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King’s College Hospital Council of Governors PUBLIC AGENDA

Time of meeting 18:00

Date of meeting Wednesday, 10 December 2014

Venue Boardroom, Hambleden Wing, KCH, Denmark Hill

Prof. Sir George Alberti Trust Chair Elected: Anoushka de Almeida-Carragher Bromley Eniko Benfield Bromley Paul Corben Bromley Penny Dale Bromley Fiona Clark Lambeth Chris North Lambeth Nanda Ratnavel Lambeth Grace Okoli Lambeth Alan Hall Lewisham Tom Duffy Patient Pida Ripley Patient Jan Thomas Patient Catriona Ogilvy Patient Derek St Clair Cattrall Patient Jan Thomas Patient Barbara Pattinson Southwark Pam Cohen Southwark Andrew McCall Southwark Victoria Silvester Southwark CV Praveen Staff - Medical and Dentistry Jo Artus Staff – Nurses and Midwives Nicky Hayes Staff – Nurses and Midwives Cornelius Lewis Staff - Allied Health Roger Engwell Staff – Administration, Clerical & Management Nominated/Partnership Organisations: Jim Gunner Bromley Clinical Commissioning Group Cllr Robert Evans Bromley Council Diane Summers Guy’s & St Thomas’ NHS Foundation Trust Phidelma Lisowska Joint Staff Committee Chris Mottershead King’s College London Cllr. Jim Dickson Lambeth Council Sue Gallagher Lambeth Clinical Commissioning Group Richard Gibbs Southwark Clinical Commissioning Group Kieron Williams Southwark Council In attendance: Tim Smart Chief Executive Officer Jane Walters Director of Corporate Affairs Roland Sinker Chief Operating Officer Simon Taylor Chief Financial Officer Geraldine Walters Director of Nursing & Midwifery Tamara Cowan Board Secretary (Minutes) Angela Huxham Director of Workforce & Development Apologies:

Circulation to: Council of Governors and Board of Directors

Enclosure Lead Time

1. STANDING ITEMS Chair 18:00

1.1. Welcome New Governors/Apologies

1.2. Declarations of interest

1.3. Chair’s action

1.4. Minutes of previous meetings – 25/09/2014 Enc. 1.4

1.5. Matters Arising/Action Tracking (No outstanding actions)

2. QUALITY FOCUS

2.1. Quarterly Patient Outcomes Report Enc. 2.1 M Marrinan 18:05

2.2. Care Quality Commission Report Enc. 2.2 J Walters 18:15

2.3. Introducing King’s Behaviours Presentation A Huxham 18:25

3. TRUST PERFORMANCE REPORTS

3.1. Board Report to the Council of Governors Enc. 3.1 T Smart 18:35

3.2. Trust Finance Report Enc. 3.2 S Taylor 18:45

3.3. Trust Performance Reports Enc. 3.3 R Sinker 18:55

4. COUNCIL UPDATE – ENGAGEMENT & INVOLVEMENT

4.1. Governor Engagement and Involvement Enc. 4.1 N Hayes 19:05

4.2. Sub-Committees Summaries/Actions 19:15

4.2.1. Membership & Community Engagement Enc. 4.2.1 A McCall

4.2.2. Strategy Enc. 4.2.2 C North

4.2.3. Patient Experience & Safety To follow T Duffy

5. GOVERNANCE FOCUS – FOR APPROVAL

5.1. New Council of Governors: Forward Plans Enc. 5.1 J Walters/ G Alberti

19:30

5.1.1. Lead Governor Role

5.1.2. Sub-Committees Structures

5.1.3. Proposed Timetables and Process for Establishing Council of Governors Governance Structures

6. FOR INFORMATION 19:45

6.1. Register of Governors Attendance Enc. 6.1

6.2. Quarter - Monitor Submission 2013/14 Enc. 6.2

6.3. Sub-Committees Confirmed Minutes

6.3.1. Membership & Community Engagement -10/07/2014

Enc. 6.3.1

6.3.2. Strategy – 31/07/2014 Enc. 6.3.2

6.3.3. Patient Experience & Safety – 31/07/2014 Enc. 6.3.3

7. ANY OTHER BUSINESS Chair 19:55

8. DATE OF NEXT MEETING – Thursday, 12 March 2015, 15:00, Boardroom

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Council of Governors – Public Session Minutes of the meeting held on Thursday, 25 September 2014 at 14:00 in the Boardroom, Hambeldon Wing, Denmark Hill

Prof Sir George Alberti Trust Chair Elected:

Anoushka de Almeida-Carragher Bromley Eniko Benfield Bromley Paul Corben Bromley Penny Dale Bromley Alan Hall Lewisham Fiona Clark Lambeth North Chris North Lambeth North Nanda Ratnavel Lambeth South Godwin Ubiaro Lambeth Central Barbara Pattinson Southwark Central Pam Cohen Southwark Central Andrew McCall Southwark North Joe Onabaworin Southwark North Michelle Pearce Southwark South Stuart Owen Southwark South (Part) Rachel Burman Staff – Medical and Dentistry (Part) CV Praveen Staff – Medical and Dentistry Nicky Hayes Staff – Nurses and Midwives Phyllis Barnett Staff – Allied Health Professionals (Part) Patti Kachidza Patient (Part) Jan Thomas Patient Pida Ripley Patient Tom Duffy Patient

Nominated/Partnership Organisations Diane Summers Guy’s & St Thomas’ NHS FT Phidelma Lisowka Joint Staff Committee Cllr. Barrie Hargrove Southwark Council Sue Gallagher Lambeth CCG Warren Turner London South Bank University (Part)

In attendance: Tim Smart Chief Executive Jane Walters Director of Corporate Affairs Tamara Cowan Board Secretary (Minutes) Tooba Ahmadi Corporate Governance Officer Roland Sinker Chief Operating Officer (Part) Simon Taylor Chief Financial Officer Geraldine Walters Director of Nursing and Midwifery Angela Huxham Director of Workforce Development Craig Wisdom Deloitte - Auditors David Fontaine-Boyd Victoria Silvester Shadow Governor Paul Brown

Apologies Graham Meek Non-Executive Director Chris Stooke Non-Executive Director

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Prof. Ghulam Mufti Non-Executive Director Faith Boardman Non-Executive Director Sue Slipman Non-Executive Director Marc Meryon Senior Independent Director Michael Robinson Lambeth Central Helen Mencia Staff – Nurses and Midwives Ahmad Toumadj Staff – Support Staff Michael Pedro Staff – Administration & Clerical Derek Cookson Patient David Sullivan Patient Carolyn Campbell-Cole Staff – Nurses and Midwives Cllr. Robert Evans Bromley Council Jim Gunner Bromley CCG Cllr. Jim Dickson Lambeth Council Richard Gibbs Southwark CCG Chris Mottershead King’s College London Madeleine Long South London and Maudsley NHS FT

Vacancies: Public Governor Lambeth South

Item Subject Action

14/45 Welcome & Apologies The apologies for absence were noted.

14/46 Declarations of Interest There were no declarations of interests raised.

14/47 Chair’s Action There was no chair’s action reported.

14/48 Minutes of Previous Meeting The minutes of the meeting held on 15 May 2014 and were approved as a correct record.

14/49 Matters Arising/Action Tracking There were no actions arising from the last meeting.

14/50 Quarterly Patient Safety Report

Ed Glucksman, Clinical Director for Medicine presented the quarterly patient safety report outlining the key patient safety issues that have been reported through the governance framework as at September 2014. The following key points were noted: A new duty of candour requirement will come into force from 01 October

2014 requiring the Trust to be more open and proactive in disclosing issues with patients and their relatives;

All incidents resulting in moderate/major harm are subject to additional

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Item Subject Action

disclosures. The Trust has appointed a Candour Guardian and established a working group to put policies and procedures in place;

There was an increase in patient falls during 2013/14. The Trust identified

this as one of the Quality Priorities for 2014/15. The Trust is putting significant efforts to address issues around falls. The number of falls has decreased by 9% at the Denmark Hill (DH) site and 10% at the Princess Royal University Hospital (PRUH); and

The I-Mobile initiative has shown demonstrable benefit since its inception in

September 2013. This initiative is also being developed at the PRUH, replacing its Critical Care Outreach programme.

The Council noted the report and the following points were highlighted in discussion: The report highlights and emphasises change in culture and behaviours.

This is an important area and governors are kept up to date through the action plan which tracks on-going learnings;

The lack of Electronic Patient Record system and the electronic software such as Wardware do not impose any significant risk at the PRUH site. The Trust has in place similar surveillance across the sites to monitor risks. Additional measures such as more establishment and robust teams are also being put in place to further minimise the risks; and

The construction of a new 60 bedded critical care unit began at the end of

2013 with planned completion in 2015/16. The revenue will be from the tariffs charged and this is supported by the Commissioners as part of the business case for Foundation Trusts (FTs).

14/51 Monthly Staffing Levels

The Council noted and received the monthly report on nurse staffing levels. The following key points were raised:

The recent national guidance now requires the Trust to publish monthly reports on the number of nursing staff on duty by ward;

The Trust is using an evidence based tool to monitor nursing numbers on a monthly basis and report to the Board. The first report was provided to the Board on 27 May 2014 and this is now available on the Trust’s website;

On reviewing the data post submission some errors were noted. The Trust commissioned KPMG to undertake a process for validating the data and reduce errors;

The Council noted two dashboards for the wards at the PRUH and DH sites.

The charts showed the number of staff who were rostered for duty, and the

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Item Subject Action

number actually available to work on the shift. It also showed the “actual” average nurse to patient ratio for each ward;

Cells highlighted ‘red’ in the dashboard indicated areas where the Trust did not achieve the number of expected nurses. The Council noted mitigating actions against each ‘red’ area;

It was highlighted that there are instances where the number of Health Care Assistants (HCAs) is greater than planned. These are due to a number of reasons such as patients requiring 1:1 care and gap in trained nurses, such as when Bank staff are not available and when overseas nurses are undertaking their registration training.

Figures are skewed in Paediatric Short Stay as it is a newly opened unit with

high band 5 vacancies; and Nursing numbers are visible to patients on the wards. The performance

board and the CQC dashboard will also be visible on the wards across all the Trust sites.

14/52 Board Report to the Council of Governors

The Council received and noted the report from the Board of Directors presented by Tim Smart. The following key points were noted: The National Health Service (NHS) is now under more pressure than at any

time before with issues around system leadership;

The NHS funding gap is circa £20-30 billion by the end of next parliament and there is a proposal for only £2.5 billion extra funding for next year;

As agreed with the Council of Governors, the Trust took the additional

challenge of acquiring the PRUH in October 2013; On 01 October 2013, the PRUH had 29% nurse vacancies. Since then, the

Trust has helped to recruit nurses to a level that will deliver safe care but this is at a cost of circa £3m a month in excess of funding;

Most trusts are experiencing the challenge of recruiting nurses at the rate required. The Trust has an extensive programme to recruit nurses from overseas;

The Trust is progressively improving performance of the emergency department (ED) and reducing long waiters at the DH site. The PRUH ED performance has improved between 10-15% since the acquisition;

Activity from other boroughs especially Lewisham and Bromley have increased disproportionately. Therefore, due to the increase in emergency patients the Trust is having to cancel elective patients. The system must commission more beds for repatriation to help resolve these issues

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Item Subject Action

The Trust also needs to make full utilisation of Orpington. There is currently 70% theatre utilisation and plans to increase this further;

The Trust must work more efficiently and effectively with local authorities on

discharge of patients and integrated care service; Across the health economy in the South, there are unusual fluctuations of

referral pathways and activity levels. This is driving the huge pressures and challenges experienced by the Trust; and

In consultation with the Commissioners and NHS England and Regulators

the Trust is considering restricting some referrals into the Trust sites to help release some of the pressures. The Trust is committed to provide care and services to its local patients and its tertiary specialities.

14/53 Trust Finance Report The Council received the Trust’s finance report for month 12 . Simon Taylor reported on the key issues in terms of ongoing negotiations with key stakeholders regarding the deficit position. The following points were noted: The Council met with the Board in July 2014 to discuss Trust’s financial

issues. It was highlighted that the Trust was running at a monthly run rate of circa £5m adverse against plan. Some mitigating actions were put in place to reduce expenditure during July and August;

There has been some positive improvement but further action needs to be undertaken to get to a sustainable position by year end;

In addition to temporary spend across sites, permanent staffing levels and the inherited vacancy rates from the PRUH need to be addressed;

The high level of emergency demand is also an area of concern as it is having a knock on effect on elective flow; and

A number of actions and recruitment plans are in place to address these issues but these need more time to come into effect.

14/54 Trust Performance Report The Council received the Trust’s performance reports for month 12 and noted the update from Roland Sinker. The following was noted: Demark Hill (DH) site There have been strong areas of performance around quality, particularly in

outcomes and patient safety;

High rate of C.difficile and lack of physical capacity, which has resulted in multiple cancellations are two areas of key concerns at DH site;

The Trust has undertaken intensive cleaning and spot checks to reduce the

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Item Subject Action

rate of C.difficile;

Access targets, in terms of ED waiting times and patients waiting for inpatient appointment have also been challenging;

A significant amount of work is being done in ED to improve pathways.

These include building additional capacity on site and improvement work around repatriation and rehabilitation;

Despite increasing demand, the Trust has managed to marginally improve

performance to 95.5% last week; Approximately 2000 patients were waiting over 18 weeks across various

specialities during the summer. The RTT waiting times have now decreased to 1600 and it is planned they will drop to 1200 by the end of November 2014;

Neurosurgery, Bariatric Surgery and Orthopaedics are three specialist areas

that are of concern for RTT. Controls on referral, cost effective ways of working as well as off-site working are enabling progress to be made;

Finance issues at DH site mainly relate to temporary staffing, drug

expenditure and lower levels of elective activity;

RS highlighted that the Trust is in advanced discussions with the Commissioners potentially to close referrals to particular catchment areas; and

PRUH site Overall there has been improvements in patient experience at the PRUH

with the Friends and Family Test (FFT) score outperforming DH scores;

Over 95% performance was maintained during August without a drop in activity;

Key concerns remain around Referral Time to Treat (RTT), cancer waits and the financial position; and

The quality improvement initiatives at the PRUH site have had a significant

financial impact on the Trust. The Council noted the report and the following points were raised in discussion: It was highlighted that the Trust has significant numbers of bank and agency

staff. The Trust is trying to maximise the use of bank staff but due to the lack of skilled nurses in the system, the use of agency staff to fill particular specialists posts becomes necessary; The Trust has developed a medium term recovery plan and engaged with the Regulators to discuss and address the Trust’s key concerns, issues as well as the underlying position;

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Item Subject Action

Financial recovery schemes for each division have also been developed with the aim to reduce costs in bank, agency and locum spend. These schemes are monitored fortnightly to ensure they are on track;

Discussions are ongoing with the Commissioners and the Trust Development Authority (TDA) regarding indemnity costs as well as other aspects of transition funding; and

A new Transition Integration Director (TID) has been appointed who will lead and monitor the benefit realisation plan.

14/55 Governor Engagement and Involvement Nicky Hayes presented the report on governor engagement and involvement and the following key points were noted: Governors have been involved and engaged with members and the public

through a number of activities and initiatives. These range from taking part and speaking at the Trust Open Day to attending various community events during the period 01 May – 19 September 2014;

The Trust recognises the exceptional inputs and valuable engagements of the governors; and

If governors wish to get involved in other ways or explore certain initiatives, they could contact the Foundation Trust Office (FTO).

The Council noted the update and thanked the out-going governors for completing their term of office, in particular Michelle Pearce and Stuart Owen for their exceptional contribution in outpatients and Pharmacy and Phlebotomy transformation projects.

14/56 Sub-Committees Reports and Action Summaries Membership & Community Engagement (MEC) Committee Andrew McCall provided an update on the activities of the Membership and Community Engagement Committee and the recent meeting. He reported the following: The last meeting of the Committee was held on 10 July 2014 and it was very

well attended;

The Committee continues to have external representation at this meeting. Hannah Kowszun, Marketing and Membership Manager at the National Council for Voluntary Organisations (NCVO) was invited at the last MEC meeting to talk about their membership strategies and how these could be reflected and applied to King’s;

The engagement with Millwall Football Club continues and there are

promising links with Bromley College to encourage membership, especially of young people;

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Item Subject Action

The Committee also discussed the Members’ Survey and commented that the survey should be more accessible and user friendly;

The contents of the next @King’s edition was discussed and the Committee

suggested that new Governors should feature in the Autumn edition; It was highlighted that the Transport Feeder Group (TFG) continues to meet

but it is not a governor committee and independent of the Trust. However, TFG is now a standing item on the MEC agenda to ensure governors are kept abreast of the local transport issues;

One of the imminent transport issues is the extension of the Bakerloo line.

The extension plan will be published soon; and Derek Ray-Hill, Business Development Director at London First has been

invited to attend the next MEC meeting and discuss how London First engages, attracts and retains members.

Strategy Committee Tom Duffy provided an update on the activities of the Strategy Committee and the recent meeting on behalf of Chris North. He reported the following: The Committee had discussed the 5-year strategy plan in depth and these

discussions were continued at the joint Board and Council meeting following the Strategy Committee meeting on 31 July 2014;

The Committee received and noted the Information Communications Technology (ICT) strategy and noted that the new system for electronic patient record at the PRUH is under investigation; and

The Committee also heard from John Hampton, the newly appointed

Director of Transition and Integration about his roles and plans for implementing the Cost Improvement Plans (CIP).

Patient Experience and Safety Committee (PESC) Tom Duffy provided an update on the activities of the Patient Experience and Safety Committee (PESC) and the recent meeting held on 31 July 2014. The following points were highlighted: The Committee noted the presentation about the King’s in Conversation

(KiC) and how the findings were integrated in the wider cultural programme, ‘All Together Better’. It was highlighted that if KiC is repeated next year, Governors should continue to be involved in this programme;

Briony Sloper, Deputy Divisional Manager TEAM reported on the initiatives to integrate and differentiate emergency department (ED) and urgent care. It was noted that approximately 25% of the emergency department attendances could have been managed by the primary care centre or GPs;

The Committee commended the Commit to Care initiative, which is in place

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Item Subject Action

and working well;

The Phlebotomy update highlighted that there has been significant improvement in reducing the average waiting times;

An update on ‘Delivering Dignity’ project was provided to the Committee and

it was noted that the project has now been launched across all the Trust sites; and

A patient letter with unsatisfactory response was discussed and Committee

noted that the incident was fully investigated and learnings have been put in place.

14/57 Elections Update Jane Walters (JW) reported the ballot for governor elections closed on Friday, 12 September and the results were announced on Monday, 15 September 2014. JW congratulated all Governors for re-election and offered her commiserations to unsuccessful candidates. The Council also welcomed Victoria Silvester, a newly elected Governor who was in attendance at the Council meeting in her capacity as Shadow Governor. It was highlighted that the newly elected governors will be invited to participate in a robust induction and training programme, which will include the Foundation Trust Network Governwell core skills training and various shadowing opportunities.

14/58 Trust Annual Reports and Accounts 2013/14 The Council received the Trust Annual Report and Accounts 2013/14 as presented by Simon Taylor (ST), Chief Financial Officer.

14/59 External Audit Report to the Council The Council noted the following reports from the external auditor, Deloitte: The report on the audit of the Trust’s 2013/14 financial statements.

The report on the findings and recommendations from the 2013/14 quality

report assurance review. Craig Wisdom (CW) advised that Deloitte had, in accordance with Monitor’s requirements, conducted the audit of the Trust financial statements and the quality report. CW reported the following: The acquisition of the PRUH was a significant accounting transaction, which

had a significant impact on the audit this year;

Deloitte followed the same process and approach as previous years;

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Item Subject Action

Overall the finance teams managed the additional work that came out of the PRUH transaction and no significant issues were identified in accounting treatments during the year;

As part of the approach, a number of risk areas such as recognition and accounting treatment of the South London Healthcare Trust (SLHT) transaction were considered and no significant issue was identified;

Deloitte issued an unqualified opinion on the financial statements and did not

report anything by exception.

The Council noted that over 74% of debtors were outstanding over 190 days. In normal circumstances Foundation Trusts would not have any outstanding debtors over 120 days. However, it was highlighted that the CCGs and NHSE are struggling to process invoices on timely basis and this year the Trust had a significant amount of transitional funding and investment funding, which were still outstanding by the end of March 2014;

The Council noted the scope for the work carried out on the quality report on

page 3 of the second report; Deloitte qualified their opinion on the quality report as the Trust took the

decision not to consolidate data in respect of the new sites acquired by the Trust on 1 October 2013. The Trust therefore has not reported consolidated performance in respect of the mandated indictors as required by Monitor; and

Page 5 of the report outlined the process for quality report review to ascertain

whether or not the Trust’s assumptions in the quality report were consistent. Apart from one minor exception Deloitte’s data testing had been satisfactory.

14/60 Update on external auditor performance Simon Taylor (ST) in the absence of Chris Stooke, Chair of the Audit Committee reported that one of the official duties of the Council is appointment and removal of external auditors. The Council should note that the Chair of the Audit Committee, the Audit Committee and the Finance team are content with the performance of the Trust’s external auditors. They are a professional team with systematic processes and procedures.

14/61 Register of Attendance The Council noted the governor register of attendance.

14/62 Quarter 1 – Monitor Submission 2013/14 The Council noted the submission made to Monitor for quarter 1.

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Item Subject Action

14/63 Sub-Committees Confirmed Minutes The Council noted the following sub-committee minutes: Membership & Community Engagement Committee – 08/04/2014 Strategy Committee – 10/04/2014 Patient Experience and Safety Committee – 10/04/2014

14/64 Any other business Viapath Chris North (CN) informed the Council that Guys & St Thomas Hospital (GSTT) discussed Viapath at their public meeting yesterday, 24 September 2014 and enquired if there is any update on the Trust’s position in relation Viapath and the transfer of staff. TS provided the following update: The restructuring of Viapath was brought about by HMRC ruling in relation to

recovery VAT and unless the business is restructured, Viapath may not be sustainable;

Previously, the Trust went through a negotiation process at which time the Trust was not prepared to agree with the proposal of restructuring the business;

The Trust has worked very hard to ensure that the Viapath management team understands that they need to put more effort to meet the future needs of the market;

The Board has now decided to support the restructuring proposals for

Viapath as the business would have a viable future; and The Trust has entered into a consultation period regarding the TUPE of circa

30 staff into Viapath. The consultation period starts on 01 October 2014.

14/65 Date of Next Meeting Wednesday, 10 December 2014 in the Boardroom at 18:00.

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Patient Outcomes Report: Q2, 2014-15

Ensuring clinical care at KCH achieves real health benefit, such as

longer life, symptom relief or quicker recovery.

Report to: Council of Governors Meeting: 10 December 2014 Status: For Information

Enc. 2.1

Executive summary (1/2) 1. Key concern • Hip fracture:

• The National Hip Fracture Database identified a 30-day mortality rate as being more than two standard deviations higher than the national average for the PRUH site only, based on 2012-13 data. This may represent a mortality higher than expected for this period.

• An internal Mortality Outlier Alert was triggered by the Medical Director’s Office and the standard Trust process to

review data quality, coding, casemix and clinical care has been initiated. The review is due to conclude by end December 2014, and will be summarised in this report, Quarter 3 (see page 7).

• Hip fracture had already been identified as an area for improvement and is a Trust Quality Priority 2014-15 (see page 14)

2. Areas of excellence

• KCH (all sites) overall Summary Hospital Mortality Indicator (SHMI) is below expected at 87 for the 12 months to June 2014.

• Denmark Hill Hyper Acute Stroke Unit (HASU) achieved the 5th highest score nationally in the Sentinel Stroke National Audit Programme this quarter. PRUH HASU performed above national average.

• Targets for dementia, alcohol and smoking set out in CQUINs were all exceeded this quarter.

• Measurable improvements in quality governance at the PRUH in relation to clinical effectiveness (mortality monitoring, evidence-based practice and clinical audit).

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Enc. 2.1

Executive summary (2/2) Clinical effectiveness overview: the extent to which clinical care achieves real health benefit, e.g. longer life, symptom relief or

quicker recovery (NHS Outcomes Framework Domains 1, 2, 3)

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Indicators Monitoring source Risk rating Comment/action

DH PRUH

External monitoring

CQC Intelligent Monitoring Report indicators - July 2014 AS REPORTED LAST QUARTER (NO NEW CQC REPORT PUBLISHED)

Hip fracture indicator (National Hip Fracture Database) Risk No evidence of risk

Relates to proportion of patients achieving compliance with national criteria of best practice. Hip fracture is a 2014-15 Trust Quality Priority.

Stroke indicator (Sentinel Stroke National Audit Programme [SSNAP])

No evidence of risk

Some evidence of risk

Relates to proportion of patients directly admitted to a stroke unit within 4 hours at PRUH . DH & PRUH above national average for overall SSNAP performance.

Mortality indicators (including SHMI) Maternity indicators Readmissions indicators

No evidence of risk

No evidence of risk

National audits - reporting this quarter

National Cardiac Arrest Audit Sentinel Stroke National Audit Programme (SSNAP) Intensive Care National Audit & Research Centre (ICNARC) Inflammatory Bowel Disease (Adult) – clinical audit Inflammatory Bowel Disease – paediatric National Joint Registry Severe Sepsis and Septic Shock (College of Emergency Med) National Hip Fracture Database

No evidence of risk

Risk 1. Mortality at PRUH for hip fracture may be above expected. Internal Mortality Outlier Alert initiated.

2. Mortality ratio at PRUH critical care was above control limit for 2012-13 and is in public domain. For Jan-Jun-14 PRUH was within control limits, possibly indicating a data or coding issue -prior to KCH integration. Monitored by Mortality Monitoring Committee.

3. Management of severe sepsis and septic shock in PRUH ED below national average but measurable improvement made since last round of audit.

Internal monitoring

Trust Quality Priority 14-15 – Preventable ill-health CQUIN – Alcohol CQUIN – Smoking

No evidence of risk

No evidence of risk

Initiative proceeding on course to achieve objectives.

Trust Quality Priority 14-15 – Hip fracture Internal monitoring No evidence of risk

No evidence of risk

Initiative proceeding on course to achieve objectives.

Mortality (Summary Hospital Mortality Indicator [SHMI]) (deaths up to 30 days after discharge)

Healthcare Evaluation Data (HED) No evidence of risk

No evidence of risk

CQUINs Alcohol Smoking Dementia Long-term conditions (COPD)

No evidence of risk

No evidence of risk

CQUIN targets all met/exceeded.

Trust Performance Scorecard • SHMI (in-hospital deaths) • Elective crude mortality • Length of stay – elective and non-elective • Outliers • Elective inpatients with EDD • Diagnostic waits >4 weeks • Cancer waiting times • Unplanned admissions to ICU/HDU • Emergency readmissions within 30 days • Repatriation delays • RTT no. 40+ week admitted waiters; incomplete • 18 week waits (admitted & non-admitted pts) • Emergency care performance

Trust Performance Scorecard, 2014-15, period 5 (August) – clinical effectiveness indicators (BIU)

Risk Risk

14/16 indicators showing red status at DH 8/13 indicators with data showing red status at PRUH

Enc. 2.1

Introduction • The Patient Outcomes Report outlines King’s College Hospital NHS Foundation Trust (KCH)

performance in relation to clinical effectiveness, which is defined as the extent to which clinical care

achieves real health benefit, such as longer life, symptom relief or quicker recovery.

• The report is structured around the NHS Outcomes Framework Domains 1, 2 & 3 – clinical

effectiveness.

• The information included is derived from the following sources: – Care Quality Commission and Dr Foster reports – Healthcare Evaluation Data (HED) – National clinical audits – these are published at varying intervals over a 2-3 year cycle (dependent on the project) and results

are provided along with the Clinical Effectiveness Committee’s rating (see Appendix 1 for definitions). – National registries of clinical data – CQUIN monitoring – KCH internal systems for monitoring NICE compliance and national audit participation.

• This report provides assurance that KCH:

– Is delivering against the NHS Outcomes Framework – Routinely monitors clinical effectiveness and implements actions that support the achievement of excellent patient outcomes – Achieves CQC Essential Standards outcomes 4 & 16 in relation to clinical effectiveness – Is effective in improving clinical care in relation to the Trust’s chosen quality priorities – Minimises reputational risk in relation to patient outcomes.

Domain 1 Preventing people from dying prematurely Domain 2 Enhancing quality of life for people with long term conditions Domain 3 Helping people to recover from episodes of ill health or following injury Domain 4 Ensuring that people have a positive experience of care Domain 5 Treating and caring for people in a safe environment and protecting them from

avoidable harm

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Healthcare Evaluation Data (HED): KCH (all sites) Summary Hospital Mortality Indicator (SHMI) is below expected at 87.15 for the 12 months to June 2014.

SHMI Overview Poisson Distribution Funnel Plot

Number of expected deaths 12 months to Jun 2014

12 months to June 2014

Preventing people from dying prematurely (Domain 1) Mortality indicators (1/2)

SH

MI

SH

MI

Enc. 2.1

Healthcare Evaluation Data (HED): for the 12 months to June 2014, Denmark Hill SHMI is below

expected at 82.04 and Princess Royal University Hospital is within expected range at 94.33.

SHMI Overview Poisson Distribution Funnel Plot Time Series (July 2013 – June 2014) Denmark Hill Denmark Hill

Princess Royal University Hospital Princess Royal University Hospital

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SH

MI

Number of expected deaths 12 months to June 2014


Preventing people from dying prematurely Mortality indicators (2/2)

NB: No PRUH data for Q1 or Q2 Apr-Sep-13

SH

MI

SH

MI

SH

MI


95% CI 77.8 86.5

95% CI 86.5 100.6

SH

MI

Enc. 2.1

1. Palliative care coding rate – Dr Foster Hospital Guide (Nov 2013) identified KCH Denmark Hill as having ‘higher than expected’ use of palliative

care codes. – Previous review of palliative care coding concluded that coding is appropriate according to our casemix. – A follow-up review was initiated April 2014 and concluded September 2014. The report is in draft and a summary

will be included in Patient Outcomes Report 2014-15 Quarter 3.

2. Hip fracture – internal mortality outlier alert initiated – Data from the National Hip Fracture Database identified a 30-day mortality rate as being more than two standard

deviations higher than national average for the PRUH site only, based on 2013 data. – An internal mortality outlier alert was raised by the Medical Director’s Office on 8 October 2014 and the standard

Trust process to investigate data quality, coding, casemix and clinical care has been initiated. – Due for completion by end December 2014 and reporting in Patient Outcomes Report 2014-15 Quarter 3.

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Preventing people from dying prematurely Outlier investigations in progress

Enc. 2.1

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Preventing people from dying prematurely Trust Quality Priority – preventable ill health

Background:

• Nationally, smoking leads to premature death in half of all smokers; half of all hospital admissions are attributable to smoking. • Deaths from lung cancer in Southwark and Lambeth are among the highest in England. • Alcohol-specific hospital admissions in Lambeth and Southwark are much higher than the London average. Key objectives are to:

• Increase the assessment of patients, number of staff trained to provide brief interventions, referrals into specialist services and number of smoking ‘quitters’.

• Identify opportunities to promote exercise and healthy eating. Progress monitored by:

• CQUIN reporting for smoking and alcohol. • Reporting to Public Health Committee. Progress to date – alcohol:

• Denmark Hill – training targets and plan are in place, recording mechanisms are in place. • PRUH – 40% of Medical Admissions Unit (MAU) and 30% of Acute Surgical Unit (ASU) patients were screened for harmful alcohol

use. A roll out plan is in place for maternity. Training targets and plan are in place. • Working on implementation of NCEPOD report ‘Measuring the Units’ on alcohol-related liver disease. Progress to date – smoking:

• Denmark Hill – training targets and plan are in place, recording mechanisms are in place. • PRUH – 40% of MAU patients and 34% of ASU patients have been screened for smoking. 80% of MAU and 41% of ASU patients

have been offered ‘ADVISE’ and ‘ACT’ elements of the evidence-based Very Brief Advice intervention. A roll out plan is in place for maternity. Training targets and plan are in place.

• Executive commitment for smoke-free King’s by 19 January 2015 and initiation of Smoke Free King’s communications plan. Progress to date – other:

• Funding provided by commissioners for two Band 7 posts to support roll out of healthy lifestyle support to KCH patients. • Detailed overview of local community provision for exercise that can be given to patients (e.g. exercise classes, gyms in the park,

seated exercise, exercise for new mothers). • Roll out of Commit to Care initiative, which includes monitoring the provision of nutrition support to KCH patients. PRUH – inpatient

adult wards; PRUH and Denmark Hill paediatrics and intensive care – in progress..

Enc. 2.1

Key: Preventing from people dying prematurely: National clinical audit results: (1/2) reviewed at Clinical Effectiveness Committee this quarter

9

King’s National Clinical Audit Rating

Symbol Definition

* One of the highest performing Trusts nationally e.g. ranked within top 5 nationally.

+ King’s performance is similar to or above the national average for 67 – 100% of audit standards / outside expected range (positive outlier)

= King’s performance is similar to or above the national average for 66 – 34% of audit standards/ within expected range.

- King’s performance is similar to or above the national average for 0 – 33% of audit standards / outside expected range (negative outlier)

N/A Not applicable – national average comparable data not available

Enc. 2.1

Preventing people from dying prematurely: National clinical audit results: (2/2) reviewed at Clinical Effectiveness Committee this quarter

10

Key: King’s National Clinical Audit Rating

Symbol Definition






Enc. 2.1

Improving quality of life for people with long-term conditions (Domain 2)

Dementia:

• Improving identification, assessment and referral of patients aged 75 and over with dementia – CQUIN target = 90% for each element:

• Denmark Hill: • Find: 95.9% • Assess: 98.5% • Refer: 100%

• PRUH: • Find: 94.3% • Assess: 100% • Refer: 100%

• On both sites, named clinicians are in place, along with training plan, baseline and targets in place.

COPD:

• Improving care of patients admitted with exacerbation of COPD at the PRUH: • Process to develop and record the COPD bundle at the PRUH set up, along with GP letter, patient

management plan and communication plan.

11

Enc. 2.1

Improving quality of life for people with long-term conditions: dementia

• The National Dementia Audit recommends that the following information relating to the care of people with dementia is routinely reported at Board-level. This information is currently for Denmark Hill site only.

Readmissions for people with dementia:

In-hospital falls for people with dementia or delirium:

12

Enc. 2.1

Improving quality of life for people with long term conditions: National clinical audit results (1/1) reviewed at Clinical Effectiveness Committee this quarter

13

Key:


Symbol Definition






Enc. 2.1

14

Helping people to recover from illness or injury (Domain 3) Trust Quality Priority – hip fracture

Background:

• Hip fracture accounts for around 500 patients and over 12,000 bed days each year at KCH, and this is set to increase with the aging population.

• Specific areas for improvement in the care of this group of patients have been identified.

Key objectives are to:

• Improvement work is focusing on achieving 9 criteria of best practice for all KCH patients: 1. Surgery within 36 hours of admission 2. Shared care with surgeon and geriatrician 3. Admitted on a care protocol agreed by geriatrician, surgeon and

anaesthetist 4. Assessment by geriatrician within 72 hours 5. Pre-operative Abbreviated Mental Test Score (AMTS) taken 6. Post-operative AMTS taken 7. Geriatrician-led multidisciplinary rehabilitation 8. Secondary prevention of falls 9. Bone health assessment.

National Hip Fracture Database results, Denmark Hill only

Progress monitored by:

• Routine internal data. • National Hip Fracture Database (NHFD).

Progress this quarter:

1. Achievement of 9 best practice criteria – data not yet available for Quarter 2.

2. NHFD data provided below (Denmark Hill only; PRUH not

available) shows that Denmark Hill improved the achievement of

all 9 criteria for all patients (the purple shaded area) from

November 2013, but that this improvement has been difficult to

sustain.

3. Improvement actions include: • establishment of a KCH-wide falls and fractures project • development of an EPR template specific for fractured neck of femur • recruitment of a fractured neck of femur nurse at PRUH • scoping of the physiotherapy complement needed to provide a good

service on both weekdays and weekends • proforma available on EPR to assist junior doctors in capturing all the

information required against the best practice criteria • increased support from an orthogeriatric multidisciplinary meeting.

Enc. 2.1

Helping people to recover from illness or injury: National clinical audit results: (1/2) reviewed at Clinical Effectiveness Committee this quarter

15

Key:


Symbol Definition






Enc. 2.1

Helping people to recover from illness or injury: National clinical audit results: (2/2) reviewed at Clinical Effectiveness Committee this quarter

16

Key: King’s National Clinical Audit Rating

Symbol Definition






Enc. 2.1

Quality governance: clinical effectiveness 1. Routine outcomes monitoring

17

1. Mortality monitoring – specialty areas which have an M&M process in place and mortality reported to the

Trust Mortality Monitoring Committee

• DH – 100%

• PRUH – 36%, and improving.

Enc. 2.1

Quality governance: clinical effectiveness 2. Evidence-based practice

18

1. NICE technology appraisals – 100% implemented on all KCH sites

2. NICE – all guidance, fully implemented Please note, this will never reach 100% as there will always be a time delay between publication and full implementation and some clinical

guidelines take years to achieve full implementation.

• Denmark Hill – 83% (Aug-14)

• PRUH – 59% and improving.

Enc. 2.1

19

Quality governance: clinical effectiveness 3. Clinical audit

a) National clinical audit: participation b) National clinical audit: results reviewed at Trust-level

c) National clinical audit: action plans in place d) Local clinical audit: programmes in place and reported

19

0

50

100

Sep-13(n = 47 at

KCH)

Oct-13(n = 47 at

DH;35 at

PRUH)

Mar-14(n = 47 at

DH;35 at

PRUH)

Jun-14(n = 39 at

DH;25 at

PRUH)

Sep-14(n = 44 at

DH;32 at

PRUH)

% in

wh

ich

KC

H is

pa

rtic

ipa

tin

g

Time (n = total relevant national audits & confidential enquiries)

Mandatory national audits and confidential enquiries - participation

KCH - all sites

Denmark Hill

PRUH

0

50

100

Sep-13(n = 19at KCH)

Oct-13(n = 19at DH;

0 atPRUH)

Mar-14(n = 35at DH;

8 atPRUH)

Jun-14(n = 49at DH;17 at

PRUH)

Sep-14(n = 57at DH;23 at

PRUH)

% r

evi

ew

ed

at

Tru

st-l

eve

l

Time (n = total published national audit results)

Mandatory national audits - results reviewed at Trust-level

KCH - all sites

Denmark Hill

PRUH

0

50

100

Sep-13(n = 19at KCH)

Oct-13(n = 19at DH;

0 atPRUH)

Mar-14(n = 26at DH;

9 atPRUH)

Jun-14(n = 30at DH;10 at

PRUH)

Sep-14(n = 40at DH;18 at

PRUH)

% r

esu

lts

pu

blis

he

d >

3 m

on

ths

wit

h a

ctio

n

pla

n in

pla

ce

Time (n = total national audit results published > 3 months)

Mandatory national audits - action plans in place within 3 months of results publication

KCH - all sites

Denmark Hill

PRUH

Enc. 2.1

1

REPORT TO COUNCIL OF GOVERNORS

Subject Care Quality Commission Inspection Briefing

Meeting Date:

10 December 2014

Action: For Information

| Overview

The CQC have informed us that King’s is in the next wave of Trusts to be inspected in early

2015. The inspection will cover all of our main sites and possibly some satellite sites too. There is no evidence to suggest the timing of this visit links in any way with the challenges currently facing the Trust, or our current IMR rating. King’s is overdue inspections across all

of our sites with the last visit at Denmark Hill in August 2012, Orpington in September 2013 and PRUH December 2013. We should anticipate something in the order of 80 inspectors arriving across all sites during the period concerned. | When – Date of the inspection is unconfirmed

The inspectors are likely to visit the sites simultaneously. While extensive review of

documentation will take place, inspectors will observe and also test out systems and processes, e.g. the ED pathway, patient records – availability and content.

CQC may also inspect services that are not on the list below and return for an out-of-hours/night-time inspection.

During the inspection patient and staff interviews and staff focus groups will take place as well as interviews with the Executives. Focus groups may take place at more than one location.

CQC is likely to conduct a further unannounced inspection within two weeks of completion of the announced inspection. The CQC out-of-hours inspection team typically arrive at the Emergency Department.

| Which locations/sites to be inspected?

Certain

a. Inpatients: Denmark Hill, PRUH and Orpington Hospital b. Outpatients/day cases: Denmark Hill, PRUH and Orpington Hospital, Beckenham

Beacon, Sevenoaks, Queen Mary’s Hospital, Sidcup.

Probable

c. Some Renal Dialysis Satellite Units, d. Frank Cooksey Neuro Rehabilitation Unit, e. Off-site clinics of the eight specialties/services listed in the Statement of Purpose (for

example - MSK Bexley services in Erith District Hospital or Lakeside Health Centre, any

Enc. 2.2

2

off-site locations for Special Care Dentistry, or Ophthalmology provided at Darent Valley or Lewisham Hospital).

| Which specialties?

The CQC teams will definitely inspect the following areas:

Emergency Department Medical Care (including older people's care) Surgery Intensive/critical care/theatres Maternity and family planning Children's care End of Life care Outpatients.

NOTE: The CQC may widen the inspection and include other areas/specialties. | The Trust will be tested against the following CQC specified standards:

a) Care and treatment must be appropriate and reflect service users’ needs and preferences.

b) Service users must be treated with dignity and respect. c) Care and treatment must only be provided with consent. d) Care and treatment must be provided in a safe way. e) Service users must be protected from abuse and improper treatment. f) Service users’ nutritional and hydration needs must be met. g) All premises and equipment used must be clean, secure, suitable and used properly. h) Complaints must be appropriately investigated and appropriate action taken in

response. i) Systems and processes must be established to ensure compliance with the fundamental

standards. j) Sufficient numbers of suitably qualified, competent, skilled and experienced staff must

be deployed. k) Persons employed must be of good character, have the necessary qualifications, skills

and experience, and be able to perform the work for which they are employed (staff and directors).

l) Registered persons must be open and transparent with service users about their care and treatment (the duty of candour).

| Actions:

In preparation for the inspections we need to know where we have problems/gaps in meeting the standards and what action is required to make sure we are compliant.

Arrange mock CQC inspections, prioritising those services that fall under the 8 services that will be inspected (see 3 above) and are at locations that will certainly be inspected (see 4 above).

Ensure that results from mock CQC inspections are shared with the service/team constructively and that action plans are in place to improve/deliver compliance.

Ensure that action plans progress against targets and that progress is reported to CQC inspection group for escalation.

CQC Assurance Framework - ensure that completed proforma (including RAG rating and action plans) are sent to Pauline Lacaille ([email protected]) for data processing and reporting so that we can form an overall picture of compliance and preparedness.

Enc. 2.2

Board Report to CoG 10 December 2014 1

Report to: Council of Governors Date of meeting: 10 December 2014 Presented By: Tim Smart, Chief Executive Subject: Board of Directors’ Report to the Council of Governors Purpose of the Report: To provide the Council of Governors with an overview of the key strategic, operational and performance issues facing the Trust. Action required: The Council of Governors is asked to receive the report and is invited to ask questions or to discuss the issues raised in the report.

Enc. 3.1


Board of Directors’ Report to the Council of Governors

10 December 2014 | Introduction Today the Trust welcomes the new Council of Governors at their first formal engagement and I congratulate those newly elected and reappointed governors who join King’s one year into its three year transformation. You join us at a most interesting and yet challenging time. In October 2013, we acquired Princess Royal University Hospital (PRUH), Orpington Hospital and services at Beckenham Beacon and Queen Mary’s Hospital and the Trust has made significant improvements and robustly striven to improve the quality of healthcare services for outer South East London. Governors play a key role in guiding the organisation and their continual engagement ensures we stick to our core objective to improve care for patients across south east London. Whilst the Trust can proudly demonstrate the material improvements it has made, these have been done so with an extremely challenged system and the healthcare economy surrounding us. The changes and improvements the Trust are making come at enormous capacity, financial and staffing pressures which will be detailed in the reports you receive. One month on from Simon Stevens’ NHS Five Year Forward View, it is comforting to know that the Trust are not alone in this challenged environment. The Forward View is much welcomed and outlines persuasively the case for change and the new models of care needed in the future. It also avoids offering a “national blueprint”, instead giving leaders of NHS organisations freedom and flexibility to adapt these models to the circumstances in which they find themselves. Flexibility is needed in the NHS as the economy changes and the central healthcare budget dwindles. NHS managers need the flexibility and freedoms to make the changes necessary to ensure that patients are getting the best standards of sustainable care. | Current Operational Challenges Operational and Financial Headlines – Month 7

The Trust financial position remains very challenged and we will hear about this in much more detail under agenda item 3.2. There are however, some very real performance improvements across all the Trust’s sites which we will revisit under agenda item 3.3. Due to the continuing operational pressures upon the Trust, in month 7, the Trust has reported a financial deficit of £37.8m and our continuity of service risk rating has fallen to 2. The financial position is receiving much attention at the Board level, but we have seen quality of care benefits of our increased expenfiture which has resulted in the Trust achieving the national emergency department (ED) target at the Denmark Hill site at above 95% for October and November. At the PRUH site, however, performance deteriorated, moving from 86.9% in September 82.7% in October. We can attribute this fall in performance, in part, to the number of patients, who, although medically or surgically fit for discharge remain in the hospital. In October there were on average 40-50 patients over the age of 70 waiting to be discharged back to their local hospitals or awaiting local community or social care support. The Trust has worked hard with Bromley stakeholders to improve the discharge process, and we have engaged MediHome to provide additional support to this process for patients medically fit for discharge who need ongoing support at home for a short period of time.

Enc. 3.1


| Key Strategic Issues Strategic Forward Plan

The South East London Clinical Commissioning Groups have had feedback on the five year strategic plan from NHS England. The 24 local care networks that are being established across the patch, based on groupings of GPs with community health services and social care alongside them, now need to have clear objectives and timescales to deliver. The work on integrated care in Southwark and Lambeth through Southwark and Lambeth Integrated Care (SLIC), and in Bromley, is vital to support this. NHSE have also said that there need to be clear plans as to how London Quality Standards will be met in all the South East London trusts. King’s is working closely with all partners on developing and implementing the strategy. King’s Health Partners are continuing to work hard on developing strengths in key academic areas. Working Groups are being established to look in detail at the key priority areas in the context of ensuring clinical, academic and educational excellence on each site. Dr Trudi Kemp, as Director of Strategic Development, is playing a vital role in this process. Transformation and Integration

The Trust’s integration plan is comprised of 22 detailed plans spanning all key clinical and corporate areas of the Trust. The review of these plans on the progress made and identification of any outstanding areas is an important and on ongoing process. The integration team are currently conducting reviews with the owners of the plans and are scheduled to complete this review by the end of the calendar year.

Delivery of Cost Improvement Plans (CIP) and productivity improvements remain a key priority for the Trust and whilst we are seeing some tangible improvements we will continue to focus on these areas. For the major transformation projects, which form a significant element of the programme, we will ensure we implement changes which deliver sustainable improvements and efficiencies. The CIP Delivery Board continues to meet twice monthly and report into the Integration Steering Group.

We have appointed PWC to support teams with CIP delivery and to work with us and others on the long term sustainability issues for the newly expanded trust.

Progress with Capital Projects

The Trust is maintaining three estates with 50 satellite sites and with demand for additional capacity rising there are a number of projects in progress to build new facilities and improve existing ones in order to enhance the environment for patients and staff and to improve efficiency. Denmark Hill Critical Care Unit (CCU) over the theatre block (OTB) – Major ground works

continue with foundation works and excavation of earth at the north end tunnel to commence in January 2015.

Helipad – Foundation works will be complete Dec 15. The project is being

phased and it is expected the Helipad will go live in December 2015. Guthrie Development (4th Floor upward extension) – Concept design drawings

and all associated design interfaces with CCUOTB and Helipad project lift shaft have been completed. The project team has now been stood down pending confirmation of funding.

Enc. 3.1


Emergency Department (ED) – The pre-assessment works for the Ebola suite/negative pressure and the expansion works in Majors has been completed. The works in Paediatrics continues and is expected to be concluded in December 2014.

Brunel Ward – Works continue for the ward and is due to be completed in

December 2015. Neurology/Imaging Block – The works in the MRI and Cardiac Catheter

Laboratory and support services continue with completion expected late – December 2014 – early January 2015.

Ultrasound Expansion – The expansion has been deferred until 2015/2016.

However, given the financial pressures facing the Trust and the impact on the capital programme married with the potential disruption to ED/Radiology this may be delayed further.

Princess Royal University Hospital (PRUH) Medical Records Facility – The Trust is in discussion with its PFI partner to

progress work with developing improved medical records facilities. It is hoped that all agreements will be finalised by December 2014 so work may begin.

Ebola Suite – The works have been concluded and the specification mirrored

those on the DH site. Orpington Hospital New Medical Records – The letter of intent has been issued with ‘go live’

expected mid-March 2015. This is subject to planning permission being finalised. MRI & Radiology – Planned refurbishment and expansion is under review due to

financial pressures on the capital plan. Midwives Lodge - internal remodelling works are in progress to enable

relocation of midwives from PRUH. | Engagement Events

Throughout the year members of the Board are pleased to attend the various events held to engage members, staff and the local community with our work. We also spread the word through the wider media.

Some noteworthy media coverage and events over the past two months include:

The Trust held a Stakeholder Summit for NHS leaders from the Care Quality Commission, Monitor, NHS England, the Trust Development Authority and local commissioners at the Princess Royal University Hospital (PRUH) and Orpington Hospital sites in October. This summit provided the Trust with an opportunity to highlight the progress we have made since the acquisition of sites and services from the former South London Healthcare Trust. We have received positive feedback from the event.

Miss Serpil Djemal, Consultant in restorative dentistry at King’s, was featured in a Daily Mail article that highlighted the launch of Dental Trauma UK, a new charity

Enc. 3.1


which has she set up to educate the public on what to do in the event of losing a tooth.

The Mail on Sunday and ITV News London reported on the news that nearly 100 women are planning legal action against a gynaecologist who worked at Queen Mary’s Hospital, Sidcup and the Princess Royal University Hospital whilst it was under the control of South London Healthcare NHS Trust (SLHT). The gynaecologist’s employment was automatically transferred to King’s when the PRUH became part of the Trust following the dissolution SLHT.

Dr Kate Prior, Consultant in anaesthetics and major trauma at King's, featured in an article in the Independent about the techniques that have been pioneered at a British military hospital in Afghanistan which are now being used to save lives in this country.

The Evening Standard, as well as ITV London News and BBC London News, reported on our in-patient facilities on our Adult Cystic Fibrosis ward. It argued there was a lack of appropriate inpatient facilities and that this poses a risk to our patients. It also discussed the current lack of progress in delivering a new ward or utilising the pledge of funding offered by the CF Trust.

The Southend Standard ran an article about Professor Kypros Nicolaides opening the new, state-of-the-art, £400,000 centre for unborn babies at Southend Hospital, which has been named in his honour.

Hugh Quarshie, star of the BBC One medical drama Holby City, met with patients, doctors and nurses at King’s College Hospital, to officially open the new Paediatric Short Stay Unit (PSSU).

Dr Shreelata Datta Consultant obstetrician and gynaecologist at King’s, has been recognised in the Health Service Journal’s ‘Top 50 BME Pioneers’ list. This list celebrates individuals from black and minority ethnic backgrounds who inspire others and help to shape and deliver excellent care for all.

Enc. 3.1

Finance Report

Month 7 (October) 2014/15

Council of Governors 10 December 2014

Enc. 3.2

Report to: Council of Governors

Date of meeting: 10 December 2014

Subject: Finance Committee Report – Month 7 (October 2014)

Presented by: Simon Taylor, Chief Financial Officer

Status: Information

1. Purpose The Finance Reports includes information on the Trust’s financial performance and position which

support the in-year submissions to Monitor on a quarterly basis.

2. Action required The Council is asked to note the report and the verbal update provided by Simon Taylor.

Enc. 3.2

Annual Budget YTD Budget YTD Actual YTD Variance

Month 6 YTD

Variance

Movement in

Month

£'000 £'000 £'000 £'000 £'000 £'000

Income (excluding off Tariff Drugs) 956,074 561,150 585,749 24,599 13,302 11,298Off Tariff drugs Income 51,763 19,014 23,602 4,588 3,427 1,160Pay (583,370) (341,599) (363,569) (21,970) (17,833) (4,137)Non-Pay (excluding off tariff drugs) (313,517) (206,199) (242,523) (36,324) (24,074) (12,251)Off Tariff Drugs Expenditure (51,763) (19,014) (23,602) (4,588) (3,427) (1,160)Capital Charges, Interest and Dividends (67,943) (22,625) (22,518) 107 113 (6)Consolidated Surplus/(Deficit) (8,756) (9,273) (42,861) (33,588) (28,492) (5,096)

Impairment Expense 8,756 5,104 5,104 0 0 0Consolidated Operating Surplus/(Deficit) 0 (4,169) (37,757) (33,588) (28,492) (5,096)

Income and Expenditure

Current deficit position

1. The Trust is reporting an adverse variance to plan of £33.6m to date excluding the asset impairment of £5.1m (non-operating cost). The year to date plan is adverse due to the phasing of the CIP schemes which are geared towards the second half of the year. The Continuity of Service Risk Rating is 2 (page 7).

2. The month 7 position has moved adversely by £5m (average monthly deficit movement is £4.75m for the for first half the year) and this consistent adverse variance is due to the structural cost pressures at the PRUH and non-achievement of the transformational. The other operating cost pressures relate to the high clinical locum usage and agency spend across all staff groups but particularly nursing.

3. The CIP achieved to date is £16.2m but this is £13.4m adverse against plan and is reflected in the Divisional adverse performances (see pages 46 to 49). The Trust has a developed a cost reduction plan (recovery plan) which is geared to reducing agency spend through extensive recruitment plans at home and abroad. Both the CIP and recovery plan forecast are built into the Trust reforecast plan.

4. Medical and Nursing staffing budgets are £18.5m over-spent due to locum and agency spend as shown on page 21. Clinical supplies £8.9m

over-spent and Drugs £8.7m over-spent as at month 7 and these variable operational costs are being covered by the additional activity income generated (£29.1m above plan). The key issues by Clinical Division are reported on pages 17 to 19 and the Corporate Departments on page 20.

5. The contract income with Commissioner’s is over-performing by £21.4m by Clinical Division and the key variances are presented on page 23 and 24 and by CCG/NHSE on page 27 and 28.

Month 7 - Executive Financial Summary Enc. 3.2

Monitor reforecast plan

The Trust has submitted a reforecast plan to Monitor in September based on month 4 financial data which incorporated the Trust’s recovery plan. The planned deficit position at year end is £28m. This would achieve a rating of 3 subject to capital funding of the Guthrie Development (£20m) and the indemnity payment of £15m by the TDA.

In line with the KMPG report the Trust has reported the performance against the reforecast plan using the key elements of the recovery plan on pages 8-15. These reflect the performance of the recovery plans by Clinical Division, Corporate Dept. and key additional income streams.

The Trust is achieving positively ahead of reforecast plan as at month 7 by £9.1m but this is purely due to phasing of contract over-performance income in September and October plus the additional resilience monies to achieve RTT and ED performance targets (£11.4m) of which £4.3m is accrued as at month 7. The Trust has also received additional Training and Education funds (Flexible trainees – £800k).

The current y/e projection is a £4.6m adverse movement from the £28m deficit forecast and this is due to additional cost pressures being forecast for the development of Orpington Hospital for additional surgical activity in theatres and the development of the Neuro Rehab unit (initially 10 beds) to help deliver the RTT activity backlog.

The Trust has also prudently accounted for the Bexley CCG MSK contract which may not deliver the anticipated savings in year 1.

There are further corporate cost pressures due to the increased valuation of land and buildings which impact adversely on the PDC dividend; together with a range of service demands as reflected on page 11.

The current year end projection excludes any further support from the TDA regarding the phasing of the bridging support and further LSB CCG investment in 14/15 to cover unfunded investments in the ED service and unplanned contract activity performance. These discussions are on-going and should be resolved within the next month.

The cash flow is reflected on page 14. A working capital facility has been agreed in principle for £10m with the Trust bank in order to partially cover the worst-case scenario (page 15). This would be required if no TDA funding is received as noted above.

Month 7 – Executive Financial Summary Enc. 3.2

Month 7 - Continuity of Service Risk Rating

Page 5

YTD - Month 7

Debt Service Cover

Revenue available for Debt Service (2,996) key to scoringDebt Service (24,258) Debt Service Cover 50%Debt Service Cover metric -0.12x 4 3 2 1Debt Service Cover rating 1 2.5 1.75 1.25 <1.25

Liquidity

Cash for CoS liquidity purposes (8,338) key to scoringOperating Expenses within EBITDA, Total (612,615) Liquidity 50%Liquidity metric -2.9 4 3 2 1Liquidity rating 3 0 -7 -14 <-14

Continuity of Service Risk Rating 2

Enc. 3.2

Recovery Plan - Summary as at Month 7

Page 6

The income and expenditure variances primarily relate to the additional resilience funding (£11.3m) to meet RTT and ED performance targets.

The other expenditure variances relate to the investments at Orpington Hospital which were disclosed in the month 6 report (Liver, Renal and Surgery Clinical Division).

Year end forecast is a £32.6m deficit pending agreement of TDA bridging support re-phasing and CCG additional investment for unfunded ED schemes (LSB CCGs) and contract over-performance (Bromley CCG).

recovery

M7 M7 M7 YE YE YE

Reforecast Plan

sent to MonitorActuals

Positive /

(Adverse)

Movement

Reforecast Plan

sent to Monitor

(as at m5)

Expected Actual

Positive /

(Adverse)

Movement

against

Reforecast Plan

Clinical Divisions (69,913) (73,317) (3,404) (105,382) (126,249) (20,867)

Corporate Departments (7,874) (6,006) 1,868 (14,717) (12,862) 1,855

Corporate Income

(Inc. T&E, R&D)25,799 36,462 10,663 83,286 97,684 14,398

Deficit (51,988) (42,861) 9,127 (36,813) (41,427) (4,614)

Impairment 5,103 5,103 0 8,750 8,750 0

Operating Deficit (46,885) (37,758) 9,127 (28,063) (32,677 ) (4,614 )

Net Income & Expenditure

Enc. 3.2

Month 7 - I & E Summary Income is £29.2m over-performing YTD, £12.5m favourable movement in M07

Off tariff drugs income is over-performing by £9.1m YTD which is offsetting YTD drugs expenditure overspend of £8.7m which is a mixture

of price and volume changes. MSK Income is over-performing by £5.9m but is offset by £7.3m of costs Details of the income over-performance are presented on pages 23 to 28.

Pay is £21.9m overspent YTD, £4.1m adverse movement in Month 7

Nursing is £11.2m overspent YTD, £2m adverse movement in Month 7 The overspend is mainly in Medicine, Critical Care, Liver, Surgery, and Neuro. Nursing agency spend was approximately £1.8m per month in 13/14 (M7-12 average), in 14/15 agency spend is averaging £2.2m per month. This overspend is due agency spend and recruitment plans to reduce vacancies are in place, including overseas recruitment. There is a time lag due to training requirements and a cost impact to training (back-filling staff to train new nurses with agency staff). The training of overseas nurses can be anything from 2 to 12 months. Some additional medicine beds have been opened at the PRUH resulting in the wards booking additional shifts (approx. 30wte’s) as only 50% of the recommended increased staffing at the PRUH was funded. There has also been “specialing” for high dependency patients which has an impact on the use of bank and agency, a business case has been approved for “specialing” which should result in a reduction in agency spend and also the use of additional agency security staff.

Medical is £7.4m overspent YTD, £1.5m adverse movement in month 7

The majority of the overspend is in Ambulatory Care, Theatres, Medicine, Surgery, Cardiac and Neuro and is caused by the use of locums covering vacancies. The vacancy rate for ED juniors is currently 42% and there are a number of consultant vacancies in acute medicine covering the additional posts in the 7/7 business case that was approved in January. Without Commissioner financial support on a recurring basis, these posts cannot be made substantive. Recruitment plans for medical staff need to be reviewed and Procurement are reviewing the rates paid to locums. There is approx. £268k of costs year to date relating to Junior Doctors non compliant rota’s (£1.2m estimated additional annual recurrent cost)

Non Pay is £40.9m overspent YTD, £13.5m adverse movement in Month 7

Drugs are £8.7m overspent YTD. The majority of this overspend is due to off tariff drugs and is recoverable through income.

Clinical Supplies are £8.9m overspent YTD. The majority of this is in Theatres, LRS, Neuro and Cardiac due to increased activity. Miscellaneous Expenses are £18.1m overspent YTD. £2m is due to a bad debt provision for overseas visitors income, £1.1m GSTS

pathology contract overperformance and £7.3m of costs relating to MSK contracts (offset by £5.9m of Income) the remainder relates to non-NHS contracted out services such as Medihome, Capita and various private sector hospitals re off-site working.

Enc. 3.2

Month 7 - Number of Patient Spells

Page 8

Category Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

All Inpatients - 2014/15 11,659 12,171 11,899 12,765 11,386 12,464 12,558

Non-elective - 2014/15 4,693 4,829 4,708 4,825 4,462 4,826 4,475

All Inpatients - 2013/14 11,325 11,401 11,037 12,016 10,852 11,265 12,056 11,874 10,885 11,779 11,407 12,107

Non-elective - 2013/14 4,673 4,883 4,687 4,873 4,483 4,757 4,955 4,638 4,738 4,935 4,375 4,830

All Inpatients - 2012/13 9,961 10,938 10,169 11,187 10,713 10,682 11,797 11,318 9,873 11,085 10,436 11,264

Non-elective - 2012/13 4,298 4,572 4,494 4,704 4,382 4,579 4,808 4,518 4,391 4,669 4,234 4,892

Note: Change in recording of Obstetrics from October 2014

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

Number of Patient Spells - KCH

All Inpatients - 2014/15

Non-elective - 2014/15





Enc. 3.2

Month 7 – Vacancies by Staff Type Summary

Page 9

This is a snapshot position as at month 7 based on WTE Finance budgets.

Denmark Hill Orpington PRUHTOTAL

Substantive

Nursing Staff 361 66 276 702

A&C inc. Ancilliary and Maintenance Staff 267 27 89 382

Professional and Technical Staff 81 2 50 133

Professions Allied to Medicine 42 10 43 95

Medical Staff 27 12 36 74

TOTAL 777 115 494 1,387

Total Budgeted Establishment 8,417 194 2,911 11,522

% variance of budgeted establishment 9% 59% 17% 12%

Enc. 3.2

Month 7 – Bank & Agency by Staff Type - Summary

Page 10

Bank Staff Agency StaffTOTAL

Bank & Agency

TOTAL

Vacancies

Over/(Under)

Establishment% B&A Backfill

Nursing Staff 621 415 1,035 702 333 47%

Medical Staff 30 80 111 74 36 49%

Professional and Technical Staff 34 99 133 133 1 1%

Professions Allied to Medicine 1 27 29 95 (67) -70%

A&C inc. Ancilliary and Maintenance Staff 151 131 282 382 (100) -26%

TOTAL 838 752 1,590 1,387 203

Denmark Hill 512 373 885

Orpington 9 6 15

PRUH 317 373 690

TOTAL 838 752 1,590

Enc. 3.2

Month 7 - 2014/15 CIP YTD Summary

Page 11

CIP Identified YTD Target YTD Actuals Variance

ACLN 4,659 2,651 1,460 -1,191

CCTD 5,708 2,678 1,821 -858

TEAM 5,810 3,285 980 -2,305

LRS 5,980 3,412 1,859 -1,553

NWS 5,547 3,360 2,658 -702

W&C 2,889 1,650 684 -966

Facilities 2,879 1,431 587 -845

Corporate 5,109 3,535 3,465 -70

Trustwide 14,494 7,687 2,742 -4,945

TOTAL 53,074 29,690 16,254 -13,436

PERFORMANCE AGAINST PLAN BY DIVISION

Year to date under performance against CIPs amounts to

£13,436k, 54.7% achievement. Major YTD adverse variances :

TIPMO Led schemes: Nursing Productivity £2,597k: staff recruitment to impact in 3-6 months OP Productivity & QIPP £2,083k: actual results not yet reported, schemes being agreed with Commissioners Length of Stay Productivity £1,238k: Schemes unidentified Theatre Productivity £772k: Divisions are reworking the schemes Medical Productivity £477k: More schemes are required Admin & Clerical Productivity £327k: Robust action plans being determined with Divisions. Other Trustwide Schemes: Other QIPP £2,168k: no robust plans yet received from Commissioners Non Clinical Budget Reduction £618k Other Schemes Neuro Rehab Move £839k: scheme will not be achieved Bed Outlier Reduction £571k Capita Outsourcing £150k: scheme not currently achieving

Scheme title (in trackers)

Annual

Target

£000

YTD

Target

£000

YTD

Actual

£000

YTD

Variance

£000

Admin & Clerical Productivity 700 349 21 -327

Divisional Agency/Locum plans 30 17 18 0

Clinical Coding Improvement 3,061 1,785 2,158 373

Divisional tactical Savings 12,192 6,821 5,418 -1,403

Drugs - Purchases 1,442 948 948 0

Drugs - Trustwide Transformational 75 44 75 31

Drugs VAT 600 600 633 33

Energy Savings scheme 240 210 210 0

Facilities central budgetary controls 200 117 83 -33

Neuro Rehab Move 1,438 839 0 -839

GSTS Viapath commercial profit 1,000 583 583 0

Length of Stay Productivity 2,816 1,441 203 -1,238

Medical productivity 1,219 700 223 -477

Non Clinical Budget Reduction 2,418 1,411 792 -618

Nursing Productivity 5,894 3,347 749 -2,597

Offsite working reduction 1,672 975 959 -17

OP Productivity & QIPP 4,500 2,083 0 -2,083

Other QIPP 3,960 2,204 35 -2,168

Procurement 5,092 2,642 2,063 -579

Capita Outsourcing - Recruitment &

Payroll 150 150 0 -150

General Medicine Bed outlier reduction 2,300 1,243 672 -571

Theatre Productivity 2,075 1,182 411 -772

53,074 29,690 16,254 -13,436

PERFORMANCE AGAINST PLAN BY MAJOR PROJECT

Enc. 3.2

Capital Investment Summary 2014-2015

Page 12

2014/15 Capital Investment Plan and YTD Expenditure

The planned capital investment expenditure for 2014/15 is £56.894m (page 53). The total capital expenditure to month 7 was £18.998m against a reforecast period budget of £20.130m (page 54).

14/15 Capital Investment expenditure is forecast to overspend by £2.475m at year end due to new projects arising during the year and projected overspends against budget (see page 55). Subject to obtaining the additional capital indexation funding from the TDA (see below), the Trust will be able to manage the overspends within its budget through the re-phasing capital expenditure over the 5–year plan and the reduction in scope of certain projects.

The 15/16 Capital plan reflects a capital funding requirement of £4.3m due to the additional cost of the Guthrie Development project (total cost £25m, requested funding £21.4m). In order to preserve the Trust’s liquidity position in 15/16 and beyond, consideration will need to be given to placing projects on hold until further funding has been identified. Therefore the Capital and Capacity Committee will need to make a decision as to which capital project will be stopped or deferred.

Capital Investment Funding

The Trust is currently completing a business case to obtain capital funding from the Trust Development Authority (TDA) of £20m for Guthrie Wing expansion. The Trust will also request an additional £1.4m funding based on the current capital indexation rate of 7%. (see above)

Helipad donations to be received total £3.5M (14/15 £800k) – The funding has been spread over 4 years in accordance with the agreement signed with the County Air Ambulance for their donation (£2m) and the Special Trustees (£1.5m).

£10.708m of Critical Care Development expenditure in 14/15 will be financed by a loan received from the Foundation Trust Financing Facility.

Other funding sources include donations (£0.65m), Integration funding (£8.2m), other PDC funded projects (£1.6m), with the balance to be funded internally by the Trust (Depreciation £22.1m).

2015/16 to 2018/19 Capital Plan

The Trust plans to spend £89.6m in 2015/16, £73.8m in 2016/17, £38.4m in 2017/18 and £7.5m in 2018/19. The majority of the spend will be on Critical Care Unit Development (total cost of £65m) and Unit 7 & 8 Development (£82M).

To improve the Monitor CoSR Rating over the next 5 years, the Trust has had to reduce internal capital investment funding by £20m and borrow the funds.

Enc. 3.2

Month 7 - Capital Expenditure Summary

Page 13

Capital Expenditure

The total capital expenditure to month 7 was £18.998m against a reforecast period budget of £20.130m Below is the summary of capital expenditure to month 7:

Capital Programme

Total per capital category

Major works 39,146 9,835 13,337 27,806 41,143 1,997 Capital Maintenance (Minor Works) 2,454 1,432 476 1,978 2,454 - Medical Equipment 6,630 3,868 919 6,189 7,108 478 IT and infrastructure 2,461 1,436 725 1,736 2,461 - Intangibles (IT) 1,594 930 1,594 - 1,594 - Donated - Major Projects 250 88 88 162 250 - Integration Project 4,359 2,543 1,859 2,500 4,359 -

Total Capital Position :

Overspend (+) / Underspend (-) 56,894 20,130 18,998 40,371 59,369 2,475

Budget Period Budget Actual to date

Anticipated

Changes Y/E Forecast

Gross capital expenditure b/f 56,894 33,130 18,998 40,371 59,369(Intangible Assets Included Above)

Gross Cost 56,894 33,130 18,998 40,371 59,369

Less:

Capital Donations held on Trust, NOF monies 1,550 588 588 962 1,550Capital Charge against Capital Resource Limit 55,344 32,542 18,410 39,409 57,819

Funding Sources

External Borrowings - CCU 11,708 11,708 11,708 0 11,708unit 7 & 8 Funding (TDA) - PDC 20,000 0 0 20,000 20,000Safer Hospitals Safer Wards - DH 1,145 1,145 1,145 0 1,145Integration PDC Funding 7,370 7,370 7,370 0 7,370Nursing Technology PDC - Carried Forward 497 497 497 0 497Depreciation 22,141 12,916 12,916 9,225 22,141Internal Cash Resources (7,517) (1,094) (15,226) 7,709 (7,517)FT Capital Plan 55,344 32,542 18,410 36,934 55,344

Variance : + over / (-) under - - - 2,475 2,475

Budget

Forecast

Variance

Expenditure

Annual Plan

14/15 Period Budget Actual YTD Cost to Complete Total Cost 14/15

Enc. 3.2

Month 7 - Working Capital Summary Trade Debtors

As at the end of Month 7, outstanding trade debtors totalled £62.558m. Significant balances were as follows:

Trade Creditors

As at Month 7, outstanding trade creditors totalled £26.691m. This total includes the following outstanding amounts: King’s College London £3.1m Guy’s & St Thomas’ NHS Foundation Trust £1.1m

Working Capital Facility

The Trust has no facility at present, but it is proposed that a facility of £10m will be implemented from Q3 2014.

FT Borrowing

The Trust currently holds loans with the Foundation Trust Financing Facility totalling £66.7m as at 31 October 2104 and PFI Liabilities of £158.3m.

Organisation Debt Type £000

Private Patients and Overseas Visitors Private Patients and Overseas Visitors 10,492NHS England Over-Performance 9,471NHS England Other 2,912CCGs CCGs Overperformance 2013/14 3,822CCGs CCGs Overperformance 2014/15 6,276CCGs Monthly SLAs 1,775CCGs NCAs 2,162CCGs CCGs - MSK Project 1,300CCGs Patient Transport and Non-Recurrent Support 691Oxleas NHS Foundation Trust Various 1,149Guy's and St Thomas' NHS Foundation Trust Various 2,673Lewisham and Greenwich Various 2,326King's College London Various 3,666South London and Maudsley NHS FT Various 848Various Pathology 3,091Provider Trusts Various 1,499Other Non NHS Bodies Various 4,827

Enc. 3.2

Month 7 - Working Capital - Debtors

Page 15

Provision for Bad Debts is based on debts outstanding over 6 months. The NHS Provision has been adjusted for debts which are not contested and are considered recoverable.

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

£'000 £'000 £'000 £'000 £'000

NHS Bodies

CCGs 16,582 4,022 5,515 121 6,924 NHS England 12,658 2,055 9,784 - 819 Provider Trusts 9,216 1,491 2,400 626 4,699 Other NHS Bodies 1,142 48 4 163 927

NHS Trade Debtors 39,598 7,616 17,703 910 13,369

Provision for Bad Debts (2,931) - - - (2,931)NHS Bodies Total 36,667 7,616 17,703 910 10,438

Non NHS Bodies

Scottish, Welsh & Irish Health Bodies 618 386 5 10 217 King's College London University 3,666 611 372 895 1,788 King's Charitable Trust 131 22 5 - 104 Other Non NHS Bodies 8,053 2,581 2,228 221 3,023

Non NHS Trade Debtors 12,468 3,600 2,610 1,126 5,132

Provision for Bad Debts (412) - - - (412)Non NHS Bodies Total 12,056 3,600 2,610 1,126 4,720

Total Accounts Receivable 52,066 11,216 20,313 2,036 18,501

% of Total Outstanding - Month 7 100% 22% 39% 4% 36%

Month 6 100% 50% 6% 2% 42%

Private Patients Accounts Receivable 5,638 522 730 112 4,274 Provision for Bad Debts (108) - - - (108)

Private Patients Accounts Receivable Total 5,530 522 730 112 4,166

Overseas Visitors Accounts Receivable 4,854 402 344 301 3,807 Provision for Bad Debts (4,667) - - - (4,667)

Overseas Visitors Accounts Receivable Total 187 402 344 301 (860)

Total PP & Overseas Visitors Accounts Receivable 10,492 924 1,074 413 8,081

Aged Debt Analysis Summary as at 31 October 2014

Enc. 3.2

Month 7 - Working Capital - Creditors

Page 16

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

£000 £000 £000 £000 £000

NHS Bodies

Guy's and St Thomas' NHS Foundation Trust 1,121 19 128 151 823Others 3,271 538 1,456 521 756

NHS Bodies Total 4,392 557 1,584 672 1,579

Non NHS Bodies

King's College London 3,103 13 390 112 2,588Others 19,196 3,238 11,909 2,524 1,525

Non-NHS Bodies Total 22,299 3,251 12,299 2,636 4,113

Total Accounts Payable 26,691 3,808 13,883 3,308 5,692

% of Total Outstanding - Month 7 100% 14% 52% 12% 21%

Month 6 100% 27% 42% 7% 25%

Aged Creditors Analysis Summary as at 31 October 2014

Enc. 3.2

Month 7 - Statement of Financial Position STATEMENT OF FINANCIAL POSITION AS AT 31 March 2014 Qtr 1

30 June

Qtr 2

30 September 31 October

Reforecast

Consolidated

Annual Plan

2014 2014 2014 31 March 2015

£'000 £'000 £'000 £'000 £'000

NON-CURRENT ASSETS

Intangible Assets 1,767 1,764 3,194 3,168 951

Property, Plant & Equipment 335,131 351,457 326,250 435,241 360,663

On-Balance Sheet PFI 236,487 217,271 241,605 135,940 237,309

Investments in associates 3,598 4,098 5,099 5,099 2,816

Trade and Other Receivables, Non- Current 4,167 4,167 4,167 4,167 4,169

Total Non-Current Assets 581,150 578,757 580,315 583,615 605,908

CURRENT ASSETS

Inventories 15,293 13,128 18,354 19,022 13,128

Trade Receivables 85,691 65,412 46,563 51,027 81,340

Other Receivables 11,901 23,727 23,292 25,161 11,626

Impairment of Receivables (7,576) (8,822) (9,660) (9,861) (8,822)

Other Financial Assets 22,610 23,065 41,673 42,019 24,710

Prepayments 4,739 5,568 8,228 8,270 4,500

Cash & Cash Equivalents 54,535 43,410 42,709 36,463 30,416

Total Current Assets 187,193 165,488 171,159 172,101 156,898

CURRENT LIABILITIES

Interest-Bearing Borrowings (1,091) (584) (523) (523) (3,885)

Deferred Income (9,989) (4,195) (4,913) (4,877) (7,500)

Provisions (1,387) (1,009) (858) (807) (1,200)

Current Taxes Payable (5,570) (11,259) (11,136) (11,327) (11,700)

Trade Payables (45,669) (23,386) (20,127) (26,686) (43,838)

Other Payables (14,552) (25,438) (24,825) (25,740) (8,537)

Other Financial Liabilities (71,322) (85,856) (90,114) (91,457) (66,266)

Total Current Liabilities (149,580) (151,727) (152,496) (161,417) (142,926)

Total Assets less Current Liabilities 618,763 592,518 598,978 594,299 619,880

NON-CURRENT LIABILITIES

Interest-Bearing Borrowings (49,542) (49,542) (67,941) (67,941) (67,612)

Provision (6,643) (6,886) (6,886) (6,886) (6,299)

Other Financial Liabilities (156,748) (157,023) (157,023) (157,023) (157,472)

Total Non-Current Liablilities (212,933) (213,451) (231,850) (231,850) (231,383)

Total Assets Employed 405,830 379,067 367,128 362,449 388,497

Financed By (taxpayers' equity):

Public Dividend Capital 162,874 228,136 230,536 230,536 250,536

Revaluation Reserve 144,998 144,998 144,998 144,998 144,997

Income & Expenditure Reserve 97,958 5,933 (8,406) (13,085) (7,036)

Total Taxpayers' Equity 405,830 379,067 367,128 362,449 388,497

Enc. 3.2

Glossary

Page 18

CIP – Cost Improvement Plan SLA – Service Level Agreement PDC – Public Dividend Capital PSPP – Public Sector Payment Policy Working Capital Facility - represents a sum of money reserved by the relevant bank for potential use

by the Foundation Trust Asset - An asset is a resource controlled by the enterprise as a result of past events and from which

future economic benefits are expected to flow to the enterprise Liability - an entity's present obligation arising from a past event, the settlement of which will result in

an outflow of economic benefits from the entity Equity - the residual interest in the entity's assets after deducting its liabilities EBITDA – Earnings before Interest, Taxation, Depreciation and Amortisation EBITDA Achieved (% of Plan) – measures the achievement of earnings against plan EBITDA Margin (%) – Measures Earnings as a percentage of total income indicating underlying

performance Return on Assets excluding Dividends – Net surplus before Dividends as a percentage of average

assets indicating financial efficiency I & E Surplus margin net of dividends – Net surplus as a percentage of total income indicating

financial efficiency Liquidity Ratio (days) - The liquidity ratio (days) indicates the number of days that net liquid assets

can cover operating expenses without further cash coming from cash sales of fixed or long-term assets.

Enc. 3.2

1

Council of Governors 2014-15 Month 7 Performance @ Denmark Hill

Roland Sinker

Chief Operating Officer

Enc. 3.3



Subject: Performance Report, Month 7 2014/2015

Presented by: Roland Sinker, Chief Operating Officer

Status: For Information

2

1. Purpose This report provides the details of performance achieved against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position for 2014/15.

2. Action required The Council is asked to note the Month 7 performance reported against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position for Kings performance at the Denmark Hill site.

Enc. 3.3

3

Executive Summary (1/8)

1. Denmark Hill 2014-15 Key Areas of Performance for Month 7:

1.1 Good Performance

1.1.1 ALOS – The elective ALOS has decreased considerably during October to achieve the internal stretch target of 4.7 days, despite an increasing trend from June to September. Target ALOS has been achieved in Liver, Surgery, Haematology and Child Health.

1.1.2 Access Targets – All Cancer waiting time targets have been achieved for the in-month October position on the DH site with the exception of the 62-day cancer target which achieved 81.3% compared to the national 85% target. Achievement of this target for Q3 is a concern with pressure on urology, colo-rectal and Hpb/Liver pathways. There has been a 15% increase in 2 week-wait referrals this year compared to last year and increased numbers of patients diagnosed with cancer, which puts further pressure on delivering the 62-day cancer target. PRUH patients continue to be seen at DH site for investigation and treatment which adds further pressure on capacity. The Referral to Treatment (RTT) standard for non-admitted completed pathways was achieved at 96.3% compared to the national 90% target, and the RTT Incomplete pathway target was achieved at 92.01% compared to the national 92% target.

1.1.3 Emergency Care 4-hour Performance –

• October 2014 Performance: Emergency care 4-hour All types attendance performance achieved the national target of 95% in October 2014 at 95.15% for the first time since September 2013. This is consistent with our revised plans to achieve the national target from October 2014. The improved strong performance continues into November where type 1 ED attendance performance has been achieving the 95% target. All types attendance performance has improved further to achieve 96.6% and 96.1% in the first 2 weeks into November.

• ED Action Plans: The Trust’s ED Recovery Action Plan continues to be reviewed and updated at the weekly Emergency Care Board (ECB) meetings, chaired by the Director of Operations. The agreed internal actions which focus on emergency care pathway management improvements have contributed to achieving the 95% target in October. Further initiatives to close the capacity bed gap are planned for Q3 and Q4 this year, combined with developments in rehabilitation, repatriation and

Enc. 3.3

4


referral restriction. Further details on the capacity and action plan initiatives can be found from slide 32 in this report. Some key highlights and further infrastructure changes include:

−Surgical Assessment Unit: The 4-trolley SAU facility is due to open in the third week in November and will manage surgical patients in a similar manner to medical patients seen in the Medical Assessment Unit.

−Neuro step-down Unit: 10 beds within the planned 20-bed Neuro step down unit opened in the first week of November on the Ontario ward in Orpington Hospital. This will enable the transfer of non-local patients from Neurosciences ward on the DH site to Orpington.

−Safer Faster Hospital: The next SFH week is scheduled to start on Wednesday 3 December and is being co-ordinated by the Site Services Manager and the Associate Director of Operational Performance. The planned focus for this SFH week is discharges to further embed the improved performance observed since October, and will be the major improvement objective for the week.

−Point of Care Testing (POCT): We plan to introduce point of care testing within the Emergency Department (ED), however, implementation of this system has been delayed due to IT-related issues and is unlikely to become operational until at least January 2015. −Mental Health (MH) patients: The number of MH patients attending ED is still high and pathway delays in managing these patients impacts on patient flow within the emergency department. We continue to work with the commissioners to resolve these issues.

−Repatriations: Whilst the number of repatriation beddays has reduced during October, we continue to work with the commissioners and NHS England to resolve issues with delays in referring patients back to their local hospital, and the commissioning of out of hospital interfaces.

•Governance: Weekly Emergency Care Board meetings continue to review progress and performance against the revised ED Action plan.

1.2 Performance challenges – 3 Areas

1.2.1 RTT Admitted –

•October 2014 Performance: The RTT Admitted pathway target of 90% was not achieved in October

Enc. 3.3

5


at 79.3%, consistent with the Trust’s plans submitted to Monitor for 2014/15. There was a reduction in the admitted backlog to 1,389 patients which is reported in the RTT Incomplete pathway return for the October month-end position, a reduction of 44 patients compared to the 1,433 backlog patients waiting at the end of September. At the end of October there were 44 patients waiting over 52 weeks (37 admitted and 7 non-admitted pathway breaches) which represents an increase of 8 patients compared to the 36 patients reported at the end of September.

• Division action plans: RTT performance and progress against division action plans are tracked at the weekly RTT performance review meetings chaired by the Director of Operations. The Trusts application for both tranche 1 and tranche 2 additional RTT funding has been signed-off by commissioners and NHS England, as being sufficient to secure reducing the 18-week backlog and meeting RTT targets from December 2014 onwards. This activity will largely be conducted off-site at private providers or completed in additional weekend sessions. There have been issues during October with private providers that we have contracted with accepting patients, in particular for Neurosurgery. As a result of the additional activity that we plan to deliver based on contracted and additional RTT tranche bids:

i. We are planning to reduce the 18-week admitted backlog to 1,200 patients and to have no patients waiting over 52 weeks by the end of November.

ii. The Trust is continuing to work with commissioners and the divisions on how we can manage GP referral and tertiary demand across a number of specialties. Despite the improvements in the backlog position there are still three key areas of challenge:

− Bariatric Surgery: The division continue to work on additional plans to reduce the backlog and patients are being offered further choice at private off-site hospitals including the King Edward VII, Princess Grace and Lister hospitals.

− Orthopaedics: The specialty plans to focus further on increasing productivity and throughput at Orpington hospital as no additional patients will be transferred to GSST.

− Neurosurgery: Unexpected consultant illness and a number of patient returns from the off-site providers means that we will have less than 10 patients waiting over 52-weeks at the end of November, but these patients will be treated in December. Having reviewed all options to treat patients on-site as well as at private providers, the service has reached an agreement with the Royal National Orthopaedic Hospital to treat backlog patients during January and February next year.

Enc. 3.3

6


Cardiothoracic Surgery: Patients are being offered treatment at the Cromwell Hospital as part of the additional waiting listing initiative, and the specialty plans to treat a further 14 patients per month from December to March.

Governance: The new Patient Access Board meets monthly which is chaired by the Director of Operations, and is responsible for reviewing performance and action plans for cancer, RTT and diagnostic waiting times. Commissioners are also invited to attend this meeting. The weekly RTT performance review meetings with divisions continue and are chaired by the Director of Operations

1.2.2 Health Care Acquired Infection (HCAI) -

• October 2014 performance: There have been no further MRSA cases attributed to the Trust in October so 2 cases have been reported year-to-date. There have been a further 2 c-difficile cases reported in October, so 34 cases have been reported to-date. This is higher than the internal quota of 24 cases set for this October YTD position as noted in previous reports. Based on the reduction target for this year, we did declare this as a risk in our self-certification with Monitor for 2014/15.

• HCAI Action Plan: The HCAI action plan was due to be completed for the end of September, however, this is now delayed due to the Ebola preparedness guidance and process work that the Infection Control team has been developing. Some key points based on the existing plan:

− Multidrug resistant organisms: Management of CRE and VRE remains a concern. Admission testing for CRE is now in place in Haematology and screening has commenced in Critical Care and Renal.

− C-difficile infection (CDI): Additional measures have been put in place to manage the number of cases attributed to-date including spot-checks of clinical departments by the Director for Infection Prevention and Control (DIPC) and Deputy DIPC, and weekly reported to Kings Executive.

− Ebola preparedness: The Trust has established a weekly Ebola Preparedness meeting which is chaired by the Director for Infection Prevention and Control and attended by representatives from all interested departments. Further details on the actions that have been taken by the Trust can be found on slides 88-89 later in this report. Training has commenced with staff on the use of personal protective equipment from 20 October, and we are working with soft FM providers to ensure that they are ready to support clinical staff.

• Governance: Quarterly divisional performance review meetings are in place to review infection control performance chaired by the Director of Nursing.

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1.2.3 Finance position:

Please refer to the separate Finance paper for more details on the financial position at Month 7.

2. Other areas of concern:

2.1 Diagnostic waiting times – The number of 6+ week diagnostic waiting time breaches at the DH site increased by 5 cases in October to 76 breaches compared to the 71 breaches reported in the September position. 1.6% of patients were therefore waiting over 6 weeks, which is above the national 1% target. There were 53 endoscopy breaches in October, an increase of 14 breaches from September. Whilst capacity has been increased through additional weekly endoscopy lists and ad hoc Saturday lists, further capacity is required to reduce the number of long waiters. There were 14 MRI breaches in October, a reduction of 5 cases from September, mainly due to a lack of MR cardiac capacity as reported last month and delays in pre-assessment. The service are working to arrange additional paediatric pre-assessment capacity, and a small number of breaches are expected until this is resolved

2.2 Tertiary transfers – Repatriation bedday delays have decreased in October to 443 beddays compared to 571 beddays in September. This still represents an average of 15 patients per days. 273 beddays delays were reported on Neuroscience wards, 85 bedday delays on Surgery wards and 46 beddays on Liver wards.

2.3 Pressure sores – The number of hospital-acquired pressure sores reduced from the 35 cases reported in September to 20 cases in October. 19 cases were reported grade 2 and 1 case reported as grade 3. Nine of the cases were reported on critical care wards, 3 cases on TEAM wards and 3 cases on Liver wards. A root cause analysis will be conducted into these cases, and 2 safer care forums are being held in November that one of the Tissue Viability clinical nurse specialist chairs to review the cases reported in September in more detail.

2.4 Red Shifts – The number of red shifts reported decreased from 82 shifts reported in September to 62 shifts in October. There were 44 shifts reported on TEAM wards, a reduction compared to the 60 shifts reported in September, 10 shifts on Child Health wards and 6 shifts on Liver wards.

2.5 Red Adverse Incidents (AIs)/Never Events – There were 12 red incidents reported in October, of which 5 were internal incidents and the remaining 7 cases were community-acquired pressure ulcers which

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we are required to report. There were a further 2 never events reported in Ophthalmology in October, so 3 cases have been reported in the last 2 months. One case was due to wrong site surgery and the other case due to the wrong lens implanted. These cases will be subject to formal investigation and the report findings taken to the Serious Incidents Committee.

2.6 Patient Complaints – HRWD survey results remained the same in October compared to September, and the overall section survey score for Care Perceptions and Patient engagement remains 1 point below their 87 point target. The number of complaints received in October reduced significantly compared to September by 48 cases to 27 cases, of which 5 were rated high or severe. The Associate Director of Operational Performance has worked with the Head of Patient Relations and Complaints to agree a process for earlier management of patient complaints. As a result, the Patient Advice and Liaison Service (PALS) team has been working closely with divisions to ensure local resolution to patient complaints before a formal complaint being registered. The number of complaints either open or not responded to within 25 days also reduced from 37 cases in September to 26 cases in October. As reported last month, the Associate Director of Operational Performance is leading a review of complaints across the Trust and plans to ensure 50% of complaints are responded to within 25 days by the end of December.

2.7 Theatre Utilisation – Overall theatre utilisation improved further by 1% to 78% in October, but remains just below the 80% internal target. Main theatre utilisation increased by 1.6% to 77.5%, and Day Surgery Unit (DSU) utilisation increased 0.4% to 79.0%, just below the 80% target. Whilst DSU activity has increased by 15% in-year, utilisation has been steadily improving from 73% in April 2014 to 79% in October.

3. Regulatory and Contractual Performance

3.1 Monitor

Monitor interim Q3 position (Denmark Hill) – The Trust has achieved most of the performance indicator targets in the Monitor Risk Assessment Framework for October with the exception of the RTT 18 Week Admitted target and the 62-day cancer performance target.

A&E attendances and sustained emergency access pressures continued during October. However, the Trust did meet the 95% target with All Types performance achieving 95.2% for the first time in 12 months.

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2 C-Difficile cases were reported in October which was below the agreed quota for the month. However, 34 cases have been attributed year to date which is above the quota of 24 cases. The total attributable cases for this site for 2014/15 is 42 cases.

Monitor interim Q3 position (Trust position) - The Trust achieved the majority of the performance indicator targets in-month for October with the exception of RTT 18 Week Admitted target, the 4-hour A&E performance target, the 62 day cancer target and the 31 day subsequent surgery cancer target.

A&E attendances and sustained emergency access pressures continued during October. The Trust did not meet the 95% target with All Types performance achieving 89.9% across the DH and PRUH sites.

3 C-Difficile cases were reported in October which is below the quota for the month. However, 42 cases have been attributed year to date which is above the quota of 34 cases. The total attributable cases for 2014/15 is 58 cases across all sites.

Monitor has written to the Trust on 17 September 2014 advising that is has updated our governance risk rating to ‘Under Review’ on the basis that the RTT 18 weeks admitted completed pathway target has not been achieved.

3.2 Care Quality Commission (CQC)

3.2.1 CQC Planned Inspection – The CQC has informed the Trust that the planned inspection will take place between 20-23 January 2015. Jane Walters, our Director of Corporate Affairs, is the assigned executive lead and along with the Assurance Team will be working with divisions to collate and ensure that all necessary documentation is available prior to the visit.

3.3 Contractual

3.3.1 CCG - The Contract has been signed with the CCG Commissioners for 2014-15. All CQUIN schemes have now been agreed.

3.3.2 NHS England – There are three separate contracts with NHSE. The largest is specialised services which has now been signed. All elements of secondary care dental (activity, finance, QIPP and CQUIN) are agreed, as is the activity, finance and CQUIN for Public Health.

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3.3.3 CQUIN 2014/15 – CCG update – The Trust achieved 100% CQUIN for Q1. Evidence has been submitted for Q2 and we are waiting for feedback from the commissioners. The falls CQUIN was not achieved in August as there were 4 falls resulting in harm compared to the target of 3 cases.

3.3.4 CQUIN 2014/15 – NHS England update – The Trust has submitted evidence for Q2 and we are waiting for confirmation of the achievement.

3.4 Flu Vaccination Programme – The national target is for 75% of all front-line staff to be vaccinated over a 5 month period to the end of February 2015. The Trust trajectory target for the end of October was 1559 and actual uptake was 1425 staff members. Uptake at the PRUH is lower than DH due to availability of staff to deliver vaccines and this is being addressed in November alongside a boosted communication programme.

4. Specific Performance Reports and other updates

This month’s report includes updates for :

4.1 Emergency Department (ED) Action Plan Update

Details of the new ED Action Plan and performance trajectory can be found in the ED Action Plan update, provided later in this report.

4.2 RTT Performance Update

Details of the new RTT Action Plan and specific division actions for reducing 52-weeks and 18-weeks backlog can be found in the RTT Performance update, provided later in this report.

4.3 Infection Control Update

Further details on the current infection control position and an update on the HCAI Action Plan and additional c-difficile infection control actions that have been put into place are provided later in this report.

4.4 Key Areas of Concern

Summary page to highlight key areas of concern on the Denmark Hill site under the categories of: Quality, Efficiency, Finance and Strategy.

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2014-15 M7 @ Denmark Hill

Key Areas of Concern Quality

Efficiency

• Wards: Fisk & Cheere, Matthew Whiting, Trundle, Oliver, Twining, David Marsden, William Gilliat and Todd. • Complaints response times: high number of complaints still open or responded to after 25 days. • Pressure sores: 20 hospital-acquired cases reported in October, a reduction compared to the 53 cases

reported in September but above the target of 10 cases for the month. • Infection Control: 2 MRSA cases reported - 1 in April and 1 in August; 2 c-difficile cases reported in October so

34 cases reported to-date which is already above the quota of 24 cases. The enlarged organisation has a stretch trajectory of 58 cases for 2014/15 which is 11 cases lower than the 2013/14 outturn position. CRE issues in Liver and Paediatrics and emerging in Haematology.

• Cancer patient experience. • HRWD on emergency pathway and in other key wards. • Francis recommendations: issues in relation to workload pressure and organisational culture.

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Finance

• Vacancies and temporary staffing: vacancy rates are improving and now lie within the target range of 5-8%. There is a continued reliance on high-cost medical locum and nursing agency usage, as well as administration and clerical staff.

• Income through capacity plan: Liver, Renal Surgery and Networked Services divisions. • Contractual position: The Trust has written to the commissioners and is looking at re-visiting the activity

contracts for 2014/15 given the financial position of the Trust and additional cost/investment that we are having to fund to maintain current performance standards.

Strategy • Clinical academic strategy for KCH; to feed into KHP • Vascular review • Specialist commissioning • Integrated care/out of hospital • South London providers and CCG’s

• Cancer waiting times and RTT: pressure on 62-day cancer treatment target and long-waits in Neurosurgery, HpB Surgery, General Surgery (bariatrics) and Orthopaedics.

• Capacity plan and multiple service moves within Denmark Hill and across the broader KCH. • Repatriations: Bedday delays for repatriation reduced to 443 beddays in October but remain a concern,

especially in Neurosciences and stroke medicine, and Liver/Surgery. • Vacancies and recruitment constraints: ensure all internal processes are efficient and iron-out Capita delays.

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Council of Governors 2014-15 Month 7 Performance @ PRUH

Roland Sinker

Chief Operating Officer

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Subject: Performance Report, Month 7 2014/2015

Presented by: Roland Sinker, Chief Operating Officer

Status: For Information

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1. Background/Purpose This report provides the details of performance achieved against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position.

2. Action required The Board is asked to approve the M7 performance reported against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position for Kings performance at the PRUH/QMS sites.

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1. PRUH 2014-15 Key Areas of Performance for Month 7:

1.1 Good Performance

1.1.1 Health Care Acquired Infection (HCAI) - PRUH continues to have no MRSA cases attributed since the acquisition in October 2014. There was 1 C-difficile case reported in October so 8 cases have been reported to-date which is still lower than the internal quota of 10 cases allocated to PRUH. There were no further VRE bacteraemia cases reported in October so 4 cases have been reported to-date. Plans to convert a room in the ED for use for suspected ebola patients have now been completed, so isolation facilities are now available on both acute sites.

1.1.2 Stroke Unit – The Stroke Unit at the PRUH scored highly in the recent Sentinel Stroke National Audit Programme (SSNAP) which scores all stroke units across the country, ranked 18th out of 180 Trusts. The unit at the PRUH scored highly for the standard of its thrombolysis care and the efficiency of its scanning. It beat the national average on the vast majority of the 44 indicators measuring performance across thrombolysis care, services for mini stroke patients, good communications between staff and patients, and pathway at discharge. 1.1.3 Patient Administration System (PiMS) migration – The ‘OASIS’ patient administration system in use at the PRUH, Sevenoaks and Beckenham Beacon sites was successfully migrated across to the PiMS system that is used on the DH and QMS sites over the weekend of 1 November. This means that there is now one unified patient administration system used to record patient activity across all of the Trust sites, and represents a huge achievement by the ICT and Operations teams. A number of issues have been identified post-migration which have impacted on medical records, and on our ability to report RTT and diagnostic waiting times. We are working with our external PAS system provider to manage a number of data issues and these are being resolved as a matter of urgency.

1.2 Performance challenges – 4 Areas

1.2.1 Emergency Care 4-hour Performance –

October 2014 Performance: Emergency care pathway 4-hour all types attendance performance moved from 86.9% in September to 82.7% in October with periods of very low performance. As a result, all type attendance performance is below the agreed internal trajectory of 86.9% set with the commissioners in

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October, for the first month since April 2014. All types attendance 4-hour performance has been on a positive trajectory since April 2014 due to the implementation of the Clinical Decision Unit, Ambulatory Unit and development of pathways as detailed in the PRUH ED recovery plan.

The change in trajectory is related to the PRUH and the wider local health systems remaining fragile. As reported last month, the number of discharges at PRUH had been steadily rising since October 2013, however this started to decrease from September 2014. At the same time, the number of patients who are either medically suitable fit for discharge (MSFD) has increased. This is as a result of PRUH therapy capacity, internal discharge processes needing further work, and ward staff education on discharge. There are a number of Emergency Department and site internal pathways which have not been resilient enough and need further work. A further factor is the external community capacity and flow to match demand.

There are a number of actions to mitigate this listed below:

• Medihome: The Medihome service has been extended to the PRUH. This is based on the model of care that has been in place with Medihome at the DH site and will provide capacity to potentially free up to 20 beds.

• Out of hospital support: Additional external support from Bromley CCG, Bromley Health Care and Bromley Social Services are being actioned. For example, ward staff are able to re-start packages of care for Bromley patients without going through a re-referral process for acute medicine patients. Further re-ablement capacity has been agreed for fracture patients, in particular. There is now a fortnightly meeting with Executives and representatives chaired by the BCCG chair to discuss and agree actions.

• Internal incident week: This ran from 10th-17th November with senior DH consultants re-allocating to PRUH medicine and ED. The Trust Head of Site and Emergency Planning has undertaken a review of bed management processes at the PRUH, and pathways are being re-vitalised as discharges improve. In addition, work is on-going to realise the bed capacity set out in the waterfall chart on slide 28.

• ED Action Plans: Details of our latest Action Plan can be found from slide 27 later in this report together with an update on our monthly performance to-date this year compared to trajectory.

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• Governance: Weekly Emergency Care Board meetings continue to review progress and performance against the revised ED Action plan.

1.2.2 RTT Admitted –

• October 2014 Performance: The RTT Admitted pathway target of 90% was not achieved in October at 67.6%, consistent with the Trust’s plans submitted to Monitor for 2014/15. The number of patients waiting over 18 weeks increased during October to 935 cases compared to the 910 patients waiting at the end of September. Bed pressures on the PRUH site have contributed to an increased number of patients cancelled, and the backlog not reducing as much as expected. The RTT Incomplete pathway target of 92% was not achieved for the PRUH site again in October, but was achieved for the combined PRUH/QMS position at 92.01%.

• 52-week wait position: There were 3 patients (2 in Orthopaedics and 1 in Rheumatology) waiting over 52 weeks reported in the October RTT Incomplete position compared to the 1 patient waiting at the end of September.

• Division action plans: The main specialities of concern for 18-week admitted backlog reduction at the PRUH are: Orthopaedics: There were just under 270 patients waiting over 18 weeks in the October RTT incomplete pathway position compared to over 290 patients waiting over 18-weeks based at the end of September. Additional Orthopaedic activity will be delivered as part of our plans to increase list utilisation and move elective non-complex Orthopaedic work to Orpington hospital, and the service has also been looking at treating patients at the private BMI hospital Chelsfield Park. Gynaecology: There were just over 90 patients waiting in the October RTT incomplete pathway position compared to 110 patients waiting over 18 weeks based on the August position. Additional activity is being delivered off-site based on the RTT monies received and we plan to have circa 30 patients waiting over 18 weeks by the end of November.

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General Surgery: 136 patients were waiting over 18 weeks based on the October RTT incomplete pathway position compared to 120 patients were waiting over 18-weeks based on the September position. The Trust plans to deliver additional activity off-site, which have been enabled by the £1.2m additional funding received from the winter resilience bidding process for PRUH-led initiatives. The service has also been trying to negotiate a contract with a private provider, the Kent Institute for Medicine and Surgery and plans to treat both General Surgery as well as ENT patients off-site.

• Governance:

Progress is measured in weekly RTT performance meetings that are chaired by the Director of Operations, as well as within the monthly Patient Access Board as detailed in DH report.

1.2.3 Cancer Waiting Times –

• Cancer waiting times were achieved across the PRUH sites in-month for October with the exception of the 62-day time to treatment target and 31-day wait for second/subsequent surgery target. The 2-week waiting time target for suspected cancer has been met for October now that the Urology clinic capacity is on-line at Beckenham Beacon, achieving 95.8% compared to the 93% target.

• Urology pathways still remain a concern with potential breaches of the 62-day standard this quarter, as the 2-week waiting time target was not met until September causing delays in some treatment pathways.

• A new breach reporting and RCA policy has now been introduced, leading to better action planning to resolve delay issues.

1.2.4 Finance position –

• Please refer to the separate Finance paper for more details on the financial position at Month 7.

2. Other areas of concern:

2.1 Diagnostic Waiting Times – The number of 6+ week diagnostic waiting time breaches at the PRUH decreased further by 116 cases in October to 329 breaches compared to the 445 breaches reported in the September position. The national target of 1% for patients waiting over 6 weeks is not being achieved with performance at 10.0%. There was a decrease of 146 breaches reported in patients waiting for non-obstetric ultrasound cases

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following the actions taken over the past few months to improve cross-cover flexibility and securing additional locum consultant sessions. Evening and weekend sessions have continued and an office space is being converted into an additional scanning room to provide further capacity. There was an increase of 7 breaches in cystoscopy so 100 breaches were reported at the end of October. The service has now moved to Beckenham Beacon, but due to the number of 6-week diagnostic patients and planned patients, it is expected to take 2 months to clear the backlog. Planned activity continues to be outsourced to maintain the planned waiting list position. MRI breaches increased by 18 cases to 35 breaches being reported in October. Patients continue to be outsourced to QMS and the InHealth mobile scanner at the DH site.

2.2 Red Adverse Incidents (AIs) – There were 26 red AI’s reported in October, of which 15 cases were community acquired pressure sores present on admissions that we are required to report. There were 11 internal incidents including 5 cases reported in Surgery and 3 cases in TEAM. Two of the medical cases and one of the surgery cases related to patient falls which resulted in a fractured neck of femur, an area of quality concern.

2.3 Pressure Sores – The number of pressures sores reported decreased from 16 cases in September to 9 cases in October, including 3 cases on TEAM wards and 3 cases on Surgery wards.

2.4 Patient Complaints – Scores for all 3 HRWD sections worsened for October with none of the section survey response targets being achieved. Only Gynaecology achieved all 3 section score targets. The number of complaints received in October decreased from 39 cases in September to 28 cases in October, of which 8 were rated high or severe. The number of complaints either open or not responded to within 25 working days increased from 23 cases in September to 29 cases at the end of October. The new processes for local resolution of potential patient complaints that have been agreed and introduced by the Associate Director of Operational Performance and the Head of Patient Relations and Complaints have contributed to the reduction in complaints received in-month.

2.5 Theatre Utilisation – Theatre utilisation rates reduced from 66% in September to 64% October, below the 80% internal target. Utilisation has been impacted by the pressure on beds and significant increase in the number of inpatient operations cancelled on the day of admission for non-clinical reasons, from 33 cases in September to 81 cases in October. 43 of these inpatient cancellations were Surgery cases.

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Theatre Productivity is one of the integration work-streams that is overseen by the Transformation & Improvement Director and reviewed at the fortnightly CIP Delivery Board meeting, with a focus on pre-op assessment and theatre scheduling, as well as on-the-day utilisation in theatres.

2.6 Weekend discharges - Weekend discharges as a proportion of all discharges remained static at 18.3% in October compared to September.

2.7 Health Records – The move of the PRUH records library off-site and issues with on-site casenote preparation space has impacted on the service that the Health Records team have been able to provide for the last couple of years. Following the recent migration from the OASIS system to the Trust-wide PiMS system, a general manager from the Operations team has been put into the PRUH to help stabilise the team. An experienced medical records staff member from the Dental Institute on the DH site has also been put into the team. A project manager has also started in November to review existing processes and develop a recovery plan which will be provided to the CQC. The service is improving but there is a long way to go, ahead of the proposed re-location of the records library to Orpington Hospital, which is delayed due to issues with planning permissions.

3. Regulatory and Contractual Performance

3.1 Monitor

Monitor interim Q3 position (PRUH) –

The Trust at PRUH has achieved the performance indicator targets in the Monitor Risk Assessment Framework for October with the exception of the RTT 18 Week Admitted and RTT 18 Week Non-Admitted targets, the 4-hour A&E performance target, 62-day and the 31 day subsequent surgery cancer target. A&E attendances and sustained emergency access pressures continued during October. The Trust did not meet the 95% target with All Types performance achieving 82.7%.

1 C-Difficile case was reported in October. 8 cases have been attributed year to date which is below the quota of 10 cases. The total attributable cases for this site for 2014/15 is 16 cases.

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4. Other Sites Update

4.1.1 Orpington Hospital – 10 beds within the planned 20-bed Neuro step down unit opened in the first week of November on the Ontario ward in Orpington Hospital with currently 7 patients transferred to the unit. Theatre utilisation has improved from 48% in July to 64% in October, and the number of Orthopaedic admissions has increased from a daily average of 7 patients to 12-14 patients in October.

4.1.2 Beckenham Beacon (BB) – The move of Paediatrics from BB to consolidate the service at the PRUH site have been completed. The Urology service move from PRUH to BB which provides outpatient as

well as increased diagnostic capacity has also been completed in October, and clinics are operational.

4.1.3 QMS – A mock CQC inspection has been conducted on the QMS site and the outcomes from the inspection are currently being pulled together. Plans are in place to implement stronger site-specific managerial, nursing and medical leadership with greater senior leadership engagement on site. 4.1.4 Sevenoaks Hospital - Following the migration from the OASIS patient administration system to the Trust PiMS system, a number of issues resulting from this project are being worked through on the site.

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5. Specific Performance Reports and other updates

This month’s report includes updates for :

5.1 RTT Performance Update

Details of the new RTT Action Plan and specific division actions for reducing 18-weeks backlog can be found in the RTT Performance update, provided later in this report. 5.2 Emergency Department (ED) Action Plan Update

Details of the new ED Action Plan and performance trajectory can be found in the ED Action Plan update, provided later in this report.

5.3 Cancer Action Plan Update

Further details on the action plan that has been developed to manage cancer pathways, incorporating recommendations from the IST review earlier in 2013 can be found in the Cancer Action Plan, provided later in this report.

5.4 HCAI Action Plan Update

Further details on the enhanced actions for 2014-15 can be found in the HCAI Action Plan, provided later in this report. This plan is still undergoing a programme of full review as the Infection Control team has focussed on its preparedness for managing Ebola. Further details can be found in the Denmark Hill report.

5.5 Key Areas of Concern

Summary page to highlight key areas of concern on the PRUH site under the categories of: Quality, Efficiency, Finance and Strategy.

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• Wards: High vacancy rate across all wards for N&M, with specific concerns for theatres and the Emergency Department. • Mid grade doctors: difficulty in recruiting to key specialities: Urology, Orthopaedics. Recruitment strategy being reviewed, implications of pulling junior

doctors from outpatient satellite units being undertaken to concentrate resource on the PRUH and Orpington sites. • Concerns regarding the suitability of Farnborough Ward for frail elderly patients due to its layout of all side rooms and the difficulty this poses in safely

nursing the patients. This is being reviewed by the Head of Capacity Planning. • Medical Records: Further issues with pathways of notes and processes impacted on location moves and PIMs implementation. Senior Operational

manager and project manager seconded to support. Typing delays are still a concern in Ophthalmology (6-7 weeks), General Surgery (2-3 weeks), plans in place to reduce using transcription and additional secretarial support.

• Acute GI bleed rota being managed by general surgeons, however a solution for small subsection of patients presenting with variceal bleeding requiring banding is still require. The Liver, Clinical Director is reviewing as the recruitment for locum gastroenterologists was unsuccessful.

• Seniority of resident OOH’s cover for General Surgery developed and is going ahead in November following rota changes and buddying initiative. • Emergency Pathway: Failure to achieve 4 hour target in month. Type 1: 69.1% • Currently a shortage of in fusion and feeding pumps, however order placed and 600 new pumps due on site at the end of November. The equipment

library space has been identified to support new pumps arriving on site. However, work is still to be completed to ensure the area is fit for purpose. • Urology: capacity to meet 2 WW wait is still a key pressure area due to increases in referrals, further work required on decontamination processes at

BB additional weekend lists and out sourcing continues whilst the issues are resolved. • Urology: repatriation of urology to QEH with support from GSTT is set at January as part of the bed capacity plan. However, there is concern regarding

QEH and GSTT ability to meet the timescale. New pathways agreed for testicular torsion agreed with QEH/GSTT in the meantime • PIMs and associate systems implementation still require support and training as PRUH staff become more familiar with systems, on –going dialogue

with IT and operations as issues arise. • Concern regarding Vinci’s capacity to deliver minor works programme for the CQC visit. Head of capacity planning and estates reviewing the list to

prioritise. • #NOF pathway results in average LOS 22 days. High mortality notification received, internal case review being completed and review of Orthopaedic

pathways underway. Two additional Orthopaedic consultants delivering service on the PRUH site. • Concerns have been raised regarding Haematology. This investigation is complete and further support from DH has been put in place. • Queen Mary’s Sidcup: Tripartite Management and clinical leadership is being reinvigorated to ensure consistency across KCH si tes

2014-15 M7 @ PRUH

Key Areas of Concern Quality

Efficiency

• Theatre utilisation improvement project to include ‘back to basics’ in theatre. Focus on DSU utilisation to be renewed. • Patients with LOS > 7 days and MFFD has increased, joint site and community discharge project has been launched. • Cancer waiting times: pressure on 62-day time to treatment achievement especially in Colorectal, Urology and HPB pathways. Consultant posts in

Colorectal and Urology agreed, out to advert soon.

Finance • Staffing (delays in recruiting to vacant posts and reliance on higher cost bank and agency staff for nursing posts).

Strategy

• Phase 2 Gynaecology move complete. Phase 3 planning reliant on finalisation of theatre timetable. Head of Capacity is currently reviewing • Some technical difficulties regarding PiMS/Symphony impacting on timely internal reporting of data. • Rehabilitation beds have opened in Orpington to decompress DH. Further scoping underway to determine if there is capactity to support PRUH.

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Subject Governor Involvement and Engagement Opportunities

Meeting Date:

10 December 2014

Action: For Information/Response

| Overview

In addition to Council of Governor and Governor Committee meetings, Governors have engaged in a wide range of initiatives across the trust, and this engagement is highly valued. With a new Council of Governors, we are circulating the current list of available opportunities, and asking again for Governor participation in these. This is a list that will evolve over time, and as new opportunities or vacancies arise, they will be added and circulated. Some governors also attend meetings and events outside of the trust, where they may have a particular role or interest. Examples include local community interest organisations such as SE5 Forum, Southwark and Lambeth Integrated Care Citizens Forum, University of 3rd Age and Healthwatch, which are great opportunities to engage with local communities. The 2011-14 Council’s Membership and Community Engagement Committee also took the lead on governor-led initiatives to engage with members and the local community. | Recommendation

Governors are asked to: 1. Consider the note the contents of this report; and

2. Consider the opportunities for engagement listed in Appendix 1 and

complete the form in Appendix 2 to indicate your area of interest and return it to Tamara Cowan.

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Appendix 1 – Detailed List of Opportunities for Governor Involvement & Engagement

Involvement Activity No. Governors Required

Trust Lead Description Status Date

Public Health Committee No Limit Chair: John Moxham Lead: Mike Marrinan

Contributing lay/Governor perspective to Public Health issues

Ongoing Meets Quarterly

Staff Commendation Panel x 2 Chair - John Karani, Contact - Angela Huxham

Contribute to decisions on staff awards Ongoing Ongoing

Improving King's Patient Food Service- Food Service and Nutrition Group

x1 Chair/Lead: Rick Wilson Contributing lay/Governor perspective Ongoing Ongoing

Patient Food Audits (DH) x1 Chair/Lead: Rick Wilson Governor / Lay input into daily ward audits of the patient food service

Ongoing Bi-weekly

Organ Donation Committee x1 Chair/Lead: Ben Rhodes

Contributing lay/Governor perspective Ongoing

Community Events (DH & PRUH) All Gov. Lead: Sally Lingard Series of annual events for members Annual February/March

Patient Experience Committee PESC Members x2

Chair: Jane Walters Lead: Jessica Bush

Lay representation on trust committee, which reports to the Board’s Quality, and Governance Committee.

Ongoing Monthly

End of Life Care Steering Group x1 Wendy Prentice Lay involvement Ongoing

National Governors' Forum (FTN Network)

x2 n/a External networking Current

Serious Complaints Committee x1 Chair: Faith Boardman, Lead: Jane Walters

Contributing lay/Governor perspective Bi-monthly

Maternity Services Liaison Committee (Maternity Matters)

x1 Lay Chair: Joanna Brien Lead: Maxine Spencer, Director of Midwifery

Lay representation of trust wide maternity group which seeks to improve all aspects of maternity care.

On-going Bi-monthly

End of Life Care Steering Group x1 Chair: TBC Lead: Wendy Prentice

Governor involvement in End of Life Care Steering Group looking at all aspects of end of life care.

On-going

Older Person's Group x1 Chair: TBC Lead: Mike Marrinan

Governor representation on Older Person's Group

Ongoing

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Go See Visits All Govs. Lead: Geraldine Walters Governors join Board of Directors on wards. Ongoing Monthly

CQC Mock Inspections All Govs. Lead: Elke Pieper This is one of a series of random, unannounced visits that we are holding to ensure that all our clinical areas are prepared for and meeting CQC standards at all times. It

Ongoing Adhoc

PLACE Visits Circa E Lead: Various The assessments give patients and the public a voice that can be heard in any discussion about local standards of care, in the drive to give people more influence over the way their local health and care services are run.

Ongoing Adhoc

Dignity Events All Govs. Lead: Participating in the dignity events and visits in during Dignity month and beyond

Ongoing Feb-2015

King’s In Conversations All. Govs Lead: Adhoc Mid-2015

Quality Accounts Engagement Initiatives All PESC Members

Lead: Adhoc

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Appendix 2

FORM - GOVERNORS INVOLVEMENT & ENGAGEMENT OPPORTUNIES We want to get has many people involved as possible so if you have particular are of interest please let us know. These assignments will be made on first come first serve basis. Please return these forms to Tamara Cowan, Board Secretary by 02 January 2015 either by email at [email protected] or in the post at King's College Hospital NHS Foundation Trust, KCH Business Park, Unit 2, Coldharbour Lane, London SE5 9NY. GOVERNOR NAME: CONSTITUENCY: AREA OF INTEREST

Public Health Committee Staff Commendation Panel Improving King's Patient Food Service- Food Service and Nutrition Group Patient Food Audits (DH) Organ Donation Committee Community Events (DH & PRUH) Patient Experience Committee End of Life Care Steering Group National Governors' Forum (FTN Network) Serious Complaints Committee Maternity Services Liaison Committee (Maternity Matters) End of Life Care Steering Group Older Person's Group Go See Visits CQC Mock Inspections PLACE Visits Dignity Events King’s In Conversations Quality Accounts Engagement Initiatives Go See Visits CQC Mock Inspections

mailto:[email protected]

SUBJECT TO CHAIR’S APPROVAL

1

Meeting: Membership and Engagement Committee

Meeting Date: 09 October 2014


Summary of key discussion points:

Learning from other organisations: Derek Ray-Hill, London First, Business Development

Director

The Committee welcomed Derek Ray Hill, Business Development Director at London First.

London First is a non-profit organisation with the mission to make London the best city in the world in which to do business. They aim to influence national and local government policies and investment decisions to support London’s global competitiveness.

Derek presented the Committee with background on London First, its projects and achievements, full details of which can be found in the minutes.

Governors in the Community

Andrew McCall thanked the departing governors Stuart Owen, Patti Kachidza and Joe Onabaworin for their contributions made to the Committee and King’s during their time.

Stuart Owen provided a summary and reflection of his time at King’s as a departing patient

governor. The points raised have been noted in the Committee minutes and will be taken on board when considering future governor engagement.

Members in Focus

Rachel Sugarman presented the Committee with the membership update report which was noted by the Committee. The following key points were highlighted:

Membership numbers remain on target and there have been a larger number of communications sent out in the last quarter with the survey and elections which has been a good data cleanse exercise at the same time;

The Member Lunchtime Health Talks remain a popular method of engagement and all scheduled sessions to the end of the calendar year have been booked to capacity; and

The Trust will look at increasing capacity capability of these and also utilising the Orpington site.

Rachel Sugarman went on to present the members survey which was the first member survey sent out since the acquisition and 11,000 surveys were sent. The results and statistics were discussed in detail

Summaries/Actions from Governor Sub-Committee

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with the following key points noted:

The Trust received a 7% response rate from the survey which is a positive response rate for such a diverse membership;

There was a disappointing response from the respondents on knowledge/awareness of the Council of Governors and how to contact them;

The Patient and Public Involvement team have met with the Foundation Trust Office to discuss these results and formalise a proposed programme of engagement and promotion;

The results of the survey must not be taken on a broad response approach however. Remembering that members are happy with their level of involvement and what they receive means that the Trust must also listen to what they want; and

The next steps are to share the results and look at the different constituencies and identify any target areas within these.

The Committee also received and noted the elections update report.

Wider Engagement

Sally Lingard provided a verbal update on the Autumn edition of the @Kings publication. The turnaround for the winter addition would be quick due to having to send this out before the Christmas season. The following suggestions for content were noted: o Changes to cancer services; o Members’ survey results; o A piece on the departing governors; o A possible piece/report on the Annual Members Meeting; and o Information and support for the Bakerloo line extension. TC provided a verbal update on the Annual Members Meeting (AMM). The following key points were raised and noted: There was good attendance with 110 member which was particularly strong attendance by

Bromley members and there was a positive feel for the meeting; and

The healthcare checks proved very popular again this year.

Community Focus

The Committee welcomed Alex Blacknell, the chair of the Transport Group.

Alex outlined the proposal for the extension of the Bakerloo line and proposed to the Committee that it would be an excellent opportunity for King’s to respond together with statistics on how the extension

could benefit staff and members.

Derek Ray-Hill had stayed to listen to this item and gave valuable advice regarding the political angles to consider when responding and to do so strategically.

Key Actions from meeting:

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Action Who Progress

The Trust will continue to explore options related to the Bakerloo line extension and the Boris Bikes and provide an update on this at a future meeting should the Committee be reinstated by the new Council of Governors

TC/JW If Committee re-

establish will be

added to 2015

Workplan

RECOMMENDATION FROM THE CHAIR

The Chair recommends that the 2014-2017 Council of Governors re-establishes the

Membership and Engagement Committee

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1

Meeting: Governor Strategy Committee



Summary of key discussion points:

Strategic Matrix Q2 and Monitoring the 5-year review

David Dawson, Deputy Director of Strategy, presented the strategic matrix. The following key points and highlights were noted:

IT projects are progressing with the Princess Royal University Hospital (PRUH) site to be migrated onto the same system as the Denmark Hill (DH) site;

The task is enormous and governor feedback of the previous migration from the Queen Mary site in Sidcup was that the move caused pressures and stress for employees on site and so the Trust should be mindful to manage any issues and offer support from the more experienced DH site;

The Trust is aware that this will be a continuing process to manage. Staff have been trained and this is an important feature for the Trust to progress;

Agreement has been reached to progress matters with the vascular network and a delivery group has been formed to support this;

The Trust is at a crucial time to now to build relationships and make the network work across the 3 sites for the benefit of the patients;

The King’s Health Partners (KHP) membership has been refreshed and a renewed internal site

strategy is being considered to align with KHP. Engagement and discussion with the partners will continue whilst the Trust works through how to proceed;

The business case for the move of cataract service to Queen Mary’s Hospital (QMH) site was not

approved and so alternative solutions are being sought which can be updated at the next meeting;

The PRUH Summit was a significant meeting with key stakeholders who see the Trust as a case study for this kind of acquisition and what lessons could be learnt from it;

The Committee will be updated on the haematology oncology transfer at the next meeting as to where services will be transferred; and

Governors commented on their pride at the representation of King’s staff signing up to assist with

the Ebola crises. Approximately 12 staff have signed up and KHP have co-ordinated this.

Strategic Issues Q2

Joe Farrington-Douglas, Senior Strategy Advisor, outlined current key issues for the Trust’s strategy.


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The release of the Five Year Forward View (FYFV) was the key issue for discussion. The 39-page report sets out a collective system perspective on the key challenges, vision for the future and a way forward centred around a menu of new care models that local areas will be expected to adopt and adapt to achieve sustainable prevention, efficiency and quality transformation.

The FYFV was discussed in detail with the following key points raised and noted by governors: Commissioner engagement and support issues have been a teething problem in the system since

2013 where there was a strong culture of silos of organisations requesting differing things at differing times;

How much change will result from the FYFV remains to be seen but King’s must now engage positively on integrated care and do its part to work with the system although there are no short term changes to be achieved;

Even though not detailed in the report, there does seem to be a stronger understanding from key

stakeholders as to the challenges of healthcare providers and the increasing demands on services; and

Localised networks and effective narratives is key for King’s now with consistent data between

parties;

Update on KHP

Trudi Kemp, the newly appointed Director of Strategic Development provided the Committee with a verbal update on the King’s Health Partners (KHP). The following key points were noted: KHP has benefitted from a change to its governance processes and there have been new

personnel joining the board; The new Chair, Professor Ed Byrne, is bringing a different approach to the partnership and his

clinical background rather than educational adds a new dimension; There have been two newly appointed NEDs (Stephen Dorrell MP and Professor Garret

FitzGerald) and one post is yet to be filled; and The changes now mark an opportunity to improve relationships amongst the partners and King’s

are approaching this constructively; Actions to explore include:

o Cardiac; o Children; o Haematology; and o Diabetes

Integrated Care

The Committee welcomed Sue Bowler, Director of Integrated Care and Partnerships, Kerry Lipsitz, Programme Manager Integrated Care and Partnerships and Paran Govender, Director of Therapies, Rehabilitation & Integrated Pathways.

Sue Bowler presented an overview of the work in Integrated Care and Partnerships. The following areas were noted in the presentation:

Structure of Southwark and Lambeth Integrated Care (SLIC);

Current SLIC projects; and

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Financing and commissioning activity.

Full discussion of the presentation is captured in the minutes.

Public Health

The Committee welcomed John Moxham to the Committee who gave a presentation on public health issues. The Public Health Committee (PHC) was formed in 2006 and 10 public health improvement workstreams were established which John Moxham encouraged governors to become part of if they wished. A copy of the presentation and details of the PHC workstreams would be circulated to governors.

Committee Work Review 2012-2014

As the last Governor Strategy Committee of the current Council of Governors Chris North presented the Committee with a review of the items discussed during the term and also, should the new Council of Governors vote to have this Committee reinstated, what issues would be appropriate to suggest for the work plan. The following suggestions were made: Clear focus for a sustainable enlarged King’s;

Building relationships with KHP; Developing South East London health services and integrated care; Public health and the health and wellbeing of staff; Development of the 5 year strategy as it embeds; and Better Health for London consultation which was also requested to be circulated;

Key Actions from meeting:

Action Who Progress

The Committee will be updated on the haematology oncology transfer at the next meeting as to where services will be transferred


establish will be

updated at the next

meeting

The business case for the move of cataract service to Queen Mary’s Hospital (QMH) site was not approved and so alternative solutions are being sought which the can be updated at the next meeting;


establish will be

updated at the next

meeting

A copy of John Moxham’s Public Health Issues presentation and details of the PHC workstreams would be circulated to governors.

NO This will be

uploaded to the

governor portal

The suggested items in the Committee work plan review are to be offered for the next Governor Strategy work plan.

If Committee re-

establish will be

added to 2015

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Workplan


The Chair recommends that the 2014-2017 Council of Governors re-establishes the Governor

Strategy Committee

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Meeting: Patient Experience & Safety Committee



SUMMARY OF KEY DISCUSSION POINTS

CQC INSPECTION BRIEFING

The Committee was informed that the Trust is in the next wave of trusts to be inspected by the CQC. All Trust sites would be visited simultaneously between 20 – 23 January, with the feedback session on 23 January 2015.

In preparation for the inspections the Trust needs to identify issues and gaps in meeting the CQC

standards and what action will be required to ensure the Trust is compliant. The Trust has established a steering group to oversee the CQC visit operation and each Trust site has been assigned a team lead. The Trust is focusing to improve on various key issues such as medical records, environment, staffing levels and response to complaints. The Committee noted that there would not be any major impact to patient care and appointments would not be cancelled as a result of the CQC visit.

It was highlighted that CQC has indicated that it will want to speak to Governors but as the exact

purpose of this was not clear, the Chair of PESC volunteered to contact CQC to find out.

Patients’ APPROACHES TO GOVERNORS

The Committee noted that patients have approached the Governors in relation to their complaints on a number of occasions either directly or through the Governor contact form, available on the Trust website.

The Committee received a summary of a patient’s experience and the Trust’s approach in handling his

complaint and expressed concern.

The Committee highlighted that there needs to be some clarification in relation to Governors’

involvement in dealing with issues or concerns raised by patients and how governors could demonstrate their role to members. The Committee noted that Governors’ have a strategic role for the wider membership and Governors are representative of members and the patient and public interest but do not represent them.


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Governors have serious concerns in relation to the numbers of complaints and about delays in response to complaints. The Trust has put in place a number of processes to improve the backlog and complaints handling. A Serious Complaints Committee has been established to discuss and review issues and mitigating actions. Tom Duffy sits on this committee in his capacity as Chair of PESC. A new system to deal with low severity complaints has also been instituted within the Trust and a fundamental review to deal with issues of backlog and complaints handling is also being undertaken by Elaine McDonald, Associate Director of Operational Performance.

The Committee noted that there is an agreed process in place for Governors to respond to members when they contact through the ‘Governor Contact Form’ and governors should consider their response

to members carefully as in most instances the cases are likely to be under review by the Trust’s PALs

service.

DIABETES

The Committee received a report on quality improvement and related service developments in diabetes, including the results of recent national audits and plans going forward.

It was noted that the National Diabetes Audit (NDA) collates data on people with diabetes from both

primary and secondary care data systems. The results appear misleading as the data are amalgamated and comparison is with the overall UK diabetes population and not between peer groups. Comparison of the Trust’s performance with other teaching hospitals in London concludes that Trust’s

performance is similar and in some cases better than that of its peers.

The Trust is aware that there are some internal data quality issues and some care process issues, which are being investigated. The Committee noted that as a result of the audit outcomes, the Trust is reviewing its IT systems at Denmark Hill (DH) site to determine how to optimise the quality of data and a number of other actions and processes have also been implemented. 2013/14 NATIONAL CANCER SURVEY RESULTS

The Committee considered the summary of the results from the National Cancer Survey capturing the whole cancer pathway. The survey was sent to over 100 Trust patients both at DH and PRUH sites.

Out of 62 comparable indictors, the Trust improved on 35 indictors, got worse in 20 indicators with no indicators in the top 20%. The response rate was 56% with good improvement in some areas but overall disappointing in comparison to some other Trusts. There has been small year on year increase in average scores with the Trust moving from fifth bottom to tenth bottom in the Macmillan league table. It was highlighted that there has been a number of achievements in the actions that were implemented over the past 2 years but overall the Trust is disappointed that the impact of these have not been reflected in this survey’s results due to time lag of when results are published and

the next survey was conducted. The PRUH has performed better than DH in 11 out of 15 sections. This is seen as being mainly due to the dedicated unit - the Chartwell Unit available for cancer patients at the PRUH. DH site does not have a dedicated cancer ward, which may lead to the perception from a patient experience point of view of a lack of continuity of care.

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It was highlighted that it is difficult to get tumour group engagement and the Trust is working to encourage cancer patient involvement at the User Group meetings. The Committee noted that improving patient experience of cancer patients is a key area of focus for the Trust and one of the Trust’s quality priorities for 2014/15. PESC WORK REVIEW

TD presented a summary of the topics which had been covered by PESC during the term of office of

the current Council of Governors, under the following headings : National and other surveys, Trust Reports (such as the Quality Accounts), Trust departmental presentations, Innovation and Change and, lastly, Governors’ own topics. The Committee noted the summary.

There was also some discussion on how much had changed as a result of the Governors’ input on

these items.

GOVERNOR INVOLVEMENT

The Committee received the latest Governor Involvement list and it was noted that list of involvement project would be revived with more information about each involvement projects. The involvement opportunities would be put forward to the new Council of Governors at their first meeting on 10 December 2014 and all Governors would have the opportunity to commit to a project of their interest.

KEY ACTIONS FROM MEETING

Action Who Progress

The CQC plan should be presented at the next Council of Governors meeting and the Trust would communicate the CQC’s approach to their visit and plans to meet with the Governors as soon as the information becomes available.

TC See agenda item 2.2

Suggested that “Patient feedback” should be a standing item on the PESC agenda.

TC/JW

Suggested that process for ‘governor contact form’ should be reviewed again at future Committee meeting.

If Committee re-establish will be added to 2015 Workplan

PESC recommends that Go See reports are presented to the Council of Governors

GW

The 64 recommendations from “Better Health for London” report which was published recently should be circulated to the Governors.

TC/JW Uploaded to Governor Portal


The Chair recommends that the 2014-2017Council of Governors re-establishes the Patient Experience and Safety Committee.

Enc. 4.2.3



Presented by: Jane Walters, Director of Corporate Affairs

Subject: Lead Governor

Action Required: FOR APPROVAL

| Introduction

Monitor recommends in their Code of Governance that Councils of Governors appoint a Lead Governor. While the appointment of a Lead Governor is considered best practice, it is not a mandatory requirement. However, the vast majority of Foundation Trust Councils of Governors have appointed a Lead Governor, as has this Trust, and the right to do so is enshrined in the Trust’s constitution ( para 15.2). The main role of a Lead Governor is to be a conduit between the Council of Governors and Monitor in circumstances when the usual communication channels via the Chair or other Directors are not appropriate. Councils can extend the role to cover other areas, as this Trust has done. The previous Council elected Nicky Hayes, a Staff Governor to be Lead Governor in 2012 and then re-elected her to the post for the reminder of the Council term. The Monitor document - ‘Your duties: a brief guide for NHS foundation trust governors’ says the following: The Lead Governor is the main point of contact in a few specific circumstances in which Monitor may need to contact the council of governors or the other way round. Trust secretaries will usually disseminate communications from Monitor to governors. Some trusts choose to broaden the role of the lead governor….. Where the role is broadened, the directors and governors should seek to agree a description of the role. | Role Description

The current role description and person specification for the Lead Governor is attached in Appendix 1. The previous Council decided to extend the role of the Lead Governor beyond the role described by Monitor. Duties include assisting with setting the annual work plan and reviewing the draft agendas ahead of each Council meeting with the Chair and

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Trust Secretary, and chairing the Council of Governors meeting when for reasons of conflict neither the Chair nor Non Executive Directors may do so. The Lead Governor cannot simultaneously hold the post of Chair of a governor sub-committee. | Term of Office

The previous Council agreed that the Lead Governor would be elected to serve a one year term eligible for reappointment on an annual basis up to a maximum of three terms (years). The reappointment of the elected Lead Governor would be subject to discussion and decision at a duly convened meeting of the Council. There would be no requirement to hold a further election. Should the Lead Governor decide not to seek reappointment, the candidate with the second highest vote at the election shall be asked appointed to the post, with the agreement of the Council. | Process for electing the Lead Governor

The process for appointing the Lead Governor is as follows: 1. All governors, regardless of constituency, will invited to consider and if so desired

nominate themselves as a candidate for the post of Lead Governor.

2. Candidates will be invited to submit a short statement as to their suitability for the Lead Governor role.

3. The election will be conducted by secret ballot. All governors are eligible to vote. 4. Candidate statements will be collated in a nominations pack and issued to the

whole Council of Governors.

5. Governors will also be provided with a ballot form and freepost envelope for electing their preferred candidate.

6. If only one candidate comes forward by the close for expression of interest that

person will be elected unopposed.

7. If two candidates receive the same number of votes after the ballot closes then a second ballot will be held to ascertain which of the tied candidates will be elected.

| Recommendation

The Council of Governors is asked to consider and approve the following proposals:

1) Elect a Lead Governor to support the Council of Governors;

2) Agree the role description in Appendix 1;

3) Agree that in the interim, Nicky Hayes be asked to remain as Lead Governor such time as it is no longer feasible for her to retain the post or until the Lead Governor is elected, whichever comes first.

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APPENDIX 1 Role of Lead Governor

1. Term of Office The Lead Governor shall be elected to serve a term of one year and shall be eligible for reappointment on an annual basis up to a maximum of three terms. 2. Role overview In certain circumstances, where it would be inappropriate for Monitor to contact the Chair or Trust Secretary, the communication will instead take place between the Lead Governor and Monitor. Routine communication from Monitor to Governors will, as a matter of course, be channelled via the Chair or Trust Secretary. On the infrequent occasions when the Chair or another Non-Executive Director is not available or it is inappropriate because of the nature of discussions for the Chair or a Non-Executive Director to chair the meeting the Lead Governor will Chair the Council of Governors meeting. The Lead Governor shall be elected by the Council of Governors. The Lead Governor will not deputise for the Vice Chair of the Board of Directors. In order to ensure no role conflicts, the Lead Governor cannot also hold the position of Chair of a Governor Committee. 3. Role described by Monitor The role of Lead Governor will encompass: 3.1. Facilitating communication between Governors and members of the Board of

Directors;

3.2. Facilitating direct communication between Monitor and the Council of Governors in the following circumstances:

3.2.1. In rare cases where it would be inappropriate for Monitor to

communicate directly with the Trust Chair or Company Secretary; 3.2.2. Where there are serious concerns about Board Leadership, which

could lead to Monitor removing the Chair or Non-Executive Directors; 3.2.3. Where there is a real risk that the Trust may be in significant breach of

its Authorisation (which also calls into question the leadership of the Board).

4. Additional duties 4.1. Chairing Council of Governors meetings, in the absence of the Chair or

another Non-Executive Director or where the Chair or a Non-Executive Director would be conflicted;

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4

4.2. Assisting the Chair in setting the annual work programme for meetings of the

Council of Governors and in reviewing draft agendas for Council of Governor meetings;

4.3. Liaising, as appropriate, with councils of governors for other NHS foundation trusts;

4.4. Facilitating communication between Governors and representing the

collective view of the Council of Governors with other organisations, such as the Care Quality Commission; and

4.5. Act as the first point of contact with the Senior Independent Director as

appropriate and required. 5. Person specification

Commitment to the Trust Willingness to devote the necessary time and effort Good independent judgement Understanding of the responsibilities of Governors Ability to work effectively as a part of a team Tact and diplomacy Good communication and interpersonal skills Impartiality, fairness and the ability to respect confidences

Enc. 5.1.1




Presented by: Jane Walters, Director of Corporate Affairs

Subject: Proposal for Council of Governor Committees

Action Required: FOR APPROVAL

| Introduction

This report outlines the current Council of Governors Committee structure and asks Governors to agree these arrangements where they are discretionary. It also proposes a process for electing members of the Nominations Committee and appointing Chairs of other Governor Committees. The current structure is shown below. Monitor’s ‘Your statutory duties: A reference guide for NHS foundation trust governors’ says: ‘Trusts and governors may choose to have working groups and sub-

committees on which governors may sit to help in specific areas of work ... The full

council should set the terms of reference of such working groups and sub-committees,

including how governors are elected or appointed to the group. The council of governors

has no power of delegation, so governor working groups and committees can make

recommendations to and advise the full council but cannot make decisions on its behalf’

An executive lead and a Corporate Governance Officer support each governor sub-committee, and Non-Executive Directors are invited to attend. With the exception of the Nominations Committee which meets as and when required, all Committees and groups meet 4 times per year. In addition, with the exception of the Nominations Committee, non-executive directors are encouraged to join and attend each governor sub-committee. The current terms of reference for each of the Committees are enclosed in Appendix 1. The summary action notes from the last meeting of each of these committees are under agenda item 4.2 for your consideration and the outgoing chairs have provided their recommendations for the 2014-2017 Council of Governors.

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Current Committee Structure

Figure 1: 2011-2014 Council of Governors Sub- Committee Structure

Nominations Committee This Committee is a mandatory Committee, with terms of reference enshrined in the Trust’s constitution. The Committee is responsible for administering the process for the appointment of the Chair and non-executive directors and recommending preferred candidates to the Council of Governors for appointment. They are also responsible for making recommendations to the Council on the remuneration and terms of service of the Chair and non-executive directors. There are 5 governor members of the Committee with a patient/public governor majority. The Trust Chair is a member, and chairs the Committee. Members of the Nominations Committee receive formal recruitment training. There are currently three other ‘voluntary’ Committees which previous Councils of Governors have created. These are not enshrined in the Trust’s constitution. They are the Membership and Community Engagement Committee, Strategy Committee and Patient Experience and Safety Committee. They are described below. All governors can become member of these Committees. A governor elected by the members of the Committee chairs each Committee. Membership & Community Engagement Committee This Committee monitors the Trust’s membership and community engagement strategy and processes. Its main objectives are to ensure that the Trust’s membership continues to be representative and identifying ways in which the membership can be more actively involved. It has a formal remit in endorsing the Trust’s membership strategy and recommending its adoption by the Council of Governors. The Committee also considers how both Committee members and the wider Council can best discharge their duty to represent the interests of the membership and the wider public. The Committee is also responsible for transport matters, and receives reports from a Transport Feeder Group

Council of Governors

Nominations Committee

Membership & Community

Engagement Committee

Transport Feeder Group

Patient Experience &

Safety Committee

Strategy Committee

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Patient Experience & Safety Committee This Committee supports the Trust in monitoring the Trust’s patient experience and safety initiatives, many of which have direct governor involvement. This Committee also supports the Trust’s work around quality priorities and the development of the annual quality accounts and reviews information received from the CQC, making recommendations to the Council as appropriate. Strategy Committee This Committee oversees the Council of Governors’ input into the Trust’s overall strategic plans including forward plans submitted annually to Monitor and makes recommendations to the Council. The Committee also considers wider strategic issues such as King’s Health Partners’. Proposed dates for committee meetings are detailed in Appendix 2. | Recommendation

1. The Council of Governors is asked to consider and agree the adoption of

the three ‘voluntary’ Committees outlined in Figure 1 above.

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APPENDIX 1

Sub-Committee Terms of Reference PATIENT EXPERIENCE AND SAFETY COMMITTEE

1 MAIN PURPOSE The main purpose of the Committee is to assist the Council of Governors in carrying out its functions. The Committee will focus on improving patient experience and safety and on monitoring the Trust’s patient experience and safety initiatives. It will report to the Council of Governors and act as a reference group for the Trust’s planned activity around patient experience and safety.

2 COMMITTEE REMIT The remit of the Committee is to: 2.1 Work collaboratively with the Trust to gain an overview of the work at King’s to

ensure the safety of patients and a positive patient experience. This will include reviewing key information and reports, such as national and local survey data and internal Trust reports.

2.2 Receive information about and get involved with a range of patient experience

and safety initiatives within the Trust e.g. Ward 20:20; Patient, Public and Member involvement programmes; the selection of the Trust’s quality indicators within the Quality Account; and to contribute to other projects to provide a patient perspective.

2.3 Review and provide input into materials, communications and publications for

patients and members. 2.4 Review information received from the Care Quality Commission (CQC),

including and reports (responsive reviews and inspections) and the regular Quality Risk Profile (QRP), and consider any response the Committee wishes to recommend to the Council of Governors.

2.5 With the approval of the Council of Governors, to share information and reports

with the CQC about the quality or safety of care at King’s as necessary. 2.6 Link to and complement the work of other Governor sub-committees where

appropriate.

3 CHAIR

The Chair of the Committee shall be elected from amongst the members of the Committee. The Chair will serve for their term of office. The role of the Chair is to run the meetings, approving the agenda in advance and subsequently approving the draft minutes of the meeting. In the absence of the Chair, a deputy will be nominated from amongst the membership.

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4 STAFF LEAD

4.1 The staff lead and liaison will be the Associate Director of Governance. 4.2 The staff lead, with the assistance of the Committee facilitator, will ensure that

actions are recorded and followed up and that the progress of the Committee is reported at Council of Governors meetings.

4.3 The Corporate Governance Officer will act as facilitator for the Committee. 5 MEMBERSHIP & ATTENDEES 5.1 The Committee is open to all Governors, although it is advisable that the

membership does not exceed 15 members. 5.2 In addition to the staff lead, the following key Trust personnel may be invited to

attend Committee meetings: Director of Corporate Affairs Director or Deputy Director of Nursing Head of Patient & Public Involvement Non-executive Director (to be confirmed)

5.3 The Committee may invite further attendees as required from time to time. 6 QUORUM

6.1 The quorum of any meeting shall be four Governors.

7 FREQUENCY OF MEETINGS

7.1 The Committee shall meet quarterly in advance of the meeting of the Council of Governors’.

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Sub-Committee Terms of Reference GOVERNOR STRATEGY COMMITTEE

1 MAIN PURPOSES The main purpose of the Committee is to assist the Council of Governors in carrying out its functions. Reporting to the Council of Governors the Committee will provide a Governor and member perspective on the Strategy of the Trust, in particular the Trust’s Annual Plan, and to help ensure that the views of the Governors and members are represented to the Board of Directors. The Committee will also assist in facilitating the communication of the strategy to the members. 2 COMMITTEE REMIT The objectives of the Committee are to:

2.1. On behalf of the Council of Governors provide a Governor and member perspective on the Strategy and the strategic priorities of the Trust.

2.2. To provide a Governor perspective on the further development of King’s

Health Partners and in particular the impact of this on King’s strategic priorities.

2.3. To comment on the draft Annual Plan to Monitor, ensuring that Governors

and members views on the Trust’s forward plans are represented.

2.4. To work with the Trust on the content of Community Involvement Meetings as opportunities for discussing the Trusts Strategy, strategic priorities and draft Annual Plan.

2.5. To link with the cross Trust King’s Health Partners Governors’ reference

group on issues relating to the AHSC.

2.6. To report back to the Governors’ meetings.

2.7. Where appropriate the Committee should have regard for any impact of legislative/regulatory issues on the Council of Governors’ roles and report back to the Council of Governors as appropriate.

3 CHAIR

3.1. The Chair of the Committee shall be elected from amongst the members of the Committee. The Chair shall be eligible for their term of office.

3.2. The role of the Chair is to run the meetings, approving the agenda in

advance and subsequently approving the draft minutes of the meeting. In the absence of the Chair, a deputy will be nominated from amongst the membership.

Enc. 5.1.2

Enc. 5.1.2

7

4 STAFF LEAD & FACILITATOR

4.1. The staff lead and liaison will be the Director of Strategy. The staff lead, will in conjunction with the Chair build the agenda and ensure that all actions arising from meetings are completed and duly reported to the Committee.

4.2. The Corporate Governance Officer will act as facilitator to the Committee.

5 MEMBERSHIP & ATTENDEES

5.1 The Committee is open to all Governors, although it is advisable that the membership does not exceed 15 members.

5.2 In addition to the staff leads, the following key Trust personnel will

attend the Committee on invitation by the Chair:

Director of Corporate Affairs Deputy Director of Strategy and Research Management Head of Service Development & Intellectual Property Lead

5.3 The Committee may invite such attendees as required from time to

time.

5.4 For the avoidance of doubt, the Corporate Governance Officer is not a member of the Committee.

6 QUORUM

6.1. The quorum of any meeting shall be four Governors.

7 FREQUENCY OF MEETINGS 7.1 The Committee shall meet quarterly in advance of the meeting of the

Council of Governors’.

Sub-Committee Terms of Reference

Enc. 5.1.2

Enc. 5.1.2

8

MEMBERSHIP AND COMMUNITY ENGAGEMENT COMMITTEE 1 MAIN PURPOSE

1.1 The main purpose of the Committee is to assist the Council of Governors in carrying out its functions.

1.2 In particular the Committee will focus on the duty placed on governors under

the Health & Social Care Act 2012 to ‘represent the interests of members of the corporation as a whole and the interests of the public’.

1.3 The Committee will achieve this by i) monitoring implementation of the

Trust’s Engagement and Experience Strategy; and ii) engaging with members of the Trust and the local community and identifying ways in which the Trust can make a contribution to the local community.

1.4 It will also report to the Council of Governors and lead by example by

actively participating in Trust-led and governor-led activity around engaging Trust members and the local community.

2 COMMITTEE REMIT The remit of the Committee is to:

2.1 Review, contribute to and monitor the implementation of the Trust’s Engagement and Experience Strategy, and to consider implementation in relation to the Princess Royal University Hospital, King’s Health Partners and other stakeholders.

2.2 Monitor and review the Engagement and Experience Strategy Work Plan.

2.3 Monitor and consider periodically the size and representativeness of

membership.

2.4 Develop, participate in and support Trust wide initiatives to grow membership.

2.5 Develop, participate in and support governor-led initiatives to engage with

members and the local community

2.6 Identify ways in which members and the wider community could be more actively involved and contribute to King’s activities.

2.7 Identify and consider wider community issues and how King’s, as a

significant employer in the area local to its sites, can develop its outreach and engagement in the local community.

2.8 Identify barriers to successful engagement and work with the Trust to

overcome them.

2.9 Facilitate effective regular communication between Governors and members, for example, through the Trust website and @King’s magazine.

Enc. 5.1.2

Enc. 5.1.2

9

2.10 Ensure a joined-up, efficient and cost effective approach to further communication with members, including facilitating the lobbying activities or campaigns of other committees by acting as a point of communication for members.

2.11 Link to and complement the work of other Governor sub-committees where

appropriate.

2.12 Contribute to the development of the Annual Membership Report which is submitted to Monitor.

2.13 Contribute to the planning of Community Events, the Trust Annual Members’

Meeting and Open Day. 3 CHAIR

The Chair of the Committee shall be elected from amongst the members of the Committee. The Chair will serve for the duration of their term of office. The role of the Chair is to run the meetings, approving the agenda in advance and subsequently approving the minutes of the meeting. In the absence of the Chair, a deputy will be nominated from amongst the membership. 4 STAFF LEAD

4.1 The staff lead and liaison will be the Head of Public and Patient Involvement, with input from the Associate Director of Communications on Community Engagement and Communications issues.

4.2 The staff lead, with the assistance of the Committee facilitator, will ensure that actions are recorded and followed up and that the progress of the Committee is reported at Council of Governors meetings.

4.3 The Corporate Governance Officer will act as facilitator for the Committee. 5 MEMBERSHIP & ATTENDEES

5.1 The Committee is open to all Governors, although it is advisable that the membership does not exceed 15 members.

5.2 In addition to the staff leads, the following key Trust personnel may be

invited to attend Committee meetings: Director of Corporate Affairs Head of Stakeholder Relations Assistant Board Secretary Non-executive Director

5.3 The Committee may invite further attendees as required from time to time.

6 QUORUM

6.1 The quorum of any meeting shall be three Governors. 7 FREQUENCY OF MEETINGS

Enc. 5.1.2

Enc. 5.1.2

10

7.1 The Committee shall meet quarterly in advance of the meeting of the Council of Governors’.

Enc. 5.1.2

Enc. 5.1.2

11

APPENDIX 2

Proposed Committee Meetings Timetable

Meeting Time Feb-15 Apr-15 Jul-15 Oct-15

Strategy 14:30-16:30 5 9 9 8

Patient Experience and Safety 09:00-11:00 5 9 9 8

Membership and Community Engagement 11:30-13:30 5 9 9 8

Nominations Committee (other dates to be confirmed) 14:00-15:30 9

Enc. 5.1.2


Subject Proposed Timetable and Process for Establishing Council of Governors Governance Structures

Meeting Date:

10 December 2014

Action: For Approval

| Process for Establishing Council of Governors Governance Structures

Should the Council of Governors agree to the proposed sub-committee structure and to appointing a Lead Governor it will need to consider a process and timetable for:

Electing Nominations Committee members Appointing the Committee Chairs, and Electing the Lead Governor

Nominations Committee Two non-executive directors’ terms are subject to reappointment in quarter 1 of 2015. Therefore, the Council will need to establish the new Nominations Committee by early February, to make a recommendation on reappointment to the next Council meeting in March 2015. Other Governor Committees The first Committee meetings are provisionally scheduled for 5 February 2015 and therefore committee members need to be identified by January 2015. It is proposed that Chairs of the Committees are appointed by the next round of committee meetings in April. Historically, the Chairs have been elected informally at the first meeting of each Committee. Governors are invited to consider whether they wish to continue with this process, or move to a more formal ‘election’ process. Lead Governor The Lead Governor plays a key role supporting the development of agendas for the Council and facilitating contact as necessary with regulatory bodies. The Lead Governor cannot also be the Chair of any Governor Committee. It is therefore proposed that the process for electing a Lead Governor follows the appointments of the Committee chairs. Proposed Timeframe and steps Appendix Three of this document details a proposed timeframe and for establishing the Committee structure and appointing the Lead Governor. The proposed sequencing is:

1) Establish Nominations Committee 2) Elect Chairs of the Governor Committees (if agreed by Governors as a

change from the current process) 3) Elect Lead Governor

Enc 5.1.3

Enc 5.1.3

2

| Recommendation

The Council of Governors is asked to:

1) Consider and approve the Council outline workplan for 2015 (Appendix 1);

2) Note the proposed 2015 timetable of meetings ( Appendix 2);

3) Consider the proposed timeframe and steps for establishing governance structure (Appendix 3);

4) Consider whether Nicky Hayes should be asked to remain as Lead Governor until a new Lead Governor is elected, unless for other reasons she becomes conflicted

Enc 5.1.3

Enc 5.1.3

3

Appendix 1 COUNCIL OF GOVERNORS FORWARD PLAN 2015

Standing Items

Minutes

Chief Executive’s Report

Feedback from Council of Governors’ Committees & Working Groups

Register of Governor Attendance

Appointment/Reappointment of Non-Executive Directors (NEDs) – as and when required

March 2015

Monitor Q3 2014/15 submission

Annual Plan and Strategic Planning Process 2012/13

Quality Priorities 2014/15 (part of Quality Account)

King’s Health Partners

Planning/Feedback for Community Meetings, Open Day & Annual Public Meeting

May 2015


Strategy/Annual Plan 2015/16 – Final Draft

Quality Priorities 2014/15 (part of Quality Account)

Quality Account 2014/15 – Final Draft

Membership Report 2014/15 (part of Strategy/Annual Plan)


July 2015 – Subject to Monitor Timetable for Annual Plan/Strategy Submission

Strategy/Annual Plan 2015/16 – Final Draft

Membership Report 2014/15 (part of Annual Plan)


September 2015


Receive Trust Annual Report and Accounts 2014/15

Annual Governance Report 2014/15

Report from Nominations Committee on NED/Chair appraisal

Update on External Auditor Performance

Infection Control Annual Report

December 2015


Forward Planning 2016

Enc 5.1.3

Enc 5.1.3

4

APPENDIX 2 – COUNCIL OF GOVERNORS TIMETABLE 2015

Council Meetings

Meeting Time Jan-15

Feb-15

Mar-15 Apr-15

May-15

Jun-15 Jul-15

Aug-15

Sep-15 Oct-15

Nov-15

Dec-15

Council of Governors (CoG)

CoG 1 14:00-17:15 12 CoG 2 18:00-21:15 14 CoG 3 14:00-17:15 24 CoG 4 18:00-21:15 10 Governor Committees

Strategy Committee 14:30-16:30 5 9 9 8 Patient Experience and Safety Committee 09:00-11:00 5 9 9 8 Membership and Community Engagement Committee

11:30-13:30 5 9 9 8

Nominations Committee Meeting 14:00-15:30 5 TBC TBC TBC

Governor Event

Joint KHP Governor Event 17:30-20:00 5* 25* 19* Governor Workshops

10:00-16:00 29 6

17:00-20:30 21 5

CoG Development Days Governor Led 15:00-17:00 10

Trust Led 09:00-17:00 19

Joint Meetings

BoD/CoG 2-3 hrs 26

(17:30-19:15)

16 (12.45-14.30)

Strategy Committee/CoG (if required dependent on

09:00-11:00 18 (TBC)

Enc 5.1.3

Enc 5.1.3

5

Monitor) Public Meetings Community Event 1 17:00-20:00 TBC Community Event 2 17:00-20:00 TBC Trust Open Day 11:00-16:00 TBC AMM 18:00-20:30 24

MEETINGS OF THE BOARD OF DIRECTORS (BOD) Board Public Session 14:00-16:30 27 24 31 28 26 30 28 29 27 24 15 Go See Visit 16:45-17:45 27 24 31 28 26 30 28 29 27 24 15

Enc 5.1.3

Enc 5.1.3

6

Appendix 3: PROPOSED TIMETABLE FOR ESTABLISHING NEW COUNCIL GOVERNANCE STRUCTURE

Date Event Actions 10 Dec 2014 Council of Governors Meeting All governors asked to agree sub-committee structure, lead governor

role and consider which committees they would like to attend.

19 Dec 2014 Call for Expressions of Interest All governors invited to indicate their interest in joining a particular Committee.

All governors invited to indicate their interest in standing for election as member of the Nominations Committee

05 Jan 2015 Call for Submission of Nominations Committee Statements

All governors who expressed interest in standing for election to the Nominations Committee invited to submit supporting statement.

12 Jan 2015 Ballot Opens (postal) - Nominations Committee Members

All governors issued with statement and ballot papers for electing candidates to the Nominations Committee.

29 Jan 2015 Governor Development Day Governors have the opportunity to network with each other and hear more about involvement opportunities.

30 Jan 2015 Ballot Closes - Election of Nominations Committee Members

Results announced

05 Feb 2015 Inaugural meetings of each Committee These first meetings will be chaired by the executive lead. The Committee will be asked to consider and agree the proposed workplan and terms of reference. Committee members will be asked to consider their interest in standing as Chair.

Inaugural meeting of Nominations Committee

12 Feb 2015 Call for Expressions of Interest and Submission of Statement – Chair of a Sub-Committee.

All Committee members invited to express interest and submit supporting statement to become chair of a Committee.

13 Feb 2015 Ballot Opens (postal) - Election of Committee Chairs All Committee members issued with statements and ballot papers for

Enc 5.1.3

Enc 5.1.3

7

Date Event Actions electing candidates to each sub-committee.

NB: No sub-committee chair can be Lead Governor

27 Feb 2015 Ballot Closed - Election of Sub-Committee Chairs.

Foundation Trust Team advises all candidates of results on 28 February.

05 Mar 2015 Council of Governors Meeting Results announced and terms of reference and membership confirmed

13 Mar 2015 Call for Expressions of Interest All governors invited to indicate their interest in becoming a Lead Governor.


23 Mar 2015 Call for Submission of Lead Governor Statements All candidates invited to submit a short statement as to their suitability for the Lead Governor role.

6 Apr 2015 Ballot Opens (postal) - Election of Lead Governor All governors issued with statements and ballot papers for electing candidates as Lead Governor.


09 Apr 2015

Sub-Committee Meetings First meeting led by elected Chairs.

27 Apr 2015 Ballot Closed - Election of Lead Governor

Results announced

Enc 5.1.3

REGISTER OF GOVERNOR ATTENDANCE

(PUBLIC)

CONSTITUENCY REASON FOR ABSENCE

1 2 3 4 5 6 7 8 9 10 11 12 13

Prof Sir George Alberti Chair c c c c

May 2012: Sent apologies - Unwell - Marc Meryon deputised. Sept 2012: Sent apologies - unwell - Graham Meek deputised. Dec 2013: Sent apologies - Overseas work - Marc Meryon deputised March 2014: Sent apologises - Marc Meryon deputised

Mr Andy Alatise Southwark Central c c c c N/A N/A N/A N/A N/A N/A

May 2012: Sent apologies for absence - Unwell Dec 2011: Sent apologies for absence - Out of the country. Resigned

Ms Phyllis Barnett Allied Health Professionals c c c c c c c Dec 2012 and May 2013: Reasons for absence personal and notified to the Chair.

Ms Carol Bell Joint Staff Committee c c c N/A N/A N/A N/A N/A N/ADec 2012: Sent apologies for absence Feb 2013: Sent apologies for absence: union commitment. Resigned

Dr Rachel Burman Medical and Dentistry

Ms Carolyn Campbell-Cole Nurses and Midwives c c c c c

Dec 2011: Sent apologies for absence - Unwell. Dec 2012: Sent apologies for absense 05 Sept 2013: Sent apologies- Reasons Unknown 15 May 2014: Sent apologies - Chaildcare

Ms Fiona Clark Lambeth North

Ms Pam Cohen Southwark Central N/A N/A N/A N/A N/A N/A c May 2013: Sent apologies for absence - Reasons Unknown

Mr Derek Cookson Patient c c c c c c c

May 2012: Sent apologies for absence - Unwell. 05 Sept 2013: Sent apologies - Reasons Unknown December 2013: Sent apologies for absence - Unwell 15 May 2014: Sent apologies - Holiday

Cllr Jim Dickson Lambeth Council N/A N/A c c c c c c

Dec 2012: Sent apologies - Urgent Council Business 05 Sept 2013: Sent apologies - Reasons Unknown 18 Sept 2013: Sent apologies - Reasons Unknown Dec 2013: Sent apologies - reasons unknown 05 Sept 2013: Sent apologies - Work Commitments

Mr Thomas Duffy Patient c c c c

May 2012: Sent apologies for absence - On holiday Sept 2012: Sent apologies for absence - On holiday May 2013: Sent apologies - Reasons Unknown 15 May 2014: Sent apologies - Reason Unknown

Cllr Robert Evans Bromley Council N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A c

Mr Richard Gibbs Southwark CCG c c c May 2013: Sent apologies for absence - On holiday

Cllr Barrie Hargrove Southwark Council N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Ms Nicky Hayes Nurses and Midwives

Ms Sue Gallagher Lambeth CCG N/A N/A N/A N/A c c c Dec 2012: Sent apologies for absence - Work commitments

Ms Patti Kachidza Patient c c c c c

May 2012: Sent apologies for absence - Away Sept 2012: Sent apologies for absence - work commitments Dec 2012: Sent apologies for absence - work commitments 05 Sept 2013: Sent apologies for absence - Reasons Unknown 18 Sept 2013: Sent apologies for absence - Reasons Unknown

Ms Christine Klaassen Patient c c c N/A N/A N/AFeb 2012: Sent apologies for absence - On holiday. Feb 2013: Sent apologies for absence - On holiday.

Mrs Phidelma Lisowska Joint Staff Committee N/A N/A N/A N/A N/A N/A N/A c 15 May 2014: Sent apologies - Reason Unknown

Ms Madeliene Long South London & Maudsley NHS Foundation Trust c c c c c c c

Feb 2013: Sent apologies for absence - conflicting meeting May 2012: Reason unknown Feb 2012: Sent apologies for absence - Conflicting meeting. 05 Sept 2013: Sent apologies for absence - Reasons Unknown 18 Sept 2013: Sent apologies for absence - Reasons Unknown Dec 2013: Sent apologies for absence - reasons unknown

Mr Andrew McCall Southwark North

Cllr Catherine McDonald Southwark Council N/A N/A N/A c c c N/AMay 2013: Sent apologies for absence - On holiday 05 Sept 2013: Sent apologies for absence - Reasons Unknown

Mr Chris Mottershead King's College London c c c c c

Feb 2012: Sent apologies for absence - Conflicting meeting Dec 2011: Unknown Dec 2012: Sent apologies for absence - Transportation problems 05 Sept 2013: Sent apologies for absence - Reasons Unknown

Mr Christopher North Lambeth North c 15 May 2014: Reason Unknown

Mr Joe Onabaworin Southwark North N/A N/A N/A N/A N/A N/A c Feb 2013: attended meeting as an observer prior to taking up role as governor

Mr Stuart Owen Southwark South c Feb 2012: Sent apologies for absence - Unwell.

Ms Barbara Pattinson Southwark Central c Sept 2012: Reason unknown

Mrs Michelle Pearce Southwark South

Mr Michael Pedro Administration and Clerical N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A c

Mr Brady Pohle Administration and Clerical c N/A N/A N/A May 2012: Sent apologies for absence - Personal conflict

Mr Nandakumar Ratnavel Lambeth South

Mr Michael Robinson Lambeth Central c c c cMay 2012: Reason unknown 18 Sept 2013: Sent apologies - Reasons Unknown

Mrs Pida Ripley Patient N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Mr David Sullivan Patient c c c c c c c c c

May 2012: Sent apologies - Reasons Unknown Sept 2012: Sent apologies - Reasons Unknown Dec 2012: Sent apologies - Reasons Unknown Dec 2013: Absent - reason unknown 15 May 2014: Sent apologies - Work Committments

Ms Diane Summers Guy's & St Thomas' Hospital NHS Foundation Trust c c c

Dec 2012: Sent apologies for absence Feb 2013: Sent apologies for absence: union commitment 18 Sept 2013: Sent apologies for absence - Clashes with GSTT Annual Meeting Dec 2013: Attended Private session, apologies for Public Session - Reason Unknown

Ms Jan Thomas Patient c c c c c

Feb 2012:Sent apologies - On holiday. Feb 2013:Sent apologies - On holiday. 18 Sept 2013: Sent apologies - Reasons Unknown Dec 2013: Attended Private session - apologies for Public session

Mr Ahmad Toumadj Support Staff c c c c c

Sept 2012: Reason unknown 18 Sept 2013: Sent apologies for absence - Reasons Unknown Dec 2013: Sent apologies for absence - reason unknown

Dr Warren Turner London South Bank University N/A N/A N/A N/A N/A c c 05 Sept 2013: Sent apologies for absence - Reasons Unknown

Mr Godwin Ubiaro Lambeth Central c c c c

Dec 2012: Sent apologies - notified to the Chair. May 2013: Sent apologies - Reasons Unknown 15 May 2014: Reasons Unknown

NAME MEETINGS ATTENDED

Meeting Dates Key: (7) 15 May 2013 (8) 05 September 2013

(9) 18 September 2013 (10) 11 December 2013 (11) 05 March 2014 (12) 15 May 2014 (13) 25 September 2014

Enc. 6.1

REGISTER OF GOVERNOR ATTENDANCE

(PUBLIC)

Mrs Alam Zabit Lambeth South c c c c N/A N/A N/A N/A N/A N/A

Sept 2012 - Hospital Appointment. May 2012: Sent apologies for absence - Unwell Feb 2012: Sent apologies for absence - Unwell. May 2013: Sent apologies for absence - Unwell Resigned 01 August 2013.

Mr Paul Corben Bromley N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Mr Alan Hall Lewisham N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A c March 2014: Work Conflict

Ms Eniko Benfield Bromley N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A c 15 May 2014: Apologies sent - work commitment

Ms Penny Dale Bromley N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Ms Helen Mencia Nurses and Midwives N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A c c cMarch 2014: Work Conflict 15 May 2014: Absent - Unknown Reason

Ms Anoushka de Almeida-Carragher Bromley N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Mr CV Praveen Medical and Dentistry N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Meeting Dates Key: (7) 15 May 2013 (8) 05 September 2013

(9) 18 September 2013 (10) 11 December 2013 (11) 05 March 2014 (12) 15 May 2014 (13) 25 September 2014

Enc. 6.1

1

Report to: Council of Governors Date of meeting: 10 December 2014 Presented By: Tim Smart, Chief Executive Subject: FOR INFORMATION: Monitor Submission Quarter 2,

2014/2015 Purpose of the Report: To provide the Council of Governors with, for information, the report detailing the Trust’s quarter 2 submission to Monitor. Action required: The Council of Governors is asked to note: The attached report presented and considered by the Board of Directors on

25 September 2014; and

That in line with Monitor’s reporting requirements, the Board approved the declarations for the Q2 Monitor detailed in the report below; and

That the Board authorise the Chair and CEO to sign-off the final submission

and the Governance Statements.

Enc. 5.2

1. Purpose NHS Foundation Trusts are required to make in-year submissions on a quarterly basis during 2014/15 which includes information on its financial performance, statements from the board certifying compliance with specific board statements including the underlying data that informs them where appropriate, any relevant exception reports and results of any governor elections. This report provides the details of the proposed submission to Monitor for the Trust based on results/data in Quarter 2, July-September 2014. 2. Action Required

Board is asked to note and approve the Quarter 2 submission to Monitor. 3. Key implications

Legal: Statutory reporting to Monitor.

Financial: Trust reports financial performance against published plan.

Assurance: The summary and appendices provide assurance that the Trust has met all targets and is compliant with its terms of authorisation.

Clinical: There is no direct impact on clinical issues.

Equality & Diversity: There is no direct impact on E&D.

Performance: Quarterly performance against national targets.

Strategy: Performance against the trust’s annual plan forecasts.

Workforce None.

Estates: There is no direct impact on Estates.

Reputation: Trust’s quarterly results will be published by Monitor.

Other (specify): None.

Report to: Board of Directors Meeting

Date of meeting: 28 October 2014

Subject: Monitor Submission Quarter 2, 2014/2015

Author: Tamara Cowan, Assistant Board Secretary

Presented by: Tim Smart, Chief Executive

Status: For Approval

Enc. 5.2

1. Introduction

The Trust is required to submit quarterly reports to Monitor as part of its in-year reporting. The Trust is also required to submit monthly reports on performance to Monitor pertaining to the Princess Royal University Hospital site and summary monthly financial summaries. 2. Quarter 2 (Q2) – Board Certification

For finance In line with the Board’s deliberations and discussions at the Finance & Performance Committee today and the discussion under agenda item 2.5 it is proposed that the Board approves Not Confirmed to governance statement 1. The Trust has attained a CSRR of 3 in Q2 but it is anticipated that this trend will not continue over the next 12 months because of the significant financial challenges the Trust is currently facing due to the following reasons certified in the Trust’s Annual Plan: Commissioner’s ability to constrain emergency demand within contracted activity

levels or to provide timely additional funding to cover any increase;

The Trust’s ability to recruit sufficient substantive staff to cover the requirements of the increased emergency workload without requiring significant agency and locum staff at increased cost;

Sufficient funding being made available to fulfil the Emergency Recovery Plans

agreed with Commissioners; Other providers quickly and completely repatriating patients who are ready to return

to their local hospital; and Satisfactory resolution of claims submitted to the Trust Development Authority in

respect of outstanding issues resulting from the acquisition of assets and services from the former South London Healthcare Trust.

For governance Given the discussions at Finance & Performance Committee today and the discussion under agenda item 2.6 it is proposed that the Board approves Not Confirmed to governance statement 2. The Trust failed to achieve the following targets and indicators as certified in its Annual Plan 2013-14:

Cancer 62 day wait for first treatment (from urgent GP referral)

18 week admitted referral to treatment targets (RTT)

Emergency Department (ED) – total time in A&E under 4 hours

Exceeding the Clostridium Difficile (C.Diff) threshold

The Trust continues to work hard to achieve these targets and indicators and have developed robust plans to recover the position as detailed in the performance report.

Enc. 5.2

Otherwise It is proposed that the Board approves Confirmed to the governance statement “the board confirms that there are no matters arising in the quarter requiring an exception report to Monitor (per the Risk Assessment Framework page 22, Diagram 6) which have not already been reported.” 3. Capital Expenditure Declaration

Where year-to-date capital expenditure is less than 85% or greater than 115% of levels in the latest annual plan (or any later capital expenditure reforecast) an NHS foundation trust must submit a capital expenditure reforecast for the remainder of the year. This is set out at the bottom of page 22 of the Risk Assessment Framework issued by Monitor April 2014. If the Trust triggered one of these criteria then it is required to complete the worksheet “Capex Reforecast” and sign one and only one of the declarations below.

The Board anticipates that the trust's capital expenditure for the remainder of the financial year will not materially differ from the attached reforecast plan.

The Board cannot make Declaration 1 and has provided relevant details on

documents accompanying this return. The Board is asked to make Declaration 1.

4. Quarter 2 (Q2) – Key Returns

As part of the submission the Board is asked to note the following key returns which will be submitted to Monitor for Q1. Appendix 1: Continuity of Service Risk Rating and Financial Summary Appendix 2: Declarations of risks against healthcare Targets and Indicators

Appendix 3: In Year Governance Statement from the Board Certification Appendix 4: Capex Reforecast

5. Recommendation

It is recommended that the Board: 5.1. Approve the Trust declarations for the Q2 detailed in this report; and

5.2. Authorise GA and TS to sign-off the final submission and the Governance

Statements.

Enc. 5.2

1

Governors’ Membership & Community Engagement Committee Minutes of the meeting held at 14:00 on 10 July 2014 in the Dulwich Committee Room, King’s College Hospital

Members: Andrew McCall (AM) Committee Chair/ Public Governor Fiona Clark (FC) Public Governor Patti Kachidza (PK) Patient Governor Joe Onabaworin (JO) Public Governor Tom Duffy (TD) Patient Governor Penny Dale (PD) Public Governor Stuart Owen (SO) Public Governor Barbara Pattinson (BP1) Public Governor Phidelma Lisowska Public Governor Michael Pedro (MP) Public Governor In attendance: Prof Sir George Alberti (GA) Trust Chair Tamara Cowan (TC) Board Secretary Sally Lingard (SL) Director of Communications Rachel Sugarman (RS) PPI and Membership Manager Jane Walters (JW) Director of Corporate Affairs Jessica Bush (JB) Head of Engagement and Patient Experience Non Owen (NO) Corporate Governance Officer (minutes) Apologies: Christopher Stooke (CS) Non-Executive Director Jan Thomas (JT) Patient Governor Pida Ripley Patient Governor

Item

Subject

Action

14/28 Welcome and apologies Apologies for absence were noted.

14/29 Minutes of the Previous Meeting The minutes of the meeting held on 08 April 2014 were approved as a correct record subject to the following changes: It was noted that Fiona Clark had sent apologies in advance of the

meeting; Item 14/19 Proposed Engagement Plan - Change the wording of bullet 11

to "The Trust has members who do not wish to become governors and are happy with their level of involvement with the Trust. It is important however to keep these members engaged and involved and provide participation opportunities to enable them to engage in a meaningful way”;

Enc. 6.3.1

2

Item Subject Action

Item 14/23 Transport Feeder Group - BP expressed her disappointment at the disbandment of the Transport Feeder Group (TFG) and the following key points were raised and noted: o The TFG was no longer functioning as a governor committee due to

low attendance and a far reaching scope. The decision was approved by the Council of Governors and in recognition the Membership and Community Engagement Committee (MEC) realises the importance of keeping the relationship and links with local community transport forums active and has agreed to bring key items to the Committee; and

o Should MEC find that the weight of transport items for discussion

require a separate focus group it will make the relevant recommendation to the Council.

14/30

Action Tracking Progress made on the action tracker was noted. 08/04/2014 014/20 Governor Elections - TC advised that time restraints

did not allow a videoed Governor Awareness Session (GAS); The GAS on the 05 June 2014 and 04 July 2014 were successful. It was

agreed that Governors represented the Trust very well at both sessions.

14/31 Matters Arising There were no additional matters arising raised for discussion.

14/32 Governors in the Community The Committee noted that this section of the meeting is for governors to provide an overview of their engagement and involvement activities in the community and with members: PD gave a summary of her activities since the last meeting: PD attended the May Bromley Clinical Commissioning Group (CCG) and

separately met with the Chair of Bromley CCG; Attending the Open Day, held at the Princess Royal University Hospital

(PRUH), provided a good opportunity to speak with the public and ask their opinions on membership and engagement;

She has also attended the Foundation Trust Governors Association

(FTGA) New Governor Session at which there was a useful session on community engagement session;

The Committee raised and discussed the following key points:

Enc. 6.3.1

3

Item

Subject

Bromley members and patients are showing a strong interest in local healthcare issues. Accordingly it was suggested information and publications could be supplied to the central library and doctors’ surgeries as they can be to provide a wider audience with publications such as @Kings

Action

The Committee felt it would be worthwhile raising awareness of who the governors are, what they do and the value they add to the governance of the Trust;

o It can be the case that when governors attend local community meetings, they can be seen as a channel for complaints and queries on the Trust which can be clinically related. It is important that the governors relay the correct place for such issues, i.e. Patient Advice and Liaison Services (PALS) or the complaints department.

14/33 Membership Update RS presented the membership update. The Committee noted the membership update and the following key points: There has been a net increase of 38 members this quarter; The demographic of members for King’s is similar to other foundation

trusts with 62% of members in the 40-74 age range; The split between constituencies of the new members recruited are 41%

Bromley, 25% Lambeth and 22% Southwark; The ageing population has an impact on the attrition rates for membership

as older members die and this trend is expected to continue over the next 3-5 years;

With healthy membership numbers, recent activity has focussed on how to engage members, give information and become involved in projects which can be mutually beneficial;

Discussions with the Head of Health and Services at Bromley College have created a link in for health talks at the college relating to their curriculum and providing volunteer opportunities on the wards. The ideal is that this would lead to students and others in the college becoming members as well as providing an excellent opportunity for engaging with our local community;

Following the presentation from Richard White of Millwall Football Club at

the meeting in April there has been continued communication to work on partnership opportunities and in particular health promotion for young people;

The Committee were also advised that Richard has extended an invitation

for a tour and attendance at a home game and are asked to contact RS if this is an offer they would like to accept;

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Item Subject Action

The relaunch of the members health talks twice a month has received positive feedback and there are a lot of repeat attendees to the sessions. The differing topics being introduced have proved popular;

The Committee were asked to note the engagement activities update and the following key points were raised: Members have been undertaking surveys with elderly patients to assist

with the Friends and Family Test and How are we doing response rates; Some members are also undergoing dementia training to help gather

patient experience feedback on the elderly care wards; The Members Reader Group, currently made up of three Governors, is

ongoing with a virtual test of a pharmacy leaflet already completed Video Stories are being reviewed and realigned to specific projects so

that there can be a specific impact to improve patient experience; and

Re Stakeholder Events – The Committee was advised of a correction to the ‘other information’ column, to read ‘Over 100 Stakeholders attended these events’. SL advised that the last event was extremely valuable and these are due to continue 6 monthly going forward.

14/34

Learning from other organisations: National Council for Voluntary Organisations The Committee welcomed Hannah Kowszun (HK), Marketing and Membership Manager at the National Council for Voluntary Organisations (NCVO). HK giving background on NCVO and highlighting that NCVO works with over 11,000 member organisations and whilst the focus is for a different delivery to organisations rather than individuals it is good to get an external view and a fresh perspective. HK outlined and discussed six key questions to look at for membership strategies: What is the niche; What do people want; What is your value; How much is it worth; Are we ready to start selling; and How much will we invest. HK reflected and applied this strategy to King’s and raised the following key observations and points: King’s has a potential niche due to the fact it is one of the largest teaching

hospital, which gives the sense that King’s are nurturing future health experts for the area;

Item Subject Action

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HK has attended King’s trauma ward and identifies it as one of the best in her opinion. HK suggested a link through other people’s experiences to engage with members by identifying a category of ‘friends of/ thank you’ for people who have used/ experienced the services;

The importance of communicating with members is well known but should also be about communicating results and actions, continuing the stories and therefore making the listening sincere;

HK observed the tweets with replies and thanks from the Trust and

identified this as a positive; A badge for members was suggested to recognise them as part of the

Trust. The committee agreed and felt that this was a very strong idea, expanding on this and suggesting categories of badges for members for ‘gold/silver/bronze’ members;

The Trust’s membership database has a lot of information which can be

used to look for marketing opportunities;

14/35 Members Survey RS presented the draft Members Survey and welcomed feedback from the committee on the content and the following key points were raised: This will be the first members survey for seven years; The survey will gather information form members on a range of issues

from how they are currently involved with the trust to how they would like us to communicate with them;

The survey content was agreed by the committee subject to the following suggested changes: o Use the term ‘King’s’ throughout and be uniform with this; o Make the questions a little less wordy where possible; and o The survey should be a little more user friendly with colour and

pictures where possible, but mindful to the expense of this

RS

14/36 Summer Elections Update TC provided a verbal update on the elections. The committee noted the following key points: Nominations for elections closed on 09 July 2014 and the Foundation

Trust Office (FTO) will now pull together and publish the attendance of the existing governors who are standing for re-election;

The voting packs will be dispatched on 24 July 2014 with publications to

go out over the summer period; Results will be published on 15 September 2014 and will lead to a

shadowing and induction period for newly elected governors; and

Item Subject Action

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There have been more nominations that in previous elections which is very encouraging and a testament to the hard work of Tooba Ahmadi in the FT Office.

14/37 Planning for the Annual Members Meeting TC provided a verbal update on the Annual Members Meeting (AMM) and the following key points were noted: The AMM will be held on 25 September 2014 and is being organised by

the FTO, communications and patient and public involvement and membership teams;

The event is being held in the ORTUS, Learning and Events Centre, on the South London and Maudsley site;

Information stands will cover subjects such as fundraising and the helipad

appeal, membership and meet your governors, volunteers and one year on following the acquisition of the PRUH;

Health checks offered will be for blood pressure, blood sugar levels and

lung capacity; The formal meeting will have presentations from Simon Taylor on the

Annual Report and Accounts, Tim Smart providing a review of the year and next steps for the Trust and Nicky Hayes providing a summary of governor activity for the year;

The Michael Parker Inclusion Awards will be presented at the end of the

formal meeting; Breakout sessions are yet to be confirmed but subjects suggested are

liver, respiratory, orthopaedics, ophthalmology and dental; The planning will involve ensuring there is good signage for the event and

a detailed map will be produced for the invitation to members; and The initial promotion and invitation to the AMM will coincide with the

circulation of the members’ survey.

14/38 @King’s: Governor Contribution and Feedback SL provided a verbal update on the preparation for the Autumn edition of the @Kings content. The following key points were noted: The planning is in early stages and so any suggestions are be welcome

by contacting the communications team. The content will be firmed up by August;

The circulation of @Kings can be analysed when it is sent out via email to see who has opened, read and selected the link; and

Requested additions to @Kings included: o A governor contact section and also a feature following the

elections as to who the new governors are and farewell stories from those who will be leaving the Council of Governors;

o Feedback from the members survey;

SL

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Item Subject Action

14/39 Possible Links with GP Surgeries Due to timing and the transport issues yet to be covered, this item was moved into any other business.

14/40

Disbandment of the Transport Feeder Group Further the discussion at the opening of the meeting the Committee discussed the disbandment of the Transport Feeder Group (TFG) further and the following key points were raised and discussed: The TFG does continue to meet but is no longer a formal sub committee

of the Council of Governors (CoG). It is now independent of the trust;

The Trust is in contact with Alex Blacknell, the Chair from the TFG who will be able to attend/ send a representative to MEC in order to pass on any points for discussion and BP volunteered attendance at the TFG meetings;

It was noted there are no Trust staff who attend the TFG; It was agreed that:

SL is happy for one of her team members to attend the TFG meetings to represent King’s but not in order to service the committee; and

Transport matters will be a standing item on the agenda and will be monitored. If the committee feels strongly enough that there is not enough opportunity to discuss these issues, then this will be reviewed.

SL NO

14/41 Extension of Boris bikes to Camberwell and the hospital The committee were advised that there are funds available and strategy for Boris bikes to be possibly introduced into the area and the committee raised and discussed the following:

Alex Blacknell from the TFG was keen for a champion. SL agreed that this was important from King’s;

Concerns were raised over safety, particularly the need to promote the

use of cycle helmets

SL

14/42 Any Other Business Open Day SL thanked governors for their contribution and support for the Open Day. The committee agreed that the day was very successful with lots of positive feedback of enjoyment from attendees. It was agreed that it was the right decision to hold the event at the Princess Royal University Hospital (PRUH);

Item Subject Action

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Item 2.3.3 - Possible Links with GP Surgeries This item has been deferred until the following meeting and there should also be a slight change to the agenda layout as this item has been deferred previously.

NO

14/43 Date of Next Meeting Thursday 09 October 2014, 14:00-16:00 – Dulwich Room, Hambleden Wing, Kings College Hospital, Denmark Hill

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King’s College Hospital Governors’ Strategy Committee

Minutes of the meeting of the Governors’ Strategy Committee held at 11.00 on Friday, 31 July 2014 in the Dulwich Committee Room, King’s College Hospital, Denmark Hill. Members: Tom Duffy (TD) Patient Governor/ Acting Committee Chair Richard Gibbs (RG) Stakeholder Governor Nanda Ratnavel (NR) Public Governor Michelle Pearce (MP) Public Governor Jim Gunner (JG) Stakeholder Governor Richard Gibbs (RG) Stakeholder Governor Penny Dale (PD) Public Governor Pida Ripley (PR) Patient Governor Joe Onabaworin (JO) Public Governor In attendance:

Prof. Sir George Alberti (GA) Trust Chair Tim Smart (TS) Chief Executive Jane Walters (JW) Director of Corporate Affairs Sue Slipman (SS) David Dawson(DD) dialled in Jill Solly (JS) Joe Farrington-Douglas (JFD)

Non-Executive Director Deputy Director of Strategy Head of Primary/Secondary Care Interface Senior Strategy Advisor

Laura Gillam (LG) Strategy Analyst John Hampton (JH) Transformation and Integration Director

Colin Sweeney (CS) Director of ICT Non Owen (NO) Corporate Governance Officer (Minutes) Apologies:

Chris North (CN) Public Governor (Committee Chair) Phidelma Lisowska (PL) Stakeholder Governor Graham Meek (GM) Non-Executive Director Item

Subject Action

014/29 Apologies Apologies for absence were noted.

014/30 Minutes of Previous Meetings – 10/04/2014 and 20/06/2014 The minutes of the meeting held on 10/0/2014 were approved as a correct record subject to following change: JG was in attendance. The minutes of the meeting held on 20/06/2014 were approved as a correct record.

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Item Subject

Action

014/31 Matters Arising/ Action Tracker The action tracker was noted.

014/32 5 Year Strategy Update and Strategic Matrix Q1 Members of the committee were thanked for their contribution to the 5-year strategy and the following key points were raised and noted: Formal feedback is expected in October 2014;

Feedback will advise if the content of the strategy is robust enough and will

be an opportunity for Monitor to point out any system issues;

Together with the 5-year strategy, the Trust has produced a 4 page summary document intended to be in the language of staff and wider stakeholders;

The 4 page summary will be taken to the joint Board of Directors and Council of Governors later in the day for approval before publishing;

The committee noted the South East London (SEL) Commission Strategy programme which details the 5-year strategy for South East London developed in partnership with local authorities, local providers, and local people led by clinicians.

The committee noted the draft strategic matrix for Q1 which has been reviewed following the requirement to submit the Trust strategy and the following key points were raised and noted: The matrix has gone out to divisional managers for input. Divisions have

been very co-operative with this process;

The matrix has changed to cover the 8 key objectives identified during the process for the 5-year strategy. The matrix is still in draft but includes the headlines;

The Trust is proceeding with the formation of the vascular surgery capability

on site at Denmark Hill (DH). NHS London are aware of this and are concerned foremost with the accessibility of 24 hour care, whether this happens at King’s or Guy’s and St Thomas’ (GSTT);

Discussions amongst the Kings Health Partners (KHP) board are ongoing

and Governors will be advised of developments; and

There was concern raised that tensions in the relationships within KHP might have an effect on the cancer, cardiac and children departments (3C’s) infrastructure and how the services work.

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Item Subject Action

014/33 Strategic Issues Q1 The committee noted the key strategic issues for the Trust in Q1 and the following key points were raised and noted: Specialist services account for approximately 14% of the total NHS budget

and are currently experiencing overspend of £850m. NHS England (NHSE) are commissioning a specialised task force in order to make some immediate improvements to the way in which it commissions specialised services, and to put commissioning arrangements on a stronger footing for the longer-term;

Areas of engagement identified at a NHSE event include capping volumes, reshaping supply, pausing the commissioning of services, managing demand and more investment into clinical trials;

NHSE are scheduled to make a decision in October and this will be very

important in terms of the Trust’s strategy and so the outcome will be monitored;

On the matrix as a political and policy issue, the Dalton Review has looked

into buddying and chains with different models for providers and ways for poorly performing providers to buddy up with those who are successful;

The report by the Nuffield Trust provides detail on a number of issues such

as levels of savings falling and becoming temporary or one offs and acute spending rising more quickly;

One of the Trust-wide transformational projects is around theatre productivity

and there will be an internal Trust target to get theatre productivity up to 85%; and

7-day working is a work stream covered in the 5-year strategy. The

committee requested that this feature as an agenda item for further discussion.

014/34

Transformation and Integration Programme The committee noted the Transformation and Integration Programme update and the following key points were raised and noted: John Hampton (JH) introduced himself to the committee in his capacity of

Director of Transition and Integration; The Trust has a circa £53m target to achieve through Cost Improvement

Programmes (CIPs). For this to be achieved there is focus on: o Transformational CIPs which are Trust wide issues such as medical

productivity, nursing productivity and length of stay and looking at how to deliver saving schemes across divisions/departments;

o Revisiting and redefining objectives which have previously been set and establishing clearer goals. These will be fed to the Integration Steering Group for approval at the end of August;

o Divisional CIPS which aim to focus ownership of targets through meetings with divisional managers;

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Item Subject Action

CIP targets are set against the difficult backdrop of the negative run rate and is very challenging as the Trust is already a third of the way through the financial year; and

Work is being done on engagement and goals so that budgets can be

communicated throughout the Trust and staff are clear on the financial position.

014/35

Information and Communications Technology Strategy Colin Sweeney (CS), Director of Information Communications Technology (ICT), provided a verbal update on the Information and Communications Technology Strategy and the following key points were noted: The ICT strategy was included as part of the 5-year strategic document

which has been submitted to Monitor; The vision for ICT remains to strive for safer, faster and efficient systems and

driving towards being a paperless hospital; The acquisition of a new site with its own systems has brought a level of

challenge and work has been focussed on integrating and linking the systems;

The Electronic Patient Record (EPR) system for the Trust has been in place

since 1999 and it has become apparent that the old technology is struggling to cope with the extra demands of the Trust;

The Trust is therefore researching new systems available to the Trust which

come with varying levels of expense. Consideration will be given to the financial situation of the Trust and also where possible, where a solution could be integrated with the Trusts neighbours to promote the best patient experience;

Methods of communication are being trialled and NHS Mail was recently

externally tested but revealed that patient information is sent to a server in Germany for a matter of seconds but is therefore not suitable;

Kings still works with a different EPR system in the A&E department due to

differing elements of functionality however the Trust is looking for a single solution;

It was noted that the Value Based Healthcare project on Endocarditis had

shown the capacity of the EPR as a basis for research and the IT and Finance staff have shown great skill and adaptability in interrogating the database to undertake this research

Data sharing between organisations is an important but complicated aspect

and so there is likely to be no solution in the short term; and The decision of IT priorities is made at the Information Steering Group, at

which there are executive members. A proposal to look at EPR replacement will be taken to the King’s Executives meeting on 04 August for consideration.

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Item Subject Action

014/34 Any Other Business There were no other items of business raised for discussion.

014/35 Date of next meeting: Thursday 30 October 12:00-14:00 in the Dulwich Room.

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Governors’ Patient Experience & Safety Committee Minutes of the meeting held at 9.30am on 31 July 2014 in the Dulwich Committee Room, King’s College Hospital Members:

Tom Duffy (TD) Patient Governor/ Committee Chair Michelle Pearce (MP) Public Governor Stuart Owen (SO) Public Governor Nicky Hayes (NH) Staff Governor Pida Ripley (PR) Patient Governor Joe Onabaworin (JO) Public Governor Penny Dale (PD) Public Governor In attendance:

Prof Sir George Alberti (GA) Trust Chair/ Non-Executive Director Jane Walters (JW) Director of Corporate Affairs & Trust Secretary Judith Seddon (JS) Associate Director of Governance Jessica Bush (JB) Head of Public & Patient Involvement Jenny Steel (JS2) Organisational Development Manager Briony Sloper (BS) Deputy Divisional Manager TEAM Emma Hough (EH) Trust GP Lead Richard Lloyd-Booth (RLB) Assistant Director of Nursing Stephen Harding (SH) Pathology Development & Liaison Manager Tooba Ahmadi (TA) Corporate Governance Officer (minutes) Apologies:

Patti Kachidza (PK) Patient Governor Derek Cookson (DC) Patient Governor Chris North (CN) Public Governor Carolyn Campbell-Cole (CC) Staff Governor Phyllis Barnett (PB) Staff Governor Jan Thomas (JT) Patient Governor Faith Boardman (FB) Non-Executive Director Marc Meryon (MM1) Non-Executive Director Sue Slipman (SS) Non-Executive Director Item Subject Action

014/13 Welcome and apologies

Apologies for absence were noted.

014/14 Minutes of the meeting held on 31 July 2014

The minutes were accepted as a correct record of the last meeting.

014/15 Action Tracker

The Committee noted the progress on the action tracker and the following comments.

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Item Subject Action

04/07/2013, 013/34, Mock CQC – The Committee agreed to cancel inviting the Trust’s new CQC Relation Manager.

11/02/2014, 014/04, Pharmacy – The Committee noted the update note from Zabina Ratansi, Divisional Manager, Critical Care, Theatres & Diagnostics on Pharmacy and Phlebotomy

014/16 Matters Arising

The following matters were raised:

Add PR and PD to the membership of the Committee; and

PR voiced concern over full day of meetings arranged for Governors. GA explained that the schedule of ‘Governor Meetings’ mirrors that of Board meetings. This was arranged at the request of the Council of Governors and the only addition to the Governor meeting ‘days’ is the Go See visits. This was added to ensure sufficient Governors are present to take part in the Go Sees.

FOR REPORT/DISCUSSION

014/17 King’s in Conversation Feedback

Kirsten Nelson and Jenny Steel presented summary feedback on King’s in Conversation (KiC) events and how it compared with the ‘cultural survey’ results. The following key points were highlighted:

KiC was launched as part of the Trust’s response to the Francis Report;

KiC listening events were held on Denmark Hill site from May to October 2013 and listening events commenced at Bromley sites in mid-November. In all KiC listening events patients and staff were ask three questions;

Cultural survey was carried out with the aim to create a culture shared by all staff across all Trust sites. To supplement the survey data a series of workshops were also run to capture qualitative information. Over 1500 staff completed the survey and 60 attended the workshops;

Based on the results of both KiC and cultural survey, a detailed action plan was developed to target improvement opportunities in three priority areas:

Doctors, Nurses and Managers working effectively together

Promoting positive behaviours and performance

Empowering staff to take confident decisions

Some of the key concerns that have been highlighted in the staff survey include staff shortage especially at the PRUH, availability of medical equipment and resources, dementia and management of older people;

A number of initiatives have been put in place to address the issues and concerns raised in the feedbacks from KiC and cultural survey. These include increase in availability of Patient Advise Liaison Service (PALS), continuous recruitment drives, promoting staff confidence and positive behaviour in delivering care;

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Item Subject Action

Work is also underway to improve on waiting times in A&E, discharge process, ward leadership, communication, medical records, cleanliness and outpatient services. These changes are being managed by the ‘All Together Better’ programme; and

It was highlighted that the Trust is engaging across all its sites to implement the cultural integration plan, which identifies best elements of the systems and processes from different sites and embed it across the enlarged organisation.

The Committee commended the initiatives and noted that cultural integration not an over-night change. Progress in implementation of the plan and improvements will be revisited early next year.

014/18 A&E and Urgent Care Briony Sloper, Deputy Divisional Manager TEAM and Emma Hough, Trust GP Lead reported on the initiatives to integrate and differentiate emergency department (ED) and urgent care. The main aim is to help reduce ED attendances. The following key points were highlighted:

A streaming nurse and a PALs Officer have been located in ED to bypass patients and re-directed them to appropriate GP or primary care team;

Due to the challenge coming from the public a security guard has also been put in place and staff are advised not put themselves at risk;

Most patients attending ED are treated but resources have been put in place to educate patients to avoid attendances to ED;

An integrated model have been adopted where local GPs, youth workers and social workers have been commissioned by the Trust to work during early morning and night shifts;

The Integrated Care Centre sees about 2000 patients a month and there are very small numbers of breaches. This is the most cost effective model, which is being explored nationally and work is underway to commission integrated workings in South East London;

A general note of demographic of ED attendances showed about 80% of patients were from Lambeth and Southwark of whom approximately 25% could have been managed at primary care centres or by GPs. Most Stroke and Major Trauma attendances were out of catchment area and very low percentages were tourists. There is a scorecard which is discussed with GPs on regular basis; and

Paediatrics is key issue for the Trust due to lack of information and family network for young parents. Paediatric patients are not streamed and there is a dedicated GP to see these patients.

The Committee noted the update and commended the initiatives. Further educational programme campaigns to educate patients and young parents were suggested.

014/19 Commit to Care Initiative Richard Lloyd-Booth (RLB), Assistant Director of Nursing presented the ‘Commit to Care’ (C2C) initiative to the Committee. The following key points were noted:

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Item Subject Action

C2C is a ward to board assurance framework, which accredits wards against quality, safety and experience metrics. It was developed in response to the CQC inspection at the PRUH in December 2013;

C2C triangulates best practice, NICE guidance, Kings Policies and CQC/NHSLA standards. It looks at 14 key performance indicators (KPIs), which include patient observation, medication, standard of documentation, discharge processes, leadership and communication;

C2C is a peer review audit, which looks at documentary evidence, observations and interviews. Wards are RAG rated ‘White wards’, ‘Bronze wards’, ‘Sliver wards’ and ‘Gold wards’;

In the first phase of the C2C initiative all general inpatient areas were audited and 4 Gold, 6 Sliver, 8 Bronze and 2 White wards were identified;

In the second phase all specialist inpatient areas, critical care & theatres, pediatrics, outpatients and ED were reviewed;

The Committee noted the PRUH ward performances across various indicators in the ‘Divisional C2C Dashboard’. It was highlighted that all the ‘yellow’ wards are re-assessed and there is an extensive action plan behind every indicator;

Overall performance in privacy & dignity indicators were good. Leadership and infection control showed an average performance. Communication required some improvement whilst nutrition is an area of concern;

It was highlighted that ward dashboards with information about various indictor performance is visible to all patients;

A patient board will also be displayed above every patient bed with information about the named nurse, doctor and patient risks; and

In the third phase the C2C initiative will be rolled out at DH site.

The Committee commended the initiative and welcomed the visibility of the dashboards to patients.

014/20 Phlebotomy Update Stephen Harding, Pathology Development & Liaison Manager provided an updated on phlebotomy service. The following key points were noted:

Phlebotomy is outsourced to Viapath, the Trust’s pathology provider (formerly GSTS), who also supplies pathology and phlebotomy at Dulwich site;

There has been a lot of refurbishment and reconfiguration work done in the phlebotomy since last year;

The environment looks much better now and the waiting times had been reduced from 60 minutes to 20 minutes;

Recently, Phlebotomy has had staff vacancies in the department and the waiting times have gone up since;

The Trust together with Viapath are looking at flexible staffing and recruitment of substantive staff to improve the service further;

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Item Subject Action

Some issues of cleanliness were identified and mitigating actions were implemented. Recent audit has shown significant improvement in cleanliness;

The Trust is continuing to work closely with Viapath to monitor the service and monthly reporting and regular inspection of cleanliness is being carried out;

Going forward the Trust is negotiating to increase the number of

phlebotomists to ensure waiting times are improved further; and

The use of volunteers at the Phlebotomy reception window to meet and greet patients will continue.

The Committee noted that update and highlighted that the turnaround times for the analysis of results require improvement and additional investment.

014/21 Dignity Project NH reported on ‘Delivering Dignity’ project which has now been launched across all the Trust sites. The following key points were noted:

Dignity project encourages staff to enhance dignified and compassionate care for older people with dementia in hospital;

Training is provided to staff by Age Exchange, the leading UK charity working in the field of reminiscence;

All grades of staff including the volunteers are provided with training and to date about 45 staff have completed their training;

Resources for wards including activity boxes have been developed to ensure wards are supported and dignity champions are sustained; and

A Dissemination Event will be organised for 04 December 2014 to showcase the work of various wards on delivering dignity.

014/22 Patient Experience Account SO presented a letter of apology from a Clinical Director for the South East London Breast Screening Programme, based at the Trust. The letter had highlighted the incident of sending the patient’s screening results to a wrong recipient inadvertently.

The patient had raised concerns in relation to the incident and the layout of the letter. The patient did not consider the letter of apology as it had a pre-printed signature, did not have the Trust’s standard letter head/logo and did not contain an address line from the sender.

JS highlighted that this is a national issue as the screening systems and processes are manual. The Trust has informed the Commissioners and the Trust’s Calidcot Guardian, Will Bernal. The incident has also been raised as Serious Incident (SI) and recorded on the Trust’s risk register.

The incident has been fully investigated and a number of changes have been put in place to ensure letters are sent to the right recipient and GP’s details are more visible.

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Item Subject Action

FOR INFORMATION

014/23 Governor Involvement Update The Committee noted the continuing opportunities for Governor involvement.

014/24 Trust Performance Report – Month 2

The Committee received and noted the month 2 Performance Report.

014/25 Trust Patient Experience Report

The Committee received and noted the Patient Experience Report

014/26 AOB

There were no matters of any other business raised for discussion.

014/27 Date of next meeting: Thursday 30 October 9:30-11:30 in the Dulwich Committee Room

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