cog (04/19) item 3...2019/01/03 · cog (04/19) item 3.1 date 16 april 2019 report for council of...

CoG (04/19) Item 3.1

DATE 16 April 2019

REPORT FOR

Council of Governors

REPORT FROM

Kate Wood, Acting Medical Director Shaun Stacey, Chief Operating Officer Jayne Adamson, Director of People and Organisational Effectiveness Richard Eley, Interim Director of Finance Sue Barnett, Strategy and Planning Consultant

CONTACT OFFICER

Kathryn Helley, Improvement Programme Director

SUBJECT

Improving Together Update

BACKGROUND DOCUMENT (IF ANY)

Project Highlight Reports

EXECUTIVE COMMENT (INCLUDING KEY ISSUES OF NOTE OR, WHERE RELEVANT, CONCERN THAT THE COG NEED TO BE MADE AWARE OF)

The attached paper outlines the progress made and the current risks identified in respect of the Improving Together Programme.

COUNCIL ACTION REQUIRED

Not Applicable

1

Improving Together Programme Summary

As at 25 March 2019

2

Contents

– 6 Quality and Safety

Page 7 – 8 Workforce

Page 9 – 14 Leadership and Culture

Page 15 – 19 Finance

Page 20 – 24 Access and Flow

Page 25 – 30 Service Strategy

Workstream RAG Key Risk Matrix Key

Green On track for delivery milestones and KPIs

Amber At risk but recoverable

Red At risk and non recoverable

3

WORKSTREAM HIGHLIGHT REPORT Workstream: Quality and Safety Senior Responsible Officer: Kate Wood Reporting Month: February 2019

Improving Together Workstream Highlight Report

*Increase - 2 new projects now up and running ** This includes all live milestones for projects, Q&S programme project plans.

Some projects are ragged red because pace has decreased or evidence not submitted **

Project Title Pro

ject

Lead

Previo

us

RA

G

Cu

rren

t

RA

G

Ne

xt RA

G

Comments (explanation of RAG, progress update etc.)

Patient Safety Maternity Mr Manohar

A

R

A

Perinatal Mortality Review Tool implemented into review meeting. Culture survey to be implemented in February/March 2019. Tablets still not purchased required for qualitative patient feedback. Concerns relating to Clinical Negligence Scheme for Trusts (CNST) regarding skills and drills training for Anaesthetists and Operating department practitioners as part of a multidisciplinary team need to achieve 90%. All midwives are rostered for their annual training and attendance is monitored by their line manager. Mr Manohar is currently reviewing the guidelines in relation to a consultants attending to a patient when called. Mr Muller has been appointed as clinical lead for Governance, meeting held on every Friday to discuss risk and governance.

Community Jenny Hinchliffe

A

A

A

5 CQC Community Dental actions have been fully signed off through Quality and Safety Oversight Meeting. 4 CQC Community Nursing actions have been fully signed off through Quality and Safety Oversight Meeting. Continence service review planned, currently using bank to support capacity however waiting lists remain a concern and is on the risk register. Infection Prevention Control bins/transport boxes in use and placed in “black boot boxes”. Ad hoc audits conducted by Infection Prevention and Control and Team Leads.

Critical Care Helen Davis

A

A

A

3 milestones starting the signing off process through divisional governance. Both Intensive Care Units now both have Administrative support in place. All staff are aware of the fire excavation procedure and have signed to say that have read and full understand the policy. Concerns regarding Guidelines for the Provision of Intensive Care Services (GPICS) competencies at Diana Princess of Wales (DPOW) currently at 32%.

Project Risk Rating Blue Complete and embedded. Green Completed. Not yet fully embedded/evidenced. Amber In progress/ on track. Red Not yet completed/ significantly behind agreed timescales.

Quality and Safety Workstream: Quality and Safety Number of Projects in Total 12* currently live Number of Project Milestones 164** Number of Project Milestones Complete in Month

20

Number of Project Milestones on Track 125 Number of Project Milestones Overdue

19**

Number of Projects Closed in Month 0

4


Emergency Department Simon Buckley

A

R

A

3 milestones starting off sign off process through divisional governance. Room identified at DPOW for Paediatric specific waiting area, funding approved through Health Tree Foundation. Reviewing Nursing Dashboard for within the department to include: Sepsis, NEWs, PEWs, escalation, Mental Health, Safeguarding and Mental Capacity Assessment. Still having difficulties with some specialities reviewing patients in a timely manner.

Children’s Services Debbie Bray

A

A

A

Staffing concerns relating to paediatric assessment unit at DPOW as not meeting national guidance. Mitigation to be written and presented at next oversight meeting in April.

2nd Paediatric Early Warning Score (PEWs) audit completed, pulling together results for review. Updating clerking in documentation to ensure that we are actively asking the question to patients/relatives in relation to accessible information.

Medical Record Keeping Colin Farquharson

Project brief written, Improvement Team met with Colin Farquharson to discuss will set project group up over next 4 weeks.

Safe Use and Storage of Medicines TBC A

R

A

Project brief written, Improvement Team met with Colin Farquharson, further discussion to occur with representation from Medical Staff, Nursing, and Pharmacy. Planning to start with looking at the safer medication group attendance and agenda and working with CCG’s feedback.

Deteriorating Patient, including AKI, Sepsis and CQUIN 2

Jenn Orton

A

A

A

Acute Kidney Infection pathway paperwork arrived on site, Doctors are preparing a simple presentation to deliver at launch, aim to present at grand rounds at both sites, Communications team involved in publicity. Score cards not distributed in February due to lack of staff, rudimentary analysis done by Improving Together Team but awaiting production of full scorecard, National Early Warning Score (NEWS) and Sepsis reporting to be explored with Information Services starting 3rd week in March. Concerns still regarding not being able to pull Sepsis 6 data from WEB V however aim to have data able to be extracted by the end of March. Engagement meeting held with a group of Doctors at DPOW to process map the escalation process and produce recommendations for improvement.

Pressure Ulcers Alison Schofield A A A Agreed that this can be removed from the programme.

Positive Identification of Patients Gain results from Phlebotomy audit that is taking place shortly to gain assurance that all patients have a wrist band Work also with Women’s and Children’s division to ensure that audits are taking place in relation to mother and baby.

Equipment, including training Mel Sharp

A

A

2 milestones starting off sign off process through divisional governance We are focusing on:- What existing Equipment we have and where we are with competencies What new equipment do we need and the competencies that we will need to capture. List of equipment with procurement to cost up. Adding the lack of equipment to the risk register.

Clinical Effectiveness Evidence Based Practice Project brief written and project group to be set up. Main focus of this work stream to begin with is to look at the current policy and

ensure that is reflects to ensure that the policy reflects to most up to date practice. Look at a check list for divisions to complete to ensure everything is captured.

5


Mental Capacity/Vulnerability/Dementia and Learning Disabilities

Craig Ferris

A

A

A

1 milestone starting off sign off process through divisional governance. Out of the records reviewed at Scunthorpe General Hospital 10/20 records a Patient’s capacity was recorded in the notes. At Diana Princess of Wales Hospital out of the records reviewed again 10/20 records had evidence of a capacity assessment on the last admission to hospital. At Goole and District Hospital 4/5 had a capacity assessment recorded on the last visit to hospital. Audit results have shown a 20% improvement in the documentation of capacity in the Nursing and Medical records of this cohort of patients since a previous audit 12 months ago. Need divisional input into the restraint training, agreed to add to the PIMs week 1 quality slide.

Nutrition and Hydration Mel Sharp

A

A

A

1 milestone starting off sign off process through divisional governance Clinical Lead still to be appointed. Re written protected meal times policy which was published 4th February 2019. 240 places on offer over the next year for Nasogastric tube training. Need to improve numbers as only currently 32% of nursing staff are trained.

SI Process/Governance Information to feed in from work by Governance Mortality and Learning from Deaths Dr

Kamath/Miss Balachandra

A

R

A

Total Number of Deaths in Scope - January 2019 = 201 Total Deaths Reviewed - January 2019 = 15 0% Definitely avoidable 0% Strong evidence of avoidability 0% Probably avoidable (more than 50:50) 0% Probably avoidable but not very likely 0% 5Slight evidence of avoid ability 100% Definitely not avoidable

Ward Assurance Tool TBC A A A To remain on programme for measurement of roll-out

6


Patient Experience End of Life Dr Adcock

A

A

A

1 CQC action starting the signing off process through divisional governance. This has Trust Management Board approval, working group being set up. Lincoln are rolling out on 4 February and Doncaster are launching in April 2019. ReSPECT documents will be accepted from other Trusts without having the need to rewrite the Do not attempt cardiopulmonary resuscitation (DNACPR) policy. Doncaster are launching in April 2019. Next meeting is 15 March, expect roll-out to start in approximately 6 months. Push will all ward managers to ensure that EoL audit is completed.

Risks Ref Date Risk

Added Risk Description RAG Mitigation/Controls Date

Mitigation Occurred

RAG

17/10/18 Matron currently leading Ward excellence programme left in November and has not been replaced due to matron consultation has finished to identify new lead. Ward excellence programmes did provide assurance for the organisation.

15 (R)

Programme has been suspended and will be replaced by 15 steps, when established this can be requested to be removed

17/10/18 15

(R)

27/12/18 No Permanent staff allocated to produce score card (Deteriorating Patient, Sepsis and AKI Project). No money in Governance budget to pay for analysis beyond this month and pick up by Information Services not imminent

15 (R)

Temporary cover arranged, no scorecard produced in January 2019

07/01/19 15 (R)

17/01/19 Slowing of progress due to winter pressures in certain areas 15 (R)

Flexibility of Improvement team to go to clinicians when possible 12 (A)

Issues for Escalation

Mandatory Training not achieving target – need trajectories from all areas on when they will achieve target of 85%

PADR’s not achieving target

KPI’s/Trajectories (including quality and finance)

None.

Risk Rating Matrix Severity / Impact /Consequence

Likelihood of recurrence

None/Near Miss (1) Low (2)

Moderate (3)

Severe (4)

Catastrophic (5)

Rare (1) 1 2 3 4 5

Unlike (2) 2 4 6 8 10

Possible (3) 3 6 9 12 15

Likely (4) 4 8 12 16 20

Certain (5) 5 10 15 20 25

7

WORKSTREAM HIGHLIGHT REPORT Workstream: Workforce Senior Responsible Officer: Shaun Stacey Reporting Month: February 2019


Workforce and Safe Staffing Number of Projects in Total 11 Number of Project Milestones 46 Number of Project Milestones Complete in Month

19


1


Project Title Pro

jec

t Lead

Previo

us R

AG

Cu

rren

t RA

G

Ne

xt RA

G


Effective Rostering Medical Staffing Jane Heaton

A

A

A

Phase 1- The implementation of the E-rota modules on track. The “E-rota” module will allow for the next modules of the allocate software to be implemented allowing enhanced visibility for users and the trust in terms of rota management. Phase 2 – Develop and agree approach for the rollout of Allocates “Medic online” module by first conducting a pilot in one speciality. Establishment of a wider project team to include Clinical and operational representatives as the project moves to support operational and clinical users.

Effective Rostering Nurse Staffing Elaine Coghill

A

A

A

Project scoping completed. EY (Ernst Young) conducted analysis of current policies against current practise to identify improvement opportunities. Met with Allocate to discuss the Safe Care live system and agreed a presentation on the full use of the system next month. This will include links to the Safer Nursing Care Tool methodology and how it can be applied to aide Deployment of staff on a daily basis. Project plans in development to move to implementation.

Agency and Bank Development Medical Staffing

Jane Heaton

A

A

A

External Rates – EY comparison of rates against Lincoln and Doncaster to identified potential savings opportunity circa £382K. Internal Rates – EY Analysis against agreed 2016 internal rate. If reinforced gives opportunity circa £212k. Met with COO (Chief Operating Officer) to discuss methodology of the above opportunities and agree approach. Next steps will be to engage with Triumvirates to understand achievability and identify any potential risk s to fill rate.

Agency and Bank Development Nurse Staffing

Elaine Coghill A A A Proposal received as a staged approach to rate reduction in line with August 2018 cap with Master Vendor Supplier, whilst mitigating

risk to supply and maintaining quality. EY scoping potential CIP opportunities for 19/20 delivery. Job Planning Medical Staffing DCDs

A A A External support from Ernst Young to review job plans for consultants for the specialities selected for the establishment review. Allocate to conduct review of how effective the trust is currently using the EJobPlan module.

Job Planning AHP/ CNS Elaine Coghill A A A Job Planning software (Allocate) demonstration with representation from Nursing, Allied Health Professionals and Clinical Support

Services. CNS - Data analysis conducted by EY to understand current CNS position and opportunities for improvement. Establishment Reviews Medical Staffing DCDs A A A Ernst Young are developing a process for effective establishment reviews in line with national guidance and trailing for two specialities.


8

WORKSTREAM HIGHLIGHT REPORT Workstream: Workforce Senior Responsible Officer: Shaun Stacey Reporting Month: February 2019

Establishment Reviews Nurse Staffing Elaine Coghill

A

A

A

Safer Nursing Care Tool (SNCT) been used to record patient acuity at DPOW for 20 days (week days) as per best practise guidance. Data collection commenced at DPOW 04 March 2019. SGH collection due to commence 01 April 2019. Communication / guidance documentation constructed for Ward Managers to ensure standardised approach in collection. Peer to Peer Validation to be completed by wards to ensure consistency and that experience is shared in the use of SNCT. Data collection output report in development to enable establishment reviews. Project Plan to be developed to track and monitor progress.

Electronic Staff Record (ESR) Rachel Maguire A A A Project Manager and Data Cleanser appointed to post. Communication initiated at Senior Leadership Forum.

Hardware ordered. Project Initiation and structure developed. Orientation of Project Manager commenced. Scoping of Resource Centre Kathryn

Helley A A A Ongoing work to produce a report on potential options to develop a Resource Centre. Plan to take options paper to Trust Management Board on 18 March 2019

Risks Ref Date Risk


Mitigation Occurred

RAG

1

13/02/19

As a result of the requirement to reduce to August 18 NHSI cap rates there is a risk that this will jeopardise supply as agency nurses may refuse to work at these rates

20 (R)

Communication with nurses from Master Vendor supplier to explain rationale and strategy. Plan to take a staged approach to rate reduction

01/03/19 16

(R)

2

01/02/19

Calculations used in e-Rota will result in different pay results for individuals 20 (R)

ESR rates of pay to be maintained on Doctors Rostering System calculated rates for all trainees currently in the Trust. Transfer to e- Rota calculation to be phased in as new rotation commences

01/02/19 10

(A)

3 01/02/19 Capacity of project teams to deliver improvements at pace given other operational priorities.

20 (R)

Priorities and phasing of the project work to reduce burden of key individuals.

01/03/19 12 (A)


Operational Lead required for Medical Staff Establishment Reviews.


In development




Moderate (3)

Severe (4)

Catastrophic (5)

Rare (1) 1 2 3 4 5

Unlike (2) 2 4 6 8 10

Possible (3) 3 6 9 12 15

Likely (4) 4 8 12 16 20

Certain (5) 5 10 15 20 25

9

WORKSTREAM HIGHLIGHT REPORT Workstream: Leadership and Culture Senior Responsible Officer: Jayne Adamson Reporting Month: February 2019


Project Title Pro

ject

Lead

Previo

us

RA

G

Cu

rren

t

RA

G

Ne

xt RA

G


Pride & Respect (including Listening to Improve)

Kay Farquharson

A

A

A

Over 750 staff now attended Pride & Respect training sessions with further promotion ongoing to increase awareness and attendance. Feedback on uptake now presented to divisions on a regular basis. Let’s Talk Service helped 44 staff at the time of writing through either mediation or alternative interventions. Trust involvement and promotion of National Stand Up To Bullying/Wear It Pink campaign held with wide-scale promotion. Linkage between Pride & Respect and Freedom to Speak Up (FTSU) established with further work to take place which includes a piloting of the Pride & Respect lead also taking on role of FTSU Guardian. This will see a development of new actions to ensure maximum output is achieved from the role as well a robust reporting structure.

Supporting the Junior Doctors

Silas Gimba

R

A

A

Initial review taken place of Work Schedules and agreement within Project Group to merge the schedules with the Training Opportunities documentation for ease of use. Agreement of need to educate Consultants on the Work Schedules, the importance of them and how the Exception Reporting process works. Further education work will follow to ensure Junior Doctors are using Exception Reporting when required. Exploration started of making documentation (Work Schedules, Training Opportunities etc.) available to Junior Doctors prior to starting with the Trust, options include facilities such as DropBox. Process mapping for Exception Reporting and Work Schedule completion commenced. Project plan to be rewritten to focus on new agenda and milestone focus.


Leadership and Culture Workstream: Leadership and Culture Number of Projects in Total 8 Number of Project Milestones 53 Number of Project Milestones Complete in Month

4


0



10

Retention & Engagement

Simon Dunn

A

A

A

Labour Turnover Rates Registered Nursing - 11.95% (decrease from 12.15% last month) Allied Health Professionals – 13.52% (same as last month) Consultant – 11.08% (slight reduction from 11.24% last month) SAS – 13.70% (decrease from 14.84% last month) Trust Wide – 9.56% (slight decrease from 9.61% last month) Review to take place of fluctuating Consultant turnover rates to determine reasons behind but also data analysis of demographics as potential for large numbers entering retirement age within short period of time.

Independent Nurse role agreed upon with full launch at the Nursing and Midwifery Conference. Role will speak with staff members who have expressed a desire to leave and ascertain reasons behind such. Retention identified as one of Future Five Nursing Priorities for 2019/20.

Medical Engagement work re-commenced with the appointment of Medical Directors Office Business Manager who will link in with project colleagues to increase engagement and participation with medical staff.

Launch of Engagement Pulse Survey in Spring across the Trust with divisional feedback done through Performance Improvement Meetings. The survey follows on from divisions tasked previously (through Leadership Conference sessions) to produce plans to increase engagement with staff.

Leadership Development

Harriet Stephens

A

A

A

Funding gained from Health Education England for Shadow Board development. Next step will involve determining individuals and roles to be put forward and what output would be expected.

Ongoing work to develop a Leadership Strategy. Draft to be produced which includes an outline of expectations. Exploration if an overarching Trust Strategy would give shape and determine how this is led.

Work ongoing across all apprenticeship programmes with feedback continuing to be positive and encouraging.

Divisional Clinical Director programme development started, linking with in Acting Medical Director and Chief Operating Officer.

Link in to be made with Nursing Leadership stakeholders to determine the shaping and development of the overall Leadership Development project, how it can be utilised across nursing areas. This may include the exploration of Nursing related development can be utilised as apprenticeships but will also serve as a sense-check that plans are matching with the Nursing (and Trust) vision.

Planning work to commence around next cohort of Leadership Conferences, likely to be September/October 2019. Chief Executive Officer input required to determine intended achievement for the day.


11

Quality Improvement

Simon Dunn

A

A

A

Continuous Improvement Strategy written and approved by Trust Management Board and Trust Board. Three further Trust Staff identified as wishing to attend QSIR College – entries to take place later in 2019. NLaG representation at ACT Academy delivered workshop on QSIR facilitation skills. Feedback that workshop was highly useful and also served as a good networking event with other Trusts seeking to host Quality Improvement faculties. First 5 day Cohort of QSIR since programme relaunch completed.

First Quality Improvement Induction session delivered to new entries into the Trust. 30 minute session is designed as a gentle introduction to Quality Improvement with a Plan-Do-Study-Act interactive task. Session is intended to serve as an introduction but also a recruitment ground for those interested in working further with Quality Improvements.

Submission to be made of Trust QSIR Delivery Plans to ACT Academy which serves as a commitment from the Trust but also individuals on the delivery of Associate training sessions.

3 milestones closed off this month:

Development of Dosing Model

Design and Embedding of NLaG Common Language

Development of Continuous Improvement Strategy for the Trust Developing the Safety Culture

Simon Dunn

A

A

A

Session held with Divisional Triumvirates for Community & Therapies and Clinical Support Services to establish approach towards workshop sessions for Manchester Patient Safety Framework. Agreement made to host various staff workshops which will then lead into a management session.

Agreement for delay of any workshops for Medicine, Surgery & Critical Care and Women & Childrens until the end of April due to operational demands.

Engagement with wide range of staff across all divisions will produce initial Manchester Patient Safety Framework score. Action plans will then be produced in turn to move towards ongoing improvement in scores (measured by revisit of Framework at to be determined date in future).

Work to take place establishing linkage with existing Ward Assurance Framework data and themes that can be produced to support a safety culture.


12

Career Pathways

Rachel Maguire

A

A

A

Health Academy Careers Pathway Co-ordinator commenced in post early February at Scunthorpe hospital with initial remit of linking in with work departments to establish what can be offered by the Trust in terms of pathways. Moving forward the Co-ordinator will be able to support and signpost students that express an interest in a Trust career.

Careers Fair hosted by recruitment team at Diana Princess of Wales Hospital will be shadowed by Health Academy Careers Pathway Co-ordinator with a view to rolling out similar approach at Scunthorpe for North Lincolnshire students.

Follow up meetings with divisions on their Career Pathways options and plans for roll-out. Careers Pathway Co- ordinator will link in with divisional representatives to determine requirements and offers that can be made to students.

1 Milestone Closed off this month:

Career Confidence Establishment (Phase 1) Organisational Redesign TBC N/A N/A N/A Project not yet commenced.

Risks Ref Date Risk


Mitigation Occurred

RAG

ODC1 January 2018 Issue: 1) Low training scores for junior doctor which is impacting future takes. 2) Lack of engagement from junior doctors in being part of improvement action plan to address issues.

12 (A)

• Increased pace and focus on reviewing junior doctor scores and surveys and agreeing responsive actions/interventions to improve target areas

• Development of project plan in conjunction with Post Graduate Medical Education to work alongside deanery ‘Rescue Plan’.

• Regain confidence and gain traction with series of ‘quick wins’ of issues affecting Junior Doctors.

Ongoing Mitigation

3 (G)

ODC2 January 2018 Issue: Danger of duplication of work with many work-streams within Leadership & Culture (and across Improving Together) having close links or cross-working. Not only potential of duplication but also contradicting work taking place, placing at risk not only the projects but the credibility of the programme overall.

6 (Y)

• Establishment of project support and appropriate governance arrangements within Leadership and Culture programme.

• Establishment of checks and balances to ensure duplication is avoided/mitigated but also to build a repository of evidence for future reference and guidance.

• Ongoing dialogue between project leads and with project support.

Ongoing Mitigation

2 (G)


13

ODC3 January 2018 Issue: Work stream quite embryonic in terms of Improving Together Programme. Measures of success for the programme are qualitative rather than quantitative, making KPI’s difficult to evidence – especially for plans which will see benefit in the long term.

6 (Y)

• Good work being delivered against a number of areas e.g. Listening to Improve and development programme

• Continued engagement with Project Management Office resource to enable plan development and progress.

• Project support embedded with all work stream leads to enable project fulfilment.

• Strong communications and engagement work on-going and planned in addition to success stories, for example Listening to Improve, but also future developments.

• Ongoing development of hotspot dashboard to give snapshot of impact of Leadership & Culture overall as opposed to specific work streams.

• Continual review and challenge of the project plans from both peers and Improvement Team support but also a degree of flexibility within the plans to account for the differing issues that the projects present, whilst still staying within the Governance arrangements of the Improving Together programme.

Ongoing Mitigation

2 (G)

ODC4 January 2018 Limited resources for QSIR project with only one accredited trainer within the Trust to deliver QSIR training and the team reliant on funding to continue delivery.

12 (A)

Newly appointed QSIR Practitioner taken online assessment to determine if successful for further training in April. If successful will progress to accredited trainer assessment along with additional resource from within Improvement Team.

Negotiations underway with NHS Improvement to determine if they can provide training resource in the meantime.

Clarity sought on funding for Quality Improvement Practitioner as post is vacant following departure of previous holder in May 2018.

Ongoing Mitigation

6 (Y)


14


Poor uptake across the Trust for Engagement Plan submission (deadline passed of 31/01/19). Only Community & Therapies and areas within Clinical Support Services have provided their plans. This is despite Chief Executive Officer

led drive (via Leadership Conference Days) to ensure plans are submitted. The low uptake coincides with the 2018 NHS Staff Survey initial data release which further highlights poor staff engagement across the Trust.

Poor engagement from divisions on their Career Pathways plans, including example of direct non-engagement when presented with opportunities to give current Trust staff placements.


February 2019 KPI’s not available at the time of report production.




Moderate (3)

Severe (4)

Catastrophic (5)

Rare (1) 1 2 3 4 5

Unlike (2) 2 4 6 8 10

Possible (3) 3 6 9 12 15

Likely (4) 4 8 12 16 20

Certain (5) 5 10 15 20 25

15

WORKSTREAM HIGHLIGHT REPORT Workstream: Finance Senior Responsible Officer: Richard Eley Reporting Month: February 2019


Project Title P

roje

ct Le

ad

Previo

us

RA

G

Cu

rren

t

RA

G

Ne

xt RA

G


18/ 19 financial recovery plan

N/A – Portfolio Summary

A

G

G

Progress update:

£13.45m delivered against a plan £13.17m an over delivery of £286k

The risk adjusted forecast is £14.70m an improvement on the January position largely due to the capture of savings relating to length of stay improvements which hadn’t been reported previously

Work is in progress to secure a circa £2m reduction in nursing agency costs through rate reductions. Deliverables next Month :

Grip & control Rob

Baxter/ Mark

Hinkley

G

G

G

Progress update: The year to date position and the forecast position are both to plan

Medical workforce

Paul Bunyan (R&R) Jane

Heaton (Agency

MM)

A

G

G

Progress update:

Delivery of £3.4m against a plan of £3.5m

The forecast position is £3.7m against a plan of £3.9m. Recruitment was again positive in February and its over delivery is mitigating the shortfall on rates.

The main area of shortfall has been on reduction to the agency rate and also use of internal locums.

Project Risk Rating Blue Not Applicable Green 95% or greater of saving plan achieved Amber Between 75% and 95% of saving plan achieved Red Less than 75% of saving plan achieved

Finance Workstream Workstream: Finance Number of Projects in Total 132 Number of Projects Green Rated Year to Date

72

Number of Projects Green Rated Forecast Year End

64

Shortfall (£000s) Year to Date £286 Shortfall (£000s) Forecast Year End -£291

16


Nursing & midwifery workforce

Elaine Coghill

R

R

R

Progress Update:

Delivery at £1.16m was £841k down against the plan of £2.0m.

Delivery of £1.35m is forecast against the plan of £2.30m a shortfall of £1.0m.

Rate reductions have been agreed which should see agency costs reduce by £500k in 2019/20

Block booking of agency shifts to secure a better rate and a number of recruitment initiatives are on-going which are described in the Safe Staffing Workstream Highlight Report

AHP workforce

Dawn Daly

G

G

G

Progress update: £1.17m delivered against a plan of £969k, however the majority of this is non-recurrent savings.

Forecast over delivery at year-end of £176k. Deliverables next month:

An AHP (Allied Health Professionals) Workforce plan to meet service needs in Community & Therapy Services has been completed. The actions from this need to commence.

Clinical productivity

G

G

G

Progress update:

Delivery of £2.64m against a plan of £1.17m

This reflects the fact that length of stay has come down on the medical wards and this has been coupled with additional activity and the methodology for counting this has been agreed.

Forecast £2.83m based on a continued improvement in length of stay and increased activity Deliverables next month:

Assessment of additional sessions year to date

Non pay and procurement

Alistair Douglas

R

R

R

Progress update:

£2.06m delivered against a plan of £3.01m, £947k shortfall.

Six schemes out of a total of fifty two were planned to deliver £1.09m of procurement CIPs but have only delivered £0.22m

Forecast delivery is a shortfall of £1.23m due to under delivery described above as well as shortfall on the lucentis and community clinics pharmacy schemes

Estates and facilities

Simon Tighe

G

G

G

Progress update:

£656k delivered against a plan of £663k, an under delivery of £7k

Forecast of £719k against plan of £737k. The main issue remains car parking however this has been partially mitigated by over delivery on other schemes

Income

Alistair Brooks

A

A

A

Progress update:

Delivery of £225k against a plan of £282k

Forecast Delivery is £244k against plan of £308k with some of the income shortfall mitigated by reduced expenditure

Deliverables next month:

Corporate

Brian Shipley

G

G

G

Progress update:

Vacancies have enabled a £288k over delivery year to date

Although the over delivery will reduce due to recruitment it is still forecast to be £247k Deliverables next month:

Vacancy assumptions need to be replaced with full schemes in the Corporate Directorates

17


Risks Ref Date Risk


Mitigation Occurred

RAG

1. Current forecast delivery is £14.7m against the £15m plan. A shortfall of £0.3m

against plan

G (3)

The development of a CIP pipeline has been ongoing and will be

continuous throughout the year. Currently potential schemes in excess

of £1.9 million have been identified.

G (3)

2.

The Trust is required to maintain their elective backlog levels and is committed to reducing their 52 week waiting patients. There is a risk to WLI (Waiting List Initiatives) reduction if productivity levels do not increase rapidly enough to increase numbers of patients seen.

A

(12)

Discussions commenced with commissioners on any waiting list

position improvements required for 18/19 and negotiate activity

funding within contract to cover costs.

A

(12)

3.

18/19 nursing agency savings are based on current nursing establishments.

Recruitment challenges, and vacancies, effectiveness of roster controls, and

ability to reduce agency rates continue to present high risk despite concerted

effort to overcome.

R

(16)

Agreement has been reached with regard to the rates however these will not take effect until 2019/20.

R

(16)

4. Significant progress has been made on Medical staffing recruitment with a

healthy pipeline in place. However there needs to be a reciprocal drop off in

the use of agency staff in order to deliver the associated CIP

A (12)

Tight roster control as well as close monitoring of dual running. Assessment of the impact of additional shifts.

A

(12)

5. Development of the 2019/20 programme is well under way with a very

challenging £29m requirement currently in place. Progress to date has

opportunities of £24m in development with a risk adjustment down to £16m

R (16)

Work is on-going with the Divisions in the development of the schemes and bringing them to delivery status however this needs to remain a priority in order to close the gap to the £29m target

R

(16)


None.

18


Financial Performance M7

19






Moderate (3)

Severe (4)

Catastrophic (5)

Rare (1) 1 2 3 4 5

Unlike (2) 2 4 6 8 10

Possible (3) 3 6 9 12 15

Likely (4) 4 8 12 16 20

Certain (5) 5 10 15 20 25

WORKSTREAM HIGHLIGHT REPORT Workstream: Access and Flow Senior Responsible Officer: Shaun Stacey Reporting Month: February 2019

20


Access & Flow – Unplanned Care

Project Title P

roje

ct

lead

Previo

us

RA

G

Cu

rren

t

RA

G

Ne

xt RA

G


Frailty Peter

Bowker

A

A

A

The purpose of this project is to implement an ambulatory facility for the management of frail patients ensuring they receive a prompt assessment by an appropriate member of the multi-disciplinary team. The service currently remains amber as the strategy required needs to be system wide rather than Trust focused so this will need to be developed in line with the system wide business case. System wide

engagement required to successfully progress this therefore a process mapping session has been arranged for 8th March 2019 to progress. Further discussion with Primary Care Home required.

SAFER patient Flow Bundle Peter

Bowker

R

R

A

SAFER refers to a senior review of all patients, consideration of the flow of patients, discharge at the earliest opportunity before midday, with a systematic review of all patients in hospital over 7 days. The purpose of the project is to roll-out the elements of SAFER across all Inpatient areas. Champion wards have been identified and a revised roll-out plan is in development which focuses on embedding four key principles. Audit of current performance against each of the indicators has been undertaken and findings will be shared at the next project group. Attendance at the next Collaborative meeting is planned for March 2019.

Discharge to Assess/Virtual Ward Jenny

Hinchliffe

A

A

A

The Virtual ward project is designed to manage patients within the community as long as possible and only stepping up to the acute sector as an when clinically necessary. In addition where patients are agreed as medically fit but require short term on going care then they are stepped down into their usual place of residence. The patient’s usual place of residence is known as the virtual ward. Virtual ward running well, Standard Operating Procedure almost finalised to be signed off at the next project group. Senior Advisor roles introduced and 2 WTE (Whole Time Equivalents) appointed. Use of increased skill mix within the Single Point of Access Team is being explored. IT systems for recording data are being reviewed. Currently in discussion with CCG commissioning colleagues regarding external communications. Business case submitted.

Urgent Treatment Centre (UTC) Peter

Bowker

A

G

G

NHSE have instructed CCGs to develop Urgent Care Treatment Centres to provide a multi-disciplinary team to manage the minor walk-in patients that attend hospital. At. Scunthorpe – currently modelling the flow through the service to agree with our partners what the final model looks like so that we can deliver this in the future following the pilot. At Grimsby – the service is currently working with its partners to model the pathways to ensure there is agreement on the final model provided. The Trust is also working with the Integrated Urgent Care Board to develop and acute and community wide model. Work is currently ongoing to finalise the governance arrangements around the Alliance which will be the operating mechanism for delivery of this urgent Treatment Centre. Pilots on both sites now running well though there are some staffing issues that are being addressed. Building

Project Risk Rating Blue Complete and embedded. Green Completed. Not yet fully embedded/evidenced. Amber In progress/on track. Red Not yet completed/significantly behind agreed

timescales.

Programme: Access & Flow Workstream: Unplanned Care Planned Care Number of Projects in Total 5 4 Number of Project Milestones 36 29 Number of Project Milestones Complete in Month 19 12 Number of Project Milestones on Track 15 17 Number of Project Milestones Overdue 2 0 Number of Projects Closed in Month 0 0


21

work to Scunthorpe Hospital is due to complete in mid-April 2019. The trust is currently working with its partners to look at utilisation of existing space within A&E.

Ambulatory Care Peter

Bowker

A

A

A

The purpose of this project is to manage patients as far as possible on an ambulatory basis in line with national guidance. This is a two part project which has initially focussed on the implementation of surgical pathways which are assessed in ED and directly streamed to a Surgical Ambulatory Ward. Numbers on the Grimsby site have remained static, 125 in February 2019 for Surgery which is 33.2% of their surgical non-elective activity. The Coding work with Grant Thornton has identified a number of pathway opportunities for Surgical Ambulatory Care which requires further exploration. Work is still underway to find a suitable location for an ambulatory care unit on the Scunthorpe site and is part of the site development work. Activity in Medicine was 452 cases across both sites in February 2019. Which is 18.7% of non-elective activity at Grimsby and 23.6% at Scunthorpe.

Risks Ref Date Risk


Mitigation Occurred

RAG

03/10/18 Financial Risks associated with continuing to run frailty the pilot R

To produce the business case promptly to maintain the financial risk to a minimum, this has been delayed and is now due to be presented to Trust Management Board in March 2019.

A

01/10/18 Risk that lack of clinical engagement for morning board rounds will mean there will be no clinical decision maker as part of the MDT therefore delayed discharges

R

To work with clinical teams during implementation of SAFER principles and Red2Green tool, any issues to be escalated. Revise job plans to accommodate workload.

A


Key issues for escalation are: insufficient clinical engagement to facilitate the implementation of the SAFER principles across the wards which will have a negative impact on Length of stay as a result of

key decisions not being made in a timely manner.


These Key Performance Indicators are yet to be populated by Information Services.

Outcome Metrics Key Performance Indicator Current

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

Unplanned Care A&E maximum waiting time of 4

hours from arrival to admission /

transfer / discharge - Type 1

Trust

91.6% 86.7% 84.9% 81.6% 77.6% 85.3% 88.3% 88.1% 84.0% 87.0% 89.2% 86.4% Trajectory

Comments: A&E Conversion rate to Inpatient

Trust

Trajectory Comments:

Non Elective Length of Stay

Trust

4.42 4.40 4.52 4.88 4.85 4.95 4.83 4.71 4.69 4.58 4.51 4.63 Trajectory

Comments: Number of 0 LOS Non-elective Patients

Trust


% of Patients being re-admitted within

30 days Trust

6.2% 7.6% 7.5% 7.2% 6.3% 6.7% 6.7% 6.4% 7.1% 6.9% 7.1% 6.3%


% of Patients being re-admitted within

7 days Trust

Trajectory Comments: showing ad missions an d not transf ers


22


Access & Flow – Planned Care Project Title P

roje

ct

lead

Previo

us

RA

G

Cu

rren

t

RA

G

Ne

xt RA

G


Performance standards and waiting lists

Jackie France

A

A

A

Clinical Harm cohorts: These are complete and closed – all further patients will be progressed through one Patient Targeted List (PTL) and managed through the Risk Stratification Framework Risk stratification process:

Draft process with Medical Director

Specialty trigger points are under development within each Division

181 deaths validated and signed off RTT:

Meeting held to determine further communications and training plan – presentation to be given at Council of Governors

Daily huddles in place for all specialities with Specialty Administration Team (SAT) members, Team Leaders and Service Managers to review clinical priorities 52 week waits and manage patient booking priorities – review of effectiveness to be undertaken and changes implemented if required

Development of electronic whiteboard underway for daily huddles management

Divisional weekly PTL meetings linked to PTL weekly meeting to review and scrutinise patient level detail and manage the 52 week wait position with some speciality reviewing down to 40 weeks and preventing “tip overs”

Division/Specialty 52 week waits reviewed daily and “tip overs” managed – daily refreshed monitoring dashboard developed

CQC high level milestone plan converted to a working document and Task and Finish Group established to monitor progress

Outpatients:

Trust reps and Commissioners met to plan Outpatient Transformation Programme for the patch

Attended OP benchmarking conference in London to network and share good practice

Dynamic OP Data Collection Form being implemented Trustwide following pilot in Ophthalmology and will be completed by end of March 2019

Post implementation review required in Spring 2019 to assess impact

Central RTT validation team business case underway. Theatres: Theatre session uptake and scheduling severely compromised by the closure of the Coronation Block F&G theatres and

wards 10 and 11 - release of 1xSGH theatre session from Gynaecology provides recovered session for ophthalmology (impact of F&G theatre closure)

Vanguard – Friday pm offer to Hull – negotiations in progress and a business case is currently under develop to consider long term use of vanguard

Theatre Staffing - High vacancy factor and sickness levels are high risk to delivery of planned activity.

Percentage of fractured neck of femur patients admitted to surgery within 36 hours: from arrival in an emergency


23

department, or time of diagnosis if an inpatient, to the start of anaesthesia: Percentage to follow.

Cancer

Denise Gale

A

R

A

Current cancer targets are being delivered with the exception of cancer 62 day performance which is 76.98% against the 85% target in February. Early indications for March show deterioration in performance with an indicative quarterly performance at 73.64%. The un-validated position is showing non-delivery in the following tumour sites: Colorectal, Haematology, Head and Neck, Lung, Upper GI and Urology.

Work ongoing with Divisions to complete timed cancer pathways commencing with Lung, Colorectal and Prostate – Referral to diagnostics determined and measured against currently

Increase in ‘straight-to-test’ diagnostics underway – colorectal has commenced implementation.

‘Faster diagnosis’ pathways work is progressing. Diagnostics

Tracey Broom

A

A

A

JAG accreditation visit 09 May 2019

Call reminding to reduce DNAs – continue to monitor impact

Feedback utilisation of bronchoscopy lists to medicine, and if underutilised consider options

Ongoing monitoring of short notice cancellations with medicine, surgery and Clinical Support Services to maximise capacity

Programme trainee increasing points per list developed – ongoing review

Medical Scopist appointed – commences 04 April

Direct access for dysphagia/dyspepsia referrals: Under review with clinicians following discussions with primary care Preoperative assessment (POA)

Helen Davis

A

R

A

POA Standard Operating Procedure (SOP) drafted and out for consultation

Anticoagulation Standard Operating Procedures (SOP) agreed in principle to use Sheffield guidelines – require drafting and sign off

Booking processes for each specialty administration team (SAT) have been collated with a view to streamlining processes Trustwide. This was discussed at the Task and Finish Group in December and a plan for improvement is being taken through the SAT huddles (in the PSWL project)

Trust visit to Northumbria to review process for Orthopaedic elective surgery and understand enhanced recovery preassessment took place on 09 November 2018. Next steps were discussed at the Task and Finish Group in December and work is also underway to utilise Goole more effectively. Improvement Programme Manager has met with T&O Clinical Lead to discuss how this project can work with ERAS to support T&O

Clinical pre-assessment training sessions scheduled in monthly for 2019

Telephone pre-assessment process has been developed – needs clinical sign off

Ensure all 40 week wait patients have a valid pre assessment date and increase dating to achieve

Risks Ref Date Risk


Mitigation Occurred

RAG

1 01/08/18 Specialty performance recovery plans may be limited by the ability to provide additional theatres, outpatients and diagnostic capacity

R

Specialty teams to work with Theatre Transformation Board and link with outpatient and diagnostic teams to understand specialty capacity requirements and improve efficiencies in core capacity to deliver increased activity

A


24

Specialty performance recovery plans not linked to waiting lists – Information Services currently reviewing to align recovery plans with impact on waiting list

Theatre dashboard now available but accuracy of data questioned – discussed at PIMs and raised with executive team

KPIs/Trajectories (including quality and finance)

Planned Care Maximum time for 18 weeks from

point of referral to Treatment (18

weeks RTT) - Incomplete

Trust 73.1% 70.5% 69.1% 68.1% 66.2% 67.6% 70.2% 70.7% 71.0% 69.8% 69.3% 71.2% Trajectory

Comments: Patient waiting < 62 days from urgent

GP referral to first definitive treatment Trust 74.6% 80.3% 69.2% 81.8% 72.6% 72.5% 69.1% 73.0% 75.0% 73.1%


Outpatient New Attendances Trust 10,882 8,688 10,841 9,778 10,155 9,943 10,627 10,268 10,949 9,590 10,033 11,500 Trajectory

Comments: showing admissions and not transfers Outpatient Review Attendances Trust 22,547 17,477 20,816 18,885 20,664 19,588 21,059 20,687 21,572 19,186 20,104 23,214

Trajectory Comments: showing admissions and not transfers




Moderate (3)

Severe (4)

Catastrophic (5)

Rare (1) 1 2 3 4 5

Unlike (2) 2 4 6 8 10

Possible (3) 3 6 9 12 15

Likely (4) 4 8 12 16 20

Certain (5) 5 10 15 20 25


WORKSTREAM HIGHLIGHT REPORT Workstream: Service Strategy Senior Responsible Officer: Sue Barnett Reporting Month: February 2019

25



Workstream Element Pre

viou

s

RA

G

Cu

rren

t

RA

G

Ne

xt RA

G

Planned Finish Date

Revised Finish Date


Strategic Oversight Group established B

B

27 November

2017

n/a Scheduled into diaries on a monthly basis. Following stocktake and relaunch of Improving Together Programme to involve wider stakeholders, the monthly meeting transferred into breakfast meetings. Currently under assessment as a result of the HASR refresh

Humber Acute Services Review Programme agreed

B

B

24 January 2017

n/a Continuous comms needed.

First Clinical Design Group met 27th June providing joint clinical leadership between HEY/NLaG Currently under assessment as a result of the HASR refresh

South bank principles agreed B B 19 January

2018 n/a Built into the proposed service changes

Bring Wave 1, Fragile services to a conclusion

A

A

NLaG 31 March 2018

HASR September

2018 HASR May

2019

n/a Trust Board received Ear’s Nose and Throat (ENT) and Urology proposals 27th

March and agreed with the clinical leaders preferred scenario. Clinical Commissioning Group leaders meeting OSC chairs (joint approach still being established). Clinical Leads to attend for ENT, Urology & Haematology to provide update on service position as per briefings provided to OSC chairs. North East Lincolnshire OSC 12/9/18, NL OSC 17/9/18. Will be factored into any wider engagement and consultation due post May 2019. To form part of the full engagement and communication from Jan 19 through to potential public consultation as part of HASR programme. Refreshed HASR will include a wider review of the sustainability of ENT and Urology services across the whole of Humber. Confirmed now included, Board to Board with HEY. Meeting held 12th March 19, progress to wider review supported. Programme being refreshed to reflect changes.

Governance Structure for Wave 2 of HASR Programme

G

G

02 May 2018 n/a Northern Lincolnshire and Goole (NLAG) Chief Executive Officer, HEY CEO and Chair of HCV STP have proposed a governance structure for confirm and challenge at the next HASR Steering Group

2nd May – approved and in place. Feeding into breakfast meetings. Next 6 specialities agreed (Cardiology, Oncology, Neurology, Stroke, Critical Care, Complex Rehab). Will be aligned with the Emerging Clinical Strategy presentation to TB 18 December 2018. To be aligned to refreshed programme.

Detailed evidence and service planning which forms the foundations of the emerging clinical strategy

A

A

25 September

2018

Tbc Trust Board agreed Emerging Strategic headlines 27th February

HASR Steering Group agreed Emerging Strategic headlines 14th March Presented Emerging Strategic headlines to NHS Improvement 28th March


26

18 December 2018

Secretary of State meeting regarding strategic headlines 24th April Nuffield workshop held 22nd/23rd June

Trust Board agreed scenarios for modelling 26th June Humber Acute Steering Group presentation 4

th July

Breakfast meetings with clinical and system leaders to work through detail of scenarios in place during July. Further breakfast meetings arranged throughout September, October and November to continue scenario modelling and development of Current State (Case for Change) through to draft Future State. Attain appointed with effect from October 2018 through agreed CEO oversight. Presenting at Trust Board 18Dec18. To be aligned to refreshed programme.

STP Capital submission aligned to emerging clinical strategy

B

B

July 2018 July 2018 First submission through the STP achieved, awaiting feedback from regulators Group established to co-ordinate detailed submission by Jul18. Executive Director representation PC/JJ Capital submission deadline of 16th July met, £71.5m submission for NLaG. Awaiting feedback. Notional allocation of £29.26m received. 5 step Business case to be developed for SOC, OBC and FBC for the Trust and STP to receive allocation from the Treasury.

Nuffield Facilitated Workshop G

G

09 February 2017

Tbc through terms of

engagement

Workshops completed. Verbal agreement to provide confirm and challenge following the detailed scenario work up. Nuffield Trust document on ‘Smaller Hospitals’ shared with Divisions November 2018. To be referenced in the Emerging Clinical Strategy.

NHS Improvement support confirmed G G 31 March

2018 02 May

2018 Confirmed and included within the HASR Governance structure highlighted above

Clinical co-dependency grid in place

G

G

28 February 2018

In draft through full

ASR

Draft shared for confirm and challenge with Strategic Oversight group. One methodology to ensure co-dependencies is front and centre of all decisions. Oversight 28 February cancelled due to Opel4

from Snow. Has been shared as part of the Trust Board briefing 27th

Feb. Will remain in draft whilst all key specialties are worked through. Live document. Linking into HASR for consistency across the wider system. Will be linked into the strategy documents. To be reviewed through Clinical Strategy

meetings (redistributed 15th March 2019) Pan STP working group

B

B

17 January 2017

Ongoing Any service change has the potential to impact upon ULHT and Doncaster. Likewise any changes proposed from their acute service review may impact upon NLaG. Regular meetings established with agreement to build sensitivity analysis into strategies. Meetings held with ULHT to detail potential impacts on NLaG – being worked through and to interlink with strategy through impact analysis.

Specialty specific transformation groups in place – Surgery

G

G 31 December

2018 In place with Commissioner and GP reps as members. 4 patient representatives recruited and

supporting Urology, ENT, Ophthalmology and Orthopaedics. General Surgery commenced. Breast in development

Specialty specific transformation groups in place – Medicine

A

A

28 February 2018

Structure in place but not yet facilitating Commissioner and GP reps as members. Rep with potential for dual role but need formal structure for rep to be part of. Alternative specialty based groups in place and will be documented for clarity.

Specialty specific transformation groups in place – Women & Children’s A A 28 February

2018 Maternity in place. Paediatrics tbc as per comments below (NHSI coordinating)


27

Maternity Strategy

G

G

31 March 2018

Maternity strategy taken as far as can go without paediatrics review. Agreed through HASR Exec, not a priority for us for radical change Feeding into LMS as part of wider Humber Strategy longer term. Maternity appendix being refreshed with triumvirate. March 19 – Formal Maternity working group being established to work through standards and impact on services (to include link to LMS and CCG)

Please note: Planned finished date for the following represents the date for completion of draft for wider sharing and engagement. This is to ensure no decisions are made without full knowledge and understanding of all clinical interdependencies. The 3mth timescale referred to above covers the 6 priority specialties In wave 2.

Paediatric Strategy

R

R

31 March 2018

Maternity decisions cannot be made without reviewing paediatric and neonatal services. Resources not available to meet turnaround timescales hence red rating. NHSi support offered, NLaG accepted. PC requested review to include HEY and Sheffield Children’s, NHSi agreed in principle. NHSi have sourced external support, terms of engagement being worked through. Awaiting confirmation of who and when. Escalated to HASR programme leads. External support not secured. NLaG anaesthetic paediatric lead completed Paediatric pathway document. Paediatric appendix in progress to support the strategy. March 19 – Formal Paediatric working group being established to work through standards and impact on services (to include CCG)

Critical Care Strategy (wave 2) G

G

31 March 2018

Scenarios fully documented critical care presence on both sites. Clinical interdependencies resulting from Scenarios being worked through as part of breakfast meetings. ODN strengthened with a focus on workforce and technology developments. Critical Care appendix being refreshed with the triumvirate and clinical leads. Outcome available for options Q1

Urgent and Emergency Care Strategy

A

A

31 March 2018

Two urgent and emergency care front doors agreed through HASR Exec. Clinical interdependencies resulting from Scenarios being worked through as part of breakfast meetings including the quantification of an UTC on site. Pilots complete. NL tender released. Tender delayed until February 2019 (awaiting Tender release). Tender withdrawn. Formal Multi-disciplinary Assessment Unit working group being established to through model of the service and programme.

Acute Medicine Strategy (inc Frailty, ambulatory care)

A

A

31 March 2018

Scenarios focussing on a multi-disciplinary assessment unit on each of the main sites. First breakfast meeting explored potential to join this unit to UTC to align staffing and reduce potential duplication. Integrating discussions into UTC models continue with CCG leads. Formal Multi- disciplinary Assessment Unit working group being established to through model of the service and programme.

Acute Surgical Strategy

A

A 31 March

2018 As above

ENT Strategy (wave 1)

G

G

31 March 2018

Timescale to share preliminary modelling of scenarios of future Acute hospital service provision including facilitated clinical discussions. Requested this be looked at PAN STP – requested support from HCV STP at Jan HASR Executive. Board received and agreed strategy March18. Due to NEL/NL OSC’s sept 18. To be further reviewed as part of HASR. ENT

Clinical Network established (26th March) including GIRFT to work through network wide solutions Urology Strategy (wave 1)

G

G 31 March

2018 Timescale to share preliminary modelling of scenarios of future acute hospital service provision

including facilitated clinical discussions. Headlines went to Trust Board briefing 27Feb18. Board received and agreed strategy March18. Due to NEL/NL OSC’s Sept 18. To be further reviewed as


28

part of HASR.

Haematology Strategy (wave 1)

A

A

31 March 2018

May Board Timescale to share preliminary modelling of scenarios of future acute hospital service provision

including facilitated clinical discussions. NLaG/HEY working through to 28th March for headlines. Actions to address in train, Board to receive progress (timescale TBC). NHSE leading, updated provided for OSC. Due to NEL/NL OSC’s Sept 18. Full business case in development, to be approved through internal structure. Clinical Senate invite to attend to update. Awaiting outcome form Specialist Commissioning.

Immunology Strategy

A

A

Priority following resignation of single handed immunologist. Red rated as HEY cannot support due to workforce shortages. Division seeking locum. Majority of allergy care is delivered in primary care in other areas; view of outgoing clinician is 90% can transfer. HEY already implemented shift. Linking into HASR. Joint support in place with HEY. Comms being worked through in terms of holding position. Paper due at TMB 17/9/18 for future decision of service. Network support in place from HEY whilst working on longer term strategy.

Cardiology Strategy (wave 2)

A

A

31 March 2018

ODN launched 12/6/18. Exploring potential change in 2018/19 as a result of long lengths of stay. Focus of breakfast meetings. Community cardiology going live Nov 18. ODN established. HASR speciality design workshop 21/11/18 – output disseminated for comment. Next review workshop scheduled for Jan19. Options available at end of Q1.

Respiratory Strategy

A

A

Linked to the acute medicine debate given the acute medical rotas. Right Care Programme also underway. NL and NE Lincs have supported a shift to community services for Resp with the potential investment of a consultant in each patch. This would provide better care for long term

conditions working with specialist nurses. Increasing pressure do to staff vacancies. Needs

alignment with Cardiology. Gastroenterology Strategy

A

A

Linked to the acute medicine debate given the acute medical and GI bleed rotas. Right Care Programme also underway indicating potential material shift away from acute care reducing demand. Three pathways agreed, implementation phasing to Jan 19. Increasing pressure do to work volumes. Needs alignment with Cardiology.

Neurology (wave 2)

A

A

Single handed service with no capacity to support any further from HEY. Requested this be looked at PAN STP – requested support from HCV STP at Jan HASR Executive. Network links in place, working through recovery plan. CNS MS funding secured. Significant progress made with RTT performance position and reduction in waiting lists. Network links continue. Options available Q1.

Oral and Maxillofacial Surgery R

R

Being driven as a HCV STP footprint due to scale needed to attract workforce. Based upon the West Yorkshire model. Builds upon relations built during orthodontic move, a HCV work stream. Strategy is wider than HCV STP, structure and timescales in discussion through STP led by York. NB immediate 18/19 issue due to limited capacity at HEY.

Trauma & Orthopaedics A

A

Transformation Board in place. GIRFT programme. HCV principle of Goole and Bridlington as elective orthopaedic centres. 70% of elective ortho now being cared for in Goole. Demand & capacity plans in progress. Links to MSK service provision and ability to reduce demand. MSK NL services out to tender March 2019.


29

Radiology A

A

Strategy in place however investment stream to deliver is not in place. Imaging Group with task & finish groups established to oversee CT and MRI developments. HCV STP taking forward agreed acute network actions including implementation of imaging equipment across the STP. Link to STP capital bid with notional allocation of £29.26m.

Ophthalmology A

A

Transformation Board in place. Plan agreed with commissioners. Recovery plan continues, significant progress made with RTT at DPoW and GDH, SGH back on track. AQP tender to increase overall capacity in the system (procurement withdrawn). Model of care changes still underway.

Community services A

A

North Lincs agreed to additional time to work through service need and structure therefore postponed tendering for 9mths. Transformation Board with task & finish groups structures in place with a clear direction of travel. Jan 19 next milestone review.

Ref

Date Risk Added

Risk Description RAG Mitigation/Controls Date Mitigation Occurred

RAG

1

Dependency of core specialty strategy (timescale) on other specialty strategies. Specifically, the ED/CC/Maternity strategies will impact the category 1,2,3 strategies and therefore the risk is timescales and sequencing.

R

(16)

Category 1 (Cardiology, Respiratory, Gastro, General Surgery, Acute Medicine) and Category 2 specialties (Urology, ENT, Haematology/Oncology), CT/MRI, Immunology) specialty strategies may need to remain temporary until Core specialty strategies are finalised. The risk will always be present . This needs to be assessed with the refreshed HASR programme.

R

(16)

2

Threat of service tendering present for community services and ophthalmology. UTC NLCCG published October 18.

R (16)

RAG improved following recent decision by NL CCG to delay community services tendering by 9mths. Keep progress through the transformation board under review. Both tenders withdrawn.

A (12)

3

Workforce strategies for 13 priority specialties are quite reactive to the immediate fix requirements. This is not necessarily providing a sustainable/long term solution.

Linkages into HASR / STP workforce strategies for joint potentials. Feb 19

4

Heat map work may identify additional specialties classified as ‘fragile’ for example; Immunology has been identified through the work. Eg we don’t know, what we don’t know. Following completion of demand and capacity across all specialties, NLaG have greater transparency and understanding of challenges and actions in place. The larger risk now, is lack of visibility of the capacity constraints in other organisations in particular our adult tertiary provider. Refresh will include reviewing additional models not just C&D constraints on existing models of care.

R

(16)

TP Board to note risk Work stream to complete heat map exercise to confirm any additional specialties No new specialty has been highlighted through the technical development. To remain a risk as we shift from technical to clinically owned indicator. Demand and capacity work for priority 8 completed. All other specialties due for completion end Sept 18 – completed (all 22) for both Hull and NLAG. Oncology and Respiratory also identified as a further risk. To align to refreshed prioritised HASR programme

A

(12)

5

Haematology service has escalated a potential issue in delivering the 3 step plan to stabilise the service with support from HEY. HEY has no capacity to take Grimsby inpatients or any patients from Scunthorpe.

R (16)

Work progressed with HEY actions in place 3rd April to expand their inpatient capacity to enable inpatient transfers. Transfer on schedule for September 2018 – delayed with specialist commissioning. Full business case to be approved. Still in development

R (16)

6 Oral Surgery – service impact due to limited capacity at HEY. R Discussions in progress (independent sector capacity)


30

Rated severe due to the length of time patients have already waited (over 52 week breaches) ENT – demand and capacity position to achieve 0 x 52 weeks

(16) Network STP wide to commence 26th March. (assessing independent sector capacity)

7 Engagement and communications (governance timeline) internal and external; resource to achieve.

R (16)

Comms & engagement plan in progress with support of ATTAIN as part of HASR.


Financial Delivery

No financial target


Ref KPI Target Aug Sep Oct Nov Dec Jan Feb Mar

Apr YTD Baseline Comments

S1

Specialties that have an agreed heat map assessment

34

0

0

0

0

0

0

0

0

0

Live document, agreement through the 18-

19 planning round.

S2

Specialities with a Board approved sustainability strategy

13*

0

0

0

0

0

0

0

2 0

ENT and Urology

S3

Specialities with a commissioner approved sustainability strategy

13

0

0

0

0

0

0

0

0 0

Target will be one month post NLAG Board date


Likelihood of recurrence None/Near Miss (1) Low (2)

Moderate (3)

Severe (4)

Catastrophic (5)

Rare (1) 1 2 3 4 5

Unlike (2) 2 4 6 8 10

Possible (3) 3 6 9 12 15

Likely (4) 4 8 12 16 20

Certain (5) 5 10 15 20 25

cog (04/19) item 3...2019/01/03 · cog (04/19) item 3.1 date 16 april 2019 report for council of...

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