Trust Board Meeting in Public: Wednesday 9th November 2016 Title NHS Improvement Monthly Review of Performance Status History For information. Regular report. Board Lead(s) Jason Dorsett, Chief Finance Officer Key purpose Strategy Assurance Policy Performance NHSI Monthly Review of Performance November Page 1 of 5
Executive Summary 1. This paper provides key points from recent liaison with NHS Improvement and the regulator s review of the Trust s performance. 2. Following the escalation by NHS England and NHS Improvement of operational performance against core standards in Oxfordshire during September, liaison with NHS Improvement, Oxfordshire CCG and NHS England as OUH works to improve performance are described. 3. Key financial metrics from Month 6 s report to the regulator are shown. Recommendation 4. The Board is asked to note the report. NHSI Monthly Review of Performance November Page 2 of 5
1. Introduction 1.1. This report provides an update on reporting to NHS Improvement and liaison with the regulator. 2. Operational performance 2.1. The NHS Improvement report to the Board in September recorded that the regulator had noted that OUH s performance during 2016/17 had not met national standards in six areas but, anticipating the trust working promptly to achieve sustainable compliance with the targets and in line with submitted improvement trajectories, the regulator had decided not to open an investigation to assess whether OUH could be in breach of its licence at this stage. 2.2. This led to the Trust being placed into segment 2 of the new Single Accountability Framework for NHS providers (1 being best, 4 being worst). 2.3. NHS England wrote on 16 September to advise that in the absence of a clear and agreed system plan to improve, NHS England and NHS Improvement were formally escalating the performance of Oxfordshire CCG and OUH and confirming joint NHS England and NHS Improvement support to the Oxfordshire system. 2.4. OUH has since refreshed and updated its performance improvement plans for Urgent Care, RTT and Cancer waits. These have been sent to and discussed with NHS Improvement. 2.5. NHSI carried out a site visit to OUH on 4 October. This was an opportunity to consider with the Trust progress made on its financial plan, with recognition that the surplus required through the 2016/17 control total at 4% of turnover and the cost improvement programme required to deliver the control total for 2017/18 at 8.5% of turnover both assumed levels of financial performance well ahead of the NHS in England. 2.6. The Trust s plans for urgent care, RTT and cancer were also considered in detail with clinical leads and a briefing was provided on the contingency plan to provide safe maternity services across the Horton and John Radcliffe sites, and on progress towards agreeing contracts for the coming two years. 2.7. Following a further deterioration in performance against the four hour wait standard in the Trust s Emergency Department during October, a meeting took place on 1 November to consider causal factors and explore the potential for urgent action in more detail. 2.8. As a result, an action plan developed by the Director of Clinical Services in close liaison with clinically-led Divisions and with NHS Improvement includes actions to: 2.8.1. Rapidly stabilise and improve waiting times for people att the minors side of the Emergency Department at the John Radcliffe, with the aim of improving overall 4 hour wait performance to above 80% during November. 2.8.2. Work with Oxfordshire organisations to strengthen out of hospital capacity and improve the flow of patients to out-of-hospital care, with the aim of further improving performance after November towards the 95% standard. 2.8.3. Continue to deliver changes to specific cancer pathways to meet the 31 day standard from November and the 62 day standard from January, from which point all cancer standards should be met by the Trust. NHSI Monthly Review of Performance November Page 3 of 5
2.8.4. Take action in specific specialties to reduce 18 week Referral to Treatment Time (RTT) waits, with the aim of meeting sustainably from January the RTT standard for patients on incomplete pathways. 2.9. These actions will be taken whilst OUH works to deliver its significant control total surplus in 2016/17 and achieve a position of underlying balance by the year end. 3. Trajectories for 2017/18 3.1. NHS Improvement s allocation of a control total to OUH came with a requirement to submit monthly improvement trajectories for 2017/18. For OUH, these will be for A&E 4 hour waits and will need to be signed off by Oxfordshire CCG and submitted by 12 noon on 24 November and finally by 23 December. 3.2. These trajectories will need to take account of the work described above. 4. Month 6 report to NHS Improvement 4.1. The key financial metrics reported to NHS Improvement for September are shown at Appendix 1. 4.2. The overall Financial Sustainability Risk Rating remained at 3. 5. Other liaison with NHS Improvement 5.1. Information about the Care Quality Commission s inspection of some OUH services was provided during October to NHS Improvement. 5.2. An update on RTT performance was provided on 25 October, highlighting causal factors behind the rise seen in breaches of the 18 week standard, summarising actions being taken to address it and explaining that weekly meetings take place to review the Patient Tracking List and agree necessary action. 5.3. As required of all NHS providers, a return was submitted on 24 October on the cost of corporate services and information was sent on 31 October about high cost agency workers and long term agency usage. 5.4. Following announcements during October by NHS England, information was sought from NHS Improvement on the process OUH could follow to clarify its access to funds from the national 130m investment in radiotherapy equipment and the national 8m investment in maternity safety training. The Board will be updated on a response once it is available. 6. Recommendation 6.1. The Board is asked to note this report. Jason Dorsett Chief Finance Officer November 2016 Report prepared by: Jonathan Horbury, FT Programme Director NHSI Monthly Review of Performance November Page 4 of 5
Appendix 1 Month 6 financial data from Oxford University Hospitals NHS FT units Plan YTD 31-Aug- 16 Actual YTD 31-Aug- 16 Adjusted Forecast Year 31-Mar- 17 Forecast Variance Year 31-Mar- 17 Capital Service Cover Capital Service, total m (18.540) (17.969) (36.075) 1.293 Revenue Available for Capital Service m 46.864 44.334 94.433 (4.813) Capital Service Cover metric 0.0x 2.53 2.47 2.62 3.72 Capital Service Cover rating Score 3 3 4 Liquidity Working capital balance m (5.291) (2.273) (2.103) (5.748) Operating Expenses within EBITDA, Total m (460.582) (456.209) (913.457) (0.053) Liquidity metric Days (2.1) (0.9) (0.8) (2.265) Liquidity rating Score 3 3 3 I&E Margin Normalised Surplus/(Deficit) m 14.290 13.082 31.240 (2.860) Adjusted Total Income for FSRR m 507.596 500.986 1,008.390 (4.560) I&E Margin % 2.82% 2.61% 3.10% (0.30%) I&E Margin rating Score 4 4 4 I&E Margin Variance From Plan I&E Margin Variance From Plan % -0.48% -0.20% -0.27% I&E Margin Variance From Plan rating Score 3 3 3 Financial Sustainability Risk Rating Capital Service Capacity rating Score 4 3 4 Liquidity rating Score 3 3 3 I&E Margin rating Score 4 4 4 I&E Margin Variance rating Score 3 3 3 Overall Financial Sustainability Risk Rating Score 4 3 4 NHSI Monthly Review of Performance November Page 5 of 5