Key: FE: For Endorsement; FA: For Approval; FR: For Report; FI: For Information

AGENDA Meeting Public Board of Directors Time of meeting 09:30-12:40 Date of meeting Wednesday, 02 November 2016 Meeting Room Dulwich Room, Hambleden Wing Site Denmark Hill site

Encl. Lead Time

1. STANDING ITEMS Chair 09:30

1.1. Apologies 1.2. Declarations of Interest 1.3. Chair’s Action 1.4. Minutes of Previous Meeting – 05 October 2016 FA Enc. 1.4 1.5. Action Tracker & Matters Arising FE Enc. 1.5

2. Chief Executive’s Report FR Enc. 2 N Moberly 09:35

3. TOP PRODUCTIVITY 3.1. Performance Report (Month 06) FE Enc. 3.1 J Farrell 09:55

4. SKILLED, CAN DO TEAMS 4.1. Monthly Nurse Staffing Levels Report FE Enc. 4.1 S Dolan 10:15 4.2. Doctors Revalidation Report FI Enc. 4.2 J Wendon 10:25 4.3. Overview of Trust Planned Restructure FA Enc. 4.3 D Brodrick 10:40

5. FIRM FOUNDATIONS Sound Finances

5.1. Finance Report (Month 06) FE Enc. 5.1 C Gentile 11:00

5.2. Finance & Performance Committee Chair Update FI Enc. 5.2 C Stooke 11:20

Rigorous Governance

5.3. Council of Governors Report FI Verbal C North 11:25 6. BEST QUALITY OF CARE 6.1. Quarterly Patient Safety Report FE Enc. 6.1 J Wendon 11:35 6.2. Quality & Governance Committee Chair Update FR Enc. 6.2 G Mufti 11:50 6.3. Patient Story – Libby’s Story FR Enc. 6.3 E Bainbridge/

V Sweeney 12:00

FOR INFORMATION 6.4. Chair & Non-Executive Directors Activities FI Enc. 6.4 Chair 12:25

6.5. Board Committee Minutes FI 6.5.1. Finance & Performance Committee – 26/09/2016 Enc. 6.5.1 Chair 12:30

7. ANY OTHER BUSINESS Chair 12:35

8. DATE OF NEXT MEETING

Wednesday,06 December 2016, 09:30 Denmark Hill site

Members:

Lord Kerslake (BK) Trust Chair

Sue Slipman (SS) Non-Executive Director, Vice Chair

Christopher Stooke (CS) Non-Executive Director

Faith Boardman (FB) Non-Executive Director

Prof. Ghulam Mufti (GM) Non-Executive Director

Prof. Jonathan Cohen (JC) Non-Executive Director

Erik Nordkamp (EN) Non-Executive Director

Nick Moberly (NM) Chief Executive Officer

Jane Bond (JB1) – Non-voting Director Director of Capital, Estates and Facilities

Dawn Brodrick (DB) Director of Workforce Development

Shelley Dolan (SD) Director of Nursing & Midwifery and DIPC

Colin Gentile (CG) Chief Financial Officer

Lisa Hollins (LH) Director of Transformation and ICT

Toby Lambert (TB) – Non-voting Director Interim Director of Strategic Development

Prof. Julia Wendon (JW) Medical Director

Attendees:

Tamara Cowan (TC) Board Secretary (Minutes)

Chris North (CN) Lead Governor

Elizabeth Bainbridge (EB) Patient’s Relative – Patient Story

Vanessa Sweeney (VS) Head of Nursing – Patient Story

Apologies:

Dr Alix Pryde (AP) Non-Executive Director

Trudi Kemp (TK) – Non-voting Director Director of Strategic Development

Circulation List:

Board of Directors & Attendees

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King’s College Hospital NHS Foundation Trust Board of Directors - PUBLIC Minutes of the Meeting of the Board of Directors held at 11:15, 05 October 2016 in the Large Hall, 4th Floor, Bromley Central Library Members: Lord Kerslake (BK) Trust Chair Chris Stooke (CS) Non-Executive Director Faith Boardman (FB) Non-Executive Director Prof. Ghulam Mufti (GM1) Non-Executive Director Prof. Jonathon Cohen (JC) Non-Executive Director Dr Alix Pryde (AP) Non-Executive Director Erik Nordkamp (EN) Non-Executive Director Nick Moberly (NM) Chief Executive Officer Jane Bond (JB1) Director of Capital Estates & Facilites Dawn Brodrick (DB) Director of Workforce Development Jane Farrell (JF) Chief Operating Officer Colin Gentile (CG) Chief Financial Officer Lisa Hollins (LH) Director of Transformation & ICT Toby Lambert (TL) – Non-voting Director Interim Director of Strategic Development (part) Judith Seddon (JS) – Non-voting Director Acting Director of Corporate Affairs Julia Wendon (JW) Medical Director In attendance: Tamara Cowan (TC) Board Secretary (Minutes) Paula Townsend (PT) Deputy Director of Nursing & Midwifery Brian Holland (BH) Patient (item 16/100.1 only) Jessica Bush (JB2) Head of Engagement & Patient Experience Robert Kettell Department of Health Various Governors (Patient, Public, Staff Constituencies) Apologies: Sue Slipman (SS) Non-Executive Director, Vice Chair Trudi Kemp (TK) – Non-voting Director Director of Strategic Development

Item Subject Action

16/96 Apologies Apologies for absence were noted. The Board also welcomed new directors on the Board, Jane Bond - Director of Capital Estates & Facilities, Shelley Dolan – Director of Nursing & Midwifery and Lisa Hollins – Director of Transformation & ICT.

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Item Subject Action

16/97 Declarations of Interest There were no declarations on interest made at the meeting.

16/98 Minutes of the previous meeting The minutes of the meeting held on 09 September 2016 were approved as a correct record subject to showing Chris North in attendance.

16/99 Matters Arising/Action Tracking The action tracker was noted.

16/100 BEST QUALITY OF CARE

16/100.1 Patient Story The Board welcomed patient Brian Holland and Jessica Bush, Head of Engagement and Patient Experience. Mr Holland outlined the contents of his presentation highlighting the challenges he has come across in communicating with the Trust and made the following salient points: The Trust’s communications pertaining to referrals and follow-up with patients

are somewhat protracted and nonsensical;

Since attending a consultation on 23 August the appointment to fit a small split is still awaited and in chase correspondence with the Trust has been unhelpful;

The Trust’s telephone answering system is not intuitive and is too long. It took 2

minutes and 20 seconds to traverse the system to no end;

Eventually when you get through to someone the approach is terse and again unhelpful;

The individuals named in the presentation are to be congratulated because they

provided a level of support and engagement over and above previous experiences;

Ways to improve the telephone message is included in the presentation; and

The following points were raised in discussion: Mr Holland’s points are highly pertinent and reflect the issues the Board have

been discussing and his points are well taken.

The Trust recognise the need for change and JW will follow-up and chase Mr Holland’s appointment letter;

The hospital must do better and outpatients services is a feature of the Trust’s

transformation programme but some interim work around telephone systems can be conducted in the short term;

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Item Subject Action

As part of the transformation programme the Trust will be working with a group of patients to ensure key changes are made with the patients at the forefront;

Bottlenecks are created in the system in the appointments process especially

when staff are away;

Other health professionals calling into the Trust also find it challenging, there should be a more tailored phone message; and

The Trust’s paediatric service at the Princess Royal University Hospital (PRUH)

site has a very effective system which means a patient does not leave before being issued with their next appointment. The Trust should use this system as a model for the rest of the Trust’s outpatient services.

16/100.2 Quarterly Patient Experience Report The Board received the quarterly patient experience report. The following key points were reported: In patient performance has remained static;

Outpatient services performance is very challenged with key issues being staff

attitudes, correspondence and appointment systems;

There is a clear rise in the number of complaints about outpatients; and

Response to complaints has dropped off to 45% with liver and surgery areas struggling the most.

The following points were raised in discussion: Complaints could be an area of quick wins and SD has some ideas of how to

tackle the response times;

The Patient Advice Liaison Service (PALS) does triage a lot of issues but a lot of patients still want to progress through the complaints route;

The issues with outpatients and complaints are to be treated separately; and

The new structure will facilitate better cohesion of the outpatient services. The Board agreed that they would receive a report on plans to improve patients’ outpatient experience and complaints performance.

SD

16/100.3 Care Quality Commission (CQC) Update The Board received and discussed the latest version of the CQC actions list. The following key points were reported: The CQC recently contacted the Trust and requested an updated copy of its

action plan in response to the required improvements;

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Item Subject Action

The action plan was presented and discussed by the Quality & Governance Committee which met on 16 September 2016;

The back to basics programme is up and running and will be a very useful tool

to drive continued improvement;

The Trust will be able to demonstrate improvement against the requires improvement actions;

There have services have been relocated such as relocation of liver outpatients,

improving the policies and processes around syringe drivers, maternity unit capacity reviewed and new practices put in place

Level 1 Mental Capacity Act and DoLs is at 90% levels 2-5 is circa 68% so

more work to be done;

Medical records availability has improved to 95%;

The Trust’s emergency department challenges remain a challenge with some areas of improvement but there are wider system drivers and the Trust has plans to improve the emergency pathway as part of the transformation programme;

The Trust has rolled out e-DNACPR trust-wide to address the issues with this

information not being recorded properly;

PT and Judith Seddon met with the CQC following submission the updated action plan and the advised they were not likely to visit before May 2017*; and

The Trust’s ambition is to move out of ‘requires improvement’ and to a good

rating. The Board noted the updated action plan against the requires improvement actions from the CQC and that SD will be progressing works to improve the Trust’s rating. *Shortly following this meeting the Trust was advised that the CQC would visit the Trust on 13 October for a short visit focusing only on the areas included in the action plan.

16/100.4 Quality & Governance Committee Chair Update GM provided an overview from the recent Quality & Governance Committee and the Board noted the summary report of the meeting. The Committee considered the national cancer patient survey and concluded that there cancer pathway called for greater focus given the number areas in the survey which is rated red. The themes from the cancer survey is reflective the Trust has no focus on the services. The Committee also reviewed the in-depth report into the CPE cases in the liver unit and assured that everything that was to be done was being done.

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Item Subject Action

The Committee also flagged its concerns about patient experience in particular the outpatients and friends and family patient feedback. The following key points were raised in discussion: The Trust should look into having a focus cancer group; A way of operationalising the way cancer services is being delivered;

A more holistic approach needs to be taken to deliver the cancer services;

Within the new organisational structure a band 9 position has been created to

focus on cancer deliver;

It is also recognised that the Trust needs to strengthen delivery and operational leadership; and

There is a sense that the cohesion of the service is missing. There needs to be

uniformity.

It was agreed that the Board would receive an update on cancer services and how the points raised about improving experience will be addressed through the new structure.

JW/SD

16/101 Chief Executive's Report The Board received and noted the report from the Chief Executive Officer (CEO). The following key points were reported: The Trust is running with a significant deficit which puts the Trust on the radar

and therefore at risk of being put in financial special measures.

The regulator, NHS Improvement, (NHSI) wants the Trust to make significant financial improvement and close a £30m gap in the financial position;

The Trust is on the brink of transitioning to the new organisational structure;

In the long-term the Trust is working on the clinical transformation programme.

There is lots of work to do but there is a formal programme which the Trust is working hard to achieve; and

There are always some areas of good news.

The following key points were raised in discussion: All providers are required to submit the joint sustainability and transformation

plan (STP) developed jointly with commissioning colleagues and other stakeholders. The Trust is required to sign-off its South East London commitments before the STP is submitted end-October.

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Item Subject Action

There are lots on uncertainty around the process and system leaders need to look at this.

The following key points were raised in discussion: The Trust is also expected to produce a 2-year operational plan by the end of

December and the STP will have to be aligned; The applications for Biomedical Research Centres have been successful which

equates to circa £120m of funding;

The Alex Mowat Paediatric Research Laboratories were opened recently;

Progress is already being made with raising funding for the KHP haematology institute;

The Trust needs to ensure that in developing the STP, 2-year plans and the

transformation programme there is now double/triple counting.

There is also a danger that there will be some under counting as it does not include social care pressures;

The Trust-wide staff survey launches today and the target is to get at least a

50% response rate; and

The outcomes are very much improved.

The Board agreed the following: 1) A summary of the STP would be circulated to board members; and 2) The Board would have a session on the STP and the interdependences

with the Trust’s 2-year plan ahead of the December submission.

16/102 TOP PRODUCTIVITY

16/102.1 Trust Performance Report 2016/17 (Month 05) The Board received and discussed the month 05 performance report which was also considered at meeting of the Finance & Performance Committee held on 26 September 2016. The following key points were reported: The Trust emergency department (ED) performance has moved from 83.5% to

88% which is in excess of the regulatory trajectory. There has been a marginal degradation in the performance at the Princess Royal University Hospital (PRUH) but performance did not drop below 90%;

The Trust, however, need to ensure that this performance is sustainable;

At the Denmark Hill (DH) site all types of performance improved to 87.2%.

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Item Subject Action

The driving force in the performance of the DH ED remains the mismatch in demand and capacity. The plans for ED however will not delivery until the end-quarter four;

The work to increase the bed capacity is underway and on track;

The Trust is 70 cases behind its 52-week breaches so the Trust has exceeded

its trajectory but this is within a highly challenged environment;

The Trust plans to eradicate all non-neurosurgery 52-waiters backlog by end of October;

One of the main challenges for the Trust is meeting cancer screening targets

but the Trust is trying to understand the issue and find a solution;

Performance against diagnostic waits has improved significantly, moving from 6.8% to 1.2% which is near the national trajectory of 1%.

The following key points were raised in discussion: The finance and performance committee recognises the challenge facing the

Trust on not only the finances but also the operational performance challenges; There have been huge improvements in the operational performance but the

Trust recognise that there is circa £15m income opportunity that can be released by improving the utilisation of theatres.

The Trust is developing plans which will identify target and to get the Trust where it needs to be as well as augment the usage of theatres especially for the neurosurgery list;

There are still pockets of blockages getting patients who are medically fit for

discharge to either local district general hospitals or the correct community forum which are using beds needed to treat other patient. The Trust continues to track these issues and the impact on the bed capacity but it is a systemic issue.

16/102.2 Carbon Reduction Update The Board received and noted the annual carbon reduction report. It was also note that the Trust would look into getting censor taps.

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Item Subject Action

16/103 SKILLED, ‘CAN DO’ TEAMS

16/103.1 Monthly Nurse Staffing Levels Report The Board received and noted the monthly nurse and midwifery staffing levels report. The following key points were raised in discussion: The Denmark Hill (DH) site uses more nurses for mental health patients

The difference in the number of red shifts between the (DH) and the Princess

Royal University Hospital (PRUH) may relate to a number of issues such as the differentials of vacancy rates, acuity of patients or simply the reporting;

There is no set benchmark for the optimal level of nurses to be placed on each

ward.

Each ward has a different level of requirement and during any shift may have to respond to staff absences or increase acuity of patients on the wards, making an assessment about what is the safe level of staff required to treat patients. NICE guidelines states that a ward should operate at 95% staffing levels but there is no perfect science.

It was agreed that the Board would receive indicators about the standard optimal level of nurse staffing for each ward.

SD

16/104 FIRM FOUNDATIONS

Sound Finance

16/104.1 Finance Report (Month 05) The Board received and discussed the month 05 finance report which was also considered at a meeting of the Finance & Performance Committee held on 26 September 2016. The following key points were reported: At month 5, the Trust has deficit of £50.8m which is circa £25m adverse against

plan;

Reflected in the sum is the non-receipt of the suitability and transformation fund’;

The Trust continues to focus on cutting cost ;

Cash is high on the Trust’s lists of financial concerns as it has drawn down most

of the working capital facility;

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Item Subject Action

The Trust will have to make some hard decisions about its capital plan programme given that its request for capital distress funding has not yet been approved by NHS England.

The Trust has already undertaken some capital works at risk to increase the bed capacity; and

The Trust is keep NHS Improvement abreast of the financial challenges facing

the Trust. The Board noted that this current position puts the Trust under the microscope and the subject of intense scrutiny therefore it is vital that the Trust manages this position very carefully.

16/104.2 Finance & Performance Committee Chair Update The Board received and noted the report from the Committee Chair. CS advised that the Committee were all too keenly aware of the significance of the financial position but it must be recognised that the current plans have no contingency. The Trust CIPs is not too far behind but given that the Trust will have to continue finding savings year on year this is putting further strain on the Trust. The lack of contingency is also affecting the Trust’s cash position. The Committee also recognised the need to improve its procurement processes, which is now under Interventional Facilities Management, and through these improvements, the Trust can make savings.

Item Subject Action

Rigorous Governance

16/105 Board Assurance Framework The Board received and noted the Board Assurance Framework (BAF) discussed at the quality & Governance Committee on 16 September and the Audit Committee on 22 September. The Board noted the following: Risk 7: Inability to generate sufficient cash to support running of Trust services

has been incorporated into Risk 1.

The rationale for this movement reflects that the generation of sufficient cash is intrinsic to the Trust’s ability to deliver financial sustainability. The corporate risk register also incorporates local risks around the cash generation.

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Item Subject Action

Risk 2: Integrated care initiatives fail to deliver reduced admissions eliminate delayed discharges or improve care outside the hospital net risk has moved from 15 to 20.

This was change with the input of Quality and Governance Committee. The equal rating of both gross and net risk is reflective of the fact that there are inherent risks which despite the Trust’s plans there are external factors which are outside the control. Accordingly, the Trust is excepting of the level of risk; and

All other risks have maintained their risk net rating indicating that the controls

are adequate to manage the risks to the strategic objectives. The Board agreed that: 1) The Board Assurance Framework would be reviewed more frequently and

in conjunction with the risk register; 2) The Trust would look at devising targets for each risk on the BAF; 3) The net rating for risk 1 remains at 20. The Board also noted that CG had taken responsibility for the BAF and has commissioned a review of the process and the format of the report.

16/106 Council of Governors Report The Board received an update on the activities of the Council of Governors from Lead Governor, Chris North. He advised that governors are extremely concerned about the Trust’ financial position especially given a recent article in the HSJ which states that the Trust was one of five hospitals facing increased financial scrutiny. Governors are also concerned about the impact of CIPs decisions and the impact on patient experience especially in outpatients. Governors are also interested in the governance processes around the South East London sustainability and transformation plan (STP) and concerned that this will represent another onerous level of input which will distract other important work. In response to the following points were raised: The Board shares the concern of governors about the financial position. This is

a very high risk position and if the Trust does not get a firm grip on finances as a matter of priority it will face increased regulatory scrutiny. The Trust is working on plans to close a £30m gap in its forecast for 2016/17. The Trust has been very clear about the challenges it is facing and has been very transparent with NHS Improvement;

Whilst there are recognised systemic issues with outpatients processes the

Board is assured by improved quality metrics and outcome data.

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Item Subject Action

The Board is concerned about the outpatients services and the experience of its patients and has discussed ways to improve these services in the short term and as part of the longer-term transformation programme; and

The Board is confident in the governance structure but there is a lot of work to

be done and it is important that the interdependencies are fully understood.

16/107 Confirmed Board Committee Minutes The Board noted and received the confirmed minutes of the Finance & Performance Committee held on 26 June 2016.

16/108 Chair's and Non-Executive Director's (NEDs) Activity Report The Board noted the report on the Chair and NED's activity.

16/109 ANY OTHER BUSINESS

Toby Lambert The Board thanked Toby for his contribution over the last few months as Interim Director of Strategic Development. This is Toby’s last public Board meeting as he leaves the Trust at the end of October.

16/110 DATE OF NEXT MEETING

Wednesday, 02 November 2016, 09:30 Dulwich Room, Hambleden Wing, Denmark Hill.

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Action Status as at: 02/11/2016 1

BOARD OF DIRECTORS (PUBLIC MEETING) ACTION TRACKER

Date Item Action Who Due Update DUE

02/02/2016 16/8.2 Adult Safeguarding Report - It was agreed that the Trust would look at DoLs benchmarking data across the Shelford Group and get some qualitative data about the process being used elsewhere.

SD 06/12/2016

05/10/2016

This report was presented to the Quality & Governance Committee on 25 October 2016 and will be presented to the Board in December

02/02/2016 16/8.3 Children Safeguarding Report - It was agreed that a progress report on the safeguarding training and the implementation of the new system would be presented to the Board in 6 months.

DB/SD 06/12/2016

05/10/2016

This report was presented to the Quality & Governance Committee on 25 October 2016 and will be presented to the Board in December.

06/04/2016 16/33.2 Quarterly Patient Safety Report – The following was agreed: 1) The Board noted that whilst it is reassured people are

not getting complacent and use to the current level of never events the Trust should test out its current position against other hospitals and garner any learning; and

2) The Board also noted and endorsed the commitment from management to improve the position by quarter 3/4.

JW/NM 02/11/2016 See agenda item 6.1

NOT DUE 02/02/2016 16/8.2 Adult Safeguarding Report - It was agreed that the Trust

would look at DoLs benchmarking data across the Shelford Group and get some qualitative data about the process

SD 06/12/2016

05/10/2016

This report was presented to the Quality & Governance Committee on

2

Date Item Action Who Due Update being used elsewhere. 25 October 2016 and will

be presented to the Board in December.

02/02/2016 16/8.3 Children Safeguarding Report - It was agreed that a progress report on the safeguarding training and the implementation of the new system would be presented to the Board in 6 months.

DB/SD 06/12/2016

05/10/2016

This report was presented to the Quality & Governance Committee on 25 October 2016 and will be presented to the Board in December

05/10/2016 16/100.2 Quarterly Patient Experience Report – The Board agreed that they would receive a report on plans to improve patients’ outpatient experience and complaints performance.

SD 06/12/2016

05/10/2016 16/100.4 Quality & Safety Committee Chair Update – The Board agreed to receive an update on cancer services and how the points raised about improving experience will be addressed through the new structure.

JW/SD 06/12/2016

05/10/2016 16/103.1 Monthly Nursing Staffing Levels Report – It was agreed that the Board would receive indicators about the standard optimal level of nursing for each ward.

SD 06/12/2016

COMPLETED 09/09/2016 16/88.1 Trust Performance Report 2016/17 (Month 04) - The

Board agreed that the executive would review the Trust’s recruitment and retention strategy and return to the Board for a full discussion.

DB/NM 02/11/2016 This item was discussed at private board in September.

06/07/2016 16/72.2 Quarterly Patient Safety Report - The following was agreed: 1) The Board would receive an update on structural issues

JW/PT 05/10/2016

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Date Item Action Who Due Update at the PRUH and the correlation to infection control issues; and

2) The Board would receive periodic updates on basic hand hygiene metrics.

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Report To: Board of Directors Date of Meeting: 02 November 2016 By: Nick Moberly, Chief Executive Officer Presented By: Nick Moberly, Chief Executive Officer Subject: Chief Executive’s Board Report OVERVIEW As we end Month 6, the Trust continues to focus on 3 main priorities:

• Managing and recovering our in-year financial position, and developing our plans for FY 17-18 and FY 18-19 as part of the current 2-year planning round.

• Driving towards the implementation of our new organisation structure • Pushing ahead with our clinical transformation programme

MISSION Work continues on all of our priority areas of focus (integrated care, the King’s Health Partners Institute programme, and pathology). The most notable development in-month is that after a period of reflection, the KHP partners have agreed the scope of work needed to complete the Strategic Outline Case for the Cardiovascular Institute. This gives confidence that the Boards of the KHP partner organisations will be able to receive and approve both the Cardiovascular and Haematology Institute SOCs before the end of Q4. Sustainability and Transformation Plans A revised sustainability and transformation plan (STP) was submitted on Friday 21st October. Alongside some revisions to the financials, the STP expands on plans for prevention and mental health, in response to feedback from NHS England and NHS Improvement. Chief executives from SE London will be reviewing the delivery plans for the work streams outlined in the STP on 28th October.

The Committee In Common between the six South East London Clinical Commissioning Group’s (CCG) has delayed its consideration of the location of South East London’s two elective orthopaedic centres to the 29th November. The Joint Health Oversight and Scrutiny Committee has been briefed, and is continuing to consider proposals.

BEST QUALITY OF CARE Outcomes DH and PRUH mortality rates remain in the best performing quartile nationally. We had noted in the data a suggestion of outlier status for readmissions > 75 years and this has resulted in an in depth analysis of case notes which will be analysed / reviewed and actioned with the local commissioners and Quality Assurance and Research Committee. The NELA report and local review shows improvement in some domains. Experience and access

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In September 2016 user satisfaction with maternity services at PRUH was 100%, which is a fantastic result. Inpatient performance continues to be strong but there is work to do in our Emergency Departments (ED) and in our outpatient areas.

The Trust’s performance against key access targets is described in the separate performance report. An overview is provided below:

• Compliance against the 95% 4 hour waits target worsened in Month 6 dropping from 88.18% to 82.01%. The Trust is now below the STF trajectory of 91.40%. ED attendances continue to remain high, and there was a 2.7% increase in patients seen in the ED at Denmark Hill and a 3% increase at PRUH during September compared to August.

• Compliance against the 92% referral to treatment (RTT) incomplete pathway target worsened in Month 6 from 82.20% to 80.79%. The Trust is below the STF trajectory of 83.47%. There were 146 patients waiting 52+ weeks at the end of September, compared with 144 in Month 5 and is better than our trajectory of 184 breaches. The Trust is ahead of trajectory for neuro-specialties but behind trajectory in our non-neuro specialties, in particular for admitted Orthopaedic pathways (32 breaches) and General Surgery (16 breaches).

• The 62-day GP referral for first treatment cancer target of 85% was not achieved in M6 at 82.9%. Cancer targets have been achieved for Q2 with the exception of the 62 day screening target where performance is 88.8% compared to the 90% target with 7.5 reported breaches.

• Diagnostic waits continued to show a significant improvement. The Trust achieved the 1% target with just 0.96% of patients waiting over 6 weeks as at the end of M6. We are continuing the daily rigour on our diagnostic waiting times to ensure compliance against the 1% going forwards. This means that the STF target of 1% has been achieved.

Safety Provisional data for Q2 (Jul-Sep 16) indicates there were 27 Serious Incidents, down from 40 in Q1. There were no ‘Never Events’ reported in Q2. The rate of incident reporting has not changed significantly in 2016 and continues at around approximately 2750 incidents per month (of which less than 0.5% involve significant harm). Care Quality Commission (CQC) On 13 October 2016, Shelley Dolan, our new Chief Nurse and Jane Farrell, Chief Operating Officer were pleased to welcome CQC inspectors to the King’s and Princess Royal Hospital sites respectively. The CQC returned to the Trust to follow up on progress with the action plan we signed up to last year. This involved visiting some clinical areas at both sites including:

• Critical Care • Theatres • Emergency Department (at PRUH) • Maternity • Renal/Endoscopy • Liver Out Patient Department (at Denmark Hill) • Fisk Ward (at Denmark Hill)

This was a great opportunity to showcase our efforts and achievements over the past 12 months. We were able to demonstrate that we have taken their recommendations firmly on board and are working hard to deliver the required improvements.

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Initial feedback from the CQC was positive and we are expecting a report in the next month. The Helipad On Wednesday 26 October, King’s College Hospital opened its helipad. The new helipad will save thousands of lives, helping the hospital serve its trauma population of 4.5 million people across south east London and Kent. Built on top of the hospital’s 10-storey Ruskin Wing, the helipad has been made possible thanks to a multi-million-pound donation from the County Air Ambulance HELP Appeal – the only charity in the country dedicated to funding the construction of hospital helipads. In addition, more than 2,600 patients, staff, and members of the local community generously donated £500,000 to the hospital’s Time is Life Appeal. The new helipad will speed up the time it takes helicopters to transfer critically ill patients to King’s, and reduce ‘landing-to-resus’ transfer times to just five minutes. At present, helicopters land in nearby Ruskin Park and patients are transferred to King’s by road - a process which can take up to 25 minutes. EXCELLENT TEACHING & RESEARCH Research Stroke is a major clinical service in Neurosciences at King’s and is a concern for the whole NHS. It affects many of our populations in inner-London and Bromley areas.

Our efforts to improve and develop new improved care of stroke patients in C21 have been boosted as King’s status as a Hyper-acute Stroke Research Centre (HSRC) has been renewed by the National Specialty Lead for the National Institute for Health Research (NIHR).

Our researchers in the HSRC and their support staff work closely with the Hyper-acute Stroke Units at Denmark Hill and PRUH. They were commended on progress this year. The HSRC review panel were pleased to hear of our close working relationship with Neuroradiology, and happy to hear of staffing developments with a full complement of staff across both sites providing greater stability in general – something that the South London Clinical Research Network (CRN) have assisted with.

The number of patients recruited to clinical trial and studies in stroke has increased – with a concerted effort to increase the number of Bromley patients from the PRUH. The panel of assessors were also impressed by our plans for a future portfolio which will include more complex studies that push forward the boundaries of care. The task the unit has set itself is to continue to grow the high-quality research in this area, and still more firmly place King’s at the forefront of this field.

There have been two important grant awards to King’s:

• Dr Debbie Shawcross has been awarded an NIHR Research for Patient Benefit grant of £260, 000 starting in October 2016. The study will investigate a type of bowel bacteria transplant for patients with liver disease and cirrhosis, and test whether the transplant has an impact on the immune system and subsequent resistance to infection. The study will recruit 32 patients from Kings College Hospital NHS Foundation Trust.

• Dr Sabrina Bajwah has been awarded an NIHR Health Service and Delivery

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Research grant of £119, 000 starting in 2017. This systematic review and meta-analysis will investigate the evidence on whether hospital palliative care teams are useful and provide good value. A synthesis of evidence of studies involving palliative care teams in hospitals and outside hospitals will be reviewed. Patient related outcomes such as pain and anxiety will be also be included in the review. The review aims to identify where the next area of research should focus within the speciality of palliative care.

SKILLED, “CAN DO” TEAMS Organisation restructure

Appointments have now been made for the three Divisional Directors of Nursing, the three Divisional Medical Directors, and four Corporate Medical Director roles. The Trust has just one senior divisional vacancy remaining (Divisional Director of Operations for Urgent and Planned care) which is still out to search. The outcomes of the formal consultation processes for individuals at Tier 2 have now been communicated, with internal post-filling for these roles due to take place in late October and early November. Regular communications are being sent out during the period of post-filling to update staff on appointments as and when they are made. The aim is to transition to the new structure during November 2016. Staff Survey The annual staff survey is now open. Invitations to take part have been sent to all staff, the closing date is 2nd December 2016. We are tracking the number of responses by staff group, site and division during the response period. The results will be available to us in February/March 2017 and will enable us to establish a baseline of staff views that can be fed into our workforce strategy and transformation programme for 2017 onwards. Senior Leaders Event An event for 130 of King’s senior leaders was held at the Kia Oval on Friday 14th October. This was a key opportunity to bring senior leaders together from across the organisation, hear an update from the Chair and CEO, and input into the latest developments across the Trust via a range of breakout sessions led by internal speakers. In the afternoon attendees heard a keynote sessions from NHS Providers giving the national policy context, followed by a panel Q&A session with local STP leads. Feedback from attendees was that they found the day really helpful to get a sense of where the organisation sees itself and an honest view on the challenges and opportunities ahead. It was also a chance for people to connect and hear others’ views and experiences. Further senior leaders briefing sessions are planned for November and December 2016. Recruitment & Retention Large numbers of new starters joined the Trust in both August and September. August is a traditionally busy month with Junior Doctor rotations adding to employees joining through traditional recruitment campaigns. A total of 976 staff joined the Trust in those 2 months alone (563 in August and 413 in September). This was an increase on 2015, which saw 523 and 387 start in those respective months. Newly qualified Nurses joining the Trust in

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September together with International Nurses resulted in 112 Band 5 starters (including 23 undertaking adaptation). This was the highest number of 'Band 5' starters in over 2 years. Significant recruitment campaigns continue with additional International Recruitment in both the Philippines and India for Nurses. The Trust is undertaking International Recruitment of Doctors with a particular emphasis on the Medical Training Initiative (MTI) in December 2016. Recruitment in support of the ED Capacity Expansion Project is underway to enable additional beds to open particularly at Orpington Hospital and in the Ruskin Wing at Denmark Hill. Retention remains an on-going challenge however with voluntary turnover at circa 17%. Medical Workforce Over the past few months we have been able to negotiate and agree with the Local Negotiation Committee (LNC) the Trust’s first Job Planning Policy which will provide guidance and standardisation for medical & dental staff, and management on the job planning process. October saw the first cohort of junior doctors successfully being recruited to the new junior doctor’s contract. This is a difficult time for junior doctors and the Medical Workforce Team have worked closely with junior doctors representatives and the LNC to ensure communication lines are kept open and concerns are dealt with. The Medical Workforce Team has also been working closely with the divisions to decrease agency expenditure on medical locums. Work continues on medical productivity and streamlining junior doctors rotas to maximise efficiency and compliance with the new contract. TOP PRODUCTIVITY Sign off of the delivery plans for the 3 wave 1 clean sheet redesign work streams (bariatrics, emergency and acute medicine and theatres) is expected in the coming 2-3 weeks, with the expectation that all 3 will deliver significant impact in terms of quality, efficiency and operational compliance in FY 17/18. Phase two of the clinical transformation programme is well underway with HPB, Elective Orthopaedics and Radiology completing their first phase of the clean sheet redesign programme. This is the “describe phase” where data is reviewed and areas for change are outlined. Each team have highlighted areas for improvement in their overall pathways and areas where teams could work more efficiently. Kings Way for Wards is progressing well and implementing changes across the five wards. This month has focussed on outlining and scheduling required estates changes to make the wards work as efficiently as possible. Each of the Kings Way work streams were presented at the Senior Leadership Away Day on Friday, 14th October, with very positive feedback and nominations for waves for the programme. A detailed plan for the Trust EPR programme is being developed to review the financial and operational elements required for the roll out of existing functionality to the PRU and other sites. In parallel, planning work continues to produce additional functionality to be built into the Trust EPR. Programme planning with Allscripts functionality will continue to work in line with the support to the Trust’s transformation agenda.

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FIRM FOUNDATIONS Sound Finances At month 6, the Trust is reporting a £59.6m operating deficit; an adverse year-to-date variance of £33.6m against a year-to-date planned deficit of £26m. This position is an in month deficit of £8.7m against a planned in month surplus of £2m.

The month 6 position reflects the recent Sustainability and Transformation Fund (STF) criteria to access the funds determined by NHSI (£30m for KCH). The Trust is not achieving the financial control total and has not accounted for the STF of £15m in M6.

Other key adverse variances at month 6 include the SPV funding relating to transformation programme (£2.5m), Hep C CQUIN (£2m), NHS Clinical Contract activity income (£6.5m), Cost Improvement plans (£4m) and expenditure cost pressures (£3.6m).

The run rate for month 6 was £8.7m (month 5 £9.7m). The Q1 average run rate was a monthly deficit of £10.8m and in Q2 this has reduced to £9.1m.

Compelling Communications New and events can be found on the Trust’s website: https://www.kch.nhs.uk/news. Some noteworthy media coverage and events include: Medium Summary

BBC Two A World Without Down's syndrome?

The BBC documentary looked at Down’s syndrome and the ethics of pregnancy screening.

The programme featured an interview with Kypros Nicolaides, Professor of Fetal Medicine at King’s, who discussed the cell-free DNA test, which he pioneered. He also talked about the screening currently available on the NHS. In the interview, Professor Nicolaides talked about the risks of more invasive testing and how the cell-free DNA test can offer families a more accurate test with fewer risks.

BBC News Mr Naveen Cavale, Consultant Plastic & Reconstructive Surgeon at King’s, was interviewed for a Facebook Live video post on the BBC’s Facebook page.

He talked about the risks involved in having cosmetic surgery with private companies overseas, and the effect it can have on the NHS.

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Medium Summary

Biggin Hill Today

Bromley News Shopper

Orpington MP Jo Johnson welcomed assurances from King’s that the specialist cancer ward at the Princess Royal University Hospital is to remain open.

Mr Johnson said: “Over the last six months I have heard from a number of constituents concerned about the future of the Chartwell Unit. Many of these people described their own experiences of the fantastic patient care that is delivered on the ward.

“I am pleased therefore that King’s chose to conduct a clinical review, and as a result, have taken the decision to secure the future of the Chartwell Unit at the Princess Royal.”

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Report to: Finance and Performance Committee

Date of meeting: 25 October 2016

Subject: Trust Performance Report 2016/17 Month 6

Author(s): Steve Coakley, Acting Assistant Director of Performance &

Contracts

Presented by: Jane Farrell, Chief Operating Officer

Sponsor: Jane Farrell, Chief Operating Officer

History: None

Status: For Information

1. Summary of Report This report provides the details of performance achieved against key national performance and quality indicators, and governance indicators defined in the Monitor Risk Assessment framework for the Q2 position in 2016/17. 2. Action required The Board is asked to approve the M6 performance reported against the governance indicators defined in the Monitor Risk Assessment framework for the Q2 position in 2016/17. 3. Key implications Legal:

Statutory reporting to Monitor and the DoH.

Financial:

Trust reports financial performance against published plan.

Assurance:

The summary report provides assurance that the Trust has met the performance targets as defined within the Monitor Risk Assessment framework (RAF) for the Q2 position with the exception of the A&E 4-hour target, the cancer 62-day screening treatment target, and the RTT incomplete pathway target.

Clinical:

There is no direct impact on clinical issues.

Equality & Diversity:

There is no impact on equality & diversity issues.

Performance:

The summary report demonstrates that the Trust has achieved the performance indicators for the Q2 position as defined in the RAF with the exception of the A&E 4-hour target, the cancer 62-day screening treatment target, and the RTT incomplete pathway target.

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Strategy:

Performance against the Trust’s annual plan forecasts and key objectives.

Workforce:

None.

Estates:

There is no direct impact on Estates.

Reputation:

Trust’s quarterly and monthly results will be published by Monitor and the DoH.

Other:(please specify)

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Key Messages of this Report • Trust performance against the 4-hour target worsened from 88.18% reported in August to

82.01% in September which is below the STF trajectory of 91.40% as agreed with commissioners and NHSI.

• RTT incomplete pathways performance worsened from 82.20% in August to 80.79% in September, and is lower than the STF performance trajectory of 83.47%. There were 146 patients waiting 52+ weeks at the end of September 2016, which is above than the 144 patients waiting at the end of August. There were 99 patients on admitted pathways and 47 patients on non-admitted pathways.

• For the Q2 position, cancer waiting time targets have been achieved with the exception of the cancer 62-day screening treatment target of 90% target at 88.8% with 7.5 breaches. Performance compared to the national 85% target for 62-day GP referrals to treatment is achieving at 85.9% for Q2.

• Diagnostic waiting time performance improved from 1.95% of patients waiting over 6 weeks for tests at the end of August to achieve the national target of 1% at 0.96% in September.

• 1 MRSA case in September on the DH site on Donne ward, so 3 MRSA cases attributed to the Trust YTD. 9 c-difficile cases were reported in September which is above the in-month quota of 6 cases – 8 on the DH site and 1 on the PRUH site. 36 cases YTD which is equal to the Trust quota of 36 cases for the YTD position.

Introduction/Background The performance report for September 2016 includes updates for the Emergency Care 4-hour performance Action plans for PRUH and DH, the Trust-wide RTT programme and HCAI.

Trust Priorities Emergency 4-hour performance at Princess Royal Hospital (PRUH): • All types attendance performance worsened from 89.3% reported in August to 82.5% in

September, which is below the internal site STF trajectory of 90.1% for the month. Type 1 ED attendance performance worsened from 82.0% in August to 69.9% in September.

• The number of attendances to ED by nearly 3% in September compared to August, and the number of type 1 breaches in ED increased from just under 890 to nearly 1,530.

• The number of attendances to the UCC remained relatively static. However, the number of type 3 breaches in UCC increased from 67 to 87, and the number of breaches due to late UCC handover increased from 113 to 155.

Emergency 4-hour performance at Denmark Hill (DH): • All types performance worsened from 87.4% in August to 81.6% in September, and is

below the internal site STF trajectory of 92.4% for the month. Type 1 ED attendance performance worsened from 85.2% to 78.5%.

• The number of type 1 attendances in ED increased by 2.7% in September compared to August, and the number of type 1 breaches increased from 1,683 to 2,515.

Referral to Treatment (RTT) Incomplete pathway performance: • The number of 52+ week breach patients increased from 144 patients reported in August

to 160 patients reported in September based on the new operational Patient Tracker List (PTL) reports. Whilst we are ahead of our overall 52-week trajectory of 184 breaches, we are 133 cases ahead in neuro specialties, but 95 cases behind in our non-neuro specialties, and are required to reduce non-neuro breaches to zero by the end of October. There are 16,145 patients waiting over 18 weeks at the end of September so our incomplete performance worsened to 80.79%% which is below the STF trajectory of 83.47% for the month.

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Key Issues Clinical Effectiveness: • The national Summary Hospital Mortality Index (SHMI) worsened slightly to 93 for the

PRUH site, but improved from 88 to 86 for the DH site and is better than the expected index of 100, based on the latest 12-months data available from the ‘HED’ benchmarking tool.

• The number of diagnostic 6-week waiting time breaches reduced by a further 89 cases reported at the end of September to 99, which represents 0.96% of the total number of patients waiting. The national and STF improvement trajectory of 1.0% has therefore been achieved for September. The main breach test modalities are endoscopy with 39 breaches, MRI with 34 breaches and non-obstetric ultrasound with 13 breaches.

Safety: • There have been 2 MRSA cases reported to-date, both within the TEAM/medical division.

Nine c-difficile cases were reported in September which is above the quota of 6 cases for the month. Eight cases were on the DH site – so there have been 27 cases YTD on the DH site which is equal to the quota of 27. One case was on the PRUH site – so there have been 9 cases YTD on the PRUH site which is also equal to the quota of 9 cases.

• The number of ward red shifts reported increased from 143 in August to 170 in September. There were 104 red shifts on TEAM/ED wards 24 on Surgery wards, 9 on Haematology and 6 on Child Health wards.

• There were no slips, trips or falls on the DH site in September and 1 case causing moderate/severe harm on the PRUH site on a cardio-vascular ward.

Patient Experience: • The HRWD Inpatient survey score remained above target at 92 for PRUH, but worsened

slightly to 88 at DH for September and is below the target of 89. The Friends and Family (FFT) scores for Inpatient/Day cases is achieving the target of 93 for both sites. FFT scores for ED worsened from 85 to 82 for PRUH, and worsened from 82 to 78 for DH but remains above the target of 61.

• The number of inpatient cancellations on the day increased from 71 cases in August to 100 in September – with 45 cancellations at the DH site and 55 cancellations at the PRUH. There were however 12 breaches of the 28-day cancellation standard for September – of which 10 were on the DH site and 2 cases at the PRUH. Three cases were cancelled due to bed/emergency pressures, three cases due to lack of clinical staff availability and two cases due to booking errors, and 4 cases cancelled due to other non-medical reasons.

• The number of patient complaints reduced from 110 in August to 95 in September, of which 14 were rated high/severe. The number of complaints still open or not responded to within 25 working days also increased from 72 to 78 cases.

Finance & Operational Efficiency: • Financial position - please see the Finance report for further details. • The proportion of inpatients discharged at weekends improved on the PRUH site from

16.3% in August to 19.8% in September. However, performance worsened on the DH site from 18.5% in August to 17.4% in September, but both indicators remain below the 28% target.

• Utilisation in main theatres at DH remains above the 80% target at 81% in September. DSU utilisation on the DH Site improved from 72% to 74% in September. On the PRUH site, main theatre utilisation improved slightly from 60% to 61%, but DSU utilisation worsened from 66% to 64%. Utilisation in Orpington main theatres also worsened further from 68% to 64%, and DSU utilisation at Sidcup worsened from 67% to 63% in September.

Staffing: • Vacancy rate improved slightly from 11.5% for August to 11.3% for September on the DH

site, and improved from 15.4% to 14.8% for the PRUH sites, so both above the internal 5-8% target.

• No staffing data for appraisals, sickness and absence and mandatory training for September was available to load into scorecards.

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Regulatory Performance/Monitor compliance Monitor – Q2 2016/17 position: • The Trust has achieved the performance indicators in the Monitor Risk Assessment

Framework for Q2 with the exception of the A&E 4-hour performance target, the cancer 62-day screening treatment targets, and the RTT incomplete pathway target.

• Our RTT incomplete performance worsened from 82.20% in August to 80.79% in September, and is below the agreed performance trajectory of 83.47% for September 2016.

• We have reported 36 c-difficile cases for the Q2 2016/17 position which is equal to the quota of 36 cases for the YTD cumulative position.

• We therefore have a score of 3.0 based on the latest RAF for our Q2 2016/17 reported performance.

Single Oversight Framework (SOF): In the middle of September, NHSI published its revised version of the Single Oversight Framework which applies from 1 October 2016 and therefore replaces the existing Risk Assessment Framework (RAF). The table below summarises the Trust’s performance position based on the RAF for Q2. Further details on the changes associated with the SOF can be found on the next 2 pages in this report.

#### #### #### ####

Metric Units Weighting YTD Threshold Qtr 1 Qtr 2 Qtr 3 Qtr 4

Acute targets - National requirements

Clostridium difficile year on year reduction YTD Number 1.0 72 14 36 36 36

31 day wait for second or subsequent treatment 1.0

Surgery % 94 95.8 98.0 #DIV/0! #DIV/0!

Anti cancer drug treatments % 98 100.0 99.0 #DIV/0! #DIV/0!

wadiotherapy % 94 98.6 100 #DIV/0! #DIV/0!

62 day wait for first treatment 1.0

from urgent GP referral to treatment: all cancers % 85 85.8 85.9 #DIV/0! #DIV/0!

consultant screening service referral: all cancers % 90 89.7 88.8 #DIV/0! #DIV/0!

Acute targets - minimum Standards

31 day wait from diagnosis to first treatment: all cancers % 1.0 96 98.3 97.9 #DIV/0! #DIV/0!

Two week wait from referral to date seen: 1.0

all cancers % 93 94.1 94.8 #DIV/0! #DIV/0!

for symptomatic breast patients (cancer not initially suspected) % 93 88.5 98.5 #DIV/0! #DIV/0!

aaximum time of 18 weeks from point of referral to treatment in aggregate – patients on an incomplete pathway

% 1.0 92 76.1 80.8 #DIV/0! #DIV/0!

!&9:

aaximum waiting time of 4 hours in 95 from arrival to admission, transfer or discharge

% 1.0 95 84.13 84.53 #DIV/0! #DIV/0!

Self-certification against compliance with requirements regarding access to healthcare for people with a learning disability

% 1.0 N/A Achieved Achieved

Total Score 4 3

Kings Monitor Scorecard Jul-16

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Regulatory Performance/Monitor compliance – the new Single Oversight Framework (1/2) The Single Oversight Framework (SOF) replaces Monitor’s existing Risk Assessment Framework and comes into effect on the 1st October 2016. There are five themes of the Single Oversight Framework: • Quality of care (safe, effective, caring, responsive): NHSI will use CQC’s most recent

assessments of whether a provider’s care is safe, effective, caring and responsive, in combination with in-year information where available. This will also include delivery of the four priority standards for 7-day hospital services.

• Finance and use of resources: NHSI will oversee a provider’s financial efficiency and progress in meeting its financial control total, reflecting the approach taken in Strengthening financial performance and accountability.

• Operational performance: They will support providers in improving and sustaining performance against NHS Constitution standards and other, including A&E waiting times, referral to treatment times and cancer treatment times for acute providers.

• Strategic change: working with system partners we will consider how well providers are delivering the strategic changes set out in the 5YFV, with a particular focus on their contribution to sustainability and transformation plans (STPs), new care models, and where relevant, implementation of devolution.

• Leadership and improvement capability (well-led): building on the joint CQC and NHS Improvement well-led framework, NHSI will develop a shared system view with CQC of what good governance and leadership look like, including organisations’ ability to learn and improve.

NHSI will segment each provider according to the scale of issues faced by individual providers. This segmentation will be informed by data monitoring and importantly, judgement based on an understanding of providers’ circumstances.

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Regulatory Performance/Monitor compliance – the new Single Oversight Framework (2/2) The segment a provider is in determines the level of the support NHSI provide but not the precise support package. There are three levels of support which will link to the segments: • universal support offered

• targeted support offered

• mandated support required

Operational Performance Metrics NHSI have limited the number of patient access and quality indicators that will be measured as part of the Trust’s operational performance assessment. The table below shows the revised list of metrics: Removed: C Difficile and all cancer metrics except the 62-day wait for first treatment Introduced: 6 week wait for diagnostics procedures Standard Frequency Standard Acute and specialist providers A&E maximum waiting time of 4 hours from arrival to admission/transfer/discharge

Monthly 95%

Maximum time of 18 weeks from point of referral to treatment (RTT) in aggregate − patients on an incomplete pathway

Monthly 92%

All cancers – maximum 62-day wait for first treatment from: - urgent GP referral for suspected cancer - NHS cancer screening service referral

Monthly 85% 90%

Maximum 6-week wait for diagnostic procedures Monthly 99% NHSI will consider whether there is a potential support need: • for a provider with one or more agreed Sustainability and Transformation Fund

trajectories against any of the metrics above: it fails to meet any trajectory for at least two consecutive months

• for a provider with no agreed Sustainability and Transformation Fund trajectory against any metrics: it fails to meet a relevant target or standard in the table above for at least two consecutive months

• where other factors (eg a significant deterioration in a single month, or multiple potential support needs across other standards and/or other themes) indicate we need to get involved before two months have elapsed.

They will then consider the issues, use this to identify the appropriate segment for the provider (see above) and develop the support offer.

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Trust Performance Scorecard – DH site

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Trust Performance Scorecard – PRUH sites

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Trust Emergency Care 4-hour performance and ED Recovery Programme Highlights – September 2016 Trust performance for all types attendances against the 4-hour target worsened from 88.18% reported in August to 82.01% in September. Performance is therefore below the national 95% target and below the STF performance target of 91.40% for September which we have agreed with commissioners and submitted to NHSI for 2016/17. The charts below compare monthly and quarterly Trust performance against the 4-hour target.

89.89%91.84%

89.34%

83.39%84.13% 84.53%

70%

75%

80%

85%

90%

95%

100%

Qtr 1 Qtr 2 Qtr 3 Qtr 4

KIngs - Quarterly !ll Types terformance

2015/16 2016/17

70%

75%

80%

85%

90%

95%

100%

Kings- Monthly !ll Types terformanceSep 2014 - Sep 2016

Sep 2014 - Sep 2015 Sep 2015 - Sep 2016

Capacity Plan Update Denmark Hill – additional 23 beds The office moves on the 9th floor of the Ruskin Wing have been completed to enable the vacated floor space to be handed over to the building contractor, to re-develop the floor and create the planned 23-bedded ward. This 17-week programme of construction work is on-track to be completed before Christmas 2016, and for the ward to become operational in January 2017. Orpington wards – additional 40 beds/chairs Following the service moves for Diabetes and Dermatology, the 1st floor of Orpington Hospital has been handed over to the building contractor, to create the 2 new wards each comprising 18 beds and 2 chair spaces. This 22-week programme of construction work is also on-track to be completed before Christmas, and for the wards to become operational in January 2017.

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Emergency Care 4-hour performance Action Plan Update @PRUH Highlights – September 2016 All types attendance performance worsened from 89.3% reported in August to 82.5% in September. Type 1 ED attendance performance worsened from 82.0% in August to 69.9% in September. All types performance was also lower compared to the 89.2% achieved in September last year as demonstrated in the charts below.

88.54%91.50%

89.26%

81.27%83.74%

85.41%

70%

75%

80%

85%

90%

95%

100%

Qtr 1 Qtr 2 Qtr 3 Qtr 4

tRUH Quarterly !ll Types terformance

2015/16 2016/17

70%

75%

80%

85%

90%

95%

100%

tRUH Monthly !ll Types terformanceSep 2014 - Sep 2016

Sep 2014 - Sep 2015 Sep 2015 - Sep 2016

STF performance and ED Action Plan Update The STF performance trajectory was achieved earlier in the year for the period April-June as well as August. However, the improvement trajectory has not been achieved for July or September at the PRUH with performance over 7.5% below the trajectory of 90.1%. There were nearly 400 more admitted breaches in September compared to August, and over 760 more non-admitted/discharged breaches. There were also over 60 more type 3 breaches with 87 breaches in UCC and 155 breaches due to late handover from the UCC. The table below summarises actual versus planned activity, breach and performance.

ED UCCAll

AttendsAdm

Breach

Non-adm

BreachUCC

Breach

UCC Handover

Delay

Apr-16 Plan 5535 5549 11084 1282 634 95 160 80.41%

Actual 5086 5203 10289 1109 522 146 212 80.67%

Var -449 -346 -795 -173 -112 51 52 0.26%

May-16 Plan 5858 5896 11754 1197 563 99 179 82.66%

Actual 5133 5626 10759 969 472 95 189 83.97%

Var -725 -270 -995 -228 -91 -4 10 1.31%

Jun-16 Plan 5595 5856 11451 1197 352 75 118 84.79%

Actual 5224 5225 10449 757 388 94 167 86.54%

Var -371 -631 -1002 -440 36 19 49 1.76%

Jul-16 Plan 5615 5808 11423 1139 317 35 78 86.26%

Actual 5260 5513 10773 911 441 119 195 84.54%

Var -355 -295 -650 -228 124 84 117 -1.73%

Aug-16 Plan 5104 5290 10394 1139 282 21 78 85.38%

Actual 4931 5030 9961 631 258 67 113 89.27%

Var -173 -260 -433 -508 -24 46 35 3.89%

Sep-16 Plan 5335 5305 10640 748 211 35 61 90.08%

Actual 5077 5049 10126 1024 503 87 155 82.53%

Var -258 -256 -514 276 292 52 94 -7.55%

PRUH

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Emergency Care 4-hour performance Action Plan Update @DH Highlights – September 2016 All types performance worsened from 87.4% in August to 81.6% in September, and type 1 ED attendance performance worsened from 85.2% to 78.5%. Performance is just over 10% below the 91.7% levels which were achieved in September last year, as shown in the charts below.

90.78%92.51%

89.41%

85.04%84.41% 83.87%

70%

75%

80%

85%

90%

95%

100%

Qtr 1 Qtr 2 Qtr 3 Qtr 4

5H Quarterly !ll Types terformance

2015/16 2016/17

70%

75%

80%

85%

90%

95%

100%

5H Monthly !ll Types terformanceSep 2014 - Sep 2016

Sep 2014 - Sep 2015 Sep 2015 - Sep 2016

STF performance and ED Action Plan Update The STF performance trajectory was achieved in April and May for the DH site, but has not now been achieved from June to September. There were 330 more admitted breaches in September compared to August, and just over 500 more non-admitted/discharged breaches from the ED. This has meant that there are over 1,430 breaches compared to our improvement plan for September. The table below summarises actual versus planned activity, breach and performance.

All Attends

Adm Breach

Non-adm

BreachT2

Breach Breaches Perf

Apr-16 Plan 13972 1285 1183 10 2478 82.26%

Actual 13791 1004 973 11 1988 85.58%

Var -181 -281 -210 1 -490 3.32%

May-16 Plan 14468 1163 1051 1 2215 84.69%

Actual 14809 1074 1000 20 2094 85.86%

Var 341 -89 -51 19 -121 1.17%

Jun-16 Plan 14781 1020 657 1 1678 88.65%

Actual 14228 1136 1449 10 2595 81.76%

Var -553 116 792 9 917 -6.89%

Jul-16 Plan 14908 971 591 0 1562 89.52%

Actual 14225 1167 1285 2 2454 82.75%

Var -683 196 694 2 892 -6.77%

Aug-16 Plan 13269 927 526 0 1453 89.05%

Actual 13380 992 691 6 1689 87.38%

Var 111 65 165 6 236 -1.67%

Sep-16 Plan 14276 692 394 1 1087 92.39%

Actual 13737 1322 1193 8 2523 81.63%

Var -539 630 799 7 1436 -10.75%

Denmark Hill

To address the increased foot-fall through the Emergency Department at Denmark Hill, the Trust’s capital plan includes the expansion of the department into Suite 1 and a re-location of clinics running in Suite 3. There has been a delay in identifying a decant solution for these clinics which means that the expanded department is not likely to be operational until 20171/8

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RTT Update

End-September 2016 Incomplete pathway position There were 16,145 incomplete pathways with a waiting time over 18 weeks, which is an increase of 1,279 pathways compared to our position at the end of August. The number of admitted incomplete pathways increased by 216, and the number of non-admitted pathways increased by 1.063. Our incomplete performance for September 2016 was therefore 80.79% which is a worsening of 1.41% compared to August. This is however lower than the performance improvement trajectory of 83.47% which was agreed between the Trust, commissioners and NHSI. The waiting time position for September 2016 compared to August 2016 is summarised below:

Patients waiting end-September (August position in brackets)

18-39 weeks 40-51 weeks 52+ weeks

Incomplete -Admitted 4,918 (4,721) 480 (465) 99 (95)

Incomplete – Non-admitted 10,167 (9,013) 434 (523) 47 (49) Total Incomplete pathways 15,085 (13,734) 914 (988) 146 (144)

52-week Waiting Time position There were 146 patients waiting over 52 weeks that we have reported in our September 2016 month-end position to Unify, of which there were 99 patients waiting on admitted pathways and 47 patients waiting on non-admitted pathways. This is a slight increase compared to the 144 patients that we reported for the end of August position. We are therefore 38 patients ahead of our agreed trajectory of 184 for the month. The number of Neuro-specialty breaches reduced from 51 to 44 and are 133 ahead of trajectory. Non-neuro breaches increased from 93 to 102 and are 95 cases behind trajectory. Demand and Capacity Modelling Phase 1 and 2 specialty models were reviewed with service representatives by the Head of the external IST team on 5th and 7th October as planned. There is some re-work that has been identified as a result of these sessions, and Service managers are completing Summary Output reports for each of their specialty/sub-specialty models for the end of October. We are planning to hold a series of ‘Check and Challenge’ sessions with senior representatives from each divisions presenting to members of Trust executive team, commissioners and IST in the first half of November. There are further specialties that we want to model as part of phase 3 and 4 of the programme, and aim to complete this activity by mid-December. MBI Health Group The Trust has engaged the support of MBI Health Group to undertake a rapid assessment of 3 specialties: Neurology, Neurosurgery and T&O. MBI have completed their assessment of each specialty against their own provider framework and have issued their key findings and recommendations report to the Trust. The report has also been shared with commissioners, NHSE and NHSI. The Trust was also asked to provide its initial response to the Strategic Oversight Group which was held on 12 October. The MBI report highlighted a number data quality issues associated with the integrity of the Trust’s operational PTL. Remedial action has been put into place and a resource implication assessment is being conducted for the central RTT pathway team to validate the following areas:

• Planned care list and completion of patient admit by dates (over 6000 pathways) • Patients in active monitoring for more than 12 weeks without clinical review (over 9300

pathways) • Past TCI dates to close the pathway or refresh TCI date (over 160 pathways) • Pathways where the RTT clock start date is the same as the decision to admit date

(over 6250 pathways) • Patients who DNA their first appointment are not re-booked (over 6400 pathways)

14 of 15

Cancer – September 2016 Performance Update The table below summarises the achievement of cancer targets at Trust-level for the latest September 2016 and Q2 position. The two-week wait suspected cancer referral target is being achieved at 93.7% for September and 94.8% for Q2 compared to the national 93% target, despite over 14% increase in referrals compared to 2015/16. The two week-wait symptomatic breast performance has also maintained its strong performance in Q2 at 98.5% for the quarter. The 62 day GP referral target of 85% was not achieved in September at 82.7% but has achieved for the overall Q2 position at 85.9%. Despite being achieved for the in-month position of August and September, the 62-day screening target of 90% has not achieved the 90% target for Q2 at 88.8%.

62-day GP Referral There have a higher number of first treatments compared to the monthly average in August and September, with 347.5 patients seen in Q2 compared to 334 patients seen in Q1. The 62-day GP referral target for first treatment was not achieved for the in-month September position at 82.74%, with 4.5 breaches in HpB and urology pathways, 3.5 breaches in skin and 2.5 breaches in lung. However, the 85% target has been achieved for the overall Q2 position at 85.90%. Weekly meetings continue with the Trust’s cancer lead, to review plans and the latest performance position. 62-day Day Screening There was 1 breach reported in each of August and September which means that we have 7.5 breaches for Q2. Performance against the 62-day screening target of 90% is therefore 88.8% so this indicator has not been achieved for Q2. Inter Trust Transfers (ITT) In April, 41.2% of pathways were referred to GSTT by day 38 which was worse than the average of 62.3% achieved for January – April 2016. The final position for May improved to 65.7%, but worsened to 54.8% for June. Our July and August positions have remained relatively static with the latest data from GSST indicating our August performance improved only to 57.5%. Performance data for September is not fully validated and is currently showing a performance improvement to 61.9% for 2WW and screening transfers to GSST. The improvement trajectory that was shared with commissioners requires us to achieve 85% by October. Key actions for the Trust to implement in 2016/17 include: • Root cause analysis of all late ITTs to enable tumour groups to identify trends and causes

of delays • Minimise delays at the start of the pathway • Work with diagnostics to improve access to diagnostic testing and availability of reports.

15 of 15

Healthcare Associated Infection (HCAI) Update (1/1) MRSA (post 48 hour bacteraemia: • 1 case identified in September which is attributable to the Trust. 1 case in June 2016 at

DH site; 2 cases YTD at DH site which is above the zero quota.

C-difficile: • 9 new cases reported in September (8 cases at DH and 1 case at PRUH); 36 cases YTD

which is equal to the quota of 36 cases for September YTD position and better than the 49 cases reported by September last year.

VRE bacteraemia: • 5 new cases at DH only; 29 cases YTD which is above the target of 13 cases for the

September position and higher than the 20 cases reported by September last year. E-Coli bacteraemia: • 19 new cases reported in September at DH and 2 new cases at PRUH; 73 cases YTD

which is above the target of 50 cases, and above the 56 cases reported by September last year.

C-Difficile (CDI) Action Plan Update: • Reviewing of current practice and integration of policies and practice:

Work is on-going to align policies and protocols across sites. This work will be overseen by the HCAI Operations Committee.

• Policies approved and published: Infection Prevention and Control, Intravascular Catheters, Waste Management and Trust Decontamination.

• Protocols approved and published: Isolation Precautions, Infectious Death Handling,

Management of Gastrointestinal Infection, Respiratory Virus and Atypical Bacterial Infections Treatment and Infection Control, Varicella Zoster Virus (VZV), Transmissible Spongiform Encephalopathy, Blood Cultures, Standard Precautions, Hand Hygiene, Linen and Laundry, Guidelines for Animals on Hospital Premises and Aseptic Non Touch Technique.

• Protocols under consultation: MRSA, Clostridium difficile, Multiple Resistant Gram

Negative, Tuberculosis protocols are under consultation. • Protocols outstanding: Control of Outbreaks of Infection, Pandemic Influenza Protocol,

Coronavirus including MERS-CoV & SARS-CoV and Streptococci and Enterococci. • Centralisation of endoscope reprocessing:

A project on-going to plan and develop a central reprocessing facility for endoscopies. The unit at DH site is being used as a template for the PRUH unit. This project is still very much in the planning stages, but should allow for a much higher level of decontamination than is currently the case.

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Monthly Unify Staffing Report (September 2016)

2nd November 2016 Board Meeting

Enc. 4.2

Report to: Board Directors

Date of meeting: 2nd November 2016

Subject: Monthly Unify Staffing Report (September 2016)

Author(s): Maria Donbavand

Presented by: Shelley Dolan

Sponsor: Shelley Dolan

History: Monthly Nursing, Midwifery and Care staff numbers to the Board

Status: For Information

Enc. 4.2

Legal:

Patients have a right to be cared for by appropriately qualified and experienced staff in safe environments. This right is enshrined within the national Health Service (NHS) Constitution, and the NHS Act 1999 makes explicit the board’s corporate accountability for quality. The NHS England Quality Board have asked all NHS Trust Boards to receive monthly information on nurse staffing (NQB 2015). Nurses’ responsibilities regarding safe staffing are stipulated by the Nursing and Midwifery council (NMC).

Financial: Nursing is the largest professional group in the Trust and consumes a large amount of resource. Cost efficiency is therefore paramount

Assurance: This report provides assurance and evidence on nursing workforce.

Clinical: Good nursing is a key part of multidisciplinary care and is an essential component of ensuring safe, efficient care with a positive patient experience.

Equality & Diversity: There are no issues or implications relating to equality and diversity within this report

Performance: This report highlights achievements against national and local key performance indicators

Strategy: The contents of this report is directly aligned to the Trust Nursing and Midwifery Objectives

Workforce: This report will inform Trust’s Nursing and Midwifery Workforce Strategy.

Estates: There are no implications

Reputation: Poor nursing care would have a deleterious effect on the reputation of the Trust

Other:(please specify) n/a

Key Implications

Enc. 4.2

This report provides assurance to the Board on the Nursing and Midwifery staffing levels across the Trust during September 2016 and provides details of the actual hours of Nursing, Midwifery and Health Care Assistant (HCA) on day and night shifts versus planned staffing levels. Nursing Hours Per Patient Day (NHPPD) are also being collected as mandated by NHS England (2016) and will be compared to other London Trusts if the data is available in November 2016.

KEY POINTS • The number of staff required per shift is calculated using an evidence based tool, based on the level of Acuity of the patients. This is further informed by

professional judgement, taking into consideration issues such as ward size and layout, patient dependency, staff experience, incidence of harm and patientsatisfaction and is in line with NICE guidance. This provides the optimum planned number of staff per shift.

• For each of the 76 clinical inpatient areas in September, the actual number of staff as a percentage of the planned number is recorded. The overall figuresare shown below.

• This illustrates that the average fill rate at the Denmark Hill site is below the 95% informal benchmark of Foundation Trusts and below other Shelford groupTrusts. Although shift by shift there is good practice in trying to ensure each shift is safe it is essential that every effort is made to recruit and retain staff sothat Kings is able to demonstrate averages above 95%. The Director of Workforce and team are leading an innovative recruitment and retention strategy toimprove nurse staffing across all Kings sites.

At Denmark Hill In September there were 23 clinical areas where the actual number of Healthcare assistants was more than 115% above the planned level, and 3 areas where the levels were less than 85% of those planned. (numbers are based on combined day and night average) At PRUH In September there were 3 clinical areas where the actual number of Healthcare assistants was more than 115% above the planned level and 4 areas where the levels were less than 85% of those planned. (numbers are based on combined day and night average)

Summary of Report 1/2

% Average fill rate RN

% Average Fill rate HCA

Denmark Hill 92% 120%

PRUH 98% 106%

Safer Staffing Fill rate - September 2016

SiteDay and Night

Enc. 4.2

Summary of Report 2/2

Understaffing • Across the Trust aggregate staffing levels for Registered nurses fell below 95% (NHS E benchmark) with an aggregate average of 92%. 20 wards had actual

staffing of below 85% over the month ( Appendix 1) highlights the reasons for this and how the shift was made safe, all such instances are reported on thered shift reporting system.(appendix 1 - 2) . A red shift occurs when fewer Registered Nurses than planned are in place, or when the number of staff planned is correct but the patientsare more acutely sick or dependent than usual requiring a higher staffing level (NICE 2015). In total there were 170 Red shifts declared in September. Themajority of these were at Denmark Hill and associated with increased acuity, vacancies or bank/agency failing to fill the shifts. In each case local managersassess the situation and make a judgement about whether moving staff from a better staffed area is required to maintain safety.

There are instances of hours exceeding those planned usually in relation to HCAs with the following reasons: o Extra staff required on an ad hoc basis to “special” high risk/vulnerable patients which has increasedo Overseas Nurses awaiting their NMC registration are recorded as unregistered and therefore HCAso HCA usage is increased to minimise the impact of reduced RN fill rates

ACTION REQUIRED • The Board is asked to note the report.

0102030405060708090

100110120130140150160170180190200

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

No. of Red Shifts between Dec 15 - Sept 16 Denmark Hill

Red

Linear (Red)

0102030405060708090

100110120130140150160

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

No. of Red Shifts between Dec 15 - Sept 16 PRUH

Red

Linear (Red)

Enc. 4.2

6

Trends and patterns, Nursing hours: Planned Vs. Actual – Denmark Hill

The summary below is based on 46 in-patient wards across the Denmark Hill site for September. RN Day and Night Shift - The overall planned versus actual RN nursing hours

for September was 8% below plan. This is an decrease of 1% compared to the previous month.

HCA Day and Night Shift - The average overall planned versus actual HCA nursing hours for September was 20% above plan. This is a decrease of 15% from the previous month.

Hospital % Against Planned (RNs) Day/NightSt Thomas Hospital 98%Imperial (St Mary's) 97%Kings College Hospital - DH 92%

Safe Staffing levels - taken from NHS choices - 20.09.2016

70%85%

100%115%130%145%160%175%190%205%220%235%250%265%280%295%310%325%

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

AVG - RN Day and Night

AVG HCA Day and Night

Over

Under

Planned vs Actual by month - Denmark Hill

Enc. 4.2

7

Trends and patterns, Nursing hours: Planned Vs. Actual – PRUH

The summary below is based on 30 in-patient wards across the PRUH site in September. RN Day and Night Shift - The overall planned versus actual RN nursing

hours for September was 2% below plan. HCA Day and Night Shift - The average overall planned versus actual HCA

nursing hours for September was 6% above plan.

70%

85%

100%

115%

130%

145%

160%

175%

190%

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

% Avg Fill rate RN Day and Night

% Avg Fill rate HCA Day and Night

Over

Under

Linear (Over)

Planned Vs Actual by month - PRUH

Hospital % Against Planned (RNs) Day/NightCroydon University Hospital 95%University Hospital Lewisham 98%Kings College Hospital - PRUH 98%

Safe Staffing levels - taken from NHS choices - 20.09.2016Enc. 4.2

Appendix 1 Exception Report – Denmark Hill HCA and RN staffing levels – Lower than Planned - September

Division Ward Name Review by HON/Matron/Ward where 15% or more of nursing hours did not meet agreed staffing levels (Highlighted in red)

Children's Toni & Guy Additional HCAs used to fill gaps from RN vacancies.

Children's Rays Of Sunshine HCAs are slightly lower than planned due to a combination of sickness and mat leave however staff moved around where required to ensure patient safety is not effected.

Children's Thomas Cook CCCC Vacancies exist however will be filled for late September and October- staff moved around from other ward to support where required to ensure patient safety is not effected.

Haematology Davidson HCAs are slightly lower than planned due to a combination of sickness and unplanned leave however staff moved around where required to ensure patient safety is not effected.

Liver and Renal Short Stay Surgical Unit 5 1/2 day ward numbers are being supported by Coptcoat.Liver and Renal Dawson Additional HCAs used to fill gaps from RN vacancies.

Liver and Renal Liver Intensive Care Unit For LITU the staffing level was safe, ongoing HCA recruitment for 1.4 wte , we do not back fill the vacancy .

Neuro David Marsden Increased use of HCA's is due to 3 patients needing specialling and backfilling RN vacancies with HCA when unable to fill RN bank shifts.

Neuro Kinnier Wilson HDU Variations due to specials but ward operating at safe staffing levels within planned number Private Patients Guthrie Ward HCAs flexed down as additional RNs were in place at night.Surgery Coptcoat Ward High RN vacancies which ar being covered with HCAs - also supporting new ward.

Surgery Katherine Monk RN vacancies which as of October should improve however in the interim gaps filledy by HCAs.

Surgery Lister RN vacancies which as of October should improve however in the interim gaps filledy by HCAs.

Surgery Twining Unable fill vacancies with RNs so have used additonal HCAs.

TEAM Annie Zunz High requirement for MH specialling (continues in Oct) resulting in increased HCA numbers. Operating at amber RN levels at night.

TEAM Matthew Whiting WardOperating at AMBER nursing levels (day shift) and GREEN at night. Skill-mix is a challenge due to high reliance on B&A to fill vacancies. Safety reviewed AM and PM (Divisional Safety Huddle 7/7) led by Matrons to maximise safe nursing levels

TEAM OliverOperating at AMBER nursing levels (day shift) and GREEN at night. Skill-mix is a challenge due to high reliance on B&A to fill vacancies. Safety reviewed AM and PM (Divisional Safety Huddle 7/7) led by Matrons to maximise safe nursing levels

TEAM Marjorie WarrenOperating at AMBER nursing levels (day shift) and GREEN at night. Skill-mix is a challenge due to high reliance on B&A to fill vacancies. Safety reviewed AM and PM (Divisional Safety Huddle) led by Matrons to maximise safe nursing levels

TEAM ByronOperating at AMBER RN nursing levels with occassional RED shifts both day and night. Safety reviewed AM and PM (Divisional Safety Huddle 7/7) led by Matrons to maximise safe nursing levels

TEAM LonsdaleOperating at AMBER RN nursing levels with occassional RED shifts both day and night. Safety reviewed AM and PM (Divisional Safety Huddle 7/7) led by Matrons to maximise safe nursing levels

Enc. 4.2

Appendix 2 Exceptions Report – PRUH

HCA and RN staffing levels – Lower than Planned – September

Division Ward Review by HON/Matron/Ward where 15% or more of nursing hours did not meet agreed staffing levels (Highlighted in red)

CCTD Intensive Care Unit 2 x HCA on long term sick, shifts prioritised and assessed to maintain safety

Children's Children's Ward Currently awaiting HCA's to start - ward operating safely with regard to number of patients, acuity and staffing levels

Children's Special Care Baby Unit Currently awaiting HCA's to start - ward operating safely with regard to number of patients, acuity and staffing levels

LRS Surgical Ward 4

The under spend for HCA's at night is due to a maternity leave and one vacancy. During September we had fairly light patients and only required one HCA at night. However, as we are now co-horting the medical patients again on Surgical 4 we will be using our full establishment due to the acuity on the ward as well as the increased confusion

LRS Boddington (ORP) We adjust staffing due to patient numbers and generally the reduced staffing is because we have a lower number of patients on the ward.

Network Stroke Unit Additional HCAs used where RN vacancies were not filled to ensure patient safety is not effected.

Enc. 4.2

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Enc. 4.2.

Board of Directors – October 2016 1 of 5

Report to: Board of Directors

Date of meeting: November 2016

Subject: GMC Revalidation of Medical Staff

Author(s): Julia Wendon, Executive Medical Director

Ed Glucksman, Assistant Medical Director, Revalidation

Presented by: Julia Wendon

Sponsor: Julia Wendon

History: None

Status: Information

1. Background/Purpose All doctors are required to be appropriately registered with the General Medical Council (GMC) and from 16 November 2009 were issued with a Licence to Practice as part of the strengthening of medical regulation in the UK. On 19 October 2012, the Secretary of State confirmed the introduction of the process of ‘revalidation’ of medical staff, which requires every doctor to be assessed at five yearly intervals in order for their Licence to be renewed. The revalidation arrangements took effect from December 2012. The purpose of revalidation is to assure patients and the public, employers and other healthcare professionals that licensed doctors are up-to-date and fit to practice. As part of the governance framework, Trusts are asked to inform their Boards of these arrangements and of any ongoing governance processes that may be required. 2. Action required The Board is asked to note the action taken by the Trust regarding Revalidation to date of medical staff and note that a revalidation management system (RMS) was implemented on 23 September 2013.

3. Key implications Legal:

The Medical Profession (Responsible Officers) Regulations 2010 which came into force on 1st January 2011 required all designated bodies to appoint a Responsible Officer to be accountable for the process of medical revalidation. At this stage it is unclear what sanctions might be imposed on Trusts and/or individuals for any failure to comply with the legislation.

Financial:

There are considerable costs associated with medical revalidation, both in terms of systems required and staffing ‘opportunity’ costs to undertake the processes required to support revalidation. The Trust has previously made additional resources available for the purchase

Enc. 4.2.

Board of Directors – October 2016 2 of 5

of a revalidation management system and associated project implementation costs during the 2012/13 financial year, and an additional Agenda for Change Band 7 post to support the Executive Medical Director. However, in order to facilitate ongoing collection of the information required by practitioners to demonstrate that their practice is safe and up-to-date, the Trust will purchase a web-based electronic revalidation management system (RMS) for appraisal and revalidation.

Assurance:

Monitoring of all aspects of the processes required for GMC Revalidation including, for example, (a) appraisals and quality of appraisal, (b) appraiser training (c) compliance with revalidation dates, will be undertaken through the Trust’s Assurance Framework.

Clinical:

Effective appraisal underpins revalidation and doctors are required to obtain colleague/peer and patient/carer feedback as part of a 360° performance review every five years, and also to demonstrate reflection on their clinical practice, to improve patient outcomes and experience.

Equality & Diversity:

The Trust has an obligation to ensure that the policies required to underpin and support revalidation are properly constructed and that Equality Impact Assessments are completed.

Performance:

The Trust must complete a first revalidation for all doctors for whom we have a prescribed connection by March 2016.

Strategy:

Revalidation is a national requirement, but will support the Trust strategy with regard to improving clinical care, the patient experience and medical productivity.

Workforce:

There are significant workforce implications with regard to ongoing responsibilities and workload. It is envisaged that the process of revalidation may require additional non-clinical time to be identified in job plans for Clinical Directors, Lead Clinicians and others with responsibility for medical appraisal.

Estates:

There are no implications for Estates.

Reputation:

Failure to secure a renewal of the Licence to Practice will have serious implications for the individual doctor which will adversely impact on professional reputation. In addition, the Trust would be publicly criticised in the event that it failed to properly support the process of revalidation, and there may be legal implications if we fail to implement the requirements of the Statutory Regulations.

4. Appendices

a. Report on GMC Revalidation of Medical Staff

Enc. 4.2.

Board of Directors – October 2016 3 of 5

REPORT ON GMC REVALIDATION OF MEDICAL STAFF Appendix (a)

Executive Summary On 19 October 2012, the Secretary of State confirmed the introduction of the process for GMC Revalidation of medical staff, with effect from December 2012. From this date, every doctor practising in the UK will be subject to regular checks to help improve the quality of patient care. In addition to holding appropriate GMC registration doctors will, through regular assessment at five yearly intervals, indicate that they are fit to practice following which their Licence to Practice will be renewed. Recommendations The Board is asked to note the Trust position with regard to revalidation of doctors.

1. Revalidation Management Framework The Responsible Officer has appointed an Assistant Medical Director (Revalidation) with specific delegated responsibilities for medical revalidation. This post holder works with a small team managing the various actions and timescales required for revalidation. The Trust’s Revalidation Management System (SARD JV – Strengthened Appraisal and Revalidation Database) was launched on 23 September 2013. This has greatly facilitated the appraisal and revalidation process and data handling across the enlarged Trust. SARD JV is the same system used by Guy’s and St Thomas’ NHS Foundation Trust. From 1 October 2013, doctors working at the PRUH and associated sites for whom King’s is the Designated Body were transferred to the King’s RMS database, so there is one database for all doctors with a prescribed connection to the Trust.

1. Revalidation – Year Zero and Year One Cohorts

The GMC has set up a national website listing all doctors with whom Trusts have a ‘prescribed connection’ (i.e. those doctors employed by the Trust or holding honorary contracts (e.g. KCL) where there is no other substantive employer – excluding doctors in Deanery training programmes) in order complete the revalidation process in accordance with the following national timescales:-

Year Zero: Jan 2013 to March 2013 (EMD + those with management/leadership roles) Year One: April 2013 to March 2014 (20% of doctors revalidated) Year Two: April 2014 to March 2015 (40% of doctors revalidated – total 60%) Year Three: April 2015 to March 2016 (40% of doctors revalidated – total 100%) The Responsible Officer is required to make one of three recommendations, as follows:- A positive recommendation that the doctor is up-to-date and fit to practice A request to defer the date of the RO’s recommendation A notification of the doctor’s non-engagement in revalidation

In preparation for their revalidation date, each consultant completes an appraisal for revalidation using the framework set out within the national medical appraisal guide (MAG),

Enc. 4.2.

Board of Directors – October 2016 4 of 5

and uploads relevant information and data as ‘evidence’ to support their appraisal discussion. The appraisal documentation and the supporting ‘evidence’ is independently validated by the Assistant Medical Director (Revalidation). Timescales and recommendations to date from Year Two to Year Four are as follows:

a. Year Two - 1st Cohort (1 April - 30 June 2014) = 113 practitioners b. Year Two - 2nd Cohort (1 July - 30 September 2014) = 122 practitioners c. Year Two - 3rd Cohort (1 October - 31 December 2014) = 135 practitioners d. Year Two - 4th Cohort (1 January - 31 March 15)= 124 practitioners e. Year Three – 1st Cohort (1 April - 30 June 15)= 126 practitioners f. Year Three – 2nd Cohort (1 July – 30 September 15) = 121 practitioners g. Year Three – 3rd Cohort (1 October – 31 December 15) = 124 practitioners h. Year Three – 4th Cohort (1 January - 31 March 16) = 197 practitioners i. Year Four – 1st Cohort (1 April – 30 June 16) = 26 practitioners j. Year Four – 2nd Cohort (1 July – 30 September 16) = 38 practitioners k. Year Four – 3rd Cohort (1 October – 31 December 16) = 20 practitioners l.

From 1st April 14 to date, recommendations for 1012 doctors have been made. In Cohorts1, 2 and 3, 268 (72.43%) were recommended for revalidation with 102 (27.57%) deferred* due to a strengthening of the requirement for patient feedback to form part of the 360° appraisal process, following the Francis Report. One doctor was reported for non-engagement in the second cohort and they have now left the Trust. *There are no implications for clinical practice associated with deferrals.

The data for the graph below is taken from GMC Connect (doctors with a prescribed

connection to King’s). .

2. Key implications

Please see summary in Section 3 on the Front sheet. 3. Options There are no options for consideration.

050

100150200250300350400450

DeferredRevalidated

Non-engagement

Year 0

Year 1

Year 2

Year 3

Year 4

Enc. 4.2.

Board of Directors – October 2016 5 of 5

4. Conclusion The Trust is continuing to progress well with revalidation. Appraisals are more easily completed and accessed and quality assurance of revalidation evidence is facilitated by SARD JV. Evidence of the Trust’s appraisal and revalidation progress was incorporated into documentation for the CQC visit in April 2015. 5. Recommendations The Board is asked to note progress with regard to medical revalidation.

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Chief Nurse

Shelley Dolan

Education, Placement Quality, Mentorship,

Preceptorship & Overseas Nurses

Angela Grainger

Associate Director Nursing – Workforce

& Productivity

TBC

Associate Director Nursing –

Transformation & Ward Accreditation

TBC

Corporate Director of Nursing

Paula Townsend

Director of Nursing – Networked

Jennifer Watson

Director of Nursing - Urgent/Planned

Tricia Fitzgerald

Director of Nursing – PRUH

Debbie Hutchinson

Proposed Corporate Nursing Structure v12 – 25.10.16

Associate Director of Governance and

Assurance

Judith Seddon

The PRUH role will also include site management of the PRUH covering risk, safety, quality, safeguarding,

stakeholder management etc.

The remaining divisional roles will have divisional accountability for

those areas, but Trust-wide accountability for a number of corporate work streams TBD.

Responsible for leading & contributing to the ward accreditation and transformation programme

Nurse recruitment and development

of strength based recruitment for band 2 – 5

Lead for recruitment and retention

initiatives for nursing

Direct line report for harm free care

teams

Monitoring and improvement of

quality and safety

Management of safer care forum

Implementation of national policy

and guidance

Management of safe staffing at

ward level via e-roster

Contribution to trust-wide

safeguarding responsibilities

Management of specials team

Lead for revalidation

Lead for quality, safety

assurance & improvement

Production of quality

accounts

Line Management of

safety teams

Lead for infection

control, Safe staffing and temporary staffing lead and implementation of national policy and guidance

Management of child

and adult safeguarding teams Leading on site based nursing developments and initiatives

Horizon scanning

networking and benchmarking

Business Manager

Maria Donbavand

Reporting to Executive Director Workforce

Deputy Director of Infection Control

Erika Grobler

Note: These Corporate roles all have Trust-wide responsibility

Covering governance, assurance, PPI and

PALS

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Organisational Design Project:

Post-filling Update

2nd November, 2016

Report to: Public Board

Date of meeting: 2nd November 2016

Subject: Organisation Redesign Project: Post-filling Update

Author(s): Marita Brown, Associate Director of Learning and Organisational Development

Presented by: Dawn Brodrick, Executive Director of Workforce Development

Sponsor: Dawn Brodrick, Executive Director of Workforce Development

History: New paper

Status: For information

Summary of Report The purpose of this report is to update the Board on progress in filling posts in the new organisational structure, and to outline the timescales for implementing the new structure. Action required The Board is asked to note the progress of this key piece of work. A summary of the key appointments made are attached in the Appendices.

2

Legal: Current employment law has been considered when designing the formal consultation process

Financial: The financial analysis has assessed the new structure as cost-neutral.

Assurance: A new suite of standard operating processes and governance will be required to oversee the new operating model

Clinical: New structure will impact on current ways of working and decision-making both across and within divisions

Equality & Diversity: Full equality impact assessment has been undertaken as part of formal consultation

Performance: New system of performance reporting aligned to the new divisional structures will need to be put in place

Strategy: This proposal supports delivery of the Trust’s vision, mission, strategy and goals

Workforce: This paper sets out progress with filling posts in the new structure/.

Estates: Not yet known

Reputation: Throughout the process we have been conscious of the need to manage the communication and engagement around the organisation redesign for existing staff, especially those directly affected.

3

Key implications

• Tier 1: to date 14 out of 16 of the new posts have been filled • Tier 2 posts (68 total):

– Medical: corporate Medical Directors posts have been filled; Clinical Director interviews on 28/10/16

– Nursing: matching process to new posts completed. Unfilled posts will be offered to current 8b nursing postholders to express their interest w/c 31st October, with interviews mid-November

– Operations: posts preference and matching due to be completed by 4/11/16, with interviews (where required) w/c 14th November

• We should be in a position to confirm all internal Tier 2 appointments by end November; any remaining vacancies within Nursing and Operations will then go to external advert

• Transition plan for implementation of new structure from January 2017 is being developed with Operations and Finance – including alignment of budgets and management information

• Once transition plan has been agreed, implementation of the new structure will be led by the COO.

4

Summary

5

Post-filling update: Tier 1 posts Role in new structure Level Division Progress as of 28/10/16

Director of Planning and Performance

VSM Corporate Operations Adam Creeggan started 3rd October 2016

Director of Delivery and Improvement

VSM Corporate Operations Under Executive Search

Director of Operations VSM Urgent & Planned Care Under Executive Search

Director of Operations VSM Networked Care Fiona Wheeler appointed

Managing Director VSM PRUH & South Sites Matthew Trainer appointed; starts 28th November 2016

Director of Nursing (x3) Band 9 All three Divisions Tricia Fitzgerald, Debbie Hutchinson and Jennifer Watson appointed

Divisional Medical Director (x3) Consultant salary plus £25K honorarium

All three Divisions Simon Cottam, Tony Pagliuca and Leonie Penna appointed

Deputy Director of Operations (x 2)

Band 9 Urgent & Planned Care Harvey McEnroe appointed – starts 19th December; Thomas Strickland appointed – starts January 2017

Deputy Director of Operations (x 2)

Band 9 Networked Care Dan Gibbs appointed Laura Badley appointed; starts 19th December 2016

Deputy Managing Director Band 9 PRUH & South Sites Ann Wood appointed

6

Post-filling update: Tier 2 posts

Role in new structure Level Division Progress as of 28/10/16

Corporate nursing roles (x2) 8c Chief Nurse Outcome document has been issued; post preferences have been submitted and matching process completed. Some posts will go to internal interview.

Heads of Nursing & Director of Midwifery (x 18 posts)

8c / 9 All 3 Divisions Outcome document has been issued; post preferences have been submitted by current 8c postholders and matching process completed. Some posts will go to internal interview; remaining unfilled posts will be offered to current 8b nursing postholders to express their preference. Director of Midwifery has been appointed (announcement pending).

General Manager / Chief of Therapies, Rehabilitation and Allied Clinical Service (x17)

8c / 8d / 9 All 3 Divisions Outcome document has been issued. Post preferences to be submitted by 31/10/16. Interviews (where required) will take place w/c 7th November 2016.

Corporate Medical Director roles (x4)

Consultant salary plus responsibility allowance of £15k

Executive Medical Director

Dr Chris Palin; Dr Paul Donohoe; Prof William Bernal and Dr Ed Glucksman have been appointed.

Clinical Directors (x 27) Consultant salary plus responsibility allowance of £15k

All 3 Divisions Post preference process completed. Interviews 28th October 2016.

Chief Operating Officer

Jane Farrell

Director of Operations

Urgent Care, Planned Care and Allied Clinical Services

(Vacant)

Divisional Medical Director

Dr. Leonie Penna

Deputy Director of OperationsUrgent Care

Harvey McEnroe

Director of Nursing

Tricia Fitzgerald

Director of Operations

Networked Care

Fiona Wheeler

Divisional Medical Director

Prof. Tony Pagliuca

Deputy Director of Operations

Laura Badley

Director of Nursing

Jennifer Watson

Managing Director – PRUH and South

Sites

Matthew Trainer

Divisional Medical Director

Dr. Simon Cottam

Deputy Managing Director

Ann Wood

Director of Nursing

Debbie Hutchinson

Director of Planning and Performance

Adam Creeggan

Director of Delivery and Improvement

(Vacant)

Deputy Director of Operations

Planned Care

Thomas Strickland

Deputy Director of Operations and

Trust Cancer Lead

Dan Gibbs

Operations Leadership Structure – v1

Executive Medical Director

Julia Wendon

Corporate Medical Director

Medical Productivity, Job Planning, GMC and

Workforce

Dr. Chris Palin

Corporate Medical Director

Quality, Risk & Governance

Dr. Paul Donohoe

Corporate Medical Director

Outcome, Morbidity, Mortality and Audit

Prof. William Bernal

Corporate Medical Director

Appraisal and Revalidation

Dr. Ed Glucksman

Finance Report

Current Financial Year 2016/2017Previous Financial Year 2015/2016

Current Month 06 SeptemberPrevious Month 05 August

Enclosure Number (Enter number in C9) .

Contents

Financial SummarySurplus/(Deficit)IncomeOperating ExpenditureRun Rate (YTD)1617 Budget PhasingCost Improvement PlansCIP DeliveryCIP - PMO Green PhasingCashRolling Cash FlowStatement of Financial PositionAged DebtorsCapitalAgency ExpenditureWhole Time EquivalentsIncome by Commissioner ContractIncome Activity AnalysisQIPPSurplus / (Deficit) (By Division)

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Page 2 of 29

Finance Report

Month 06 (September) 2016/17

Finance Committee 25 October 2016

Page 3 of 29

Report to: Finance and Performance Committee

Date of meeting: 25th October 2016

Subject: Finance Committee Report – Month 06 (September 2016)

Author(s): Simon Dixon, Nicola Hoeksema, Rita Ragunath, Iris Lewis

Presented by: Colin Gentile, Chief Financial Officer

Sponsor: Colin Gentile, Chief Financial Officer

History: First submission to Finance and Performance Committee

Status: Decision/Discussion/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. This report covers the Income & Expenditure position, Cost Improvement Programme, Capital and Working Capital Plans.

2. Action required The Finance Committee is asked to approve the Finance Report

Page 4 of 29

Legal: Reporting to Monitor

Financial:Trust reports financial performance and position against published plan and notifies the committee of financial risks, cost pressures and action plans to mitigate any material variance from financial targets.

Assurance: The summary and appendices provide assurance that the Trust is meeting Financial targets (internal and those set by Monitor) 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: Financial Performance against annual plan, budgets, CIPs and Monitor Risk Ratings and Limits.

Strategy: Performance against the Trust’s Annual Plan including Risk Ratings

Workforce: There are implications for workforce recruitment in respect to service developments and vacancies.

Estates: There are implication on the Trust’s estates strategy.

Reputation: Finance Committee Report is provided to Monitor and Commercial Bankers as additional information to support the quarterly Monitor Return.

Other:(please specify) None.

3. Key implications

Page

Key Messages 5Summary 6Month 2 Surplus / (Deficit) £k 7Income 8Operating Expenditure 9Run Rate 104+8 forecast 1116/17 Annual Plan Budget Phasing 12Cost Improvement Plans 1316-17 CIP Programme Delivery Summary (£71M) 14PMO CIP Green Phasing 15Cash 1613 Week Cash Flow Forecast 17Statement of Financial Position (Balance Sheet) 18Aged Debtors 19Debtors Detail 20Bad Debt Provision 21Capital 22Agency Run Rate 23Agency Cap 24Whole Time Equivalents 25Income by Commissioner Contract 26Income Activity Analysis 27Surplus / (Deficit) (By Division) 28

Contents

Page 6 of 29

Income and Expenditure1

2

3

4

5

6

7

Cash9

Capital10

SPV relating to transformation programme - adverse variance of £2.5m (FYE £5m) Hep C CQUIN - adverse variance of £2m (FYE £4m)

The cumulative CIP achieved as at month 6 is £21.5m (annual risk-adjusted target £64m). The CIP adverse variance at month 6 (£3.9m) mainly relates to the FYE of 15/16 schemes (£2.7m) in 16/17 (a combination of pay and non-pay schemes related to proposed ward closures and Procurement schemes) and new schemes in 16/17 (£1.2m) (Drug cost savings, Private Patients income and agency savings through Medacs). The Trust has currently identified £46.6m PMO Green schemes for implementation against the £50m target for new schemes in 16/17.

At month 6 the Trust is estimated to be over-performing against the block contracts for Bromley and Bexley CCG due to high levels of Emergency activity and Critical Care activity. The Trust is under-achieving against “non-block” contracts (primarilly NHSE specialised services).

Expenditure Cost Pressures - adverse variance of £3.6m (excluding pass-through drugs and devices)

The Trust's 4+8 Financial Forecast (using month 4 actuals to forecast to year end) is shown on page 11. The comparison shows minimal difference at month 6 but the forecast reflects the back ended phasing of the CIPs, in particular, month 12 which assumes CCG support and a number of non-recurrent transactions. In order for the Trust to achieve this forecast, the run rate needs to improve significantly from month 7 in respect to delivering a further £42.5m CIPs, £27.6m mitigations, income catch-up on cost and volume contracts through improved operation performance and operational cost control. The forecast is still based on a best case scenario and contains minimum contingency. The Efficiency Board is now meeting weekly with the key focus on the delivery of CIP schemes and the monthly financial performance against the forecast recovery plan. The Trust is completing a year end forecast variance based on month 6 (6+6) forecast.

The Trust has drawn down £18.1m against its Working Capital Facility (WCF) in September and a further in £6.8m drawdown in October in order to maintain a minimum cash balance of £3m. The total value of the Working Capital Facility drawndown as at Month 7 2016/17 will be £80.7m (90%) against a current approved facility of £89.6m. As the WCF cannot be utilised to improve creditor payment days and the Trust's available cash is insufficient to maintain creditor days, outstanding debts are increasing. This is putting pressure on supplier relationships and impacting on operational delivery. The Trust is awaiting approval from NHSI of additional working capital support and Distressed Capital funding. The CFO has written to NHSI explaining the critical requirement for cash support in order not to impact on patient services.

The planned capital expenditure for 2016/17 of £71.189m was approved by the board and assumes additional distressed capital funding of £41m will be received from NHSI.The underspend of £8.8m against planned YTD spend at month 6 of £21.6m reflects the delay in confirmation of Distressed Capital funding from NHSI. Projects totalling £24m (including the additional bed capacity and ED projects £10.9m) have been started at risk prior to formal NHSI approval of the distressed capital funding.

STF - adverse variance of £15m (FYE £30m)

The Trust’s cumulative operating deficit at month 6 is £59.6m. This is an adverse variance of £33.6m against the year to date planned deficit of £26m. These figures exclude the estimated impairment costs of £5.15m to date.

The key cumulative variances at month 6 relate to:

The YTD variance is £33.5m and would be £19.5m if the income variances acknowledged by NHSI were excluded. These items are STF, SPV relating to Transformation Programme and Hep C CQUIN. These income losses have been phased equally across the year.

NHS Clinical Contract activity income - adverse by £6.5mCost Improvement plans - adverse variance of £4m

The run rate for month 6 was £8.7m (month 5 £9.7m). The run rate was averaging a monthly deficit of £10.8m in Q1 . In Q2 the monthly average has reduced to £9.1m . The NHSI agency cap for the Trust year to date was £15m and the Trust has spent £21.1m with increases predominately in medical and nursing staff categories.

Key Messages

Page 7 of 29

Finance Report Month 06 2016/2017 Summary

Surplus / (Deficit) £k R Income £k R Operating Expenditure £k R

Plan Actual Variance Plan Actual Variance Plan Actual VarianceYear to Date £k (26,036) (59,584) (33,547) Year to Date £k 550,821 532,153 (18,668) Year to Date £k (545,877) (560,780) (14,903)

Run Rate £k R Cost Improvement Plans £k R Capital £k R

M2Actual

M3Actual

M4Actual

M5Actual

M6Actual Plan Actual Variance Plan Actual Variance

Income £k 88,734 91,167 89,319 86,973 91,180 Year to Date £k 25,481 21,512 (3,969) Year to Date £k 21,616 12,804 8,812Pay £k (52,918) (54,465) (52,377) (54,105) (53,468)Non-Pay £k (44,903) (47,299) (45,718) (42,564) (46,450)Deficit £k (9,087) (10,597) (8,776) (9,696) (8,738)

Cash £k R Key Risks R Mitigating Actions RPlan Actual Variance

Year to Date £k 19,482 17,164 (2,318)

The Trust is reporting a £59.6m deficit at the end of M06 against a planned deficit of £26.0m resulting in a £33.6m adverse YTD variance. The current month position is a £8.7m adverse variance. There is an acknowledge income variance of £19.5m YTD (£3.3m in month) relating to the STF (£15m), Hep C CQUIN (£2m) and SPV for the transformation programme (£2.5m). The underlying deficit for 15/16 was £118m which equates to a monthly run rate deficit of circa £10m. The average run rate year to date was £9.9m.

The programme overall achieved 84% of its YTD target with the flow through element achieving 79% and the new schemes achieving 90%. The CIP programme as at M6 has had a total scheme slippage of £4m against target (16%). The programme slipped by £1.1M in M6. The key themes on YTD slippage are a combination of failed schemes in income; Private Patient and Overseas Visitors, compensation recovery optimisation' delayed implementations, failed recruitment implementation relating to agency reduction (TEAM) and wards/escalation beds remaining opened (TEAM and NWS). The key themes for in month slippage are HepC drug scheme, Overseas Visitors, failed implementation of ward closure at the PRUH (TEAM) and Chartwell and a delayed implementation of compensation recovery optimisation.

1. Mitigating CIP schemes totaling £7m of which 2 schemes are dependant on capital funding approval (Finance Leases and Windsor Walk) with a net benefit of £4m.2. Implementing operational plans to acheive growth and RTT activity3. Reduce agency spend through recruitment plans, master vendor suppliers to control agency rates and increased use of bank staff.

The M6 deficit of £8.7m is lower than last month’s £9.7, the average for the previous 5 months being £10.169m. Income has increased from last month by £4.2m primarily due to off-tariff drugs. Pay costs have reduced by £637k. A&C have reduced by £751k but offset by slight increase in nursing costs of £178k compared to last month. Agency costs have reduced by £221k compared to last month. Non-pay has increased by £3.9m, This is due to off-tariff drug and devices expenditure which is reflected in the increased income (£1.7m). The previous month non-pay was lower than usual due the Medirest payment of £2.5m under misc expenditure.

1. CIP achievement £51.5m new and £21m flow through. £67.4 approved 'greened' schemes to date (week ending 14/10/16)2. Income targets includes RTT backlog £4.8m and 2.3% growth, £20.7m.3. The key income risks will be the NHSE QIPP target for 16/17 (£7.7m) and Bromley CCG activity demand management (£3m). The Trust led CCG QIPP for Lambeth, Southwark and Bromley CCG's is £5.3m and this is embedded in the Block contract.4. Cost control measures re: agency spend5. Cash flow impacting on operational delivery

Month 6 is based on Month 5 spell/FCE activity and pro-rata for Month 5.Bromley, Lambeth & Southwark contracts have been agreed and are reflected within the plan. All other commissioners e.g. NHSE are based on KCH internal income proposals, although the NHSE contract for 16/17 has now been agreed.The adverse variance relates to clinical contract income, overseas visitors income and other operating income. The Trust is over-performing against the Bromley & Bexley CCG block contract values due to high levels of critical care activity.

Pay is breaking even at the end of M06 including £2.3m of CIP slippage (£2.1m 15/16 flow through). Admin and Clerical pay is underspent due to a number of vacancies. Nursing pay had a favourable movement in month.Nonpay is over spent due to clinical supplies and drugs (£11.6m) which is mostly offset by income, viapath contract overperformance (£3.5m) and bad debt provision (£2.1m). There is £920k of CIP slippage in M06 (£616k 15/16 flow through)

The planned capital expenditure for 2016/17 of £71.189m was approved by the board and assumes additional distressed capital funding of £41m will be received from NHSI.The underspend reflected at month 6 reflects the delay in confirmation of Distressed Capital funding from NHSI. Projects totalling £24m (including the additional bed capacity and ED projects £10.9m) have been started at risk prior to NHSI approval of the distressed capital funding. Other projects are on hold until external funding is confirmed.

The Trust has drawn down £18.110m against its Working Capital Facility in September 2016 and a further in £6.774 drawdown is planned for October in order to maintain a cash balance of £3m. The total value of the Working Capital Facility drawndown as at Month 7 2016/17 will be £80.698m (90%) against a current approved facility of £89.6m. As the WCF cannot be utilised to improve creditor payment days and the Trust's available cash is insufficient to maintain creditor days, outstanding debts are increasing. This is putting pressure on supplier relationships and risking availability of supplies.

The Trust is reporting a £59.6m deficit at the end of M06 against a planned deficit of £26.0m resulting in a £33.6m adverse YTD variance. The current month position is a £8.7m adverse variance. There is an acknowledge income variance of £19.5m YTD (£3.3m in month) relating to the STF (£15m), Hep C CQUIN (£2m) and SPV for the transformation programme (£2.5m). In respect to NHS clinical contract income : Off-tariff drugs and devices over-performance of £7.8m YTD; are being offset by activity income underperformance of £6.5m YTD. Pay is breaking even at the end of M06. Nonpay is over spent due to clinical supplies and drugs which is mostly offset by income, viapath contract overperformance and bad debt provision.

Page 8 of 29

Finance Report Month 06 2016/2017 Surplus / (Deficit) £k R

YTD Plan YTD ActualYTD

VarianceMvnt in Month

£k £k £k £kSurplus / (Deficit) (26,036) (59,584) (33,547) (8,693)

YTD Plan YTD ActualYTD

VarianceMvnt in Month

£k £k £k £kIncome 550,821 532,153 (18,668) (2,788)

Pay (319,333) (319,507) (175) (770) Underspent mainly in admin and clerical payNon-Pay (226,544) (241,272) (14,728) (5,260)

EBITDA * 4,944 (28,626) (33,571) (8,818)EBITDA % 0.9% -5.4%

Profit/Loss on Disposal of Fixed Assets (50) 29 79 24Interest Payable (14,662) (14,704) (42) 110Interest Receivable 66 57 (9) (5)Depreciation (13,163) (13,167) (4) (4)Impairments (5,150) (5,150) 0 0Public Dividend Capital (3,171) (3,171) 0 0Net surplus/(deficit) (31,186) (64,734) (33,547) (8,693)Reverse Impairment 5,150 5,150 0 0Performance against Control Total (26,036) (59,584) (33,547) (8,693)

Total (26,036) (59,584) (33,547) (8,693)Surplus/(Deficit) % -4.7% -11.2%

* EBITDA Earnings before Interest, Taxation, Depreciation and Amortisation

The Trust is reporting a £59.6m deficit at the end of M06 against a planned deficit of £26.0m resulting in a £33.6m adverse YTD variance. The current month position is a £8.7m adverse variance. There is an acknowledge income variance of £19.5m YTD (£3.3m in month) relating to the STF (£15m), Hep C CQUIN (£2m) and SPV for the transformation programme (£2.5m). In respect to NHS clinical contract income : Off-tariff drugs and devices over-performance of £7.8m YTD; are being offset by activity income underperformance of £6.5m YTD. Pay is breaking even at the end of M06 including £2.3m of CIP slippage (£2.1m 15/16 flow through). Admin and Clerical pay is underspent due to a number of vacancies. Nursing pay had a favourable movement in month.Nonpay is over spent due to clinical supplies and drugs (£11.6m) which is mostly offset by income, viapath contract overperformance (£3.5m) and bad debt provision (£2.1m). There is £920k of CIP slippage in M06 (£616k 15/16 flow through)See Appendix 3 for Divisional and Corporate Analysis.

£19.5m YTD (£3.3m in month) relating to the STF, Hep C CQUIN and SPV for the transformation programme

Clinical supplies and drugs which is mostly offset by income, viapath contract overperformance and bad debt provision

(15,000)

(10,000)

(5,000)

-

5,000

10,000

Apr-

16

May

-16

Jun-

16

Jul-1

6

Aug-

16

Sep-

16

Oct

-16

Nov

-16

Dec-

16

Jan-

17

Feb-

17

Mar

-17

£k

Deficit by Month 2016/17 Net Operating Deficit Actuals Net Operating Deficit Plan

Page 9 of 29

Finance Report Month 06 2016/2017 Income R

YTD Plan YTD Actual YTD VarianceMvnt in Month

£k £k £k £kTotal Income 550,821 532,153 (18,668) (2,788)

YTD Plan YTD Actual YTD VarianceMvnt in Month

£k £k £k £kCommissioning Contract Income 391,541 386,333 (5,208) (1,321)

NHS Acute: Drugs - Non Tariff 54,001 60,581 6,580 1,793NHS Acute: Devices - Non Tariff 6,970 8,206 1,236 (289)Other Clinical Income 3,001 (284) (3,286) (719) Prior year adjustments (estimate v actual variances) and patient data challenges.NHS Clinical Contract Income Total 455,513 454,836 (677) (537)RTA Income 2,813 2,466 (347) (555)Other NHS Clinical Income 2,837 1,950 (887) (332) Provider to Provider income not recovered as per last year (e.g. Fetal Medicine service).Private Patient Income 7,675 7,477 (199) (334)Overseas (Reciprocal & Non-Reciprocal) 3,866 3,439 (427) 19 Plans in place to recover prior months activity as patient identification systems are improved.Education & Training Income 23,597 23,415 (182) 42Research & Development Income 6,707 6,912 205 (26)Other Operating Income 47,813 31,658 (16,154) (1,064)

Total Trust Income 550,821 532,153 (18,668) (2,788)

There is an acknowledge income variance of £19.5m YTD (£3.3m in month) relating to the STF (£15m), Hep C CQUIN (£2m) and SPV for the transformation programme (£2.5m). In respect to NHS clinical contract income : Off-tariff drugs and devices over-performance of £7.8m YTD; are being offset by activity income underperformance of £6.5m YTD.

Underperformance against NHSE activity growth target. Offset by an overacheivement against off tariff drugs and devices. NHSE contract restrictions (MRET, Marginal rate).

Pass through payments to Commissioners offsetting expenditure over-spends.

£19.5m YTD (£3.3m in month) relating to the STF, Hep C CQUIN and SPV for the transformation programme

80,000

85,000

90,000

95,000

100,000

105,000

Apr-

16

May

-16

Jun-

16

Jul-1

6

Aug-

16

Sep-

16

Oct

-16

Nov

-16

Dec-

16

Jan-

17

Feb-

17

Mar

-17

£k

In Month Income 2016/17 Actual Plan

Page 10 of 29

Finance Report Month 06 2016/2017 Operating Expenditure R

YTD Plan YTD ActualYTD

VarianceMvnt in Month

£k £k £k £kPay (319,333) (319,507) (175) (770)Non-Pay (226,544) (241,272) (14,728) (5,260)Operating Expenditure (545,877) (560,780) (14,903) (6,029)

YTD Plan YTD ActualYTD

VarianceMvnt in Month

£k £k £k £kPay

Nursing & Midwifery (125,614) (126,078) (463) 337 CIP not being achieved. TEAM follow through CIPS from prior year (wards not closed).Medical & Dental Staff (101,351) (102,935) (1,584) (515) Agency spend up and backdated banding payments.Administration & Clerical / Senior Managers (52,919) (50,568) 2,351 414 Holding vacancies.PAMS / Scientific / Professional (39,448) (39,927) (478) (1,007) Agency spend up

Total Pay (319,333) (319,507) (175) (770)Non-Pay

Drugs (incl. Medical Gases) (66,210) (73,541) (7,331) (3,111) Off -tariff drugs increase, QIPP/CIP review and revenue capture review.Supplies & Services - Clinical (47,098) (50,961) (3,863) (1,497) Off -tariff devices increase, CIP non-achievement and also stock levels to be reviewed.Supplies & Services - General (1,869) (1,915) (47) 168Establishment Expenses (3,041) (2,892) 149 (97)Transport Expenses (4,536) (4,067) 469 (91)Premises (19,088) (18,370) 718 584Purchase of Healthcare from Non-NHS Provider (13,661) (17,158) (3,497) (2,532) Independent sector and Pathology service. Services from other NHS Bodies (27,870) (27,504) 366 393Consultancy (6,759) (7,186) (427) (88)Private Finance Initiative (25,910) (25,427) 483 116 Favourable due to VINCI costs being transferred out of PRUH revenue into Capital Other Non-Pay/Reserves (10,502) (12,250) (1,748) 894 Bad debt provision increase from prior year (£2.1m) and current year impact.

Total Non-Pay (226,544) (241,272) (14,728) (5,260)Total Expenditure (545,877) (560,780) (14,902) (6,029)

Pay is breaking even at the end of M06 including £2.3m of CIP slippage (£2.1m 15/16 flow through). Admin and Clerical pay is underspent due to a number of vacancies. Nursing pay had a favourable movement in month.Nonpay is over spent due to clinical supplies and drugs (£11.6m) which is mostly offset by income, viapath contract overperformance (£3.5m) and bad debt provision (£2.1m). There is £920k of CIP slippage in M06 (£616k 15/16 flow through)

Page 11 of 29

Finance Report Month 06 2016/2017 Run Rate R

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16£k £k £k £k £k £k

Deficit (13,548) (9,945) (11,455) (9,634) (10,554) (9,596)Impairment 858 858 858 858 858 858Operating Deficit (12,690) (9,087) (10,597) (8,776) (9,696) (8,738)

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16£k £k £k £k £k £k

Income 84,780 88,734 91,167 89,319 86,973 91,180

PayAdministration & Clerical / Senior Managers Agency (717) (743) (648) (692) (790) (775)

Bank (223) (230) (272) (259) (258) (262)substantive (7,310) (7,288) (7,339) (7,308) (8,097) (7,357)

Medical & Dental Staff Agency (870) (1,104) (1,440) (1,290) (1,329) (1,162)Bank (384) (486) (513) (438) (508) (468)substantive (15,325) (15,620) (15,462) (15,100) (15,526) (15,910)

Nursing & Midwifery Agency (878) (872) (963) (1,099) (1,090) (1,126)Bank (2,409) (2,295) (2,572) (2,577) (2,620) (2,549)substantive (17,557) (17,336) (17,872) (17,441) (17,493) (17,329)

PAMS / Scientific / Professional Agency (343) (762) (849) (570) (548) (473)Bank (190) (158) (246) (196) (194) (165)substantive (5,967) (6,023) (6,290) (5,408) (5,652) (5,892)

Total Pay (52,174) (52,918) (54,465) (52,377) (54,105) (53,468)Non-PayDrugs (12,631) (11,848) (12,384) (12,273) (11,509) (12,896)Supplies & Services - Clinical (8,819) (8,412) (9,420) (7,621) (8,217) (8,473)Non-Clinical Supplies (4,512) (4,704) (4,497) (4,248) (5,102) (4,181)Purchase of Healthcare from Non-NHS Provider (2,355) (2,651) (3,043) (3,008) (3,172) (2,929)Services from other NHS Bodies (4,601) (4,597) (4,837) (4,673) (4,586) (4,210)Consultancy (626) (798) (1,195) (1,849) (1,504) (1,213)Private Finance Initiative (4,716) (4,609) (4,701) (4,720) (1,874) (4,808)Other Non-Pay/Reserves (1,784) (2,030) (1,962) (2,094) (1,489) (2,891)

Total Non-Pay (40,044) (39,649) (42,038) (40,486) (37,453) (41,601)

Total Financing (6,111) (6,111) (6,118) (6,090) (5,969) (5,707)

Deficit (13,548) (9,945) (11,455) (9,634) (10,554) (9,596)Impairment 858 858 858 858 858 858Operating Deficit (12,690) (9,087) (10,597) (8,776) (9,696) (8,738)

Non Recurrent ItemsNon Recurrent PRUH Financial Support (700) (700) (700) (700) (700) (700)Non Recurrent CIPs (60) (154) (436) (530) (3,047) (229)

Total Non Recurrents (760) (854) (1,136) (1,230) (3,747) (929)Underlying Run Rate Deficit (13,450) (9,941) (11,733) (10,006) (13,443) (9,667)

The M6 deficit of £8.7m is lower than last month’s £9.7, the average for the previous 5 months being £10.169m. Income has increased from last month by £4.2m but this is primarily due to off-tariff drugs which is a pass through cost. Pay costs have marginally reduced by £637k. A&C have reduced by £751k but offset by slight increase in medical costs of £178k compared to last month. Agency costs have only marginally reduced by £221k compared to last month. Non-pay has increased by £3.9m, This is due to off-tariff drug and devices expenditure which is reflected in the increased income (£1.7m). The previous month non-pay was lower than usual due the Medirest payment of £2.5m under misc expenditure.

Page 12 of 29

Finance Report Month 06 2016/2017 4+8 Forecast R

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 CumulativeActual Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Clinical Income 72,166 75,473 79,077 76,089 73,416 76,238 77,691 76,871 74,759 77,553 76,801 79,277 915,409Non-Clinical Income 12,487 13,114 11,763 12,543 13,053 13,053 13,173 13,173 13,173 13,173 13,173 14,338 156,215

Total Income 84,653 88,588 90,840 88,631 86,469 89,290 90,863 90,044 87,932 90,725 89,974 93,615 1,071,623Total Pay (53,665) (54,483) (55,585) (53,981) (55,331) (55,331) (55,082) (55,082) (55,082) (55,083) (55,083) (55,083) (658,871)Total Nonpay (47,275) (47,351) (49,512) (47,742) (47,331) (47,997) (46,921) (46,921) (46,537) (46,537) (46,537) (44,539) (565,201)

Flow Through CIP 1,918 2,239 1,437 1,403 1,539 1,236 672 624 541 452 401 1,510 13,97216/17 CIP 820 1,062 1,365 2,055 4,905 3,167 5,608 3,673 3,605 4,238 4,415 15,102 50,015Mitigations 0 0 0 0 0 3,463 3,463 3,463 10,388Additional Recovery Actions 0 214 214 214 214 214 214 15,916 17,200

Deficit (13,548) (9,945) (11,455) (9,634) (9,749) (9,420) (4,646) (7,449) (9,327) (2,529) (3,154) 29,983 (60,874)Impairment 858 858 858 858 858 858 858 858 858 858 858 858 10,296

(12,690) (9,087) (10,597) (8,776) (8,891) (8,562) (3,788) (6,591) (8,469) (1,671) (2,296) 30,841 (50,578)

Operating Deficit (Actual) (12,690) (9,087) (10,597) (8,776) (9,696) (8,738)

Cumulative Deficit (Forecast) (12,690) (21,777) (32,374) (41,150) (50,041) (58,603) (62,392) (68,983) (77,452) (79,123) (81,419) (50,578)

Cumulative Deficit (Actual) (12,690) (21,777) (32,374) (41,150) (50,846) (59,584)

Operating Deficit (Forecast)

Page 13 of 29

Finance Report Month 06 2016/2017 16/17 Annual Plan Budget Phasing

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Cumulative£k £k £k £k £k £k £k £k £k £k £k £k £k

ThemesIncome 87,182 91,092 94,447 93,778 89,375 95,465 99,502 96,321 89,287 95,092 92,827 96,553 1,120,922Pay (53,942) (54,961) (54,436) (55,091) (54,820) (54,363) (55,323) (55,856) (55,884) (55,510) (55,360) (56,127) (661,672)Nonpay (47,524) (46,958) (47,039) (46,344) (44,778) (43,652) (46,101) (45,996) (45,659) (44,720) (43,371) (41,313) (543,454)Flow Through CIP 2,430 2,299 2,126 2,634 2,288 1,992 1,351 1,327 1,209 1,079 1,016 1,003 20,75316/17 CIP 805 1,084 1,221 1,483 1,576 1,745 6,293 6,346 6,581 7,120 7,188 10,057 51,500

Deficit (11,048) (7,445) (3,681) (3,540) (6,358) 1,188 5,722 2,143 (4,465) 3,059 2,301 10,172 (11,951)Impairment 858 858 858 858 858 858 858 858 858 858 858 858 10,296

Operating Deficit (10,190) (6,587) (2,823) (2,682) (5,500) 2,046 6,580 3,001 (3,607) 3,917 3,159 11,030 (1,655)

Source: Extracted from Annual Plan re-submission which reflects deficit position for months 1-3The phasing will be adjusted as the CIP delivery plans are materialised in robust and accountable schemes.

0

1000

2000

3000

4000

5000

6000

7000

8000

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

CIP Monthly Phasing

Flow Through CIP

16/17 CIP

0

10,000

20,000

30,000

40,000

50,000

60,000

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

Cummulative Total CIP

Flow Through CIP

16/17 CIP

-80000

-60000

-40000

-20000

0

20000

40000

60000

80000

100000

120000

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

I&E

Income

Pay

Nonpay

Operating Deficit

Page 14 of 29

Finance Report Month 06 2016/2017 Cost Improvement Plans R

Year to Date Plan Actual Variance£k £k £k

Cost Improvement Plans 25,481 21,512 (3,969)

£k £k £kThemesIncome

NHS Commissioner (NHSE) 1,368 1,165 (203)NHS Commissioner (CCG) 398 369 (29)NHS Provider to Provider 223 223 (0)Private Patient 702 334 (369)Other Operating 664 531 (133)

Research And Development 0 0 0Training & Education 20 20 0

Total Income CIPs 3,375 2,641 (734)Pay

Administrative and Clerical Staff Reduction 1,958 1,897 (61)Medical Staff Reduction 451 414 (37)Nursing Staff Reduction 3,313 2,110 (1,203)Prof & Tech/PAMS/Other Reduction 1,198 1,180 (17)Procurement 185 650 465Recruitment - Agency Reduction 1,235 544 (690)VAT 24/7 Payroll Service 825 740 (84)Nurse Rotas 671 339 (332)Vacancy Freeze 276 147 (129)Theatre Savings 235 235 0Reducing Clinical Services 1 1 0Medical Job Planning 671 444 (227)

Total Pay CIPs 11,017 8,701 (2,316)Non-Pay Capital 0 0 0 Clinical Supplies and Services 907 849 (58) Contracting Services Out 9 9 (0) Drugs 1,260 998 (262) Establishment Expenses 180 134 (46)

External Contract staffing and Consultants 3,079 3,079 0General Supplies and Services 148 148 (0)Miscellaneous 604 480 (124)Non-Clinical Spend Reduction 85 85 0Premises and Fixed Plant 1,089 1,089 (0)Reserves 0 0 0Reducing Services 141 127 (14)Services Provided by non-NHS bodies 1,671 1,671 0Sub Contracted Healthcare - NHS bodies 375 375 (0)Transport and Moveable Plant 152 152 0Procurement 1,389 973 (417)

Total Non-pay CIPs 11,090 10,170 (920)Efficiency Plan Total 25,481 21,512 (3,969)

£k £k £k

Ambulatory 2,998 2,979 (20)CCTD 4,118 4,116 (2)Pathology 0 0 0TEAM 3,575 1,809 (1,766)LRS 2,514 1,437 (1,077)NWS 3,420 2,875 (544)W&C 1,886 1,907 21Facilities 3,558 3,558 (0)Corporate 3,412 2,832 (581)

Efficiency Plan Total 25,481 21,512 (3,969)

The programme overall achieved 84% of its YTD target with the flow through element achieving 79% and the new schemes achieving 90%. The CIP programme as at M6 has had a total scheme slippage of £4m against target (16%). The programme slipped by £1.1M in M6. The key themes on YTD slippage are a combination of failed schemes in income; Private Patient and Overseas Visitors – £352k, compensation recovery optimisation – £123k delayed implementations , failed recruitment implementation relating to agency reduction (TEAM) and wards/escalation beds remaining opened (TEAM and NWS).The key themes for in month slippage are HepC drug scheme, Overseas Visitors, failed implementation of ward closure at the PRUH (TEAM) and Chartwell and a delayed implementation of compensation recovery optimisation.

Page 15 of 29

Finance Report Month 06 2016/2017 16-17 Programme Delivery Summary (£71M) R

Plan Actual Variance£k £k £k % Achievement

In Month 4,338 3,235 (1,103) 75%Year To Date 25,481 21,512 (3,969) 84%

The information on this report includes all schemes sent across to finance as at 26/09/2016. The programme has converted more schemes since that time so the numbers will not reconcile against the weekly KPI report.The programme in M6 slipped by £1.1M. Overall the programme is achieving 84% of its YTD target with the flow through element achieving 79% and the new schemes achieving 90%. The in month achievement was 75%.The CIP programme as at M6 has had a total scheme slippage of £4M against target (16%) of which £2.7M is slippage from the flow through and £1,231k is slippage from the new schemes. The total slippage is made up of Income (£734k), Pay (£2,316k) and Non pay (£919k).The key themes on YTD slippage are a combination of failed schemes in income; Private Patient and Overseas Visitors – £352k, compensation recovery optimisation – £123k delayed implementations , failed recruitment implementation relating to agency reduction (TEAM) and wards/escalation beds remaining opened (TEAM and NWS).The key themes for in month slippage are HepC drug scheme, Overseas Visitors, failed implementation of ward closure at the PRUH (TEAM) and Chartwell and a delayed implementation of compensation recovery optimisation.

Page 16 of 29

Finance Report Month 06 2016/2017 PMO Green Phasing R

M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 TotalIncome 46 86 84 241 232 228 196 196 187 152 152 152 1,952 Pay 1,430 1,418 1,304 1,663 1,433 1,210 766 755 662 599 540 529 12,309 Non Pay 954 795 738 327 523 453 288 275 258 227 222 1,432 6,492 Total: 2,430 2,299 2,126 2,231 2,188 1,891 1,250 1,226 1,108 978 915 2,113 20,753 Income 223 202 419 523 560 580 540 566 520 591 652 5,330 10,705 Pay 304 281 348 589 691 639 761 823 867 933 936 1,470 8,641 Non Pay 523 783 815 979 3,713 2,007 4,342 1,831 1,937 1,935 2,942 5,443 27,251 Total: 1,050 1,265 1,582 2,091 4,964 3,226 5,642 3,220 3,325 3,458 4,530 12,243 46,598

3,480 3,564 3,708 4,322 7,152 5,118 6,892 4,446 4,432 4,436 5,445 14,355 67,351 Grand Total:

A total of £67.4M has been signed off as ‘PMO Green’ from the programme as at the 19th October made up of both flow through schemes from 15/16 and new schemes from this financial year. The phasing is shown on the left graph below. There remains approx. £6.3M in pre-pod and POD received status which continue to be worked up. The graph on the right shows the current phasing against the phasing that was submitted on the trusts annual plan. Note all the above has not been removed from financial budgets yet as a large proportion was converted during month 7.

16/17 PMO Green Phasing

15-1

6 FY

E Sc

hem

es16

-17

New

Sc

hem

es

Original

Revised

0

2000

4000

6000

8000

10000

12000

14000

M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12

Phasing Split By Type

15-16 FYE Schemes 16-17 New Schemes

02000400060008000

10000120001400016000

M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12

Combined 16/17 'PMO Green' Phasing

16/17 PMO Green Phasing 16-17 Annual Plan Phasing 16-17 Annual Plan Phasing

Page 17 of 29

Finance Report Month 06 2016/2017 Cash R

Year to Date Plan Actual Variance£k £k £k

Cash Balance 19,482 17,164 (2,318)

Year to Date Plan Actual Variance£k £k £k

EBITDA 4,151 (6,922) (11,073)Movement in Working Capital (1,831) (2,189) (358)Provisions (825) (324) 501

Cash flow from Operations 1,495 (9,435) (10,930)Capital Expenditure (12,989) (2,746) 10,243Cash Receipt from Asset Sales 0 15 15Other Cash Flows from Investing Activities 11 6 (5)

Cash Flow before Financing (11,483) (12,160) (677)PDC Received 0 600 600PDC Repaid 0 0 0Dividends Paid (3,672) (930) 2,742Interest on Loans and Leases (1,959) (2,994) (1,035)Drawdown of Debt 15,856 18,110 2,254Repayment of Debt (325) (325) 0Other Cash Flows from Financing Activities 250 0 (250)

Cash Flow from Financing 10,150 14,461 4,311Net Cash Inflow/(Outflow) (1,333) 2,301 3,634

Opening Cash Balance 20,815 14,863 (5,952)Closing Cash Balance 19,482 17,164 (2,318)

The Trust has drawn down £18.1m against its Working Capital Facility in September and a further in £6.8m drawdown is planned for October in order to maintain a cash balance of £3m. This will bring the total value drawndown against the Working Capital Facility to £80.7m. (90% of the approved Working Capital Facility).

At month end the Trust’s cash balance was £5.9m below plan due to reduced drawdown.

The Trust has recorded higher deficit than anticipated during the month. The payable balances remains high as the Trust cannot use the working capital facility to un-wind its payables, putting pressure on supplier relationship and price negotiations. Capital expenditure for month 6 was £8.8m below plan due to delay in capital plan approval and NHSI capital funding not yet agreed.

Page 18 of 29

Finance Report Month 06 2016/2017 Rolling Cash Flow (13 Week) R

Week ending 30-Sep-16 07-Oct-16 14-Oct-16 21-Oct-16 28-Oct-16 04-Nov-16 11-Nov-16 18-Nov-16 25-Nov-16 02-Dec-16 09-Dec-16 16-Dec-16 23-Dec-16Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast

£k £k £k £k £k £k £k £k £k £k £k £k £k

Balance B/F 22,325 17,965 39,719 75,903 47,058 14,703 33,250 18,174 29,894 (4,746) 14,495 3,074 9,805Receipts (inflows)

LSB receipts 1 27,519 0 0 0 27,471 0 100 0 27,471 0 50 0SLA receipts 2,060 385 11,430 0 0 1,026 0 13,653 0 146 0 13,653 0Patient SLA Over performance 2014/2015 (60) 0 0 0 0 0 0 0 0 0 0 0 0Patient SLA Overperformance 2015/2016 1 (61) 0 0 0 0 0 0 0 0 0 0 0Private Patients receipts 457 340 300 300 300 300 300 300 300 300 300 300 300Training & Education receipts 0 0 10,901 0 0 0 0 0 0 0 0 0 0NHSE Inflows 0 1,056 29,442 0 0 7,158 0 31,640 0 0 0 31,640 0DoH - National RTT, ED Monies & Project Diamond 0 0 0 0 0 0 0 0 0 0 0 0 0VAT reclaims 0 2,853 0 0 0 1,900 0 0 0 4,320 0 0 0Other 2,960 4,432 1,432 630 380 4,994 580 6,546 380 430 5,538 953 380

Total Receipts 5,419 36,524 53,505 930 680 42,849 880 52,239 680 32,667 5,838 46,596 680Payments (outflows)

Pay monthly (incl Pay Awards) 56 155 0 0 24,275 0 70 0 24,275 0 70 0 24,275PAYE/NIC/SUPER (CHAPS) 0 0 0 20,154 0 0 0 20,075 0 0 0 20,075 0Agency Spend 1,332 1,161 1,398 1,257 1,495 1,180 1,505 1,300 1,300 1,300 1,300 1,300 1,300PFI project 0 4,245 0 4,100 0 4,300 0 4,100 0 4,300 0 4,100 0Trade Creditors 5,696 5,394 6,606 6,325 5,354 5,325 5,375 5,325 5,383 5,325 5,401 5,325 5,378Other 2,414 3,157 9,141 4,265 1,845 10,828 8,176 9,446 1,120 2,080 9,732 7,686 1,400

Total Payments 9,498 14,112 17,145 36,101 32,969 21,633 15,126 40,246 32,078 13,005 16,503 38,486 32,353Cash from operations (4,079) 22,412 36,360 (35,171) (32,289) 21,216 (14,246) 11,993 (31,398) 19,662 (10,665) 8,110 (31,673)Capital & Financing Items

Capital expenditure (outflow) 283 658 176 448 66 2,669 830 273 3,242 421 756 1,127 3,136PDC Dividends (TDR) (outflow) 0 0 0 0 0 0 0 0 0 0 0 0 0Revolving Working Capital Facility 0 0 0 (6,774) 0 0 0 0 0 0 0 0 0Interest Paid on Revolving Credit Facility 0 0 0 0 0 0 0 0 0 0 0 0 0

Loans Repaid (outflow) 0 0 0 0 0 0 0 0 0 0 0 225 1,709Interest on Loans (outflow) 0 0 0 0 0 0 0 0 0 0 0 27 876Other (inflow) (2) 0 0 0 0 0 0 0 0 0 0 0 0Total Capital & Financing 281 658 176 (6,326) 66 2,669 830 273 3,242 421 756 1,379 5,721Net Inflow / Outflow (4,360) 21,754 36,184 (28,845) (32,355) 18,547 (15,076) 11,720 (34,640) 19,241 (11,421) 6,731 (37,394)Forecast Balance C/F 17,965 39,719 75,903 47,058 14,703 33,250 18,174 29,894 (4,746) 14,495 3,074 9,805 (27,589)

The rolling cash flow forecasts forward for a 13 week period currently to the 4th Week of December.The 13 week cash flow allows the Trust to forecast its requirement for drawdown against the agreed Workng Capital Facility over the following 2 months.

17,965

39,719

75,903

47,058

14,703

33,250

18,174

29,894

(4,746)

14,495

3,074 9,805

(27,589)

(40,000)

(20,000)

0

20,000

40,000

60,000

80,000

100,000

30-Sep-16 07-Oct-16 14-Oct-16 21-Oct-16 28-Oct-16 04-Nov-16 11-Nov-16 18-Nov-16 25-Nov-16 02-Dec-16 09-Dec-16 16-Dec-16 23-Dec-16

Forecast Weekly Cash Balance (Before Forecast Drawdown)

Page 19 of 29

Finance Report Month 06 2016/2017 Statement of Financial Position (Balance Sheet)

Year to Date 31-Mar-16Actual Plan Actual Variance Notes

£k £k £k £kProperty, Plant & Equipment 532,001 547,694 525,849 (21,845) 1Intangible Assets 3,670 3,027 4,351 1,324Other Assets 11,145 10,950 10,596 (354)

Non Current Assets 546,816 561,671 540,796 (20,875)Inventories 17,748 19,200 9,461 (9,739)Trade & Other Receivables 118,917 113,973 164,628 50,655 2Cash and Cash Equivalents 18,982 20,815 17,164 (3,651) 4

Current Assets 155,647 153,988 191,253 37,265Trade and Other Payables (151,607) (136,131) (163,272) (27,141) 3Borrowings (7,960) (74,592) (78,002) (3,410) 4Other Financial Liabilities 0 0 0Provisions (1,473) (1,613) (1,153) 460Other Liabilities (10,139) (7,000) (22,471) (15,471)

Current Liabilities (171,179) (219,336) (264,898) (45,562)Borrowings (314,651) (312,216) (314,652) (2,436)Other Financial Liabilities 0 0 0 0Provisions (5,455) (5,000) (5,455) (455)

Non Current Liabilities (320,106) (317,216) (320,107) (2,891)TOTAL ASSETS EMPLOYED 211,178 179,107 147,044 (32,063)Financed by:

Public Dividend Capital (223,838) (223,838) (224,438) (600)Retained Earnings 109,055 141,124 173,789 32,665Revaluation Reserve (96,395) (96,393) (96,395) (2)

TOTAL TAXPAYERS' EQUITY (211,178) (179,107) (147,044) 32,063

The Statement of Financial Position reflects changes in asset values as well as movements in liabilites. The plan figures reconcile to the Annual Plan submitted to Monitor in June 2016.

Year to Date

1. Capital expenditure is behind plan at month 5 due to delay in NHSI approval of Distressed Capital funding. Once funding is confirmed planned projects will commence.2. Trade and Other Receivables balances are above plan due mainly to the following: £11.4m raised to HEE for Q3 Education Funding, £7.6m raised to KIFM , £3.1m raised to Compass Group and £13m WIP 3. Trade and Other Payables continue to increase due to restricted cash availability and restrictions in place on the use of the Working Capital Facility to reduce outstanding Creditor balances. Other Liabilities includes deferred income of £16m of which £11m is for Training and Education as we have received Q3 in advance.4. The differences in Inventory is due to the transfer of the Trust stock to KIFM in September.

Page 20 of 29

Finance Report Month 06 2016/2017 Aged Debtors

Invoiced Debtors Within Terms

1 Month Overdue

2 Month Overdue

3 Month Overdue

Total Current Month Prior Month Notes

Other ReceivablesNotes

Current Month Prior Month

1-30 Days

31-60 Days

61-90 Days

Over 90 Days Over 30 Days Over 30 Days £k £k

£k £k £k £k £k £k £kCCG's/NHSE 6,616 9,983 4,899 2,655 24,153 17,537 10,808 1 Accrued IncomeTrusts 1,808 510 489 4,916 7,723 5,915 6,531 2 Work in Progress 17,750 17,750Other NHS 11,825 186 77 730 12,818 993 1,270 CCG/NHSE SLAs 4 4,714 1,990Other Debtors 9,851 6,509 2,670 10,994 30,024 20,173 15,154 Injury Cost Recovery Fund 3,656 3,047Private Patients 660 769 349 2,316 4,094 3,434 2,946 NHSE Drugs Accrual 5 5,540 5,385Overseas Visitors 506 293 751 8,626 10,176 9,670 9,512 Clinical Income accrual 10,240 6,771Total Invoiced Debtors 9,874 9,315 4,782 31,697 88,988 57,722 46,221 KIFM 8,320 5,194.00

Other 7,630 9,259Provision for Bad Debts (Incl. RTA Provision) (10,570) Total Accrued Income 57,850 49,396Accrued Income 57,850Prepayments 6,913Other Debtors 20,099Total Trade & Other Receivables 163,280

5. NHSE Drugs accrual - Monthly accruals relating to months 4-6. Data validation was in progress resulting in increased accrual values. Months 1 to 3 have been invoiced.

The Trust debtors are mixture of invoiced debtors, accrued income and prepayments. The level of invoiced debtors' balance has increased by £20.4m and private and overseas patients balance has increased by £0.5m. Overdue debts (those >30 days old) has increased by £11.5m.

1. CCG's/NHSE - Outstanding debt has increased by £0.8m during the month. Debts over 30 days old has increased by £6.7m due to more drug and overperformance invoices due from NHSE becoming overdue at 2. Other NHS - Outstanding debt has increased by £11.4m due to Q3 education funding invoice raised in advance to HEE to ensure prompt payment.3. Other debtors - Outstanding debt has increased by £7.6m due to invoices raised to KIFM. Overdue debt has increased by £5m (£3.1m of this due from Compass group was paid in Month 7).4. CCG SLA Accruals - this includes accruals for 50% CQUIN (£2m) and contract SLA accrual (£2.7m) as at Month 6

Page 21 of 29

Finance Report Month 06 2016/2017 Debtor Detail

Organisation Over 30 daysNHS Organisations

NHS England (Central) £15.9m

CCGs £1.9mNEL CSU (12 CCGs) £0.111mWest Sussex CSU (7 CCGs) £0.849mCambridge and Peterborough CCG £0.043mSlough CCG £0.590mSwale CCG £0.175mGuildford & Waverley CCG £0.067mBedfordshire CCG £0.66m

NHS Trusts £4.6mLewisham and Greenwich NHS Trust £1.336mGuys & St Thomas NHS Foundation £1.711mDartford & Gravesham NHS FT £0.624m

Oxleas NHS FT £0.483m

Maidstone & Tunbridge Wells NHS Trust

£0.336m

South London and Maudsley NHS FT £0.149m

Other NHS Bodies £1.933m

TOTAL NHS ORGANISATIONS £24.333m

Non-NHS Organisation

Viapath LLP £3.6mKCH Commercial Services Ltd £2.7mKings College London £2.5mBromley CIC £0.779mISS Mediclean £1mSainsburys £0.321m

Councils £0.637m

Compass Group £3.1m

Other Non-NHS Bodies £3.333m

KCH INTERVENTIONAL FACILITY MGMT LLP KIFM

£1.442m

TOTAL NON-NHS ORGANISATIONS £19.412m

Some accounts in credit, the remainder are reviewing backing dataContracts working through PLD queriesContracts reviewing PLD and advising if credits needed

£2.269m relates to Month 2 Freeze data for 2016/17 NHSE have raised a number of queries, contracts reviewing

August Invoices - detailed here due to size of debtPayment to be agreed once bank accounts fully functioning

No payment is being received from KCS LtdReciporal payment agreement in place. KCH pay more to KCL weeklyContracts have been in contact with local CCG for help in resolving ongoing issuesTo be referred to Business Analyst to follow up with contract parties.

Contracts to review against PLD for remaining 15/16 & 16/17 invoices Contracts to review against PLD for remaining 15/16 & 16/17 invoices

Reciprocal payments agreement in place. KCH payments higher.

Credit of £84k raised remainder agreed payment date 15.10.16

£515k relates to BEXLEY AND GREENWICH CERVICAL OF 2015 / 16

August Invoice - detailed here due to size of debt Agreed payment 3.10.16

Disputes relating to the set tariff rates agreed by South East CSU. Queries have been referred to Contracts to provide proof of agreements in place. With regards to two councils, we are pursuing urgent resolution and are looking to charge interest on the outstanding debt.

Payment not being recieved due to outstanding invoices owed to Sainsburys

Director of Finance has issued a letter confirming withdrawal of Neurosciences services if invoices are not paid. M&TW have agreed to pay, but receipt of payments has been slow.Reciprocal payments agreement in place and payments being made weekly. KCH payments higher.

Credit team chasing organisation for payment

Rental for Beckenham Beacon as well Community Diabetes Service invoices are Invoice against contract raised in March; invoice still to be approved for payment by ISS

PLD queries 15/16 & Mths 1 - 3 16/17Challenges relating to patient identifiable data Mths 1 - 3 16/17Challenges raised against 15/16 & 16/17 NCA invoices

Relates to various invoices against multiple NHS organisations

Challenges relating to freeze dataChallenges relating to patient identifiable dataChallenges relating to patient identifiable data

Qtr 1-3 Freeze invoices for 2016/17

KCH owe KCL £2.5m

Reciprocal payments agreement in place. KCH returning payments to GSTT when received

Contracts attempting to resolve outstanding challenges, looking to return to SLA contracts Contracts to review against PLD for remaining 15/16 & 16/17 invoices

Periodic reciprocal payments are agreed to reduce this balance.

KCH has agreed weekly payments to D&G to reduce outstanding balance. No payments being received from D&G.KCH has agreed weekly payments to Oxleas to reduce outstanding balance. No payments being received from Oxleas.

KCH owe Viapath £3.6mKCH owe KCS Ltd £46k

Neurosciences invoices disputed by M&TW, do not agree that these invoices should be paid as included in contract. KCH disagree.KCH owe SLAM £232k

KCH owe Sainsburys £5.2m

KCH owe L&G £3.043mKCH owe GSTT £2.696mKCH owe D&G £2.068m

KCH owe Oxleas £2.086m

Finalising contract amount, invoice will then be cancelled and re-issued for correct amount

£480k relates to Overseas Patients 15/16 debts - specific details required by NHSE£849k relates to Cancer Drugs Fund for Jun-Jul 2016£1.226m relates to Month 1 Freeze data for 2016/17£464k relates to NHS Area Teams NCA data for 2015/16£5.544m relates to SOFOSBUVIR - Months 1-6 2016

Final letter sent to NHSE, awaiting responseAgreed payment date 1.10.16NHSE have raised a number of queries, contracts reviewingQueries on backing data and finalisation of year end figures

Resolutions and Follow up

Contracts Department is currently discussing with NHSE regarding backing data for these invoices

£3.601m relates to Month 3 Freeze data for 2016/17

Issue

£900k relates to IFRs 15/16 - current dispute on how these are being invoiced.

NHSE have raised a number of queries, contracts reviewing

Page 22 of 29

Finance Report Month 06 2016/2017 Bad Debt Provision

M1 16/17£'000

M2 16/17£'000

M3 16/17£'000

M4 16/17£'000

M5 16/17£'000

M6 16/17£'000

Provision For Bad Debts : Current Year 244 377 488 913 1,297 1,731

Provision For Bad Debts : Prior Year 2,124 2,124 2,124 2,484 2,736 2,124

2,368 2,501 2,612 3,397 4,033 3,855

23% 28% 28% 35% 41% 38%

M1 16/17£'000

M2 16/17£'000

M3 16/17£'000

M4 16/17£'000

M5 16/17£'000

M6 16/17£'000

Provision For Bad Debts : Current Year 25 50 75 100 125 150

Provision For Bad Debts : Prior Year 282 282 282 572 485 282

307 332 357 672 610 432

6% 7% 8% 17% 16% 11%

M1 16/17£'000

M2 16/17£'000

M3 16/17£'000

M4 16/17£'000

M5 16/17£'000

M6 16/17£'000

Provision For Bad Debts : NHS 2,514 2,514 2,514 2,434 2,434 2,434

Provision For Bad Debts : Non-NHS 830 830 830 1,112 1,112 1,112

3,344 3,344 3,344 3,546 3,546 3,546

6% 9% 7% 8% 7% 5%

Trust Debt

Total Provision

Percentage of Bad Debts Provision against Outstanding Debts

Overseas Visitors

Total Provision

Percentage of Bad Debts Provision against Outstanding Debts

Private Patients

Total Provision

Percentage of Bad Debts Provision against Outstanding Debts

Page 23 of 29

Finance Report Month 06 2016/2017 Capital R

Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance£k £k £k £k £k £k

Major Works 15,639 10,407 (5,232) Major Works 52,344 53,297 953 Minor Works 880 225 (655) Minor Works 2,580 2,580 - IT (Incl Intangibles) 2,115 1,436 (679) IT (Incl Intangibles) 8,025 7,002 (1,023)Medical Equipment 2,982 736 (2,246) Medical Equipment 8,240 7,555 (685)

Total 21,616 12,804 (8,812) Total 71,189 70,434 (755)

Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance£k £k £k £k £k £k

Major Works Major WorksCritical Care Unit 7,556 6,152 (1,404) Critical Care Unit 26,205 26,205 - Cath Lab Developments 0 - 0 Cath Lab Developments 1,295 1,295 - Helideck 1,550 781 (769) Helideck 1,550 1,550 - Site Wide Infrastructure 100.00 14.00 86.00- Site Wide Infrastructure 1,500 1,500 - Ruskin Wing - to increase bed capacity 542 239 (303) Ruskin Wing - to increase bed capacity 3,100 3,100 - ED Additional Bed Capacity 250 64 (186) ED Additional Bed Capacity 2,000 2,000 - Portakabin enabling - to increase bed capacity 1,202 1,043 (159) Portakabin enabling - to increase bed capacity 1,400 1,400 - Orpington major works - to increase bed capacity 906 577 (329) Orpington major works - to increase bed capacity 4,100 4,100 - Other - Denmark Hill 1,892 924 (968) Other - Denmark Hill 5,932 6,725 793 Other - PRUH 827 297 (530) Other - PRUH 2,410 2,410 - Other - Orpington 814 316 (498) Other - Orpington 2,852 3,012 160

Minor Works 880 225 (655) Minor Works 2,580 2,580 - IT (Incl Intangibles) 2,115 1,436 (679) IT (Incl Intangibles) 8,025 7,002 (1,023)Medical Equipment 2,982 736 (2,246) Medical Equipment 8,240 7,555 (685)Total Capital Spend 21,616 12,804 (8,812) Total Capital Spend 71,189 70,434 (755)

Funded by: Funded by:External Borrowing - - - External Borrowing - - - Donations (1,223) (1,223) - Donations (4,203) (4,203) - PDC Receipts 600.00- 600.00- - PDC Receipts (600) (600) - Depreciation (13,167) (13,167) - Depreciation (26,100) (26,100) -

Total Funding (14,990) (14,990) - Total Funding (30,903) (30,903) - Internal Cash Funding Requirement 6,626 (2,186) (8,812) Internal Cash Funding Requirement 40,286 39,531 (755)

The capital report shows capital expenditure year to date against plan and full year forecasts as agreed with NHSI.

The year to date plan is based on the revised annual plan profile submitted to NHSI in June 2016. The underspend reflected at month 6 is due to the delay in confirmation of Distressed Capital funding from NHSI. Projects totalling £24m have been started at risk prior to formal NHSI approval of the distressed capital funding. These include Additional Bed Capacity including ED (£10.6m), EPR Systems Development & Infrastructure (£1.5m), Site wide infrastructer and Minor Works (£4.6m), Link building (£3m) and other approved business cases and major works (£4.3m).It is expected that actual spend against the phased forecast plan will increase from quarter 3 once confirmation of agreed funding has been received from NHSI.The planned capital expenditure for 2016/17 is £71.189m was approved by the board on the assumption that the Trust will be able to secure additional distressed capital funding of £41m from NHSI.

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Finance Report Month 06 2016/2017 Agency Run Rate RYear to Date Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

£k £k £k £k £k £kA&C Staff/Senior Managers (717) (743) (648) (692) (790) (775)Medical Staff (870) (1,104) (1,440) (1,290) (1,329) (1,162)Nursing Staff (878) (872) (963) (1,099) (1,090) (1,126)PAMS/Scientific/Professional (343) (762) (849) (570) (548) (473)

Total Agency Spend (2,808) (3,481) (3,899) (3,650) (3,757) (3,535)

-

200

400

600

800

1,000

1,200

1,400

1,600

Apr-

16

May

-16

Jun-

16

Jul-1

6

Aug-

16

Sep-

16

Oct

-16

Nov

-16

Dec-

16

Jan-

17

Feb-

17

Mar

-17

£k

Agency Run Rate A&C Staff/Senior ManagersMedical StaffNursing StaffPAMS/Scientific/Professional

Page 25 of 29

Finance Report Month 06 2016/2017 Agency Cap R

NHSI Agency Price Cap Monthly Trend Analysis

Staff group Control breached Jan 2016 (4 wks)

*Feb 2016 (4 wks)

March 2016 (5 wks)

*April 2016 (4 wks)

May 2016 (4 wks)

June 2016 (5 wks)

*July 2016 (4 wks)

Aug 2016 (4 wks)

Sept 2016 (5 wks)

Actual Reported Number of breaches each month

Nursing, Midwifery & HVPrice cap, wage cap and framework 254 494 692 1,379 1,333 1,832 1,874 1,861 2,356

HCA and other support Price cap and framework 34 37 65 46 46 111 208 177 186Medical and Dental Price cap and wage cap 790 1571 1995 1,590 1,747 2,174 2,054 1,938 2,244

Sci, Ther & TechnicalPrice cap, wage cap and framework 78 262 304 518 525 724 1,401 1,236 1,403

Healthcare science Price cap and wage cap 36 129 111 339 302 327 365 86 110

Admin & EstatesPrice cap, wage cap and framework 354 397 466 365 325 350 1,037 1,159 1,253

Total 1546 2890 3633 4237 4278 5518 6939 6457 7552

Breaches as a percentage of bookingsNursing, Midwifery & HV 13% 20% 22% 52% 54% 61% 65% 66% 63%HCA and other support 41% 44% 52% 37% 29% 49% 65% 57% 56%Medical and Dental 56% 92% 89% 81% 98% 93% 95% 96% 95%Sci, Ther & Technical 4% 19% 19% 35% 36% 40% 81% 77% 78%Healthcare science 7% 20% 16% 59% 52% 40% 62% 29% 37%Admin & Estates 28% 27% 22% 21% 18% 16% 54% 59% 58%Total 24% 38% 36% 50% 52% 53% 72% 71% 71%

Agency Cap Rules:(1) Price caps for all staff from 1 April 2016 are calculated at 55%* above the hourly rate.

Key Dates:01-Apr-1601-Jul-1601-Nov-16

*Change in cap/reportingNov 2016-Jan 2016 Junior Dr cap was 150%, all other staff was 100%Feb 2016-March 2016 Junior Dr cap was 100%, all other staff was 75%July 2016 wage cap takes effect

Monthly Totals

Maximum wage rates take effectThe latest date that approved framework agreements must have pricing structures that fully reflect NHS Improvement’s conditions for approval, including contractually embedding the price caps and maximum wage rates

(4) NHS Improvement is separately setting the maximum amount an agency worker receives per hour. Trusts are encouraged to comply with the maximum rates from 1 April 2016. Trusts are required to comply with the maximum wage rates from 1 July 2016. Trust compliance with the maximum wage rates is required in addition to compliance to the price caps. Trusts can override the maximum wage rates under exceptional patient safety circumstances only.

(2) The price caps set by NHS Improvement apply to the total amount a trust can pay per hour for an agency worker (exclusive of VAT and including all related costs eg holiday pay for the worker, employer National Insurance, employer pension contributions, administration fee/agency charge). Trusts must not pay more than the price caps to secure an agency worker. Trusts can override the price caps in exceptional patient safety circumstances only. (3) From 1 April 2016, trusts are required to procure all agency staff (nurses, doctors, other clinical and non-clinical staff) via framework agreements that have been approved by NHS Improvement. Overrides to the rule are permitted on exceptional patient safety grounds only.

Rules on mandatory use of approved frameworks for trusts take effect

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Finance Report Month 06 2016/2017 WTEs R

Year to DateBudgeted Substantive

Budgeted Vacancies Bank Agency

Total Staff in Post

Gap (Budget - Actuals)

WTE WTE WTE WTE WTE WTE WTEAmbulatory Services 1,387.6 1,299.4 88.2 28.6 16.8 1,344.8 42.9Critical care, Theatres and Diagnostics 2,122.8 1,915.9 206.9 98.6 60.8 2,075.2 47.5Liver, Renal and Surgery 1,791.9 1,560.6 231.3 154.8 69.9 1,785.3 6.6Networked Services 1,603.2 1,373.6 229.6 140.5 57.4 1,571.5 31.7Trauma, Emergency and Medicine 2,099.3 1,849.8 249.4 180.5 127.3 2,157.6 (58.3)Women's and Children 1,518.3 1,405.2 113.1 94.6 33.4 1,533.2 (14.9)

Corporate DirectoratesCorporate Services 98.2 92.6 5.6 0.0 1.3 93.9 4.3Executive Nursing 114.5 107.2 7.3 0.7 107.9 6.6Facilities 152.6 123.7 28.9 10.4 5.0 139.2 13.4Finance, Procurement and Information 349.0 285.7 63.3 3.0 24.9 313.6 35.5Human Resources 263.7 231.1 32.6 2.3 5.3 238.6 25.0Medical Director 4.9 2.5 2.4 2.5 2.4Operations 399.6 319.2 80.4 9.2 25.1 353.5 46.2R&D 122.3 159.6 (37.3) 1.0 2.5 163.1 (40.8)Strategic Development 8.1 8.2 (0.2) 8.2 (0.2)Turnaround and Transformation 27.5 20.0 7.5 8.1 28.1 (0.6)

Total Corporate Directorates 1,540.3 1,349.9 190.4 26.5 72.2 1,448.6 91.7

Contract Services 52.3 43.7 8.6 0.6 (0.6) 43.7 8.6Private Patients and Overseas Visitors 66.1 57.4 8.7 16.3 3.1 76.8 (10.7)Total WTEs 12,181.7 10,855.5 1,326.2 741.0 440.3 12,036.8 145.0

The Trust is showing a budgeted vacancy level of 1326.2WTEs, of which 741.0 are covered by Bank and 440.3 are covered by Agency. This leaves a vacancy gap of 145 WTEs and explains the YTD pay underspend. Details exclude Kings Kewitt ACU department (38.9WTE).The Finance Department is working closely with Workforce to reconcile the WTE numbers

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Finance Report Month 06 2016/2017 Income by Commissioner Contract

Commissioner M6 Budget YTD M6 Actual YTD Block Adjustment M6 Variance YTDBlock 220,867 222,226 -1,359 0

NHS BROMLEY CCG 83442 85827 -2385 0NHS SOUTHWARK CCG 42458 41360 1098 -0 NHS LAMBETH CCG 35042 34724 319 -0 NHS LEWISHAM CCG 15770 16541 -772 0NHS BEXLEY CCG 11769 12098 -329 -0 NHS GREENWICH CCG 9957 8814 1142 0LONDON COMMISSIONING HUB (Community Dental & Haven) 7150 7150 1 0NHS DARTFORD, GRAVESHAM AND SWANLEY CCG 5166 5779 -613 0NHS MEDWAY CCG 1565 2015 -450 0NHS SOUTH KENT COAST CCG 1032 1160 -128 0NHS WANDSWORTH CCG 1338 1128 210 0NHS THANET CCG 882 934 -52 0LONDON BOROUGH OF SOUTHWARK COUNCIL 995 860 135 0NHS ASHFORD CCG 514 667 -153 0LONDON BOROUGH OF LAMBETH COUNCIL 643 501 142 0NHS CENTRAL LONDON (WESTMINSTER) CCG 646 492 154 0NHS HOUNSLOW CCG 285 370 -85 -0 NHS SURREY DOWNS CCG 396 316 81 0NHS EALING CCG 230 232 -2 -0 NHS WEST LONDON CCG 361 206 155 0NHS HAMMERSMITH AND FULHAM CCG 216 170 47 -0 NHS KINGSTON CCG 146 169 -24 0NHS BRENT CCG 167 143 24 0NHS HILLINGDON CCG 168 105 62 0NHS HARROW CCG 122 59 63 0NEURO REHAB 407 407 0 0

C&V 215,533 216,037 0 503LONDON COMMISSIONING HUB - Specialised 153626 169270 0 15644LONDON COMMISSIONING HUB - Over-Performance 14014 0 0 -14014 LONDON COMMISSIONING HUB - MRET -672 -269 0 403LONDON COMMISSIONING HUB - Marginal Rate 0 -631 0 -631 LONDON COMMISSIONING HUB - IFRs 570 973 0 402LONDON COMMISSIONING HUB - Hep C 4450 4316 0 -134 LONDON COMMISSIONING HUB - CDF 3350 3350 0 0NHS ENGLAND LONDON - Dental & Screening 15490 15212 0 -278 NHS CROYDON CCG 9637 9668 0 31NHS WEST KENT CCG 4663 4579 0 -84 NHS CANTERBURY AND COASTAL CCG 1378 1368 0 -10 NHS SWALE CCG 686 846 0 160NHS ENGLAND SOUTH (SOUTH EAST) 763 700 0 -63 ALL OTHER CCGs 6215 6656 0 441Cost & Volume CCGs - Over-Performance Target 1363 0 0 -1363

Local Authority 1,393 1,026 0 -367 NCA 4,695 6,485 0 1,790NHSE NCA 382 437 0 54Non-English 1,343 1,269 0 -75 CQUIN (100%) 9,000 9,000 0 0Seasonality Phasing -702 0 0 702Grand Total 452,512 456,479 -1,359 2,608

Key Income Headlines:* Block CCGs Over-performance driven by Critical Care activity and devices & drugs* Primary reason for Elective under-performance driven by theatre closure for development/maintenance* NHSE drugs (Hep C) and BMT activity over-performing against plan* Business plans for activity growth are being implemented but are not fully operational yet.

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Finance Report M

Month 6 actuals are based on Month 5 flex data (Contracts) extrapolated using Month 6 activity figures from OLAP report (Inpatient & Outpatient), all other categories (Drugs, Devices, Diagnostics, Critical Care, Patient Transport) are straight-lined but factoring in seasonality. Bromley, Lambeth & Southwark contracts have been agreed and are reflected within the plan. All other commissioners e.g. NHSE are based on KCH proposals. There is always the potential for monthly variations between the estimate and actual patient data. In comparison to last year inpatient activity is lower, primarily driven by theatre closure for development/maintenance.

Income Activity Analysis

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Finance Report Month 06 2016/2017 Surplus / (Deficit) (By Division) RYear to Date Plan Actual Variance

£k £k £kSurplus / (Deficit) 36,334 69,881 (33,547) Key Variances (more details can be found in the appendix 3)

Year to Date Plan Actual Variance£k £k £k

Ambulatory Services 11,567 11,538 29Critical care, Theatres and Diagnostics (2,731) (917) (1,814)

Liver, Renal and Surgery 13,096 22,179 (9,083)Networked Services 15,470 16,203 (733) CIP SlippageTrauma, Emergency and Medicine 17,356 20,551 (3,195)Women's and Children 15,180 15,182 (2)Corporate Income (33,947) (13,215) (20,732) STF, SPV and Hep C CQUINCorporate ServicesCapital charges and reserves 3,825 (1,822) 5,647Commercial Services (475) (475) 0Corporate Services (10) (674) 664Executive Nursing (7) 191 (198)Facilities 245 (614) 859Finance, Procurement & Information 0 (558) 558Human Resources 39 (485) 524Medical Director 0 (77) 77Operations (254) (738) 484PFI (1,800) (2,253) 453R&D 271 291 (20)Strategic Development 0 (28) 28Turnaround and Transformation (32) (302) 270Corporate Services Total 1,801 (7,545) 9,346Contract Services (MSK, ACU, Pathology Services) (1,122) 2,734 (3,856) Viapath contract overperformancePrivate Patients and Overseas Visitors (5,485) (1,976) (3,508) Income underperformance and provision for bad debtsSurplus / (Deficit) 31,186 64,733 (33,547)Impairment 5,148 5,148 0Operating Surplus / (Deficit) 36,334 69,881 (33,547)

The YTD overspend is mainly driven by the double running of the radiology PACs system and the use of mobile imaging units. This is being partly offset by pay vacancies and income overperformance.Clinical income underperformance due to elective cancellations and CIP slippage

Clinical income underperformance due to elective cancellations and CIP slippage

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INTRODUCTION

This report provides the Board of Directors with a brief summary of all the key issues considered by the Finance & Performance Committee on 25 October 2016. STRATEGIES: TOP PRODUCTIVITY We were informed that the 4 hour emergency department (ED) target worsened from 88.18% reported in August to 82.01% in September, which is below agreed commissioner and NHSI improvement trajectories of 91.40% for the month. Performance was disappointing in light of all improvement work streams implemented, but we noted that the Trust is undergoing a major service transformation programme and capital developments at the same time; The Princess Royal University Hospital(PRUH) experienced significant increase in the number of attendances at the urgent care centre which was regularly overwhelmed. The Denmark Hill(DH) site also experienced increased attendance at ED in September leading to a crowded department and stagnated patient flow through the pathway; We discussed the poor performance which is short of agreed improvement trajectories and 10% lower than the same period last year. The winter pressure period is approaching and the Trust must be prepared to meet further demand for its services; We noted that the progress on increased capacity programmes which are progressing according to plan. Workforce recruitment associated with these measures is also on point, particularly relating to the plans to open additional beds at Orpington. We were updated on the Trust’s ED expansion and improvement plans which are scheduled to materialise in quarter 1 (Q1) of 2017/18; We received and discussed the review report produced by MBI Health Group who undertook a rapid assessment of 3 referral to treatment (RTT) specialties: Neurology, Neurosurgery and Trauma & Orthopaedics. We noted the findings and all the mitigation measures the Trust will implement to address the data issues identified; We were pleased to learn that the Trust is achieving all cancer performance targets to date, in almost all areas except the 62-day general practitioner referral for first treatment. This target was not achieved in September, but has been achieved for the overall Q2 position at 85.9% against target of 85%; and

Report to: Board of Directors

Date of meeting: 2 November 2016

Subject: Summary Record of Finance & Performance Committee Meeting

Presented by: Chris Stooke, Non-Executive Director

Status: For Information

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The Trust is the only provider in South East London achieving its cancer targets. Diagnostics performance is currently within target of 1% and in line with national guidance. The Trust’s overall performance score for Q2 is 3. FIRM FOUNDATIONS: SOUND FINANCES We were informed that the Trust’s cumulative operating deficit as at month 6 is £59.6m. This is an adverse variance of £33.6m against the year to date planned deficit of £26m. The key drivers of the variance are:

• Sustainability and Transformation Fund (STF) £15m loss for Q1 and Q2; • Special Purpose Vehicle (SPV) relating to transformation programme £2.5m; • Hepatitis C national CQUIN variance of £2m; • NHS Clinical Contract activity income adverse by £6.5m; • Cost Improvement Plans (CIP) slippage variance of £4m; and • Non-pay Expenditure Cost Pressures variance of £3.6m.

To maintain key operational functions the Trust has withdrawal 90% of the full value of its Working Capital Facility for 2016/17. This means that the Trust’s cash position is now critical, the Chief Financial Officer has written to the department of health regarding the issues; and We noted that the Trust has started drafting a high level outline of the two year operational plan. Committee Chair Chris Stooke, Non-Executive Director

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Report to: Board of Directors, Public Session

Date of meeting: 2nd November 2016

Subject: Quarterly Patient Safety Report

Author(s): Dr Jules Wendon (Medical Director) & Richard Hinckley (Head of Patient Safety)

Presented by: Dr Jules Wendon (Medical Director)

Sponsor: Dr Jules Wendon (Medical Director)

Status: For discussion

1. Summary of Report

The purpose of the report is to present an overview of patient safety issues to the Board of Directors highlighting areas of concern.

2. Action required The Board of Directors is asked to review the report and make any recommendations as required.

3. Key Implications

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1. Executive Summary

No Never Events have occurred since the last report to the Board on 5th July 2016 A maternal death was heard at Inquest in August where the Coroner held that the

death was from natural causes contributed to by neglect. The Coroner was satisfied that the Trust had taken appropriate action to improve safety and gave no further instructions

One MRSA bacteraemia was reported in September on Donne ward bringing the year to date total up to 3

The new Sunrise EPR was successfully implemented in August - some patient safety issues relating to the rollout were identified but all have now been resolved

Important Patient Safety Issues 2. Safety Quality Priority: Improving Safety in Invasive Procedures As noted in previous reports a number of actions have been taken to reduce the risk of post-procedure guide wire retention and the risk of fluid administration through misplaced naso-gastric tubes (NGTs). There have been no further incidents of this type since the last report. An update on ongoing work to improve safety in these areas (and safety in relation to invasive procedures in general) is provided below. Retained guidewires: There have been no retained guidewire incidents since January 2016. A series of actions that have been taken to prevent recurrence were summarised in the last report. An update on these actions is provided below:

Optional checkboxes on the EPR chest x-ray request have been developed to allow the requestor to note lines/drains/tubes in situ and the radiologist to report on these 

Invasive procedure packs are being rationalised into large & small sizes (to include the insertion sticker) 

Junior doctor induction has been updated to reference the new standard operating procedures relating to seldinger procedures performed outside a traditional theatre setting 

 Fluid administration via misplaced naso-gastric tubes (NGTs): As noted in the last report a series of actions had been taken to reduce this risk. An update on the current status of the actions to prevent recurrence is provided below:

Radiologists are now reporting all NGT chest x-rays within 2 hours – a specific NGT radiology request code has been developed to facilitate this. Regular monitoring of compliance with 2 hour turnaround is to be monitored through Patient Safety Committee 

An electronic training package on NGT insertion and x-ray interpretation is available for junior staff who require further training 

NGT awareness days were held at both the DH and PRUH sites in August to publicise the new algorithms, practice and policy. A communications campaign has accompanied this (internal safety alert, Fact of the Fortnight bulletin, memo to all staff in June, screensavers, Kingsweb news item, an updated Kwiki page, and 2 incident summaries or “vignettes”) 

Other actions planned or underway to improve surgical safety: In addition to the actions mentioned above, the following action is also being taken:

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Surgical safety induction presentation has been incorporated into local induction for doctors in surgical specialities

The addition of ‘Team Brief’ and ‘Debrief’ as a specific time slot on the electronic theatre system (Galaxy) is not technically possible - however when the Galaxy system is replaced this will be incorporated

All specialties carrying out invasive procedures have been tasked with developing local safety standards for invasive procedures (LocSSIPs). LocSSIPs in higher risk areas (ophthalmology, orthopaedics, and obstetrics) have been prioritised

Safety in invasive procedures is monitored by the Safer Surgery Improvement Group (chaired by a Consultant Neurosurgeon) which reports to the Patient Safety Committee chaired by the Medical Director. 3. Safety Quality Priority: Improving the recognition and management of sepsis Improving the recognition and management of sepsis is a safety quality priority and also a national CQUIN. The performance indicators will be used to track improvement in sepsis recognition and management are:

% screened against locally developed screening criteria (screening bundle) % of those screened with severe sepsis/septic shock who have received appropriate

management (time to antibiotic therapy) (sepsis bundle) Baseline data for Q1 (Apr-Jun 16) has been collated. This data indicates that the Trust will need to see an incremental increase of 5-10% per quarter in order to demonstrate a 50% improvement in compliance with the screening and sepsis bundles by the end of 2018-19 to meet the prescribed targets. The baseline audit data reflects existing national trends. For example, the Q1 figure for the proportion of emergency department patients with severe sepsis, red flag sepsis or septic shock who were administered IV antibiotics within 1 hour was 55% which is very similar to the national average. A Sepsis Strategy was drafted in July 2016 which sets out how the Trust will achieve its sepsis targets and ultimately improve the safety and outcomes for patients Work to improve the recognition and management of sepsis is led by the Medical Director and will be monitored through the Patient Safety Committee. 4. Infection Control

One MRSA bacteraemia was reported in September on Donne ward bringing the year-to-date total up to three. A local action plan has been put in place to improve documentation of line insertion and management on the ward. Work has been ongoing to improve hand hygiene compliance at the PRUH following an outbreaks of norovirus there earlier in the year. Actions have included:

Holding a hand hygiene awareness day at PRUH on 21/10/16 Installation of an additional 21 sinks across the site Automatic magnetic locking of all the entrance doors to (and between) the wards at

PRUH Identification of hand hygiene champions in specific areas A communications campaign to raise awareness of good hand hygiene practice

(including fact of the fortnight, CEO brief, Kingsnews and new posters for display)

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Nine c-difficile cases (eight at DH and one at the PRUH) were reported in September which is above the in-month quota of six cases - although the year-to-date position is in line with the quota (thirty-six cases). Further details with respect to infection control governance and performance is provided in the quarterly DIPC infection control report to QGC.

5. Falls & Pressure Ulcers The incidence of hospital acquired pressure ulcers and patient falls across all sites are monitored closely by the respective Tissue Viability and Falls Teams. All serious falls and pressure ulcers (grade 3 or 4) are reviewed by the Safer Care Fora at DH or PRUH. The Safer Care Fora report to the Patient Safety Committee.

5.1 Falls Serious falls (those involving major harm/death) decreased from 10 to 8 in the last

quarter. There were 4 serious falls at both DH and PRUH. There was no trend with respect to the location of serious falls

At DH overall falls rate declined during Q1 but has risen again in July to above 5 per 1000 bed days. The rate of falls reporting fell below 5 per 1000 bed days for the first time at the PRUH in Q1, but in July increased again to previous levels. A similar trend is evident at Orpington and the other sites. It is not clear why there was a dip in both the number and rate of falls in Q1 but this will remain under review

At DH and PRUH themes with respect to falls continue to relate to toileting (falling while attempting to mobilise to the toilet or falling whilst in the toilet)

Current actions to reduce avoidable falls are provided below:

The Specials Team continues to provide 1:1 specials at DH to monitor patients specifically assessed as at risk of falling. This team is being expanded through the use of volunteers

The Falls Team is working jointly with the Dementia Team on the management of patients with cognitive impairment in the prevention of falls. A similar joint project is underway with the Continence Team focusing on the link between incontinence and falls

5.2 Pressure Ulcers Across the Trust there were 79 Hospital Acquired Pressure Ulcers (HAPUs) graded 2

or above (including unstageable HAPUs) in the period Apr-Jun 16, down from the 93 reported in Jan-Mar 16

At DH there were 61 HAPUs in Q1 (compared to 59 in Q4), of which there were 2 grade 3s

At PRUH HAPUs decreased from 34 (Jan-Mar 16) to 18 (Apr-Jun 16) and remain well below the peak in Oct-Dec 2013

Current actions to reduce avoidable pressure ulcers are provided below:

A drive to reinforce the correct Waterlow Score calculation as this ensures prompt provision of the most appropriate pressure relieving equipment

Continued staff training in HAPU assessment and prevention 6. Hospital Acquired Thromboses (HATs)

Enc. 6.1

5 | P a g e   

The incidence of hospital acquired thromboses are monitored closely by the VTE team. All HATs leading to significant harm are reviewed by the Safer Care Fora at DH or PRUH, or by the Serious Incident Committee if serious avoidable harm has occurred. The Safer Care Fora report to the Patient Safety Committee. Note that venous thromboembolism (VTE) risk assessment and treatment (prophylaxis) are the main methods of prevention of HAT. A summary of the current position is as follows:

At DH the number of HATs decreased from 62 to 49 in the last quarter. The number of potentially preventable HATs declined markedly from 11 to 3 over the same period (one is still being assessed)

The VTE risk assessment rate at DH remained above 97% for Q1 At PRUH the number of HATs increased in Q1 to 31 (from 27 in the Jan-Mar 16

quarter), but the number of potentially preventable HATs (2) remained relatively low The VTE risk assessment rate at PRUH averaged 96% in Q1 but rose to 97% in July

and August 2016 Reassessment of VTE risk following a change in condition changes is an ongoing

issue at the PRUH. There is a Thrombosis Day being held at the PRUH Boardroom on 13th October where reassessment will be discussed, and ongoing training for VTE link nurses to raise this issue on the wards

Recommendation The Board of Directors is asked to note the content of this report.

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Enc. 6.2

1  

Report to: Board of Directors

Date of meeting: 02 November 2016

Subject: Summary Record of Quality & Governance Committee Meeting

Presented by: Prof Ghulam Mufti, Non-Executive Director & Committee Chair

Status: For Information

Introduction This report provides the Board of Directors with a summary of all the key issues considered by the Quality & Governance Committee at its meeting on 25 October 2016.

Deep Dive: Improving the Value of Care for People with Hip Fractures The Committee considered the Trust’s progress in improving the care of patients with hip fractures at the Princess Royal University Hospital, which was a Trust quality priority for 2015-16. Fracture neck-of-femur fracture patients have a potentially high 30-day mortality rate following emergency admission, and as such the Trust has developed standardised processes and pathways for the management of such patients with a well-developed multi-disciplinary engagement process. These actions have resulted in better outcomes for patients, including decreased mortality rates, with rates that compare favourably with other centres nationally. . The progress provided the Committee with assurance that the Trust has a good handle on the situation, but that this should be kept under review. Maternal Deaths Update As agreed by the Board in its October meeting, the Committee received the findings of an external review into four maternal deaths within 42 days of childbirth. All four of the women had underlying health conditions. Two of the women who died were transferred to King’s after giving birth for specialist (non-obstetric) care. They were classified as maternal deaths due to timeframe in which they died following childbirth. The report shows that there were no systemic failures in maternity, but it did reiterate the need to recognise and respond to deteriorating patients. A number of steps have been taken to address these points. Maternity services remain a priority for the Trust. 

CQC Action Plan Progress The Care Quality Commission (CQC) visited the Trust on 13 October to assess progress against meeting requirement notices. The CQC are confident that many of these requirement notices can be closed off but have two main areas of concern: flow and capacity issues in the emergency department (ED); and the quality and consistency of ‘Do No Attempt Cardio-Pulmonary Resuscitation’ (DNACPR) documentation. The Committee was assured that actions plans are in place to address the DNACPR issues and the operational teams led by the Chief Operating Officer have a systems wide implementation plan for improving ED flow at the Princess Royal University Hospital (PRUH). Quarterly Patient Safety Report The Committee considered the Quarterly Patient Safety Report, also on today’s Public Board meeting agenda (item 6.1). Action plans have been implemented to address these issues, and work continues to improve the type of learning and dissemination of learning from incidents and complaints.

     

Enc. 6.2

2  

The Committee was concerned about the volume of the incidents, and was assured that the governance processes around the management and investigation of serious incidents will continue to be undertaken robustly with improved cross departmental learning and dissemination being facilitated by the new organisational structure. The Trust continues to encourage an open reporting culture. Quarterly Patient Outcomes Report A range of matters related to performance in patient outcomes were reported. The Committee noted the previously documented issues with regards to diabetic care as delineated in national audit at the PRUH. An action plan for improvement in diabetes care has been implemented but the results of the next national audit will not be received until quarter 1 of 2017-18. The Committee agreed that the feasibility of an interim proxy audit will be looked into.

Quarterly Infection Control Report The Committee noted the contents of the report and an update was provided on an emerging fungal infection known as Candida Auris which has been detected at the Trust. The Committee was assured that a number of actions have been put in place to minimise transmission. Given the potential severity of this infection, the Committee agreed to keep it under review and suggested matrix-assisted laser desorption/ionization for rapid speciation. Safeguarding Adults Annual Report An overview was provided on the Trust’s application of Deprivation of Liberty Safeguards (DoLS) during the financial year 2015-16. Some inconsistency in DoLS applications was identified, and in response to this the safeguarding team has developed guidance which incorporates learning from rejected applications and this has been made available on the Trust Intranet. Safeguarding Children Annual Report The Committee received the Safeguarding Children Annual Report, which provided assurance that actions raised in the previous annual report are in train and have been addressed with staff. The number of referrals this year is roughly the same as the last reporting period but the cases seem more complex in nature. Safeguarding in maternity has been placed on the Trust’s ‘at risk’ register due to the volume and complexity of the cases. Complaints Annual Report The Committee noted the Complaints Annual Report and received an update from the Chief Nurse on the Trust’s intentions with regards to improving performance with complaints handling. The Committee was assured on the initiatives discussed, such as early face-to-face contact with patients and quickly isolating more serious complaints from less serious ones, and that these initiatives would be incorporated into a formal update to come to the Board in December. Revised Committee Terms of Reference The Committee considered and approved a revision to its terms of reference research (see appendix) and a change in its name to the Quality, Assurance and Research Committee. The Board is asked to consider and adopt the revised terms of reference and new Committee name. Royal College of Surgeons Report on Orthopaedics The Trust commissioned an external review of orthopaedics services by the Royal College of Surgeons (RCS) into professional behaviours and practices.

     

Enc. 6.2

3  

Actions are in place to address recommendations from the RCS to implement a code of conduct for consultant staff, and a process for addressing situations where staff deviate from this.

Any Other Business The Committee suggested that meeting agendas had become too busy and the paper packs too large, and asked the Chair to consider how processes may be refined to keep agendas and the volume of information at a level which allows for more meaningful consideration and discussion of material in meetings.

Trust Board Committee Terms of Reference

Appendix

1

Report to: Board of Directors

Date of meeting: 02 November 2016

Subject: Revised Committee Terms of Reference

Author(s): Tamara Cowan, Board Secretary Andy Simpson, Corporate Governance Officer

Presented by: Shelley Dolan, Chief Nurse Prof. Julia Wendon, Medical Director

Sponsor: Shelley Dolan, Chief Nurse Prof. Julia Wendon, Medical Director

History: Approved by the Quality and Governance Committee in its meeting on 25 October 2016.

Status: For approval

1. Summary of Report The Quality and Governance Committee reviewed its terms of reference on 25 October 2016 to take into consideration previous suggestions relating to the Committee’s membership and scope. The Committee agreed the following: A new name to reflect the revised area of focus, Quality Assurance and Research

Committee;

That Prof. Julia Wendon and Dr Shelley Dolan will be joint executive leads for the Committee;

To revise the executive membership to include only key executive directors with the proviso that other executive directors and senior leaders can be invited to the Committee for exception reporting;

The align the Committee membership with that of other Board level Committees to distinguish clearly between the Members of the Committee and the attendees;

To revise the remit and the duties of the Committee to ensure that they are more concise and less prescriptive;

To reflect a focus on research matters; and

To include an explicit provision for the Committee to receive regular reports from clinical leaders about patient safety, experience and outcomes.

Trust Board Committee Terms of Reference

Appendix

2

2. Recommendation The Board is asked to consider and adopt the revised terms of reference. 3. Key Implications

Legal: The Trust has a statutory duty to delivery high standards of care to

its patients. The Board of Directors also has a statutory duty to ensure that it is kept updated and assured that there are effective mechanisms in place to deliver good patient outcomes, experience and treat patients safely.

Financial: There are no direct financial implications.

Assurance: This Committee is the mechanism by which the Board receives assurance on these matters therefore it is essential that these terms of reference give the Committee sufficient focus and oversight over the key areas which fall under its remit.

Clinical: There are no direct clinical implications.

Equality & Diversity: There are no direct implications for equality and diversity. Performance: The core purpose of the Committee is to provide assurance to

the Board on all aspects of quality and governance and to review performance against the three dimensions of quality; Patient Safety, Patient Experience and Patient Outcomes..

Strategy: There are no direct strategic implications

Workforce: There are no direct workforce implications.

Estates: There are no direct implications for estates.

Reputation: If the Board does not have an effective mechanism for delivering assurance on quality matters this could present a reputational issues.

Other:(please specify): N/A

Trust Board Committee Terms of Reference

Appendix

3

Name: Quality, Assurance & Research Committee

Chair: Non-Executive Director Clinical

Executive Leads:

Medical Director Director of Nursing & Midwifery

Secretary: Corporate Governance Officer

Membership: 4 Non-Executive Directors Medical Director Director of Nursing & Midwifery Chief Operating Officer Chief Executive

Attendees: Associate Director of Governance NHS Southwark Clinical Commissioning Group representative NHS Bromley Clinical Commissioning Group representative Either: Senior Information Risk Owner, Caldicott Guardian, or Information Governance Lead

Observers: Governor representative

Frequency: Monthly

Quorum: 4 members including the Committee Chair, at least one other Non-Executive Director and two Executive Directors. If Executive Directors are unable to attend a meeting, they should identify a deputy in agreement with the CEO and Committee Chair.

Main Purpose:

To provide assurance to the Board on all aspects of quality, keeping under review performance against but not limited to the following domains of quality: Patient Safety Patient Experience Patient Outcomes Organisational Safety Information Governance Clinical Research To ensure that a good standard of governance is maintained in delivering high quality services to the Trust’s patients. To ensure that the services delivered by the Trust comply with all external regulatory requirements.

Duties:

Assurance Oversight and assurance of statutory and mandatory requirements relating to quality of care. Ensure there are trust-wide integrated risk management processes and systems in place which enable reactive and proactive risk identification. Oversee the effectiveness of clinical systems to ensure they comply with the CQC’s

Trust Board Committee Terms of Reference

Appendix

4

fundamental standards of care and reviewing the work undertaken by the CQC Delivery Board to ensure the Board has assurance that robust action plans are being delivered.

Monitor and review the impact on quality and safety of cost improvement programmes when there are significant cost improvement proposals which may potentially have an impact upon services. Consider any relevant risks within the Board Assurance Framework and corporate level risk register as they relate to the remit of the Committee as part of the reporting requirements, and to report any areas of significant concern to the Board and relevant Committees. Regularly review major risks and ensure adequacy of controls and action plans. Oversight and assurance of external assessment systems, including the Care Quality Commissions (CQC) and other professional and regulatory bodies’. Monitor and review the system for Quality Governance, Information Governance and Research and Development Governance, ensuring the Board is assured of continued compliance through its annual report and through reporting by exception when required. Quality Oversee an effective system for monitoring clinical/patient outcomes and clinical effectiveness; with a particular focus on ensuring patients receive the best possible outcomes of care across the full range of Trust activities. Oversee an effective system for safety within the Trust, with particular focus on patient safety, staff safety and wider health and safety requirements. Ensure ongoing oversight of a robust reporting framework charting the Trust’s performance on all aspects of organisational safety. This will include, but not be limited to, health and safety, safeguarding vulnerable children and adults, statutory and mandatory training and business continuity and emergency preparedness. Oversee an effective system for delivering a high quality experience for all inpatients, service users, families, carers and staff, with particular focus on involvement and engagement for the purposes of learning and making improvements. Receive quarterly updates on complaints and claims as a barometer of the quality of care. Receive quarterly updates on services from frontline staff from all professional areas to assure the Committee on quality, safety and patient experience. Receive patient stories detailing their experiences at the Trust in order to provide the Committee with insights into areas for improvement as well as assurance over areas of good performance. Research Support the development and implementation of, and review, strategies for research and innovation and having ongoing oversight of research and development activities.

Monitor and review key research milestones and providing assurance to the Board and ensuring that highly effective controls for research and governance are implemented.

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Libby Shearon

1942 – 2016

Enc. 6.3

“That no one else ever experience the cruel treatment that I have experienced whilst in this 

hospital”

Enc. 6.3

Admission 24.1.16 - 1.2.161) Failure by the Trust to follow NICE guidelines CG68 &CG162 relating to stroke diagnosis, acute management and rehabilitation.

2) Multiple treating teams and their failure to communicate with one another or Libby and her family. This left Libby feeling “humiliated and distressed”.

3) The lack of dignity, care and compassion demonstrated by hospital staff when Libby was informed that she had pancreatic cancer

4) Failure by the Trust to follow NICE guidance and best practice in relation to cancer diagnosis, symptom management and treatment

5) Unkind, degrading and neglectful care and treatment of Libby during her short but significant admission to RD Lawrence Ward.

Enc. 6.3

Looking Forward…

• Libby’s art raised £8000 for homeless charity

• New baby on the way

• Learning events for KCH

• Family committed to supporting Lib’s dying wish

• Missing Libby Society

• Heartache

Enc. 6.3

Enc. 6.4

1

Report to: Board of Directors

Date of report: 22 August 2016 to 14 October 2016

Subject: Chair’s and Non-Executive Directors’ Activity Report

Presented by: Lord Kerslake, Chairman

Status: For information

1. Background/ Purpose This report details the activities undertaken by the Non-Executive Directors of the Board for the period from 22 August 2016 to 14 October 2016. 2. Action required The Board of Directors is asked to note the contents of this report.

Lord Kerslake - Chairman Date Activity

5 September

Met with Chris Stooke and Colin Gentile to discuss financial performance Attended CoG planning meeting

6 September Chaired Nominations Committee meeting

9 September

Chaired Public Board meeting Undertook Go See Visit – Elf & Libra Ward Attended Chair’s/NEDs’ Lunch Chaired Private Board meeting Met with Alix Pryde for NED appraisal

12 September Attended Efficiency Board meeting

15 September

Attended KHP Joint Board meeting Chaired Non-Executive Directors & Council of Governors Review Session

Enc. 6.4

2

16 September

Attended Quality & Governance Committee meeting Chaired additional Board meeting – finance focus

22 September

Attended Commercial Services Board meeting Attended Audit Committee meeting

26 September

Attended Finance & Performance Committee meeting Chaired Nominations Committee meeting Attended Efficiency Board meeting

29 September Chaired Annual Members Meeting

30 September Hosted the opening of the Alex Mowat Paediatric Research Labs

5 October

Chaired Private Board meeting Attended Chair’s/NEDs’ Lunch Chaired Public Board meeting Attended Council of Governors Public meeting

10 October Attended Efficiency Board meeting

14 October Attended Senior Leaders Team Away Day

Jon Cohen – Non-Executive Director, Lead for Improving Quality of Patient Care Date Activity

25 August Tel. call with Chris Goulding re. consultant exclusion

7 September Tel call with Chris Goulding re. consultant exclusion

8 September Trauma peer review, PRUH

Enc. 6.4

3

9 September

Attended Public Board meeting Undertook Go See Visit Attended Chair’s/NEDs’ Lunch Attended Private Board meeting

15 September Attended Joint Governors Review meeting

16 September

Attended Education & Workforce Development Committee meeting Attended Quality & Governance Committee meeting Additional Private Board meeting (finance focus)

22 September Attended Private Board meeting

27 September Chaired KCH Dignity Awards

5 October

Attended Private Board meeting Attended Chair’s/NEDs’ Lunch Attended Public Board meeting

12 October Chaired Consultant Interview Panel

Alix Pryde – Non Executive Director, Chair of Audit Committee, Lead for Move to Operational Sustainability

Date Activity

26 August Call with CFO

Enc. 6.4

4

9 September

Attended Audit Committee pre-meet with CFO Attended Public Board Meeting Conducted Go See visit of R.D. Lawrence Ward Attended Chair’s/NEDs’ Lunch Attended Private Board Meeting Attended Audit Committee pre-meet with Internal Auditor Annual appraisal with the Chair

13 September

Supported the Counter Fraud team at the Government Counter Fraud Awards

22 September

Attended Private Board Meeting Attended Strategy Board Meeting Chaired Audit Committee

29 September Attended Annual Members Meeting

4 October

Met with Head of Volunteering Introduction meeting with Executive Director of Nursing & Midwifery and Executive Director of Transformation & ICT

5 October

Attended Private Board Meeting Attended Chair’s/NEDs’ Lunch Attended Public Board Meeting Attended Public Council of Governors Meeting

Chris Stooke – Non Executive Director, Chair Finance and Performance Committee, Lead for Delivering Financial Plans

Date Activity

23 August Attended meeting with Chair and Colin Gentile Conference call re KCH charity fundraising

Enc. 6.4

5

5 September Attended finance update with Colin Gentile

13 September Chaired KCH Charity Finance Committee

15 September Attended meeting with Governors

16 September Chaired consultant interview panel Attended private board

26 September Chaired F&P meeting Attended Efficiency board

5 October Attended Private Board Meeting Attended Chair’s/NEDs’ Lunch Attended Public Board Meeting Attended public Governors meeting

10 October Attended Efficiency Board meeting

Faith Boardman – Non-Executive Director, Chair of Education Workforce and Development Committee, Lead for Organisational Development

Date Activity

9 September

Attended Public Board meeting Undertook Go and See Visit Attended Chair’s/NEDs’ Lunch Attended Private Board meeting

15 September Attended Governors' Joint Review session

16 September

Chaired Education and Workforce Committee Attended Quality and Governance Committee Attended Board meeting on finances

22 September

Attended Private Board meeting (Strategy) Attended Audit Committee meeting

Enc. 6.4

6

26 September Presented Chair's Appraisal to Nominations Committee

5 October

Attended Private Board meeting Attended Chair’s/NEDs’ Lunch Attended Public Board meeting Attended Council of Governors meeting

14 October Attended Senior Leaders Team Away Day

Sue Slipman – Non Executive Director, Deputy Trust Cahir, Chair of Private Board Strategy Focus, Lead for Trust Strategy

Date Activity

6 September Met with Toby Lambert

9 September

Attended Public Board meeting Undertook Go and See Visit Attended Chair’s/NEDs’ Lunch Attended Private Board meeting

15 September

Met with Rhian Burgess and Rob Eames Attended KCH Joint Board/Council of Governors Meeting

16 September Attended Private Board Meeting

21 September Attended NHS Providers Chairs and Chief Executives Meeting

22 September

Attended KCH Commercial Board Attended KCH Board Strategy Focus

13 October Attended NHS Speak Up Guardians Day Conference

Professor Ghulam Mufti – Non Executive Director, Chair of Quality and Governance Committee, Lead of Trust Strategy (KHP)

Enc. 6.4

7

Date Activity

23 August 2016 NED appraisal with Lord Kerslake

9 September 2016 Attended Chair’s/NEDs’ Lunch

16 September 2016 Attended Quality & Governance Committee

5 October 2016

Attended Public Board Meeting Attended Chair’s/NEDs’ Lunch Attended Private Board Meeting

6 October 2016 Met with Dawn Brodrick

Erik Nordkamp – Non Executive Director, Chair of Commercial Services Board, Lead for Commercial Services

Date Activity

8 Sept Chaired interview panel for Dermatologist Consultant post

9 Sept

Attended Public Board meeting Undertook Go and See Visit Attended Chair’s/NEDs’ Lunch Attended Private Board meeting

16 Sept

Met with Simon Taylor and Simon Miller Attended Private Board meeting (finance focus)

22 Sept

Chaired Commercial Services Board meeting Attended Private Board meeting (finance focus) Attended Private Board meeting (strategy focus)

5 Oct

Attended Private Board meeting Attended Chair’s/NEDs’ Lunch Attended Public Board meeting Attended Council of Governors meeting Met with Jane Bond & Lisa Hollins

Enc. 6.4

8

Enc. 6.5.1

1

King’s College Hospital NHS Foundation Trust - Finance & Performance Committee Minutes of the Finance & Performance Committee meeting held on Thursday, 26 September from 09:00-11:00 in the Dulwich Committee Room, Denmark Hill.

Present: Chris Stooke (CS) Non-Executive Director/ Committee Chair Lord Kerslake (BK) Trust Chair Nick Moberly (NM) Chief Executive Officer Colin Gentile (CG) Chief Financial Officer Jane Farrell (JF) Chief Operating Officer Julia Wendon (JW) Medical Director Dawn Brodrick (DB) Director of Workforce and Development Jane Bond (JB1) Director of Capital Estates and Facilities Debbie Hutchinson (DH) Assistant Director of Nursing In attendance: Jane Badejoko (JB) Corporate Governance Officer (Minutes) Phillip Burns (PB) Director of Turnaround (item 3.1 only) Apologies: Trudi Kemp (TK) Director of Strategic Development Sue Slipman (SS) Non-Executive Director/ Deputy Trust Chair Toby lambert (TL) Interim Director of Strategy Simon Dixon (SD) Director of Finance Lisa Hollins (LH) Director of Transformation and ICT

Item Subject Action

016/101 Apologies Apologies for absences were noted.

016/102 Declarations of Interest There were no declarations of interest reported.

016/103 Chair’s Actions/ Updates The 28 November Finance and Performance Committee (FPC) meeting will focus on operational performance.

Minutes of the Previous Meeting The minutes of the meeting held on 26 July were approved as an accurate record.

Enc. 6.1.1

2

Item Subject Action

016/104 Action Tracker/ Matters Arising The following updates were provided: Item 016/75 from 28 June 2016:- The statutory and mandatory training record of

staff at the PRUH is available. The information will be incorporated into the performance report next month;

The Trust has recruited a new Director of Planning and Performance Adam Creeggan. One of his key tasks once he takes up his post would be to review staff performance;

Item 016/47 from 26 April:- Deep Dive into Theatre Efficiency. Feedback on this

item will be via the Clean Sheet Redesign Programme which is evaluating theatre efficiency and opportunities for improvement. The outcome of this work stream will be presented FPC in November 2016;

The Trust’s theatre efficiency work should start to produce results in November and that will provide the Trust some indication of on the level of efficiencies it can expect to achieve this year and in 2017/18;

Item 016/51 from 26 April 2016- deep dive on non-pay expenditure will be

brought to the Committee in October; and

The Committee will receive a presentation focused on the Trust’s 2 year planning with details of the timetable and the processes.

TOP PRODUCTIVITY

016/105 Monitoring Operational Performance – Month 05 The Committee received and discussed the performance report for month 05. The following key points were reported: The Trust’s emergency department (ED) performance against the 4-hour target

improved from 83.51% reported in July to 88.18% in August. The Trust achieved commissioners and NHSI agreed improvement trajectory of 87.44% for the month;

The Princess Royal University Hospital (PRUH) performance improved from 84.5% reported in July to 89.3% in August. However, performance was lower than the last few weeks which saw performance peak in excess of the national target of 95%;

Better forecasting for the PRUH will be realised via the clean sheet redesign

programme. The enhanced leadership structures at the PRUH should also be in full effect following disruptions over the summer period;

The single biggest factor affecting the PRUH site is workforce shortage followed

by bed capacity constraints; Denmark Hill (DH) performance in August was 87.4% an improvement on July.

Attendance to ED continues to remain high with no indication of a reduction in the near future;

DH has an established dependence between onward flow and capacity. The

plan to distinguish major and minor’s emergency care via the ED expansion plan has been delayed due to lack of decanting options;

Enc. 6.1.1

3

Item Subject

Action

The Trust has implemented a new £30m recovery plan which will further affect delivery of ED expansion as the plans will be subject to further financial scrutiny. The Trust must also secure highways permission to create a new access entrance;

The Trust initially planned to have an expanded ED launching just before Christmas, this deadline has now slipped, not only due to the lack of decanting facility but also due to a number of external factors including securing appropriate planning permissions;

The Trust’s referral to treatment (RTT) over 52 week patients reduced from 154

patients reported in July to 144 patients reported in August with 110 cases ahead in neuro specialties. However, the Trust is 76 cases behind in non-neuro specialties;

The Trust is planning to increase orthopedics capacity by moving more cases to

Orpington which will in turn release capacity on DH site to carry out neuro procedures. Orpington is not currently operating at maximum capacity and there is room to optimize efficiency and the use of operational theatres;

The cancer two-week wait suspected referral target was achieved at 93.6%% for

August against national target of 93%;

The two week-wait symptomatic breast performance continues to maintain strong performance at 98.7%. The 62 day screening performance is at risk of non-achievement for Q2 due to failure of the target in July; and

Diagnostics screening has made significant improvement in performance it is

currently operating at 1.6% with plans to be at 1% by October. The following key points were discussed: The financial risk around slippage of the bed capacity programme will have some

reputational implications and commissioner expectation must be managed appropriately. Slippage around the capacity work may have financial implications;

The improvement plans at the PRUH are challenging they are a mixture of lacking the correct staff skill mix and leadership approach. Having the right people leading changes and improvement will be key to achieving lasting improvements; and

The Trust is on trajectory for Clostridium Difficile, but there is a risk of a patient

with MRSA currently in treatment at Croydon Hospital which may be attributed to the Trust, this will take the Trust above trajectory for MRSA.

The Committee will receive and update on ED expansion plans at its next meeting.

JF

SOUND FINANCES

016/106 2016/17 CIP Planning/Stocktake The Committee received the CIPs progress report. The following key points were reported:

Enc. 6.1.1

4

Item Subject

Action

The Trust’s main target remains a CIPs figure of £72m which includes circa £51.5m for this year and circa £20m follow through from last year. The Trust has identified £63m worth of CIPs but there are further options under review;

There is currently a £7m in year gap due to agency spend not reducing as expected, planned ward closures schemes which were not realised and a gap in procurement CIP;

There are a number of risks associated with schemes and management is

working on identifying mitigation measures. The Trust is in discussion with Viapath to increasing efficiency and produce further savings;

The sale of the Trust’s assisted conception unit (ACU) is progressing in the right

direction. Liverpool women’s clinic have presented the Trust with a revised offer in line with expectations;

The Synergy CIP is being worked through, the Interventional Facility

Management (IFM) vehicle has been set up and progressing. The Trust has a risk associated with this vehicle and this area is closely monitored; and

The Trust’s agency reduction CIP currently holds £2m in Amber but there are

plans to turn that green. Medical productivity has begun to indicate the savings potential with early results expected in November.

The following key points were discussed: The circa £7m CIPs gap is composed of £1.5m agency spend, £1m procurement

unrealised savings and £2m due for ward closures which have not occurred; and

Reduction of agency spend is a key CIP area and this is not yet coming through in the figures where spend remains at high levels. The areas of high spend are known and each has had a targeted reduction plan designed. Corporate services are identified as an area with high spend, each service is aware of its expenditures, they must make decisions on how they will address the situation.

016/107 Update on Budget Setting and Contract Negotiations The Committee was informed that negotiations with NHS England are ongoing. The contract has not be signed because there is a point of dispute around payment for foetal services, the Trust will continue to negotiate.

016/108 PFI Review The Committee was informed this is in the very early stages and updates will be provided at a later date.

016/109 Finance Report – M05 The Committee received month 5 finance report. The following key points were reported: The Trust’s cumulative operating deficit at the end of month 5 was £50.8m. With

an adverse variance of circa £24.8m against the year to date planned deficit of £25m;

Enc. 6.1.1

5

Item Subject

Action

The Trust is not achieving its financial control total target set by NHSI on a year to date bases, it is therefore unable to claim the sustainability and transformation fund (STF) payment for Q1.

To maintain key operational function the Trust has made larger than planned

cash withdrawals from its available Working Capital Facility to the tune of 82% of the full facility available for the year; and

The Trust has not underperformed on it block contract, but there has been over

performance some area against under performance in others.

The following key points were discussed: The Trust’s capital programme funding is yet to be confirmed by NHSI. The Trust

has a £70m gap in funding for 2016/17, while £40m is beyond the Trust’s control there is still a £30m gap that the Trust must re-forecast its finances and make sufficient savings;

The Trust’s July agency spend was the third highest for the year, this is an unsustainable position which must receive immediate attention;

The Trust’s cash position is concerning and the Finance team are actively

monitoring and NHSI informed. It was suggested that the Trust explore the opportunity setting up a credit facility with its Bank; and

The Trust is steadily developing a better understanding of its financial position

and ascertain the areas where it forecasting is not optimal. The activity levels is another area that the Trust’s forecasting has been less than sufficient.

016/110 2016/17 CIP Planning/Stocktake The Committee received an update on the Trust’s CIPs position 2016/17. The following key points were discussed: The Trust’s total CIPs value is circa £72m. 2016/17 CIPs are £51.5m plus

£20.8m flow through from last year;

There is a risk of circa £5.5-£6m to 2016/17 CIPs which will require mitigation measures to limit exposure. All CIPs are being reviewed to ensure the Trust has a clear picture of the risks and potential for non-achievement;

The Trust is making progress with more CIPs being approved and highlighted

green. Currently the Trust has circa £34.5m green highlighted CIPs with a £5.4m risk adjustment. The Trust’s refinancing CIPs will deliver substantial savings once finalised;

016/111 Any Other Business There were no items of any other business raised for discussion.

016/112 Date of Next Meeting Tuesday, 25 October 2016, 09:00-11:00 in the Dulwich Committee Room.

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