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Board Agenda Public – 30th May 2012

Trust Board – 25

th April 2013 of 54

A G E N D A

The next meeting of the Royal National Hospital of Rheumatic Diseases NHS Foundation Trust Board

to be held in Public will be on

Thursday 25th April 2013 at 1400 hrs

to be held in the RNHRD Lecture Hall

Action Person Paper

OPENING BUSINESS

1. Training : 15 Step Guidance for Walkrounds - Director of Operations & Clinical Practice

-

2. Apologies for Absence

- Chair -

3. Declaration of Interests

- Chair -

4. Minutes of meeting held in public – 20th

March 2013

For approval

Chair 4.1

5. Action List / Matters Arising For information Chair 5.1

6. i) Chair’s Report ii) Chief Executive’s Report iii) Medical Director’s Report

For information For information For information

Chair Chief Executive Medical Director

6.1 6.2 6.3

QUALITY / GOVERNANCE

7. i) Patient Safety Walkround – CFS ii) Q4 Quality Report iii) Inpatient Survey 2012 Results iv) Changes to Constitution v) Provider Licence Update

For information

For information

For information

For information

For information

Chief Executive

Director of Governance




7.1

7.2

7.3

7.4

7.5

PERFORMANCE

8.

Q4 Operational Performance & Clinical Practice Report

For information

Director of Operations & Clinical

Practice

8.1

9. Finance Report Month 12 2012/13

For information

Director of Finance

9.1

CORPORATE / REGULATORY

10. Corporate Objectives 2013/14 For approval Chief Executive 10.1

11. Monitor Q4 Submission For approval Director of Finance 11.1

CLOSING BUSINESS

12. Any Other Business

- - -

Royal National Hospital for Rheumatic Diseases NHS Foundation Trust

RNHRD Trust Board 20th

March 2013

Trust Board held in Public – 20

th March 2013 of

54

Minutes of the Trust Board

Board held in public

Wednesday 20th March 2013 1400 hrs, Lecture Hall, RNHRD Members Present Peter Franklyn Chair (PF) Kirsty Matthews Chief Executive Officer (KM) Rachel Hepworth Director of Finance (RH) Rayna McDonald Director of Operations & Clinical Practice (RM) Peter Spencer Non-Executive Director (PS) Chris Johns Non-Executive Director (CJ) Stephen Cole Non-Executive Director (SC) Niall Bowen Non-Executive Director (NTB)

In attendance Hayley Sewell Director of Governance (HS) Caroline Coles Board secretary (CC) ITEM TOPIC ACTION

The Chair welcomed all to the RNHRD NHS FT Trust Board of Directors meeting held in public.

PM 03/13/1 Apologies for Absence No apologies were received.

PM 03/13/2 Declarations of Interests There were no declarations of interests.

PM 03/13/3 Minutes of Meeting Held in Public – 28th

February 2013 The minutes of 28

th February 2013 meeting held in public were approved.

PM 03/13/4 Action List / Matters Arising The action list was noted with an additional action added to “future actions” as follows:-

Francis Report Next steps to consider those recommendations relating to clinical staff, recruitment, training and the operational delivery of care and present a course of action to implement as required.

PM 03/13/5 i) Chair’s Report The Chair presented the report and highlighted:-

Attendance at the Bath University Annual Court and Founder’s Day Lecture

The letter from Monitor outlining the arrangements for the new Provider Licence that comes into effect from 1st April 2013

The letter from the Secretary of State outlining proposals ensuring an Open NHS Culture The Board noted the report.


Agenda Item : 4.1


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54

ii) Chief Executive’s Report The Chief Executive presented the report and highlighted:-

The update on the closure of the neuro rehab unit in particular the two commissioners public engagement events held on 1st and 8th March 2013 (not 8th and 15th March as stated in the report), and a document that has been submitted to Wellbeing Policy & Development Scrutiny Panel to support the agenda item on describing the plans for the neuro rehabilitation unit re-provision on 22nd March 2013

The EMG agenda and the terms of reference which the Board where asked to approve

The link to the results of the 2012 NHS staff survey published in February 2013

The Friends and Family Test that is launched on 1st April 2013. The Director of Governance will provide an update to the Board at the April 2013 Board meeting Action : Director of Governance

The communications and marketing update in particular the next steps in the closure of the neuro rehab unit

The Board approved the EMG terms of reference subject to the following amendments:- - Delete neuro rehabilitation from the Reporting and Assurance Framework section - In the Outputs section add “to ensure that the Trust’s communications system is effective

both as an upwards as well as a downward flow”.

The Board noted the report.

HS

iii) Medical Director’s Report The Medical Director presented the report and highlighted:-

The Locum Consultant will join the consultants on call rota from 1st April 2013 to cover the shortfall created by the departure of two consultants

The new guide published by the GMC “Effective Governance to Support Medical Revalidation” for board and governing bodies. A copy of the handbook is available on request.

The Employee Based Awards for 2011 had been completed on 25th February 2013; there were no RNHRD awards allocated.

The Medical Director formally thanked the consultants and trainees who have undertaken additional clinics which replaced those lost due to adverse weather conditions. The Board noted the report.

PM 03/13/6 i) Patient Safety Walkround- Rheumatology

Rheumatology – 13th

February 2013 This was conducted by the Director of Finance who reported that at the time the ward was quiet, however, did speak to two patients who were very happy with their care. All safeguarding training was up to date. A Non-Executive Director questioned the dirty linen trolley on the ward. The Director of Operations & Clinical Practice explained that this was waiting for collection and was not there normally. The Chair queried a patient being moved several times. The Director of Operations & Clinical Practice replied that this was very rare and on this occasion was considered to be in the best interest of meeting the patient’s particular needs. The Board noted the report.


March 2013


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ii) Quality Report The Director of Governance presented the report and highlighted that for February 2013:-

The trust met all the applicable national targets and indicators

There were no serious untoward incidents

There were no serious complaints or new trends in complaints

In terms of the pilot indicators introduced by Monitor to reflect the government’s priorities for the delivery of NHS care in England, the Trust was showing compliance in all areas.

The Board noted the report.

PM 03/13/7 Operational Performance & Clinical Practice Report The Director of Operations & Clinical Practice presented the report and highlighted:-

The bed occupancy in neuro rehabilitation in February 2013 was an average of 5 patients, in March 2013 the figure is 3 patients, with the last patient to be discharged on 25

th March 2013. Redeployment currently stands at 52%

Endoscopy activity is below plan. The endoscopy service will not be able to recover its year end position

Rheumatology outpatient activity is above plan

In terms of workforce, it was noted that the induction figure of 50% attendance February equated to 1 person not attending out of 2

The key changes to Agenda for Change that will be implemented from 1st April 2013

There were no adverse harm events. It was noted that on the table presented to the Board there was an error in reporting catheter infections. This should have read nil

The VACs report has been included with a summary of the action plans The Chair wished to formally recognise how well the HR team and the senior management team had managed the safety and support aspects of the closure of the neuro rehabilitation unit. The Chair queried the number of overdue follow up appointments in Rheumatology which appears to now be remaining more or less constant. The Director of Operations & Clinical Practice confirmed that the figure had now levelled out. The Medical Director added that the winter pressures had had a knock on effect. The Chair commented that this would have to be managed very carefully. The Chair asked what would happen to the space on the second floor after neuro rehabilitation has vacated. The Director of Operations & Clinical Practice reported that a number of options were being reviewed with regard to utilising the space and equipment in a cost efficient way. The Board noted the report.

PM 03/13/8 Finance Report Month 11 2012/13 The Director of Finance presented the report and highlighted:-

The title of the report should read Board meeting not Finance & Activity Committee meeting

The income and expenditure position for the Trust to February 2013 shows a deficit of £(357k) compared to a planned deficit of £(31k) giving a year to date variance of £(326k) under plan.

The cash balance at 28th February 2013 was £2,154k.

The forecast for the year-end deficit is the same as reported last month £(646k).

The balance sheet for 28th February 2013 shows net current liabilities of £(839k) compared with the figure of £(827k) at 31st January 2013.

The debtor’s position now stands at £941k (£1,070k at 31st January 2013) with creditors at £2,030k (£2,527k at 31st January 2013).

The Trust continues to maintain a financial risk rating of 1 after the application of over-riding rules.


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The Chair pointed out an inconsistency between the Finance Report and the Operational Report in respect in the shortfall in Endoscopy activity which needs to be addressed. A discussion took place on whether the underspend to the capital budget for 2012/13 can be carried over to the following financial year. The Director of Finance replied that this was determined by our cash position, however it was concluded that a review of the contingency cover for health and safety would take place at the next H&S Committee meeting in April 2013 to ensure sufficient funds for 2013/14 were in place. The Board noted the report.

PM 03/13/9 Any Other Business Risk Assessment Framework

The Chair of the Finance & Activity Committee had attended an event run by Monitor outlining the principles behind the Risk Assessment Framework (RAF) which will replace the existing Compliance Framework. A presentation will take place in due course with a summary of the new regulatory measures. Action : Non-Executive Director / Director of Governance The Director of Governance also reported, for information, that Monitor had issued a new model constitution which reflects legislative changes implemented by the Health and Social Care Act 2012. The Trust had updated its constitution in line with the Monitor Model Constitution. The majority of the changes concern the new responsibilities of the governor representatives. The Chair added that the governors have been previously briefed on these new responsibilities.

SC/HS

The next public meeting will be held on 25

th April 2013

http://www.monitor-nhsft.gov.uk/monitors-new-role/overview/the-health-and-social-care-act-2012



March 2013

Trust Board held in Public Action List – 20th March 2013 of 54

TRUST BOARD held in Public ACTION LIST – 25th April 2013 Item Action Responsible Action/Update

1. PM 03/13/5 : Chief Executive Report Update on Friends & Family Test


Included in the Quality Report

Future Actions Item Action Responsible Action/Update

1. PM 02/13/1 : Francis Report Next steps to consider those recommendations relating to clinical staff, recruitment, training and the operational delivery of care and present a course of action to implement as required.

Director of Operations & Clinical Practice / Medical

Director

June 2013

2. PM 03/13/9 : Any Other Business Presentation on Risk Assesment Framework

Non-Executive Director / Director of Governance

TBC. Monitor have advised “The Revised Compliance

Framework for 2013/14 will apply for Foundation Trusts up until the Risk Assessment Framework comes into effect later

this year”


Agenda Item : 5.1


March 2013

Trust Board 25th April 2013 of 54

Chair’s Report

Royal National Hospital for Rheumatic Diseases

NHS Foundation Trust

1. Meetings 22 March Council of Governors 3 April Brian Stables Chair RUH (telephone update post deferral of FT bid) 2. Monitor’s Regulatory Approach under the provider licence Monitor has identified how they will address the granting of provider licences from 1 April 2013. Monitor’s view is that the circumstances which gave rise to the Trust’s status of being in significant breach of its terms of Authorisation could give rise also to breaches of its Provider Licence. The Trust has therefore received the formal Proposed Enforcement Undertakings that Monitor is willing to accept from the Trust in relation to the relevant licence conditions. The Trust was given 5 days in which to make representations and after consultation with Board members a response was sent to Monitor on 12 April. 3. Council of Governors The Lead Governor has indicated her wish to step down from the duties of Lead Governor after 2 years in the post. A process is underway to elect a successor and this is expected to be concluded by the time of the next Council of Governors meeting in May when there will be a public opportunity to acknowledge the considerable contribution that Judy Coles has brought to the role. In the interim a letter expressing such sentiments has been sent in response to her letter of resignation. 4. NED Remuneration At the Council of Governors meeting held on 22 March the Lead Governor reported to the Council in closed session on the deliberations of the Nominations committee and made recommendations on NED remuneration for 2013 -14. Following discussion it was acknowledged that the Nominations committee would have wished to reflect that the NEDs have not received any uplift since 2007 by recommending a 10% increase. However they felt that this would be inappropriate given the stretched financial situation at the Trust and a decision was made to leave NED remuneration levels unchanged. Peter Franklyn Chair RNHRD NHS Foundation Trust 18 April 2013

Title Author Meeting Appendices Review Action Required

CHAIR’S REPORT Peter Franklyn, Chair Trust Board, 25

th April 2013

n/a n/a For Information

Agenda Item : 6.1


March 2013


Chair’s Report

A G E N D A

EMG THURSDAY 18TH APRIL 2013

1400 hrs In the

BOARD ROOM

Paper

1. Apologies - -

2. Declarations of Interests

KM -

3. Minutes of the 7th

March 2013

KM √

4. Action List and Matters Arising

KM √

5. CEO Update

KM -

6. Business Planning 2013/14 6.1 Corporate Objectives 2013/14 6.2 2013/14 Budgets

KM RH

-

√

-

7. Financial Update RH -

8. Monthly Activity Report RM √

9. Contracts 9.1 Contracts Update 9.2 Specialist Commissioning Update

RH HS

-

-

10. Governance 10.1 Governance Report 10.2 Inpatient Survey 2012 Results

HS HS

-

√

12. Annual Report 2012/13 & Annual Report 2013/14 Process Update

HS/EM -

13. Staff Survey 2012 Results RM √

14. Agenda for Change Proposed Changes RM -

15. Space Review – 2nd

Floor Update LS -

16. Major Event Training Debrief RM -

17. Any Other Business

- -


Agenda Item : 6.2 / Appendix 2


March 2013


Chair’s Report

Dear Mr Hunt Re. Closure of the Neuro-Rehabilitation Unit, Royal National Hospital for Rheumatic Disease (RNHRD), Bath from 31st March 2013 We are writing to you as the Chairman and Vice-Chairman of the Wellbeing Policy Development and Scrutiny (PDS) Panel at Bath & North East Somerset Council. The Panel has taken a proactive interest in the proposal by the Board of the RNHRD to close the Unit. There has been significant public interest. We have concerns about the way in which the Board have engaged with both the public and the Council in its Health Scrutiny role. What are our concerns? At our public meeting on January 28th 2013, the PDS Panel were officially informed of the decision by the RNHRD Board to close the Neuro-Rehabilitation Unit. Prior to this meeting, Local Involvement Network representatives informed us they had insufficient opportunity to comment on the proposal. RNHRD Governors also expressed their concerns about the plans in respect of maintaining an appropriate service for the Unit’s current patients elsewhere. We also discovered that the staff team at the Unit had been given notices. It was not until 22nd March 2013 when the Panel received a report upon our request from the Specialised Commissioning Team for the South West about the re-provision of specialised neuro-rehabilitation services and further presentations from the NHS Clinical Commissioning Group and the RNHRD about this important aspect of the decision. Why does this matter? Elected representatives acting on behalf of their local communities must have an adequate amount of time to review and scrutinise any matter relating to the planning, provision and operation of the health service in its area. By the 28th January 2013, it was clear that the RNHRD Board had already made a decision to close the Unit without operating within the spirit of The Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 – part 4 (Health Scrutiny by Local Authority), Section 23 – Consultation by responsible persons. We had no opportunity to meaningfully feedback on the proposal, nor did the RNHRD Board have proper time to act on any comment from us. The consultation that did take place was post-hoc and the assessment of the impact on current patients was reported just 9 days before the closure. If the duties of Local Authorities as set out in statute are to have any impact we’d expect decisions, such as those proposed by the RNHRD Board, to be reported to us at a much earlier stage. What would we like you to do? We feel it is important that the Coalition Government stands strongly behind its own legislation and backs Local Authorities to do an effective job of scrutinising local health decision-making. We would like you to:

Investigate this matter and consider the points we have made about this case;

Offer some guidance about your expectations in relation to health bodies reporting substantial developments of the health service in the area of a Local Authority, or for a substantial variation in the provision of service – particularly in respect of the timing of reporting.

Finally, we would like to put on record the excellent clinical service provided by the Neuro-Rehabilitation Unit.



March 2013


Chair’s Report

We thank you for your time in considering this issue. Yours sincerely, Councillor Vic Pritchard Chairman Wellbeing Policy Development and Scrutiny Panel Bath and North East Somerset Council Councillor Katie Hall Vice Chairman Wellbeing Policy Development and Scrutiny Panel Bath and North East Somerset Council


March 2013


Chief Executive Report - Open



1. Update on Neuro Rehabilitation 1.1 The Neuro Rehabilitation unit closed on 31

st March 2013. It was resolved at the Policy & Development

Scrutiny Committee meeting on 22nd

March 2013 “to send a letter to the Secretary of State asking them to conduct the investigation on the way the Board of the Royal National Hospital for Rheumatic Disease led a process to close the neuro-rehabilitation services”. The letter is attached as appendix 1. The link to the full minutes is http://democracy.bathnes.gov.uk/documents/g3325/Public%20minutes%2022nd-Mar-2013%2010.00%20Wellbeing%20Policy%20Development%20and%20Scrutiny%20Panel.pdf?T=11

2. RNHRD Update

2.1 RNHRD Executive Management Group (EMG) The agenda for the April 2013 EMG meeting is attached as appendix 2.

3. National Update 3.1 NHS England (formerly NHS Commissioning Board

3.1.1 The NHS Commissioning Board, launched in March 2013, has been renamed NHS England with effect from 1

st April 2013.

3.1.2 The Department of Health has updated the NHS Constitution, improving areas such as patient involvement, feedback and dignity, and bringing it in-line with the new health and care system. The link to the constitution is below:-

https://www.gov.uk/government/publications/the-nhs-constitution-for-england 3.1.3 NHS England has published its Business Plan for 2013/14 – 2015/16, called “Putting Patients

First”, which explains how they will deliver their mandate for the Government and ensure the best possible outcomes for patients. The full document can be found at:-

http://www.england.nhs.uk/wp-content/uploads/2013/04/ppf-1314-1516.pdf A full set of organisation structure charts can be found on:

http://www.england.nhs.uk/about/structure/ 3.1.4 NHS England publishes clinical access policies for specialised services. These new clinical

commissioning policies underpin the commissioning of specialised services. They are important in clearly defining what NHS England expects to be in place for providers to offer evidence-based, safe and effective services and importantly, sets equitable access to services across the country. The policies were initially developed by specialised clinicians, expert patients and public health representatives, working together in Clinical Reference Groups, before being put out for consultation during late 2012/early 2013. These versions are the final documents which NHS England will adopt for the 2013/14 annual commissioning round. The link to the full documents : http://www.england.nhs.uk/ourwork/d-com/spec-serv/policies/


CHIEF EXECUTIVE REPORT Kirsty Matthews, Chief Executive Trust Board, 25

th April 2013

Appendix 1 : Policy & Development Scrutiny Committee Letter to Secretary of State Appendix 2 : EMG Agenda – 18

th April 2013

n/a For Information

Agenda Item : 6.2

http://democracy.bathnes.gov.uk/documents/g3325/Public%20minutes%2022nd-Mar-2013%2010.00%20Wellbeing%20Policy%20Development%20and%20Scrutiny%20Panel.pdf?T=11

http://democracy.bathnes.gov.uk/documents/g3325/Public%20minutes%2022nd-Mar-2013%2010.00%20Wellbeing%20Policy%20Development%20and%20Scrutiny%20Panel.pdf?T=11

https://www.gov.uk/government/publications/the-nhs-constitution-for-england

http://www.england.nhs.uk/wp-content/uploads/2013/04/ppf-1314-1516.pdf

http://www.england.nhs.uk/about/structure/

http://www.england.nhs.uk/ourwork/d-com/spec-serv/policies/


March 2013



3.2 Monitor

3.2.1 Provider Licence. All Foundation Trusts were issued with a Provider Licence on 1st April 2013

which replaces the trust’s Terms of Authorisation. 3.2.2 On 28

th March 2013 Monitor published an “Enforcement Guidance” which explains the action that

can be taken to enforce compliance with the provider licence and other regulatory obligations on providers and others required to provide Monitor with information needed to perform its functions.

Link : http://www.monitor-nhsft.gov.uk/home/news-events-publications/our-publications/monitors-new-role/enforcement-guidance

3.3 Department of Health

3.3.1 Patients First and Foremost : The Department of Health have published its initial response to the recommendations of the Mid Staffordshire NHS Foundation Trust Public Inquiry “Patients First and Foremost”. Link : https://www.gov.uk/government/publications/government-initial-response-to-the-mid-staffs-report

3.3.2 Assessment Notices under the Data Protection Act 1998 - Extension of the Information Commissioner’s Powers : On 25 March 2013, the Ministry of Justice published a consultation paper proposing to extend the powers of the Information Commissioner to carry out compulsory assessments of NHS bodies’ compliance with the Data Protection Act 1998 and its data protection principles. The Information Commissioner's proposals are based on his view that there is strong evidence of significant and widespread data protection compliance concerns in the health sector.

Link: https://consult.justice.gov.uk/digital-communications/ico-assessment-notices

The deadline is 17 May 2013.

4. Communications Update 4.1 Media Summary 23

rd March – Mid April 2013

Media interest in this reporting period has been high due to the reporting of the closure of the neuro rehabilitation unit and B&NES Policy & Development Scrutiny Committee approach to the Secretary of State. All approaches have been managed through agreed communication responses in line with the communications strategy.

Location Activity Content Date

Sourcewire Online Thermal Imagining camera – to help patients with cold hand/chronic pain

21.03.13

Bath Chronicle Online and newspaper

CQC Dignity and respect report includes RNHRD results –meeting all standards of care

23.03.13

Guardian (National Newspaper)

Newspaper (full page) and online. Quote from CEO

“Patients needing crucial and cost effective support are being abandoned and expertise lost as specialist units close”

27.03.13

HSJ Live Online Cuts at the RNHRD –highlighting Guardian neuro rehab closure story

27.03.13

Bath Chronicle Letter to the editor

“We must be prepared to fight to protect the Min”

28.03.13

BBC News Somerset

Online. Quote patient and governors

B&NES Policy & Development Scrutiny Committee Scrutiny write to Secretary of State to investigate neuro rehabilitation closure decision

01.04.13

Local radio Bristol

News bulletin. Quote Councillor

B&NES Councillors ask government to investigate the closure of a highly-regarded service for people with head injuries in the city.

02.04.13

Bath Chronicle Online and B&NES Councillors ask government to 02.04.13

http://www.monitor-nhsft.gov.uk/home/news-events-publications/our-publications/monitors-new-role/enforcement-guidance

http://www.monitor-nhsft.gov.uk/home/news-events-publications/our-publications/monitors-new-role/enforcement-guidance

https://www.gov.uk/government/publications/government-initial-response-to-the-mid-staffs-report

https://www.gov.uk/government/publications/government-initial-response-to-the-mid-staffs-report

https://consult.justice.gov.uk/digital-communications/ico-assessment-notices


March 2013



4.2 Media releases and reactive statements

Statement released to Bath Chronicle to acknowledge results of CQC Dignity and Respect report

Statement and additional information provided to Guardian to assist in preparation of neuro

rehabilitation story

Proactive local media release – positive CQC results

Proactive local media release – Eat out, eat well award

Letter to the Bath Chronicle editor – RNHRD working towards future 4.3 Neuro Rehabilitation

Event to mark closure of service

Detailed response to Department of Health query on neuro rehabilitation closure process

4.4 Staff

CEO Briefing to all staff

E-newsletter circulated to all staff

Q&A circulated to all staff – transition update following RUH FT status delay

Kirsty Matthews Chief Executive 18/04/2013

Newspaper. Quote Councillor

investigate the closure of a highly-regarded service for people with head injuries in the city.

NOWBath Online Concerns raised over RNHRD neuro rehabilitation closure – referred to Secretary of State

02.04.13

Bath Chronicle, This is Somerset

Online and newspaper

RUH FT bid delayed –impact on RNHRD 05.04.13

BBC Radio Bristol

Saturday Surgery Programme

Anne Johnson interviewed about new Step Up service for cancer survivors at the RNHRD

07.04.13

Chartered Society of Physiotherapy

Website CSP askes health Secretary of State to review neuro rehabilitation service

11.04.13

Trust Board Meeting – 25th April 2013 of 54

Title Author Meeting Sponsor Appendices Review Action Required

Medical Director’s Report Dr Ashok Bhalla, Medical Director Trust Board Meeting – 25th April 2013 n/a None n/a For information

1. Senior Medical Staff The Medical Director is pleased to announce that the Consultant Clinical Lead for Paediatric Chronic Fatigue Syndrome services has been awarded ‘bronze’ in the Clinical Excellence Award (CEA), 2012 round. This is a national award that recognises not only the high quality of local clinical practice, leadership, research and innovation and teaching, but also the impact of the individual’s work elsewhere within the NHS. The Medical Director is also pleased to announce that two Consultant Rheumatologists have been awarded Fellowship of The Royal College of Physicians (FRCP). Fellowship is the highest level of membership of the Royal College of Physicians. 2. Consultant Job Planning All initial job planning meetings have taken place. Two consultants are in agreement with proposed job plans. Four job plans remain under discussion and further meetings will be held. 3. Revalidation The Medical Director and Lead for Education were both proposed to the GMC and achieved Revalidation in March 2013. Revalidation covers a 5 years period and the new submission date will therefore be in 2018. A phased plan to cover the remainder of the doctors is in place in line with GMC guidance. 13 of 14 senior doctors were appraised during 2012/13. Owing to staff sickness it was not possible to hold an appraisal for one consultant, but this is scheduled for May 2013. The Medical Director will be submitting the Organisational Readiness Self-Assessment (ORSA) End of Year Questionnaire to the NHS Revalidation Support Team in May 2013. The ORSA exercise is designed to help designated bodies in England develop their systems and processes in preparation for the implementation of revalidation. Following completion of the ORSA the Medical Director will produce an action plan to address any identified development needs. A copy of this report will be provided in the Medical Director’s report to the Board for May 2013. Dr Ashok Bhalla Medical Director

Agenda Item : 6.3

of 54

A Patient Safety Walkround is a visit to a ward or department by a Senior Manager. The walkround gives staff the opportunity to discuss safety issues and areas of concern. Patients and relatives are also interviewed. Following the walkround a report and an action plan are developed allowing improvements to occur.

PATIENT SAFETY WALKROUND REPORT

Department: Adult Chronic Fatigue Services Lead area representative: Consultant Therapists/Service Leads

Walk round carried out by: Chief Executive of the RNHRD and the Patient Safety Coordinator

Date: 17/4/2013 Format of walk round: Details of where and discussions with whom: The CFS areas, including

discussions with colleagues and patients.

Time: 10am

Report completed by: Patient Safety Co-ordinator

Distribution: Adult Chronic Fatigue Service Leads, CEO, and the Trust Board

NB Please do not include any patient identifiable information on this form e.g. full name List 3 most important action points only No maintenance actions unless significant

# PATIENT SAFETY ISSUE IDENTIFIED / DISCUSSED

ACTION REQUIRED ACTION OWNER

PLANNED COMPLETION

DATE

ACTION COMPLETE?

1.

Group room and clinic rooms have nurse call system in place with no signage to show how to make a call The Team are not aware of how to use system

Facilities to provide signage next to call-bell units Resuscitation lead to carryout BLS session with team and include how to use nurse call- bell

Facilities team

Resuscitation lead

24/4/2013

June 2013

2.

CFS clients need to have drinking water in group sessions and during clinic appointments for medical needs Staff are unable to leave the area to obtain water for clients due to data protection considerations and patients’ safety.

Clarification of whether water in the rooms is drinking water If water is found to be not drinkable a water dispenser should be

Department Lead and Facilities team

June 2013

Agenda Item : 7.1

of 54



PLANNED COMPLETION

DATE

ACTION COMPLETE?

provided within reach of the rooms

3.

Adult Chronic Fatigue clients have been reporting difficulties in finding the location of their clinic Outpatients often sit in the wrong places and feel they may miss appointments

Review of signage to empower client to find clinic area safely

Department Lead and facilities

June 2013

PATIENT’S STORY

1.

The Adult CFS team were running a patient feedback and engagement session at the time of the patient safety walk around the main purpose of which was to “recruit” past patients to act as expert patients, patient educators or support the education agenda for the service. The group were happy for the CEO and Patient Safety Co-ordinator to sit in on part of the session to elicit patient stories and feedback. The feedback for the service was overwhelmingly positive, key points are summarised below:

Several of the patients had finally accessed the service after years of misdiagnosis and had found the service life transforming

The new facilities, funded in part by Macmillan had made a real difference to the patient experience as all rooms were now co-located, fit for purpose and designated for the service to allow continuity of care

There were no issues raised with regard to patient safety for the CFS service

One comment was made with regard to Consultants elsewhere in the Trust speaking to their Junior medical staff about the patient as if the patient was not in the room

Staff were thanked for their approach that made patients feel as if they were being treated as individuals

SAFEGUARDING QUESTIONS TO ASK STAFF RESPONSE

1. Have you attended Safeguarding Adults training and or Safeguarding Children training?

All staff are up to date with safeguarding training

of 54



PLANNED COMPLETION

DATE

ACTION COMPLETE?

2. Can you tell me what you think your responsibilities are with regards to safeguarding patients and members of the public from abuse?

During discussions, staff identified clearly their responsibilities in regards to safeguarding

Safeguarding level 1 adults and children training is provided to all staff on Induction to the Trust. This provides general awareness of safeguarding issues to all levels of staff.

Safeguarding level 2 training provides more detailed information to staff with face-to-face contact with adults or children and staff are required to attend once every 3 years.

LEARNING FROM INCIDENTS – QUESTIONS TO ASK STAFF RESPONSE

1 Have there been any recent incidents on the ward, for example, a patient fall resulting in harm, or C. difficile infection, and what lessons have been learned from that?

Not applicable

2 Are there any patient safety issues you would like to raise?

SEE ABOVE ACTIONS

3 Would you be happy for a member of your family to be treated in this area?

YES

Trust Board: April 2013 of 54 Compliance Code performance March 2013.



1. Compliance Framework National Targets and Pilot Metrics - In March 2013; the trust met all the applicable national targets and indicators for acute trusts detailed in Monitor’s

Compliance Framework 2012/131.

there were no serious untoward incidents, serious complaints or new trends in complaints in March 2013.

Table 1. Targets and indicators, thresholds and monitoring periods for 2012/13

Targets and indicators, thresholds, and monitoring periods for 2012-13

Threshold Weighting Monitoring Period for Monitor

March2013

YTD RAG YTD

Safety

Clostridium difficile year on year reduction (to fit the trajectory for the year as agreed with PCT; 6 cases in 6 separate patients – profiled as 1 case in Q1, 2 cases in Q2, 2 cases in Q3 and 1 in Q4)

0

1.0

Quarterly

0

1

MRSA Bacteraemia – meeting the MRSA objective

0

1.0

Quarterly

0

0

Patient Experience

Maximum time of 18 weeks from point of referral to treatment in aggregate admitted

90%

1.0

Quarterly

100%

100%

Maximum time of 18 weeks from point of referral to treatment in aggregate – non-admitted

95%

1.0

Quarterly

96.26%

97.77%

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

92%

1.0

Quarterly

99.43%

98.36%

Certification against compliance with requirements regarding access to healthcare for people with a learning disability

N/A

0.5

Quarterly

Comp -liant

Comp -liant

Certification of a minimum published CNST Level 1

N/A

2.0

Quarterly

Comp -liant

Comp -liant

Pilot metrics and standards introduced from Q3 2012-13

6 weeks referral to diagnostics Monitor to advise

Monitor to advise

Quarterly

100%

100%

30 day emergency readmissions Monitor to advise

Monitor to advise

Quarterly

0%

0%

Pressure ulcers - newly acquired grade 2/3 or4

Monitor to advise

Monitor to advise

Quarterly

0

0

Medication errors causing serious harm

Monitor to advise

Monitor to advise

Quarterly

0

0

Incidence of healthcare-related Monitor to Monitor to

Paper number: Title: Author: Meeting Action Required:

7.2 Compliance Framework

1 Performance March 2013, Q4 Patient

Experience Report and Q4 CQC compliance declaration. Hayley Sewell, Director of Governance Trust Board, April 2013 For information


venous thromboembolism (VTE) advise advise Quarterly 0 0

References: 1. Compliance Framework, Monitor, March 2012

2. Q4 2012/13 Patient Experience Report This report provides details of all patient experiences reported to PALS and all written complaints received by the Trust. Information about patient experience is collected through the following methods:

Written complaints

PALS telephone/ email and visits to the wards

Comment cards

Tea with Matron

Council of Governors coffee mornings

NHS Choices website

Patient Opinion website

Twitter This report details:

Written and verbal complaints received by the Trust

Actions taken as a result of the complaints received and improvements to services as a result of complaints received

Clinical risks identified from written and verbal complaints

Trends in patient experiences collected through written complaints and PALS by nationally identified categories for each service area

In quarter 4, 2012/13 the Trust received 7 new written complaints. Three of these complaints were considered to be well-founded. Written Complaints trends by quarter for 2012/13:

Complaint type by subject

New Complaints received in Quarter 1

New Complaints received in Quarter 2

New complaints received in Quarter 3

New complaints received in Quarter 4

Total Complaints received YTD 2012/13

Admissions, discharge and transfer arrangements

2 1 3

Aids, appliances, equipment, premises (including access)

1 1

Appointments Delay/ Cancellation (outpatients)

1 1

Attitude of staff 1 1

All aspects of clinical treatment/ care

1 1 5 7

Communication verbal/ written

2 1 1 4

TOTAL 5 3 2 7 17

Actions taken as a result of written complaints and improvements to services as a result of complaints received in Q4.

Grade Complaint Actions Complaint required further action

11 Low Dissatisfied with the outcome of outpatient appointment

Provided an explanation of decisions made by doctors.

None

12 Low Nursing care Head of nursing met with patient’s family to discuss concerns and assess issues.

Review of levels of nursing staff to meet the needs of patients.


13 Low Delay in access to biologics treatment

Reviewed the patient’s journey through the patient pathway and provided an explanation of the findings.

None

14 Low Patient experience during inpatient stay

Improvements in bank and agency staff orientation to the ward routine. Review of access to TV facilities on ward to ensure all patient rooms have TV facilities Height of paper towel dispensers lowered for easier access.

15 Low Delay in diagnosis and treatment

Reviewed decisions made by doctors. Patient met with Associate Specialist to discuss concerns, diagnosis and treatment.

None

16 Moderate Difficulties in being admitted to the hospital in an emergency

Identified that hospital procedure was not followed. Procedure reviewed and re-iterated to staff.

Answerphone installed on admission co-ordinators telephone

17 Low Doctors verbal communication during an outpatient appointment

Appointment arranged for patient to see Consultant to discuss medical concerns and future treatment. - Communication issues reviewed by Medical Director.

None

Actions taken as a result of key verbal complaints received and improvements to services as a result of complaints received.

Cases Grade Verbal complaint Actions Complaint required further action

4 PALS cases

Moderate Concerns regarding strategic decision to close neuro rehabilitation services

Individual letters of response sent to all those expressing a concern

Reactive communication as required

36 PALS cases

Low Patients unable to access appointment office by telephone

Facilitate contact with appointments office. Highlight issue to General Managers and relevant directors.

This is a substantial increase on previous quarters during 2012/13, see page 6 of this report.

Clinical risks identified from complaints.

Case number Clinical risk

Complaint 12 Nursing care – level of nurses on duty to meet the needs of patients.

Complaint 16 Difficulties in being admitted to the hospital in an emergency.

Trends identified by complaints (more than one patient has reported the issue).

Strategic Decision to close neuro-rehabilitation services

Delays in follow-up appointments

Patients unable to access appointment office by telephone

Number of written complaints received by profession during quarter 4 2012/13:


Profession Number of written complaints

Doctors 3

Nursing 2

Administration 2

Number of written complaints received in 2012/13, number responded to within timescale and number re-opened and comparisons to complaints received in 2011/12:

Verbal Complaints for 2012-13

Q 1 2012/13

Q2 - 2012/13

Q 3 - 2012/13

Q4 2012/13

Average per

quarter 2011/12

Total verbal complaints 54 50 45 78 57

Key Issues:

Patients unable to access appointment office by telephone

6 5 2 36 12

Delays in follow-up appointments

2 4 4 4 4

Strategic plan; to be acquired by the RUH

- 10 9 4 8


Quarter 4 2012/13 Care Quality Commission (CQC) Essential standards of quality and safety Compliance Declaration

The RNHRD NHS FT is required to register with the Care Quality Commission (CQC) as a provider of NHS health care. The requirement for the CQC to register the trust includes an assessment of compliance against the “Essential standards of quality and safety

1”. In order to support registered

providers in their ongoing compliance with these essential standards the CQC have developed a self-assessment tool called the Provider Compliance Assessment (PCA). The PCA focuses on outcomes for the 16 essential standards most directly related to the quality and safety of care. The Executive Directors have reviewed the 16 essential standards and agreed a lead director for each standard. The lead director for each standard has responsibility for assessment against the standard and agreeing the compliance level and any associated action plans for areas where the outcome is not met in full. Directors are required to sign their compliance statements each quarter.

The CQC may ask a provider to submit some or part of the PCA when a review of compliance (either planned or responsive) is being undertaken. Monitor requires FTs to report on a failure or likely failure to meet the CQC registration requirements of the CQC. Compliance against the essential standards forms part of Monitor’s quarterly declaration against healthcare targets and indicators. The compliance assessments are reported to the Patient Safety and Quality Forum, Integrated Governance and Quality Assurance Committee (IGQAC), Board, CQC and Monitor in the quarterly self-certification submission. The Board will receive the full assessment and action plans for any areas where compliance has not been met in full. The detailed compliance assessments and any associated action plans will be presented to the Integrated Governance and Quality Assurance Committee. Evidence files to support the compliance assessments are available from the lead Directors. The compliance assessments will be repeated by the Executive Directors at the end of quarter 1 in 2013/14. During February 2013, Internal Audit conducted an audit of the evidence to support the declarations for a sample of the standards and the report presented to the March 2013 Audit Committee concluded that the processes in place received a green compliance rating.

The Executive Directors have completed an assessment against the essential standards of quality and safety for quarter 4 of 2012/13 and signed a statement declaring full compliance in all areas.


Table 3. The essential standards, lead Director and compliance level for Q4 2012/13.

Outcome Essential Standards Lead Director Quarter 4 2012/13 Compliance

1 Respecting and involving people who use services


2 Consent to care and treatment Director of Governance

4 Care and welfare of people who use services

Director of Operations & Clinical Practice

5 Meeting nutritional needs Director of Operations & Clinical Practice

6 Cooperating with other providers Director of Operations & Clinical Practice

7 Safeguarding people who use services from abuse


8 Cleanliness and infection control Director of Operations & Clinical Practice

9 Management of medicines Director of Operations & Clinical Practice

10 Safety and suitability of premises Director of Finance

11 Safety, availability and suitability of equipment


12 Requirements relating to workers Director of Operations & Clinical Practice

13 Staffing Director of Operations & Clinical Practice

14 Supporting workers Director of Operations & Clinical Practice

16 Assessing and monitoring the quality of service provision


17 Complaints Director of Governance

21 Records Director of Governance

Table 4. Compliance Definitions

Compliance Definitions Compliance

Evidence available at the time of assessment shows the outcome is met

Evidence available at the time of assessment shows that the outcome is mostly met or there is not sufficient evidence to demonstrate the outcome is met. Impact on people who use services, visitors or staff is low. Action required is minimal.

Evidence available at the time of assessment shows that the outcome is mostly met or there is not sufficient evidence to demonstrate the outcome is met. Impact on people who use services, visitors or staff is medium. Action required is moderate.

Evidence available at the time shows that the outcome is at risk of not being met or there is no available evident that the outcome is met. Impact on people who use services, visitors or staff is high/significant. Action is required quickly.

The definitions of ‘impact’ are: Low: No or minimal level of impact on people who use services in one or more areas Medium: A moderate impact, but no long-term effects on people who use services in one or

more of the areas. High: A significant or long-term impact on people who use services in one or more of the areas.

Trust Board: April 2013 of 54 National CQC Survey of Adult Inpatients in the NHS 2012 results for the RNHRD



National CQC Survey of Adult Inpatients in the NHS 2012 results for the RNHRD

To improve the quality of services that the Trust delivers, it is important to understand what patients think about their care and treatment. One way of doing this is by asking patients who have recently used the Trust’s services to tell us about their experiences.

National CQC Survey of Adult Inpatients in the NHS 2012 results for the RNHRD 231 patients who were inpatients at the RNHRD during 2012 completed the National CQC Survey of Adult Inpatients in the NHS 2012, a response rate of 59% compared to 51% nationally. The benchmark report presents the data as a score out of 10 and describes whether trusts are performing better, worse or about the same as most other trusts in the survey. The results for the RNHRD for the 2012 survey are as follows;

Section heading 2012 Score out of 10 for RNHRD NHS FT

2012 How this score compares with other Trusts

2011 Score out of 10 for RNHRD NHS FT

2011 How this score compares with other Trusts

Waiting list and planned admissions

9.4

About the same

7.6

Best performing trusts

Waiting to get a bed on a ward

9.6 Best performing

trusts

9.7 Best performing

trusts

The hospital and ward

8.8 Best performing

trusts

8.7 Best performing

trusts

Doctors 9.2


8.6

About the same

Nurses 9.2


8.5

About the same

Care and treatment 8.4


7.6

About the same

Leaving hospital 8.0


7.5


Overall views and experiences

6.6 Best performing

trusts

7.4 Best performing

trusts

The results of the 2012 inpatient survey showed that the RNHRD had the highest score achieved for all Trusts for the following section scores;

waiting to get a bed on a ward

the overall views and experiences

The results of the 2012 inpatient survey showed that the RNHRD had the highest trust score achieved for the following 10 individual questions:

Was your admission date changed by the hospital?

From the time you arrived at the hospital, did you feel that you had to wait long time to get to a bed on the ward?


7.3 National CQC Survey of Adult Inpatients in the NHS 2012 results for the RNHRD Hayley Sewell, Director of Governance Trust Board, April 2013 For information


After you used the call button how long did it usually take before you got help?

Afterwards, did a member of staff explain how the operation or procedure had gone?

Were you given enough notice about when you were going to be discharged?

Discharge delayed due to wait for medicines/to see doctor/for ambulance?

How long was the delay?

Did you receive copies of letters sent between hospital doctors and your family doctor (GP)?

Were the letters written in a way that you could understand?

Did you see or were you given any information explaining how to complain to the hospital about the care you received?

The RNHRD NHS FT was rated as one of the best performing trusts in the following questions, Waiting list and planned admissions

Was your admission date changed by the hospital?

From the time you arrived at the hospital, did you feel that you had to wait a long time to get to a bed on a ward?

The hospital and ward

Were you ever bothered by noise at night from other patients?

How clean were the toilets and bathrooms that you used in hospital?

Were hand-wash-gels available for patients and visitors to use?

How would you rate the hospital food? Doctors

When you had important questions to ask a doctor, did you get answers that you could understand?

Did doctors talk in front of you as if you weren’t there?

Nurses

When you had important questions to ask a nurse, did you get answers that you could understand?

Did you have confidence and trust in the nurses treating you?

Did nurses talk in front of you as if you weren’t there

In your opinion, were there enough nurses on duty to care for you in hospital?

Care and treatment

Did a member say one thing and another say something different?

Were you involved as much as you wanted to be in decisions about your care and treatment?

Did you find someone on the hospital staff to talk to about your worries and fears?

After you used the call button, how long did it usually take before you got help?

Leaving hospital

Did you feel you were involved in decisions about your discharge from hospital?

Were you given enough notice about when you were going to be discharged?

Discharge delayed due to wait for medicines/to see doctor/for ambulance.

How long was the delay?

Before you left hospital, were you given any written or printed information about what you should or should not do after leaving hospital?

Did you receive copies of letters sent between hospital doctors and your family doctor (GP)?

Were the letters written in a way that you could understand? Overall views and experiences

Overall, did you feel you were treated with respect and dignity while you were in the hospital?

During your hospital stay, were you ever asked to give your views on the quality of your care?

Did you see, or were you given any information explaining how to complain about the care you received?


There were no questions where the RNHRD NHS FT was rated as performing worse than most other trusts.

At the April 2013 IGQAC meeting, members reviewed the results. An action plan will be prepared by the Director of Operations to address priority areas identified for improvement which will be monitored by IQGAC. Following national publication by the CQC on 16.4.13, these results were shared with staff at the Executive Management Meeting and will be communicated in the Chief Executive’s Brief and communicated to the Council of Governors through the draft 2012/13 Quality Report. The results are shared with the public through our web site and a press release forwarded to the local media.




3. Monitor Model Constitution

The updated Model Core Constitution reflects legislative changes to be implemented by the Health and Social Care Act 2012 which come into effect on 1 October 2012. These changes affect the constitutions of all foundation trusts.

A summary for the changes in the Model Constitution are detailed below: • The continuation of the body corporate known as Monitor; • Change from the ‘Board of Governors’ to the ‘Council of Governors’; • Requirement for the principal purpose (i.e. provision of goods and services for the

health service in England) to be stated in the constitution; • Introduction of the new legal duty to ensure that income of NHS funded goods and

services is greater than income from other sources; • Introduction of additional oversight and scrutiny by the Council of Governors over

activities generating non-NHS income; • Replacement of HM Treasury with Secretary of State as regards giving guidance

over FT accounts. The board was advised of these changes by the Director of Governance at the November 2012 board meeting. These changes have been incorporated into the RNHRD NHS FT Constitution, in accordance with Monitor’s Model Constitution and are presented to the Board today for approval. The full version of the updated RNHRD NHS FT Constitution is available in hard copy from the Board secretary. References: 1. Model Constitution, Monitor, October 2012


7.4 RNHRD NHS FT Constitution – amended as per Monitor’s Model Constitution

1

Hayley Sewell, Director of Governance Trust Board, April 2013 For approval



Trust Board: April 2013 of 54 Monitor Licence

- Royal National Hospital for Rheumatic Diseases


From April 1 2013 Monitor took on new powers as the sector regulator for health, with a duty to protect and promote the interests of patients. Monitor is no longer referred to as the “Independent Regulator of FTs”. Monitor is now the “Heath Care Regulator”.

As a consequence of the 2012 Health and Social Care Act, Monitor now has responsibility for: licensing providers of NHS-funded services; preventing anti-competitive behaviour that is against the interests of patients; supporting the continuity of services; enabling integrated care; and regulating prices for NHS-funded services.

Monitor will continue to regulate foundation trusts and take regulatory action where necessary, although the basis of Monitor’s regulation has changed. Instead of ensuring foundation trusts comply with their terms of authorisation, Monitor will now ensure they comply with the conditions of the new provider licence.

Monitor has reviewed all the outstanding issues at the 19 foundation trusts which were in significant breach of their terms of authorisation to ensure continuity of its regulatory scrutiny. Monitor is now formally notifying these trusts that they intend to place them in breach of their licence.

The RNHRD NHS FT has received a provider licence and the Chair has received notification in a letter dated 3.4.13 that the trust is in breach of the licence. The letter set out Monitor’s view that the circumstances which gave rise to the Trust’s status of being in significant breach of its terms of authorisation, could give rise also to breaches of its provider licence which came into effect on 1 April 2013.


7.5 Monitor – New Provider Licence Hayley Sewell, Director of Governance Trust Board, April 2013 For information



Adverse Harm Events 2012-13

Event Info.

Source

Total for

Year 2011/12

No. of days

since last incidence

Total for Q1

Total for Q2

Total for Q3

Total for Q4

Mar 2013

YTD 12/13 total

Total no. events

Adverse events

tool

18

46 5 0 0 2 0 7

Adverse Events Summary

MRSA bloodstream

infections

Audit 0

2097 0 0 0 0 0 0

C Diff infection

Audit 4

266 1 0 0 0 0 1

No. patients with catheter

Audit

34

46

14 11 11 7 0 43

No. patients with catheter

infection 9 2 0 0 0 0 2

Pressure Ulcers Grade 2-4 RNHRD

acquired

Audit 1

608 0 0 0 0 0 0

Patient Falls with adverse

event

DATIX reports

0 38

1 0 0 2 0 3

Medication errors with adverse events

DATIX reports

0

1359 0 0 0 0 0 0

Blood transfusion

adverse event

DATIX reports

0

1359 0 0 0 0 0 0

Transfer to acute care within 72

hours admission

WebTrak 4

299 1 0 0 0 0 1

DVT or PE following

admission

DATIX reports

0

398

0 0 0 0 0 0

Unexpected deaths

WebTrak 0 669 0 0 0 0 0 0


Agenda Item : 8.1 / Appendix 2 Vital Aspects of Care Trust Overall Summary - Vital Aspects of Care

Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13Combined

RNHRD Vital

Aspects 97% 88% 90% 92% 86% 96% 95% 96% 96% 95% 96% 93%

HDU

Combined 100% 95% 97% 96% 96% 96% 98% 99%

Ward not

in use

Ward not

in use

Ward not

in use

Ward not

in use

HDU

Quesionnaires 100% 86% 86% 83% 85% 86% 90% 95%

Ward not

in use

Ward not

in use

Ward not

in use

Ward not

in use

YPNR

Combined 96% 95% 92% 93% 93% 99% 99% 99% 99% 99% 98% 98%

YPNR

Questionnaires 95% 81% 86% 94% 76% 100% 95% 95% 95% 95% 90% 90%

HDU Vital

Aspects 98% 89% 90% 92% 87% 95% 96% 97% 97% 97% 94% 94%

VAPS (HIU) 93% 92% 94% 90% 90% 92% 93% 92% 92% 89%

VP Combined 96% 88% 89% 94% 84% 99% 96% 97% 97% 97% 97% 94%

VP

Questionnairs 95% 81% 86% 94% 76% 100% 95% 95% 95% 95% 96% 90%

Rheu Vital

Aspects 96% 84% 87% 94% 80% 100% 95% 96% 96% 96% 97% 92%

VACs

(Nursing)

VAPs

(Physio

Neuro)

Low 85%+ 85%+

Medium 75-84% 75-84%

High Below 75%Below 75%

Risk Rating

78%80%82%84%86%88%90%92%94%96%98%

Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13

Trust Total Vital Aspects Target >85%

RNHRD Combined VACC 2012-13

0%

20%

40%

60%

80%

100%

120%


VAPS (HIU) Vital Aspects HDU Vital Aspects Rheu Target

Vital Aspects of Care by Area - 2012-13

78%80%82%84%86%88%90%92%94%96%98%



RNHRD Combined VACC 2012-13

78%80%82%84%86%88%90%92%94%96%98%



RNHRD Combined VACs 2012-13

0%

20%

40%

60%

80%

100%

120%


VAPS (HIU) Vital Aspects HDU Vital Aspects Rheu Target

Vital Aspects of Care by Area - 2012-13


Trust Scorecard

Domain Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 YTD (avge)

Matrons

Questions 97% 83% 86% 90% 79% 95% 93% 95% 95% 95% 93% 90% 91%

Record Keeping 99% 100% 99% 100% 96% 99% 99% 100% 100% 95% 100% 100% 99%

Self Care 84% 78% 78% 78% 100% 100% 99% 100% 98% 100% 100% 100% 93%

Privacy & Dignity 98% 100% 91% 99% 100% 99% 99% 98% 98% 95% 100% 100% 98%

Elimination 90% 100% 83% 100% 100% 100% 100% 100% 100% 100% 100% 93%

Personal 100% 100% 95% 98% 100% 100% 100% 100% 100% 100% 100% 100% 99%

Safety 100% 100% 100% 95% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Infection Control 94% 100% 94% 97% 97% 99% 99% 98% 99% 100% 100% 100% 98%

Tissue Viability 100% 96% 100% 96% 100% 100% 100% 100% 100% 100% 100% 100% 99%

Nutrition 100% 96% 96% 82% 96% 100% 100% 100% 98% 100% 100% 100% 97%

Communication 100% 94% 97% 100% 97% 83% 97% 97% 96% 96% 92% 96% 95%

Mental Health 100% 100% 100% 100% 100% 100% 100% 100% 100%

Medicines 99% 100% 93% 92% 94% 95% 96% 100% 100% 99% 98% 100% 97%

Challenging

Behaviour 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% 100% 100% 100%

Safeguarding

Adults 80% 77% 83% 87% 80% 100% 100% 100% 100% 99% 100% 100% 92%

Falls 100% 100% 100% 100% 88% 100% 100% 100% 100% 100% 100% 100% 99%

Tracheostomy

Record Keeping

on Admission 93% 95% 100% 99% 100% 99% 100% 100% 99% 100% 100% 100% 99%

VTE 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

EWS 99% 100% 77% 100% 73% 100% 100% 100% 100% 100% 100% 100% 96%

Safeguarding

Children 100% 67% 89% 100% 100% 100% 100% 100% 100% 100% 100% 100% 96%

Learning

Disabilities 100% 100% 100% 100%

Training 92% 55% 62% 78% 67% 95% 92% 98% 96% 100% 100% 100% 86%

Lead Roles 100% 96% 96% 96% 96% 96% 96% 100% 100% 100% 100% 100% 98%

Combined 97% 93% 93% 94% 91% 98% 98% 98% 98% 98% 98% 96% 96%

HDU Vital

Aspects 98% 89% 90% 92% 87% 95% 96% 97% 97% 97% 94% 94% 94%

Rheu Vital

Aspects 96% 84% 87% 94% 80% 100% 95% 96% 96% 96% 97% 92% 93%

VAPs (HIU) 93% 92% 94% 90% 90% 92% 93% 92% 92% 89% 92%

Vital Aspects

Total 97% 88% 90% 92% 86% 96% 95% 96% 96% 95% 96% 93% 93%

VACs

(Nursing)

VAPs

(Physio

Neuro)

Low 85%+ 85%+

Medium 75-84% 75-84%

High Below 75%Below 75%

Risk Rating


___________________________________________________________________ Title: Operational Performance & Clinical Practice Report Author: Rayna McDonald, Director of Operations & Clinical Practice Meeting: Trust Board Meeting – 25 April 2013 Appendices: Adverse Harm Events; & Vital Aspects of Care March 2013 Action Required: For information ___________________________________________________________________ Introduction This report provides the Board with a variance report against key performance indicators in the following areas: patient safety, workforce and activity. Neuro Rehabilitation Unit The unit closed on the 28th March 2013, all inpatients were discharged appropriately either to home or their proposed long term residence by the middle of March. Following clinical review of all current outpatients they were either transferred to other providers for on-going care or discharged to the care of their GPs. All out-patients and their GPs received an individual letter accordingly. An inventory of equipment has been prepared and where appropriate equipment has been distributed to other departments within the hospital, remaining equipment is being sold or donated to charity. Proposals are being considered by the senior management group for the optimum future usage of the space released on the second floor. Performance and Activity In Rheumatology outpatients the plan was exceeded significantly (+1826) for follow-ups and was slightly below plan for new appointments, this reflects the on-going additional clinics undertaken to reduce the back log of follow-ups. The back log currently stands at circa 400 patients whose appointment has been delayed for a maximum of 12 weeks; the majority of patients are delayed for up to 8 weeks. GP referrals for the year have exceeded last year by 479. In Neuro Rehabilitation average bed occupancy in March was 1 as predicted, the year-end position is 20% below plan in terms of bed days.

In the Pain service there has been significant activity above plan for complex bed days (individual admissions) for the year 229 against a plan of 80. This is offset by a reduction in patients suitable for the in-hospital and 3 week programmes. Plans for next year reflect the trends seen this year. Referrals to pain are approximately 53 less than those received in the same period in 2011/12. 113 referrals have been returned this year due to the PCT’s funding pathway. Referrals to the adolescent service for Pain and CRPS remain very strong for the next financial year. Private referrals to the service remain steady and are increasing in numbers. In CRPS inpatients admissions for the year have exceeded plan by 22%. Referrals have increased from last year. There is a waiting list for admission and plans are underway to increase activity within CRPS.


Agenda Item : 8.1


CFS Paediatrics have exceeded their plan in new and follow-up appointments, with an underperformance in domiciliary visits, the service continues to experience growth in referrals. As predicted endoscopy finished the year under plan by 209 (15%), referrals have remained variable month to month.

Workforce HR KPI’s (Mar)

HR KPI’s Target Feb Mar Flag Rolling YTD*

Induction attendance (%) 100% 100% 50% Red n/a

CRB % completed before start date (%)

100% 100 100 Green 100

Sickness rolling year to date (%) 3% 4.57* 2.49* Red 4.88*

Of which short term absence % 92.28* 91.60* n/a n/a

Of which long term absence % 7.72* 8.94* n/a n/a

Personal development Plans (%) 80% 72.46 68.87 Red 68.87

*Information processed in arrears and as such may not be available/accurate information

The induction attendance rate has fallen to 50% in March due to one of the two new starters being unable to attend. The individual is based in finance and will not be able to be released until the May induction due to the pressure of year-end accounts. Appraisal rates have decreased as expected as Neurorehabilitation have not completed any reviews since the announcement to close the Unit. Sickness rates have improved in March; however the year end figure of 4.88% is significantly higher than the target of 3%. The Trust has volunteered to be part of a Department of Health and NHS employers project for 2013-14 to reduce sickness levels, reducing sickness absence will be a priority for the coming year. Patient Safety There have been no adverse events in March; see appendix 1. There has been a significant decrease in the year in terms of adverse events which reflects the on-going development in the work of the clinical teams in relation to minimising risks to patients. Clinical Practice The VACS report for March is attached as appendix 2. There were no areas that scored as red or amber. An action plan has been prepared for April which includes the following:

Formal Violet Prince ward meetings have been recommenced

Prescription chart audits will be carried out weekly and recommendations/actions implemented.

Ensure that all band 5 nurses have had an appraisal within the allotted timescale

Ensure all registered nurses are able to demonstrate evidence of continuing professional development via a portfolio.

These actions will be addressed by the Team Leader and monitored by the Matron and are due for completion by the start of May 2013.


Recommendations The Board is asked to:

1. Note this report and the key risks identified and to support the actions being taken to meet activity plans and mitigate risk.

of 54

The

Title: 2012 Staff Survey results Author: Marianne Spaans, Head of HR Director: Rayna McDonald, Director of Operations & Clinical

Practice Meeting: Trust Board meeting 25 April 2013 Action Required: For information ___________________________________________________________________ Introduction This report represents the findings of the 2012 national NHS staff survey conducted in Royal National Hospital for Rheumatic Diseases NHS Foundation trust. The response rate is 60% against a national average of 51%. Against the national 2012 average for acute specialist trusts, on the 28 key findings of the survey the trust scored 9 better than average, 7 average and 12 below average. The majority of the below average findings can be found under staff pledge 1: to provide all staff with clear roles, responsibilities and rewarding jobs (paragraph 4.0) and staff pledge 2; to provide all staff with personal development, access to appropriate training for their jobs, and line management support to succeed. In comparison with the 2011 staff survey results, there is no change in 20 out of 28 key findings and one deterioration. There is no comparative data for 7 of the key findings. The trust achieved best 2012 score for acute specialist trusts for;

Percentage of staff saying hand washing materials are always available

Percentage of staff witnessing potentially harmful errors, near misses or incidents in the last month

Percentage of staff reporting potentially harmful errors, near misses or incidents in the last month.

The details of the resulting Staff Survey action plan 2012 will be incorporated in the HR Plan for 2013/14. 1.0 Overall indicator of staff engagement The figure below shows how the Trust compares with other acute specialist trusts on an overall indicator of staff engagement. Possible scores range from 1 to 5, with 1 indicating that staff are poorly engaged (with their work, their team and the trust) and 5 indicating that staff are highly engaged. The trust’s staff engagement score of 3.72 was below (worse than) average when compared with trusts of a similar type. There is no change since the last survey in 2011(3.72).


Agenda Item : 8.2

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The national average for acute specialist trusts is 3.92. The overall indicator of staff engagement was calculated using key findings related to the extent which staff are able to make suggestions to improve the work of their team, have frequent opportunities to show initiative in their role and are able to make improvements at work. In addition, it indicates the extent to which staff think care of patients/service users is the Trust’s top priority, would recommend this trust to others as a place to work and would be happy with the standard of care provided by the Trust if a friend or relative needed treatment. The extent to which staff look forward to going to work, and are enthusiastic about and absorbed in their jobs is also included in the staff engagement indicator. The areas scoring lowest scores include;

Clinical support team*

Estates, Portering, housekeeping and caterings teams

Neurorehabilitation service * clinical support team includes health records, appointments, Outpatients department, medical secretaries, clinical measurement and X-Ray and IM&T. 2.0 Top five ranking scores

Indicator 2012 scores National average

Percentage of staff reporting errors, near misses or incidents witnessed in the last month

100% 92%

Percentage of staff witnessing potentially harmful errors, near misses or incidents in last month (lower is better)

21% 30%


81% 61%

Percentage of staff feeling pressure in last 3 months to attend work when feeling unwell (lower is better)

21% 23%

Percentage of staff having equality and diversity training in last 12 months

74% 61%

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3.0 Bottom five ranking scores

Indicator 2012 scores National average

Percentage of staff agreeing that their role makes a difference to patients

87% 91%

Percentage of staff receiving job-relevant training, learning or development in last 12 months

75% 81%

Staff motivation at work (out of 5. Higher is better)

3.70 3.88

Support from immediate managers (out of 5. Higher is better)

3.57 3.69

Effective team working (out of 5. Higher is better)

3.68 3.77

4.0 Largest local changes since the 2011 survey The Key finding that has deteriorated at trust since the 2011 survey is the percentage of staff receiving health and safety training in the last 12 months.

Indicator 2012 scores 2011 scores

Percentage of staff receiving health and safety training in last 12 months

76% 87%

76% is the national 2012 average for acute specialist trusts. The majority of Health and safety training provided is delivered as individual subjects, e.g. infection control, basic life support and food hygiene, these are all included within the generic group titled health and safety and risk management training within the Trust’s training guidelines. Managers receive two subjects, all of the subjects reported monthly in the L&D scorecard are included in the H&S category. Looking at the October/November 2012 scorecard, at the time the survey took place, the average percentage of the above mentioned subjects were over 80%. 4.0 Key findings for the RNHRD NHS FT Staff Pledge 1: to provide all staff with clear roles, responsibilities and rewarding jobs.

Key finding 2012 National average

Comparison 2011

Percentage of staff feeling satisfied with the quality of work and patient care they deliver

77% 82% No change

Percentage of staff agreeing that their role makes a difference to patients

87% 91% No change

Work pressure felt by staff (out of 5. Lower is better)

3.02 2.88 Not available

Effective team working (out of 5. Higher is better)

3.68 3.77 No change

Percentage of staff working extra hours (lower is better)

67% 72% No change

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Staff pledge 2: to provide all staff with personal development, access to appropriate training for their jobs, and line management support to succeed.


Comparison 2011

Percentage of staff receiving job-relevant training, learning or development in last 12 months

75% 81% 65% in 2011

Percentage of staff appraised in last 12 months

83% 83% No change

Percentage of staff having well-structured appraisals in last 12 months

34% 36% Deterioration

Support from immediate managers 3.57 3.69 No change

Staff pledge 3: to provide support and opportunities for staff to maintain their health, well-being and safety


Comparison 2011

Percentage of staff receiving health and safety training in last 12 months

76% 76% deterioration

Percentage of staff suffering work-related stress in last 12 months (lower is better)

37% 32% No change


81% Best score

61% No change

Percentage of staff witnessing potentially harmful errors, near misses or incidents in last month (lower is better)

21% Best score

30% No change

Percentage of staff reporting errors, near misses or incidents witness in the last month

100% Best score

92% No change

Fairness and effectiveness of incident reporting procedures

3.55 3.60 No change

Percentage of staff experiencing physical violence from patients, relatives or the public in last 12 months

10% 6% Deterioration

Percentage of staff experiencing physical violence from staff in last 12 months

2% 2% No change

Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months

19% 14% Improvement

Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months

19% 15% Improvement

Percentage of staff feeling pressure in last 3 months to attend work when feeling unwell (lower is better)

21% 23% No change

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Staff pledge 4: to engage staff in decisions that affect them, the services they provide and empower them to put forward ways to deliver better and safe services.


Comparison 2011

Percentage of staff reporting good communication between senior management and staff

31% 41% No change

Percentage of staff able to contribute towards improvements at work

70% 71% No change

Staff job satisfaction (out of 5) 3.58 3.66 No change

Staff recommendation of the trust as a place to work or receive treatment

3.79 4.06 No change

Staff motivation at work 3.70 3.88 No change

Percentage of staff having equality and diversity training in last 12 months

74% 61% No change

Percentage of staff believing the trust provides equal opportunities for career progression or promotion

87% 88% No change

Percentage of staff experiencing discrimination at work in last 12 months

6% 8% No change

5.0 key findings more detailed analyses The 2012 national staff survey report allows us to unpack some of the findings and look at the finer detail. The teams with the ‘worst’ scores in nearly all the key findings were;

Neurorehabilitation

Clinical support services

Estates, Portering, housekeeping and catering services The detailed analyses also brought to light, that the staff in CFS/ME (Adults/Paeds) and the step up service scored worse in; - percentage of staff suffering from work-related stress - fairness and effectiveness of incident reporting. Furthermore, BCPS & CRPS reported staff feeling under pressure in the last 3 months to attend work when feeling unwell and work-related stress. The Exec team, HR and BCPS & CRPS scored worse in the percentage of staff working extra hours. An action plan to address the five worst scoring areas and any areas where there has been a deterioration is being developed in conjunction with 2013-14 HR plan.

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SUMMARY NOTE This paper summarises the financial position of the Trust for 2012/13. This is based on the draft accounts which will be audited over the course of May 2013. The key points to note are as follows: (i) The income and expenditure position for the Trust deficit of £(3,725k) before additional funding.

(ii) Additional funding of £4,648k was received from Bath and North East Somerset PCT during the year, compared to £2,081k anticipated in the plan. The draft financial position of the Trust was £923k surplus after taking into account this income.

(iii) The cash balance at 31st March 2013 was £2,130k.

(iv) The draft balance sheet for 31st March 2013 shows a net current asset of £524k compared with a net current liability of £(839k) at 28th Feburary 2013. The balance sheet is provided at Appendix 4.

(v) The debtor’s position now stands at £2,022k (£941k at 28th February 2013) with creditors at £3,902k (£2,030k at 28th February 2013). The top ten debtors and creditors are provided at Appendices 6 and 7 respectively.

(vi) The Trust continues to maintain a financial risk rating of 1 after the application of over-riding

rules.

(vii) Capital expenditure for the year was £345k, of which £116k was donated. The capital programme is shown at Appendix 6.

(viii) Please note this report was based on the draft and unaudited accounts, correct at the time of

writing. However, the accounts are still subject to change.

The Trust Board is asked to note the report.

Title : Month 12 2012/13 Finance Report

Author of Document : Rachel Hepworth, Director of Finance

Meeting : The Trust Board

Action Required : For information

Summary of Document : To update the Trust Board on the draft financial position of the Trust for the year 2012/13.

Agenda Item : 9.1

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1. Summary Income & Expenditure Account

The Trust’s income and expenditure position is summarised at Appendix 1. 1.1 Income 1.1.1 PCT Income

PCT activities and income revenues were £(71k) below plan in month. Pain Management, Neuro Rehabilitation and AS Residential Patients continue to show an underperformance.

Overall Rheumatology is £29k above plan in month. Although the majority of the services are under plan this is offset by a significant overperformance in Outpatients of £73k in month.

Rheumatology Inpatient activity includes £20k income relating to the non-recurring Winter Pressures for March. The total income included to date for these Winter Pressures is £71k, this figure is not included in the budget.

Neuro Rehabilitation was below plan by £(168k) in month compared with £(86k) last month. The service discharged its last patient on 25th March 2013 and fomally closed on 31st March 2013.

1.1.2 Private Patient Income

Private patient income for the year is below plan by £(63k). 1.1.3 Education, Training and Research

Education, Training and Research Income was £197k above plan for the year.

1.1.4 Other Income

Other income finished the year £(285k) below plan. This category includes the Breast Radiation Injury Rehabilitation Service (BRIRS, sometimes referred to as Late Effects) and MacMillan Step-Up service which commenced in September 2012.

1.1.5 Additional Funding The Trust had included £2,081k of additional funding when preparing its 2012/13 budgets. £2,800k was received in July and August 2012 and a further £1,648k agreed with Bath and North East Somerset Primary Care Trust. This is one-off, non repayable funding. 1.2 Expenditure 1.2.1 Pay Expenditure

A service line breakdown is provided in Appendix 2. The £595k underspend includes £161k relating to savings made from vacancies during the development and recruitment process in the BRIRS and MacMillan Step-Up Services.

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The other main contributors to the under spend are Neuro Rehab £201k, Pain Management £95k and CRPS £121k.

1.2.2 Non-Pay Expenditure Non-pay expenditure has moved significantly in month. It includes the provision for restructuring costs following the closure of the Neurological Rehabilitation service.

2. Balance Sheet

The Balance Sheet is provided at Appendix 4. 2.1 Capital Programme The movement on fixed assets is the net effect of additions as per the capital expenditure shown at Appendix 5 and the year-to-date depreciation charge. The capital programme remains under continual scrutiny with purchases or work approved only as necessary. The capital expenditure for the period April 2012 to March 2013 totalled £345k, relating to MacMillan Parry ward, roof upgrade and IT equipment. 2.2 Cash The cash balance at the 31st March 2013 was £2,130k. 2.3 Debtors and Creditors

The top ten debtors and creditors are provided at Appendices 6 and 7 respectively.

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Favourable Variance + \ Adverse Variance (-)

Month 12

Actual

Month 12

Budget

Month 12

Variance

YTD

Actual

YTD

Budget

YTD

Variance

Forecast at

Month 11

£'000 £'000 £'000 £'000 £'000 £'000 £'000

INCOME

PCTs 878 948 ( 71) 10,644 11,303 ( 658) 10,470

Private patient ( 1) 6 ( 7) 137 200 ( 63) 139

Education, training & research 179 111 68 1,535 1,338 197 1,467

Other income 25 131 ( 106) 873 1,157 ( 285) 877

Additional funding 2,745 173 2,572 4,648 2,081 2,567 2,081

sub total 3,825 1,370 2,456 17,837 16,079 1,759 15,035

PBR excluded drugs 586 458 127 5,837 5,500 337 5,491

Total income 4,411 1,828 2,583 23,674 21,579 2,095 20,525

EXPENDITURE

Pay expenditure 963 978 16 11,130 11,725 595 11,102

Non-pay expenditure 1,487 308 ( 1,179) 5,124 3,726 ( 1,398) 3,967

sub total 2,449 1,286 ( 1,163) 16,254 15,452 ( 802) 15,069

PBR excluded drugs 586 458 ( 127) 5,837 5,500 ( 337) 5,491

Total expenditure 3,035 1,744 ( 1,291) 22,091 20,952 ( 1,139) 20,559

EBITDA 1,376 84 1,292 1,583 627 956 ( 34)

Depreciation ( 41) ( 37) ( 5) ( 428) ( 440) 12 ( 422)

Impairment ( 55) 0 ( 55) ( 55) 0 ( 55) 0

Interest receivable 1 0 1 5 0 5 2

Dividend payments on PDC 0 ( 16) 16 ( 182) ( 187) 5 ( 192)

Total surplus/(deficit) 1,280 32 1,249 923 ( 0) 924 ( 646)

INCOME & EXPENDITURE ACCOUNT

FOR THE PERIOD ENDING 31 March 2013

Appendix 2

Appendix 1

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Month 12

Actual

Month 12

Budget

Month 12

VarianceYTD Actual

YTD

Budget

YTD

Variance

Forecast at

Month 11

£'000 £'000 £'000 £'000 £'000 £'000 £'000

Neuro Rehabilitation 151 197 46 2,166 2,367 201 2,180

Rheumatology 290 271 ( 18) 3,303 3,253 ( 50) 3,294

Pain Management Dept 56 62 7 653 748 95 650

CFS Adults 15 14 ( 2) 186 162 ( 24) 186

Macmillan Step Up Services 9 8 ( 1) 72 91 19 72

CFS Paeds 47 26 ( 21) 294 313 19 272

CFS 71 47 ( 24) 551 566 15 531

CRPS 18 15 ( 3) 205 185 ( 21) 205

Late Effects 15 24 9 141 282 142 150

CRPS 33 39 6 346 467 121 355

Clin Measurement Dept 14 15 1 172 185 13 171

Porters/Stores/Switch Dpt 18 22 4 246 265 19 247

Catering Dept 14 16 2 179 196 17 180

Domestic Dept 25 30 5 314 363 49 315

Facilities Dept 11 9 ( 2) 109 111 2 107

Human Resources Dept 20 22 2 228 262 34 230

Governance Dept 11 11 0 129 131 2 130

Patient Sec.Services 20 22 2 227 262 35 225

Medical Records Dept 9 12 2 118 138 20 120

IT + Computer Dept 20 22 3 270 269 ( 1) 278

Finance Dept 25 25 0 280 295 14 276

Research & Development 42 42 ( 0) 566 503 ( 64) 567

Other 133 112 ( 21) 1,273 1,345 72 1,245

Total expenditure 963 978 16 11,130 11,725 595 11,102

FOR THE PERIOD ENDING 31 March 2013

ANALYSIS OF PAY EXPENDITURE

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Appendix 3

Month

12

Actual

Month

12

Budget

Month

12

Variance

YTD

Actual

YTD

Budget

YTD

Variance

Forecast at

Month 11

£'000 £'000 £'000 £'000 £'000 £'000 £'000

Neurology Inpatients 9 11 2 146 136 ( 11) 150

Rheumatology Inpats 9 11 3 70 136 66 70

Rheumatology - Orthotics 12 6 ( 6) 75 70 ( 4) 67

Diagnostic Dept 8 8 ( 0) 93 93 ( 0) 94

Pain Management Dept 1 1 0 13 22 9 14

Rheumatology Services 41 45 5 593 559 ( 34) 595

Medical Contracts 57 49 ( 8) 636 584 ( 52) 635

Facilities Dept 46 46 0 564 553 ( 11) 558

Human Resources Dept 18 5 ( 13) 51 57 6 34

Patient Transport 6 6 ( 1) 59 70 11 55

Executive 8 5 ( 3) 58 57 ( 2) 55

IT + Computer Dept 12 14 2 143 169 26 146

Finance Dept 1,196 21 ( 1,175) 1,587 256 ( 1,330) 402

Total R&D 74 23 ( 51) 358 278 ( 81) 317

Total Other ( 6) 56 63 678 686 8 775

Non Pay 1,490 308 ( 1,182) 5,124 3,726 ( 1,397) 3,967

ANALYSIS OF NON-PAY EXPENDITUREFOR THE PERIOD ENDING 31 March 2013

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Appendix 4 BALANCE SHEET AS AT 31 March 2013

31 Mar 2012 31 Mar 2013 Movement 28 Feb 2013

Fixed Assets £'000 £'000 £'000 £'000

Intangible 126 78 (3) 81

Tangible 7,162 6,604 (557) 7,161

Total Fixed Assets 7,288 6,682 (560) 7,242

Current Assets

Stock 44 81 37 44

NHS Trade Debtors 1,589 1,461 904 557

Provision for Irrecoverable Debt (138) (235) (41) (194)

Other Prepayments and Accrued Income 204 767 (154) 921

Other Debtors 208 561 177 384

Cash at Bank * 690 2,130 (24) 2,154

Total Current Assets 2,597 4,765 899 3,866

Total Assets 9,885 11,447 339 11,108

Current Liabilities

NHS Trade Creditors (1,307) (659) (189) (470)

Non-NHS Trade Creditors - Revenue (1,212) (733) 395 (1,128)

Non-NHS Trade Creditors - Capital (27) 0 0 0

PDC Dividend Creditor (9) 7 89 (82)

Other Creditors (249) (2,510) (2,078) (432)

Payments Received on Account (0) (1) 738 (739)

Accruals and Deferred Income - transitional support 0 0 897 (897)

Accruals and Deferred Income (299) (345) 612 (957)

Total Current Liabilities (3,103) (4,241) 464 (4,705)

Non Current Liabilities

Trade and other payables (22) 0 0 0

Provisions (15) (10) 5 (15)

Deferred Income (32) (27) 5 (32)

Total Non Current Liabilities (69) (37) 10 (47)

TOTAL ASSETS EMPLOYED 6,713 7,169 813 6,356

TAXPAYERS' EQUITY

PDC 6,015 6,015 0 6,015

Retained I & E Surplus (249) (249) 0 (249)

YTD I & E Surplus 0 923 1,280 (357)

Revaluation Reserve 947 480 (467) 947

TOTAL TAXPAYERS' EQUITY 6,713 7,169 813 6,356

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Appendix 5

CAPITAL FUNDING AVAILABLE 2012/13 2012/13 2012/13

£000 £000 £000

Actual Budget Variance

- From Depreciation 232.0 440.0 208.0 440.0

- NHS South West Project Funding 17.0 0.0 -17.0 0.0

- Macmillan 32.0 54.0 22.0 54.0

- Charitable Funds 64.0 268.0 204.0 268.0

345.0 762.0 417.0 762.0

CAPITAL EXPENDITURE

Future in

Year

Actual Budget Variance CommitmentsActual Budget Variance

£000 £000 £000 £000 £000 £000 £000

General IM&T

Replacement PC's 72.4 0.0 -72.4 0.0 72.4 45.0 -27.4

Windows Upgrade 0.0 0.0 0.0 0.0 0.0 30.0 30.0

EPR Developments 0.0 0.0 0.0 0.0 0.0 20.0 20.0

Back-up servers 0.0 0.0 0.0 0.0 0.0 15.0 15.0

Printers 0.0 0.0 0.0 0.0 0.0 5.0 5.0

Server 4.4 0.0 -4.4 0.0 4.4 5.0 0.6

DATIX upgrade 0.0 0.0 0.0 0.0 0.0 5.0 5.0

76.8 0.0 -76.8 0.0 76.8 125.0 48.2

Building & Maintenance

Refresh 0.0 0.0 0.0 0.0 0.0 250.0 250.0

Macmillan Step Down Service / Parry Ward 75.4 0.0 -75.4 0.0 75.4 54.0 -21.4

Lightening Conductor 1.1 0.0 -1.1 0.0 1.1 50.0 48.9

Refridgerant (R22) 0.0 0.0 0.0 0.0 0.0 13.0 13.0

Medical Air Plant 0.0 0.0 0.0 0.0 0.0 15.0 15.0

Legionella 0.0 0.0 0.0 0.0 0.0 25.0 25.0

HTM Compliance (Sink Replacement) 0.0 0.0 0.0 0.0 0.0 10.0 10.0

Fire Precautions 0.0 0.0 0.0 0.0 0.0 10.0 10.0

Hydro Pool Maintenance 21.9 0.0 -21.9 0.0 21.9 10.0 -11.9

Roof 90.4 0.0 -90.4 0.0 90.4 20.0 -70.4

CFS 33.0 0.0 -33.0 0.0 33.0 20.0 -13.0

221.8 0.0 -188.8 0.0 221.8 477.0 255.2

Medical Equipment

Bladder Scanner 8.7 0.0 -8.7 0.0 8.7 9.0 0.3

Endoscopy Equipment 0.0 0.0 0.0 0.0 0.0 75.0 75.0

X-Ray 0.0 0.0 0.0 0.0 0.0 82.0 82.0

8.7 0.0 -8.7 0.0 8.7 166.0 157.3

Other Schemes

Nurse Call System 0.0 0.0 0.0 0.0 0.0 50.0 50.0

PACS replacement (10% contribution to RUH) 0.0 0.0 0.0 0.0 0.0 50.0 50.0

Contingency 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Furniture from Charitable funds 37.7 0.0 -37.7 0.0 37.7 0.0 -37.7

37.7 0.0 -37.7 0.0 37.7 100.0 62.3

TOTAL 345.0 0.0 -312.0 0.0 345.0 868.0 523.0

2012-13 Capital Plan

M12 YTD Year End Forecast

Appendix 6

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Top Ten Debtors as at 31-03-13

Customer 0 - 30 31 - 60 61 - 90 91 - 180

181 -

360 361+

Total

Debtors

1 BATH AND NORTH EAST SOMERSET PCT 1257.6 0.0 0.0 0.0 0.0 0.0 1257.6

2 WELSH ORGANISATIONS 20.9 5.5 1.1 8.1 45.5 34.0 115.0

3 NHS HEALTH SCOTLAND 36.1 0.0 0.0 9.5 30.8 -5.9 70.4

4 ROYAL UNITED HOSPITAL BATH NHS TRUST 36.3 2.0 0.0 8.1 14.0 2.7 63.0

5 PFIZER LTD 5500 37.7 0.0 0.0 0.0 0.0 0.0 37.7

6 WORCESTERSHIRE PCT 36.4 0.0 0.0 0.0 0.2 0.0 36.6

7 NHS PENSION 34.5 0.0 0.0 0.0 0.0 0.0 34.5

8 SOUTH GLOUCESTERSHIRE PCT 25.7 0.0 0.0 0.0 0.0 0.0 25.7

9 NORTHERN HEALTH AND SOCIAL SERVICES 10.0 0.0 0.0 11.4 0.0 3.4 24.7

10 RAYNAUDS&SCLERODERMA ASSOCIATION 21.9 0.0 0.0 0.0 0.0 0.0 21.9

1517.1 7.5 1.1 37.0 90.5 34.1 1687.2OthersNHS 91.9 5.9 1.5 7.5 5.1 11.9 123.8NON NHS 159.6 4.8 15.1 7.4 8.6 15.6 211.0

TOTAL at 31-03-13 1768.6 18.1 17.7 51.8 104.1 61.7 2022.0% at 31-03-13 87% 1% 1% 3% 5% 3% 100%

TOTAL at 28-02-13 448.7 21.7 12.2 288.4 120.6 49.5 941.0% at 28-02-13 48% 2% 1% 31% 13% 5% 100%

TOTAL at 31-01-13 556.0 17.8 130.7 200.6 118.7 47.3 1071.0% at 31-01-13 52% 2% 12% 19% 11% 4% 100%

TOTAL at 31-12-12 332.1 156.2 61.9 175.7 115.2 40.1 881.2% at 30-12-12 38% 18% 7% 20% 13% 5% 100%

TOTAL at 30-11-12 485.0 140.9 137.7 164.0 113.9 13.5 1055.0

% at 30-11-12 46% 13% 13% 16% 11% 1% 100%

TOTAL at 31-10-12 690.0 196.5 80.4 169.0 108.7 -0.6 1244.0

% at 31-10-12 55% 16% 6% 14% 9% 0% 100%

TOTAL at 30-09-12 666.4 87.9 78.2 175.9 100.1 -13.5 1095.0

% at 30-09-12 61% 8% 7% 16% 9% -1% 100%

TOTAL at 31-08-12 710.6 94.8 36.4 134.6 96.5 -4.5 1068.4

% at 31-08-12 67% 9% 3% 13% 9% 0% 100%

TOTAL at 31-07-12 2155.1 134.2 60.7 72.4 109.1 129.1 2660.6

% at 31-07-12 81% 5% 2% 3% 4% 5% 100%

TOTAL at 30-06-12 624.7 228.1 42.5 64.4 109.7 99.1 1168.5

% at 30-06-12 53% 20% 4% 6% 9% 8% 100%

TOTAL at 31-05-12 1039.5 59.3 26.1 138.1 129.6 102.5 1495.1

% at 31-05-12 70% 4% 2% 9% 9% 7% 100%

TOTAL at 30-04-12 38304% 10096% 8205% 8407% 12609% 9380% 87000%

% at 30-04-12 0.4 0.1 0.1 0.1 0.1 0.1 1.0

Appendix 7

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Top 10 Creditors as at 31-03-2013

Supplier 0 - 30 31 - 60 61 - 90 91 - 180 181 - 360 361+

Total

Creditors

1 ROYAL UNITED HOSPITAL BATH NHS TRUST 146.0 153.8 1.4 47.1 19.2 0.0 367.5

2 HEALTHCARE AT HOME LTD -0.7 340.6 0.0 0.0 0.0 0.0 339.9

3 ROYAL COLLEGE OF ART 90.0 0.0 0.0 0.0 0.0 0.0 90.0

4 BATH INSTITUTE FOR RHEUMATIC DISEASES TRADING LTD 16.7 13.8 43.4 1.4 1.7 0.4 77.4

5 GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST 63.5 0.0 0.0 0.0 0.0 0.0 63.5

6 BARTS HEALTH NHS TRUST 61.6 0.0 0.0 0.0 0.0 0.0 61.6

7 NATIONAL SPECIALIST COMMISSIONING TEAM 54.6 0.0 0.0 0.0 0.0 0.0 54.6

8 GREAT WESTERN AMBULANCE SERVICE NHS TRUST 0.0 0.0 20.7 32.7 0.0 0.0 53.4

9 HEALTH COMMISSION FOR WALES 0.0 0.0 0.0 0.0 0.0 41.7 41.7

10 UNIVERSITY HOSPITALS BRISTOL NHS FOUNDATION TRUST 7.9 7.9 0.0 7.9 0.0 0.0 23.8

439.5 516.2 65.5 89.1 20.9 42.0 1173.3

OTHERS 101.6 94.6 -1.8 2.9 8.8 1.2 207.3

PAY EXPENDITURE 350.0 0.0 0.0 0.0 0.0 0.0 350.0

ACCRUED EXPENDITURE 2171.4 0.0 0.0 0.0 0.0 0.0 2171.4

TOTAL at 31/03/2013 3028.5 610.7 63.7 92.0 29.7 43.3 3902.0

% at 31-03-13 78% 16% 2% 2% 1% 1% 100%

TOTAL at 28/02/2013 1413.9 341.0 46.3 179.2 5.2 44.3 2030.0

% at 28-02-13 70% 17% 2% 9% 0% 2% 100%

TOTAL at 31/01/2013 1565.5 704.1 115.4 82.0 18.6 41.4 2527.0

% at 31-01-13 62% 28% 5% 3% 1% 2% 100%

TOTAL at 31/12/2012 1137.5 758.9 104.5 193.2 468.7 46.1 2709.0

% at 31-12-12 42% 28% 4% 7% 17% 2% 100%

TOTAL at 30/11/2012 994.3 157.9 130.6 181.5 467.1 45.5 1977.0

% at 30-11-12 50% 8% 7% 9% 24% 2% 100%

TOTAL at 31/10/2012 966.2 199.7 96.4 157.7 445.5 45.5 1911.0

% at 31-10-12 51% 10% 5% 8% 23% 2% 100%

TOTAL at 30/09/2012 1666.7 104.0 559.6 98.2 44.7 43.9 2517.2

% at 30-09-12 66% 4% 22% 4% 2% 2% 100%

TOTAL at 31/08/2012 1045.7 638.2 70.4 78.4 40.5 53.6 1926.9

% at 31-08-12 54% 33% 4% 4% 2% 3% 100%

TOTAL at 31/07/2012 743.3 296.5 64.1 168.5 24.5 61.7 1358.5

% at 31-07-12 55% 22% 5% 12% 2% 5% 100%

TOTAL at 30/06/2012 1312.7 279.4 83.8 402.7 21.5 70.9 2171.0

% at 30-06-12 60% 13% 4% 19% 1% 3% 100%

TOTAL at 31/05/2012 923.0 404.4 368.4 66.1 27.1 65.9 1855.0

% at 31-05-12 50% 22% 20% 4% 1% 4% 100%

TOTAL at 30/04/2012 1273.0 326.3 77.2 21.1 32.5 59.9 1790.0

% at 30-04-12 71% 18% 4% 1% 2% 3% 100%

of 54



Business Planning : Draft 2013/14 Trust Corporate Objectives

1. Introduction 1.1 The Board of Directors is asked to approve the content and structure of the draft 2013/14 Trust

Corporate Objectives. 2. Background 2.1 The Trust’s corporate objectives for 2013/14 will form the backbone of our Annual Plan, which is

submitted to Monitor in May 2013. They should reflect the Trust’s ambitions, values and strategic direction.

2.2 Following Board approval, the corporate objectives will:-

Identify the aspects of our clinical, quality and financial strategies which the Trust is expected to deliver in 2013/14

Communicate this simply and clearly to staff and stakeholders

Be reflected in performance management and individual appraisal across the Trust during 2013/14

2.3 The Trust Annual Plan will reflect the current shared vision and strategy of the Trust Board and

describe the programmes of activity and operational plans to enable the Trust to achieve its objectives.

3. Proposed Objectives 3.1 The proposed objectives are outlined as appendix 1. 4. Recommendation 4.1 The Board of Directors is asked to approve the content and structure of the draft 2013/13 Trust

Corporate Objectives. Kirsty Matthews Chief Executive


CORPORATE OBJECTIVES 2013/14 Kirsty Matthews, Chief Executive Trust Board, 25

th April 2013

Appendix 1 – Corporate Objectives 2013/14 n/a For approval

Agenda Item : 10.1

of 54

ROYAL NATIONAL HOSPTIAL FOR RHEUMATIC DISEASES CORPORATE OBJECTIVES 2013/14 Trust Board Meeting 25th April 2013 Agenda Item : 10.1 / Appendix 1

STRATEGIC

To develop a realistic and deliverable strategic plan

to describe, within a timescale to be agreed with Monitor, the optimum future for our services

To develop a sustainable outreach model to take RNHRD services out in to the community

To identify innovative and effective methods to

improve branding and increase awareness of the quality and range of our services to assist patients, carers and commissioners in making the choice to access our services

To ensure our workforce is fit for purpose and

flexible to meet the strategic objectives

QUALITY OF PATIENT CARE To continue to provide high quality, safe care

by demonstrating compliance with the CQC essential standards of quality and safety and implement the recommendations from the Mid-Staffordshire Public Enquiry/Francis Report

To develop health outcome measures across all

specialties to evidence patient benefit and effectiveness of services in line with Commissioners requirements

To achieve quality improvement targets for

2013/14 and CQUIN targets identified in 2013/14 contract

To implement the Friends and Family test

GOVERNANCE To meet the Code of Governance To meet the measures detailed in the Compliance

Framework/Risk Assessment Framework To meet the NHS Connecting for Health Information

Governance Assessment To maintain NHSLA level 1 accreditation To have regard to the NHS Constitution

IM&T To develop the IM&T strategy to support the

organisation in achieving its strategic objectives to include: - the further development of the Electronic

Patient Record system to improve clinical and cost effectiveness and collection of clinical outcomes data

- the further development of the Trust scorecard and data warehouse

- improved use and knowledge of information in order to make informed business decisions and to meet commissioning requirements

Board Agenda Public – 30th May 2012

Trust Board – 25

th April 2013 of

54


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