AGENDA Report from the Board & Strategy Update FR Enc. 2.2 N Moberly 14:35

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1 AGENDA Meeting Public Council Of Governors Time of meeting 14:00-15:50 Date of meeting Thursday, 17 March 2016 Meeting Room Bill Whimster Suite, Weston Education Centre Site Denmark Hill Encl. Lead Time 1. STANDING ITEMS Chair 14: Apologies 1.2. Declarations of Interest 1.3. Chair s Action 1.4. Minutes of Previous Meeting 10/12/2015 FA Enc Matters Arising FE Enc FOR REPORT 2.1. Best Quality of Care Patient Experience Report FE Enc J Seddon 14: Quality Priorities & Indicators FA Enc G Walters/ 14:20 H Day 2.2. Report from the Board & Strategy Update FR Enc. 2.2 N Moberly 14: Trust Performance Report FR Enc J Tozer 14: Trust Finance Report FR Enc C Gentile 15: Governor Involvement & Engagement Governor Elections FI Verbal J Seddon 15: Governor Engagement & Involvement FI Enc C North 15: Sub-Committees Summaries/Actions Membership & Community Engagement FR Enc F Clark Strategy FR Enc A McCall Patient Experience & Safety FR Enc T Duffy 3. FOR INFORMATION 3.1. Register of Governors Attendance FI Enc Monitor Quarterly Submission Quarter 3 FI Enc : Sub-Committee Confirmed Minutes Membership & Community Engagement Strategy Patient Experience & Safety 4. ANY OTHER BUSINESS 5. DATE OF NEXT MEETING FI Enc Enc Enc Chair 15:45 Joint Board of Directors and Council of Governors Meeting on Wednesday, 4 May 2016 from 14:30-15:30 at Bromley Library Key: FE: For Endorsement; FA: For Approval; FR: For Report; FI: For Information

2 Lord Kerslake Trust Chair Elected: Anoushka de Almeida-Carragher Bromley Eniko Benfield Bromley Paul Corben Bromley Penny Dale Bromley Fiona Clark Lambeth Chris North Lambeth Nanda Ratnavel Lambeth Grace Okoli Lambeth Tim Bradley Lewisham Tom Duffy Patient Pida Ripley Patient Helen Ahmet Patient Derek St Clair Cattrall Patient Jan Thomas Patient Craig Jacobs Patient Barbara Pattinson Southwark Pam Cohen Southwark Andrew McCall Southwark Victoria Silvester Southwark CV Praveen Staff Medical and Dental Jo Millet Staff Nurses and Midwives Nicky Hayes Staff Nurses and Midwives Cornelius Lewis Staff - Allied Health Professionals, Scientific & Technical Roger Engwell Staff Administration, Clerical & Management Nominated/Partnership Organisations: Cllr Robert Evans Bromley Council Phidelma Lisowska Joint Staff Committee Cllr. Jim Dickson Lambeth Council Dr Sadru Kheraj Lambeth Clinical Commissioning Group Kieron Williams Southwark Council Dr Noel Baxter Southwark Clinical Commissioning Group Roger Pafford South London & Maudsley NHS FoundationTtrust Diane Summers Guy s & St. Thomas NHS Foundation Trust In attendance: Nick Moberly Chief Executive Officer Judith Seddon Interim Director of Corporate Affairs Jeremy Tozer Interim Chief Operating Officer Colin Gentile Chief Financial Officer Geraldine Walters Director of Nursing & Midwifery Julia Wendon Medical Director Helen Day Associate Director of Nursing Tamara Cowan Board Secretary Jane Badejoko Governance Officer (Minutes) Apologies: Trudi Kemp Director of Strategic Development Vacancies Vacant Bromley Clinical Commissioning Group Circulation to: Council of Governors and Board of Directors

3 Enc. 1.4 Council of Governors Public Session Minutes of the meeting held on Thursday, 10 December 2015, Boardroom meeting room, Hambelden Wing, King s College Hospital, Denmark Hill, London, SE5 9RS Lord Kerslake Trust Chair Elected: Anoushka de Almeida-Carragher Bromley Fiona Clark Lambeth Chris North Lambeth Grace Okoli Lambeth Nanda Ratnavel Lambeth Tim Bradley Lewisham Helen Ahmet Patient Tom Duffy Patient Pida Ripley Patient Andrew McCall Southwark Victoria Silvester Southwark Pam Cohen Southwark Roger Engwell Staff Administration and Clerical Jo Millett Staff Nurses and Midwives Nicky Hayes Staff Nurses and Midwives Cornelius Lewis Staff Allied Health Professionals, Scientific and Technical Nominated/Partnership Organisations Cllr. Robert Evans Bromley Council Phidelma Lisowka Joint Staff Committee Cllr Jim Dickson Lambeth Council Cllr. Kieron Williams Southwark Council (part) In attendance: Judith Seddon Acting Director of Corporate Affairs Tamara Cowan Board Secretary Nick Moberly Chief Executive Officer Colin Gentile Chief Financial Officer (Shadowing) Tooba Ahmadi Corporate Governance Officer (Minutes) Silviyana Yankova Corporate Governance Assistant Geraldine Walters Director of Nursing & Midwifery Trudi Kemp Director of Strategy Dawn Brodrick Director of Workforce & Development Jeremy Tozer Interim Chief Operating Officer Craig Wisdom KPMG Auditor- part of the meeting Prof. Julia Wendon Medical Director Prof. Ghulam Mufti Non-Executive Director Dr Alix Pryde Non-Executive Director Chris Stooke Non-Executive Director Apologies Eniko Benfield Bromley Paul Corben Bromley Penny Dale Bromley Derek St Clair Cattrall Patient Craig Jacobs Patient Jan Thomas Patient Barbara Pattinson Southwark 1

4 Enc. 1.4 CV Praveen Diane Summers Chris Mothershead Roger Paffard Prof Jonathan Cohen Faith Boardman Sue Slipman Sally Lingard Steve Leivers Alan Goldsman Ahmad Toumadj Staff Medical and Dentistry Guy s & St Thomas NHS Foundation Trust King s College London South London & Maudsley NHS Foundation Trust Non-Executive Director Non-Executive Director Non-Executive Director Associate Director of Communication Director of Transformation and Turnaround Interim Chief Financial Officer Interim Director of Capital & Estates Item Subject Action 15/42 Welcome & Apologies The apologies for absence were noted. The Council welcomed Judith Seddon, Interim Corporate Affairs Director, Prof. Julia Wendon, Medical Director, Dawn Brodrick, Director of Workforce & Development, Colin Gentile, Chief Financial Officer (shadowing) and Dr. Alix Pryde, Non-Executive Director to their first Council of Governors meeting. 15/43 Declarations of Interest There were no declarations of interest. 15/44 Chair s Action There was no Chair s action reported. 15/45 Minutes of Previous Meeting The minutes of the meeting held on 24 September 2015 were approved as a correct record. The Chair highlighted that Trust will continue with the standard format of minutes and will not adopt the verbatim style for any Board, Council and their Committees. Names will only be attributed in the minutes when a speaker/ presenter does not agree with a specific decision. 15/46 Matters Arising/Action Tracking There were no matters arising from the last meeting. 15/47 FOR REPORT 15/48 Improving Quality of Care 15/48.1 Patient Safety Report The Council received and noted the report on Patient Safety. The following key points were raised and discussed: 2

5 Enc. 1.4 Item Subject Action There has been one never event since September 2015, relating to a retained swab. This has not resulted in any significant patient harm but it is being fully investigated in line with the Trust s Serious Incident procedure; The never event incidents are now occurring more in non-traditional surgical areas such interventional medicine and the issues are more related to process issues; The Trust has increased training for junior doctors on the use of the surgical safety checklists, which was recommended by the CQC to improve the use of the checklist and promote correct procedures; A separate action plan is in place in Ophthalmology to address the specific concerns with respect to surgical safety that were identified and it also incorporates the recommendations from two independent reviews; There were three maternal deaths in the past three months, which will all be fully investigated as Serious Incidents; A patient communications campaign that includes screensavers, posters and a fact of the fortnight bulletin was launched in September to improve medication safety. Most incidents relate to medication omissions or delays; The Trust s monitoring of deteriorating patients has been improved by the use of electronic systems to enter patient data at their bed side, which also supports the pathway escalation and the imobile initiative; The rate of falls reported at the PRUH remains higher than at DH. A number of actions have been implemented to reduce avoidable falls. These include running falls awareness days and the Specials Team is monitoring and focusing on patients at risk of falls; and The general trend in grade two pressure ulcers is downward with the lowest recorded quarterly level at the PRUH. Staff training is now provided through a downloadable App, an e-learning package and monthly face-to-face sessions. The Council raised the following points in discussions: Learnings from never events are shared with staff and patient ID bands are in use at all sites for interventional procedures in Ophthalmology; The Council suggested that the report should include a sentence about what was the learnings and what actions were taken each time a never event occurs; The Council raised concern over the planned reduction in the number of specialist nurses, in particular the maternity specialist nurses and its impact on patient care as well as never events; 3

6 Enc. 1.4 Item Subject Action The Council was assured that all posts go through robust risk and quality impact assessments. Vigorous analysis are undertaken to ensure patient care and safety are not compromised; The Trust reviews value for money and if services can be provided in a different way whilst maintaining quality standards. The Trust s Saving Board Committee evaluates service moves, scrutinise controls, and if any change would be detrimental on patient safety; Additionally, as part of the turnaround and transformation work triangulation of actions and decisions are reviewed regularly and if areas of increased concerns are identified measures are put in place to mitigate any risk; and The Board is satisfied that processes in place are robust and Cost Improvement Plans (CIPs) are analysed regularly to ensure patient safety and experience are not compromised. 15/49 Strategic Development 15/49.1 Update on KHP & Institutes MoU It was reported that the King s Health Partners (KHP) is an importantcollaboration for the Trust. KHP have agreed to progress with the plans to develop and create a number of clinical academic institutes. The institute model will be the vehicle to support and drive exceptional patient care and treatment whilst ensuring delivery of its key objective to lead science and research nationally and internationally. It was highlighted that the partners have signed up to the Memorandum of Understanding (MoU). The Council noted in the report the MoU as well as the summary of discussions and progress on moving the partnership forward. The following key points were raised and discussed: Work is underway in developing the models of integrated care that will effectively and efficiently meet the need of the local community. The Trust would play a full part in integrated care with more collaborative working with the community and partners; In addition to the Cardiovascular, Haematology and Liver institutes there are a number of other proposals in the pipeline that the KHP partners will review and consider. Progress update on these will be provided to the Governors as discussions develop; and Governors raised concern over the consultation to remove funding for dental research. This is very important and the Trust will take this issue on board. 15/49.2 Haematology Institute & NED Role The Council received and noted overview of the KHP developments in Institute of Haematology. 4

7 Enc. 1.4 Item Subject Action Prof Ghulam Mufti, in his capacity as the Trust lead on KHP haematology institute and as a Non-Executive Director of the Trust outlined the vision and plans for developing the haematology institute. The following key points were raised and noted in discussion: There has been significant improvement and development in the KHP haematology institute with innovative research trials underway in Leukaemia cell therapy as well as acceleration in the innovations from bench to bedside ; The KHP s existing building blocks, which include its integrated clinical and research programme combined with its population profile has provided the unique opportunity to deliver its vision and become renowned leaders in haematological medicine nationally and internationally; The institute s desire and commitment to achieve clinical excellence has resulted in being national exemplar centre for Haemostasis and Thrombosis; Delivering academic excellence is integral to KHP and the institute has been one of the global leader in haematological research publications with significant opportunities in gene therapy and DNA editing; The institute is now looking to consolidate all haematology work in one hub consisting of inpatient, outpatient, clinical trials, integrated diagnostics and research; Linking academic with the pharmacy industry will provide new platforms for drug discoveries and innovative learning. Similarly integrating mind and body will improve physiological effects of leukaemia patients, survivorship and patient involvement; and In response to Governors comment it was noted that some services may be allocated to private facility. However, this is a very early predication and discussions about the development of the model, the strategic business cases for the institute with complete financial baselines are underway. The Council commended the presentation and the progress of the haematology institute to date. The programme is aspirational with very positive achievements and outcomes. 15/50 Move to Operational Sustainability 15/50.1 Report from the Board & Transformation Programme Update The Council received and noted the Chief Executive s Board Report. The following key points were raised and noted: 5

8 Enc. 1.4 Item Subject Action The Trust is mobilised to move forward with the executive team leading on a number of useful workstreams to improve performance with the key focus being on finances and delivering the 65m deficit; In collaboration with the regulators the Trust is working on various transformational programmes and clinical pathways to analyse best practice and the resources required to deliver initiatives efficiently; Work has begun to develop and crystallise an explicit strategy for the Trust. This will shape the direction of travel for the organisation and staff, setting out clear visions, missions, strategies to deliver best quality of care; The Trust is also in the process of refining and retuning its operational structures to ensure strong leadership with key focus on better staff engagement and providing opportunities to increase visibility of the leaders across the Trust; and The Trust is reviewing its longer term visions nationally and internationally with various KHP propositions such the Haematology Institute to consider. Trust Finance Report, Budget Planning 2016/17 and appointment of external auditors At month 7 the run rate has improved to 3.6m with the year to date position at 58.2m against year-end forecast deficit of 65m; There is still a lot to do to close the current 11m gap in the savings target. The Trust is continuing to work hard to develop effective Cost Improvement Programmes (CIPs) and focus on budgetary controls, review of capacity deployment and procurement efficiencies; The Trust has also begun to focus on financial planning for 2016/17. All budget holders have been informed about the budget setting process with detailed information on key parameters that were agreed by the Board and the regulators; Deloitte LLP currently provides the external audit service for the Trust and their contract will expire on 30 June In line with Monitor s guidance, the Trust is required to undertake a market-testing exercise for the appointment of external audit services; and The Council of Governors noted and endorsed the tender process for the appointment of external auditors. Trust Performance Report The Council received and discussed the month 7 performance report. The following key points were reported and noted: 6

9 Enc. 1.4 Item Subject Action Overall the emergency department (ED) performance moved from 89% to 91% mainly due to maintained performance at the Princess Royal University Hospital (PRUH) compared to poor performance on the Denmark Hill (DH) site; The 18 Weeks referral to treatment (RTT) backlog position at Denmark Hill (DH) reduced by 20 patients and the admitted backlog at the PRUH reduced by 53 at the end of October; The Trust had agreed with approval from its commissioners, NHS England and Monitor for a further 6-month extension of its reporting suspension period. However, the Trust is required to return to reporting in February 2016; The validation process for 52 week patient records continues. During the validation process additional patients were identified and therefore, the Trust remains an outlier for 52 week waiters nationally; A root cause analysis has been conducted and review meetings chaired by the Medical Director with clinical input from commissioners have been established to look at the issues and identify treatment pathways and what can be done in the short-term; The Trust is achieving cancer waiting time targets and is on point to achieve compliance for Q3; Plans are in place for the transfer of care bureau (TCB) to be fully implemented at the PRUH; and There have been 52 c-difficile cases reported which is above the quota of 42 cases for the cumulative position to-date. Managing infection control at the Trust is a key priority for the Trust and the ward deep cleaning programme at the PRUH continues. The following key points were noted in discussions: Governors raised concern over the high number of A&E attendances given the pressures on capacity at the Trust, in particular during the winter period as well as the Trust s contingency plans in the light of the recent terrorist attacks in Paris; It was highlighted that the Trust has developed a robust winter resilience plan, which Commissioners and Monitor are pleased with. The Trust is focusing to discharge patients efficiently in order to reduce the constraint on capacity. The Trust follows the NHS extensive contingency plans for any major incidents nationally; At the Annual Members Meeting, Members raised concerns about front line processes and services at the outpatient department. The Trust has implemented numerous changes to drive improvement and the initial area of focus in the transformational work will be outpatients, theatres and diagnostics; and 7

10 Enc. 1.4 Item Subject Action Discussions in relation to reconfiguration of sites and services in South East London are still at a very early stage. Primary care is a working assumption and its details are still unknown. Consolidation of planned care such as Orthopaedics is under consideration and it is likely to fit with the SE London plans. 15/51 Governor Involvement & Engagement Chris North (CN) gave best wishes on behalf of the Council to Craig Jacobs, a Patient Governor who is undergoing some treatment at the Trust; Cornelius Lewis, a Staff Governor representing Allied Health Professionals, Scientific and Technical will be retiring at the end of March 2016 and the Trust will be looking to identify a replacement; The Governors representing Bromley, Lambeth and Southwark Clinical Commissioning Groups (CCGs) have had to resign as Trust governors due to a conflicting clause within their respective constitutions. The Trust and the Commissioners will be looking to resolve the issue and identify suitable representatives; The Annual Members Meeting (AMM) was held on 24 September 2015 and a number of comments such as extending the Q&A time were raised by Members. The Trust will take their comments on board; The Joint Governor Development Day held on 19 November 2015, was well organised and the presentation of external speakers were appreciated; and Governors are urged to get more involved in the Council of Governor Workshops, which are excellent sessions to discuss and look at specific issues in greater depth. 15/51.1 Sub-Committees Summaries/Actions Membership & Community Engagement Membership recruitment strategies were discussed with key focus being on recruiting young members. The membership team is working hard to improve engagement in particular with younger members; Work with the Bromley College to re-design the Trust s young member s recruitment poster was excellent and it was highlighted that the Committee have already discussed a bulletin that can be shared on social media as a tool to encourage young membership; and The road closures around Loughborough Junction station affecting staff and patient journeys were cancelled recently. 8

11 Enc. 1.4 Item Subject Action Strategy Committee The Committee received a presentation about the Maurice Wohl Clinical Neuroscience Institute and there was a wide ranging discussion about the Trust s five year financial recovery plan. Patient Experience & Safety Committee The Committee listened to a number of patient experience comments as part of the patient story item; and There was an in depth discussion about the key issues in relation to patient food and nutrition at the Trust. Governors were pleased to hear about reinstating the Patient Food audits and governor involvement in this activity. 15/52 PwC Governance Review The Council received and noted the PwC Governance Review, which was conducted to ensure that the Trust s governance arrangements were fit for purpose. The following key points were noted: The scope of the review included individual interviews with each Board members, completion of surveys, review of past Board papers and PwC observing a number of Board and Committee meetings including a Council of Governors meeting; The Board accepted a number of practical recommendations and implemented a number of changes such as Board workings; and There will be additional Board Development days to consider the progress of actions and review self assessments. The Trust will also conduct a review of the well led framework to ensure effective governance processes are in place. The Council of Governors noted report and that there are sufficient and robust mechanisms in place to adequately address the recommendations of the PwC review. It was also highlighted that Governors should also take on board some of the recommendations and reflect on their role as Governors of the Trust. FOR INFORMATION 15/53 Register of Governors Attendance The Council noted the register of Governors attendance. 15/54 Monitor Quarterly Submission Quarter 2 The Council noted the Trust s quarter 2 Monitor submission. 9

12 Enc. 1.4 Item Subject Action 15/55 Sub-Committee Confirmed Minutes The Council noted the following sub-committee minutes: Membership & Community Engagement Committee 09/07/2015 Strategy Committee 09/07/2015 Patient Experience and Safety Committee 09/07/ /56 ANY OTHER BUSINESS There were no matters of any other business to discuss. 15/57 DATE OF NEXT MEETING Thursday, 17 March 2016, 14:00 17:15 in the Boardroom, Hambleden Wing. 10

13 COUNCIL OF GOVERNORS (PUBLIC MEETING) ACTION TRACKER Enc. 1.5 Date Item Action Who Due Update COMPLETED 24/09/ /29 Improving Quality of Care It was agreed that Dr Ian Webb IW TBC Update as at 09/03/2016: The will attend the Patient Experience & Safety Governor sub- action item has been transferred Committee to present the results of his findings and his recommendations. to Patient Experience & Safety Committee This item will be presented to the Patient Experience & Safety Committee. The Committee Chair will feedback to the Council of Governors in due course. Action Status as at: 17 March

14 Patient Experience Report Enc Report to: Date of meeting: Sponsored by: Presented by: Action Required: Council of Governors 17 March 2016 Judith Seddon, Acting Director of Corporate Affairs Judith Seddon, Acting Director of Corporate Affairs FOR INFORMATION Action The Council is asked to note the report

15 Enc Report to: Council of Governors Date of meeting: 17 March 2016 Subject: Author(s): Presented by: Sponsor: History: Status: Patient Experience Report Jessica Bush, Head of Engagement and Patient Experience Sophie Dalton, Head of Patient Relations and Complaints Judith Seddon, Acting Director of Corporate Affairs Judith Seddon, Acting Director of Corporate Affairs N/A Information 1. Summary of Report This quarterly report to the Council of Governors about patient experience presents data and qualitative feedback from patients for Quarter / Action required The Council is asked to note this report and offer comments and recommendations. 3. Key implications Legal: Financial: Assurance: Clinical: Equality & Diversity: Performance: Strategy: Workforce: Estates: Reputation: Other:(please specify) N/A Reputational risk CQC Fundamental Standards Caring and Responsiveness. Delivery of mandated Friends and Family Test N/A The Equality Delivery System seeks to ensure that all patient groups receive the same quality patient experience Performance against CQC Fundamental Standards Friends and Family Test Complaints performance CQC National Patient Survey performance Patient Experience is a key deliverable of the King s Strategy and forms a part of the Trust Quality Account Links to Staff Friends and Family Quality of estate from a patient perspective Poor patient experience is a reputational risk.

16 Enc Executive Summary 1.1. The headline for Quarter 3 patient experience is one of variable performance. There has been continued positive inpatient satisfaction across inpatient services sites with a rise since Q2. Complaints have also fallen slightly for inpatients and remain steady. ED performance has dropped off over the last two months of the quarter. Maternity at the PRUH remains consistently high but satisfaction at DH is more variable. Outpatient performance is below target and the trust is performing below the national average for FFT Overall complaints performance has improved in Q3 with 46% of complaints being responded to within 25 working days compared to Q2 at 38% with a year to date performance at 42%. Performance in closing lower severity complaints is better with 53% of complaints closing on time In December the CQC published the results of the 2015 National Maternity Survey which saw King's rated amber 'as expected'. This is the first set of results for King's as an enlarged organisation. Overall, the service improved although there remain key areas for improvement with KCH maintaining a strong position against London and national peer trusts, but there is some way to go to be amongst the best trust in the country. As part of improvement work for maternity, two 'Whose Shoes' events were held at both the DH and Bromley sites. This will be reported at the March committee Patient ratings on the NHS Choices have increased from 3.5 stars to 4.5 stars for the PRUH This report highlights the following areas of patient experience, and actions for improvement: Patient Experience - How are we doing, Friends and Family Test and complaints 2. Patient Experience Overview 2.1. Summary

17 Enc Dashboard: The dashboard shows comparative performance for quarters 2 and 3 for key patient experience metrics against this year's internal targets which are calculated as follows: How are we doing survey - historically, the HRWD target has been set to drive improvement locally and as measured by the CQC national survey programme. The internal targets are agreed annually to provide stretch where performance is good or to drive improvement on specific metrics where performance needs improvement Friends and Family - this year's internal targets were set to place King's above the average scores for London trusts Targets will be reviewed before the end of the year and will reflect targets agreed as part of the King's Quality Strategy. The headline for Quarter 3 patient experience is one of variable performance against our targets. There has been continued positive inpatient satisfaction with both sites exceeding the overall How are we doing score and FFT targets. The overall trend remains up. Outpatient performance is less positive with both sites trending below target both for overall How are we doing performance and for FFT. As a trust, our FFT scores are some 5% below the national average. There are key areas for improvement relating to appointments, waiting times in clinic and not providing patients with information or reasons for their wait. For our emergency patients, there has been a fall in satisfaction on both sites over the quarter with disappointing scores compared to trusts nationally. For maternity, satisfaction overall at the PRUH improved but remains below target. For the DH site, December saw a higher number than usual of 'Extremely Unlikely' to recommend ratings across the four touch points and this caused a significant drop in the score which has impacted on the average for the quarter. Performance on responding to complaints within the target 25 working days showed some improvement but there is still considerable work to be done to ensure that we answer our complaints in a timely manner. The overall trend for complaints over the year is down over the year. After a rise in complaints on the DH site since April 2015, performance has been improving and, although variable, numbers are going down. Levels at the PRUH remain higher than this time last year but are maintaining.

18 Enc The Trust received 224 complaints in Q3 compared to 228 in Q2; 129 (137) at DH and 95 (91) at the Bromley sites. Overall there is a downward trend in complaints received which reflects the continued focus on agreeing local resolution thus averting the need to initiate the formal pathway. 23% of complaints (52) related to a low severity experience and 5% (12) are linked to a duty of candour investigation. The ratio of complaints received during the quarter to patient activity (per 1000 patient attendances) was 0.5 compared to 0.8 in Q2 and 0.5 in Q1. Denmark Hill has a monthly average of 40 complaints which continues to be below the scorecard maximum target of 50 per month. Bromley site complaints have a monthly average of 28 complaints. Performance in responding to complaints within 25 working days is 46% for Q3 up from 38% in Q2. Overall YTD performance is 42% Inpatient experience Overall, satisfaction levels for inpatients is high. Satisfaction scores for surveys are improved and complaints fell slightly at the DH site Patient satisfaction surveys The How are we doing survey asks our patients about aspects of care that are key drivers of satisfaction including: being treated with respect and dignity being involved in decisions about care pain control kindness and understanding of staff The survey also asks about delays to discharge and has the FFT question as the first question on the survey. For both the DH and PRUH sites, performance exceeds the benchmark target of 89. For the PRUH, performance has improved on Q2 with an overall score of 92 for the quarter. DH scores have also lifted back up to 93 for the last two months of the quarter. Word cloud for inpatient comments themed by patient emotion (Q3) Within the divisions, all divisions met the overall target of 89 apart from TEAM on both sites who were rated amber, one point below target.

19 Enc Inpatient complaints - including maternity Inpatient Complaints April - December Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 DH Orpington Hospital Princess Royal University Hospital Headlines Inpatient complaints represent half of the overall total of complaints received in Q3 (113) DH, 63 and Bromley sites, 50. Numbers fell on both sites in November but otherwise have been consistent over consecutive months. Maternity complaints are consistently low with 8 in Q3 (Q2 10); DH 5 and PRUH 3. 7 inpatient complaints received in the quarter are linked to a Duty of Candour investigation (4 DH, 3 PRUH). For DH site, the distribution of complaints received in Q3, to patient activity represents 2 complaints per 1000 inpatient attendances (based on 63 received). For Bromley sites the distribution is 2.4 complaints per 1000 in patient attendances (based on 50 complaints received). Denmark Hill inpatients - complaint themes Clinical treatment (doctor led) is by far the greatest area that inpatient complaints relate to (24-38%). Concerns are varied both in theme and in their severity and are categorised by using dataset codes set by the DoH. The main areas of concern in Q3 include post treatment complications, incorrect treatment and pain management. Neurosurgery received the most complaints about clinical treatment (6). Patient Care (i.e. nurse led care) reduced in Q3 to 8 complaints from 12 in Q2. 4 Complaints linked to Duty of Candour investigations: Cardiovascular, Child Health, Neurosciences, and ED.

20 Enc Bromley sites inpatients - complaint themes Clinical Treatment (doctor led) complaints (21) reflects 42% of the total inpatient complaints made on the Bromley sites. 9 of the 21 concern one of the surgery specialities (e.g. orthopaedics, colorectal). Patient care (i.e. nurse led care) reduced to 4 from 12 in Q2. This is the lowest level since the new subject categories were introduced in April 15. Prescribing errors have increased to 4 from 0 in Q2 1 is linked to a Duty of Candour investigation. Communication increased to 7 from 1 in Q2. 3 complaints linked to Duty of Candour investigations: Child Health, Stroke, and Medicine Outpatient experience Overall, satisfaction levels for outpatients are disappointing. It's clear from the 'word cloud' that, although overall we are providing excellent services, there are much higher levels of negative emotion displayed by outpatients. Satisfaction levels measured by both our surveys and through complaints are disappointing Patient satisfaction surveys The How are we doing outpatient survey asks the same core questions of patients in terms of the key drivers of satisfaction and the FFT question. In addition we ask our outpatients about specific areas of their outpatient experience. their experience of the appointments system waiting times in clinic if they had to wait, were they told why Word cloud for outpatient comments themed by patient emotion (Q3) In terms of staff kindness and understanding we ask our outpatients about both reception and clinical staff. patients about aspects of care that are key drivers of satisfaction including: being treated with respect and dignity being involved in decisions about care pain control

21 Enc kindness and understanding of staff The survey also asks about delays to discharge and has the FFT question as the first question on the survey. In terms of overall patient satisfaction, both sites are performing below the How are we doing target score of 83. As the graph illustrates, PRUH scores are variable and this can be explained by very low response rates. In April 2016, we will be starting to use SMS to link patients to our surveys in order to boost response rates. We are also using Trust volunteers more widely to help gather outpatient feedback at the Bromley sites. There are plans to make use of electronic devices. Both sites are also performing below the national average for the Friends and Family Test.

22 Enc Our surveys are indicating clear areas for action to improve the outpatient experience. Difficulties with appointment Not being seen on time Not being given information about waits and reasons for waits Going forward, improving outpatient experience is one of two priorities that King's would like to focus on next year and any potential transformation workstream should include a strong focus on improving patient experience. Denmark Hill 2015 Question: Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Benchmark 1. Friends and Family Test Service from Appointment Centre Seen on time Information on Waiting Involvement in Care Dignity and Respect Kindness & understanding reception staff Kindness & understanding clinical staff Overall: Respondents: PRUH and Bromley Sites 2015 Question: Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Benchmark 1. Friends and Family Test Service from Appointment Centre Seen on time Information on Waiting Involvement in Care Dignity and Respect Kindness & understanding reception staff Kindness & understanding clinical staff Overall: Respondents:

23 Enc Outpatient Complaints Headlines Outpatient complaints (including the Emergency Department) represent 49.5% of all complaints received in Q3 (111) DH, 68 and Bromley sites, 43. Upward trend overall on both sites since April 15 although numbers on DH site have fallen back in line following a spike in September. 5 PRUH complaints are linked to a Duty of Candour investigation. Liver DH received the most outpatient complaints (9). Concerns included delays in receiving results and correspondence following consultations and treatment. Based on 81 outpatient complaints received, the ratio to patient activity is 0.2 complaints per 1000 attendances (0.2 - DH and Bromley sites). For Emergency Department attendances, the ratio of complaints is 0.6 per 1000 (0.4 DH and 0.9 PRUH). Denmark Hill Clinical treatment (doctor led care) is the predominant cause of outpatient complaints (30) which includes Emergency Department related complaints. Just over a quarter of these type of complaints relate to treatment received in the ED (8); appropriateness of clinical assessment and treatment being the overall theme. 5 complaints relate to access to treatment which covers a range of presenting concerns, including patient criteria for referral to tongue tie clinic, renal patient removed from kidney transplant list, and eligibility for NHS dental treatment. Reduction in Admission, discharges and transfers, patient care (nurse led) and values & behaviours (previously staff attitude). Communications and appointments (delays and cancellations) have remained static. 9

24 Enc Bromley sites Clinical Treatment (doctor led care) makes up 63% of the overall cause of complaint made by outpatients; 41% of these relate to concerns about clinical assessment and delays in receiving treatment within the Emergency Department (11). Other areas include ophthalmology where concerns relate to diagnosis and delays in receiving treatment or a procedure. 5 complaints are linked to a Duty of Candour investigation (2 Haematology, stroke, cardiac and ambulatory) Emergency Services Word cloud for emergency comments themed by patient emotion (Q3) After improved performance at DH in September, performance has returned to similar levels for the last six months AT the PRUH performance improved in October but has fallen back over the last two months of the quarter. Both sites continue to perform below the national average. Complaint levels on both sites remain relatively low but have risen over the quarter 10

25 Enc Maternity internal survey performance Performance has been variable over the quarter. For the Friends and Family test combined score, DH performance has been variable. The dip in December is due to an increase in the month of negative recommendations across the FFT touch points and specifically for the post natal service illustrated in the heat map. Performance has risen over the quarter. 11

26 1 Jan Enc Heat map for all sites - survey asked of women on our post natal wards Trust wide 2015 Question: Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Benchmark 1. Friends and Family Test Labour Friends and Family Test Post natal service Dignity and Respect Involvement in Care Kindness and Understanding Pain Control Involvement in Discharge Overall: Respondents: Improvement work There is an on-going programme of improvement work which includes a range of listening programmes. In the last six months, three patient video stories have been made with women using both the DH and PRUH services. These videos are playing a key part in staff gaining a better understanding of the experience of women using our maternity services. Another innovative initiative is the Whose Shoes programme. In January and February, King s held pilot sessions at the PRUH and Denmark Hill to gather feedback from women who had used the Trust s maternity services within the past two years. Further information will be provided at the March committee with the results of the CQC Maternity Service survey

27 Enc Quality Priorities for The Director of Nursing will provide an overview of the Quality Priorities in her report to the Quality and Governance Committee. Each year, our stakeholders play a key part in working with the trust to agree our current priorities. We consult with the following key groups: Commissioner Counsellors from local Health Overview and Scrutiny Committees Foundation Trust Governors Healthwatch The trust has put forward the following potential priorities for patient experience and are awaiting input and ideas from our stakeholders which is due by 26th February. 1. Improving outpatient experience Reason: Across all our sites, we have over 1 million outpatient appointments each year. Outpatients is often the first experience that our patients have of the trust and we need to ensure that patients experience receive an excellent service. Data from our How are we doing surveys and the Friends and Family Test show that KCH clearly show a need for improvement. For FFT, just under 5% less patients would recommend KCH as a place to receive outpatient care compared to trusts in London and England. In our How are we doing surveys, there are clear areas for improvement in waiting times and communication on waiting times. Over the last year there has also been an increase in formal complaints from outpatients. Outpatients will be a key are of transformation for the trust over the coming period and we want to ensure that patient experience is a key element of this change 2. Improving accessible information for disabled people Reason: The Accessible Information Standard will be implemented on 31 July King s has many informal systems in place that provide excellent examples of good practice and our Corporate Communications department strive provide accessible information via our website for example. However we would like to improve our systems, processes and auditability, aim for consistency and ensure no patients are missed and we meet the standards laid down by the new NHSE mandate. 4. Feedback on public websites Current star ratings on NHS Choices based on patient reviews are: DH remains at 4 stars PRUH rating has increased from 3.5 stars to 4.5 stars Orpington remains at 4.5 stars The Quality and Governance Committee is asked to note this report and offer any comments. 13

28 King s Quality Account Review of current Quality Priorities and Developing Priorities for 2016 / 2017 Enc Report to: Council of Governors Date of meeting: 17 March 2016 Sponsored by: Presented by: Action Required: Geraldine Walters, Director of Nursing and Midwifery Geraldine Walters, Director of Nursing and Midwifery FOR APPROVAL Action The Council is asked to: Review the Quality Priority Indications for 2016/217 Discuss the priority areas Approve the Quality Account

29 King s Quality Account Review of current Quality Priorities and Developing Priorities for 2016 / 2017 March 2016

30 PATIENT OUTCOMES Quality Priorities 2015/2016 On target Partial achievement Not on target Patient outcomes working to reduce preventable ill health: objectives Status Develop DH and PRUH as health promoting hospitals, continuing the culture change that started in 2014/15 to make health promotion mainstream. Increase the number of staff trained to support patients in reducing smoking /harmful alcohol use. Increase provision of advice and brief interventions relating to smoking and harmful alcohol use. Increase referrals into smoking cessation and alcohol services. Work with the providers of hospital food, both on wards and in cafes, to promote & deliver healthier food. Review ways in which we can increase promotion of exercise to improve health. Continue work to implement NICE public health guidance. 1 Patient outcomes improving outcomes following hip fracture: objectives Increase the proportion of patients getting the surgery they need to repair their hips in under 36 hours. Ensure that all patients receive the physiotherapy they need. Ensure effective shared care between orthopaedics and geriatrics. Increase the proportion of patients who have a geriatric assessment within 72 hours. Ensure all patients are tested for delirium before and after surgery. Ensure all patients have a falls assessment and a bone health review. Our work in will focus on the care pathway for hip fracture patients on both of our acute hospital sites, DH and PRUH.

31 Patient Outcomes Ambers (Working to reduce preventable ill health: Review ways in which we can increase promotion of exercise to improve health: Smoking and alcohol have been the initial focus promoting exercise is to be a key focus in Ambers (Improving outcome after hip fracture) Increase the proportion of patients getting the surgery they need to repair their hips in under 36 hours The PRUH has achieved significant improvements and is now achieving this standard for the vast majority of patients. Denmark Hill has achieved the standard for 80% of patients since July This is an improvement from 75% in

32 Appendix 1: Hip fracture KCH Denmark Hill, results in the National Hip Fracture Database (as at 15/1/16). 3

33 KCH PRUH, results in the National Hip Fracture Database (as at 15/1/16). 4

34 PATIENTSAFETY Quality Priorities 2015/2016 On target Partial achievement Not on target Patient safety Surgical Safety Culture objectives Status Zero Surgical Never Events 100% compliance with completion of safer surgical checklist >75% compliance with quality of checks performed 20% improvement in Surgical Safety Culture rating Not available Patient Safety Medication administration objectives Reduction in incidents involving 10 fold errors Reduction in incidents involving administration of drugs to patients with known allergies Increase in % of nursing staff passing the drug calculation competency assessment at 100% Reduction in the number of medication errors involving the wrong patient 5

35 Patient Safety Safer Surgery Culture Amber: >75% compliance with quality of checks performed: 2014/15 = 41%, 2015/16 = 61% Red: Zero Surgical Never Events: 2014/15 = 8, 2015/16 = 6 (to date) Not available: 20% improvement in Surgical Safety Culture rating (The 2015/16 culture survey (done Jul 15) differed from the 2014/15 one so results not comparable. Plan is to re do 15/16 culture survey in Feb 16 & compare) 6

36 Patient Safety Medication Safety Amber Reduction in incidents involving administration of drugs to patients with known allergies: the majority of clinical areas recording 0 1 per month therefore this is statistically very low in relation to the number of medication administered therefore more benchmarking is required Increase in % of nursing staff passing the drug calculation competency assessment at 100%: started from a baseline of zero in 2015 of the existing workforce now at 52% (this initiative excludes new starters of within 12 months as they will have completed the test) Reduction in the number of medication errors involving the wrong patient: Number has reduced over 12 months but has now plateaued at 7 8 per month Red Reduction in incidents involving 10 fold errors: Incident numbers were 10, 7 and 9 for Q1, Q2 and Q3 respectively 7

37 PATIENTEXPERIENCE Quality Priorities 2015/2016 On target Partial achievement Not on target 8 Patient Experience Improving experience for patients with cancer objectives Ensure that all the core MDT members (doctors and CNSs) are trained in national advanced communication skills training Ensure that all patients are seen by the CNS/support worker at diagnosis Ensure all patients receive a FU call from the CNS teams within 48 hours of diagnosis, and within 24 hours of discharge from hospital following treatment Ensure that the CNS teams to review in patients at least once during their in patient stay in order to provide further information and support Ensure patients and GPs are provided with an end of treatment summary / care plan Establish health and well being events for patients (for example HOPE courses) Undertake specialist training for nurses and HCAs on the in patient wards Work with Macmillan to develop the band 4 support worker role in each MDT an innovative role aimed at helping patients to navigate through their pathways and to provide one to one support Introduce designated nurse led pre assessment clinics for patients commencing chemotherapy treatment Continue with the rolling annual internal peer review of each MDT holding teams to account for progress being made against their patient experience action plans Develop a designated cancer information hub in the PRUH and work with Macmillan to ensure that information pods are available in key areas throughout the PRUH Establish a Trust cancer patient experience steering group Develop KPIs for the CNS teams which aid to hold the teams to account for quality improvements Stat us

38 Patient Experience Improve the experience of cancer patients - what have we achieved Amber: Seen by CNS at diagnosis : upward trend if the CNS is not available contact details are always given to patients. National Advanced Communication skills lack of commissioned courses now available., therefore issue is more with new post holders Red: Ensure all patients receive a follow up call from the CNS teams within 48 hours of diagnosis, and within 24 hours of discharge from hospital following treatment: Challenging due to CNS capacity and also being able to collate data. New CNS KPI s will monitor this. Undertake specialist training for nurses and HCAs on the in patient wards: CNS do undertake some in patient training this is challenging because of the demands on the ward teams and CNS time. Work with Macmillan to develop the band 4 support worker role in each MDT an innovative role aimed at helping patients to navigate through their pathways and to provide one to one support Macmillan did not agree funding for this role. Establish a Trust cancer patient experience steering group we have tried several ways to engage patients none have successful and we will review how other trust have success. 9

39 PATIENT EXPERIENCE Improving discharge On target Partial achievement Not on target Patient experience improving discharge Denmark Hill Status Southwark and Lambeth Integrated Care (SLIC): Achieve integrated working in the hospital environment building better communications between all parties (internal & external) to facilitate safer patient discharge. SLIC: Increase and embed Care home interface meetings group including hospital and care home managers to enable effective admission and discharge communications. Continue to increase usage and profile of Homeless team. Increased usage service across all specialties. Improve timeliness and quality of information around medications for patients and carers. Commit to Care ward accreditation system discharge indicators to be green across the organisation. Ensure all in patient wards have individual actions plans to improve discharge, share good practice and innovative ideas. Ensure all patients who have received care from a therapist has a detailed discharge summary sent to GP. Patient experience improving discharge PRUH Increase the number of discharges before 11:00 Ensure a robust referral system to external agencies, Bromley Health Care LBB via the TOC Implement criteria led discharge throughout medicine and surgery Introduce the exemplar wards around discharge Telephone follow up calls to embedded and routine in all appropriate in patient wards areas(50% in first 6/12 up to 85% by year end)routinely carried for 50% of patient on supportive discharge 10

40 PATIENT EXPERIENCE - Improving Discharge On target Partial achievement Not on target Ambers These are ongoing and on an upward trajectory Reds Commit to Care ward accreditation system discharge indicators to be green across the organisation: Detailed introduction of Commit to Care at Denmark Hill and currently reviewing and validating scoring system Ensure all patients who have received care from a therapist has a detailed discharge summary sent to GP (Denmark Hill): Multidisciplinary discharge approach still not optimum and not electronically aligned Increase the number of discharges before 11:00 (PRUH): TBC Telephone follow up calls to embedded and routine in all appropriate in patient wards areas(50% in first 6/12 up to 85% by year end)routinely carried for 50% of patient on supportive discharge: Not taken forward this year as other discharge initiates took priority and focus 11

41 Longlist for suggested priorities for 2016 OUTCOMES Improving outcomes for patients undergoing emergency abdominal surgery Improving outcomes for patients following planned major surgery SAFETY Never Events improve safety in invasive procedures. Sepsis (improvement of its recognition, management and escalation) Reduce Medication Omissions EXPERIENCE Improving staff health and wellbeing to improve patient experience Improving outpatient experience Improving accessible information for disabled people Improved discharge information for patients 12

42 13 Indicator Options 1. Monitor requirement: Referral to treatment within 18 weeks for patients on incomplete pathway A&E four hour wait 62 day cancer treatment wait 28 day readmissions The list is in order of Monitor s preference. Accordingly the Trust is required to conduct data testing on the following: A&E four hour wait Referral to treatment within 18 weeks for patients on incomplete pathway 2. Council of Governors is also required to chose one local indicator. The following options are available for consideration: Medication Safety Errors VTE 62 day cancer waits 28-day readmission.

43 Enc. 2.2 REPORT TO COUNCIL OF GOVERNORS Report To: Council of Governors Date of Meeting: 17 March 2016 By: Presented By: Subject: Nick Moberly, Chief Executive Officer Nick Moberly, Chief Executive Officer Board Report to the Council of Governors OVERVIEW As King s moves towards the end of the FY, we continue to focus on 3 broad themes: Maintaining financial and operational grip, both for the remainder of FY 15/16,and for FY 16/17 and beyond Laying the groundwork for a major push on transformation as we move into FY 16/17 Pushing ahead with a number of strategic initiatives which will contribute to the longer term sustainability of the organisation. Useful progress is being made on all 3 themes; but with 6 weeks to go until the end of the FY our key focus is on the here and now and maintaining grip i.e. delivering our 65m deficit plan, ensuring that there is a robust financial plan in place for FY 16/17, and closely managing our day to day operational pressures. Further detail is set out below, organised under the main headings of our strategy triangle. MISSION Strategic Service Developments Useful discussions are under way with the health and social care partners in both Lambeth and Southwark, and Bromley, on how we can work together more effectively to deliver joined up care for local people. Although there is much to do in both geographies, there is a very welcome sense of determination amongst the partners to move forward on what is seen nationally as a key priority; and I will look forward to reporting back in future months on how we are doing. Nationally, strong emphasis is being placed on developing overarching Sustainability and Transformation Plans covering a broad regional or sub-regional geography. It has been agreed that commissioners and providers in South East London will come together to develop an STP for South East London, and work on this is now underway under the auspices of the Our Healthier South East London. A number of important efficiency and quality initiatives are being scoped as part of this plan with early attention being given to the configuration of orthopaedic services across the sector. In parallel, we are continuing to work with our partners in King s Health Partners to develop our specialist service portfolio. Currently, work is focused on developing plans to create powerful new KHP Institutes for Neurosciences, Haematology and Cardiovascular Services. We are also looking at options for collaboration in Child Health, and considering opportunities to strengthen our academic profile in Liver and Transplantation. 1

44 Enc. 2.2 Underpinning much of the above work, over the coming months we will be working to develop an overarching clinical/site strategy which will lay out clearly what services we intend to offer, on which of our sites, and the capacity which will be required to meet forecast levels of demand. Clinical Support Services Nationally, pathology has been highlighted as a discipline which could benefit significantly in terms of quality, responsiveness and efficiency from consolidation. King s is a longstanding partner in Viapath, a pathology services JV which it jointly owns with GSTT and Serco and which is one of the largest pathology players nationally. Together with our partners, we are conducting a strategic review to consider how Viapath can best develop its offering and footprint, and what operational configuration of its services will best support its strategic plans. King s is also in discussion with Viapath about the potential for Viapath to assume responsibility for delivering pathology services at the PRUH. Back Office Services At a national level, strong emphasis is also being placed on NHS bodies identifying opportunities to collaborate in the provision of back office services and procurement. We anticipate that over the coming months (as part of the STP process described above) we and our partners will scope options to work together in this area. BEST QUALITY OF CARE Outcomes The Trust continues to perform well against most available outcomes metrics, and in particular remains a strong performer in terms of mortality. Of particular note this month is the encouraging recent progress on emergency laparotomy, which was discussed at the Quality and Governance Committee. Safety Overall, the Trust continues to perform well against most safety metrics. In terms of infection control, there have been no MRSA cases reported in January so we have had 2 cases year-to-date (YTD). However, we had 10 c-difficile cases in January so 77 cases reported YTD, which has now exceeded our annual quota of 72 cases. Regrettably, Q4 has seen further Never Events resulting, in recent months in the following: 3 retained wires from Seldinger techniques (2 intercostal chest tubes and one central line), one wrong type prosthesis and two nasogastrc tube misplacements. This is obviously deeply concerning and requires us all to focus upon ensuring the delivery of high quality care at all times with adherence to the safety checklists to ensure that we do not contribute to avoidable harm for our patients. Experience Although the great majority of our patients give positive feedback on our services, King s Friends and Family Test scores are below the average when compared to other trusts nationally. This is a very important aspect of our care, which we will have to focus on in the months ahead. The number of complaints we receive from patients is in broadly line with national norms and gradually declining, but we continue to perform very poorly in terms of complaints response

45 Enc. 2.2 times, with less than 50 % of complaints being responded to within 25 working days. This will be a major focus for us in the coming months. In terms of access, we are performing strongly against Cancer Waiting Times standards, and in particular continue to deliver consistent quarterly compliance against the key 62 day target. A&E waits remain very challenging for us, as for other London trusts, with performance in January running at under 90%. We are on track to return to full RTT reporting in April, but expect to be some way short of compliance with the 92% incompletes standard when we do so and a realistic improvement trajectory for returning to compliance will have to be agreed with CCG colleagues. General We are now in the process of developing a comprehensive quality strategy setting out how we plan to move towards our ambition of delivering consistently outstanding care for our patients. We are also continuing to work on delivering actions against each of the must do and should do actions identified by the Care Quality Commission (CQC) following their inspection in April Whilst the Trust continues to face challenges related to activity levels it is generally meeting all the key milestones set out its CQC Action Plan. These actions are being reviewed through the CQC Steering Group and at executive meetings. EXCELLENT TEACHING & RESEARCH Our major current focus is to ensure that the Trust is well represented in bids which our KHP partners (GSTT and SLAM) will be submitting to reapply for NIHR BRC status. Over the coming months we will be developing a more detailed Research and Teaching strategy setting out how we move towards our ambition of cementing our position as a centre of research and teaching excellence. SKILLED, CAN DO TEAMS The high-level priority areas for organisation development for the next 3 years, in line with the Trust s emerging vision and strategy, have now been agreed and will form part of the overall Trust objectives for These will also be fleshed out into a more detailed workforce strategy setting out how we achieve our ambition of making King s a great place to learn and develop. Work on redesigning the organisation's operating model and the structures needed to deliver this is progressing well and a paper is being presented to the Board to outline the proposed way forward and seek endorsement of the start of a formal consultation process in April TOP PRODUCTIVITY Although we are very proud of our clinical services, overall there is a significant opportunity to improve productivity. To achieve longer term sustainability, we will need to move to national upper quartile or upper decile performance levels on key operational metrics such as day case rates, length of stay and theatre utilisation. As the Board is aware, we are well advanced in designing a major transformation programme to unlock some of these opportunities, with the aim of launching the programme in Q1 of FY 16/17. The programme will focus on systematically driving a clean sheet clinically-led redesign of our clinical services, establishing a pervasive continuous improvement culture throughout the organisation, and exploiting technology to support joined

46 Enc. 2.2 up clinical decision making. A business case is being presented to Board seeking formal approval to proceed, which will need to be submitted to Monitor for subsequent review and endorsement. FIRM FOUNDATIONS Sound Finances As at month 10 the Trust s cumulative deficit stands at 73.8m. We are continuing to forecast a FY outturn deficit of 65m, in line with our plan. To achieve this, we will have to maintain very tight controls on our expenditure for the remaining 2 months of the year, as well as taking a number of mitigating actions. Looking ahead to FY 16/17 we are focusing intensively on developing a robust 50m cost improvement programme. We have responded positively to the offer from NHS Improvement of transitional financial support in FY 16/17, subject to a variety of caveats. Compelling Communications Work has now begun on audit of our internal and external communications activity, with a view to implementing a refreshed overall communications strategy in the new FY. Further meetings with key stakeholders have taken place including the local MP for Camberwell and Peckham. The local MP for Dulwich and West Norwood also returned for a tour of maternity, sexual health and HIV services. Work is underway to deliver membership community events. This will provide Trust members with an update on our work over the past year, new developments and our future strategic priorities. New and events can be found on the Trust s website: Some noteworthy media coverage and events include: Medium The Daily Telegraph The Times Daily Mail BBC South East South London Press The Guardian Summary The article was on a pioneering new treatment for Multiple Sclerosis, which is being carried out at King s and the Royal Hallamshire Hospital in Sheffield. The treatment involves using a high dose of chemotherapy to knock out the immune system before rebuilding it with stem cells taken from the patient s own blood. Following a Trust press release, a number of national media outlets featured a story about a new cardiac device called a Mitra- Spacer, which was used in a world-first procedure by King s Professor of Cardiac Surgery, Olaf Wendler. The balloon-shaped device, no bigger than a chilli pepper, was implanted into the heart of a patient deemed too weak to undergo conventional surgery. The device prevents leakage from a valve that has been damaged by a heart attack. Professor Kypros Nicolaides, Director of Fetal Medicine at King s, was the subject of a feature in the newspaper as part of its longrunning This is the NHS series. The article focussed on some of the pioneering treatments Prof Nicolaides performs on unborn babies to correct potentially life-threatening conditions.

47 Enc. 2.2 Medium BBC2 South London Press The Daily Telegraph Health Service Journal Summary King s neurologist Professor Al-Chalabi provided expert comment on MND, and also explained the responsibilities of physicians in the UK with regards to the law and assisted dying as part of the documentary about former patient, Simon Binner, who made the decision to end his life in Switzerland, following a diagnosis of Motor Neurone Disease (MND). King s featured in the South London Press, following a press release we issued about a former patient who was able to celebrate Valentine s Day thanks to emergency open heart surgery at King s. 26-year-old Murtaza Abbas underwent four hours of emergency open heart surgery last April, after being diagnosed with endocarditis. His partner, Katy Jackson, has decided to run the London Marathon this year to raise money for the cardiac unit. King s was mentioned in a Daily Telegraph article about patients with dementia being discharged from hospital in the middle of the night. King s was highlighted for discharging more than 250 patients with dementia overnight in 2014/2015. The data we provided in our FOI response does not necessarily reflect a high number of evening discharges. This is because individual entries show the time a patient s discharge was entered into our records system, rather than when they actually left hospital. We were not approached for comment on this article. The article about NHS Block Contracts referred to King s as having the biggest growth in block contracts for planned care. The article quotes a King s spokesperson as saying, We transferred acquired sites on to the King s patient administration system during 2014 and wanted increased financial stability while we embedded and validated PRUH patient data during the following year. Robust IT And Information Work is now kicking off on the implementation of the new Allscripts EPR across all of our sites, and the parallel programme to reduce reliance on paper notes through the implementation of an Electronic Document Mangement System. I will look forward to updating the Board on how this important project is progressing in future months. Fit For Purpose Infrastructure A major longer term objective for the Trust is to undertake a major renewal of its infrastructure, on the Denmark Hill campus in particular. Work is now kicking off to develop an overall master plan for the Denmark Hill site, and to consider options for financing the major capital investment that will be required.

48 Appendix: Our Strategy BEST Care Globally Enc. 2.2

49 Trust Performance Report 2015/16 Month 10 Enc Report to: Date of meeting: Sponsored by: Presented by: Action Required: Council of Governors 17 March 2016 Jeremy Tozer, Interim Chief Operating Officer Jeremy Tozer, Interim Chief Operating Officer FOR INFORMATION Action The Council is asked to note the M10 performance reported against the governancee indicators defined in the Monitor Risk Assessment framework for the interim Q4 position in 2015/16.

50 Enc Report to: Council of Governors Date of meeting: 17 March 2016 Subject: Trust Performance Report 2015/16 Month 10 Author(s): Presented by: Sponsor: History: Status: Steve Coakley, Acting Assistant Director of Performance & Contracts Jeremy Tozer, Interim Chief Operating Officer Jeremy Tozer, Interim Chief Operating Officer None For Information 1. Summary of Report This report provides the details of performance achieved against key national performance and quality indicators, and governance indicators defined in the Monitor Risk Assessment framework for the interim Q4 position in 2015/ Action required The Council is asked to note the M10 performance reported against the governance indicators defined in the Monitor Risk Assessment framework for the interim Q4 position in 2015/ Key implications Legal: Financial: Assurance: Clinical: Equality & Diversity: Performance: Statutory reporting to Monitor and the DoH. Trust reports financial performance against published plan. The summary report provides assurance that the Trust has met the performance targets as defined within the Monitor Risk Assessment framework (RAF) for the interim Q4 position with the exception of the A&E 4-hour target and the c-difficile threshold. There is no direct impact on clinical issues. There is no impact on equality & diversity issues. The summary report demonstrates that the Trust has achieved the performance indicators for the interim Q4 position as defined in the RAF with the exception of the A&E 4-hour target and the c-difficile threshold. An extension for a further 6 months beyond reporting September 2015 Referral to treatment (RTT) performance returns has been agreed with host commissioners, NHS England and our regulator which now extends to March

51 Strategy: Workforce: Estates: Reputation: Other:(please specify) Performance against the Trust s annual plan forecasts and key objectives. None. There is no direct impact on Estates. Trust s quarterly and monthly results will be published by Monitor and the DoH. N/A 2 of 16

52 Key Messages of this Report There was a 3% increase in patients attending the Trust s Emergency Departments (ED) in January compared to December, and managing winter pressures continues to be extremely challenging. Trust performance against the 4-hour target worsened further from 87.47% reported in December to 86.23% in January. Latest Q4 performance is 85.12% compared with 89.34% reported for Q3. RTT incomplete pathways have been validated down to 18 weeks for admitted pathways, and to 24 weeks for non-admitted pathways. There were 171 patients waiting 52+ weeks at the end of January 2016, which is slightly higher than the 169 patients waiting at the end of December. There were 88 patients on admitted pathways and 83 patients on nonadmitted pathways. Cancer targets are being achieved at a Trust level for the January 2016 position but there are 2 breaches of the 31-day subsequent surgery target. The 62-day first treatment target of 85% is being achieved in January at 90.3% although there are 5.5 breaches on the DH site, so the target is not being achieved on this site at 84.1%. There have been 3 MRSA cases YTD with one case reported in October, one case in December 2015 and one case in January, all on the DH site. 77 c-difficile cases reported to the end of January which is above the quota of 60 cases, and now exceeds the annual quota of 72 cases. There were 8 cases reported in January on the DH site, so 56 cases reported YTD which is above the quota of 44 cases. There were 2 cases at PRUH so 21 cases reported YTD which is above the quota of 16 cases. Introduction/Background The performance report for January 2016 includes updates for the Emergency Care 4-hour performance Action plans for PRUH and DH, the Trust-wide RTT programme and HCAI. Trust Priorities Emergency 4-hour performance at Princess Royal Hospital (PRUH): All types performance worsened further from 86.12% reported in December to 83.20% in January. Type 1 attendance performance also worsened from 76.37% in December to 71.39% in January. The number of breaches in Urgent Care Centre (UCC) increased from 75 in December to 99 in January, and breaches due to late handover from the UCC increased from 118 to 179 which further adversely impact on our all types attendance reported performance. There was 1 breach of the 12-hour trolley standard on the PRUH site. Emergency 4-hour performance at Denmark Hill (DH): All types performance improved slightly from 88.55% in December to 88.70% in January, and type 1 attendance performance improved from 86.56% to 86.94%. Attendances remain high in the ED with nearly 12,150 patients seen in January, which is a 3.7% increase compared to December attendances. There was 1 breach of the 12-hour trolley standard on the DH site during January. Referral to Treatment (RTT) Incomplete pathway performance: The number of 52+ week breach patients increased from 169 patients reported in December to 171 patients reported in January based on the new operational Patient Tracker List (PTL) reports. The number of patients waiting weeks decreased slightly from 1,198 at the end of December to 1,185 at the end of January. RTT incomplete pathways have been validated to 18 weeks for admitted pathways and 24 weeks for non-admitted pathways for the end-january 2016 position, consistent with our plans. The central RTT tracker team are on-track to have all incomplete pathways validated to 18 weeks for the February month-end position which will we report in mid- March. There are 15,865 patients waiting over 18 weeks at the end of January so our incomplete performance is 79.9% compared to the national 92% waiting time target. 3 of 16

53 Key Issues Clinical Effectiveness: The national Summary Hospital Mortality Index which includes deaths outside of hospital is now being reported based on data published from the HED benchmarking tool. The SHMI is improving and better than the expected index of 100, with the SHMI index at 89 for PRUH and 85 for DH, based on latest external data available. The number of diagnostic 6-week waiting time breaches reduced by 66 cases reported at the end of January to 564, which represents 5.9% of the total number of patients waiting. This is therefore above the national target of 1%. Main breach areas are MRI with 242 breaches (mainly neuro-mri cases), and non-obstetric ultrasound with 179 breaches (a reduction of 157 breaches compared to the December position). Current action plans and trajectories from divisions show a planned improvement to 2.6% by the end of March. Cancer waiting time targets are being achieved at a Trust level for the January position in Q4. Whilst the 62-day time to first treatment target is not being achieved at the DH site at 84.1%, the Trust position is achieving the 85% target at 90.3%. We are now required to submit a weekly cancer PTL and 62-position including backlog and patient activity to NHSE. Safety: 3 MRSA cases have been reported YTD, all on the DH site. There were 10 new c-difficile cases reported in January, of which 8 were on the DH site and 2 on the PRUH site. 77 c- difficile cases have therefore been reported to the end of January which is above the quota of 60 cases. There have been 56 cases reported at the DH site, above the quota of 44 cases, and 21 cases at the PRUH which is above the quota of 16 cases. There were 8 patient slips, trips & falls cases rated as moderate or major injury in January. The number of red shifts reported remains high with 154 in January 79 shifts were reported in TEAM wards/ed, 27 shifts in Haematology wards and 26 shifts in Surgery wards and 10 shifts in Liver/Renal wards. Patient Experience: The HRWD Inpatient survey overall score and all Friends and Family (FFT) scores for Inpatient and Day Case patients continue to achieve their targets in January. FFT scores for ED patients are below target on both the DH site at 84.0% and the PRUH site at 80.0% compared to their respective targets of 88% and 87%. The number of inpatient cancellations on the day remained at 60 cases in January at PRUH but increased from 34 in December to 46 in January at the DH site. The number of 28-day cancellations reduced from 14 cases to 9 in January 3 at DH and 6 at PRUH of which 4 were due to a lack of beds. The number of complaints reduced from 83 received in December to 69 received in January, but there were 7 rated as high or severe. The number of complaints still open or not responded to within 25 working days increased from 32 to 43. Finance & Operational Efficiency: Financial position - please see the Finance report for further details. The proportion of inpatients discharged at weekends improved by over 6% on the DH site to 24%, and by over 4.5% on the PRUH site to 22% in January; but remain below the 28% target. Utilisation remained below the 80% target across all theatres in both December and January. On the DH site, main theatre utilisation reduced slightly further from 79% to 78%, and DSU utilisation reduced from 73% to 69%. On the PRUH site, main theatre utilisation improved from 60% to 65% and DSU utilisation improved from 68% to 70%. Utilisation in Orpington main theatres also improved from 69% to 72%. Staffing: Vacancy rate worsened from 8.3% in December to 10.3% in January on the DH site, and worsened from 14.7% to 15.7% for the PRUH sites, with vacancy rates for both sites remaining above the internal 5-8% target. Compliance against mandatory and statutory training and induction courses remains above the target of 80 at 81 for the DH. No data available for PRUH at this stage. 4 of 16

54 Regulatory Performance/Monitor compliance Monitor Q4 2015/16 position: The Trust has achieved the performance indicators in the Monitor Risk Assessment Framework for the interim Q4 position with the exception of the c-difficile target and the A&E 4-hour performance target. RTT performance indicators are not being reported, consistent with the extended RTT reporting suspension that has been agreed with local and national commissioners. We currently have a score of 4.0 based on the latest RAF as the RTT completed targets for admitted and non-admitted pathways are no longer included in national submissions to Unify and to Monitor. RTT performance will only therefore be measured on incomplete pathways achieving 92% within 18 weeks. We are planning to submit March 2016 RTT national performance returns to Unify in April We have now reported 77 c-difficile based on the latest reporting position in Q4, so the annual quota of 72 cases has now been exceeded. There were 2 breaches of the 31-day second/subsequent cancer (surgery) target in January, so the 94% target is not being achieved for January. However, we would expect this target to be achieved for Q4 overall which is how we will be assessed. 5 of 16

55 Trust Performance Scorecard DH site 6 of 16

56 Trust Performance Scorecard PRUH sites 7 of 16

57 Trust Emergency Care 4-hour performance Week Ending 06/12/ /12/ /12/ /12/ /01/ /01/ /01/ /01/ /01/ /02/ /02/ /02/ /02/ /03/ /03/ /03/ /03/2016 Actual All Types Performance 83.56% 87.54% 85.43% 93.82% 89.02% 86.96% 88.88% 85.60% 82.22% 84.12% Trajectory PRUH 88% 90% 91% 92% 92% 93% 93% 95% 95% 95% 95% 95% 95% 95% 95% 95% Trajectory DH 88% 89% 90% 88% 88% 89% 89% 90% 91% 91% 91% 91% 92% 92% 92% 92% Trajectory Combined 88% 89% 89% 88% 88% 89% 89% 90% 91% 91% 91% 92% 92% 93% 93% 93% Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% % Combined ED Performance and Trajectory % 90.00% 85.00% 80.00% Actual All Types Performance Trajectory PRUH Trajectory DH Trajectory Combined Target 75.00% Highlights January 2016 Trajectories for ED 4-hour recovery plans were agreed with commissioners in December for each of the DH and PRUH sites. The data table and chart above reflect the combined-site Trust trajectory up to the week-ending 7 February Weekly trajectory performance targets were achieved for the last week in December and first weekend in January. However, performance has largely worsened across the last four weeks in January. The trajectory for the beginning of February was to achieve 91% and performance for the first week in February is 84.12%. The charts below compare monthly and quarterly Trust performance against the 4-hour target. Performance is 86.23% in January 2016, just over 0.5% higher compared to 85.7% achieved in January % Kings Monthly All Types Performance Jan 2014 Jan % KIngs Quarterly All Types Performance 95% 95% 90% 85% 80% 90% 85% 75% 80% 88.94% 89.89% 90.83% 91.84% 88.49% 89.34% 85.82% 70% 75% 70% Qtr 1 Qtr 2 Qtr 3 Qtr 4 Jan 2014 Jan 2015 Jan 2015 Jan / /16 8 of 16

58 Emergency Care 4-hour performance Action Plan (1/2) Week Ending 06/12/ /12/ /12/ /12/ /01/ /01/ /01/2016 Actual All Types Performance 82.63% 88.06% 81.96% 93.91% 87.83% 82.89% 86.35% 79.53% 79.85% 84.93% Trajectory 88% 90% 91% 92% 92% 93% 93% 95% 95% 95% 95% 95% 95% 95% 95% 95% Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 24/01/ /01/ /02/ /02/ /02/ /02/ /03/ /03/ /03/ /03/ % PRUH ED Performance and Trajectory for % 90% 85% 80% Actual All Types Performance Trajectory 75% Target 70% The data table and chart above show the weekly all types 4-hour performance at PRUH from the beginning of December to the week-ending 7 February 2016, including the improvement trajectory that has been agreed with commissioners for the remainder of 2015/16. Highlights January 2016 Emergency 4-hour all types attendance performance worsened further on the PRUH site from 86.1% in December to 83.2% in January, and performance for type 1 attendances in ED worsened from 76.4% to 71.4%. Attendances increased in ED by 1.8% in January 2016 compared to December 2015, and UCC attendances increasing by 6.5%. Despite the worsening performance reported in January 2016 to 83.2%, it is nearly 5% higher than the 78.3% performance reported in January 2015, as demonstrated by the charts below. 100% PRUH Monthly All Types Performance Jan 2014 Jan % PRUH Quarterly All Types Performance 95% 95% 90% 85% 90% 80% 85% 75% 80% 88.54% 87.98% 91.50% 89.26% 70% 75% 83.96% 81.04% 79.58% 70% Qtr 1 Qtr 2 Qtr 3 Qtr 4 Jan 2014 Jan 2015 Jan 2015 Jan / /16 9 of 16

59 Emergency Care 4-hour performance Action Plan (2/2) Emergency Care Programme (ECP) update Due to the internal pressures that we have been facing at the PRUH sites during January, the ECP Board has not met so there have been no formal updates on the Emergency Care Programme. ED Recovery Plan The Acute Care Hub (ACH) has opened at PRUH and the additional A&E consultants identified from the earlier McKinsey-led review are now in post. However, due to wider capacity issues, patient flow has been an issue on the ACH since the beginning of January. A new ambulatory area also opened on 25 January 2016 and it is planned that this facility will provide direct access to GP s going forwards. Pulling Together Week (early March 2016) We are planning to run a Pulling Together week at PRUH in early March 2016 which will be supported by the external ECIP team. Dates for the week are being finalised with ECIP, and plans for the week are in progress, similar to the event that was run previously on the DH site in December Out Of Hospital Winter Plan Primary Care Access Hubs Two primary care access hubs have been setup as part of a 4-month pilot running from December 2015 to April 2016, co-designed with the Bromley GP Alliance for Bromley CCG. Hubs have been setup at opposite ends of the Bromley borough in Cator and Poverest Medical Centres. The hubs provide week-day access for same-day booked appointments from 4-8pm and weekend access from 9am-1pm. Figures for the first 5 weeks of service fluctuate between 70-85% slot utilisation, with low update on Sundays at ca 32%. Transfer of Care The Transfer of Care bureau has been implemented across PRUH with an additional 19 case managers recruited to enable every medical ward to have a dedicated case manager, and the 6 surgical wards sharing 4 case managers. There has been a delay in implementing the transfer of service which was due to go live in December 2015, due to a lack of staff. Additional Discharge to Assess beds have been sourced from The Sloane hospital for Q4, mainly for patients awaiting social care or nursing home placements. 10 of 16

60 Emergency Care 4-hour performance Action Plan (1/2) Week Ending 06/12/ /12/ /12/ /12/ /01/ /01/ /01/ /01/ /01/ /02/ /02/ /02/ /02/ /03/ /03/ /03/ /03/2016 Actual All Types 84.27% 87.13% 88.12% 93.73% 90.05% 90.23% 90.83% 90.43% 84.19% 83.48% Performance Trajectory 88% 89% 90% 88% 88% 89% 89% 90% 91% 91% 91% 91% 92% 92% 92% 92% Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 96% DH ED Performance and Trajectory % 92% 90% 88% 86% 84% 82% 80% 78% Actual All Types Performance Trajectory Target 76% The data table and chart above show the weekly all types 4-hour performance at DH from the beginning of December to the week-ending 7 February 2016, including the improvement trajectory that has been agreed with commissioners for the remainder of 2015/16. Highlights January 2016 Emergency 4-hour all types attendance performance improved slightly on the DH site from 88.6% in December to 88.7% in January, and performance for type 1 attendances in ED improved from 86.6% to 86.9%. Attendances in the ED remained high with nearly 12,500 attendances in ED during January which is 3.7% higher than December. Weekly performance trajectory targets were achieved for the week-ending 27 December 2015 to 24 January 2016, but has reduced below trajectory to 83-4% since w/e 31 January % DH Monthly All Types Performance Jan 2014 Jan % DH Quarterly All Types Performance 95% 95% 90% 85% 80% 75% 90% 85% 80% 92.82% 92.99% 90.78% 92.51% 94.06% 89.41% 90.50% 70% 75% 70% Qtr 1 Qtr 2 Qtr 3 Qtr 4 Jan 2014 Jan 2015 Jan 2015 Jan / /16 11 of 16

61 Emergency Care 4-hour performance Action Plan (2/2) Winter Bed Plan Update The Acute Care Hub (ACH) which is a joint medical and surgical facility opened on 5 January 2016 as planned in Matthew Whiting ward with 16 beds during its first week of opening, increasing to 23 by the end of January. The staff plan is being worked-up to open the full 26 beds available. The Surgical Assessment Unit on Katherine Monk ward has also moved to the ACH creating an additional 4 beds. Medical Assessment Centre (MAC) trolley beds are closed now that the ACH has become operational, but MAC clinics remain open. Ontario ward at Orpington Hospital increased from 10 to 15 beds, with 20 beds planned for the end of February. The Frank Cooksey rehabilitation unit moved from Lewisham Hospital to Orpington Hospital on 27 January 2016, enabling an overnight rota to support the move of additional orthopaedic patients from Denmark Hill to Orpington. Management of minors area in the Emergency Department Emergency Nurse Practitioner (ENP) overnight cover in ED commenced 29 January 2016, to support the treatment and management of minors patients, along with the GP overnight model which has been funded with winter pressures additional monies. 12 of 16

62 RTT Update RTT Reporting Suspension update Monitor and our commissioners agreed to the Trust s Board request for an extension to the original suspension of national RTT waiting times performance reporting for a further 6-month maximum period. The Trust is on-track to return to national reporting of its RTT incomplete performance position for the March 2016 month-end position in mid-april This submission will be based on a PTL that is fully validated to 18 weeks. We will be providing Unify-based shadow monitoring of the January and February RTT monthend positions with our commissioners. We have also agreed with commissioners to request that the RTT Intensive Support Team (IST) conduct a further review our reporting processes ahead of the first national submission in April We are currently working with the IST team to confirm dates for this review, and are planning to have the visit conducted between March Validation Update Incomplete pathways for the end-january 2016 position have been validated down to 18+ weeks for admitted pathways, and 24+ weeks for non-admitted pathways. Further details of this position can be found below. The central RTT validation team are on-track for having all incomplete pathways validated to 18 weeks to support the reporting of the end-february position by 17 March. End-January 2016 Incomplete pathway position There were 171 patients waiting over 52 weeks that we reported to commissioners and Monitor based on the position as at the end of January, of which there were 88 patients waiting on admitted pathways and 83 patients waiting on non-admitted pathways. This constitutes a slight increase in the number of patients waiting compared to end-december position where we reported 65 patients waiting over 52 weeks on admitted pathways and 104 patients waiting on non-admitted pathways. The waiting time position for January 2016 compared to December 2015 is summarised below: 52 weeks Patients waiting end-january (December position in brackets) Incomplete -Admitted 2, (269) 88 (65) Incomplete Non-admitted 11, (929) 83 (104) Root Cause Analysis (RCA) review meetings which are chaired by our Medical Director and include representatives from the commissioners continue. The next set of meetings will be focussed on new 52+ week breaches which were reported in our December 2015 position. 13 of 16

63 Cancer January 2016 Performance Update The table below summarises the achievement of all cancer targets at Trust-level for the January 2016 position, although this is not yet fully validated. The 62 day GP referral target of 85% was also achieved at 90.43% based on the latest available position. However, there were 5 patients who were treated in January 2016 who waited over 100 days into their 62-day target treatment pathway as follows: Gynaecology: PRUH patient treated on day 103. The patient was referred to GSST on day 42, and the patient advised GSST that they did not want to commence treatment before Christmas so their admission was deferred until January. HpB (Liver): Two DH patients treated on day 120 and 149. One patient was referred into Kings from Croydon on day 65, and the other patient was not available for their first outpatient appointment and delayed their planned treatment until after Christmas. Lung: DH patient treated on day 157. The patient was transferred to GSST on day 28 but the patient was on a complex diagnostic pathway, and also wanted to look at nonsurgical options before agreeing the treatment plan. Urology: Two PRUH patients treated on day 114 and 112. There were pathway delays as the first patient was on holiday for 2 separate outpatient appointments; delays in the diagnostic pathway meant that the second patient was not referred to GSST until day 85. Colorectal: DH patient treated on day 130. The patient was referred for two suspected cancers, and required complex investigation and review under colorectal surgery and urology teams across both Kings and GSST sites. Intra-Provider Transfers 1 of the 2 patients transferred into Kings for treatment in January 2016 was after 42 days on an HpB pathways. Of the 21 transfers out (to GSST), 3 of the patients were referred after 42 days so 86% of pathways treated in January were referred prior to the 42-day standard. There was 1 late transfer in each of the lung, skin, and urology tumor group referrals. 14 of 16

64 Healthcare Associated Infection (HCAI) Update (1/2) MRSA (post 48 hour bacteraemia: 3 cases YTD (1 in October 2015, 1 in December 2015 and 1 in January 2016.) C-difficile: 10 new cases reported in January; 77 cases YTD compared to quota of 60 cases. VRE bacteraemia: 2 new cases at DH only and no new cases at PRUH in January; 33 cases compared to target of 16 YTD. E-Coli bacteraemia: 6 new cases reported in January at DH and 5 new cases at PRUH; 95 cases YTD compared to 97 cases reported YTD last year across both sites. C-Difficile (CDI) Action Plan Update: Reviewing of current practice and integration of policies and practice: Work is on-going to align policies and protocols across sites. This work will be overseen by the HCAI Operations Committee. Policies approved and published: Infection Prevention and Control, Intravascular Catheters, Waste Management and Trust Decontamination. Protocols approved and published: Isolation Precautions, Infectious Death Handling, Management of Gastrointestinal Infection, Respiratory Virus and Atypical Bacterial Infections Treatment and Infection Control, Varicella Zoster Virus (VZV), Transmissible Spongiform Encephalopathy, Blood Cultures, Standard Precautions, Hand Hygiene, Linen and Laundry, Guidelines for Animals on Hospital Premises and Aseptic Non Touch Technique. Protocols under consultation: MRSA, Clostridium difficile, Multiple Resistant Gram Negative, Tuberculosis protocols are under consultation. Protocols outstanding: Control of Outbreaks of Infection, Pandemic Influenza Protocol, Coronavirus including MERS-CoV & SARS-CoV and Streptococci and Enterococci. Centralisation of endoscope reprocessing: A project on-going to plan and develop a central reprocessing facility for endoscopies. The unit at DH site is being used as a template for the PRUH unit. This project is still very much in the planning stages, but should allow for a much higher level of decontamination than is currently the case. 15 of 16

65 Healthcare Associated Infection (HCAI) Update (2/2) C-Difficile (CDI) Action Plan Update: Kay Areas of Concern NICU ESBL Klebsiella Denmark Hill No new cases of ESBL Klebsiella. All confirmed cases have now been discharged. Occupancy in NICU currently stands at 36. The outbreak has been declared over. An escalation plan has been devised when occupancy goes beyond 36. NICU Parainfluenza Denmark Hill A total of nine babies have been confirmed as Parainfluenza positive. Outbreak meetings have taken place. The NICU escalation protocol has been revised and is awaiting ratification. Incident involving theatre packs and Instruments Denmark Hill Following the increase in the number of damaged wraps, sets are not being back on time and missing instruments have been seen in Cardiac Theatres. Weekly review meetings have continued. A revised action plan with clear timescales has been implemented and improvements have been seen. There has been a reduction in the number of adverse incidents reported. CDI Action The Hygiene Code check list has been rolled out at Denmark Hill to ensure standards are being monitored and maintained. Norovirus at PRUH Four wards closed. Daily reviews and outbreak meetings are being held. TB incident Maternity at PRUH A student midwife who completed a placement in the Oasis Birthing Centre in July and August 2015 has subsequently been diagnosed in October with pulmonary TB. The Trust was not notified of this until 22nd December. Work is currently underway to do the contact tracing of staff as well as patients (who include both mothers and their babies). Corporate Communications are involved. Mothers, babies and birthing partners have been assessed and screened. Staff close contacts have been sent letters by Occupational Health and casual contacts sent inform and advise letter. 16 of 16

66 Trust Finance Report Month 10 Enc Report to: Date of meeting: Sponsored by: Presented by: Action Required: Council of Governors 17 March 2016 Colin Gentile, Chief Financial Officer Colin Gentile, Chief Financial Officer FOR INFORMATION Action The Council is asked to note the month 10 Finance Report

67 Enc Finance Report Month 10 (January) 2015/16 Council of Governors 17 March 2016

68 Enc Report to: Date of meeting: Council of Governors 17-Mar-16 Subject: Finance Committee Report Month 10 (January 2016) Author(s): Presented by: Sponsor: History: Status: Simon Dixon, Nicola Hoeksema Colin Gentile, Chief Financial Officer Colin Gentile, Chief Financial Officer First submission to Finance and Performance Committee For 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 Council is asked to note the Finance Report

69 Enc Key implications Legal: Financial: Assurance: Clinical: Equality & Diversity: Performance: Strategy: Workforce: Estates: Reputation: Other:(please specify) Reporting to Monitor and Commercial Bank Trust reports financial performance and position against published plan and notifies the committee of financial risks, cost pressures and action plans to mitigate any material variance from financial targets. The summary and appendices provide assurance that the Trust is meeting Financial targets (internal and those set by Monitor) and is compliant with its terms of authorisation. There is no direct impact on clinical issues There is no direct impact on E&D Financial Performance against annual plan, budgets, CIPs and Monitor Risk Ratings and Limits. Performance against the Trust s Annual Plan including Risk Ratings There are implications for workforce recruitment in respect to service developments and vacancies. There are implication on the Trust s estates strategy. Finance Committee Report is provided to Monitor and Commercial Bankers as additional information to support the quarterly Monitor Return. None.

70 Enc Key Messages 1. The Trust cumulative deficit at month 10 is m. This is an adverse variance of 8.753m against the year-end deficit plan of 65m. 2. The deficit for the month was 1.839m ( 2.297m before Impairment) which included 6.9m of new mitigation actions. There was a fall in the underlying income position due to contract income adjustments such as CCG block, Genitary Urinary Medicine new tariff prices and NHSE marginal rate on emergency services. These non-recurrent adjustments were compensated for by the application of planned mitigations. The pay and non-pay underlying spend is still flat and the Cost Improvement Programme is 3.5m adverse YTD against the current schemes ( 0.98m adverse in month). 3. The Trust has identified a number of new mitigating actions in line with NHS Improvement guidance regarding financial improvement in Quarter 4. The total mitigation figure is now 41.8m which includes the original CCG Sustainability and Transformation funding of 10.6m. The mitigations include local capital to revenue transfers, revenue maximisation from local CCGs, balance sheet review of prudent accruals, VAT changes regarding recent guidance on contracted out services, asset valuations and asset lives review. These actions are predominantly non-recurrent and generate a material underlying deficit for the next financial year. 4. A detailed financial run rate forecast has been completed with each Clinical Division as well as the Corporate Departments; including a review of contract income and CIP assumptions. For the mitigation actions to deliver the deficit target of 65m, the run rate forecast profiles for months 11 and 12 must be achieved. Further stringent financial controls and operational savings are being implemented to ensure these targets are delivered. There are still a number of material risks, particularly regarding a year end income control total with NHSE regarding specialist services, which will be resolved by month 11. The Trust is also still to confirm the benefits of the asset revaluation for 15/16 and 16/ The cash-flow is being managed to not exceed the current approved working capital facility of 98.9m. The finance department is focusing on outstanding debts and in particular resolving all NHS Commissioner debts by 31st March; by including this matter in the current 16/17 contracting round with CCGs.

71 Enc Finance Report Month /2016 Summary The deficit for month 10 was 2.297m and the cumulative operational income and expenditure deficit is m as at month 10. This equates to an adverse variance of 8.753m from the planned deficit target of 65m by the close of the financial year. The Trust is still forecasting to meet the target deficit through planned mitigations which include financial opportunities following guidance from NHS Improvement (see page 6). The NHSE outturn position has not been agreed and the forecast position is dependent on managing the reinvestment of fines for not achieving access and emergency performance targets. A sufficient number of the mitigation plans should also deliver cash benefits to enable the Trust to stay within the approved working capital facility. Overall the outcome of month 10 has made reaching the 65m deficit target very tight. Surplus / (Deficit) k R Income k G Operating Expenditure k R Plan Actual / Forecast Variance Plan Actual / Forecast Variance Plan Actual / Forecast Variance Year to Date k (76,004) (73,753) 2,251 Year to Date k 851, ,469 29,299 Year to Date k (875,422) (904,773) (29,351) Year End Forecast k (65,000) (65,000) 0 Year End Forecast k 1,028,267 1,068,463 40,196 Year End Forecast k (1,030,934) (1,077,358) (46,424) The Trust is reporting an adverse variance to plan of 2.2m to date excluding the asset impairment (non-operating cost). The month10 budget is higher than the year end plan due to the unidentified cost improvement plans of 24m ( 61.7m identified against a plan of 86m). The unmet CIP target is not allocated to revenue budgets to date and held in month 12. The budget plan also excludes any mitigating actions which total 19.4m (inc. 10.6m original CCG Sustainability support) as at month 10. The income is showing a positive variance due to activity over-performance on NHSE contract services and pass through specialised drugs; together with the CCG sustainability and transformation funding ( 14.5m). A potential risk to income is the resolution of the NHSE contract for 2015/16 regarding the reinvestment of fines and penalties for not achieving Access and Emergency targets. Income is above target for additional services provided to other providers and overseas visitors but is under-performing in respect to other operating income (exc. mitigation income). The adverse non-pay movement was predominantly due to activity related expenditure off set against income over performance (clinical supplies and drugs). General supplies and services are over-spent as well as Consultancy services which are not directly related to paitent activity. The Consultancy fees (PWC, Four Eyes) are phased to reduce over the remaing weeks. RTT off-site work has stopped but the Trust is still dependent on subcontracted healthcare services which are over-spent by 2.8m. Run Rate k R Cost Improvement Plans k R Capital k G Q1 Actual Q2 Actual Q3 Actual M10 Actual 15/16 Forecast Plan Actual / Forecast Variance Plan Actual / Forecast Variance Income k 257, , ,131 87,955 1,070,215 Year to Date k 48,080 44,592 (3,488) Year to Date k 26,633 21,875 (4,758) Pay k (161,972) (155,266) (155,035) (50,977) (625,849) Year End Forecast k 64,908 60,722 (4,186) Year End Forecast k 38,910 29,581 (9,329) Non-Pay k (128,737) (130,010) (133,408) (39,276) (509,366) Deficit k (33,057) (21,544) (17,313) (2,297) (65,000) The cost improvement programme is under-performing by 3.5m to date. The The reforecast capital expenditure for 2015/16 is 29.5m; a reduction of 9.4m The month 10 run rate ( 2.3m deficit) has reduced compared to the previous adverse movements are split by income ( 1.6m), pay ( 1m) and non-pay from the Trust s planned capital expenditure of 38.9m (see page 17). The total month ( 8.4m deficit) due to the additional mitigation action plans. Pay and ( 900k). The in month movement was 0.98m. capital expenditure to month 9 was 18.8m against a forecast period budget of non-pay costs are still flat despite the cost improvement plans. The income run The Trust has identified 61.9m of CIPs and there are 3m in the pipeline to be 25.65m. rate has only marginally improved due income mitigations being offset by a implemented. This is a shortfall of 21.1m and these un-identified CIPs are held Cost estimates and cash flow phasing for the CCU Project have been reviewed number of non-recurrent income adjustments. The non-clinical income was also as negative unmet CIP budgets in month 12. This accounting treatment will and 15/16 capital spend has been revised in line with forecast spend ( 7.8m in higher in month 9 than planned. The underlying run rate is shown on page 10 explain the material budget adverse variances in month /16). The difference in spend has been phased over the remaining years of and also reflects the non-operating Impairment charge. the project. Cash k R Financial Sustainability Risk Rating R Key Risks Plan Actual / Forecast Variance Liquidity Capital Servicing The deficit target will be achieved providing : 1) The Divisions and Corporate departments maintain their run rate forecasts in month 11 and Year to Date k 19,899 28,519 8,620 Year to Date That is they do not deteriorate from month 10 run rate and there is no additional CIP slippage. Year End Forecast k 11,040 11,040 0 Year End Forecast 1 1 2) The NHSE fines are re-investment and year end control total is agreed in line with the Trust s performance projection. Based on the 13-week cash forecast, the Trust cash position will not drop below the minimum limit of 3m before the end of the financial year. At month end the Trust s cash balance was 4.9m above plan. This primarily relates to Sustainability and Transformation funding and Winter Pressure funding received from CCGs 12.3m and Local Authorities payments received in December 1.2m, offset by higher than forecast payments to suppliers including Agency and Bank staff payments ( 8.6m). I&E Margin Variance from I&E Margin Plan Year to Date FSRR (Weighted Average) Year End Forecast The Trust is currently reporting an overall FSRR rating of 1 for both the year to date and forecast positions. The deficit position is adversely affecting both the capital servicing ratio and liquidity. A granular financial run rate review has been completed for each Clinical Division and Corporate Department. This is to ensure no cost pressure surprises and that the mitigation plan is sufficient to achieve the year-end target. Additional operational efficiencies and CIP pipe-line schemes are being worked-up to impact by year end. The introduction of even more stringent financial controls (e.g. hold on the purchase of non-clinical supplies) are being imposed for the remaining months of the financial year. In respect to the mitigation actions the revaluation of the assets (buildings) has yet to be determined and commercial discussions are still on-going with PFI providers which could deliver in -year potential benefits.

72 Enc Finance Report Month /2016 Surplus / (Deficit) k R The Trust is 73.7m overspent at month 10 against a year end plan of 65m deficit. Given the level and rate of deficit, the Trust has put in place a mitigation plan to manage the position back to 65m by the close of the financial year. The plan has strong focus from the executive team. For the mitigation to be effective the Trust needs to deliver to the planned profile for months 11 and 12, with particular emphasis on CIP delivery and continued cost containment. The Trust will also need to manage the risk of fines/penalties and data challenges from NHSE specialist commissioners. We are meeting with NHSE with the aim to resolve this prior to the completion of month 11. The cash flow is being managed to not exceed the current approved working capital facility of 98.9m. This is underpinned by tight management of accounts payable, with an additional focus to recover NHS Commissioner contract over-performance debts as year end approaches. The mitigation plan should also deliver cash benefits to enable the Trust to stay within the approved working capital facility. Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Surplus / (Deficit) (76,004) (73,753) 2,251 Surplus / (Deficit) (65,000) (65,000) 0 1. The underlying income position deteriorated 4.5m before applying CCG non-recurrent support. This related to a number of non-recurrent contractual adjustments to the income position along with prior month income estimate changes. 2. Expenditure shows a broadly flat run rate. 1. The forecast projection is reliant on the mitigations identified below. 2. The forecast variances for Pay and Non-pay are materially different from the month 10 variance due to the unidentified CIPs ( 21m) held as negative budgets in month There are 3m pipeline schemes that could still impact in the last 2 months. Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Income 851, ,469 29,299 Income 1,028,267 1,068,463 40,196 Pay (523,088) (523,249) (161) Pay (629,177) (638,513) (9,336) Non-Pay (352,334) (381,524) (29,190) Non-Pay (401,757) (438,845) (37,089) EBITDA * (24,252) (24,304) (52) EBITDA * (2,667) (8,896) (6,229) EBITDA % -2.8% -2.8% EBITDA % -0.3% -0.8% Profit/Loss on Disposal of Fixed Assets (234) (111) 123 Profit/Loss on Disposal of Fixed Assets (350) (100) 250 Interest Payable (22,560) (22,892) (332) Interest Payable (27,234) (28,447) (1,213) Interest Receivable (98) Interest Receivable (88) Depreciation (19,538) (17,867) 1,671 Depreciation (23,446) (17,938) 5,508 Impairments (4,583) (4,583) 0 Impairments (5,500) (5,500) 0 Public Dividend Capital (9,603) (8,664) 939 Public Dividend Capital (11,523) (9,751) 1,772 Net surplus/(deficit) (80,587) (78,336) 2,251 Net surplus/(deficit) (70,500) (70,500) 0 Reverse Impairment 4,583 4,583 0 Reverse Impairment 5,500 5,500 0 Performance against Control Total (76,004) (73,753) 2,251 Performance against Control Total (65,000) (65,000) 0 Surplus/(Deficit) % -8.9% -8.4% Surplus/(Deficit) % -6.3% -6.1% * EBITDA Earnings before Interest, Taxation, Depreciation and Amortisation k Net Operating Deficit Actuals Cumulative Deficit by Month 2015/16 Net Operating Deficit Plan - (10,000) (20,000) (30,000) (40,000) (50,000) (60,000) (70,000) (80,000) Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Mitigations Actions k Financial Improvement Actions in Q4 as per NHS Improvement directive. Reviewing In-Year priorities Revenue Maximisation (CCG Sustainability Support) 18,560 Revenue Maximisation (PFI and Bromley Assessment Discharge Ward) 1,285 Local Cap to Rev Transfers 9,400 Balance Sheet Review Prudence 4,600 VAT Changes 500 Asset Life Review and Asset Valuations 7,500 Total benefits to 2015/16 bottom line 41, m of CCG Sustainability Support and 0.7m release of Bad Debt Provision were included in the trusts forecast position as at month 9.

73 Enc Finance Report Month /2016 Income G The income position reflects the reliance on non-recurrent CCG sustainability and transformation funding which was unplanned ( 14.5m to date). The majority of the clinical income over performance relates to pass through drugs ( 8.2m to date). The Trust does make any margin on this additional activity which also represents a cash flow pressure. Other NHS Clinical income relates to providing other acute hospitals with services (e.g. diagnostics) which is under performing to date. Overseas Visitors income is above plan due to the changes in billing whereby the Trust can recover costs from the local CCGs and NHS England. The income forecast has been reviewed at a granular level to ensure all income risks have been considered. The forecast Miscellaneous Operating Income includes the local Capital to Revenue transfer which is part of the mitigation plan. Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Total Income 851, ,469 29,299 Total Income 1,028,267 1,068,463 40,196 Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Commissioning Contract Income 625, ,845 2,017 Commissioning Contract Income 749, ,147 4,509 NHS Acute: Drugs - Non Tariff 69,064 75,147 6,083 NHS Acute: Drugs - Non Tariff 85,306 90,176 4,870 NHS Acute: Drugs (IFRs, CDF & Hep C) 8,629 10,791 2,162 NHS Acute: Drugs (IFRs, CDF & Hep C) 10,355 12,950 2,595 Local Authority Income - GUM Services 6,904 6,832 (72) Local Authority Income - GUM Services 8,285 8,198 (87) Commissioning Income: Sustainability & Transformation 0 14,535 14,535 Commissioning Income: Sustainability & Transformation 0 18,560 18,560 NHS Clinical Contract Income 710, ,150 24,726 NHS Clinical Contract Income 853, ,031 30,447 RTA Income 3,459 4, RTA Income 4,151 5, Other NHS Clinical Income 4,818 4,445 (373) Other NHS Clinical Income 5,831 4,485 (1,346) Overseas Visitors Income 5,111 7,324 2,213 Overseas Visitors Income 6,137 8,400 2,263 Private Patient Income 11,502 12, Private Patient Income 13,978 13,810 (168) Education & Training Income 42,190 41,421 (769) Education & Training Income 50,635 49,705 (930) Research & Development Income 9,502 10, Research & Development Income 10,958 12,227 1,269 Miscellaneous Other Operating Income 64,164 65,699 1,536 Miscellaneous Other Operating Income 82,994 90,765 7,771 Total Trust Income 851, ,469 29,299 Total Trust Income 1,028,267 1,068,462 40,195 k In Month Income 2015/16 Actual Plan 94,000 92,000 90,000 88,000 86,000 84,000 82,000 80,000 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

74 Enc Finance Report Month /2016 Operating Expenditure R The Pay budget is in balance despite the Pay CIPs not achieving by 1m to date, as the Clinical divisions and Corporate departments are holding vacancies. The Nonpay budgets are over spent due to activity over performance (drugs and clinical supplies) and the non-achievement of CIPs by 910k to date. The Trust has incurred additional Consultancy costs to deliver the cost savings programme (PMO) and offsite costs in the earlier part of the year. Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Pay (523,088) (523,249) (161) Pay (629,177) (638,513) (9,336) Non-Pay (352,334) (381,524) (29,190) Non-Pay (401,757) (438,845) (37,089) Operating Expenditure (875,422) (904,773) (29,351) Operating Expenditure (1,030,934) (1,077,358) (46,424) Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Pay Pay Nursing & Midwifery (205,993) (205,417) 576 Nursing & Midwifery (247,882) (247,122) 760 Medical & Dental Staff (166,420) (167,614) (1,193) Medical & Dental Staff (199,451) (204,533) (5,082) Administration & Clerical / Senior Managers (83,873) (83,484) 389 Administration & Clerical / Senior Managers (100,799) (105,534) (4,735) PAMS / Scientific / Professional (66,802) (66,734) 67 PAMS / Scientific / Professional (81,045) (81,324) (279) Total Pay (523,088) (523,249) (161) Total Pay (629,177) (638,513) (9,336) Non-Pay Non-Pay Drugs (incl. Medical Gases) (26,768) (34,594) (7,827) Drugs (incl. Medical Gases) (29,646) (38,970) (9,324) Drugs : Non-Tariff (69,064) (75,147) (6,083) Drugs : Non-Tariff (85,306) (90,176) (4,870) Supplies & Services - Clinical (73,567) (79,738) (6,171) Supplies & Services - Clinical (87,936) (92,992) (5,056) Supplies & Services - General (3,144) (5,168) (2,024) Supplies & Services - General (3,761) (6,202) (2,440) Establishment Expenses (4,876) (5,420) (545) Establishment Expenses (5,837) (6,505) (667) Transport Expenses (7,748) (7,199) 549 Transport Expenses (9,311) (8,638) 673 Premises (29,807) (29,753) 54 Premises (35,446) (34,275) 1,171 Purchase of Healthcare from Non-NHS Provider (19,125) (21,972) (2,848) Purchase of Healthcare from Non-NHS Provider (22,911) (27,338) (4,427) Services from other NHS Bodies (42,999) (44,871) (1,873) Services from other NHS Bodies (52,682) (53,846) (1,164) Consultancy (12,363) (16,040) (3,678) Consultancy (13,853) (15,101) (1,248) Private Finance Initiative (43,792) (42,812) 980 Private Finance Initiative (52,550) (53,309) (759) Other Non-Pay/Reserves (19,082) (18,808) 274 Other Non-Pay/Reserves (2,516) (11,494) (8,978) Total Non-Pay (352,334) (381,524) (29,190) Total Non-Pay (401,757) (438,845) (37,089) Total Expenditure (875,422) (904,774) (29,352) Total Expenditure (1,030,934) (1,077,358) (46,424)

75 Enc Finance Report Month /2016 RunRate R The Pay and Nonpay remain flat and the Income position has only marginally improved in month 10 due to income contracting adjustments. The underlying run rate is reported on page 10. Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 k k k k k k k k k k Deficit (13,080) (12,241) (9,112) (5,692) (10,579) (6,648) (4,049) (6,213) (8,426) (2,297) Impairment (458) (458) (458) (458) (458) (458) (458) (458) (458) (458) Operating Deficit (12,622) (11,782) (8,653) (5,233) (10,121) (6,190) (3,590) (5,754) (7,968) (1,839) Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 k k k k k k k k k k Income NHS & Local Authority Clinical Contract Income 66,556 63,896 66,803 71,835 65,414 63,775 70,196 68,596 65,008 60,355 Off-tariff Drugs Pass-Through Income 6,331 5,775 6,570 5,507 5,912 10,617 8,819 7,480 8,492 9,644 Other Clinical Income (P2P, RTA, Overseas Visitors) 874 1,956 1,965 1,653 1,300 1, ,418 1,765 5,133 Private Patients 963 1,167 1,466 1, ,320 1,154 1,279 1,015 1,687 Other Operating Income (T&E, R&D) 10,974 12,713 9,645 11,079 10,696 11,370 11,893 11,580 10,659 11,136 Total Income 85,697 85,506 86,448 91,125 84,262 88,345 92,838 91,354 86,938 87,955 Pay A&C Staff/Senior Managers Agency (1,347) (1,532) (1,200) (831) (1,060) (972) (960) (600) (781) (594) Bank (324) (282) (313) (298) (246) (286) (224) (168) (165) (172) substantive (7,180) (7,140) (6,983) (7,252) (6,908) (7,002) (7,170) (7,314) (6,970) (7,213) Medical Staff Agency (1,402) (1,407) (1,463) (1,404) (1,178) (1,117) (1,385) (1,391) (844) (962) Bank (494) (274) (343) (356) (447) (291) (206) (322) (400) (286) substantive (14,953) (15,294) (15,216) (14,799) (14,840) (15,340) (15,335) (15,363) (15,347) (15,153) Nursing Staff Agency (2,926) (1,590) (1,065) (1,097) (1,057) (943) (761) (743) (842) (795) Bank (2,354) (2,143) (2,087) (2,037) (2,235) (2,095) (2,223) (2,150) (2,153) (2,230) substantive (17,155) (17,505) (17,562) (17,074) (17,005) (17,065) (17,029) (17,375) (17,195) (16,928) PAMS/Scientific/Professional Agency (927) (752) (686) (734) (588) (495) (429) (502) (459) (506) Bank (201) (168) (176) (194) (157) (180) (157) (166) (192) (156) substantive (5,773) (5,800) (5,955) (5,933) (5,822) (5,929) (6,003) (5,920) (5,791) (5,984) Total Pay (55,036) (53,886) (53,049) (52,009) (51,542) (51,715) (51,882) (52,014) (51,139) (50,977) Non-Pay Drugs (3,945) (4,282) (3,446) (6,238) (5,251) 238 (3,109) (4,235) (2,505) (1,822) Off-tariff Drugs Expenditure (6,331) (5,775) (6,570) (5,507) (5,912) (10,617) (8,819) (7,480) (8,492) (9,644) Clinical Supplies (7,819) (8,273) (8,493) (8,668) (7,623) (7,159) (8,148) (8,219) (8,089) (7,247) Non-Clinical Supplies (4,510) (5,041) (4,104) (5,304) (4,100) (5,031) (4,626) (5,442) (4,792) (4,591) Sub Contracted Healthcare - NHS bodies (4,498) (4,189) (4,458) (4,551) (4,233) (4,959) (4,770) (4,433) (4,580) (4,201) Services Provided by non-nhs bodies (2,413) (2,926) (1,622) (2,697) (2,703) (2,510) (2,739) (1,976) (1,880) (506) Private Finance Initiative (4,676) (4,642) (4,763) (4,691) (4,652) (4,642) (4,512) (5,026) (4,513) (4,344) Misc. Other Operating Exependiture (3,595) (2,405) (2,582) (1,169) (2,334) (2,326) (1,890) (2,073) (3,087) (2,851) Total Non-Pay (37,787) (37,532) (36,037) (38,823) (36,808) (37,006) (38,613) (38,886) (37,938) (35,206) Financing Loan/PFI Interest & PDC Dividends (2,893) (3,266) (3,127) (2,974) (3,221) (3,170) (3,297) (3,513) (3,188) (2,929) Depreciation and Impairment (2,441) (2,450) (2,501) (2,409) (2,520) (2,445) (2,388) (2,543) (2,460) (383) Lease Charges (619) (613) (845) (602) (751) (656) (706) (611) (639) (758) Total Financing (5,954) (6,329) (6,473) (5,985) (6,491) (6,272) (6,391) (6,667) (6,287) (4,070) Deficit (13,080) (12,241) (9,112) (5,692) (10,579) (6,648) (4,049) (6,213) (8,426) (2,297)

76 Enc Finance Report Month /2016 Run Rate and CIP Integrated Report Apr-15 m May-15 m Jun-15 m Jul-15 m Aug-15 m Actual Sep-15 m Oct-15 m Nov-15 m Dec-15 m Jan-16 m Feb-16 m Plan Mar-16 m Total I&E Actual and Plan Clinical Income (inc. PP, Overseas Visitors, P2P, NT Drugs) Non-Clinical Income (E&T, R&D, Other miscellaneous) Original CCG Support Pay (55.0) (53.9) (53.0) (52.0) (51.5) (51.7) (51.9) (52.0) (51.1) (51.0) (51.5) (51.1) (625.8) Nonpay (37.8) (37.5) (36.1) (38.8) (36.8) (37.1) (38.6) (38.9) (37.9) (36.4) (37.7) (38.5) (452.2) Financing (5.9) (6.4) (6.4) (6.0) (6.5) (6.2) (6.4) (6.7) (6.3) (6.2) (6.4) (6.5) (75.7) Mitigations (Planned) Mitigations (Unplanned) Net Deficit (13.1) (12.2) (9.1) (5.7) (10.6) (6.7) (4.1) (6.2) (8.4) (2.3) (70.5) Impairment Net Operating Deficit Actual/Forecast (12.6) (11.8) (8.7) (5.2) (10.1) (6.2) (3.6) (5.8) (8.0) (1.8) (65.0) Net Operating Deficit Plan (as at month 7) (12.6) (9.7) (8.5) (4.0) (10.1) (5.2) (2.6) (3.1) (4.8) (5.5) (65.0) Variance to plan (0.1) (2.1) (0.2) (1.2) (0.1) (1.0) (1.0) (2.7) (3.1) (2.4) (0.0) CIP Actual & Forecast CIPs identified ("Green") - Actual CIP phasing as per PMO CIP in pipeline CIP Identified Control Total Original CCG Support Mitigating Actions to cover CIP Shortfall Total CIPs (Revised phasing as at month 10) Total CIPs (By Category) CIP - Revenue Generation CIP - PAY CIP - Non-Pay Total

77 Enc Finance Report Month /2016 Cost Improvement Plans R CIP performance shows a slippage of 3.5m which is a deterioration of 0.98m compared to month 9. The majority of the slippage is not recoverable in 15/16. A number of the CIPs were identified from month 3 and subsequently based on historic underspends. Therefore the CIPs have not impacted positively on the run rate from month 3. The CIP forecast slippage for the year is 4.2m based on a straight line projection. Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Cost Improvement Plans 48,080 44,592 (3,488) Cost Improvement Plans 64,908 60,722 (4,186) Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Themes Themes Income Income NHS Income 4,784 4,253 (531) NHS Income 7,480 6,843 (637) NHS Provider to Provider NHS Provider to Provider Private Patient (57) Private Patient (68) Other Operating 2,013 1,021 (992) Other Operating 2,603 1,412 (1,190) Total Income CIPs 7,534 5,970 (1,565) Total Income CIPs 11,236 9,358 (1,878) Pay Pay Recruitment - Agency Reduction 4,218 3,723 (495) Recruitment - Agency Reduction 5,665 5,070 (594) Medical Job Planning 1,604 1,550 (54) Medical Job Planning 2,240 2,175 (64) Nurse Rotas 3,921 3,692 (229) Nurse Rotas 5,695 5,420 (275) A & C Staff Reduction 2,565 2,514 (51) A & C Staff Reduction 3,356 3,295 (61) Prof & Tech Staff Reduction 1,373 1,362 (11) Prof & Tech Staff Reduction 1,828 1,815 (13) Vacancy Freeze 4,096 4,093 (3) Vacancy Freeze 4,937 4,933 (4) VAT 24/7 Payroll Service (144) VAT 24/7 Payroll Service (173) Theatre Savings 1,114 1,001 (114) Theatre Savings 1,348 1,211 (136) Patient LOS Savings Patient LOS Savings Reducing Clinical Services Reducing Clinical Services Procurement - Agency Rates (208) Procurement - Agency Rates (250) Total Pay CIPs 20,631 19,618 (1,013) Total Pay CIPs 27,459 26,243 (1,216) Non-Pay Non-Pay VAT Saving VAT Saving Contracting Services Out 1,939 2, Contracting Services Out 2,615 2, In-House service provision 1, (311) In-House service provision 1,705 1,332 (373) Clinical spend reduction 1,332 1,185 (148) Clinical spend reduction 1,615 1,438 (177) Non-Clinical spend reduction 4,839 4,794 (45) Non-Clinical spend reduction 7,020 6,967 (53) Integration and Consultancy baseline budget reduction 3,912 3,912 0 Integration and Consultancy baseline budget reduction 4,341 4,341 0 Drug savings 1,568 1,539 (30) Drug savings 1,871 1,835 (36) Service provision reduction (228) Service provision reduction (274) Procurement 4,746 4,420 (326) Procurement 6,261 5,869 (391) Total Non-pay CIPs 19,914 19,004 (910) Total Non-pay CIPs 26,213 25,121 (1,092) Efficiency Plan Total 48,079 44,591 (3,488) Efficiency Plan Total 64,908 60,722 (4,186) Unidentified Schemes 18,692 Annual Plan CIP Target 83,600 Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Divisions Divisions Ambulatory 5,308 4,896 (412) Ambulatory 7,175 6,843 (331) CCTD 10,300 9,697 (602) CCTD 13,017 12,416 (601) TEAM 5,040 4,520 (520) TEAM 6,885 6,567 (318) LRS 5,182 4,083 (1,099) LRS 7,406 7,064 (342) NWS 6,743 6,460 (283) NWS 9,521 9,081 (439) W&C 3,621 3,411 (210) W&C 5,249 5,007 (242) Facilities 2,387 2,233 (154) Facilities 4,275 4,078 (197) Corporate 9,498 9,292 (206) Corporate 11,381 10,856 (525) Efficiency Plan Total 48,080 44,592 (3,488) Efficiency Plan Total 64,908 61,913 (2,995)

78 Enc Finance Report Month /2016 Cash R Based on the 13-week cash forecast, the Trust will need to drawdown a further 3.9m against its Term Loan in March in order to maintain a cash balance of 3m. This will bring the total value drawndown against the Term Loan to 98.7m againt the 98.9m approved limit. Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Cash Balance 19,899 28,519 8,620 Cash Balance 11,040 11,040 0 At month end the Trust s cash balance was 8.6m above plan. This primarily relates to Sustainability and Transformation funding received from CCGs in January 6m, reduced capital payments 0.6m, reduced AP/AR Net-off payments 0.5m, and higher than forecast receipts from Local Authorites 1.5m. The plan and forecast cash balance remain at 11m for year end. The Trust is forecasting to drawdown the full limit ( 98.7m) of the Term Loan by year end. Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k EBITDA (24,252) (24,304) (52) EBITDA (2,667) (8,896) (6,229) Movement in Working Capital (32,070) (28,605) 3,465 Movement in Working Capital (43,308) (44,303) (995) Provisions (433) Provisions (1,300) (775) 525 Cash flow from Operations (56,755) (52,909) 3,846 Cash flow from Operations (47,275) (53,974) (6,699) Capital Expenditure (28,399) (22,013) 6,386 Capital Expenditure (37,703) (28,262) 9,441 Cash Receipt from Asset Sales 17 1 (16) Cash Receipt from Asset Sales Other Cash Flows from Investing Activities 145 (249) (394) Other Cash Flows from Investing Activities (17) Cash Flow before Financing (84,992) (75,170) 9,822 Cash Flow before Financing (84,737) (82,012) 2,725 PDC Received 1,484 1, PDC Received 1,484 1, PDC Repaid PDC Repaid 0 (9,400) (9,400) Dividends Paid (5,000) (5,000) 0 Dividends Paid (11,523) (10,361) 1,162 Interest on Loans and Leases (22,419) (21,197) 1,222 Interest on Loans and Leases (26,322) (24,773) 1,549 Drawdown of Debt 93,581 93,582 1 Drawdown of Debt 95,218 98,900 3,682 Repayment of Debt (6,841) (6,841) 0 Repayment of Debt (7,433) (7,434) (1) Other Cash Flows from Financing Activities 633 (2,075) (2,708) Other Cash Flows from Financing Activities Cash Flow from Financing 61,438 60,236 (1,202) Cash Flow from Financing 52,324 49,599 (2,725) Net Cash Inflow/(Outflow) (23,554) (14,934) 8,620 Net Cash Inflow/(Outflow) (32,413) (32,413) 0 Opening Cash Balance 43,453 43,453 0 Opening Cash Balance 43,453 43,453 0 Closing Cash Balance 19,899 28,519 8,620 Closing Cash Balance 11,040 11,040 0 The movement working capital is showing a favourable variance against plan due to weekly creditor payments being below the required amount to maintain the forecast level of creditors. Creditor balances remain high as the Trust cannot use the facility to un-wind its payables, putting pressure on supplier relationship and price negotiations. Capital expenditure is behind plan due to the revised capital plan agreed with Monitor and the delayed in the CCU project. Other cash flows from financing activites include loans to KCH Management with respect to clinics in Abu Dhabi. Part repayment of these loans is forecast to be received before year end. The full year plan assumes the planned deficit of 65m is achieved. Full drawdown of the Term Loan facility is expected by year end. Foecast Capital expenditure has decreased by 9.4m as agreed with Monitor with regards to Capital to Revenue funding. This funding was received and PDC repaid in month 11.

79 Enc Finance Report Month /2016 Rolling Cash Flow (13 Week) R The rolling cash flow forecasts forward for a 13 week period currently to the end of April The 13 week cash flow allows the Trust to forecast its requirement for drawdown against the agreed Term Loan facility over the following 2 months. Year to Date Plan Actual Variance Year End Forecast Plan Actual Variance k k k k k k Cash Balance 19,899 28,519 8,620 Cash Balance 11,040 11,040 0 Week ending 29-Jan Feb Feb Feb Feb Mar Mar Mar Mar Apr Apr Apr Apr Apr-16 Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast k k k k k k k k k k k k k k Balance B/F 24,763 28,387 40,452 35,970 50,172 20,640 9,545 2,661 41,788 9,645 7,732 3,000 63,567 18,524 Receipts (inflows) LSB receipts 0 21, , , SLA receipts ,768 9, , , Patient SLA Overperformance 2014/ Patient SLA Overperformance 2015/ Private Patients receipts Training & Education receipts ,000 0 NHSE Inflows 5, , , , DoH - National RTT, ED Monies & Project Diamond 0 9, VAT reclaims 3, , , ,150 Income Generation CIPs Other 1,567 1,536 1,425 1, , , , Total Receipts 11,032 32,902 5,651 45,026 4,052 1,150 1,057 73,089 1,207 6,523 1,000 72,491 11,457 4,007 Payments (outflows) Pay monthly (incl Pay Awards) , , ,250 0 PAYE/NIC/SUPER (CHAPS) , , ,200 0 Agency Spend 1, ,185 1,023 1,134 1,043 1,400 1,400 1,400 1,400 1,400 1,400 1,400 1,400 Agency CIP (1,199) (1,199) (1,199) (1,199) (1,199) (1,199) (1,199) PFI project 0 4, , , , , ,100 0 Trade Creditors 4,854 5,248 5,670 5,168 5,351 4,566 4,716 4,266 4,416 4,266 4,416 4,266 4,416 4,266 Other ,174 3,106 3,187 1,159 1, ,164 3,179 1, ,879 2, Total Payments 7,090 20,529 9,961 32,678 32,894 11,479 7,185 30,931 33,046 10,137 5,343 11,346 56,157 5,137 Cash from operations 3,942 12,373 (4,310) 12,348 (28,842) (10,329) (6,128) 42,158 (31,839) (3,614) (4,343) 61,145 (44,700) (1,130) Capital & Financing Items Capital expenditure (outflow) (665) 1, (1,701) PDC Dividends (TDR) (outflow) , Revolving Working Capital Facility (1,189) (3,895) Interest Paid on Revolving Credit Facility , Other (inflow) (2) (426) Total Capital & Financing (1,854) , (1,701) Net Inflow / Outflow 3,624 12,065 (4,481) 14,202 (29,532) (11,095) (6,885) 39,127 (32,143) (1,913) (4,732) 60,567 (45,043) (1,538) Forecast Balance C/F 28,387 40,452 35,970 50,172 20,640 9,545 2,661 41,788 9,645 7,732 3,000 63,567 18,524 16,986 70,000 60,000 Forecast Weekly Cash Balance 63,567 k 50,000 50,172 40,000 40,452 41,788 35,970 30,000 28,387 20,000 20,640 18,524 16,986 10,000 9,545 9,645 7, ,661 3, Jan Feb Feb Feb Feb Mar Mar Mar Mar Apr Apr Apr Apr Apr-16

80 Enc Finance Report Month /2016 Statement of Financial Position (Balance Sheet) The Statement of Financial Position reflects changes in asset values as well as movements in liabilites. The plan figures relate to the Annual Plan submitted to Monitor in June Year to Date 01-Apr-15 Year to Date Year End Forecast Full Year Actual Plan Actual Variance Notes Plan Forecast Variance Notes k k k k k k k Property, Plant & Equipment 612, , ,755 (12,200) 1 Property, Plant & Equipment 633, ,380 (20,060) 1 Intangible Assets 3,495 2,836 2,726 (110) Intangible Assets 2,704 2,610 (94) Other Assets 11,658 12,644 13,734 1,090 Other Assets 13,410 13, Non Current Assets 627, , ,215 (11,220) Non Current Assets 649, ,674 (19,880) Inventories 17,092 17,090 19,518 2,428 Inventories 17,090 19,597 2,507 Trade & Other Receivables 98,217 93, ,375 21,689 2 Trade & Other Receivables 95, ,171 21,683 Cash and Cash Equivalents 43,445 16,294 28,519 12,225 4 Cash and Cash Equivalents 11,040 11,040 0 Current Assets 158, , ,412 36,342 Current Assets 123, ,808 24,190 Trade and Other Payables (167,999) (142,288) (162,476) (20,188) 3 Trade and Other Payables (134,544) (139,419) (4,875) Borrowings (4,074) (78,600) (94,361) (15,761) 4 Borrowings (94,166) (103,093) (8,927) 2 Other Financial Liabilities Other Financial Liabilities Provisions (1,239) (635) (723) (88) Provisions (1,300) (1,764) (464) Other Liabilities (10,012) (6,000) (8,357) (2,357) Other Liabilities (8,000) (7,320) 680 Current Liabilities (183,324) (227,523) (265,917) (38,394) Current Liabilities (238,010) (251,596) (13,586) Borrowings (222,571) (219,912) (222,570) (2,658) Borrowings (214,597) (214,599) (2) Other Financial Liabilities Other Financial Liabilities Provisions (6,295) (5,862) (6,295) (433) Provisions (4,995) (4,995) 0 Non Current Liabilities (228,866) (225,774) (228,865) (3,091) Non Current Liabilities (219,592) (219,594) (2) TOTAL ASSETS EMPLOYED 374, , ,845 (16,363) TOTAL ASSETS EMPLOYED 315, ,292 (9,278) Financed by: Financed by: Public Dividend Capital (231,316) (232,800) (233,083) (283) Public Dividend Capital (232,800) (223,683) 9,117 1 Retained Earnings 22,139 87, ,475 13,314 Retained Earnings 92,466 92, Revaluation Reserve (165,237) (168,569) (165,237) 3,332 Revaluation Reserve (175,236) (175,236) 0 TOTAL TAXPAYERS' EQUITY (374,414) (314,208) (297,845) 16,363 TOTAL TAXPAYERS' EQUITY (315,570) (306,292) 9, Capital expenditure is behind plan due to the reduction in the capital plan of 9.4m in agreement with Monitor. 2. Trade and Other Receivables are higher than plan and includes Private patients and Overseas Visitors debts 8.1m, CNST prepayments of 5.4m and Capital to Revenue Transfer invoice outstanding at month m. 1. Planned Capital expenditure has reduced by 9.4m due to the Capital to Revenue Transfer agreemenet with Monitor. PDC Reserve has reduced due to repayment of this funding through the PDC account. Further forecast variance against capital is in relation to revaluation of the Denmark Hill site based on utilising an alternative site in Modern Equivalent Asset Valuation. 3. Trade and Other Payable are increasing due to restricted cash availability and in-line with the terms of the Term Loan agreement, where the Trust cannot use the facility to un-wind its payables. 2. The forecast Borrowings assume that the full value of the Term Loan will be drawndown by year end. 4. The differences in Cash and Borrowings are primarily due to the inclusion of the additional available facility agreed with Monitor and DH alond side additional Sustainablity and Transformation funding received from local CCGs.

81 Enc Finance Report Month /2016 Aged Debtors Trust debtors consist of Invoiced Debtors (including NHS, Non-NHS, Private Patients and Overseas Visitors), accrued income, prepayments and other debtors (including RTA debtor and VAT reclaims). The level of invoiced debtors has increased by 6.4m since the end of December 2015 and overdue debts (those >30 days old) have increased by 1.1m. Invoiced Debtors Within 1 Month 2 Month 3 Month Total Current Prior Other Receivables Current Prior Terms Overdue Overdue Overdue Month Month Notes Month Month Over 90 Over 30 Over Days Days Days Days Days Days k k k k k k k k k CCG's 8,253 1,588 1,275 4,523 15,639 7,386 6,557 1 Accrued Income Trusts 1,463 1, ,760 9,206 7,743 7,473 2 Work in Progress 7,424 7,424 Other NHS 17,383 4, ,537 26,130 8,747 5,425 3 CCG SLAs 9,353 6,523 Other Debtors 2,677 1,153 1,866 8,110 13,806 11,129 14,145 4 Injury Cost Recovery Fund 5,423 4,881 Private Patients 1, ,591 4,182 2,883 3,465 5 Other Income 6,198 13,909 Overseas Visitors ,986 10,492 10,010 9,679 Total Accrued Income 28,398 32,737 Total Invoiced Debtors 31,557 9,505 5,886 32,507 79,455 47,898 46,744 Provision for Bad Debts (Incl. RTA Provision) (12,195) Accrued Income 28,398 Prepayments 7,858 Other Debtors 11,859 Total Trade & Other Receivables 115, CCG's - Outstanding debt has increased by 6.1m. This is mainly due to Bexley ( 1.81m), LSB sustainability and transformation funding ( 3.77m) and other CCGs 2. Trusts - Outstanding debt from Trusts has decreased by 11.8m due to payment of HEE Sift invoice. The overdue debt has increased by 0.27m 3. Other NHS - Outstanding debt has increased by 13.4m mainly due to capital to revenue invoice ( 9.4m) to Department of health and over performance and drugs invoices to NHS England. The overdue debt has increased by 3.3m - mainly due to M6 performance invoice to NHS England ( 3m) 4. Other debtors has decreased by 1.5m due to payment from Local councils for GUM invoices. This is reflected in the decrease in overdue debt of 3m 5. Private patients and overseas visitor has increased by 0.4m 6. Matching creditor balances with some organisations e.g. SLAM, KCL, Lewisham NHS Trust and GSTT.

82 Enc Finance Report Month /2016 Capital G The capital report shows capital expenditure year to date against plan and revised full year forecasts reduced as agreed with Monitor. Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Major Works 21,037 18,271 (2,766) Major Works 32,287 23,853 (8,434) Minor Works 1, (1,170) Minor Works 1,673 1,673 0 IT (Incl Intangibles) 3,767 1,729 (2,038) IT (Incl Intangibles) 4,300 3,405 (895) Medical Equipment 443 1,659 1,216 Medical Equipment Total 26,633 21,875 (4,758) Total 38,910 29,581 (9,329) The reforecast Month 10 planned capital expenditure for 2015/16 is 26.6m; with total capital expenditure to month 10 of 21.8m. Cost estimates and cash flow phasing for the CCU Project have been reviewed and 15/16 capital spend has been revised in line with forecast spend ( 7.8m in 2015/16). The difference in spend has been phased over the remaining years of the project. Planned Capital expenditure has reduced by 9.4m due to the Capital to Revenue Transfer agreement with Monitor. Due to the Trust s cash position and cost pressures, the re-phasing of the CCU Project spend was reviewed and agreed by the Board. A potential overspend of 1.2m at year end is due to the purchase of and MRI scanner and CathLab equipment originally planned for 2014/15 and not budgeted for this financial year. Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Major Works Major Works Critical Care Unit 6,535 6,408 (127) Critical Care Unit 20,262 7,842 (12,420) Cath Lab Developments 1, (378) Cath Lab Developments 925 1, Helideck 5,363 5, Helideck 4,900 5, Site Wide Infrastructure 1,458 1,327 (131) Site Wide Infrastructure 2,000 1,750 (250) Other - Denmark Hill 4,026 3,244 (782) Other - Denmark Hill 1,320 4,638 3,318 Other - PRUH (606) Other - PRUH 2, (2,072) Other - Orpington 1, (771) Other - Orpington 55 1,755 1,700 Minor Works 1, (1,170) Minor Works 1,673 1,673 0 IT (Incl Intangibles) 3,767 1,729 (2,038) IT (Incl Intangibles) 4,300 3,405 (895) Medical Equipment 443 1,659 1,216 Medical Equipment Total Capital Spend 26,633 21,875 (4,758) Total Capital Spend 38,910 29,581 (9,329) Funded by: Funded by: External Borrowing External Borrowing Donations (633) (967) (334) Donations (900) (967) (67) PDC Receipts (1,484) (1,767) (283) PDC Receipts (1,484) (1,767) (283) Depreciation (19,538) (17,960) 1,578 Depreciation (23,446) (17,938) 5,508 Total Funding (21,655) (20,694) 961 Total Funding (25,830) (20,672) 5,158 Internal Cash Funding Requirement 4,978 1,181 (3,797) Internal Cash Funding Requirement 13,080 8,909 (4,171)

83 Enc Finance Report Month /2016 Agency R The agency spend for each staff group is remaining constant with the exception of Medical Staffing which has increased in month 10. The additional spend is in TEAM and LRS. In respect to the Monitor Agency Price Caps, the overall number of shifts of agency booked has increased again but the proportion over the cap has fallen marginally from last week. The only notable increase in absolute numbers is medical staff where 97% of shifts are now above the price cap. The price caps have reduced from 1st February, causing a significant change in the number of shifts breaching the caps for clinical staff, particularly for medical staff. This position will deteriorate when the price caps are reduced for clinical staff on the 1st of April 2016 (55% above the basic). Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k A&C Staff/Senior Managers (3,416) (9,876) (6,459) A&C Staff/Senior Managers (4,191) (13,892) (9,701) Medical Staff (2,972) (12,556) (9,583) Medical Staff (3,336) (14,739) (11,403) Nursing Staff (1,803) (11,819) (10,016) Nursing Staff (1,870) (13,194) (11,324) PAMS/Scientific/Professional (608) (6,079) (5,470) PAMS/Scientific/Professional (937) (8,030) (7,093) Total Agency Spend (8,800) (40,328) (31,529) Total Agency Spend (10,334) (49,855) (39,521) 3,500 Agency Run Rate A&C Staff/Senior Managers Medical Staff Nursing Staff PAMS/Scientific/Professional 3,000 2,500 k 2,000 1,500 1, Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16

84 Enc Finance Report Month /2016 WTEs A The Trust is showing a budgeted vacancy level of 1,411 WTEs, of which 672 are covered by Bank and 327 are covered by Agency. This leaves a vacancy gap of 408 WTEs and explains the cumulative pay budget underspend at month 10. The pay underspend does not correlate to the vacancy gap due to the premium on Agency costs, the use of consultancy staff and the Pay CIP non-achievement. The R&D WTE is greater than the budget due to the number of short term research staff working on commercial trials which are covered by additional income but not reflected in the WTE budget. The Finance Department is working closely with Workforce to reconcile the WTE numbers and progress on the reconciliation is at approximately 86%. Year to Date Budgeted Total Staff in Gap (Budget - Budgeted Substantive Vacancies Bank Agency Post Actuals) WTE WTE WTE WTE WTE WTE WTE Ambulatory Services 1, , , Critical care, Theatres and Diagnostics 2, , , Liver, Renal and Surgery 1, , , Networked Services 1, , , Trauma, Emergency and Medicine 2, , , Womens and Children 1, , , Corporate Services Corporate Services (1.3) Executive Nursing Facilities Finance, Procurement and Information Human Resources Kings Hewitt ACU (0.4) (0.9) Medical Director Operations PFI (0.2) PRUH Integration R&D (42.0) (45.7) Strategic Development Turnaround and Transformation Total Corporate Services 1, , , Contract Services Private Patients and Overseas Visitors (4.3) Total WTEs 12, , , ,

85 Enc Finance Report Month /2016 Income by Commissioner Contract Month 10 Actuals based on Month 9 Flex activity extrapolated using January working days. Flex activity are an indicative income position, which can potentially change (positive or negative) based on income capture and financial adjustments such as fines, penalties & marginal rate adjustments. * Includes Bromley CCG-Led QIPP ( 2.837m - Plan & Actual) ** NHSE - excludes 1.5m risk of Fines and Penalty (potentially to be re-invested). Currently included 2.25m MRET & 0.3m Claims Adjustment. *** Block Contracts over-performing 1.435m against Plan. Majority relate to Bromley CCG around Critical Care and Emergency activity. Activity outside Contract Monitoring (Held Centrally): Cancer Drugs Fund ( 4.8m), IFRs ( 0.9m) & Sofosbuvir ( 5m) Contract M10 Actual (Excl Block Adjustment Bromley CCG-Led M10 Actual (Incl COMMISSIONER_CODE_NAME M10 Budget Penalties/MRET Mapping Adjustments) *** (see note) QIPP (10/12ths) Adjustments) M10 Variance Block NHS BROMLEY CCG * (see note) 133,297, ,520,994 (1,614,067) (3,445,262) (2,164,166) 133,297,499 0 NHS SOUTHWARK CCG 70,751,667 70,727,883 (727,337) 751,121 70,751,667 0 NHS LAMBETH CCG 59,467,500 60,233,979 (659,420) (107,059) 59,467,500 0 NHS LEWISHAM CCG 27,875,000 25,665,261 (289,722) 2,499,461 27,875,000 0 NHS BEXLEY CCG 20,164,464 19,721,248 (108,100) 551,316 20,164,464 0 NHS GREENWICH CCG 16,395,562 17,192,346 (138,574) (658,210) 16,395,562 0 NHS DARTFORD, GRAVESHAM AND SWANLEY CCG 9,525,888 9,720,672 (194,784) 9,525,888 0 NHS WEST KENT CCG 8,197,847 8,099,135 98,712 8,197,847 0 NHS MEDWAY CCG 2,895,149 2,591, ,655 2,895,149 0 NHS WANDSWORTH CCG 2,205,706 2,136,414 (20,222) 89,514 2,205,706 0 NHS CANTERBURY AND COASTAL CCG 1,602,045 2,270,002 (667,957) 1,602,045 0 NHS SOUTH KENT COAST CCG 1,586,520 1,689,445 (102,925) 1,586,520 0 NHS ASHFORD CCG 1,139,907 1,169,231 (29,324) 1,139,907 0 NHS THANET CCG 1,042,652 1,527,406 (484,754) 1,042,652 0 NHS MERTON CCG 1,006, ,171 (3,762) 239,321 1,006,730 0 NHS SWALE CCG 938,937 1,214,318 (275,381) 938,937 0 NHS CENTRAL LONDON (WESTMINSTER) CCG 803, ,230 (114,450) 803,780 0 NHS EAST SURREY CCG 725, ,534 (38,388) (166,279) 725,868 0 NHS WEST LONDON CCG 630, , , ,857 0 NHS EALING CCG 583, , , ,458 0 NHS SURREY DOWNS CCG 566, ,851 (17,774) (68,461) 566,616 0 NHS HAMMERSMITH AND FULHAM CCG 449, ,585 80, ,015 0 NHS KINGSTON CCG 382, ,777 (4,594) 31, ,271 0 NHS HOUNSLOW CCG 348, ,037 (126,230) 348,807 0 NHS RICHMOND CCG 329, ,204 (35,984) 55, ,126 0 NHS BRENT CCG 283, , ,796 0 NHS HILLINGDON CCG 228, ,290 5, ,804 0 NHS HARROW CCG 192, ,022 (8,514) 192,508 0 GUM - RSH 1,231,956 1,231,956 1,231,956 0 Block Total 364,849, ,107,604 (3,657,943) (1,435,559) (2,164,166) 364,849,936 0 C&V NHSE London ** (see note) 251,622, ,787,984 (2,550,000) 259,237,984 7,615,462 NHSE Screening ** (see note) 4,453,603 4,409,726 4,409,726 (43,876) NHSE Dental ** (see note) 21,222,942 21,970,186 21,970, ,244 NHSE Block 13,913,978 13,913,978 13,913,978 0 NHS CROYDON CCG 15,987,167 16,775,469 (115,533) 16,659, ,769 KENT AND MEDWAY AREA TEAM 744, , , ,979 NHS HERTS VALLEYS CCG 509, , ,416 50,048 Other CCGs 2,881,552 2,684,703 (12,489) 2,672,213 (209,338) C&V Total 311,336, ,967,415 (2,678,022) ,289,392 8,953,287 NCA Total 23,348,934 25,294, ,294,801 1,945,867 Grand Total 699,534, ,369,819 (6,335,966) (1,435,559) (2,164,166) 710,434,129 10,899,154

86 Enc Finance Report Month /2016 Income Activity Analysis The month 10 income accrual is based on month 8 actual spell data agreed with Commissioners (freeze data) and month 9 spell activity not confirmed with Commissioners (flex data). In order to reflect the latest activity an income accrual adjustment is based on the inpatient FCEs for the current month. Therefore there is always the potential for monthly variations between the month estimate and actual patient data.

87 Enc Finance Report Month /2016 Surplus / (Deficit) (By Division) The key variations are Corporate Income (CCG support and mitigations), Capital Charges (Asset base review), Finance, Procurement and Information (Holding staff vacancies and reduction on ICT maintenance contracts), Operations (Agency costs relating to Medical Records, BIU, Emergency Care Pathways consultancy and Homecare discharge scheme), Turnaround and Transformation (PWC and FourEyes consultancy) and Contract Services (Income for additional pathology activity costs is reflected in the Divisions). Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Surplus / (Deficit) (76,004) (73,753) 2,251 Surplus / (Deficit) (65,000) (65,000) 0 Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance k k k k k k Ambulatory Services (5,139) (6,232) (1,093) Ambulatory Services (1,460) (5,899) (4,438) Critical care, Theatres and Diagnostics (5,982) (7,259) (1,277) Critical care, Theatres and Diagnostics (4,273) (7,752) (3,478) Liver, Renal and Surgery (27,600) (30,097) (2,497) Liver, Renal and Surgery (28,665) (35,505) (6,840) Networked Services (27,806) (27,577) 229 Networked Services (24,978) (28,747) (3,769) Trauma, Emergency and Medicine (38,318) (40,669) (2,351) Trauma, Emergency and Medicine (45,984) (47,886) (1,902) Womens and Children (15,792) (17,103) (1,311) Womens and Children (15,537) (19,264) (3,727) Corporate Income 30,651 43,083 12,432 Corporate Income 35,952 64,671 28,719 Corporate Services Corporate Services Capital charges and reserves (0) 2,938 2,938 Capital charges and reserves (708) 5,479 6,187 Commercial Services 1,900 1,900 (0) Commercial Services 2,280 2,280 0 Corporate Services (258) (604) (346) Corporate Services (369) (553) (184) Executive Nursing (63) Executive Nursing (76) Facilities 184 1, Facilities (315) Finance, Procurement & Information (238) 1,317 1,555 Finance, Procurement & Information (363) 1,183 1,546 Human Resources (605) (856) (251) Human Resources (722) (898) (176) Medical Director (0) (50) (50) Medical Director 35 (60) (95) Operations (1,441) (3,565) (2,124) Operations (1,731) (4,079) (2,348) PFI 0 (899) (899) PFI 3,347 (2,145) (5,492) R&D (713) (646) 67 R&D (860) (662) 198 Strategic Development (163) (21) 142 Strategic Development (163) (207) (44) Turnaround and Transformation 0 (3,116) (3,116) Turnaround and Transformation 0 (3,691) (3,691) Corporate Services Total (1,396) (2,397) (1,001) Corporate Services Total 1,323 (2,867) (4,190) Contract Services (MSK, ACU, Pathology Services) 4,992 3,630 (1,362) Contract Services 5,887 4,176 (1,711) Private Patients and Overseas Visitors 5,802 6, Private Patients and Overseas Visitors 7,235 8,572 1,337 Surplus / (Deficit) (80,588) (78,337) 2,251 Surplus / (Deficit) (70,500) (70,500) 0 Impairment 4,584 4,584 0 Impairment 5,500 5,500 0 Operating Surplus / (Deficit) (76,004) (73,753) 2,251 Operating Surplus / (Deficit) (65,000) (65,000) 0

88 Enc GOVERNOR ENGAGEMENT & INVOLVEMENT REPORT Report to: Council of Governors Date of meeting: 17 March 2016 Action Required: FOR INFORMATION Introduction Governors have a general duty to to represent the interests of the members of the corporation as a whole and the interests of the public. Monitor s guidance for governors suggests the following key principless as the means for governors to representt the interest of members and the public: Governors should seek the viewss of members and the public p on material issues or changes being discussed by the trust. Governors should feedback to members and the public informationn about the trust, its vision, performance and material strategic proposals madee by the trust board. Governors should try to t make sure when they are communicating with directors of the trust that they epresent thee interests of memberss and the public rather than just their own personal views. The report details the following for information: Schedule of Meetings Involving Governors during the Period Undertakenn Governor Engagement & Involvement Initiatives Governor Engagement & Involvement Register Action Required Governors are asked to t note the engagement and involvement activities undertaken since the last l meeting of the Council. 1

89 1. Engagement & Involvement Opportunity During the Period Enc Governors have attended the following scheduled meetings for the period 21 November March 2016: Date Activity 24 November Board of Directors Meeting (Public) 10 December Council of Governors Meeting 15 December Board of Directors Meeting (Public) 29 January Governor Workshop 02 February Board of Directors Meeting (Public) 15 February Governor Strategy Committee Meeting 15 February Joint KHP Governor Event 18 February Patient Experience & Safety Committee Meeting 18 February Membership & Community Engagement Committee Meeting 01 March Board of Directors Meeting (Public) 09 March Governor Led Development Day Governors have also been busy undertaking the initiatives outlined in the Governor Engagement & Involvement Register as follows: Involvement Activity Governor Attendee(s) Governors Attended During the Period Members Health Talk Penny Dale Yes Chris North Tim Bradley Breakfast Meeting with Chairman Penny Dale Yes Phidelma Lisowska Tom Duffy Chris North Cornelius Lewis Victoria Silvester Fiona Clark Community Events Penny Dale Yes Chris North Victoria Silvester Tim Bradley Fiona Clark Staff Side & JCC Meetings Phidelma Lisowska Yes Public Health Committee Victoria Silvester Yes Fiona Clark Commissioner Quality Review Tom Duffy Yes Committee Mentoring Tom Duffy Yes Appointment of External Auditor Panel Tom Duffy Yes Finance & Performance Committee (Governor Observer) Tom Duffy Yes 2

90 Quality & Governance Committee Tom Duffy Yes (Governor Observer) Lead Governors Meeting with GSTT & Chris North Yes SLAM SLIC Citizen Forum Chris North Yes Fiona Clark Corporate Induction Roger Engwell Yes Cornelius Lewis Staff Commendation Panel Cornelius Lewis Yes Patient Food Audit Victoria Silvester Yes Fiona Clark Stakeholder Events Tim Bradley Yes Lewisham CCG Meeting Tim Bradley Yes End of Life Care Steering Group Fiona Clark Yes Go See Visits Fiona Clark Yes Enc

91 Involvement Activity Public Health Committee Staff Commendation Panel Governor attendee(s) Tom Duffy Pida Ripley Victoria Silvester Grace Okoli Sue Gallagher Fiona Clark Jan Thomas Cornelius Lewis Trust Lead Meeting Date Meeting Time Meeting Venue Additional Information Chair: John Moxham (organiser Mika Kuszai) Chair: John Karani Contact: Linda Flay 21/04/ :00-11:30 TBC 28/07/ :00-11:30 Dulwich Room, DH 27/10/ :00-11:30 Dulwich Room, DH Enc There is no limit to governor attendance for these meetings. Should any other governors wish to attend, please advise the Foundation Trust Office Improving King s Patient Food Service Food Service and Nutrition Group Patient Food Audits (DH) Organ Donor Committee Community Events (DH & PRUH) Patient Experience Committee Victoria Silvester Jan Thomas Victoria Silvester Fiona Clark Jan Thomas Jan Thomas No limit to attendance Victoria Silvester Pida Ripley 7 March 10:00 Dulwich Room, DH 9 May 11:00 Dulwich Room, DH 7 November 11:00 Dulwich Room, DH Chair/Lead: Jan Flint TBC TBC TBC Reserve Governor: Roger Engwell Comes under the Nutrition Support Steering Group (NSSG) which is a sub-group of the Patient Safety Committee. Chair/Lead: Jan Flint TBC TBC TBC Reserve Governor: Roger Engwell Chair/Lead: Ben Rhodes The committee meets quarterly, the next date is yet to be agreed 13 January TBC TBC Lead: Sally Lingard Detail provided in the monthly stakeholder calendar Lead: Jessica Bush Reserve Governor: Tom Duffy 27/01/ :00-16:00 Board Room, PRUH 4

92 Involvement Activity NHS providers Focus Group Serious Complaints Committee End of Life Care Steering Group Governor attendee(s) Enc Trust Lead Meeting Date Meeting Time Meeting Venue Additional Information 23/03/ :30-16:30 Dulwich Room, DH 25/05/ :00-16:00 Board Room, PRUH 27/07/ :00-16:00 Dulwich Room, DH 27/09/ :00-13:00 Board Room, PRUH 29/11/ :00-12:00 Dulwich Room, DH Tim Bradley n/a 20 April :00-15:30 28 Great Russell Street Pida Ripley Lead: Judith Seddon Reserve Governor: Fiona Clark Fiona Clark Jan Thomas Contact: Wendy Prentice, Xan Neethling 25/02/ :00-15:00 Dulwich Room, DH 12/05/ :00-12:00 Dulwich Room, DH 14/07/ :30-13:30 TBA 13/10/ :00-15:00 Dulwich Room, DH Reserve Governor: Penny Dale Maternity Services Liaison Group Anoushka de Almeida-Carragher Lay Chair: Joanna Brien Go See Visits All Governors Geraldine Walters (Helen Day) 1 April 10:00-11:30 Dulwich Room, DH 6 May 10:00-11:30 Dinwoodie 1 & 2 10 June Dulwich Room, DH 22 Jul 10:00-11:30 Dulwich Room, DH 26 Aug 10:00-11:30 Dulwich Room, DH 30 Sep 10:00-11:30 Dulwich Room, DH 4 Nov 10:00-11:30 Dinwoodie 1 & 2 9 Dec 10:00-11:30 Dulwich Room, DH 29 Jan 12:30-14:30 Jenny Lee House Remaining dates and venues Monthly following Board meetings PLACE Visits All Governors Meryem Shrimpton Adhoc Dignity Visits All Governors Nicky Hayes TBC King s In Conversations All Governors Jenny Steele TBC Denmark Hill and Princess Royal University Hospital sites TBC Please advise the Foundation Trust Office should you wish to attend the Go See Visits following the Trust Board of Directors meeting 5

93 Involvement Activity Quality Accounts Engagement Denmark Hill Phlebotomy Focus Group Enc Governor Trust Lead Meeting Date Meeting Time Meeting Venue Additional Information attendee(s) All PESC Members Adhoc See governor sub-committee 1 required Phil Brown/ Althea Haye (Linda Akkad PA) TBC TBC TBC This group is looking for one governor to attend discussion on the present services at the King s site and be a source of consultation for improvements. 6

94 Enc Summaries/ /Actions from f Governor Sub-Committee Meeting: Meeting Date: Action: Membership and Community Engagement Committee 17 March 2016 For Information SUMMARY OF KEY DISCUSSION POINTSS External Speaker The Committee received a presentation from Nicola Kingston and Valerie V Dinsmore form Southwark and Lambeth Integrated Care (SLIC) Citizens Board. SLIC was formed as a partnership organisation between the local GP Federations, the three local NHS Foundation Hospital Trusts namely Guy s and St Thomas (GSTT) NHS Foundationn Trust, South London & Maudsley NHS Foundation Trust and King s College Hospital NHS Foundationn Trust and Southwark and Lambeth Clinical Commissioning Groups, Southwark and Lambeth local authorities and peoplee in Southwark and Lambeth localities with support fromm the GSTT Charity. It was created about 3 years ago to form a common discussion platform between health and social care providers, voluntary sector organisation ns and local people. With the aim to work together on integrated care and improve the way care is currently provided in the community. SLIC services the community by keeping them informed of service available inn their area and also collecting feedback on services received andd passing on to appropriate bodies. The organisation has no influence over how services are provided or run but it does feedback to providers via its i open meetings which are attended by members off the public and care providers senior staff. SLIC is a transitional organizationn formed forr 3 years with a specific aim on integrated care but it has evolved and service a purpose in the community. The future of the organisation is in transition beyond 31 March 2016 when the current funding ceases. However, there iss a lot of enthusiasm to keep the momentumm going and to continue in a new format of strategic health partnership currently being formed to continue the work on integrated i care and care in the community. Stakeholder & Transport Updates The Committee received the Trust s Stakeholder and Transport updates Stakeholder Update The team attended stakeholder events at Lambeth, Lewisham and Southwarkk in November In attendancee were local authority staff, Clinical Commissioning Group (CCG) staff and NHS England representatives, the main topic was strategicc updates and discussions on the future of healthcare. The team organised a number of face to facee meetings between Nick Moberly, Chief Executive Officer and Ministers of Parliaments (MP) and the new the Chief Executive Officer for NHS improvement agency Jim Mackey. 1

95 Enc Transport Update The Committee discussed transport as an integral part of the Trust s operation. The Trust ss transport feeder group was disbanded in 2014 due to low Governor attendance, but it was agreed thatt transport matters are important and must be discussedd and monitored at sub-committeee level. Therefore update on transport matters were allocated to the Membership and Community Engagement Committee. Transport for London (TFL) published a commissioner report at thee end of 2015 indicating their proposed intensions to proceed with the Bakerloo line extension via Old Kent Road and not via Camberwell. No date has been announced for the planned work ass of yet. The Trust will be liaising with TFL and puttingg forward an evidence based casee to support the Bakerloo line extension via Camberwell. Which would be beneficial to local resident r provide easy access to the Denmark Hill site and improved transport linkk for the whole in the area. a Bromley bus services are running a consultation on proposed bus route changes that will allow easier access between the Orpington site and the Princess Royal University Hospital. Southwark Council has announced it will be developing a businesss case for the proposed re-opening of Camberwell Rail station which was closedd in Membership Update The Committee received an updated on Trust membership. The Trust will be submitting the annual membership report to Monitor at the end of March The report will be accompanied a narrative summary, this is a new reporting feature. The Trust will be looking to increase its membership numbers in Lambeth constituency and young members in all areas. Young Person s Involvement att Bromley College The Committee received a presentation on the Trust s project at Bromley College. The Trust engaged with students at Bromleyy College in 2015, during which students participated by redesigningg the Trust ss membership s recruitment poster for young adults. They also provided key insight on how to engage and attract young adults. The use of NHS discounts to attract young members was discussed. Update on Volunteers The Committee receive an update on Trust Volunteers The Trust ss volunteer programme will be reviewed, as part of the review it will be getting a new software to help manage volunteers efficiently. Part of the review will w also lookk at inviting Volunteers to register as members at the recruitment stage. The Trust has been very successful in recruiting volunteers, but there are some issues around retaining them once they have been trained with some individuals moving on to other opportunities within a short period of time. 2

96 Governor Contribution s magazine Enc The Committee were informed s magazine issues will be b reduced to 3 publications per financial year; this has been implemented to generate savings. Thee next issuee magazine will be published in the new financial year and will focus on the upcoming Governor elections. Governor Engagement & Involvement Report The Committee noted the report. Membership Community Events The Committee were informed that the Trustt will be holding its annual membership community events in March: Thursday 3 March, 5pm-8pm - Bromley Central Library Wednesday 9 March, 5pm-8pm - Cambridgee House All governors are invited to attend; the Trust will need one governor to give a short presentation at both events. Month 9 - Finance & Performance Reportss The Committee noted the month 9 Finance and Performance reports. KEY ACTIONS/DICIONS FROM MEETING Action Who The Foundation Trust team will re-design thee governor election JB1 flyer beforee the next round of governor elections. Progress Completed March 2016 The Trust must review the material used to recruit volunteers as part of the wider communications review. PS/SL 06/ /10/2016 Committeee Decision The Committee agreed to no longer receive the Finance and Performance reports as part of it papers as they are sent to all Governors regularly ass part of the Board of Directors D papers. 3

97 Enc Meeting: Governor Strategy Committee Meeting Date: 15 February 2016 Action: For Information SUMMARY OF KEY DISCUSSION POINTS Integration of Health and Social Care Services in Lambeth The Committee received and noted the presentation from Cllr Jim Dickson relating to the integration of health and social care services in Lambeth. The integration initiative aims to improve the outcomes for vulnerable adults in Lambeth and deliver cashable savings best achieved by integrating commissioning and services supported by wider partnerships with health providers. The purpose of the Southwark and Lambeth Strategic Partnership is to align key strategies and build a shared vision of integrated care. Strategic Planning Update (Where Are We Now?) Alan Goldsman, Interim Director of Strategy, provided brief overview of the current strategic planning aims and related issues. In accordance with planning timetable requirements, the Trust has to produce 2016/17 operational plan which will be submitted on 11 April The key issue is that the organisation needs to achieve a better alignment between the expectations from NHS Trusts, Commissioners and the healthcare sector as a whole. The NHS is moving towards a place-based commissioning where NHS commissioners and providers come together to deliver best value through collaborative planning. Trust Strategic Vision/Mission (Triangle) The Committee received and discussed the Emerging Trust Strategy which provides clear strategic objectives allowing the Trust to transform into an organisation that is financially sustainable, operationally efficient and offering outstanding care for patients across all services. The Trust aims to articulate a shared understanding of key principles to set clear organisational purpose and forward strategy. The overall goals will be translated into annual operational objectives at each level of the organisation, clearly communicating them so they are owned at the frontline. The Trust will attract and retain outstanding people across clinical and non-clinical services offering them great development opportunities so that they can reach their full potential. The introduction of a clean sheet approach aims to systematically redesign clinical services and consistently deliver outstanding quality that is best in class in levels of efficiency. 1

98 The Committee reacted positively to the Trust s forward initiatives and noted that the changes will boost staff morale and organisational culture. Enc Update on Financial Plan, CIPs & Transformation The Committee received and noted the Financial Plan, CIPs and Transformation update. The Trust remains focused on delivering its 65m deficit target for 2015/16. It is 71.9m overspent at month 9 and is aiming to implement a mitigation plan to successfully manage the deficit target. The success of the mitigation plan will require particular emphasis on CIP delivery and managing the risk of penalties from NHSE. KHP Update The Committee noted the KHP update and it was highlighted that committee members can forward their views to David Dawson, Deputy Director of Strategy. Horizon Scan The Committee noted the horizon scan and the relevant strategic issues. There have been significant changes across the external healthcare environment mainly focusing on financial, regulatory and planning frameworks. The front-loaded funding has been taken away from the front line and healthcare providers need to meet certain criteria to obtain the additional funding. For the first time Commissioners and NHS providers are working on same framework and timetables for their annual planning and demonstrate that they can meet their financial control targets in order to qualify for additional financial support. The newly implemented regulatory framework across the healthcare sector is closely aligned with the system for Commissioners and NHS England which is aiming to bring together quality and finance. Draft Work Plan for Governors Strategy Committee for 2016 The Committee noted the draft work plan for 2016 and the Committee Chair thanked members for their contribution. Finance and Performance Reports (M09) The Committee received and noted the month 9 Finance and Performance reports. KEY ACTIONS FROM MEETING Action Who Progress The Committee agreed that the strategy objectives would be discussed at the next meeting. GSC 14/04/2016 The Committee agreed that Governors will have an opportunity to input into the Operational Plan via the NEDs/Governors Review Session or another forum. Govs TBC 2

99 Enc Meeting: Patient Experience & Safety Committee Meeting Date: 18 February 2016 Action: For Information SUMMARY OF KEY DISCUSSION POINTS Patient Safety Update and Safer Surgical Checklist The Committee received a comprehensive report on patient safety at the Trust, highlighting the safety culture and systems that are embedded within the Trust to ensure patient safety. The feedback from the recent CQC inspection found the Trust to have robust governance structures to investigate AIs. However, communicating learnings to staff was flagged as an issue. This has been added as a should do action and a number of improvement initiatives have already been put in place; Falls and pressure ulcers continue to remain an issue and this is reflective of increased complexity and acuity of the patients at the Trust. Grip socks are provided to patients at risk of falls and pre-existing pressure ulcers are assigned to the community that the patient has come from to the Trust. In ophthalmology changes have been made to improve the service. This includes appointing a Clinical Director for the service who is driving cohesive behaviours and standardisation of IT systems and equipment across the sites; It is difficult to bench mark 10-fold errors as allergy data are not coordinated nationally and information is not easily accessible; and Staff are informed about never events through speciality, safety and local ward level meetings to ensure key messages reach all front line staff. There is also staff alert through regular newsletters and bulletins. Patient Story The Committee watched a video of a patient relaying her experience following the birth of her two children. The patient s story highlighted issues with the lack of professionalism, communication and attention from the midwife during her first labour. The patient also described her positive experience through the caseload midwifery care, which provided continued care throughout her pregnancy. She suggested that patients should be asked for feedback about their experience during labour and how the midwives performed soon after birth. Governors raised the following points in discussions: It is important patient video stories are shared with staff so lessons can be leant; 1

100 It was highlighted that the maternity team works very hard to drive improvements through various initiatives with limited resources. There has been significant improvement in the vacancy rates and the Trust is continuing to ensure the core staff are in post; Governors commented that the patient video stories should be shorter and snappier. Governors also appreciated the hard work that goes into producing the video from a raw recording to this level with limited resources, time and media expertise; and The video story was difficult to hear. Governors suggested that the external review of the Communication s team, which is currently being undertaken, should consider providing support to internal patient communication and information such as video stories. National Maternity Survey Results 2015 Maxine Spencer, Director of Midwifery presented with the results of the Care Quality Commission (CQC) 2015 National Maternity Survey and the Trust s performance. This was the first maternity survey results as an enlarged organisation where all women (excluding under 16s) who had live births at the Trust in February 2015 were surveyed. The following key points were noted: The Trust s response rate was 38% compared to 41% nationally and the overall performance was rated Amber same as expected ; Overall DH performed slightly better than the PRUH. The Oasis birthing centre at the PRUH is performing well and the Trust is pushing the use of this facility further; Initiatives such as continuity of care and whose shoes are important to help the Trust drive further improvements and it was important that these initiatives were more widely publicised; and Governors raised concern on scores relating to care in hospital after birth question, which was rated Red. The Trust is working to address a number of issues including reducing the unproductive admin processes that a very busy team is encumbered with. The Committee commended and thanked MS for presenting the patient video story and the maternity survey results as well as her transformational work in whose shoes initiative. Trust Quality Priorities 2016/17 The Committee received the review of the Trust performance against the quality priorities and the proposed quality priorities for The following key points were noted: On the whole performance against priorities have been mixed with most of the objectives in progress; Governors noted the proposed long list of priorities in each quality domain for , which has also been sent to stakeholders for their input; 2

101 Enc Governors were supportive of all the proposed priorities and suggested that the Trust should avoid lighter life style changes such as smoking and alcohol. There should be more focus on clinical issues; The Trust should consider front line services such as administration and appointment issues as a quality priority to improve patient experience with greater focus on getting the communication right; and The Trust s performance in infection control is satisfying and as infection control is given a key focus at the weekly Executive meetings and in balancing with other priorities, it may not be appropriate as a priority this year. The Committee recommended the proposed priorities to the Council of Governors and it was noted that the Council will be asked to select and ratify the mandated quality priority at its meeting on 17 March Governor Involvement Updates Governor representatives of Serious Complaints Committee, Patient Experience Committee, Commissioners Quality Review Group and Board Quality and Governance Committee provided feedback on key messages and discussions from the recent meetings they attended. Quality and Governance Committee was the first Board committee attended by a Governor. It was a very useful meeting and provided the opportunity to observe the Non-Executive Directors (NEDs) in action. There was a significant amount of challenge from the NEDs on various issues including lack of isolation facility at NICU, providing training to non-compliant staff and complaints performance. The CQRG is a Committee of the Commissioners with a long membership list, which includes GPs. It is a very different Committee compared to Trust committees and there is no consistency of attendees. 3

102 Register of Governors Attendance Enc. 3.1 Report to: Council of Governors Date of meeting: 17 March 2016 Action Required: FOR INFORMATION Action The Council is asked to note the Register of Governors Attendance.

103 REGISTER OF GOVERNOR ATTENDANCE (PUBLIC) NAME CONSTITUENCY MEETINGS ATTENDED REASON FOR ABSENCE Prof Sir George Alberti Chair N/A N/A N/A Retired on 31/03/2015 Lord Robert Kerslake Chair N/A N/A Joined on 01/04/2015 Ms Anoushka de Almeida-Carragher Bromley c Ms Eniko Benfield Bromley c Mr Paul Corben Bromley c c Ms Penny Dale Bromley c c Mr Alan Hall Lewisham c c Resigned on 10/09/2015 Ms Fiona Clark Lambeth Mr Christopher North Lambeth Mr Nandakumar Ratnavel Lambeth Dr Grace Okoli Lambeth Ms Barbara Pattinson Southwark c c c Ms Pam Cohen Southwark c Mr Andrew McCall Southwark c Mrs Victoria Silvester Southwark Miss Jo Millett (nee Artus) Staff - Nurses and Midwives Ms Nicky Hayes Staff - Nurses and Midwives Mr CV Praveen Staff - Medical and Dentistry c c Dr Cornelius Lewis Staff - Allied Health Professionals c Mr Roger Engwell Staff - Administration and Clerical Ms Helen Ahmet Patient Mr Derek St Clair Cattrall Patient c Mr Thomas Duffy Patient Mrs Catriona Ogilvy Patient c c c c c Governor role terminated. Replaced by Craig Jacobs Mrs Pida Ripley Patient c Ms Jan Thomas Patient c c c Mr Craig Jacobs Patient N/A N/A N/A N/A c Joined on 25/09/2015 OBE Mr Tim Bradley Patient N/A N/A N/A N/A Joined on 25/09/2015 Cllr Robert Evans Bromley Council c Ms Diane Summers Guy's & St Thomas' Hospital NHS Foundation Trust c c Mrs Phidelma Lisowska Joint Staff Committee c Mr Chris Mottershead King's College London c Ms Sue Gallagher Lambeth CCG c N/A Resigned on 24/10/2015 Mr Richard Gibbs Southwark CCG c c N/A Resigned on 22/10/2015 Mr Jim Gunner Bromley CCG N/A N/A c N/A Resigned on 29/04/2015 Cllr Jim Dickson Lambeth Council c Cllr Kieron Williams Southwark Council c c Mr Roger Pafford South London and Maudsley NHS FT N/A c c c Joined on 02/01/2015 Dr Sadru Kheraj Lambeth CCG N/A N/A N/A N/A N/A Joined on 01/01/2016 Mr Noel Baxter Southwark CCG N/A N/A N/A N/A N/A Joined on 01/02/2016 Meeting Dates Key: (1) 10 December 2014; (2) 12 March 2015; (3) 14 May 2015; (4) 24 September 2015; (5) 10 December 2015

104 Report to: Council of Governors Date of meeting: 17 March 2016 Subject: Action Required: Quarterly Monitor Submission Q3 FOR INFORMATION Introduction This is a copy of the report which was presented and discussed by the Board of Directors in February The recommendations in the report were approved and the Trust submitted its quarter 3 submission. Recommendation The Council of Governors is asked to note, for information, this report.

105 Report to: Board of Directors Date of meeting: 2 February 2016 Subject: Monitor Submission Quarter 3, 2015/2016 Author: Presented by: Status: 1. Overview Tamara Cowan, Board Secretary Nick Moberly, Chief Executive For Approval NHS Foundation Trusts are required to make in-year submissions on a quarterly basis during 2015/16. The submission is based on the Trust s quarterly performance in finances, meeting national targets and indicators and any other areas pertinent to meeting conditions enshrined in the its licence. The submission is made in the form of a comprehensive return to monitor which includes analysis of the financial position, performance against national targets, continuity of risk rating against the information submitted in the Trust s annual plan, in addition to other information. The Board delegated authority to the Finance & Performance Committee to review and approve the quarterly submissions to ensure that submission are made within the required timeframe to Monitor. On 26 January the Committee considered the Trust s performance during the quarter, 01 October 31 December 2015, and decide how best to respond to the statements (Confirmed/Not Confirmed) below taking account of the latest reports on operational and financial performance. 2. Recommendation The Committee: Consider the rationale and proposed Board responses in Appendix 1 and offer any comments or suggested amendments; and To review the following key elements of the Monitor return: Appendix 2: Continuity of Service Risk Rating and Financial Summary Appendix 3: Declarations of risks against healthcare Targets and Indicators Agreed that BK and NM sign-off the final Board self-certification which was made on 28 January 2016.

106 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.

107 Enc. 3.2 Click to go to index Summary of Financial Statements for King s College Hospital NHS Foundation Trust units sense Audited For PrevYE ending 31-Mar-15 Plan For Month ending 31-Dec-15 Actual For Month ending 31-Dec-15 Variance For Month ending 31-Dec-15 Plan For YTD ending 31-Dec-15 Actual For YTD ending 31-Dec-15 Variance For YTD ending 31-Dec-15 Plan For Year ending 31-Mar-16 Simple Forecast Year ending 31-Mar-16 Adjusted Forecast Year ending 31-Mar-16 Forecast Variance Year ending 31-Mar-16 Summary Income and Expenditure Account Operating income (inc in EBITDA) NHS Clinical income m (+ve) Non-NHS Clinical income m (+ve) Non-Clinical income m (+ve) (0.848) (12.626) (12.626) Total m 1, , , , Operating expenses (inc in EBITDA) Employee expense m (-ve) ( ) (51.539) (51.139) ( ) ( ) ( ) ( ) ( ) Non-Pay expense m (-ve) ( ) (27.900) (34.064) (6.164) ( ) ( ) (41.288) ( ) ( ) ( ) (48.450) PFI / LIFT expense m (-ve) (51.173) (5.202) (4.513) (39.100) (41.518) (2.418) (53.891) (56.309) (56.309) (2.418) Total m (1, ) (84.641) (89.716) (5.075) ( ) ( ) (37.269) (1, ) (1, ) (1, ) (48.511) EBITDA m (2.829) (4.092) (13.952) (25.935) (11.983) (5.850) (17.833) (3.836) EBITDA Margin % % 1.02% 1.47% (3.26%) (4.73%) (1.82%) (3.27%) (1.45%) (0.57%) (1.70%) (0.36%) 0.20% Operating income (exc from EBITDA) Donations and Grants for PPE and intangible assets m (+ve) Operating expenses (exc from EBITDA) Depreciation & Amortisation m (-ve) (22.152) (1.954) (2.002) (0.048) (17.584) (18.036) (0.452) (23.446) (23.898) (23.938) (0.492) Impairment (Losses) / Reversals m (+/-ve) (4.535) (0.459) (0.458) (4.125) (4.123) (5.500) (5.498) (5.500) - Restructuring costs m (-ve) Total m (26.687) (2.413) (2.460) (0.047) (21.709) (22.159) (0.450) (28.946) (29.396) (29.438) (0.492) Non-operating income Finance income m (+ve) (0.193) (1.738) (1.798) Gain / (Losses) on asset disposals m (+/-ve) (0.285) (0.233) (0.350) (0.100) (0.100) Gain on transfers by absorption m (+ve) Other non - operating income m (+ve) Total m (0.193) (1.488) (1.548) Non-operating expenses Interest expense (non-pfi / LIFT) m (-ve) (1.809) (0.337) (0.420) (0.083) (2.661) (2.856) (0.195) (3.670) (3.865) (4.795) (1.125) Interest expense (PFI / LIFT) m (-ve) (17.279) (1.414) (1.414) - (12.721) (12.725) (0.004) (16.962) (16.966) (16.966) (0.004) PDC expense m (-ve) (11.272) (0.961) (0.812) (8.642) (8.150) (11.523) (11.031) (10.501) Other finance costs m (-ve) (0.153) (0.013) (0.004) (0.112) (0.092) (0.150) (0.130) (0.150) - Non-operating PFI costs (e.g. contingent rent) m (-ve) (6.163) (0.537) (0.547) (0.010) (4.839) (4.923) (0.084) (6.452) (6.536) (6.536) (0.084) Losses on transfers by absorption m (-ve) Other non-operating expenses (including tax) m (-ve) (0.250) Total m (36.926) (3.262) (3.197) (28.975) (28.746) (38.757) (38.528) (38.948) (0.191) Surplus / (Deficit) after tax m (51.887) (4.210) (8.426) (4.216) (62.551) (76.035) (13.485) (70.503) (83.988) (70.513) (0.010) Profit/(loss) from discontinued Operations, Net of Tax m (+/-ve) Surplus / (Deficit) after tax from Continuing Operations m (51.887) (4.210) (8.426) (4.216) (62.551) (76.035) (13.485) (70.503) (83.988) (70.513) (0.010) Memorandum Lines: Surplus / (Deficit) before impairments and transfers m (47.352) (3.751) (7.968) (4.217) (58.426) (71.912) (13.487) (65.003) (78.490) (65.013) (0.010) One off income/costs m (4.820) (0.459) (0.458) (4.358) (4.106) (5.850) (5.598) (5.600) Normalised Surplus / (Deficit) m (47.067) (3.751) (7.968) (4.217) (58.193) (71.929) (13.737) (64.653) (78.390) (64.913) (0.260) Normalised Surplus / Deficit Margin % % (4.34%) (4.36%) (9.16%) (4.81%) (7.56%) (9.06%) (1.50%) (6.31%) (7.47%) (6.04%) 0.30% Summary Statement of Financial Position Non-current Assets Intangible assets m (+ve) (0.094) (0.094) (0.094) Property, Plant & Equipment m (+ve) (0.115) (0.115) (9.515) On-balance sheet PFI m (+ve) (10.548) (10.548) (10.548) Other m (+ve) Total m (9.283) (9.283) (18.683) Current Assets Cash and cash equivalents m (+ve) Other current assets m (+ve) Total m Current Liabilities Overdrafts and drawdowns in committed facilities m (-ve) - (16.821) (16.821) (26.494) (9.673) PFI / LIFT leases m (-ve) (3.550) (0.886) (0.887) (0.001) (0.886) (0.887) (0.001) (3.898) (3.899) (3.899) (0.001) Other borrowings m (-ve) (4.074) (61.737) (93.770) (32.033) (61.737) (93.770) (32.033) (63.774) (95.807) (95.807) (32.033) Other current liabilities m (-ve) ( ) ( ) ( ) (42.156) ( ) ( ) (42.156) ( ) ( ) ( ) (18.286) Total m ( ) ( ) ( ) (57.369) ( ) ( ) (57.369) ( ) ( ) ( ) (23.826) Non-current Liabilities PFI / LIFT leases m (-ve) ( ) ( ) ( ) - ( ) ( ) - ( ) ( ) ( ) - Other borrowings m (-ve) (67.462) (67.460) (67.462) (0.002) (67.460) (67.462) (0.002) (63.386) (63.388) (63.388) (0.002) Other non-current liabilities m (-ve) (6.295) (6.295) (6.295) - (6.295) (6.295) - (4.995) (4.995) (4.995) - Total m ( ) ( ) ( ) (0.002) ( ) ( ) (0.002) ( ) ( ) ( ) (0.002) Reserves m (+ve) (13.378) (13.378) Summary Statement of Cash Flows Surplus (Deficit) from Operations m (15.645) (1.150) (5.238) (4.088) (35.161) (47.386) (12.226) (33.896) (46.122) (32.167) Operating activities Non-operating and non-cash items in operating surplus/(deficit) m (+/-ve) Operating Cash flows before movements in working capital m (0.633) (2.125) (22.902) (33.536) (10.635) (16.546) (27.181) (11.412) Movements in working capital m (+/-ve) (8.983) (36.181) (26.787) (29.445) (20.051) (48.132) (18.687) Increase/(Decrease) in non-current provisions m (+/-ve) (1.300) (1.300) (1.300) - Net cash inflow/(outflow) from operating activities m (7.491) (59.083) (60.323) (1.241) (47.291) (48.532) (60.844) (13.553) Investing activities Capital Expenditure (Accruals basis) m (-ve) i (49.147) (3.258) (1.400) (29.123) (18.835) (38.903) (28.615) (28.615) Increase/(decrease) in Capital Creditors m (+/-ve) (1.669) (0.100) (0.051) (0.951) Proceeds on disposal of PPE, intangible assets and investment property m (+ve) (0.001) (0.014) (0.014) Other cash flows from investing activities m (+/-ve) (0.003) (0.259) (0.367) (0.147) (0.017) Net cash inflow/(outflow) from investing activities m (50.591) (3.145) (1.391) (28.100) (19.144) (37.462) (28.506) (27.174) Financing activities Public Dividend Capital repaid m (-ve) Repayment of borrowings m (-ve) i (1.285) (0.645) (3.883) (1.951) (3.883) (1.951) (1.951) Capital element of finance lease rental payments m (-ve) i (3.199) (0.296) (0.295) (2.662) (2.662) - (3.550) (3.550) (3.550) - Interest element of finance lease rental payments m (-ve) i (23.443) (1.951) (1.961) (0.010) (17.560) (16.007) (23.414) (21.861) (21.861) Interest paid on borrowings m (-ve) (1.452) (0.654) (0.420) (2.908) (2.912) (0.004) (2.908) (2.912) (2.912) (0.004) Other cash flows from financing activities m (+/-ve) Net cash inflow/(outflow) from financing activities m (19.917) (3.546) Opening cash and cash equivalents less bank overdraft m (+/-ve) (0.639) (0.008) (0.008) Net cash increase / (decrease) m (11.081) (14.182) (58.274) (16.658) (67.947) (26.332) (32.405) Changes due to transfers by absorption m (+/-ve) Closing cash and cash equivalents less bank overdraft m (14.821) (14.821) (24.494) Financial Sustainability Risk Rating Capital Service Cover Revenue Available for Capital Service m (12.134) (25.855) (13.721) (3.350) (17.071) (3.134) Capital Service m (41.160) (35.520) (33.359) (46.190) (44.029) (44.449) Capital Service Cover metric 0.0x 0.29 (0.34) (0.78) (0.43) (0.07) (0.39) (0.07) 0.00 Capital Service Cover rating Score Liquidity Working Capital for FSRR m (+/-ve) (41.663) ( ) ( ) (6.604) ( ) ( ) ( ) Operating Expenses within EBITDA, Total m (1, ) ( ) ( ) (37.269) (1, ) (1, ) (1, ) (48.511) Liquidity metric Days (13.982) (38.192) (38.632) (0.439) (46.050) (46.671) (38.524) Liquidity rating Score I&E Margin Normalised Surplus/(Deficit) m (+/-ve) (47.067) (58.193) (71.929) (13.737) (64.653) (78.390) (64.913) (0.260) Adjusted Total Income for FSRR m (+ve) 1, , , , I&E Margin % (4.34%) (7.56%) (9.06%) (1.50%) (6.31%) (7.47%) (6.04%) 0.30% I&E Margin rating Score I&E Margin Variance I&E Margin % (7.56%) (9.06%) (1.50%) (6.31%) (7.47%) (6.04%) 0.30% I&E Margin Variance From Plan % -4.37% (4.37%) -1.50% (4.37%) (1.17%) 0.26% I&E Margin Variance From Plan rating Score Overall Financial Sustainability Risk Rating Score Continuity of Service Risk Rating Score 2

108 Enc. 3.2 Click to go to index Declaration of risks against healthcare targets and indicators for by King s College Hospital NHS Foundation Trust Annual Plan Quarter 1 Quarter 2 Quarter 3 Targets and indicators as set out in the Risk Assessment Framework (RAF) - definitions per RAF Appendix A NOTE: If a particular indicator does not apply to your FT then please enter "Not relevant" for those lines. Threshold or target YTD Scoring Per Risk Assessment Framework Risk declared Scoring Per Risk Assessment Framework Performance Declaration Comments / explanations Scoring Per Risk Assessment Framework Performance Declaration Comments / explanations Scoring Per Risk Assessment Framework Performance Declaration Comments / explanations Scoring Per Risk Assessment Framework Key: must complete may need to complete Target or Indicator (per Risk Assessment Framework) Referral to treatment time, 18 weeks in aggregate, incomplete pathways i 92% 1.0 Yes 1 0.0% Not met Data not submitted with agree 1 0.0% Not met Data not submitted with agree 1 0.0% Not met Data not submitted with agree 1 A&E Clinical Quality - Total Time in A&E under 4 hours i 95% 1.0 Yes % Not met % Not met % Not met 1 Cancer 62 Day Waits for first treatment (from urgent GP referral) - post local breach re-allocation i 85% 1.0 Yes 84.6% Not met 86.4% Achieved 86.4% Achieved 1 1 Cancer 62 Day Waits for first treatment (from NHS Cancer Screening Service referral) - post local breach re-allocation i 90% 1.0 No 95.5% Achieved 92.6% Achieved % Achieved Cancer 62 Day Waits for first treatment (from urgent GP referral) - pre local breach re-allocation i 0.0% 0.0% 0.0% 0 Cancer 62 Day Waits for first treatment (from NHS Cancer Screening Service referral) - pre local breach re-allocation i 0.0% 0.0% 0.0% Cancer 31 day wait for second or subsequent treatment - surgery i 94% 1.0 No 98.8% Achieved 95.3% Achieved 99.4% Achieved Cancer 31 day wait for second or subsequent treatment - drug treatments i 98% 1.0 No % Achieved % Achieved 100.0% Achieved 0 Cancer 31 day wait for second or subsequent treatment - radiotherapy i 94% 1.0 No 100.0% Achieved 100.0% Achieved % Achieved Cancer 31 day wait from diagnosis to first treatment i 96% 1.0 No % Achieved % Achieved % Achieved 0 Cancer 2 week (all cancers) i 93% 1.0 No 97.0% Achieved 97.5% Achieved 95.1% Achieved Cancer 2 week (breast symptoms) i 93% 1.0 No 99.1% Achieved 99.2% Achieved % Achieved Care Programme Approach (CPA) follow up within 7 days of discharge i 95% 1.0 N/A 0.0% Not relevant 0.0% Not relevant 0.0% Not relevant Care Programme Approach (CPA) formal review within 12 months i 95% 1.0 N/A 0.0% Not relevant 0.0% Not relevant 0 0.0% Not relevant Admissions had access to crisis resolution / home treatment teams i 95% 1.0 N/A 0 0.0% Not relevant 0 0.0% Not relevant 0 0.0% Not relevant 0 Meeting commitment to serve new psychosis cases by early intervention teams OLD measure - use until Q1 2016/17 i 95% 1.0 N/A 0 0.0% Not relevant 0 0.0% Not relevant 0 0.0% Not relevant 0 Ambulance Category A 8 Minute Response Time - Red 1 Calls i 75% 1.0 N/A 0 0.0% Not relevant 0 0.0% Not relevant 0 0.0% Not relevant 0 Ambulance Category A 8 Minute Response Time - Red 2 Calls i 75% 1.0 N/A 0 0.0% Not relevant 0 0.0% Not relevant 0 0.0% Not relevant 0 Ambulance Category A 19 Minute Transportation Time i 95% 1.0 N/A 0 0.0% Not relevant 0 0.0% Not relevant 0 0.0% Not relevant 0 C.Diff due to lapses in care (YTD) i Yes 1 28 Not met 1 47 Not met 1 67 Not met 1 Total C.Diff YTD (including: cases deemed not to be due to lapse in care and cases under review) i C.Diff cases under review i Minimising MH delayed transfers of care i <=7.5% 1.0 N/A 0 0.0% Not relevant 0 0.0% Not relevant 0 0.0% Not relevant 0 Meeting commitment to serve new psychosis cases by early intervention teams NEW measure (scored from Q4 2015/16) i 50% 0.0% Not relevant 0.0% Not relevant 0.0% Not relevant Improving Access to Psychological Therapies - Patients referred within 6 weeks NEW measure (scored from Q3 2015/16) i 75% 0.0% Not relevant 0.0% Not relevant 0.0% Not relevant Improving Access to Psychological Therapies - Patients referred within 18 weeks NEW measure (scored from Q3 2015/16) i 95% 0.0% Not relevant 0.0% Not relevant 0.0% Not relevant Data completeness, MH: identifiers i 97% 1.0 N/A 0 0.0% Not relevant 0 0.0% Not relevant 0 0.0% Not relevant 0 Data completeness, MH: outcomes i 50% 1.0 N/A 0 0.0% Not relevant 0 0.0% Not relevant 0 0.0% Not relevant 0 Compliance with requirements regarding access to healthcare for people with a learning disability i N/A 1.0 No 0 N/A Achieved 0 N/A Achieved 0 N/A Achieved 0 Community care - referral to treatment information completeness i 50% 1.0 N/A 0.0% Not relevant 0.0% Not relevant 0.0% Not relevant Community care - referral information completeness i 50% 1.0 N/A 0 0.0% Not relevant 0 0.0% Not relevant 0.0% Not relevant 0 Community care - activity information completeness i 50% 1.0 N/A 0.0% Not relevant 0.0% Not relevant 0.0% Not relevant 0 Risk of, or actual, failure to deliver Commissioner Requested Services N/A N/A No No No Date of last CQC inspection i N/A N/A 13/04/ /04/ /04/2015 CQC compliance action outstanding (as at time of submission) N/A N/A No Final CQC Inspection Report pending Yes Yes CQC enforcement action within last 12 months (as at time of submission) N/A N/A No No No CQC enforcement action (including notices) currently in effect (as at time of submission) N/A N/A No Final CQC Inspection Report pending No No Moderate CQC concerns or impacts regarding the safety of healthcare provision (as at time of submission) i N/A Report by Exception N/A No Final CQC Inspection Report pending No We have requirement notices in place and must do's which we No We have requirement notices in place and must do Major CQC concerns or impacts regarding the safety of healthcare provision (as at time of submission) i N/A N/A No Final CQC Inspection Report pending No No Overall rating from CQC inspection (as at time of submission) i N/A N/A N/A Final CQC Inspection Report pending Requires improvement Requires improvement CQC recommendation to place trust into Special Measures (as at time of submission) N/A N/A No No No Trust unable to declare ongoing compliance with minimum standards of CQC registration N/A N/A No No No Trust has not complied with the high secure services Directorate (High Secure MH trusts only) N/A N/A N/A N/A N/A Results left to complete: Checks Count: Checks left to clear: Service Performance Score 0 i i 0 i OK i

109 Enc Governors Membership & Community Engagement Committee Minutes of the meeting held at 11:30 on 8 October 2015 in the Dulwich Committee Room, King s College Hospital Members: Fiona Clark (FC) Penny Dale (PD) Chris North (CN) Victoria Silvester (VS) Tom Duffy (TD) In attendance: Chris Stooke (CS) Andrew McCall (AM) Tim Bradley Craig Jacobs Janaki Kuhanendran Jessica Bush (JB) Helen Merati (HM) Sally Lingard (SL) Sarah Willoughby (SW) Petula Storey (PS) Tamara Cowan (TC) Jane Badejoko (JB1) Apologies: Lord Kerslake (BK) Pida Ripley (PR) Barbara Pattinson (BP1) Phidelma Lisowska (PL) Public Governor/ Committee Chair Public Governor Public Governor (Lead Governor) Public Governor Public Governor Non-Executive Director Public Governor Public Governor Patient Governor Lambeth Health Watch Head of Engagement and Patient Experience Engagement and Experience Manager (PRUH) Director of Communications Stakeholder Relations Manager Head of Volunteering Board Secretary Corporate Governance Officer (minutes) Trust Chair Patient Governor Public Governor Joint Staff Governor Item Subject Action 15/35 Welcome and apologies Apologies for absence were noted. 15/36 Minutes of the Previous Meeting The minutes of the previous meeting were agreed as a correct record. 15/37 Action Tracker The Committee noted the action tracker. The Committee was informed that Tim Smart the Trust s former Chief Executive Officer enjoyed the article written by Tom Duffy and Pida Ripley in summer issue Magazine. 1