recovery plan version 6.0 18 th march 2013

1

Recovery Plan

Version 6.0

18th March 2013

2

ContentsI Executive summary 2

II The Current Reality and Context 9

III The Plan – Overview 31

IV Financial plan 46

V Governance 61

VI Quality 63

Appendices

Forecast assumptionsMonthly board scorecard

3

Executive SummaryContext1. As at February 2013, The Rotherham NHS Foundation

Trust (“TRFT”) is facing a number of significant challenges. These were highlighted in the Monitor letter dated 15th Feb 2013:

1. A challenged financial position resulting from a failure historically to deliver savings plans – TRFT has made a net loss in each of the past 3 financial years. Given reducing top-line income in future years, unless action is taken this position will worsen. Clearly, this trend is not sustainable;

2. A poorly executed IT implementation – the implementation of a new electronic patient record (“EPR”) system in FY 2013 has not gone well. As a result, the accuracy of information around clinical activities has declined, there is clear evidence of decreased clinical productivity and increased pressure on front line staff. In addition, the ability to recover income for activity performed has been hampered. A significant amount of work is required to rectify the position; and

3. A weak governance environment – outdated Board governance arrangements and management structures have resulted in a lack of clear accountability and weak links into front line staff, resulting in a repeated failure to deliver plans.

2. This Recovery Plan outlines a proposed path forward.

The Recovery Plan - Objectives1. This High Level Recovery Plan (“the Plan”) has been

compiled in February and March 2013. It aims to address the key concerns raised in the Monitor letter, specifically:

1. To outline a path to sustainable Financial Recovery – this Plan forecasts at a detailed level the result for FY 2014, together with the savings plans in progress/ to be taken to reduce operating costs by £13m in that year. In order to mitigate risk to patient quality, initial actions are focused on “corporate overhead” and other areas deemed “lower risk” to patient care. For future years (FY2015/2016), savings plans are at a higher level. The detail will be worked up for the strategic plan due 30 September 2013;

2. To outline the current EPR position with the steps required to rectify this – this plan provides an update on EPR together with the key issues faced and the timetable to develop a plan to resolve these issues; and

3. To start the process of remedying governance issues – one of the key factors behind the failure to deliver previous plans is likely to have been the lack of clear accountability in the management structure. Through steps already initiated, the structure has been slimmed down and new clear lines of reporting introduced. However, further work is required.

2. It aims to do this in a logical and sequenced manner while at all times preserving the high quality of patient care.

4

The Plan - Overview

Phase 1 – 4 Months

“Stabilisation and Control”

Phase 2 – 4 months

“Operational Excellence”


“Strategic Initiatives”

Phase 1 - Key Activities

1. Build functioning executive team and cohesive board with appropriate clinical input and with transparent provision of information.

2. Focus on rapidly driving cost reduction from targeted “lower-risk” non patient facing areas, with overall target of £13m in Year 1:

1. Corporate overhead of £21.9m. Target reduction of £5m in Year 1;

2. Tactical control areas. Target reduction of £4m in Year 1; and

3. CSU and divisional plans of £4m in Year 1.

3. Establish underlying EPR position and options. Develop plan for rectification with costings.

4. Build infrastructure to drive clinical productivity.


1. Work through key operational areas to improve patient processes and efficiency (e.g. theatre utilisation, length of stay, admissions, delayed discharges), patient safety and QIA.

2. Review clinical productivity by specialty and individual and work with clinical leadership to drive improved operational and financial performance.

3. Work on synthesizing community and acute services and review divisional linkages.

4. Review and initiate larger scale opportunities (e.g. outsourcing).

5. Set-up savings and productivity opportunities for Years 2/3 of the plan (target £13 - £15m).


1. Work through strategic planning issues (e.g. estates; portfolio of services; alliances and JVs).

2. Prepare and submit detailed 3 year plan to Monitor.

3. Review longer term strategic opportunities for the Trust.

4. Recruitment of permanent CEO.

12 months

5

The Plan – Initial Financial ProjectionsKey messages1. The forecast outturn for the current financial year (FY 2013) is

a deficit of £6.5m after restructuring costs of £4m. The recovery plan starts from this point.

2. The Recovery Plan targets savings of £13m in FY 2014, underpinned by Phase 1 activities focused on “lower risk” savings targets. These are:

i. A significant reduction in corporate overhead (£5m);ii. Tactical controls around pay / non-pay expenditure (£4m); andiii. CIPs schemes put forward by CSUs of £4m (£2.5m against

current run rates).

On current planning assumptions, savings at this level will ensure that the Trust breaks even (prior to restructuring costs) in FY 2014. This forecast assumes further EPR costs of £350k (should the final EPR report show a materially higher amount, then the Plan will need to be updated). The Plan also incorporates increased spending (Francis report) and other identified cost pressures.

3. Savings in FY 2015 are based on delivering an additional £13m of efficiencies - The critical piece of work in driving this will be the strategic planning process, which will need to include all key constituents such as Governors, Board, execs, CDs, consultants, specialist, matrons, CCG Board and GPs, and LA’s.

TRFT Financial PerformanceFY 2013 - 2016

FY 2013 FY 2014 FY 2015 FY 2016forecast outturn forecast forecast forecast

Operating RevenuesIncome from Activities 210.3 206.2 196.1 193.8Other Income 20.8 19.6 19.6 19.6

231.1 225.8 215.7 213.4

Operating ExpensesPay -152.3 -147.9 -140.4 -134.8 Non-Pay -67.7 -67.2 -65.0 -64.3

-220.0 -215.1 -205.4 -199.1

EBITDA (before Restructuring) 11.1 10.7 10.3 14.3EBITDA (%) 4.8% 4.7% 4.8% 6.7%

Restructuring Costs -4.0 -5.0 0.0 0.0

EBITDA (after Restructuring) 7.1 5.7 10.3 14.3

Net Interest -0.6 -0.4 -0.3 -0.3 Depreciation & Amortisation -8.9 -7.7 -6.8 -6.8 Impairments -2.0 0.0 0.0 0.0PDC -2.1 -2.4 -2.4 -2.4

-13.6 -10.6 -9.5 -9.5

Surplus / (def) before Restruct. -2.5 0.2 0.7 4.7

Surplus / (def) after Restruct. -6.5 -4.8 0.7 4.7

Trading Performance (£m)

6

Key Risks and Mitigations1. Ensuring that Savings Initiatives do not Risk the Quality or Safety of Patient Care – this initial Recovery Plan has been specifically designed to

drive a rapid improvement in financial position while minimising risk to patient care. Specifically:

1. The Plan has deferred any closure of wards or removal of outpatients capacity, until EPR is functioning more effectively and until more reliance can be placed on performance statistics. Ward closures were previously planned for December 2012 and outpatients capacity was also scheduled to be removed – these actions have been delayed and will only be progressed once it is demonstrably safe to do so;

2. The Plan initially focuses on “non-patient” facing areas (e.g. corporate overhead) where cost can be removed without a direct impact on patient care. Given stresses on front line operations and the impact of EPR, further detailed review will be undertaken before implementing changes in front line services;

3. There is clinical and front line representation into all tactical controls – actions will only be taken in conjunction with the front line staff in each area. In many cases, the tactical controls simply represent application of suitable financial controls (e.g. negotiating down supplier rates, ensuring that basic reconciliation processes are followed);

4. The Plan specifically assumes that all wards and other clinical areas are recruited to establishment. This was not the case at the end of the last financial year when a significant number of vacancies had been allowed to build up. In addition, an investment of £1m is provided in the Plan for additional investment in nursing staff as a result of the Francis Report; and

5. The only CSU schemes included in this Recovery Plan have been QIA’d at the end of 2012 and have been put forward by the clinical leads in each area. This has been confirmed with the Executive Directors of Nursing and Medicine.

2. Governance and Management Arrangements - The Trust has historically suffered from ineffective governance and consequently poor delivery of major projects in recent years (e.g. EPR, staff consultation, delivery of savings). As a starting point, a simplified Executive structure with enhanced representation of Clinicians and other staff groups is in the process of being implemented. There will need to be significant ongoing work on re-engaging and listening to staff, simplifying management structures, improving information reporting and board governance over the coming year to ensure a more effective Governance environment is established. Specifically, a cohesive management team and Board relationship must be established.

3. EPR – issues with EPR in FY 2013 have resulted in lost activity and income as well as creating a barrier to implementing operational efficiency improvements. The precise approach, timing and costs to fix EPR are yet to be finalised. An EPR expert has now been engaged by the Trust specifically to identify the major issues faced, to outline the potential solutions and to provide a plan of rectification with timings and costings. The current plan includes estimated “rectification” expenditure on EPR of £350k. Should the final EPR report require a significantly higher investment, the Plan will need to be updated.

4. Cash and Capex – there is no immediate risk to cash and liquidity at TRFT. However, in the strategic plan, there will need to be a consideration of the longer term financial position of the Trust and funding of appropriate investment in the longer term. This will be covered in the strategic plan.

7

Monitor Letter (15tH February 2013) - Next StepsRef Requirement Actions (x Ref)

6.1 “The Trust is required to report regularly on progress toward delivery of its turnaround plan, the specific milestones set out in Appendix 2 and described below and to meet with Monitor on a monthly basis until we are assured that the Trust is returning to full and sustainable compliance with its terms of Authorisation”

1. Peter Lee (“PL”), TRFT Chair, is in regular dialogue with Monitor (PL)

2. Turnaround (“Recovery”) Plan to be provided to Monitor 18th March 2013 (TB)

3. Monthly meetings to be set up with Monitor (KR)

6.2 “Monitor will agree with TRFT a programme of assurance to ensure that the Recovery Plan is both feasible and likely to deliver sustainable turnaround without compromising on patient safety. The Trust’s Recovery Plan should detail clear deliverables and accountabilities with defined timescales so progress can be tracked on a timely basis by the Trust including the Trust’s board and kept under review by Monitor ”

1. External review of Recovery Plan to be scoped, commissioned and copied to Monitor (TB)

2. Overall plan timings (included)3. Key deliverables timings (included)

6.3 “The Trust is required to resolve outstanding issues relating to EPR, including undertaking a diagnostic review of the EPR system and the related issues and necessary solutions. The diagnostic and related action plan to be shared with Monitor (with clear deliverables and accountabilities…”

1. External review of EPR initiated (PB/ LB)2. Report due April (PB/LB)3. Report to Monitor 30 April (PB/LB)

6.4 “Monitor has residual concerns relating to Board Governance. We are aware that the Trust has undertaken a review of the Board and Management Reporting structures. You are required to send us details of and timescales of the actions from this work and provide Monitor with the assurance that the capacity and capability of the management team has been strengthened such that it can deliver its turnaround plan. We will expect further updates on progress at subsequent progress review meetings.”

1. Evidence of initial actions taken in this Recovery Plan (MM/TB)

2. Residual risks identified (MM/TB)3. Updates to be provided (MM/TB)

8

Monitor Milestones 2013 – Control Schedule (Appendix 2) – high level timetable

Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1. Financial underperformance leading to concerns over financial viability

Recovery plan 18th March

External Assurance

Review April

Strategic Plan 30th Sept

2. Deteriorating liquidity Weekly 13 week / 26 week cash flow shared with Monitor

3. EPR Implementation Issues (Identification and Resolution)

Appointment of CIO or equivalent

Initial Diagnostic Report

Regular reporting of Progress

4. Weakness in Board Governance

Develop plan to implement TD

recommendations

External Assurance over Effectiveness of new Structure and effective clinical

engagement + Peer Support for Chair

Monthly Financial Reporting (incl. CIPS Reporting)

9





V Governance 61

VI Quality 63

Appendices


10

Overview of TRFTTRFT• Provider of Acute and Community Services from

one main site: ~450 beds across 20 wards• Revenue of ~ £230m• Loss making for last 3 years• 85% of clinical revenue from local commissioner

(Rotherham) • ~3,600 WTE staff including ~150 consultants

Elective Care• Revenue of ~£82m• ~1,000 WTE staff• CSUs: (i) Anaesthetics & Theatres (ii)

General Surgery (iii) Obs & Gynae (iv) Orthopaedics (v) Specialist Surgery (vi) Urology (vii) Ophthamology

Urgent Care• Revenue of ~£67m• ~1,000 WTE staff• CSUs: (i) Radiology (ii) Lab Medicine (iii)

Pharmacy (iv) Therapies (v) Photopheresis (vi) Specialist Medicine (vii) Integrated Medicine (viii) A&E (ix) Medicine (x) Specialist Medicine

Community Services• Revenue of ~£53m• ~900 WTE staff• CSUs: (i) Adults LTC/ Urgent Care/ Re-

Ablement (ii) Adults – planned care (iii) Adults – Staying Healthy (iv) Children & Young People

Clinical Services

Facilities & Estates Infrastructure• Net cost base of £15m (£18m gross cost base offset by £3m revenue)• ~ 250 WTE staff

Corporate Infrastructure• Net cost base of £22m (£24m gross cost base offset by £2m revenue)• ~ 400 WTE staff including Finance (49), HR (63), Medical (55), Nursing (18), IT (34), Corporate Affairs (31), Patient Services (110) and Business Information

(25)

11

ContextElective Care includes all standard DGH specialties as well as a full Maxillofacial service. In summary it employs 1,070 WTEs based at the main hospital including 75 consultants, has 11 theatres and 162 beds across 8 wards. Anaesthetics and TheatresDedicated day surgery facility, but run together with Main Theatres to maximise usage. Centralised pre op assessment/theatre scheduling and in-house service provision of Sterile Services.11 theatres23 consultants2 wards, ITU (6 beds) and HDU (8 beds)Dedicated JAG accredited Endoscopy Unit Obstetrics and GynaecologyDedicated Outpatient facilityCurrently in deficit against plan, which in the main can be attributed to issues surrounding EPR particularly around volumes in outpatients and consequently in elective admissions, also had some 18ww breaches.Obstetrics includes the community midwifery services, covering around 3,000 births per annum. Midwives to births around 1 to 28 (within CNST recommended parameters). Bookings and births around 4% above last year.1 theatre10 consultantsGynaecology has dedicated early pregnancy/TOP facility and ward area for inpatients (14 beds)

OphthalmologyCurrently responding to changes in demands on their service, decreased cataract demand, increased demand in ARMDWard facility is combined day care area and some outpatient facilities (no beds).TRFT runs the Barnsley service at the BFT site and there are 4 consultants at each site.

Elective Care

Anaesthetics & Theatres

£4.4m5%

General Surgery£15.6m19%

Obstetrics & Gynaecology

£18.7m23%

Orthopaedics £19.3m

23%

Specialist Surgery

£6.7m8%

Urology £4.2m

5%

Ophthalmology£13.7m

17%

12

Context (continued)Orthopaedics85% compliance to #NOF best practice tariff, above national averages2 wards configured between Elective and Non Elective with 60 beds13 consultantsDaily dedicated trauma lists, weekly lists extended into the eveningStructure includes Orthotics, and recently integrated Podiatry servicesHas lost income mainly attributed to EPR implementation difficulties. Since EPR implementation waits for outpatients increased from around 4 weeks to 12 resulting in lost referrals. This has also led to some 18ww breaches

General SurgeryFacilities cover breast, general, colorectal and satellites clinics provided by Sheffield for vascular conditions2 wards with 60 beds (including 6 surgical admission beds)9 consultantsCase mix issues on non-elective admissions (partly EPR related)

UrologyRecently completed a refurbishment, providing an integrated outpatient/inpatient (14 beds)/chemotherapy facility1 ward with 14 beds4 consultantsHas lost income mainly attributed to issues around EPR, both in volumes and capturing the activity done i.e. Outpatient procedures

Specialist Surgery (made up of ENT and OMFS & Orthodontics)Has had issues surrounding EPR particularly around volumes in outpatients in PMFS and consequently in elective admissions, also had 18ww breaches

ENTDay Case and Outpatients service provision, inpatient facility at Doncaster Royal Infirmary, but care provided by RFT consultant3 consultants

OMFS & OrthodonticsRFT provide inpatient facility for Doncaster Royal InfirmaryInpatients for cancer patients treated at Chesterfield by RFT consultant5 consultants

Elective Care

13

Urgent CareContextThe Urgent Care division employs 981 WTE staff and encompasses a diverse range of services with main emphasis on the Non Elective pathway – A & E, assessment, admissions unit and specialty beds. Direct clinical support departments such as radiology, pathology labs and pharmacy are managed within Urgent Care. In addition, relevant Elective, Outpatient and Community care pathways are provided.

Urgent Care has 58 consultants and 225 beds across 12 wards. There are also 46 surge beds.

Overall, the division’s financial performance is close to plan, although additional Non Elective activity has triggered 70% threshold tariff loss and additional unfunded bed costs, whilst Outpatient activity has performed under plan since EPR system go-live. Specific issues are:

A & E• 77,000 attendances planned. Actual trend +3% more.• Spend budgets on plan, following previous investment.

Integrated Medicine (General & Elderly Medicine)• NEL activity 13,500 planned. Actual trend +10% more.• Devolved 70% NEL Threshold loss forecast at -£1m.• Outpatients 34,000 planned. Actual is -8% less (post-EPR).• Cost pressures – sustained unfunded beds open & locum medics.

Radiology & Medical Physics• Cost pressures in sustaining access times & 7 day working

Specialist Medicine Foundation Unit (Rheum, Dermatology, Haem)• Outpatients 35,000 plan. Actual Follow Ups -16% down (post-EPR)

Clinical Radiology and

Medical Physics£2.0m

3%

Laboratory Medicine

£3.1m5%

Pharmacy£0.7m

1%Therapies

£0.0m0%

Photopheresis£2.9m

4%

Specialist Medicine£10.6m

16%

Integrated Medicine£35.7m

54%

Accident & Emergency

£8.5m13%

Medicine Division £0.0m

0%

Specialist Medicine CSU

£3.0m4%

14

Community Revenue ContextCommunity Services transferred to TRFT in April 2011 in response to the national Transfer of Community Services directive. Services are provided in a variety of locations including Health Centres, clinics, GP practices, Schools, Children’s Centres, Care Homes and patients’ own homes. These services are in the form of individual contacts, case management and ongoing care for patients which provide care closer to home and alternatives to a hospital admission. The division has a funded establishment of 969 WTEs (made up of 50 Medical Staff, 468 Nurses, 232 AHPs, 149 admin and clerical and 70 other). Following a programme of integration the overall Community Division now incorporates a number of Acute services, these being Children and Young People, Therapies, Dietetics, Audiology and Sexual Health.

Adults-LTC/ Urgent Care and Re-ablement Mainly funded by NHSR and other PCTs which is mainly block income (estimated 96%). A number of services are jointly commissioned with the local authority RMBC, with c.£800k of income associated.2 consultants

Adults – Planned CareIncludes Direct Access, Dental and Audiology plus £1m of RMBC funding. Activity contract delivery pressures in Physiotherapy both in the community and in the hospital.1 Dental consultant

Adults – Staying Healthy GUM made up of £1.3m PbR, £0.9m Non-PbR (Excluded Drugs). Out-Patient activity up 5% on plan.2 consultants

Children and Young People Made up of Child Health and Critical Care (Paediatrics) 14 Paediatric Critical Care Beds, 24 Ward Based Beds and 8 assessment beds. Out-patient activity down on plan linked to EPR and vacant Consultant post, but not anticipated to be an issue when vacancy filled. Still on-going issue with Medical staff Job Plans and future Clinical Service Model required going forward. 8 consultants

NHSR, £29.5m55%

Other PCTs, £3.5m7%

Critical Care (Paediatrics), £3.7m

7%

Audiology, £1.3m2%

Dental, £2.8m5%

Child Health, £4.1m8%

Direct Access (Therapies/Dietetics)

, £1.5m3%

GUM, £2.3m4%

Other income (mainly MBC), £5m

9%

15

Executive Structure – “Current”Rotherham NHS Foundation Trust

EPR, SystmOne, IT Services, Service Improvement

Director of IT & Service Improvement

Kim Ashall

Acting Chief Executive

Matthew Lowry

Chief NurseJuliette Greenwood

Medical DirectorGeorge Thomson

Chief of Legal and Corporate Affairs

Kerry Rogers

Chief Human Resources Officer

Jacqui Bate

Acting Chief Operating Officer

Mike Dennis

Chief Financial Officer

John Somers

Acting Chief of Business

IntelligenceTricia Bain*

Interim Transformation DirectorTim Bolot

Acting Director of PMOMichelle Kemp

Governance & AssuranceLegal & regulatory ComplianceQAS (self assessment)Legal Services, Claims and LitigationCommunications, Marketing & GraphicsGovernors / Members / PPIVolunteering, Charity, CSRPatient & Health Info

Human Resource Management

MAST

Workforce Planning

Payroll

Learning & Development

Occupational Health

Operational Management of all Clinical Directorates and Services

Outpatients / Patient Access

Estates and Facilities

Business Resilience

Screening Services

Business Intelligence including Information & Performance Monitoring

*Tricia will continue to fulfil her role as Director of Quality & Standards

Financial Management

Contracting

Business Planning & Investment

Procurement

Business Development

Professional Leadership, Development and Integration of Nursing and AHP

Patient Experience

Safeguarding

Dementia Strategy

Patient Services (incl. complaints)

Clinical Quality, Safety & Risk

Quality Accounts

Infection Prevention & Control

Public Health

Caldicott Guardian

Medical Workforce Planning

Clinical Education & PGME

R&D, Clinical Effectiveness

Cancer Services

Management Structure – 1st Jan 2012Observations

1. TRFT has, in recent years, had an outdated Management structure with unclear accountabilities and responsibilities. It is likely that the complexity of the structure has directly impacted the ability of the organisation to deliver to its plans. Evidence:

1. Failure to synthesize community services with the acute organisation;

2. Failure to deliver savings plans;

3. Failure to successfully implement EPR and then to respond to the challenges faced; and

4. A poor consultation process around proposed redundancies.

2. Features of the structure were numerous reporting lines into the CEO (19), a very heavy executive level (9 direct non clinical reports into the CEO) and a very fragmented approach to managing

3. Actions have already been taken to simplify the top level structure (included later).

16

Financial Performance – Recent Years

Observations1. In each of the last 3 years including FY 2013, TRFT has

made a net loss (i.e. spent more than it has received in revenue). In the last 2 years, the loss has been in excess of £6m.

2. In FY 2012, TRFT significantly expanded its size through the acquisition of Community Services (remunerated on a “block” basis of ~£29m). One of the key challenges facing TRFT is assessing the scope of community services that it currently provides and the relationship of these services to acute.

3. Operating expenditure has been stable over the past 2 years at ~£218m (comprising £152m of pay costs and £66m of non-pay costs). While costs have not increased (which would have been expected given inflation and incremental drift), no significant progress has been made on cost reduction or improvement of clinical productivity.

4. Impairments in FY 2014 mainly relate to EPR, the Mental Health Unit together with other items such as the Mortuary.


FY 2011 FY 2012 FY 2013 Grow th actual actual forecast forecast

Operating RevenuesIncome from Activities 167.3 210.0 210.3 25.7%Other Income 17.2 22.7 20.8 20.7%

184.5 232.7 231.1 25.2%

Operating ExpensesPay -123.3 -151.6 -152.3 23.5%Non-Pay -52.0 -66.0 -67.7 30.4%

-175.3 -217.5 -220.0 25.5%

EBITDA (before Restructuring) 9.3 15.2 11.1 19.2%EBITDA (%) 5.0% 6.5% 4.8%

Restructuring Costs -1.7 -4.5 -4.0

EBITDA (after Restructuring) 7.6 10.7 7.1

Net Interest -0.6 -0.6 -0.6 Depreciation & Amortisation -6.3 -7.5 -8.9 Impairments 0.0 -6.7 -2.0 PDC -2.2 -2.3 -2.1

-9.1 -17.0 -13.6

Surplus / (def) before Restruct. 0.2 -1.8 -2.5

Surplus / (def) after Restruct. -1.5 -6.3 -6.5


17

Financial Performance – Current Year

Observations1. In the current financial year (FY 2013), as at month 10,

TRFT had lost £4.9m vs a planned loss of £0.9m (i.e. £4m worse than planned).

2. The following observations can be made:

i. The poor financial performance is a cost issue – operating expenditure is £6.4m higher than planned with £2.9m restructuring costs on top. This partly reflects the failure of the organisation to deliver its cost saving plans. Costs in total are £9.3m higher; and

ii. Commissioners have been supportive – revenue is £4.9m higher than plan, and while this has included significant non-recurrent support (as PbR income has fallen short), indications are that commissioners are attempting to support RTFT through a difficult period.

Rotherham Foundation TrustConsolidated Trading Results (Month 10)

actual plan variance

RevenueClinical Income 175.3 173.5 1.8Education and Training 3.8 3.5 0.4Other Operating Income 13.7 10.9 2.8

192.8 187.9 4.9

ExpenditurePay -126.3 -123.8 -2.5 Non Pay -56.9 -52.9 -3.9

-183.2 -176.7 -6.4

EBITDA (pre Exceptionals) 9.7 11.2 -1.5 5.0% 6.0% -0.9%

Restructuring Costs -2.9 0.0 -2.9

EBITDA (post Exceptionals) 6.8 11.2 -4.4

Depreciation -7.3 -6.5 -0.8 Asset Impairment -2.0 -3.1 1.1Interest -0.6 -0.5 -0.1 PDC -1.8 -2.0 0.2

-11.6 -12.1 0.4

Net surplus/(deficit) -4.9 -0.9 -4.0

Year to Date (Month 10)

18

Income analysis (Month 10 YTD)M10 YTD Income and Activity analysis

%

Specialty

Integrated Medicine 0 437 2,545 52 20,316 2,476 12 21 3,793 29,651 15.4%Trauma and Orthopaedics 0 0 8,551 93 2,698 246 372 48 3,325 15,333 8.0%General Surgery 0 123 4,741 100 4,934 385 124 208 1,790 12,405 6.4%Central Income 0 0 43 16 2,128 244 8,847 0 0 11,279 5.8%Obstetrics and Gynaecology 0 0 439 2 6,028 101 25 199 1,230 8,024 4.2%A & E 6,175 955 0 0 0 0 0 0 6 7,137 3.7%Rheumatology 0 380 2,585 53 678 24 143 724 1,762 6,349 3.3%Paediatrics 0 325 42 4 2,023 216 2,633 3 1,002 6,248 3.2%Ophthalmology 0 0 2,254 111 92 13 937 263 2,357 6,026 3.1%Barnsley Ophthalmology 0 0 1,925 0 1 0 657 478 2,265 5,326 2.8%Urology 0 0 1,962 26 317 7 23 167 928 3,430 1.8%Adult Critical Care 0 0 1 0 88 10 3,206 0 0 3,305 1.7%Clinical Haematology 0 0 936 31 477 9 683 1 761 2,897 1.5%ENT 0 0 1,358 0 291 14 0 580 538 2,781 1.4%Oral Surgery 0 0 1,361 23 342 1 14 43 510 2,295 1.2%Community Midw ifery 0 0 1 0 2 0 0 2 1,884 1,889 1.0%Dermatology 0 0 384 9 17 3 0 452 1,003 1,869 1.0%Pathology 0 0 1 0 0 0 1,758 0 72 1,831 0.9%Therapy Services 0 0 0 0 0 0 1,260 0 0 1,260 0.7%Audiology 0 0 0 0 0 0 1,153 0 38 1,191 0.6%Radiology 0 0 0 0 0 0 1,149 0 0 1,149 0.6%GUM 0 0 0 0 1 0 0 0 1,133 1,135 0.6%Rehabilitation 0 0 0 0 0 0 1,067 0 36 1,103 0.6%Anti - Coagulation Clinic 0 0 0 0 0 0 0 0 233 233 0.1%Orthodontics 0 0 2 0 1 0 0 124 43 170 0.1%Anaesthetics 0 0 0 0 18 0 0 0 0 18 0.0%Grand Total 6,175 2,220 29,130 520 40,452 3,747 24,061 3,315 24,711 134,332 69.7%

Non-SLAM recorded activityCommunity Block 27,336 14.2%Dental Barnsley & Doncaster 1,487 0.8%Dental OOH / DAC 629 0.3%Photopheresis 2,427 1.3%Other Community 43 0.0%Central Non Recurrent funding (£1m accelertated dep'n + 10/12 of £4m Restructuring) 4,333 2.2%Other (a/c code 10500) -150 -0.1%

PbR / Non-PbR income 170,437 88.4%

OtherOther Clinical Income (RTA and deferred income) 4,891 2.5%Educations and Training 3,831 2.0%Other Operating Income 13,687 7.1%

Total income 192,846 100%

Non-elective Excess Beddays

Elective Excess

Beddays Outpatients Total

Income by activity £'000

A & E Attend

Assess-ments Elective

Non Elective NON PBR

Outpatient procedure

Observations1. The mix of income / activity is in-line with a typical

DGH with a concentration around large specialties such as Medicine, T&O, and General Surgery. There does not appear to be any reason why such a mix of business could not be delivered on an economically viable basis from a one-site acute provider, without PFI commitments.

2. There are a few specialties which do appear to be larger than average for a Trust this size. These include:

1. Ophthalmology; and2. Rheumatology.

In Phase 2 of the Recovery Plan, detailed service by service reviews (based on SLR) will be conducted to assess the productivity and quality improvement initiatives potentially available in each specialty.

3. It will also be necessary to review in detail the community services provided to understand their linkage with acute services and to understand the best manner in which to manage patient pathways.

19

Activity analysis (Month 10 YTD)

Specialty

Integrated Medicine 0 1,206 3,557 228 11,228 11,308 1,612 133 26,647 55,919Trauma and Orthopaedics 0 0 3,158 397 1,012 1,037 371,547 362 32,698 410,211General Surgery 0 341 5,082 429 2,933 1,670 689 1,317 14,073 26,534Central Income 0 0 14 70 1,223 1,081 block 0 0 2,388Obstetrics and Gynaecology 0 0 246 4 6,264 249 25,137 1,600 17,101 50,601A & E 63,658 2,639 0 0 0 0 0 1 76 66,374Rheumatology 0 1,477 3,466 204 782 94 79,172 3,987 15,757 104,939Paediatrics 0 841 46 13 2,670 723 71,563 13 5,966 81,835Ophthalmology 0 0 3,534 407 54 46 44,434 1,795 28,386 78,656Barnsley Ophthalmology 0 0 3,006 0 1 0 879 3,174 27,291 34,351Urology 0 0 3,679 116 206 31 9,907 454 7,537 21,930Adult Critical Care 0 0 1 0 32 46 3,473 0 0 3,552Clinical Haematology 0 0 1,832 131 195 36 682,562 4 5,855 690,615ENT 0 0 1,181 0 229 57 0 4,606 6,740 12,813Oral Surgery 0 0 2,136 92 207 3 13,904 313 4,952 21,607Community Midw ifery 0 0 1 0 3 0 0 16 27,984 28,004Dermatology 0 0 592 40 8 14 0 4,367 11,689 16,710Pathology 0 0 2 0 0 0 1,451,412 0 280 1,451,694Therapy Services 0 0 0 0 0 0 50,677 0 0 50,677Audiology 0 0 0 0 0 0 42,497 0 2,775 45,272Radiology 0 0 0 0 0 0 588,533 0 0 588,533GUM 0 0 0 0 1 0 0 0 14,399 14,400Rehabilitation 0 0 0 0 0 0 56,089 0 330 56,419Anti - Coagulation Clinic 0 0 0 0 0 0 0 2 17,412 17,414Orthodontics 0 0 2 0 1 0 0 933 323 1,259Anaesthetics 0 0 0 0 7 0 0 0 2 9Grand Total 63,658 6,504 31,535 2,131 27,056 16,395 3,494,088 23,077 268,273 3,932,717

Activity by attendences, spells and OBDs

Outpatient procedure Outpatients Total

A & E Attend

Assess-ments Elective

Elective Excess

Beddays

Non-elective Excess

Beddays Non

Elective NON PBR

Observations1. In respect of activity levels, clearly the “non-

elective excess beddays” is a major operational issue for the Trust (as identified by PwC).

2. In Phase 2 of the Recovery, a major target will be ensuring an appropriate bed base is established for the Trust so that elective activity does not continue to be “crowded out” by non-elective activity.

3. In addition, as specialty by specialty reviews are conducted and as EPR is stabilised, outpatient attendances and capacity will need to be reviewed (again identified by PwC).

20

Consolidating analysis (Month 10 YTD)Rotherham Foundation TrustConsolidating P&L (Month 10)

Urgent Care Elective Community CSUs OSUs Corporate Total Urgent Care Elective Community CSUs OSUs Corporate Total

RevenueClinical Income 52.5 66.6 39.7 158.8 0.0 16.6 175.3 1.2 -4.3 -0.1 -3.2 0.0 5.0 1.8Education and Training 0.0 0.0 0.1 0.1 0.4 3.3 3.8 0.0 0.0 -0.0 0.0 0.0 0.3 0.4Other Operating Income 3.7 1.8 4.2 9.7 4.0 0.1 13.7 1.5 0.1 0.2 1.8 0.8 0.1 2.8

56.2 68.4 43.9 168.5 4.4 19.9 192.8 2.8 -4.2 0.0 -1.4 0.8 5.5 4.9

ExpenditurePay -38.2 -39.4 -29.3 -106.9 -19.4 0.0 -126.3 -0.2 1.1 0.8 1.6 -0.6 -3.5 -2.5Non Pay -16.9 -18.1 -6.5 -41.4 -14.7 -0.7 -56.9 -2.6 -0.3 -0.2 -3.2 -0.7 -0.1 -3.9

-55.0 -57.5 -35.8 -148.4 -34.1 -0.7 -183.2 -2.9 0.7 0.6 -1.6 -1.2 -3.6 -6.5

EBITDA (pre Exceptionals) 1.2 10.9 8.1 20.2 -29.7 19.3 9.7 -0.1 -3.4 0.6 -2.9 -0.4 1.8 -1.52.1% 15.9% 18.4% 12.0% 5.0% -3.3% 82.3% 1825.0% 217.0% -30.4%

Restructuring Costs 0.0 0.0 0.0 0.0 0.0 -2.9 -2.9 0.0 0.0 0.0 0.0 0.0 -2.9 -2.9

EBITDA (post Exceptionals) 1.2 10.9 8.1 20.2 -29.7 16.3 6.8 -0.1 -3.4 0.6 -2.9 -0.4 -1.1 -4.4

Depreciation -0.2 -0.0 0.0 -0.2 -0.4 -6.7 -7.3 -0.0 -0.0 0.0 -0.0 -0.0 -0.8 -0.8Asset Impairment 0.0 0.0 0.0 0.0 0.0 -2.0 -2.0 0.0 0.0 0.0 0.0 0.0 1.1 1.1Interest -0.0 -0.0 0.0 -0.0 -0.1 -0.4 -0.6 -0.0 -0.0 0.0 -0.0 0.0 -0.1 -0.1PDC 0.0 0.0 0.0 0.0 -0.0 -1.8 -1.8 0.0 0.0 0.0 0.0 -0.0 0.3 0.2

Net surplus / (deficit) 0.9 10.9 8.1 19.9 -30.2 5.5 -4.9 -0.1 -3.4 0.6 -3.0 -0.4 -0.6 -4.0

Key messages

1 The Trust has made the first significant actual surplus in 2012/13 of £1.1m in M10 which is £0.2m better than plan.2 The main contributions to the Trust's £4.0m shortfall vs plan YTD are Elective Care (£3.4m) and Corporate £0.6m). 3 Elective Care is the largest contributor (£10.9m) to Corporate overheads after taking account of YTD shortfalls versus plan (£3.4m).4 EBITDA actual is 5% but this is inflated due to £3.3m NHSR transitional support shown "above the line" and matching expenditure "below the line".5 NEL threshold loss (mainly in Urgent Care) is £1.0m.

Year to Date (Month 10) Actuals Year to Date (Month 10) Variance from Plan

21

Balance sheet (Month 10 FY 2013)Balance sheet summary at January 2013

£m £mFixed assets

Tangible 85.9Intangible 12.7

98.6Working capital

Inventories 3.2Trade and other debtors / prepayments 8.0Accrued income 4.4Trade and other creditors / accruals -11.6Tax and NI -4.9Deferred income -2.3

-3.1Financing

Cash and cash equivalents 5.0FTFF loans -22.1Finance leases -1.2Other financial liabilities -2.3

-20.6Provisions -3.2

Net assets 71.6

PDC 72.7Retained deficit -2.5Revaluation Reserve 1.4Equity 71.6

Observations1. The Recovery Plan is based on the balance sheet as presented

(i.e. it assumes no significant further provisions / write-offs are required in relation to fixed assets, stocks or debtors / accrued income);

2. Fixed assets currently includes £12.6m relating to EPR;

3. Trade and other debtors / accrued income have significant accruals in relation to other NHS bodies including a outstanding £0.4m owed by Doncaster and Bassetlaw;

4. Trade and other creditors / accruals includes £1.6m owed to Doncaster and Bassetlaw of which £0.3m is in dispute. Other than Doncaster and Bassetlaw there are no significant arrears of any creditors;

5. FTFF loans are being paid over 10 and 20 years ending in 2019 (EPR £20m) and 2029 (general estates £10m) - no arrears at present;

6. Provisions are mainly restructuring of £2.6m.

22

Liquidity – weekly cash flow to AugustShort term cash flow

Actual£'m w/e 01-Mar 08-Mar 15-Mar 22-Mar 29-Mar 05-Apr 12-Apr 19-Apr 26-Apr 03-May 10-May 17-May 24-May 31-May 07-Jun 14-Jun 21-Jun 28-Jun 05-Jul 12-Jul 19-Jul 26-Jul 02-Aug 09-Aug 16-Aug 23-Aug 30-AugIncomeNHS block contract income 14.1 0.5 3.4 - - 13.2 - 2.0 1.0 13.2 - 2.0 - 1.0 13.2 - 2.0 1.0 13.2 - 2.0 1.0 13.2 - 2.0 - 1.0 NHS non contract income 0.4 0.4 2.6 0.2 0.2 - 0.4 0.2 0.8 0.2 0.2 0.2 0.4 0.2 0.4 0.2 0.4 0.2 0.4 0.2 0.4 0.2 - 0.4 0.2 0.4 0.2 Other * 0.1 0.7 0.1 0.2 0.3 0.0 0.2 0.2 0.1 0.2 0.2 0.2 0.1 0.2 0.0 0.2 0.2 0.3 0.1 0.2 0.2 0.1 0.3 0.1 0.2 0.2 0.3

14.6 1.6 6.0 0.4 0.5 13.3 0.6 2.5 1.9 13.6 0.4 2.5 0.5 1.4 13.7 0.4 2.7 1.5 13.7 0.4 2.6 1.3 13.5 0.5 2.4 0.6 1.5 PaymentsSalaries/Wages (6.9) - - - (7.1) - - - (7.2) - - - (7.6) - - - - (7.4) - - - (6.6) - - - - (6.6) Tax & NI & Superannuation - - - (4.8) - - - (1.9) (2.9) - - (1.9) (3.0) - - - (5.2) - - - (2.0) (3.0) - - (1.8) (2.7) - PRL Payments (1.5) (1.2) (1.2) (0.5) (0.5) (4.0) (1.0) (2.0) (1.0) (1.5) (1.5) (1.5) (1.0) (1.0) (1.5) (1.5) (1.5) (1.5) (1.5) (1.2) (1.2) (1.5) (1.5) (1.2) (1.0) (1.5) (1.3) Capital expenditure (0.1) (0.1) (0.1) - - - - - - - - - - - - - - - - - - - - - - - - Loan repayment - - (0.3) - - - - - - - - - - - - - (1.1) - - - - - - - - - - Loan interest - - (0.1) - - - - - - - - - - - - - (0.2) - - - - - - - - - - PDC Dividend - - (0.9) - - - - - - - - - - - - - - - - - - - - - - - - Other ** (0.0) (0.0) (0.0) - - - (0.5) - - - - (0.5) - - - (0.5) - - - (0.5) - - - - (0.5) - -

(8.6) (1.3) (2.6) (5.3) (7.6) (4.0) (1.5) (3.9) (11.1) (1.5) (1.5) (3.9) (11.6) (1.0) (1.5) (2.0) (7.9) (8.9) (1.5) (1.7) (3.2) (11.2) (1.5) (1.2) (3.3) (4.2) (7.9)

Operating cash flow 6.1 0.3 3.4 (4.9) (7.1) 9.3 (0.9) (1.5) (9.3) 12.1 (1.1) (1.5) (11.1) 0.4 12.2 (1.6) (5.3) (7.5) 12.2 (1.4) (0.6) (9.9) 12.0 (0.8) (0.9) (3.6) (6.5)

Off /(onto) deposit (6.4) - - 3.9 7.0 (9.8) 1.4 1.4 10.4 (12.5) 1.2 1.5 10.6 - (12.2) 1.5 4.3 10.6 (13.7) 0.5 1.1 10.5 (13.2) 1.2 0.9 3.6 7.0

Net cash movement (0.3) 0.3 3.4 (1.0) (0.1) (0.5) 0.4 (0.1) 1.2 (0.4) 0.1 0.0 (0.5) 0.4 0.0 (0.1) (1.0) 3.1 (1.5) (0.9) 0.5 0.5 (1.2) 0.4 (0.0) 0.0 0.5

Current a/c b/f 0.5 0.2 0.5 3.9 2.9 2.7 2.2 2.6 2.6 3.7 3.3 3.4 3.4 2.9 3.3 3.3 3.1 2.2 5.3 3.8 2.9 3.5 4.0 2.8 3.3 3.3 3.3 Current a/c c/f 0.2 0.5 3.9 2.9 2.7 2.2 2.6 2.6 3.7 3.3 3.4 3.4 2.9 3.3 3.3 3.1 2.2 5.3 3.8 2.9 3.5 4.0 2.8 3.3 3.3 3.3 3.8

Cash on deposit 21.4 21.4 21.4 17.5 10.5 20.3 19.0 17.6 7.2 19.7 18.5 17.0 6.4 6.4 18.5 17.0 12.7 2.1 15.8 15.3 14.2 3.8 16.9 15.7 14.8 11.2 4.2

Cash and cash equivalents b/f 15.5 21.6 21.9 25.3 20.4 13.3 22.5 21.6 20.1 10.9 23.0 21.8 20.3 9.2 9.6 21.8 20.1 14.9 7.4 19.6 18.2 17.7 7.8 19.7 19.0 18.0 14.4 Cash and cash equivalents c/f 21.6 21.9 25.3 20.4 13.3 22.5 21.6 20.1 10.9 23.0 21.8 20.3 9.2 9.6 21.8 20.1 14.9 7.4 19.6 18.2 17.7 7.8 19.7 19.0 18.0 14.4 8.0

* Income other - Non NHS income, chip & pin, cash collections, returned BACS and VAT refunds** Payments other - NHSLA payments, bank charges & petty cash

Weekly summaryForecast

Risks The forecast does not include settlement of Doncaster and Bassetlaw (net accrual of £1.1m) who are now looking to make a settlement.In April the key contract receipt will be via SBS and could move to mid-month. The forecast assumes that this potential issue can be resolved but the sensitivity highlights the potential impact. Contract income is yet to be agreed but the forecast assumes income at current levels. However, from April c. £1m will come from SCG, LA and NBS and it is currently unknown when it will be received (currently prudently forecast for the end of the months).

Sensitivity after mitigations

The sensitivity for the SBS timing risk has the impact of elongating the period of minimum cash balance but the other risks should be offset by cash management (delayed creditor payments and capex).

2013/14 Longer term trend remains downwards in the absence of CIPs / tactical controls and FTFF drawdown although there is no imminent risk to cash. The forecast month end balances have all improved by £2.0m with a minimum point of £7.4m on 28 June following both payroll, restructuring and the half yearly £1.1m loan repayment. We now have credit approval from Lloyds for a £17m WCF although this was on the basis of FTFF drawdown but if FTFF is not to be pursued, Lloyds may need to return to credit.

Key issues

Q4 2012/13 At the end of this current week the cash position is £25.3m, £2.0m better than forecast, mainly due to the receipt of £1.9m from NHSR for the year end forecast adjustment which has been agreed this week and not in any previous forecasts.

Trend The forecast position at year end £13.3m, £2m higher than last week due to the additional payment of £1.9m from NHSR as noted above. There are no other significant changes.Following discussions with the CFO around Payroll & restructuring costs the payroll has been reduced to £6.6m with restructuring costs factored in for April, May & June, thus giving an improved cash position from last week.The forecast continues to reflect redundancy payments of £2.4m phased over Q1 (£0.6m, £1.0m and £0.8m) but it still does not reflect any non recurrent income supporting the first quarter, cash management or drawdown of FTFF. It is possible that some redundancy payments will be made pre year end in which case the forecast year end balance could be lower (although this would just be a timing difference).

-

5,000

10,000

15,000

20,000

25,000

30,000

Cash

£'0

00

Daily cash forecast to 30 August

14 Mar forecast Sensitised after mitigation Actual

23

EPR ContextThe Trust has made a significant investment in EPR, both capital

and revenue costs that are now forecast to be in the order of £40m

(compared to the original forecast of £30m).

The project ran late but went live on 1 July 2012. There have been

difficulties with implementation leading to inaccurate coding of case

mix and data recording, duplication and possibly lost activity. This

has impacted financial performance through lost referral activity

and income (estimated at £2.2m for YTD). Detailed financial impact

analysis is incorporated on page 28.

Root causes of financial and data quality impacts:

• Impacts – remediable in the short term

• Merging of data files from Choose & Book to Contact

Centre, affecting patient referrals, patient call response

times, clinic bookings, duplicate entries. This impacted

on 18 week and cancer targets; and

• Data quality issues - relating to activity reduction,

backlog of coding cases, cross mapping error in relation

HRG assignment. Thus creating significant validation

workload within specialties and the Information Team.

Short term remedial actions:• Postponed different module implementation within EPR until options

appraised.

• Redirection of resources to data validation and analysis.

• Targeted training for end users – specifically in relation to 18 week

validation.

• Review of Contact Centre systems and processes, new leadership and

introduction of new Standard Operating Procedures.

• Comprehensive data quality analysis, including financial impact.

Current outcomes in relation to the Contact Centre:• Call times from an average of 9 minutes in December 2012, reduced to an

average of 1 minute in February 2013.

• Duplicate entries reduced from 50 per week in November 2012, to 2 per

week in February 2013 (lower than pre go-live levels).

• Additional clinic sessions, to reduce backlog, have positively influenced 18

week targets, cancer targets are now being met – GP referrals also reflect

an increase (see page 25).

Data Quality validation (see pages 26-27):• Data quality benchmarking is comparable with peers, both Nationally and

Regionally.

• Review of user error origins has resulted in focussed training, financial

impact assessed and meeting with commissioners suggest some re-

imbursement – to be agreed.

25

Quality Impact Status

Diagnostic waiting times - ensure nobody waits 6 weeks or over for 15 Key diagnostic tests

1.0% 1.5% 3.9% 0.3% 0.3%

40.20%

3.4% 1.2% 1.9%0.9% 3.5% 0.9% 0.2%

8.3% 7.4% 13.0% 11.1% 9.7%11.0% 11.5% 11.5%

48.59%

1082

79187993 7014 6632

2.89 2.752.58

38843715 4256

3.10 2.63

1726

2.52 2.92 2.75 2.692.51 2.41 2.47

Quarter 4

Rating Period Change

Target YTD Apr-12 May-12 Jan-13Dec-12

48194717 5344 4605 49665487 4958 37985930 5018

Out

Pati

ents

Prim

ary

Care

Quarter 1 Quarter 2 Quarter 3

29653698 3767

1104 1231 8332232 1251 1096

2879

Total number of New outpatients

- Non Rotherham

- Rotherham

Total number of GP referrals TBC 49642

0.00% TBC 36929 3706 4197

0.00%

0.00%

TBC 12713 1011 1147

72624

Out patient New to Follow up ratio

Out patient DNA rates 7.7%

3862

67859

12.8%10.8%

6777 8139 5051 5311 6815 6209

-15.00%

6.56%

TrendlineJun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12

13.8%

Switchboard

The Rotherham NHS Foundation Trust - MONITOR Scorecard - Position for Month 11 QTR 4 12/13 Finance & Governance Compliance Framework

Rated on Qtr Position

75.0%

91.2%

97.0%

95.4%

96.2%

96.0%

100.0%

100.0%

100.0%

90%

0 85%

94%

95.6%

76.6% 96.8% 96.0%93.7% 98.2% 94.2% 93.3% 84.8% 89.4%

97.8% 96.2%

94.0% 95.1%

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

Cancer 2 week wait from referral to date first seen, sympomatic breast patients (cancer not initally suspected)

0 93% 91.0%

97.0%

91.8%

97.2%

Maximum time of 18 weeks from point of referral to treatment in aggregate, patients on incomplete pathways

0 92% 93.1% 97.6%

100.0%

100.0% 97.2%

100.0% 100.0%

91.0% 90.3%

83.3%

95.6% 98.6% 90.7%

100.0%

0 95%

Relia

ble

92.6%

100.0%

98.7% 98.3% 97.9% 97.2%

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

0 90% 94.2% 98.0% 99.1% 97.9%

100.0% 100.0% 100.0% 100.0% 100.0% 75.0%

91.2%90.3%

1

92.2%

96.8% 97.4%

100.0%

92.4% 91.1% 86.5% 89.6%

94.2%

100.0% 100.0% 100.0%

99.0% 100.0% 85.7% 100.0% 100.0% 100.0% 100.0%

92.6% 100.0%

100.0%

100.0% 100.0% 100.0% 100.0%

TrendJun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12

92.2% 96.1% 95.8%Cancer 2 week wait from referral to date first seen, all urgent referrals (cancer suspected)

0 93% 95.2% 95.2% 89.7% 94.6%96.8% 96.4%

Cancer 31 day wait from diagnosis to 1st treatment 0 99.1% 100.0% 97.4% 100.0% 98.8% 100.0% 98.4%96%

Quarter 1 Quarter 2 Quarter 3 Quarter 4Rating Score

Month Change

QTR Target

YTD Apr-12 May-12 Dec-12 Jan-13QTR Value

0Cancer 31 day wait for 2nd or subsequent treatment - surgery

96.2%

Cancer 62 Day Waits for first treatment (from NHS cancer screening service referral)

87.8%Cancer 62 Day Waits for first treatment (urgent GP referral for suspected cancer)

100.0% 100.0% 100.0%Cancer 31 day wait for second or subsequent treatment - anti cancer drug treatments

0

100.0%

98%

94.8% 92.0% 89.9% 87.8%

75.0% 88.9%

98.0% 99.6% 99.8%

93.6% 94.3%

95.8%

95.4%

24

25

SUS Data Quality Dashboard for Apr-Nov Data – All data items

Rotherham compared to other SHA trusts

26

SUS Data Quality Dashboard for Apr-Nov Data – Inpatient data items

27

SUS Data Quality Dashboard for Apr-Nov Data – Outpatient data items

28

Financial Impact of EPR (in addition to planned spend) Observations1. Excludes £2.16m of deferred capital invoice payments, these are

planned to be paid in FY 2014.

2. Re-validation of data impacted on both corporate teams and also CSU service managers. This equated to approximately £0.8m additional overtime and implementation costs.

3. Due to the additional time taken to log information into the system, the number of patients in clinics had to be reduced, this led to loss of income due to the drop in activity levels.

4. Commissioner fines were also incurred due to missing 18 week targets (£0.3m).

5. Financial impact of data quality recording issues currently being reviewed by commissioners, it is hoped we will recover at least half of the £1.3m in lost income.

6. Options appraisal of training needs plus additional staff resource has been estimated at £350k to cover the next six months of the Recovery Plan. Any further cost requirements will be considered as part of the April report.

7. These figures relate to known costing – it is unlikely that we can calculate confidently all costs but we feel we have captured the vast majority.

Electronic Patient Records costs FY1213 Forecast Outturn (£m)

Plan Actual VarianceCapital Scheme

Summary costs 5.7 4.3 1.4

Other CostsCost pressures - Staff - 0.2 - 0.2Staff currently charged to capital no budget - - - Interest on Loan (1) 0.3 0.3 - Interest on Loan(2) 0.1 0.1 - Maintenance - External Consultant - 0.0 - 0.0

0.4 0.6 - 0.2Income Issues

Loss of income - 3.3 - 3.318ww Commissioner Fine - 0.3 - 0.3

- 3.6 - 3.6

Loss of Opportunity for Cost SavingsO-P Review (cost retraction) - 1.6 - - 1.6A&C Review - 0.5 - - 0.5

- 2.1 - - 2.1

Overspends - extended implementation pressuresIT 1.2 1.4 - 0.2Medical Records - 0.1 - 0.1Other Departments - 0.0 - 0.0IT Overtime - 0.1 - 0.1New authorised spend - 0.0 - 0.0

1.2 1.5 - 0.4

Total of all spend/deficits against plan 5.2 10.0 - 4.8

Annual Cost of repayment on the capital of the loanLoan (1) 1.5 1.5 - Loan (2) 0.3 0.3 -

1.8 1.8 -

29

EPR Medium to long term issues

System and implementation specific root causes:

• Configuration of system not based on clinical user needs;

• Training limited, insufficiently proximate to go-live so as to ensure

effective use;

• Testing was a unit based approach, failing to assess ‘whole system’

efficacy;

• Configuration and architecture overly complex, not tailored to meet

mandatory reporting functions;

• Clinical engagement limited;

• Implementation was not phased in as granular fashion as might

have been - thereby reducing risk;

• Financial governance – systems and processes – weak;

• Change management controls were not administered effectively;

• IT, Information and EPR project teams working in silos, not

coordinating activities; and

• Purchased a development system with inherent issues,

implemented based on a time frame rather than functional outcome.

Medium to long term actions, already in place include:• Implementation of clinical engagement strategy, we are already seeing

increased clinical engagement;

• Governance processes reviewed, strengthened and aligned to

corporate governance structures with agreed Terms of Reference;

• Change control process reviewed and strengthened via weekly Change

Advisory Board meetings, sign off and agreement prior to actions;

• Financial governance has been reviewed and strengthened – with

regular budgetary reporting;

• Reconfiguration and integration of IT, Information teams and EPR staff

into Health Informatics Directorate – to be complete by April 2013;

• Informatics Project Management Team aligned to chosen options, going

forward – this will include provision of appropriate training resource;

• Implementation using a phased approach, will be piloted and fully

integration tested within the clinical setting, prior to application in the live

environment;

• System configured to acknowledge mandatory (CDS) and operational

reporting needs is currently under review; and

• Clinical sign off of usability - for any new developments, will be made

prior to going live, via the Clinical User Group (CUG).

30

Further medium to longer term actions / developments• Integration of the Health Informatics Directorate will provide a more stream lined and

integrated services with savings of approximately £1m.

• Following systems options appraisal, a further financial impact will be costed (excluding the training costs already highlighted).

• Immediate training programmes will focus on data quality impact that also affect financial activity payments i.e.

• Not creating follow-up attendances accurately;• Outpatient summary, day case incompletion - means activity not logged;• Failing to record co-morbidity, cross mapping errors SNOWMED; and• Procedures not recorded.

• Specific programmes of work that will bring immediate resolution to quality of data and activity will be:

• Single sign off process for clinicians, currently time consuming;• De-construct some of the functionality, ambulatory orders to reduce the time for

clinicians data entering in clinics; and• Time to complete discharge summaries to be reduced.

Additional options appraisal currently underway via external expert, this report will be completed by April 2013.

31





V Governance 61

VI Quality 63

Appendices


32

The Plan - Overview










1. Corporate overhead of £21m. Target reduction of £5m in Year 1;
















12 months

33

Phase 1 – Summary of savings target FY 2014Category Initiative Savings to Date Annual Savings Notes

1) Cancellation of Community Consulting Engagement (Capita) £50,000 £50,000 Cancellation of project.2) Removal of 5 agency, admin & clerical (offset by YR) 0 1,300,000 Removal ofmost temps in HR, BI, finance, etc.3) Removal of 2 executive directors + 2 additional executives 0 500,000 Reduction in executive team (COO; SI; PMO; HR)4) Identification of other corporate savings targets (non pay; etc) 1,000,000 1,000,000 Reduction of spend incurred in FY13 (professional fees; "one-offs"5) Balance for Executive to reduce corporate from £21m to £16m 0 2,150,000 Reduction in people; professional fees; vacancies when they arise.

£1,050,000 £5,000,000

(1) Agency. Reduction in spend from £3.2m to £2.0m. 160,000 1,200,000 Rates renegotiated (reduction of 5-10%). Weekly reporting. Controls.(2) Overtime. Reduction in spend from £1.3m to £0.7m. 0 600,000 Analysis circulated to resp. Executives. Tightening of controls.(3) Additional Sessions. Reduction in spend from £1.2m to £0.9m 0 300,000 Controls tightened. Weekly reporting.(4) Non Medical Overtime Rates. Reduction in spend from £0.2 to £0.15m 0 50,000 Analysis circulated to resp. Executives. Tightening of controls.(5) VR implementation 115,000 115,000 Reduced VR list has now been implemented. No replacements.

Sub-Total £275,000 £2,265,000(1) Taxis. Tightening of controls to reduce spend from £230k to £130k £10,000 £100,000 Controls tightened. Weekly reporting. Evidence of reduction.

(2) Interpreters. Tightening of controls to reduce spend from £120k to £80k 2,000 40,000 Rates renegotiated. Controls tightened. Weekly reporing.

(3) IT. Tightening of controls to reduce spend (from £7m cash down) tbd tbd Weekly reporting. Clearer structure and accountability.Included in corporate

(4) Consolidation of other budgets (printing, telephone, etc) 0 500,000 Consolidation and clear accountability nderway.

(5) Examination of other significant non pay areas (weekly) 0 500,000 Weekly review of BACS runs. Removal of non-compliant suppliers.

Sub-Total £12,000 £1,140,000£287,000 £3,405,000

Category Area Budget CIPsIncremental

savingsNotes

Elective Care 1,765,384 1,082,932 Previously identified CSUs. Quality assessed and signed off by Chief Nurse; MD in 2012.

Urgent Care 1,230,700 867,000 Previously identified CSUs. Quality assessed and signed off by Chief Nurse; MD in 2012.

Community Services 1,068,476 559,901 Previously identified CSUs. Quality assessed and signed off by Chief Nurse; MD in 2012.

Other reviews (Nursing; A&C; AHP) 0 676,700 Nursing consultation and other CR.

£4,064,560 £3,186,534

Total cost reductions identified £11,591,534

Additional cost reductions (to be identified and delivered) £1,408,466

CSUs

Total

Executive Structure

Tactical Controls (Pay)

Tactical Controls (Non Pay)

Total

Total

34

Phase 1 – Corporate Overhead Reduction

Overview

1. RFT corporate overheads (excluding facilities and estates and financing costs) are currently running at £21.9 m per annum (as per the table opposite). This represents ~10% of revenue and excludes a significant amount of overhead that is included at the CSU level.

2. A rapid and significant reduction in corporate overheads has been targeted for the following reasons:

1. Low risk to clinical quality and patient safety - given the impact of EPR and the operational challenges currently being faced by TRFT, Management believe that there is significant operational risk attached to some of the previous CIPS schemes (e.g. ward closures, outpatient clinic capacity). By contrast a reduction in corporate overhead is seen as possible in the short term with relatively little impact on clinical quality or patient safety;

2. Practically achievable – significant progress on reducing the corporate structure has already been made. Over the past 3 months, 6 senior executives have departed TRFT and there has been a consolidation to 5 direct reports to the CEO. The next level of corporate restructuring is well-advanced (detail next page); and

3. Improving governance and accountability – the streamlining of corporate functions is seen as an important step in improving accountability and governance in the Trust. The absence of clear reporting lines and overlapping responsibilities is seen as a key reason for some of the failures in governance in recent years.

3. The cost of restructuring corporate overhead is estimated at £2-2.5m. This cost is included in the £4m restructuring cost for FY 2013 and has been agreed with commissioners. Given timings, it is assumed that, on average, 10 months benefit will be obtained in FY 2014.

Executive Structure – “Current”Rotherham NHS Foundation Trust

EPR, SystmOne, IT Services, Service Improvement

Director of IT & Service Improvement

Kim Ashall

Acting Chief Executive

Matthew Lowry

Chief NurseJuliette Greenwood

Medical DirectorGeorge Thomson

Chief of Legal and Corporate Affairs

Kerry Rogers

Chief Human Resources Officer

Jacqui Bate

Acting Chief Operating Officer

Mike Dennis

Chief Financial Officer

John Somers

Acting Chief of Business

IntelligenceTricia Bain*

Interim Transformation DirectorTim Bolot

Acting Director of PMOMichelle Kemp

Governance & AssuranceLegal & regulatory ComplianceQAS (self assessment)Legal Services, Claims and LitigationCommunications, Marketing & GraphicsGovernors / Members / PPIVolunteering, Charity, CSRPatient & Health Info

Human Resource Management

MAST

Workforce Planning

Payroll


Occupational Health

Operational Management of all Clinical Directorates and Services

Outpatients / Patient Access

Estates and Facilities

Business Resilience

Screening Services

Business Intelligence including Information & Performance Monitoring

*Tricia will continue to fulfil her role as Director of Quality & Standards

Financial Management

Contracting

Business Planning & Investment

Procurement

Business Development

Professional Leadership, Development and Integration of Nursing and AHP

Patient Experience

Safeguarding

Dementia Strategy

Patient Services (incl. complaints)

Clinical Quality, Safety & Risk

Quality Accounts

Infection Prevention & Control

Public Health

Caldicott Guardian

Medical Workforce Planning

Clinical Education & PGME

R&D, Clinical Effectiveness

Cancer Services

SUMMARY WTE BudgetForecast Outturn

1. Executive Medical Director 166.85 4.304 4.0412. Executive Nurse Offi cer 29.85 1.983 2.2203. Executive Director Health Informatics 120.55 5.366 6.7434. Executive Director of Corporate Affairs 102.08 4.573 4.5035. Executive Financial Offi cer 59.83 3.688 4.1166. Chief Executive Offi cer 2.00 0.257 0.257Total 481.16 20.171 21.880

"As-Is" (FY 13)

35

Phase 1 – Simplification of Top Level Structure

Overview

1. Following a Board decision in February 2013, the top level executive structure is in the process of being greatly simplified. There has been a reduction in 4 senior executives (from 9 to 5) reporting directly to the CEO.

2. Management of several corporate functions has been merged to reduce the number or executives (e.g. HR and corporate affairs; Finance and PMO). As a result of this activity, 4 executives have or are in the process of being exited with no replacement. This will bring to 6, the number of senior executives that have left the organisation since October 2012.

3. The new Executive team have been working through the corporate budget areas in detail over February and March with a view to reducing the overall cost of this structure from £21.8m (outturn in FY2013) to £16.7m in FY 2014. This will be achieved through the following actions:

1. Elimination of “one-off” spend incurred in FY 2013 relating to professional fees, staff in post, agency usage. This figure is estimated to be in excess of £2m (details are currently being finalised);

2. A restructure of staff within Corporate (with proposed consultation by the end of March) which will result in additional staff leaving the organisation; and

3. Re-negotiation and tighter control over other non-pay categories (e.g. audit fees, graphics, legal fees).

4. The new budgets will be finalised over the coming weeks and the consultation will commence prior to 31 March 2013.

SUMMARY WTEWTE

Reduction Budget

Reduction from

Budget

Reduction from

Outturn1. Executive Medical Director 163.34 3.51 3.865 0.380 0.1882. Executive Nurse Officer 24.69 5.16 1.518 0.465 0.7023. Executive Director Health Informatics 89.12 31.43 5.075 0.291 1.6564. Executive Director of Corporate Affairs 79.25 22.83 3.156 1.417 1.3475. Executive Financial Offi cer 59.33 0.50 2.720 0.968 1.4146. Chief Executive Officer 2.00 0.00 0.350 -0.093 -0.093Total 417.73 63.43 16.684 3.428 5.214

"To-Be" (FY 14)

Executive Medical Director

• Cost = £3.87 m• WTE = 163.34

Includes• Corporate MD function (2

WTE) + Clinical Effectiveness (10 WTE)

• PGME (18 WTE)• Patient Access (116 WTE)• Cancer Services (3 WTE)• R&D (6 WTE)

• FT docs (7 WTE)

Includes:• CEO + PA• Small budget for professional fees

1

Executive Nurse Officer

• Cost = £1.52 m• WTE = 24.69

Includes• Corporate Nursing

function (9 WTE)• Patient Services Centre

(Complaints) (5 WTE)• Quality (10 WTE)

CEO

• Cost = £0.35 m• WTE = 2.0

Executive Director of Health Informatics

• Cost = £5.08 m• WTE = 89.12

Includes• Computing support (49 WTE)• Also includes:

• Coding• EPR• Service improvement• Planning & Info

Executive Director of Corporate Affairs

• Cost = £3.2 m• WTE = 29.25

Includes• HR• Corporate Affairs• Legal Affairs• Community Involvement

Executive Financial Officer

• Cost = £2.7m• WTE = 59.33

Includes• Management Accounts• Financial Control• PMO Reporting• Payroll

New Corporate Structure

36

Phase 1 – Tactical controls - Pay TRFT - Expenditure reviewPay Update Meeting - 28 February 2013

PayAnnualised

Value (£'000) % of total

expenditure

Future Savings secured to date

(annualised basis)

Further savings

being pursued

Nursing (Bank) 2,151 1.0% 215 Nursing (Agency) 209 0.1% 105 Admin (Bank) 497 0.2% 50 Admin (Agency) 1,543 0.7% 1,300 24 AHP (Agency) 119 0.1% Additional Hours / Overtime 1,255 0.6% 105 112 Extra Sessions (Medical) 1,236 0.0% 124 277 Additional sessions (Non-Medical) 177 0.0% 96 From 1 AprilOn-call TBC 0.0% Locum and agency (Medical) 3,236 1.5% 1,550 717

10,423 4.1% 3,175 1,500

£152,00169%

Annual Trust Expenditure FY11/12 (£'000)

353,109

424,642 435,148

353,851

184,302231,192 211,615 207,560

175,979 157,452 155,003

- 50,000

100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000

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

Monthly run rate

£

Progress on Spend on Locum and Agency (Medical)

37

Phase 1 – Tactical controls – Headcount

3,000

3,500

4,000

9,400

9,600

9,800

10,000

10,200

10,400

10,600

FTE

(Cou

nt)

Payr

oll £

'000

All Payroll

38

£152,00169%

£69,15031%

Annual Trust Expenditure FY11/12 (£'000)

Pay (£'000)Non-pay (£'000)

03f5e6c234bb4a37a2cead56f9daec80

88bab05a940247e88fe92af1b927d5b1

88bab05a940247e88fe92af1b927d5b1

Pie

Phase 1 – Tactical controls – Non-pay

Non-pay Annualised Value

(£'000)% of total

expenditure

Future Savings secured to date

(annualised basis)

Further savings being pursued

Interpreters 0 0.1% 10 25 Taxis 234 0.1% 19 12 Telecoms 845 0.4% 50 35 Computer and IT consumables 7,883 4.2% 207 39 Lab equipment and consumables 2,854 1.3% - 40 Business Administration Services 4,650 2.1% - 24 Procurement - orthopaedics M&S 2,865 2.1% 64 -

19,331 10.3% 350 175

39

Non-pay tactical controls - examplesActionsInterpreting

1. New control in place to move from face to face interpreting to telephone interpreting.

2. Negotiated a rates reduction on both telephone and face to face interpreting.

3. Access to online records system to reduce staff cost of managing service.

Taxis

4. New Standard operating procedure to reduce use of taxis.

5. New agreement to move some services to alternative transport suppliers.

IT expenditure

6. New control process to monitor IT expenditure trust wide requiring executive level approval.

7. On going program to renegotiate cost of software licences and maintenance contracts as they fall due or find alternative suppliers.

8. Switch from colour to black and white printing as a default.

9. Double sided printing as default wherever possible.

10. Process underway to replace desktop printers with communal print devices.

11. New software to manage and reduce printing outputs costs.

12. Program of recycling existing equipment more efficiently.

02/12

/2012

09/12

/2012

16/12

/2012

23/12

/2012

30/12

/2012

06/01

/2013

13/01

/2013

20/01

/2013

27/01

/2013

03/02

/2013

10/02

/2013

17/02

/2013

24/02

/2013

03/03

/2013

0500

100015002000250030003500

Interpreting cost

TI

F2F

£

09/12

/2012

16/12

/2012

23/12

/2012

30/12

/2012

06/01

/2013

13/01

/2013

20/01

/2013

27/01

/2013

03/02

/2013

10/02

/2013

17/02

/2013

0

2000

4000

6000

Taxi costs by week

Total

£'00

0

Apr-1

2

May-1

2

Jun-

12Ju

l-12

Aug-1

2

Sep-1

2

Oct-12

Nov-1

2

Dec-1

2

Jan-

13

Feb-1

30

500000

1000000

1500000

2000000

IT spend by type (YTD FY12/13)Software LicensesPeripheralsConsumablesContracted servicesMaintenanceEquip repairEquip rentalEquip leaseEquip purchase

40

Phase 1 – CSU cost reductions Observations1. As part of the normal budgeting process, CSUs are requested

to identify CIPs as a saving against prior year budget (which

are then removed from the CSU budget for the following year).

2. The items opposite are a summary of the 10s of individual

savings schemes for the CSUs and are a mixture of WTE or PA

reductions together with specific non-pay savings identified.

3. These schemes have been QIA’d and signed off by the Nursing

and Medical Directors.

4. The Recovery Plan is based on current cost run rates and

therefore only recognises the element of cost reduction which

is incremental (i.e. no vacancy releases). As shown the second

column, an assessment has been made of the truly incremental

savings as opposed to cost budgets that are already

underspending.

FY 2014 CSU cost reduction summary

£'000 £'000 Elective Care

Anaesthetics & Theatres 297 152 General Surgery & Specialist Surgery 354 192 Urology 75 40 Obstetrics & Gynaecology 393 218 Orthopaedics 406 388 Ophthalmology 240 92

1,765 1,083

Urgent CareRadiology 255 243 Pathology & Labs 248 207 Pharmacy 110 35 Integrated Med 331 156 Spec Med F.U. 169 109 A & E 118 118

1,231 867

Community ServicesAdults - LTC/Urgent Care and Re-ablement 293 76 Adults - Planned Care 105 55 Ear Care /Audiology 43 34 Adults - Staying Healthy 32 32 Integrated Sexual Health 83 18 CSU Management 18 1 Planned Care - Hospital Therapies 131 125 Planned Care - Dietetics 25 20 Children & Young People 339 199

1,068 560

Total CSU cost reductions 4,065 2,510

Incremental cost

reductions Budget

CIPs

41

The Plan - Overview










1. Corporate overhead of £21m. Target reduction of £5m in Year 1;
















12 months

42

Phase 2 OverviewIssues to be reviewed

1. Divisional structure and linkage with community services

2. Specialty productivity opportunities based on solid KPIs

3. Excess bed-days, bed base

4. Outpatient capacity

5. Outsourcing and re-contracting opportunities

6. Development of comprehensive strategic plan working with all key stakeholders, including:

1. Governors

2. Board (Execs and Non Execs)

3. Clinical and Non Clinical Leadership (CDs, Consultants, Specialists, Matrons)

4. Commissioners (CCG, NCB)

5. Other key external stakeholders (Local Authorities, Social Services, etc)

43

Phase 2 – Illustrative Operational Efficiency Analysis (1)

8

Theatre Profitability by Procedure Taking theatre time and LoS into consideration, we can see a range of profitability between procedures

Cost per Hour of Theatre

Cost per Night on Ward

£451 £109

Source: Theatre Activity Data and Spell Analysis.xlsNote: Excludes procedures with less than 15 patients per year, Component Costs are for Knees and Hip procedures, , Time in Theatre is time from providing the Anaesthetic to the Patient going into Recovery

HRG Avg Tariff Avg Time inTheatre

Cost of Theatre Avg LoS Cost of

StayAvg Component

Cost "Profit per

Procedure"Number of

Patients per YearTotal Profit

per Year

Reconstruction Procedures Category 3 £10,321 03:08 £1,420 6 £608 £260 £8,033 18 £144,594Reconstruction Procedures Category 1 £8,791 02:13 £1,000 3 £286 £0 £7,504 26 £195,112Reconstruction Procedures Category 2 £9,707 02:48 £1,265 5 £590 £1,290 £6,563 26 £170,625Major Hip Procedures Category 1 for Trauma £7,353 01:47 £811 17 £1,807 £79 £4,656 36 £167,619Major Shoulder and Upper Arm Procedures for non Trauma £5,186 01:35 £717 1 £116 £0 £4,354 142 £618,281Multiple trauma diagnoses, with interventions, score 9 - 18 £5,787 02:06 £951 9 £1,024 £0 £3,812 34 £129,592Intermediate Hip Procedures for Trauma £6,348 01:52 £849 19 £2,066 £0 £3,433 168 £576,693Major Knee Procedures for non Trauma Category 2 £6,012 02:15 £1,018 6 £602 £1,073 £3,319 340 £1,128,352Major Skin Procedures category 1 £3,530 00:50 £377 3 £303 £0 £2,850 34 £96,897Major Hip Procedures for non Trauma Category 1 £5,675 02:22 £1,069 6 £648 £1,120 £2,838 282 £800,294Major Elbow and Lower Arm Procedures for Trauma £3,665 01:50 £833 3 £320 £0 £2,512 130 £326,534Major Shoulder and Upper Arm Procedures for Trauma £3,493 02:12 £993 2 £185 £0 £2,315 26 £60,181Intermediate Foot Procedures for non -Trauma Category 2 £3,140 01:25 £646 2 £255 £0 £2,239 36 £80,600Intermediate Knee Procedures Category 2 for Trauma £3,274 01:41 £761 3 £325 £0 £2,189 56 £122,582Major Knee Procedures Category 1 for Trauma £3,773 02:23 £1,078 6 £602 £0 £2,093 28 £58,605Intermediate Elbow and Lower Arm Procedures for non Trauma £2,466 01:05 £492 0 £31 £0 £1,942 28 £54,386Intermediate Hand Procedures for non Trauma Category 2 £2,498 01:20 £605 0 £27 £0 £1,866 40 £74,636Intermediate Shoulder and Upper Arm Procedures for non Trauma £2,500 01:12 £545 1 £120 £0 £1,835 64 £117,436Major Knee Procedures for non Trauma Category 1 £2,448 01:11 £537 1 £87 £0 £1,824 58 £105,771Intermediate Hand Procedures for Trauma Category 2 £2,449 01:23 £625 1 £68 £0 £1,756 16 £28,092Intermediate Hip Procedures for non Trauma Category 1 £2,391 00:23 £175 5 £554 £171 £1,492 34 £50,718Intermediate Knee Procedures for non Trauma £1,904 00:56 £422 0 £40 £38 £1,403 240 £336,838Intermediate Foot Procedures for Non -Trauma Category 1 £1,640 01:02 £467 0 £40 £0 £1,133 66 £74,768Minor Foot Procedures for Non -Trauma Category 2 £1,421 00:42 £318 0 £50 £0 £1,054 150 £158,109Minor Shoulder and Upper Arm Procedures for non Trauma £1,401 00:48 £368 0 £21 £0 £1,013 42 £42,527Minor Foot Procedures for Trauma Category 1 £1,533 00:54 £411 1 £137 £0 £986 16 £15,770Minor Hip Procedures for non Trauma Category 1 £1,014 00:11 £85 0 £5 £0 £923 40 £36,916Intermediate Foot Procedures for Trauma Category 1 £2,073 01:48 £816 3 £379 £0 £877 56 £49,128Minor Foot Procedures for Non -Trauma Category 1 £950 00:22 £171 0 £1 £11 £767 226 £173,415Minor Elbow and Lower Arm Procedures for Trauma £1,110 00:37 £285 1 £70 £0 £755 44 £33,229Minor Hand Procedures for Trauma Level Category 1 £1,006 00:42 £319 0 £11 £0 £677 20 £13,531Minor Hand Procedures for non Trauma Category 2 £950 00:34 £262 0 £7 £9 £672 222 £149,078Minor Hand Procedures for non Trauma Category 1 £826 00:18 £137 0 £27 £0 £662 32 £21,170Intermediate Hand Procedures for non Trauma Category 1 £1,282 01:18 £592 0 £41 £0 £649 32 £20,768Skin Therapies level 4 £776 00:35 £265 0 £0 £0 £511 38 £19,422Minor Skin Procedures category 2 £1,014 00:54 £408 1 £109 £0 £497 24 £11,921Minor Knee Procedures for non Trauma Category 1 £1,037 00:53 £399 2 £174 £0 £463 44 £20,382Minor Knee Procedures for non Trauma Category 2 £1,289 00:42 £317 2 £167 £406 £399 46 £18,373Skin Therapies level 3 £576 00:35 £266 0 £0 £0 £310 42 £13,022Minor Pain Procedures £225 00:13 £101 0 £0 £0 £124 32 £3,968Other Procedures for non Trauma £331 00:55 £416 0 £24 £0 -£109 18 -£1,967Minor Hip Procedures for Trauma £2,251 01:50 £834 15 £1,631 £0 -£214 38 -£8,135Other Procedures for Trauma £1,222 02:20 £1,053 7 £741 £0 -£572 26 -£14,880

NB: in the absence of e.g. PLICS, not all component costs will be included 6

Theatre Income by Consultant – performing surgeonThere is a wide range of income based on surgeon performing the operation

Assumes all procedures carried out in recorded job plan time, WLI patients are removed from total

Income per PA

The numbers in brackets show the total income received per theatre PA and the number of theatre PAs for each consultant: e.g. Ashwood was the named surgeon for 279 patients in the year, generating a total income of £1,392k with 2.9 PAs of operating time. This gives an average of 96 patients per PA at an average tariff of £4,217, and generates on average £480k per theatre PA

Blue isolines are for comparison purposes. Each line shows the range of variables resulting in that income per PA

Theatre activity is based of the activity under the named consultanttheatre PAs are those recorded in CRMS

Consultant A

Consultant B

Consultant C

Consultant E

Consultant F Consultant GConsultant H

Consultant I

Consultant D

44

Phase 2 – Illustrative Operational Efficiency Analysis (2)

10

Breakdown of PAs by Consultant

Consultant G

Categories Details

11

Clinic AttendancesHigh DNAs and initial bookings below capacity result in some clinics having low utilisation rates

Scheduled Frequency of Clinic Clinic Times Total Clinic

HoursTotal

Capacity Slot Length Two Patients Seen at Once

Average Number of Patients per Clinic Utilisation %

Weekly 09:30 - 12:05 02:35 20 00:07 Yes 8.37 42%

0

2

4

6

8

10

12

14

Freq

uenc

y

Number of Patients Seen in Clinic

AHMEDM - MONDAY FU CLINIC

Frequency

Template Capacity

01/01/1900 01/01/1900 01/01/1900 01/01/1900 01/01/1900 01/01/1900 01/01/1900 01/01/1900 01/01/1900 01/01/1900 02/01/1900

0

5

10

15

20

AHMEDM - MONDAY FU CLINICNumber of Anttendees DNAs Leave Bank Holidays On-Call Week Total Capacity Average Number of Patients per Clinic

This clinic is underutilised, due to a high number of DNAs (up to 6 people per clinic), and high under-

booking. On average the clinic sees 8 patients, and never more than 14, which is significantly below the 20

patient capacity

CONSULTANT A

CONSULTANT A

45

Restructuring costsRestructuring costs analysis

Comments

FY 2013 FY 2014

Redundancy / termination costs

VR / MAR reductions 1,109 47 WTEs have left via redundancy during the course of FY 2013 in addition to redundancies provided for in the FY 2012 accounts

Executive structure changes 784 Since October, 6 Execs and Senior Managers have left the Trust

Identified VR and CR posts 589 This includes agreed VR proposals (6) and a further 15 identified posts Corporate Restructuring posts

Further Corporate Restructuring 1,518 Additional posts being identified as part of the ongoing Corporate Restructuring

Professional fees 1,250 Estimated costs associated with consultancy to support delivery of the Recovery Plan and resolution of EPR issues

Restructuring intiatives 3,750 Expected costs associated with delivery of Phase 2 and 3 of the Recovery Plan

Restructuring costs 4,000 5,000

£'000

46





V Governance 61

VI Quality 63

Appendices


47

Financial Performance – 3 year forecast summary

Observations1. The Trust plans to return to surplus over a 2 year period.

2. Other than further non-recurrent support for restructuring of £5m in FY 2014, income reflects a gradual phasing out of non-recurrent support from NHSR.

3. Costs are based on current underlying run rates of expenditure adjusted for cost pressures and cost reduction plans.

4. In addition to inflationary pressures, specific cost pressures include the ongoing resource for EPR and additional nurses in light of the Francis report recommendations.

5. Forecast includes cost reductions over the 3 years of £36m phased £13m, £13m and £10m in FY 2014 – FY 2016. Restructuring costs associated with the delivery of cost reductions are estimated to be £5m in FY 2014 in addition to the £4m in FY 2013.


FY 2013 FY 2014 FY 2015 FY 2016forecast outturn forecast forecast forecast

Operating RevenuesIncome from Activities 210.3 206.2 196.1 193.8Other Income 20.8 19.6 19.6 19.6

231.1 225.8 215.7 213.4

Operating ExpensesPay -152.3 -147.9 -140.4 -134.8 Non-Pay -67.7 -67.2 -65.0 -64.3

-220.0 -215.1 -205.4 -199.1

EBITDA (before Restructuring) 11.1 10.7 10.3 14.3EBITDA (%) 4.8% 4.7% 4.8% 6.7%

Restructuring Costs -4.0 -5.0 0.0 0.0

EBITDA (after Restructuring) 7.1 5.7 10.3 14.3

Net Interest -0.6 -0.4 -0.3 -0.3 Depreciation & Amortisation -8.9 -7.7 -6.8 -6.8 Impairments -2.0 0.0 0.0 0.0PDC -2.1 -2.4 -2.4 -2.4

-13.6 -10.6 -9.5 -9.5

Surplus / (def) before Restruct. -2.5 0.2 0.7 4.7

Surplus / (def) after Restruct. -6.5 -4.8 0.7 4.7


48

Financial Performance – Current underlying performance

Observations1. The forecast outturn for FY 2013 of deficit £6.5m has been

adjusted for non-recurrent items that should not occur in perpetuity and also run rate cost changes that have already implemented in FY 2013 to assess the current underlying performance of the Trust (as a basis for comparison with its future forecast).

2. Non-recurrent income, Recovery Plan costs (e.g. Bolt Partners and PwC), Restructuring costs and the proposed EPR impairment have been removed. To the extent any of these may re-occur, they have been added back as non-recurrent income or cost pressures in FY 2014 (next page).

3. The run rate adjustments reduce the cost base to the ongoing level of expenditure seen in Q3 and Q4 (i.e. reflecting run rate savings (CIPs) that were achieved in Q1 / Q2). No run rate adjustment has been made in relation to lost income attributed to EPR issues.

4. This suggests that the underlying level of underperformance is currently c. £7.5m deficit.

TRFT Financial PerformanceFY 2013

Operating RevenuesIncome from Activities 210.3 -10.5 0.0 199.8Other Income 20.8 -0.7 0.0 20.1

231.1 -11.2 0.0 219.8

Operating ExpensesPay -152.3 0.0 2.3 -150.0 Non-Pay -67.7 1.0 1.0 -65.8

-220.0 1.0 3.2 -215.8

EBITDA (before Restructuring) 11.1 -10.3 3.2 4.0EBITDA (%)

Restructuring Costs -4.0 4.0 0.0 0.0

EBITDA (after Restructuring) 7.1 -6.3 3.2 4.0

Net Interest -0.6 0.0 0.0 -0.6 Depreciation & Amortisation -8.9 0.0 0.0 -8.9 Impairments -2.0 2.0 0.0 0.0PDC -2.1 0.0 0.0 -2.1

-13.6 2.0 0.0 -11.6

Net surplus / (deficit) -6.5 -4.3 3.2 -7.5

Adjustment to current performance (£m)Forecast

outturn FY2013

Non-recurrent

adjustment Run rate

adjustment Current

underlying

49

TRFT Financial PerformanceFY 2013 - FY 2014

FY 2013 ContingencyCost

reductions Other FY 2014

Operating RevenuesIncome from Activities 199.8 2.1 -0.1 -2.9 -1.6 1.3 6.6 1.0 206.2Other Income 20.1 -0.5 19.6

219.8 2.1 -0.1 -2.9 -1.6 1.3 6.6 0.0 0.0 0.0 0.0 0.0 0.5 225.8

Operating ExpensesPay -150.0 -1.5 -2.0 -1.9 -2.5 10.0 -147.9 Non-Pay -65.8 -0.5 -1.3 -0.9 -1.7 3.0 -67.2

-215.8 0.0 0.0 0.0 0.0 -0.5 0.0 -2.8 -2.0 -2.8 -4.2 13.0 0.0 -215.1

EBITDA (before Restructuring) 4.0 2.1 -0.1 -2.9 -1.6 0.8 6.6 -2.8 -2.0 -2.8 -4.2 13.0 0.5 10.7EBITDA (%)

Restructuring Costs 0.0 -5.0 -5.0

EBITDA (after Restructuring) 4.0 2.1 -0.1 -2.9 -1.6 0.8 1.6 -2.8 -2.0 -2.8 -4.2 13.0 0.5 5.7

Net Interest -0.6 0.2 -0.4 Depreciation & Amortisation -8.9 1.2 -7.7 Impairments 0.0 0.0PDC -2.1 -0.3 -2.4

-11.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 -10.6

Net surplus / (deficit) -7.5 2.1 -0.1 -2.9 -1.6 0.8 1.6 -2.8 -2.0 -2.8 -4.2 13.0 1.5 -4.8

NHSR contract income

Inflation

Cost pressures

Current underlying Forecast QIPP

Non-recurrent

support Specif ic

pressures Incremental

drift Inflation Baseline

adjustments Grow th CQUIN

Financial Plan FY 2014

Analysis of specific cost pressures included in the plan are set out on the next page.

50

Financial Performance – FY 2014

Observations1. The contract income adjustments are based on the 3 year

framework agreement with NHSR together with non-recurrent support including £5m for Restructuring purposes and the re-investment of FY 2014 tariff deflation.

2. Inflationary pressures have been included at 1% for pay and 2% for non-pay. Incremental drift is based on the last actual % calculated in March 2012.

3. Specific cost pressures totalling £2.8m are set-out opposite and a further 2% contingency against current costs has been included.

4. Other includes:

i. An element of recovery of underperformance against contract in FY 2014 (due to EPR);

ii. A more prudent assessment of other income for FY 2014; and

iii. Reduced depreciation on a reducing NBV and (depreciation and impairment exceeding capex).

Specific cost pressure summary for FY 2014Pay Non-pay Total

Items that are above and beyond current run rate £'m £'m £'m

Children and Young People - specific funding provided to increase specific resource

0.6 0.6

Increase in CNST and other insurance premiums

0.6 0.6

Care Co-ordination Centre 0.1 0.1

Medical staff and devices 0.1 0.2 0.2

Carbon reduction commitment levy 0.1 0.1

Impact of Francis report 1.0 1.0

Other 0.1 0.0 0.2

1.9 0.9 2.8

51


Observations1. Contract income is in line

with the 3 year framework agreement with NHSR and the remaining non-recurrent support (£5m restructuring and £1.6m tariff re-investment) is assumed to drop away.

2. Inflationary cost pressures are assumed to be as for FY 2014 with any additional cost pressures assumed to be covered by contingency (built into FY 2014).

3. No further restructuring costs assumed.

4. Cost reductions of £13m assumed.

5. Other includes removal of additional Recovery costs (e.g. EPR, Bolt Partners).


FY 2014 NHSR contract income ContingencyCost


Operating RevenuesIncome f rom Activities 206.2 2.1 -2.9 -1.6 -1.2 -6.6 196.1Other Income 19.6 19.6

225.8 2.1 -2.9 -1.6 -1.2 -6.6 0.0 0.0 0.0 0.0 0.0 215.7

Operating ExpensesPay -147.9 -1.5 -1.5 10.0 -140.9 Non-Pay -67.2 -1.3 3.0 1.0 -64.5

-215.1 0.0 0.0 0.0 0.0 0.0 -2.8 -1.5 0.0 13.0 1.0 -205.4

EBITDA (before Restructuring) 10.7 2.1 -2.9 -1.6 -1.2 -6.6 -2.8 -1.5 0.0 13.0 1.0 10.3EBITDA (%)

Restructuring Costs -5.0 5.0 0.0

EBITDA (after Restructuring) 5.7 2.1 -2.9 -1.6 -1.2 -1.6 -2.8 -1.5 0.0 13.0 1.0 10.3

Net Interest -0.4 0.1 -0.3 Depreciation & Amortisation -7.7 0.9 -6.8 Impairments 0.0 0.0PDC -2.4 -2.4

-10.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 -9.5

Net surplus / (deficit) -4.8 2.1 -2.9 -1.6 -1.2 -1.6 -2.8 -1.5 0.0 14.0 1.0 0.7

Forecast Baseline

adjustments

Non-recurrent

support Grow th QIPP Inflation Incremental

drift Inf lation Forecast

Cost pressures

52


Observations1. Income has been adjusted

for growth, QIPP and tariff deflation in line with prior years.

2. Inflationary pressures have been reflected but no significant further cost pressures are assumed (bearing in mind the rolling contingency built into prior year forecasts).

3. Cost reductions of £10m are assumed, lower than in prior years but without the benefit of Restructuring costs or support to implement.


FY 2015Cost


Operating RevenuesIncome from Activities 196.1 2.0 -2.4 -1.9 193.8Other Income 19.6 19.6

215.7 2.0 -2.4 -1.9 0.0 0.0 0.0 0.0 0.0 0.0 213.4

Operating ExpensesPay -140.4 -1.4 -1.0 8.0 -134.8 Non-Pay -65.0 -1.3 2.0 -64.3

-205.4 0.0 0.0 0.0 0.0 0.0 -2.7 -1.0 10.0 0.0 -199.1

EBITDA (before Restructuring) 10.3 2.0 -2.4 -1.9 0.0 0.0 -2.7 -1.0 10.0 0.0 14.3EBITDA (%)

Restructuring Costs 0.0 0.0

EBITDA (after Restructuring) 10.3 2.0 -2.4 -1.9 0.0 0.0 -2.7 -1.0 10.0 0.0 14.3

Net Interest -0.3 -0.3 Depreciation & Amortisation -6.8 -6.8 Impairments 0.0 0.0PDC -2.4 -2.4

-9.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -9.5

Net surplus / (deficit) 0.7 2.0 -2.4 -1.9 0.0 0.0 -2.7 -1.0 10.0 0.0 4.7

NHSR contract income Cost pressures

Forecast Forecast Grow th QIPP Inf lation Baseline

adjustments

Non-recurrent

support Inflation Incremental

drif t

53

Income forecast summary FY2013 – FY2016

Observations1. NHSR provides nearly 80% of total income via contract income,

community services and non-recurrent support. From 1 April, this income will largely be from the new CCG but elements of funding will move to the NCB (e.g. Specialised services such as Photopheresis) and RMBC (e.g. GUM).

2. NHSR income has been forecast forward on the basis of the 3 year framework agreement adjusted for latest expectations of tariff deflation and non-recurrent re-investment indicated by NHSR.

3. Non-recurrent support of £11.2m is forecast to drop away over FY 2014 and FY 2015 (activity related £10.5m and other income, £0.7m).

4. Together with other growth and inflation adjustments, this has the impact of reducing overall income by some £18m (8%) over the next three years.

5. In addition to RNHS, TRFT also receives income from a number of other local PCTs and income for other activities that sit outside contract. Aside from RNHS, income is assumed to remain relatively constant throughout the forecast (both a small risk (tariff deflation) and opportunity (increased activity)).

6. Other income comes from many sources and includes Educational Income, Recharges to third parties, R & D and Car Park income.


FY 2013 FY 2014 FY 2015 FY 2016forecast forecast forecast forecast

NHS Rotherham

Recurrent

Baseline (exc non-elective thres) 136.4 135.3 131.8 129.5

Community Services 29.5 29.5 29.5 29.5

166.0 164.8 161.3 159.0

Non-recurrent

Deferred Income 3.2

Accelerated Depreciation 1.0

Restructuring Costs 4.0 5.0

Tariff deflation re-investment 1.6

Other items (eg w inter support) 2.4Discontinuing support 10.5 6.6 0.0 0.0

Non-elective Threshold 1.4 1.4 1.4 1.4Community Services 2.0 2.0 2.0 2.0

13.9 10.0 3.4 3.4

Total NHSR 179.9 174.8 164.7 162.4

Other PCTs

Barnsley 11.2 11.2 11.2 11.2

Sheffield 5.8 5.8 5.8 5.8

Doncaster 5.4 5.4 5.4 5.4

Derbyshire 0.8 0.8 0.8 0.8Bassetlaw 0.7 0.7 0.7 0.7Wakefield 0.6 0.6 0.6 0.6Other PCTs 2.8 2.8 2.8 2.8Community 0.8 0.8 0.8 0.8

28.1 28.1 28.1 28.1Other services

Photopheresis 2.7 2.7 2.7 2.7RTA Income 1.4 1.4 1.4 1.4

Performance variance and other -1.7 -0.8 -0.7 -0.7

Total activity related income 210.3 206.2 196.1 193.8

20.1 19.6 19.6 19.6

Non-recurrentMerit funding 0.1MADEL funding 0.1Other 0.5

Total other income 20.8 19.6 19.6 19.6

Total income 231.1 225.8 215.7 213.4

Income analysis (£m)

Activity related

Other income

54

Pay forecast summary – FY 2014

Observations1. Pay has been forecast by reference to current run rates

adjusted for inflation and other specific pressures (e.g. Capitalised EPR people coming back into I&E and extra nurses light of the Francis report recommendations) offset by savings / reductions.

2. At January 2013, the Trust had 3,560 WTE which is lower than average for the year to date reflecting reductions already achieved in the year (and shown as a run rate reduction in the assessment of current underlying performance).

3. To achieve the FY 2014 forecast implies a further net reduction from current WTE of 81 (based on average wages). It is expected that the majority will be from Corporate areas (and therefore not impacting on clinical delivery) through Phase 1 ‘Stabilisation and Control’. Actual reductions required may be smaller due to the mix being weighted to higher paid employees.

150.0 1.5 2.0 3.0 1.5 -10.0 148.0

-20 40 60 80

100 120 140 160 180

£'m

Pay bridge

3,000

3,500

4,000

9,400

9,600

9,800

10,000

10,200

10,400

10,600

FTE

(Cou

nt)

Payr

oll £

'000

All Payroll

55

Balance sheet forecast summary

Observations1. Fixed assets reduce over the period with residual capex only

exceeded by annual depreciation. No major projects are assumed.

2. Working capital is assumed to remain relatively consistent throughout the period. No significant improvement in debtor collection or creditor extension is assumed.

3. FTFF falls by £8m over the 3 years reflecting scheduled half yearly repayments. No further drawdown or repayment holiday has been assumed (although consideration is being given to both as a solution to potential medium term funding issues).

4. Provisions for Restructuring are made in both FY 2013 and FY 2014 (funded by non-recurrent support from NHSR) to be paid during the year and early in the following year (FY 2014 and FY 2015).

5. Cash deteriorates over the period which is due to ongoing deficits in the short term allied to financing obligations. The effect of financial restructuring funding received in FY 2013 and FY 2014 partially being paid out in early FY 2014 and FY 2015 – this is highlighted on the cash flow summary on the next page – also has an impact.



Fixed assets 99.4 97.8 95.2 94.4

Working capital

Inventories 3.1 3.1 3.1 3.1

Trade and other debtors 7.3 7.3 7.3 7.3

Trade and other creditors -20.2 -20.0 -20.0 -20.0

-9.8 -9.6 -9.6 -9.6

Financing

Cash and cash equivalents 10.0 2.3 1.0 3.6

FTFF loans -21.8 -19.2 -16.6 -13.9

Finance leases -1.1 -0.6 -0.2 0.0

-13.0 -17.4 -15.8 -10.4

Provisions (including Restructuring) -4.4 -3.4 -1.8 -1.7

Other financial liabilities -2.3 -2.2 -2.1 -2.0

Net assets 70.0 65.2 65.9 70.7

PDC 72.7 72.7 72.7 72.7

Retained deficit -4.1 -9.0 -8.2 -3.5

Revaluation Reserve 1.4 1.4 1.4 1.4

Equity 70.0 65.2 65.9 70.7

Balance sheet (£m)

56

Cash flow forecast summary

Observations1. Capex includes a further £2.3m in relation to EPR in FY 2014

(full provision for the final stage payment in dispute) but capex is otherwise assumed to be kept to a minimum (although sufficient for critical requirements to maintain clinical and service standards) – see next page for further analysis.

2. Restructuring payments in FY 2014 and FY 2015 are funded through non-recurrent support in the prior year.

3. No FTFF draw down is assumed although the Trust plans to seek a 2 year repayment holiday to provide additional headroom.

4. Financing payments (excluding PDC) are currently £3.8m p.a. of which £2.6m relates to existing FTFF loans.

5. Despite the mitigating effects of the Recovery plan, the Trust is likely to continue losing cash over the next two years (effectively to £nil) and on a monthly basis (before new funding or cash management) is forecast to run into overdraft during FY2015 – see monthly chart and observations on page 58. This is largely due to the withdrawal of non-recurrent support which has been significant historically. As highlighted by the simple analysis opposite, the underlying net cash flow is actually forecast to significantly improve from a very low base.



EBITDA (before Restructuring) 11.1 10.7 10.3 14.3

Working capital movements -1.5 -0.3 -0.1 -0.1 Capital expenditure -8.6 -6.1 -4.2 -6.0 Restructuring -2.6 -5.9 -1.6 0.0

Cash flow before financing -1.6 -1.7 4.3 8.1

FTFF draw dow n 0.0 0.0 0.0 0.0Loan repayments -2.6 -2.6 -2.6 -2.6 Finance lease payments -0.6 -0.5 -0.4 -0.2 Net interest -0.6 -0.4 -0.3 -0.3 PDC -1.9 -2.4 -2.4 -2.4

Net cash flow -7.4 -7.6 -1.4 2.6

Cash b/f 17.3 10.0 2.3 1.0Cash c/f 10.0 2.3 1.0 3.6

Cash assuming repayment holiday 4.9 6.2 8.8

Non-recurrent support -11.2 -6.6 Restructuring 2.6 5.9 1.6 0.0FTFF drawdown 0.0 0.0 0.0 0.0

Underlying net cash flow -16.0 -8.3 0.2 2.6

Cash flow (£m)

57

Capex forecast

Observations1. Capex requirements will be reviewed as part of the strategic

planning process. In the interim, the projections include the levels of capex in the table opposite.

2. Other than in relation to EPR, capex has been relatively restricted in recent years and as shown by the forecast (by comparison to annual depreciation) this is expected to continue over the forecast period (in the absence of further major projects) with an uplift in FY 2016.

3. Estates – the FY 2014 forecast covers essential schemes (£1.2m) plus a further allowance for schemes that should ideally go ahead which is assumed to continue at a similar level in FY 2015.

4. EPR includes a further £2.3m FY 2014 (full provision for the final stage payment in dispute) but further expenditure on EPR is to be kept to a minimum.

5. There is a long request list for medical equipment which will be assessed on a case by case basis through the normal investment committee (based on clinical need and pay back).

6. Other is to cover the further ad-hoc requirements that are likely to arise over time.

FY 2013 FY 2014 FY 2015 FY 2016

Estates General Schemes 1.0 1.6 1.6 2.5Electronic Patient Record 4.3 2.3 0.4 0.0Medical Equipment 1.3 1.0 1.0 1.5Other 2.1 1.2 1.2 2.0

8.6 6.1 4.2 6.0

Depreciation 8.9 7.7 6.8 6.8

Capex £m

58

Monthly cash forecast

Observations1. There is no immediate liquidity issue for the Trust on even the

most pessimistic forecasting basis. However, clearly the Trust cannot continue to lose money. With active liquidity management and the addition of “contingency” (through a WCF and/or repayment holiday), the Trust is confident that liquidity can be managed through the planning period. The graph opposite illustrates this.

2. There is no discernible seasonality in the cash flow in relation to working capital movements and therefore movements in cash tend to relate to large income or payments including:

i. Non-recurrent income;ii. Capex (EPR);iii. Loan repayments; andiv. PDC.

3. EPR final instalment (in dispute) of £2.3m is assumed to be paid in December 2013.

4. Loan repayments are half yearly, £1.1m in June and December and £0.25m in September and March for existing loans.

5. PDC is paid in September and March each year.

(2)

-

2

4

6

8

10

12

£'m

Monthly cash forecast

Base forecast With 2 year holiday

59

FRR forecast

Observations1. Based on the forecast the Trust is expected to be

FRR 2 for FY 2013 (subject to Monitor override) and is likely to remain so until FY 2016 when it is forecast to improve to 3.

2. Financial efficiency shows a steady improvement over the period.

3. Liquidity rating is and remains an issue due to relatively low cash reserves. Calculation shown alongside excludes any WCF.

FY 2013 FY 2014 FY 2015 FY 2016 Weighting

Underlying Performance (EBITDA Margin)EBITDA YTD 11.1 10.7 10.3 14.3

Operating Income YTD 231.1 225.8 215.7 213.4

Score 4.8% 4.7% 4.8% 6.7% 11% 9% 5% 1% <1%

Risk Rating 2 2 2 3 25% 5 4 3 2 1

Achievement of Plan (EBITDA %)EBITDA YTD Actual 11.1 10.7 10.3 14.3EBITDA YTD Plan 14.0 10.7 10.3 14.3

Score 79.2% 100.0% 100.0% 100.0% 100% 85% 70% 50% <50%

Risk Rating 3 5 5 5 10% 5 4 3 2 1

Financial Efficiency (Net Return after Financing)EBITDA YTD 11.1 10.7 10.3 14.3

Depreciation & Amortisation YTD -8.9 -7.7 -6.8 -6.8

Interest Receivable 0.2 0.3 0.3 0.3

Interest & PDC Dividends Payable -2.9 -3.1 -2.9 -2.9

Net Return after Finance Costs -0.5 0.2 0.7 4.8

Opening Assets (Current & Non-Current) 131.0 119.8 110.6 106.6

Opening Liabilities (Current) -28.7 -27.3 -26.2 -24.4

Closing Assets (Current & Non-Current) 119.8 110.6 106.6 108.3

Closing Liabilities (Current) -27.3 -26.2 -24.4 -21.8

Score -0.5% 0.2% 0.9% 5.6% 3% 2% -0.5% -5% <-5%

Risk Rating 2 3 3 5 20% 5 4 3 2 1

Financial Efficiency (I&E Margin)Surplus/(Deficit) YTD -6.5 -4.8 0.7 4.8Profit/(Loss) on Asset Disposals YTD 0.0 0.0 0.0 0.0Impairments & Restructuring Costs YTD -6.0 -5.0 0.0 0.0Operating Income YTD 231.1 225.8 215.7 213.4

Score -0.2% 0.1% 0.3% 2.2%Risk Rating 2 2 2 4 20% 3% 2% 1% -2% <-2%

5 4 3 2 1

LiquidityCash for Liquidity Purposes -11.3 -17.8 -17.5 -12.3

Operating Expenditure YTD -220.0 -215.1 -205.4 -199.1

WCF in Terms of Operating Expenditure YTD 27.8 28.5 29.8 30.7

Score -18.5 -29.9 -30.6 -22.2 60 25 15 10 <10

Risk Rating 1 1 1 1 25% 5 4 3 2 1

Calculated Total Weighted Risk Rating 1.9 2.3 2.3 3.3

Rounded Total Risk Rating 2 2 2 3

Adjusted Total Weighted Risk Rating 2 2 2 3 100%

Criteria

60

Service Risk Rating forecast

Observations1. The new Service Risk Rating is in consultation although the SRR has

been calculated on the guidance currently available. This assumes that a WCF will not meet the ‘committed’ facility criteria.

2. This suggests the Trust will reach 3 in FY 2016 (on the assumption of rounding – up.

3. If a FTFF loan repayment holiday is taken, the improvement to 3 may be accelerated with the improvement in Capital servicing capacity.

Service Risk RatingFY 2013 FY 2014 FY 2015 FY 2016

1 Current assets 19.1 11.4 10.1 12.7 Inventories (3.1) (3.1) (3.1) (3.1) Current liabilities (27.3) (26.2) (24.4) (21.8) Before WCF (11.3) (17.8) (17.5) (12.3) WCF - - - - Including WCF (11.3) (17.8) (17.5) (12.3)

2 Operating expenditure (220.0) (215.1) (205.4) (199.1)

3 EBITDA (pre-restructuring) 11.1 10.7 10.3 14.3

4 PDC Dividends Paid (1.9) (2.4) (2.4) (2.4) Interest Paid (0.8) (0.7) (0.5) (0.5) Capital Paid on Finance Leases (0.6) (0.5) (0.4) (0.2) Interest Received 0.2 0.3 0.3 0.3 Repayment of Non Commercial Loans (2.6) (2.6) (2.6) (2.6)

(5.7) (6.0) (5.7) (5.6)

Liquidity ratio (before WCF) (18.5) (29.9) (30.6) (22.2) 1 1 1 1

Capital servicing capacity 1.9 1.8 1.8 2.6 3 3 3 4

Continuity of Service Risk Rating (before WCF) 2.0 2.0 2.0 2.5

61





V Governance 61

VI Quality 63

Appendices


62

Current Governance ArrangementsObservations1. Along with the simplification in Executive

Structures, there is a clear need to streamline the number of corporate meetings held and to clarify the roles and responsibilities of each of these meetings. The current governance structure is unwieldy and has not been effective in ensuring transparency and good governance (e.g. EPR, staff consultation, savings programmes).

2. Specific issues noted:

1. The number of meetings – there is a need to greatly reduce the number of meetings required to “satisfy” governance and reduce the administrative burden these place on staff. As the organisational structure is simplified, the meeting structure needs to be greatly simplified so that execs and staff have time to deliver commitments;

2. The role and remit of meetings – at present, there are several meetings, which although they have theoretically clear Terms of Reference, it is not clear what their practical remit is (e.g. audit & assurance; NRATs; CMB). There is a need to ensure that executive, staff and non-executive time is used efficiently and that there are clear parameters and time limits to each meeting.

Meetings Attendees Period

Board of Directors Execs / NEDs Monthly (last Thursday)

Audit and Assurance Committee (A&A) Execs / NEDs Monthly (last Tuesday)

Corporate Management Board (CMB) Execs Monthly (last Monday)

Nomination, Rumuneration and Terms of Service Committee (NRATS) Execs / NEDs Bi-monthly

Programme Steering Group (PSG) Execs and management Weekly

Corporate Informatics Committee (CIC) Some execs and management Monthly

Corporate Business Planning and Investment Committee (CBPIC) Some execs and management Monthly

Corporate People and Organisational Development Committee Some execs and management Monthly

Corporate Safety and Experience Committee Some execs and management Monthly

Various sub-committees Mainly management Monthly

Charitable Funds Committee Some Execs / Trustees Quarterly

Various Governor committees Governors and some execs Typically quarterly

Other project boards / committees (e.g. EPR) Some execs and management As required

63





V Governance 61

VI Quality 63

Appendices


64

Quality Governance FrameworkObservations1. The Trust Quality Governance Framework and

Monitoring process, that includes non-executive scrutiny has been identified as very favourable by KPMG.

2. The framework is assessed monthly by the Board to provide evidence for quarterly sign off to Monitor.

3. An evidence database has been developed and all documents, data and information relating to the framework are updated and stored on the system.

4. The end of year score will remain as those highlighted in the left hand diagram.

5. The data quality score has been impacted by EPR issues, although we now have evidence this is improving we will retain red score until Q1 FY 2014 assessment.

6. We anticipated changing 2a this quarter to 0, however we will await the feedback from Monitor in relation to the Recovery Plan before re-assessing this score.

7. Overall we have moved from a score of 3.5 Q1 FY 2013 to 3.00 at Q4. The target was 2.5 at year end however the data quality issues from EPR implementation have prevented this target being reached.

Table 1: Overall risk rating in Q3 July to December 2012 (including all domains) Results from JULY to DEC 2012 review

Q1 April to

June

Q2 July to Sept

Q3 Oct to Dec

Strategy 1A Does quality drive the trust’s strategy? Green 0.0 0.0

1B Is the board sufficiently aware of potential risks to quality? Amber/ Green 0.5 0.5

Capability & Culture

2A Does the board have the necessary leadership, skills and knowledge to ensure delivery of the quality agenda?

Amber/ Green 0.5 0.5

2B Does the board promote a quality focused culture throughout the trust? Green 0.0 0.0

Processes & structure

3A Are there clear roles and accountabilities in relation to quality governance? Green 0.0 0.0

3B Are there clearly defined, well understood processes for escalating issues and managing quality performance? Green 0.0 0.0

3C Does the board actively engage patients, staff and other key stakeholders on quality?

Amber/ Green 0.0 0.0

Measurement

4A Is appropriate quality information being analysed and challenged? Amber/ Red 1.0 0.5

4B Is the board assured of the robustness of the quality information? Amber/ Green 0.5 1.0

4C Is quality information used effectively? Amber/ Green 0.5 0.5

Overall score (If below 4.0 then rating green as this allows sign off) 3.5 3.0 3.0

65





V Governance 61

VI Quality 63

Appendices


66

Forecast assumptions – IncomeComments

£m % £m % £m %

-6.5 -4.8 0.7 Each years forecast is based on prior year rolled forward for key adjustments (inflation, CIPs etc)

Income Based mainly on NHSR framework agreement with a phasing out of non-recurrent support

NHSR Underperformance 1.0 0.5% FY 2013 is currently under contract for elective activity (EPR issues etc) which is assumed to recover nearer to contract levels

Activity growth 2.1 1.0% 2.1 1.0% 2.0 1.0% Based on framework agreement with NHSR / no change in non-elective threshold (i.e. 2009 levels for short stay, same day and excess bed days) except where revisions already enacted

CQUIN -0.1 0.0% 0.0 0.0% Based on framework agreement with NHSR (excluding non-recurrent support - see below) - assumed to remain the same going forward

QUIPP -2.9 -1.4% -2.9 -1.4% -2.4 -1.2% Based on framework agreement with NHSR - mainly reductions through demand management (planned and non-elective) and reduced follow-ups

Tariff deflation -1.6 -1.7% -1.6 -1.7% -1.9 -1.7% National guidance of 4% efficiency target offset by 2.3% inflation applied to contract income

Other -1.2 Reduction in assessment tariff per framework agreement relating to ambulatory care

Non-recurrent support -4.7 -6.6 Deferred income, accelerated depreciation, reablement, CQUIN FY 2012 accrual received FY 2013, chlamydia screening and workforce transformation assumed to drop away in 2014 £5m of restructuring support assumed to be available in FY 2014 (in addition to the £4m in FY 2013) before dropping away in FY 2015 Non-elective threshold and community service support totalling £3.4m is assumed to continue throughout

Baseline adjustments 0.8 For Montagu and Chlamydia & Estate charges based on PCT high level summary net of associated cost

Other income -0.5 -2.4% FY 2013 FOT includes a level of non-recurrent income (c.£2.5m (FOT vs plan) that was not identified when the budget was prepared). Forecast effectively £2m of currently unidentified income Whilst a level of unidentified income is likely to occur, a more cautious assumption has been adopted going forward

Description

I&E prior year

FY 2014 FY 2015 FY 2016

Income and Expenditure

67

Forecast assumptions – ExpenditureComments

£m % £m % £m %

Pay Based on current run rates (Q3/Q4 FY 2013) subject to inflation and cost reductions

National inflation -1.5 1.0% -1.5 1.0% -1.4 1.0% Assumes national pay awards will remain minimal (given austerity etc)

A4E -2.0 1.3% -1.5 1.0% -1.0 0.8% Calculated % applied in FY 2013 based on pay records and assumed to gradually reduce going forward

Cost reductions 10.0 -6.6% 10.0 -6.8% 8.0 -5.7% Represents the pay proportion (roughly 3/4) of targeted cost reductions

Non-pay Based on current run rates (Q3/Q4 FY 2013) subject to inflation and cost reductions

Inflation -1.3 2.0% -1.3 2.0% -1.3 2.0% Aligned to BoE CPI target (includes drugs)

In-year CIPs 3.0 -4.4% 3.0 -4.5% 2.0 -3.1% Represents the non-pay proportion (roughly 1/4) of targeted cost reductions

Other items

Interest / PDC -0.1 0.1 Interest based on original plan submitted to Monitor adjusted for interest on additional FTFF at 3% p.a.

Impairments 2.0 Impairment forecast for FY 2013 (EPR) assumed not to recur

Depreciation 1.2 0.9 Based on original plan for FY 2014 and FY 2015 - depreciation calculated based on actual assets and depreciation rates - reduces due to assets being fully written down together with EPR impairment

Restructuring -1.0 5.0 0.0 Effectively assumes £5m of restructuring costs in FY 2014

-4.2 1.0% 1% applied to total pay and non-pay costs in FY 2013 - effectively builds in £2.2m of contingency into each year due to the roll forward

Run rate adjustments

4.2 Add back of Recovery Plan costs (PwC and Bolt Partners) and adjustment for cost reductions already achieved in Q1/Q2 2012/13

-2.8 1.0 EPR (£0.35m), Bolt Partners (£0.6m), EPR consultancy (£0.3m), CNST (£0.6m), Children and Young People Resources (£0.6m) and other various - Recovery elements assumed to reverse in FY 2015

Other non-recurrent items

0.0 Its probably optimistic that will be no unforeseen non-recurrent items but new non-recurrent items assumed to be covered by contingency

-4.8 0.7 4.8

Description FY 2014 FY 2015 FY 2016

I&E forecast

Contingency - split between pay and non-pay in the detailed forecast

Specific cost pressures

Income and Expenditure

68

Forecast assumptions – Cash flowComments

£m % £m % £m %

-4.8 0.7 4.8

ITDA 15.6 9.5 9.5 Mainly depreciation (£7.7m reducing to £6.8m), PDC (£2.4m p.a.) and restructuring provision (£5m in FY 2014 and FY 2015)

Working capital -0.3 -0.1 -0.1 Based on a roll forward of the forecast balance sheet at March 2013 with no significant changes assumed

Capex -6.1 -4.2 -6.0 FY 2014 includes the EPR final stage payment of £2.3m - might be lower pending dispute resolution (but fully provided at present) Other expenditure as per original plan subject to removal of surplus retention and contingency (totalling £1.0m p.a.) in each of FY 2014 and FY 2015

Restructuring -5.9 -1.6 0.0 FY 2014 represents payment of £2.5m in relation to the FY2013 provision in Q1 together with ongoing restrucutring expenditure incurred in-year. FY 2015 reflects payment of residual FY 2014 provision

PDC -2.4 -2.4 -2.4

FTFF 0.0 0.0 0.0 No FTFF draw down assumed although this remains an option with borrowing capacity of £10m

Financing -3.6 -3.3 -3.2 Based on existing payment commitments against existing loans of £22m plus finance leases

-7.6 -1.4 2.6

Net I&E

Net cash flow

Description

Cash flow

FY 2014 FY 2015 FY 2016

69





V Governance 61

VI Quality 63

Appendices


70

Monthly Board scorecard – Exec SummaryThe Rotherham NHS Foundation Trust - Executive SummaryHighlights & Escalations of metrics aligned to Trust performance areas & NHS Outcome Framework domains

The board are asked to note that the Trust is one of a very few that achieved nationally in Qtr 3 and continue to achieve year to date. However, in January the target of 95% has not been met achieving 92.74%. The quarterly position as at the 18th Feb is 94.15%

Work is ongoing in the A&E department to sustain/improve performance as part of the emergency care pathway programme.

The executive team are asked to support the emergency care review.

Monitor scorecard.

The monthly trajectory of 3 has been met with only 1 case reported in January, the year to date is also being met with 19 cases reported against the annual target of 31.

Messages regarding the importance of maintaining good hand hygiene and the use of hand gels continues to be communicated via different media sources to all staff, patients and visitors

The executive team are asked to support the ongoing work to help reduce infections.

Monitor scorecard.

The cancer targets are always reported a month behind due to the validation process undertaken. The 93% target has been met in December achieving 96.8%.

Daily checking and appointing has now been implemented by the contact centre following a review of the choose and book system. The importance of patients accepting an appointment within 2 weeks is being promoted by the healthcare professionals in the hospital and community.

The executive team need to note that the breast symptomatic target previously breached as a result of patient choice and a potential Choose and Book failure leading to ASI process issue.

Monitor scorecard.

The number of GP referrals has increased in January by 1,168 . The number referred by Rotherham GPs has increased by 919 and the Non Rotherham have increased by 249.

Work is ongoing with the contact centre regarding the availability of slots on the choose and book system. Changes in the management arrangements of the contact centre have been recently undertaken.

The executive team are asked to support the ongoing work in the contact centre.

Efficiency scorecard

The number of new outpatients has increased in January by 1286 aptts which brings the total back in line with the pre christmas figures. Performance is still under the contract plan.

Activity now monitored weekly on the Flash report and is showing an increase since 27th December from 861 to 1797 week ending 14th February.


The number of elective admissions has increased in January by 339 which brings the total back in line with the pre christmas figures. Performance is still slightly under the contract plan.

The Business and service managers are informed of their activity performance.


The target has been met for January achieving 0.2% against a target of 1.0%, although currrently not meeting the target year to date 1.5%. Out of 1558 pts only 3 pts have waited over 6 weeks for diagnostic procedure. 1x Audiology 1xColonoscopy 1x Cystoscopy.

The polling range on choose and book has been lowered from 48 days to 42 days to give more time for appointments. This has resulted in the reduction in the number of sleep studies having to wait more than 6 weeks to zero.

The executive team are asked to recognise the amount of work undertaken to reduce the historical long waits for sleep studies.


There has been a significant reduction in the number of emergency patients being re admitted within 30 days during January from 17.02% in December to 15.66% in January.

Now monitored weekly on the Flash report . Work is ongoing regarding urgent care pathways.

The executive team are asked to support the ongoing work around reducing non elective admissions.


The Trusts overall average length of stay is showing a reduction in January to 6.3 from 7.5 in December. Both the medical and surgical specialties show reductions with medicine being the better performer.

Daily monitoring against the target of 5 discharges per day for the medical wards has been implemented and the findings shared with the medical management team and project leads.


The number of non elective admissions re admitted within 7 days shows a slight increase in January.

Daily information is available to specialties showing the most common causes for readmissions so action can be taken to manage re admissions for specific conditions.

The executive team are asked to promote the use of information available to help manage processes.


The number of cancellations during January significantly increased from 0.41% in Dec to 1.25% in January. The main reason for the cancellations was the availability of beds.

Cancelled operations are reported daily to the DH on the sitrep report, bed management meetings occur throughout the day


A&E: maximum waiting times of 4 hours from arrival to admission/transfer/discharge.

C Diff: meeting the C Diff objective.

Page Ref

GP Referrals Rotherham and non Rotherham

Highlighted Issue Issue Description Management Actions Taken Executive Action Required

Cancer 2 week wait: from referral to date first seen, symptomatic breast patients (cancer not initially suspected).

Non elective admissions readmitted within 30 days

Average length of stay - TRUST (elective and non elective combined by discharging speciality)

Non elective admissions readmitted within 7 days

Cancelled operations - % of patients cancelled on day of operation for non clinical reasons


Diagnostic waiting times: ensure nobody waits 6 weeks or over over for any 15 key diagnostic tests.

Elective Admissions

Switchboard

71

Monthly Board scorecard – Finance and GovernanceThe Rotherham NHS Foundation Trust - MONITOR Scorecard - Position for Month 10 QTR 4 12/13 Finance & Governance Compliance Framework

N/A

N/A

-

0

Rated on Qtr Position

-

91.2%

97.0%

95.4%

100.0%

100.0%

100.0%

85.6%

100.0%

92.7%

1

0

-

-

-

-

-

90%

- 85%

94%

2

76.6% 96.8%

0 0

93.7% 98.2% 94.2% 93.3% 84.8% 89.4%

0

97.8%

1 0

94.0% 95.1%

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

Cancer 2 week wait from referral to date first seen, sympomatic breast patients (cancer not initally suspected)

- 93% 90.2%

97.0%

91.8%

97.2%

Maximum time of 18 weeks from point of referral to treatment in aggregate, patients on incomplete pathways

0 92% 93.1% 97.6%

100.0% 97.2%

100.0% 100.0%

91.0% 90.3%

83.3%

- 98.6% 90.7%

Safe

100.0%

100.0%

95%

0

Data

Qua

lity

0 95%

Community care data completeness - End of life patients deaths at home information completeness

0 50%

95.2% 96.46% 95.18%A&E: maximum waiting time of 4 hours from arrival to admission/transfer/discharge

1

Relia

ble

92.6%

Community care data completeness - patient identifier information completeness

0 50% 87.1% -

100.0%

98.7% 98.3% 97.9% 97.2%

- 100.0% - - 100.0%

88.0% 85.0%

100.0% 100.0% 100.0%

85.6% 85.6%91.1%-

100.0%

-

100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0%-

-

Community care data completeness - referral information completeness

0 50% 100.0% - - 100.0% -

- -Community care data completeness - activity information completeness

0 50% 100.0% - -

100.0%

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

0 90% 94.2% 98.0% 99.1% 97.9%

100.0% 100.0% 100.0% 100.0% 100.0%

91.2%90.3%

Community care data completeness - referral to treatment information completeness

0 50%

-

100.0%

92.2%

96.8% 97.4%

92.4% 91.1% 86.5% 89.6%

95.5%

100.0% 100.0% 100.0%

98.9% 100.0% 85.7% 100.0% 100.0% 100.0% 100.0%

92.4% 100.0%

100.0%

100.0% 100.0% 100.0% 100.0%

TrendJun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12

94.49% 97.44% 95.91% 93.71% 92.74%95.02% 96.13% 95.15%

019 4

92.2% 96.1% 95.8%

0

Cancer 2 week wait from referral to date first seen, all urgent referrals (cancer suspected)

- 93% 95.1% 95.2%

0 0 0MRSA - meeting the MRSA objective 0

89.7% 94.6%

1 0

2 13

0

96.8% 96.4%

Cancer 31 day wait from diagnosis to 1st treatment - 99.0% 100.0% 97.4% 100.0% 98.8% 100.0% 98.4%96%

Quarter 1 Quarter 2 Quarter 3 Quarter 4Rating Score

Month Change

QTR Target

YTD Apr-12 May-12 Dec-12 Jan-13 Feb-13 Mar-13QTR Value

2 1 3Clostridium Difficile - meeting the C.Diff objective 5 1

Income & Expenditure vs plan (878) (4,855) 34% 56% (12%) (40%) (53%) (63%) (139%) (283%) (232%) (453%)

-Cancer 31 day wait for 2nd or subsequent treatment - surgery

96.2%

Cancer 62 Day Waits for first treatment (from NHS cancer screening service referral)

87.8%Cancer 62 Day Waits for first treatment (urgent GP referral for suspected cancer)

100.0% 100.0% 100.0%Cancer 31 day wait for second or subsequent treatment - anti cancer drug treatments

- 98%

94.8% 92.0% 89.9% 87.8%

100.0%

100.0%

100.0%

-

87.5% -

N/A

N/A

75.0%

100.0%

88.9%

98.0%

100.0% - 100.0% - -

99.6% 99.8%

100.0% 100.0% 100.0%

93.6% 94.3%

95.8%

95.4%

(26%) (26%) (25%)

(25%) (32%) (34%) (44%) (42%) (36%) (36%)

(23%) (49%) (32%) (43%)

(30%)

5% (24%) (46%)

Fina

nce

Financial Risk Rating vs Plan

Monitor Governance Rating

1 1 2 3 2

0 0

Cash vs plan

Capex vs plan

Cost Improvement Programmes vs plan

8,731 4,974 (25%) (15%) 3%

9,800 6,230 (33%) (32%) (53%)

12,120 8,435 (34%) (30%) (22%)

1

1

-

-

-

-

2 2 2 2 2 1 1

(22%) (21%) (25%)

Switchboard

72

Monthly Board scorecard – Quality Governance The Rotherham NHS Foundation Trust - MONITOR QUALITY GOVERNANCE FRAMEWORKMonitor Quality Governance Framework Scorecard

StrategyDoes quality drive the trust’s strategy?

Overall Quality Score TBC

Is quality information used effectively?

Capability & Culture

Measurement

Processes & structure

3C

4A

4B

4C

Is the board assured of the robustness of the quality information?

Does the board promote a quality focused culture throughout the trust?

TBC

Is the board sufficiently aware of potential risks to quality?

TBC

Is appropriate quality information being analysed and challenged?

3.0 3.0 3.0 3.0 3.03.5 3.5 3.5 3.5 3.5

0.5 0.5 0.5 0.5 0.5 0.5

1A

1B

2A

2B

3A

3B

1.0 1.0TBC 0.5

0.0

Does the board actively engage patients, staff and other key stakeholders on quality?

Are there clearly defined, well understood processes for escalating issues and managing quality performance?

Are there clear roles and accountabilities in relation to quality governance?

0.0

TBC

0.5 0.5 0.5

0.5

0.00.0

TBC

0.5 0.5 0.5 0.5

0.0

TBC

0.0TBC 0.0

0.5 0.5 0.5 0.5

0.0 0.0

0.5 0.5 0.5 0.5

0.5 1.0 1.0

0.0

1.0 1.0 1.0 1.0 1.0 1.0

0.5 0.5 0.5 0.5 0.0 0.0 0.00.5

0.0 0.0 0.0

Does the board have the necessary leadership, skills and knowledge to ensure delivery of the quality agenda?

0.0 0.0

0.00.0

0.0 0.0 0.0TBC 0.0 0.0 0.0

0.0 0.0 0.0 0.0 0.0

0.5 0.5 0.5 0.5 0.5 0.5

0.0 0.0 0.0 0.0

0.5 0.5 0.5 0.5 0.5

TBC

0.5 0.5 0.5

TBC

0.0 0.0 0.0 0.00.0 0.0 0.0 0.0 0.0 0.0

0.5

0.5

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Rating Month Change

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

Switchboard

73

Monthly Board scorecard – QualityThe Rotherham NHS Foundation Trust - QUALITY ScorecardReview of MANDATORY Quality metrics

Serious Incidents per 1,000 bed days -99.67% 0.093 0.000 0.0001 0.0001

Never' events per 1,000 bed days ####### 0.005 0.000 0.0000 0.0000

NHS Safety Thermometer - No Harm VTE (new) -4.32% 95% 99.1% 97.7% 98.0% 99.4% 98.2% 99.0% 99.6% 99.7% 99.3% 99.8% 99.4%

NHS Safety Thermometer - No Harm Falls (new) -3.79% 95% 98.6% 97.7% 97.1% 98.7% 99.1% 99.4% 98.0% 98.8% 98.9% 99.3% 98.0%

NHS Safety Thermometer - No Harm Pressure Ulcer (new) -2.74% 95% 97.6% 96.8% 97.0% 97.6% 97.1% 97.6% 98.0% 97.7% 97.9% 97.8% 97.7%

NHS Safety Thermometer - No Harm UTI (new) -0.53% 95% 95.5% 93.9% 94.8% 93.7% 95.0% 93.6% 97.5% 96.3% 96.5% 96.2% 96.2%

NHS Safety Thermometer - 'Harm Free Care' (new) -0.45% 95% 95.4% 93.0% 93.2% 95.7% 94.7% 94.7% 96.8% 96.8% 95.7% 96.2% 96.2%

Number of recorded patient safety incidents per 1,000 bed days -7.52% 29.7 31.9 30.0 33.9

Rate of patient safety incidents resulting in severe harm -33.48% 0.6% 0.4% 0.2% 0.0% 0.4% 1.0% 0.7% 0.2% 0.0% 0.5% 0.4% 0.5%

Pressure ulcers - Acute attributable (grade 2+) 31.18% 170 223 22 27 25 28 18 16 24 23 18 22

Pressure ulcers - Community attributable (grade 2+) 77.73% 220 391 38 37 44 38 32 40 49 40 35 38

Admissions of full term babies to neonatal care 0.00% 110 110 9 16 11 11 14 11 7 13 8 10

% of medication errors causing serious harm ####### 0.2% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0

RAMI (CHKS Live - last rolling year) 2.97% 86.6 89.2 86.4 87.1 88.8 90.5 89.8 89.2 90.5 91.4

SHMI (CHKS: In-hospital death only. Last rolling year) 2.42% 74.1 75.9 74.1 73.6 75.2 76.7 76.6 76.5 77.4 77.3

Weekend mortality (% of total in-hospital deaths) -7.44% 28.4% 26.3% 24.7% 16.9% 29.9% 27.8% 24.7% 36.6% 24.7% 21.3% 29.6% 26.7%

Neonatal mortality (Labour Ward & Neonatal Unit) -52.00% 8 4 1 1 0 0 0 2 0 0 0 0

Rate of stillbirths (Labour Ward) -41.60% 0.76% 0.44% 0.40% 0.00% 0.00% 0.85% 0.71% 0.38% 0.43% 0.0% 0.4%

Percentage of dementia patients on FAST track - 90.0% -

Patients with dementia having Assessment/Investigation - 90.0% -

Complaints - Overall -50.56% 540 813 47 70 96 103 87 71 84 134 60 61

Proportion of deceased patients on the EoL pathway -20.75% 47.0% 56.8% 56.7% 56.8%

Patient Experience Tracker (composite score of 3 surveys) -3.11% 86.7 89.4 82.9 85.3 87.2 88.0 83.6 92.3 89.5 91.5 91.7 91.8

Percentage of admissions for a fragility fracture (=>55) -7.26% 0.9% 0.9% 0.7% 1.1% 0.8% 0.9% 0.8% 0.9% 0.7% 0.9% 1.3% 0.7% 0.2%

Number of emergency admissions from care homes ####### 2 93 0 3 9 6 5 0 4 12 25 29

Rate of readmissions from care homes within 30 days ####### - 7.12% 0.00%


Mar-13 TrendlineJun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Jan-13 Feb-13

Safe

Reliable

Caring

Reliable

Dec-12May-12YTD Rating

Period Change

Target YTD Apr-12

Switchboard

74

Monthly Board scorecard – Efficiency The Rotherham NHS Foundation Trust - Efficiency Scorecard Review of Key Strategic metrics

0.00%Theatre Utilisation TBC

9.1 6.8

0.00% TBC 5.2 5.6 5.0 5.5 4.8 4.7 5.5 5.3 5.2

5.5 6.3 4.8 4.5 4.7 4.3 7.1

In P

atien

ts

-15.00%

6.56%

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12

83.3% 92.3% 100.0%

13.8%

92.6%89.7%

3862

67859

12.8%

170

93.8%

5.68% 6.13%6.91%

10.8%

6777 8139 5051 5311 6815 6209

- Non Rotherham

- Rotherham

Total number of GP referrals TBC 49642

0.00% TBC 36929 3706 4197

-44.19%

0.00%

0.00%

TBC 12713 1011 1147

72624

Out patient New to Follow up ratio

Out patient DNA rates 7.7%

Publ

ic H

ealth

Out

Pati

entsPr

imar

y Ca

re

Quarter 1 Quarter 2 Quarter 3

60.0% 86.5% 100.0%

29653698 3767

1104 1231 8332232 1251 1096

2879


Quarter 4

Rating Period Change

Target YTD Apr-12 May-12 Jan-13 Feb-13 Mar-13Dec-12

48194717 5344 4605 49665487 4958 37985930 5018

38843715 4256

3.10 2.63

1726

2.52 2.92 2.75 2.692.51 2.41 2.47

1082

79187993 7014 6632

2.89 2.752.58

40.20%

3.4% 1.2% 1.9%0.9% 3.5% 0.9% 0.2%

8.3% 7.4% 13.0% 11.1% 9.7%11.0% 11.5% 11.5%

48.59%Diagnostic waiting times - ensure nobody waits 6 weeks or over for 15 Key diagnostic tests

1.0% 1.5%

100.0%100.0% 100.0% 100.0%

3.9% 0.3% 0.3%

100.0% 100.0% 100.0%Access to GUM Clinics - the % of patients offered an appointment within 48hrs of contacting a service 0.00%

100.0%

88.0% 85.3% 76.0%

75.0% 70.0% 83.3% 81.8% 75.0%88.9%

82.1% 87.9%% of Stroke patients who spend at least 90% of their time on a stroke unit

80.0%-10.04%

% of non-admitted higher risk TIA cases who are treated within 24 hours of first contact with any healthcare professionalUnplanned hospitalisation for chronic ACS conditions rate (per 100,000)

1700 1505 158 158 146-11.47%

94.7% 83.3% 96.3%

100.0% 100.0%100.0% 100.0%

927 15 10

125 169 143170 148 118

16Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19's rate (per 100,000)

170 150 20 11 11 26 5-11.76%

1.3%1.9% 2.0% 1.5%1.4% 1.1% 1.1%

1.16%

Delayed transfers of care - % of patients whose transfer of care from hospital was delayed

3.5% 1.6%-54.20%

25032 27114

0.81% 0.41% 1.25%0.89% 0.82%

1.5%

0.80% 0.82% 0.49% 0.58% 0.91% 0.84%

2.8% 1.7%

2767

Number of Elective admissions 32578 31902 2878 3372 2858 3998

2797 2754 27262775 2684 25372740 2730 2604Number of Non Elective admissions

- % of ELECTIVE patients re admitted within 7 days 1.40% 1.00% 0.84% 0.64% 0.63% 0.69% 0.65%

3418 2686 30253207 2930 35302.08%

1.34% 1.63%

12.27% 16.32% 13.91%

1.02% 1.09% 1.52%

3.54%3.22% 3.23%

6.84%6.36% 5.97%

4.23%

6.62%5.44%6.20% 6.25% 6.51% 6.10%

17.02% 15.66%

2.71%3.00% 3.17% 2.86% 3.00% 3.16% 3.09%

82.0%

12.50% 14.08% 13.81% 14.58% 13.09% 11.19% 13.10%

2.82%

6.1 5.0

88.3% 88.7%

TBC

0 00 0 0 0 0 0 0

4.8

0 0 0

6.6 7.54.1 5.5

The % of mothers defined as having initiated breast feeding 7.12%

5.71%

12.66%

-7.92%

The number of breaches of mixed sex accommodation

2.36%

8.32%

35.05%

0.00%

Cancelled Operations - % of patients cancelled on day of operation

- % of ELECTIVE patients re admitted within 30 days

- % of NON ELECTIVE patients re admitted within 7 days 0.81%

Average Length of Stay - Trust

Bed utilisation - Trust

-28.67%

- % of NON ELECTIVE patients re admitted within 30 days

Average Length of Stay - Medical

Average Length of Stay - Surgical0.00%

The % of women Smoking during Pregnancy -9.74% 20.0% 18.1% 17.96%

65.10% 63.57%63.81% 60.17% 63.48%53.97% 62.72% 63.43%66.0% 61.3% 57.20%

87.5% 80.68%

20.13%

91.32% 91.29% 82.24%

59.38%

MRSA screening - % of Non Elective patients screened 18.60% 100.0% 81.4% 83.46% 78.41% 85.39% 86.98%

86.65%

82.31%

16.23%The % of women seeing a midwife/maternity healthcare professional by 12 weeks and 6 days of pregnancy 2.77%

90.0%

MRSA screening - % of Elective patients screened 3.61% 100.0% 96.4% 98.40%

83.56% 61.04%

89.63% 93.81%

95.41% 97.33%98.41% 95.33%

84.79% 87.10%

89.43% 85.65% 87.55%

6.34.8 4.6

Health visitor numbers against plan 737.51% 49.0 37.7 38.8 40.5 40.5

96.70% 94.47%96.40%

43.243.7 42.340.6 39.8 43.2

94.68%

% Unplanned re-attendance to A&E rate (within 7 days) -41.64% 5.0% 2.9% 2.67% 3.09% 3.16% 4.02% 2.75% 3.19%

3.65% 4.60% 3.14%

2.94% 2.67% 3.25% 2.70%

5.0% 4.0% 3.15% 4.80% 4.88% 6.61% 4.37% 4.90% 3.20%

% of A&E attenders that convert to admisisons 0.00% TBC 21.9% 22.53% 21.26% 20.81% 21.25% 21.50% 21.71% 21.00%

% Patients leaving A&E without being seen -20.26%

A&E 22.61% 23.23% 23.10%

Switchboard

75

Monthly Board scorecard – People The Rotherham NHS Foundation Trust - People and Organisational Development ScorecardReview of indicators aligned to Workforce Intelligence


Dec-12 Jan-13 Feb-13 Mar-13

Head Count (HC) - Exc. Bank None -

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12Rating Month Change

Target YTD Apr-12 May-12

4317 4306 4273 42474380 4357 4340 4326 4322 4305

4585 4587 4577 4545Head Count (HC) - Inc. Bank None - 4644 4627 4603

Full Time Equivalent (FTE) None -

45264588 4593

34983605 3586 3571 3566 3563 3561

Turnover None - 12.28% 11.73%

3564 3555 3523

Sickness Absence None - 4.25%

12.46% 12.24%11.47% 13.43% 11.83% 12.28% 12.08% 12.33%

4.44% 4.42% 4.53%4.28% 4.28% 4.34% 4.37% 4.39% 4.41%

129 89 48 132New Applications None 778 - - - 137 115

Applications Refused / Referred None 95 - -

128

3 17 14- 23 24 5 9

120 9 98 118Approved applications None 673 - - - 114

MAST - overall completeness None - -

91 123

76.9% 77.1% 75.0%- - - 78.00% 77.3% 77.5%

74.0% 74.4% 72.5% 65.9%Information Governance Training completeness None - 83.00% 81.79% 82.00% 80.00%

Personal Development Reviews None - 48.70%

81.53% 77.2%

52.0% 50.9% 48.9%49.61% 50.10% 52.39% 54.93% 53.7% 52.5%

111,891 98,644 93,379 67,527Agency - Medical (£) None 1.54m 265,306 253,057 243,663 225,949

Agency - Non Medical (£) None 366k 28,368

79,069 101,175

39,083 40,504 48,437 36,430 57,304 50,341

Locum - Medical (£) None 227k 19,061 17,435 25,951

44,531 20,712

Bank - Non Medical (£) None 1.84m

11,81732,874 19,521 27,640 31,020 18,613

224,264 254,593 233,669 240,627 236,516 168,879

22,787

175,620 154,668 155,052

71,098 68,258 52,980 46,668 163,255Extra Sessions (£) None 793k 126,529 65,179 47,852

133,129On Call (£) None 1.13m

53,05298,076

Overtime (£) None 939k 92,916 81,731 83,506

123,835 74,326

88,236

Workforce

Establishment Control


Contingent Labour Spend

132,574 90,005 90,009 93,446 97,291 89,608

84,527 87,085124,547 127,336 114,414 124,151 139,952

Switchboard

recovery plan version 6.0 18 th march 2013

Documents

plan forecasts

plan overviewphase

strategic plan

recovery plan objectives

high level recovery

savings plans

sustainable financial

patient quality