Integrated Performance Report

Mid Essex, Southend and Basildon Hospitals Joint Working Board - 5 th July 17 Integrated Performance Report May 2017

Mid Essex, Southend and Basildon Hospitals Joint Working Board - 5 th July 17 Contents Section Content Page Performance Overview Introduction by CEO 3 Executive Summary 4 Domain Scorecards Quality of Care 5 Operational Performance 8 Workforce, Leadership and Improvement Capability 16 Finance and Use of Resources 23 Appendices Operational Recovery Trajectories 35 MRSA Trust data 38

Mid Essex, Southend and Basildon Hospitals Introduction by CEO May 2017 The Single Oversight Framework (http://bit.ly/2eq8sne) places Providers into Segments based on NHS Improvement s judgement of the seriousness and complexity of issues faced by each Provider. Joint Working Board - 5 th July 17

Operational Performance Overview Page 4 Approach to performance recovery The three Trusts have recently formed a joint Performance Oversight Committee resulting in a commitment to: - Shared ownership of performance trajectories - A single PTL management approach - Focus on improving current delivery against site specific trajectories - Demand and capacity modelling across the three sites to address Cancer, Diagnostic and RTT backlogs Key issues A&E 4 hour performance At the last quarterly review, all three Trusts committed to delivering 90% from April 2017, which is the must do requirement. All three Trusts are working through their site specific improvement plans and jointly on one system wide escalation plan. Workforce issues along with our ability to discharge medically fit for discharge remains a collective problem to resolve. Mid Essex s performance remained the most variable of the three Trusts since April, with the added challenge of the implementation of the new electronic patient record (EPR) system in May. Cancer Delivery against the 62 day standard requires intensive focus across MSB. The Joint Executive Group decided in March 2017 to initiate a Cancer Programme across the three Trusts in order to meet the urgent challenge of Oncology service sustainability, cancer waiting time performance recovery and delivery of the national strategy for cancer. A Cancer Programme Director has been appointed on a short term secondment basis to initiate the programme, commencing in post 18 th April. RTT Performance against RTT remains a challenge, with some improvements at Basildon and Southend, but a decline at Mid Essex. There is a growing backlog within Orthopaedics across the group, following cancellations in the winter period. Surgery has resumed across all three sites; with productivity opportunities being quantified and additional bed capacity at the Broomfield site is being explored, to aid inpatient flow and performance for both non elective and elective pathways. Right Size the bed base The site MDs are currently working with the Joint Trust information and analytics service in developing our approach to capacity modelling across MSB Hospitals. A workshop is due to be held within the next two months with the objective of matching our contracted activity levels to our capacity. We are also undertaking benchmarking of our productivity and efficiency setting of beds, outpatient, diagnostic and theatre use to set clear targets for improvement which we will then feed into our capacity plans. This will undoubtedly inform future job planning.

Mid Essex, Southend and Basildon Hospitals Joint Working Board - 5 th July 17 Quality of Care Celia Skinner & Diane Sarkar (CQC Safe, Caring, Excellent, Well Led) May 2017

Harm Free Care (1) Infection Control and Never Events Commentary Actions / Mitigations Issues There was a total of 7 MRSA across the 3 sites (see next slide for detail) in 2016-17. A further three have been identified in April 17, but none in May 17. There were a total of 87 C Diff across the 3 sites against a collective trajectory of 74 in 2016-17. There were 18 during April 17 and six in May 17: BTUH 1, MEHT 3, SUHFT 2 There were a total of 45 cases of Ecoli across the three Trusts in May 17: BTUH 18, MEHT 15, SUHFT 12. This is the first reported data for E Coli in this report and further work is required to confirm reliability of data. Across the 3 sites there were a total of 9 never events in 2016-17: BTUH 2, MEHT 4, SUHFT 3 There were no never events in April 17, but one at Southend in May 17. Current infection control data across the 3 sites demonstrates a deteriorating position. This was shared with NHSi at the last PRM meeting. Subsequently, the infection control data has been discussed at the local site boards, and quality committees including the Quality Committee in Common (07/06/17). The CNO and CMO had a planned telephone call with Dr. Debra Adams Senior Infection Prevention and Control Advisor (Midlands and East) and have agreed that a review of the provision of Infection Prevention across the 3 sites will be undertaken on the 8,9 and 10 th August 2017. The CCG and PHE will also be invited to contribute and participate, with consideration being given to a multi-agency peer review approach. The reviewer will require site based documentation prior to the visit which will include data and policies. In addition to the above, the following actions will also be undertaken: Meeting with CNO and Ward Sisters / Matrons / HoNs from involved wards at MEHT CNO / CMO to attend local site Infection Control Committees CNO / CMO to attend Panel Review meetings with CCGs Development of standardised template for evaluation of peer review process and harm reviews Report of correlation of data / cleaning scores etc., identifying any themes / trends / lapses in care Reviews to be taken to local Quality Committees / Boards and JWB Integrated Performance Report Performance Mid & South Essex Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Total Apr-17 May-17 C.Diff Confirmed cases attributed to Trust 4 4 3 7 9 12 10 11 6 7 8 6 87 18 6 Never Events Total 1 0 2 0 0 0 1 1 0 4 0 0 9 0 1 Quality of Care Page 6

Harm Free Care - Mortality Performance Commentary Actions / Mitigations Issues The latest SHMI publication for the 12 months up to December 16 shows SUHFT as above expected (1.17) and MEHT (1.08) and BTUH (1.04) within expected limits, but with a sustained increase for BTUH. All 3 sites have well established MD-led oversight of mortality performance, with reliant support from CCGs and NHSI. The CMO has met with all local teams and is holding a further workshop in July with CCG and NHSI participation. Critical actions in the next period are: Development of shared policy of learning from deaths". Completion early July Commissioning of external IT company to enhance the electronic mortality audit tool at BTUH for dissemination across the 3 sites. Standardisation and shared learning from structured case note review. Overview and critique of assurance processes by NHSI completion of the coding audit at MEHT Quality of Care Page 7

Mid Essex, Southend and Basildon Hospitals Joint Working Board - 5 th July 17 Operational Performance Yvonne Blucher Lisa Hunt Clare Culpin (CQC Responsive) May 2017

Accident and Emergency 4 Hour Standard - MEHT Performance Commentary Actions / Mitigations MEHT Mar-17 Apr-17 May-17 Performance 84.0% 90.4% 85.6% Attendances 8,591 8,052 8,419 Waits over 4-hours 1,378 776 1,209 Issues Performance in March to 84.0% but an improved position is evident for April and May 17. Non elective activity remains high - resulting in capacity pressures on Medical beds Medically fit for discharge numbers remain high. The national acute provider bed audit on 28 March showed 112 patients as medically fit for discharge and 84 DToC s against a target of 50 MFFD. Clinical vacancies continues to impact on delivery Actions embedded in system wide recovery plan yet to be completed First phase of the bed reconfiguration has been implemented in April resulting in 18 additional medical beds Reduce MFFD by 50%. Delayed by CCG - but now on track to increase capacity by Mid April. Clinical gaps covered by locums Two newly recruited ED consultants due to start May 2018 The Integrated Discharge team model is being embedded with improved information and communication to support flow. DToC and MFFD data is reviewed daily and outcomes of escalations shared with ward areas to expedite discharges. Once residual issues have been addressed we anticipate performance can be sustained in line with our trajectory delivering 95% by year end 2017/18. Operational Performance Page 9

Accident and Emergency 4 Hour Standard - BTUH Performance Commentary Actions / Mitigations BTUH Mar-17 Apr-17 May-17 Performance 91.0% 92.1% 91.5% Attendances 11,987 11,252 12,259 Waits over 4-hours 1,075 886 1,042 Improving care for emergency patients continues to be a Trust priority, steadily improving but remains fragile. Performance in May was 91.5% of patients being seen and treated/admitted within 4 hours and 90.1% for Q4. Issues Staffing Remains a risk for Trust The high numbers of Medically Fit patients continues to be high although DTOCs have decreased Attendances remain high specifically on Monday and Tuesday despite primary and community care remodelling Health and social care provision and capacity within the community Actions and Mitigations Streaming in place with senior decision maker and senior clinical support 24/7 in ED Ambulatory care model now embedded well. Operates a PULL system in medicine and surgery. Plan to remodel emergency pathways with support from Four Eyes Insight. Regular board rounds in place 7 days a week revisiting SAFER bundle Consultants/therapies, social care/pharmacy in place at weekends to improve discharge process Red2Green(R2G) and Clinical Utilisation Reviews (CUR) are now live and being utilised by staff on 15 wards Creating a single point of referral for complex discharges Daily Breach analysis and RCA if performance below 90% Revising bed management model including roles and responsibilities of all divisions to support performance Weekly LOS meetings including daily monitoring of all medically fit patients including DTOC Dedicated manager of day in ED Robust weekend planning Resumed elective activity Change of culture and practice within escalation RAG rating which now changes as per current status of the hospital Operational Performance Page 10

Accident and Emergency 4 Hour Standard - SUHFT Performance Commentary Actions / Mitigations SUHFT Mar-17 Apr-17 May-17 Performance 92.1% 95.3% 91.7% Attendances 8,595 8,057 8,733 Waits over 4-hours 680 379 721 Issues May outturn was 91.7% - struggled to recover from the 2 Bank Holidays despite going into them with 85% bed occupancy. Performance for May declined slightly due to increased attendance levels., but the Trust continues to deliver performance above 90% Medical workforce shortage continues to be a challenge DME cover has been reviewed internally Discharges still occur too late in the day ED Nursing vacancy position has been impacted by recent short term sickness Red to Green reporting still an issue Overnight is the period of most breaches, during the day the main ones are clinical and managed through improved flow and escalation. Actions and Mitigations Medical workforce recruitment 54 job offers in place (39 Deanery) with 4 new starters in May. Dedicated recruitment officer remains in place DTOC figures are showing a downward trend throughout May with a final week return of 2.4% DME Consultant support for AL cover has been in place from BTUH and MEHT Southend have recovered their position by service redesign and obtaining some Locum cover New frailty model being designed with senior nursing support, implementation of new service model on target for July LoS review undertaken actions in place including initiative to use discharge lounge early in the day and rolling out the use of CCD. Initiatives such as Last 1000 Days and End PJ Paralysis are being commenced to reinforce the R2G and SAFER work. Red to Green/SAFER Focused week has taken place, electronic reporting is now being used daily to identify blockages to flow. Trust focus on R2G and SAFER, reported monthly by the Directorates, is expected to return benefits in terms of flow and discharges happening earlier in the day Stranded patient reviews are now being set up in all Directorates End of May Bank Holiday was challenging and impacted performance overall Bed modelling and Estates work is continuing - more beds to be allocated to Medicine from Surgery before Winter pressures Additional registrars are being recruited, in order to provide 2 Registrars overnight, the posts are filled and start dates awaited. Also during the period from 17:00-21.30 there are 2 registrars working (long day and late) this will be increased further once the additional registrars have started. CDU comes on stream on 3 rd July. Acute bedbase redesign and delivered : 14 short stay medical beds 24 acute medical assessment beds Capacity for 24 patients in Ambulatory Care (4 trolleys) Operational Performance Page 11

Cancer 62 day Standard Performance Commentary Actions / Mitigations Key issues across the group: Not now possible to deliver current trajectory for July compliance with 62 day standard (based upon patients already passed 62 days on the PTL and expected breach dates) access to facilities for one-stop skin clinics in Southend Plastics capacity (OP and TCI) Capacity for diagnostics (Endoscopy, CT, MRI) Capacity for TCIs SUHFT MEHT BTUH MSB Hospitals Feb-17 Mar-17 Apr-17 Feb-17 Mar-17 Apr-17 Feb-17 Mar-17 Apr-17 Feb-17 Mar-17 Apr-17 62- day performance 65.9% 71.8% 71.9% 76.2% 79.1% 80.3% 61.2% 68.4% 71.0% 68.6% 73.9% 75.1% Treatment Points 69.0 85.0 67.5 105.0 117.0 91.5 82.5 78 66 256.5 279.5 224.5 Treatment Points over 62 days 23.5 24.0 19.0 25.0 24.5 18.0 32.0 25 19 80.5 73.0 56.0 Treatment Points over 104 days 7.0 9.0 6.0 8.0 4.5 4.0 8.5 8 6 23.5 21.5 16.0 SUHFT MEHT BTUH MSB Hospitals Feb-17 Mar-17 Apr-17 Feb-17 Mar-17 Apr-17 Feb-17 Mar-17 Apr-17 Feb-17 Mar-17 Apr-17 2ww performance 97.1% 96.7% 95.3% 97.6% 95.2% 93.6% 90.3% 90.6% 88.2% 94.4% 93.6% 91.7% Referrals 661 871 716 1,013 1,241 1,043 1,227 1,580 1,343 2,901 3,692 3,102 Referrals seen after more than 2 weeks 19 29 34 24 60 67 119 149 158 162 238 259 Actions and Mitigations Group actions: Cancer escalation meeting with NHSI & NHSE 21 st June. Expectation that all Trusts individually achieve compliance with the 62 day standard from September. Trajectory for BTUH and SUHT are being re-profiled. SUHT recovery is particularly challenging due to casemix. Group action plan including use of rapid recovery funding in place with actions underway including: Additional theatre lists in Plastics (MEHT) and Urology (SUHT). Outsourcing of SUHT benign urological cases Insourcing and outsourcing of endoscopy Insourcing and outsourcing of CT and MRI activity Standardisation of CWT oversight continuing across group. All Trusts undertaking weekly tumour site specific PTL review meetings with best practice being shared supported by Cancer Alliance colleagues. Daily check in started in BTUH and now SUHT and under discussion at MEHT. Data reporting across sites aligned to ensure equitable. The objective to enable future single Somerset PTL Additional one-stop Dermatology capacity on line from 14 th July in Southend STP Cancer Board re-launched with focus on delivering national and regional priorities STP Tumour Site Specific Groups (TSSG) will be established in September to lead STP-wide co-design process in key priority pathways (Urology, Skin, Lung, Lower GI). Operational Performance Page 12

Cancer 62 day Standard Cancer Escalation Meeting 21 st June 2017 Key actions: Give patient details relating to hpb treatment delays at Royal London to Alliance to facilitate resolution COMPLETE Investigate discrepancy in BTUH Unify returns COMPLETE Clarify position for MEHT and BTUH against 10 HIAs COMPLETE [HIA actions incorporated in revised recovery plan submitted to regulators 30 th June] Re-profile rapid recovery funding spend COMPLETE [now forecasting all spend by end of September with increased use of outsourcing] Need to develop a clearer understanding of whether there is sufficient theatre capacity across the system to support the recovery plan IN PROGRESS [Foureyes working across 3 Trusts to firm up theatres plan in support of CWT recovery] CWT Recovery Battle Rhythm focus on recovery actions / transformation & individual patient actions Monday Tuesday Wednesday Thursday Friday Daily check in (x3) Issue PTL & Trajectory return to NHSI x3 Daily check in (x3) - MEHT Tumour site PTL reviews Daily check in (x3) - SUHT Tumour site PTL reviews Issue 104+ waiters return to NHSI x3 Daily check in (x3) - BTUH Tumour site PTL reviews Daily check in (x3) - Group t.con Skin - Group t.con Urology - CEO & MDs t.con review of performance and progress Produce tumour site specific Dashboards Group progress report & Dashboard issued to CEO Operational Performance Page 13

18 weeks Referral to Treatment Incomplete Standard Performance Commentary Actions / Mitigations Issues Incomplete 52 week breach at month end MEHT May - 60 - Biggest risk area - Plastic Surgery (Complex Breast) BTUH - May - 2 - Biggest Risk areas - Neurology and Respiratory Sleep SUHFT May = 3. Backlog Positions MEHT 2,387 Hot spots in Plastics, T&O, Rheumatology, Neurology, General Surgery BTUH 3,639 - Neurology, Dexa/Osteoporosis, T&O, Gastroenterology SUHFT 3,966 - Key areas ; Hot spots - admitted Orthopaedics, ENT and General Surgery, non admitted - Ophthalmology, Chest Medicine, Cardiology and Paediatrics (2 new consultants started in May) SUHFT MEHT BTUH MSB Hospitals Mar-17 Apr-17 May-17 Mar-17 Apr-17 May-17 Mar-17 Apr-17 May-17 Mar-17 Apr-17 May-17 Performance 86.4% 86.0% 86.3% 92.0% 90.6% 90.4% 83.7% 83.8% 84.6% 87.4% 86.8% 87.1% Waiting List Size 28,078 28,590 28,875 24,358 24,391 24,745 23,901 24,321 23,548 76,337 77,302 77,168 Waits over 18 weeks 3,808 4,004 3,966 1,947 2,296 2,387 3,898 3,939 3,639 9,653 10,239 9,992 Waits over 52 weeks 0 2 3 3 17 60 1 3 2 4 22 65 Actions and Mitigations RTT x-group being formed with initial focus on the development of cross-site PTLs (and PTL discussions) for long waiting patients to identify opportunities to transfer patients across site to aid earlier booking and prevent excessive waits for patients. Examine areas of capacity which could aid backlogs on other site. For example backlog of DC T&O at BHUT and SUHFT could potentially be supported by MEHT as although they have a T&O backlog this is predominately IP. SUHFT Exploring Theatre Costs and staff cost prior to potential commencement Network wide approach to neurology backlog to be discussed MEHT specific recovery plan for complex breast patients in discussion with CCG. 74 patients moved from Planned list to elective following audit. 41 of which were already over 52 weeks. Rheumatology locum appointed, longer term plans for T&O service in development MEHT PAS to Lorenzo switch over weekend of 27 th /28 th May. External Validation team currently validating entire elective PTL (approx 27000) to ensure accuracy. Planned PTL being validated by sample. Issues regarding RTT out-coming identified and additional training packages being developed for roll out. Bank staff currently working weekends to reduce the number of encounters no cashed up totalling 3400 currently. MEHT Harm review process for all 52 week breaches continues but is under review to ensure roles and responsibilities are clear. Action plan developed and agreed with CCG. Separate discussions underway with clinical lead regarding DIEP patients to ensure that process adds no further anxiety to patients. BHUT Theatre and Outpatient utilisation and productivity programme supported by Four Eyes Insight. BTUH Weekly PTL and Access Board meetings restructured, now supported by Four Eyes Insight. BTUH Planned move of cystoscopy from endoscopy unit to provide extra space for endoscopy. BTUH Possible cystoscopy outsourcing at Brentwood working through governance issues with CCG. SUHFT - PTL process reviewed and re- structured. New weekly PTL meetings also includes activity and productivity monitoring. Trust in dialogue with CCG regarding high increase in referrals within Ophthalmology. Outsourcing of Ophthalmology (1000 cases, 60 per week) has commenced All site implementing robust PTL meetings and management and RTT leads from each site to ensure consistency of approach in relation to RTT Guidance application and Access Policies. Harm reviews routinely in place for all long waiting patients. Operational Performance Page 14

6 week Diagnostic Standard Performance Commentary Actions / Mitigations The main ongoing concern relates to diagnostic service at Southend, which the group are supporting to resolve. Performance deterioration in April., cause Endoscopy shortfall. Issues Increase in demand including 2ww The internal steriliser machines have been decommissioned due to water contamination that cannot be resolved. All scopes now sent to CSSD which has impacted further upon performance. Consultant vacancies SUHFT MEHT BTUH Mar-17 Apr-17 May-17 Mar-17 Apr-17 May-17 Mar-17 Apr-17 May-17 Performance 93.0% 88.5% 89.2% 99.7% 99.3% 99.5% 98.5% 99.0% Waiting List Size 5,022 4,378 4,399 4,491 3,714 5,666 5,531 5,679 Waits over 6 weeks 352 505 477 14 25 31 81 54 Actions and Mitigations Whole group escalation policy and process in development to identify potential risks and to secure mutual support. Whilst we are developing the role of the CNS to provide non medical prescribing, a PGD is in place for the administration of specific drugs without the need for cardiologist presence which will be trialled in the cardiology perfect week commencing 3 July. Additional sessions re-commenced for Echo as an interim solution whilst considering the business case for 7/7 echo service. Whilst additional scopes were purchased to assist with the normal run rate this has not taken into consideration the service model change due to the decommissioning of the endoscopy washer/disinfector.. A current review of scope requirements is being undertaken with the expected outcome of the need to purchase more scopes Southend and CP&R CCG review of referral pathway completed. New proposal will be presented to GP s on the 27 th June. Insourcing for Endoscopy commenced and progress is being made against DM01 recovery plan. To maximise the capacity within endoscopy a service improvement plan has been developed and is in the process of implementation starting with the booking pathway. Continuing to recruit a locum to the substantive position whilst recruiting into a substantive post The trajectory for improvement at Southend Hospital is shown here: SUHFT Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Performance 99.2% 97.7% 98.7% 97.6% 92.7% 92.0% 93.0% 88.5% 89.2% Waiting List Size 4,837 4,425 4,510 4,035 4,350 4,125 5,022 4,378 4,399 Waits over 6 weeks 39 103 57 96 318 331 352 505 477 Operational Performance Page 15

Mid Essex, Southend and Basildon Hospitals Joint Working Board - 5 th July 17 Workforce, Leadership and Improvement Capability Mary Foulkes (CQC - Well Led) May 2017

Workforce KPIs Agency Spend Performance SUHFT MEHT BTUH Mid & South Essex KPI May -16 May-17 KPI May-16 May-17 KPI May-16 May-17 KPI May-16 May-17 Agency Spend (as a % of the pay bill) 10.0% 10.81% 8.39% 10.0% 7.58% 8.36% 10.0% 7.74% 4.75% 10.0% 8.65% 7.08% SUHFT MEHT BTUH In May 2017 agency cost was 8.39% The implementation of the medical model resulted in an increased medical staffing requirements in the Medicine Directorate An establishment review across the Trust has resulted in a further 257.39 FTE being added May has seen an increase in agency spend to 8.36% (6.96% in April), although the Agency Cap was still met in month. Internal targets of 8.4% for both Nursing and Medical Agency spend both targets achieved for both April and May. Additional consultant sessions remain a significant cost ( 405k in May. High Agency spending areas include; A&E Medical and Nursing Staff, Medical Staff Dermatology, Orthopaedics, Oral Surgery, General Surgery, Paediatrics and Radiology. May agency spend has for the second month in 17/18 shown a significant reduction Medical and Dental spend reduced again in May by 178,000 Nursing maintained its reduction from the Mar 17 position creating a two month trend down from over 500,000 to under 300,000 Significant impact in nursing agency reduction is due to some wards not booking agency on a Sunday and reducing reliance on agency staff to support enhanced care Mitigation Top 20 highest agency spend and top 20 longest serving agency identified and reviewed fortnightly with action plans to remove Weekly Review meetings with specialist areas with high agency spend CIP review meeting scheduled monthly Verumed agency contracted for overseas Doctor Recruitment Move to CPP framework with standardised rates 01/07 for Doctors review for nursing/ahps Agency controls in place include strict prior authorisation by senior managers, weekly financial control meetings, Weekly Agency Rule Breaches approval meeting, Non-Clinical shifts reviewed weekly at SDM. Project linking areas of high nursing agency spend to vacancies and specific recruitment plans. Vacancies remain high in nursing however a number of advertising and recruitment strategies are being used to seek to reduce the number The assurance group model is being rolled out to non-medical/non-nursing clinical workforce The corporate wide agency reduction plan is being shared with divisions and each apportioned a target to meet the plan Group Actions Seeking common rates across the 3 Trusts to encourage more bank worker uptake Introduce one bank and agency team across the three trusts Sharing and piloting initiatives to reduce agency rates Workforce, Leadership and Improvement Capability Page 17

Workforce KPIs Recruitment Performance SUHFT MEHT BTUH Mid & South Essex KPI May -16 May-17 KPI May-16 May-17 KPI May-16 May-17 KPI May-16 May-17 Vacancy Vacancy Rate 7% 9.27% 12.21% 7% 13.85% 13.15% 7% 11.13% 9.63% 7% 11.50% 11.64 Nurses 7% 15.15% 12.69% 7% 15.52% 15.53% 7% 16.26% 15.54% 7% 15.69% 14.71% Consultants 7% 9.78% 10.79% 7% 9.41% 10.39% 7% 5.43% 6.46% 7% 9.76% 9.12% Total in Recruitment Process (WTE) Projected new starters WTE (Jun- Jul) Total in Recruitment Process (WTE) Projected new starters WTE (Jun- Jul) Total in Recruitment Process (WTE) Projected new starters WTE (Jun- Jul) Total in Recruitment Process (WTE) Projected new starters WTE (Jun- Jul) Recruitment Consultants Nurses 34 6 181 37 11 1 147 65 6 3 160 32 51 10 488 134 Overseas Recruitment - Nurses EU Non - EU Total in Recruitment Process (WTE) Projected new starters WTE (Jun- Jul) 75 2 71 7 Total in Recruitment Process (WTE) Projected new starters WTE (Jun- Jul) 5 5 33 2 Total in Recruitment Process (WTE) Projected new starters WTE (Jun- Jul) 0 0 3 0 Total in Recruitment Process (WTE) Projected new starters WTE (Jun- Jul) 77 7 107 9 Finland Campaign- opportunity trusts to join Task and finish group meeting weekly Hard to fill posts (DME) - all posts filled following successful campaign and changing job roles 61 Doctors offered since 01/01/2017 Nurses - Non EU campaign with Medacs Continuing EU and Non EU recruitment through MSI and KCR Recruitment of student nurses and return to practice nurses in conjunction with ARU Continuing Overseas campaigns via Medacs. National and international campaigns continue for nursing positions Keep in touch scheme operating with student nurses Improvement in attracting doctors, 12 new starts and 6 consultants pending and a further 7 specialty medicine doctors in the pipeline Group Actions Nurses EU Campaign procurement includes all the Trusts Joint attendance at careers fairs Standardised recruitment process and material Group Actions - Doctors Joint recruitment radiology Group representation on agreed consultant panels Standardised consultant recruitment process Workforce, Leadership and improvement Improvement capability Capability Page 18

Workforce KPIs Turnover Performance SUHFT MEHT BTUH Mid & South Essex KPI May -16 May-17 KPI May-16 May-17 KPI May-16 May-17 KPI May-16 May-17 Voluntary Turnover (rolling over 12 months) 9.50% 12.33% 12.78% 9.50% 9.71% 15.12% 9.50% 14.58% 13.62% 9.50% 13.86% 13.84% Voluntary Turnover Nurses 9.50% 12.39% 12.42% 9.50% 6.64% 15.11% 9.50% 16.51% 11.89% 9.50% 12.45% 13.14% Consultants 9.50% 6.95% 9.39% 9.50% 4.44% 5.19% 9.50% 3.54% 6.76% 9.50% 5.63% 7.19% Issues SUHFT MEHT BTUH The rolling 12 month turnover rate at the end of May 2017 was 12.78%, increased from 12.33% at the end of May 2016. The rolling 12 month turnover rate at the end of May was 8.78%, a slight increase from 8.71% at the end of April. The rolling voluntary 12 month turnover rate at the end of May 2017 was 13.62%, a decrease from 14.15% at the end of April 2017. Actions & Mitigation Exit/ leaver meetings and questionnaires form part of the leaver process. Leaver information being enhanced by including where individuals are going, removing other reason and on-line questionnaires. Feedback and response evaluated monthly and fed back to relevant managers. Directorate and corporate staff survey action plans Health and wellbeing action plan in place to support staff Reviewing retention initiatives in line with the national programme for nurses Exit meetings and questionnaire offered to all leavers. Feedback and responses evaluated and fed back to relevant managers. HR Managers discuss with leads areas of concern, support managers in addressing issues and improving processes and culture. Engagement and stay interviews being used to develop divisional recruitment strategies (e.g. Surgery) Continuing to gather better leaver data through improving on exit questionnaires and focus groups CTC developing career pathway maps to inform training opportunities for staff. Investigating news of working and role design as a means to enrich jobs and improve staff retention Group Actions Joint staff survey action Recruitment and retention plan for registered nurses Consultant engagement activities Develop career pathway outlines for clinical staff development of core improvement skills/resilience training for all staff Workforce, Leadership and Improvement Capability Page 19

Workforce KPIs Training Performance SUHFT MEHT BTUH Mid & South Essex KPI May -16 May-17 KPI May-16 May-17 KPI May-16 May-17 KPI May-16 May-17 Issues Training Statutory and Mandatory Training 85.0% 78.72% 84.22% 85.0% 87.36% 87.99% 85.0% 73.54% 82.28% 85.0% 81.86% 85.37% SUHFT MEHT BTUH Statutory and mandatory training continues to improve steadily and has increased in May 2017 to 84.22% from 78.72% in April 2016 Overall compliance for end of May was 87.99%, an increase of 0.49% on April; and in comparison to the same time last year a sustained increase of 0.63%. Mandatory training compliance stayed at 82% between April and May 2017. Actions & Mitigation Revamped the learning and development intranet including Simplifying access to elearning Easy access to individual or team mandatory training League table and DNA are published monthly Dedicated suite for easy access to e learning SME reviewed and streamlined the content Audit to ensure correct target audience for mandatory training Targeted focus continues, and each element has as many modes of delivery as possible to support ease of access. Dedicated section reported in the HRD workforce report submitted to every Patient Safety and Quality Committee Further work in progress to identify fitness to practice elements for nursing clinical staff. DN to take informed decision re barring individuals from practice after period of notice to complete. HR BPs are working with Divisions and teams to address areas of low compliance. Cleaning and Ward Catering Service are releasing staff during working hours to complete training. Acute Medicine are offering protected time for staff in the form of study days to enable staff to get their training done. Paediatrics are concentrating on Medical mandatory training to bring it within target Group Actions Consultation process has begun to integrate the LLOD team Plans to implement same learning platforms Workforce, Leadership and Improvement Capability Page 20

Mid Essex, Southend and Basildon Hospitals Joint Working Board - 5 th July 17 Finance and use of Resources James O Sullivan (CQC Use of Resources) May 2017

2017 / 2018 I&E Position BTUH I&E Position for the period ending 31 st May 2017 (BTUH) Trust is behind pre STF control total by 0.7m YTD. There is no STF assumed in the month 2 position. Including STF the Trust is behind plan by 1.7m. BTUH Plan Actual Variance I&E deficit pre STF -5.4-6.1-0.7 STF 1.0 0.0-1.0 I&E deficit inc. STF -4.4-6.1-1.7 Finance and Use of Resources Page 22

2017 / 2018 I&E Position MEHT I&E Position for the period ending 31 st May 2017 (MEHT) Trust is ahead of pre STF control total by 0.1m All STF income has been assumed in the month 2 position Therefore including STF the Trust is ahead of plan by 0.1m MEHT Plan Actual Variance I&E deficit pre SFT -7.5-7.3-0.1 STF 0.9 0.9 0.0 I&E deficit inc. SFT -6.6-6.4-0.1 Finance and Use of Resources Page 23

2017 / 2018 I&E Position SUHFT I&E Position for the period ending 31 st May 2017 (SUHFT) The Trust met the control total before STF funds. There is 0.8m of STF income assumed in the position Finance and Use of Resources Page 24

Structure Agency Spend BTUH 2017/18 Agency Run Rate (BTUH) Spend for the first 2 months is 1.9m against the profiled ceiling of 1.9m Medical agency for the first 2 months is 0.8m against a pro rata plan of 1.0m The Trust continues to focus on agency spend and controlling the run rate. Finance and Use of Resources Page 25

Structure Agency Spend MEHT 2017/18 Agency Run Rate (MEHT) The 17/18 agency ceiling target is 17.5m Spend for the first 2 months is 2.6m against the profiled ceiling of 2.9m but with M2 spend rising. Medical agency for the first 2 months is 1.1m against a pro rata plan of 1.1m The Trust continues to strengthen grip and control with focus on run rate impact. Continued review all of agency usage across the Trust at Divisional and Directorate level. Finance and Use of Resources Page 26

Structure Agency Spend SUHFT 2017/18 Agency Run Rate (SUHFT) Spend for the first 2 months is 2.5m against the profiled ceiling of 2.2m This is an adverse variance of 0.3m (or 16%) However, the Trust provided a separate agency trajectory which included the Medical Model and the spend is 0.1m favourable compared to this Finance and Use of Resources Page 27

2017 / 2018 Financial Position BTUH Year-to-Date Financial Headlines (BTUH) Clinical Income is behind plan by 0.4m YTD This is down to the decommissioned MSK Connect service and is offset by the same reduction in non-pay. Other income is above plan by 0.5m. 0.7m of which relates to the hosting of ESR system services. Pay is 1.6m above plan YTD. ESR system services account for 0.7m. The remaining overspend relates to unfunded escalation beds, nursing and medical overspends and non delivery of CIP. Non-Pay including financing costs is favourable to plan by 0.8m, but allowing for MSK Connect this reduces to 0.4m CIPs have delivered 0.6m of savings but are behind plan by 0.5m (Pay 0.3m and Non Pay 0.2m) Cash balance of 6.0m was on plan Capital spend of 0.6m was behind plan by 2.4m Finance and Use of Resources Page 28

Structure Agency Spend MEHT Year-to-Date Financial Headlines (MEHT) Clinical Income is behind plan by 1.0m YTD. 0.5m relates to HCD s which is a pass through cost while under performance on maternity pathway, outpatients and A&E activity is driving the balance Other income remains on plan Pay is 0.5m favourable to plan YTD with only medical staff overspent. While vacancies remain high the ability to fill shifts is constrained by bank and agency capacity and this driving some of the underspends as is the lower than planned activity. Non-Pay including financing costs is also favourable to plan by 0.5m. This is partly related to HCD s but also to slippage on planned developments and lower activity. CIPs have delivered 0.3m of savings to May which would be behind plan by 2.0m but CIPs are being reported as being implicitly delivered as the Trust is on plan YTD. The cash balance of 1.1m against a plan of 1.0m Capital spend of 1.2m was behind plan by 0.3m with this expected to accelerate. Finance and Use of Resources Page 29

2017 / 2018 Financial Position SUHFT Year-to-Date Financial Headlines (SUHFT) Clinical Income is behind plan by 0.2m YTD This is largely out-patients & critical care partly offset by favourable position on NELs and PSD Pay is 0.7m favourable across all staff groups but particularly nursing and scientific & therapeutic Agency spend is above the NHSI ceiling (by 0.3m) but there were still vacancies not being covered Non-Pay is adverse by 0.5m mainly on drugs and clinical supplies CIPs have delivered 1.4m of savings but are behind plan by 0.2m (mainly on procurement and agency) Cash balance of 1.5m was on plan Capital spend of 0.3m was on plan Finance and Use of Resources Page 30

2017 / 2018 CIP Pipeline BTUH CIP Pipeline (BTUH) The Current pipeline position is 16.7m against a plan of 16.3m. Green and Amber Green account for 53%, whilst Amber accounts for 40%. The remaining balance is Amber Red & Red. 88% of the schemes are still at the ideas stage or awaiting QIA sign off. Finance and Use of Resources Page 31

Mid Essex, Southend and Basildon Hospitals Joint Working Board - 5 th July 17 Appendices: 1. Trust and Group Operational Performance Recovery Trajectories 2. MRSA Trust data

Accident and Emergency 4 Hour Standard Recovery Trajectories Mid & South Essex Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 A&E 4-hour Performance Trajectory 88.3% 91.5% 91.8% 92.0% 92.3% 92.7% 93.4% 93.4% 93.4% 93.1% 92.8% 93.2% 95.0% Attendances 29,048 27,683 29,325 28,289 29,579 27,769 27,977 28,988 28,078 28,517 28,241 26,396 29,872 Waits over 4-hours 3,413 2,352 2,417 2,257 2,264 2,022 1,845 1,919 1,860 1,972 2,041 1,796 1,492 MEHT Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 A&E 4-hour Performance Trajectory 82.0% 90.0% 90.0% 90.0% 91.0% 92.0% 93.0% 93.0% 93.0% 92.0% 91.0% 92.5% 95.0% Attendances 8,242 8,159 9,122 8,562 9,125 8,528 8,842 8,905 8,312 8,418 8,300 7,693 8,752 Waits over 4-hours 1,480 815 912 856 821 682 618 623 581 673 747 576 437 BTUH Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 A&E 4-hour Performance Trajectory 89.8% 91.5% 91.5% 91.4% 91.5% 91.5% 92.5% 92.5% 92.5% 92.5% 92.4% 92.4% 95.0% Attendances 12,268 11,272 11,675 11,500 11,988 10,819 10,993 11,698 11,658 11,717 11,558 11,101 12,679 Waits over 4-hours 1,250 959 993 990 1,020 919 820 877 874 880 875 840 633 SUHFT Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 A&E 4-hour Performance Trajectory 92.0% 93.0% 94.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% Attendances 8,538 8,252 8,528 8,227 8,466 8,422 8,142 8,385 8,108 8,382 8,383 7,602 8,441 Waits over 4-hours 683 578 512 411 423 421 407 419 405 419 419 380 422 Operational Performance Page 33

Cancer 62 day Standard Recovery Trajectories Mid & South Essex KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 62-day Cancer (urgent GP referral) Performance Trajectory 85% 74.9% 76.5% 80.2% 83.4% 84.9% 85.1% 85.5% 85.6% 85.2% 85.4% 85.2% 85.2% 85.3% Treatment Points 268 277 251 286 271 285 254 275 271 245 277 262 275 Treatment Points over 62 days 0 67 65 50 48 41 42 37 40 40 36 41 39 40 Treatment Points over 104 days 0 21 21 19 17 16 5 5 5 2 0 0 0 0 Waits over 104 days 0 83 68 53 36 19 8 5 2 0 0 0 0 0 Adjustment for double reporting 19 10 8 6 5 2 2 1 - - - - - Group Trajectory 0 64 58 45 30 14 6 3 1 - - - - - MEHT KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 62-day Cancer (urgent GP referral) Performance Trajectory 85% 73.5% 77.2% 79.3% 81.2% 85.3% 85.2% 85.0% 85.1% 85.2% 85.4% 85.2% 85.2% 85.2% Treatment Points 106 119 107 117 109 125 100 111 118 96 122.0 115 115 Treatment Points over 62 days 0 28 27 22 22 16 19 15 17 18 14 18.0 17 17 Treatment Points over 104 days 0 5 5 5 5 5 5 5 5 2 - - - - Waits over 104 days 0 23 20 17 14 11 8 5 2 0 0 0 0 0 BTUH KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 62-day Cancer (urgent GP referral) Performance Trajectory 85% 70.3% 70.3% 79.3% 84.5% 85.1% 85.1% 86.4% 86.9% 85.4% 85.9% 85.2% 85.4% 85.7% Treatment Points 82.5 77.5 84.5 87.0 84.0 84.0 84.5 84.0 85.5 78.0 84.5 82 84 Treatment Points over 62 days 0 24.5 23.0 17.5 13.5 12.5 12.5 11.5 11.0 12.5 11.0 12.5 12 12 Treatment Points over 104 days 0 10.0 10.0 10.0 10.0 10.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Waits over 104 days 0 36.0 28.0 20.0 12.0 4.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 SUHFT KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 62-day Cancer (urgent GP referral) Performance Trajectory 85% 81.6% 81.5% 83.0% 85.3% 84.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% Treatment Points 80.0 81.0 60.0 82.0 78.0 76.0 69.0 80.0 67.0 71.0 70.0 65.0 76.0 Treatment Points over 62 days 0 14.7 15.0 10.2 12.1 12.5 11.4 10.4 12.0 10.1 10.7 10.5 9.8 11.4 Treatment Points over 104 days 0 5.5 5.5 3.5 1.5 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Waits over 104 days 0 24.0 20.0 16.0 10.0 4.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Operational Performance Page 34

18 weeks Referral to Treatment Incomplete Standard Recovery Trajectories Mid & South Essex KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 18wRTT (Incomplete Pathways) Performance Trajectory 92% 87.2% 87.4% 88.0% 88.6% 89.1% 89.4% 89.8% 90.2% 90.6% 91.0% 91.3% 91.7% 92.2% Waiting List Size 74,979 75,011 74,571 74,138 73,865 73,783 73,464 73,125 72,743 73,090 73,336 73,584 73,823 Waits over 18 weeks 0 9,569 9,446 8,943 8,464 8,059 7,790 7,489 7,146 6,840 6,613 6,366 6,127 5,730 SUHFT KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 18wRTT (Incomplete Pathways) Performance Trajectory 92% 86.0% 86.0% 86.5% 87.0% 87.5% 88.0% 88.5% 89.0% 89.5% 90.0% 90.5% 91.0% 92.0% Waiting List Size 27,509 27,650 27,788 27,923 28,056 28,187 28,317 28,445 28,572 28,698 28,823 28,948 29,071 Waits over 18 weeks 0 3,851 3,871 3,751 3,630 3,507 3,382 3,256 3,129 3,000 2,870 2,738 2,605 2,326 BTUH KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 18wRTT (Incomplete Pathways) Performance Trajectory 92% 84.0% 84.5% 85.9% 87.2% 88.3% 88.8% 89.4% 90.1% 90.7% 91.2% 91.7% 92.2% 92.8% Waiting List Size 24,055 23,966 23,856 23,747 23,678 23,686 23,675 23,637 23,549 23,461 23,373 23,285 23,188 Waits over 18 weeks 0 3,845 3,704 3,358 3,037 2,782 2,656 2,516 2,334 2,191 2,069 1,937 1,814 1,679 MEHT KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 18wRTT (Incomplete Pathways) Performance Trajectory 92% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% Waiting List Size 23,415 23,395 22,927 22,468 22,131 21,910 21,472 21,043 20,622 20,931 21,140 21,351 21,564 Waits over 18 weeks 0 1,873 1,871 1,834 1,797 1,770 1,752 1,717 1,683 1,649 1,674 1,691 1,708 1,725 Operational Performance Page 35

Harm Free Care - MRSA Mid & South Essex Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Total Apr-17 May-17 MRSA Confirmed cases attributed to Trust 0 0 0 1 1 1 0 1 0 0 1 2 7 3 0 MEHT Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Total Apr-17 May-17 MRSA Confirmed cases attributed to Trust 0 0 0 1 0 0 0 0 0 0 1 0 2 0 0 BTUH Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Total Apr-17 May-17 MRSA Confirmed cases attributed to Trust 0 0 0 0 1 1 0 1 0 0 0 0 3 2 0 SUHFT Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Total Apr-17 May-17 MRSA Confirmed cases attributed to Trust 0 0 0 0 0 0 0 0 0 0 0 2 2 1 0 Quality of Care Page 36