EPB53/825 Title of Report: Prepared By: Sponsor: Action Required: Integrated Performance Committee Assurance Reports, January 2016 and December 2015 Crishni Waring, Chair, IPC Committee Gale Hart, Director of Finance, Performance and Information The Board to note performance and assurance provided (where relevant). The Board to refer concerns about staff retention and turnover to Integrated Workforce Committee. Purpose of Paper: To highlight performance and any areas of concern to the Board and provide assurance that appropriate action is in place, where such assurance has been obtained. Key Messages/Issues: Safer staffing on LD wards remains red-rated; a ward-by ward review is underway. Directorates have plans in place to achieve 90% safeguarding training compliance by end March. Despite new guidance which makes the target more challenging, the new Early Intervention target is on track to be achieved. The Out of Hours Service Urgent Home Visits target was breached primarily as result of an operational issue which has been addressed; there was no risk to patient safety. The Trust is on track to achieve a revised surplus of 1.582 for 2015/16 before impairments. Links to Strategic Objectives: To deliver an exceptional patient experience first time, every time To provide excellent care, ensuring effective, person-centred clinical outcomes To be an employer for whom people choose to work To be an active partner, always ready to improve by working with others To be an efficient organisation providing excellent services Resource Implications, if any: Links to BAF: None To provide an additional source of assurance and highlight any gaps identified. PB53 26 January 2016 Page 1 of 2
EPB53/825 Has an Equality Impact Assessment been completed? N/A This is a monthly strategic report to the Board and any EIA implications will be considered via individual items Paper History: Considered by Date Summary of Outcome Initial drafts sent to relevant Executive Directors 14 January 2016 7 January 2016 Amended to ensure factual accuracy Amended to ensure factual accuracy PB53 26 January 2016 Page 2 of 2
EPB53/825 Board Committee Assurance Report - Integrated Performance Committee Date of Meeting - 8 December 2015 Key items of assurance obtained on behalf of Board Decisions/actions to be taken by Trust Board Acute Services The Committee considered an increasing trend in Emergency Readmissions as requested by the Board and concluded that it was essentially based on one spike in performance during 2015 and there was no evidence to indicate an underlying problem. The Committee noted that the Directorate was forecasting a significant year-end overspend position caused predominantly by CIP slippage. Whilst the Directorate Leadership Team remained focused on this, it was expected that this shortfall will need to be addressed Trust-wide. The Committee noted good progress being made on L3 Safeguarding Children Training and the expectation that L3 for Adults would be on track by year-end. However there is a risk of the Directorate not achieving the expected year-end target for Statutory and Mandatory Training. The Committee recognised the efforts of staff to manage and minimise the impact on patients of the planned power outages and fire stopping work across the Caludon Centre. Integrated Community Services (ICS) The Committee noted that funding for the Transforming Care Transitions Team has not been received but was assured that the CCG has committed to the funding. 4 beds on Gosford Ward are currently unoccupied. The programme, driven by the national Transforming Care initiative, is currently on track. The implications for the Brooklands site as a whole are currently under consideration. The Committee received an update on recruitment activity to support the Rehabilitation and Reablement Service with a view to reducing its reliance on agency staff. It was noted that 83 posts had been added to this Directorate as a PB53 26 January 2016 Page 1 of 4
EPB53/825 results of new initiatives. Child & Family Services (CFS) The Committee welcomed a significant increase in the Directorate s Appraisal performance in October from 75.44% to 83.1%. The CFS Patient Assembly Launch event took place on 11 th November and was very successful. The Committee noted high agency staff costs due to requirements for medical staffing, Health Visiting and AHP staff. An increase in Speech and Language locums is also expected due to agreed additional income from the CCG to support a reduction in the waiting list. The particular challenge of recruiting suitable medical staff in the current market conditions was highlighted, necessitating a review of skill mix. L3 Safeguarding Children Training remained below targeted levels and had been impacted by the proposed Junior Doctor industrial action. CFS has an action plan in place to deliver a 3% increase on monthly basis to achieve the year-end target. Board to note positive performance. Board to note performance. ITC The Committee noted the implications for CWPT IT Services of the Arden CSU merger with Greater East Midlands CSU to become Arden GEM CSU. CWPT IT Services have been renewed within the current SLA for 12 months from 1 st April 2016 but the subsequent impact has yet to be worked through. The Committee noted the high agency usage to cover vacancies and the challenges of staff retention in a competitive external IT market. Job roles and structure are under review to address this challenge. PB53 26 January 2016 Page 2 of 4
EPB53/825 Integrated Workforce and HR It was noted that Trust Induction attendance was below the Trust target. The Committee was assured that a previous situation when staff had started in post without attending Induction, due to staffing pressures, would not be allowed to happen again in future. The Committee was concerned about staff retention and turnover and recommends to the Board that the Integrated Workforce Committee considers this matter further. The Committee noted that the sickness absence rate had increased 0.22% compared to the previous month and was above the Trust-wide target. However compared to this period last year, performance is 0.87% lower. The management of sickness absence in the Trust continues to be a high priority. The Committee reviewed the performance of the COPE service providing psychological support to staff and noted that recovery rates compared favourably with IAPT services. The Committee was also assured that the service received positive feedback from staff. Safety & Quality The Committee noted that information on the number of fire drills carried out and the number of fire risk assessment reviews undertaken were currently being reviewed to ensure accurate reporting. The Committee noted that 12 complaints, 42 PALS enquiries and 56 compliments were received in October 2015. Cost Improvement Programme 2015/16 (CIP) The Committee noted that the Trust has underachieved against its year to date CIP target for Month 7 by 249,700 against a target of 3,582,200. Of the 76 original schemes, 42 met their target and 34 have incurred slippage. In order to partly mitigate the total slippage of 1,109.700, contingency schemes at a value of 860,000 have been implemented. These schemes related to specific vacancies and a reduction in non-pay costs including payments for rates and reductions in travel expenses. Board to approve recommendation and refer the matter to Integrated Workforce Committee. Board to note performance. PB53 26 January 2016 Page 3 of 4
EPB53/825 The Committee noted that the current forecast shortfall for the year is 657,100, an increase from the previous forecast shortfall. Plans to bridge the gap continue to be developed and will be reported via the Finance Report at Board. Signature of Committee Chair: Crishni Waring Date: 14 January 2016 PB53 26 January 2016 Page 4 of 4
EPB53/826 Board Committee Assurance Report - Integrated Performance Committee Date of Meeting 12 January 2016 Key items of assurance obtained on behalf of Board Decisions/actions to be taken by Trust Board Acute Services Safer Staffing on LD wards at night remained red rated albeit marginal monthly improvements had been achieved since August. The Committee explored the multidimensional challenges of recruitment and retention of staff across Brooklands including uncertainty arising from the Transforming Care initiative and increasing acuity of patients. A ward by ward review of staffing levels, admission policies, acuity levels and bed numbers is underway and will inform local action plans. The Committee was assured that Acute Services has an action plan in place to ensure safeguarding training compliance exceeds 90% by end March. An in-month reduction in L3 safeguarding training compliance for adults and children has arisen from one new starter whose requirement for L3 competence was triggered as they started. The Directorate is forecasting an improved overspend position at year-end of 636k compared to 727k last month. The overspend is primarily due to CIP slippage. The Committee noted that the Trust had received additional guidance on the new national Early Intervention KPI due to take effect from April which makes it more challenging for the 50% target to be achieved. However given that the current performance is exceeding the required trajectory, the Committee was assured that the Trust will remain on course to achieve the new target. The Committee welcomed the very positive Friends and Family Test results from November with 94% of respondents Extremely Likely or Likely to recommend the service they received. Integrated Community Services (ICS) The Committee noted that the Out of Hours (OOH) service fell marginally short of its target for Urgent Home Visits seen within 2 hours due to 4 cases breaching. Whilst resourcing challenges within the service continue and are the subject of a Board to note assurance provided. Board to note assurance provided. PB53 26 January 2016 Page 1 of 6
EPB53/826 risk register entry, the breaches were primarily caused by an operational issue in relation to prioritisation of appointments. The Committee was assured that this had now been addressed and that there was no risk to patient safety. The Directorate was 429K underspent in November and achieved its CIP target. Although non-pay is overspent by 102K, pay is significantly underspent and some costs relating to agency are in the non-pay line. The Committee noted that the Transforming Care transition was officially launched by commissioners in December. A small team of clinicians have commenced work reviewing patients, packages of care available and crisis response. The potential threats and opportunities for the Brooklands site of the initiative were considered at an internal workshop in December with a follow-up planned for February. This will culminate in a paper initially to FPIC although the Board will also be kept appraised through the Chief Executive s report. The Committee welcomed the progress made with scaling up of the Integrated Neighbourhood Teams for Coventry and noted that c85% of posts had been staffed. Child & Family Services (CFS) Whilst noting that CFS had achieved all monitor, regulatory and commissioning targets, the Committee was concerned about the range of capacity/demand and competitive challenges faced by the Directorate and the implications of these for patients and the Trust. The Committee noted that CFS have a number of red-rated HR indicators but there have been significant in-month improvements in KPIs such as Statutory and Mandatory training performance from 35.9% to 49.7%, Appraisal performance from 83.1% to 90.7% and L3 Safeguarding Children training from 78.0% to 84.2%. The Attendance at Induction was affected by the significant influx of new staff associated with the new Immunisations and Vaccinations contract where staff had prior operational commitments at the time of transfer. The Committee explored the significantly below par performance on Waiting Times WT4 and WT6 (AHP and Combined AHP and Consultant respectively) and was reminded that these were locally agreed indicators with no associated penalties. The lack of thresholds had meant that there was no historical cap on demand for PB53 26 January 2016 Page 2 of 6
EPB53/826 AHP services such as Physiotherapy and OT and the existing funding envelopes are insufficient to meet that demand. A new service specification for OT has now been agreed which will reduce access in the future but the Committee was assured that a clinically robust process is in place to ensure existing patients receive an appropriate service. A draft new service specification for Physiotherapy is currently under review. Risks relating to these issues are recorded on the Trust s Risk Register and are currently under review. Estates The Committee was concerned about the very high levels of agency usage in the Maintenance team but was assured that the most of the posts had been recruited to. The Committee explored the implications of non-compliance relating to the food safety indicator scores and recognised that there were some short-term risks which need to be managed until the Facilities Review is concluded. The Review is expected to report to FPIC in February. The Committee noted that Estates has an overspend of 160K due to unplanned expenditure incurred in supporting the Caludon decant arrangements. This is expected to be recovered. Workforce and HR The Committee noted that the Trust s Sickness Absence Policy had been benchmarked against other Trust s and found to be comparable. The Committee explored the number and value of overpayments reported and was assured that most of these are recoverable. Any unrecoverable amounts are reported as losses for write-off and approved by the Audit Committee. The Committee noted that the number of queries relating to staff without a current DBS had reduced from 96 last month to 22. 55 of these had no longer required a DBS in their role as a result of the change in the Trust s policy. PB53 26 January 2016 Page 3 of 6
EPB53/826 Safety & Quality An incident of C Difficile Infection within an inpatient ward had occurred. The patient had had two admissions to an acute hospital for surgery and was at increased risk as defined by national guidance. The Committee was assured that the patient received treatment in line with national guidance and is fully recovered. The Committee noted a complaints breach due to difficulties in the initial allocation of an investigating officer. This has been discussed by the Complaints Review Group to determine action including additional trained staff for investigations. Cost Improvement Programme 2015/16 (CIP) The Committee noted that the Trust has underachieved against its year to date CIP target for Month 7 by 375,400 against a target of 4,326,200. Of the 76 original schemes, 41 met their target and 35 have incurred slippage. In order to partly mitigate the total slippage of 1,460,100, contingency schemes at a value of 1,074,100 have been implemented. These schemes related to specific vacancies and a reduction in non-pay costs including payments for rates and reductions in travel expenses. In addition, 2 schemes are delivering savings ahead of plan at a value of 10,500. The Committee noted that the current forecast shortfall for the year is 637,700, a small decrease from the previous forecast shortfall. Plans to bridge the gap are outlined in the Finance Report. Reference Costs/ Benchmarking Reports The Committee noted that for 2014/15, the Trust has a Market Forces Factor (MFF) adjusted index of 102, broken down to 95 for Mental Health services and 117 for Physical Community services. It was recognised that changes from the previous year were in part attributable to changes in the way activity is counted and that comparison with other Trusts can be limited unless account is taken of significant variations in service mix e.g. a mental health provider that delivers mainly community based services. The Committee received a presentation summarising key benchmarking data for each Directorate based on participation in the NHS Benchmarking Network. Board to note performance. PB53 26 January 2016 Page 4 of 6
EPB53/826 The Committee agreed that Reference Cost data at service level should be considered alongside the key benchmarking data to inform business development and cost improvement opportunities by the relevant New Business and CIP Groups. It was agreed that these should also be inputs to the Directorate-based strategy sessions currently underway and that access to all the benchmarking data available should be provided to the Executive team via a shared drive. Information and Business Intelligence Strategy The Committee welcomed the progress in implementing the strategy, in particular the delivery of new mandated data sets and integrated reporting through dashboards at various levels in the organisation. An opportunity to explore an example of a new dashboard in more detail is to be provided at a future meeting. The Committee recognised the important role that the new clinical system would play in supporting the introduction of self-service reporting and highlighted the cultural change needed to enable and take advantage of real-time data reporting. The Committee approved the refreshed strategy and objectives for 2016-2020. Finance and Contracting The Committee noted that the Trust is on track to achieve a revised surplus of 1.582m for 2015/16 before impairments. The Trust has overachieved against the year to date revised plan by 9K. Financial pressures include overspending on nurse staffing on inpatient wards as a result of using agency staff to cover vacancies and specialling, and the shortfall in CIP forecast for year end. Debtors over 3 months have decreased by 124K compared to the previous month. Cumulative non-nhs performance against the Better Payments Practice Code at November 2015 was 98% by number which is better than target. The Trust s FSRR is 4. Patient income for services is under-recovered by 583K due to reduced occupancy at Brooklands and the Aspen Unit and decommissioning of 2 beds in the Gillliver Road Unit. PB53 26 January 2016 Page 5 of 6
EPB53/826 Integrated Performance The Committee noted that 8 indicators were Red-rated, 10 indicators were Amberrated and 48 indicators were Green-rated. Key exceptions are highlighted in other parts of this report. Signature of Committee Chair: Crishni Waring Date: 18 January 2016 PB53 26 January 2016 Page 6 of 6