King s College Hospital Council of Governors

Transcription

1 King s College Hospital Council of Governors PUBLIC AGENDA Time of meeting 19:00 Date of meeting Wednesday, 11 December 2013 Venue Boardroom, Hambleden Wing, King s College Hospital Marc Meryon NED/Senior Independent Director Chair of Meeting Elected Michael Robinson Lambeth Central Godwin Ubiaro Lambeth Central Fiona Clark Lambeth North Chris North Lambeth North Nanda Ratnavel Lambeth South vacancy Lambeth South Tom Duffy Patient Patti Kachidza Patient Derek Cookson Patient Christine Klaassen Patient Jan Thomas Patient David Sullivan Patient Barbara Pattinson Southwark Central Pam Cohen Southwark Central Andrew McCall Southwark North Joe Onabaworin Southwark North Stuart Owen Southwark South Michelle Pearce Southwark South Phyllis Barnett Staff Allied Health Professionals Rachel Burman Staff Medical and Dentistry Carolyn Campbell-Cole Staff Nurses and Midwives Nicky Hayes Staff Nurses and Midwives Brady Pohle Staff Admin, Clerical and Management Nominated/Partnership Organisations Diane Summers Guy s & St Thomas NHS Foundation Trust Phidelma Lisowska Joint Staff Committee Chris Mottershead King s College London Cllr. Jim Dickson Lambeth Council Sue Gallagher Lambeth Clinical Commissioning Group Richard Gibbs Southwark Clinical Commissioning Group Warren Turner London South Bank University Madeliene Long South London and Maudsley NHS Foundation Trust Cllr. Catherine McDonald Southwark Council In attendance: Tim Smart Chief Executive Office Jane Walters Director of Corporate Affairs Sally Lingard Associate Director of Communications Simon Taylor Chief Financial Officer Roland Sinker Chief Operating Officer Angela Huxham Director of Workforce & Development Tamara Cowan Board Secretary (Minutes) Apologies: George Alberti, Ahmad Toumadj Circulation to: Council of Governors and Board of Directors

2 Enclosure Lead Time 1. STANDING ITEMS M Meryon 19: Apologies 1.2. Declarations of interest 1.3. Chair s action 1.4. Minutes of previous meetings Minutes of 05/09/2013 Enc Minutes of 18/09/2013 Enc Matters Arising/Action Tracking Enc FOR REPORT 2.1. Sub-Committees Reports & Action Summaries Membership & Community Engagement & Transport Feeder Group Enc B Pohle 19: Strategy Enc C North 19: Patient Experience & Safety Enc T Duffy 19:25 3. FOR REPORT/DISCUSSION 3.1. Board Report to the Council of Governors, including KHP Update 3.2. Update on Integration Programme & Trust Performance Report Enc. 3.1 T Smart 19:35 Enc. 3.2 R Sinker 19: Francis Report Trust Update Enc. 3.3 R Sinker 19: Trust Finance Report Enc. 3.4 S Taylor 20: Council of Governors Reports J Walters 20: Council Activity Report Enc Council Forward Plan Enc Patient Complaints Presentation J Walters 20:40 4. FOR INFORMATION 20: Council of Governors Annual Review Enc Register of Governor Attendance Enc Quarter 2 - Monitor Submission Enc Member-Governor Contact via Trust Website (MEC) Enc New Governors Induction Programme (MEC) Enc Sub-Committees Confirmed Minutes Membership & Community Engagement Enc Strategy Enc Patient Experience & Safety Enc ANY OTHER BUSINESS 20:55 6. DATE OF NEXT MEETING Wednesday 05 March 2014, 14:00 venue at the PRUH or Orpington to be confirmed

3 Enc Subject to Chair s Approval Council of Governors Public Session Minutes of the meeting held on Thursday, 05 September 2013 at 14:00 in the Dulwich Room, King s College Hospital Prof. Sir George Alberti Elected Fiona Clark Chris North Michael Robinson Nanda Ratnavel Vacancy Andrew McCall Barbara Pattinson (part only) Pam Cohen Stuart Owen Michelle Pearce Jan Thomas Tom Duffy Christine Klaassen Rachel Burman Nicky Hayes Brady Pohle Ahmad Toumadj Nominated/Partnership Organisations Sue Gallagher Diane Summers Phidelma Lisowska In attendance: Tim Smart Jane Walters Jacob West Roland Sinker Simon Taylor Dr Geraldine Walters Dr Mike Marrinan Angela Huxham Faith Boardman Prof Ghulam Mufti Sally Lingard Leonie Mallows Apologies Patti Kachidza Joe Onabaworin Carolyn Campbell-Cole Chris Mottershead Warren Turner Madeliene Long Chair Lambeth North Lambeth North Lambeth Central Lambeth South Lambeth South Southwark North Southwark Central Southwark Central Southwark South Southwark South Patient Patient Patient Staff Medical and Dentistry Staff Nurses and Midwives Staff Admin, Clerical and Management Staff Support Staff Lambeth PCT Guy s & St Thomas NHS FT Joint Staff Committee Chief Executive Director of Corporate Affairs Director of Strategy Chief Operating Officer Chief Financial Officer Director of Nursing and Midwifery Medical Director Director of Workforce Development Non-Executive Director Non-Executive Director Associate Director of Communications Corporate Governance Officer (Minutes) Patient Southwark North Staff Nurses and Midwives King s College London London South Bank University South London and Maudsley NHS FT 1

4 Richard Gibbs Cllr. Catherine McDonald Cllr. Jim Dickson Godwin Ubiaro Derek Cookson David Sullivan Phyllis Barnett Enc Subject to Chair s Approval Southwark PCT Southwark Council Lambeth Council Lambeth Central Patient Patient Staff Allied Health Professionals Item Subject Action 13/36 Welcome & Apologies The apologies for absence were noted. 13/37 Declarations of Interest There were no declarations of interests reported. 13/38 Chair s Action There was no chair s action reported. 13/39 Proposed acquisition of SLHT assets and services TS provided the Council with a summary of the Trust s current position in relation to the proposed acquisition. The following key points were noted: If the Council decides to proceed with the acquisition it would be momentous for the Trust; The Council can be assured of support for the acquisition from the executive team, consultant body and senior leaders team; Over the past 12 months there have been extensive discussions about the process and terms of the acquisition; In a climate that is becoming ever more challenging financially, the acquisition would allow the Trust to improve healthcare services for the population of Lambeth and Southwark as well as in outer south east London; The acquisition would be on behalf of KHP and the partner organisations had held healthy and robust discussions of the implications and benefits to KHP The Council noted the following documents: Results of Monitor s risk assessment; Overview of the business transaction agreement; and Overview of the full business case (FBC). The Council agreed that there had been robust discussion of these three documents in today s earlier meetings and agreed to move immediately to item 2.2 on the agenda. 2

5 Enc Subject to Chair s Approval Item Subject Action 13/40 Formal Council decision on the Board recommendation regarding the proposed acquisition and transaction The Chair offered all members of the Council present at the meeting the opportunity to offer their opinion of the proposed acquisition, and for these opinions to be recorded, prior to putting the decision to a vote. The following statements are a reflection of the comments made by members of the Council: Barbara Pattinson I am in favour of the acquisition. Michael Robinson The acquisition is a very positive move. Fiona Clark I am in agreement but with reservations about the sheer size of the organisation and whether it would become too big for good governance. Pam Cohen No comment. Sue Gallagher I would like to compliment the Trust Board on the transparency with which the process to this point has been conducted and for the involvement of the Council. This is a massive challenge but if anyone can do it, King s can. Andrew McCall There have been good opportunities for governors to listen and contribute to the process. Diane Summers I wish King s the best of luck. Nanda Ratnavel I support the proposal but it would be useful for the Council to have sight of the definitions and details which underpin the financial assumptions relating to cost improvement plans at the PRUH. Christine Klaassen Congratulations on the quality of the FBC. I agree that the acquisition should go ahead but with reservations over how difficult it will be to oversee such a large organisation and the effect of this on staff. Rachel Burman I am convinced that the case for acquisition is more than just the least worst option and recognise the hard work of the executive team in producing it. The staff will continue to work hard to implement the plans. 3

6 Enc Subject to Chair s Approval Item Subject Action Chris North Congratulations to the team for the scoping, planning and negotiation of what looks like a good deal. It represents a huge opportunity and challenge, as illustrated by the four key risks identified in Monitor s letter, and specifically the behavioural and cultural challenge. I am in favour of the acquisition but the Trust must not lose sight of pushing forward with KHP. Brady Pohle I support the acquisition. Lots of work has been completed to date and now there is massive amount of work to do to ensure its success. As a member of staff, I am looking forward to it. Jan Thomas The huge effort that has been made to reach this point is recognised and impressive. I have reservations about the size of the enlarged organisation and the cultural change that will be required. Phidelma Lisowska Thanks to the Board for all their hard work. The information has been transparent and the figures helpful. Change can be seen as threatening and this is a great opportunity for staff and patients both here and at the PRUH. Clear leadership is helpful. Michelle Pearce Capacity of senior leaders must be monitored as moving forward with the acquisition will place more strain than ever on the management teams. Tom Duffy The financial and patient care case has been clearly set out and the right values demonstrated. A new culture should be developed that is appropriate to the enlarged organisation. The King s in Conversation project has also identified the need for a cultural shift and so the acquisition provides an opportunity to do both. Nicky Hayes I am in favour of the acquisition and acknowledge the leadership of the Board. We can do this and move from a culture of meeting targets to patient-centred care that is dignified and compassionate. Stuart Owen I have two major concerns about the proposals. A study of 112 UK hospital mergers between 1997 and 2006 found that non enhanced care quality. One of the key risks identified by Monitor the need to ensure sufficient management capacity and capability to deliver the turnaround of the PRUH position whilst maintaining focus on delivery at King s. Ahmad Toumadj As a past employee of King s and now as a contractor I think the acquisition is important for the health of patients. 4

7 Enc Subject to Chair s Approval Item Subject Action The Chair thanked governors for their comments and concerns, which had been duly noted. It was also noted that there was a quorum of governors present and that more than 50% of governors voting were needed to approve a significant transaction. The Council voted to approve the decision to proceed with the acquisition of assets and services of SLHT as set out in the FBC, subject to the resolution of details relating to the financial deal, as follows: For: 17 Against: 0 Abstain: 1 13/41 Enlarged Organisation Constitution JW advised the Council that they had approved the proposed changes to the Trust Constitution in February but that formal ratification was now required. There have been no substantive changes and no changes to the governor constituencies. The Council voted to ratify the constitution for the enlarged organisation as follows: For: 17 Against: 1 Abstain: 0 13/42 Any Other Business Lead Governor, Nicky Hayes, thanked the Board of Directors on behalf of the Council for their hard work and dedication. TS thanked the non-executive directors for their role in the acquisition process. He also thanked the Council for their efforts and wisdom in carrying out their responsibilities in relation to the acquisition. 13/43 Date of next meeting Wednesday, 18 September 2013 at Avonmouth House, 6 Avonmouth Street, London SE1 6NX 5

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9 Enc Subject to Chair s Approval Council of Governors Public Session Minutes of the meeting held on Wednesday, 18 September 2013 at 15:00 in the Dulwich Room, King s College Hospital. Prof. Sir George Alberti Elected: Godwin Ubiaro Fiona Clark Chris North Nanda Ratnavel Derek Cookson Tom Duffy Patti Kachidza (part) Christine Klaassen Barbara Pattinson Pam Cohen Andrew McCall Joe Onabaworin Stuart Owen Michelle Pearce Rachel Burman Nicky Hayes Carolyn Campbell-Cole Brady Pohle Nominated/Partnership Organisations Cllr. Jim Dickson (part) Chris Mottershead Richard Gibbs Sue Gallagher Warren Turner Phidelma Lisowka In attendance: Tim Smart Jane Walters Geraldine Walters Michael Marrinan Simon Taylor Roland Sinker Jacob West Rachel Sugarman Tamara Cowan Apologies Ahmad Toumadj Diane Summers Madeliene Long Michael Robinson Alam Zabit Chair Lambeth Central Lambeth North Lambeth North Lambeth South Patient Patient Patient Patient Southwark Central Southwark Central Southwark North Southwark North Southwark South Southwark South Staff Medical and Dentistry Staff Nurses and Midwives Staff Nurses and Midwives Staff Admin, Clerical and Management Lambeth Council King s College London Southwark CCG Lambeth CCG London South Bank University Joint Staff Committee Chief Executive Director of Corporate Affairs Executive Director of Nursing and Midwifery Medical Director Chief Financial Officer Chief Operating Officer Director of Strategy PPI and Membership Manager Board Secretary (Minutes) Staff Support Staff Guy s & St Thomas NHS FT South London and Maudsley NHS FT Lambeth Central Lambeth South 1

10 David Sullivan Jan Thomas Phyllis Barnett Cllr. Catherine McDonald FT Members: + 1 members of the public Enc Subject to Chair s Approval Patient Patient Staff Allied Health Professionals Southwark Council Item Subject Action 13/36 Welcome & Apologies The apologies for absence were noted. 13/37 Declarations of Interest There were no declarations of interests raised. 13/38 Chair s Action There was no chair s action reported. 13/39 Minutes of Previous Meeting The minutes of the meeting held on 15 May 2013 and were approved as a correct record. 13/40 Matters Arising/Action Tracking The action tracker was noted. It was aslo noted that the Bakerloo Line is not at the top of the London Mayor s priorities. It was agreed that the ongoing options could be removed from the action tracker. 13/41 Membership & Community Engagement (MCE) Committee Brady Pohle provided an update on the activities of the Membership and Community Engagement Committee and the recent meeting. He reported the following: Eight governors had completed the community links survey. The next phase of linking governors with appropriate community organisations will be completed shortly; The recruitment of new governors for the constituencies is underway; It was noted that there is currently a mechanism for members to contact Governors via the trust website. This would be re-advertised in future publications 2

11 Enc Subject to Chair s Approval Item Subject Action The Committee had agreed that it would be made clear, on the website, that the s are sent, in the first instance, to the Foundation Trust Office and that the s would be sent unfiltered to governors; The Transport Feeder Group continues to work hard on the key transport issues that matter to patient, staff and the local community. The feeder group also considered matters pertaining to transport planning in the event that acquisition of the new sites and services goes ahead; The feeder group is doing valuable work and other governors are encouraged to participate in the group. The Council noted the verbal update from Brady Pohle and the supporting key discussion points and actions arising from the feeder group and MCE meetings on held on 13 and 26 June 2013 respectively. 13/42 Strategy Committee In Chris North s absence, Tom Duffy provided an update on the activities of the Strategy Committee. He reported the following: Governors are keen to hear more about complaints especially as this is something which is reflected in the Francis Report; and Governors also want more insight into the NHS Commissioning Landscape. It was also noted that the Trust is working very hard to get the right IT infrastructure in place ahead of the proposed acquisition date. It was noted that engagement, including with external stakeholders, makes or breaks mergers. The Council noted the verbal update from Tom Duffy and the supporting key discussion points and actions arising from the Strategy Committee meeting held on 25 July /43 Patient Experience and Safety Committee Tom Duffy provided an update on the activities of the Patient Experience and Safety Committee (PESC). At its meeting on 04 July 2013 the Committee: Noted the National Cancer patient survey results and was provided with a presentation on the initiatives being undertaken by the Trust to improve the experience of cancer patients; 3

12 Enc Subject to Chair s Approval Item Subject Action Discussed the cleaning of public toilets and the process followed by the Trust; Heard about some of the key themes and messages from the programme of work being conducted by the Francis Working Group. Some governors also noted some frustration about the lack of opportunities to conduct ward visits; Discussed the phlebotomy project and the related building works, which it was felt, was causing some discomfort to patients. Kath Dean would attend the next meeting to provide further insight to the Committee. The following comments were raised in discussion: If the Trust has plans to sub-contract its phlebotomy services it should ensure that the standards of services are not diminished; and The provision of public toilets is not sufficient with the increased throughput of people using the hospital services currently. 13/44 Board Report to the Council of Governors, including KHP Update The Council received and noted the report from the Board of Directors presented by Tim Smart. The following key points were noted: The Care Quality Commission (CQC) would visit the Princess Royal University Hospital in December; Preparations are underway for King s Health Partners interview for accreditation with the international panel on 29 October 2013; The King s in Conversation initiative has been progressing well with over 650 staff and patients participating in the events. Governors have also given feedback at pop-up events and participated in the initiative. There has also been feedback from governors at pop-up events. A detailed report will be presented to the Board in November followed by a report to the Council; The Trust continues to experience high demand on services normally associated with winter months. This has been the trend throughout the year; and To date the Trust has not experienced any tangible material impact from the ruling on the judicial review into the decision about Lewisham hospital. 4

13 Enc Subject to Chair s Approval Item Subject Action 13/45 Update on the PRUH & forward planning for Council of Governors The Council noted the following update from the Chair: On 05 September 2013 the Board and Council agreed to proceed with the acquisition of assets and services from South London Healthcare Trust (SLHT) subject to the Chair and Chief Executive finalising the relevant outstanding contractual matters; On 13 September 2013 the Trust finalised and signed the Transaction Agreement; On 16 September 2013 the Secretary of State will make a final decision; On 20 September 2013 the Dissolution Order will be laid in front of Parliament; On the 30 September 2013 SLHT will be dissolved; On 01 October 2013 the Trust will acquire the following sites: Princess Royal University Hospital Orpington Hospital Services at Queen Elizabeth Hospital Services at Queen Mary Hospital Services at Beckenham Beacon Satellite Unit Services at Sevenoaks Satellite Unit Services at Darent Valley Hospital, Dartford The Trust will mark the acquisition by holding its 01 October public Board meeting in Orpington Village Hall; The election process for 4 Bromley, 1 Lewisham and 2 Interim Staff Governors will commence in October with the expectation that new governors will be in post and inducted by end January 2014; It is proposed that 2 out of the 4 Council meetings be held in Bromley in addition to the Annual Members Meeting in September 2014; Governors will be invited to all opportunities for engagement at the new sites. A programme of site visits for governors will be developed and rolled out shortly after a settling period after the acquisition. Some of the governor workshops in 2014 will be held at the acquired sites to provide the opportunity for governors to hear from new staff. 5

14 Enc Subject to Chair s Approval Item Subject Action In discussion, it was also noted that the transport links between the Denmark Hill and newly acquired sites are far from ideal. The Trust continues to work on making these issues more bearable and will continue to pursue ways of getting direct links but this a longer-term strategy. 13/46 Trust Performance Report The Council received the Trust s performance report for month 4 and noted the verbal update from Roland Sinker. The following key points were noted: The Trust has had good performance in a range of areas including cancer waits, long-waiters, healthcare acquired infection, C. difficile and MRSA trajectories and targets; The Trust had forecast, in the Annual Plan, that it would not be able to meet referral to treatment (RTT) trajectories due to the demand on services. This continues to be the status quo, although the Trust is doing all it can to address this; The Trust is behind trajectory in day cases for orthopaedics with the continued pressure on emergency services; When the works on Infill Block 4 and Orpington Hospital are completed, this will ease capacity pressures and improve RTT performance; The main pressures on the hospital relate to the volume and high acuity of patients needing to be admitted through the ED; The Trust is holding monthly meetings with local commissioning groups to keep them abreast of these challenges; There is a greater level of collaborative working between local commissioning groups and other local health organisations to address some of the wider issues facing the system; The Trust has significant concerns about the emergency department performance at the Princess Royal University Hospital (PRUH); About 40 members of the current Trust staff have been working intensively at the PRUH in the run up to the acquisition date. The gaps created at the Denmark Hill site are being back filled; There are some nursing staff gaps to which the Trust is finding it hard to recruit full time staff. This is especially prevalent in specialist areas such as neurosciences, acute and critical care. These gaps have necessitated the need to use more agency staff. 6

15 Enc Subject to Chair s Approval Item Subject Action 13/47 Update from the Francis Working Group The Council noted the report from the Francis Working Group. The following was noted: The Trust took the decision to approach its work around the Francis Report in a considered and holistic fashion; The Trust is getting some very good quality information from this programme of work; Over 600 patients and staff have now participated in the King s in Conversation events and the Francis Working Group are reviewing some of the early feedback; Work will also be done to feedback to patients; This is not just a box-ticking exercise this initiative will form part of the Trust s performance and quality reporting requirements; The results from the Francis Working Group will eventually become part of the Trust s business as usual model ; and Governors would be interested in seeing the new performance scorecards for this data. 13/48 Trust Finance Report The Council received the Trust s finance report for month 4 and noted the verbal update from Simon Taylor. The following was noted: The Trust s finances were broadly on track; The Trust is having to spend more as a result of the high acuity of patients coming to the hospital. This is the same story across a majority of South East London trusts; The Trust will reopen wards at Orpington Hospital which will help to appease the capacity constraints on the Denmark Hill site, resulting in a better financial position in the long run; There have been changes in the way care is being commissioned which is having an adverse financial impact on local hospitals. 7

16 Enc Subject to Chair s Approval Item Subject Action 13/49 Trust Annual Report and Accounts 2012/13 The Council received the Trust Annual Report and Accounts 2012/13 as presented by Simon Taylor (ST), Chief Financial Officer. 13/50 External Auditor Report to Council /13 The Council noted the following reports from the external auditor, Deloitte: The first, a report on the audit of the Trust s 2012 financial statements. The second, a report of findings and recommendations from the 2012/13 quality report assurance review which is confidential and was circulated separately. Craig Wisdom (CW) advised that Deloitte had, in accordance with Monitor s requirements, conducted the audit of the Trust financial statements and the quality report. CW reported the following: The audit was a smooth process despite the very tight deadlines imposed by the regulatory process; Deloitte issued an unqualified opinion on the Trust s 2012/13 financial statements; The process for completing the audit was the same as in previous year and is outlined on page 5 of the first report; There were no high priority recommendations; Following testing of high risk areas it was concluded that there were no material changes required; The scope for the work carried out on the quality report is set out on page 3 of the second report; The process for the quality report review is data testing to ascertain whether or not the Trust s assumptions in the quality report were consistent; This year Monitor mandated that the local indicator would be that of severe harm. Before this change in protocol the local indicator was chosen by the Council; Severe harm is a difficult key performance indicator (KPI) to test because it is based on clinical opinion, and scoring is often moderated over time, depending on the outcome of investigation of incidents; 8

17 Enc Subject to Chair s Approval Item Subject Action 62 day cancer waits and C. Difficile KPIs were was also tested; and Some errors were found in the initial testing of 62 day cancer waits so the testing was extended Deloitte issued an unmodified limited assurance report on the Quality Report and Accounts It was noted that PESC reviewed the quality report and was assured and pleased to see the level of quality imbedded in the Trust. 13/51 Update on external auditor performance Simon Taylor (ST) in the absence of Chris Stooke, Chair of the Audit Committee reported the following: The audit and finance teams have worked well together in the second year of the audit contract; The information exchanges have improved; The Trust is a large complex organisation with different transaction portfolios and Deloitte s responsiveness and provision of regular regulatory advice has proved invaluable; The current contract with Deloitte is for three years with the option to extend for a further 2 years. The Audit Committee will discuss this and make an appropriate proposal to the Council in December; and Should the Trust/Council decide to go to market to appoint auditors it will go through the same process which involved a panel made up of a combination of governors, executive and non-executive directors. 13/52 Governor Development Day 14 November 2013 The Council noted the following arrangements for the Governor Development Day: King s Governor Development Day is scheduled for 14 November 2013 At Governors request, KHP Partner organisation governors were invited to join Development Day: 11 Confirmed Governors from King s 10 Confirmed Governors from Guy s & St Thomas 10 Confirmed Governors from South London and Maudsley (SLaM) The FTN were booked to deliver their GovernWell Core Skills Module which includes: Introduction to the NHS The governor and the FT NHS Finances & Business Skills: an introduction 9

18 Enc Subject to Chair s Approval Item Subject Action Effective questioning and challenge Quality Matters: An Insight Training will be conducted in the Adamson Room in the SLaM Learning Centre. The draft agenda was circulated for information. 13/53 Revised MCE Committee Terms of Reference The Council noted and approved the proposed changes to the terms of reference of the Membership & Community Engagement Committee. 13/54 Quarter 1 Monitor Submission The Council noted the Trust s quarter 1 submission to Monitor. 13/55 Register of Governor Attendance The Council noted Register of Governors Attendance. 13/56 Governor Involvement List The Council noted the Governor Involvement List. 13/57 Sub-Committees Confirmed Minutes The Council noted the following sub-committee minutes: Membership & Community Engagement Committee 10 April 2013 Strategy Committee 25 April 2013 Patient Experience and Safety Committee 19 March /58 Any other business There were no matters of any other business raised from discussion. Date of Next Meeting Wednesday, 11 December 2013 in the Boardroom at 18:00. 10

19 Council of Governors Action Tracker Enc 1.5 Meeting Date Item Action Who Due Date Notes Completed Due Governors Strategy Committee 25/07/ /29 In general, governors would like to be more sighted on the details of complaints. It was agreed that this would be added to a future CoG agenda; JW 11/12/2013 See agenda item 3.6 Council of Governors Meeting 11 December of 1

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21 Enc Membership & Community Engagement Committee Key discussion points & actions arising from the meeting on 16 October 2013 Issue Discussion Point/Action Lead Membership Recruitment Rachel Sugarman presented a summary of membership numbers, changes and recruitment activity as at September Key points included: Election Update & New Governors Induction Programme 74 new members in the Public Constituency and 189 in the Patient Consistency have joined in the second quarter of 2013/14; Recruitment mailing was sent to PRUH patients and landed on doorsteps from 04 th October 2013; Recruitment activity has focused on the Bromley area. CK and FC have actively participated in initiatives to recruit new members at the PRUH; and The Trust is on track to reach the 2000 membership target (500 members per constituency) before the Governor Elections takes place in November The Committee also noted the membership breakdown by area with 66.3% members being in the inner London boroughs, 19.9% members in the outer London boroughs and the remaining from other parts of the country. TC updated the Committee on the forthcoming governor election process and the proposal for an induction programme for new governors. The Committee noted the election timetable, which is predicated on the Trust s ability to register sufficient number of members (at least 500) in each constituency. Effective Engagement Member- Governor Contact via It was highlighted that a number of methods such as letters, flyers, information in staff bulletin, face to face engagement and pop-up events by current governors are being used to reach out to different groups to become members and subsequently stand for elections. The Committee also noted that a Governor Awareness Session is being introduced for prospective Governors to ensure they are aware of the breadth of the role. The Session will be held on 25 November 2013 and it will largely be delivered by current Governors. The Committee noted the election and induction update and agreed for the report to be presented at the next Council of Governors meeting on 11 December TC presented a summary of the existing mechanism in place where members can contact a governor via the Trust s website using the generic address and how the process for incoming queries is being managed. It was highlighted that the process and wording on the web TC 1

22 Enc Issue Discussion Point/Action Lead Website page has now been refined to highlight to members that s will be reviewed by the Foundation Trust Office in the first instance. Members will also be asked to give formal consent for their information to be shared with the named governor, if their contained sensitive or confidential information. Effective Engagement Engaging with Diverse s: Feedback on special edition and ideas for February 2014 edition Committee Work Plan The Committee noted the refined process and agreed for the report to be presented at the next Council of Governors on 11 December 2013 for information. Angela Grainger, Assistant Director of Nursing reported on engaging with the diverse community and highlighted a number of inclusivity initiatives that are being undertaken by the Disability Inclusivity Group (DIG). The existence and work of the DIG is also being communicated to the PRUH & Orpington based staff. Governors are invited to engage and be Governor Champions of the DIG. AG will circulate the DIG meeting dates for 2014 to all Governors via the next Governor Bulletin. SL reported that the September edition s was a special edition to mark the acquisition. It focused on the three main sites of the Trust; the Denmark Hill, the PRUH and the Orpington sites. The next edition will be published in February 2014 and Governors are invited to take an active part and suggest as well as write a Governor focus article about their involvements in various initiatives. A note will go out in the next Governor Bulletin to inform Governors to contribute an article for the next edition s. The Committee commended the layout and the content of the magazine and suggested a number of items that could feature in the February edition. The Committee made suggestions for the forward work plan. Suggestions included: Governor induction update Community event planning Update s Forward plan for July Governor elections and Open day TC AG/LM LM 2

23 Enc Governors Strategy Committee Key discussion points & actions arising from the meeting on 24 October 2013 Issue Discussion Point/Action Lead Trust-wide Strategic Matrix Q1 David Dawson presented the Trust s Strategic Matrix for quarter 2 which outlined Trust-wide and divisional strategic priorities. The Committee noted that 800 staff and patients have been interviewed as part of King s in Conversation would be rolled out to PRUH patients and staff from November. The long-running Outpatient transformation project in Suite 3 is beginning to have a positive effect on patient experience and continued dialogue with health professionals and teams is moving implementation of the project forward. Research and Development is a key area of focus for the Trust including involvement with the establishment of an Academic Health Sciences Network and a successful bid to set up Collaboration for Leadership in Applied Health Research and Care. It was agreed that information about how governors can become involved in the next phase of King s in Conversation and opportunities to learn more about the Research and Development Department will be circulated in due course. LM/DD Integration Programme Tony Johnston presented the governance framework for integrating and transforming the enlarged organisation and how this sits alongside day to day operations as business as usual. The Committee noted that there were currently 7 major projects driving the integration programme, each with an executive sponsor and internal project champion, and were subject to a Gateway Review process to ensure that the benefits of the business case are secured. King s Health Partners Update Jacob West provided an update on discussions regarding the future of KHP. The committee noted that the KHP Partners Board would meet on 30 October to consider two options and one major issue. The two options relate to merger of the three foundation trusts and whether the option to merge should be pursued immediately or at a slower pace, bearing in mind recent developments such as the acquisition of the PRUH and the Competition Commission s decision to prohibit the merger of Bournemouth and Poole hospitals. The major issue is whether clinical and academic strategies and end goals can be commonly agreed between partners and, if so, how merger would help achieve them. Academic Integrated Care Organisation Jill Solly presented a summary of Southwark and Lambeth Integrated Care s (SLIC) ambitions to create an Academic Integrated Care organisation (AICO). The Committee noted that since SLIC s bid for pioneer status was unsuccessful it is exploring possibilities of working with KHP,

24 Enc Issue Discussion Point/Action Lead commissioners, GPs and social care organisations to achieve radical system change through an AICO. There is a clear vision for how the new system will be different from the present system. Differences include the creation of a care co-ordinator role which has overall responsibility for an individual s care and significant changes to care providers and the way in which they work, focusing on providing proactive, preventative, joined up and reliable care packages. A provider business case (planned to begin work in January 2014) will explore the possibilities of changing organisational form as an enabler of delivery, including the case for capitated health and social care budgets and the transfer of some services from incumbent organisations to the AICO. Strategic Issues Q2 The Committee noted the review of strategic context for 2013/14 quarter 2 and noted that significant issues had been raised for KHP by the Competition Commission s (CC) decision regarding the merger of Bournemouth and Poole, including financial implications and the respective roles of Monitor, the CC and the Office of Fair Trading. Commissioner-driven integrated care is being demonstrated by whole pathway tenders of the musculo-skeletal and diabetes pathways in the London Borough of Bexley. Organisational Development & Learning Strategy Sarah James presented a summary of the Trust s Organisational Development & Learning Strategy, which was developed earlier this year in anticipation of the Trust becoming an enlarged organisation. The Committee noted that development is taking place at three levels: organisational, directorate/divisional and individual. A Trust-wide staff survey would be carried out in November to inform the culture change programme. The Committee noted the strategy and acknowledged its importance as crucial underpinning to the success of the acquisition and requested an update in approximately 6 months time. SJ New NHS Commissioning Landscape Andrew Eyres, Chief Officer of Lambeth CCG, presented an outline of the new NHS commissioning landscape since changes came into force on 01 April The Committee noted Commissioning responsibilities are now divided across local government, CCGs and NHS England and that the commissioning context is growing demand from a population that is living longer, but with increased incidence of long term conditions, resourced by flat NHS funding and a reduced social care budget. There is a shift in focus from access targets and waiting times to innovation, quality assurance and preventing ill health. Central to this new approach to commissioning is partnerships from the local level, to sector-wide and national initiatives.

25 Enc Patient Experience & Safety Committee Key discussion points & actions arising from the meeting on 22 October 2013 Issue Discussion Point/Action Lead Phlebotomy Stephen Harding, Pathology Development & Liaison Manager reported Transformation that the Phlebotomy Transformation Project is in its final stages with 2 Project outstanding issues in relation to signage and training Phlebotomists on Electronic Patient Request (EPR). It was noted that: Changes to Pharmacy Services The Phlebotomy service is run by GSTS and there have been major improvements; Patient waiting times have improved with an average waiting time of 7 minutes; Customer care issues have been resolved with more phlebotomists during peak hours; Issue with the automatic display downtime would be reported to GSTS; and The phlebotomy service at the PRUH and Beckenham Beacon sites will be managed by the Trust and long waiting times will not be acceptable. A demand analysis will be carried out as at Denmark Hill to inform service improvement. Chris Barrass, Director of Pharmacy provided the Committee with an overview of the Pharmacy services and answered a number of questions that were put forward by SO in advance of the meeting. Key discussion points included: The Trust contracted out its Outpatient Pharmacy dispensing service to Sainsbury s, which officially opened in July 2013; The main reason for outsourcing the Outpatient Pharmacy service was to improve the quality of outpatient dispensing services by having longer opening hours, shorter waiting times and wider collection options. It also provides considerable VAT savings to the NHS and the Trust; The nature of business between the Trust and Sainsbury s is a standard NHS contract with normal contractual safeguards, that includes 38 Key Performance Indicators (KPIs); The Trust monitors the KPIs on monthly basis to check the quality of service and apply any financial penalties where quality and safety KPIs are not met; CB presented the average outpatient waiting times and the KPI charts to the Committee. The waiting times have decreased significantly since August 2013; and It was noted that the space provided to Sainsbury s Pharmacy was agreed by the Trust and there are 25 seats in total in the pharmacy waiting areas. It was highlighted by Governors that adequate seating space in the pharmacy for patients and in particular for elderly patients is essential. The Committee noted the update and Chris Barrass offered to come CB/TA to a future PESC meeting to update on progress. 1 of 3

26 Issue Discussion Point/Action Lead Update on Francis Working Group Outpatients Update Governor Involvement Updates TD reported on his involvement in the Francis Working Group and highlighted the following key points: The Group recently met on Monday, 21 October 2013 and considered the draft report from King s in Conversation (KiC) project; TD presented a summary of the key themes from the pop-up conversations and the table discussions that he had conducted to the Committee. It was highlighted that overall staff and patients are happy with the Trust and there are some areas of concerns, which the Trust should consider and take the opportunity to improve on; and In order to carry out their accountability to members and the public, it was suggested that Governors should contribute to and feature s magazine as well as at the next Annual Members Meeting (AMM) in September 2014 by writing and presenting short articles about their involvements in various projects. It was agreed that the PESC and Governor Strategy Committee should continue to look at the issues and themes that are coming out of the KiC project. CK reported on her involvement in the Outpatients Transformation Project and highlighted the following key points: The outpatient appointment booking system is now centrally managed; There have been significant improvements in the outpatient area with good IT system and an information board to advise patients on waiting times; Suite 3 has improved in a number of ways with electronic check-in systems now in place. There are volunteers and reception staff to assist patients, but further customer care training should be considered for the reception staff; and The Transformation Project work is on-going and it will now focus on improving Suite 1 and the Ophthalmogy department. CK will continue her involvement in this initiative. Jessica Bush outlined continuing opportunities for Governor involvement and key points included: There is an opportunity for governor involvement in quality improvement work in the Darwin Unit at the PRUH site. Governors interested to take part in this initiative to carry out patient interviews should inform JB. NH will follow up with Ann Wood on possible governor involvement in the mock CQC inspections; NH also highlighted that dignity month and dignity ward visits will take place during February Dignity awards ceremony will be on 17 March A schedule of ward visits will be developed and circulated to Governors in due course. A message will go out to all Governors in the next Governor Bulletin; and MP volunteered to get involved in the Ophthalmology Transformation project. All NH/AW LM 2 of 3

27 Enc Issue Discussion Point/Action Lead 2014 Committee The Committee noted the draft work plan for 2014 and suggested the Work-plan following additions to the work plan: Patient Experience from the PRUH dimension; Legal claims; and Maternity 3 of 3

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29 Enc. 3.1 Report to: Council of Governors Date of meeting: 11 December 2013 Presented By: Subject: Tim Smart, Chief Executive Board of Directors Report to the Council of Governors Purpose of the Report: To provide the Council of Governors with an overview of the key strategic, operational and performance issues facing the Trust. Action required: The Council of Governors is asked to receive the report and is invited to ask questions or to discuss the issues raised in the report. 1

30 Enc. 3.1 Board of Directors Report to the Council of Governors 11 December 2013 Introduction Today you are a Council of Governors representing staff, patient and public members across several sites. The enlarged organisation has been in existence for more than two months now and we have all had to rise to the challenge. The third quarter of the year can be particularly difficult for the NHS when the effects of the cold weather and seasonal illness begin to take a hold, particularly in emergency and critical care departments. The Board will be thinking carefully about the issues at hand and its priorities for the remaining months of the financial year. It is important that the Trust continues to work towards all of the targets it set last May. At the same time we recognise the hard work and efforts of staff across all sites to provide the highest standards of patient care during this doubly challenging period. Key Strategic Issues 1. One Hospital, Multiple Sites It s been a busy couple of months at the Trust s three hospitals. The elective orthopaedic centre and refurbished wards have opened at Orpington. The Centenary Wing in Camberwell has opened its doors to patients with four brand new wards treating elective surgery, liver and haematology patients. It is anticipated that the theatres will become fully operational by January. In the lead up to 01 October high priority areas were identified at the Princess Royal University Hospital (PRUH) and now a number of cross cutting work programmes are underway to help drive the integration programme, improve productivity and promote workforce integration and cultural change. Strong leadership and support is being provided to staff working at the PRUH by Operational Site Lead, Kath Dean, Director of Operations, Peter Fry, Assistant Medical Director, Paul Donohoe and Deputy Director of Nursing, Paula Townsend. During the first week of December the CQC conducted an inspection. In addition, the Trust is providing some services at Beckenham Beacon and Queen Mary Sidcup and planning is underway for the development of these services. On behalf of the Board I would like to thank those governors who have visited our new sites and participated in membership recruitment and other engagement activities. This is important work for successful integration and a fully representative Council. We look forward to welcoming governor colleagues from our newest constituencies and staff groups who are to be elected in January. 2. King s Health Partners I am pleased to report that King s Health Partners (KHP) has been successful in its bid to be accredited for a second time as an Academic Health Sciences Centre. KHP is one of six centres to have this status awarded to them. This represents an important step in our joint ambitions to bring patient care, research and teaching more closely together. Over the past few weeks the KHP Partners Board and the boards of the three foundation trusts within KHP have met separately to discuss the options for next 2

31 Enc. 3.1 steps on our KHP journey towards better patient outcomes and experience, enabled by better academic and education performance. While the three foundation trusts have concluded that now is not the right time to launch a full merger process - not least because of continuing lack of clarity over the regulatory and competition framework, as evidenced by the situation at Bournemouth/Poole - we have reached agreed in principle on some next steps precedent to the development of a Full Business Case (FBC) for merger. These include the development of a Clinical and Academic Site Strategy to inform the FBC, accelerated work to develop the Academic Integrated Care Organisation for south east London, further definition of the patient benefits case, and proposed changes to the governance of KHP going forward. I hope you will be able to join me at the joint governors event on 16 December, attended by the Chairs and other senior representatives from all three foundation trusts, when a discussion of these key elements will take place. 3. Culture Change Programme Integration of the workforce is a vital part of the enlarged organisation s future and so, in response to the changes which took place on 01 October, we have launched the Culture Change programme. Every member of staff from every level within the organisation has been offered the opportunity to share personal views by completing a culture survey which asks questions about what is working well in the organisation and what is not working so well. The anonymous survey was conducted throughout November and will be followed up by focus groups before an action plan is produced. This is an ambitious project but the Board feels very strongly that in bringing together staff from many different sites with many different ways of working we need a clear understanding of the opportunities and challenges and how we can develop into a stronger, integrated organisation. We plan to repeat the survey and focus groups in a year s time so that we can assess the progress made and plan future work. In addition, the King s in Conversation project that was launched as part of our response to the Francis Report has now been rolled out at the PRUH. 4. Progress with Capital Projects The Trust now has three estates to maintain and with demand for additional capacity rising there are a number of projects in progress to build new facilities and improve existing ones in order to enhance the environment for patients and staff and to improve efficiency. Helipad, Ruskin Wing, Camberwell Lambeth Council have granted planning permission to build a helipad on top of Ruskin Wing. As the largest Major Trauma Centre in the south of England, a helipad on the hospital site will ensure that a patient arrives at the emergency department within 5 minutes, reducing transport time by 80%. New Critical Care Unit, Camberwell Enabling works have begun for this ambitious project to build a brand new 60-bed critical care unit. Set over two floors and built over the existing neurosurgical theatres, the new unit will be equipped with state of the art equipment and will provide a better environment for patients and staff. Emergency Department, Camberwell The two storey temporary additional portakabins have been installed on site and are being prepared to provide accommodation for the Clinical Decision Unit and Paediatrics from mid-december. 3

32 Enc. 3.1 Centenary Wing in Camberwell has opened its doors to patients with three brand new wards treating elective surgery, liver and haematology patients. It is anticipated that the theatres will become full operational by January. Orpington Hospital - The third and final theatre is expected to open in January next year. Works will also begin shortly to create a canteen and seminar room on the ground floor for staff to use. Current Operational Challenges 5. Operational Performance Month 7 (October) was another peak month in a year which has seen consistently high levels of activity levels in the emergency department and across the Camberwell site. October was also the month when we formally took over responsibility for the PRUH and Orpington and began to implement our systems to monitor and manage performance. The emergency care 4-hour wait target has not been achieved in October at either of our emergency departments. Camberwell reached 94.2% against the target of 95% and, as predicted, delivery of this target will be under pressure in quarters 3 and 4. The emergency department at the PRUH is particularly challenged and a focus area for improvement. It reached 82.8% in October which was a worsening of the position in September. There have been three cases of MRSA attributed to the Camberwell site year to date. No cases of MRSA have been attributed to the PRUH since the Trust took over responsibility on 01 October. C-difficile rates are currently just above trajectory at both Camberwell and the PRUH. Infection control remains an area closely monitored at both sites. Bed pressures are having an effect on the achievement of referral to treatment (RTT) targets. The RTT admitted target has not been achieved in Camberwell due to the on-going efforts to reduce the long-wait position as planned. However, the RTT nonadmitted target and cancer waiting time targets have been achieved. At the PRUH, the admitted and non-admitted completed pathway targets have not been achieved and the 62-day wait for first time cancer treatment is under pressure. The How are we doing? survey was implemented at the PRUH in October. Results show that each overall section score is 1-2% below target. Analysis of subsequent months results will allow a clearer picture to be formed. In Camberwell survey scores have achieved their targets in two out of the three sections. The patient engagement score remains 1% below target. 6. Financial Performance The Trust is now reporting its financial position according to Monitor s new Risk Assessment Framework. The continuity of service risk (CSR) rating is intended to flag the risk of insolvency over the next months on a scale of one to four, with the lowest rating signifying the highest level of concern. For the month of October, we have a CSR rating of 4 Finances are very tight across the system. Here at the Trust, we have an operating deficit of just over 3m which represents a significant adverse movement in-month. The key drivers for this adverse movement are a reduction in the level of income 4

33 Enc. 3.1 over-performance, continued cost pressures arising from bank and agency staff and a sharp increase in drug expenditure. The Secretary of State for Health has announced further funding for emergency departments this winter and we wait to hear whether we will receive monies from this. Capacity is another key issue as we head into the challenging winter months as well as the need to ensure safe staffing levels as the new capacity comes online. 7. CQC Inspection of the PRUH Earlier this year Chief Inspector of Hospitals Professor Sir Mike Richards identified 18 trusts that would be among the first to be inspected by the end of 2013 under the new inspection regime. The now dissolved South London Healthcare Trust appeared on the list as high risk. On 02 December a team of inspectors arrived at the PRUH. They were provided with information about the acquisition process and as part of their inspection spoke with members of staff, patients and carers and individual directors. This is the first external test for the newly expanded organisation and we await their report. Review of the Last Quarter Throughout the year members of the Board are pleased to attend the various events held here to engage members, staff and the local community with our work. We also spread the word through the wider media. These are a few of the highlights from the past three months: Our Annual Members Meeting was held on 18 September at Avonmouth House near Elephant & Castle. It was well attended and included free health checks, information stands, a review of the year and a presentation on the contribution and role of governors plus a question and answer session. ITV Tonight broadcast a special documentary on 10 October about the recovery of Thusha Kamaleswaran the five year old girl who was shot in Brixton in Dr Malcolm Tunnicliff was interviewed about the night she came in and a reunion was held in the Boardroom for Thusha and staff who were involved in her care. Celebrations marking 100 years in Camberwell continued with a service of thanksgiving hosted by King s College London on 13 November and two further centenary lectures: The History of King s by Professor Edward R. Howard on 09 October and The Emergency Department at King s by Dr Malcolm Tunnicliff on 26 November. On 21 October the BBC published an article about a pioneering heart operation which took place here at King s. In the first operation of its kind in the UK, surgeons used a form of cardiac sewing to remodel the heart whilst it was still beating. The procedure is less invasive than existing cardiac surgery and it is hoped that the operation will provide a better outcome for patients. The fourth series of 24 Hours in A&E started on 13 November and was watched by 2.5 million people. This is the penultimate series to feature King s College Hospital. The final series will be broadcast next year. In recognition of the importance of spiritual care and as part of the Trust s on-going world faith calendar, a celebration of Chanukah, the Jewish festival of lights, took 5

34 Enc. 3.1 place on 04 December and there will be Christmas Carol Services on the 17 and 18 December at the PRUH and Camberwell respectively. 6

35 Enc. 3.2 Council of Governors Month 7 Denmark Hill 11 December 2013 Roland Sinker Chief Operating Officer 1

36 Enc. 3.2 Report to: Council of Governor Date of meeting: 11 December 2013 Subject: Performance Report, Month /2014 Author(s): Presented by: Sponsor: History: Status: Steve Coakley, Acting Associate Director of Performance and Contracts Roland Sinker Roland Sinker First presented to the Finance and Performance Committee For Information 1. Background/Purpose This report provides the details of performance achieved against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position. It also contains an update on the Trust s contractual position with the CCG s and NHS England at Month 7 including the latest position on CQUIN agreements. 2. Action required The Board is asked to approve the M7 performance reported against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 for Kings performance at the Denmark Hill site. 2

37 Contents Enc. 3.2 Executive Summary Trust Performance Summary Divisional Performance Summary Regulatory/Contractual Performance Monitor Q3 position Care Quality Commission s Quality Surveillance Contractual position update Specific Performance Reports Key Areas of Concern Infection Control Plan ED Action Plan Update RTT Action Plan Update 3

38 Executive Summary (1/6) 1. Enc. 3.2 Denmark Hill Key Areas of Performance for Month 7: 1.1 Good Performance Access Targets Cancer waiting time targets, the RTT Non-admitted completed pathway and RTT Incomplete pathway targets have been achieved in October. The 6-week diagnostic waiting time target was also achieved for the second month in succession in October, consistent with our plans that were communicated to commissioners. There were 41 breaches of the 6-week diagnostic wait standard meaning that the Trust achieved 0.96% patients waiting over 6-weeks and therefore achieving the national 1% target. 1.2 Performance challenges 7 Areas RTT Admitted As planned, the RTT Admitted completed pathway target was not achieved in October with 87.8% of patients admitted within 18 weeks which is below the 90% target, but consistent with the Trust s planned self-certification with Monitor not to achieve this target during Whilst the backlog position continues to reduce, the Trust is approximately 90 patients above the target level for the endoctober 2013 position due to the delayed handover of Infill 4. The Trust does remain on-track against its backlog trajectory across a number of the key challenged specialties with the exception of HpB (Liver) Surgery, Orthopaedic day-cases and Neurosurgery. Emergency Care Performance The Emergency Care performance target was not achieved in October with 94.2% of patients seen within 4 hours compared to the 95% target for all emergency type attendances. Pressure continues within the A&E department into November and whilst the 4-hour target is being achieved for all type attendances in-month, the Trust needs to maintain a run-rate of just over 95.5% in order to achieve the target for Q3. Health Care Acquired Infection (HCAI) There were no further MRSA cases attributed to the Trust in October so 2 cases have been reported to-date this year. There were a further 7 c-difficile cases reported in October so 28 cases have been attributed to date which is lower than the trajectory of 29 cases, and a better position compared to the 39 cases reported last year. Just over 65% of CDT positive patients were isolated within the timescales set, remaining below the 100% target levels and those reported from 4 August. There were 3 further VRE bacteraemia cases reported in October, but the cumulative reported

39 Executive Summary (2/6) Enc. 3.2 number of cases to-date is lower than the internal trajectory of 12 cases, and better than the 19 cases reported at this time last year. Never Events - There is 1 never event being investigated in relation to an emergency trauma admission where a scratch pad was found in the patient s wound which was not recorded on the swab count. Red Shifts The number of ward-based red shifts increased from 43 in September to 59 in October: with 32 red shifts reported in TEAM wards, 15 in Surgery wards, and 11 in Child Health wards. Complaints The number of complaints received decreased from 77 cases in September to 59 cases in October. However, the number of responses that were either still open or not responded to within the 25 day internal target increased from 26 cases in September to 54 cases in October. Finance The Trust has moved from a financial rating of 3 to 2 in month 7, due to an adverse movement of 6.2m in month from a break-even position. This is due to the continued reliance on high cost medical locum usage, nursing agency usage and off-site working using private hospital facilities to meet RTT targets. These unplanned spends have not been covered by income over-performance in month 7 due to medical outliers, critical care demand and capacity constraints. Drug expenditure has sharply increased over the last two months and the usage is being reviewed in line with patient activity. 1.3 Actions 7 areas RTT admitted - The Trust s first priority remains the reduction of the number of 52+ week wait patients. There were 32 breaches reported at the end of October compared to the 28 patients waiting at the end of September. 19 of the breach patients are waiting in HpB (Liver) Surgery and 10 patients are waiting in General Surgery specialties. The opening of the short-stay surgical ward in Infill 4 in November will provide additional elective capacity and 13 HpB patients have already been booked for December, in additional to booking patients at off-site providers. The Trust s second priority is the reduction in the number of over-18 week wait patients, and based on the month-end position for open RTT admitted pathways, the Trust is 90 patients above its trajectory position. Given the delays in Infill 4 becoming operational, revised trajectories have been worked-up by divisions which will be monitored weekly to reduce the over 18-week backlog to the agreed number of 550 patients waiting by the end of March. 5

40 Executive Summary (3/6) Enc. 3.2 Emergency Care Performance Weekly Emergency Care Board meetings are currently being held to review performance and progress against the revised Action Plan which is included later in this report. Health Care Acquired Infection (HCAI) Management of in-dwelling devices (IV line and urinary catheter care) and consistent review of MRSA pre-admission screening of patients across all specialties remains the key area of focus. The latest C-difficile Action Plan is included later in this report. Never Events Following investigation, the never event case will be taken to the Serious Incident Committee. Red Shifts All red shifts are reported to the Deputy Director of Nursing to manage on a daily basis in order to resolve any shortfall of staff on the wards. Red shifts are reviewed in more detail at the divisional Nursing & Midwifery meetings held by the Deputy Director of Nursing. Complaints - The complaints backlog continues to be challenged at the weekly Performance Improvement Group now chaired by the Director of Operations. Finance - The Trust needs to ensure capacity developments at Denmark Hill (Infill 4, Critical Care in ASU) and Orpington are fully utilised to ensure a profitable margin and address the Trust deficit. The slow recruitment process is a pressing problem and compounding the agency nursing dependency. 2. Other areas of concern: 2.1 Tertiary transfers - Repatriation bedday delays increased from 346 beddays in September to 485 beddays in October - effectively 16 beds per day on average for October compared to 12 beds per day for September. The increase was largely observed on the Neurosciences wards: David Marsden and Kinnier Wilson, and a 50 bedday delay increase on The Friends Stroke Unit. We continue to track and prioritise our Tertiary transfers on a daily basis. Repatriation delays are escalated daily to the Director of Operations at relevant Trusts. 2.2 Hospital Acquired Alert Organisms The increase in colonised cases seen continues with nearly 100 more cases reported to the end of October compared to the same position last year. The increase is largely observed in VRE where over 110 more cases have been reported YTD in October compared to the same position last year. 6

41 Executive Summary (4/6) Enc Red Adverse Incidents (AIs) 16 incidents were reported in October compared to 23 in September, of which 4 cases were community-acquired pressure ulcer cases that we are required to report. 4 of the incidents were black breaches where there was a delay of over 60 minutes in transferring ambulance arrival patients into the Emergency department. 2.4 Patient Cancellations The number of inpatient operations cancelled on the day for non-clinical reasons increased from 59 cases in September to 82 cases in October, of which 1 case was a 28-day subsequent cancellation in Neurosciences due to the lack of an HDU bed. 2.5 Mixed Sex Accommodation (MSA) breaches There were 27 MSA breaches reported during October, all of which were breaches on the Clinical Decision Unit (CDU) and reported in our national return to the DH. There were also 10 MSA breaches for delayed discharge patients from the intensive care units. When the portacabin is operational in early-december which will house the second CDU facility, then patient mixing will be able to better managed within this facility. 2.6 Mandatory and Statutory Training - The overall index score for reporting staff who have attended mandatory & statutory training courses remained at 72, compared to the expected index of 100. Further focus on training is required in order to achieve the internal target of 95%. 3. Regulatory and Contractual Performance 3.1 Monitor Monitor Q3 position - The Trust has achieved all the performance indicator targets in the Monitor Risk Assessment Framework for October with the exception of the RTT 18 Week Admitted target and the 4-hour A&E performance target. A&E attendances and sustained emergency access pressures continued into October and All Types performance of 94.2% was achieved. MRSA is no longer reported to Monitor under the new Risk Assessment Framework but 2 cases have been attributed to the Trust to-date. The Trust therefore has a risk score of 2 in the new Risk Assessment Framework, and currently Monitor has our risk rating as Green. 7

42 Executive Summary (5/6) Enc Care Quality Commission s Quality Surveillance The Care Quality Commission (CQC) has developed a new model of Intelligent Monitoring Reports (IMR which replace the previously published monthly Quality Risk Profile reports. In the first report published in October, Kings was categorised as band 5 as an overall risk score where the summary risk band range from band 1 representing the highest risk and band 6 representing the lowest risk. The CQC s analysis of the key indicators for Kings shows two indicators rated as an elevated risk (one related to the number of cases assessed as achieving compliance with the 9 standards of care measured within the National Hip Fracture database and one for Whistleblowing alerts). One indicator was measured as a risk in relation the Healthcare Worker Flu vaccination uptake. 3.3 Contractual Clinical Commissioning Group (CCG) - The Contract has been signed with the CCG Commissioners for NHS England (NHSE) The revised offer from NHSE has been accepted and the Contract has now been signed. CQUIN 2013/14: CCG Q2 update The Q2 CQUIN evidence has been submitted with 100% compliance. NHS England Q2 CQUIN evidence has been submitted and we are forecasting 100% achievement and are awaiting a formal response for Q1 and Q2. 4. Specific Performance Reports and other updates This month s reports includes updates for : 4.1 Key Areas of Concern Summary page to highlight key areas of concern on the Denmark Hill site under the categories of: Quality, Efficiency, Finance and Strategy. 8

43 Executive Summary (6/6) Enc Infection Control Action Plan Update Further details on the enhanced actions for can be found in the HCAI Action Plan, provided later in this report. 4.3 Emergency Department (ED) Action Plan Update Further details on the additional action plans to manage the 4-hour emergency care performance target can be found in the ED Action Plan update, provided later in this report. 4.4 RTT Performance Update Further details on the revised trajectories and additional action plans to reduce the over 18 week backlog can be found in the RTT Performance update, provided later in this report. 9

44 Enc. 3.2 Council of Governors Month 7 PRUH 11 December 2013 Roland Sinker Chief Operating Officer 1

45 Enc. 3.2 Report to: Council of Governors Date of meeting: 11 December 2013 Subject: Performance Report, Month /2014 Author(s): Presented by: Sponsor: History: Status: Steve Coakley, Acting Assistant Director of Performance and Contracts Roland Sinker Roland Sinker First presented to Finance and Performance Committee For Information 1. Background/Purpose This report provides the details of performance achieved against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position for PRUH hospital only. It also contains an update on the Trust s contractual position with the CCG s and NHS England at Month 7 including the latest position on CQUIN agreements. 2. Action required The Board is asked to approve the M7 performance reported against the governance indicators defined in the Monitor Risk Assessment framework for the interim Quarter 3 position for PRUH. 2

46 Executive Summary (1/5) Enc PRUH Key Areas of Performance for Month 7: 1.1 Good Performance Access Targets The RTT Incomplete pathway 92% target and the 6-week diagnostic waiting time target were achieved for the end of October position. 1.2 Performance challenges 4 Areas RTT Completed Pathways The RTT Admitted completed pathway target was not achieved in October with breaches reported primarily in General Surgery, T&O, Ophthalmology and Oral Surgery which includes breaches at the Sidcup site. Delivery against this target was impacted by the service shifts and capacity re-balancing which took place during the month across the Sidcup, PRUH and Orpington sites which impacted particularly on Orthopaedic activity. There was a delay in the Orpington wards and theatres becoming operational, and there were elective cancellations due to sustained bed pressures. The RTT Non-admitted pathway target was also not achieved in October with the majority of the breaches reported in Dental specialties and Ophthalmology. Further work needs to be undertaken to validate the pathway data specifically on the Sidcup site, and the Trust has secured access to the Sidcup RTT validation team who now work for Darenth Valley hospital. Emergency Care Performance The Emergency Care performance target was not achieved in October for either the Type 1 A&E attendances or for the Type 3 attendances in the Urgent Care centre (UCC) at the PRUH. All type attendance performance achieved 82.8% for October compared to the 95% target, a worsening of the position compared to the 87.4% achieved in September. Cancer Waiting Times - Cancer waiting time data for October is not available so it is not possible to confirm the final waiting time position for all cancer waiting time targets at the time of publishing this report. The 2 week waiting time indicators for all cancers and for symptomatic breast patients have been achieved in October. Achievement of the 62-day waiting time to first treatment is currently at risk for October. Cancer targets were achieved based on the Q2 end-september position. 3

47 Executive Summary (2/5) Enc. 3.2 Red Adverse Incidents (AIs) and Never Events There were 5 red AI s reported in October of which 2 incidents were patient fall related. A further case is a potential never event which is being jointly investigated between Kings and Lewisham Trusts. The patient involved had 3 procedures initially at the Queen Elizabeth site and then a subsequent procedure at the PRUH in September. Following a third procedure undertaken at the PRUH in October a retained swab was found. 1.3 Actions 4 areas RTT admitted A new RTT Board meeting with Service Manager attendance from each division is being re-launched on 21 November, similar to the meetings that take on the Denmark Hill site. The meetings will take place bi-weekly and will review key RTT indicator performance based on the Monitor targets and long-wait profile and in-month position. Emergency Care Performance Daily operational site performance meetings are held at 10:30 to highlight and review key areas of concern. An Action plan to improve 4-hour performance has been developed which will be signed-off by the Trust s Board for submission to Monitor and will be reviewed at weekly Emergency Care Board meetings. Cancer Waiting Times A Cancer Action Plan has been developed which will be signed-off by the Trust s Board for submission to Monitor. Red Adverse Incidents (AIs) and Never Events The never event is being jointly reviewed by both Kings and Lewisham Trusts and the case will be presented to the our Serious Incidents Committee following the initial investigation. 4

48 Executive Summary (3/5) Enc Other areas of concern: 2.1 Summary Hospital Mortality Index (SHMI) The latest SHMI data available for the wider SLHT hospitals was 1.06 for April 2012 March 2013 position which was published in October. Whilst the index is greater than the expected value of 1.0, the SHMI was banded As Expected. We have not yet received data specific to the PRUH site, but SHMI data due to be published in January 2014 will reflect mortality across the combined Denmark Hill and PRUH sites. 2.2 Length of Stay (LOS) Non-elective average length of stay was 6.1 days in October and has been steadily increasing since June 2013, and more than 1 day higher than the average LOS this time last year. Length of Stay is one of the priority transformation projects which will be identifying opportunities at both the Denmark Hill and the PRUH sites. 2.3 HRWD and Friends & Family October was the first month in which the HRWD survey programme has been implemented on the PRUH site which included the Friends & Family questions. Denmark Hill section score targets have been applied to PRUH survey responses and the initial month s survey highlights that none of the overall section scores have been achieved. The targets have not been achieved by only 1 or 2 % points and subsequent month s results will need to be reviewed in order to understand any underlying trends. The Friends & Family Inpatient responder score was 58 consistent with Denmark Hill. 2.4 Patient Cancellations There were 50 inpatient cancellations during October, a slight decrease on the number reported in September, however, 13 were 28-day subsequent cancellations with 6 in Urology and 4 in General Surgery. There was also an increase of 700 outpatient cancellations by the hospital in October compared to the 1000 cancellations reported in September. 2.5 Theatre Utilisation Overall theatre utilisation was 67% for October, an increase of 2% compared to the September position. However, this is low compared to the internal 80% target that has been set for the Denmark Hill site for current reporting. Theatre utilisation is one of the priority projects which will be identifying opportunities at both the Denmark Hill and the PRUH sites. 2.6 Vacancy Rate this is the only staffing measure that we have been able to report for PRUH based on the October position. The vacancy rate was 16.2% for October compared to the 5-8% internal target that 5 has also been set for the Denmark Hill site.

49 Executive Summary (4/5) 3. Enc. 3.2 Regulatory and Contractual Performance 3.1 Monitor Monitor Q3 position - Only the RTT Incomplete pathway target was achieved at PRUH, as neither the RTT Completed Admitted and Non-Admitted targets were achieved for October. A&E attendances and sustained emergency access pressures continued during October and PRUH did not achieve the 4-hour A&E performance target at 82.8% for All Types for October compared to the 95% target. 3 C-Difficile cases were reported in October with the Trust having 3 attributable cases YTD, due a new trajectory being set for Kings. This is below the trajectory of 5 cases for the quarter which puts this target at risk. Cancer waiting time data was not available at the time that this report was published but achievement of the 62-day cancer treatment target is currently at risk. PRUH acquisition Action Plan conditions As one of the conditions of the acquisition of the PRUH, Monitor require a submission of detailed action plans and threshold trajectories in January 2014 which have been signed-off by the Trust s Board. The action plans that have been requested can be found later in the Specific Performance Reports section of this report. 3.2 Care Quality Commission s Quality Surveillance The Care Quality Commission (CQC) has developed a new model of Intelligent Monitoring Reports (IMR) for monitoring a range of key indicators about NHS acute and specialist hospitals which will supercede the previously published monthly Quality Risk Profile reports. The CQC propose to publish the IMR on a quarterly basis on their website which will be available directly in the public domain. PRUH specific data has not been included in an IMR so the first report reflects on South London Healthcare Trust performance which had 17 risks/elevated risks identified a high proportion of which relate to poor patient and staff survey results, as well as operation and safety issues. 6

50 Executive Summary (5/5) Enc CQC Visit in December The Trust is preparing for the CQC Visit which will involve over 35 of their staff and is scheduled to take place on the 3rd and 4th December at the PRUH. The Trust executive will be presenting to the CQC team on the 2nd December, followed by visits to 8 areas which will take place over the subsequent 2 days. 3.4 Contractual Clinical Commissioning Group (CCG) - Contracts have been novated to receivers, however, there is a contract variation required to move Direct Access Pathology ( 4m FYE) into the King s Contract, and Queen Mary s Sidcup Neurology outpatients ( 274k FYE) out of the King s Contract. Subject to other resolving other receiver issues, the expectation is that this will be signed before the end of Q3 reporting. NHS England (NHSE) Contracts have been novated successfully with no issues outstanding to resolve. CQUIN 2013/14: CCG Q3 update The CQUIN is still be negotiated with commissioners and a contract variation will be signed before the next Board report. NHS England Q3 update There are 2 PRUH NHS England CQUINs; NICU involving administration of TPN and breast feeding and providing data via the dashboards which are both on-track. 7

51 Enc 3.3 Council of Governors Update Francis Report Progress Report November Executive Summary This is the fourth Board update and follows the October Board paper describing the analysis of the feedback from the listening events held over the last four months. This report will provide further information about the on-going work programme in response to the Francis Report (March 2013). The Francis Report is the final report following a public inquiry that was commissioned to investigate the Mid Staffordshire Trust and to explain why concerns about the quality of patient care were not identified and reported sooner. The inquiry examined how the hospital s failure in clinical standards and care was not acted on by the Trust Board and associated regulatory and monitoring authorities. The Report includes 290 recommendations for change based on evidence and interviews with staff, patients and families. The recommendations are wide ranging and have implications for hospitals, as well as the wider health care environment including regulatory bodies. The Government s full response to the Francis Report and six other related independent related reports was published on the 19 th November This response identifies the action that will be taken nationally and the undertaking by Parliament to review progress on an annual basis. The Francis Working Group will consider this response fully and incorporate the recommendations in it forward plan. The Foundation Trust Network has written a briefing, summarising the key points and this is attached as Appendix 1. This programme of work will be developed to support the good practice already being undertaken across the Trust and to make improvements and amendments where necessary to existing activities. In particular, the listening exercises have been fundamental in the development of a programme of improvement that responds specifically to the needs of our workforce and the patients and families who use our services. 2.0 Trust Work Programme and Governance The Francis Working Group, chaired by Roland Sinker continues to meet monthly and is attended by representatives from the Trust Executive and Board including the Non Executive Directors and Chairman, professional leads from nursing and medicine. The Trust Governors are also represented as well as governance and clinical leads from Southwark CCG. 1

52 Enc 3.3 The Francis Operational Group that supports the Francis Working group also meets monthly and provides a regular forum for operational updates and work planning. The Francis Working Group is supported by a dedicated Project Manager. The Project Manager will continue to support this work until the end of March After March 2014, the improvement work relating to Francis will become business as usual and taken forward within the Trust wide meetings structure. A final report will be presented to the Board in March outlining the achievements to date and identifying the further work to be undertaken. 3.0 Work Programme Themes Each of the six work themes is led by a member of the Executive and work is progressing across the hospital. Achievements so far and the detailed forward plan are described below for each of the themes. i) Identifying pressure in the hospital led by Geraldine Walters and Peter Fry A group of six measures that are currently collected separately within the Trust will be collated as one report and used to flag ward level pressures signalling a need for management action. These measures have been identified as hotspots that demonstrate operational difficulties over and above those expected. The hotspots report will use information such as the National Early Warning score derived from bedside patient observations to provide real time information for staff. This reporting tool will be piloted in two divisions TEAM and Liver and Renal during December and the pilot will be evaluated early in As an extension to this work, the team are also developing an application to capture daily information on capacity and staffing. This information will help the operations team improve the management of patient flow and capacity in real time. ii) Listening to patients and staff led by Angela Huxham The feedback from the staff and patient listening exercises was presented to the Board in October. This work stream will now concentrate on sharing this feedback with key staff groups. The analysis of the feedback will be presented at existing hospital wide and divisional staff group meetings and will include all professional groups. The groups will be asked to comment on the feedback and make suggestions about where improvement work should be undertaken as well as sharing positive comments. This phase will be launched by the Chief Executive and will set out a vision and signal the executive commitment to responding to what staff and patients say. A programme of work will be established as a result of the staff discussions and this will be overseen by the Francis Working Group. The initial analysis of the feedback has identified five broad themes that will provide a different emphasis for each area: 2

53 Enc 3.3 a) Patient Experience b) Behavioural standards c) Leadership and Management Development d) Hospital environment out of hours e) Bureaucracy and time wasting (including encouraging innovation) The roll out of listening exercises to the Bromley sites will also be implemented during November with a series of Pop up and round table events planned at Orpington, PRUH, QMS and Beckenham Beacon. These events will run up to the end of January The scheduled events have been advertised on the intranet supported by flyers and banners around the hospital sites. A schedule of feedback events at Denmark Hill as well as the listening events at the Bromley sites will be provided at the meeting. There is further work on cultural integration and the King s in Conversation work (Listening exercises) will be rebranded as part of the All Together Better campaign. There are plans for a Trust-wide surgery on organisational change later in the year. iii) Listening to patients A programme of work is underway to improve the way the Trust listens to patients. Since June, patient have participated in the staff and patient listening events, providing important feedback that complements the other ways in which we receive patient feedback such as the HRWD surveys, PALs and patient complaints. The Clwyd/Hart review of hospital complaints was published in October. We have reviewed and improved the internal processes in advance of the reports publication and any further action required now the review has been published will be implemented. The improvements to date have included looking at the accessibility of the complaints process and escalation of serious complaints, which now go immediately to key Directors when received. A patient complaint or patient story now forms the first agenda item at every Board Quality and Governance Committee meeting and Faith Boardman has been appointed as the NED Patient Experience Champion. A Serious Complaints Committee has been established to provide greater focus with both Executive and Non-Executive members. This will increase Board level scrutiny and independent challenge as well as ensuring appropriate learning from complaints. iv) Clinical Workforce led by Michael Marrinan and Geraldine Walters The medical and nursing recommendations from the Francis Report (February 2013) 3

54 Enc 3.3 have been reviewed by Michael Marrinan and Geraldine Walters to identify where current practice required updating or improving. This work will continue as national standards and government recommendations are published. The medical workforce is looking at ward leadership as well as improving job plans to ensure adequate time is provided for patient care. There are plans to develop the interaction with junior staff through a series of regular meetings held at both the PRUH and Denmark Hill sites, attended by senior clinicians. The nursing team are improving the mentoring and preceptor roles across the hospital and will also play a key part in the actions relating to the staff feedback sessions. v) Performance and Quality Management led by Peter Fry and Judith Seddon As assessment of the performance framework within the Trust was presented to the Finance and Performance Committee at the end of September. A number of metric changes are now being implemented on the Trust Performance Scorecard that add greater focus to quality and leading indicators of care. The RPUH has added an extra dimension to this and we have prioritised the development of performance and patient experience scorecards. Further work on improving performance monitoring will continue with work streams looking at easier access to information and transparency of information. The first of these groups will focus on complaints and PALS activity, patient safety and outcomes using data already recorded within the Trust. In addition, work to improve daily and live information for A&E and the acute medical pathway is underway. vi) Communication Plan led by Sally Lingard This project has two main communication objectives. To ensure all audiences both internal and external receive consistent messaging about our response to the Francis Report and to promote and encourage participation in the various staff and patient listening events. Internal communication has formed the majority of our activity to date. The first phase included the development of the King s in Conversation branded materials, the high level launch of the programme to staff and the promotion of the listening and pop events at Denmark Hill. This has now been completed. The next phase is to duplicate this work at the PRUH, Orpington, and other sites with new King s staff. The second phase of communication will consist of feeding back to staff the findings of the listening events, highlighting areas of concern and outlining planned actions to address these. This feedback will be led by the Chief Executive using the Chief Executive s monthly brief to all staff and using existing staff groups to feedback and encourage discussion about the issues raised. 4

55 Enc 3.3 4) Forward Plan The external stakeholders most engaged in the Francis work are our local CCGs and the Health Scrutiny Overview Committee (HOSC). Southwark CCG has representation on our Francis Working Group and has been involved in every stage of the project. A project update was presented to the Southward HOSC in September with further updates planned over the coming months. As the work at the PRUH commences, there will be increased participation from Bromley CCG and updates to the HOSC. The Francis Groups will continue to meet to progress the agreed actions and to ensure we make real progress. A further update report will be presented to the Trust Board in March ) Recommendations The Board are asked to note the action taken and approve the approach to the work programme that has been developed in response to the Francis Report. 5

56

57 Government s response to the Francis report On the day briefing 19 November 2013 Enc. 3.3 BACKGROUND The Government has today published its full response to the Mid Staffordshire public inquiry (the Francis Report). This incorporates the Government response to six expert independent reports on safety, complaints, bureaucratic burdens, support workers and trusts with the worst mortality rates. Volume I builds on the Government s initial response, Patients First and Foremost, and Volume II details the specific response to each recommendation. The Government has accepted 281 out of the 290 Francis recommendations, including 57 in principle and 20 in part. Progress against the report will be reported to Parliament on an annual basis. This briefing summarises the Government s response and the FTN s view, but giving the far-reaching nature of the recommendations, we encourage members to read the full Government response. There is an also expectation that trusts publish their own response to Francis by close of This does not need to be by detailed recommendation and can show local consideration of the learning from the report. EXECUTIVE SUMMARY The February 2013 Francis Report called for a fundamental culture change across the health and social care system to put patients first at all times. It looked at six core themes: culture, compassionate care, leadership, standards, information, and openness, transparency and candour. The Government calls for a cultural shift, built on candour and continuous improvement, which recognises and addresses variations in quality: Being honest and open about this and creating an environment in which problems are prevented, detected quickly and addressed firmly and in the interests of patients is the basis for re-establishing public trust. The Government sees the Francis recommendations as resonating across health and social care, and is explicit that its response applies equally to mental health and physical health services. Developments in this report include: The expectation of monthly reporting of ward-by-ward staffing levels Hospitals to set out clear routes for patients to raise complaints and concerns, with trusts reporting complaints data and lessons learned on a quarterly basis A statutory duty of candour on providers, and a professional duty of candour on individuals through changes to professional guidance and codes Consultation on whether trusts should contribute to the NHS Litigation Authority s compensation costs when they have not been open about a safety incident Legislation to hold accountable those responsible for wilful neglect A fit and proper person s test which will act as a barring scheme A protocol to minimise bureaucratic burdens on Trusts signed by all arm s length bodies and the Department of Health A Care Certificate to ensure that Healthcare Assistants and Social Care Support Workers have the right fundamental training and skills A new criminal offence applicable to care providers that supply or publish certain types of information that is false or misleading The nine rejected recommendations are: Merger of system regulatory functions. Rather than merging Monitor and the CQC, a single failure regime will be created. Commissioners powers of intervention. Rejected to avoid blurred roles and responsibilities. For further information, please contact: Ferelith Gaze, Public Affairs Manager (ferelith.gaze@foundationtrustnetwork.org) FTN 1

58 Designated Healthwatch structure. Local Healthwatch organisations will be set up to best meet the needs and reflect the circumstances of their local communities. Criminal offence to obstruct statutory duties. The Government does not intend to criminalise untruthful statements to commissioners and regulators made by healthcare professionals. Statutory regulation and developing standards for healthcare support workers. Rejected on the basis of sufficient safeguards already existing. Dismissing unsatisfactory staff following breach of code of conduct. Rejected on the basis that the Government does not believe regulation of health care assistants and support workers will improve the quality of care. This report incorporates the Government s response to the following reviews: Review into the Quality of Care and Treatment Provided by 14 Hospital Trusts in England, led by Professor Sir Bruce Keogh, the NHS Medical Director in NHS England. The Cavendish Review: An Independent Review into Healthcare Assistants and Support Workers in the NHS and Social Care Settings, by Camilla Cavendish. A Promise to Learn A Commitment to Act: Improving the Safety of Patients in England, by Professor Don Berwick. A Review of the NHS Hospitals Complaints System: Putting Patients Back in the Picture by Rt Hon Ann Clwyd MP and Professor Tricia Hart. Challenging Bureaucracy, led by the NHS Confederation. The report by the Children and Young People s Health Outcomes Forum, co-chaired by Professor Ian Lewis and Christine Lenehan. FTN PRESS STATEMENT Enc. 3.3 The NHS exists to treat and care for patients and to keep them well. Quality of care is at the heart of everything that the NHS and its staff do. The Francis Report was a valuable reminder of why it is fundamental we get this right and the tragic consequences that can occur when we do not. Trusts across the country have already learnt from the recommendations which Robert Francis QC set out and we welcome the Government s final response to the Francis Report today in support of that continuous improvement. Chris Hopson, Chief Executive of the Foundation Trust Network said today: The Berwick Report earlier this year was the first review of safety in today s NHS. It highlighted areas for improvement but equally found much to celebrate. We should see today s announcement in this context and remember that both Francis and Berwick cited the importance of learning and openness over blame and recrimination. We have some concerns that today s response does not fully reflect that crucial balance. We seem to be focussing more and more on NHS failure, actual, perceived and feared rather than NHS success. Only last week the respected, independent, international, US based Commonwealth Fund found the NHS to be one of the best healthcare systems in the world when compared to the rest of Europe and North America. This was barely reported. We owe it to the public and NHS staff to strike a better balance in the summary judgements we reach on the success of the NHS and how these are reported. Don Berwick also said that the best keys to health care safety do not lie in blame, regulation, or punishment. Yet many of the proposals in today s announcement rely on these approaches. We all accept the need for accountability in the event of gross failures of care like those identified in the Francis Reports. But, as Professor Berwick wisely reminded us, health care is complicated, and, even when the staff and clinicians are doing their very best (which is most of the time), errors occur and problems arise for patients that no one intends. For further information, please contact: Ferelith Gaze, Public Affairs Manager (ferelith.gaze@foundationtrustnetwork.org) FTN 2

59 Patient safety and quality of care will always be the guiding principle of NHS providers. But those providers are facing ever increasing demands that need to be delivered on ever decreasing real budgets. While instances of quality failure will never be acceptable, the NHS also needs a much more honest debate about what improvements can be made and how quickly, given the unprecedented financial squeeze the service is facing. FTN s comment on the new expectations that trusts regularly publish ward and shift staffing levels Chris Hopson, Chief Executive of the Foundation Trust Network, said: We welcome the Government s decision to avoid mandatory minimum staffing levels. We support the key principle of today s announcement that it must be for each Trust Board to determine the appropriate level of staffing within its trust and to be publicly accountable for that decision. We just need to be careful that additional reporting requirements, however well intentioned, do not divert precious frontline resources from a trust s core goal of providing high quality outcomes for patients. GOVERNMENT ACTIONS IN RESPONSE TO THE FRANCIS REPORT Chapter 1 Preventing problems Culture and patient safety A new Patient Safety Collaborative Programme to spread best practice, build skills and capabilities in patient safety and improvement science. A named hospital consultant and nurse responsible for care to be listed at each patient s hospital bed; and a named accountable clinician for people receiving out-of-hospital care, starting with vulnerable older people. By April 2015 everyone with a long-term condition will be offered a personalised care plan. People who are already receiving NHS Continuing Care will have a right to ask for a personal health budget (including direct payments) from April 2014 and a right to have one from October CQC and NHS England will develop a hospital safety website to include information on staffing, HCAIs and other key indicators and NHS England will begin to publish never events data (quarterly before the end of 2013 and monthly from April 2014). NHS England will also re-launch the patient safety alert system by the end of Openness and Candour Statutory duty of candour: the Government will consult on whether, where a trust has not been open with patients or their families about a patient safety incident, the NHS Litigation Authority could have the discretion to reduce or remove that Trust s indemnity cover for that claim, and whether trusts could be required to reimburse the NHS Litigation Authority for a proportion or all of the payment. The professional duty of candour on individuals will be strengthened through changes to professional guidance and codes, to include consistent approaches to candour and prompt reporting of errors (including near misses). This is to include a common responsibility to be candid with patients when mistakes occur whether serious or not, and clear guidance that professionals who seek to obstruct others in raising concerns or being candid would be in breach of their professional responsibilities. Listening to patients As previously announced, the Friends and Family Test (FFT) will be extended to mental health settings by the end of December 2014 (and to other services by 2015). Local Healthwatch organisations will be supported to ensure the patient voice is heard, and patients are now involved in CQC inspections. Enc. 3.3 Trusts will be expected to provide clear complaints guidance to patients, families and carers, with trust boards to take personal responsibility for responding to complaints. Complaints data and For further information, please contact: Ferelith Gaze, Public Affairs Manager (ferelith.gaze@foundationtrustnetwork.org) FTN 3

60 Safe Staffing lessons learned will be published quarterly. CQC will review complaints responses in its inspections, and NHS England will explore complaint resolution levels to enable comparison across hospitals. The National Quality Board and Chief Nursing Officer are publishing guidance on current evidence on safe staffing to clarify expectations on NHS bodies. By summer 2014, NICE will issue evidencebased guidance on safe staffing levels in acute care settings, and thereafter for staffing in nonacute settings, including mental health, community and learning disability services. From April 2014, and June 2014 at the latest, NHS trusts will publish ward-level information on whether they are meeting staffing requirements, with nursing and midwifery staffing published monthly. A six month intervals, trusts will be required to review levels and evidence their conclusions. The data will form the basis for commissioner-provider discussion. The Chief Inspector of Hospitals will monitor trusts performance on staffing levels and take action where there is a risk of patient harm. Appropriate staffing levels will be included as a core element of the CQC s registration regime. FTN view Duty of candour The FTN supports an open, honest and transparent culture in the NHS. Where harm has been caused, it is clear that providers will want to act within the spirit of the duty of candour. However, the practical application of the strengthened statutory and professional duties of candour will not be straightforward. Urgent clarity is required to establish how compliance will be assessed and enforced, given the serious consequences for providers and individuals. Given the potential impact on liability cover, we are concerned that there may be a chilling effect, with the duty creating a perverse incentive for trusts to become excessively risk averse in the care they are willing to provide. The FTN will also seek to challenge the levying of such financial penalties on providers, as they simply result in poorer care for patients by reducing the funding and resources available for the frontline. Listening to patients While we welcome the patient engagement sought by the friends and family test (FFT), the FTN has consistently raised reservations about the usefulness of the current net promoter methodology in producing clear and reliable data for patients. It is also clear that the FFT constitutes only one part of the comprehensive quality assurance and monitoring system our members have in place for patients. We continue to encourage trusts to act on, and respond to, local complaints which form an important source of information about the quality of their care. Safe staffing Enc. 3.3 The FTN supports the Government s decision not to impose minimum staffing requirements, avoiding a more prescriptive approach which could undermine local innovation and provider autonomy and fail to serve the best interests of patients. However greater clarity is required to ensure that CQC s requirements do not form de facto minimums. We remain of the view that it is for individual providers to ascertain the appropriate skills mix and patient/staff ratio for their services and we welcome the use and development of professional guidance in support of this aim. In the current financial climate, as with other additional requirements, it is important that the Government recognises the investment required to deliver appropriate staffing levels and agreed quality standards. Staffing levels and workforce training should not be seen as distinct from achieving appropriate service configurations, clear funding levels and fair risk apportionment. These are interrelated endeavours. For further information, please contact: Ferelith Gaze, Public Affairs Manager (ferelith.gaze@foundationtrustnetwork.org) FTN 4

61 Enc. 3.3 Chapter 2 Detecting problems quickly CQC inspections will look more closely at records, with visits taking place at night and at weekends, with more unannounced inspections. From January 2014, the CQC will rate hospitals quality of care from outstanding to inadequate. Ratings will be published from October 2014 for the NHS, and from January 2015 for the independent sector. By the end of 2015, the CQC will have inspected all acute trusts through two inspection waves, with the first wave of 18 to be completed by the end of 2013, and the second wave of 19 inspections to begin in January The second wave will include re-inspection of the 14 investigated in the Keogh mortality review. In mental health, inspection will begin with wave one pilots in January 2014, with a second wave from April. DH and CQC are developing fundamental standards, below which care should never fall. These will be complemented by more stretching enhanced and developmental standards that will be used by commissioners and the CQC in assessing provider services. The CQC will ask five key questions is a service safe, effective, caring, responsive and well-led? to identify potential failures. The Care Bill will enhance the CQC s independence from political interference. CQC will examine whether a culture of transparency is being promoted, and staff can whistleblow through professional regulatory bodies. All compromise agreements must include a clause making clear that the agreement does not prevent disclosure under the Public Interest Disclosure Act NHS England is developing a friends and family test for NHS staff and piloting a cultural barometer. New arrangements for regulators and commissioners will ensure that the distinct roles and responsibilities, as well as the issues and areas they need to co-operate on, are clear and unambiguous. This includes structures for sharing information and joint decision-making where they are needed. The Care Quality Commission will focus on assessing quality and publishing its findings rather than intervening to drive improvement which falls to the NHS Trust Development Authority and Monitor. FTN view We support the introduction of more risk-based and in-depth inspections with specialist teams, tailored to particular types of provider, and a balance between announced and unannounced inspections. However, important aspects of the CQC s approach require further refinement and clarification for example: the appropriate selection of indicators for surveillance and monitoring and the accuracy of the data, the balance between routine and risk-based inspections; and the length of time between inspections for outstanding providers. A further important unresolved issue is how quality is assessed and regulated across care pathways in a regulatory system based on registration of individual organisations. FTN welcomes CQC s adoption of five accessible and transparent questions. However, clarification is needed on CQC s approach and how the fundamental standards relate to the other standards that are being introduced. In addition, establishing the wording for the standards to apply consistently to all settings will be challenging. Current guidance is too acute / social care focused and relates primarily to episodic care, taking too little account of the specific needs of mental health, community and ambulance settings. Sector-specific guidance is required, as well as focusing on the provision of care to people with long-term conditions and multiple care needs. The FTN has raised concerns about the potential for confusion and overlap in the roles of the regulators, in particular between CQC and Monitor. We welcome steps to ensure clarity and look forward to working with the Government to improve coordination. Chapter 3 Taking action promptly Ratings will be given based on expert inspection against standards, informed by hard data and soft intelligence. CQC will judge whether providers are: For further information, please contact: Ferelith Gaze, Public Affairs Manager (ferelith.gaze@foundationtrustnetwork.org) FTN 5

62 o o o o Outstanding: sustained high quality care over time across most services, together with good evidence of innovation and shared learning. Good: the majority of services meet high quality standards and deliver care which is person centred and meet the needs of vulnerable users. Requires Improvement: significant action is required by the provider to address concerns. Inadequate: serious and/or systematic failings in relation to quality. Aspirant trusts will need to achieve good or outstanding to be authorised. From April 2014, Monitor and the CQC will implement a joint registration and licensing system. Enc. 3.3 The regulatory regime will be based around a single version of the truth with a single failure regime where clinical or financial unsustainability is grounds for failure procedures, including special measures. The CQC, NHS England, TDA and Monitor will publish guidance after April 2014 on how they will work together to address quality issues. Through Monitor s Risk Assessment Framework and the TDA s April 2014 accountability framework, the respective approaches to oversight and intervention will be set out. When a foundation trust is placed in special measures, it will have its freedom to operate as an autonomous body suspended. The trust board will need to demonstrate that it is credibly and effectively addressing the issues raised. The appointment of a special administrator in the place of the trust board will be used as a last resort. FTN view The FTN believes that ratings will be of most value to patients and the public, and will not be sufficiently granular to inform commissioning or regulatory decisions. For this reason, we are concerned at the weight attributed to them in consideration of foundation trust authorisation and will seek assurance from Monitor as to how ratings will be used and contextualised. We would also welcome clarification from the CQC about how non-acute aspirant trusts will be rated and authorised and assurances that they will not be delayed in the pipeline awaiting a new style CQC inspection. Given the autonomy of the FT board, the FTN remains concerned about where accountability will lie for those trusts in special measures: will responsibility remain with the board, or transfer to Monitor / the TDA? How will this be determined? Chapter 4 Ensuring robust accountability NHS England will hold CCGs to account for quality and outcomes and for their financial performance. It will have the power to intervene where there is evidence that CCGs are failing or are likely to do so. The new fit and proper persons test and barring mechanism for board level appointments will enable the CQC to bar directors who are unfit from individual posts at the point of registration. Legislation will follow if the mechanism is not having the desired impact. NHS Employers will be commissioned to work with the CQC, TDA and Monitor to develop guidance to support the effective performance management of very senior managers in hospitals through appraisal and other means. This will include, linking ratings to individual contracts and rewording contracts to make it easier for leaders to be removed when their CQC ratings are unsatisfactory. The Government will legislate to deliver the Berwick recommendation for a new criminal offence for wilful or reckless neglect or mistreatment of patients, and will consult on the proposed legislation. The Care Bill proposes a new criminal offence applicable to care providers and senior individuals who supply, publish or otherwise make available false or misleading information that is subject to statutory or legal obligation. Monitor will publish an updated Code of Governance for FTs in early 2014 which will make recommendations to strengthen corporate governance in light of the Inquiry report. There are also plans for regular governance reviews of FTs which will include quality governance. For further information, please contact: Ferelith Gaze, Public Affairs Manager (ferelith.gaze@foundationtrustnetwork.org) FTN 6

63 The Government will seek to enable the professional regulators to move rapidly to a maximum 12 month period for concerns raised about professionals to be resolved or brought to a hearing, in all but a small minority of cases. The medical revalidation programme will be transferred the programme to NHS England. Clinically-led commissioning groups will have an explicit focus on improving health outcomes for the whole population. They will be supported by strategic clinical networks and clinical senates. FTN view We appreciate Government s recognition of the work the FTN has been undertaking in partnership with others to promote good governance and to support board leadership. This includes our GovernWell development programme for governors, the development of best practice guidance in partnership with Monitor, CQC and the FTGA, and the development of a new induction programme for NEDs in partnership with Monitor However, we remain extremely concerned about the chilling effect of criminal sanctions relating to the provision of false or misleading information, and to wilful neglect of patients. The FTN is seeking far greater definition to ensure that individuals are not left vulnerable to liability over complex and ill-defined matters. There is also the danger that the requirements around false or misleading information, and the fit and proper persons test, will be a significant deterrent to capable individuals taking on nonexecutive director (NED) and senior roles. Such roles are critical to the sound governance of an organisation and it is essential that we continue to attract, retain and support high calibre individuals to take up these positions. Chapter 5 Ensuring staff are trained and motivated Well-treated staff treat patients well. Guidance to support good staff engagement will be developed, and Health Education England will lead the focus on training, CPD and appraisal improvements to support a compassionate culture. Enc. 3.3 Improving the quality of nursing and the support available to nurses is at the heart of the response to the Francis report. The Government will continue to implement Compassion in Practice and the 6Cs, fostering nurse leadership and supporting the implementation of nurse revalidation. How older people are treated is seen as the key test of whether there is safe, compassionate care. A bespoke older persons nurse post-graduate qualification training programme will be developed. Pre-degree care experience for nurses is also being explored. Following the Cavendish review, the Government has asked HEE to lead development of a new Care Certificate to ensure that Healthcare Assistants and Social Care Support Workers have the right fundamental training and skills in order to give personal care to patients and service users. Cutting back on bureaucracy in order to release time to care can be achieved by: understanding, reducing and actively policing the volume of requests from national bodies; by reducing the amount of effort it takes providers to respond to information requests; and by increasing the value derived from information that is collected. The Department of Health and every arm s length body have signed a Concordat to reduce the administrative burden arising from national requests for information. The NHS Leadership Academy will support a range of NHS staff (including clinical staff) to lead their teams and organisations to achieve more compassionate care for patients. A new fast-track leadership programme will attract senior clinicians and external talent to manage NHS hospitals. FTN view The FTN strongly supports the fostering of staff development and engagement as a key driver of better patient care and outcomes. The FTN was pleased to be part of advisory group to the bureaucracy review led by the NHS Confederation, and supports the Government s leadership in lessening bureaucratic burdens. For further information, please contact: Ferelith Gaze, Public Affairs Manager (ferelith.gaze@foundationtrustnetwork.org) FTN 7

64 Chapter 6 Conclusion: Learning from Mid Staffordshire The Government urges trusts to continue holding listening events to understand the concerns of their patients and staff and identify areas for improvement. Across the health and care system, staff want to deliver safe, effective and compassionate care, to feel safe to raise any concerns, and to have confidence that these will be tackled. This response is of necessity detailed in order to do justice to the insightful findings of a major public inquiry. Within this complexity, however, it is important never to lose sight of the simple messages at the core of changing culture: hear the patient, speak the truth, and act with compassion. FTN view The FTN has argued for the need to recognise the dangers of prioritising regulation and litigation over other approaches to improve quality, in particular culture and leadership. In the context of increasing financial pressure and the acknowledged 2015 cliff-edge facing the NHS, the question of how providers can meet the rising expectations and demands placed on them has not been answered. There is a further danger that the threat of litigation will become a key driver in resource allocation, distracting from patient outcomes and clinical quality. We hope that in implementing Francis recommendations, the importance of encouraging a positive culture and emphasising quality care in a learning environment will be preserved for the good of patient outcomes. FURTHER INFORMATION Government s full response to the Francis Report (November 2013): Hard Truths: the journey to putting patients first Government press releases: o New era for patients and NHS as Government accepts recommendations of Mid Staffordshire inquiry o Francis report on Mid Staffs: government accepts recommendations Related FTN on the day briefings: Special measures announcement Keogh mortality review Berwick safety review Friends and family test publication Government s initial response to the Francis Report (March 2013): Patients First and Foremost FTN s on the day members briefing Enc. 3.3 The Francis Report (February 2013): Final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry FTN s on the day briefing Quality of Patient Care letter sent to all chairs and chief executives of FTN members, January 2013 For further information, please contact: Ferelith Gaze, Public Affairs Manager (ferelith.gaze@foundationtrustnetwork.org) FTN 8

65 Enc. 3.4 Finance Report Month 7 (October) 2013/14 Council of Governors 11 December 2013

66 Enc. 3.4 Report to: Council of Governors Date of meeting: 11 December 2013 Subject: Finance Report Month 7 (October 2013) Author(s): Presented by: Sponsor: History: Status: Simon Dixon, Nicola Hoeksema, Iris Lewis Simon Taylor, Chief Financial Officer Simon Taylor, Chief Financial Officer First presented to Finance and Performance Committee Decision/Discussion/Information 1. Purpose The Finance Reports includes information on the Trust s financial performance and position which support the in-year submissions to Monitor on a quarterly basis. This report covers the Income & Expenditure position, Cost Improvement Programme, Capital and Working Capital Plans. 2. Action required The Board is asked to approve the Finance Report Page 2

67 Month 7 Executive Financial Summary Enc. 3.4 Annual Budget YTD Budget YTD Actual Month 7 YTD Variance Month 6 YTD Variance Movement in Month '000 '000 '000 '000 '000 '000 Income (excluding off Tariff Drugs) 802, , ,500 16,963 18,457 (1,493) Off Tariff drugs Income 45,122 25,319 29,795 4,476 3,123 1,352 Pay (469,121) (242,576) (255,516) (12,940) (10,665) (2,275) Non-Pay (excluding off tariff drugs) (387,661) (183,325) (193,569) (10,244) (8,304) (1,941) Off Tariff Drugs Expenditure (45,122) (25,319) (29,795) (4,476) (3,123) (1,352) Capital Charges, Interest and Dividends 50,989 25,906 24,762 (1,144) (792) (352) SLR/Internal Recharges (117) 134 (3) (137) (18) (119) Total (3,541) (324) (7,826) (7,502) (1,322) (6,180) Impairment Expense 8,000 4,660 4, Consolidated Annual Surplus/(Deficit) 4,459 4,336 (3,166) (7,502) (1,322) (6,180) Financial Key issues: The Trust is reporting an operating deficit of 3,157k year to date excluding the asset impairment accrual of 4.6m. The Continuity of Service Risk Rating is 4. (The previous Financial Risk Rating is a rating of 2 compared to the old annual plan target of 3.) The annual surplus target is 4.459m excluding the non-operating asset impairment cost of 8m for the year. The phased operating surplus plan for month 7 is 4,336k and therefore the Trust is 7,502k adverse from plan. The adverse movement in month is 6,180k compared to the previous month s adverse movement of 1,322k. The reason for the material movement in month 7 is due to the activity income over-performance reduction against plan; and the continued cost pressures resulting from agency nursing, medical locums and the use of off-site private hospital facilities. The drug expenditure has also increased sharply over the last two months. The income has remained in line with budget; whereas in previous months it has been over-performing by up to 3m. The contract income was phased in line with last years outturn patient spell activity figures and adjusted to meet income generation targets. The Trust is out-performing last year s activity numbers and the non-elective work split is still comparable with last year (about 42%). Last year October was the busiest month for inpatient activity and close to maximum capacity. The activity trends for all inpatient activity are presented on page 14. Page 3

68 Month 7 Executive Financial Summary Enc. 3.4 General medicine outliers and critical care activity demands have led to elective activity cancellations due to a shortage of beds and consequently reduced the level of income over-performance. The Orpington site was opened in the second week of October but is not fully operational to date. This is the reason for the adverse income variance of 1.3m in month 7. The overall position is a net loss of 863k to date, as there are under-spends on pay costs. No stock count was completed and therefore consumable costs will be over-stated. The staff cost base is increasing due to the continued use of medical locums and nursing agency staff. Medical staffing has moved adversely by 1m in month and relates to ED medical locums. The Nursing position has adversely moved by 1.2m and this due to agency nursing in Critical Care, TEAM and Liver theatre nurses. The slow recruitment process to fill nursing vacancies and the requirement to employ new nurses for service developments is compounding the agency financial cost pressure. The drugs expenditure has materially shifted over the last two months and there was an adverse movement in month of 2.4m. The drug usage and link to patient activity is being reviewed, particularly as a new Pharmacy stock control system was implemented in late July this year. The other significant cost pressure is the continued use of off-site private healthcare facilities to achieve elective RTT activity targets. This is unplanned expenditure and a contingency reserve of 1.7m was set aside for the delayed new capacity coming on line. The Trust has spent 4.3m to date which is an adverse variance of 2.6m as at month 7. The Trust spent 600k in month and this expenditure will be reviewed in light of additional capacity in January. This includes Infill Block 4 Theatres, Critical Care expansion in Christine Brown (ASU) and fully utilising Orpington. Clinical supplies were over-spent by 885k in month and this is related to activity over-performance. Contract income over-performance At month 7 the LSL CCG s are over-performing by 12.5m and NHSE by 10.9m against their contract values. The key service areas generating contract over-performance are critical care and emergency/non-elective in-patients. Off tariff drugs and the new maternity pathway tariff are also impacting on the income over-performance. The Trust is close to finalising the NHSE contract for 2013/14 but still awaiting confirmation of the Project Diamond Funding support ( 2.7m). The prior year PCT outstanding debts are still to be resolved with NHSE. A meeting with GSTT to resolve outstanding debts is being arranged to cover Vascular true-up activity, procurement costs and Dental SIFT transition. Page 4

69 Month 7 Executive Financial Summary Enc. 3.4 Winter Pressure Monies The Trust has invested 3.7m to date on DH winter pressure schemes (see page 8) and accrued the equivalent income figure based on funding indications given by LSL CCGs and NHSE. The income assumptions are based on receiving the tariff for emergency admission s at 100% which would equate to 3.4m in total. (LSL CCG s 2.2m and NHSE 1.2m based on current activity projections). A further 300k has been spent on PRUH winter pressure schemes (see page 9) and income has been accrued against this spend. ( 1.9m has been agreed with Bromley CCG). The Trust needs to implement winter pressure schemes to a value of 9m this year and therefore further funding is required from Commissioners. These schemes are required to achieve the A&E target and enable sufficient strides towards the elective RTT target. There is likely to be further central funding from the DoH to meet A&E targets and reduce emergency admissions. Cost Improvement Programme The cumulative total value of CIPs achieved at month 7 is 14.8m against a plan of 20.9m which includes the PRUH CIPs. The DH CIP performance has dropped from 75% to 73% achievement; against an internal target of 75%. The PRUH CIP is 16% against a target of 50%. (See pages 24-27) Capital and Cash The capital plan is over-committed by 9.4m primarily due to 2 schemes. The delivery of the Orpington Hospital development in quick time to meet the capacity pressures and a further 2m re-phasing on the Energy Performance Scheme. A capital development strategy is under review to meet future requirements and within the available resources. The Trust has received the PRUH PDC transactional funding ( 23m) and part payment of the revenue integration funding from NHSE ( 5.4m). Page 5

70 King s Winter Pressure Schemes 2013/14 Enc. 3.4 Denmark Hill Site M1-7 Actual Exp '000 M8-9 Forecast ' /14 Total '000 Neuro Nursing needed to cope with the increased acuity of patients CDU portacabin hire/ housekeeping & hostess service LAS performance nursing/ admin 1 band 6 ED Paeds nurse shift 24/7 ED Twilight SpR shift 7/7 RDL additional beds (12 beds until 30/9/13 then increasing to 28 beds) Acute Medicine wards nursing shift review Acute Medicine Consultant rota review to support weekend cover for 7/7 working Increased CDU capacity & new RAT/ majors assessment area Paediatric Short Stay Unit 2 Story CDU/Paediatric short stay modular unit Acute Medicine 7 day working Other Schemes , , ,408 1, Kings Total 3,680 5, , ,002 Page 6

71 King s Winter Pressure Schemes 2013/14 Enc. 3.4 PRUH Site Portacabin CDU facility outside EAU/ED & staffing Winter pressure ward (M1) 2 additional nursing shifts in ED 24/7 (to include all new majors capacity and paeds) Therapists - 7/7 working (ED/ CDU & EAU) 15 Paediatric Beds Other Schemes Total M1-7 Actual Exp '000 M8-9 Forecast ' /14 Total ' , ,934 Page 7

72 Month 7 Capital Summary Enc. 3.4 Capital Plan The Capital Plan has been included on page 32. The annual budget for 2013/14 has been reduced from m to 31,699m due to the re-phasing of the Critical Care Unit ( m) between 13/14 and 14/15. In 13/ m for the Critical Care Unit is to be funded by the loan received from the Foundation Trust Financing Facility m of the Capital Plan will be funded by charitable donations, 3m is funded by an Energy Grant from the Department of Health Energy Fund, with the remaining being funded by internal Trust resources such as Depreciation. The 3m budget for Orpington major works is funded by SLHT. Forecast Capital Expenditure Forecast capital expenditure for 13/14 has increased by 9.456m against the Trust s Annual Plan budget. Below is the breakdown of the changes to date. Budget per Annual Plan Revised Forecast Spend Net Variance Scheme 2013/ / /14 Comment '000 '000 '000 Additional costs for Fees and VAT, and project now incorporates the Maternity & Paediatrics 1, , refurbishment of Suites 4 & 7 in the Golden Jubilee Wing Emergency Centre 1, Lease of a 2 storey Portakabin with CDU and Paediatric beds has reduced the (729) need for capital spend on this project. ASU upgrade works - 1, , Upgrade of ASU to level 2 use Trundle Ward (550) Scheme aborted Energy Performance Contract 4, , , VAT excluded from initial estimate and payment to supplier has been re-phased Ultrasound reconfiguration (400) Scope of project reduced due to design viability issue CT Scanner Enabling Works Additional enabling works to install CT Scanner on ground floor of GJW Other major works Projects overspent at month 6 Minor Works - Capital Maintenance 1, , Budget required to complete Corridor Refurbishment project. Medical Equipment 1, , Additional funding required for Infill Block 4 Equipments and ED CDU unit Medical Equipment - CCU Additional funding required for Infill Block 4 Equipments and ED CDU unit Orpington Major Works 3, , Overspend due to change in planned use of Orpington hospital resulting in additional works been carried out. Orpington Equipment & IT - 2, , IT Infrastructure, theatre and therapies equipments for Orpington Hospital Total - KCH 13, , , PRUH - Estate projects 1, , Total - PRUH - 1, , Total capital budget/ forecast / variance (+ over, - under spend) 13, , , Page 8

73 Capital Expenditure Summary - KCH Month 7 Capital Expenditure - KCH Capital expenditure to month 7 was m against a re-phased year-to-date budget of m. The current under-spend against year-to-date budget relates primarily to the major works projects i.e. CCU Build and Energy Performance Contract and the phasing of their budgets over the first quarter of the financial year. It is anticipated that the spend will accelerate in this quarter. Overall, the Trust is forecasting to spend m at the end of the year against the budget of , resulting in an overspend of 8.136m ED has requested for additional works to be carried out which is estimated to cost 700k but yet to be approved Enc. 3.4 Capital Programme - KCH Budget Expenditure Total per capital category Annual Plan 13/14 Period Budget Actual YTD Cost to Complete Total Cost 13/14 Forecast Variance Major works 26,010 15,173 11,290 17,501 28,791 2,781 Capital Maintenance (Minor Works) 1, , Medical Equipment 1, , , IT and infrastructure 2,498 1, ,701 2,498 - Intangibles (IT) Donated - Major Projects ,198 1, Donated - Medical Equipments Orpington - Estate major works 3,000 3,000 3,946-3, Orpington - Equipments & IT ,905 2,700 2,700 Total Capital Position : Overspend (+) / Underspend (-) 34,699 21,077 19,420 23,415 42,835 8,136 Budget Period Budget Actual to date Anticipated Changes Y/E Forecast Gross capital expenditure b/f 34,699 18,077 19,420 23,415 42,835 (Intangible Assets Included Above) Non Cash Purchase of OMS Gross Cost 34,699 18,077 19,420 23,415 42,835 Less: Capital Donations held on Trust, NOF monies 1, ,024 Total 1, ,024 Capital Charge against Capital Resource Limit 33,675 17,895 19,238 22,573 41,811 Depreciation (Including Orpington) 15,876 9,261 7,520 8,356 15,876 PDC Receivable 2,980 2,980 2, ,980 SLHT Funding - Orpington External Borrowings 14,095 12,100 12,100 1,995 14,095 Internal Cash Resources (2,276) (9,446) (6,362) 4,086 (2,276) FT Capital Plan 33,675 17,895 19,238 14,437 33,675 Variance : + over / (-) under ,136 8,136 Page 9

74 Capital Expenditure Summary - KCH Month 7 Major Works Enc. 3.4 Major capital works breakdown There is a significant increase in the forecast for energy performance contract as the initial budget did not include VAT that will not be reclaimable. Also, there has been a re-phasing of payment as indicated in the plan above. MAJOR WORKS PROJECTS Scheme Annual Plan 2013/14 '000 Actual Spend to Month 4 '000 Cost to Complete '000 Forecast Cost '000 Variance to Plan '000 Maternity (MLU/MAU Expansion) 1,280 1, , Emergency Centre (Majors & External Works) 1, (729) ASU upgrade works - - 1,500 1,500 1,500 Energy Performance Contract 4,000 2,899 3,181 6,080 2,080 Day Surgery Unit (147) Liver Lab Research Facility Critical Care Unit - Phase 1 2, ,826 1,831 (669) Critical Care Unit - Fees Phase 1 & 2 1, ,000 - CCU Enabling Works - general 1, ,667 1,700 - CCU Enabling Works - IFB 4 1, ,000 - CCU Enabling Works - IFB 5 3, ,405 2,000 (1,500) CCU Development - Unit 8 (Waste Compound) 1,770 2,114-2, Site Wide Infrastructure 2,625 1,031 3,419 4,450 1,825 Pharmacy Dispensing Expansion Helideck Pet CT Scanner Enabling Works 1, ,000 - Diabetic Foot Clinic Office Moves & Reconfigurations (eg E-learning to Unit 4) Trundle Ward (550) Ultrasound Reconfiguration (400) Mortuary Expansion Endoscopy - Perfusionists Move Endoscopy - Changing Rooms Endoscopy - Fire Damage Works (7) Endoscopy - Building Works Decked Car Park Clinical Research Facility (Building) CT Scanner Enabling Works Other Major Works TOTAL 26,010 11,290 17,501 28,791 2,781 Page 10

75 Capital Expenditure Summary - Integration Month 7 Enc. 3.4 Capital Expenditure PRUH Integration There is a forecast overspend in integration works as we are currently forecasting to spend m of which 11m is funded by capital integration funding. The overspend of will impact on the Trust total overspend as this will have to be funded internally from depreciation Budget Capital Programme - Integration of PRUH Total per capital category Annual Plan 13/14 Expenditure Period Budget Actual YTD Cost to Complete Total Cost 13/14 Forecast Variance PRUH PRUH - Estate Projects Integration Projects 11,000 11, ,472 1,320 11,000 1,320 - Total Capital Position : Overspend (+) / Underspend (-) 11,000 11,000 1,032 11,288 12,320 1,320 Budget Period Budget Actual to date Anticipated Changes Y/E Forecast Gross capital expenditure b/f 11,000 11,000 1,032 11,288 12,320 Gross Cost 11,000 11,000 1,032 11,288 12,320 Depreciation - PRUH PDC - Capital Integration Funding Internal Cash Resources FT Capital Plan 1,944 11,000 (1,944) 11,000 1,134 11,000 (1,134) 11, ,000 (9,968) 1,032 1, ,024 9,968 1,944 11,000 (1,944) 11, ,320 1,320 Variance : + over / (-) under Page 11

76 3 Year Capital Plan Enc. 3.4 Scheme 2013/14 '000 Annual Plan Forecast Spend Variance 2014/15 '000 Maternity (MLU/MAU Expansion) 1, , Emergency Centre (Majors & External Works) 1, (729) 0 0 ASU upgrade works ,500 1, Energy Performance Contract 4,000 3, ,080 2,383 2,080 (617) 0 Day Surgery Unit (147) 0 0 Liver Lab Research Facility Adult Cystic Fybrosis Inpatient Facility - Guthrie Renal Dialysis Expansion 0 1, , Critical Care Unit - Phase 1 10,000 5, ,500 13,036 (7,500) 7,500 0 Critical Care Unit - Fees Phase 1 & 2 1,000 4,000 1,000 4, CCU Enabling Works - general 1, , CCU Enabling Works - IFB 4 & 5 4, , CCU Development - Cyber Knife Enabling Works (IFB 5 Basement) 2, , CCU Development - Unit 8 (Waste Compound) 1, , Site Wide Infrastructure 4,625 2,625 2,000 (2,000) 2,000 0 Critical Care Unit - Phase 2 11,736 9, ,600 (11,736) 11,736 0 Consulting Rooms for ATOS (Funded by ATOS) Pharmacy Dispensing Expansion Helideck Pet CT Scanner Enabling Works 1, , Diabetic Foot Clinic Office Moves & Reconfigurations (eg E-learning to Unit 4) Trundle Ward (550) 0 0 Ultrasound Reconfiguration (400) 0 0 Mortuary Expansion Additional Major Schemes 0 0 3,000 3, Endoscopy - Perfusionists Move Endoscopy - Changing Rooms Endoscopy - Fire Damage Works Portakabin Replacement Decked Car Park Clinical Research Facility (Building) CT Scanner Enabling Works Other Major Works Minor work schemes 1,000 1,000 1,000 1,147 1,000 1, Information Technology - Tangible Assets 2,000 1,500 1,500 2,000 1,500 1, Information Technology - Intangible Assets Medical Equipment new and replacement 1,540 1,250 1,250 2,490 1,250 1, Medical Equipment new and replacement (Critical Care) 0 3,349 3, ,388 3, (961) 0 Orpington Major Works 3, , Orpington Equipment & IT ,700 2, Total Capital Budget Expenditure 55,586 35,609 10,250 42,835 55,267 10,250 (12,751) 19,658 0 CCU Capital Expenditure 35,331 20, ,095 41, ,236 (21,236) Net Spend after CCU Loan 20,255 15,340 10,250 28,740 13,762 10,250 8,485 (1,578) 0 Donated - Equipment Donated - Critical Care Equipment (349) 0 Donated - Consulting Rooms Atos Donated - Adult Cystic Fibrosis Energy Grant 2,980 2, /16 ' /14 ' /15 ' /16 ' /14 '000 SLHT Funding - Orpington 3,000 3,000 0 Depreciation 15,876 15,989 16,289 15,876 15,989 16, Internal Funding 22,531 17,018 16,539 22,880 16,669 16, (349) 0 Additional Internal Funding (Available) / Required - KCH (2,276) (1,678) (6,289) 5,860 (2,907) (6,289) 8,136 (1,229) 0 PRUH - Estate works 0 1,320 1, Integration & PRUH 11,000 11, Depreciation - PRUH (1,944) (1,944) Integration & PRUH PDC Funding (11,000) (11,000) Additional Internal Funding Required - Integration (1,944) 0 0 (624) 0 0 1, Total Additional Internal Funding (Available) / Required (4,220) (1,678) (6,289) 5,236 (2,907) (6,289) 9,456 (1,229) /15 ' /16 '000 Page 12

77 Month 7 Working Capital Summary Enc. 3.4 Trade Debtors As at month 7 outstanding trade debtors totalled 53.8m. This total includes the following outstanding amounts: Private Patient and Overseas Visitors debts PCT Invoices 2012/2013 (net of credits) CCG SLA & NHS Commissioning monthly invoices 2013/2014 CCG Over-performance Months 1-4 Health Education England (Funding Oct-Dec) South London Healthcare NHS Trust Guy s & St Thomas NHS Foundation Trust King s College London 9.144m m 3.202m 8.904m 1.058m 2.200m 3.133m 3.702m Cash The Cash balance at the end of Month 7 was 35.6m against a forecast cash balance of 33.1m. Trade Creditors As at month 7, outstanding trade creditors totalled 22.2m. This total includes the following outstanding amounts: King s College London Guy s & St Thomas NHS Foundation Trust NHS Supply Chain 3.680m 2.702m 1.342m Working Capital Facility The Trust has not utilised its Working Capital Facility of 40m in the current financial year. The Trust s Working Capital Facility has been approved by NatWest and the new contract agreed. FT Borrowing The Foundation Trust Financing Facility agreed in December 2012 to provide external funding to the Trust to finance the construction of the Critical Care Unit. The first drawdown of funds against this loan was received in March 2013 for 4.4m and a further 5.9m was received in June 2013 and 6.2m in September Page 13

78 Statement of Financial Position (Balance Sheet)Enc. 3.4 STATEMENT OF FINANCIAL POSITION AS AT NON-CURRENT ASSETS Intangible Assets Property, Plant & Equipment Investments in associates On-Balance Sheet PFI Trade and Other Receivables, Non- Current Total Non-Current Assets CURRENT ASSETS Inventories Trade Receivables Other Receivables Impairment of Receivables Other Financial Assets Prepayments Cash & Cash Equivalents Total Current Assets CURRENT LIABILITIES Interest-Bearing Borrowings Deferred Income Provisions Current Taxes Payable Trade Payables Other Payables Other Financial Liabilities Total Current Liabilities 31 March 2013 Qtr 1 30 June '000 '000 '000 '000 1, , ,496 3, ,856 Qtr 2 30 September 31 October Consolidated Annual Plan Forecast 31 March 2014 '000 1, , ,111 3, ,052 1, , ,646 3, ,587 1, , ,491 3, ,005 1, ,946 1,749 74,372 3, ,005 11,333 38,684 1,968 (4,666) 5,866 3,258 40,502 96,945 11,250 17,871 19,257 (4,821) 51,228 5,188 16, ,001 13,299 32,398 26,679 (6,067) 40,823 6,429 11, ,761 11,670 51,512 21,756 (5,938) 28,712 11,867 35, ,240 11,300 39,934 2,968 (4,667) 9,613 3,258 26,551 88,957 (1,135) (5,552) (3,316) (4,095) (32,908) (14,958) (31,664) (93,628) (629) (6,199) (3,181) (8,173) (33,358) (18,724) (36,691) (106,955) (567) (7,635) (1,327) (8,147) (27,222) (19,640) (49,287) (113,825) (567) (10,342) (1,275) (10,495) (22,159) (17,956) (63,559) (126,353) (1,091) (4,442) (1,006) (4,400) (30,908) (14,974) (30,742) (87,563) 360, , , ,399 (21,249) (6,893) (75,584) (103,726) (27,449) (6,893) (75,584) (109,926) (27,449) (6,893) (75,584) (109,926) (49,590) (6,384) (74,702) (130,676) Total Assets less Current Liabilities 356,173 NON-CURRENT LIABILITIES Interest-Bearing Borrowings Provision Other Financial Liabilities Total Non-Current Liablilities (15,349) (6,893) (75,583) (97,825) Total Assets Employed 258, , , , ,723 Financed By (taxpayers' equity): Public Dividend Capital Revaluation Reserve Income & Expenditure Reserve 135,678 87,538 35, ,678 87,757 32, ,678 87,302 31, ,904 87,302 27, ,678 88,913 29,132 Total Taxpayers' Equity 258, , , , ,723 Trade and Other Receivables includes NHS and Non-NHS debtors on page 34 Trade and Other Payables includes NHS and Non-NHS creditors on page 35 Page 14

79 Glossary Enc. 3.4 CIP Cost Improvement Plan SLA Service Level Agreement PDC Public Dividend Capital PSPP Public Sector Payment Policy Working Capital Facility - represents a sum of money reserved by the relevant bank for potential use by the Foundation Trust Asset - An asset is a resource controlled by the enterprise as a result of past events and from which future economic benefits are expected to flow to the enterprise Liability - an entity's present obligation arising from a past event, the settlement of which will result in an outflow of economic benefits from the entity Equity - the residual interest in the entity's assets after deducting its liabilities EBITDA Earnings before Interest, Taxation, Depreciation and Amortisation EBITDA Achieved (% of Plan) measures the achievement of earnings against plan EBITDA Margin (%) Measures Earnings as a percentage of total income indicating underlying performance Return on Assets excluding Dividends Net surplus before Dividends as a percentage of average assets indicating financial efficiency I & E Surplus margin net of dividends Net surplus as a percentage of total income indicating financial efficiency Liquidity Ratio (days) - The liquidity ratio (days) indicates the number of days that net liquid assets can cover operating expenses without further cash coming from cash sales of fixed or long-term assets. Page 15

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81 Enc Report to: Council of Governors Date of meeting: 11 December 2013 Presented By: Subject: Jane Walters, Director of Corporate Affairs & Trust Secretary Council of Governors Update Purpose of the Report: This report provides an update on council of governors activities since the last meeting on 18 September The report covers the following: Annual Members Meeting. Election process for new governors; Engagement and involvement opportunities; Governor Development Day 14 November 2013; Action required: The Council of Governors is asked to note the contents of the report. 1

82 Enc Annual Members Meeting 18 September The Annual Members Meeting was held on 18 September at Avonmouth House near Elephant & Castle. It was a successful meeting, which was well attended by members (circa 200), governors and staff. This event represents the ideal opportunity for governors to engage with members and the local community. Lead Governor, Nicky Hayes, delivered a presentation on the contribution of governors during the year and changes to the Trust Constitution. 2. Governor Elections The Trust commenced the election process to fill the following vacant governor seats. Constituency Title Bromley Lewisham Medical & Dental (Staff) Nursing & Midwifery (Staff) Number of Governor Seat 4 Seats 1 Seat 1 Seat (Interim) 1 Seat (Interim) Prospective governor candidates were invited to attend an awareness session held at the Princess Royal University Hospital on 28 November. The event was well attended and governors Patti Kachidza, Andrew McCall, Brady Pohle and Fiona Clark were presenters. Nominations closed on Thursday, 05 December 2013 and there have been a significant number of nominees. The remaining timetable is as follows: Stages Date Final date for candidate withdrawal Thursday, 12 December 2013 Notice of Poll Monday, 06 January 2014 Voting packs despatched by ERS to members Tuesday, 07 January 2014 Close of the poll Thursday, 30 January 2014 Results Published Friday, 31 January 2014 New Governor Inductions February 2014 Council of Governors Meeting 05 March 2014 Additional promotion will be conducted to encourage members to vote. 2

83 Enc Governor Involvement and Engagement Initiatives Governors continue to participate in additional opportunities for involvement and engagement beyond the schedule of Council and committee meetings. Governors also assisted with Trust surveys in the Emergency Department, conducting clinic observations, completing how are we doing surveys? and also participating and facilitating King s in Conversations events with patients and staff. Outside the initiatives organised by the Trust a number of governors regularly attend local community forums and community groups. Governors also attend Health Overview and Scrutiny Committees and local health forums. From January 2014, the Board Go See programme is being rolled out to the PRUH and other sites, and Governors will be invited to participate in this programme. Involvement Activity Governor Trust Lead Description Status Date Public Health Committee Michelle Pearce Chair - Mike Marrinan Contributing lay/governor perspective to Public Health issues Ongoing Meets quarterly Staff Commendation Panel Tom Duffy, Jan Thomas Chair - John Karani, Contact - Angela Huxham Contribute to decisions on staff awards Ongoing Ongoing Improving King's Patient Food Service Food Service and Nutrition Group Jan Thomas Rick Wilson Contributing lay/governor perspective Ongoing Ongoing Community Events All Governors Jane Walters / Sally Lingard Series of annual events for members Annual Spring 2014 Patient Experience Jan Thomas, Tom Jane Walters / Jessica Lay representation on trust committee Ongoing Monthly Committee Duffy, Christine Klaassen Bush which reports to the Board's Quality and Governance Committee. End of Life Care Steering Jan Thomas Wendy Prentice Lay involvement Ongoing Group National Governors' Forum (FTN Network) Tom Duffy and Jan Thomas n/a External networking Current 3

84 Enc Involvement Activity Governor Trust Lead Description Status Date Maternity Services Liaison Committee (Maternity Matters) Patti Kachidza Maxine Spencer, Director of Midwifery Lay representation of trust wide maternity group which seeks to improve all aspects of maternity care. MDT group with lay membership of women who have had babies at On-going End of Life Care Steering Group Outpatient Experience Outpatient Transformation Patient Experience Workstream Outpatient CQUIN 2013/2014 Suite One Brady Pohle Expressions of interest welcome for an ongoing programme of gathering a range of outpatient feedback alongside roll-out of the HRWD outpatient survey. Taking part to date: Christine Klaassen, Michelle Pearce, Stuart Owen Stuart Owen and Christine Klaassen Michelle Pearce Jessica Bush and Wendy Prentice Jessica Bush TBC Anna Starling/ Rachel Sugarman King's. Meet bi-monthly. Governor involvement in End of Life Care Steering Group looking at all aspects of end of life care Patient feedback to inform trust-wide transformation of outpatient services. Carrying out observations, 'Adopt a Suite' to provide on-going support for staff engaged in service improvement Governor representation on Patient Experience Working Group for the outpatient transformation programme Improving the patient experience in Suite 1 which is a 2013/2014 patient experience CQUIN Older Person's Group Fiona Clarke Graeme Groome Governor representation on Older Person's Group Patient Video Stories Expressions of interest Jessica Bush / Sam Block To take part in filming patient video from Stuart Owen, Tom stories and linking with Divisions on Duffy, Jan Thomas and service improvement Michelle Pearce On-going Started Autumn 2012 TBC Jul-12 Ongoing January 2014 Ongoing 4

85 Enc Involvement Activity Governor Trust Lead Description Status Date PLACE - Patient Led Assessments of the Care Stuart Owen Jorge Sousa / Cristina Romao Patient involvement environment - PLACE has replaced PEAT Annual 2014 dates TBC Environment inspections. Francis Steering Group Tom Duffy Roland Sinker Trust-wide Steering Group to lead on KCH's response to the Frances May-13 King's In Conversation Tom Duffy, Fiona Clark, Jan Thomas Forthcoming opportunities to get involved include: Angela Huxham Site Visit to Orpington Hospital - 13 December 10:00-12:00 KHP Safety Connections Event - 09 December - 17:30-19:00 Report To be facilitators at King's In Conversation Events. Jun-13 Oct-13 Joint KHP Governors - 16 December 17:30-19:30 Boardroom, Denmark Hill Trust Christmas Party 17:00 20:00 Boardroom, Denmark Hill Dignity Month - February 2014 Other opportunities are published in the regular Governors bulletin. 5

86 Enc Governor Development Day 14 November 2013 The Foundation Trust Network (FTN) delivered the governor development day held on 14 November and the invitation was extended to all governors from the three KHP foundation trusts. It was a bespoke session but based on the core skills module of the FTN s national GovernWell training programme for governors. The event was well attended by governors with varying experience from new to longstanding governors: 10 Governors from King s College Hospital NHS Foundation Trust 9 Governors from Guy s and St Thomas Hospital NHS Foundation Trust 14 Governors from South London & Maudsley Hospital NHS Foundation Trust Governors were asked to complete an evaluation form at the end of the day. In summary, 19 out of the 20 governors who responded said they would recommend the course to other governors and the overall impression of the event was rated an average of 4.65 out of 5 (5=excellent) A selection of comments from the feedback forms include: A repeat of what has been delivered before uninteresting A repeat of what has been delivered before a useful repetition and reinforcement of the key issues Too much material for one day It would have been good to have 1 st hand experience from governors how they do things and what would perhaps be good to try. Better understanding of the role and confidence to perform duties in light of Health & Social Care Act Need to develop effective ways to hold NEDs to account. 6

87 Enc Report to: Council of Governors Date of meeting: 11 December 2013 Presented By: Subject: Jane Walters, Director of Corporate Affairs & Trust Secretary Council of Governors Forward Planning Purpose of the Report: This report provides details of the proposed forward plans for the Council of Governors Action required: The Council of Governors is asked to: Note the contents of the report ; Offer any comments or suggestions as appropriate; Approve, where appropriate the proposed forward plan

88 Enc Forward Planning Scheduled Meetings and Events 2014 Appendix 1 provides the timetable of governor meetings and events for These meetings have been agreed with the Chair, Lead Governor and Governor Committee/Group Chairs. The timetable is also based on the regulatory timetable imposed on the Trust. The timetable reflects requests from the Council as follows: Meetings have been consolidated over fewer days; An additional joint Board/Council meeting has been added to the timetable; The governor-led development day remains on the timetable; Meetings have been scheduled at the other sites; Meetings scheduled to take place in the morning, afternoons and evenings to accommodate different availability; and There are opportunities for governors to meet informally. Subject to any material changes arising from this meeting, this schedule can be considered as final and all the meetings will go ahead as timetabled. It should also be noted the at least one non-executive director is linked to each governor committee or group. Action: The Council is asked to approve the Council of Governors 2014 Meetings and Events in Appendix Other Governor Involvement and Engagement Initiatives Last year the foundation trust office launched the governor bulletin in response to calls from Council to streamline the number of s sent to governors. 16 bulletins were issued in The bulletins detail forthcoming council meeting dates and opportunities for governors to get involved with engagement organised by the Trust or local community organisations and groups. At a recent meeting, the Board of Directors agreed that the Go See Programme would be extended to include governors. This programme is currently being developed and will be presented to the Council early in In addition, to provide more opportunity for engagement with members, the Trust is proposing using 2 of the governor workshops as membership focus groups members, from a mix of public, patient and staff, would be invited to attend a session with governors, to enable 2-way feedback. Action: The Council is asked to consider this proposal and agree that the Trust should explore the feasibility of putting this in place with the Lead Governor with the view of providing an update at the next meeting of the Council Governor workshops and development days Governors have indicated that they welcome opportunities to hear from external speakers. Accordingly, the Trust will attempt to schedule an external speakers or consultants for workshops and development days. The agenda for the workshop and in part the Trust-led development day will be driven by the feedback from governors. 2

89 Enc Reflecting on some comments from governor it is proposed governors review the suggested outline for governor workshops and offer any comments: Session Focus Delivered by Opportunities to gain a better understanding of Trust s Knowledge Session systems and processes for Trust Director of Senior example, finance, IT, Managers performance management. External Outlook Non-Executive Director Updates Exploring the wider environment and strategic challenges influencing the Trust. Hear from one of the Non- Executive director about the performance of the Trust. Strategy Directors and/or external speakers Chair or NED Action: The Council is asked to consider this proposal and agree that the Trust should explore the feasibility of putting this in place with the Lead Governor with the view of providing an update at the next meeting of the Council. 3

90

91 Enc. 4.1 Report to: Council of Governors Date of meeting: 11 December 2013 Presented By: Subject: Jane Walters, Director of Corporate Affairs & Trust Secretary Council of Governors Annual Review Purpose of the Report: This report contains a review of Council of Governors activities between January-December December 2013 marked the second anniversary of the current Council of Governors and in what has been an important year this seems an appropriate point to review the work of the Council. In addition, it is equally important that the Council looks forward and plans its activities for the year ahead. Action required: The Council of Governors is asked to note the report. 1

92 Enc. 4.1 Council of Governors Annual Review January-December

93 Enc. 4.1 At a glance Council activities Scheduled Meetings/Events The Council holds four meetings per year and attendance at these meetings is recorded in the Trust s Annual Report & Accounts. The current Council has constituted three sub-committees to take a deeper look into specific matters such as membership and community engagement (MCE), strategy (SC) and patient safety and experience (PESC). The Council formed a transport feeder group (TFG) which looks into transport issues. Governors with particular interests are encouraged join these sub-committees and the working group. In 2013 each group was scheduled to meet four times. The Trust is also required to provide governors with the appropriate training which will equip them with the necessary skills to carry out their duties. This is done at the Governor Development Days and Governor Workshops. The Trust also holds an Annual Members Meeting, which provides governors with the opportunity to engage with the local community and the membership body. In addition, the Trust ensures there are sufficient opportunities for the Council to engage with members of the Board of Directors and to network with governor colleagues across King s Health Partners (KHP) organisations. Meeting/Event Number Council of Governors (CoG) 4 Membership & Engagement Committee 4 (MCEC) Patient Experience and Safety Committee 4 (PESC) Strategy Committee (SC) 4 Transport Feeder Group (TFG) 4 Trust-led Governor Development Day 1 (GDD) Annual Members Meeting (AMM) 1 Governor Workshops 4 Joint meeting of the Board & Council 1 KHP Joint Governor Events 3 Total number of scheduled meetings in 2013 Table 1: List of meetings scheduled for Additional meetings were timetabled to respond to requests from the Council for more information, training and engagement or in accordance with the regulatory timeframes. Table 2 outlines the actual meetings and events convened to support the work of the Council in In total, six additional Council meetings and events took place in

94 Enc. 4.1 Table 2: List of Council Meetings and Events 2013 Schedule (S) Actual (A) Meeting/Event Notes Programmed Council of Governors S A S A July and 05 September to discuss matters relating to SLHT. Sub-committees and feeder Additional meeting of the MCE group to discuss proposed changes to MCEC the Trust Constitution. SC PESC One meeting of the Transport TFG Feeder Group was cancelled. Governor Workshops 01 July became an extraordinary Council to discuss proposed acquisition of SLHT assets and services. 03 October was converted to a site visit of the PRUH site, which was rescheduled for 19 November because of low take-up Special Seminars Governor-led Development Days Trust-led Governor Development Days Governor workshops are opportunities for governors to hear more about specific areas of work in the Trust. They are in effect deep dive session which provides learning opportunities for participants. 06 March - Special seminar to discuss the outcome of the Francis inquiry and the planned Trust response. Development day scoped and planned by governors themselves. At request of Governors Trust organised joint development day with KHP Governors. The programme was delivered by the Foundation Trust Network and was based on the core GovernWell training programme. Joint KHP meetings Two joint meetings have taken place and the third is scheduled for 16 December Joint Board and Council Meetings Annual Members Meeting

95 5 Enc Training and Development The previous Council of Governors were keen to ensure that the incoming Council were provided with the right level of induction and training. Similarly, the current Council s input and feedback has shaped a neww induction, development and training programme for governors. The development and training opportunities provided to governors in 2013 are as follows: Meeting/Event Number Trust-led Governor Development Day (GDD) 1 Governor-led Governor Development Day 2 (GDD) Governor Workshops 2 Table 3: Training Opportunities provided in Governor-led Governor Development Day At the request of governors, two additional governor-led development days were added to the timetable in These were held on 07 January and 10 June. These events where coordinated by the Lead Governor, Nicky Hayes, with support from the Foundation Trust Office team. In consultation with governors, the following topics were agreed for the development days: 07 January June 2013 New NHS Commissioning Structures Francis and the Implications for FT Peter Fry, Associate Director of Contracts Governors & Performance John Coutts, FTN Communicating Key Messages Chris Rolfe, Head of Communications Finance Update Jonathon Rowell, Associate Director of Finance South London Healthcare Trust Jacob West, Director of Strategy Mergers and takeovers Simon Morioka, PPL Consulting How can I add value as a King s Governors? Review and empowerment facilitated session Table 4: Governor-led Development Days Agendas A facilitated discussion session for exploring ideas, issues and giving feedback was held at the end of each of the seminar session Trust-led Governor Development Day The agenda for the annual Trust-led governor development has traditionally been dictated by current topical events, feedback from governors about learning needs and skills gaps and internal strategic goals. Executive directors and senior managers of the Trust predominately delivered the programme. In 2013, the following factors drove the agenda for the development day: The Health and Social Care Act 2013 reconfirmed the duty of the Trust to take steps to equip governors with the skills and knowledge they need to discharge their duties appropriately;

96 6 Enc. 4.1 The introduction of the Foundation Trust Network s GovernWell training programme; and Request from the governor-led development days for the Trust to provide joint training across King s Health Partners (KHP). Accordingly, the Foundation Trust Network (FTN) delivered the Trust-led development day held on 14 November and the invitation was extended to all governors from the three KHP foundation trusts. It was a bespoke session but based on the core skills module of the FTN s national GovernWell training programme for governors Other development and training opportunities Governor workshops are one of the key ways in which the governors can learn more about a particular subject and activity. In 2013, the topics covered at the two governor workshops were: PRUH Operational Structure PRUH Clinical Services Engagement initiatives and the Friends and Family Test Cancer Clinical Academic Group Transformation programme Neurosciences Clinical Academic Group HR update The agendas for these workshops are set by governors who are asked to suggest topics. Governors were also offered the opportunity to attend a course from the FTN s national GovernWell programme Induction of governors As part of the development and training programme, governors were keen to ensure that the induction element of the programme was robust. Taking on board feedback from current governors, that it is important to ensure that prospective governors are made aware of the breadth of the role they are taking on, the introduction of a Governor Awareness Session for prospective governors was agreed by the Membership and Community Engagement Committee (MCE) on 16 October. The MCE also agreed that the new governor induction programme should be enhanced as follows: Meetings with the Chair, Chief Executive, Trust Secretary and Lead Governor 2 day induction programme which includes the sessions detailed above some of which will be delivered by governors. Supplementary training from the FTN GovernWell Programme. An online governor handbook located on the password protected Trust extranet Governors attend Trust corporate induction this will become mandatory Opportunity to buddy with a serving governor - a rota of current governors available to mentor new governors will be drawn up and new governors will be assigned to an existing governor. This will become a mandated remit. Signposting to relevant external organisations such as Monitor, Foundation Trust Network and the FT Governors Association A knowledge review is completed by each governor

97 7 Enc Key Council Decisions in 2013 The following is an overview of some of the key decision taken by the Council in 2013.

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99 REGISTER OF GOVERNOR ATTENDANCE (PUBLIC) Enc. 4.2 NAME CONSTITUENCY MEETINGS ATTENDED REASON FOR ABSENCE May 2012: Sent apologies for absence - Unwell Prof Marc Meryon deputised. Sept George Alberti Chair c c Sir 2012: Sent apologies for absence - unwell. Graham Meek deputised. Mr Andy Alatise Southwark Central c c c c N/A N/A May 2012: Sent apologies for absence - Unwell Dec 2011: Sent apologies for absence - Out of the country. Ms Phyllis Barnett Allied Health Professionals c c c c c Dec 2012 and May 2013: Reasons for absence personal and notified to the Chair. Ms Carol Bell Joint Staff Committee c c c N/A N/A Dec 2012: Sent apologies for absence Feb 2013: Sent apologies for absence: union commitment Dr Rachel Burman Medical and Dentistry Ms Carolyn Campbell-Cole Nurses and Midwives c c c Ms Fiona Clark Lambeth North Dec 2011: Sent apologies for absence - Unwell. Dec 2012: Sent apologies for absense 05 Sept 2013: Sent apologies for absence - Reasons Unknown Ms Pam Cohen Southwark Central N/A N/A N/A N/A N/A N/A c May 2013: Sent apologies for absence - Reasons Unknown Mr Derek Cookson Patient c c c May 2012: Sent apologies for absence - Unwell. 05 Sept 2013: Sent apologies for absence - Reasons Unknown Cllr Jim Dickson Lambeth Council N/A N/A c c c Dec 2012: Sent apologies for absence - Urgent Council Business 05 Sept 2013: Sent apologies for absence - Reasons Unknown 18 Sept 2013: Sent apologies for absence - Reasons Unknown Mr Thomas Duffy Patient c c c May 2012: Sent apologies for absence - On holiday Sept 2012: Sent apologies for absence - On holiday May 2013: Sent apologies for absence - Reasons Unknown Mr Richard Gibbs Southwark Primary Care Trust c c May 2013: Sent apologies for absence - On holiday Ms Nicky Hayes Nurses and Midwives Ms Sue Gallagher Lambeth PCT N/A N/A N/A N/A c c Dec 2012: Sent apologies for absence - Work commitments Ms Patti Kachidza Patient c c c c c Ms Christine Klaassen Patient c c May 2012: Sent apologies for absence - Away Sept 2012: Sent apologies for absence - work commitments Dec 2012: Sent apologies for absence - work commitments 05 Sept 2013: Sent apologies for absence - Reasons Unknown 18 Sept 2013: Sent apologies for absence - Reasons Unknown Feb 2012: Sent apologies for absence - On holiday. Feb 2013: Sent apologies for absence - On holiday. Mrs Phidelma Lisowska Joint Staff Committee N/A N/A N/A N/A N/A N/A N/A Ms Madeliene Long South London & Maudsley NHS Foundation Trust c c c c c Feb 2013: Sent apologies for absence - conflicting meeting May 2012: Reason unknown Feb 2012: Sent apologies for absence - Conflicting meeting. 05 Sept 2013: Sent apologies for absence - Reasons Unknown 18 Sept 2013: Sent apologies for absence - Reasons Unknown Mr Andrew McCall Southwark North Cllr Catherine McDonald Southwark Council N/A N/A N/A c c c May 2013: Sent apologies for absence - On holiday 05 Sept 2013: Sent apologies for absence - Reasons Unknown 18 Sept 2013: Sent apologies for absence - Reasons Unknown Mr Chris Mottershead King's College London c c c Feb 2012: Sent apologies for absence - Conflicting meeting Dec 2011: Unknown Dec 2012: Sent apologies for absence - Transportation problems 05 Sept 2013: Sent apologies for absence - Reasons Unknown Mr Christopher North Lambeth North Mr Joe Onabaworin Southwark North N/A N/A N/A N/A N/A N/A c Feb 2013: attended meeting as an observer prior to taking up role as governor Mr Stuart Owen Southwark South c Feb 2012: Sent apologies for absence - Unwell. Ms Barbara Pattinson Southwark Central c Sept 2012: Reason unknown Mrs Michelle Pearce Southwark South Mr Brady Pohle Administration and Clerical c May 2012: Sent apologies for absence - Personal conflict Mr Nandakumar Ratnavel Lambeth South Mr Michael Robinson Lambeth Central c c Mr David Sullivan Patient c c c c c c May 2012: Reason unknown 18 Sept 2013: Sent apologies for absence - Reasons Unknown May 2012: Sent apologies for absence - Reasons Unknown Sept 2012: Sent apologies for absence - Reasons Unknown Dec 2012: Sent apologies for absence - Reasons Unknown Ms Diane Summers Guy's & St Thomas' Hospital NHS Foundation Trust c c Dec 2012: Sent apologies for absence Feb 2013: Sent apologies for absence: union commitment 18 Sept 2013: Sent apologies for absence - Clashes with GSTT Annual Meeting Meeting Dates Key: (1) 01 December 2011; (2) 14 February 2012; (3) 09 May 2012; (4) 13 September 2012; (5) 05 December 2012; (6) 13 February 2013; (7) 15 May 2013 (8) 05 September 2013 (9) 18 September 2013

100 REGISTER OF GOVERNOR ATTENDANCE (PUBLIC) Enc. 4.2 Ms Jan Thomas Patient c c c c Feb 2012:Sent apologies for absence - On holiday. Feb 2013:Sent apologies for absence - On holiday. 18 Sept 2013: Sent apologies for absence - Reasons Unknown Mr Ahmad Toumadj Support Staff c c Sept 2012: Reason unknown 18 Sept 2013: Sent apologies for absence - Reasons Unknown Dr Warren Turner London South Bank University N/A N/A N/A N/A N/A c 05 Sept 2013: Sent apologies for absence - Reasons Unknown Mr Godwin Ubiaro Lambeth Central c c c Mrs Alam Zabit Lambeth South c c c c N/A N/A Dec 2012: Sent apologies for absence - Personal reasons notified to the Chair. May 2013: Sent apologies for absence - Reasons Unknown Sept Hospital Appointment. May 2012: Sent apologies for absence - Unwell Feb 2012: Sent apologies for absence - Unwell. May 2013: Sent apologies for absence - Unwell Resigned 01 August Meeting Dates Key: (1) 01 December 2011; (2) 14 February 2012; (3) 09 May 2012; (4) 13 September 2012; (5) 05 December 2012; (6) 13 February 2013; (7) 15 May 2013 (8) 05 September 2013 (9) 18 September 2013

101 Enc 4.3 Report to: Council of Governors Date of meeting: 11 December 2013 Subject: Monitor Submission Quarter 2, 2013/2014 Author: Presented by: Status: Tamara Cowan, Assistant Board Secretary Tim Smart, Chief Executive For Information 1. Purpose NHS Foundation Trusts are required to make in-year submissions on a quarterly basis during 2013/14 which includes information on its financial performance, statements from the board certifying compliance with specific board statements including the underlying data that informs them where appropriate, any relevant exception reports and results of any governor elections. This report provides the details of the submission made to Monitor for the Trust based on results/data in Quarter 2, July-September Action Required The Council is asked to note the Quarter 2 submission to Monitor approved by the Board and submitted to Monitor. 3. Key implications Legal: Financial: Assurance: Clinical: Equality & Diversity: Performance: Strategy: Workforce Estates: Reputation: Other (specify): Statutory reporting to Monitor. Trust reports financial performance against published plan. The summary and appendices provide assurance that the Trust has met all targets and is compliant with its terms of authorisation. There is no direct impact on clinical issues. There is no direct impact on E&D. Quarterly performance against national targets. Performance against the trust s annual plan forecasts. None. There is no direct impact on Estates. Trust s quarterly results will be published by Monitor. None.

102 Enc Background Under Monitor s reporting regime, the Trust is required to make in-year submissions on a quarterly basis during 2013/14 which include: Quarterly financial and performance risk rating; Board certification of compliance with governance statements as detailed below; and Results of any governor elections. 2. In year reporting 2.1. In year governance statement The Board is required to respond, confirmed of not confirmed to following statements: For finance that: The board anticipates that the trust will continue to maintain a financial risk rating of at least 3 over the next 12 months. For governance that: The board is satisfied that plans in place are sufficient to ensure: ongoing compliance with all existing targets after the application of thresholds) as set out in Appendix B of the Compliance Framework; and a commitment to comply with all known targets going forwards. Otherwise: The board confirms that there are no matters arising in the quarter requiring an exception report to Monitor (per Compliance Framework page 17 Diagram 8 and page 63) which have not already been reported Quarterly financial risk rating The quarterly financial performance for the Trust is included in Appendix 1. The Board noted that the Trust confirmed a financial risk rating of 3 for Quarter 2 (1 July 30 September 2013). The Board approved the signing Confirmed to the finance statement Quarterly performance risk rating The quarterly performance against healthcare targets and indicators set out in the Monitor s Compliance Framework for the Trust is included in Appendix 2. The Board noted that the Trust confirmed a governance rating of Amber-Green for Quarter 2 (1 July 30 September 2013). The Board approved the signing of Confirmed to the governance statement. 2 of 3

103 Enc Exception reports The Board is asked to note that there have been no matters arising which required and exception report to Monitor which have not already been reported. The Board approved the signing of Confirmed to the otherwise statement Results of Governor Elections The Trust has held no Governor elections during the quarter. 3. Risk Assessment Framework On 1 October 2013, Monitor s Risk Assessment Framework ( RAF ) replaced the Compliance Framework as Monitor s approach to overseeing foundation trusts. Monitor has assigned the Trust a governance risk rating (GRR) Green and advised that the Trust s Q1 13/14 financial risk rating (FRR) will remain unchanged. The introduction of the RAF would result in the format of this report changing. 4. Recommendation The Council is asked to note that the Board approved the following recommendations: 4.1. In line with Monitor s reporting requirements, approved the Trust declarations for the Q2 Monitor detailed in this report; 4.2. Authorised GA and TS to sign-off the final submission and the Governance Statements; and 4.3. Noted that the introduction of the Risk Assessment Framework this report will change next quarter. The following appendices are attached: Appendix 1 Financial Summary Appendix 2 Declarations of risks against healthcare targets and indicators Appendix 3 Governance Statements 3 of 3

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105 Risk Ratings based on Annual Planning return from KINGS Appendix 1 Reported Quarter to 30-Jun-13 Reported YTD to 30-Jun-13 Reported Quarter to 30-Sep-13 Reported YTD to 30-Sep-13 Underlying performance key to scoring EBITDA YTD Underlying performance 25% Operating Revenue for EBITDA YTD EBITDA Margin metric 4.4% 4.4% 4.4% 4.4% EBITDA Margin rating % 9% 5% 1% <1% Achievement of plan Actual EBITDA from SoCI Achievement of plan 10% Planned EBITDA from SoCI (APR Plan) EBITDA % of plan achived metric 92.1% 92.1% 94.4% 93.3% EBITDA % of plan achived rating % 85% 70% 50% <50% Financial Efficiency Net return after financing costs, YTD (0.286) (0.286) Opening Financing Net Return after financing 20% Closing Financing Net return after Financing metric -0.3% -0.3% 0.4% 0.0% Net return after financing rating % 2% -0.5% -5% < -5% Surplus / (deficit) YTD (2.194) (2.194) (1.774) (3.968) Gain / (loss) on asset disposals (0.025) (0.025) (0.070) (0.095) Gain / (loss) on transfers by absorption I & R (Impairments & restructuring) expenses YTD (2.000) (2.000) (2.000) (4.000) IS surplus margin 20% Total IFRS Operating Revenue YTD IS Surplus margin metric -0.1% -0.1% 0.2% 0.0% IS Surplus margin rating % 2% 1% -2% < -2% Liquidity Financial Efficiency rating Cash for liquidity purposes Operating expenditure within EBITDA YTD Liquidity metric 25% WCF in terms of Operating Expenditure YTD Liquidity days metric (WCF limited to 30 days) Liquidity rating <10 Weighted Average Rating Financial Risk Rating

106 Continuity of Service Shadow Risk Ratings (pilot indicators for 2013/14) Appendix 1 Debt Service Cover Historic Year to 31-Mar-13 Reported Quarter to 30-Jun-13 Reported YTD to 30-Jun-13 Reported Quarter to 30-Sep-13 Reported YTD to 30-Sep-13 PDC dividend expense (7.764) (1.950) (1.950) (2.050) (4.000) Interest Expense on Overdrafts and Working Capital Facilities - (0.035) (0.035) (0.035) (0.070) Interest Expense on Bridging loans Interest Expense on Non-commercial borrowings (0.578) (0.215) (0.215) (0.215) (0.430) Interest Expense on Commercial borrowings Interest Expense on Finance leases (non-pfi) Interest Expense on PFI leases & liabilities (7.513) (1.860) (1.860) (1.860) (3.720) Other Finance Costs (0.175) (0.042) (0.042) (0.040) (0.082) Non-Operating PFI costs (eg contingent rent) (2.143) (0.622) (0.622) (0.622) (1.244) Public Dividend Capital repaid Repayment of bridging loans Repayment of non-commercial loans (1.012) (0.506) (0.506) - (0.506) Repayment of commercial loans (0.123) - - (0.062) (0.062) Capital element of finance lease rental payments - On-balance sheet PFI (0.733) (0.201) (0.201) (0.201) (0.402) Capital element of finance lease rental payments - other Debt Service Revenue available for Debt Service Debt Service Debt Service Cover metric 1.77x 1.42x 1.42x 1.63x 1.53x Debt Service Cover rating Liquidity Cash for CoS liquidity purposes Operating Expenses within EBITDA, Total Liquidity metric Liquidity rating Continuity of Service Risk Rating key to scoring Debt Service Cover 50% <1.25 key to scoring Liquidity 50% <-14 2

107 Appendix 1 Financial Summary Previous YE Quarter YTD FY Actual Plan Actual Variance Plan Actual Variance Plan Operating Revenue for EBITDA Employee Expenses (374.1) (98.6) (105.1) (6.5) (196.9) (207.9) (11.0) (395.6) Drugs (67.9) (16.5) (19.7) (3.2) (31.6) (37.3) (5.7) (68.7) PFI operating expenses (26.4) (6.9) (6.9) (0.0) (13.8) (13.7) 0.1 (27.6) Other costs (175.2) (40.8) (49.6) (8.8) (78.1) (88.8) (10.7) (169.8) Clinical supplies (64.9) (16.1) (17.6) (1.4) (30.9) (31.8) (0.9) (67.2) Decrease (increase) in inventories of finished goods & WIP Vehicle Fuel costs (ambulance trusts) Non-clinical supplies (35.2) (7.8) (10.3) (2.5) (14.9) (17.9) (3.0) (32.4) Cost of Secondary Commissioning of mandatory services Research & Development expense Education and training expense Misc. other Operating expenses (73.4) (16.9) (20.4) (3.6) (32.3) (37.7) (5.3) (70.2) EBITDA (0.5) (1.2) 32.8 Donations of PPE & intangible assets (0.1) (1.1) (1.0) 3.7 Depreciation and amortisation (14.7) (4.0) (3.1) 0.9 (8.0) (6.4) 1.5 (16.6) Impairment Losses (Reversals) net (on non-pfi assets) (9.1) (2.0) (2.0) 0.0 (4.0) (4.0) 0.0 (8.0) Impairment Losses (Reversals) net on PFI assets Restructuring Costs Operating Surplus (0.7) (0.6) 11.8 Net interest (7.9) (2.1) (2.1) 0.0 (4.2) (4.2) 0.0 (8.4) Interest Income Interest Expense on Overdrafts and Working Capital Facilities 0.0 (0.0) (0.0) 0.0 (0.1) (0.1) 0.0 (0.1) Interest Expense on Bridging loans Interest Expense on Non-commercial borrowings (0.6) (0.2) (0.2) 0.0 (0.4) (0.4) 0.0 (0.9) Interest Expense on Commercial borrowings Interest Expense on Finance leases (non-pfi) Interest Expense on PFI leases & liabilities (7.5) (1.9) (1.9) 0.0 (3.7) (3.7) 0.0 (7.4) Other Non-Operating items (9.8) (2.4) (2.8) (0.4) (4.7) (5.4) (0.7) (9.4) Gain (Loss) on Financial Instruments Designated as Cash Flow Hedges Gain (Loss) on Derecognition of Available-for-Sale Financial Assets Gain (Loss) on Derecognition of Non-Current Assets Not Held for Sale, Total Gain (Loss) from investments Dividend Income Share of profit (loss) from equity accounted Associates, Joint Ventures, Total (0.3) (0.6) 1.2 Other Non-Operating income, Total (0.5) (0.0) (0.1) (0.0) (0.1) (0.1) (0.0) (0.1) Other Finance Costs (0.2) (0.0) (0.0) 0.0 (0.1) (0.1) 0.0 (0.2) PDC dividend expense (7.8) (2.0) (2.1) (0.1) (3.9) (4.0) (0.1) (7.8) PFI Contingent Rent (2.1) (0.6) (0.6) 0.0 (1.2) (1.2) (0.0) (2.5) Other Non-Operating expenses (incl. Misc) Income Tax (expense)/ income Net Surplus / (Deficit) (5.9) (0.6) (1.8) (1.2) (2.6) (4.0) (1.3) (6.0) EBITDA % Income 5.1% 5.1% 4.4% -0.7% 5.1% 4.4% -0.7% 4.7% CIP% of Op.Exp. less PFI Exp. 1.5% 3.0% 0.0% -3.0% 2.7% 0.6% -2.0% 2.8% Pay CIPs as % Pay Costs -1.1% -1.9% 0.0% 1.9% -1.5% -0.2% 1.2% -1.6% Net Surplus / (Deficit) (5.9) (0.6) (1.8) (1.2) (2.6) (4.0) (1.3) (6.0) Change in working capital 13.1 (0.8) (5.8) (5.0) (14.7) (36.5) (21.8) (12.3) (Increase)/decrease in inventories (0.4) (0.1) (2.0) (2.0) 0.1 (2.0) (2.0) 0.0 (Increase)/decrease in tax receivable (Increase)/decrease in NHS Trade Receivables (1.6) 2.0 (20.3) (22.3) (5.0) (19.8) (14.8) (2.0) (Increase)/decrease in Non NHS Trade Receivables (4.8) 0.0 (1.6) (1.6) (1.6) 1.0 (Increase)/decrease in other related party receivables (1.0) (0.3) (Increase)/decrease in other receivables (1.0) 0.0 (0.1) (0.1) (2.0) (0.0) 2.0 (1.0) (Increase)/decrease in accrued income 2.5 (7.0) (14.0) (35.2) (21.2) (4.0) (Increase)/decrease in other financial assets (Increase)/decrease in prepayments 0.6 (3.0) (1.2) 1.8 (4.0) (3.2) (Increase)/decrease in Other assets Increase/(decrease) in Deferred Income (excl. Donated Assets) (0.6) (0.3) (1.1) Increase/(decrease) in Deferred Income (Donated Assets) Increase/(decrease) in Current provisions 2.3 (1.4) (1.9) (0.5) (1.6) (2.0) (0.4) (2.3) Increase/(decrease) in post-employment benefit obligations Increase/(decrease) in tax payable (0.1) (0.2) 0.2 (0.0) (0.2) 0.3 Increase/(decrease) in Trade Creditors (4.3) (6.3) (2.0) Increase/(decrease) in Other Creditors (3.8) 2.9 (0.7) (3.5) 0.9 (4.8) (5.7) 0.0 Increase/(decrease) in accruals (1.0) Increase/(decrease) in other Financial liabilities (0.3) (0.3) 0.0 (0.4) (0.4) 0.0 Increase/(decrease) in Other liabilities Increase/(decrease) in Non Current provisions (0.0) (0.1) (0.5) Non cash I&E items Tax expense/(refund) Finance (income)/charges (0.0) (0.0) 8.4 Share of (profit)/loss from equity accounted investments net of cash distributions received 0.7 (0.2) (0.5) (0.9) Donations & Grants received of PPE & intangible assets (non cash) Other operating non-cash (revenues)/expenses Depreciation and amortisation, total (0.9) (1.5) 16.6 Impairment losses/(reversals) Unrealised (gains)/losses on foreign currency exchange (Gain)/loss on disposal of property plant and equipment (Gain)/loss on disposal of intangible assets Share of (profit)/loss loss from investments PDC dividend expense Other increases/(decreases) to reconcile to profit/(loss) from operations 0.5 (0.1) (0.1) Cashflow from operations (5.3) 2.3 (20.3) (22.6) 21.2 Cashflow from investing activities (23.1) (10.3) (8.4) 2.0 (20.6) (12.6) 8.0 (52.6) Property, plant and equipment - maintenance expenditure (1.1) (0.2) (0.4) (0.2) (0.5) (0.5) (0.1) (1.0) Property, plant and equipment - non-maintenance expenditure (18.3) (9.2) (6.5) 2.8 (18.4) (8.7) 9.7 (47.5) Plant and equipment - Information Technology (1.1) (0.4) (0.2) 0.2 (0.8) (0.5) 0.4 (2.0) Plant and equipment - Other (1.6) (0.4) (1.1) (0.8) (0.7) (1.8) (1.1) (1.5) Property, plant and equipment - other expenditure Proceeds on disposal of property, plant and equipment Purchase of investment property Proceeds on disposal of investment property Purchase of intangible assets (0.6) (0.1) (0.2) (0.0) 0.2 (0.5) Proceeds on disposal of intangible assets Expenditure on capitalised development Increase/(decrease) in Capital Creditors (0.3) 0.0 (0.2) (0.2) 0.0 (1.1) (1.1) 0.0 Payments for other capitalised costs Purchase of subsidiaries net of cash acquired Net bank balance acquired with subsidiaries Proceeds from disposal of subsidiaries net of cash disposed Net bank balance disposed with subsidiaries Purchase of associates net of cash acquired Net bank balance acquired with associates Proceeds from disposal of associates net of cash disposed Net bank balance disposed with associates Purchase of joint ventures net of cash acquired Net bank balance acquired with associates Proceeds from disposal of joint ventures net of cash disposed Net bank balance disposed with joint venture Government grants received Deposits and investments made Deposits and investments liquidated Other cash flows from investing activities Cashflow before financing 26.2 (2.0) (5.3) (3.3) (18.2) (32.9) (14.6) (31.4) Cashflow from financing activities (13.3) (0.3) (0.8) 17.5 Public Dividend Capital received Public Dividend Capital repaid PDC Dividends paid (7.8) (3.6) (3.6) 0.1 (3.6) (3.6) 0.1 (7.5) Interest (paid) on bridging loans Interest (paid) on commercial loans Interest (paid) on non-commercial loans (0.6) (0.1) (0.4) (0.3) 0.1 (0.9) Interest (paid) on overdraft and working capital facility 0.0 (0.0) (0.1) (0.1) Interest element of finance lease rental payments - other

108 Appendix 1 Financial Summary Previous YE Quarter YTD FY Actual Plan Actual Variance Plan Actual Variance Plan Interest element of finance lease rental payments - On-balance sheet PFI (7.5) (1.9) (1.9) 0.0 (3.7) (3.7) 0.0 (7.4) Capital element of finance lease rental payments - other Capital element of finance lease rental payments - On-balance sheet PFI (0.7) (0.2) (0.2) 0.0 (0.4) (0.4) 0.0 (0.8) Interest received on cash and cash equivalents Movement in Other grants/capital received Donations received in cash Drawdown of bridging loans Repayment of bridging loans Drawdown of non-commercial loans (0.5) (1.0) 35.3 Repayment of non-commercial loans (1.0) (0.5) (0.5) 0.0 (1.0) Drawdown of commercial loans Repayment of commercial loans (0.1) (0.1) (0.1) 0.0 (0.1) (0.1) 0.0 (0.1) (Increase)/decrease in non-current receivables (0.3) Increase/(decrease) in non-current payables Other cash flows from financing activities Net increase/(decrease) in cash 12.9 (1.2) (4.8) (3.7) (13.9) (29.3) (15.4) (14.0) Cash at period end (15.4) (15.4) 26.6 Cash and Cash equivalents at period end (15.4) (15.4) 26.6 Detailed Financial Summary Previous YE Quarter YTD FY Actual Plan Actual Variance Plan Actual Variance Plan Community Co Cost & volume contract revenue Co Block contract revenue Ambulance Am Cost & volume contract revenue Am Block contract revenue Am Other clinical MS revenue Mental Health Mh Cost & volume contract revenue Mh Block contract revenue Mh Clinical partnership (s31) revenue Mh Secondary commissioning revenue Mh Other clinical MS revenue Acute Ac Elective revenue (3.3) (6.5) Ac Non-Elective revenue (1.0) (3.2) Ac Outpatient revenue Ac A&E revenue Ac other revenue Private patient revenue (0.3) (0.6) 15.8 Grants and donations in cash Other operating revenues Total operating revenue for EBITDA Grants and donations of PPE and intangible assets (0.1) (1.1) (1.0) 3.7 Total operating revenue Employee Expenses (374.1) (98.6) (105.1) (6.5) (196.9) (207.9) (11.0) (395.6) Drugs expense (67.9) (16.5) (19.7) (3.2) (31.6) (37.3) (5.7) (68.7) Supplies (clinical & non-clinical) (100.1) (23.9) (27.9) (4.0) (45.8) (49.7) (3.9) (99.6) Clinical supplies (64.9) (16.1) (17.6) (1.4) (30.9) (31.8) (0.9) (67.2) Non-clinical supplies (35.2) (7.8) (10.3) (2.5) (14.9) (17.9) (3.0) (32.4) PFI expenses (26.4) (6.9) (6.9) (0.0) (13.8) (13.7) 0.1 (27.6) Other expenses (75.1) (16.9) (21.7) (4.8) (32.3) (39.1) (6.8) (70.2) Decrease (increase) in inventories of finished goods & WIP Vehicle Fuel costs (ambulance trusts) Cost of Secondary Commissioning of mandatory services Research & Development expense Education and training expense Misc. other Operating expenses (73.4) (16.9) (20.4) (3.6) (32.3) (37.7) (5.3) (70.2) Total operating expenses within EBITDA (643.6) (162.8) (181.3) (18.5) (320.5) (347.8) (27.2) (661.8) EBITDA (0.5) (1.2) 32.8 Depreciation and amortisation (14.7) (4.0) (3.1) 0.9 (8.0) (6.4) 1.5 (16.6) Depreciation and Amortisation - owned assets (12.3) (3.5) (2.6) 0.9 (6.9) (5.4) 1.5 (14.5) Depreciation and Amortisation - assets held under finance leases (0.1) Depreciation and Amortisation - PFI assets (2.3) (0.5) (0.5) 0.0 (1.1) (1.1) 0.0 (2.1) Impairments & Restructuring (9.1) (2.0) (2.0) 0.0 (4.0) (4.0) 0.0 (8.0) Total operating expenses (667.4) (168.8) (186.4) (17.6) (332.5) (358.2) (25.7) (686.5) Operating Surplus (Deficit) (0.7) (0.6) 11.8 Profit (loss) on asset disposal (0.5) (0.0) (0.1) (0.0) (0.1) (0.1) (0.0) (0.1) Net interest (7.9) (2.1) (2.1) 0.0 (4.2) (4.2) 0.0 (8.4) Taxation PDC dividend (7.8) (2.0) (2.1) (0.1) (3.9) (4.0) (0.1) (7.8) Other non-operating items (0.5) 0.7 (0.7) (1.4) 0.3 (1.3) (1.6) 2.2 Net Surplus / (Deficit) (5.9) (0.6) (1.8) (1.2) (2.6) (4.0) (1.3) (6.0) EBITDA % of Op. revenue 5.1% 5.1% 4.4% -0.7% 5.1% 4.4% -0.7% 4.7% EBITDA (0.5) (1.2) 32.8 Change in Current Receivables (8.5) 2.0 (22.0) (24.0) (4.0) (18.4) (14.4) (2.3) (Increase)/decrease in tax receivable (Increase)/decrease in NHS Trade Receivables (1.6) 2.0 (20.3) (22.3) (5.0) (19.8) (14.8) (2.0) (Increase)/decrease in Non NHS Trade Receivables (4.8) 0.0 (1.6) (1.6) (1.6) 1.0 (Increase)/decrease in other related party receivables (1.0) (0.3) (Increase)/decrease in other receivables (1.0) 0.0 (0.1) (0.1) (2.0) (0.0) 2.0 (1.0) Change in Current Payables (5.1) (10.0) (1.7) Increase/(decrease) in tax payable (0.1) (0.2) 0.2 (0.0) (0.2) 0.3 Increase/(decrease) in Trade Creditors (4.3) (6.3) (2.0) Increase/(decrease) in Other Creditors (3.8) 2.9 (0.7) (3.5) 0.9 (4.8) (5.7) 0.0 Other changes in WC 10.5 (7.8) (13.8) (22.2) (8.4) (8.4) Change in Non Current Provisions (0.0) (0.1) (0.5) Other non-cash items (0.2) Cashflow from operating activities (5.3) 2.3 (20.3) (22.6) 21.2 Capital expenditure (accurals basis) 0.0 (10.3) (8.2) 2.2 (20.6) (11.5) 9.1 (52.6) Asset sale proceeds other Investing cash flows (23.1) 0.0 (0.2) (0.2) 0.0 (1.1) (1.1) 0.0 Cashflow before financing 26.2 (2.0) (5.3) (3.3) (18.2) (32.9) (14.6) (31.4) Net interest (8.1) (2.0) (1.9) 0.1 (4.2) (4.0) 0.1 (8.5) Interest (paid) on bridging loans Interest (paid) on commercial loans Interest (paid) on non-commercial loans (0.6) (0.1) (0.4) (0.3) 0.1 (0.9) Interest (paid) on bank overdrafts 0.0 (0.0) (0.1) (0.1) Interest element of finance lease rental payments - other Interest element of finance lease rental payments - On-balance sheet PFI (7.5) (1.9) (1.9) 0.0 (3.7) (3.7) 0.0 (7.4) PDC dividends (paid) (7.8) (3.6) (3.6) 0.1 (3.6) (3.6) 0.1 (7.5) Movement in loans (0.5) (1.0) 34.2 PDC received/(repaid) Donations received in cash other financing cashflows (0.9) (0.2) (0.2) 0.0 (0.4) (0.4) 0.0 (0.7) Net cash inflow (outflow) 12.9 (1.2) (4.8) (3.7) (13.9) (29.3) (15.4) (14.0) Cash at period end (15.4) (15.4) 26.6 Cash and Cash equivalents at period end (15.4) (15.4) 26.6 Non Safe Harbour Investments at period end

109 Worksheet "Targets and Indicators" Declaration of risks against healthcare targets and indicators for by King s College Hospital Classified as Restricted per Monitor's Information Security Policy Appendix 2 These targets and indicators are set out in the Compliance Framework Key: must complete Definitions can be found in Appendix B of the Compliance Framework 13/14 may need to complete NOTE: If a particular indicator does not apply to your FT then please enter "Not relevant" for those lines. Quarter 1 Quarter 2 Threshold or Risk declared at Actual Achieved Actual Achieved Target or Indicator (per Compliance Framework 13/14) target YTD Annual Plan Performance /Not Met Performance /Not Met Any comments or explanations Referral to treatment time, 18 weeks in aggregate, admitted patients 90% Yes 88.90% Not met 88.0% Not met July 88.1, Aug 87.1, Sept 88.6 Referral to treatment time, 18 weeks in aggregate, non-admitted patients 95% No 97.10% Achieved 96.9% Achieved July 97, Aug 97.4, Sept 96.3 Referral to treatment time, 18 weeks in aggregate, incomplete pathways 92% No 92.20% Achieved 92.1% Achieved July 92.1, Aug 92.1, Sept 92.1 A&E Clinical Quality- Total Time in A&E under 4 hours 95% Yes 96.30% Achieved 95.1% Achieved Cancer 62 Day Waits for first treatment (from urgent GP referral) 85% No 85.50% Achieved 90.2% Achieved Cancer 62 Day Waits for first treatment (from NHS Cancer Screening Service referral) 90% No 96.60% Achieved 92.1% Achieved ed ed Cancer 31 day wait for second or subsequent treatment - surgery 94% No 98.10% Achieved 97.8% Achieved Cancer 31 day wait for second or subsequent treatment - drug treatments 98% No 98.30% Achieved 100.0% Achieved Cancer 31 day wait for second or subsequent treatment - radiotherapy 94% No 99.20% Achieved 100.0% Achieved Cancer 31 day wait from diagnosis to first treatment 96% No 99.00% Achieved 98.2% Achieved Cancer 2 week (all cancers) 93% No 97.20% Achieved 96.8% Achieved Cancer 2 week (breast symptoms) 93% No 98.90% Achieved 97.0% Achieved Care Programme Approach (CPA) follow up within 7 days of discharge 95% No 0.00% Not relevant 0.0% Not relevant Care Programme Approach (CPA) formal review within 12 months 95% No 0.00% Not relevant 0.0% Not relevant Admissions had access to crisis resolution / home treatment teams 95% No 0.00% Not relevant 0.0% Not relevant Meeting commitment to serve new psychosis cases by early intervention teams 95% No 0.00% Not relevant 0.0% Not relevant Ambulance Category A 8 Minute Response Time - Red 1 Calls 75% No 0.00% Not relevant 0.0% Not relevant Ambulance Category A 8 Minute Response Time - Red 2 Calls 75% No 0.00% Not relevant 0.0% Not relevant Ambulance Category A 19 Minute Transportation Time 95% No 0.00% Not relevant 0.0% Not relevant Clostridium Difficile -meeting the C.Diff objective 38 Yes 8 Achieved 21 Achieved 21 against a target of 25 MRSA - meeting the MRSA objective 0 Yes 2 Achieved 2 Achieved Minimising MH delayed transfers of care 7.5% No 0.00% Not relevant 0.0% Not relevant Data completeness, MH: identifiers 97% No 0.00% Not relevant 0.0% Not relevant Data completeness, MH: outcomes 50% No 0.00% Not relevant 0.0% Not relevant Compliance with requirements regarding access to healthcare for people with a learning disability N/A No 0.00% Achieved N/A Achieved Community care - referral to treatment information completeness 50% No 0.00% Not relevant 0.0% Not relevant Community care - referral information completeness 50% No 0.00% Not relevant 0.0% Not relevant Community care - activity information completeness 50% No 0.00% Not relevant 0.0% Not relevant Risk of, or actual, failure to deliver Commissioner Requested Services N/A No No No CQC compliance action outstanding (as at 30 Sep 2013) N/A No No No CQC enforcement action within last 12 months (as at 30 Sep 2013) N/A No No No CQC enforcement action (including notices) currently in effect (as at 30 Sep 2013) N/A No No No Moderate CQC concerns or impacts regarding the safety of healthcare provision (as at 30 Sep 2013) N/A No No No Major CQC concerns or impacts regarding the safety of healthcare provision (as at 30 Sep 2013) N/A No No No Trust unable to declare ongoing compliance with minimum standards of CQC registration N/A No No No Results left to complete Overide Rating (if any) Enter the reason for any non-scoring related rating override here Compliance Framework Indicative Governance Risk Rating RED AMBER-GREEN AMBER-GREEN 1

110 Appendix 3 Worksheet "Governance Statement" In Year Governance Statement from the Board of [MARSID] The board are required to respond "Confirmed" or "Not confiirmed" to the following statements (see notes below) For finance, that: Board Response 4 The board anticipates that the trust will continue to maintain a continuity of service risk rating of at least 3 over the next 12 months. 11 The board is satisfied that plans in place are sufficient to ensure: ongoing compliance with all existing targets (after the application of thresholds) as set out in Appendix A of the Risk Assessment Framework; and a commitment to comply with all known targets going forwards. Confirmed For governance, that: Not Confirmed Otherwise The board confirms that there are no matters arising in the quarter requiring an exception report to Monitor (per Compliance Framework page Confirmed Signed on behalf of the board of directors Signature Signature Name Professor Sir George Alberti Capacity Chair Date 31 October 2013 Name Tim Smart Capacity Chief Executive Date 31 October Notes: Monitor will accept either 1) electronic signatures pasted into this worksheet or 2) hand written signatures on a paper printout of this declaration posted to Monitor to arrive submission In the event thanby anthe NHS foundationdeadline. trust is unable to confirm these statements it should NOT select 'Confirmed in the relevant box. It must provide a response (using the section explaining the reasons for the absence a full certification the action it proposes to take to address it. This may include include anybelow) significant prospective risks and concerns theof foundation trust hasand in respect of delivering quality services and effective quality Monitorgovernance. may adjust the relevant risk rating if there are significant issues arising and this may increase the frequency and intensity of monitoring for the NHS foundation trust. The board is unable to make one of more of the confirmations in the section above on this page and accordingly responds: A The Board is self-certifying non-compliance with Statement 11 in the following areas: C-Difficile Despite good performance in 12/13, the new prescribed quota of 49 case presents further challenges therefore this is an area of risk for the Trust; MRSA The Trust performed very well with only 2 cases in 12/13, however, the de-minimus of 6 means that this is a continued risk in 13/14; 18 week admitted referral to treatment The Trust is planning to proactively reduce more of its longer-waiters. This will result in the Trust breaching its 18 week admitted RTT target; and Emergency Department (ED) target In line with trend in the health system, the Trust has experienced two years of step increase it the acuity of emergency patients attending ED. The Trust believes this trend will continue in 13/14 which puts achievement of the ED 4-hour target at risk. The Trust Board will review action plans for addressing these risks on a monthly basis and keep Monitor abreast of any material developments. B C 1

111 Enc. 4.4 Report to: Council of Governors Date of meeting: 11 December 2013 Subject: Status: Purpose of Report: Council of Governors Annual Review FOR INFORMATION The enclosed report was presented to the Membership & Engagement Committee on 16 October The Committee noted, the contents of the report, offered comments and approved the recommendations. The Committee also agreed that the report be presented to the Council for information. 1

112 Enc. 4.4 Report to: Membership & Community Engagement Committee Date of meeting: 16 October 2013 By: Subject: Jane Walters, Director of Corporate Affairs Member-Governor Contact via Trust Website 1. Summary At its meeting on 26 June 2013, the Committee discussed the best way for governors to communicate and engage with members. The Committee noted there was already a mechanism on the Trust s website where members can contact a governor via the address. Although it was recognised that the most cost effective way for governors to communicate with members is through , the Committee accepted that due to issues of confidentiality and data protection it was not appropriate for the Trust to issue patient or staff member contact details, nor for the same reason was it desirable to make private governor addresses public. It was further recognised that each governor has different resources and time availability therefore some correspondence may not be responded to in a timely manner. This represented a significant risk for members, the Trust, the Council and individual governors. This report responds to the request from the Committee for further information about this system and the process for managing incoming queries. 2. Trust Mechanism for Contacting Governors The Policies and Procedures document, issued to governors as part of the information pack on the Governor Website, details the protocol for dealing with members queries and a brief explanation on how members can contact governors Members can contact the Trust direct for information, by phone or , and they can also contact individual Governors via the generic governors@ address. These s are forwarded to the Assistant Board Secretary, who will send on to the private address of the relevant Governor. Information about how to contact the Trust is publicised in regular members newsletters, and on the Trust s website. On the Trust website, there are two areas which Members of the Trust and members of the general public can access details on how to contact governors. The first way is to visit the Council of Governors section on the King s College Hospital (KCH) website and click on the link Contact [Governor A] (see Example A overleaf), which is located under each profile. When the link is clicked, the contactor will be taken to the online form as per Example B overleaf. The second way is to visit the Contact Us page on KCH s website which has a section for Contact a Governor ( Here Members of the Trust and the public can complete the online form (Example B overleaf) and submit their queries. 2

113 Enc. 4.4 Example A Stuart Owen - Southwark South I have lived in South Dulwich for nearly twenty years. As a long-standing member of KCH Foundation Trust, and especially as a patient of the hospital where I underwent a bone marrow transplant five years ago, I have a deep understanding of what it is like to be dependent on the quality of its services and the expertise of its doctors and nurses. I am particularly concerned that proposed NHS changes will not erode the range and quality of patient care, and I want to bring my own experience as a patient to help improve the standard of everyone s care at King s. Contact Stuart Owen Example B Contact a Governor Governors represent your interests. You can help them carry out their role effectively by giving them your views. Tell them how you think services could be improved. Pass on the ideas and suggestions you think would enhance patient care. Let them know what you want your local hospital to offer. Please note that this will be received and read by the Foundation Trust office who will then forward it to the Governor you have specified. Governors cannot deal with any personal queries or issues you have about the hospital, or your care and treatment. Instead, please contact the Patient Advice and Liaison Service. Governor to Contact Tom Duffy, PatientGovernor Your Comments Both these methods go to a generic governors@ address. These s are accessed by the Corporate Governance Team in the Foundation Trust Office (FTO). 3