agenda - king's college hospital
TRANSCRIPT
Key: FE: For Endorsement; FA: For Approval; FR: For Report; FI: For Information
AGENDA
Meeting Public Board of Directors
Time of meeting 11:00-14:00
Date of meeting Wednesday, 5 October 2016
Meeting Room Large Hall, 4th Floor, Bromley Central Library
Site High Street, Bromley, BR1 1EX
Encl. Lead Time
1. . STANDING ITEMS Chair 11:00
1.1. Apologies
1.2. Declarations of Interest
1.3. Chair’s Action
1.4. Minutes of Previous Meeting – 9 September 2016 FA Enc. 1.4
1.5. Action Tracker & Matters Arising FE Enc. 1.5
2. . BEST QUALITY OF CARE
2.1. Patient Story (Communication) FR Presentation B Holland 11:05
2.2 Quarterly Patient Experience FE Enc. 2.2 S Dolan/ J Bush
11:25
2.3 Care Quality Commission Update FE Enc. 2.3 S Dolan/ P Townsend
11:40
2.4 Quality & Governance Committee Chair Update FR Enc. 2.4 G Mufti 11:55
3. . Chief Executive’s Report (to follow) FR Enc. 3 N Moberly 12:00
4. TOP PRODUCTIVITY
4.1. Performance Report (Month 05) FE Enc. 4.1 J Farrell 12:10
4.2. Annual Energy and Carbon Management Report FR Enc. 4.2 J Bond 12:25
5. . SKILLED, CAN DO TEAMS
5.1. Monthly Nurse Staffing Levels Report FE Enc. 5.1 S Dolan/ P Townsend
12:35
6. . FIRM FOUNDATIONS
Sound Finances
6.1. Finance Report (Month 05) FE Enc. 6.1 C Gentile 12:45
6.2. Finance & Performance Committee Chair Update FI Enc. 6.2 C Stooke 13:10
Rigorous Governance
6.3. Board Assurance Framework FI Enc. 6.3 C Gentile 13:25
6.4. Council of Governors Report FR Verbal C North 13:35
6.5. Board Committee Minutes
6.5.1. Finance & Performance Committee – 26/07/2016 FI Enc. 6.5.1 Chair 13:45
7. . ANY OTHER BUSINESS Chair 13:55
8. DATE OF NEXT MEETING
Wednesday, 02 November 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
Dr Alix Pryde (AP) 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)
Paula Townsend (PT) Interim Director of Nursing & Midwifery
Brian Holland (BH) Patient (Agenda Item 2.1)
Cathal Griffin (CG) Energy and Environmental Manager
Chris North (CN) Lead Governor
Apologies:
Trudi Kemp (TK) – Non-voting Director Director of Strategic Development
Circulation List:
Board of Directors & Attendees
Enc. 1.4
1
King’s College Hospital NHS Foundation Trust Board of Directors - PUBLIC
Minutes of the Meeting of the Board of Directors held at 09:30 on 09 September 2016 in the Dulwich Committee Meeting Room, Hambleden Wing, Denmark Hill site Members: Lord Kerslake (BK) Trust Chair Sue Slipman (SS) Non-Executive Director, Vice Chair Faith Boardman (FB) Non-Executive Director Prof. Ghulam Mufti (GM1) Non-Executive Director Prof. Jonathon Cohen Non-Executive Director Dr Alix Pryde (AP) Non-Executive Director Nick Moberly (NM) Acting Chief Executive Officer Dawn Brodrick (DB) Director of Workforce Development Colin Gentile (CG) Chief Financial Officer Toby Lambert (TL) – Non-voting Director Interim Director of Strategic Development (part) Judith Seddon (JS) – Non-voting Director Acting Director of Corporate Affairs Paula Townsend (PT) Acting Director of Nursing & Midwifery Julia Wendon (JW) Medical Director In attendance: Tamara Cowan (TC) Board Secretary (Minutes) Helen Mothersole (HM) Speech & Language Therapist Elizabeth Allan (EA) Speech & Language Therapist Petula Storey (PS) Head of Volunteering Penny Dale (PD) Public Governor Fiona Clark (FC) Public Governor Lisa Hollins (LH) Shadow Director of Transformation & ICT Robert Kettell Department of Health Andy Simmons Southwark Council Apologies: Chris Stooke (CS) Non-Executive Director Jane Farrell (JF) Chief Operating Officer Ahmad Toumadj (AT) – Non-voting Director Interim Director of Capital, Estates & Facilities Erik Nordkamp (EN) Non-Executive Director Trudi Kemp (TK) – Non-voting Director Director of Strategic Development
Item Subject Action
16/82 Apologies Apologies for absence were noted.
16/83 Declarations of Interest There were no declarations on interest made at the meeting.
Enc. 1.4
2
Item Subject Action
16/84 Minutes of the previous meeting The minutes of the meeting held on 06 July 2016 were approved as a correct record.
16/85 Matters Arising/Action Tracking The action tracker was noted.
16/86 BEST QUALITY OF CARE
16/86.1 Patient Story The Board welcomed patient Charles Stott and his wife Norah Stott along with Christine Greensitt, IV Practitioner. Charles and Norah relayed the following details of their experience at the Trust: Having developed an infection of the titanium bar in his leg the patient was
treated and prescribed antibiotics which had to be taken once daily via a peripherally inserted central catheters (PICC) line;
The antibiotic had to be given by a district nurse but the service was somewhat sporadic with a different nurse attending the patient at home each day for only 30 minutes;
This resulted in the infusion of the antibiotics being administered over a shorter
time than recommended resulting in the development of some bad side effect and readmission to the hospital. The patient developed Redman syndrome;
The reliance on the district nurse and the time it took to adequately administer
the antibiotic seriously impeded the patient’s work and personal life;
Having explored the issue with community services and originating hospital Norah contacted King’s College Hospital;
Having listened to the patient’s story Chris Greensitt recognised that there had
been a breakdown in the service provision and a that this was impacting on not only the patient’s quality of life but also their business;
Chris therefore proposed that the patient considered the feasibility of his wife
administering the infusion which would enable greater flexibility, allow the correct time for the infusion to be given;
Norah was given access to training in making up the infusion and administering
through the picc line at Kings and provider her with a comprehensive list of instructions. Norah was also able to email Chris when supplies were running low;
The support from King’s was very progressive and efficient and since the
support Charles has had all clear blood test and no more infection in the leg; and
Enc. 1.4
3
Item Subject Action
A business case has been considered and approved for the Trust to provide an Outpatient Parenteral Antibiotic Therapy (OPAT) service.
The following points were raised in discussion: The breakdown of the care happened when the patient was discharged from
hospital and into community district nurse services; The district nurse service is highly stretched and there is evident issues for
patients who are impacted by the challenges in the health economy ;
The patient’s wife felt the magnitude of taking responsibility for administering the infusion however this is outweighed by the significant benefits of managing the provision of antibiotics;
The Trust’s IV service is supported by four practitioners at the Denmark Hill site
and 2 on the Princess Royal University Hospital (PRUH); This is a good example of the type of transformative service design which the
Trust is embarking in order to improve its service; and
As the Trust develops its transformation programme it needs to keep at the centre testing success the voice of patients, staff and process metrics.
16/86.2 Quarterly Patient Outcomes Report The Board received the quarterly patient outcomes report. The following key points were reported: There have been two red indicators for diabetes during the quarter which relate
to changes in management. The Trust is looking also looking at diabetes management and inpatient services and ways to improve pharmacy service ;
The PCI performance relates to process issues;
Dementia screening is increasing and there is a high prevalence in the PRUH;
The quality priority for enhanced recovery after surgery will form part of the transformation programme;
The Trust is performing well against SHMI but the SHMI scores for patients
over 75 is an issue and will be subject to a deep dive; and The following points were raised in discussion: The Trust monitors pregnant women with diabetes very closely;
The Trust is staking steps to reduce and erode the disparities for over 75 but
there are issues in the community. There need to be greater pooling of resources.
The Trust is focusing on speeding up discharge of patients as the data for SHMI is standardised comorbidity data;
Enc. 1.4
4
Item Subject Action
Lots of issues about how people are support in the community; There has historically been a lack of investment in diabetes services at the
PRUH because this service was previously provided by Bromley Healthcare; and
The outcomes and the good areas of practice and care being delivered to
patients assure the Board.
It was agreed that the key for the outcomes report would be moved to the top of the report.
JW
16/86.3 Quality & Governance Committee Chair Update GM an overview from the recent Quality & Governance Committee. He advised that whilst outcome performance is good and definitely better than it has been over the five years the following things remain of concern: Never events are concerning and the Committee took a detailed review and
considered what has been done to address the issues. The Committee note the number of steps in place to ensure no more never events happen. Despite the introduction of the new measures the Committee is not wholly assured and will keep never events on the Committee’s agenda;
The other area of concern for the Committee is volume and the types of hospital acquired infections. In particular the norovirus outbreak at the Princess Royal University Hospital (PRUH) site and at Denmark Hill have been particular significant. Full reports were presented to the Committee and the issue will be kept under review. CPE is also very concerning as these infection strains are very resistant to powerful antibiotics. At its meeting the Committee also looked at the types of bugs, why the resistants’ develops and whilst the concern remains the Committee was assured that the Trust is taking a number of steps including routine screening; and
The Committee was also considered nursing report with the vacancy rates and retention of nurses being particular areas of focus and concern.
It was also noted that the Committee would be considering its terms of reference to make room to explore and consider research matters.
16/87 Chief Executive's Report The Board received and noted the report from the Chief Executive Officer (CEO). The following key points were reported: There are lots of things going in the right direction but big issue is the financial
position;
Enc. 1.4
5
Item Subject Action
The King’s Way transformation work is making decent progress; The appointments into the new structure is also going well and the new
structures will be implemented in the November. The focus has been on getting the very senior operations role in place;
King’s Academy is making good progress and improve what the Trust has to
offer to its employees;;
The Trust is focusing on improving standards and processes to ensure efficiencies are achieved in line with providing the best clinical care;
The roll out of the new electronic patient record (EPR) has begun and it is up
and running on the Denmark Hill (DH) site;
Good progress has been made on improving performance against the diagnostic waits trajectory;
As above, the big material issue is the Trust’s material variance of £10m
against the month 4 position.
Some of the challenges relate to activity underperformance and the Trust is carefully scrutinising its numbers.
The following key points were raised in discussion: The Trust cannot loose site of the fact that the Trust outcomes are very
encouraging; From feedback it would seem that the rational for the organisational structural
changes are not be clearly understood throughout the organisation.
The narrative of change needs to be clear, everyone needs to be on board which will drive the necessary behavioural change;
There is considerable risk in the organisation and the new structure will foster
better clarity in the chain of command and produce a fit for purpose organisation. This is a high risk point for the organisation which is on a journey. There has been extensive engagement with the organisation and the revised structures will drive considered systemic change in a focused way but there needs to be more work on behavioural changes. The organisation needs this change now and there will always be tension during any major change project. The narrative will need to change and getting the right leadership in place to help get the right messages across. The new communications director will help shape the right messaging;
Enc. 1.4
6
Item Subject Action
The Trust needs to be able to measure the level of engagement. This in part would be done by measuring how people are feeling. Simple measures will be utilised by leaders to gauge how local teams are feeling on a daily basis;
The Trust will benchmark engagement and staff mood but this cannot be reliant on just a survey question it has to be embedded in the working practice of the Trust and measured in real time;
Ideally the Trust would have implemented the new structure earlier but had to
wait for the JF to start as Chief Operating Officer to inform the structure;
The important thing now is how the Trust engages with the leaders being appointed in new leadership roles;
The case for change was very clear but the narrative has to demonstrate that is
critical to have a useful structure. The Trust is at a vulnerable point and it is important to make consistent process;
The Trust has been working hard to ensure its plans to complete the agreed
Care Quality Commission (CQC) actions are progressing well given that a visit from the CQC may be imminent.
The Trust has made some good progress and there are other areas which require more structure and intervention. The Trust need to look at data on statutory mandatory training and make a strict commitment to make serious improvements as the CQC would not look favourably on failure by the Trust.
It was agreed that the Board would receive monthly updates on the CQC actions.
SD/JW/JF
16/88 TOP PRODUCTIVITY
16/88.1 Trust Performance Report 2016/17 (Month 04) The Board received and discussed the month 04 performance report which was also considered at a virtual meeting of the Finance & Performance Committee meeting on 23 August 2016. The following key points were reported: Referral to treatment (RTT) trajectory is still challenged relating to the issues of
capacity on wards and resources; In June performance dipped below the Trust’s target; Whilst there has not been any growth in the Emergency Department (ED)
admissions activity has been stepped up which has slowed down ED pathway;
Enc. 1.4
7
Item Subject Action
In July the Princess Royal University Hospital (PRUH) site dropped in performance with more pressure on emergency beds impacting on flow out of the hospital;
There has been in admission at the PRUH but in August there was a stepped improvement;
The Trust was above its ED trajectory at 88.1% in August but did now meet the
sustainable transformation fund trajectory for the quarter;
At the beginning of September PRUH has been very challenged and issues relate to having sufficient medical beds. The pace of turnaround but there is fragility in the performance;
The Trust will be running a safer faster week at the DH site to get the whole
organisation geared up and involved in progress discharges;
The Trust needs to do more assess the increased activity levels to ascertain if the acuity of the patients is the sole driving factor.
The urgent care centre at the PRUH is not delivering on breaches but Angela Bahn is working with the Trust to improve the performance;
The transfer of care bureau is working well to get discharges done however this is countered by the number of emergency increases;
The key issue is about failed discharged and how the Trust can improve this in the next few weeks;
The Trust has been working on the RTT backlog and is marginally ahead of trajectory;
The challenge lies with 52-day wait and there has been an increase in July. The
Trust is treating patients on a daily basis but there have been 77 breaches in September;
The Trust is monitoring the PTL on a weekly basis;
There is an issue with admitted and non-admitted neuro patients pathways but
the Trust is making good progress with 17 patients seen recently and another 16 have dates;
The Trust forecast coming ahead of its RTT targets by end of March 2017;
On hold, the Trust is making significant progress on cancer. Screening targets
are slightly off;
The diagnostics wait position has improved although still of the national trajectory of 1% which the NHS England expect the Trust to fill;
The Trust has had two reported cases on MRSA in the period; and
Enc. 1.4
8
Item Subject Action
CPE cases is an issue with 46 cases reported during the period. The Trust is conducting a deep dive into the position.
The following key points were raised in discussion: If the focus is on discharges the Trust has to be careful about the link to
readmission rates; Consultants are more involved in the discharge process and with the
implementation of the seven-day working and the Trust will continue to drive consultant involvement in discharge;
The performance for ED is critical but the impact of increased activity on the
financial position and the ability generate income;
The Trust has a number grade 2 bed sores but not grade 4. These relate the condition of patients and sometimes the drugs that they are on;
The vacancy rates are rising but there has been a huge recruitment drive over
the last three months with new nurses starting in January 2017.
Medical vacancy rates are also a concern comes to a point where the Trust has long term viability. The DH site is more attractive than the PRUH due in part of the higher cost of living; and
The Trust need people to apply for jobs at the PRUH and will therefore apply
different recruitment campaigns. The Trust will have to consider the different models to match London weighting pay scales for PRUH based staff. The Trust is also looking into retention of staff through initiatives such as moving staff around providing learning, development and promotion activities.
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
16/89 SKILLED, ‘CAN DO’ TEAMS
16/89.1 Monthly Nurse Staffing Levels Report The Board received and noted the monthly nurse and midwifery staffing levels report.
16/90 FIRM FOUNDATIONS
Sound Finance
16/90.1 Finance Report (Month 04) The Board received and discussed the month 04 finance report which was also considered at a virtual meeting of the Finance & Performance Committee meeting on 23 August 2016.
Enc. 1.4
9
Item Subject Action
The following key points were reported: At month 4 the Trust has deficit of £44.1m which is £19m adverse against plan.
Attributing factors include: non-receipt of the £10m sustainable transformation fund (STF); Income shortfalls related to cost on volume contract with NHS England
(NHSE) and local commissioners circa £7.4m; CIPs is behind by £2.4m and £2m flow through from the previous year –
and mitigations are being explored; Impact of last year’s shortfall.
The Trust is exploring mitigations but this is not a good position to be at this period of item and the Trust will attract scrutiny by regulators;
The Trust has conducted a detailed review and projection from the month four
position extrapolated over the next eight months with the view of developing a robust plan to mitigate the position;
The Trust is also looking at its spend and is keeping vigil on the cash position;
Because of the size of the deficit the Trust has utilised most of its funding facility
and the Trust will put in an application for future case support to NHS Improvement (NHSI);
NHSI has not yet confirmed approval of the Trust’s £71.2m capital programme;
and
The Trust has already undertaken £24m worth of capital schemes at risk in order to increase bed capacity and improve ED pathway.
The following key points were raised in discussion: The July position includes all the consequences of not achieving the targets;
The Trust is doqn on dental , neuro-surgery, ITU/elective care and cardiac
targets which is attributing to the position;
The Trust is over performing on its block contract but under performing against the NHSE cost and volume contract; and
Critical care and emergency activity is crowding out tertiary activity.
16/90.2 Finance & Performance Committee Chair Update The Board received and noted the report from the Committee Chair.
Enc. 1.4
10
Item Subject Action
Rigorous Governance
16/91 Council of Governors Report The Board received an update on the activities of the Council of Governors from Lead Governor, Chris North. On behalf of the governors he relayed the following key matters: Governors would like to participate in new nurses induction programmes;
The recent governor and non-executive review session was very useful and all
governor questions were addressed;
It is important that governors are kept in the loop about the developments within the Trust such as the transformation programme and the restructure so they may ably articulate to members and the public;
It would be useful to give the governors a briefing note a briefing note ahead the
Annual Members Meeting and that there will be fortnightly communications update on communications updates sent to governors about pertinent news stories.
DB/NM
16/92 Confirmed Board Committee Minutes The Board noted and received the confirmed minutes of the Finance & Performance Committee held on 26 May 2016.
16/93 Chair's and Non-Executive Director's (NEDs) Activity Report The Board noted the report on the Chair and NED's activity.
16/94 ANY OTHER BUSINESS
Peter Fry The Board noted that this was Peter Fry’s last meeting of the Board and that he will leave the Trust on 23 September. The Board thanked Peter for his contribution to the Trust and wished him well in his new role as Chief Operating Officer at Mid Essex Hospital Services NHS Trust.
16/95 DATE OF NEXT MEETING
Wednesday, 05 October 2016, 11:00, Bromley Library, High Street, Bromley, BR1 1EX
Enc. 1.5.1
Date Item Action Who Due
06/07/2016 16/72.2
Quarterly Patient Safety Report 1) The Board would receive an
update on structural issues at the PRUH and the correlation to infection control issues.
JW/PT 05/10/2016
Structural issues at the PRUH and their relationship to infection control Vinci have been tasked with installing 21 additional sinks at the PRUH to improve hand hygiene and reduce the risk of infection spread. As at 22/9/16, 16 sinks had been installed and signed-off. The remaining 5 sinks were in the process of being installed with an expected date of completion of the end of September 2016. It was agreed following the last norovirus outbreak at the PRUH that all of the entrance doors to (and between) the wards would be locked (magnetic lock – can be opened from the inside). However, this has presented an access issue for visitors (and some staff) who have difficulty gaining entry and have to attract staff attention through the glass from outside. The cost of an intercom system is being explored with security and the facilities contractor Vinci. Date Item Action Who Due
06/07/2016 16/72.2
Quarterly Patient Safety Report 2) The Board would receive
periodic updates on basic hand hygiene metrics.
JW/PT 05/10/2016
Update on basic hand hygiene metrics At DH the hand hygiene results for July (93.4%) and August (93.6%) were just below target (95%). At PRUH the hand hygiene results for Jul (90.8%) and Aug (86%) were lower than expected given the relatively recent issues with norovirus at the site. In response a PRUH hand hygiene action plan has been developed which includes the scheduling of 2 hand hygiene awareness days (19/10/16 at DH and 21/10/16 at PRUH), new posters for display, identification of hand hygiene champions in specific areas and a communications campaign (including fact of the fortnight, CEO brief, and Kingsnews).
This page has been left blank
Enc. 1.5
Action Status as at: 05/10/2016 1
BOARD OF DIRECTORS (PUBLIC MEETING) ACTION TRACKER
Date Item Action Who Due Update DUE
06/07/2016 16/72.2 Quarterly Patient Safety Report - The following was agreed: 1) The Board would receive an update on structural issues
at the PRUH and the correlation to infection control issues; and
2) The Board would receive periodic updates on basic hand hygiene metrics.
JW/PT
05/10/2016
See Enc. 1.5.1
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 05/10/2016 Update to be provided at the meeting.
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 05/10/2016 Update to be provided at the meeting.
NOT DUE 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;
2) The Board also noted and endorsed the commitment from management to improve the position by quarter 3/4.
JW/NM 02/11/2016
2
Date Item Action Who Due Update 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
COMPLETED 06/07/2016 16/77 PwC Governance Review - The Board noted the progress
on implementing the actions from the PwC Governance Review and it was agreed that the revised management governance structure would be circulated.
NM 05/10/2016 Was presented as part of Restructure Report provided to the private Board in September.
06/04/2016 16/34 Chief Executive's Report - It was agreed that the Trust would start to promote its Orthopaedics outcomes and the merits of the Trust hosting one of the centres in the interim.
NM 09/09/2016
06/04/2016 16/34 Chief Executive's Report - It was also agreed that FB, BK and JF would have a side meeting about hitting the 50% response to complaints.
JF/BK/FB 09/09/2016
09/09/2016 16/88.1 Quarter Patient Outcomes Report - It was agreed that the key for the outcomes report would be moved to the top of the report.
JW 05/10/2016 TC advised report author.
09/09/2016 16/87 Chief Executive’s Report - It was agreed that the Board would receive monthly updates on the CQC actions.
JW/JF/SD 05/10/2016 Now part Board workplan
Patient Experience Report
Board of Directors 05 October 2016
1
Enc. 2.2
Patient Experience ReportQuality and Governance Committee
2
Report to: Board of DirectorsDate of meeting: 05 October 2016Subject: Patient Experience ReportAuthor(s): Jessica Bush, Head of Engagement and Patient Experience, Sophie Dalton, Head of Patient
Relations and Complaints, Cathy Varley, PALS and Support Services Manager
Presented by: Jessica Bush and Judith SeddonSponsor: Paula Townsend, Acting Director of NursingHistory: Discussed at Quality & Governance Committee on 16 September 2016Status: For Report
1. Summary of Report
This quarterly report to the Board of Directorsabout patient experience presents data andqualitative feedback from patients for Quarter 12016/2017.
2. Action required
The Board is asked to note this report and offercomments and recommendations.
3. Key implications
Legal: N/A
Financial:Reputational risk
Assurance:CQC Fundamental Standards – Caring and Responsiveness.Delivery of mandated Friends and Family Test
Clinical: N/A
Equality & Diversity:
The Equality Delivery System seeks to ensure that all patient groups receive the same quality patient experience
Performance:Performance against CQC Fundamental StandardsFriends and Family TestComplaints performanceCQC National Patient Survey performance Delivery of Quality Account PrioritiesDeliver of Quality Strategy
Strategy:Patient Experience is a key deliverable of the King’s Strategy and forms a part of the Trust Quality Account
Workforce: Links to Staff Friends and FamilyEstates: Quality of estate from a patient perspective Reputation: Poor patient experience is a reputational risk.Other:
Enc. 2.2
King's Corporate Strategy seeks to provide 'Best Care Globally' and one of the key strategies underpinning this goal is 'Best Quality Care' which encompasses our desire to treat our patients with courtesy and compassion, to listen to the views of patients, carers and the community to improve what we do and to provide accessible and user friendly services.
Executive Summary
• The overall picture for Quarter 1 is of varied patient experience with particular issues in outpatients and our emergency departments
• For the Friends and Family Tests– Inpatient performance continues to be strong with satisfaction on a par with both
London and trusts nationally. Particularly strong for Liver with average FFT score of 99 (in the top 10% nationally) with Cardiac and Renal on 97. Their remain key wards where satisfaction rates are lower. The roll‐out of Kingsway for Wards should begin to have an impact overall as it is rolled out
– Emergency Departments remain challenged and satisfaction fell overall for the trust. Again, there was some improvement going into Q2, particularly at PRUH
– Outpatients satisfaction remains low and dipped to 86% in May, lowest score this year– Maternity satisfaction improved in April and May, on a par with both trusts in London
and nationally. However, scores fell back in June
• How are we doing– Inpatients – all divisions met/ exceeded overall internal target of 89, an improvement
on Q4– Outpatients – satisfaction remains static at 82% recommending
• Complaints– In Q1 16/17, 241 complaints were received compared to 206 in Q4 15/16; 156 (110) at
DH and 85 (97) at the Bromley sites. There has been a significant increase in DH complaints since April 16 with a surge in activity in June, July and August (64% increase compared to March‐May) This appears to relate to a steep upward trend in outpatient related complaints since April which also correlates with a growth in PALS outpatient activity.
– Performance in responding to complaints in Q1 is 47% closed within 25 working days; however overall 16/17 YTD performance is 45%. Just over half of the complaints investigated were upheld. Performance is down from Q4 which was at 50%
• PALS: – The key theme of this quarter is increased outpatient activity relating to a generic
deterioration in the response to telephone answering Quality Account priorities progressing though some delays in OP work
3
Enc. 2.2
• Satisfaction continued to fall over the quarter but has recovered slightly in July, particularly at PRUH. This is in line with increase nationally and for London Region
• Trust remains well below both London and National averages and the Shelford Group with a recommendation rate of 79% compared to 95% for Imperial
• Feedback continues to focus on waiting times, staff attitude and aspects of the environment
• The slight uplift in July is in spite of worsened performance against the 4 hour target
Friends and Family Test A&E – target to be in top 10% of trusts nationally nationally
Very friendly staff. Although I had to wait a long time, doctors were very attentive and very helpful.
Chaotic triage, but good care once seen.
4
Shelford Group – May FFT A&E + FFT
Imperial 95University College Hospitals London 93
Cambridge University Hospitals 93
Newcastle upon Tyne 92Sheffield Teaching 89Central Manchester 86University Hospitals Birmingham 84
England average 84Guy’s and St Thomas’ 82London average 82Oxford University Hospitals 81King’s College Hospital 79
Enc. 2.2
•Performance over the quarter has been positive with satisfaction in both April and June meeting or exceeding London and National averages. Satisfaction dipped in May
•Within the clinical divisions, Liver had a brilliant 99% recommendation over Q1, amongst the best in the country, with Cardiovascular and Renal averaged 97%, above the national average
•Top Shelford group Trust (May data) remains Newcastle with a 98% recommend score with King’s performing on a par with UCLH and Oxford
•Continued strong Orpington performance which will support our bid to be one of the SE
London specialist orthopaedic centres.
Friends and Family Test Inpatient – target to be in top 10% of trusts nationally
Your staff have been amazing. They were patient, kind, full of empathy, and explained everything clearly. Totally understood and accommodated any fears. Friendly, cheerful, and made an unpleasant experience as good as it possibly could be. From cleaning staff to surgeons, you have been brilliant. Thank you! 5
Shelford Group – May FFT Inpatients + FFT
Newcastle upon Tyne 98
Imperial 97
University Hospitals Birmingham 97
Guy’s and St Thomas’ 97
University College Hospitals London 96
Oxford University Hospitals 96
King’s College Hospital 96
England average 95
London average 95Cambridge University Hospitals 95
Sheffield Teaching 95
Central Manchester 92
Enc. 2.2
Friends and Family Test Outpatients –target to be in top 10% of trusts nationally
Good experience, but the one and a half hour wait was ridiculous when the appointment only took 20 minutes.
The staff are so helpful and kind. There is nothing they wouldn’t do for you. It really is a wonderful department.
6
Shelford Group – March FFT Inpatients + FFT Score
University Hospitals Birmingham 97
Imperial 94Newcastle upon Tyne 94Sheffield Teaching 93Guy’s and St Thomas’ 93Oxford University Hospitals 93University College Hospitals London 92England average 92London average 92Cambridge University Hospitals 88King’s College Hospital 88Central Manchester 87
•Performance over the quarter has been positive with satisfaction in both April and June meeting or exceeding London and National averages. Satisfaction dipped in May
•Within the clinical divisions, Liver had an excellent 99% recommendation over Q1, amongst the best in the country, with Cardiovascular and Renal averaged 97%, above the national average
•Top Shelford group Trust (May data) remains Newcastle with a 98% recommend score with King’s performing on a par with UCLH and Oxford
•Continued strong Orpington performance which will support our bid to be one of the SE
London specialist orthopaedic centres.
Enc. 2.2
•The table provides the average rating over the four maternity FFT touchpoints – ante natal, labour and birth, post natal and post natal in the community
• Trending below the London and national average scores, though April and May results more positive
•Highest satisfaction ratings received for care during labour and birth•Continuing low responses for post natal community•National combined recommend percentage was 88% over the quarter
Friends and Family Test Maternity –target to be in top 10% of trusts nationally
I last used the maternity services on the post-natal ward 5 years ago, and was very impressed to see how many changes have been made for the better! Wonderful service, and brilliant midwives who go out of their way to help despite the time constraints they are clearly under. I felt very well looked after.
Nurses and midwives have been excellent. However, the room has been much too hot at times.
7
Enc. 2.2
• HRWD Performance against our internal benchmarks has improved this month with all Divisions meeting or exceeding the overall target score of
• Child Health continue to score very highly with an average satisfaction score over Q1 of 95 compared to 97 for Q4
• Involving patients in decisions about their discharge is green across the board which is positive as this is an area where performance struggled in the last CQC national inpatient survey
• Five wards were red rated over the quarter with a further four one below target
• Medical 1 and Trundle were the best performing wards over Q1
How are we doing? Inpatients performance Q1
8
Enc. 2.2
• Overall, the Trust satisfaction score remained at 82 for the second quarter, one point below target• Some good performance from the Divisions with five meeting or exceeding the current HRWD target satisfaction score of 83• However, Ambulatory, Child Health, Haematology and Women’s are all scoring well below target • Satisfaction with being seen on time dropped this quarter and information on waiting remains poor – TEAM scores dropped
significantly from 66 in Q4 to 41 in Q1 • Work is underway to improve information about delays through the Trust’s Improving Outpatient Experience quality priority for this
year – focus will be on ophthalmology on both sites • Performance is better for caring aspects of the service including involving patients in their care, treating them with respect and dignity
and kindness
How are we doing? Outpatients performance Q4
9
Question / Overall Site & Divisions
Trust
Cardiovascular
CC
TD
Haem
atology
Liver
Renal
Surgery
TEAM
Therapies
Wom
ens Services
Benchm
ark
1 . Friends and Family Test 88 94 83 78 93 94 86 96 92 81 873 . Experience of booking an appointment 74 81 80 64 74 86 78 83 67 72 804 . Seen on time 65 71 67 52 52 69 59 84 84 61 705 . Information on Waiting 36 28 31 30 30 56 36 48 38 24 606 . Involvement in Care 86 89 85 80 79 93 84 93 93 82 857 . Dignity and Respect 94 96 92 90 97 100 94 99 98 86 948 . Kindness & understanding – reception staff 91 95 92 86 93 98 92 97 94 78 949 . Kindness & understanding – clinical staff 95 98 94 95 97 98 95 100 99 88 94
Overall 82 86 83 74 79 88 80 90 87 76 83Respondents 2057 83 103 36 109 31 521 247 138 110273 56 211 139
78 72 81 8194 90 92 9789 74 86 9394 91 89 9586 83 85 8635 25 29 4454 56 72 6266 60 74 6584 79 87 90
Am
bulatory
Child H
ealth
Dental
Neurosciences
Enc. 2.2
• New appointment letters launched• Easy read survey has been developed to evaluate if the accessible information standards are being met. Next step to get feedback from local groups
• Initial meetings have taken place with key staff and working group set up to develop accessible feedback tools to include speech and language, stroke and LD expertise
• Draft survey and images ready for testing• Initial work underway to develop training for volunteers about learning disability and communication to enable supported feedback
• Initial baseline data analysis completed identifying key areas for improvement at DH and PRUH
• First clinics for improvement work identified and agreed with Divisional Manager as Ophthalmology at both DH and PRUH where satisfaction rates are very low
• Given capacity issues, work will focus on one specialty
• Further meetings on both sites being held in September to discuss interventions to address issues
• Not as far forward as we would like and general capacity issues within both PPI team and service are proving challenging
Patient Experience Quality Priorities –progress to‐date
Accessible information: Improve access to information for patients, carers , service users and parents where those needs relate to a disability, impairment or sensory loss.
Improving Outpatient Experience: Improving information about waiting times for patients in clinic
10
Enc. 2.2
Patient Complaints Q16/17
In Q1 16/17, 241 complaints were received compared to 206 in Q4 15/16; 156 (110) at DH and 85 (97) at the Bromley sites. There has been a significant increase in DH complaints since April 16 with a surge in activity in June, July and August (64% increase compared to March-May) This appears to relate to a steep upward trend in outpatient related complaints since April which also correlates with a growth in PALS outpatient activity.
Performance in responding to complaints in Q1 is 47% closed within 25 working days; however overall 16/17 YTD performance is 45%. Just over half of the complaints investigated were upheld.
Inpatient complaints (including maternity) represent 53.5% of the overall total complaints received in Q1 (129) which is no change from Q4 (127); DH, 71 and Bromley sites, 50. The number of complaints at DH increased in July and August which will potentially increase activity by 50% in Q2 16/17. Maternity complaints increased from 14 in Q4 (11 DH, 3 PRUH) to 22 in Q1 (11 DH, 11 PRUH).Outpatients significant increase in concerns becoming complaints since April16 across both sites (Q1, DH 69, BR 20). Issues such as cancelled appointments, delays in clinics, staff attitude, have further deteriorated since June, with local resolution increasingly achieving little success. This may reflect the current significant operational challenges within the organisation. This upward trend peaked in August (33). ED static in Q1 with activity at both DH and PRUH rising in July with many citing long waits for assessment and incorrect discharge decisions.
Enc. 2.2
Responsiveness
Responding to complaints fell from 50% in Q4 15/16 to 47% in Q1 16/17. Response rates within the divisions is varied with several areas achieving >60% response rate which is encouraging. The overall response rate YTD in 16/17 is 45%. Struggling areas in this period to highlight include Liver, Surgery, cardiovascular, haematology, neurosciences, Dental, CCTD, and ED.
With the trend in higher complaint levels seen in the past 4 months, operational support will need to be targeted to ensure response rates stay on track and do not further deteriorate.
A new complaints web module (Datix) will be built around the new organisational structure in October – November 2016. This will allow the Divisions to access live complaints data so that numbers of complaints, timeliness of response times and progress against action plans can be captured and monitored locally.
Enc. 2.2
Complaint themes
38% (53) of inpatient complaints relate to clinical treatment (doctor led) which is a decrease from Q4 (68); DH 25, BR 28. Complaints fall across all areas with no common theme. Neurosciences, General Medicine and Surgery had the most complaints of this type. Communication concerns have increased at DH (9) and include issues such as updating and including the patient on care plans for treatment. Across both sites admissions and discharges remains a theme with elective cancellations more evident at DH and discharge decisions (early, planning) at the PRUH.
In stark contrast to Q4, outpatient activity has significantly increased by 38% in Q1 to 109 (Q4 79), due to a sharp increase in OPD complaints at DH (Q1 84, Q4 37) – BR (Q1 25, Q4 40). This is in part due to the rise in process type issues at DH for which local handling has not been successful. Also, complaints about staff attitude have risen at DH for the first time in 12 months. Complaints about clinical treatment are multifaceted and are not specific to any particular area. DH OPD complaints have continued to rise in July and August (61). Appointments - long waits or cancellations appear to be a trend.
Enc. 2.2
Divisional Activity
Denmark Hill: Networked Services (cardiovascular, haematology and neurosciences) continue to have the highest profile of complaints, with 20% of the overall DH total in Q1 (31). Neurosciences’ complaint (19) are varied in their theme and while some relate to complex clinical decisions, some highlight difficulties accessing staff, obtaining information and understanding their care plans. Ambulatory complaints doubled in Q1 (24 from 11 in Q4) and reflect a general increase in outpatient concerns (not Dental) and include appointments, staff behaviour and clinical treatment. Surgery complaints increased in Q1 to 22 from a low in Q4 (9). Concerns are largely inpatient related and cover a range of issues, including staff behaviour, elective cancellations and clinical decisions/treatment.
Bromley sites: Overall Surgery has the highest profile of complaints which was consistent throughout 2015/16. However in Q1, complaints about General Medicine continued at higher level with 25 (Q4, 26). There was a small decrease in Surgery (Q1 17, Q4 19). Maternity experienced an unusually high number of complaints in Q1 (11) from 4 in Q4. These concerned management of labour, communication and support to women. ED complaints reduced to 5 in Q1, from 9 in Q4 and 15 in Q3.
Enc. 2.2
When investigation and responding to complaints, we are continually identifying areas of our service that we can improve on, which may also include individual performance and personal development. As part of our approach to resolving complaints, we invite patients, their families and/or advocates to meet with us, as listening first hand to experiences, enables us all to reflect and ensure changes are made when we have not got things right. During Q1 we have used complaints to contribute towards a range of general improvements across the organisation. Below is one case which has resulted in a number of actions being identified which have been completed or remain ongoing.
Learning
Elderly patient attended the Emergency Department feeling unwell and unsteady on their feet. He suffered from dementia. When assessed as clinically fit and able to go home, the hospital booked patient transport, but this was delayed and the patient had an extended wait in the clinical decision unit (CDU). Desperate to leave, the patient left the hospital independently and made his own way home.
In response to the complaint, the Trust acknowledged and apologised for the family’s distress at the patient leaving the hospital in a vulnerable state. The patient transport service was delayed in providing a car and the nurses were monitoring this at regular intervals and actively escalating the situation to senior clinical colleagues. The patient was recognised as becoming more anxious at the delay and staff were caring for him during this time. When it was observed that the patient hadleft their bed space, the Trust’s policy for missing patients was triggered and the Police were contacted.
Often patients who are confused or agitated and who are admitted to the CDU to wait for transport home, often do not fit the criteria for a one-to-one nurse special to look after them. It was accepted that in this case, the patient’s level of vulnerability meant that a security guard should have been requested to keep an eye on the patient, either as a standby presence or via the CCTV.
A number of key learning actions were taken which include:1. Closer monitoring of transport delays to minimise the extended delay of a vulnerable patient. 2. CDU to work with the Trust’s Specials Team who provide one-to-one support to ensure vulnerable patients who require
additional supervision, get the appropriate care. 3. A number of distraction games, memorabilia aids and other tactile stimulants for dementia patients have been purchased
to provide therapeutic intervention to reduce anxiety in patients with dementia and other cognitive impairments.
Enc. 2.2
Patient Advice and Liaison Service Overview of activity
In addition PALS contact details have been added to all outpatient appointment correspondence which has increased activity with simple appointment enquiries. Communication at Queen Marys has deteriorated again with a peak of activity in June relating to Ophthalmology appointments.
The key theme of this quarter is increased outpatient activity relating to a generic deterioration in the response to telephone answering. There are an increasing volume of patients with clinical enquiries in the delays in their pathway, diagnostic results or future care plan.
16
Enc. 2.2
Activity for Liver Renal and Surgery Bromley sites comparison of Q4 15/16 and Q1 16/17
Bromley Sites
Q1 16/17 Audiology Colorectal ENT GastroGeneral Surgery Orthopaedic Urology Total
April 0 2 8 14 26 50 18 118May 0 8 5 11 40 36 13 113June 0 5 8 12 52 45 15 137Total 0 15 21 37 118 131 46 368
• Cancellation of elective surgery has continued to adversely impact on patient experience over the quarter quarter. Although bed capacity remains the significant factor, some short notice cancellations have occurred relating to lack of availability of clinical staff.
• Contacts with PALS relate to information/assistance regarding admissions, clinical enquiries and outpatient appointments.
• Trend for General Surgery continues upward with the highest number of monthly contacts in June• Although Orthopaedics dropped back in May, contacts have increased again in June
0
10
20
30
40
50
60
January February March April May June
Comparison of LRS Cases Bromley Sites Jan – June 2016
Audiology
Colorectal
ENT
Gastroenterology
General Surgery
Orthopaedics
Urology
Enc. 2.2
Activity for Liver Renal and Surgery Denmark Hill site comparison of Q4 15/16 and Q1 16/17
Denmark HillQ1 16/17
Colorectal General Surgery Liver Orthopaedic Renal Urology TotalApril 10 19 24 25 3 8 89May 14 14 33 24 3 10 98June 8 18 31 23 6 11 97Total 32 51 88 72 12 29 284
• The reduction in availability of elective ‘clean’ beds adversely impacted Orthopaedic patients, increasing their waiting time for surgery.
• Generic bed capacity issues caused on going cancellations of elective surgery with associated patient enquiries/concerns
Enc. 2.2
Activity for Ophthalmology all sites comparison of Q4 15/16 and Q1 16/17
• Opthalomology contacts remain high and increased at the Princess Royal site this quarter whilst remaining static at Queen Mary’s.
• Telephone access for appointment and clinical enquiries is the key problem on all sites.
Ambulatory Q1 16/17
Ophthalmology PRUH
Ophthalmology QM
Ophthalmology DMH Total
April 21 92 32 145May 24 75 21 120June 20 113 24 157Total 65 280 77 422
Ambulatory Q4 15/16
Ophthalmology PRUH
Ophthalmology QM
Ophthalmology DMH Total
January 12 77 20 109February 7 110 34 151March 19 78 26 123Total 38 265 80 383
Enc. 2.2
Activity for ED all sites comparison of Q4 15/16 and Q1 16/17
ED Q4 15/16Emergency
Medicine PRUHEmergency
Medicine DMH TotalJanuary 35 16 51February 38 13 51March 34 12 46Total 107 41 148
• There has been an overall decrease in contacts on both sites this quarter.• However, contacts for June were higher overall, particularly at the DH site where contacts went from just 7 in April to 16 in
June
ED Q1 16/17Emergency
Medicine PRUHEmergency
Medicine DMH TotalApril 20 7 27May 14 13 27June 20 16 36Total 54 36 90
Enc. 2.2
Activity for Radiology all sites 1 April – 30 June 2016
TEXT BOX
Radiology is not an area historically associated with significant PALS activity. Telephone accessibility for appointment enquiries has now become a generic problem across all sites. At Denmark Hill 55% of contacts focus on the Ultrasound department.
Enc. 2.2
Activity for Neurosciences all sites comparison of Q4 15/16 and Q1 16/17
Neurosciences Q1 16/17
Neurology Bromley Neurology DMH
Neurosurgery DMH Total
April 12 15 52 79May 5 28 59 92June 10 32 62 104Total 27 75 173 275
The number of Neurosurgical contacts have decreased this quarter with the improvements and resolution of referral backlogs in the Spinal surgery pathway. Current contacts are from patients with clinical enquiries those seeking information on the progress of a referral and information about their neurosurgical waiting list position.
NeurosciencesQ4 15/16
Neurology Bromley Neurology DMH
Neurosurgery DMH Total
January 3 26 88 117February 8 25 83 116March 16 41 68 125Total 27 92 239 358
Enc. 2.2
Total number of PALS cases by Division 1 Jan to 31 March 2016
PALS outpatient activity continues to be greatest in the specialties where capacity has become a significant problem.
The relative numbers in TEAM are low despite the numbers of attendances.
23
Enc. 2.2
This page has been left blank
Enc. 2.3
1
Progress Report against CQC Requirement Notices as at 15th September 2016
Denmark Hill Site Regulation Requirement Notice Summary of Progress Regulation 15
Regulation 15 HSCA (RA) Regulations 2014 Premises and equipment All premises and equipment used by the provider were not: - suitable for the purpose which they are being used - properly used - properly maintained because; 1. The bed spacing and storage facilities, particularly for IV fluids and blood gas machines within critical care, did not meet patient needs or complied with building regulations.
a) Bed spacing – non-compliance with building regulations In the short term, closure of beds in order to increase bed spacing would have a direct impact on the Trust’s ability to provide critical care for an increasing number of high acuity patients. To mitigate the risk of infection, robust cleaning regimes are in place and are audited by Matrons and the Heads of Nursing. Infection rates are very low and are monitored separately by the Infection Control team and the Unit. If an infected patient is being cared for in the Unit, nurse staffing levels are increased to ensure 1:1 nursing. Please note that this remains on the risk register. A 60 bedded Critical Care Unit was commissioned and is being built at the Denmark Hill Site. It is located above the existing Theatre Block and is being constructed on stilts to ensure the ability to sustain theatre operations throughout the build. The building is scheduled to be handed over to the Trust in 2 phases: Phase one – December 2017 and Phase two in March 2019. The Unit will be fully compliant with building regulations and significantly improve patient experience. b) Storage facilities Completed and subject to ongoing Trust-wide Back to Basics Audit Programme
Storage of fluids, in particular for IV and Haemofiltration fluids, has been reviewed and is in line with guidance. The risk to patients and staff has been assessed and managed accordingly. Some ward–specific fluids on Fisk were stored in a glass covered area which impacted on temperature control. These have now been
Enc. 2.3
2
Denmark Hill Site appropriately rehoused.
The location of a blood gas analyser on Christine Brown Critical Care Unit was reviewed and found to be in line with the NHS Purchasing and Supply Chain Guidance 2010.
New mobile medical gas storage units were delivered and positioned on the Critical Care Units - Jack Steinberg, Christine Brown and Frank Stansil.
The Back to Basics Audit Programme (B2B) has recently been introduced to address a number of compliance areas under the CQC fundamental standards. B2B is a 7 week rolling programme across all wards addressing the following: - Medicines management - Environment - Infection Prevention and Control - Care, treatment and welfare - Confidentiality and documentation - Equipment, supplies and devices - Safe staffing levels and staff training.
2. The Liver outpatient clinic was overcrowded with patients.
Completed The Liver Outpatient Clinic was relocated to Suite 9, a purpose built outpatient area on the 3rd floor of the in Golden Jubilee Wing at the end of January 2016. The move enables all liver clinics to be co-located in one area, a larger waiting area, bigger consulting rooms to accommodate patients and their families and dedicated quiet rooms for breaking bad news.
3. The space capacity of the maternity unit was inadequate, which meant that women and their babies were not always receiving appropriate care at the right place and at the right time.
Since the inspection in April 2015, a series of actions have been put in place: A review of maternity capacity was undertaken, risks were assessed and controls put in place. Importantly changes to midwifery practice were successfully implemented.
Enc. 2.3
3
Denmark Hill Site We have audited the number of births on William Gilliatt 2015/16 compared to 2014/15. This shows a reduction of > 60% in births occurring on William Gilliatt ward. The following action points are in place:
New triage area on Nightingale Birth Centre (NBC) – this will improve assessments of women in labour and flow through the NBC. Funding for this has been approved by the Trust’s Business Resource and Strategy Group and allocation is awaited.
The development of transitional care – increasing staffing levels on the ward skilled in neonatal care – confirmation of funding is awaited.
Improving work flow – the maternity IT system 'Badgernet' is due to be implemented on 3 October 2016. The system will free up time to care for women in labour.
4. There was periodic flooding following heavy rain to the renal dialysis unit and endoscopy suite
Completed Maintenance work has been carried out to stop future flooding due to heavy rain in the Renal Dialysis Unit. An emergency flood kit is available at a designated point should it be required. There have been no subsequent flooding incidents in this area.
5. The current Trust policy around syringe drivers was not consistent across the sites and could as a consequence, result in adverse incidents.
Completed A series of action plans were put in place following the Inspection. All actions have been acted upon and completed as follows: Changes to practice summary:
1. All pumps must be changed if they are not King’s property. This takes place in ED on admission
2. Syringe pumps to have 2 identifiable syringes BD Plastipak and Omniflex 20ml and 30ml options used in Trust
3. Self-addressed envelopes to go with patients on discharge for return of pumps
4. Training for ED and clinical site managers at PRUH and DH
Enc. 2.3
4
Denmark Hill Site completed. Training of new staff is ongoing
5. Develop a competency tool for training of CME T34 pumps for nursing staff
6. Order Plastic covers for all pumps without the need for a key for DH
7. Stock levels of pumps in medical library checked once a week prior to weekend (Thurs)
8. Updated the syringe pump guidelines with these change 9. Pouches for pumps MHRA alert March 2016 10. Ongoing communication to ward teams
This issue continues to be monitored through the End of Life Care Steering Group.
6. The cover for the concealment trolley for deceased patients was not in good repair and was also an infection control risk. Regulation 15 (1) (c) (d) (e)
Completed A new concealment trolley was on order during the inspection and was delivered by the end of May 2015. To prevent similar incidents from happening in the future a back-up concealment trolley is also in place.
Regulation 17 Regulation 17 HSCA (RA) Regulations 2014
Good governance Systems and processes were not established or operated effectively …..because : 1. The 'Five steps to safer surgery' checklist was
not always fully completed for each surgical patient.
Extensive work has been undertaken to continue to embed the ‘Five Steps to Safer Surgery’. Improving Safety in Invasive Procedures has been continued as a Quality Priority in 2016/17 and has also been identified as a Sign Up to Safety Priority. The Safer Surgery Improvement Group is chaired by a neurosurgeon, reporting to the Trust Patient Safety Committee and the Quality & Governance Committee. An extensive Safer Surgery Observational re-audit is currently underway. An analysis of the results will be available in late October/ November 2016.
Regulation 14 Regulation 14 HSCA (RA) Regulations 2014
Meeting nutritional and hydration needs Completed The Trust is satisfied that safe levels of dietetic support are currently
Enc. 2.3
5
Denmark Hill Site The nutritional and hydration needs of patients was not always met because; 1. The hospital did not comply with national guidance regarding critical care patients’ access to a dietician. Regulation 14 (2) (a) (ii) (b)
provided including cover during absence and leave. A review of job plans to take place to ascertain whether further support can be provided by Dietetics to ITU (expected completion Autumn 2016). A business case will be developed to increase dietetic capacity in the longer-term
Regulation 11 Regulation 11 HSCA (RA) Regulations 2014
Need for consent. The provider was not complying with regulation 11 (1) and (3) as the provider was not always acting in accordance with the Mental Capacity Act 2005 as people who use the service did not always have their capacity assessed before physical restraint was applied.
The application of DoLS in critical care is not always straightforward as a large proportion of the patients arrive sedated and so MCA or DoLS cannot be performed in the majority. In December 2016 DoLS is potentially set to be changed to the Protective Care Law because it is not enforceable in its current complex form. A patient safety analysis document was introduced in February 2015 pre CQC visit for every patient admitted to critical care and incorporates MCA/DoLS restraints/falls LD and SG information for staff and is part of the patients notes where nurses, clinicians and social workers update and make changes accordingly. Critical care patients usually have capacity or fluctuating capacity and MCA is documented where the patient is a danger to themselves or others. This has been presented at the serious incident committee for agreed roll out. Compliance is audited every 3 months.
Regulation 12 Regulation 12 HSCA (RA) Regulations 2014 Safe
care and treatment The provider was not complying with regulation 12 (1) and (2) (c) as persons providing the care and treatment to service users did not always have the qualifications, competence and skills to do so safely as they were not always aware of their responsibilities under the Mental Capacity
MCA and DoLs training are included in the adult safeguarding training sessions. Adult Safeguarding training is provided at induction to all members of staff and additional sessions of approximately 15 sessions per month. In addition the Adult Safeguarding team provides bespoke sessions for large groups or at established meetings within the divisions which account for a further 3 – 4 per month. On average 25+ members of staff are trained at the monthly sessions and at the bespoke sessions anything
Enc. 2.3
6
Denmark Hill Site Act 2005 and training rates for staff in the Mental Capacity Act 2005 were well below the trust target of 90%.
up to 100 members of staff are trained. An example of this is provision of training at the Consultants Development Day on 8th September 2016 at which 103 Drs were trained. There are 70 sessions planned between now and the end of December 2016 and bespoke sessions will occur over and above this number. Safeguarding adults training compliance is currently:
Level 1 – 90% Level 2-5 – 71%
Broken down into professional groups compliance is as follows:
Nurses and Midwives – 89% Allied Health Professionals – 76% Medical and Dental – 43%
Princess Royal University Hospital (PRUH) Regulation 12 Regulation 12 HSCA (RA) Regulations 2014
Safe care and treatment Patient pathways and plans were not always followed. Patients experienced risks to their care and treatment due to cancelled operations, delayed discharges, long waiting times for a bed to become available once a decision to admit them had been made and delays in outpatient clinics. Regulation 12 (2) (b)
1. Emergency Department We have three areas of focus that form our ED recovery plan for both sites – PRUH and Denmark Hill. The plan has been discussed and approved with the NHSI, NHSE and CCGs at tripartite summits. Within the plan there are specific actions for the PRUH site delivery, with the bed capacity piece being a cross-site delivery. The plan is a measure of system performance with 3 areas of focus:
Out of hospital care: “front door” to “back door” - working in partnership to review and develop opportunities to strengthen integrated working focused on admission avoidance; proactive care; access to ambulatory and rapid access specialist services; early supported discharge and enhanced community services.
In hospital care: reviewing and re-designing the urgent care
Enc. 2.3
7
Princess Royal University Hospital (PRUH) pathway to optimise flow and decision making, and improve patient experience and outcomes – non elective end to end transformation programme.
Bed capacity: increase and reconfigure bed capacity across PRUH, DH, and Orpington to address the net deficit in beds essential to right sizing capacity and securing sustainability.
These are underpinned by a 7 point in hospital action plan for the PRUH site that has been signed off by the Board, NHSE and CCGs and is being led by the Chief Operating Officer (COO). The COO chairs a fortnightly review meeting to discuss progress. The plan covers 7 themed hospital actions:
a. Clean sheet redesign/patient flow b. Ambulatory Care c. Acute Care Hub/AMU d. ED Processes e. Frailty Care f. Infection Control Planning g. Inpatient capacity (bed configuration) – plan to create
additional 63 beds across both our sites, delivering 20 additional medical beds for the PRUH site
In addition there are a number of out of hospital actions for Bromley: h. Extended primary care services i. Admission Avoidance j. DTOCs/MSfT k. Mental Health
The approved plan provides us with an agreed improvement trajectory for the ED recovery at the PRUH. The trajectory we have agreed as part of our STF delivers 95% by March 2017. So far we have achieved that trajectory in 4 out of the first 5 months as shown below:
PPrincess Royaal University HHospital (PRUHH)
Note: Themade ava
2. ImThe Trustwide trans
2.1.
At
At
ere are granular ailable if more in
mprove Patient t’s work in this asformation progr
Local action b(ACLN) divisioservices at thesupport improv
t the PRUH theyo Staggered
have their experience
o Increased Ophthalmo
o Service Maworking wipatients in
t Denmark Hill: o Clinic appo
plans underpinnformation is req
Flow through orea falls into 2 wramme and shor
by the Ambulatoon, the Trust’s me PRUH, has devements in outp
y have introduce Clinic start timetest done, impro
e establishment, f
ology responsiblanager for Outpith Patient Expeclinic including
ointment letters
ning the above wuired.
outpatients workstreams: a lort-term local acti
ory Care & Locamain provider of O
veloped a rangepatients’ clinics. d:
es to bring patienoving efficiency
for example a Ble for managing atients and Ophrience team to gwaiting time to b
have been revie
Enc. 2.
which can be
ong-term Trust-ion plans.
l Networks Outpatients e of actions to
nts in earlier to of clinic and
and 8A nurse foflow
hthalmology get feedback frombe seen
ewed to better
.3
8
or
m
Enc. 2.3
9
Princess Royal University Hospital (PRUH) inform patients of time they will be required in the department
o Improved communication between admin and nursing team to inform patients of possible delays to clinic appointment times
o To improve waiting times in Golden Jubilee scope the rollout of ‘In Touch’ to all outpatient suites
In addition, medical notes availability has been consistent at 95% at PRUH and 92% at Orpington. This is monitored through the Patient Records Committee. This was a particular concern from CQC that has been turned around and sustained.
Performance data, weekly specialty level reports developed looking at patients being registered and triaged on our Docman system developed, with appropriate escalation across divisions as necessary.
Trustwide restructure of all divisions with a view to centralise the majority of outpatients, and the booking processes to standardise Trust protocols and processes.
Demand and Capacity work (as mentioned below in RTT) led with ECIST support to inform right sizing of clinics. Phase 1 and 2 to be complete by October with 2 workshops planned for early October 2016.
2.2. Planned work within the Trust’s Transformation Programme
includes: Re-design of booking systems. Improving systems to inform patients of waiting times. Service redesign of outpatient flow. Organisational restructure to improve accountability and
performance management. Share of Outpatients performance data with clinical staff.
Current position:
Service redesign for Outpatients will form part of the transformation programme in Wave 3 (January 2017). Start date
Enc. 2.3
10
Princess Royal University Hospital (PRUH) to be confirmed.
Measures are in place to inform patients better of delays in clinics. Monthly performance metrics on imaging and outpatient activity
on divisional and specialty scorecards are available.
3. Referral to Treatment Times At the time of the last inspection, the Trust was in the midst of a RTT reporting break due to data issues. The Trust did not have a clean PTL which meant we could not confirm where every patient was on our waiting list. The Trust returned to reporting in April 2015, with a clear picture of our waiters and the extent of the challenge. The return to reporting was signed off by the Board and was given approval by ECIST, who commended the work that had been done. The following data relates to the Trust-wide position. The actual position of the PTL showed that the Trust had 77,592 incomplete pathways, with 14,433 waiting over 18 weeks. We were at 81.4% compliance with 18 weeks, so some way off the 92% target. Using the cleaned PTL and developing actions it was agreed with CCGs and NHSE that the 92% target was not achievable in year and so a revised target of 88% by March 2017 was agreed, with 92% achieved by December 2017. In addition there were a number of 52+ week waiters, all of which went through clinical review with the Medical Director. A trajectory was set for a reduction in 52 week waiters over the year, and currently the Trust remains on the monthly trajectory. In addition, monthly backlog reductions targets were set on the incomplete pathway to attain 92% compliance by Dec 2017 and for the first 4 months of the year we have been on track. The admitted side of this has slipped due to bed pressures but not-admitted has improved ahead of target meaning overall the Trust is on track. Some examples of actions taken to reduce the position are: For the admitted pathway:
Enc. 2.3
11
Princess Royal University Hospital (PRUH) A consistent inpatient run-rate is achieved throughout the year,
previously the run-rate drops in Q3 & Q4 due to increased emergency pressures reducing the bed pool available for elective activity. The impact of maintaining run-rate was included in the bed analysis and contributed to the bed gap on both sites. Implementing the plans to deliver 64 additional beds will reduce the risk of the run-rate dropping due to bed pressures.
Increased activity levels in existing capacity through increased utilisation of theatre capacity for both inpatient and day cases using the outputs of work undertaken by Four Eyes in 15/16, and a shift of activity from inpatient to day case and day case to ambulatory.
Weekend capacity in a range of specialties with: o 4 theatres planned to run in both DH and PRUH day
surgery units for 42 weeks of the year commencing Saturday 7 May 2016. This will provide increased capacity for dental, ENT, general surgery, gynaecology, ophthalmology, orthopaedics and paediatric gastroenterology
o Full year impact of running theatres on a Saturday at Orpington with plans to increase from 2 theatres to 3 theatres
o Weekly inpatient neurosurgery theatre list at DH o Outsourcing activity to the Independent Sector in: o Neurosurgery - simple spines to HCA and KiMS. Activity
levels based on full year effect of levels achieved in February / March which means an increase from 222 cases in 15/16 to 500 in 16/17
o General surgery – 100 inpatient cases to BMI for hernias and lap. choles
o Gynaecology – 100 inpatient cases to BMI The Trust non-admitted backlog reduction is based on:
Continued focus on clinic outcomes focusing on both the completeness and accuracy of appointments
Stringent application of the Trust’s Access Policy (the latest version has been endorsed by the IST) – ensuring where clinically
Enc. 2.3
12
Princess Royal University Hospital (PRUH) appropriate patients who DNA are discharged to the referrer
Pooling / cohorting to fully maximise the use of available capacity using the outputs of work undertaken by Four Eyes
Reviewing the clinic templates to maximise number of patients seen and ensure the correct split between new and follow-ups, based on work undertaken by Four Eyes
Balancing capacity and demand across sites Converting some clinics to non face-to-face to free capacity to
address backlogs Creation of one-stop clinics to reduce steps in the pathway Creation of additional capacity in some specialties to address long
outpatient waits Focus on diagnostic waits to reduce non-admitted pathway Man-marking of long waiters
Other actions:
MBI (consultancy group recommended by NHSE) are currently working with the Trust in 3 of our challenged specialties. Formal feedback from them is awaited.
A full capacity and demand review of our sites, led by ECIST, is currently underway. Phase 2 is due for completion in October. Formal feedback will follow the completion.
Regulation 15 Regulation 15 HSCA (RA) Regulations 2014
Premises and equipment The admissions unit was found to be unsuitable for its intended purpose. The area afforded little privacy for patients who were having blood taken, anaesthetic assessments and surgical consent all within public view and hearing. Confidential information could be heard when staff went through the theatre checklist with patients. Regulation 15 (1) (c)
Completed The Surgical Admission Lounge at PRUH was relocated to a new facility adjacent to theatres in August 2016. The new area is larger, provides additional consulting rooms for consenting patients and single sex rooms for patients to change and wait to be called to theatre. Patients then exit through a door at the back of the admissions lounge directly into theatre.
Enc. 2.3
13
Princess Royal University Hospital (PRUH) Regulation 17 Regulation 17 HSCA (RA) Regulations 2014
Good governance a) Information about patient care and treatment
was not always fully recorded including information related to do not attempt cardio pulmonary resuscitation orders (DNACPR).
b) Medical records were not always available in
a) DNACPR This is being addressed as a Trust-wide issue. This is an iterative process and is linked to the roll out of EPR across the Trust. The current position is as follows: e-DNACPR to be rolled out across the organisation. DH
implementation completed; PRUH implementation to be linked to the roll-out of EPR but will require project support.
Repeat audit at DH and PRUH in spring 2016 demonstrated ongoing issues with completeness / quality of the documentation: as a result, the Trust has targeted education delivered to all consultants (via consultant development morning, PRUH grand round) and consultants and junior doctors in the AMUs at DH and PRUH.
Rolling audit of DNACPR documentation to be built into monthly quality sampling of Trust deaths – data fields agreed; revised quality sampling to start from October 2016.
Ongoing teaching to improve clinicians’ skills to discuss and support decisions about CPR: DNACPR decisions included in Trust induction and medical local induction programmes from August 2016.
Sunrise EPR – new EPR system went live in August 2016 at DH and will be rolled out across others sites. (See section b below). Teething issues in relation to DNACPR documentation were resolved. Next steps: Daily report of patients with Not for CPR order but with no explanatory form completed as required. This will be submitted to the Medical Director, who will email to the patient’s consultant to chase and ensure this is completed as required. To update list of clinicians that can electronically ‘sign’ DNACPR forms (all doctors of ST3 grade and above)
b) Availability of Medical Records
Enc. 2.3
14
Princess Royal University Hospital (PRUH) outpatient clinics and medical wards. Regulation 17(2) (c)
Extensive work has been undertaken to improve the availability of health records at the PRUH and other Bromley sites, including Orpington. 90-95% availability has been achieved since February 2016.
The Trust is moving towards an Electronic Patient Record across all sites to obviate the need for paper records. Sunrise EPR is an upgrade to an existing system at Denmark Hill but will include new features such as electronic discharge notifications. It was rolled out at Denmark Hill and Orpington Hospital Inpatients on 5 August 2016, and will be rolled out across all sites by the end of 2016.
To Note: The availability of records was subject an internal audit - Audit Report – Access to Medical Records (May 2016) – Significant Assurance with minor improvements. This report can be provided, but the CQC will need to sign a disclosure agreement for KPMG (i.e. Provision of document without responsibility).
Orpington Hospital Regulation 17 Regulation 17 HSCA (RA) Regulations 2014
Good governance Systems and processes were not established and operated effectively to ensure an accurate, complete and contemporaneous record for each patient because most clinics were often run without the patients' medical notes. Regulation 17 (2) (c)
Complete Availability of records – now achieving 95% availability. See the attachments under PRUH site – Regulation 17.
SUBJECT TO CHAIR’S APPROVAL Enc. 2.4
1
Report to: Board of Directors
Date of meeting: 05 October 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 16 September 2016.
National Cancer Survey Results: Updates & Improvements The Committee welcomed Ann Duffy (AD, Divisional Head of Nursing) and Jessica Bush (JB2, Head of Engagement and Patient Experience), who presented a summary of the 2015 National Cancer Patient Experience Survey results. The following key points were noted: A full comparison between the 2015 survey results and the previous survey is difficult because a
significant proportion of the questions have changed;
It is clear there have been improvement compared to previous years, but overall the Trust is still behind compared with Shelford Group peers; and
There were a number of areas for which the Trust’s performance was 5% lower than the national average and for which performance had worsened compared to last year. One of these areas was the quality of information provided on side effects. Consideration needs to be given to where responsibility sits for the provision of information.
Public Health England Review: Liver Unit The Committee received the report on the external review that Public Health England were commissioned to conduct after an outbreak of Carbapenemase-OXA-48 producing Klebisella pneumoniae. The following key points were noted: Five patients became infected with carbapenemase-producing enterobacteriacae having undergone
endoscopic retrograde cholangiopancreatography with the same duodenoscope. The outbreak was detected promptly and the implicated duodenoscope was taken out of service; and
An infection control policy would be developed which makes management lines and responsibility for infection control much clearer. Infection control practice needed to be aligned more closely with the standards of the Department of Infection and Control. It also needed be streamlined with microbiology. Work to this effect is already underway.
CQC Action Plan Progress The Committee received an update on the Trust’s progress in delivering its action plan to meet ‘requirement notices’ issued by the Care Quality Commission (CQC). The following key points were noted: The Trust’s action plan with documented progress was submitted to the CQC on Thursday, 15
September in response to the CQC’s request for a progress update; and
SUBJECT TO CHAIR’S APPROVAL Enc. 2.4
2
The Trust has action plans in progress to address all of the requirement notices issued by the CQC. These include a rolling 7-week Back-to-Basics programme to reinforce fundamental standards of care which commenced in mid-June and is ongoing.
Organisational Safety Report The Committee welcomed William Pitt (WP, Head of Organisational Safety) who delivered the Patient Safety Report for the period February 2016 to August 2016. The following key points were noted: Between March and April 2016 Work Place Risk Assessments were conducted, but still neither the
Denmark Hill nor the PRUH site has achieved the 45% required margin of assessed areas;
It continues to be difficult to have staff released to complete statutory and mandatory training. The training team are to conduct visits to staff to facilitate the training. It is hoped that by the end of the current quarter there will be 80% compliance with mandatory and statutory training;
The campaign to reduce slips, trips and falls was postponed due to a NHS England inspection for dermatitis. The campaign will take place next year instead;
Sixteen RIDDOR incidents were notified to the Health and Safety Executive. These incidents have totalled more than 243 days in staff absence; and
The Health and Safety Executive have issued new guidance in the way health and safety breaches are to be prosecuted.
Quarterly Patient Experience Report The Committee received the Quarterly Patient Experience Report for quarter 1 of 2016-17. The following key points were noted: In outpatients satisfaction remains low and dipped to 86% in May, the lowest score this year;
Patient dissatisfaction about outpatients had also surged, with complaints across Trust sites but in
particular at Denmark Hill. The themes highlighted included cancelled appointments, delays in clinics and staff attitude;
Inpatients performance was good. The overall score of 89% was an improvement on quarter 4 21015-16. Some wards were in the top 10% of the country; and
Friends and Family Test (FFT) responses showed a decrease in satisfaction compared to other trusts locally and nationally.
Quarterly Board Assurance Framework Review The Committee received the Quarterly Board Assurance Framework Review and was asked to consider whether the financial risk rating adequately reflected the Trust’s current financial circumstances. The following key points were noted: The financial risk rating should remain at 20, since a rating of 25 would indicate that there were no
controls in place; and
All risks apart risk number 2 on integrated care would increase to 20; and
Risk number 7 on inability to generate cash would be incorporated into risk number 1 (financial).
SUBJECT TO CHAIR’S APPROVAL Enc. 2.4
3
Information Governance Report The Committee received the Information Governance Annual Report. The following key points were noted: The most recent information governance internal audit received an amber-red risk rating, meaning
that there was partial assurance with improvements required; and
The Trust is taking compliance seriously and is implementing an action plan and campaign to embed information governance principles much more firmly and affect cultural change.
Corporate and Divisional Risk Register The Committee received the Corporate and Divisional Risk Register. The following key points were noted: All risks included on the risk registers are red and amber;
There had been resilience issues with the Trust’s data warehouse. New servers had been
purchased and there is confidence that this will address the issues; and
There is a new infection control risk relating to a lack of norovirus testing at the PRUH. Capacity issues at the Trust have impacted upon the Trust’s ability to manage the risk of infection adequately.
Any Other Business It was noted that the Committee would discuss at the next meeting a proposal to change the name of the Committee to the Quality Committee, and an amendment to the terms of reference to reflect a focuson research.
This page has been left blank
Enc. No. 4.1
1
Report to: Board of Directors (Public)
Date of meeting: 05 October 2016
Subject: Trust Performance Report 2016/17 Month 5
Author(s): Steve Coakley, Acting Assistant Director of Performance &
Contracts
Presented by: Jane Farrell, Chief Operating Officer
Sponsor: Jane Farrell, Chief Operating Officer
History: Gone to the Finance and Performance Committee on the 26 September 2016.
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 interim Q2 position in 2016/17. 2. Action required The Board is asked to approve the M5 performance reported against the governance indicators defined in the Monitor Risk Assessment framework for the interim 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 August 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 August 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.
Enc. 4.1
2 of 13
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)
Enc. 4.1
3 of 13
Key Messages of this Report • Trust performance against the 4-hour target improved from 83.51% reported in July to
88.18% in August which meant that the STF trajectory of 87.44% as agreed with commissioners and NHSI was achieved.
• RTT incomplete pathways performance improved further from 82.03% in July to 82.20% in August, but is lower than the STF performance trajectory of 82.74%. There were 144 patients waiting 52+ weeks at the end of August 2016, which is lower than the 154 patients waiting at the end of July. There were 95 patients on admitted pathways and 49 patients on non-admitted pathways.
• All cancer waiting time indicators are exceeding national targets for the in-month August position. For the interim-Q2 position, the cancer 62-day screening treatment target is not achieving the 90% target at 85.9% with 7 breaches. Performance compared to the national 85% target for 62-day GP referrals to treatment is achieving at 85.14% for Q2.
• Diagnostic waiting time performance improved significantly from 6.8% of patients waiting over 6 weeks for tests at the end of July to 1.95% in August. We have not though achieved the STF performance trajectory of 1.0% for August as planned.
• There were no MRSA cases in August so we have reported 2 MRSA cases reported YTD. 6 c-difficile cases were reported in August – 2 on the DH site and 4 on the PRUH site. 27 cases YTD which is below the Trust quota of 30 cases for August YTD position.
Introduction/Background The performance report for August 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 improved from 84.5% reported in July to 89.3% in
August, which is better than the internal site STF trajectory of 85.4% for the month. Type 1 ED attendance performance also improved from 74.3% in July to 81.2% in August.
• The number of attendances to ED reduced by over 6.2% in August compared to July, and the number of type 1 breaches in ED reduced from over 1,350 to just under 890.
• There was also an 8.8% decrease in attendances to the UCC. As a consequence the number of type 3 breaches in UCC reduced from 119 to 67, and the number of breaches due to late UCC handover reduced from 195 to 113.
Emergency 4-hour performance at Denmark Hill (DH): • All types performance improved from 82.7% in July to 87.4% in August, but is below the
internal site STF trajectory of 89.1% for the month. Type 1 ED attendance performance also improved from 79.8% to 85.2%.
• The number of type 1 attendances in ED also reduced by over 6.2% in August compared to July, and the number of type 1 breaches reduced from 2,453 to 1,683.
Referral to Treatment (RTT) Incomplete pathway performance: • The number of 52+ week breach patients reduced from 154 patients reported in July to
144 patients reported in August based on the new operational Patient Tracker List (PTL) reports. Whilst we are ahead of our overall 52-week trajectory of 178 breaches, we are 110 cases ahead in neuro specialties, but 76 cases behind in our non-neuro specialties, and are required to reduce non-neuro breaches to zero by the end of October. There are 14,866 patients waiting over 18 weeks at the end of August so our incomplete performance improved further to 82.20% but is below the STF trajectory of 82.74% for the month.
Enc. 4.1
4 of 13
Key Issues Clinical Effectiveness: • The national Summary Hospital Mortality Index (SHMI) remained at 92 for the PRUH site,
but worsened from 85 to 88 for the DH site but 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 577 cases reported at the end of August to 188, which represents 1.95% of the total number of patients waiting. This is above the performance improvement trajectory of 1.0% for August which was agreed with commissioners. The improvement was largely due to the further reduction in non-obstetric ultrasound across both the DH and PRUH sites where there were 54 breaches waiting at the end of August. The main other breach test modalities are MRI with 54 breaches, paediatric gastroenterology with 31 breaches and sleep studies with 21 breaches. Work continues to achieve the STF and national target of 1% for end-September.
Safety: • There have been 2 MRSA cases reported to-date, both within the TEAM/medical division.
Six c-difficile cases were reported in August which is consistent with the quota of 6 cases for the month. Two cases were on the DH site – so there have been 19 cases YTD on the DH site which is below the quota of 23. Four cases were on the PRUH site – so there have been 8 cases YTD on the PRUH site which is now above the quota of 7 cases.
• Despite the reduction of red shifts reported on the DH site for August, they remain high with 110 reported for DH and 34 reported for PRUH.
• Whilst there were no slips, trips or falls on the DH site in August, there were 5 cases causing moderate/severe harm on the PRUH site – 2 cases were on cardiovascular wards, 2 on medical wards and 1 case on a haematology ward.
Patient Experience: • The HRWD Inpatient survey score worsened in August but is still achieving the target of 89
on both DH and PRUH sites. The Friends and Family (FFT) scores for Inpatient/Day cases is achieving the target of 93 at PRUH, but worsened to 92 for the site. FFT scores for ED improved on both sites to 82 for DH, above the target of 61, and to 85 for PRUH but is below the target of 89.
• The number of inpatient cancellations on the day increased from 52 cases in July to 71 in August – with 41 cancellations at the DH site and 30 cancellations at the PRUH. There were however 5 breaches of the 28-day cancellation standard for August – all reported for the DH site. Two cases were due to emergency cases taking priority with the remaining 3 cases cancelled due to other non-medical reasons.
• The number of patient complaints reduced slightly from 116 in July to 110 in August, of which 17 were rated high/severe. The number of complaints still open or not responded to within 25 working days also increased from 57 to 67 cases.
Finance & Operational Efficiency: • Financial position - please see the Finance report for further details. • The proportion of inpatients discharged at weekends worsened on both acute sites: from
23.4% in July to 18.4% in August on the DH site, and from 21.1% in July to 16.2% in August on the PRUH site; but both indicators remain below the 28% target.
• Utilisation in main theatres at DH remains above the 80% target at 81% in August. DSU utilisation on the DH Site worsened from 78% to 72% in August. On the PRUH site, main theatre utilisation worsened from 69% to 60%, and DSU utilisation worsened from 70% to 66%. Utilisation in Orpington main theatres also worsened from 73% to 68%, but DSU utilisation at Sidcup improved from 49% to 67% in August.
Staffing: (no staffing data for August has been available to feed into scorecards) • Vacancy rate worsened slightly from 11.7% for June to 11.9% for July on the DH site, but
worsened from 14.6% to 16.2% for the PRUH sites, so above the internal 5-8% target. • Compliance against mandatory and statutory training and induction courses remains above
the target of 80, at 82 for DH.
Enc. 4.1
5 of 13
Regulatory Performance/Monitor compliance Monitor – interim Q2 2016/17 position: • The Trust has achieved the performance indicators in the Monitor Risk Assessment
Framework for August 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 improved in August to 82.20% but us below the agreed performance trajectory of 82.74% for August 2016.
• We have reported 27 c-difficile cases for the interim Q2 2016/17 position which is below the quota of 30 cases for the YTD cumulative position.
• We therefore have a score of 3.0 based on the latest RAF for our interim Q2 2016/17 reported performance.
#### #### #### ####
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 30 14 27
31 day wait for second or subsequent treatment 1.0
Surgery % 94 95.8 97.0
Anti cancer drug treatments % 98 100.0 100.0
wadiotherapy % 94 98.6 100
62 day wait for first treatment 1.0
from urgent GP referral to treatment: all cancers % 85 85.8 85.1
consultant screening service referral: all cancers % 90 89.7 85.9
Acute targets - minimum Standards
31 day wait from diagnosis to first treatment: all cancers % 1.0 96 98.3 98.1
Two week wait from referral to date seen: 1.0
all cancers % 93 94.1 94.5
for symptomatic breast patients (cancer not initially suspected) % 93 88.5 98.7
aaximum time of 18 weeks from point of referral to treatment in aggregate – patients on an incomplete pathway
% 1.0 92 76.1 82.0
A&9:
aaximum waiting time of 4 hours in 95 from arrival to admission, transfer or discharge
% 1.0 95 84.13 85.01
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 Aug-15
Enc. 4.1
6 of 13
Trust Performance Scorecard – DH site
Enc. 4.1
7 of 13
Trust Performance Scorecard – PRUH sites
Enc. 4.1
8 of 13
Trust Emergency Care 4-hour performance and ED Recovery Programme Highlights – August 2016 Trust performance for all types attendances against the 4-hour target improved from 83.51% reported in July to 88.18% in August. Whilst this is below the national 95% target, it is better than the STF performance target of 87.44% for August 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% 85.16%
70%
75%
80%
85%
90%
95%
100%
Qtr 1 Qtr 2 Qtr 3 Qtr 4
KIngs - Quarterly All Types terformance
2015/16 2016/17
70%
75%
80%
85%
90%
95%
100%
Kings- Monthly All Types terformanceAug 2014 - Aug 2016
Aug 2014 - Aug 2015 Aug 2015 - Aug 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.
Enc. 4.1
9 of 13
Emergency Care 4-hour performance Action Plan Update @PRUH Highlights – August 2016 All types attendance performance improved from 84.5% reported in July to 89.3% in August. Type 1 ED attendance performance also improved from 74.3% in July to 82.0% in August. Performance was also lower compared to the 92.3% achieved in August last year as demonstrated in the charts below.
88.54%91.50%
89.26%
81.27%83.74%
86.02%
70%
75%
80%
85%
90%
95%
100%
Qtr 1 Qtr 2 Qtr 3 Qtr 4
tRUH Quarterly All Types terformance
2015/16 2016/17
70%
75%
80%
85%
90%
95%
100%
tRUH Monthly All Types terformanceAug 2014 - Aug 2016
Aug 2014 - Aug 2015 Aug 2015 - Aug 2016
STF performance and ED Action Plan Update The STF performance trajectory was achieved in April, May and June for the PRUH site, despite the 2 norovirus outbreaks impacting on bed capacity and flow. Whilst the trajectory was not achieved in July, performance improved in August to 89.3% which is nearly 3.9% above the internal trajectory for the month. There were over 500 fewer admitted breaches compared to plan, and a significant reduction in the number of type 3 breaches due to late handover from UCC to ED. 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%
PRUH
Enc. 4.1
10 of 13
Emergency Care 4-hour performance Action Plan Update @DH Highlights – August 2016 All types performance improved from 82.7% in July to 87.4% in August, and type 1 ED attendance performance improved from 79.8% to 85.2%. Performance does however remain below the 93.4% level achieved in August 2015 as shown in the charts below.
90.78%92.51%
89.41%
85.04%84.41% 85.51%
70%
75%
80%
85%
90%
95%
100%
Qtr 1 Qtr 2 Qtr 3 Qtr 4
5H Quarterly All Types terformance
2015/16 2016/17
70%
75%
80%
85%
90%
95%
100%
5H Monthly All Types terformanceAug 2014 - Aug 2016
Aug 2014 - Aug 2015 Aug 2015 - Aug 2016
STF performance and ED Action Plan Update The STF performance trajectory was achieved in April and May for the DH site, but was not achieved between June to August. Our plan was to de-escalate the winter pressure beds on Matthew Whiting ward to enable re-delivery of acute care hub. However, patient acuity, increased pressure on acute adult beds combined with an increased LOS, meant that Matthew Whiting opened to additional beds to support flow with minimal ambulation. The table below summarises actual versus planned activity, breach and performance.
All Attends
Adm Breach
Non-adm
BreachT2
Breach Breaches Impr Perf
Apr-16 Plan 13972 1285 1183 10 2478 10% 82.26%
Actual 13791 1004 973 11 1988 85.58%
Var -181 -281 -210 1 -490 -10% 3.32%
May-16 Plan 14468 1163 1051 1 2215 20% 84.69%
Actual 14809 1074 1000 20 2094 85.86%
Var 341 -89 -51 19 -121 -20% 1.17%
Jun-16 Plan 14781 1020 657 1 1678 50% 88.65%
Actual 14228 1136 1449 10 2595 81.76%
Var -553 116 792 9 917 -50% -6.89%
Jul-16 Plan 14908 971 591 0 1562 55% 89.52%
Actual 14225 1167 1285 2 2454 82.75%
Var -683 196 694 2 892 -55% -6.77%
Aug-16 Plan 13269 927 526 0 1453 60% 89.05%
Actual 13380 992 691 6 1689 87.38%
Var 111 65 165 6 236 -60% -1.67%
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 currently running in Suite 3. There has been a delay in identifying a decant solution for these clinics, and a feasibility of two proposed options is still being assessed.
Enc. 4.1
11 of 13
RTT Update
End-August 2016 Incomplete pathway position There were 14,866 incomplete pathways with a waiting time over 18 weeks, which is a decrease of 43 pathways compared to our position at the end of July. The number of admitted incomplete pathways increased by 189, and the number of non-admitted pathways reduced by 232. Our incomplete performance for August 2016 was therefore 82.20% which is a slight improvement of 0.17% compared to July. This is however lower than the performance improvement trajectory of 82.74% which was agreed between the Trust, commissioners and NHSI. The waiting time position for August 2016 compared to July 2016 is summarised below:
Patients waiting end-August (July position in brackets)
18-39 weeks 40-51 weeks 52+ weeks
Incomplete -Admitted 4,721 (4,544) 465 (445) 95 (103)
Incomplete – Non-admitted 9,013 (9,051) 523 (715) 49 (51) Total Incomplete pathways 13,734 (13,595) 988 (1,160) 144 (154)
52-week Waiting Time position There were 144 patients waiting over 52 weeks that we have reported in our August 2016 month-end position to Unify, of which there were 95 patients waiting on admitted pathways and 49 patients waiting on non-admitted pathways. This is a reduction compared to the 154 patients that we reported for the end of July position. We are therefore 34 patients ahead of our agreed trajectory of 178 for the month. The number of Neuro-specialty breaches reduced from 61 to 51 and are 110 ahead of trajectory. Non-neuro breaches reduced from 95 to 93 and are 76 cases behind trajectory. Outsourcing Progress Update 171 Neurosurgery patients have been seen this year at 3 providers (HCA, Kent Institute of Medicine and Surgery primarily for Kent patients, and BMI Clementine Churchill) compared to a plan of 215 cases. An additional contract schedule has been agreed with London Independent and patients are currently being contacted to agree transfer and treatment dates. A number of patients have already agreed to be transferred to BMI Hospitals in General Surgery, Gynaecology and Orthopaedics, and the Trust is currently in discussions with BMI for the transfer of ENT patients. Demand and Capacity Modelling A review of all phase 1 and 2 specialty models which have been populated to site and sub-specialty level has been undertaken. Service teams have been asked to complete the modelling and summarise key outputs by 28 September 2016. This will form the basis of a review by the Head of the external IST team being held on 5th and 7th October, where teams will be required to present their models. 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 are in the process of compiling their report which will include recommendations for improvement and the sequencing of these improvements to make gains in RTT performance as quickly as possible.
Enc. 4.1
12 of 13
Cancer – August 2016 Performance Update The table below summarises the achievement of cancer targets at Trust-level for the latest August 2016 and interim Q2 position. The two-week wait suspected cancer referral target is being achieved at 93.6%% for August and 94.5% for Q2 to-date compared to the national 93% target. The two week-wait symptomatic breast performance has also maintained its strong performance in Q2 at 98.7% for Q2. The 62 day GP referral target of 85% is being achieved at 89.8% for August and 85.14% for the latest Q2 position. Despite being achieved for the in-month position of August, the 62-day screening target of 90% is not being achieved at 85.9% for Q2.
62-day GP Referral There were 103.5 first treatments reported for July with 18.5 breaches which meant that performance compared to the national 85% target was 82.13%. However, the number of treatments increased considerably in August with 127.5 recorded on the PCS cancer system with only 13 breaches, so performance improved to 89.8%. Performance for the interim-Q2 position is 85.14%. As reported last month, tumour groups have refreshed their action plans, and weekly meetings continue with the Director of Operations and the Trust’s cancer lead, to review plans and the latest performance position. 62-day Day Screening There were 5.5 breaches reported in July and just 1 breach in August. However, this means that 62-day screening performance is just under 85.9% for the latest interim-Q2 position, and is therefore the 90% target is at risk of not being achieved for the quarter. 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%. This is below the improvement trajectory that was shared with commissioners of achieving 80% by August, with a commitment 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.
Enc. 4.1
13 of 13
Healthcare Associated Infection (HCAI) Update (1/1) MRSA (post 48 hour bacteraemia: • 1 case in June 2016 at DH site; 2 cases YTD at DH site which is above the zero quota.
C-difficile: • 6 new cases reported in August (2 cases at DH and 4 cases at PRUH); 27 cases YTD
which is below the quota of 30 cases for August YTD position and better than the 41 cases reported by August last year.
VRE bacteraemia: • 4 new cases at DH only; 24 cases YTD which is above the target of 11 cases for the
August position and higher than the 17 cases reported by August last year. E-Coli bacteraemia: • 4 new cases reported in August at DH and 2 new cases at PRUH; 52 cases YTD which is
above the target of 41 cases, and above the 47 cases reported by August 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.
This page has been left blank
Enc. 4.2
CEF Directorate
Unit 7, King’s Business Park, London.SE5 9NY
T: +44 (0)203 203 3204 F: +44 (0)203 203
W: www.kch.nhs.uk
Annual Energy & Carbon Management
Report
1st April 2015 to 31st March 2016 Produced by: Chris Kukla - Energy Officer Reviewed by: Cathal Griffin - Energy & Environmental Manager No. of pages: 40 Published: September 2016
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust ii
CONTENTS
1 EXECUTIVE SUMMARY ......................................................................................................................... 1
2 KCH UTILITY PERFORMANCE HEADLINES 2015‐16 ................................................................................. 4
3 INTRODUCTION ................................................................................................................................... 5
4 COST SAVINGS ..................................................................................................................................... 7
5 ENERGY BENCHMARKING & PRICE EVALUATION ................................................................................ 10
5.1 ENERGY PERFORMANCE ANALYSIS ..................................................................................................... 10
6 ANNUAL ENERGY ANALYSIS ............................................................................................................... 12
6.1 TOTAL KCH ENERGY COMSUMPTION .................................................................................................. 12 6.2 PURCHASED ENERGY CONSUMPTION ................................................................................................. 13 6.3 PURCHASED ENERGY COSTS................................................................................................................ 14 6.4 ON‐SITE ELECTRICITY GENERATION .................................................................................................... 15 6.5 ON‐SITE ELECTRICITY GENERATION REVENUE .................................................................................... 16 6.6 DENMARK HILL SITE TOTAL ELECTRICITY USE ..................................................................................... 16 6.7 CONDITIONS AFFECTING ENERGY CONSUMPTION ............................................................................. 17 6.8 SITE SIZE & ACTIVITY ........................................................................................................................... 18 6.9 ENERGY PERFORMANCE SUMMARY ................................................................................................... 18
7 PFI BUILDINGS – ENERGY PERFORMANCE ........................................................................................... 20
7.1 GOLDEN JUBILEE WING ....................................................................................................................... 20 7.2 PRINCESS ROYAL UNIVERSITY HOSPITAL ............................................................................................. 21
8 GREENHOUSE GAS EMISSIONS ........................................................................................................... 22
8.1 GHG CALCULATION METHODOLOGY .................................................................................................. 22 8.2 GHG RE‐BASELINE CALCULATION ........................................................................................................ 22 8.3 KCH GHG EMISSIONS 2015‐16 ............................................................................................................ 23 8.4 LONG TERM GHG EMISSIONS TREND .................................................................................................. 23
9 WATER CONSUMPTION ANALYSIS ...................................................................................................... 26
9.1 WATER MARKET REVIEW ‐ HOW IS THE WATER MARKET CHANGING? ................................ 26
10 ENERGY PROJECTS UPDATE ................................................................................................................ 27
10.1 COMPLETED PROJECTS 2015‐16 ......................................................................................................... 27 10.2 FUTURE PROJECTS ............................................................................................................................... 28 10.3 DELIVERED PROJECTS .......................................................................................................................... 30
11 LEGISLATIVE COMPLIANCE ................................................................................................................. 31
11.1 COMPLIANCE PROGRESS & REGULATION CHANGES .......................................................................... 31
APPENDIX A: UTILITY CONSUMPTION DATA ............................................................................................... 33
KCH ESTATE ‐ CONSUMPTION DATA ................................................................................................................ 33 DENMARK HILL SITE – CONSUMPTION DATA ................................................................................................... 34 PRUH ‐ CONSUMPTION DATA .......................................................................................................................... 35 ORPINGTON ‐ CONSUMPTION DATA ............................................................................................................... 36
APPENDIX B: COST SAVINGS HISTORIC RECORD – 2014‐15 .......................................................................... 37
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust iii
Tables
Table 1: Summary of KCH energy costs, consumption and GHG emissions ........................................... 1 Table 2: Summary of annual cost savings 2014‐15 to 2016‐YTD ............................................................ 7 Table 3: Cost savings achieved April 2016 – YTD 2017 ........................................................................... 8 Table 4: Cost savings achieved 1st April 2015 – 31st March 2016 ........................................................... 9 Table 5: KCH Performance metrics & comparison to comparable Trust’s ........................................... 10 Table 6: Explanation of relative performance between quartiles ........................................................ 10 Table 7: KCH utility price changes for 2015‐16 compared to 2014‐15 & UK average .......................... 11 Table 8: KCH GHG emissions reduction compared to external targets ................................................ 24 Table 9: Project progress for 2015‐16 .................................................................................................. 27 Table 10: Future projects for 2016‐17 and beyond .............................................................................. 29 Table 11: Projects delivered to up the end of 2014‐15 ........................................................................ 30 Table 12: KCH Energy compliance status .............................................................................................. 31 Table 13: DEC Ratings for KCH eligible buildings .................................................................................. 32 Table 14: KCH Estate Utilities Consumption, Cost and Carbon Emissions 2009‐16.............................. 33 Table 15: Denmark Hill Utilities Consumption, Cost and Carbon Emissions 2009‐16 .......................... 34 Table 16: PRUH Utilities Consumption, Cost and Carbon Emissions from 1/10/2013 ......................... 35 Table 17: Orpington Utilities Consumption, Cost and Carbon Emissions from 1/10/2013 .................. 36
Figures
Figure 1: Total KCH energy consumption ............................................................................................. 12 Figure 2: Total KCH purchased electricity consumption 2015 – 2016 .................................................. 13 Figure 3: Total KCH purchased gas consumption 2015 ‐ 2016 ............................................................. 13 Figure 4: Total purchased gas & electricity costs .................................................................................. 14 Figure 5: Total generated electricity ..................................................................................................... 15 Figure 6: Exported electricity kWh ........................................................................................................ 15 Figure 7: Exported electricity revenue .................................................................................................. 16 Figure 8 Total electricity used on the Denmark Hill site ....................................................................... 16 Figure 9: Heating Degree Day records for the Thames Valley Region .................................................. 17 Figure 10: Cooling degree day records for the Thames Valley region .................................................. 18 Figure 11: Total gas & electricity consumption .................................................................................... 20 Figure 12: Total gas & electricity consumption .................................................................................... 21 Figure 13: Comparison of KCH GHG emission pre & post base‐year re‐calculation ............................. 22 Figure 14: Net CO2 emissions ................................................................................................................ 23 Figure 15: Comparison of annual GHG emissions with the Base year .................................................. 25
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 1
1 EXECUTIVE SUMMARY
The good performance of 2014-15 has continued through 2015-16 with KCH’s energy
consumption being maintained at a near constant level, with a 1% increase observed,
achieving a reduction in energy costs, and meeting the greenhouse gas (GHG) emissions
reduction target set in KCH’s Annual Report and Accounts 2014-151. The Summary results
are shown in Table 1 below.
Table 1: Summary of KCH energy costs, consumption and GHG emissions
Campus Costs Trend Consumption Trend GHG
Emissions Trend
Denmark Hill £4,080,321 ‐6% 145,185 MWh 2% 22,866 tCO2 2%
PRUH £1,320,915 ‐14% 28,160 MWh ‐3% 9,069 tCO2 ‐7%
Orpington Hospital £281,777 ‐1% 4,125 MWh ‐2% 1,300 tCO2 ‐5%
Total £5,683,013 ‐8% 177,471 1% 33,235 ‐1%
Arrows indicate performance relative to 2014-15
Energy Performance
The energy demand of the site has been maintained with a 1% increase in energy
consumption shown compared to 2014-15. This small increase is attributable to the
Denmark Hill site and increased on-site activity. Reductions in energy demand were
observed for the PRUH and Orpington sites.
Energy Cost
KCH’s energy spend has been reduced at each site for the year 2015-16, reducing by
£469,571 compared to the 2014-15 spend. The bulk of this reduction was achieved through
a 12% (£418,586) reduction in the gas spend with a 2% (£50,986) reduction achieved on the
electricity spend.
The majority of this saving has been achieved through KCH benefiting from the recent
reductions in the commodity price of energy. This report shows that while KCH ranks in the
second highest quartile among comparable NHS organisations for its energy spend, KCH is
amongst the top performers for the per unit price of energy achieved2. KCH’s performance in
this area is further supported by the favourable comparison with the average energy prices
achieved by non-domestic consumers in the UK.
1 King’s College Hospital, ‘Annual Report and Accounts 2014-15’, King’s College Hospital NHS Foundation Trust, 2015. 2 This analysis is based on the data submitted by NHS Trusts for the ERIC report in 2014-15 and can be found in section 5 of this report.
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 2
The commodity price of energy is now showing an upward trend meaning KCH can expect
the energy prices it receives to increase in the short to mid-term. Further increases are likely
to be seen in the non-energy costs element of utility costs following the outputs of the
government’s consultation on ‘Reforming the business energy efficiency tax landscape’.
Cost Savings
In addition to the cost savings made through the reductions in KCH’s energy spend, further
costs savings have been achieved. The total cost savings achieved from 2014-15 to the
year-to-date are £834,039, with additional monies saved through revenue recovery,
£205,134 and costs avoided £138,746. Of these savings £558,000 have been able to be
offered to the cost improvement programme.
One of the most significant savings for 2015-16 has been achieved through changes to the
legislative landscape. An estimated cost improvement of over £260,000 per year will be
achieved by no-longer participating in the CRC Energy Efficiency Scheme, a mandatory
GHG emissions trading platform. In consultation with the Environment Agency, it has been
determined that KCH is not eligible for ‘Phase 2’ of this scheme.
Further actions have resulted in costs to KCH being avoided. For 2015-16 £68,972 in cost
avoidance have been achieved through identifying duplicate payment requests and incorrect
utility invoices.
The potential for future savings in 2016-17 are being assessed. To date, through
renegotiation of the contract with Veolia for running the Energy Centre at Denmark Hill an
annual estimated cost saving of £160,000 has been identified. Additionally recovery of
revenue from utility suppliers due to over-charges and account credits by KCH currently
totals circa £108,000.
Carbon Management
Despite the increase in KCH’s energy consumption KCH can report a 1% reduction in GHG
emissions for 2015-16 compared to 2014-15. This reduction means the internal GHG
emissions reduction target, set in the Annual Report and Accounts 2014-15, has been met1.
Over the longer term KCH is showing a 6% reduction compared to its base-year in the GHG
emissions associated with operating its buildings, otherwise known as direct GHG
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 3
emissions. This is ahead of the trend for NHS organisations in England, who on average are
reported as showing a 4% reduction by the NHS Sustainable Development Unit3.
Utility Demand Reduction Projects
The Trust is currently undertaking a large scale upgrade of steam traps. A site wide audit of
the current steam trap system has been completed at the Denmark Hill site during 2015-16.
The first phase of replacement steam traps are due to be installed during the 2016-17 period
and will provide the Trust with reduced risk to staff, maintenance costs and improved energy
efficiency by reducing steam lost to the environment.
The Capital Projects Team have been working to build energy efficiency and sustainability
measures into the design of refurbishments and new build projects. KCH has targets to
attain ‘Excellent’ under the Building Research Establishment Environmental Assessment
Method (BREEAM) on all new build projects and ‘Very Good’ on all refurbishments.
A list of projects completed in 2015-16 and projects completed in previous years is available
in section 10 of this report.
Legislative Compliance
Section 11 of this report outlines the legislation relevant to energy use and KCH’s current
compliance status. Currently KCH is compliant with all known obligations.
The main change to the legislative landscape over 2015-16 has been within the CRC Energy
Efficiency Scheme, a mandatory GHG emissions trading platform. The Trust was an eligible
participant in Phase 1 of the CRC which ran from 2010 to 2014. The eligibility criteria for
‘Phase 2’ of the scheme have changed and, in consultation with the Environment Agency, it
has been determined that KCH does not qualify for ‘Phase 2’. As such KCH will not be
eligible to make payments under the CRC from 2015-16 onwards. This development has
contributed to the cost savings achieved.
However, looking ahead a review is currently being under taken of the carbon and energy
efficiency taxation within the UK under the consultation on ‘Reforming the business energy
efficiency tax landscape’. No indications are currently available on the outcomes of this
consultation, however it is likely to result in increased utility costs for KCH.
3 Public Health England, ‘Percentage redction in building energy carbon emissions from 2007/08 to 2014/15 for NHS providers by NHS England Area’, NHS Sustainable Development Unit, 2015.
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 4
2 KCH UTILITY PERFORMANCE HEADLINES 2015-16
Utility Performance Figures
Performance figures are given for key metrics covering the KCH estate. Performance Metric Units 2015‐16 Trend 2014‐15
Energy consumption kWh 177,471,852 1% 175,148,098
Energy spend £ £5,683,013 ‐8% £6,152,584
GHG emissions tCO2 33,235 ‐1% 33,508
Water consumption m3 313,371 9% 286,449
Water cost £ £589,101 11% £533,001
KCH Benchmarked Performance Figures Comparison of KCH to other Acute-Teaching & Acute-Large NHS Trusts using ERIC data.
Performance Metric Unit Trust Performance Quartile Ranking
Total Energy Spend £ 5,905,870 Q3 ‐ High
Energy Cost £/kWh 0.034 Q1 ‐ Lowest
Total Energy Consumed kWh 174,650,786 Q4 ‐ Highest
Energy Intensity kWh/m2 836.9 Q4 ‐ Highest
Quartile 1 Lowest Quartile 2 Lower Quartile 3 High Quartile 4 Highest
Energy Costs The below shows the trend in energy prices and annual cost savings. Performance Metric Units 2015‐16 Trend 2014‐15 Electricity unit cost £/kWh 0.08 - 0.08 Gas unit cost £/kWh 0.024 0.027
Annual change in spend £ ‐469,571 474,208
Water Costs The below shows the trend in energy prices and annual cost savings.
Performance Metric Units 2015‐16 Trend 2014‐15 Water unit cost £/m3 1.88 1.86 Annual change in spend £ 56,100 165,771
CHP Performance Operational metrics for the CHP engines operated at the Denmark Hill Energy Centre.
Performance Metric Units 2015‐16 Trend 2014‐15
Veolia Contractual KPI’s met Yes/No Yes ‐ Yes
Generated Electricity kWh 32,343,600 ‐ 32,359,737
Exported Electricity kWh 6,699,690 ‐10% 7,471,281
Export Revenue £ £264,656 ‐19% £328,364
GHG management long-term trend GHG emissions performance metrics and comparison with performance benchmark. Performance Metric Units 2015‐16 Trend Base‐Year 2007‐08
GHG Emissions tCO2 33,235 35,182
Reduction % 6 0
NHS Wide Reduction Benchmark % 4 ‐ 0
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 5
3 INTRODUCTION
This report presents the annual consumption, costs and carbon emissions arising from the
Trust’s demand for utilities, including electricity, gas and water. Updates are given on King’s
progress on carbon management, utility demand reduction projects and cost savings.
King’s College Hospital NHS Foundation Trust expanded in October 2013, adding the
Princess Royal University Hospital (PRUH), Orpington Hospital and a number of smaller
satellite sites to its main campus at Denmark Hill. This year sees the second full year of
operation of the PRUH and Orpington sites by King’s College Hospital.
Within this report the total King’s College Hospital estate consists of The Denmark Hill
Campus, the PRUH and Orpington Hospitals and is referred to as ‘KCH’. The individual
campuses are referred to as the Denmark Hill, PRUH and Orpington sites. Figures for the
small numbers of accommodation sites are included under the KCH data.
Figures for The Denmark Hill, PRUH and Orpington sites are reported individually along with
total figures for the total KCH Estate.
The need for KCH to actively manage and reduce its energy consumption and associated
carbon emissions are driven by financial and legislative factors. The main drivers and the
targets the NHS aims to meet are set out below:
Carbon emission reductions
o 10% reduction by 2015 – NHS Sustainable Development Unit
o 34% by 2020 - The UK Government Climate Change Act
Energy efficiency
o New developments to achieve an energy efficiency performance of 35-55
Gj/100 m3
o All refurbished facilities to achieve a performance of 55-65 Gj/100 m3
Carbon taxation including:
o European Union Emissions Trading Scheme, Carbon Price Support and
Climate Change Levy
Throughout this report the energy and carbon performance in the financial year 2015 - 2016
are compared with that of the same period in the previous financial year.
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 6
Data used in this report are sourced from the utility suppliers, Veolia who manage the on-site
energy centre at Denmark Hill and SSE who manage the energy centre at the PRUH. It
summarises the consumption (kWh for energy use or m3 for water), carbon (tCO2), costs (£
Gross) for:
Purchased gas and electricity - Gas and electricity purchased from suppliers
Generated electricity - Electricity generated by the CHP plant
Exported electricity - Electricity generated and sold to the national grid
Water – Water purchased from suppliers
Detailed tables showing energy consumption and associated costs for each metered building
by month are held by Capital Estates & Facilities.
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 7
4 COST SAVINGS
Table 2 below shows a summary of the cost savings achieved by the Energy Team for the
Denmark Hill, PRUH and Orpington Hospital sites since the financial year 2014-2015 to the
year-to-date (YTD). These are a combination of avoided costs, revenue recovery and cost
improvement programmes (CIPs) and are the result of invoice validation, revenue recovery,
negotiations with suppliers and work on legislative compliance. Savings from previous years
are listed in Appendix B.
Table 2: Summary of annual cost savings 2014-15 to 2016-YTD
Year Cost Avoided Cost Savings Revenue Recovery
2016‐YTD £3,778 £231,000 156,308
2015‐16 134,968 438,993 48,826
2014‐15 ‐ £164,046 ‐
Totals £138,746 £834,039 £205,134
Total Recurring Savings ‐ £558,000 ‐
Table 3 and 4 show in detail how these savings have been achieved in the respective years.
Only savings and cost avoidance achieving over £1,000 are shown.
The most significant savings have been achieved through: confirming KCH’s in-eligibility,
with the Environment Agency, for ‘Phase 2’ of the CRC Energy Efficiency Scheme resulting
in an estimated Cost Improvement Plan (CIP) of over £260,000 per year.
Savings and revenue recovery for 2016-17 are being identified. Notably the Trust instructed
an external company to conduct a retrospective audit of the last seven years of utility
invoices. From a total spend of £32.5 million on energy over this seven year period, the total
errors identified amount to a rebate to KCH of £47,740. In addition to this work KCH has
carried out its own internal revenue recovery exercise. During 2016-YTD this has resulted in
the recovery of circa £108,000 due to recovering over-charges and account credits.
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 8
Table 3: Cost savings achieved April 2016 – YTD 2017
Supplier Date Explanation of cost savings CIP/Cost Saving /
Revenue Recovery
Value
Veolia 2016‐17 Energy Centre Costs – Renegotiation of the contract with Veolia for running the Energy Centre.
CIP £160,000
EDF 2016‐17 Revenue Recovery – Sum of KCH revenue recovery across the Main Incomer, Dental, GJW and Orpington accounts & historic accounts: Unit 5 Thistlebrook, Security Office.
Revenue Recovery
£94,539
EA 2016‐17 Carbon Reduction Commitment (CRC) Charge – An additional saving made from no‐longer being eligible for charges against the PRUH site.
CIP £71,000
Axiom 2016‐17 Revenue recovery – External audit of all utility invoices covering a retrospective period of 7 years.
Revenue Recovery
£47,740
EDF 2016‐17 Late Payment Interest – Reconciliation of the EDF accounts has reduced the level of LPI paid across the four accounts.
Revenue Recovery
£6,300
EDF 2016‐17 Late Payment Interest Charges – Refund of LPI charges for 2014‐15.
Revenue Recovery
£5,767
Thames Water
2016‐17
Account Review – Identification of credit on closed accounts.
Revenue Recovery
£1,962
Thames Water
2016‐17
TBC ‐ Identification of Duplicate payments. Cost Avoidance £1,860
BGB 2016‐17 Multiple Accounts – Identification of duplicate invoicing without credit notes.
Cost Avoidance £1,918
Total Cost Avoided £3,778
Total Revenue Recovery £156,308
Total Cost Saving £231,000
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 9
Table 4: Cost savings achieved 1st April 2015 – 31st March 2016
Supplier Date Explanation of cost savings CIP or Cost Saving
Value
EDF 2015‐16 161 Denmark Hill – Unclaimed credit on a closed account brought back to KCH.
Revenue Recovery
£2,913
Thames Water
2015‐16 Unit 2 KBP – Identification of duplicate invoice. Cost
Avoidance £1,063
BGB 2015‐16 Multiple Accounts ‐ re‐enrolled onto the CCS framework agreement to secure cheaper utility prices.
Non‐recurring saving
£18,853
EDF 2015‐16 Main Site Account – Identification of duplicate invoice. Cost
Avoidance £49,119
Thames Water
2015‐16 Multiple Accounts – Recovery of built up credit, returned to KCH.
Revenue Recovery
£26,824
GAZProm 2015‐16 Accounts Error – Invoice entered to Sprinter for a property not owned by KCH.
Cost Avoidance
£11,348
BGB 2014‐15 The Haven Brady Street – Identification of duplicate invoices.
Cost Avoidance
£5,954
Thames Water
2014‐15
Orpington Hospital Invoiced Water Meter Charges – Cancelled invoices due to Thames water being unable to accurately invoice for water services from acquisition on 1st October 2013. In June 2015 Thames water confirmed agreement that the Trust would not pay any invoices for this period. Invoices to the value of £42,825.62 were cancelled.
Non recurring CIP.
Budget to be maintained
going forward £60,000
£90,000 Non recurring
saving
Thames Water
2014‐15
Orpington Hospital Invoiced Water Meter Charges ‐ Avoided costs due to dispute with Thames Water who were requested to cease invoicing King’s until resolved. Thames Water agreed in June 2015 Charges of ~ £29,370 were not invoiced to King’s.
Veolia 2014‐15
Denmark Hill Energy Centre credit ‐ Veolia were asked to carry out a review of their 2014‐2015 monthly operational invoices due to unexpected increase in costs. Errors identified relating to the overcharge of Ruskin gas and under refunding of the export electricity credit. #310062821
Revenue Recovery
£19,089
VAT Reclaim
2014‐15
VAT Reclaim on PRUH Gas ‐ The Finance Depart had been reclaiming VAT on the electricity purchased from SSE at the PRUH. Finance will now reclaim the VAT on gas purchased from Corona for the SSE energy centre at the PRUH.
CIP £67,000
EA 2015‐16
Carbon Reduction Commitment (CRC) Charge ‐ King’s has been eligible for payments under ‘Phase 1’ of the CRC. The Environment Agency (EA) has confirmed KCH is not eligible for Phase 2.
CIP/Cost Saving
£260,000
Others 2014‐15 Other savings/Costs avoided – Savings & cost avoidance below £1000 are not listed separately but shown as a cumulative total.
Cost Savings £3,140
Total Cost Avoided 134,968
Total Revenue Recovery 48,826
Total Cost Saving 438,993
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 10
5 ENERGY BENCHMARKING & PRICE EVALUATION
The following analysis is based on the data submitted by NHS Trusts for the ERIC return
covering the period 2014-15. It follows the ‘Dashboard’ format available through the ERIC
return portal. The aim is to assess KCH’s performance in comparison to other ‘Acute
Teaching’ and ‘Large Acute’ NHS Trusts.
5.1 ENERGY PERFORMANCE ANALYSIS
The results of the energy performance analysis are shown in Table 5. The table shows
KCH’s reported performance to ERIC, and under the ‘Quartile’ heading, KCH’s respective
performance compared to other Trust’s. For interpretation of the quartile performance
indicators please see Table 6.
Table 5: KCH Performance metrics & comparison to comparable Trust’s
Performance Metric Unit Trust Performance Quartile Ranking
Total Energy Spend £ 5,905,870 Q3 ‐ High
Energy Cost £/kWh 0.034 Q1 ‐ Lowest
Total Energy Consumed kWh 174,650,786 Q4 ‐ Highest
Energy Intensity kWh/m2 836.9 Q4 ‐ Highest
Table 6: Explanation of relative performance between quartiles
Quartile Performance Indicates
Quartile 1 Lowest Best performing group
Quartile 2 Low ‐
Quartile 3 High ‐
Quartile 4 Highest Poorest performing group
5.1.1 Energy Use & Cost
KCH is amongst the highest energy users compared to comparable NHS Trust’s, ranking in
the highest quartile (Q4), shown in Table 5. However, KCH also has one of the largest sites
and oldest site infrastructures. This explains KCH’s comparatively high energy demand as a
large portion of energy demand is driven by building size and the energy efficiency of the site
infrastructure in place.
Despite this, KCH’s energy spend falls into Q3, the second highest quartile, indicating that
KCH is achieving competitive rates for its utilities within the current market. This is further
supported by KCH being ranked in Q1, the lowest quartile, for the cost per kWh (£/kWh), see
‘Energy Cost’ in Table 5.
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 11
5.1.2 Energy Procurement
To obtain competitive utility prices KCH secures its supplies through a Crown Commercial
Services (CCS) framework agreement. Recently, utility markets have shown a downward
trend in terms of the price per kWh of energy, particularly for gas cost. Under the CCS frame
work KCH has benefitted from these reductions. As shown in Table 7 these prices compare
favourable to those achieved on average in the UK. KCH achieved reductions in the unit
price of gas in-line with market trends and increases in unit price of electricity costs, again
that are reflective of market trends4,5.
Table 7: KCH utility price changes for 2015-16 compared to 2014-15 & UK average
Utility Units 2015‐16 Unit Cost
Trend 2014‐15 Unit Cost
UK National Average5 (Non‐Domestic)
Electricity £ 0.08 - 0.077 0.1024
Gas £ 0.024 0.027 0.0264
During 2016-17 market indications are that the per unit price for electricity and gas will
increase.
However, the price per kWh now makes up only 57 % of utility bills. The remaining 43% is
made up of: availability charges, connection charges, distribution and transmission charges,
administration charges, Climate Change Levy and VAT. These elements have shown little to
no reduction, and currently look set to increase year-on-year. The outcome of the UK
Government’s consultation on ‘Reforming the business energy efficiency tax landscape’ is
likely to have a significant impact on future utility costs in the short to medium term for KCH.
4 DECC, ‘Quarterly Energy Prices, March 2016’, Department for Energy & Climate Change, 2016. 5 DECC, ‘Prices of fuels purchased by non-domestic consumers in the UK’, Department for Energy & Climate Change, 2016.
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 12
6 ANNUAL ENERGY ANALYSIS
The following analysis presents the annual energy consumption and costs for the whole
KCH estate. The total energy consumption of the KCH estate is made up of three
components:
Purchased electricity from the national grid
Gas use to provide heating, hot water and on-site generation of electricity via the
CHP plant
Electricity generated from the CHP plant that is consumed on-site
6.1 TOTAL KCH ENERGY COMSUMPTION
Figure 1: Total KCH energy consumption
The results for 2015/16 show a:
1% increase in total energy consumption to 177.5 GWhs
8% decrease in total costs to £5.9 million
1% decrease in CO2 emissions to 33,235 tonnes CO2
0
2
4
6
8
10
12
14
16
18
20
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Total En
ergy consumption (kW
h)
Millions
2015/16 2014/15
ANNUAL
King’s C
6.2
The bul
nationa
Figure 2
The res
Figure
Purchased Electricity Consumption
(kWh)
Purchased Gas Consumption
(kWh)
L ENERGY & C
College Hosp
PURCHAS
lk of KCH’s
al networks.
2: Total KCH
sults for 201
0.7% decre
6.7% decre
2% decrea
These dec
Orpington
per unit pr
3: Total KC
0.0
0.5
1.0
1.5
2.0
2.5
3.0
()
Millions
‐
2
4
6
8
10
12
14
16
()
Millions
CARBON MA
pital NHS Fou
SED ENERG
energy dem
H purchased
15/16 show
ease in pur
ease in CO
ase in purc
creases ar
, a decreas
rice of gas.
H purchase
Apr
May
Apr
May
NAGEMENT R
undation Tru
GY CONSU
mand is me
d electricity
a:
rchased ele
O2 emission
hased elec
re attributa
se in the ca
.
ed gas consu
Jun
Jul
20
Jun
Jul
20
REPORT - 1S
ust
UMPTION
et through p
consumptio
ectricity co
ns due to pu
ctricity cos
able to red
arbon inten
umption 201
Aug
Sep
15/16 20
Aug
Sep
15/16 20
T APRIL 2015
urchasing e
on 2015 – 20
onsumption
urchased e
ts of £50,9
ductions in
nsity of the
15 - 2016
Sep
Oct
014/15
Sep
Oct
014/15
5 TO 31ST MAR
electricity an
016
n to 25,191
electricity t
86 to £2,51
n demand
e grid and
Nov
Dec
Nov
Dec
RCH 2016
nd gas thro
1,623
to 12,605 to
14,331 milli
a the PRU
a reductio
Jan
Feb
Jan
Feb
13
ugh the
onnes
ion
UH and
n in the
Mar
Mar
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 14
The results for 2015/16 show a:
1% increase in purchased gas consumption to 126,636,319 kWhs
1% increase in purchased gas CO2 to 23,371 tonnes
12% decrease in invoiced purchased gas costs of £418,586 to £3,168,682
6.3 PURCHASED ENERGY COSTS
Figure 4: Total purchased gas & electricity costs
The results for 2015/16 show a:
8% decrease in gas & electricity costs to £5.68 million
This comprised a:
o 12% decrease in gas costs falling by £418,586
o 2% decrease in electricity costs falling by £50,986
£0
£100,000
£200,000
£300,000
£400,000
£500,000
£600,000
£700,000
Apr
May Jun
Jul
Aug
Sep
Oct
Nov
Dec Jan
Feb
Mar
Total Purchased Gas & Electricity
Cost (£)
2015/16 2014/15
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 15
6.4 ON-SITE ELECTRICITY GENERATION
The Denmark Hill site houses a CHP plant. In addition to producing heat the CHP plant
generates electricity which can be used to meet the on-site demand for electricity.
Figure 5: Total generated electricity
There was no increase/decrease in electricity generated by the KCH Energy
Centre giving an output of 32,343,600 kWhs
At times when the electricity output from the CHP exceeds the on-site demand the
generated electricity is exported to the national grid. KCH receives a payment for any
electricity that is exported to the national grid.
Figure 6: Exported electricity kWh
‐
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Apr
May Jun
Jul
Aug
Sep
Oct
Nov
Dec Jan
Feb
Mar
Total CHP Generated Electricity
(kWh)
Millions
2015/16 2014/15
0
200
400
600
800
1,000
Apr
Ma
y
Jun
Jul
Aug
Sep Oct
Nov
Dec
Jan
Feb
Ma
r
Total Exported Electricity (kW
h)
Thousands
2015/16 2014/15
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 16
6,699,690 kWh of electricity exported to the grid
10% decrease in exported electricity due to increased on-site use
10% decrease in exported CO2 to 2,740 tonnes
6.5 ON-SITE ELECTRICITY GENERATION REVENUE
Figure 7: Exported electricity revenue
19% decrease in exported electricity revenue of £63,708
Total revenue generated from exported electricity of £264,656
6.6 DENMARK HILL SITE TOTAL ELECTRICITY USE
Figure 8 Total electricity used on the Denmark Hill site
Net electricity consumption of 43.6 GWhs
2% increase in purchased electricity consumption
£‐
£10,000
£20,000
£30,000
£40,000
£50,000
Apr
May Jun
Jul
Aug
Sep
Oct
Nov
Dec Jan
Feb
Mar
Exported Electricity Revenue
2015/16 2014/15
0
2
4
6
8
10
12
14
16
18
20
Apr
May Jun
Jul
Aug
Sep
Oct
Nov
Dec Jan
Feb
Mar
Total Electricity Used
(Generated + Im
ported ‐Exported)
(kWh)
Millions
2015/16 2014/15
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 17
Purchased electricity consumption on the Denmark Hill Site has decreased each year and is
60% lower in 2015/16 compared to 2009/10. This is mainly due to the commissioning of the
Energy Centre at Denmark Hill which generates electricity on site reducing the need to
purchase electricity from the national grid.
6.7 CONDITIONS AFFECTING ENERGY CONSUMPTION
The following section aims to outline the factors affecting the trusts energy demand and the
influence these have had during 2015-16.
6.7.1 Prevailing Weather Conditions
The prevailing weather conditions have a significant impact on the energy demand of
buildings, both during winter through either higher or lower space heating demand and
during the summer with higher or lower demand for space cooling.
Heating degree-days and cooling degree-days indicate the intensity of cooler and hotter
weather conditions. The cooler or hotter the weather in a given month, the larger the degree-
day values for that month. They are a summation over time of the difference between a
reference or base temperature and the outside temperature.
In 2015-16 the recent trend in more moderate weather conditions continued. The total
heating degree-days for the year was 7% lower than in 2014-15 with the cooling degree-
days being 28% lower. These conditions would be expected to support lower energy
demand across the KCH sites.
Figure 9: Heating Degree Day records for the Thames Valley Region
0
50
100
150
200
250
300
350
400
450
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Heating Degree‐days
2015/16 2014/15 5 Yr Av
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 18
Figure 10: Cooling degree day records for the Thames Valley region
6.8 SITE SIZE & ACTIVITY
During 2016 the GIA of the KCH site has increased due to small additions to the site such as
the development of the Alex Mowart area. This will have contributed towards increasing the
site’s energy demand.
KCH’s energy demand is set to continue to increase as infrastructure projects are brought
into operation. The opening of additional space at Orpington Hospital and the King’s Critical
Care Centre at Denmark Hill for example, will all contribute to an increase in energy
demand. The building of these facilities will also be increasing King’s energy demand,
however this will simply be replaced and overtaken by the facilities demand as they come
online.
The increase in energy demand from these new facilities will result in KCH reaching and
potentially breaching its current ‘available capacity’ agreement. This will be particularly
significant in any future long-term site plans.
6.9 ENERGY PERFORMANCE SUMMARY
Overall, KCH’s energy demand for 2015-16 has remained relatively constant compared to
2014-15 with only a, small, 1% increase observed. Weather conditions favourable to lower
energy use will have helped to mitigate any increases in energy use, while increases in on-
site activity and floor area will have promoted increased energy consumption.
0
5
10
15
20
25
30
35
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Coolin
g Degree‐days
2015/16 2014/15 5 Yr Av
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 19
However despite this small increase of 1% in energy use, improvements in costs and GHG
emissions have been shown. Significantly a:
8% decrease in total energy costs of £413,471 was achieved
1% decrease in total net GHG emissions
For 2016-17 the Trust aims to maintain its energy use at the current level, and is setting a
target of a 0% increase in energy use.
The 0% increase in energy use target is seen as a positive target owed to the continuing
increase in on-site activity across the Trust.
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 20
7 PFI BUILDINGS – ENERGY PERFORMANCE
Within the KCH estate two buildings are run under PFI agreements, The Golden Jubilee
Wing and The Princes Royal Hospital. Their respective energy performance is reported
separately due to the differing nature of these buildings operational contracts.
7.1 GOLDEN JUBILEE WING
Figure 11: Total gas & electricity consumption
The results for 2015/16 shows a:
Total gas costs £125,082
Total electricity costs £541,283
Total gas and electricity costs £666,365
3% decrease in gas & electricity costs of £16,734
18% decrease in gas & electricity consumption
9% decrease in CO2 emissions of 77 tonnes
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
Apr
May Jun
Jul
Aug
Sep
Oct
Nov
Dec Jan
Feb
Mar
Total G
as & Electricity Use (kW
h)
2015‐2016 2014‐2015
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 21
7.2 PRINCESS ROYAL UNIVERSITY HOSPITAL
Figure 12: Total gas & electricity consumption
The results for 2015/16 show a:
Total Gas costs £463,764
Total Electricity costs £857,151
Total Gas and Electricity costs £1,320,915
14% decrease in gas & electricity costs of £218,327
3.5% decrease in gas & electricity consumption
7% decrease in CO2 emissions of 712 tonnes
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Total G
as & Electrcity Use
(kWh)
Millions
2015‐2016 2014‐2015
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 22
8 GREENHOUSE GAS EMISSIONS
8.1 GHG CALCULATION METHODOLOGY
KCH’s net GHG emissions have been calculated using the Carbon Trust Standard method,
which is based on the internationally recognised GHG Protocol, using the standard GHG
conversion factors issued by the Department for Business, Energy and Industrial Strategy.
The emissions presented in this report cover KCH’s emissions from the built environment
(Scope 1 and 2) and exclude the embodied emissions due to goods and services (Scope 3).
Broadly, KCH’s total emissions are calculated in-line with the equation below:
CO2 emissions = Purchased Natural Gas + Purchased Electricity – Exported Electricity
8.2 GHG RE-BASELINE CALCULATION
Following the acquisition of the PRUH and Orpington hospitals, KCH’s GHG base year
calculations were no-longer reflective of the organisation. This meant KCH’s progress on
GHG emissions reduction could not be accurately tracked, and appeared to show a
significant increase on the base-year. This is shown in Figure 13 under the ‘Original Base-
year’ and ‘Original Annual Emissions’ trend lines.
A base-year re-calculation was carried out to include KCH’s acquisition of these new sites
and published under the King’s College Hospital ‘GHG Emissions Base-year Recalculation
Report’. The output of the base-year re-calculation more accurately reflects KCH’s GHG
emissions performance, the changes brought about by this re-calculation are shown in
Figure 13 under ‘Re-calculated Annual Emissions’ and ‘Re-calculated Base-year’ trend lines.
Figure 13: Comparison of KCH GHG emission pre & post base-year re-calculation
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2007‐08 2009‐10 2011‐12 2013‐14 2015‐16
Total G
HG emissions (tCO
2)
Year
Re‐calculatedAnnualEmissions
Re‐calculatedBase‐Year
Original AnnualEmissions
Original BaseYear
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 23
8.3 KCH GHG EMISSIONS 2015-16
The results for 2015-16 represent a 1% decrease in GHG emissions compared to the
previous year, a decrease of 273 tCO2 giving a total of 33,235 tCO2. This decrease is
attributable to:
Decreases in the GHG intensity of the UK’s energy generation and distribution. This
has the effect of reducing KCH’s GHG per kWh GHG emissions and therefore total
GHG emissions.
o This is illustrated by the purchased electricity consumption at the DH site
increasing by 2%, but the GHG emissions due to purchased electricity
reducing by 5%.
The purchased energy consumption at the PRUH and Orpington has reduced in
2015-16 compared to the previous year by 3.5% and 2% respectively, meaning they
have contributed less to KCH’s overall GHG emissions.
Mild weather conditions over this reporting period, promoting reduced energy use
compared to 2014-15, as confirmed by the degree day figures.
Figure 14: Net CO2 emissions
1% net decrease in CO2 emissions of 273 tonnes
8.4 LONG TERM GHG EMISSIONS TREND
The Trust continues to show a reduction in its annual scope 1 and 2 GHG emissions
compared to the base-year in 2007-08. A 5.9% reduction in GHG emissions was achieved
during 2015-16, figures which have helped the Trust to continue its long-term performance of
‐
500
1,000
1,500
2,000
2,500
3,000
3,500
Apr
May Jun
Jul
Aug
Sep
Oct
Nov
Dec Jan
Feb
Mar
Net GHG Emissions (tCO₂)
2015/16 2014/15
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 24
achieving an above 6% cumulative year-on-year reduction in direct GHG emissions6. These
reductions put KCH ahead of the national average trend for reductions in NHS organisations’
buildings. This also supports KCH’s progress towards the NHS interim target of 10%
reductions in GHG emissions by 2015, and the UK Government’s target of 34% by 2020.
Table 8: KCH GHG emissions reduction compared to external targets
Year Unit KCH NHS Wide Average NHS Target
GHG emissions reductions 2015‐16 % 5.9 4 10
For an accurate appraisal of KCH’s progress towards these external targets, KCH’s Scope 3
GHG emissions, those embodied in the goods and services consumed by the organisation,
need to be included in the emissions calculations. KCH has taken steps to estimate these
Scope 3 emissions, using the Sustainable Development Unit’s reporting template. As
understanding of these data develops, KCH hopes to identify future targets to reduce GHG
emissions.
Figure 12 shows the long term GHG emissions performance. Reduction in GHG emissions
of 16% between 2010-11 and 2011-12 were achieved through commissioning two on-site
Combined Heat and Power engines (CHPs), reducing GHG emissions by shifting more of
KCH’s energy demand towards natural gas, an energy source with lower associated GHG
emissions. Subsequent increases in GHG emissions are due to site expansion, but recent
energy efficiency projects have brought stability to the GHG emissions associated with
KCH’s activity.
6 Descrepencies between GHG emissions data presented in the ‘Utility Consumption’ section the ‘Long Term GHG Emissions Trend’ section are due to variations in the energy consumption data used for the base-year re-calculations compared to the energy consumption database. These decrepencies do not affect the overall trend presented and will be corrected in the next annual report.
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 25
Figure 15: Comparison of annual GHG emissions with the Base year
For 2016-17 the Trust aims to maintain its GHG emissions at the current level, setting a
target for GHG emissions to increase by 0%. This target is seen as a positive target due to
continuing increases in on-site activity and the lack of lower GHG emission energy sources
at sites outside the Denmark Hill campus.
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2007‐08 2008‐09 2009‐10 2010‐11 2011‐12 2012‐13 2013‐14 2014‐15 2015‐16
GHG emissions (tCO
2)
Year
Base YearGHGemissions
Annual GHGemissions
UK GHGreductiontarget
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 26
9 WATER CONSUMPTION ANALYSIS
Water consumption across the Trust rose in 2015-16 by 9%. This represents an increase in
water use of 26,922m3, at a cost of £589,101, an increase of £56,100 from the 2014-15
spend. This increase is due to increased use at Denmark Hill and water use now being
charged for at Orpington.
Denmark Hill: 2015-16 saw an increase in water use at the Denmark Hill site of 4%. This
increase was caused by:
Additional buildings and activity on site.
Increased system flushing required under infection control measures L8 and HTM04.
And the ageing water infrastructure which is susceptible to leaks.
PRUH and Orpington: Water consumption at the PRUH increase marginally by 0.4%,
however costs increased by 4%, costing £160,853 an increase of £5,690.
A comparison cannot be given for Orpington as during 2014-15 the site received its water on
a ‘Free of Charge’ basis due to a metering issue. Details on this cost saving are given in
section 4 of this report. For 2015-16 Orpington consumed 18,031m3 of water at a cost of
£24,123.
9.1 WATER MARKET REVIEW - HOW IS THE WATER MARKET CHANGING?
The majority of business customers in England cannot choose which company provides them
with water supply and sewerage services. In April 2017, the water market will be de-regulated
and a fully competitive water retail market will open. All non-domestic customers in England will
have the option to transfer their business to a retailer of their choice.
The Trust will initially purchase water from a new CCS Framework. This is not expected to
provide significant savings to customers due to retailers only being able to influence 7% of the
total tariff to the end user, 93% of the delivered tariff is made up of wholesaler costs.
However, it is believed that the public sector can take advantage of a number of other service
offerings to facilitate savings through added value services such as: electronic billing,
consolidated invoicing, improved metering services i.e. AMR/smart metering, and the
provision of affordable technologies and services to decrease water consumption.
Initially the Trust will look to work closely with the new water supplier to carry out leak
detection projects across the site.
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 27
10 ENERGY PROJECTS UPDATE
The project areas run by the energy team typical cover three areas of energy management,
projects to improve: energy efficiency, energy security or operational performance. The
sections below outline the energy projects completed at KCH during 2015-16, previously
completed projects and planned future projects.
10.1 COMPLETED PROJECTS 2015-16
Table 9 shows the projects that have been completed during 2015-16, along with their
completion dates and performance benefits.
Table 9: Project progress for 2015-16
Project Title & Description Payback (years)
Benefits Delivered
Cost/Energy/GHG
Pipework Insulation Project
A large area of steam, low temperature hot water, domestic hot water and condensate pipework has been insulated.
TBC
Reduced heat loss Reduced energy use
Reduced risk of burns
Improved patient & staff environment by reduced overheating.
2015‐16
Boiler Installation Camberwell Building
An inadequate electric heating system has been replaced on the ground floor with a new gas fired boiler. This will greatly improve the comfort of staff and reduce energy costs.
TBC
Reduced energy use & costs
Improved staff environment
2015‐16
Normanby Building Boiler Replacement
Old and inefficient boilers originally designed to run on coal have been replaced with high efficiency gas boilers.
TBC
Reduced energy use/cost
Reduced risk of heating loss
2015‐16
CRC Review of eligibility for CRC N/A Reduced costs 2015‐16
Energy Centre Invoice Review
Review of Denmark Hill energy centre invoicing.
N/A Reduced costs 2015‐16
GHG Emissions Base‐Year Recalculations
KCH’s GHG emissions baseline needs to be updated to reflect the acquisition of the PRUH & Orpington.
N/A Improved progress reporting on GHG reduction.
2015‐16
Utility Account Reviews
Review & reconciliations of the 4 utility accounts.
N/A
Improved financial management, recovery of revenue and reduced interest payment costs.
In Progress
Operation TLC ‐Behaviour Change Campaign
Stage 1: Pilot of Operation TLC a behavioural change programme to support the environments for patients and deliver financial and energy
N/A Supporting comfortable environments for patient care
2015‐16
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 28
savings.
This project focused on the 3 actions: Introducing Quiet Time, light switch off campaign and Improving Air Conditioning with the closure of doors & windows.
AM & T Service Stage 1: Scoping of metering & targeting requirements, available technologies and providers.
N/A To improve bill validation reducing costs & assist with required reporting
2015‐16
KCCc Assisting Capital Projects with energy elements of the KCCC development
N/A ‐ In
Progress
PC Power Management
Investigating deployment of power management software to PRUH & Orpington.
‐ ‐ In
Progress
10.2 FUTURE PROJECTS
The following sections outlines the projects planned to commence in 2017-18 along with
delivery year. These are listed in Table 10.
There are additional projects listed within the energy management plan that cannot be
moved forward until budgets and resources are allocated to the project.
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 29
Table 10: Future projects for 2016-17 and beyond
Project Project Description Payback (Years)
Benefits Delivery Year Cost/Energy/GHG
Steam Trap Audit & Install
Multi‐phase project ‐ Steam trap survey at Denmark Hill which will be used to develop a programme of works to upgrade steam traps. Under Phase 1, fifty five STS17.2 steam traps have been purchased and will be installed during the summer of 2016.
TBC
Reduced risk to staff Reduced maintenance
costs Improved energy
efficiency by reducing steam loss
2015‐16
Revenue Recovery
Procurement of utility revenue recovery services
N/A Recoup incorrectly charged utility costs
2016‐17
AM&T Service Stage 2: Procure and deploy AM&T service across KCH’s utilities.
N/A To improve bill validation reducing costs & assist with required reporting
2016‐17
DSR
Demand Side Response: Two stage project to scope potential/suitability for KCH’s participation in DSR and procure DSR services.
TBC TBC 2016‐18
ISO 50001
Two stage project: Develop ISO 50001 energy management systems and complete accreditation process.
TBC TBC 2016‐18
Condensate Improvement
To deliver a new condensate main in phases to improve the condensate returned & reduce risk.
TBC Phase 1 £350,000 2016‐17
Travel Plan
To deliver a new Travel Plan for the Denmark Hill site to encourage a shift from car use to more sustainable transport.
N/A £ 26,000 2016‐17
Maximum Available Capacity
Review of available capacity and Trust’s future energy demands.
N/A Security of Supply Corporate Risk
Cost management 2016‐17
Water Supply Failure ‐ ERP
Stage 2, 3, 4. To be progressed when finances are available.
‐ Security of Supply TBC
CHP interface with GJW
To displace the use of the GJW boilers by using Steam/LTHW from the energy centre. Audit available
TBC TBC TBC
Steam Infrastructure upgrade
Upgrades to the Denmark Hill site wide steam system infrastructure. Audit available
TBC TBC TBC
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 30
10.3 DELIVERED PROJECTS
Table 11 outlines projects that have already been delivered up to 2015-16.
Table 11: Projects delivered to up the end of 2014-15
Project Project Description Payback (Years)
Energy/CO2/Cost Benefits
Delivered
Energy Performance Contract
£3 million grant awarded to deliver energy efficiency measures under an EPC at Denmark Hill started in 2013. Comprised 4 projects installing: 1. District LTHW Heating Scheme Using
free heat from the CHP jackets to supply five plant rooms with heat, displacing the use of steam.
2. Plate Heat Exchangers (PHXs) PHXs installed to replace old, inefficient shell and tube clorifiers.
3. Thermal Insulation Fitted on extensive areas of steam and hot water pipework to reduce heat loss, energy use and reduce overheating in the patient / staff environment.
4. BMS Upgrade Works in order to upgrade out of date systems and improve control over heating and cooling systems.
11
Reduced energy consumption by 6% & GHG emissions by 1,892 tonnes
Reduced corporate risk
Reduced Reactive maintenance
2014‐15
Water Use Minimisation
Stage 1: Installation of Fusion remote meter monitoring system to provide accurate consumption data and leak detection. First stage of water use reduction strategy is being developed with Thames Water.
N/A Allows accurate monthly invoicing
2014‐15
Water Supply Failure ‐ ERP
Stage 1: Development of emergency response plan failure of mains water supply at Denmark Hill site. Stage 1, development of an area hydraulic model is completed. Project to be delivered in four stages.
‐ Security of Supply 2014‐15
PC Power Management
PC management software detects computers left on out of hours and powers down. Covers 78% of PCs at Denmark Hill.
1
£86,000 cost saving
523 tonnes of CO2
2011
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 31
11 LEGISLATIVE COMPLIANCE
This section shows the relevant legislation that applies to the area of energy use and the
Trust’s compliance status with this legislation. Relevant legislation listed includes legislation
from all bodies that affect the Trust.
Table 12: KCH Energy compliance status
Area Requirement Relevant Legislation Status Evidence
Building En
ergy
Efficiency
Display Energy Certificates
(DEC)
Energy Performance of
Buildings Directive, 2003 Compliant
Energy & Environment Record of Compliance
Energy Performance
Certificates (EPC)
Energy Performance of
Buildings Directive, 2003 Compliant
TM44 Air Conditioning
Inspections
Energy Performance of
Buildings Directive, 2003 Compliant
GHG M
anagemen
t
CRC Energy Efficiency
Scheme (CRC)
The CRC Energy Efficiency Scheme (Amendment) Order 2014 (Currently ending in 2018‐19)
Compliant
EUETS ‐ Permits
The Greenhouse Gas
Emissions Trading Scheme
Regulations, 2012
Compliant
EUETS ‐ AER Validation
The Greenhouse Gas
Emissions Trading Scheme
Regulations, 2012
Compliant
Policy
Documen
ts
Energy & Carbon
Management Policy ISO 14001 Compliant
11.1 COMPLIANCE PROGRESS & REGULATION CHANGES
The sections below outline areas of development within relevant legislation, any actions
taken to ensure compliance with current legislation or newly introduced legislation.
11.1.1 EU ETS
Compliance with the EU ETS (European Emissions Trading Scheme) is required under the
UK’s membership of the European Union (EU). Currently there is no indication on how any
proposed withdrawal from the EU by the UK will affect this legislation and KCH’s
requirement to comply with it.
11.1.2 CRC Energy Efficiency Scheme
The main change to the legislative landscape over 2015-16 has been within the CRC Energy
Efficiency Scheme, a mandatory GHG emissions trading platform. The Trust was an eligible
participant in Phase 1 of the CRC which ran from 2010 to 2014. The eligibility criteria for
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 32
‘Phase 2’ of the scheme have changed and, in consultation with the Environment Agency, it
has been determined that KCH does not qualify for ‘Phase 2’. As such KCH will not be
eligible to make payments under the CRC from 2015-16 onwards. This development has
contributed to the cost savings achieved
11.1.3 Display Energy Certificates
2015-16 saw changes to the Display Energy Certificate (DEC) requirements. DECs show the
energy performance of a building by providing an energy rating of the building on a scale
from A to G, where A is very efficient and G is the least efficient. This is based on the actual
amount of energy used by the building over a period of 12 months.
The scope of the legislation increased to cover properties occupied in whole or part by a
public authority, that are frequently visited by the public, with a GIA of 250m2 or above7. This
resulted in eight additional properties requiring a DEC to be issued. Of the 19 buildings
issued with a DEC, seven have achieved a typical rating or higher.
Table 13: DEC Ratings for KCH eligible buildings
7 DCLG, ‘Improving the energy efficiency of our buildings, A guide to display energy certificates and advisory reports for public buildings’. Department for Communities and Local Government, 2015.
Site Address Postcode Typical 2010‐11 2011‐12 2012‐13 2013‐14 2014‐15 2015‐16
King's College Hospital Main Hospital Site SE5 9RS D F ‐ 146 E ‐ 115 F ‐ 126 F ‐ 131 F ‐ 128 F ‐ 138
Golden Jubilee Wing D E ‐ 119 E ‐ 125 E ‐ 120 E ‐ 117 E ‐ 123 E ‐ 116
Dental Institute D F ‐ 132 D ‐ 92 D ‐ 91 D ‐ 99 F ‐ 139 F ‐ 131
Day Surgery Centre D E ‐ 120 G ‐ 208 G ‐ 176 G ‐ 178 C ‐ 67 C ‐ 63
Normanby Building D D ‐ 100 C ‐ 54 C ‐ 52 C ‐ 66 B ‐ 44 B ‐ 50
Caldecot Centre 15‐22 Caldecot Road SE5 9RS D D ‐ 82 D ‐ 83 C ‐ 75 C ‐ 74 D ‐ 78 D ‐ 81
Camberwell Building 94‐104 Denmark Hill, London SE5 8RX D F ‐ 149 E ‐ 111 E ‐ 106 E ‐ 105 E ‐ 111 E ‐ 125
Jennie Lee House 34 Love Walk SE5 8AD D ‐ ‐ ‐ E ‐ 122 D ‐ 81 D ‐ 88
Sydenham Renal Unit Unit 9, Worsley Bridge Rd SE26 5BN D ‐ ‐ ‐ E ‐ 117 TBC G ‐ 183
PRUH Main Farnborough Common BR6 8ND D ‐ ‐ ‐ G ‐ 160 F ‐ 150 F ‐ 149
PRUH Day Farnborough Common BR6 8ND D ‐ ‐ ‐ N/A F ‐ 137 G ‐ 167
Orpington Sevenoaks Road BR6 9JU D ‐ ‐ ‐ C ‐ 73 (2012) D ‐ 98 D ‐ 91
Unit 6 D ‐ ‐ ‐ ‐ ‐ F ‐ 135
Midwives Centre D ‐ ‐ ‐ ‐ ‐ C ‐ 69
Midwives House D ‐ ‐ ‐ ‐ ‐ C ‐ 73
PGMC ‐ Main Building D ‐ ‐ ‐ ‐ ‐ G ‐ 171
PGMC ‐ Annexe D ‐ ‐ ‐ ‐ ‐ G ‐ 178
Whitechapel Haven D ‐ ‐ ‐ ‐ ‐ F ‐ 131
Bromley Renal Unit D ‐ ‐ ‐ ‐ ‐ G ‐ 231
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 33
APPENDIX A: UTILITY CONSUMPTION DATA
KCH ESTATE - CONSUMPTION DATA
The following summary table shows the annual energy, water and carbon data for 2009-16
and are based on actual consumption figures. 2015-16 saw a decrease in utility costs of
£413,471 despite an increase in demand for utilities. The increases seen across all data in
2013-2014 and 2014-2015 are due to KCH taking over operations at the PRUH and
Orpington hospitals.
Table 14: KCH Estate Utilities Consumption, Cost and Carbon Emissions 2009-16
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 34
DENMARK HILL SITE – CONSUMPTION DATA
The following summary table shows the annual energy and carbon data for 2009-16, for the
Denmark Hill site only.
Table 15: Denmark Hill Utilities Consumption, Cost and Carbon Emissions 2009-16
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 35
PRUH - CONSUMPTION DATA
The following summary table shows the annual energy and carbon data from 1/10/2013 for
the PRUH only.
Table 16: PRUH Utilities Consumption, Cost and Carbon Emissions from 1/10/2013
Utility CostsYear
2015 ‐ 16
Year
2014 ‐ 15
Year
2013 ‐ 14
Variance
2014‐15 to
2015‐16
% Change
2014‐15 to
2015‐16
Total Gas Cost £ 463,764 £ 537,715 £ 323,792 ‐£73,951 ‐13.8%
Total Electricity Cost £ 857,151 £ 1,007,216 £ 587,544 ‐£150,065 ‐14.9%
£ 1,320,915 £ 1,544,931 £ 911,337 ‐£224,016 ‐14.5%
% Change ‐14.5% 70% ‐
Total Water Cost £ 160,853 £ 155,163 £ 49,768 5,690£ 4%
% Change 4% 212% ‐
Total Utilities Cost £ 1,481,768 £ 1,700,095 £ 961,104 ‐£218,327 ‐13%
Exported Electricty
Revenue ‐£ ‐£ ‐£ ‐£ ‐
Utility Consumption
Energy Consumption
Purchased Gas (kWh) 15,900,727 16,535,793 9,037,373 ‐635,066 ‐4%
Purchased Electricity (kWh) 12,259,749 12,637,684 6,124,317 ‐377,935 ‐3.0%
Total Purchased kWh (kWh) 28,160,476 29,173,477 15,161,690 ‐1,013,001 ‐3.5%
% Change ‐3.5% 92% ‐
Generated Electricity (kWh) 0 0 0 0 ‐
Exported Electricity (kWh) 0 0 0 0 ‐
Total Net Energy
Consumption(kWh) 28,160,476 29,173,477 15,161,690 ‐1,013,001 ‐3.5%
Water Consumption
Total Water (m3) 77,238 76,945 23,964 293 0.4%
Total Wastewater (m3) 77,238 76,945 23,964 293 0.4%
% Change 0.4% 221% ‐
Carbon Emissions
Purchased Gas (tCO₂) 2,934 3,052 1,672 ‐117 ‐4%
Purchased Electricity (tCO₂) 6,134 6,729 2,993 ‐594 ‐8.8%
Total Purchased
Emissions(tCO₂) 9,069 9,780 4,665 ‐712 ‐7.3%
Generated Electricity (tCO₂) 0 0 0 0 ‐
Exported Electricity (tCO₂) 0 0 0 0 ‐
Total Net Emissions (tCO₂) 9,069 9,780 4,665 ‐712 ‐7.3%
% Change ‐7.3% 110% ‐
Combined Energy Cost
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 36
ORPINGTON - CONSUMPTION DATA
The following summary table shows the annual energy and carbon data from 1/10/2013 for
the Orpington hospital only.
Table 17: Orpington Utilities Consumption, Cost and Carbon Emissions from 1/10/20138
8 Water use and costs are not included for 2014-15 due water being provided ‘in gratis’ by the supplier because of a faulty water meter.
ANNUAL ENERGY & CARBON MANAGEMENT REPORT - 1ST APRIL 2015 TO 31ST MARCH 2016
King’s College Hospital NHS Foundation Trust 37
APPENDIX B: COST SAVINGS HISTORIC RECORD – 2014-15
Supplier Date Explanation of cost savings CIP or Cost Saving
Value
Thames Water
Budget accrued from
2014/15 Credit notes
received 19/06/2015
Orpington Hospital Invoiced Water Meter Charges – cancelled invoices Thames water has been unable to provide accurate invoices for water and waste water services at Orpington Hospital since acquisition on 1
st October 2013. In June 2015 Thames water
confirmed agreement with our stance that the trust would not pay any invoices raised over this period. Invoices to the value of £42,825.62 cancelled for the period 1/10/13 to 15/09/2014 by Thames Water by credit note.
Non recurring CIP. Budget to be
maintained going forward
£60,000
£90,000 Non recurring
saving
Thames Water
Avoided costs not invoiced from
16/09/2014 to
1/06/2015
Orpington Hospital Invoiced Water Meter Charges – avoided costsAs the trust was in dispute with Thames Water we requested they cease invoicing King’s until this was resolved. Hence charges of approximately £29,370 were not invoiced to King’s. Thames Water agreed in June 2015 that they would not invoice these costs.
Veolia
Credit note received
23/06/2015
Veolia – credit re monthly invoice errors – refundVeolia were asked to carry out a review of their 2014‐2015 monthly operational invoices as it was felt they had become higher than expected. Errors relating to the overcharge of Ruskin gas and under refunding of the export electricity credit resulted in a credit note of £19,089.71. Credit No 310062821 Received 23
rd June 2015.
Cost Saving (not a CIP)
£19,089
VAT Reclaim
VAT Reclaim on PRUH Gas The finance depart have been reclaiming VAT on the electricity purchased from SSE for the PRUH site. Finance will now reclaim the VAT on the gas purchased from Corona for the SSE energy centre at the PRUH. This is estimated to reduce the gas costs by £67,000 per annum.
CIP – A POD has been completed by
RH.
£67,000
Environment Agency
Carbon Reduction Commitment (CRC) Charge – CIPKing’s is captured by a number of carbon taxes including: CRC, EUETS, Carbon Price support and CCL. We are looking to reduce our CRC charge for phase 2 of the CRC.
CIP/Cost Saving
TBC
Total to July 2015 £176,089
Monthly Unify Staffing Report(August 2016)
5th October 2016Board Meeting
Enc.5.1
Report to: Board Directors
Date of meeting: 5th October 2016
Subject: Monthly Unify Staffing Report (August 2016)
Author(s): Maria Donbavand
Presented by: Paula Townsend
Sponsor: Paula Townsend
History: Monthly Nursing, Midwifery and Care staff numbers to the Board
Status: For Information
Enc.5.1
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. 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: Nursing is a key component in provision of good patient experience and harm free care
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.5.1
This report provides assurance to the Board of Directors on the safety of the Nursing and Midwifery staffing levels across the Trust during August 2016 and provides details of the actual hours of Nursing, Midwifery and Health Care Assistant (HCA) time on day and night shifts versus planned staffing levels.We are also submitting Nursing Hours Per Patient Day (NHPPD) as per Department of Health requirements. The benchmark is still to be agreed but the details of these hours are recorded in appendix 3-4.
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 patient satisfaction and is in line with NICE guidance. This gives us the optimum planned number of staff per shift
• For each of the 76 clinical inpatient areas in August, the actual number of staff as a percentage of the planned number is recorded. The overall figures are shown below.
The report explores in detail where there was a variance of greater than 15% between actual fill rates and planned staffing levels.
Across the Trust, the (combined) average actual level of registered nursing staff was within 15% of the levels planned across all shifts.At Denmark HillIn August there were 21 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 PRUHIn August there were 4 clinical areas where the actual number of Healthcare assistants was more than 115% above the planned level and 6 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 91% 135%
PRUH 95% 100%
Safer Staffing Fill rate - August 2016
SiteDay and Night
Enc.5.1
Summary of Report 2/2
Understaffing• On average across the Trust staffing levels for Registered nurses did not fall below 85% over the month with the exception of a number of wards. The
exception reports at the end of the presentation highlight reasons for this and how the shift was made safe and all are reported on our red shift reportingsystem(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. In total there were 143 Red shifts declared in August. The majority of thesewere at Denmark Hill and associated with increased acuity, vacancies or bank/agency failing to fill the shifts. In each case local managers assess thesituation and make a judgement about whether moving staff from a better staffed areas is required to maintain safety.
Where there are instances of hours exceeding those planned, the reasons particularly in relation to HCAs are as follows:o Extra staff required on an ad hoc basis to “special” high risk/vulnerable patients which has increased o Overseas Nurses awaiting their NMC registration are recorded as unregistered, o HCA usage is increased to minimise the impact of reduced RN fill rateso Where the planned staffing level is only one person, an increase of one member of staff on a few occasions generates a large percentage increase.
In summary the actual number of additional healthcare assistants used is less than the percentage would suggest, usage issubject to controls and is decreasing.
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
No. of Red Shifts between Dec 15 - Aug 16 Denmark Hill
Red
Linear (Red)
0102030405060708090100110120130140150160
Dec‐15 Jan‐16 Feb‐16 Mar‐16 Apr‐16 May‐16 Jun‐16 Jul‐16 Aug‐16
No. of Red Shifts between Dec 15 - Aug 16 PRUH
Red
Linear (Red)
Enc.5.1
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 sitefor August.
RN Day and Night Shift - The overall planned versus actual RN nursing hoursfor August was 9% below plan. This is an increase of 1% compared to theprevious month and is within acceptable limits.
HCA Day and Night Shift - The average overall planned versus actual HCAnursing hours for August was 35% above plan. This is a decrease of 30% fromthe previous month.
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
AVG ‐ RN Day and Night
AVG HCA Day and Night
Over
Under
Planned vs Actual by month ‐ Denmark Hill
Hospital % Against Planned (RNs) Day/NightSt Thomas Hospital 98%Imperial (St Mary's) 97%Kings College Hospital ‐ DH 91%
Safe Staffing levels ‐ taken from NHS choices ‐ 20.09.2016
Enc.5.1
7
Trends and patterns, Nursing hours: Planned Vs. Actual – PRUH
The summary below is based on 30 in-patient wards across the PRUH site inAugust.
RN Day and Night Shift - The overall planned versus actual RN nursinghours for August was 5% below plan. This is a decrease of 1% compared tothe previous month and is within acceptable limits.
HCA Day and Night Shift - The average overall planned versus actual HCAnursing hours for August was as per the plan. This is a decrease of 7% fromthe previous month.
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
% 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 95%
Safe Staffing levels ‐ taken from NHS choices ‐ 20.09.2016
Enc.5.1
Appendix 1Exception Report – Denmark Hill
HCA and RN staffing levels – Lower than Planned - AugustDivision Ward Name Review by HON/Matron/Ward where 15% or more of nursing hours did not meet agreed staffing
levels (Highlighted in red)
CCTD Frank Stansil Critical Care There is currently a HCA vacancy within this ward however patient care is not affected as staff moved around appropriately.
Children's Thomas Cook CCCC Vacancies exist however will be filled for September - staff moved around from other ward to support where required to ensure patient safety is not affected.
Children's DH-The Children's Surgical Ward Additional HCAs required at night.
Haematology ELF & LIBRA Ward The additional HCAs in haem have been used to compensate where RN shifts are unfilled and/ or to special patients
Haematology Derek Mitchell Unit The additional HCAs in haem have been used to compensate where RN shifts are unfilled and/ or to special patients
Haematology Waddington The additional HCAs in haem have been used to compensate where RN shifts are unfilled and/ or to special patients
Liver and Renal Dawson Dawson ward has higher number of HCAs as they use HCA to supplement the RNs due to vacancy and long term sickness. The ward operates moderately safe depending on the acuity of the patients.
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 WilsonHigh rate of specials on day and night shift. Specials team do provide some of the cover but can have 2-3 patients requiring specials at any one time. High RN vacancies which are often filled with bank HCA
Surgery Lister Large vacancy of RN covered at times by CSW. Again CSW increased for specialling.Surgery Coptcoat Ward Opened new 10 bedded unit (Surgical Short Stay Unit) have had to recruit agency nurses.Surgery Twining CSW needed for specialing and cover for Vacancies where possible.
Surgery Katherine Monk Increased need for patients that need specialing by CSW & RMN have vacancies. Having to cover other wards RN vacancy.
TEAM Lonsdale There are currently RN vacancies which could not be filled by Bank however ward operating at safe staffing levels (amber / green) with moves from other ward.
TEAM Byron Ward operating at safe staffing levels (amber) with occasional red shifts. Additional HCA staffing at night to support 1:1 care
TEAM Oliver Small sickness and vacancies however staff were moved around to ensure that patient safety was not affected.
TEAM Marjorie Warren Ward operating at safe staffing levels (amber) with occasional red shifts. Additional HCA staffing at night to support 1:1 care
TEAM Mary Ray Due to unplanned leave/sickness additional HCAs used to support where possible as well as specialling of patients.
Enc.5.1
Appendix 2Exceptions Report – PRUH
HCA and RN staffing levels – Lower than Planned – August
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 Shifts not covered by HCA due to sickness . Shifts assessed individually as to whether NHSP backfilling required to ensure safe staffing
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
Children's Children's Ward Currently awaiting HCA's to start - ward operating safely with regard to number of patients, acuity and staffing levels
LRS Quebec (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.
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.
LRS Surgical Ward 4 There is currently a HCA who is on maternity leave therefore we are only requesting bank shifts depending on the acuity of the patients each day.
Network Hyper Acute Stroke Unit (HASU) Vacancies being recruited to however to ensure patient safety is not affected TIA nurse supports where possible.
Network Ontario (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.
TEAM Medical Ward 7 There are currently HCA vacancies that exist on this ward however staff were moved around to ensure patient safety was not affected.
TEAM Farnborough Ward Lower RN usage at night is due to reduction of beds from 25 - 20 and therefore skill mixed with additional HCAs instead.
Enc.5.1
Appendix 3New Return NHPPD – Denmark Hill
This is calculated by taking the Actual hours of Day and Night combined for each staff type and dividing by the number of patients on the ward at 23:59 – August 2016
Division Ward Name
% Average fill rate
RN - Day
% Average Fill rate HCA - Day
% Average fill rate
RN - Night
% Average Fill rate HCA - Night
Patients at
Midnight 23:59
Registered
midwives/ nurses
Care Staff
Overall CHPPD
No. of Beds
TEAM Annie Zunz 92% 115% 96% 135% 674 6.3 3.3 9.6 28Women's Brunel 97% 98% 99% 103% 465 5.0 2.3 7.3 18TEAM Byron 83% 119% 76% 145% 876 3.6 3.2 6.8 30CCTD Christine Brown CCU 96% 106% 96% 97% 495 24.9 1.5 26.4 17Surgery Coptcoat Ward 71% 165% 97% 172% 416 5.3 2.6 7.9 15Cardiac Cotton 88% 117% 93% 120% 828 3.5 2.0 5.5 26Neuro David Marsden 75% 156% 81% 156% 935 4.0 4.9 8.9 31Haematology Davidson 86% 92% 86% 150% 511 5.4 2.3 7.7 17Liver and Renal Dawson 75% 142% 82% 139% 613 4.0 3.3 7.3 21Haematology Derek Mitchell Unit 85% 179% 98% 203% 430 5.9 3.3 9.2 14Cardiac DH - Coronary Care Unit (Sam Oram) 101% 97% 99% 400% 224 9.5 1.7 11.2 8Children's DH-The Children's Surgical Ward 88% 97% 93% 125% 455 9.0 1.6 10.6 21TEAM Donne 90% 96% 90% 108% 917 3.5 3.1 6.6 30Haematology ELF & LIBRA Ward 84% 93% 92% 111% 503 5.8 2.3 8.1 16Liver and Renal Fisk and Cheere Ward 91% 141% 85% 153% 754 5.6 2.9 8.5 29CCTD Frank Stansil Critical Care 99% 81% 98% 87% 382 25.7 1.6 27.3 30Private Patients Guthrie Ward 88% 94% 101% 103% 480 6.2 1.5 7.7 21Liver and Renal Howard Ward 95% 106% 100% 110% 482 4.8 2.1 6.9 16CCTD Jack Steinberg Critical Care 99% 98% 99% 106% 500 24.0 1.5 25.5 16Surgery Katherine Monk 88% 120% 85% 146% 661 6.5 4.9 11.4 28Neuro Kinnier Wilson 97% 125% 85% 175% 610 4.8 4.2 9.0 20Neuro Kinnier Wilson HDU 94% 109% 98% 100% 341 12.0 1.0 13.0 11Surgery Lister 70% 167% 82% 186% 848 3.4 3.0 6.4 25Liver and Renal Liver Intensive Care Unit 97% 68% 96% 42% 418 29.3 0.7 30.0 19TEAM Lonsdale 80% 95% 79% 111% 751 4.1 2.4 6.5 25TEAM Marjorie Warren 84% 97% 96% 93% 901 3.6 3.1 6.7 30TEAM Mary Ray 90% 126% 61% 130% 894 3.8 3.0 6.8 30TEAM Matthew Whiting Ward 88% 97% 99% 106% 528 4.7 3.1 7.8 21Neuro Murray Falconer 91% 113% 93% 123% 991 4.1 2.5 6.6 31Children's Neonatal Intensive Care Unit 115% 100% 117% 100% 1027 12.5 0.0 12.5 34TEAM Oliver 84% 104% 92% 115% 939 3.7 2.5 6.2 30Children's Paediatric Short Stay 95% 97% 95% 100% 97 14.0 7.0 21.0 6Women's Postnatal William Gilliat 91% 93% 99% 99% 1539 3.3 2.0 5.3 48TEAM R D Lawrence 91% 86% 89% 134% 654 6.5 2.9 9.4 28Children's Rays Of Sunshine 96% 116% 94% 87% 443 8.6 1.6 10.2 19Cardiac Recovery Ward 100% 100% 96% 100% 98 25.3 0.0 25.3 17Cardiac Sam Oram 91% 120% 92% 186% 511 4.4 2.9 7.3 17Neuro The Friends Stroke Unit 95% 100% 98% 102% 798 7.1 3.2 10.3 29Children's Thomas Cook CCCC 72% 74% 71% 39% 239 25.5 1.7 27.2 15Liver and Renal Todd 92% 102% 91% 112% 622 5.6 2.9 8.5 22Children's Toni & Guy 91% 127% 99% 250% 399 9.3 1.5 10.8 15Surgery Trundle 94% 135% 97% 146% 453 5.0 5.6 10.6 16Surgery Twining 84% 112% 85% 161% 806 3.3 3.5 6.8 26Cardiac V&A HDU Ward 99% 96% 98% 93% 322 9.4 1.9 11.3 10Cardiac Victoria & Albert 94% 145% 89% 300% 518 4.5 1.5 6.0 18Haematology Waddington 85% 119% 86% 1200% 279 6.6 2.0 8.6 9
Enc.5.1
Appendix 4New Return NHPPD – PRUH
This is calculated by taking the Actual hours of Day and Night combined for each staff type and dividing by the number of patients on the ward at 23:59 – August 2016
Division Ward
% Averag
e fill rate
RN/RM -Day
% Averag
e Fill rate
HCA - Day
% Averag
e fill rate
RN/RM -Night
% Averag
e Fill rate
HCA - Night
Patients at
Midnight 23:59
Registered midwives/
nurses
Care Staff
Overall CHPPD
No. of Beds
LRS Boddington (ORP) 96% 84% 121% 69% 432 5.2 2.5 7.7 24Network Chartwell Unit 99% 100% 99% 100% 359 5.9 3.0 8.9 12Children's Children's Ward 98% 56% 101% 9% 258 9.0 0.8 9.8 12TEAM Darwin 1 (S1) 89% 102% 102% 133% 618 3.6 5.3 8.9 20TEAM Darwin 2 (S2) 101% 105% 100% 116% 614 3.5 5.3 8.8 20TEAM Emergency Assessment Unit (EAU) 96% 105% 98% 96% 702 5.9 3.6 9.5 28TEAM Farnborough Ward 99% 187% 81% 285% 632 4.1 3.8 7.9 20Neuro Frank Cooksey 105% 100% 98% 99% 457 4.2 4.9 9.1 15Network Hyper Acute Stroke Unit (HASU) 100% 80% 90% 93% 381 10.6 3.2 13.8 20CCTD Intensive Care Unit 103% 67% 98% 58% 252 25.2 2.0 27.2 10Women's Maternity Unit (PRU) 96% 95% 93% 100% 671 5.0 2.6 7.6 30TEAM Medical Ward 1 98% 111% 99% 102% 339 6.4 4.5 10.9 12TEAM Medical Ward 2 99% 100% 99% 110% 607 3.5 3.1 6.6 20TEAM Medical Ward 3 93% 95% 90% 95% 616 3.8 4.0 7.8 20TEAM Medical Ward 4 91% 92% 99% 101% 643 3.6 3.7 7.3 20TEAM Medical Ward 6 99% 124% 100% 133% 614 3.5 3.8 7.3 20TEAM Medical Ward 7 99% 100% 99% 76% 616 3.4 3.1 6.5 20Cardiac Medical Ward 8 97% 95% 95% 105% 601 3.6 2.3 5.9 20TEAM Medical Ward 9 92% 88% 98% 97% 732 5.6 3.6 9.2 28Network Ontario (ORP) 102% 73% 92% 115% 536 3.2 3.0 6.2 20Cardiac PRUH - Coronary Care Unit (CCU) 94% 100% 94% 300% 348 6.9 0.1 7.0 12LRS Quebec (ORP) 46% 42% 29% 38% 104 6.9 4.3 11.2 19Children's Special Care Baby Unit 94% 62% 92% 38% 206 9.5 1.6 11.1 12Network Stroke Unit 100% 94% 86% 109% 785 3.2 2.7 5.9 20LRS Surgical Ward 3 98% 98% 99% 102% 446 5.4 3.1 8.5 20LRS Surgical Ward 4 101% 97% 98% 68% 406 4.3 2.7 7.0 14LRS Surgical Ward 5 97% 92% 103% 100% 800 3.9 2.1 6.0 28LRS Surgical Ward 6 94% 108% 102% 102% 552 4.4 2.7 7.1 20LRS Surgical Ward 7 99% 95% 96% 100% 816 3.8 3.4 7.2 28Women's Surgical Ward 8 97% 98% 96% 112% 397 5.8 2.8 8.6 16
Enc.5.1
This page has been left blank
Finance Report
Month 05 (August) 2016/17
Board of Directors
05 October 2016
Page 2 of 28
Enc. 6.1
Report to: Board of Directors
Date of meeting: 05-Oct-16
Subject: Finance Report – Month 05
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 Board of Directors is asked to approve the Finance Report
Enc. .
Page 3 of 28
Enc. 6.1
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 4 of 28
Enc. 6.1
Page
Key Messages 5
Summary 6
Month 2 Surplus / (Deficit) £k 7
Income 8
Operating Expenditure 9
Run Rate 10
16/17 Annual Plan Budget Phasing 11
Cost Improvement Plans 12
16-17 CIP Programme Delivery Summary (£71M) 13
PMO CIP Green Phasing 14
Cash 15
13 Week Cash Flow Forecast 16
Statement of Financial Position (Balance Sheet) 17
Aged Debtors 18
Debtors Detail 19
Bad Debt Provision 20
Capital 21
Agency Run Rate 22
Agency Cap 23
Whole Time Equivalents 24
Income by Commissioner Contract 25
Income Activity Analysis 26
Surplus / (Deficit) (By Division) 27
Contents
Enc. 6.1
Income and Expenditure
1
2
3
4
5
6
7
Cash
8
Capital
9
At month 5 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).
The CIP adverse variance mainly relates to the FYE of 15/16 schemes (£2.8m) in 16/17; a combination of pay and non-pay schemes related to proposed ward
closures and Procurement schemes. The Trust has currently identified £45.2m PMO Green schemes for implementation and potential mitigation schemes of
£3.7m against the £51.5m target for new schemes in 16/17.
NHSI have acknowledged elements of the deficit is due to external factors. The Trust is currently developing a financial recovery plan to reduce the deficit
position.
The Trust has drawn down £4.5m against its Working Capital Facility (WCF) in August and a further in £18.1m drawdown in September in order to maintain a
minimum cash balance of £3m.
The total value of the Working Capital Facility drawndown as at Month 5 2016/17 will be £73.9m (82%) 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 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 £6.5m against planned YTD spend at month 5 of £16.5m 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 £12.5m
The run rate was averaging a monthly deficit of £10.8m in Q1. The deficit in M04 was £8.8m and £9.7m in M05, the increase in M05 rate is largely due to August
being a lower activity month. This was expected and has been factored into the income plan phasing. The NHSI agency cap for the Trust year to date was £12.5m
and the Trust has spent £17.6m with increases predominately in medical and nursing staff categories.
The Trust’s cumulative operating deficit at month 5 is £50.845m. This is an adverse variance of £24.854m against the year to date planned deficit of £25.991m.
These figures exclude the estimated impairment costs of £4.292m to date.
The key cumulative variances at month 5 relate to:
The month 5 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 £12.5m in M5. The trust will not acheive the control total set by NHSI
and will not receive any of the £30m (STP)
NHS Clinical Contract activity income – adverse by £6.5m
Cost Improvement plans - adverse variance of £2.8m
Key Messages
Page 6 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Summary
Surplus / (Deficit) £k R Income £k R Operating Expenditure £k R
Plan Actual Variance Plan Actual Variance Plan Actual Variance
Year to Date £k (25,990) (50,845) (24,854) Year to Date £k 456,853 440,973 (15,880) Year to Date £k (456,836) (465,709) (8,873)
Run Rate £k R Cost Improvement Plans £k R Capital £k R
M1
Actual
M2
Actual
M3
Actual
M4
Actual
M5
Actual Plan Actual Variance Plan Actual Variance
Income £k 84,780 88,734 91,167 89,319 86,973 Year to Date £k 18,643 15,820 (2,823) Year to Date £k 16,000 10,066 5,934
Pay £k (52,174) (52,918) (54,465) (52,377) (54,105)
Non-Pay £k (45,297) (44,903) (47,299) (45,718) (42,564)
Deficit £k (12,690) (9,087) (10,597) (8,776) (9,696)
Cash £k R Key Risks R Mitigating Actions R
Plan Actual Variance
Year to Date £k 20,815 14,863 (5,952)
The Trust is reporting a £50.8m deficit at the end of M05 against a planned deficit of £26.0m resulting in a £24.9m adverse YTD variance. Following recent guidance from NHSI the trust is not acheiving its financial control total year to date so we are unable
to reflect any of the STF in our numbers, this is £12.5m of the YTD adverse variance.
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 £10.2m.
The programme overall achieved 85% of its YTD target with the flow through
element achieving 78% and the new schemes achieving 96%. The CIP
programme as at M5 has had a total scheme slippage of £2.8m against target
(15%) of which £332k is slippage against procurement schemes which have
failed from the flow through from 15-16. The remaining slippages are a
combination of failed schemes in income, delayed implementations, failed
recruitment and ward escalation beds remaining opened.
1.
Mitigating CIP schemes totaling £7m of which 2 schemes are dependant on NHSI
capital funding approval (Finance Leases and Windsor Walk) with a net benefit of
£4m.
2. Implementing operational plans to acheive growth and RTT activity
3. Reduce agency spend through recruitment plans, master vendor suppliers to
control agency rates and increased use of bank staff.
The run rate worsened by £0.9m compared to M4. Income worsened by £2.3m in month
mainly in off tariff drugs and devices. Pay run rate worsened by £1.7m mainly in
substantive admin pay (R&D staff costs offset by income). Medical pay also increased in
M04 mostly due to additional anaesthetics medical costs. Nonpay improved by £3m,
£2.5m is to the medirest CIP.
1. CIP achievement £51.5m new and £21m flow through. £56.3 approved
'greened' schemes to date (week ending 12/08/16)
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 spend
5. Cash flow impacting on operational delivery
6. Income - the following have not yet been applied - agreed data challenges,
marginal rates on cost and volume lines for BMT & NICU, MRET adjustment,
gain share adjustment calculated on actual outsourced pharmacy savings, other
high cost drugs Gain Share Savings (TBA) and CQUIN (Quarterly performance)
which will drive down the over-performance
Month 5 is based on Month 4 spell/FCE activity and pro-rata for Month 4.
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.
The Trust is reporting a £50.8m deficit at the end of M05 against a planned deficit of
£26.0m resulting in a £24.9m adverse YTD variance.
In respect to NHS clinical contract income : Off-tariff drugs and devices over-performance
of £6.3m YTD; are being offset by activity income underperformance of £6.5m YTD.
Pay is £0.6m underspent at the end of M05.
Nonpay is over spent due to off-tariff drugs and devices over performance which is mostly
offset by income. The trust is not acheiving its financial control total year to date so we
are unable to reflect any of the STF funding in our numbers, this is £12.5m of the YTD
adverse variance.
Pay is £0.6m underspent at the end of M05 including £1.9m of CIP slippage
(15/16 flow through). Admin and Clerical pay is underspent due to a number of
vacancies. This is partly offset by medical pay which is overspent due to
backdated banding payments and increased locum expenditure (covering
vacancies and on call) mainly in Orthopaedics,Urology and Neuroscience.
Nonpay is over spent due to off-tariff drugs and devices over performance which
is mostly offset by income. There is £518k of CIP slippage in M05 (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 5 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 £4.531m against its Working Capital Facility in August and a
further in £18.1m drawdown is planned for September in order to maintain a cash balance
of £3m.
The total value of the Working Capital Facility drawndown as at Month 5 2016/17 will be
£73.9m (82%) 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.
Page 7 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Surplus / (Deficit) £k R
YTD Plan YTD Actual
YTD
Variance
Mvnt in
Month
£k £k £k £k
Surplus / (Deficit) (25,990) (50,845) (24,854) (5,988)
YTD Plan YTD Actual
YTD
Variance
Mvnt in
Month
£k £k £k £k
Income 456,853 440,973 (15,880) (3,366) £12.5m of the YTD variance relates to STF (£2.5m in month)
Pay (266,634) (266,039) 595 (697) Underspent mainly in admin and clerical pay
Non-Pay (190,201) (199,669) (9,468) (1,788) Off-tariff drugs and devices over performance which is mostly offset by income
EBITDA * 17 (24,736) (24,753) (5,851)
EBITDA % 0.0% -5.6%
Profit/Loss on Disposal of Fixed Assets (42) 13 55 20
Interest Payable (12,218) (12,371) (152) (158)
Interest Receivable 55 51 (4) 4
Depreciation (10,993) (10,992) 0 (3)
Impairments (4,292) (4,292) 0 0
Public Dividend Capital (2,810) (2,810) 0 0
Net surplus/(deficit) (30,282) (55,136) (24,854) (5,988)
Reverse Impairment 4,292 4,292 0 0
Performance against Control Total (25,990) (50,845) (24,854) (5,988)
Total (25,990) (50,845) (24,854) (5,988)
Surplus/(Deficit) % -5.7% -11.5%
* EBITDA Earnings before Interest, Taxation, Depreciation and Amortisation
The Trust is reporting a £50.8m deficit at the end of M05 against a planned deficit of £26.0m resulting in a £24.9m adverse YTD variance. The current month position is a £5.9m adverse variance.
In respect to NHS clinical contract income : Off-tariff drugs and devices over-performance of £6.3m YTD; are being offset by activity income underperformance of £6.5m YTD. Also overseas visitor income is adverse as well as
misc operating income which are partly off-set by additional R&D and RTA income. The trust is not acheiving its financial control total year to date so we are unable to reflect any of the STF in our numbers, this is £12.5m of
the income variance.
Pay is £0.6m underspent at the end of M05 including £1.9m of CIP slippage (15/16 flow through). Admin and Clerical pay is underspent due to a number of vacancies. This is partly offset by medical pay which is overspent due
to backdated banding payments and increased locum expenditure (covering vacancies and on call) mainly in Orthopaedics,Urology and Neuroscience.
Nonpay is over spent due to off-tariff drugs and devices over performance which is mostly offset by income. There is £518k of CIP slippage in M05 (15/16 flow through)
See Appendix 3 for Divisional and Corporate Analysis.
(15,000)
(10,000)
(5,000)
-
5,000
10,000
15,000
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
Oct
-16
No
v-1
6
Dec
-16
Jan
-17
Feb
-17
Mar
-17
£k
Deficit by Month 2016/17 Net Operating Deficit Actuals Net Operating Deficit Plan
Page 8 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Income R
YTD Plan YTD Actual YTD Variance
Mvnt in
Month
£k £k £k £k
Total Income 456,853 440,973 (15,880) (3,366)
YTD Plan YTD Actual YTD Variance
Mvnt in
Month
£k £k £k £k
Commissioning Contract Income 327,004 323,117 (3,887) 1,260
NHS Acute: Drugs - Non Tariff 42,246 47,034 4,788 58
NHS Acute: Devices - Non Tariff 5,532 7,057 1,526 (205)
Other Clinical Income 2,349 (217) (2,566) (370) Prior year adjustments (estimate v actual variances) and patient data challenges.
NHS Clinical Contract Income Total 377,131 376,990 (141) 743
RTA Income 1,875 2,083 208 (213)
Other NHS Clinical Income 2,363 1,809 (555) (191) Provider to Provider income not recovered as per last year (e.g. Fetal Medicine service).
Private Patient Income 6,349 6,485 135 (162)
Overseas (Reciprocal & Non-Reciprocal) 3,132 2,686 (446) 95 Plans in place to recover prior months activity as patient identification systems are improved.
Education & Training Income 19,664 19,441 (223) (142)
Research & Development Income 5,448 5,679 232 (546)
Other Operating Income 40,890 25,800 (15,090) (2,949)
Total Trust Income 456,853 440,973 (15,880) (3,366)
In respect to NHS clinical contract income : Off-tariff drugs and devices over-performance of £6.3m YTD; are being offset by activity income underperformance of £6.5m YTD. The trust is not acheiving its financial control total
year to date so we are unable to reflect any of the STF in our numbers, this is £12.5m of the income variance.
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.
STF allocation not recovered £12.5m and urology theatre recharges no longer recoverable (£1.2m FYE).
CCG funding support for wards - M4 (Bromley CCG) no longer funded.
80,000
85,000
90,000
95,000
100,000
105,000
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
Oct
-16
No
v-1
6
Dec
-16
Jan
-17
Feb
-17
Mar
-17
£k
In Month Income 2016/17 Actual Plan
Page 9 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Operating Expenditure R
YTD Plan YTD Actual
YTD
Variance
Mvnt in
Month
£k £k £k £k
Pay (266,634) (266,039) 595 (697)
Non-Pay (190,201) (199,669) (9,468) (1,788)
Operating Expenditure (456,836) (465,709) (8,873) (2,485)
YTD Plan YTD Actual
YTD
Variance
Mvnt in
Month
£k £k £k £k
Pay
Nursing & Midwifery (104,273) (105,073) (801) (534) CIP not being achieved. TEAM follow through CIPS from prior year (wards not closed).
Medical & Dental Staff (84,325) (85,395) (1,069) (472) Agency spend up and backdated banding payments.
Administration & Clerical / Senior Managers (44,111) (42,174) 1,936 120 Holding vacancies.
PAMS / Scientific / Professional (33,926) (33,397) 529 189 Holding vacancies.
Total Pay (266,634) (266,039) 595 (697)
Non-Pay
Drugs (incl. Medical Gases) (56,425) (60,645) (4,221) (1,450) Off -tariff drugs increase, QIPP/CIP review and revenue capture review.
Supplies & Services - Clinical (40,122) (42,488) (2,366) (351) Off -tariff devices increase, CIP non-achievement and also stock levels to be reviewed.
Supplies & Services - General (1,569) (1,784) (215) (3)
Establishment Expenses (2,542) (2,296) 246 (82)
Transport Expenses (3,780) (3,219) 561 101
Premises (15,897) (15,764) 133 (333)
Purchase of Healthcare from Non-NHS Provider (13,264) (14,229) (965) (45) Independent sector and Pathology service. Projected to under-spend by year end.
Services from other NHS Bodies (23,267) (23,294) (27) 38
Consultancy (5,634) (5,973) (339) (611)
Private Finance Initiative (20,985) (20,618) 367 247 Favourable due to VINCI costs being transferred out of PRUH revenue into Capital
Other Non-Pay/Reserves (6,717) (9,359) (2,642) 701 Bad debt provision increase from prior year (£3.2m) and current year impact.
Total Non-Pay (190,201) (199,669) (9,468) (1,788)
Total Expenditure (456,836) (465,709) (8,872) (2,485)
Pay is £0.6m underspent at the end of M05 including £1.9m of CIP slippage (15/16 flow through). Admin and Clerical pay is underspent due to a number of vacancies. This is partly offset by medical pay which is
overspent due to backdated banding payments and increased locum expenditure (covering vacancies and on call) mainly in Orthopaedics,Urology and Neuroscience.
Nonpay is over spent due to off-tariff drugs and devices over performance which is mostly offset by income. There is £518k of CIP slippage in M05 (15/16 flow through)
Page 10 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Run Rate R
Apr-16 May-16 Jun-16 Jul-16 Aug-16
£k £k £k £k £k
Deficit (13,548) (9,945) (11,455) (9,634) (10,554)
Impairment 858 858 858 858 858
Operating Deficit (12,690) (9,087) (10,597) (8,776) (9,696)
Apr-16 May-16 Jun-16 Jul-16 Aug-16
£k £k £k £k £k
Income 84,780 88,734 91,167 89,319 86,973
Pay
Administration & Clerical / Senior Managers Agency (717) (743) (648) (692) (790)
Bank (223) (230) (272) (259) (258)
substantive (7,310) (7,288) (7,339) (7,308) (8,097)
Medical & Dental Staff Agency (870) (1,104) (1,440) (1,290) (1,329)
Bank (384) (486) (513) (438) (508)
substantive (15,325) (15,620) (15,462) (15,100) (15,526)
Nursing & Midwifery Agency (878) (872) (963) (1,099) (1,090)
Bank (2,409) (2,295) (2,572) (2,577) (2,620)
substantive (17,557) (17,336) (17,872) (17,441) (17,493)
PAMS / Scientific / Professional Agency (343) (762) (849) (570) (548)
Bank (190) (158) (246) (196) (194)
substantive (5,967) (6,023) (6,290) (5,408) (5,652)
Total Pay (52,174) (52,918) (54,465) (52,377) (54,105)
Non-Pay
Drugs (12,631) (11,848) (12,384) (12,273) (11,509)
Supplies & Services - Clinical (8,819) (8,412) (9,420) (7,621) (8,217)
Non-Clinical Supplies (4,512) (4,704) (4,497) (4,248) (5,102)
Purchase of Healthcare from Non-NHS Provider (2,355) (2,651) (3,043) (3,008) (3,172)
Services from other NHS Bodies (4,601) (4,597) (4,837) (4,673) (4,586)
Consultancy (626) (798) (1,195) (1,849) (1,504)
Private Finance Initiative (4,716) (4,609) (4,701) (4,720) (1,874)
Other Non-Pay/Reserves (1,784) (2,030) (1,962) (2,094) (1,489)
Total Non-Pay (40,044) (39,649) (42,038) (40,486) (37,453)
Total Financing (6,111) (6,111) (6,118) (6,090) (5,969)
Deficit (13,548) (9,945) (11,455) (9,634) (10,554)
Impairment 858 858 858 858 858
Operating Deficit (12,690) (9,087) (10,597) (8,776) (9,696)
Non Recurrent Items
Non Recurrent PRUH Financial Support (700) (700) (700) (700) (700)
Non Recurrent CIPs (60) (154) (436) (530) (547)
Total Non Recurrents (760) (854) (1,136) (1,230) (1,247)
Underlying Run Rate Deficit (13,450) (9,941) (11,733) (10,006) (10,943)
The underlying deficit for 15/16 was £118m which equates to a monthly run rate deficit of circa £10m. The phasing of the CIPs should improve this run rate and reduce the deficit position. The run rate
worsened by £0.9m compared to M4. Income worsened by £2.3m in month mainly in off tariff drugs and devices. Pay run rate worsened by £1.7m mainly in substantive admin pay (R&D staff costs offset
by income). Medical pay also increased in M04 mostly due to additional anaesthetics medical costs. Nonpay improved by £3m, £2.5m is to the medirest CIP.
Month 1 income was potentially understated and month 2 overstated due to activity recording errors and the average run rate of £8.2m is reflective of quarter 1 (prior year run rate average was £10m).
Page 11 of 28
Enc. 6.1
Finance Report Month 05 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
Themes
Income 87,182 91,092 94,447 93,778 89,375 95,465 99,502 96,321 89,287 95,092 92,827 96,553 1,120,922
Pay (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 20,753
16/17 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 1-3
The 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 12 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Cost Improvement Plans R
Year to Date Plan Actual Variance
£k £k £k
Cost Improvement Plans 18,643 15,820 (2,823)
Year to DatePlan Actual Variance
£k £k £k
Themes
Income
NHS Commissioner (NHSE) 1,041 905 (136)
NHS Commissioner (CCG) 304 293 (12)
NHS Provider to Provider 170 170 (0)
Private Patient 501 333 (168)
Other Operating 569 474 (95)
Research And Development 0 0 0
Training & Education 17 17 0
Total Income CIPs 2,601 2,191 (410)
Pay
Administrative and Clerical Staff Reduction 1,653 1,618 (35)
Medical Staff Reduction 392 375 (16)
Nursing Staff Reduction 2,855 1,894 (961)
Prof & Tech/PAMS/Other Reduction 1,127 1,122 (5)
Procurement 181 259 77
Recruitment - Agency Reduction 922 409 (513)
VAT 24/7 Payroll Service 687 684 (3)
Nurse Rotas 529 283 (247)
Vacancy Freeze 218 122 (96)
Theatre Savings 235 235 0
Reducing Clinical Services 1 1 0
Medical Job Planning 498 402 (96)
Total Pay CIPs 9,299 7,404 (1,895)
Non-Pay
Capital 4 4 1
Clinical Supplies and Services 843 773 (70)
Contracting Services Out 6 6 (0)
Drugs 813 813 0
Establishment Expenses 148 111 (37)
External Contract staffing and Consultants 333 333 0
General Supplies and Services 678 781 103
Miscellaneous 474 409 (64)
Non-Clinical Spend Reduction 81 81 0
Premises and Fixed Plant 895 895 (0)
Reserves 0 0 0
Reducing Services 96 87 (9)
Services Provided by non-NHS bodies 703 712 9
Sub Contracted Healthcare - NHS bodies 301 301 0
Transport and Moveable Plant 127 127 0
Procurement 1,243 793 (451)
Total Non-pay CIPs 6,743 6,225 (519)
Efficiency Plan Total 18,643 15,820 (2,823)Divisions YTD Plan Actual Variance
£k £k £k
Ambulatory 2,439 2,399 (40)
CCTD 3,484 3,460 (24)
Pathology 0 0 0
TEAM 3,098 1,628 (1,471)
LRS 1,688 1,145 (542)
NWS 2,857 2,336 (521)
W&C 1,669 1,640 (29)
Facilities 874 874 (0)
Corporate 2,534 2,339 (196)
Efficiency Plan Total 18,643 15,820 (2,823)
The programme overall achieved 85% of its YTD target with the flow through element achieving 78% and the new schemes achieving 96%. The CIP programme as at M5 has had a total scheme slippage of £2.8m against target (15%) of which £332k is slippage
against procurement schemes which have failed from the flow through from 15-16. The remaining slippages are a combination of failed schemes in income, delayed implementations, failed recruitment and ward escalation beds remaining opened.
Page 13 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 16-17 Programme Delivery Summary (£71M) R
Plan Actual Variance
£k £k £k % Achievement
In Month 4,443 3,765 (678) 85%
Year To Date 18,643 15,820 (2,823) 85%
The information on this report includes all schemes sent across to finance as at 26/08/2016. The programme has converted more schemes since that time so the numbers will not reconcile against the weekly KPI report.
The programme in M5 slipped by £0.7M. Overall the programme is achieving 85% of its YTD target with the flow through element achieving 78% and the new schemes achieving 96%. The in month achievement was 85%.
The CIP programme as at M5 has had a total scheme slippage of £2.8M against target (15%) of which £2.5M is slippage from the flow through and £332k is slippage from the new schemes.
The total slippage is made up of Income (£410k), Pay (£1,895k) and Non pay (£518k).
The key themes on YTD slippage are a combination of failed schemes in income; Private Patient and Overseas Visitors – £153k, delayed implementations , failed recruitment implementation relating to agency reduction (TEAM) and
wards/escalation beds remaining opened.
The key themes for in month slippage are failed implementation of ward closure at the PRUH (TEAM) and Chartwell and a delayed implementation of compensation recovery optimisation which is expected to recover from Q3.
Page 14 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 PMO Green Phasing R
M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 Total
Income 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 223 202 419 544 581 601 552 578 532 603 664 4,542 10,040
Pay 304 281 348 589 684 639 743 794 836 909 912 1,620 8,660
Non Pay 490 753 786 950 1,186 6,637 1,760 1,778 1,906 1,906 1,935 6,436 26,522
Total: 1,017 1,236 1,553 2,083 2,451 7,877 3,054 3,151 3,274 3,418 3,511 12,598 45,223
3,447 3,535 3,679 4,314 4,638 9,768 4,304 4,377 4,382 4,396 4,426 14,710 65,976
A total of £66M has been signed off as ‘PMO Green’ from the programme as at the 16th September 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. £5.8M 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 6.
16/17 PMO Green Phasing
15
-16
FY
E
Sch
em
es
16
-17
Ne
w
Sch
em
es
Grand Total:
Original
Revised
0
2000
4000
6000
8000
10000
12000
14000
16000
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 15 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Cash R
Year to Date Plan Actual Variance
£k £k £k
Cash Balance 20,815 14,863 (5,952)
Year to Date Plan Actual Variance
£k £k £k
EBITDA (3,395) (7,619) (4,224)
Movement in Working Capital (4,418) (9,000) (4,582)
Provisions (867) 96 963
Cash flow from Operations (8,680) (16,523) (7,843)
Capital Expenditure (5,576) (2,229) 3,347
Cash Receipt from Asset Sales 0 0 0
Other Cash Flows from Investing Activities 11 15 4
Cash Flow before Financing (14,245) (18,737) (4,492)
PDC Received 0 0 0
PDC Repaid 0 0 0
Dividends Paid 0 0 0
Interest on Loans and Leases (1,959) (2,018) (59)
Drawdown of Debt 17,166 4,531 (12,635)
Repayment of Debt (325) (325) 0
Other Cash Flows from Financing Activities 0 0 0
Cash Flow from Financing 14,882 2,188 (12,694)
Net Cash Inflow/(Outflow) 637 (16,549) (17,186)
Opening Cash Balance 20,178 31,412 11,234
Closing Cash Balance 20,815 14,863 (5,952)
The Trust has drawn down £4.5m against its Working Capital Facility in August and a further in £18.1m drawdown is planned for September in order to maintain a cash balance of £3m. This will bring the total
value drawndown against the Working Capital Facility to £73.9m (82% 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 5 was £1.6m below plan due to delay in capital plan approval and NHSI capital funding not yet agreed.
Page 16 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Rolling Cash Flow (13 Week) R
Week ending 09-Sep-16 16-Sep-16 23-Sep-16 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
Actual Forecast 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 33,185 28,683 60,351 17,866 14,957 33,733 68,292 30,438 (3,774) 13,813 2,254 19,884 (14,783)
Receipts (inflows)
LSB receipts 0 0 0 0 27,470 0 0 0 27,470 0 0 0 27,470
SLA receipts 138 12,401 0 1,213 146 13,653 0 0 146 0 13,653 0 146
Patient SLA Over performance 2014/2015 0 0 0 0 0 0 0 0 0 0 0 0 0
Patient SLA Overperformance 2015/2016 0 0 0 0 0 0 0 0 0 0 0 0 0
Private Patients receipts 116 300 300 300 300 300 300 300 300 300 300 300 300
Training & Education receipts 0 0 0 0 0 0 0 0 0 0 10,250 0 0
NHSE Inflows 0 32,489 0 0 0 30,279 1,758 0 0 0 31,689 0 0
DoH - National RTT, ED Monies & Project Diamond 0 0 0 0 0 0 0 0 0 0 0 0 0
VAT reclaims 2,297 0 0 0 3,480 0 0 0 4,000 0 0 0 4,000
Other 1,277 4,792 340 3,643 1,213 2,695 1,060 785 390 540 2,587 340 390
Total Receipts 3,828 49,982 640 5,156 32,609 46,927 3,118 1,085 32,306 840 58,479 640 32,306
Payments (outflows)
Pay monthly (incl Pay Awards) 165 0 24,375 0 70 0 0 24,375 0 70 0 24,375 0
PAYE/NIC/SUPER (CHAPS) 0 20,320 0 0 0 0 20,075 0 0 0 20,075 0 0
Agency Spend 1,779 1,340 1,234 1,332 1,161 1,398 1,300 1,300 1,300 1,300 1,300 1,300 1,300
PFI project 0 0 4,100 0 4,300 0 4,100 0 4,300 0 4,100 0 4,300
Trade Creditors 5,052 5,429 5,175 5,435 5,325 5,356 5,325 5,354 5,325 5,375 5,325 5,383 5,325
Other 1,228 7,718 7,609 1,013 2,480 4,955 9,764 1,270 2,080 4,706 9,764 1,050 2,080
Total Payments 8,224 34,807 42,493 7,780 13,336 11,709 40,564 32,299 13,005 11,451 40,564 32,108 13,005
Cash from operations (4,396) 15,175 (41,853) (2,624) 19,273 35,218 (37,446) (31,214) 19,301 (10,611) 17,915 (31,468) 19,301
Capital & Financing Items
Capital expenditure (outflow) 106 98 1,232 285 497 659 407 2,999 1,714 948 285 3,199 715
PDC Dividends (TDR) (outflow) 0 930 0 0 0 0 0 0 0 0 0 0 0
Revolving Working Capital Facility 0 (18,110) 0 0 0 0 0 0 0 0 0 0 0
Interest Paid on Revolving Credit Facility 0 588 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 0 0
Interest on Loans (outflow) 0 0 0 0 0 0 0 0 0 0 0 0 0
Other (inflow) (600) 0 0 0 0 0 0 0 0 0 0 0 0
Total Capital & Financing 106 (16,494) 632 285 497 659 407 2,999 1,714 948 285 3,199 715
Net Inflow / Outflow (4,502) 31,668 (42,485) (2,909) 18,775 34,559 (37,853) (34,212) 17,587 (11,559) 17,630 (34,667) 18,586
Forecast Balance C/F 28,683 60,351 17,866 14,957 33,733 68,292 30,438 (3,774) 13,813 2,254 19,884 (14,783) 3,803
The rolling cash flow forecasts forward for a 13 week period currently to the 3rd Week of October.
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.
28,683
60,351
17,866 14,957
33,733
68,292
30,438
(3,774)
13,813
2,254
19,884
(14,783)
3,803
(20,000)
(10,000)
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
£'0
00
Forecast Weekly Cash Balance (Before Forecast Drawdown)
Page 17 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Statement of Financial Position (Balance Sheet)
Year to Date 31-Mar-16
Actual Plan Actual Variance Notes
£k £k £k £k
Property, Plant & Equipment 532,001 547,694 527,778 (19,916) 1
Intangible Assets 3,670 3,027 2,708 (319)
Other Assets 11,145 10,950 10,596 (354)
Non Current Assets 546,816 561,671 541,082 (20,589)
Inventories 17,748 19,200 17,180 (2,020)
Trade & Other Receivables 118,917 113,973 133,401 19,428 2
Cash and Cash Equivalents 18,982 20,815 14,863 (5,952) 4
Current Assets 155,647 153,988 165,444 11,456
Trade and Other Payables (151,607) (136,131) (160,842) (24,711) 3
Borrowings (7,960) (74,592) (60,216) 14,376 4
Other Financial Liabilities 0 0 0
Provisions (1,473) (1,613) (1,486) 127
Other Liabilities (10,139) (7,000) (7,835) (835)
Current Liabilities (171,179) (219,336) (230,379) (11,043)
Borrowings (314,651) (312,216) (314,652) (2,436)
Other Financial Liabilities 0 0 0 0
Provisions (5,455) (5,000) (5,455) (455)
Non Current Liabilities (320,106) (317,216) (320,107) (2,891)
TOTAL ASSETS EMPLOYED 211,178 179,107 156,040 (23,067)
Financed by:
Public Dividend Capital (223,838) (223,838) (223,838) 0
Retained Earnings 109,055 141,124 164,193 23,069
Revaluation Reserve (96,395) (96,393) (96,395) (2)
TOTAL TAXPAYERS' EQUITY (211,178) (179,107) (156,040) 23,067
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.
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 to performance invoice issued to NHSE and one off invoice (£3.12m) invoiced to Compass Group
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.
4. The differences in Cash and Borrowings are due to £6.9m received from NHSE for the difference in the 16/17 Contract value and expected drawdown of capital funding which has not been approved.
Year to Date
Page 18 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Aged Debtors
Invoiced Debtors Within
Terms
1 Month
Overdue
2 Month
Overdue
3 Month
Overdue
Total Current
Month Prior Month Notes
Other Receivables
Notes
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 £k
CCG's/NHSE 12,505 4,768 1,094 4,946 23,313 10,808 11,076 1 Accrued Income
Trusts 607 810 897 4,824 7,138 6,531 6,485 2 Work in Progress 17,750 20,015
Other NHS 160 204 445 621 1,430 1,270 1,508 CCG/NHSE SLAs 3 1,990 1,662
Other Debtors 7,209 2,934 1,034 11,186 22,363 15,154 14,532 Injury Cost Recovery Fund 3,047 2,438
Private Patients 851 454 215 2,277 3,797 2,946 3,434 NHSE Drugs Accrual 4 5,385 3,409
Overseas Visitors 377 834 292 8,386 9,889 9,512 8,759 Clinical Income accrual 6,771 16,246
Total Invoiced Debtors 9,874 9,315 4,782 31,697 67,930 46,221 45,794 KIFM 5,194 -
Other 9,259 3,482
Provision for Bad Debts (Incl. RTA Provision) (10,894) Total Accrued Income 49,396 47,252
Accrued Income 49,396
Prepayments 6,932
Other Debtors 18,304
Total Trade & Other Receivables 131,668
The Trust debtors are mixture of invoiced debtors, accrued income and prepayments. The level of invoiced debtors' balance has increased by £12.2m and Private and Overseas Patients' balance has
remained relatively the same at the end of the month. Overdue debts (those >30 days old) have increased by £0.2m.
1. CCG's/NHSE - Outstanding debt has increased by £8.3m due to Overperformance and clinical excellence awards Invoices outstanding against NHSE. Debts over 30 days old has decreased by £0.3m.
2. Trusts - Outstanding debt from Trusts has decreased by £0.3m. The overdue debt has remained on the same level as previous month.
3. CCG SLA Accruals - Due to the finalisation of SLA contracts with CCG's, income accrual figures are confirmed and are higher than month 4.
4. NHSE Drugs accrual - Monthly accruals relating to months 1-5. Data validation was in progress resulting in increased accrual values. Months 1 to 3 have been invoiced.
Page 19 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Debtor Detail
Organisation Over 30 days
NHS Organisations
NHS England (Central) £6.8m
CCGs £4.1m
NEL CSU (12 CCGs) £0.698m
West Sussex CSU (7 CCGs) £2.108m
Cambridge and Peterborough CCG£0.348m
Slough CCG£0.677m
Guildford & Waverley CCG £0.044m
Bedfordshire CCG£0.219m
NHS Trusts £4.6m
Lewisham and Greenwich NHS Trust £1.336m
Guys & St Thomas NHS Foundation
Trust
£1.711m
Dartford & 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 £3.109m
TOTAL NHS ORGANISATIONS £18.609m
Non-NHS Organisation
Viapath LLP £3.9m
KCH Commercial Services Ltd £3.8m
Kings College London £2.2m
Bromley CIC £1.127m
ISS Mediclean £1m
Sainsburys £0.042m
Councils £0.547m
Resolutions and Follow up
Contracts Department is currently discussing with NHSE regarding backing data for these
invoices
£1.131k relates to Month 2 Freeze data for 2016/17
Issue
£900k relates to IFRs 15/16 - current dispute on how these are being invoiced.
invoice awaiting validation
Brett Ellingham in contracts is discussing with NHSE
£480k relates to Overseas Patients 15/16 debts - specific details required by NHSE
£487k relates to Cancer Drugs Fund for Mar 2016
£356k relates to Month 1 Freeze data for 2016/17
£464k relates to NHS Area Teams NCA data for 2015/16
£2.490m relates to SOFOSBUVIR - APRIL 2016
Disputes relating to the set tariff rates agreed by South East CSU.
KCH owe L&G £6.276m
KCH owe GSTT £5.064m
KCH owe D&G £3.1m
KCH owe Oxleas £3.1m
Neurosciences invoices disputed by M&TW, do not agree that these invoices should be
paid as included in contract. KCH disagree.
KCH owe SLAM £290k
KCH owe KCS Ltd £46k
KCH owe KCL £2.5m
Rental for Beckenham Beacon as well Community Diabetes Service invoices are
outstanding as previously disputed. Payments not being received as Bromley CIC
expecting payment of their outstanding debt (£0.339m)
Relates to various invoices against multiple NHS organisations
KCH owe Sainsburys £5.2m
Challenges relating to patient identifiable data
Challenges raised against 15/16 NCA invoices
Challenges relating to patient identifiable data
CCG unresponsive to chasing debt
Qtr 1 Freeze invoices for 2016/17
Current queries relating to Diagnostics Invoices (percentage of NCA invoices)
Invoice against contract raised in March; invoice still to be approved for payment by ISS
KCH has agreed weekly payments to Oxleas to reduce outstanding balance. No payments
Some accounts in credit, the remainder are reviewing backing data
Credit notes have been raised for 3 CCG's (£1.5m) and payment dates confirmed as
15/9/16.
Credit of £64k raised to close 2013/14 accounts, now reviewing 2014/15 for closure and
finalised payment
Contracts attempting to resolve outstanding challenges, looking to return to SLA contracts
for 16/17. £481k payment made 31.8.16
Contracts to review against PLD for remaining 15/16 invoices
Bedfordshire has raised £10,703k worth of queries against Diagnostics, credit to be raised
payment agreed for 30.9.16
Reciprocal payments agreement in place. KCH payments higher.
Reciprocal payments agreement in place. KCH returning payments to GSTT when received
KCH has agreed weekly payments to D&G to reduce outstanding balance. No payments
Provided data to NHSE and awaiting confirmation from NHSE
Agreed payment date 1.9.16
No queries. NHSE currently reviewing the data
Reciporal payment agreement in place. KCH pay more to KCL weekly
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
Queries on backing data and finalisation of year end figures
NHSE currently reviewing backing data
Periodic reciprocal payments are agreed to reduce this balance.
£515k relates to BEXLEY AND GREENWICH CERVICAL OF 2015 / 16
Queries have been referred to Contracts to provide proof of agreements in place. With
KCH owe Viapath £4.5m
Contracts have been in contact with local CCG for help in resolving ongoing issues
To be referred to Business Analyst to follow up with contract parties.
Payment not being recieved due to outstanding invoices owed to Sainsburys
No payment is being received from KCS Ltd
Page 20 of 28
Enc. 6.1
Finance Report Month 05 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
Provision For Bad Debts : Current Year 244 377 488 913 1,297
Provision For Bad Debts : Prior Year 2,124 2,124 2,124 2,484 2,736
2,368 2,501 2,612 3,397 4,033
23% 28% 28% 35% 41%
M1 16/17
£'000
M2 16/17
£'000
M3 16/17
£'000
M4 16/17
£'000
M5 16/17
£'000
Provision For Bad Debts : Current Year 25 50 75 100 125
Provision For Bad Debts : Prior Year 282 282 282 572 485
307 332 357 672 610
6% 7% 8% 17% 16%
M1 16/17
£'000
M2 16/17
£'000
M3 16/17
£'000
M4 16/17
£'000
M5 16/17
£'000
Provision For Bad Debts : NHS 2,514 2,514 2,514 2,434 2,434
Provision For Bad Debts : Non-NHS 830 830 830 1,112 1,112
3,344 3,344 3,344 3,546 3,546
6% 9% 7% 8% 7%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
Trust Debt
Total Provision
Page 21 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Capital R
Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance
£k £k £k £k £k £k
Major Works 13,346 8,276 (5,070) Major Works 52,344 53,185 841
Minor Works 320 169 (151) Minor Works 2,580 2,580 -
IT (Incl Intangibles) 1,163 984 (179) IT (Incl Intangibles) 8,025 7,002 (1,023)
Medical Equipment 1,171 637 (534) Medical Equipment 8,240 7,756 (484)
Total 16,000 10,066 (5,934) Total 71,189 70,523 (666)
Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance
£k £k £k £k £k £k
Major Works Major Works
Critical Care Unit 6,113 4,935 (1,178) Critical Care Unit 26,205 26,205 -
Cath Lab Developments 388 - (388) Cath Lab Developments 1,295 1,295 -
Helideck 1,550 756 (794) Helideck 1,550 1,550 -
Site Wide Infrastructure - - - Site Wide Infrastructure 1,500 1,500 -
Ruskin Wing - to increase bed capacity 542 62 (480) Ruskin Wing - to increase bed capacity 3,100 3,100 -
ED Additional Bed Capacity 250 59 (191) ED Additional Bed Capacity 2,000 2,000 -
Portakabin enabling - to increase bed capacity 1,202 1,028 (174) Portakabin enabling - to increase bed capacity 1,400 1,400 -
Orpington major works - to increase bed capacity 406 158 (248) Orpington major works - to increase bed capacity 4,100 4,100 -
Other - Denmark Hill 1,392 883 (509) Other - Denmark Hill 5,932 6,613 681
Other - PRUH 777 88 (689) Other - PRUH 2,410 2,410 -
Other - Orpington 726 307 (419) Other - Orpington 2,852 3,012 160
Minor Works 320 169 (151) Minor Works 2,580 2,580 -
IT (Incl Intangibles) 1,163 984 (179) IT (Incl Intangibles) 8,025 7,002 (1,023)
Medical Equipment 1,171 637 (534) Medical Equipment 8,240 7,756 (484)
Total Capital Spend 16,000 10,066 (5,934) Total Capital Spend 71,189 70,523 (666)
Funded by: Funded by:
External Borrowing - - - External Borrowing - - -
Donations (914) (914) - Donations (4,203) (4,203) -
PDC Receipts - - - PDC Receipts (600) (600) -
Depreciation (10,992) (10,992) - Depreciation (26,100) (26,100) -
Total Funding (11,906) (11,906) - Total Funding (30,903) (30,903) -
Internal Cash Funding Requirement 4,094 (1,840) (5,934) Internal Cash Funding Requirement 40,286 39,620 (666)
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 5 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.
Page 22 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Agency Run Rate R
Year to Date Apr-16 May-16 Jun-16 Jul-16 Aug-16
£k £k £k £k £k
A&C Staff/Senior Managers (717) (743) (648) (692) (790)
Medical Staff (870) (1,104) (1,440) (1,290) (1,329)
Nursing Staff (878) (872) (963) (1,099) (1,090)
PAMS/Scientific/Professional (343) (762) (849) (570) (548)
Total Agency Spend (2,808) (3,481) (3,899) (3,650) (3,757)
-
200
400
600
800
1,000
1,200
1,400
1,600
£k
Agency Run Rate A&C Staff/Senior ManagersMedical StaffNursing StaffPAMS/Scientific/Professional
Page 23 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Agency Cap R
NHSI Agency Price Cap Monthly Trend Analysis
Staff group Control breached Dec 2015
(5 wks)
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)
Actual Reported Number of breaches each month
Nursing, Midwifery & HVPrice cap, wage cap and
framework 317 254 494 692 1,379 1,333 1,832 1,874 1,861
HCA and other support Price cap and framework 71 34 37 65 46 46 111 208 177
Medical and Dental Price cap and wage cap 1083 790 1571 1995 1,590 1,747 2,174 2,054 1,938
Sci, Ther & TechnicalPrice cap, wage cap and
framework 82 78 262 304 518 525 724 1,401 1,236
Healthcare science Price cap and wage cap 42 36 129 111 339 302 327 365 86
Admin & EstatesPrice cap, wage cap and
framework 386 354 397 466 365 325 350 1,037 1,159
Total 1981 1546 2890 3633 4237 4278 5518 6939 6457
Breaches as a percentage of bookings
Nursing, Midwifery & HV 14% 13% 20% 22% 52% 54% 61% 65% 66%
HCA and other support 57% 41% 44% 52% 37% 29% 49% 65% 57%
Medical and Dental 62% 56% 92% 89% 81% 98% 93% 95% 96%
Sci, Ther & Technical 5% 4% 19% 19% 35% 36% 40% 81% 77%
Healthcare science 6% 7% 20% 16% 59% 52% 40% 62% 29%
Admin & Estates 31% 28% 27% 22% 21% 18% 16% 54% 59%
Total 29% 24% 38% 36% 50% 52% 53% 72% 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-16
01-Jul-16
01-Nov-16
*Change in cap/reporting
Nov 2016-Jan 2016 Junior Dr cap was 150%, all other staff was 100%
Feb 2016-Marc 2016 Junior Dr cap was 100%, all other staff was 75%
July 2016 wage cap takes effect
Maximum wage rates take effect
The 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
(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.
Monthly Totals
(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
Page 24 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 WTEs R
Year to Date
Budgeted Substantive
Budgeted
Vacancies Bank Agency
Total Staff in
Post
Gap (Budget -
Actuals)
WTE WTE WTE WTE WTE WTE WTE
Ambulatory Services 1,385.4 1,272.5 112.9 28.4 17.8 1,318.6 66.8
Critical care, Theatres and Diagnostics 2,135.5 1,942.8 192.7 112.9 74.2 2,129.9 5.6
Liver, Renal and Surgery 1,788.7 1,576.1 212.6 170.5 64.5 1,811.1 (22.4)
Networked Services 1,603.2 1,389.1 214.1 150.9 60.0 1,600.0 3.3
Trauma, Emergency and Medicine 2,073.0 1,789.7 283.2 193.6 124.4 2,107.7 (34.8)
Women's and Children 1,506.5 1,366.7 139.8 108.9 44.3 1,519.9 (13.4)
Corporate Directorates
Corporate Services 94.5 88.2 6.3 0.0 0.7 88.9 5.6
Executive Nursing 116.4 114.2 2.1 0.5 114.8 1.6
Facilities 152.6 124.7 27.9 3.8 2.6 131.1 21.5
Finance, Procurement and Information 348.1 287.9 60.1 2.1 22.3 312.3 35.8
Human Resources 240.2 242.9 (2.8) 3.4 5.7 252.0 (11.8)
Medical Director 4.9 2.5 2.4 2.5 2.4
Operations 399.6 321.7 77.9 9.6 31.3 362.7 37.0
R&D 122.3 157.6 (35.4) 1.4 2.6 161.6 (39.4)
Strategic Development 8.1 8.2 (0.2) 8.2 (0.2)
Turnaround and Transformation 23.0 19.0 4.0 11.5 30.5 (7.5)
Total Corporate Directorates 1,509.5 1,367.1 142.4 20.9 76.6 1,464.6 44.9
Contract Services 53.0 44.3 8.7 0.9 (1.4) 43.8 9.2
Private Patients and Overseas Visitors 66.1 59.4 6.7 21.9 2.7 84.0 (17.9)
Total WTEs 12,120.9 10,807.7 1,313.3 808.8 463.1 12,079.6 41.4
The Trust is showing a budgeted vacancy level of 1313.3WTEs, of which 080.8 are covered by Bank and 463.1are covered by Agency. This leaves a vacancy gap of 41.4WTEs 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
Page 25 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Income by Commissioner Contract
CommissionerM5 Budget YTD M5 Actual YTD
Block
Adjustment
M5 Variance
YTD
Block 183,809 183,653 156 0
NHS BROMLEY CCG 69,535 70,342 -807 -0
NHS SOUTHWARK CCG 35,382 34,743 638 0
NHS LAMBETH CCG 29,202 28,733 469 0
NHS LEWISHAM CCG 13,142 13,544 -402 -0
NHS BEXLEY CCG 9,808 10,268 -461 -0
NHS GREENWICH CCG 8,297 7,442 855 -0
Kings College Hospital 6,021 6,020 1 0
NHS DARTFORD, GRAVESHAM AND SWANLEY CCG 4,305 4,726 -421 -0
NHS MEDWAY CCG 1,304 1,673 -369 0
Other CCGs 6,814 6,162 652 -0
C&V 178,556 180,638 0 2
LONDON COMMISSIONING HUB (£305.8m excl CQUIN) 127,463 138,573 0 11
LONDON COMMISSIONING HUB (Over-Performance) 11,478 0 0 -11
LONDON COMMISSIONING HUB (IFRs) 333 781 0 0
LONDON COMMISSIONING HUB (Hep C) 3,542 5,427 0 2
LONDON COMMISSIONING HUB (CDF) 2,583 2,583 0 0
NHS ENGLAND LONDON (Dental & Screening) 12,908 12,698 0 -0
NHS CROYDON CCG 8,031 7,975 0 -0
NHS WEST KENT CCG 3,886 3,886 0 0
NHS CANTERBURY AND COASTAL CCG 1,148 1,275 0 0
NHS MID ESSEX CCG 92 961 0 1
NHS ENGLAND SOUTH (SOUTH EAST) 636 564 0 -0
NHS MERTON CCG 475 513 0 0
NHS SWALE CCG 572 483 0 -0
Healthcare Commission for Wales 182 469 0 0
NHS EAST SURREY CCG 406 373 0 -0
NHS NEWHAM CCG 248 273 0 0
NHS SUTTON CCG 199 263 0 0
NHS BASILDON AND BRENTWOOD CCG 128 255 0 0
NHS TOWER HAMLETS CCG 236 254 0 0
NHS WEST ESSEX CCG 80 243 0 0
NHS WALTHAM FOREST CCG 214 232 0 0
NHS NORTH WEST SURREY CCG 298 218 0 -0
NHS HARINGEY CCG 174 209 0 0
NHS CITY AND HACKNEY CCG 253 185 0 -0
NHS RICHMOND CCG 142 184 0 0
NHS HERTS VALLEYS CCG 270 179 0 -0
NHS BARKING AND DAGENHAM CCG 139 143 0 0
NHS ISLINGTON CCG 146 141 0 -0
NHS ENFIELD CCG 155 138 0 -0
NHS BARNET CCG 108 137 0 0
NHS CAMDEN CCG 99 136 0 0
NHS CHILTERN CCG 99 132 0 0
NHS REDBRIDGE CCG 207 118 0 -0
NHS HAVERING CCG 108 112 0 0
NHS NORTH EAST ESSEX CCG 119 103 0 -0
NHS THURROCK CCG 124 85 0 -0
NHS EAST AND NORTH HERTFORDSHIRE CCG 146 79 0 -0
NHS NORTH HAMPSHIRE CCG 20 58 0 0
NHS SOUTH NORFOLK CCG 31 57 0 0
NHS SOUTHEND CCG 73 51 0 -0
NHS CASTLE POINT AND ROCHFORD CCG 82 47 0 -0
NHS BRACKNELL AND ASCOT CCG 15 26 0 0
NHS SURREY HEATH CCG 25 22 0 -0
ESSEX AREA TEAM 0 0 0 -0
Cost & Volume CCGs (Over-Performance) 885 0 0 -1
Local Authority 952 828 0 -0
NCA 5,265 5,481 0 0
NHSE NCA 319 352 0 0
Non-English 429 650 0 0
CQUIN (100%) 7,500 7,500 0 0
Grand Total 376,830 379,103 156 2
Key Income Headlines:
* Block CCGs Over-performance driven by Critical Care activity
* 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.
Page 26 of 28
Enc. 6.1
Finance Report Month 05 2016/2017
Month 5 actuals are based on month 4 flex activity extrapolated using straight-line method. 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. There has been a decrease in elective bed use
and an increase in emergency/tertiary activity in adult on-site bed occupancy in comparison to last year.
Income Activity Analysis
Page 27 of 28
Enc. 6.1
Finance Report Month 05 2016/2017 Surplus / (Deficit) (By Division) R
Year to Date Plan Actual Variance
£k £k £k
Surplus / (Deficit) (25,993) (50,847) (24,854) Key Variances (more details can be found in the appendix 3)
Year to Date Plan Actual Variance
£k £k £k
Ambulatory Services (7,069) (7,106) (37)
Critical care, Theatres and Diagnostics 1,167 737 (430)
Liver, Renal and Surgery (11,091) (18,551) (7,461)
Networked Services (11,877) (12,245) (368) CIP Slippage
Trauma, Emergency and Medicine (13,737) (16,361) (2,624) CIP Slippage and SLR recharges (outliers and escalation beds)
Women's and Children (13,461) (13,431) 30
Corporate Income 22,450 5,848 (16,603) STF
Corporate Services
Capital charges and reserves (4,808) 1,927 6,735
Commercial Services 396 396 0
Corporate Services 8 525 517
Executive Nursing (27) (184) (157)
Facilities (199) 810 1,008
Finance, Procurement & Information (0) 540 540
Human Resources (0) 493 493
Medical Director 0 21 21
Operations 229 595 365
PFI 2,100 2,442 342
R&D (383) (369) 14
Strategic Development 0 30 30
Turnaround and Transformation 27 23 (4)
Corporate Services Total (2,656) 7,247 9,904
Contract Services (MSK, ACU, Pathology Services) 1,536 (2,296) (3,832) Contract Overperformance
Private Patients and Overseas Visitors 4,455 1,022 (3,433) Overseas and PP income underperformance and provision for bad debts (OV)
Surplus / (Deficit) (30,283) (55,137) (24,854)
Impairment 4,290 4,290 0
Operating Surplus / (Deficit) (25,993) (50,847) (24,854)
Clinical income underperformance due to elective cancellations and CIP slippage
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.
Page 28 of 28
Enc. 6.1
This page has been left blank
Enc. 6.2
1 of 2
Report to: Board of Directors
Date of meeting: 5 October 2016
Subject: Summary Record of Finance & Performance Committee Meeting
Presented by: Chris Stooke, Non-Executive Director
Status: For Information
INTRODUCTION
This report provides the Board of Directors with a brief summary of all the key issues considered by the Finance & Performance Committee on 26 September 2016.
STRATEGIES: TOP PRODUCTIVITY We were informed that 4 hour emergency department (ED) target improved from 83.51% reported in July to 88.18% in August which meant that the commissioner agreed trajectory of 87.44% were achieved. However, performance was still short of the 95% national target; The Denmark Hill (DH) site saw increased attendance to ED. Performance on the site is closely dependent on having on flow bed capacity. The options for ED expansion are progressing and a suitable decanting option for services has been identified. This is dependent on securing planning permission; Due to delays in identifying a suitable decanting solution the delivery of the increased capacity option scheduled for Q4 may be delayed into Q1 of 2017/18; The Princess Royal University Hospital (PRUH) performance improved, from 84.5% reported in July to 89.3% in August; The two-week wait suspected cancer referral target was achieved at 93.6%% for August and 94.5% for Q2 to-date compared to the national 93% target; We were pleased to learn that the Trust is achieving cancer performance to date, in almost all areas. The 2 week wait suspected cancer referral target is being achieved at 93.6%% for August and 94.5% against national target of 93% target; The 62-day general practitioner referral for first treatment target is being achieved at 89.8% for August against target 85% target. Breast screening performance is just under 85.9% against target of 90%, this remains at risk for achievement in Q2; and Diagnostics performance improved significantly, it is currently approximately 1.6% against target of 1%. The Trust’s overall compliance score for Q2 (interim position) is currently 3.
FIRM FOUNDATIONS: SOUND FINANCES We noted that the Trust’s financial position is challenging cumulative operating deficit at month 5, was circa £50.8m. This is an adverse variance of circa £24.8m against the year to date planned deficit of circa £25.9m; The key drivers of the adverse position are the Trust not achieving the control total set by NHS Improvements under the sustainability and transformation fund target for Q1 and the loss of the payment associated with achieving the target. The NHS Clinical Contract activity
Enc. 6.2
2 of 2
income underperformed and there was Cost Improvement Programmes (CIP) slippage on agency spend and non-pay cost pressures; To maintain key operational function the Trust has made larger than planned cash withdrawals from the Working Capital Facility being 82% of the full facility to date. The Trust is exploring alternative options on reducing its expenditure and looking to create further savings and efficiencies; and The financial position is a major concern. Committee Chair Chris Stooke, Non-Executive Director
Enc. 6.3
1
Report to: Board of Directors
Date of meeting: 05 October 2016
Subject: Board Assurance Framework
Author(s): Tamara Cowan, Board Secretary
Presented by: Colin Gentile, Chief Financial Officer
Sponsor: Colin Gentile, Chief Financial Officer
History: Quality & Governance Committee on 16 September 2016 Audit Committee on 22 September 2016
Status: For Report/Discussion 1. Overview The quarterly review of the Board Assurance Framework (BAF) was undertaken in September. The gross and net risks as well as all controls were reviewed by the responsible Executive Directors and updated as appropriate. The BAF is shown at Appendix 1. The Quality & Governance Committee considered the revised BAF on 16 September 2016 and the Audit Committee considered the controls around the BAF process and the recommendations are below for the Board’s consideration. 2. Notable changes during the period
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.
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.
All other risks have maintained their risk net rating indicating that the controls are adequate to manage the risks to the strategic objectives.
Action: The Board is asked to note the movements in the BAF, consider if any further movement is required to the risk scoring in particular around Risk 1: financial sustainability given the financial position of the Trust. The Audit Committee also considered whether the process for managing the BAF is appropriate and there are adequate controls are in place.
Enc. 6.3
2
Action: The Committee would like to recommend that the Board reviews the BAF and the Risk Register firstly in conjunction and secondly more frequently. 3. Next Steps Action: The Board is asked to note that with the responsibility for the BAF now falls within the Chief Financial Officers domain. A process is underway to review the structure of the BAF and the review process with planned changes including:
Gauging and plotting risk appetite;
Closer correlation with the risk register; and
Revised structure for reflecting controls and assurance mechanisms and follow up actions. Appendix 1 – Quarterly BAF Review as at 28 September 2016 Key implications
Legal:
Supports monitoring of strategic risks and effectiveness of controls to regulatory and compliance frameworks. Links to Health and Social Care Act 2012 and the CQC Compliance Framework of ‘Safe, Effective, Caring, Responsive and Well-led’. The Trust is currently in breach of Licence as NHS Foundation Trust and under Monitor Enforcement action.
Financial:
None arising directly from this report
Assurance:
Supports monitoring of governance arrangements to ensure compliance with CQC Compliance Framework as outlined in the ‘Fundamental Standards’ and Monitor’s Quality Governance Framework.
Clinical:
None arising directly from this report
Equality & Diversity:
None arising directly from this report
Performance:
None arising directly from this report
Strategy:
Supports monitoring of strategic risks and the effectiveness of controls in place to manage such risks
Workforce:
None arising directly from this report
Estates:
None arising directly from this report
Reputation:
Non-compliance with regulatory and compliance frameworks may impact on reputation with stakeholders and patients
Other: None arising directly from this report
Enc. 6.3
1
Appendix 1: Board Assurance Framework Review as at 28 September 2016 - Summary of Movements and Recommendations
Principal Risk Strategic goals
Ref: Executive Lead(s)
Responsible Committee
Gross risk*
(I x L)
Net risk
(I x L)
Net Risk Movement
Trend analysis (Net risk)
2015/16 16/17
Q2 Q3 Q4 Q1 Risk 1: Failure to deliver financial sustainability
FF Risk 1 Page 3
Chief Financial Officer
Finance and Performance Committee
5x5=25 5x4=20
5x5=25
5x4=20
5x4=20
5x4 =20
Risk 2: Integrated care initiatives fail to deliver reduced admissions, eliminate delayed discharges or improve care outside the hospital
FF Risk 2 Page 4
Chief Operating Officer and Director of Strategy
Senior Governance Group, Clinical Summit, Tripartite
5x4=20 5x4=20
-
5x4=20
5x4=20
5x3 =15
Risk 3: Failure to deliver
workforce capacity and
capability
S Risk 3 Page 5
Director of
Workforce
Development
Workforce
Committee 4x5=20 4x4=16
4x5=20
4x4=16
4x4=16
4x4 =16
Risk 4: Failure to deliver benefits from KHP
FF Risk 4 Page 6
Chief Executive
Board
4x5=20 4x3= 12
4x4=16
4x4=16
4x4=16
4x3 =12
Risk 5: Demand and Capacity leads to target failure
T Risk 5 Page 7
Chief Operating Officer
Finance and Performance Committee 4x5=20 4x4=16
4x5=20
4x4=16
4x4=16
4x4 =16
Risk 6: Failure to achieve operational performance and maintain quality
B Risk 6 Page 8
Chief Operating Officer
Quality and Governance & Finance and Performance Committees
4x5=20 4x4=16 4x4=16
4x4=16
4x4=16
4x4 =16
*For Risk Matrix please see Appendix 2.
Strategic goals: B – Best quality of care, E- Excellent Teaching And Research, S - skilled can do teams, T - Top productivity, FF - Firm Foundations
Enc. 6.3
2
BAF Action Heat Map as of 28 September 2016:
= Gross risk; = Net risk (with Controls)
Enc. 6.3
3
Firm Foundations: Finances
Principal Risk Ref:
Executive Lead(s)
Responsible Committee
Gross risk (I x L)
Net risk (I x L)
Net Risk Movement
Last up-dated by
Failure to deliver financial sustainability
Inability to deliver cost improvements
Inability to control and maintain cost base
Inability to secure sufficient commissioner income
Inability to generate sufficient cash to support running of Trust services
Risk 1 Chief Financial Officer
Finance and Performance Committee
5x5=25 5x4=20 08/09/2016 by Chief Financial Officer
Risks Associated Measures Source
Opened: November 2012 Review date: May 2016 Corporate Risk Register? N
Links with Risk 5: Demand and Capacity leads to target failure, Risk 3: Workforce capacity and capability and Risk 7: Inability to generate sufficient cash
NHS Improvement (NHSI) CSSR
CIP run rate
Trust Deficit run rate
Finance Report
Controls Assurance Level of Assurance: 3
Financial strategy, Annual Plan and Budget Setting
Finance & Performance Committee structure
Trust recovery plans
Capital Plan
Estates Strategy
King’s Commercial Services
Cost Improvement Programme (CIP) Governance framework & QIA
Performance Management Framework
Business case approval process
King’s Executive ownership of Operational Plan
Improvement of data capture and data quality required
Trust under NHSI enforcement action since 1 April 2015 - increased scrutiny of financial position, performance and implementation of plans
Monthly Finance report to the Board (reviewed by Finance & Performance Committee)
Finance and Performance Committee reports
Internal audit reports
Annual Board review of Trust’s Annual Plan and Budgets
NHSI scrutiny of progress and implementation of plans
Monthly Commercial Services up-date
Monthly review of Divisional and Directorate financial performance incl. CIP delivery
Gaps in Controls Gaps in Assurance
Review of Performance Management Framework and process required none
Action plan to address gaps
Action
Lead Due By Progress up-date by Status
Review of Performance Management Framework, process and controls Chief Financial Officer March through June 2016 September 2016 In progress
Strengthening data capture/data quality (coding) Chief Operational Officer February 2017 September 2016 To be confirmed
Development of contracting strategy and plan Chief Financial Officer May 2016 September 2016 In progress
Review and relaunch of Business Case Governance Chief Financial Officer March 2016 Completed
Review of Financial Reporting Chief Financial Officer March 2016 for new FY Completed
Increase King’s Executive ownership of Budget setting Chief Financial Officer February to April 2016 Completed
Greater King’s Executive sight of contract negotiations Chief Financial Officer February to April 2016 Completed
Enc. 6.3
4
Firm Foundations: Partnerships
Principal Risk Ref:
Executive Lead(s)
Responsible Committees
Gross risk (I x L)
Net risk (I x L)
Net Risk Movement
Last up-dated by
Integrated care initiatives fail to deliver reduced admissions, eliminate delayed discharges or improve care outside the hospital
Risk 2
Chief Operating Officer and Director of Strategy
Senior Governance Group, Clinical Summit, Tripartite
5x4=20 5x4=20
16/09/2016 - Updated by Quality & Governance Committee
Risk Associated Measures Source
Opened: November 2012 Review date: May 2016 Corporate Risk Register? N
NHSI 4-hour wait A&E target
NHSI RTT 18 weeks incomplete
NHSI Cancer waiting times
Average Length of Stay
Performance Score Card
Controls Assurance Level of Assurance: 3
Emergency Care Recovery Plan - PRUH
Transformation programme includes PRUH
5 Year Recovery Plan
OHSEL implementation plan including Southwark and Lambeth Integrated Care (SLIC) and Bromley Out-of-Hospital Transformation Programme
Senior Governance Group, Clinical Summit, Tripartite meetings
Memorandum of Understanding issued by Bromley CCG
Performance reports and Performance Scorecard
Quarterly NHSI submissions
Transformation programme reports
Key Performance Indicators for DH and PRUH in place
Gaps in Controls Gaps in Assurance None None
Action plan to address gaps
Action
Lead Due By Progress up-date by Status
None
Enc. 6.3
5
Skilled, “Can Do” Teams
Principal Risk Ref:
Executive Lead(s)
Responsible Committee
Gross risk (I x L)
Net risk (I x L)
Net Risk Movement
Last up-dated by
Failure to deliver workforce capacity and capability
Risk 3 Director of Workforce Development
Workforce Committee
4x5=20 4x4=16 05/05/2016 by Director of Workforce Development
Risk Associated Measures Source
Opened: November 2012 Review date: May 2016 Corporate Risk Register? N
Links to Risk 1: Inability to deliver financial sustainability, Risk 5: Demand and Capacity leads to target failure
NHS Annual Staff survey results
Vacancy rates
Sickness absence rates
Net recruitment rate for Nursing
NHS Annual Staff Survey
Workforce Key Performance indicators
PULSE staff survey
Controls Assurance Level of Assurance: 3
Recruitment Plan - 2016/17
Nursing revalidation programme for all registered nursing staff (from April 2016)
5-year Workforce strategy and plan with focus on capacity and capability
Delivery of workforce priorities 2016/17
Workforce Key Performance Indicators
NHS Annual Staff Survey
PULSE staff survey
Friends and Family Test results
Reports on a series of deep dive exercises reported at Education and Workforce Committee
Gaps in Controls Gaps in Assurance None None
Action plan to address gaps
Action Lead Due By Progress up-date by Status
None
Enc. 6.3
6
Firm Foundations: Partnerships
Principal Risk Ref:
Executive Lead(s)
Responsible Committee
Gross risk (I x L)
Net risk (I x L)
Net Risk Movement
Last up-dated by
Failure to deliver benefits from KHP
Risk 4 Chief Executive
Board 4x5=20 4x3=12
27/04/2016 by Interim Director of Strategy
Risk Associated Measures Sources
Opened: November 2012 Review date: May 2016 Corporate Risk Register? N
None
Controls Assurance Level of Assurance: 3
Memorandum of Understanding
New Governance structure in place with: o KHP Board o Executive Board o Operational Executive
5 Year Recovery Plan
Agreed work plan for KHP Institutes
Strategic Oversight Group
Reports to Operational Group and Executive Group
KHP reports to KCH board
Maintaining KHP accreditation
Gaps in Controls Gaps in Assurance None
None
Action plan to address gaps
Action
Lead Due By Progress up-date by Status
None
Enc. 6.3
7
Top Productivity Principal Risk Ref:
Executive Lead(s)
Responsible Committee
Gross risk (I x L)
Net risk (I x L)
Net Risk Movement
Last up-dated by
Demand and Capacity leads to target failure
Risk 5 Chief Operating Officer
Finance and Performance Committee
4x5=20 4x4=16 08/09/2016 by Director of Performance
Risk Associated Measures Source
Opened: November 2012 Review date May 2016 Corporate Risk Register? N
Links with Risk 1: Inability to deliver financial sustainability, Risk 3: Workforce capabilities and capacity and Risk 6: Failure to achieve operational performance and maintain quality
NHSI 4-hour wait A&E target
NHSI RTT 18 weeks incomplete
NHSI Cancer waiting times
CQC rating for ‘Responsive’ domain
Monthly Performance Scorecard
CQC inspection report
Controls Assurance Level of Assurance: 3
Performance and Finance Framework
Quality and Governance Committee
Finance and Performance Committee structure
5 Year Recovery Plan
CIP Governance framework & QIA
Trust under NHSI enforcement action since 1 April 2015 - increased scrutiny of financial position and performance
Quarterly submissions to NHSI
Internal and external audits
Monthly Finance & Performance Reports
License as Foundation Trust
CQC inspection report
Gaps in Controls Gaps in Assurance
To be reviewed by Chief Operating Officer
To be reviewed by Chief Operating Officer
Action plan to address gaps
Action
Lead Due By Progress up-date by Status
Controls, assurances and action plans to be reviewed
Chief Operating Officer 30/08/2016 September 2016 To commence
Enc. 6.3
8
Best Quality of Care Principal Risk Ref:
Executive Lead(s)
Responsible Committee
Gross risk (I x L)
Net risk (I x L)
Net Risk Movement
Last up-dated by
Failure to achieve operational performance and maintain quality
Risk 6 Chief Operating Officer
Quality and Governance and Finance and Performance Committees
4x5=20 4x4=16
08/09/2016 by Director of Performance
Risk Associated Measures Source
Opened: November 2012 Review date: May 2016 Corporate Risk Register? N
Links with Risk 1: Inability to deliver financial sustainability, Risk 3: Workforce capabilities and capacity.
NHSI 4-hour wait A&E target
NHSI RTT 18 weeks incomplete
NHSI Cancer waiting times
Friends and Family Test
CQC Ratings for the 5 domains
Monthly Performance Scorecard
CQC inspection report
Quarterly Quality and Governance report
Controls Assurance Level of Assurance: 3
Performance and Finance Framework
Quality and Governance Committee
Finance and Performance Committee structure
5 Year Recovery Plan
CIP Governance framework & QIA.
Self-assessments against NHSI ’s Quality and Governance standards and NHSI’s Risk Assessment Framework
Quarterly Quality and Governance Report to Board
Negative assurance from KPMG review of CQC compliance
Gaps in Controls Gaps in Assurance
Further review of actions to be undertaken by Chief Operating Officer None
Action plan to address gaps
Action
Lead Due By Progress up-date by Status
Business case for new VM software approved,
software sourced and currently implemented.
Tony Corkett End of May 2016 In implementation
Controls, assurances and action plans to be reviewed
Chief Operating Officer 30/08/2016 September 2016 To commence
Enc. 6.3
9
Appendix 2: Risk Scoring Matrix
LEVEL
5 Almost certain Will occur given existing controls
4 Likely Will probably occur given existing controls
3 Possible Could occur given existing controls
2 Unlikely Not expected to occur, except for in exceptional circumstances, given existing controls
1 Rare Not expected to occur given existing controls
TABLE 2 - LIKELIHOOD SCORE
TABLE 1 - CONTROL EFFECTIVENESS SCALE
LEVEL DESCRIPTOR
Ad Adequate controls in place.
Li Limited controls in place and/or controls have known weaknesses.
In Controls non-existent or largely ineffective.
TABLE 3 - RISK IMPACT SCORE
LEVEL INJURY/HARM
(i)
SERVICE DELIVERY
(ii)
FINANCIAL/
LITIGATION (iii)
REPUTATION/PUBLICITY
(iv)
5
Catastrophic
Multiple fatalities or large number injured or
affected e.g. (Breast Screening Errors).
Complete breakdown of a
critical service / ‘Significant
underperformance’ against
key targets
Losses; claims/ damages;
overspending; resourcing
shortfall: >£5M
National adverse publicity/reputation
irreparably damaged. Director/Board
removal, Breach of Terms of
Authorisation or loss of key service.
4
Major
Fatality/multiple serious injuries/major
permanent loss of function/increased length
of stay or level of care > 15 days.
Intermittent failures of a
critical service /
‘underperformance against
key targets’
£1M - £5M Limited adverse national publicity
impacting patient choice and market
share. HSE /Healthcare Commission
review
3
Moderate
Semi-permanent harm (1 month - 1 year).
Increased length of stay/level of care 8-15
days.
> 1 month’s absence from work for staff.
Failure of support services /
underperformance against
other key targets
£51K - £1M Repeated local media publicity leading to
some short-term impact on patient choice
2
Minor
Short term injury (< 1 month). Increased
length of stay or level of care < 7 days. 3
days to one months absence for staff.
Service disruption £11K—£50K One off local media publicity causing
some short-term impact on patient choice.
1
Insignificant
No harm. Injury resulting in < 3 days
absence from work for staff
Minor service disruption <£10K No adverse media coverage
Enc. 6.3
10
TABLE 4 - RISK RATING MATRIX
Likelihood 1 2 3 4 5
Impact 5 5 10 15 20 25 4 4 8 12 16 20
3 3 6 9 12 15
2 2 4 6 8 10
1 1 2 3 4 5
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 July 2016 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
Sue Slipman (SS) Non-Executive Director/ Deputy 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
Toby lambert (TL) Interim Director of Strategy
Ahmad Toumadj (AT) Interim Director of Capital Estates and Facilities
Paula Townsend (PT) Acting Director of Nursing and Midwifery
In attendance:
Simon Dixon (SD) Director of Finance
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
Item Subject Action
016/87 Apologies Apologies for absences were noted.
016/88 Declarations of Interest There were no declarations of interest reported.
016/89 Chair’s Actions/ Updates There were no actions to report. The Committee Chair noted that the FPC agenda has been financial driven over the last few months due to the Trust’s financial position; and To ensure operational performance is given sufficient air time the Trust will hold performance focused meeting in the Autumn.
Enc. 1.4
2
Item Subject Action
016/90 Minutes of the Previous Meeting
The minutes of the meeting held on 28 June 2016 were approved as a correct record subject to correction of the meeting date and the word ‘differed’ on page 9.
016/91 Action Tracker/ Matters Arising The action tracker was noted.
TOP PRODUCTIVITY
016/92 Monitoring Operational Performance – Month 03 The Committee received and discussed the performance report for month 03. The following key points were reported: Trust emergency department (ED) performance against the 4-hour target
deteriorated June. This is the first dip in performance since the agreed improvement trajectories. The commissioner agreed improvement trajectories were however achieved in Quarter 1;
The Princess Royal University Hospital (PRUH) performance improved again in
June despite limited capacity due to Norovirus infection outbreak. Type 1 ED attendance performance worsened from 83.4% to 78.5% for urgent care but there were less trolley breaches;
All types of performance at Denmark Hill (DH) worsened in June. On certain
occasions there over 400 attendance to the ED, staff in the service are worn down and fatigued. The is the first time they have not experienced a reduction in patient flow over the summer month;
There are capacity management mitigation measures being implemented on DH.
The issue identified so far are gaps in staff rota and long term staff sickness on an upward trend;
The agreed improvement trajectories and capacity planning work are achievable
but not at the current pace taking into account the increase patient flow;
Performance improvement plans at the PRUH are progressing, the DH capital plans are on track to deliver is quarter 4 (Q4). However, DH improvement plans are at risk of delays due to the lack of decanting facility for Suit 3;
The Trust’s Director of Capital Estates and Facilities, Medical Director and Chief
Operating Officer are meeting to allocate a decanting facility that will be suitable to accommodate Suit 3.
The Trust’s Referral to Treatment (RTT) trajectories for Q1 have been achieved,
performance for June was 81.3%. Over 52 week waiters reduced from 197 patients waiting at the end of May to 137 patients at the end of June. A significant improvement on the previous month;
The Trust neuro specialty RTT breaches reduced from 80 to 61 and remain 68
ahead of trajectory. Non-neuro breaches have also reduced from 117 to 76 but are 28 cases behind trajectory;
Enc. 1.4
3
Item Subject
Action
Orthopedics’ patients were behind trajectory with 32 admitted and 6 non-admitted breaches at the end of June. All information has been reported to commissioner;
While performance has been good, there continue to be risks associated with the successful delivery of the improvement programme such as limited bed capacity, unavailable operation theatres and financial restrictions;
The Trust is awaiting results of the orthopedics tender to provide a consolidated
service from the Orpington site. If this is successful the Trust will have additional capacity to treat orthopedics patients;
Cancer diagnostic services displayed improved performance in June, but due to
poor performance in April they did not achieve this target in Q1. The 62 day GP referral target of 85% was achieved at 91.52% for June which has meant that performance for Q1 was achieved. It should be noted that achievement of this target is challenging;
The following key points were discussed: Trust performance at DH is lower than expected, with the winter pressure period
coming up the Trust must improve performance which will permit room for the extra activity associated with the winter months;
The Trust needs to carryout activity modelling and forecasting which will allow for more informed and better prepared position going forward;
The Trust presented a deep dive into Accident and Emergency (A&E) issues and their effect on capacity at a recent tripartite meeting. All partners were satisfied that the Trust is doing all it can to address the demand and there is confidence in Trust’s capability;
The work around improving A&E is focused on redesigning of A&E pathway processed, expanding A&E capital structures and better management of bed capacity to improve patient flow;
The improvement trajectories agreed with commissioners and partners were
over optimistic but necessary. The Trust is aiming to achieve all trajectories but they remain high risk;
The Trust has good people working for it but it must be wary of the additional
pressure on senior managers who are already performing at peak levels;
It was noted that benchmarking information produced by NHS England is no longer available, JF will liaise with other colleges to find out if there are alternative sources of comparison;
The Trust’s Length of Stay (LOS) parameters need to improve;
Trust activity was affected by two operational theatres being unavailable at the
same time, the repairs to one will be completed in August and it should be fully operational thereafter; and
It was noted the nursing staffing levels at the PRUH have improved. The Committee would like to receive a breakdown of year by year increased activity by age range.
JF
Enc. 1.4
4
Item Subject
Action
SOUND FINANCES
016/93 Update on Budget Setting and Contract Negotiations Letter to NHSI The Committee received and discussed the Trust’s response to NHS I. The following key points were discussed: The Committee noted the letter the Trust sent to NHSI regarding the
sustainability and transformation funding. The Trust has become an outlier as it is yet to sing up to the proposed performance conditions and control total target; and
The Committee noted the letter. Sustainability & Transformation Fund(STF ) Update-Criteria to access 2016/17 The Committee received the Sustainability and Transformation Fund (STF) 2016/17 criteria to access the fund document. The following key points were reported: The STF is financial support based on performance, the Trust has been offered
£30m for 2016/17 which is subject to achieving performance targets and a controlled total at the end of the year;
Achieving both the financial and operational performance targets is necessary to qualify for the STF;
The Trust’s year to date deficit is of concern, as the criteria for funding stipulates
that achievement of the financial control target for further quarters is weighted at 70%. The other 30% comes from achieving operational performance targets relating to referral to treatment (RTT) times, accident and emergency and the cancer 62-day wait.
The funding will be paid out quarterly upon confirming achievement of targets; Quarter 1 (Q1) performance against the criteria for funding was not achieved and
it was not clear from the guidance that it would be 100% linked to the financial performance. The Trust did not achieve the financial performance targets for Q1 and will not receive the STF payment;
It should be noted that even if the Trust’s gets back on track in Q2 it cannot claim
back the payment for Q1 retrospectively;
The Trust’s financial performance as at month 4 is off track, it has an adverse variance of circa £5.2m against the year to date planned deficit of circa £19.5m. To get a better understanding of the drivers of the overspend the Trust is carrying out a budget bottom up exercise for all services;
The following key point were discussed: The Trust’s cash position is challenging with more invoice requests than cash
available to spend;
Enc. 1.4
5
Item Subject
Action
The Trust will be meeting with NHSI in September to go through its financial position, it is key to highlight with tangible evidence what the drivers of overspend are and the reasons for under performance on activity;
The running of a safe hospital and provision of services to its patient remains a the Trust’s number one priority. What must be done before the September meeting is compiling a full picture with evidence of Trust performance and the drivers of the deficit levels; and
It was noted that there is a very real possibility that a regime of special measures may be the outcome of the September meeting for the Trust.
The Committee will receive the NHS provider guide on Trust performance.
CG
016/94 Critical Care Unit (CCU) Business Case The Committee received a presentation of the updated business case for the CCC from Komal Whittaker-Axon and Jade Acaster. The following key points were reported: The CCU business case was originally drafted in 2012, since then it has been
periodically updated. The Trust and Monitor approved the construction of a new 60 bedded Critical Care Centre at King’s to be located above the existing theatre Block;
There are 3 business cases supporting the delivery of the CCU project including Liver ITU and Nursing Recruitment Proposal for Critical Care. The recruitment plan is progressing well with the Trust expecting to recruit 863 Critical Care nurses over the next 4 years;
The recruitment plan was amended slightly due to financial pressures in year.
The Trust is receiving supplementary funding from the King’s Charity to build a rooftop garden and KHP contribution of £0.5m for enhancements;
The following key points were discussed: The additional contribution will be utilised to make enhancements to the facility;
There is capital risk associated with the project, the Trust has spent £70m of the
£83.7m to date, in year spend has been £22m. the Trust is confident with progress of the project and the monthly CCU steering group has oversight on all matters; and
It was note that the risk is circa £3m.
016/95 Finance Report – M03 The Committee receive month 2 finance report. The following key points were reported: At the end of month 3 the Trust operating deficit is circa £24.8m. This is an
adverse variance of circa £5.2m against the year to date planned deficit of circa £19.54m;
The Trust had previously accrued the benefit STF income of £7.5m into Q1 accounts, as the Trust did not achieve the finance target associated the Trust will not be receiving the STF funding. Therefore the true cumulative deficit at month
Enc. 1.4
6
3 is circa £32.3m. Item Subject
Action
The Trust experienced underperformance of acuity, delay in re-setting the Trust plan to account for the loss of STF and slippage on CIPs schemes;
The Trust’s cash position remains challenging and it is reliant on distress funding to cover some of its operating costs;
The Trust’s key challenge is to deliver the activity it signed up to. Limitations due
to capacity and the bed shortage must be overcome. The Trust will be carrying out a detailed review of activity trends and capacity;
The Trust is in breach of the NHSI agency spending cap. 70% of all agency
booked breached the cap due to the rates levels being lowered. Majority of the breaches are in Medical and Dental staffing;
The Trust appointed a master vendor who’s responsibility will be to fill all vacant
shifts with approved Bank staff;
The following key points were discussed: If the Trust is to have a successful 2016/17 it must have a firm grip on Trust
CIPs programmes and activity. The CIPs stock take exercise will be detailed with projections going forward month by month;
The reduced activity in months 1 and 2 was due to technical issue and problems in diagnostics the Trust is a on a recovery path;
The Trust must focus on getting its activity back of track and in particular areas in which it can achieve profit margins, such as orthopaedics;
While focusing on other areas where activity can be improved, it must not be
done to the detriment of referral to treatment (RTT) trajectories which have been agreed by commissioners and have targets associated to them;
To meet some of the performance targets the Trust is outsourcing activity. This
can be useful but there are financial implications associated with increased expenditure; and
The Trust has been looking at internal process that can produce savings and
improve productivity. All business cases that provide for 24% growth margins are approved. Business cases with lower margins are being reviewed.
016/96 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;
Enc. 1.4
7
Item Subject Action
The agency scheme is being explored further as a key area the Trust is keen to
implement. Nursing agency CIP is progressing and delivering but Medical and Dental savings are still a work in progress;
The Trust’s private patient scheme is progressing however, overseas visitors
element is behind plan as other options for recovering payments are being explored;
The Trust is in negotiations with Synergy to identify a viable buyer; and
The Trust is also pushing forward with the theatre efficiency work.
016/97 Finance Function Review The Committee received the results of the finance function review. The following key points were reported: The finance team were very engaged and participate in the review with great
interest;
A number of work streams were identified around financial control and accuracy of numbers;
On 5 July the governance structure launch event took place, this was the
starting point for implementation of the changes to the staff establishment and work structures. The process is also looking at how we strengthen the departments the first meeting of the steering group is scheduled for 11 August;
The finance team restructure is aimed at better alignment of the team to the
new structure of the organisation; The following key points were discussed: It was noted that the Trust finance team expenses are lower than other
organisations. The restructure will not be aiming to increase expenditure but to better align the team and produce a more efficient way of working;
The finance team has good staff but responsibility is not adequately spread out amongst the team. The support systems are also not functioning at an appropriate level; and
The department re-structure will also provide better operational functionality
and eliminate dependency on particular staff. The process for implementation will be seamless, it will be business as usual with as little disruption as possible.
Enc. 1.4
8
016/98 Quarterly NHSI Submission The Committee noted and approved the submission of the quarter 1 (2016/17), return to NHS Improvement.
Enc. 1.4
9
Item Subject Action
NHSI Single Oversight Framework The Committee noted the NHSI single oversight framework.
016/99 Any Other Business There were no items of any other business raised for discussion.
016/100 Date of Next Meeting Tuesday, 26 September 2016, 09:00-11:00 in the Dulwich Committee Room.
This page has been left blank