,203) (8.1%) 3,515 3,158 (357) (10.2%)Gross PbR Income 41,982 41,074 (907) (2.2%) 13,737 13,485 (252) (1.8%) 412,828 408,358 (4,469) (1.1%) 134,869 134,852 (16) (0.0%)Income Reductions (2.2.6) (309) 507 816 (264.2%) (3,089) (2,566) 523 (16.9%)Other patient income (2.2.7) 8,538 8,828 290 3.4% 79,316 79,817 500 0.6%Ledger timing dif ferences 10 (451) (461) n/a 100 11 (89) n/aTotal income from activities 21,976 22,369 393 1.8% 211,196 212,114 918 0.4%Memo: Divisional PbR IncomeAcute Adult 19,830 18,587 (1,243) (6.3%) 5,293 5,403 111 2.1% 194,891 193,523 (1,368) (0.7%) 51,927 53,575 1,648 3.2%Elective 17,180 17,533 354 2.1% 5,270 5,161 (109) (2.1%) 168,917 167,561 (1,356) (0.8%) 51,647 51,137 (509) (1.0%)Family 4,972 5,196 224 4.5% 3,174 3,280 106 3.4% 49,020 47,516 (1,504) (3.1%) 31,295 30,500 (795) (2.5%)Gross PbR 41,982 41,316 (665) (1.6%) 13,737 13,845 108 0.8% 412,828 408,600 (4,227) (1.0%) 134,869 135,213 344 0.3%

Month 10 Year To DateIncome IncomeActivityActivity

2.3 Pay

2.3.1 Pay spend

• The classification as “other pay budgets” arises because although the division and speciality has agreed the savings these are only allocated at specialty level not subjective code level.

• The ‘other pay budget’ contains the ICIP gap where costs have not yet been allocated to individuals budget lines. No further allocation of costs to other areas happened this month.

• Although the pay budget is now overspent by £1.1m YTD, a proportion of this will have been spent generating the extra £0.4m of income received by the trust over budget.

8

2.3.1 Pay - Actual vs Budget

Annual Budget Budget Actual Var.

Prior Year Budget Actual Var.

£m £m £m £m £m £m £m £mSenior Managers (5.1) (0.4) (0.4) 0.0 (5.4) (4.3) (3.6) 0.6Medical and Dental (48.1) (4.0) (4.1) (0.0) (38.7) (40.1) (39.5) 0.6Nursing, Midw ifery And Health Visiting (75.4) (6.4) (6.1) 0.3 (62.2) (62.8) (60.8) 2.0Scientif ic, Therapeutic and Technical (23.4) (2.0) (1.8) 0.1 (20.2) (19.5) (18.4) 1.1Professional and Technical (5.2) (0.4) (0.4) 0.0 (4.4) (4.3) (3.9) 0.4Administrative and Clerical (23.2) (1.9) (1.8) 0.1 (19.7) (19.3) (18.2) 1.2Healthcare Assistants and Other Suppo (20.5) (1.7) (1.6) 0.1 (16.2) (17.1) (15.5) 1.5Other Pay Budgets 5.1 0.6 (0.0) (0.7) (0.0) 3.7 (0.1) (3.7)Agency Staff (2.4) (0.2) (0.7) (0.5) (5.9) (2.0) (7.0) (4.9)Pay (198.4) (16.5) (16.9) (0.4) (172.8) (165.9) (167.0) (1.1)Bank (included in above) (3.2) (0.3) (0.5) (0.2) (4.9) (2.7) (4.8) (2.0)

Agency SplitNursing (0.1) (0.0) (0.2) (0.2) (0.1) (1.8) (1.7)A&C (0.7) (0.1) (0.1) (0.0) (0.6) (1.4) (0.8)Locum Doctors (1.6) (0.1) (0.3) (0.2) (1.3) (3.2) (1.9)Other (0.0) (0.0) (0.1) (0.1) (0.0) (0.6) (0.6)

Year To DateIn-Month

275

(2,268)

(16)

868

(1,141)

88

(579)

29 64

(398)

(3,000)

(2,000)

(1,000)

-

1,000

2,000

Acute Elective Family Corporate Trust

2.3.2 Pay variance to budget (£'000)

YTD In month

5. Cashflow

5. Cashflow summary

• The 13 week cash forecast includes PDC funding of £14m. £6.5m in February and £7.5m in March.

• Forecast redundancy payments of £0.6m in February and £2.6m in March.

9

Key assumptions

The cashflow forecast is underpinned by the followingassumptions:

• PDC funding of £17.25m included in the forecast;• Level of overdue debt to remain at current levels;• Forecast is based on a outturn of a £7.8m I&E deficit

before exceptional items.

0.0

4.0

8.0

12.0

16.0

20.0

02-F

eb

09-F

eb

16-F

eb

23-F

eb

02-M

ar

09-M

ar

16-M

ar

23-M

ar

30-M

ar

5.1 Cash forecast to year end (£m)

Cash forecast

0.0

1.0

2.0

3.0

4.0

5.0

6.05.2 Actual month end cash balance (£m)

Forecast Actual

6. Capital expenditure

6.1 Capital expenditure

• The Trust capital plan as submitted to Monitor at the end of May is £5.9m

• At the end of January capital expenditure was £3.0m underspent

• The Trust has spent 40% of the year to date capital plan, this is below the 85% Monitor threshold

• Action is being taken to ensure all capital is spent by year-end

• Forecast is £140k overspend at year end

10

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0


Cumulative capital expenditure (£m)

Actual spendAnnual Budget

6.1 Capital expenditure YTD

Budget Actual Var Budget Fcast Var£000 £000 £000 £000 £000 £000

ReplacementsSigmoid Flexiscope 94.2 0.0 94.2 113.0 0.0 113.0Blood Gas Analyser 44.2 40.2 4.0 53.0 53.0 0.0Laporoscopic Stacking System 49.2 0.0 49.2 59.0 0.0 59.0Upgrade of Haemoglobin Testing Systems 285.0 0.0 285.0 342.0 64.0 278.0Tissue Processor 33.3 0.0 33.3 40.0 48.0 (8.0)Replacement of Franking Machine 16.2 (16.2) 17.0 (17.0)Retinal Camera - community 15.5 (15.5) 15.5 (15.5)Wireless Endoscopy 7.0 (7.0) 8.4 (8.4)Diagnostic Immunocytochemistry 0.0 78.0 (78.0)2 servers 0.0 128.0 (128.0)Orthopaedic Drills 22.9 (22.9) 34.0 (34.0)Retinal Camera 0.0 225.0 (225.0)Examination Lamps 0.0 32.0 (32.0)Defibrillators 0.0 140.0 (140.0)Replacements Subtotal 505.8 101.8 404.1 607.0 842.9 (235.9)MaintenanceUrology Fire Precautions and Structural Floor 266.7 0.0 266.7 320.0 0.0 320.0Urology Scheme Design and Consultancy Fees 5.9 (5.9) 14.0 (14.0)Repairs to Highw ays Churchill Drive 38.6 (38.6) 50.0 (50.0)Upgrade of Ward A4 668.3 711.2 (42.8) 802.0 802.0 0.0Churchill Service Duct Fire Precautions 1,080.8 230.1 850.8 1,297.0 1,297.0 0.0C. Dif icile 72.5 229.8 (157.3) 87.0 472.0 (385.0)Ugrade of Parental Accomodation for MIB 8.3 5.5 2.8 10.0 7.0 3.0A&E (Bandit screen and ambulance handover) 0.0 41.0 (41.0)Chillers 0.0 650.0 (650.0)Main w alkw ay duct 0.0 50.0 (50.0)Air conditioning 0.0 20.0 (20.0)Maintenance Subtotal 2,096.7 1,221.0 875.7 2,516.0 3,403.0 (887.0)EnhancementsEndoscopy 708.3 361.9 346.4 850.0 383.0 467.0PACS 250.0 104.5 145.5 300.0 362.0 (62.0)CT Enabling Works 41.7 1.0 40.7 50.0 2.0 48.0Information Technology 672.5 0.0 672.5 807.0 795.0 12.0Enhancements Subtotal 1,672.5 467.4 1,205.1 2,007.0 1,542.0 465.0OtherCapitalised Salary Costs 108.3 108.3 0.0 130.0 130.0 0.0Fees Maternity Unit 33.3 1.5 31.8 40.0 20.0 20.0Other Subtotal 141.7 109.8 31.8 170.0 150.0 20.0

2012/13 SlippageEndoscopy - phase 1 365.0 0.0 365.0 365.0 0.0 365.0Other 235.0 101.6 133.4 235.0 101.6 133.4Transfer to revenue 0.0 0.5 (0.5) 0.0 0.5 (0.5)2012/13 Slippage Subtotal 600.0 102.1 497.9 600.0 102.1 497.9

GROSS CAPITAL EXPENDITURE 5,016.7 2,002.1 3,014.6 5,900.0 6,040.0 (140.0)

Year to date Annual

10.1 Appendix: Activity trends

11

7,000

7,500

8,000

8,500

9,000

9,500

10,000

10,500

11,000

A&E activity

13/14 Actual 13/14 Plan 12/13 Actual

3,0003,1003,2003,3003,4003,5003,6003,7003,8003,9004,0004,100

Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14

Non elective activity (spells only) inc births


15,000

17,000

19,000

21,000

23,000

25,000

27,000

O/P activity (including procedures)


1,500

1,700

1,900

2,100

2,300

2,500

2,700

2,900

3,100

3,300

Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14

Elective / day case activity (spells only)


Committee Chair Report

Name of Committee: Quality Assurance Committee

Date of Meeting: 12th February 2014

Report to: Board of Directors

Chair: David Wakefield

Key Issues Discussed/Papers received

The main focus of the meeting was the presentation of quality reports from each of the three clinical

divisions.

Each division produced a detailed written report prior to the meeting and followed this up with a

presentation to highlight achievements and concerns; each presentation was followed up by

questions from committee members.

Elective Care Division

Improvements CDT sustained performance, reduction in pressure ulcers and reduction of

incidents relating to staffing levels in Q3. Encouraging trends in mortality and appraisals sustained

above 80%.

Concerns - Tracheostomy incidents on ward F4 and falls on ward E4; increase in the number of

incidents relating to equipment, mandatory training slight improvement but still below target and

divisional sickness rate 5.33% in December.

Acute Adult Division

Improvements reduction in pressure ulcers, improvement in appraisals although still below target,

downward trend in mortality.

Concerns - 2 cases of CDT and 1 case of MRSA; staff vacancies and response rate for Friends

and Family test in A&E

Family Care Division

Improvements - appraisals and mandatory training both over 85%; all complaints managed with

the timescale, positive feedback from Friends and Family test, National maternity results very

positive; Breastfeeding CQUIN ahead of target Q4 already achieved.

Concerns - sickness absence and medication incidents.

All three divisions were commended for the overall quality of their reports

In discussion similar themes were identified in all reports, questions were posed regarding incident

reporting, the status of NICE guidance reports and actions taken to address the number of

medication incidents.

Further Actions have been requested as follows:

to address concerns regarding medical device training

to determine the sign off process for NICE guidance after concern was expressed regarding

the number defined as amber

Future division reports to include more information about lessons learned from incidents

Mandatory training to be reported with cancelled attendance as a result of staff pressures

differentiated from overall failed/cancelled attendance

For Escalation to the Board - no items identified

Apologies received from Gina Ashworth

Date of next meeting – 12th March 2014

Bolton NHS Foundation Trust Council of Governors’ Meeting – 9th January 2014 Page 1 of 5

Meeting Council of Governors

Time 5.30 p.m.

Date 9th January 2014

Venue BICS Room 1 and 2, Musgrave House

Present

David Wakefield Chairman

Ann Bain Breightmet

Bill Riley Astley Bridge

Bob Airey Farnworth

Champak Mistry Harper Green

Debra Graham Rest of England

Derek Burrows Kearsley

Jack Firth HealthWatch

Jackie Leigh University of Salford

Janet Roberts Nurses and Midwives

Jeffrey Mangnall Rumworth

Jim Sherrington Tonge with the Haulgh

John Taylor Smithills

Kate Cowpe Out of Area

Kenneth Hahlo Heaton and Lostock

Margaret Evans Hulton

Martin McLoughlin Halliwell

Michael Connolly Westhoughton South

Pauline Lee Westhoughton and Chew Moor

Peter Hindle All Other Staff

Geoffrey Hargreaves Bolton Community and Voluntary Services

Sorie Sesay Great Lever

Thaira Qureshi Bolton Community and Voluntary Services

In Attendance

Jackie Bene Acting Chief Executive

Allan Duckworth Non-Executive Director

Andy Ennis Chief Operating Officer

Carol Davies Non-Executive Director

Ebrahim Adia Non-Executive Director

Esther Steel Trust Secretary

Heather Edwards Head of Communications

Simon Worthington Director of Finance

Trish Armstrong-Child Director of Nursing

Observers

S Lomax

Apologies

Mark Harrison Barbara Ronson Gina Ashworth Dipak Fatania Eric Hyde

Jack Ramsay Caroline Greenhalgh Samir Naseef Geoffrey Minshull


2. Declarations of Interest

None

3. Minutes of the Council of Governors’ Meeting held 5th September 2013 and 7th

November 2013

Approved as an accurate record.

3.1 Matters Arising

None

4. Chairman’s Update

The Chairman introduced Suzanne Lomas to publicly acknowledge her achievement in being

honoured in the recent New Year’s Honours list with an MBE for services to nursing and

healthcare.

Suzanne, who was nominated for the award by her husband, started her career in nursing as

a student nurse in Bolton and has remained with the trust throughout a career spanning over

30 years, fulfilling the forecast of one of her early referees who predicted that she would make

a good nurse manager. Suzanne has continued to display a passion for nursing care and has

received other accolades during her career including clinical leader of the year. Suzanne has

managed to balance this career with bringing up two children now aged 17 and 14 and

remarkably has not had a single day of sickness throughout this time.

Governors applauded Susanne who was presented with a bouquet of flowers on behalf of the

Trust.

Suzanne responded to the Chairman’s thanks saying she was proud to be a nurse and proud

to work in Bolton where the importance of getting everything right for the patient was

recognised.

Board update

Andy Ennis, the new Chief Operating Officer joined the Trust at the start of the month; Andy

was welcomed to his first council of governors meeting.

Interviews for the Chief Executive post are scheduled for January 16th, The next meeting of

the PSV sub group will be convened as a full governor meeting in order for Governors to

consider and approve the appointment made by the nomination and remuneration committee.

Monitor

Representatives of the Monitor regional team visited the Trust in December, discussions were

positive. The trust is performing well, and although the Trust remains in breach of the

provider licence, there was recognition of the progress made. The trust will continue working

closely with Monitor and will require further capital support to address estates and IT issues.

Quality

The Board have recently approved new strategies for falls, pressure ulcers and patient

experience with a significant amount of each Board meeting spent focused on quality.


Annual Plan

Work has begun to pull together the annual plan for submission to Monitor; the format has

changed from previous years with the plan now required in two submissions, the first

operational submission is required by 4th April 2014 with the second strategic plan due on 30th

June 2014. The operational plan will be discussed with governors in March 2014 and the

strategic plan in June 2014; in addition to the formal governor meetings there will be

additional opportunities for governors to provide their views on the forward plans through the

sub-committee meetings.

Questions

Questions were raised regarding the use of the winter care wards and the impact of GP

opening over Christmas. The Chairman advised that the winter wards were used to their full

capacity and continue to be used, the additional GP opening does not appear to have had a

significant impact on A&E performance.

Governors suggested that more staff should be nominated for awards and honours and that

consideration should be given to continuing with the local staff awards to recognise the

achievements of our staff.

Executive Directors to give consideration to continuing with staff awards

6. Performance Update

The acting Chief Executive introduced the new integrated performance report and highlighted

the following areas:

C. difficile - Although the Trust are over trajectory, the rate of infection has reduced

significantly, after a poor start to the year infections are well contained and a 50% reduction

on the number of cases in 2012/13 has been achieved.

All other targets and indicators on the Monitor risk assessment framework are being

achieved.

Finance - performance currently ahead of the plan and we remain on target to achieve the

planned £7.8m deficit.

Questions

Governors were asked if they had any questions relating to the performance report which had

been circulated a week prior to the meeting or in relation to other areas of performance.

With the new initiative to publish staff ratios on wards is there planned capacity to provide

sickness cover?

In July 2013 the Board agreed to invest to increase the nursing establishment, the

establishment levels take account of the need to provide cover for sickness absence and

holidays. The use of bank and agency staff is reviewed monthly, the Director of Nursing

works closely with HR to understand areas identified as “hot spots” for sickness absence.

The positive results are not portrayed in CCG meetings, should there be consideration given

to sending a representative to attend CCG meetings to address concerns.

We work closely with the CCG and recently received a very complementary letter on recent

performance however awe gree that consideration should be given to addressing adverse


comments.

Has the move to long shifts had any impact on staff sickness?

This is monitored through the ward to board dashboard at this stage, no correlation has been

noted.

Has the recruitment target for nurses been achieved, if not are there any plans to recruit from

abroad.

Additional funding was provided for 144 nurses plus a requirement to recruit to new vacancies

as they occur creating a constant cycle of recruitment. The 35 student nurses due to qualify

in March 2014 have been offered posts. At present there are no plans to recruit

internationally although consideration may be given to recruiting from Ireland.

Is there a procedure to thank staff for having a full year of attendance?

Letters are sent from line managers to thank team members for a full year’s attendance.

7. Feedback from Governor Sub Committees

7.1 Patient Staff and Visitor Experience Sub Group

The meeting of this group scheduled for November 2013 had been postponed to avoid a

clash with the training sessions shared with Salford and Wigan.

Governors noted that Kate Cowpe had communicated her intention to step down as Chair of

the PSV sub group.

Kate Cowpe thanked the members of the PSV sub group for their support during her time as

Chair.

The Chairman and governors thanked Kate for her contribution to the sub-group and for her

wider contribution as one of the three lead governors.

Governors were reminded to cast their votes for the three sub group chairs before the end of

the meeting.

7.2 More than a Hospital Sub Group

The More than a Hospital group enjoyed an interesting visit to the diabetic centre where they

received a very interesting presentation giving them a better understanding of the care of

diabetic patients in Bolton.

7.3 Membership and Member Communications Sub Group

Following the Annual Members Meeting in November 2013 the Membership and Member

Communications group had been delegated to consider proposed changes to the constitution

to review member representation.

The subgroup had initial discussions regarding the proposal before agreeing to establish a

small task and finish sub group to give the matter further consideration.


Feedback on constitution changes to March governor meeting

8. Date and Time of Next Meeting

6th March 2014 at 5.30pm Seminar Room One, Education Centre

After the close of the formal meeting Governors spent some time in development work to

contribute to the annual evaluation of the Council of Governors.

A summary of the discussions and points raised will be produced separately in a you said/we

did/we will do format for further discussion and development.

bolton nhs foundation trust – board meeting february 27th 2014€¦ · a question was raised as...

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