board of directors board/trust board... · 2018-01-12 · board of directors meeting board of...

Board of Directors Thursday 07 December 2017

08:30am

Boardroom, Trust HQ, Sceptre Point, Sceptre Way, Walton Summit, Preston, PR5 6AW

Board of

Directors

Quality Committee

Finance & Performance Committee

Nomination / Remuneration

Committee

Audit Committee

Board of Directors

Meeting Board of Directors Meeting

Location Boardroom, Trust HQ, Sceptre Point, Sceptre Way, Walton Summit, Preston,

PR5 6AW

Date Thursday 07 December 2017

Time 08:30am Formal Public Board meeting

Reference Item Lead Action Enc. FOIA

PART ONE (PUBLIC MEETING)

TB 179/17 Welcome and opening comments Chair Verbal

TB 180/17 Apologies for absence and confirmation of quoracy

Chair Verbal

TB 181/17 Declarations of Interest Chair Verbal

TB 182/17 Minutes of the previous meetings Chair Decision Paper

TB 183/17 Action Tracker Chair Decision Paper

SCRUTINY & ASSURANCE

TB 184/17 Finance Report Chief Finance Officer Noting Paper

TB 185/17 Performance Report Chief Operating Officer Noting Paper

TB 186/17 Trust Chair’s Report Chair Noting Paper

TB 187/17 Quality Committee Chairs Report Committee Chair Noting Paper

TB 188/17 Chief Executive’s Report Chief Executive Discussion Paper

TB 189/17 Quality Report Director of Nursing and

Quality/Medical Director Noting Paper

PART TWO (PRIVATE MEETING)

TB 190/17 Minutes of the last meeting Chair Decision Paper

TB 191/17 Chief Executive Report Chief Executive Noting Paper

TB 192/17 Public Health Initiatives in LCFT Medical Director Noting Pres.

TB 193/17 Inpatient Reconfiguration Programme

Chief Executive Decision Paper

TB 194/17 Cumbria Strategic Options Business Case

Chief Finance Officer Noting Paper &

Pres.

TB 195/17 Staffing for Safety and Quality Action Plan Update

Director of Nursing Noting Paper

TB 196/17 Any Other Business Chair Verbal

TB 197/17 Date & Time of the Next Meeting

04 January 2018, 8.30am

Chair Verbal

Declaration of Interest – Board of Directors

Date of Declaration

Surname First Name

Job Title Nature of Interest

Do you envisage a conflict of interest between outside employment and

your NHS employment?

Nil Declaration

21/02/2017 Eva David Trust Chair Employed by Union Learn as National Manager

Yes TUC funds learning in relation to apprenticeship and Trade Union representation.

06/02/2017 Tierney-Moore

Heather Chief Executive

1. Director of Lancashire Sport Partnership2. Trustee of Community Integrated Care3. Macmillan Allumni Patron4. Retained Consultant Glenview5. Patron Breakthrough Mental Health Charity

Yes Potential risk of CIC bidding to provide services in Lancashire that are also of interest to LCFT

06/09/2017 Furlong Gwynne Non-Executive Director &

SID

1. 1. Non-Executive Director of Together HousingGroup

2. 2. CEO of Regain Sports Charity3. 3. Trustee of Chorley Youth Zone4. 4. Non-Executive Director of subsidiary of

Progress Housing Group called Concert LivingLimited

No

13/02/2017 Ballard Peter Deputy Chair & Non-

Executive Director Chief Executive DSE Service No

29/03/2017 Dickinson Louise Non-Executive Director

1. Director at Talegar Limited2. Consultancy Services at Talegar Limited3. Foundation Governor and Finance Chair at

St.Vincents Primary School

No

03/02/2017 Wilson Isla Non-Executive Director

1. NED - Progress Housing Group2. Shareholder – FSquared Ltd3. Shareholder - Ruby Star Associates Ltd4. Consultancy/Advisory Work – Ruby Star

Associates5. Chair - Borough Care Stockport

No

Declaration of Interest – Board of Directors

03/02/2017 Curtis David Non-Executive Director 1. Director at Clinical and Corporate Governance

Limited2. Clinical Associate at MIAA (Advisory Section)

No

07/02/2017 Gregory Bill Chief Finance Officer

1. Trustee of Healthcare Financial ManagementAssociation

2. Governor of Stockport College3. Co-opted member of Lancaster University

Financial and General Purpose Committee.4. Director of Red Rose Corporate Services

No

02/10/2017 Possener Julia Non-Executive Director (Start date 01.02.2017)

1. Lay member of the Lancaster UniversityManagement School and Faculty of Arts andSocial Science Ethics Committee. Although theTrust and LU have a working relationship andcollaborate such matters do not fall usuallywithin these Faculties.

2. My partner's sister is the owner of a domiciliarycare business which does have contracts withThe Trust. I am including this for the sake ofcompleteness. Bluebird Lancaster and SouthLakeland Ltd. I have no formal nor informalinvolvement in that business.

No No business with the Trust or other NHS organisation or organisations providing services to NHS No unrelated faculties or formal or informal business.

13/02/2017 Roach Dee Executive Director of

Nursing & Quality

06/02/2017 Marshall Max Medical Director

06/02/2017 Moore Sue Chief Operating Officer

07/02/2017 Gallagher Damian Director of HR

BOARD OF DIRECTORS

Minutes of the Part One Board of Directors Meeting held on 02 November 2017 Training Rooms 1 & 2, the Harbour, Blackpool

PRESENT: David Eva, Trust Chair (Chair)

Heather Tierney Moore, Chief Executive Max Marshall, Medical Director Peter Ballard, Deputy Chair Bill Gregory, Chief Finance Officer Sue Moore, Chief Operating Officer Dee Roach, Director of Nursing Damian Gallagher, Director of HR Louise Dickinson, Non-Executive Director Isla Wilson, Non-Executive Director Julia Possener, Non-Executive Director David Curtis, Non-Executive Director Jo Alker, Company Secretary

IN ATTENDANCE: Darren Conway, Quality Improvement Manager accompanying service user (Agenda Item TB 159/17) Bev Howard, Head of Communications Julie-Ann Bowden, Associate Director of Risk & Assurance Viv Prentice, Deputy Company Secretary (minutes)

OBSERVERS: Lisa Knight, Insight Development Programme

Pauline Walsh, Public Governor Adnan Gharib-Omar, Staff Governor Public Member: Jinette Hindmarsh, Partner Engagement Office, MHC UK

TB 154/17 WELCOME & OPENING COMMENTS

The Chair welcomed everyone to the meeting and introductions were made.

TB 155/17 APOLOGIES FOR ABSENCE & CONFIRMATION OF QUORACY Apologies for absence were received from Non-Executive Director, Gwynne Furlong and confirmation of quoracy was provided.

TB 156/17 DECLARATIONS OF INTEREST A declaration was made by the Chief Finance Officer in relation to his position on the Red Rose Corporate Services Board.

TB 157/17 MINUTES OF THE PREVIOUS MEETING

The minutes of the previous meeting held on 05 October 2017 were approved as a true and accurate record subject to including the detail of a discussion around care co-ordinators attendance at CPA meetings that was raised by a Non-Executive Director.

TB 158/17 ACTION TRACKER The Board reviewed the action tracker and noted the updates provided. Items were closed off as necessary. The actions relating to future staffing and clinical pathways were discussed at the Finance & Recovery Group and it was agreed that a further update would be provided at the December Board. ACTION

UNCONFIRMED

TB 159/17 PATIENT STORY The Board heard a patient story from a service user who had previously used the Trust’s CAMHS inpatient service. They spoke of their experience and journey to recovery providing the Board with examples of good practice and areas they felt could be improved.

TB 160/17 TRUST CHAIR’S REPORT

The Chair presented his report which included an overview of the activity of both Non-Executive Directors and Governors. An update was provided following the Chair’s recent visit to Scarisbrick Inpatient Unit at Ormskirk Hospital which provided the Chair with the opportunity to speak with staff about some of the challenges they face. The Board noted the content of the Chair’s Report.

TB 162/17 CHIEF EXECUTIVE REPORT The Chief Executive introduced her report and confirmed that 30% of employees had now received the flu vaccination. Areas of success were highlighted which included the recent visit from HRH Prince Harry to the MyPlace project at Brockholes Nature Reserve. The MyPlace project is a partnership supported by Big Lottery Funding and is one of 31 UK projects co-ordinated through Our Bright Futures. Constitutional changes in relation to the Council of Governors constituencies had been approved at the Annual Members’ Meeting. The election process was currently underway and the Board would be kept informed of the outcome. The Medical Director provided an update following a visit undertaken with colleagues to Northumberland, Tyne & Wear NHS Foundation Trust that had been successful in applying lean methodology focusing on improving patient experience. This discussion would be picked up with the Board as part of the scheduled session in January 2018. ACTION

TB 162/17 AUDIT COMMITTEE CHAIR’S REPORT

The Chair of the Audit Committee introduced the Chair’s Report and highlighted the key areas of discussion and focus for the Committee. This included an update on the delivery of the Internal Audit Plan which was currently amber rated in terms of progress. It was noted that this was not a concern and the delay would be mitigated in quarter three. Assurance had been received that sufficient processes and mechanisms were in place for staff to raise concerns within the organisation. The Quality Report that formed part of the Board agenda would provide an overall view of the key themes and hot spots from those concerns. Assurance had been received from the Corporate Governance and Risk Management health-checks undertaken during quarter two in the Children & Young People Network and the HR Directorate. In addition, the annual assurance programme update highlighted the key pieces of work that had been undertaken within the last twelve months relating to risk assurance. The Committee considered the extension of the internal and external audit contracts and it was agreed that stakeholder feedback in relation to the internal audit contract would be obtained prior to approving a contract extension. With

regards to external audit, a recommendation would be put forward to the Council of Governors in November to extend the contract for a further two years.

The Board noted the content of the Audit Committee Chair’s Report.

TB 163/17 QUALITY COMMITTEE CHAIR’S REPORT The Chair of the Quality Committee introduced the Chair’s Report and highlighted the key areas of discussion and focus for the Committee which included recognition of the significant amount of work that had been undertaken at HMP Liverpool.

It was noted that work was currently underway to enhance the Quality & Safety Surveillance Reports and that work was being undertaken to address staffing levels as a result of the reduction in staff from the EU.

The Board noted the Trust’s achievement of 100% compliance with PREVENT training.

The Board noted the content of the Quality Committee Chair’s Report.

TB 164/17 FINANCE & PERFORMANCE COMMITTEE CHAIR’S REPORT The Chair of the Finance & Performance Committee introduced the Chair’s Report and highlighted the key areas of discussion and focus for the Committee. This included an update on the EPR programme and the work that was being undertaken to address the small amount of overpayments to staff.

In relation to the perinatal business case update, the Chief Operating Officer confirmed that the Trust was close to signing the lease for the perinatal facility and had agreed access with Lancashire Teaching Hospitals for the inpatient reconfiguration work. The Chief Finance Officer also confirmed that funding had been approved by NHS Improvement.

The Board noted the content of the Finance & Performance Chair’s Report.

TB 165/17 QUALITY & PERFORMANCE REPORT The Chief Operating Officer presented the Quality & Performance Report for month six and confirmed that the Trust was compliant with all NHS Improvement indicators with the exception of performance against the Early Intervention in Psychosis (EIS) 2 week target. The Chief Operating Officer outlined the context of the discrepancy and the actions that were being taken to address this.

It was noted that CAMHS Tier 4 was underperforming and whilst A&E was still challenged there had been a significant reduction in the number of 12 hour breaches. The Trust also remained challenged in terms of beds and occupancy.

Patients with over 180 day’s length of stay on mental health wards had increased slightly due to the patient cohort. The lead commissioner had formally been informed of the position and the financial impact of holding chronic presentations on acute mental health wards.

The Board’s attention was drawn to the Memory Assessment Service (MAS) which, with the exception of the Central Lancashire MAS team, continued to perform well against the 79% target for the six week referral to assessment standard.

Non-Executive Director, David Curtis, highlighted that the target for Care Coordinators attending CPA reviews had not been achieved again this month. Following a question from the Chair in relation to secure services, the Chief Operating Officer outlined the work that was being undertaken with the psychology associates which included looking at violence reduction and the number of wards vs number of patients.

TB 166/17 FINANCE REPORT The Chief Finance Officer presented the finance report and confirmed that the financial position in month 6 was similar to month 5 and showed a gap of £2.6m at the half year point. Whilst staffing pressures and OAPs continued to be an issue, a task force was underway to address staffing led by the Director of Nursing and Quality. In addition, the high number of PICU OAPs was being addressed with the commissioners. An update was provided on land disposals which included the conclusion of the Ridge Lea offer. In addition, it was highly likely that a VAT reclaim relating to a capital scheme would be concluded this year. Financial pressures relating to the prison contract had been discussed with the commissioners and a response was currently awaited. In addition, the Board noted that the Trust had secured a contribution to establish the Core 24 liaison service. The Chief Finance Officer confirmed that the cash position was back on plan and that progress against the capital programme was slow due to issues with the Chorley site. Work had been progressing on a revised format of the Finance Report and therefore month 6 would be re-presented in the new format for comment. ACTION

TB 167/17 QUARTERLY WORKFORCE REPORT

The Director of HR presented the workforce report for quarter two and highlighted that whilst levels of sickness absence remained the same as the previous year work was underway to address this. This included the back to basics programme. The turnover rate for quarter two had seen a slight increase, reporting 13.95% at the close of the quarter. The Director of HR confirmed that future reports would also include additional detail in respect of the breakdown of reasons for leaving. It was referenced that there had been fewer registrations from EU workers and an increase in leavers indicating a future problem. Whilst appraisal compliance was below the Trust target, this was being addressed within the Networks. Overall mandatory and statutory training compliance continued to improve, reporting an overall compliance of 89% at the close of quarter two. For those individual subjects that remained non-compliant, Networks were agreeing new trajectories to support their achievement of the Trust target by December.

Following the percentage drop in visa compliance, the Director of HR assured the Board that this related to one individual whose application was currently being processed. Non-Executive Director, Isla Wilson, took the opportunity to update the Board following her attendance at a recent Workforce Quality Standard event. A discussion ensued in relation to the importance of increasing the Trust’s awareness of diversity. Following a question in relation to the spike in sickness rate figures in the Children and Young People’s Network, the Chief Operating Officer outlined the reasons that this could be attributed to. This included the recent changes in the network and long term sickness absence. The Director of Nursing responded to a question in relation to mandatory training from a Non-Executive Director and advised that a detailed piece of work was being undertaken in respect of moving to competency based training. This would ensure that staff are able to evidence competencies around core skills.

TB 168/17 BOARD ASSURANCE FRAMEWORK

The Associate Director of Risk and Assurance presented the Board Assurance Framework (BAF) Quarter 2 Review and provided an update on BAF risks 1.1 and 4.2 that had moved in score at the end of Quarter 2. The Board’s attention was drawn to the appendices to the BAF which included a thematic summary of the operational risks scored at 12 and above. Following a question from a Non-Executive Director in relation to CIP targets, the Chief Finance Officer explained that whilst the overall position was directly related to the mental health run rate scheme he was confident it would result in a satisfactory conclusion. The Chief Operating Officer confirmed that the current position in relation to secure services transformation would be mitigated before the end of the year. The Board approved the BAF 2016/17 Risk Register at Quarter 2.

TB 169/17 MENTAL HEALTH ACT MANAGERS The Director of Nursing presented the Assurance Report on the effective discharge of duties of Hospital Managers under the Mental Health Act and confirmed that a development session was planned for the Board in relation to its responsibility in discharging the Act. A discussion followed in relation to the responsibilities of Non-Executive Directors and it was agreed that their responsibilities would be agreed following the development session in February 2018. ACTION

TB 170/17 LEARNING FROM DEATHS

The Director of Nursing presented the Learning from Deaths Assurance Report and drew the Board’s attention to the baseline assessment against the national guidance. The Board noted that the Trust was compliant with all deadlines and would achieve upcoming deadlines by Q3/Q4. The Medical Director highlighted that that this was an important development in supporting a safety culture within the NHS in the context of openness and

transparency. It was noted that there would also be potential media interest as Trusts begin to publish their reports.

TB 177/17 On behalf of the Board, the Chair thanked Non-Executive Director, Peter Ballard for his valued contribution and support following his many years’ service within the Trust adding that as a personal colleague he would be incredibly missed.

TB 178/17 DATE AND TIME OF NEXT MEETING 07 December 2017 @ 08:30a.m. Training Room 1 & 2, The Harbour

Board of Directors

Agenda Item TB 184/17 Date: 07/12/2017

Report Title Finance Report

FOIA Exemption Part Exemption

Prepared by Shannon Carroll, Financial Services Director

Presented by Bill Gregory, Chief Finance Officer

Action required Noting

Supporting Executive Director Chief Finance Officer

PURPOSE OF THE REPORT:

Report purpose To summarise and analyse actual and forecast financial performance and standing of the Trust, the implications and any proposed management action.

Strategic Objective(s) this work supports

To provide excellent value for money in a financially sustainable way

Board Assurance Framework risk 5.1 The Trust does not achieve financial performance sufficient to maintain resilience and sustainability

CQC domain Effective

Summary

Actual Plan Var Forecast Plan VarSustainability

EBITDA 6,820 9,696 -2,876 15,860 17,745 -1,885Operational Deficit -2,255 610 -2,865 2,194 2,167 27Deficit after Impairment* -3,358 -1,274 -2,084 -1,359 -1,390 31

CIPs (against Trust Plan) 7,386 8,440 -1,054 15,100 15,100 0Cash and Liquidity 11,441 11,829 -388 24,601 10,989 13,612Capex 1,834 5,989 -4,155 13,661 9,591 4,070UOR

Capital Service 4 2 3 2Liquidity 1 2 1 2I&E Margin 4 2 2 2I&E Variance 3 1 2 1Agency 2 1 2 1Overall 3 2 2 2

Sustainability

CIPs

Liquidity

Summary continued overleaf

The cash position remains strong but shows a minor adverse variance from plan of £0.4m. The capital position continues to offset the I&E position. High debtors are placing some pressure on working capital though this is considered transient. Forecast cash is currently expected to exceed plan, a combination of an improved opening position, capital funding, and anticipated disposals. - see Cash and Liquidity for more details.

Current Out-Turn

At month 7 with CIPs of c£7.4m against a plan of c£8.4m the Trust is £1.1m behind plan, a deterioration of £0.1m on month 6 (£1.0m behind plan). The adverse variance is mainly due to a lack of performance on Run Rate Reduction Programmes on staffing pressures. Compensating schemes have, and continue to be, developed and confirmation of transactions are expected in month 8. Networks continue to create and implement measures aimed at improving the position.

Month 7 sees a year to date operating deficit of -£2.3m, excluding planned Sustainability and Transformation funding of £0.9m, against a planned surplus to date of £0.6m. This shows an improvement on month 6 and represents a small budgetary surplus in month and nearly £0.2m when excluding STF monies. The position remains driven by staffing pressures in ward and prison areas and consequential impact on cost improvement programmes (rising agency costs will also impact Use of Resources targets). Additionally OAPs expenditure continues to exceed funding - see Out Of Area Activity for more details. The forecast assumes current pressures and risks are addressed or mitigated in line with the recovery plan (see forecasting) and financial performance achieves (or exceeds) plan but the unmitigated projection indicates a gap of c£4.8m, c£6.9m without STF monies. This is represents an improvement on month 6 forecasts (£6.2m), and is driven by excess OAPs of c£0.8m (all be that significantly below last month), prisons (see also Bank and Agency section) and additional mental health pressures. Delivery of the recovery plan and financial targets will required a significant and coordinated response with robust management and oversight. After taking in to account £1.7m of disposals, which are accounted for after EBITDA, EBITDA is broadly in line with I&E Margin. The new Use of Resources (UoR) metric is rated at 3, but will rise to a 2 should the Trust meet its financial plans and targets, see below.

Capital and Financing

Use of Resources (UoR) risk ratings

Forecasting

Recovery Plan

#

Whilst it would appear that the gap can be bridged through the plan, this is not without significant risk. Delivery will only be achieved with a considerable coordinated and sustained effort across the organisation. The plan will continue to be refined and presented in more detail to the Financial Recovery Group along with the actions required.

Progress against the capital programme has been slow to date with expenditure at £1.8m against the original profile of £6.0m. The scheduling profile of many schemes was dependent on a number of tendering exercises (the last of which, Perinatal, has now been completed), agreements with third parties (now substantially resolved) and final funding approval (Inpatient schemes approval now received from NHSI, awaiting final confirmation of funds and timing from DH). Schedules for these and related/dependant schemes are now being finalised through discussions with the incumbent contractors and the Trust is pushing forward with work on the affected projects. Discussions with contractors indicate the delays will cause slippage, mainly on the Inpatients (Chorley site - c5 weeks) though a risk of slippage on the Perinatal scheme remains and is being worked on. Impacts on the respective projects have yet to be finalised and incorporated in to forecasts.

Revised year end control totals are being provided to networks in line with the recovery plan and will require:• Progress and delivery of ward staffing actions• Implementation of the recovery plan.• Agreement of OAPs mitigations with commissioners.• Progress on land sales.

Though slightly improved the current I&E position continues to give a rating of 4 and a Capital Service rating of 4 constraining the current overall UoR to a 3. Assuming current pressures and risks are addressed through the recovery plan and I&E performance achieves (or exceeds) forecast the Trust will achieve a UoR of 2 in line with the plan. However, though forecast would achieve the overall target rating, Capital Service is based on EBITDA and since part of the Trusts recovery plan is based on disposals (which are excluded from EBITDA) the Trust is not forecast to achieve planned Capital Service. The Trust is also forecast to exceed its liquidity and slip against it's planned Agency target. Should conditions persist and costs not be managed within the control total then the resulting deterioration might trigger a review of our segmentation.

Forecast ForecastYTD YTD Out-turn Out-turn

Oct 2017 Sep 2017 at Oct 2017 at Sep 20177 6 Note 12 12 Note

Plan 0.610 0.321 Plan 2.167 2.167

Major Variances Major VariancesCIP Slippage -1.054 -0.982 - See CIP section CIP Slippage 0.000 0.000 - See CIP sectionOAPs -0.773 -0.773 - See OAPs section OAPs -1.792 -1.792 - See OAPs sectionStaffing -5.471 -5.000 - See also Bank and Agency section Staffing -8.139 -8.201 - See also Bank and Agency sectionOther Bud Vars 1.708 1.791 - See Services section Other Bud Vars 1.929 0.601 - See Services sectionReserves 3.210 3.040 - See Reserves section Reserves 7.231 8.899 - See Reserves sectionIncome -0.699 -0.688 - See Reserves section Income 0.584 0.514 - See belowMinor Variances 0.000 0.000 Minor Variances 0.000 0.000

Variance -3.079 -2.612 Variance -0.187 0.021

Actual -2.469 -2.291 Actual Forecast 1.980 2.188

----

Surplus - YTD (£m) Surplus - Out-turn (£m)

This month sees an operating deficit of £2.5m, £2.3m after adjusting for impairments, £2.9m behind plan. Of this £0.9m relates to STF funding leaving a net gap from plan of £1.9m.

YTD income variance relates mainly to STF funds which are assumed in forecast along with additional funds re NCAs and R&D

Staffing variance has increased in part due to phasings of development funding in mental health, but more materially due to ward pressures.The full year projection is a surplus of £2.0m, £2.2m after adjusting for impairments. The position models an upside of c£7.0m and includes profit on disposals of c£1.7m.

-10,000.0

-8,000.0

-6,000.0

-4,000.0

-2,000.0

0.0

2,000.0

4,000.0

Plan CIP Surplus OAPs Staffing Other BudVars

Reserves Addl Income MinorVariances

2,167.0 0.0 -1,792.0 -8,139.1 1,928.8 7,231.4 584.1 0.0

-8,000.0

-7,000.0

-6,000.0

-5,000.0

-4,000.0

-3,000.0

-2,000.0

-1,000.0

0.0

1,000.0

Plan CIP Shortfall OAPs Staffing Other BudVars

Reserves Addl Income MinorVariances

610.0 -1,054.2 -773.0 -5,471.3 1,708.2 3,209.9 -698.53 0.0



Plan 193.922 166.144 Plan 332.908 332.908

Major Variances Major VariancesCommunity Services 1.073 0.659 - Note 1 Community Services 2.232 2.172 - Note 1Mental Health 2.956 2.380 - Note 2 Mental Health 2.704 2.598 - Note 2Specialist Services -0.355 -0.196 - Note 3 Specialist Services -1.160 -1.145 - Note 3Non NHS Healthcare Income-1.018 -0.835 - Note 4 Non NHS Healthcare Income-1.804 -1.758 - Note 4R&D 0.274 0.180 R&D 0.389 0.600ETR 0.204 0.167 - Student Income ETR 0.356 0.297 - Student IncomeMiscellaneous -0.047 0.209 - Note 5 Miscellaneous 2.260 1.529 - Note 5STF -0.939 -0.730 STF 0.000 0.000

Minor Variances 0.000 -0.039 Minor Variances 0.000 0.015

Variance 2.148 1.794 Variance 4.978 4.308

Actual 196.070 167.938 Actual Forecast 337.886 337.216

12

345 Major increases in the latter part of the year generated by AHSN.

Monthly Income Variances (£m) Cumulative Income Variances (£m)

Major decrease due to Southport commencing in May and not April offset by minor gains in other services including Rheumatology and District Nursing.Major increases revolve around the phasing of the Out of Area Placements expenditure, in addition to Liaison & Diversion and Eating Disorders. Major decreases in Rehabilitation Services and Hospital Liaison.Income is in line with plan at this stage. Year end variances are driven by the anticipated cessation of the HIV contract.Major decrease in respect of lower than planned activity in Sexual Health services and forecasts for Sexual Health and Offender Health later in the year.

0.000

5.000

10.000

15.000

20.000

25.000

30.000

35.000

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

Actual/Forecast

Plan

0.000

50.000

100.000

150.000

200.000

250.000

300.000

350.000

400.000


Actual/Forecast

Plan



Budget 164.955 141.407 Budget 281.644 281.506

Major Variances Major VariancesMental Health -6.479 -5.654 - Note 1 Mental Health -9.257 -9.961 - Note 1Community & Wellbeing -0.216 -0.274 - Note 2 Community & Wellbeing -0.401 -0.489 - Note 2Children & Young People 0.844 0.705 - Note 3 Children & Young People 0.824 0.866 - Note 3Pharmacy 0.188 0.169 - Note 4 Pharmacy 0.260 0.265 - Note 4Property Services 0.000 0.000 - Note 5 Property Services 0.000 0.000 - Note 5Corporate 0.073 0.089 - Note 6 Corporate 0.571 -0.073 - Note 6

Variance -5.590 -4.965 -8.002 -9.392

Actual 170.545 146.372 Actual Forecast 289.646 290.898

1

23

456 Corporate services are slightly ahead of plan year to date, with overspends in IM&T currently met by underspends in Medical and Human Resources.

Mental Health in year overspend is driven more acutely by excess staffing costs, primarily on wards, (£3.9m). Actions to review the patients in inpatients setting, their appropriateness for the ward and levels of staffing associated with acuity are advanced and should furnish us with the appropriate information to discuss necessary action to recover the position, though risk remains until this is enacted. There is also significant CIP slippage, as all CIPS have been withdrawn but some schemes are still in development (c£1.9m). The Network's position is diminished further by ward overspends in Secure Services wards (c£1.2m). OAPs are now manifesting as overspends (£0.8m for the year)

Community's position is impacted by undelivered CIPs to date (£0.35m). Underspends on community teams and non-pay continue to alleviate the current position.Children and Young People have similarly been impacted by a shortfall on CIP delivery(£0.25m) and Sexual Health activity shortfall (£0.2m) but is currently being compensated for by vacancies and non-pay underspends.

YTD Service Net Expenditure Variance (£m) Forecast Service Net Expenditure Variance (£m)

Pharmacy is performing broadly in line with plan, with some underspends on staffing.Property Services are performing in line with plan and are expected to remain so.

-£7,000

-£6,000

-£5,000

-£4,000

-£3,000

-£2,000

-£1,000

£0

£1,000

£2,000Mental Health

Community &Wellbeing

Children &Young People Pharmacy

PropertyServices Corporate Total

Service Forecast Variance

-£10,000

-£8,000

-£6,000

-£4,000

-£2,000

£0

£2,000Mental Health

Community &Wellbeing

Children &Young People Pharmacy

PropertyServices Corporate Total

Service Year to Date Variance

CIP Achievement (£)Notes

Year to Date PerformanceAt month 7 with CIPs of £7.4m against a plan of £8.4m the Trust is c£1.1m behind plan, a deterioration of £0.1m on month 6 (£1.0m behind plan). The adverse variance is mainly due to the continued lack of performance on Run Rate Reduction Programmes on staffing pressures. Compensating schemes have, and continue to be, developed and network management team are being supported by to implement measures aimed at improving the position.

Schemes to be Transacted£0.9m of schemes are yet to be transacted at month 7 leading to year to date slippage of c£0.5m. There is a good degree of confidence in the delivery of these schemes.

Schemes In Process£1.5m of additional schemes identified are not yet sufficiently detailed to transact and after allowing for slippage factored into plan this results in slippage of c£0.6m. There is some confidence in the delivery of these schemes.

Schemes to be IdentifiedIncluding pipeline schemes plan totals exceed target and though not without risk forecast continues to be broadly in line with plan requirements.

ForecastThe programme is currently expected to achieve the Annual Plan however risk of slippage, particularly on mental health and community schemes, remains.

Plan Actual Variance Plan Forecast Variance

£'m £'m £'m £'m £'m £'m

Cost Improvement Programmes 6.11 6.69 0.58 11.10 13.10 2.00

Run Rate Reduction Programmes 2.33 0.70 -1.63 4.00 2.00 -2.00

Total 8.44 7.39 -1.05 15.10 15.10 0.00


£'m £'m £'m £'m £'m £'m

Monitored Schemes 7.31 7.39 0.07 12.74 12.73 -0.01

Schemes to be transacted 0.52 -0.52 0.89 0.89 0.00

Schemes in Process 0.61 -0.61 2.12 1.51 -0.61

Slippage/Schemes to be identified 0.00 -0.65 -0.03 0.62

Total 8.44 7.39 -1.05 15.10 15.10 0.00

Year to Date Annual

Year to Date Annual

Month Month Month MonthOct 2017 Sep 2017 Oct 2017 Sep 2017

7 6 Note 7 6 Note

Agency Spend 774 863 Note 1 Bank Spend 1,388 1,813

Network Analysis Network AnalysisMental Health 564 554 - Note 2 Mental Health 1086 1484 - Note 2Children & Young Peoples 11 64 - Note 3 Children & Young Peoples 81 80 - Note 3Community & Wellbeing 282 215 - Note 4 Community & Wellbeing 160 197 - Note 4Corporate Services -83 30 - Note 5 Corporate Services 60 52 - Note 5

Actual 774 863 Actual 1,388 1,813

1

2

34

5

The Trust has been given a ceiling by NHS Improvement for agency spend. This target is£7.695m for the year. At the end of period 7, the Trust is -£758k, or 17% above it'strajectory. The new Use of Resources rating measures agency against target and containstrigger points. Key trigger points are a requirement for 50% and 25% or better for ratings of3 and 2 respectively. An individual rating of at least 3 is required to obtain an overall ratingof 2 (see also Use of Resources section).

Corporate Services is net of the charge levied for agency staff. Agency spend is negligible with the exceptions of Health Informatics.

Agency Costs Over Time (£'000) Bank Costs Over Time (£'000)

A high level of vacancies is supported by bank and agency, though increased levels of recruitment mean overall staffing costs remain high. Agency costs have decreased from last month as well as bank costs.Mental Health Networks bank and agency costs are primarily due to the level of acuity on inpatient wards being beyond the level established although the in month decrease in bank is almost entirely attributable to staffing on Adult and Secure wards.Children and Young Peoples temporary staffing remains relatively minor and consistent.Community and Wellbeing sees an increase in both Agency but a fall in Bank, with the major agency change being the with regard to Learning Diability, and bank recovering in Integrated Teams and Southport.


2015/16 935 1108 932 1180 1119 1176 1139 1183 1170 1072 1289 1209

2016/17 1536 1521 1728 1390 1238 1570 1154 1219 1401 1289 1321 1613

2017/18 1312 1268 1625 1365 1481 1813

0200400600800

100012001400160018002000


2015/16 1030 988 1262 1242 909 1202 1149 939 1073 1077 978 1174

2016/17 1098 862 1250 1184 986 1133 781 827 825 738 661 1006

2017/18 647 691 711 704 825 863

0

200

400

600

800

1000

1200

1400

Agency Ceiling Apr May Jun Jul Aug Sep Oct Total Projection

Actual 647 691 711 704 825 863 774 5,216 8,353Plan 639 639 639 636 636 636 633 4,458 7,695Variance -8 -52 -72 -68 -189 -227 -141 -758 -658% of Plan -17% -9%

Month Month YTD ForecastOct 2017 Sep 2017 Oct 2017 Out-turn

7 6 Note 7 12 Note

Plan 0.2 -3.6 Plan 11.8 11.0

Major Variances Major VariancesI&E -0.3 -0.6 - Note 2 I&E -3.1 -2.1 - Note 2Capital & financing 0.6 0.8 - Note 2 Capital & financing 4.4 11.8 - Note 2Contract Vars and Adjs 0.2 -1.1 Note 3 Contract Vars and Adjs -2.7 Note 3Debtors -1.7 1.2 - Note 4 Debtors -3.7 -0.3 - Note 4Timing of settlements to suppliers -0.3 2.9 - Note 4

Timing of settlements to suppliers 0.0 0.5 - Note 4

Provisions and deferred income 0.6 0.0 - Note 5

Provisions and deferred income 1.4 0.4 - Note 5

Opening cash 0.0 0.0 Opening adjustment 2.7 2.7

Minor Variances 0.2 0.3 Minor Variances 0.5 0.6

Variance -0.7 3.4 Variance -0.4 13.6

Actual -0.5 -0.2 Note 1 Forecast Actual/Forecast 11.4 24.6 - Note 1

1

2

34

56 Provisions and Deferred Income are currently generating gains of c£1.9m over plan. Crystallisation of income and redundancy settlements are expected to reduce gains and this is

factored into forecasts.

Monthly Cash and Liquidity Variance (£m) Forecast Cash and Liquidity (£m)

Timing of settlements to suppliers are broadly in line with plan.

Reductions in capital expenditure are supporting cash more than compensating for the impact of the deficit. Forecasts assume planned revenue and capital forecasts are achieved, that PDC for the inpatients Programme is in line with expectations, and that the disposal of Westfields, Ridge Lea and Ribbleton take place in 2017/18.

Late payments by CCGs (£1.0m) and local authorities (£2.1m) coupled with outstanding CQUIN (£0.5m) have lead to a large adverse position on debtors. Late payments were largely settled in early November and the issues are being addressed accordingly (as problems over payment timing rather than disputes). CQUIN payments are a national issue and payment is expected by March.

Forecast cash is ahead of plan by c13.6m partly due to the change in opening position c2.7m, but mainly due to assumptions around disposals (net improvement c£5.75m - Westfields, Ribbleton and Ridge Lea) and the assumed external cash funding of a substantial part of the Inpatient Scheme (net improvement £4.6m). The forecast assumes that proposed management action to bring financial performance back in to line is achieved (including profit on disposals), that capital receipts are in line with expectations, and that the Trust maintains eligibility for Sustainability Funding (achieves the control total).

Cash shows an adverse variance from plan of £0.4m. The capital position continues to offset the I&E position and pressures on working capital have been reduced - see below.

Contract variations and phasing adjustments negatively impact on cash and are not included in plans.

-10.000

-5.000

0.000

5.000

10.000

15.000


Opening cash balance

Financing and Other

Capital and Investment Activities

Changes to WC

Non Cash Flows

Cash flows from operating activities

0.000

5.000

10.000

15.000

20.000

25.000

30.000


Forecast

Plan

YTD Plan YTD Act Annual ForecastOct 2017 Oct 2017 Variance Plan Out-turn Variance

£000 £000 £000 £000 £000 £000

IT Schemes 1.015 0.664 -0.351 1.900 1.900 0.000 - Note 1

Estate and infrastructure SchemesLarge Schemes

MH Inpatient Schemes 3.194 0.401 -2.793 4.580 5.700 1.120 - Note 2

Perinatal 0.000 0.113 0.113 0.000 2.470 2.470 - Note 3

Places of Safety 0.000 0.100 0.100 0.000 0.490 0.490 - Note 4

High Priority Schemes 0.697 0.147 -0.550 1.263 1.260 -0.003 - Note 5

Maintenance and Replacement 0.543 0.310 -0.233 0.930 0.930 0.000Other (inc. contingency) 0.541 0.099 -0.442 0.918 0.911 -0.007

Total 5.989 1.834 -4.155 9.591 13.661 4.070

12

3

4

5

6 The underspend largely relates to contingency and reserves. Some delays as a result of dependencies/focus on large schemes and fire safety have resulted in slippage rather than the expected pressures on contingency. Transfers between revenue and capital transacted are as required.

Note 6-

£3.5m of external cash funding was allocated for the Perinatal project, £2.5m in 2017/18. Again issues with third parties have caused some delays and whilst it was hoped this can be managed, some slippage may be likely. The impact has yet to be finalised and incorporated in to forecast.

£0.5m of external cash funding was allocated for Places of Safety. Funding currently exceeds planned work and should spend not be required this year then funding will be retained by DoH.

Capital Expenditure

Progress against the capital programme has been slow to date with expenditure at £1.8m against the original profile of £6.0m. The scheduling profile of many schemes was dependent on a number of tendering exercises (the last of which, Perinatal, has now been completed), agreements with third parties (now substantially resolved) and final funding approval (Inpatient schemes approval now received from NHSI, awaiting final confirmation of funds and timing from DH). Schedules for these and related/dependant schemes are now being finalised through discussions with the incumbent contractors and the Trust is pushing forward with work on the affected projects. Discussions with contractors indicate the delays will cause slippage, mainly on the Inpatients (Chorley site - c5 weeks) though a risk of slippage on the Perinatal scheme remains and is being worked on. Impacts on the respective projects have yet to be finalised and incorporated in to forecasts.

IT programme is expected to be delivered on forecast.External cash funding was provisionally allocated to the Inpatient project through the STP and was approved by NHSI in October. DH have requested additional information, including additional governance requirements, and final approval remains to be confirmed. Work has commenced though delays in relation to the Chorley site, primarily caused by third parties, have meant that works have started later than originally intended and whilst it was hoped this could be managed, slippage of c5 weeks now appears likely. The impact has yet to be finalised and incorporated in to forecast.

Schemes are underway and despite some delays, partly as a result of inpatient development, schemes are expected to be completed in line with planned outturns.

Use Of Resource Metric

unitsPlan

YTD ending 31-Oct-2017

Actual YTD ending 31-

Oct-2017

Variance YTD ending 31-May-17

Plan YTD ending 31-

Mar-2018

Forecast YTD ending 31-

Mar-2018

Forecast Variance

Year ending31-Mar-18

Threshold 1 2 3 4

\ Capital Service Cover 2.5 1.75 1.25 <1.25Capital Service Cover Liquidity 0 -7 -14 <-14

I&E Margin 1.00% 0.00% -1.00% <=-1%

Capital service metric 0.0x 1.803 1.208 (0.594) 1.909 1.647 (0.262) Variance from plan 0.00% -1.00% -2.00% <=-2%

Capital service rating Rating 2 4 2 3 Agency 0.00% 25.00% 50.00% >=50%

Liquidity Metric Weighting

Capital Service Cover rating 20.00%

Liquidity metric £m (1.062) 3.807 4.869 (0.433) 13.631 14.064 Liquidity rating 20.00%

Liquidity rating Rating 2 1 2 1 I&E Margin rating 20.00%

Variance From Plan rating 20.00%I&E Margin Agency Spend 20.00%

I&E Margin metric % 0.31% (1.15%) (1.46%) 0.65% 0.65% (0.00%)

I&E Margin rating Rating 2 4 2 2

I&E Variance From Plan

I&E Variance from plan metric % (1.46%) (0.00%)

I&E Variance from plan rating Rating 3 2

Agency

Agency metric % (0.65%) 16.24% 16.88% (0.95%) 7.87% 8.82%

Agency rating Rating 1 2 1 2

Use Of Resources Rating

Overall rating unrounded Rating 2.80 2.00 If unrounded score ends in 0.5 Rating - -Rounded score Rating 3 2

Use Of Resources Rating before overrides Rating 3 2

4 Rating Trigger for Use Of Resources Rating Text Trigger No trigger

Use Of Resources Rating after 4 rating override Rating 3 2

Control total override - Control total accepted Text YES YES

Is the provider in Financial Special Measures? Text No No

Use Of Resources Rating after overrides Rating 3 2

Finance and use of resources is one theme of 5 in the Single Oversight Framework. Segmentation and therefore autonomy and support is dependent on performance across all themes.

Note that under the Single Oversight Framework a score of 1 is now the best rating and 4 the worst. A rating of 4 on any metric or an average rating of 3 triggers a concern and a potential support need.

Though slightly improved the current I&E position continues to give a rating of 4 and a Capital Service rating of 4 constraining the current overall UoR to a 3. Assuming current pressures and risks are addressed through the recovery plan and I&E performance achieves (or exceeds) forecast the Trust will achieve a UoR of 2 in line with the plan. However, though forecast would achieve the overall target rating, Capital Service is based on EBITDA and since part of the Trusts recovery plan is based on disposals (which are excluded from EBITDA) the Trust is not forecast to achieve planned Capital Service. The Trust is also forecast to exceed its liquidity and slip against it's planned Agency target. Should conditions persist and costs not be managed within the control total then the resulting deterioration might trigger a review of our segmentation.

• Capital Service is currently a 4 against a plan of 2, an increase in operating performance of c£0.2m would be required to increase the rating to 3.

• Liquidity is currently a 1 against a plan of 2, a deterioration in the liquidity metric of c£3.8m would be required to reduce the rating to 2.

• I&E Margin rating is currently 4 against a plan of 2, an increase in operating performance of c£0.3m would be required to increase the rating to 3 - Note that the adjusted deficit of -£2.3m is £2.9m behind the RCT (£1.9m exc STF)).

• I&E Variance from Plan is currently 3, an increase in operating performance of c£0.3m would be required to increase the rating to 2.

Reserves

Reserve Budget Actual £ Annual Projected £

To Date To Date Variance Budget Actual Variance Narrative

£'000 £'000 £'000 £'000 £'000 £'000

Capital Charges £8,966 £9,168 -£202 £15,546 £13,852 £1,694 Anticipated Profit on Disposals offset by var due to revaluation of estate

Pay Reserve £1,166 £566 £600 £1,529 £969 £559 Charge for Apprentice LevyPressures Reserve £293 £117 £176 £503 £201 £302 Funds to be applied to servicesCIP Reserve £1,028 -£47 £1,075 £1,834 -£80 £1,914 Gain on CIP to be applied to service pressuresEmerging Pressures -£315 £0 -£315 -£2,261 £0 -£2,261 Utilisation of Reserves to meet Emerging PressuresDevelopments £729 £280 £449 £934 £250 £684 Costs to be applied as incurredContracts £168 £0 £168 £227 £0 £227 Minor contract gains to be applied to servicesOrganisational Reset £1,017 £235 £782 £1,734 £573 £1,162 Funds to be returned to Networks, with some staffing chargesAgency & Direct Engagement -£350 -£343 -£7 -£600 -£612 £12 Premium for using non-contracted staffNon Clinical Development £4 £0 £4 £22 £0 £22 Premium for using non-contracted staffSavings to be Identified £0 -£2 £2 £0 -£2,420 £2,420 Additional savings required to deliver control total

Non Pay Inflation £638 £162 £477 £794 £216 £578 Funds to be applied for inflationary pressures

Total £13,346 £10,136 £3,210 £20,263 £12,949 £7,313

MATTERS

ID Meeting DatePaper Status

2017/01 Jul-17 VerbalPartial




2017/05 Jul-17 Verbal

Excluded

2017/06 Jul-17 VerbalExcluded

2017/07 Jul-17 Verbal Excluded

2017/08 Jul-17 VerbalExcluded

The Trust is actively exploring the potential for land sales. Gains may crystallise in 17/18 dependent on timing and profits willcontribute toward the control total.

On-going Claims: The process of reclaiming VAT in relation to older developments continues. Communications with HRMC progressthough timing and amounts remain uncertain. Treatment is being discussed with external audit but initial indications are positive. Thevalue may be up to £2m, though less than half this amount is included in plans and forecasts. Our advisors are actively engaged inbringing this to a final resolution.

SubjectA number of disputes require resolution and may result in arbitration. These concern NHSE, West Lancs, and Pennine CCGs. These arebeing escalated through NHSI.

NHSI is currently clarifying the position around elements of the national contingency reserve, £0.5m of which is now outstanding.

The forecast trajectory with regard to Out of Area Placements (OAPs) is currently projected to £1.6m, with the assumption that the50% risk share applies.

Provision for charges incurred as a result of the organisational reset have been made, the process is largely complete, but somechallenges remain and these may have financial consequences.

STF monies have been included in forecasts on the assumption that the Trust will achieve its revenue control total. Should this not bethe case £2.1m of funding would be lost.The Trust is assessing the impact of recent court decisions around pay for sleepover in Learning Disabilities care placements.

OUT OF AREA ACTIVITY

NetworkActual/ Forecast Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar TotalAcute OAPs (places) 15 11 14 13 10 11 13 15 9 9 9 9 138PICU OAPs (places) 9 13 9 12 12 11 9 9 8 8 8 8 116Total Beds 24 24 23 25 22 22 22 24 17 17 17 17 254Acute OAPs (£'000) 244 185 228 218 168 179 218 244 151 151 137 151 2274PICU OAPs (£'000) 206 308 206 284 284 252 213 206 189 189 171 189 2697Total £'000 450 493 434 502 452 431 431 450 340 340 308 340 4971

1

23

4

567

The Trust has written to commissioners about the pressure caused by patients awaiting alternative placements.The Trust has opened negotiations with commissioners about the financial impact of patients inappropriately occupying our beds in excess of 180 days.

The Trust is mobilising Acute Therapy Services in Pennine and Chorley, Crisis Support Units in Preston and Blackpool, and a Crisis House in Coppull. These services have an impact on the bed trajectory and variations in timing will alter the OAPs usage accordingly.

There is a fund of c£3m for OAPs, financed 50:50 by the Trust and Lancashire CCGs. After this fund is exhausted, any additional OATs are accounted for on the basis of 50:50 split between the Trust and CCGs.

Current projection suggest there will be expenditure of £5.0m for OAPs in 2017/18., though slippage on developments takes the net impact to £4.8m as reported elsewhere.

Commissioners have asked for, and are receiving, monthly actual performance against the profile.

If the current trajectory persists this would present pressure in the order of £2.3m (net).

ForecastActuals

Board of Directors


Report Title Performance Report (QPR)

FOIA Exemption No Exemption

Prepared by Louise Corlett, Head of Business Intelligence

Presented by Sue Moore, Chief Operating Officer


Supporting Executive Director Chief Operating Officer


Report purpose To appraise the Board of Directors of key elements and themes from the Month 7 QPR


To provide high quality services

Board Assurance Framework risk 2.1 The Trust is unable to reposition in the marketplace to become established as a provider of choice achieving excellence

CQC domain Well-led

The Board are asked to note the QPR for month 7 with following comments below:

All NHS I metrics are compliant with the exception of the Early Intervention in Psychosis 2-week

target.

The revised Single Oversight Framework from NHS I contains changes to Operational

Performance metrics, in particular introduction of a new measure on Inappropriate Out of Area

Placements. A reduction in the number of bed days used for inappropriate OAPs is expected

against an agreed baseline and trajectory, both of which are currently being formulated in

conjunction with the STP. This will be presented in further detail at the next Trust Board.

The measures within the Board Balanced Scorecard continue to show the challenges faced by

the organisation currently in relation to our financial position and attracting the best people.

Are we SAFE? Current CQC rating is ‘requires improvement’

Progress on the 16 key priorities in the Quality plan are being monitored through the designated sub-

committee and as shown in the BBSC the current status is that we are on track with 14 priorities and 2

are off track. A detailed update was presented to Board through the Q2 update report.

In month 7, we reported one incident of a potentially avoidable pressure ulcer (grade 3 and 4) however

this is in line with the annual rolling average and is not thought to be the start of a new upward trend.

Nevertheless, a full root cause analysis of the incident is being conducted to identify any new learning

points not already in practice.

As reported last month, levels of physical violence towards staff is still tracking at higher than average in

month 6, and has remained largely static for the last 3 months at around 220 (219 this month). There are

no new areas of concern and the work into the hotspots (PICU and OAMH) continues: The report on a

deep dive review conducted on PICUs has been reported to the Quality and Safety sub-committee and

recommendations accepted which are now being implemented. In addition, the review of personal care

activities on Older Adult wards continues, alongside provision of specific training, and will identify if there

are any changes in clinical practice required. However, as reported last month, the impact of this work

on physical violence against staff is unlikely to deliver a reduction in the short term, and therefore it is

positive that incidence is not increasing.

The incidence of physical violence towards staff alongside the in-month increase in the use of restraint

has also impacted on the performance against the mental health harm free care metric, which has fallen

to 80% against the 90% target in month 7. These 2 metrics are likely to be linked, with the increase in

violence resulting in the requirement for restraint.

The number of Serious Incidents has slightly increased this month and is above the rolling 12-month

average of 7.7 at 10.

Are we CARING?

Current CQC rating is ‘Good’.

We maintain 100% compliance against mixed sex accommodation breaches.

Feedback received through the Friends and Family test is not available at the time of writing for month

7.

The number of compliments has risen slightly in month to 549, however this continues to be well below

the rolling 12 month average. There is a lag in submission of compliments in some areas therefore this

number may increase slightly.

Are we EFFECTIVE?


The improvement in readmission rate for both 30 and 90 days, across both adult and older adult services

has been retained for the fourth consecutive month in month 7. Whilst for 30d the standard of below 8.7%

was achieved, for 90d readmission the target number of 28 was met and the 15% standard exceeded by

only 0.1%. This position demonstrates the impact of maintaining the team leader reviews at

CMHT/CRHTT clinical discussion meetings and maintaining the profile of this cohort of patients at locality

governance groups.

Average Length of stay still remains just above the 31 day standard at 38.8 days. The length of stay on

adult wards includes PICU patients and it is noted that PICU length of stay has fallen slightly to 34 days.

Over the last 4 months, the positive impact of the Joint Advisory Group has been evident and whilst the

focus has been maintained on the patients with a length of stay of greater than 180 days it is inevitable

that the LOS will be variable as patients are discharged. In future months the QPR will also contain LOS

for current inpatients so that we are able to review a complete picture.

Are we RESPONSIVE?


The Trust continues to perform well against NHS I indicators, however, as reported last month an issue

has been identified regarding performance in the Early Intervention in Psychosis service against the 2

week target. Current performance falls significantly below the required 50% at 9.5%. A remedial action

plan to address the under-performance has been developed and is being monitored through a fortnightly

task group. Operationally, the requirement to enable timely access and treatment for this patient group

within 2 weeks, is being managed through a daily call with all team leaders. This daily call is enabling

current referrals to be managed in accordance with the 2 week standard, notwithstanding patient choice.

However, the impact of long waiting patient referrals on our performance throughout the remainder of Q3

will make recovery of the target challenging. A formal report was received by SLT in November and SLT

will be kept briefed on progress in achievement of the Q3 target. In addition, formal reporting against the

remedial action plan will be reported to Corporate Governance and Compliance sub-committee.

Responsiveness is also demonstrated through our achievement of the 18 week referral to treatment

(RTT) standard for AHPs and for dental waiting times. In the Community Wellbeing Network, the dental

service RTT in Liverpool prison has recovered back to 100% following the failure to meet the 95% target

in month 6. The Community Well Being Network are compliant against all contractual RTT measures.

In the Children and Young People’s Wellbeing Network, 3 out of 5 services across which we report in

month 7 against the 18 week RTT pathways are compliant, which maintains the improvement seen in

month 5 and month 6.

The Children’s Speech and Language Therapy service have achieved the RTT measure of 92% of

patients on the waiting list having waited less than 18 weeks for the third consecutive month, reporting

98% and as such are no longer required to submit an exception report.

The 2 areas of performance which remain challenged are Child Psychology and CAMHs Tier 3.

Performance in Child Psychology for month 6 has improved to 89%, a further increase on the 84%

reported in month 6 against the 95% RTT standard. In addition, the number of children on the waiting list

who have waited >18 weeks continues to reduce (from 49 in month 6 to 32 in month 7) which is a positive

indicator of the impact that the recovery plan is having and moves the service closer to being able to

achieve the 95% target once the backlog is cleared.

Conversely, performance in the CAMHS Tier 3 service has deteriorated further and the service are

reporting 57% against the 95% RTT standard for completed pathways (compared to 59% in month 6).

The Chorley and South Ribble team continue to be the main contributor to the under-performance with

264 of the 289 service users who are on the waiting list having waited greater than 18 weeks. This is a

result of capacity shortfalls caused by sickness and vacancies, an issue that is being addressed by the

appointment of a new team leader and further appointments are expected in Q3. The longest waiters

are being focussed on in month 8 with all patients waiting greater than 36 weeks being offered

appointments. Weekly meetings are being held with teams to manage the actions necessary to deliver

improvements in line with the trajectory.

In Mindsmatter, a number of measures are monitored that indicate our overall responsiveness. The

service continues to perform well against the NHS I indicators for referral to treatment in 6 and 18 RTT

weeks and percentage of patients entering recovery. Also positive is the reduction in the number of

patients on the waiting list who have waited longer than 26 weeks which has fallen this month to 14. This

will be monitored closely to ensure it drops further. Performance against

prevalence continues to be challenging at team level. Cumulative prevalence is being measured against

the current target and the trajectory required to meet the 16.8% by Q4 (for all teams except BwD). Teams

are largely on track with the current target (with exception of St Helens) but are falling short against the

increased targets for Q4. In depth monitoring and a number of interventions are underway to increase

prevalence.

The high demand for inpatient beds continues, with occupancy levels exceeding 100%, consequently,

the number of out of area placements (OAPs) continues to exceed plan. Work on reducing the number

of patients who have a length of stay of greater than 180 days continues, as identification of alternative

provision would potentially enable the resolution of the OAPs position. As reported last month STP leads

have supported the view that the financial impact of this cohort of patients is separate to the OAPs spend

and as a result the Network have secured support for the implementation of an integrated discharge team

from the end of December.

Mental health liaison teams (MHLT) are reporting an improved position in relation to the 12 hour breach

numbers with a reduction from 8 to 6 in month 7. This demonstrates the impact of the significant

operational management oversight on patient flow and ensuring patients access care in a timely manner.

Demand for the teams continues to be challenging and performance against the 1h and 4h metrics

remains below target. Improvement is expected over coming months given the early investment that has

been secured around Core 24, of which we were notified on the 1st November.

This month the number of complaints has reduced very slightly to 145 compared to 149 in month 6, but

is only marginally above the rolling average of 136 per month. The number of upheld complaints has

risen sharply in month to 43 from 21 in month 6 against an average of 26.7. Notable themes within the

upheld complaints are communication and treatment are addressed via service level action plans. The

number of re-opened complaints and those escalated to the ombudsman remains extremely positive and

may demonstrate the satisfaction of complainants with the outcome of their complaints.

Are we WELL-LED?


As reported last month, the staff engagement score for the Q2 position shows a static position with only

a decimal point increase on the Q1 position. A further update will be available after Q3.

Sickness rates have risen again to 6.88%, off track in relation to achieving a 4.5% target. The increase

is largely driven by increases in the Mental Health Network where the percentage is 8.5%. Work

continues on absence management across all areas in accordance with policy.

Summary and Recommendations

The information in the QPR provides evidence of our performance against key metrics aligned to each

CQC domains. From this, and the exception reporting against each measure, we are able to provide

information that supports the assessment of our position against each domain.

Quality & Performance

Report

Month 7 – October 2017

Performance Management

Quality and Performance Report:-

Section 2:- Performance and Data Quality

Section 2.1:- Performance Activity

• NHS Improvement Indicators Dashboard • NHS Improvement Indicators Kitemarking • Key Exceptions • CCG Level Data • Network Level Summary • Key Network Exceptions

Section 2.2:- Patient Flow • Patient Flow Summary • Key Patient Flow Exceptions

Section 2.3:- Data Quality • Data Quality Summary • Key Data Quality Exceptions

Section 3:- Finance and Contracting

Section 3.1:- Financial Activity

• UoR Risk Rating • Summary I&E Position • Summary of Clinical Services • CIPS • Capital Expenditure

Section 3.2:- Community Contract Activity • Community & Wellbeing – Network Line Totals • Community & Wellbeing – Service Line Totals • Community & Wellbeing – Total Activity Split by CCG • Community & Wellbeing – Activity Exception Reports by CCG • Children & Young People’s Wellbeing – Service Line Totals • Children & Young People’s Wellbeing – Exception Reports by

Service • Children & Young People’s Wellbeing – Total Activity Split by CCG • Mental Health – Total Activity Split by CCG • Mental Health – Activity Totals

Section 3.3:- Commissioning for Quality & Innovation • CQUIN Executive Summary

2

Section 6:- Risk

• Board Assurance Framework

Section 4:- Quality

• Quality and Safety Tile • Quality Surveillance – Safe • Quality Surveillance – Effective • Quality Surveillance – Caring • Quality Surveillance – Responsive • Quality Surveillance – Well Led • Delivering the Strategy

Section 5:- Workforce

• Actual Workforce Costs Compared to Budget • Sickness Absence Rates • Appraisals and Mandatory Training Compliance • Vacancy Management and Active Recruitment • Core Workforce Headcount • Workforce Turnover

Section 1:- Board Balanced Score Care

• Trust Strategic Priorities • Board Summary • Quality & Safety • Service Delivery • People & Leadership • Finance

Appendix 1:- Southport & Formby

• NHS Improvement Indicators Dashboard • NHS Improvement Indicators Kitemarking • Southport & Formby Summary • Finance & Contracting • Quality • Workforce


Board Balanced Score Card

Section 1

3


1. Board Balanced Score Card Trust Strategic Priorities

Strategic Priority Strategic Blueprint

Co

mp

as

sio

n

To provide high quality

services

We will ensure that people who use our services are at the heart of everything we do, and the people who deliver and support

delivery of services are motivated, engaged and proud to provide high quality, compassionate, continually improving care. We

will empower people to share their stories so that we know how we are doing and we will listen to learn and to improve quality

together. We will continue to strive to be the best that we can be by upholding our 8 quality commitments and the ‘I’ statements,

empowering everyone to embrace these personal pledges.

Inte

gri

ty

To deliver sustainable services

that meet the needs of local

people

We will collaborate with partners to deliver system wide transformation and we will be an active partner in delivering a bespoke

offer to a number of Accountable Care Systems by

being the prime provider of specialist, acute and community mental health services, and

a lead provider in delivering new models of integrated physical and mental health out of hospital services, and

realising the benefits of our geographical footprint to deliver system wide sustainable infrastructure solutions and

organisational vehicles for new models of care.

Whilst our principal footprint for delivery of services is Lancashire and South Cumbria, we will continue to seek opportunities

across North West STP footprints.

Te

am

wo

rk

To become recognised

for excellence

Our service users and carers will tell us that our services are of high quality. Our people will recommend us to family and

friends. We will be respected by our commissioners and other providers as a co-producing partner in shaping new service

models that deliver our aligned strategies with an emphasis on place based care.

Res

pe

ct

To employ the best

people

We will develop an organisational culture and leadership team equipped to meet its strategic intent and the needs of both its

workforce and the population it serves; in short, a culture of high performing, continually improving and compassionate care.

Staff will be motivated, engaged, high performing and proud of the service they provide. We will proactively support staff to look

after their own health and wellbeing, and to reach their full potential. We will identify and grow our future leaders. People will

want to work here.

Ac

co

un

tab

ilit

y

To provide financially

sustainable services

We will restore and maintain financial balance, and provide services that offer excellent value for money without compromising

financial sustainability. We will work with local partners to deliver system wide efficiency measures. We will actively seek

business opportunities that add value for local people.

Ex

ce

lle

nc

e

To innovate and exploit

technology to transform

care

We will develop and promote digital enabled care, and lead research and innovation to enhance patient experience, reduce

costs and/or improve quality. We will have a culture where staff are given the time, training and resources to research and

innovate. Research will validate innovations and innovations will direct research. Partnerships with third party organisations will

enable rapid execution and exploitation of innovation projects.

4


Research Studies

Aug Sep Oct

127 60 38

Business Gained - Lost

Aug Sep Oct

-£2,230,000 -£602,688 -£51,600

OAPS

Aug Sep Oct

23.68 26.17 24.58

NHSI Compliance

Aug Sep Oct

92.9% 92.9% 92.9%

Sickness Absence

Aug Sep Oct

6.18% 6.35% 6.88%

Agency Ceiling

Aug Sep Oct

-188,237 -222,185 -132,475

UoR

Aug Sep Oct

3 3 3

Revenue Control Total

Aug Sep Oct

-1.4% -1.4% -1.2%

CIP

Aug Sep Oct

86% 86% 88%

Liquidity

Aug Sep Oct

1 1 1

1. Board Balanced Score Card Summary

Capital Expenditure

Aug Sep Oct

33% 29% 31%

Contract Performance (MH)

Aug Sep Oct

+0.88% +0.84% -0.84%

Contract Performance (Comm)

Aug Sep Oct

-1.2% -0.4% -0.6%

Engagement Score

Q4 16-17 Q1 17-18 Q2 17-18

3.77 3.73 3.74

National COPD Audit

Programme

Report due Feb

2018

Use of depot/LA

antipsychotics for relapse

prevention – baseline audit

Report due Nov 2017

Prescribing for bipolar

disorder (use of sodium

valproate) re-audit

Report due Feb 2018

Quality Plan

17/18 objectives 16

On track Off track

12 4

Service Delivery Quality & Safety

People & Leadership Finance

5

Prescribing of high dose

antipsychotics

Acute wards & PICU rank 14/57

Secure Services 20/46


1. Board Balanced Score Card Quality & Safety

Quality Plan

Four Quality Priorities are currently marked as “off track” which are: violence to staff, pressure ulcers, new professional roles

and mental health law. In all cases this is due to the outcome measure not being achieved, the actual improvement projects

themselves are on track. A mid year review is planned for December to review each programme in detail.

Target: 16 objectives

On track 12 Off track 4

Research Studies

Data is subject to a 6-8 week lag as it is uploaded by research teams to a national system retrospectively. Recent recruitment

to the SSHEW clinical trial has an additional 5 weeks until randomisation, leading to significant lag in recruits appearing in

national figures. Local data shows that activity is currently forecast to meet this year’s annual target. Target: 100 participants monthly

38

6

National Audit –

National COPD Audit

Programme

The aim of the project is to audit the activity of the 2 LCFT PR programmes against BTS Quality standards for Pulmonary Rehabilitation in Adults

and compare results with the initial audit which took place in 2015.

The report is due February 2018. Target: Upper quartile nationally

National Audit –

Prescribing for bipolar disorder

(use of sodium valproate) re-

audit

The aim of this topic is to identify any improvement in practice around prescribing in bipolar since the initial audit carried out by POMH-UK.

The report will be published Feb 2018.

Target: Upper quartile nationally

National Audit –

Use of depot/LA antipsychotics

for relapse prevention –

baseline audit Data for this project has been submitted and a report is due November 2017.


National Audit –

Prescribing of High dose

antipsychotics

A total of 3 standards were included in the audit. The results demonstrated the trust were in the upper quartile for 2 standards.

These standards assessed that the dose of an antipsychotic was within SPC/BNF limits and that only one antipsychotic should

be prescribed at a time. Upper quartile performance was not achieved for standard 3, this was a newly introduced audit

standard. However, overall across all 3 standards acute wards and PICUs were in the upper quartile nationally. Secure

Services were not in the upper quartile, this was a smaller sample than for acute wads and PICUs and an improvement plan has

been developed.


Achieved


1. Board Balanced Score Card Service Delivery

Business Gained – Business

Lost

Target: 1.5% over next 12 months

(year-end)

Out of Area Placements

(OAPS) The average number of OAPs decreased slightly in October by 1.59 alongside a decrease in the OAP OBD in October with a position of 762, a

decrease of 23 from September.

The overall number of OAPs remains relatively static against an assumed fall in the trajectory.

Target: 15 contracted beds

24.58

Contract Activity - Community

Target achieved. Target: 100% (+/-10%)

-0.6%

Contract Activity – Mental

Health Following an investigation into MAS data being inflated due to ‘Notes’ being included within reporting, LCFT have removed ‘Notes’ from the

following affected services: MAS, ADHD, Eating Disorders and Hospital Liaison, which has seen the Trust overall variance against last year’s plan

fall from 0.84% to -0.84%. Target: 100% (+/-10%)

-0.84%

NHSI Compliance

All NHSI measures are compliant for M7 apart from EIP (MR13), which has been under a period of revalidation and investigation. Work within the

Network is currently ongoing and it is anticipated that performance is still achievable for Q3. Target: 100% in each quarter

92.9%

7


Agency Ceiling

Usage of Agency in Community, HMP Liverpool and Medics has been

consistent across the last two months, with only small deviation.

The percentage of annual leave in month has dropped considerably

and this can be seen in the reduction in Agency spend.

Target: 641,250

Not achieved

1. Board Balanced Score Card People & Leadership

Aug Sep Oct

YTD Target 641,250 641,250 641,250

YTD Actuals 829,487 863,435 773,725

Under/(Over)

Agency

Usage

-188,237 -222,185 -132,475

Engagement Score Q2 2017/18 period results :

• Recommend LCFT as a place to receive treatment (Workforce Advocacy): Yes – 71.41%, No – 10.31%, Don’t Know – 18.28%

• Recommend LCFT as a good place to work: (Workforce Involvement and Motivation): Yes – 51.75%, No – 27.35%, Don’t Know – 20.89%

Improvement Initiatives:

A Wellbeing dimension has been added to the Quarterly Staff FFT questionnaire. This supplements the 3 existing dimensions of Advocacy,

Motivation and Involvement. The first Staff FFT report to include this new dimension will be available in January 2018.

Target: Top 25% of other Trusts

Not achieved

Sickness Absence

The sickness absence rate for October has increased, reporting at 6.88%. Please refer to the relevant M7 QPR detailed slides for information

about Improvement plans and initiatives. Target: 4.5%

6.88%

8


1. Board Balanced Score Card Finance

Use of Resources (UoR)

The current I&E position gives a rating of 4 and delivers a Capital Service rating of 4 constraining the current overall UoR to a 3. Assuming

current pressures and risks are addressed through the recovery plan and I&E performance achieves (or exceeds) forecast the Trust will achieve

a UoR of 2 in line with the plan. Target: 2

3

Capital Expenditure Progress against the capital programme continues to be slow with year-to-date expenditure at £1.8m against the original

profile of £5.9m. A number of issues have recently been resolved which will allow the Trust to push forward with the work

required to complete its capital programme in line with its control total and funding, however given the delays, risks of slippage

remain.

Target: 85-100%

31%

Revenue Control Total A number of risks and pressures have been identified that if not addressed will compromise the Trusts ability to deliver the planned control total

for 2017/18. Whilst it would appear that the gap can be bridged through the recovery plan, this is not without significant risk. Delivery will only be

achieved with a considerable coordinated and sustained effort across the organisation. Target: ≥0%

-1.2%

Cost Improvement

Programmes (CIPs) At £7.4m in month 7 the Trust is c£1.1m behind the plan of £8.4m. The adverse variance is mainly due to a lack of performance on Run Rate

Reduction Programmes on staffing pressures. Compensating schemes have, and continue to be, developed and network management team are

being supported by to implement measures aimed at improving the position. Target: ≥100%

88%

Liquidity

Forecasts indicate that with the delivery of the planned surplus the Trust will achieve a liquidity of 1. Target: 2

1

9

*Under the Single Oversight Framework, the Trust is now managed against the Use of Resource Metrics (UoR). Under the Single Oversight Framework, a score of 1 is now the

best rating and 4 the worst. A rating of 4 on any metric or an average rating of 3 triggers a concern and a potential support need.


2. Performance and Data Quality

10

Section 2:- Performance and Data Quality

Section 2.1:- Performance Activity

• NHS Improvement Indicators Dashboard

• NHS Improvement Indicators Kitemarking

• Key Exceptions

• CCG Level Data

• Network Level Summary

• Key Network Exceptions

Section 2.2:- Patient Flow

• Patient Flow Summary

• Key Patient Flow Exceptions

Section 2.3:- Data Quality

• Data Quality Summary

• Key Data Quality Exceptions


Performance Activity

Section 2.1

11


2.1 Performance Activity NHS Improvement Indicators Dashboard

12

.

Indicator Target Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Q1 17-18 Q2 17-18 YTDRolling 12

Month Sparkline

MR01 - 7 Day Follow Up 95.00% 96.9% 98.2% 98.8% 96.1% 97.6% 98.6% 96.8% 95.9% 94.1% 96.8% 99.5% 98.0% 97.1% 96.7% 97.04%

MR02 - CPA Review within 12 Months 95.00% 97.4% 97.8% 96.9% 97.1% 97.5% 97.0% 97.1% 96.1% 95.9% 97.0% 96.4% 96.5% 96.7% 96.4% 96.57%

MR03 - Mental Health Delayed Transfers of Care ≤ 7.5% 3.68% 4.19% 3.81% 2.84% 2.59% 3.01% 3.21% 3.36% 2.80% 2.52% 2.77% 2.65% 3.19% 2.70% 2.90%

MR05 - RTT - Consultant Led (Completed Pathway) 95.00% 95.2% 96.3% 96.7% 97.6% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.00%

MR06 - RTT - Consultant Led (Incomplete Pathway) 92.00% 95.2% 95.4% 97.3% 100.0% 99.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.7% 100.0% 100.0% 99.94%

MR07 - IP Access to Crisis Res. Home Treatment 95.00% 100.0% 100.0% 98.6% 99.4% 97.7% 100.0% 100.0% 99.5% 100.0% 100.0% 100.0% 100.0% 99.8% 100.0% 99.92%

MR08 - MH Data Completeness - Identifiers 97.00% 99.6% 99.6% 99.6% 99.6% 99.6% 99.6% 99.6% 99.7% 99.4% 99.4% 99.4% 99.4% 99.6% 99.4% 99.51%

MR09 - MH Data Completeness - Outcomes 50.00% 83.7% 83.8% 83.4% 83.2% 83.4% 83.7% 82.2% 81.8% 81.8% 81.7% 80.8% 81.2% 82.5% 81.4% 81.83%

MR13 - 2 Week wait for Treatment for EIP Programme 50.00% 74.3% 76.7% 82.0% 81.4% 74.4% 11.1% 7.1% 0.0% 9.5% 11.8% 15.6% 9.5% 6.0% 12.6% 9.42%

MR14 - RTT - IAPT 6 Weeks 75.00% 93.0% 96.5% 95.1% 95.7% 93.4% 96.4% 94.7% 95.1% 94.5% 94.4% 94.5% 94.6% 95.4% 94.4% 94.85%

MR15 - RTT - IAPT 18 Weeks 95.00% 99.0% 99.8% 99.4% 99.8% 98.8% 99.4% 99.2% 99.7% 99.3% 99.4% 99.5% 99.7% 99.5% 99.4% 99.47%


2.1 Performance Activity NHS Improvement Indicators Kitemarking

Kitemarking key:

• SOP – Does the indicator have an associated SOP that is within date?

• External Audit – Has this measure been subjected to an external audit within the last 2 years?

• Internal Audit – Has this measure been subjected to an internal audit within the last 2 years?

• Electronically Populated – Is this indicator produced using electronically generated numerators and denominators?

• Manual Overrides – Has the performance for this indicator been produced using manual overrides to indicate false positives or

negatives?

13


2.1 Performance Activity NHS Improvement Indicators Kitemarking

14


Trust position for Lancashire CCGs:

- In Month 7, the Trust has achieved a performance of 97.9%

against a target of 95% across 8 CCGs.

CCG position:

- In Month 7, the Trust has underperformed in 1 CCG: Greater

Preston.

Unassigned CCG:

- In Month 7, there were 4 records unassigned a CCG, of which

100% (4) were completed.

15




CCG position:

- In Month 7, the Trust has achieved compliance for all CCGs.

Unassigned CCG:


88.5% (54) were completed.

CPA 12 Month Review 7 Day Follow Up

2.1 Performance Activity NHS Improvement Indicators reported by CCG

Note: The total figures in the tables above differ from page 12 as they are

representative of only 8 contracted CCGs.

Jun-17 Jul-17 Aug-17 Sep-17 Oct-17

100.0% 90.9% 94.7% 100.0% 100.0%

97.4% 100.0% 92.9% 96.2% 100.0%

100.0% 83.3% 100.0% 100.0% 100.0%

93.5% 95.7% 100.0% 100.0% 98.0%

100.0% 95.5% 100.0% 100.0% 100.0%

100.0% 94.7% 100.0% 100.0% 93.8%

100.0% 100.0% 86.7% 100.0% 95.0%

90.0% 90.9% 100.0% 100.0% 100.0%

97.5% 94.6% 97.2% 99.5% 97.9%

NHS Fylde & Wyre CCG

NHS Greater Preston CCG

NHS Morecambe Bay CCG

NHS West Lancashire CCG

7 DFU CCG

NHS Blackburn with Darwen CCG

NHS Blackpool CCG

NHS Chorley & South Ribble CCG

NHS East Lancashire CCG

Total Figure - 8 CCGs


97.2% 95.3% 98.8% 96.7% 95.6%

95.8% 95.5% 96.2% 96.8% 95.5%

95.2% 95.1% 96.6% 94.0% 95.3%

95.1% 95.6% 96.0% 96.0% 96.5%

96.0% 95.6% 98.0% 98.0% 99.6%

97.9% 97.9% 98.4% 98.2% 98.0%

96.7% 97.0% 95.5% 96.8% 96.1%

95.6% 95.6% 96.9% 95.2% 97.8%

96.2% 96.0% 97.1% 96.5% 96.6%Total Figure - 8 CCGs






12 month CPA


NHS Blackpool CCG






Delayed Transfers of Care (DToC)

16

IP Access to Crisis Resolution Home Treatment



against a target of <7.5% across 8 CCGs.

CCG position:


Unassigned CCG:


0% (0) were delays.


- In Month 7, the Trust has achieved a performance of 100%


CCG position:



3.97% 1.57% 1.56% 1.55% 1.63%

0.68% 0.00% 0.09% 2.32% 2.00%

2.00% 6.70% 3.82% 2.64% 4.05%

3.20% 2.69% 2.53% 2.92% 3.91%

4.20% 3.37% 2.80% 2.21% 2.11%

5.68% 4.49% 4.63% 3.56% 2.64%

0.00% 0.00% 0.13% 2.09% 0.00%

0.14% 0.00% 3.67% 4.28% 4.98%

2.99% 2.55% 2.47% 2.72% 2.61%




NHS Lancashire North CCG



DToC


NHS Blackpool CCG



100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

94.7% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

99.4% 100.0% 100.0% 100.0% 100.0%

% IP Access to CRHTT


NHS Blackpool CCG












RTT – Consultant Led (Completed Pathway)

17

RTT – Consultant Led (Incomplete Pathway)


- In Month 7, the Trust has achieved a performance of 100%


CCG position:





CCG position:


Note: NHS England guidance published in October 2015 confirmed that the incomplete pathway operational standard should became the sole

measure of patients’ constitutional right to start treatment within 18 weeks. And whilst we are required to maintain reporting on the completed

admitted pathway, the removal of the completed admitted pathway as an operational standard means that there is no longer any provision to report

pauses or suspensions in RTT waiting time clocks in monthly RTT returns to NHS England. This means that patients choosing to cancel

appointments can impact negatively on this measure.


100.0% - - 100.0% -

- - - - 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

- - - - -

- 100.0% - 100.0% -

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% - - - -

100.0% - - - -

100.0% 100.0% 100.0% 100.0% 100.0%Total Figure - 8 CCGs






RTT Complete


NHS Blackpool CCG



- - - - -

- - 100.0% 100.0% -

100.0% 100.0% 100.0% 100.0% 100.0%

- - 100.0% - -

100.0% - 100.0% - -

100.0% 100.0% 100.0% 100.0% 99.4%

- - 100.0% 100.0% 100.0%

- - - - -

100.0% 100.0% 100.0% 100.0% 99.7%

RTT Incomplete


NHS Blackpool CCG












MH Identifiers

18

MH Outcomes




CCG position:


Unassigned CCG:

- In Month 7, there were 3120 records unassigned a CCG, of

which 94.3% (2941) were completed.




CCG position:


Unassigned CCG:


84.6% (148) were completed.


99.8% 99.8% 99.8% 99.8% 99.8%

99.9% 99.7% 99.7% 99.8% 99.8%

99.7% 98.8% 98.8% 98.8% 98.9%

99.8% 99.8% 99.8% 99.8% 99.8%

99.7% 99.7% 99.7% 99.7% 99.7%

99.8% 99.6% 99.6% 99.6% 99.6%

99.7% 99.7% 99.7% 99.7% 99.6%

99.7% 99.7% 99.7% 99.7% 99.6%

99.8% 99.6% 99.6% 99.6% 99.6%

MH Identifiers


NHS Blackpool CCG









77.3% 76.0% 74.7% 72.9% 73.8%

78.6% 77.7% 78.6% 78.1% 79.3%

86.8% 86.6% 86.0% 85.0% 84.2%

83.0% 83.4% 83.4% 82.8% 82.5%

84.9% 84.8% 84.9% 86.0% 85.8%

80.4% 80.6% 80.9% 80.4% 80.5%

89.5% 90.1% 89.4% 89.0% 89.9%

77.1% 78.1% 78.2% 75.6% 75.2%

81.9% 81.9% 81.7% 80.9% 81.3%

MH Outcomes


NHS Blackpool CCG












2ww EIS

19


- In Month 7, the Trust has achieved a performance of 9.5% against a target of

97% across 8 CCGs.

CCG position:

- In Month 7, the Trust has underperformed for 7 CCGs: Blackburn with

Darwen, Blackpool, Chorley & South Ribble, East Lancs, Fylde & Wyre,

Greater Preston and West Lancs.

Due to ongoing validation, CCG split is only available for October.


16.7%

0.0%

0.0%

0.0%

0.0%

0.0%

50.0%

0.0%

9.5%

2ww EIS


NHS Blackpool CCG












IAPT – 6 Weeks

20

IAPT – 18 Weeks




CCG position:





CCG position:



77.3% 78.7% 82.0% 83.8% 79.6%

97.4% 95.6% 95.1% 99.1% 92.4%

96.1% 98.1% 97.5% 97.4% 97.4%

97.6% 94.1% 96.7% 94.4% 97.8%

95.3% 94.4% 91.9% 94.8% 99.2%

94.2% 91.1% 92.4% 90.4% 88.7%

97.3% 93.9% 98.6% 92.7% 98.5%

94.4% 93.6% 93.8% 94.1% 94.2%

Not Commissioned







RTT IAPT 6 Wks


NHS Blackpool CCG



98.7% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 99.2% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 97.1% 98.9% 98.9% 100.0%

100.0% 99.2% 98.1% 98.7% 100.0%

98.1% 96.7% 100.0% 97.9% 98.1%

100.0% 100.0% 100.0% 100.0% 100.0%

99.6% 99.2% 99.4% 99.4% 99.8%

RTT IAPT 18 Wks


NHS Blackpool CCG




Not Commissioned






2.1 Performance Activity Summary – Mental Health

21

Indicators achieved Target Type Target Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17Rolling 12 Month

Sparkline

NHS Improvement

CPA 7 Day Follow Up (Total Network Performance) NHSI 95.00% - 96.7% 98.1% 98.7% 96.7% 97.8% 98.5% 96.8% 95.7% 94.3% 96.6% 99.4% 97.8%

CPA 7 Day Follow Up (AMH) NHSI 95.00% 97.5% 96.8% 98.4% 98.5% 96.9% 98.4% 98.9% 96.9% 96.2% 94.4% 96.0% 99.4% 97.5%

CPA 7 Day Follow Up (OA) NHSI 95.00% 83.3% 95.5% 95.7% 100.0% 95.0% 93.5% 96.2% 100.0% 96.0% 92.3% 100.0% 100.0% 100.0%

CPA 7 Day Follow Up (SS) NHSI 95.00% - 100.0% 100.0% 100.0% 50.0% 100.0% 0.0% 80.0% 50.0% 100.0% 100.0% 100.0% 100.0%

CPA 12 Month Review (Total Network Performance) NHSI 95.00% - 97.3% 97.7% 96.7% 97.0% 97.5% 97.0% 97.2% 95.9% 95.7% 96.8% 96.3% 96.4%

CPA 12 Month Review (AMH) NHSI 95.00% 97.4% 96.9% 97.4% 96.3% 96.6% 97.3% 96.5% 96.8% 95.3% 95.1% 96.3% 95.7% 95.9%

CPA 12 Month Review (OA) NHSI 95.00% 98.8% 100.0% 99.7% 100.0% 100.0% 100.0% 99.7% 100.0% 99.1% 98.4% 99.7% 99.7% 99.4%

CPA 12 Month Review (SS) NHSI 95.00% 98.8% 100.0% 100.0% 98.2% 98.2% 97.0% 100.0% 98.8% 100.0% 100.0% 99.4% 100.0% 100.0%

Delayed Transfers of Care (Total Network Performance) NHSI ≤ 7.50% - 4.20% 4.79% 3.76% 2.60% 2.39% 3.10% 3.33% 3.48% 2.89% 2.39% 2.55% 2.49%

Delayed Transfers of Care (AMH) NHSI ≤ 7.50% 1.82% 1.23% 3.06% 3.66% 2.19% 2.27% 3.26% 3.42% 2.94% 2.31% 1.06% 0.49% 0.66%

Delayed Transfers of Care (OA) NHSI ≤ 7.50% 16.59% 14.48% 10.34% 4.11% 3.92% 2.70% 3.27% 2.06% 3.08% 2.72% 4.03% 6.29% 6.01%

Delayed Transfers of Care (SS) NHSI ≤ 7.50% 1.35% 2.41% 2.77% 3.91% 3.80% 3.08% 2.74% 3.85% 4.61% 4.00% 3.82% 4.03% 3.68%

IP Access to Crisis Res. Treatment (Gatekeeping) NHSI 95.00% 98.3% 100.0% 100.0% 98.6% 99.4% 97.7% 100.0% 100.0% 99.5% 100.0% 100.0% 100.0% 100.0%

MH Data Completeness - Identifiers NHSI 97.00% - - - - - - 99.6% 99.6% 99.7% 99.5% 99.5% 99.6% 99.5%

MH Data Completeness - Identifiers (AMH) NHSI 97.00% 99.6% 99.7% 99.7% 99.7% 99.8% 99.7% - - - - - - -

MH Data Completeness - Identifiers (SS) NHSI 97.00% 98.1% 98.1% 97.9% 98.4% 98.4% 98.5% - - - - - - -

MH Data Completeness - Outcomes NHSI 50.00% - - - - - - 85.8% 84.8% 84.5% 84.6% 84.5% 83.6% 83.7%

MH Data Completeness - Outcomes (AMH) NHSI 50.00% 84.4% 85.1% 85.3% 85.2% 85.2% 85.4% - - - - - - -

MH Data Completeness - Outcomes (SS) NHSI 50.00% 84.3% 85.1% 83.4% 82.5% 81.3% 79.6% - - - - - - -

Other Indicators

AQ Dementia (OA) (1 month in arrears) NHSE 59.30% 100.0% 90.9% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% -

Memory Assessment Service (MAS) seen within 6 weeks (OA) NHSE 70.00% 40.5% 40.2% 39.5% 25.7% 40.3% 48.4% 47.0% 52.1% 70.4% 79.8% 80.4% 79.6% 78.1%

PBR Clustering NHSE 95.00% 94.2% 96.1% 96.4% 96.8% 96.4% 96.5% 96.5% 96.6% 96.7% 96.4% 95.7% 95.9% 95.1%

No of Patients without a Care Co-ordinator Allocated > 2 Weeks (Total

Network Performance)NHSE 0

407 331 307 313 255 260 267 255 211 233 210 - -

No of Patients without a Care Co-ordinator Allocated > 2 Weeks (AMH) NHSE 0324 292 266 262 222 253 245 243 187 203 183 - -

No of Patients without a Care Co-ordinator Allocated > 2 Weeks (SS) NHSE 0 83 39 41 51 33 7 22 12 24 30 27 - -

MHLT

MHLT 1hr compliance Commissioners 95.00% 37.8% 52.6% 45.7% 46.9% 38.7% 51.8% 51.6% 45.9% 47.5% 40.8% 39.5% 42.5% 45.5%

No of 4hr breaches (Percentage of total) 5.00% 4.8% 10.1% 7.7% 11.2% 15.4% 9.7% 9.5% 11.4% 14.8% 16.1% 15.1% 16.4% 14.5%

No of 4hr breaches (Number of breaches) 36 25 53 49 75 102 71 67 79 110 116 102 108 104

No of 12hr breaches (Percentage of total) 0.00% 1.5% 2.1% 0.9% 1.5% 1.2% 3.3% 0.9% 1.4% 4.0% 1.8% 2.5% 1.2% 0.8%

No of 12hr breaches (Number of breaches) 0 800.0% 11 6 10 8 24 6 10 30 13 17 8 6

Stretch

Stretch


2.1 Performance Activity Summary – Mental Health (Secure)

22


Sparkline

Secure Mental Health Business Unit

Overall Gross Occupancy NHSE 93.00% 90.5% 90.5% 90.2% 91.8% 93.3% 93.7% 97.2% 95.9% 96.0% 94.2% 91.3% 91.0% 92.4%

Violent Incidents resulting in Restraint Stretch ≤ 20.00% 23.8% 20.3% 16.1% 20.8% 17.5% 20.5% 18.4% 15.6% 22.2% 27.1% 17.2% 29.1% 19.3%

% of SU that have had a CPA Review in last 6 months Stretch 100% 100.0% 100.0% 100.0% 100.0% 99.3% 99.3% 98.0% 97.4% 96.1% 94.5% 97.2% 96.0% 100.0%

% of service users who have a Care Coordinator allocated within 2 weeks Stretch 100% - 60.0% 62.5% 75.0% 77.8% 75.0% 66.7% 100.0% 50.0% 66.7% 99.3% 100.0% 100.0%

% of CPA reviews attended by Local Care Coordinators Stretch 80% - 37.5% 50.0% 25.0% 42.9% 39.3% 65.2% 33.3% 51.7% 42.9% 44.0% 48.1% 43.5%

% of service users who have Cardiometabolic risk factors assessed within

12 months Stretch 90% - 94.4% 94.6% 96.0% 89.7% 96.8% 100.0% 100.0% 99.4% 100.0% 100.0% 100.0% 100.0%

25hrs Meaningful Activity - Offered NHSE 100% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

25hrs Meaningful Activity - Uptake NHSE 100% 87.9% 82.4% 82.8% 85.0% 80.4% 79.9% 75.6% 82.3% 81.3% 86.8% 74.1% 78.2% 85.2%

Community Business Unit

% of caseload with a Local Care Coordinator allocated Stretch 100% - 89.8% 96.1% 96.0% 97.9% 100.0% 95.3% 97.0% 95.5% 100.0% 97.0% 100.0% 100.0%

% of caseload carried longer than 12 months post SMHBU discharge Stretch ≤ 20.00% - 57.1% 58.8% 72.0% 66.7% 74.0% 60.9% 60.6% 59.7% 63.5% 58.2% 60.9% 66.0%

% of CPA Reviews Attended by Local Care Coordinators / Local Teams Stretch 80% - 42.9% 50.0% 62.5% 75.0% 30.0% 33.3% 40.0% 54.5% 33.3% 50.0% 63.6% 25.0%

No of Incidents exceeding PACE Clock Commissioners 0 6 4 3 4 3 5 7 3 4 5 5 9 3

Health & Justice Business Unit - HMP Liverpool

GP Waits over 2 Weeks NHSE 0% 43.6% 52.6% 64.1% 55.0% 59.5% 64.2% 49.4% 22.8% 0.0% 18.8% 43.6% 43.1% 44.9%

NHS Health Checks NHSE 40.00% 13.5% 19.8% 3.6% 26.1% 13.2% 8.9% 1.9% 57.1% 28.6% 14.3% 22.6% 0.0% 33.3%

Well Man Assessment completed NHSE 100.00% - 98% 98% 97% 95% 89% 75% 63% 33% 96% 120% 98% 124%

Hep B Vaccinations completed NHSE - 0.0% 25.0% 30.4% 25.0% 0.0% 3.7% 0.0% 8.6% 0.0% 0.0% 4.2% 0.0%

Chlamydia Screening U25's Uptake NHSE 50.00% 8.8% 6.3% 20.7% 14.3% 33.3% 5.3% 13.0% 27.3% 63.6% 100.0% 21.4% 13.3% 17.7%

Men C Vaccinations Uptake NHSE 95.00% 12.8% 5.7% 5.7% 12.2% 4.9% 2.6% 2.4% 21.1% 44.7% 5.3% 7.7% 7.1% 19.4%

MMR Vaccinations Uptake NHSE 95.00% 21.7% 50.0% 4.4% 11.1% 0.0% 14.3% 23.8% 3.6% 2.3% 2.3% 1.0% 1.7% 4.1%

Prison 6 Month CPA Reviews NHSE 100.00% 100.0% 100.0% 100.0% - 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 0.0%

QOF NHSE 238 302 322 327 323 314 319 316 323 334 354 385 381 410


2.1 Performance Activity Summary – Community & Wellbeing

23

Indicators achieved Target Type Target Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17Rolling 12 Month

Sparkline

NHS Improvement

RTT - Consultant Led (Completed Pathway) NHSI 95% 95.2% 96.3% 96.7% 97.6% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

RTT - Consultant Led (Incomplete Pathway) NHSI 92% 95.2% 95.4% 97.3% 100.0% 99.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.7%

RTT - IAPT 6 Weeks NHSI 75% 93.0% 96.5% 95.1% 95.7% 93.4% 96.4% 94.7% 95.1% 94.5% 94.4% 94.5% 94.6%

RTT - IAPT 18 Weeks NHSI 95% 99.0% 99.8% 99.4% 99.8% 98.8% 99.4% 99.2% 99.7% 99.3% 99.4% 99.5% 99.7%

Waiting Times - AHP RTT

Adult Learning Disability Service NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Community Stroke Service NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% -

Intermediate Care NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Podiatry NHSE 95% 99.9% 100.0% 100.0% 99.8% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Pulmonary Rehabilitation NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Rapid Assessment Team NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Adult Speech and Language Therapy NHSE 95% 100.0% 100.0% 100.0% 100.0% 99.0% 100.0% 100.0% 100.0% 98.6% 100.0% 98.6% 100.0%

Community Neuro Team NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Community Respiratory Service NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 98.7%

Continence Service NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 97.8% 100.0% 100.0% 98.5% 98.3% 100.0%

Domiciliary Physiotherapy NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Falls Team NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.5% 100.0% 100.0% 99.0% 100.0%

Nutrition & Dietetics NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Other Indicators

RTT Complete Learning Disablity Commissioner 95% 98.1% 98.8% 98.9% 98.9% 100.0% 98.7% 96.1% 96.3% 99.2% 99.2% 100.0% 100.0%

12 Week Dentist Waits - HMP Liverpool Commissioner 95% 100.0% 98.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 94.6% 100.0%

Community Dental Waits Commissioner 95% 91.2% 95.2% 96.1% 98.0% 99.4% 97.1% 98.3% 100.0% 97.5% 98.2% 98.1% 100.0%

Unallocated Cases NHSE 0 12 11 12 12 7 15 13 2 7 19 - -


2.1 Performance Activity Summary – Community & Wellbeing

24

Indicators achieved Target Type Target Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17Rolling 12 Month

Sparkline

IAPT

IAPT in Month Prevalence Trust NHSE 1.44% 1.39% 1.67% 1.28% 1.72% 1.05% 1.32% 1.43% 1.32% 1.27% 1.31% 1.38%

IAPT in Month Prevalence

Blackburn with Darwen CCGCommissioner 1.18% 1.02% 1.22% 1.32% 1.26% 0.89% 0.74% 1.85% 1.13% 1.27% 1.38% 1.20% 1.09%

IAPT Cumulative Prevalence

Blackburn with Darwen CCGCommissioner 8.28% - - - - - 0.74% 2.59% 3.72% 4.99% 6.37% 7.57% 8.66%


East Lancashire CCGCommissioner 1.25% 1.30% 1.05% 1.56% 1.11% 1.77% 1.00% 1.13% 1.64% 1.42% 1.22% 1.30% 1.38%


East Lancashire CCGCommissioner 8.75% - - - - - 1.00% 2.13% 3.76% 5.19% 6.41% 7.72% 9.09%


Chorley & South Ribble CCGCommissioner 1.25% 1.40% 1.42% 1.59% 1.08% 1.44% 1.29% 1.53% 1.47% 1.31% 1.45% 1.38% 1.40%


Chorley & South Ribble CCGCommissioner 8.75% - - - - - 1.29% 2.81% 4.29% 5.60% 7.05% 8.43% 9.83%


Greater Preston CCGCommissioner 1.25% 1.45% 1.14% 1.24% 1.18% 1.20% 0.92% 1.38% 1.46% 1.41% 1.07% 1.24% 1.67%


Greater Preston CCGCommissioner 8.75% - - - - - 0.92% 2.30% 3.76% 5.17% 6.23% 7.48% 9.15%


West Lancashire CCGCommissioner 1.25% 1.02% 1.26% 1.71% 0.83% 1.53% 1.13% 1.51% 1.34% 1.08% 1.48% 1.21% 1.33%


West Lancashire CCGCommissioner 8.75% - - - - - 1.13% 2.64% 3.98% 5.06% 6.54% 7.75% 9.08%


Fylde and Wyre CCGCommissioner 1.25% 0.95% 1.55% 1.33% 0.96% 1.40% 1.23% 1.33% 1.36% 1.44% 1.35% 1.37% 1.33%


Fylde and Wyre CCGCommissioner 8.75% - - - - - 1.23% 2.55% 3.91% 5.35% 6.70% 8.07% 9.39%


Morecambe Bay CCGCommissioner 1.25% 1.19% 1.64% 1.31% 1.22% 1.41% 1.34% 1.07% 1.40% 1.46% 1.32% 1.27% 1.03%


Morecambe Bay CCGCommissioner 8.75% - - - - - 1.34% 2.41% 3.81% 5.27% 6.59% 7.86% 8.88%


St. Helens CCGCommissioner 1.25% 1.26% 0.74% 1.31% 1.02% 1.67% 0.88% 1.13% 1.31% 1.07% 1.09% 1.43% 1.56%

IAPT Cumulative Prevalence Trust Commissioner 8.75% 11.76% 13.15% 14.82% 16.10% 17.82% 1.05% 2.36% 3.79% 5.11% 6.38% 7.69% 9.07%


St. Helens CCGCommissioner 8.75% - - - - - 0.88% 2.01% 3.32% 4.39% 5.48% 6.91% 8.47%

IAPT Waiting Times (Internal Target) Stretch 0pts >26 wks - - - - - 22 23 23 25 14 26 14

IAPT Recovery NHSE 50% 56.3% 56.3% 53.8% 57.0% 53.4% 54.5% 52.6% 57.0% 50.0% 55.1% 57.3% 53.6%


2.1 Performance Activity Summary – Children & Young People’s Wellbeing

25


Sparkline

NHS Improvement

CPA 7 Day Follow Up NHSI 95.00% 75.0% 100.0% 100.0% 100.0% 100.0% 95.5% 100.0% 100.0% 100.0% 88.9% 100.0% 100.0% 100.0%

CPA 12 Month Review NHSI 95.00% 98.8% 97.6% 98.3% 99.5% 98.5% 97.9% 97.5% 95.6% 99.0% 99.5% 100.0% 98.7% 98.7%

MH Data Completeness - Identifiers NHSI 97.00% 99.6% 99.7% 99.7% 99.7% 99.7% 99.7% 99.6% 99.6% 99.7% 99.6% 99.6% 99.5% 99.6%

MH Data Completeness - Outcomes NHSI 50.00% 67.1% 67.2% 66.3% 64.8% 81.3% 64.9% 63.5% 60.7% 59.3% 58.1% 57.9% 56.7% 58.8%

2 Week wait for Treatment for EIP Programme NHSI 50.00% 69.0% 74.3% 76.7% 82.0% 81.4% 74.4% 11.1% 7.1% 0.0% 9.5% 11.8% 15.6% 9.5%

Waiting Lists - RTT 18 Weeks (Completed Outcomes)

EIS Therapies (The Hub) NHSE 95.00% 86.8% 90.3% 93.0% 83.9% 80.0% 94.7% 92.7%

Child Psychology - Total Network Performance NHSE 95.00% 70.7% 69.9% 70.9% 71.0% 60.3% 64.8% 66.6% 62.4% 66.9% 74.1% 77.7% 84.4% 89.0%

CAMHS Tier 3 - Total Network Performance NHSE 95.00% 96.4% 99.0% 97.5% 100.0% 98.1% 88.8% 79.4% 78.0% 78.4% 68.1% 64.5% 59.1% 56.9%

Waiting Lists - RTT 18 Weeks (Incompleted Outcomes)

CITNS - Occ Therapy - Total Network Performance NHSE 92.00% 83.1% 81.8% 81.8% 88.2% 91.2% 95.1% 94.9% 94.0% 96.4% 99.1% 96.3% 98.2% 97.9%

CITNS - Physiotherapy - Total Network Performance NHSE 92.00% 100.0% 100.0% 100.0% 98.1% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.4%

CITNS - SLT- Total Network Performance NHSE 92.00% 92.6% 86.9% 86.9% 86.6% 83.6% 82.7% 84.2% 86.7% 87.0% 88.4% 96.2% 96.3% 98.0%

CAMHS Tier 4

Bed Occupancy - The Cove NHSE 85.00% 83.0% 65.0% 55.0% 65.5% 80.5% 90.5% 92.8% 86.5% 96.7% 94.6% 68.8% 68.2% 78.9%

Average Length of Stay (days) - The Cove Bench 83 80.00 78.00 57.00 44.00 41.00 39.00 67.00 57.00 33.30 60.70 27.70 48.10 26.60

National Child Measurement Programme

NCMP - Central NHSE 90.00% 4.4% 19.3% 26.8% 39.5% 52.6% 64.5% 73.8% 88.7% 94.4% - - - 5.1%

NCMP - BwD (Cumulative) NHSE 95.00% 5.5% 17.8% 24.9% 37.1% 46.3% 60.2% 67.6% 82.2% 95.7% - - - 22.4%

NCMP - East (Cumulative) NHSE 90.00% 9.1% 21.9% 30.3% 44.3% 56.0% 67.9% 79.5% 93.0% 98.5% - - - 6.4%

Other Indicators

ADHD - New < 18 Weeks NHSE 95.00% 35.7% 38.3% 40.1% 36.1% 31.6% 37.7% 46.4% 39.0% 35.7% 22.7% 20.9% 34.7% 36.7%

PBR Clustering NHSE 95.00% 95.7% 94.9% 93.6% 96.2% 96.3% 95.4% 96.0% 97.2% 96.4% 96.5% 95.1% 95.3% 95.1%

Number of Patients without a Care Co-ordinator Allocated > 2 Weeks NHSE 0 16 13 14 8 18 29 23 5 4 2 2 - -

Currently being validated


2.1 Patient Flow Mental Health – Mental Health Liaison Team (MHLT)

26

MHLT:

1 Hour Compliance:

The Network is reporting low compliance against target for patients to be seen within 1 hour of referral, with 45.48% compliance in M7.

4 Hours Breaches:

The Network is reporting 104 actual 4 hour breaches in A&E for which LCFT were responsible in month 7, reporting 85.5% compliance.

12 Hours Breaches:

The Network is reporting 6 actual 12 hour breaches in A&E from the decision to admit time in month 7, this is 0.8% of all A&E referrals to

MHLT.

Actions: Due: Owner: Outcome:

CORE 24 workshops in progress for development of the working

models. Apr-18

Deputy Head of

Operations

Workshop with Acute Trusts completed

18th September to agree key points of

clinical SOP, with LCFT finalisation

workshop booked for 30th November.


2.1 Patient Flow Mental Health – Mental Health Liaison Team (MHLT)

27


28

Occupancy:

Throughout October, although occupancy levels across the service continue to be below the contracted threshold, occupancy has

increased to 92.43%. The following rationale illustrates the reasons for the monthly bed occupancy:

• Bleasdale ABI Medium had 3 vacancies - 1 allocated to SU in Ashworth awaiting MOJ permission to step down

• Whinfell Ward Male Medium ABI had 4 vacancies - no one currently on the waiting list

• Elmridge Ward Medium had 1 vacancy - Female Community Bed

• Hermitage ABI/MI Step down Community House had 1 vacancy - Male Community Bed

• Calder Ward Male MSU had 1 vacancy

• Fairsnape Ward MSU had 1 vacancy - 1 SU on the waiting list waiting medical recommendations to be completed and to apply to MOJ

for transfer warrant

There are no actions for this measure.

2.1 Performance Activity Mental Health (Secure Services) – Occupancy

OBD Available %

2112 2325 90.84%

1685 1736 97.06%

902 1023 88.17%

4699 5084 92.43%

Low Secure Wards

Step down Wards

Total

Oct-17

Medium Secure Wards


29

Violent Incidents resulting in Restraint:

In October 2017, staff reported a total of 150 incidents of verbal and physical violence within the inpatient unit. The overall use of restraint

as a response to violent incidents has decreased slightly with 19% of violent incidents ending in restraint, compared to 29% in September

2017.

Elmridge ward has a significantly higher than average use of restraint. In total there were 40 incidents on the ward which resulted in the

use of restraint.

2.1 Performance Activity Mental Health (Secure Services) – Violent Incidents

resulting in Restraint


The service is looking at recruiting to a new post that will support teams in

the use of restraint and debriefs.

End of

Quarter 3

Care Group

Manager

New Band 7 Quality Lead to be in

post.


30

CPA Reviews within 6 Months:

In October, all of the 144 eligible service users have had a CPA within the last 6 months.

Through monitoring of the planned reviews, the service is expecting all planned reviews to take place next month.

2.1 Performance Activity Mental Health (Secure Services) – CPA Reviews

Within 6 Months


Review the process for arranging CPA reviews.

Sep-17 revised

to End of

Quarter 3

Performance

Analyst

This has been extended as a role

review is involved and is continuing.


31

Attendance of CPA reviews:

Attendance at CPA reviews has reduced to 43.5% for October due to a reduced number of planned CPAs. Of the 23 CPAs planned for

October, 10 local care co-ordinators attended, 1 sent apologies and 12 did not attend.

This issue has been flagged to the Network for urgent resolution by the Chief Operating Officer. All dates of CPAs have been provided to

the Deputy Head of Operations, who has received confirmation of named attendees from community teams. This work commenced in

November and thus has not impacted on reported October activity.

2.1 Performance Activity Mental Health (Secure Services) – Attendance of

CPA reviews


1) All teams have been asked to forward the names of attendees for

all planned CPAs until the end of December 2017. 10-Nov-17

Care Group

Manager

2) Outlook invites are now being included within the invite process

and the secretaries will be following up all invites where apologies or

the name of the attendee have not been received.

10-Nov-17 Admin

Manager

Attended Apologies DNA

21 10 1 10

2 0 0 2

Breakdown of LCCNo of CPA

reviews

LCFT LCC

Non LCFT LCC

Oct-17


32

25hr Meaningful Activity:

In October, 4 wards failed to meet the 100% target in relation to meaningful activity uptake. Overall, uptake has continued to improve

across most wards increasing from 78.23% in September to 85.23% for October.

There are wards that continue to experience high acuity resulting in a static level of activity uptake. Work is ongoing with service users to

improve engagement and to take up opportunities of activity both on and off the ward. Levels of recording have improved and the wards

continue to work with staff to accurately record activity.

2.1 Performance Activity Mental Health (Secure Services) – 25hr Meaningful Activity


33

2.1 Performance Activity Mental Health (Secure Services) – 25hr Meaningful Activity


1. Lead OT to meet with Clinical Audit team to agree the set of

standards to audit for 25hr meaningful activity in September. 01-Dec-17

Care Group

Manager

Audit took place 27th October 2017 and

the results are due to be available by the

end of Q3.

2. Ward Managers and Team Leaders on Fairoak and Mallowdale

wards to work with the named nurses and OT assistants in supporting

service users to take up activities, with a view to gaining a greater

understanding of the importance of structured activity on wellbeing.

31-Oct-17

Ward

Manager/

Team Leader Completed.

3. Marshaw ward will have a new OT Assistant in post with effect from

mid-September. The new Ward Manager is working with staff to

ensure that weekly activity plans are formulated. 31-Oct-17

Care Group

Manager Completed.

4. Ensure that 25 hours activity is a standing agenda item on the team

debrief at the end of every shift on Fairoak ward, and check daily that

staff on duty are completing the activity recording form. 31-Oct-17

Ward

Manager/

Team Leader Completed.

5. Ward Managers and Team Leaders on Fairoak Ward and

Mallowdale Ward to ensure that 25hr activity is discussed with staff at

the end of each shift to improve the recording of activity and the

promotion for service user wellbeing.

End of Q3 Ward

Manager

6. Following the work with the service users on Marshaw ward to

understand what activities they would like to do, staff to purchase new

games and introduce new activities to improve uptake. End of Q3

Ward

Manager

7. The ward manager of Fairoak Ward to send a recurring email to

shift leaders to promote accurate recording of activities. End of Q3

Ward

Manager


2.1 Performance Activity Mental Health (Secure Services) – % of FCMHT

Caseload with Care Co-ordinator allocated

34

% of FCMHT Caseload with Care Co-ordinator allocated:

The service has continued to achieve 100% for October.

There has been a reduction in the caseload figure for community from October. It has been identified that pre discharge patients have

been included in the caseload count when they are still counted within inpatients until their actual discharge to the community.


35

% of FCMHT Caseload >12 months:

There are currently 50 service users on the FCMHT case load; 33 of these service users have been on the FCMHT caseload for over 12

months.

There has been a reduction in the caseload figure for community from October. It has been identified that pre discharge patients have

been included in the caseload count when they are still counted within inpatients until their actual discharge to the community.

The team will be discussing the clinical appropriateness of this target with the Commissioner.

2.1 Performance Activity Mental Health (Secure Services) – % of FCMHT

Caseload >12 months


1. The service manager will continue to work with the team to

review pathways and the continued need for intensive input by the

FCMHT.

End of

Quarter 3

Care Group

Manager

Continued FCMHT input is dictated by a

balance of risk, legal status and psychological

need and now reviewed on a weekly basis.

2. A meeting is taking place with the commissioner and the

percentage of caseload being carried over 12 months will be

discussed with a suggestion for a more clinically appropriate target.

Oct-17

revised to

Dec-17

FMCT Care

Group

Manager

Due to change in managerial positions, this

discussion will take place at the next

commissioner meeting in December.


36

Attendance of CPA Reviews within Community Services:

Attendance of CPA reviews in October has decreased to 25% with 2 out of 8 CPA reviews attended by the local care coordinators.

The FCMHT continues to work with all local care coordinators to improve attendance. Out of those not attended, any actions/minutes will

be communicated. No delayed transfers of care have resulted from local care coordinator non-attendance.

2.1 Performance Activity Mental Health (Secure Services) – Attendance of

CPA Reviews within Community Services


Admin staff to contact local care co-ordinators in week

prior to planned CPA to increase levels of attendance at

CPA reviews and identify an alternative representative if

care co-ordinator is unable to attend due to leave or

sickness.

End of Q3 Service

Manager


2.1 Performance Activity Mental Health (Secure Services) – Number of

Incidents exceeding PACE Clock

37

Number of Incidents exceeding PACE Clock:

There has been a reduction in PACE breaches in October. Of the 3 breaches that took place, one was in excess of 50 hours, one in

excess of 20 hours and one in excess of 10 hours longer in Police custody than the PACE Limit of 24hrs. Two occurred at Preston and

one at Skelmersdale.

One was a transfer back to own commissioning area, one was due to no beds being available and the other was an out of hours

assessment with the crisis team which became delayed.



HMP Liverpool – HJIP Indicators:

GP Waiting Times:

There are currently 156 patients on the GP waiting list with the longest wait now up to 24 working days, an increase of 4 days from

September. One GP clinic session was lost though 32 more appointments were offered than in the previous month, however the DNA rate

was also increased by 3% to 38.7%. There was a reduction in the number of appointments seen by the Nurse Practitioner as 13 clinics

were dedicated to the flu campaign. Enablement issues are highlighted below.

NHS Health Checks:

Six men were eligible for the NHS Health Check at the start of the month. Seven men were called up: three attended but declined on

arrival, two DNAd and two were seen. The uptake of the NHS Health checks is very poor with the client base.

Wellman Screening:

The Integrated Mental Health Team has worked hard to catch up with the Wellman Screening. The backlog has been cleared and as of 1st

October, they are screening new receptions within the 72 hour timescale.

Immunisations and Vaccinations:

In October, 151 Imms & Vacs appointments were offered and 66 DNA (44%). Enablement issues are highlighted below.

Pharmacy ordered 50 MMR vaccinations however delivery was not possible due to a national shortage. The supplier has informed us that

this could continue until March 2018; the same applies to Hep B vaccinations. The seasonal flu campaign is going well; at the 1st

November 2017 there are 6 men eligible. 91 patients were vaccinated last month. 84 declined the influenza vaccination and 235 declined

the offer of Hep B vaccination.

DNA - Enablement Issues:

During October, there has been no improvement on the enablement issues, however the prison have now agreed to attend the Local

Delivery Group meeting on Thursday 9th November. The following items are on the agenda:- Amey (works) issues, ACCT reviews,

CQC/HMIP Action plan, Enablement, Access to Mental Health and Social Care Beds, Wheelchairs, Low officer presence in inpatients and

medication hatches, Safeguarding referrals, Stabilisation Unit, Body Worn cameras, Chromatic Doors and Gated rooms on healthcare.

2.1 Performance Activity Mental Health (Secure Services) – HMP Liverpool

HJIP Indicators

38



HJIP Indicators

39


1. Enablement issues. 09-Nov-17 Care Group

Manager

Prison representatives to attend the Local Delivery

Group Meeting 9th November to discuss various

issues.

2. NHS Health Checks:

Primary Care manager has been tasked by Head of

Healthcare with targeting NHS Health Checks.

09-Nov-17 Care Group

Manager

This is continuing to take place and all eligible men are

being provided appointments.

3. Wellman Screening:

Continue the good work and target “first timers”

through reception. 09-Nov-17

Care Group

Manager Achieved.

4. Immunisation and Vaccination:

Continue to offer as many appointments as possible

for Men C and MMR but the current emphasis will be

on Influenza vaccinations.

09-Nov-17 Care Group

Manager

Continue to liaise with supplier regarding vaccination

supplies.



HJIP Indicators

40

Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17

165 134 258 247 103 14 14 21 31 22 6

3.64% 26.12% 13.18% 8.91% 1.94% 57.14% 28.57% 14.29% 22.58% 0.00% 33.33%

29 28 18 19 23 11 11 6 14 51 17

20.69% 14.29% 33.33% 5.26% 13.04% 27.27% 63.64% 100.00% 21.43% 13.33% 17.65%

35 41 41 38 41 38 38 19 26 28 31

5.71% 12.20% 4.88% 2.63% 2.44% 21.05% 44.74% 5.26% 7.69% 7.14% 19.35%

23 27 25 21 21 225 132 129 203 241 222

4.35% 11.11% 0.00% 14.29% 23.81% 3.56% 2.27% 2.33% 0.99% 1.66% 4.05%

1 0 5 2 6 2 2 4 1 2 3

100.00% - 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 0.00%

Patients received NHS

HC Screen

Patients Accpeting

Men C Vacc

Patients Accpeting

MMR Vacc

SU received CPA

review <6 months

Total Eligible

% Screened

Total Eligible

% Recieved

Total Eligible

% Recieved

Total Eligible

% Recieved

Patients Screened for

Chlamydia

Total Eligible

% Screened


257 276 307 375 261 336 358 422 359 307 274

253 269 292 335 196 211 117 406 432 301 341

98.44% 97.46% 95.11% 89.33% 75.10% 62.80% 32.68% 96.21% 120.33% 98.05% 124.45%% completed

Wellman Checks

No. of new receptions

No. of Wellman checks completed


5 6 7 8 9 10 11 16 27 44 16

51 27 49 41 19 18 39 54 28 35 37

39 41 59 35 52 31 45 47 69 57 33

166 127 169 165 80 23 0 27 96 103 70

GP Waits

0-2 days

3-7 days

8-14 days

14+ days


239 248 260 296 261 336 358 422 359 307 274

84 23 12 3 27 35 35 99 55 24 43

21 7 3 0 1 0 3 0 0 1 0

33 29 13 7 31 61 72 53 54 24 60

25.00% 30.43% 25.00% 0.00% 3.70% 0.00% 8.57% 0.00% 0.00% 4.17% 0.00%

Hep B Vaccinations

No. of new receptions

No. of patients accepting Hep B

Patients vaccinated >4wks

Total vaccinations in month

% patients accepting within 4 wks


2.1 Performance Activity Community & Wellbeing – Improving Access to

Psychological Therapies (IAPT) Prevalence

41

IAPT - Prevalence:

• West Lancs CCG teams have met the 15% contractual target for M7, but not met the 16.2% internal cumulative target

• Fylde and Wyre CCG have met the 15% contractual target for M7, but not met the 16.2% internal cumulative target

• BwD CCG teams have not met the 14.2% contractual target

• Morecambe Bay have not met the 15% contractual target for M7, or the 16.2% internal cumulative target

A cumulative prevalence model is in place to direct and support teams to achieve the 16.8% prevalence target set by NHS England by 31st

March 2018. Quarter 3 's contractual target remains at 15% (BwD is 14.2%), however teams have now moved to an internal cumulative

target of 16.2% in preparation. St Helens CCG have agreed that prevalence will stay at 15% as they have not received any national LTC

funding. Blackburn with Darwen CCG's prevalence target has been confirmed as 14.2% with an expectation that this will increase and

funds will be reattributed to this locality next year.

The teams are aware that December has historically been a lower month for referrals and prevalence. In order to prepare for this, the

teams are working to increase referrals and assessments in October and November.

The leadership team, including the recently appointed interim team leaders and admin leads have daily oversight of performance across all

teams. Performance data is examined daily to enable teams to respond quickly to areas of deficit in prevalence and, in conjunction with

team members, directs resources within each specific locality. Deficits and risk areas to achieve prevalence are highlighted at team and

management level and are escalated to the Leadership team and the Network managers immediately in order to expedite actions.

The team continues to increase 'Taster' and awareness sessions in M7 to improve prevalence across teams. Mindsmatter continues to

enhance the diversity of the audience for taster sessions.


2.1 Performance Activity Community & Wellbeing – IAPT Prevalence

42


1. West Lancs additional taster sessions planned for

Aug, Sept, Oct.

31-Aug-17

revised to

31-Dec-17

Team Leader This action is ongoing for 3 months to increase

prevalence. Taster sessions continue alongside

exploring direct referral options.

2. Action plan developed with Preston and St Helens to

increase prevalence.

30-Sep-17

revised to

31-Dec-17

Service Manager Acton plan remains in place.


1.13% 1.27% 1.38% 1.20% 1.09%

1.47% 1.31% 1.45% 1.38% 1.40%

1.64% 1.42% 1.22% 1.30% 1.38%

1.36% 1.44% 1.35% 1.37% 1.33%

1.46% 1.41% 1.07% 1.24% 1.67%

1.40% 1.46% 1.32% 1.27% 1.03%

1.31% 1.07% 1.09% 1.43% 1.56%

1.34% 1.08% 1.48% 1.21% 1.33%

1.43% 1.28% 1.22% 1.26% 1.30%

CWB IAPT Prev CCG (Monthly)









NHS St Helens CCG



43



44


2.1 Performance Activity Community & Wellbeing – IAPT Waits

45

IAPT - Waits:

• 1 person has been waiting over 26 weeks for CBT in BwD, this is an increase from September

• 1 person has been waiting over 26 weeks for CBT in Greater Preston, this is an increase from September

• 2 people have been waiting over 26 weeks in West Lancs, this is a reduction from September

• 9 people have been waiting over 26 weeks for CBT in Fylde and Wyre, this is a reduction from September

• All people waiting over 26 weeks have been reviewed.

In Preston and BwD, the patients have been reviewed and either appointments offered or the wait is due to patient request.

In Fylde and Wyre, an action plan has been implemented to manage and reduce the waiting list. The action plan will remain in place,

supported by the Clinical Lead for CBT with weekly monitoring by the Leadership team. This will remain in place until significant

improvement is sustained. Supplementary CBT resource has been introduced from the Women's Centre and CBT staffing across teams

is being reviewed to increase input into the Fylde and Wyre team.

In West Lancs, the increase in counselling waiting times is due to staff leaving and sickness. An action plan is in place supported by the

Clinical Lead for Counselling. In addition, counselling staff via the existing Women's Centre contract have recently commenced in

increase the resource in the West Lancs Team.

Waiting times across each waiting time bracket are also being reviewed weekly by the leadership team and priority areas are being

addressed at management and team level.

Direct referral is being explored to improve waiting times.


2.1 Performance Activity Community & Wellbeing – IAPT Waits

46


Internal performance reporting increased and reviewed to closely

monitor waiting times across the teams.

30-Sep-17

revised to

31-Dec-17

Service

Manager

This will remain in place as there is a large

amount of staff movement in Quarter 3 which

will have an impact on waiting times.


2.1 Performance Activity Children & Young People’s Wellbeing – EIS

47

EIS (Therapies):

Findings from validations conducted from concerns raised, indicated that the EIS 2ww standard has been reported at an inflated rate due

to inaccuracies within data recording. These issues have been raised to an executive level. Following on from this, a validation of all

records from April 2017 has been completed and data has been updated.

Main issues that have been identified as causing delay with the 2ww standard are:

• Lack of timely referrals to the EIS team

• Lack of timely telephone/Face to face treatment contact

It is estimated that to be able to achieve quarter performance, the network will have to achieve 80-90% for November and December,

although this forecast should improve when further analysis is completed Oct-17.


2.1 Performance Activity Children & Young People’s Wellbeing – EIS

48


1. Establishment of daily teleconference focusing on achieving

the 2 week target for new referrals Oct-17

Deputy Head of

Operations These calls are now fully embedded.

2. Develop PTL and performance forecasting/tracking tool to

inform daily huddles Oct-17 Performance Lead Complete

3. Review and amend SOP to ensure clarity and triangulation

with most recent national Guidance Jan-18 Deputy Director Underway

4. Validate PTL to ensure it presents an accurate starting point

of current patients waiting Nov-17

Network Lead

Psychologist On target for completion

5. Provide additional oversight to monthly validation of patients

treated each month Oct-17 Performance Lead

October complete and plan in place

for future months

6. Appoint 2 week wait coordinator to manage pathways of

referred patients Nov-17

Deputy Head of

Operations Candidate appointed and has a start

date of 27/11/17

7. Appoint to vacant Band 8a Manager post Jan-17 Deputy Head of

Operations Currently out to advert

8. Review demand, activity and capacity across EIS pathway Nov-17 Deputy Head of

Operations

DTOC cases being progressed by

Care Group Manager, Productivity

and caseload information under

examination.

9. Review of referral processes to ensure timely receipt by

service, including a review of impact of Bluelight 71 Dec-17

Deputy Head of

Operations

In the interim, contact being made

daily with SPoA and AMH teams in

each locality. This is being extended

to include AMH admission wards

10. Review of allocation processes for telephone and first face

to face with case manager to plan for sufficient timely first face

to face treatment appointments. Dec-17

Deputy Head of

Operations and

Lead Psychologist

11. Establish an operational team to clear long term EIS case

backlog Dec-17

Head of

Operations

12. Training update for staff and team leaders on NCRS,

EDMS and records management Jan-18

Deputy Head of

Operations


2.1 Performance Activity Children & Young People’s Wellbeing – Child Psychology

49

Child Psychology (Total Network Performance):

In M7, overall service performance increased to 89%, an increase of 4.6% from M6, and this is the fifth consecutive monthly increase (+26% since May

17).

Three out of the five team’s performance remains above the target of 95% (BwD/EL; Blackpool; Fylde and Wyre) and two teams under the target. The

total number of SUs on the waiting list reduced to currently 290 from 315 in M6, of which 32 are waiting over 18 weeks – a reduction from 17 in M6.

75% of waiters over 18 weeks are now from Lancaster Team (24).

Issues affecting performance:

Preston Community

Performance increased to 93% in M7. The total number of children waiting over 18 weeks for treatment has reduced further to 2, the lowest level in the

last year. One of the 3 over 18 weeks DNA’d their appointment and the other 2 have TCI dates.

Lancaster

Performance decreased to 55.6% in M7 from 60.6% in M6 - the only area that saw worsening performance. Of the 24 SUs waiting over 18 weeks, 4

have a TCI date in M8 and 1 in M9.

An agency clinical psychologist completed her contract in M5, whilst another clinical psychologist is on long term sickness, leaving a capacity gap.

Funding has been provided for an additional one day a week from a CAMHS practitioner and there is an agency psychologist assisting with caseloads.

These actions make some steps to manage demand; however there is a national shortage of psychologists which is impacting on the opportunities to

improve performance.


2.1 Performance Activity Children & Young People’s Wellbeing – Child Psychology

50


In Lancaster CPS, a request for extra capacity in the team will be

discussed with the Care Group Manager. 30-Nov-17

Service

Manager


2.1 Performance Activity Children & Young People’s Wellbeing – CAMHS Tier 3

51

CAMHS Tier 3

In M7, overall service performance reduced by 2.2% from 59.1% to 56.9% (382 SUs). This equates to 289 out of 671 waiting over 18

weeks for treatment. The total number of SUs on the waiting list increased to currently 671 from 575 in M6. Two out of the five team’s

performance remains above the target of 95% (West Lancashire and Fylde and Wyre) and three teams under the target.

Issues affecting service level performance:

Chorley and South Ribble

Performance increased in M7 to 40.2% from 39.9% in M6. There are currently 264 out of 440 SUs waiting over 18 weeks. 22 SUs have

TCI dates in November so far and more slots are available. The longest wait is currently 52 weeks. Processes are in place for the top 25

waiters to be written to each week from the beginning of M8. This action will ensure that all families down to 36 week wait will have been

contacted in M8. Families are invited to call and can be offered an appointment, or advise they no longer require a service. If no response

results from the letter, the referrer is written to advising of no further action from CAMHS. As appointments are being booked at families

discretion, the longest waits may not show improvement until the end of M10.

Vacancies are being progressed and one long term sickness absence with no anticipated date for return at present is being progressed

within the LCFT Absence Management Policy.

Preston

Performance reduced to 85.6% in M7 from 89.6% in M6. There are currently 18 out of 125 SUs waiting over 18 weeks. 16 SUs have TCI

dates. The longest waiter is 33 weeks.

Lancaster

Performance also reduced in M7, from 75% in M6 to 57.9%. There are currently 8 out over 19 SUs waiting over 18 weeks. 6 SUs have

TCI dates. The longest waiter is 25 weeks.

The increase in waiting times reflects a reduction in capacity to meet demand due to sickness in the team. There is an agency

psychologist assisting with caseloads, and other strategies to improve capacity are being considered.


2.1 Performance Activity Children & Young People’s Wellbeing – CAMHS Tier 3

52


1. Weekly SITREP has been established to monitor progress with all

underperforming teams attending.

Weekly

review

Dep Head of

Ops/ Service

Manager

Improve effectiveness of the team.

2. Waiting list reduction trajectory developed and populated ready for

RAC to use. 23-Oct-17

Network

Performance

Analyst

This has now been implemented and

will be reviewed weekly.

3. HR still supporting the long term sickness absence. 31-Dec-17 Service

Manager Ongoing.

4. Admin processes are being reviewed in the Referral Assessment

Centre (RAC). Options paper to be drafted regarding future functioning of

the RAC.

23-Oct-17

revised to

30-Nov-17

Service

Manager

Ensure correct cases are on waiting

list each week.

5. 25 validation letters a week to be sent to waiters down to 36 weeks for

CSR. 30-Nov-17

Service

Manager

6. 12 Initial Appointments each week to be arranged. 30-Nov-17 Performance

Analyst


2.1 Performance Activity Children & Young People’s Wellbeing – Occupancy

53

Occupancy:

In M7, bed occupancy performance at The Cove increased to 78.9% from 68.2% in August 17, against the target of 85%. The CAMHS

Outreach Team received 31 referrals at The Cove, and 15 of these referrals resulted in admission.

There were 13 discharges from The Cove in October 2017.

Length of stay of discharges during August 2017 was 26.6 days against the national benchmark of 83 days.

Issues affecting performance:

The Cove was open to admissions through August and was running at full capacity. Bed occupancy was reflective of demand for beds

throughout the North West.



2.1 Performance Activity Children & Young People’s Wellbeing – ADHD

54

ADHD:

The proportion of new referrals to the ADHD service waiting under 18 weeks for treatment was 36.7% as at the end of M7. This equates to

104 out of 283 new referrals waiting under 18 weeks. Performance improved slightly from M6 (34.7%).

Issue affecting performance

• A request to recruit has been completed to fill a current vacant post for an NMP, and has been identified for the North area.

• It is expected that this will create 3 NMP posts each with a specific locality as their prime caseload, North, Central and East and will

provide further efficiencies.

• The NMP recently joining the service has now begun independently prescribing under close supervision of the team leader, again

creating capacity.

• Improvements in data processes have been completed with teams to ensure timely, accurate and appropriate reporting of performance.

• In M7, a presentation was delivered to Mental Health Quality and Performance Group, describing lessons learnt from the delivery of

Adult ADHD Service. The presentation included the analysis of New and Transitional referrals, and highlighted strategies to improve

the service offer going forward. CSU advised further discussion would occur between Trust and Commissioners


1. A new service model to be developed, focusing on effective gatekeeping

and triage alongside robust efficiency of treatment. 30-Nov-17

Service

Manager

More effective service

provision.

Reduction in waiting

times.

2. Change the referral route process. 30-Nov-17 Service

Manager

3. Validate existing waiting lists. 31-Dec-17 Service

Manager

4. Set up a virtual neuro-development assessment team. 31-Jan-18 Service

Manager

5. Review all service users who are stable and also open to Adult Mental

Health (AMH) with aim to transfer to AMH. 31-Mar-18

Service

Manager

6. Seeking approval to recruit to additional permanent Band 7 nurse

prescriber, to help reduce waiting list. 30-Sep-17

Service

Manager Recruitment is ongoing.

7. A second NMP has been in post for 3 months and training is still in

process. There will be a gradual improvement to the waiting list following this

preceptorship.

End of Oct Service

Manager Improved staff capacity.


2.1 Performance Activity Children & Young People’s Wellbeing – ADHD

55


Patient Flow

Section 2.2

56


2.2 Patient Flow Summary – Patient Flow

57


Sparkline

Patient Flow

Average Number of Patients (OAPS) Commissioner 15 22.65 33.10 27.42 22.48 23.29 23.42 24.27 25.52 25.67 24.23 23.68 26.17 24.58

OAPS Occupied Bed Days Commissioner 465 702 993 850 697 652 726 728 791 770 751 734 785 762

LCFT and OAPS Occupancy % (Total Network Performance) Commissioner 85.00% - 104.8% 100.6% 101.1% 98.2% 96.8% 105.7% 106.1% 106.4% 105.4% 107.4% 107.6% 107.9%

Number of LCFT and OAPS Occupied Bed Days (Total Network

Performance)Commissioner 9836 - 10943 10880 10667 10009 10927 10593 10988 10665 10917 11120 10777 11171

LCFT and OAPS Occupancy % (AMH) 102.4% 107.1% 101.0% 102.9% 102.8% 101.2% 108.6% 107.9% 108.0% 107.7% 107.6% 108.9% 108.3%

Number of LCFT and OAPS Occupied Bed Days (AMH) 8351 8481 8297 7799 7630 8317 8148 8364 8097 8349 8340 8167 8394

LCFT and OAPS Occupancy % (OA) 97.7% 97.7% 99.2% 96.5% 85.8% 85.0% 97.0% 100.8% 101.9% 98.6% 106.8% 103.6% 106.6%

Number of LCFT and OAPS Occupied Bed Days (OA) 2544 2462 2583 2868 2379 2610 2445 2624 2568 2568 2780 2610 2777

LCFT only Occupancy % (Total Network Performance) NHSE 85.00% 99.5% 99.6% 96.9% 98.7% 100.1% 98.5% 98.5% 98.5% 98.8% 98.7% 100.3% 101.9% 100.5%

Number of LCFT only Occupied Bed Days (Total Network Performance) Stretch 9836 7649 9950 10030 9970 9357 10201 9865 10197 9895 10216 10386 10212 10409

LCFT only Occupancy % (AMH) 99.5% 100.3% 96.1% 99.6% 99.9% 99.1% 99.2% 98.3% 99.0% 98.7% 98.9% 99.9% 99.5%

Number of LCFT only Occupied Bed Days (AMH) 7649 7491 7447 7102 6990 7679 7437 7622 7426 7648 7665 7492 7715

LCFT only Occupancy % (OA) - 97.6% 99.2% 96.5% 100.6% 96.9% 96.3% 98.9% 98.0% 98.6% 104.5% 107.9% 103.5%

Number of LCFT only Occupied Bed Days (OA) - 2459 2583 2868 2367 2522 2428 2575 2469 2568 2721 2720 2694

Secure Overall Gross Occupancy NHSE 93.00% 90.5% 90.5% 90.2% 91.8% 93.3% 93.7% 97.2% 95.9% 96.0% 94.2% 91.3% 91.0% 92.4%

Average Episode Length of Stay (LOS) (AMH) Bench 31 41.70 31.30 31.20 29.72 40.23 33.00 34.70 36.10 46.40 47.60 29.60 33.30 38.80

Average Ward Length of Stay (LOS) (PICU) 47.70 58.50 45.08 58.50 55.20 37.80 39.90 35.10 38.80 30.10 27.60 38.10 34.00

Average Episode Length of Stay (LOS) (OA) 119.60 109.40 144.50 123.56 95.35 115.60 122.30 135.50 97.90 104.50 86.90 95.00 129.80

Re-Admission Rates - 30 Days (AMH) % NHSE <8.7% 9.9% 9.1% 16.7% 7.8% 12.6% 9.5% 15.3% 13.8% 14.8% 11.5% 6.9% 6.7% 8.6%

Re-Admission Rates - 30 Days (AMH) Number of patients NHSE 16 20 22 36 18 24 22 31 30 30 24 14 13 16

Re-Admission Rates - 30 Days (OA) % NHSE <8.7% - 0.0% 4.5% 0.0% 0.0% 3.4% 8.0% 0.0% 4.0% 0.0% 3.7% 0.0% 0.0%

Re-Admission Rates - 30 Days (OA) Number of patients NHSE 1 - 0 1 0 0 1 2 0 1 0 1 0 0

Re-Admission Rates - 90 Days (AMH) % NHSE 15% 17.7% 12.8% 25.0% 16.5% 23.0% 19.0% 20.7% 22.6% 22.2% 18.7% 17.3% 12.9% 15.1%

Re-Admission Rates - 90 Days (AMH) Number of patients NHSE 28 36 31 54 38 44 44 42 49 45 39 35 25 28

Re-Admission Rates - 90 Days (OA) % NHSE 15.00% - 0.0% 4.5% 0.0% 0.0% 13.8% 0.0% 10.3% 4.0% 5.3% 7.4% 0.0% 0.0%

Re-Admission Rates - 90 Days (OA) Number pf patients NHSE 2 - 0 1 0 0 4 - 3 1 1 2 0 0


2.2 Patient Flow Out of Area Placements (OAPS)

58

OAPS:

The average number of OAPs decreased slightly in October by 1.59 alongside a decrease in the OAP OBD in October with a position of

762, a decrease of 23 from September.

The overall number of OAPs remains relatively static against an assumed fall in the trajectory. As reported last month, given the positive

impact of Intensive Community Support Schemes on admission numbers, focus remains on those patients of over 180+ day Length of

Stay on acute mental health wards. Case review confirms that these patients are ready for their next stage of treatment away from the

acute ward or PICU that they are on. The patient cohort have chronic mental health presentations with slow responses to treatment.

Typically, their presentations fall short of the threshold for a secure services bed, but will not be accepted by independent providers.

LCFT have agreed with commissioners to establish an integrated discharge team to manage this patient cohort, with a planned go-live

of December for this team. STP leads have agreed that the costs of ‘discharge to assess' beds are not within the OAPs spend, as this is

a clear and distinct cohort of patients to those require an OAP due to an acute presentation. As report in October, from the current

inpatient cohort, zero 180+ day cases would result in zero acute OAPs and LCFT occupancy on acute wards below 100%, zero older

adult OAPs and LCFT occupancy on older adult wards below 100%, and zero PICU OAPS. The lead commissioner has responded to an

initial formal letter regarding the impact of 180+ Day LOS, and further dialogue is underway.


2.2 Patient Flow OAPS

59


1. Maintain focussed case review panel with senior

commissioning managers. Nov-17

Capacity &

Flow Manager

Ongoing; benefits are realised with

focussed discussions.

2. Daily bed calls with Service Managers to address blocks to

discharge such as funding delays. Nov-17

Bed

Management Ongoing.

3. Maintain the process of identifying and escalating all 180+ day

LOS inpatients for review. Fortnightly scheduled meeting in

place with stakeholders regarding review of these patients.

Nov-17 Capacity &

Flow Manager

Fortnightly meetings are taking place

improving the flow of patients with a LOS

of 180+ days.

4. Continue regular review of C&WL OAPs to identify any that

can be stepped to the Crisis House/beds. Nov-17

Capacity &

Flow Manager /

Central CGM

Ongoing.

5. Produce report on the use of Habilitation beds. Nov-17 Capacity &

Flow Manager

6. Desktop review of all LCFT PICU patients with a longer than

anticipated LOS to ensure they are in the right care setting.

Action plans to be developed for all patients not in the right care

setting.

Oct-17

Deputy Head of

Operations /

Capacity &

Flow Manager

Reviews have taken place, and cases are

being review by the PICU CAG (joint

LCFT/CSU review group) to identify

appropriate providers for onward treatment

when indicated.


2.2 Patient Flow OAPS Trajectory

60


2.2 Patient Flow Occupancy – Mental Health

61

Occupancy:

LCFT and OAPs Occupancy position in October increased from the September position at 107.89%. The occupancy for LCFT beds in

October was 100.53%, thus the requirement for OAP beds.


1. MCAP standardisation workshop for defining non-qualified bed days

consistently across Trust Wards Dec-17

Deputy Head

of Operations

2. Integrated Discharge Team to become operational Dec-17 Head of

Operations


2.2 Patient Flow Occupancy – Mental Health Total

62


2.2 Patient Flow Occupancy – Adult Mental Health

63


2.2 Patient Flow Occupancy – Older Adults

64


2.2 Patient Flow Mental Health – Average Length of Stay – PICU

65

Average Ward Length of Stay - PICU:

The Network is reporting an average length of stay of 34 days. This is above the Trust set target of 30 days however is a decrease from

September's position.

The Network has maintained a LOS under 40 days for eight months for PICU, indicating a level of stability. The Joint Advisory Group is

having a positive impact on PICU LOS and the feedback from Care Co-ordinators and the Gateway team is positive about this group.

Average LOS in PICU skewed by use of PICU to provide medium/long-term placement for patients with high dependency needs and no

identified available suitable placement.


1. Commissioners are also joining twice weekly conference calls to

assist with alleviating any blockages in the discharges of patients. Nov-17

Capacity &

Flow Manager Ongoing.

2. Discharge planning for all patients near completion of

assessment/treatment to be discussed daily at the bed call. Nov-17

Capacity &

Flow Manager

3. Escalation routes are clear - the capacity and flow manager is to be

utilised to expedite any difficulties. Nov-17

Capacity &

Flow Manager


2.2 Patient Flow Mental Health – Average Episode LOS – Adult

66

Average Ward Length of Stay - Adult:

The Network is reporting an average LOS of 38.80 days for October, an increase from September's position. PICU LOS is included within

the Average Network LOS.




Capacity &




Capacity &

Flow Manager



Capacity &

Flow Manager


2.2 Patient Flow Mental Health – Average Episode LOS – Older Adult

67

Average Episode Length of Stay – Older Adult:

M7 has seen an increase in the average length of stay, reporting an average LOS 129.8 days.

Continued efforts in proactive discharge management across all wards and an additional member to the discharge facilitator team has

added support across the wards, working towards timely discharge.




Capacity &




Capacity &

Flow Manager



Capacity &

Flow Manager


2.2 Patient Flow Mental Health – Readmission Rate (90 days)

68

Re-Admission Rate (90 Days):

The Network achieved compliance with the 90 day re-admission rate this month with14% for M7. This includes Older Adult ward data.

The underlying position with Adult Wards has declined from M6 with a position of 15.14%. Older Adults had no re-admissions in M7.

28 cases were re-admitted within 90 days. These include the 16 cases re-admitted within 30 days. 12 cases were re-admitted 31-90 days

after discharge.


1. Team Leaders to ensure to review in CMHT/CRHTT

Clinical Discussion Meetings.

Nov-17 revised

to Jan-18 Team Leaders

Target date revised, this process will be

designed within sectorisation process, and

delayed timescale to ensure appropriate

process has been decided on given that the

target is being met currently and so there is no

urgent pressure on this indicator.

2. Re-admission data to be routinely reviewed in Locality

Governance groups.

Nov-17 revised

to Jan-18 Team Leaders

Target date revised, this process will be

designed within sectorisation process, and

delayed timescale to ensure appropriate

process has been decided on given that the

target is being met currently and so there is no

urgent pressure on this indicator.


2.2 Patient Flow Mental Health – Readmission Rate (90 days)

69


Data Quality

Section 2.3

70


2.3 Data Quality Summary – Data Quality

71

Indicators achieved Target Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Sparkline

PBR Clustering

Trust PBR Clustering 95% 96.06% 96.28% 96.75% 96.37% 96.43% 96.45% 96.66% 96.64% 96.44% 95.70% 95.90% 95.00%

Mental Health PBR Clustering 95% 96.12% 96.43% 96.78% 96.37% 96.48% 96.47% 96.63% 96.65% 96.44% 95.70% 95.90% 95.10%

Children & Young People's Wellbeing PBR Clustering 95% 94.90% 93.60% 96.16% 96.31% 95.35% 95.99% 97.17% 96.35% 96.51% 95.10% 95.30% 95.10%

Allocated Patients (within 2 weeks)

Trust Allocated Patients 0 472 454 461 413 443 430 300 228 242 223 - -

Mental Health Allocated Patients 0 331 307 313 255 260 267 255 211 233 203 - -

Community Wellbeing Allocated Patients 0 12 11 12 12 7 15 13 2 7 19 - -

Children & Young People's Allocated Patients 0 13 14 8 18 29 23 5 4 2 2 - -

Manual Overrides

Trust NHSI Manual Overrides 0 6 16 21 11 13 2

MR01 NHSI Manual Overrides 0 5 4 6 8 1 0

MR07 NHSI Manual Overrides 0 1 11 6 3 8 0

Other NHSI Manual Overrides 0 0 1 9 0 4 2

Note: Allocated patients figures are not provided for September or October as the report is offline due to a technical error. The report has been redefined and rebuilt and is

in the process of final validation.


2.3 Data Quality Data Quality – Manual Overrides

72

Manual Overrides:

A combination of better recording, checking and reporting has seen manual overrides greatly reduce. Meetings have been diarised

aimed at addressing those that remain.


73

Section 3:- Finance and Contracting

Section 3.1:- Financial Activity

• UoR Risk Rating

• Summary I&E Position

• Summary of Clinical Services

• CIPS

• Capital Expenditure

Section 3.2:- Contract Activity

• Community & Wellbeing – Network Line Totals

• Community & Wellbeing – Service Line Totals

• Community & Wellbeing – Total Activity Split by CCG

• Community & Wellbeing – Activity Exception Reports by CCG

• Children & Young People’s Wellbeing – Service Line Totals

• Children & Young People’s Wellbeing – Exception Reports by Service

• Children & Young People’s Wellbeing – Total Activity Split by CCG

• Mental Health – Total Activity Split by CCG

• Mental Health – Activity Totals

Section 3.3:- Commissioning for Quality & Innovation

• CQUIN Executive Summary

3. Finance and Contracting


Financial Activity

Section 3.1

74


Use of Resources rating (UoR)

The current I&E position gives a rating of 4 and delivers a Capital Service rating of 4 constraining the current overall UoR to

a 3. Assuming current pressures and risks are addressed through the recovery plan and I&E performance achieves (or

exceeds) forecast the Trust will achieve a UoR of 2 in line with the plan. However, though forecast would achieve the overall

target rating, Capital Service is based on EBITDA and since part of the Trusts recovery plan is based on disposals (which

are excluded from EBITDA) the Trust is not forecast to achieve planned Capital Service. The Trust is also forecast to

exceed its liquidity and slip against it's planned Agency target.

Should conditions persist and costs not be managed within the control total then the resulting deterioration might trigger a

review of our segmentation.

3.1 Financial Activity Use of Resources (UoR) Risk Rating

75

FINANCE AND USE OF RESOURCES RATING

Plan Actual Plan Forecast

Capital service cover rating 3 4 2 3

Liquidity rating 2 1 2 1

I&E margin rating 2 4 2 2

I&E margin: distance from financial plan 1 3 1 2

Agency rating 1 2 1 2

Overall 2 3 2 2

Year to Date Annual


Sustainability

Month 7 sees a year to date operating deficit of -£2.3m, excluding planned Sustainability and Transformation funding of

£0.9m, against a planned surplus to date of £0.6m. This represents a small budgetary surplus in month and nearly £0.2m

when excluding STF monies and indicated the position has improved in month. The position remains driven by staffing

pressures in ward and prison areas and consequential impact on cost improvement programmes (rising agency costs will

also impact Use of Resources targets). Additionally OAPs expenditure continues to exceed funding. The forecast assumes

current pressures and risks are addressed or mitigated in line with the recovery plan and financial performance achieves (or

exceeds) plan but the unmitigated projection indicates a gap of c£4.8m, c£6.9m without STF monies. This is represents an

improvement on month 6 (£6.2m), and is driven by excess OAPs of c£0.8m (all be that significantly below last month),

prisons and additional mental health pressures. Delivery of the recovery plan and financial targets will required a significant

and coordinated response with robust management and oversight.

3.1 Financial Activity Summary I&E Position

76

FUNDED WTE BUDGET DETAIL BUDGET ACTUAL £ ANNUAL PROJECTED £

EST. ACTUAL TO DATE TO DATE VARIANCE BUDGET ACTUAL VARIANCE

£'000 £'000 £'000 £'000 £'000 £'000

Healthcare Income 178,911 178,212 -699 303,991.4 304,576 584

5,731.5 5,771.4 Clinical Services -134,317 -139,980 -5,663 -228,457 -237,031 -8,574

761.8 702.9 Corporate Services -30,638 -30,565 73 -53,187 -52,615 572

Reserves and Capital Charges -13,956 -10,136 3,820 -22,348 -12,949 9,398

6,493.3 6,474.3 -2,469 -2,469 1,980 1,980


3.1 Financial Activity Summary of Clinical Services

77

FUNDED WTE BUDGET DETAIL BUDGET ACTUAL £ % ANNUAL PROJECTED £

EST. ACTUAL TO DATE TO DATE VARIANCE VARIANCE BUDGET ACTUAL VARIANCE

£'000 £'000 £'000 £'000 £'000 £'000

PAY

2,956.8 3,181.7 ADULT PAY 68,171.7 73,959.1 -5,787.3 -8.5 116,697.6 124,971.6 -8,274.0

NON PAY 6,901.8 7,875.8 -974.0 -14.1 10,206.4 11,817.2 -1,610.8

PATIENT RELATED INCOME -335.6 -485.4 149.9 -44.7 -496.7 -871.3 374.6

NON PATIENT RELATED INCOME -1,205.5 -1,337.7 132.2 11.0 -2,066.6 -2,320.0 253.4

2,956.8 3,181.7 TOTAL 73,532.4 80,011.7 -6,479.3 -8.8 124,340.7 133,597.6 -9,256.8

1,616.4 1,525.6 ADULT COMMUNITY PAY 32,474.5 33,087.7 -613.2 -1.9 55,868.6 56,741.0 -872.5

NON PAY 7,162.2 6,815.7 346.4 4.8 12,339.3 12,243.2 96.1

PATIENT RELATED INCOME -5,102.6 -5,180.2 77.7 -1.5 -9,016.5 -9,416.3 399.8

NON PATIENT RELATED INCOME -1,553.5 -1,526.6 -26.9 -1.7 -2,572.5 -2,548.3 -24.2

1,616.4 1,525.6 TOTAL 32,980.7 33,196.6 -215.9 -0.7 56,618.9 57,019.6 -400.7

1,103.2 1,013.2 CHILDREN AND FAMILY PAY 24,753.3 23,961.9 791.5 3.2 42,169.4 41,383.7 785.7

NON PAY 3,041.5 2,539.9 501.6 16.5 4,830.0 4,295.7 534.3

PATIENT RELATED INCOME -1,093.0 -569.6 -523.4 47.9 -1,534.1 -910.4 -623.7

NON PATIENT RELATED INCOME -762.7 -837.1 74.4 9.8 -1,164.6 -1,291.9 127.3

1,103.2 1,013.2 TOTAL 25,939.2 25,095.1 844.0 3.3 44,300.7 43,477.0 823.7

55.2 51.0 PHARMACY PAY 1,566.4 1,428.7 137.8 8.8 2,685.3 2,463.8 221.6

NON PAY 298.4 250.7 47.8 16.0 511.6 477.9 33.7

NON PATIENT RELATED INCOME 0.0 -2.7 2.7 No Budget 0.0 -4.8 4.8

55.2 51.0 TOTAL 1,864.9 1,676.6 188.2 10.1 3,196.9 2,936.8 260.1

5,731.5 5,771.4 TOTAL 134,317.1 139,980.1 -5,663.0 -4.2 228,457.3 237,031.1 -8,573.8


Cost Improvement Programmes

At month 7 with CIPs of c£7.4m against a plan of c£8.4m the Trust is £1.1m behind plan, a deterioration of £0.1m on

month 6 (£1.0m behind plan). The adverse variance is mainly due to a lack of performance on Run Rate Reduction

Programmes on staffing pressures. Compensating schemes have, and continue to be, developed and network

management team are being supported by to implement measures aimed at improving the position.

Note a number of schemes are still being transacted and that mapping of individual schemes to projects and programmes is still

being finalised.

3.1 Financial Activity CIPs

78


£'m £'m £'m £'m £'m £'m

Cost Improvement Programmes 6.11 6.69 0.58 11.10 13.10 2.00

Run Rate Reduction Programmes 2.33 0.70 -1.63 4.00 2.00 -2.00

Total 8.44 7.39 -1.05 15.10 15.10 0.00

Year to Date Annual


Capital Expenditure

Progress against the capital programme continues to be slow with year-to-date expenditure at £1.8m against the original

profile of £5.9m. The scheduling profile of many schemes was dependent on a number of tendering exercises (the last of

which, Perinatal, has now been completed), agreements with third parties (now substantially resolved) and final funding

approval (Inpatient schemes approval now received from NHSI, awaiting final confirmation of funds and timing from DH).

Schedules for these and related/dependant schemes are now being finalised through discussions with the incumbent

contractors and the Trust is pushing forward with the work required to complete its capital programme in line with its control

total and funding. Risks of slippage due to the delays remain.

3.1 Financial Activity Capital Expenditure

79

YTD Plan YTD Act Annual Forecast

Oct 2017 Oct 2017 Variance Plan Out-turn Variance

£000 £000 £000 £000 £000 £000

IT Schemes 1.015 0.664 -0.351 1.900 1.900 0.000

Estate and infrastructure Schemes

Large Schemes

MH Inpatient Schemes 3.194 0.401 -2.793 4.580 5.700 1.120

Perinatal 0.000 0.113 0.113 0.000 2.470 2.470

Places of Safety 0.000 0.100 0.100 0.000 0.490 0.490

High Priority Schemes 0.697 0.147 -0.550 1.263 1.260 -0.003

Maintenance and Replacement 0.543 0.310 -0.233 0.930 0.930 0.000

Other (inc. contingency) 0.541 0.099 -0.442 0.918 0.911 -0.007

Total 5.989 1.834 -4.155 9.591 13.661 4.070


Contract Activity

Section 2.2

80


81

3.2 Contract Activity – Variance to Plan Community & Wellbeing - Network Line Totals

2017-18 M7 Activity

LCFT are now providing variances against monthly plans at CCG level, however where C&SR and GP provide services that flex to meet the

demands of the central Lancashire area these will be reported as Central Lancashire Locality. Where services are reporting over and

underperformance of 10% or more, LCFT will produce exception narrative as follows:-

• Underperformance – Explain the current position and issues and where known provide a timeframe of when the service anticipates to be back

on plan.

• Over performance – Explain the reasons for the over performance.

For those services that have been reporting underperformance of 10% or more for 3+ months LCFT have submitted exception reports for the worst

preforming services at CCG level as of M6 with a recovery plan and comprehensive narrative explaining the reasons for their under-performance.

LCFT will provide an exception report with a recovery plan and comprehensive narrative for all other services that have been reporting

underperformance of 10% or more for 3+ months in M7 and M8.

Network17-18 Monthly

PlanApr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 YTD 17-18

YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Community & Wellbeing Total 96,998 90,069 94,927 98,778 90,684 91,640 90,102 95,299 651,499 9,435 1.5% 642,064

Children and Young People's

Wellbeing Total 11,118 6,830 9,676 8,101 7,920 7,188 8,855 9,362 57,932 -14,073 -19.5% 72,005

Trust Total Against Plan 108,116 96,899 104,603 106,879 98,604 98,828 98,957 104,661 709,431 -4,638 -0.6% 714,069


82

3.2 Contract Activity – Variance to Plan Community & Wellbeing - Service Line Totals

Service17-18 Monthly


YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Adult Learning Disability Service Total 2,603 1,646 2,345 2,312 2,017 2,080 1,985 1,939 14,324 -1,725 -10.7% 16,049

Adult Speech and Language Therapy Total 266 349 298 375 415 368 311 351 2,467 674 37.6% 1,793

CHESS Total 372 307 427 300 96 213 133 246 1,722 -639 -27.1% 2,361

Children's Learning Disability Service Total 1,307 1,235 1,660 1,655 1,363 1,214 1,585 1,578 10,290 2,000 24.1% 8,290

Community IV Service BwD Total 303 84 97 66 118 92 62 145 664 -1,107 -62.5% 1,771

Community Matrons Total 1,658 1,264 1,199 1,293 1,236 1,093 879 848 7,812 -2,504 -24.3% 10,316

Community Neuro Team Total 1,216 1,067 1,245 1,254 1,246 1,260 1,123 1,081 8,276 845 11.4% 7,431

Community Respiratory Service Total 1,814 1,968 2,074 1,933 1,918 2,110 1,798 2,268 14,069 2,391 20.5% 11,678

Community Stroke Service Total 486 339 359 382 431 467 399 557 2,934 -574 -16.4% 3,508

Complex Case Management Total 475 413 395 385 321 294 543 641 2,992 -26 -0.9% 3,018

Continence Service Total 342 227 304 223 234 287 290 267 1,832 -205 -10.1% 2,037

Dermatology Service Total 441 455 489 400 333 433 276 423 2,809 -272 -8.8% 3,081

DESMOND Total 94 65 78 64 75 68 94 123 567 32 6.0% 535

Diabetes Specialist Nursing Total 1,240 847 956 974 1,038 1,152 1,081 1,114 7,162 -856 -10.7% 8,018

District Nursing Total 38,400 40,895 40,999 39,943 37,898 38,888 37,705 39,840 276,168 9,581 3.6% 266,587

Domiciliary Physiotherapy Total 479 701 610 708 704 784 800 918 5,225 2,243 75.2% 2,982

Falls Team Total 419 425 658 656 685 667 727 805 4,623 2,047 79.5% 2,576

Heart Failure Service Total 526 147 249 261 213 220 251 274 1,615 -1,719 -51.6% 3,334

Intermediate Care Total 3,929 2,804 3,168 3,223 2,779 2,747 2,900 2,755 20,376 -5,663 -21.7% 26,039

Nutrition & Dietetics Total 239 269 262 251 289 211 265 334 1,881 220 13.2% 1,661

Oxygen Service Total 356 237 269 313 445 371 333 292 2,260 30 1.3% 2,230

Phlebotomy Total 18,985 16,855 16,160 22,004 17,610 16,671 17,630 18,013 124,943 11,541 10.2% 113,402

Podiatry Total 5,328 4,396 5,455 5,071 5,009 5,083 4,848 5,055 34,917 -1,170 -3.2% 36,087

Pulmonary Rehabilitation Total 569 441 598 680 618 790 597 631 4,355 899 26.0% 3,456

Rapid Assessment Team Total 1,705 1,527 1,735 1,659 1,730 1,700 1,479 1,502 11,332 781 7.4% 10,551

Rheumatology Total 1,568 1,306 1,587 1,729 1,440 1,684 1,641 1,760 11,147 1,176 11.8% 9,971

Specialist Nurse TB Total 343 618 381 525 471 481 533 428 3,437 683 24.8% 2,754

Tissue Viability Service Total 272 228 247 267 296 297 247 282 1,864 -263 -12.4% 2,127

Treatment Room Total 11,218 8,862 10,500 9,768 9,574 9,895 9,446 10,752 68,797 -9,216 -11.8% 78,013

Viral Hepatitis Service Total 45 92 123 104 82 20 141 77 639 231 56.6% 408

Community & Wellbeing Total 96,998 90,069 94,927 98,778 90,684 91,640 90,102 95,299 651,499 9,435 1.5% 642,064


3.2 Contract Activity – Variance to Plan Community & Wellbeing – Total Activity Split by CCG

Community & Wellbeing - Total Activity split by CCG17-18 Monthly


YTD 17-18

Variance

YTD 17-18

Variance

(%)

Planned YTD

17-18

Central Lancs Locality Total 18,985 16,855 16,160 22,004 17,610 16,671 17,630 18,013 124,943 11,541 10.2% 113,402

NHS Blackburn with Darwen CCG Total 24,752 21,957 24,654 23,309 23,422 23,699 22,170 24,413 163,624 -4,150 -2.5% 167,774

NHS Blackpool CCG Total 64 150 120 142 97 108 139 72 828 321 63.3% 507

NHS Chorley and South Ribble CCG Total 23,766 26,116 26,299 26,278 24,088 25,577 24,647 25,358 178,363 16,997 10.5% 161,366

NHS East Lancashire CCG Total 866 649 948 772 668 647 887 796 5,367 -22 -0.4% 5,389

NHS Fylde & Wyre CCG Total 499 322 330 478 391 430 464 584 2,999 -167 -5.3% 3,166

NHS Greater Preston CCG Total 27,220 23,281 25,375 24,630 23,500 23,637 23,388 25,237 169,048 -16,038 -8.7% 185,086

NHS Morecambe Bay CCG Total 440 341 486 584 456 396 373 405 3,041 246 8.8% 2,795

NHS West Lancashire CCG Total 406 398 555 581 452 475 404 421 3,286 707 27.4% 2,579

Community & Wellbeing Totals 96,998 90,069 94,927 98,778 90,684 91,640 90,102 95,299 651,499 9,435 1.5% 642,064


3.2 Contract Activity – Variance to Plan Community & Wellbeing – Activity Exception Reports by CCG

Community & Wellbeing Planned Contract Activity M7

The Community & Wellbeing Network has provided the following explanations as to why certain services are underperforming by more than 10% against the baseline.

Commissioner: NHS Blackburn with Darwen CCG

Under Performance Exception Reporting:-

Adult Learning Disability Service 59%-

Current position and issues:

The ongoing work regarding data capture has provided an increase in activity for October. This is despite a reduction of staff during the month. Long term sickness for

the clinical psychologist continues and there have been a number of absences during the month.

Actions:

1. Ongoing validation of the data.

2. Monthly Performance meetings with Team Leaders, Service Manager and Care Group Manager to review performance.

Forecast:

A deep dive into the data continues so understand the full extent of the under-performance however the return from sickness and the improved data capture should start

to have a more positive impact on baseline activity.

Until these further investigations have been carried out it is difficult to propose an accurate recovery trajectory and therefore this will be proposed once the increase in

activity of the returning staff has been quantified.



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Adult Learning Disability Service 482 135 189 178 160 143 178 237 1,220 -1,753 -59.0% 2,973

Children's Learning Disability Service 94 106 121 179 109 140 144 124 923 324 54.1% 599

Community IV Service BwD Total 303 84 97 66 118 92 62 145 664 -1,107 -62.5% 1,771

Community Respiratory Service 603 644 596 578 570 621 566 670 4,245 528 14.2% 3,717

Community Stroke Service 486 339 359 382 431 467 399 557 2,934 -574 -16.4% 3,508

DESMOND (Completed Courses) 36 28 25 6 19 11 35 42 166 -40 -19.4% 206

Diabetes Specialist Nursing 515 274 387 265 305 429 414 362 2,436 -901 -27.0% 3,337

Pulmonary Rehabilitation 569 441 598 680 618 790 597 631 4,355 899 26.0% 3,456

Tissue Viability Service 82 105 119 111 121 97 92 126 771 117 17.9% 654

Treatment Room - Non-Serious Injury 130 141 195 189 184 144 166 169 1,188 245 26.0% 943

Treatment Room Total 7,178 5,590 6,359 5,721 5,659 6,008 5,686 6,373 41,396 -8,465 -17.0% 49,861

Treatment Room - Ulcer & Vascular 173 164 260 330 270 272 195 200 1,691 551 48.3% 1,140





Community IV Service BwD 62.5%-


In M7 the IV team became a step down service only. The service continues to work with BWDCCG and ELHT to maximise referrals. The IV team have capacity to

accept and see more referrals. In M7 the team had the highest number of contacts in this financial year.

In M7 there was a staff member on long term sickness which has had an impact upon our ongoing promotions.

The service continues to support the nursing element of IHSS to ensure all service needs and demands are delivered in a timely way to provide acute responses.

Recovery action plan:

We will continue to promote the IV service in ELHT and other acute sites and liaise with the OPAT nurse at ELHT daily regarding potential patients to try and increase

referrals to the service.

Trajectory:

From October 1st 2017 the service stopped accepting step up referrals from primary Care so this will have a further impact on referrals to the service.

Forecast:

As we will cease to receive step-up referrals this will have an impact on our proposed recovery trajectory.

The IV service continues to work with stakeholder colleagues to promote and identify patients for Community IV therapy.

The staff member who was on long term sick has now returned to work. This will increase our teams capacity and ensure further promotion work can be completed.

Community Stroke Service 16%-


The teams monthly plan was to achieve 486 contacts. For M7 this target was exceeded however previous months positions left us at 16.% negative variance. This has

been due to a number of factors. Long term sickness has impacted on our capacity for a number of months but we have also had some short term sickness. In M7 we

have had reduced staff sickness levels.

We continue reviewing the vacancies in terms of skill mix and in line with the Pennine Lancashire stroke specification which is currently being worked on. We aim to start

recruitment as soon as possible.

A locum has now been in place since the beginning of M7 to support Speech and Language Therapy until permanent staff are in place.

Forecast:

With increased staffing levels over the coming months we expect that we will be back within tolerance by M11 and the YTD Plan will be met.

We will continue to build on our working relationships and promoting the service within the acute trust to facilitate timely discharges.




Under Performance Exception Reporting continued:

DESMOND (Completed Courses) 19%-


Month 7 is showing a negative variance of 19% which equates to a total of 42 contacts. This is an improvement on the previous month of 7.7%.

The service has had problems with long term sickness throughout 17/18 which has reduced the amount of courses it has been able to offer, this was particularly

challenging in months 3,4 &5 but has recovered in recent months with the past 2 months being over plan.


An action plan has been agreed with the CCG which includes the following:

• Team to contact all patients that have been referred in by telephone to give more detail of the value and benefits of attending a DESMOND course

• Increase the number of people trained in Desmond to enable backfill when staff are off sick.

Forecast:

There are 4 courses planned for Month 8 and 2 for Month 9 which should maintain our recovery trajectory which has been set at 10% above monthly plan. If achieved our

year end position should be within our target performance tolerance.

Diabetes Specialist Nursing 27%-


The monthly plan was 515 contacts and the team achieved only 362 in M7 leaving us in a -27% negative variance. Due to unplanned levels of sickness within our

Diabetes Education Programme (DESMOND), Diabetes Specialist Nurses supported the education courses so that patients did not have to be cancelled. This however

has had a negative impact on our own Diabetes baseline figures.


A member of staff on long term sickness had now returned to work in M8. In M8 we will expect to see an increase in number of contacts completed.

Forecast:

With the new member of staff in post and DESMOND staff returning to work in M8, we would expect to see an increase in contacts over the coming months leaving us in a

positive year-end position.

Treatment Room

Meetings are taking place in November with Commissioners to understand decreasing activity. The outcomes and subsequent action plans from the meetings will be

published in month 8 QPR.




Over Performance Exception Reporting:-

Children's Learning Disability Service 54%+


There have been a number of groups running over the past 2 months which has increased our activity figures leaving us in a positive variance of 54% in M7. These

groups are set to continue throughout the year.

Community Respiratory Service 14%+


We continue to see high levels of referrals and the service responds to the demand and needs of the population.

Pulmonary Rehabilitation 26%+


The current position in maintaining activity over plan is due to the numbers of patients attending and successfully completing their course. This is due to intensive work

contacting patients, building relationships within the service/stakeholders which has resulted in more patients completing a six week course.

Tissue Viability Service 17%+


The team have noted an increase in the complexity of the patients requiring more visits. The team are now completing an increasing number of reviews due the

increased number of referrals which are more complex, including referrals from the acute, nursing homes and district nurses. The team continue to meet current

demands.



Commissioner: NHS Blackpool CCG


Specialist Nurse TB 63%+


Increased numbers of referrals over several months has contributed to a positive in month variance against plan.

Commissioner: Central Lancs Locality


Community Matrons 24%-


Referrals into the matron service have decreased over the last three months which has impacted on activity linked to new face to face contacts and associated reviews.

A reduction in WTE linked to vacancy and implementation of the action plan to support the CHESS service has also impacted on matron activity.

All patients referred have been seen and care plans formulated. New care pathways are being developed between matrons and specialist teams to ensure seamless care

across pathways are in place. This may see a reduction in follow up activity for matrons moving forwards as patients are managed along specialist pathways.

Forecast:

Additional vacancy from the end of November is likely to further impact on activity. It is unlikely that the service will be fully recruited to before M10 and this will further

impact on activity with a projected negative end of year variance of -22%.



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Specialist Nurse TB 64 150 120 142 97 108 139 72 828 321 63.3% 507



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Adult Speech and Language Therapy Total 266 349 298 375 415 368 311 351 2,467 674 37.6% 1,793

Community Matrons Total 1,658 1,264 1,199 1,293 1,236 1,093 879 848 7,812 -2,504 -24.3% 10,316

Community Neuro Team Total 1,216 1,067 1,245 1,254 1,246 1,260 1,123 1,081 8,276 845 11.4% 7,431

Community Respiratory Service Total 1,211 1,324 1,478 1,355 1,348 1,489 1,232 1,598 9,824 1,863 23.4% 7,961

DESMOND (Completed Courses) Total 58 37 53 58 56 57 59 81 401 72 21.9% 329

Domicillary Physiotherapy Total 479 701 610 708 704 784 800 918 5,225 2,243 75.2% 2,982

Falls Team Total 419 425 658 656 685 667 727 805 4,623 2,047 79.5% 2,576

Heart Failure Service Total 526 147 249 261 213 220 251 274 1,615 -1,719 -51.6% 3,334

Intermediate Care ACS Total 2,799 1,938 2,102 2,155 1,809 1,745 1,954 1,798 13,501 -5,045 -27.2% 18,546

Nutrition & Dietetics Total 239 269 262 251 289 211 265 334 1,881 220 13.2% 1,661

Tissue Viability Service Total 90 49 50 48 53 57 53 50 360 -380 -51.4% 740




Under Performance Exception Reporting continued:-

Heart Failure Service 51%-


The existing staff are supporting the Chorley expansion until new staff in post. This has contributed to the drop in Greater Preston activity in month.

Intermediate Care ACS 27%-


Activity in Intermediate Care is to be viewed in the context of Falls and Community Therapies. These are collectively above baseline and delivered as one overall service

specification. Taking account of the overall activity of the combined Community Therapy teams overall they are over-performing. Staff are flexed across all areas within the

Integrated rehabilitation Team to respond according to clinical demand - performance of the combined team is showing well above activity taking into account the

Intermediate Care, Domiciliary Physio and Falls data.

Tissue Viability Service 51%-


The patient pathway following referral has been reviewed, and opportunities to access the multi-disciplinary team have been maximised. This supports clear case holding

responsibility and access to services in the wider neighbourhood team, most suited to the patient need (e.g. podiatry). This supports increased availability for consultation

and supervision. Referral rates remain constant.


Adult Speech and Language Therapy 37%+


The service have increased their use of non face to face reviews which has had a positive impact on our activity levels. There has also been a significant increase in

referrals over the last 2 quarters of the year. New staff have commenced employment and have full caseloads.

Community Neuro Team 11%+


Team resource is flexed across the Central Lancs locality and overall the demand has increased for the service which is reflected in the increase numbers of referrals

across the locality. Overall the service is showing a positive variance.




Over Performance Exception Reporting Continued:-

Community Respiratory Service 23%+


An increase in the number of in month referrals combined with increased acuity of caseload has contributed to increased activity in month.

DESMOND (Completed Courses) 21%+


The service currently has an action plan in place to increase uptake of diabetes structured education. This is continuing to deliver improvements in attendance and

contributing to a positive variance in month against plan.

Domiciliary Physiotherapy 75%+


The Team's continued over performance reflects activity delivered to support admission avoidance. This activity should also be taken in conjunction with all other

community therapy activity (as part of one combined service specification for Central Lancs Community Rehabilitation Team). This combines Domiciliary Physiotherapy

and Falls Team data. Whilst Intermediate care is showing an underperformance, collectively the rehabilitation team is significantly overperforming on activity - as per

previous exception narrative. Note, Falls data does not include that of Steady On which is reported separately to LCC.

Falls Team 79%+


The Team's continued over performance reflects activity delivered to support admission avoidance. This activity should also be taken in conjunction with all other

community therapy activity (as part of one combined service specification for Central Lancs Community Rehabilitation Team). This combines Domiciliary Physiotherapy

and Falls Team data. Whilst Intermediate care is showing an underperformance, collectively the rehabilitation team is significantly overperforming on activity - as per

previous exception narrative. Note, Falls data does not include that of Steady On which is reported separately to LCC.

Nutrition & Dietetics 13%+


A high demand for the service combined with increasing numbers of patients requiring ongoing follow up reviews continues to place the service under pressure and

contributes to higher than planned activity.



Commissioner: NHS Chorley & South Ribble CCG

Under Performance Exception Reporting

Adult Learning Disabilities 13%-


There have been unfilled vacancies since July and also maternity leave and sickness absence With a significant amount of annual leave in October (half term) this has

contributed to lower activity levels in M7.


Children's Learning Disability Service 48%+


Overactivity is due to the number of groups that the team now undertake. The additional activity within Chorley & South Ribble team to see ASD referrals has also

contributed to the increase in activity.

Rheumatology 16%+


Increasing numbers of referrals is contributing to increased activity which is both positive in month and YTD variance against plan.



Increased numbers of referrals over several months has contributed to a positive in month variance against plan.

Viral Hepatitis Service 19%+


Increases in group activity continues to contribute to a positive in month variance.



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Adult Learning Disability Service 382 295 394 315 290 263 254 234 2,045 -309 -13.1% 2,354

Children's Learning Disability Service 299 351 504 462 408 273 421 388 2,807 919 48.7% 1,888

Rheumatology 641 579 677 745 631 695 703 720 4,750 674 16.5% 4,076


Viral Hepatitis Service 14 20 13 0 15 0 89 15 152 25 19.7% 127



Commissioner: NHS Fylde and Wyre CCG




The revision of the baseline and the continuing validation of the data is reflected in the improving performance and the diminishing YTD variance.

Actions:

1. Ongoing validation of the data.

2. Analysis of data on a weekly basis to identify issues in advance.

3. Monthly Performance meetings with Team Leaders, Service Manager and Care Group Manager to review performance. The focus of these meetings being on

performance and contributing factors.

Forecast:

With the revised baseline and the work to improve data capture coming to fruition it is felt that we will over perform against the new monthly plans by approximately 10%

each month however this will be reviewed and adjusted accordingly once the revised activity levels have been quantified over the next few months.

This trend is expected to continue and may result in a review of baselines for 2018.




Increased numbers of referrals over several months has contributed to a positive in month variance against plan



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Adult Learning Disability Service 346 168 184 268 210 284 268 415 1,797 -337 -15.8% 2,134




Commissioner: NHS Greater Preston CCG


CHESS 39%-


The CHESS team supports services across both GPCCG and CSRCCG. Both localities have seen reduced numbers of referrals from 29 in M4 down to only 5 in M7

which is a significant reduction and which has led to reduced activity, although activity has significantly increased in M7.

The team experienced substantial unplanned absence from June onwards which will have contributed to the reduced referrals and impacted upon activity levels over the

last 5 months. Coupled with this, there has been an increase in vacant beds in both homes over the latter months which will also have impacted on referrals to the service

and associated activity.

Recovery Actions:

LCFT have been in regular communication with the CCG and have put actions in place to address the immediate staffing issues within the CHESS service using a rotation

of senior matrons to manage the two intermediate care facilities. This is now working more smoothly and activity has increased in M7. Longer term LCFT has formulated

a business case to create a sustainable integrated frailty service able to work in an integrated and flexible manner to deliver the specifications set out in the Frailty,

CHESS and Community Matron service lines and establishing a longer term sustainable service. This business case is awaiting CCG sign off to enable full recruitment

into appropriate skill mixed roles.

Forecast:

Assuming that bed occupancy and associated referrals increases in line with the time of the year based on previous years referral activity then we would expect to see

activity increasing.

It is unlikely that we will meet the plan in year as recruitment to posts proposed in the new model will need to take place. It is estimated that it will take 3 months to

achieve full recruitment. The trajectory has been based on this and will still give a negative variance of approx -37%.



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Adult Learning Disability Service 267 185 298 351 381 430 292 186 2,123 474 28.7% 1,649

CHESS 234 151 222 193 63 70 56 150 905 -581 -39.1% 1,486

Children's Learning Disability Service 264 232 271 275 242 246 327 314 1,907 234 14.0% 1,673






Adult Learning Disability Service 28%+


This months over performance is largely due to consistent communications with staff to record all activity they undertake for a patient. There has also been a

significant increase in referrals to this team over the last quarter resulting in increased activity in M7.

Children’s Learning Disabilities 14%+


Over activity is due to the groups that commenced in M6 'Riding the Rapids' These courses are set to continue.




Commissioner: NHS Morecambe Bay CCG




Sickness has contributed to targets not being met. 1 nurse on long term sick and a number of short term sickness. There has been no impact to patient care.



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Adult's Learning Disability Service 368 184 321 384 300 248 271 234 1,942 -324 -14.3% 2,266

Children's Learning Disability Service 33 91 128 99 80 74 69 108 649 437 206.1% 212





Children’s Learning Disability Service 206%+


Over activity due to the significant number of groups running e.g. 'Riding the Rapids'. A re-evaluation of baselines may need to be considered in respect of the new

activity and capacity in north Lancs (ASD pathways).


Current position and issues: Significant increases in referrals continues to result in a positive variance against plan.

Commissioner: NHS West Lancashire CCG


Adult Learning Disability Service 74%+


This months over performance is largely due to consistent communications with staff to record all activity they undertake for a patient. There has also been a small

increase in referrals received over the last quarter which has led to an increase in activity in M7. The complexity of clients on the caseload has also increased the

numbers of contacts undertaken in month.



High levels of referrals continue to contribute to a positive variance against monthly plan.






YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Adult Learning Disability Service 157 230 292 324 187 273 184 198 1,688 721 74.6% 967




3.2 Contract Activity – Variance to Plan Children & Young People’s Wellbeing – Total Activity by CCG

96

Children & Young People's Wellbeing -

Total Activity split by CCG

17-18

Monthly PlanApr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 YTD 17-18

YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

NHS Blackburn with Darwen CCG Total 779 561 753 718 591 535 766 770 4,694 -298 -6.0% 4,992

NHS Chorley and South Ribble CCG Total 2,046 1,011 1,339 1,310 1,178 830 1,198 1,196 8,062 -4,975 -38.2% 13,037

NHS East Lancashire CCG Total 4,663 3,448 5,028 4,026 3,971 3,779 4,438 4,935 29,625 -1,230 -4.0% 30,855

NHS Greater Preston CCG Total 2,908 1,399 1,994 1,524 1,751 1,575 1,876 1,988 12,107 -6,394 -34.6% 18,501

NHS West Lancashire CCG Total 722 411 562 523 429 469 577 473 3,444 -1,176 -25.5% 4,620

Children & Young People's Wellbeing

Total 11,118 6,830 9,676 8,101 7,920 7,188 8,855 9,362 57,932 -14,073 -19.5% 72,005


3.2 Contract Activity – Variance to Plan Children & Young People’s Wellbeing - Service Line Totals

97



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Children's Occupational Therapy Total 1,164 618 835 851 610 550 799 785 5,048 -2,651 -34.4% 7,699

Children's Physiotherapy Total 879 574 645 632 580 518 648 679 4,276 -1,294 -23.2% 5,570

Children's Speech & Language Therapy Total 3,389 1,960 2,859 2,573 2,361 1,938 2,772 2,981 17,444 -4,146 -19.2% 21,590

Paediatric Liaison Total 5,686 3,678 5,337 4,045 4,369 4,182 4,636 4,917 31,164 -5,982 -16.1% 37,146

Children and Young People's Wellbeing

Total Against Plan11,118 6,830 9,676 8,101 7,920 7,188 8,855 9,362 57,932 -14,073 -19.5% 72,005


3.2 Contract Activity – Variance to Plan Children & Young People’s Wellbeing – Exception Reports by Service

98

Commissioner: NHS Chorley & South Ribble CCG


Children’s Occupational Therapy 23%-


October manual activity data was 204 against a baseline of 240. The current YTD total based on CITNS manual count is 1,220 -338 YTD. (Variance % -23.2%).

Based on the planned activity total, the service is required to see an extra 96 contacts in total to meet the 10% threshold.

Average staff capacity in Chorley & South Ribble OT during the 17/18 monitoring year has been at 100%.

The team continues to now meet RTT target during 17/18.

Paediatric Liaison 62%-


The service receives 100% of its referrals from the Emergency Department (ED), and have no control over the number of children attending however the activity is

lower than expected as we are currently unable to identify the activity that is deflected through the Go To Doctor service.

Commissioner: NHS East Lancashire CCG




October manual activity data was 350 against a baseline of 379. The current YTD total based on CITNS manual count is 2,155 -358 YTD. (Variance % -14%). Based

on the planned activity total, the service is required to see an extra 154 contacts in total to meet the 10% threshold.

Average staff capacity in East Lancashire OT during the 17/18 monitoring year has been at 83%.




YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Children's Occupational Therapy 240 116 166 223 186 112 213 204 1,220 -368 -23.2% 1,588

Paediatric Liaison 964 261 434 311 366 291 366 277 2,306 -3,788 -62.2% 6,094



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18


Children's Speech & Language Therapy 1,272 667 1,114 1,090 904 804 1,006 1,258 6,843 -1,263 -15.6% 8,106



99

Commissioner: NHS East Lancashire CCG

Under Performance Exception Reporting Continued:-

Children’s Speech & Language Therapy 15%-


October manual activity data was 1258 against a baseline of 1272. The current YTD total based on CITNS manual count is 6843 YTD. (Variance % -15.6%). Based


Average staff capacity in East Lancs SLT during the 17/18 monitoring year has been at 84%.






October manual activity data was 212 against a baseline of 232. The current YTD total based on CITNS manual count is 1,137 -400 YTD. (Variance % -26%). Based


Average staff capacity in Greater Preston OT during the 17/18 monitoring year has been at 83%.




YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18


Children's Physiotherapy 360 224 268 229 202 224 290 327 1,764 -523 -22.9% 2,287

Children's Speech & Language Therapy 606 357 562 383 450 341 532 591 3,216 -645 -16.7% 3,861

Paediatric Liaison 1,710 831 1,219 916 1,036 963 1,037 1,076 7,078 -3,738 -34.6% 10,816



100


Under Performance Exception Reporting Continued:-

Children’s Physiotherapy 22%-


October manual activity data was 327 against a baseline of 360. The current YTD total based on CITNS manual count is 1,764, -523 YTD. (Variance % -22.9%).

Based on the planned baselines, the service is required to record an extra 155 F2F contacts by year end to meet the 10% threshold.

Staff capacity in Greater Preston Physio team during the 17/18 monitoring year has been at 83%.

The team continues to meet RTT target during 17/18.

Children’s Speech and Language Therapy 16%-


October manual activity data was 591 against a baseline of 606. The current YTD total based on CITNS manual count is 3,216 -645 YTD. (Variance % -16.7%).


Average staff capacity in Greater Preston SLT team during the 17/18 monitoring year has been at 77%.


Children’s Paediatric Liaison 34%-


The service receives 100% of its referrals from the Emergency Department (ED), and have no control over the number of children attending however the activity is

lower than expected as we are currently unable to identify the activity that is deflected through the Go To Doctor service.


3.2 Contract Activity – Variance to Plan Children & Young People’s Wellbeing–Exception Reports by Service

101

Commissioner: NHS West Lancashire CCG




October manual activity data was 103 against a baseline of 166. The current YTD total based on CITNS manual count is 742 -358 YTD. (Variance % -33%). Based


Average staff capacity in West Lancashire OT during the 17/18 monitoring year has been at 98%.


Children’s Physiotherapy 25%-


October manual activity data was 155 against a baseline of 194. The current YTD total based on CITNS manual count is 909, -315 YTD. (Variance % -25.7%).


Average staff capacity in West Lancashire Physio team during the 17/18 monitoring year has been at 66%.




YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Children's Occupational Therapy 166 81 120 124 64 117 133 103 742 -358 -32.5% 1,100

Children's Physiotherapy 194 97 128 130 127 124 148 155 909 -315 -25.7% 1,224


3.2 Contract Activity – Variance to Plan Mental Health – Total Activity Split by CCG

Demand Metrics Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 YTD 17-18

Adult/PICU Ward Admissions Total 169 195 180 187 175 171 166 1,243

Adult/PICU Ward Discharges Total 167 187 177 165 168 163 159 1,186

CMHT Adult - Accepted Referrals Total 153 171 167 153 212 189 188 1,233

CMHT Older Adult - Accepted Referrals Total 90 139 131 120 142 127 122 871

Community Restart Teams - Accepted Referrals Total 130 176 178 165 163 122 158 1,092

CRHT Teams - Referrals Total 720 793 870 806 769 822 790 5,570

Eating Disorder Service - Referrals Total 73 86 93 79 69 69 94 563

Hospital Liaison Referrals Total 149 171 155 158 175 152 153 1,113

MAS Teams - Referrals Total 492 565 627 607 617 580 579 4,067

Older Adult (Dementia) Inpatient Ward Admissions Total 7 12 6 7 7 9 5 53

Older Adult (Dementia) Inpatient Ward Discharges Total 10 6 8 8 5 6 8 51

Older Adult (Functional) Inpatient Ward Admissions Total 11 9 11 12 9 11 4 67

Older Adult (Functional) Inpatient Ward Discharges Total 12 10 9 14 9 11 7 72

PICU Wards - Transfers In Total 16 27 24 26 21 17 24 155

RITT Referrals Total 169 154 168 151 204 154 145 1,145


3.2 Contract Activity – Variance to Plan Mental Health – Activity Totals

Productivity Metrics Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 YTD 17-18

ADHD Contacts Total 371 253 390 454 315 268 329 2,380

CMHT AD - Contacts Total 8,189 9,706 9,627 9,171 9,015 8,881 8,936 63,525

CMHT OA Contacts Total 2,584 2,846 2,815 2,754 2,862 2,766 2,712 19,339

CRHT Face to Face Contacts - Below 18 Total 123 242 153 171 130 137 145 1,101

CRHT Face to Face Contacts - 18 to 65 Total 3,667 4,042 3,766 3,921 3,874 3,657 3,697 26,624

CRHT Face to Face Contacts - Over 65 Total 65 74 43 73 39 9 19 322

CRHT Telephone Contacts - Below 18 Total 66 128 96 69 80 96 101 636

CRHT Telephone Contacts - 18 to 65 Total 2,130 2,487 2,148 2,404 2,508 2,518 2,557 16,752

CRHT Telephone Contacts - Over 65 Total 37 106 47 40 41 40 35 346

Criminal Justice Liaison - Contacts Total 571 667 587 580 648 576 595 4,224

Eating Disorder Service - Contacts Total 692 869 964 1,139 1,114 1,043 1,151 6,972

Hospital Liaison Contacts Total 372 410 387 363 470 368 432 2,802

MAS Teams - Contacts Total 2,899 3,399 3,206 3,097 3,268 2,958 3,140 21,967

RITT Contacts Total 1,921 2,265 2,270 2,571 2,742 2,640 2,482 16,891

Mental Health Productivity Total 23,687 27,494 26,499 26,807 27,106 25,957 26,331 183,881

Mental Health - Total Contacts Activity split by CCG Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 YTD 17-18

NHS BLACKBURN WITH DARWEN CCG 2,665 3,162 2,928 2,848 2,838 2,775 2,922 20,138

NHS BLACKPOOL CCG 2,751 3,225 2,915 2,991 2,991 3,030 3,001 20,904

NHS CHORLEY AND SOUTH RIBBLE CCG 2,339 2,584 2,341 2,219 2,307 2,279 2,494 16,563

NHS EAST LANCASHIRE CCG 4,870 5,770 5,560 5,834 5,612 5,195 5,353 38,194

NHS FYLDE & WYRE CCG 2,398 2,589 2,699 2,549 2,599 2,408 2,262 17,504

NHS GREATER PRESTON CCG 2,898 3,659 3,494 3,389 3,460 3,322 3,622 23,844

NHS MORECAMBE BAY CCG 2,584 2,757 2,823 2,879 2,901 2,863 2,848 19,655

NHS WEST LANCASHIRE CCG 1,419 1,677 1,664 1,676 1,766 1,607 1,517 11,326

Grand Total 21,924 25,423 24,424 24,385 24,474 23,479 24,019 168,128


104

3.2 Contract Activity – Variance to Plan Mental Health – Activity Totals

2017-18 Baseline Proposal

Last month it was reported that the MAS Contact activity has been over inflated due to the reporting of ‘Patient Notes’ and as result an investigation

was required to determine which other teams maybe affected and whether the baselines would need to be adjusted as a result.

Since then a meeting with Practitioners has been carried out to determine whether Patient/Proxy contacts are reported within ‘Patient Notes.’ The

outcome of which concluded that Practitioners have sporadically been using the ‘Notes’ contact type to record patient contacts across all services.

If we therefore take the decision to remove ‘Notes’ from the Schedule 6 reporting we would be excluding a percentage of legitimate patient contacts.

The Performance team are therefore co-ordinating an ad-hoc audit to determine the percentage of Patient/Proxy contacts recorded within ‘Notes’

against each service. The results of this audit, which we are planning to complete by the end of November, will then enable more accurate revised

baselines to be set and for the reported figures to be adjusted appropriately.

Aside from the above audit, LCFT are investigating whether other Contact Types that do not hold Patient/Proxy contacts have been misreported within

the Schedule 6 figures and the results of this investigation will also be known by the end of November.

2017-18 M7 Activity

For M7, LCFT have continued to provide the activity totals and YTD position only whilst the baselines are being finalised.

Following the initial investigation into LCFT including ‘Patient Notes’ within Schedule 6 reporting and the resulting over inflated activity of MAS contact

activity, LCFT have determined that the same error had been replicated in the following services: ADHD, Eating Disorders and Hospital Liaison, and a

decision was taken to remove ‘Patient Notes’ and refresh the activity back to April 17. This refresh has been completed for M7, however following the

Practitioner meeting it has become apparent that this will need to be amended following the aforementioned audit.

Quality Metrics Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 YTD 17-18

Adult Ward Occupied Bed Days Total 5,744 5,835 5,676 5,885 5,904 5,784 5,908 40,736

Eating Disorder Service DNA's - Follow Up Contacts 94 98 76 123 129 93 87 700

Eating Disorder Service DNA's - New Contacts 7 8 14 14 19 3 6 71

PICU Ward Occupied Bed Days Total 817 849 846 893 952 897 909 6,163

Older Adult (Dementia) Ward Occupied Bed Days Total 812 850 854 909 945 924 969 6,263

Older Adult (Functional) Ward Occupied Bed Days Total 1,034 1,104 1,081 1,102 1,154 1,101 1,119 7,695

Older Adult (Functional) Inpatient 30 Day ReAdmissions 1 0 0 0 0 0 0 1

Older Adult (Functional) Inpatient 90 Day ReAdmissions 1 1 0 1 0 0 0 3

Adult Inpatient 30 Day ReAdmissions Rate (8% Target) 9.58% 7.49% 9.04% 9.09% 6.55% 7.36% 9.43% 8.32%Adult Inpatient 90 Day ReAdmissions Rate (15% Target) 14.97% 13.90% 16.38% 12.12% 7.74% 7.36% 9.43% 13.06%


3.2 Contract Activity – Variance to Plan Children & Young People’s Wellbeing – Sexual Health Activity

as at w/c 23rd October 2017

105

• Revised planned attendances full year are 27,344. Actual attendances during October 2017 was 1,497 – 808 below the

planned total of 2,305.

• Initial income for the 17/18 monitoring year shows a increase in M6 and 7 in comparison to M4, with the total income as at

end of August 2017 at £810,020.


106

3.3 CQUIN Executive Summary

CQUIN Executive Summary:

Quarter 2 submissions for 2017/18 schemes have taken place for the Mental Health & Community contracts. The staff flu scheme is currently

behind plan but is expected to meet the 70% target by the end of February 18. Discussions are ongoing with acute trusts regarding the A&E

scheme, however we are working towards the targets for the scheme with commissioner support. Some further work needs to be done

regarding the Physical Health schemes to achieve the required increase in targets for future quarters. An audit is currently underway.

The Trust has not been successful in achieving the required targets for the preventing illness through the risky behaviours scheme. The

expected loss is £40k relating to Mental Health and £10k for Longridge. Work needs to focus on referrals to the stop smoking services and

staff training to ensure Quarter 3 and Quarter 4 targets are achieved.

Quarter 2 schemes for Southport & Formby contract have been submitted in line with the agreed milestones. No issues are expected.

£1,033k CQUIN funding across CCG contracts is agreed based on the Trust meeting its control total in 2016/17, however there are ongoing

discussions between NHSE and NHSI regarding the payment mechanism. A further £1,033k CQUIN funding across CCG contracts is agreed

based on the Trust's engagement and commitment to the STP process. Confirmation has been received via BWD CCG that this element of

funding has been agreed by the STP.

The Trust is waiting feedback from NHS England regarding the Cumbria Liaison & Diversion scheme submission but are not expecting any

issues.

There are not expected to be any issues with the submission for the Specialist Services schemes for Q2.

Measures are expected to be put into place to ensure that the Trust achieves the remaining

CQUIN funding available and no further losses are seen than those identified in Quarter 2.

Executive Summary

Contract Actual

Loss/

concern Expected

Loss/

concern Expected

Loss/

concern Expected

Loss/

concern % Met Expected

Loss/

concern

Mental Health 100% £652,503 £0 93% £518,134 £40,150 100% £515,457 £0 100% £1,842,663 £0 99% £3,528,758 £40,150

Southport 100% £45,584 £0 100% £48,657 £0 100% £33,294 £0 100% £128,513 £0 100% £256,048 £0

Community 100% £238,378 £0 96% £244,404 £10,042 100% £174,107 £0 100% £672,046 £0 99% £1,328,935 £10,042

NHS England - Spec Comm MH 100% £193,941 £0 100% £193,941 £0 100% £193,941 £0 100% £193,941 £0 100% £775,762 £0

NHS England - Liaison & Diversion 100% £5,201 £0 100% £5,201 £0 100% £5,201 £0 100% £5,201 £0 100% £20,803 £0

NHS England - Imm & Vacc 100% £3,675 £0 100% £3,675 £0 100% £7,350 £0

Qtr. 4

100%

Expecte

d

Position

Full Year

99%£2,842,363 £0 £5,917,656 £50,193£0

Expecte

d

Position

£922,000 £0100%

Oct 2017 CQUIN Position

Expected

PositionTotal

Expected

Position100%

Qtr. 2Qtr. 1

£1,139,282 95% £1,014,011 £50,193

Qtr. 3


Quality

Section 4

107


108

Section 4:- Quality

• Quality and Safety Tile

• Quality Surveillance – Safe

• Quality Surveillance – Effective

• Quality Surveillance – Caring

• Quality Surveillance – Responsive

• Quality Surveillance – Well Led

• Delivering the Strategy

4. Quality


4. Quality Quality & Safety Tile

109

15251 94.40%

92 8701

38

1

10 1632

3930 320

13 0.54

2869

2172

90.05%

95% N/A

83% 9

QUALITY AND SAFETY TILE

CARING

Compliments

F&F Test

RIDDOR incidents

Incidents

STEIS-reportable serious

incidents

EFFECTIVE

Never Events

Number of red flag incidents

(inpatients only)

Core Skills (%)

SAFE

Physical violence to staff from

patients

Serious HCAI incidents

Use of restraint

Potentially avoidable grade 3 and

4 pressure ulcers

As a result of the Network Re-design historical data prior to 15 May 2017 is recorded in the four Network structure and has been aggregated in this report to provide the best available comparison.

Data provided shows the following 12 month figure (where a number) or the rolling 12 month average (where a percentage).

Physical Health HFC Rate (%) Appraisals (%)

Mental Health HFC Rate (%) Concerns raised

Good

Completed within agreed

timeframe (%)

RESPONSIVE

Complaints

Upheld/partially upheld

complaints

WELL LED

Trust CQC rating


4. Quality Safe

110

Domain Indicator Target Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct12 months

total

12 months

averageSparkline Risk

Incidents n/a 1867 2094 2345 2358 2168 2090 2329 15251 2178.7

Incidents with harm n/a 404 436 487 547 437 473 535 3319 474.1


incidentsn/a 6 6 7 9 4 9 8 10 4 11 8 10 92 7.7

RIDDOR incidents n/a 2 6 2 0 3 4 5 2 6 1 6 1 38 3.2

Never Events 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0.1

Medication incidents n/a 127 149 177 150 148 183 186 1120 160.0

Infection control Serious HCAI incidents 0 1 4 1 0 1 1 0 1 0 0 1 0 10 0.8

Use of restraint n/a 349 252 189 263 308 329 300 400 461 335 346 398 3930 327.5

Use of seclusion n/a 85 65 73 68 66 64 65 486 69.4

Safeguarding alerts n/a 100 158 138 129 130 95 152 902 128.9

Potentially avoidable grade 3

and 4 pressure ulcersn/a 0 0 0 2 0 2 0 5 1 2 0 1 13 1.1

Number of instances of 1 or less

qualified on duty (inpatients)0 244 207 192 170 145 139 197 140 132 177 132 84 1959 163.3


(inpatients only)n/a 316 261 260 268 221 195 270 227 228 258 228 137 2869 239.1

Staff safetyPhysical violence to staff from

patients n/a 162 137 140 129 151 155 150 218 268 220 223 219 2172 181.0

Legal Regulation 28 Notices received n/a 0 0 0 0 1 0 0 1 1 0 0 0 3 0.3

QUALITY AND SAFETY SURVEILLANCE - Safe

Incidents

Patient safety

Staffing


4. Quality Effective

111

Domain Indicator Target Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Sparkline Risk

Pressure ulcers (%) - 4.61% 3.96% 2.72% 2.91% 5.27% 3.45% 3.45% 4.04% 3.05% 3.12% 2.55% 2.72%

Falls with harm (%) - 1.76% 1.29% 1.28% 1.64% 1.55% 1.55% 0.60% 0.75% 1.21% 0.64% 0.93% 0.53%

Catheter and UTI (%) - 0.29% 0.18% 0.64% 0.27% 0.26% 0.43% 0.45% 0.27% 0.21% 0.07% 0.23% 0.15%

VTE (%) - 0.59% 0.55% 0.08% 0.36% 0.35% 0.35% 0.15% 0.69% 0.43% 0.43% 0.93% 0.38%

Physical Health HFC Rate (%) 95% 93% 94% 95% 95% 93% 94% 96% 94% 95% 96% 96% 96%

Self harm (%) - 3.69% 3.35% 4.04% 3.55% 3.43% 3.56% 3.76% 3.75% 4.37% 4.63% 3.71% 3.59%

Victim of violence (%) - 2.87% 1.89% 1.62% 2.71% 1.07% 2.30% 1.46% 2.50% 1.66% 1.89% 1.75% 3.17%

Feel safe (%) - 10.86% 9.22% 6.26% 8.35% 9.01% 9.62% 10.65% 7.08% 7.90% 10.53% 8.08% 11.21%

Omission of medication (%) - 15.57% 18.87% 13.74% 16.08% 17.17% 17.99% 18.37% 23.54% 20.37% 19.79% 20.09% 24.10%

Restraint (%) - 5.74% 6.29% 4.65% 4.80% 3.65% 5.23% 5.43% 7.08% 6.86% 7.16% 5.68% 4.86%

Mental Health HFC Rate (%) 90% 82% 83% 86% 84% 85% 83% 83% 84% 81% 80% 84% 80%

QUALITY AND SAFETY SURVEILLANCE - Effective

12 months

average

3%

1%

0%

83%

Physical Health

Harm Free Care

Mental Health

Harm Free Care

0%

19%

6%

95%

4%

2%

9%


4. Quality Effective

112

N/L/R* Compliance Date

L 100% 7.11.17

L 66% 7.11.17

R 100% 7.11.17

R

R

L

L

L

L

R

L

L

L

L

R

R

R

Clinical Audits Date

Prevention of Dehydration MHN 54% Sep-17

NetworkNICE Baseline Assessments

NG73 Endometriosis CYPWN

Network Compliance (%)

MHN

Nursing Management of Clozaril MHN 60% Oct-17 NG71 Parkinsons Disease CWB

Absent Without Leave MHN 55% Oct-17NG6 Mental Health of Adults in contact with

the criminal justice system

* N/L/R - National Audit, Local Audit, Re-Audit (if re-audit, the previous compliance figure will be included).

Carers CYPWN 54% Oct-17

Diabetes MHN 65% Sep-17

83%CYPWNRisk Assessments

Cerebral Palsy in under 25's (NICE) CYPWN 82%

Clozapine

Antibiotics in dentistry

CYPWN

CWN

80%

94%

85%

70%

79%

85%

Nutrition CYPWN 77%

Consent to Treatment MHN 94%

Completion of Waterlow risk assessments

Wound assessment documentation

Care of Dying

Learning Disability

CWN

CWN

CWN

CWN

Use of restrictive practices within LD CWN 93%

Acupuncture - Rheumatology & Physiotherapy CWN 97%


4. Quality Caring & Responsive

113


total

12 months


F&F Test 95% 85% 87% 96% 96% 96% 96% 97% 95% 97% 97% 97% - 94.40%

F&F Test - Response Rate n/a 3371 1744 1659 2042 1562 1263 1815 1218 1241 1652 923 18490 1680.9

Compliments Compliments n/a 719 529 678 1031 788 593 987 697 774 819 537 549 8701 725.1

QUALITY AND SAFETY SURVEILLANCE - Caring

Friends & Family -

Patients

The Friends and Family Test real time reporting is locked and nationally reported on the 19th of each month and will therefore be reported in arrears most months


total

12 months


Complaints n/a 134 150 114 111 167 95 108 152 134 173 149 145 1632 136.0


complaintsn/a 42 26 22 21 31 26 23 19 24 22 21 43 320 26.7


timeframe (%)n/a 54.0% 54.0% 54.0%

Reopened complaints n/a 3 3 3 4 2 4 4 7 5 0 0 3 38 3.2

PHSO complaints n/a 0 0 1 2 3 1 3 1 0 1 0 0 12 1.0

MP enquiries n/a 8 7 13 9 15 7 8 5 9 11 5 12 109 9.1

Environment Mixed Sex Breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

QUALITY AND SAFETY SURVEILLANCE - Responsive

Complaints


4. Quality Well Led

114


total

12 months


Trust CQC rating Good RI RI Good Good Good Good Good Good Good Good Good Good

Regulatory inspections/visits n/a 4 5 4 3 4 3 2 1 2 1 29 2.9

CQC notifications n/a 0

Core Skills (%) 85% 87.72% 88.24% 89.07% 89.41% 90.68% 90.33% 89.26% 91.06% 91.55% 90.81% 90.87% 91.64% - 90.05%

Supervision (%) n/a -

Appraisals (%) n/a -

Overdue 3 day reviews 0 1652 1305 1176 1267 1295 1695 1349 1573 2192 13,504 1500.44

Overdue 7 day reviews 0 105 80 71 65 77 82 74 59 97 710 78.89

Overdue incident actions 0 94 -

Duty of candour breaches 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0

Overdue safety alerts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Concerns raised n/a 9 -

Quality Plan priorities off track 0 0 0 0 0 -

Quality assurance visits n/a 1 0 0 0 2 3 0.6

Assurance

QUALITY AND SAFETY SURVEILLANCE - Well Led

Regulatory

People

Good

Learning and

candour


115

4. Quality Audit 2017

National Audit Data collection period Report due Compliance

National Audit of Intermediate Care

(NAIC)

May 2017 to August 2017

Participants will be asked for outturn data

April 2018

National chronic Obstructive

Pulmonary Disease (COPD) audit

programme

April 2017 to July 2017 February 2018

National Diabetes Audit – Adults April 2017 to July 2017 February 2018

Sentinel Stroke National Audit

programme (SSNAP)

April 2017 to March 2018

Collection: April to July, August to November, December to

March, April to March (annual)

January 2018

UK Parkinson’s Audit: (incorporating

Occupational Therapy

Speech and Language Therapy,

Physiotherapy

Elderly care and neurology)

1 May 2017 to 30 September 2017

May 2018

National Audit of Psychosis Autumn/Winter 2017 TBC

National Audit of Anxiety & Depression TBC TBC

Topic 17: Use of depot/LA

antipsychotics for relapse prevention

– baseline audit

May 2017 to June 2017

Sampling & Data Collection: May 2017

Online Data Submission: June 2017

Nov 2017

Topic 15: Prescribing for bipolar

disorder (use of sodium valproate) –

re-audit

September 2017 to October 2017

Sampling & Data Collection: Sept 2017

Online Data Submission: October 2017

Feb 2017

Topic 6: Assessment of side effects of

depot antipsychotic medication – 2nd

supplementary

February 2018 to March 2018

Sampling & Data Collection: February 2018

Online Data Submission: March 2018

July 2018


4. Quality Delivering the Strategy

116

Not currently assessed

Project Element not in place

Project Element in place but requires update or further

work

Project Element in place and fit for purpose

Project Element not required

Project Element not in place

Key

Exec SRO Sue Moore

Programme SRO Joanne Moore

Programme Manager Carly SteerReporting Period October 2017 (Month 7)

Report date 13-Nov-17

The purpose of Delivering the Strategy (DTS) is to deliver the Trust's transformation programme and the operational annual plan. The focus is on

tranformational schemes that are aligned to the STP and LDPs and on continuous improvement of quality within our services. There are 6 DTS portfolios in

2017/18 aiming to deliver a wide range of redesign programmes.

Programme Description

DTS Programme Report

Overview

Across each network portfolio, for all schemes that have been initiated, work is ongoing to develop detailed delivery plans where this is not already in place status

summarised for each scheme in Programme assurance heat maps.

Complex packages of care within C&YP is now underway for a tender submission in November and work has also started to scope out Transformation of Secure

Services, Core 24 and Core Home Treatment 24/7.

Further work required to establish benefit trackers for each programme, to enable leads to measure performance and provide robust assurance on delivery.

ASSURANCE CRITERIONComplex Packages of Care

(CPOC)

CAMHS Tier 4

Transformation

0-25 Clinical Pathway

including integration of

Child psychology and

LCC contract for Health

Visiting and School

Nursing

PROGRAMME RESOURCE

Project Manager assigned Janet Thorpe Janet Thorpe Janet Thorpe Janet Thorpe

Transformation Lead

assignedTBC Nicola Adams Nicola Adams Michael Orchard

Project Lead assigned TBC Paul AndertonSarah Wright/Anita

DemariaCathy Allen

Clinical Lead assigned Lorna Taylor Terry Drake Julie Ross Debra Wilson

Full resource plan agreed

PROGRAMME

DOCUMENTATION

Programme initiation

document

To be reviewed

Nov/Dec 17

Programme under

review Oct/Nov 17

Not currently required –

pre tender periodMove to the Cove –

in placeTransformation work

Programme PlanUnder review –

deadline 30 Nov

Under review – deadline

30 NovHigh level – Aug 17

Risks and Issues log In place In place In place

Programme Governance In place In place In place

TOR Redrafted Redrafted Agreed

Regular meetings 1st meeting 13 June 1st meeting 13 June 1st meeting 13 June

PROJECT PERFORMANCE

On time

On cost

Benefits tracker in place Not applicable

Children & Young People's Wellbeing DTS Portfolio

QIAs drafted for

Integrated MDT offer and

Point of Access

Quality Impact Assessment

Not currently required –

quality issues addressed

within tender process



117

PROGRAMME RESOURCE

PMO Lead assigned Dawn Killey Dawn Killey Dawn Killey Dawn Killey Dawn Killey Dawn Killey Dawn Killey

Transformation Lead

assignedSarah Neve Helena Owen Sarah Neve Sarah Neve

Natalie Hilton/Fran

RileySarah Neve Sarah Neve

Clinical Lead assigned Lorraine Chadwick Lorraine ChadwickLorraine Chadwick/Claire

BensonGuz Singh Jeremy Tudway TBC Lorraine Chadwick

Full resource plan agreed n/a currently n/a currently

PROGRAMME

DOCUMENTATIONProgramme initiation

documentScoping n/a currently

n/a In Progress

Currently Nov-17In Progress

Nov-17

Programme Governance n/a currently

In Progress

Nov-17

Regular meetings n/a Currently n/a Currently n/a currently

Benefit trackerIn progress- met

with PerformanceStarted to map benefits TBC n/a currently

n/aCurrenty

On cost

On time( from

dashboard)n/a currently 83% 30% 16% n/a n/a

S136

99% 33%

New Models of Care?

Dawn Killey

Sarah Neve

Phil Horner

Transforming Secure

Services

TOR n/a currently

Risks and Issues log

Programme Plan Scoping


Signed off by Clinical

Lead, to be presented to

Network Leads on 21st

Phil Horner Bev Liddle

Richard Morgan

Scoping TBC n/a currently Update In progress

n/a currently

n/a currently

Core Home

Treatment 24/7 Core 24

Project Lead assigned Lorraine McDonald-Johnson Bev Liddle Joe Crocock Phil Horner Pauline Cullen

Crisis House eastASSURANCE CRITERIONMental Health

Access Line

Inpatient Reconfiguration

programme

Mental Health DTS Portfolio



118

ASSURANCE CRITERION LD IAPT CPSR South Ribble Central BwD Dental CPOC

ASSURANCE CRITERION LD IAPT CPSR South Ribble Central BwD Dental CPOC

PROGRAMME RESOURCE

Programme Lead assigned Stuart Sheridan Deborah Bretherton Julie Nowell Julie Nowell Tanya Hibbert Tanya Hibbert Andy Jones

Transformation Lead

assignedDeborah Howe

Clinical Lead assigned Mahesh Odiyoor Janine Williams Tracy Cook- Scowen Tracy Cook- Scowen Sarah Procter

Full resource plan agree

PROGRAMME

DOCUMENTATIONProgramme initiation

document


Programme Plan Plans to be finalisedTo be updated in line

with new governance

structure

High-level – plan in

place further detail

required.

Risks and Issues log

Programme Governance

TOR

Regular meetings Fortnightly

Benefits Tracker

PROJECT PERFORMANCE

On time

On cost

Community and Wellbeing DTS Portfolio

Mark Wardman

MCP Prime Provider

MCP


119


Annual

Performance

Plan (£000)

Annual

Forecast

Performance

Actual (£000)

15,100

15,100

12,744 12,730

886

Risks

14

2,370 a+b+c

886 d

1,484 (a+b+c)-d

419 a+b+c

Value of schemes at Feasibility

Slippage Against Annual Performance

Gross Risk of Delivery Against Overall DTS

Baseline

Additional Programme Reporting

2017/18

Overall Target

Value of approved schemes

Mitigation

Net Risk of Delivery Against Overall DTS

Value of non-recurrent schemes


120


Programme SRO Goal (£000) MonthTransacted

(£000)Narrative

Q2 502,634

Sep (06) 89,361

Oct (07) 89,361

Q2 2,669,787

Sep (06) 464,539

Oct (07) 464,539

Q2 853,000

Sep (06) 115,039

Oct (07) 115,039

Organisational

reset

Joanne

Moore

Savings delivered through this programme will be reported through the relevant

Network or Corporate services. Phase 2 is in development.

Mobilisation &

DemobilisationLouise Giles

Savings delivered through this programme will be reported through the relevant

Network or Corporate services.

Q2 2,102,128

Sep (06) 350,355

Oct (07) 350,355

Children &

Young PeopleSteve Tingle 2,142,770

Support

Services

£1.4m is registered on the CIP system, £1,172k approved and £254k at feasibility.

Current forecast of £1049k delivery due to £117k slippage on the continence and

dental scheme, which is a static position on last month leaving an in year gap of £962.

However, further work has progressed on the gap and pipeline schemes with current

schemes rated green to the value £392k with further pipeline schemes anticicpated to

convert. CIP plans and additional pipeline schemes are monitored weekly.

£5.4m of schemes are registered as approved leaving a gap of £2.4m. This position

includes £2.4, of schemes related to cost reduction including temporary staffing and

OAPs. This a static position on last month, with schemes worth £384k still in the

pipeline. Further recovery schemes are underway whilst expenditure reduction

schemes are being tested in order to determine the underlying recurrent position. CIP

plans, additional pipeline schemes and recovery plans are being monitored weekly.

£1.54m of schemes are registered on the system, all of which are approved leaving a

gap of £603k. Pipeline schemes to the value of £600k are in train- and if all schemes

are approved this will meet 17/18 target. This is an static position on last month. CIP

plans and additional pipeline schemes are monitored weekly.

Schemes to the value of £4.5m are registered at approved stage. In addition there is

£534k of schemes at feasibility. If delivered, this will give an over-acheivement of

£2m which is offsetting gaps elsewhere. There are £134k worth of pipeline schemes

that are being monitored weekly

Dominic

McKenna2,801,600

Community

Wellbeing

Tanya

Hibbert2,265,460

Mental HealthLisa

Moorhouse7,869,522


Workforce

Section 5

121


5. Workforce

122

Section 5:-

• Actual Workforce Costs Compared to Budget

• Sickness Absence Rates

• Appraisals and Mandatory Training Compliance

• Vacancy Management and Active Recruitment

• Core Workforce Headcount

• Workforce Turnover


123

Actual Workforce Costs Compared to Budget - Quarterly Trend

Peripheral Workforce Spend and Usage

5. Workforce Actual Workforce Costs Compared to Budget

Actual Workforce Costs compared to Budget:

Overall spend on peripheral labour has decreased

slightly in the month of October, when compared

to the September position. MHN and C&WBN

continue to be the highest spenders.

Actions:

Mental Health Network:

Secure Services and the Harbour are holding

weekly Bank and Agency meetings to establish

the reasons for high usage and agree how this

can be mitigated. The content of this meeting

updates the monthly Network Bank and Agency

usage meeting.

Regular reviews are being conducted by the

Care Teams to appraise the level of service

user acuity and staffing levels. Their focus is to

ensure an appropriate level of staffing is in

place to provide safe and effective care.

Community & Wellbeing Network:

Services continue to review their need for the

use of Bank and Agency and usage escalation

processes in place at Longridge have been

extended to Southport & Formby.


5. Workforce Sickness Absence Rates

124

Trust 12 Month, Year on Year Trend

Sickness Absence Breakdown

Sickness Absence Rates:

Sickness Absence has increased in the month of October,

reporting 6.88%. The Trust increase this month is attributable to

the increase in sickness experienced in MHN.

Actions:


The management of sickness absence remains a top priority

for the Network’s Senior Leadership Team as is the focus on

the Back to Basics Sickness Absence Management Action

Plan.

Service Managers are working closely with HR to effectively

manage sickness absence.

Community & Wellbeing Network: Sickness absence management remains a top priority with Network

SMT and the Network continues to review its action plan alongside the Trust Back to Basics plan

Action plans are in place for significant Long Term Sickness Cases in the Network and are monitored by and discussed with Care Group managers on a monthly basis

Children & Young Persons Wellbeing Network:

Q3 & Q4 will see the HRBP’s focus the Network on the

management of Short Term repetitive Absence Management.

Network has agreed a Sickness Absence trajectory to support

its achievement of the Trust Target of 4.5% by the end of Q4.


5. Workforce Appraisals and Mandatory Training Compliance

125

Appraisals and Mandatory Training Compliance:

Networks continue to work closely with Quality Academy and focus on improvement in this key performance measure. Appraisal Compliance for Q3 is

calculated using the number of employees who have objectives and who have completed a PDR review.

Actions:


The Network continue to work closely with the Quality Academy to develop and implement their Network compliance improvement plans for the training

areas that are, individually, below the compliance target.

PDR compliance is monitored on a monthly basis at the Network People Group Meeting and uses the Tier 2 monthly Network People Performance

Report.

The new Network structure has enhanced accountability and responsibility lines for ensuring that there is a quality PDR process in place across the

Network.


• Network continue to work closely with Quality Academy to improve compliance and enhance data quality.

• PDR compliance has been monitored on a monthly basis at the Network SMT and People Group Meeting using the Tier 2 monthly Network People

Performance Report.

• The new network structure is expected to enhance accountability and reasonability lines for ensuring that Quality PDR process take place and that

compliance across the Network is improved and bi-weekly tracking will continue post reset for Q3.

• Refinement of reporting lines post reset continues to take place and systems updated to ensure alignment of staff to mangers to allow PDR completion.

Children & Families:

• The Network are currently developing a PDR achievement Trajectory and it is anticipated that this will be ready by the close of November 2017. This is

being prepared to facilitate an increase in compliance in delivering the PDR experience and process.

• The Network discuss PDR compliance, compliance recovery and delivery expectations at the monthly People and Leadership Sub-Committee and

through Q3, the Network will be refining the cascade process for recovery activity from this meeting.


5. Workforce Vacancy Management and Active Recruitment

126

Vacancy Management and Active Recruitment:

The Budgeted Establishment Vacancy Rate has increased slightly in October and reports a closing rate of 12.17%. The number of those vacancies

being actively recruited has also increased, moving from 48.55% in September to 57.49% in October.

Actions:


• The new Network have amalgamated the Specialist Services and Mental Health Ongoing Recruitment Programmes, designed to target hard to fill

posts and continue to effectively manage its delivery.


• Vacancy clarity and management continues to be high on the Network agenda.

Children & Young People’s Wellbeing Network:

• Health Visitor Vacancies, held in in light of the Universal 0-19 contract Tender exercise, will be released through Q3 and actively recruited to as the

Trust is now in receipt of the new Service Specification that we are bidding against.

• The Network continue to hold a number of vacancies across Tier 3 Services as a result of the financial variation to contract removal of the CAHMS

Grant.

Support Services:

• A refresh of the Support Services Organisational Structure has been undertaken. The ESR system updates are complete and Financial EFIN system

updates are underway. The refresh has seen a move of ‘Hosted Services’ out of the Trust main workforce information data set and the temporary non

alignment of the ESR and EFIN systems (due to update timing differences) has resulted in a reported increase in BEVR for Support Services in

September.


5. Workforce Core Workforce Headcount

127


5. Workforce Workforce Turnover

128


129

6. Risks Board Assurance Framework 17/18 Quarter 2

BOARD ASSURANCE FRAMEWORK DASHBOARD 2017/18 – Q2

Strategic

Priority BAF Risk Sub-committee Director Lead

Risk

Score

01.04.17

Risk

Score

Q1

Risk

Score

Q2

Risk

Score

Q3

Risk

Score

Q4

2017/18

Risk

Target

2017/18

Risk

Target Gap

Final

Risk

Target

Final Risk

Target

Gap

SP

1

Qu

ality

1.1 If we do not meet regulatory

standards for quality and safety we will

not be fit for purpose as care provider.

Quality & Safety DoNQ 12

High

12

High

16

Significant

8

High

8

Close Monitoring

4

Moderate

12

Significant

1.2 If we do not create a culture of

learning then we will be unable to

provide high quality care.


Significant

16

Significant 16 Significant

12

High

4

Tolerable

4

Moderate

12

Significant

1.3 If we do not provide integrated

physical and mental health services we

will lose opportunities to improve patient

outcomes.

Quality & Safety MD 16

Significant

16

Significant

16

Significant

12

High

4

Tolerable

4

Moderate

12

Significant

SP

2

Su

sta

inab

le

Serv

ices

2.1 If we do not work collaboratively with

partners we will not be able to influence

system wide transformation.

Business Dev &

Delivery COO

12

High

12

High

12

High

8

High

4

Tolerable

4

Moderate

8

Close Monitoring

2.2 If we do not deliver new models of

care we will cease to be a creditable

lead provider.

Business Dev &

Delivery COO

12

High

12

High

12

High

8

High

4

Tolerable

4

Moderate

8

Close Monitoring

SP

3 E

xcell

en

ce

3.1 If we do not engage with our

patients and service users we cannot

achieve excellence and quality.


High

12

High

12

High

8

High

4

Tolerable

4

Moderate

8

Close Monitoring

3.2 If we fail to project our achievements

then our reputation will not improve.

Business Dev &

Delivery COO

16

Significant

16

Significant

16

Significant

12

High

4

Tolerable

4

Moderate

12

Significant

SP

4

Peo

ple

4.1. If we do not support the health and

wellbeing of staff we will struggle to

attract, recruit and retain our workforce.

People HRD 20

Significant

20

Significant

20

Significant

10

High

10

Concern

5

Moderate

15

Significant

4.2 If staff are not provided with

extensive education, training and

leadership development we will not

have an organisational culture that

supports high performance.

People HRD 9

High

9

High

12

High

6

Moderate

6

Close Monitoring

3

Low

9

Close Monitoring

SP

5

Mo

ney

5.1 If we do not meet financial

objectives we will not be able to provide

sustainable services.

Finance CFO 15

Significant

20

Significant

20

Significant

10

High

10

Concern

10

High

10

Concern

5.2 If we do not work with partners to

deliver system wide efficiencies this will

undermine our own financial position

and that of the STP.

Finance CFO 15

Significant

15


10

High

5

Tolerable

5

Moderate

10

Concern

SP

6

Inn

ovati

on

6.1 If we do not develop and maintain

infrastructure, we will not be able to

deliver safe, responsive and efficient

care.

Infrastructure CFO 16

Significant

12

High

12

High

8

High

4

Tolerable

4

Moderate

8

Close Monitoring

6.2 If we do not exploit the full

capabilities of the new EPR system and

wider technology to redesign services

we will miss important opportunities to

improve care.

Infrastructure CFO 16

Significant

16


8

High

8

Close Monitoring

4

Moderate

12

Significant


Southport & Formby

Appendix 1

130


1. Performance Activity Southport & Formby – Summary

131

Southport & Formby - Summary:

The validation of the performance within the teams is still on going. The final teams are scheduled in for their first meeting by the end of

November. The treatment room and continence audit requirements are under discussions with completion schedule by the end of

November.

During October initial contact has occurred with CERT, Dietetics, Phlebotomy, Podiatry and Diabetes. The teams are currently self

validating their with the support of Performance.

Several introductory meetings have been planned for November. These include the teams of Podiatry, Falls, Adult Therapies, Psychology,

Stoma, Pain management, Community Matrons, Chronic Care Coordinators and Leg Ulcers.

The EMIS team continue to provide their expertise in EMIS to aid in this ongoing programme of work.


1. Performance Activity Southport & Formby – Summary

132

ServiceFirst Contact with

TeamData Analysis Data Validation

1st reported in

QPR

(reporting month)

Follow up Audit

Continence May-17 Jul-17 Aug-17 Aug-17 Nov-17

Treatment Rooms Jul-17 Jul/Aug-17 Oct-17 Nov-17 Nov-17

District Nurses Aug/Sept-17 Aug/Sept-17 Oct-17 TBC TBC

District Nurses OOH Aug/Sept-17 Aug/Sept-17 Oct-17 TBC TBC

CERT Oct-17 Oct-17 Nov-17 Dec-17 TBC

Dietetics Oct-17 Oct-17 Nov-17 Dec-17 TBC

Adult Therapies - MS End Oct-17 Oct-17 Nov-17 TBC TBC

Adult Therapies - Neurology End Oct-17 Oct-17 Nov-17 TBC TBC

Adult Therapies - Non Neuro End Oct-17 Oct-17 Nov-17 TBC TBC

Adult Therapies - SALT End Oct-17 Oct-17 Nov-17 TBC TBC

Adult Therapies - Vestibular End Oct-17 Oct-17 Nov-17 TBC TBC

Diabetes End Oct-17 Oct-17 Nov-17 TBC TBC

Pain Management Nov-17 Nov-17 Dec-17 Oct-17 TBC

Psychology Nov-17 Nov-17 Dec-17 Dec-17 TBC

Podiatry Nov-17 Nov-17 Dec-17 TBC TBC

Chronic Care Coordinators End Nov-17 Nov-17 Dec-17 TBC TBC

Community Matrons End Nov-17 Nov-17 Dec-17 TBC TBC

Leg Ulcer End Nov-17 Nov-17 Dec-17 TBC TBC

Falls End Nov-17 Nov-17 Dec-17 Dec-17 TBC

Stoma Awaiting team's availability

Queens Court Hospice Apr-17 Apr-17 May-17 May-17 Nov-17

Phlebotomy (St Helens & Knowsley) Jun-17 Jul-17 Sep-17 Oct-17 Dec-17

Sub Contracts

Complete

Planned/In Progress


1. Performance Activity Southport & Formby – Referrals Summary

133

Unvalidated Figures

Validated Figures

Service CCG May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Total

Adult Therapies - MS NHS Southport and Formby CCG 1 1 1 2 1 0 6

Adult Therapies - Neurology NHS Southport and Formby CCG 51 40 39 48 62 45 285

Adult Therapies - Non Neuro NHS Southport and Formby CCG 154 162 140 163 169 147 935

Adult Therapies - SALT NHS Southport and Formby CCG 3 5 3 9 7 8 35

Adult Therapies - Vestibular NHS Southport and Formby CCG 11 10 6 12 4 11 54

CERT NHS Southport and Formby CCG 103 119 85 105 98 137 647

Chronic Care Coordinators NHS Southport and Formby CCG 155 117 141 134 127 119 793

Community Matrons NHS Southport and Formby CCG 35 47 49 35 40 52 258

NHS South Sefton CCG 62 84 77 93 98 119 533

NHS Southport and Formby CCG 68 93 90 149 104 99 603

Diabetes NHS Southport and Formby CCG 81 96 97 73 89 96 532

Dietetics NHS Southport and Formby CCG 251 215 208 209 194 207 1284

District Nurses NHS Southport and Formby CCG 543 683 632 668 770 774 4070

District Nurses OOH NHS Southport and Formby CCG 183 169 207 182 195 231 1167

Falls Service NHS Southport and Formby CCG 81 88 60 72 65 59 425

Leg Ulcer NHS Southport and Formby CCG 6 13 3 6 10 8 46

Pain Management NHS Southport and Formby CCG 29 71 47 33 70 23 273

Phlebotomy NHS Southport and Formby CCG 1738 2215 2234 2261 2090 2315 12853

Podiatry NHS Southport and Formby CCG 369 391 316 366 291 352 2085

Psychology NHS Southport and Formby CCG 18 13 20 26 20 19 116

Stoma NHS Southport and Formby CCG 19 24 70 28 13 25 179

Treatment Rooms NHS Southport and Formby CCG 843 1036 1020 1006 936 1100 5941

Grand Total 4804 5692 5545 5680 5453 5946 33120

Continence


1. Performance Activity Southport & Formby – Contacts Summary

134

Unvalidated Figures

Validated Figures

Service CCG May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Total

Adult Therapies - MS NHS Southport and Formby CCG 5 4 3 3 6 4 25

Adult Therapies - Neurology NHS Southport and Formby CCG 309 248 280 293 313 285 1728

Adult Therapies - Non Neuro NHS Southport and Formby CCG 384 424 397 420 477 564 2666

Adult Therapies - SALT NHS Southport and Formby CCG 13 9 7 12 21 19 81

Adult Therapies - Vestibular NHS Southport and Formby CCG 30 41 40 42 36 52 241

CERT NHS Southport and Formby CCG 2146 2529 2567 2495 2393 3154 15284

Chronic Care Coordinators NHS Southport and Formby CCG 478 445 409 320 389 356 2397

Community Matrons NHS Southport and Formby CCG 256 387 370 361 279 405 2058

NHS South Sefton CCG 87 92 120 239 235 172 945

NHS Southport and Formby CCG 66 156 254 296 223 206 1201

Diabetes NHS Southport and Formby CCG 450 446 376 486 468 482 2708

Dietetics NHS Southport and Formby CCG 403 442 439 451 454 436 2625

District Nurses NHS Southport and Formby CCG 6466 8439 7858 8312 7780 8354 47209

District Nurses OOH NHS Southport and Formby CCG 556 480 604 497 549 684 3370

Falls Service NHS Southport and Formby CCG 109 91 90 148 151 145 734

Leg Ulcer NHS Southport and Formby CCG 51 84 95 80 94 100 504

Pain Management NHS Southport and Formby CCG 244 288 278 206 353 317 1686

Phlebotomy NHS Southport and Formby CCG 1337 2214 2063 2128 2003 2127 11872

Podiatry NHS Southport and Formby CCG 1895 2212 2127 2272 2011 2272 12789

Psychology NHS Southport and Formby CCG 250 290 290 376 262 322 1790

Stoma NHS Southport and Formby CCG 95 99 118 107 69 87 575

Treatment Rooms NHS Southport and Formby CCG 2090 2618 2454 2569 2118 2368 14217

Grand Total 17720 22038 21239 22113 20684 22911 126705

Continence


1. Performance Activity Southport & Formby – Continence

135

Southport & Formby - Continence:

Improvements in data recording and waiting list management continue to improve the waiting list profile for the Continence Service. The

latest snapshot from 15/11/2017 shows the team has reduced the high number of +25 weeks and the profile of the waiting list is front

loaded, decreasing in numbers moving through the longer wait bands.

The Continence service is scheduled to be audited by the end of November 17 by the EMIS and Performance teams.


2.1 Finance Activity Southport & Formby

Detail for Southport and Formby can be found in the Trust's main QPR Finance and Contracting Section.


137

A temporary data sharing agreement is in place and data will start to populate the Trust’s data warehouse over the coming weeks and

months. When data has been validated it will appear within this report. A project has been initiated to validate each service’s

data. The projected end date for all services is Oct 2017.

2.2 Contract Activity Southport & Formby


138

2.2 Contract Activity Queens Court – Palliative Care subcontract

CNS MAY JUNE Q1 JULY AUG SEP Q2 OCT Q3 Total

Number of referrals received 88 84 172 83 93 76 252 69 69 317

% appropriate referrals (SEEN BY SERVICE) 80% 79% 79% 78% 78% 74% 77% 91% 91% 82%

Primary health care team (GP) 20 15 35 16 19 22 57 23 23 115

Specialist nurse / team (internal) 9 13 22 9 4 10 23 7 7 52

Other hospital staff (internal) 47 46 93 36 50 30 116 31 31 240

Internal Referral (QCH & SPCS) 11 10 21 21 20 14 55 8 8 84

Other(other) 1 0 1 1 0 0 1 0 0 2

Not recorded 0 0 0 0 0 0 0 0 0 0

Pain/Symptom Control 83 76 159 81 86 66 233 68 68 460

Psychological Support 44 48 92 39 60 40 139 13 13 244

Social/Financial 0 0 0 2 0 0 2 0 0 2

Family Support 0 1 1 1 0 1 2 0 0 3

Other 0 1 1 0 0 0 0 0 0 1

Number of patients 'active' 364 363 727 383 390 390 1163 390 390 2280

82 41 123 37 43 46 126 45 45 294

19 18 37 18 20 20 58 6 6 101

Inappropriate 1 0 1 1 1 2 4 1 1 6

Died within 24hrs of referral 2 2 4 2 4 1 7 1 1 12

Declined 0 1 1 1 1 1 3 0 0 4

Unable to contact (includes admissions) 1 0 1 0 0 4 4 0 0 5

Contact made, appointment arranged 12 11 23 11 10 8 29 3 3 55

Other 3 3 6 5 3 4 12 1 1 19

Unknown 0 1 1 0 1 0 1 0 0 2

Number 70 66 136 65 73 56 194 63 63 393

New and re-referred as % of all patients seen

in month41% 39% 40% 36% 39% 33% 58% 35% 35% 44%

Cancer 42 44 86 42 49 34 125 32 32 243

Non-malignant 28 22 50 23 24 22 69 31 31 150

Not recorded 0 0 0 0 0 0 0 0 0 0

% Primary Diagnosis of Cancer 60% 67% 63% 65% 67% 61% 64% 51% 51% 59%

Total (New Non F2F) 82 84 166 83 93 76 252 69 69 487

Within 48 hours 69 69 138 67 74 54 195 50 50 383

% target achieved 84% 82% 83% 81% 80% 71% 77% 72% 72% 78%

Number of referrals ended (of those seen)

Reason for Referral (maybe more

then 1 per patient)

Referral source

Diagnosis (of those seen)

New and re-referred patients (seen)

Initial Telephone contact

Time from referral to patient contact.

No more than 48hours (75% target)

Referrals not seen (non F:F)


139


New assessment with patient (New F2F) 54 64 118 59 70 49 178 66 66 362

OPD 0 20 44 22 34 21 77 30 30 151

Current place of residence 54 44 74 37 39 28 104 36 36 214

Review FU with patient (face-to-face) 251 266 578 263 220 252 735 303 303 1616

OPD 0 78 139 53 63 49 165 44 44 348

Current place of residence 312 188 439 210 157 203 570 259 259 1268

Review FU with patient (telephone) 270 270 540 301 203 187 691 305 305 1536

Advice & Support relative/carer F:F 185 171 356 166 175 190 531 212 212 1099

Advice/support to a Professional F:F 168 173 341 162 179 145 486 175 175 1002

Advice & Support relative/carer Tel 222 232 454 217 240 231 688 281 281 1423

Advice/support to a Professional Tel 147 184 331 158 207 152 517 166 166 1014

Bereavement visit with relative / carer 0 0 0 1 0 1 2 2 2 4

Bereavement Telephone with relative / carer 11 16 27 17 24 12 53 16 16 96

Bereavement Letter to relative / carer 14 17 31 18 15 9 42 16 16 89

DNA (Total DNA) NR NR NR NR NR NR NR NR NR NR

0 31 23 54 33 37 22 92 22 22 168

1 15 14 29 10 7 9 26 16 16 71

2 5 3 8 0 5 2 7 4 4 19

3 1 5 6 7 4 5 16 1 1 23

4 4 6 10 4 5 6 15 3 3 28

5 1 3 4 2 3 1 6 4 4 14

6 2 1 3 0 6 0 6 4 4 13

7 1 4 5 3 1 4 8 0 0 13

8-14 6 6 12 5 2 6 13 7 7 32

15-21 3 0 3 0 3 1 4 1 1 8

22-28 0 0 0 1 0 0 1 1 1 2

29-41 0 0 0 0 0 0 0 0 0 0

> 42 0 0 0 0 0 0 0 0 0 0

Total 69 65 134 65 73 56 194 63 63 391

Primary healthcare team 24 15 39 22 18 13 53 9 9 101

Internal referral 1 3 4 2 2 0 4 3 3 11

Died 57 21 78 12 19 31 62 33 33 173

Other 0 2 2 1 4 2 7 0 0 9

Not recorded 0 0 0 0 0 0 0 0 0 0

Contacts

(related to caseload)

Discharged to (of those seen)

Time from Referral to Assessment

in days (seen)


140


Average time 119 21 32 19 34 45 33 35 35 33

Shortest time 0 0 0 0 0 0 0 0 0 0

Longest time 1898 154 1898 279 315 572 572 939 939 1136

63% 33% 55% 25% 42% 55% 45% 42% 42% 48%

Home 16 3 19 2 5 6 13 8 8 40

Hospital 21 14 35 9 11 14 34 19 19 88

Hospice 13 0 13 0 1 1 2 4 4 19

Care home 7 4 11 1 2 10 13 2 2 26

Prison 0 0 0 0 0 0 0 0 0 0

Other 0 0 0 0 0 0 0 0 0 0

Unknown 0 0 0 0 0 0 0 0 0 0

PPC achieved 29 9 38 5 7 13 25 19 19 82

PPC not achieved 14 3 17 0 3 7 10 2 2 29

PPC unknown 14 9 23 7 9 11 27 12 12 62

Not recorded 0 0 0 0 0 0 0 0 0 0

0 - 5 57 54 111 56 61 45 162 50 50 323

6 - 14 9 11 20 8 9 10 27 11 11 58

15 - 21 3 0 3 0 3 1 4 1 1 8

22 - 28 0 0 0 1 0 0 1 1 1 2

29 - 42 0 0 0 2 0 0 2 2 2 4

> 42 0 0 0 0 0 0 0 0 0 0

% Non Hospital Deaths (of those seen)

Time on caseload (of those seen)

Time to receiving care

for referrals in this month

(active data)

Deaths (of those seen)

Place of death (of those seen)


141


Activity perfomance indicator Report frequency May June Q1 July Aug Sept Q2 Oct Q3 Annual total

SERVICE USER EXPERIENCE

1. Complaints received Monthly 0 0 0 0 0 0 0 0 0 0

2. Compliments Monthly 6 9 15 3 4 1 8 3 3 26

3. Incidents reported (about the service) Monthly 0 0 0 0 0 0 0 0 0 0

4. Incidents reported (by the service) Monthly 1 0 1 0 2 0 2 1 1 4

5. Iwantgreatcare (number of returns) Annually 0 0

STAFF TURNOVER /ATTENDANCE

1. Left employment Quarterly 1 0 0 1

2. Recruited Quarterly 0 0 0 0

3. Sickness % per establishment Quarterly 10.60% 1.59% TBC 0.00%

STAFF TRAINING / DEVELOPMENT

1. Annual apprisals completed 100% Annually 0

2. Mandatory training completed 100% Annually 0

3. Clinical supervision (hours) 100% Monthly 0 0 0 1.5 0 1.5 3 1.5 1.5 4.5

GSF Attendance Monthly 6 6 12 8 7 11 26 11 11 49


3. Quality Southport & Formby

142

KLOE Domain Indicator Target Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct12 months

total

12 months


Incidents n/a 20 50 58 56 53 44 281 47


incidentsn/a 0 1 0 0 0 1 2 0

RIDDOR incidents n/a 0 1 0 0 1 0 0 0 0 0 0 0 2 0

Fall incidents n/a 0 0 1 0 1 1 3 1

Pressure ulcer incidents n/a 4 20 20 18 15 11 88 15


and 4 pressure ulcersn/a 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Safeguarding alerts n/a 1 3 4 3 1 7 19 3

Staff safetyViolence or aggression to staff

from patients n/a 0 0 1 0 0 0 1 0

Pressure ulcers (%) - 1.06% 5.15% 1.09% 1.59% 4.23% 1.95% - 2.51%

Falls with harm (%) - 0% 0% 0% 0% 0% 0% - 0.00%

Catheter and UTI (%) - 0% 0% 0% 0% 0% 0% - 0.00%

VTE (%) - 0.53% 1.47% 1.46% 1.27% 0.94% 0.98% - 1.11%

Physical Health HFC Rate (%) 95% 99% 94% 98% 97% 96% 97% - 96.89%

F&F Test 95% 99.2% 100.0% - 99.60%

F&F Test - Response Rate n/a 126 113 239 120

Compliments Compliments n/a 0 4 16 45 54 25 41 185 26

Complaints n/a 0 0 0 0 0 0 1 2 12 11 1 7 34 3


complaintsn/a 0 0 0 0 0 0 0 0 6 6 3 2 17 1


timeframe (%)n/a

Reopened complaints n/a

Overdue 3 day reviews 0 2 2 2

Overdue 7 day reviews 0 12 12 12

Overdue incident actions 0 0 0 0

Duty of candour breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Assurance Concerns raised n/a

Learning and

candour

Patient safety

Incidents

FOCUSED QUALITY AND SAFETY SURVEILLANCE - Southport & Formby Services

Safe

Effective

Caring

Responsive

Well Led

Physical Health

Harm Free Care

Friends & Family -

Patients

Complaints


143

Actual Workforce Costs Compared to Budget - Quarterly Trend

Peripheral Workforce Spend and Usage

4. Workforce Actual Workforce Costs Compared to Budget

Spend £ % Spend £ % Spend £ %

Southport & Formby 664,517 14,652 2.0% 49,572 6.8% 0 0.0% 64,224 728,740 8.81%

Flexible

Labour

Reliance

%Business Area

Core

Workforce

Spend £

Bank Agency Medical Agency

Total Spend

£

2017 10

Total

Peripheral

Workforce

Spend £


4. Workforce Sickness Absence Rates

144

Trust 12 Month, Year on Year Trend

Sickness Absence Breakdown

Rate Rate Rate Trend

2017 08 2017 09 2017 10

% Long

Term

Absence

% Short

Term

Absence

12mths

Southport & Formby 5.08% 6.70% 5.07% 45.25% 54.75%

2017 10


4. Workforce Appraisals and Mandatory Training Compliance

145

Conflict

Resolution

3yr

E&D 3yrFire Safety

1yr

Health &

Safety 3yr

Infection

Control

Admin 2yr

Infection

Control

Clinical 1yr

Manual

Handling 1

3yr

Mental

Capacity Act

(Admin) One

Time

Completion

Mental

Capacity Act

(Clinical) 3yr

Resuscitation

1yr

Safeguarding

Children 1

3yr

Safeguarding

Adults 1 3yrCore Total ILS 1yr

Manual

Handling 2

3yr

Manual

Handling 3

2yr

Safeguardin

g Children 2

3yr

Safeguardin

g Children 3

3yr

Information

Governance

Local

Total

Co

re &

Lo

cal

Tota

l

S&F 77% 95% 93% 89% 95% 91% 93% 88% 91% 75% 98% 98% 90% x 96% x 88% x 95% 93% 91% 52%

Core Mandatory & Statutory Training Local Mandatory & Statutory Training

Appraisals

Compliance


4. Workforce Vacancy Management and Active Recruitment

146

Budgeted

Establ ishment (BE)

(FTE)

Actual

Establ ishment (FTE)

Budgeted

Establ ishment

Vacancies

(FTE)

BE Vacancy

Rate

Active Vacancy

Rate

Active Vacancy

FTENo. Pos i tions

Avg. No Days

to Recruit

Southport & Formby 224.10 204.75 19.35 8.63% 62.02% 12.00 16.00 N/A

2017 10

Establ ishment Vacancies Vacancies in Active Recruitment


4. Workforce Core Workforce Headcount

147

Core Workforce

Network Headcount FTE Headcount FTE

Southport & Formby 260 204.51 260 204.75

2017 09 2017 10


148

4. Workforce Workforce Turnover

Board of Directors


Report Title Trust Chairs Report


Prepared by Umme Batan, Corporate Governance Support

Presented by David Eva, Trust Chair

Action required Noting and Decision

Supporting Executive Director Chief Executive


Report purpose The purpose of the report is to provide the Board with an overview of the activity undertaken by the Board and Non-Executive Directors in addition to the Board of Director meetings and Council of Governor meetings.

The Board of Directors is also asked to approve the appointment of the Senior Independent Director and the Deputy Chair.


To become recognised for excellence

Board Assurance Framework risk 1.1 If we do not meet regulatory standards for quality and safety we will not be fit for purpose as a care provider.

CQC domain Well-led

1.0 NON-EXECUTIVE DIRECTOR ACTIVITY

The Non-Executive Directors have been attending the Board Committee meetings of which they are a member (including the Financial Recovery Group) and apologies have been given where they were unable to attend. In addition to the usual Board business, Non-Executive Directors (NEDs) have been involved in their areas of special interest during the period of October 2017 – November 2017: Gwynne Furlong

Attended the Quality Committee Attended the CoG Quality & Assurance Meeting Sat on the panel of a disciplinary hearing Met with the Property Services Director Attended the Hearing Feedback Steering Group Had an introductory meeting with the Head of Operations for the Children and Young

People’s Network Met with the Head of Communications to discuss the delivery of November Team Talk

and filmed Team Talk Attended a meeting with the Trust Chair to discuss Housing Association

Louise Dickinson Met with the Assistant Director from MIAA to discuss 18/19

planning

Met with the Company Secretary to discuss the Audit Committee Effectiveness Review

Julia Possener

Attended the Charitable Trustee Funds Committee meeting

David Curtis Chaired the monthly SI Panel Attended the Audit Committee Effectiveness Review

Met with the Deputy Company Secretary to discuss the Quality Committee agenda

Attended the Quality Committee

Attended the Opportunity Knocks event

Met with the Director of Nursing for their monthly catch up Attended the Clinical Research Unit opening event at Royal Preston Hospital

Isla Wilson

Attended the Quality Committee

Met with the Chief Executive to discuss STP

Attended the planning for the social value workshop

Sat on the panel of an appeal hearing Attended the NHS Workforce Race Equality Standard (WRES) Conference on behalf of

the Chair Met with the Director of HR to discuss WRES Attended the STP Board Development Session Met with Amanda Thornton to discuss BDRW Attended the Opportunity Knocks event

Peter Ballard

Attended the AAC Panel Attended the Council of Governors meeting in November Attended the Opportunity Knocks event Met with the Chair for an exit interview

In addition to the above:

Gwynne, Louise and Peter attended the November Council of Governors meeting Louise, Julia and Isla attended the Audit Effectiveness Review meeting which the

Company Secretary was in attendance for

2.0 CHAIR’S ACTIVITY The Chair attended the Board meetings and Council of Governors meetings. The Chair has been having weekly catch up meetings with the Chief Executive and had

monthly meetings with the Company Secretary and has met with several Board members and Senior Managers and colleagues

The Chair continues to meet with MPs Attended the Partnership Leaders Forum Met with a member of the public Attended a meeting with the Senior Independent Director to discuss Housing

Association

3.0 COUNCIL OF GOVERNORS UPDATE This section has been added to the Chair’s Report in order to keep the Board updated on Council of Governor activity, recognising that since 01 April 2017 Board members have been attending meetings on an invitation basis. Since the last Chair’s Report received on 02 November 2017, the following items have been considered by the Council of Governors: 15th November 2017

The Council of Governors approved the extension of the External Audit contract with

KPMG for a period of two years (from 1 April 2018 until 31 March 2020).

It was confirmed that Staff Governors Max Oosman and James Harper would not apply for a second term of office from December 2017 due to work commitments.

The Chief Operating Officer deputised for the Chief Executive and provided an update on the STP and the high and low points for the month

The Head of Strategy & Business Planning provided a presentation on the Annual Planning 2018/19

The Health & Wellbeing Project Manager provided the Governors with insight into the Health and Wellbeing agenda within the Trust.

4.0 USE OF THE COMMON SEAL To inform the Board that the Common Seal has been used as follows since the Board of Directors meeting on the 02 November 2017:

30/11/2017 – Licence to occupy on short term basis relating to offices at Croston House, Lancashire Business Park, Centurion Way, Leyland between LCFT and Lancashire County Developments (Property) Limited (sign only)

30/11/2017 – Renewal Lease re Friday Street, Chorley, PR6 0AA between LCFT and Bugle Inn Motor Company Limited

5.0 RAISING CONCERNS As Trust Chair I continue to oversee the Dear David process for staff to raise concerns. This

process compliments other mechanisms for staff to raise concerns such as the Raising

Concerns Guardian. During October 2017, the following concerns were raised with me through

Dear David:

Concerns over the proposed installation of baths in initial designs for the Chorley

inpatient unit;

Staff smoking on the road outside Sceptre Way;

High caseload and demand in Community Mental Health Teams;

Lack of commissioned services for people suffering with Autistic spectrum disorder and

behavioural difficulties;

High caseloads in Community Mental Health Teams;

Caseloads, lack of management support and supervision Community Mental Health

Teams;

Staff suffering with stress in Community Mental Health Teams.

The Executive Director of Nursing and Quality (as Executive Lead for Raising Concerns) and Associate Director of Safety and Quality Governance (as Raising Concerns Guardian) continue to administer the Dear David process on my behalf and they have ensured that all concerns are

being reviewed with feedback provided to those raising concerns directly, where possible, and also included in the Quality Matters electronic bulletin to staff.

6.0 DEPUTY CHAIR APPOINTMENT The Board of Directors is aware of the departure of the Deputy Chair Peter Ballard whose term of office finished on 30 November 2017. In line with NHSI requirements the Trust must nominate a Deputy Chair. The Trust Chair proposes that Gwynne Furlong is appointed as the new Deputy Chair with effect from 01 December 2017. Gwynne was re-appointed as a NED for a second term of office in 2015 and will be finishing his term of office in October 2018. Gwynne is the longest serving Non-Executive Director. The Board of Directors is asked to consider and agree with the proposal and make a recommendation to the Council of Governors.

7.0 SENIOR INDEPENDENT DIRECTOR APPOINTMENT In line with NHS Improvement requirements the Trust must nominate a Senior Independent Director, a role which Gwynne Furlong held till 30 November 2017. The Trust Chair proposes that Isla Wilson is appointed as the new Senior Independent Director with effect from 01 December 2017. The Code of Governance states that:

A.4.1. In consultation with the council of governors, the board should appoint one of the

independent non-executive directors to be the senior independent director to provide a

sounding board for the chairperson and to serve as an intermediary for the other

directors when necessary.

The Board of Directors is asked to consider and agree with the proposal and make a recommendation to the Council of Governors.

8.0 NON-EXECUTIVE DIRECTORS ROLES & COMMITTEE MEMBERSHIP On approval of the above Non-Executive Director appointments the new committee membership will be as below effective of 01 December 2017.

Non-Exec Role

David Eva Trust Chair

Gwynne Furlong Deputy Chair

Isla Wilson Senior Independent Director and

Finance & Performance Committee Chair

David Curtis Quality Committee Chair

Louise Dickinson Audit Committee Chair

Julia Possener Non-Executive Director

Board of Directors Audit Committee Quality Committee Finance and Performance Committee

Charitable Trustee Funds

Committee

David Eva

Chair

Louise Dickinson

Committee Chair

David Curtis

Committee Chair

Isla Wilson

Committee Chair

Gwynne Furlong

Committee Chair

Gwynne Furlong

Louise Dickinson

David Curtis

Isla Wilson

Julia Possener

David Curtis

Isla Wilson

Julia Possener

Gwynne Furlong

Isla Wilson

Gwynne Furlong

Louise Dickinson

Julia Possener

9.0 BOARD ACTION

The Board is asked to note the updates provided for information and make a recommendation to the Council of Governors to ratify: The appointment of Gwynne Furlong as the Deputy Chair with effect from 01 December

2017 The appointment of Isla Wilson as Senior Independent Director with effect from 01

December 2017

Board of Directors


Report Title Quality Committee Chair Report


Prepared by Viv Prentice, Deputy Company Secretary

Presented by David Curtis, Chair of Quality Committee


Supporting Executive Director Executive Director of Nursing and Quality


Report purpose To provide an outline of the activity undertaken by the Quality Committee.



Board Assurance Framework risk 1.1 The Trust does not protect services users from avoidable harm and fails to comply with the CQC standards for the quality and safety of services

1.2 The Trust does not deliver safe, appropriate and therapeutic environments to deliver high quality services

3.1 The Trust fails to deliver the benefits of being a Health and Wellbeing provider.

4.1 The Trust is unable to attract, recruit and retain high quality staff impacting on a continued dependency on temporary staffing levels, affecting quality of care and financial costs

4.2 The Trust does not deliver effective education, training and leadership opportunities resulting in a workforce who are unable to deliver high quality, safe care

7.3 The Trust does not comply with Mental Health Legislation

CQC domain Well-led

1.0 INTRODUCTION This Chair Report outlines the activity undertaken by the Quality Committee held on the 13 November 2017. 2.0 COMMITTEE ACTION

The Trust Board is asked to note the content of the Chair’s Report for assurance.

CHAIR’S REPORT

CHAIRS REPORT OF: Quality Committee

DATE OF MEETING: 13 November 2017

BOARD ASSURANCE FRAMEWORK RISKS ALIGNED TO COMMITTEE:

1.1 The Trust does not protect services users from avoidable harm and fails to comply with the CQC standards for the quality and safety of services

1.2 The Trust does not deliver safe, appropriate and therapeutic environments to deliver high quality services

3.1 The Trust fails to deliver holistic whole person care (Physical and Mental Health)

4.1 The Trust is unable to attract, recruit and retain high quality staff impacting on a continued dependency on temporary staffing levels, affecting quality of care and financial costs

4.2 The Trust does not deliver effective education, training and leadership opportunities resulting in a workforce who are unable to deliver high quality, safe care

7.3 The Trust does not comply with Mental Health Legislation

AGENDA ITEMS BAF RISK DISCUSSION, ASSURANCE, RISK OR FURTHER ACTION

Board Assurance Framework Report

1.1, 1.2, 1.3, 3.1, 4.1, 4.2

Assurance

Consideration was given to each of the assurance reports during the meeting and the Committee received assurance that there had been no significant changes to the risks in the last quarter.

Raising Concerns Bi-Annual Report

1.1 Discussion The development work that had taken place to continually promote the right culture to enable staff to raise concerns was outlined. This included engagement with the National Guardian’s office, regular communication with staff and the recruitment of Raising Concerns Advocates. Concerns are now themed against set criteria developed by the National Guardian’s office which highlighted quality and safety as the predominant theme. These concerns related in particular to violence and aggression, caseloads and feelings of stress.

An internal indicator to assess the confidence in the culture of raising concerns indicated that just over half of the staff members that raised concerns wished to remain anonymous. Assurance Significant assurance was provided in relation to the Raising Concerns process and compliance with the system. In addition, both the Audit Committee and the Council of Governors had previously received assurance in respect of the Trust’s systems and processes that are in place to enable staff to raise concerns. Following a survey of all local Guardians undertaken by the National Freedom to Speak up Guardian, the work that was being undertaken to address the three areas of improvement that had been identified were outlined. This included recruiting Raising Concerns Advocates and working closely with the Equality & Diversity Project Manager to ensure hard to reach staff groups are supported and encouraged to raise concerns. The Committee noted that 59 concerns had been raised during the last six months with the majority of concerns raised via the Trust’s ‘Dear David’ method. This clearly highlighted how well embedded this had become as a way for staff to raise concerns. Further Action The Committee agreed with the recommendation to receive future reports on a quarterly basis thereby ensuring more timely information and detail. The Committee consented to the Raising Concerns Guardian appointing a Deputy from the pool of Advocates (on a recurrent 12 month appointment basis) to ensure continuity during periods of absence.

Quality and Safety Surveillance Reports

1.1 Discussion The Committee’s attention was drawn to the lack of Southport & Formby data prior to May 2017 and noted that this was due to the non-availability of data from the previous provider. Assurance The Committee received significant assurance in respect of the Quality Surveillance systems and controls and the continued improvement of the reports, which now included a Mental Health Law Surveillance Report. There had been a decrease in the number of Grade 3 and 4 pressure ulcers and it was noted that an investigation was being undertaken following the Never Event that had occurred earlier in the year. Upheld complaints remained broadly static whilst re-opened complaints had dropped significantly and complaints to the PHSO were very low.

In relation to Mental Health Law, the number of section 136 lasting over 72 hours remained consistent. However, with the introduction of new legislation there was an expectation that this would increase. It was noted that the risk to the organisation was fairly low as the Trust would rely on some common law powers to hold people in their best interests. There had been an increase in compliance with patients having a Section 132 rights form in place at the beginning of the month. As a result of the increase in medication incidents within the Community and Wellbeing Network, there was now renewed visibility in that area. Risk The number of RIDDORs had increased which related to incidents of violence on inpatient units. The use of restraint had also increased with the highest use being reported on PICU wards and older adult wards. A deep dive would therefore be undertaken and a summary provided to the Quality & Safety Sub-Committee. The overall Mental Health Harm Free Care target remained below the Trust aspiration, although it was higher than the previous two months. Whilst overall compliance with Core Skills was above target, compliance with key modules in some subject areas remains challenged. Whilst the number of overdue incident reviews continues to be high, this remains a focus for the networks. A further quality measure has been added to look at the percentage of patients who have their rights read within 24 hours of detention as compliance with this is currently very poor. As a result of the increase in the number of complaints, work is underway to improve the approach to hearing feedback. Further Action

Following a query regarding levels of detention and if there was any data relating to ethnicity, it was noted that following development of the MH Act recording system this information should be extractable. However, the Associate Director of Safety and Quality Governance agreed to look into this further and report back to the MH Law Sub-Committee.

Quality & Safety Sub-Committee Chair’s Report

1.1, 1.2, 3.1 Assurance The Chair’s Report following the meeting held on the 25 October was presented which highlighted the approval of the Quality Assurance Framework.

The Committee were informed that the number of self-harm incidents at The Cove related to a small number of patients.

Further Action

The Executive Director of Nursing confirmed that a development session may be held upon completion of the deep dive into incidents of violence on older adult wards.

People Sub-Committee Chair’s Report

4.1, 4.2 Assurance The Chair’s Report following the meeting held on the 15 June was presented and it was noted that the outcome of the effectiveness review undertaken was positive. In addition, an in-depth discussion had been held in relation to the untapped talent project report which had been well received. The Committee had received positive assurance following the LADO Allegations Thematic Review Report, which provided strong evidence of engagement. Risk It was disappointing to note non-compliance against the core skills target. Further Action An overview of the apprenticeship levy delivery plan was provided. The Director of HR agreed to provide further assurance in respect of the delivery of the plan at the next meeting.

Quality Account 1.1 Assurance The Associate Director of Quality and Experience presented the Quality Account quarter two position and provided an update on the quality priorities reflected in the Quality Account aligned to the four domains of effectiveness, experience of care, safety and well-led. The Committee noted the good progress with the Quality Account. The work that had been undertaken in respect of each domain was outlined. This included the recent ‘thinking space’ session that had been held to drive improvement and consistency in seclusion practice. In addition, eight Always Events had been planned and the Trust were implementing the Care and Compassion programme (adopted from the Sit and See approach) to ensure that feedback informs quality improvements at the point of care. A further quality improvement had seen the launch of the Safety Cross model of reporting, providing teams with an at a glance picture of pressure ulcer prevention. The work being undertaken in partnership with AQuA to develop a ‘bite-size’ quality improvement learning programme was outlined. Small scale testing of the programme had been undertaken with further testing to be undertaken during quarter three. Plans were also being developed for the next Quality Improvement Conference which would provide the opportunity to showcase the quality improvements taking place throughout the Trust.

All NHS Improvement core indicator targets were achieved. It was noted that the data relating to the Early intervention Service (EIS) was currently being reviewed and validated and would be available within the quarter three report.

Risk Assurance 1.1, 1.2, 3.1, 4.1, 4.2, 7.3

Assurance It was agreed that following discussions throughout the meeting adequate assurance had been received and there had been no impact on the risk scores relevant to the Committee.

Board of Directors


Report Title Chief Executive’s Report – Part One


Prepared by Heather Tierney-Moore, Chief Executive

Presented by Heather Tierney-Moore, Chief Executive

Action required Discussion/Decision

Supporting Executive Director Chief Executive


Report purpose The purpose of this report is to provide Board members with an overall summary of the Trust position and highlight areas for further discussion.



Board Assurance Framework risk 2.1 – The Trust does not receive assurance of the accuracy, timeliness and consistency of data and reporting with the potential to compromise decision making and service quality

CQC domain Well-led

Introduction This report aims to give Board members an overview of the activity undertaken since the last Board meeting, both within the Trust and externally.

QUALITY AND SAFETY

Serious Incidents

During October 2017, the following serious incidents were reported:

(brief information is provided to protect confidentiality, the term suicide is only used once a Coroner’s

Inquest has returned a verdict of suicide)

Serious self-harm (suspected attempted suicide) of a prisoner at HMP Liverpool;

Death (suspected suicide) of a patient under the care of the Assessment and Treatment Team in Chorley and South Ribble;

Concerns around the care of a patient in Podiatry in Central Lancashire – no immediate concerns for Lancashire Care Foundation Trust (LCFT) services however a patient under the care of Podiatry underwent an operation at an Acute Trust where the wound deteriorated resulting in an above knee amputation;

Death (suspected suicide) of a patient under the care of the Assessment and Treatment Team in Lancaster and Morecombe;

Death (suspected suicide) of a patient under the care of the Rapid Intervention and Treatment Team in Lancaster and Morecombe;

Death (suspected suicide) of a person recently seen by the Mental Health Liaison Team in Central Lancashire;

Death of a patient in an Acute Trust which may have been contributed to by a pressure ulcer, where the patient was under the care of Southport and Formby District Nursing;

Death (suspected suicide) of a prisoner at HMP Liverpool;

Death of a patient under the care of the Mindsmatter Service in West Lancashire.

In all cases, a formal investigation is now underway and the incidents have been reported to

commissioners, NHS England and regulators as required under the NHS Serious Incident

Framework.

Significant Health and Safety Incidents During October 2017, the following incident was reported to the Health and Safety Executive and

Care Quality Commission under the Reporting of Injuries, Diseases and Dangerous occurrences

Regulations (RIDDOR):

(brief information is provided to protect confidentiality)

Injury to a staff member’s back whilst opening a door resulting in absence for over seven days. Raising Concerns During October 2017, the following concerns were reported through the various mechanisms including the Raising Concerns Guardian and through Dear David:

The proposed installation of baths in initial designs for the Chorley Inpatient Unit;



Staff attack alarms not available to staff when entering wards at the Harbour at the start of their shift;

Lack of commissioned services for people suffering with Autistic Spectrum Disorder and behavioural difficulties;


Caseloads, lack of management support and supervision Community Mental Health Teams;

Culture and clinical practice at the Harbour;

Staff suffering with stress in Community Mental Health Teams. In all cases a review of proportionate scale has been commissioned. The findings from each review

are individually fed back to the person raising the concern if they have provided their name. The

findings from every concern is summarised in the Quality Matters bulletin.

Changes to the Mental Health Act The government has formally announced through regulations laid in Parliament that changes in law to

sections 135 and 136 of the Mental Health Act 1983 will come into effect on 11 December 2017. The

changes are as follows:

section 136 powers may be exercised anywhere other than in a private dwelling;

it is unlawful to use a police station as a place of safety for anyone under the age of 18 in any circumstances;

a police station can only be used as a place of safety for adults in specific circumstances, which are set out in regulations;

the previous maximum detention period of up to 72 hours will be reduced to 24 hours (unless a doctor certifies that an extension of up to 12 hours is necessary);

before exercising a section 136 power police officers must, where practicable, consult a health professional;

where a section 135 warrant has been executed, a person may be kept at their home for the purposes of an assessment rather than being removed to another place of safety (in line with what is already possible under section 136);

a new search power will allow Police Officers to search persons subject to section 135 or 136 powers for protective purposes.

The Trust has been preparing for these changes and the Lancashire-wide multi-agency protocol has

been updated. However, the estimate is that 40% of section 136s will run over the reduced period of

24 hours. Longer term developments in mental health services should reduce this over time. A further

report will go to the Mental Health Law Sub-committee in December 2017.

Modern Slavery/Human Trafficking – ‘Duty to Notify’ “Human trafficking destroys lives and its effects damage communities” (Home Office, 2011). The

Modern Slavery Act (2015) introduced measures to enhance the protection of victims of slavery and

trafficking. Section 52 of the Act refers to the ‘Duty to notify’ the Secretary of State about suspected

victims, improving identification, creating a statutory duty to notify for specified public authorities. This

raises awareness, and builds a picture of the nature and scale of modern slavery/human trafficking, to

inform the law enforcement response. It has been confirmed that health agencies do not have a ‘duty

to notify’ but are encouraged to make voluntary notifications.

The Safeguarding Team have integrated this into the Trust’s safeguarding practices which now

require LCFT practitioners to make voluntary notifications if they suspect someone may be a victim.

This is seen as good safeguarding practice which fully supporting the Trust Values, strategic priorities

and 5 year plan; to provide high quality compassionate care and protect people from harm as part of

our quality plans; doing the right thing at the right time for vulnerable people. It is also consistent with

the Trust’s safeguarding vision.

The Safeguarding Team have now implemented processes and steps to fully embed this agenda into

practice, raise awareness and undertake the ‘duty to notify’ as well as undertaking the following:

Trust Safeguarding Team representation at the Pan Lancashire Human Trafficking Group. Within this forum we were made aware of ‘Duty to notify’. It is acknowledged that this is not a statutory requirement of health organisations; however, it was identified as good practice that LCFT front line practitioners make voluntary notifications, if they suspect someone may be a victim.

Received support from NHS England to fund and deliver a conference in 2016 to raise awareness and highlight the agenda within Lancashire. The conference was fully supported by the Trust Board Chair who published a public declaration describing the Trust’s commitment to ensuring no modern slavery or human trafficking in our supply chains or in any part of our business. As part of our commitment the Trust reviewed its supply chains and will be introducing a ‘Supplier Code of Conduct’ with a view to requesting all existing and new suppliers to confirm that they are compliant with the Act.

Identification of the Safeguarding Operational Lead Nurse as a Strategic Lead to drive the agenda forward. Specific training on human trafficking was accessed and she has recently received a MSc in Safeguarding in an international Context.

Introduction of a notification pathway.

The facilitation of several workshops for staff to introduce the “duty to notify” process, regular workshops are available as part of the safeguarding training offer.

Upskilling of the Safeguarding Team to provide advice, support, information and resource for staff. This supported responses to concerns that a patient may have been trafficked and embedded the agenda into the role of the Safeguarding Team as well as staff providing care.

Updated safeguarding training to raise awareness and include information and resources on human trafficking.

Incorporated human trafficking and modern slavery into adult and child safeguarding policies and practice.

Work with Safeguarding Board partners to monitor local human trafficking trends and consider care needs arising

The steps taken have increased staff awareness significantly. In all cases, staff are encouraged to

trust and act on their instinct and if they have concerns about a child, young person or adult they are

advised to take immediate action to ask further questions to help identify victims and offer support.

The Trust is fully engaged in the multi-agency work taking place across the county, contributing to the

intelligence gathering of potential victims in order to protect vulnerable people. In October 2017 the

Operational Safeguarding Lead and Associate Director Safeguarding were invited to present the work

which the Trust has undertaken at a multi-agency conference led by Lancashire Constabulary. Our

actions were recognised by partners as excellent practice and Trust leads have since been invited to

share our process with partner organisations.

The focus of the event was how to build current partnership working practices. Police colleagues fed

back how significant it was that the Trust highlighted the importance of our role when providing care to

individuals who may present themselves either alone or with perhaps a controlling ‘other’ and take on

the role of a ‘duty to notify’ responder. This step is not yet replicated in other areas of the country and

has been praised by the ‘National Police Transformation Team’, who reported that they are

‘enlightened by LCFT’s approach to this area of work’.

Risk and Assurance The Risk and Assurance Team are continuing to build relationships with other organisations to share

best practice and learn from each other. In facilitating this approach, the Associate Director of Risk

and Assurance is co-chairing a new Governance, Assurance and Risk Network with the Deputy

Director of Governance at The Walton Centre NHS Foundation Trust in Liverpool. GARNet is aimed

at colleagues across health and social care in the north west who have an interest in these areas and

would welcome an opportunity to come together to share best practice, learn from each other and to

general promote a better system-wide understanding of governance, assurance and risk. The first

meeting is scheduled for Tuesday 12 December 2017 and is being hosted by The Walton Centre.

The meetings will be held quarterly with Lancashire Care hosting the next meeting in March 2018.

Awards

Karen Seal, Acting Clinical Lead for the Eating Disorder Service won the Mental Health Worker of the

Year Award at The Gazette Best of Health Awards in September.

The Psychosis and Bipolar Psychological Care Network won the Psychological Therapies in

Secondary Care (NHS England) Award at the National Positive Practice in Mental Health Awards in

October and The Acute Therapy Service (PDMCN) were also highly commended within this category.

Allied Health Professions Return to Practice Guidance The Framework and Mentor Guidance for Allied Health Professions (AHP) Return to Practice has

been finalised and is now in place to guide our provision of placements for these professional groups.

This is part of the recruitment and retention strategy and workforce planning. The Associate Director

for AHPs has now promoted and aligned developments within the Trust with an emerging national

piece of work led by Health Education England with LCFT being a recognised placement provider. A

local marketing campaign is due to commence in early January which will dovetail with national

marketing strategy.

Quality Improvement Showcase A showcase session focussing on areas of harm free care improvement work was co-ordinated by the

Quality Improvement Team with presentations from Nursing, AHPs and Psychology with

commissioner colleagues invited. The three key improvement themes were pressure ulcers, falls and

psychological approaches in children’s mental health. Key quality improvement projects were

presented with outcomes to date demonstrating direct impact at the point of care across the

organisation. These projects will be revisited later in the year to track continuous improvement and

sustained change achievements.

HMP Liverpool The Trust has received the draft of the HMP Liverpool joint HMIP/CQC inspection report. The report is

subject to a factual accuracy checking process before being published.

HMP Liverpool Press Enquiry The Board have been separately briefed on a comprehensive media request from the BBC regarding

the Trust’s contract to provide healthcare services at HMP Liverpool. The questions posed and the

formal response was shared with the Board and were signed off by the Chief Executive and the Chair,

as well as shared with NHS Improvement and NHS England. The Board will continue to receive

updates on when the report will be featured and any subsequent media interest generated as a result.

PEOPLE & LEADERSHIP

Head of Organisational Development Appointed Emma Dawkins joins the Trust on Monday 04 December as the new Head of Learning and

Organisational Development. Emma will report directly to Deborah Cox, Deputy Director of Human

Resources & Quality Academy. Emma has a wealth of experience working within the NHS and more

recently for the North West Leadership Academy. Emma is an experienced OD Professional with a

large amount of knowledge and experience in Leadership Development, Talent Management,

Coaching and Mentoring and Organisational Development.

STP-wide Workforce & OD Appointment Paula Roles will commence with the Trust on 4th December in the position of HR Strategic Lead for

the Healthier Lancashire and South Cumbria Sustainability and Transformation Partnership (STP).

This is a new position funded by Health Education England to strengthen workforce, leadership and

organisational development throughout the STP area. Paula is seconded from Blackpool Teaching

Hospitals where she was the acting Director of Human Resources & Organisational Development.

Paula will report to Damian Gallagher and brings with her vast experience of workforce issues,

leadership and organisational development gained through years of experience working throughout

the North West region.

FINANCE AND PERFORMANCE

Finance Report Month 7 sees a year to date operating deficit of -£2.3m, excluding planned Sustainability and

Transformation funding of £0.9m, against a planned surplus to date of £0.6m. This shows an

improvement on month 6 and represents a small budgetary surplus in month and nearly £0.2m when

excluding STF monies. The position remains driven by staffing pressures in ward and prison areas

and consequential impact on cost improvement programmes (rising agency costs will also impact Use

of Resources targets). Additionally OAPs expenditure continues to exceed funding - see Out Of Area

Activity for more details. The forecast assumes current pressures and risks are addressed or

mitigated in line with the recovery plan (see forecasting) and financial performance achieves (or

exceeds) plan but the unmitigated projection indicates a gap of c£4.8m, c£6.9m without STF monies.

This is represents an improvement on month 6 forecasts (£6.2m), and is driven by excess OAPs of

c£0.8m (all be that significantly below last month), prisons (see also Bank and Agency section) and

additional mental health pressures. Delivery of the recovery plan and financial targets will required a

significant and coordinated response with robust management and oversight. After taking in to

account £1.7m of disposals, which are accounted for after EBITDA, EBITDA is broadly in line with I&E

Margin. The new Use of Resources (UoR) metric is rated at 3, but will rise to a 2 should the Trust

meet its financial plans and targets.

Performance Report & Quality Report The Performance Report can be viewed under item TB 185/17 and the separate Quality Report can be viewed under TB 189/17. Changes to the Single Oversight Framework NHS Improvement has published the updated Single Oversight Framework (SOF) in response to an

exercise to seek feedback from providers. The organisation NHS Providers have produced a helpful

briefing which summarises the changes which have been made as a result by NHS Improvement. The

Senior Leadership Team has already considered how the changes will shape the Trust’s performance

reporting accordingly. The briefing can be accessed here.

High Value Requisition: Perinatal Unit As agreed by the Board in February 2017, the RRCS JV partnership is delivering the Trust’s Capital

Programme for 2017/18. The Board is required to provide authorisation to progress project C3:

Central Perinatal Unit following the Trust successfully winning the tender to provide this service,

awarded by NHSE on 10th April 2017. The scheme is within the financial envelope of £3.5m and the

contracted works will commence December 2017 with completion target date of July 2018. RRCS is

recommending that Board approve the attached purchase order requisition for £2,122,535.28

including VAT to enable the work package to be completed within the agreed timeframes for the

Chorley re-design work.

Autumn Budget Following the recent autumn budget statement from the Chancellor, a helpful briefing has been issued

by NHS Providers which summarises the announcements and the potential implications for the NHS

and providers. The briefing can be accessed here.

Memorandum of Understanding: Ribblesdale Partnership The Ribblesdale Community Partnership (RCP) was formed to involve organisations with looking at

ways that services can be locally developed for the Ribblesdale community. The RCP membership

includes all four Ribblesdale medical practices, which serve a population of around 38,000 people, as

well as other provider organisations including the Trust, East Lancashire Hospitals and Lancashire

County Council.

The RCP have developed a unified vision “To create a new integrated system for the management of

community services in Ribblesdale locality run in partnership by local health and care organisations,

removing organisational boundaries to deliver care pathways designed around the needs of our local

population not organisational structures.”

The vision describes similar aspirations to the development of the Chorley Integrated Community

Wellbeing Service, an initiative which is supported by a detailed Memorandum of Understanding

(MOU). As such, a more concise MOU has been developed and circulated by East Lancashire CCG

for the Ribblesdale Partnership which sets out the broad principles and objectives for working

together as part of the RCP. Work has been undertaken to understand the needs of local

communities and what they feel are the health priorities and the partnership is now seeking

agreement from all organisations to sign up to the MOU and therefore the Board are asked to sign off

the MOU which can be viewed here.

NHS Improvement Quarterly Review Follow Up In October, the Trust had its routine quarterly review meeting with NHS Improvement and received

confirmation it would be remaining within segmentation 1.

https://improvement.nhs.uk/resources/single-oversight-framework/

https://improvement.nhs.uk/uploads/documents/SOF_feedback_response_Nov_2017.pdf

https://nhsproviders.org/resource-library/submissions/nhsi-consultation-on-updates-to-the-single-oversight-framework-nhs-providers-response

mailto:[email protected]

https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf

mailto:[email protected]

22222222 November November November November 2012012012017777

NHS Providers | ON THE DAY BRIEFING | Page 1

THE OBR BORROWING FOTHE OBR BORROWING FOTHE OBR BORROWING FOTHE OBR BORROWING FORECASTRECASTRECASTRECAST

November 2017 Budget

Overview

This was the first Autumn Budget, following Philip Hammond’s announcement that he was changing both

the timing and the frequency of the Government‘s “fiscal event “. The budget outlook was significantly less

optimistic about economic prospects than in March. This cut to Britain’s productivity growth has meant a

downgrading of the growth forecast and signals that the UK economy is weaker than hoped.

The NHS in England received more funding than we had expected, but less than needed. The chancellor

announced £1.6 billion extra revenue for 2018/19; £3.5 billion extra capital funded by the treasury, £0.5bn

this year and an additional £3bn over the next five years; and the government has committed to fund with

new money an increase to agenda for change staff, subject to the recommendation from the pay review

bodies. In addition, the government has committed extra capital and extra revenue for this year.

This briefing outlines the economic headlines within the Budget, key announcements for health and the

wider economy, and NHS Providers’ response.

Economic Overview

• Public sector net borrowing has

been revised down for 2016/17

by £8.4bn, relative to the

estimate published in March.

The downward revision is being

driven by higher than expected

PAYE income tax and NICs

receipts (up by £1.9bn this year),

underspending by Government

departments (down by £3.2bn),

an increase in other receipts,

such as VAT and

exercise duty (revised up by £1.3bn), and a downward revision in various annually managed

expenditure lines, such as state pensions and tax credits (down by £4.7bn).

• The deficit is expected to rise to 2.3% of GDP in 2017/18 before falling steadily over the next four years.

• Economic growth for this year (2017/18) has been revised down from 2% to 1.5%. The OBR has

downgraded the forecasts for the three subsequent years. The average annual growth rate over the

next five years is 1.4%.


OBR PRODUCTIVITY GROOBR PRODUCTIVITY GROOBR PRODUCTIVITY GROOBR PRODUCTIVITY GROWTH (OUTPUT PER HOURWTH (OUTPUT PER HOURWTH (OUTPUT PER HOURWTH (OUTPUT PER HOUR) ) ) ) ––––

FORECASTS AND OUTURNFORECASTS AND OUTURNFORECASTS AND OUTURNFORECASTS AND OUTURNS S S S

Productivity • The OBR has revised down its forecast growth over the coming years, based on current productivity

levels.

• Productivity growth has been

revised down by 0.7% a year.

• Employment increased by around

230,000 between the end of 2016

and the third quarter of 2017,

however average hours worked

per person remained flat, rather

than falling.

Department of Health spending profile

Overview of Department of Health spending: revenue and capital

• The Government has increased the Department

of Health’s budget by £2.8bn. This funding has

been made on an ‘exceptional’ basis, which

means it is not clear whether this will be

recurrently carried forward in to 2020/21.

• The allocation has been made directly to the

Department of Health’s budget, rather than NHS

England’s budget as we have seen in previous

years which means that this is genuinely new

funding, rather than taking additional funds

from other non-frontline services, such as

education and training budgets.

OBR GDP forecast growth: 2017/18 to 2021/22OBR GDP forecast growth: 2017/18 to 2021/22OBR GDP forecast growth: 2017/18 to 2021/22OBR GDP forecast growth: 2017/18 to 2021/22

2017/182017/182017/182017/18 2018/192018/192018/192018/19 2019/202019/202019/202019/20 2020/212020/212020/212020/21 2021/222021/222021/222021/22

MMMMarch 2017 forecastarch 2017 forecastarch 2017 forecastarch 2017 forecast +1.6%+1.6%+1.6%+1.6% +1.7%+1.7%+1.7%+1.7% +1.9%+1.9%+1.9%+1.9% +2%+2%+2%+2% --------

November 2017 forecastNovember 2017 forecastNovember 2017 forecastNovember 2017 forecast +1.5%+1.5%+1.5%+1.5% +1.4%+1.4%+1.4%+1.4% +1.3%+1.3%+1.3%+1.3% +1.5%+1.5%+1.5%+1.5% +1.6%+1.6%+1.6%+1.6%

Contact: Name Person, Does This Job [email protected]


• It is estimated that with the increase next year, the Department of Health’s budget will grow from 0.5%

to 1.4%.

• 2019/20 still looks incredibly challenging for the sector, as £665m of the additional £900m will need to

be used to fund additional NHS pension cost increases.

• The Treasury will fund £3.5 billion of capital investment between 2017/18 and2022-23, including:

• £2.6 billion for STPs to deliver transformation schemes that improve their ability to meet demand

for local services and improvements in facilities .The government has today provisionally allocated

up to 10% of this £2.6bn funding to 12 of the schemes it judges the highest quality, on the basis

of their potential to meet future demand and develop local clinical and financial accountability.

The rest of the funds will be allocated ‘in due course’. You can read which schemes have been

provisionally allocated funding here

• £700 million to support turnaround plans in the trusts facing the biggest challenges, and to tackle

the most urgent and critical maintenance issues

• £200 million to support efficiency programmes

• Other sources of capital funding will come from:

• £3.3bn from land sales

• £2.8bn is expected to come from private finance investment.

Funding for pay award • Additional funding in addition to today’s settlement will be provided for NHS staff on the Agenda for

Change contract subject to the Pay Review Body recommendation. This will be linked to productivity

improvements the Government wishes to see through the contract.

• Any pay award for doctors will not be funded by the government, but will need to be funded from

existing NHS budgets.

Increases to the Department of Health’s budgetIncreases to the Department of Health’s budgetIncreases to the Department of Health’s budgetIncreases to the Department of Health’s budget

YearYearYearYear 2017/182017/182017/182017/18 2018/192018/192018/192018/19 2019/202019/202019/202019/20 Total increase between Total increase between Total increase between Total increase between

17/1817/1817/1817/18----19/2019/2019/2019/20

RevenueRevenueRevenueRevenue +£335m+£335m+£335m+£335m +1.6bn+1.6bn+1.6bn+1.6bn +900m+900m+900m+900m £2.8bn£2.8bn£2.8bn£2.8bn

Department of Health budgDepartment of Health budgDepartment of Health budgDepartment of Health budget: RDEL and CDELet: RDEL and CDELet: RDEL and CDELet: RDEL and CDEL

DH RDEL DH RDEL DH RDEL DH RDEL (£bn)(£bn)(£bn)(£bn) 119.1119.1119.1119.1 121.9121.9121.9121.9 124.2124.2124.2124.2

DH CDELDH CDELDH CDELDH CDEL (£bn)(£bn)(£bn)(£bn) 5.65.65.65.6 6.46.46.46.4 6.76.76.76.7

TotalTotalTotalTotal (£bn)(£bn)(£bn)(£bn) £124.7bn£124.7bn£124.7bn£124.7bn £128.3bn£128.3bn£128.3bn£128.3bn £130.9bn£130.9bn£130.9bn£130.9bn


Mental Health • The government announced that a green paper will be published in December, which will set out plans

for mental health services for children and young people.

Overview of other key / relevant announcements in the budget

Brexit

• £3 billion will be set aside over the next two years to ensure that the UK is prepared for every possible

outcome in the Brexit negotiations. This is in addition to the £700 million already invested in Brexit

preparations.

National Living Wage (NLW) and National Minimum Wage (NMW)

• Following the recommendations of the independent Low Pay Commission (LPC), the government will

increase the National Living Wage (NLW) by 4.4% from £7.50 to £7.83 from April 2018.

• The government will also accept all of the LPC’s recommendations for the other NMW rates to apply

from April 2018. The recommendations include:

• increasing the rate for 21 to 24 year olds by 4.7% from £7.05 to £7.38 per hour



• increasing the rate for apprentices by 5.7% from £3.50 to £3.70 per hour

Business rates

• The government announced that it would be providing a further £2.3 billion of support to businesses

to reduce the burden of business rates.

Pensions and savings • The lifetime allowance for pension savings will increase in line with CPI, rising to £1,030,000 for 2018/19.

• Employees on maternity and parental leave will be able to take up to a 12 month pause from saving

into their Save As You Earn employee share scheme, up from the current six months.

• The tax relief for employer premiums paid into life assurance products or certain overseas pension

schemes will be modernised to cover policies when an employee nominates an individual or registered

charity as their beneficiary.

• The basic State Pension will be increased by the triple lock. This represents a rise of 3% in April 2018, a

cash increase of £3.65 per week for the full basic State Pension.

• There will be an increase to the Standard Minimum Guarantee in Pension Credit to match the cash rise

in the basic State Pension.

• The full new State Pension will also be increased by the triple lock, rising by £4.80 per week.


Welfare • The Budget confirms that the OBR forecasts welfare spending to remain within the Government’s

welfare cap and margin, and so the fiscal rule is judged to have been met with £2.5 billion of headroom.

• The government is now required to reset the welfare cap for the new parliament which will apply to

welfare spending in 202223.

• In the interim years, progress towards the cap will be managed internally, based on the OBR’s

monitoring of forecasts of welfare spending and performance against the cap will be formally assessed

by the OBR in 202223.

• The government will invest in better use of data to ensure benefit fraud and error related payments are

reduced.

• The government will provide funding for the Department for Work and Pension’s relationship support

work, to help keep families together and reduce parental conflict.

• The government has announced new measures and a £1.5bn package to address concerns about the

delivery of Universal Credit

Taxation Income tax, national insurance and employee benefits

• In 2018-19 the personal allowance and higher rate threshold will increase to £11,850 and £46,350

respectively. The government will now allow marriage allowance claims on personal allowances where

a partner has died before the claim was made, with claims backdated up to 4 years.

• The government will consult on how to tackle non-compliance with off-payroll working rules (IR35) in

the private sector, drawing on the experience of the public sector reforms, including through external

research already commissioned by the government and due to be published in 2018.

• The government will publish a consultation in 2018 on how to make the taxation of trusts simpler,

fairer, and more transparent.

• Following the call for evidence published in March 2017, the government will make changes to the

taxation of employee expenses including self-funded training (the government will consult on

extending the scope of tax relief), subsistence benchmark scale rates (the burden will be reduced) and

guidance and claims process for employee expenses (this will be improved through work with external

stakeholders).

• The scope of Qualifying Care Relief (QCR) will be extended to cover self-funded Shared Lives care

payments, to encourage the use of Shared Lives care.

Business and corporate tax

• The corporate indexation allowance will be frozen from 1 January 2018. Accordingly, no relief will be

available for inflation accruing after this date in calculating chargeable gains made by companies.

• The government will consult in 2018 on the tax treatment of intellectual property (the Intangible Fixed

Asset regime). This will consider whether there is an economic case for targeted changes to this regime,

so that it better supports UK companies investing in intellectual property.


• A number of measures relating to non-resident companies and activity in other jurisdictions were also

announced.

Property tax

• The planned switch in indexation from RPI to the main measure of inflation (currently CPI) will be

brought forward to 1 April 2018

• The government will legislate retrospectively to address the so-called “staircase tax”. Affected

businesses will be able to ask the Valuation Office Agency (VOA) to recalculate valuations so that bills

are based on previous practice backdated to April 2010 (including those who lost Small Business Rate

Relief as a result of the Court judgement). The government will publish draft legislation shortly.

• The government will increase the frequency with which the VOA re-values non-domestic properties by

moving to revaluations every three years following the next revaluation, currently due in 2022. The

government will consult on the implementation of these changes in the spring.

• Local government will be fully compensated for the loss of income as a result of these property tax

measures.

New technologies, innovation and infrastructure

Technology

• The government will create a new Centre for Data Ethics and Innovation, invest over £75 million to take

forward key recommendations of the independent review on AI, create new AI fellowships, and

establish a new £10 million Regulators’ Pioneer Fund.

• The government will invest £21 million over the next 4 years to expand Tech City UK’s reach – to

become ‘Tech Nation’ – and support regional tech companies and start-ups to fulfil their potential. Tech

Nation will roll out a dedicated sector programme for leading UK tech specialisms, including AI and

FinTech.

Electric vehicles

• To support the transition to zero emission vehicles, the government will regulate to support the wider

roll-out of charging infrastructure; invest £200 million, to be matched by private investment, into a new

£400 million Charging Investment Infrastructure Fund; and commit to electrify 25% of cars in central

government department fleets by 2022. The government will also provide £100 million to guarantee

continuation of the Plug-In Car Grant to 2020 to help consumers with the cost of purchasing a new

battery electric vehicle.

Research and development

• The National Productivity Investment Fund (NPIF) will grow by a further £2.3 billion of additional

spending in 2021-22, taking total direct R&D spending to £12.5 billion per annum by 2021-22. The

Industrial Strategy White Paper will provide further detail on what this funding will support, including


new support to grow the next generation of research talent and ensure that the UK is able to attract

and retain the best academic leaders globally.

• The government will increase the rate of the R&D expenditure credit from 11% to 12% with effect from

1 January 2018. To provide businesses with the confidence to make R&D investment decisions, the

government will also introduce a new Advanced Clearance Service for R&D expenditure credit claims.

• The government will: change immigration rules to enable world-leading scientists and researchers

endorsed under the Tier 1 (Exceptional Talent) route to apply for settlement after three years; make it

quicker for highly-skilled students to apply to work in the UK after finishing their degrees; and reduce

red tape in hiring international researchers and members of established research teams by relaxing the

labour market test and allowing the UK’s research councils and other select organisations to sponsor

researchers. This is alongside the expansion of the exceptional talent route, benefiting current and

future leaders in the digital technology, science, arts and creative sectors.

Housing

House building

• The government will support more housebuilding, raising housing supply to make homes more

affordable in the long term and help those who aspire to homeownership.

• The government has outlined additional measures to boost the supply of skills, resources and building

land, and to create financial incentives to deliver 300,000 net additional homes a year on average by the

mid-2020s:

• Make available £15.3 billion of new financial support for housing over the next five years, bringing

total support for housing to at least £44 billion over this period.

• Introduce planning reforms to ensure more land is available for housing, and that better use is made

of underused land in our cities and towns.

• Provide £204 million of funding for innovation and skills in the construction sector, including to train

a workforce to build new homes.

Grenfell Tower fire

• £28m will be provided to Kensington and Chelsea Council for mental health services, regeneration

support for the surrounding areas and for new community space for Grenfell United community group.

• The government will not let financial constraints get in the way of essential safety work. Any local

authority that cannot access funding to pay for essential fire safety work should contact the

government.

Implications for the NHS and providers

Following today’s budget, our view is that while any additional funding is welcome, there remains an

unfunded gap between the costs currently faced by providers and increasing demand for care which

needs to be addressed.


• The announcement of an additional £1.6bn revenue funding in 2018/19 and an additional £900m in

2019/20 is welcome, given the intense financial and operational pressure trusts are facing. We will be

seeking early clarity from NHS England and NHS Improvement about how this additional funding will

flow to providers, including whether there will be a national planning exercise for next year given

today’s announcement.

• In the current financial year, an additional £335m for trusts to help meet the challenge of the

approaching winter period is welcome, and yet, comes too late to have maximum impact. We are

concerned that unrealistic expectations might be set nationally about how this additional funding

might be used to improve performance over winter. Members will be understandably keen to

understand how and when, exactly, additional revenue this financial year and beyond will reach them –

we will update members on this as soon as possible.

• We welcome the announcement that additional funding for Agenda for Change staff will be provided,

conditional on ongoing talks over contract reform. The pay uplift will be determined as always by the

NHS Pay Review Bodies. NHS Providers will actively contribute to this process. At this stage, we

understand that the pay award for doctors will not be funded by the government; instead this will need

to come from existing NHS budgets.

• On capital funding, Sir Robert Naylor’s review of NHS property and estates calculated that £10bn was

required to fund and maintain an NHS estate that could continue to deliver safe, high-quality care for

patients. While the Government today announced an additional £10bn ‘package of capital investment’,

only £3.5bn additional funding from the Treasury has been announced. This falls short of what we know

the NHS needs for backlog maintenance and transformation. Around £3.3bn is expected to come from

land sales, but the Naylor Review itself, for example, calculated that 57% of the total gross risk adjusted

potential financial opportunity for the sector was accounted for by the London Sustainability and

Transformation Partnerships alone. In practice, trusts across the country may continue to find it difficult

to access the capital they need to enable productivity improvements they are committed to delivering.

This is particularly disappointing given capital investment in the NHS has fallen sharply in recent years.

Press statement

NHS Providers press statement setting out our response to the Budget is below and also accessible online

here.

LessLessLessLess thanthanthanthan needed:needed:needed:needed: momomomorererere thanthanthanthan expectedexpectedexpectedexpected –––– NHSNHSNHSNHS ProvidersProvidersProvidersProviders responseresponseresponseresponse totototo thethethethe BudgetBudgetBudgetBudget

Responding to the Budget, the chief executive of NHS Providers, Chris Hopson, said:

“NHS providers needed three things from the Budget: extra revenue for day to day spending in 2018/19;

more capital funding for transformation and tackling the maintenance backlog; and fully funding the

ending of the 1 per cent pay cap.

“The NHS has been given £1.6 billion extra revenue for 2018/19; £3.5 billion extra capital funded by the

treasury; and the government has committed to fund the main NHS pay rise. In addition, the government


has committed extra capital and extra revenue for this year, though this has come very late to be used

with maximum impact for this winter.

“Any extra investment in the NHS is welcome given the overall economic context and the other demands

on public expenditure. It is a clear signal that the government has listened to the NHS’ definitive statement

that the existing spending review plans for 2018/19 were undeliverable.

“However it is disappointing that the government has not been able to give the NHS all that it needed to

deal with rising demand, fully recover performance targets, consistently maintain high quality patient care

and meet the NHS’s capital requirements. We also note that the extra revenue has been tied to acute

hospital performance at a point when the pressures across the rest of the health service – community,

mental health and ambulance services – are just as great.

“Tough choices are now needed and trade offs will have to be made. It is difficult to see how the NHS can

deliver everything in 2018/19, for example fully recovering performance targets. The next step is a

conversation with frontline leaders to clearly agree what can and can not be done.

“We are also still trying to live hand to mouth without a sustainable long term financial and capital

settlement for the health and care sector. This makes it impossible to plan effectively. The existing gap

between demand and funding is still scheduled to grow significantly by the end of the parliament and we

must address this underlying problem.

“Overall this new funding is less than the NHS needed but more than was expected. But, as always, NHS

trusts will do their absolute best to provide the highest quality care for patients within the funding

settlement that’s been allocated.”

Useful links

The full Budget document can be accessed here The full text of the Chancellor’s speech is accessible here OBR figures are available here

Ribblesdale Community Partnership Memorandum of Understanding V0.1 14/09/17

RVBC

Ribblesdale Community Partnership Memorandum of Understanding (MOU)

This Ribblesdale Community Partnership MOU is an understanding between Provider Organisations working in the Ribblesdale Neighbourhood to deliver on the objectives outlined in the Ribblesdale Community Partnership Strategy. Furthermore signing up to this document confirms that the Organisation you are representing supports the activities of the Community Partnership. COMMENCEMENT

1 This Memorandum of Understanding is made on the insert relevant date between Organisations’ participating in the Ribblesdale Community Partnership listed in paragraph five of this document. This agreement will be reviewed in April 2018.

RIBBLESDALE COMMUNITY PARTNERSHIP VISION AND AIMS

2 VISION

To create a new integrated system for the management of community services in Ribblesdale locality run in partnership by local health and care organisations, removing organisational boundaries to deliver care pathways designed around the needs of our local population not organisational structures.

3 AIMS/OBJECTIVES

The aims and objectives of the Ribblesdale Community Partnership are to:

Develop the Ribblesdale Community Partnership.

Develop a Ribblesdale Community Partnership Strategy and Plan.

To be the overseeing body to ensure the delivery of the agreed plan.

To test out models of delivery for health, wellbeing and care services within a locality.

To ensure that the model supports the delivery of health, wellbeing and care needs for the Ribblesdale population.

To ensure the maximisation of all available resources.

To performance monitor the impact of the Ribblesdale Community Partnership.

To continually improve the development of the Ribblesdale Community Partnership.

To support the strategic direction of the Pennine Lancashire Transformation Programme.

MEMBERSHIP Member Organisations

4 The membership of the group consists of those listed as follows:-

Sabden & Whalley Medical Practice (Whalley)

The Castle Medical Group (Clitheroe)

Pendleside Medical Practice (Clitheroe)

Slaidburn Country Practice (Slaidburn)


East Lancashire Hospitals Trust (ELHT)

Lancashire Care Foundation Trust (LCFT)

Lancashire County Council (LCC)

Ribble Valley Borough Council (RVBC)

Hyndburn and Ribble Valley CVS (HRVCVS)

Foundation for Ribble Valley Families (FRVF) Applications from other organisations wishing to join the partnership will be considered following application to the secretariat at the East Lancs CCG. GEOGRAPHIC AREA COVERED

5 The Ribblesdale Community Partnership will support the development of services to patients registered with its constituent practices.

GOVERNING STUCTURE AND ACCOUNTABILITY

6 The Ribblesdale Community Partnership will be accountable to each Partnership Members Organisation. Each partner will be responsible for their own arrangements for reporting progress to their Organisation.

ROLES AND RESPONSIBILITIES OF THE RIBBLESDALE COMMUNITY PARTNERSHIP REPRESENTATIVES

7 The roles and responsibilities of each partner representative is as follows:

To ensure regular attendance at meetings. Where a representative can’t attend a nominated deputy will attend.

To provide all information requested by the Strategy Group on time and ensuring involvement of their organisation.

All information must be shared honestly and transparently.

To cascade information about decisions reached and agreements made by the Board to their respective organisations.

To ensure communication is clear, concise and timely.

To make recommendations on behalf of their organisation.

To develop a communications and engagement strategy in line with the agreed Strategic Plan.

ADOPTION OF THE RIBBLESDALE COMMUNITY MEMORANDUM OF UNDERSTANDING

8 The persons whose signatures and Organisation appear at the bottom of this document are the partners named representatives and sign that on behalf of their member Organisation they shall support as appropriate and applicable the activities of the Ribblesdale Community Partnership.

Organisation

Organisation Representative / Designation

Sabden & Whalley Medical Practice (Whalley)


The Castle Medical Group (Clitheroe)

Pendleside Medical Practice (Clitheroe)

Slaidburn Country Practice (Slaidburn)

East Lancashire Hospital’s Trust

Foundation for Ribble Valley Families

Lancashire Care Foundation Trust

Lancashire County Council

Ribble Valley Borough Council

Hyndburn and Ribble Valley CVS

Board of Directors


Report Title Quality Report

FOIA Exemption No Exemption Not Applicable

Prepared by Matthew Joyes

Associate Director of Safety and Quality Governance

Presented by Dee Roach, Executive Director of Nursing and Quality

and

Professor Max Marshall, Medical Director

Action required Decision

Supporting Executive Director Executive Director of Nursing & Quality


Report purpose To provide the Trust Board with latest version of the Quality Report



Board Assurance Framework risk 1.1 If we do not meet regulatory standards for quality and safety we will not be fit for purpose as a care provider

CQC domain Well-led

Quality and Safety Report

December 2017

(data from November 2016 to October 2017)

Prepared by: Presented to the Trust Board by:

Matthew Joyes, Associate Director of Safety and Quality Governance Dee Roach, Executive Director of Nursing and Quality

Max Marshall, Executive Medical Director

Lancashire Care NHS Foundation Trust Quality and Safety Report

Page 2 of 34

Contents

Contents ...................................................................................................................................................................................................................................... 2

Quality and Safety Tile ................................................................................................................................................................................................................. 3

Executive Summary ..................................................................................................................................................................................................................... 4

Safe ............................................................................................................................................................................................................................................. 5

Effective .................................................................................................................................................................................................................................... 14

Caring ........................................................................................................................................................................................................................................ 19

Responsive ................................................................................................................................................................................................................................ 22

Well Led .................................................................................................................................................................................................................................... 24

Appendix 1 – Extracts from the Quality and Safety Surveillance Report and Mental Health Law Surveillance Report ................................................................ 29


Page 3 of 34

QUALITY AND SAFETY TILE

SAFE

Incidents 15251


incidents 92

RIDDOR incidents 38

Never Events 1

Serious HCAI incidents 10

Use of restraint 3930

Potentially avoidable grade 3 and

4 pressure ulcers 13


(inpatients only) 2869

Physical violence to staff from

patients 2172

CARING

F&F Test 94.40%

Compliments 8701

RESPONSIVE

Complaints 1632


complaints 320


timeframe (%) 54%

WELL LED

Trust CQC rating Good

Core Skills (%) 90.05%

Appraisals (%)

Concerns raised 9

EFFECTIVE

Physical Health HFC Rate (%) 95%

Mental Health HFC Rate (%) 83%


Page 4 of 34

Executive Summary

This is the second report of the new format Quality and Safety Report.

In relation to current quality and safety performance, attention is drawn to:

The levels of physical violence to staff;

The levels of restraint;

The under-performance of the Mental Health Harm Free Care rate;

The high number of overdue incident reviews.

There is a clear correlation between violence, restraint, staffing and the performance of the Mental Health Harm Free Care rate. The Quality and Safety Sub- committee is receiving deep dive presentations into the data across inpatient services. A review of the existing programme and improvement initiatives is underway through the Positive and Safe Group.

The data shows a noticeable increase in serious incidents however this should be considered against the context of a significant reduction over the last 4 years. The number of RIDDOR incidents is noticeably low in the last month.

Mortality review data is included in this report for the first time in accordance with requirements set-out by NHS Improvement. Reporting in this area will improve over coming months as the Trust commences its programme of structured case judgement reviews however there is still an absence of nationally standardised tools and definitions in this area as they relate to mental health and community health services.

Staffing continues to be a challenge and a number of wards at Guild Lodge have high use of bank staff. As mentioned above, there is a correlation between the use of temporary staff, staffing challenges, and levels of violence and restraint on wards. The Staffing for Quality and Safety Group continues to receive Network reports to monitor action being taken locally to mitigate risk. The Executive Director of Nursing and Quality is leading a task and finish group to review and take action in relation to inpatient staffing challenges.


Page 5 of 34

Safe

This section of the report looks at the domain of safety – that services are safe, and people are protected from abuse and avoidable harm. The following

indicators are covered in the report:

Serious Incidents ..................................................................................................................................................................................................................... 6

RIDDOR Incidents ................................................................................................................................................................................................................... 7

Never Events ........................................................................................................................................................................................................................... 8

Serious HCAI Incidents ............................................................................................................................................................................................................ 8

Pressure Ulcer Incidents – Potentially Avoidable Grade 3 and Grade 4 ................................................................................................................................... 9

Physical Violence to Staff Incidents .......................................................................................................................................................................................... 9

Use of Restraint ..................................................................................................................................................................................................................... 10

Suicide (Reported as a Serious Incident) ............................................................................................................................................................................... 10

Staffing Incidents – One or Less Qualified Staff on Duty ........................................................................................................................................................ 11

Staffing Incidents – Red Flags ............................................................................................................................................................................................... 11

Safer Staffing – Wards with over 40% hours worked by bank staff ......................................................................................................................................... 12

Safer Staffing – Wards with over 10% hours worked by agency staff ..................................................................................................................................... 12

Mortality Review – Numbers of Deaths and Reviews ............................................................................................................................................................. 13

Mortality Review – Classification of Deaths ............................................................................................................................................................................ 13


Page 6 of 34

Serious Incidents - Rolling 12 Months

12

10

8

6

4

2

0

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

Serious Incidents

A serious incident is defined as “acts or omissions in care that result in; unexpected or avoidable death, unexpected or avoidable injury resulting in serious harm - including those where the injury required treatment to prevent death or serious harm, abuse, Never Events, incidents that prevent (or threaten to prevent) the ability to continue to deliver healthcare services and incidents that cause widespread public concern resulting in a loss of confidence in healthcare services.”

The number of serious incidents fell throughout 2014-2016, however the long term reduction has now plateaued with a minor increase over the rolling 12 month period.

During October 2017, the following serious incidents were reported:

Serious self-harm (suspected attempted suicide) of a prisoner at HMP Liverpool;

Death (suspected suicide) of a patient under the care of the Assessment and Treatment Team in Chorley and South Ribble;

Concerns around the care of a patient in Podiatry in Central Lancashire – no immediate concerns for LCFT services however a patient under the care of podiatry underwent an operation at an acute Trust where the wound deteriorated resulting in an above knee amputation;

Death (suspected suicide) of a patient under the care of the Assessment and Treatment Team in Lancaster and Morecombe;

Death (suspected suicide) of a patient under the care of the Rapid Intervention and Treatment Team in Lancaster and Morecombe;

Death (suspected suicide) of a person recently seen by the Mental Health Liaison Team in Central Lancashire;

Death of a patient in an acute Trust which may have been contributed to by a pressure ulcer, where the patient was under the care of Southport and Formby District Nursing;

Death (suspected suicide) of a prisoner at HMP Liverpool;

Death of a patient under the care of the Mindsmatter Service in West Lancashire.

In all cases, a formal investigation is now underway and the incidents have been reported as required under the NHS Serious Incident Framework.


Page 7 of 34

RIDDOR Incidents - Rolling 12 Months

7

6

5

4

3

2

1

0


RIDDOR Incidents

The Trust is required to report certain incidents under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013. These notifications are received by the Care Quality Commission and Health and Safety Executive. A RIDDOR incident is defined as an incident were someone has died or has been injured because of a work-related accident including specified injuries to workers (certain fractures, amputations, loss of sight, crush injury to head or torso, serious burns, loss of consciousness, etc.), injury causing absence of work for more than 7 days, injuries to non-workers requiring transfer to hospital, occupational diseases and certain dangerous occurrences.

The number of RIDDOR incidents shows a small increase during the year however improved awareness of reporting requirements is considered to be partially responsible. The predominance of incidents relate to absence of work of over 7 days and originates from violence to staff.

During October 2017, the following RIDDOR incident was reported:

Injury to a staff member’s back whilst opening a door resulting in absence for over seven

days.


Page 8 of 34

Never Events - Rolling 12 Months

2

1

0


Never Events

Never events are serious incidents that are entirely preventable as guidance, or safety recommendations providing strong systemic protective barriers, are available at a national level, and should have been implemented by all healthcare providers. Each never event type has the potential to cause serious patient harm or death. However, serious harm or death is not required to have happened as a result of a specific incident occurrence for that incident to be categorised as a never event.

The Trust reported one Never Event in September 2017, which related to an incident in May 2017. This related to an overdose of methotrexate in rheumatology services. The report is due for completion

HCAI Incidents - Rolling 12 Months

5

4

3

2

1

0


Serious HCAI Incidents

A serious HCAI incident is considered to be an avoidable incident of Clostridium Difficile (C.Diff), Meticillin-Resistant Staphylococcus Aureus (MRSA), Methicillin-Susceptible Staphylococcus Aureus (MSSA), Gram-negative bacteria, Carbapenemase-Producing Enterobacteriaceae (CPE), or another infection control incident resulting in a ward closure.

The number of HCAI incidents remains low with no exceptions to report. The Infection Prevention and Control Team continue to drive improvements in reporting and compliance with the Essential Steps Hand Hygiene Audit and to drive forward the annual staff flu vaccination campaign.


Page 9 of 34

Potentially Avoidable G3 and G4 Pressure Ulcer Incidents - Rolling 12

Months

6

5

4

3

2

1

0


Pressure Ulcer Incidents – Potentially Avoidable Grade 3 and Grade 4

Pressure ulcers are injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin. Pressure ulcers can affect any part of the body that's put under pressure. They're most common on bony parts of the body and often develop gradually, but can sometimes form in a few hours. In a grade three pressure ulcer, skin loss occurs throughout the entire thickness of the skin and the underlying tissue is also damaged. The underlying muscles and bone are not damaged. A grade four pressure ulcer is the most severe type of ulcer. The skin is severely damaged and the surrounding tissue begins to die (tissue necrosis). The underlying muscles, or bone, may also be damaged. People with grade four pressure ulcers have a high risk of developing a life-threatening infection

The number of pressure ulcer incidents increased over the summer period but has declined over the last two months. Pressure ulcer prevention is a priority for 2017/18 in the Quality Plan and work so far has included revising the policy, introducing safety huddles, a safety senate and the safety cross. Localities where these initiatives have been piloted have shown a reduction incidents.

Physical Violence to Staff Incidents - Rolling 12 Months

300

250

200

150

100

50

0


Physical Violence to Staff Incidents

Physical violence to staff includes any degree of harm, including near miss incidents, where staff are physical assaulted. Incidents are recorded by staff on the Trust’s quality governance system (Datix).

The number of incidents of physical violence to staff increased notably in 2014 and remained increased since, with a further increase during 2017/18 which appears to have levelled during the last few months. Hot spots have been identified in older adult wards and psychiatric intensive care units (PICUs). A deep dive into the data for PICUs was presented to the Quality and Safety Sub- committee in October, with a deep dive into older adults planned for December 2017. Targeted improvement work is taking place in older adult wards focused on reducing violence from personal care activities. Ongoing support and training to clinical teams continues to be provided by the Violence Reduction Team.


Page 10 of 34

Use of Restraint - Rolling 12 Months

500

450

400

350

300

250

200

150

100

50

0


Use of Restraint

The use of restraint shows a notable increase. This is closely linked to the increase in violence and the work to address violence includes restraint reduction as an outcome measure. The hot spot areas mirror those for violence and aggression mentioned earlier in the report.

Suicide (Reported as a Serious Incident) - Rolling 12 Months

7

6

5

4

3

2

1

0


Suicide (Reported as a Serious Incident)

The overall rate of suicide incidents (deemed to meet the criteria for a serious incident) show a noticeable increase over the rolling 12 months with October 2017 seeing the second highest reported number over that period. No emerging risks have been identified for this sudden increase and serious incident investigations are underway.


Page 11 of 34

Staffing Incidents – One or Less Qualified Staff on Duty

Instances of one qualified staff on duty are reported and escalated in accordance with the Staffing for Quality and Safety Escalation Procedure. This allows managers to put into place mitigations by moving staff, supporting the area with senior nurses or using bank and agency staff.

Wards which reported more than 10 instances of this are:

Marshaw

Marshaw Ward reported more than 10 instances in the last reporting period.

Red Flags - Rolling 12 Months

350

300

250

200

150

100

50

0


Staffing Incidents – Red Flags

All staff are encouraged to use the Red Flag facility on the eRostering Safe Care system to alert managers to staffing incidents such as low staffing numbers, missed breaks, etc.

The majority of Ref Flag incidents relates to the above issue of one or fewer qualified staff on duty.

One or Less Qualified Staff on Duty -

Rolling 12 Months 250

200

150

100

50

0



Page 12 of 34

Wards with over 40% hours worked by bank staff

Townley CSU

Marshaw

Bleasdale

Elmridge

Byron

Bronte

Dunsop

40% 45% 50% 55% 60%

Safer Staffing – Wards with over 40% hours worked by bank staff

The services identified on the chart used bank staff for greater than 40% of hours worked.

Marshaw, Bleasdale, Elmridge, Byron and Dunsop also reported greater than 40% bank staff usage in the last reporting period. The Executive Director of Nursing and Quality is leading a task and finish group to explore and address inpatient staffing challenges.

Teams with over 10% hours worked by agency staff

HMP Liverpool

0% 5% 10% 15%

Safer Staffing – Wards with over 10% hours worked by agency staff

The following services used bank staff for greater than 40% of hours worked:

HMP Liverpool

The Clinical Director of Secure Services presented an assurance report on staffing at HMP Liverpool to the Quality and Safety Sub-committee in November 2017. Sustained recruitment has been underway and several new staff have been appointed and are awaiting prison security clearance.


Page 13 of 34

Numbers of Deaths and Mortality Reviews - Rolling 12 Months

80

60

40

20

0


SCJ Reviews SI Reviews Deaths

Mortality Review – Numbers of Deaths and Reviews

The Trust is required to declare how many deaths were deemed as avoidable.

Deaths are reviewed through two processes: the serious incident (SI) process and the structured case judgement (SCJ) process. The SI process determines whether a death was predictable and/or preventable. The SCJ process determines whether a death was due to a problem in care. Neither of these terms are legal terms or formal causes of death.

Since April 2017, one death reviewed through the serious incident process was deemed predictable and preventable. No structured case judgement reviews have taken place – a cohort of reviewers have been recruited and the process will commence in January 2018.

The Trust is engaged in the Learning Disability Mortality Review Programme (LeDeR) however at this stage it is unclear how this programme will return feedback into the Trust and this is being explored with NHS England.

Classification of Deaths - Rolling 12 Months (data available from July

2017)

40

20

0

Jul Aug Sep Oct

Expected Natural Expected Unnatural

Unexpected Natural Unexpected Unnatural

Not Yet Known

Mortality Review – Classification of Deaths

The Trust records deaths as incidents, where appropriate and in accordance with the Incident Procedure. A daily review process, supported by a weekly review panel, determines which deaths meet the threshold for a serious incident and (when established) which deaths will be subject to a structured case judgement review.

Deaths are recorded against one of four categories: Expected Natural (i.e. terminal illness), Expected Unnatural (i.e. drug misuse), Unexpected Natural (i.e. sudden cardiac condition) and Unexpected Unnatural (i.e. suicide). This framework was developed by Mazars in their investigation into deaths at Southern Health NHS Foundation Trust and helps determine which deaths require further review.


Page 14 of 34

Effective

This section of the report looks at the domain of effectiveness – that care, treatment and support achieves good outcomes, helps people to maintain quality of

life and is based on the best available evidence. The following indicators are covered in the report:

Mental Health Harm Free Care ........................................................................................................................................................................................... 15

Physical Health Harm Free Care ........................................................................................................................................................................................ 15

Local Clinical Audit ............................................................................................................................................................................................................. 16

National Clinical Audit ......................................................................................................................................................................................................... 17

Clinical Audit Summary Report ........................................................................................................................................................................................... 18


Page 15 of 34

Mental Health Ham Free Care - Rolling 12 Months

92%

90%

88%

86%

84%

82%

80%

78%

76%

74%


Mental Health Harm Free Care

The Mental Health Harm Free Care rate remains below the aspirational goal of 90%. The overall rate is made up of several individual measures. The area’s most impacting the overall measure includes violence, restraint, medication safety and feeling safe.

Physical Health Harm Free Care - Rolling 12 Months

97%

96%

95%

94%

93%

92%

91%


Physical Health Harm Free Care

The Physical Health Harm Free Care rate has achieved the target in 7 of the last 12 months with an improving picture seen over recent months. The overall rate is made up of several individual measures.


Page 16 of 34

Local Clinical Audit

Clinical Audits N/L/R* Network Compliance (%) Date

Prevention of Dehydration L MHN 54% Sep-17

Absent Without Leave L MHN 55% Oct-17

Nursing Management of Clozaril R MHN 60% Oct-17

Diabetes R MHN 65% Sep-17

Carers R CYPWN 54% Oct-17

Cerebral Palsy in under 25's (NICE) L CYPWN 82%

Risk Assessments L CYPWN 83%

Clozapine L CYPWN 80%

Nutrition L CYPWN 77%

Consent to Treatment R MHN 94%

Completion of Waterlow risk assessments L CWN 85%

Wound assessment documentation L CWN 70%

Care of Dying L CWN 79%

Learning Disability L CWN 85%

Acupuncture - Rheumatology & Physiotherapy

R CWN 97%

Antibiotics in dentistry R CWN 94%

Use of restrictive practices within LD R CWN 93%


Page 17 of 34

National Clinical Audit

Audit Start Quarter End Quarter 2016/17 Compliance

2017/18 Compliance

National Audit of Anxiety and Depression Q4 2017/18

National Audit of Intermediate Care (NAIC) Q1 2017/18 Q4 2017/18

National Audit of Psychosis Q4 2016/17 Q4 2017/18

National Chronic Obstructive Pulmonary Disease (COPD) audit programme Q1 2017/18 Q4 2017/18 90%

National Diabetes Foot care Audit - Adults Q1 2017/18 Q4 2017/18 81%

Sentinel Stroke National Audit programme (SSNAP) Q1 2017/18 Q4 2017/18 LCFT were above national average in a total of 6 out of 16 indicators

UK Parkinson’s Audit Q1 2017/18 Q4 2017/18

National Audit of Inpatient Falls Q1 2017/18 Q4 2017/18

POMHUK High Dose and Combination Antipsychotic Prescribing Q4 2016/17 Q2 2017/18 14/ 57

POMHUK Use of depot and Long acting antipsychotic injections Q1 2017/18 Q4 2017/18

POMHUK Prescribing for bipolar disorder (use of sodium valproate) Q1 2017/18 Q4 2017/18

POMHUK Assessment of the side effects of depot antipsychotics Q1 2017/18 Q4 2017/18

POMHUK Rapid Tranquillisation Audit Q4 2016/17 Q2 2017/18 41/58 - 41%


Page 18 of 34

Clinical Audit Summary Report

POMHUK Rapid Tranquillisation Audit

An action plan has been devised to ensure patients receive the necessary monitoring following use of rapid tranquillisation. Progress has been made as follows:

An alert has been added to the relevant medication templates on EPMA so nursing staff are prompted to monitor the patient if medication for rapid tranquillisation is administered.

A flowchart has been devised to support staff in undertaking the required monitoring and this is due to be ratified at the November Drugs and Therapeutics Committee.

Discussions are progressing to consider how Nerve Centre may be used to prompt physical health monitoring following use of rapid tranquillisation.

A template will also be devised for the new electronic patient record to support high standards of clinical care following use of rapid tranquillisation

POMHUK Audit: High Dose and Combination Antipsychotic Prescribing

This audit assessed the following three standards:

1. The dose of an individual antipsychotic should be within its SPC/BNF limits

2. Individuals receive only one antipsychotic at a time

3. Where high dose antipsychotics are prescribed, there should be a clear plan for regular clinical review including safety monitoring

331 patients were audited across 36 teams in LCFT. 22 patients medication regimen met the criteria for high dose prescribing. Eight of these patients were

on an adult ward or PICU and fourteen patients on forensic wards

Upper quartile performance was achieved by adult wards and PICUs. Forensic services performed higher that the national average for Standards One and Two.

Considering each standard individually, the trust achieved upper quartile performance for Standards One and Two. Upper quartile performance was not achieved for Standard Three, a newly introduced audit standard

Overall the Trust is upper quartile of Trust nationally.


Page 19 of 34

Caring

This section of the report looks at the domain of caring – that staff involve and treat people with compassion, kindness, dignity and respect. The following


Friends and Family Test – Results .................................................................................................................................................................................. 20

Friends and Family Test – Submissions .......................................................................................................................................................................... 20

Compliments ................................................................................................................................................................................................................... 21

CQC Community Mental Health Survey .......................................................................................................................................................................... 21


Page 20 of 34

Friends and Family Test Results - Rolling 12 Months

100%

95%

90%

85%

80%

75%

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

Friends and Family Test – Results

A key part of the Trust’s real time feedback process is the Friends and Family Test (FFT). The Friends and Family Test is a tool that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. It asks people if they would recommend the services they have used and offers a range of responses. When combined with supplementary follow-up questions, the FFT provides a mechanism to highlight both good and poor patient experience.

The Friends and Family Test overall response rate has been at or above the target of 95% for 10 of the last 12 months with the target achieved and maintained since January 2017.

Friends and Family Test Submissions - Rolling 12 Months

4000

3000

2000

1000

0

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

Friends and Family Test – Submissions

The number of submissions has notably reduced over the 12 months, however has remained broadly consistent during the last 10 months. There are a number of reasons for this including changes to how the data is captured (such as reducing multiple collection points).


Page 21 of 34

Compliments - Rolling 12 Months

1200

1000

800

600

400

200

0


Compliments

The number of compliments has had a marginal decrease during the last 12 months.

CQC Community Mental Health Survey

Workers

Overall 9 Organising care experience

7

5 Overall views Planning care

3

1 Support and

Reviewing care wellbeing

Treatments Staff changes

Crisis care

CQC Community Mental Health Survey

The CQC use national surveys to find out about the experience of service users receiving care and treatment from healthcare organisations and mental healthcare providers. CQC asked people to answer questions about different aspects of their care and treatment. Based on their responses, CQC gave each NHS Trust a score out of 10 for each question (the higher the score the better). Each trust also received a rating of ‘About the same’, ‘Better’ or ‘Worse’.

Responses were received from 172 people who use services of the Trust.

The Trust was rated as “about the same” for all ten questions and each of their sub-questions.


Page 22 of 34

Responsive

This section of the report looks at the domain of responsiveness – that services are organised so that they meet people’s needs. The following indicators are

covered in the report:

Complaints .................................................................................................................................................................................................................. 23

Mixed Sex Breaches .................................................................................................................................................................................................... 23


Page 23 of 34

Complaints - Rolling 12 Months

200

150

100

50

0


Complaints Upheld Complaints

Complaints

The number of complaints has noticeably increased over the 12 months. This reflects a national picture. The predominant theme is in relation to access to treatment or drugs (22%), admission and discharge (17.5%), communication (14%), appointments including delays and cancellations (10%) and clinical treatment (9%).

Despite the overall increase, the number of upheld or partially upheld complaints remains consistent although there is a noticeable increase in the last month which will be closely monitored.

Mixed Sex Breaches - Rolling 12 Months

1

0


Mixed Sex Breaches

There have been zero mixed sex breaches over the rolling 12 month period.


Page 24 of 34

Well Led

This section of the report looks at the domain of well les – that the leadership, management and governance of the organisation make sure it's providing high-

quality care that's based around individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture. The following


Care Quality Commission (CQC) Rating) ................................................................................................................................................................. 25

Core Skills................................................................................................................................................................................................................ 25

Overdue Incident Reviews ....................................................................................................................................................................................... 26

Accreditations .......................................................................................................................................................................................................... 26

Concerns Raised ..................................................................................................................................................................................................... 27

Quality Plan Dashboard ........................................................................................................................................................................................... 28

Quality Plan Exception Report ................................................................................................................................................................................. 28


Page 25 of 34

Care Quality Commission (CQC) Rating)

The Trust was last inspected in September 2016 and the overall rating was Good. Two core services were rated as Requires Improvement – community inpatient services and community health services.

The CQC inspected healthcare services at HMP Liverpool in September 2017 in a process separate from the main Trust inspection. The draft report is now being check for factual accuracy.

Core Skills - Rolling 12 Months

95%

90%

85%

80%

75%

70%


Core Skills

The overall core skills rate is above the Trust target of 85% however performance remains below target in:

Manual Handling Level 2

Manual Handling Level 3

Basic Life Support

Intermediate Life Support

Safeguarding Children Level 3


Page 26 of 34

Overdue Incident Reports - Rolling 12 Months (data available from Feb

2017)

2500

2000

1500

1000

500

0

Feb Mar Apr May Jun Jul Aug Sep Oct

7 Day Reviews 3 Day Reviews

Overdue Incident Reviews

The number of overdue incident reports, particularly 7 Day Reviews for incidents categorised as Level 1, 2 or 3 remains high with no improvement over the last 12 months. Targeted work has taken place within the Networks and has seen improvement in the Community and Wellbeing Network in particular. The Mental Health Network accounts for the vast predominance of overdue incidents.

Accreditations

This section is currently under development.


Page 27 of 34

Concerns Raised - Rolling 12 Months (data available from April 2017)

20

10

0

Apr May Jun Jul Aug Sep Oct

Concerns Raised

During October 2017, the following concerns were reported through the various mechanisms including the Raising Concerns Guardian and through Dear David:

The proposed installation of baths in initial designs for the Chorley inpatient unit;



Staff attack alarms not available to staff when entering wards at the Harbour at the start of their shift;

Lack of commissioned services for people suffering with Autistic spectrum disorder and behavioural difficulties;


Caseloads, lack of management support and supervision Community Mental Health Teams;

Culture and clinical practice at the Harbour;

Staff suffering with stress in Community Mental Health Teams.

In all cases a review of proportionate scale has been commissioned. The findings from each review are individually fed back to the person raising the concern if they have provided their name. The findings from every concern is summarised in the Quality Matters bulletin.

The themes from concerns over the year to date are management culture and conduct, demand, staffing and violence.


Page 28 of 34

Quality Plan Dashboard Key: Off Track On Track Complete Data Not Provided

Priority Lead QI Plan CQC Requirements

Process Measures

Outcome Measures

Balancing Measures

Mental Health Clinical Risk Assessment and Management Helen Lilley Holistic Care Planning Patsy Probert Standards of Record Keeping Patsy Probert Staffing for Quality and Safety Paula Flint Seclusion Julie Seed End of Life Care Michaela Toms Supporting Staff following Adverse Events Caroline Waterworth Reduction in Violence and Aggression Caroline Waterworth Pressure Ulcers Michaela Toms Medication Safety Sonia Ramdour Physical Healthcare in Mental Health In-patient Services Debra Wilson Appraisals Damian Gallagher Core Skills Deborah Cox Supervision Gita Bhutani New Professional Roles Patsy Probert

Mental Health Law Matthew Joyes

Quality Plan Exception Report

Improvement plans for all priorities are now in place. The priority of violence reduction is underperforming in the outcome measures as described in the safety section above. The priorities of appraisals and core skills are underperforming and information is detailed above for core skills and in the quarterly workforce report for both. The HR Directorate are assisting services with reporting and other support to improve compliance. Of particular note, both these areas are Requirement Notices from the last CQC inspection. The priority of new professional roles is progressed in respect of planning however the actual implementation of new professional roles is behind plan. Work is underway across all professional groups to address this. The priority of mental health law is well progressed in respect of new systems and processes however the outcomes are behind plan particularly in relation to ensuring patients are given their verbal Section 132 rights. This is being closely monitored as the new systems and processes are embedded.


Page 29 of 34

Appendix 1 – Extracts from the Quality and Safety Surveillance Report and Mental Health Law Surveillance Report

The Quality and Safety Surveillance Report is designed to provide the Committees and Subcommittee of the Trust Board with a range of indicators that provide

assurance and/or early warning escalation of risk. Risk indicators are used to draw attention to areas of focus. Green flags indicate a measure that is on target

or where performance is in-line with accepted levels. Yellow flags indicate a measure for close watch (perhaps because of a worsening position) or where a

measure is off target but has no immediate risk. Red flags indicate a measure that presents an immediate and/or high level risk. The Quality and Safety Tile, in

the front of this report, is a headline summary of key indicators.

In addition, a Mental Health Law Surveillance Report is produced alongside Network-level Quality Surveillance Report.

The data tables from the Trust Quality and Safety Surveillance Report (monthly) and Mental Health Law Surveillance Report (quarterly) are included in this

Quality and Safety Report for additional information and context.


Page 30 of 34

Domain

Indicator

Target

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct 12 months

total

12 months

average

Sparkline

Risk

Incidents

Incidents n/a 1867 2094 2345 2358 2168 2090 2329 15251 2178.7

Incidents with harm n/a 404 436 487 547 437 473 535 3319 474.1


incidents n/a 6 6 7 9 4 9 8 10 4 11 8 10 92 7.7

RIDDOR incidents n/a 2 6 2 0 3 4 5 2 6 1 6 1 38 3.2

Never Events 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0.1

Medication incidents n/a 127 149 177 150 148 183 186 1120 160.0

Infection control Serious HCAI incidents 0 1 4 1 0 1 1 0 1 0 0 1 0 10 0.8

Patient safety

Use of restraint n/a 349 252 189 263 308 329 300 400 461 335 346 398 3930 327.5

Use of seclusion n/a 85 65 73 68 66 64 65 486 69.4

Safeguarding alerts n/a 100 158 138 129 130 95 152 902 128.9


and 4 pressure ulcers n/a 0 0 0 2 0 2 0 5 1 2 0 1 13 1.1

Staffing

Number of instances of 1 or less

qualified on duty (inpatients) 0 244 207 192 170 145 139 197 140 132 177 132 84 1959 163.3


(inpatients only) n/a 316 261 260 268 221 195 270 227 228 258 228 137 2869 239.1

Staff safety Physical violence to staff from

patients n/a 162 137 140 129 151 155 150 218 268 220 223 219 2172 181.0

Legal Regulation 28 Notices received n/a 0 0 0 0 1 0 0 1 1 0 0 0 3 0.3

QUALITY AND SAFETY SURVEILLANCE - Safe


Page 31 of 34

QUALITY AND SAFETY SURVEILLANCE - Effective

Clinical Audits N/L/R* Network Compliance (%) Date Prevention of Dehydration L MHN 54% Sep-17

Absent Without Leave L MHN 55% Oct-17

Nursing Management of Clozaril R MHN 60% Oct-17

Diabetes R MHN 65% Sep-17

Carers R CYPWN 54% Oct-17

Cerebral Palsy in under 25's (NICE) L CYPWN 82% Risk Assessments L CYPWN 83% Clozapine L CYPWN 80% Nutrition L CYPWN 77% Consent to Treatment R MHN 94% Completion of Waterlow risk assessments L CWN 85% Wound assessment documentation L CWN 70% Care of Dying L CWN 79% Learning Disability L CWN 85% Acupuncture - Rheumatology & Physiotherapy R CWN 97% Antibiotics in dentistry R CWN 94% Use of restrictive practices within LD R CWN 93%

Domain

Indicator

Target

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct 12 months

average

Sparkline

Risk

Physical Health

Harm Free Care

Pressure ulcers (%) - 4.61% 3.96% 2.72% 2.91% 5.27% 3.45% 3.45% 4.04% 3.05% 3.12% 2.55% 2.72% 3.5%

Falls with harm (%) - 1.76% 1.29% 1.28% 1.64% 1.55% 1.55% 0.60% 0.75% 1.21% 0.64% 0.93% 0.53% 1.1%

Catheter and UTI (%) - 0.29% 0.18% 0.64% 0.27% 0.26% 0.43% 0.45% 0.27% 0.21% 0.07% 0.23% 0.15% 0.3%

VTE (%) - 0.59% 0.55% 0.08% 0.36% 0.35% 0.35% 0.15% 0.69% 0.43% 0.43% 0.93% 0.38% 0.4%

Physical Health HFC Rate (%) 95% 93% 94% 95% 95% 93% 94% 96% 94% 95% 96% 96% 96% 94.7%

Mental Health

Harm Free Care

Self harm (%) - 3.69% 3.35% 4.04% 3.55% 3.43% 3.56% 3.76% 3.75% 4.37% 4.63% 3.71% 3.59% 3.8%

Victim of violence (%) - 2.87% 1.89% 1.62% 2.71% 1.07% 2.30% 1.46% 2.50% 1.66% 1.89% 1.75% 3.17% 2.1%

Feel safe (%) - 10.86% 9.22% 6.26% 8.35% 9.01% 9.62% 10.65% 7.08% 7.90% 10.53% 8.08% 11.21% 9.1%

Omission of medication (%) - 15.57% 18.87% 13.74% 16.08% 17.17% 17.99% 18.37% 23.54% 20.37% 19.79% 20.09% 24.10% 18.8%

Restraint (%) - 5.74% 6.29% 4.65% 4.80% 3.65% 5.23% 5.43% 7.08% 6.86% 7.16% 5.68% 4.86% 5.6%

Mental Health HFC Rate (%) 90% 82% 83% 86% 84% 85% 83% 83% 84% 81% 80% 84% 80% 82.9%

NICE Baseline Assessments Network Compliance Date

NG73 Endometriosis CYPWN 100% 7.11.17

NG6 Mental Health of Adults in contact with

the criminal justice system MHN 66% 7.11.17

NG71 Parkinsons Disease CWB 100% 7.11.17


Page 32 of 34

Domain

Indicator

Target

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct 12 months

total

12 months

average

Sparkline

Risk

Friends & Family -

Patients

F&F Test 95% 85% 87% 96% 96% 96% 96% 97% 95% 97% 97% 97% - 94.40%

F&F Test - Response Rate n/a 3371 1744 1659 2042 1562 1263 1815 1218 1241 1652 923 18490 1680.9

Compliments Compliments n/a 719 529 678 1031 788 593 987 697 774 819 537 549 8701 725.1

QUALITY AND SAFETY SURVEILLANCE - Caring

The Friends and Family Test real time reporting is locked and nationally reported on the 19th of each month and will therefore be reported in arrears most months


Page 33 of 34

Domain

Indicator

Target

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct 12 months

total

12 months

average

Sparkline

Risk

Complaints

Complaints n/a 134 150 114 111 167 95 108 152 134 173 149 145 1632 136.0


complaints n/a 42 26 22 21 31 26 23 19 24 22 21 43 320 26.7


timeframe (%) n/a 54.0% 54.0% 54.0%

Reopened complaints n/a 3 3 3 4 2 4 4 7 5 0 0 3 38 3.2

PHSO complaints n/a 0 0 1 2 3 1 3 1 0 1 0 0 12 1.0

MP enquiries n/a 8 7 13 9 15 7 8 5 9 11 5 12 109 9.1

Environment Mixed Sex Breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

QUALITY AND SAFETY SURVEILLANCE - Responsive


Page 34 of 34

Domain Indicator Target Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 12 months

total

12 months

average Sparkline Risk

Regulatory

Trust CQC rating Good RI RI Good Good Good Good Good Good Good Good Good Good Good

Regulatory inspections/visits n/a 4 5 4 3 4 3 2 1 2 1 29 2.9

CQC notifications n/a

People

Core Skills (%) 85% 87.72% 88.24% 89.07% 89.41% 90.68% 90.33% 89.26% 91.06% 91.55% 90.81% 90.87% 91.64% - 90.05%

Supervision (%) n/a

Appraisals (%) n/a

Learning and

candour



Overdue incident actions 0 94 - 94

Duty of candour breaches 0 0 0 0 0 0 0 0 1 0 0 0 1 9.09%

Assurance

Overdue safety alerts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00%

Concerns raised n/a 9 9 9

Quality Plan priorities off track 0 0 0 0 0 - 0.00%

Quality assurance visits n/a 1 0 0 0 2 3 0.6

QUALITY AND SAFETY SURVEILLANCE - Well Led

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