The Hillingdon Hospitals NHS Foundation Trust. Meeting of the Board of Directors

Transcription

1 The Hillingdon Hospitals NHS Foundation Trust Meeting of the Board of Directors Wednesday 27 April 2016, 5pm Board Room, Hillingdon Hospital Paper a) Introductory business 1. Welcome and apologies for absence - 2. Declaration of hospitality or amendments to the Register of Interests - 3. Minutes of the Board meeting held in Public on 23 March Actions Log 5. Declaration of Any Other Business - 6. Patient Story (TM) for information - 7. Chair s Oral Report (RS) for information - 8. Chief Executive s Report (SDG) for information b) Strategy 9. Delivering the Strategy (DS) for information 10. A&E Performance Report (JS) for information 11. SaHF Paediatric Transition Readiness Assurance (JS) for information c) Monitoring 12 Safer Staffing: Planned and Actual Staffing Levels (TM) for review 13 Quality & Operational Performance Report (JS / TM / AK) for review 14. Financial Report (MT) for review 15. QIPP Report (JS) for review d) Regulatory 16. Clinical Pathology CPA Accreditation (JS) for information 17. CQC Action Plan (TM) for review

2 18. Risk Register (TM) for review 19. Health and Safety Report (MT) for review e) Other Business /16 Staff Survey (TR) for information 21. Car Parking Update (DS) for information 22 Use of Trust Seal/MoUs signed for information 23. Board Agenda Planner for information 24. Any Other Business Questions from the Public This item is an opportunity for members of the public to ask questions to the Board on matters that relate to the Board agenda. Where possible, questions should be sent to Carolyn Cullen, Trust Secretary, by Monday 25 April 2016 in order that the Board can ensure the information is available to answer the question raised. - Date of next meeting: Wednesday 25 May 2016

3 ITEM 3 Board Meeting in Public THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST MINUTES OF THE MEETING OF THE BOARD OF DIRECTORS HELD ON WEDNESDAY 23 MARCH 2016 IN THE BOARD ROOM, HILLINGDON HOSPITAL Meeting held in public Present: Richard Sumray (RS) Abbas Khakoo (AK) Carol Bode (CB) David Searle (DS) Joe Smyth (JS) Katey Adderley (KA) Lis Paice (LP) Richard Whittington (RW) Shane DeGaris (SDG) Theresa Murphy (TM) Chair Medical Director Deputy Chair and Non-Executive Director Director of Strategy & Business Development Chief Operating Officer Non-Executive Director Non-Executive Director Non-Executive Director Chief Executive Director of the Patient Experience & Nursing Apologies: Soraya Dhillon, Non-Executive Director In Attendance: Trevor Roberts (TR) Trevor Mayhew (TMa) Carolyn Cullen (CC) Also Present: Rekha Wadhwani (RWa) Arnelle Thomas (AT) Jacqueline Westaway Joan Davis (JD) Matt Tattersall (MT) Director of People Interim Director of Finance Trust Secretary (Minutes) Governor Member of the Public Member of the Public Member of the Public Member of the Public 02/03/2016 Declaration of Hospitality or Amendments to Register of Interests ACTION None. 03/03/2016 Minutes of the last Meeting CB pointed out that she was not present at the last Board meeting. 1

4 ACTION TM asked that the Sarah Hunnisett s name be amended to the correct spelling. 04/03/2016 Action Log The Board agreed the alteration and the removal of those actions marked as complete. 05/03/2016 Declaration of Any Other Business There were no declarations of other business. 06/03//03/2 016 Patient Story : Nurse led services in Ophthalmology TM introduced Doris Bilayon who updated the Board on nurse led treatment for retinal disease by intravitreal injection of Anti VEGF medication. DB explained that in 2013 The Royal College of Ophthalmology revised its view and now considered that it is reasonable for nurses to administer anti-vegf agents so long as proper and appropriate training is given. This was in response to the need to cope with a massive increase in workload and ensure that treatment can be made available in a timely fashion to all those who need it. Doris is one of our first nurses to be trained as a Nurse Injector. Doris explained that she is fully supported by her clinicians; especially Sheena George and Nick Lee, who initially pushed for, and trained, the Nurse Injectors. At present the Trust has two nurses trained and operational as Nurse Injectors. Doris Bilayon explained that the reaction from patients, as measured through audit and feedback surveys, is very positive and this additional resource had led to a significant reduction in waiting time for treatment. TM explained that the future vision for the service is: To train more ophthalmic nurses to be Nurse Injectors To reduce the number of patient visits by using this additional resource Nurse Injectors to administer off-labelled Avastin medication To develop more Nurse-led clinics to release Doctors to attend to more complex cases. 2

5 RS asked if nurse run clinics could be extended to other areas of ophthalmology. TM stated that not only could this be extended in ophthalmology this could be extended to other specialties. ACTION DS considered this a useful development of the nurse role. KA asked how the Nurse Injectors had improved the patient experience. DB stated that patients often say that they prefer nurses because they perceive them as kinder; having Nurse Injectors has cut significantly the waiting time for treatment. CB asked what appetite and enthusiasm do other nurses have to take on this role and embark on the training. DB stated it was important that candidates had a passion for ophthalmology and that they were confident. DB anticipated that more nurses will come forward to undertake the training. RS asked what, in Ophthalmology, is holding back the development of more nurse led clinics. DB explained it was in fact the amount of space available in the Department to hold clinics both to have a sufficient number of treatment rooms and waiting space. The Chair thanked Doris Bilayon and TM for presenting this story.. 07/03/2016 Chair s Oral Report RS reported on a successful Board to Board workshop with the CCG held in early March; the next one would be held in September. RS and SDG had attended a meeting of NHS Providers where they had been briefed on the financial position for the NHS for 2016/17; it was noted that the financial position would be tight right up until RS reported that the leadership for the North West London Sustainability and Transformation Plan had been announced: Clare Parker (Chief Officer, CWHHE CCGs) as Joint Commissioner Lead Rob Larkman (Chief Officer, BHH CCGs as Joint Commissioner Lead Tracey Batten (Chief Executive, Imperial College Healthcare Trust) as Provider Lead Carolyn Downs (Chief Executive, Brent Council) as Local Authority Lead 3

6 RS counselled that it was important that the leadership ensured full consultation and collaboration across North West London. ACTION 08/03/2016 Chief Executive s Report SDG drew attention to: Monitor Quarter 3 financial outturn report and highlighted that the overall financial position of the NHS during 2015/16 is likely to be a deficit of 1.8 billion The refreshing change of tone adopted by NHS Improvement as regards A&E performance across the sector From a Blame Culture to a Learning Culture, our Trust had been rated as Good for its approach to openness. KA noted that our Trust achieved over the 5% EBITDA (Earnings before Interest, Tax and Amortisation as a percentage of income) threshold for the indicator that is used to assess Trust s long term financial viability. CB stated that the Quality and Safety Committee has already begun looking at the issues in A Blame Culture to a Learning Culture but was pleased that the Trust has scored highly. RS stated that it was important that lines of communication were kept open with junior doctors during this period of contractual dispute (this was an item in the Chief Executive s Report). SDG replied that a meeting was being arranged with the junior doctors. The Board noted the report. 09/03/2016 (A) Draft Operational/Annual Plan 2016/17 DS introduced the Operational Plan which will be submitted to NHS Improvement on the 11 April 2016 and sets out the Trust actions for 2016/17. The Operational Plan will form the first the first year of the five year Sustainability and Transformation Plan (STP) which will cover the entire North West London health sector. The Operational Plan provides detail on how the Trust will implement seven day service standards and highlights that the Trust has insufficient capacity to meet expected demand for both A&E and diagnostic services. (B) Financial Plan 2016/17 4

7 ACTION TMa briefed the Board on the Financial Plan 2016/17 which sets the parameters for what the Trust can put forward as actions for 2016/17 within the Operational Plan. In order to deliver our plans for 2016/17, and to qualify for Sustainability and Transformation Funding (STF), the Trust will need to stretch its current financial assumptions. Additional funding will be needed from our host commissioner and Monitor will need to be flexible with either the control total or the level of support from the STF to deliver our proposed Operational Plan... TMa cautioned that if Monitor does not allow flexibility to the control total or level of STF funding, it is anticipated that the Trust will need to submit a financial plan with a deficit and a FSRR of 1. DS stated that as the financial negotiations are still ongoing, the draft Operational Plan will need to be amended before it is submitted on 11 April. DS asked for delegated authority for the Chairman and Chief to agree these changes. KA stated that although she realised that there is limited flexibility, but she was concerned about the level of funding allocated to deliver quality improvements. SDG replied that the Trust will endeavour to increase QIPP savings in order to make quality investments. CB asked that the quality section in the plan to be more focussed. It was agreed that DS s team would liaise with CB to revise this section. SDG stated that the A&E section will be revised to reflect discussion with NHS England, Monitor and our Commissioners and the action plan being put in place as a result of the work with Methods Analytics. RS asked that that section on engagement between Governors, Members of the Trust and the public be reworded. RS said it was clear that as discussions on the Financial Plan might not be concluded until after the submission of the Operational Plan, an update will be given at the April Board meeting. DS/MT The Board: Reviewed the draft Operational Plan 2016/17 Delegated authority to the Chairman and Chief Executive to approve the Operational Plan 2016/17 to 5

8 be submitted on 11 April 2016 Reviewed and approved the self-certification that accompanies submission of the Operational Plan Reviewed and approved the Declaration of Risks against Healthcare Targets and Indicators 2016/17 which accompanies submission of the Operation Plan Reviewed the draft financial modelling within the Operational Plan Delegated authority to the Chairman and Chief Executive to approve the Financial Plan submitted as part of the Operational Plan. ACTION 10/03//2016 Safer Staffing: Planned and Actual Staffing TM introduced the overview of planned and actual staffing levels for January on all inpatient wards. TM asked the Board to note that average RN/RM fill rates were at or above 86% against plan for both our sites during the day and above 98% at both sites at night. Work is being progressed to understand and address the high average fill rates for HCAs at night on the Hillingdon site which is currently running at 129%. TM drew attention to the significant RN/RM vacancy rate of 98 vacancies at Hillingdon Hospital. TM explained that the NICE suboptimal staffing incident reporting template has been piloted since February but needs further refinement. TM hoped to report under the new template in April. KA asked about the staffing levels on Jersey and Kennedy wards; TM explained that particularly on Kennedy four days out of five the ward typically has only three nurses on. However Matrons are not included in the reporting template but are a resource available. RS stated that it is the third month in a row that Fleming Ward is down on the action plan as having a targeted recruitment campaign to reduce nursing vacancies; what progress has been made in recruiting staff. TM stated that she had interviewed for a Ward Manager but had not appointed. TM is now exploring how to improve leadership on the ward as that will attract more Band 5s and 6s that Fleming Ward needs. The Board noted the report. 11/03//2016 Quality and Operational Performance Reports 6

9 JS outlined the key messages: ACTION The Trust has reported a total of 12 cases of Clostridium Difficile infection to the end of February 2016 against a threshold of 8. No new cases were reported in February and only one case has been deemed a lapse in care by our commissioners. There has been a significant improvement in FFT response rates as a result of a specific drive; however disappointingly all areas saw a decrease in the percentage of respondents who would be likely or extremely likely to recommend the area where they were treated. The Trust achieved an in month performance of 85% against the A&E 4 hour target with a year to date position of 92.8%. The Trust s vacancy rate fell to 9.18% in February 2016; however Bank spend increased by 27% although agency spending reduced by 29%. The use of off framework agency workers has decreased significantly from 19.02% in February 2015 to 0.52% in February The Trust s completion of medical appraisals has reached 63.3% but the Trust will not meet its 90% target; non-medical PDRs are likely to exceed last year s 94% completion rate by the end of the financial year. CB informed the Board that the Quality and Safety Committee had reviewed actions to improve the Friends and Family Test response rates. RS asked which specialties complaints had gone up in. TM replied that it is particularly surgery and there is a clear line of sight as to what the issues are. TM will be bringing the annual complaints report to the May Board meeting. RS stated that the average of 81 days to recruit to a post needs to be improved. TR replied that systems and processes are currently being reviewed. CB noted that there is an increase in the number of staff grievances. TR replied that the findings from the staff survey will be reported to the April Board. AK reported that all medical appraisees are being allocated an appraiser for 2016/17; which will improve completion rates. TIAA, our internal auditors, are currently auditing the quality of medical appraisals. These findings will be reported to the Audit and Risk Committee. The Board noted the report. 7

10 ACTION 12/03//2016 Finance Report TMa informed the Board that the Trust ended the month with a year to date deficit of 1,396k, 1,529k behind plan and with a Financial Sustainability Risk Rating (FSRR) of 2. The deficit is primarily driven by a 4.2m adverse variance on pay expenditure; as the Trust has seen a net increase of 159 whole time equivalent staff. The end of year deficit remains forecast at 1.5m. Capital expenditure is running at 7,471k, 2,388k below plan. The year-end forecast for capital expenditure has been reduced by 900k. This reflects slippage on the paediatric scheme which has slipped into the first half of 2016/17. Based on the current forecast the Trust would maintain a Financial Sustainability Risk Rating of 2 (2.25) The Board: Noted the current and forecast financial performance of the Trust Agreed the further action proposed to ensure that the FSRR does not drop to a 1. 3/03//2016 QIPP Report Efficiency savings achieved to date were 6,996k. This is 1,540k behind target. There has been under achievement on incomes schemes and pay control schemes. Expected cost savings remain at 8.0m which is below the 9.5m target set for the year. The Board noted the report. 14/03//03/2 016 CQC Action Plan Update TM explained that progress on outstanding actions within the CQC improvement plan continued to be monitored by the Sitrep group and divisional leads. A mock CQC inspection took place at the Hillingdon Site on 4 March. Areas requiring focus are: To improve clinical record keeping standards Ensure compliance with the NEWS policy Ensure high standards of cleanliness and infection 8

11 control practice are in place; particularly with regard to cleaning of patient equipment and the use of personal protective equipment (such as gloves) Ensure adequate security with regard to medicines storage Reduce clutter Keep information boards up to date. ACTION CB reported that that there had been an in-depth review of the mock CQC inspection at the Quality and Safety Committee. LP asked what it would take to address some of the actions that are outstanding on the CQC action plan, in particularly the storage of medicines. TM replied that a solution to the storage of medicines is often more complicated than it seems, as space is often the key constraint. DS stated that there is ongoing work between Estates and the Pharmacy Department to have ward by ward solutions on how to store, and where to put the storage, in each ward. RS stated that it was important to review the actions on the CQC action plan and state what could be addressed and what could not; and to feedback what could not be to the CQC. The Board noted the report.. 15/03/2016 Update from Board Committees RS introduced the update of the work of the Board Committees for the fourth quarter 2015/16. KA reported that the Audit and Risk Committee would be closely monitoring the action plan resulting from the health and safety audit. The announcement of who had been successful in winning the internal audit contract for the Trust would be made shortly. RS updated the Board on decisions relating to a 400k legacy the Trust had received. The Board noted the report. 16/03/2016 Use of Trust Seal/MoU signed 9

12 The Board noted the report. ACTION 17/03/2016 Board Agenda Planner The Board noted the agenda planner. 18/03/2016 Any other Business None. 19/03/2016 Questions from Governors and the Public AT reported back on her discussions with Central and North West London Foundation Trust (CNWL) on end of life care. AT was pleased to read about the patient story that concerned Grange Ward in February, as Grange Ward was where her husband had received care. AT asked how prepared the Trust was for an incident similar to the Brussels terrorist incident. JS replied that the Trust regularly tests its procedures. RWa asked why the Friends and Family Test that monitors whether patients would recommend services had fallen for two consecutive months. TM replied that there are often fluctuations in satisfaction levels, but she was pleased to say that a recent survey of the views of carers of services provided by the Trust was very positive. CB added that the Quality and Safety Committee is actively monitoring patient satisfaction. Date of Next Meeting The next meeting is scheduled to take place on Wednesday 27 April 2016 in the Board Room at Hillingdon Hospital. 10

13 Richard Sumray Chair Date. 11

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15 ITEM 4 Board action log - public session Green Complete Amber In hand / not yet due Red Overdue / date to be confirmed Patient Story Draft Annual/Operational Plan Update on the progress of the issues raised in Charlotte's patient story to be given in 4-6 months time. Board members provided comments to be included into the Annual/Operational Plan submission TM DS/MT Apr-16 Apr Patient Story Review the social media policy in relation to patient complaints. TM May Safer Medical Staffing Patient Story Report to review the adequacy of medical staffing in terms of numbers and skills and actions being taken to address gaps. AK to report back in June 2016 on progress on improving the transition of care for patients graduating paediatrics to adult services with long term conditions. AK AK Jun-16 Jun Patient Story TM to review the patient experience for the 17 to 21 age group. TM Jun Maternity Picker Survey Survey of mothers who gave birth at Hillingdon Hospital in February 2016 is being undertaken. The results from this, and an update on progress on the action plan drawn up as a result of the Picker Survey will be presented to the June 2016 Board. TM Jun-16 Verbal update to be given on the progress of issues highlighted in Charlotte's story to the April Board. Verbal update to be given on the final Annual/Operational Plan and Financial Plan submission. Revised social media policy to be considered by the Board. That the June report include an update on system for gathering reliable information on days lost to sickness. Verbal update on improvements on handover and the continuity of care for this patient group. Verbal updat on findings of review of patient experience for 17 to 21 age group. Survey results, and update on action plan progress to be presented to June Board. Verbal Update Verbal Update Not yet due Not yet due Not yet due Not yet due Not yet due Medical Education Report Chair's Report AK to include comparative satisfaction ratings in the July update. AK Jul-16 The art curator from the Homerton Hospital be invited to attend the July Board Seminar. Comparative satisfaction ratings fromother trusts for student experience to be included in July report. Not yet due CC Jul-16 Invitation extended. Not yet due

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17 Meeting of the Board of Directors Public session Wednesday 27 April 2016 Agenda item 8 Chief Executive s Report Reason for item: This is a standard monthly report to the Board that seeks to ensure the Board is informed of key issues not otherwise covered in the agenda papers. Summary: The report updates the Board on a range of issues including local, regional and national strategic developments, recent publications, and developments at the Trust not otherwise covered in the Board reports. As such, it seeks to provide context to the Board s discussions. This month s report includes an update on the junior doctors industrial action, NHS England statistics across the NHS showing a worsening performance in February, DH consultation on student funding for nurses, midwives and allied health professionals and the Trust s ICT Department shortlisted as a finalist for the HSJ Value in Healthcare Awards. Board Action required: The Board is asked to: 1. Review the report and agree any further actions as required. Report from: Shane DeGaris, Chief Executive Links to Trust strategic priorities: The report is relevant to all of the strategic priorities. Previous consideration at Board or Committees: n/a. Equality and diversity considerations: none. Financial implications: There are no direct financial implications arising from this information report. 1

18 Chief Executive s Report 1. Junior Doctors Strike A&E departments are likely to be put under further strain during the next junior doctors strike on 26 and 27 April, which for the first time will include those working in emergency care, although consultants will be providing cover.. A verbal update will be given at the Board meeting. 2. NHS England: Statistics show worsening performance NHS England has published statistics showing worsening performance. The number of patients waiting more than four hours in hospital A&E departments has risen by more than 70% in the past year. NHS England said that A&E departments had had to cope with flu cases peaking later than in the previous winter. Official statistics, published on 14 April 2016, show that hospital A&E departments kept 224,116 patients waiting more than the maximum four hours to be admitted, transferred or discharged, compared with 212,136 in January and 131,248 in February A&E departments only treated 81.6% of patients within four hours, way below the 95% standard they are meant to achieve. This Trust s performance is therefore in line with the national position. Other performance measures also show a worsening position, with the largest number of patients ever 263,580 waiting more than the supposed maximum of 18 weeks to have planned care in hospital. However, there was a slight improvement in cancer waiting time statistics, with hospitals breaching one of the eight waiting time targets, compared with two the previous month. The breach was in the proportion referred by their GP to have a first treatment for cancer within 62 days. The recorded level was 81%, below the standard of 85% and the joint worst performance ever recorded. The 10 NHS regional ambulance services also struggled. The proportion arriving to Red 2 calls, which cover less serious but still potentially lifethreatening illnesses, within eight minutes, was 60.3%, the lowest since records began and well below the 75% target. Of the most urgent Red 1 calls, such as for someone having a cardiac arrest, 68.0% saw an ambulance arriving within eight minutes, down from 69.9% in January and the ninth month in a row in which the 75% target was missed. 2

19 3. Research shows GP appointment waiting times crisis Research finds 14.2m patients waited a week to see their doctor or did not manage to get an appointment at all in The number of people having to wait at least a week to see their GP rose by 500,000 last year. About 14.2 million patients had to wait a week or did not get an appointment at all the last time they tried to see their doctor in 2015, compared with 13.8 million the year before, research from the House of Commons library found. The research concluded that many of the UK s 9,770 GP surgeries are struggling to cope with a growing and ageing population and as pressures have risen, the number of GPs has not kept pace, with an increasing number opting for early retirement. That has coincided with a failure to attract enough graduate medics into choosing general practice as a career. 4. Freedom to Speak Up A national integrated whistleblowing policy that will help standardise the way NHS organisations support staff that raise concerns has been published. The policy is called Freedom to speak up: raising concerns policy for the NHS. Recommended by Sir Robert Francis in his Freedom to Speak Up review, this policy contributes to the need to develop a more open and supportive culture that encourages staff to raise any issues of patient care quality or safety. The policy is aimed to ensure: NHS organisations encourage staff to speak up and set out the steps they will take to get to the bottom of any concerns organisations will each appoint their own whistleblowing guardian, an independent and impartial source of advice to staff at any stage of raising a concern any concerns not resolved quickly through line managers are investigated investigations will be evidence-based and led by someone suitably independent in the organisation, producing a report which focuses on learning lessons and improving care whistleblowers will be kept informed of the investigation s progress high level findings are provided to the organisation s board and the policy will be annually reviewed and improved. The Department of Health expects all NHS organisations in England to adopt this policy as a minimum standard to help to normalise the raising of concerns for the benefit of all patients. 3

20 5. DH Consultation on student funding for nurses, midwives and allied health professionals Consultation was launched by the Department of Health on 7 April 2016 regarding how changes to student funding for nurse, midwife and allied health professional degree places can be implemented. According to the Department of Health, under the existing system two-thirds of people who apply to become a nurse aren t accepted for training. The proposals will create up to 10,000 more training places by 2020, allowing universities to accept more applicants with the right qualifications than they currently do. The changes are part of a wider plan from the government to ensure the NHS can adapt to the changing needs of the population, train more nurses in England and reduce the reliance on agency and overseas staff. Interested organisations and the public are asked to contribute to the consultation which looks at how the changes can best be implemented. This includes looking at opportunities for students who apply for nursing, midwifery and allied health professional training as a second degree to be eligible for a student loan. Plans to increase the nursing workforce also include the creation of a new nursing associate role, which will sit between care assistants and registered nurses, to give support to nurses. The DH is working with representative organisations on the development of this role. The consultation will run until 30 June, our Trust will be responding. 6. Hillingdon ICT Department Shortlisted for Award The Trust s ICT Department has been shortlisted as a finalist for the HSJ Value in Healthcare Awards in recognition of its continued effort and improvement. The team have been shortlisted in the category of Non-Clinical Support Services. The HSJ Value in Healthcare Awards seek to recognise and reward outstanding efficiency and improvement by the NHS. 4

21 7. Increased Recycling at the Trust The Trust is increasing its efforts to improve recycling. During April the Facilities Team have been replacing the Trust's waste bins with new mixed recycling bins. The aim is to further reduce the amount of recyclable waste going into landfill at London Borough of Hillingdon disposal sites. The new bins themselves are 100% recycled plastic. In other recycling initiatives, the catering team has an arrangement to give our used cooking oil to a local charity which in turn recycles the oil into bio-fuel and provides employment opportunities for people with learning disabilities. Shane DeGaris Chief Executive 18 April

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23 Meeting of the Board of Directors public session Delivering the Strategy 2015/16 Wednesday 27 th April 2016 Agenda item 9 Reason for item: The purpose of this paper is to provide the Board with an update on delivery of the Trust s Strategy 2015/16. Summary: The attached report summarises achievement against the Board agreed objectives for the financial year 2015/16. End of year achievement status against objectives and bullet points on what more needs to be done going into the next financial year are provided. Key areas of regulatory compliance are highlighted, with further commentary, overleaf. This is followed by a summary of high level achievements organised by strategic priority. Board Action required: The Board is asked to note the report Report from: Gordon MacMillan, Assistant Director of Strategy & Business Development Report sponsor: David Searle, Director of Strategy and Business Development Links to Trust strategic priorities: This report is relevant to all of the strategic priorities. Previous consideration at Board or Committees: Delivering the strategy is monitored quarterly at board, most recently in January 2016 Equality and diversity considerations: None Financial implications: There are no direct financial implications arising from this report.

24 COMMENTARY ON KEY AREAS Monitor Compliance Compliance with the conditions of the Trust s Monitor licence is at risk in two areas: financial performance and achieving the required level of performance against the A&E standard. Finance: At the start of 2015/16, the Trust forecast a break even position, however in year this was revised to a projected 2.7 million deficit. Following negotiation with Hillingdon Clinical Commissioning Group, the Trust has received in year funding, resulting in an end of year outturn position of 1.5 million deficit. Following discussion with NHS Improvement, they are aware of the Trust intention to submit a deficit plan for 2016/17, with further negotiation ongoing to allow the Trust to access sustainability and transformation funding for 2016/17. Even if this funding is received and the Trust is able to achieve a surplus for 2016/17, there will still be a need to address the underlying deficit. Performance: The Trust has not met the 95% A&E standard in quarter 4. Contributing factors have included staffing and higher than anticipated activity levels. More detail is provided in Integrated Quality & Performance Report, agenda item 13 CQC Compliance Continued focus and traction is required in 2016 to address concerns raised by the CQC from their inspection in The Trust still has an outstanding requirement notice relating to infection control and must ensure that this notice would be removed upon reinspection. To support this objective, the Trust has a programme of mock CQC inspections. Key achievements in 2015/16 by priority 1. To create a patient centred organisation to deliver improvements in patient experience and the quality of care we provide. (objectives 1-4) Financial and A&E performance an area of challenge, as noted above Strong performance against targets for referral to treatment time, cancer diagnosis and cancer treatment times Warning notices relating to assessing and monitoring the quality of service provisions (regulation 10) and cleanliness and infection control (regulation 12) deescalated by CQC following May 2015 reinspection, with the latter replaced by a requirement notice. The four red inadequate ratings in the safety domain were upgraded to requires improvement and the overall rating for safety was upgraded to requires improvement. Achievement of majority of areas within clinical quality strategy and against patient safety measures, though need to improve performance against pressure ulcers Performance against complaints improved, following quarter 2 dip in performance, although higher response rate required for Friends and Family Test (FFT) targets

25 Trust part of northwest London early adoption of national 7 days standards for 2016/17 Reduction in HSMR figures compared to 2014/15 and weekday to weekend variation within expected tolerance 2. A clinically led service strategy that responds to the needs of patients and other health and social care partners (objectives 5-7) A key role in north west London wide transformation programmes Operational divisional structure reordered to provide clinical leadership CCG funded 2 x geriatrician consultant posts to work in the Trust, A&E and the community Better care fund target achieved, 3.5% reduction in non-elective admissions for over 65s Undertaken national baseline benchmarking for 4 national priority 7 day standards 3. To deliver high quality care in the most efficient way (objectives (8-11) Ambulatory care models in place and improving throughput Year 2 of the informatics strategy achieved Capital programme delivered, including paediatric A&E relocation and major theatre ventilation works Trust master planning in progress developing estates plans for the Trust s two sites Workforce transformation plan and an inclusion and diversity plan established 4. To develop sufficient sustainable scale to enable us to improve and grow healthcare services for our communities (objectives 12-13) Transfer of maternity services from Ealing hospital successful, plans for June 2016 paediatric transfer progressing Development of Hepatitis C and neuro-rehabilitation services with partners Areas of collaboration identified with Brunel university London being developed, such as the training of physician associates Progress made in the development of Hillingdon Accountable Care Partnership

26 Trust Objectives Exec 15/16 Actions/ measures of success Comply with requirements of Monitor licence and CQC and other regulators Maintain Monitor risk rating green or amber/green Maintain CQC registration and deliver action plan from inspection Delivering the Trust Strategy 1. Fully comply with licence to operate/ regulators DPEN End of year completion status: Monitor governance risk rating is amber, following deterioration in Trust financial position and performance against the A&E 4 hour standard CQC warning notices de-escalated following May inspection, with outstanding requirement notice relating to infection control Improved monitoring of CQC compliance including an overview of static areas on CQC action plan provided to executive and monthly sit-reps in place, CEO briefed weekly What more needs to be done: Improve CQC rating to good or higher by implementing refreshed action plan Ensure that the CQC requirement notice against Trust would be removed upon reinspection Implement mock inspection programme in preparation for CQC Desktop review of Health and social care act fundamental standards DPEN link with Director of People and Development focussing on Recruitment and Retention FD Achieve the main objectives of the annual financial plan Continuity of Service Risk Rating (COSRR) of at least 3 (amended to 2 in annual plan submission May 2015) End of year completion status: Financial Sustainability Risk Rating (replacing COSRR) is at 2 Following negotiation with commissioners, the Trust was able to receive in year funding, resulting in a year end deficit of 1.5m. What more needs to be done: Achieve the main objectives of the annual financial plan Maintain Financial Sustainability Risk Rating (FSRR) of at least 2 Achieve the revenue and capital control totals agreed with NHS Improvement Achieve 2016/17 QIPP totals 2. Improve the quality of care and clinical effectiveness MD Deliver the Clinical Quality Strategy Achieve 15/16 indicators within Clinical Quality Strategy End of year completion status: Delivery against annual action plan Majority of areas completed, report sent to Quality and Safety Committee What more needs to be done: Transition the Clinical Quality Strategy and quality improvement strategy Achieve the 16/17 indicators of the Quality Improvement Strategy

27 Trust Objectives Exec 15/16 Actions/ measures of success Delivering the Trust Strategy Align CQC action plan with Quality Improvement Strategy Implement transition from Clinical Quality Strategy to Quality Improvement Strategy 3. Improve patient and carer experience Fully implement Friends and Family test across the trust, and apply lessons learned into practice. FFT in place in all required areas and targets met Improved accessibility of information for patients End of year completion status: FFT response below target and down in A&E and below target but improving for admitted patients, though improvements have led to target being consistently met in Maternity Divisional triumvirates engaged to improve FFT performance What more needs to be done: Increase proportion of FFT responses and deliver >96% satisfaction scores from respondents Improve accessibility of information for patients Agree strategy for improved metrics in national and local patient surveys Circulate carers survey DPEN Utilise learning from complaints to improve patient and family experiences at THH Reduction in complaints related to key themes End of year completion status: Trust below target in complaints response times, largely owing to drop off in performance in quarter 2 What more needs to be done: Improve performance against complaints targets Improve performance following appointment of temporary complaints manager in March 2016 Embed patient and carers stories at the Trust Board. Improvement in national patient survey metrics for key areas Learning from first hand patient stories Implement and embed yr2 priorities for London End of year completion status: Patient and carer stories, along with staff stories fully embedded at board What more needs to be done: Ensure that learning from patient stories continues to inform improvement in patient experience at the Trust 4. Improve patient safety MD End of year completion status: Delivery of agreed year 2 standards

28 Trust Objectives Exec 15/16 Actions/ measures of success Delivering the Trust Strategy Health Programmes Emergency Care Standards in conjunction with Commissioners Delivery of agreed yr 2 standards Trust part of NWL early adopter for national 7 day standards from 2016/17 What more needs to be done: Implement core 7 day standards as a part of NWL early adopter status 6 monthly board reports to include NHSE 7 day standards audit Reduce variability of weekend v weekday HSMR Reduce weekend HSMR to at least London Average. End of year completion status: Reduction in HSMR figures compared to previous year Weekend to weekday variation within expected tolerance Lower than expected SHMI for the Trust What more needs to be done: Improve mortality governance in line with NHSE guidance to identify avoidable deaths Demonstrate improvement in achieving patient safety thermometer standards Reduce to 95% harm free Agreed safety improvement plan - Eradicate grade 3 and 4 pressure ulcers and 50% reduction in harms over 3 yrs End of year completion status: Year to date achievement of harm free care target Agreed safety plan implemented Unable to achieve zero tolerance on hospital acquired grade 3 and 4 pressure ulcers 12 cases of C Diff. at the Trust, though only 2 were found to be avoidable 1 positive MRSA culture, though due to contamination of the sample, rather than patient infection What more needs to be done: Demonstrate improvement in all patient safety thermometer standards Implement medication safety thermometer Improve use of early warning scoring systems (EWS) in escalating the treatment of acutely unwell patients Meet C Diff target

29 Trust Objectives Exec 15/16 Actions/ measures of success Delivering the Trust Strategy Implement pledges within Sign up to Safety Campaign End of year completion status: Implemented year 1 of sign up to safety campaign What more needs to be done: Implement year 2 of the sign up to safety pledges Roll out patient safety champion roles, patients and staff 5. Work with CCG collaboratively to improve services within available resources COO Deliver in conjunction with CCG the shared health economy transformation programme Achieved to date: Progress made in setting up Accountable Care Partnership (ACP) Shadow Board for 2016/17 Linking with NWL sector on 5 McKinsey project areas, End of Life, Orthopaedics, Bank and Agency, Procurement and improvement approach CCG Funded joint appointment (THH, CNWL, Metro Health, Hillingdon for All) of a Programme director to progress the integration agenda. Ongoing participation in the CCG/Trust Transformation board Progressed transformation agenda through a series of Board to Board meetings with the CCG CCG funded 2 x geriatrician consultant posts to work in the Trust, A&E and the community. New model of care involving primary, community and acute care and the voluntary sector in the north of the borough being evaluated, with a view to roll out across borough. What more needs to be done: Implement action plan for the 5 McKinsey project areas, including meeting national agency caps Further develop ACP, movement towards full board, rather than shadow board Finalise potential roll out of new care model across borough Agree funding for the on-going development of the ACP Achieve 15/16 targets of the NW London integration plan and the 7 day working model End of year completion status: Better care fund target achieved, 3.5% reduction in non-elective admissions for over 65s NWL early adopter of national 7 day working standards Subject to final agreement, achieved 70% of clinical milestones of CQUINs for national 7 day standards relating to multi-disciplinary teams, handover and diagnostics

30 Trust Objectives Exec 15/16 Actions/ measures of success Delivering the Trust Strategy Undertaken national baseline benchmarking for 4 national priority 7 day standards, time to first consultant review, access to diagnostics, access to consultant led intervention and ongoing review 6. Improve Patient & Public involvement DPEN Agree a broad stakeholder management strategy which facilitates collaborative and productive relationships in order to directly meet the objectives of both the Trust and wider health economy partners, and the licence requirement to co-operate with third party bodies Deliver a programme of events that will capture wider sections of the community, and reflect the patient groups. Board agreed stakeholder management strategy Stakeholder supplied evidence of well managed relationships What more needs to be done: Further develop Whole Systems Integrated Care work Implement action plans for the national 7 day working standards Achieve agreed better care fund target for 2016/17 End of year completion status: Series of events held throughout the year, such as October 2015 adult and young people stakeholder events, December 2015 Hillingdon health stakeholder event RAF Northolt open day and West Drayton Mayday fair Stakeholder management strategy agreed What more needs to be done: Implement year 1 objectives of the Stakeholder Management Strategy, through head of patient and public engagement Facilitate collaborative relationships to meet the objectives of the Trust and wider health economy partners, and the licence requirement to co-operate with third party bodies Establish annual plan for 12 months of stakeholder engagement events and anticipated outcomes Focus on hard to reach communities Activate learning from October focus events

31 Trust Objectives Exec 15/16 Actions/ measures of success Develop the clinical strategy for MVH Board agree aligned clinical & estate strategy Delivering the Trust Strategy 7. Engage clinicians to develop innovation and expansion of services End of year completion status: Master planning to determine estate plan for both sites in progress, including clinical input What more needs to be done: Ensure continued effective engagement in development of site plans MD Establish a pipeline of schemes for clinical expansion 4 new schemes in development pipeline New revenue growth of 2% of turnover Implementation of the Skin Centre development End of year completion status: Robust process established to appraise and qualify tenders; bid pipeline actively managed and support given to clinical teams; 15 opportunities qualified; 5 contracts awarded; 4 live bids in progress., although the net revenue growth of 2% turnover will not be achieved. KPIs for integrated care in Hillingdon have been successfully negotiated diabetes, respiratory, cardiovascular. Skin centre development business case sent to March 2016 board What more needs to be done: Continue to develop pipeline and opportunities for Trust growth where clinically, operationally and financially viable Implementation of approved skin centre development option, following March board Move to a clinically led divisional structure Divisional Directors and clinical service leads from agreed structure in place End of year completion status: Clinically led divisional structure in place Divisional Directors appointed to all divisions What more needs to be done: Succession planning in place for clinical specialty leads and divisional directors Clarify of roles and responsibilities for divisional triumvirates, divisional directors, assistant directors of operations and assistant directors of nursing

32 Trust Objectives Exec 15/16 Actions/ measures of success Roll out key ambulatory and outreach service models across key inpatient specialties Models in place for Medicine, Surgery and Gynaecology Clinical model for Acute Medical Unit in place Delivering the Trust Strategy 8. Deliver healthcare more efficiently COO End of year completion status: Models in place for medicine surgery and gynaecology Achieved an average of 319 new patients a month through ambulatory clinics and increased to 400 per month in Q4. Clinical model for Acute Medical Unit in place Extension of Ambulatory Emergency Care (AEC) to Saturdays and to each evening Monday to Friday. What more needs to be done: Continue to develop appropriate ambulatory and outreach models with commissioners Continue to grow the use of ambulatory care pathways Extend the department Increase Saturday working hours Develop a three year transformation plan Deliver on key transformation priorities End of year completion status: Director of Transformation in place and team established Programmes set up for transforming patient care, workforce and responsive and accessible service Root Cause analysis of CQC report undertaken, with action plan created Leadership away days undertaken with Triumvirate Divisional Management teams. Re-launch of the Transforming Patient Care workstream focusing on discharge planning What more needs to be done: Strengthen performance of transformation programmes through accountability framework Build on leadership programme through further away days and through a series of individual coaching sessions with Divisional Directors to promote clinical engagement/leadership. Develop staff at the Trust to undertake transformation Implement changes from Lord Carter review

33 Trust Objectives Exec 15/16 Actions/ measures of success Implement Pathology Modernisation Programme Deliver yr1 of the plan Delivering the Trust Strategy End of year completion status: Pathology JV set and agreed by the 3 Trust, requiring NHS Improvement approval of IT system purchasing Contract negotiated and pricing agreed What more needs to be done: Obtain NHS Improvement approval and sign the JV Implement the setting up of agreed pathology JV Develop a project plan to safely transition the service Appoint a programme manager 9. Improve and invest in IT to support service improvement FD Develop a plan to have all in-patient wards, including escalation wards, out of the annex corridor (by date TBC ) Inpatient annex wards closed permanently Deliver yr 2 of the Informatics strategy Digital Hillingdon Care Records in place Virtual desktops/clinical workstations Initial e-prescribing rollout EPR & Clinical viewer End of year completion status: Lister and Pinewood wards closed, with a discharge lounge created on Lister What more needs to be done: Review the required inpatient beds, in light of demand and capacity modelling across NWL Implement new models of care to reduce lengths of stay to prevent occupation of link wards. End of year completion status: Core Hillingdon Care Record (EPR) development completed and integrated with GP systems and Coordinate My Care (for palliative care patients in London) Clinical viewer available on mobile devices and desktop PCs and continues to be rolled out Clinical Handover system procured Piloted Care Information Exchange in Hillingdon as part of North West London programme Mobile devices rolled-out to capture responses for the Friends and Family Test Board Members and senior managers have been equipped with ipads to support move towards paperless working Guest Wifi provided for patients, the public and staff ICT security systems upgraded (including replacement firewalls, new Enterprise Mobility Management and anti-malware upgrade) to address Cyber security threats ICT infrastructure upgrades procured and being implemented, including replacement of the Bleep (Paging) System and new data network switches

34 Trust Objectives Exec 15/16 Actions/ measures of success Delivering the Trust Strategy ICT contracts centralised ICT Service Desk upgraded and monitoring system procured to support proactive working National Digital Maturity Assessment completed Readiness and Infrastructure scoring 90% and 95%, compared with national averages of 73% and 68%, respectively, for the Trust s ICT. The Capability of the Trust s electronic records is just below average (but with the recent rollout of the HCR to desktop PCs, the Trust should now be above average). There is no business case to move to virtualise desktop PCs at this point in time. What more needs to be done: Refresh and deliver year 4 of the Informatics Strategy Pilot and roll out Clinical Handover across the Trust Enhance the Hillingdon Care Record with electronic forms Ensure Trust developments are included in the Hillingdon Digital Roadmap, in line with NWLwide STP development When transformation funds become available, secure sufficient monies and implement electronic prescribing and electronic document management systems 10. Modernise & reconfigure the Estate & Facilities to meet the needs of our clinical services DSBD Agree the Estate Strategy Deliver year 1 of the Estate Strategy End of year completion status: Capital Investment Committee (CIC) established to provide oversight of developing master plan for both Hillingdon and Mount Vernon sites Phase 1 of trust master planning exercise begun, with external company commissioned to undertake the development of site master plans for both Hillingdon Hospital and the Mount Vernon site Capital programme delivered, including paediatric A&E relocation and major theatre ventilation works What more needs to be done: Continuation of Trust master planning Develop strategic outline case for Trust estates, alongside development of second phase of master planning Agree MoU with East and North Herts NHS Trust

35 Trust Objectives Exec 15/16 Actions/ measures of success Delivering the Trust Strategy Develop best in class estate assurance, compliance and performance reporting Agreed board reporting format and frequency End of year completion status: Board assurance format agreed, with monitoring of compliance through Audit and Assurance committee Following Estates review, filling substantive staff begun, though issues remain recruiting to some posts, including trade and technician staff and property manager What more needs to be done: Resolve issues with recruiting to estates posts, with full workforce plan, including mitigation for hard to recruit to posts and plans on apprenticeship Deliver the in-year PLACE improvement plan Completed action plan Achieved to date: PLACE improvement group established with improved governance arrangements PLACE improvement plan for 2015/16 implemented through PLACE improvement group PLACE assessment of Hillingdon Hospital completed in March 2016, Mount Vernon site scheduled for May 2016 What needs to be done: Develop and implement 2016/17 PLACE action plan from 2015/16 report Secure more timely completion of resourced and agreed actions

36 Trust Objectives 11. Maximise staff contribution to transforming the way we deliver our services 12. Develop a service plan in response to SaHF Exec DPD COO 15/16 Actions/ measures of success Workforce and Organisational Development Transformation Strategy Leadership and management programme delivered including Coaching for Health & Paired Learning Improved staff survey metrics to national average Workforce transformation plan Inclusion & Diversity action plan Extended Leadership development programmes for bands 3-5, 6-7 and consultants Retention and Engagement work-stream Publish a SaHF consistent Clinical Strategy and implementation plan Board approved clinical strategy and SaHF implementation plans Develop OBCs for capital builds Agree and embed activity and workforce Delivering the Trust Strategy End of year completion status: Leadership and management programme delivered including Coaching for Health & Paired Learning delivered Workforce transformation plan developed Inclusion & Diversity action plan established and steering group chaired by NED to deliver strategy and action plan Retention and engagement work stream established What more needs to be done: Further reduce recruitment time in the Trust Develop peripatetic pool of staff, able to move between wards or potentially other organisations Develop training partnerships with potential partners End of year completion status: Submission of documentation required for revised Implementation Business Case (ImBC) Provided documentation and reports in line with the SaHF time table attended SaHF operational and board meetings. What more needs to be done: Submit further documentation for the ImBC End of year completion status: Safe transfer of maternity services from Ealing in June 2015

37 Trust Objectives Exec 15/16 Actions/ measures of success transition plans for paediatric and maternity services Safe transfer of work as part of the planned SaHF closures Delivering the Trust Strategy SaHF implementation underway, project plan developed to ensure a safe transition and on delivery of paediatric service from June What more needs to be done: Complete transfer of paediatric services from Ealing Hospital in June 2016 Agree new medical model of care and funding for paediatrics Liaise with SaHF team over future SaHF changes 13. Develop strategic alliances with appropriate partners DSBD Strengthen existing strategic relationships with key acute providers Jointly bid for a new service with a partner. Extend support arrangements for RBH Embed specialist neurorehab pathways with ICHT Develop strategy for the development of services and alliances within the community and primary care settings Board approved strategy for developing services and alliances within the community and primary care settings End of year completion status: Joint agreement for Hepatitis C service amongst NWL partners Collaboration with RBH clarified, currently no plan to extend Successful collaborative bid to provide specialist neuro rehab services, jointly with ICHT and CLCH What more needs to be done: Continue to develop appropriate joint bids with key partners Extend our networked model of providing neuro-rehabilitation services with ICHT and CLCH End of year completion status: ACP working group set up, options for organizational form presented, currently receiving legal advice on legal entity options. Agreements in place for contract variations for community respiratory, cardiology and diabetes services in Hillingdon What more needs to be done: Agree the legal form of the ACP and move to operating beyond shadow form in 2017/18 Build strategic alliances with Brunel and Imperial College Health Partners Identify specific areas of collaboration with Brunel End of year completion status: Specific collaboration with Brunel University London achieved on physician associates to be trained at the Trust from October 2016 Discussion underway on partnership for the development of an academic centre for the training of allied health professionals

38 Trust Objectives Exec 15/16 Actions/ measures of success Delivering the Trust Strategy Project manager identified to support the delivery of academic centre What more needs to be done: Continue to explore possibilities of co-location developments with Brunel University London Continue to develop academic centre for allied health professionals with Brunel University London

39 Meeting of the Board of Directors - public session Wednesday 22 nd April 2016 Agenda item10 A&E Performance Report Reason for item: This report provides the Board with an overview of Hillingdon Hospitals performance against the 4 hour A&E standard and outlines the actions being undertaken. Summary: This report provides the Board with an overview of Hillingdon Hospital s performance against the 4 hour A&E standard and outlines the actions being undertaken within Hillingdon to recover performance. The report highlights the key factors inhibiting attainment of the four hour standard as, physical capacity, departmental flows, cumbersome IT systems, intra department flows into the hospital and low morale. The Trust has been working with Hillingdon CCG to develop a system wide 3 box plan. The first box focuses on preventing attendance at A&E, and is led by the CCG. The 2 nd box focuses on flows, process and procedures within the A&E and led by the Trust. The final box looks at inpatient flows and discharge planning, communication with social services and intermediate care. This is jointly delivered by the CCG and the Trust. As part of this programme the Trust and CCG commissioned Method s Analytics to undertake a full review of flows into and through A&E. The outputs from this review were incorporated into box 2 to provide a comprehensive action plan to redress the issues within A&E. This paper provides a summary of actions already taken to recover performance and sets out next steps. The current action plan needs extensive revision and critical steps and codependences need to be identified. To obtain the traction required to deliver a change programme of this scale will require dedicated resource (number one recommendation from Methods). As such the CCG have agreed to fund a programme manager for 6 8 months to co-ordinate the response to recovering the four hour standard. This plan will also be tracked by the CCG and will be discussed at the local resilience meetings. Large scale system wide change, across the entire health economy will be required to meet the ever growing demands for emergency services. This paper alerts the board to the real danger that if demand can t be curtailed then there remains a considerable risk to achieving the four hour standard. 1

40 Board Action required: The Board is asked to: 1) Note the report an actions taken to recover performance. Report Authors: Melissa Mellett, Director of Operational Performance Report Sponsors: Joe Smyth, Chief Operating Officer Links to Trust strategic priorities: To create a patient centred organisation to deliver improvements in patient experience and the quality of care we provide. To deliver high quality care in the most efficient way. Previous consideration at Board or Committees: Equality and diversity considerations: There is no positive or negative impact from this report. Financial implications: The financial implications of delivering the additional capacity to meet the non-elective demand over and above plan are detailed in the report. 2

41 A&E Recover Action Plan 1. Background Despite strong performance in 2013/14, a good start to 2014/15 and several individually successful resilience schemes, the Trust has struggled to sustain 4 hour performance since August As a result of continued winter pressures, the Trust was unable to achieve the 95% standard for the year. The Trust and the CCG have been working together to address the issues and commissioned an external body Methods Analytics to undertake a review of flows and processes within the department. The CCG also commissioned The Cumberland Initiative to undertake a review of the flows and process within the community and primary care to try and identify additional schemes that might be implemented to prevent attendance at A&E. These reviews are part of a wider 3 Box Plan that the CCG and the Trust developed to try and recover the A&E position. The three box plan focuses on attendance avoidance (box 1) flows within A&E (box 2) and intra departmental/discharge process into the community (box 3). The CCG is responsible for delivery of box 1, while the Trust takes ownership of box 3. The 3 rd box is jointly owned by the CCG and the Trust. A high level copy of the 3 box plan is attached at appendix 1. The purpose of this paper is to provide the board with an update on box 2 component of this plan and to provide assurance that all possible actions are being taken to recover A&E performance. 2. Key Factors Affecting Performance: 2.1 Capacity Growth in overall demand for A&E services is the most significant contributory factor inhibiting the Trust achieving the 4 hour standard. Attendances to the department have reached unprecedented levels. There has been an increase of 12 % in Type 1 activity and 58% increase in blue light attendances over the last two years. Quarter 4 of 15/16 has been particularly challenging as type 1 attendances increased by an average of 13% over the same period last year There has been a significant increase in demand from Ealing CCG of 16% compared to 14/15 and now accounts for between 35 and 40 patients per day. The majority of this is in Type 3 activity (managed by the Urgent Care Centre (UCC). On average, the conversion rate from UCC to the A&E pathway is 10% - approximately 25 patients per day. When the UCC experiences significant pressure this rate increases. The impact of this is that patients are often transferred to A&E with 2 hours+ into their pathway. Given the capacity constraints within the department these patients are often have to wait to be seen. This makes it very difficult to treat these patients within 4 hours. 3

42 Capacity within the department is now frequently exceeded, this often means that doctors are available but there no cubicles to assess patients. The department has 14 majors cubicles which makes it the smallest A&E in North West London. Blue light activity has increased by 53% in two years is also having a detrimental impact on achieving the four hour standard. Blue Lights now represent 16% of the total ambulances attending the Trust. LAS have confirmed that this is the second highest ratio in London the first being St Georges in South London. Patients attending by blue light are conveyed to the Trusts 4 bedded resus unit. Occupancy in the unit has increased by 17% and often exceeds maximum capacity. There are a number of other factors compromising the Trusts ability to meet the four hour standard 2.2 Departmental Flows It is recognised that flows within the department could be improved as highlighted by the Methods report. The report states that there is room from improvement by removing duplicate and redundant steps. There can be significant delays in accessing the intermediate mental health assessment team. This is particularly true for young adults and teenagers. These patients can occupy cubicles for considerable amounts of time delaying other patients. There are increasing numbers of patients attending from care homes, who almost all get admitted. There can be significant discharge problems when care homes refuse to accept the patients back, often saying that the acuity or dependency has surpassed the home s ability to cope. This causes bed blocking and creates exit problems from A&E. 2.3 IT system The IT systems requires updating, again highlighted by the Methods report. The system is cumbersome and does not link with the Trust pathology system. This means that staff have to access two systems to keep track of patients blood results. In addition the system does not allow for clear communication between the department and the site / bed management office. This results in endless phone calls passing patient information and bed locations. 2.4 Intra Department Flows GP expected patients arrive in department and its not clear about their onward journey. These patients have been medically accepted, but are not given clear instruction on where to go when they attend the hospital. Therefore even when the patient is expected on AMU they arrive in A&E. Methods also highlighted intra department flows as a significant barrier to achieving the four hour standard. Patients often wait for medical or surgical review and this prolongs their the time they spend in A&E 4

43 2.5 Leadership and morale As mentioned earlier, the physical capacity of the department is often exceeded. This often inhibits new ways of working and causes frustration amongst the A&E staff. For instance, the department tried to implement Early First Assessment (EFA) by senior decision marker (usually consultant). Unfortunately when the department becomes over crowded the EFA area reverts to a treatment area. The frustration at not being able implement new systems and the constant demand is leading to low morale amongst staff. Senior leadership in the department has struggled to remotive staff. 3. Comprehensive Action Plan To try and redress the issues hightailed above and as part of the 3 box system wide plan, the Trust has developed a comprehensive action plan. This plan incorporates all the actions from box two of the system wide plan as well as actions highlighted in the methods report. In addition the plan incorporates Trust identified actions and sets out clear roles and responsibilities. The plan is extensive and will take time to implement. However a number of actions have already been taken. 3.1 Actions undertaken by the Trust: Intensive Executive Director leadership and support in the A&E department, with Increased on-call manager presence on site, both in and out of hours. Introduction of A&E board ward round attended by medical and surgical teams. The Trust & CCG Commissioned Methods Analytics to undertake an in depth analysis of demand and capacity at the hospital to diagnose and understand the root causes affecting performance. A restructure to enhance Senior Leadership within the department, creating a new 8c senior service manager role as well as a 8a nurse manager. Appointment of a new clinical lead and a new nurse consultant to support training and development within the department. A new twilight registrar role has been created to work between A&E; Ambulatory care and AMU. This post pulls patients from A&E into ambulatory care and is part of the reason that activity in this clinic has increased from 150 to 400 per month. Agreement has been reached with the CCG to fund two geriatricians who will provide a presence in A&E five days a week (Monday to Friday). The posts have been advertised and interviews are scheduled to take place in May Meetings have take place with the Director of People to start to develop a package of measures to provide leaders within the department with the skills to drive through change and address morale issues. 5

44 Ambulatory care has been extended on a trial bases to Saturday opening. While good progress has been made there are still significant number of actions that need to be delivered. These actions are continued within the Trusts A&E action plan, which is attached at appendix 2, and summarised below. 3.2 Capacity As previously stated the cubicle capacity and layout of the ED department is a key factor in preventing achievement of the A&E 4 hour standard. Expanding the department is problematic as it is blocked on all sides by a court yard, outpatients x- ray and the UCC and waiting room. There is a long term 7m SaHF solution of expanding into the court yard. However even if this were approved now it would take between years to commission and build. Therefore the action plan provides for an intermediate solution. While this solution does not provide sufficient capacity to meet demand, it does provide more capacity and this will somewhat alleviate the over crowding. It is intended to covert the current temporary paediatric are (previously endoscopy) area into an enhanced CDU. This will provide an extra 4 CDU beds and 4 recliner chairs to treat patients who require longer than four hours to be treated. Additional staff will be required to service the extended CDU and a business case as been submitted to SaHF for 495k capital and 450k ongoing staffing costs Activity Growth In February the Trust and CCG meet with NHS I agreed that activity in the coming year will be in the region of 6%. However the CCG (Box 1) plan should divert attendance and mitigate against this growth. On this bases it was agreed with NHS I that activity growth for the coming year is forecasted at 2.5%. It should be noted that activity in April is running at 10%. If demand continues to grow at this rate it is highly unlikely that the Trust will be able to recover the A&E position, irrespective of the planned expansion of the department. 3.3 Information and Communication Technology (ICT) The current ICT provision is cumbersome and does not lend itself to supporting optimal patient flows. The lack of integration with other systems slows patient flows through the department. The action plan seeks to address this by setting up a sub group to review the current IT system to see if this can be improved. The group will also explore other available IT systems with the objective of ensuring greater integration 3.4 A&E Flows/structure A number of GP expected patients still turn up at A&E rather then going directly to AMU. The action plan seeks to work with GP s to make sure they advise patients to go to AMU and avoid A&E. Further work is also required with London Ambulance Service (LAS) to redirect flows to AMU. 6

45 Having sufficient capacity on AMU and in the Ambulatory Care clinics is vital. A business case is being developed to invest approximately 100k to expand the Ambulatory Care Hot Clinics. The new A&E service manager and Nurse Consultant will be working to implement the recommendations highlighted in the Methods report to reduce duplication and remove redundant steps in the patient pathway. 3.4 Intra department flow It is recognised that A&E can not deliver the four hour standard without considerable support from the rest of the hospital. Over the coming weeks the action plan will be up dated with plans to engage medical and surgical staff and recognise that the four hour standard is a Trust wide target. In the meantime plans have been developed to expand emergency surgery ambulatory care services. To develop dedicated, co-located emergency and ambulatory care facilities for children and young people including improved assessment, treatment and observation facilities. In addition plans are afoot to strengthen operational policies and patient tracking processes so patients spend as little time in A&E as necessary. The Improving Patient Care Steering Board are focusing on improving discharge times, to ensure that more beds are available early in the day and the weekend to support A&E flows. 3.5 Leadership / Morale Constant demand on the service, which is overwhelming capacity means that new ways of working don t get opportunity to work and this demoralises staff. Band sevens are finding it difficult to stay supernumerary and manage the department. A leadership programme being worked up with HR and the new nurse consultant is working up a training programme for the band 7s A detailed communication plan is being developed to provide assurance to staff that actions are being taken to improve the situation in the department. 3.6 Programme Management This is an extensive plan and will need dedicated time to deliver. The number one recommendation from the Methods report was that dedicated resource should be found to support delivery of this plan. Therefore a programme manager has been identified and the Trust is currently in negotiations. The programme manager will track and report progress against the plan. They will develop a more comprehensive action plan that details key milestone and a critical path. 4. Monitoring and Measuring success Through the actions outlined, it is intending that the following objectives will be achieved. 7

46 Only patients requiring acute inpatient care are admitted to hospital overnight; Increase the number of people discharged before midday each day and reduce delays for patients waiting for medications to take home; Increase the proportion of weekend discharges by 30%; Through the workstreams of Transforming Patient Care which include weekend consultants presents 12 hours, board rounds, and discharge planning. Reduce the number of people staying in hospital for more than 14 days; Ensure 85% of ambulance handovers happen within 30 minutes; All the key operational trigger points are being monitored for example triage within 15 minutes of arrival, seen by a doctor within 1 hour and treatment complete 3 hours. Meet the national 4 hour A&E standard. The progress of the action plan is monitored at a fortnightly CCG/THHFT meeting and weekly in the internal meeting chaired by the COO. 5. Board Action The board is asked to note the actions been take as outlined in the A&E action plan. The board is asked to note the progress to date in developing the plan, and to be assured that all necessary steps are being taken to deliver the four hour standard. 8

47 9

48 ACTION NUMBER ACTION SUCCESS CRITERIA CLINICALLY RESPONSIBLE OFFICER (CRO) SENIOR RESPONSIBLE OFFICER (SRO) LEAD ORGANISATION DUE DATE RAG RATING UPDATE A1 See and Treat by LAS to be maximised. Target: Fewer patients conveyed to ED. Mitch G Rashesh M LAS Live G A2 A3 A4 A5 A6 A7 A8 A9 Review of LAS Blue Light Activity Integrated Care Programme Empowered Patients Programme (EPP) Intermediate Care (Home Treatment Service) Intermediate Care (Rapid Response direct access by GPs and Care Homes) Care Homes Support Programme UCC Enhancement Integrated Urgent & Emergency Care System Target: Reduce Blue Lights (and reduce impact of Blue Lights) Target: 288 fewer attendances in 15/16 Target: 1000 fewer attendances in 15/16 Target: 186 fewer attendances in 15/16 Target: 800 fewer attendances in 15/16 Target: 500 fewer attendances in 15/16 Target: See, Treat & Discharge 60% of all Patients presenting. Target: Improve Effectiveness of 111, GP OOH and UCC Services Abbas K Jeff B BHH CCG Live R Kuldhir J Joan V Hillingdon CCG Live A Mitch G Diana G Hillingdon CCG Live G Stephen V-S Jane W Hillingdon CCG Live A Kuldhir J Jane W Hillingdon CCG Live A Kuldhir J Jane W Hillingdon CCG Live A Mitch G Rashesh M Hillingdon CCG Live A Mitch G Rashesh M Hillingdon CCG Mar-17 A A10 Falls & Falls Prevention Service Target: 200 fewer attendances Kuldhir J Jane W Hillingdon CCG Live G 15/16 Contract contains Quality Indicators for LAS to see and treat at a minimum of 34% of its total call volume without the need for onward referral. This is currently achieving 37% non conveyance rate for received calls. An investigation is required into Blue Light conveyances which seem to be increasing but the Methods work suggests that the acuity of patients is not as high as should be expected. Methods to investigate from hospital data and Bernard to initiate LAS investigation into the issue. Programme has started and is being delivered by 4 GP Networks. Reduction in NEL admissions (288 target) is counted from October Estimated 365 reduction in attendance based on current data as proxy with aim of achieving 1,000 in 15/16. Agreement with provider to realign home treatment functions and capacity has been reached. Average of 18 attendances per month avoided year to date( ie 144 upuntil 1st Dec) Average of 46 direct referrals GP to Rapid Response and 16 Care Home to Rapid Response per month year to date. Community Matrons supporting care home staff and Care Home Pharmacist undertaking Medication Reviews + liaison with LBH care home team. The CCG is also funding Rapid Access COTE Clinics and is about to provide additional COTE support to both ED and GPs to help reduce the number of older people arriving at ED (either from Care Homes or elsewhere). Further work is underway to continue to reduce attendances from Care Homes. Additional support in the form of GPs and ENPs along with Health Connectors are being funded via Resilience Funding to support increased capacity. The CCG is working with the UCC to increase capacity including undertaking bloods and therefore divert more activity away from ED. The CCG is seeking to procure a fully integrated UEC System that integrates NHS 111 and a GP Advice Hub in one contract and the UCC and GP OOH Service in a second contract. The CCG is funding a Falls Prevention Service that works with patients who has previously fallen including a Falls Liaison Service. A11 Cumberland (Whole Systems Review) Target: Identification of System Hotspots Mitch G Rashesh M Hillingdon CCG Live A Programme to map current Urgent Care System is about to commence with aim of modelling system and identifying hot spots. A12 Complex Patient Programme Target: to reduce nuumber of frequent attenders Mitch G Helen D/ RashesM THH/UCC/LAS/CCG Q4 15/16 R The CCG, UCC, Las and THH need to establish an MDT team to review this. Page 1 of 19

49 ACTION NUMBER B1 B2 B4 B5 B6 B7 B8 B9 Improve Flow Through ED (Methods 18) Avoiding ED attendances B10 B11 B12 B13 B14 B15 B16 B17 B18 B19 B21 B22 B23 B24 B25 B26 B27 B28 B29 B30 Providing additional capacity for ED Infastructure Ensuring appropriate nursiuung and medical staff to Leadership

50 B31 B32 B33

51 ACTION Review Capacity with Rapid Response Review Interface with RR/A&E Implement Methods Process redesigns Resource, Review, Scope AEC Surgery Resource, Review, Scope AEC Paeds Weekend extention to AEC Medicine Direct CoE conssultant support to A&E CoE/Rapid Response Partnership Short -term Capacity increase ShaHF capacity increase TPC key priorties for down stream Review & re-launch Discharge Lounge function (inc processes) Review the opportunity for a partnership approach Benchmark best practice from peer group Develop exemplar frail elderly care unit Capacity Management - re run bed model Create weekly dashboards with greater detail of A&E breaches, and a weekly task force in place to act on department level issues and tackle breach reasons which are not related to bed capacity Review/Scope IT infastrucutre for flows and information Create Operational daily report bottlenecks Matching staff to need/nice Guidelines Creation of Band 4 role Extended Triage - increase capability Review Roles & Resposibilities Weekly triumvirate meeting to review progress against plan Analysis of key data at weekly review Senior rep at ED handover Recruit Nurse consultant Post Recruit A&E Manager

52 Recruit A&E Matron Post Recruit ED clinical Lead Provide T&D for leadershiproles

53 SUCCESS CRITERIA Less dwell time within the patient journey. Redirection of patients from A&E to SAU. LEAD NR MW MM DR DR DR DR DR JS Reduction in Length of Stay. Enabler /Visibility &Improve staff morale Improve staff morale Improve staff morale JS AK MM JW MM JW MM MM MM MM CS CS AS MK CS/ME MM MM ME/CS/MM CS

54 CS CS CS/ME

55 LEAD ORGANISATION DUE DATE RAG RATING THH Feb-16 A THH Feb-16 A THH Apr-16 A THH May-16 A THH Mar-16 A THH Mar-16 G THH Mar-16 A THH Apr-16 A THH A THH A THH A THH Oct-15 G THH A THH Feb-16 G THH Apr-16 A THH Mar-16 A THH Apr-16 A THH Apr-16 A THH Apr-16 A THH Mar-16 A THH May-16 A THH Mar-16 A THH Mar-16 A THH Mar-16 A THH Jan-16 G THH Feb-16 G THH Dec-16 G THH Feb-16 A

56 THH Dec-16 A THH Oct-16 G THH Mar-16 A

57 UPDATE Through CWG In process Staff workshops and anaylisis have been complete. Business cases and Project plans being currently written Resource implications and benefits need to be defined. Pathways complete, nurse recruitment unsucessful provided adhoc 12 hour consultant cover on weekend in place. Clinics began 13th Feb. Awaiting recruitment Awaiting recruitment - pathways being designed. Capacity plans drawn Discharge Lounge fully implemented CoE post signed off. Recruitment underway Work commenced. A temporary process is in place Matching complete, establisment increase. Recruitement gap currently 7WT Post being developed Training programme developed, roll out in process On track Complete Recruited Started 1st Feb 2016 Out to advert - Interim arrangement to start 7th March

58 Failed to recruit in December, out to advert interviewsmarch. Interim arrang Appointed On track

59 TE

60 gement

61 ACTION NUMBER C1 C2 C3 C4 C5 C6 C7 C8 C9 C10

62 ACTION Home Safe Beds Support Community Beds Integrated Discharge Team Improving Discharge Rates at Weekend and by Midday. Achieve Ambition for Weekend & Midday Discharge Rates Additional Reablement Capacity (Resilience Funded) Care Home Selection (Resilience Funded) Inpatient Flows (Surgery & Medicine) (Resilience Funded) Hospital Discharge Lounge (Resilience Funded)

63 SUCCESS CRITERIA Q1: 5.5 Pts/Day Q2: 6.0 Pts/Day Q3: 6.5Pts/Day Q4: 7.5 Pts/Day Target: Support A&E 4 Hour Performance Target: 5 Community Beds with 80%+ Utilisation Supports Early Discharge Targets Target: Discharges at the weekend are 80% of weekday discharges and 35% of all discharges 7/7 are achieved by Midday. Target: Weekend Discharges are 80% of Weekday Rates and 35% of all Discharges 7/7 occur prior to midday. Supports Early Discharge Targets Supports Early Discharge Targets Supports Early Discharge Targets Supports Early Discharge Targets CLINICALLY RESPONSIBLE OFFICER (CRO) Abbas K Abbas K Cherry A Kuldhir J Abbas K Abbas K Kuldhir J Kuldhir J Abbas K Abbas K

64 SENIOR RESPONSIBLE OFFICER (SRO) LEAD ORGANISATION DUE DATE Melissa M/Gill D Joint THH/CNWL Live Melissa M THH Apr-16 Rashesh M Hillingdon CCG Live Jane W Joint HCGG/THH/CNWL/LBH Live Melissa M THH Live Melissa M THH Live Gary Collier LBH Live Melissa M THH Live Melissa M THH Live Melissa M THH Live

65 RAG RATING G G G G A A G G G G

66 UPDATE This programme is being mainstreamed into 16/17. Funding is be made available for 16/17 to support bed capacity and plans are being worked up by THH for this. The CCG have commissioned 5 community beds throughout and will commission a further 4 step-down through winter. Funding for this will continue into 16/17. CQUIN in place with THH to progress 7 Day performance including in this area. THH have 7 Day Steering Board in place to manage local performance. Performance to be reviewed. Additional Medical Consultant on site 12 hrs/day for Saturday and Sunday. THH manage this programme via their Improving Inpatient Care Programme and via the CQUIN that is associated with this action. Performance update to be provided. 25k of funding has been approved to enhance the reablement team to support patients going home. Funding is being held pending additional information to confirm the benefits of a Care Home Selection Team to support Discharge A total of 165k has been approved to have additional clinical cover in the Surgical Assessment Unit. A total of 86k has been approved to support a Discharge Lounge that provides nursing and hospitality services for patients to cover the Winter

67 A&E Action Plan Category Outcomes Task lead Start End Day/duration % complete Due dates Jan Feb March April May June July Aug Sep Oct Nov Dec Jan Feb March Programme management Agree funding Funding identified MM 01/04/ /04/ % Recruit programme manager Project delivery of Methods Analytics recommendations: MM 01/04/ /11/ Implement agreed portfolio approach for managing improvement opportunities 2. Remove performance constraining practices associated with downstream (UCC/ GP heralded) and interdepartmental flows, eliminate batch working eg discharges, transfers to reduce exit block. 3. Specify and create additional substantive physical capacity. 4. Improve staff morale in the ED by communicating measures being taken to improve performance. 5. Speed flows in the ED to reduce dwell time, reorder tasks, defer tests, procedures and administrative tasks that can safely be delayed until after admission. 6. Standardise escalation and remedial actions for managing ED flows. Major escaltion steps reserved for disruptive situations. 2. Avoid ED attendance and improve interdepartmental flows. Refresh GP heralded pathways Reducing numbers of GP heralded patients in ED CS/JD/PT ongoing 31/03/ % Medicine Surg/gynae Flow chart developed for GPs/ sent to GP CCG lead Medical GP heralded patients bypass ED CS 01/03/ /03/ % Medicine Surg/gynae Refresh and agree patient pathways with UCC/ Divisions Consistency in response CS/PT/DR 01/03/ /06/ % Increase capacity in AEC /AMU Increase AEC numbers per day/ weekends JS/KB/CS 01/10/2015 ongoing % Medicine Scope cote consultant support direct to A&E Increase discharge with RR CS/JV 01/01/ /07/ Resource review for surgical and gynae AEC Identify resource required DR/PT/CS 01/03/ /04/ % Scope need for UCC to request bloods Identify demand and impact on UCC flows CS/WM/J 01/03/ /03/ Lower limb pop UCC capability to request bloods Reduce referrals from UCC to ED MK/MW/CCG 01/03/ /04/ Expedite discharge from ED Review capacity of rapid response Clarity re: daily capacity CS/KR 01/03/ /03/ % Refresh RR interface with ED Increase numbers of patients discharged with RR CS/KR/KW/MK 01/03/ /03/ % CCG to hold review meeting with RR and THH Agree realistic numbers from ED/AMU ME 01/04/ /04/ % RV - Pathology/ xray support services Reduction in reported delays JM/MW ongoing Clinical lead to meet with pathology Identify efficiencies MK 01/04/ /04/2016 RV - transport provision zero breach count due to transport (not tertiary referral) CS/MS 25/02/ /03/ Scope cote consultant support direct to A&E Increase discharge with RR CS/JV 01/01/ /07/ CCG Approval Implement Staffing Benchmark against NICE guidelines Comply with NICE guidelines CS/TLR 01/01/ /01/ Benchmark with similar trust (WMUH) Adopt successful staffing model CS/KW/AS 18/01/ /01/ Scope remit of support staff Adequate skill mix to support demand AS/KW/MK 01/03/ /03/ Gain agreement from DON for HCA transfer from ED Increase capacity for peak periods CS/AM/TM Feb Div Review 100 Agree competencies for support staff Confirm staffing model MK/KW/AS 01/04/ /04/ Scope extended triage Increase capability MK/KF/AS 01/04/ Develop training program for RN triage Increase capability MK/KF 01/11/ /09/ Review coordinator role Reduce duplication of roles/ achieve clarity of role KW/MW/MK 15/03/ /05/ Review resource required to respond to internal triggers ie increase capacity for triage KW/MK/CS 01/03/ /03/ Restructure of department to include 8C operational lead Recruit high calibre, experienced operational lead CS 01/03/ /04/ Recruited Appoint interim Head Nurse/ Matron Provide senior nursing leadership CS/TM 10/03/ /03/ In post 6. Response to demand (ED escalation) Refresh internal ED processes to trigger: Senior ED huddle and response required ie Clinically led response KW/MK 01/03/ Apr Increase triage Reduce time to decision < 2 hours KW/MW 01/03/ /04/2016 Use of UCC cubicles as interim measure on an adhoc basis Identify physical space to permanently increase triage capacity Reduce time to decision < 2 hours KW/MW 01/03/ /03/2016 Space identified Negotiation with UCC Move cas card notes storage off site To release triage capacity MW/AP/SF 01/04/ /07/2016 Heightened response from specialty teams 'pull through' Reduce time to decision < 2 hours ME/VC/MC 01/03/ /03/2016 Medicine Frequency of board rounds Clinically led response MK/KW/MW 01/03/ /03/2016 Triage of LAS arrivals Divert LAS arrivals to UCC, AEC where appropriate MK/MW/WM 01/03/2016 ongoing During peak activity Purchase additional ED trolley Increase cubicle utilisation > 95% at peak demand CS/MW complete 31/03/ Response to demand (Whole hospital) Refresh internal escalation plan Appropriate response MM In progress Explore systems to alert ward staff to escalation in real time Increased discharge before 1200hrs. MM In progress 3, 5 Improving patient flow Review CDU/ Chair capacity (internal reconfiguration post paediatric move) No stable patients waiting in majors for test results ie troponin levels MW/KW/MK Post June 2016 Funding request to SaHf for capital and revenue Creation of new CDU with staff resource JS March 01/04/2016 Increase inpatient discharge before 1200hrs 5 patients discharged before 1200 DDs/ADNs 01/09/2015 ongoing 180 Medicine to trial a discharge coordinator 5 patients discharged before 1200, 5 AMU beds available before 1200 CS/AM 01/09/2015 ongoing 4. Improving morale Weekly meeting to review progress against plan Track progress JS/CS/MM weekly Analysis of key data at weekly review Track progress JS/CS/MM weekly Senior rep at 0730 ED handover Identification of bottlenecks CS/MM/MW daily M-F Meeting with Director of People to discuss Leadership in ED Develop strategy JS/TR/MM/CS Leadership development programme Develop leadership capability TR Band 7 clinical development programme Improved coordination/ performance KF/AS/KW 50% Programme developed Delivery Weekly trumvirate ED meeting with new team Review performance, track actions against plan KW/MW/MK weekly 5. IT enablers Review current systems re: operational efficiency Identify ED requirements MK/CS/MW/CY 50% Source integrated IT solution eg symphony Integration of IT systems, efficient tracking of patient journey/ improved performance MM/JS 0 Increased efficiency in communication re: GP heralded patient/ Implement clinical handover system patient transfer CY/ JB 25% Trial Roll out Staff key Staf member Karen Blackbond Vicky Cook Michele Cruwys Jay Dungeni Initials KB, VC, Divisional Director, Surgery MC, Divisional Director, W&C JD, AD Nursing Surgery

68 Mark Edwards Sinead Fagan Kirsty Farrell Milena Kostic Audrey Malik Melissa Mellett Jon Mitchell Annette Panksztelo Kim Rice Terry Roberts Claire Sheppard Aiden Slowie Joe Smyth Michael White Charles Yeomanson ME, Divisional Director. Medicine SF, ADO CCSS KF, Prcatice Development Nurse, ED MK, Clinical Lead ED AM, AD Nursing for Medicine MM, Director of Operations JM, Business Manager, CCSS AP, ED Administration Manager KR, Managerial Lead, CNWL, Rapid Response TR, Executive Director CS, ADO Medicine. AS, Consultant Nurse for ED JS, Chief Operating Officer MW, Interim ED Manager CY, Director of IT

69 Meeting of the Board of Directors private session SaHF Paediatrics Transition Readiness Assurance Wednesday 27 th April 2015] Agenda item 11 Reason for item: This report forms part of the assurance process for Shaping a Healthier Future (SaHF). North West London Collaboration of Clinical Commissioning Groups (NWLCCCG) requires sites receiving transferring activity to privately discuss operational readiness for paediatrics transition through a meeting of the Trust Board in April Summary: Plans to transfer paediatric services and deliver the necessary associated estates work are well under way. Recruitment is under way and significant progress has been made on increasing the paediatric nursing establishment. Plans to deliver a resident consultant staffing model have been submitted to SaHF and funding requested. Subject to approval of this funding, the Trust can safely transition services from Ealing from 30 th June. The Trust is required to issue official confirmation on its preparedness at the end of April and confirm its intention to proceed with a safe transition at the Public Board. Board Action required: The Board is asked to discuss and comment on the state of the Trust s readiness to receive transferring activity, subject to approval of funding for the resident consultant model. Report from: Liz Weller, SaHF Programme Manager Report sponsor: Joe Smyth, Chief Operating Officer Links to Trust strategic priorities: To develop sufficient sustainable scale to enable us to improve and grow healthcare services for our communities Previous consideration at Board or Committees: May 2015 Private Board Equality and diversity considerations: None Financial implications: There are no direct financial consequences arising from this report. 1

70 Paediatric transition readiness 1. Progress Update 1.1 Estates On 20 th May 2015 Ealing Clinical Commissioning Group (CCG) Governing Body set a date of 30th June 2016 for the closure of the children s inpatient services and A&E at Ealing Hospital. The additional capacity is expected at Hillingdon is 1,800 paediatric A&E attendances and up to 500 inpatients per annum. To accommodate this activity the Trust submitted a business case to extend the A&E department and increase the number of beds on Peter Pan by 4. This business case was approved by the Board in May 2015, and central SaHF funding of 3.2m was subsequently received. Construction of the A&E and extension to Peter Pan is well under way, and scheduled completion dates of June and September respectively. 1.2 Operational Readiness The Trust is working closely with SaHF on refining the medical model. It had been intended that 4 6 registrars would transfer to the Trust to ensure the continued provision of a safe service. However it is widely recognised that there is a national shortage of paediatric registrars and it will not be possible to recruit to these posts. The Trust has therefore put forward a new model of care to provide a 24/7 consultant delivered service. This new model will allow the Trust to expand integrated care partnerships with GP s, and alignment with the SaHF North West London service reconfiguration programme. The proposal will provide sufficient Paediatric consultant cover to facilitate in delivering future ambitions such as permanent and funded Paediatric critical care services (HDU) at THHFT and a level 2 or 3 POSCU service. To implement this service model an increase of 7 WTE consultants is required. A business case has been put to SaHF to fund this model for the next 3 years, after which the service will be financially sustainable. Without approval of this business case the Trust will be unable to safely accept the transition of paediatric services from Ealing Hospital. The Commissioners and the SaHF team understand this and we are working together to reach a speedy resolution over the next few weeks. In addition to ensure a safe transition the Women and Children s division will require an additional 10 whole time equivalent (WTE) paediatric nurses. The division has already successfully recruited to these posts and some of the staff have already started, the remainder will start over the summer. 2. Assurance / Next Steps The Trust is asked to provide a letter of assurance on its operational readiness to proceed with the transfer of paediatric services by the 4th of May The letter needs to provide assurance on Workforce, Estates, Models of Care, Communications and Project Support. A template of this letter is attached at appendix 1. 2

71 The Trust fully anticipates that all Estates work will be complete by the required transfer dates, Models of care have been agreed and there is appropriate project management support in place. A communications strategy is being developed and all nursing staff required have been recruited. At the time of writing final agreement on funding the new medical model had not yet been agreed. Provided funding can be agreed by the end of April, the Women s and Children s Division are confident that they can recruit the consultants required to implement the new medical model. 3. Board Action Recommendation Subject to approval of the funding for the resident consultants, the Trust Board is asked to provide authorisation for the Chief Executive to sign the letter (as attached at appendix 1) providing the appropriate assurances to SaHF. 3

72 4

73 Chief Executive s Office Hillingdon Hospital Pield Heath Road UXBRIDGE Middlesex UB8 3NN <INSERT DATE> Telephone: Fax: Dear Dr Parmar Re: Confirmation of operational readiness from The Hillingdon Hospitals NHS Foundation Trust (THHFT) board ahead of the forthcoming meeting of Ealing CGG Governing Body I am writing to inform the Ealing CCG Governing Body that this organisation is operationally ready and fully supports the proposed transition of paediatric in-patient services from Ealing Hospital on behalf of the Trust Board. At its meeting in December 2015, I note that Ealing CCG Governing Body confirmed that further work needed to be undertaken on operational readiness before the agreed transition date of June 30 th 2016 for the closure of Ealing paediatric in-patient services could be confirmed. Following this meeting, we have continued to work as a Trust with clinical and operational colleagues across North West London to ensure we are ready for any decision your Governing Body may make. We have set out below the work undertaken since your last meeting to support your decision making process and confirm our operational readiness for transition. Actions required to support operational readiness ahead of the next Ealing CCG GB meeting: Domain Progress made since last meeting 1 Paediatric workforce All paediatric workforce recruitment plans are in place and active steps are being taken to recruit to these positions. THH is committed to ensuring that the required workforce will be in place at the point of transition. Orientation and induction of paediatric staff transferring from Ealing Hospital is taking place as planned. 2 Estates Expansion of the Paediatric A&E is due to complete prior to transition. Additional 4 inpatient beds will be ready for occupancy in September Due to seasonal activity levels these beds are not required before October Should uncharacteristically high levels of activity take place over the summer then mitigation plans have been developed which will be enacted; for example 9 current day beds can be turned into inpatient beds to create flexible surge capacity. 3 New paediatric model of care THH is working to implement the new NWL paediatric model of care, and appropriate actions are being taken to establish the PAU and operational pathways. The PAU will go live in June.

74 Domain Progress made since last meeting 4 - Internal staff communications Appropriate internal communications plans are in place and on track to ensure that THH staff at all levels are fully aware of the trust plans for receiving paediatric activity from Ealing Hospital. This includes training and awareness of new pathways as a result of transition for Ealing Borough children who receiving treatment at the Trust. 5 Trust project support Project support requirements to deliver all operational plans have been confirmed and are in place. Based on the progress we have made and as agreed by the Trust Board, I am writing to you in order to confirm that this organisation is ready for the transition of paediatric in-patient activity from Ealing Hospital. We will continue to work with the Shaping a Healthier Future programme and the Paediatric Project Delivery Board to ensure that all preparatory steps are in place for transition to take place as agreed on 30 June 2016 Yours sincerely Shane DeGaris Chief Executive The Hillingdon Hospitals NHS Foundation Trust

75 Meeting of the Board of Directors public session Safer Staffing Planned and actual staffing levels Agenda item 12 Reason for item: Regular monthly report to advise the Board of compliance with planned nurse staffing levels. Summary: The report provides the Board with an overview of the planned and actual staffing levels for March on all substantive inpatient wards. Fill-rates vary against plan in response to fluctuations in activity, patient acuity/dependency levels and when early and late shifts are compressed into long day shifts. The Board should note that: Where fill-rates are below plan during days, gaps that need to be filled are covered by Matrons and other senior nursing staff working clinically. Average night fill rates were at or above 97% against plan for both sites. High patient dependency saw a continued need for additional nights staffing on the THH site. Significant RN vacancies persist on THH site; MVH site at establishment: Role Vacancies Starters Leavers Hillingdon RN/RMs HCAs MVH RN/RMs HCAs The Suboptimal Staffing incident reporting template was revised to include NICE Red Flag Events to improve objectivity. Pilot for this has been completed; review by the Director of Nursing and the DDoN has shown this model is not accurate an dhas not improved objectivity. The DDoN is continuing to find a solution with a new trial due to commence in May. We will not be reporting on either of these indicators until this work is complete. Reporting is by exception where indicators have varied significantly from target and/or increased management action is required to mitigate risk. Board Action required: The Board is asked to: 1. Note the information provided in this report 2. Agree any further actions that are required. Report from: Vanessa Saunders, Interim Deputy Director of Nursing Report sponsor: Theresa Murphy, Director of the Patient Experience & Nursing Links to Trust strategic priorities: To create a patient centred organisation to deliver improvements in patient experience and the quality of care we provide. Previous consideration at Board or Committees: N/A. Equality and diversity considerations: none. Financial implications: There are no direct financial implications arising from this monitoring report; the ongoing drive to recruit substantive staff will have a positive financial impact by reducing reliance on agency staff. 1

76 Planned and Actual staffing levels 1. Information The table and graphs below shows the overall average fill rates for January across both sites, and the monthly trends. Site Day Night Summary Average fill Average fill rate Average fill Average fill rate Data rate RN/RM % Care staff % rate RN/RM % Care Staff % Hillingdon 87.7% 104.7% 104.6% 134.2% Mount Vernon 77.9% 83.4% 97.6% 106.2% 2

77 2. Insights and Actions Area Insights Actions Recruitment High fill rates for care staff Maternity fill rates Despite continuous recruitment vacancies remain across the divisions. A significant number are within Fleming ward. Retention requires increased focus. A number of wards had HCA fill rates significantly above plan. This is associated with high patient dependency. CCU template includes HCA. This only used if appropriate for patient acuity/dependency Average fill-rates continue to calculate at below 90% for day shifts. Regular recruitment events continue, both at trust wide level and speciality-specific. Recent/upcoming events include: - Surgical recruitment day 21/4/16 - Attendance at Bucks New University Recruitment Fair 22/4/16 - Trust Open Day 14/05/16 To ensure effective leadership and continuity of care, a number of staff from Kennedy and Jersey have been moved to Fleming. Plans for further international recruitment are being finalised. To improve both recruitment and retention, the surgical division is implementing an 18 month rotation programme where nurses will work in blocks of 6 months across 3 specific clinical areas. Trial of patient movement sensors is in scoping stage. This may enable reduction in 1:1 care. Scrutiny by the HOM revealed an error in the shift template held on e-roster sytem. This has been corrected; impact will be apparent from June rota. Finance manager and e-roster system manager continuing to review options for creating a flexible shift template. FFT responses Deterioration in patient satisfaction for AMU. Matron working with Head of Public Engagement to increase response rate and to identify themes or trends. Pressure ulcers and falls incidents Kennedy ward Pressure ulcers were all Grade 1 or 2. 2 patients accounted for 4 of the falls. No falls resulted in fractures. The Lead Nurse for Practice Development, working with the ADoN, is undertaking a deep dive into these incidents to identify underlying reasons/emerging themes. This will be presented at the Falls Group. 3

78 Appendix 1 STAFFING LEVELS March 2016 Data - April 2016 Report Environment Fill Rates** Temporary Staffing Reported concerns Nurse Sensitive Outcome Indicators RAG Division Ward Beds Average fill rate: /Midwives % Days RN Average fill rate: Care Staff % Average fill rate: RN /Midwives % Nights Average fill rate: Care Staff % Proportion Bank hours Proportion Agency hours**** Suboptimal staffing Nursing Red Flags***** Hospital Acquired Pressure Ulcers*** Falls with no harm / Falls resulting in harm*** FFT % of patients extremely likely/likely to recommend FFT % of patients extremely unlikely/unlikely to recommend Medicine Surgery Women & Children Ald % 152.9% 98.4% 198.5% 37.27% 1.86% NR NR 1 0/1 100% 0% B'East % 108.6% 100.0% 138.7% 31.48% 0.00% NR NR 1 1/3 100% 0% Bevan % 106.1% 96.8% 138.7% 22.27% 6.09% NR NR 1 0/2 94% 0% CCU % 51.6% 108.5% 51.6% 33.96% 11.01% NR NR 1 0/1 100% 0% Daniels % 84.2% 96.8% 98.1% 4.32% 0.00% NR NR 2/0 100% 0% Dray % 103.0% 130.6% 116.1% 12.71% 10.91% NR NR 2 1/1 95% 3% AMU % 127.3% 100.7% 139.7% 18.85% 14.65% NR NR 1 2/5 86% 5% Grange % 109.2% 131.2% 154.8% 29.34% 26.87% NR NR 1 1/4 100% 0% Hayes % 148.8% 103.2% 197.1% 29.71% 1.05% NR NR 3 2/3 100% 0% Stroke % 87.4% 109.7% 114.5% 3.20% 5.78% NR NR 1 1/2 100% 0% Churchill % 132.4% 99.6% 104.7% 19.85% 5.25% NR NR 2/0 100% 0% Jersey % 105.4% 108.6% 187.0% 30.16% 21.64% NR NR 2/0 97% 0% Kennedy % 109.4% 97.8% 161.3% 32.75% 12.78% NR NR 5 7/3 94% 1% ITU/HDU % % % 14.02% NR NR 100% 0% Trinity % 86.5% 98.4% 122.2% 2.42% 0.00% NR NR 2/0 100% 0% Fleming % 86.7% 108.1% 128.4% 20.15% 38.21% NR NR 2/0 92% 3% Peter Pan % 54.6% 128.2% % 15.32% NR NR 98% 0% NNU % 45.2% 90.0% 51.6% 10.72% 0.00% NR NR 98% 0% Alex % 89.6% 97.6% 97.5% 13.37% 3.32% NR NR 98% 1% Kath % 85.8% 89.6% 100.3% 17.48% 9.83% NR NR 100% 0% Labour % 72.3% 104.7% 100.0% 11.25% 9.85% NR NR 1/0 100% 0% Assurance Key Cause for concern: assertive management interventions in progress Heightened surveillance: some interventions planned/in progress Assured. Usual oversight and support **E-rostering report, workforce report ***Incidents reported via datix **** Proportion of bank and agency nursing information provided by temporary staffing office and workforce information *****Reported occurences of specific events validated by NICE as indicating staffing may be inadequate to meet patient needs NR = not reported 4

79 Meeting of the Board of Directors - public session Wednesday 29 th April 2016 Agenda item Integrated Quality & Performance Report Reason for item: To provide assurance to the Board that the Trust's key quality, operational and experience objectives are being delivered. To direct the Board's attention to significant risks, issues and exceptions ensuring we remain focused on the delivery of our vision "To put compassionate care, safety and quality at the heart of everything we do." Summary: This report provides the Board with an analysis of quality, experience and operational performance to the end of March The report covers performance against the Monitor Risk Assessment Framework as well as national and local key performance indicators. The board is asked to note that due to the earlier production of this report, some indicators have not been updated. Board Action required: The Board is asked to: 1) To agree any actions arising from the contents of this Report Report Authors: Melissa Mellett, Director of Operational Performance Jacqueline Walker, Deputy Director of Nursing and Integrated Governance Obi Maduako-Ezeanyika, Head of Workforce and OD Report Sponsors: Professor Theresa Murphy - Director of Patient Experience and Nursing Dr Abbas Khakoo - Medical Director Joe Smyth, Chief Operating Officer Terry Roberts, Director of People Links to Trust strategic priorities:

80 To create a patient centred organisation to deliver improvements in patient experience and the quality of care we provide. To deliver high quality care in the most efficient way. Previous consideration at Board or Committees: Reviewed monthly as standard Equality and diversity considerations: There is no positive or negative impact from this report. Financial implications: The financial implications of delivering the additional capacity to meet the non-elective demand over and above plan are detailed in the report.

81 Integrated Quality & Performance Report 1. Summary This report reflects on achievements in performance standards for Month 12, March 2016, including the improvements made in delivery against all key standards. The format of the performance dashboard reflects the core principles of the five Domains set out in the Care Quality Commission's Intelligent Monitoring System (i.e. Caring, Well-led, Effective, Safe and Responsive). It should be noted that some indicators have not been update due to the earlier production of this report. 2. Key Highlights 2.1 Safe The Trust has reported a total of 12 cases of Clostridium difficile infection to end of March 2016, against a threshold of eight. There were no new cases reported in March. Detailed root cause analysis investigation has been undertaken and only one case has been deemed by the Trust to be a lapse in care in relation to antimicrobial prescribing practice; this position has been agreed with our commissioners. Confirmation has been received from Monitor that for cases where no lapse in care has been identified, these cases will not count against the Trust as part of the outcomes metric assessment on the Monitor scorecard or our quality governance rating. Therefore the RAG rating on the balance score card has been adjusted accordingly. The new guidance for 2016/17 for C diff published by NHS England will see our threshold remain at eight cases for the forthcoming year (as in 2015/16). It has been agreed with our commissioners that there will be no contractual sanction applied for cases identified as a lapse in care up to a threshold of eight cases. The Safety Thermometer is a snapshot audit carried out one day a month to identify prevalence of specific patient safety incidents. There is a target of 95% harm-free care for new harms (i.e. hospital acquired harms) and all harms (a combination of old and new harms). Our year-end position was 94.7% for all harms and 98.5% for new harms. Continued improvements with rate of falls and pressure ulcers, bot h of which narrowly missed our self-imposed targets but have continued their downward trend for rate per 1000 bed day, helped ensure our good performance. The increased prevalence of patients admitted with pre-existing pressure ulcers impacted on our performance against all harms ; we are working collaboratively with community colleagues to build an integrated approach to pressure ulcer prevention. 2.2 Caring We have been challenged all year with achieving Friends and Family Test response rate targets and despite improvements in the last few months have not managed to do so. The Head of Public Engagement has been working closely with divisional leads to identify how they can ensure patients are consistently given the opportunity to complete the survey. Maternity achieved their target in March, and Inpatients were much improved. Greater focus is still required in A&E will shortly be trialling electronic data capture as an alternative to paper-based systems.

82 In February we contracted a new provider for collating and analysing our FFT responses. We are confident this will improve both response rates and the quality and scope of intelligence we derive from the returns due to: Feedback available at departmental level, for all staff User-friendly system, with capability to drill-down across a range of themes, age-ranges and demographic groups Ability to create visually stimulating poster reports to aid patient interest and engagement Multiple options for obtaining responses such as texting and online The percentage of complaints responded to within agreed timeframe improved again in March, with 88.2% answered by date agreed with complainant. Our yearend position was below where we aspired to be, at 70.7%. Significantly low performance in June and July had a lasting impact on our position for the year such that despite recovery in subsequent months we were unable to achieve our 90% target. Actions have been put in place to strengthen the service including up-skilling of individual team members and increased partnership working with the PALS service, monitoring of activity to identify surges in activity at an early stage and increased ownership of complaint resolution within divisions. Responsive March saw good performance against all the key operational metrics, with the exception of the 4 hour standard, and allowed the Trust to finish 2015/16 in a strong position. Of particular note was: Continued compliance with the key 18 week elective standards meaning that the Trust maintained reasonable elective activity throughout a difficult winter period not least with regard to bed occupancy and availability. Successful delivery of the 2-week Cancer Standards and confirmation of compliance with the 31day screening requirements for February. The 62 day requirement was narrowly missed for February. At the time of writing, the Trust expects to be compliant with the 31-day and 62-day Standards for March thereby also achieving compliance for Quarter 4 overall although this remains a provisional assessment and carries with it some risk. Performance against the 4 hour standard has remained a challenge. During March, the Trust showed an in-month performance of 85.3%, with a year- end position of 92%. On average there were 172 type 1 attendances per day, (an additional 619 patients when compared to March last year). Blue light activity remains high (43% greater than last year) stretching resource within the department, impacting on patient throughput. A separate paper details the actions encompassed in the comprehensive action plan. 2.4 Well-Led The Trust sickness rate increased in March 2016 to 3.57%, following 3 consecutive months where the rate reduced. The Trust completed the financial year with a YTD sickness rate of 3.53% - although this rate is higher than the Trust target of 3%, it

83 was less than the 15/16 YTD figure of 3.59%. In addition our estimated cost of sickness (excluding the cost of temporary staff) for 15/16 was 2,843,315, which was less than the cost for 14/15 ( 2,853,736). In March 2016, our vacancy rate was 8.64% against a target of 8.00%. The trust is in the process of selecting a provider for overseas nurse recruitment and will embark on this process shortly. Since the introduction of agency price caps in November 2015, the trust usage of staff above the agency price cap has seen month on month fluctuations. March 2016 saw a significant increase in above price cap usage for all professional groups aside from admin and estates workforce which has seen a reduction since January This rise in usage was due to increases in clinical activity and where patient safety considerations justified breaches. Divisions continue to review their workforce needs to ensure that services can be delivered in a different way and to reduce the trust s agency spend. In terms of recruitment, to substantive positions, time to hire in March 2016 was 65 days (against 96 days for March 2015). Whilst this is a significant improvement we still need to increase our efforts in this area to hit the target of 55 days. March 2016 also saw a continuing trend in a reduction in total bank and agency spend compared to same period in March Overall there was a significant reduction of 488,902 for the same comparative period. This is during a period of continuing high activity. The percentage filled by agency staff saw a 6.01% drop in March 2016 compared to March 2015 with a 2.97% increase in bank staff usage over the same periods. The use of off framework agency workers was 0.52% in March 2016 down from a high of 21.76% in March There still remain pockets of use by off framework but these are now minimal. Equally, the tenure of staff leaving the trust continues to fluctuate however March 2016 recorded the highest median years of the last two years at 4.91 years. This is 1.08 median years more compared to March Since 2016, trust overall establishment has grown by 10% compare d with our total establishments in When looking at staff in post data by professional groups, the establishments of our registered nurse and midwifery workforce have increased by 11% and medical and dental by 5% compared to establishments in Non-medical appraisal compliance was 94% however a new PDR window opened on 01 April 2016 and close on 30 th June 2016.This high compliance rate was also reflected in our 2015 staff survey findings. Medical Appraisal compliance reached 72.3% and was below trust 90% target. There is ongoing work to improve compliance. Trust overall compliance with Core Skills Training (STAM) in March 2016 has remained stable at 89%, exceeding the trust 80% target. This improved performance is reflected in our 2015 staff survey report. STAM subjects with low compliance rates are being managed through individual subject action plans. Finally, the number of employee relations cases progressing to a formal stage compared to the last financial year (YTD), was 55 versus 41 - a 25% increase in activity. Increases in staff raising complaints (grievance and harassment) may be

84 attributed to initiatives such as the Dignity at Work poster campaign, which clarified the routes available to staff to resolve and deal with concerns. These initiatives are having some impact on staff engagement scores as the trust reported positive findings in the 2015 staff survey report on issues relating to bullying, harassment and abuse.

85 Trust Overview March-2016 Domain Ref Theme Management Priority Last Month This Month Forecast Status [1] Safe [2] Effective [3] Caring [4] Responsive HCAI Minor On Track Improving Stroke & TIA Minor Minor Stable FNOF Minor Minor Stable Maternity Minor Minor Improving Falls Moderate Moderate At Risk Medication Minor Minor At Risk VTE Moderate Moderate At Risk Pressure Ulcers Minor Minor At Risk Safety Thermometer On Track On Track At Risk Serious Incidents On Track On Track Stable Never Events Moderate Moderate Stable Patient Safety On Track On Track Improving Mortality On Track On Track Improving Readmissions On Track On Track Improving DNAs Moderate Moderate Improving ASIs Significant Significant Improving FFT (Admitted Care) On Track Moderate At Risk FFT (A&E Care) Minor Moderate At Risk FFT (Maternity Care) Minor Minor Stable Complaints Excellent Minor At Risk PALS Moderate Minor Stable Accident & Emergency Significant Significant At Risk RTT On Track On Track Improving Cancer Excellent Excellent Improving Mixed Sex Accommodation Excellent Excellent Improving [5] Well Led PDR, Medical Appraisal & STAM Sickness On Track Minor On Track Minor Improving Stable 5.3 LTR, Vacancy, LoS &TtR Minor Minor Stable Employee Relations Establishment On Track On Track On Track On Track Stable Stable

86 Key To Scorecard Assessments March-2016 Management Priority Significant Moderate Minor On Track Excellent Significant interventions are planned or in progress due to one or more factors: an externally-reported metric is off-track; multiple internal metrics are off-track; qualitative experiences are raising significant concerns Moderate interventions are planned or in progress due to one or more factors: an important internal metric is off-track; qualitative experiences are raising concerns; future projections are off-track Some interventions are planned or in progress: stretch targets are off-track; trends are adverse; qualitative experiences suggest performance may be at risk All areas within this theme on track Amongst top performers nationally, with internal stretch targets consistently met Forecast Status At Risk Stable Improving Expected to Worsen by next reporting period Not expected to change significantly by next reporting period Expected to improve by next reporting period Indicator Status Achieving standard Just missing standard Significantly missing standard No Target Set

87 [1] SAFE Domain Scorecard March-2016 Theme Ref Indicator Target RAG Jan-2016 Feb-2016 Mar-2016 YTD 1.01 HCAI 1.02 Stroke & TIA MRSA Cases (Trust Attributable) C.Diff Cases (Trust Attributable) n/a C.Diff Cases (Lapses in Care) MSSA Cases (Trust Attributable) n/a E.Coli Cases (Trust Attributable) n/a % of Time On The Stroke Unit 80% 100.0% 100.0% 100.0% 99.1% High Risk TIA Treated W/I 24 Hours 100% 100.0% n/a 100.0% 100.0% 1.03 FNOF FNOF Patients In Theatre W/I 36 Hours 90% 92.3% 94.4% n/a 90.0% 1.04 Maternity 1.05 Falls Booking 95% 94.2% 96.4% 96.4% 96.1% C-Section Rates (Combined) 27% 27.7% 28.5% 32.2% 28.8% C-Section Rates (Elective) n/a 9.4% 12.0% 10.8% 10.2% C-Section Rates (Emergency) n/a 18.3% 16.5% 21.4% 18.6% Tears 5% 2.2% 2.3% 1.8% 2.4% Rate of Patient Falls (All) Rate of Patient Falls (with Harm) n/a Patient Falls With Fracture <= Medication Incidents as a % of Total Incidents >11% 9.3% 9.7% 9.1% 9.0% 1.07 VTE VTE Compliance 95% 93.4% 93.5% 90.5% 94.5% 1.08 Pressure Ulcers 1.09 Safety Thermometer Pressure Ulcers (Grade 2, 3 & 4) n/a 23,0,0 18,0,0 20,0,0 141,2, Pressure Ulcers per 1,000 Beddays Harm Free Care (All Harms) 95% 94.8% 95.4% 96.9% 94.7% Harm Free Care (New Harms) 95% 99.1% 98.4% 99.2% 98.5% 1.10 Serious Incidents Serious Incidents n/a Never Events Never Events Patient Safety Incidents n/a Reporting Rate per 1,000 Beddays > Incidents Resulting In Harm n/a Percentage Resulting in Harm <6% 3.5% 2.8% 2.8% 2.4%

88 [1] SAFE Domain Scorecard March-2016 Theme Ref Indicator Target RAG Jan-2016 Feb-2016 Mar-2016 YTD 1.13 Mortality Crude Mortality Rate n/a 1.1% 1.5% 1.3% 1.2% Number of Deaths n/a Theme Ref Indicator Target RAG Oct-2015 Nov-2015 Dec-2015 YTD 1.13 Mortality Aggregate HSMR Weekday HSMR Weekend HSMR Limits Limits Limits < n/a ( ) ( ) ( ) ( ) < n/a ( ) ( ) ( ) ( ) < n/a ( ) ( ) ( ) ( )

89 [1.01] SAFE HCAIs March MRSA cases (Annual Target 0 Cases) Where we want to be: targets and benchmarks We want to be able to sustain our zero case objective for 2015/16 Chart : CDiff Cases (Trust Attributable) By Month 2015/ /2015 Where we are: trends and patterns - The trust reported one case of MRSA for 2013/14 and one for 2014/15. The trust had an MRSA reporting rate of 0.7 per 100,000 bed-days for 2014/15 compared to a London average rate of 1.8 per 100,000 bed-days and a national average rate of 1.1 per 100,000 bed-days. No cases of MRSA BSI have been reported in March (previous MRSA contaminant reported in January). Risks or opportunities for the Trust - The trust's aim is to achieve the annual objective for MRSA of zero. There is an inherent risk of the trust breaching this objective with regard to seeing a complex patient case mix with much increased acuity and patients having attended both primary and secondary care providers for linked episodes of care CDiff Cases (Annual Target 8 Cases) Where we want to be: targets and benchmarks - Aim to ensure that C diff infections do not exceed our objective for 2015/16 of eight cases. Where we are: trends and patterns The trust reporting rate for CDiff per 100,000 bed-days for 2014/15 was 12.3, compared to the London average of 14.4 and a national rate of 17.3 per 100,000 bed-days. We have had twelve cases of CDiff YTD 2015/16. There were no new cases in March. 11 cases have been deemed by the Trust as there being no lapse in care (acting in the patients best interest); all of these have been confirmed as such by the CCG. One case YTD was deemed a lapse in care due to antimicrobial prescribing. Confirmation has been received from Monitor that for cases where no lapse in care has been identified, these cases will not count against the Trust as part of the outcomes metric assessment on the Monitor scorecard or our quality governance rating. Risks or opportunities for the Trust - There is a governance and financial risk with regard to breaching our CDiff objective. Learning from RCA investigation is in place - this is fully described on the corporate risk register. Additional preventative measures are being implemented with regard to antimicrobial prescribing and stewardship Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Chart : CDiff Cases (Lapses of Care) Cumulative 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Chart : MRSA Cases (Trust Attributable) 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

90 [1.01] SAFE HCAIs March-2016 Chart 1.0.3: MSSA Cases (Trust Attributable) Chart : E.Coli Cases (Trust Attributable) 2015/ / / / Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

91 [1.02 & 1.03] SAFE Stroke, TIA & FNOF March-2016 ( & ) Stroke Fully meeting our Stroke and TIA target. (1.03.1) FNOF February : 94.4% (18 patients, 1 breach) YTD: 90% (161 patients, 16 breaches) In February 2016, the FNOF 90% target was met. Of the 18 patients, 17 were taken to theatre within 36 hours. The YTD performance is 90% which meets the target % 80.0% 60.0% 40.0% 20.0% 0.0% 90% of Time On Stroke Unit 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% High Risk TIA Treated w/i 24 Hours 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% FNOF Patients in Theatre w/i 36 Hours 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

92 [1.04] SAFE Maternity March-2016 (1.04.2) C-Section performance - Target: 27% - Performance 32.1% Although the target set for combined LSCS is 27%, from the 1st March it will increase to 29% (16% emergency/13% elective) as part of the London wide target based on demographic and complexity of the population. March showed a significant increase in emergency caesarean section rates at 21.4% against a current target of 16%.The year end final average for emergencies was 18.4%. A recent audit of emergency caesarean sections showed that appropriate planning and management had occurred, however we will be looking at other Trusts in the sector with lower rates to see if there is any learning to be shared and implemented. Elective caesareans remain on target with a YTD average of 10.1% set against a target of 11%. (1.04.1) Booking Target 95% - Performance 96.4% The service continues to achieve the target of 95% with a year-end average of 96.2%. We have seen a significant increase in women using the self-referral tool which was 53% for March. The challenge continues to be late bookers where we are working with the CCG and Public Health to explore options for improvement. (1.04.3) Tears Target 5% - Performance 2.5% We continue to remain within the recommended level of tears. However all 3rd and 4th tears are datixed and reviewed to ensure no clinical practice concerns are identified % 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% % 80.00% 60.00% 40.00% 20.00% 0.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% Chart 1.4.2: C-Section Rates (Combined) 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Chart 1.4.1: Booking 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Chart 1.4.3: Tears 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

93 [1.05] SAFE Falls March Inpatient falls Rate of Patient Falls (With Harm) Where we want to be: targets and benchmarks: We wanted to achieve a 20% reduction in falls in 2014/15. The target was missed, with the overall rate for the year being 4.38 per 1,000 bed-days against a target of 3.8. For 2015/16 we aim to reduce inpatients falls by 10% based on final performance for 2014/15. Where we are: trends and patterns: In 2012/13 our falls rate was 5.8, in 2013/14 it was 5.0 against a NPSA average of 5.4. We have therefore seen a reduction in inpatient falls year-on-year. We have not achieved this year's target, with overall rate of falls being very slightly improved from last year at 4.3 per 1000 bed days. The falls rate for March 4.3 per 1000 bed days, which is lower than the previous 2 months and also lawer than March The rate of falls with harm increased in March, with 2 fractures reported, bringing the year-end total to 10 against a target of no more than 10. Risks or opportunities for the Trust: There is a risk that of limited scope for further reduction in falls over coming years having seen a a levelling off ouf our previous downward trend, and given that performance is better than national benchmarks. We do however remain committed to ensuring we minimise this risk to patient safety through the programme of work being taken forward via the Trust-wide Falls Group under the Sign up to Safety campaign / /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Rate of Patient Falls (All) 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Patient Falls With Fracture 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

94 [1.06, 1.07 & 1.08] SAFE Medication, VTE & Pressure Ulcers March Medication Incidents Where we want to be: targets and benchmarks: We want to increase incident reporting of no/low harm incidents for medication errors. This will support us to learn from near misses / low harm incidents to prevent more harmful incidents. Where we are: trends and patterns: Our reporting rate of medication errors has not been in line with the national average for acute (non-specialist) organisations - 9.1% (Mar) against a national average of 11%, however we are seeing an improving picture in reporting during this year compared to previous years - now 9%. Risks or opportunities for the Trust: The trust is involved in a pilot programme with the ICHP Patient Safety Collaborative to improve pharmacists provision of feedback to doctors on prescribing errors. A new Medication Safety Officer is now working at the Trust and is takign a programme of work forward VTE - Target 95% Compliance was below the 95 % target for February at 93.5% and at 90.5% for March, however March data is still going through the process of validation. The Trust reached the target for venous thromboembolism (VTE) risk assessment compliance until Quarter 2 since when it has been within 1% of the target with regard to YTD position. There continue to be a small number of poorly performing areas identified (please note figures for February will improve post validation). These areas are where patients often stay for a very short inpatient admission. This adversely affects performance but does not necessarily impact on patient safety. There is now improved staff education including junior doctors during their induction and nursing staff during education on documentation and drug administration requirements. There is imminent implementation of the addition of VTE risk assessment compliance as part of the WHO sign-out in operating theatres. In addtion, there is involvement of ward pharmacists as part of the multidisciplinary team to draw attention to any omissions on drug charts and modification of the drug chart to aid in ease of VTE risk assessment has been approved. Measures to mitigate risk to patients: Information leaflets are to be distributed to every admitted patient regarding the risk of VTE during their hospital stay and subsequently Pressure Ulcers: (15% reduction by year end) Where we want to be: targets and benchmarks: We aimed to achieve a 15% reduction of all pressure ulcers during 2015/16. This is in line with our Sign up to Safety campaign to reduce patient harms by 50% over three years. Where we are: trends and patterns: The hospital acquired pressure ulcer rate during 2013/14 was 1.34 per 1,000 bed-days and in 2014/15 this was 1.20 against a target of For March the rate was within target at 0.9 with a YTD rate of 1.1, narrowly missing this year's target; howeve rthis is a slight reduction on the rate for 2014/15. There were no grade 3 or grade 4 pressure ulcers reported in March. Risks or opportunities for the trust: This is a priority area of focus for the Sign up to Safety work and there are Medication Related Incidents as a Percentage of Total Incidents 2015/ /2015 Target 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar VTE Compliance 2015/ /2015 Target 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Pressure Ulcers per 1,000 Beddays 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

95 [1.09, 1.10 & 1.11] SAFE ST, SIs and Never Events March Where we want to be: The target for the Safety Thermometer is 95% harm free care. This includes all harms; old and new (hospital acquired) in 2014/ % of patients surveyed received harm free care. Where we are: Performance for March was 96.9% (all harms). Where harm free care is measured taking just new hospital acquired harm, the harm free rate was 99.2% - above target. Risks or Opportunities: hospital acquired pressure ulcers and falls are included in the Sign up to Safety Campaign, this will ensure that there is focused attention on reducing these harms by 50% over 3 years. This will have an impact on the rate of harm free care recorded on the Safety Thermometer. The high number of community acquired pressure ulcers will impact negatively on our overall harm performance; the TVN is working with community colleagues to support improvements in this aspect of out of hospital care Serious Incidents: There were no new Non-Executive/Executive-led panel serious incidents declared in March Never Events - There was a further never event reported in March - this was a further misplaced naogastric tube. This case is currently under investigation following the SI process. The never event reported in February will be presented to the April Board. Safety Thermometer Harm Free Care (All Harms) 2015/ /2015 Target Safety Thermometer Harm Free Care (New Harms) 2015/ /2015 Target 100.0% 100.0% 80.0% 80.0% 60.0% 60.0% 40.0% 40.0% 20.0% 20.0% 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Serious Incidents Never Events 2015/ /2015 Target 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

96 [1.12] SAFE Patient Safety March Patient Safety Incidents Where we want to be: targets and benchmarks: We aim to be in the top 25% of high reporting trusts. Comparative data from the National Reporting and Learning Service shows that the trust increased its reporting rate from 8.33 per 100 admissions (1 April Sept 2013) to 9.00 per 100 admissions (1 Oct 2013 and 31 March 2014). This was compared to a median reporting rate for the cluster of medium acute organisations of 7.82 incidents per 100 admissions. Where we are: trends and patterns: For March we have achieved targets for rate of incidents and percentage resulting in harm in line with and better than the national averages. The number of patient safety incidents that resulted in severe harm or death has remained within target and remains lower than the previous year (YTD position). Risks or opportunities for the Trust: The Trust will continue to raise awareness of the importance of incident reporting and in particular near misses and no/low harm incidents (this will ensure learning to avoid the more harmful incidents from occurring). NB - note that the Volume of Incidents / Incidents Resulting in Harm are presented as contextual indicators only to support the 'Reporting Rate' and 'Percentage Resulting in Harm' Indicators and as such will not have targets by themselves. Patient Safety Incidents 2015/ /2015 Target Reporting Rate per 1,000 Beddays 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0.0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

97 [1.12] SAFE Patient Safety March-2016 Incidents Resulting In Harm 2015/ /2015 Target Percentage Resulting In Harm 2015/ /2015 Target % % % 4.0% % 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

98 [1.13] SAFE Mortality (HSMR) March Mortality: Hospital Standardised Mortality Ratio (HSMR) as provided by Dr Foster provides an in-hospital mortality measure on a monthly basis with a delay of 4 months. The latest available HSMR to Dec 2015 is 79.6 compared to previous years 97.3 (13/14), 96.6 (12/13) and (11/12). There is a current weekday to weekend variation of 80.7 (14/ ) v 73.6 (14/ ) with regard to latest figures provided. These results are all within the expected range. Mortality Review Process There is a trust-wide Mortality Review Process (MRP) which reviews every in-hospital death by day of week admitted, looking for any issues of care which could have contributed to the patient s death. Using the latest NHS England guidance on avoidable mortality a Mortality Review Surveillance Group is to convene in May 2016 and one of its tasks is to write a Trust Mortality Review Process Policy to clarify and document the roles and responsibilities, governance arrangements and reporting requirements of the process HSMR (Basket of 56) 2015/2016 Benchmark 2015/2016 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Weekday HSMR (Basket of 56) 2015/2016 Benchmark 2015/2016 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar Weekend HSMR (Basket of 56) 2015/2016 Benchmark 2015/ Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

99 [1.13] SAFE Mortality (Crude) March-2016 Crude Mortality Rate 2015/ /2015 Number of Deaths 2015/ / % % % % Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

100 [2] Effective Domain Scorecard March-2016 Theme Ref Indicator Target RAG Jan-2016 Feb-2016 Mar-2016 YTD 2.1 Readmissions Day Readmission Rates 8% 7.6% 7.3% 7.3% 7.8% 2.2 DNAs 2.3 Appointment Slot Issues DNA Rates 9% 9.5% 9.0% 9.2% 9.2% Appointment Slot Issue (ASI) Rate 7% 14.2% 21.4% 0.0% 17.5%

101 [2.1, 2.2 & 2.3] Effective Readmissions, ASIs, DNAs March (2.1) Readmissions Target 8% - March Performance 7.% Several streams of work are active within the Trust and, via a joint CQUIN, we are working collaboratively with Primary Care and Community Services although we do not expect to see measurable outcomes until towards the end of the year. 2) (2.2) Did Not Attend (DNA) Target 9% March Performance - 9.2% The DNA rate for M12 was 9.2% - Most service are on the appointment reminder service. Negotiations with Netcall is still ongoing for adding Maternity clinics to the reminder service. 3) (2.3) Available Slot Issues (ASI) for Choose and Book - Target 7.5% - January Performance 21.4% The ASI for Feb 2016 was 21.4% or 951 Appointments that could not be booked. There is a slight increase in the number of referrals received for Q4 from last year. the main driver in the increase of ASIs is attributed the clinics being moved (made unavailable) for Drs' Strikes. 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 30 Day PBR Readmission Rates 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar DNA Rates 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 20.0% Appointment Slot Issue (ASI) Rate 2015/ /2015 Target 15.0% 10.0% 5.0% 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

102 [3] Caring Domain Scorecard March-2016 Theme Ref Indicator Target RAG Jan-2016 Feb-2016 Mar-2016 YTD Inpatient FFT: Response rate 30% 17.8% 24.3% 26.0% 21.0% 4.1 FFT (Admitted Care) Inpatient FFT: % Recommended n/a 95.8% 94.6% 96.7% 95.3% Inpatient FFT: % Not Recommended n/a 0.8% 1.2% 1.2% 1.2% 4.2 FFT (A&E Care) A&E FFT: Response rate 20% 8.7% 7.6% 6.7% 9.6% A&E FFT: % Recommended n/a 95.3% 91.5% 97.3% 93.4% A&E FFT: % Not Recommended n/a 1.8% 4.0% 1.9% 2.8% Maternity FFT: Response rate 20% 17.7% 36.0% 32.3% 16.4% 4.3 FFT (Maternity Care) Maternity FFT: % Recommended n/a 93.8% 89.9% 95.7% 92.1% Maternity FFT: % Not Recommended n/a 0.8% 1.4% 1.4% 1.4% 4.4 Complaints Complaints: Received n/a Complaints: Due for Response n/a Complaints: Trust Total 90% 80.0% 84.6% 88.2% 70.7% Complaints: CCSS 90% 100.0% 0.0% 100.0% 76.8% Complaints: Medicine 90% 62.5% 91.7% 90.0% 72.5% Complaints: Surgery 90% 100.0% 80.0% 70.0% 62.1% Complaints: W&C 90% 100.0% 100.0% 100.0% 79.2% 4.5 PALS Number of Negative PALS Concerns n/a

103 [3.1] CARING FFT Admitted Care March-2016 Where we want to be: The target response rate is 30%, this is based on the CQUIN for 2014/15 and should be seen as a minimum target, there are no targets set currently for the % of patients giving positive and negative responses. Where we are: The proportion of patients recommending has increase by 2.1% to 96.7% and those unlikely to recommend has remained static at 1.2%. The response rate has increased to 26.0 in March Risks and Opportunities: Response rates have improved over the last month on 13 wards. ADOs and ward managers continue to receive a mid month report on number of surveys so that remedial action can be taken if response rates are too low. Inpatient Friends & Family Test: Response Rate 2015/ /2015 Target Inpatient Friends & Family Test: % Recommended 2015/ / % 100.0% 80.0% 90.0% 60.0% 80.0% 40.0% 70.0% 20.0% 60.0% 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Inpatient Friends & Family Test: % Not Recommended 2015/ / % 8.0% 6.0% 4.0% 2.0% 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

104 [3.2] CARING FFT A&E Care March-2016 Where we want to be: The target response rate is 20%, this is based on the CQUIN for 2014/15 and should be seen as a minimum target, there are no targets set currently for the % of patients giving positive and negative responses. Where we are: The proportion of patients recommending has increased by 5.8% to 97.3% and there has been a decrease in patients unlikely to recommend, 1.9% compared to 4.0% in February The response rate continues to be significantly below the target of 20% at 6.7%. The percentage of responses for Minor Injuries remains the same as in February (9%) while the percentage of responses for A&E reduced to 5.1%. Risks and Opportunities: A&E are trialling the introduction of an electronic tablet positioned on a trolley which staff can wheel into a patient's cubicle prior to discharge. A&E Friends & Family Test: Response Rate A&E Friends & Family Test: % Recommended 2015/ /2015 Target 2015/ / % 100.0% 80.0% 90.0% 60.0% 80.0% 40.0% 70.0% 20.0% 60.0% 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar A&E Friends & Family Test: % Not Recommended 2015/ / % 8.0% 6.0% 4.0% 2.0% 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

105 [3.3] CARING FFT Maternity Care March-2016 Where do we want to be: The minimum response rate target for 2014/15 for all four maternity FFT surveys combined is 20%, there are no targets set currently for the % of patients giving positive and negative responses. Where we are: In March Maternity exceeded the target with a response rate of 32.3%. The proportion of women recommending the service has increased by 5.8% to to 95.7%; the percentage of women unlikely to recommend has remained static at 1.4%. Risks and Opportunities: Matron is working closely with the Labour Ward manager to increase the number of responses from ladies who have just delivered a baby in the unit. The Head of Midwifery and Matron receive a mid month report on number of surveys so that remedial action can be taken if response rates are too low. Maternity Friends & Family Test: Response Rate 2015/ /2015 Target Maternity Friends & Family Test: % Recommended 2015/ / % 100.0% 80.0% 90.0% 60.0% 80.0% 40.0% 70.0% 20.0% 60.0% 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Maternity Friends & Family Test: % Not Recommended 2015/ / % 8.0% 6.0% 4.0% 2.0% 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

106 [3.4 & 3.5] CARING Complaints & PALS March-2016 Target: Complaints performance is measured by the percentage of complaints answered within the timescale that has been agreed with the complainant, the target is set at 90%. Where we are: The number of complaints due for responses in March was 34 compared to 26 in February. Reply performance improved by 3.6% to 88.2% within agreed timeframe; we failed to respond to 4 complainants within agreed time. These breeches were spread across Medicine (1) and Surgery(3). The number of complaints received decreased by 16 in March. The PALS team continue to receive more than 90 negative concerns. Risks and Opportunities: As predicted the Trust did not achieve its year-end target, due mainly to very poor performance earlier in Complaints Performance 2015/ /2015 Target Number of Complaints Received 2015/ / % % % 40.0% 20.0% % Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Number of Complaints due for Response Number of Negative PALS Concerns 2015/ / / / Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

107 [4] RESPONSIVE Domain Scorecard March-2016 Theme Ref Indicator Target RAG Jan-2016 Feb-2016 Mar-2016 YTD 4.1 Accident & Emergency 4.2 RTT 4.3 Cancer Performance Against 4Hr Target (All) 95% 88.1% 85.0% 85.3% 92.0% Performance Against 4Hr Target (Type 1) 95% 69.6% 61.2% 61.1% 79.2% LAS Handover Times (30 Mins) 100% 78.3% 75.5% 77.6% 86.0% Black Breaches RTT - Admitted Perf. (Unadjusted) 90% 81.2% 78.4% 77.8% 84.1% RTT - Non Admitted Perf. 95% 97.7% 97.9% 97.7% 98.1% RTT - Incomplete Pathways Perf. 92% 94.8% 94.7% 93.8% 96.1% RTT - 52 Week Waiters Cancer Perf.- 2WW (All) 93% 96.5% 97.0% n/a 97.2% Cancer Perf. - 2WW (Breast) 93% 94.9% 98.8% n/a 96.3% Cancer Perf Day (First Treat) 96% 98.5% 96.8% n/a 99.2% Cancer Perf Day (Subsequent Surg.) 94% 100.0% 100.0% n/a 100.0% Cancer Perf Day (Subsequent Drug.) 98% 100.0% 100.0% n/a 100.0% Cancer Perf Day (GP) 85% 90.7% 84.7% n/a 91.7% Cancer Perf Day (Screening) 90% 100.0% 100.0% n/a 98.4% Cancer Perf Day (Upgrade) n/a 98.4% 94.0% n/a 97.6% 4.4 MSA Mixed Sex Accommodation Breaches Cancelled Operations 4.6 Theatres Cancellation Rate 0.5% 0.2% 0.6% 0.7% 0.5% Day Readmission Urgent Cancellation More than Once Utilisation 83% 61.5% 71.3% 69.7% 68.2% Productivity 97% 112.6% 99.8% 101.2% 100.7% Avg Cases Per Session Cancellation Rate 3.6% 3.7% 3.7% 3.8% 3.5%

108 [4.1] RESPONSIVE A&E March A&E Performance During March, the Trust showed an in-month performance of 85.3%, with a year- end position of 92%. On average there were 172 type 1 attendances per day, (an additional 619 patients when compared to last years figures) March showed a spike in attendances in the 65 + and 80+ age groups. This was reflected in the numbers of emergency admissions for complex care of the elderly which has resulted in occupancy of all escalation capacity and a reduced patient flow from the emergency department (ED). Blue light activity remains high (43% greater than last year) stretching resource within the department, impacting on patient throughput. The ongoing high demand has necessitated further expansion to ambulatory care and increased staffing resource for the ED. A&E Performance Against 4Hr Target (All Types) 2015/ /2015 Target A&E Performance Against 4Hr Target (Type 1) 2015/ /2015 Target 100.0% 100.0% 90.0% 90.0% 80.0% 80.0% 70.0% 70.0% 60.0% 60.0% 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

109 [4.2] RESPONSIVE RTT March RTT Performance Admitted Target 90% - Achieved 77.8% Non Admitted Target 95% - Achieved 98.7% Incomplete Target 92% - Achieved 93.8% Overall performance remains good. The trend in the RTT admitted performance is decreasing due to stopping additional waiting list activity and some recent validation. The Trust Elective Patient Management meeting is monitoring this closely to ensure patient safety and ensure we do not breach the incomplete target RTT Admitted Performance (Unadjusted) 2015/ /2015 Target RTT Non Admitted Performance 2015/ /2015 Target 100.0% 100.0% 90.0% 90.0% 80.0% 80.0% 70.0% 70.0% 60.0% 60.0% 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar RTT Incomplete Pathways Performance 2015/ /2015 Target 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

110 [4.3] RESPONSIVE Cancer (a) March-2016 All operational targets achieved in February excluding 62 day performance Cancer Performance: 2WW (All) 2014/ /2016 Target Cancer Performance: 2WW (Breast) 2014/ /2016 Target 100.0% 100.0% 90.0% 90.0% 80.0% 80.0% 70.0% 70.0% 60.0% 60.0% 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 100.0% 90.0% 80.0% 70.0% Cancer Performance: 31 Day (First Treatment) 2014/ /2016 Target 100.0% 90.0% 80.0% 70.0% Cancer Performance: 31 Day (Subsequent Treatment, Surgery) 2014/ /2016 Target 60.0% 60.0% 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

111 [4.3] RESPONSIVE Cancer (b) March-2016 Cancer performance All operational targets achieved in February excluding 62 day performance - failed the 62 day standard in February by 0.3% at 84.7%. This reflects a low number of treatments, 23 with 2 internal breaches, and 13 shared treatments, 5 of which were breaches. Trends and Patterns Ongoing escalation within divisions with regard to cancer pathways/validations continues, Requirement for all divisions to review Demand and Capacity for Cancer for 2016/2017. Risks or opportunities for the Trust National Cancer Breach Allocation Guidance April the Trust will be required to ensure patients are diagnosed by Day 31 of the pathway and when transfer of the patient to a Tertiary Centre is necessary, for this to be achieved by Day 38. It is crucial therefore that the demand and capacity studies are completed. These new "standards" will impact on the demand for responsive diagnostic services to support patient pathways and capacity for both testing and reporting must be reviewed. Quarter 4 62 day performance will require close scrutiny in view of failed February performance % 90.0% 80.0% 70.0% 60.0% Cancer Performance: 62 Day (Screening) 2014/ /2016 Target 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 100.0% 90.0% 80.0% 70.0% 60.0% Cancer Performance: 31 Day (Subsequent Treatment, Drug) 2014/ /2016 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Cancer Performance: 62 Day (GP) 2014/ /2016 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Cancer Performance: 62 Day (Consultant Upgrade) 2014/ /2016 Target 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

112 [4.4] RESPONSIVE MSA March-2016 No mixed sex accommodation breaches. 2 Mixed Sex Accommodation Breaches 2015/ /2015 Target 1 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

113 [4.5] RESPONSIVE Cancelled Operations March-2016 Cancelled Operations - March 2016 Cancelled operations: 0.73% (15/2046) Tolerance (0.50%) 28 Day re-admissions: 0 Tolerance (0) Urgent cancellations: 0 Urgents cancelled more than once: 0 YTD Cancelled operations: 0.5% (127/25101) - [Includes 12 Non Theatre for Medicine] Tolerance (0.50%) 28 Day re-admissions: 2 Tolerance (0) Urgent cancellations: 0 Urgents cancelled more than once: 0 3.0% 2.0% 1.0% Cancelled Operations Rate 2015/ /2015 Target In March, 15 patients had their procedure cancelled on the day of surgery due to hospital reasons. The dip in performance for March is due to a high number of cancellations against reduced activity due to Easter bank holidays and the junior doctor strikes. The year to date performance for cancelled operations is 0.5% which is above the contract threshold of <0.5% set for 2015/16; the failure to achieve the standard is due to the volume of cancellations in March, specifically those caused by bed pressures. Break down of March 2016 reasons for cancellation: Equipment not available: 1 Unexpected complications: 2 No bed at time of admission: 12 (4 x HDU & 8 x ward) 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 28 Day Readmissions 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Urgent Cancelled More Than Once 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

114 [4.6] RESPONSIVE Theatres March Theatre Management (nb Targets based on 2013/2014 position) Theatre Management (nb Targets based on 2013/2014 position) Theatre utilisation March: 69.9% Theatre productivity March: 100.9% Average cases per list March: 3.2 The Division of Surgery is including a Theatre Productivity Project as one of its QIPP schemes next year and has started discussing this project with Divisional Clinical leads. The Division is also working with the Information Team to decide which metrics will be used to track performance improvement. Some early issues have been identified and one of these is pre-operative assessment capacity. There are times when at short notice, theatre slots becomes available (e.g. due to another patient being unwell or cancelling) and the Admissions Team are unable to fill the slot as patients have not yet attended a suitable pre op assessment. The Division has recently held an initial process mapping workshop to identify ways of improving this process and maximise current pre op capacity in a way that better supports theatre utilisation Avg Cases Per Session 2015/ /2015 Target 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 120.0% 110.0% 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 5.0% 4.0% 3.0% 2.0% 1.0% Utilisation 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Productivity 2015/ /2015 Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Cancellation Rate 2015/ /2015 Target 0.0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

115 Indicator Data Sources Domain: Safe Indicator ID Indicator Description Data Source MRSA Cases (Trust Attributable) Infection Control C.Diff Cases (Trust Attributable) Infection Control MSSA Cases (Trust Attributable) Infection Control E.Coli Cases (Trust Attributable) Infection Control % of Time On The Stroke Unit PAS / Patient Notes High Risk TIA Treated W/I 24 Hours PAS / Patient Notes FNOF Patients In Theatre W/I 36 Hours PAS / Patient Notes Booking Euroking C-Section Rates (Combined) Euroking C-Section Rates (Elective) Euroking C-Section Rates (Emergency) Euroking Tears Euroking Rate of Patient Falls (All) Governance (Datix) Rate of Patient Falls (with Harm) Governance (Datix) Patient Falls With Fracture Governance (Datix) Incidents as a % of Total Incidents VTE Compliance PAS Pressure Ulcers (Grade 2, 3 & 4) Governance (Datix) Pressure Ulcers per 1,000 Beddays Governance (Datix) Harm Free Care (All Harms) Safety Thermometer Harm Free Care (New Harms) Safety Thermometer Serious Incidents Governance (Datix) Never Events Governance (Datix) Incidents Governance (Datix) Reporting Rate per 1,000 Beddays Governance (Datix) / PAS Incidents Resulting In Harm Governance (Datix) Percentage Resulting in Harm Governance (Datix) Domain: Effective Indicator ID Indicator Description Data Source Day Readmission Rates PAS DNA Rates PAS Appointment Slot Issue (ASI) Rate C&B / ereferrals Domain: Caring Indicator ID Indicator Description Data Source Inpatient FFT: Response rate iwantgreatcare / Meridian / Rate / PAS Inpatient FFT: % Recommended iwantgreatcare / Meridian / Rate / PAS Inpatient FFT: % Not Recommended iwantgreatcare / Meridian / Rate / PAS A&E FFT: Response rate iwantgreatcare / Meridian / Rate / PAS A&E FFT: % Recommended iwantgreatcare / Meridian / Rate / PAS A&E FFT: % Not Recommended iwantgreatcare / Meridian / Rate / PAS Maternity FFT: Response rate iwantgreatcare / Meridian / Rate / PAS Maternity FFT: % Recommended iwantgreatcare / Meridian / Rate / PAS Maternity FFT: % Not Recommended iwantgreatcare / Meridian / Rate / PAS Complaints: Trust Total Datix Complaints: CCSS Datix

116 Indicator Data Sources Complaints: Medicine Datix Complaints: Surgery Datix Complaints: W&C Datix Number of Negative PALS Concerns PALS Team Domain: Responsive Indicator ID Indicator Description Data Source Performance Against 4Hr Target (All) PAS Performance Against 4Hr Target (Type 1) PAS LAS Handover Times (30 Mins) LAS Portal Black Breaches LAS Portal RTT - Admitted Perf. (Unadjusted) PAS RTT - Non Admitted Perf. PAS RTT - Incomplete Pathways Perf. PAS RTT - 52 Week Waiters PAS Cancer Perf.- 2WW (All) Somerset Cancer Perf. - 2WW (Breast) Somerset Cancer Perf Day (First Treat) Somerset Cancer Perf Day (Subsequent Surg.) Somerset Cancer Perf Day (Subsequent Drug.) Somerset Cancer Perf Day (GP) Somerset Cancer Perf Day (Screening) Somerset Cancer Perf Day (Upgrade) Somerset Mixed Sex Accommodation Breaches Manual Cancellation Rate PAS Day Readmission PAS Urgent Cancellation More than Once PAS Utilisation PAS Productivity PAS Avg Cases Per Session PAS Cancellation Rate PAS

117 The Hillingdon Hospital NHS Foundation Trust PDR, Medical Appraisals and Mandatory Training Compliance March 2016 Medical Appraisals - Medical Appraisals reached 72.3% in March This is significantly below the 90% target despite the direct contact with Doctors and chasing by the Divisions and Medical Appraisal and Revalidation Team. Medicals Appraisal and Revalidation Team will take the issue of outstanding appraisals up directly with the Responsible Officer and Medical Appraisal Lead to ensure the final appraisals are completed by the end of May The breakdown by Divisions is: CSS 81% (34 out of 42); Medicine 62.6% (57 out of 91); Surgery 77.3% (75 out of 97); W&C 71.4% (30 out of 42) and Corporate 83.3% (5 out of 6). Core Skills Training - The Trust compliance with Core Skills Training (STAM) has remained stable at 89%, exceeding the trust 80% target. However compare with 2014/2015 there was a slight drop in compliance. This was due to the large numbers of staff due for their annual refresher training. Key subjects with ongoing low compliance are Fire Level 1 and 2, Information Governance and Infection Control and Prevention. An action plan has been put in place to improve these areas of low compliance. PDR Compliance - In 2015, 94% of trust staff received an appraisal exceeding the trust compliance target of 90%. This high compliance rate was also reflected in our 2015 staff survey findings, with 93% of staff completing the survey reporting that they received a PDR. In addition, the trust scored 3.24 for quality of appraisals compared to 3.05 score national average for acute trusts. This year the trust PDR window opened on 01 April 2016 and will close on 30th June We plan to meet trust target of 90% with a programme of support, communication and training for both appraisers and appraisees. As the case last year, levers have been incorporated into the PDR processes to encourage compliance including a link of PDR completion to pay 100% PDR compliance % 100% Medical Appraisals Compliance % 100% Mandatory Training compliance % 80% 80% 80% 60% 60% 60% 40% 40% 40% 20% 0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2014/ /16 Target (%) 20% 0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2014/ /16 Target (%) 20% 0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2014/ /16 Target

118 The Hillingdon Hospital NHS Foundation Trust Sickness Rate and Sickness Cost March 2016 Sickness - The Trust sickness rate increased in March 2016 to 3.57%, following 3 consecutive months where the rate reduced. The Trust completed the financial year with a YTD sickness rate of 3.53% - although this rate is higher than the Trust target of 3%, it was less than the 15/16 YTD figure of 3.59%. The Corporate Division completed the year with the highest YTD sickness rate (3.78%), followed by W&C (3.68%), Surgery (3.65%), CCSS (3.64%), Medicine (3.21%). The estimated cost of sickness (excluding the cost of temporary staff) for 15/16 was 2,843,315, which was less than the cost for 14/15 ( 2,853,736). In March 2016, the Nursing & Midwifery staff group accounted for approximately 34% ( 90k) of the overall cost of sickness ( 265K). The next highest staff group continues to remain the admin & clerical group, which accounted for approximately 22% ( 60K) of the total cost of sickness. The overall reduction in the sickness rate for 15/16 (3.53% compared to 3.59%), can be partly attributed to the focussed work carried out by the People Management & Productivity Working Group, (a sub group of the Workforce Transformation Board); which undertook a wholesale review of the managing sickness absence policy, worked with the Divisions to ensure that they captured greater levels of doctors sickness, and delivered sickness absence training to managers as part of the HR Workshops. Further work and initiatives are being planned to help reduce the sickness rate further during Trust Sickness Rate % Total Sickness Cost 4.50% 300, % 3.50% 250, % 200, % 2.00% 150, % 100, % 0.50% 50, % Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2014/ /16 Target (%) 2014/ /16

119 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar The Hillingdon Hospital NHS Foundation Trust LTR and Vacancy Rate March 2016 Trust vacancy Rate: The Trust vacancy rate for March 2016 was 8.64% against a target of 8.00%. We are in the process of selecting a provider for overseas nurse recruitment and hope to embark on this process shortly. Time to recruit: Time to hire for March 2016 was 65 days (against 96 days for March 2015). Whilst this is a significant improvement we still need to increase our efforts in this area to hit the target of 55 days. There have been delays in the eprocurement pilot and the recently appointed Interim Recruitment Manager will be looking to resolve this as soon as possible. We are also sourcing end to end recruitment software to enable the Trust to gain more accurate reporting in this area. Leavers Tenure: Leavers Tenure: The tenure of staff leaving the trust continues to fluctuate however March 2016 recorded the highest median years of the last two years at 4.91 years. This is 1.08 median years more compared to March In total, 34 employees left the trust in March 2016 including a high number of retirees. The longest tenure was 29 years. Nearly two thirds of leavers (14) in March 2016 can be attributed to leavers from CCSU division due to resignations or career progression. A large percentage of these leavers were Occupational Therapists. The trust continues to implement initiatives to retain staff within this professional group however due to the range of specialities offered by the trust and profile of this group, movement to other trusts or agency working (which can be lucrative) is expected. The trust is undertaking a detailed analysis of leavers data, particularly exit interviews to enable us achieve a better understanding of reasons for staff leaving the trust. This is with a view to improve our retention rate. Trust Vacancy Rate % Labour Turnover Rate % Time to recruit at point of formal offer (average days) Leavers - Tenure (LoS) Median yrs 15% 10% 5% 0% 20% 15% 10% 5% 0% / /16 Target (%) 2014/ / / /16 Target 2014/ /16

120 The Hillingdon Hospital NHS Foundation Trust Temporary Staffing Usage March 2016 Temporary Staffing: March 2016 saw a continuing trend in reducing total bank and agency spend compared to same period in March Overall there was a significant reduction of 488,902 for the same comparative period. This is during a period of continuing high activity. The percentage filled by agency staff saw a 6.01% drop in March 2016 compared to March 2015 with a 2.97% increase in bank staff usage over the same periods. The use of off framework agency workers was 0.52% in March 2016 down from a high of 21.76% in March There still remain pockets of use by off framework but these are now minimal and since the introduction of the agency price caps in November 2015 this has helped support this reduction. Bank Cost ( ) Agency Cost ( ) Bank and Agency Total spend 1,000, , , , ,000 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2,000,000 1,500,000 1,000, ,000 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 3,000,000 2,500,000 2,000,000 1,500,000 1,000, , / / / / / /16 %'s filled with bank %'s filled with agency %'s filled with off framework 80.00% 30.00% 25.00% 60.00% 40.00% 20.00% 0.00% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 20.00% 10.00% 0.00% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 20.00% 15.00% 10.00% 5.00% 0.00% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2014/ / / / / /16

121 The Hillingdon Hospital NHS Foundation Trust Employee Relations March 2016 Employee Relations - - There has been an increase in the number of employee relations cases progressing to a formal stage compared to the last financial year (YTD), 55 versus 41 - a 25% increase in activity. When looking at complaints made by staff (grievances and harassment claims), there has been a 47% increase compared with last year, and accounts for 31% of all ER activity this financial year. The increases in staff raising complaints (grievance and harassment) may be attributed to work that was undertaken by the CARES Dignity at Work group, which put greater emphasis on highlighting what behaviours are unacceptable. This initiative culminated in the creation and launch of the Dignity at Work poster campaign, which clarified the routes available to staff to resolve and deal with their concerns. In addition to this, there have been a number of major organisational change programmes, which have resulted in either staff having to move wards and / or sites, or also some staff seeing a reduction in on-call payments/ supplements - these programmes did result in disengagement amongst staff, evidenced by collective grievances that were made. The Directorate is continuing to offer its People Management Modules / HR Workshops to Managers and Supervisors, which have been positively received. Further work is ongoing with an external consultancy which has run focus groups on themes such as bullying and harassment and career progression. This is with a view to listening to the staff voice on these matters and proactively identifying sustainable solutions to manage this issue. Number of Grievances Number of Harrasment Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2014/ / / /16 Number of Disciplinary Number of Capability/ Performance Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2014/ / / /16

122 The Hillingdon Hospital NHS Foundation Trust Establishment March 2016 Staff in Post: The trust s reduction in the use of temporary staff and off framework agencies has positively impacted our ability to recruit to establishments. Since 2016, trust overall establishments have grown by 10% compare d with our total establishments in When looking at SiP by professional groups, the establishments of our registered nurse and midwifery workforce have increased by 11% and medical and dental by 5% compared to establishments in Managers are managing establishment hot spots by creatively thinking implementing initiatives to fill posts. In Flemming ward as an example, posts at lower bands have been converted to higher bands in order to attract staff to posts and meet patient care needs. In therapies, managers continue to actively put in place initiatives to recruit to vacancies and eliminate use of temporary staff; this includes running open days and increasing the number of student placements to retain staff when they qualify. Other areas are implementing structures which promote career progression and ultimately retention. Staff in Post ~ FTE Add Prof Scientific and Technic Staff in Post ~ FTE Additional Clinical Services Staff in Post ~ FTE Admin and Clerical Staff in Post ~ FTE Allied Health Professionals Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2014/ / / / / / / /16 Staff in Post ~ FTE Nursing and Midwifery Registered Staff in Post ~ FTE Healthcare Scientists Staff in Post ~ FTE Medical and Dental Staff in Post ~ FTE, Estates and Ancillary Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2014/ / / / / / / /16

123 The Hillingdon Hospital NHS Foundation Trust Price Cap March 2016 Price caps: Price caps were introduced in November 2015 to help trusts reduce agency spend and ensure they procure agency staff at below national price cap levels. The agency rules cover all staff groups. Controls are in place to ensure CAP rates are only exceeded where there is clinical demand and patient safety justifies it. Sign off is required at Executive level for any breaches. Since the introduction of price caps there has been significant reduction in the use of off and on framework agencies and month on month reduction in price cap breaches. Some areas remain challenging and in March 2016 there was a significant increase in use of agency staff over the price cap namely: medical locums (85 breaches), Nursing (61 breaches) and AHP (61 breaches). Reasons for breaches include the need to fill long term vacancies, lack of appropriate clinical skills to meet service and patient care needs the need to reduce patient waiting list times, increased service activity and demand and the opening and closing of pressure wards. Divisions continue to review their workforce needs to ensure that services can be delivered in a different way and reduce All other clinical Staff (AHPs) Administration & Estates Nov Dec Jan Feb Mar 0 Nov Dec Jan Feb Mar 2015/ / Medical Locums Nursing 0 Nov Dec Jan Feb Mar 0 Nov Dec Jan Feb Mar 2015/ /16

124 The Hillingdon Hospital NHS Foundation Trust Glossary March 2016 PDR Compliance - Based on assignment category; active primary assignment, internal secondments and acting up, excluding maternity leave, Medical and Dental, Student Staff Group, staff employed after 1st Nov 2014 and long term sickness. This report also excludes recharge and Senior Management Team. PDR 2014 cycle did not commence until 1st July 2014 therefore no data. Information extracted from ESR through Business Intelligent reporting tool. Medical Apprisals - include all doctors with a connection to the trust for revalidation. This does not include doctors in training or doctors connected to another designated body. This information is provided by the Medical Staffing Team. Mandatory Training - Figures are based on active assignments, internal secondments and acting up. Maternity Leave is excluded. Please note, this figure does not include the following courses: Customer Care, Dementia Awareness, EPLS/APLS annd MCA and DoLs. Data extracted from WIRED. Trust sickness - Figures are based on current month data, across permenant and fixed term employees only. Information extracted from ESR and uploaded by E- rostering and Finance Interface. Trust sickness cost - Figures are based on current month data, across permenant and fixed term employees only. Information extracted from ESR. Trust Vacancy Rate - the percentage of vacancies across all divisions in the trust in the current reporting month. Staff in post data is extracted from ESR and funded establishment data is provided by finance. Labour Turnover Rate - based on current month only across the Trust for Permenant Staff only. Time to recruit at point of formal offer (average days) - this is based on information provided by HR from advert to point of formal offer (average days) Leavers - Tenure (LoS) Median yrs - Information extracted from ESR, information on permanent staff only. Temporary Staffing useage - Information extracted from E-rostering and provided by Employee Services. Employee relations - this information is extracted from employee relations log and cases recorded in ESR, and is provided by the HRC's Establishment (SiP) - Information extracted from ESR for permenant and fixed term employees only as a snapshot of the last day of the reporting month

125 Measures of Infection Prevention and Control March 2016 Mandatory Reporting Performance in 2014/15 March Performance Year-to-Date Performance 2015/16 Target 2015/16 traffic light Clinical Support Services Medicine Surgery Women & Children's Comments MRSA blood stream infections (attributed to the Trust) Clostridium difficile infections (attributed to the Trust) 8 or less laspes in care MSSA blood stream infections (attributed to the Trust) NT 1 lapse in care out of 12 cases reported following internal RCA and CCG review. E Coli blood stream infections (attributed to the Trust) NT 2 Local Reporting Compliance with MRSA screening policy (elective) 101% 101% 94% 100% Compliance with MRSA screening policy (non elective) 91% 77% 88% 100% End of year performance is 3% lower than 2014/15. Several incidents relating to unlabelled samples has contributed to this figure. Number of needle stick injuries reported Local Monthly IP&C performance indicators NT Sharps and splash injuries reported either directly to occupational health or indirectly through the A&E department during the period 1st April st April All incidents were dealt with as per the Trusts Sharps Injury policy. Uptake of mandatory IP&C training (clinical level 2) 86% 79% 84% >80% 87% 77% 78% 86% Uptake of mandatory IP&C training (clinical level 1) 76% 95% 94% >80% 97% 91% 98% 97% Technical Audit Domestic Cleaning - VHR 97% 98% 98% >98% 97% 100% 98% Extracted from Wired 05/04/2016. Bespoke sessions have been scheduled but attendance has been poor. Some data from L and D and HR is not up to date and some staff are no longer working in the Trust which is affecting compliance figures. Bank Staff are also an area of significant non compliance. Technical Audit Domestic Cleaning - HR 97% 97% 96% >95% 97% 98% 96% 97% Technical Audit Nurse Cleaning - VHR 97% 92% 89% >98% 88% 96% 91% Technical Audit Nurse Cleaning - HR 97% 83% 87% >95% 72% 91% 88% 82% Work continues to be done to address areas of poor compliance and a meeting with senior nursing staff and facilities is planned. Audit ratio and number continues to be a problem and this will discussed at the meeting Compliance with restricted antibiotic policy 87% NA 87% >95% Data not in audit department as yet for period :February Compliance with hand hygiene policy End of year compliance 98%, but in March 16 areas were scoring below the 95% compliance target, 2 ward areas scored < 70%. ICN 98% 89% 95% >95% 89% 88% 97% 82% input and peer review will be taking place in April. Compliance with Bare Below Elbows 99% 95% 98% >95% 91% 95% 96% 99% Contamination of Blood Cultures 3% 6% 4% NT Blood culture audit to be undertaken in next quarter. Monthly High Impact Interventions (HIIs) HII No. 1 - Central venous catheter care 99% 100% 99% >97% 100% HII No. 2 - Peripheral line care (VIP) 98% 97% 97% >97% 98% 99% 93% Poor documentation in women's and children's has brought this overall score down. No phlebitis identified in any patient cases. HII No. 5 - Ventilator care 98% 99% 99% >97% 99% HII No. 6 - Urethral catheter care 93% 94% 96% >95% 92% 95% 100% HII No. 7 - Clostridium difficile care bundle 94% NM 93% >95% No cases for THH or CCG in March so no audits to measure performance Matrons Quick Question Assessment 94% 93% 95% >90% 96% 92% 93% 95% Bi-annual / Annual IP&C local measures Compliance with Isolation Policy 85% NM 91% >90% Compliance to linen policy 89% 71% 79% >95% HII No. 4 - Preventing surgical site infection 93% NM 84% >85% Audit undertaken by Sue Jones on 3rd March 2016; areas of non - compliance were - lack of linen bags, no bagging of linen posters visible, inappropriate items stored in linen rooms NM = not measured NA = not available NT = No Target IP&C RAG rating for compliance of: 95% 90% 80% Compliance 95% Compliance >90% Compliance >80% Partial Compliance 70%-94% Partial Compliance 70%-89% Partial Compliance >60% Minimal Compliance < 69% Minimal Compliance <69% Minimal Compliance <60%

126 Meeting of the Board of Directors Public Session Financial Report Wednesday 27 th April 2016 Agenda item 14 Reason for item: This is a standing monthly report to the Board in respect of its key regulatory financial responsibilities in compliance to the terms of its provider licence. Summary: This is the financial report and commentary to the end of March 2016 (month 12), quarter 4 of the 2015/16 financial year. The Trust ended the year with a deficit of 1,488k, 1,518k behind plan, consistent with our forecast position since Month 9 and aligned with the position discussed throughout Quarter 4 with Monitor. Financial Sustainability Risk Rating (FSRR) of 2 with a 3 for variance from plan, a 1 for liquidity and 2 s for the other two metrics. It was anticipated that a deficit of 1.5m would allow the Trust to maintain a liquidity score of 2, this has not materialised as the revenue position was been supported by a number of non-cash gains revaluation of Investment Properties, reduction in depreciation following review of asset lives, and an increase in stock. Efficiency savings achieved for the year were 8,014k. This was 3.6% of operating expenses and 1,486k behind target. The forecast for the delivery of efficiency savings was reduced from 9.5m to 8.0m at the end of Quarter 1. The Board should note the financial deficit was primarily driven by a 4.9m adverse variance on pay expenditure. Compared to March last year there was a net increase of 89 whole time equivalent (wte) staff; 171wte more substantive staff and 82 fewer non-substantive staff. Following the closure of Edmunds there were fewer beds open at the end of March than the same time last year. The transfer of maternity activity from Ealing was part of the reason for the additional staff. However, there has been a significant increase in the use of 1:1 nurses for higher risk patients over and above funded establishment as well as CQC and Shaping a Healthier Future (SaHF) related quality investment. Against the Monitor target of 12% for the proportion of qualified nursing expenditure incurred as agency the average for quarters 3 & 4 was 12.5%, but performance for March was 14.8%. Cash ended the month at 4.1m, which was 741k above plan. Significant cash was received in March from Hillingdon CCG, Ealing CCG and East & North Herts in particular. Page 1 of 6

127 Capital expenditure was 10,370k, 780k below plan. This reflects the slippage on the paediatric scheme, moving expenditure from this financial year into the first half of 2016/17. Capital expenditure below plan of 900k had been forecast since the beginning of Quarter 3. Board Action required: The Board is asked to: 1. Note the current financial performance of the Trust. Report from: Matt Tattersall, Director of Finance Links to Trust strategic priorities: To create a patient centred organisation to deliver improvements in patient experience and the quality of care we provide. To deliver high quality care in the most efficient way. Previous consideration at Board or Committees: n/a Equality and diversity considerations: none. Financial implications: The Trust s ability to comply with the terms of its provider licence in respect of financial sustainability is critical to the organisation being able to continue to provide the fullest range of high quality health services. Page 2 of 6

128 EXECUTIVE SUMMARY FINANCIAL REPORT MARCH 2016 (MONTH 12) QUARTER 4, 2015/16 The March financial position was a deficit of 92k, 11k better than plan. EBITDA was 541k, 2.8% of revenue and 691k worse than plan. Year-to-date there was a deficit of 1,488k, 1,518k worse than plan. EBITDA was 13,491k, 5.7% of revenue and 1,451k worse than plan. The Board should note that the adverse variance on depreciation has reduced from 694k in February to 325k this month. This is due to a review of the useful lives of some assets which has reduced the depreciation charge in the current year. Pay expenditure increased by 168k in-month, making it the highest pay expenditure of any month this year. Additional acute beds had to be opened on Lister Ward, in addition to those already opened on Pinewood Ward, although this pressure should have been reduced by the transfer of nurses following the closure of Edmunds Ward. Nursing agency increased by 18 wtes, 124k, compared to February, and overall agency costs increased by 200k to 1,209k. Drugs over-spent in month by 243k and Clinical Supplies and Services underspent by 343k. The drugs over-spend was offset by an over-recovery of excluded drugs income of 288k. The improvement in Clinical Supplies and Services was in part due to an increase in balance sheet stocks of 206k. Other Operating Expenses was 66k underspent. This was due to a review of our Bad Debt provision rate, which reduced the provision by about 100k. Operating revenue for the month was 145k below plan; there has been movement between the categories as entries were finalised at year-end. At the end of March 2016 the Trust s FSRR was 2 with a score of 3 for Variance from Plan, a 1 for liquidity and 2s for the other two metrics. The liquidity score has reduced from a 2 to 1 in March, as although the deficit has remained around 1.5m, this has been achieved through a number of non-cash items in March which has impacted the liquidity score. KEY MESSAGES Commissioning income over-performed by 6,511k for the year, mainly in respect of the Hillingdon Clinical Commissioning Group (HCCG) contract and the planned transfer of maternity activity from Ealing Hospital. It should be noted the marginal rate for over-performance with NHS England reduced commissioning income by 960k. Non-NHS Clinical revenue was below plan by 292k for the year, with the planned increase during 2015/16 not fully materialising. Other Operating Revenue was above plan by 84k for the year. Page 3 of 6

129 Efficiency savings of 1,018k were delivered in March 2016, 53k (5.5%) above plan. This compared with 955k of savings identified in February 2016 and 780k in March last year. Efficiency savings of 8,014 were achieved for the year, compared to 7,502k for 2014/15. This represented 3.6% of operating expenses. DIVISIONAL FINANCES Women & Children achieved a 265k under-spend for the year, an increase of 38k in month. Cancer & Clinical Support Services overspend reduced by 126k to 504k for the year. An overspend on pay was more than offset by an underspend on non-pay. Agency costs increased by 10k to 134k in March compared February. The monthly average for the first 3 quarters was 182k. Surgery s financial position improved by 28k in month, from an over-spend of 2,031k to an overspend of 2,003k. Pay remained on trend, however non-pay improved, partly due to an increase in year-end Theatre stocks ( 139k). Medicine s position deteriorated in-month by a significant 259k to an overspend of 3,566k for the year. Their in-month movement primarily reflected NHS Commissioning Income below plan, this was largely due to the decommissioning of Edmunds Ward, as well as the escalation of their adverse pay variance. Pay in March was the highest of any month this year, and the average monthly pay expenditure was 245k higher in quarter 4 than in quarter 3. Pressure during quarter 4 due to the opening of additional acute beds on Pinewood Ward and Lister should have been largely offset by the closing of Edmunds Ward. People and Development had an adverse variance of 370k at the end of March 2016 driven in part by increased recruitment activities. Page 4 of 6

130 CASH AND BALANCES The Trust ended the month with a 4.1m cash balance. This was 741k above plan. The balance sheet reported a 6.4m net current liability; an adverse movement of 3.5m in-year primarily due to the deficit incurred and capital expenditure above depreciation. Capital expenditure was 10,370k year-to-date and 780k below plan. The Board should note the major paediatric scheme had slipped and expenditure will now continue into the first half of the 2016/17 financial year. There has been a short-term cash benefit this financial year. OTHER KEY STRATEGIC POINTS Births at 385 were 49 higher than March last year and year-to-date 596 higher than last year. The increase of births following the transfer from Ealing Hospital was 65 additional in month; 588 additional for the year. New GP outpatient referrals were 313 (4.8%) higher than March last year. Year-to-date referrals were 2,724 (3.5%) higher than the same period last year. Emergency Department attendances increased by 638 (9%) compared to March last year and increased by 4,142 (5.1%) for the year. In addition, there had been an increase in the acuity of patients arriving in A&E with a significant increase in the number of patients arriving by emergency ambulance. During quarter 4 emergency department attendances have increased by 2,498, 12.7%, compared to the same period last year an increase of 27 patients each day on average. Non-Maternity Emergency inpatient spells decreased by 113 (5.2%) compared to March last year and decreased by 184 (0.7%) for the year. The expansion of ambulatory care during 2016/17 has prevented the increase in emergency department attendances converting into more emergency admissions. Elective inpatient and day cases decreased by 106 (4.9%) compared to March last year and increased by 128 (0.5%) for the year. Equality Impact Assessment: N/A there is no positive or negative impact from this report. Matt Tattersall Director of Finance April 2016 Page 5 of 6

131 Page 6 of 6

132 Appendix A THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST Statement of Comprehensive Income Period Ending 31st March 2016 (Month 12) Annual Yr on Yr Actual Actual Var Actual Var Year Yr on Yr Var 2016/17 Plan Growth to to-date Yr on Yr to-date This Yr on Yr This End Forecast to Plan Outturn Growth Month Growth Month Forecast Growth Plan 000s % 000s % 000s 000s % 000s 000s % 000s 000s Operating Income NHS Clinical Income 199, % 205, % 6,511 16,074 (0.8%) (511) 205, % 6, ,822 Non-NHS Clinical Income 3, % 3,683 (2.2%) (292) 399 (30.0%) 68 3,683 (2.2%) (292) 3,610 Other Operating Income 29, % 29, % 84 2,744 (28.0%) , % 84 25,824 Total Operating Income 232, % 238, % 6,303 19,217 (6.6%) (145) 238, % 6, ,256 Operating Expenses Employee Expenses (151,702) 5.1% (156,624) 8.5% (4,922) (13,348) (4.0%) (712) (156,624) 8.5% (4,922) (158,052) Drugs (16,324) 5.2% (18,027) 16.2% (1,703) (1,606) 20.3% (243) (18,027) 16.2% (1,703) (19,328) Clinical Supplies and Services (24,983) 8.9% (23,949) 4.4% 1,034 (1,742) (8.0%) 343 (23,949) 4.4% 1,034 (23,846) Other Operating Expenses (24,453) (10.8%) (26,616) (0.2%) (2,163) (1,980) (44.8%) 66 (26,616) (2.9%) (2,163) (27,100) Total Operating Expenses (217,462) 3.4% (225,216) 7.5% (7,754) (18,676) (9.9%) (546) (225,216) 7.1% (7,754) (228,326) EBITDA 14, % 13, % (1,451) % (691) 13, % (1,451) 13,930 PFI & Lease Depreciation (1,633) (0.7%) (2,039) 24.0% (406) (167) 12.9% (30) (2,039) 24.0% (406) (2,036) Other Depreciation (7,413) 5.9% (7,332) 4.7% 81 (312) (23.9%) 399 (7,332) 4.7% 81 (7,838) Interest Income % % 2 1 (28.1%) (2) % 2 24 Other Finance Costs (83) 0.0% (78) (6.4%) 5 (5) (32.7%) 1 (78) (6.4%) 5 (78) Interest Expense on Capital Investment Loans (254) 0.0% (240) (5.5%) 14 (20) (4.8%) 0 (240) (5.5%) 14 (240) Interest Expense on Working Capital Loans (65) 0.0% (164) 151.7% (99) (13) (10.1%) (6) (164) 151.7% (99) (168) Interest Expense on LIFT Contract (1,392) (0.5%) (1,401) 0.1% (9) (120) (2.4%) (4) (1,401) 0.1% (9) (1,394) Interest Expense on Other Finance Leases (277) (3.1%) (276) (3.5%) 1 (23) (28.1%) 1 (276) (3.5%) 1 (268) PDC Dividend Expense (3,812) 0.7% (3,957) 4.5% (145) (463) 9.5% (146) (3,957) 4.5% (145) (3,832) Surplus(Deficit) before Exceptionals 30 - (1,977) - (2,007) (581) - (478) (1,977) - (2,007) (1,900) Gains/(Loss) on Investment Properties Profit/(Loss) on the Disposal of Assets 0 (5) (5) (5) (5) (5) (5) 0 Impairments Surplus(Deficit) after Exceptionals 30 - (1,488) - (1,518) (92) - 11 (1,488) - (1,518) (1,900) EBITDA % 6.4% 5.7% 2.8% 5.7% 5.8% Normalised Surplus (Deficit) % 0.0% (0.6%) (0.6%) (0.5%) 0.1% (0.6%) (0.6%) (0.8%) ( ) variance indicates it is adverse

133 Appendix B Income and Expenditure Trend Analysis 000s Income Trend Analysis January 2014 to May ,000 20,500 20,000 19,500 19,000 18,500 18,000 17,500 17,000 16,500 16,000 15,500 15,000 Jan Mar May Jul Sep Nov Jan Mar May 000s Operating Expenses Trend Analysis January 2014 to May ,000 20,500 20,000 19,500 19,000 18,500 18,000 17,500 17,000 16,500 16,000 15,500 15,000 Jan Mar May Jul Sep Nov Jan Mar May Last Year This Year Trend Last Year This Year Trend 000s 1,800 1,600 1,400 1,200 1, EBITDA Trend Analysis January 2014 to May Jan Mar May Jul Sep Nov Jan Mar May Last Year This Year Trend 000s Surplus/(Deficit) Against Plan April 2015 to March 2016 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Plan Actual

134 Appendix C THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST Divisional Performance Summary Period Ending 31st March 2016 (Month 12) Annual Plan Actual Variance Variance Risk WTE's WTE's WTE's Change Plan to Substantive Other Total from To-Date To-Date To-Date Last Month Achieving Last 000's 000's 000's 000's % 000's Plan Month Cancer & Clinical Support Services (25,847) (25,847) (26,351) (504) 1.9% (630) High Medicine and Emergency Care (42,798) (42,798) (46,364) (3,566) 8.3% (3,307) High Surgery (46,163) (46,163) (48,166) (2,003) 4.3% (2,031) High Women & Children (22,521) (22,521) (22,256) 265 (1.2%) 227 Low (6) Estates and Facilities & Corporate Devt. (14,146) (14,146) (14,188) (42) 0.3% 19 Medium (2) Finance and Information (8,817) (8,817) (8,875) (58) 0.7% 9 Low Corporate Nursing (6,221) (6,221) (6,307) (86) 1.4% (99) Medium (1) Senior Management (2,341) (2,341) (2,319) 22 (0.9%) 33 Low People & Development (1,791) (1,791) (2,161) (370) 20.7% (359) Medium Education Centre (324) (324) (353) (29) 9.0% (58) Low Director of Operations (2,619) (2,619) (2,786) (167) 6.4% (161) Medium Other Corporate and Reserves 173, , ,638 5,020 (2.9%) 4,828 Low Total (1,488) (1,518) (1,529) High 2, , Efficiency Savings Delivery by Division Period Ending 31st March 2016 (Month 12) Last Year Plan Plan Actual Variance Variance Actual For Year To-Date To-Date To-Date Last Month 000's 000's 000's 000's 000's % 000's Cancer & Clinical Support Services 1,068 1,921 1,921 1,132 (789) (41.1%) (669) Medicine and Emergency Care 1,876 2,137 2,137 1,822 (315) (14.8%) (197) Surgery 1,180 2,183 2, (1,450) (66.4%) (1,271) Women & Children 387 1,063 1,063 1, % (8) Estates and Facilities & Corporate Devt. 1,178 1,159 1, (511) (44.1%) (482) Finance and Information % (53) Corporate Nursing (32) (28.3%) (31) People & Development (68) (53.5%) (87) Director of Operations (57) (47.1%) (52) Trustwide Savings 1, ,008 1, % 1,310 Contingency Total 7,502 9,500 9,500 8,014 (1,486) (15.6%) (1,540)

135 Appendix D THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST Efficiency Savings Delivery by Programme Period Ending 31st March 2016 (Month 12) Plan for the Year Plan To- Date Actual To- Date Variance To-Date Efficiency Saving Project 000's 000's 000's 000's % Seven Day Services & Improving Inpatient Care 1,442 1,442 1,091 (351) (24.3%) Accessible and Responsive Services (44) (5.0%) Building a Sustainable & Safer Nursing Workforce (393) (91.2%) Procurement (268) (38.9%) Reducing Reliance on Temporary Staffing 2,274 2,274 1,266 (1,009) (44.3%) Internal Referral Management (17) (100.0%) Maximising utilisation of the MV Site (60) (100.0%) Other 3,701 3,701 4, % Contingency Total 9,500 9,500 8,014 (1,486) (15.6%)

136 Appendix E THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST Analysis of Operating Expenses Period Ending 31st March 2016 (Month 12) Last Annual Budget Actual Var Actual Year Plan To-date To-date To-date Yr on Yr Actual Growth 000s 000s 000s 000s 000s % Pay Medical Staffing - Non-Training Grades (26,128) (27,454) (27,454) (27,705) (251) 6.0% Medical Staffing - Training Grades (14,006) (14,717) (14,717) (15,362) (645) 9.7% Nurses & Midwives (43,450) (45,655) (45,655) (46,906) (1,251) 8.0% Scientific, Therapeutic & Technical Staff (11,673) (12,265) (12,265) (12,361) (96) 5.9% Other Clinical Staff (22,327) (23,460) (23,460) (25,617) (2,157) 14.7% Non-Clinical Staff (26,790) (28,150) (28,150) (28,673) (523) 7.0% Total Pay Costs (144,374) (151,702) (151,702) (156,624) (4,922) 8.5% To note on Pay Agency Staff (13,529) (8,799) (8,799) (14,635) (5,836) 8.2% Bank Staff (6,708) (6,708) (6,708) (7,578) (870) 13.0% Discretionary Pay (3,899) (3,899) (3,899) (4,626) (727) 18.6% Total (24,136) (19,406) (19,406) (26,839) (7,433) 11.2% Non-Pay Clinical Supplies & Services (38,459) (41,307) (41,307) (41,976) (669) 9.1% General Supplies & Sevices (3,764) (3,586) (3,586) (3,987) (401) 5.9% Establishment (4,559) (4,344) (4,344) (5,089) (745) 11.6% Premises and Fixed Plant (7,934) (7,559) (7,559) (7,793) (234) (1.8%) Ambulance Services (843) (803) (803) (894) (91) 6.0% Other Non-Pay (9,559) (8,161) (8,161) (8,853) (692) (7.4%) Total Non-Pay Costs (65,118) (65,760) (65,760) (68,592) (2,832) 5.3% Total Expenses (209,492) (217,462) (217,462) (225,216) (7,754) 7.5%

137 Appendix F THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST Thirteen Month Rolling Cashflow Report & Forecast Period Ending 31st March 2016 (Month 12) Monthly Analysis 2015/ / / / / / / / / / / / / / / / / / / / / / / /17 April May June July August September October November December January February March April May June July August September October November December January February March 2015/16 Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s Opening Cash 5,415 9,014 4,761 5,281 4,419 3,502 3,279 2,638 2,322 2,433 1,636 1,774 4,092 4,137 3,682 3,727 3,772 3,817 2,251 2,796 2,841 3,386 3,931 4,476 4,092 Receipts Healthcare Contracts 13,744 14,232 14,868 14,327 14,017 15,715 15,390 16,037 14,920 14,913 14,783 14,906 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15, ,000 Other NHS 10, ,928 5, ,494 6,200 2,157 1,744 4,447 3,883 9,507 2,500 2,500 2,500 2,500 2,500 3,000 3,000 3,000 3,000 3,000 3,000 3,000 33,500 Commercial 1, ,377 1,725 1,482 1,106 1, ,030 2,164 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 24,000 PDC Dividend Receipt Payments Salaries & Wages (6,768) (6,546) (6,708) (6,365) (6,856) (6,933) (7,039) (6,925) (7,010) (7,011) (6,967) (7,156) (7,200) (7,200) (7,200) (7,200) (7,200) (7,200) (7,200) (7,200) (7,200) (7,200) (7,200) (7,200) (86,400) Tax, N.I. & Pensions (4,759) (4,912) (4,815) (4,900) (5,020) (4,925) (4,967) (4,992) (4,930) (4,946) (5,192) (5,087) (5,100) (5,100) (5,100) (5,100) (5,100) (5,100) (5,100) (5,100) (5,100) (5,100) (5,100) (5,100) (61,200) Other Expenses (9,328) (7,105) (6,364) (8,415) (4,168) (3,842) (10,453) (5,945) (5,065) (7,741) (6,145) (8,467) (6,215) (6,215) (6,215) (6,215) (6,215) (6,215) (6,215) (6,215) (6,215) (6,215) (6,215) (6,218) (74,583) Dividend Payable (2,008) (2,182) (1,916) (1,916) (3,832) LIFT and Lease Payments (400) (400) (400) (500) (400) (400) (400) (400) (400) (400) (400) (300) (169) (169) (169) (169) (169) (169) (169) (169) (169) (169) (169) (173) (2,032) Capital Payments (500) (634) (955) (853) (854) (854) (854) (854) (854) (854) (854) (872) (771) (771) (771) (771) (771) (771) (771) (771) (771) (771) (771) (771) (9,252) Working Capital Loan Repayment 0 (500) (500) (500) (500) (1,000) Existing Loans Repayments (195) (195) (195) (195) (390) Closing Cash 9,014 4,761 5,281 4,419 3,502 3,279 2,638 2,322 2,433 1,636 1,774 4,092 4,137 3,682 3,727 3,772 3,817 2,251 2,796 2,841 3,386 3,931 4,476 2,903 2,903 Weekly Analysis Week Comm Week Comm Week Comm Week Comm Week Comm Week Comm Week Comm Week Comm Week Week Comm Week Comm Week Comm Week Comm Comm 13 Week Rolling Forecast 1/3/16 8/3/16 15/3/16 22/3/16 29/3/16 5/4/16 12/4/16 19/4/16 26/4/16 3/5/16 10/5/16 17/5/16 24/5/16 Opening Cash 1,774 2,457 3,131 11,192 4,092 3,842 3,992 12,342 4,027 3,527 3,427 12,327 11,347 Receipts Healthcare Contracts , , , Other NHS 2,500 2,500 2,500 2, , Commercial Payments Salaries & Wages (117) (126) (109) (6,804) (100) (150) (150) (6,800) (100) (100) (100) (100) (6,800) Tax, N.I. & Pensions 0 0 (5,087) (5,100) (5,100) 0 0 Other Expenses (2,000) (2,000) (2,000) (2,467) (1,250) (1,500) (1,600) (1,675) (1,000) (1,000) (1,400) (1,100) (1,645) Dividend Payable 0 0 (2,182) Lease Payments (300) (400) (280) 0 Capital Expenditure (200) (200) (272) (200) (200) (200) (300) (140) 0 (150) (150) (300) (240) Working Capital Loan Repayment (500) 0 0 Existing Loans Repayments 0 0 (195) Closing Cash 2,457 3,131 11,192 4,092 3,842 3,992 12,342 4,027 3,527 3,427 12,327 11,347 3,462 Creditor Stretch b/f (7,115) (7,015) (6,915) (4,521) (2,395) (3,045) (3,445) (3,645) (3,530) (4,630) (5,580) (5,630) (6,050) Expenditure (2,100) (2,100) (2,255) (841) (2,100) (2,100) (2,100) (2,100) (2,100) (2,100) (2,100) (2,100) (2,100) Payments 2,200 2,200 4,649 2,967 1,450 1,700 1,900 2,215 1,000 1,150 2,050 1,680 1,885 Creditor Stretch c/f (7,015) (6,915) (4,521) (2,395) (3,045) (3,445) (3,645) (3,530) (4,630) (5,580) (5,630) (6,050) (6,265)

138 Appendix G THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST Statement of Financial Position Period Ending 31st March 2016 (Month 12) 31-Mar Mar-16 Movement 31-Mar-17 Actual Actual Actual Forecast 000's 000's 000's 000's Non-Current Assets Intangible Assets 2,980 2,832 (148) 2,832 Plant, Property and Equipment (Owned) 120, ,412 1, ,900 Plant, Property and Equipment (Leased) 16,013 15,427 (586) 14,738 Investment Property 19,137 19, ,641 Trade and other receivables (127) 800 Total Non-Current Assets 159, ,152 1, ,911 Current Assets Inventories 2,778 3, ,800 NHS Trade Receivables 10,621 11,940 1,319 9,500 PDC Dividend Receivable Non-NHS Trade Receivables 912 1, Prepayments and Accrued Income 3,087 5,357 2,270 3,050 Cash and Cash Equivalents 5,483 4,092 (1,391) 2,903 Total Current Assets 22,881 26,015 3,134 19,153 Total Assets 182, ,167 4, ,064 Current Liabilities Trade Payables 6,434 8,298 1,864 8,129 Capital Payables and Accruals 1, (311) 1,300 Other Payables 4,363 5, ,371 Accruals and Deferred Income 5,953 10,979 5,026 6,553 PDC Dividend Payable (227) 0 Provisions (832) 957 Payments Received on Account 2,163 3,604 1,441 1,163 Other Liabilities Borrowing Capital Investment Loans Working Capital Loan 1,000 1, ,000 LIFT (112) 328 Finance Leases 1,521 1, ,500 Net Current Assets/(Liabilities) (1,572) (6,403) (4,831) (8,538) Total Assets Less Current Liabilities 158, ,749 (3,471) 151,373 Non-Current Liabilities (amounts falling due after more than one year) Provisions 2,314 2, ,314 Borrowing Capital Investment Loans 6,295 5,905 (390) 5,515 Working Capital Loan 9,000 8,000 (1,000) 7,000 LIFT 12,390 12,174 (216) 11,732 Finance Leases 4,119 3,714 (405) 4,087 Total Assets Employed 124, ,636 (1,466) 120,725 Taxpayers Equity Public Dividend Capital 71,456 71, ,479 Retained Earnings 18,847 17,992 (855) 16,927 Revaluation Reserve 33,799 33,165 (634) 32,319 Total Taxpayers' Equity 124, ,636 (1,466) 120,725

139 THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST Statement of Cash Flows Period Ending 31st March 2016 (Month 12) Cash flow generated from operating activities 31-Mar-16 Actual 000's Appendix H EBITDA 13,491 Inventories (393) NHS Trade Receivables (1,319) Non-NHS Trade Receivables (427) Other Receivables (2,270) PDC Receivable (116) Movement in Long-Term Receivables 127 Trade Payables 1,864 Capital Payables and accruals (311) Other Payables 5,793 Provisions (826) Payments on account 1,441 Total cash flow generated from operating activities 17,054 Cash Flow fom investing activities : capital expenditure and receipts (10,370) Cash Receipt from Asset Sales 0 Cash flow from financing activities Interest Interest Received on Cash Balance 19 Other Interest Payable (78) Interest Paid on Capital Investment Loans (240) Interest Paid on Working Capital Loans (164) Interest Paid on LIFT Contract (1,401) Interest Paid on Finance Leases (276) Capital Loans and Leases Repayment of Capital Investment Loans (390) Repayment of Working Capital Loans (1,000) Repayment of LIFT Contract (328) Additional funding by Finance Leases 1,369 Repayment of Finance Lease Capital (1,652) PDC Dividends Paid (3,957) Dividend Received 23 Total cash Flow from financing activities (8,075) Net cash (Outflow)/Inflow (1,391) Opening Cash Balance 5,483 Closing Cash Balance 4,092

140 Appendix I THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST Capital Expenditure Report Period Ending 31st March 2016 (Month 12) 2015/16 Actual Plan Variance Plan To-Date To-Date To-Date 000s 000s 000s 000s Major Medical Equipment - Outright Purchase Information Management Technology - Outright Purchase 1, ,653 (657) Estates - Outright Purchase 4,087 4,502 4, Paediatric Transition SaHF 3,220 1,398 3,220 (1,822) Contingency Sub-Total Outright Purchase 10,012 8,556 10,012 (1,456) Major Medical Equipment - New Lease Funded 828 1, Information Management Technology - New Lease Funded Sub-Total inc. New Lease Funded 11,000 9,925 11,000 (1,075) Maternity Transition SaHF Replacement Lease Funded Capital (350) VAT Reclaim (400) 0 (400) 400 Donated Assets Grand Total 11,150 10,370 11,150 (780)

141 Appendix K THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST Financial Sustainability Risk Rating Period Ending 31st March 2016 (Month 12) 14/15 Continuity of Service Risk Rating 15/16 15/16 To-Date Actual Rating Metric Plan Rating Actual Rating Capital Service Capacity (25%) (6.5) 3 Liquidity (25%) (12.9) 2 (15.3) 1 0.6% 3 Underlying Performance (25%) 0.0% 3 (0.6%) 2 0.6% 4 Variance from Plan (25%) 0.0% 3 (0.6%) Weighted Average Overriding Rules Impact 3 2

142 Appendix L THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST CONTRACT INCOME Period Ending 31st March 2016 (Month 12) Trust Position Hillingdon CCG (Main Contract) Hillingdon CCG (Other) NHS England (incl Dental, AF & DESP) Other Contracts Annual Financial Actual Var Var Actual Contract Actual Actual Contract Actual Actual Contract Actual Actual Contract Actual Actual Actual Actual Financial YTD YTD Yr onyr YTD YTD Yr onyr YTD YTD Yr onyr YTD YTD Yr onyr YTD YTD Yr onyr Yr onyr Plan Plan Growth Growth Growth Growth Growth Growth 000's 000's % % 000's 000's % 000's 000's % 000's 000's % 000's 000's % 000's % NCA's Inpatients Daycase (spells) % -2% % 0 0 n/a % % % Elective (Spells) % -15% % 0 0 n/a % % 93-78% Non-Elective (Spells) % 5% % 0 0 n/a % % % Total Inpatients % 1% % 0 0 n/a % % % Outpatients Outpatients % 5% % 0 0 n/a % % % Total Outpatients % 5% % 0 0 n/a % % % A&E (Attendance) % 15% % 0 0 n/a % % % Total A&E % 15% % 0 0 n/a % % % Critical Care Critical Care - Neonatal % 20% 0 0 n/a 0 0 n/a % 0 0 n/a 0 n/a Critical Care - Adults % 24% % 0 0 n/a % % % Total Critical Care % 22% % 0 0 n/a % % % Other Income Rehabilitation - spec & non-spec (beddays) % 24% % 0 0 n/a % % % Chemotherapy (spells) % 28% 0 0 n/a 0 0 n/a % 0 0 n/a 0 n/a Direct Access (tests) % 74% % % % % 8 0% Excluded drugs & devices (pass through costs) % 32% 0 0 n/a % % % 360-4% Ambulatory Emergency Care % 288% 0 0 n/a % 0 6 n/a % 47 n/a Rapid Response Discharges % n/a 0 0 n/a n/a 0 0 n/a 0 0 n/a 0 n/a Community Services % 28% 0 0 n/a % 0 0 n/a 0 0 n/a 4 n/a Edmunds Ward (beddays) % -44% 0 0 n/a 0 0 n/a 0 0 n/a % 0 n/a Block and other clinical income % -15% % % % % % Operational Resilience Funding % -13% % 0 0 n/a 0 0 n/a 0 0 n/a 0 n/a Transitional funding % n/a n/a 0 0 n/a 0 0 n/a 0 0 n/a 0 n/a Metrics & Penalties % n/a n/a n/a 0 0 n/a n/a 0 n/a Marginal Rate adjustments n/a n/a n/a 0 0 n/a n/a 0 0 n/a 0 n/a Total Other Clinical Income % 20% % % % % % CQUIN % -4% % 0 0 n/a % % 0-100% Total CQUIN % -4% % % % % 0-100% Total Clinical Income % 7% % % % % %

143 Appendix M THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST CONTRACT ACTIVITY Period Ending 31st March 2016 (Month 12) Activity Annual Plan Activity Plan Trust Position Actual Var Var % Activity Plan Hillingdon CCG (Main Contract) Actual Var Var % Activity Plan Hillingdon CCG (Other) Actual Var Var % Activity Plan NHS England (incl Dental, AF & DESP) Actual Var Var % Activity Plan Other Contracts NCA's Actual Var Var % Actual YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD Inpatients Daycase (Spells) 21,597 21,597 22, % 16,181 15,713 (468) -3% n/a 1,885 2, % 4,081 4,051 (30) -1% 228 Elective (Spells) 2,823 2,823 3, % 2,259 2, % n/a % % 28 Non-Elective (Spells) 32,407 32,407 30,034 (2,373) -7% 22,785 22,086 (699) -3% n/a % 5,167 6,283 1,116 22% 1,131 Total Inpatients 56,826 56,826 55,080 (1,746) -3% 41,224 40,128 (1,096) -3% n/a 2,430 2, % 9,821 10,962 1,141 12% 1,387 Outpatients Outpatient 389, , ,886 35,846 9% 290, ,687 26,118 9% n/a 13,743 14, % 74,082 87,707 13,625 18% 5,791 Total Outpatients 389, , ,886 35,846 9% 290, ,687 26,118 9% n/a 13,743 14, % 74,082 87,707 13,625 18% 5,791 A&E (Attendance) 89,890 89,890 85,550 (4,340) -5% 54,899 56,405 1,506 3% n/a % 23,439 25,327 1,888 8% 3,617 Total A&E 89,890 89,890 85,550 (4,340) -5% 54,899 56,405 1,506 3% % 23,439 25,327 1,888 8% 3,617 Critical Care - Neonatal 5,210 5,210 5, % % n/a 4,390 5,580 1,190 27% n/a 0 Critical Care - Adults 4,325 4,325 4,200 (125) -3% 2,795 3, % n/a (34) -42% % 215 Total Critical Care 9,535 9,535 9, % 2,795 3, % n/a 4,473 5,628 1,155 26% % 215 Other Activity Rehabilitation - spec & non-spec (beddays) 13,162 13,162 19,456 6,294 48% 9,146 10,820 1,674 18% n/a % 4,069 7,508 3,439 84% 901 Chemotherapy (spells) 1,432 1,432 1, % n/a n/a 1,432 1, % n/a 0 Direct Access (tests) 4,529,553 4,529,553 4,614,800 85,247 2% 1,117,589 1,144,790 27,201 2% n/a 765 1,787 1, % 3,458,501 3,467,827 9,326 0% 396 Ambulatory Emergency Care 3,311 3,311 7,661 4, % n/a 3,240 6,661 3, % n/a n/a 133 Rapid Response Discharges % n/a % n/a n/a 0 Community Services 13,037 13,037 19,553 6,516 50% n/a 13,037 19,553 6,516 50% n/a n/a 0 Edmunds Ward (beddays) 8,172 8,172 6,902 (1,270) -16% n/a n/a n/a 8,172 6,902 (1,270) -16% 0 Block and other clinical income n/a n/a n/a n/a na/ 0 Total Other Clinical Activity 4,569,050 4,569,050 4,671, ,966 2% 1,126,735 1,155,610 28,875 3% 16,660 26,917 10,257 62% 2,408 3,971 1,563 65% 3,470,816 3,483,088 12,272 0% 1,430 Total Clinical Activity 5,114,341 5,114,341 5,246, ,971 3% 1,516,222 1,572,181 55,959 4% 16,660 26,917 10,257 62% 23,198 27,104 3,906 17% 3,578,696 3,607,670 28,974 1% 12,440

144 Appendix N Activity Trend Analysis Spells/ Attendances A&E Activity March 2013 to July ,800 7,600 7,400 7,200 7,000 6,800 6,600 6,400 6,200 6,000 5,800 5,600 Mar May Jul Sep Nov Jan Mar May Jul Spells/ Attendances All New Outpatient Referrals March 2013 to July ,200 7,000 6,800 6,600 6,400 6,200 6,000 5,800 5,600 5,400 5,200 5,000 Mar May Jul Sep Nov Jan Mar May Jul This year Last Year Trend This year Last Year Trend Spells Inpatient Activity March 2013 to July ,000 2,900 2,800 2,700 2,600 2,500 2,400 2,300 2,200 2,100 2,000 1,900 1,800 1,700 Mar May Jul Sep Nov Jan Mar May Jul Elective This year Emergency This year Elective Last Year Emergency Last Year Births Births March 2013 to July Mar May Jul Sep Nov Jan Mar May Jul This year Last Year Trend

145 Meeting of the Board of Directors public session 2015/16 Month 12 Transformation and QIPP update Wednesday 27 th March 2016 Agenda item 15 Reason for item: The purpose of this paper is to report on the final position of the 2015/16 QIPP Programme as well as the work underway in the Transformation programme. Summary: The forecast QIPP total for 2015/16 of 8m has been achieved. A breakdown of delivery by area is provided in the paper. The paper also provides a further update on the development of the 2016/17 QIPP plans. There are currently confirmed schemes to the value of 7.2m, with a further 2.2m in the pipeline, against a target of 9.14m. Board Action required: The Board is asked to: Note final delivery 2015/16 QIPP and progress in establishment of the 2016/17 QIPP. Agree any further steps that need to be undertaken Report from: James Ross, Director of Transformation Report sponsor: Joe Smyth, Chief Operating Officer (COO) Links to Trust strategic priorities: - To create a patient centred organisation to deliver improvements in patient experience and the quality of care we provide - To deliver high quality care in the most efficient way Previous consideration at Board or Committees: N/A Equality and diversity considerations: N/A Financial implications: There may be financial implications for some of the changes. These will be worked through with regards to their impact/benefit and prioritised for consideration within the appropriate governance framework. Page 1 of 8

146 1 Month 12 Performance Overview The final position for the 15/16 QIPP programme is achievement of 8.01m against the revised programme target of 8m. The target was revised from 9.5m in Month 5. The programme in Month 12 has delivered a total of 1.02m against a forecast of 890k. This is an improvement on previous monthly performance of 60k. This value includes the usage of one-off in year benefits to ensure that the Trust achieved delivery of the promised QIPP. Figure 1 The green line in Figure 1 represents year to date delivery for 2015/16 and the purple line is the phasing of the revised programme for 8m. The red line represents the phasing of original 9.5m plan. Finally the blue line represents what was actually delivered in 2014/15 ( 7.5m). 1.1 Month 11 Performance by Area The table below at figure 2 shows Month 11 delivery by area against the revised forecast. A summary of performance by area is provided below. Figure 2 Division Identified Forecast ( 8m) M12 Forecast M12 Actuals M12 Forecast Variance YTD Forecast Plan ( 8m) YTD Actuals YTD Variance Surgery 1.65M 1.16M K 43.10K K 1.16M K K Medicine 2.94M 2.49M K 98.66K K 2.49M 1.82M K W&C 1.04M 1.01M K K 4.05K 1.01M 1.07M 62.7k CCSS K K 28.90K 75.17K 46.27K K 1.13M K CORP - CD 17.0K 17.0K 1.49K 1.49K K 17.0K 0 CORP - DIRN 90.0K 90.0K 10.65K 9.93K K 80.98K - 9.0K CORP - DOF K K K K K K 7.39K CORP - HR 127.0K 85.50K 2.08K 32.08K 30.0K 85.50K 58.80K K CORP - DO K 32.0K 8.56K 7.40K - 1.2K 32.0K 64.15K 32.15K Estates - ES 322.0K K 9.05K 20.55K 11.50K K K K Estates - FM 710.0K K 87.78K 67.88K K K K 28.4k Trustwide 1.56M 1.29M 92.07K K 346.0K 1.29M 2.01M K Grand Total 9.96M 8.01M K 1.02M K 8.01M 8.01M 5.72K Surgery Underachieved against forecast by 431k. This is mainly due to shortfalls in nurse and medical agency savings, procurement and overseas and other income. Medicine Underachieved against forecast by 668k. This is mainly due to shortfalls in length of stay schemes, nurse agency savings, and medical pay. Women and Children s Overachieved against forecast by 63k. This over-performance was assisted by reduced CNST premia. CCSS Overachieved against forecast by 365k. This over-performance was significantly assisted by income from charging for direct access pathology testing. Corporate Achieved the forecast QIPP (+ 3.8k). Estates Underachieved by 72k. The shortfall was due to underachievement of income for service contracts and lower than expected reduction in the cost of utilities. Facilities Overachieved by 28k. Retail income in particular achieved ahead of plan. Trust-wide Overachieved by 717k. This is mainly due to the inclusion of one-off in year benefits. Page 2 of 8

147 2 Pay and Agency Expenditure This section of the board report considers in more detail the pay and agency schemes. Pay schemes made up fifty per cent of the new schemes in the 2015/16 QIPP programme and are primarily to do with length of stay and recruitment/agency reduction schemes. The majority of this pay spend reduction is from nursing staff. 2.1 Length of Stay Schemes From May to December, the Trust closed two wards (Lister and Pinewood). The organisation was successful in keeping Pinewood ward closed during December, and Pinewood was then opened to meet demand requirements in January. Lister ward was opened in February, and the discharge lounge re-provided in the elderly care day hospital. In total the programme has achieved 1.17m against a target of 1.34m. Ambulatory care volumes have continued to increase, helping to further mitigate the shortfall in these schemes. The following are key initiatives within the programme: The Discharge lounge operating from Lister ward from mid-october New ambulatory pathways for Surgery and Paediatrics began in November. 2.2 Medical Agency Additional Sessions Expenditure The red line in Figure 3 shows the medical agency and additional sessions spend that has been incurred year to date. This expenditure is driven by junior doctor vacancies being filled by locum / agency staff. Across the divisions there is an ongoing recruitment drive to fill consultant and junior doctor rota gaps with substantive posts or fixed term Trust grade doctors as opposed to more expensive locums and agency doctors. Figure 3 In total, the trust has spent an additional 1.66m in 2015/16 compared to 2014/15 on Medical Discretionary pay. 2.3 Nurse Pay Expenditure Figure 4 shows overall qualified nursing pay expenditure for the organisation over the past 19 months. Total pay expenditure increased in March by 190k. This is mainly due to the use of both Pinewood and Lister wards, extra beds utilised on Pagett ward during the month, and further expenditure in A&E and in the assessment units to meet significant demand issues. Page 3 of 8

148 Figure 4 Nursing Agency Expenditure As shown in Figure 5, expenditure in Month 12 increased by 114k compared to Month 11. This is mainly due to the additional agency expenditure incurred by opening Pinewood and Lister wards, and the increased demands on A&E, and this therefore disguises a continued downward trend in underlying agency expenditure. The underlying reduction in agency expenditure has been enabled by the on-going recruitment drive, the improved controls on the booking of agency nurses, the ban on the use of off-framework agencies, and the Monitor cap on agency rates. The red line in the graph below represents the agency expenditure on Nurses and Midwives for 2014/15. The blue line is the YTD expenditure for the current financial year. In total the trust has spent 970k less on Nursing Agency in 2015/16 compared to 2014/15. Figure 5 Page 4 of 8