EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST REPORT TO: BOARD OF DIRECTORS DATE: 7 AUGUST 2015 SUBJECT: REPORT FROM: PURPOSE: CHIEF EXECUTIVE S REPORT CHIEF EXECUTIVE Decision CONTEXT / REVIEW HISTORY / STAKEHOLDER ENGAGEMENT The Chief Executive provides a monthly report to the Board of Directors providing key updates from within the organisation, Monitor, Department of Health and other key stakeholders. SUMMARY The monthly report from the Chief Executive provides the Board of Directors with key issues related to: RECOMMENDATIONS: The Board of Directors is asked to note the report. The Board of Directors is asked to endorse the recommendation to move to full Trauma Unit status on recommendation from the Trust s Management Board. NEXT STEPS N/A IMPACT ON TRUST S STRATEGIC OBJECTIVES: Compliance with notifications from regulatory bodies and policy changes all contribute towards achievement of strategic objectives. Page 1 of 8
LINKS TO THE BOARD ASSURANCE FRAMEWORK: To enable the Trust to respond in a timely fashion with appropriate information which may affect the Trust s rating with Monitor and the CQC. IDENTIFIED RISKS AND RISK MANAGEMENT ACTIONS: None FINANCIAL AND RESOURCE IMPLICATIONS: None LEGAL IMPLICATIONS / IMPACT ON THE PUBLIC SECTOR EQUALITY DUTY: None. PROFESSIONAL ADVICE TAKEN ON ANY NOVEL OR CONTENTIOUS ISSUES: None BOARD ACTION REQUIRED: The Board of Directors is asked to note the report. CONSEQUENCES OF NOT TAKING ACTION: Failure of the Trust to respond in a timely fashion with appropriate information may affect the Trusts rating with Monitor and the CQC. Page 2 of 8
1 EXECUTIVE SUMMARY 1.1 Cultural change programme 1.2 CQC CHIEF EXECUTIVE S REPORT July saw the launch of the trust s revised We Care values. Bringing back respect for each other was a key message from the staff focus groups that were held in February 2015 at the start of our great place to work programme. The importance of respecting colleagues has come up again and again through the different staff forums we have held and in individual conversations I and other executive directors have had with staff since concerns over bullying and harassment was brought into sharp focus by the CQC visit in March 2014. So much so, the Board of Directors agreed to make respect one of the defining values at East Kent Hospitals University NHS Foundation Trust. At the beginning of 2014 the Board adopted the caring, safe and making a difference values after hundreds of staff contributed to the development of our values through the initial phase of the We care programme. This builds on that work and develops our values further. The week commencing 13 July the trust received an inspection by the CQC with some 50 inspectors visiting the trust s five sites. This was a challenging week but gave staff the opportunity to talk with the CQC about the progress made in recent months as part of the trust s Improvement Journey as well as issues that still require improvement and further attention. The CQC made specific comment on how well the inspection had been organised and how positively they had been received by the staff that they met. At the time of writing we have not received a follow up unannounced inspection visit. We are not expecting to receive the CQC s report until October. The trust s Improvement Board are now reviewing the existing action plan with the aim of integrating quality/cqc improvements, cultural change, financial recovery, operational performance and strategic development into one integrated improvement plan. This plan will be discussed at the Management Board and finally presented to the Board of Directors for agreement. 1.3 Quality We continue to see a high level of satisfaction via the friends and family test, in particular with inpatients and maternity of whom 95% and 98% respectively would recommend the Trust to their friends or family. We have also agreed this year s CQUINs with our commissioners and are on track to achieving them for the first quarter. This will be formally reported next month. This month we have provided a heat map of the wards that shows at a glance where some of our hotspots are with patient experience in relation to staffing. The detail of this can be found in the Clinical Quality & patient Safety Report. The Trust also reported under trajectory for C-Diffs with only one case reported in June 2015. 1.4 Strategy - 'delivering our future' An update on the timeline and engagement plan is on the Board as a separate item. A third medical engagement event is being planned for September along with primary care colleagues (CCGs) to consider further the strategic options available to the trust Page 3 of 8
to secure clinically viable and sustainable services to our patients going forwards. This will feed into the full public consultation process planned for 2016. 1.5 Finance Our financial position has been deteriorating rapidly and we have established a Financial Recovery Group to address these issues. The current budget forecast for 2015/16 is that even if we deliver a 16 million cost improvement plan we could see a deficit of around 37 million by the end of this financial year. The main reasons for the large forecast deficit is: the very high use of temporary staffing, particularly medical locums (our total spend on temporary staff after three months is 6.7m; this includes 3.7m on locums and 1.4m on nursing), additional out-sourcing of activity to the private sector to meet waiting time targets ( 2.8 m in the first 3 months of this year), additional medical sessions to manage waiting lists ( 1.8 m so far this year), and the complexities of running three acute sites with high levels of vacancies. Unlike some other acute providers, we have so far not had to seek cash support, known as distressed funding, from the Department of Health, but our financial position makes this eventuality a very high risk however every action must and is being taken to mitigate this risk, this includes a reduction in the 2015/16 capital programme and disposal of assets that are surplus to requirement. We need to get a firm grip on the finances and we have and are putting in place futher measures to both reduce our expenditure and increase income across the trust. This is a huge task and we will have some difficult and no doubt unpopular decisions to make as we develop our 3 year financial recovery programme. Patients are at the heart of services and we will not compromise patient safety, but to be able to invest in services for the future, we need to ensure that we bring the budget back into surplus. 1.6 Performance The trust continues to underperform in the delivery of the A&E target, with pressures in RTT and some cancer pathways remaining. The Board performance report reflects the current position. An A&E performance Summit was held on 28 July with Monitor and NHS England with all health and social care partners in east Kent to consider progress against the whole system urgent care action plan. Improving the emergency/urgent care pathway both within the trust s hospitals and in the community remains a key priority for the board. 4 KEY MESSAGES FROM MONITOR 4.1 Agency Spend Monitor is continuing to develop, working with the NHS Trust Development Authority and Department of Health (DH), our proposals for: applying a ceiling on agency spend by provider applying a cap on maximum rates of agency pay for different types of staff using agency frameworks Page 4 of 8
Proposals will be discussed with Trusts over the coming weeks, with a view to these arrangements coming into force between July and September. Monitor will not implement their proposals until they are confident that there is an evidence base to support the limits set, particularly where there may be regional variations. Until this work concludes, Monitor has asked Trusts to manage agency spend in line with initial guidance published. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/431694 /Annex_to_letter_to_Chairs_and_CEs_of_FTs_020615.pdf Trust Response: The Trust continues to address its use of temporary staff. Staff have been advised to stop using off framework agency staff by 1 September.,Agency staff who currently work for an off framework agency are being advised to consider either applying for one of our vacancies, joining NHSP or joining a framework agency to enable them to continue to be able to work at the Trust. Procurement Services have been working with Trust Divisions to prepare for this change and have increased the number of framework agencies we have available to us wherever possible. The Trust is also reviewing use of all temporary staff to reduce its dependency wherever possible. 4.2 Latest assumptions for provide inflation Monitor is asking Trusts to familiarise themselves with the latest assumptions for provider inflation for the period 2015/16 to 2019/20. https://www.gov.uk/government/publications/economic-assumptions-201516-to- 201920 Monitor is recommending Trusts use these assumptions when undertaking planning and forecasting activities, while also taking account of local circumstances, opportunities and pressures. 4.3 Nursing and Midwifery Revalidation Nurses and midwives are now required to revalidate when they renew their registration every 3 years. This is a recommendation of the Mid Staffordshire NHS Foundation Trust Public Inquiry and from April 2016 will replace the post-education and practice standards. Monitor s Nurse Director Ruth May has produced some key questions that may be helpful to consider as you develop your plans. Trust Response: A steering group is in place that is ensuring we are prepared as a Trust. All nurses who are due for revalidation will be identified through the electronic staff record. Documentation is available and frequently asked questions are being developed. These resources will be provided on line as part of the Quality Improvement and Innovation Hub website and support will be provided for all staff due in the first wave to help them develop their portfolios. 2 TRAUMA CENTRE REMOVAL OF INTERIUM STATUS The Board will be aware that our hospitals William Harvey and Queen Elizabeth the Queen Mother are part of the Trauma Network with King s College Hospital as the Trauma Centre. This network has been the best performing in the country. At the last visit to the William Harvey Hospital, it was stated that The SELKaM Trauma Network and CCG panel members would be keen to support the Trust in moving to full Page 5 of 8
Trauma Unit status in order to raise their prestige and assist with recruiting difficulties provided this would not pre-determine the outcome of the Clinical Strategy review. It was the Panel s view that this would not, as Trauma Status is fluid (dependent on performance and on-going compliance with requirements), so an alternative model could be adopted in East Kent should the outcome of the Clinical Strategy require this. The recommendation of the trust s Management Board to the Board of Directors is that we move to full Trauma Unit status. This is supported by the Divisional Medical Directors. 3 STROKE SERVICES Local clinical commissioning groups are reviewing the area s stroke services because of concern over the performance of seven units currently admitting patients in the area. The national recommendation is that a unit should see more than 600 patients per year and none of the units in the area meet these guidelines. Access to a specialist unit within four hours of being taken to the unit is also below the national average. Performance across units is also variable and there is a shortage of specialists within these services. All units have improvement plans in place, but several have recognised that continuing with the current model is unsustainable. The commissioners case for change focuses on the first two weeks of care following stroke hyper acute and acute stroke care. It is currently being reviewed by the CCGs and the South East Coast Clinical Senate. If approved, options for reconfiguration will be drawn up with a preferred option expected to be approved this year. 4 TRUST DEVELOPMENTS New BSL Interpreting Services Deaf patients across Kent are now sporting an innovative card to help health services support them at their appointments by providing a British Sign Language (BSL) interpreter. The business-style card, which is completely free and the brainchild of East Kent University Hospitals Foundation NHS Trust (EKHUFT), Kent Community Health NHS Foundation Trust (KCHFT), and Kent County Council (KCC), was launched at theend of May 2015. Most people do not realise that for many deaf people, English is not their first language. It must be very frightening having to sit through a medical appointment if you cannot understand what is being said to you. Deaf people can now show this card before their appointments to make sure their healthcare professional is prepared and able to support them with an interpreter. Learning Disability Practice Award 2015 Kings D Ward staff were awarded the Barbara Mushett Award after it was recognised they had developed a culture (under the guidance of the Surgical Matrons) where people with learning disabilities and their families can expect that standards tools like the Hospital Communication Book and My Healthcare passport will be used effectively, while they will go that extra mile to ensure that care is coordinated and led effectively at the bed side. Their case study identified how they engaged all stakeholders and crucially identified reflective learning points for future care delivery. Page 6 of 8
Ground breaking quality improvement initiative One of the Trust s Consultant Nephrologists has been selected to join the inaugural participants of a ground-breaking new initiative to improve the quality of care for patients in the NHS. The Q initiative, run by independent health care charity the Health Foundation together with NHS England, will connect people dedicated to improving the quality of care across the UK. The initiative will make it easier for people from all parts of the health system with expertise in quality improvement to share ideas, enhance their skills and introduce changes to make care better for patients. There are 231 people in the founding cohort of Q from front-line clinicians, managers and researchers to policy makers and patient leaders. The test will be designed, refined and testing during 2015. The initiative will then launch more widely in 2016, with an aim to recruit 5,000 participants by 2020. Integration through education More than 20 GPs from within the Thanet CCG practices attended the pilot primary care-secondary care joint learning programme organised by one of the Trust s Consultant Physician & RCP College Tutor and GP StR. Although this was primarily intended as an academic event, it provided a significant platform and opportunity for hospital consultants, GPs and health professionals to network, discuss and share many ideas for future service developments in order to improve care for our patients within the Thanet community. Staff presentation at Renal Conference Congratulations to members of the renal team from the Kent Kidney Care Centre who presented their work at the British Renal Society conference in Leeds last week. The conference was attended by over 700 delegates from renal multi-disciplinary teams across the UK. All the presentations generated a lot of interest from the audience and we are very proud of all those who were able to present and attend. ISO Standards The Department of Medical Physics was recently audited by their notified body against ISO 9001 and ISO 13485 standards. The auditors were very impressed with the level of service being provided across the three main sites and were happy that the Department remain compliant with both standards in all areas. No corrective actions or observations were raised which is fantastic news and demonstrates that The Department of Medical Physics and Clinical Engineering provide services to a high and globally recognised standard. Campaign for Better Hospital Food Latest figures from the Campaign for Better Hospital Food reveal that the Trust is among the best in the country for minimising waste. According to their statistics, the Trust wastes just 1.73% of the meals it prepares for patients, against a national average of 26%. The number has reduced since the Page 7 of 8
Trust began working with its catering partners Serco, and changed its meal delivery system. Food is monitored by dieticians and is considered nutritious and high quality. Donations improve QEQM Fracture Clinic The QEQM Fracture clinic is creating a much needed child-friendly environment for its patients through a series of donations and fund-raising activities. The Trust would like to thank local businesses, schools and the QEQM League of Friends. All these things will make a tremendous difference to the young patients attending our Fracture Clinic as waits & injuries can be traumatic and distraction through play works really well. Cancer Health and Wellbeing Clinic The Cancer Health and Wellbeing Clinic has been re-launched. The clinic is being run for any patients who have completed their chemotherapy or radiotherapy treatment, or recently had cancer surgery. The re-launch event was held at Chartham Village Hall and was well attended by cancer patients, their relatives and staff. Some of the topics covered during the day included: Counselling in Cancer Care Services Supportive Therapies and meditation including Reiki therapy sessions Financial information, employment and you Diet and nutrition How to access local services Initial feedback was very positive and there is due to be another event in September. 5 PUBLICATIONS Monitor list all latest publications on their website by accessing the link below: https://www.gov.uk/government/publications?departments%5b%5d=monitor Chris Bown Interim Chief Executive Page 8 of 8