Agenda and Papers

for the

Formal meeting of the

Kent Community Health NHS Foundation Trust Board

In Public

to be held at 10am

on

Thursday 28 November 2019

in

Sevenoaks Town Council Offices Bradbourne Vale Road

Sevenoaks TN13 3QG

Meeting of the Kent Community Health NHS Foundation Trust Board

to be held at 10am on Thursday 28 November 2019 in

Sevenoaks Town Council Offices, Bradbourne Vale Road, Sevenoaks TN13 3QG

This meeting will be held in Public

AGENDA

1. STANDARD ITEMS

1.1

Introduction by Chair

Trust Chair

1.2 To receive any Apologies for Absence

Trust Chair

1.3 To receive any Declarations of Interest

Trust Chair

1.4 To agree the Minutes of the Kent Community Health NHS Foundation Trust Board meeting held on 25 July 2019

Trust Chair

1.5 To receive the Matters Arising from the Kent Community Health NHS Foundation Trust Board meeting held on 25 July 2019

Trust Chair

1.6 To receive the Trust Chair’s Report

Trust Chair

1.7 To receive the Chief Executive’s Report

Chief Executive

2. BOARD ASSURANCE/APPROVAL

2.1

To receive the Patient Story Chief Nurse (Interim) Presentation

2.2

To receive the Board Assurance Framework

Corporate Services Director

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Board Committee Reports

2.3

To receive the Quality Committee Chair’s Assurance Report

Chair of Quality Committee

2.4 To receive the Audit and Risk Committee Chair’s Assurance Report

Chair of Audit and Risk Committee

2.5

To receive the Strategic Workforce Committee Chair’s Assurance Report

Chair of Strategic Workforce Committee

2.6 To receive the Charitable Funds Committee Chair’s Assurance Report

Non-Executive Director, Charitable Funds Committee member

2.7 To receive the Integrated Performance Report

Director of Finance Executive Directors

2.8 To approve the Remuneration and Terms of Service Committee’ Terms of Reference

Trust Chair

2.9

To approve the Emergency Planning and Business Continuity Annual Assurance Statement

Corporate Services Director

2.10 To endorse the Public Health Partnership Renewal Agreement

Director of Finance

3. REPORTS TO THE BOARD

3.1

To receive the Seasonal Infection Prevention and Control Report

Chief Nurse (Interim)

3.2 To receive the Learning From Deaths Annual 2018/19 Report

Medical Director

3.3

To receive the Freedom To Speak Up Report

Corporate Services Director

3.4 To receive the approved Minutes of the Charitable Funds Committee meeting of 30 January 2019

Non-Executive Director, Charitable Funds Committee member

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4. ANY OTHER BUSINESS

To consider any other items of business previously notified to the Trust Chair

Trust Chair

5. QUESTIONS FROM MEMBERS OF THE PUBLIC RELATING TO THE AGENDA

6. DATE AND VENUE OF NEXT MEETING

Thursday 6 February 2020

The Committee Room, Tonbridge and Malling Council Offices, Gibson Building, Gibson Drive, Kings Hill, West Malling, Kent ME19 4LZ

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Unconfirmed Minutes

of the Kent Community Health NHS Foundation Trust Board meeting held at 10am on Thursday 25 July 2019

in the Garden Room, The Orchards Events Venue, New Road East Malling ME19 6BJ

Meeting held in Public

Present: John Goulston, Trust Chair (Chair) Pippa Barber, Non-Executive Director Paul Bentley, Chief Executive Peter Conway, Non-Executive Director Martin Cook, Non-Executive Director Prof Francis Drobniewski, Non-Executive Director Gill Jacobs, Deputy Director of Finance Mark Johnstone, Deputy Medical Director Louise Norris, Director of Workforce, Organisational

Development and Communications Gerard Sammon, Director of Strategy Bridget Skelton, Non-Executive Director Dr Mercia Spare, Chief Nurse (Interim) Lesley Strong, Deputy Chief Executive/Chief Operating Officer Nigel Turner, Non-Executive Director In Attendance:

Natalie Davies, Corporate Services Director Joy Fuller, Governor Lead (Note-taker)

25/07/01 Introduction by Chair

Mr Goulston welcomed everyone present to the Public Board meeting of Kent Community Health NHS Foundation Trust (the Trust).

25/07/02 Apologies for Absence

Apologies were received from Gordon Flack, Director of Finance; Dr Sarah Phillips, Medical Director and Jen Tippin, Non-Executive Director. Ms Gill Jacobs and Dr Mark Johnson attended the meeting deputising for the Executive Directors with full voting rights. The meeting was quorate.

Min

utes

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25/07/03 Declarations of Interest

No conflicts of interest were declared other than those formerly recorded.

25/07/04 Minutes of the Meeting of 23 May 2019

The Board AGREED the Minutes.

25/07/05 Matters Arising from the Meeting of 23 May 2019

All actions were confirmed and closed. The Board RECEIVED the Matters Arising.

25/07/06 Trust Chair’s Report Mr Goulston presented the report to the Board for information. It was confirmed that the list of service visits for Mr Turner and Mr Drobniewski were incomplete. Mr Cook confirmed that he had attended the Strategic Workforce Committee, not the Management Committee as indicated in the report. It was agreed that the report would be updated, and circulated to the Board. Action – Mr Goulston Mr Goulston had attended the Kent and Medway Non-Executive Oversight Group of the Sustainability and Transformation Partnership (STP). He explained that members of the group included David Highton, Chair of Maidstone and Tunbridge Wells NHS Trust and Interim Chair of the STP, two lay members of the Clinical Commissioning Group (CCG) and two Local Authority representatives. He described the role of the group as providing oversight of governance in the Kent and Medway STP. He explained that the group had recently agreed the process for appointing the Accountable Officer for Kent and Medway CCGs who would also be the Accountable Officer for the Integrated Care System (ICS). There would also be an appointment process for the Independent Chair and Clinical Chair of the Kent and Medway CCG / ICS. In response to a question from Mr Conway, it was agreed that the Terms of Reference for the Kent and Medway Non-Executive Oversight Board would be circulated to Board members. Action – Mr Goulston Mr Cook had attended the recent Quality Improvement (QI) Conference and commented that it had been an impressive day. The Board RECEIVED the Trust Chair’s Report.

25/07/07 Chief Executive’s Report

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Mr Bentley presented the report to the Board for information.

Mr Bentley highlighted that an update had been provided to staff 12 months on from the Big Listen, and that an action plan had been developed which would focus on cultural change. Ms Skelton praised the way in which the message had been distributed to staff, and added that it was important to look strategically at how this would support the Trust’s future strategy. A discussion took place regarding the recent QI Conference, and the Board supported the view that it was a successful and uplifting event. Following a comment from Prof Drobniewski, Dr Spare agreed that behavioural aspects of QI were harder to measure, and added that human factors were a key quality priority this year. Ms Skelton commented that the momentum of QI needed to continue to ensure that it would become ‘business as usual’ within the Trust. Mr Bentley confirmed that the Trust had been looking at how it could constrain capital spending. He confirmed that the 20 per cent system reduction in capital programmes had been achieved and had been shared with NHS Improvement (NHSI). Mr Bentley highlighted that any future capital spending could be further complicated by the comprehensive spending review scheduled for the Autumn. Mr Cook commented that the ability to spend capital was a cause for concern and was a move away from the Trust’s ability to be semi-autonomous and make its own decisions. Mr Bentley reflected that this was being driven by a number of factors including the legacy issues relating to the collapse of Carillion, the comprehensive spending review in the Autumn, as well as the merger of NHSI and NHS England. He believed that as a Trust it was positively positioned, and that NHS Providers was taking this issue forward on behalf of all foundation trusts. In response to a question from Ms Barber regarding capital constraints, Ms Strong provided assurance that any impact on quality or the Cost Improvement Programme (CIP) would be thoroughly reviewed including by the Quality Committee where appropriate. The Care Quality Commission (CQC) had published its report earlier that week, and Mr Bentley was delighted to report that the Trust had been rated as Outstanding. The energy displayed by staff and positive messages received had been excellent. The Board acknowledged that the outcome was a testament to the hard work of all of the staff. The Board RECEIVED the Chief Executive’s Report.

25/07/08 Patient Story Dr Spare presented the video to the Board. The story related to a patient’s treatment for Lymphedema.

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utes

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The Board praised the service and agreed that the video was a real testament to the great work undertaken by the staff. Ms Barber reflected on a recent We Care visit to the Lymphoedema service in east Kent and felt that there was more that could be done to develop the service further, potentially extending and sharing best practice. Following a question from Ms Barber around specialist support, Ms Strong confirmed that the service did have a link to specialist provisions in the area. She further explained that the service was growing and had recently expanded to provide the service in West Kent and Medway. In response to a question from Mr Sammon, Dr Spare confirmed that there were educative opportunities to be explored further with GPs and practice nurses. She added that there was already a lot of joint working in place with nursing homes, but there was more that could be done.

The Board RECEIVED the Patient Story.

25/07/09 Board Assurance Framework (BAF) Ms Davies presented the report to the Board for assurance.

Ms Davies highlighted that since the last meeting, there had been three new risks identified against the strategic objectives. Ms Davies confirmed that Risk 101 relating to the UK Exit of the European Union would need a heightened focus over the coming months. In response to a question from Prof Drobniewski, Ms Davies confirmed that all planning and mitigation measures that had been implemented in March would be reviewed and updated to ensure that the plan continued to be robust, reflecting the additional consideration of the impact of winter. A discussion took place regarding the ownership of Risk 103 associated with changes to the system architecture. Ms Barber fed back that the Quality Committee members felt that the risk should be owned by the Board as a whole rather than the Committee. The Board agreed that it would be best placed to make the strategic decisions associated with this risk, with elements going to specific committees to take forward i.e. changes to pathways. It was further confirmed that the UK Exit risk would also sit with the Board. Mr Conway suggested that all risks were owned by the Board whichever committee the Board might delegate to examine them. Mr Sammon provided an overview of the system architecture risk for the members of the public. A discussion took place regarding the disability and race equality schemes and was identified as a potential BAF risk. It was agreed that this should be reviewed for the next meeting. Action – Ms Davies

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Ms Barber confirmed that the Quality Committee had reviewed and made changes to Risk 105 relating to referral to treatment waiting times. The Board RECEIVED the Board Assurance Framework.

25/07/10

Care Quality Commission Inspection Report Mr Bentley presented the report to the Board for information. Mr Bentley confirmed that the report had been published earlier that week. He explained that the CQC had acknowledged that there were a number of quality control issues identified within the report. The CQC had agreed to amend the report within 21 days which was when the Trust had a duty to formally publish the ratings. Mr Goulston was pleased to report that he had received a personal message of congratulations from the Chair of NHSI. Ms Norris confirmed that in recognition, every member of staff would receive an additional day of annual leave this year pro rata. In response to a question from Mr Turner, Mr Bentley confirmed that this had been costed. Mr Johnston reflected on behalf of the Dental Service that staff were enormously pleased with the outcome and that morale within the teams had increased. Mr Johnston confirmed that he had met with the staff interviewed to thank them personally for their involvement. Dr Spare commented on the remarkable work of the Communications Team to publicise the outcome. Mr Goulston formally recorded his thanks to his executive colleagues and all staff within the Trust. The Board RECEIVED the Care Quality Commission Inspection Report.

25/07/10

System Update Mr Sammon gave a presentation to the Board to provide an overview of the system changes and the emergence of the single Kent and Medway Clinical Commissioning Group, the four integrated care partnerships and the primary care networks. In response to a question from Ms Skelton, it was agreed that Dr Phillips and Mr Bentley would be included in any initial discussions relating to offers made to the primary care networks. It was agreed that a formal update report would be presented to the Board meeting in October. Action – Ms Sammon Mr Goulston confirmed that each STP was required to submit a draft five

Min

utes

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year strategic delivery plan by the end of September 2019. Mr Goulston added that the draft plan would then be presented to every Kent and Medway Board for comment and input. It was agreed that the draft plan would be presented to the Board at the meeting in October. Action – Mr Sammon The Board RECEIVED the System Update presentation.

25/07/11 Quality Committee Chair’s Assurance Report Ms Barber presented the report to the Board for assurance.

Ms Barber confirmed that there had been two Quality Committee meetings since the last Board meeting. Ms Barber highlighted that good progress had been made following the last Patient-Led Assessments of the Care Environment (PLACE) visit in 2018/19 and that there had been no high risk areas outstanding. She confirmed a risk on wayfinding being addressed by NHS Property Services (NHSPS). Ms Barber provided assurance that the action plan in place regarding the earlier CQC visit to the Dental Services was progressing satisfactorily. She added that waiting times for prison dental services would also be added to the Integrated Performance Report (IPR). Ms Barber confirmed that considerable work had been undertaken to reduce the waiting list backlog, and was pleased to report that capacity had increased and the number of complaints had reduced. Ms Barber confirmed that the Committee had reviewed the Infection Prevention and Control Report, and was pleased to note that there was a focused approach to the way outbreaks were managed. Ms Barber added that the Trust was compliant with the Hygiene Code. Ms Barber reflected on the Safeguarding Annual Report. She confirmed that good progress had been made and that there were good systems in place for both children and adults. Both annual reports were recommended to the Board for their approval. Ms Barber highlighted the changes to the Deprivation of Liberty Safeguards (DoLS) legislation. Ms Barber was pleased to report that the Trust would be strengthening its bereavement support provided to patients and families. Ms Barber confirmed that there had been a deep dive on the Health Visiting Service and highlighted that there had been a number of areas where good progress had been made. She reported that the achievement of the antenatal target remained a challenge. Ms Barber confirmed that the Committee had conducted the meeting

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effectiveness review, and it was agreed that they would move to bi-monthly meetings with an extraordinary meeting in February to review the quality impact assessment of the coming year’s CIP. The Board RECEIVED the Quality Committee Chair’s Assurance Report.

25/07/12 Strategic Workforce Committee Chair’s Assurance Report Ms Skelton presented the report to the Board for assurance.

Ms Skelton confirmed that the Workforce Report continued to show an improving but challenging picture; which included a decrease in turnover in June. She added that recruitment activity remained high but noted that the average time to recruit had reduced. Ms Skelton was pleased to report that the academy had expanded to include apprenticeships for facilities and administrative staff. The academy would also provide opportunities for current staff to develop. Ms Skelton reported that TIAA, the Trust’s internal auditors had provided limited assurance regarding General Data Protection Regulations (GDPR) compliance on personnel files. The Committee would continue to look at electronic personnel filing systems as well as other more cost effective options. Ms Skelton confirmed that the Committee had received some data and summary of findings around the Workforce Race Equality Scheme (WRES) and Workforce Disability Equality Scheme (WDES) reports. The Committee had looked at specific elements, and there would be some further work to understand some of the issues, and actions agreed to address them Ms Skelton confirmed that there had been a discussion in relation to the Operational Workforce Report around recruitment challenges. She provided assurance that they were trying to be as innovative as possible to improve the situation. Ms Skelton confirmed that the Committee had received assurance that the Trust was meeting all principles in relation to Safer Staffing, but that more work was ongoing through the Safer Staffing Group. A progress update would be provided to the Committee in September. Ms Skelton confirmed that all elements of the national Interim People Plan launched since the last meeting of the Board are were already part of the Trust’s plan. In response to a question from Prof Drobniewski regarding prevention of sickness relating to musculoskeletal disorders (MSK), Ms Skelton confirmed that the Committee would be undertaking some work to understand the contributing factors and identify the scale of the problem. Ms Norris confirmed that MSK disorders was the biggest reason for

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sickness and needed to be tackled. She added that the Trust would be reviewing the moving and handling training. In response to a question from Prof Drobniewski regarding strategies in place to capture the level of disabilities within the Trust, Ms Skelton confirmed that there had been reporting issues and that there needed to be better understanding with staff around what was classified as a disability. Ms Skelton added that there needed to be increased staff awareness as to why the information was required and to feel comfortable when reporting their disability. Staff should also be made aware that this information would provide the Trust with the knowledge to better support them in their working life. Ms Norris added that there would be a campaign to highlight disability, which would include disability classifications and why it was so important to provide the information. She added that staff would be able to update their own details directly on the system. The Board RECEIVED the Strategic Workforce Committee Chair’s Assurance Report.

25/07/13

Finance, Business and Investment Committee Chair’s Assurance Report Mr Cook presented the report to the Board for assurance.

Mr Cook provided assurance that BAF risk 99 in relation to the Community Information System (CIS) was being effectively managed. Mr Turner supported the view that the Trust would continue to struggle year on year to extract sufficient savings from the CIP and confirmed that he had been part of some conversations around the possibility of looking at more structural initiatives looking at levels/layers across the Trust. In response to a question from Prof Drobniewski which related to 100 per cent of contracts being retained and whether this included those contracts which did not add any contribution, Mr Cook confirmed that all contracts were reviewed and monitored closely. In response to a question from Mr Conway, Mr Cook agreed that the Trust would need to continue to invest in technology and other initiatives to improve productivity. Mr Turner added that this was already happening with initiatives like the Transforming Integrated Care in the Community (TICC) Project, based on the principles of Buurtzorg. The Board RECEIVED the Finance, Business and Investment Committee Chair’s Assurance Report.

25/07/14 Integrated Performance Report (IPR)

Ms Strong presented the report to the Board for assurance.

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Ms Strong highlighted that a review of the Key Performance Indicators (KPIs) was still ongoing, and added that once the review was complete the format of the IPR would change. In response to a query from Mr Goulston regarding the corporate scorecard which had been missing from the report, Ms Strong confirmed that the report would be amended and recirculated. Action – Ms Strong In response to a question from Mr Turner, Ms Strong confirmed that the number of children’s audiology referrals had been significantly impacted by the influx of referrals from Medway, and that they had been working closely with the Medway School Health Service to try to resolve this. Dr Spare added that they were also working in conjunction with Medway Community Healthcare to look at the quality impact. The Board RECEIVED the Integrated Performance Report.

25/07/15 Committees’ Terms of Reference Mr Goulston presented the Terms of Reference to the Board for approval.

Ms Davies confirmed that the Terms of Reference for the Nomination Committee should not have been included within the papers. She confirmed that the Terms of Reference for the Remuneration and Terms of Service Committee should have been included and would be brought to the next meeting for approval. Action – Ms Davies It was agreed that a review of the Terms of Reference for the Formal Board meetings would also be undertaken at the next meeting. Action – Ms Davies The Board APPROVED the Terms of Reference for the following Committees:

• Audit and Risk Committee

• Charitable Funds Committee

• Finance, Business and Investment Committee

• Quality Committee

• Strategic Workforce Committee

25/07/16 Infection Prevention and Control Annual Report Dr Spare presented the report to the Board for assurance.

The Board RECEIVED the Infection Prevention and Control Annual Report.

25/07/17 Learning from Deaths Dr Johnston presented the quarterly report to the Board for assurance.

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The Quality Committee had scrutinised the report.

In response to a question from Prof Drobniewski, Dr Spare confirmed that the results of the water testing at Sevenoaks Hospital had been received. She confirmed that all appropriate control measures were in place and the next step in the improvement works regarding water at Sevenoaks Hospital was around chlorination of the system. The Board RECEIVED the Learning from Deaths Report.

25/07/18 Safeguarding Annual Report including the Safeguarding Declaration Dr Spare presented the report to the Board for assurance.

In response to a question from Ms Skelton, it was agreed that non-executive directors should be offered safeguarding training, if required. Action – Dr Spare In response to a question from Mr Conway, Dr Spare confirmed that the Safeguarding Team did review benchmarking data. In response to a question from Prof Drobniewski regarding seasonal trends, Ms Spare agreed to look at trends with the Safeguarding Team, and would report back to the next meeting. Action – Ms Spare The Board RECEIVED the Safeguarding Report.

25/07/19 Any Other Business

There was no further business to discuss.

25/07/20 Questions from members of the public relating to the agenda In response to a question from Janet Allen, Staff Governor and Head of Emergency Preparedness, Resilience and Response (EPPR), Ms Strong agreed to provide further information on referrals and waiting times within the Lymphoedema service. Action – Lesley Strong The meeting ended at 12.20pm.

25/07/21 Date and Venue of the Next Meeting

Thursday 26 September 2019 Village Hotel, Castle View, Forstal Road, Maidstone, Kent ME14 3AQ

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Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 1.6

Agenda Item Title: Trust Chair’s Report

Presenting Officer: John Goulston, Trust Chair

Action - this paper is for: Decision ☐ Information ☒ Assurance ☒

Report Summary

The report sets out the service visits and partnership meetings that were attended by the Trust Chair and non-executive directors between 1 August and 31 October 2019.

Proposals and /or Recommendations

To note the report.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒

High level position described and no decisions required.

Thomas Fentem, PA and Project Officer Tel: 01622 211900

Email: thomas.fentem@nhs.net

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SERVICE VISITS AND PARTNERSHIP MEETINGS ATTENDED BY THE CHAIR AND NON EXECUTIVE DIRECTORS OF

KENT COMMUNITY HEALTH NHS FOUNDATION TRUST

Period covered – 1 August – 31 October 2019

Name Service visits Stakeholder/ Partnership meetings / events

Other meetings / events

John Goulston

2 August - Home First Team, West Kent, Coxheath Clinic 15 August - Service Visit - Community Nursing Teams, Sevenoaks 21 August - Tonbridge Cottage Hospital and WK Health Visiting Team -visits with Kent County Council, Cabinet Member and deputy cabinet member for Adult Social Care 9 September - KCH Physiotherapy Conference 8 October – Team Leaders Conference 9 October - Specialist & Elective Services Conference 14 October - Allied Health Professionals – East Kent 28 October – Nursing Academy Launch

6 August - Chair of Kent & Medway NHS & Social Care Partnership Trust 19 August - Kent & Medway Provider Chairs and Chief Execs Meeting 23 August - West Kent Integrated Care Partnership (ICP) Development Board 10 September - NHS Providers Chairs & CEO Network 14 October - Kent & Medway NED Oversight Group 14 October - Kent & Medway Provider Chairs and Chief Execs Meeting 22 October – West Kent ICP engagement event 22 October – Staff Networks Conference 24 October - Kent & Medway Medical School and Kent & Medway chairs & CEOs 28 October - Kent & Medway STP NED engagement event

19 August - Long Service awards lunch, Sevenoaks 29 August – Strategy Delivery Meeting, directors 25 September – Strategic Workforce Committee 25 September - Board of Directors 26 September - Board of Directors and AGM

Pippa Barber

16 September - We Care Visit Lymphedema Service Medway. 27 September - KCHFT Safeguarding Conference. 30 September - Research champions meeting. 7 October - Kent School Health Folkestone CIP

28 October - STP Chairs and NEDs briefing

29 August – Strategy Delivery Meeting, directors 3 September – ARC 13 September – Chief Operating Officer stakeholder event. 17 September –

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Name Service visits Stakeholder/ Partnership meetings / events

Other meetings / events

Pippa Barber (cont.)

Deep Dive. 8 October – Team Leaders Conference 9 October - Kent specialist Services conference. 15 October – Quality Improvement Training 22 October – West View Integrated Care Unit, quality visit 28 October – Nursing Academy Launch

Quality Committee 25 September - Board of Directors 26 September - Board of Directors and AGM 30 October - Board of Directors 31 October – Council of Governors

Peter Conway

7 October – School Health Team, Folkestone 28 October – Nursing Academy Launch

24 September – Clinical Excellence Awards 28 October - Kent & Medway STP NED engagement event

29 August – Strategy Delivery Meeting, directors 3 September – ARC 13 September – Chief Operating Officer stakeholder event. 25 September – Strategic Workforce Committee 4 October – FBI Committee 30 October - Board of Directors 31 October – Council of Governors 30 October - Remuneration Committee.

Prof Francis Drobniewski

12 September - We Care; King’s and Canterbury Hospital Rapid Transfer service visit 22 October – West View Integrated Care Unit, quality visit

11 September - We care planning meeting 17 October – End of Life Care Meeting

29 August – Strategy Delivery Meeting, directors 13 September – Chief Operating Officer stakeholder event. 17 September – Quality Committee 25 September – Strategic Workforce Committee 25 September - Board of Directors

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Name Service visits Stakeholder/ Partnership meetings / events

Other meetings / events

Prof Francis Drobniewski (cont.)

26 September - Board of Directors and AGM

Bridget Skelton

28 October – Nursing Academy Launch

14 October - NHS Leadership Compact & NHS Best Place to work - National Meeting 22 October – Staff Networks Conference 28 October - STP Chairs and NEDs briefing

19 August – Met with Chief Operating Officer Candidate 29 August – Strategy Delivery Meeting, directors 25 September – Strategic Workforce Committee 25 September - Board of Directors 26 September - Board of Directors and AGM 4 October – FBI Committee 30 October - Board of Directors 30 October - Remuneration Committee. 31 October – Council of Governors

Jen Tippin Jen Tippin

29 August – 1:1 with John Goulston 29 August – Strategy Delivery Meeting, directors 29 August - Remuneration Committee. 13 September - 1:1 with John Goulston 20 September - 1:1 with John Goulston 25 September – Strategic Workforce Committee 4 October – FBI Committee 30 October - Board of Directors 30 October -

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Name Service visits Stakeholder/ Partnership meetings / events

Other meetings / events

(cont.)

Remuneration Committee.

Nigel Turner

22 October – West View Integrated Care Unit, quality visit

3 October - Meeting with Lloyds for workforce Benchmarking

29 August – Strategy Delivery Meeting 29 August – Human Resources Strategy meeting 29 August - Remuneration Committee. 17 September – Quality Committee 25 September – Strategic Workforce Committee 25 September - Board of Directors 26 September - Board of Directors and AGM 30 October - Board of Directors

Key

Acronym Full name

AGM Annual General Meeting

ARC Audit and Risk Committee

CEO Chief Executive Officer

FBI Finance, Business and Investment Committee

ICP Integrated Care Partnership

KCC Kent County Council

KCHFT Kent Community Health NHS Foundation Trust

NED Non-Executive Director

STP Sustainability and Transformation Partnership

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Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 1.7

Agenda Item Title: Chief Executive’s Report

Presenting Officer: Paul Bentley, Chief Executive

Action - this paper is for: Decision ☐ Information ☒ Assurance ☐

Report Summary

This report highlights key business and service developments in Kent Community Health NHS Foundation Trust in recent weeks.

Proposals and /or Recommendations

Not applicable.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒ Not applicable.

Paul Bentley, Chief Executive Tel: 01622 211903

Email: p.bentley@nhs.net

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CHIEF EXECUTIVE’S REPORT

November 2019

As previously I wanted to highlight to the Board the following significant developments since my last formal report during the Board meeting in July 2019, the report follows the regular practice of categorising matter reported into patients, our people staff teams and partnerships. Patients

1. Kent and Medway Delivery Plan

The Trust has been strongly engaged with the work to deliver the NHS plan in Kent and Medway, the Trust has repeatedly made the point that investment in the prevention of ill-health and healthcare delivered in people’s homes, along with a clearer view of what the Kent and Medway priorities need to be will see the opportunities presented by the plan delivered more effectively. 2. Winter planning

The winter plan was approved by the Board at its meeting in October. Since then there has been an increase in demand in both whole systems with a higher number of patients than expected attending A&E. Current A&E performance against the four hour waiting time target for the week ending 10 November is as follows:

East Kent Hospitals – 80.4%

Maidstone and Tunbridge Wells – 90.3%

This has placed demand on the whole system to increase the flow of patients The following actions have been taken by KCHFT:

East Kent: increase in the number of complex discharges from the acute trust (week ending 10th November 2019 222 discharges). There have been an increase in care packages as part of Home with Support, and an increased number of spot purchased beds in the independent sector (currently 34 patients in addition to the 40 Health and Social Care Village beds).

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West Kent: increase in the number of patients on Hospital @ Home service (on 12/11/19 20 patients) and a month by month increase in patients accessing the rapid response and Home Treatment Service

Internal twice weekly conference calls are in place

External whole system calls are being held as required

3. Physiotherapy Conference

I was delighted to open the Physiotherapy Conference that took place in September in part to mark international physiotherapy day. More than 65 physiotherapists and physio support workers attended the event to hear inspiring presentations from internal presenters, representatives from the universities of Brighton and Canterbury Christ Church, and the Chartered Society of Physiotherapists. Our Chair along with Claire Poole, Deputy Chief Operating Officer, presented the awards for the physiotherapist of the year, Burnnett Hartzenberg, and the physiotherapist support worker of the year, James Page.

4. Service Visits

During September I was delighted to spend time with the Looked After Children’s (LAC) team. The whole team were together for a day for their away day. Pippa White, Head of Service LAC, working with her team has fundamentally redesigned the service for the benefit of the children the team serves. I saw two presentations from two different team members, different in style and substance, but both highly uplifting. They focused on how they had devolved responsibility, how they were looking after each other as a team and how they were given licence by their leaders to try different things and really importantly, how they were all looking after each other’s emotional and physical wellbeing. Freedom to Speak Up Guardian

I am delighted to report that I met with Joy Fuller, the Trusts’ newly appointed Freedom to Speak Up Guardian (FTSU). Joy is keen to develop the FTSU role, as well as providing advice and support, but to also promote the culture of speaking up across the trust and ensure that effective processes are in place to support staff. In discussing further with Joy no common or reoccurring themes of concern are being reported.

Our People

1. Staff survey The national staff survey was initially sent out at the beginning of October to our workforce and across the country. There has been significant communications activity encouraging and reminding all colleagues to complete the survey, which

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must be returned by 29 November. Reminder surveys were sent out in mid-November. We are aiming to reach and exceed our return rate of 60 per cent from 2018. A full of the findings will be presented to the Strategic Workforce Committee in March, with onwards reporting to the Board. 2. Opening of the Nursing Academy We were very pleased to welcome Baroness Dido Harding, chair of NHS Improvement, to officially open our Nursing Academy in October. During her visit to the academy base in Coxheath, Dido was especially pleased to meet two students who talked about their experiences to date, as well as touring the clinical skills lab. She described her visit as ‘fantastic’ and said the initiative was something the whole sector could learn from and that she had seen ‘future leaders in the pipeline’.

3. Appointment of the Chief Operating Officer and Director of Strategy

Following the announcement of Lesley Strong’s retirement, a recruitment process took place to appoint a chief operating officer and I am delighted that Pauline Butterworth will join the trust on 16 December 2019 as chief operating officer. Pauline joins the trust from East Sussex Healthcare Trust where she has been deputy chief operating officer since 2013. Finance Director Gordon Flack will become deputy chief executive. I am also pleased to confirm on a substantive basis the appointment of Gerard Sammon to the role of Director of Strategy and Partnerships.

4. Formation of the Kent and Medway medical school

Since the last time the Board met the Trust has been working with the University of Kent, Canterbury Christchurch University and other partners in the NHS to make a Medical School in and for Kent and Medway a reality. As a trust the school has our full support and we look forward to the first students arriving next year.

Partnerships

1. Visit by Chris Hopson

Chris Hopson, NHS Providers Chief Executive, visited the trust to find out more about our services. Chris met the Chair, the Executive Team and observed first-hand what the organisation does while spending time with the Long Term Nursing Team and Integrated Musculoskeletal (IMSK) Team at the Churchill Centre in Aylesford.

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Chris also saw how KCHFT is developing and investing in its workforce, along with our transformation project of the IMSK service to streamline and further improve the service.

2. Meeting with the newly appointed NHSE/I Senior Leadership team

Since the last time the Board met NHS England and NHS Improvement has continued the process of closer integration and I have met with a number of the senior team, there is a welcome commitment to come out to the service and listen to the issues which service providers face. 3. Partnership agreement with Kent County Council

Since the last time the Board met the Trust has worked in partnership with Kent County Council to extend the successful public health partnership agreement which covers the provision of Kent County Council commissioned services. I am delighted that agreement has been reached and very strongly value the work of both parties to make the agreement a success. 4. Development of the Integrated Care Partnership (ICP) and engagement

with the Primary Care Networks (PCNs)

The four Integrated Care Partnerships (ICP’s) are continuing their development work and are all due to introduce a shadow form by April 2020. Engagement work and plans with stakeholders is underway and the integration of the newly formed Primary Care Networks (PCN’s) into the ICP’s is also taking place. The Trust remains committed to providing leadership and support to setting up this new way of collaborative working with a particular emphasis on the East and West Kent systems. Engagement activities with Primary Care Networks are ongoing and the Trust is seeking to collaborate with all PCN’s and potentially form deeper relationships with 5-8 in the first instance to jointly develop new and innovative ways of working together.

5. Meeting of the West Kent Primary Care Networks (PCNs) Clinical

Directors

The Medical Director and I attended a meeting of the newly appointed Clinical Directors of the Primary Care Networks across West Kent. It was helpful to meet and listen to the views expressed, and the Board will receive regular updates on the relationships being formed with this important group.

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6. The Trusts Annual General Meeting (AGM) September saw the Trusts AGM. As part of the AGM a number of people spoke at the Let’s discuss cancer event, including Ellen in a pre-recorded film about how she had been supported through her cancer journey by KCHFTs Learning Disability Nursing Team. There was a packed market place with KCHFT, partner and voluntary organisations explaining what support was locally on offer. The event culminated in a rousing performance from some of the KCHFT choir. The AGM was wrapped up with presentations from our Public Governor, Carol Coleman, reflecting on the past year for the governors, while the Chief Nurse and Medical Director gave an insight into the Quality Report.

Paul Bentley Chief Executive November 2019

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Committee / Meeting Title: Board Meeting - Part 2 (Confidential)

Date of Meeting: 28 November 2019

Agenda Number: 2.2

Agenda Item Title: Board Assurance Framework

Presenting Officer: Natalie Davies, Corporate Services Director

Action - this paper is for: Decision ☐ Information ☐ Assurance ☒

Report Summary

The function of the Board Assurance Framework (BAF) is to inform and elicit discussion about the significant risks which threaten the achievement of the Trust’s strategic objectives.

To provide assurance that these risks are being effectively managed, the BAF details the controls in place to mitigate each risk, any gap in control, assurance of the controls’ effectiveness, the actions planned and being executed together with the date by when the actions are due to be completed.

The full BAF as at 04 November 2019 is shown in Appendix 1.

Proposals and /or Recommendations

The Board is asked to note this report.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒

High level position described and no decisions required.

Barry Norton, Head of Risk Management Tel: 01233667744

Email: barry.norton@nhs.net

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BOARD ASSURANCE FRAMEWORK

1. Introduction

1.1 The Board Assurance Framework (BAF) is comprised of strategic risks

identified against the strategic goals defined within the Integrated Business Plan (IBP) in addition to risks identified against the achievement of business and operational objectives with a high gross (inherent) risk rating.

1.2 The BAF is therefore comprised of high risks. Refer to section 7 below for a definition of high risk.

1.3 Risks may be identified by Services or Directorates and escalated

upwards to the Executive Team, or may be identified at the Board or any of its sub Committees.

1.4 The Executive Team review newly identified high risks to ensure that those

with significant potential to impact on the achievement of strategic goals are recorded on the BAF and reported to the Board. This allows the Board to monitor mitigating actions. As actions are implemented, controls improve and this can enable the exposure to risk to reduce.

1.5 The full BAF as at 04 November 2019 is shown in Appendix 1. This

version has not previously been presented to the Board. 2. New risks

2.1 Since the BAF was last presented to the Board there have been three new risks identified against the strategic objectives. BAF ID 105 - ‘Challenges in meeting the referral to treatment waiting time target could impact on patient experience and the trust segmentation rating’.

BAF ID 106 - ‘Risk that the organisation’s services may suffer significant challenges as result of the impact of winter pressures’

3. Risks that have been closed since the last report

3.1 Since the BAF was last presented to the Board no risks have been closed.

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2

4. Risks that have been de-escalated since the last report

4.1 Since the BAF was last presented to the Board the following risk has been de-escalated.

BAF ID 104 - ‘Inability to meet CIP targets as detailed in 19/20 plans as growing reliance on economy level transformation for savings’.

5. Risks previously de-escalated to Directorate risk registers that have closed 5.1 There are no risks that have been de-escalated to Directorate risk

registers that have now closed.

5.2 The total number of risks documented on the BAF is six. Figure 1 (below) provides a visual representation of the organisational risk profile based on the current risk rating within section 1 of the BAF.

5.3 Figure 1: Organisational High Risk Profile

6. High risk definition 6.1 A high risk is defined as any risk with an overall risk rating of 15 or above,

as well as those risks rated as 12 with a consequence score of 4. The risk matrix below provides a visual representation of this.

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3

Figure 2: Trust risk matrix

← Consequence / Severity →

Insignificant Minor Moderate Major Catastrophic

↓Likelihood ↓ 1 2 3 4 5

Rare 1 1 2 3 4 5

Unlikely 2 2 4 6 8 10

Possible 3 3 6 9 12 15

Likely 4 4 8 12 16 20

Almost Certain 5 5 10 15 20 25

The scores obtained from the risk matrix are assigned grades as follows:

1 – 6 Low risk

8 – 12 Medium Risk

12 – 25 High Risk

7. Risk Overview 7.1 The total number of open risks within the Trust stands at 220 this is

comprised of 118 low risks, 91 medium risks and 11 high risks. Figure 3 (below) provides a visual representation. There are currently 15 out of date risks and 1 risk past its target completion date. Low risks are initially reviewed by Heads of Service with further reviews by the responsible officer at least bi monthly. Medium risks would initially be reviewed by Heads of Service and then onward to the Community Service Director/Assistant Director for approval, these would normally be reviewed on a monthly basis. All risks are extracted by the Risk Team on a weekly basis and the officer responsible for those risks that have passed their review date or target completion date are contacted by the team to prompt a review.

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4

7.2 Figure 3: Organisational Risk Overview. 8. Recommendation

8.1 The Board is asked to consider the Board Assurance Framework in Appendix 1 and determine whether sufficient mitigating actions are in place to address these.

Barry Norton Head of Risk 14 November 2019

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nt C

are

Rec

ord

is a

bout

to s

tart

from

Apr

il 20

and

may

neg

ativ

ely

impa

ct o

n th

e EP

R p

roje

ct c

ompe

ting

for s

taff

reso

urce

s e.

g.

train

ing.

Boar

d C

omm

ittee

Lea

d on

Ass

uran

ce:

Fina

nce,

Bus

ines

s an

d In

vest

men

t Com

mitt

ee

• Gov

erna

nce

stru

ctur

e &

proj

ect p

lan

in p

lace

• Eng

agem

ent w

ith th

e pr

ojec

t tea

m d

eliv

erin

g th

e Ke

nt C

are

Rec

ord

• Pro

ject

Lea

ders

hip

team

job

desc

riptio

ns• E

xper

tise

from

NEL

FT• P

hase

impl

emen

tatio

n pl

an a

nd re

sour

cing

app

ropr

iate

ly• C

omm

unic

atio

n pl

ans

deve

lope

d w

ith s

take

hold

ers

Inc.

co

mm

issi

oner

s.• O

pera

tiona

l ris

k an

d m

itiga

tions

log

• Reg

ular

Boa

rd re

ports

link

ed to

oth

er

proj

ects

• Pro

ject

Gro

up re

port

to M

anag

emen

t C

omm

ittee

, Exe

c T

eam

and

Boa

rd

Paul Bentley

• Tim

esca

les

to im

plem

ent n

ew s

yste

m• C

ompr

ehen

sive

pro

gram

me

plan

for

repl

acem

ent s

yste

m to

be

deve

lope

d in

re

spon

se to

em

ergi

ng ti

mes

cale

s

12H

Gordon Flack

High

Upd

ated

04

Nov

embe

r 201

9

Def

initi

ons:

Initi

al R

atin

g =

The

risk

ratin

g at

the

time

of id

entif

icat

ion

Cur

rent

Rat

ing

= R

isk

rem

aini

ng w

ith c

urre

nt c

ontro

ls in

pla

ce. T

his

is

revi

ewed

mon

thly

and

sho

uld

decr

ease

as

actio

ns t

ake

effe

ct.

Targ

et D

ate

= M

onth

end

by

whi

ch a

ll ac

tions

sho

uld

be c

ompl

eted

Initi

al ra

ting

Cur

rent

ratin

g

Appe

ndix

1

Ris

ks w

ith a

hig

h ne

t ris

k ra

ting

whi

ch h

ave

not b

een

tole

rate

d.

Actio

n st

atus

key

:Ac

tions

com

plet

edO

n tra

ck b

ut n

ot y

et d

eliv

ered

Orig

inal

targ

et d

ate

is u

nach

ieva

ble

Boa

rd A

ssur

ance

Fra

mew

ork

Sect

ion

1103

A

• Inc

reas

e in

dem

and

rais

ed w

ith C

CG

’s

but n

o de

cisi

ons

Gordon Flack

Plan

ned

Actio

ns a

nd M

ilest

ones

43

99

12H

3

Risk

Des

crip

tion

(Sim

ple

Expl

anat

ion

of th

e Ri

sk)

Inte

grat

e Se

rvic

es

Paul Bentley

4

Jan 2019

12H

Mar 2020

Lesley Strong

Cha

lleng

es in

mee

ting

the

refe

rral t

o tre

atm

ent w

aitin

g tim

e ta

rget

cou

ld im

pact

on

patie

nt e

xper

ienc

e an

d th

e tru

st

segm

enta

tion

ratin

g

Boar

d C

omm

ittee

Lea

d on

Ass

uran

ce:

Qua

lity

Com

mitt

ee

43

12H

• Acc

ess

polic

y in

clud

es h

arm

risk

ass

essm

ent f

or p

ts w

aitin

g ov

er 1

8 w

eeks

• Reg

ular

repo

rts IP

R• S

PC c

hard

s• Q

ualit

y co

mm

ittee

revi

ew o

f are

as o

f co

ncer

n• Q

I app

roac

h to

ser

vice

impr

ovem

ent

312

H

Lesley Strong

Medium

Mar 2020

Prev

ent i

ll he

alth

105

May 2019

12H

• Sus

tain

abilit

y an

d Tr

ansf

orm

atio

n Pl

an (S

TP) P

rogr

amm

e •B

oard

TO

Rs

and

mem

bers

hip

• TO

Rs

for:

Loca

l Car

e Bo

ards

; Fra

ilty

Gro

up; C

hief

Exe

cutiv

es

Foru

m• S

TP G

over

nanc

e St

ruct

ures

• Wes

t Ken

t Im

prov

emen

t Boa

rd te

rms

of re

fere

nce

• Eas

t Ken

t Tra

nsfo

rmat

ion

Boar

d te

rms

of re

fere

nce

NH

S I/E

sys

tem

mee

ting

term

s of

refe

renc

e • C

hief

Exe

cutiv

e as

SIR

O fo

r Eas

t IC

P• C

hair

as C

hair

for W

est I

CP

• Sys

tem

tran

sfor

mat

ion

gove

rnan

ce s

truct

ure

• Wes

t Ken

t int

egra

ted

care

par

tner

ship

dev

elop

men

t boa

rd's

te

rms

of re

fere

nce

• Eas

t Ken

t int

egra

ted

care

par

tner

ship

dev

elop

men

t boa

rd's

te

rms

of re

fere

nce

Mar 2021

Jan 2019

Boa

rd A

ssur

ance

Fra

mew

ork

Page 32 of 194

Page

2 o

f 2

ID

Opened

Board Level Risk Owner

CL

Rating

Cont

rols

Des

crip

tion

Posi

tive

Assu

ranc

esG

aps

in c

ontr

ol o

r Neg

ativ

e As

sura

nce

CL

Rating

Action owner

Confidence Assessment

Target Date (end)

Initi

al ra

ting

Cur

rent

ratin

g

Plan

ned

Actio

ns a

nd M

ilest

ones

Risk

Des

crip

tion

(Sim

ple

Expl

anat

ion

of th

e Ri

sk)

D ev

Indi

vidu

al A

ctio

nsO

wne

rTa

rget

Com

plet

ion

(end

)St

atus

Syst

em te

st 'E

x Lu

ndy'

11t

h Se

pN

atal

ie D

avie

sSe

p 20

19G

Dai

ly S

yste

m s

itrep

s fro

m 1

st O

ctN

atal

ie D

avie

sO

ct 2

019

GD

evel

op s

taff

info

rmat

ion

days

Nat

alie

Dav

ies

Oct

201

9G

Esta

blis

h es

cala

tion

rout

es fo

r pro

cure

men

t N

atal

ie D

avie

sO

ct 2

019

GIm

plem

ent E

U E

xit t

rain

ing

for s

taff

Nat

alie

Dav

ies

Oct

201

9G

Impl

emen

t win

ter p

ress

ure

plan

s in

to E

U E

xit p

lans

Nat

alie

Dav

ies

Oct

201

9G

Indi

vidu

al A

ctio

nsO

wne

rTa

rget

Com

plet

ion

(end

)St

atus

Scop

ing

exte

nsio

n to

clin

ical

aca

dem

yLo

uise

Nor

risO

ct 2

019

AD

evel

op, c

omm

issi

on a

nd im

plem

ent a

Boa

rd D

evel

opm

ent

prog

ram

me

Loui

se N

orris

Nov

201

9A

Del

iver

wel

l bei

ng a

ctio

n pl

anLo

uise

Nor

risN

ov 2

019

A

Del

iver

the

Big

List

en a

ctio

n pl

anPa

ul B

entle

yM

ar 2

020

A

Oct 19

101

Dec 2019

Natalie Davies"U

ncer

tain

ty a

roun

d EU

exi

t may

affe

ct o

ur a

bilit

y to

del

iver

co

re o

bjec

tives

Boar

d C

omm

ittee

Lea

d on

Ass

uran

ce:

Boa

rd

43

12H

• Loc

al H

ealth

Res

ilienc

e Pa

rtner

ship

(LH

RP)

term

s of

refe

renc

e• E

xecu

tive

lead

app

oint

ed•

Hea

d of

Res

ilienc

e JD

Actio

n pl

an d

evel

oped

• EU

exi

t ris

k re

gist

er e

stab

lishe

d

• Reg

ular

dis

cuss

ion

and

revi

ew a

t Ex

ec/M

anag

emen

t Com

mitt

ee a

nd B

oard

.• N

HS

Engl

and

(NH

S E)

repo

rting

re

quire

men

ts m

et.

• LH

RP

mee

tings

atte

ndan

ce.

• Fur

ther

dev

elop

pla

n in

resp

onse

to n

ew

info

rmat

ion.

• Bi-w

eekl

y Tr

ust E

U e

xit m

eetin

gs h

eld.

• Wor

king

in c

olla

bora

tion

with

Clin

ical

C

omm

issi

onin

g G

roup

s (C

CG

s)

4

Louise Norris

Medium

43

12H

Natalie Davies

Medium

43

12H

• Stra

tegi

c W

orkf

orce

Com

mitt

ee T

oRs,

• Ser

vice

qua

lity

visi

ts• D

irect

or o

f Wor

kfor

ce J

D;

• Wor

kfor

ce S

trate

gy A

gree

d• O

pera

tiona

l wor

kfor

ce re

ports

• Com

plai

nts

syst

em e

stab

lishe

d ag

ains

t agr

eed

polic

y• F

riend

s an

d Fa

mily

Tes

t• T

alen

t Man

agem

ent S

trate

gy• T

ime

to C

hang

e C

ham

pion

s sy

stem

est

ablis

hed

• Ser

vice

vis

it re

porte

d to

qua

lity

com

mitt

ee• W

orkf

orce

repo

rt to

boa

rd• I

PR K

PIs

repo

rted

and

revi

ewed

by

Boar

d• S

afer

Sta

ffing

repo

rts• w

orkf

orce

pla

ns• T

ime

to h

ire b

ench

mar

ks p

ositi

vely

• ban

k fil

l rat

es im

prov

ing,

• age

ncy

usag

e re

port.

• Wor

kfor

ce re

port

to S

WC

• Qua

lity

Rep

ort t

o th

e Q

ualit

y C

omm

ittee

312

H

102

Jan 2019

Louise Norris

Inab

ility

to re

crui

t and

reta

in s

taff

coul

d ha

ve a

det

rimen

tal

impa

ct o

n m

aint

aini

ng q

ualit

y of

car

e an

d m

oral

e

Boar

d C

omm

ittee

Lea

d on

Ass

uran

ce:

Stra

tegi

c W

orkf

orce

Com

mitt

ee

Mar 2020

• vac

anci

es 9

.69%

, tur

nove

r 18.

14%

Page 33 of 194

Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 2.3

Agenda Item Title: Quality Committee Chair’s Assurance Report

Presenting Officer: Pippa Barber, Chair of Quality Committee

Action - this paper is for: Decision ☐ Information ☐ Assurance ☒

Report Summary

The paper summarises the Quality Committee meetings held on 17 September and 19 November 2019.

Proposals and /or Recommendations

The Board is asked to receive the Quality Committee Chair’s Assurance Report.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒

High level position described and no decisions required.

Pippa Barber, Non-Executive Director Tel: 01622 211906

Email:

Qua

lity

Com

mitt

ee R

epor

t

Page 34 of 194

QU

AL

ITY

CO

MM

ITT

EE

CH

AIR

’S A

SS

UR

AN

CE

RE

PO

RT

Th

is r

ep

ort

pro

vid

es u

pd

ate

s o

n k

ey r

isks/issue

s f

ollo

win

g t

he

Qua

lity C

om

mitte

e P

art

One

me

etin

g h

eld

on 1

7 S

ep

tem

be

r 2

019

. A

ge

nd

a i

tem

A

ss

ura

nce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

Qu

alit

y R

epo

rt

Th

e C

om

mitte

e r

ece

ive

d a

ssu

ran

ce

on

the

on

go

ing

wo

rk

su

ppo

rtin

g th

e tra

nsitio

nin

g o

f th

e W

est V

iew

un

it f

rom

Ke

nt

Co

un

ty C

ou

ncil

to t

he

Tru

st.

Th

e u

nit is b

ein

g s

up

po

rte

d

du

rin

g th

is p

roce

ss w

ith

a fo

llow

up W

e C

are

vis

it b

ein

g

un

de

rta

ken

in

De

ce

mbe

r 2

019

. C

ha

ng

es to

the

skill

mix

on

the

un

it a

re b

ein

g u

ndert

ake

n.

Qu

alit

y C

om

mitte

e n

on-e

xe

cu

tive

dire

cto

rs (

NE

Ds)

to u

nd

ert

ake a

se

rvic

e

vis

it t

o t

he

We

st V

iew

un

it in

Octo

be

r

20

19

.

Sta

ff F

lu V

accin

ation

s

Assu

ran

ce

wa

s g

ive

n th

at

the

pro

gra

mm

e is u

nde

r w

ay w

ith

ap

pro

pria

te v

accin

es a

nd

va

ccin

ato

rs in

pla

ce

. T

he

pla

n is fo

r

the

ma

jority

of

sta

ff to

be

va

ccin

ate

d in

Octo

be

r a

nd

No

ve

mb

er

20

19.

Bo

ard

Assu

ran

ce

Fra

me

wo

rk (

BA

F)

Ris

k 1

05

- A

ssu

ran

ce

an

d u

pda

tes w

ere

pro

vid

ed

on

th

e R

TT

wa

itin

g t

ime

s. P

aed

iatr

ic A

ud

iolo

gy w

as m

akin

g g

oo

d

pro

gre

ss a

nd

wa

s o

n t

raje

cto

ry to

me

et

its ta

rge

t. H

ow

eve

r,

furt

he

r risk h

ad

be

en

ide

ntified

to t

he

Mu

scu

loske

leta

l (M

SK

)

targ

et fo

llow

ing c

han

ge

s t

o th

e c

om

mis

sio

nin

g o

f th

e s

erv

ice

.

Mitig

atin

g a

ctio

ns w

ere

in

pla

ce

and

it

wa

s a

nticip

ate

d t

his

wo

uld

be

com

plia

nt

by N

ove

mb

er

20

19.

To

co

ntin

ue m

on

ito

ring a

nd o

ve

rsig

ht

thro

ugh

th

e In

teg

rate

d P

erf

orm

an

ce

Re

po

rt (

IPR

).

Qua

lity

Com

mitt

ee R

epor

t

Page 35 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

Op

era

tion

al D

ee

p D

ive:

Ra

pid

Tra

nsfe

r o

f C

are

(RT

OC

)

De

laye

d T

ran

sfe

r O

f

Ca

re

Th

e C

om

mitte

e r

ece

ive

d a

n a

ssu

ran

ce

up

da

te f

rom

sen

ior

ma

na

ge

rs in

the

se

rvic

e.

Goo

d p

rog

ress is b

ein

g m

ade

in

a

se

rvic

e w

hic

h w

ork

s c

lose

ly w

ith

oth

er

pa

rtners

. T

he

te

am

wo

rk c

lose

ly w

ith

Ea

st K

en

t H

osp

ita

ls U

niv

ers

ity N

HS

Fo

un

da

tion

Tru

st

(EK

HU

FT

) a

nd

th

e n

eed

fo

r fu

rth

er

se

nio

r

de

cis

ion

ma

ke

rs a

t B

an

d 7

ha

s b

ee

n r

ais

ed

with

co

mm

issio

ne

rs. A

no

n-e

xe

cu

tive

dire

cto

r (N

ED

) h

ad

re

cen

tly

un

de

rta

ken

a W

e C

are

vis

it t

o th

e te

am

so w

as a

ble

to

fee

db

ack o

n th

at vis

it. A

ssu

ran

ce

wa

s g

ive

n th

at

the

fin

an

cia

l

issu

es w

ith

th

e m

od

el w

ere

we

ll sig

hte

d o

n b

y t

he

Fin

an

ce

,

Bu

sin

ess a

nd

In

ve

stm

en

t (F

BI)

Com

mitte

e.

An

up

date

an

d v

erb

al a

ssu

ran

ce

re

po

rt w

as p

rovid

ed b

y th

e

Ch

ief

Ope

rating

Off

ice

r (C

OO

). A

nu

mb

er

of actio

ns a

re in

pla

ce

in

clu

din

g a

dd

itio

na

l w

ard

rou

nd

s a

nd

esca

latio

n c

alls

.

Th

e T

rust

is a

lso

re

vie

win

g t

he

pote

ntia

l u

se

of

an

NH

S

Imp

rove

me

nt (N

HS

I) t

racke

r to

ol cu

rre

ntly u

se

d in

acu

te

se

ttin

gs a

nd

will

be

con

sid

erin

g its

use in

a c

om

mun

ity

ho

sp

ita

l se

ttin

g w

ith

NH

SI.

Fu

rth

er

follo

w u

p b

y the

Ch

ief O

pe

ratin

g

Off

ice

r (C

OO

) w

ith

com

mis

sio

ne

rs w

ill

be

un

de

rta

ken

on

th

e w

ork

forc

e n

ee

de

d

for

the t

ea

m.

Pro

gre

ss w

ill c

on

tin

ue

to

be

mo

nito

red

an

d tra

cke

d t

hro

ug

h t

he

IP

R.

Pip

pa

Ba

rber

Ch

air

, Q

uali

ty C

om

mit

tee

21

Oc

tob

er

20

19

Page 36 of 194

QU

AL

ITY

CO

MM

ITT

EE

CH

AIR

’S A

SS

UR

AN

CE

RE

PO

RT

Th

is r

ep

ort

is fo

un

ded

on

th

e Q

ua

lity C

om

mitte

e P

art

One

me

etin

g h

eld

on

19

No

ve

mb

er

20

19

.

Ag

en

da

ite

m

As

su

ran

ce

an

d k

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

No

n-E

xe

cu

tive

Dire

cto

r

(NE

D)

Le

d

Se

rvic

e

Vis

its

A n

um

be

r o

f vis

its w

ere

und

ert

ake

n b

y N

ED

s in

la

st

mo

nth

. A

vis

it to

the

Sch

oo

l H

ea

lth

Se

rvic

e to

re

vie

w t

he

imp

act o

f th

e C

ost

Impro

ve

me

nt P

rog

ram

me

(C

IP)

wa

s

ab

le to

pro

vid

e g

ood

assu

ran

ce

fo

llow

ing

a m

an

ag

em

ent

an

d s

tru

ctu

ral re

vie

w o

f th

e s

erv

ice

. T

his

wa

s b

ein

g

rece

ive

d w

ell

by t

he

tea

m.

We

st V

iew

: A

ssu

ran

ce

wa

s r

ece

ive

d o

n p

rog

ress o

f th

e

un

it f

rom

a K

en

t C

ou

nty

Co

un

cil

(KC

C)

un

it to K

en

t

Co

mm

un

ity H

ea

lth N

HS

Fo

un

datio

n T

rust (T

rust)

; th

is is

on

go

ing

. S

taff

fe

lt w

ell

su

ppo

rte

d in

the

pro

cess.

Re

co

mm

en

datio

ns w

ere

su

gg

este

d o

n lea

rnin

g f

or

the

futu

re. A

ssu

ran

ce

wa

s r

ece

ive

d th

at th

ere

is a

cle

ar

un

de

rsta

nd

ing

of

the

re

lative

ro

les a

nd

re

spon

sib

ilitie

s o

f

KC

C a

nd

Tru

st

sta

ff o

n t

he

diffe

ren

t w

ard

s o

n th

e s

ite

.

Re

co

mm

en

datio

ns a

re b

ein

g f

ollo

wed

up

loca

lly a

nd o

ve

rsee

n b

y t

he

Ch

ief

Nu

rse

’s

(In

terim

) te

am

.

Qua

lity

Com

mitt

ee R

epor

t

Page 37 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d k

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Qu

alit

y R

epo

rt A

ug

ust

an

d S

epte

mb

er

da

ta

Assu

ran

ce

wa

s r

ece

ive

d o

n W

est V

iew

sta

ffin

g a

nd

pro

gre

ss w

ith

re

cru

itm

en

t a

nd s

taff c

on

su

ltatio

n.

The

exp

ecta

tio

n o

f th

e s

en

ior

team

wa

s t

ha

t sta

ffin

g le

ve

ls

wo

uld

ach

ieve

ta

rget

leve

ls in

Jan

ua

ry.

Ris

ks w

ere

be

ing

mitig

ate

d.

Sa

feg

ua

rdin

g d

ata

ha

s b

een

ad

ded

to

the

repo

rt a

nd

no

risks id

en

tifie

d.

Re

se

arc

h p

ort

folio

re

cru

itm

en

t h

as s

ign

ific

antly

ove

rach

ieve

d o

n its

ta

rge

t.

Lo

ca

l re

cru

itm

en

t p

lans a

re b

ein

g

de

ve

lop

ed.

Fill

ra

tes a

re m

on

ito

red

in

th

e

Mo

nth

ly Q

ua

lity R

ep

ort

. E

nd o

f L

ife

Ca

re

(EO

LC

) ca

re p

lan

s w

ill b

e a

dd

ed

to

the

rep

ort

fro

m J

an

ua

ry a

s a

gre

ed

by t

he

Tru

st

Bo

ard

.

Sa

fer

Sta

ffin

g

(In

pa

tien

t A

rea

s)

A r

ob

ust

pro

ce

ss h

as b

ee

n u

nde

rta

ke

n w

ith a

re

vis

ed

too

l

to r

evie

w c

om

mun

ity h

osp

ita

l sta

ffin

g le

ve

ls .A

n a

ud

it h

as

be

en

und

ert

ake

n a

nd

a n

um

be

r o

f fin

din

gs ide

ntified

to

imp

rove t

he e

ffe

ctivene

ss o

f sta

ffin

g o

n th

e w

ard

s.

The

wo

rk w

ill b

e t

aken

fo

rwa

rd b

y a

Sa

fer

Sta

ffin

g S

takeh

old

er

Gro

up

with a

prio

rity

be

ing

em

be

dd

ing

of th

e B

an

d 4

Nu

rsin

g A

sso

cia

te r

ole

. T

he

wo

rk w

ill p

rog

ress w

ith

in

pu

t

fro

m H

R a

nd

Op

era

tion

s a

nd

wo

rk w

ill in

clu

de

re

vie

win

g

the

use

of

the

e r

oste

r syste

m.

Up

da

tes w

ill b

e p

rovid

ed

to

the

Qu

alit

y

Co

mm

itte

e in

Ma

rch

.

Mo

de

llin

g w

ork

to

de

vis

e a

se

t of

prin

cip

les

for

sta

ffin

g le

ve

ls o

f com

mu

nity te

am

s w

ill

be

ta

ke

n t

hro

ug

h t

o the

Str

ate

gic

Wo

rkfo

rce

Co

mm

itte

e.

Le

arn

ing

fro

m D

ea

ths

Re

po

rt

Th

e C

om

mitte

e r

ece

ive

d th

e q

ua

rte

rly r

ep

ort

.G

ood

pro

gre

ss w

as n

ote

d o

n t

he

de

ve

lopm

en

t of

the

pro

ce

ss

an

d w

ith

wo

rk w

ith

pa

rtn

er

org

an

isa

tion

s b

ein

g h

igh

ligh

ted

Th

e n

ee

d f

or

the

En

d o

f L

ife

Ca

re S

tee

rin

g

Gro

up

to

con

tinu

e to

revie

w d

eliv

ery

of

EO

LC

ca

re p

lan

s a

nd

wid

er

do

cum

en

tatio

n

Page 38 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d k

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

inclu

din

g d

iscu

ssio

n o

n t

he

futu

re m

ed

ica

l e

xa

min

er

role

.

Th

e C

om

mitte

e f

elt th

is w

as a

ve

ry p

roa

ctive

ap

pro

ach

.

Ap

pen

dix

1 w

as w

ell

rece

ive

d b

y t

he

Com

mitte

e.

The

Co

mm

itte

e r

ecom

me

nd

the

re

po

rt t

o t

he

Board

.

as p

art

of

its w

ork

pla

n.

Op

era

tion

al D

ee

p D

ive

18

wee

k R

efe

rra

l T

o

Tre

atm

en

t (R

TT

)

Wa

itin

g T

ime

s

Assu

ran

ce

wa

s r

ece

ive

d o

n th

e fo

llow

ing

are

as.

Pa

ed

iatr

ic A

ud

iolo

gy is n

ow

ach

ievin

g a

nd

su

sta

inin

g its

targ

ets

.

Th

e f

ollo

win

g te

am

s a

re n

ot

ach

ievin

g ta

rge

ts w

ith

up

da

tes r

ece

ive

d o

n p

rog

ress a

nd

action

s f

or

ea

ch

se

rvic

e.

Co

mm

un

ity

Ort

ho

pa

ed

ic S

erv

ice

, W

es

t K

en

t

Ad

ditio

na

l cap

acity is n

ow

in

pla

ce

an

d it

is e

xp

ecte

d th

at

co

mp

lian

ce

will

be r

each

ed

at

the

be

gin

nin

g o

f D

ecem

be

r.

Lo

ng

er

term

su

sta

inm

en

t o

f im

pro

vem

ent

is a

lso

be

ing

pu

t

in p

lace.

No

rth

Ke

nt

Ag

reem

en

t ha

s n

ow

bee

n r

ea

che

d w

ith

co

mm

issio

ne

rs o

n th

e fu

ture

of th

e s

erv

ice

. D

ue

to

pre

vio

us u

nce

rta

inty

, pe

rfo

rman

ce

had

de

clin

ed

.

Ad

ditio

na

l cap

acity is n

ow

in

pla

ce

to im

pro

ve

pe

rfo

rma

nce

.

All

ied

He

alt

h P

rofe

ssio

na

l (A

HP

) S

erv

ices

A

ra

ng

e o

f

issu

es a

re d

rivin

g n

on

-ach

ievem

en

t o

f ta

rge

ts.

Ad

ult

Sp

ee

ch

an

d L

an

gu

ag

e T

he

rap

y (

SA

LT

) T

he

se

rvic

e

exp

ects

to

be

co

me

com

plia

nt

with

ta

rge

ts in

Fe

bru

ary

.

On

go

ing

de

live

ry o

f ta

rge

ts w

ill b

e m

on

ito

red

thro

ugh

th

e I

nte

gra

ted

Pe

rfo

rma

nce R

epo

rt

(IP

R).

Qua

lity

Com

mitt

ee R

epor

t

Page 39 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d k

ey p

oin

ts t

o n

ote

F

urt

he

r a

cti

on

s a

nd

fo

llo

w u

p

Mu

sc

ulo

ske

leta

l (M

SK

) W

es

t K

en

t B

y D

ece

mbe

r.

Ch

ild

ren

’s T

he

rap

ies

By F

eb

rua

ry.

Pla

ns f

or

all

are

as

inclu

de

on

go

ing s

usta

ina

bili

ty p

lan

s

Exte

rna

l R

eg

ula

tio

n a

nd

Insp

ectio

n

A v

erb

al u

pda

te w

as p

rovid

ed b

y th

e C

hie

f N

urs

e (

Inte

rim

)

on

th

ree

re

ce

nt in

sp

ectio

ns t

ha

t h

ave in

vo

lved s

erv

ice

s

pro

vid

ed b

y th

e T

rust.

Tw

o c

ove

red f

ollo

w u

p v

isits t

o t

he

Priso

n D

en

tal S

erv

ice

. N

o n

ew

co

nce

rns w

ere

ra

ise

d a

nd

wa

itin

g t

ime

s a

re n

ow

in

clu

ded

in

th

e I

nte

gra

ted

Pe

rfo

rma

nce R

epo

rt (

IPR

).T

he

th

ird r

ep

ort

by P

ub

lic

He

alth

wa

s fo

r th

e N

ew

Bo

rn S

cre

en

ing

Pro

gra

mm

e. N

o

ma

teria

l co

nce

rns o

r risk w

ere

id

en

tifie

d b

ut

so

me

reco

mm

en

datio

ns w

ere

ba

se

d o

n th

e n

atio

nal sta

nda

rds.

Th

e Q

ua

lity C

om

mitte

e t

o r

ece

ive

the

rep

ort

s o

nce

co

mp

lete

with

action

s p

lan

s if

ne

ed

ed

.

Bo

ard

Assu

ran

ce

Fra

me

wo

rk

Ris

k 1

05

. D

iscu

ssio

n a

nd

assu

ran

ce

on

the

actio

ns in

pla

ce

to

mitig

ate

an

d m

an

age

th

is r

isk. P

aedia

tric

Au

dio

log

y is n

ow

ach

ievin

g t

arg

et.

Ris

k 1

06

. T

he

sta

ff flu

pro

gra

mm

e is p

rog

ressin

g

Cu

rre

ntly a

t 3

7%

ahe

ad

of th

is p

ositio

n la

st

ye

ar.

Pip

pa

Ba

rber

Ch

air

, Q

uali

ty C

om

mit

tee

19

No

vem

be

r 20

19

Page 40 of 194

Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 2.4

Agenda Item Title: Audit and Risk Committee Chair’s Assurance Report

Presenting Officer: Peter Conway, Chair of Audit and Risk Committee

Action - this paper is for: Decision ☐ Information ☐ Assurance ☒

Report Summary

The paper summarises the Audit and Risk Committee meeting held on 3 September 2019.

Proposals and /or Recommendations

The Board is asked to receive the Audit and Risk Committee Chair’s Assurance Report.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒

High level position described and no decisions required.

Peter Conway, Non-Executive Director Tel: 01622 211906

Email:

Aud

it an

d R

isk

Com

mitt

eeR

epor

t

Page 41 of 194

AU

DIT

AN

D R

ISK

CO

MM

ITT

EE

CH

AIR

’S A

SS

UR

AN

CE

RE

PO

RT

Th

is r

ep

ort

is fo

un

ded

on

th

e A

ud

it a

nd

Ris

k C

om

mitte

e (

AR

AC

) m

ee

tin

g h

eld

on

3 S

ep

tem

be

r 2

01

9.

Are

a

Assu

ran

ce

Item

s f

or

Bo

ard

’s c

on

sid

era

tio

n a

nd

/or

next

ste

ps

Ris

k M

anagem

ent

Board

Assura

nce F

ram

ew

ork

(B

AF

) -

Positiv

e a

ssura

nce

. R

isk M

anagem

ent P

olic

y -

Revis

ion s

upport

ed b

y the

AR

AC

.

The B

oard

should

receiv

e a

Bre

xit u

pdate

at

the

Septe

mber

Retr

eat giv

en f

luid

ity o

f situation

.

The R

isk M

anagem

ent

Polic

y t

o b

e f

urt

her

update

d t

o

make it

short

er,

more

readable

and w

ith g

reate

r le

vels

of

dele

gation.

Third

Part

y A

ssura

nces

Inte

rnal A

udit -

Tw

o r

eport

s (

reasonable

assura

nce)

and

one a

dvis

ory

covering A

ssura

nce F

ram

ew

ork

and R

isk

Managem

ent, D

ata

Qualit

y o

f six

week A

udio

logy K

ey

Perf

orm

ance I

ndic

ato

r and A

ppoin

tment

of

Applic

ants

w

ith P

rote

cte

d C

hara

cte

ristics.

Counte

r F

raud

- P

ositiv

e a

ssura

nce. O

ne c

ross T

rust

Them

atic R

evie

w o

n C

onsultant Job P

lannin

g.

Exte

rnal A

udit -

No a

ctivity a

t th

is s

tage in t

he a

nnual

cycle

.

Various m

anagem

ent

actions b

ein

g f

ollo

wed u

p b

y

rele

vant sub-c

om

mitte

es.

Low

ris

k fin

din

gs w

hic

h the M

edic

al D

irecto

r is

on t

op o

f.

National A

udit O

ffic

e/N

HS

are

consid

ering t

he V

alu

e f

or

Money R

eport

and the a

dded v

alu

e o

f E

xte

rnal A

udito

rs.

Govern

ance

Sta

ndard

s o

f B

usin

ess C

onduct

- (V

ery

) positiv

e

assura

nce.

Susta

inabili

ty a

nd T

ransfo

rmation P

art

ners

hip

(S

TP

) govern

ance -

In p

lace b

ut

com

plic

ate

d a

nd o

paque

.

Positio

n o

f agency s

taff to b

e r

evie

wed

T

he B

oard

to r

eceiv

e a

n u

pdate

in O

cto

ber

with s

om

e

‘’what

if’’

scenarios.

Aud

it an

d R

isk

Com

mitt

eeR

epor

t

Page 42 of 194

Are

a

Assu

ran

ce

Item

s f

or

Bo

ard

’s c

on

sid

era

tio

n a

nd

/or

next

ste

ps

Fin

ancia

l C

ontr

ols

S

ingle

Tender

Waiv

ers

, R

etr

ospective R

equis

itio

ns,

Losses, S

pecia

l P

aym

ents

and W

rite

Off

s -

Positiv

e

assura

nce.

Som

e n

egative tre

nds b

ut th

ese a

re legitim

ate

one-o

ffs.

The F

inance T

eam

reta

ins a

good g

rip.

Focus Ite

ms

C

yber

Security

- P

ositiv

e a

ssura

nce (

am

ber-

gre

en o

vera

ll ra

ting).

H

ealth &

Safe

ty,

Security

and F

ire S

afe

ty R

evie

w -

(V

ery

) positiv

e a

ssura

nce

.

Cyber

Essential P

lus a

ccre

ditation to b

e a

chie

ved Q

1

2020.

Recent

att

ack (

NH

S m

ail)

led to g

ood r

em

edia

tion b

ut a

dis

appoin

ting level of

sta

ff infr

action. M

ore

sta

ff

aw

are

ness tests

to b

e c

arr

ied o

ut

and A

RA

C t

o m

onitor

pro

gre

ss.

Red r

isk =

netw

ork

sharin

g w

ith p

art

ner

trusts

(A

ssis

tant

Directo

r of IC

T t

o r

ais

e a

nd s

uggest S

TP

level w

ork

str

eam

, oth

erw

ise tole

rate

and/o

r tr

eat

locally

where

possib

le).

T

he C

orp

ora

te A

ssura

nce a

nd R

isk M

anagem

ent G

roup

(CA

RM

) to

keep v

erb

al abuse a

nd a

ggre

ssiv

e b

ehavio

ur

again

st

sta

ff u

nder

revie

w a

nd c

onsid

er

trends /

benchm

ark

ing.

Pete

r C

on

way

Ch

air

, A

ud

it a

nd

Ris

k C

om

mit

tee

Sep

tem

ber

2019

Page 43 of 194

Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 2.5

Agenda Item Title: Strategic Workforce Committee Chair’s Assurance Report

Presenting Officer: Bridget Skelton, Chair of Strategic Workforce Committee

Action - this paper is for: Decision ☐ Information ☐ Assurance ☒

Report Summary

The paper summarises the Strategic Workforce Committee meeting held on 19 July 2019 and 25 September 2019. A verbal update on the meeting of 27 November will also be presented.

Proposals and /or Recommendations

The Board is asked to receive the Strategic Workforce Committee Chair’s Assurance Report.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒

High level position described and no decisions required.

Bridget Skelton, Non-Executive Director Tel: 01622 211906

Email:

Str

ateg

ic W

orkf

orce

Com

mitt

ee R

epor

t

Page 44 of 194

ST

RA

TE

GIC

WO

RK

FO

RC

E C

OM

MIT

TE

E C

HA

IR’S

AS

SU

RA

NC

E R

EP

OR

T

Th

is r

ep

ort

is fo

un

ded

on

th

e S

tra

teg

ic W

ork

forc

e C

om

mitte

e m

ee

tin

g h

eld

on

19

Ju

ly 2

019

. A

ge

nd

a i

tem

A

ss

ura

nce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

Wo

rkfo

rce R

ep

ort

T

he

Wo

rkfo

rce

Re

po

rt c

on

tinu

es to

illu

str

ate

an

im

pro

vin

g

bu

t ch

alle

ng

ing

pic

ture

. H

igh

ligh

ts in

clu

de

:

Tu

rno

ve

r sa

w a

de

cre

ase

in

Jun

e to

16

.57

%, th

e lo

we

st

leve

l sin

ce

Octo

be

r 201

7 w

he

n t

he

Tru

st ch

an

ged

the

wa

y

lea

ve

rs w

ere

re

co

rded

.

De

sp

ite

re

cru

itm

en

t a

ctivity r

em

ain

ing

hig

h a

ve

rag

e tim

e

to r

ecru

it o

f 6.9

3 w

ee

ks h

as n

ow

me

t th

e t

arg

et

of se

ven

we

eks f

or

the

first

tim

e s

ince

Octo

be

r 2

01

7. W

ork

is a

lso

be

ing u

nd

ert

ake

n w

ith th

e S

usta

ina

bili

ty a

nd

Tra

nsfo

rma

tio

n P

art

ners

hip

(S

TP

) to

se

e if th

ere

are

an

y

str

ea

mlin

ing

op

po

rtu

nitie

s.

Fu

rthe

r im

pro

ve

me

nts

in

pro

ce

ss a

nd

so

urc

ing a

re b

ein

g c

on

tinu

ally

loo

ke

d fo

r.

Re

so

urc

ing

issu

es a

re s

till

ch

alle

ng

ing

with

72 s

tart

ers

in

Ju

ne

, b

ut

ba

lan

ced

by 7

0 lea

ve

rs.

Ba

nk f

ill r

ate

s r

epo

rt a

ne

ga

tive

pe

rfo

rma

nce

an

d a

gen

cy

sp

end

ro

se

sh

arp

ly in M

ay,

altho

ugh

dro

pp

ing

slig

htly in

Ju

ne

still

so

me

wa

y o

ff t

he

ta

rget.

The

se

tw

o in

dic

ato

rs

Th

e issu

es b

eh

ind t

he

Ba

nk f

ill r

ate

s a

nd

ag

en

cy s

pen

d is b

ein

g fu

rth

er

exp

lore

d,

fro

m w

hic

h a

ction

s w

ill b

e a

gre

ed

to a

dd

ress

the

pro

ble

ms ide

ntified a

nd a

str

ate

gic

dire

ctio

n a

gre

ed

.

Str

ateg

ic W

orkf

orce

Com

mitt

ee R

epor

t

Page 45 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

are

re

late

d.

Th

e m

uch im

pro

ve

d s

tre

ss le

ve

ls a

nd

sic

kn

ess d

ata

follo

ws t

he

po

sitiv

e in

terv

en

tion

s in

clu

din

g ‘T

ime

To

Ch

an

ge

Ch

am

pio

ns’ an

d a

ctio

ns fo

llow

ing

The

Big

Lis

ten.

Assu

ran

ce

tha

t a

ctio

ns t

o m

itig

ate

th

e B

oa

rd A

ssu

ran

ce

Fra

me

wo

rk (

BA

F)

wo

rkfo

rce

ris

k w

ere

be

ing ta

ke

n

inclu

din

g th

e p

ropo

sed s

eco

nd

nu

rse

coh

ort

in

to th

e

Aca

dem

y a

nd t

he

ap

pro

va

l o

f a

Bo

ard

De

ve

lop

men

t

Pro

gra

mm

e.

Aca

dem

y U

pd

ate

T

he

bro

ad

en

ed

mu

lti-

pro

fessio

na

l A

cad

em

y c

on

tinu

es to

focu

s o

n n

ew

wo

rkfo

rce

mo

de

ls a

nd

ca

ree

r pa

thw

ays to

ma

xim

ise

th

e u

se

of

ap

pre

ntice

sh

ips to

su

ppo

rt t

he

recru

itm

en

t of

sta

ff a

nd p

rovid

e th

e a

bili

ty fo

r th

e T

rust’s

ow

n s

taff

to

de

ve

lop.

Th

e p

rop

osa

l fo

r a s

eco

nd

co

ho

rt o

f 1

5 n

urs

e

ap

pre

ntice

sh

ips h

as n

ot

ye

t b

ee

n a

pp

rove

d.

A F

acili

tie

s

Aca

dem

y a

nd A

dm

in A

ca

dem

y a

re h

elp

ing

with

recru

itm

en

t, d

eve

lopm

en

t a

nd r

ete

ntio

n.

Th

e d

em

an

d o

n c

linic

al p

lacem

ents

is t

he

big

ge

st

risk –

no

w h

ave

cen

tra

l o

ve

rsig

ht

to e

nsu

re ind

ivid

ua

ls h

ave

a

go

od

expe

rie

nce a

nd

“ch

oo

se

com

mu

nity’ a

s a

pla

ce

to

wo

rk.

Sh

are

th

e T

erm

s o

f R

efe

ren

ce o

f th

e

Aca

dem

y B

oa

rd w

ith

th

e C

om

mitte

e t

o

de

mo

nstr

ate

sco

pe,

gove

rna

nce

on

de

cis

ion

ma

kin

g a

nd

issue

re

so

lutio

n.

Cre

ate

an

ove

rvie

w o

f a

ll A

ca

de

my

dis

cip

line

s,

sca

le,

the

asso

cia

ted

re

so

urc

e

nu

mb

ers

, in

ve

stm

en

t, r

isk a

nd

issue

s

asso

cia

ted

with

ea

ch

pro

gra

mm

e’s

su

cce

ss.

GD

PR

Co

mp

lian

ce

Pro

gre

ss

TIA

A a

ud

it p

rovid

ed

lim

ite

d a

ssu

ran

ce

in

re

latio

n to

resp

on

sib

ilitie

s u

nde

r th

e G

en

era

l D

ata

Pro

tectio

n

Sco

pin

g t

he

po

ssib

ility

of

pu

rch

asin

g a

n

ele

ctr

on

ic f

ile s

yste

m, w

ith

alte

rna

tive

Page 46 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

Re

gu

lation

(G

DP

R)

with

pe

rson

ne

l file

s.

Assu

ran

ce

wa

s g

ive

n th

at

five

actio

ns a

re c

om

ple

te.

On

e

actio

n th

at

cou

ld n

ot

be

ach

ieve

d h

as h

ad

alte

rna

tive

actio

ns ta

ken

to

mitig

ate

it.

An

ad

ditio

na

l a

ction

ha

s b

ee

n

ad

de

d r

eg

ard

ing

the

sca

nn

ing

an

d d

estr

uctio

n o

f pa

pe

r

file

s if

don

e lo

ca

lly.

All

po

ssib

le s

ho

rt te

rm s

tep

s h

ave

be

en

ta

ke

n to

mitig

ate

th

e r

isks id

en

tified

in

the

aud

it.

On

e

lon

g te

rm a

ctio

n r

em

ain

s w

ork

in

pro

gre

ss.

op

tion

s c

on

sid

ere

d i.e

. o

nly

scan

ne

w

em

plo

ye

es a

nd

co

st

of m

itig

atio

n o

f risk

ke

ep

ing

all

file

s p

ap

er

ba

sed

.

Pe

op

le S

trate

gy A

ction

Pla

n

Pe

op

le S

trate

gy a

ctions w

ere

re

fre

she

d a

t th

e b

eg

inn

ing

of

the

yea

r a

nd

all

are

ma

kin

g p

rog

ress.

Ke

y p

ositiv

es

inclu

de

th

e in

tro

du

ction

of

co

ach

ing

an

d a

ctio

n s

ets

, th

e

intr

od

uctio

n o

f a s

limm

ed

do

wn

HR

ha

ndb

oo

k m

ovin

g

fro

m in

str

uctio

na

l to

guid

an

ce w

he

re p

ossib

le, a

nd g

ett

ing

str

on

g g

ove

rna

nce

in

pla

ce

so

qu

ickly

with

th

e n

ew

pa

yro

ll

pro

vid

er

wh

ich

ha

s a

ll p

ositiv

e K

ey P

erf

orm

an

ce

Ind

ica

tors

(K

PIs

).

Th

e b

igg

est ch

alle

ng

es in

clu

de f

ind

ing

clin

ical p

lacem

ents

an

d th

e c

lea

nsin

g o

f da

ta a

s p

art

of

the E

SR

pro

gra

mm

e

of

wo

rk.

Mo

re e

mp

ha

sis

to

be

pu

t on

actio

ns to

su

ppo

rt o

ur

‘Eq

ua

lity S

tra

teg

y’, p

art

ly to

en

su

re s

taff a

re c

om

fort

ab

le ta

lkin

g a

bou

t

race

, an

d d

isa

bili

ty.

Me

dic

al R

eva

lidatio

n

Th

e C

om

mitte

e r

ece

ive

d a

ssu

ran

ce

re

ga

rdin

g t

he

po

licie

s

an

d s

yste

ms in

pla

ce

with

in t

he

Tru

st

to m

eet

the

req

uire

me

nts

of m

ed

ica

l a

pp

rais

al, r

eva

lida

tion

and

lice

nsin

g.

Th

is r

ep

ort

is r

eq

uire

d b

y N

HS

En

gla

nd

with

the

Ch

ief

Exe

cu

tive

Off

ice

r (C

EO

) sig

nin

g a

‘S

tate

me

nt

of

Re

co

mm

en

d to

th

e B

oa

rd a

pp

rova

l o

f

‘Sta

tem

en

t o

f C

om

plia

nce

’.

Str

ateg

ic W

orkf

orce

Com

mitt

ee R

epor

t

Page 47 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

Co

mp

lian

ce

’. T

his

co

mp

lian

ce

in

clu

de

s m

on

ito

rin

g

fre

qu

en

cy a

nd

qua

lity o

f m

ed

ica

l a

pp

rais

als

, ch

eckin

g

eff

ective

syste

ms a

re in

pla

ce

fo

r m

on

ito

rin

g c

on

du

ct

an

d

pe

rfo

rma

nce

of d

octo

rs,

co

nfirm

ing

fe

ed

ba

ck f

rom

pa

tien

ce

is s

ou

gh

t, a

nd

en

su

rin

g th

at a

ll p

re-e

mp

loym

en

t

ba

ckg

rou

nd c

he

cks a

re p

erf

orm

ed

. A

ll re

qu

ire

d p

olic

ies

are

in

pla

ce

an

d h

ave

ha

d a

n e

qua

lity im

pa

ct a

sse

ssm

ent.

(Th

ere

we

re 4

3 d

octo

rs w

ith

pre

scrib

ed

con

ne

ctio

n to

Ke

nt

Co

mm

un

ity H

ea

lth

NH

S F

oun

datio

n T

rust

(KC

HF

T)

at

the

en

d o

f th

e a

pp

rais

al ye

ar

20

18/1

9.

Th

ere

are

17

ge

ne

ral p

ractition

ers

wh

o d

o n

ot h

ave

a p

rescrib

ed

co

nne

ctio

n to

KC

HF

T w

ith

wh

om

we

ha

ve ‘no

co

nce

rn’

an

d s

up

ply

th

eir a

pp

rais

ers

with

the

ne

ce

ssa

ry a

pp

rais

al

do

cum

en

tatio

n.

Wo

rkfo

rce R

ace

Eq

ua

lity S

tan

da

rds

(WR

ES

)

Th

e C

om

mitte

e r

ece

ive

d th

e W

RE

S a

nd W

ork

forc

e

Dis

ab

ility

Eq

ua

lity S

tand

ard

s (

WD

ES

) re

po

rts p

rio

r to

th

e

pu

blic

ation

to

the

Str

ate

gic

Da

ta C

olle

ction

Se

rvic

e a

nd

on

the

Tru

st w

eb

site

. A

t K

CH

FT

th

e t

ota

l B

ME

wo

rkfo

rce

is

10

.98

% w

hic

h is a

n in

cre

ase

fro

m 1

0.7

5%

in th

e p

revio

us

ye

ar.

Th

e n

um

be

r of

issu

es a

risin

g f

rom

the

an

nu

al d

ata

inclu

de

:

BM

E s

taff a

re s

till

less lik

ely

to

be

app

oin

ted a

t in

terv

iew

tha

n W

hite

sta

ff a

nd

th

is h

as w

ors

en

ed

ove

r th

e la

st th

ree

ye

ars

. B

ME

sta

ff a

re s

till

less lik

ely

to

fee

l th

at th

e T

rust

Fu

rth

er

wo

rk to

be

tte

r u

nde

rsta

nd

wh

y

pro

gre

ssio

n t

o 8

A is O

K b

ut a

bo

ve

8A

ha

s

little

re

pre

sen

tatio

n.

Ne

ed

to

im

pro

ve

th

e a

ccu

racy a

nd

qu

alit

y o

f th

e d

ata

ra

isin

g a

wa

ren

ess o

f w

hat

co

nstitu

tes a

Dis

ab

ility

, a

nd t

he

be

ne

fits

to

sta

ff o

f sha

rin

g th

is in

form

atio

n w

ith

th

e

Tru

st.

Page 48 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

pro

vid

es e

qua

l o

pp

ort

un

itie

s f

or

ca

ree

r p

rog

ressio

n.

Tru

st

Bo

ard

an

d s

en

ior

ma

na

gem

en

t a

re n

ot

rep

rese

nta

tive

of

the

wo

rkfo

rce

no

r th

e lo

ca

l com

mu

nitie

s t

he

Tru

st

se

rve

s.

Dis

ab

led

sta

ff r

ep

ort

ed e

xp

erien

cin

g h

ighe

r le

ve

ls o

f

ab

use

fro

m p

atie

nts

, p

ressu

re to

com

e t

o w

ork

de

sp

ite

no

t

fee

ling w

ell

eno

ugh

to

do

so,

an

d w

ere

le

ss e

ng

ag

ed

th

an

the

ir n

on

-dis

ab

led

co

un

terp

art

s.

Op

era

tion

al W

ork

forc

e

Re

po

rt

Fo

cu

s o

n w

ork

forc

e g

ap

s w

hic

h c

ou

ld h

ave a

n im

pa

ct o

n

op

era

tio

na

l p

erf

orm

ance

. In

no

va

tive

pra

ctice

is h

avin

g

so

me p

ositiv

e r

esu

lts b

ut

furt

he

r w

ork

is r

eq

uire

d.

Ea

st

Ke

nt A

du

lt S

erv

ice

s –

sta

tic v

aca

ncy o

f 4

0fte

at b

an

d

2/3

. S

ix e

ven

ts h

eld

adve

rtis

ed

wid

ely

, 5

1 a

tten

ded

, 34

off

ers

fill

ing

28

.8 v

aca

ncie

s.

Ch

ildre

n’s

Pub

lic H

ea

lth

usin

g s

ocia

l m

ed

ia for

ad

ve

rtis

ing,

rece

ived

hig

h r

espo

nse

, a

sse

ssm

en

t ce

ntr

e

an

d s

pe

ed

da

ting

te

chn

iqu

es a

llow

ed m

an

y c

an

did

ate

s to

be

see

n. F

eed

ba

ck w

as p

ositiv

e fro

m c

and

idate

s a

nd

ma

na

ge

rs.

Tra

nsfo

rmin

g In

teg

rate

d C

are

in

th

e C

om

mu

nity (

TIC

C)

an

d D

evo

lvin

g A

uth

ority

– m

ade

go

od p

rog

ress a

ga

inst

mile

sto

ne

s in t

he

TIC

C p

rog

ram

me

fro

m th

e te

am

at

Ed

enb

rid

ge a

nd

ha

ve

la

un

ch

ed

a s

eco

nd

team

in

Cha

rin

g.

KC

HF

T is in

th

e e

arly s

tag

es o

f se

ttin

g u

p d

evo

lve

d

au

tho

rity

pilo

ts in

fou

r clin

ica

l a

rea

s –

hea

lth

vis

itin

g,

Ha

wkh

urs

t com

mu

nity h

osp

ita

l, a

du

lt s

pe

ech

an

d

Str

ateg

ic W

orkf

orce

Com

mitt

ee R

epor

t

Page 49 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

lan

gua

ge,

an

d L

oo

ke

d a

fte

r C

hild

ren

Se

rvic

es.

Th

ere

is a

sig

nific

an

t ove

rla

p in

bo

th a

rea

s o

f w

ork

,

brin

gin

g th

e p

rog

ram

me

s t

og

eth

er

will

brin

g im

me

dia

te

be

ne

fits

fo

r K

CH

FT

in

clu

din

g r

isk o

f du

plic

ation

of e

ffo

rt,

red

ucin

g p

rog

ram

me

pla

nn

ing,

an

d e

nsu

ring

le

sso

ns a

re

em

be

dd

ed a

cro

ss th

e o

rga

nis

atio

n.

Actio

n L

ea

rnin

g

Se

ts/C

oa

ch

ing

Ne

two

rk

Th

e c

oa

ch

ing

skill

s p

rog

ram

me

as p

art

of

the

cu

ltu

ral

ch

ang

e w

ork

sta

rts in

Se

pte

mb

er

with

da

ta b

ein

g c

olle

cte

d

to p

rovid

e a

ba

se

lin

e fro

m w

hic

h o

utc

om

es a

nd

me

asu

rem

ent

of im

pa

ct

and

effe

ctiven

ess c

an b

e

me

asu

red.

Th

e c

oa

ch

ing

skill

s s

hou

ld p

rovid

e a

co

mm

on

lan

gua

ge,

ap

pro

ach

and

sty

le to

im

pa

ct o

n t

he

wa

y w

e

ma

na

ge

an

d lea

d o

ur

pe

op

le.

He

alth

an

d W

ellb

ein

g

Re

po

rt

Tim

e T

o C

ha

ng

e a

nd

Th

e B

ig L

iste

n in

itia

tive

s c

ontin

ue t

o

su

ppo

rt im

pro

ve

d h

ea

lth

and

we

ll be

ing

in

the

Tru

st

illu

str

ate

d b

y im

pro

vin

g s

tre

ss a

nd

ab

sen

ce

nu

mbe

rs.

Mu

scu

loske

leta

l (M

SK

) is

on

e o

f to

p t

hre

e r

easo

ns fo

r

sta

ff s

ickne

ss,

ca

used

oft

en

by tra

nspo

rtin

g e

qu

ipm

ent.

Wo

rk is u

nd

erw

ay to

org

an

ise w

ork

sh

op

s t

o a

llow

fu

rth

er

su

ppo

rt f

or

sta

ff a

nd

ma

nag

ers

on

the

me

no

pa

use

. T

his

will

allo

w q

ue

stion

s t

o b

e a

ske

d a

nd d

ispe

l m

yth

s.

A m

ore

in

de

pth

re

vie

w o

f in

cid

en

ts w

ill h

elp

ide

ntify

fu

rthe

r a

ction

s t

o s

up

po

rt th

e

red

uction

of

incid

en

ts c

au

sin

g t

his

MS

K

leve

l o

f in

jury

.

Sa

fer

Sta

ffin

g R

ep

ort

T

he

Com

mitte

e r

ece

ive

d a

ssu

ran

ce

tha

t K

CH

FT

me

t a

ll

the

ma

in p

rin

cip

les o

f th

e N

HS

Im

pro

ve

me

nt D

eve

lop

ing

Wo

rkfo

rce g

uid

elin

es a

nd

re

qu

ire

me

nt fo

r re

po

rtin

g

A S

afe

r S

taff

ing

Gro

up h

as b

een

set

up t

o

ma

p o

ut

an

d im

ple

ment

the

se

cha

ng

es –

utilis

ing

fu

ll po

ten

tia

l o

f th

e e

-ro

ste

r syste

m,

Page 50 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

pro

gre

ss in

de

ve

lop

ing s

afe

r sta

ff r

ep

ort

ing

for

co

mm

un

ity

nu

rsin

g a

nd c

om

mu

nity h

osp

ita

ls.

The

wo

rk d

id h

ow

eve

r

ide

ntify

op

po

rtun

itie

s fo

r fu

rthe

r str

eng

then

ing

com

plia

nce

an

d in

form

sa

fer

sta

ffin

g,

inclu

din

g b

ette

r consis

ten

cy in

the

ap

plic

atio

n o

f qu

alit

y im

pa

ct

asse

ssm

en

t (Q

IA)

wh

en

ne

w r

ole

s a

re in

trod

uce

d, o

r th

ere

are

ch

an

ge

s in

se

rvic

e

de

live

ry.

No

t a

ll te

am

s u

se

e-r

oste

r to

its

fu

ll eff

ect,

and

roste

rs c

urr

en

tly d

o n

ot in

clu

de a

llie

d h

ea

lth

pro

fessio

na

ls

(AH

P),

le

arn

ers

an

d s

om

e s

up

po

rt s

taff

, su

ch

as

the

rape

utic s

upp

ort

work

ers

.

mo

re c

on

sis

ten

t a

pp

lica

tio

n o

f M

erid

ian

, a

s

we

ll a

s id

entify

cap

ab

ilitie

s o

f th

e n

ew

IT

syste

m to

fu

rthe

r e

nh

an

ce

th

e u

se

of

da

ta in

pla

nn

ing

fo

r a

nd

ach

ievin

g s

afe

r sta

ffin

g

acro

ss t

he

Tru

st.

Th

ey w

ill r

ep

ort

ba

ck to

th

e

Co

mm

itte

e in

Octo

be

r.

Inte

rim

Na

tio

na

l P

eo

ple

Pla

n

Th

e P

eo

ple

Pla

n h

as f

ive

the

me

s:

- M

akin

g t

he

NH

S th

e b

est p

lace

to

wo

rk

- Im

pro

vin

g N

HS

lea

ders

hip

cu

ltu

re

- A

dd

ressin

g w

ork

forc

e s

ho

rtag

es

- D

eliv

erin

g 2

1st c

entu

ry c

are

- D

eve

lop

ing

a n

ew

ope

ratin

g m

od

el fo

r w

ork

forc

e

Th

e T

rust

ca

ptu

res a

ll th

em

es in

its

cu

rre

nt P

eo

ple

Str

ate

gy b

ut

can

pu

t g

rea

ter

em

ph

asis

on

som

e th

em

es

i.e

. m

akin

g K

CH

FT

th

e b

est p

lace t

o w

ork

. W

ork

to

en

su

re

we

are

th

e ‘be

st e

mp

loye

r’ w

ill b

e g

ive

n g

reate

r a

tten

tion

,

an

d u

se

of d

igita

l to

und

erp

in n

ew

op

era

tin

g m

ode

ls. W

e

ha

ve

go

od

exam

ple

s o

f in

itia

tive

s to

de

live

r th

em

es lik

e

lesso

ns lea

rnt

from

The

Big

Lis

ten,

Tim

e t

o C

ha

ng

e

Ch

am

pio

n w

ork

, le

ad

ers

hip

pro

gra

mm

e o

f coa

ch

ing a

nd

actio

n s

ets

, B

oa

rd d

eve

lopm

ent

an

d th

e g

row

th o

f th

e

Str

ateg

ic W

orkf

orce

Com

mitt

ee R

epor

t

Page 51 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

Aca

dem

y to

ad

dre

ss s

om

e w

ork

forc

e s

ho

rtage

s.

In

su

mm

ary

we

are

in

lin

e w

ith

th

e th

em

es o

f th

e p

lan

but

ha

ve

mo

re t

o d

o.

Fo

rwa

rd P

lan

T

he

Com

mitte

e a

pp

rove

d a

re

fre

she

d fo

rwa

rd p

lan

to

be

tte

r re

fle

ct

str

ate

gic

in

itia

tive

s, a

nd T

erm

s o

f R

efe

ren

ce

.

Bri

dg

et

Sk

elt

on

Ch

air

, S

tra

teg

ic W

ork

forc

e C

om

mit

tee

19

Ju

ly 2

019

Page 52 of 194

ST

RA

TE

GIC

WO

RK

FO

RC

E C

OM

MIT

TE

E C

HA

IR’S

AS

SU

RA

NC

E R

EP

OR

T

Th

is r

ep

ort

is fo

un

ded

on

th

e S

tra

teg

ic W

ork

forc

e C

om

mitte

e m

ee

tin

g h

eld

on

25

Se

pte

mb

er

201

9.

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

Wo

rkfo

rce R

ep

ort

A v

ery

po

sitiv

e in

cre

asin

g p

ositio

n b

ut w

ith

no

co

mp

lace

ncy a

nd

an

ap

pre

cia

tion

of

the

con

tin

ued

wo

rk

req

uire

d to

ma

inta

in th

is p

ositio

n.

Clo

se

to

ach

ievin

g s

taff

turn

ove

r fig

ure

, sta

bili

ty is a

bo

ve

ta

rge

t, t

hird

co

nse

cu

tive

mo

nth

with m

ore

sta

rters

th

an

le

ave

rs. A

bse

nce

co

ntin

ue

s

to b

e b

elo

w t

arg

et a

ltho

ugh

note

d t

ha

t w

e a

re a

bou

t to

go

into

Win

ter

wh

ich

pre

se

nts

ch

alle

ng

es a

s s

taff c

ann

ot

co

me t

o w

ork

if

ill.

Str

ess le

ve

ls h

ave

red

uced a

s a

re

su

lt

of

Tim

e t

o C

han

ge

in

itia

tive

s a

nd

en

ha

nce

d p

eo

ple

ma

na

ge

me

nt. V

aca

ncie

s s

tan

d a

t 8.3

6%

. E

nco

ura

gin

g a

fle

xib

le a

pp

roa

ch

to

recru

itm

en

t, if a

can

did

ate

is n

ot

rig

ht

for

one

po

st

con

sid

ering

the

m fo

r an

oth

er.

Tim

e to

hire

co

ntinu

es to

be

go

od. S

ho

rtlis

ted

fo

r tw

o C

IPD

aw

ard

s -

HR

Ris

ing

Sta

r an

d T

ime

to

Cha

nge

. T

he

use

of a

ge

ncy

sta

ff A

ugu

st

da

ta is s

ho

win

g a

s b

ein

g n

ea

rly 2

% a

bo

ve

targ

ets

, a

nd

slig

htly a

bo

ve

ave

rage

fo

r th

e

ten

th

co

nse

cu

tive

m

on

th,

du

e to

in

cre

ase

d d

em

and

. V

aca

ncie

s

Ne

w K

ey P

erf

orm

an

ce I

nd

icato

rs (

KP

Is)

will

ne

ed

to b

e lo

oked

at

for

va

ca

ncie

s, B

an

k

usa

ge

and

ag

en

cy.

Str

ateg

ic W

orkf

orce

Com

mitt

ee R

epor

t

Page 53 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

at

8.3

6 is th

e lo

we

st fo

r a

wh

ile b

ut

will

be

cha

llen

ged

with

the

Lo

ng

Te

rm P

lan

incre

asin

g s

taff

by a

t le

ast

500

. A

ne

w O

ccup

ation

al H

ealth

Pro

vid

er

sta

rts in N

ove

mb

er

wh

ich

sh

ou

ld p

ositiv

ely

im

pa

ct

on

the

re

cru

itm

en

t p

roce

ss.

BA

F R

isk m

itig

ate

d f

urt

he

r b

y 1

7 e

xtr

a a

pp

rentice

nu

rse

s

sta

rtin

g 2

020

, N

ew

Boa

rd D

eve

lop

me

nt P

rogra

mm

e a

nd

Be

tte

r P

lace

to

Wo

rk initia

tive

- B

ig L

iste

n 2

pro

vid

ing

en

ga

gem

en

t w

ith s

taff a

nd

mate

ria

l fo

r a

de

velo

pm

en

t o

f a

str

on

ge

r p

hysio

log

ica

l co

ntr

act

with

sta

ff. W

ellb

ein

g

co

ntinu

es to

be

a p

rio

rity

with

fu

rth

er

Tim

e T

o C

ha

nge

wo

rksh

op

s, K

eep

We

ll F

or

Win

ter

initia

tive

and

ne

w

foo

tba

ll a

nd

ne

tba

ll te

am

s b

ein

g s

et u

p.

De

ep

Div

e C

ost

Imp

rove

me

nt

Pro

gra

mm

e (

CIP

)

Sch

em

es

Wo

rkfo

rce D

ire

cto

rate

CIP

is b

ein

g d

eliv

ere

d s

ucce

ssfu

lly

an

d c

on

ve

rsa

tio

ns h

ave

sta

rted

ab

ou

t ne

xt

yea

r’s C

IPs.

All

wo

rkfo

rce

CIP

s a

re te

ste

d f

or

qu

alit

y a

nd

sa

fety

imp

act.

Ba

nk a

nd

Age

ncy

Issu

es a

nd A

ction

s

De

man

d -

Hug

e in

cre

ase

of d

em

an

d 6

0%

up

, sin

ce

20

16

de

ma

nd

on

Ban

k h

as in

cre

ased

by 9

0%

. T

his

dem

and

resu

lts f

rom

55

% m

ate

rnity in

cre

ase

, se

rvic

e d

em

and

50

an

d v

aca

ncy 2

5.

Du

e a

lso

to

in

cre

ased

acu

ity o

f pa

tie

nts

an

d in

ve

stm

en

t in

ne

w S

erv

ice

s t

ha

t h

ave

re

qu

ire

d a

qu

ick

se

t up

in

ad

van

ce

of

recru

itin

g s

ub

sta

ntive

sta

ff.

An

Fu

rth

er

wo

rk to

un

de

rsta

nd t

he

de

ma

nd o

n

Ba

nk a

nd a

ge

ncy fo

r ou

t o

f h

ou

rs a

nd

initia

tive

s t

o a

ttra

ct

sta

ff a

nd

oth

ers

to

the

Ba

nk.

No

te th

e n

eed

fo

r a

t le

ast

50

0 a

dd

itio

na

l

Page 54 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

un

de

rsp

end

on

op

era

tio

ns p

utt

ing

pre

ssu

re o

n w

aitin

g lis

ts

ha

s a

lso

pro

mp

ted

in

cre

ased

use o

f B

an

k a

nd A

gen

cy.

Su

pp

ly la

un

ch

ing

ne

w c

am

pa

ign t

o a

ttra

ct sta

ff a

nd

oth

ers

to t

he

Ba

nk.

Fu

rth

er

wo

rk o

n f

lexib

ility

, skill

s m

ix a

nd

tech

no

log

y w

ill a

ll im

pact

on

su

pp

ort

ing t

he

best

leve

l of

de

ma

nd

an

d s

up

ply

.

sta

ff to

de

live

r fo

rwa

rd lo

ng

te

rm p

lan

and

all

the

asso

cia

ted

ch

alle

ng

es th

is b

rin

gs.

Tra

inin

g N

eed

s

An

aly

sis

(TN

A)

Re

ce

nt

wo

rk m

ea

ns w

e a

re n

ow

we

ll sited

on d

em

and

fo

r

tra

inin

g. W

ork

forc

e p

lan

s,

cu

ltu

re c

ha

nge

pla

n,

RIP

,

ap

pre

ntice

sh

ip m

ode

l p

rovid

e r

ich

er

ba

se lin

e o

f n

ee

d.

Sp

ecia

l p

roje

cts

Tra

nsfo

rmin

g I

nte

gra

ted

Ca

re in

th

e

Co

mm

un

ity (

TIC

C),

devo

lve

d a

uth

ority

an

d d

igita

l e

tc a

re

als

o in

clu

de

d. Q

ua

lity is e

va

lua

ted a

nd

ne

w v

eh

icle

s

co

nsid

ere

d to

brin

g e

asie

r a

cce

ss to

tra

inin

g.

Fu

rth

er

wo

rk to

be

tte

r e

nsu

re T

NA

fits w

ith

ove

rall

Tru

st

str

ate

gy, i.e

. w

ork

ing c

lose

r

with

prim

ary

ca

re n

etw

ork

s (

PC

Ns).

Ta

len

t M

an

agem

ent

Se

co

nd

yea

r im

pro

ve

d q

ua

lity o

f a

pp

rais

al p

rovid

ing

ta

lent

da

ta b

ut

still

furt

he

r w

ork

to

do.

Be

tte

r u

se

of p

ers

ona

l

de

ve

lop

me

nt p

lan

s w

ill r

ed

uce t

he

ne

ed f

or

de

ve

lopm

en

t

de

cis

ion

s to

be

mad

e b

y t

he

Ta

len

t B

oa

rd.

Exa

min

e h

ow

to e

mbed

ca

ree

r

co

nve

rsa

tio

ns in e

ve

ryd

ay m

ana

ge

me

nt,

an

d th

e im

plic

atio

ns for

Ta

len

t M

an

age

me

nt

an

d a

pp

rais

al in

se

lf m

an

ag

ed

te

am

s.

Ne

ed

to

de

fin

e w

ha

t go

od

Ta

len

t

Ma

na

ge

me

nt

wo

uld

loo

k lik

e a

nd

su

cce

ssio

n p

lann

ing t

oo

.

Str

ateg

ic W

orkf

orce

Com

mitt

ee R

epor

t

Page 55 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

De

ep

Div

e E

mp

loyee

Re

latio

ns

An

exa

min

ation

of

Ke

y P

erf

orm

an

ce

In

dic

ato

rs (

KP

Is)

de

mo

nstr

ate

s a

po

sitiv

e im

pa

ct o

n h

and

ling

em

plo

ye

e

rela

tio

ns, a

s w

ell

as ide

ntifica

tio

n o

f fu

rth

er

wo

rk r

eq

uire

d.

Tra

inin

g h

as b

ee

n s

ucce

ssfu

l to

de

live

r h

igher

pro

fessio

na

l sta

nda

rds a

nd a

pp

recia

tion

of

polic

y.

Mo

vin

g t

o c

ultu

re o

f re

so

lutio

n t

o r

eso

lve

issue

befo

re

en

tre

nch

ed

po

sitio

ns a

re r

ea

che

d.

Con

flic

t and

critica

l

co

nve

rsa

tio

ns a

re a

ll pa

rt o

f o

ngo

ing c

oa

ch

ing

and

actio

n

lea

rnin

g p

rog

ram

me

of d

eve

lopm

ent.

Op

era

tion

al W

ork

forc

e

Re

po

rt

TIC

C -

de

vo

lve

d a

uth

ority

in

itia

tive

s c

om

ing to

ge

the

r a

s

join

t p

rog

ram

me n

ow

be

ing

ro

lled

ou

t to

exis

tin

g s

taff

. S

elf

ma

na

ge

d te

am

a b

ig p

art

of o

ur

PC

N o

ffe

rin

g.

KC

C p

ulli

ng

ou

t so

TIC

C t

ea

ms w

ith

ou

t so

cia

l ca

re e

lem

en

t. T

he

se

T

ea

ms d

esig

ned

to w

ork

clo

se

r to

th

e p

atien

t.

KC

HF

T h

as t

he

am

bitio

n th

at e

ve

ry c

om

mun

ity n

urs

ing

team

will

be

led

by a

Dis

tric

t N

urs

e w

ith

a s

pecia

list

qu

alif

ica

tion

an

d th

is is p

art

icu

larly im

po

rtan

t a

s p

art

of th

e

mo

de

l o

f se

lf-m

ana

ged t

eam

s. T

his

yea

r w

e r

ece

ive

d a

n

allo

ca

tio

n o

f 1

2 p

lace

s o

n th

e s

pe

cia

list

cou

rse

. T

he

se

h

ave

be

en

fill

ed w

ith

bo

th inte

rna

l a

nd

exte

rna

l ca

nd

ida

tes.

Ea

st

Ke

nt h

ave r

eq

ue

ste

d a

fu

rth

er

two

p

lace

s f

rom

Hea

lth

Edu

ca

tion

Eng

land

( H

EE

).

S

pe

cia

list a

nd E

lective S

erv

ice

s a

nd

Ch

ildre

n’s

Pu

blic

H

ea

lth

Se

rvic

es a

re b

oth

sup

po

rtin

g s

tud

en

t de

ve

lopm

en

t a

nd

Ad

van

ced

Pra

ctitio

ne

r p

rog

ram

me

s to

attra

ct

both

n

ew

sta

ff a

nd

de

ve

lop

/re

tain

ou

r o

wn

sta

ff.

Page 56 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

Win

ter

pla

nn

ing

an

d h

igh

va

ca

ncie

s c

on

tin

ue to

pre

se

nt

op

era

tio

na

l ch

alle

ng

es.

Re

co

gn

itio

n a

nd

Be

nefits

Pa

y is m

ain

ly b

oun

d b

y N

atio

na

l T

and

C. W

he

re th

ere

is

so

me f

lexib

ility

we

ne

ed

to

ca

utio

us w

e a

re n

ot

com

pe

tin

g

with

oth

er

tru

sts

in

the

‘syste

m’.

Th

ere

are

a fe

w lo

ca

lly a

gre

ed

te

rms in

clu

din

g s

pe

cia

lists

,

GP

s,

an

d s

om

e d

en

tal sta

ff.

With

be

ne

fits

we h

ave

mo

re s

co

pe t

o b

e c

rea

tive

- o

ffe

r is

alre

ad

y a

ttra

ctive.

Co

ntin

ua

lly lo

ok a

t h

ow

we c

an

be

th

e

be

st e

mp

loye

r. T

he

art

icu

latio

n a

nd

com

mu

nic

atio

n o

f th

e

ph

ysio

log

ica

l co

ntr

act

is im

po

rta

nt, t

o d

em

on

str

ate

liste

nin

g a

nd r

esp

on

din

g to

ne

ed

s o

f sta

ff e

sp

ecia

lly

aro

und

fle

xib

ility

of

wo

rk a

nd w

ays o

f w

ork

ing

to

pro

mote

sa

tisfa

ction

an

d e

nha

nce

d p

erf

orm

an

ce

.

Gre

ate

r cla

rity

on

issue

s w

e fa

ce

an

d

op

tion

s f

or

cre

ativity.

Na

tio

na

l co

nsu

lta

tion

ab

ou

t ch

an

ge

s t

o

pe

nsio

n a

rra

ng

em

en

ts is a

hig

h p

rio

rity

with

HM

RC

, K

CH

FT

is w

ork

ing

with

pa

rtne

rs

acro

ss t

he

syste

m in

ad

va

nce

of a

ny

na

tion

al cha

nge

s.

De

sp

ite

co

st

imp

lica

tion

s o

ptio

ns to

ch

ang

e

ma

y p

ositiv

ely

im

pa

ct

recru

itm

en

t a

nd

rete

ntion

. T

he

re a

re c

ase

stu

die

s w

he

re

oth

er

syste

ms h

ave

acte

d in a

dva

nce o

f

na

tion

al gu

idan

ce

.

Aca

dem

y U

pd

ate

s

Th

ree

ke

y s

tre

am

s:

Nu

rsin

g -

17

app

ren

tice

sh

ips s

tart

in

Fe

bru

ary

20

20

se

lecte

d f

rom

29

0 a

pp

lica

nts

. U

nsu

cce

ssfu

l ca

nd

ida

tes

ha

ve

be

en

red

ire

cte

d to

oth

er

op

po

rtu

nitie

s.

AH

P -

Ad

va

nced

Pra

ctitio

ne

r de

ve

lop

me

nt n

ew

ap

po

intm

ent

ma

de

to o

ve

r se

e th

e p

rog

ram

me

.

Ad

min

- w

ork

on p

ath

wa

ys f

or

de

ve

lop

me

nt an

d

ad

van

cem

ent.

Te

rms o

f R

efe

ren

ce f

or

the

Aca

de

my B

oa

rd

req

uire

fu

rth

er

wo

rk to

en

su

re le

ve

ls o

f

au

tho

rity

and

acco

un

tab

ility

are

cle

ar.

Str

ateg

ic W

orkf

orce

Com

mitt

ee R

epor

t

Page 57 of 194

Ag

en

da

ite

m

As

su

ran

ce

an

d K

ey

po

ints

to

no

te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

Issu

es c

on

tinu

e to

be

th

e p

lacem

ent

of stu

den

ts a

nd

en

su

rin

g g

reate

r cla

rity

of

the

men

tor

role

- e

sp

ecia

lly t

he

dis

tin

ctio

n b

etw

ee

n s

up

erv

iso

r a

nd

asse

sso

r.

AO

B E

qu

alit

y, D

isa

bili

ty

an

d D

ive

rsity

Em

ph

asis

on

im

po

rta

nce

of e

qu

alit

y, d

isa

bili

ty a

nd

div

ers

ity is b

ein

g m

ain

tain

ed b

y a

‘sh

ifting

the

dia

l’

wo

rksh

op

fo

r th

e M

anag

em

en

t T

eam

, a

s w

ell

as it

be

ing

the

ma

in t

he

me

of th

e S

en

ior

Le

ad

ers

Co

nfe

ren

ce

.

Tra

inin

g a

nd

aw

are

ne

ss a

va

ilab

le f

or

all

ke

y s

take

ho

lde

rs

inclu

din

g G

ove

rno

rs.

AO

B E

qu

alit

y A

na

lysis

Cla

rity

on

wh

at

is r

equ

ire

d t

o c

om

ple

te a

equ

alit

y a

na

lysis

w

as s

oug

ht. A

gre

em

ent

that m

ore

eq

ua

lity a

na

lysis

wa

s

ne

ed

ed

on

mo

st

Str

ate

gic

Wo

rkfo

rce

Com

mitte

e p

ap

ers

. A

pp

recia

tio

n th

at th

is is a

min

dset

an

d p

rocess s

hift.

T

he

use

of th

e t

erm

Assu

ran

ce

Re

po

rt n

ot to

be

use

d a

s a

rea

so

n n

ot to

co

nd

uct th

e e

qu

alit

y a

na

lysis

.

Exa

min

e p

roce

ss to

pro

vid

e a

se

t o

f crite

ria

to

ea

se

pro

ce

ss, b

ut en

su

re it

is m

ore

co

nsis

ten

tly c

om

ple

ted.

Th

e C

om

mitte

e t

o tria

l a

ne

w p

roce

ss a

nd

se

t an

exa

mp

le to

oth

er

co

mm

itte

es a

nd

Bo

ard

pa

pe

rs.

Bri

dg

et

Sk

elt

on

Ch

air

, S

tra

teg

ic W

ork

forc

e C

om

mit

tee

Da

te

25

Se

pte

mb

er

20

19

Page 58 of 194

Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 2.6

Agenda Item Title: Charitable Funds Committee Chair’s Assurance Report

Presenting Officer: Pippa Barber, Member of Charitable Funds Committee

Action - this paper is for: Decision ☐ Information ☐ Assurance ☒

Report Summary

The paper summarises the Charitable Funds Committee meeting held on 26 July 2019.

Proposals and /or Recommendations

The Board is asked to receive the Charitable Funds Committee Chair’s Assurance Report.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒

High level position described and no decisions required.

Jen Tippin, Non-Executive Director Tel: 01622 211906

Email:

Cha

ritab

le F

unds

Com

mitt

eeR

epor

t

Page 59 of 194

CH

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ITA

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is r

ep

ort

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un

ded

on

th

e C

ha

rita

ble

Fu

nds C

om

mitte

e m

eetin

g h

eld

on

Frid

ay 2

6 J

uly

20

19

. A

ge

nd

a i

tem

A

ss

ura

nce

an

d K

ey

po

ints

to

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te

Fu

rth

er

ac

tio

ns

an

d f

oll

ow

up

Intr

odu

ctio

n b

y C

ha

ir

Je

n T

ipp

in w

elc

om

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eve

ryo

ne

pre

sen

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me

etin

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the

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rita

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nd

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om

mitte

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ee

tin

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Ap

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po

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ere

re

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ive

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rom

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rtin

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k N

on

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cu

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ord

on

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ck D

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ief

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era

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cla

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tere

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ere

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tere

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dd

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o t

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se

form

ally

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pro

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y th

e B

oard

th

e p

revio

us d

ay.

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e m

inu

tes

we

re a

gre

ed

. T

he

Matte

rs A

risin

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ab

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as a

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pa

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age

me

nt

to c

larify

th

e n

um

be

r o

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nve

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r £5

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.

Cha

ritab

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Com

mitt

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Page 60 of 194

•

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ad

of

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pa

ign

s a

nd

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age

me

nt

to c

larify

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e p

roced

ure

fo

r re

turn

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do

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rol

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lem

an

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lic

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re

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ab

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urs

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ho

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age

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t.

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mu

nity

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sp

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Page 61 of 194

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Page 62 of 194

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26

Ju

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019

Page 63 of 194

Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 2.7

Agenda Item Title: Integrated Performance Report Part One

Presenting Officer: Nick Plummer, Assistant Director of Performance and Business Intelligence

Action - this paper is for: Decision ☐ Information ☐ Assurance ☒

Report Summary

The Integrated Performance Report is presented with the use of Statistical Process Control (SPC) charts. It should be noted that the full Finance, Workforce and Quality reports are presented at their respective committees. The report has been produced in collaboration with the Executive Team and their support teams. This report contains the following sections:

• Corporate Scorecard and Summary

• Quality Report

• Workforce Report

• Finance Report

• Operational Report

Historic data has been provided to show trends, with the SPC charts being used to show a rolling 2 year view of performance for each indicator. Upper and Lower control limits are used to indicate a shift in performance over a sustained period and to highlight where performance deviates from these expected ranges. Key Highlights from report Within NHS Improvement's Single Oversight Framework, KCHFT was moved from segment 1 to segment 2. This level is categorised as "targeted support offer" (segment 1 is "maximum autonomy"). The move from segment 1 to segment 2 was as a result of deterioration in performance in RTT and 6 week diagnostics and while 6 week diagnostics is now meeting target, RTT is failing to meet the 92% standard consistently (92% of the waiting list under 18 weeks). See the operations section for more details There are 10 KPIs moving favourable in month and 8 moving unfavourably whilst 23 are in normal variation. There are 6 KPIs consistently failing target including the two system targets tracked of A&E wait times at MTW and EKUFT. The others are:

• KPI 2.7 Contract activity at 100.4% for Month 6 and moving favourably, but upper limit still below 100% (99.8%) so achievement not assured.

• KPI 2.20 Friends and Family Test Response Rate for MIU and Community

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 64 of 194

Hospitals is now in normal variation but the previous low performance has resulted in the upper control limit now being below the target

• KPI 5.3 Turnover (planned and unplanned) at 16.1% against 16.5% target and moving favourably below the lower control limit.

• KPI 5.6 Stability (% of workforce who have been with the trust for 12 months or more) moving favourably at 85.8% but 85% target is still marginally above the upper control limit.(84.3%)

Of the 9 indicators not measured by SPC charts 8 are achieving target and the one that has not is KPI 3.8 East Kent Rapid Transfer Service (new KPI) at 27.4 average discharges per day against 30 per day target Quality

• In August and September there were there were 5 lapses in

care with learning for KCHFT and these related category 2

pressure ulcers. Investigations identified a need for timely skin

assessments.

• There were 49 falls reported across KCHFT during August and September 2019, 3 of which were found to be avoidable. With the exception of June 19, the number of avoidable falls has consistently remained below 4

• 6,375 surveys were completed by KCHFT patients, relatives and carers in October 2019, with a combined satisfaction score of 97.1%, the same percentage as September.

Workforce

• Turnover in October 2019 has decreased since the last report to

16.10%, a 0.53% decrease on the reported figures in August of

16.63%. It has increased from September’s rate of 16.02% but

continues to remain below average and below target.

• Since the sharp drop in sickness absence in March 2019, reported levels of absence have started to slowly increase back up towards the mean. The figures for October 2019 have increased to its highest level since March 2019. The Trust absence figure has increased to 4.6% and is now above the 4.2% target. Absence levels do usually increase over this winter period.

• Following the increase in vacancy rates in April 2019 due to budget setting, levels have been on a continual downward trajectory below the mean. Vacancies are at an all-time low of 7.16% significantly below the target of 9.66%.

• The use of agency staff across the Trust in October 2019 has been significantly reduced from September’s spend with a figure of 93.24% of budgeted trajectory reported, a reduction of 24.63% over September’s figure of 117.87%. This is reporting 6.76% below target, this is the lowest it has been since April 2019.

Page 65 of 194

Finance

• The Trust achieved a surplus of £1,695k (1.2%) to the end of

October. Cumulatively pay and depreciation/interest have

underspent by £3,714k and £58k respectively and non-pay has

overspent by £1,783k. Income has under-recovered by £1,660k

• £2,761k of savings has been achieved for the YTD against a risk rated plan of £3,086k which is £325k (11%) behind target

• Spend to October was £1,439k, against a YTD plan of £4,252k (34% achieved). The full year forecast is £7.4m and the Trust expects to utilise this in full.

Operations

• Performance to month 5 is currently showing as special cause

variation above the upper control limit; however investigation

has found that there has been no specific reason attributed to

this strong level of performance, which has continued into Month

5 as predicted

• New birth visits continue to show strong performance above the

target.

• The proportion of patients on a consultant-led Referral to

Treatment (RTT) pathway at month end who are waiting less

than 18 weeks is showing negative special cause variation,

being below both target and the lower control limit. This is

caused by increased waits in Orthopaedics in West and North

Kent which are a large portion of the Trustwide RTT position.

See the full report for more detail around cause and actions.

• Prison waits are currently experiencing adverse special cause

variation at Standford Hill and Swaleside, plus at all sites cases

current performance is above the mean and the target is either

below or near the lower control limit, suggesting consistent

achievement of the 6 week target is unlikely to occur in the

current environment.

• Audiology 6 week diagnostics has been performing above the

mean for the last 12 months, although occasionally below the

challenging 99% target within 6 weeks. The Service has moved

to business as usual and going forward if the referral rates

remain within the normal parameters of between 300 and 400

per month, the service will continue to be fully compliant with the

99% target within six weeks.

• Delayed Transfers of Care (DTOCs) KCHFT target to reduce to

average 7 per day in East & West Kent which is a rate of 9.5%.

Performance had improved in month 6 but remains near the

upper control limit with a period of 7 months above the mean,

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 66 of 194

caused by an increased level of delayed transfers in east Kent.

There has been an increase in delays due to availability of social

care packages and also delays due to patient choice.

• Looked After Children the Initial Health Assessment is achieving

target most months. Performance is variable due to late

requests from KCC. The Review Health Assessment has met

target and showing normal variation

• Bed Occupancy is showing a varying trend with no periods of special cause variation or changes in performance that would be a particular concern.

Proposals and /or Recommendations

The Board is asked to note this report.

Relevant Legislation and Source Documents

Not Applicable

Has an Equality Analysis (EA) been completed?

No ☒

High level position described and no decisions required.

Nick Plummer, Assistant Director of Performance and Business Intelligence

Tel: 01233 667722

Email: nick.plummer@nhs.net

Page 67 of 194

 

Integrated

 Perform

ance Rep

ort 2

019/20

 

Novem

ber 2

019 repo

rt 

Part One

 

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 68 of 194

 

Con

tent

s

P

age

3

P

age

4

Glo

ssar

y of

Ter

ms

Ass

uran

ce o

n St

rate

gic

Goa

ls

Pag

e 5-

8

Cor

pora

te S

core

card

Pag

e 9-

14

Q

ualit

y R

epor

t

Pa

ge 1

5-20

Wor

kfor

ce R

epor

t P

age

21

Fin

ance

Rep

ort

Page

22-

37

O

pera

tiona

l Rep

ort

Pag

e 38

App

endi

x 1

– SP

C C

hart

s  

Page 69 of 194

 

Glo

ssar

y of

Ter

ms

SPC

– S

tatis

tical

Pro

cess

Con

trol

LTC

– L

ong

Term

Con

ditio

ns N

ursi

ng S

ervi

ce

ICT

– In

term

edia

te C

are

Serv

ice

Qua

lity

Scor

ecar

d –

Wei

ghte

d m

onth

ly ri

sk ra

ted

qual

ity s

core

card

s

C.D

iff –

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strid

ium

Diff

icile

MR

SA –

Met

hici

llin R

esis

tant

Sta

phyl

ococ

cus

Aure

us

MIU

– M

inor

Inju

ry U

nit

RTT

– R

efer

ral t

o Tr

eatm

ent

GU

M –

Gen

itour

inar

y M

edic

ine

CQ

UIN

– C

omm

issi

onin

g fo

r Qua

lity

and

Inno

vatio

n

MTW

– M

aids

tone

and

Ton

brid

ge W

ells

NH

S Tr

ust

WTE

– W

hole

Tim

e Eq

uiva

lent

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 70 of 194

Non

-SPC

KPI

on

targ

etN

on-S

PC K

PI p

erfo

rman

ce u

nder

revi

ewN

on-S

PC K

PI o

ff ta

rget

Spec

ial C

ause

Not

e - t

his

indi

cate

s th

at s

peci

al c

ause

var

iatio

n is

occ

urrin

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a K

PI, w

ith th

e va

riatio

n be

ing

in a

favo

urab

le d

irect

ion.

Hig

h (H

)spe

cial

cau

se n

ote

indi

cate

s th

at v

aria

tion

is u

pwar

ds in

a K

PI w

here

per

form

ance

is id

eally

abo

ve a

targ

et li

ne e

.g. N

ew B

irth

Visi

ts. L

ow

(L) s

peci

al c

ause

not

e is

whe

re th

e va

rianc

e is

dow

nwar

ds fo

r a b

elow

targ

et K

PI e

.g. D

NA

Rat

e.

1.0

Assu

ranc

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Str

ateg

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oals

Spec

ial C

ause

Con

cern

- th

is in

dica

tes

that

spe

cial

cau

se v

aria

tion

is o

ccur

ring

in a

KPI

, with

the

varia

tion

bein

g in

an

adve

rse

dire

ctio

n.

Low

( L) s

peci

al c

ause

con

cern

indi

cate

s th

at v

aria

tion

is d

ownw

ards

in a

KPI

whe

re p

erfo

rman

ce is

idea

lly a

bove

a ta

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line

e.g

. New

Birt

h Vi

sits

. Hig

h sp

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l cau

se c

once

rn (H

) is

whe

re th

e va

rianc

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upw

ards

for a

bel

ow ta

rget

line

KPI

e.g

. DN

A R

ate

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rall,

of th

e 41

indi

cato

rs th

at w

e ar

e ab

le to

plo

t on

a st

atis

tical

pro

cess

con

trol (

SPC

) cha

rt, 2

4.4%

are

exp

erie

ncin

g fa

vour

able

in-m

onth

var

iatio

n (1

0, K

PIs

1.1

1.7,

1.8

, 2.7

, 2.2

3, 5

.2, 5

.3, 5

.4, 5

.5 a

nd 5

.6),

19.5

%

are

show

ing

in- m

onth

adv

erse

var

ianc

e (8

, KPI

s 2.

6, 2

.12,

2.1

3, 3

.1, 3

.2, 3

.7, 4

.2 a

nd 4

.5) a

nd th

e re

mai

ning

56.

1% (2

3) a

re s

how

ing

norm

al v

aria

tion.

14.6

% (K

PIs

2.7,

2,2

0, 3

.5, 3

.7, 5

.3 a

nd 5

.6) a

re c

onsi

sten

tly fa

iling

,

w

ith th

e re

mai

ning

61%

var

iabl

y ac

hiev

ing

targ

et w

ith n

o tre

nd o

f con

sist

ent a

chie

vem

ent/f

ailu

re.

Of t

he 9

indi

cato

rs w

here

an

SPC

cha

rt is

not

app

ropr

iate

, 89%

(8) h

ave

achi

eved

the

in-m

onth

targ

et.

With

in N

HS

Impr

ovem

ent's

Sin

gle

Ove

rsig

ht F

ram

ewor

k, K

CH

FT h

ave

been

mov

ed fr

om s

egm

ent 1

to s

egm

ent 2

. Thi

s le

vel i

s ca

tego

rised

as

"tar

gete

d su

ppor

t offe

r" (s

egm

ent 1

is "

max

imum

aut

onom

y").

The

mov

e fro

m s

egm

ent 1

to s

egm

ent 2

was

as

a re

sult

of d

eter

iora

tion

in p

erfo

rman

ce in

RTT

and

6 w

eek

diag

nost

ics

and

whi

le 6

wee

k di

agno

stic

s is

now

mee

ting

targ

et, R

TT is

faili

ng to

mee

t the

92%

st

anda

rd c

onsi

sten

tly (9

2% o

f the

wai

ting

list u

nder

18

wee

ks).

See

the

oper

atio

ns s

ectio

n fo

r mor

e de

tails

24.4

% o

f the

KPI

s ar

e co

nsis

tent

ly a

chie

ving

targ

et (K

PIs

1.4,

2.9

, 2.1

1, 2

.15,

2.1

8, 2

.19,

2.2

2, 3

.2, 4

.2, a

nd 5

.4),

0%20%

40%

60%

80%

100%

Preven

t Ill He

alth

Deliver high‐qu

ality

 care at

home an

d in th

e commun

ity

Integrate Services

Develop Sustaina

ble Services

Be The

 Best E

mployer

Favourable Variance KP

Is (%

)

0%20%

40%

60%

80%

100%

Preven

t Ill He

alth

Deliver high‐qu

ality

 care at

home an

d in th

e commun

ity

Integrate Services

Develop Sustaina

ble Services

Be The

 Best E

mployer

Common

 Variance KP

Is (%

)

0%20%

40%

60%

80%

100%

Preven

t Ill He

alth

Deliver high‐qu

ality

 care at

home an

d in th

e commun

ity

Integrate Services

Develop Sustaina

ble Services

Be The

 Best E

mployer

Adverse Va

riance KP

Is (%

)

Page 71 of 194

Met

ricLo

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KPI

1.1

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p Sm

okin

g - 4

wee

k Q

uitte

rsAu

gust

201

911

5.8%

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92%

108%

KPI i

s ex

perie

ncin

g a

perio

d of

pos

itive

sp

ecia

l cau

se v

aria

tion

with

the

last

5 m

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s pe

rform

ing

abov

e th

e up

per c

ontro

l lim

it

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

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1.2

Hea

lth C

heck

s C

arrie

d O

ut

Sept

embe

r 201

910

6.0%

VAR

100%

62%

91%

121%

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

1.3

Hea

lth V

isiti

ng -

New

Birt

h Vi

sits

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erta

ken

by 1

4 da

ysSe

ptem

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019

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I will

mos

tly a

chie

ve ta

rget

but

the

cont

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limits

indi

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faili

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e ta

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is a

po

ssib

ilty

with

in th

e cu

rrent

pro

cess

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1.4

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lth V

isiti

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6-8

wee

k ch

eck

unde

rtake

n by

8 w

eeks

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embe

r 201

988

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85%

90%

95%

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s co

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gges

ts

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unl

ikel

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occ

ur.

KPI

1.5

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choo

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hild

ren

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tSe

ptem

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019

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% (y

ear

end)

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mul

ativ

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roug

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ach

ieve

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e ta

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for t

he 1

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sc

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r

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(N) S

choo

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Year

6

Chi

ldre

n Sc

reen

ed fo

r Hei

ght a

nd

Wei

ght

Sept

embe

r 201

928

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90%

(yea

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d)KP

I is

cum

ulat

ive

thro

ugh

the

scho

ol y

ear

KPI h

as a

chie

ved

the

targ

et fo

r the

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scho

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ear

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LTC

/ICT

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issi

ons

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agr

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ria)

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r 201

963

9952

5747

2159

6472

07KP

I is

expe

rienc

ing

a pe

riod

of p

ositi

ve

spec

ial c

ause

var

iatio

n w

ith th

e la

st 9

mon

ths

perfo

rmin

g ab

ove

the

mea

n

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

1.8

% L

TC/IC

T pa

tient

s th

at h

ad

at le

ast o

ne v

isit

whi

ch A

void

ed a

H

ospi

tal A

dmis

sion

Sept

embe

r 201

917

.3%

15.0

%13

.7%

16.8

%19

.9%

KPI i

s ex

perie

ncin

g a

perio

d of

pos

itive

sp

ecia

l cau

se v

aria

tion

with

the

last

10

mon

ths

perfo

rmin

g ab

ove

the

mea

n

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

Met

ric

19/2

0 YT

D

Actu

al

19/2

0 YT

D

Tar g

etK

PI 2

.1 N

umbe

r of T

eam

s w

ith a

n Am

ber o

r Red

Qua

lity

Scor

ecar

d R

atin

g Se

ptem

ber 2

019

01

36

Ther

e ha

ve b

een

3 Am

ber/R

ed ra

tings

for t

he

finan

cial

yea

r to

date

KPI

2.2

(N) N

ever

Eve

nts

Sept

embe

r 201

90

00

0N

o ne

ver e

vent

s ex

perie

nced

this

yea

r. La

st

even

t in

Dec

embe

r 201

6

KPI

2.3

(N) I

nfec

tion

Con

trol:

C.D

iffSe

ptem

ber 2

019

00

00

Last

cas

e in

Jan

uary

201

9

KPI

2.4

(N) I

nfec

tion

Con

trol:

MR

SA

case

s w

here

KC

HFT

pro

vide

d ca

reSe

ptem

ber 2

019

00

00

4 ca

ses

in 2

018-

19 (O

ne in

eac

h of

Apr

il,

Augu

st, S

epte

mbe

r and

Oct

ober

)

Ken

t Com

mun

ity H

ealth

NH

S Fo

unda

tion

Trus

t - C

orpo

rate

Sco

reca

rd

Actu

alTa

rget

Com

men

tary

1. Prevent Ill Health

Actu

alTa

rget

Com

men

tary

*NO

TE: N

atio

nal T

arge

ts a

re d

enot

ed b

y (N

) in

the

KPI

nam

e2. Deliver high-quality

care at home and in the community

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 72 of 194

Ken

t Com

mun

ity H

ealth

NH

S Fo

unda

tion

Trus

t - C

orpo

rate

Sco

reca

rd*N

OTE

: Nat

iona

l Tar

gets

are

den

oted

by

(N) i

n th

e K

PI n

ame

Met

ricLo

wer

Mea

nU

pper

KPI

2.5

Inpa

tient

Fal

ls (M

oder

ate

and

Seve

re H

arm

) per

100

0 O

ccup

ied

Bed

Day

sSe

ptem

ber 2

019

0.00

0.19

-0.1

60.

070.

29KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

KPI

2.6

Avo

idab

le P

ress

ure

Ulc

ers

- La

pses

in C

are

Sept

embe

r 201

93

1-1

.11.

74.

5KP

I is

expe

rienc

ing

high

neg

ativ

e va

riatio

n,

with

the

last

8 m

onth

s ab

ove

the

mea

nKP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

.

KPI

2.7

Con

tract

ual A

ctiv

ity: Y

TD a

s %

of Y

TD T

arge

tSe

ptem

ber 2

019

100.

4%10

0.0%

97.2

%98

.5%

99.8

%KP

I is

expe

rienc

ing

high

pos

itive

var

iatio

n,

with

the

last

3 m

onth

s pe

rform

ing

abov

e th

e up

per c

ontro

l lim

it

KPI w

ill c

onsi

sten

tly fa

il th

e ta

rget

. Thi

s su

gges

ts a

chie

vem

ent i

s lik

ely

to b

e do

wn

to

chan

ce w

ithou

t a p

roce

ss o

r tar

get c

hang

e

KPI

2.8

Tru

stw

ide

Did

Not

Atte

nd

Rat

e: D

NAs

as

a %

of t

otal

act

ivity

Sept

embe

r 201

93.

6%4.

0%3.

1%3.

6%4.

0%

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs.H

owev

er, t

he ta

rget

is n

ear t

he

uppe

r lim

it su

gges

ting

failu

re to

mee

t tar

get i

s un

likel

y.

KPI

2.9

LTC

/ICT

Res

pons

e Ti

mes

M

et (%

) (re

quire

d tim

e va

ries

by

patie

nt)

Sept

embe

r 201

997

.7%

95.0

%95

.3%

97.2

%99

.1%

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et w

ith

the

targ

et m

argi

nally

bel

ow th

e lo

wer

con

trol

limit

KPI

2.1

0 Pe

rcen

tage

of R

apid

R

espo

nse

Con

sulta

tions

sta

rted

with

in 2

hrs

of re

ferr

al a

ccep

tanc

eSe

ptem

ber 2

019

95.1

%95

.0%

90.0

%95

.6%

101.

1%KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

KPI

2.1

1 (N

) Tot

al T

ime

in M

IUs:

Le

ss th

an 4

hou

rsSe

ptem

ber 2

019

99.7

%95

.0%

99.4

%99

.7%

100.

0%KP

I is

cons

iste

ntly

ach

ievi

ng th

e ta

rget

with

th

e ta

rget

sig

nific

antly

bel

ow th

e lo

wer

lim

it

KPI

2.1

2 (N

) Con

sulta

nt L

ed 1

8 W

eek

Ref

erra

l to

Trea

tmen

t (R

TT) -

In

com

plet

e Pa

thw

ays

Sept

embe

r 201

986

.9%

92.0

%88

.6%

92.7

%96

.8%

KPI i

s ex

perie

ncin

g lo

w a

dver

se v

aria

tion

with

th

e la

st 3

mon

ths

belo

w th

e lo

wer

con

trol l

imit

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

2.1

3 (N

) Con

sulta

nt L

ed 1

8 W

eek

Ref

erra

l to

Trea

tmen

t (R

TT) -

W

aitin

g Li

st S

ize

(>18

wee

ks)

Sept

embe

r 201

990

153

214

647

580

4KP

I is

expe

rienc

ing

high

adv

erse

var

iatio

n w

ith th

e la

st 3

mon

ths

abov

e th

e up

per c

ontro

l lim

it

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

2.1

4 AH

P (N

on-C

onsu

ltant

Led

) R

efer

ral t

o Tr

eatm

ent T

imes

(RTT

) Se

ptem

ber 2

019

92.4

%92

.0%

89.6

%93

.0%

96.4

%KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

KPI

2.1

5 (N

) Acc

ess

to G

UM

: with

in

48 h

ours

Sept

embe

r 201

910

0.0%

100.

0%10

0.0%

100.

0%10

0.0%

Con

sist

ently

mee

ting

targ

et. F

ailu

re to

mee

t ta

rget

wou

ld b

e a

chan

ce e

vent

with

out a

pr

oces

s ch

ange

. Has

met

targ

et fo

r the

last

5

year

s

KPI

2.1

6 Le

ngth

of C

omm

unity

H

ospi

tal I

npat

ient

Sta

y (M

edia

n Av

erag

e)

Sept

embe

r 201

919

.121

.014

.320

.526

.7KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

KPI

2.1

7 R

esea

rch:

Par

ticip

ants

re

crui

ted

to n

atio

nal p

ortfo

lio

stud

ies

(Yea

r to

Dat

e)Se

ptem

ber 2

019

841

300

KPI i

s cu

mul

ativ

e fo

r the

fina

ncia

l yea

rKP

I is

cons

iste

ntly

ach

ievi

ng th

e ta

rget

of 7

5 pe

r qua

rter

Actu

alTa

rget

Com

men

tary

2. Deliver high-quality care at home and in the community

Page 73 of 194

Ken

t Com

mun

ity H

ealth

NH

S Fo

unda

tion

Trus

t - C

orpo

rate

Sco

reca

rd*N

OTE

: Nat

iona

l Tar

gets

are

den

oted

by

(N) i

n th

e K

PI n

ame

Met

ricLo

wer

Mea

nU

pper

KPI

2.1

8 Pe

rcen

tage

of p

atie

nt

goal

s ac

hiev

ed u

pon

disc

harg

e fo

r pl

anne

d an

d th

erap

y se

rvic

esSe

ptem

ber 2

019

88.5

%80

.0%

86.4

%90

.4%

94.4

%

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et a

s th

e lo

wer

lim

it is

sig

nifc

antly

abo

ve th

e ta

rget

. Th

is w

ould

mea

n fa

ilure

to m

eet t

arge

t wou

ld

likel

y be

due

to c

hanc

e

KPI

2.1

9 (N

) Frie

nds

and

Fam

ily -

Perc

enta

ge o

f Pat

ient

s w

ho w

ould

R

ecom

men

d K

CH

FTSe

ptem

ber 2

019

97.1

%95

.0%

95.4

%96

.9%

98.5

%KP

I is

cons

iste

ntly

ach

ievi

ng th

e ta

rget

as

the

low

er li

mit

is a

bove

the

targ

et. T

his

sugg

ests

fa

iling

to m

eet t

arge

t is

an u

nlik

ely

even

t.

KPI

2.2

0 Fr

iend

s an

d Fa

mily

Tes

t (P

atie

nts

surv

eyed

for M

IUs

&

Com

m. H

osp)

- R

espo

nse

Rat

eSe

ptem

ber 2

019

14.2

%20

.0%

10.2

%15

.0%

19.9

%KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

, alth

ough

mos

tly fa

il du

e to

the

targ

et b

eing

so

clos

e to

the

uppe

r con

trol l

imit

KPI

2.2

1 C

linic

al A

udit:

% o

f aud

it re

com

men

datio

ns im

plem

ente

d by

de

adlin

eSe

ptem

ber 2

019

98.0

%55

.0%

52.9

%80

.5%

108.

1%KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

KPI

2.2

2 (N

) NIC

E Te

chni

cal

Appr

aisa

ls re

view

ed b

y re

quire

d tim

e sc

ales

follo

win

g re

view

Sept

embe

r 201

910

0.0%

100.

0%10

0.0%

100.

0%10

0.0%

Con

sist

ently

mee

ting

targ

et. F

ailu

re to

mee

t ta

rget

wou

ld b

e co

nsid

ered

a c

hanc

e ev

ent

with

out a

pro

cess

cha

nge.

Has

met

targ

et fo

r th

e la

st 5

yea

rs

KPI

2.2

3 (N

) 6 W

eek

Dia

gnos

tics

Sept

embe

r 201

910

0.0%

99.0

%80

.2%

92.7

%10

5.3%

KPI i

s ex

perie

ncin

g hi

gh p

ositi

ve v

aria

tion,

w

ith th

e la

st 1

3 m

onth

s pe

rform

ing

abov

e th

e m

ean

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

Met

ricLo

wer

Mea

nU

pper

KPI

3.1

Del

ayed

Tra

nsfe

rs o

f Car

e fro

m a

Com

mun

ity H

ospi

tal b

ed a

s a

% o

f Occ

upie

d B

ed D

ays

Sept

embe

r 201

915

.7%

9.5%

4.8%

10.3

%15

.8%

KPI i

s ex

perie

ncin

g hi

gh n

egat

ive

varia

tion,

w

ith th

e la

st 7

mon

ths

perfo

rmin

g ab

ove

the

mea

n

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

3.2

Per

cent

age

of L

TC/IC

T R

efer

rals

com

ing

from

with

in

KC

HFT

Sept

embe

r 201

915

.7%

10.0

%15

.0%

18.8

%22

.6%

KPI i

s ex

perie

ncin

g lo

w n

egat

ive

varia

tion,

w

ith th

e la

st 8

mon

ths

perfo

rmin

g be

low

the

mea

n

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et w

ith

the

targ

et c

onsi

dera

bly

belo

w th

e lo

wer

lim

it

KPI

3.3

CQ

UIN

s (%

of C

QU

IN m

oney

ac

hiev

ed to

19/

20 Q

1)Ju

ne 2

019

92.9

%10

0%SP

C n

ot a

ppro

pria

te fo

r thi

s m

etric

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

3.4

Hom

e Fi

rst i

mpa

ct -

redu

ctio

n in

ave

rage

exc

ess

bed

days

(Wes

t Ken

t)Se

ptem

ber 2

019

0.52

0.20

-0.2

20.

541.

31KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

KPI

3.5

(N) A

vera

ge w

ait t

ime

(min

utes

) for

MTW

Acc

iden

t and

Em

erge

ncy

Serv

ices

Augu

st 2

019

357

240

263

316

368

KPI i

s co

nsis

tent

ly fa

iling

the

targ

et a

s th

e lo

wer

lim

it is

abo

ve th

e ta

rget

. Thi

s su

gges

ts

perfo

rman

ce is

unl

ikel

y to

dec

reas

e to

mee

t ta

rget

with

out a

pro

cess

cha

nge

KPI

3.6

Rap

id T

rans

fer i

mpa

ct -

redu

ctio

n in

ave

rage

exc

ess

bed

days

(Eas

t Ken

t)Se

ptem

ber 2

019

0.75

0.20

-0.1

40.

200.

55KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

, alth

ough

see

ms

to b

e m

ovin

g to

war

ds th

e up

per c

ontro

l lim

it

KPI

3.7

(N) A

vera

ge w

ait t

ime

(min

utes

) for

EK

HU

FT A

ccid

ent a

nd

Emer

genc

y Se

rvic

esAu

gust

201

938

324

031

136

942

7KP

I is

expe

rienc

ing

high

neg

ativ

e va

riatio

n,

with

the

last

8 m

onth

s pe

rform

ing

abov

e th

e m

ean

KPI i

s co

nsis

tent

ly fa

iling

the

targ

et a

s th

e lo

wer

lim

it is

abo

ve th

e ta

rget

. Thi

s su

gges

ts

perfo

rman

ce is

unl

ikel

y to

dec

reas

e to

mee

t ta

rget

with

out a

pro

cess

cha

nge

KPI

3.8

Eas

t Ken

t Rap

id T

rans

fer

Serv

ice

- Ave

rage

Com

mis

sion

ed

Dis

char

ges

per d

ayO

ctob

er 2

019

27.4

30N

ew m

etric

- da

ta b

uild

ing

to a

llow

SPC

re

porti

ng

2. Deliver high-quality care at home and in the community

Actu

alTa

rget

Com

men

tary

Actu

alTa

rget

Com

men

tary

3. Integrate Services

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 74 of 194

Ken

t Com

mun

ity H

ealth

NH

S Fo

unda

tion

Trus

t - C

orpo

rate

Sco

reca

rd*N

OTE

: Nat

iona

l Tar

gets

are

den

oted

by

(N) i

n th

e K

PI n

ame

Met

ricLo

wer

Mea

nU

pper

KPI

4.1

Bed

Occ

upan

cy: O

ccup

ied

Bed

Day

s as

a %

of a

vaila

ble

bed

days

Sept

embe

r 201

987

.9%

87.0

%81

.5%

88.9

%96

.3%

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

4.2

Inco

me

& E

xpen

ditu

re -

Surp

lus

(%)

Oct

ober

201

91.

2%1.

0%1.

1%1.

5%1.

9%KP

I is

expe

rienc

ing

low

adv

erse

var

iatio

n, w

ith

the

last

7 m

onth

s pe

rform

ing

belo

w th

e m

ean

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et a

s th

e lo

wer

lim

it is

abo

ve th

e ta

rget

. Thi

s su

gges

ts

perfo

rman

ce is

unl

ikel

y to

dec

reas

e to

bel

ow

targ

et

KPI

4.3

Cos

t Im

prov

emen

t Pla

ns

(CIP

) Ach

ieve

d ag

ains

t Pla

n (%

)O

ctob

er 2

019

89.5

%10

0.0%

66.2

%84

.7%

103.

1%KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

, exp

ecia

lly e

arly

in e

ach

finan

cial

yea

r

KPI

4.4

Ext

erna

l Age

ncy

spen

d ag

ains

t Tra

ject

ory

(£00

0s)

Oct

ober

201

9£4

40,7

67£6

28,0

00£2

19,9

00£4

43,5

74£6

67,2

49KP

I will

var

iabl

y m

eet t

he ta

rget

som

e m

onth

s an

d fa

il ot

hers

,

KPI

4.5

Per

cent

age

base

d on

val

ue

of S

ervi

ce L

ines

with

def

icits

gr

eate

r tha

n 5%

Oct

ober

201

916

.2%

0%-1

.1%

12.6

%26

.4%

KPI i

s ex

perie

ncin

g hi

gh a

dver

se v

aria

tion,

w

ith th

e la

st 9

mon

ths

perfo

rmin

g ab

ove

the

mea

n

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs.H

owev

er, t

he ta

rget

is n

ear t

he lo

wer

lim

it su

gges

ting

failu

re to

mee

t tar

get w

ould

be

mor

e lik

ely

than

ach

ievi

ng

Met

ricLo

wer

Mea

nU

pper

KPI

5.1

Sic

knes

s R

ate

Oct

ober

201

94.

60%

4.20

%3.

76%

4.46

%5.

15%

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

5.2

Sic

knes

s R

ate

(Stre

ss a

nd

Anxi

ety)

Oct

ober

201

91.

15%

1.15

%1.

00%

1.28

%1.

56%

KPI i

s ex

perie

ncin

g lo

w p

ositi

ve v

aria

tion

with

th

e la

st 1

0 m

onth

s pe

rform

ing

belo

w th

e m

ean

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

5.3

Tur

nove

r (pl

anne

d an

d un

plan

ned)

Oct

ober

201

916

.10%

16.4

7%16

.64%

17.9

3%19

.22%

KPI i

s ex

perie

ncin

g lo

w p

ositi

ve v

aria

tion

with

th

e la

st 1

0 m

onth

s pe

rform

ing

belo

w th

e m

ean.

The

last

2 m

onth

s ar

e al

so b

elow

the

low

er c

ontro

l lim

it

KPI i

s co

nsis

tent

ly fa

iling

the

targ

et w

ith th

e ta

rget

bel

ow th

e lo

wer

lim

it. T

his

sugg

est

achi

evin

g ta

rget

with

out a

pro

cess

cha

nge

will

be

dow

n to

cha

nce.

KPI

5.4

Man

dato

ry T

rain

ing:

C

ombi

ned

Com

plia

nce

Rat

eO

ctob

er 2

019

95.9

%85

.0%

94.4

%95

.5%

96.7

%KP

I is

expe

rienc

ing

high

pos

itive

var

iatio

n w

ith

the

last

8 m

onth

s pe

rform

ing

abov

e th

e m

ean

KPI i

s co

nsis

tent

ly a

chie

ving

the

targ

et a

s th

e lo

wer

lim

it is

abo

ve th

e ta

rget

KPI

5.5

Gro

ss V

acan

cy F

acto

r (%

of

the

budg

eted

WTE

unf

illed

by

perm

anen

t wor

kfor

ce)

Oct

ober

201

97.

2%9.

7%7.

3%9.

3%11

.4%

KPI i

s ex

perie

ncin

g lo

w p

ositi

ve v

aria

tion

with

th

e cu

rrent

mon

th p

erfo

rmin

g be

low

the

low

er

cont

rol l

imit

KPI w

ill v

aria

bly

mee

t the

targ

et s

ome

mon

ths

and

fail

othe

rs

KPI

5.6

Sta

bilit

y (%

of w

orkf

orce

w

ho h

ave

been

with

the

trust

for 1

2 m

onth

s or

mor

e)O

ctob

er 2

019

85.8

%85

.0%

82.5

%83

.4%

84.3

%KP

I is

expe

rienc

ing

high

pos

itive

var

iatio

n w

ith

the

last

12

mon

ths

perfo

rmin

g ab

ove

the

mea

n

New

targ

et h

as b

een

set a

t 85%

. Whi

le th

e ta

rget

cur

rent

ly s

its a

bove

the

uppe

r con

trol

limit,

cur

rent

per

form

ance

sho

uld

see

the

uppe

r lim

it in

crea

se a

bove

targ

et

Actu

alTa

rget

Com

men

tary

5. Be The Best Employer4. Develop sustainable services

Actu

alTa

rget

Com

men

tary

Page 75 of 194

 

2.0

Qua

lity

Rep

ort

2.1

Ass

uran

ce o

n Sa

fer S

taffi

ng

Fave

rsha

m, W

est V

iew

and

Ton

brid

ge c

omm

unity

hos

pita

ls h

ad a

shi

ft fil

l rat

e be

low

90%

in A

ugus

t and

Wes

t Vie

w a

nd T

onbr

idge

in

Sept

embe

r. Th

e re

ason

s w

ere

sick

ness

and

una

vaila

bilit

y of

ban

k st

aff

durin

g ho

liday

per

iods

. In

mos

t circ

umst

ance

s th

e ov

erfil

l shi

ft ra

tes

for

HC

A’s

is p

redo

min

antly

due

to

patie

nts

requ

iring

enh

ance

d ca

re.

The

elec

troni

c ro

ster

tem

plat

e fo

r W

est

View

nee

ds t

o be

ad

just

ed to

refle

ct th

e re

quire

d st

affin

g le

vels

.

Nur

ses

have

bee

n tra

nsfe

rred

from

oth

er s

ervi

ces

to s

uppo

rt w

ards

at F

aver

sham

and

Ton

brid

ge. S

taff

on lo

ng te

rm s

ick

leav

e ha

ve n

ow

retu

rned

and

2 n

ew m

embe

rs o

f st

aff

are

in p

ost

at W

est

View

. W

ards

incr

ease

the

use

of

heal

th c

are

assi

stan

ts t

o ex

pand

gen

eral

nu

rsin

g ca

paci

ty e

spec

ially

dur

ing

nigh

t sh

ifts.

On

revi

ew o

f th

e in

cide

nts

durin

g th

is t

ime

fram

e, t

here

wer

e no

inci

dent

s of

har

m t

o pa

tient

s w

hen

ther

e w

as o

ne R

N o

n du

ty.

How

ever

, th

ese

inci

dent

s ar

e re

gula

rly m

onito

red

to e

nsur

e th

at le

arni

ng is

iden

tifie

d an

d di

ssem

inat

ed.

2.2

Ass

uran

ce o

n Pr

essu

re U

lcer

s

Ther

e w

as 1

pre

ssur

e ul

cer s

erio

us in

cide

nt re

porte

d in

Aug

ust a

nd n

one

in S

epte

mbe

r. T

he in

vest

igat

ion

of th

is in

cide

nt is

stil

l ong

oing

. Le

arni

ng a

lread

y id

entif

ied

thro

ugh

the

inve

stig

atio

n fo

rms

part

of th

e pr

essu

re u

lcer

impr

ovem

ent p

lan.

In A

ugus

t and

Sep

tem

ber t

here

wer

e th

ere

wer

e 5

laps

es in

car

e w

ith le

arni

ng fo

r KC

HFT

and

thes

e re

late

d ca

tego

ry 2

pre

ssur

e ul

cers

. In

vest

igat

ions

iden

tifie

d a

need

for

tim

ely

skin

ass

essm

ents

. Th

ere

is a

n ac

tion

rela

ting

to t

imel

y as

sess

men

ts o

n th

e pr

essu

re u

lcer

ac

tion

plan

whi

ch is

mon

itore

d at

the

Patie

nt S

afet

y an

d C

linic

al R

isk

Gro

up.

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 76 of 194

 Th

ere

wer

e 35

4 oc

casi

ons

whe

re a

pre

ssur

e ul

cer

was

rep

orte

d on

adm

issi

on to

KC

HFT

cas

eloa

d du

ring

Augu

st a

nd S

epte

mbe

r; 21

4 ca

tego

ry 2

, 61

cate

gory

3, 7

cat

egor

y 4,

25

deep

tiss

ue in

jurie

s an

d 43

ung

rada

ble

pres

sure

ulc

ers.

All

of th

ese

have

bee

n th

roug

h SI

pr

oces

s an

d de

emed

the

patie

nt n

ot to

hav

e ac

quire

d th

e pr

essu

re u

lcer

whi

le in

the

care

of K

CH

FT.

2.3

Ass

uran

ce o

n Fa

lls

Ther

e w

ere

49 f

alls

rep

orte

d ac

ross

KC

HFT

dur

ing

Augu

st a

nd S

epte

mbe

r 20

19,

3 of

whi

ch w

ere

foun

d to

be

avoi

dabl

e fo

llow

ing

inve

stig

atio

n.

Two

of th

e th

ree

avoi

dabl

e fa

lls in

cide

nts

rela

te to

sw

itchi

ng o

ff th

e se

nsor

pad

; one

whi

lst a

pat

ient

wen

t to

the

bath

room

and

it w

as n

ot

reco

nnec

ted

upon

ret

urn

and

the

othe

r a

patie

nt w

ith c

ogni

tive

impa

irmen

t bec

ame

agita

ted

and

diso

rient

ated

with

the

nois

e fro

m th

e se

nsor

, wal

ked

inde

pend

ently

to th

e ba

thro

om a

nd fe

ll du

e to

impa

ired

bala

nce.

No

harm

cam

e to

eith

er p

atie

nt.

The

third

avo

idab

le fa

lls in

cide

nt w

as d

ecla

red

as a

ser

ious

inci

dent

in S

epte

mbe

r and

the

inve

stig

atio

n is

ong

oing

. The

pat

ient

sus

tain

ed

a fra

ctur

ed n

eck

of fe

mur

. The

root

cau

se a

naly

sis

mee

ting

is o

n th

e 19

th o

f Nov

embe

r 201

9.

Page 77 of 194

 

2.4

Ass

uran

ce o

n M

edic

atio

n in

cide

nts

The

maj

ority

of

inci

dent

s re

porte

d re

late

to

‘adm

inis

tratio

n or

sup

ply

of a

med

icin

e fro

m a

clin

ic o

r in

patie

nt a

rea’

. 43

% o

f in

cide

nts

occu

rred

in p

atie

nt’s

ow

n ho

mes

and

32%

occ

urre

d in

com

mun

ity h

ospi

tals

. Th

e hi

ghes

t ca

tego

ry o

f m

edic

atio

n in

cide

nts

rela

ted

to

‘om

itted

med

icat

ion’

. KC

HFT

dem

onst

rate

a p

ositi

ve b

ench

mar

k fo

r med

icat

ion

erro

rs

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 78 of 194

 Al

l m

edic

atio

n in

cide

nts

are

revi

ewed

by

the

Phar

mac

y Te

am w

ho a

re u

nder

taki

ng t

arge

ted

wor

k w

ith t

he s

peci

fic t

eam

. M

edic

ines

m

anag

emen

t will

also

form

par

t of t

he ‘W

e C

are’

vis

its.

The

Phar

mac

y Te

am a

re w

orki

ng a

long

side

ope

ratio

nal s

ervi

ces

on Q

ualit

y Im

prov

emen

t Pro

ject

s.

2.5

Ass

uran

ce o

n Pa

tient

Exp

erie

nce

2.

5.1

Mer

idia

n Pa

tient

Exp

erie

nce

surv

ey re

sults

6,37

5 su

rvey

s w

ere

com

plet

ed b

y KC

HFT

pat

ient

s, re

lativ

es a

nd c

arer

s in

Oct

ober

201

9, w

ith a

com

bine

d sa

tisfa

ctio

n sc

ore

of 9

7.1%

, the

sa

me

perc

enta

ge a

s Se

ptem

ber.

Surv

ey v

olum

es in

Oct

ober

(6,3

75) i

ncre

ased

by

757

on S

epte

mbe

r ret

urns

. Th

e Sc

hool

Hea

lth S

ervi

ce K

ent h

ad th

e la

rges

t inc

reas

e in

lin

e w

ith th

e us

ual t

rend

see

n at

this

tim

e of

yea

r due

to th

e st

art o

f a n

ew s

choo

l yea

r. A

pron

ounc

ed in

crea

se in

vol

umes

was

see

n fo

r Ep

ileps

y, C

hron

ic P

ain,

Sex

ual h

ealth

and

the

Den

tal s

ervi

ce.

Volu

mes

for

the

Hom

e Fi

rst S

ervi

ce in

wes

t Ken

t con

tinue

to in

crea

se

sinc

e th

e in

trodu

ctio

n of

the

surv

ey b

ack

in M

arch

201

9.

2.5.

2 Th

e N

HS

Frie

nds

and

Fam

ily T

est (

FFT)

In O

ctob

er t

he r

ecom

men

d sc

ore

for

the

NH

S Fr

iend

s an

d Fa

mily

Tes

t qu

estio

n w

as 9

7%,

a 1%

dec

reas

e on

Sep

tem

ber

(98%

). In

O

ctob

er 0

.7%

of

our

patie

nts

chos

e no

t to

rec

omm

end

the

serv

ice

they

rec

eive

d co

mpa

red

with

0.4

% in

Sep

tem

ber.1

00 p

atie

nts

in

Oct

ober

cho

se th

e ‘n

eith

er li

kely

nor

unl

ikel

y’ a

nsw

er o

ptio

n, c

ompa

red

with

57

in S

epte

mbe

r. Se

rvic

es th

at re

ceiv

ed th

e hi

ghes

t num

ber

Page 79 of 194

 of

the

se r

espo

nses

wer

e Sc

hool

Hea

lth (

Kent

) (1

9),

Den

tal s

ervi

ces

(12)

, Ta

rget

ed s

ervi

ces

(Chi

ldre

n’s

Psyc

holo

gica

l ser

vice

s) (

11),

CH

ATS

(5),

Chr

onic

Pai

n (5

) an

d H

ealth

Vis

iting

(4)

. Th

e re

mai

nder

of t

he ‘n

eith

er li

kely

nor

unl

ikel

y’ r

espo

nses

wer

e sp

read

acr

oss

vario

us s

ervi

ces.

In O

ctob

er 1

8 pa

tient

s ch

ose

‘unl

ikel

y’ (1

8) c

ompa

red

to S

epte

mbe

r (9)

and

23

chos

e ex

trem

ely

unlik

ely,

hig

her t

han

the

13 in

Sep

tem

ber.

38 p

eopl

e in

Oct

ober

cho

se ‘d

on’t

know

’ com

pare

d w

ith 2

5 in

Sep

tem

ber.

2.

6 A

ssur

ance

on

Clin

ical

Aud

it an

d R

esea

rch

2.

6.1

Aud

it

The

annu

al K

PI ta

rget

is 9

5% o

f clin

ical

aud

it re

com

men

datio

ns to

be

impl

emen

ted.

Thi

s is

ach

ieve

d vi

a a

step

ped

targ

et d

urin

g th

e ye

ar.

The

targ

et fo

r Sep

tem

ber w

as a

chie

ved.

2.6.

2 C

linic

al A

udit

Rep

ortin

g

Clin

ical

Aud

it Ac

tions

– A

ll th

ree

KPI a

ctio

ns a

chie

ved.

To

date

89

out o

f 91

due

actio

ns h

ave

been

impl

emen

ted.

Onl

y ar

ea w

ith a

ny

actio

ns o

utst

andi

ng fo

r mor

e th

an 3

mon

ths

is S

exua

l Hea

lth (n

=1).

Clin

ical

Aud

it R

epor

ting

- Fur

ther

wor

k re

quire

d to

ens

ure

prom

pt re

view

of f

inal

repo

rt by

rele

vant

qua

lity

or g

over

nanc

e gr

oup.

Thi

s ha

s m

oved

fro

m 4

7% in

Jul

y.

This

is im

pact

ed b

y re

leva

nt m

eetin

g be

ing

canc

elle

d he

nce

the

requ

irem

ent

that

the

Cha

ir or

nom

inat

ed

pers

on ta

ke re

spon

sibi

lity

for r

evie

win

g th

e re

leva

nt re

ports

. C

linic

al A

udit

Faci

litat

ors

will

wor

k m

ore

clos

ely

with

Div

isio

ns to

enc

oura

ge

this

.

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 80 of 194

 

2.6.

3 R

esea

rch

We

have

exc

eede

d ou

r an

nual

rec

ruitm

ent p

ledg

e to

the

Clin

ical

Res

earc

h N

etw

ork

(CR

N K

SS).

This

was

hig

her

in Q

2 bu

t a n

atio

nal

dent

al s

tudy

had

inap

prop

riate

ly a

ssig

ned

recr

uits

for l

ast y

ear.

Thes

e ha

ve s

ince

bee

n w

ithdr

awn.

One

of t

he C

RN

Hig

h Le

vel O

bjec

tives

(HLO

) is

to a

chie

ve a

t lea

st 8

0% re

crui

tmen

t, in

tim

e an

d to

targ

et fo

r all

com

mer

cial

stu

dies

.

We

have

ach

ieve

d 10

0% re

crui

tmen

t to

time

and

over

targ

et fo

r a c

ardi

ac c

omm

erci

al s

tudy

.

2.6.

4 N

atio

nal I

nstit

ute

for C

linic

al E

xcel

lenc

e (N

ICE)

543

piec

es o

f NIC

E G

uida

nce

have

bee

n is

sued

sin

ce 2

017.

Onl

y 11

8 ar

e ap

plic

able

to K

CH

FT.

Of t

hese

19

(16%

) rem

ain

unde

r ini

tial

revi

ew a

nd h

ave

exce

eded

our

3 m

onth

targ

et to

com

plet

e th

e ba

selin

e as

sess

men

t. W

as 2

7%

Boar

d ha

s vi

sibi

lity

of o

utst

andi

ng g

uida

nce.

NIC

E W

orki

ng G

roup

focu

s on

bot

h Q

A an

d Q

I asp

ects

of N

ICE

Page 81 of 194

 

3.0

Wor

kfor

ce R

epor

t: 3.

1 A

ssur

ance

on

Ret

entio

n 3.

1.1

Turn

over

Turn

over

in O

ctob

er 2

019

has

decr

ease

d si

nce

the

last

repo

rt to

16.

10%

, a 0

.53%

dec

reas

e on

the

repo

rted

figur

es in

Aug

ust o

f 16.

63%

.

It ha

s in

crea

sed

from

Sep

tem

ber’s

rat

e of

16.

02%

but

con

tinue

s to

rem

ain

belo

w a

vera

ge a

nd b

elow

targ

et.

It is

now

sitt

ing

at 0

.37%

be

low

the

targ

et o

f 16.

47%

. As

mor

e th

an 7

pos

itive

var

iatio

ns h

ave

occu

rred

a re

com

men

datio

n is

bei

ng m

ade

to th

e Ex

ecut

ive

to re

duce

th

e tu

rnov

er ta

rget

to 1

6%.

3.1.

2 St

abili

ty

Stab

ility

cont

inue

s to

per

form

abo

ve th

e m

ean

and

the

targ

et, i

t has

reco

vere

d th

e sm

all d

rop

repo

rted

in M

arch

201

9, a

nd is

sitt

ing

at ju

st

abov

e th

e 85

% ta

rget

, at 8

5.77

% a

s of

Oct

ober

201

9; a

slig

ht in

crea

se fr

om th

e la

st re

port

on A

ugus

t’s fi

gure

of 8

5.38

%. In

tegr

ated

Per

form

ance

Rep

ort

Page 82 of 194

 

3.2

Ass

uran

ce o

n Si

ckne

ss

3.2.

1 Si

ckne

ss A

bsen

ce

Sinc

e th

e sh

arp

drop

in s

ickn

ess

abse

nce

in M

arch

201

9, re

porte

d le

vels

of a

bsen

ce h

ave

star

ted

to s

low

ly in

crea

se b

ack

up to

war

ds th

e m

ean.

Th

e fig

ures

for

Oct

ober

201

9 ha

ve in

crea

sed

to it

s hi

ghes

t lev

el s

ince

Mar

ch 2

019.

Th

e Tr

ust a

bsen

ce fi

gure

has

incr

ease

d to

4.

6% a

nd is

now

abo

ve th

e 4.

2% ta

rget

. Ab

senc

e le

vels

do

usua

lly in

crea

se o

ver t

his

win

ter p

erio

d.

Page 83 of 194

 

3.2.

2 St

ress

Abs

ence

In-m

onth

stre

ss a

bsen

ce f

igur

es f

or O

ctob

er 2

019

have

inc

reas

ed s

light

ly t

o 1.

15%

fro

m 1

.13%

in

Sept

embe

r. O

ctob

er’s

fig

ure

is

follo

win

g a

patte

rn v

aryi

ng a

roun

d th

e ta

rget

of 1

.15%

. Th

e fin

anci

al y

ear-t

o-da

te fi

gure

for O

ctob

er 2

019

is a

lso

1.15

%, a

slig

ht d

ecre

ase

from

the

last

repo

rted

figur

e in

Aug

ust o

f 1.1

8%.

The

cont

inue

d tre

nd o

f im

prov

ed p

erfo

rman

ce b

elow

the

mea

n in

stre

ss a

bsen

ce h

as n

ow b

een

in p

lace

for 1

1 m

onth

s (s

ince

Dec

embe

r 20

18).

Thi

s ha

s tri

gger

ed a

spe

cial

cau

se v

aria

tion

flag,

indi

catin

g th

at a

sig

nific

ant i

mpr

ovem

ent i

n th

e pe

rform

ance

of t

his

met

ric is

now

in

pla

ce.

This

will

cont

inue

to b

e m

onito

red

in th

e co

min

g m

onth

s to

ens

ure

this

leve

l of p

erfo

rman

ce is

mai

ntai

ned.

3.3

Ass

uran

ce o

n Fi

lling

Vac

anci

es

3.3.

1 Es

tabl

ishm

ent a

nd V

acan

cies

Follo

win

g th

e in

crea

se in

vac

ancy

rate

s in

Apr

il 20

19 d

ue to

bud

get s

ettin

g, le

vels

hav

e be

en o

n a

cont

inua

l dow

nwar

d tra

ject

ory

belo

w

the

mea

n. V

acan

cies

are

at a

n al

l-tim

e lo

w o

f 7.1

6% s

igni

fican

tly b

elow

the

targ

et o

f 9.6

6%. O

ctob

er 2

019

saw

the

low

est v

acan

cy ra

te in

th

e la

st 2

yea

rs. W

ith th

e in

crea

se in

pos

ts to

sup

port

the

long

term

pla

n, it

is a

ntic

ipat

ed th

at th

ere

may

be

an in

crea

se in

vac

anci

es in

th

e in

terim

of t

he p

ost b

eing

incl

uded

in e

stab

lishm

ent a

nd p

ost b

eing

fille

d.

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 84 of 194

 

3.3.

2 Te

mpo

rary

Sta

ff U

sage

Both

Ban

k an

d To

tal f

ill ra

tes

had

been

rep

orte

d as

an

incr

ease

in A

ugus

t 201

9.

Alth

ough

ther

e ha

d be

en a

dro

p in

Sep

tem

ber,

the

Tota

l fill

rate

and

Ban

k Fi

ll ra

te in

Oct

ober

201

9 ha

s in

crea

sed

agai

n. T

he T

otal

fill

rate

incr

ease

d to

86.

06%

and

the

Ban

k fil

l rat

e in

crea

sed

to 6

3.58

%. B

ank

fill r

ates

had

repo

rted

8 da

ta p

oint

s be

low

the

mea

n un

til O

ctob

er.

Tota

l fill

rate

s ha

ve b

een

vary

ing

arou

nd

the

mea

n pr

evio

usly

and

hav

e dr

oppe

d to

bel

ow th

e m

ean

in S

epte

mbe

r and

Oct

ober

.

As p

revi

ous

repo

rted

the

fill r

ate

is b

eing

incr

ease

d by

the

sign

ifica

nt in

crea

se in

dem

and.

We

are

wor

king

with

our

STP

par

tner

s lo

okin

g at

a s

yste

m th

at w

ill en

able

vac

ant s

hifts

to b

e sh

ared

Page 85 of 194

 

3.3.

3 A

genc

y Sp

end

The

use

of a

genc

y st

aff a

cros

s th

e Tr

ust i

n O

ctob

er 2

019

has

been

sig

nific

antly

redu

ced

from

Sep

tem

ber’s

spe

nd w

ith a

figu

re o

f 93.

24%

of

bud

gete

d tra

ject

ory

repo

rted,

a re

duct

ion

of 2

4.63

% o

ver S

epte

mbe

r’s fi

gure

of 1

17.8

7%. T

his

is re

porti

ng 6

.76%

bel

ow ta

rget

, thi

s is

th

e lo

wes

t it h

as b

een

sinc

e Ap

ril 2

019.

It is

like

ly th

at th

is is

rela

ted

to th

e im

prov

ed b

ank

fill r

ate

outli

ned

abov

e so

will

also

form

par

t of

the

inve

stig

atio

n be

ing

unde

rtake

n

3.4

Ass

uran

ce o

n Tr

aini

ng C

ompl

ianc

e

3.4.

1 M

anda

tory

Tra

inin

g C

ompl

ianc

e

Man

dato

ry T

rain

ing

figur

es a

re c

urre

ntly

in a

sta

te o

f nat

ural

var

iatio

n ar

ound

the

mea

n, a

nd a

re c

onsi

sten

tly a

bove

the

targ

et.

Whi

lst t

here

has

bee

n a

drop

of 0

.1%

in c

ompl

ianc

e ov

eral

l the

re h

ave

been

no

nega

tive

chan

ges

in th

e to

pic

base

d R

AG ra

tings

. M

ovin

g an

d ha

ndlin

g le

vel 4

has

mov

ed fr

om a

mbe

r to

gree

n th

is m

onth

and

ass

umin

g al

l tho

se b

ooke

d to

atte

nd in

Nov

embe

r and

Dec

embe

r do

atte

nd t

his

will

rem

ain

abov

e ta

rget

com

ing

into

the

pre

ssur

e of

Jan

uary

. T

here

are

als

o an

add

ition

al 2

3 sp

aces

not

cur

rent

ly b

eing

ut

ilised

ove

r th

ose

mon

ths.

The

re i

s a

risk

that

whi

lst

ther

e ar

e su

ffici

ent

spac

es i

n Ja

nuar

y, F

ebru

ary

and

Mar

ch 2

020

(420

) to

ac

com

mod

ate

all s

taff

out o

f dat

e, s

houl

d ba

d w

eath

er h

it or

the

traffi

c di

srup

tions

ant

icip

ated

from

Bre

xit o

ccur

, the

n th

ere

will

not b

e en

ough

of a

cus

hion

to k

eep

com

plia

nce

abov

e th

e ta

rget

ed 8

5%.

Esse

ntia

l to

role

trai

ning

is s

how

ing

abov

e ta

rget

as

an a

ggre

gate

d fig

ure

but t

here

are

som

e ar

eas

whi

ch a

re b

elow

targ

et Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 86 of 194

 

Page 87 of 194

 

4.0

Fina

nce

Rep

ort:

4.1

Key

Mes

sage

s Su

rplu

s:

The

Trus

t ac

hiev

ed a

sur

plus

of

£1,6

95k

(1.2

%)

to t

he e

nd o

f O

ctob

er.

Cum

ulat

ivel

y pa

y an

d de

prec

iatio

n/in

tere

st h

ave

unde

rspe

nt b

y £3

,714

k an

d £5

8k re

spec

tivel

y an

d no

n-pa

y ha

s ov

ersp

ent b

y £1

,783

k. I

ncom

e ha

s un

der-r

ecov

ered

by

£1,6

60k.

Con

tinui

ty o

f Ser

vice

s R

isk

Rat

ing:

EB

ITD

A M

argi

n ac

hiev

ed is

2.6

%. T

he T

rust

sco

red

1 ag

ains

t the

Use

of R

esou

rces

Rat

ing,

the

best

pos

sibl

e sc

ore.

CIP

: £2

,761

k of

sav

ings

has

bee

n ac

hiev

ed fo

r the

YTD

aga

inst

a ri

sk ra

ted

plan

of £

3,08

6k w

hich

is £

325k

(11%

) beh

ind

targ

et.

Cas

h an

d C

ash

Equi

vale

nts:

Th

e ca

sh a

nd c

ash

equi

vale

nts

bala

nce

was

£40

,117

k, e

quiv

alen

t to

64

days

exp

endi

ture

. Th

e Tr

ust

reco

rded

the

follo

win

g YT

D p

ublic

sec

tor p

aym

ent s

tatis

tics

98%

for v

olum

e an

d 97

% fo

r val

ue.

Cap

ital:

Spe

nd to

Oct

ober

was

£1,

439k

, aga

inst

a Y

TD p

lan

of £

4,25

2k (

34%

ach

ieve

d). T

he fu

ll ye

ar fo

reca

st is

£7.

4m a

nd th

e Tr

ust

expe

cts

to u

tilis

e th

is in

full.

Staf

f: T

empo

rary

sta

ff co

sts

for O

ctob

er w

ere

£1,1

40k,

repr

esen

ting

8.06

% o

f the

pay

bill.

Of t

he te

mpo

rary

sta

ffing

usa

ge in

Oct

ober

, £4

50k

rela

ted

to e

xter

nal a

genc

y an

d th

ere

was

a c

redi

t of £

10k

for l

ocum

s du

e to

a c

orre

ctio

n of

cos

ts fr

om lo

cum

to b

ank

staf

fing,

3.1

%

of th

e pa

y bi

ll. V

acan

cies

dec

reas

ed to

316

in O

ctob

er w

hich

was

7.2

% o

f the

bud

gete

d es

tabl

ishm

ent.

4.2

Das

hboa

rd

Surp

lus

Rag

ratin

g: G

reen

Us

e of

Res

ourc

e Ra

ting

Rag

ratin

g: G

reen

CI

P

Rag

ratin

g: A

mbe

r

Actu

alPl

anVa

rianc

eYe

ar to

Ye

ar E

nd

Actu

alPl

anVa

rianc

eDa

te R

atin

gFo

reca

st R

atin

gYe

ar to

Dat

e £k

1,69

51,

366

329

Capi

tal S

ervi

ce C

apac

ity1

1Ye

ar to

Dat

e £k

2,76

13,

086

-325

Year

End

For

ecas

t £k

2,46

32,

350

113

Liqu

idity

11

Year

End

For

ecas

t £k

5,29

95,

299

0I&

E m

argi

n (%

)1

1Th

e Tr

ust a

chie

ved

a su

rplu

s of

£1,

695k

to th

e en

d of

Oct

ober

.Di

stan

ce fr

om F

inan

cial

Pla

n1

1Ag

ency

Spe

nd1

1Th

e Tr

ust a

chie

ved

CIP

s of

£2,

761k

to th

e en

d of

Oct

ober

aga

inst

a ri

sk ra

ted

plan

of £

3,08

6k, w

hich

is £

325k

Pay

and

dep

reci

atio

n/in

tere

st h

ave

unde

rspe

nt b

y £3

,714

k an

d £5

8k re

spec

tivel

yO

vera

ll Ra

ting

11

behi

nd ta

rget

.an

d no

n-pa

y ha

s ov

ersp

ent b

y £1

,783

k.In

com

e ha

s un

der-r

ecov

ered

by

£1,6

60k.

86.5

% o

f the

tota

l ann

ual C

IP ta

rget

has

bee

n re

mov

ed fr

om b

udge

ts a

t mon

th s

even

.

The

fore

cast

is to

del

iver a

sur

plus

of £

2,46

3k w

hich

is £

113k

ahe

ad o

f the

pla

nTh

e Tr

ust i

s fo

reca

stin

g to

ach

ieve

the

full

plan

of £

5,29

9k b

y th

e en

d of

the

year

.fo

r the

yea

r, du

e to

add

ition

al p

rovid

er s

uppo

rt fu

ndin

g re

ceive

d in

201

9/20

but

rela

ting

to 2

018/

19 o

f £11

3k.

Cash

and

Cas

h Eq

uiva

lent

sRa

g ra

ting:

Gre

en

Capi

tal E

xpen

ditu

reRa

g ra

ting:

Am

ber

Agen

cy T

raje

ctor

ies

Rag

ratin

g: G

reen

Actu

alFo

reca

st

Varia

nce

Actu

al/F

orec

ast

Plan

Varia

nce

YTD

Actu

alTr

ajec

tory

Varia

nce

Actu

alTr

ajec

tory

Varia

nce

Year

to D

ate

£k40

,117

37,9

342,

183

YTD

Expe

nditu

re £

k1,

439

4,25

22,

813

£k£k

£k£k

£k£k

Year

End

For

ecas

t £k

33,2

52Ye

ar E

nd F

orec

ast £

k7,

372

7,65

428

2Ex

tern

al A

genc

y Ex

pend

iture

(in

c. L

ocum

s) £

k44

162

818

73,

620

4,39

677

6

Locu

m E

xpen

ditu

re £

k-1

010

611

656

174

218

1C

ash

and

Cas

h E

quiva

lent

s as

at M

7 cl

ose

stan

ds a

t £40

,117

k,C

apita

l Exp

endi

ture

yea

r to

date

is £

1,43

9k, r

epre

sent

ing

34%

of t

he Y

TD in

itial

pla

n su

bmitt

ed.

equi

vale

nt to

64

days

ope

ratin

g ex

pend

iture

. Th

e Tr

ust r

ecor

ded

the

follo

win

g Y

TD p

ublic

sec

tor p

aym

ent s

tatis

tics

The

full

year

fore

cast

is £

7,37

2k a

nd th

e Tr

ust e

xpec

ts to

util

ise

this

in fu

ll.E

xter

nal a

genc

y ex

pend

iture

(inc

ludi

ng lo

cum

s) w

as £

441k

aga

inst

£62

8k tr

ajec

tory

in O

ctob

er.

98%

for v

olum

e an

d 97

% fo

r val

ue.

(YTD

£3,

620k

aga

inst

£4,

396k

traj

ecto

ry).

Lo

cum

exp

endi

ture

in O

ctob

er w

as £

-10k

aga

inst

£10

6k tr

ajec

tory

. (Y

TD £

561k

aga

inst

£74

2k tr

ajec

tory

).

The

Trus

t has

sco

red

the

max

imum

'' ra

ting

agai

nst t

he U

se o

f Res

ourc

e ra

ting

met

rics

for M

6 20

19-2

0.

M7

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 88 of 194

 

5.0

Ope

ratio

nal r

epor

t: 5.

1 A

ssur

ance

on

Nat

iona

l Per

form

ance

Sta

ndar

ds a

nd C

ontr

actu

al T

arge

ts

5.1.

1 H

ealth

Che

cks

and

SS Q

uits

Hea

lth C

heck

s

Hea

lth C

heck

s ha

s no

w s

tabi

lised

and

is e

xper

ienc

ing

norm

al v

aria

tion,

follo

win

g M

1 an

d M

2 pe

rform

ing

abov

e th

e up

per c

ontro

l lim

it.

The

spec

ial c

ause

resu

lting

in th

e in

crea

sed

perfo

rman

ce in

M1

& 2

was

rela

ted

to th

e pr

oble

ms

last

yea

r with

the

intro

duct

ion

of th

e ne

w

IT s

yste

m a

nd la

te in

vite

s, c

ausi

ng a

hig

her n

umbe

r of c

heck

s co

mpl

eted

dur

ing

this

per

iod.

Thi

s w

as re

solv

ed a

nd p

erfo

rman

ce is

now

st

able 

Page 89 of 194

 

Stop

Sm

okin

g Q

uits

Perfo

rman

ce to

mon

th 5

is c

urre

ntly

sho

win

g as

spe

cial

cau

se v

aria

tion

abov

e th

e up

per

cont

rol l

imit;

how

ever

inve

stig

atio

n ha

s fo

und

that

ther

e ha

s be

en n

o sp

ecifi

c re

ason

attr

ibut

ed to

this

stro

ng le

vel o

f per

form

ance

, whi

ch h

as c

ontin

ued

into

Mon

th 5

as

pred

icte

d.

Nat

iona

l sm

okin

g pr

eval

ence

con

tinue

s to

mov

e in

a d

ownw

ards

tren

d. W

ith th

e su

cces

sful

out

com

es o

f the

Hom

e Vi

sits

for

preg

nant

m

ums,

KC

C a

nd K

CH

FT h

ave

met

to d

iscu

ss n

ew a

ppro

ache

s to

eng

agin

g th

e co

unty

’s to

ughe

st a

nd h

arde

st to

reac

h sm

oker

s.

5.1.

2 H

ealth

Vis

iting

N

ew B

irth

Visi

ts

Mon

ths

1-4

wer

e ab

ove

both

targ

et a

nd th

e m

ean,

alth

ough

the

mon

th 5

and

6 p

ositi

ons

have

dip

ped.

The

dat

a cl

eans

e co

ntin

ues

to

occu

r m

onth

ly a

nd in

volv

es te

ams

rece

ivin

g a

patie

nt le

vel l

ist o

f chi

ldre

n w

ho h

ave

had

no v

isit,

DN

A or

ref

usal

rec

orde

d fo

r th

em to

en

sure

thei

r st

atus

is r

ecor

ded

corre

ctly

, whi

ch g

ener

ally

impr

oves

the

mos

t rec

ent m

onth

upo

n re

fresh

. The

targ

et o

f 90%

is g

ener

ally

be

ing

achi

eved

and

is c

lose

ly m

onito

red

thro

ugh

the

mon

thly

dis

trict

leve

l rep

orts

and

is s

how

ing

vary

ing

perfo

rman

ce a

cros

s th

e di

stric

ts.

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 90 of 194

 

6-8

Wee

k C

heck

s

Perfo

rman

ce is

sta

ble,

with

the

targ

et b

eing

con

sist

ently

ach

ieve

d, w

ith m

onth

s 2

and

4 ab

ove

the

mea

n. M

onth

ly p

roce

sses

con

tinue

to

be in

pla

ce fo

r loc

aliti

es to

dril

l dow

n in

to a

ny a

dver

se tr

ends

and

impr

ove

the

data

qua

lity

whe

re is

sues

are

iden

tifie

d.

Page 91 of 194

 

5.1.

3 N

atio

nal C

hild

Mea

sure

men

t Pro

gram

me

(NC

MP)

The

mea

sure

men

t pro

gram

me

for Y

ear R

and

6 p

upils

met

the

traje

ctor

y fo

r the

18/

19 s

choo

l yea

r, w

ith b

oth

prog

ram

mes

ach

ievi

ng th

e 90

% ta

rget

for t

he s

choo

l yea

r. Th

e 19

/20

prog

ram

me

has

now

sta

rted

and

is o

n tra

ck

5.1.

4 M

inor

Inju

ry U

nits

(MIU

) 4 H

our W

ait T

arge

t

KCH

FT’s

ach

ieve

men

t of t

he 4

hou

r wai

t tar

get f

or M

inor

Inju

ries

Uni

ts h

as c

onsi

sten

tly b

een

high

, with

ver

y lit

tle v

aria

tion

from

the

mea

n,

with

the

cont

rol r

ange

sug

gest

ing

that

failin

g ta

rget

is h

ighl

y un

likel

y to

hap

pen.

How

ever

, the

re h

ad b

een

a pe

riod

of v

aria

tion

show

ing

a

Yea

r RY

ear 6

19/20 Scho

ol 

Year to

 Sep

‐19

29.0%

28.8%

18/19 Scho

ol 

Year

95.3%

94.4%

Annu

al Target

90%

90%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Sep‐19

Oct‐19

Nov

‐19

Dec‐19

Jan‐20

Feb‐20

Mar‐20

19/20 Scho

ol Year

Year R

Year 6

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 92 of 194

 di

p be

low

the

mea

n w

ith a

few

ext

ra b

reac

hes

caus

ed b

y th

e in

crea

sed

dem

and

in th

e su

mm

er m

onth

s (a

s no

ted

by in

crea

sed

activ

ity),

whi

ch h

as n

ow im

prov

ed a

nd p

erfo

rman

ce is

sta

ble.

5.1.

5 G

UM

48h

r

Acc

ess

to G

UM

clin

ics

with

in 4

8hrs

has

bee

n co

nsis

tent

ly 1

00%

, with

no

repo

rted

brea

ches

5.1.

6 C

onsu

ltant

-Led

RTT

Inco

mpl

ete

Wai

ts O

ver 1

8 w

eeks

The

prop

ortio

n of

pat

ient

s on

a c

onsu

ltant

-led

Ref

erra

l to

Trea

tmen

t (R

TT) p

athw

ay a

t mon

th e

nd w

ho a

re w

aitin

g le

ss th

an 1

8 w

eeks

is

show

ing

nega

tive

spec

ial c

ause

var

iatio

n, b

eing

bel

ow b

oth

targ

et a

nd th

e lo

wer

con

trol l

imit

for

the

third

con

secu

tive

mon

th. T

his

has

been

cau

sed

by in

crea

sed

wai

ts in

Orth

opae

dics

whi

ch a

re a

larg

e po

rtion

of t

he T

rust

wid

e R

TT p

ositi

on.

Con

tinue

d pr

essu

re fr

om in

crea

sed

dem

and

affe

cted

wai

ting

lists

with

in th

e or

thop

aedi

c se

rvic

e pa

rticu

larly

in W

est K

ent.

Avai

labl

e sk

illed

wor

kfor

ce h

as a

lso

impa

cted

incl

udin

g th

e lo

ss o

f an

adva

nced

phy

siot

hera

py p

ract

ition

er (

APP)

to a

GP

prac

tice

in W

K w

hich

affe

cted

th

e ab

ility

of th

e se

rvic

e to

del

iver

ass

essm

ent a

ctiv

ity w

ithin

18

wee

k. T

he s

ervi

ce is

als

o re

porti

ng p

ress

ure

on a

ccep

tanc

e an

d tri

age

proc

esse

s in

resp

ect o

f hig

her t

han

envi

sage

d re

ferra

l vol

ume

in W

est K

ent w

here

gre

ater

num

bers

than

ant

icip

ated

hav

e be

en tr

iage

d to

th

e co

mm

unity

orth

opae

dic

serv

ices

by

dive

rting

act

ivity

fro

m M

TW.

As a

res

ult

a re

cove

ry p

lan

has

been

dev

elop

ed a

nd a

for

ecas

t tra

ject

ory

cons

truct

ed to

sup

port

over

sigh

t and

sen

ior m

anag

emen

t con

vers

atio

ns in

tern

ally

and

with

com

mis

sion

ers.

This

reco

very

pla

n in

clud

es a

rang

e of

sho

rt te

rm m

easu

res

(add

ition

al w

eeke

nd c

linic

s, s

ubco

ntra

ctin

g re

gist

rar s

essi

ons

and

wee

kday

ba

nk s

hifts

), as

wel

l mor

e lo

nger

ter

m p

lans

(R

evis

iting

and

rem

odel

ling

the

WK

MSK

pat

hway

with

com

mis

sion

ers

and

MTW

via

the

Page 93 of 194

 al

lianc

e st

eerin

g gr

oup,

dev

elop

men

t of a

n AP

P w

orkf

orce

via

a 1

2 m

onth

inte

rnal

acc

redi

ted

train

ing

sche

me

and

nego

tiatin

g w

ith th

e W

K al

lianc

e th

e ne

ed to

per

man

ently

incl

ude

regi

stra

r ses

sion

s in

to th

e M

SK s

ervi

ce m

odel

)

Base

d up

on c

urre

nt tr

ajec

torie

s, a

vaila

ble

data

and

ass

umpt

ions

it is

ant

icip

ated

that

orth

opae

dics

will

be R

TT c

ompl

iant

for c

ompl

ete

and

inco

mpl

ete

wai

ts b

y th

e en

d of

Nov

embe

r (pr

evio

us e

stim

ate

was

end

of O

ctob

er)

The

abov

e ta

ble

show

s th

e cu

rrent

bre

akdo

wn

of th

e w

aitin

g lis

t for

all

serv

ices

on

a co

nsul

tant

-led

path

way

. 86.

9% o

f wai

ts a

re n

ow

belo

w 1

8 w

eeks

, al

thou

gh o

nly

1 w

ait

abov

e 36

wee

ks.

The

aver

age

wai

t fo

r pa

tient

s w

aitin

g ov

er 1

8 w

eeks

is

22.5

wee

ks,

with

O

rthop

aedi

cs th

e on

ly s

ervi

ce n

ot m

eetin

g ta

rget

5.1.

7 6

Wee

k D

iagn

ostic

s (A

udio

logy

)

6 w

eek

diag

nost

ics

wai

ts f

or p

aedi

atric

aud

iolo

gy is

exp

erie

ncin

g a

perio

d of

pos

itive

spe

cial

cau

se v

aria

tion,

with

the

last

13

mon

ths

perfo

rmin

g ab

ove

the

mea

n. H

owev

er, p

erfo

rman

ce h

isto

rical

ly c

an s

omet

imes

bee

n m

argi

nally

bel

ow th

e ch

alle

ngin

g 99

% ta

rget

with

in 6

w

eeks

(1%

ove

r 6

wee

ks a

s pe

r N

HSI

Sin

gle

Ove

rsig

ht F

ram

ewor

k st

anda

rd).

How

ever

, ta

rget

has

bee

n ac

hiev

ed f

or 4

con

secu

tive

mon

ths.

0‐12

 Wks

12‐18 Wks

18‐36 Wks

36‐52 Wks

52+ Wks

< 18

 Weeks

622

4021

00

96.9%

3165

1029

864

10

82.9%

242

10

00

100.0%

687

206

150

098

.3%

4716

1276

900

10

86.9%

KCHF

T Total

Chronic P

ain

Ortho

paed

ics

Child

ren's A

udiology

Commun

ity Paediatrics

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 94 of 194

 Th

e Se

rvic

e ha

s m

oved

to b

usin

ess

as u

sual

and

goi

ng fo

rwar

d if

the

refe

rral r

ates

rem

ain

with

in th

e no

rmal

par

amet

ers

of b

etw

een

300

and

400

per m

onth

, the

ser

vice

will

cont

inue

to b

e fu

lly c

ompl

iant

with

the

99%

targ

et w

ithin

six

wee

ks. W

eekl

y te

leco

nfer

ence

s co

ntin

ue

to e

nsur

e th

at w

e m

axim

ise

clin

ical

cap

acity

to m

eet d

eman

d.

5.1.

8 D

enta

l Pris

ons

Wai

ting

Tim

es

Page 95 of 194

 Th

e ab

ove

char

ts s

how

that

pris

on w

aits

are

cur

rent

ly e

xper

ienc

ing

adve

rse

spec

ial c

ause

var

iatio

n at

Sta

ndfo

rd H

ill an

d Sw

ales

ide,

plu

s in

all

thre

e ca

ses

curre

nt p

erfo

rman

ce i

s ab

ove

the

mea

n an

d th

e ta

rget

is

eith

er b

elow

or

near

the

low

er c

ontro

l lim

it, s

ugge

stin

g co

nsis

tent

ach

ieve

men

t of t

he 6

wee

k ta

rget

is u

nlik

ely

to o

ccur

in th

e cu

rrent

env

ironm

ent.

The

Den

tal p

rison

ser

vice

had

bee

n pr

ovid

ing

addi

tiona

l ses

sion

s w

ithin

pris

ons

at o

ur o

wn

cost

to m

anag

e w

aitin

g tim

es w

hich

had

bee

n m

aski

ng th

e tru

e co

ntra

ctua

l lev

el o

f per

form

ance

. A

busi

ness

cas

e is

with

NH

S En

glan

d to

fund

the

addi

tiona

l ses

sion

s re

quire

d to

brin

g th

e w

aitin

g tim

es to

an

aver

age

of 6

wee

ks.

Thi

s ha

s be

en p

ositi

vely

rece

ived

but

as

yet n

ot a

gree

d.

In th

e m

eant

ime

all p

rison

hea

lth s

ervi

ces

in K

ent a

re b

eing

mar

ket t

este

d in

clud

ing

the

dent

al

elem

ent.

The

mod

el is

a le

ad p

rovi

der

with

sub

-con

tract

ors

whi

ch w

ould

incl

ude

dent

istry

. Th

e co

mm

issi

oner

wis

hes

to d

iscu

ss w

ith u

s th

e co

nseq

uenc

e of

this

and

may

pul

l de

ntal

ser

vice

s fro

m th

e le

ad p

rovi

der

mod

el a

nd c

ontra

ct d

irect

ly.

The

dela

y th

is h

as c

ause

d is

cre

atin

g m

ore

unce

rtain

ty a

nd r

isk

of

long

term

bre

achi

ng o

f wai

ting

times

. If

as a

con

sequ

ence

of d

iscu

ssio

n w

ith th

e co

mm

issi

oner

the

addi

tiona

l fun

ding

is n

ot a

gree

d ei

ther

as

the

curre

nt b

usin

ess

case

or i

n a

lead

pro

vide

r mod

el w

e ne

ed to

con

side

r with

draw

ing

from

pris

on c

ontra

cts

alto

geth

er.

5.1.

9 D

elay

ed T

rans

fers

of C

are

(DTO

Cs)

KCH

FT’s

targ

et fo

r de

laye

d tra

nsfe

rs is

to a

chie

ve a

n av

erag

e of

7 p

er d

ay in

bot

h ea

st K

ent a

nd w

est K

ent,

whi

ch e

quat

es to

aro

und

9.5%

as

a ra

te o

f occ

upie

d be

d da

ys. P

erfo

rman

ce h

ad im

prov

ed in

mon

th 6

but

rem

ains

nea

r the

upp

er c

ontro

l lim

it w

ith a

per

iod

of 7

m

onth

s ab

ove

the

mea

n, c

ause

d by

an

incr

ease

d le

vel o

f del

ayed

tran

sfer

s in

eas

t Ken

t. Th

ere

has

been

an

incr

ease

in d

elay

s du

e to

av

aila

bilit

y of

soc

ial c

are

pack

ages

and

als

o de

lays

due

to p

atie

nt c

hoic

e. T

he p

atie

nt c

hoic

e po

licy

is b

eing

revi

ewed

follo

win

g ev

alua

tion

of th

e Li

ncol

nshi

re m

odel

and

if th

is is

impl

emen

ted

this

sho

uld

redu

ce th

ese

type

s of

del

ay.

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 96 of 194

 

5.1.

10 L

ooke

d A

fter C

hild

ren

Initi

al H

ealth

Ass

essm

ents

(IH

As)

and

Rev

iew

Hea

lth A

sses

smen

ts (R

HA

s)

Initi

al H

ealth

Ass

essm

ent (

IHA)

per

form

ance

is s

how

ing

norm

al v

aria

tion

and

is a

chie

ving

targ

et m

ost m

onth

s. P

erfo

rman

ce c

an s

till b

e va

riabl

e an

d lia

ble

to fa

iling

targ

et s

ome

mon

ths,

due

to la

te re

ques

ts b

eing

rece

ived

from

KC

C a

nd w

hich

KC

HFT

is s

trugg

ling

to

influ

ence

. We

have

an

addi

tiona

l KPI

to e

nsur

e th

at w

e co

mpl

ete

the

IHA

with

in 2

3 da

ys o

f rec

eipt

of t

he re

ferra

l whi

ch a

chie

ves

targ

et

mos

t mon

ths.

Com

plia

nce

with

the

Rev

iew

Hea

lth A

sses

smen

t tar

get i

s ex

perie

ncin

g a

perio

d of

pos

itive

var

iatio

n ab

ove

the

mea

n w

ith th

e la

st 8

m

onth

s pe

rform

ing

abov

e th

e m

ean.

5.1.

11 N

HS

Num

ber C

ompl

eten

ess

NH

S N

umbe

r com

plet

enes

s ac

ross

KC

HFT

’s m

ain

syst

ems

are

cons

iste

ntly

c.1

00%

, with

the

mai

n ex

cept

ion

bein

g ne

w b

irths

yet

to h

ave

a N

HS

num

ber a

ssig

ned

(alth

ough

late

r upd

ated

) and

Ove

rsea

s M

IU a

ttend

ance

s.

5.1.

12 B

ed O

ccup

ancy

Bed

Occ

upan

cy is

sho

win

g a

vary

ing

trend

with

no

perio

ds o

f spe

cial

cau

se v

aria

tion,

alth

ough

the

M4

perfo

rman

ce h

ad d

ippe

d to

nea

r th

e lo

wer

con

trol l

imit.

Page 97 of 194

 

5.1.

13 C

QU

IN

The

2019

-20

Q1

CQ

UIN

ach

ieve

men

t (%

of p

oten

tial i

ncom

e) is

at 9

2.7%

, alth

ough

the

natio

nal C

QU

INs

are

mor

e hi

ghly

wei

ghte

d to

the

end

of th

e ye

ar

5.2

Ass

uran

ce o

n ac

tivity

and

pro

duct

ivity

5.2.

1 A

ctiv

ity

Dur

ing

Sept

embe

r 201

9 KC

HFT

car

ried

out 1

74,8

42 c

linic

al c

onta

cts,

of w

hich

11,

568

wer

e M

IU a

ttend

ance

s. F

or th

e ye

ar to

Sep

tem

ber

2019

KC

HFT

are

0.4

% a

bove

pla

n fo

r al

l ser

vice

s (s

ome

serv

ices

hav

e co

ntra

ctua

l tar

gets

, som

e ar

e ag

ains

t an

inte

rnal

pla

n), a

slig

ht

decl

ine

on th

e M

6 po

sitio

n. T

he la

rges

t neg

ativ

e va

rianc

es a

re w

ithin

Pub

lic H

ealth

Ser

vice

s (-6

%) a

nd W

est K

ent A

dults

(-3.

5%).

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 98 of 194

 

The

follo

win

g ch

arts

sho

w t

he m

onth

ly a

ctiv

ity a

gain

st t

arge

t fo

r Ea

st a

nd W

est

Kent

Adu

lts,

Spec

ialis

t an

d El

ectiv

e Se

rvic

es a

nd

Chi

ldre

n's

Spec

ialis

t & A

dult

LD S

ervi

ces,

with

Eas

t Ken

t sho

win

g a

perio

d of

spe

cial

cau

se v

aria

tion

with

a s

hift

abov

e th

e m

ean,

and

W

est K

ent s

how

ing

a ne

gativ

e sh

ift (a

lbei

t im

prov

ing)

.

53,283

332,046

321,951

3.1%

Negative

4,051

24,393

23,106

5.6%

Negative

Internal

Contract

120

696

469

48.6%

Positiv

e>+5%

>+10%

24,841

147,121

152,446

‐3.5%

Negative

>‐5%

>‐10%

7,517

45,164

42,998

5.0%

Negative

+/‐ 2.5‐5%

n/a

2,640

16,438

13,333

23.3%

Negative

<+/‐ 2.5%

<+/‐ 10%

27,636

166,955

171,779

‐2.8%

Positiv

eNo Target

19,804

114,016

109,936

3.7%

Positiv

e

27,828

179,325

190,772

‐6.0%

Positiv

e

7,122

63,754

58,731

8.6%

Negative

174,842

1,089,908

1,085,519

0.4%

Static

*the

se figures a

re not includ

ed in

 the 

table totals as the

y do

n’t h

ave a 

contractual target

Trust Total Activity

 against plan

West K

ent A

dults

 ‐ MIU

West K

ent A

dults

 ‐ Be

d Da

ys

Specialist and

 Elective Services

Child

ren's S

pecialist &

 Adu

lt LD

 Services

Public Health

 Services

Dental Service

West K

ent A

dults

 ‐ Co

ntacts

Service Type

M6 Actual

YTD Actual

YTD Plan

YTD Va

riance

Movem

ent

Internal BRA

GCo

ntract BRG

East Ken

t Adu

lts ‐ Co

ntacts

East Ken

t Adu

lts ‐ MIU

East Ken

t Adu

lts ‐ Ad

mission

s

Page 99 of 194

 

5.2.

2 D

NA

rate

s

DN

A ra

tes

cont

inue

to fa

ll be

low

the

targ

et o

f 5%

, alth

ough

are

sig

nific

antly

hig

her w

ithin

som

e se

rvic

es, p

artic

ular

ly c

hild

ren’

s th

erap

ies.

Th

is K

PI is

now

exp

erie

ncin

g no

rmal

var

iatio

n. T

he ta

rget

is c

lose

to th

e up

per c

ontro

l lim

it in

dica

ting

that

it is

unl

ikel

y th

at le

vels

wou

ld

incr

ease

abo

ve ta

rget

.

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 100 of 194

 

5.2.

3 A

dmis

sion

s A

void

ed

Ther

e ha

ve b

een

a hi

gher

lev

el o

f ad

mis

sion

s av

oide

d in

the

las

t 9

mon

ths,

with

the

abo

ve c

hart

indi

cate

s th

at p

erfo

rman

ce i

s ex

perie

ncin

g sp

ecia

l cau

se v

aria

tion.

Thi

s sp

ecia

l cau

se is

bel

ieve

d to

be

rela

ted

to th

e w

ork

with

in lo

cal c

are

that

has

led

to in

crea

sed

refe

rrals

for a

dmis

sion

avo

idan

ce, a

s w

ell a

s in

crea

sed

nurs

ing

activ

ity g

ener

ally

. Per

form

ance

aga

inst

targ

et is

favo

urab

le, a

lthou

gh w

ith

perfo

rman

ce b

eing

var

iabl

e, a

chie

ving

the

targ

et m

onth

ly is

not

alw

ays

guar

ante

ed.

5.2.

4 R

apid

Res

pons

e re

ferr

als

seen

with

in 2

hou

rs

The

mea

n le

vel o

f per

form

ance

is s

ittin

g m

argi

nally

abo

ve th

e ta

rget

leve

l of 9

5%, w

ith p

erfo

rman

ce s

tabl

e ot

her t

han

a sl

ight

dip

in M

3.

Giv

en th

e vo

latil

ity a

nd th

e hi

gh 9

5% ta

rget

, it’s

unl

ikel

y th

e co

ntro

l lim

its w

ill fu

lly m

ove

abov

e th

e ta

rget

leve

l in

the

near

futu

re to

giv

e fu

ll as

sura

nce

of c

ontin

ual a

chie

vem

ent.

Page 101 of 194

 

5.2.

5 Fr

iend

s an

d Fa

mily

Tes

t (Pa

tient

s su

rvey

ed fo

r MIU

s &

Com

mun

ity H

ospi

tals

) - R

espo

nse

Rat

e

Whi

le th

e le

vel o

f per

form

ance

is s

how

ing

norm

al v

aria

tion,

ther

e ha

s be

en a

shi

ft be

low

the

mea

n an

d th

e ta

rget

is n

ow m

argi

nally

abo

ve

the

uppe

r con

trol l

imit.

Pat

ient

s ar

e as

ked

to c

ompl

ete

the

surv

eys

befo

re th

ey le

ave

but o

nce

they

hav

e be

en s

een

the

upta

ke is

diff

icul

t to

ach

ieve

. Occ

asio

nally

pat

ient

s co

mpl

ete

the

surv

eys

whi

lst t

hey

are

in th

e w

aitin

g ro

om b

ut th

is is

not

a re

flect

ion

of th

eir v

isit

just

the

book

ing

in p

roce

ss. E

mai

ling

the

link

to th

e su

rvey

has

bee

n tri

alle

d bu

t thi

s ha

s no

t wor

ked.

The

decl

ine

has

mai

nly

due

to d

ecre

ased

sur

veys

bei

ng c

ompl

eted

at S

ittin

gbou

rne,

She

ppey

, Sev

enoa

ks a

nd E

denb

ridge

. Whi

le c

urre

nt

perfo

rman

ce is

bel

ow th

e m

ean,

ther

e ap

pear

s to

be

the

star

t of a

n im

prov

emen

t alth

ough

this

will

need

to b

e m

onito

red

to s

ee if

this

is a

co

ntin

uing

tren

d or

a c

hanc

e ev

ent.

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 102 of 194

 

5.3

Ass

uran

ce o

n Lo

cal W

ait T

imes

Com

plet

ed w

ait t

imes

for a

ll no

n-co

nsul

tant

-led

AHP

serv

ices

are

now

sho

win

g no

rmal

var

iatio

n an

d si

gns

of a

n im

prov

ing

trend

as

som

e of

the

back

log

has

now

bee

n cl

eare

d an

d pe

rform

ance

is s

how

ing

impr

ovem

ent.

Page 103 of 194

 

5.4

Out

com

es

Aggr

egat

e ou

tcom

es a

re c

urre

ntly

rep

orte

d fo

r Ad

ult

Spec

ialis

t an

d C

hild

ren’

s Th

erap

y se

rvic

es,

with

pat

ient

s re

ceiv

ing

a fa

vour

able

ou

tcom

e in

the

vast

maj

ority

of c

ases

on

a co

nsis

tent

bas

is, w

ith th

e be

low

sho

win

g no

rmal

var

iatio

n in

rece

nt m

onth

s. T

he b

elow

cha

rt al

so s

how

s th

at a

chie

vem

ent o

f tar

get i

s al

way

s lik

ely

to o

ccur

unl

ess

a pr

oces

s ch

ange

occ

urs,

as

the

cont

rol l

imits

indi

cate

the

rang

e of

pe

rform

ance

var

ying

mon

th to

mon

th s

houl

d no

t fal

l low

eno

ugh

to b

reac

h ta

rget

.

The

follo

win

g ta

ble

and

char

t sho

ws

the

prop

ortio

n of

the

grad

ing

of e

ach

outc

ome

for

the

year

to d

ate,

spl

it by

ser

vice

type

for

furth

er

deta

il on

out

com

es.

Each

out

com

e w

ill be

spe

cific

to

the

patie

nt a

nd w

ill be

per

sona

lised

, th

eref

ore

not

allo

win

g fu

rther

det

ail t

o be

su

mm

aris

ed.

Specialist and

 Electiv

e Services

Child

ren's 

Specialist Services

Worsene

d1.1%

0.0%

Not Achieved

8.6%

3.2%

Partially

 Achieved

30.3%

10.2%

Mostly

 Achieved

14.1%

9.2%

Fully

 Achieved

45.9%

77.5%

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 104 of 194

App

endi

x - S

core

card

SPC

Cha

rts

1. P

reve

nt Il

l Hea

lth

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

140.0%

Stop

 Smok

ing Quits

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

40.0%

60.0%

80.0%

100.0%

120.0%

140.0%

160.0%

180.0%

Health

 Che

cks

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

6‐8 Week Ch

ecks

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

3750

4250

4750

5250

5750

6250

6750

7250

7750

Admission

s Av

oide

d

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

% LT

C/ITC Patie

nts w

ith an avoide

d ad

mission

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

New

 Birth Visits

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Data Outside

 Lim

itsCo

mmon

 Variance

Page 105 of 194

2. D

eliv

er h

igh-

qual

ity c

are

at h

ome

and

in th

e co

mm

unity

‐0.30

‐0.20

‐0.10

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

Mod

erate an

d Severe fa

lls per 1,000

 bed

 days

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

‐2.0

‐1.00.0

1.0

2.0

3.0

4.0

5.0

Pressure Ulcers (Lap

ses in Ca

re)

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%

101.0%

102.0%

Contractua

l activity

 against ta

rget

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

DNA Ra

te

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%

LTC/ICT Re

spon

se Tim

es Being

 Met

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

102.0%

% 2Hr R

apid Respo

nses m

et

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%

101.0%

MIU 4Hr Target

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Consultant‐Led

 RTT

 Incomplete Waits

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

0

200

400

600

800

1000

1200

Consultant‐Led

 RTT

 Incomplete Waits (w

aitin

g list size >18 

weeks)

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

Inte

grat

ed P

erfo

rman

ceR

epor

t

Page 106 of 194

2. D

eliv

er h

igh-

qual

ity c

are

at h

ome

and

in th

e co

mm

unity

99.0%

99.2%

99.4%

99.6%

99.8%

100.0%

100.2%

GUM Access with

in 48H

rs

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

0.00

5.00

10.00

15.00

20.00

25.00

30.00

Med

ian length of stay (days)

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Positiv

e ou

tcom

es achieved for p

lann

ed care an

d therap

y services

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

93.00%

94.00%

95.00%

96.00%

97.00%

98.00%

99.00%

Percen

tage of p

atients who

 wou

ld re

commen

d ou

r services

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Friend

s an

d Family Respo

nse Ra

te (M

IU and

 Inpa

tients)

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Clinical Aud

it Im

plem

entatio

ns by de

adlin

e

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

98.0%

98.5%

99.0%

99.5%

100.0%

100.5%

NICE guidan

ce re

view

ed with

in timescales

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

87.0%

89.0%

91.0%

93.0%

95.0%

97.0%

99.0%

AHP Non

 Con

sulta

nt‐le

d 18

 Week complete waits with

in 18 

weeks

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

105.0%

110.0%

6 week Diagnostic

s

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

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3. In

tegr

ate

Serv

ices

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

Delayed

 Transfers of C

are

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Percen

tage of ICT/LTC

 Referrals  from with

in KCH

FT

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

‐0.50

0.00

0.50

1.00

1.50

2.00

Excess Bed

 Days ‐

West K

ent

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

050100

150

200

250

300

350

400

Average wait tim

e (m

inutes) for Acciden

t and

 Emergency 

Services (W

est K

ent)

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

050100

150

200

250

300

350

400

450

Average wait tim

e (m

inutes) for Acciden

t and

 Emergency 

Services (E

ast K

ent)

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

‐0.20

‐0.10

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

Excess Bed

 Days ‐

East Ken

t

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

Inte

grat

ed P

erfo

rman

ceR

epor

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4. D

evel

op s

usta

inab

le s

ervi

ces

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Bed Occup

ancy

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

0.00

%

0.50

%

1.00

%

1.50

%

2.00

%

2.50

%

Income an

d Expe

nditu

re Surplus vs p

lan

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

CIP Ac

hieved

 Against Plan

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

0

1000

00

2000

00

3000

00

4000

00

5000

00

6000

00

7000

00

8000

00

External Agency Spen

d

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

‐5.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Percen

tage based

 on value of Service Lines with

 deficits

 greater tha

n 5%

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

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5. B

e Th

e B

est E

mpl

oyer

3.0%

3.5%

4.0%

4.5%

5.0%

5.5%

6.0%

Sickne

ss Absen

ce

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

0.6%

0.8%

1.0%

1.2%

1.4%

1.6%

1.8%

Absence (Stress)

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

10.0%

11.0%

12.0%

13.0%

14.0%

15.0%

16.0%

17.0%

18.0%

19.0%

20.0%

Turnover (P

lann

ed and

 Unp

lann

ed)

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

82.0%

87.0%

92.0%

97.0%

102.0%

107.0%

Man

datory Training Ra

te

values

Target

Mean

UCL

LCL

Positive Va

riance

Negative Va

riance

Breach

Common

 Variance

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%

13.0%

Vacancy Ra

te

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

80.0%

81.0%

82.0%

83.0%

84.0%

85.0%

86.0%

87.0%

Stab

ility

values

Target

Mean

UCL

LCL

Positive Va

riatio

nNegative Va

riatio

nBreach

Common

 Variatio

n

Inte

grat

ed P

erfo

rman

ceR

epor

t

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Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 2.8

Agenda Item Title: Remuneration and Terms of Service Committee’s Terms of Reference

Presenting Officer: John Goulston, Trust Chair

Action - this paper is for: Decision ☒ Information ☐ Assurance ☐

Report Summary

The Terms of Reference has been reviewed and approved.

Proposals and /or Recommendations

The Board is asked to ratify the Terms of Reference.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒

High level position described.

Louise Norris, Director of Workforce, Organisational Development and Communications

Tel: 01622 211906

Email: louisenorris@nhs.net

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KENT COMMUNITY HEALTH NHS FOUNDATION TRUST

REMUNERATION COMMITTEE

TERMS OF REFERENCE

1. ROLE

1.1 The Remuneration Committee is constituted as a standing committee of the Trust

Board and has no executive powers, other than those specifically delegated in these

terms of reference. Its constitution and terms of reference are set out below and can

only be amended with the approval of the Trust Board.

2. PURPOSE

2.1 The Remuneration Committee shall have delegated authority from the Trust Board to

set the remuneration, allowance and other terms and conditions of office for the

Trust’s Executive Directors and Senior managers not employed on national terms

and conditions and to recommend and monitor the structure of remuneration.

2.2 In setting the remuneration and conditions of service for the Chief Executive, other

Directors and Senior managers, the committee shall take into account all factors

which it deems necessary including relevant legal and regulatory requirements, the

provisions and recommendations the Foundation Trust Licence and associated

guidance from Monitor.

2.3 When required the committee will oversee the appointment of Executive Directors in

accordance with Standing Orders.

3. DUTIES

3.1 To agree and keep under review the overall remuneration policy of the Trust.

3.2 To set the individual remuneration, allowances and other terms and conditions of

office (including termination arrangements) for the Trust’s Executive Directors and

other Senior Managers reporting to the Chief Executive.

3.3 To recommend and monitor the structure of remuneration, including setting pay

ranges.

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3.4 To monitor and evaluate the performance of the Trust’s Chief Executive against

objectives and previous year and note forward objectives. Act as ‘grandparent’ to

Executive Directors performance. Performance of other senior managers will be

monitored and evaluated by their line managers.

3.5 To ratify where appropriate actions taken between meetings by the Chair of the

Committee using delegated authority.

3.6 In determining remuneration policy and packages, to have due regard to the policies

and recommendations of NHS improvement and the wider NHS, and to adhere to all

relevant laws and regulations.

3.7 To keep abreast of executive level remuneration policy and practice and market

developments elsewhere in the NHS and in other relevant organisations, drawing on

external advice as required.

3.8 To scrutinise and where appropriate authorise those Compromise Agreements,

Settlements and Redundancy Payments which require the final approval by HM

Treasury as well as any proposed termination payment to the Chief Executive or an

Executive Director.

3.9 To receive regular reports on other Compromise Agreements, Settlements and

Redundancies approved in accordance with Trust policies.

3.10 To receive an annual report on the outcome of the employer-based (local) Clinical

Excellence Awards round.

3.11 In relation to other employees of the Trust, the Committee is responsible for:

• Approving any non-contractual payments that have to be reported to the HM

Treasury (via Monitor);

• Approving any business cases for redundancy for any staff reporting directly to

the Chief Executive or any other Executive Director, or where the value exceeds

£100k, or where the business case requires reporting to HM Treasury;

• The structure, payment criteria and targets for any bonus or incentive scheme

proposed by the executive;

• Approving the terms and conditions for any staff outside of nationally agreed pay

frameworks;

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• Considering and approving any payments in settlement of an employment

tribunal claim

3.12 To undertake any other duties as directed by the Trust Board.

4. ROLE OF THE COUNCIL OF GOVERNORS

4.1 The Council of Governors is required to approve the appointment and proposed

remuneration of the Chief Executive.

5. ACCOUNTABILITY

5.1 The Remuneration Committee is accountable to the Kent Community Health

Foundation Trust Board.

5.2 Accountable for: The Remuneration and Terms of Service Committee has no sub committees.

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Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 2.9

Agenda Item Title: Emergency Planning and Business Continuity Annual Assurance Statement

Presenting Officer: Natalie Davies, Corporate Services Director

Action - this paper is for: Decision ☒ Information ☐ Assurance ☐

Report Summary

A set of core standards for Emergency Preparedness, Resilience and Response (EPRR) has been in place since April 2013. All organisations who receive NHS funding are asked to carry out an assessment against the NHS Standards for EPRR. In September 2019 Kent Community Health NHS Foundation Trust (KCHFT) performed a self-assessment. The Trust has achieved full compliance.

Proposals and /or Recommendations

To approve the statement.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒

High level position described.

Natalie Davies, Corporate Services Director Tel: 01622 211900

Email: Natalie.davies1@nhs.net

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EMERGENCY PREPAREDNESS, RESILIENCE AND RESPONSE

ANNUAL ASSURANCE REPORT

2018/19

Assurance Process A set of core standards for Emergency Preparedness, Resilience and Response (EPRR) has been in place since April 2013. All organisations who receive NHS funding are asked to carry out a self- assessment against the NHS Standards for EPRR.

In September 2019 Kent Community Health NHS Foundation Trust (KCHFT) performed a self-assessment and achieved Full level of compliance against the EPRR Core Standards. Assurance Process 2019 The NHS North and East London Commissioning Support Unit assessed the evidence provided by the Head of Emergency Preparedness, Resilience and Response in September 2019 The assurance audit was conducted to demonstrate to the commissioners the preparedness of KCHFT against the NHS England EPRR Core Standards. The audit provided evidence against each of the core standards identified by NHS England as being required to be in place by a community provider. The investigated areas were:

• EPRR Core Standards

• Deep Dive – Adverse weather

Audit Results Based on the NHS England’s levels of assurance the self-assessment demonstrated the Trust meets the requirements for full compliance. This report is presented to the Board to be agreed and approved. Jan Allen Head of Emergency Preparedness, Resilience and Response 9 September 2019

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Committee / Meeting Title:

Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Item: 2.10

Subject: Public Health Partnership Renewal

Presenting Officer: Gordon Flack, Director of Finance

Action - this paper is for:

Decision ☒ Assurance ☐

Report Summary (including purpose and context):

This report is that which was presented to the Kent County Council (KCC) Health Reform and Public Health Cabinet Committee by KCC officers to scrutinise and endorse the recommendation to renew the partnership arrangement to March 2025. In September 2017, KCC took the decision to create an innovative partnership with Kent Community Health NHS Foundation Trust (KCHFT) to maximise the opportunity to improve the health of Kent residents, deliver common objectives and accelerate delivery of the Sustainability and Transformation Plan (STP), which is now known as the Sustainability and Transformation Partnership. A comprehensive review has been undertaken which has provided substantial evidence that the partnership approach has enabled rapid service transformation, delivery of agreed projects and supported the prevention strand of the STP. Services delivered by the Trust have demonstrated measurable improvements in health, delivered statutory requirements, provided and maintained excellent user satisfaction and given value for money. The KCC Internal Audit’s review of this partnership has given a rating of ‘Substantial’ and the Care Quality Commission (CQC) has reported significant strength in the organisational delivery, resulting in the Trust being awarded a rating of “Outstanding”. The health governance system continues to evolve in line with NHS Long Term Plan and transformation is needed at pace to deliver required changes. In line with this, KCC recommended that the partnership arrangement was extended for at least five years (until March 2025) and improvements are both sustained and built upon. KCC officers would continue to closely monitor performance, finances and quality of services thus continuing to hold the Trust to account for delivery. A detailed options appraisal was developed to inform the proposal as attached. The arrangement is aligned to the vision set out in the Kent County Council paper (Kent and Medway Integrated Care System update, May 2019) and provides the ability to function as an integrated public health system which supports local care. Health Partners have both been supportive of this approach.

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The Public Contract Regulations enable this type of co-operation between contracting authorities such as KCC and KCHFT. Following scrutiny by the KCC Health Reform and Public Health Cabinet Committee the Cabinet member approved the proposal to renew the partnership until at least March 2025. A Voluntary Ex Ante Transparency (VEAT) notice was issued by KCC and expires on the 6th December. In completing the VEAT notice contracting authorities must give sufficient information as to the justification for direct award of a contract without OJEU advertising and observe a minimum 14 day standstill period before the contract is awarded. This allows economic operators the opportunity to challenge the decision of the contracting authority and obtain pre-contractual remedies should a challenge be upheld. The advantage to the contracting authority is that the penalty of mandatory ineffectiveness does not apply in the event of a challenge to a contract awarded after the standstill period has elapsed.

Proposals and /or Recommendations:

To endorse the partnership renewal.

Relevant Legislation and Source Documents:

Monitor Consultations. Other specific references noted in report.

Has an Equality Analysis been completed?

No. This is a renewal of an existing arrangement and in the detailed review by KCC indicated

that services under this arrangement demonstrate a positive impact on health inequalities and

good reach to those most in need.

Gordon Flack, Director of Finance Tel: 01622 211934

Email: gordon.flack@nhs.net

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PUBLIC HEALTH PARTNERSHIP RENEWAL

1. KCC paper to the Health Reform and Public Health Cabinet Committee Introduction

1.1 Kent County Council (KCC) has a legal duty to improve and protect the health of people in Kent. They receive a ring-fenced grant which is to be used to commission a range of Public Health services delivered in line with NHS principles.

1.2 A number of these services funded by the grant have been delivered by Kent Community Health NHS Foundation Trust (KCHFT) for many years, a number have been competitively tendered. KCHFT is a key delivery partner within the Kent and Medway STP and delivers a range of other community-based services across Kent on behalf of KCC and the NHS. The Care Quality Commission (CQC) has recently awarded the Trust with a rating of Outstanding. KCHFT is the only south east community trust and one of only three Trusts in England to have this rating1.

1.3 Kent County Council took the decision to enter into an innovative partnership with Kent Community Health Foundation Trust (KCHFT) in September 2017, with the aim to maximise the opportunity to improve the health of Kent residents, deliver common objectives and accelerate delivery of the Sustainability Transformation Plan (STP), now known as the Sustainability Transformation Partnership. This arrangement was also designed to offer the flexibility to align to new, local care arrangements.

1.4 This decision recognised that KCHFT was integral to the delivery of the STP and recognised that both KCC and KCHFT faced significant challenges which could be better managed through a joint open and transparent approach.

1.5 The original decision put procurement in “abeyance” until at least March 2020 and a further decision is required on how best to deliver these services in the future. This paper presents the committee with a summary of the findings from a comprehensive review conducted to inform future recommendations and decisions.

2.0 National Context

2.1 Since the partnership commenced in October 2017, there have been a number of significant national developments including the launch of the NHS Long Term Plan2 (LTP) and Green Paper on prevention, Prevention is Better than Cure3.

1 https://www.kentcht.nhs.uk/2019/07/24/care-quality-commission-says-we-are-outstanding/ 2 https://www.longtermplan.nhs.uk/ 3 https://www.gov.uk/government/publications/prevention-is-better-than-cure-our-vision-to-help-you-live-well-for-longer

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2.2 These policy documents build on aspirations set out in the Five Year Forward

view which aimed to respond to pressures in the Health and Social Care system driven by changing demographics, reducing budgets and a system of commissioning that resulted in too many people ending up in hospital rather than being seen in primary care or the community.

2.3 They emphasise the importance of prevention and the need for system wide collaboration to enable a sustainable Health and Social Care system. The industrialisation of digital services and new technologies is clearly articulated. To date, good progress has been made in Kent services including online Sexually Transmitted Infection (STI) testing, improved websites and targeted social media campaigns.

2.4 The NHS LTP sets out ambitious targets for the NHS including preventing over 150,000 heart attacks, strokes and dementia cases over the next 10 years. These aspirations will result in a need to increase uptake of programmes such as NHS Health Checks in the future.

2.5 A review of Public Health commissioning arrangements took place following the publication of the Long Term Plan and concluded that Local Authorities should continue to commission services such as sexual health and Health Visiting. Mr Hancock, Secretary of State for Health and Social Care praised collaborative models that make the best use of shared resources between Local Authorities and the NHS. This type of model is being adapted for delivery of sexual health services in Kent.

3.0 Local Context

3.1 The Kent and Medway Sustainability and Transformation structures are more advanced than in 2017 and local leaders are working to deliver the local plan, Case for Change4. This includes a series of commitments which have been supported by KCHFT such as the implementation of a Kent wide smoking in pregnancy service as part of the prevention strategy.

3.2 Kent and Medway STP is developing a five-year plan in response to the NHS LTP and is required to become an Integrated Care System (ICS) in the coming months. This change will see a move away from the seven Clinical Commissioning Groups to the proposed four Integrated Care Partnerships (ICPs), 42 Primary Care Networks (PCNs) and one CCG across Kent and Medway. Services and health providers will need to align to these changes and work with commissioners to determine how they can best integrate and support acceleration of local care.

4 https://kentandmedway.nhs.uk/stp/caseforchange/

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3.3 The County Council paper5 endorsed by Cabinet Members in May 2019, describes KCC’s relationship with the emerging Integrated Care System. The paper asked County Council to agree that: “a) KCC describes its relationship with the emerging Integrated Care System (ICS) as being partners to the ICS supporting the vision and direction of travel and not partners in the ICS. b) KCC is not bound to any system wide decisions made through STP/ICS Governance but continues to influence, support and align to the vision for the ICS where it makes sense for the County Council to do so.”

3.4 The partnership approach taken with KCHFT aligned to this vision set out in the Council paper and supports the ability to function as an integrated Public Health system which supports local care.

3.5 Kent continues to face a series of significant demographic pressures alongside budget constraints. Kent’s population is forecast to increase by a further 19.2% between 2017 and 20376 and data illustrates that despite best efforts, deprivation differences in life expectancy and premature mortality have remained broadly similar over the last five years (health inequalities).

3.6 The Public Health grant (65.8M) which funds the majority of the spend on Public Health, has been subject to annual reductions totalling £11.0M (or 14.3% of the total grant in 2015/16) since 2015/16. In addition to the nationally applied cuts, the grant continues to face a series of additional pressures including a lack of long-term clarity on national NHS pay and how pension increases will be met, review of mandation of Public Health Services and uncertainty on future funding arrangements for the Public Health grant.

4.0 KCC and KCHFT Partnership

4.1 Public Health is due to invest £37.5M into services delivered by the Trust in 2019/20 which includes mandated programmes (e.g. NHS Health Checks, National Childhood Measurement Programme) or clinical elements delivered by specialist staff (e.g. smoking or sexual health). The majority of services have been provided by the Trust for many years. School Public Health and Sexual Health services were procured through competitive processes and awarded to KCHFT. Others were novated to KCC when Public Health transferred to the Local Authority in 2013.

4.2 Delivery is supported by enablers such as IT systems, payroll services and premises and KCC and KCHFT have collaborated on these to support best value. It is worth noting that KCC funds other services with KCHFT which are not currently incorporated into the partnership. Appendix 1 provides a summary of services currently delivered by the Trust which are funded by KCC.

5 https://democracy.kent.gov.uk/documents/s90388/Item%209%20-%20Kent%20and%20Medway%20Integrated%20Care%20System%20update.pdf 6 KCC Housing Led Forecast

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4.3 The rules that govern public sector procurements allow for contracts which

establish or implement co-operation between contracting authorities such as KCC and KCHFT to ensure certain conditions are met. Independent legal advice has supported the legality of the approach in relation to the public health functions which are the subject of the partnership. , and in 2017 it was felt that both KCC and KCHFT operate in the public interest and share common objectives in relation to:

• Improvement and protection of the public’s health • Prevention of ill-health among the population of Kent • Sustainability and transformation of local care and health services in Kent • Provision of integrated, cost effective and high-quality services to the

residents of Kent • Prevention and reduction of unnecessary or avoidable demand on the

health and social care system in Kent.

4.4 This type of approach differs from a traditional commissioner provider relationship by empowering both organisations to work in a solution focused way to tackle key challenges. It fosters innovation, efficiency, a drive for continuous improvement and sharing of skills and expertise to provide greater public benefit. It still enables the Council to hold the Trust to account for delivery of services through close monitoring against KPIs, service specifications and regular meetings.

4.5 Key reasons for taking this approach was flexibility to fit with the evolving health structures, accelerated STP implementation - especially in relation to workforce and infrastructure work streams. This will minimise disruption to users of services, the workforce and implementation of a new model to deliver efficiencies.

5.0 The Review – Progress to Date

5.1 Despite only being in place for a short period of time – two years - the partnership has made significant progress. The pioneering arrangement has facilitated collaborative discussions in a way that differs from a traditional commissioner/ provider split and enabled continuous improvement and wider opportunities to be taken forward.

5.2 Since 2017, a number of significant programme changes have been successfully delivered or are on track for delivery including:

• A new model for delivering infant feeding services

• A Kent wide targeted family service which works with identified parents for up to a year and replaces a more rigid programme of support which was only offered previously in five areas of Kent to teenage mums

• Remodelling of sexual health services to embrace digital technologies and support the management of demand pressures

• Implementation of an integrated lifestyle model and a Kent wide Smoking In Pregnancy Home Visit service. (The latter forms part of the STP

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prevention plan).

5.3 Services have delivered statutory requirements, perform within expected levels and made good progress in areas where improvement was required. For example, waiting times have been significantly reduced for children and young people accessing mental health support through the School Health service. Services can also demonstrate a positive impact on health inequalities and good reach to those most in need.

5.4 The arrangement has successfully managed shared challenges described earlier in this paper, maintaining high user and staff satisfaction. Delivery of over £5.8M worth of savings and management of growing service pressures through service transformation e.g. increased use of digital in sexual health. The Trust has worked proactively to address these pressures for example, KCHFT has in place a bespoke training academy through Canterbury Christ Church University to grow the future workforce of nursing staff and also offers retention payments, and relocation fees for those attracted to work in Kent.

5.5 External perspectives considered as part of the review include:

• The Care Quality Commissioning (CQC) who rated the Trust as Outstanding7 overall and praised the way it delivers safe and effective care for its patients and service users. A particular focus of the inspection was sexual health services which achieved a rated of Outstanding across four domains and good in the fifth domain.

• KCC Internal Audit who highlighted many benefits to the collaboration giving a rating of “Substantial with Good Prospects for Improvement”.

• Feedback from the Special Educational Needs and Disability (SEND) inspection which highlighted significant strength and only a few areas for development

• Feedback from health partners who were very supportive of the approach and benefits it has and could continue to bring to health transformation.

6.0 Resulting Recommendations

6.1 The comprehensive review provides strong evidence to underpin the extension

of the partnership for five years. Continuation of the arrangement is within the public interest and will provide the right mechanism to maximise resources, opportunities and improve the health of the local population.

6.2 The benefits and drivers for first entering into this partnership are still relevant today and there is clear evidence that both organisations continue to share common aims. For example, the values and aims articulated in KCHFT’s annual statement make reference to delivering sustainable services, close to the home, in an integrated way that prevent ill health. Both organisations are also committed to delivery of the NHS 10-year and local STP plan.

6.3 It is felt that continuation of this approach will enable KCC to implement fully the

7 https://www.kentcht.nhs.uk/wp-content/uploads/2019/07/Kent-Community-Provider-FINAL.pdf

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findings from the review which includes those listed below:

• A refinement of service models for Start Well and One You Kent so as to support integration and delivery of strategic objectives including alignment to Primary Care Networks and multi-disciplinary teams

• Explore opportunities to outsource or insource services which cannot be delivered within the current capacity of the children’s workforce and do not need to be delivered by specialist nursing staff

• Develop a coordinated offer to schools for School Public Health and related services

• Explore how the model can support improvements with partners in relation to SEND

• Continued transformation at pace of services for smoking and sexual health to respond to the needs assessments, improve outcomes and meet demand pressures.

6.4 An options appraisal has been developed and presented through internal

governance. This considered a range of options including procurement. This analysis set out a strong case that the continuation of the collaborative working would support the vision set out in the NHS Long Term Plan, enable the findings of the partnership review to be fully realised and support delivery of the STP. It would continue work to remodel services to manage demand pressures or target services more effectively to those in need and maintain the ability to manage financial risk through use of an open book approach.

7.0 Financial Implications and Extension Terms

7.1 The investment of the Public Health grant will continue to be in the region of £37.5M. Open book accounting and activity-based contracting will support value for money. Both parties will remain committed to delivering an efficiency programme which will see a further reduction in corporate overheads across the five years. These saving could be found by reducing costs associated with functions such as HR, premises or employment services.

7.2 It is recommended that all Public Health funded services are included within the partnership and as such school Public Health will move into the arrangement by April 2020.

7.3 The review highlighted a number of service priorities and opportunities to learn from other areas such as Hertfordshire or Essex who are more advanced in the integration of children models. The partnership will oversee a delivery plan that drives forward this work to benefit local residents. There will be a principle of co-production which underpins this work and a collaboration with the workforce to minimise any disruption to services.

7.4 As part of the extension there will be regular review points to ensure the arrangement still provides the expected benefits. This will include review of service performance including quality, financial benchmarking, user feedback and analysis of offer compared to need. Commissioners will continue to monitor

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the arrangements and expect performance and statutory obligations to be maintained. Termination of the arrangement is an option for both sides.

7.5 There is the potential to expand the scope of the partnership during the lifetime of this extension, if deemed beneficial to local residents. Work in relation to this will be developed by the relevant Corporate Director(s) and subject to appropriate Cabinet Committee endorsement. KCC currently invests in other services Trust including Paediatric Therapy Services to Schools, Community based services for Adults, Short Breaks and Learning Disabilities.

8. Conclusions and Next Steps

8.1 KCHFT are fundamental partners for KCC and are uniquely placed to continue to deliver these services. KCHFT have already delivered significant transformation whilst working with KCC and as a result, KCC is confident that they can deliver improved outcomes for local people and can offer the flexibility needed to align to the strategic landscape and meet future needs.

8.2 The Trust’s recent CQC rating of Outstanding gives increased confidence that service quality will remain high and support recruitment and retention of skilled workforce despite national shortages in nursing staff.

8.3 There is clear evidence that KCHFT have supported the Public Health agenda through the whole work of the Trust and both organisations have worked towards shared aims such as delivery of the STP. There is also clear evidence that local residents have benefitted from the approach which has seen millions of pounds reinvested to improve services.

8.4 The effective investment of the funding provides a significant opportunity to improve outcomes for local residents, support our ambitions for integration with health and help realise the vision set out in the NHS Long Term Plan and KCC Strategic Statement. It also builds on the NHS investment through the STP prevention workstream led by Public Health.

8.5 It is therefore recommended that the partnership is extended for five years until March 2025 and improvements are both sustained and built upon. This timeframe will align with the local five-year plan which is currently in development in response to the NHS Long Term Plan.

9.0 Recommendations

The Health Reform and Public Health Cabinet Committee is asked to

CONSIDER and ENDORSE or make a recommendation to the Cabinet Member

on the proposed decision to authorise the County Council to extend the

collaborative arrangement with Kent Community Health NHS Foundation Trust,

for the services listed in this paper until March 2025.

10.0

Contact Details

Report Authors:

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Vicky Tovey Public Health Senior Commissioning Manager 03000416779 victoria.tovey@kent.gov.uk Karen Sharp Head of Public Health Commissioning 03000 416668 karen.sharp@kent.gov.uk Relevant Director Andrew Scott-Clark, Director of Public Health 03000 416659 Andrew.scott-clark@kent.gov.uk

11.0 Background documents

Kent and Medway Sustainability Transformation plan:

https://kentandmedway.nhs.uk/stp/

The NHS Long Term Plan - https://www.longtermplan.nhs.uk/

Public Health Green Paper – Prevention is Better than Cure:

https://www.gov.uk/government/publications/prevention-is-better-than-cure-our-

vision-to-help-you-live-well-for-longer

Kent and Medway Integrated Care System update presented to County Council, 23 May 2019 https://democracy.kent.gov.uk/documents/s90388/Item%209%20-%20Kent%20and%20Medway%20Integrated%20Care%20System%20update.pdf

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Appendix 1: KCC spend with KCHFT

The below values are assumed levels of contracted spend and will be depend on

activity delivered within services and presenting demand for open access services.

A. Public Health Services

Contract Title Contract Values 2019/20

Health Visiting Service £22,120,202

School Public Health Services

£4,858,259

Lifestyle services including NHS Health Checks

£5,21,318

Sexual Health Services (GUM) £5,062,287

Postural Stability services £63,724

Kent Dental Epidemiology Survey and Oral Health Promotion

£140,000

Total spend £ 37,456, 790

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Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 3.1

Agenda Item Title: Seasonal Infection Prevention and Control Report

Presenting Officer: Mercia Spare, Chief Nurse (Interim) and Director of Infection Prevention and Control (DIPC)

Action - this paper is for: Decision ☐ Information ☐ Assurance ☒

Report Summary

This paper provides a summary of infection prevention and control activity between 1 July 2019 and 31 October 2019.

• There have been 2 Community Onset Healthcare Associated and 1 Hospital Onset Healthcare Associated Clostridium difficile Infections reported in this timeframe where the patient received some care from KCHFT staff, none were attributed to KCHFT, and no learning was identified for KCHFT staff.

• There have been no MRSA bacteraemias in this timeframe.

• MRSA screening compliance for podiatric surgery was 100% in this time frame, and in community hospitals was 97% pertaining to one missed screen in July, August and September. All subsequently tested MRSA negative.

• Gram Negative Bacteraemia Blood Stream Infection (GNBSI) surveillance continues, both in KCHFT and across Kent and Medway, and a reduction is now being seen (4% reduction in the last year). KCHFT continue to focus on reduction of UTI’s and CAUTI’s through a hydration and hygiene campaign. Projects to reduce respiratory tract infections and IV line infections being planned.

• Since April 2019 there have been 5 patients who have developed gram negative bacteraemias whilst inpatients in our hospitals. The sources were deemed to be respiratory tract infection (2), abdominal mass (1) urosepsis - catheter associated (1) and unknown (1). Learning for KCHFT staff from these are included in the projects from the regional group.

• The Kent and Medway Infection Prevention Control and Antimicrobial Stewardship strategy has been published, for local adoption and implementation. KCHFT are currently reviewing this, and this will be discussed at the next Infection Prevention Control and Antimicrobial Stewardship Committee meeting.

• Between July and 1 November, there were 27 UTI’s and 4 CAUTI’s reported, this is a reduction from the previous months. Overall compared to the same time last year, cases have increased – however, rates per 100,000OBD’s have

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decreased significantly – with a 14% reduction in UTI’s and a 22% reduction in CAUTI’s compared to last year.

• Cleaning reports for July to October highlight compliance with national standards of cleaning in all hospitals.

• Trust Compliance with hand hygiene training was reported as 94% and mandatory training 98% in September. Compliance amongst clinical staff was 92.2% for hand hygiene, and 97.5% for mandatory training.

• There have been 2 outbreaks of infection in this time, 1 rhinovirus outbreak at Whit and tank – and one diarrhoea and vomiting outbreak at QVMH. In both cases the wards remained opened to admissions, with bays closed and in isolation measures.

• The staff flu vaccination programme has commenced, and at the point of report writing, 34% of patient facing staff have been vaccinated

• There have been no further ‘failure to decontaminate’ issues relating to IHSS

• The legionella incident at Sevenoaks remains ongoing, with low levels recorded in outpatient areas, which continue to decrease. 3 chlorinations have occurred and remedial actions continue to be completed by the landlord, and all infection prevention and control measures remain in place on the ward.

• The Hydrotherapy pool at Sevenoaks closed due to a positive pseudomonas

report. All remedial actions were completed, no patients were affected by the

result, and the pool has subsequently re-opened.

Proposals and /or Recommendations

To note the report.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒

High level position described and no decisions required.

Lisa White, Assistant Director Infection Prevention and Control

Tel: 07795427421

Email: lisa.white1@nhs.net

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SEASONAL INFECTION PREVENTION AND CONTROL REPORT

1. Clostridium difficile infection (CDI) Objective: The Trust will be attributed no Clostridium difficile infections with a level 3 lapse in care in 2019/20. New Objectives have been released for clostridium difficile infections for 2019 / 20, changing the allocation of cases to 4 new ‘attributions’:

• hospital onset healthcare associated: cases that are detected in the hospital three or more days after admission

• community onset healthcare associated: cases that occur in the community (or within two days of admission) when the patient has been an inpatient in the Trust reporting the case in the previous four weeks

• community onset indeterminate association: cases that occur in the community (or within two days of admission) when the patient has been an inpatient in the Trust reporting the case in the previous 12 weeks but not the most recent four weeks

• community onset community associated: cases that occur in the community (or within two days of admission) when the patient has not been an inpatient in the Trust reporting the case in the previous 12 weeks.

There have been NO cases attributed to KCHFT in this timeframe. However there have been two COHA’s and one HOHA reported in the acute trusts, where the patients were in our inpatient units during the preceding episode of care (up to four weeks). No learning was identified in any case for our organisation, and all were deemed to be associated with antimicrobial prescribing in the acute trusts. 2. MRSA Bacteraemia MRSA bacteraemia cases are allocated as ‘Pre 48 hour onset or Post 48 hour onset, and lessons learned identified for organisations and healthcare economies. Investigations continue into all cases where we have provided care, and the clinical commissioning group (CCG) or acute trust manage these investigations, with a co-ordinated response to any learning identified through organisational Infection Prevention and Control committees, and CCG Quality meetings. There have been no MRSA bacteraemias investigated in this timeframe. 3. MRSA screening. The expected standard is 100% compliance with screening as identified in the Trust

policy.

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MRSA screening compliance for podiatric surgery was 100% in this time frame, and in community hospitals was 97% pertaining to ne missed screen in July, August and September. The patients subsequently tested negative, and the IPC team continue to work alongside clinical staff to embed the new screening policy. 4. Gram Negative bacteraemia Blood Stream Infections (GNBSI) There is no specific objective for KCHFT in relation to Gram negative bacteraemias (GNBSI), as currently cases are not attributed; however there is a national focus to reduce healthcare associated cases by 50% as identified in the Government paper on tackling antimicrobial resistance 2019 – 2024. Kent and Medway are collectively aiming to reduce by 10% per year. GNBSI surveillance continues, both in KCHFT and across Kent and Medway, and a reduction is now being seen (4% reduction in the last year). UTI’s (including CAUTI’s) are the highest cause of these infections, therefore KCHFT continue to focus on reduction of these infections, and have implemented a hydration and hygiene campaign (concurrently with other organisations in the County).Projects to reduce respiratory tract infections and IV line infections being planned. Since April 2019 there have been 5 patients who have developed gram negative bacteraemias whilst inpatients in our hospitals. The sources were deemed to be respiratory tract infection (2), abdominal mass (1) urosepsis (catheter associated (1) and unknown (1). Learning for KCHFT staff from these are included in the projects from the regional group. Local learning includes access to specimen results, and recognition of deteriorating patients – both of which are being addressed. The draft Kent and Medway Infection Prevention Control and Antimicrobial Stewardship strategy has been published, for local adoption and implementation. KCHFT are currently reviewing this, and this will be discussed at the next Infection Prevention Control and Antimicrobial Stewardship Committee meeting. The HCAI aspects have been incorporated into the annual workplan, however actions relating to antimicrobial stewardship will require both short and long term actions for this organisation. 5. Urinary Tract Infections (UTI) and Catheter Associated UTI’s The aim for 2019/20 is to reduce the rate of these infections compared to 2018/19 in our community hospitals. Between July and November 1st, there were 27 UTI’s and 4 CAUTI’s reported, this is a reduction from the previous months, however, compared to the same time last year, cases have increased. The Trust has increased it’s inpatient beds and in order to reflect this, rates per 100,000 OBD’s were reviewed, and the rates decreased significantly – with a 14% reduction in UTI’s and a 22% reduction in CAUTI’s compared to last year.

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6. Cleaning and Environment

The Infection Prevention Control and Antimicrobial Stewardship committee monitors the progress of all areas, see cleaning summary for 6 months up to October 2019 below.

Cleaning reports indicate compliance with national standards in all areas.

7. Training

Trust Compliance with hand hygiene training was reported as 94% and mandatory training 98% in September. Compliance amongst clinical staff was 92.2% for hand hygiene, and 97.5% for mandatory training.

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The IPC Team has contacted all heads of service and team leads to address non compliant areas, and there is an improvement in compliance since the previous report. 8. Outbreaks There have been 2 outbreaks of infection in this time, 1 rhinovirus outbreak at Whit and tank – and one diarrhoea and vomiting outbreak at QVMH. In both cases the wards remained opened to admissions, with bays closed and in isolation measures. The outbreaks were well managed in both cases. 8.1 – Flu vaccination The staff flu vaccination programme has commenced, and at the point of report writing, 34% of patient facing staff have been vaccinated. 9. Decontamination There have been no further ‘failure to decontaminate’ issues relating to IHSS. Internal decontamination audits found full compliance in our outpatient departments relating to scopes, and the dental service have also reported full compliance with HTM 01-05 (verified by the Trust independent authorised engineer) 10. Water safety and incidents. The Water Safety Committee continues to meet to highlight gaps in assurance, and evidence risk reduction actions.

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846 300 L3 Operations Directorate 846 L4 4103 Childrens Specialist Services98.1% 100.0% 98.7% 99.4% 100.0% 92.2%

846 300 L3 Operations Directorate 846 L4 4204 West Kent 100.0% 97.6% 97.2% 100.0% 95.3% 92.3%

846 300 L3 Operations Directorate 846 L4 4206 Specialist & Elective Services100.0% 99.1% 97.5% 100.0% 96.5% 96.1%

846 300 L3 Operations Directorate 846 L4 4215 Public Health 100.0% 100.0% 98.6% 99.4% 99.1% 95.2%

846 300 L3 Operations Directorate 846 L4 4216 Dental N/A 100.0% 98.1% N/A 100.0% 98.1%

846 300 L3 Operations Directorate 846 L4 4217 East Kent 100.0% 100.0% 95.5% 100.0% 95.4% 87.4%

846 300 L3 Operations Directorate 846 L4 4219 Operations Management 100.0% N/A 100.0% 87.5% N/A 66.7%

846 325 L3 IT 846 L4 4220 IT 100.0% N/A N/A 98.6% N/A N/A

846 330 L3 Nursing & Quality Directorate 846 L4 4301 Deputy Chief Nurse 100.0% N/A N/A 100.0% N/A N/A

846 330 L3 Nursing & Quality Directorate 846 L4 4302 Clinical Governance 100.0% N/A N/A 85.7% N/A N/A

846 330 L3 Nursing & Quality Directorate 846 L4 4303 Infection Prevention & Control100.0% N/A N/A 100.0% N/A N/A

846 330 L3 Nursing & Quality Directorate 846 L4 4304 Chief Nurse 100.0% N/A N/A 100.0% N/A N/A

846 330 L3 Nursing & Quality Directorate 846 L4 4305 Safeguarding 100.0% N/A N/A 100.0% N/A N/A

846 330 L3 Nursing & Quality Directorate 846 L4 4307 Patient Experience 100.0% N/A N/A 100.0% N/A N/A

846 330 L3 Nursing & Quality Directorate 846 L4 4308 Tissue Viability 100.0% N/A N/A 100.0% N/A N/A

846 335 L3 Medical Director 846 L4 4306 Medicines Management 100.0% N/A 100.0% 80.0% N/A 77.1%

846 335 L3 Medical Director 846 L4 4350 Medical Director 100.0% N/A N/A 100.0% N/A N/A

846 350 L3 HR, OD & Communications 846 L4 4300 Management of Human Resources100.0% N/A N/A 100.0% N/A N/A

846 350 L3 HR, OD & Communications 846 L4 4502 Human Resources 100.0% N/A 100.0% 100.0% N/A 100.0%

846 350 L3 HR, OD & Communications 846 L4 4503 Communication & Patient Engagement100.0% N/A N/A 100.0% N/A N/A

846 355 L3 Finance Directorate 846 L4 4550 Finance 100.0% N/A N/A 100.0% N/A N/A

846 355 L3 Finance Directorate 846 L4 4560 Finance and IT Management100.0% N/A N/A 80.0% N/A N/A

846 355 L3 Finance Directorate 846 L4 4601 Business Development and Service Improvement100.0% N/A N/A 100.0% N/A N/A

846 355 L3 Finance Directorate 846 L4 4602 Performance & Business Intelligence100.0% N/A N/A 100.0% N/A N/A

846 370 L3 Corporate Services Directorate 846 L4 4701 Corporate Services 100.0% N/A N/A 100.0% N/A N/A

846 370 L3 Corporate Services Directorate 846 L4 4703 Corporate Assurance & Legal100.0% N/A N/A 100.0% N/A N/A

846 370 L3 Corporate Services Directorate 846 L4 4706 Executive Teams 100.0% N/A N/A 100.0% N/A N/A

846 375 L3 Estates 846 L4 4554 Estates Management 100.0% 100.0% N/A 96.4% 87.5% N/A

846 375 L3 Estates 846 L4 4556 Facilities Service (Soft FM) 100.0% 92.2% N/A 100.0% 83.7% N/A

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The legionella incident at Sevenoaks remains ongoing, with low levels recorded in outpatient areas, which continue to decrease. 3 chlorinations have occurred and remedial actions continue to be completed by the landlord, and all infection prevention and control measures remain in place on the ward. The Hydrotherapy pool at Sevenoaks closed due to a positive pseudomonas count.

All remedial actions were completed, no patients were affected by the result, and the

pool has subsequently re-opened.

11. Conclusion The IPC Team is predominantly focussing on Winter outbreak planning and control measures currently. Alongside this, we continue to focus on reduction of gram negative bacteraemias, predominantly through the implementation of the hydration and hygiene campaign, which was designed by KCHFT staff, and has rolled out across the County, in Acute Trusts, Mental Health providers, and now being adopted in some care homes, hospices and is being reviewed for a ‘carers app’ in east Kent. Lisa White Assistant Director of Infection Prevention and Control 20 November 2019

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Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 3.2

Agenda Item Title: Learning from Deaths Annual Report

Presenting Officer: Dr Sarah Phillips, Medical Director

Action - this paper is for: Decision ☐ Information ☐ Assurance ☒

Report Summary

In line with national guidance on learning from deaths, KCHFT collects and publishes mortality data quarterly via a paper to Quality Committee and Public Board, which must include mortality data and learning points. Guidance states this data should include the total number of the Trust’s inpatient deaths and those deaths that the Trust has subjected to case record review. Of those deaths reviewed, the Trust must report how many deaths were judged more likely than not to have been due to problems in care. Each year an annual report is submitted in November. Mortality reviews are conducted through a centralised process where the review team is made up of a doctor, a ward matron or other senior clinical staff member, a pharmacist, a quality lead and centralised administrative support. Members rotate monthly to maintain a degree of independence. An internal process for reviewing deaths of patients with Learning Disabilities is in place alongside the national LeDeR process for additional assurance, best practice and to meet the Trust’s ethical obligations. Learning from these reviews is submitted to the Mortality Surveillance Group. As defined in the Policy, the Trust Board has overall responsibility for ensuring compliance with all legal and statutory duties, along with best practice including having oversight of mortality review processes and awareness of the learning emerging from reviews that drive improvements in care. The focus of trust mortality review is on quality improvement and sharing meaningful learning. Reviews taking place in the recent quarter (July to September 2019) reflect positive findings similar to those emerging from reviews throughout the rest of the year, with recurring examples of excellent holistic care, communication with families, thorough documentation and consideration of spiritual needs. Recurring themes around areas for learning and improvement identified throughout the past year are medication, end of life recognition and documentation. These are summarised in the report along with ongoing or planned actions. Also included in the report is a summary of developments to review processes over the last year along with future plans.

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Proposals and /or Recommendations

To note the report.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒

High level position described and no decisions required.

Dr Sarah Phillips Tel: 01622 211922

Medical Director Email: sarahphillips4@nhs.net

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1. Introduction 1.1 In line with national guidance on learning from deaths, KCHFT collects and publishes

mortality data quarterly via a paper to Quality Committee and Public Board, which must include mortality data and learning points. Guidance states this data should include the total number of the Trust’s inpatient deaths and those deaths that the Trust has subjected to case record review. Of those deaths reviewed, the Trust must report how many deaths were judged more likely than not to have been due to problems in care. Each year an annual report is submitted in November.

2. September Dashboard 2.1 The dashboard below has been based on national suggested format. Deaths in scope

include all community hospital inpatient deaths, any deaths where a complaint or potential SI has been raised, and a small sample of deaths in the community.

Total Number of Deaths in Scope

Total Deaths Reviewed

Number of deaths judged to be more likely than not due to problems in healthcare

This Month Last Month This Month Last Month This Month Last Month

1 3 3* 7 0 0

This Quarter (QTD) Last Quarter

This Quarter (QTD) Last Quarter

This Quarter (QTD) Last Quarter

13 19 17 13 0 0

This Year (YTD) Last Year This Year (YTD) Last Year

This Year (YTD) Last Year

47 77 41 69 0 0

*Deaths reviewed in a calendar month may exceed the number of deaths reported that month, as the figure includes deaths taking place in the previous month, but falling into the next month for review; this also applies to those occurring in one year e.g. December, but reviewed in January of the next.

2.2 Four deaths in the last year have been reviewed or are being reviewed, as part of an SI:

• 1 in March 2019 re a pressure ulcer while under the care of Thanet community teams

• 1 in July 2019 at Whit & Tank re sub-optimal care of a deteriorating patient (ongoing)

• 1 in July 2019 re delay in receiving EOL medication while under care of Faversham Long Term Services team (ongoing)

• 1 in July 2019 re delayed visit to check faulty syringe driver while under care of Canterbury Long Term Services team (ongoing)

2.3 The graph below shows the number of deaths in scope this year along with the average.

LEARNING FROM DEATHS ANNUAL REPORT

October 2018 – September 2019

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3. Learning from Mortality Reviews 3.1 The table below outlines key areas of good practice identified in reviews completed this

quarter. These reflect positive findings similar to those emerging from reviews throughout the rest of the year, with recurring examples of excellent holistic care, communication with families, thorough documentation and consideration of spiritual needs.

3.2 All areas of good practice and areas for learning are reported at monthly matrons’ meetings in the East and West and wider dissemination to all ward staff is encouraged. A summary report is also reviewed at the bi-monthly End of Life Steering Group, and themes are discussed at the bi-monthly Mortality Surveillance Group (MSG).

Areas of Good Practice aligned to the Five Priorities for Care of the Dying Person

Recognise

- End of Life was acknowledged

explicitly and discussed with the family – Faversham

- Observations and medications

stopped appropriately – Faversham

- Excellent forward planning as it

was noted that need for end of life meds should be established or if Fast Track should be considered, as the weekend was approaching – Faversham

- End of Life assessment and individualised care plan in place, enabling clear documentation of priorities for the patient’s care and the needs of the family - QVMH

- An End of Life care plan was put in place on the day of admission, evidencing good, appropriate recognition – Deal

- NEWS2 chart was clearly and

appropriately marked and discontinued in view of end of life - Deal

Involve

- Personalised care evident in the

provision of specific dietary requirements for the patient, to suit their preferences as a vegan – Whit & Tank

- The patient’s wishes were considered as it was noted that she did not want further hospitalisation in the event of deterioration – Faversham

- The patient’s husband was involved as much as possible, despite being elsewhere in the county undergoing his own health investigations – Faversham

- A very holistic approach was evident, which involved the family and spiritual considerations, with a visit from a priest arranged as requested by the patient – Faversham

- This is Me document was in place with very detailed information about the patient’s likes and hobbies, showing an excellent holistic overview of the patient as an individual – Faversham

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Support

- The team contacted the family very promptly on recognising the patient’s deterioration and the family were able to come to the ward to be present when she died - Tonbridge

- The patient’s friends were involved and visited regularly. She was nursed in a side room with soft lighting and it was noted that her friends were sitting around her bed and sharing stories. It was documented that the friends were given refreshments and made aware they could call the nurse at any time if they noticed any discomfort or concerns – QVMH

- Daily delivery of care was well documented, providing a good review of the patient’s evolving needs and symptoms and addressing the son’s emotional needs - QVMH

- It was well documented that the doctor asked the family to come in to discuss the patient’s poor prognosis rather than deliver the news over the phone, which shows sensitivity and support for the family. Further discussions were documented after death as to whether they wanted to come in to see their relative, and their funeral wishes were noted – Faversham

- Very sensitive approach from nurse who had a needle stick injury, as she was discreet in order not to cause further distress to the family, and followed the policy appropriately – Thanet Community Nursing

- A DNA CPR form was signed by

the doctor 3 days after admission. This reflects excellent care as it was completed promptly, shows the patient’s view, clearly documents capacity, and involved discussion with the patient’s daughter - Hawkhurst

- It was documented that it was the

patient’s wish to stay at Deal and that he was aware he was at end of life and wanted his family around him. This is good evidence of an understanding by the nursing staff of the patient’s individual needs and wishes - Deal

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Plan & Do

- Good general nursing care

provided and relevant assessments completed including input from dietician, and the patient’s food preferences were noted – Tonbridge

- All relevant assessments completed and physio review occurred promptly – QVMH

- MCA requirements followed in completion of complex decision form when patient could not discuss DNA CPR – QVMH

- Appropriate response to stool type 5 or above, with samples sent to IPC and contact barrier nursing documented – QVMH

- Staff took the correct action to contact on-call pharmacist for advice when no drug chart came over with the patient from the acute – QVMH

- NEWS scores were regularly recorded and observations were increased in frequency when it rose to 4, showing good ongoing monitoring with thorough documentation and appropriate actions – QVMH

- Sticker present on the drug chart alerting staff to the importance of accurate timing of medication for Parkinson’s disease - QVMH

- Very good initial assessment and care after patient was admitted at midnight in a vulnerable state – Hawkhurst

- This patient would normally trigger

outreach care so the team did well to keep him in the community hospital; good work with other

Communicate

- Ward staff escalated all concerns

appropriately and many services were involved, with good communication throughout – Hawkhurst

- Excellent documentation of discussions with the family around end of life, early in the admission. Good evidence of collaborative work with the family – Whit & Tank

- Conversations with the family were well documented throughout – Faversham

- Detailed documentation throughout and staff responded appropriately and sensitively to complaint from granddaughter re delay with death certificate and cremation form, which was out of the control of ward staff – Faversham

- There were well documented discussions with the family about what would be best for the patient – Faversham

- Conversations with the family well documented throughout. A family meeting also took place with the patient present – Hawkhurst

- Every effort was made to communicate with the acute to chase gastroenterology appointment for the patient and dilatation procedure for oesophageal stricture, showing excellent cross-team communication.

- The team involved the family and

hospice, and discussions were well documented – Cranbrook Community Nursing

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service providers – Hawkhurst

- Very comprehensive medical review on admission and Personalised Care Plan in place – Hawkhurst

- Clerking was completed at the earliest available opportunity. CIS checklist was in place on admission, enabling a clear check of assessments completed. All items on checklist completed within first 24 hours, evidencing good care – Hawkhurst

- Good care shown by the presence of a handwritten care plan on the day of admission, written by an agency nurse despite known issues of lack of access to CIS for agency staff - Hawkhurst

- Comfort round charts were commenced on the day of admission and recorded 2 hourly checks throughout the day and night with no gaps or omissions – Hawkhurst

- Good follow-up and actions from medical findings, e.g. the presence of atrial fibrillation following ECG at the acute was reviewed and Apixaban commenced – Hawkhurst

- The patient’s falls were well documented and responded to appropriately - Hawkhurst

- Good respiratory assessment carried out – Whit & Tank

- Good response to discomfort caused by catheter, as it was promptly changed for a smaller size – Whit & Tank

- Good assessment of syringe driver use and response to this, with appropriate pain

- A positive action arose from a 72 hour report re a medication delay, to devise a sticky label for the patient’s home notes with all numbers and instructions on so in future, patients’ families are clear on contact numbers and cover for out of hours – Thanet Community Nursing

- There was thorough documentation on CIS of long conversations with the patient’s daughter - Deal

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management throughout – Whit & Tank

- All assessments completed promptly on admission and Personalised Care Plan in place - Faversham

- Good care given considering a challenging situation where the patient consistently refused input – Faversham

- Nurse noticed moisture lesion on admission and promptly Datixed appropriately – Faversham

- All assessments completed on first visit and MCA consent documented appropriately – Cranbrook Community Nursing

- Very thorough notes on CIS throughout – Cranbrook Community Nursing

- All assessments completed promptly and well documented – Thanet Community Nursing

- Good care given in a challenging situation where the patient’s disease was unpredictable and distressing – Thanet Community Nursing

- All appropriate assessments completed and well documented on CIS, and all policies and guidelines followed. The patient’s capacity was well documented when he declined to attend hospital against advice – West Kent Home Treatment Service

- All care was offered and good care provided considering the patient had a history of being non-concordant with treatment and advice and had been verbally aggressive – West Kent Home Treatment Service

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3.3 Recurring themes around areas for learning and improvement identified throughout the past year are medication, end of life recognition and the need for standardised documentation. These are summarised below along with ongoing or planned actions.

Themes for Learning Comments/Actions

Medication

- Possible inappropriate prescribing, e.g. use of midazolam for coughing and struggling when other meds could have been considered first

- Glycopyrronium prescribed as a dose of 400mcg, when a first dose of 200mcg for a frail, elderly patient should have been considered

- Non-essential drugs being stopped at end of life are not always clearly crossed through, dated and signed on drug chart

- Consideration not always given to stopping antibiotics at end of life

- Sub-therapeutic dose of midazolam prescribed on “0-30mg” scale with insufficient guidance

- Transfer of Care issue re meds; in one case, patient died within 24 hours of discharge from the acute back to community hospital, but no preparations were made for End of Life. Crisis drugs should have been prescribed either upon discharge or re-admission to KCHFT care.

All feedback from mortality reviews around medication issues are notified to Ruth Brown, Chief Pharmacist, and Clare Fuller, Lead Practitioner for Palliative and End of Life Care. Feedback is also sent to ward matrons for sharing with the team, and is presented at monthly matrons’ meetings and bi-monthly End of Life Steering Group. Ruth Brown is planning an accelerated education programme for staff around syringe driver dosing. Staff have been made aware of upcoming MedSavvy events to improve knowledge and confidence.

Where appropriate, ward staff are encouraged to Datix any Transfer of Care issues which are then taken forward with the acute via the Transfer of Care Working Group.

Documentation

- Delirium is not always explicitly

recognised or noted. Conversations with family

Dr Shelagh O’Riordan, Clinical Director for Adult Services, has proposed a

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around delirium are not always taking place or being documented.

- Patient’s wishes re ceiling of care/transfer to the acute on deterioration are not always explicitly recorded.

- In many cases, care plans are not written in the own words of the patient and could reflect more of the patient voice.

- In response to one case, the Safeguarding team suggested that discussions should be documented as a written entry in the notes at the time, with the Safeguarding consultation document being uploaded to the patient record when available, to support others being aware of any concerns, advice and actions given.

- DNA CPR forms are not always robust. In one case, the DNA CPR noted that the decision was “not discussed with IMCA as health related issue”; it is unclear why this wording was used. It was also unclear whether this had been discussed with the patient, and if not, the reason why. Attempts should have been made to contact the IMCA. In another case a post-it note was stuck to the form stating that the NHS number was incorrect which has then been amended on form, but it is unclear who made this amendment. The form should have been re-written.

delirium screening tool and action plan to be in place consistently across the Trust. Denise Hylton-McIntosh, Head of Patient Safety, is to take this forward with input from Dr Lisa Scobbie, Deputy Medical Director.

Advanced Care Plans should be clearer around patients’ explicit wishes for each possible situation. Denise Hylton-McIntosh, Head of Patient Safety, is to take this forward to look at more consistent documentation to make recording patient wishes easier.

A Trust-wide QI project is ongoing around standardising Personalised Care Plans, with input from the Heads of Quality, Governance and Professional Standards. All feedback is sent to ward matrons or team leaders for sharing with the team, and is presented at monthly matrons’ meetings and bi-monthly End of Life Steering Group.

Advice around robust record keeping sought from Trust Solicitor and fed back to teams re post-it notes and incomplete DNA CPRs. A DNA CPR audit recently took place; actions to be agreed when findings become available.

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Recognition

- In some cases, although patients

had been originally for rehab and plans made for discharge home, there could still have been consideration to “what if…?” discussions and early exploration of patient wishes in the event of deterioration.

- Good response to deterioration, but failure to holistically plan for End of Life. Missed opportunities for discussions; earlier response to signs needed.

- In one case, family were still

discussing possible homes for the patient so it was unclear whether situation was fully communicated or understood re End of Life.

All feedback is sent to ward matrons or team leaders for sharing with the team, and is presented at monthly matrons’ meetings and bi-monthly End of Life Steering Group. Clare Fuller, Lead Practitioner for Palliative and End of Life Care is also copied into feedback and earlier recognition forms part of the future programme of work.

3.4 Although the Trust is only required to review inpatient deaths in community hospitals and there is no national mandate to review deaths in the community, a process began in November 2018 which aims to sample one to two deaths per month from across East and West community teams to incorporate into the existing review process, subject to capacity of the review teams. Deaths are selected by team leaders who identify cases where there may be particularly rich learning, i.e. where problems occurred or care went well despite challenges.

3.5 For assurance, there are administrative processes in place for liaison with PALs, SI and Safeguarding teams so that all deaths where a complaint or concern has been raised will be reviewed, even if not normally in scope. Deaths going through the SI process may not be re-reviewed to avoid duplication, if the RCA already identifies detailed learning. Cases deemed not to be SIs following a conference call and not subject to an RCA will undergo a mortality review to ensure no learning is missed.

3.6 Between October 2018 and September 2019, a total of 20 ‘other’ deaths were reviewed that did not take place in community hospitals, but were either samples selected by community teams, deaths referred for mortality review by the Patient Safety team due to complaints or cases where concerns were raised but deemed not to be SIs. Areas of good practice from these cases were included in the table above, and areas for learning were consistent with issues identified across the Trust generally.

4. Learning Disability (LD) Mortality Review Process Update 4.1 At the July 2019 Quality Committee, a full report was submitted by Mark Anderson,

Deputy Head of Service for Learning Disabilities, covering April 2017 – March 2019.

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This report confirmed that the internal review process, developed in response to the lack of feedback from the national LeDeR programme, had led to a successful clearing of the backlog of deaths for review. MDT meetings are now arranged when needed; a snapshot provided to the Mortality Surveillance Group in September 2019 showed that 117 reviews had been completed and only four were currently pending.

4.2 Initial findings indicate that causes of death are similar to those reported nationally, i.e.

respiratory, circulatory disorders and cancer. The majority of service users were on end of life care and there were no avoidable or preventable deaths from a KCHFT perspective, or Serious Incidents. Good practice has been highlighted around End of Life pathways, anticipatory care planning and joint working with other organisations such as GPs and hospices. Practitioners who attend the LD mortality review meetings have given very positive feedback and KCHFT staff have been found to be very proactive in supporting discharge from acute hospitals in order for people to die at home.

5. Mortality Review process developments, joint working and future plans

5.1 Over the past year, the Structured Judgement Review form and methodology has

become further embedded, bringing KCHFT’s mortality review process increasingly in line with acute trusts. This will facilitate greater ease of information sharing and quantitative analytics, should national requirements evolve for community trusts’ learning from deaths reporting in the future. Quantitative data collection of themes and trends is also now aligned to the Royal College of Physicians problem categories; the up-to-date summary spreadsheet can be found in Appendix 1.

5.2 In November 2018, an additional question was added into the Structured Judgement Review form for assurance following the Gosport Inquiry, which asks the review group to answer ‘yes’ or ‘no’ to the question, ‘Is there any evidence of unsafe practice by mismanagement or misuse of controlled drugs that contributed to death?’

5.3 At the September Mortality Surveillance Group, the Healthcare Insight Specialist from Dr

Foster presented the latest insight report covering the latest available data up to May 2019. The long-term picture shown by the data in terms of mortality rates is stable, but it was noted that the volume of step-downs has been slowly increasing over the last three years. Step up volumes are decreasing overall although there were peaks over the winter period as expected.

5.4 Following the publication of the NHS England document ‘Guidance for NHS trusts on

working with bereaved families and carers’, a gap in formal processes for involving families in mortality reviews was identified nationally. There is an ongoing QI project focusing on the bereavement questionnaire for relatives and carers, led by the Patient Experience Manager and building on examples of good practice from other trusts highlighted in the report. This work is overseen by the End of Life Steering Group and will be supported as appropriate by the Mortality Surveillance Group.

5.5 Within the past year, a mortality review identified an issue of awareness around what to do when a patient dies with no known next of kin. Written guidance has now been circulated to community hospitals for clarity, and the procedure has also been added to the Care after Death policy.

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5.6 Work is ongoing to put a process in place for the Mortality Surveillance Group to receive regular reports from the Child Death Overview Panel for assurance, and to identify any themes and trends. This is to ensure any learning is received for child deaths where KCHFT teams may have had some input. Any Serious Case Reviews are included in an Action Tracker presented by the Safeguarding team at each Mortality Surveillance Group meeting so there is assurance that the Trust would already be aware of any cases of specific concern.

5.7 Contact has been made with acute trusts and the local mental health trust KMPT.

While joint working with acute trusts is an aspiration for the future, it is hoped that imminent progress will be made with KMPT around sharing learning from mortality reviews of mutual patients, to ensure that care provided to patients with serious mental health needs who have died, is being reviewed from a KCHFT perspective where appropriate. A meeting is due to take place in the coming months between Dr Lisa Scobbie, Deputy Medical Director at KCHFT and Annie Oakley, Head of Patient Safety at KMPT, to take forward formal plans for collaboration.

5.8 Initial contact has been made with Patient Safety teams at West Kent CCG, and

Ashford and Canterbury CCGs with a view to involving primary care in mortality reviews in the future. How this will be affected by potential CCG structure changes is currently unclear.

5.9 The Head of Nursing at Pilgrims Hospice has been identified as a contact point and is

receptive to any shared learning for the hospice emerging from KCHFT mortality reviews.

5.10 Details of deaths where a mortality review has identified potential for cross-

organisational learning are now brought to the next available bi-monthly Mortality Surveillance Group for discussion around how to take forward shared insights.

5.11 KCHFT took part in a focus group organised by the Patient Safety Fellow at the Kent Surrey and Sussex Patient Safety Collaborative in September 2019. Five clinical staff shared their views and experiences around deaths occurring at work, what they found helpful to support them as a team as well as the patient’s family, and what other support they would find useful in future. The participants were from across East and West Kent, community hospitals and community teams. Findings will be shared with managers in due course, to inform further organisational improvements around supporting both staff and families leading up to, and following, a death.

5.12 The Learning from Deaths policy will be reviewed by the end of 2019 to ensure the

document reflects the ongoing evolution of the process and the developments noted above.

Dr Lisa Scobbie, Deputy Medical Director Melissa Ganendran. Mortality Review Project Lead on behalf of Dr Sarah Phillips, Medical Director October 2019

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Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 3.3

Agenda Item Title: Freedom To Speak Up (FTSU) Report

Presenting Officer: Natalie Davies, Corporate Services Director

Action - this paper is for: Decision ☐ Information ☐ Assurance ☒

Report Summary

The report provides a summary of concerns raised by staff between 1 April 2019 and 30 September 2019 (Quarter 1 and Quarter 2).

Proposals and /or Recommendations

To note the report.

Relevant Legislation and Source Documents

Freedom To Speak Up Policy

Has an Equality Analysis (EA) been completed?

No ☒

High level position described and no decision required.

Joy Fuller, Governor Lead / Freedom To Speak Up Guardian

Tel: 01622 211972

Email: joy.fuller@nhs.net

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FREEDOM TO SPEAK UP GUARDIAN REPORT

1. Introduction

1.1 There are now 5001 Freedom to Speak Up Guardians across NHS organisations in England. Some of these are full-time posts, some part-time and some are added to people’s day job. In the period from 1 April 2019 to 30 September 2019 (Quarter 1 and Quarter 2), they had dealt with 6,659 concerns, 1,620 of which related to patient safety issues and 2,476 included elements of bullying and harassment2.

1.2 Sir Robert Francis QC has urged NHS Boards and managers to welcome staff raising concerns (whistleblowing), in the same way as staff are encouraged to report incidents. Kent Community Health NHS Foundation Trust’s (KCHFT) policy is in line with the national Freedom to Speak Up (Whisteblowing) policy. This says that staff should initially try to raise concerns with their manager or a more senior manager, but if this does not lead to satisfactory action (for example an investigation) or if the staff member feels uncomfortable for whatever reason, they can contact the Freedom to Speak Up Guardian for advice and support. It is all in support of creating a more open culture that puts patient and staff safety at the heart of what we do.

1.3 No-one should experience discrimination or be victimised for speaking up, but

we know fear of this can prevent staff from doing so. Those who raise concerns via the Freedom to Speak Up process can expect to receive support and advice from the Trust’s Freedom to Speak Up Guardian, as will managers with whom the concerns are raised. The role of the Freedom to Speak Up Guardian is to be impartial and ensure that a fair and timely investigation into concerns takes place and that outcomes, actions and learning are shared.

1.4 This report covers the period 1 April 2019 to 30 September 2019 (Quarter 1

and Quarter 2).

2. Summary of cases

2.1 Four cases have been opened during the period of 1 April 2019 to 30 September 2019. Of these cases, two remain open and staff members are being supported to take the issues forward. A summary of the categories covered is below:

• Bullying and Harassment

• Patient safety

• Perceived detriment

1 Source: Freedom to Speak Up Index Report 2019 2 Source: National Guardians Office Website

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2.2 Within the data submitted, no cases were raised by staff members going through either the Capability or Disciplinary process.

2.3 The FTSU Guardian offers a 3 month follow up of all cases to establish that

any changes that have been put into place are sustainable.

2.4 It remains difficult to obtain formal feedback (verbal or written), however the 3 month review encourages staff members to reflect on their experience of speaking up.

3. Fostering a culture of openness

3.1 Since the last report, the number of FTSU Ambassadors within the Trust has reduced from 14 to 9 with ambassadors leaving the Trust or being unable to continue in the role.

3.2 Details of the new FTSU Guardian has been published on FLO and

communicated through FLOMail in September 2019. This has resulted in one member of staff expressing an interest in becoming an Ambassador.

3.4 The FTSU Guardian will continue to promote the speaking up culture via

regular communications on FLO, distributing leaflets and other promotional material across all sites, as well as attending team meetings when required.

4. Freedom to Speak Up Index Report 2019

Background In September 2019, the National Guardian’s Office published the ‘Freedom to Speak Up Index Report 2019’. This Index identifies the view of staff on the speaking up culture in all NHS Trusts and NHS Foundation Trusts across the country. The Index Report has been included as Appendix 1. The index calculations were based on the mean average of responses to four questions in the 2018 annual staff survey. The survey questions used were:

• % of staff responded “agreeing” or “strongly agreeing” that their organisation treats staff who are involved in an error, near miss or incident fairly (Q17a).

• % of staff responded “agreeing” or strongly agreeing” that their organisation encourages them to report errors, near misses or incidents (Q17b).

• % of staff responded “agreeing” or “strongly agreeing” that if they were concerned about unsafe clinical practice, they would know how to report it (Q18a).

• % of staff responded “agreeing” or “strongly agreeing” that they would feel secure raising concerns about unsafe clinical practice (Q18b).

Assessment The current FTSU Index for Kent Community Health NHS Foundation Trust is 81%.

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The national median FTSU Index for Community Trusts is 83%, and there are currently 10 community trusts across the country with a higher index score.

5. Forward Plan

• To maintain and work towards improving the FTSU Index score by continuing to promote the role of the FTSU Guardian and embed a positive culture of speaking up across the trust.

• To develop a FTSU Improvement Strategy aligned to a gap analysis against the recommendations from the National Guardian.

• To arrange a FTSU meeting for Ambassadors to ensure that the ambassador role is embedded within services.

• To target the staff networks and ensure that all staff members and groups access FTSU when requiring the service.

• Strengthen the support for the Guardian and Ambassadors including access to peer support, counselling and professional development.

• To develop case studies and continue to report on themes and trends from cases.

6. Recommendation

The Board is asked to note the report. Joy Fuller Freedom to Speak Up Guardian November 2019

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Freedom to Speak Up

Index Report 2019

Sub heading F

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National Guardian’s Office

2

Contents

Foreword by Simon Stevens, CEO NHS England and NHS Improvement 03 Foreword by Dr Henrietta Hughes, National Guardian for the NHS 04 Introduction 05 Survey questions and Freedom to Speak Up Index 06 Summary of results 08 Cambridgeshire Community Services NHS Trust 10 Liverpool Heart and Chest NHS Foundation Trust 11 Tees Esk and Wear Valleys NHS Foundation Trust 14 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust 17 Increase and decrease in the Freedom to Speak Up Index 2015-2018 20 London Ambulance Service 22 Surrey and Borders Partnership NHS Foundation Trust 23 Conclusion and next steps 25 Annex 1: The Freedom to Speak Up Index 26 Acknowledgements 32

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Foreword by Simon Stevens

Speaking out when you see something going wrong at work takes courage no matter what your job. When you work in the NHS – as a nurse, doctor, physio or in any other role – it can sometimes also feel a lonely and daunting experience. That is why we are determined to ensure we do everything possible to support those who make their voices heard on behalf of patients. Freedom to speak up guardians can be a very powerful presence to ensure that NHS organisations – their management and boards – listen to concerns. NHS England is tripling funding and we now have 500 guardians in place across the country.

In the past, however, not every NHS organisation has done enough to make staff feel that they can speak out. That is why last year I asked the National Guardian to help measure how free nurses, doctors and other staff felt to raise concerns at different organisations. Twelve months on there is encouraging progress in making NHS organisations more open and transparent. Our staff are world-class but if we want to help them to deliver the improvements in care and treatment set out in the NHS Long Term Plan we need to show them the same duty of care, compassion and empathy that we provide our patients. A porter, nurse or consultant surgeon who speaks up is an invaluable part of any NHS organisation – they do so because they want the very best for their patients and their colleagues. And trusts that allow staff to speak out about issues are likely to deliver better outcomes for patients and will have happier staff. The Freedom to Speak Up Index helps trusts understand how their staff perceive the speaking up culture. Trusts can compare their scores to others, buddy up with those that have received higher index scores and promote learning and good practice. Already the index is having a significant impact, with 180 trusts (82%) having made progress in making it easier for staff to speak out since 2015, with London Ambulance improving its rating by 18%. This means more staff than ever before feel secure raising concerns if they see something unsafe and feel confident that if they were to make a mistake, they would be treated fairly by their trust. But a more open and transparent working culture will not just mean happier staff, it will also mean happier patients too. Evidence consistently shows that a positive speaking up culture leads to better CQC ratings, and ultimately better care for our patients. And this is what drives over a million people to go to work for the NHS every day. It is everyone’s responsibility to speak up when they see something that doesn’t look right – and now more than ever, staff are doing exactly that.

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Foreword by Dr Henrietta Hughes

Everyone needs to be valued and listened to and feel fairly treated at work. Nowhere is this more important than in health when it can be a matter of life or death. A positive environment and a supportive culture are key elements of the People Plan1. We have shown that a positive speaking up culture is often associated with higher performing organisations. Workers are the eyes and ears of an organisation and they should be listened to when considering patient safety and experience. The best leaders understand how important this is. These leaders create an inclusive speaking up culture where everyone’s insight and expertise is valued, and all workers are empowered to speak up and contribute to improvements in patient care. Culture is a term which can be interpreted in different ways. To some it might seem vague and difficult to pin down. Some organisations want their culture to change but do not know where to start or how to change. In our Freedom to Speak Up Guardian Surveys, we showed that guardians in organisations rated Outstanding by the Care Quality Commission were more positive in their perceptions of the speaking up culture2. To ensure speaking up becomes business as usual, the voices of other workers must also be involved. We have therefore created a single measure from four questions from the 2018 NHS Staff Survey3. This new Freedom to Speak Up Index, brought together by my office and NHS England, identifies the view of the staff on the speaking up culture in NHS Trusts and Foundation Trusts (FTs). For trust boards to be able to use a measure to learn more about their own Freedom to Speak Up culture, as experienced by their workforce, is an opportunity for improvement. This is not a perfect tool, as it is based on a sample of staff and there are additional limitations as students, volunteers and others are not included. When it comes to establishing effective speaking up cultures, the highest scoring NHS trusts and Foundation Trusts featured in this report have shared their experience for the rest of the health system to learn from. They have had meaningful conversations with their workers, embraced opportunities to improve, followed guidance from my office and developed innovative ways to create and sustain a positive speaking up culture for their workforce. The average FTSU Index score nationally has increased since 2015 and I am optimistic that this will continue to improve but not complacent about the organisations in which there is significant room for improvement. I call on leaders and Freedom to Speak Up Guardians in NHS trusts and FTs to use the index as a new measure for assessing the speaking up culture in their organisation. The insights of the organisations featured in this report will help you find comparable organisations with whom you can buddy up and learn from the best in the NHS. I encourage commissioners and regulators to use the FTSU Index to ask providers about their speaking up arrangements and to encourage improvement.

1 https://www.longtermplan.nhs.uk/publication/interim-nhs-people-plan/ 2 https://www.cqc.org.uk/sites/default/files/20171115_ngo_annualreport201617.pdf 3 https://www.nhsstaffsurveys.com/Page/1056/Home/NHS-Staff-Survey-2018/

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Introduction

The Interim People Plan aims to ‘to grow the NHS’s workforce, support and develop NHS leaders and make our NHS the best place to work’. The plan says that in addition to recruiting extra staff, much more needs to be done to improve staff retention and transform ways of working. Secretary of State Matt Hancock MP has said that ‘we need …. a more supportive culture to make that plan a reality’4. A positive speaking up environment where workers feel valued and listened to is fundamental to developing a supportive culture. The events at Mid Staffs5 and Gosport War Memorial Hospital6 serve as reminders of the harm that can occur to patients when this type of culture does not exist. Following the publication of the Francis Freedom to Speak Up Review in 20157 Trusts and Foundation Trusts in England have appointed Freedom to Speak Up Guardians8. The network has now grown to over 1000 guardians, champions and ambassadors in NHS trusts and FTs, independent sector providers, national bodies and primary care organisations. Thousands of cases have been brought to Freedom to Speak Up Guardians since April 20179. The National Guardian’s Office has previously published survey reports that indicate that a positive speaking up culture is associated with higher performing organisations as rated by CQC. The annual NHS staff survey contains several questions that serve as helpful indicators of the speaking up culture. Working with NHS England, the National Guardian’s Office has brought four questions together into a ‘Freedom to Speak Up (FTSU) index’. This is to enable trusts to see at a glance how their FTSU culture compares with others. This will promote the sharing of good practice and enable trusts that are struggling, to ‘buddy up’ with those that have recorded higher index scores. The results throughout are based on the results of the 2018 NHS annual staff survey. Where percentage point improvement is recorded, this is based on the overall changes recorded between 2015 and 2018. Nationally the median FTSU score has improved since 2015. Some trusts have seen a rapid improvement in their FTSU index score and in others there has been a reduction in the score. We have included case studies from the best performing trusts of each type and those that have made the most significant improvement. These case studies detail the changes that trusts have made to engage with their workforce and develop a positive speaking up culture and the impact that this has made. The Freedom to Speak Up Index for each trust and the CQC ratings for Overall and Well Led are included in Annex 1. The information is taken from the CQC website10 and the annual NHS Staff Survey at the time of publication.

4 https://www.england.nhs.uk/2019/06/more-staff-not-enough-nhs-must-also-be-best-place-to-work-says-new-nhs-people-plan/ 5 https://www.bbc.co.uk/news/health-21244190 6 https://www.bbc.co.uk/news/topics/cx2pw2r8yp9t/gosport-hospital-deaths 7 http://freedomtospeakup.org.uk/the-report/ 8 https://www.cqc.org.uk/sites/default/files/20180213_ngo_freedom_to_speak_up_guardian_jd_march2018_v5.pdf 9 https://www.cqc.org.uk/sites/default/files/CCS119_CCS0718215408-001_NGO%20Annual%20Report%202018_WEB_Accessible-2.pdf 10 https://www.cqc.org.uk/

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Survey questions and FTSU Index

The FTSU index was calculated as the mean average of responses to four questions from the NHS Annual Staff Survey.

The survey questions that have been used to make up the FTSU index are:

• % of staff responded "agreeing" or "strongly agreeing" that their organisation

treats staff who are involved in an error, near miss or incident fairly (question 17a)

• % of staff responded "agreeing" or "strongly agreeing" that their organisation

encourages them to report errors, near misses or incidents (question 17b)

• % of staff responded "agreeing" or "strongly agreeing" that if they were concerned

about unsafe clinical practice, they would know how to report it (question 18a)

• % of staff responded "agreeing" or "strongly agreeing" that they would feel secure

raising concerns about unsafe clinical practice (question 18b)

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Summary of results

Overall, the national median FTSU index has increased since 2015, and this pattern is reflected for all trust types:

FTSU index

Trust type 2015 2016 2017 2018

National 75% 77% 77% 78%

Acute Specialist Trusts 79% 79% 79% 81%

Acute Trusts 75% 76% 76% 77%

Ambulance Trusts 66% 69% 69% 74%

Combined Acute and Community Trusts 76% 77% 77% 78%

Combined Mental Health / Learning Disability and Community Trusts

78% 77% 79% 80%

Community Trusts 79% 80% 81% 83%

Mental Health / Learning Disability Trusts 74% 76% 77% 79%

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The following represent the trusts with the highest FTSU index result for 2018, broken down by trust type:

Trust type Trust FTSU index value 2018

Community Cambridgeshire Community Services NHS Trust

87%

Combined mental health / learning disability and community trust

Solent NHS Trust 86%

Acute Specialist Liverpool Heart and Chest Hospital NHS Foundation Trust

86%

Acute The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

84%

Combined acute and community

Gateshead Health NHS Foundation Trust 83%

Combined mental health / learning disability

Surrey and Borders Partnership NHS Foundation Trust

81%

Combined mental health / learning disability

Northumberland, Tyne and Wear NHS Foundation Trust

81%

Combined mental health / learning disability

Tees, Esk and Wear Valleys NHS Foundation Trust

81%

Combined mental health / learning disability

Tavistock and Portman NHS Foundation Trust

81%

Ambulance Isle of Wight NHS Trust (ambulance sector) 79%

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Cambridgeshire Community Services NHS Trust: Visible leadership in action

“Our transparent and open culture has been built up over a number of years and during that time we have developed a style across the organisation that puts our people first. We have a long

standing systematic ‘back to the floor’ programme in place that our senior leaders prioritise each month and this visibility and approach is positively received by our staff. Additionally, it is in the DNA of the organisation for all our leaders to be out and about every week, talking and listening to staff in an informal and low-key way. We have lots of examples through these visits of our staff sharing concerns and issues and feeling very comfortable and confident to speak up. We support our managers to be leaders and have embedded compassionate leadership into our internal

development programmes and our appraisal systems and processes.

We developed our values with our staff over 8 years ago and we continually check that they remain valid today through talking with our staff. Our values and agreed set of behaviours are embedded in all that we do, and we spend time and energy on making sure we encourage people to speak up if they are concerned about anything. How our staff speak up is entirely up to them, there is never a wrong way. We are explicit at induction about

them never worrying about telling the wrong person the most important thing if they are concerned about anything is to tell someone! They can raise concerns informally or formally and we work with them directly to agree how they wish their concern to be handled. They can speak with their line manager; another member of their team; contact our Freedom to

Speak Up Guardian or one of our Freedom to Speak Up Champions; link with our full-time staff side chair; speak with one of our Cultural Ambassadors or share directly with our Chief Executive or another member of our Executive team and we have lots of examples of when our staff have done this. We always provide feedback to individuals who raise concerns so that they are assured and confident that their issue/s have been dealt with. We

also deal with concerns anonymously if requested to do so - the most important thing for us is that the concern is being heard and acted upon. We are very proud of our annual national staff survey results and have seen year on year improvements. We focus on a small number of improvement areas each year rather than everything and through the results our staff have fed back that they feel secure in raising concerns; that they are confident that we would deal with these and that they feel engaged and valued. We continue to make further improvements to ensure that we are an excellent employer and one of the NHS Best Places to Work.”

‘it is in the DNA of the organisation for all our leaders to be out and about every week, talking and listening to staff in an informal and low-key way. We have lots of examples through these visits of our staff sharing concerns and issues and feeling very comfortable and confident to speak up’.

‘We support our managers to be leaders and have embedded compassionate leadership into our internal development programmes and our appraisal systems and processes’.

‘We are explicit at induction about them never worrying about telling the wrong person the most important thing if they are concerned about anything is to tell someone!’

‘..through the results our staff have fed back that they feel secure in raising concerns; that they are confident that we would deal with these and that they feel engaged and valued’.

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Liverpool Heart and Chest Hospital NHS FT: Learning and Sharing to create an open and safe culture

Freedom to Speak Up Guardian Helen Turner with Mr Sanjay Ghotkar and the FTSU Charter “Liverpool Heart and Chest Hospital is committed to FTSU and its principles, patient safety and staff experience are at the heart of everything we do. Our Board of Directors takes an active interest in concerns raised by staff, the process in which these are dealt with and supports an ethos of learning and sharing. The Trust’s approach to FTSU is summed up by the Chief Executive’s 3-point pledge which is widely communicated:

Please Speak Up – when you do:

I will listen

I will investigate, and if you let me know who you are you will receive feedback

I will keep you safe

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A quarterly ‘Freedom to Speak Up Summit’ is chaired by the Director of Corporate Affairs /Executive Lead for FTSU and attended by the Chief Executive, Medical Director, Director of Nursing, Director of Workforce, Deputy Director of Nursing, Freedom to Speak up Guardian and Deputy Freedom to Speak up Guardian. The commitment of the Trust towards empowering staff to speak up, keeping both patients and staff safe is demonstrated by the membership of the group. The purpose of the summit is to review the quarter’s speak ups and triangulate data from staff experience and patient safety looking for trends, themes and any areas that maybe hotspots in order that any action can be identified and swiftly taken.

Patient Safety

The Trust is constantly innovating to ensure patient safety, the data produced for the summit includes serious incidents, never events and incident reporting but also data from the daily trust wide safety huddle convened in the Chief Executive’s office where current issues are raised and escalated immediately. Other data shared at the summit include HALT an innovation that was introduced at the Trust in 2015. HALT is an acronym that stands for Have you seen this? Ask – did you hear my concern? Let them know it is a patient safety issue Tell them to STOP until it is agreed it is safe to continue HALT empowers all staff no matter what grade and whether clinical or not to use the HALT process if they see a potential patient or staff safety incident. HALT has not only prevented 92 safety incidents to date, since its inception but has broken down hierarchical barriers that have traditionally existed in healthcare. A monthly Learning and Sharing Forum brings together senior leaders, including ward and departmental managers to cascade learning, share examples and promote an open and safe culture.

‘The Trust is constantly innovating to ensure patient safety, the data produced for the summit includes the usual serious incidents, never events, incident reporting but also data from the daily trust wide safety huddle convened in the Chief Executive’s office where current issues are raised and escalated immediately’.

HALT is an acronym that stands for Have you seen this? Ask – did you hear my concern? Let them know it is a patient safety issue Tell them to STOP until it is agreed it is safe to continue

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Staff Experience

Workforce data is shared at the summit including an HR relations report, which includes the number of bullying and harassment, grievances/ET claims, disciplinaries, suspensions etc. Also, innovations such as ‘grass is greener’ data is shared and discussed. The ‘grass is greener’ is an initiative which encourages staff who are leaving or thinking about leaving the Trust to understand their reasons and look at what we could do to reduce turnover and improve staff safety and experience.

Freedom to Speak Up Guardian

The Freedom to Speak Up Guardian (FTSUG) reports to the membership not just on concerns raised and action taken but also on national guidance and any actions the Trust needs to take to ensure best practice, this means benchmarking against case reviews, information from the latest NGO guidance and reporting on pertinent issues from the regional network groups and the national conference.

Learning from Freedom to Speak Up

Feedback from our staff has revealed that at times managers and those with supervisory roles have felt vulnerable about staff speaking up against them, sometimes as a result of unpopular management decision. In response to this we have worked with staff to develop an ‘FTSU Charter’ setting out clearly what can be expected both when you speak up and when you are spoken up about. The focus on FTSU and Board level membership of the summit means that the Trust is proactive and not just reactive in dealing with matters of patient and staff safety and is constantly pushing the agenda forward through innovation.”

‘The “grass is greener” is an initiative which encourages staff who are leaving or thinking about leaving the Trust to understand their reasons and look at what we could do to reduce turnover and improve staff safety and experience’

‘we have worked with staff to develop an ‘FTSU Charter’ setting out clearly what can be expected both when you speak up and when you are spoken up about’.

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Tees Esk and Wear Valleys NHS Foundation Trust: Speaking Up drives improvement

Freedom to Speak Up Guardian Dewi Williams “We are using the principles identified within the 2017 Freedom to Speak Up Guardians survey as a framework for the description of how Tees, Esk and Wear Valleys NHS Foundation Trust has sought to make Freedom to Speak Up arrangements business as usual.”

• FAIRNESS. The Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) Freedom to

Speak Up Guardian (FTSUG) Dewi Williams, was appointed in October 2016 following

interview as part of a post retirement redeployment process. He currently works 18 ½

hours a week, and this is his sole employment.

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• REACH AND DIVERSITY. We have a developing network of ‘Dignity at work champions,’

who support the FTSUG and who will be key to the success of our new Bullying and

Harassment Resolution Procedure. We currently have 16 champions but hope to have

around 40 by the end of the year. It is intended that

they are present within each of the TEWV

geographical localities and will be representative of

protected characteristic groups. We also have a

deputy FTSUG working one day a week, Barry

Speak, who is a psychologist and works in a staff

wellbeing service.

• COMMUNICATION. We have a monthly awareness raising message attached to our

electronic staff newsletter which communicates key messages and reminds staff about

where they can get support with Speaking Up. The FTSUG also has an intranet page

where staff can get contact details, see the policy, and get downloadable posters.

• PARTNERSHIP. We have developed a monthly in-house support forum. Staff from a range

of staff wellbeing services get together to share intelligence, debrief, and support each

other in what could otherwise be very isolated and challenging roles. Part of the FTSUG

role is to meet as many people as possible to raise awareness. The FTSUG conducts

regular staff training in all our sites. The opportunity is taken to conduct informal meetings

with teams in those sites.

• LEADERSHIP. Board of Directors and Executive Management Team members undertake

a series of planned visits each month to individual wards and departments throughout the

Trust to engage directly with staff about service and workplace issues, including speaking

up. The FTSUG meets at least bi-monthly with the chief executive and the director of

human resources. He also meets regularly with many other senior managers as part of the

role. He meets at least twice yearly with the executive and non-executive directors with

responsibility for Speaking Up. They also

deliver twice yearly board reports.

Demonstrating board commitment to Speaking

Up can be seen by our [staff] video which

shares directors’ values, beliefs, and

commitment to ensuring that staff can feel safe

to come forward.

‘Board of Directors and Executive Management Team members undertake a series of planned visits each month to individual wards and departments throughout the Trust to engage directly with staff about service and workplace issues, including speaking up’

‘We have a monthly awareness raising message attached to our electronic staff newsletter which communicates key messages and reminds staff about where they can get support with Speaking Up’.

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• FEEDBACK. At the conclusion of cases the FTSUG has asked two questions; would you

do it again, and did you experience any detriment? Whilst getting many complimentary

replies, the specific questions have been sporadic. We will be addressing this issue as part

of an upcoming process review day. In addition to approaching their line manager, the

Dignity at Work Champions and the FTSUG all TEWV staff can raise concerns

electronically and anonymously, should they

choose to do so. Each of these concerns are

published within the TEWV e-bulletin along

with the responses that are agreed by the

Executive Management Team under the

heading of ‘You said, we did.’

• PROACTIVE AND REACTIVE ROLE. We

are constantly reviewing how we are doing

and improving practice. We are to hold an

event with some of those who have

experience of conducting whistleblowing

investigations, and some who have

experienced being investigated, to look for

opportunities to standardise and improve the

experience for all involved. Initially the FTSUG role was predominantly reactive. However,

are using our Staff ‘Friends and Family’ results to identify teams that may benefit from

proactive support awareness raising, and training.

•

• ATTENDING SUPPORT NETWORKS. On appointment the FTSUG attended the initial

training provided by the National Guardian’s Office and has since attended updates

delivered within the regional network. To date the FTSUG has been to three national

conferences, and regularly attends the very useful and supportive regional meetings.

• DATA MANAGEMENT. We have a confidential data storage system. It has benefitted

from being audited. Currently we only log issues raised with the FTSUG and we know that

many more issues are raised with line managers and are successfully handled. However,

we do not know exactly how many, and therefore are not able to quantify, or benefit from

the potential shared learning. We aspire to developing an acceptable data gathering

approach that will help us develop a library of experience from which we can share more

learning.”

In addition to approaching their line

manager, the Dignity at Work

Champions and the FTSUG all

TEWV staff can raise concerns

electronically and anonymously,

should they choose to do so. Each

of these concerns are published

within the TEWV e-bulletin along

with the responses that are agreed

by the Executive Management

Team under the heading of ‘You

said, we did.’

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The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust: Reach and visibility to engage staff

Freedom to Speak Up Guardian Helen Martin with Tom Beaumont, Sally Papworth and Catherine Bishop “In 2013 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust faced a number of significant challenges, including a poor CQC rating. A programme of improvement and culture change was introduced by our Board. Within this journey we heard staff in our cultural audit say that they wanted to feel safer in raising concerns, so we developed our culture of safety. A major part of this was the creation of our first Freedom to Speak Up Guardian (FTSUG) post. The Trust took guidance from the National Guardian

Office (NGO) conference to ensure that the role was ring-fenced to meet its full requirements and that networking with national and local colleagues was encouraged to help develop and evolve the role. We used feedback from our cultural audit to shape our own [framework]. Staff wanted easy access, more face-to-face interactions and visibility irrespective of ethnicity or background. Our Guardian devised a clear policy around speaking up, supported by a communications strategy.

‘we heard staff in our cultural audit say that they wanted to feel safer in raising concerns, so we developed our culture of safety’.

‘The Trust took guidance from the

National Guardian Office (NGO) conference to ensure that the role was ring-fenced to meet its full requirements and that networking with national and local colleagues was encouraged to help develop and evolve the role’.

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Our guardian attended team meetings, delivered presentations including to trust induction, facilitated focus groups, as well as deployed our highly successful (and decorated) roaming trolley. The trolley rounds of our wards were often accompanied by our diversity team or one of our executives, demonstrating that we wanted to hear the voices of all our staff and as part of our Board commitment. Our Board developed a public statement of commitment and benchmarked our progress within interactive Board development session. They also receive regular feedback from our Guardian and support her wellbeing through supervision. The Trust built on our local and trust governance structure, with a renewed focus on learning from errors. This was underpinned with new incident reporting forms which encourage sharing and learning of good practice from errors as well as raising improvement ideas and issues. Both have made significant impacts to the reporting culture of RBCH. Helen Martin, the Trust’s Freedom to Speak Up Guardian, said: ‘The key to all our work has been listening to our staff to develop a culture of safety and feedback. Raising concerns is something that should routinely be done and as part of an ongoing conversation. We continue to evolve our model

and feel that we are in the best position to support our staff in our future organisation change.’ Our guardian has now expanded the role to a team of six ambassadors across a variety of professional backgrounds which has made speaking up more accessible. Helen is now also working across Royal Bournemouth and Poole hospitals, as our two trusts move towards merger. This ensures staff have access to FTSU teams while undergoing significant organisational

changes. Six years on and RBCH is seeing the benefits of the Trust-wide programme of improvement, including national leaders for safety culture and staff engagement. Helen Martin added, ‘We are proud to see that RBCH is recognised as having the highest index score for 2018 for acute trusts further demonstrating the success of our cultural journey over the last six years’.”

‘The trolley rounds of our wards were often accompanied by our diversity team or one of our executives, demonstrating that we wanted to hear the voices of all our staff and as part of our Board commitment’.

‘..new incident reporting forms which encourage sharing and learning of good practice from errors as well as raising improvement ideas and issues. Both have made significant impacts to the reporting culture of RBCH’.

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The ‘Roaming Trolley’ at Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

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Increase and decrease in the FTSU index by individual trust

The table below shows the percentage point increase and decrease in FTSU Index value during the period 2015 – 2018 for 220 trusts. Of these 220 trusts:

• 180 recorded an overall increase 2015 - 2018 in FTSU index (82%)

• 40 recorded an overall decrease 2015 – 2018 in FTSU index (18%)

• The highest overall increase was recorded by London Ambulance Service NHS Trust (18 percentage points)

• The greatest overall decrease was recorded by Wrightington, Wigan and Leigh NHS Foundation Trust (-4 percentage points)

Trusts with greatest overall increase in FTSU index

Trust 2015 2018 2015 - 18

London Ambulance Service NHS Trust 57 75 18

Isle of Wight NHS Trust (ambulance sector) 62 79 17

North East Ambulance Service NHS Foundation Trust

64 76 12

East Sussex Healthcare NHS Trust 66 78 12

South East Coast Ambulance Service NHS Foundation Trust

64 74 10

The Royal Orthopaedic Hospital NHS Foundation Trust

73 82 9

Sherwood Forest Hospitals NHS Foundation Trust

70 79 9

Isle of Wight NHS Trust (mental health sector) 69 77 8

Gloucestershire Care Services NHS Trust 74 82 8

Lincolnshire Partnership NHS Foundation Trust

72 80 8

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Trusts with greatest overall decrease in FTSU index

Trust 2015 2018 2015 - 18

Great Western Hospitals NHS Foundation Trust

81 79 -2

Salisbury NHS Foundation Trust 82 80 -2

East and North Hertfordshire NHS Trust 75 73 -2

The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust

74 72 -2

King's College Hospital NHS Foundation Trust 77 75 -2

Great Ormond Street Hospital for Children NHS Foundation Trust

80 78 -2

James Paget University Hospitals NHS Foundation Trust

79 76 -3

Wrightington, Wigan and Leigh NHS Foundation Trust

81 77 -4

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London Ambulance Service: 100 Voices Case Study

At London Ambulance Service NHS Trust (LAS), a paramedic spoke up to the Freedom to Speak Up Guardian, Katy Crichton, about a number of matters. The issues reported to Katy ranged from challenging behaviours to service-wide problems, such as a lack of training for new staff and inadequate capacity to deal with call volumes. The paramedic told Katy, “I had sat in the office for several weeks worrying if I should speak to a colleague, a manager or a friend outside work. Occasionally, I would convince myself that I was exaggerating the state of affairs. Feeling isolated, I decided to contact the LAS guardian. “My brief email prompted a very quick reply back from the guardian. We met a few days later in a coffee shop away from work and I already felt I was going to be taken seriously.” Katy escalated the matters and, with the involvement of the leadership team, including the Chief Executive, an action plan was established. After a couple of months, a review of the issues revealed that the actions had not gone far enough, and further measures were put in place, taking into account advice from the paramedic who spoke up.

The paramedic said, “I have seen significant changes in my place of work. It is a much more pleasant place to be. People are listened to and actions have been taken.” As a result of the issues raised, the trust increased

staffing levels in some areas, developed a new operational structure for the service, invested in additional training for staff, and monitored calls through a regular audit. Feedback from commissioners reported positive changes to the service and outcomes for patients. Katy said, “We are very grateful that the paramedic felt able to come forward. By speaking up they have improved the working environment for themselves and for our patients. “Listening to staff and learning from them is hugely important. It was particularly gratifying that the leadership team continued to listen, even after they had drawn up an action plan, and modified it based on further feedback. The ongoing experiences of the paramedic who spoke up really helped to address the problems in a comprehensive way.” The paramedic remarked when reflecting on their experience of speaking up, “One thing is for sure – an email to the guardian changed a lot, making the trust a better place to work and providing safer care for our patients.”

‘an email to the Guardian changed a lot, making the trust a better place to work and providing safer care for our patients’

‘I have seen significant changes in my place of work. It is a much more pleasant place to be. People are listened to and actions have been taken’

‘Listening to staff and learning from them is hugely important’

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Surrey and Borders Partnership NHS Foundation Trust: Joy at work

Freedom to Speak Up Guardian Lynn Richardson with Roopavathay Krishnan “Surrey and Borders Partnership NHS Foundation Trust appointed its Freedom to Speak Up Guardian (FTSUG) through open competition in October 2016. The FTSUG came into post from April 2017 and since then has worked with the senior leadership and staff teams as part of our work to further develop the culture within our Trust. SABP is a mental health and learning disability Trust with many sites spread across Surrey and North East Hampshire. We have always aspired to be a diverse and inclusive Trust; one of our first activities when we were formed in 2005, led by our Chief Executive and Chair, was to coproduce our Vision and Values through a series of conversations with people who use our services, carers and families, other stakeholders and our staff. Our Values have guided us, as our “compass”, and formed the foundations for our aspirations ever since. Building upon them we have placed great importance on our staff’s

‘one of our first activities when we were formed in 2005, led by our Chief Executive and Chair, was to coproduce our Vision and Values through a series of conversations with people who use our services, carers and families, other stakeholders and our staff. Our Values have guided us, as our “compass”, and formed the foundations for our aspirations ever since’.

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responses through the national staff survey and working closely with our Staff Networks to develop our practice as part of staff engagement. Once our FTSUG was in post, we began to gain a rich intelligence through our quarterly Speaking Up reports. These enabled the senior leadership team to begin thinking about building upon Speaking Up, as part of our quality improvement approach, to build a workforce where our employees enjoy coming to work, are encouraged to develop their skills and by so doing, create a compassionate, caring culture for the people who use our services. Our Senior Leadership team undertook a programme of staff consultations with our workforce in the summer of 2018 in order to understand what gave our employees ‘Joy At Work’ but also where we needed to do better to improve their working experience. We took away actions such as improved information technology needs and the re-introduction of water coolers. The important part of this exercise was for the voice of our staff to be heard by our senior

leaders and this has been built upon since then. For example, we used to organise our own programme of Board and Governor “walkaround” visits with a checklist of things to look out for in our services. Since really listening to our staff, we now ask our teams to invite us to their service and encourage them to show us the things they are really proud of.

We also really wanted to welcome our new recruits into the organisation effectively and instil our belief in a speaking up culture. We changed our induction programme to make it shorter, based on feedback, and since our FTSUG has been speaking at that programme, we have had some excellent intelligence from our new staff on things we can improve upon. Our staff gain confidence by meeting our Guardian in person, either through induction or at team meetings/formal training events and we are pleased with our achievements to date in the first two years of our Raising Concerns approach.

‘we now ask our teams to invite us to their service e.g. to showcase for us the things they are proud of, rather than them feeling that we are checking up on them’

‘Our Senior Leadership team undertook a programme of staff consultations with our workforce in the summer of 2018 in order to understand what gave our employees ‘Joy At Work’ but also where we needed to do better to improve their working experience’.

‘Our staff gain confidence by meeting our Guardian in person, either through induction or at team meetings/formal training events and we are pleased with our achievements to date in the first two years of our Raising Concerns approach’.

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Conclusions and next steps

Listening to the voice of workers is fundamental to improving patient safety and experience and improving the working lives of our colleagues. At a time when the NHS workforce is under extreme pressure and trusts are seeking to recruit and retain staff the annual NHS Staff survey can provide vital insights into the experience of workers. In our previous publications we have shown that the perceptions of Freedom to Speak Up Guardians are linked with the performance of organisations as shown by their overall CQC rating. Freedom to Speak Up is inspected as part of the CQC Well Led Domain. For trust Boards to be able to use information to learn more about their own Freedom to Speak Up culture, as experienced by their workforce, is an opportunity for improvement. This may help to open a new conversation with their workforce, as many of the trusts featured in this report have done, developing their own innovations, borrowing the innovations identified here or buddying with similar trusts with higher FTSU index scores. For commissioners and regulators, this is potentially a lead indicator which can be viewed together with other information about safety, workforce and culture. The system needs to offer support, guidance and expertise to organisations where the workforce has indicated that there is room for improvement in the speaking up culture. Not all organisations in the health service ask their workforce the same questions as in the NHS staff survey, therefore we have not been able to use the FTSU Index for primary care organisations, independent sector providers and national bodies who have Freedom to Speak Up Guardians. For these organisations, there are insights to learn from this report, in terms of leadership behaviours and listening to the ideas and concerns from the workforce. Similar survey questions could potentially be devised to develop a FTSU Index for national bodies and others. We will continue to track the progress of NHS trusts and Foundation Trusts as they develop positive speaking up cultures for their workforce. In this way we work towards speaking up being business as usual.

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Annex 1

FTSU Index

FTSU index Name of trust

87% Cambridgeshire Community Services NHS Trust

86% Solent NHS Trust

86% Liverpool Heart and Chest Hospital NHS Foundation Trust

85% Hounslow and Richmond Community Healthcare NHS Trust

85% Northamptonshire Healthcare NHS Foundation Trust

84% Leeds Community Healthcare NHS Trust

84% The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

84% The Royal Marsden NHS Foundation Trust

84% Lincolnshire Community Health Services NHS Trust

83% The Christie NHS Foundation Trust

83% Hertfordshire Community NHS Trust

83% Sussex Community NHS Foundation Trust

83% Gateshead Health NHS Foundation Trust

83% Royal Brompton and Harefield NHS Foundation Trust

83% Moorfields Eye Hospital NHS Foundation Trust

83% Derbyshire Community Health Services NHS Foundation Trust

83% Norfolk Community Health and Care NHS Trust

83% Shropshire Community Health NHS Trust

82% The Royal Orthopaedic Hospital NHS Foundation Trust

82% Wirral Community NHS Foundation Trust

82% Surrey and Sussex Healthcare NHS Trust

82% Frimley Health NHS Foundation Trust

82% Guy's and St Thomas' NHS Foundation Trust

82% Northern Devon Healthcare NHS Trust

82% Gloucestershire Care Services NHS Trust

82% The Clatterbridge Cancer Centre NHS Foundation Trust

82% Cambridgeshire and Peterborough NHS Foundation Trust

82% Berkshire Healthcare NHS Foundation Trust

82% Northumbria Healthcare NHS Foundation Trust

82% Cumbria Partnership NHS Foundation Trust

82% Harrogate and District NHS Foundation Trust

81% Kent Community Health NHS Foundation Trust

81% Cambridge University Hospitals NHS Foundation Trust

81% The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT

81% South Warwickshire NHS Foundation Trust

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81% Airedale NHS Foundation Trust

81% City Hospitals Sunderland NHS Foundation Trust

81% Worcestershire Health and Care NHS Trust

81% Tavistock and Portman NHS Foundation Trust

81% East Lancashire Hospitals NHS Trust

81% Surrey and Borders Partnership NHS Foundation Trust

81% Kingston Hospital NHS Foundation Trust

81% St Helens and Knowsley Teaching Hospitals NHS Trust

81% University Hospital Southampton NHS Foundation Trust

81% North Tees and Hartlepool NHS Foundation Trust

81% The Newcastle upon Tyne Hospitals NHS Foundation Trust

81% Northumberland, Tyne and Wear NHS Foundation Trust

81% Royal Devon and Exeter NHS Foundation Trust

81% Pennine Care NHS Foundation Trust

81% West Suffolk NHS Foundation Trust

81% Somerset Partnership NHS Foundation Trust

81% Royal Surrey County Hospital NHS Foundation Trust

81% North East London NHS Foundation Trust

81% Midlands Partnership NHS Foundation Trust

81% Tees, Esk and Wear Valleys NHS Foundation Trust

80% Leicestershire Partnership NHS Trust

80% Oxford Health NHS Foundation Trust

80% Salisbury NHS Foundation Trust

80% Dorset HealthCare University NHS Foundation Trust

80% University Hospitals Coventry and Warwickshire NHS Trust

80% Cheshire and Wirral Partnership NHS Foundation Trust

80% Dudley and Walsall Mental Health Partnership NHS Trust

80% Hertfordshire Partnership University NHS Foundation Trust

80% Lincolnshire Partnership NHS Foundation Trust

80% Mersey Care NHS Foundation Trust

80% Central London Community Healthcare NHS Trust

80% Oxleas NHS Foundation Trust

80% North West Anglia NHS Foundation Trust

80% University Hospitals Plymouth NHS Trust

80% 2gether NHS Foundation Trust

80% Sheffield Children's NHS Foundation Trust

80% Nottingham University Hospitals NHS Trust

80% Tameside and Glossop Integrated Care NHS Foundation Trust

80% Southern Health NHS Foundation Trust

80% Queen Victoria Hospital NHS Foundation Trust

80% East London NHS Foundation Trust

80% East Cheshire NHS Trust

80% Royal Papworth Hospital NHS Foundation Trust

79% University Hospitals Bristol NHS Foundation Trust

79% Poole Hospital NHS Foundation Trust

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79% South West Yorkshire Partnership NHS Foundation Trust

79% Luton and Dunstable University Hospital NHS Foundation Trust

79% Mid Cheshire Hospitals NHS Foundation Trust

79% Sandwell and West Birmingham Hospitals NHS Trust

79% Leeds Teaching Hospitals NHS Trust

79% Isle of Wight NHS Trust (ambulance sector)

79% North West Boroughs Healthcare NHS Foundation Trust

79% Royal Berkshire NHS Foundation Trust

79% North Staffordshire Combined Healthcare NHS Trust

79% Central and North West London NHS Foundation Trust

79% Great Western Hospitals NHS Foundation Trust

79% Sherwood Forest Hospitals NHS Foundation Trust

79% Chelsea and Westminster Hospital NHS Foundation Trust

79% Cornwall Partnership NHS Foundation Trust

79% Blackpool Teaching Hospitals NHS Foundation Trust

79% Royal National Orthopaedic Hospital NHS Trust

79% Leeds and York Partnership NHS Foundation Trust

79% Sheffield Teaching Hospitals NHS Foundation Trust

79% University Hospitals of Morecambe Bay NHS Foundation Trust

79% Bolton NHS Foundation Trust

79% Portsmouth Hospitals NHS Trust

79% Bradford District Care NHS Foundation Trust

79% Calderdale and Huddersfield NHS Foundation Trust

79% The Walton Centre NHS Foundation Trust

79% Homerton University Hospital NHS Foundation Trust

79% West Hertfordshire Hospitals NHS Trust

79% Gloucestershire Hospitals NHS Foundation Trust

79% Devon Partnership NHS Trust

79% Camden and Islington NHS Foundation Trust

79% Sussex Partnership NHS Foundation Trust

79% Yeovil District Hospital NHS Foundation Trust

79% Bridgewater Community Healthcare NHS Foundation Trust

78% Manchester University NHS Foundation Trust

78% Buckinghamshire Healthcare NHS Trust

78% Lancashire Teaching Hospitals NHS Foundation Trust

78% Barnsley Hospital NHS Foundation Trust

78% Wye Valley NHS Trust

78% The Princess Alexandra Hospital NHS Trust

78% Birmingham Community Healthcare NHS Foundation Trust

78% West London NHS Trust

78% Hull and East Yorkshire Hospitals NHS Trust

78% Kettering General Hospital NHS Foundation Trust

78% Alder Hey Children's NHS Foundation Trust

78% Kent and Medway NHS and Social Care Partnership Trust

78% Milton Keynes University Hospital NHS Foundation Trust

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78% Southend University Hospital NHS Foundation Trust

78% Torbay and South Devon NHS Foundation Trust

78% University College London Hospitals NHS Foundation Trust

78% Greater Manchester Mental Health NHS Foundation Trust

78% East Sussex Healthcare NHS Trust

78% Bradford Teaching Hospitals NHS Foundation Trust

78% Great Ormond Street Hospital for Children NHS Foundation Trust

78% University Hospitals of Derby and Burton NHS Foundation Trust

78% South Tyneside NHS Foundation Trust

78% Birmingham Women's and Children's NHS Foundation Trust

78% Warrington and Halton Hospitals NHS Foundation Trust

78% Essex Partnership University NHS Foundation Trust

78% Taunton and Somerset NHS Foundation Trust

78% Dartford and Gravesham NHS Trust

78% Northampton General Hospital NHS Trust

78% Coventry and Warwickshire Partnership NHS Trust

78% Barnet, Enfield and Haringey Mental Health NHS Trust

77% Western Sussex Hospitals NHS Foundation Trust

77% Rotherham Doncaster and South Humber NHS Foundation Trust

77% Bedford Hospital NHS Trust

77% Ashford and St Peter's Hospitals NHS Foundation Trust

77% Stockport NHS Foundation Trust

77% Brighton and Sussex University Hospitals NHS Trust

77% The Royal Liverpool and Broadgreen University Hospitals NHS Trust

77% Barts Health NHS Trust

77% Nottinghamshire Healthcare NHS Foundation Trust

77% East Suffolk and North Essex NHS Foundation Trust

77% Hampshire Hospitals NHS Foundation Trust

77% Mid Essex Hospital Services NHS Trust

77% George Eliot Hospital NHS Trust

77% Lancashire Care NHS Foundation Trust

77% Isle of Wight NHS Trust (mental health sector)

77% Wrightington, Wigan and Leigh NHS Foundation Trust

77% Lewisham and Greenwich NHS Trust

77% Basildon and Thurrock University Hospitals NHS Foundation Trust

77% Imperial College Healthcare NHS Trust

77% Walsall Healthcare NHS Trust

77% Chesterfield Royal Hospital NHS Foundation Trust

77% Dorset County Hospital NHS Foundation Trust

77% Royal Free London NHS Foundation Trust

77% Oxford University Hospitals NHS Foundation Trust

77% Derbyshire Healthcare NHS Foundation Trust

77% Humber Teaching NHS Foundation Trust

77% The Royal Wolverhampton NHS Trust

76% South Central Ambulance Service NHS Foundation Trust

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76% Salford Royal NHS Foundation Trust

76% South London and Maudsley NHS Foundation Trust

76% The Rotherham NHS Foundation Trust

76% York Teaching Hospital NHS Foundation Trust

76% The Hillingdon Hospitals NHS Foundation Trust

76% North East Ambulance Service NHS Foundation Trust

76% Sheffield Health and Social Care NHS Foundation Trust

76% London North West University Healthcare NHS Trust

76% Avon and Wiltshire Mental Health Partnership NHS Trust

76% Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust

76% Isle of Wight NHS Trust (community sector)

76% Black Country Partnership NHS Foundation Trust

76% University Hospitals of Leicester NHS Trust

76% James Paget University Hospitals NHS Foundation Trust

76% Whittington Health NHS Trust

76% Liverpool Women's NHS Foundation Trust

76% Birmingham and Solihull Mental Health NHS Foundation Trust

76% South West London And St George's Mental Health NHS Trust

76% Barking, Havering And Redbridge University Hospitals NHS Trust

75% Countess of Chester Hospital NHS Foundation Trust

75% North Bristol NHS Trust

75% Croydon Health Services NHS Trust

75% Mid Yorkshire Hospitals NHS Trust

75% King's College Hospital NHS Foundation Trust

75% University Hospitals Birmingham NHS Foundation Trust

75% Royal United Hospitals Bath NHS Foundation Trust

75% County Durham and Darlington NHS Foundation Trust

75% Maidstone and Tunbridge Wells NHS Trust

75% Aintree University Hospital NHS Foundation Trust

75% The Dudley Group NHS Foundation Trust

75% Royal Cornwall Hospitals NHS Trust

75% Norfolk and Norwich University Hospitals NHS Foundation Trust

75% Weston Area Health NHS Trust

75% Norfolk and Suffolk NHS Foundation Trust

75% Epsom and St Helier University Hospitals NHS Trust

75% London Ambulance Service NHS Trust

75% Pennine Acute Hospitals NHS Trust

75% East Kent Hospitals University NHS Foundation Trust

74% North Middlesex University Hospital NHS Trust

74% St George's University Hospitals NHS Foundation Trust

74% South East Coast Ambulance Service NHS Foundation Trust

74% University Hospitals of North Midlands NHS Trust

74% Worcestershire Acute Hospitals NHS Trust

74% West Midlands Ambulance Service NHS Foundation Trust

74% Northern Lincolnshire and Goole NHS Foundation Trust

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74% North West Ambulance Service NHS Trust

73% Wirral University Teaching Hospital NHS Foundation Trust

73% Isle of Wight NHS Trust (acute sector)

73% South Tees Hospitals NHS Foundation Trust

73% East and North Hertfordshire NHS Trust

73% Southport and Ormskirk Hospital NHS Trust

72% United Lincolnshire Hospitals NHS Trust

72% The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust

72% Medway NHS Foundation Trust

72% South Western Ambulance Service NHS Foundation Trust

71% North Cumbria University Hospitals NHS Trust

71% Yorkshire Ambulance Service NHS Trust

70% The Shrewsbury and Telford Hospital NHS Trust

70% East of England Ambulance Service NHS Trust

68% East Midlands Ambulance Service NHS Trust

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Acknowledgements

We would like to thank everyone who has helped with the preparation of the Freedom to Speak Up Index and this report. This includes all the trusts featured, the survey team at NHS England and current and previous members of the team at the National Guardian’s Office F

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Committee / Meeting Title: Board Meeting - Part 1 (Public)

Date of Meeting: 28 November 2019

Agenda Number: 3.4

Agenda Item Title: Approved Minutes of the Charitable Funds Committee Meeting of 30 January 2019

Presenting Officer: Pippa Barber, Member of Charitable Funds Committee

Action - this paper is for: Decision ☐ Information ☐ Assurance ☒

Report Summary

The paper presents the confirmed Minutes of the Charitable Funds Committee meeting of 30 January 2019.

Proposals and /or Recommendations

The Board is asked receive the confirmed minutes.

Relevant Legislation and Source Documents

Has an Equality Analysis (EA) been completed?

No ☒

High level position described and no decisions required.

Jen Tippin, Non-Executive Director Tel: 01622 211906

Email:

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CONFIRMED Minutes of the Charitable Funds Committee

held on Wednesday 30 January 2019 in the Boardroom, The Oast, Hermitage Court, Hermitage Lane, Barming,

Maidstone Kent ME16 9NT

Dial in Skype – Conference ID 9723586

Present: Richard Field, Non-Executive Director (Chair) Pippa Barber, Non-Executive Director (Skype) Carol Coleman, Public Governor, Dover and Deal Martin Cook, Non-Executive Director Designate Gordon Flack, Director of Finance Jennifer Tippin, Non-Executive Director (Skype) In Attendance: Gina Baines, Committee Secretary/Assistant Trust Secretary

(note-taker) Jo Bing, Assistant Financial Accountant (agenda item 2.4) Stephanie Rhodes, Head of Service, Long Term Services West

Kent (agenda item 2.3) Jo Treharne, Head of Campaigns (agenda item 2.2) Carl Williams, Head of Financial Accounting (agenda item 2.1) 001/19 Introduction by Chair

It was agreed that Richard Field would chair the meeting as Jen Tippin was

attending via Skype. He welcomed everyone present to the meeting of the Charitable Funds Committee meeting.

002/19 Apologies for Absence

Apologies were received from Peter Conway, Non-Executive Director; Neil Sherwood, Convenor Staffside; Lesley Strong, Chief Operating Officer/Deputy Chief Executive and Jane Thackwray, Strategic Delivery Manager. The meeting was quorate.

003/19 Declarations of Interest There were no Declarations of Interest given apart from those formally

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noted on the record.

004/19 Minutes and Matters Arising from the Meeting of 29 November 2018

The Minutes were AGREED. Matters Arising The Matters Arising from the previous meeting were reviewed and updated as follows: 039/18 Marketing the Charitable Funds Report – Action open. 040/19 Fund Manager Presentation – Mermikides Heron Ward Board Restricted Fund – Action open. 042/18 Forward Plan – Jo Bing confirmed that there were funds available for West Kent. As Lesley Strong was the fund manager, she would be able to approve any bids that were put forward. The relevant personnel in the community hospitals were aware that the funds could be used to purchase these resources. Action closed. 042/18 Forward Plan - Action open. All other open actions were closed. The Matters Arising Table was AGREED.

005/19 Relevant Feedback from Other Committees

Management Committee Gordon Flack confirmed that a report had been presented to the Management Committee the previous day regarding the method for allocating training funds in the Trust. Louise Norris, Director of Workforce, Organisational Development and Communications had highlighted that going forward it would not be appropriate for training funding requests to be lodged with the Charitable Funds. Jo Bing confirmed that this was duly noted. In response to a question from Pippa Barber as to whether this applied to volunteer training, Gordon Flack confirmed that Louise Norris had referred to staff training only.

006/19 Charitable Funds Annual Report and Accounts 2017/18 Carl Williams presented the report to the Committee for approval.

Jen Tippin confirmed that she was happy with the report and accounts. It was agreed that Richard Field would sign them on her behalf as she was unable to do so that day.

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The Committee agreed that an Independent Examination, rather than full audit, was sufficient for the 2017/18 accounts. The Committee APPROVED the Charitable Funds Annual Report and Accounts 2017/18.

007/19 Fund Manager Presentation – Bow Road Fund Update Stephanie Rhodes presented the report to the Committee for approval.

Martin Cook declared his shareholding and other ownership interests in the company Interactive Me, a seller of curated memory boxes for dementia sufferers. It was agreed that it would be clarified if the Trust purchased their products. Action –Gina Baines In response to a question from Gordon Flack as to whether she was aware of any other areas that could benefit from similar support, Stephanie Rhodes was uncertain but agreed that there were likely to be similar opportunities elsewhere. In response to a further question regarding how she would measure the value of the investment, Stephanie Rhodes indicated that possible outcome measures might include onward referral and take up. She already collected confidence scores which she would be happy to bring back to the Committee in the future. Gordon Flack suggested that she should carry out a baseline survey to begin with. The Committee APPROVED the purchase of the high backed vinyl chairs, the lounge chairs, a reminiscence kit and a self-check health monitor for proactive care. With regards to the support for the two enhanced palliative care pilot collaborations with the Heart of Kent Hospice, Pippa Barber questioned whether Charitable Funds had previously supported similar ventures and whether there were alternative funding streams available. Gordon Flack suggested that the schemes could be pump primed by the Trust rather than funded through Charitable Funds. Jo Bing confirmed that the Charitable Fund had not considered this kind of scheme previously. Richard Field suggested that it was relevant for the Committee to discuss whether it was able to use its funds to support pump priming initiatives such as these pilots. Carol Coleman suggested that the funding of the staffing resource should be considered by the Executive Team while the Charitable Funds could consider funding any associated equipment. In response to a question from Jen Tippin as to what the Executive Team’s response would be to the proposal, Gordon Flack indicated that it would receive it positively and pump prime the pilots from Trust resources. Although there was some support for the scheme, there was general agreement that it should be considered by the Executive Team for funding instead. However, the Committee agreed that the scheme could come back

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if funding was not forthcoming from the Trust. In response to a comment from Pippa Barber that the funding period should be made clear to the Committee, Stephanie Rhodes confirmed that it would be for 12 months. Stephanie Rhodes added that she had approached the Paddock Wood and Yalding GP practices to enquire whether there was any equipment that they required to enhance their patient services. The practices had highlighted that they would welcome the purchase of a pill counter and asthma machine for use by their patients. It was confirmed that the funding would be proportionate between the practices and the Trust. The Committee approved the funding. With regards to applying to the Charitable Fund for funding to develop the loft space at a GP practice which would be occupied by Trust services, the Committee agreed that this would not be an appropriate use of funds and the request was declined. The Committee NOTED the Fund Manager Presentation – Bow Road Fund Update. Stephanie Rhodes left the meeting.

008/19 Marketing the Charitable Funds Report Jo Treharne presented the tabled report to the Committee for assurance.

It was highlighted that many trusts had a policy that any fundraising that was undertaken on their sites and during staff work time should only support their own charitable fund. The Committee was asked to consider whether the Trust should apply a similar policy. Further to a discussion, it was agreed that there would be nothing to be gained from such an approach. Such a policy would not be pursued. With regards to increasing the profile of i Care, it was confirmed that information was on the back of all leaflets published by the Trust. However, further to a suggestion from Pippa Barber, it was agreed that donation envelopes would be purchased and circulated to the community hospitals. Their design would include the opportunity for the donor to Gift Aid. Action – Jo Treharne Martin Cook highlighted the opportunities afforded by online sites such as Easyfundraising which allowed shoppers to donate to their preferred charities when they were shopping online. It was agreed that this would be investigated. Action – Jo Treharne With regards to the issue highlighted previously around the brand name of the Trust’s Charitable Fund, it was agreed that advice would be sought

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from the Legal Team regarding the trademark and any risks related to continuing to use the name. Action – Jo Bing Jen Tippin left the meeting. In response to a question from Jo Treharne regarding how the funds could be spent in the future, Martin Cook questioned whether any of the pump priming ideas that were fed to the Executive Team could come to the Charitable Fund Committee for consideration. In response to a question from Jo Treharne regarding whether further funds could be raised for the designated HIV Fund, Jo Bing explained that the fund had been left by a patient with clear directions as to how it should be run. Additional funds were not required. It was agreed that there would be further thought given as to which services might be potential recipients for future fundraising activities. The Committee NOTED the Marketing the Charitable Funds Report.

009/19 Charitable Funds Assurance Report Jo Bing presented the report to the Committee for assurance.

The Committee NOTED the Charitable Funds Assurance Report.

010/19 Committee Effectiveness Review Richard Field presented the report to the Committee for approval. The Committee APPROVED the Committee Effectiveness questionnaire.

011/19 Committee Terms of Reference Review

Richard Field presented the report to the Committee for approval

In response to a comment from Pippa Barber regarding the executive director membership of the Committee, it was agreed that the Terms of

Reference would be amended from ‘The Charitable Funds Committee is a

non-executive committee of the Board with delegated decision-making powers specified in these Terms of Reference to…’ to read ‘ The Charitable Funds Committee is established as a Committee of the Board of Kent Community Health NHS Foundation Trust (the Trust) with delegated decision-making powers specified in these Terms of Reference to…’. Action – Gina Baines The Committee APPROVED the Terms of Reference, subject to the

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amendment.

012/19 Forward Plan Richard Field presented the report to the Committee for approval.

In response to a request from Carol Coleman, it was agreed that a marketing report would be presented at the April meeting regarding income to the Charitable Funds other than bequests and projected fundraising for 2019/20. Action – Jo Treharne and Jo Bing The Committee APPROVED the Forward Plan.

013/19 Any Other Business

There was no other business. The meeting ended at 2.05pm.

014/19 Date and time of next meeting Wednesday 24 April 2019, 12.30pm, The Boardroom, The Oast, Hermitage Court, Hermitage Lane, Barming, Maidstone, ME16 9NT

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