A G E N D A. (b)to provide updates to the Actions Log

Transcription

1 A meeting of the Board of Directors will be held on Friday 11 July 2014 at 8.30am in the Committee Room, Trust Management Suite, Royal Bournemouth Hospital. If you are unable to attend on this occasion, please notify me as soon as possible on Karen Flaherty TRUST SECRETARY A G E N D A TIMINGS 1. APOLOGIES FOR ABSENCE APPENDIX MINUTES OF THE PREVIOUS MEETING (a)to approve the minutes of the meeting held on Friday 13 June 2014 (b)to provide updates to the Actions Log A B 3. DECLARATIONS OF INTEREST 4. MATTERS ARISING (a)update from Pharmacy on Medication on Elderly Care Services Wards (46/14(a)) Paula Shobbrook Verbal 5. QUALITY IMPROVEMENT (a) Patient Story Paula Shobbrook Verbal (b) Update on CQC Action Plan Tony Spotswood/ Paula Shobbrook C (c) Feedback from Staff Governors Jane Stichbury Verbal 6. PERFORMANCE (a) Performance and Productivity Helen Lingham D (b) Quality Paula Shobbrook E (c) Finance and Activity Stuart Hunter F (d) Workforce Report Karen Allman G 7. STRATEGY AND RISK (a) Trust Strategy Tony Spotswood H (b) Informatics Strategy Update Peter Gill I 8. INFORMATION (a) Update on the Process of Appointment for new Chief Operating Officer Tony Spotswood Verbal (b) Communications Update (including Core Brief and RAAI June) Richard Renaut J (c) Corporate Events Calendar Karen Flaherty K (d) Board of Directors Forward Programme Karen Flaherty L BoD/ Page1 of 2

2 9. NEXT MEETING Friday 12 September 2014 at 8.30am in the Committee Room, Royal Bournemouth Hospital. Although there is no meeting scheduled in August, the Board of Directors will meet during August if necessary. 10. ANY OTHER BUSINESS Key Points for Communication to Staff 11. COMMENTS AND QUESTIONS FROM THE GOVERNORS Board Members will be available for minutes after the end of the Part I meeting to take comments or questions from the Governors on items received or considered by the Board of Directors at the meeting. 12. RESOLUTION REGARDING PRESS, PUBLIC AND OTHERS To resolve that under the provision of Section 1, Sub-Section 2, of the Public Bodies Admission to Meetings Act 1960, representatives of the press, members of the public and others not invited to attend to the next part of the meeting be excluded on the grounds that publicity would prove prejudicial to the public interest by reason of the confidential nature of the business to be transacted. BoD/ Page2 of 2

3 THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST (the Trust) Minutes of a Meeting of The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Board of Directors (the Board) held on Friday 13 June 2014 in the Committee Room, Royal Bournemouth Hospital Present: In attendance: Apologies: Jane Stichbury Tony Spotswood Karen Allman David Bennett Derek Dundas Basil Fozard Stuart Hunter Helen Lingham Ian Metcalfe Steven Peacock Alex Pike Richard Renaut Paula Shobbrook Bill Yardley Karen Flaherty Peter Gill Paul Bolton Jane Bruccoleri-Aitchison Anneliese Harrison Donna Parker Michelle Richards Mike Allen David Bellamy Glenys Brown Sue Bungey Sharon Carr-Brown Derek Chaffey Carole Deas Bob Gee Eric Fisher Doreen Holford Keith Mitchell Margaret Neville Douglas Smith Helen Warren None (JS) (TS) (KA) (DB) (DD) (BF) (SH) (HL) (IM) (SP) (AP) (RR) (PS) (BY) (KF) (PG) (PB) (JBA) (AH) (DPa) (MR) (MA) (DB) (GB) (SB) (SCB) (DC) (CD) (BG) (EF) (DH) (KM) Chairman (in the chair) Chief Executive Director of Human Resources Non-Executive Director Non-Executive Director Medical Director Director of Finance Chief Operating Officer Non-Executive Director Non-Executive Director Non-Executive Director Director of Service Development Director of Nursing and Midwifery Non-Executive Director Trust Secretary Director of Informatics Senior Infection Prevention & Control Nurse Communications Officer Assistant to the Trust Secretary Deputy Chief Operating Officer Ward Sister, Ward 22 Public Governor Public Governor Public Governor Public Governor Public Governor Public Governor Public Governor Public Governor Public Governor Public Governor Public Governor Chairman, Friends of the Eye Unit Member of Public The Learning Clinic BOD/Part 1 Mins PAGE 1 OF 14

4 70/14 MINUTES OF THE MEETING HELD ON 9 MAY 2014 (Appendix A) The minutes were taken as read and approved as a correct record of the meeting. 71/14 ACTIONS LOG (Appendix B) (a) enews Update PS explained that the low levels of completed observations recorded by the Stroke Unit reported at the previous meeting had been due to a faulty device which had now been resolved. (b) Quality Performance Report PS confirmed that both of these issues would be followed up by the Healthcare Assurance Committee (HAC). (c) Improvement Board Update HL noted that an update had been included on the agenda and a briefing paper had recently been circulated to all Board members. 72/14 DECLARATIONS OF INTEREST There were no new interests declared. 73/14 MATTERS ARISING (a) Update on Restructuring of Management Support to Clinical Directorates (Verbal) JS emphasised that this was one of the most significant issues for the Trust at the moment with the uncertainty amongst staff involved impacting upon staff who were not directly affected by the changes. HL reported that there would be a global communication to all staff once the process had been completed which would give details of all the appointments which had been made internally together with an explanation of the rationale for change. She also updated that: the Trust was now looking to appoint externally where there were vacant posts in the new structure; the Trust had advertised the Director of Operations and Head of Nursing and Quality roles with eight candidates long-listed for the first role and six for the second role; interviews for the Director of Operations roles would take place BOD/Part 1 Mins PAGE 2 OF 14

5 on 23 June and on 7 July for the Head of Nursing and Quality roles; the assessment and interview process for these roles would follow the process which was used internally so there would be parity in terms of the decision-making; the Directorate roles in the new structure were being advertised internally and externally and the Matron roles were to be advertised internally as there was there was a great deal of interest from within the organisation; and by the end of July all the appointments would have been made but both she and PS would be meeting with Clinical Directors from each Care Group to establish interim arrangements to be put in place from July while the individuals appointed worked their notice periods before taking up the new posts. She explained that the process had been handled with sensitivity with support for the individuals involved but had been challenging as there had not been a restructuring within the organisation for some time. She emphasised that this had been the right decision in terms of ensuring the Trust was ready for the changes facing the NHS. She added that other organisations locally were similarly carrying out changes to their structures. AP asked about the impact of personal uncertainty on day-to-day activity and performance to which HL responded that the individuals remained committed to the organisation, with some seeking redeployment, and additional support had been provided where necessary recognising that this was a difficult period for individuals. TS summarised the rationale for the changes: to strengthen capacity and capability in terms of both the structure and the skills, something which had been reflected back to the Board in the review by Sir Ian Carruthers, and would have been put in place sooner in this organisation if not for the merger; to address drawbacks as a result of silo working by creating a more effective Care Group structure; and to address variability in the quality of nursing through strong matron and senior nursing functions with a greater presence on the wards. PS explained that the new nursing structure would be supported by a ward sister s development programme with individual coaching. JS encouraged regular communication with staff using a variety of means to both explain the reasons for the changes and the benefits for the organisation and to provide updates on actions and the timeframe. BOD/Part 1 Mins PAGE 3 OF 14

6 74/14 QUALITY (a) Patient Story (Verbal) BF explained that his original intention was to use the patient story to introduce an initiative on communication skills across the Trust to the Board but this work, led by the End of Life Steering Board was not yet ready to be presented to the Board. BF described the story of a patient who he had treated for cancer two years previously, whose family had been upset with the lack of sensitivity in the way a new cancer diagnosis had been delivered to the patient by another clinician more recently. He explained that the patient had been admitted under the care of the vascular surgeons and how the investigations carried out sometimes identified other things, in this case that the cancer had spread to the patient's liver and the condition was considered as terminal. He relayed how the patient felt that the news that the cancer had spread and that the condition was terminal had been delivered in a brutal way, without any support and without any family or friends present. BF stated that this was unacceptable and while this was an isolated occurrence, in a large organisation with a high patient throughput there may be other occurrences of which we were not aware. While the consultant in this case had received communication skills training, BF emphasised the need to continue to work on communications in a timely fashion. He added that other members of staff should feel able to step forward in these situations to provide reassurance to the patients and make it clear this was not the way we communicate with patients in the Trust. AP thanked BF for his transparency as it had not been easy to tell or hear the story. She felt there should be a greater emphasis on appointing the right people with true natural compassion as well as focussing on communication skills training. DB added that as consultants were seen as leaders in the organisation and there was a danger that other staff would perceive this behaviour as acceptable so it was important to address this quickly. TS questioned why the 360 degree appraisal process for medical staff had not identified the issue with communication skills for this consultant. BF responded that he would be presenting more data on the appraisal process in the private session of the meeting and while he acknowledged that these behaviours can develop over a period of time, he believed they the Trust was making progress in terms of delivering a far better appraisal process for doctors. BOD/Part 1 Mins PAGE 4 OF 14

7 BY also noted that instilling core leadership skills so other staff would challenge un acceptable behaviour was also important. KA described the training that those in senior nursing roles were receiving and also the implementation of the Trust's new the values would take some time but would support this challenge and a caring and compassionate culture within the organisation. (b) Update on CQC Action Plan (Appendix C) TS reported that while the actions had been implemented, the key now was to maintain this progress and for the Board to be able to chart the progress in terms of the outputs. He reported that the Trust was still awaiting the two day re-inspection and noted that other trusts had been given some advance notification before the inspectors arrived. PS highlighted: the internal clinical quality review process; that the Quality and Risk Committee were also carrying out a regular internal review as part of its meetings to ensure high quality patient care was consistent; and the refurbishment of Ward 26 refurbishment had been a success and well received by the staff although the Ward Sister on that Ward was going on maternity leave so that vacancy would need to be filled. SP commented that ensuring improvements had been made was one aspect of the action plan but queried whether the Trust was in a better place than before the last Care Quality Commission (CQC) inspection and whether the re-inspection would go well. PS explained that external reviewers with strong nursing leadership backgrounds, such as Irene Grey, had been assessing the Trust's progress and had seen demonstrable changes since March and April. She also noted that the HAC were reviewing the ward scorecard and care audits in terms of assessing improvement as well. TS noted that the CQC would recognise the improvements which had been made but also that there was still work to be done, in common with most other NHS organisations. He expressed that his main concern was the level of activity and the need to address issues around community and social services support for patients prior to admission and on discharge, while recognising that there were issues with funding these services. JS added that the internal review process must continue and that she had received feedback that staff appreciated these reviews as it was helpful and effective way to maintain and improve standards. (c) NHS England Hard Truths Requirements for publication of staffing data (Appendix D) PS presented the report and highlighted the change in format of the data to meet the requirements set out by NHS England. She described: BOD/Part 1 Mins PAGE 5 OF 14

8 the way in which templates for the wards had been set based upon best practice guidelines and were reviewed every six months and the substantial additional investment made as a result; the use of external guidance to set appropriate staffing levels but also the importance of the professional judgment of senior nursing staff in determining whether staffing levels were appropriate; the use of the Staff Resource Pool and agency staff where additional support was required on the wards due to the higher dependency or acuity of patients; how the data on vacancies had been drawn from the Electronic Staff Record whereas previously she had reported on vacancies using data from the weekly senior nurse reviews at ward level; the 96.6% fill rate across the Trust was very positive; that one of the areas with the highest number of vacancies was the Acute Medical Unit, where four block-booked agency staff were being used to provide continuity, and new junior sister roles had been identified and she was confident that the Trust would be able to permanently recruit to these roles; that there were qualified nurse vacancies across the Surgical Directorate and in Theatres but again these were being mitigated in a number of ways including using Healthcare Assistants and a new cadre of operating department assistants in Theatres; by way of assurance, using Ward 2 and Ward 7 and the Derwent Unit as examples, how nurses were available to work on other wards; and how the information would be published on the NHS Choices website but PS wanted the Board to have this information first and would add a link to the Trust s website where more commentary would be available. In response to a question from SP, PS explained that the reporting was against planned staffing levels so some increases were included in the plan. SP suggested that the data could be expanded to show the minimum and maximum fill rates to give a better impression of what it felt like for staff and patients on the wards. AP stressed the importance of having a consistent number around staffing and the need to ensure that the information provided to the Board focused on what the Board needed to do. BY agreed, suggesting that it was important to understand the trends and projections so that the Board could focus on the areas where there may be concerns. JS supported the way that this information was being presented to the Board more regularly as staffing was such a key issue for the Trust. She also endorsed the need to emphasise to staff and the public that the Trust was performing well compared to other trusts. BOD/Part 1 Mins PAGE 6 OF 14

9 (d) Feedback from Staff Governors (Verbal) 75/14 PERFORMANCE JS noted that there had been some negative press coverage following the last meeting as a result of comments made by a Staff Governor but she had reassured the individual involved as it was important for the Board and the Trust that staff felt able to bring issues to the Board even if these messages were blunt or were subsequently picked up by the media and portrayed in a negative light. She explained that she and TS would now have a regular meeting with Staff Governors in advance of the Board meeting to ensure a fuller response to any issues raised could be provided at the Board meeting. She highlighted that the first message from staff was that the Trust was very busy and this pressure was being felt by staff. She noted that RR had been looking for staff input on how to address this challenge as it was unlikely to go away given the underlying issues across the NHS. She added that the other issue which had been raised by Staff Governors was the need for clarification around the new clinical management structure and those points had been raised earlier in the meeting. She concluded by noting that Staff Governors had also raised issues relating to particular areas in the Trust which were being followed up separately. (a) Performance Report (Appendix E) HL presented her report, highlighting the following: That there had been an increase in non-elective admissions; an overall improvement in the position on bed occupancy compared to the previous year including the downward trajectory on bed occupancy in adult medicine, however occupancy levels in geriatric medicine had increased in recent months due to restrictions on the Trust's ability to discharge patients; that patients' length of stay and the number of outliers remained on a downward trend; that Emergency Department attendances were up due to a 10.5% increase in activity from ambulance conveyances which was double the number for acute hospitals in the rest of Dorset; That there had been breaches of cancer waiting time standards and while the breaches related to a small number of patients this meant that those individual patients were waiting longer than they should for diagnosis or treatment; the progress on the action plan for Urology in order to return to compliance with the performance standard for the 62 day wait from referral to first cancer treatment; the national Blood in Pee campaign which was planned for the autumn and the additional capacity planned in the month BOD/Part 1 Mins PAGE 7 OF 14

10 following the campaign; that predictions on cancer performance remained difficult, although the NHS Interim Management and Support Team had confirmed that the predictor used by the Trust was as good as any other they had seen in use; based on the predictor, the Trust would be above threshold for 62 and 31 day cancer standards in the first quarter of 2014/15; the importance of creating capacity during the summer to meet the targets for 18 week referrals to treatment as this would not be possible during the winter with increased demand on services; certain issues relating to diagnostics which were being well managed; where the Trust benchmarked against the Sentinel Stroke National Audit Programme (SSNAP) data with improvement on thrombolysis and the formal swallow screen although more work was needed. In response to a question from DD, HL confirmed that the Trust's position should have improved as the seven day Speech and Language Therapy service provision had been introduced after the period in which the data was collected. AP thanked HL for the way in which the Stroke data had been presented to highlight the improvement trajectory and performance against the national benchmarks. (b) Quality Performance Report (Appendix F) PS presented the report, highlighting: the improvement required on reducing the number of patients with pressure damage, although she noted that some other trusts had not been recording the data in same way as the Trust and would be required to do so going forward which should enable better comparisons to be made; that while the Trust may not be able to achieve zero pressure damage given the number of frail, elderly patients with existing pressure damage admitted to the Hospital, the Trust should ensure that pressure ulcers do not deteriorate during admission; the improvement in the percentage of assessments carried with an update using the latest data for May; and that there was a stable but still positive position on the Friends and Family Test. In response to a question from SP, PS confirmed that performance was improving in relation to pressure ulcers as there had been no recent serious incidents which related to the more severe pressure ulcers even though the harm-free scores were based on a point prevalence audit. DB confirmed that he was seeing improvements on wards through the HAC. He also highlighted that there had been examples of exceptional leadership on some wards in addressing the issues. The BOD/Part 1 Mins PAGE 8 OF 14

11 Board agreed that the category of pressure ulcers should be included in the report as this would help demonstrate the improvement being described. PS (c) Activity and Finance (Appendix G) SH presented the report. He highlighted that: a deficit budget had been set for 2014/15 with a good investment programme and a low cost improvement requirement so as to continue the focus on quality; the ability to manage cost pressures through contingency was much reduced in 2014/15 compared to 2013/14; there had been a significant adverse variance in the first month with a deficit of 652,000 and although agency costs had been budgeted these had been exceeded; there was a significant level of additional activity which was not being funded through the managed contract with NHS Dorset. Clinical Commissioning Group (CCG); the early data for May indicated that the position was worse; and significant action needed to be taken and the options would be discussed in the private session of the meeting before making a decision. IM noted that while activity was outside of the Board s control, the under-delivery of the Trust's cost improvement programme was a concern and the position would be difficult to recover if this continued. PS added, regarding agency costs, that just over 36 nurses were starting in June, July and October which should help reduce these costs. JS added that while the Trust needed to have the right number of staff to deliver safe care, it was important that the cost improvement programme was delivered. The Trust needed to ensure a balanced position between quality and finances. (d) Clinical Indicators (Verbal) BF reported that performance was very positive. PS noted that the Quality and Risk Committee were reviewing these indicators and they would be changing as these had evolved over the year and would be submitted to the HAC for review once agreed. HL also highlighted the percentage of Continuing Healthcare fast track patients that died in Hospital as this was not always in line with the patient's wishes about where they wanted to die. She noted that the Trust and Poole Hospital NHS Foundation Trust, which was in a similar position, would be writing jointly to the CCG about this had deteriorated. BOD/Part 1 Mins PAGE 9 OF 14

12 76/14 STRATEGY (a) Chief Executive s Update on Trust Strategy (Appendix H) TS presented the report. He described: how the financial modelling is was focused on creating a clear five year strategy for the provision of services that was sustainable; if the Trust continued on the same basis and there were no changes there would be a substantial operating deficit; and the strategy looked at three themes, improving care through vertical integration with community services, the future pattern for the provision of services through the reconfiguration of acute services and, for the next 2 years, the improvement work around care and the organisational capability and development plans to improve leadership capability. RR added that there would be more staff engagement after the initial work in June to develop these themes further. TS drew the Board's attention to the article from David Bennett, the chief executive of Monitor, in The Times that day about the sustainability of district general hospitals and urging organisations to look at different approaches other than mergers. (b) Improvement Board Update (Appendix H) 77/14 DECISION HL presented the report, noting that the improvement programme was about quality and best practice with the end result being that the Trust becomes more efficient and financially stable. She highlighted in particular the improvements in ambulatory care, as an alternative to admitting to assess and the need for greater focus on earlier diagnostics and completing assessments for ongoing needs in a different way TS added that unscheduled care was the key area to get right in order to reduce how busy the hospital was by ensuring that the right staff were available with the right skills to meet the patients' needs. (a) Board Objectives (Presentation) TS delivered a presentation and outlined the six objectives and the metrics for each of these: reducing the variation in the quality of care - focusing on harmfree care; supporting improvement work to make the hospital less busy, BOD/Part 1 Mins PAGE 10 OF 14

13 drive down bed occupancy, with coverage over seven days and a focus on unscheduled care; a clear vision and strategic direction for the Trust going forward to shape a new clinical service model with major investment in Christchurch Hospital and the development of a private patient strategy; organisational development and leadership capability; continuing to deliver a strong operational performance based on a range of financial and performance objectives including cancer standards and Emergency Department waiting times; and taking forward and sustaining the actions from the CQC's report and the recommendations from Sir Ian Carruthers review. TS invited comment, noting that he was looking for support from the Board. The Board discussed the metrics to measure delivery of the objectives including the introduction of additional financial metrics and a metric in relation to Acute Kidney Injury as well as a reduction in the overall number of metrics. SH agreed to review the finance metrics. AP queried some of the language used to express the objectives as this should accurately reflect the humanity and compassion of the organisation and offered assistance to reword these. SH AP The Board supported the objectives subject to a review of finance metrics and the language of the objectives. (b) Quality Objectives (Appendix J) PS introduced the proposed Quality Objectives which had been considered by the HAC. She added that the aim was to reduce the levels of harm and increase reporting rates. SP asked which of the objectives were mandated and the financial implications of failure. PS replied that the information about the source of the objective was in the report but she did not have the details of the financial implications. She also clarified the different metrics around pressure ulcers and agreed to add a footnote to provide commentary for the different measures. PS The Board agreed the recommended quality objectives and improvement aims for the Trust (c) Strategy Steering Committee Terms of Reference (Appendix K) RR presented the paper. The Board approved the terms of reference. RR requested volunteers from the Non-Executive Directors to be members of the Strategy Steering Committee. NEDs BOD/Part 1 Mins PAGE 11 OF 14

14 78/14 INFORMATION (a) Corporate Events Calendar (Appendix L) The report was noted for information. (b) Core Brief (May) (Appendix M) The report was noted for information. (c) Communications Update (including RAAI May) (Appendix N) The report was noted for information. (d) Board of Directors Forward Programme (Appendix O) The report was noted for information. 79/14 DATE OF NEXT MEETING Friday 11 July 2014 at 8.30am, Committee Room, Royal Bournemouth Hospital. 80/14 ANY OTHER BUSINESS There was no other business. 81/14 Key Communications points for staff 1. Indications of improvement on quality 2. Reporting on staffing 3. Finance 4. Summary of approach on strategy 82/14 QUESTIONS FROM GOVERNORS 1. EF acknowledged the focus on the CQC and asked when the report on the progress against the Francis Report would be coming to the Board. PS confirmed that the focus had been on the CQC action plan but that this supported the delivery of the recommendations in the Francis Report and would discuss timing of the report to the Board with TS and JS. 2. GB asked how confident the Board whether the current levels of activity may be the new "normal" and how this would be addressed. TS PS BOD/Part 1 Mins PAGE 12 OF 14

15 responded that there had been progress in terms of bed occupancy and he felt that staff were aware that the Trust had more to do to ensure on it was on top of the discharge process on a consistent basis but it was also important to ensure the community was providing alternatives for patients and not just at crisis points. 3. SB was pleased to hear the discussion about the restructuring and the support given to the staff and emphasised the importance of communication. She asked whether the report from Sir Ian Carruthers was ready. TS explained that comments on the draft report had been requested and provided and Sir Ian Carruthers was now working on a revised draft which would be presented to the Board and should be received very shortly. 4. SCB emphasised the importance of not compromising on skills and behaviours given the pressure to recruit and cited an example of a registrar who was on an intensive language course. KA added that part of the organisational development was around values-based recruitment and this was already part of the process for more senior appointments. TS also wanted to emphasise that the Trust was not lowering the bar and was working to recruit doctors in New Zealand for some of the positions which had been harder to fill. PS also added that Ward Sisters and Charge Nurses were appointing their own teams and were providing support to staff from overseas around colloquial use of the English language. 5. CD was pleased to hear the patient story from BF. She noted an issue around the number of hip and knee revisions being carried out at the Trust and referred elsewhere. which she had been seeking to resolve for over a year. TS noted that there was no evidence to support the view that the Trust's performance on hip and knee replacements was poor and that the Trust was one of the best Orthopaedic centres in the country. JS confirmed that she had been trying to arrange a meeting with CD to discuss her concerns. HL also confirmed that she would to be happy to meet with CD to discuss this. 6. DH was disappointed to hear the patient story and cited a similar experience from over three years ago and wanted to understand whether things had improved and the importance of properly trained specialist cancer nurses to assist patients given a cancer diagnosis. BF noted that the patient story was not highlighting something which he believed was endemic within the Trust but had highlighted this as it was particularly distressing. He confirmed that work was in progress to raise the Trust s standards and that there were specialist cancer and palliative care nurses in place. 7. DC asked whether there was any opportunity to put inpatient beds in Christchurch Hospital. TS responded that there were no plans to reintroduce inpatients beds in Christchurch Hospital but there needed to be discussions about how patients were supported in the community. He felt the comments from Simon Stevens, the chief executive of NHS England, were part of a wider discussion about issues in the NHS. He agreed there were sufficient community beds but in the wrong places and the Trust needed to work with commissioners and other providers to ensure that there the right services were in place for the local BOD/Part 1 Mins PAGE 13 OF 14

16 population. There being no further business the meeting was declared closed at 11:10am BOD/Part 1 Mins PAGE 14 OF 14

17 U RBCH Board of Directors Part 1 Actions Date of Meeting Ref Action Action Response /14 PERFORMANCE Quality Performance Report PS agreed to discuss making data available sooner to PS the Board at the next meeting of the Healthcare Assurance Committee. SP asked to see the trend in terms of the lower quintile PS improvement in the information presented to the Board on the FFT scores and highlighted the importance of understanding the data behind this /14(b) QUALITY Quality Performance Report The Board agreed that the category of pressure ulcers should be included in the report as this would help demonstrate the improvement being described PS 77/14(a) DECISION Board Objectives The Board discussed the metrics to measure delivery of the objectives including the introduction of additional financial metrics and a metric in relation to Acute Kidney Injury as well as a reduction in the overall number of metrics. SH agreed to review the finance metrics. SH AP queried some of the language used to express the objectives as this should accurately reflect the humanity and compassion of the organisation and offered assistance to reword these. AP 77/14(b) DECISION Quality Objectives SP asked which of the objectives were mandated and Brief Update Completed. An additional finance metric for the Board objectives has been added: to ensure it achieves its finalised plan. Completed. Revised objectives circulated to Board members. BOD Actions Log PAGE 1 OF 2

18 RBCH Board of Directors Part 1 Actions Date of Meeting Ref Action Action Response the financial implications of failure. PS replied that the information about the source of the objective was in the report but she did not have the details of the financial implications. She also clarified the different metrics around pressure ulcers and agreed to add a footnote to provide commentary for the different measures. PS 77/14(c) DECISION Strategy Steering Committee Terms of Reference RR presented the paper. The Board approved the terms of reference. RR requested volunteers from the Non- Executive Directors to be members of the Strategy Steering Group NEDs 82/14 (1) QUESTIONS FROM GOVERNORS EF acknowledged the focus on the CQC and asked when the report on the progress against the Francis Report would be coming to the Board. PS confirmed that the focus had been on the CQC action plan but that this supported the delivery of the recommendations in the Francis Report and would discuss timing of the report to the Board with TS and JS. PS Brief Update Completed. The report will be presented to the Board in September and the Forward Programme has been updated to reflect this. BOD Actions Log PAGE 2 OF 2

19 BOARD OF DIRECTORS Meeting Date and Part: 11th July 2014 Part 1 Subject: Update on CQC Action Plan June 2014 Section: Executive Director with overall responsibility Author(s): Quality Improvement Paula Shobbrook, Director of Nursing and Midwifery Joanne Sims, Associate Director Quality & Risk Previous discussion and/or HAC 26 th June 2014 dissemination: Action required: The Board of Directors is recommended to approve closure of the action plan and approve ongoing monitoring by the Healthcare Assurance Committee. Summary: The action plan in response to the compliance actions from the Care Quality Commission was submitted to the CQC in January This has been monitored monthly by the Healthcare Assurance Committee (HAC) and the Board of Directors. The actions have been progressed; there is one action rated amber (2.1) which relates to appointment of administrative staff to support ward sisters/charge nurses and enable supervisory time across the Trust. The impact of the actions in practice is being monitored by a programme of internal quality peer reviews and the ward level quality scorecard, which is showing positive trend of improvement. This is reported monthly through the HAC and Trust Management Board (TMB). Sir Ian Carruthers has undertaken a review of the Trust s response to the findings of the CQC inspection and the action plan. This will be presented at the TMB on 6 th July and a verbal update will be provided to the Board of Directors in part 1. Related Strategic Goals/ All objectives detailed in the Quality Strategy Objectives: Relevant CQC Outcome: Safe, Caring, Effective, Responsive & Well Led Risk Profile: i. Have any risks been reduced? The risks will be monitored by HAC and this will not be reduced until the re-inspection by the CQC. ii. Have any risks been created? No Reason paper is in Part 2 Not applicable

20 Reg Action to meet regulation What the action intends to achieve Who is responsible? Action Lead How to ensure improvements have been made & sustained? What measures to check this? Who is responsible? Monitoring Lead Resources needed to implement the changes Date actions will be completed Current Status Trust wide daily review and authorisation of ward staffing levels by ward sisters, daily review of compliance to Formal assurance and risk mitigation templates by Senior Nurse by shift. process for all inpatient wards to ensure Weekly retrospective compliance report appropriate staffing levels to Chief Operating Officer and Director of Nursing and prospective plan for following week Ward Sisters & Senior Nurses Trust overview by Deputy Director of Nursing *Daily review of templates and allocations, including sign off by ward sisters and senior nurses and escalation to Director of Nursing as required. *Weekly review by Executive Team *Weekly review and assurance of escalation process used to ensure compliance or mitigation Chief Operating Officer and Director of Nursing. Board of Directors to review monthly report on compliance and forecasts On-going recruitment plus bank and agency staffing to fill shifts. Action plans restricted by the current national availability of experience trained nurses. Overseas recruitment included in Trust recruitment plan (see below) 28/02/2014 Action complete with ongoing monitoring via Senior Nurses and internal inspection programme. COMPLETE *Implement recruitment plan to establish a substantive workforce across all in patient wards and create capacity to manage short term sickness and expected levels of staff turnover including: *Targeted Journals recruitment plan recruitment fayre *Overseas *Local Management of staff turnover and short term sickness via over recruitment and effective and timely recruitment processes HR Manager / Deputy Director of Nursing *Review of milestones for recruitment process *Vacancy template report weekly and fill rates HR Director Successful recruitment campaign *Interviews 30/1/14 *Advertise 30/01/14 *30/03/2014 Rolling recruitment programme for directorates. Trust recruitment fayre 11th June Portuguese nurses starting work 25/3/14 and 14/4/ Italian nurses starting WC 24/3/ nurses from Spain, Greece, Portugal and Italy signing agreements. 12 more overseas nurses interviewed 11/4/14. Advert for newly qualified nurses placed 14/4/14. Newly Qualified Nurse interviews being planned by end May 17 Staffing and skill mix to recommended 1.3 As a priority ensure Wards 3 and 26 templates for all shifts. Ward sisters / are fully staffed to template Daily review of compliance with To ensure strong leadership and develop Senior Nurse Care New established ward leadership on Ward templates new team culture to support high standards of the Elderly 26 and Ward 3 of patient care and safety Senior Nurse Care of the Elderly Director of Nursing Review of use of bank and agency to maximise staffing opportunities 4/12/13 (Ward 26 sister) 6/1/14 (Ward 3 sister) ACTION COMPLETED with ongoing monitoring via safety handover checklist ensuring compliance Additional senior nurse cover for hospital site at weekends and bank holidays Increased and enhanced nursing leadership Deputy Director to support improved and consistent nursing of Nursing standards at ward level out of hours Weekly review of senior nurse cover. Audit of activity, stakeholder views and quality improvement as a result of senior cover Director of Nursing Budget to support extra cover 4th Dec 2013 Rota established COMPLETE

21 Reg Action to meet regulation What the action intends to achieve Who is responsible? Action Lead How to ensure improvements have been made & sustained? What measures to check this? Who is responsible? Monitoring Lead Resources needed to implement the changes Date actions will be completed Current Status Recruitment of Senior Nurse Elderly Care Directorate Specialist nurse leadership for Elderly Care General Manager Elderly Care Monthly review of standards via CARE and Safety Thermometer audits Director of Nursing Availability and recruitment of high calibre candidate Appoint by 31/3/14 Appointment to be included as part of wider restructure. Interim post in place Senior nurses in elderly care directorate to implement a weekend rota to support consistent approach and scrutiny of high standards of care across all wards Senior nursing leadership provided 7 days per week to provide on-site support and leadership General Manager Elderly Care Monthly review of standards via CARE and Safety Thermometer audits Director of Nursing Availability and recruitment of high calibre candidate Rota to start 31/1/14 Rota established COMPLETE Engage expertise and support from external consultant nurse practitioner in elderly care and dementia and dignity, for leadership training Increased and enhanced specialist nursing leadership and training needs assessment Senior Nurse to support improved and consistent nursing Elderly Care standards Weekly review of effectiveness of external support Director of Nursing Appointment of external consultant with specialist knowledge and experience Starts 6/1/14 for 3 months initially Process completed COMPLETE Public display of staffing template and shift staffing levels on all wards Increased public confidence with regard to staffing levels Ward sisters/senior Nurses Daily review of compliance and weekly report to Executive Team Deputy Director of Nursing Implementation of new Display Boards 31/1/2014 Ongoing checking that templates are being updated daily via Senior Nurses and internal inspection programme COMPLETE Implementation of new Privacy and Dignity Policy and education programme to support embedding. Focus on key standards to include: response to call bells, provision of suitable gowns, communication, noise at night, use of curtains and privacy of conversations Cascade of corporate and directorate actions at ward level. Greater staff awareness of Trust action plans for Privacy and Dignity. Consistency of approach and compliance across the Trust Ward sisters Trust overview by Deputy Director of Nursing Repeat Privacy and Dignity Observational Audit across all wards. Tool to be refined to assess impact of previous actions implemented. Audit to include assessment of staff awareness of actions implemented Deputy Director of nursing monthly report to execs and Board of Directors Staff time to understand and implement. Education and communication with staff. Re-audit following policy implementation via CARE Audit. Implement policy by 31/1/14 Complete re audit by 31/3/14 Daily dignity launched for embedding practice. Re-audit completed and action has been completed but will require continued monitoring via Care Audits COMPLETE

22 Reg Action to meet regulation What the action intends to achieve Who is responsible? Action Lead How to ensure improvements have been made & sustained? What measures to check this? Who is responsible? Monitoring Lead Resources needed to implement the changes Date actions will be completed Current Status Monthly Patient Association CARE audit of 20 patients per ward across all Elderly Care and Medical wards Reducing variation in practice and spreading good practice via: audit of wound care, call bell response, communication and nutrition Ward Sisters/Senior nurses Medicine and Care of Elderly Trust overview by Deputy Director of Nursing Results and actions to be reviewed monthly at ward sister and Senior Nurse meetings, and Executive Team meeting Director of Nursing to Patient Association contract. provide monthly report Availability of Volunteers to to Executive Team and undertake interviews and data Board of Directors collection Start by 31/1/14 Care Audits routinely collected and Ward Sister / Senior Nurses can access real time data on shared drive COMPLETE New patient gowns to be used across the Trust with improved design To improve patient dignity and protect patients privacy Deputy Director of Nursing Repeat Privacy and Dignity Audit across all wards. Tool to be refined to assess impact of previous actions implemented. Audit to include assessment of staff awareness of actions implemented Senior Nurses. Director of Nursing to provide report to Executive Team and Board of Directors Procurement and laundry contract to ensure gowns fully available 01/03/2014 Gowns delivered and rolled out. COMPLETE Implementation of standard checklist for daily ward safety briefing and handover by ward sisters at start of each shift with all available staff. To include discussion on staffing levels, risk issues, patient safety issues, staff questions and concerns for shift To improve clarity and consistency of safety briefing and handover information to support patient care and patient safety. To ensure ward teams receive consistent daily information of ward safety and staffing. To ensure wards consistently communicate key actions to all staff and staff are engaged and aware of safety issues and responsibilities Ward sisters / Deputy Director of Nursing Audit of safety briefing implementation Director of Nursing Design of checklist and support for roll out 01/03/2014 Safety checklist designed and launched March Process for use being embedded at ward level COMPLETE *Remove escalation beds in ED *Remove escalation beds in AMU To improve privacy, dignity and safety for emergency patients General Manager Medicine Daily bed state report Chief Operating Officer Appropriate bed base and emergency care measures ED 1/12/13 AMU 14/1/14 Escalation beds removed from ED 1/12/13 and AMU 14/1/14 COMPLETE Implementation of a Code of Conduct for Healthcare Assistants supported by training and appraisal processes To implement consistent standards, responsibilities and accountabilities for healthcare assistants across all wards. To support further development of Healthcare Assistants roles Ward and directorate compliance Trust overview by report confirming all Healthcare Training Manager assistants have received and signed a and Senior nurses copy of the Code of Conduct Deputy Director of Nursing No additional resources beyond time for training 28/02/2014 Code of Conduct implemented COMPLETE

23 Reg Action to meet regulation What the action intends to achieve Who is responsible? Action Lead How to ensure improvements have been made & sustained? What measures to check this? Who is responsible? Monitoring Lead Resources needed to implement the changes Date actions will be completed Current Status Generate 50% supervisory time for ward sisters releasing time to ensure all inpatients in their area have their needs assessed, then met in a safe and timely way Enhanced leadership time to monitor and ensure high and consistent standards of nursing care are delivered across the ward. To improve risk assessment and audit compliance. To support a learning culture from additional review and feedback of learning from adverse events and complaint Deputy Director of Nursing Agreed plan with each ward sister Director of Nursing 350k fund allowing recruitment and backfill *AMU and Stroke AMU, Stroke, Ward 3, Ward 26 from 1/11/13 complete. Plan for wards developed *Ward 3 and 26 from and admin support being apt for 'Ward 31/1/14 Sisters assistant' roles. This is to *Plan for all wards by enable time for ward sisters to be 31/3/14 supervisory in practice Monthly Patient Association CARE audit of 20 patients per ward across all Elderly Care and Medical wards Reducing variation in practice and spreading the good practice via: Monthly care audit of wound care, call bell response, communication and nutrition Ward Sisters/ Deputy Director of Nursing Results and actions to be reviewed monthly at ward sister and Senior Nurse meetings, and Executive meetings Senior Nurses Patient Association contract. Director of Nursing to Availability of Volunteers to provide monthly report undertake interviews and data to Executive Team and collection Board of Directors Start by 31/1/14 Care Audits routinely collected and Ward Sister / Senior Nurses can access real time data on shared drive COMPLETE Implementation of a Wound Care Plan Documentation Audit across all wards Assess compliance with Wound Formulary and the Standard Operating Procedure (SOP) for stock dressings. Highlight areas for additional Wound Care and Pressure Ulcer Prevention training. Ensuring appropriate wound care Lead Tissue Viability Nurse Monthly audit report Director of Nursing to Additional nursing / HCA time in provide monthly report place to Board of Directors To start by 31/1/14 Ongoing monitoring established COMPLETE Develop Standard Operating Procedure to implement, in addition to daily review and care planning, twice weekly pressure ulcer ward rounds by Ward sisters of all inpatient with recorded pressure damage (hospital or externally developed). Assess compliance with SOP for Pressure Ulcer ward rounds and Pressure Ulcer policy Highlight areas for additional Wound Care and Pressure Ulcer Prevention training Ward sister using supervisory time. Lead Tissue Viability Nurse Audit of compliance as part of monthly report to Board See supervisory time action. Ward rounds to be supported by ward consultant and Tissue Director of Nursing to Viability Team where high patient provide monthly report To start by 31/1/14 acuity, risk factors or clinical need. to Board of Directors Initial targeted approach and focus with audit of implementation in Vascular and Elderly Care Ongoing monitoring established COMPLETE

24 Reg Action to meet regulation What the action intends to achieve Who is responsible? Action Lead How to ensure improvements have been made & sustained? What measures to check this? Who is responsible? Monitoring Lead Resources needed to implement the changes Date actions will be completed Current Status Highlight all Nutrition and Hydration Standard Operating Procedures to ward staff Further education around utilisation of the nutrition risk assessment scoring (MUST score) Implement standard signs and operating procedures for nil by mouth on all wards *To ensure practice is research based and uniform throughout the Trust *To improve awareness of methods to calculate a MUST score and ensure appropriate referrals, nutrition plans and provision *To have a corporate approach and standard Dietetic Team Nutrition team Monitoring by Nutrition Steering Group MUST score reports Audit Director of Nursing to of compliance, using patient and carers n/a provide monthly report views: CARE Audit. to Healthcare Assurance Committee and Board of Directors 31/01/ /02/ /02/2014 Permanent boards have been put up. Agreement of new standards for risk assessment on admission to Trust and ward agreed with Nutrition team. Masterclass sessions on completion of care plan documentation held with senior nurses and ward sisters, additional sessions planned. This action will remain open until MUST scores improve - this is being monitored via the monthly ward audits Expand use of meal time companions to encourage and support relatives, carers Mealtime companions can give greater and volunteers to support patient s support for nutrition nutritional intake in elderly care Senior nurse elderly care Monitor implementation and views of patients, carers and volunteers via CARE Audit Senior nurse elderly care Recruitment of volunteers 31/03/2014 Training schedule in place COMPLETE Review visiting times to remove any Facilitate carers feeding patients if they unnecessary restrictions that may deter Deputy Director wish, and greater visiting times to allow this relatives, carers and volunteers to support of Nursing and provide companionship meal times Monthly CARE audit results reported to Wards Sisters and Senior Nurses meetings Director of Nursing n/a All actions by 31/3/14 Visiting times reviewed with new schedule in place COMPLETE Implementation of bay based nurse stations to all wards Nursing staff to be based in bays to provide increased visible presence Basing staff within a bay to reduce need for call bells use and ensure more proactive and visible nursing care. To improve access to documentation and nurses based in bays directly inputting and reviewing risk assessments and care plans. Ensuring patients have sufficient care, nutrition and communication Ward Sisters / Senior nurses Monthly Board report on implementation by ward Director of Nursing Mobile trolleys to be ordered to support phased roll out. *Ward 3 & 26 by 31/1/14 *All medical wards by 31/3/14 *All wards by 30/6/14 Bay based nursing in progress and action on track to roll out to all wards by action plan timescale.

25 Reg Action to meet regulation What the action intends to achieve Who is responsible? Action Lead How to ensure improvements have been made & sustained? What measures to check this? Who is responsible? Monitoring Lead Resources needed to implement the changes Date actions will be completed Current Status Extend Speech and Language Therapy (SALT) service Phased approach to 6 and then 7 day service More rapid swallow assessment General Manager Audit of response times Specialist Services Chief Operating Officer Extra funding for SALT team 6 day service by 31/1/14 7 day service by 30/6/14 Existing staff going through consultation to convert to 7 day service. The 7 day service for SALT will commence from mid May *Implement new Pressure Area Care Together (PACT) strategy for pressure ulcer prevention and management *Monthly newsletter (PACT sheet). Resource folder (PACT file) *Monthly programme of training and resource materials for ward staff To raise awareness of appropriate standards of care and support consistent approach to implementation and compliance Tissue viability lead nurse Monthly audit of implementation, Safety Thermometer data collection, AIRS Director of Nursing to produce monthly report to Healthcare Assurance Committee and Board of Directors Training and communication time 31/01/2014 New strategy implemented. Study day for all resource staff held in April 2014 COMPLETE Strengthen governance framework to support a more open, learning culture for clinical governance and quality assurance and quality improvement Clearly defined roles and responsibilities for quality and patient safety at directorate level. Increased focus on learning and quality improvement in relation to serious incidents, audits and NICE guidance, including Weekly Grand Round presentation on SI or RCA Clinical Directors Clinical Governance Risk Committee (reporting into Healthcare Assurance Committee) Overview by Board of Directors Chief Executive Agreement of dedicated time for governance lead functions in consultant job plans 31/01/2014 New Terms of Reference for Quality and Risk Committee, Clinical Audit and Effectiveness Group and Healthcare Assurance Committee agreed. Roles and Responsibilities for governance and risk within directorate management teams agreed at Trust Management Board and implemented COMPLETE Consistent governance framework across all directorates Increased accountability and clinical leadership with feedback on actions taken Associate Medical Director Undertake audit of governance frameworks and implementation in Q1 14/15 Medical Director n/a 31/03/2014 Agreed at TMB and implemented COMPLETE Creation of Care of the Elderly Directorate To provide greater focus and transparency for frail elderly care Clinical Director and General Manager Elderly Care Directorate Governance Committee minutes and action plans Chief Operating Officer Additional senior leader resources 27/10/2013 COMPLETE

26 Reg Action to meet regulation What the action intends to achieve Who is responsible? Action Lead How to ensure improvements have been made & sustained? What measures to check this? Who is responsible? Monitoring Lead Resources needed to implement the changes Date actions will be completed Current Status Three new Non-Executive appointments including one with clinical background To provide new challenge to the board and organisation HR Director Council of Governors scrutiny committee will review outcome Chairman n/a 31/01/2014 COMPLETE Review of Directorate management and nursing leadership structure and accountabilities To provide better governance and responsiveness to patient and service needs Chief Operating Staff consultation and reporting to Officer Director of Trust Management Board and Board of Nursing Directors Chief Executive n/a 30/06/2014 New directorate and nursing leadership structure out to consultation 17th March. Interviews in progress for Director of Operations and Head of Nursing roles Develop Quality Dashboard to provide To increase transparency at Board level and Board with overview of ward level metrics, ensure early action and mitigation plans trends and quality assurance discussed and implemented Associate Director Clinical Governance Healthcare Assurance Committee, Board of Directors Director of Nursing No external resources required 28/02/2014 Ongoing monitoring at TMB and BoD COMPLETE Undertake an in-depth focus group for patients, carers and relatives who have previously made a complaint. Repeat 6 monthly To understand the important issues for complainants and relatives with the aim to improve our responsiveness processes for communication and build positive relationships to support patient care and patient experience Head of Patient Engagement Stakeholder feedback Report Deputy Director of to Patient Engagement and Nursing Communication Committee (PECC) Stakeholder participation and support 09/01/2014 Ongoing monitoring via Patient Engagement and Communication Committee COMPLETE Implement a new Complaints Policy and process, considering views from independent external review by former Deputy Parliamentary Health Service Ombudsmen and stakeholder listening event Policy changes to include revised process to ensure more timely discussion with Complaints complainant, improved communication and Manager earlier resolution Audit of acknowledgement and response times, complainant feedback and implementation of action plans from reviews. Monthly report to Board of Directors Deputy Director of Nursing Additional resource in Complaints team 31/01/2014 COMPLETE Governors Scrutiny Group audit of patient and staff views on all Elderly Care wards To understand the important issues for patients, relatives, carers and the public. To Lead governor involve stakeholders in development of the Sharon Carr- Trust Strategy for Elderly Care and quality Brown priorities for 2014/15 Council of Governors Directors Board of Director of Nursing Governor and volunteers support *Interim Apr 14 *Re-audit Jul 14 *Final report Oct 14 The governors scrutiny group are no longer planning an additional audit for elderly care but are supporting the CARE audit and other patient engagement work COMPLETE

27 Reg Action to meet regulation What the action intends to achieve Who is responsible? Action Lead How to ensure improvements have been made & sustained? What measures to check this? Who is responsible? Monitoring Lead Resources needed to implement the changes Date actions will be completed Current Status Undertake six monthly public listening events To understand the important issues for patients, relatives, carers and the public. To Head of involve stakeholders in development of the Communications Trusts Quality priorities, objectives and action plans for 2014/15 Patient Engagement and Communication Committee (PECC) Director of Service Development Public and stakeholder participation via Patient Association and Health watch To start by 28/2/14 The target date for these events was successfully met with ongoing future events organised COMPLETE Undertake six monthly listening events, starting with a Developing our Values Workshops and surveys. Development of on-going employee engagement strategy *To understand the important issues for our employees and to act on feedback. To involve all our employee groups in development of the Trust s new Values and behaviours *To ensure employees understand the OD Lead Trust s Quality priorities, objectives and action plans for 2014/15 *To support and role model the new Trust Values and behaviours and be a part of the employee engagement programme Staff Survey results Developing our Values Workshops & survey outputs Workforce Committee Director of Human Resources *Employees need to be released to get involved. * Individual business cases to be submitted for To start by 31/1/14 launch & embedding *Change Leaders to support Vision and Values Workshop held and linked to Improvement Board Programme COMPLETE *Improving incident reporting levels. Implementation of Datix web to improve incident reporting, tracking, feedback and learning. *Implement additional training and awareness to support open culture for reporting, investigation and learning Improve availability and ease of reporting across the Trust Improve feedback mechanisms to provide staff with assurance that reports have been received and appropriate actions taken, as part of roll out Associate Director Clinical Governance AIRS reporting profiles, NRLS data set via Healthcare Assurance Committee Director of Nursing Datix web installation Later stage integration with current IT systems (e.g. PAS, ESR) To start phased implementation on 1/4/14 Datix web project launch date 29th April Monitor progress and improvement in incident reporting External peer review of mortality with Frimley Park for internal and external alerts Reformed approach to internal mortality reviews deficiencies in care, avoidable deaths (Nick Black paper) and if death in acute hospital was appropriate Medical Director E-mortality, M&M actions logs and completion. HSMR/SHMI via Trust Mortality Group Medical Director Time for external peer review 31/03/2014 The review is in progress with Frimley Park

28 Reg Action to meet regulation What the action intends to achieve Who is responsible? Action Lead How to ensure improvements have been made & sustained? What measures to check this? Who is responsible? Monitoring Lead Resources needed to implement the changes Date actions will be completed Current Status Improve mortality reporting and learning via: Further develop framework for e-mortality at Directorate and specialty Mortality and Morbidity meetings Reformed approach to internal mortality reviews deficiencies in care, avoidable deaths (Nick Black paper) and if death in acute hospital was appropriate Clinical Directors / Directorate Mortality leads E-mortality, M&M actions logs and completion. HSMR/SHMI via Trust Mortality Group Medical Director Time for external peer review 31/03/2014 E-mortality system established with ongoing monitoring via Mortality Group COMPLETE Ensure Serious Incidents resulting in death are discussed at Grand round, with learning points promoted and shared across all specialties and directorates To promote learning and implementation of actions Associate Medical Director Via Trust Mortality Group Medical Director n/a 31/03/2014 Completed with regular presentations to Grand Round COMPLETE Initiate Carers café in elderly care directorate *To improve direct feedback from relatives and carers of current inpatients *Enable early resolution of any issues and signposting support services available *To involve carers in developing services for the future Head of Patient Stakeholder feedback from event to Engagement Patient Engagement and Senior Nurse Care Communication Committee (PECC) of the Elderly Senior Nurse Care of the Elderly Stakeholder time 31/01/2014 Carers Café is established COMPLETE Initiate regular forum for staff governors to meet with Trust Chairman to discuss any issues or concerns To increase engagement of staff governors Trust Chairman Report to Board of Directors Trust Chairman n/a 31/01/2014 Regular drop in sessions established COMPLETE Establishment of an Improvement Board structure and programme to support quality improvement initiatives, innovation, service redesign. Board to include stakeholder engagement (patients, carers, staff) and learning from best practice outside of the organisation Wider improvement and learning systems to be developed. Learning from best practice. Recent initiatives include: ECIST and Professor David Oliver reviews of Urgent care and Care of the Elderly Director of Improvement Monthly Improvement Board reporting Chief Executive Stakeholder engagement Endorsed by Clinical Management Board 3/1/14 Inaugural board meeting 19/2/14 Improvement Board programme established. Staff Leading Improvement Day planned for Tuesday, 13th May 2014 COMPLETE

29 Reg Action to meet regulation What the action intends to achieve Who is responsible? Action Lead How to ensure improvements have been made & sustained? What measures to check this? Who is responsible? Monitoring Lead Resources needed to implement the changes Date actions will be completed Current Status External review of Trust governance arrangements by Beachcrofts solicitors To ensure effective structures, reporting lines systems and processes in place to meet requirements of condition FT4 of NHS Trust Secretary Foundation Trust Conditions of the Trust s provider licence Report to Board of Directors Council of Governors Chief Executive To be finalised To start by 31/1/14 Ongoing monitoring COMPLETE Independent review of the implementation of CQC actions, via Sir Ian Carruthers Independent assurance and challenge of the Board Chief Executive Report to Board of Directors Trust Chairman Availability of external resource To start by 31/1/14 Final Report to Board of Directors on Friday, 9th May 2014.

30 Trust Balanced Dashboard Quality, Performance, Clinical Outcomes, Productivity and Efficiency Reporting Month: May 2014

31 Trust Performance Dashboard: May 2014 Report produced: 27/06/ :14:17 Quality Clinical Indicators Productivity & Workforce KPI Units Actual Plan Last Month Last Year Rolling 12 Month Trend KPI Units Actual Plan Last Month Last Year Rolling 12 Month Trend KPI Units Actual Plan Last Month Last Year Rolling 12 Month Trend HSMR - RBH (2) Ratio HSMR - MAC (2) Ratio % Harm Free Care (Patient Safety Thermometer) % 90.7% 95.0% 88.8% 88.6% Serious incidents No Emergency Department Friends & Family Test Score Inpatient Friends & Family Test Score Delayed Transfers of Care No day readmissions No Performance Medication administration incidents IP cardiac arrest calls / 1,000 bed days Acute Kidney Injuries / 1,000 bed days Returns to theatre / 1,000 bed days Unplanned IP admissions to ITU or HDU / 1,000 bed days Dementia CQUIN (step 1 compliance) % of CHC fasttrack patients that die on a ward Time to antibiotics for patients with severe sepsis No Average number of Outliers No Ratio TBC TBC TBC 0.75 Average length of Stay Days Ratio Theatre session utilisation % 88.4% 85.0% 86.4% 87.2% Ratio Average follow-ups per new attendance Ratio Ratio TBC TBC TBC 2.0 Sickness absence % 3.2% 3.0% 3.4% 3.3% % 90% 87% 10% Vacancy % 6.4% 15.0% 5.6% 6.2% % 21% 24% 30% Appraisals % 76% 90% 79% 72% hh:mm TBC TBC TBC TBC Mandatory training compliance % 79% 79% 80% Activity & Finance Last Month Last Year Rolling 12 Month Trend KPI Units Actual Plan KPI Units Actual Plan Last Year Hospital at Night Average hh:mm 02:44 04:00 02:13 02:32 Response Time - Amber Calls MRSA Bacteraemias No ED Attendances No. 7,506 7,064 7,200 7,328 Last Month Rolling 12 Month Trend Clostridium difficile No Elective admissions No. 5,628 5,283 5,547 5,562 Hospital at Night Average hh:mm 00:44 01:00 00:45 00:46 Response Time - Red Calls RTT metrics (below plan) No Non-elective admissions No. 2,724 2,466 2,722 2,365 Cancer metrics (below plan) (1) No GP OP Referrals No. 5,399 5,513 5,407 5,600 % of Stroke patients discharged % 68% 69% 66% to usual residence Stroke metrics (below plan) No. TBC TBC TBC 3 Risk ratings Rating 3 3 A&E 4 hr maximum waiting time % 94.4% 95.0% 93.9% 98.3% Surplus 000s - 1, Patients with a learning disability (Monitor compliance) Stroke mortality rate % 19% 19% 14% Y / N Y Y Y Y Transformational plans 000s (1) Metric reported 1 month in arrears in monthly views; quarterly values are unadjusted (2) Metric reported 2 months in arrears in monthly views; quarterly values are unadjusted (3) Ward 9 has now become a decant ward with varying specialties occupying from April onwards (4) HSMR data is 4 months out of date due to delay with Dr Foster 2

32 BOARD OF DIRECTORS Meeting Date and Part: 11 th July - Part 1 Subject: Section: Executive Director with overall responsibility Author(s): Performance and Productivity Performance Helen Lingham, Chief Operating Officer Donna Parker, Deputy Chief Operating Officer David Mills, Head of Performance & Information Previous discussion and/or Performance Management Group dissemination: Action required: The Board of Directors is asked to consider the information provided and support any actions highlighted in relation to non compliant or at risk indicators. Summary: The attached Performance Indicator Matrix and Exception Report outline the Trust s performance exceptions against key access and performance targets for the month of May The report has been revised following the proposals agreed by the Board for 14/15 reporting, in line with the Monitor Compliance Framework, Everyone Counts planning guidance and contractual requirements. It also incorporates an indicative RAG rating for expected performance in the following month based on internal monitoring to date, as well as an indication of Trust level risk in relation to the metrics over the quarter. Key non compliances (May reporting) were: Cancer 2ww symptomatic breast referrals and 31 day subsequent surgical treatment targets (April) though both currently expected to be compliant for Quarter 1 A&E 4 hour target Diagnostics 6 week wait Admitted RTT in General Surgery, Orthopaedics and Ophthalmology. Performance risks for the following month (June reporting) are: Cancer 62 day (May reporting), though our current predictor report indicates compliance A&E 4 hour target Diagnostic 6 week wait this is due to demand and capacity pressures in the month. Outsourcing is currently being implemented and a Consultant Radiologist has been appointed. RTT admitted target in Orthopaedics, Ophthalmology and Gynaecology. For the Quarter (Q1) the key risks to the Trust remain: Cancer 62 day, though our current predictor report indicates compliance for Q1 A&E 4 hour wait - an increase in ambulance conveyances has been seen through the quarter and current data suggests non compliance in Q1 Continued non compliance with RTT admitted target at speciality level, resulting in potential contract penalties 6 week diagnostic target and associated potential penalties - mobile vans have been secured for July. Productivity In addition to the performance indicator exceptions, the Balanced Dashboard shows a further reduction in outliers in May compared to April and remains well below the same period in 13/14. Average LoS is also lower than May 13, with a slight increase on April 14. Theatre utilisation has also continued to improve, achieving over 88% in May and the outpatient follow-up to new ratio remains lower than May 13 with a slight increase on April

33 Related Strategic Goals/ Objectives: Relevant CQC Outcome: Performance Section 2 Outcome 4: Care and welfare of people who use services. Outcome - 6 Co-operating with others. Risk Profile: i. Risk assessments for the cancer 62 day wait continued non compliance and potential risk to the trust s authorisation have been reduced marginally. This is to reflect improvements to date and confirmation from Monitor that, although under monthly review, we have not currently been escalated for further investigation. The risk assessment is reviewed monthly. ii. Risk assessment against the 4 hour target has been reviewed to reflect the increase in ambulance conveyances and attendances and our current anticipated non compliance in Q1. Reason paper is in Part 2 N/A

34 Board of Directors 11 th July 2014 Performance Exception Report 2014/15 - July 1 Purpose of the Report This report accompanies the Performance Indicator Matrix and outlines the Trust s performance exceptions against key access and performance targets for the month of May 2014, as set out in Everyone counts: Planning for Patients 2014/15, the Monitor Risk Assessment Framework and in our contracts. 2 Cancer Performance against Cancer Targets Key Performance Indicators Threshold Q4 Apr-14 2 weeks - Maximum wait from GP 93% 95.1% 95.1% 2 week wait for symptomatic breast patients 93% 100.0% 89.5% 31 Day 1st treatment 96% 93.9% 98.7% 31 Day subsequent treatment - Surgery 94% 96.3% 91.4% 31 Day subsequent treatment - Others 98% 100% 100% 62 Day 1st treatment 85% 79.7% 88.1% 62 day Consultant upgrade (local target) 90% 100% 100% 62 day screening patients 90% 91.8% 100% The Trust achieved above threshold performance against the 62 day target in April reflecting improvement work to date, particularly in Urology. We do currently anticipate a non-compliant position in June as our work continues and we bring forward treatment dates, particularly for prostatectomies and brachytherapy. This may also impact on the 31 day targets. However, our performance predictor shows a compliant position overall for Q1. This is based on current known position and we do remain cautious, monitoring this closely. The following actions continue in Urology: Additional brachytherapy capacity on line from June Further additional prostatectomy capacity commences July June date for additional template biopsy list further discussion underway with the CCG and local providers to review current demand and capacity Performance Monitoring Page 1 of 3 For Information

35 Board of Directors 11 th July 2014 Final IMAS report received further actions added to the Action Plan Exemplar site visit/shared learning, pathway process mapping and demand/capacity modelling to be supported by IMAS. We have also received notification that the Blood in Pee campaign is to be repeated in the Autumn. Last year this resulted in a 28% increase in fast track referrals nationally during last campaign. With regard to the other Cancer standards, in April we were non-compliant against the 2 Week Wait for Breast Symptom Referrals due to two patients who cancelled their outpatient appointments. We were also non-compliant against the 31 Day Subsequent Surgical Treatment standard: 1 due to unplanned surgeon sickness (skin) 1 due to requirement for and availability of specific consultant for specialist treatment (skin) 1 due to cardiac testing being required prior to surgery. 3 A&E Performance 4 hour maximum waiting time 95% The 4 hour target has been challenging since the start of the new financial year with 94.4% of patients being seen within 4 hours in May. We have continued to experience a significant increase in ambulance conveyances and ED attendances compared to the same period last year and as a result, based on June data to date, we currently anticipate that we will be below threshold for the Quarter. This is despite our provision of additional staff at peak times and commencement of Practitioner posts in ED, as well as continued work on ambulatory care and bed capacity. We have also had a number of Executive level escalated health community responses at peak times due to pressures across Dorset and elsewhere. 4 Diagnostics 99% of patients to wait less than 6 wks for a diagnostic test Our performance against the target of 99% of patients to wait less than 6 weeks for a diagnostic test was 97.0% in May compared to 99.4% in April. This was due to ongoing inpatient and outpatient demand pressures as well as limitations in capacity. Mobile vans have been secured in July when we expect to recover the position. We were unable to secure these earlier due to pressures across a number of providers. Performance Monitoring Page 2 of 3 For Information

36 Board of Directors 11 th July Admitted RTT - Specialty Level 90% of patients on an admitted pathway treated within 18 weeks The Trust continues to achieve the RTT targets at an aggregate level. However, as previously outlined, admitted RTT performance continued to be below threshold in General Surgery, Ophthalmology and Orthopaedics in May. Gynaecology has improved from 80.7% in April, to 93.0% in May, however we do anticipate this will drop in June as a small backlog of patients are treated. Nationally trusts are being supported in reducing their waiting lists and all trusts have been requested to provide RTT recovery plans to the national teams via their CCGs. These will include local additional activity as well as outsourcing. 6 Recommendation The Board of Directors is requested to note the performance exceptions to the Trust s compliance with the 2014/15 Monitor Framework and Everyone Counts planning guidance requirements. HELEN LINGHAM CHIEF OPERATING OFFICER Performance Monitoring Page 3 of 3 For Information

37 2014/15 PERFORMANCE INDICATOR MATRIX FOR BOARD OF DIRECTORS Area Indicator Measure Target Monitor Jan-14 Feb-14 Mar-14 Apr-14 May-14 Forecast - Next Month Forecast - Quarter RAG Thresholds Monitor Governance Targets & Indicators Infection Control Clostridium difficile Number of hospital acquired C. Difficile cases ( pcm) > trajectory <= trajectory Referral to Treatment Cancer RTT Admitted 18 weeks from GP referral to 1 st treatment aggregate 90% % 90.1% 90.2% 90.0% 90.2% <90% >90% RTT Non Admitted 18 weeks from GP referral to 1st treatment aggregate 95% % 98.0% 98.7% 98.5% 98.8% <95% >95% RTT Incomplete pathway Patients on an 18 week pathway awaiting treatment aggregate 92% % 95.1% 94.9% 94.7% 95.0% <92% >92% 2 week wait From referral to to date first seen - all urgent referrals 93% % 95.7% 95.9% 95.1% <93% >93% 2 week wait From referral to to date first seen - for symptomatic breast patients 93% % 100.0% 100.0% 89.5% <93% >93% 31 day wait From diagnosis to first treatment 96% % 94.5% 91.6% 98.7% <96% >96% 31 day wait For second or subsequent treatment - Surgery 94% % 100.0% 93.8% 91.4% <94% >94% 31 day wait For second or subsequent treatment - anti cancer drug treatments 98% % 100.0% 100.0% 100.0% <98% >98% 62 day wait For first treatment from urgent GP referral for suspected cancer 85% % 76.6% 81.7% 88.1% <85% >85% 62 day wait For first treatment from NHS cancer screening service referral 90% % 100.0% 94.4% 100.0% <90% >90% A&E 4 hr maximum waiting time From arrival to admission / transfer / discharge (Type 1 & 2) 95% % 95.8% 95.8% 93.9% 94.4% <95% >95% LD Patients with a learning disability Compliance with requirements regarding access to healthcare n/a 1.0 No Yes Indicators within the Everyone Counts: Planning Guidance/ Key Contractual Priorities MSA Mixed Sex Accommodation Minimise no. of patients breaching the mixed sex accommodation requirement n/a > 0 0 Infection Control MRSA Bacteraemias Number of hospital acquired MRSA cases >1 0 Cancer 62 day Consultant upgrade Following a consultant s decision to upgrade the patient priority * 90% 100.0% 100.0% 100.0% 100.0% < 90% >90% VTE Venous Thromboembolism Risk assessment of hospital-related venous thromboembolism 95% 93.5% 95.3% 95.0% 95.3% 95.3% <95% >95% Diagnostics Six week diagnostic tests More than 99% of patients to wait less than 6 wks for a diagnostic test >99% 96.30% 99.00% 96.50% 99.4% 97.0% <99% >99% A&E Cancelled Operations Admission via A&E No. of waits from decision to admit to admission over 12 hours >1 0 Ambulance Handovers No. of breaches of the 30 minute handover standard tbc tbc Ambulance Handovers No. of breaches of the 60 minute handover standard tbc tbc 28 day standard No. of patients not offered a binding date within 28 days of cancellation >1 0 Urgent ops Cancelled for 2nd time No. of urgent operations cancelled for a second time >1 0 Referral to Treatment 52 week waiters Zero tolerance of over 52 week waiters (Incomplete Pathways) >1 0 RTT Specialty RTT Admitted General Surgery 90% 85.1% 84.9% 85.8% 89.3% 86.9% <90% >90% RTT Admitted Urology 90% 91.8% 90.0% 91.8% 94.8% 92.0% <90% >90% RTT Admitted Orthopaedics 90% 89.6% 89.0% 90.3% 89.5% 89.9% <90% >90% RTT Admitted Ophthalmology 90% 85.4% 86.3% 83.9% 81.4% 84.2% <90% >90% RTT Admitted General medicine 90% 99.7% 99.7% 99.7% 99.7% 98.7% <90% >90% RTT Admitted Cardiology 90% 93.8% 91.3% 92.0% 91.0% 92.1% <90% >90% RTT Admitted Dermatology 90% 90.2% 91.2% 93.4% 95.9% 91.5% <90% >90% RTT Admitted Rheumatology 90% 97% 100% 100% 97% 95.1% <90% >90% RTT Admitted Gynaecology 90% 91.3% 88.7% 88.4% 80.7% 93.0% <90% >90% RTT Admitted Other 90% 97.3% 98.6% 99.3% 98.1% 98.1% <90% >90% RTT Non admitted General Surgery 95% 95.3% 95.0% 99.3% 96.5% 98.5% <95% >95% RTT Non admitted Urology 95% 99.2% 99.1% 99.6% 98.1% 99.1% <95% >95% RTT Non admitted Orthopaedics 95% 98.8% 97.6% 98.7% 99.4% 99.2% <95% >95% RTT Non admitted ENT 95% 95.2% 95.4% 95.1% 95.2% 95.8% <95% >95% RTT Non admitted Ophthalmology 95% 100.0% 99.4% 99.6% 99.5% 100.0% <95% >95% RTT Non admitted Oral surgery 95% 96.2% 97.4% 97.3% 97.4% 95.6% <95% >95% RTT Non admitted General medicine 95% 95.3% 95.2% 97.6% 97.6% 98.6% <95% >95% RTT Non admitted Cardiology 95% 98.2% 97.8% 97.0% 98.3% 97.8% <95% >95% RTT Non admitted Dermatology 95% 100% 100% 100% 100% 100.0% <95% >95% RTT Non admitted Thoracic medicine 95% 100% 100% 100% 100% 100.0% <95% >95% RTT Non admitted Neurology 95% 100.0% 100.0% 100.0% 98.5% 100.0% <95% >95% RTT Non admitted Rheumatology 95% 99.0% 98.4% 97.2% 97.7% 98.3% <95% >95%

38 RTT Non admitted Gynaecology 95% 99.0% 98.9% 98.5% 99.4% 99.4% <95% >95% RTT Non admitted Other 95% 98.0% 97.1% 100.0% 99.6% 99.3% <95% >95% SUS Submissions NHS Number Compliance Completion of NHS Numbers in SUS Submission (IPS/OPS) 99% N/A N/A N/A tbc tbc <99% >99% NHS Number Compliance Completion of NHS Numbers in SUS A&E Submissions 95% N/A N/A N/A tbc tbc <95% >95% * Local standard of 90% with a de minimis of 2 breaches per month or 6 per quarter

39 BOARD OF DIRECTORS Meeting Date and Part: 11th July 2014 Part 1 Subject: Quality June 14 Section: Executive Director with overall responsibility Author(s): Performance Previous discussion and/or dissemination: Action required: The Board of Directors is asked to: note the report Paula Shobbrook, Director of Nursing and Midwifery Joanne Sims, Associate Director Quality & Risk Ellen Bull, Deputy Director of Nursing and Midwifery HAC 26 th June 2014, TMB 4 th July 2014 Summary: Improvement in overall Harm free care compliance in month Reduction in Safety Thermometer hospital acquired pressure ulcers in month (4 th consecutive month) and below the National average. Risk assessment compliance improved from April 14 figures. Continuous improvement evidenced. Related Strategic Goals/ See list of current goals/objectives agreed by Board Objectives: Relevant CQC Outcome: Safe, Caring, Effective, Responsive & Well Led Risk Profile: i. Have any risks been reduced? Risk rating remains the same however the number of new hospital acquired pressure ulcers have reduced each month for the previous 4 months thereby showing a positive improvement trend. ii. Have any risks been created? No Reason paper is in Part 2 Not applicable

40 Quality & Patient Safety Performance Exception Report May Purpose of the Report This report accompanies the Quality/Patient Performance Dashboard and outlines the Trust s performance exceptions against key quality indicators for patient safety and patient experience for the month of May Patient Safety 2.1 New Serious Incidents Reported May Serious Incidents was confirmed and reported on STEIS in May Safety Thermometer All inpatient wards collect the monthly Safety Thermometer Harm Free Care data. The survey, undertaken for all inpatients the first Wednesday of the month, records whether patients have had an inpatient fall within the last 72 hours, a hospital acquired category 2-4 pressure ulcer, a catheter related urinary tract infection and/or, a hospital acquired VTE. If a patient has not had any of these events they are determined to have had harm free care. The results for the May 14 data collection are as follows: NHS SAFETY THERMOMETER Safety Thermometer %Harm Free Care Safety Thermometer % Harm Free Care (New Harms only) Monthly survey using Safety Thermometer (Number of patients with Harm Free Care) 13/14 Average per month 14/15 Target April 2014 May % 95% 88.8% 90.73% 97.5% 95.5% 97.6% 480 NA Harm free care results May /14 14/15 April May 14/15 Total Trajectory YTD Number of patients surveyed 6475 NA NA Number of new pressure ulcers Number of repeat new pressure ulcers in above figure 144 < NA 5 2 NA New falls (Total) 105 < Falls with Harm 0 0 New VTE 14 < New Catheter UTI 35 <

41 Monthly risk assessment compliance is recorded as part of the Safety Thermometer data collection. Results are as follows: 13/14 Total 14/15 Trajectory April 2014 May 2014 June 2014 Risk assessment compliance Falls NA 100% 83% 92% 91% Waterlow NA 100% 87% 96% 95% MUST NA 100% 77% 88% 88% Mobility NA 100% 83% 91% 91% Bedrails NA 100% 83% 95% 93% Wards scoring below 75% Compliance were as follows: Wards scoring below 75% compliance Risk assessment Falls 26, 14, Waterlow 26, 14 MUST 16, ITU Mobility 26, Bedrails 11, 14, 4. Patient Experience May data 4.1 Friends and Family Test (FFT) NHS England have published April FFT data, this positions ED based on the FFT score as joint 9th with 3 other trusts (sample 143 trusts) with an FFT score of 75 (top score 89). The Trust inpatient FFT score of 75, places the Trust joint 23rd with 8 other trusts (of 170 trusts). 4.2 FFT Data compliance and FFT scores Trust wide compliance with the National 15% target is maintained. Internal data reports are indicated in the table below FFT Score May (April) Compliance Rate (April) Trust-wide 77 (75) 19 % (21%) Inpatient 76 (75) 42 % (47%) ED 78 (75) 10 % (10%) Maternity 73 (70) 13 % (15%) 4.3 Extremely Unlikely results from FFT Trust-wide, including areas not included for FFT data submission, there were 18 extremely unlikely respondents. Of those included in the data submission there are 13 extremely unlikely. The data is drawn from a sample of 2441 respondents who utilised the Patient Experience Cards Trust Wide.

42 Ward Extremely Likely likely Neither likely nor unlikely 4.5 CQUIN Question data from the patient experience cards T 4.4 Quintiles Report May 2014 data for top and lowest quintile base on the FFT score. This data now exclude areas that do not meet the minimum 15% compliance rate. Top Quintile and Bottom Quintile reports were discussed at the Healthcare Assurance Committee. Note the lowest quintile scores are elevating from the initial publication, where lower scores were in the minus range. The three CQUIN questions relating to the inpatient experience all demonstrated a maintained position in yes definitely answers when compared to the same timeframe in April. 1. Were you involved as much as you wanted to be in decisions about your care and treatment remains static at 84% (n=156) 2. Did you find someone on the hospital staff to talk to about your worries and fears remains static at 84% (n=140) 3. Were you given enough privacy when discussing your condition or treatment. Remains static at 91% (n=140) 4.6 Care Audit Campaign Unlikely Extremely unlikely Don't know FFT Score Ward Birth Eye Unit Ward Ward Ward Ward Ward Ward ITU Ward The Care Campaign audit (CCA) continues in elderly care, medicine, the acute medical unit and ED. The number of red rated scores has decreased from 133 to 83 within 4 months. In addition the number of green rated scores has increased by 20, and the improvement trend is sustained. 5. Recommendation The Board is requested to note the report which is provided for information and assurance

43 BOARD OF DIRECTORS Meeting Date and Part: Subject: Section: Executive Director with overall responsibility Author(s): Previous discussion and/or dissemination: Action required: For information 11 July Part I Finance and Activity Performance Stuart Hunter, Director of Finance Pete Papworth, Deputy Director of Finance Finance Committee and Trust Management Board Summary: Review of the financial performance for Month Related Strategic Goals/ Objectives: Relevant CQC Outcome: Risk Profile: N/A Goal 7 Financial Stability Outcome 26 Financial Position Reason paper is in Part 2 N/A

44 Board of Directors July 2014 Financial Performance Report 1. Introduction This report summarises the Trust s financial performance as at 31 May A financial overview is attached. 2. Overview For the first time since authorisation in 2005, the Trust has set a deficit budget for the year. Within this; a deficit of 1 million was planned for the first two months of the year. The Trust has actually delivered a deficit of 1.9 million, being an adverse variance of 903, Key Financials Income: During May the Trust reported income broadly in line with its budgeted levels; meaning that the year to date position reports increased income of 299,000. This has mainly been driven by additional cost and volume drugs within oncology; and additional pharmacy issues in relation to the Aseptic unit. In both cases, additional costs have been incurred which offset this income. Expenditure: Overall, activity is 4% above contracted levels with particular increases in elective, non elective and emergency department attendances. This continued upward trend means that activity is currently 12% greater than the same period last year, which is placing pressure on the Trust. Expenditure reports an over spend of 1.2 million to date. In addition to activity related over spends, key variances include: Cost and volume drugs, most notably within oncology; Drug issues in relation to the Aseptic unit, which have been recharged to Poole Hospital; Additional pay costs as a result of continued reliance upon locum and agency staff; This is a considerable overspend, and immediate action is required to recover this position. As a result; directorate management teams have been asked to prepare detailed recovery plans to address their current variances together with any envisaged future over spends. Capital: Capital expenditure remains on plan at the end of May, and includes the continuation of the Jigsaw Haematology and Women s Health new build; the purchase of Abbotsbury House (additional residences); and spend in relation to the IT Strategy. Continuity of Services Risk Rating: The significant deficit delivered to date is adversely impacting on the Trusts continuity of service risk rating. This has reduced from a rating of 4 during 2013/14 to the current rating of Recommendation Members are asked to note the Trust s financial performance as at 31 May Financial Performance Page 1 of 1 For information

45 ANNEX A THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST FINANCIAL PERFORMANCE FOR THE PERIOD TO 31 MAY 2014 KEY FINANCIALS 2013/14 CURRENT YEAR TO DATE YTD ACTUAL PLAN ACTUAL VARIANCE VARIANCE '000 '000 '000 '000 % NET SURPLUS/ (DEFICIT) 259 (1,012) (1,915) (903) 89% EBITDA 2,274 1, (767) (68%) TRANSFORMATION PROGRAMME 1,285 1, (461) (40%) CAPITAL EXPENDITURE 701 2,194 2,165 (29) (1%) CONTINUITY OF SERVICE RISK RATING 2013/14 CURRENT YEAR TO DATE YTD ACTUAL PLAN ACTUAL RISK WEIGHTED METRIC METRIC METRIC RATING RATING Debt Service Cover 2.94x 1.27x 0.45x 1 1 Liquidity CONTINUITY OF SERVICE RISK RATING 4 3 ACTIVITY 2013/14 CURRENT YEAR TO DATE YTD ACTUAL PLAN ACTUAL VARIANCE VARIANCE NUMBER NUMBER NUMBER NUMBER % Elective 10,925 10,578 11, % Outpatients 47,043 53,398 54,768 1,370 3% Non Elective 4,739 4,853 5, % Emergency Department Attendances 14,058 13,926 14, % TOTAL PbR ACTIVITY 76,765 82,755 86,099 3,344 4% INCOME 2013/14 CURRENT YEAR TO DATE YTD ACTUAL PLAN ACTUAL VARIANCE VARIANCE '000 '000 '000 '000 % Elective 12,094 10,971 11, % Outpatients 5,157 5,066 5, % Non Elective 8,588 9,067 9, % Emergency Department Attendances 1,266 1,407 1, % Non PbR 10,518 10,918 10,879 (39) (0%) Non Contracted 3,963 4,119 4, % Research % Interest % TOTAL INCOME 41,942 41,877 42, % EXPENDITURE 2013/14 CURRENT YEAR TO DATE YTD ACTUAL PLAN ACTUAL VARIANCE VARIANCE '000 '000 '000 '000 % Pay 24,758 26,488 26,937 (448) (2%) Clinical Supplies 5,230 5,580 5,592 (12) (0%) Drugs 4,129 4,396 4,898 (502) (11%) Other Non Pay Expenditure 4,858 3,692 3,926 (233) (6%) Research (11) (3%) Depreciation 1,602 1,575 1, % PDC Dividends Payable % TOTAL EXPENDITURE 41,683 42,890 44,091 (1,201) (3%) STATEMENT OF FINANCIAL POSITION 2013/14 CURRENT YEAR TO DATE YTD ACTUAL PLAN ACTUAL VARIANCE VARIANCE '000 '000 '000 '000 % Non Current Assets 144, , ,111 (108) (0%) Current Assets 67,361 67,335 67,007 (328) (0%) Current Liabilities (25,192) (28,150) (28,606) (456) 2% Non Current Liabilities (2,754) (5,239) (5,254) (15) 0% TOTAL ASSETS EMPLOYED 183, , ,258 (907) (0%) Public Dividend Capital 78,674 78,674 78, % Revaluation Reserve 64,485 73,002 72,999 (3) (0%) Income and Expenditure Reserve 40,659 42,489 41,585 (904) (2%) TOTAL TAXPAYERS EQUITY 183, , ,258 (907) (0%)

46 BOARD OF DIRECTORS Meeting Date and Part: 11 th July Part 1 Subject: Section: Executive Director with overall responsibility Author(s): Previous discussion and/or dissemination: Action required: Workforce Performance Karen Allman, Director of Human Resources Jenny Dempsey, Deputy Director of Human Resources No For information/discussion by the Board. Summary: This report concentrates on 3 specific areas: an update on the action plan which was compiled as a consequence of the staff survey results 2013; a brief outline of the position with regard to nursing and medical staff recruitment including the junior doctor intake commencing in August 2014; a report on the current Organisational Development initiatives. Related Strategic Goals/ To listen to, support, motivate and develop our staff. Objectives: Relevant CQC Outcome: Outcomes 12, 13 and 14 Risk Profile: i. Have any risks been reduced? No ii. Have any risks been created? No Reason paper is in Part 2 n/a

47 WORKFORCE REPORT JULY 2014 Introduction This report concentrates on 3 specific areas. Firstly there is an update on the action plan which was compiled as a consequence of the staff survey results There is a brief outline of the position with regard to nursing and medical staff recruitment including the junior doctor in-take commencing in August 2014 and finally a report on the current Organisational Development initiatives. 1. Staff Survey Report Update on Action Plan The staff survey action plan identified corporate actions needed to improve working conditions and practices with particular emphasis in the following areas:- 1.1 Bullying and Harassment 28% of staff who responded to the staff survey reported that they had experienced bullying, harassment or abuse during the preceding 12 months. The following actions are now underway: Development of a bullying and harassment awareness guide This has been drafted and circulated to a small group of managers and staff side for comment. The final version is currently with communications team for setting into booklet format. Dedicated bullying and harassment 24 hour reporting line This is being explored with the Employee Assistance Programme provider, Care First. An initial quotation has been received and further details are being requested regarding the completeness of the service provided and the experience of other Care First customers who already have this service; one being the BBC. Bullying and harassment awareness sessions Bullying and harassment awareness sessions are already in place during induction and mandatory training sessions. In addition to these, sessions are being held in specific areas of the hospital, where we are concerned that bullying and harassment has taken place and also upon request. Health and Wellbeing session A bullying and harassment awareness session has been planned as part of the Health and Wellbeing programme of events: Board of Directors:11 th July 2014 Page 2 of 6 Part 1, 6(d) - Workforce

48 January: February: March: April: May: June: July: August: Detox Healthy Heart Nutrition, Hydration and Sleep Healthy bowels Walking for health Healthy living for men Healthy living for women September: Healthy backs Stress and behaviour at work All of the above sessions include Occupational Health presence for blood pressure readings, Dietician representation for dietary advice and a variety of fitness promotions. The bullying and harassment session will take place once the booklets are in print, with a representative of Occupational Health, Human Resources and the Employee Assistance Programme present. Staff Side and Governor representation will also be sought Some additional resources will be required for payment of the booklets, approximately 500 and the 24 hour line, approximately The awareness sessions are being picked up by the HR team and Health and Wellbeing lead. There are many benefits of developing enhanced bullying and harassment awareness and a prevention programme including conduct of staff, better working conditions, improved patient care by happier staff, less management time dealing with staff problems and fewer grievances and/or potential Employment Tribunal claims and supports the trust values and behaviours. 1.2 Diversity Training The staff survey showed that 10% of staff felt they had been discriminated against while at work by managers, team leaders or other colleagues. It was acknowledged that not all staff had attended Diversity training in the last 12 months. It was therefore agreed that additional Diversity training sessions would be arranged to ensure all staff had this opportunity. Some sessions have been arranged within departments, so the service needs are inconvenienced as little as possible. There have also been open sessions, with more planned over the next few months. Plans are in place to provide Diversity training via e-learning during Mandatory training compliance has been reviewed with the clinical directorates as part of the recent directorate reviews. Board of Directors:11 th July 2014 Page 3 of 6 Part 1, 6(d) - Workforce

49 2. Recruitment 2.1 Recruitment Nursing staff During 2014 there have already been extensive recruitment campaigns in order to fill nursing vacancies. Overseas nurses Over 40 nurses have been recruited mainly from Spain, Portugal and Italy, with more to be interviewed in the next few weeks. These nurses were interviewed by Skype and have been placed in vacancies throughout the hospital. Some of the nurses were initially provided with accommodation in the homes of other hospital staff and others had onsite accommodation, which has helped them to settle-in. There has also been an afternoon tea party to welcome the nurses and regular supportive meetings are in place. Recruitment fair A recruitment fair is planned for an afternoon and evening on 01July This is specifically aimed at band 2 Health Care Assistants and band 5 Registered Nurses, although details will be taken from other interested parties who turn up on the day. A number of departments are taking part in the fair. There are currently 14 stands from various areas of the hospital, all of whom will be providing details of their specialty and what it is like to work in their departments. The lecture theatre will also be running information films on a loop. Interested candidates will have access to computers in the library to enable them to apply on-line and receive assistance if required. A second recruitment fair is planned for later in the year. This has required additional resources within the HR Recruitment team, which have been sourced on a temporary basis via the Staff Resource Pool. Newly Qualified Staff Nurses The Trust has strong links with Bournemouth University and brought forward its recruitment of newly qualified nurses, so that interview dates were held prior to those of other local Trusts. A successful open day was held on Saturday 10 May 2014 and so far, over 40 newly qualified staff nurses have been offered posts to commence in late September/October Board of Directors:11 th July 2014 Page 4 of 6 Part 1, 6(d) - Workforce

50 2.2 Recruitment - Medical staff Since October 2013 the Trust has made 19 consultant appointments and a further 9 Consultant Appointment Panels have been arranged throughout the summer and early autumn. Overall the Trust has been successful in recruiting consultant staff, the main difficulties lie in those specialties for which there is a national shortage of candidates and the Trust is considering alternative recruitment initiatives such as international recruitment. With regard to doctors in training, all the August intake, apart from one F2 post has been successfully filled through the national/regional process for filling posts. This is, of course, subject to the current medical students passing their examinations. It is expected that the outstanding F2 post will be filled as there are currently 147 applicants within the Region and 5 vacancies. The Trust is also recruiting to 11 junior posts supporting the doctors in training and 5 candidates have already been offered posts and there are a further 20 candidates to be shortlisted and interviewed. 3. Organisational Development Initiatives RBCH Proud of Badges We have some of our own Proud of RBCH badges for staff to wear to show they are proud of the Trust. We are looking for opportunities to give these out and will soon be issuing them at induction. We have also designed some values branded lanyards and pens for individuals who show they are on the pulse. Staff impressions survey This quarter s survey closes on Monday 30 th June. This will give us data on staff overall impression (currently 86% mainly good), and on whether staff would recommend the Trust as a place for treatment or as a place to work. It will also give us leaving data by directorate and staff group and there are already many useful comments for review. In July we have to report the results for the Family & Friends Test to NHS England. The OD team will work with the HR Managers and the Directorate Managers & Matrons to develop and monitor actions plans from this data. Board of Directors:11 th July 2014 Page 5 of 6 Part 1, 6(d) - Workforce

51 Exit Questionnaires An online survey is being drafted to capture the views and experiences of our staff who choose the leave the organisation. This will form part of a wider initiative to ensure line managers do not use the questionnaire as a way of not having difficult but important 1-1 conversations. It will give us leaving data by directorate and staff group and free text comments. Board of Directors:11 th July 2014 Page 6 of 6 Part 1, 6(d) - Workforce

52 BOARD OF DIRECTORS Meeting Date and Part: 11 th July 2014 Part I Subject: RBCH Strategy Section: Executive Director with overall responsibility Author(s): Previous discussion and/or dissemination: Strategy and Risk Richard Renaut, Director of Service Development Richard Renaut, Director of Service Development TMB in July 2014 and Strategy Update in June 2014 Action required: The Board of Directors is asked to note this report. Summary: This is the RBCH Strategy for 2014 to 2019 document. This document has been submitted to Monitor. Related Strategic Goals/ Objectives: Relevant CQC Outcome: All All Risk Profile: N/A

53 1. Executive summary RBCH Strategy Our aim is to provide excellent care for every patient, every time, every day. To do this our five year strategy focuses on strengthening the provision of high quality district general hospital and integrated community services. We aim to consolidate our specialist services. Our focus is to ensure the care we provide is compassionate and personal care to all our patients. The key elements of our strategy are: 1.1 Internal improvement continuing to improve the quality and effectiveness of our services through staff development, rigorous application of new technology, innovation and rapid adoption of best practice strengthening existing centres of excellence strengthening the care provided in the evening and at weekends, ensuring timely review and treatment of patients through consultant-delivered services 1.2 Clinical strategies and partnerships In order to sustain excellent care to the population we serve, our intention is to: become an integrated community health provider, and a centre of excellence for older people s care, offering all patients a seamless experience when care extends beyond hospital become an urgent care and specialist hub, providing consistently high quality services seven days a week work with local trusts and commissioners as part of the Clinical Services Review. This includes improving emergency services and recognising the need across Dorset to concentrate some complex emergency services onto fewer sites. This will ensure patients have access to more comprehensive, timely care provided by senior clinicians and clinical teams maintain our portfolio of specialist services develop our private patient income to support investment in NHS services 1.3 Organisational capability ensure the organisation is well led, and focused on improvement has a healthy open, learning culture invest in the development of staff, to ensure they are skilled and supported to provide high quality care for all of our patients Page 1 of 36

54 We will do this while working to be the most improved hospital in England by 2016 through delivering on our ambitious quality, cost and service improvement programme and supporting strategies set out in this document. The financial model assumptions indicate that there will be extreme difficulty in sustaining the current mix of services and care (business) models in the base case and downside case. The mitigated downside though offers three specific changes around the integration of community and then hospital services, and thirdly alignment with commissioner funding. Even with these it still remains a very tight position recovering from the downside financially. An integrated model is however stronger on the clinical and governance (performance) criteria, because of better deployment of staffing and pathways. 2. Declaration of sustainability The Board of Directors confirm it will be sustainable for the next year, and subject to the caveats below, will be sustainable in three years. The Board does not confirm it can be sustainable in five years, even on the basis of these plans and best endeavours, given the scale and uncertainty of factors outside of the organisation s control. The reasons for this, and strategic options in response, are set out in this document. The Board s definition of financial, operational and clinical criteria for sustainability uses the following regulatory standards: Finance - a Continuity of Service Risk Rating (CoSRR) of 3 out of 4. Governance (operational performance) - NHS Constitution and Monitor Governance measures, especially around waiting times, infection control and safety measures. This also includes compliance with commissioner contracts. Clinical includes CQC compliance, as well as the ability to staff services safely. This means all levels of doctors, nurses, Allied Health Professionals and others being recruited and retained in sufficient numbers and skills to meet Royal College and CQC expectations. The options and strategic intention set out in this document provide the framework for the organisation, working within our local health system, to navigate the next five years. This builds upon our two year operational plan. What is striking is the scale of the gap between success in the three sustainability criteria, and the challenges. These challenges are set out in the Market Analysis and Context section. They are summarised here as: real terms reductions in funding for hospital services and social care growing and ageing local population, all requiring more services reducing doctor numbers in training posts and other workforce gaps increasing public and political expectations of quality and access. Sustainability for one year relies upon our robust plans, financial reserves and a strong operational focus on maintaining high quality care. However, the scale of challenges over five years carries a significant risk in maintaining clinically and financially viable services, resulting in the potential to fail these criteria. The speed and scale of the response by RBCH and the local health system, and the significance of the challenges, makes the year three assessment marginal, i.e. can tip either way given the lack of buffers to mitigate risk. Given our current assessment of risks and mitigation, we believe, on balance, we can be sustainable to year three, but wish to highlight how finely balanced this assessment is and could be affected by forces outside our control or beyond our ability to mitigate. Page 2 of 36

55 Given this assessment the Trust Board, following consultation with our clinical directors, senior clinicians and Council of Governors, propose the following strategic plan to maximise our opportunity to maintain operational success in delivering sustainable care. Continuing as we are is not viable. Within the next three years, the organisation will need to look radically different if it is to survive. The challenge is made more complex by the uncertainties of making large scale change happen in the NHS with the different agendas and priorities of partner organisations, and the political and legal barriers that tend to default to the status quo. Nevertheless the Board is confident it is able to navigate a path of sustainability over years one to three. It is in this context that the strategic options section sets out the areas of work that we will develop with our staff, partners, public and others. The strategic framework is proposed as: our two year improvement programme, which focuses on 8 key streams of activity: o Unscheduled Care o Integrated Pharmacy o Cancer Pathway o Inpatient Bed Modelling o Integrated Pathology o Surgical Pathway including Productive Theatre o Productive Series o Workforce Development community integration, with social care (Better Together) and in the NHS (Clinical Services Review) with community and primary care. This is to provide joined up care, especially for the frail elderly and chronic disease management, with greater predictive and preventative care. This represents a key part of our strategy to maintain a sustainable level of provision acute hospital reform through the seven day acute care hub (hot/warm service model) and greater networks of care, providing more clinical, financial and performance sustainability via centres of excellence. greater ambition and scaled improvement in delivery for supporting strategies (such as IT, workforce, commercial, research and innovation). These will be set in ways that support the core mission of the organisation. Each clinical service area is developing a clear plan and set of activities to enable implementation of the wider trust framework. As important is the work to develop the four key organisational capabilities, which are key to underpin this work. These are: 1. Leadership 2. Strategic planning 3. Organisational development 4. Operational improvement Developing these at both organisational, service area and individual level is a crucial underpinning activity, if we are to be a successful, healthy organisation. A step change has already started in each area and developments are described in the document. Page 3 of 36

56 The purpose of this strategic plan is to establish the framework to deliver progress, such that within three years the Board s forecast can be more confident of sustainable success. 3. Four capabilities to succeed This document ensures the Trust compliance with the Monitor 2014 requirement to submit a five year strategy for the Foundation Trust. This is in addition to the two year operational plan recently submitted, which covers the near term in more detail. The strategic planning process will continue actively within the Trust with greater speciality / service line planning detail, and progress on the organisational capabilities in the four key areas listed. These are: 1. Individual Leadership at all levels across the Trust. 2. Strategic Planning for an uncertain future, including work with partners. 3. Organisational Development is how we do things here, our culture and behaviours. 4. Operational Improvement especially for quality, cost and performance measures. Our development against these draws on the Monitor Well-led Framework for Governance Reviews, which encompasses the four above domains into a framework for monitoring Board performance. We had a Board review of corporate governance by Price Waterhouse Coopers in 2013 and more recently Sir Ian Carruthers has also undertake a review of our governance process and our leadership capabilities. 3.1 Developing our approach We have taken an open approach using the Monitor Strategy Self-Assessment Toolkit as well as surveys and discussions with governors, clinicians, the Board of Directors and other staff groups. We have also used online (SurveyMonkey) and in-meeting (voting) approaches to test other factors that will affect the Trust strategy, including environmental factors, wild cards and testing alternative strategic options. In developing the scenarios we have drawn on a variety of sources including, Monitor: A Call to Action: Transformative Ideas for the Future NHS and; The Kings Fund: The Productivity Challenge. Undertaking this approach has served three purposes: 1. Raising and debating the subjects ensures that there is wider recognition of the difficulties facing the Trust and NHS and the need to find solutions to these. Page 4 of 36

57 2. The dialogue that takes place in these discussions has helped us refine the questions we ask, the scenarios we explore and to develop the options we envisage as this process rolls out to wider staff and stakeholder groups. 3. The priorities the various groups have highlighted in these discussions build a consensus as to where to invest energy, time and money. It is critical that staff inform, shape and give effect to our vision for the future and the plans and strategies that will get us there. Therefore the engagement process that we have embarked upon will continue and develop under the auspices of the Board and its Strategy group. 3.2 Organisational development: culture and values Of the four areas Monitor has identified, organisational culture is particularly significant. During January to March 2014, we conducted an Appreciative Inquiry approach with our employees, patients and other stakeholders to identify what made us proud of our Trust and what we want to provide in our ideal vision of the future. This was developed by a group of employees into a revised set of core values. 3.3 Leadership These were launched in April 2014: We intend that these values guide everything we do, how we make our decisions, how we care for patients and engage with colleagues, but we recognise that this requires a long timescale and sustained commitment for successful adoption. The Trust values need to be recognised by all staff and there is a calendar of events to roll out over the year to introduce the values to the Trust. Over the next few years our values will become embedded into the systems and processes of the organisation, with our leaders being role models and recognising and encouraging the values in others to improve the quality of patient care. The Trust has a strong and effective board and is investing in strategic leadership capacity within the organisation in conjunction with the Kings Fund and other partners. Specific actions underway include building on the Appreciative Inquiry work to help focus our culture on our values and our significant investment in leadership at many levels including for Clinical Directors, Matrons and ward sisters. A Board development programme and an exercise to review our Trust Management Board (TMB) role are also underway. Page 5 of 36

58 The Trust has purposefully invested in a medical management model to lead clinical directorates. This focus and approach will continue and be developed further through investment in our leadership capability. The organisation is also restructuring management into three care groups, each with a Director of Operations and Head of Nursing and Quality. This will provide senior level support and leadership with better operational focus. 3.4 Strategic planning The first main development area is the action plan from the self-assessment exercise. This will be overseen by the Board s strategy group. The second area is the outward facing engagement into system wide initiatives, such as the Clinical Service Review, which will run for approximately a year, and have a significant implementation timescale. The work outlined here provides the Board with specific strategic options outlined below which will be taken forward with the Clinical Services Review. As well as the work on this strategy and the staff engagement that flows from it, there are well established multi-year planning processes for supporting strategies, incorporating all corporate services. 3.5 Operational improvement This is an area of traditional strength especially around focused effort to deliver quality, performance and financial improvement. However a refreshed approach, through the newly appointed Director of Improvement and the Improvement Programme Office is designed to accelerate the scale and pace, with the ambition of being the most improved Trust in the NHS by A particular focus is urgent care improvements, as well as 7 other work programmes that have engagement, quality and value as intrinsic elements. This work is overseen by the Improvement Board, which includes Executive and Clinical Director membership. The new core group model, allied to investment in leadership capability will help mould the necessary capability to manage the delivery of services and our operational performance going forward. Other improvement activities include for example IT, initially through electronic document management, and after that electronic prescribing, both of which have safety and cost improvement benefits. Our quality improvement work, set out in more detail in our Operational Plan, is another key example. 3.6 Summary of approach for strategic development Our forward planning has two distinct phases. The first two years (Operational Plan 2014/16), submitted to Monitor in April, focused on quality and operational improvements. Year s three to five will focus on our playing a key role in the development and reconfiguration of the health and social care system across Dorset to ensure we provide clinically and financially sustainable services. Our Operational Plan includes the transformation of the Royal Bournemouth Hospital s urgent and emergency care pathways (unscheduled care), especially for the frail elderly, ensuring ambulatory diagnosis and treatment is provided, where appropriate. Transforming the way we provide unscheduled care will ensure patients Page 6 of 36

59 across the hospital receive the right care in the right place, at the right time and with the right person. In parallel to this improvement work, the Trust will use the next year to further develop its plans for how best to meet patient needs over the next five years and beyond. This will entail specialty level plans to cope with the various scenarios and uncertainties that face the organisation. Where change requires consultation, preparatory work will also be started, mindful of good practice and the secretary of state s four tests: clinical evidence of benefit; support of GPs and commissioners; public engagement; and maintaining choice. Any proposals developed will comply with these tests. Longer term the case for change across Dorset is compelling. Across the whole health economy, with the acute trusts in Poole and Dorchester, we will need to reconfigure services in order to: sustain the quality of health and social care move to more seven day services meet the needs of an ageing population introduce new technologies recruit and retain the right staff improve outcomes meet financial challenges A key element of successful change will be closer working with partners such as GPs, community health and social services. Likewise, working with other acute specialist hospital services is needed to ensure centres of excellence can survive and thrive in Dorset. Haematology, cardiology, obstetrics, emergency departments, acute surgery and pathology are examples of where integrated networks of care combined in specific instances with site / service rationalisation can provide better outcomes for patients, improve access and allow us to recruit and retain the best staff. Our intention is to integrate our care with community, primary and social care, learning from models elsewhere, such as Torbay. For hospital services the right model and location of care needs to be agreed through a collaborative process. RBCH is well placed to adapt to change, with a modern hospital building that can flex to meet new requirements. Our geographic location is well placed to serve Dorset, South Wiltshire and the New Forest for specialist services requiring one million catchment populations, with good road links and a helipad next to the Emergency Department. Our extensive theatres, diagnostics, cardiac and interventional radiology infrastructure are also difficult to replicate elsewhere. Although this document is submitted at the end of June 2014, in line with Monitor s timetable, we consider our strategic planning as on going. There will be further discussions both internally and, critically, with external organisations such as our commissioners and other providers. This is to optimise the compatibility of this approach with that of others in the Local Health Economy (LHE), and to ensure an iterative and agile approach to the changing circumstances. Page 7 of 36

60 4. Strategic analysis 4.1 Background Two events took place during 2013/14 that had a significant bearing on both the Trust s two year operational plan and the five year strategic plan. Firstly, the Trust was engaged in a merger process with Poole Hospital NHS Foundation Trust which, following review by the competition authorities, was prohibited. Many of the drivers for change are still valid i.e. reduction in the number of available medical trainees, increased specialist services developments, the need for seven day consultant-led services and capital investment requirements. Some of the responses to these issues were delayed pending the merger and these are now being re-examined to find alternative solutions, or to be progressed via commissioner led reviews. Secondly, in October 2013, the Trust was inspected by the Care Quality Commission (CQC) with particular areas of focus being the urgent care pathway, including the Emergency Department, medical and surgical services and care of the elderly. The report identified inconsistent quality in the services we provide in some of these services. Improved staffing levels, attention to consistency of patient assessments, privacy and dignity and becoming a more open, learning organisation were the four key actions. The organisation has embarked on a number of new quality improvement initiatives, as well as enhancing many work streams that were already in place. The ageing population of Dorset will present a number of challenges for the future; in particular potential increases in demand for social care (community and residential based services), supported housing needs and taking account of the increasing burden of chronic disease. The impact of population ageing will vary greatly depending on whether older people are enabled to remain independent and remain in good health for longer. The Trust sees this as a vital part of its future work. There will also be a growth in the overall population size across Bournemouth, Dorset and Poole of about 150,000 more residents by This is due to people living longer, internal migration and a rapid growth in the birth rate. The proportion of people aged over 85 years is 50% higher in Bournemouth than England. There are an estimated 2,300 people now aged 90 or more in Bournemouth. The population of Bournemouth and Poole is healthier than many parts of England when assessed on measures like life expectancy, all age all-cause mortality rate, and mortality Page 8 of 36

61 rates due to major causes of death like cancer and circulatory disease. But this relatively healthy picture masks very different health outcomes between smaller areas within the conurbation. All Age All-Cause Mortality (AAACM) rates in the fifth of areas ranked as most deprived are similar to those in some of the most deprived CCGs in England. Analysis suggests that many deaths due to cancer and circulatory disease are due to preventable lifestyle and health behaviours tackling these risk factors in the most deprived areas as a priority is the only way that further progress can be sustained in reducing national targets such as AAACM rates, under 75 cancer mortality rates and under 75 circulatory disease death rates. Planning for the increasing birth rate is also important. The total number of births in Bournemouth and Poole has been increasing from 2005 onwards and now stand at more than 4,000 per year up from about 2,900 a decade ago. Despite this, the births in the midwife led unit have declined as mothers choose obstetric led services. Since 2007 the overall number of births has exceeded the number of deaths, reversing the previous long term trend. These population changes are likely to require an increased need for both formal and informal care. The age groups of are significantly under-represented across the county, due to a period of low birth rates and the outward migration of this group. Dorset is therefore gaining an ageing population but losing its workforce and those with the ability to deliver informal care. This means the requirement to deliver the required level of care, arising from the expected increase in the ageing population, will be challenging. Creating attractive jobs, giving help with housing, and career progression will be important for our workforce retention. 4.2 Financial context This plan assumes continuation of the austerity in public services for the next five years as the most likely scenario, given the state of public finances and the national deficit only having been halved, in the current Parliament. Internal, recurrent Cost Improvements Plans (CIPs) are a critical factor. The Trust predicts only c1.2-2% p.a. as the maximum safe and deliverable savings. This is an average of 4m new CIPs annually. This is because RBCH has over the last five years considerably outperformed the sector average for CIP (4% vs. 2.5%) resulting in actual costs being 10% Page 9 of 36

62 lower than NHS averages. Going forward we will take a strategic approach to identifying CIP with further analysis of the opportunities that present. Never the less the scope to achieve the reported level of savings is diminished. This translates into assumptions for RBCH of: flat cash income (0% funding growth each year, i.e. below inflation) activity levels, service mix and quality targets are all contained within the flat cash funding envelope. Meeting these will require internal productivity improvement, stopping some things to do others, and some wider system re-design, especially to reduce demand below what the demographics predict will occur very tight cost control, especially for wages and pension (assumed to rise 1.2-2% p.a.), drugs, consumables, utilities, and NHS Litigation Authority premiums there will need to be internal investment each year in staffing, IT and services so as to meet rising quality, staffing levels and access expectations, regardless of the public sector austerity. The effect of these assumptions results in the current planned deficit considerably worsening. By 2018/19 the annual, recurrent deficit could be - 22m. The downside scenario is significantly worse at - 50m per year. This would fully deplete our cash reserves and require debt for the Trust to remain operational. 4.3 Mitigations The main aspects of the Trust s mitigation plans for austerity involve whole system reconfiguration. Firstly, this is community integration, especially focusing support around the frail elderly and complex co-morbidity management. Secondly, hospital service reconfiguration towards centres of excellence and seven day working, to improve quality, cost and outcomes. For the vast bulk of services patient access will remain or improve for clinics, daycase and routine procedures. Finally, a redesigned system will allow commissioner confidence to commit to funding that matches their uplift, i.e. at inflation. If all these plans were achieved in a timely way with excellent benefits realisation, then this would enable a sustainable Trust. However given the high degree of uncertainty and external factors at work in achieving even one of these three aspects, then they are not included in the base case. Our ambition and work programmes and the CCG Clinical Services Review, will work towards community and hospital service integration. This is because we believe this remains the most sensible and effective way to deliver sustainable care for our population. 4.4 Cost Improvement Programme In all cases CIP at c 4m of new savings per year is challenging. While it is half our average for the last five years, there is less to go at now with strategic change providing opportunities to limit future cost exposure. In our forward programme for CIP we have several large ( 1m+) savings based on multiyear programmes: e.g. EDM (electronic document management) which will improve quality and reduce health records costs significantly. Securing Christchurch Hospital through a multi-million pound investment also delivers significant savings in reduced building costs and improved commercial income. Procurement savings, emergency care reforms and workforce productivity all continue to be other significant elements of future plans. Page 10 of 36

63 The full impact of demographics and rising expectations, and the reconfigurations and demand management to offset some of these, are both difficult to quantify. However it is clear that productivity in our main activities to absorb much of this demand will be an essential, but non-cash releasing, part of our Improvement Programme. 4.5 Strategic analysis There are a number of tools that we have used to help us understand the context in which our organisation operates. These include PESTEL and SWOT analyses and updated versions of these for our Trust are shown below PESTEL analysis (Political Economic, Sociological, Technological, Environmental, Legal) Clearly an external analysis of the environment in which the Trust finds itself is dependent on national as well as local factors and dynamics. There are often grouped under the PESTEL headings. PESTEL analysis for RBCH Political 1. Election in May 2015, leads to paralysis before and reorganisation after 2. Increasing trend to open up the healthcare market to private sector/ increase competition 3. Increasing emphasis on sector regulation 4. Strengthening in policy of shifting care to community settings with potential for loss of Trust income. 5. Further adjustment of role of NHS England vs. CCGs (primary care, specialist commissioning) 6. Increasing tendency to commission services on a county wide basis 7. New CEO of NHS England 8. Potential for further development of the use of personal health budgets. Economic 1. Flat cash scenario for Trust via real term reductions in tariff. 2. Inflation and pay rises increase cost pressures. 3. Substantial deficit position for many Trusts; potential for failure 4. Significant regulatory pressure to invest in services 5. Reduce spend by local commissioners leading to rationing or decommissioning of some services; development of demand management initiatives. 6. Increasing potential for paid for health services, but NHS remains free at the point of delivery 7. As tax receipts recover, potential for increased resources for the NHS 8. Poole, Bournemouth conurbation still relatively affluent. Page 11 of 36

64 Sociological 1. Growing and ageing population 2. Increased patient and public expectations of NHS 3. Increasing access to health information and understanding of health issues 4. Significant differences in deprivation and longevity within conurbation. 5. Increasing use of IT for social healthcare purposes 6. Potential for more joint provision of healthcare 7. Increasing use of and access to the internet by all demographic groups. Environmental 1. Pressure to reduce carbon footprint 2. Planning requirements require increased management of traffic / parking / congestion around our sites 3. Recognition of environmental footprint of all organisations and plans and strategies to mitigate this. 4. Recognition that opportunities exist to treat patients outside of hospital leading to smaller estate requirement Technological 1. Sharing of health records horizontally and vertically across health economy. 2. Opportunity for increased efficiencies that IT developments offer 3. Increased opportunity for and cost of new technologies (robots, prostheses) and pharmacological treatments (molecular treatments, genetic profiling) 4. Improving opportunities for tele-health and associated technologies 5. Increasing expectation of local health IT developments rather than national 6. Increasing number of mobile phone apps, allowing direct access to health professionals and cloud based storage of personal health records Legal 1. Competition undertakings placed on the Trust 2. Novel Joint Venture (JV) models developing with different organisations 3. Approach to competition legalities continues to develop and is influenced by European legislation SWOT analysis Many of the issues raised in the PESTEL analysis translate into opportunities and threats for our Trust. Strengths excellent clinical services and clinicians larger structure enables efficiency and provides clinical and financial stability trust has record of successful operational performance high level of internal clinical engagement strong GP sector locally strong clinical relationships with referrers RBCH site has substantial space for further expansion excellent access by road (including parking) and public transport Weaknesses poor co-ordination of services with community providers difficult to recruit to consultant posts e.g. ED, Elderly Care & Acute Medicine relationship with Local Health Economy (LHE) partners mixed some services provided inconsistent quality weak financial metrics in some specialities insufficient junior doctor posts in acute specialities and limited substitution absence of alternatives to admission within the community limited community capacity in east of the conurbation, especially via community hospitals Page 12 of 36

65 Opportunities integrated primary and secondary care will fundamentally improve quality and efficiency develop further strategic alliances and networks recognition of the need to develop different models of care integration encouraged nationally and therefore more local opportunities share more services with other partners to reduce costs internet offers an opportunity to improve administrative efficiency and as marketing tool opportunities to repatriate activity from outside of the county Threats competition for skilled workforce NHS financial position likely to worsen increasing need for clinical scale as defined by Royal Colleges and other medical bodies preference to commission and centre services within primary care/ the community and away from secondary care providers competition for patient s from other providers new NHS CEO will encourage further competition increase use of IT as competitive advantage inability of CCG s and local health system to effectively manage non elective demand Many of the items in the list above can be viewed in either box. The organisation that is able to respond quickly and flexibly to these will not only display the four capabilities expressed by Monitor but will, as a result, be able to turn these issues into opportunities. There are some key synergies in the above tables the need for a hot / warm acute configuration would be well served by the excellent access to the RBH site and space available for further expansion. This would also be supported by the primary population centre being in our location. The absence of significant community hospital capacity in the east of the conurbation, lends itself to the increasing emphasis on providing service to patient in their homes wherever possible CCG strategies, plans and programmes The CCG has published its draft five year strategy and has included some demographic analysis including the following highlights: overall the population of Dorset enjoys relatively good health with a higher life expectancy than the England average major causes of death are cardiovascular disease (CVD) and cancer, death from CVD and cancer accounted for 29% of deaths in 2011 increasing numbers of people living with long term conditions (LTC). In 2011 in Dorset 19% of people living with LTC or disability which impact on their health inequalities in life expectancy across Dorset; although fallen, gaps of 4.4yrs for men and 3.5yrs women still exist health related behaviours in the main are good however issues such as smoking, smoking in pregnancy, sexual health, alcohol consumption, and obesity are a cause for concern and focused effort. The high number of older people across Dorset poses a significant challenge for the health and social care system, using on average triple the health resources of the overall Page 13 of 36

66 population. This could therefore mean the equivalent of an 18% increase in demand in the next five years. 4.6 Public views From the Dorset health system-wide engagement exercise in 2013 The big ask, over 2,000 members of the public highlighted the following issues: focus on prevention and self-management and personal responsibility to shift the focus of local services enhance and encourage the use of technology to support self-management and selfcare integrate health and social care services across NHS and local authorities to improve points of contact for each patient consider alternative settings of care which don t always need to be in a hospital or clinic improve access to services, including primary care and community services over a seven day period support training and development of patients, families and carers to manage their conditions ensure that carers are supported and that services are developed which meet their needs improve opportunities for local people to engage with our work to develop and design services which meet local need. Issues arising from this analysis and feedback include; key commissioning trends are away from hospitals: Moving from reactive to proactive healthcare in community settings and in particular avoiding emergency hospital admissions is not borne however by current referral patterns which show year on year an 11% rise in emergency admissions commissioners (internationally) perceive hospital systems as tending towards being reactive, centralised and high cost, and the default, or barrier, rather than the solution to the future population health needs. This misconception needs challenging without challenging these views there is a risk that even if wider NHS funding picks up, the hospital sector sees no benefit. For this reason the Trust needs to fully engage with this agenda, as it is likely to be where the effort and funding growth occurs. International evidence points to these shifts in care being more successful when the hospital sector is involved or leading the new models of care. 4.7 CCG commissioning Commissioning is an important part of achieving Dorset wide reconfiguration and system transformation. There are three principal local programmes linked to the five year plans of commissioners, these are; Better Together health and social care transformation Page 14 of 36

67 Urgent Care Board, emergency services improvement Clinical Services Review, including acute hospital service reconfiguration The commissioning landscape has changed significantly. Dorset and Bournemouth and Poole primary care trusts have been replaced by Dorset CCG and NHS England and the Local Area Team for Wessex, with a specialised commissioning role. Additionally, the commissioning of some services has been taken over by public health, which in turn has been relocated under the responsibility of the local authorities. 4.8 Operational Resilience Board The Urgent Care Board (now Operational Resilience Board ) for Dorset has been in operation since 2013 and has been key in developing plans and initiatives across the local health economy. The focus has been two pronged in providing interim support to short term management of winter 2014 and a longer term development of strategy to implement new models of care. A particular focus has been on pathways for the frail elderly. The plan for Bournemouth and its localities has included: seven day radiology interim discharge to assess community beds primary care presence extended in the Emergency Department improved discharge coordination and integration with social care virtual ward, with GP led co-ordination of frail elderly care. 4.9 Better Together This Dorset-wide programme has been awarded one of the only two large funding grants, to help accelerate the work in this area. This exciting development is actively supported by RBCH and has the potential to reduce unnecessary emergency admissions and support discharge from hospital. These are critical to ensure safe, sustainable services, given the current and growing demand from an ageing population. The CCG is working with the three local authorities in Dorset, the four major NHS providers in Dorset and voluntary groups to deliver integration, with new models of delivery and commissioning being developed. Improvements will focus on: frail elderly and long term conditions (links to urgent care) early intervention support and reablement / intermediate care urgent and emergency care (links to urgent care) The UCB and Better Together programmes are also ensuring that the Better Care Fund is spent to best effect to enable an integrated, effective response to the challenging local environment Clinical Services Review (CSR) In parallel with the health and social care agenda, the NHS Dorset CCG is developing a review to determine the service model that will best meet the future needs of our local people in the context of projected demographic and economic change. Page 15 of 36

68 The key outcomes for patients; delivery of care close to home services which are designed around patients integrated whole system services fast, flexible and focussed access to diagnostics, reports, clinical guidance for clinicians for treatment and care planning sustainable workforce across health and social care provision improved quality and outcomes value for money The expectation is the review will consider some reconfiguration among hospital services and between community and hospital care. This will be developed over the next two years, for implementation in year s three to five. Co-production of the solutions, especially between primary and secondary care clinicians, and with public and patient representatives, is critical for success. RBCH will seek to play a full partnership role in this process. The CCG has issued a tender for a partner to deliver this work, with an expectation that the first stage review will concluded by spring 2015, with any public and stakeholder consultation in later The cumulative effect of these three programmes for change needs careful coordination, in particular the effect on the acute hospitals fixed cost base. Given both RBCH and Poole Hospital have very efficient services, and growing demand, this leaves little scope for significant funding shifts out of hospital Specialist commissioning Specialised services are those provided in relatively few hospitals, accessed by comparatively small numbers of patients. RBCH provides cardiac, vascular, cancer, bariatric and HIV care as examples of specialist care. Specialised services account for approximately 10% of the total NHS budget, spending circa 11.8 billion per annum. These services tend to be located in specialist hospitals that can recruit staff with the appropriate expertise and that enable them to sustain and develop their skills. Maintaining and potentially growing a sustainable portfolio of specialised services for our local population is strategically important for RBCH and Dorset residents. The on-going action is to ensure these services meet the service specifications and provide quality care and outcomes. This will often require network solutions with Dorset, Salisbury and Southampton hospitals. All of the RBCH services are candidates for network solutions and this is likely to increase further to meet the criteria of staffing, funding and minimum number of cases. There is of course the possibility that RBCH may lose some services where the level of activity is below that required to deliver an effective service in future. The details will develop over the next two years, and are being actively managed and will form part of the speciality level strategies. Page 16 of 36

69 26 Specialist Services Provider Network Potential Growth Hepatobiliary & Pancreas (Adult) Cancer: Pancreatic (Adult) Specialised Endocrinology Services (Adult) Colorectal: Trans anal Endoscopic Microsurgery (TEMs) (Adult) P Specialised Dermatology Services (All ages) P P Specialised Rheumatology Services (Adult) P P Haemophilia (All ages) P Specialised Urology- Cancer: Specialised Kidney, Bladder and Prostate (Adult) Severe and complex obesity (All ages) P P Colorectal: Complex IBD P P Colorectal: Faecal Incontinence (Adult) P Cardiology: Cardiac Magnetic Resonance Imaging (Adult) P P Complex Gynaecology: Recurrent prolapse and urinary incontinence P P Complex Gynaecology: Urinary fistulae P Haematopoietic Stem Cell Transplantation (Adult) P P Cancer: Oesophageal and Gastric (Adult) P P Cancer: Chemotherapy (Adult) P P Cancer: Chemotherapy (Children, Teenagers and Young Adults yrs. only) Cancer: Teenager and Young Adults (16-19 Yrs. only) Cardiology: Implantable Cardioverter Defibrillator (ICD) & Cardiac Resynchronisation Therapy (CRT) (Adult) Cardiology: Electrophysiology and Ablation Services (Adult) P P Cardiology: Inherited Cardiac Conditions (All ages) P P Cardiology: Primary Percutaneous Coronary Intervention (PPCI) (Adult) P P Complex Gynaecology: Urogenital & anorectal conditions P P Specialised Vascular Services P P Specialised Human Immunodeficiency Virus Services (Adult) P P 4.12 Market forecasting For the purposes of understanding what the local health market will look like in the next five years, we have held a number of debates with governors and staff to explore some changes and scenarios that might be expected to develop over the period of the strategy. We have focused on this initially, to develop our internal understanding amongst our key clinicians of: 1. The difficulties facing the NHS, both nationally and locally, especially the extreme nature of the financial position. 2. The demographic issues as they affect patient demand, but at least as importantly, how they impact on staffing issues, including recruitment, retention and specialisation. P P P P P P P P Page 17 of 36

70 3. Over this five year period there is considerable potential for disruptive innovation(s) that will profoundly affect the way services are made available and funded. These need to be understood at national, local and speciality level. At this stage in our strategy cycle we believe it is important to explore these and establish the likelihood and impact of these, prior to varying our current activity, costs and revenue plans for the next five years. To engage with our own stakeholders we have taken a workbook and questionnaire approach to test many of the assumptions pertinent to forecasting, with our clinicians, governors and other staff. Specifically we have asked them to grade the likelihood and impact of a series of issues that will impact on our organisation and its sustainability over the five year strategic period. Statement / issue 1. Ageing population, baby boomers entering their 70s and 80s (triple costs). Plus overall population growth. 2. Austerity for public sector for whole next Parliament ( ) so hospitals get 0% funding growth. 3. Expectations of quality continue to rise 4. Growing consensus frail elderly and complex co-morbidities management (rather than episodic, disease specific care) is the critical change for survival of health systems. 5. Commissioners interpret best way to respond to four is integrated localities of health and social care (person-centred, care closer to home etc.) 6. Commissioners interpret best way to respond to four is larger acute sector leading on this. 7. Workforce becomes more stretched with pay and training pegged, meaning less new staff available. Results Of the above, ageing population, financial austerity, patient expectations and workforce stretched were rated most significant. We also tested the following Wild Cards. In the next 5-10 years could we see: Statement / issue 1. Breakthrough treatments e.g. dementia, personalised cancer treatments etc. 2. NHS but not as we know it e.g. reduced offer, charging, greater private sector role and competition 3. Health and social carefully merge, so an end to the assessment culture 4. Digital NHS, revolutionising care processes, and self-care 5. Disease burden shifts, we re due a pandemic, obesity, drug resistance etc. 6. Cultural change to accept ceilings of care especially in last year of life 7. Future workforce: Generation Y has different motivations and work ethic, so retention factors will be different Results Of these the most highly rated were workforce attitude, digital NHS, disease burden changes and ceilings of care. Page 18 of 36

71 4.13 Competitor assessment The county of Dorset has a population of around 750,000, extending across a large swathe of the south coast, from Lyme Regis in the west to Christchurch in the east, a distance of around 60 miles. However the main population is in the east of the county within the Poole /Bournemouth conurbation. This is served by two district general hospitals (DGHs). Poole Hospital is in the centre of Poole and the Royal Bournemouth Hospital is on the east side of Bournemouth. Neither hospital trust carries the complete set of typical DGH services and across many specialities can be considered to be complementary. As such the majority of services operate in a collaborative, way between the Trusts. Further to the west in Dorchester is Dorset County Hospital, serving the more rural west of the county. There is limited overlap with other hospital s catchment areas, as the table shows: Table: Hospital providers and main catchment areas (source Competition Commission) All of the hospitals have experienced, or are experiencing, financial difficulties, summarised as follows: Trust RBCH Poole Dorset County Dorset Healthcare Operating Income Ms (12/13) & 14/15 plan 249m; planned deficit 202m; planned deficit 152m; planned deficit 226m; planned deficit Summary financial issues Non-elective (NEL) income does not cover costs, tariff deflation of elective income reduces cross subsidisation for NEL services Predominant income NEL discounted NEL payments reduce potential for surplus Smaller scale, rural geography means scale required for sustainability either clinically or financially is more difficult Community and mental health services, mainly on a block funding basis Community NHS services There are very strong synergies between RBCH and the majority of the community services. This is especially so in intermediate care, elderly care and palliative care. Other strong links include sexual health services and the more general services like dietetics, podiatry and interfaces services for dermatology and orthopaedics. Page 19 of 36

72 In addition to the acute hospital sector, there is a significant community hospital sector, mostly situated in the west of the county, as well as community services delivered in and around GP practices and patient homes. The latter operate across the whole county including the Poole / Bournemouth conurbation. The Dorset county community services were tendered three years ago as part of the Transforming Community Services (TCS) initiative and were acquired by the existing mental health provider Dorset Healthcare NHS Foundation Trust. Integration of these services with those of the acute services has been difficult, partly due to the reconfiguration taking some time to bed in, but also to the conflicting priorities of the community provider versus those of the acute providers. In the interim there have been some changes in these services, especially an increasing focus on building services around the locality groups within the CCG. At the time of the TCS exercise the services were moved as whole, whereas it is possible that if services are reallocated, this is done on the basis of operational necessity and or geographical appropriateness. As a Trust we would wish to ensure that given the preponderance of community hospitals in the west of the county, the east of the county was given an allocation of resources commensurate with its demographic Private Sector There are three principal private hospitals in Dorset; The Bournemouth Nuffield in central Bournemouth, the BMI Harbour hospital, adjacent to Poole Hospital and the BMI Winterbourne on the south side of Dorchester. There has been some potential for an additional private hospital the Circle Group has explored the possibility of a private location in the Wallisdown area, between Bournemouth and Poole but its future remains uncertain. Our existing private work is based mainly on significant capital investments in interventional cardiology and in radiology. These labs and scanners have put us ahead of the local market in terms of technology and we have significant income associated with these. One of our strategic options is to develop our private work further, both in our existing markets and into new markets. A key component of this strategy will be to ensure that our private facilities are ring-fenced so that they are separate from NHS capacity. This may be better achieved by a dedicated private operator and this option is being explored Competition versus collaboration Increasingly as the hospital moves into a more commercial environment, the tension between competition and collaboration is exacerbated. When looked at across a whole Trust, the temptation is to default to one or the other. The reality is, like the private sector, we need to be able to operate both approaches simultaneously. Each of the Trust's specialities has the possibility of moving toward one or other of these approaches. Some of this is not driven by the Trust itself, but by the approach taken by our commissioners for example, to support competition by tendering services. Page 20 of 36

73 The findings of the competition commission (now the Competition and Market Authority, CMA) on the proposed merger with Poole Hospital will also affect our forward plans. While emergency, diagnostic, community and specialist services were generally found to be acceptable to merge, elective, outpatient and maternity services were not. These were balanced judgements and any new proposals would need to be re-evaluated. The new approach by Monitor and CMA following the merger being blocked, may produce a different result if on a service by service basis the cases were represented. However the main changes in Dorset are expected to be commissioner led in the next five years. Therefore there is a further rationale why service changes are likely to meet competition law requirements. 5. Risk to sustainability and strategic options As the market analysis and context section has made clear, RBCH faces the a significant challenge of rapidly rising demand, declining real terms funding, greater recruitment and retention issues and a political-legal framework that makes significant change difficult to enact. In crafting a strategic direction that best navigates these issues and maximises the chances of sustainable success, the following are the high level options that the Board are considering: Change of care model at large scale, for significant level of services. See table below. Internal improvement in quality, cost, and supporting strategies (workforce, IT, commercial, back office etc.) RBCH Vertical Integration with the community, GPs and social services, to improve quality and cost for the local population. Greater networks at service level for 7 day, high volume hospital care, resulting in some RBCH services growing or shrinking. This may mean Trust and health system reconfiguring to hot or warm sites, via a commissioner led process. These options can largely be progressed simultaneously, that is they are not mutually exclusive. However a strategy of progressing on all fronts has the risks of not making real progress on any. Therefore the Board, Clinical Directors and Governors are engaged in a process of prioritisation as to which of these high level directions should attract the most attention and resource, and within these what programmes of work should be prioritised. Page 21 of 36

74 5.1 Clinical developments and different models of care The significance of the issues facing the NHS is substantial in scale and scope and we recognise the need to develop different models of care to address this. We have therefore tested these with clinicians, governors within the Trust and our board. The models we have used were principally published in the NHS Futures document by Monitor and NHS England. We added two further items to this: reduction of variation in our care processes and developing a more commercial approach, the latter including enhancement of our private patient income. Capitated budgets Genuine single budget, for all, or cohorts of complex patients with single lead provider. (e.g. personalised care budgets) Hi-volume Centres of Excellence for planned surgery and specialist centres. (e.g. Derwent hip and knee centre) 7 day hospital hub Consultant care, in reconfigured acute sector, with vertical integration as well. (e.g. stroke and trauma in London) Reduce variation in services delivery, Toyota model, Quality management, Lean manufacturing Extensivists for sickest c2% Community doctor coordinates all care for sickest patient, regardless of setting. (e.g. palliative care) Co-production and lose fixed costs. Niche new entrants to disrupt & convert fixed to variable costs, as is retail. (e.g. diabetic selfcare) Current technology & big data used. Manage, at home, chronic diseases and prevention. (e.g. Airedale FT) Commercial developments e.g. formal partnering with a private patient partner. The applicability of these approaches differs by speciality, and so work is being undertaken with staff in each of these groups to understand and consider these approaches. However, taking a trust wide view, centres of excellence; seven day working; reduced variations in care; and increasing commercial income had particular appeal and as such the strategic framework reflects this. Finally, we also considered a number of scenarios, broadly under the categories of Internal Improvement, and Vertical and Horizontal Integration. Internal improvement encompasses the high priority given to reducing variation in our services, delivering operational improvement especially in urgent care and for the frail elderly, the development of private patient income and other initiatives that lie largely within our own control. Community (vertical) integration was given particular emphasis around the need for better integration and coordination with the community services and GPs, to ensure a seamless patient experience and to optimise the use of expensive healthcare resource. Discussions on this highlighted the potential for the CCG to retender Community Services either together or in lots. Our discussions highlighted the need to position ourselves for the successful submission of a tender alongside appropriate partners. We also recognise our appetites for more close working with GPs including the possibility of joint ventures. Page 22 of 36

75 Hospital (horizontal) integration focussed on the potential for a reorganisation of clinical services across the acute sector, including the development of hot / warm hospital sites within the Poole / Bournemouth conurbation. Also in this category is potential for network or hub and spoke arrangements to deliver higher quality services mitigating manpower and financial constraints. This builds upon the thinking that was developed through the abortive merger process. The initial feedback from the Operational Board and Governors included: Hospital Horizontal Integration (hot / warm) Hot sites services, in order of priority: Operational / Clinical Board General Surgery Colorectal Upper GI. Vascular Trauma A&E Interventional Cardiology Interventional Radiology Governors A&E Stroke Trauma Vascular General Surgery Interventional Cardiology Interventional Radiology Urology RBCH as small, viable, colder site: Negative response Mixed response Hospital Horizontal Integration Networks / hub and spoke) Priority Activities Operational / Clinical Board Networks Mixed response P Hub and spoke Mixed response Mixed Work more closely with community / integration P Operational / Clinical Board Bidding for tenders P Mixed JVs with GPs / other health providers Health Prevention / Promotion P Lower priority P P P Governors Governors 1 st priority area of focus? Internal improvement Hospital Integration (Horizontal) Community Integration (Vertical) Operational / Clinical Board Governors 28% 21% 39% 21% 33% 57% These will be integrated with the views of other staff groups and agreed by the Board of Directors Page 23 of 36

76 5.2 Conclusions A key conclusion is that while there is consensus about the issues to address for sustainability, there are mixed views as to the correct speciality level response, and the order of priority and timings. For example integration with community services may be appropriate for medicine for the elderly, whereas our cardiac services might give a higher priority to integration of hospital services. As a result further work is being undertaken on speciality level plans and timing of activities to ensure we maximise the potential to maintain sustainable services. The table below represents the strategic framework tool we will use to help facilitate speciality level planning. The nine options are set along the two axis. The first is how much control RBCH has over the actions, and secondly the level of cultural acceptance and degree of radicalism inherent in the option. Each speciality can progress on multiple fronts or pick and mix solutions at sub speciality and point of delivery (i.e. outpatients, emergency admissions etc) as well as in timing terms over the next five years. This can be build up to a plan, recognising where external and cultural factors will need to be managed to ensure engagement and success. All of these options require on-going engagement with partners, to co-produce the right outcomes. For each there are many variables and options, not all are yet fully evaluated. As a result these are strategic options requiring greater assessment and options appraisal, and a dedicated programme management approach, using gateways to make formal decisions, as to what is progressed or abandoned. Much of this work is via engagement with whole system processes, such as the CCG led Clinical Services Review for Dorset. However before RBCH engages in that process we will ensure we have considered the potential outcomes, and our response in anticipation of these. Page 24 of 36

77 We have therefore modelled various scenarios, especially regarding community and hospital integration. This modelling is both on a clinical as well as a financial and estates basis. To do this the current and projected financial plan and assumptions is set out here, from which variations are tracked. 5.3 Base case key assumptions current service mix maintained overall c2% activity growth per annum overall c2% cost improvement delivered per annum flat cash income of 0% (i.e. no inflation) wages and other costs rise by 1-2% per annum non-activity and non-inflation funding of 2.5m per annum (quality and staffing investments for clinical and performance sustainability). [Non elective activity has risen in 2014/15 by 11% compared with 2013/14. This rate of growth cannot be sustained and demonstrates the need for and integrated acute / community strategy]. This results in a Year 5 recurrent deficit of - 22m, and no financial reserves. This would then not allow any buffer against clinical or performance pressures, resulting in the conclusion RBCH would be non-viable organisation. A downside scenario to this assessment is that: demand rises more quickly (evidenced this year) commissioner decisions and system cost pressures rise more quickly, leading to widespread provider failure in Dorset the combined effect of failure by year three, and a recurrent deficit of - 50m by year five, triggers a system wide administration process and a rushed reconfiguration of hospital care services to at least maintain clinical and governance sustainability of the system. Mitigations to the downside are that: commissioners support early moves to integrated service models and investment in RBCH as an acute and community hub for the locality reconfigured services, in line with commissioner intentions, means income growth can track inflation these in turn result in demand being better managed, and headroom to cope with activity and performance fluctuations (e.g. wait times, bed utilisation) integration with other acute hospitals (as networks or hot / warm models) resolves most workforce and clinical sustainability concerns in more cost effective way overall this still leaves a recurrent deficit by year 5 and a COSRR rating of 2, but with clinical and performance sustainability. Page 25 of 36

78 These three main scenarios, and the strategic options contained within, form the long term financial model, upon which the five year plans are based. 6. Strategic plans 6.1 Board leadership The Board and its committees will oversee the development of the right set of actions and mitigations to ensure effective delivery is a whole organisation-wide activity. Included within this is the Trust Management Board, comprising clinical and executive directors, ensuring a strong clinical leadership giving effect to our medical leadership model. Rather than detail the Terms of Reference and full governance structure here, this section provides a summary of the principles and approach that RBCH has currently, and is adapting, to ensure sustainability and key capabilities are delivered. The issues of sustainability and developing the capabilities for success are inherent in all our work, however the structure diagram represents where, beneath the Board, the practical leadership and oversight occurs. Board of Directors (BoD)* Trust Management Board Sustainabilit y criteria Monitor 4 Key Capabilities Finance Committee Financial Workforce Committee Leadership and organisational development Healthcare Assurance Committee Clinical Strategic Planning Group Strategic planning Improvement Board Governance (performance) Operational improvement * Other BoD committees include audit, infection control, patient experience, charities and remuneration. Page 26 of 36

79 6.2 Assurance framework Underpinning this is our extensive Assurance Framework (AF). This is seen by the Board, with more detailed scrutiny at the Healthcare Assurance Committee (HAC). Strategic five year plan Operational two year plan. Directorate Risks Risk Register Assurance Framework Risks (initial, mitigated, target) Action plans Responsible Director and Manager Timescales The AF spans operational risks, which might be generated by adverse incidents, audit findings, performance concerns etc. and are entered on the Trust risk register. It may also include delivery of objectives within the operational and strategic plans, where significant risks requires deliberate mitigations plans, active oversight, and where failure to deliver may generate a critical issue, especially for financial, governance (performance) and clinical sustainability. As with this entire process, considerable judgement is required to strike the right balance in identifying the key actions and risks, without creating too many or too few items to manage. The AF process provides transparency, with a unified and consistent approach. 6.3 Supporting strategies Crucial to the success of the overall strategic plan are the specific strategies and processes, in particular for: Quality Strategy Improvement Programme (including CIP) workforce development information technology estates leadership and organisational development strategic planning process including engagement with external processes, especially the Clinical Services Review and Better Together These strategies are referred to within the two year operational plan, and have their own processes and structures to ensure delivery and on-going updating. Therefore only very high level summaries are also included below. Crucially the inter-connections between each of these strategies are important to the success of the overall enterprise. This is achieved through the annual process of updating and setting the operational plan, finances and Board objectives. This is monitored monthly and in some cases, weekly. The Executive team s weekly meetings also allow a rapid, Page 27 of 36

80 cross organisation and cross function approach to ensure co-ordinated and successful implementation. 6.4 Quality strategy The Trust embraces the three key quality components of High Quality Care for All and the key quality objectives are therefore to: ensure patient safety is a top priority for all staff by: o reporting and learning from adverse events o delivering Harm Free care o implementing high quality falls and pressure ulcer prevention programmes o reducing and preventing medication errors o maintaining high standards of infection prevention and control o maintaining a safe environment for patient care ensure patients are offered up to date and effective clinical care by: o reporting on clinical outcomes o implementing and monitoring delivery of national guidance to provide the optimum patient experience by: o treating our patients with compassion and respect o gaining feedback from our patients and improving in response o publishing our findings for the public for each ward o managing complaints in an open, transparent and timely way Key priorities derived from the above include: Safety reduction in inpatient falls reduction in hospital acquired pressure ulcers increase in harm free care (as measured by the National Safety Thermometer) for all patients reduction in medication incidents increased reporting and learning from potential and actual adverse events via implementation of a new web based reporting system Clinical Effectiveness deliver the National Clinical Audit programme requirements reduce hospital mortality as measured by HSMR and SHMI use new IT innovations to support the management of the deteriorating patient Patient Experience improve the Trust Friends and Family results reduce the number of formal complaints and improve the timeliness of complaints investigations and responses Page 28 of 36

81 a programme of estates improvements, covered in the capital plan The other significant focus for quality improvement in the short term will be the continued progress of actions arising from the CQC inspection in October This is developed further in our Operational Plan. Specific metrics which articulate the ambitious pace of improvement are contained in the Trusts Quality Strategy. 6.5 Workforce strategy The NHS is a labour intensive organisation and around 60% of our costs are staff salaries or benefits. It is therefore of paramount importance that we have the right staff available at the right time and that they are prepared, trained and motivated to deliver our service in line with our performance obligations and our cultural aspirations. We have recently expanded our clinical workforce and have found recruitment in specific areas difficult due to national shortages in supply. We therefore recognise that we need to take a much more strategic approach to planning and implementing our plans in this area. Some key components of this are already in place, including programmes to develop leadership, organisational development (OD), staff engagement and organisational capability. The redefinition of our vision and values is a also a part of this and was described in the introduction to this document. 6.6 Workforce development The aims of this are: to agree future workforce models and developing a plan for the required workforce changes to support seven day working to review our approach to succession planning and talent management, including clinical leadership to modernise our teaching to improve learning, including development of simulation training and e-learning methods. Supporting / innovating and a can do, will do culture to develop existing partnerships with education providers and partner organisations, ensuring that students receive an excellent experience to encourage a climate in which staff embrace personal and organisational development and are given real opportunities to improve their own progress. 6.7 Leadership We have a substantial portfolio of leadership programme underway within the Trust and these are supporting the development of leadership at all levels of the organisation. The aim of this is to have leaders who understand the role of strategic and cultural leadership, and are able to role model both transformational and transactional leadership styles as appropriate. Specifically these include several strands of leadership development which have been initiated over the last few months. These include a leadership development programme for Page 29 of 36

82 Clinical Directors and Consultants run by the King s Fund and our in-house Time to Lead Ward Sister Leadership Development Programme. In addition, we have managers from across the Trust taking part in the third cohort of the Acua programme and alumni events are being arranged with previous cohorts to work on embedding the new values with their teams. There are also a number of local and national NHS Leadership Academy development programmes that individual members of staff are attending. We are developing a process whereby they feed in their learning from these courses back into the Trust. We have also appointed a Leadership Development Coordinator on a fixed term basis to support these initiatives. The reorganisation of the Trust around three care groups will be supported via these leadership programmes and it is likely that in addition to activities already underway there will be further work with the senior nurse group (Matrons). The range and depth of these programmes is testament to the fact that we believe they will substantially support the development and implementation of this strategy especially give the constraints facing the NHS over this period. In the medium term we will: develop and deliver a Leadership Development suite of programmes by Band, to be identified through development conversations with line managers. establish a Coaching for Performance register with regular supervision personal leadership development time and reflective learning practices introduced to all senior management roles. In the long term we will: formalise career progression plans for key generic roles introduce leadership development alumni activities to reinforce learning and maintain good practice. We intend to monitor the impact of these programmes and will use the following metrics for this purpose. more staff reporting that they would recommend the Trust as a place to work through the Employee Family & Friends test. reduced reports of bullying and harassment, and incidents of formal grievances reduced turnover Page 30 of 36

83 6.8 Organisational development Following the decision not to merge with Poole Hospital in 2013, The Trust developed an initial Organisational Development plan which was focussed on: developing a positive culture (the way we do things) continuous learning and improvement ensuring clarity of our Trust purpose and direction through a cohesive mission and employee driven values. It also identified the need to develop the necessary capability to meet our Trust s goals in a sustainable way, with mechanisms to effectively measure performance, encourage accountability and improve recognition. Exciting progress has been made and the foundations are being laid. 6.9 OD Strategy development timeframe and considerations a comprehensive three year Organisational Development Strategy is now being developed for review by September 2014 high level costs to be developed on the basis of this proposal & then detailed implementation plans to be developed for each strand. consider implications of strategic plans on skills and workforce required to ensure the OD strategy is fit for purpose. work with the new Care Groups to determine development needs across specialty roles and management roles Staff engagement We will develop the engagement of our workforce such that our staff feel proud to work for our hospital and would recommend the Trust to family and friends, both as patients and as members of staff. There have been several different employee listening events in 2014, including the Values development work. We have launched the Staff Impressions survey which helps us to capture how our staff are feeling about the Trust, and records the Employee Family and Page 31 of 36

84 Friends results. Directorate action plans will be developed each quarter based on this feedback. Charitable funds have been agreed to support an increased programme for employee recognition and to encourage team building activities. #ThankYou! is now live and receiving regular nominations for individuals who have gone out of their way to provide excellent service. We have thirty change leaders who represent a cross section of the Trust. Their role is to champion change and to act as communication ambassadors, feeding information to and from their spheres of influence. In the medium term we will undertake: regular Employee Listening events new Staff Recognition programme will ensure at least 50% of staff are invited to a formal recognition event quarterly Staff Impressions Survey nd Employee Friends and Family Test and appropriate action plans annual Staff Survey new Starters and Leavers questionnaires values development and increased behavioural focus identify opportunities for increased Doctor input and engagement Roll out of #ThankYou! In the long term we will have: increased patient involvement in developing trust initiatives change leader representation across the Trust and involvement in strategic projects. We will use the following metrics for this purpose. quarterly improvements in staff reporting they would recommend the Trust as a place to work. change leader representation is at least 2% of the overall Trust headcount People processes (organisational capability) We will ensure we have the right skills, processes and people in place to meet our organisation s goals. Programmes of current work include the development of essential core skills (formerly mandatory training) and commencing delivery of the Health Care Support Worker Certificate. We are also beginning work on a framework for delivering communication skills training across the organisation, in particular, with an emphasis on end of life care In the medium term we will have: values based recruitment Page 32 of 36

85 trust wide training needs analysis talent management conversation tool rolled out care group development plans education and training strategic group education and training restructure values and behaviours linked to appraisals new starter and leavers questionnaires HCSW care certificate In the long term we will have: an effective talent management and career development framework to ensure people are developed towards their full potential We will use the following metrics for this purpose: reduced turnover and vacancy rates staff report increased personal development opportunities and understanding of career pathways more staff report they would recommend the Trust as a place to work through the Employee Family and Friends Test increased number of applicants for roles and reduction in number of candidates declining jobs We intend that the above approaches ensure that RBCH remains an attractive place to work and learn. However, we also recognise that the recruitment difficulties facing the NHS are unprecedented and we need to ensure that through an iteration of this strategy we have made the best possible plans to mitigate the recruitment risks RBCH informatics strategy The Informatics service for RBCH is combined with that of Poole Hospital this gives the advantages of scale and expertise as well as ensuring that the two hospitals, dealing with the same patient population are maximising the opportunity to use the same patient record and the same IT systems. Key themes of the Informatics Strategy include: access to information (instant, 24/7, anywhere) automation and process improvement system intelligence/memory patient in control Page 33 of 36

86 The informatics strategy will deliver the following key elements: An Electronic Patient Record, presenting clinical information to clinicians at the point of care. This includes scanning existing paper health records. Procuring Best of Breed Clinical Systems including Picture Archive and Communication System (PACS), Electronic Document Management/Scanned Health Records and Electronic Prescribing and Medication Administration. In addition to this the strategy will provide access in secondary care to primary care / community information. Another component of the informatics strategy is to support and encourage the digital consumer. This will be a significant challenge to the way the trust currently works so, to begin with, relatively straightforward services will be offered, such as the electronic transmission of patient letters. Subsequently more complex projects such as the development and use of patient held medical devices and patients accessing their own medical records will be pursued Estates An extensive estates strategy has been updated in the light of not merging, and to reflect the increasing financial constraints. The details for the next two years are set out in the operational plan. Most significant amongst these are the developments at Christchurch Hospital, the new Jigsaw Unit for ambulatory care based Oncology, haematology, breast and gynaecology services and a major programme of ward refurbishments. With completion of the Christchurch project the vast bulk of the Trust s backlog maintenance is resolved. Looking at the 3-5 year time horizon then the capital programme is flexible to follow the results of any clinical service review and several scenarios have been planned at high level. If there is a major reconfiguration generating a large capital requirement beyond our annual budget sums, then the Trust would need to use ITFF loans, or a commercial partnership. The latter route has been informally market tested recently and we are confident there could be alternative funding sources for the capital and construction phase. The RBH site has great flexibility with outline planning permission for additional buildings. The main constraint is the revenue implication of the capital, which would be a significant impact on the financial position of the Trust from 2019 onwards, and would be an important factor in any reconfiguration decisions Commercial Commercial developments to diversify the income sources for the Trust, in areas that leverage our knowledge and support our wider aims are being explored. The two most developed are private patient activities, and our commercial joint venture with a nursing home and senior living development on the Christchurch site. Both of these are being developed and feature as objectives for having longer term strategies in place by the end of 2014/15. Page 34 of 36

87 6.15 Research and innovation The Trust has recently strengthened this function, and is appointing a clinical lead with dedicated time to provide medical leadership. A strategy has been recently adopted, which includes better support and take up of NIHR trials, alongside the continued growth of commercial trials on site. Our close working links with Bournemouth University in particular, (where the research team offices are based) and active participation in the Wessex Research network will continue. The Trust is also well represented on the Board of the newly established Wessex Innovation joint venture, and will use this as the primary route to capitalise on any intellectual property developments. Our improvement work programmes have also a strong element of innovation diffusion and spread of best practice. Learning from others around quality improvement, urgent care and ambulatory emergency clinics, as well as cancer pathways are recent examples. Developing this operational improvement capacity remains one of the four key criteria the organisation will continue to nurture as an enabler for success Strategic planning The Trust Board has also completed the strategic planning self-assessment tool, and identified areas for development. In our initial assessment using the Monitor Toolkit the areas that we felt required the most development are summarised as follows: Regular and frank strategy discussions with a range of LHE stakeholders. Quantification of risks to clinical and financial sustainability and developed transformation plans. Identifying a vision that establishes why and how the organisation should change or transform. Vision is supported by plans for initiatives that can be shown to address any sustainability gap identified. Trust staff, patients and other stakeholders able to explain the ambition and initiatives of the provider when asked. This strategy and the executive summary is the start of addressing these gaps. The Board s creation of the strategy working group will oversee and co-ordinate this work, reporting directly to the Board so that this work has a high profile. The particular focus of effort will be to generate the internal engagement of staff with the longer term strategic direction of the Trust. The dialogue has started about the need for change and to develop mitigating strategies. As this will need to be speciality based and owned by each service, this will entail using much of year one of this plan in supporting each service developing its own plans, within the Trust (and health system) framework and priorities. Page 35 of 36

88 The second area of important focus is the external engagement, specifically with partner organisations. These relationships exist but can be strengthened, and targeted work is required to co-produce a sustainable health and social care local economy. The strategic planning working group will, over the next five years, seek to significantly strengthen our strategic planning capability. The self-assessment tool kit approach will be the mechanism to assess gaps and priorities, and agree action to achieve this. In conclusion our strategic plans are: 1. Early focus on internal improvement 2. Integration of community, then some hospital services 3. Developing our organisational capabilities and supporting strategies The success of all of these approaches will be key to sustaining excellent care for all patients, every time. This is the set of strategic choices the Trust is passionate about delivering. Page 36 of 36

89 BOARD OF DIRECTORS Meeting Date and Part: 11 July 2014 Part 1 Subject: Informatics Strategy update Section: Strategy and Risk Executive Director with overall responsibility Peter Gill, Director of Informatics Author(s): Peter Gill, Director of Informatics Previous discussion and/or dissemination: Informatics Steering Board Action required: The Board of Directors is asked to: Note the progress towards the agreed Informatics strategy and the position of the 27 strategic projects. Summary: The PHFT and RBCHFT Trust Boards have agreed an ambitious strategy for achieving paperless patient journeys and a programme of work to achieve this. This report provides an update to the RBCHFT Trust Board of that progress and indicates the themes that will be worked into a refreshed strategy which will be brought before both boards in autumn Related Strategic Goals/ To support the continual improvement of patient safety Objectives: Relevant CQC Outcome: Risk Profile: The overall ambition of the strategy is to make care safer by ensuring all the patient s historic information is available at the point of care 24/7.

90 1. INTRODUCTION JULY 2014 INFORMATICS STRATEGY UPDATE In April 2013 the 5 year joint Informatics Strategy was approved by both PHFT and RBCHFT Trust Boards. Within this strategy a vision of paperless healthcare was described and 27 strategic projects were identified. It was intended that this strategy would be refreshed each year to ensure that it remains an effective enabler for both trusts overall clinical and organisational strategies. This report describes the progress to the strategy and provides an introduction to planned work for 14/15 and onwards which will be written up in full as a refreshed strategy which will be presented to the boards in Autumn 2014 for approval. 2. PROGRESS SINCE APRIL 2013 The table below provides an overall summary of progress against the 27 strategic projects Project Status Green (running to planned timescale, <3months slippage) Amber (slipped timescale by 3-6 months) Red (slipped timescale by more than 6 months) Timescales changed by Informatics Steering Board (ISB) Projects not planned to have started yet. Number of projects Appendix 1 provides more details of progress and timescales against each of the project. The reasons for the 3 projects being red rated are shown below: Project Title Reason for Delay Project 2. Project 10. Project 19. Network replacement Interim Electronic Patient Record (EPR) New Service Desk System More complexity in the procurement phase than planned and significant delays with third party providers of broadband connections between sites (intersite links) Supplier delays relating to the technical development taking longer than planned Impact of the merged Informatics service and new roles for the IT senior managers slowed down the progress on creating the specification and business case for the new Service Desk System

91 The main successes of the Informatics Service over the last 12 months can be summarised as follows: PACS/RIS successful cutovers at both trusts Full Business Case for new network signed off and procurement completed. Full Business Case for Health Record Scanning and Electronic Document Management (HRS/EDM) signed off and procurement completed. Stability within infrastructure: Client devices, networks, servers, storage and backup facilities running 24/7 for 99.9%+ of the year C.80,000 service desk incidents managed ios (Apple products) based services launched enews at RBCH launched on time and adding significant value. Capability to develop in-house ios applications (apps) developed and piloted with electronic nurse assessments (starting with VTE and nutritional screening) Electronic form for mortality review (emortality) at RBCH has made a significant contribution to clinical governance. Sommerset Cancer Registry launch at RBCH for cancer reporting. Large screen displays on all RBCH wards showing which consultants are responsible for which patients. Computer screens at ward entrances showing staffing levels and other public information (e.g. Friends and Family Test data) New Informatics service launched, TUPE transfer of staff without loss Single Service Desk launched to pool staff resources between trusts. New governance arrangements implemented for managing strategy, controlling risk and reporting performance. New working processes introduced for managing changes and prioritising work Treasury approval (approximately 1M for each trust) relating to c.50% funding for HRS/EDM Paperless ITU (RBCH only) Electronic National Early Warning Score (enews) Treasury approval in principle (approximately 1M for each trust) relating to c.50% funding for Electronic Prescribing and Medicines Administration 3. LOOKING AHEAD TO 2014/15 AND BEYOND The Informatics Steering Board has been considering the major changes that should be represented in the Informatics Strategy for 2014/15 and beyond. 2014/15 must be a year of delivering the current in flight projects (especially EDM and the new data network) PHFT have declared that their financial position and the strength of their current EPR means that they could not support a business case to invest in a new single EPR. The implications of this decision have led to an options appraisal for the EPR investment at RBCH which is still ongoing. enews should be rolled out to PHFT as a result of the with the experience of RBCH Electronic Nurse Assessments (ena) should be created and rolled out as a blend of inhouse developed apps and commercially procured systems but integrated so that nursing staff have efficient access to this critical patient data.

92 Order Communications and Results Reporting (OCSRR) should be deployed beyond the existing GP sites into the acute setting of both trusts. Investment should be made in data storage facilities to provide resilience to critical clinical services Investment should be made in the wireless network at PHFT to respond to the pressures expected from enews and HRS. The plans to access primary care information should be reviewed in conjunction with Dorset CCG. The plans for Thin Client Computing should be put back 2 years as there is no value in planning for this now given the investment that must be made in desktop computing to support HRS/EDM. The plans for a single Active Directory (i.e. staff would have the same logins between PHFT and RBCH) should be cancelled as this is not necessary (and would be too disruptive) given the merger being prohibited. 4. ANNUAL PLANNING In terms of major organisational wide clinical software changes the following table provides a high level view of the 5 major events for the next 4 years. OCSRR and ena are not shown yet as these are currently being planned. 5. RECOMMENDATIONS The Trust Board is asked to note the progress of the Informatics Strategy and the outline plans for 2014/15 and onwards. These plans are being refined (particularly with respect to the strategic EPR business case) and will then feed into a refreshed strategy which will be brought to the Trust Boards for approval Peter Gill Director of Informatics.

93 Appendix 1: Progress of the 27 Strategic Projects Ref Title Progress (Red, Amber, Green) Timescale comments Project 1. Project 2. Workstream 1: Single Informatics Service Implement a Single Informatics Service based on recognised best practice, ITIL 1 Workstream 2: Infrastructure development Network replacement Project 3. Server Virtualisation 2 Ongoing work in progress New service launched, ITIL procedures lead allocated to IT senior managers. Internal alignment of teams and standardisation of processes is work in progress Supplier appointed. Contract signed. In design phase. Significantly delayed by the procurement and installation of the intersite links. Project 4. Thin Client Environment 3 Has not started Strategy has been drafted and is being reviewed within Project 5. Computer Room Strategy Informatics Project 6. Mobile Devices Ongoing work in progress Project 7. Single Active Directory Agreed to cancel this as it was merger related Launched on time slipped by 6+ months ISB agreed to put this back by 2 years due to EDM requiring substantial PC refresh which reduces the value of the business case. It has been agreed by ISB that there is no need to have a single Active Directory in a non merger scenario. 1 IT Infrastructure Library is the internationally recognised best practice for IT service management. 2 Server Virtualisation: the process of replacing the old physical servers which typically only run one software application with more efficient devices which can run up to 20 3 Thin Client is a technology that enables a desktop PC to last for upto 10 years (instead of the typical 4) by a significant investment in servers instead.

94 Project 8. Wireless network standardisation Not yet started. Project 9. Storage, back up and archive strategy Workstream 3: Clinical applications developments Strategy has been drafted and is being reviewed within Informatics Live for a small number of users and adding value. Wider rollout has been delayed by an error in the software which has now been fixed and is being retested. Project 10. Interim EPR Project 11. Strategic EPR Business Case in development Project 12. New Picture Archive and Communication System (PACS) service Cutover to new services fully live. Significant benefits being achieved related to the new functionality of the PACS and the image sharing between RBCH and PHFT. Plan to bring this forward from 2015 to 2014 due to pressure on the wireless network expected from enews and EDM slipped by 6+ months ISB agreed to put this back by 1 year due to the required focus on EDM Software testing underway. Clinical engagement plan Project 13. Electronic Document Management/Scanned Health Records has started and is being stepped up. Processes have been mapped and the training plan is ready to launch once the software is signed off. Small slippage (1-2months) on start date expected due to the delay in the intersite links Project 14. Electronic National Early Warning Score (enews) (RBCH only) Service launched on time and completed the rollout phase for VitalPac nurse on time. VitalPac Dr rollout delayed following feedback from the pilot. Project 15. Electronic Discharge Summaries (EDS) Not yet started Not planned to have started yet Project 16. Order Communications/Results Reporting (OCS/RR) Options appraisal has now concluded and business case in development. Timescales are being planned as part of the business case Project 17. Electronic Prescribing and Medication Administration (EPMA) Procurement launched Feb 2014 expected to conclude by Oct/Nov 2014.

95 Project 18. Access to primary/community information Business Case approved Following the business case the options are being re-examined in conjunction with Dorset CCG. Workstream 4: Effective support Project 19. New Service Desk system Specification written. Procurement launched slipped by 6+ months Project 20. Service Catalogue and Service Pipeline Templates for service catalogue have been drafted Daily system status launched at PHFT. Monthly articles in Core Brief (RBCH) and Staff Bulletin (PHFT). More attendance of IT senior managers to critical operational meetings (e.g. OMG and Directorate meetings). Improve communications with Business Relationship managers nominated for new customers Care Groups at RBCH following the pilot in Cardiology. Project 21. Project 22. Innovative skill building Project 23. IG Assurance Project 24. Service Level Agreements Workstream 5: Responding to Requests for Change Projects being defined pending the outcome of the CC's review Workstream 6: The Digital consumer Continued development of e-learning materials is ongoing IG development at PHFT progressing in accordance to the strategy The interim SLA between PHFT and the Informatics Service is live. A longer term SLA has been drafted and is with PHFT stakeholders for review and feedback. Formal Request for Change process launched with a Change Advisory Board supported by the trust s Clinical Safety Officers. Project Electronic Transmission of patient Technical work to enable this has started and pilots are Workstream changed in light of the merger decision.

96 25. letters planned. Some challenges have emerged with the Information Governance and Clinical Safety signoff. Project 26. Patient held medical devices Not yet started Not planned to have started yet Project 27. Patient Access to their online records Pilots in GUM & Cancer services being developed

97 BOARD OF DIRECTORS Meeting Date and Part: 11 July Part 1 Subject: Section: Executive Director with overall responsibility Author(s): Communications Update, including RAAI and Core Brief Information Richard Renaut, Director of Service Development Tracey Hall, Head of Communications Previous discussion and/or dissemination: Action required: The Board of Directors is asked to note the content of the paper Summary: A summary of communication and fundraising activities including media coverage and Core Brief for June. Related Strategic Goals/ Objectives: Relevant CQC Outcome: Risk Profile: i. Have any risks been reduced? No ii. Have any risks been created? No To promote and improve the quality of life of our patients. To strive towards excellence in the services and care we provide. To be the provider of choice for local patients and GPs. To listen to, support, motivate and develop our staff. To work collaboratively with partner organisations to improve the health of local people. Outcome 1: Respecting and involving people who use services Outcome 12: Requirements relating to workers Outcome 16: Assessing and monitoring the quality of service provision Reason paper is in Part 2 n/a

98 Board of Directors Part I 11 July 2014 Communications and fundraising activities July Introduction The following paper sets out: recent and future communication and fundraising activities RAAI 2. Recent activities 2.1 Communications: promoting and supporting entries for the staff Pride Awards continuing to promote quality and improvement stories through all internal and external communication methods developing the website. Our priorities are updating the following homepage design A-Z of services news channel A-Z of consultants patient information leaflets patient information apps (top 10 most popular leaflets/those for younger services) Ask us section recruitment section Why choose us section patient films supporting the recruitment open day and High Sheriff event first staff social events have been organised for July and August 2.2 Fundraising: Twilight Walk for Women saw over 400 people take to Bournemouth Promenade to raise money for equipment in the Women s Health Unit. To date the event has raised 11.6k (profit) and continues to rise as sponsorship money is paid. the charity s first Will Week takes place week commencing 7 July. This is focused at staff and information stands will be set up for the whole week in the Oasis staff area. This is a free Will writing service but a donation to the charity is suggested to staff. Pedal Power Event bike ride raising funds for Cardiac taking place on Sunday 28 September Light up the Pier this is a commemorative event organised in conjunction with MacMillan Caring Locally and is provisionally booked for Friday 24 October. Funds raised from the event will go towards art in the new haematology and oncology unit with the other 50% to benefit Macmillan Caring Locally. examples of charity purchases include: exercise therapist for bariatric services - 3k eye unit laser - 64k TVs for Coronary Care Unit - 15k Communications activity July 2014 Page 1 of 2 For information

99 Board of Directors Part I 11 July 2014 fingertip oximetres for Thoracic - 1.4k ECG machine for Cardiac - 18k kitchen for patients in Coronary Care Unit - 13k staff recognition and organisational development - 56k two specialist support posts in Haematology / Oncology 69k the Bishop of Southampton visited the Jigsaw building site in June to bless the site. A foundation stone was also laid by Robin Scott, Chair of Women s Health Appeal and Dr Rachel Hall, representing haematology and oncology. The event was very well received by staff and the public with many commenting that is was a very emotional service. The next Board walk around is scheduled for Friday 12 September. 3. Future activities website strategy development developing communication key performance indicators supporting the improvement programmes supporting organisational development work promoting staff recognition programmes fundraising strategy 4. Recommendation The Board is asked to note the report. Communications activity July 2014 Page 2 of 2 For information

100 Read All About It... June 2014 June saw another positive month for media coverage overall as we launched our revised values, along with our #ThankYou! site. Our annual Open Day received positive public feedback and there was also interest in the second stage of the Christchurch transformation project. Coverage about our Bournemouth Hospital Charity was also very good, and a number of articles appeared across a range of media, celebrating the record numbers achieved for the Twilight Walk for Women along with promotion of the Charity World Cup. The Echo also joined us on site to celebrate the fantastic revamp of Ward 26 as well as the blessing of the foundation stone of the Jigsaw building. Articles are published with the kind permission of the Daily Echo, Advertiser, the New Milton Advertiser, and the Stour and Avon Magazine. Summary of media coverage: June 2014 Online 7 Print 28 Radio 0 Television 0 June 2014 coverage Positive 29 Negative 0 OK 3 June 2013 Positive 56 Negative 1 OK 4 June 2014 l 1

101 Date Publication Title Information Page number Article size Value 3 June 2014 Daily Echo Walking to raise cash The Twilight walk for women. 5 Sixteenth of a page 635 Date Publication Title Information Page number Article size Value 3 June 2014 Daily Echo Experts will talk on care Dr Sean Weaver and Dr Ros Pugh will talk about end of life care on June 25 at Christchurch Civic office. 11 Sixteenth of a page 635 Date Publication Title Information Page number Article size Value 4 June 2014 Daily Echo Specialist lupus nurse Dorset lupus groups have welcomed a new specialist nurse Carol Brumpton who will be based at RBH. 20 Sixteenth of a page 635 June 2014 l 2

102 Date Publication Title 5 June Bournemouth Hospital launches a thank you website June 2014 l 3

103 Date Publication Title Information Page number Article size 7 June 2014 Daily Echo Excellent care for every patient, every day, everywhere Advertisement feature. 21 Full page June 2014 l 4

104 Date Publication Title Information Page number Article size Value 7 June 2014 Daily Echo It s just what the doctors ordered Ward 26 has been redecorated following the CQC inspection last December. 12 and 13 Two pages 20,730 Date Publication Title 22 June Bournemouth Hospital ward is turning itself around after damning CQC report June 2014 l 5

105 June 2014 l 6

106 Date Publication Title Information Page number Article size Value 6 June 2014 Stour & Avon Magazine Family fundraising team staging event this weekend Mother and daughter team fundraising for Jigsaw appeal have raised over 5, Quarter of a page 180 Date Publication Title Information Page number Article size Value 6 June 2014 Stour & Avon Magazine End of Life Care Talk to take place on 25 June at the Civic Centre Christchurch. 24 Sixteenth of a page 45 Date Publication Title Information Page number Article size 7 June 2014 New Milton Advertiser Hospital Trust ages Inaccurate article printed. 21 Sixteenth of a page June 2014 l 7

107 Date Publication Title Information Page number Article size Value 10 June 2014 Daily Echo Revamp of hospital is ready to go ahead Work at Christchurch hospital is moving forward. 16 Two thirds of a page 7005 June 2014 l 8

108 Date Publication Title 12 June Enter local world cup June 2014 l 9

109 Date Publication Title 13 June Royal Bournemouth Hospital s Open Day deemed a success June 2014 l 10

110 Date Publication Title Information Page number Article size Value 13 June 2014 Stour & Avon Magazine Thank you for my care RBH is making it easy for people to show appreciation for the care they have received. 30 Eighth of a page 90 Date Publication Title Information Page number Article size Value 14 June 2014 New Milton Advertiser 12m hospital overhaul enters second stage 12m transformation of Christchurch Hospital is set to enter its second stage. 7 10cm x 2 columns Date Publication Title Information Page number Article size Value 14 June 2014 New Milton Advertiser Hospital patients can say thank you on new website New website has been launched for patients, relatives and carers to thank Royal Bournemouth and Christchurch Hospitals staff. 5 10cm x 2 columns June 2014 l 11

111 Date Publication Title Information Page number Article size Value 16 June 2014 Daily Echo Huge turnout for Hospital Twilight Walk Record number of fundraisers took part in the Twilight Walk. 16 Half page 2535 Date Publication Title 22 June Twilight Walk is a record breaker as hundreds raise cash for women s unit Date Publication Title Information Page number Article size Value 18 June 2014 Daily Echo Heroin addict abused patients in hospital Patient who shouted at RBH staff was given a four week prison sentence. 10 Eighth of a page 845 June 2014 l 12

112 Date Publication Title Information Page number Article size Value 18 June 2014 Daily Echo Building to be blessed The Bishop of Southampton will officially bless the new Jigsaw building site at RBH on 18 June Sixteenth of a page 635 Date Publication Title Information Page number Article size Value 18 June 2014 Daily Echo RBH to host carers event A carers event will be held in the conference room at RBH on Saturdy at 10am. 20 Sixteenth of a page 635 June 2014 l 13

113 Date Publication Title Information Page number Article size Value 19 June 2014 Daily Echo Coming together Dream for staff as Jigsaw building is blessed. 10 Two thirds of a page 7005 June 2014 l 14

114 Date Publication Title Information Page number Article size Value 19 June 2014 Daily Echo Annual open day success for hospital Visitors allowed to see behind the scenes at RBH open day. 10 Eighth of a page 845 Date Publication Title Information Page number Article size Value 19 June 2014 Christchurch Advertiser Revamp of hospital is ready to go ahead Work at Christchurch hospital is moving forward with plans to build a new nursing home. 11 Eighth of a page June 2014 l 15

115 Date Publication Title Information Page number Article size 20 June 2014 Daily Echo Banishing boozers is not the answer A&E departments at RBH and Poole say alcohol is a big issue for A&E. 4 Two thirds of a page Date Publication Title 20 June Banning drunks from A&E would create more problems say hospital staff June 2014 l 16

116 Date Publication Title Information Page number Article size Value 21 June 2014 Daily Echo Great praise for NHS staff Patient comments on good care received at RBH. 18 Sixteenth of a page 635 Date Publication Title Information Page number Article size Value 23 June 2014 Daily Echo Lift the World Cup for charity Bournemouth Charity six-a-side tournament will take place at Littledown Centre on20 July. 10 Eighth of a page 845 June 2014 l 17

117 Date Publication Title Information Page number Article size Value 25 June 2014 Daily Echo Thank you for caring Patient comments on the good care received at RBH. 6 Eighth of a page 845 Date Publication Title Information Page number Article size Value 25 June 2014 Daily Echo Coffee time for Friends League of Friends holding a coffee morning on Saturday from 10:30am. 20 Sixteenth of a page 635 Date Publication Title Information Page number Article size Value 26 June 2014 Daily Echo Macmillan fundraiser Fundraiser will take place to support Macmillan unit at Christchurch Hospital on July Eighth of a page 845 June 2014 l 18

118 Date Publication Title Information Page number Article size Value 26 June 2014 Bournemouth Advertiser Bless this building The Bishop of Southampton blesses the Jigsaw building site at RBH. 1 Eighth of a page June 2014 l 19

119 Date Publication Title Information Page number Article size Value 27 June 2014 Daily Echo Hospital trusts praised for clinical research RBCH and Poole Hospital have been praised for their clinical research. 4 Eighth of a page 845 June 2014 l 20

120 Date Publication Title Information Page number Article size 28 June 2014 Daily Echo Now you have aids Prison sentence for nurse death threats Serge van Den Heerik sentenced to 4 months in prison for assaulting a doctor and abusing a nurse while receiving treatment. 1,4 and 5 Two and a half pages June 2014 l 21

121 June 2014 l 22

122 June 2014 l 23

123 Date Publication Title 27 June Mastectomy patient organising disco June 2014 l 24

124 Core Brief June From: Tony Spotswood, Chief Executive 2014 How we are acting on your ideas It is the year of change for our Trust, and throughout 2014 we are building on what we do well, changing to improve and developing the skills and commitment to staff. Over the last few weeks the Staff Leading Improvement roadshow has been visiting the Royal Bournemouth, Alderney and Christchurch hospitals, asking for your improvement ideas (our prize raffle has been drawn and winners notified) and showing you what we have already achieved. You have also been learning about our new vision and values and the new Improvement Academy. We have reviewed all of your ideas which can be grouped around the following themes: culture communication environment organisational reputation patient care - safety patient care - effectiveness patient care - experience Some of your ideas are already being progressed and we will communicate the progress on these together with how all other ideas will be prioritised within the next two or three weeks. What you thought of the event: It is lovely to have an event like this which is open to staff and enables others to listen to their views and suggestions. It means they can help shape the way they work and improve the hospital. It improves their morale and makes them feel like they are being listened to. Denise Richardson, project team coordinator I am really pleased this event has come to Christchurch. This day is really positive and gives staff here a good chance to learn about the good work being done across both hospitals, and it gives them a chance to have a voice and feel valued. Kathy Bluston, physiotherapist Events like this are a great way for staff to raise any concerns they have and let their feelings be known. I think some people find it hard to speak directly to managers at times, but this way they can speak out with the confidence that their feelings will be heard, and acted upon. Stephen Coombes, Estates It s not too late to submit an idea. You can contact Sharon McAndrew in the Improvement Team at sharon.mcandrew:@rbch. nhs.uk

125 Workplace ambassadors - could you make a difference to a young person? We have been approached by the Bourne Academy to build links between their sixth form students and people in the world of work. The idea is to develop a professional relationship between the student and a workplace ambassador, which would be a rewarding experience for both parties. Students are studying a variety of topics and may require help and support to build confidence, understand the working environment, complete university/ job applications and write CVs. If you are interested you will need to commit to five, one-hour sessions during the 2014/15 academic year. These can be in the workplace or another agreed location. Ambassadors should: be currently working for the Trust able to listen and advise enjoy passing on their knowledge and experience be committed to the learning and development of others willing to undertake a DBS (previously known as CRB) check All staff are welcome to apply to the scheme. If you are interested please your name, department and contact details to vicky.douglas@rbch.nhs.uk These details will be passed to the Raising Achievement and Lifelong Learning Co-ordinator at Bourne Academy. You will then be invited to attend an information session prior to making a final commitment to the scheme. Celebrating compliance At RBH, around 40% of inpatients have dementia - higher than the national average. The government has developed a Commissioning for Quality and Innovation (CQUIN) assessment for the screening of patients aged 75 or over who are admitted as an emergency admission. The screening promotes early identification of patients with an existing diagnosis of dementia and identifies patients with cognitive problems which had not previously been investigated. This in turn ensures our patients receive the right care and management while they are being treated at our hospitals, thus potentially reducing their length of stay. In order to meet the CQUIN standard, the Trust must meet 90% compliance in all three stages of the screening process for three consecutive months. The first stage is undertaken by nurses and we are very close to reaching the 90% target across all wards. To celebrate this, wards that achieved 100% compliance have been given certificates and vouchers for the Shelley Restaurant for their team, while those who achieved 90% or above have been awarded certificates. Lisa Lee, Dementia CQUIN Project Lead, has been supporting wards and offering guidance on how to carry out the screening. She said: If we are aware that a patient has dementia, we can ensure their individual needs are being met therefore promoting a better hospital experience. Our nurses work hard to complete these important assessments and it s great to be able to recognise this with certificates and vouchers. Lisa will continue to work with other staff to improve the compliance with stages two and three of the screening process. For further support call ext 4049 or lisa.lee@rbch.nhs.uk

126 2014 Pride Awards - start nominating! Over the past five years we have recognised the contribution from staff through an annual awards ceremony. This year the awards have been relaunched to reflect the values you told us that you wanted to focus on - communicate, improve, teamwork, and pride. To deliver excellent care for every patient, every day, everywhere, we need the best staff who are living our values, are highly motivated, feel valued, are encouraged to contribute their good ideas and achieve excellence. There are nine award categories in which you can nominate your colleagues and staff. The closing date for nominations is 12noon on Monday 7 July. Go to for more details and to make your nomination. Staff Family and Friends Test - give us your impressions Following on from the national Friends and Family Test for patients, we are now asking you, our staff, if you would recommend our hospitals to friends and family if they needed treatment and as a place to work. However we want to know more than that, so we have decided to use this opportunity to ask you every three months for your views on working for our hospitals. We want to know how you are feeling so we can support you in providing excellent care to every patient, every day, everywhere. Please tell us about the good and the not-so good so that we can work with teams and departments to make plans for constructive changes. In quarter one, which will run until Monday 30 June, staff are being asked to fill in a short online questionnaire that should take no more than 10 minutes to complete. You can access it at myimpression.co.uk/2014qtr1. Quarter 2 will consist of a more in-depth questionnaire and will be introducing additional surveys for new starters and for those leaving the Trust. Please take the time to complete the survey to make sure we hear your views. As a leader, please encourage your employees to complete the survey. If you have any questions about the survey or the Staff Family and Friends Test, please contact the Organisational Development Team on ext or via organisational. development@rbch.nhs.uk #ThankYou! Have you ever wanted to thank a colleague but didn t know how to, or been really impressed by a team member who has gone out of their way to help you? We are giving you the chance to tell everyone about it. When we were developing our values, you told us how good it makes you feel when someone says thank you. Having staff or patients saying thank you still gives me a buzz knowing one little thing made a difference that day. I feel proud when I get a thank you or compliments from colleagues/patients about my work. You also told us you like it when patients say thank you or send in notes and cards. Patients say they like to be able to recognise your efforts and contribute towards their care. It is not necessarily the big things but a patient who says thank you to us for explaining their treatment/input makes a difference to our day. We have introduced the #ThankYou recognition pages which you can access via the intranet. They are also available to patients, carers and family members at It doesn t take long to submit a thank you. There are no prizes or awards but we will make sure the individual and their line manager is aware of your nomination. We will also celebrate them on the #ThankYou! pages and on our social media pages. So the next time someone goes out of their way to help you, why not say #ThankYou!

127 Let s talk about IT Desktop changes to your PC or laptop You will soon be able to view all of the key information about your PC or laptop on your desktop. This should ensure the IT department has more information available rather than having to ring back to confirm any necessary details. The content will be situated in the bottom right of your screen and will appear on every PC or laptop in use in the Trust. This will not interfere with the overall functionality of your desktop, and there will be no change to icons or files. Electronic Document Management (edm) Our hospitals, Poole Hospital and hospitals in the community are starting the process of converting all current paper patient notes into electronic format. If you and your staff use the patient case notes, you will need to ensure that you know how to find and view them on Evolve, our new edm system. Once the paper version has been scanned, it will only be available on Evolve. The roll out will begin later this year. In order to prepare and support you and your staff during this transition, IT Training will be offering training sessions on how to use Evolve. Basic IT skills training will also be available for staff that need to develop their skills in this area. For guidance and an assessment of the skills required please go to the edm webpage on the Intranet at index.php. Following the assessment, if you feel you or your staff would benefit from additional basic IT skills training or have any queries regarding this, please contact IT Training on ext edm superusers We need representatives from all staff groups to become edm uperusers as we move towards electronic patient notes. The role will be busiest during the rollout period from September 2014 to April 2015, with the workload decreasing over time. All you need to know about edm superusers but were afraid to ask! the main difference between superuser and end user training will be access to more information to enable you to support your colleagues this is a supportive role, and there is no expectation to train other staff superusers will get a named contact in the IT Training Department so they are supported in their role and have information to disseminate you will need to attend refresher sessions as required don t forget to book your training as soon as possible - you will not be an authorised superuser unless you have attended the super training session. If you are interested in getting involved, please edm@rbch.nhs.uk with your name and contact information.

128 Clinical Viewer blank event An issue has been raised to Informatics where occasionally on Clinical Viewer an event is opened for a Pathology test but it is showing blank when pulled up. This is resolved in CaMIS Version 21 which is being put into the training environment later this month and will go live during July. In order to resolve this you can slightly resize the event window when you have opened it and the screen will automatically refresh. Apologies for the inconvenience this is causing. DatixWeb - a new online incident reporting system All staff will soon be able to report incidents, such as patient falls, medication errors, pressure ulcers and staff accidents, using a new online database. Currently, all incidents are reported using a paper based system, but this has proved time consuming, cumbersome to use, and does not give staff prompt feedback. Soon every department will have access to DatixWeb, which will enable staff to record the details of an incident using an online form, and create reports for their own areas. The system will be piloted in selected areas before being rolled out across the Trust. Having a more effective web based system means we can improve reporting of near miss and no harm events to ensure early actions are taken to mitigate patient safety risks. Become a staff governor Would you like to represent the views of your work colleagues on how the Trust is run? The Trust has a Council of Governors which represents the interests of members, partner organisations and the local population. This includes staff at the hospitals. Governors also regularly feedback information about the Trust and its performance to members. The Council of Governors has specific powers and responsibilities, including: There are two staff governor vacancies: Allied Health Professions, Scientific and Technical Nursing, Midwifery and Healthcare Assistants Only members in these staff classes will be eligible to stand as a governor and vote in this election. The nomination packs will be available from Wednesday 11 June the appointment of the Chairman and non-executive directors on the Board of Directors approving the appointment of the Chief Executive by the Chairman and non-executive directors appointing the external auditors giving their views on the Trust s forward plans and strategy and on its quality priorities and objectives. For more information on what the role of a governor involves, or if you would like to talk to one of the current staff governors, please contact Dily Ruffer, the Governor Co-ordinator, on ext 4246 or at dily.ruffer@rbch.nhs.uk.