general meeting of the council of governors of … · 2016-10-14 · 5.30-7.30pm, wednesday 19. th....

GENERAL MEETING OF THE COUNCIL OF GOVERNORS OF BARNSLEY HOSPITAL NHS FOUNDATION TRUST

5.30-7.30PM, WEDNESDAY 19th OCTOBER 2016 IN THE EDUCATION CENTRE, BARNSLEY HOSPITAL

AGENDA

1. Apologies & Welcome

2. To invite comments from members of the public

3. To receive any declarations for interest ENC 03

4. To approve Minutes of the General Meeting held on 17th August 2016 ENC 04

5. To consider any matters arising from the Minutes of the last General Meeting

6. To receive a presentation on Assistive Care Technology at BHNFT Presentation – Mr S Judge, Service Lead

7. To receive a report from the Trust’s Chairman, Mr S Wragg ENC 07

8. To receive a report from the Lead Governor, Mr J Unsworth ENC 08

9. To receive an update report from the Trust’s Chief Executive ENC 09 – Ms D Wake, Chief Executive

10. To receive and approve the Nomination Committee’s report on the ENC 10 Annual Review of Terms & Conditions for Non Executives & Chairman

11. To receive latest update report from the Council of Governors’ sub-groups ENC 11 – Mr D Brannan (Chair, Finance & Performance) and Mr T Dobell (Vice-Chair, Quality & Governance)

12. To receive and note reports from the Board of Directors ENC 12 – latest Board agenda and Minutes (meetings held in public) – latest monthly integrated performance report (month 5) – Horizon Scanning report

13. To consider issues raised by Governors – items highlighted in pre-meeting

14. Any other business, including – matters raised by the public – date of the next General Meeting: Wednesday 19th October 2016, 5.30-7.30pm – schedule of meetings 2017 (attached)

15. To resolve that representatives of the press and other members of the public be excluded from this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest in accordance with 8.13.2 and 8.13.3 of the Trust’s Constitution.

Signed: ………………….. Chairman

NB: all General Meetings preceded by informal meeting for Governors only, 4.45-5.20pm

Council of Governors 2017 schedule of meetings

General Meetings (open to public) Training

Sub-group meetings Finance &

Performance Quality &

Governance

25th January 18th January

15th February 8th February

15th March 8th March

19th April 12th April

17th May 10th May

14th June 7th June

19th July 12th July

16th August 9th August

AGPMM date to be advised 20th September 13th September

18th October 11th October

2nd November 9am invitation to Board

meeting 15th November 8th November

20th December 13th December

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COUNCIL OF GOVERNORS – OCTOBER 2016 REF: CG/16/10/04

04

MINUTES OF A GENERAL MEETING OF THE COUNCIL OF GOVERNORS HELD ON 17TH AUGUST 2016, 5.30PM

IN THE EDUCATION CENTRE, BARNSLEY HOSPITAL

Present: Ms K Armitage Public Governor, Barnsley Public Constituency Mr D Brannan Partner Governor, Voluntary Action Barnsley Mrs P Buttling Public Governor, Barnsley Public Constituency Ms G Cockerline Staff Governor, Non Clinical Support Mr A Dobell Public Governor, Barnsley Public Constituency Mr A Grierson Public Governor, Barnsley Public Constituency

Mr B F Leabeater Public Governor, Barnsley Public Constituency Mr C Millington Partner Governor, Barnsley Clinical Commissioning Group

Ms A Moody Public Governor, Barnsley Public Constituency Cllr J Platts Partner Governor, Barnsley MBC Mr R Raychaudhuri Staff Governor, Medical & Dental Mr F Skorrow Public Governor, Barnsley Public Constituency Mr R Slater Public Governor, Barnsley Public Constituency Mr T Smith Public Governor, Barnsley Public Constituency Mr J Unsworth Lead & Public Governor, Barnsley Public Constituency Mr S Wragg Trust Chairman

In attendance: Mr S Clarke Senior Manager, PriceWaterhouse Coopers (PwC)* Ms C Dudley Secretary to the Board & Governors Ms R Moore Non Executive Director

Miss C Wake Membership & Communications Assistant* Ms D Wake Chief Executive Mr M Wright Director of Finance (* left the meeting after presentation of their reports)

Apologies: Mr P Ardron Partner Governor, Sheffield Universities Ms J Bleasdale Co-opted Governor

Mr A Conway Staff Governor, Volunteers Mrs J Gaines Public Governor, Barnsley Public Constituency Mr M Jackson Partner Governor, Joint Trade Unions Committee Mr P Lleshi Partner Governor, Barnsley Together

Mr S Long Public Governor, Barnsley Public Constituency Ms G Morritt Staff Governor, Nursing & Midwifery Mrs J O’Brien Public Governor, Barnsley Public Constituency Mr H Patel Public Governor, Barnsley Public Constituency Mr L Pryor Partner Governor, Barnsley College Mrs C Robb Public Governor, Barnsley Public Constituency Mr L Steenson Public Governor, Public Constituency O (out of area)

CG/16 50 APOLOGIES & WELCOME

The Chairman welcomed Governors and Directors to the meeting. He also welcomed Mr Clark, from the External Auditors (PwC), attending to present the Auditors’ report on the Quality Account, and Ms Chloe Wake, attending her first meeting since joining the Trust. Apologies were noted as above.

Action

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For good order the Chairman also advised that due to recent technical difficulties, the meeting would be taped albeit the tape would be wiped out as soon as the Minutes of the meeting were approved. Governors and attendees consented to the meeting being taped on this occasion.

CG/16 51 COMMENTS FROM THE PUBLIC None.

CG/16 52 REGISTER OF INTERESTS AND (Enc 3) DECLARATIONS OF INTEREST The latest Register of Interests for the Council of Governors was reviewed and noted. Governors were reminded of the need to report any changes for their entry on the Register to the Chairman or Secretary to the Board & Governors, Ms Dudley, as soon as possible at or between meetings. For good order the Chairman and Ms Moore declared their interests in the latest report from the Nominations Committee (agenda item 13a).

CG/16 53 MINUTES OF LAST MEETING (Enc 4)

The Minutes of the General Meeting held on 22nd June 2016 were reviewed and accepted as a true record.

CG/16 54 MATTERS ARISING It was noted that the latest available information on the Yorkshire Ambulance Service was reflected in the Minutes (CG/16 42 refers). With regard to Minute 16/43(a) – Non Executive Directors’ objectives for 2016/17 – the Chairman advised that these were nearly complete and would be confirmed with the Nominations Committee when finalised. All other issues arising from the Minutes were integral to the agenda.

SW

CG/16 55 QUALITY ACCOUNT (Enc 6 & presentation) The Chairman introduced Mr Clark from the external auditors, PwC, who had attended to provide fuller assurance on the 2015/16 Quality Account. The full report had been sent to Governors direct, in addition to the Quality Account and the limited assurance report included in the Trust’s Annual Report & Accounts for 2015/16. In his presentation Mr Clark outlined the audit requirements for quality accounts, in accordance with national guidance from both the Department of Health and NHS Improvements (the latter including the regulator, Monitor) and the key findings for Barnsley Hospital (BHNFT). The audit was intended to verify that a trust’s quality account met national requirements and was consistent against other reporting in year. Trusts were reviewed against three indicators: two selected from a short list of mandatory indicators for review and one selected by the Governors. For 2015/16 BHNFT had been reviewed against two specified indicators: 18 weeks referral to treatment (RTT) and A&E, and, as the Governors’ choice, pressure ulcers. Mr Clark confirmed that no issues of concern had been identified with regard to the general content or consistency of the Trust’s Quality Account and no major concerns identified in relation to the three selected indicators although a clean opinion could not be given against RTT. Mr Clark explained that this

CoG Oct 16: Mins 08 2016/ page 2 of 9

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did not relate to the data per se but to a small number of issues around control points integral to the data collection system. He assured Governors that the Trust had the right processes in place for RTT; the Trust was managing validation well and improving data. The problem related to capturing data post-validation as the year progressed. It was anticipated that this would be reported as a common issue with many trusts and BHNFT had taken steps to redress it for 2016/17. Looking ahead, Mr Clark anticipated that a similar audit process would be operated for 2016/17. Following annual national consultation, updated guidance was expected to be issued in March 2017. Mrs Buttling noted the comments regarding the lack of coding entries for A&E, which could be improved. Ms Wake explained that this mainly arose at peak times when staff, quite rightly, had to give more focus to patients’ needs due to high attendances at the expense of administration until the immediate demand had reduced but she also confirmed that a process was in place to ensure that all patients were validated daily. It did not indicate staff shortages. Ms Wake had recently been on call herself for a week, during which she had attended the Emergency Department on several occasions. At a peak time she had seen 55 patients in the department with 23 staff, which reflected a good patient:staff ratio. She also advised that the national Emergency Care Intensive Support Team had been on site and had not raised any issues of concern regarding A&E; this was reassuring although the Trust was still working hard to drive further improvements. Mr Clarke commented that the Trust’s performance on coding was similar to other trusts he had worked with. Before leaving the meeting, Mr Clarke was thanked for attending the meeting and for providing a comprehensive and informative assurance report for the Governors. The meeting was conscious that it was the last audit to be carried out by PwC as the Trust’s External Auditors and the Chairman extended sincere thanks to Mr Clarke and everyone on the PwC team for their work to date.

CG/16 56 UPDATE REPORT ON MEMBERSHIP (Enc 7) Miss Chloe Wake introduced herself as the new membership lead, having joined the Trust in May. The latest update report outlined the current composition of the Trust’s members and plans to develop membership engagement. The latter would include participating in more Trust, Barnsley Hospital Charity and community events (eg the Hospital’s summer fete and Annual General & Public Members meeting/AGPM and potentially the Penistone and/or Elsecar Shows) and making greater use of social media to promote membership and the benefits of membership. She would also be campaigning for members to provide their email as well as postal addresses, to allow more engagement electronically. The latter would enable the Trust to make better use of the improved membership database system being introduced shortly by CHKS (the current managers of the database). Governors welcomed the approach outlined by Miss Wake and agreed that it would be good to be able to respond to the valued support for the hospital across the community. This continued to be evidenced at the many community meetings the Chairman had been invited to attend recently to receive generous donations for the Tiny Hearts Appeal; he suggested it might be useful to take membership forms along in future as there was a clear wish to engage with the hospital. Additionally Ms Armitage and


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Mr Brannan shared feedback from the Rainbow Dash held at Locke Parke in July, at which 25 new members had signed up to join the Trust. On the day a member of the public had also spoken of his very positive experience at the hospital, which had compared more than favourably with private healthcare received elsewhere. The member had also shared a less favourable comment regarding a meal offered to him during his stay, fuller details on which had been shared with the Chairman and Chief Executive and would be followed up. The increased focus on membership was appreciated and Miss Wake was thanked for a useful update report.

CG/16 57 REVIEW OF CONSTITUTION (Enc 8) The Chairman expanded on the report presented on behalf of the working group, which had undertaken the latest review of the Trust’s Constitution. As well as the Chairman, the working group had included the Lead & Deputy Lead Governors, Mr Brannan, Mr Dobell and Mr Grierson, and had been supported by Ms Dudley. As set out in the report, the main recommendations were (i) to offer a seat on the Council of Governors to each of the Sheffield Universities – Sheffield Hallam University and the University of Sheffield – rather than the single shared seat currently provided, and (ii) to increase the number of elected Public Governors from 16 to 17, by adding an additional seat in the Barnsley Public Constituency, to retain a balanced ratio of public vs other governors. No further proposals for change were mooted and both recommendations were unanimously approved by the Governors present. To complete the review process, the recommendations would be put to the Board of Directors for approval at its next meeting on 1st September 2016.

SW

CG/16 58 SUSTAINABILITY & TRANSFORMATION PLAN (STP) The CEO, Ms Wake, provided an update on the work around the South Yorkshire & Bassetlaw STP. Submissions to date were still at very high level and the partners involved were trying to get more understanding around the financial implications. PwC had been commissioned to undertake some financial analysis of key issues to ascertain the cost/ efficiency impacts. The regional plan should be progressed throughout August, in time for the initial national submission deadlines. Ms Wake reminded the meeting that service plans would also be affected by ongoing reviews by the commissioners, such as stroke services. The proposed changes for stroke recommended only two hyper acute stroke units (HASU) in the region – one at Doncaster & Bassetlaw Hospitals (DBH) and one at Sheffield Teaching Hospital. Other stroke services would continue to be provided at hospitals such as Barnsley. This change would affect a small number of Barnsley stroke patients (say five per annum) but with the expectation that local patients taken to a HASU at DBH or Sheffield would be transferred back to BHNFT within 72 hours if not discharged home. These plans had been reported in the media and given some concerns to local people, several of which were reiterated by the Governors. Mr Skorrow and Mr Smith mentioned cases reported to them independently whereby patients brought into BHFT had received immediate and life saving treatment, which the patients could not praise highly enough. The patients were concerned whether the same fast treatment and good outcomes could


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be expected if patients had to travel further afield in future. The Chairman and Ms Wake emphasised that BHNFT would continue to provide stroke services and that discussions were ongoing to ensure the right pathways were in place and patients were not disadvantaged by the new system. Ms Wake advised that similar changes had been introduced previously for vascular surgery and whilst, understandably there had been concerns at the outset, the improved outcomes for patients had been notable. It was anticipated that the new systems for stroke service would deliver similar benefits. Governors appreciated the assurance provided and several also expressed their support for the growing use of centres of excellence. Ms Wake also reported on current issues within the stroke services at BHNFT, with two consultants leaving the Trust for family reasons (one of whom was expected to return after 12 months). The Executive Team was working hard to resolve this to ensure safe services continued to be provided on site; discussions were ongoing with neighbouring trusts in relation to both the short and longer term arrangements. In terms of other service changes, Mrs Buttling suggested that it would be timely to expand the roles of Allied Health Practitioners and nursing staff. Ms Wake fully agreed and was pleased to report on several changes already being progressed, including the use of stroke nurse specialists. Mr Leabeater also supported this approach, with the benefits from using nurse specialists already evidenced in a number of specialisms, including cancer. With regard to potential changes in other services: • Ms Wake outlined key elements to the commissioner reviews ongoing for

children’s services and anaesthesia and chemotherapy, both of which remained subject to ongoing discussions before going out to public consultation. Public consultation would be required before any of the plans could be finalised and enacted.

• Mr Unsworth reported Governors’ concerns regarding ophthalmology services, which seemed to face growing waiting lists. Governors were aware that, although it was provided at Barnsley Hospital, the service was managed by Rotherham Hospital NHS Foundation Trust (RFT) and it was therefore difficult for BHNFT to influence improvements. Nevertheless, the Trust shared patients’ concerns and had reported the situation to the commissioners, who had recently given notice to RFT that the contract would be going out to tender shortly. BHNFT was considering its options to bid for the contract and deliver its own ophthalmology services on site.

• The STP was also exploring options for urgent and emergency care, the initial thoughts around which were outlined. Ms Wake undertook to provide more information at the next meeting.

• With regard to local A&E provision, Ms Wake advised that there had been a gap in primary care support on site recently. A new contract for out of hours support would be in place from the end of August, with work being taken forward to enhance regular support too, all of which should ensure better provision ahead of the winter pressures.

At a sub-group meeting, Mr Millington had queried arrangements for governance and reporting on the STP. The Chairman advised that acute trust Chairs involved with the STP and the Working Together Programme were working hard to ensure proper checks and balances were put in place. Ms Wake also affirmed that supportive systems would be developed over the next three months and it was clarified that each participating organisation would continue to be managed by its own Board.

DW


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CG/16 59 CHAIRMAN’S REPORT (Enc 10) The Chairman’s report was received and noted. It provided commentary and updates on a range of activities, items of interest and Board reviews since the last General Meeting. Several issues were highlighted in discussion:

• the annual elections for up to 1/3 of the public and staff Governors were due to start shortly. The Chairman urged those whose terms of office would expire at the end of December to consider standing for re-appointment and asked all Governors to encourage others to consider standing too

• the AGPM mentioned earlier by Miss Wake would be held on 6th September. Each Governor was urged to bring a guest to the meeting. It would be followed by a public engagement event and the summer fete

• the appointment of Mr Dobell as Vice Chair of both the Finance & Performance and Quality & Governance Sub-group was noted and endorsed by the Council of Governors

• the continuing support for the Hospital Charity was greatly appreciated. The Chairman and CEO highlighted several recent donations to illustrate the diverse and growing support for the Tiny Hearts Appeal, including £12,500 from the Mayor’s Office and two anonymous donations of £2,000 put into the incubator collection unit at main reception. The fundraising team continued to work hard to promote donations to the Charity’s general funds too. Events would include the Zombie Run in October, for which the organisers would welcome offers of help from the Governors

• continuing concerns around the central computer system. The IT team had led a number of improvements in-house but further improvements remained outside of the Trust’s remit as the system was linked to a national contract. Mr Raychaudhuri enquired about support from the local MPs and the Chairman explained how they would be writing to the providers and raising the Trust’s concerns by other routes as well, which would be helpful.

CG/16 60 LEAD GOVERNOR’S REPORT (Enc 11) Mr Unsworth’s latest report on his activities as Lead Governor and items of interest to the Council was received and noted. On behalf of the Council of Governors he formally recorded a note of congratulations to Mrs Brain England, who had been appointed recently as Chair of DBH. He also emphasised the importance of the AGPM for Governors and members, enabling them formally to receive and raise questions on the Annual Report & Accounts.

CG/16 61 CHIEF EXECUTIVE’S REPORT (Enc 12) Ms Wake expanded on her report, which provided news and updates on a range of operational issues and invited questions and comments from the Governors. She also provided a brief verbal report on the month 4 outcomes (July), with finance in a positive position slightly ahead of plan (albeit still in deficit) and activity also ahead of plan, particularly in Trauma & Orthopaedics and Urology, the latter reflecting investment over the past 12 months to improve services available at Barnsley, enabling patients to receive treatment locally rather than having to travel to Sheffield. There had


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been good performance against key targets despite continued pressures. Compliance against the <4 hour target for A&E was variable: it had been at 95% for the past nine days but lower in the previous two weeks reflecting both demands on the hospital and gaps in primary care. Work continued on the planned bed reconfiguration which would help to match demand, minimise medical outliers and protect surgical beds. With support from the Clinical Commissioning Group (CCG) to help with additional demands on staff January-March, the Trust expected to be well placed to address the winter pressures for 2016/17. Good progress had also continued on quality issues. Ms Wake believed Barnsley was generally seen as a good hospital and she would continue to champion that view. Mr Dobell noted the Chief Executive’s comments regarding primary care and highlighted press reporting on reasons for patients preferring to go directly to A&E and avoid their GPs, one being the approach of reception staff. Mr Millington advised that he had previously carried out his own research, with similar findings in some practices. Since joining the CCG’s Governing Body he had worked with the CCG Chair to drive improvements, which were now being rolled out. The Trust Chairman reported on his own very positive experience of a local GP’s receptionist, who had sorted things out swiftly and effectively. Ms Wake and Mr Millington also reminded the meeting that the option of a walk-in centre had been trialled at Barnsley and subsequently closed as it had not proved efficient although that was not to say it could not be revisited in the future; Ms Wake was conscious that a similar centre at Doncaster was working well and was very cost effective.

CG/16 62 NOMINATIONS COMMITTEE (Encs 13a-b) a) Annual Review of Non Executives’ Terms & Conditions of Service

The Chairman and Ms Moore left the meeting during discussion of this item. As Lead Governor, Mr Unsworth assumed the Chair and presented the Nomination Committee’s recommendations following the annual review of the Terms & Conditions of Services (T&C) for the Non Executive Team, including the Chairman. The review had taken account of benchmarking data provided by the Trust’s HR team, the Trust’s financial position, the general economic situation and demands on the Non Executive Team’s time. In conclusion the Committee had not proposed any changes other than an annual uplift in line with the increase agreed for the latest national NHS Pay Review – ie 1% from 1st April 2016. Mr Millington expressed some disappointment that the Committee had not been more bullish as he believed that the Non Executive Directors (NEDs) at BHNFT were significantly underpaid and suggested that their remuneration should be increased to at least £14,000 (and pro rata for the Chairman). The comparatively low rate of remuneration currently paid was recognised by everyone present. Despite regular review, it remained below average for the sector and no-one would wish the gap to become detrimental to the Trust in terms of not attracting the right candidates for the post. Mr Unsworth pointed out that this had certainly not been the case to date, as evidenced by the strong team currently in situ. Governors agreed that it was essential to strike the right balance and were also conscious of the issue from the perspective of staff, who had faced very limited pay uplifts for several years. For accuracy,


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however, Ms Wake pointed out that many staff on the national pay structure, Agenda for Change, also received a gateway increase each year over and above the national pay review uplift. In conclusion it was agreed that the Nominations Committee should be asked to revisit the review taking account of the meeting’s wish to ensure that members of the Non Executive team were fairly remunerated, that the gap compared with other FT Boards should not be allowed to widen at the risk of the Trust becoming unattractive to high calibre candidates and that a balance was maintained with staff pay reviews. The Trust Chairman and Ms Moore rejoined the meeting and the Chairman resumed the Chair.

b) Non Executive Appointment process The Chairman expanded on the key messages within the report, taking account of the current size of the Board (among the smallest in the region), the growing demands on Board members and the impending departure of Mrs Brain England. Governors were asked to consider two recommendations:

• firstly to support the appointment of a seventh Non Executive Director. Governors were reminded that the appointment of another NED (and an additional Executive Director) had been incorporated into the Trust’s Constitution previously but not yet implemented, and

• secondly to support the extension of Mr Patton’s service agreement by an additional year (to 31st December 2017), to support the newer (and future) NEDs for a further year.

Both recommendations were approved unanimously. Accordingly the current NED appointment process would encompass two posts: the new (seventh) member of the Non Executive post and appointment to the vacancy arising from Mrs Brain England’s move to DBH. Mr Brannan echoed Mr Unsworth’s previous congratulations to Mrs Brain England and also observed that her appointment reflected well on the quality of the NEDs at BHNFT. The Chairman reported that another NED, Ms Dean, had been asked to take on the role as Chair of the Audit Committee to facilitate a smooth handover prior to Mrs Brain England’s departure.

Nom Com’tee

CG/16 63 SUB-GROUP REPORTS (Enc 14) The submitted report provided by Mr Brannan, for FPSG, and Mr Smith, for QGSG, was received. Progress from the sub-groups’ meetings held in July and August respectively were noted and any questions were welcomed at or outside of the meeting. The FPSG had reviewed and proposed some updates to the Governors’ Strategy, which was presented for approval. Mr Millington suggested one further change: the vision should read, “Barnsley Hospital to be the best integrated healthcare organisation for our local community and beyond”. This was agreed and the revised Strategy was approved. Governors were reminded of next meeting dates for FPSG and QGSG, both of which were open to all Governors.


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CG/16 64 BOARD OF DIRECTORS (Enc 15) The agenda (August), Minutes (July) and latest Integrated Performance (IPR) and Horizon Scanning reports presented to the Board of Directors meeting held in public in August 2016, were received and noted. The revised Infection Prevention & Control Strategy 2016-2019 was also presented and noted. With regard to nurse staffing and skill levels, Mr Smith had become aware of salary changes across some 8b-c bandings in several areas and queried if this would have any impact on safety huddles or quality of care. Ms Wake assured the meeting that the changes affected only a small number of staff and would not affect quality or safety standards. The changes, which had been subject to consultation, had been made to ensure consistency in salaries across the board. Risk assessments had been carried out too to ensure that the salaries were equitable and would not be disadvantageous in the event of any future recruitment to the posts involved. Mrs Buttling also referred to the number of nurse staffing vacancies reported as being over appointed. Ms Wake explained that this was marginal and had been intended to take account of any attrition in appointments made in January prior to staff becoming qualified and taking up post in September. Mr Skorrow queried the reported fill rates for nurse staffing, which showed 17 instances where the fill rate had been above 100%. Ms Wake and the Chairman affirmed that this reflected good management, looking at staffing issues, patient needs and appropriate assignment of staff on a daily basis. From the Board Minutes Mr Millington had been pleased to note plans to appoint a Guardian of Safe Working. Ms Wake advised that the first recruitment round had not been successful (the Junior Doctors had not approved any of the applicants) and the post had gone out to re-advertisement, which would hopefully be more successful. The Chairman reminded Governors that the Junior Doctors’ dispute had not yet been resolved although the Trust would be implementing the new contract as required.

CG/16 65 ISSUES RAISED BY GOVERNORS It was confirmed that all issues raised in the Governors’ pre-meeting had been covered in earlier discussions.

CG/16 66 ANY OTHER BUSINESS None.

CG/16 67 CLOSE OF MEETING The date of the next Annual General & Public Members Meeting was confirmed for Tuesday 6th September 2016, starting at 9am. The next General Meeting of the Council of Governors was confirmed for 19th October 2016, 5.30-7.30pm. There being no further business, the meeting closed at 7.45pm.


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COUNCIL OF GOVERNORS – OCTOBER 2016 REF: CG/16/10/07

07

CHAIRMAN’S REPORT

1. INTRODUCTION

1.1 This report is intended to give a brief outline of some of the work and activities undertaken as Trust Chairman since the last General Meeting and highlight a number of items of interest.

2. TRUST POSITION 2.1 Our financial position continues to be an issue that we are addressing, along with

almost every other provider in the NHS, however the early indicators for the first half of the year reflect the improvements we have made. There are caveats as 2016/17 brings more challenges and more pressure from the centre to reduce the overall deficit. We must continue to make real progress with our deficit so we can contribute to the overall NHS savings. Our continued record on patient safety will continue to give confidence to the population of Barnsley and our key stakeholders that care will not be compromised and we will continue to improve our current position. I will keep reiterating this message as I think it should be constantly in people’s minds. Whilst we are bringing about our return to stability, we will not compromise on quality of care and patient safety.

2.2 We must also continue to give confidence to our staff that the Trust is doing everything it can to improve patient experience and the quality of care our patients receive. In addition we continue to pay tribute to all our staff for their valued work and their efforts to conceive new ideas to deliver better care.

2.3 We must also be conscious of the continuing pressures on the hospital, including activity and cost improvement plans. It is essential we keep on track to return to financial balance whilst protecting the quality of our services for our patients and meaningful staff engagement.

3. COUNCIL OF GOVERNORS 3.1 1-to-1 meetings

I am continuing to meet with Governors on a 1:1 basis to discuss their valuable input and development into the role of a Governor. If you have not yet booked in to meet me, I would encourage you to do so before the end of December. If you have already done so, I hope you found it useful as I did and I would be delighted if you would like to book another session in 2017.

3.2 Elections As I write, the annual elections to the Council of Governors are underway. As usual we are seeking election for up to a third of our public and staff seats, which this year includes six governors in our Barnsley Public Constituency and one in our Out of Area Constituency, and two staff Governors: one in Nursing & Midwifery and one in Clinical Support.

CoG June 16: Chairman’s Report (p1)

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3.3 I hope the Governors approaching the end of their current terms of office in December will consider seeking re-appointment. These include Tony Dobell, Joan Gaines, Jacky O’Brien, Luke Steenson and Rachel Hewitt. I do sincerely thank each of you for your contribution to the Council and the Trust so far; I would welcome the opportunity to work with you again next year. It would be remiss of me not to mention Joanne Bleasdale whose term as co-opted Governor also ends in December. I greatly appreciated her stepping up into that role to ensure that we retained valuable staff input to the Council whilst Rachel Hewitt was on maternity leave. Joanne will also be eligible to apply for the seat as staff governor for Clinical Support.

3.4 There are two names not listed in 3.3 – our Lead Governor, Joe Unsworth, and public Governor Bruce Leabeater, both of whom have already advised that they will not be seeking re-election. They will be a great loss to the Trust but I know they will leave with thanks and best wishes from their fellow Governors, everyone on the Board of Directors and the many members and staff they have supported whilst serving on the Council of Governors. I am sure we will have opportunity to repeat these sentiments many times before they leave us.

3.5 I would ask all Governors to take every opportunity to talk to their friends, neighbours and colleagues to encourage them to consider seeking election too. From your own experience as Governors, you know better than anyone how important a role it is, what it brings to the hospital and what you have gained from it too.

3.6 There is a final drop-in election workshop scheduled for 25th October, 5.30pm in the Education Centre. This is open to anyone who would like to learn more about the role of a Governor before submitting their nomination form.

3.7 Don’t forget - closing date for nominations is 31st October 2016. 3.8 Lead Governor

With Joe leaving the Council at the end of December, the role of Lead Governor will become vacant. It is not an easy role; it carries considerable responsibility and is often quite demanding but I am sure Joe would say that it is also very worthwhile. The Deputy Lead Governor role is also due for appointment/re-appointment; this is currently held by Trevor Smith.

3.9 Both Joe and Trevor have done a great job in their respective roles, for which I do thank them both very much.

3.10 If Trevor does seek re-appointment as Deputy Lead Governor, the agreed appointment process (copy attached) allows me to recommend a further 12 months term of office for him and I would have no hesitation in doing so. As a public governor, however, he is also eligible to apply for the role of Lead Governor.

3.11 I would therefore like to invite expressions of interest from all public governors for the role of Lead Governor and/or Deputy Lead Governor. Applications should be with me by 5pm on 9th December please. This is the day after the election results are due to be announced for the Council of Governors, so if you are seeking re-election that will not preclude you applying for either of these roles.

3.12 As stated in appendix 1, your expression of interest should be submitted in writing (or by email), with a supporting statement of no more than 200 words. Applications can be sent to me direct or via Carol Dudley, Secretary to the Board & Governors.

3.13 Nominations Committee When Bruce steps down from the Council, this will also create a vacancy for a public governor on the Nominations Committee. Governors will be aware that this is a very important Committee, responsible for the appointment of our Non Executive Directors, annual review of their terms and conditions and continuing oversight of their performance (including my own).

CoG Oct 16: Chairman’s Report (p2)

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3.14 Expressions of interest for the arising vacancy are also invited to be with me by 5pm on 9th December.

3.15 All of the above submissions – for Lead Governor, Deputy Lead Governor and Public Governor on the Nominations Committee – will be finalised at the next General Meeting, on 14th December.

3.16 Training September saw the last planned session of the 2016 training programme sessions for Governors; November’s session will include either the Annual Development meeting or an additional training element.

3.17 From the feedback I have received it is evident that the first year of this in-house training programme – developed by Governors, for Governors – has focussed on key issues to help Governors deliver their roles and has worked well. The programme for 2017 will be established at the next Annual Development Session.

3.18 I am sure those of you who have been involved will endorse my thanks to Ms Kerry Gillott, Learning & OD Manager. Kerry was instrumental in setting up and running the programme and will help to deliver the new programme for 2017.

4. NEWS & EVENTS

4.1 Shortly after the last General Meeting, on 17th August I attended a meeting of the Sparkles community group, who passed on a donation of £301 to the Tiny Hearts appeal.

4.2 On 31st August I attended Denise Gibson’s retirement lunch, and made a presentation to her on behalf of the Trust in recognition of the work she had led around infection prevention and control.

4.3 On 5th September I attended the monthly Working Together meeting with the CEO, where the latest issues around both the Working Together programme and the STP were discussed. A key issue at this stage is the governance of the STP as there is no guidance from the centre, therefore governance has to be developed locally. From my perspective the practicality of delivery of the STP will be a major issue going forward.

4.4 Our Annual General and Public Members Meeting (AGPM) took place on 6 September, where the Trust’s annual report and accounts were formally presented to Governors. The meeting was well attended and a number of questions were put to the Board around potential reconfiguration of services. These were answered openly and an offer was made to meet with those who were interested in the future of services at the Trust.

4.5 As reported at the AGPM, service proposals for Children’s surgery with anaesthesia and hyper acute stroke services are now out to consultation, issued by the Working Together Commissioners. The Board’s views on these proposals have been fed back and Governors will already be aware of these from the Board’s discussions and in your sub-groups but I would be pleased to reiterate them at the General Meeting. Agenda item 12 in your packs includes several papers from the Board of Directors’ latest meeting; I have added the report on the consultation to these. It includes a link to further information if you want to know more about the proposals and what they could mean for Barnsley.

4.6 On 7th September the Council of Governors’ Finance and Performance sub-group met, which I was not able to attend due to other commitments. However it was attended by three Non-Executive Directors and our Director of Finance to talk Governors through our financial position.

4.7 Following the Council of Governors’ decision in August to appoint a seventh Non Executive Director, interviews were held on 29th September, recommendations from


Page pg 14

which are presented separately. This has also enabled the Trust’s Remuneration & Terms of Service Committee to support the request to appoint another Executive Director to the Board and bring the Executive Directors’ Team to a total of six, including the CEO. I am pleased to advise that Mr Bob Kirton has been appointed to the new executive post. Bob is well known to Governors and I am sure you will agree that he will be a strong addition, bringing his proven strengths and skills to the Board. His appointment is also recognition of his tremendous work to date.

4.8 On 15th September I was pleased to receive a cheque from Marks and Spencers from £4,500 raised in aid of the Tiny Hearts Appeal.

4.9 On 16th September I attended the Healthcare Assistants’ conference to open their meeting for the day and take questions on the performance of the Trust.

4.10 The AGM of our Clinical Commissioning Group took place on 22nd September and I attended on behalf of the Trust.

4.11 On 27th September I was delighted to be one of the team of staff who attended Sandhill Primary School to talk to children about working in the NHS, help them learn a little more about the hospital and take some searching questions. All of the children reported that they were pleased with the hospital when they have had to use our services.

5. BARNSLEY HOSPITAL CHARITY 5.1 The generosity of local people and the support for our Charity continues to grow. The

work done by the charity team is spreading our message throughout the borough and this has resulted in continued increase in donations to the Charity, which allows it to continue to deliver its aims. These are the latest figures for this financial year up to the latest balance at the time of writing.

5.2 Donations £101,849.30 Legacies - Other Income - Tiny Hearts £225,169.64

6. BOARD OF DIRECTORS

6.1 Last, but by no means least, on behalf of the Board of Directors I am pleased to remind you of the annual invitation to the Council of Governors to join our meeting on 3rd November, commencing at 9am. As usual this will enable Governors to participate in the full Board meeting (held in public and private) rather than attend as observers.

7. RECOMMENDATIONS The Governors are asked to: a) receive and note this report b) encourage support for this year’s elections to the Council of Governors c) endorse my sincere thanks to Mr Unsworth and Mr Leabeater for their work on the

Council of Governors d) note the date of the November Board meeting.

Stephen Wragg CHAIRMAN October 2016


Page pg 15

LEAD GOVERNOR – OUTLINE OF ROLE AND PROCESS OF APPOINTMENT

1. OVERVIEW

The Lead Governor for Barnsley Hospital NHS Foundation Trust (“the Trust”) shall be a public Governor, appointed by the Chairman and Council of Governors to act as a lead or spokesperson on behalf of all Governors. The role of the Lead Governor is intended to be an additional resource to all members of the Council of Governors. Governors may raise any questions, suggestions or concerns via the Lead Governor at any time. The Lead Governor may call upon the support of the other Governors, the Chairman and the Secretary to the Board & Governors to carry out this role effectively to the benefit of the Council of Governors. The role of Lead Governor shall not obviate the rights or responsibilities of any other Governor, either individually or collectively.

2. ROLES AND RESPONSIBILITIES Amongst any other duties or responsibilities that may arise on an ad hoc basis, the Lead Governor shall: 2.a act as spokesperson on behalf of the Council of Governors or individual

Governors and make appropriate representations to the Chairman and/or Board of Director and any internal or external groups as may be required from time to time. This does not override the Trust’s protocols on external statements or responses (eg to the media or patients etc), which shall still require express permission in advance;

2.b in the event of the absence of the Trust’s Chairman and the Deputy Chair, be the first person among the Governors to be invited to Chair a formally convened meeting of the Council of Governors, including any general or committee meetings. In their absence, the Council of Governors retains the option to invite another Governor to so serve, as set out in the Trust’s Constitution;

2.c in liaison with the Chairman, ensure that all of the statutory roles and responsibilities of the Council of Governors are carried out effectively;

2.d serve as one of the three public Governors on the Nominations Committee; 2.e liaise with the sub-group Chairs regularly and attend at least two meetings of each

sub-group per annum; 2.f liaise with Governors representing the wider Council of Governors on any other

groups throughout the Trust; 2.g in liaison with the Chairman, support the development of the skills and strength of

the Council of Governors and raise public awareness of all Governors.

Lead Gov TOR (p1) Page pg 16

3. PROCESS OF APPOINTMENT 3.a As and when a vacancy for the role of Lead Governor arises, the Chairman of the

Trust will invite expressions of interest from all public Governors. Applications must be submitted to the Chairman in writing, with a supporting statement of not more than 200 words.

3.b If only one suitable application is received, the Chairman shall present a recommendation at the next general meeting to be ratified by the Council of Governors.

3.c If more than one suitable application is received, the appointment will be determined by a majority vote of the Council of Governors present and voting at a General Meeting. This shall be conducted by ballot or show of hands, with public, staff and partner Governors (including the applicants) having one vote each; the Chairman shall have a casting vote if required. The vote shall be co-ordinated by the Secretary to the Board & Governors, under the scrutiny of the Chairman.

3.d When a vote is held, the supporting statements provided by the candidates shall be shared with the wider Council of Governors.

3.e To support the Lead Governor and succession planning, the Trust shall have a Deputy Lead Governor, appointed on the same basis as the Lead Governor (per 3.a above).

4. TERM OF OFFICE 4.a The appointment shall be for an initial period of twelve months.

4.b At each anniversary of appointment, the term of office may be extended for up to a further 12 months if so recommended by the Chairman and supported by a majority vote of Governors present at the general meeting. Any such further appointment shall be subject to:

• satisfactory performance appraisal (led by the Chairman of the Trust),

• the recommendation of the Chairman of the Trust, and

• the support by a majority vote of Governors present at a general meeting of the Council of Governors.

4.c The Lead Governor or Deputy Lead Governor may step down from this role at any time by mutual agreement with the Chairman.

4.d To support succession planning and ensure that the responsibilities of the Council of Governors are shared as equitably as possible, other eligible Governors are welcome to submit an expression of interest to the Chairman at any time.

Lead Gov:TOR (p2) Last reviewed and agreed: June 2016 Next review due: June 2017

Page pg 17

LEAD GOVERNOR’S REPORT

1. INTRODUCTION

First an apology for missing this Council of Governors (CoG) meeting. I have missed very few governor meetings over the past twelve years, but my wife and I are taking a long-planned October holiday this year to celebrate our wedding anniversary.

2. COUNCIL OF GOVERNORS’ PRE-MEETING

The informal governors pre-meeting which we now hold just before each General Meeting has proved useful and popular, so in my absence, and in the absence of my deputy, we need another governor to chair the October pre-meeting. This needed to be arranged in advance, so I asked Tony Dobell, who is vice-Chair of the sub-groups if he would do this, and he agreed.

3. REPORT ON TERMS AND CONDITIONS OF NON-EXECUTIVE DIRECTORS

3.1 You will recall that the August CoG meeting asked the Nominations Committee to re-consider the Nomination Committee’s recommendations on the remuneration of the Non-Executive Directors (NEDs), which were presented at that meeting.

3.2 The Nominations Committee has produced revised recommendations which are on the October CoG agenda. I will not be there to present the report, so another governor from the Nominations Committee is needed to do this.

3.3 Given that the deputy Lead Governor, who is also a member of the Nominations Committee, will also miss the CoG meeting, I asked David Brannan if he would introduce the report, and the other governors on the Nominations Committee are happy with that. David is, along with me, the longest serving member of the Nominations Committee.

3.4 Clearly the Chairman of the Trust, or any of the other Non-Executive Directors, cannot be present when the Council of Governors discuss and decide their remuneration. Our constitution states that in those circumstances the meeting should choose a public governor to chair that agenda item, normally the Lead Governor. In the absence of myself and my deputy the October CoG meeting will need to choose a public governor to take the chair for the report on the NEDs remuneration.

3.5 It would not be right for me to decide in advance which public governor should take the chair for that item of business. This is a decision for the governors present at the meeting. Public governors who intend to attend the October CoG should give some thought at whether they would be prepared to do this, so we have some volunteers ready on that evening.

COUNCIL OF GOVERNORS – OCTOBER 2016

REF: CG/16/10/08

08

CoG Oct 2016 / Lead Gov (p1 of 2) Page pg 18

4. REPRESENTATIVE ROLE OF FOUNDATION TRUST GOVERNORS

4.1 One of our roles is to represent the interests of our members and the wider community. In this regard I am particularly concerned about the direction of the NHS nationally and the effect on healthcare in Barnsley. Most Trusts are in financial deficit; after years of underfunding there is clearly not enough money in the system. This is the background to the Sustainability and Transformation Plans (STPs).

4.2 NHS England has divided England into 44 “footprints” each with an STP involving the healthcare organisations in that footprint. As you will be aware, we are in the South Yorkshire and Bassetlaw footprint. The overall STP programme is a saving of £22billion of NHS spending over 5 years by reconfiguration of NHS services. It is simple arithmetic to divide £22 billion by 44 to give an average saving of half a billion pounds per footprint.

4.3 There is widespread concern that savings of this magnitude can only be realised by significant cuts and/or closures. The suspicion is heightened by the fact that there is no statutory basis for the STPs, which, operating in secret, have not been subject to any sort public scrutiny, and have received scant media attention.

4.4 We are promised announcements later this month and I am concerned about what may be announced. I am sure the Chairman, Chief Executive, and the entire Board are doing their very best for the hospital and the healthcare needs of the people of Barnsley. The problem lies with the STP programme imposed by NHS England. As governors we are free to comment on the system and discharge our responsibility to the communities we represent. I have lobbied my MP and I urge you to do the same.

5. RECOMMENDATION

The Council of Governors is recommended to receive this report

J Unsworth LEAD GOVERNOR October 2016

CoG Oct 2016 / Lead Gov (p2 of 2) Page pg 19


REF: CG/16/10/09

09

CHIEF EXECUTIVE’S REPORT

1. INTRODUCTION 1.1 This report is intended to give a brief outline of some of the key activities undertaken

as Chief Executive since the last report and highlight a number of items of interest. 1.2 The items below are not reported in any order of priority.

2. TEST SITE FOR ASSOCIATE NURSE PILOT 2.1 The Trust has submitted an application to the University of Sheffield to become a test

site for the Associate Nurse Pilot. The outcome will be announced in October 2016.

3. BARNSLEY ACCOUNTABLE CARE PARTNERSHIP BOARD 3.1 During August and September, the Chairman and I attended the latest Barnsley

Accountable Care Partnership Board meetings. The agendas included for information purposes details of the Legal Report and Project Management Office Progress Report.

4. DIVERSITY CONFERENCE 4.1 The Learning and Development Department is running a one day Diversity on Friday

28th October 2016 at 08:30 until 14:00hrs. The conference is open to all members of staff at any level, including students. The conference will take place in the Education Centre and the day will include stalls from local stakeholders such as Jehovah’s Witnesses, Deaf Forum and Learning Disabilities. The day will also include guest speakers.

5. SUSTAINABLE TRANSFORMATION PROGRAMME (STP) MEETINGS 5.1 Work on the STP continues, with a number of meetings held throughout August and

September, including the STP Finance Committee, the STP Executive Steering Group and the STP Finance Oversight Committee

5.2 Outcomes from these meetings will feed into the STP plans for our region. I will ensure that our Board members and Governors are kept informed of progress and, of course, present the final plans for Board approval as soon as they are available

5.3 I will provide a verbal update at the General Meeting.

6. D1 QUALITY MEETING 18TH AUGUST 2016 6.1 A constructive meeting with the Clinical Commissioning Group and NHS England

agreed a number of changes to the D1 process that should improve the accuracy of medicines information. The current letter template has been revised to mirror the approach taken in another local trust and the team is currently looking at it further following receipt of feedback from the CCG. A later audit will be undertaken to assess the impact on quality.

Page pg 20

7. UPDATE ON STROKE SERVICES 7.1 As a result of both of our substantive Stroke Consultants leaving the Trust, an

immediate plan has been mobilised to maintain safe and effective Stroke services moving forward until substantive recruitment is completed:

• locum cover will be provided from early September with the support and supervision of Dr Orme

• one of our current substantive Stroke Consultants will be with us until the end of September to support handover

• Doncaster and Bassetlaw Hospitals NHSFT will support our two slots on the regional hyper-acute Stroke rota

• stroke patients suitable for thrombolysis will be taken to Sheffield, Doncaster or Mid Yorkshire depending on their location.

8. BED RECONFIGURATION 8.1 The Executive Team has approved detailed plans to proceed with the proposed

hospital bed reconfiguration. This programme of work sets out to deliver three main objectives:

• to improve clinical efficiency by physically aligning the most appropriate clinical services to one another

• to reduce the impact of seasonal pressures which increase demand for non-elective capacity over our elective workloads

• to reduce the impact of unnecessary lengthy journeys for patient and staff in transferring patients throughout their clinical pathways.

8.2 The programme of work commenced in late August 2016 and is scheduled for completion in December 2016, in time to reinforce on winter plans.

9. A&E IMPROVEMENT PROGRAMME 9.1 The A&E agenda continues to be a challenge. The Trust saw delivery of the 95%

standard in Q1 but just under in Q2 at 93.76% (within the Sustainability & Transformation Funding permitted tolerance). A number of key workstreams continue to be progressed delivering improvement in the following areas:

• Middle-grade rotas fully staffed from mid August

• ED Consultant returning from maternity leave in October 2016

• additional Emergency Nurse Practitioners cover to support primary care streams in the evenings and out of hours

• new primary care stream provider now online to support evening and weekend volumes

10. MEETING WITH THE CHIEF EXECUTIVE OF BARNSLEY HOSPICE 10.1 I met with Julie Ferry, the new Chief Executive of Barnsley Hospice in August.

Regular meetings will be scheduled in the diaries to strengthen partnership working between the two organisations.

11. OPERATIONAL DELIVERY NETWORK (ODN) PROGRAMME BOARD MEETING WITH NHS ENGLAND 11.1 I attended the ODN Programme Board meeting in August at Sheffield Children’s

Hospital. The ODNs’ Programme Board meets quarterly, with one agenda, split into

CoG Oct 16: CEO (p2)

Page pg 21

three key sections: Major Trauma, Adult Critical Care and Burns with time slots allocated to each. I Chair of the Northern Care Burns ODN.

11.2 The Northern Burns Care ODN, with the exception of Sheffield Teaching and Sheffield Children’s, has a different geographical foot print to other ODNs, covering the whole of North of England, North Wales and Isle of Man.

12. EXECUTIVE TO EXECUTIVE MEETING WITH MID YORKSHIRE HOSPITALS (Mid Yorks) – 7 SEPTEMBER 2016 12.1 These meetings continue to be a useful forum to share news and develop closer

working across a range of services to mutual benefit. 12.2 Areas explored this month included radiology (with the development of our radiology

services, we could offer more support to Mid Yorks), and potential opportunities for more collaborative working in cardiology and gastroenterology.

12.3 The Executive Team will continue to meet with their counterparts at Mid Yorks and Board to Board meetings are also scheduled on a quarterly basis.

13. PLANNING GUIDANCE 13.1 The latest national guidance was received in the post w/c 19th September. The

Executive Team are working through the implications of this. A detailed timeline of delivery has been reviewed by the Board. As usual Governors will be kept involved with our plans prior to submission.

14. SINGLE OVERSIGHT FRAMEWORK (SOF) 14.1 The SOF was published by NHS Improvements (NHSI) in September, with the

intention of bringing oversight of Foundation Trusts and other NHS providers into closer alignment, replacing Monitor’s Risk Assessment Framework and the Trust Development Authority’s Accountability Framework. It will apply equally to FTs and non FTs.

14.2 Under the SOF, NHSI intends to support all NHS providers to achieve ‘Good’ or ‘Outstanding’ assessment ratings from the Care Quality Commission (CQC). The Framework will not give performance ratings itself but providers will be assigned into segmentation according to the level of support each provider needs – from 1 (no issues of concern, maximum autonomy) to 4 (major/complex concerns, mandatory and targeted support).

14.3 The SOF is based on five themes: 14.3.1 Quality of care (safe, effective, caring, responsive) – aligned to CQC

assessments as well as each organisation’s in year reporting on quality (including the four priority standards for 7-day hospital services)

14.3.2 Finance and use of resources – overseeing a provider’s financial efficiency and progress in meeting its financial control total

14.3.3 Operational performance – the NHSI aims to support providers performance against NHS Constitution standards and key national targets

14.3.4 Strategic change – overview of providers’ delivery against the Five Year Forward View, the STP and new care models.

14.3.5 Leadership and improvement capability (well led) – building on the joint CQC and NHSI well-led framework.

14.4 Wherever possible, data will be obtained from existing sources (internal and external); it is not intended for the SOF to add to the demands for reports from providers.

14.5 With the SOF released in October 2016, month 6 will be the first period reported under the new system, with some elements to be rolled out later in the year as the Framework develops.


Page pg 22

14.6 Copies of the SOF are available on the NHSI website or on request from the Secretary to the Board & Governors.

14.7 I had a useful telephone conference with NHSI on 3rd October 2016 to discuss this and the implications for our Trust. The new Director for our region is due to visit Barnsley on later this month and I welcome this opportunity to show him the Trust’s continuing good work.

15. WORKING TOGETHER PROGRAMME (WTP) – CEO/CHAIRS MEETING 15.1 The latest meeting of the WTP was held on 3rd October. The Trust remains committed

to the work of the WTP alongside developments being driven by the Sustainability & Transformation Programme, which were also discussed at the meeting.

15.2 The proposals from the Commissioner Collaboration for Children’s Surgery and Anaesthesia and Hyper Acute Stroke Services were reviewed, and the engagement and public consultation plans supporting them. Findings from the Chemotherapy Review were also discussed. As part of the public consultation commencing this month, the papers were presented separately on the Board’s agenda and the Chairman has also included an overview under agenda item 12 for ease of reference.

15.3 Governance arrangements were updated, emphasising the continuing independence of each Trust Board and responsibility – and accountability – to their patients, members and staff.

15.4 Opportunities for closer working and shared benefits for WTP member Trusts continue to be explored, in both front line and back office service.

16. ANNUAL GENERAL & PUBLIC MEMBERS MEETING (AGPM) 16.1 On 6 September, the Trust held a day of events showcasing the excellent work we

do. The Annual General and Public Members meeting enabled members of the Trust, staff and members of the public to review the Trust’s achievements over the past year, helping people to understand how the Trust has performed, overcome challenges and delivered against its objectives for 2015/16. Following this, the Trust held its first public Join the Conversation session, inviting members of the public to have their say on how services are delivered and the Trust’s performance in general.

16.2 The day of events ended with the first Summer Fete at the hospital, attended by local businesses and Trust departments and staff. The event raised over £500 for Barnsley Hospital Charity.

17. TALENT MANAGEMENT PROGRAMME LAUNCH 17.1 On 7th September I attended the Trust’s launch event for two new Talent

Management Programmes. The aim of the programmes is to develop current and potential leaders within the organisation and to equip them with the skills required to support the Trust to achieve its Strategic Objectives.

17.2 The launch event offered an opportunity for the students on the programmes to introduce themselves to their mentors.

17.3 There are currently 18 students on the Aspiring programme, which is aimed at staff who are both clinical and non clinical working at bands 4-6. The Ascending programme is supporting staff working at band 7 and above.

17.4 The programmes run for 12 and 18 months respectively and require candidates to undertake both practical leadership tasks, such as shadowing and coaching, as well as engaging in formal leadership training. Students are all being mentored by senior leaders within the organisation, these mentors include members of the Executive Team and others in leadership roles. The programmes have been developed and will


Page pg 23

be delivered in house using the current talented leaders within the organisation to support its infrastructure.

18. EMPOWERING PATIENTS AND COMMUNITIES 18.1 This event was co-hosted by innovation and education networks across the NHS. It

highlighted the need to support self-management of health & wellbeing at individual and community level as we move forward with the STP.

18.2 It was an interesting event and certainly gave focus to an aspect that can be all too easily overlooked in our haste to support progress in the NHS: management of our own health and well being as well as that of our patients.

Diane Wake CHIEF EXECUTIVE October 2016


Page pg 24


REF: CG/16/10/10

10

REPORT OF THE NOMINATIONS COMMITTEE

- ANNUAL REVIEW OF THE TERMS AND CONDITIONS OF SERVICE FOR THE NON-EXECUTIVE DIRECTORS AND CHAIRMAN

1. INTRODUCTION 1.1. At the last General Meeting, the Nominations Committee recommended a

remuneration uplift for the Non Executive Directors and the Chairman of 1% - the Non Executive team - in line with the national pay review.

1.2. The Council of Governors was conscious that the remuneration for the Non Executive team remained an outlier compared to other Foundation Trusts (FTs) and requested that the Committee revisit the review.

1.3. The Council did not ask the Committee to revisit its recommendation of ‘no change’ for any other aspects of the team’s Terms and Conditions of Service

2. REVIEW 2.1. As reported in August, the Chairman and Non-Executive Directors’ current rates of

remuneration are:

• Non-Executive Directors £12,120 pa • Chairman £40,400 pa

2.2. The recommended uplift of 1% would have adjusted these rates to:

• Non-Executive Directors £12,241 pa • Chairman £40,804 pa

2.3. At the time of the first review, and in accordance with national guidance, the Committee had taken account of market forces, the Trust’s continuing deficit financial position, the demands on the Non Executive team and the constraints on uplifts over recent years for staff on the national Agenda for Change pay structure. The Committee was conscious that the proposed uplift would still leave the Non Executive team below the median rates for FTs and intended to address the gap when practicable. Equally, Committee members acknowledged that the extant rates had not adversely impacted on the Trust’s ability to recruit high calibre people to the Board to date, as evidenced by the strong team currently in place.

2.4. At the last General Meeting, several Governors expressed concerns that members of Non Executive team continued to be significantly under remunerated for their tremendous work. This was certainly not a view disputed by the Committee. A higher uplift would reflect the team’s hard work and value to the hospital but that could be said of many of the Trust’s staff too and it was important to strike the right balance. At the time of revisiting the review, the Committee was also aware of the strong response to the latest recruitment drive for two new members to the Non Executive team - with 39 applications received.

2.5. The Committee requested further information from the HR team, who reissued the national data issued by Capita in 2015 and obtained more information on NED remuneration rates from the latest Annual Reports issued by peer Foundation Trusts

Page pg 25

(FTs) in the region. It was highlighted that the Capita data reported 2014 rates and showed a lower quartile median of £12,500 for NEDs and £42,500 for Chairs. Regional FT figures were obtained from 2015/16 reports and reflected a minimum average of £12,500 for NEDs and a mid-point of £50,000 for Chairs.

2.6. The Committee had three main options: i) to reiterate its initial recommendation – but acknowledged the growing need to

bring the rates more into line with market forces before the gap did impact adversely on the calibre of candidates attracted to the Trust

ii) to consider significantly higher rates as proposed by several Governors – this would undoubtedly reflect the worth of the team but, in the Committee’s opinion, would not be acceptable in the current local, regional and national economic climate, and

iii) to recommend a slightly higher uplift, to bring the team closer to national and regional comparators albeit still in the lower quartiles.

3. CONCLUSIONS AND RECOMMENDATION 3.1 The Council of Governors is asked to approve the recommendations with effect

from 1st April 2016: a) that the NEDs’ remuneration be increased to £12,500 pa, bringing it into line

with the national lower quartile median and the lower average regional levels for FTs, and

b) that the Chairman’s remuneration be increased to £41,625 pa, to maintain the agreed ratio for the NEDs:Chairman’s rates,

3.2 These rates will still be below the national and regional FT averages for both NEDs and Chairs (and below the lower quartile for Chairs) but the Committee did not believe a larger uplift should be considered at this time.

Joe Unsworth LEAD GOVERNOR For and on behalf of the Nominations Committee, October 2106

CoG Oct 2016: 10_NomCom T&C review

Page pg 26


REF: CG/16/10/11

11

STRATEGIC SUB-GROUPS

1 INTRODUCTION

1.1 This report provides an update on the work and discussions of the Council of Governors’ Finance & Performance sub-group (FPSG) and Quality & Governance sub-group (QGSG) meetings held in September and October respectively.

2 SUB-GROUP LEADERSHIP & MEMBERSHIP 2.1 David Brannan (for FPSG) and Tony Dobell (for QGSG) chaired the meetings. 2.2 Membership of the sub-groups remains informal. Governors are welcome to attend

the sub-group meetings regularly or on an ad hoc basis if preferred. If any Governor wishes to raise an item through either of the sub-groups, the Chairs would be pleased to hear from you ahead of the next meeting’s agenda setting.

3 WORK OF THE SUB-GROUPS 3.1 One of the primary objectives of the sub-groups is to support the Governors’ role of

holding the Non Executive Directors (NEDs) – and through them, the Board – to account for the Trust’s performance. As part of this, the sub-groups continue to review progress against the strategic aims and objectives underpinning the Trust’s business plan.

3.2 The sub-group meetings also provide a valuable opportunity for Governors to share feedback from their constituencies (public, partners and staff) and members.

3.3 Minutes from the sub-groups are shared with all Governors by email. Printed copies are available to Governors on request and key points from each meeting are reported at General Meetings (see below).

4 REPORT ON SUB-GROUP MEETINGS Finance & Performance Sub-Group (FPSG) 4.1 The latest FPSG meeting was held on 7th September. The meeting was well

attended by Governors and the Board members. The latter included three Non Executive Directors - Mrs Suzy Brain England, Ms Janet Dean and Mr Nick Mapstone – and Mr Michael Wright, Director of Finance.

4.2 In addition to its regular review of the latest workforce and performance data from the Integrated Performance Report (IPR) and the Finance & Performance Committee (F&P) Chair’s Log, the sub-group also received an update on the Trust’s financial performance for the year, the 2015/16 annual reports from the Audit and Finance & Performance Committee and the quarter 1 return to NHS Improvements. It also began looking ahead at the next Annual Development Session and agreed the draft 2017 schedule of meetings for Governors.

CoG Apr 16: 11_Sub-groups report

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4.3 In his year to date report on finance, Mr Wright reminded Governors of the closing position for 2015/16 and the Trust’s challenging Control Target for 2016/17, which had been contributory factors to the budget planning for 2016/17. As at month 4 the Trust was £227,000 favourable to plan (albeit a deficit plan). This reflected tight financial controls, close management of cash, continuing good oversight on agency spend and strong activity performance generally albeit with continuing pressures on demand. Undeniably there was still a lot of work and many challenges (locally and nationally) ahead but the Trust was currently on track to achieve year end targets. The impact of the Carter Review was highlighted as an important factor and more information on this would be presented at the next FPSG meeting.

4.4 The 2015/16 annual report from the Finance & Performance Committee illustrated the Committee’s detailed scrutiny of financial matters and operational performance in order to provide assurance and raise concerns, as appropriate, to the Board of Directors. Mr Patton, Chair of F&P, was pleased to highlight the Committee’s continuing development and strong delivery against its key objectives, reports on which were shared with FPSG regularly as well as the Board of Directors.

4.5 Similarly the Audit Committee’s annual report outlined its work over the last year and plans for 2016/17. The Committee had a challenging role to ensure that the right controls were in place to deliver good governance across the Trust. Its work was supported by external and internal audit expertise. Year on year progress and effectiveness of the systems in place had been evidenced by the year end audit outcomes and the Head of Internal Audit’s Opinion, which had given “Significant Assurance” for 2015/16 compared to “Limited Assurance” in 2014/15.

4.6 Looking at 2016/17, the meeting was reminded that, following a robust tender process, the Council of Governors had appointed Grant Thornton as the Trust’s new external auditors.

4.7 Members were also advised of changes to the Committee, with Ms Dean taking on the role of Chair from October in advance of Mrs Brain England’s move to Doncaster & Bassetlaw Hospitals. The Committee continued to be observed by Mr Dobell, as the Audit Liaison Governor, and he had no hesitation in affirming his confidence in the Committee’s performance.

4.8 Review of operational outcomes via the Chair’s Log and the IPR reinforced Mr Wright’s comments on the Trust’s financial position to date. It also highlighted progress of the cost improvement programme (on track for the year end but challenging and subject to continued close monitoring). Reporting on activity showed continued improvements in harm from falls, did not attends (DNAs), the <4 hours emergency pathway target (although still facing high demands), complaint response times and key diagnostics. Work was continuing to drive further improvements in some cancer pathways and around elective orthopaedics. Data on staffing was encouraging with sickness absence rates still among the best in the region. Support for staff continued to be reinforced through the Workforce Strategy, which had been refreshed and was approved by the Committee.

Quality & Governance Sub-group (QGSG) 4.9 The latest QGSG meeting took place on 12th October. Ms Moore, Non Executive

Director and Chair of the Board’s Q&G meeting joined the meeting, as did Ms Feerick (Head of Quality & Governance) and Ms Pell (Head of Patient Experience). The meeting was chaired by Mr Tony Dobell in the absence of the Sub-group Chair, Mr Trevor Smith.

4.10 Ms Pell presented the Quarter 1 “Learning from Experience” (LFE) report. It was explained that the Clinical Business Units (CBUs) received statistical reports on all complaints/concerns/compliments each month. The LFE was a narrative report

CoG Oct 2016: sub-group report (2)

Page pg 28

intended to give a more qualitative overview and give greater triangulation of patient feedback received across the Trust from various routes, including but not limited to Friends & Family Tests (FFT), informal contacts through the Patient Advice and Liaison Service, feedback from the Quality & Safety visits, ward reports and feedback posted on national websites. The LFE was subject to close scrutiny at the Patient Experience Group (PEG) and Q&G Committee, both of whom looked at the trends and noted the learning required and actions taken to drive further improvements in the quality and safety of services for patients. Governors appreciated the overview and the report’s comprehensive approach but also requested more information on the trends and improvements over the past three years. This should be available for the next meeting.

4.11 Ms Feerick provided feedback from the Quality & Safety visits for the first half of 2016/17. To date 19 visits had been completed under the new system, which Governors had helped to redesign. It was intended to visit all clinical areas at least once each year and to carry out the visits in line with the Care Quality Commission approach, talking to staff and patients about a range of issues – from patient experience, to completion of daily ward checks, medicines management, documentation, handwashing and adherence to the uniform policy – and this was by no means an exhaustive list. The programme aimed to help maintain high quality and safe services for patients, identifying areas of good practice and areas for improvement. Ms Feerick highlighted some of the key themes found to date, including the need for improvements in communications between staff groups (which would be helped by the continued roll out of initiatives such as the safety huddles) and noises on the wards at night (disturbing patients’ rest), and the very positive feedback received regarding nursing and medical care, food and overall patient experience. Governors agreed that these mirrored their own experience of the visits.

4.12 Ms Feerick thanked the Governors for making time to support the visits programme; their input was valuable and appreciated.

4.13 As Chair of the Q&G Committee, Ms Moore gave a useful overview of the issues identified in the latest Chair’s Log and the Committee’s review of the month 5 IPR (quality issues). The Committee’s discussions reinforced many of the points outlined earlier in the LFE and the feedback from the Quality & Safety visits. As another strand of patient feedback, the Committee had also been pleased to note the good outcomes from the latest PLACE (Patient-led assessment of care environment) inspections. The reports gave assurance on the continued monitoring of staffing levels too despite recent pressures over the holiday season, actions in place around stroke services to ensure continued safe service, the Committee’s response to a recent review of the Trust’s mature workforce outlining support for these staff and planning for the future, and sustained improvements in mortality ratios and complaint response times. The increase in the number of falls in August was highlighted although it was not reflected in the low levels of harm from falls, which had been maintained. The continued focus on reducing hospital acquired pressure ulcers was noted.

4.14 Ms Moore also presented the Q&G Committee’s annual report for 2015/16. It described the richness of the work undertaken by the Q&G Committee, underpinned by key reporting groups, to give assurance to the Governors, Board and the public on the robust governance systems in place to provide safe, effective and high quality services to patients and to identify gaps and seek improvements where needed.

4.15 As well as a self-assessment of its own progress in year and plans for 2016/17, the Committee had also looked at the membership of the reporting groups to make sure that the right people were involved with each one, enabling the groups to address any issues quickly and effectively.


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4.16 PEG remains one of the key groups reporting into the Q&G Committee and is regularly attended by two Governors as observers: Mr Steve Long and Ms Annie Moody. Steve and Annie gave assurance on this group’s effectiveness and the thoroughness with which it looked at the issues under its remit every month.

4.17 The QGSG also appreciated management’s replies to questions from earlier discussions around the self check-in kiosks, the wheelchair review (the outcomes of which will be shared with Governors) and confirmation of work still to be progressed on other issues.

4.18 Both sub-groups had discussed the Governors’ next Annual Development Session. There was strong support for the proposal to (a) use the last training date for 2016 to focus on security and, if practicable, use that time also to hear more about the outcomes for PLACE and the wheelchair review, and (b) use the first date in the 2017 calendar for the Annual Development Session, to be led by the new Lead Governor.

4.19 Governors were also reminded of several invitations:

• to join the Trust’s flu fighters - drop in sessions for flu vaccinations for staff were being held on site throughout the month,

• to the Board meeting being held on 3rd November 2016, as the annual joint meeting of Governors and Director, and

• to the Trust’s first Christmas Ball, to be held on 2nd December 2016. As well as being a great social event for staff, all profits will be going to the Hospital’s Charity.

5 CONCLUSION & RECOMMENDATIONS 5.1 As stated previously, sub-group meetings are intended to supplement and support

the work of the wider Council of Governors. Other information will also continue to be available to Governors via formal and informal updates from the Chairman, Governor attendance at Board meetings held in public, the joint meeting of the Governors and Board, briefings received at General Meetings, private briefing sessions for Governors, and the Board’s responses to any questions raised by Governors.

5.2 The notes above are by no means a full reflection of the meetings’ business. Governors are encouraged to come along to hear more and contribute to the sub-groups’ discussions and work.

5.3 Governors are asked to: • note and support this report • agree the schedule for the next Annual Development Session, and • approve the 2017 meeting schedule (copy attached to the agenda)

David Brannan Tony Dobell Finance & Performance Quality & Governance Sub-Group Chair Sub-Group Vice Chair October 2016


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COUNCIL OF GOVERNORS – OCTOBER 2016 REF: COG/16/10/12

12

BOARD OF DIRECTORS

1 MEETING PAPERS & AGENDA

1.1 The Agenda for the meeting of the Board of Directors held in public on 6th October 2016, is attached for information. The Minutes of the previous meeting, held in September, are also attached.

1.2 Governors have access to all of the papers from the Board meetings held in public but the following three reports are attached for your attention: 1.2.1 The latest performance report (to end August 2016). These monthly reports

continue to be subject to closer review regularly at Governors’ sub-group meetings. Progress against delivery of the strategic objectives for the Business Plan is monitored through the sub-groups too.

1.2.2 The latest Horizon Scanning report. This is provided each month by our communications lead to add to the Board’s awareness of news items and upcoming national and regional issues.

1.2.3 The report on public consultation on children’s surgery and anaesthesia and hyper acute stroke services.

1.3 Copies of the full reports from all Board meetings held in public are available on the Trust’s website (www.barnsleyhospital.nhs.uk) or on request from the Secretary to the Board & Governors, Carol Dudley.

2 FUTURE MEETINGS 2.1 Governors, staff and members of the public are welcome to come along to observe

any meetings of the Board held in public. Meeting papers will be provided on the Trust’s website and at the meeting.

2.2 The Board of Directors’ regular meetings are usually held on the first Thursday of every month but there are exceptions and Governors are advised to check with the Governors’ Office or on the Trust’s website for further details.

2.3 The next Board of Directors’ meetings to be held in public are scheduled for 3rd November (joint meeting of Board and Governors) and 1st December 2016, both commencing at 9am.

3. RECOMMENDATION Governors are asked to receive and note this report.

Stephen Wragg CHAIRMAN October 2016

CoG October 2016: BoD reports Page pg 31

A MEETING OF THE BOARD OF DIRECTORS WILL TAKE PLACE ON 6TH OCTOBER 2016, 9AM

IN THE EDUCATION CENTRE, BARNSLEY HOSPITAL

AGENDA

No Item Sponsor Ref

1. Apologies and Welcome

S Wragg, Chairman

2. To receive any declarations of interest

3. To approve the Minutes of the meeting of the Board of Directors held in public on 1st September 2016 16/10/P-03

4. To approve the Action Log in relation to progress to date and review any outstanding actions 16/10/P-04

Strategic Aim: Patients will experience safe care

5. To receive and review latest Patient’s Story H McNair Dir of Nursing & Quality Presentation

6. To receive and support the Chair’s Log and assurance from the Quality & Governance Committee

R Moore, Quality & Governance

Committee Chair 16/10/P-06

7. To review the Chair’s Log on any escalation issues from the Executive Team

D Wake Chief Executive Verbal

8. To approve the Trust’s response to NHS England core standards for emergency preparedness, resilience and response (EPRR) 2016/17

K Kelly Director of Operations 16/10/P-08

9. To receive and review the quarterly report on mortality ratios

Dr R Jenkins Medical Director 16/10/P-09

Strategic Aim: People will be proud to work for us Strategic Aim: Performance matters

10. To receive and endorse the Chair’s Log and assurance from the Finance & Performance Committee

F Patton Committee Chair 16/10/P-10

11. To review the integrated performance report (month 5) Executive Team 16/10/P-11

Strategic Aim: Partnership will be our strength

12. To receive and consider the Working Together Commissioners’ public consultations and proposals for service change

D Wake, Chief Executive 16/10/P-12

13. To note the monthly report from the Chairman S Wragg, Chairman 16/10/P-13

14. To note the monthly report from the Chief Executive D Wake, Chief Executive 16/10/P-14

15. To receive and review monthly Horizon Scanning report E Parkes, Director of Marketing & Comms 16/10/P-15

Cont/…

BoD Oct 2016: Agenda (PUM)

Page pg 32

No Item Sponsor Ref

16. In accordance with the Trust’s Standing Orders and Constitution, to resolve that representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted. Date of next meeting: 03 November 2016, 9am (joint meeting with Council of Governors)

Signed: ………..…………………… CHAIRMAN

Please see reference section at back of papers for key to business plan and glossary of terms/acronyms

BoD Sept 2016: Agenda (PUM)

Page pg 33

REF: 16/10/P-03

REPORT TO THE BOARD OF BARNSLEY HOSPITAL NHSFT

MINUTES OF A MEETING OF THE BOARD OF DIRECTORS

HELD ON 1ST SEPTEMBER 2016 IN THE EDUCATION CENTRE, BARNSLEY HOSPITAL NHSFT

PRESENT: Mrs S Brain England OBE Non Executive Director Ms J Dean Non Executive Director Dr R Jenkins Medical Director Mr N Mapstone Non Executive Director Mrs H McNair Director of Nursing & Quality Ms R Moore Non Executive Director Mr F Patton Non Executive Director Ms D Wake Chief Executive Mr S Wragg Chairman Mr M Wright Director of Finance

IN ATTENDANCE: Mr J J Bannister Deputy Medical Director Mr B Brewis Deputy Director of Operations Mrs L Christopher Director of Estates & Facilities Ms M Dass Clinical Director, CBU3 (Women, Children & Clinical Support) Mr T Davidson Director of ICT Ms C E Dudley Secretary to the Board & Governors Mr K Hickman Senior HR Business Partner Mr R Kirton Director of Strategy & Business Development Ms J Murphy Community Midwife Team Leader Ms E Parkes Director of Marketing & Communications

APOLOGIES: Ms K Kelly Director of Operations

16/144 APOLOGIES & WELCOME

Members and attendees were welcomed, together with several public observers. Apologies were noted from Mrs Kelly and, as a courtesy, had also been received from Dr Atkinson and Mr Mitchell, Clinical Directors.

16/145 DECLARATION OF INTERESTS None.

16/146 MINUTES OF LAST MEETING (16/09/P-03) The Minutes of the meeting of the Board of Directors held in public on 4th August 2016 were received and approved as a true record.

16/147 ACTION LOG (16/09/P-04) The action log showing progress on matters arising from the last and previous meetings held in public was reviewed and noted.

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16/148 PATIENT’S STORY Mrs McNair introduced Ms Murphy and explained that the story to be presented related to a home birth. This was very topical in light of the new national strategy encouraging more women to have births at home. Barnsley’s current home birth rate was c1%, compared to the national average of 3% - up to 8% in some areas. The patient’s story presented by Ms Murphy (copy attached) gave an overview of how the midwifery team had worked recently with a mum-to-be’s choice for a home birth. The mother had been supported by a doula and had requested minimal monitoring by or intervention from the midwives at the birth. Ms Murphy explained that doulas are usually experienced women, with some basic non clinical training, hired from a recognised organisation to support expectant mums (and their families) throughout their pregnancy and birth at home. With a doula involved, the midwives would have to work differently to support the expectant mums. It had been the Barnsley team’s first experience of working with a doula and had required learning from all parties. The midwives had engaged with the family from the outset to ensure that the mother was aware of the choices available to her, to agree the level of support to be provided and to put provisions in place that would support both good clinical practice and her personal wishes at the birth. The experience for the family and the midwifery team had been a very positive one, as evidenced in the presentation. The team intended to share the good feedback with other mums-to-be and relevant patient groups as part of its work to encourage home births and dispel some of the unfounded concerns about the risks of having a baby at home. Ms Parkes offered to provide support from the communications team to share the account more widely too. Ms Murphy emphasised some the many benefits of home births for families (quicker recovery, more relaxed environment) and trusts (including finance with average costs of £1066 per home birth, compared to £1631 in hospital). There was clear evidence that most home births were just as safe as hospital births, particularly for second and subsequent babies. It was acknowledged, however, that home births were contrary to current expectations and many expectant mums were understandably attracted to units such as the Barnsley Birthing Centre, which offered excellent services at births. Miss Dass advised that the Trust’s low C-section rate was among the best in the country, which would also be an important factor for many patients. Ms Wake highlighted the understandable concerns mothers-to-be would have around pain management; raising awareness of alternative pain control methods for home births would be a vital component of promoting fewer hospital births. It was acknowledged that a lot of work would be required to raise awareness around home births: they were not suitable for all mums-to-be but offered a good option for many. Similarly trusts would have to revise their service structure if/when more mums opted to give birth at home, to work differently with them and meet the changing needs. Ms Murphy outlined some of the work already in hand and/or being considered to encourage home births where safe to do so. Before she left the meeting, Ms Murphy was thanked for an informative and useful presentation.

16/149 QUALITY & GOVERNANCE COMMITTEE (Q&G) (16/09/P-06) - CHAIR’S LOG As Chair of the Committee, Ms Moore presented the Chair’s Log from the latest meeting, which provided assurance and notice of ongoing actions across a range of issues monitored by Q&G. She drew attention to the positive findings in recent reports on the Trust’s cancer services – the Quality

BoD Oct 2016: Sept Minutes PUM (p2 of 9)

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Surveillance External Review on Cancer of Unknown Primary (CUP) and the published outcomes from the national Cancer Patient Experience Survey 2015. Whilst a small number of areas for improvement had been identified in both reports, the feedback had been very positive overall, with particular recognition of the high standards of care provided by the nursing staff involved. The continued good performance on mortality ratios was also highlighted, together with the good outcomes from the latest (and probably last) annual audit report from the Supervisor of Midwives Local Supervisory Authority. In relation to mortality ratios, Dr Jenkins referred to an outlier alert received for bronchitis. He advised that a review of all relevant cases had been undertaken and no issues identified; a deep dive into sepsis samples had also been completed recently and no issues had been found on qualitative care. Fuller outcomes from the reviews would be reported via the Clinical Effectiveness Group shortly. In terms of ongoing improvements, Ms Moore emphasised the continued focus on pressure ulcers. Q&G had received assurance on the new approach to management of pressure ulcers and the new assessment tool being introduced, which were expected to drive similar improvements to those experienced in reduction of harm from falls. Mr Mapstone sought more information about work on the discharge summaries (D1s) to address concerns raised by local GPs and use of more forward looking indicators as had been proposed several months ago. With regard to the D1s, Dr Jenkins reported on a recent meeting with the Clinical Commissioning Group (CCG), also attended by NHS England, at which the Trust and CCG had agreed a way forward to develop a revised D1. The new version would be drafted by mid-September and, following roll out, would be audited in the new year to review effectiveness. In terms of forward looking indicators, it was confirmed that work was ongoing to introduce these with some steps already being taken towards a change of approach as evidenced by the greater use of statistical process charts. Ms Dean observed that the Log reported on a number of issues such as pressure ulcers and harm from falls, which presented higher risks to older and more vulnerable patients. This mirrored feedback to Ms Moore from a recent visit to physiotherapy, where staff had highlighted the growing number of frail elderly patients in the Trust. It was acknowledged that the Trust needed to be mindful of the needs of the ageing local populace when reviewing services.

16/150 EXECUTIVE TEAM (ET) CHAIR’S LOG (16/09/P-07) The ET Chair’s Log presented by Ms Wake reported two issues for the Board’s attention, both of which would continue to be monitored through Q&G:

• The Board noted the arrangements in place to ensure continued safe stroke services. Two locums had been appointed and would be overseen by one of the Trust’s senior care of the elderly physicians. Ms Wake also advised that the Trust would be looking at joint appointments with Doncaster & Bassetlaw Hospital NHSFT in future.

• Developments in primary care services on site were also noted: there had been some gaps in the Emergency Department (ED) recently. The new service provided on site by Vocare since mid-August had already made an impact, seeing over 40 patients daily in the first weekend. This was a marked improvement on the primary care service previously provided, although that service provider was still working on site to support 111 patients.


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16/151 FINANCE & PERFORMANCE COMMITTEE (F&P) (16/09/P-08) a) Chair’s Log

Mr Patton, Chair of F&P, presented the Chair’s Log from the Committee’s meeting held in August. As noted in the Log, Month 4 had continued to see good performance against plan (albeit still a deficit) at +£190,000 for the month and £227,000 better than plan year to date. F&P continued to push for more focus on EBITDA rather than the bottom line position, as this would give more operational focus. The Committee was looking to see break even at EBITDA but that would be a big challenge. Other issues highlighted from the Log included: • improved performance in Clinical Business Unit (CBU) 1 but more work

still required • cash still adversely affected by ongoing significant debts and the

consequent need to draw down more money, with a cost impact. The position continued to be closely monitored. Mrs Brain England sought clarity on the Trust’s powers to redress the continuing debts. Mr Wright clarified that the Trust expected to receive c£1.5million against a £2million debt shortly; the Trust would be able to invoice the debtor organisation for interest costs incurred due to non-payment to date. It was also noted that, like any other organisation, the Trust was able to utilise debt recovery services but so far had opted not to do so on the main debtor. NHS Improvements (NHSI) had been kept informed of the debtor positions. In addition Mr Wright advised that Sustainability & Transformation (S&T) funds for Quarter 1 had been received recently, resulting in an improvement in month 4

• essential provision against debts had been made • the main capital programme had not yet received national approval but

some limited work had progressed with careful management, supported by the Trust’s own capital. In reply to Mr Mapstone, Mr Wright advised that outcomes from the national review of capital plans were expected within the next two months. The work delayed pending approval had been prioritised in readiness and would be revisited as soon as approval was confirmed

• reporting of the cost improvement programme (CIP) had been impacted by the holiday period, resulting in some schemes not being reflected in the month 4 outcomes. Assurance on several schemes had been received, reducing the gap against plan to £73,000 year to date and increasing the number of schemes at level 4 maturity. The Chairman welcomed further assurance from Mr Patton that expected improvements would be reflected in month 5 reports and more work was ongoing to ensure the plan would be fully met and exceeded

• discussions had also focussed on the good position on penalties and the 1% margin permissible against S&T funding on the <4 hour emergency access target, albeit the Trust remained committed to delivery of the 95% target as a minimum in terms of quality of service to patients

• an increase in sickness absence had been noted (up to 4.6%), reflecting a historical pattern for July. F&P had recognised that this would, in part, reflect home care needs during the holiday period and had charged the HR team with considering a better and cost effective way to avoid a repeat of the trend in 2017. Mr Hickman explained that initial thoughts had included options around child care support, working with areas who


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had reported high sickness in the month and working with individual staff. He confirmed that the team would be taking account of the changes in school holidays still being considered for Barnsley and the variance in holiday dates in other areas too

• F&P had also reviewed and endorsed the Board Assurance Framework, with some minor amends requested.

16/152 INTEGRATED PERFORMANCE REPORT (IPR) (16/09/P-09)

The month 4 IPR was received and reviewed. Whilst many of the key points had been reported in F&P and Q&G Chair’s Logs and subsequent discussions, ET members provided more information on key issues from each section: Activity Mr Brewis highlighted the improved performance in cancer services and continued good performance in Referral to Treatment Times (RTT). He also noted progress on the 4 hour access target, with August on target although the quarter 2 target would be challenging. The position was supported by the strong middle grade rotas now in place, minimal use of escalation capacity and the increased primary care services on site (as above); due to good planning, performance had also been good over the bank holiday. Ms Moore queried the increase in cancelled operations. Mr Brewis confirmed that the Trust was not an outlier in cancelled operations but a lot of work was ongoing to review and address the increase. No single issue of concern had been identified and the position continued to be scrutinised by the ET on a weekly basis. Ms Wake also flagged a recent significant increase in Trauma & Orthopaedics work, which had resulted in a number of elective cancellations. More research may be needed to identify the underlying reasons for the spike. To give a scale of the situation, Mr Brewis advised that during this period seven elective procedures had been cancelled to enable 29 non elective cases to be undertaken. Ms Wake also reported on plans to help another trust with its overload of surgical work. This could be beneficial to both trusts but discussions were ongoing to ensure that the work could be done without compromising the Trust’s RTT position and at no detriment to local patients. Quality Mrs McNair highlighted the continued improvements in complaint response rates and recorded her thanks to the CBUs who had helped to drive this important agenda. She also reiterated the continued good trend in reduction in harm from falls, with the last incidence of significant harm from a fall now over 75 days ago (the longest period in four years), reflecting a sustained improvement. The Chairman observed that the improvements had started to be delivered since Mrs McNair had taken up leadership of the Falls Steering Group. Other areas of note included: • pressure ulcers, with more work ongoing and a detailed report due to be

presented to Q&G in October • the latest Serious Incidents (SIs) • continued improvements in mortality ratios, as reported earlier. The

Chairman was pleased to note the lowest crude morality rates to date, as well as the continued fall in the Trust’s Hospital Standardised Mortality Ratio (HSMR).


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Ms Moore highlighted the continued good performance in dementia care. Whilst further improvements were needed, progress to date was encouraging and she had seen clear evidence of the better working during a recent ward visit. From discussion, two points of process were noted:

• Ms Moore mooted that it would be useful to add some more informative narrative on key points in the staffing report on nursing & midwifery if possible, even though the format was largely prescribed by the Department of Health. Mrs McNair also referenced discussions at Q&G around the new national guidance on staffing and the review of establishments to meet the needs of the new ward configurations, more detail on which would be reported at Q&G and subsequently the Board, as soon as possible. She was also pleased to report on work being led by the new Adult Safeguarding Lead, who was trying to introduce a new Vulnerable Adult Risk Management model within the Trust. Further information on this would be reported shortly.

• With regard to HSMR, the Chairman requested that reference to transitioning from the old to the new data providers be removed as this had now been actioned. This would be addressed by Dr Jenkins.

Workforce In addition to earlier comments on sickness absence, Mr Hickman highlighted the increase in turnover, whilst this was still comparatively low it was unusual for the Trust and was being monitored. Ms Wake requested that, if the trend continued, it would be useful to see a breakdown by staff group. Mr Hickman also highlighted the position in mandatory training, with a strong focus on resuscitation training to ensure that the right individuals were being targeted for the appropriate level of training. In addition the continued good position on appraisals was noted. Mr Patton advised that it was the second year the Trust had achieved target, reflecting the effectiveness of the changed timetable for appraisals. The improved quality of appraisals had also been reflected by positive feedback in the latest staff survey. Finance Mr Wright tabled a revised worksheet on finance (minor corrections, provided for accuracy). He reconfirmed the position was ahead of plan year to date. The improved position had been underpinned by increase in clinical activity (above plan), reductions in did not attends (DNAs), weekly updates on activity and good grip on pay, particularly around management of agency spend, waiting list initiatives and backfill. Payments to creditors were still taking longer than the Trust would like although a slight improvement had been achieved and, as discussed earlier, ongoing debts continued to cause some tensions. Mrs Brain England enquired if payment against the over activity might be questioned by commissioners. Ms Wake and Mr Kirton explained that the main reasons for the increased activity were twofold: (a) to get ahead of plan in readiness in order to give some flexibility when the winter pressures impacted and (b) delivery of the Trust’s plans to repatriate work into Barnsley, which was beginning to be seen in market share data. This would not put pressure on commissioners as they would still be paying for much the same level of work overall from whichever provider, although the CCG may wish to discuss the changing patterns at some point.

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In relation to repatriation, Dr Jenkins noted and supported the work undertaken to ensure better access/greater availability of clinic slots. He suggested, and it was agreed, that it would be useful to publicise the qualitative improvements being delivered too (falls, mortality ratios, infection rates – and others), so that GPs were more aware and members of the public were able to make a more informed choice to come to Barnsley for care. It was noted that a range of good work to promote awareness was already ongoing through opportunities such as the CEO’s monthly column in the Barnsley Chronicle and engagement events such as the Annual General Public Members Meeting (AGPM) and the summer fete. Ms Parkes gave assurance that her team would continue to explore other opportunities too.

16/153 REVIEW OF THE CONSTITUTION (16/09/P-10) The proposed changes to the Constitution were received and reviewed and the Chairman expanded on the rationale set out in the report. It was confirmed that at its General Meeting held on 17th August, the Council of Governors had approved the recommendations to offer a seat on the Council of Governors to each of the Sheffield Universities (Sheffield University and the Sheffield Hallam University) and to increase the number of elective public Governors from 16 to 17, with an additional seat to be provided in the Barnsley Public Constituency. The Board approved the recommendations. The changes were therefore adopted and a copy of the revised Constitution would be posted on the Trust’s website and sent to NHSI.

SW

16/154 CHAIRMAN’S REPORT (16/09/P-11) The Chairman’s report was received and noted, providing an overview on a number of activities undertaken by the Chairman since the last Board meeting and items of interest, including feedback from national and local events and the continuing work of the Council of Governors and Barnsley Hospital Charity. Reports were also received from the Non Executive Team on the most recent Board-to-Ward visit - to physiotherapy. The Non Executives involved had found it very interesting and commented on the excellent services provided by the physio team. Ms Dean reported on one aspect of the service - pre-admission for hip replacements, which a patient had queried as an over provision; they had commented that the guidance provided in the information leaflet had been sufficient. Ms Wake advised that she had shared similar concerns initially but had seen evidence that the current system provided considerable post-operative benefits, with patients being better prepared for the recovery process and any post-surgery concerns. Mrs Brain England advised that she had recently Chaired an Appeal against dismissal. She did not report the outcome but did comment on the improvements in the supporting processes: the paperwork had been much improved; the participation of all parties had been very professional; proper advice had been available to the panel and a much more timely approach had been applied.

16/155 CHIEF EXECUTIVE’S REPORT (16/09/P-12) The Chief Executive’s report was received and noted, providing information on a number of internal, regional and national matters. Ms Wake also reported two additional items:


Page pg 40

a) 7-day working As well as a joint meeting regarding D1s, the Trust had recently met with the CCG with regard to 7-day services, the outcome from which had resulted in a revised payment structure for 2016/17 following discussion on contractual issues and notice that no funding for 7-day services would be provided in 2017/18. This would undoubtedly impact on the significant improvements achieved to date. The ET was working through the impact of the likely change to funding. It was acknowledged that the CCG had helped the Trust by funding 7-day services non-recurrently historically, which had been appreciated. However, the CCG was now of the view that it was an outlier by continuing to provide additional funding for this work. The Trust believed that the parameters had changed with a greater focus on four priority standards from the Keogh report. Two of these standards were in place already and work continued on the others (consultant review within 14 hours of arrival and twice daily reviews of people in high dependency areas and at weekends) but these were progressive aims, to be delivered by the national target date of 2020. Ms Wake reminded members that the Trust had carried out a strategic review of 7-day services when the funding had been reduced for 2016/17, at which time £1.7 million had been identified as the minimum needed. The Chairman was also conscious that the community had been underfunded historically and the Trust had been impacted by previous plans to limit some services on site to 5 days/week, making the step up to 7-day services more challenging for BHNFT than for some other trusts. Ms Moore emphasised that 7-day services did not just relate to the ED: physiotherapists were on the wards 7-days a week and this sort of preventative service was having a huge impact on patient outcomes. Ms Dean endorsed Ms Moore’s view that the impact of 7-day services could not be undervalued. Members agreed it was imperative that discussions with the CCG continued.

• Junior Doctors’ Industrial Action Further strike action had been announced by the BMA. This had been largely unexpected as anecdotal reports had indicated reluctance amongst Junior Doctors to take further action even though they remained discontent with the new national contract and its imposition. Dr Jenkins advised that the first planning group had already been held and would be meeting regularly to ensure robust plans were in place during the strike days – 5 days a month, 8am-5pm, up until Christmas. The Trust’s plans would be based on the previous actions, which had proved very effective during the earlier 1- and 2-day strikes and would ensure safe services. Other options would also be considered, including working before/after strike times although he and Mr Bannister cautioned that these would be limited as they might involve staff who had worked throughout the day too, which could be unsafe. Dr Jenkins forewarned that the effect of the longer and more frequent strikes would be greater than the previous action as rescheduling patients would be more difficult, particularly with winter pressures approaching, and it would be harder to give a guarantee of the impact on patients whose care was rearranged. Mr Wright also forecast a greater financial impact, possibly up to £1-200,000, compared to c£10,000 from the last action. Ms Parkes confirmed that communications were being prepared for both internal and external use. The Chairman requested a briefing note for the Board as well. It was also agreed that any issues of concern should be escalated to the Board as and when they arose.

RJ

EP


Page pg 41

16/156 COUNCIL OF GOVERNORS (16/09/P-13)

The agenda (August) and approved Minutes (June) for the Council of Governors’ latest General Meeting were received and noted.

16/157 QUARTERLY MARKETING & COMMUNICATIONS (16/09/P-14) REPORT Ms Parkes presented and expanded upon the quarterly report. She highlighted some recent new appointments, which would bring added strength and skills to the team. She also flagged the overall balanced media reporting although there had been a slight increase in negative reporting following recent inquest hearings and understandable concerns regarding the immediate risk to the Trust’s stroke services, which had now been resolved. She was pleased to report that the Tiny Hearts Appeal was now almost a quarter of the way towards its target, thanks to the continued generosity of local people and businesses.

16/158 ANY OTHER BUSINESS & DATE OF NEXT MEETING a) Public Comments

Mr Millington, Partner Governor for the CCG, referenced the patient story and discussions around 7-day services, both of which had highlighted the need for providers to think of new ways of working within current constraints and the benefits of care closer to home. Mr Smith, Public & Deputy Lead Governor, had a financial question, which he requested to address with the Chair of F&P and/or the Director of Finance outside the meeting.

b) Date of Next meeting The next meeting of the Board of Directors was scheduled for 6th October 2016, commencing at 9am.

The meeting was also reminded of the AGPM to be held on 6th September In accordance with the Trust’s Constitution and Standing Orders, it was resolved that members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted.


Page pg 42

EXECUTIVE SUMMARY

RECOMMENDATIONS

STRATEGIC CONTEXT

REPORT TO THE BOARD OF BARNSLEY HOSPITAL NHSFT REF: BoD 16/10/P-11 SUBJECT: INTEGRATED PERFORMANCE REPORT DATE: OCTOBER 2016

PURPOSE:

Tick as applicable Tick as

applicable For decision/approval Assurance For review Governance For information Strategy

PREPARED BY: Executive Team SPONSORED BY: Karen Kelly, Director of Operations PRESENTED BY: Karen Kelly, Director of Operations

The attached report is the latest template for the integrated performance report, to give the Board a full overview against key indicators. The report will include trends and actions needed if any indicators are non compliant.

The attached integrated performance report provides an overview of the Trust’s performance to the end of August. It identifies the current quality and performance compliance of the Trust, trends, benchmarks (where available) against other organisations in our network and actions to address non compliance against key indicators. Members are referred to the Executive Summary and are reminded that the summary and key data is also subject to close scrutiny by the Executive Team and, relevant sections, by the Finance & Performance and Quality & Governance Committees.

The Board of Directors is asked to receive and consider the contents of the report.

BoD Oct 2016 – IPR (Aug)

Page pg 43

HSMR - updated with Dr Foster figures

Created by: Healthcare Information and Insight Service

Title of report: Integrated Performance Report

Executive Lead: Karen Kelly

August 2016

Integrated Performance Report

Page pg 44

Contents

Executive Summary……………………………… 3

Summary…………………………………………….. 9

Patients will experience Safe Care………. 11

Partnerships will be our Strength………. 25

People will be proud to work for us…… 26

Performance Matters………………………… 30

a) Key Performance Indicators……………… 31

b) Data Quality……………………………………… 40

c) Activity……………………………………………… 44

d) Financial Overview……………………………. 46

2 Page pg 45

Executive Summary by Exception

Key Messages

1 Patients will experience safe care Committee: Q&G Page: 11-24

Quality & Patient Experience:-

Falls

During August the Trust received 21 new complaints bringing the year to date total to 110, with a primary focus on clinical care and treatment. The complaints were risk

assessed as follows: low risk (7), moderate risk (7), high risk (7) and extreme risk (0).

The complaints were allocated as follows; CBU 1 (10),CBU 2 (5), CBU 3 (6) and Corporate services (0).

The percentage of complaints closed within target increased to 77% which is a further improvement on the previous month; year to date figure of 66% against a target of

90%. All CBUs have seen an increase of the percentage closed within target in August.

The average number of working days taken has increased this month to 62 from 59 in July. However there have been a number of long standing complaints closed in this

period.

1 complaint was re-opened this month in CBU 1.

The number of open complaints is continuing to reduce.

Complaints

In August we have seen a notable increase in the total number of falls incidents reported across the Trust. After four months of demonstrating a sustained reduction in falls

incidents, August saw numbers reported increasing by about a third. In the main this increase can be attributed to an increase in falls in three of our known high risk areas –

wards 19, 20 and 28. All teams continue to adhere to our new falls management approaches – falls alarms, multifactorial assessments etc and all teams report benefits from

these new approaches. We need to continue to monitor closely to assess whether this is a notable change in the number of falls or a one off.

On a more positive note the reduction in significant harm from falls continues to be maintained with just the one moderate harm reported on ward 19. This is the first

moderate harm or above we’ve had reported in the past four moths.

Patients Partnerships People Performance

3 Page pg 46


Key Messages

1 Patients will experience safe care cont. Committee: Q&G Page: 11-24Pressure UlcersHospital acquired grade 3 pressure ulcers

There was 1 avoidable hospital acquired grade 3 pressure ulcer in August – attributable to ward 23.

Device related pressure ulcer caused by catheter tubing pulled tight over the patients thigh.

Action:

Staff informed to ensure they check catheter tubing is not causing damage to patients skin, and also to ensure catheter bags are not so heavy as to cause the tubing to pull tight.

The new pressure ulcer risk assessment will alert staff to the importance of checking the skin beneath any devices


4 Page pg 47


Key Messages

1 Patients will experience safe care cont. Committee: Q&G Page: 11-24

Pressure UlcersHospital acquired grade 2 pressure ulcers

There were 3 avoidable hospital acquired grade 2 pressure ulcers – 1 to the sacrum, and 2 to the buttocks.

2 of the pressure ulcers were attributable to AMU. Both patients had fallen prior to admission and spent an unknown period of time on the floor. Robust skin assessments were not undertaken

in ED, and preventative measures were insufficient in ED / AMU.

Action:

ED and AMU to treat all patients who have been found on the floor at home as high risk of developing pressure damage, and to commence preventative measures to reduce the risks. ED to

utilise the hybrid trolley mattresses / hybrid mattresses, both with compressors, for this group of patients.

On-going Tissue Viability action plan on AMU, with introduction of TV Forum to feedback investigations findings and actions.

1 pressure ulcer was attributable to ward 23. The patient had suffered a stroke and was immobile. Despite this, they were only repositioned 4 hourly and, even when they developed moisture

damage to the sacrum, turns were not increased to 2 hourly, until patient reviewed by the Lead Nurse.

Action:

Practice to be standardised on the Stroke Unit - all patients to be treated as high risk and preventative measures utilised, including 2 hourly repositions.


5 Page pg 48


Key Messages

1 Patients will experience safe care cont. Committee: Q&G Page: 11-24

Safety

Incident Resulting in Severe Harm

Mortality

A&E 4 Hour Wait

There have been 3 SIs in total reported in August 2016.

• 2016/22483 – delayed diagnosis of lung cancer in ED; incident occurred in March 2016 (DTX 29817)

• 2016/21200 – delayed diagnosis of breast cancer in breast outpatients; this incident occurred in May 2016 (DTX 27997)

• 2016/22139 – avoidable grade 3 pressure ulcer on ward 23; this incident occurred in July 2016 (DTX 29402)

ED performance achieved at 95.3% against agreed trajectory of 95%, Year To date position 94.1%

HSMR – The rolling 12 months HSMR (to May 2016 ) from Dr Foster is 97.7.

SHIMI - The latest SHMI for Q2 2015/16 is 97.8 This is our lowest value to date. SHMI has steadily fallen since Q4 2013/14

Serious Incidents

The 1 incident resulting in severe harm is regarding a complication in treatment in ophthalmology. The patient was undergoing a cataract operation. Whilst using 2 metallic instruments to

sculpt the cataract mode in the eye, the anterior chamber collapsed causing damage to the corneal endothelium and peripheral cataract posterior capsule (Datix 29683).


6 Page pg 49


Key Messages3 People will be proud to work for us Committee: F&P Page: 26-29

Staff Turnover

Appraisals

Mandatory Training

Sickness AbsenceAugust sickness is at 4.55%. A small decrease on the previous month. However, sickness is at a higher level than at August last year. A report on the trend for higher sickness

rates in July/August is being prepared with an action plan for tackling the underlying issues for next summer. Also a review for all on-going cases, both long and short term, is

underway to see how they are being managed and what we can do to improve attendance levels. Overall, this year to date, we stand at 4.07%.

Appraisals Medical - Overall compliance for August is 98.8%, all CBU’s have achieved compliance.

Appraisals Non Medical - Overall compliance for August is 94.4%, all CBU’s have achieved compliance.

Overall compliance for August is 86.7%. CBU 3 has achieved compliance at 90.1%. The remainder are as follows; CBU1 81.2%, CBU2 85.9%, Corporate services 88.5%.

Staff Turnover is within the expected range.


7 Page pg 50

Executive Summary by Exception cont.

Key Messages4 Performance Matters Committee: F&P Page: 30-39

a) Key Performance Indicators62 Day - Urgent GP Referral to Treatment

Consultant Upgrade

Breast symptomatic 2WW

Performance against the locally agreed 62 Day Consultant Upgrade remains variable but is compliant at month end for August 2016. A revised process is due to be discussed at the

Cancer Performance and Improvement Group on the 22nd September; and forms part of the Action Plan following the external review by the Intensive Support Team.

The breast symptomatic target was compliant in August and shows a compliant position for quarter to date.

The 62 day GP referral to treatment target is compliant in August and demonstrates a compliant quarter position to date.

In August there were 7 breaches of the 62 day GP target – 6 shared and 1 local breach. Breaches were seen in CBU2 (1 x breast, 1 x Colorectal, 3 x Urology) and in

CBU3 (2 x Gynaecology). Breach agreement and validation is underway with the tertiary centre but reasons identified to date include complex pathways, patient

choice, medical reasons and one administrative delay in sending referral.

Of the 7 shared pathways, 1 (Gynae) was referred to the tertiary centre after Day 62 and this appears to relate to medical reasons.


8 Page pg 51

Executive Summary by Exception cont.

Key Messages4 Performance Matters cont. Committee: F&P Page: 46-49b) Financial overview

The Trust has a consolidated year to date deficit position of £4.2m that is £0.3m favourable to plan. CIP delivery for month 5 is adverse to plan year to date. Clinical income is

ahead of plan, although the activity mix is varied. Planned Sustainability and Transformation funding has been achieved for quarter 1, partially achieved for month 4 due to

breaching the A&E target in month and fully achieved for month 5. Other income is adverse to plan at month 5. The principal driver being RTA income. Capital expenditure

is £1.88m below plan. The programme is behind plan due to uncertainty around the receipt of external funding. Should external funding not be received, the programme

will be scaled back to match the internal funding . Loan drawdown to support cashflow requirements is £0.7m ahead of plan.


9 Page pg 52

1 2 3 4 6 7 11 12 13 14 15 16 17 18 19 20

Domain April 16 Summary Target Set By Current QtrFinancial Year

to DateApr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Trend

FFT Positivity Rates - ED G >85%, A >=80%-85%, R <80% (> ) BHNFT 88.6% 89.1% 89.1% 90.5% 88.0% 79.6% 91.4%

FFT Positivity Rates - IP G >85%, A >=80%-85%, R <80% (>) BHNFT 97.7% 97.6% 96.7% 97.4% 98.7% 96.9% 98.4%

FFT Positivity Rates - OP G >85%, A >=80%-85%, R <80% (>) BHNFT 94.6% 94.8% 95.4% 94.4% 94.7% 94.6% 95.0%

FFT Positivity Rates - MAT G >85%, A >=80%-85%, R <80% (>) BHNFT 96.9% 98.1% 98.8% 98.0% 99.3% 96.8% 97.1%

Complaints closed within target % G >90%, A >=70%-90%, R <70% (>) BHNFT 76.5% 65.6% 35.7% 66.7% 73.5% 76.2% 76.7%

Dementia - Find/Assess 90% (>) National 95.0% 95.3% 97.0% 97.0% 92.5% 95.2% 94.8%

Dementia - Investigate 90% (>) National 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Dementia - Refer 90% (>) National 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Falls 785 (<) BHNFT 137 304 58 56 53 55 82

Multiple Falls n/a BHNFT 26 63 10 16 11 8 18

Falls resulting in moderate harm or above 20 (<) BHNFT 1 5 1 3 0 0 1

Hand washing 95% (>) National 99.7% 99.6% 99.7% 99.3% 99.4% 99.8% 99.7%

Pressure Ulcers Grade 3 & 4 (Avoidable) 0 (<) BHNFT 2 10 4 2 2 1 1

Pressure Ulcers Grade 2 (Avoidable) 0 (<) BHNFT 12 26 3 6 5 9 3

Single Sex Breaches 0 (<) National 0 0 0 0 0 0 0

Hospital Acquired Clostridium Difficile 13 (<) NHSE 3 3 0 0 0 3 0

MRSA Bacteraemia 0 (<) NHSE 0 0 0 0 0 0 0

VTE Screening Compliance 95% (>) NHSE 94.5% 95.0% 94.7% 95.5% 95.8% 94.4% 94.7%

Recorded Medication Incidents 400 (<) National 68 202 41 57 36 31 37

Recorded Medication Errors - Causing harm 10 (<) National 0 1 0 1 0 0 0

Never Events - Occurred in Month 0 0 0 0 0 0 0

Never Events - Reported in Month 0 0 0 0 0 0 0

Serious Incidents n/a NHSE 8 26 3 8 7 5 3

Death 0 (<) National 1 3 0 2 0 1 0

Severe 0 (<) National 1 4 2 1 0 0 1

Percentage of Incidents Causing Harm 28% (<) BHNFT 7.3% 8.0% 8.3% 9.3% 6.3% 9.0% 7.3%

Total (All) 7400 (<) National 1134 2928 568 602 624 545 589

HSMR (Rolling 12 months) Latest Data is May 2016 100 (<) National 104.6 100.1 98.7 95.7 97.7

SHMI (Rolling 12 months) Latest Data is December 2015 105 (<) National 97.8 98.6

HSMR (Financial Year to date) - April 16 - May 2016 100 (<) 77.6 100.8 99.5 99.3 95.7 77.6

Duty of Candour Duty of Candour 0 (<) National 0 0 0 0 0 0 0

Summary

Quality & Patient

Experience

Patients will experience safe care

Mortality

Patient Safety

0 (<) NHSE


10 Page pg 53

Domain KPI Target Set By Current Qtr.Financial Year

to DateApr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Trend

Staff Turnover (Rolling 12 months) G <=10%, A >10%-11%, R >11% (<) BHNFT 9.6% 9.6% 9.3% 8.5% 9.3% 9.7% 9.6%

Appraisals (Rolling 12 months) G >90%, A >=70%-90%, R <70% (>) BHNFT 94.7% 94.7% n/a 40.5% 90.9% 94.0% 94.7%

Mandatory Training (Rolling 12 months) G >90%, A >=85%-90%, R <85% (>) BHNFT 86.7% N/A 86.6% 86.2% 85.5% 85.5% 86.7%

Sickness Absence (Rolling 12 months)G <=3.75%, A >3.75%-4.25%, R >4.25%

(<)BHNFT 4.6% 3.9% 4.1% 3.7% 3.9% 4.6% 4.6%

RTT Admitted 90% (>) National 89.3% 88.5% 87.2% 88.0% 88.3% 90.4% 87.8%

RTT Non-Admitted 95% (>) National 98.2% 98.2% 98.3% 98.4% 97.9% 98.1% 98.3%

RTT Incomplete Pathways 92% (>) National 94.3% 94.4% 95.0% 94.3% 94.2% 94.7% 93.9%

Diagnostic patients waiting more than 6 weeks 99.88% National 11 208 141 52 4 2 9

Cancer 2 Week Waits 93% (>) National 95.3% 94.6% 93.9% 95.1% 93.3% 95.4% 95.3%

Symptomatic Breast 2 Week Waits 93% (>) National 96.0% 92.9% 85.3% 92.7% 95.2% 96.4% 95.5%

31 Day - 1st Definitive Treatment 96% (>) National 98.5% 98.9% 98.7% 100.0% 98.6% 97.2% 100.0%

31 Day - Subsequent Treatment (Surgery) 94% (>) National 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

31 Day - Subsequent Treatment (Chemotherapy) 98% (>) National 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

62 Day - GP Referral to Treatment 85% (>) National 89.7% 86.3% 84.4% 79.2% 88.5% 91.4% 87.8%

62 Day - Screening Referral to Treatment 90% (>) National 100.0% 97.6% 100.0% 90.9% 100.0% 100.0% 100.0%

62 Day - Consultant Upgrade to Treatment 85% (>) BHNFT 63.6% 77.8% 80.0% 75.0% 90.9% 0.0% 87.5%

Emergency % Patients Waiting <4 Hours 93% (>) National 94.1% 94.1% 93.0% 95.4% 95.5% 91.4% 95.3%

Average Length of Stay - Elective G <=2.42, A >2.42-2.67, R >2.67 (<) BHNFT 2.29 2.14 2.33 2.34 2.50 2.08

Average Length of Stay - Non-Elective G <=3.44, A >3.44-3.69, R >3.69 (<) BHNFT 2.67 2.68 2.83 2.68 2.60 2.70

Re-admissions % BHNFT 9.6% 9.3% 9.5% 10.0% 9.2% 9.6% 9.3%

Cancelled Operations - Breaches of the 28 day rule 0 (<) National 0 0 0 0 0 0 0

DNA Outpatient DNA Rates G <=10%, A >10%-11%, R >11% (<) BHNFT 9.4% 10.4% 11.2% 11.0% 8.5% 8.8% 8.4%

RAG Description

RED Failed Target

AMBER Failed by <5% (This tolerance does not apply to Cancer & A&E targets

which will be RED if the target is not achieved)

GREEN Achieved Target

< Less Is Good

> More is good

NOTE: National Indicators such as Cancer, RTT, Cancelled Ops, etc. are considered as being either Achieved or Failed. These are therefore RAG rated as Green or Red.

All other indicators are classed as Achieved or Failed with the exception of all Workforce KPIs, Average Length of Stay & DNA rates which detail the tolerances applied in the Target column.

Elective Access

Cancer

Operational

Efficiency

Performance matters - Key Performance Indicators

People will be proud to work for us

Workforce

Summary


11 Page pg 54

1 2 3 4 5 8 18 19 20 # 22 # 24 25 26 27 39 40 41 42 43

Patients will experience safe care - "At a glance"

Target

16/17

Target

YTDAug-16

Actual

YTDTrend

YTD

Status

Target

16/17

Target

YTDAug-16

Actual

YTDTrend

YTD

Status

Friends & Family Test (Quality Strategy Goal 1) Mortality (Quality Strategy Goal 3)

Friends & Family Test - ED 85% 85% 91.4% 89.1% ↑ 89.1% HSMR Rolling 12 months (Latest data May 16) 100 100.0 97.7 97.7 ↔ 97.7

Friends & Family Test - Inpatients 85% 85% 98.4% 97.6% ↑ 97.6% SHMI Rolling 12 months (Latest data Sept 15) 105 105.0 98.6 98.6 ↔ 98.6

Friends & Family Test - Maternity 85% 85% 97.1% 98.1% ↑ 98.1% HSMR Year to date (Latest data May 16) 100 100.0 77.6 77.6 ↔ 77.6

Friends & Family Test - Outpatients 85% 85% 95.0% 94.8% ↑ 94.8% VTE Screening Compliance (Quality Strategy Goal 2)

April 2016 - July 2016 95% 95% 94.7% 95.0% ↑ 95.0%

Complaints (Quality Strategy Goal 1)

Total no. of complaints N/A N/A 21 110 ↑ Medication Incidents (Quality Strategy Goal 2)

Complaints closed within target 90% 90% 76.7% 65.6% ↑ 65.6% Recorded Medication Incidents 400 200 37 202 ↓ 0

Complaints re-opened N/A N/A 0 11 ↔ Recorded medication errors - Causing harm 10 5 0 1 ↔ 1

Dementia (Quality Strategy Goal 1) Serious Incidents (Quality Strategy Goal 2)

Find/Assess 90% 90% 94.8% 95.3% ↓ 95.3% Never Events Occurring in Month 0 0 0 0 ↔ 1

Investigate 90% 90% 100.0% 100.0% ↔ 100.0% Never Events Reported in Month 0 0 0 0 ↔ 1

Refer 90% 90% 100.0% 100.0% ↔ 100.0% Serious Incidents N/A N/A 3 26 ↑ 1

Falls (Quality Strategy Goal 2) Incident Grading (Quality Strategy Goal 2)

No. of Falls 785 393 82 304 ↑ 1 Death 0 0 0 3 ↑ 0

No. of Multiple Falls N/A N/A 18 63 ↑ 1 Severe 0 0 1 4 ↓ 0

Falls resulting in moderate harm or above 20 10 1 5 ↑ 1 Moderate N/A N/A 5 52 ↑

Low N/A N/A 37 174 ↓

Hand washing (Quality Strategy Goal 2) 95% 95% 99.7% 99.6% ↓ 99.6% No Harm N/A N/A 546 2681 ↓

Percentage of incidents causing harm <28% 28% 7.3% 8.0% ↑ 8.0%

Pressure Ulcers (Quality Strategy Goal 2)

Grades 3 & 4 (Avoidable) 0 0 1 10 ↔ 0

Grade 2 Post (Avoidable) 0 0 3 26 ↑ 0 Patient Safety (Quality Strategy Goal 2)

Total Incidents 7400 3700 589 2928 ↑ 1

Single Sex Breaches (Quality Strategy Goal 1) 0 0 0 0 ↔ 1

Infections (Quality Strategy Goal 2)

Hospital Acquired Clostridium Difficile 13 3 0 3 ↑ 1

MSSA N/A N/A 1 5 ↑

MRSA Bacteraemia 0 0 0 0 ↔ 1

Ecoli - Total hospital N/A N/A 1 5 ↓

Patients will experience safe care - Quality & Experience Patients will experience safe care - Patient Safety


12 Page pg 55

Patients will experience safe care (Safety)

Mortality (Quality Strategy - Goal 3: Delivering Consistently Effective Care)

HSMR rolling 12 month target

HSM

RH

SMR


13 Page pg 56



SHIMI rolling 12 month target

Comments

HSMR

SHMI

SHM

I an

d C

rud

e M

ort

alit

yC

rud

e M

ort

alit

y

SHIMI - The latest SHMI for Q3 2015/16 is 98.6. SHMI has steadily fallen since Q4 2013/14

HSMR - The rolling 12 months HSMR (to May 2016 ) is 97.7, FYTD is 77.6 and the crude

mortality is 17.6 for August 16.

14 Page pg 57



Incidents (Quality Strategy - Goal 2: Delivering Consistently Safe Care)

Med

icat

ion

Inci

de

nts

- C

ausi

ng

har

m

Nev

er E

ven

ts &

Ser

iou

s In

cid

en

ts

Inci

de

nt

Gra

din

g

Pat

ien

t Sa

fety

Inci

den

ts (

All)

0

10

20

30

40

50

60

0

2

4

6

8

10

12

Total Medication Incidents Causing Harm Cumulative Target

Causing Harm Cumulative Actual

0

1

2

3

4

5

6

7

8

9

Serious Incidents Never Events SI Target Never Event Target

0

100

200

300

400

500

600

700

Actual Target

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

0

10

20

30

40

50

60

Pe

rce

nta

ge C

ausi

ng

Har

m

Gra

din

g

Low Moderate Severe Death % Causing Harm

15 Page pg 58

Patients will experience safe care (Quality & Experience)

7

9

Frie

nd

s &

Fam

ily T

est

Frie

nd

s &

Fam

ily T

est


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ED Actual IP Actual OP Actual MAT Actual Target

95.5% 97% 97% 99% 97% 95% 92% 97% 94% 97% 97%

73%

96% 98% 97%

0%

20%

40%

60%

80%

100%

120%

Friends & Family Test - Inpatient Benchmarking (Latest NHS England Published Data - Feb 2016)

Peer Group Local Target

95.9%

100% 99% 99% 96%

92%

97%

92%

97% 97% 97% 97% 98%

93%

75%

80%

85%

90%

95%

100%

105%

Friends & Family Test - Maternity Benchmarking (Latest NHS England Published Data - Feb 2016)


86% 95%

89% 90% 90% 92% 93% 86% 85%

94% 85%

90% 85%

92%

79%

0%10%20%30%40%50%60%70%80%90%

100%

Friends & Family Test - A&E Benchmarking (Latest NHS England Published Data - Feb 2016)


16 Page pg 59



Complaints (Quality Strategy - Goal 1: Delivering Patient Centred Care)

Comments:

Co

mp

lain

tsC

om

pla

ints

Co

mp

lain

ts

0

5

10

15

20

25

30

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

Complaints by Category

Patient Care Access, Appts, etc Communication Medical Records Medication

Falls Infection Control Infrastructure Other

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pe

rce

nta

ge w

ith

in t

arge

t

Complaints Closed within Target

% closed Target

150

160

170

180

190

200

0

5

10

15

20

25

30

Complaints & Concerns

Complaints Re-opened PALS

17 Page pg 60



Dementia (Quality Strategy - Goal 1: Delivering Patient Centred Care)

Comments:

De

me

nti

aD

eme

nti

a -

Ben

chm

arki

ng

Dem

en

tia

- B

ench

ma

rkin

g

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Find/Assess Actual Investigate Actual Refer Actual Target

95% 95% 94%

90%

98%

91% 91%

95% 94%

90%

100% 98%

84%86%88%90%92%94%96%98%

100%

Percentage of Cases Identified (Latest NHS England published data December 2015)

Peer Group Target

94%

100% 100% 100% 100% 100% 100% 98%

100% 100% 100% 100%

84%86%88%90%92%94%96%98%

100%

Percentage of Cases with Diagnostic Assessment (Latest NHS England

Published data December 2015)

Peer Group Target

18 Page pg 61



Falls (Quality Strategy - Goal 2: Delivering Consistently Safe Care)

Comments:

Falls

re

sult

ing

in m

od

era

te h

arm

or

abo

veFa

lls

The number of falls reported in February remains around the same number as prior

months.

Mu

ltip

le F

alls

In August we have seen a notable increase in the total number of falls incidents reported across the Trust. After four months of demonstrating a sustained

reduction in falls incidents, August saw numbers reported increasing by about a third. In the main this increase can be attributed to an increase in falls in three

of our known high risk areas – wards 19, 20 and 28. The reported reasons for the notable increases in these areas were an increase in patient dependency and

risk and also some staffing shortfalls at times. All teams continue to adhere to our new falls management approaches – falls alarms, multifactorial assessments

etc and all teams report benefits from these new approaches. We need to continue to monitor closely to assess whether this is a notable change in the number

of falls or a one off.

On a more positive note the reduction in significant harm from falls continues to be maintained with just the one moderate harm reported on ward 19. This is

the first moderate harm or above we’ve had reported in the past four moths.

0

10

20

30

40

50

60

70

80

90

No

. of

Falls

No. of Falls

Actual Target

0

2

4

6

8

10

12

14

16

18

20


No

. of

Mu

ltip

le F

alls

Multiple Falls

Actual Target

0

1

2

3

4

No

. of

Falls

Falls resulting in moderate harm or above

Actual Target

19 Page pg 62



Pressure Ulcers (Quality Strategy - Goal 2: Delivering Consistently Safe Care)

Comments:

As stated

last

Pre

ssu

re U

lce

rs -

Gra

de

3 &

4P

ress

ure

Ulc

ers

- G

rad

e 2

Whilst there has been no reduction in the actual numbers of overall grade 2 pressure ulcers in August there has been a substantial reduction of avoidable

grade 2 pressure ulcers from 9 in July to 3 in August. Following on from July there remains a reduction in overall numbers of grade 3 pressure ulcers from 4 last

month to three this month with only one being deemed as avoidable following the RCA process.

The trust has now appointed the React to Red facilitator (Half time) to roll out education and training with material sourced and funded by NHS England. A

new pressure ulcer assessment process will also be rolled out at the same time as this initiative to make it easier for staff to recognise those patients who are at

risk of developing pressure ulcers.

Hospital acquired grade 3 pressure ulcers



Action:

Staff informed to ensure they check catheter tubing is not causing damage to patients skin, and also to ensure catheter bags are not so heavy as to cause the

tubing to pull tight.

The new pressure ulcer risk assessment will alert staff to the importance of checking the skin beneath any devices.



2 of the pressure ulcers were attributable to AMU. Both patients had fallen prior to admission and spent an unknown period of time on the floor. Robust skin

assessments were not undertaken in ED, and preventative measures were insufficient in ED / AMU.

Action:

ED and AMU to treat all patients who have been found on the floor at home as high risk of developing pressure damage, and to commence preventative

measures to reduce the risks. ED to utilise the hybrid trolley mattresses / hybrid mattresses, both with compressors, for this group of patients.


1 pressure ulcer was attributable to ward 23. The patient had suffered a stroke and was immobile. Despite this, they were only repositioned 4 hourly and, even

when they developed moisture damage to the sacrum, turns were not increased to 2 hourly, until patient reviewed by the Lead Nurse.

Action:


0

1

2

3

4

5

6

7

8

9

10

Grade 2 Unavoidable Grade 2 Avoidable Target

0

1

2

3

4

5

6

7

8

9

10

Grade 3&4 Unavoidable Grade 3&4 Avoidable Target

20 Page pg 63



Infections (Quality Strategy - Goal 2: Delivering Consistently Safe Care)

Comments:

Eco

li B

acte

rae

mia

Ho

spit

al A

cqu

ire

d C

lost

rid

ium

Dif

fici

le T

oxi

n

0

1

2

3

4

5


0

2

4

6

8

10

Hospital Acquired Clostridium Difficile Toxin (cumulative position)

Tolerance Actual

21 Page pg 64



Nursing Staffing Fill Rate (Quality Strategy - Goal 4: Building on Capacity and Capability)

Comments:

14 100.0% 98.4% 100.0% 100.0% 2.8 1.6 Registered Nurses

17 83.1% 89.7% 98.4% 129.0% 2.8 2.1 Registered Midwives

18 74.5% 116.1% 81.7% 241.9% 3.4 3.2 Unregistered health care/midwifery care assistants

19/20 69.3% 98.3% 100.0% 131.5% 2.3 3.7 Unregistered nursing/midwifery auxiliaries.

AMU 70.6% 94.4% 89.4% 103.3% 4.6 3.5

Acute Stroke 60.3% 88.6% 87.0% 161.5% 3.0 3.3

24 99.2% 107.2% 98.4% - 4.7 3.3

28 95.3% 107.2% 100.0% 145.2% 2.3 3.3

31 71.6% 123.1% 98.4% 93.0% 2.7 2.9

32 86.2% 98.2% 98.4% 190.3% 3.4 3.1

34 69.9% 90.2% 74.2% 110.8% 3.2 6.3

ITU 78.4% 72.7% 98.6% - 38.1 2.4

SHDU 97.4% 57.0% 98.4% - 16.6 3.0

CCU 95.3% 86.2% 100.1% - 12.0 1.6

AN/PN 92.2% 98.2% 96.8% 103.2% 5.7 2.1

Birthing Centre 91.7% 95.5% 93.8% 96.9% 27.4 5.1

37 95.5% 65.4% 82.5% 25.0% 10.5 1.7

15 94.6% 70.5% 91.4% 90.3% 14.3 3.2

BHNFT is committed to ensuring that levels of nursing staff, match the acuity

and dependency needs of patients in order to provide safe and effective care.

Nurse staffing includes:

Ave fill rate

Care staff

(%)

NightRegistered

Nurses/Midw

ives

Care Staff

Care Hours Per Patient

Nu

rsin

g St

affi

ng

Fill

Rat

e

422- NEONATOLOGY

110 - TRAUMA & ORTHOPAEDICS

192 - CRITICAL CARE MEDICINE

Day

300 - GENERAL MEDICINE

300 - GENERAL MEDICINE

Ward

name

Ave fill rate

Registered

320 - CARDIOLOGY

340 - RESPIRATORY MEDICINE

430 - GERIATRIC MEDICINE

502 - GYNAECOLOGY

We are now submitting Care Hours per patient to unify.

This allows for contingency plans to be made where the roster identifies that

the planned staffing falls short of the minimum requirement, for example

where there are vacant nursing posts or staff appointed have not started in

post. These contingency plans can include: moving staff from a shift which is

above the minimum required level, moving staff from another ward/area which

is above the minimum required level, or the use of flexible/temporary staffing

from the Trust’s internal bank or via an external nursing agency.

420 - PAEDIATRICS

192 - CRITICAL CARE MEDICINE

Specialty

100 - GENERAL SURGERY

Ave fill rate

Registered

320 - CARDIOLOGY

501 - OBSTETRICS

501 - OBSTETRICS

370 - MEDICAL ONCOLOGY

301 - GASTROENTEROLOGY

100 - GENERAL SURGERY

The Trust uses an e-rostering system with duty rosters created eight weeks in

advance to ensure the levels and skill mix of the nursing staff on duty are

appropriate for providing safe and effective care.

Ave fill rate

Care staff (%)

22 Page pg 65

Patients will experience safe careHeatmap Aug-16

MR

SA

Bac

tera

emia

C D

iff

Falls

- N

o

Ad

vers

e

Ou

tco

me

Falls

- A

dver

se

Out

com

e

Mu

ltip

le f

alls

-

No

Ad

vers

e

Ou

tco

me

Mu

ltip

le f

alls

-

Ad

vers

e

Ou

tco

me

Med

icat

ion

Erro

rs -

No

Ad

vers

e

Ou

tco

me

Med

icat

ion

Erro

rs -

Nea

r

mis

s

Med

icat

ion

Erro

rs -

Cau

sin

g H

arm

Nu

mb

er o

f

Seri

ou

s

Inci

den

ts

Nu

mb

er o

f

Nev

er E

ven

ts

Pre

ssu

re

Ulc

ers

Gra

de

2 (

Avo

idab

le)

Pre

ssu

re

Ulc

ers

Gra

de

3 (

Avo

idab

le)

Pre

ssu

re

Ulc

ers

Gra

de

4 (

Avo

idab

le)

Inci

den

ts -

Dea

th

Inci

den

ts -

Seve

re

Inci

den

ts -

Mo

der

ate

Inci

den

ts -

Low

Inci

den

ts -

No

Har

m

Trust 0 0 69 13 12 6 27 10 0 0 0 3 1 0 0 1 1 37 543

AMU 7 1 4 1 2 5 74ARUCardiology DepartmentCCU 3CDU 2 14Chemo Unit 1 1Diabetes Centre 2Discharge Unit 1 1 1 6DVT clinic 1ED 5 1 2 77Endoscopy 3Renal DialysisRheumatologyWard 17 1 4 5Ward 18 5 2 3 15Ward 19 11 2 3 1 1 3 1 3 28Ward 20 15 2 2 2 2 3 22Ward 23 5 2 1 1 1 1 2 12Ward 24 3 1 1 1 1 14Ward 28 8 2 4 2 1 1 3 17

Breast Outpatients 1Breast Surgery 2Day Surgery 2ENT OutpatientsFracture Clinic 2 1 13HDUHospital at Night 1ICU 1 5Opthalmology OPD 1 2Oral SurgeryOrthopaedic OutpatientsOrthoptics OPDPlanned Investigation Unit 3Plaster roomPre Assessment Unit 1SAUSDA 1 5SHDU 1 2 2Theatres 1 18Theatres recovery 3Urology Investigation UnitWard 29 2Ward 30Ward 31 5 1 1 1 1 15Ward 32 3 2 6Ward 33 3 1 13Ward 34 6

Antenatal Clinic 6Antenatal Day Unit 1Anticoagulation ClinicBreast ScreeningCBU 3 management/ admin team 1Childrens Assessment Unit 1ColposcopyCommunity Midwifery 4Community PaediatricsEarly Pregnancy Assessment Unit 1Gynaecology OPD 3Labour Suite 1 69Lifts MaternityMaternity BasementMedical Imaging 1 14Obstetric OutpatientsObstetric Theatre 1Paediatric Outpatients 2Pathology 2Patient's Home (Maternity) 1Pharmacy 2 2Phlebotomy OutpatientsPhysiotherapyPostnatal/Antenatal Ward 10Speech and Language Therapy 2Ultrasound (maternity) 1Urgent Care Therapy TeamWard 14 1 1 1 1 9Ward 15 2 5Ward 37 1 8Ward 38Ambulance 1Chest clinic 1Education centre 1Medical Outpatients 3Medical Records and stores 1Surgical Outpatients 2

CB

U 1

CB

U 2

CB

U 3

Co

rpo

rate


23

Page pg 66

Patients will experience safe careThe heatmap below is designed to show the areas of greatest concern.

AMUARUCardiology DepartmentCCUCDUChemo UnitDiabetes CentreDischarge UnitDVT clinicEDEndoscopyRenal DialysisRheumatologyWard 17Ward 18Ward 19Ward 20Ward 23Ward 24Ward 28Breast OutpatientsBreast SurgeryDay SurgeryENT OutpatientsFracture ClinicHDUHospital at NightICUOpthalmology OPDOral SurgeryOrthopaedic OutpatientsOrthoptics OPDPlanned Investigation UnitPlaster roomPre Assessment UnitSAUSDASHDUTheatresTheatres recoveryUrology Investigation UnitWard 29Ward 30Ward 31Ward 32Ward 33Ward 34Antenatal ClinicAntenatal Day UnitAnticoagulation ClinicBreast ScreeningCBU 3 management/ admin teamChildrens Assessment UnitColposcopyCommunity MidwiferyCommunity PaediatricsEarly Pregnancy Assessment UnitGynaecology OPDLabour SuiteLifts MaternityMedical ImagingObstetric OutpatientsObstetric TheatrePaediatric OutpatientsPathologyPatient's Home (Maternity)PharmacyPhlebotomy OutpatientsPhysiotherapyPostnatal/Antenatal WardSpeech and Language TherapyUltrasound (maternity)Ward 14Ward 15Ward 37Ward 38AmbulanceChest clinicEducation centreMedical OutpatientsMedical Records and storesSurgical Outpatients

CB

U 1

CB

U 2

C

BU

3C

orp

ora

te


24

Page pg 67

Patients will experience safe careHeatmap

Reporting Month: Aug-16

Executive lead : Heather McNair

Comments




Action:

Staff informed to ensure they check catheter tubing is not causing damage to patients skin, and also to ensure catheter bags are not so heavy as to cause the tubing to pull tight.

The new pressure ulcer risk assessment will alert staff to the importance of checking the skin beneath any devices.



2 of the pressure ulcers were attributable to AMU. Both patients had fallen prior to admission and spent an unknown period of time on the floor. Robust skin assessments were not undertaken in ED, and preventative measures were

insufficient in ED / AMU.

Action:

ED and AMU to treat all patients who have been found on the floor at home as high risk of developing pressure damage, and to commence preventative measures to reduce the risks. ED to utilise the hybrid trolley mattresses / hybrid

mattresses, both with compressors, for this group of patients.


1 pressure ulcer was attributable to ward 23. The patient had suffered a stroke and was immobile. Despite this, they were only repositioned 4 hourly and, even when they developed moisture damage to the sacrum, turns were not

increased to 2 hourly, until patient reviewed by the Lead Nurse.

Action:


Pressure Ulcer

Serious Incidents

No incidents occurred in August; however 3 were reported in the month. Please see Executive Summary

Indicator Name


25

Page pg 68

0 1 2 3 4 5 6 18 19 20 # 22

People - "At a glance"

Target Target Actual Month

16/17 YTD Aug-16 YTD Trend Status

Workforce (Quality Strategy - Goal 4: Building on Capacity and Capability)

Sickness Absence Rate 3.75% 3.75% 4.55% 3.91% ↑ 3.91%

Staff Turnover 10% 10% 9.6% 9.6% ↑ 9.58%

Mandatory Training 90.0% 90.0% 86.7% N/A ↑ N/A

Appraisal Rates - Medical 90.0% 90.0% 98.8% N/A ↑

Appraisal Rates - Non Medical 90.0% 90.0% 94.4% N/A ↑ N/A

Appraisal Rates - Total 90.0% 90.0% 94.7% 94.7% ↑ 94.67%

People


26 Page pg 69

People will be proud to work for usWorkforce (Quality Strategy - Goal 4: Building on Capacity and Capability)

Staf

f Tu

rno

ver


5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

Pe

rce

nta

ge P

osi

tivi

ty

Staff Turnover

Actual

Staff Turnover - is within the expected range.

27 Page pg 70


Comments

Comments

Ap

pra

isal

sM

and

ato

ry T

rain

ing

50%55%60%65%70%

75%80%85%90%95%

100%

Pe

rce

nta

ge P

osi

tivi

ty

Mandatory Training

Actual Target


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Appraisals

Total Non-Medical Medical Target

Mandatory Training - Overall compliance for August is 86.7%. CBU 3 has achieved compliance at 90.1%. The remainder are as follows; CBU1 81.2%, CBU2 85.9%, Corporate services 88.5%.

Appraisals Medical - Overall compliance for August is 98.8%, all CBU’s have achieved compliance. Appraisals Non Medical - Overall compliance for August is 94.4%, all CBU’s have achieved compliance.

28 Page pg 71


Comments

Sick

ne

ss A

bse

nce

Sick

ne

ss A

bse

nce


1%

2%

3%

4%

5%

Pe

rce

nta

ge P

osi

tivi

ty

Sickness Absence

Actual Target

Sickness - August sickness is at 4.55%. A small decrease on the previous month. However, sickness is at a higher level than at August last year. A report on the trend for higher sickness rates in July/August is being prepared with an action plan for tackling the underlying issues for next summer. Also a review for all on-going cases, both long and short term, is underway to see how they are being managed and what we can do to improve attendance levels. Overall, this year to date, we stand at 4.07%.

29 Page pg 72

1 2 3 4 5 6 18 19 20 # 22 # 24 25 26 27 39 40 41 # #

Performance - "At a glance"

Target

16/17

Target

YTDAug-16 Actual YTD Trend

Current

Qtr

Qtr

Status

YTD

Status

Target

16/17

Target

YTDAug-16 Actual YTD Trend YTD Status

Cancer Reporting Cancelled Operations

All Cancer 2 week waits 93% 93% 95.3% 94.6% ↑ 95.3% 95.3% 94.6% % Cancelled Operations 1% 1% 0.6% 0.7% ↓ 0.7%

2 week wait - Breast Symptomatic 93% 93% 95.5% 92.9% ↓ 96.0% 96.0% 92.9% Urgent operations - cancelled twice 0 0 0 0 ↔ 0

31 day diagnostic to 1st treatment 96% 96% 100.0% 98.9% ↑ 98.5% 98.5% 98.9% Cancelled operations - breaches of 28 day rule 0 0 0 0 ↔ 0

31 day subsequent treatment - Surgery 94% 94% 100.0% 100.0% ↔ 100.0% 100.0% 100.0%

31 day subsequent treatment - Drugs 94% 94% 100.0% 100.0% ↔ 100.0% 100.0% 100.0% Theatre Utilisation

62 day urgent GP referral to treatment 85% 85% 87.8% 86.3% ↓ 89.7% 89.7% 86.3% Theatre Utilisation - Day 76.7% 79.7% ↑ 79.7%

62 day screening programme 90% 90% 100.0% 97.6% ↔ 100.0% 100.0% 97.6% Theatre Utilisation - Main 85.0% 90.8% ↑ 90.8%

62 day consultant upgrades 85% 85% 87.5% 77.8% ↓ 63.6% 63.6% 77.8% Theatre Utilisation - Trauma n/a 92.5% ↑ 92.5%

Breast Screening GP Referrals

Screening to offer of 1st assessment <=3 weeks (June 16) 90% 90% 97.6% 58.9% ↑ 58.9% GP Written Referrals - made 0 16462 ↑ 16462

Screening to 1st assessment (June 16) 90% 90% 90.5% 82.8% ↑ 82.8% GP Written Referrals - seen 0 16795 ↑ 16795

Screening to issue of normal results <=2 weeks (June 16) 90% 90% 99.6% 92.5% ↑ 92.5% Other Referrals - Made 0 6862 ↑ 6862

GP referral rate year on year (2015/16 + 2016/17) -252 -30350 ↓ -30350

Referral to Treatment Total referral rate year on year (2015/16 + 2016/17) -88 -10420 ↓ -10420

RTT Admitted - % treatment within 18 weeks 90% 90% 87.8% 88.5% ↓ 89.3% 89.3% 88.5%

RTT Non Admitted - % treatment within 18 weeks 95% 95% 98.3% 98.2% ↑ 98.2% 98.2% 98.2% DNA Rates

RTT Incomplete Pathways - % still waiting 92% 92% 93.9% 94.4% ↓ 94.3% 94.3% 94.4% New outpatient appointment DNA rate 10% 10% 8.8% 9.3% ↑ 9.3%

Follow-up outpatient appointment DNA rate 10% 10% 8.2% 9.5% ↑ 9.5%

Diagnostics Total outpatient appointment DNA rate 10% 10% 8.4% 10.4% ↑ 10.4%

No. of diagnostic tests waiting over 6 weeks 0 0 9 208 ↓ ######

% of diagnostic tests waiting over 6 weeks 0% 0% 0.4% 1.4% ↓ 1.4% Appointment Slot Issues

No. of appointment slot issues 0 0 n/a 0 ↔ 0

ED % of appointment slot issues 4.0% 4.0% n/a ↔

Percentage of patients treated in less than 4 hours 95% 95% 95.3% 94.1% ↑ 94.1% 94.1% 94.1%

Emergency Department Attendances n/a n/a 6820 35348 ↓ 0 Average Length of stay (Quality Strategy Goal 3)

12 Hours Trolley Waits 0 0 0 0 ↔ 0 0 Average Length of Stay - Elective 2.4 2.4 2.1 2.3 ↑ 2.29

Average Length of Stay - Non-Elective 3.4 3.4 2.7 2.7 ↓ 2.67

Ambulance to ED Handover Time

% under 15 mins 50.6% 57.1% ↑ 57.1% Re-admissions

% between 15 and 30 mins 41.1% 33.2% ↑ 33.2% Percentage of re-admissions N/A N/A 9.6% 9.3% ↔

% between 30 and 60 mins 2.6% 2.7% ↓ 2.7%

% between 60 and 120 mins 0.4% 0.6% ↓ 0.6%

Over 120 mins (SI) 0.0% 0.0% ↓ 0.0%

% Not Recorded 5.3% 6.3% ↓ 6.3%

Total Ambulance Handovers 1951 9910 ↓ 9910

Performance - Key Performance Indicators Performance - Key Performance Indicators cont.


30 Page pg 73

Performance Matters (KPIs)Operational Efficiency

7

9

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

Ave

rage

Le

ngt

h o

f St

ay

Bre

ast

Sym

pto

mat

ic

Re

-ad

mis

sio

ns

Can

celle

d O

pe

rati

on

s


0.8% 0.8%

1.1%

0.4%

0.6%

0.0%

0.5%

1.0%

1.5%

2.0%

0

1

2

3


28 Day Breaches Target % Cancelled Ops 2015/16

0.00

1.00

2.00

3.00

4.00

5.00


Average Length of Stay (Quality Strategy - Goal 3: Delivering Consistently Effective Care)

Elective Non-Elective Elective Target Non-Elective Target 2015/2016 Elective 2015/2016 Non Elective

31 Page pg 74

Performance Matters (KPIs)


87.83% 82.94% 83.71% 80.84% 82.40% 82.58% 83.48% 77.24% 84.60% 79.23% 86.09%

GP

Re

ferr

als

DN

A R

ate

s

The

atre

Uti

lisat

ion

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Theatre Utilisation

Day Main Trauma 2015/2016

0.0%

5.0%

10.0%

15.0%

DNA Rates

New Follow Up

Total Target

2015/2016 Total DNA's

0

1000

2000

3000

4000

5000

6000

GP Referrals Made & Seen

15/16 Made 15/16 Seen 14/15 Made 14/15 Seen

32 Page pg 75



Diagnostics

Comments:

Dia

gno

stic

Te

sts

ove

r 6

wee

ks (

DM

01

)

4.3%

1.5%

0.1% 0.1% 0.4%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

0

20

40

60

80

100

120

140

160


Pe

rce

nta

ge o

ver

6 w

ee

ks

No

. ove

r 6

we

eks

Target Actual Actual 2015/2016

33 Page pg 76



Regulatory Performance - ED

A&E All Types Benchmarking

A&E benchmarking Quarter % YTD %

93.41%Barnsley

Rotherham

90.67% 89.38%

92.67% 93.10%Doncaster & Bassetlaw

94.11%

92.01% 91.78%

A&

E 4

Ho

ur

Wai

tA

&E

4 H

ou

r W

ait

- B

en

chm

arki

ng

Sheffield Teaching

0

500

1000

1500

2000

2500 No. Ambulance Handover Times (pre-validated YAS)

No. under 15 mins No. between 15 & 30 mins

No. between 30 & 60 mins No. between 60 & 120 mins

No. over 120 mins Not recorded

5600

5800

6000

6200

6400

6600

6800

7000

7200

7400

7600

86%

88%

90%

92%

94%

96%

98%

100%

Within 4 Hours Total Attendances

Target % Achievement

34 Page pg 77



Regulatory Performance - 18 Week Referral to Treatment

As stated

RTT 18 Week Performance - August 2016Final Position

Specialty <18 >18 Total % <18 >18 Total % <18 >18 Total %

General Surgery 142 22 164 86.6% 375 16 391 95.9% 1815 125 1940 93.6%Urology 23 7 30 76.7% 132 5 137 96.4% 774 55 829 93.4%Trauma & Orthopaedics 174 13 187 93.0% 383 6 389 98.5% 1412 115 1527 92.5%ENT 44 29 73 60.3% 492 2 494 99.6% 1151 95 1246 92.4%Oral Surgery 56 9 65 86.2% 222 4 226 98.2% 870 62 932 93.3%General Medicine 8 0 8 100.0% 18 0 18 100.0% 93 5 98 94.9%Gastroenterology 11 0 11 100.0% 95 2 97 97.9% 822 71 893 92.0%Cardiology 1 0 1 100.0% 227 0 227 100.0% 609 10 619 98.4%Dermatology 84 3 87 96.6% 303 12 315 96.2% 1124 97 1221 92.1%Respiratory - - - - 45 2 47 95.7% 302 7 309 97.7%Rheumatology - - - - 64 0 64 100.0% 240 16 256 93.8%Geriatric Medicine 5 2 7 71.4% 63 1 64 98.4% 311 11 322 96.6%Gynaecology 110 7 117 94.0% 343 0 343 100.0% 694 15 709 97.9%Other 6 0 6 100.0% 303 4 307 98.7% 769 28 797 96.5%Total 664 92 756 87.8% 3065 54 3119 98.3% 10986 712 11698 93.9%

Co

nsu

ltan

t 1

8 W

ee

k R

efe

rral

to

Tre

atm

en

t

Admitted - Target 90% Non-Admitted - Target 95% Incompletes - Target 92%

75%

80%

85%

90%

95%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Pe

rce

nta

ge P

osi

tivi

ty

Non-Admitted Pathways

Actual Target

75%

80%

85%

90%

95%

100%

Pe

rce

nta

ge P

osi

tivi

ty

Incomplete Pathways

Actual Target

75%

80%

85%

90%

95%

100%A

pr-

16

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Pe

rce

nta

ge P

osi

tivi

ty

Admitted Pathways

Actual Target

35 Page pg 78



Regulatory Performance - Cancer

Bre

ast

Sym

pto

mat

ic

All

Can

cer

2 W

ee

k W

aits

31

Day

- S

ub

seq

ue

nt

Tre

atm

en

t (S

urg

ery

)

31

Day

- T

arge

ts

75%

80%

85%

90%

95%

100%

Pe

rce

nta

ge P

osi

tivi

ty

Actual Target

75%

80%

85%

90%

95%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Pe

rce

nta

ge P

osi

tivi

ty

31 Day Diagnostic to Treatment

Actual Target

75%

80%

85%

90%

95%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

Pe

rce

nta

ge P

osi

tivi

ty

31 Day Subsequent Treatment (Drugs)

Actual Target

75%

80%

85%

90%

95%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

Pe

rce

nta

ge P

osi

tivi

ty

31 Day Subsequent Treatment (Surgery)

Actual Target

75%

80%

85%

90%

95%

100%

Pe

rce

nta

ge P

osi

tivi

ty

Actual Target

36 Page pg 79




Comments

Can

cer

Pe

rfo

rman

ce b

y Tu

mo

ur

Site

62

Day

Can

cer

Targ

ets

62

Day

- S

cre

en

ing

Pro

gram

me

All Key Performance Indicators are compliant at August month end including the locally agreed Consultant Upgrade target.

62 Day GP referral to treatment target

In July there were 4 breaches of the 62 day GP referral to treatment target – 3 local and 1 shared breach. Breaches were as

follows:

CBU1

1 x Haematology – pathway commenced as Head and Neck and referral not made to haematology until after breach date.

Definitive breach reason was complex diagnostic pathway with multiple tests required to achieve definitive diagnosis.

CBU2

1 x Colorectal – Cancelled on day due to lack of HDU bed capacity but first definitive treatment was scheduled within original

threshold.

1 x Upper GI – Inter-provider transfer sent after 62 day breach date but analysis showed delays related to patient choice and

complexity in achieving definitive diagnosis

1 x Urology – Inefficient pathway. Analysis shows generally slow processes. Despite administrative tracking and chasing of pathway

elements there was a failure to escalate until post breach date. Patient then declared medically unfit.

Consultant Upgrades

In July there were 2 breaches of the 62 day Consultant Upgrade target. Breaches were as follows:

1 x Breast – Delays to scheduling and acting on pre-assessment

1 x Lung – Complex Diagnostic pathway

75%

80%

85%

90%

95%

100%A

pr-

16

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Pe

rce

nta

ge P

osi

tivi

ty

62 Day - Urgent GP Referral to Treatment

Actual Target

75%

80%

85%

90%

95%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

Pe

rce

nta

ge P

osi

tivi

ty

62 Day - Screening Programme

Actual Target

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pe

rce

nta

ge P

osi

tivi

ty

62 Day - Consultant Upgrades

Actual Target

2wwBreast

Symptom

First

Treatment

Subsequent

Treatment

GP Referral

to TreatmentScreening

Consultant

Upgrade

93% 93% 96% - 85% 90% 85%

Haematology 100.0% - 100.0% 100.0% 0.0% - -

Lung 100.0% - 100.00% - - - 0.0%

Skin 93.6% - 100.0% 100.0% 100.0% - -

Breast 95.5% 96.4% 100.0% 100.0% 100.0% 100.0% 0.0%

Head & Neck 96.4% - 100.0% - 100.0% - -

Lower GI 94.7% - 91.7% 100.0% 84.6% 100.0% -

Upper GI 97.0% - 100.0% - 0.0% - -

Urology 98.5% - 91.7% 100.0% 88.2% - -

CBU 3 Gynae 90.3% - 100.0% - 100.0% 100.0% -

Aug-16 95.3% 95.5% 100.0% 100.0% 87.8% 100.0% 87.5%

Jul-16 95.4% 96.4% 97.2% 100.0% 91.4% 100.0% 0.0%

Jun-16 93.3% 95.2% 98.6% 100.0% 88.5% 100.0% 90.9%

May-16 95.1% 92.7% 100.0% 100.0% 79.2% 90.9% 75.0%

Apr-16 93.9% 85.3% 98.7% 100.0% 84.4% 100.0% 80.0%

Mar-16 93.0% 87.9% 98.8% 100.0% 91.5% 100.0% 94.4%

Feb-16 92.1% 87.3% 100.0% 100.0% 89.9% 100.0% 100.0%

Jan-16 92.8% 91.0% 97.4% 90.0% 89.5% 100.0% 81.3%

Dec-15 95.0% 89.0% 94.9% 100.0% 85.9% 100.0% 87.0%

Nov-15 95.8% 90.4% 100.0% 100.0% 85.1% 85.7% 80.0%

Oct-15 98.0% 98.9% 100.0% 100.0% 89.2% 100.0% 100.0%

Sep-15 96.5% 98.1% 97.3% 100.0% 85.3% 100.0% 92.3%

2 Week 31 Day 62 Day

Jul-16

Target

Trustwide

CBU 1

CBU 2

Tumour Site

37 Page pg 80




Comments

Can

cer

Shar

ed

Pat

hw

ay P

erf

orm

ance

Latest shared referral performance for August shows improvement from previous months (excluding June which was exceptionally high) and is moving towards the required position of

85% of referrals by day 38. This included lung and gynaecology pathways and is encouraging. Work remains on-going at network level regarding inter-provider transfers and the

implementation of the revised breach allocation policy by October 2016.

38 Page pg 81



Regulatory Performance - Breast Cancer Screening

Comments:

Scre

en

ing

to is

sue

of

no

rmal

re

sult

s

<=2

we

eks

Scre

en

ing

to 1

st a

sse

ssm

en

t

Scre

en

ing

to o

ffe

r o

f 1

st a

sse

ssm

en

t

<=3

we

eks

30%

40%

50%

60%

70%

80%

90%

100%P

erc

en

tage

Po

siti

vity

Actual Target

30%

40%

50%

60%

70%

80%

90%

100%

Pe

rce

nta

ge P

osi

tivi

ty

Actual Target

75%

80%

85%

90%

95%

100%

Pe

rce

nta

ge P

osi

tivi

ty

Actual Target

39 Page pg 82

Performance Matters Data QualityUncoded Episodes (As at 16th September 2016)

Treatment Specialty August September Total Specialty August September Total

ACCIDENT AND EMERGENCY 79 79 1 1

BREAST SURGERY 10 10 3 19 22

CARDIOLOGY 9 40 49 3 3

CLINICAL HAEMATOLOGY 5 17 22 1 1

CLINICAL ONCOLOGY 12 12 4 22 26

COLORECTAL SURGERY 6 6 1 1

DERMATOLOGY 4 32 36 13 13

DIABETIC MEDICINE 2 6 8 4 4

ENDOCRINOLOGY 6 13 19 1 5 6

ENT 32 32 6 6

GASTROENTEROLOGY 3 62 65 25 25 50

GENERAL MEDICINE 47 206 253 3 3

GENERAL SURGERY 1 128 129 6 6

GERIATRIC MEDICINE 1 2 3 1 1

GYNAECOLOGY 1 31 32 4 55 59

NEONATOLOGY 7 17 24 2 2

OBSTETRICS 15 70 85 14 14

OPHTHALMOLOGY 1 44 45 2 2

ORAL SURGERY 15 15

PAEDIATRIC ENT 9 9 Comments

PAEDIATRICS 29 29

PAEDIATRIC T&O 0

PAEDIATRIC OPHTHALMOLOGY 1 1

RESPIRATORY MEDICINE 2 16 18

RHEUMATOLOGY 3 3

Stroke Medicine 2 5 7

TRAUMA AND ORTHOPAEDICS 5 100 105

UROLOGY 31 31

VASCULAR SURGERY 3 3

WELL BABIES 6 32 38

Total 117 1051 0 0 1168

Missing Outcomes

DERMATOLOGY

CLINICAL HAEMATOLOGY

CARDIOLOGY

ANTICOAGULANT SERVICE

ACCIDENT AND EMERGENCY

GYNAECOLOGY

GENERAL SURGERY

GENERAL MEDICINE

ENDOCRINOLOGY

DIABETIC MEDICINE

PAEDIATRICS

PAEDIATRIC DERMATOLOGY

ORTHODONTICS

ORAL SURGERY

OBSTETRICS

Uncoded Episodes - All episodes for January, February, March, April, May, June & July have

been coded.

There are 117 uncoded for August 2016 and 1051 for September 2016.

Overall there are 1168 uncoded episodes for 16/17.

RHEUMATOLOGY

PRE-ASSESSMENT

PHYSIOTHERAPY


40 Page pg 83

Performance Matters A

dm

itte

d P

atie

nt

Car

e C

DS

Barnsley is currently unable to flow the RTT patient pathway data in the APC & OP datasets, hence the

reduced data quality score.

Ad

mit

ted

Pat

ien

t C

are

CD

SA

dm

itte

d P

atie

nt

Car

e C

DS


99.6% 99.3% 98.3% 98.1% 94.7%

82.3%

96.5% 98.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Doncaster &Bassetlaw

SheffieldChildren's

SheffieldTeaching

Rotherham Barnsley RDASH St Luke'sHospice

NationalAverage

Area Team

Data validity summary average of all fields in SUS Dashboard April-July 2016

99.8% 99.7% 99.9% 99.8% 99.6% 99.5%

0.0%

99.2% 99.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

NHS Number

100.0% 100.0% 100.0% 100.0% 100.0% 99.9%

0.0%

99.9% 100.0%

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

100.0%

Registered GP Practice 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

0.0%

99.8% 99.8%

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

100.0%

Postcode

41 Page pg 84

Performance Matters Data Quality - Secondary Uses Service (SUS) Dashboard

Ou

tpat

ien

ts C

DS

Ou

tpat

ien

ts C

DS

Ou

tpat

ien

ts C

DS

Ou

tpat

ien

ts C

DS


99.9% 99.8% 99.9% 99.9% 99.7% 99.4% 99.9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Barnsley SheffieldChildren's

SheffieldTeaching

Rotherham Doncaster &Bassetlaw

NationalAverage

Area TeamAverage

NHS Number 100.0% 100.0% 100.0% 100.0% 100.0% 99.8% 100.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%


SheffieldTeaching


NationalAverage

Area TeamAverage

Registered GP Practice

99.9% 100.0% 100.0% 100.0% 100.0% 99.8% 99.9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%


SheffieldTeaching


NationalAverage

Area TeamAverage

Postcode

95.6% 100.0% 100.0% 99.4% 98.4% 97.2% 99.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%


SheffieldTeaching


NationalAverage

Area TeamAverage

Attendance Outcome

42 Page pg 85

Performance Matters

Data Quality - Secondary Uses Service (SUS) Dashboard

Acc

ide

nt

& E

me

rge

ncy

CD

SA

ccid

en

t &

Em

erg

en

cy C

DS

Acc

ide

nt

& E

me

rge

ncy

CD

SA

ccid

en

t &

Em

erg

en

cy C

DS


99.3% 99.6%

99.3%

93.6%

97.6%

96.3%

98.0%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%


SheffieldTeaching


NationalAverage

Area TeamAverage

NHS Number

95.6%

100.0% 100.0%

98.4%

99.9%

98.8%

99.6%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%


SheffieldTeaching


NationalAverage

Area TeamAverage

Registered GP Practice

99.9% 100.0% 100.0%

98.2%

100.0%

99.3%

97.6%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%


SheffieldTeaching


NationalAverage

Area TeamAverage

Postcode 100.0% 100.0% 100.0%

99.4% 99.9%

97.7%

96.3%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%


SheffieldTeaching


NationalAverage

Area TeamAverage

Attendance Disposal

43 Page pg 86

Performance MattersActivity

15/16 16/17 16/17

Actual Plan Actual Variance %

Elective Day cases 9,745 9,806 10,053 247 3%

Elective Inpatients 1,726 1,749 1,715 -34 -2%

Elective Total 11,471 11,554 11,768 214 2%

Non Elective 14,915 14,750 14,572 -178 -1%

Maternity Pathway 2,479 2,661 2,771 110 4%

A&E Attendances 33,678 34,713 35,344 631 2%

Outpatients 96,828 100,332 108,227 7896 8%

* Please note excess bed days are not included in these figures. 2016/17 Activity Plan

2016/17 Activity Actual

2015/16 Outturn

2016/17 Activity Plan 2016/17 Activity Plan

2016/17 Activity Actual 2016/17 Activity Actual

2015/16 Outturn 2015/16 Outturn

Act

ivit

y

Day

Cas

es

Obstetric outpatient attendances are excluded as they are covered by the Maternity Pathways

Ele

ctiv

e In

pat

ien

ts

No

n-E

lect

ive

Inp

atie

nts


0

500

1000

1500

2000

2500

Apr May June July Aug Sept Oct Nov Dec Jan Feb March

Act

ivit

y

Month

Day Cases

0

50

100

150

200

250

300

350

400

450


Act

ivit

y

Month

Elective Inpatients

0

500

1000

1500

2000

2500

3000

3500


Act

ivit

y

Month

Non-Elective Inpatients

44 Page pg 87

Performance MattersActivity

2016/17 Activity Plan 2016/17 Activity Plan

2016/17 Activity Actual 2016/17 Activity Actual

2015/16 Outturn 2015/16 Outturn

Comments:

2016/17 Activity Plan

2016/17 Activity Actual2015/16 Outturn

Ou

tpat

ien

tsM

ate

rnit

y P

ath

way

A&

E A

tte

nd

ance

s

Main areas of overperformance are Outpatients and A&E. Main area of underperformance is Non-Elective Inpatients.

Outpatients:- areas of underperformance with the highest variances (against aggregated attendances and procedure plans) in

Gynaecology -720, Clinical Heamatology -277, and General Medicine -210. Overperforming are Cardiology 1109, Diabetic

Medicine 1255, T&O 1107 and Gastroenterology 777. Non-Elective Inpatients:-

General Medicine, Paediatrics, General Surgery, Gynaecology & Cardiology are the main areas of underperformance.


0

100

200

300

400

500

600

700


Act

ivit

y

Month

Maternity Pathway

0

1000

2000

3000

4000

5000

6000

7000

8000


Act

ivit

y

Month

A&E Attendances

0

5000

10000

15000

20000

25000


Act

ivit

y

Month

Outpatients

45 Page pg 88

Performance - "At a glance"

Month

Plan

Month

Actual

Variance

%Variance Plan YTD

Actual

YTD

Variance

%Variance

Month

Plan

Month

ActualVariance % Variance

Plan

YTD

Actual

YTD

Variance

%Variance

ACTIVITY LEVELS (PROVISIONAL) £'000 £'000 £'000 £'000 £'000 £'000

Elective inpatients 332 299 -9.94% -33 1,749 1,715 -1.94% -34 EBITDA -566 -484 14.49% 82 -1,450 -1,112 23.31% 338

Day Cases 1,863 2,003 7.51% 140 9,808 10,053 2.50% 245 Depreciation -404 -389 3.71% 15 -1962 -1922 2.04% 40

Non-elective inpatients 2,850 2,802 -1.68% -48 14,760 14,614 -0.99% -146 Restructuring & Other -14 1 107.14% 15 -156 -139 10.90% 17

Outpatients 18,914 20,725 9.57% 1,811 99,449 107,227 7.82% 7,778 Financing Costs -189 -216 -14.29% -27 -944 -1012 -7.20% -68

A&E 6,746 6,816 1.04% 70 34,713 35,344 1.82% 631 SURPLUS/(DEFICIT) -1,173 -1,088 7.25% 85 -4,512 -4,185 7.25% 327

'Clinical' Activity

Other (excludes direct access tests) 9,919 10,100 1.82% 181 51,994 52,161 0.32% 167 SOFP £'000 £'000 £'000 £'000 £'000 £'000

Total activity 40,624 42,745 5.22% 2,121 212,473 221,114 4.07% 8,641 Capital Spend -296 -75 -74.66% 221 -3,009 -1,129 -62.48% 1,880

Inventory 2,161 2,116 2.08% 45

CIP £'000 £'000 £'000 £'000 £'000 £'000 Receivables & Prepayments 8,053 12,427 -54.32% -4,374

Income 158 207 31.01% 49 614 759 23.62% 145 Payables -13,440 -14,932 11.10% 1,492

Pay 136 58 -57.35% -78 522 179 -65.71% -343 Accruals -4,764 -5,091 6.86% 327

Non-Pay 190 255 34.21% 65 731 692 -5.34% -39 Deferred Income -592 -607 2.53% 15

Total CIP 484 520 7.44% 36 1,867 1,630 -12.69% -237

Cash & Loan Funding £'000 £'000 £'000 £'000 £'000 £'000

INCOME £'000 £'000 £'000 £'000 £'000 £'000 Cash 2,157 2,644 22.58% 487

Clinical (Activity) 8,778 9,164 4.40% 386 45,694 46,961 2.77% 1,267 Loan Funding -43,750 -44,489 -1.69% -739

Other Clinical 4,142 4,296 3.72% 154 20,923 21,661 3.53% 738

CQUINS 289 289 0.00% 0 1,445 1,445 0.00% 0 KPIs

Risks & Penalties 0 -54 -54 0 -275 -275 EBITDA % -3.79% -3.10% -18.26% 3.79% -1.89% -1.42% 24.97% 0.47%

Non Recurrent Income 142 303 161 709 722 13 Deficit % -7.85% -6.96% 8.81% 0.69% -5.89% -5.35% 9.26% 0.55%

Other 1,596 1,639 2.69% 43 7,785 7,737 -0.62% -48 Receivable Days 15.6 24.1 -54.32% -8.5

Total income 14,947 15,637 4.62% 690 76,556 78,251 2.21% 1,695 Payable (excluding accruals) Days 66.1 73.4 11.10% 7.3

Payable (including accruals) Days 89.5 98.4 9.99% 9

OPERATING COSTS £'000 £'000 £'000 £'000 £'000 £'000 Financial Sustainability Risk Rating 1 2 100.00% 1

Pay -10,346 -10,793 -4.32% -447 -51,954 -52,360 -0.78% -406

Drugs -1,243 -1,149 7.56% 94 -6,224 -5,874 5.62% 350

Non-Pay -3,924 -4,179 -6.50% -255 -19,828 -21,129 -6.56% -1,301 Consolidated

Total Costs -15,513 -16,121 -3.92% -608 -78,006 -79,363 -1.74% -1,357 excl charity

Payable days are total op exps, less total pay, add back lead units and agency control total

Performance - Financial Overview Performance - Financial Overview


46 Page pg 89

Performance Matters - Finance

August 2016 Summary

Summary Performance:


Commentary Key to RAG Rating The RAG rating applied to Variance % is based on the following criteria: • Green equating to 0% or greater • Amber behind plan by up to 5% • Red greater than 5% behind plan

The key points derived from this table are as follows: • Total activity is favourable to plan year to date excluding Direct Access. The main driver is overperformance on Outpatient activity. Direct Access tests were excluded from the Other

activity because large variances in these figures skew the overall activity variance.

• CIP achievement is adverse to plan by £0.24m. The main driver for this is on pay schemes

• Clinical activity based income is £1.3m favourable to plan before risks and penalties. The main variances are Outpatients income £0.85m favourable to plan. Other clinical income is £0.74m ahead of plan.

• Other income is £0.05 adverse to plan.

• Operating costs are adverse to plan. Pay is £0.4m adverse. Agency costs covering vacant posts create a cost pressure, although the costs year to date are significantly lower than at this point last year.

• Non-pay costs total are £0.95 adverse to plan, which links to activity.

• EBITDA is £0.34m above plan.

• Depreciation, restructuring and finance costs are broadly to plan.

• The overall deficit is £0.33m favourable to plan.

• Capital expenditure is £1.88m favourable to plan.

• Inventory is £0.05m below plan.

• Total receivables incl. prepayments are £4.4m adverse to plan. Action is being taken to address this position.

• Total payables incl. accruals are £1.5m favourable to plan .

• Deferred income is on plan.

• Cash is £0.5m favourable to plan.

• Debtor days are 24.1 year to date, which is 8.5 days adverse to plan.

• Payable days 73.4 year to date which is 9 days higher than plan (down from 10 days at month 4). Payable days have been calculated excluding accruals, because whilst accruals include certainties in respect of future payments, the timing of these payments is uncertain.

• The Financial Sustainability rating is a 2 at month 4.

47 Page pg 90

Performance Matters (Financial Overview)

Comments:

Clinical income per day - this is ahead of plan for August 2016

Act

ual

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me

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alys

is

Clin

ical

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me

Pe

r D

ay

Pay

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Income analysis - this graph analyses the split of income on a monthly basis and

demonstrates the variability of clinical income.

Pay as a % of clinical income is slightly below plan for August 2016


0

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Actual Income Analysis

Clinical Non Recurrent Income Other

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Apr-16 Jun-16 Aug-16 Oct-16 Dec-16 Feb-17

%

Pay as a % of Income

Pay as a % of Income Plan Pay as a % Plan Income

48 Page pg 91

Performance Matters (Financial Overview)


Comments:

CIP is adverse to plan at month 5.

Age

ncy

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Agency monthly spend - Total agency spend ytd is £1.93m. Agency expenditure is

reviewed in depth.

Deficit trend analysis - this graph highlights the gap between plan and actual at month 5.

Currently the Trust deficit is below plan.

0

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CIP Actual CIP Plan

-9

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Deficit Trend Analysis

Deficit Plan Deficit

49 Page pg 92

EXECUTIVE SUMMARY

RECOMMENDATIONS

STRATEGIC CONTEXT

REPORT TO THE BOARD OF DIRECTORS REF: BoD /16/10/15 SUBJECT: HORIZON SCANNER DATE: OCTOBER 2016

PURPOSE:



PREPARED BY: EMMA PARKES, DIRECTOR OF MARKETING & COMMUNCATIONS

SPONSORED BY: DIANE WAKE, CHIEF EXECUTIVE

PRESENTED BY: EMMA PARKES, DIRECTOR OF MARKETING & COMMUNICATIONS

To provide a brief overview of key developments and initiatives across the national and regional healthcare landscape which may impact or influence the Trust’s strategic direction.

Summary of content for September 2016:

• MY NHS/NHS Choices • National Planning Guidance (April 2017 – March 2019) • More GPs needed as 600 practices face closure • NHS England issues STP Consultation Guidance • Publication of Single Oversight framework • Capital Spending Plans Stretched • NHSI considering a new category of special measures for trusts with poor 4hr

performance • NHSI Guidance on reducing locum spend – Barnsley Hospital is a positive example

The Board of Directors is asked to receive the contents of this report for information.

BoD Oct 2016 / Horizon Scanner

Page pg 93

Subject: INTELLIGENCE MONITORING/HORIZON SCANNING OCTOBER 2016 Ref:

*please note that this is not an exhaustive report, submissions welcome to [email protected] Publication Detail Impact/ Action/

Owner / Will Board be involved?

My NHS/NHS Choices

MY NHS: All indicators ‘OK’ - Recommended by staff; Open and honest reporting; Infection control and cleanliness; Mortality rate; Food: Choice and Quality. NHS Choices User Rating – 3.5* (5* is Excellent) Feedback Fantastic staff – 5 STARS Been to Barnsley hospital today to the endoscopy unit and was seen by two of the most professional people I have come across. Both fantastic at there job they put me at ease from the moment that I arrived. Many thanks. Visited in September 2016. Treatment of my wife in A@E – 5 STARS My wife visited the Hospital today and on her behalf we would like to state that the staff could not do enough they were extremely polite, friendly and very knowledgeable. They put my wife at ease. On the occasions that I have had to visit personally I have to say that I have the same opinion. Excellent Visited in September 2016. Left Clavicle fracture - open reduction/internal fixation – 5 STARS Underwent this tricky procedure 24/25-09-2016. All staff were superb. The care and professionalism was World Class. A great team, and great banter, I felt I was always their only patient (I clearly wasn't). The procedure and risks were clearly explained all my queries were answered. I will certainly be recommending Barnsley to others. Visited in September 2016.

Potential impact on reputation / All postings responded to / Board to note for information

National issue

National Planning Guidance (April 2017 – March 2019) NHS England and NHS Improvement publish planning guidance, setting out the new orders and priorities for STPs, providers and CCGs. Commissioner and provider plans need to demonstrate how they will deliver these nine ‘must-dos’. 1. STPs – includes: Implement agreed STP milestones, on track for full achievement by 2020/21, and achieve agreed trajectories against the STP core metrics set for 2017-19. 2. Finance – includes: Deliver individual CCG and NHS provider organisational control totals and achieve local system financial control totals. Also implement local STP plans, moderate demand growth, increase provider efficiencies, including Carter proposals. 3. Primary care – includes: Implement the General Practice Forward View, ensure local investment meets or exceeds minimum required levels. Increasing the number of doctors working in general practice, improve weekend and evening access, and Support general practice at scale and the expansion of MCPs or PACS.

Board to review


Page pg 94

Publication Detail Impact/ Action/ Owner / Will Board be involved?

4. Urgent & emergency care – includes: Deliver the four hour A&E standard and standards for ambulance response times. By November 2017, meet the four priority standards for seven-day hospital services for all urgent network specialist services. Implement the Urgent and Emergency Care Review. 5. Referral to treatment times and elective care – includes: Deliver the NHS Constitution standard that more than 92 per cent of patients on non-emergency pathways wait no more than 18 weeks from referral to treatment. Deliver patient choice of first outpatient appointment, and achieve 100% of use of e-referrals by April 2018 in line with the 2017/18 CQUIN. Implement the national maternity services review 6. Cancer – includes: Implement the cancer taskforce report. Deliver the NHS Constitution 62 day cancer standard. Make progress in improving one-year survival rates and ensure all elements of the Recovery Package are commissioned. 7. Mental health – includes: Deliver in full the implementation plan for the mental health five year forward view for all ages. Ensure delivery of the mental health access and quality standards including 24. Increase baseline spend on mental health and eliminate out of area placements for non-specialist acute care by 2020/21. 8. People with learning disabilities – includes: Deliver Transforming Care Partnership plans with local government partners, reduce inpatient bed capacity. Reduce premature mortality by improving access to health services, education and training of staff, and by making necessary reasonable adjustments for people with a learning disability or autism. 9. Improving quality in organisations – includes: Implement plans to improve quality of care, particularly for organisations in special measures.

National coverage

More GPs needed as 600 practices face closure Primary medical care will be short-staffed and unsafe for patients unless more GPs are recruited to address the shortfall in the service, the Royal College of General Practitioners (RCGP) has said, as it warned that nearly 600 practices are currently at risk of closure. The RCGP estimates that the number of full-time equivalent GPs across the UK has now fallen to just over 35,500, from almost 36,000 in 2013-14. It predicts that there could be a shortage of 9,940 GPs across the UK by 2020, leading to 594 practices which are now predominantly staffed by GPs aged over 55 closing as doctors retire. The RCGP has launched a new video and guide, both called ‘Think GP’, intended to encourage new doctors to work in general practice. The video and guide, aimed at medical students, foundation doctors and sixth form students, will strive to address the misconception that the role of a GP is somehow run-of-the-mill, with family doctors simply treating coughs and colds.

Board to note for information


Page pg 95

http://www.rcgp.org.uk/thinkGP

http://www.rcgp.org.uk/thinkGP


National coverage

NHS England issues consultation guidance for STP s All local health groups have been instructed to involve local people in consultations on their sustainability and transformation plans (STPs) in new guidance from NHS England. The guidance says footprints should engage with local people and public and patient groups via HealthWatch, starting once enough information is available to identify key stakeholders but before plans are published. Footprints should then develop engagement plans. It said a consultation is not needed for every service change, but will “likely be needed” when plans involve substantial changes to the configuration of health services in a local area, including hospital closure, or significant service change. This will also trigger the requirement to consult the local authority on substantial developments or variation in health services. STP footprints and membership organisations are recommended to take advice from a legal perspective if necessary, as well as consulting with local stakeholders. The consultation should involve a variety of methods, including digital involvement, face-to-face meetings, focus groups and meetings with specific communities, although the guidance cautioned that online methods are “unlikely to be accessible for all audiences”. In addition, the guidance said plans should be published in “jargon free and accessible language” so that people can participate meaningfully, and that the consultation should last for 12 weeks unless STPs can justify a shorter consultation period. https://www.england.nhs.uk/wp-content/uploads/2016/09/engag-local-people-stps.pdf

Board to monitor. Dir Marketing & Comms to review guidance requirements against local CCG STP engagement plans

National coverage

Single Oversight Framework Published NHSI has published its single oversight framework setting out the rules FTs and trusts will be assessed under now that Monitor and the NHS Trust Development Authority have merged. Providers will placed into one of four bands and rated as an organisation with: • no concerns; • some support needs; • significant concerns; or • major or complex concerns

To determine which band a provider is placed in, NHSI will judge them against criteria covering: quality of care; operational performance; leadership; strategic change, which includes their contribution to sustainability and transformation plans; and finance. Trusts with no concerns will be given “maximum autonomy” status and only monitored on a quarterly basis – the lowest level of regulatory oversight – and will also be expected to support other providers.

Board to review


Page pg 96

http://www.nationalhealthexecutive.com/Search/stps

https://www.england.nhs.uk/wp-content/uploads/2016/09/engag-local-people-stps.pdf

https://www.england.nhs.uk/wp-content/uploads/2016/09/engag-local-people-stps.pdf

https://improvement.nhs.uk/uploads/documents/Single_Oversight_Framework_130916.pdf


The lowest band will be reserved for trusts in special measures for financial or quality reasons. Providers with significant or major concerns that have breached, or are suspected of breaching, their licences will be given mandated support from NHSI. https://improvement.nhs.uk/resources/single-oversight-framework/?utm_campaign=1507515_Single%20Oversight%20Framework&utm_medium=email&utm_source=Monitor&utm_orgtype=FT&dm_i=2J9J,WB7F,4KV9DI,2FTOA,1

National coverage

NHS trusts have been told to scale back their capital spending plans and warned that the Treasury could insist on signing off even the smallest projects The regulator said trusts have forecast a combined capital spend of £4.3bn in 2016-17, against a provider sector budget of just £2.7bn. There is a growing backlog of maintenance problems on NHS estates, while many of the 44 regions drawing up a sustainability and transformation plan are likely to put forward a case for significant capital investment in order to transform services.

DoF to monitor

National coverage

NHS Improvement is considering a new category of “special measures” for trusts with the worst performance on high profile access targets such as accident and emergency The regulator is expected to make a decision as to whether to introduce the category for organisations which are seriously failing the target of seeing 95 per cent of attendances within four hours. The news comes as the NHS in England recorded the worst performance against the target since 2003, with 90.3 per cent of people attending A&E being seen within four hours in quarter one of 2016-17 (against a 94.1 per cent in Q1 2015/16).

Exec to monitor

National issue

NHSI - Reducing reliance on medical locums: a practical guide for medical directors The best practice guide goes through steps which medical directors could take to help reduce their trust's spend on medical locums. Barnsley hospital is highlighted as a positive example throughout for the work undertaken to reduce our spend.

Board to note for information


Page pg 97

https://improvement.nhs.uk/resources/single-oversight-framework/?utm_campaign=1507515_Single%20Oversight%20Framework&utm_medium=email&utm_source=Monitor&utm_orgtype=FT&dm_i=2J9J,WB7F,4KV9DI,2FTOA,1




https://www.hsj.co.uk/topics/finance-and-efficiency/trusts-make-do-and-mend-as-capital-investment-squeeze-hits-estates-repairs/5091788.article

https://www.hsj.co.uk/following-the-money-the-capital/7010336.article

https://www.hsj.co.uk/following-the-money-the-capital/7010336.article

Reducing reliance on medical locums: a

practical guide for medical directors

Page pg 98

Introduction

This best practice guide goes through steps which medical directors could

take to help reduce their trust's spend on medical locums. It includes a list against which you can check your trust is taking effective action and advice on where to start if you have yet to tackle your trust’s over-reliance on medical locums. It distils the experience of trusts that have substantially cut their spend on medical locums.

Trusts should only use locums as a last resort to fill short-term staffing gaps after other options have been exhausted. This is because:

• locums are an expensive solution to staffing shortages; the 2015/16 bill for medical locums in the NHS in England was £1.3 billion, representing over a third of agency spend, or £51 per taxpayer

• their overuse can put care quality at risk; a stable workforce whose members have regular appraisals is most likely to deliver high quality care and achieve continuity of services.

Maintaining a stable medical workforce is challenging: doctors are highly mobile and many specialties and parts of the country face a shortage of trained medical staff. National action is being taken to tackle these shortages, but every trust needs to take steps now to wean itself from an over-reliance on medical locums filling short-term and long-term gaps. Better deployment of the existing workforce, led by medical directors, is key.

2

Some trusts are substantially

reducing medical locum spend

• Barnsley Hospital has reduced weekly medical locum spend by 40% between October 2015 and April 2016.

• East Cheshire Hospital has halved its weekly number of medical and dental price cap overrides since February 2016, despite the price cap reduction in April 2016.

• Barts has adjusted its temporary medical staff use from 50% bank, 50% locum in May 2015 to 65% bank, 35% locum in May 2016.

Page pg 99

Six steps to reducing reliance on locums

3

1

2

3

Medical directors take greater control of workforce deployment, locum use and spending

Collect timely and accurate data

Develop alternatives to using locums

4

5

6

Introduce formal processes for requesting locums

Reduce future reliance on locums

Work supportively with local neighbours

Page pg 100

Checklist: has your trust taken these actions?

4

FOR AN IMPACT IN 3-6 MONTHS FOR AN IMMEDIATE IMPACT

STEP 1. Ensure that board accountability for locum spend is clearly defined and adequate management resources are allocated. A senior manager should be responsible for reducing medical locum spend (usually this is the medical director, supported by the finance director and HR director).

STEP 2. Collect weekly data on locum usage for all specialties and develop reporting templates and metrics, eg:

1 page monthly summary for the board 2–3 page weekly reports for the medical director, finance director and HR director.

STEP 3. Develop consistent policies on finding

alternatives to using locums, and encourage buy-in from all teams:

Share staff between specialties Establish and promote use of internal banks Flexibly deploy different grades of staff.

STEP 4. Establish processes for approving locum use: Standard form and checklist (preferably online) for requesting locum shifts A senior panel reviews locum requests and only a limited number of senior staff can approve requests Centralised locum booking and price negotiation.

STEP 6. Set up a working group led by executives from trusts across your local area to collectively tackle locum

spend. The group should decide: Consistent approaches to using frameworks, employing locums and using price overrides Common narrative when communicating with agencies and agency workers across the local area How to share staff.

STEP 5. Identify underlying staffing issues and develop

solutions: Identify current and future staffing gaps by analysing workforce demand and capacity. This work should be led by senior clinical staff. Review and simplify recruitment processes Support staff to develop new operating models and innovative approaches to recruitment and retention Actively involve the board in workforce planning.

Page pg 101

Medical directors take greater control of workforce

Leadership must start right at the top with the chief executive and the medical director. What does leadership involve?

• Agreeing a plan with the board for achieving or maintaining sustainable medical staffing.

• Being informed about workforce issues by getting the right information through a clear governance process.

• Ensuring staff know where decision-making responsibility sits and are confident in the support of their executive and board when taking steps to reduce reliance on medical locums.

Medical directors with a good grasp of their trust’s use

of medical locums should be able to answer the

following questions:

• How many locum doctors were employed by your trust last week and why were they needed?

• Which locums are most expensive? • Which services are most dependent on locums for their

staffing?

5

Medical directors need to be confident in the following

processes for an effectively deployed workforce:

• You have control over the mechanism for using locums with a senior person signing off all spend.

• You have effective workforce planning – do you know how many medical staff are required for each specialty?

• Your trust exhausts all alternatives before using a medical locum.

• You work with your neighbours to get locums at best value.

STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 STEP 6

GET STARTED

Ensure that board accountability for locum spend is clearly defined and adequate management resources are allocated. A senior manager should be responsible for reducing medical locum spend (usually this is the medical director, supported by the finance director and HR director).

Case study: Establishing clear lines of governance

The Paybill Reduction Group at East Cheshire consists of the HR director, finance director, deputy medical director and a senior nurse. The group meets weekly to review data, policies and processes on establishment, recruitment and retention, staff costs and agency booking trends, and commissions reviews of workforce policies and processes (eg leave booking processes). Since it was set up, the group has significantly improved the quality of data collected and harmonised rostering, leave and agency booking processes to improve staff deployment across the trust.

Page pg 102

Collect timely and accurate data

Case study: Software packages can collate and present

data on locum use

Example

dashboard

included

in pack

Just collecting data is not enough. Its presentation must send clear messages to clinical teams, eg flagging payments above the agency price caps.

Timely and accurate data, presented in a helpful way, can uncover real-time ward-level issues and solutions, such as: • staff shortage hotspots – specialties and grades where

services are at greatest risk, and causes that need to be addressed

• expensive and career locums who should be encouraged to take permanent roles

• best value methods for obtaining locum cover • individuals working unsafe hours. Good data can also hold senior managers to account for locum use and spending, and help staff develop solutions suited to their own specialties.

6


GET STARTED

Collect weekly data on locum usage for all specialties: Develop clear reporting templates and metrics:

1 page monthly summary for the board 2–3 page weekly reports for the medical director, finance director and HR director.

Specialty/ward/grade Date/time of shift Price paid for shift Method of engagement

Reason (eg sickness) Date of approval Name of approver Name of locum

Case study: One trust found evidence of locum misuse

once they started collecting good quality data,

including:

• locums paid over £10,000 per week • locums working over 4,000 hours per year • positions filled by locums (sometimes the same locum)

for 3 years or more • locum shifts booked more than 6 months in advance.

Page pg 103

Develop alternatives to using locums

While every trust will face long-term and short-term workforce challenges, using a locum should always be a last resort after alternatives have been explored. First: move medical staff across wards

Barnsley Hospital uses a simple ‘heat map’ to identify staff surpluses (green) on the rota that can be reallocated to meet shortages (red) on other wards. Implementing electronic rostering or using existing rostering more effectively will identify surpluses and shortfalls. You may be able to schedule a “floating week” in your junior doctor rotas, which will allow you to move staff between wards to cover exceptional periods. Doctors like this arrangement but you may need approval from deaneries/foundation schools.

7


Second: promote internal banks

Always use internal bank staff if available before resorting to locum staff. Trusts can increase participation in banks through: • auto-enrolment of staff • weekly payment for shifts, rather than monthly • active recruitment of non-substantive doctors to banks,

eg some trainees will want temporary work from a trust after their placement ends. Non-substantive staff often choose to do more bank hours than substantive staff.

Trusts can promote bank staff use among managers by simplifying the engagement process – it must be easier to request bank staff than locum staff.

Third: use different grades of doctors

East Cheshire’s Deputy Medical Director asks divisional clinical leads to step down to provide clinical cover when an alternative to a locum or a locum at below price cap rates cannot be found. This approach can be more cost-effective than resorting to locums and reduces clinical risk to the trust.

Monday Tuesday Wednesday Thursday Friday Minimum Rota Adj Rota Adj Rota Adj Rota Adj Rota Adj

Ward 1 2 4 3 3 3 1 2 3 2 3 2 Ward 2 3 1 3 2 3 4 3 4 3 3 3 Ward 3 1 1 1 1 1 0 1 1 1 1 1 Ward 4 3 4 3 5 4 4 3 1 3 2 3

GET STARTED

Develop consistent policies on finding alternatives to using locums, and encourage buy-in from all teams:

Share staff between specialties Establish and promote use of internal banks Flexibly deploy different grades of staff.

Page pg 104

GET STARTED

Establish processes for approving locum use: Standard form and checklist (preferably online) for requesting locum shifts A senior panel reviews locum requests and only a limited number of senior staff can approve requests Centralised locum booking and price negotiation.

Introduce formal processes for requesting locums

A trust’s process for requesting medical locum cover needs to be documented and all teams informed about it. The process should challenge clinical leads to consider if cover is really needed. Where it is, the process should support clinical leads in making sure all alternatives are first ruled out and in getting the best value.

8


Case study: Standardised forms and panels for locum

requests

Medical teams at Barnsley Hospital must submit a locum

request form in advance of making a booking, regardless of the price to be paid.

Barnsley locum request form – full template on page 12

A locum review panel, consisting of the medical director, finance director and HR director, then scrutinises each request. Divisional clinical leads must attend to justify their locum requests. The trust found that by implementing a form and requiring managers to justify their requests to a panel, managers gave more thought to whether a locum was really needed. The panel initially met daily but now meets fortnightly with the establishment of the system the number of requests has fallen. Larger trusts may prefer to set up similar panels in each hospital or only scrutinise a sample of requests in this way.

Case study: Centralised locum booking and payment

Derby has centralised its locum booking. The dedicated central team negotiates agency rates for all divisions, using the agency price caps as a negotiation tool. This is a model developed from that used by the nursing directorate; the central booking team now covers both medical and nursing bookings. A central team is also well placed to collate and present the data required to keep track of progress.

Page pg 105

Reduce future reliance on locums

9


GET STARTED

Identify underlying staffing issues and develop solutions: Identify current and future staffing gaps by analysing workforce demand and capacity. This work should be led by senior clinical staff. Review and simplify recruitment processes Support staff to develop new operating models and innovative approaches to recruitment and retention Actively involve the board in workforce planning.

High locum usage should prompt managers to look for ways to plan their workforce better. Start with a staffing stocktake – divisions need to do

proper demand and capacity analysis and workforce

planning.

Workforce planning needs to: • start from future demand and commissioning intentions

for the service • be informed by good data on workload • be done by a team of senior clinical leads and service

managers. NHS Employers provides a guide to workforce planning and runs courses to support medical directors and consultants.

Case study: Innovative approaches to recruitment

Dr Dan Boden, Emergency Medicine Consultant at Derby Hospital, set up Certificate of Eligibility for Specialist Register (CESR) posts as a response to high vacancy and sickness rates at junior doctor level. These provide professional development and progression for junior doctors outside an official training programme through mentoring, protected training time and budget, and rotations across other specialities. The trust now has a waiting list of junior doctors wanting to work in the ED, significantly improved job satisfaction and reduced sickness rates. Listen here to Dr Boden talk about the scheme and its impacts.

Case study: Introducing new staffing models

University Hospitals of Leicester assembled a team of advanced nurse practitioners and specialist nurses in cardiology and respiratory medicine to work in its busy cardiorespiratory admissions unit. Leicester is piloting a model in which these staff work with a GP to assess those patients who are unlikely to require admission to an ambulatory clinic. This has freed medical staff to spend more time on complex cases and improving patient care.

Page pg 106

http://www.nhsemployers.org/your-workforce/pay-and-reward/nhs-terms-and-conditions/consultants-and-dental-consultants/consultant-job-planning-toolkit

http://www.gmc-uk.org/doctors/24630.asp

http://www.gmc-uk.org/doctors/24630.asp

http://www.workcast.com/?pak=2079445618044693&cpak=9747167076605020

Work supportively with your local neighbours

10


Case study: Aligning locum request and override

principles across local trusts

Bedfordshire and Hertfordshire have developed cross-trust working groups to voluntarily agree common policies and procedures, including: • common narrative when communicating with agency

workers and agencies • aligned governance processes around overrides and a

common approach to overrides where needed on safety grounds

• use of the same frameworks across the area • a policy of not using substantive/bank staff from a

neighbouring trust to encourage workers to work for their own trust’s bank

• running mini competitions to lower the rates paid for agency workers. The hub has set up a system where agencies that can supply medical staff at or below 1 April price cap levels are awarded ‘tier 1 status’ and receive more advanced notice of shifts.

They have formed working groups for different staff groups to raise and tackle shared issues, such as problems with specific agencies. They have been able to make good progress on their total agency spend because of the senior buy-in from the trusts.

Trusts can reduce their reliance on locums by acting individually, but more can be achieved through working with other trusts in your local area to better understand demand and supply of staff and to keep down locum prices. This is particularly important for medical locums who are often more mobile than agency nurses.

GET STARTED

Set up a working group led by executives from trusts across your local area to collectively tackle locum spend. The group should decide on:

Consistent approaches to using frameworks, employing locums and using price overrides Common narrative when communicating with agencies and agency workers across the local area How to share staff.

Page pg 107

Case study:

Barnsley Hospital NHS Foundation Trust

11

How did Barnsley do it?

When the medical director started collecting medical staffing information to present to the board (similar to the nursing staffing ratios the nursing director provided), he realised that medical locum usage was very high and that reliance on locums had become the norm in some specialities, such as emergency medicine. Some of this was due to fundamental supply shortages but in other cases it was driven by culture. The medical director introduced: 1. real-time, ward-level information on staffing levels which

is used to construct ‘heat-maps’ of staffing issues 2. a locum request panel made up of senior staff and

chaired by the medical director to challenge locum requests, and to prompt divisional clinical leads and managers to think whether locums were actually required

3. a locum request form that forced clinical and operational leads to think about alternatives before resorting to locum use

4. a recruitment drive targeted at gaps identified from the data and locum request panel process, to reduce reliance on temporary staffing. Some specialties had previously been unsuccessful in recruiting to middle-grade and junior doctor rotas and had started to rely on locums instead of continuing to try and recruit substantively. These posts were again put out to recruitment with success in many specialties. No incentives were used to recruit staff.

Barnsley Hospital NHS Foundation Trust is a small single site DGH in South Yorkshire. It is close to the M1 motorway with around 15 other hospitals within a 1 hour drive distance. The trust has reduced both the number of shifts and prices paid per shift at consultant level and prices paid per shift at SHO level. The trust still faces challenges in recruiting middle-grade doctors. Barnsley is targeting further reductions in medical agency spend in 2016/17 through alterative workforce solutions and employment of flexible cover doctors linked to in-house training opportunities.

Page pg 108

Case study:

Barnsley’s locum request form

12

Page pg 109

REPORT TO THE BOARD OF DIRECTORS REF: BOD 16/10/12

SUBJECT: WORKING TOGETHER COMMISSIONERS – PUBLIC CONSULTATIONS AND PROPOSALS FOR SERVICE CHANGE

DATE: SEPTEMBER 2016

PURPOSE:



PREPARED BY: STP COMMISSIONER COLLABORATION

SPONSORED BY: STEPHEN WRAGG, CHAIRMAN DIANE WAKE, CEO

PRESENTED BY: DIANE WAKE, CEO STRATEGIC CONTEXT The Trust is a member of the Working Together programme. This report is intended to update Board members regarding forthcoming public consultations led by the Working Together Commissioners relating to proposed service changes in two areas:

• Children’s surgery and anaesthesia • Hyper acute stroke

The proposals will directly affect services provided by Barnsley and are likely to require important service changes and responses to new models of care should they be approved following public consultation. EXECUTIVE SUMMARY Background Services are being reviewed as part of work being carried out by Commissioners Working Together. Over the past year commissioners, working with providers, have been discussing hyper acute stroke care and children’s surgery and anaesthesia. This has been undertaken in the context of workforce concerns as well as benchmarking against service specifications and outcomes in South Yorkshire compared to elsewhere. Senior clinicians and managers from each of the Trusts were asked to assess themselves against national core standards for providing services, and gather data on numbers of people needing the services and staffing levels. Proposals Hyper Acute Stroke Services With hyper acute stroke services, the commissioners, supported by independent strategic clinical advice and an independent review have developed a proposal to reduce the number of hyper acute stroke units from five to three. Three of the five current units admit less than 600 patients per year, which is below the national best practice level. There are also challenges with medical cover and the timeliness of diagnostics in some units. This proposal recommends the hyper acute stroke units in Barnsley and Rotherham close, with the three remaining units in Chesterfield, Doncaster and Sheffield (STH). Patients would be repatriated to their local acute BoD Oct 2016: WTP Commissioners

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stroke unit following the first 72 hours of care. Should this proposal proceed as planned, this will result in a significant increase in activity for STH and will require important changes to workforce, diagnostic and physical configuration of resources. There will also be a need to agree the financial model as well as day to day operational flows for repatriation. Children’s Surgery and Anaesthesia Commissioners, working with the clinicians and managers from each of the hospitals have developed three options that would reduce the number of hospitals where operations for some conditions for children are carried out at night, at a weekend or require an overnight stay. Operations under these circumstances would no longer be provided in Barnsley, Chesterfield, Doncaster or Rotherham. Subject to approval by the Joint Overview and Scrutiny Committee and NHS England, both of the above proposals will be open to consultation with people across the region from 3 October 2016 to 20 January 2017. At the moment, it means no change as this is a proposal and subject to public consultation. Next steps A commissioner led public consultation will take place between October 2016 and January 2017 regarding hyper-acute stroke and children’s surgery. During this time Trusts will be working with commissioners on the practical implications of the possible outcomes of the consultations. Members of the public can visit www.smybndccgs.nhs.uk or call 0114 305 4487 for more information.

RECOMMENDATIONS

The Board is recommended to: a) consider the commissioner proposals b) debate the possible implications for Barnsley c) to inform the input of Executive Directors to the forthcoming public consultations and

ongoing analysis.

BoD Oct 2016: WTP Commissioners

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http://www.smybndccgs.nhs.uk/

general meeting of the council of governors of … · 2016-10-14 · 5.30-7.30pm, wednesday 19. th....

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