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Key: FE: For Endorsement; FA: For Approval; FR: For Report; FI: For Information
AGENDA
Meeting Public Board of Directors
Time of meeting 09:00-11:30
Date of meeting Wednesday 5 April 2017
Meeting Room Dulwich Meeting Room
Site Denmark Hill
Encl. Lead Time
1. . STANDING ITEMS Chair 09:00
1.1. Apologies
1.2. Declarations of Interest
1.3. Chair’s Action
1.4. Minutes of Previous Meeting – 10/03/2017 FA Enc. 1.4
1.5. Action Tracker & Matters Arising FE Enc. 1.5
2. . BEST QUALITY OF CARE
2.1. Patient Story - Gaby’s story FR Oral G Charing 09:05
2.2. Liver and Hepato-Pancreato-Biliary (HPB) Unit FR Enc. 2.2 L Hollins 09:35
3. . Chief Executive’s Report FR Enc. 3 N Moberly 09:55
4. TOP PRODUCTIVITY
4.1. Performance Report (Month 11) FE Enc. 4.1 J Farrell 10:10
5. . SKILLED, CAN DO TEAMS
5.1. Monthly Nurse Staffing Levels Report FE Enc. 5.1 S Dolan 10:30
6. . FIRM FOUNDATIONS
Sound Finances
6.1. Finance Report (Month 11) FE Enc. 6.1 C Gentile 10:40
Rigorous Governance
6.2. Declaration of Directors' Interest Register FI Enc. 6.2 Chair 11:00
6.3. Report from the Governors FR Oral C North 11:05
FOR INFORMATION 11:15
6.4. Chair & Non-Executive Directors Activities FI Enc. 6.4 Chair
6.5. Board Committee Minutes
6.5.1. Finance & Performance Committee – 28/02/2017 FI Enc. 6.5.1 Chair
7. . ANY OTHER BUSINESS Chair 11:20
8. DATE OF NEXT MEETING
3 May 2017, 09:00-11:30, Trust Headquarters, PRUH
Members:
Lord Kerslake Trust Chair
Sue Slipman Non-Executive Director, Vice Chair
Faith Boardman Non-Executive Director
Prof. Richard Trembath Non-Executive Director
Prof. Jonathan Cohen Non-Executive Director
Prof. Ghulam Mufti Non-Executive Director
Dr Alix Pryde Non-Executive Director
Christopher Stooke Non-Executive Director
Nick Moberly Chief Executive Officer
Colin Gentile Chief Financial Officer
Jane Farrell Chief Operating Officer
Prof. Julia Wendon Medical Director
Dr Shelley Dolan Chief Nurse
Dawn Brodrick Director of Workforce Development
Alan Goldsman– Non-voting Director Director of Strategic Development
Lisa Hollins– Non-voting Director Director of Transformation and ICT
Attendees:
Sao Bui-Van Director of Communication
Heather Morley Trust Secretary and Head of Corporate Governance
Jane Badejoko Corporate Governance Officer (Minutes)
Chris North Lead Governor
Gaby Charing Patient
Apologies:
Trudi Kemp (TK) – Non-voting Director Director of Strategic Development
Jane Bond– Non-voting Director Director of Capital, Estates and Facilities
Erik Nordkamp Non-Executive Director
Circulation List:
Board of Directors & Attendees
Enc. 1.4
1
King’s College Hospital NHS Foundation Trust Board of Directors - PUBLIC
Minutes of the Meeting of the Board of Directors held at 11:30, 10 March 2017 in Gilroy Hall Cambridge House, 1 Addington Square, London SE5 0HF Members: Lord Kerslake Trust Chair Chris Stooke Non-Executive Director Prof. Richard Trembath Non-Executive Director Prof. Jonathon Cohen Non-Executive Director Erik Nordkamp Non-Executive Director Dr Alix Pryde Non-Executive Director Faith Boardman Non-Executive Director Sue Slipman Non-Executive Director, Vice Chair Nick Moberly Chief Executive Officer Prof Julia Wendon Medical Director Dawn Brodrick Director of Workforce Development Dr Shelley Dolan Chief Nurse Jane Farrell Chief Operating Officer Colin Gentile Chief Financial Officer Jane Bond - Non-voting Director Director of Capital Estates & Facilities Alan Goldsman - Non-voting Director Interim Director of Strategic Development Lisa Hollins - Non-voting Director Director of Transformation & ICT In attendance: Dr Snch Rodriguez-Villar Subject of Patient Storey Sao Bui-Van Director of Communications Jane Badejoko Assistant Board Secretary (Minutes) Jessica Bush Head of Engagement and Patient Experience Pam Cohen Public Governor Fiona Clark Public Governor Nanda Ratnavel Public Governor Craig Jacobs Patient Governor Victoria Silvester Public Governor Chris North Public Governor Abdrew McCall Public Governor Derek Cattrall Patient Governor Penny Dale Public Governor Pida Ripley Patient Governor Diana Coutts-Pauling Patient Governor Susan Wise Public Governor Dr Sadry Kheraj Nominated Governor Bibi Saffina Zafar King’s Member Apologies: Heather Moreley (HM) Trust Secretary and Head of Corporate Governance Prof. Ghulam Mufti (GM) Non-Executive Director Trudi Kemp (TK) – Non-voting Director Director of Strategic Development
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Item Subject Action
017/21 Apologies Apologies for absence were noted.
017/22 Declarations of Interest There were no declarations of interest made at the meeting.
017/23 Chair’s Action
There were no Chairs’ actions to report.
017/24 Minutes of the previous meeting The minutes of the meeting held on 1 February, were approved as a correct record.
017/25 Matters Arising/Action Tracking The action tracker was noted.
017/26 Patient Story - Dr Sancho Rodriguez-Villar
The Board welcomed, Dr Sancho Rodriguez-Villar, a consultant employed by the Trust who was recently a patient at The Princess Royal University Hospital (PRUH). The following key points were reported: Sancho is a 42 year old male originally from Spain, currently resides in the UK with his partner and 2 children. He is a consultant employed within the Trust’s critical care services, he has a known Asthma condition and in the past has suffered from acute attacks. In December 2016, Sancho began to experience chest pains and shortness of breath; he attended a primary care centre in the first instance but was quickly transferred to the accident and emergency (A&E) department at the PRUH from where he was admitted. Sancho spent 10 days and 9 nights as an inpatient in the respiratory ward at the PRUH. He remembered feeling frightened and vulnerable in his first few days. While he did not feel like himself in those initial few days he remembered the excellent care and attention he received. Staff treated him very well, they referred to him by his first name explained what medication he was getting and his prescribed treatment plan. He received fresh sheets and change of attire daily; he was always asked if he wanted a drink or if he was feeling unwell. The bathroom was clean and well stocked. He was able to have low lighting in the room as he was sensitive to light. He received care from the same nurse who was aware of his condition and would anticipate his need before he made the request.
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Item Subject Action
Sancho is very grateful for the care and attention he received as a patient and he would like to say thank you and commend the improvement the Trust has implemented at the PRUH. The Board thanked Sancho for attending and speaking to them of his experience. Sancho noted that his experience has positively changed him as a physician and the way in which he now delivers care to his patients. As a clinician he now always introduces himself to a patient he is meeting for the first time, he asks for permission to approach patients and is more in tune to patient fears and insecurities. He noted that the care he received at the PRUH was a pleasant surprise, the clinical standards had improved considerable due to the close relationship with Denmark Hill site teaching hospital.
017/27 Quarterly Patient Experience Report The Board received the Quarterly Patient Experience report. The following key points were noted: The Trust’s inpatients services continue to report high levels of satisfaction, the Trust is rated top in this area in England a considerable achievement. In contrast to patients who received care in ED and Outpatient clinics, where satisfaction levels were significantly lower. To improve outpatient services the Trust has launched King’s Way for Outpatients services under the Transformation programme to accelerate its improvement plans. Transactional process areas such as timely communication letters, updates to clinics waiting times and staff attitude are a priority for the project. Trust service users are engaged in the improvement plans with 2 focus group meetings already held. Following which there were deep dive exercise into complex data, which indicated that patients experience different levels of service from different teams. It was noted that not all Trust outpatient services perform poorly, there are some areas that delivery exemplary work. The Chief Nurse lead a complaints improvement campaign which would have cleared all legacy back log complaints by 31 March 2017. Strick KPIs are being embedded into the complaints process going forward. There is need for a different improvement approach relating to maternity services. The Trust has held focus groups at both major sites to obtained feedback from mothers at different stages of maternity(pregnancy, childbirth and follow on care). The work in this area is ongoing.
017/28 Quality Assurance & Research Committee Chair’s Update The Board noted the report.
Enc. 1.4
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Item Subject Action
017/29 Chief Executive’s Report
The Board received the Chief Executive’s Report. The following key points were noted: The Trust continuous to produce innovative care for its patient, an example is the very first virtual reality app for children. Developed by the Trust in partnership with King’s College London. The app was designed to help children and their parents prepare for a MRI scan. Trust operational performance was challenging over the Christmas period and into January, pressures have begun to subside but the level of patient acuity remains high. The Trust was invited to an emergency services performance escalation meeting with regulators. The ED recovery plan presented at the meeting was accepted as very detailed and well planned out. The Trust will aim to successfully deliver improvement trajectories and deliver improved operational performance. The Trust implemented its new organisational restructure in January 2017; the new structure is a key component that will support the Trust’s transformation programme and delivery of financial targets. The Trust launched a high profile national nurse’s recruitment campaign seeking staff for the Princess Royal University Hospital and Orpington Hospital. Nursing recruitment in London remains a significant challenge for all health providers. As part of the new organisational restructure the Trust also launched an internal talent management programme that will support staff in their career progression. The consultation on the programme has involved staff from different professional groups and sites. It was discussed that good talent management starts with an effective appraisal, which supports the inclusion of good practice and tools to that will facilitate career.
017/30 Performance Report (Month 10)
The Board received the Trust’s Performance Report for M10. The following key points were reported: The Trust’s A&E compliance against the national 4-hour target improved from 75.48% reported in December 2016 to 78.21% reported in January 2017. Performance improvement was sustained into February with compliance reported at 81.9% at point of presentation. March to date performance was recorded at 82% aggregate for the first 10 days. Both sites are showing signs of improvement and recovery, the results are encouraging and a testament to staff dedication. Referral to Treatment (RTT) RTT incomplete pathway compliance improved from 77.1% reported in December 2016 to 77.3% reported in January 2017.
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Item Subject Action
Compliance with this metric was influenced by the reduced elective mode of operation over the holiday period as instructed by NHSI and NHS England (NHSE). The number of patients waiting over 18 weeks decreased by 59 pathways, but the number of patient waiting over 52 increased from 129 waiting at the end of December 2016 to 158 at the end of January 2017. However, the number of Neuro-specialty breaches reduced from 32 to 22 and remained 185 ahead of trajectory. Non-neuro breaches increased from 97 to 136.
Cancer Trust compliance against the national treatment within 62 days for patients referred from a screening programme was provisionally non-compliant at 81.8% against target of 90% for January, representing a deep in performance. The position was not achieved in January largely due to patient choice option.
Diagnostics The Trust was non-compliant in diagnostics during January with performance recorded at 1.2% against target of 1%. January performance was particularly challenging due to loss of working days, staff holiday leave and increased operational pressures. Performance is on stable recovery trend at present. Trust regulators have launched a formal review of the Trust’ RTT pathway performance. The Trust is complying with all regulator request. NHSI staff recently attended the February Finance and Performance Committee meeting as part of their review. Trust efforts in improving operational performance were commended, but the Trust should also take advantage of the opportunity and improve quality and safety in parallel.
017/31 Monthly Nurse Staffing Levels Report The Board received and discussed the Monthly Staffing Report. The following key points were reported: The recruitment of nursing staff in London is challenging. This issue was further discussed at a recent meeting between nursing leads and NHS employers at which unaffordable housing and high travel cost in London were sighted as key factors influencing nursing shortage in the capital. It was noted that Band 5, nursing turnover is almost 50% with an average length of employment between 9 months to 1 year. Nursing turnover of oversees nurses was lower. The withdraw student nursing bursaries will have additional implication to the nursing profession over the next few years. There were 189 red shifts recorded in January 2017. The majority of these were at DH and associated with increased patient acuity, vacancies or bank/agency failing to fill shifts. In each case Matrons and Heads of Nursing assessed the situation and judgement about whether moving staff from better staffed areas were made to maintain safety.
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Item Subject Action
The Trust will continue to monitoring the level of red shifts.
FIRM FOUNDATIONS
Sound Finances
017/32 Finance Report (M10) The Board received month 10 Finance Report. The following key points were noted: The Trust’s cumulative operating deficit as at month 10 was £76.1m. This was an adverse variance of £49.5m against the year to date planned deficit of £26.6m, of which £32.5m relates to known variances acknowledged by NHSI. The key drivers of the deficit are NHS clinical contract activity income, Cost Improvement Plans (CIP) slippage and expenditure on cost pressures. The Trust’s exhausted the entire working capital facility allowance for 2016/17 and to date has received £125m in cash support. An additional loan facility of £19m has been requested by the Trust until the end of the financial year, this will bring the Trust’s total spend to £145m for 2016/17. The Trust’s cash position remains fragile and subject to constant financial scrutiny of all expenditures. The Trust continues to spend at risk on pressing capital project. To date at risk spend is circa £9.5m, spending only on projects that affects patient safety. Trust regulators are apprised of all at risk spend. The Trust will be requesting above its annual capital allowance in distressed capital funding for next year. The Trust Chair and Chief Financial Officer were informed that the Trust will not receive commissioner support funds as previously advised. This financial shortfall will represent a £12m gap in the end of year position. The Trust will be exploring alternative options for achieving the control total for the year end. There will also be greater focus on securing Sustainability and Transformation funding (STF) for next year.
017/33 Finance & Performance Committee Chair Update The Board agreed that the points in the report were covered adequately by the discussions on other items on the agenda.
017/34 Annual Report and Accounts Plan The Board noted the sequencing of dates for approval of the Trust Annual Report and Account for 2016/17.
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Item Subject Action
Rigorous Governance
017/35 Council of Governors Report The Board welcomed Chris North, Lead Governor who delivered the Council of Governors (CoG) Report. The following key points were noted: The lead Governor noted that the Council of Governors received replies to important questions. The Council is supportive of the Trust’s efforts to improve performance. The Council would ask for a more timely paper distribution in future.
FOR INFORMATION
017/36 Chair & Non-Executive Directors’ Activities The Board noted the Chair and Non-Executive Directors’ Activities report.
017/37 Board Committee Minutes The Board noted the Finance and Performance Committee minutes.
017/38 ANY OTHER BUSINESS
There were no items of any other business raised for discussion.
017/39 DATE OF NEXT MEETING Wednesday 3 May 09:00-11:30, Dulwich room, Denmark Hill
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Enc. 1.5
Action Status as at: 01/02/2017 1
BOARD OF DIRECTORS (PUBLIC MEETING) ACTION TRACKER
Date Item Action Who Due Update DEFERRED
05/10/2016 16/100.4 Quality & Safety Committee Chair Update – The Board agreed to receive an update on cancer services and how the points raised about improving experience will be addressed through the new structure.
Update from 26/01/2017: The Trust is preparing a wider Cancer Strategy, this will be presented to QARK in March, and the Public Board in April 2017.
Update from 31/03/2017: The QARK meeting schedule for 28 March was not held due to operational pressures and a governance re-arrangement of the Committee. QARK will be moving to a new
Julia Wendon/
Shelly Dolan
03/05/2017
05/04/2017
17/01/2017
06/12/2016
Update 16/11/2016: JW and SD have allocated Cancer as an item for presentation to the QARC in December feel it would be more appropriate to present the output from that paper and discussion at the next appropriate Public Board. As such this will be deferred until February board.
02/11/2016 16/121.1 Quarterly Patient Safety report (Q2, 2016-17 – The Board agreed that work would be undertaken to understand how Shelford Group peers define levels of harms caused to patients.
Julia Wendon
03/05/2017
01/02/2017
There is a group of risk, quality and safety leads across London hospitals meeting to look at how similar or different reporting is for harm across trusts. The Board will be updated within 3-6 months when this learning has been shared.
05/10/2016 16/100.2 Quarterly Patient Experience Report – The Board agreed that they would receive a report on plans to improve patients’ outpatient experience and complaints performance. Update from the Public Board meeting on 02/11/2016: The Board agreed that this work around improving patient experience in outpatients should focus on attitude and the communication of delays.
Shelley Dolan
03/05/2017 10/03/2017
Work on this project is ongoing, as updated in 01 February 2017 Board meeting in the QARC Chair’s report. Further information on the Transformation work in outpatient will be provided in May 2017.
2 Action Status as at: 26/01/2017
Date Item Action Who Due Update 01/02/2017 17/07 Quarterly Patient Outcomes
The Board will receive an update on over 75 re-admission for Trust which will include the number of re-admission over the weekend and the number of bed day at Orpington.
Julia Wendon
03/05/2017 05/04/2017
NOT DUE 02/11/2016 16/116.1 Re-designed of the Trust performance report will be
delivered in April 2017.
Jane Farrell
07/06/2017
COMPLETED 02/11/2016 16/116.1 Performance Report (M06) – It was agreed that an update
on staff morale levels will be presented to the Board at its meeting in February 2017 after the National Staff Survey results have been analysed.
Dawn Brodrick
10/03/2017
06/12/2016
Update 16/11/16: DB will not have the survey results until Jan/Feb 2017. As such action to be deferred to February board.
See agenda item 4.1 Private Board 10/03/2017
Transformation Programme2017-18 Design
2
Our approach
• Get Everyone Involved
• Make Life Simple
• Keep Patients Safe
• Spend Money Wisely
• Use the Evidence
“Change is vital, improvement is the logical form of change”James Cash Penney
3
How will deliver this….
• Get Everyone Involved - our staff will be supported to design services with the patient in mind and wherever possible the introduction of standard processes will ensure improved consistency
• Make Life Simple - working together across the Trust we will develop simpler systems and processes to reduce any impact on patient care and always find ways to improve their experience and outcomes
• Keep Patients Safe - from their very first moment, the patient must always come first at King’ College Hospital NHS Foundation Trust
• Spend Money Wisely - the Trust will always ensure that it uses its resources for the benefit of patients, reducing our focus on areas that do not directly enhance the quality of their experience
• Use the Evidence – we will use international benchmarking combined with agreed transformation metrics will ensure that the quality and reliability of our services remains undiminished and improves over time.
4
Clinical Transformation Programme 2017
A
B
C
D
The King’s Academy – Multi-Layered Continuous Improvement Training. Acapability building programme will be developed to equip our people with the skillsand tools they need to deliver King’s-wide service redesign and continuousimprovement
Functional Clean Sheet Redesign. Services and functions will be redesigned,leveraging national and international innovative best practice to develop a robustfuture state. The creation of standardised evidence based care pathways (CareProcess Models) and core operational processes (“Functional Process Models”) willbe at the heart of this redesign process
Continuous improvement. A toolkit will be developed and deployed whichsupports standardised and effective daily work routines and continuousimprovement in the workplace. This will initially be rolled out on our wards, linked toa new accreditation scheme, with a view to subsequent deployment to theatres,outpatients, and imaging, in due course.
EPR workflow. Our new Allscripts Sunrise EPR will be configured to reflect andsupport our new Care Process Models and Functional Process Models (withdiagnostic and treatment algorithms, smart logic, process workflow and smartforms/order sets created to support consistent and efficient delivery)
Centralisation – developing the operational delivery models for all services including OP booking centralisation, theatre schedule design, theatre booking centralisation.
E
HPB Clean Sheet Design
6
HPB Clean Sheet Design
Lisa Hollins Executive Sponsor
Mr AndreasPrachalias
Clinical Lead
Emily Carter / Harriet Livesey
General Manager
Wendy Martin HPB CNS Lead
Hannah Jackson Service Manager
Jane Clarke /Alister Notridge
Project Manager
HPB CSD was part of wave 2 of the Transformation programme and has been running since September 2016. Currently the programme is in its delivery phase.The membership of the HPB CSD is as follows:
Cancer Nurse Specialists Gillian Al-Kadhimi and Elmie Cananea discuss project plans with management representatives Hannah Jackson, Harriet Livesey and Robin Garner (Left to Right)
Harriet Livesey reviews admission plans on Dawson ward with Ward Manager Era Balentogo and Service Manager Hannah Jackson
HPB Clean Sheet Redesign Core Group members:
7
Hepatobiliary (HPB)We provide all-round care for people with liver, pancreatic, biliary and gall bladder disorders. Our team offers specialist investigations and care for conditions such as:
• primary liver cancer: hepatocellular carcinoma (HCC)
• benign liver tumours: focal nodular hyperplasia (FNH), adenoma, haemangioma
• biliary cystadenoma• primary biliary cancers: cholangiocarcinoma
and gallbladder cancer• primary pancreatic cancer• secondary liver tumours from a colorectal,
breast or other primary• chronic and acute pancreatitis• complex benign hepato-biliary and pancreatic
conditions.
The treatments delivered by the HPB service include a mixture of surgery, medicine and interventional radiology.
1,968 1,552 1,363
5,042 5,704 6,062
7,010 7,256 7,425
14/15 15/16 16/17
ActivityActivity Inpatient Activity Outpatient Activity Total
£0
£1,000,000
£2,000,000
£3,000,000
£4,000,000
£5,000,000
£6,000,000
£7,000,000
14/15 15/16 16/17
Income
Inpatient income
Outpatient income
Total income
Hepatobiliary (HPB)
* 2016/17 data is shown as full year estimate based on M10 actual figures
8
Our main challenges
Experience
• Capacity issues lead to delays and poor patient experience
• Patients experience long and variable post-operative stays due to the lack of standardised clinical processes
Workforce • Existing processes do not make the best use of our workforce
Information
• Information sharing between Trusts impacts on clinical decisions
• Limited access to IT tools means lack of visibility of patients on the ward and missed opportunities to improve patient care
Pathway
• Current process between decision to operate and starting surgery fraught with delays
• Lack of standardised post-operative outpatient care• There is significant theatre downtime and
cancellations due to increased demand and lack of beds
• Lack of clarity on 48hour pre-discharge plan leads to lengthened inpatient stays
9
The future state streamlines the patient pathway, and will be delivered through 12 initiatives
Coding
Care co-ordination IT system
• Accessible by King’s staff, external referrers and patients
• Ensures standard diagnostic work-up and submission protocols
1
Extend and revamp CPMs
• Identify and define care pathways for particular patient groups
• Use best practice guidelines and local expertise to develop guidance
• Communicate and educate HPB staff on new care process models, and encourage their use
6
Future state
Returned to care of referrer
GP referral
Tertiary referral
Internal referral
Self-referral2
One-stop shop for diagnostic work-up1
Inpatient care Post-operative outpatientsReferral to MDM Pre-
operativeoutpatients
Discussedat MDM
Outpatient & pre-assess-
ment
Admissions unit Procedure Discharge
unitPost-Op ICU & ward stay
Post-Op follow-up
1
52 3 4 6 7 8
3-10 days 0-30 days 6 days
Emergency admission
9
10 11
One-stop diagnostic work-up
• One-stop assessment and diagnostic clinic for local patients
• All necessary diagnostics completed in single visit, with standard work up defined for each patient group
2
New MDM model
• Includes streams for specific patient cohorts
• Virtual MDTs for less complex patients
• Support for local hospitals to ensure more tests completed pre-MDM
3
Referrer outreach training programme
• Train referrers on suitable work-up for complex diagnoses
4
Same-day pre admission
• Collection of fitness information earlier in pathway
5Develop standard operating model for HPB surgery
• Ring-fenced ICU beds• Agree mechanism for early
ward discharges allowing vacation of ICU beds
• Accordion theatre lists• Develop SOPs including
defining who should be admitted to ICU/HDU
Develop short-stay capacity
• Short stay ward and capacity to ensure timely discharge
8
7
Revised follow-up shared care governance
• More patients treated locally• Better links with referrers
Step-down discharge unit
• Ensures medically fit patients able to be discharged when ready
Structured discharge model
• Ward SOPs for discharge e.g. 24/48 hour checklists
• Early phlebotomist round
11
10
9
12
↑ performance against 62 day and 18 week wait↓ admin and delays
↑ performance against 62 day and 18 week wait↑ effective use of consultant time↓ administrative burden
↑ performance against 62 day and 18 week wait↑ patient experience and national cancer survey results↓ patient waits for decision
↑ local ownership of patient care↑ patient experience – tests closer to home↓ incomplete referrals
↑ performance against 62 day and 18 week wait↓ patient waits for decision
↑ quality of care↑ patient experience↓ delays in care provision and discharge
↑ theatre utilisation↑ performance again 62 day and 18 week wait↓ cancellations and delays
↑ patient experience↓ cancellations and delays
↑ patient experience↓ delays
↑ patient experience↓ delays
↑ patient experience
↑ financial performance
10
The initiatives were prioritised by the team by considering their likely impact and ease of delivery
Likely impact
Ease of delivery
12
3
4
5
6
7
8
9
10
11
Initiative
Care coordination IT system
One-stop assessment and diagnostic clinic
Develop new MDM model with streams for specific patient cohorts
Develop referrer outreach training programme
Fully implement same-day pre-admission service
Extend and revamp standard care pathway CPMs
Develop and agree standard operating model for HPB surgical flow, including ring-fencing, with theatres and ICU
Plan and develop short-stay capacity
Roll out structured discharge planning model
Establish step-down discharge unit
Establish revised follow-up shared care governance model
Coding
7
11
10
9
8
6
5
4
3
2
1
12
12X XInitiative Prioritised initiative
Source: Discussion with HPB CSD group & HPB CSD: Delivery Plan (dt. 19th December 2016)
Last Modified 17/11/2016 17:02 G
MT S
tandard Time
Printed 15/11/2016 16:25 G
MT S
tandard Time
11
Group Initiatives and Actions Delivery Phases 16/17 2017/18 2018/19 2019/20
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3
Referral to MDM
1 Care co-ordination IT system
2 One-stop shop*
3 New MDM model with streaming for patient cohorts
4 Referrer outreach training programme
Pre-operative and pre-assessment 5 Same-day pre-assessment service
Inpatient care
6 Extend and revamp CPMs
7 Re-designed HPB surgical flow with theatres and ICU, including ring-fenced beds
8 Develop short stay capacity
9 Structured discharge planning model
10 Step-down discharge unit
Post-operative follow-up 11 Revised follow-up with shared care governance model
Coding 12 Review of coding to ensure paid appropriately for all activity
Initiatives will be phased, with priority work streams starting immediately and all completed by Q4 2018/19
DESIGN INITIATIVES AND PHASING OVER THE NEXT THREE YEARS
Initiatives in blue and bold are suggested priority workstreams
Source: Discussion with HPB CSD group. *Commencing work stream dependent on agreement with radiology regarding ring-fenced diagnostics and impact on capacity and staffing in radiology
12
Achievements
Improving access and experience for patients
Access improved through reducing length of stay using a discharge checklist and golden beds initiative. This has reduced cancellations, reduced waiting times for tertiary emergency transfer, increased discharges before lunch, improved flow with ITU.
Improving quality through the use of a Care Process Model
A care process model has been designed to set standards on high quality pathways for patients
Increasing financial sustainability
Contributions an additional £622K in income through treating additional patients and recording £416K of additional income through better coding of patients
Developing our staff
Training clinical and administrative staff within the Kings Academy – who are undertaking their local improvement projects
13
Proposed scheduling of CSD for next year
17/18 Q1 17/18 Q2 17/18 Q3 17/18 Q4
Inpatient flow
16/17 Q4 18/19 Q1
Dental redesign
Outpatient redesign
Neurology redesign
Pharmacy redesign
Short stay elective redesign
Ophthalmology redesign
Neurosurgery
Medical/LTC redesign
Cardiac redesign
Back office redesign
Obstetrics redesign
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1
Report To:
Board of Directors
Date of Meeting: 5 April 2017
Presented By: Nick Moberly, Chief Executive
Subject: Chief Executive's Report to the Board
Introduction and summary
The last month of financial year 2016/17 has been a significant one for the NHS, and for King’s.
On 22 March, we saw the NHS at its very best, in the aftermath of the brutal terrorist attack at Westminster. King’s played a key role in responding to this tragic event, treating eight of the casualties and stepping in to receive women in labour who were diverted from St Thomas’ Hospital. Our staff were absolutely magnificent in responding to this challenge. This was recognised when HRH the Prince of Wales visited Denmark Hill. He spent time not only with some of the injured but also with colleagues from our Emergency Department and Katharine Monk ward, and was quite rightly fulsome in his praise for the outstanding and compassionate care that our clinical teams had been able to provide.
March also saw the publication of the “Next Steps on the NHS Five Year Forward View”. (The original NHS Five Year Forward View was a forward strategy for the NHS, authored by NHS England and originally published in October 2014). This new publication highlights significant progress in a number of areas in recent years, but also acknowledges the challenges faced by the service – in particular, the increasing pressures nationally both in terms of finance and compliance with access standards. Whilst acknowledging the challenges, “Next Steps” expresses a determination to achieve a balanced financial position, and highlights a number of key priorities to be delivered in the coming two years – including a return to 95% compliance with the A&E 4 hour waits standard (linked to the further £2bn of funding for social care which was announced in the Budget), as well as improvements in cancer care, mental health, access to general practice, treatment of the frail elderly and integrated care. A useful summary from NHS Providers is attached as an appendix to this report.
Whilst this is a challenging environment for King’s, as for other trusts, it is one which also affords some opportunities. Over the last month, as always, our primary focus has been on delivering the best possible care for our patients. In the run-up to the year end, we have also been working hard to:
Deliver the best possible full year position in terms of financial performance and compliance with key operational targets
2
Develop robust financial and operational plans for financial year 2017/18 which command the support of our regulator, NHS Improvement
Build a durable and high performing organisation which over time will enable us to deliver outstanding patient care on a financially sustainable basis
Collaborate with partners in our local system in South East London and beyond to deliver joined up care for our patients and improve productivity
Mission and Strategy
STPs (now rebranded as “Sustainability and Transformation Partnerships”) feature strongly within the “Next Steps” document as a key vehicle for delivering integrated and “place
based” care. Whilst the document does not prescribe a “one size fits all” approach to the
future development of STPs it does give some clear pointers to their future development and sets out some minimum requirements which will apply to all STPs. King’s is participating
very actively in discussions within the South East London STP about its future development. We are also engaged in the STP’s clinical and collaborative productivity work streams and, as previously reported, I have personally agreed to take on the role of chairing the STP’s
Collaborative Productivity Board.
One of the key areas of clinical focus within the STP is the development of “community
based care”. Good progress is being made, with King’s involvement, in developing the Local
Care Networks in Lambeth and Southwark. In Bromley, we are bidding with Oxleas and other partners in response to the CCG-led tender process for community services in the borough.
Within King’s Health Partners, the most significant development in the last month has been
the launch of Programme Boards to drive the development of a number of the planned new Institutes. King’s will be playing a key role in leading the Institutes whose centre of gravity will be Denmark Hill, notably Haematology and Neurosciences.
March also saw progress in a number of key areas of strategic importance, for example further progress in developing our portfolio of overseas ventures, further steady progress in developing a clear strategic direction for our Viapath pathology joint venture with Guy’s and
St Thomas’ and Serco, and further work to strengthen and establish our King’s IFM
interventional facilities business.
Finally, work is underway, with input from senior clinicians, on defining in more detail a Clinical Strategy for the Trust and considering the most appropriate disposition of services across our sites.
Best Quality of Care
Overall quality of care across the Trust remains strong, as evidenced by continued strong performance across a range of key outcomes indicators.
Mortality rates and relative risk of readmission at both Denmark Hill and the Princess Royal University Hospital continue to be below expected, and overall we are in the best performing quartile nationally.
Within the last month, we have heard that King’s has been shortlisted by CHKS (a provider of intelligence and quality improvement services in healthcare) for its annual Quality of Care Award.
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Looking back over the year, there have been exciting developments across many of our services. In recent months BBC Two and Louis Theroux highlighted the work of our liver, medical and Emergency Department teams do with patients struggling with excessive alcohol consumption and addiction and we also launched universal HIV testing in our Emergency Departments in partnership with the Elton John AIDS Foundation. Lambeth and Southwark have one of the highest prevalence rates in the UK.
Frustratingly, six months on from the Care Quality Commission’s most recent inspection in
October 2016, a formal inspection report has yet to be published. We do however anticipate this being finalised and published within the coming weeks.
Notwithstanding the Trust’s strong performance overall in terms of clinical effectiveness and
safety, we continue to face significant challenges in delivering the national access standards for A&E 4 hour waits and elective access. These have both been the subject of significant focus over the last month, and our current performance and plans are described in more detail in a separate report.
Excellent Teaching and Research
King’s hosts one the UK’s largest portfolios of applied, clinical and basic research, both commercially sponsored and academically led. Our strategy is to conduct research to improve current and future healthcare for our patients and the population.
One key development in the last twelve months has been the opening of the Alex Mowat Paediatric Research Laboratories, part of our internationally recognised paediatric liver services. The year has also seen a series of world ‘firsts’. Mr Ranjit Deshpande used 3D technology to develop a new technique in heart bypass surgery and Dr Jonathan Hill used high speed pressure waves to remove calcium in coronary arteries prior to stent insertion. Most recently, the very first MRI virtual reality app for younger patients was launched by the Trust. Designed to allay their anxieties during treatment, it was developed by former King’s
colleague Jonathan Ashmore.
In March, Professor Iain Macdougall and Professor Peter Goadsby received National Institute for Health Research (NIHR) Senior Investigator awards. NIHR Senior Investigators are among the most prominent and prestigious research roles funded by the NIHR as the most outstanding leaders of patient and people-based researchers in the country. They provide visible leadership within the NIHR and act as a key source of advice to the Department of Health’s Chief Scientific Adviser.
Skilled, Motivated, “Can Do” Teams
Following on from its launch in January, we have continued to focus strongly on embedding our new organisational structure. The great majority of leadership posts at Divisional and Care Group level have been filled, with most of those appointed either in post or due to arrive over the coming three months. Although it is still early days, this new leadership team is already making a palpable difference to clinical and operational delivery across the Trust. We are bringing this group together in a newly constituted Senior Leadership Group, meeting monthly.
Staff engagement and satisfaction are widely recognised to be critical in delivering high quality care, and although the annual staff survey results (discussed at last month’s Board)
contained some positives, it is clear that there are a number of areas where improvements are urgently required. The Executive team is working closely with the Senior Leadership
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Group to develop a range of actions designed to address seven key focus areas over the next six to twelve months.
Top Productivity
Our King’s Way clinical transformation programme, launched in summer 2016, remains a major focus for the Trust, and is the subject of considerable interest and scrutiny from our regulator.
In line with the business case originally approved by NHS Improvement, it is anticipated that the transformation work undertaken thus far will deliver £10m of recurrent efficiencies in financial year 2017/18 as part of our cost improvement programme, growing to £20m of recurrent savings over time. Detailed implementation plans have been written for HPB, bariatrics, theatres, outpatients, elective orthopaedics, dental and emergency care. The efficiency savings will be achieved through improving discharge of patients, increasing productivity of theatres, improving utilisation of outpatients and reducing the on the day cancellations for services.
Overall, we remain confident that over a 3-year time horizon the programme has the potential to deliver around £60m of recurrent savings.
Firm Foundations
Finance
Since October, the Trust has been forecasting a full year deficit position of £49m for financial year 2016/17, excluding any monies from the Sustainability and Transformation Fund. This position has been shared with, and acknowledged by, our regulator NHS Improvement. Although it is too soon to confirm the final financial result for the year, we have worked extremely hard in recent weeks to maximise our chances of delivering this forecast position.
Looking ahead we filed a revised version of our operational plan for financial year 2017/18 with NHS Improvement. This envisages a full year deficit (excluding any contribution from STF) of £39m, with improving compliance trajectories for A&E 4 hour waits and elective access. This plan, which will require formal sign off by NHS Improvement, is challenging, and will require the organisation to deliver a Cost Improvement Programme of some 7% for the year. Good progress is being in developing our programme, but there is more work to do to land a fully secure savings plan.
Capital funding across the NHS has been exceptionally tight during financial year 2016/17. Given this national position, we have been obliged to scale back our capital expenditure plans for the year very substantially, but even so have had to seek additional funding of some £20m to cover a necessary minimum of expenditure. We only received final formal confirmation that this additional funding would be made available during March, but have nonetheless been able to ensure that all these monies were spent before the 31 March deadline.
Looking ahead to financial year 2017/18, we expect that capital will again be extremely tight, and we will require additional external funding support from NHS England if we are to deliver the projects we have identified. We will be working with the NHS Improvement team in the coming weeks as they assess our proposals. Works have been prioritised on the basis of patient safety, health and safety, CQC requirements, patient experience, environment and financial impacts. The 2017/18 Investment Programme will be reviewed by the King’s
Executive and reported to the Board in early May.
IT
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Following the successful implementation of our new Allscripts Sunrise Electronic Patient Record at our Denmark Hill site earlier in the year, work on deploying Sunrise at our “southern sites” (in particular the Princess Royal and Orpington) was delayed because of the pressures on capital described above. I am pleased to report that we have now secured the funding required to complete the deployment of Allscripts Sunrise to our southern sites in summer 2017, as well as to implement some other key aspects of our EPR “roadmap” such
as deploying the Allscripts Emergency Departments and Theatres modules. This is very welcome news and will have a significant, and positive, impact in terms of safety and productivity.
At an individual service level, King’s maternity service is driving forward with the digital
agenda by introducing a new maternity information system that will allow the maternity team to use an electronic record for documenting care throughout women’s pregnancy, birth and postnatal period. The maternity information system is called ‘Badgernet’ and the maternity
team are using smart technology, mobile tablet devices and desktop computers rather than paper records to document the care they are providing.
Badgernet will transform our maternity service and bring numerous benefits to our patients and staff. Our previous systems were used primarily for summaries of care and data collection for payment systems. The Badgernet system allows direct, live information to be input via tablets and PCs to be a contemporaneous care record, visible to all in the team. Replacing hand written paper documentation reduces duplication, lessens our currently cumbersome paper records to a minimum and facilitates a contemporaneous live patient record accessible to the whole team. It is maintained at the bedside therefore freeing up time to care.
The new system allows us to make more effective use of the clinical data set and helps manage patient flow and workload across the maternity service. Clinical audit is simple and streamlined, and accurately reports on crucial contract activity to ensure our maternity service is appropriately funded.
Women in our care are also able to view a summary of their electronic maternity record via a secure online portal accessible at www.pregnotes.net. This reduces the use of paper while communicating more efficiently with women. We will also be moving all of our maternity healthcare patient information such as pregnancy guides and advice leaflets to an online platform on the Badgernet system, diminishing the need for printed copies. This means that women and their families will be able to access this information at any time and in any place and in a format that is cost effective, reduces waste and is environmentally friendly.
It will take several months for our service to move to the new system completely; so far it has gone well. There has been a lot of investment in training and support for the multidisciplinary team. The final transition will be digitalising the intrapartum pathway. Additional training and assurances are required prior to use going live during the intrapartum care period but this is expected to be achieved by mid-summer.
Estates
Works in regard to our Critical Care Centre Project at Denmark Hill continue. The new facility will provide a sixty bed Critical Care facility, over two operational floors, the first floor of which is due to open in March 2018.
Works to provide outpatients facilities in Caldecot Road will be delivered in spring 2017. This will enable the release of space in the Golden Jubilee Win at Denmark Hill as
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part of our project to provide further facilities in support of the Emergency Department. Works to reconfigure Suite Three and then Suite One in the Golden Jubilee Wing will start after Easter.
Works have been completed at the Princess Royal University Hospital to replace one of our two CT Scanners. Works at Denmark Hill to replace ten x-ray machines will commence in late March. Investment into ICT and equipment, over and above those mentioned, continues. We are working with our landlord at Beckham Beacon to enhance the clinical facilities within Dermatology.
The outcome of our “Six Facet” survey concluded in early March. Providing an oversight of the condition of our estate and how we utilise the facilities we have, the estates team are now reviewing the outcome of the survey as part of the development of our Trust-wide Estates Strategy. This Estates Strategy will also be informed by our Clinical Strategy and proposals in regard to Education and Research.
The age and condition of the majority of our estate at Denmark Hill is such that extensive redevelopment and refurbishment will be required to provide the level of services required in the future. As part of the overarching Estates Strategy, the estates team remain focussed on the development of a Masterplan for Denmark Hill to inform the Trust of the options available to redevelop the site over the next five to twenty five years. As previously reported, the Masterplan will consider the options the Trust has at Denmark Hill, the timing of works and will explore options for financing. Discussions continue with the Local Authority’s town planning team to ensure their requirements are included within the options that are being developed. Our estates team have also discussed with South London and Maudsley NHS Foundation Trust the opportunities that a redevelopment could bring to their site at Denmark Hill too. Engagement with our Clinical, Research and Operational teams is underway, to ensure the Masterplan reflects the needs of the Trust in the short, medium and longer term. The Masterplan will be presented to the Board in late spring 2017. Wider consultation will be undertaken after the Board has had an opportunity to consider the progress made and the options available.
Communications
In the last six months we have been reviewing our internal and external communications to improve our reach both with staff across the Trust and with patients and other key audiences.
In January 2017 we launched a new weekly Chief Executive’s note which focuses on
specific themes or subjects. Since the beginning of the year traffic statistics show that the average open rate is between 6,000 and 6,500. In the same month, we launched The Pulse@King’s. It is not possible to currently track accurate performance data for The Pulse as current analytics do not include Kingsdoc. We are looking to improve reach, functionality and the data available. We are finalising an engagement strategy following the results of the staff survey which will include supporting senior leadership visibility, improving two-way conversation and creating staff-based forums. In 2017/18 a priority will be to evolve the current intranet into a more user-friendly and mobile-first platform.
In terms of external communications, a focus on digital campaigns on Twitter and Facebook has reaped a six month reach of 250,000 people for six campaigns including World AIDS Day, World Cancer Day, nursing recruitment and a bespoke Christmas campaign featuring staff. Additionally a press briefing to launch the first ever MRI virtual reality app for children secured coverage on news and broadcast outlets globally. Leading with an exclusive on the
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BBC it garnered coverage in key UK national press, specialist press and a number of international outlets including Wired, MSNBC, Endgadget and the Verge. Reach and awareness in terms of the King’s brand was global.
This month, during the recent incident at Westminster, the media team instigated its emergency procedures and ran a 24-hour operation. Handling over 100 calls and number of news crews on site, we managed to secure positive coverage as well as specific acknowledgement from the Chartered Institute of Public Relations.
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31 March 2017
NHS Providers | ON THE DAY BRIEFING | Page 1
NEXT STEPS ON THE FIVE YEAR FORWARD VIEW: NHS PROVIDERS ON THE DAY BRIEFING This briefing is a NHS Providers summary of the Next Steps on the NHS Five Year Forward View document (FYFVNS for the purposes of this briefing), published on 31 March 2017. FYFVNS has been drafted by both NHS Improvement (NHSI) and NHS England (NHSE). It outlines progress on the ambitions set out in the Five year forward view since its original publication in October 2014, defines what still needs to be achieved over the next two years, and how this will be achieved. It also outlines priorities for the service specifically in 2017/18 as follows:
Deliver financial balance across the NHS
Improve A&E performance
Strengthen access to GP & primary care services
Improve cancer and mental health services
The document breaks down into 11 chapters covering a range of areas - however this briefing focuses on the most relevant points for NHS trusts and foundation trusts in particular the “what still needs to be achieved” parts of the document and new announcements. To see the full FYFVNS document please follow this link: https://www.england.nhs.uk/publication/next-steps-on-the-nhs-five-year-forward-view/. At the end of this briefing we have attached the NHS Providers press statement. If you have any questions about this briefing, please contact [email protected].
KEY AREAS OF INTEREST
Urgent and emergency care and RTT waiting times
Urgent and emergency care
The document notes the progress made in urgent and emergency care over the past three years, then outlines the key deliverables for urgent and emergency care in both 2017/18 and 2018/19. These deliverables are a mix of actions for both for local organisations and national bodies to deliver. The key item to note here is the adjustment to the 95% A&E standard trusts will be required to meet. This is in line with what was announced in the Government’s 2017/18 mandate to the NHS. These changes are:
before September 2017 over 90% of emergency patients are treated, admitted or transferred within 4 hours (up from 85% currently being delivered)
the majority of trusts will have to meet the 95% standard in March 2018
the NHS overall returns to the 95% standard within the course of 2018
Also to note, the document confirms the previous standard contract fines for A&E have been dropped for those providers who have agreed control totals. From April 2017 the rules governing the performance element of the £1.8 billion sustainability and transformation fund (STF) for acute trusts that relates to A&E will be amended. The non-appealable rules expected for access to the STF are set out at the end of the FYFVNS document at reference 24.
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The document also prescribes how the trusts should achieve these changes and improve their current A&E performance: By October 2017: Every hospital must have “comprehensive front-door clinical streaming”.
Every hospital and its local health and social care partners must have “adopted good practice to enable appropriate patient flow”. This includes better hand-offs between A&E and acute physicians, ‘discharge to assess’, ‘trusted assessor’ arrangements, streamlined continuing healthcare processes, and seven day service (7DS) discharge capabilities.
By March 2018: Trusts should work with local councils to ensure that the extra £1 billion provided in the March 2017 budget for
adult social care is used in part to reduce delayed transfers of care (DTOC), thereby helping to free up 2000-3000 acute hospital beds. Progress against this figure “will be regularly published” - the document does not say by whom or how frequently.
ensure that 85% of all assessments for continuing health care funding take place out of hospital in the community setting,
Implement the “High Impact Change Model” for reducing DTOCs. It also notes a range of actions that the national bodies will undertake: Roll-out by spring 2018 of 150 standardised new ‘Urgent Treatment Centres’ which will open 12 hours a day,
seven days a week, integrated with local urgent care services.
Implement the recommendations of the Ambulance Response Programme by October 2017, putting an end to long waits not covered by response targets.
It also notes a range of actions that the national bodies will undertake regarding with NHS 111 and primary care: Enhance NHS 111 by increasing from the proportion of 111 calls receiving clinical assessment by March 2018,
By 2019, NHS 111 will be able to book people into urgent face to face appointments
Roll out evening and weekend GP appointments, to 50% of the public by March 2018 and 100% by March 2019. To support these changes, the FVFVNS outlines the following support measures: £100m in capital funding, as announced in the budget, to support modifications to A&Es to enable clinical
streaming by October 2017.
Aligned national programme management. NHSI/NHSE will appoint a single national leader accountable for all of the above actions. Also from 1 April 2017 a single Regional Director drawn from either NHSI or NHSE will hold to account both CCGs and trusts in each STP area for the delivery of the local urgent care plan.
RTT waiting times
The document makes reference to the referral to treatment time 18 week 92% target. It says: “Looking out over the next two years we expect to continue to increase the number of NHS-funded elective operations. However given multiple calls on the constrained NHS funding growth over the next couple of years, elective volumes are likely to expand at a slower rate than implied by a 92% RTT incomplete pathway target. While the median wait for routine care may move marginally, this still represents strong performance compared both to the NHS’ history and comparable other countries.”
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This has been taken as recognition by NHSI and NHSE that performance against the 92% constitutional standard is not likely to be achieved in 2017/8.
Integrating care - STPs, ACOs and ACSs
The FYFVNS document has a chapter dedicated to integrating care. This provides two main functions: 1. Outlining key areas of clarification for STPs (now referred to in the document as Sustainability and
Transformation Partnerships), accountable care system and accountable care organisation integration models 2. Outlining new policy changes associated with these models These areas are summarised in the two tables following below:
Area of clarification Explanation
Statutory role of STPs The document says: “STPs are not new statutory bodies. They supplement rather
than replace the accountabilities of individual organisations. It’s a case of ‘both the organisation and our partners’, as against ‘either/or”
Uniformity and running of STPs
The document says: “The way STPs work will vary according to the needs of different parts of the country. Place-based health and care systems should be defined and assessed primarily by how they practically tackle their shared local health, quality and efficiency challenges. We do not want to be overly prescriptive about organisational form… [but] all STPs need a basic governance and implementation ‘support chassis’ to enable effective working ”
What Accountable Care Systems (ACSs) are
Essentially what the most advanced STPs will aspire to be. The document says: “ACSs will be an ‘evolved’ version of an STP that is working as a locally integrated health system. They are systems in which NHS organisations (both commissioners and providers)…choose to take on clear collective responsibility for resources and population health …specifically, ACSs are STPs - or groups of organisations
within an STP sub-area… that get far more control and freedom over the total operations of the health system in their area”
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What ACS’s can or should do
Agree an “accountable performance contract” with NHSE and NHSI to commit to make faster improvements in the key deliverables set out in the FYFVNS
Manage funding for their defined population, committing to shared performance goals and a financial system ‘control total’ across CCGs and providers.
Effectively abolish the annual transactional contractual purchaser/provider negotiations within their area.
Create an effective collective decision making and governance structure
Demonstrate how their provider organisations will operate on a horizontally integrated basis
Demonstrate how they will simultaneously also operate as a vertically integrated care system, partnering with local GP practices.
Deploy rigorous population health management capabilities that improve prevention
Establish clear mechanisms by which residents within the ACS’ defined local population will still be able to exercise patient choice.
What Accountable Care Organisations (ACOs) are
The document says: “In time some ACSs may lead to the establishment of an accountable care organisation. This is where the commissioners in that area have a contract with a single organisation for the great majority of health and care services and for population health in the area. A few areas in England are on the road to establishing an ACO, but this takes several years”
Area of policy change Explanation
Assessment of STPs NHSI and NHSE will publish metrics at STP level in July that will “align” with the
Single Oversight Framework for NHS provider trusts and NHSE’s annual CCG Improvement and Assessment Framework.
Governance of STPs
STPs must: form an STP board drawn from constituent organisations and including
appropriate non-executive participation, partners from general practice, and in local government wherever appropriate.
establish formal CCG Committees in Common or other appropriate decision making mechanisms where needed for “strategic decisions between NHS organisations.”
ensure the STP has the necessary programme management support by pooling expertise and people from across local trusts, CCGs, CSUs and other partners.
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Communication of STPs
From 1 April 2017, NHS organisations will have to show that proposals for significant hospital bed closures, requiring formal public consultation, can meet one of three “common sense conditions”:
That sufficient alternative provision is being put in place alongside or ahead of bed closures, and that a new workforce can deliver it; and/or
That specific new treatments or therapies will reduce specific categories of admissions; and/or
Where a hospital has been using beds less efficiently than the national average, has a credible plan to improve performance without affecting patient care
How to become an ACS
The document says: “We expect that candidates for ACS status to include successful vanguards, ‘devolution’ areas, and STPs that have been working towards the ACS goal. In Q1 2017/18, NHSE and NHSI will jointly run a light-touch process to encourage other STPs (or coherent parts of STPs) to come forward as potential ACSs. This is a complex transition which requires careful management, including of the financial framework so as to create opportunity while also reducing instability and managing risk.”
Freedoms given to ACSs by the national bodies
The ability for the local commissioners in the ACS to have delegated decision rights in respect of commissioning of primary care and specialised services.
A devolved transformation funding package from 2018, potentially bundling together national funding for GPFV, mental health and cancer.
A single ‘one stop shop’ regulatory relationship with NHSE and NHSI with streamlined oversight arrangements, with an integrated CCG IAF and trust single oversight framework.
The ability to redeploy attributable contracting staff and related funding from NHSE and NHSI to support the work of the ACS.
OTHER AREAS OF INTEREST
Funding and efficiency
The document outlines a 10 point plan for the next two years to increase efficiency for the NHS in England. This briefing picks out the key points of this plan below and the keys areas where they impact on providers. 1. Free up 2000 to 3000 hospital beds
Using the extra £1bn awarded to adult social care in the last budget hospital trusts “must now work with their local authorities, primary and community services to reduce delayed transfers of care.”
2. Further clamp down on temporary staffing costs and improve productivity
Trusts are set a target of cutting £150m in medical locum expenditure in 2017/18. NHSI will require public reporting of any locum costing over £150,000 per annum.
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3. Use the NHS’ procurement clout
All trusts will be required to participate in the Carter Nationally Contracted Products programme, by submitting and sticking to their required volumes and using the procurement price comparison tool.
4. Get best value out of medicines and pharmacy
NHSI support trusts to save £250m from medicines spend in 2017/18 by publishing the uptake of a list of the top ten medicines savings opportunities, and work with providers to consolidate pharmacy infrastructure
5. Reduce avoidable demand and meet demand more appropriately
NHS provider trusts will have to screen, deliver brief advice and refer patients who smoke and/or have high alcohol consumption in order to qualify for applicable CQUIN payments in 2017/18 and 2018/19.
6. Reduce unwarranted variation in clinical quality and efficiency
Trusts to improve theatre productivity in line with Get it right first time (GIRFT) benchmarks and implement STP proposals to split ‘hot’ emergency and urgent care from ‘cold’ planned surgery clinical facilities for efficient use of beds.
7. Estates, infrastructure, capital, and clinical support services
The NHS and Department of Health are aiming to dispose of £2bn of surplus assets this parliament, following recommendations from the forthcoming Naylor review.
8. Cut the costs of corporate services and administration
NHSI is targeting savings of over £100m in 2017/18, from trusts consolidating these services, where appropriate across STP areas. NHSI is also establishing a set of national benchmarks.
9. Collect income the NHS is owed
The Government has set the NHS the target of recovering up to £500m a year form overseas patients, Twenty trusts will now pilot new processes to improve the identification of chargeable patients
10. Financial accountability and discipline for all trusts and CCGs
Outlines the operation of control totals - 70% of the STF will again be tied to delivery against control totals. Provider trusts not agreeing control totals will lose their exemption from contract fines. From August 2017 CQC will begin incorporating trust efficiency in their inspection regime based on a Use of Resources rating. Trusts missing their control totals may be placed in the Special Measures regime.
Mental Health
What still needs to be achieved
An extra 35,000 children and young people being treated through NHS-commissioned community services next year compared to 2014/15
NHSE to fund 150-180 new CAMHS Tier 4 specialist inpatient beds, rebalancing beds from parts of the country where more local CAMHS services can reduce inpatient use.
74 24-hour mental health teams at the Core 24 standard, covering five times more A&Es by March 2019
An extra 140,000 physical health checks for people with severe mental illness in 2017/18. How it will be achieved
Expand the mental health workforce – 800 mental health therapists embedded in primary care by March 2018, rising to over 1500 by March 2019.
Reform of mental health commissioning so that local mental health providers control specialist referrals and redirect around £350m of funding.
Clear performance goals for CCGs and mental health providers, matched by unprecedented transparency using the new mental health dashboard.
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Cancer
What still needs to be achieved
Introduction of a new bowel cancer screening test for over 4m people from April 2018.
Introduce primary HPV testing for cervical screening from April 2019 to benefit 3m women per year.
Expand diagnostic capacity so that England is meeting all 8 of the cancer waiting standards.
Performance incentives to trusts for achievement of the cancer 62-day waiting standard will be applied to extra funding available to our cancer alliances.
23 hospitals have received new or upgraded radiotherapy equipment in early 2017, and over 50 new radiotherapy machines in at least 34 hospitals will be rolled out over the next 18 months.
How it will be achieved
Targeted national investment, including £130m for a national radiotherapy modernisation fund. £36m has been spent so far, with a further £94m planned to be spent over the next 18 months.
Expand the cancer workforce: HEE to have trained 160 non-medical endoscopists by 2018, alongside 35 more places for ST1 clinical radiology training.
Performance goals for CCGs and cancer providers, and transparency using the new cancer dashboard.
Three cancer vanguards creating population cancer budgets so as to integrate commissioning of cancer surgery, radiotherapy and cancer drugs for 9.6m people., and
Other areas of relevant interest the document says will be delivered in the next two years
Workforce
A new nurse retention collaborative run by NHSI and NHS Employers will support 30 trusts with the highest turnover.
A consultation will be launched on creating a Nurse First route to nursing, similar to the Teach First programme.
NHSI will publish guidance on effective electronic rostering.
Undergraduate medical school places will grow by 25% adding an extra 1500 places, starting with 500 extra places in 2018 and a further 1000 from 2019.
Technology
By summer of 2017 GPs will be able electronically to seek advice and guidance from a hospital specialist without the patient needing an outpatient appointment.
In the summer 2017 an updated online patient appointment system will be launched, providing patients with the ability to book their first outpatient appointment with access to waiting time information on a smartphone, tablet or computer.
The NHS e-Referral Service is currently used by patients to arrange just over half of all referrals into consultant-led first outpatient appointments. By October 2018 all referrals will be made via this route, improving patients’ experience and offering real financial and efficiency benefit
By December 2018 there will be a clear system in place across all STPs for booking appointments at particular GP practices and accessing records from NHS 111, A&Es and UTCs
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NHS PROVIDERS PRESS STATEMENT NHS PROVIDERS COMMENTS ON THE NHS FIVE YEAR FORWARD VIEW DELIVERY PLAN
Embargoed until 00.01 hours, Friday 31 March 2017 Commenting on the NHS Five Year Forward View Delivery Plan published today, Chris Hopson, NHS Providers Chief Executive said: “We welcome the plan’s recognition of the scale of challenge the NHS faces - rapidly rising demand, the longest and deepest financial squeeze in NHS history and growing staff shortages.”
On the task facing NHS trusts in 2017/18 and 2018/19 “Two weeks ago, in our Mission Impossible? report, we set out how impossible the task was for NHS trusts in 2017/18 and we called for greater realism. We therefore welcome the new performance trajectories for the key four hour A&E and 18 week elective surgery targets next year. But we do need to remember the impact on patients. More will have to wait longer in A&E and for routine surgery than they should. That’s why, in our report, we said that NHS trusts would much prefer to be properly funded to meet the NHS constitutional standards. “Trusts look forward to working with NHSE and NHSI to finalise two key details not covered in the plan. “First, we need to finalise the 2017/18 financial targets. Our recent survey of trust finance directors estimated a £1 billion gap in the 2017/18 budget if trusts are to achieve the required financial balance. Given the new financial year starts tomorrow we need to rapidly work out how to fill this gap and what the overall provider sector financial target should be. We believe trusts will be doing well to reproduce this year's likely performance of an £800-900m deficit. “Second, we need to work out what can actually be delivered in 2018/19 given that NHS frontline funding increases drop even further from +3.6% in 2016/17 to +1.3% in 2017/18 and then to +0.4% in 2018/19. This means that NHS real terms spending per person (adjusting for age) will actually decrease in 2018/19 - a very rare occurrence. “We also welcome the explicit acknowledgement in the plan of the scale of risk facing NHS trusts in delivering all they are required to in 2017/18. We must not forget how difficult this winter was for staff and patients with unacceptable levels of patient safety risk. We need to ensure this risk is much better managed next winter. For example, the NHS needs between 2,000 and 3,000 beds freed up as a result of the extra £1 billion social care funding allocated in the Budget. Without this, or other extra capacity, the plan’s A&E performance trajectories in the second half of 2017/18 already look very difficult indeed – even though these are already below the NHS constitutional standard. “Trust leaders also recognise the importance of their role in delivering the new cancer and mental health improvements for patients and service users. It is important that we continue to make progress in these two areas.”
On the development of Sustainability and Transformation Partnerships (STPs) “We welcome the pragmatic and flexible approach to developing STPs. The plan recognises that the 2012 Health and Social Care Act prevents the creation of a formal ‘mid level STP tier’ with statutory powers.
NHS Providers | ON THE DAY BRIEFING | Page 9
“The plan also recognises the importance of existing governance and accountability structures focussed on trusts, but also the opportunity for shared decision making at the STP level. “Finally, it allows different STPs to move at different speeds: enabling the fastest to progress without delay but not forcing others to adopt a single uniform approach they neither want nor are ready for. “We look forward to working with NHSI and NHSE on the details of how STPs will develop in future over the next few weeks.” On workforce “Trust leaders tell us that concerns over workforce are now at the top of their worry list. This includes concerns about growing staff shortages, the unsustainable pressure on staff and the viability of maintaining a 1% pay cap. We note the workforce proposals in the plan and will want to test with NHS trusts whether these really do represent a viable and sustainable solution.” On the future strategic direction of the NHS “We welcome the restatement of the Five Year Forward View vision of closing the health, care and financial gaps and the move to new care models, which we strongly support. “We also welcome recognition that transformation at the required speed can only occur with capital investment and by growing capacity closer to people’s homes in the community. The Chancellor’s commitment to address these needs in the Autumn Statement is welcome but the detail of how that commitment is met will be important. Trust leaders tell us they are very worried by the current approach to capital – it is short sighted and unsustainable to carry on robbing capital budgets to prop up daily running costs “Transformation also requires the right leadership capacity that is in desperately short supply given the increasing fragility of services and the leadership time required to keep them stable.” Summary “The plan reinforces a simple, stark, truth: that you get what you pay for. Trusts will do all they can to transform and realise efficiencies as quickly as possible. But if NHS funding increases fall way behind demand and cost increases NHS services inevitably deteriorate. That is clearly now happening.”
ENDS
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Report to: Trust Board - Public
Date of meeting: 5th April 2017
Subject: Trust Performance Report 2016/17 Month 11
Author(s): Adam Creeggan, Director of Performance and Planning Steve Coakley, Acting Assistant Director of Performance & Contracts
Presented by: Jane Farrell, Chief Operating Officer
Sponsor: Jane Farrell, Chief Operating Officer
History: None
Status: For Information
1. Summary of Report This report provides the details of performance achieved against key national performance and quality indicators, and governance indicators defined in the Monitor Single Oversight Framework (SOG) at Month 11 2016/17. 2. Action required The Board is asked to approve the M11 performance reported against the governance indicators defined in the SOG 3. Key implications Legal: Report relates to performance against statutory requirements of the
Trust licence Financial: Trust reports financial performance against published plan. Assurance:
The summary report provides detailed performance against the operational metrics defined within the NHSI SOG.
Clinical: There is no direct impact on clinical issues. Equality & Diversity: There is no impact on equality & diversity issues. Performance: The report summarises performance against local and national
KPIs. Strategy:
Highlights performance against the Trust’s annual plan forecasts and key objectives.
Workforce: Links to effectiveness of workforce and forward planning Estates: Links to effectiveness of estate use and forward planning Reputation: Trust’s quarterly and monthly results will be published by NHSI and
the DoH. Other:(please specify)
Key Single Oversight Framework Compliance Metrics
A&E compliance against the 4-hour target improved from 78.21% reported in January to 81.41% in February. Performance has continued to improve into March with the in-month compliance position c.83% at the point of finalising this report.
RTT incomplete pathway compliance has worsened slightly from 77.3% reported in January to 76.9% for February. The number of patients waiting >18 weeks increased by 454 pathways, with admitted pathways accounting for 401 of the increase. The number of patient waiting 52+ weeks has also increased from 158 waiting at the end of January 2016 to 183 at the end of February.
Cancer data is provisional at the time of writing. Treatment within 62 days for patients
referred from a national screening programme is compliant at 96.0% against a target of 90% for February. At the time of writing provisional data shows 80.3% of patients received first treatment within 62 days following referred an urgent GP referral under the 2 week cancer rule against the target of 85.0%, and compliance for this target is at risk for February.
Diagnostic waiting time performance for February was compliant against the 1% national
target, with 0.93% of patients waiting longer than 6 weeks for diagnostic examination.
NHSI: Single Oversight Framework YTD
Target Qtr 1 Qtr 2 Qtr 3 Month
11
Cancer 62 days for first treatment: from urgent GP referral: all cancers 85% 85.8% 85.4% 87.3% 80.3% Cancer 62 days for first treatment: national screening service referral: all cancer 90% 89.7% 88.1% 91.7% 96.0%
Diagnostics: Maximum waiting time of 6 weeks for diagnostic test. <1% 9.40% 0.97% 0.98% 0.93% RTT: Maximum waiting time of 18 weeks from referral to treatment for patients on an incomplete pathway 92% 76.1% 81.7% 77.1% 76.9% A&E: Maximum waiting time of 4 hours from arrival to admission, transfer or discharge 95% 84.1% 84.5% 78.9% 81.4%
Key Issues Clinical Effectiveness: The national Summary Hospital Mortality Index (SHMI) improved from 97.9 to 91.7 for the
PRUH site, but declined slightly from 87.1 to 87.7 for the DH site. Both sites significantly exceed the expected index of 100.
Safety: At Month 11 the Trust has had 66 cases of c-difficile, exactly matching trajectory. 3 cases
were identified in February, 50% below the in-month ceiling of 6 cases. One MRSA case has been reported in January but is subject to a Post Infection Review
meeting, due to be held in late-March to confirm attribution. If attributed to the Trust this will bring the cumulative volume in 2016/17 to 5 cases, all of which have occurred on the DH site.
The number of ward red shifts reduced from 204 in January to 127 in February. Of these, 66 red shifts were on medical wards, 23 on child health wards and 20 on surgical wards.
There were 7 slips, trips or falls cases causing moderate/severe harm reported in February. 5 cases reported on medical wards (3 on the DH site and 2 at PRUH), and one case reported on stroke unit and one case on a liver ward at DH.
The number of grade 2-4 pressure sores reduced from 24 reported in January to 22 cases reported in February. All 17 cases for the DH site were grade 2, including 5 cases on critical care units as well as the acute surgical unit, and 3 cases on medical wards. One of the five cases reported at PRUH was a grade 3 case and the remaining four cases were grade 2.
Patient Experience: The HRWD Inpatient survey score improved by 1 point at PRUH to 92 and remained static
at DH at 89, both achieving the target of 89. The Friends and Family (FFT) scores for Inpatient/Day cases remained static at 95 at PRUH and worsened slightly at DH to 92, but both continue to achieve their internal targets. The FFT score for ED improved by 4 points on both sites, to 86 at DH and to 82 at PRUH.
The number of inpatient cancellations on the day reduced from 102 cases in January to 53 in February, 23 of which related to the DH site and 30 to PRUH. There were 13 breaches of the 28-day cancellation standard for February, of which 11 were on the DH site and 2 cases at the PRUH. Cancellations related directly to acute bed pressures and enforced prioritisation of emergency cases.
The number of patient complaints increased remained static with 86 cases in February, although none were rated high/severe. The number of complaints open or not responded to within 25 working days increased from 42 to 51 cases.
Finance & Operational Efficiency: Financial position - please see the Finance report for further details. The proportion of inpatients discharged at weekends has remained relatively static on the
PRUH site at 23% in February, but has declined on the DH site from 21.8% in January to 20.4% in February.
Utilisation in main theatres at DH improved from 75% to 78%, and DSU utilisation improving from 71% to 77%. On the PRUH site, main theatre utilisation improved from 55% to 62%, but DSU utilisation reduced slightly from 64% to 62%.
Staffing: Data for sickness, absence and mandatory training are not available at time of writing. Vacancy rates remain static for the DH site at 13.2% and have improved by 0.8% to 11.4%
for the PRUH site. Data for staff appraisal show static compliance.
Highlights – February 2017
Trust performance for all types attendances against the 4-hour remains challenged but saw a further performance improvement from 78.21% in January to 81.41% in February. Performance has continued to improve into March with the in-month compliance position at 83.2% at the point of writing and remains on course achieve the improvement trajectory milestone of 83.58% set for the month.
89.89%91.84%
89.34%
83.39%84.13% 84.53%
78.88%
70%
75%
80%
85%
90%
95%
100%
Qtr 1 Qtr 2 Qtr 3 Qtr 4
KIngs ‐ Quarterly All Types Performance
2015/16 2016/17
70%
75%
80%
85%
90%
95%
100%
Kings‐ Monthly All Types PerformanceFeb 2015 ‐ Feb 2017
Feb 2015 ‐ Feb 2016 Feb 2016 ‐ Feb 2017
Recovery Plan Update Nick Moberly, Chief Executive Officer and Accountable Officers from Lambeth, Southwark and Bromley CCGs have met NHSI and NHSE representative as part of a round of escalation review meetings relating to A&E compliance and whole system flow. Health economy leaders presented augmented action plans focussed on: additional bed capacity subject to staffing constraints on the DH and PRUH sites centralised bed management and improved discharge planning development of a new frailty assessment service at DH and full use of frailty pathway at
PRUH/Orpington hospital development of an ambulatory model and improvement to acute medical assessment and
admissions pathways re-design of ED processes to support performance improvements for non-admitted patients
including the new UCC and additional ED capacity at DH, and timely referral pathway from UCC to ED at the PRUH site
Though these actions, health economy leaders have agreed a revised compliance trajectory restoring sustainable compliance in 2017/18. This plan sets out ambitious milestones based on the collective benefit of Trust based actions, and those relating to health and social care partners in improving system flow. The first month of this revised compliance trajectory has been met in February and the Trust is on course to deliver to target in March. Here and Now Steering Groups have been setup for both the DH and PRUH sites which will oversee the clinical working groups, and will report monthly into the Emergency Pathway Transformation Board. The focus until May 2017 is on immediate improvement and delivery of
Trust Emergency Care 4-hour performance and ED Recovery Programme
first-stage plans developed through the Clean Sheet Redesign and revised site-based ED recovery plans. February 2017 performance position
Compliance was fully achieved in February. The number of diagnostic 6-week waiting time breaches reduced from 128 for the end-January to 106 for the end-February 2017 position, representing 0.93% of the total number of patients waiting (11,368 patients). Significant challenges remain in cardiac MRI and CT, and the Trust continues to use independent sector capacity to maintain compliance with this standard. The essential replacement of a CT scanner at PRUH compounds this risk until the new CT becomes operational in April. Mitigating capacity has been secured using the independent sector, and available capacity on both acute sites versus variation in demand is being closely monitored through the duration of the CT replacement programme.
February 2017 Incomplete performance position
On-going emergency pressures on beds on the DH and the PRUH sites has resulted in a reduction of elective inpatients able to be admitted. During periods of heighted emergency demand elective admissions have been restricted to those patients waiting for cancer treatment or other urgent needs, and long-wait patients.
Consequently the waiting list increased by 584 pathways to 85,993 incomplete pathways at the end of February 2017. The February month-end position that was submitted to the national Unify system shows 19,828 incomplete pathways with a waiting time over 18 weeks, which is an increase of 454 pathways compared to January. The number of admitted incomplete pathways increased by 401, and the number of non-admitted pathways has increased by 53 cases.
The February positon has 183 patients waiting over 52 weeks, of which 117 patients are on admitted pathways and 66 patients waiting on non-admitted pathways. This is an increase compared to the 158 patients reported for the end of January position, but remains 32 patients ahead of the agreed trajectory of 215 for the month. The number of Neuro-specialty breaches reduced from 22 to 17 and are 198 ahead of trajectory. Non-neuro breaches increased from 136 to 166 and are therefore 166 cases behind trajectory, as the submitted plan had zero non-neuro specialty breaches from October 2016.
To elevate waiting list pressure and expedite patient treatment, the Trust is undertaking triage and redirection of patients in March for patients waiting in Dermatology and Ophthalmology, made possible by NHSE funding. These specialties make up crudely 30% of all patients waiting over 18 weeks at KCH, and the triage process will allow clinically appropriate patients the
Diagnostics
Referral to Treatment
opportunity to be seen and treated by in a primary care setting by multi-disciplinary teams including Optometrists and GPs with a special interest in Dermatology.
In partnership with commissioning CCGs, the Trust has also recently secured in principle agreement of funding to extend the access to independent sector outpatient and day case capacity in 2017/18. Detailed operational scenario plans demonstrate that the extension of capacity this funding unlocks will have significant impact in reducing the waiting list size and improving associated >18 week compliance in 2017/18. The Trust is rapidly working this agreement in principle into full delivery plans, and these will be presented to the April meeting of the Finance and Performance Committee for ratification.
62 Day Treatment The February 2017 position cannot be finalised until the 25th working day after month-end, therefore the positions in this report should be treated as provisional until all treatments are captured and validated based on completed histopathology, and confirmation of treatment for shared care pathways across multiple providers. Based on the latest information available, treatment within 62 days for patients referred urgently from a GP referral stands at 80.3% compared to the 85% target for February. Urology and colorectal breaches across both sites account for 60% of the breaches in February with CT reporting being a significant factor in root cause analysis. An investigation into a backlog of CT scans waiting to be reported was escalated to the Cancer Committee meeting in February, identifying that 379 scans were unreported. These have since been outsourced to an independent reporting company and this backlog has now been cleared. The 62 day first treatment target for patients referred by a screening service in February is 96.0%, and therefore forecast to be comfortably compliant in relation to 90% national target.
MRSA (post 48 hour bacteraemia: One case has been reported in January but is subject to a Post Infection Review meeting,
due to be held in late-March to confirm attribution of this case to the Trust or not. The previous case was reported in October on Guthrie war. 1 case in September, 1 case in June 2016 and 1 case in May 2016 at DH site; 4 cases YTD at DH site which is above the zero quota. No cases reported at PRUH site.
C-difficile:
Cancer
Healthcare Associated Infection (HCAI) Update
3 new cases reported in February, 2 at the DH site and 1 at PRUH site; 66 cases YTD which is equal to the quota of 66 cases for February YTD position and better than the 83 cases reported by February last year.
VRE bacteraemia: 6 new cases at DH only; 50 cases YTD which is above the target of 23 cases for the
February position and higher than the 36 cases reported by February last year. E-Coli bacteraemia: 14 new cases reported in February, 12 cases on the DH site and 2 case2 on the PRUH site ;
129 cases YTD which is above the target of 91 cases, and above the 105 cases reported by February last year.
C-Difficile (CDI) Action Plan Update: Reviewing of current practice and integration of policies and practice:
Work is on-going to align policies and protocols across sites. This work will be overseen by the HCAI Operations Committee.
Policies approved and published: Infection Prevention and Control, Intravascular Catheters, Waste Management and Trust Decontamination.
Protocols approved and published: Isolation Precautions, Infectious Death Handling,
Management of Gastrointestinal Infection, Respiratory Virus and Atypical Bacterial Infections Treatment and Infection Control, Varicella Zoster Virus (VZV), Transmissible Spongiform Encephalopathy, Blood Cultures, Standard Precautions, Hand Hygiene, Linen and Laundry, Guidelines for Animals on Hospital Premises and Aseptic Non Touch Technique.
Protocols under consultation: MRSA, Clostridium difficile, Multiple Resistant Gram
Negative, Tuberculosis protocols are under consultation. Protocols outstanding: Control of Outbreaks of Infection, Pandemic Influenza Protocol,
Coronavirus including MERS-CoV & SARS-CoV and Streptococci and Enterococci.
Centralisation of endoscope reprocessing: A project on-going to plan and develop a central reprocessing facility for endoscopies. The unit at DH site is being used as a template for the PRUH unit. This project is still very much in the planning stages, but should allow for a much higher level of decontamination than is currently the case.
Appendix 1: Site Performance Scorecards
Trust Performance Scorecard – DH site
Appendix 1: Site Performance Scorecards
Trust Performance Scorecard – PRUH site
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Monthly Nurse Safer Staffing Report February 2017
Trust Board April 2017
Dr Shelley Dolan Chief Nurse /Executive Director Midwifery
1
Report to: Trust Board
Date of meeting: Wednesday 5th April 2017
Subject: Monthly Unify Staffing Report (February 2017)
Author(s): Maria Donbavand
Presented by: Shelley Dolan
Sponsor: Shelley Dolan
History: Monthly Nursing, Midwifery and Care staff numbers to the Board
Status: For Information
2
Introduction
Following the investigation into Mid Staffordshire NHS Trust, the resultant Francis report NHS England (NHSE) and NHSImprovement (NHSi) requested that all Trust Boards receive monthly reports on the levels of planned and actual nursing and carestaff. This report provides evidence to the Board on the Nursing and Midwifery and care staff levels across the Trust during February2017 and provides details of the actual hours of Nursing, Midwifery and Health Care Assistant (HCA) on day and night shifts versusplanned staffing levels.Care Hours Per Patient Day (CHPPD) are also being collected as mandated by NHS England (2016) and will be routinelycompared to all other London and Shelford Trusts when the data is available through the Carter review and NHSI.
To ensure that this data is more meaningful this report at Kings has from January 2017 included nurse staffing levels in the context of care provision. Each wards staffing levels including CHPPD is therefore provided in the context of “harm free care” and patient experience.
Background
The international evidence demonstrates that the six critical issues for safe staffing and quality patient care and experience are the following:
1. Expert clinical leadership at Sister /Charge Nurse and Matron level 2. Appropriate skill mix for the acuity and dependency of the patient group3. Appropriate establishment for the size / complexity of the unit 4. Ability to recruit the numbers required to fill the establishment 5. Good retention rates to ensure staff that are experienced in the clinical speciality and context / environment6. Ability to flex at short notice to fill with temporary staff when there are unplanned vacancies / or to use staff from other areas.
Summary of Report 1/2
3
Overall Trust nurse recruitment / retention data
4
Band Headcount Establishment FTE In-Post FTE Vacancy FTE Vacancy % Voluntary
Turnover %Monthly Sickness
%
Band 5 1,894 2,185.50 1,811.40 374.10 17.12% 24.28% 3.07%Band 6 1,256 1,288.55 1,144.44 144.11 11.18% 13.85% 3.91%Band 7 680 685.53 631.71 53.82 7.85% 10.95% 3.58%Band 8 - A 200 208.02 187.90 20.12 9.67% 11.49% 3.32%Band 8 - B 30 46.98 29.28 17.70 37.68% 6.40% 0.95%Band 8 - C 22 17.75 22.40 -4.65 0.00% 20.00% 1.50%Band 8 - D 1 3.23 1.00 2.23 69.04% 54.55% 25.00%Band 9 5 1.00 5.00 -4.00 0.00% 0.00%Other 2 2.00 2.00 0.00 0.00% 57.14% 0.00%Grand Total 4,090 4,438.56 3,835.13 603.43 13.60% 17.92% 3.39%
Nurse and Care staff turnover 2015-2016
5
N&M and Support Staff Feb-17
Voluntary Turnover %
Band DH & Ass. Sites PRUH & Ass. Sites Grand Total
Band 2 15.38% 17.52% 16.29%
Band 3 16.56% 8.21% 14.22%
Band 4 9.72% 8.56%
Band 5 25.31% 21.41% 24.21%
Band 6 16.47% 8.19% 13.85%
Band 7 11.88% 8.21% 11.04%
Band 8 - A 12.59% 5.85% 11.49%
Band 8 - B 3.73% 29.27% 6.61%
Band 8 - C 31.25% 25.00%
Band 8 - D 54.55% 54.55%
Other 36.36% 100.00% 63.16%
Grand Total 18.59% 14.72% 17.44%
The number of staff required per shift is calculated using an evidence based tool, based on the level of acuity of the patients. This is further informed by professional judgement, taking into consideration issues such as ward size and layout, patient dependency, staff experience, incidence of harm and patient satisfaction and is in line with NICE guidance. This provides the optimum plannednumber of staff per shift.
For each of the 80 clinical inpatient areas in February, the actual number of staff as a percentage of the planned number is recorded. The average nurse fill at DH in February was 93% and at the PRUH 96%. In comparison average fill rates at Guys and St.Thomas NHS FT was 100%, Imperial College NHS Trust was 97% and UCLH 98% for the same months. Therefore at KCH the average fill rates are acceptable but there are instances where vacancy rates are high with shifts unable to be filled bytemporary staff. There is a system in place to ensure daily monitoring of red shifts using safety huddles but there are many shifts currently where there are high numbers of unfilled places. Poor skill mix and low numbers consistently have a significant effect on staff morale and patient care. It is therefore essential that KCH focus on innovative recruitment, retention and clinical leadership strategies to reduce the current variation across the Trust.
Understaffing26 wards had actual staffing of below 85% over the month ( Appendix 1 + 2) highlights the reasons for this and how the shift wasmade safe, all such instances are reported on the red shift reporting system.
6
Planned and actual nurse & Care staff fill
% Average fill rate RN
% Average Fill rate HCA
Denmark Hill 93% 137%
PRUH 96% 109%
Safer Staffing Fill rate - February 2017
SiteDay and Night
Red shifts A red shift occurs when fewer Registered Nurses than planned are in place, or when the number of staff planned is correct but the patients are more acutely sick or dependent than usual requiring a higher staffing level (NICE 2015). In total there were 103 Red shifts declared in February 2017. The majority of these were at Denmark Hill and associated with increased acuity, vacancies or bank/agency failing to fill the shifts. In each case Matrons and Heads of Nursing assessed the situation and made a judgementabout whether moving staff from a better staffed area was required to maintain safety.
7
0102030405060708090
100110120130140150160170180190200
Jan‐16 Feb‐16 Mar‐16 Apr‐16 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17
No. of Red Shifts between Jan 16 - Feb 17 Denmark Hill
Red
Linear (Red)
0102030405060708090
100110120130140150160
Jan‐16 Feb‐16 Mar‐16 Apr‐16 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17
No. of Red Shifts between Jan 16 - Feb 17 PRUH
Red
Linear (Red)
Denmark Hill February 2017
8
Cost
Cen
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t Nam
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C2C
Est
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Cost
Cen
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Divi
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Depa
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t Nam
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d
C2C
Dec
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Tota
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ancy
%va
c/ab
s
% o
f B+A
Vs
Est
Acui
ty d
ata
occu
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RMs/
RNs
Care
Sta
ff
Ove
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CHPP
D
Red
Ambe
r
Gra
de 2
Gra
de 3
Gra
de 4
Min
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Mod
Maj
or
Deat
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MRSA
CDIF
F
UTIs
E Co
li
No. o
f Com
plai
nts
Resp
rate
% F
FT
Reco
mm
end
(%)
Beds
2206 UPAC Post-Acute and Planned Medicinie + Outpatients Byron n/a 42.64 7.13 26% 33% 48.59 99% 4.1 3.2 7.3 0 21 1 0 0 4 0 0 0 0 0 n/a 0 1 4% 100% 302238 UPAC Post-Acute and Planned Medicinie + Outpatients Donne 0 45.20 3.59 26% 23% 49.20 95% 3.4 2.9 6.3 5 24 0 0 0 0 0 0 0 0 0 n/a 2 2 63% 74% 302239 UPAC Post-Acute and Planned Medicinie + Outpatients M. Warren n/a 45.20 6.00 25% 19% 52.92 97% 3.2 3.1 6.3 1 28 0 0 0 2 0 0 0 0 0 n/a 1 1 48% 100% 322497 UPAC Post-Acute and Planned Medicinie + Outpatients Lonsdale 2 40.08 4.28 20% 11% 30.37 97% 4.7 2.5 7.2 1 26 0 0 0 1 0 0 0 0 0 n/a 0 0 49% 83% 252935 UPAC Post-Acute and Planned Medicinie + Outpatients Mary Ray 0 42.64 5.89 17% 25% 46.44 99% 4.1 2.6 6.7 0 17 1 0 0 0 2 0 0 0 0 n/a 0 1 0% 0% 302211 UPAC Post-Acute and Planned Medicinie + Outpatients Oliver 2 no data 3 19 0 0 0 0 0 0 0 0 0 n/a 0 0 1% 0% 302211 UPAC Post-Acute and Planned Medicinie + Outpatients Charles Polkey 2 no data 0 0 0 0 0 1 0 0 0 0 0 n/a 0 0 0% 0% 302336 UPAC Post-Acute and Planned Medicinie + Outpatients Mathew Whiting (ACH) 1 0 0.00 #DIV/0! #DIV/0! 30.14 84% 4.3 2.4 6.7 0 4 0 0 0 1 0 0 0 0 0 n/a 0 1 0% 0% 252202 UPAC Post-Acute and Planned Medicinie + Outpatients AZ n/a 51.11 11.92 15% 4% 41.43 99% 5.4 2.3 7.7 8 37 0 0 0 0 0 0 0 0 0 n/a 0 0 29% 91% 282794 UPAC Acute and Emergency RDL AMU 3 51.71 9.66 19% 17% 33.94 96% 5.4 2.1 7.5 5 29 1 0 0 2 0 0 0 0 0 n/a 0 1 12% 92% 28
2776/2237 UPAC Acute and Emergency E D (Adults and Paeds) n/a 150.58 15.83 25% 31% n/a n/a n/a n/a n/a 0 0 1 0 0 0 0 0 0 1 0 n/a 0 2 4% 84% n/a2337 UPAC Planned Surgery and Opthalmology Lister 1 40.48 10.36 31% 28% 40.82 100% 3.5 2.7 6.2 1 23 1 0 0 2 0 0 0 0 0 n/a 1 1 45% 92% 282977 UPAC Planned Surgery and Opthalmology Coptcoat 3 42.35 5.06 26% 14.68 89% 5.6 2.4 8.0 4 13 0 0 0 0 0 0 0 0 0 n/a 0 0 80% 100% 15n/a UPAC Planned Surgery and Opthalmology Short Stay SU n/a 0.00 0.00 0% 9.54 82% 6.4 3.1 9.5 6 11 0 0 0 0 0 0 0 0 0 n/a 0 1 0% 0% 10
2578 UPAC Planned Surgery and Opthalmology Trundle 3 32.00 -8.07 28% 11% 24.58 94% 5.0 5.0 10.0 0 12 0 0 0 0 0 0 0 0 0 n/a 0 0 70% 100% 162841 UPAC Planned Surgery and Opthalmology Twining n/a 0.00 0.00 #DIV/0! 25% 41.86 100% 3.7 2.6 6.3 0 21 1 0 0 2 0 0 0 0 0 n/a 2 0 19% 93% 262842 UPAC Planned Surgery and Opthalmology K. Monk ASU 0 49.74 6.04 27% #DIV/0! 37.12 94% 6.1 5.3 11.4 3 14 3 0 0 1 0 0 0 0 0 n/a 0 0 43% 96% 282932 UPAC Planned Surgery and Opthalmology Anaes n/a 17.50 8.73 39% 17% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/a2767 UPAC Planned Surgery and Opthalmology Neuro n/a 44.00 12.00 19% 12% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/a2766 UPAC Planned Surgery and Opthalmology Cardiac n/a 16.00 0.20 34% 10% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/a2769 UPAC Planned Surgery and Opthalmology Recovery n/a 32.30 6.04 22% 29% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/a2762 UPAC Planned Surgery and Opthalmology Theatre 1-6 n/a 15.77 -3.20 25% 20% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/a2765 UPAC Planned Surgery and Opthalmology Theatre 7, obs, nights n/a 33.00 8.18 19% 19% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/a2764 UPAC Planned Surgery and Opthalmology Theatre 8, 9 +10 n/a 20.00 4.00 17% 16% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/a2366 UPAC Planned Surgery and Opthalmology Radiology n/a 15.45 2.45 23% 8% n/a n/a n/a n/a n/a n/a n/a 0 0 0 1 0 0 0 0 0 n/a 0 0 n/a n/a n/a2353 UPAC Planned Surgery and Opthalmology Breast n/a 12.53 0.13 19% 5% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 1 n/a n/a n/a2364 UPAC Planned Surgery and Opthalmology N.Med n/a 3.00 1.00 96% 0% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/a2144 UPAC Planned Surgery and Opthalmology Pain n/a 7.07 2.07 27% 0% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/a
various UPAC Planned Surgery and Opthalmology DSU n/a 65.11 4.42 28% 22% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/a2468 UPAC Planned Surgery and Opthalmology Guthrie n/a 30.01 1.92 18% 6% 21.85 87% 6.5 1.5 8.0 0 0 0 0 0 0 0 0 0 0 0 n/a 0 0 0% 0% 212294 UPAC Women's health W. Gilliatt n/a 59.44 -3.77 29% 21% n/a n/a 3.4 2.0 5.4 0 0 0 0 0 0 0 0 0 0 0 n/a 0 4 0% 0% 502284 UPAC Women's health NBC n/a 88.21 -3.21 34% 16% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 1 n/a n/a 232283 UPAC Women's health Brunel 1 26.92 2.51 31% 19% 17.18 96% 4.9 2.2 7.1 0 1 0 0 0 0 0 0 0 0 0 n/a 0 1 0% 0% 182198 Networked Care Liver + Renal Todd 3 41.04 4.52 24% 14% 30.58 100% 4.9 2.4 7.3 4 13 0 0 0 0 0 0 0 0 0 n/a 1 0 44% 96% 222186 Networked Care Liver + Renal Dawson 3 35.35 5.12 26% 19% 31.73 99% 4.0 2.9 6.9 1 22 0 0 0 1 0 0 0 0 0 n/a 0 0 70% 90% 21
2302/2946 Networked Care Liver + Renal Fisk and Cheere 2 49.80 11.19 41% 25% 45.25 90% 5.4 3.0 8.4 0 7 0 0 0 2 0 0 0 0 0 n/a 0 0 20% 77% 302854 Networked Care Liver + Renal Howard 2 25.18 1.34 19% 14% 21.44 100% 5.4 2.6 8.0 1 4 0 0 0 1 1 0 0 0 0 n/a 0 1 39% 91% 162215 Networked Care Haematology and Precision DMU n/a 26.65 3.53 31% 32% 25.34 100% 6.6 2.7 9.3 0 12 0 0 0 3 0 0 0 0 0 n/a 1 0 35% 86% 152618 Networked Care Haematology and Precision Davidson n/a 31.79 6.53 25% 31% 27.94 100% 6.2 2.1 8.3 0 18 1 0 0 0 0 0 0 0 0 n/a 1 0 7% 100% 172899 Networked Care Haematology and Precision Waddington n/a 18.96 1.58 30% 27% 15.02 100% 7.4 1.8 9.2 0 6 0 0 0 0 0 0 0 0 0 n/a 0 0 54% 86% 9
Networked Care Haematology and Precision Elf & Libra n/a 31.79 4.25 23% 19% 26.00 99% 6.0 2.1 8.1 0 16 0 0 0 0 0 0 0 0 0 n/a 2 1 0% 0% 16Networked Care Cardiovascular V&A n/a 23.17 99% 4.6 0.6 5.2 0 6 0 0 0 0 0 0 0 0 0 n/a 0 0 7% 86% 18Networked Care Cardiovascular HDU n/a n/a n/a 10.8 2.6 13.4 0 3 0 0 0 0 0 0 0 0 0 n/a 0 1 n/a n/a 10Networked Care Cardiovascular CRU n/a n/a n/a 21 0.4 21.4 0 1 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a 0Networked Care Cardiovascular Sam Oram 2 4.7 3.7 8.4 0 4 0 0 0 1 0 0 0 0 0 n/a 0 0 18% 92% 17Networked Care Cardiovascular Sam Oram CCU n/a 9.1 1.3 10.4 0 3 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a 8
2158 Networked Care Cardiovascular Cath lab n/a 28.53 3.26 24% 0% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/a2344 Networked Care Cardiovascular Cotton n/a 36.07 1.02 27% 15% 37.63 99% 3.8 1.9 5.7 0 0 0 0 0 1 0 0 0 0 0 n/a 0 0 0% 0% 262246 Networked Care Neurosciences K.Wilson 3 37.12 8.50 20% 29% 32.29 100% 5.1 4.5 9.6 0 15 0 0 0 0 0 0 0 0 0 n/a 0 1 0% 0% 202667 Networked Care Neurosciences Kinnier Wilson HDU n/a 34.15 8.31 18% 30% n/a n/a 12.7 1.0 13.7 1 2 0 0 0 0 0 0 0 0 0 n/a 0 1 n/a n/a 112612 Networked Care Neurosciences David Marsden 2 55.96 14.27 31% 38% 51.49 100% 4.3 4.7 9.0 0 16 1 0 0 1 0 0 0 0 0 n/a 0 0 25% 92% 312242 Networked Care Neurosciences MF n/a 48.38 4.79 24% 21% 38.29 95% 4.5 2.6 7.1 0 17 1 0 0 2 0 0 0 0 0 n/a 0 0 58% 95% 312225 Networked Care Neurosciences Friends n/a 61.38 14.74 17% 25% 43.13 92% 7.2 3.2 10.4 0 11 0 0 0 2 0 0 0 0 0 n/a 1 2 33% 89% 292205 Networked Care Neurosciences FCRU 2 32.84 9.84 50% 16% 24.22 99% 4.1 4.0 8.1 0 3 0 0 0 0 2 0 0 0 0 n/a 0 0 0% 0% 152L18 Networked Care Neurosciences Ontario 3 33.50 2.20 30% 12% 38.06 97% 3.1 2.9 6.0 0 6 0 0 0 0 0 0 0 0 0 n/a 0 0 83% 90% 202167 Networked Care Variety Children's Hospital T&G n/a 32.79 2.96 35% 21% 17.21 93% 7.7 1.6 9.3 6 24 0 0 0 0 0 0 0 0 1 n/a 0 0 16% 100% 152171 Networked Care Variety Children's Hospital RoS n/a 38.92 4.88 20% 10% n/a n/a 7.8 1.5 9.3 1 7 0 0 0 0 0 0 0 0 0 n/a 0 1 28% 100% 182177 Networked Care Variety Children's Hospital Children's surgical Ward n/a 39.75 -7.52 20% 16% 41.45 100% 6.8 1.7 8.5 2 35 0 0 0 1 0 0 0 0 0 n/a 0 0 12% 100% 102173 Networked Care Variety Children's Hospital Thomas Cook CCCC n/a 73.10 4.26 25% 11% n/a n/a 19.0 1.6 20.6 4 9 0 0 0 0 0 0 0 0 0 n/a 0 1 n/a n/a 142170 Networked Care Variety Children's Hospital NICU n/a 101.51 20.69 23% 30% n/a n/a 12.5 0.2 12.7 7 16 0 0 0 0 0 0 0 1 0 n/a 0 0 n/a n/a 342176 Networked Care Variety Children's Hospital Ambulatory n/a 13.10 0.42 18% 3% n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a 92989 Networked Care Variety Children's Hospital Paediatric Short Stay Unit n/a 20.39 1.47 20% 12% n/a n/a 10.5 5 15.5 1 5 0 0 0 0 0 0 0 0 0 n/a 0 0 34% 88% 122936 Networked Care Critical Care, Radiology + MEP Christine Brown n/a 100.90 2.70 22% 8% n/a n/a 24.1 1.3 25.4 0 14 2 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a 18
Networked Care Critical Care, Radiology + MEP Frank Stansil (MCCU) n/a 80.05 5.79 25% 12% n/a n/a 25.6 1.7 27.3 0 7 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/aNetworked Care Critical Care, Radiology + MEP Jack SteinBerg (SCCU) n/a 95.04 -3.38 20% 7% n/a n/a 24.4 1.1 25.5 0 9 2 0 0 0 0 0 0 0 1 n/a 0 0 n/a n/a
2195 Networked Care Critical Care, Radiology + MEP LITU n/a 100.65 12.97 26% 16% n/a n/a 30.0 1.0 31.0 0 1 1 0 0 0 0 0 0 0 0 n/a 0 1 n/a n/a 192607.61 292.76 20% 65 612 17 0 0 32 5 0 0 2 2 12 28 1084
42.64 4.39 5.8 3.5 9.321%
WTE
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2160 75.36 12.91 16%44%
2153 44.88
2133/2993 30
27% 36.90 97%36%4.07
44%
PRUH February 2017
9
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PRUH and SS 2A24 Post-Acute Medicine S1 (Darwin 1) n/a 35.51 1.25 25% 34% 34.19 100% 3.6 5.6 9.2 1 13 0 0 0 0 0 0 0 0 0 n/a 0 1 0% 0% 20PRUH and SS 2A37 Post-Acute Medicine S2 (Darwin 2) 2 36.51 4.15 32% 23% 34.34 100% 3.3 5.2 8.5 1 14 0 0 0 0 0 0 1 0 0 n/a 0 0 0% 0% 20PRUH and SS 2A68 Post-Acute Medicine Medical 1 3 23.69 6.46 43% 50% no data 5.7 5.3 11.0 6 5 1 0 0 0 0 0 0 0 0 n/a 0 0 55% 94% 12PRUH and SS 2A21 Post-Acute Medicine Medical 2 2 29.82 1.45 31% 38% no data 3.3 3.5 6.8 5 3 0 0 0 0 1 0 0 0 0 n/a 1 0 0% 0% 20PRUH and SS 2A28 Post-Acute Medicine Medical 3 1 29.82 5.59 33% 46% 33.45 99% 3.7 4.0 7.7 0 1 0 0 0 0 0 0 0 0 1 n/a 0 1 4% 100% 20PRUH and SS 2A23 Post-Acute Medicine Medical 4 2 4.13 -20.87 -341% 257% 24.39 100% 3.7 3.7 7.4 0 1 0 0 0 0 0 0 1 0 0 n/a 0 0 100% 91% 20PRUH and SS 2A26 Post-Acute Medicine Medical 6 2 29.82 5.21 41% 51% 33.15 100% 3.5 4.5 8.0 0 0 0 0 0 0 0 0 0 0 0 n/a 0 2 64% 100% 20PRUH and SS 2A27 Post-Acute Medicine Medical 7 2 29.82 1.37 20% 29% 34.31 100% 3.5 3.0 6.5 0 6 0 0 0 0 0 0 0 0 0 n/a 0 0 55% 92% 20PRUH and SS 2A74 Post-Acute Medicine Farnborough 2 29.82 2.06 40% 99% 45.50 100% 4.4 3.8 8.2 1 8 1 0 0 0 1 0 0 0 0 n/a 0 0 16% 100% 25PRUH and SS TBA Post-Acute Medicine Elizabeth Ward n/a 0.00 0.00 10.46 35% 3.7 5.0 8.7 0 8 0 0 0 0 0 0 0 0 0 n/a 0 0 0% 0% 19PRUH and SS 2L35 Post-Acute Medicine Churchill Ward n/a 0.00 0.00 26.62 91% 3.9 5.1 9.0 5 9 0 0 0 0 1 0 0 0 0 n/a 0 0 0% 0% 19PRUH and SS Post-Acute Medicine Medical 8 33.30 100% 3.6 2.2 5.8 0 2 0 0 0 0 0 n/a 0 0 0% 0% 20PRUH and SS Post-Acute Medicine CCU 24.87 97% 6.2 0.5 6.7 0 1 0 0 0 0 0 n/a 0 0 0% 0% 13PRUH and SS 2A43 Post-Acute Medicine Chartwell 2 24.09 4.43 50% 29% no data 5.6 2.7 8.3 2 11 0 0 0 0 2 1 0 0 0 n/a 0 0 0% 0% 12PRUH and SS 2A04 Post-Acute Medicine Med 5 - S 44.48 100% 3.0 2.8 5.8 0 1 0 0 0 0 2 0 0 0 0 n/a 1 0 0% 0% 26PRUH and SS 2A05 Post-Acute Medicine Med 5 - H 22.26 97% 9.5 4.0 13.5 0 2 0 0 0 0 0 0 0 0 0 n/a 0 0 53% 100% 14PRUH and SS 2A01 Post-Acute Medicine ED 1 96.23 13.43 41% 25% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 1 0 0 0 n/a 0 5 8% 81% n/aPRUH and SS 2A35 Acute & Emergency Care AMU 2 (Med 9) 4.9 3.3 8.2 1 19 0 0 0 0 0 0 0 0 0 31% 96% 28PRUH and SS 2A35 Acute & Emergency Care AMU 1 (EAU) 45.17 98% 5.5 3.3 8.8 2 8 0 0 0 0 0 0 0 0 0 9% 40% 28PRUH and SS 2A36 Surgery, Theatres, Anaesthesia & Endoscopy Surgical 3 3 29.98 6.22 39% 27% no data 4.6 2.6 7.2 0 14 0 0 0 0 0 0 0 0 0 n/a 0 0 57% 91% 20PRUH and SS 2A82 Surgery, Theatres, Anaesthesia & Endoscopy Surgical 4 3 24.10 2.37 29% 20% 20.07 99% 4.1 3.0 7.1 0 5 0 0 0 0 0 0 0 0 0 n/a 0 1 72% 100% 14PRUH and SS 2A55 Surgery, Theatres, Anaesthesia & Endoscopy Surgical 5 2 39.48 8.48 41% 26% 43.77 98% 3.9 2.7 6.6 0 26 0 0 0 0 0 0 0 0 0 n/a 0 0 32% 95% 28PRUH and SS 2A72 Surgery, Theatres, Anaesthesia & Endoscopy Surgical 6 3 29.22 1.69 37% 16% 29.05 98% 4.1 2.5 6.6 0 7 0 0 0 0 0 0 1 0 0 n/a 0 0 41% 89% 20PRUH and SS 2A54 Surgery, Theatres, Anaesthesia & Endoscopy Surgical 7 3 44.61 7.33 40% 29% 47.08 99% 3.6 3.8 7.4 0 5 1 0 0 0 2 0 0 0 0 n/a 0 0 0% 0% 29PRUH and SS 2L08 Surgery, Theatres, Anaesthesia & Endoscopy Quebec n/a 17.90 -1.01 17% 13% 10.93 58% 7.0 3.7 10.7 0 6 0 0 0 0 1 0 0 0 0 n/a 0 0 100% 97% 19PRUH and SS 2L07 Surgery, Theatres, Anaesthesia & Endoscopy Bodington 2 26.00 6.75 39% 18% 16.05 68% 5.8 3.3 9.1 1 3 0 0 0 0 0 0 0 0 0 n/a 0 0 48% 94% 24PRUH and SS 2A88 Surgery, Theatres, Anaesthesia & Endoscopy 171 Day Surgery Unit n/a 67.00 8.02 40% 9% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/aPRUH and SS 2B62 Surgery, Theatres, Anaesthesia & Endoscopy 171 QMS Theatre Staff n/a 17.00 2.31 35% 2% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/aPRUH and SS 2L02/2L03 Surgery, Theatres, Anaesthesia & Endoscopy 171 Orpington Orthopaedic Theatre Pay n/a 32.50 -2.53 30% 13% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/aPRUH and SS 2A85 Surgery, Theatres, Anaesthesia & Endoscopy 171 Theatres Staffing 1 to 6 n/a 93.50 13.55 34% 11% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a n/aPRUH and SS 2C12 Women's, Children's & Core Services Children's ward 1 23.35 1.28 51% 46% 20.22 100% 8.6 0.7 9.3 0 7 0 0 0 0 0 0 0 0 0 n/a 0 0 0% 0% 19PRUH and SS 2C13 Women's, Children's & Core Services SCBU UD 22.52 3.36 47% 15% n/a n/a 7.2 1.5 8.7 2 7 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a 12PRUH and SS 2A73 Women's, Children's & Core Services Surgical 8 3 25.19 4.82 37% 31% 21.26 100% 5.4 2.5 7.9 0 6 0 0 0 0 0 0 0 0 0 n/a 0 2 21% 100% 16PRUH and SS 2C10 Women's, Children's & Core Services Birthing Centre PRU n/a 17.06 -3.45 12% 12% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 0% 0% 6PRUH and SS 2A95 Women's, Children's & Core Services PRUH Labour Ward n/a 77.95 3.02 37% 13% n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 0 0 0 0 0 n/a 0 0 93% 98% 10PRUH and SS 2A99 Women's, Children's & Core Services Maternity Ward UD 37.91 4.12 41% 24% n/a n/a 4.9 2.1 7.0 0 1 0 0 0 0 0 0 0 0 0 n/a 0 0 35% 92% 30PRUH and SS 2F13 Women's, Children's & Core Services ITU 3 53.70 2.68 30% 17% n/a n/a 27 1.9 28.9 7 3 0 0 0 0 0 0 0 0 0 n/a 0 0 n/a n/a 10Total 1278.12 138.12 33 189 3 0 0 0 11 2 3 0 1 0 2 15 613
3
24%45%
n/a31% 25% 125.332 105.99
0 0 0 0
2 79.29 15.69
35% 22%2A25 3 44.61 3.56
Area
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#DIV/0!
Conclusions and recommendations
Conclusions1.The CHPPD across KCH at moderate levels for London general wards 5.7 – 6.8 they are below those for GSTT (10.6) and UCLH (10.5) about the same as Imperial (6-7). 2.Variation across the KCH sites with better retention seen at the PRU than DH. Variation between wards and units with particularly low substantive staff seen on the neuro sciences and medicine wards DH.. 3. A new Matron has been appointed to the medical wards and new Sister posts being actively recruited.4.The only area where poor staffing metrics have been shown to date to affect care or patient experience is on the medical wards at DH and there is an action plan led by the Chief Nurse and colleagues addressing issues rapidly.5.Poor uptake of the FFT over the last few months which has limited analysis of the effect on patient experience. The Patient experience team now recruited to vacant posts. In the OPD Volunteers will be working with staff to ensure higher numbers of FFT returns.Recommendations for 20171.A proactive recruitment initiative to be launched in 2017 aimed at attracting band 5/6 nurses to utilise social media/ recruitment days /evenings and expert nurse days.2.Kings is a fast follower pilot for the Nursing Associate role which will eventually contribute to the skill mix on the wards. The first NAs have been recruited.3.A new initiative to provide employment contracts for all undergraduate students as they complete the second of their three year degree.4.A comprehensive establishment and skill mix review to be commenced in March 2017 and presented to the Board in May 2017.5.A new comprehensive development and education framework for nursing will be published in 2017 with all the major mandatory competencies being provided and measured at baseline and advance level. 6.Medicine at DH has its own proactive plan to ensure recruitment into the critical leadership posts and cover from across other divisions until this is completed. 7.The Chief Nurse at KCH is working with Professor Mark Radford (NHSi) and other CN to ensure that CHPPD can be utilised proactively with other Carter metrics as soon as possible in 2017.8.A renewed focus on collecting the FFT data to provide more data on patient experience across KCH.The Board of Directors are asked to note the information contained in this briefing: the use of the red flag system to highlight concerns raised and the continued focus on recruitment and retention, as well as controlling the use of temporary staff. 10
Appendix 1Exception Report – Denmark HillHCA and RN staffing levels – Lower than Planned – February 2017
11
Division Care Group Ward Name Review by HON/Matron/Ward where 15% or more of nursing hours did not meet agreed staffing levels (Highlighted in red)
Networked Care Variety Children's Hospital Neonatal Intensive Care Unit >34 babies on some shifts requiring more staff, infection control issues meaning 1:1 staffing
Networked Care Liver + Renal Dawson Additional HCAs used to augment RN numbers keeping the staffing levels safe.
Networked Care Neurosciences David Marsden Additional HCAs used to special patients and fill RN shifts when not filled.
Networked Care Cardiovascular Victoria & Albert Additional HCAs used to special patients.
Networked Care Critical Care, Radiology + MEP Liver Intensive Care Unit HCA low fill at night- due to long term sickness , safe staffing level maintained with mainly 1:1 Networked Care Neurosciences Kinnier Wilson HCA replacing RN vacancies plus high number of HCA specials required. Networked Care Haematology and Precision Davidson low fill rate of Hca day shifts - very high levels of patients requiring specialling on the other Networked Care Variety Children's Hospital Toni & Guy Recruited to vacancy awaiting start dates, RN posts when not cover extra bookings for HCA's
Networked Care Variety Children's Hospital DH-The Children's Surgical Ward Recruited to vacancy awaiting start dates, RN posts when not covered - Extra bookings for HCA's put out, Also safeguarding specialling
Networked Care Critical Care, Radiology + MEP Jack Steinberg Critical Care Where some shifts are not filled with bank nurses senior nurses are in place to support
UPACS Post-Acute and Planned Medicinie + Outpatients Annie Zunz Some RN shift not covered .ward operating at amber levels which is safe staffing levels
UPACS Planned Surgery and Opthalmology Katherine Monk Additional HCAs being used to cover where RN vacancy Shifts not filled to ensure patient safety is not affected.
UPACS Planned Surgery and Opthalmology Coptcoat WardAdditional HCAs being used to cover where RN vacancy Shifts not filled to ensure patient safety is not affected. In addition to this we have had to keep SSU open.
UPACS Planned Surgery and Opthalmology Twining Additional HCAs used at night to special patients where required.
UPACS Planned Surgery and Opthalmology Lister Moved staff off of lister to support other surgical wards and have had to use additional HCAs to support this shortage.
UPACS Post-Acute and Planned Medicinie + Outpatients Donne NHSP bookings not filled - Ward staff escalated to performance phone and support provided with reallocation of HCAs if possible . Reviewed at the wards safety huddle to ensure patient
UPACS Planned Surgery and Opthalmology Short Stay Surgical Unit RN vacancies not filled by bank however staff have been moved from other surgical wards to support in addition to HCAs.
UPACS Acute and Emergency R D Lawrence Where shifts were not filled on HCA day staff were moved around from other ward to ensure patient safety was not affected.
Appendix 2Exceptions Report – PRUH
HCA and RN staffing levels – Lower than Planned – February 2017
12
New Division New Dept Name Ward Review by HON/Matron/Ward where 15% or more of nursing hours did not meet agreed staffing levels (Highlighted in red)
Networked Care Neurosciences Frank Cooksey We adjust staffing due to patient numbers and generally the reduced staffing is because we have a lower number of patients on the ward.
PRUH and SS Women's, Children's & Core Services Intensive Care Unit 1 x HCA on LTS during month. Staffing adjusted to optimise safety and out to NHSP when needed, though not all shifts backfilled.
PRUH and SS Women's, Children's & Core Services Children's Ward Recruited to vacancy of HCA's awaiting start datePRUH and SS Women's, Children's & Core Services Special Care Baby Unit Recruited to vacancy of HCA's awaiting start date
PRUH and SS Women's, Children's & Core Services Maternity Unit (PRU) There has been support staff consultation, which has resulted in staff moving into different roles/areas, therefore some shifts have been difficult to fill.
PRUH and SS Post-Acute Medicine Chartwell Unit We adjust staffing due to patient numbers and generally the reduced staffing is because we have a lower number of patients on the ward.
PRUH and SS Post-Acute Medicine Elizabeth (ORP) We adjust staffing due to patient numbers and generally the reduced staffing is because we have a lower number of patients on the ward.
PRUH and SS Surgery, Theatres, Anaesthesia & Endoscopy
Quebec (ORP) We adjust staffing due to patient numbers and generally the reduced staffing is because we have a lower number of patients on the ward.
Finance Report
Month 11 (February) 2016/17
Public Baord of Directors Meeting 5 April 2017
Page 1 of 29
Report to: Public Baord of Directors
Date of meeting: Wednesday 5 April
Subject: Finance Committee Report – Month 11 (February 2017)
Author(s): Simon Dixon, Nicola Hoeksema, Rita Ragunath, Iris Lewis
Presented by: Colin Gentile, Chief Financial Officer
Sponsor: Colin Gentile, Chief Financial Officer
History: First submission to Finance and Performance Committee
Status: Decision/Discussion/Information
1. Purpose The Finance Reports includes information on the Trust’s financial performance and position which support the in-year
submissions to Monitor on a quarterly basis.
This report covers the Income & Expenditure position, Cost Improvement Programme, Capital and Working Capital Plans.
2. Action required The Board of Directors is asked to approve the Finance Report
Page 2 of 29
Legal: Reporting to Monitor
Financial:Trust reports financial performance and position against published plan and notifies the committee
of financial risks, cost pressures and action plans to mitigate any material variance from financial
targets.
Assurance: The summary and appendices provide assurance that the Trust is meeting Financial targets
(internal and those set by Monitor) and is compliant with its terms of authorisation.
Clinical: There is no direct impact on clinical issues
Equality & Diversity: There is no direct impact on E&D
Performance: Financial Performance against annual plan, budgets, CIPs and Monitor Risk Ratings and Limits.
Strategy: Performance against the Trust’s Annual Plan including Risk Ratings
Workforce: There are implications for workforce recruitment in respect to service developments and
vacancies.
Estates: There are implication on the Trust’s estates strategy.
Reputation: Finance Committee Report is provided to Monitor and Commercial Bankers as additional
information to support the quarterly Monitor Return.
Other:(please specify) None.
3. Key implications
Page 3 of 29
Page
Key Messages 5
Summary 6
Year to date Surplus/(Deficit) 7
Year to date Income 8
Year to date Operating Expenditure 9
1617 Financial Year end Deficit 10
Run Rate 11
6+6 forecast - rephased 12
CIP forecast variance 13
Forecast Variance by division 14
Cash 15
13 Week Cash Flow Forecast 16
Statement of Financial Position (Balance Sheet) 17
Aged Debtors 18
Debtors Detail 19
Bad Debt Provision 20
Capital 21
Agency Run Rate 22
Whole Time Equivalents 23
Income by Commissioner Contract 24
Income Activity Analysis 25
17/18 & 18/19 Contracts over £10m 26
17/18 NHS Clinical Income 27
Surplus / (Deficit) (By Division) 28
1617 Year End Timetable 29
Contents
Income and Expenditure
1
2
3
4
5
£M
6 Predicted Year End Forecast 49.0
Delivery Subject to:
i) Non recurrent commercial negotiations 27.7
ii) Prior year 5.6
Cash
7
Capital
8
The Trust has drawn down the full £89.6m against its Working Capital Facility in December 2016 and a further in £36 drawn down as uncommitted revenue loan bringing the total drawdown
to £125.6. The Trust is planning to draw down another £19.7m in March 2017 in order to maintain a cash balance of £3m.
The Trust is awaiting approval from NHSI of additional working capital support and Distressed Capital funding. The CFO has written to NHSI explaining the critical requirement for cash
support in order not to impact on patient services. We are in active dialogue with NHSI on the capital but continue to spend at risk where the spend is essential. Developments during March
will be reported verbally.
The planned capital expenditure for 2016/17 has been reduced to £40.7m (previously £71.189m) due to funding restriction. The DoH has approved a revenue support loan of £26.4m to fund
capital expenditure. This will be drawn between April and June 2017 to pay capital invoices.
The underspend at month 11 reflects the delay in confirmation of Distressed Capital funding from NHSI. The Trust is still forecasting to spend £40.6m by end of March. Developments during
March will be reported verbally.
NHSI aknowledged variances of £35.7m (FYE £39m)
The Trust’s cumulative operating deficit at month 11 is £78.9m. This is an adverse variance of £53.2m against the year to date planned deficit of £25.7m. These figures exclude the estimated
impairment costs of £9.4m to date.
The key cumulative budget variances at month 11 relate to:
The YTD variance is £53.2m and would be £17.5m if the income variances acknowledged by NHSI were excluded, such as the Transformation Funds. These income losses have been phased
equally across the year.
NHS Clinical Contract activity income - adverse by £8.2m
Cost Improvement plans - adverse variance of £1.0m against original CIP plan (excluding unallocated CIPs and mitigations)
The run rate for month 11 was £2.8m adverse (month 10 £2.8m favourable). The run rate was averaging a monthly deficit of £8.8m in Q3 . The monthly average has reduced to £7.3m mainly
due to £20m of mitigations in M10 & M11. The NHSI agency cap for the Trust year to date was £23.52m and the Trust has spent £35.5m with increases predominately in medical and nursing
staff categories.
At month 11 the Trust is estimated to be over-performing against the block contracts for Bromley by £1.4m and Lewisham CCG by £1.6m due to high levels of Emergency activity and Critical
Care activity. Overall block contracts are underperforming by £2.6m. The Trust is over performaing against specialised “non-block” contracts (primarily NHSE specialised services) by £2.3m
based on year end projections.
Expenditure Cost Pressures - adverse variance of £13.7m (excluding pass-through drugs and devices)
Key Messages
Page 5 of 29
Finance Report Month 11 2016/2017 Summary
Surplus / (Deficit) £k R Income £k R Operating Expenditure £k R
Plan Actual Variance Plan Actual Variance Plan Actual Variance
Year to Date £k (25,661) (78,894) (53,233) Year to Date £k 1,018,098 997,937 (20,161) Year to Date £k (988,608) (1,021,799) (33,192)
Run Rate £k R Cost Improvement Plans £k R Capital £k R
M7
Actual
M8
Actual
M9
Actua8
M10
Actual
M11
Actual Forecast Actual Variance Plan Actual Variance
Income £k 93,207 89,851 90,342 93,907 96,238 Year to Date £k 53,751 45,606 (8,145) Year to Date £k 34,509 28,084 6,425
Pay £k (52,831) (53,616) (53,513) (53,891) (53,858)
Non-Pay £k (43,137) (44,354) (45,237) (37,208) (45,214)
Deficit £k (2,761) (8,120) (8,407) 2,808 (2,834)
Cash £k R Key Risks R Mitigating Actions R
Plan Actual Variance
Year to Date £k 19,841 32,406 12,565
The Trust is reporting a £78.9m deficit at the end of M11 against a planned deficit of £25.7m resulting in a £53.2m adverse YTD variance. The current month position is a £3.7m adverse variance. There is an acknowledge income variance of £35.8m YTD
(£3.3m in month)
The underlying deficit for 15/16 was £118m which equates to a monthly run rate deficit of circa £10m. The average run rate year to date was £7.2m at the end of M11.
The programme is achieving 85% of its YTD forecast target.
The CIP programme as at M11 has had a total scheme slippage of £8.1m against
forecast (15%).
The key themes on YTD slippage are a combination of under-performing
schemes in Private Patient Income & Overseas Visitors Income Optimisation;
medicines management and procurement.
This slippage is being off set by a number of additional mitigations (detailed on
page 13). £16.1m of additional mitigations are in the YTD position.
Delivery Subject to:
i) Non recurrent commercial negotiations £27.7m
ii) Prior year £5.6m
The improvement in run rate from M9-10 was driven by £3.3m commercial income
mitigations brought forward from M12 and £8.3m new nonpay commercial mitigations.
1. Landing high value mitigations in month 12.
2. Income targets includes RTT backlog £4.8m and 2.3% growth, £20.7m.
3. The key income risks will be the NHSE QIPP target for 16/17 (£7.7m) and
Bromley CCG activity demand management (£3m). The Trust led CCG QIPP for
Lambeth, Southwark and Bromley CCG's is £5.3m and this is embedded in the
Block contract.
4. Cost control measures re: agency spend
5. Cash flow impacting on operational delivery
The Trust has drawn down the full £89.6m against its Working Capital Facility in December
2016 and a further in £36 drawn down as uncommitted revenue loan. The Trust is planning
to draw down another £19.7m in March 2017 in order to maintain a cash balance of £3m.
The total value of the Working Capital Facility drawndown as at end of January was
£125.6m which is £36m above approved facility limit. The Trust did not require a draw
down in February 2017 but a request has been put in to draw down £19.789m in March
2017.
The varience of £12m to the plan is due to the LSB Support received as well as the some of
the Overperformance income from NHSE. As a result of this income the Trust will not
require a draw down against its Working Capital Facility in April 2017.
DH have agreed the Capital Facility for 1617 and the first draw down will be requested to
be paid in April 2017.
The Trust is reporting a £78.9m deficit at the end of M11 against a planned deficit of
£25.7m resulting in a £53.2m adverse YTD variance. The current month position is a £3.7m
adverse variance. There is an acknowledge income variance of £35.8m YTD (£3.3m in
month)
In respect to NHS clinical contract income : Off-tariff drugs and devices over-performance
of £12.2m YTD; are being offset by activity income underperformance of £8.2m YTD.
Pay is £2.7m deficit at the end of M11. Admin and Clerical pay is underspent due to a
number of vacancies.
Nonpay is over spent due to clinical supplies and drugs (£25.6m) which is mostly offset by
income, viapath contract overperformance (£3.2m) and bad debt provision (£3.4m).
Month 11 actuals are based on Month 10 flex data (Contracts) extrapolated
using Month 10 activity figures from the OLAP report (Inpatient & Outpatient),
all other categories (Drugs, Devices, Diagnostics, Critical Care, Patient Transport)
are straight-lined but factoring in seasonality. Bromley, Lambeth & Southwark
contracts have been agreed and are reflected within the plan. All other
commissioners e.g. NHSE are based on KCH proposals.
Pay is £2.7m deficit at the end of M11. Admin and Clerical pay is underspent due
to a number of vacancies.
Nonpay is over spent due to clinical supplies and drugs (£13.7m net of pass
through income) which is driven by block activity overperformance and changes
in casemix due to emergency admissions, viapath contract overperformance
(£3.2m) and bad debt provision which has increased due to an underprovision in
the previous financial year (£3.4m).
The planned capital expenditure for 2016/17 has been reduced to £40.7k
(previously £71.189m) due to funding restriction. The remaining projects has
been delayed till 2017/18. NHSI has approved £26.4m loan to fund capital
expenditure for the year.
The underspend at month 11 reflects the delay in confirmation of Distressed
Capital funding from NHSI. Projects totalling £38.5m (including the additional bed
capacity and ED projects £10.9m) have been started at risk prior to NHSI approval
of the distressed capital funding. This is to enable completion by the end of the
financial year. Other projects are on hold until external funding is confirmed.
There will be a verbal update covering devlopments in March.
Page 6 of 29
Finance Report Month 11 2016/2017 Surplus / (Deficit) £k R
YTD Plan YTD Actual
YTD
Variance
Mvnt in
Month
£k £k £k £k
Surplus / (Deficit) (25,661) (78,894) (53,233) (3,753)
YTD Plan YTD Actual
YTD
Variance
Mvnt in
Month
£k £k £k £k
Income 1,018,098 997,937 (20,161) 3,467
Pay (585,462) (588,193) (2,731) (868) Underspent in admin and clerical pay offset by medical and nursing pay overspend
Non-Pay (403,146) (433,607) (30,461) (6,363)
EBITDA * 29,490 (23,862) (53,353) (3,764)
EBITDA % 2.9% -2.4%
Profit/Loss on Disposal of Fixed Assets (92) (56) 36 7
Interest Payable (26,880) (26,764) 116 11
Interest Receivable 121 88 (33) (6)
Depreciation (23,319) (23,319) 0 0
Impairments (9,442) (9,442) 0 0
Public Dividend Capital (4,981) (4,981) 0 0
Net surplus/(deficit) (35,103) (88,336) (53,233) (3,753)
Reverse Impairment 9,442 9,442 0 0
Performance against Control Total (25,661) (78,894) (53,233) (3,753)
Total (25,661) (78,894) (53,233) (3,753)
Surplus/(Deficit) % -2.5% -7.9%
* EBITDA Earnings before Interest, Taxation, Depreciation and Amortisation
The Trust is reporting a £78.9m deficit at the end of M11 against a planned deficit of £25.7m resulting in a £53.2m adverse YTD variance. The current month position is a £3.7m adverse variance. There is an acknowledge income
variance of £35.8m YTD (£3.3m in month) In respect to
NHS clinical contract income : Off-tariff drugs and devices pass throug over-performance of £12.2m YTD; are being offset by activity income underperformance of £8.2m YTD.
Pay is £2.7m deficit at the end of M11. Admin and Clerical pay is underspent due to a number of vacancies.
Nonpay is over spent due to clinical supplies and drugs (£25.6m less £12.2m pass through income) which is driven by block activity and changes in casemix due to emergency admissions, viapath contract overperformance
(£3.2m) and bad debt provision which has increased due to an underprovision in the previous financial year (£3.4m).
Acknowledged income variance of £35.8m YTD (£3.3m in month)
Clinical supplies and drugs which is mostly offset by income, viapath contract overperformance and bad
debt provision
(15,000)
(10,000)
(5,000)
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
Oct
-16
No
v-1
6
De
c-1
6
Jan
-17
Feb
-17
Mar
-17
£k
Deficit by Month 2016/17
Net OperatingDeficit Actuals
Net OperatingDeficit Plan
Net OperatingDeficit Forecast
Page 7 of 29
Finance Report Month 11 2016/2017 Income R
YTD Plan YTD Actual YTD Variance
Mvnt in
Month
£k £k £k £k
Total Income 1,018,098 997,937 (20,161) 3,467
YTD Plan YTD Actual YTD Variance
Mvnt in
Month
£k £k £k £k
Commissioning Contract Income (activity) 738,060 733,876 (4,184) 1,353
NHS Acute: Drugs - Non Tariff (pass through) 98,816 109,275 10,459 (479)
NHS Acute: Devices - Non Tariff (pass through) 13,083 14,820 1,737 185
Other Clinical Income (activity) 3,421 5,500 2,079 6,027
NHS Clinical Contract Income Total 853,380 863,471 10,091 7,086
RTA Income 4,735 3,758 (977) (143)
Other NHS Clinical Income 4,726 3,626 (1,100) (145) Provider to Provider income not recovered as per last year (e.g. Fetal Medicine service).
Private Patient Income 15,339 13,159 (2,180) (424)
Overseas (Reciprocal & Non-Reciprocal) 6,601 6,687 86 68
Education & Training Income 43,261 43,461 200 7
Research & Development Income 13,890 15,475 1,585 41
Other Operating Income 76,167 48,300 (27,867) (3,022)
Total Trust Income 1,018,098 997,937 (20,161) 3,467
There is an acknowledge income variance of £35.8m YTD (£3.3m in month)
In respect to NHS clinical contract income this can be reported under two seperate elements : Off-tariff drugs and devices over-performance of £12.2m, this is a pass through payment so no financal margin; activity income
underperformance of £8.2m YTD.
Underperformance against NHSE activity growth target. NHSE contract restrictions (MRET, Marginal rate).
Bromley CCG is currently overperforming by £1.4m and Lewisham by £1.6m but they are being offset by
other underperforming CCGs. Net block underperformance is £2.6m (see page 29 for details)
Pass through payments to Commissioners offsetting expenditure over-spends.
acknowledged income variance of £35.8m YTD (£3.3m in month)
In month favourable movement relates to NR CCG support
80,000
85,000
90,000
95,000
100,000
105,000
110,000
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
Oct
-16
No
v-1
6
De
c-1
6
Jan
-17
Feb
-17
Mar
-17
£k
In Month Income 2016/17 Actual Plan
Page 8 of 29
Finance Report Month 11 2016/2017 Operating Expenditure R
YTD Plan YTD Actual
YTD
Variance
Mvnt in
Month
£k £k £k £k
Pay (585,462) (588,193) (2,731) (868)
Non-Pay (403,146) (433,607) (30,461) (6,363)
Operating Expenditure (988,608) (1,021,799) (33,192) (7,231)
YTD Plan YTD Actual
YTD
Variance
Mvnt in
Month
£k £k £k £k
Pay
Nursing & Midwifery (230,862) (232,466) (1,604) (649) CIP not being achieved.
Medical & Dental Staff (186,495) (191,522) (5,027) (517) Agency spend up and backdated banding payments.
Administration & Clerical / Senior Managers (95,557) (92,198) 3,359 332 Holding vacancies.
PAMS / Scientific / Professional (72,548) (72,007) 541 (35)
Total Pay (585,462) (588,193) (2,731) (868)
Non-Pay
Drugs (incl. Medical Gases) (114,990) (135,066) (20,076) (1,503) Off -tariff drugs increase, QIPP/CIP review and revenue capture review.
Supplies & Services - Clinical (85,968) (91,496) (5,528) (1,133) Off -tariff devices increase stock levels to be reviewed.
Supplies & Services - General (3,350) (3,835) (485) 73
Establishment Expenses (5,579) (5,466) 113 (50)
Transport Expenses (8,318) (7,766) 552 (95)
Premises (34,709) (37,063) (2,354) (367)
Purchase of Healthcare from Non-NHS Provider (26,625) (31,325) (4,700) (442) Independent sector and Pathology service.
Services from other NHS Bodies (49,859) (50,750) (891) (1,061)
Consultancy (13,242) (13,481) (239) 7
Private Finance Initiative (46,900) (46,303) 597 (19) Favourable due to VINCI costs being transferred out of PRUH revenue into Capital
Other Non-Pay (13,605) (11,056) 2,549 (1,773)
Total Non-Pay (403,146) (433,607) (30,461) (6,363)
Total Expenditure (988,608) (1,021,799) (33,191) (7,231)
Pay is £2.7m deficit at the end of M11. Admin and Clerical pay is underspent due to vacancies.
Nonpay is over spent due to clinical supplies and drugs (£13.4m net of pass through income) which is driven by block activity and changes in casemix due to emergency admissions, viapath contract overperformance
(£3.2m) and bad debt provision which has increased due to an underprovision in the previous financial year (£3.4m).
Bad debt provision increase from prior year (£3.4m) and current year impact. This is being
offset by a positive £9m commercial CIP mitigation
Page 9 of 29
Finance Report Month 11 2016/2017 Run Rate R
Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17
£k £k £k £k £k £k £k £k £k £k
Deficit (13,548) (9,944) (11,454) (9,634) (10,556) (9,596) (3,619) (8,978) (9,265) 1,950 (3,692)
Impairment 858 858 858 858 858 858 858 858 858 858 858
Operating Deficit (12,690) (9,086) (10,596) (8,776) (9,698) (8,738) (2,761) (8,120) (8,407) 2,808 (2,834)
Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17
£k £k £k £k £k £k £k £k £k £k £k
Income 85,135 89,070 91,619 89,703 87,347 91,518 93,207 89,851 90,342 93,907 96,238
Pay
Administration & Clerical / Senior Managers Agency (717) (743) (648) (692) (790) (775) (491) (542) (342) (143) (217)
Bank (223) (230) (272) (259) (258) (262) (266) (297) (328) (418) (518)
substantive (7,310) (7,288) (7,339) (7,308) (8,094) (7,357) (7,379) (7,529) (8,458) (7,360) (7,344)
Medical & Dental Staff Agency (870) (1,104) (1,440) (1,290) (1,329) (1,162) (1,048) (1,031) (836) (1,268) (1,345)
Bank (384) (486) (513) (438) (508) (468) (374) (510) (358) (330) (360)
substantive (15,502) (15,804) (15,639) (15,280) (15,697) (16,071) (15,860) (15,894) (15,968) (16,527) (15,828)
Nursing & Midwifery Agency (878) (872) (963) (1,099) (1,090) (1,126) (957) (908) (849) (970) (996)
Bank (2,409) (2,295) (2,572) (2,577) (2,620) (2,549) (2,405) (2,473) (2,219) (2,477) (2,574)
substantive (17,557) (17,336) (17,872) (17,441) (17,493) (17,324) (17,524) (17,914) (17,814) (18,154) (18,158)
PAMS / Scientific / Professional Agency (343) (762) (849) (570) (548) (473) (510) (613) (451) (318) (502)
Bank (190) (158) (246) (196) (194) (165) (182) (208) (170) (184) (230)
substantive (5,967) (6,023) (6,290) (5,404) (5,617) (5,867) (5,836) (5,697) (5,718) (5,741) (5,785)
Total Pay (52,350) (53,103) (54,641) (52,554) (54,238) (53,599) (52,831) (53,616) (53,513) (53,891) (53,858)
Non-Pay
Drugs (12,631) (11,848) (12,384) (12,273) (11,509) (12,896) (11,971) (13,529) (11,477) (12,695) (11,854)
Supplies & Services - Clinical (8,819) (8,412) (9,420) (7,625) (8,255) (8,503) (7,586) (7,036) (8,136) (8,640) (9,064)
Non-Clinical Supplies (4,690) (4,855) (4,772) (4,450) (5,307) (4,359) (5,745) (5,329) (4,236) (5,622) (4,765)
Purchase of Healthcare from Non-NHS Provider (2,355) (2,651) (3,043) (3,008) (3,172) (2,929) (2,269) (2,543) (3,166) (3,158) (3,031)
Services from other NHS Bodies (4,601) (4,597) (4,837) (4,673) (4,586) (4,210) (4,991) (4,314) (4,707) (4,592) (4,642)
Consultancy (626) (798) (1,195) (1,849) (1,504) (1,213) (1,522) (843) (1,074) (1,566) (1,290)
Private Finance Initiative (4,716) (4,609) (4,701) (4,720) (1,874) (4,808) (2,199) (4,612) (4,665) (4,662) (4,739)
Other Non-Pay (1,784) (2,030) (1,962) (2,094) (1,489) (2,891) (2,042) (971) (2,660) 7,695 (827)
Total Non-Pay (40,222) (39,800) (42,314) (40,692) (37,696) (41,809) (38,325) (39,177) (40,120) (33,240) (40,212)
Total Financing (6,111) (6,111) (6,118) (6,090) (5,969) (5,707) (5,670) (6,035) (5,975) (4,826) (5,860)
Deficit (13,548) (9,944) (11,454) (9,634) (10,556) (9,596) (3,619) (8,978) (9,265) 1,950 (3,692)
Impairment 858 858 858 858 858 858 858 858 858 858 858
Operating Deficit (12,690) (9,086) (10,596) (8,776) (9,698) (8,738) (2,761) (8,120) (8,407) 2,808 (2,834)
Page 10 of 29
Finance Report Month 11 2016/2017 1617 Financial Year End Projection R
Page 11 of 29
Finance Report Month 11 2016/2017 FORECAST OUTTURN - Rephased RApr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Cumulative
Actual Actual Actual Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast
£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000
Clinical Income 72,166 75,473 79,077 76,089 74,185 77,846 79,013 77,846 74,609 77,542 76,501 80,101 920,447
Non-Clinical Income 12,487 13,114 11,763 12,543 11,953 12,967 11,909 12,431 12,461 12,561 12,561 13,248 149,998
Total Income 84,652 88,588 90,840 88,632 86,139 90,813 90,923 90,277 87,070 90,103 89,061 93,348 1,070,445
Total Pay (53,665) (54,483) (55,585) (53,981) (55,538) (54,865) (54,327) (54,327) (54,327) (54,327) (54,327) (54,327) (654,080)
Total Nonpay (47,275) (47,351) (49,512) (47,742) (47,175) (48,736) (46,204) (46,204) (46,204) (46,204) (46,204) (46,204) (565,016)
Flow Through CIP (Green) 1,913 2,234 1,153 1,791 1,467 1,213 649 609 526 437 387 1,589 13,968
16/17 CIP (Green) 825 1,067 1,649 1,667 4,554 1,979 5,631 3,688 5,050 6,886 6,240 9,277 48,513
16/17 CIP (Red/Amber) 0 0 0 0 0 0 0 0 0 33 33 5,117 5,182
Mitigations/Additional Actions 0 0 0 0 0 0 0 0 0 1,035 1,035 19,747 21,818
Deficit (13,549) (9,945) (11,455) (9,634) (10,554) (9,596) (3,329) (5,959) (7,885) (2,037) (3,775) 28,546 (59,170)
Impairment 858 858 858 858 858 858 858 858 858 858 858 858 10,296
(12,691) (9,087) (10,597) (8,776) (9,696) (8,738) (2,471) (5,101) (7,027) (1,179) (2,917) 29,404 (48,874)Operating Deficit (Forecast)
(12,691)
(9,087)(10,597)
(8,776) (9,696) (8,738)
(2,471)(5,101)
(7,027)
(1,179)(2,917)
29,404
(2,759)
(8,121) (8,408)
2,808
(2,834)
(15,000)
(10,000)
(5,000)
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17
Operating Deficit (Forecast) Operating Deficit (Actual)
Forecast Actual Diff Forecast Actual Diff
£'000 £'000 £'000 £'000 £'000 £'000
Clinical Income 76,501 76,113 (388) 840,347 835,927 (4,420)
Non-Clinical Income 12,561 11,337 (1,224) 136,750 142,963 6,213
Total Income 89,061 87,450 (1,612) 977,097 978,889 1,793
Total Pay (54,327) (54,862) (534) (599,753) (601,601) (1,848)
Total Nonpay (46,204) (48,049) (1,845) (518,812) (527,398) (8,586)
Flow Through CIP 387 383 (4) 12,379 12,758 379
16/17 Green CIP 6,240 2,853 (3,387) 39,236 28,848 (10,388)
16/17 Amber CIP 33 0 (33) 65 0 (65)
Mitigations/Additional Actions 1,035 8,533 7,498 2,071 20,166 18,095
Total CIP 7,696 11,769 4,073 53,751 61,772 8,021
Deficit (3,775) (3,692) 82 (87,716) (88,337) (621)
Impairment 858 858 0 9,438 9,438 0
Operating Deficit (Forecast) (2,917) (2,834) 82 (78,278) (78,899) (621)
Month 11 Year to Date
Page 12 of 29
Finance Report Month 11 2016/2017 CIP And Mitigation Variances R
16/17 Planned
Forecast (Risk
Adjusted)
YTD Planned
Forecast YTD Actual YTD Variance
Full Year CIPs and
Mitigations Full Year Variance R/NR Notes
Network Care 8,068 3,997 3,925 (72) 6,542 (1,525) R/NR HepC Drugs CQUIN
PRUH & South Sites 1,320 1,212 1,196 (16) 1,303 (17) R/NR
Urgent Care, Planned Care & Allied Clinical Services 4,501 4,047 3,633 (414) 4,481 (20) R/NR
Corporate 17,078 12,120 10,710 (1,411) 16,039 (1,039) R/NR PP and OSV Income Optimisation
15/16 Flow Through 13,968 12,379 12,758 379 14,342 374 R/NR
Divisions/Corporate total 44,935 33,755 32,221 (1,534) 42,708 (2,227)
Finance Asset lives review 1,734 1,367 1,000 (367) 1,000 (734) NR See prior year adjustments
IFT (consolidated trading surplus and VAT recovery) 4,691 3,700 2,800 (900) 3,300 (1,391) R Stock Take VAT - KiFM
KCS Int Operations 275 0 0 0 275 0 R
Medical Productivity 2,045 1,070 866 (204) 1,176 (869) R/NR
Medicines (off tariff drug income) 3,303 2,710 1,034 (1,676) 1,645 (1,658) R Double count with 6+6 Income
Procurement 3,954 3,839 532 (3,307) 584 (3,370) R/NR
Reduce Agency Spend 3,320 2,468 2,387 (81) 2,799 (521) R/NR
Operating leases review 1,468 0 0 0 0 (1,468) -
Sterile Services Procurement 1,000 0 0 0 1,000 0 NR
Pathology Contract Services 939 0 0 0 0 (939) NR
Cross cutting total 22,728 15,154 8,618 (6,536) 11,779 (10,949)
Maximising Income 900 600 0 (600) 0 (900) NR
Discretionary spend reductions 600 400 0 (400) 0 (600) NR
NHSE long-stop disputes 1,150 767 766 (1) 1,150 0 R
Pay Reductions 455 304 0 (304) 0 (455) NR
Commercial Services 370 0 0 0 0 (370) -
Commercial mitigations 4,000 4,000 4,000 4,000 R
Prior year adjustments (benefit to 1617) 3,343 2,771 0 (2,771) 4,200 857 NR
Mitigations total 6,818 4,842 4,766 (76) 9,350 2,532
*Total CIPs and Mitigations 74,481 53,751 45,606 (8,145) 63,837 (10,644)
CCG Income 1% reserve 15,000 0 0 0 0 (15,000)
CCG Income 7,000 7,000 7,000 7,000
New commercial mitigation 9,166 9,166 10,000 10,000
Commercial funds 0 0 21,300 21,300
Prior year adjustments (benefit to 1617) 0 0 1,400 1,400
Additional Mitigations and CCG Support total 15,000 0 16,166 16,166 39,700 24,700
Total Including additional Mitigations and CCG Support 89,481 53,751 61,772 8,021 103,537 14,056
CIPs and Mitigations (actuals)* as a percentage of Turnover
(Excludes additional mitigations and CCG support above) £m % £m %
Turnover 902 1,082
Recurrent CIPs & Mitigations 30 3% 41 4%
Non-Recurrent CIPs & Mitigations 12 1% 27 3%
Time lag in delivery, unallocated CIPs to divisions and reporting
mechinism
Year to Date Forecast
Page 13 of 29
Finance Report Month 11 2016/2017 FORECAST OUTTURN BY DIVISION (net of CIPs)
Divison/Department TypeM11 Forecast
(6+6)M11 Actual M11 Variance
YTD Forecast
(6+6)YTD Actual YTD Variance Additional Information
Income 36,233 35,296 (937) 398,637 392,114 (6,524) Change in methodology of WIP calc for critical care offset by
over performance in Haem and Ambulatory activity
Pay (16,068) (16,431) (363) (177,015) (177,616) (601) Backdated CEA arrears/Cons pay/Adj re R&D tfr. Nursing pay
mainly sickness related).
Non-Pay (12,761) (12,446) 315 (140,798) (142,723) (1,925) Activity related increases in OT Drugs spend - recoverable
through income
Networked Care Total 7,405 6,419 (986) 80,824 71,774 (9,049)
Income 19,312 17,955 (1,357) 207,746 209,375 1,629 All PRUH drugs (excluded & homecare) were all held centrally
(Budget & Actual) – transferred back to PRUH in M8
Pay (11,569) (11,514) 56 (126,575) (126,325) 250
Non-Pay (4,809) (3,967) 842 (53,062) (51,178) 1,884
PRUH and South Sites Total 2,934 2,474 (460) 28,109 31,873 3,764
Income 28,053 26,329 (1,724) 303,368 300,961 (2,408) Adverse movement against forecast within Women's Health.
This is for Q2 casemix adjustment plus a slight variation
within activity. lower than planned.
Opthamology income/activity within an Outpatient setting.
This is seasonal and any variation should correct itself in the
coming month
Pay (19,302) (19,417) (115) (208,172) (208,389) (217) Opthamology backdated Agency invoices (Nov-Jan) Timing is
due to previous lack of Divisional sign off.
Non-Pay (5,948) (6,368) (420) (73,964) (74,076) (112)
Urgent Care, Planned Care and Allied Clinical Services Total 2,802 544 (2,258) 21,232 18,496 (2,736)
CLINICAL DIVISIONS TOTAL 13,141 9,437 (3,704) 130,165 122,143 (8,022)
Capital, Estates and Facilities (7,196) (6,686) 510 (73,743) (72,616) 1,128 One off benefits to reduce provision for utilities accruals after
review with Energy Manager. £50k recurrent saving on
Carbon Reduction Commitment (CRC) scheme until YE after
negotiation with regulatory body.
Commercial (1,711) (930) 781 (17,345) (18,044) (699) Offset with finance - Procurement transferred to KIFM
Corporate Services (50) (58) (8) (562) (575) (13)
Executive Nursing (4,031) (3,815) 217 (44,044) (43,598) 447
Finance (720) (840) (120) (10,966) (9,171) 1,794 Offset with KIFM - Procurement transferred from finance
Medical Director (63) (53) 11 (482) (645) (163) Med Director budget for 8 PAs AMD role, not built into
original forecast
Operations (1,590) (1,525) 65 (16,991) (17,023) (32)
Strategy (537) (135) 402 (2,375) (1,248) 1,127 Research and development.
Transformation and ICT (1,438) (1,292) 146 (16,514) (15,950) 564 Mckinsey consultancy service to be invoiced on a reducing
basis until YE. Favourable movement in last quarter should be
delivered.
Workforce Development (1,420) (1,501) (82) (14,332) (14,616) (284)
CORPORATE DEPARTMENTS TOTAL (18,756) (16,834) 1,922 (197,353) (193,485) 3,868
Original Cross cutting CIPs substituted with mitigating actions 7,091 (7,091) 22,889 (22,889)
Commercial mitigations brought forward from month 12 0 700 700 0 4,000 4,000 Drugs income M1-11
New commercial mitigation 0 833 833 0 9,166 9,166 Revised procurement M1-11
CC Income 0 7,000 7,000 7,000 7,000
Unallocated Cross cutting CIPs and Mitigations TOTAL 7,091 8,533 1,442 22,889 20,166 (2,723)
Trust Income 162 3,416 3,253 19,652 24,026 4,374
Capital charges and reserves (5,413) (8,244) (2,830) (63,068) (61,187) 1,881
Impairement 858 858 0 9,438 9,438 0
Operational Deficit Total (2,917) (2,834) 83 (78,278) (78,898) (621)
Urgent Care, Planned Care and Allied Clinical Services
Networked Care
PRUH and South Sites
Page 14 of 29
Finance Report Month 11 2016/2017 Cash R
Year to Date Plan Actual Variance
£k £k £k
Cash Balance 19,841 32,406 12,565
Year to Date Plan Actual Variance
£k £k £k
EBITDA 5,260 (901) (6,161)
Movement in Working Capital (7,839) 20,172 28,011
Provisions (156) (164) (8)
Cash flow from Operations (2,735) 19,107 21,842
Capital Expenditure (8,006) (2,705) 5,301
Cash Receipt from Asset Sales 0 0 0
Other Cash Flows from Investing Activities 11 5 (6)
Cash Flow before Financing (10,730) 16,407 27,137
PDC Received 0 0 0
PDC Repaid 0 0 0
Dividends Paid 0 0 0
Interest on Loans and Leases (1,959) (1,957) 2
Drawdown of Debt 15,436 0 (15,436)
Repayment of Debt (325) (325) 0
Other Cash Flows from Financing Activities 0 82 82
Cash Flow from Financing 13,152 (2,200) (15,352)
Net Cash Inflow/(Outflow) 2,422 14,207 11,785
Opening Cash Balance 17,419 18,199 780
Closing Cash Balance 19,841 32,406 12,565
The Trust did not require any loan draw down against its Working Capital Facility in January. The value of loan drawn to date remains at £125.6m, which is £36m over the Working Capital Facility approved.
At month end the Trust’s cash balance was £12.5m above plan due payment for additional support from CCGs and NHSE invoice payments. This extra cash will be used to bring the creditor balance down to
within 60 days
The payable balances has reduced during the month but still puts pressure on supplier relationship and price negotiations. Capital expenditure for month 11 was £5.3m below plan due to delay in capital plan
approval and NHSI capital funding not yet agreed.
Page 15 of 29
Finance Report Month 10 2016/2017 Rolling Cash Flow (16 Week) R
Week ending 03-Mar-17 10-Mar-17 17-Mar-17 24-Mar-17 31-Mar-17 07-Apr-17 14-Apr-17 21-Apr-17 28-Apr-17 05-May-17 12-May-17 19-May-17 26-May-17 02-Jun-17 09-Jun-17 16-Jun-17
Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast
£k £k £k £k £k £k £k £k £k £k £k £k £k £k £k £k
Balance B/F 34,337 54,685 54,011 68,845 35,767 18,673 32,249 64,498 42,657 3,000 17,787 8,310 17,800 (26,034) (10,943) (16,838)
Receipts (inflows)
LSB receipts 27,697 0 50 0 0 28,000 0 0 0 28,001 0 50 0 28,001 0 0
SLA receipts 345 6,020 7,892 0 0 145 13,903 0 0 145 0 13,903 0 145 0 13,903
LSB - Financial Support 16/17 3,250 0 0 1,000 0 0 0 0 0 0 0 0 0 0 0 0
Patient SLA Overperformance 2016/17 - NHSE
Patient SLA Overperformance 2016/2017 (21) 16 247 0 0 0 0 0 0 0 0 0 0 0 0 0
Private Patients receipts 252 563 300 300 300 300 300 300 300 300 300 300 300 300 300 300
Training & Education receipts 0 0 0 0 0 0 0 10,000 0 0 0 0 0 0 0 0
NHSE Inflows 2,230 0 31,405 1,758 0 0 32,645 0 0 0 0 35,085 0 0 0 35,085
DoH - National RTT, ED Monies & Project Diamond
Income Generation CIPs
Other 1,049 1,638 1,712 440 5,959 440 665 590 4,768 440 590 1,533 5,551 440 390 790
Total Receipts 34,802 11,009 41,606 3,498 6,259 31,885 47,513 10,890 5,068 31,886 890 50,871 5,851 28,886 3,690 50,078
Payments (outflows)
Pay monthly (incl Pay Awards) 51 85 0 25,350 0 70 0 0 25,350 70 0 0 25,350 0 70 0
PAYE/NIC/SUPER (CHAPS) 0 0 20,564 0 0 0 0 20,609 0 0 0 20,609 0 0 0 20,609
Agency CIP
PFI project 4,295 0 4,100 0 0 4,300 0 4,100 0 4,300 0 4,100 0 4,300 0 4,100
Trade Creditors 6,849 6,953 7,221 7,415 7,265 6,415 6,265 6,415 6,265 5,915 5,765 5,915 5,765 5,915 5,765 5,915
Other 1,515 2,312 8,289 1,497 10,955 4,848 6,827 4,954 9,552 2,248 3,280 8,221 16,767 2,078 2,150 8,221
Total Payments 14,094 10,755 41,219 36,109 19,581 17,169 14,392 37,378 42,467 13,833 10,345 40,145 49,182 13,593 9,285 40,145
Cash from operations 20,708 254 387 (32,611) (13,322) 14,716 33,121 (26,488) (37,399) 18,053 (9,455) 10,726 (43,331) 15,293 (5,595) 9,933
Capital & Financing Items
Capital gross exp (Facility Funded) 613 876 3,772 500 328 500 1,571 1,066 22 500 503 48 275 0
PDC Dividends (TDR) (outflow) 0 0 2,306 0 0 0 0 0 0 0 0 0 0 0 0 0
PDC Receivable 0 0 0 (409) 0 0 0 0 0 0 0 0 0 0 0 0
Loan Facility Drawdown (Capital Rev Facility £33.6m) 0 0 0 0 0 0 0 (5,476) 0 0 0 0 0 0 0 0
Revolving Working Capital Facility 0 0 (19,789) 0 0 0 0 0 0 0 0 0 0 0 0 0
Interest Paid on Revolving Credit Facility 0 0 1,511 0 0 0 0 0 0 0 0 736 0 0 0 0
Loans Repaid (outflow) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Interest on Loans (outflow) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Other (inflow) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total Capital & Financing 360 928 (14,447) 467 3,772 1,140 872 (4,647) 2,258 3,266 22 1,236 503 202 300 1,320
Net Inflow / Outflow 20,348 (674) 14,834 (33,078) (17,094) 13,576 32,249 (21,841) (39,657) 14,787 (9,477) 9,490 (43,834) 15,091 (5,895) 8,613
Forecast Balance C/F 54,685 54,011 68,845 35,767 18,673 32,249 64,498 42,657 3,000 17,787 8,310 17,800 (26,034) (10,943) (16,838) (8,225)
The rolling cash flow forecasts forward for a 16 week period currently to the 3rd Week in June 2017.
The 16 week cash flow allows the Trust to forecast its requirement for drawdown against the agreed Workng Capital Facility over the following 2 months.
Page 16 of 29
Finance Report Month 10 2016/2017 Statement of Financial Position (Balance Sheet)
Year to Date 31-Mar-16
Actual Plan Actual Variance Notes
£k £k £k £k
Property, Plant & Equipment 532,001 547,694 527,428 (20,266) 1
Intangible Assets 3,670 3,027 3,472 445
Other Assets 11,145 10,950 10,596 (354)
Non Current Assets 546,816 561,671 541,496 (20,175)
Inventories 17,748 19,200 16,856 (2,344)
Trade & Other Receivables 118,917 113,973 158,334 44,361 2
Cash and Cash Equivalents 18,982 20,815 31,624 10,809
Current Assets 155,647 153,988 206,814 52,826
Trade and Other Payables (151,607) (136,131) (167,101) (30,970) 3
Borrowings (7,960) (74,592) (126,199) (51,607)
Other Financial Liabilities 0 0 0 0
Provisions (1,473) (1,613) (876) 737
Other Liabilities (10,139) (7,000) (11,506) (4,506)
Current Liabilities (171,179) (219,336) (305,682) (86,346)
Borrowings (314,651) (312,216) (314,652) (2,436)
Other Financial Liabilities 0 0 0 0
Provisions (5,455) (5,000) (5,455) (455)
Non Current Liabilities (320,106) (317,216) (320,107) (2,891)
TOTAL ASSETS EMPLOYED 211,178 179,107 122,521 (56,586)
Financed by:
Public Dividend Capital (223,838) (223,838) (224,520) (682)
Retained Earnings 109,055 141,124 198,392 57,268
Revaluation Reserve (96,395) (96,393) (96,395) (2)
TOTAL TAXPAYERS' EQUITY (211,178) (179,107) (122,523) 56,584
The Statement of Financial Position reflects changes in asset values as well as movements in liabilites. The plan figures reconcile to the Annual Plan submitted to Monitor in June 2016.
Year to Date
1. Capital expenditure is behind plan at month 11 due to delay in NHSI approval of Distressed Capital funding. Once funding is confirmed planned projects will commence.
2. Trade and Other Receivables balances are above plan due to the invoices raised to KIFM, overperformance not yet paid by NHSE, accrual for WIP.
3. Trade and Other Payables continue to increase due to restricted cash availability and restrictions in place on the use of the Working Capital Facility to reduce outstanding Creditor balances.
Page 17 of 29
Finance Report Month 11 2016/2017 Aged Debtors
Invoiced Debtors Within
Terms
1 Month
Overdue
2 Month
Overdue
3 Month
Overdue
Total Current
Month Prior Month Notes
Other Receivables
Notes
Current
Month Prior Month
1-30 Days 31-60 Days 61-90 Days Over 90 Days Over 30 Days Over 30 Days £k £k
£k £k £k £k £k £k £k
CCG's/NHSE 17,065 3,967 3,823 6,180 31,035 13,970 19,076 1 Accrued Income
Trusts 1,387 1,012 661 4,906 7,966 6,579 6,911 2 Work in Progress 16,588 17,367
Other NHS 397 (3) (5) 457 846 449 642 CCG/NHSE SLAs 4 4,402 3,365
Other Debtors 8,380 5,305 7,909 29,464 51,058 42,678 50,484 3 Injury Cost Recovery Fund 3,047 6,094
Private Patients 831 765 665 4,262 6,523 5,692 5,721 NHSE Drugs Accrual 3,887 3,264
Overseas Visitors 449 434 236 9,376 10,495 10,046 9,621 Clinical Income accrual 5 8,831 8,067
Total Invoiced Debtors 28,509 11,480 13,289 54,645 107,923 79,414 92,455 KIFM 1,067 933
Other 16,924 10,016
Provision for Bad Debts (Incl. RTA Provision) (12,150) Total Accrued Income 54,746 49,106
Accrued Income 54,746
Prepayments 6,206
Other Debtors 16,599
Total Trade & Other Receivables 173,324
5. Clinical Income accrual - This relates to overperformance accrual for NHSE and CCG contracts (£8m).
The Trust debtors are mixture of invoiced debtors, accrued income and prepayments. The level of invoiced debtors' balance has decreased by £6.9m and private and overseas patients balance has decreased by £0.2m.
Overdue debts (those >30 days old) has decreased by £13m.
1. CCG's/NHSE - Outstanding debt has increased by £0.6m during the month while over due debt has increased by £5.1m in the same period. This is due to payment from NHSE
2. Trusts - Outstanding debt from other Trusts has decreased by £0.3m.
3. Other debtors - Overdue debt has decreased by £7.8m due to payment received from KIFM while overall total debt has decreased by £6m since December due to same reason.
4. CCG SLA Accruals - this relates to accruals for 50% CQUIN (£4.3m) as at Month 11
Page 18 of 29
Finance Report Month 11 2016/2017 Debtor Detail
Organisation Over 30 days
NHS Organisations
NHS England (Central) £10.1m
CCGs £4.6m
NEL CSU (12 CCGs) £0.593m
West Sussex CSU (7 CCGs) £1.497m
Cambridge and Peterborough CCG £0.160m
Slough CCG £0.265m
Swale CCG £0.272m
Guildford & Waverley CCG £0.181m
Bedfordshire CCG £0.206m
Southwark CCG £1.317m
West Kent CCG £0.97m
Bexley CCG £1.730m
NHS Trusts £4.0m
Lewisham and Greenwich NHS Trust £0.475m
Guys & St Thomas NHS Foundation Trust £1.392m
Dartford & Gravesham NHS FT £0.794m
Oxleas NHS FT £0.982m
Maidstone & Tunbridge Wells NHS Trust £0.338m
South London and Maudsley NHS FT £0.989m
Other NHS Bodies £5.861m
TOTAL NHS ORGANISATIONS £26.239m
Non-NHS Organisation
Viapath LLP £2.592mm
KCH Commercial Services Ltd £4.460m
Kings College London £4.230m
Bromley CIC £0.917m
Lloyds Pharmacy £0.688m
Councils £0.445m
ISS Mediclean £1.205m
Other Non-NHS Bodies £2.620m
KCH INTERVENTIONAL FACILITY MGMT LLP KIFM £26.933m
TOTAL NON-NHS ORGANISATIONS £44.090m
Challenges raised against 15/16 & 16/17 NCA invoices Small challenges remaining on account, however new invoices now all paid
Invoices from August to date Payment to be agreed once bank accounts fully functioning
PLD queries 15/16 & Mths 1 - 8 16/17 CCG's are between CSU's currently, Contracts have sent an email stating we must receive all
Mth 1-8 Freeze invoices for 2016/17 Some payments due in March 2017, the rest will be negotiated at year end with the
Sexual Health & GUM Services Small amounts across several UK Councils, chased daily, will look to ask for Contracts to help
with resolving any outstanding queries
November invoice due for payment
KCH owe L&G £2m
KCH owe GSTT £3.363m
Agreed pay date end of March 2017 unless contract isn't signed
Reciprocal payments for circa £650k being finalised with SLAM - made w/e 10/3/17
Reciprocal payments agreement in place. KCH returning payments to GSTT when received
Director of Finance has issued a letter confirming withdrawal of Neurosciences services if
invoices are not paid. M&TW have agreed to pay, but receipt of payments has been slow.
Reciprocal payments agreement in place. KCH payments higher.
Periodic reciprocal payments are agreed to reduce this balance.
KCH has agreed weekly payments to D&G to reduce outstanding balance. No payments being
received from D&G.
Contracts reviewing challenges currently , once challeges are accepted a credit will be raised
Contracts have made contact to find out the reason for delay in payment and whether it
relates to PLD
Negotiating payments with CCG - contracts are involved
£180k cleared looking to have remainder cleared in year end payments
Contracts Department is currently discussing with NHSE regarding backing data for these
invoices
Contracts will negotiate payment of Months 7-9 in next set of meetings
Contracts will negotiate payment of Months 7-9 in next set of meetings
Chasing NHSE team - we have now replied to all outstanding queries
NHSE refusing to pay until they see line by line details
Credit control chasing individual areas
Email sent to Swale asking them to review freeze data
Contracts have made contact as there are numerous queries about backing and where this is
being sent to
£815k relates to IFRs 15/16 - current dispute on how these are being invoiced.
£1,367m relates to IFRs 16/17 - current dispute on how these are being invoiced.
£2.303m relates to Month 7 Freeze data for 2016/17
£2.875m relates to Month 8 Freeze data for 2016/17
£1,613m Cancer Drugs Fund Invoices
£647k Overseas visitors Qtr 1 & 2 16/17
£452k relates to NHS Area Teams NCA data for 2015/16 & 16/17
Issue Resolutions and Follow up
Amanda Munro has agreed a first installment of £445k to be paid 15.3.17
Overseas Patient Data Months 1 - 8 16/17
Mth 1-8 Freeze invoices for 2016/17
£0.981m paid beginning of March, negotiating remaining payment
Challenges relating to freeze data and Neurosciences invoices
Challenges relating to patient identifiable data
Challenges relating to patient identifiable data
Challenges relating to patient identifiable data Mths 1 - 8 16/17
KCH owe KCS Ltd £46k
KCH owe D&G £2,3m
KCH owe Oxleas £0.517m
KCH owe Viapath £6m
KCH owe KCL £5m +
Neurosciences invoices disputed by M&TW, do not agree that these invoices should be paid
as included in contract. KCH disagree.
KCH owe SLAM £711k
Outstanding 16/17 Invoices including MSK for Month 10
No payment is being received from KCS Ltd
Reciporal payment agreement in place. KCH pay more to KCL weekly
Contracts have been in contact with local CCG for help in resolving ongoing issues
Payment not being recieved due to outstanding invoices owed to Lloyds
Credit team chasing organisation for payment
Rental for Beckenham Beacon as well Community Diabetes Service invoices are outstanding
as previously disputed. Payments not being received as Bromley CIC expecting payment of
their outstanding debt (£0.343m)
KCH owe LLoyds £5m
Relates to various invoices against multiple NHS organisations
KCH has agreed weekly payments to Oxleas to reduce outstanding balance. No payments
being received from Oxleas.
Page 19 of 29
Finance Report Month 11 2016/2017
M1 16/17
£'000
M2 16/17
£'000
M3 16/17
£'000
M4 16/17
£'000
M5 16/17
£'000
M6 16/17
£'000
M7 16/17
£'000
M8 16/17
£'000
M9 16/17
£'000
M10 16/17
£'000
M11 16/17
£'000
Provision For Bad Debts : Current Year 244 377 488 913 1,297 1,731 2,020 2,309 2,597 2,885 3,173
Provision For Bad Debts : Prior Year 2,124 2,124 2,124 2,484 2,736 2,124 2,124 2,124 2,124 2,124 2,124
2,368 2,501 2,612 3,397 4,033 3,855 4,144 4,433 4,721 5,009 5,297
23% 28% 28% 35% 41% 38% 44% 46% 49% 50% 50%
M1 16/17
£'000
M2 16/17
£'000
M3 16/17
£'000
M4 16/17
£'000
M5 16/17
£'000
M6 16/17
£'000
M7 16/17
£'000
M7 16/17
£'000
M7 16/17
£'000
M7 16/17
£'000
M7 16/17
£'000
Provision For Bad Debts : Current Year 25 50 75 100 125 150 175 200 225 250 275
Provision For Bad Debts : Prior Year 282 282 282 572 485 282 282 282 282 282 282
307 332 357 672 610 432 457 482 507 532 557
6% 7% 8% 17% 16% 11% 8% 9% 8% 7% 9%
M1 16/17
£'000
M2 16/17
£'000
M3 16/17
£'000
M4 16/17
£'000
M5 16/17
£'000
M6 16/17
£'000
M7 16/17
£'000
M7 16/17
£'000
M7 16/17
£'000
M7 16/17
£'000
M7 16/17
£'000
Provision For Bad Debts : NHS 2,514 2,514 2,514 2,434 2,434 2,434 2,434 2,434 2,434 2,434 2,434
Provision For Bad Debts : Non-NHS 830 830 830 1,112 1,112 1,112 1,112 1,112 1,112 1,112 1,112
3,344 3,344 3,344 3,546 3,546 3,546 3,546 3,546 3,546 3,546 3,546
6% 9% 7% 8% 7% 5% 5% 4% 4% 4% 4%
Bad Debt Provision
Percentage of Bad Debts Provision against Outstanding Debts
Overseas Visitors
Total Provision
Percentage of Bad Debts Provision against Outstanding Debts
Private Patients
Total Provision
Percentage of Bad Debts Provision against Outstanding Debts
Trust Debt
Total Provision
Page 20 of 29
Finance Report Month 11 2016/2017 Capital R
Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance
£k £k £k £k £k £k
Major Works 26,962 23,011 (3,951) Major Works 52,344 30,841 (21,503)
Minor Works 1,476 1,008 (468) Minor Works 2,580 1,716 (864)
IT (Incl Intangibles) 4,253 2,623 (1,630) IT (Incl Intangibles) 8,025 5,827 (2,198)
Medical Equipment 1,818 1,442 (376) Medical Equipment 8,240 2,276 (5,964)
Total 34,509 28,084 (6,425) Total 71,189 40,660 (30,529)
Year to Date Plan Actual Variance Year End Forecast Plan Forecast Variance
£k £k £k £k £k £k
Major Works Major Works
Critical Care Unit 14,041 12,793 (1,248) Critical Care Unit 26,205 15,835 (10,370)
Cath Lab Developments 0 - 0 Cath Lab Developments 1,295 0 (1,295)
Helideck 961 956 (5) Helideck 1,550 961 (589)
Site Wide Infrastructure 400 371 (29) Site Wide Infrastructure 1,500 550 (950)
Ruskin Wing - to increase bed capacity 2,150 1,939 (211) Ruskin Wing - to increase bed capacity 3,100 3,399 299
ED Additional Bed Capacity 550 181 (369) ED Additional Bed Capacity 2,000 1,400 (600)
Portakabin enabling - to increase bed capacity 1,617 1,211 (406) Portakabin enabling - to increase bed capacity 1,400 1,217 (183)
Orpington major works - to increase bed capacity 4,164 3,438 (726) Orpington major works - to increase bed capacity 4,100 4,164 64
Other - Denmark Hill 2,031 1,341 (690) Other - Denmark Hill 5,932 2,089 (3,843)
Other - PRUH 548 362 (186) Other - PRUH 2,410 531 (1,879)
Other - Orpington 500 419 (81) Other - Orpington 2,852 695 (2,157)
Minor Works 1,476 1,008 (468) Minor Works 2,580 1,716 (864)
IT (Incl Intangibles) 4,253 2,623 (1,630) IT (Incl Intangibles) 8,025 5,827 (2,198)
Medical Equipment 1,818 1,442 (376) Medical Equipment 8,240 2,276 (5,964)
Total Capital Spend 34,509 28,084 (6,425) Total Capital Spend 71,189 40,660 (30,529)
Funded by: Funded by:
External Borrowing - - - External Borrowing - - -
Donations (1,840) (1,840) - Donations (4,203) (1,943) 2,260
PDC Receipts (682) (682) - PDC Receipts (600) (1,091) 491.00-
Depreciation (23,358) (23,358) - Depreciation (26,100) (25,500) 600.00
Total Funding (25,880) (25,880) - Total Funding (30,903) (28,534) 2,369
Internal Cash Funding Requirement 8,629 2,204 (6,425) Internal Cash Funding Requirement 40,286 12,126 (28,160)
The capital report shows capital expenditure year to date against plan and full year forecasts as agreed with NHSI.
The year to date plan is based on the revised annual plan profile been discussed with NHSI.
The underspend reflected at month 11 is due to the delay in confirmation of Distressed Capital funding from NHSI. Capital plan for the year have further been reduced by £8.8m following review. These include
Additional Bed Capacity including ED (£10.6m), EPR Systems Development & Infrastructure (£1.5m), Site wide infrastructer and Minor Works (£1.9m), Link building (£253k) and other approved business cases and
major works (£4.3m).
The planned capital expenditure for 2016/17 is £71.189m was approved by the board but reduced to £40.6m due to NHSI not approving the ealier plan. Some of the project have been move to 2017/18.
Page 21 of 29
Finance Report Month 11 2016/2017 Agency Run Rate R
Year to Date Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17
£k £k £k £k £k £k £k £k £k £k £k
A&C Staff/Senior Managers (717) (743) (648) (692) (790) (775) (491) (613) (267) (143) (217)
Medical Staff (870) (1,104) (1,440) (1,290) (1,329) (1,162) (1,048) (1,031) (836) (1,268) (1,345)
Nursing Staff (878) (872) (963) (1,099) (1,090) (1,126) (957) (908) (849) (970) (996)
PAMS/Scientific/Professional (343) (762) (849) (570) (548) (473) (510) (618) (451) (318) (502)
Total Agency Spend (2,808) (3,481) (3,899) (3,650) (3,757) (3,535) (3,006) (3,170) (2,403) (2,699) (3,060)
-
200
400
600
800
1,000
1,200
1,400
1,600
Ap
r-1
6
May
-1
6
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
Oct
-16
No
v-1
6
De
c-1
6
Jan
-17
Feb
-17
£k
Agency Run Rate A&C Staff/Senior Managers Medical Staff
Nursing Staff PAMS/Scientific/Professional
Page 22 of 29
Finance Report Month 11 2016/2017 WTEs R
Year to Date
Budgeted Substantive
Budgeted
Vacancies Bank Agency
Total Staff in
Post
Gap (Budget -
Actuals)
WTE WTE WTE WTE WTE WTE WTE
Capital, Estates and Facilities Estates and Facilities 151.70 114.13 37.57 8.91 2.34 125.38 26.32
Commercial Guthrie Clinic 66.11 59.18 6.93 18.32 0.68 78.18 (12.07)
Kings Commercial Venture 0.00 0.00 0.00 0.00 0.00
Corporate Services Corporate Services 6.00 4.00 2.00 4.00 2.00
Executive Nursing Corporate Services 73.89 71.73 2.16 0.00 0.45 72.18 1.71
Executive Nursing 113.69 97.67 16.02 0.82 98.49 15.20
Finance Finance 140.12 101.63 38.49 8.08 11.55 121.26 18.86
Procurement 0.00 0.00 0.00 0.65 8.05 8.70 (8.70)
Medical Director Medical Director 4.90 3.00 1.90 3.00 1.90
Networked Care Sub Division A 1,984.60 1,789.76 194.84 110.12 43.80 1,943.68 40.92
Sub Division B 1,636.69 1,431.77 204.92 142.36 42.80 1,616.93 19.76
Operations Operations 402.65 342.75 59.90 14.82 5.51 363.08 39.57
PRUH and South Sites PRUH 2,686.24 2,318.73 367.51 271.42 128.30 2,718.45 (32.21)
Strategy R&D 216.66 181.01 35.65 0.71 1.21 182.93 33.73
Strategy 8.05 9.70 (1.65) 9.70 (1.65)
Transformation and ICT ICT 147.92 147.89 0.03 2.00 1.50 151.39 (3.47)
Transformation 29.50 22.40 7.10 1.52 23.92 5.58
Urgent Care, Planned Care and Allied Clinical Services Planned Care 2,250.28 2,027.63 222.65 146.43 48.50 2,222.56 27.72
Urgent Care 2,054.39 1,885.81 168.58 90.09 56.96 2,032.86 21.53
Workforce Development HR and employee relations 82.47 71.06 11.41 1.30 0.00 72.36 10.11
Learning and Organisational Development 51.89 37.89 14.00 37.89 14.00
Nursery 53.61 49.71 3.90 49.71 3.90
Occupational Health 34.50 32.95 1.55 0.93 3.17 37.05 (2.55)
Post Graduate Medical Education 64.48 62.78 1.70 1.25 64.03 0.45
Total WTEs 12,260.34 10,863.18 1,397.16 818.21 356.34 12,037.73 222.61
The Trust is showing a budgeted vacancy level of 1,397.16 WTEs, of which 818.21 are covered by Bank and 356.34 are covered by Agency. This leaves a vacancy gap of 222.61 WTEs.
The Finance Department is working closely with Workforce to reconcile the WTE numbers.
Page 23 of 29
Finance Report Month 11 2016/2017 Income by Commissioner Contract
Commissioner Name M11 Budget YTDM11 Actual YTD (Before Block
Adj)Block Adjustment M11 Actual YTD (After Block Adj) M11 Variance YTD
Block 422,159,296 426,528,846 2,630,450 429,159,296 7,000,000
NHS BROMLEY CCG 153,122,488 154,481,957 -1,359,469 153,122,488 0
NHS SOUTHWARK CCG 78,241,900 75,932,134 2,309,766 78,241,900 0
NHS LAMBETH CCG 64,293,368 63,289,187 1,004,181 64,293,368 0
NHS LEWISHAM CCG 29,313,680 30,897,038 -1,583,358 29,313,680 0
NHS BEXLEY CCG 21,979,980 21,832,627 147,353 21,979,980 -0
NHS GREENWICH CCG 18,656,980 17,001,456 1,655,524 18,656,980 -0
NHS ENGLAND LONDON - Dental (Block) 7,840,200 7,816,637 23,563 7,840,200 0
NHS ENGLAND LONDON - Haven (Block) 4,585,810 4,572,029 13,781 4,585,810 0
NHS ENGLAND LONDON - Bowel Screening (Block) 681,660 679,610 2,050 681,660 0
NHS ENGLAND LONDON 1,430 0 1,430 1,430 0
NHS DARTFORD, GRAVESHAM AND SWANLEY CCG 9,470,590 9,906,593 -436,003 9,470,590 0
NHS MEDWAY CCG 2,868,760 3,592,927 -724,167 2,868,760 0
NHS SOUTH KENT COAST CCG 1,892,290 2,652,509 -760,219 1,892,290 0
NHS WANDSWORTH CCG 2,452,350 2,123,526 328,824 2,452,350 -0
LONDON BOROUGH OF SOUTHWARK COUNCIL 1,823,360 1,466,137 357,223 1,823,360 0
NHS ASHFORD CCG 942,200 1,055,760 -113,560 942,200 0
NHS THANET CCG 1,617,230 889,755 727,475 1,617,230 0
LONDON BOROUGH OF LAMBETH COUNCIL 1,179,620 879,838 299,782 1,179,620 0
NHS CENTRAL LONDON (WESTMINSTER) CCG 1,184,860 837,743 347,117 1,184,860 0
NHS HOUNSLOW CCG 521,850 788,166 -266,316 521,850 0
NHS SURREY DOWNS CCG 726,740 519,653 207,087 726,740 -0
NHS KINGSTON CCG 266,810 435,371 -168,561 266,810 0
NHS EALING CCG 421,330 434,011 -12,681 421,330 0
NHS WEST LONDON CCG 661,940 381,531 280,409 661,940 0
NHS HAMMERSMITH AND FULHAM CCG 396,760 319,879 76,881 396,760 0
NHS BRENT CCG 306,010 258,173 47,837 306,010 0
NHS HILLINGDON CCG 307,230 211,949 95,281 307,230 0
NHS HARROW CCG 223,790 94,572 129,218 223,790 0
Neuro Rehab (Contract Variation) 1,829,667 1,829,667 0 1,829,667 0
LSB - ED Beds 1,006,000 1,006,000 0 1,006,000 0
BEXLEY MSK 13,342,413 13,342,413 0 13,342,413 0
CCG additional Financial Support 0 7,000,000 0 7,000,000 7,000,000
C&V 395,010,733 398,386,652 0 398,386,652 3,375,919
LONDON COMMISSIONING HUB - 13R 280,157,735 307,635,562 0 307,635,562 27,477,827
LONDON COMMISSIONING HUB - 13R (Over-Performance) 25,190,891 0 0 0 -25,190,891
LONDON COMMISSIONING HUB - Hep C 7,975,000 11,929,654 0 11,929,654 3,954,654
LONDON COMMISSIONING HUB - CDF 6,141,667 4,509,894 0 4,509,894 -1,631,773
LONDON COMMISSIONING HUB - IFRs 1,045,200 1,728,408 0 1,728,408 683,208
NHS ENGLAND LONDON - Dental 23,787,930 22,566,955 0 22,566,955 -1,220,975
NHS ENGLAND LONDON - Screening 4,610,460 5,191,726 0 5,191,726 581,266
NHS ENGLAND LONDON 0 8,143 0 8,143 8,143
NHS CROYDON CCG 17,668,020 17,885,471 0 17,885,471 217,451
NHS WEST KENT CCG 8,549,020 9,896,057 0 9,896,057 1,347,037
NHS CANTERBURY AND COASTAL CCG 2,526,040 2,042,875 0 2,042,875 -483,165
NHS ENGLAND SOUTH (SOUTH EAST) - Dental 1,399,030 1,411,552 0 1,411,552 12,522
NHS ENGLAND SOUTH (SOUTH EAST) - Screening 0 28,183 0 28,183 28,183
NHS MERTON CCG 1,045,390 1,100,675 0 1,100,675 55,285
NHS SWALE CCG 1,257,550 1,041,619 0 1,041,619 -215,931
CCGs - Over Performance 3,309,290 0 0 0 -3,309,290
All Other CCGs (below £1m) 10,347,510 11,409,878 0 11,409,878 1,062,368
NHSE NCA 701,290 856,935 0 856,935 155,645
NCA 9,983,762 12,063,690 0 12,063,690 2,079,928
Local Authority 3,144,990 1,875,374 0 1,875,374 -1,269,616
Non-English - N Irish 1,833,336 837,943 0 837,943 -995,393
Non-English - Scottish 207,480 383,117 0 383,117 175,637
Non-English - Welsh (C&V) 399,440 957,672 0 957,672 558,232
Non-English - Welsh (NCA) 18,480 0 0 0 -18,480
CQUIN 16,500,000 20,450,407 0 20,450,407 3,950,407
Grand Total 849,958,807 862,340,636 2,630,450 864,971,086 15,012,279
Key Income Headlines:
* Month 11 Actuals are based on Month 10 Flex data (Contracts) extrapolated using working days (February) for all Inpatient and Outpatient activity, all other datasets (Drugs, Devices, Diagnostics, Critical Care, Patient Transport) are
straight-lined with adjustment to factor seasonality.
* Block Over-Performance driven by Critical Care, Devices & Drugs (Cytokine Modulaters usage high across Lambeth and Southwark)
* Excluded Drugs (Paroxysmal Nocturnal Haemoglobinuria (PNH) & HIV) - still large part of NHSE over-performance
* Hep C drugs up against plan but data has not been validated by NHSE yet - a Contract Variation has been signed in order to receive payment on a monthly basis and any outstanding over/under performance will be sorted during Year-End
process
* Bone Marrow Tranplant (NHSE) activity trending high above plan, marginal rate applied at Service Line in Month 11
* Stroke Unit and HASU (Emergency) activity for all commisisoners trending under plan
* Welsh contract yet to be signed - performance driven by PNH drugs (last year Excluded Drugs were being recorded outside of Contract Monitoring)
Page 24 of 29
Finance Report Month 11 2016/2017 Income Activity Analysis
Month 11 actuals are based on Month 10 flex data (Contracts) extrapolated using Month 11 activity figures from the OLAP report (Inpatient & Outpatient), all other categories
(Drugs, Devices, Diagnostics, Critical Care, Patient Transport) are straight-lined but factoring in seasonality. Bromley, Lambeth & Southwark agreed contracts are reflected
within the plan. There is always the potential for monthly variations between the estimate and actual patient data.
Page 25 of 29
Finance Report Month 11 2016/2017 Contracts over £10m
Commissioner
2016/17 FOT
Basline value
(M)
2017/18
Contract Value
(M)
2018/19
Contract Value
(M)
Contract Status
(M)
Contract
Signed? (M)
Actual
/Expected
contract
signature date
(M)
Likely to require
mediation? (M)
Likely to require
arbitration? (M)
£'000 £'000 £'000
Bexley CCG £23,998 £22,883 £22,883Finalising contract paperwork Yes 31/01/2017 No No
Bromley CCG £170,925 £176,224 £176,119 Complete Yes 23/12/2016 No No
Croydon CCG £19,490 £18,902 £18,902Finalising contract paperwork Yes 31/01/2017 No No
Greenwich CCG £20,869 £18,414 £18,414Finalising contract paperwork No 31/01/2017 No No
Lambeth CCG £71,767 £74,766 £72,588 Complete Yes 23/12/2016 No NoSouthwark CCG £86,956 £89,066 £85,534 Complete Yes 23/12/2016 No No
Lewisham CCG £32,286 £35,625 £35,625Finalising contract paperwork Yes 31/01/2017 No No
NHSE Specialised £342,775 £342,000 £384,906 Complete Yes 23/12/2016 No No
West Kent CCG £9,067 £10,034 £10,034Agreed heads of terms No 31/01/2017 No No
Dartford, Gravesham & Swanley CCG £10,563 £11,100 £11,100Finalising contract paperwork Yes 31/01/2017 No No
NHSE Non-Specialised £38,503 £36,167 £36,167Awaiting response to revised offer Yes 31/01/2017 No No
Page 26 of 29
Finance Report Month 11 2016/2017 NHS Clinical Income 2017/18
Original Income
Baseline
CCG/NHSE
PROPOSAL
CHANGES
17/18 Planned
Income
£'000 £'000 £'000
CCGs: LSB 326,821 0 326,821
CQUIN 8,065 0 8,065
1% Growth 3,287 0 3,287
Unfunded Services 1,011 1,011
Price Adjustments (HRG4+, QIPP & Non-Recurrent Adj) -7,336 4,664 -2,672
RTT 3,000 3,000
Neuro Level 2b 533 0 533
TOTAL CCGs: LSB 331,370 8,675 340,045
CCGs: Other 152,203 0 152,203
CQUIN 3,443 0 3,443
Price Adjustments (HRG4+ & Non-Recurrent Adj) 344 3,277 3,621
Neuro Level 2b 2,200 0 2,200
Bexley MSK 14,555 0 14,555
TOTAL CCGs: Other 172,745 3,277 176,022
CCGs: NCAs 14,692 0 14,692
CQUIN 287 0 287
TOTAL CCGs: NCAs 14,979 0 14,979
NHSE: Specialised (13R) 342,157 0 342,157
CQUIN 7,167 0 7,167
Price Adjustments (HRG4+, QIPP & Non-Recurrent Adj) 0 12,235 12,235
Business Cases (including neuro ruskin wing beds and BMT) 7,088 0 7,088
Foetal Med & MRET benefit 1,600 1,600
TOTAL NHSE: Specialised (13R) 356,412 13,835 370,247
NHSE: Dental (Q71) 25,142 -500 24,642
CQUIN 628 0 628
TOTAL NHSE: Dental (Q71) 25,770 -500 25,270
NHSE: Screening (Q71) 8,246 -1,800 6,446
CQUIN 193 0 193
TOTAL NHSE: Screening (Q71) 8,439 -1,800 6,639
TOTAL NHSE: Block (Community Dental/ Haven) 16,395 0 16,395
TOTAL NHSE: NCAs 2,369 0 2,369
NHSE: Hep C/CDF/IFRs 21,135 -1,900 19,235
16/17 drugs coming through 17/18 -1,000 0 -1,000
TOTAL NHSE: Hep C/CDF/IFRs 20,135 -1,900 18,235
TOTAL Local Authorities: English 4,930 -800 4,130
TOTAL Local Authorities: N Irish 927 0 927
TOTAL Local Authorities: Scottish 355 0 355
TOTAL Local Authorities: Welsh 1,290 0 1,290
0
956,117 20,787 976,904
Notes:
CCGs (LSB) 1% CQUIN reserve excluded from calculations
RTT Backlog funding to be confirmed for SEL CCGs and NHSE
Page 27 of 29
Finance Report Month 11 2016/2017 Surplus / (Deficit) By Division
Year to Date Plan Actual Variance
£k £k £k
Surplus / (Deficit) (25,661) (78,895) (53,234)
Year to Date Plan Actual Variance
£k £k £k
Networked Care Neurosciences (4,129) (8,368) (4,239)
Haematology and Precision Medicine (7,444) (4,111) 3,333
Critical Care, Radiology and MEP 8,944 3,304 (5,639)
Cardiovascular Sciences (4,788) (4,276) 512
Cancer (1,396) 716 2,112
Variety Children's Hospital 4,516 1,522 (2,994)
Liver and Renal 4,021 (1,556) (5,577)
Networked Care Total (275) (12,768) (12,492)
PRUH and South Sites Post-Acute Medicine (20,269) (35,915) (15,646)
Women's & Children's and core services (812) (61) 751
Acute and Emergency Care (14,861) (7,704) 7,157
Surgery, theatres, Anaesthetics and Endoscopy (14,532) (19,676) (5,145)
PRUH and South Sites Total (50,474) (63,357) (12,882)
Urgent Care, Planned Care and Allied Clinical Services Therapies (3,854) (3,673) 181
Pharmacy (749) 148 897
Dental (4,188) (4,794) (606)
Women's Health (13,569) (17,948) (4,379)
Post-Acute and Planned 5,893 2,103 (3,789)
Theatres and Anaesthetics (841) (2,705) (1,864)
Acute and Emergency (14,984) (16,024) (1,040)
Planned surgery and Ophthalmology (12,487) (20,633) (8,147)
Urgent Care, Planned Care and Allied Clinical Services Total (44,778) (63,526) (18,748)
Clinical Divisions Total (95,527) (139,651) (44,123)
Capital, Estates and Facilities (510) 1,666 2,176
Commercial 8,419 (1,970) (10,389)
Corporate Services 0 327 327
Executive Nursing 18 653 634
Finance 26 65 39
Medical Director 0 (52) (52)
Operations 0 647 647
Strategy 0 105 105
Research & Innovation 402 375 (27)
Transformation and ICT 0 2,007 2,007
Workforce Development 0 569 569
Corporate Departments Total 8,355 4,393 (3,962)
Capital charges (2,234) 11,895 14,129
Trust Income 54,304 35,026 (19,277)
Surplus / (Deficit) (35,102) (88,336) (53,234)
Impairment 9,441 9,441 0
Operating Surplus / (Deficit) (25,661) (78,895) (53,234)
Page 28 of 29
Finance Report Month 11 2016/2017 Summary 1617 Year End Timetable
TASK DATE
Draft set of accounts completed for review by DoF & CFO 19-Apr
Draft Final Accounts to Monitor/Auditors incl SIC & FTCs & AR (9am) 26-Apr
M12 Finance Committee Report & Treasury Management Reports Completed (Noon) 18-Apr
External Auditors Preliminary Review & Audit 27-Apr
Board Meeting (April) / Finance & Performance Committee (M12) 25-Apr
Q4 Monitor Return submission to Monitor 28-Apr
Audit Committee - Review of Final Draft Annual Accounts prior to sign-off (9-11am) 22-May
Board Meeting - Formal Approval of Accounts and Annual Report text (2-3pm) 25-May
Board Meeting (May) / Finance & Performance Committee (M1) 30-May
Audited Accounts & FTCs, final text for Annual Report, signed audit opinion on the accounts & FTCs,
Auditors' final ISA 260 report, signed AGS, signed CEO's and CFO's certificate to FTCs to Monitor (Noon)31-May
Annual Accounts and Annual Report to Parliamentary Clerk (bound as 1 document) 26-Jun
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REGISTER OF DIRECTORS FIT AND PROPER PERSON DECLARATIONS 2017
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Name Office Date Appointed Fit & Proper Person Declaration Executive Director Mr Nick Moberly Chief Executive 02/11/2015 Not Received Ms Dawn Brodrick Executive Director of Workforce Development 02/10/2015 Not Received Professor Julia Wendon Executive Medical Director 02/11/2015 Not Received Ms Jane Farrell Chief Operating Officer 01/04/2016 Not Received Mr Colin Gentile Chief Financial Officer 01/01/2016 Not Received Dr Shelley Dolan Chief Nurse 04/10/2016 Not Received
Non-Executive Director Lord Bob Kerslake Chair 01/04/2015 Not Received Ms Sue Slipman Vice Chair 23/07/2012 Yes Mr Christopher Stooke 01/11/2011 Yes Mrs Faith Boardman 18/03/2012 Not Received Professor Jonathan Cohen 23/07/2012 Yes Professor Ghulam Mufti 05/12/2012 Not Received Mr Erik Nordkamp 01/01/2016 Yes Dr Alix Pryde 01/11/2015 Yes Professor Richard Trembath 05/12/2016 Yes
REGISTER OF DIRECTORS FIT AND PROPER PERSON DECLARATIONS 2017
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Non-voting Executive Director Ms Trudi Kemp Director of Strategic Development 01/10/2014 Long-tern Sick Leave Ms Lisa Hollins Executive Director of Transformation and ICT 19/09/2016 Not Received Ms Jane Bond Director of Capital, Estates & Facilities 12/09/2016 Not Received Mr Alan Goldsman Interim Director of Strategy 01/02/2016 Not Received
Enc. 6.5
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Report to: Board of Directors
Date of report: 27 February 2017 to 24 March 2017
Subject: Chair’s and Non-Executive Directors’ Activity Report
Presented by: Lord Kerslake, Chairman
Status: For information
1. Background/ Purpose This report details the activities undertaken by the Non-Executive Directors of the Board for the period from 27 February 2017 to 24 March 2017. 2. Action required The Board of Directors is asked to note the contents of this report.
Lord Kerslake - Chairman Date Activity
27 February Attended Additional Audit Committee meeting
28 February
Attended Finance & Performance Committee meeting Attended Quality & Governance Committee meeting
10 March
Chaired Private Board meeting Chaired Public Board meeting Chaired Public Council of Governors meeting Chaired Private Council of Governors meeting
15 March
Attended Board Development Day Chaired KCH Membership Community Event
16 March
Chaired Haematology Institute Programme Board
Enc. 6.5
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Jon Cohen – Non-Executive Director, Lead for Improving Quality of Patient Care Date Activity
7 March Teleconference re. KHP Neurosciences Board
8 March Chaired KHP Neurosciences Board
10 March
Met with KPPM Audit Group Attended Private Board meeting Attended Public Board meeting Attended Public Council of Governors meeting
15 March Attended Board Development Day
Alix Pryde – Non Executive Director, Chair of Audit Committee, Lead for Move to Operational Sustainability
Date Activity
27 February Chaired Audit Committee
10 March
Chaired NED meeting re. Annual Audit Plan Attended Private Board meeting Attended Public Board meeting
15 March Attended Board Development Half-Day
Chris Stooke – Non Executive Director, Chair Finance and Performance Committee, Lead for Delivering Financial Plans
Date Activity
8 March Chaired KCH Charity meeting
9 March Attended KCH Charity meeting
10 March Attended meeting with KPMG internal auditors Attended Private Board meeting Attended Public Board meeting Attended Public Council of Governors meeting
20 March Met with Adam Creegan re. RTT
Enc. 6.5
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Faith Boardman – Non-Executive Director, Chair of Education Workforce and Development Committee, Lead for Organisational Development
Date Activity
27 February Attended Audit Committee meeting Met with Estates Director
28 February Chaired Quality and Governance Committee meeting
10 March
Attended Audit Committee meeting Attended Private Board meeting Attended Public Board meeting Attended Public Council of Governors meeting
15 March Attended Board Development Day
28 March Attended Private Board meeting Chaired Education and Workforce Committee meeting
Sue Slipman – Non Executive Director, Deputy Trust Chair, Chair of Private Board Strategy Focus, Lead for Trust Strategy
Date Activity
28 February Chaired KCH Finance & Performance Sub-Committee meeting
7 March Attended pre-meeting briefing with Colin Gentle Attended meeting with NHSI
8 March Attended National Freedom to Speak Up Guardian Conference
10 March
Attended meeting with KPMG Attended Private Board meeting Attended Public Board meeting Attended Public Council of Governors meeting
15 March
Attended Board Development Day Attended meeting with N. Watson
16 March Attended meeting with Chair and Chief Executive
23 March Attended meeting NHS Providers Chairs as Chief Executives
Enc. 6.5
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Professor Ghulam Mufti – Non Executive Director, Chair of Quality and Governance Committee, Lead of Trust Strategy (KHP)
Date Activity
28 March
Attended Private Board meeting Attended Educational & Workforce Development Committee meeting
Erik Nordkamp – Non Executive Director, Chair of Commercial Services Board, Lead for Commercial Services
Date Activity
10 March
Attended meeting with the Non-Executive Directors and internal auditors, KPMG Attended Private Board meeting Attended Public Board meeting Attended Public Council of Governors meeting Met with Richard Trembath
15 March Attended Board Development Day
Professor Richard Trembath - Non Executive Director – Board Member
10 March
Attended Audit Committee meeting Attended Private Board meeting Attended Public Board meeting Attended Public Council of Governors meeting
15 March Attended Board Development Day
20 March Attended induction meeting with Colin Gentile
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King’s College Hospital NHS Foundation Trust - Finance & Performance Committee Minutes of the Finance & Performance Committee meeting held on Tuesday 28 February 2017 from 08:30-10:30 in the Dulwich Committee Room, Denmark Hill.
Present: Sue Slipman (SS) Non-Executive Director/ Committee Chair Lord Kerslake (BK) Trust Chair Colin Gentile (CG) Chief Financial Officer Jane Farrell (JF) Chief Operating Officer Prof. Julia Wendon (JW) Medical Director Dr. Shelley Dolan (SD) Chief Nurse Dawn Brodrick (DB) Director of Workforce and Development Jane Bond (JB1) Director of Capital Estates and Facilities Lisa Hollins (LH) Director of Transformation and ICT In attendance: Adam Creeggan Director of Planning and Performance Simon Dixon Director of Finance Harvey McEnroe Deputy Director of Operations ( Items 2.1 & 2.2 only) Catherine Saunders Transformation Programme Director Emergency Care ( Items 2.1 &
2.2 only) Jane Badejoko Assistant Board Secretary (Minutes) Nanda Ratnavel Governor Observer Apologies: Trudi Kemp (TK) Director of Strategic Development Chris Stooke (CS) Non-Executive Director Nick Moberly (NM) Chief Executive Officer Heather Morley (HM1) Trust Secretary and Head of Corporate Governance Alan Goldsman (AG) Interim Director of Strategic Development
Item Subject Action
017/35 Apologies
Apologies for absences were noted.
017/36 Declarations of Interest There were no declarations of interest reported.
017/37 Chair’s Actions There were no Chair’s actions to report.
017/38 Minutes of the Previous Meeting The minutes of the meeting held on 24 January 2017 were approved as a correct record.
017/39 Action Tracker/ Matters Arising The Committee received an update on the following action:
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Item Subject Action
Item 016/147 from 20/12/2016 Update on Windsor Walk: The Trust’s internal auditors KPMG have reviewed the accounting treatment and provided assurance to NHS Improvement (NHSI) that the accounting treatment for Windsor Walk was accurate. The Trust is exploring two potential means of purchasing the site. The first is directly through NHSI with funding from the Department of Health. The second is the NHS Pension Fund.
TOP PRODUCTIVITY
017/40 Monitoring Operational Performance ( this section of the meeting was observed by NHSI representatives) The Committee received an update on the Trust’s performance in M10: Accident and Emergency (A&E) The Trust’s A&E compliance against the national 4-hour target improved from 75.48% reported in December 2016 to 78.21% in January 2017. Performance improvement has been sustained with February compliance at 81.9% at the time of writing this report. Both sites are showing signs of improvement and recovery, the results are encouraging and should provide a good base for a lasting move to a sustainable position. The Trust is focusing on recording and management of acuity in various patient groups at the PRUH – the targeted measures have produced positive indicators. These improvements are important, as the site has been lacking in performance behind Denmark Hill. The recent senior appointment of a managing director at the PRUH will provide further stability and a focused approach to driving change. The improvements being rolled out across both sites will underpin the longer term strategy and changes to the way staff work. The Trust shared the deep dive into emergency medicine with the regulators (NHSI). Referral to Treatment (RTT) RTT incomplete pathway compliance improved from 77.1% reported in December 2016 to 77.3% in January 2017. Compliance with this metric was influenced by the reduced elective mode of operation over the holiday period, as instructed by NHSI and NHS England (NHSE). The number of patients waiting more than 18 weeks decreased by 59 pathways, but the number of patient waiting over 52 weeks increased from 129 at the end of December 2016 to 158 at the end of January 2017. However, the number of Neuro-specialty breaches reduced from 32 to 22 and remained 185 ahead of trajectory. Non-neuro breaches increased from 97 to 136, resulting in 136 cases behind trajectory. The Trust has updated the assessment tool used in risk reviews of clinical harm to patients waiting over 52 weeks. The new process provides adequate assessment and, where necessary, swift access to medical intervention.
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Item Subject Action
The RTT challenge before the Trust is vast – it cannot be completed without additional support. The Trust is exploring a number of options that would provide safe,/high quality and timely patient assessment. Cancer Trust compliance against the national treatment within 62 days for patients referred from a screening programme was provisionally non-compliant at 81.8% against a target of 90% for January. This figure is still being validated. Patient choice was a key factor in the higher number of breaches reported in January. Breast cancer symptomatic treatment was not achieved in January, but February performance is showing signs of recovery. The Trust has formed a cancer board which meets regularly. Diagnostics The Trust was non-compliant in diagnostics during January with performance recorded at 1.2% against a target of 1%. January performance was particularly challenging due to loss of working days and increased operational pressures. The Trust was fully compliant with diagnostic targets for quarter 3. General Update The emergency department transformation programme is aiming to build in resilience in emergency care pathway and facilitate close working relationships between the Trust, community care and local care network. The Trust trialed a pilot which assessed 26 patients in ED. 13 patients were identified as at risk of readmission. The pilot was well received by ED staff – a recommendation to NHSI for support will be sent. The transfer of care bureau pilot at the PRUH was a time limited project which will be up for performance review. The Operating Officer at Bromley CCG is keen to meet and discuss a transition of the service from the current model to something more wholesome which will incorporate both patient discharge and enhanced process management of the pathway. Lambeth local authority has agreed to set up a multifunctional working group to assess and identify the key drives to delayed discharge. This will include capacity and recommendations to reduce length of stay. The Trust will be increasing its elective workload over the next few weeks. This is as a result of the requirement to reduce elective footprint to provide capacity for ED being relaxed. The Trust is on trajectory to clear all backlog complaints by the end of March 2017. The 25 working days’ response time will be fully functional in the new year. The Trust continues to experience challenging nurse recruitment in a few areas. The Trust’s communication, workforce/recruitment teams and nursing have been working together to raise the profile of the Trust nursing profile on social media. To further enhance visibility, the Trust will publish a one page nurse advertisement in the Guardian on 1 March.
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Item Subject Action
The Committee will receive details of commissioner QIPP target encouraging a joint agenda to improve the ED pathway in May. The Committee agreed to keep RTT as a standing agenda item.
J Farrell
017/41 Capacity, ED Expansion and pressing operational issues updates This item was covered elsewhere on the agenda.
FIRM FOUNDATIONS
017/42 Finance Report – M10 The Committee received the Trust’s month 10 financial report. The Trust’s cumulative operating deficit as of month 10 was £76.1m. This was an adverse variance of £49.5m against the year to date’s planned deficit of £26.6m. However, £32.5m of the variance relates to known alterations acknowledged by NHSI. The key drivers of the deficit are NHS clinical contract activity income, Cost Improvement Plans (CIP) slippage, and expenditure cost pressures. The Trust has exhausted the entire working capital facility allowance for 2016/17 and, to date, has received £125m in cash support. An additional facility of £19m has been requested by the Trust until the end of the year. The Trust cash position remains fragile and subject to constant financial scrutiny of all expenditures. It was noted that the Trust’s original cash requirement for 2016/17 was £130m. The Trust continues to spend at risk on pressing capital project. To date, spend is £9.5m – all at risk spend directly affects patient safety. Trust regulators have been informed of all at risk spend. The Trust Chair and Chief Financial Officer were informed that the Trust will not receive the 1% frozen commission funds as previously advised. This financial shortfall will represent a £12m gap in the end of year position. The Trust will focus on achieving the £49m deficit target and the value of the bridge into the next financial year for the weeks before the end of the year. The Trust will be exploring alternative options for achieving the control total for the year, and aims to attain a break-even financial position in 3 years’ time. There will also be greater focus on securing Sustainability and Transformation funding (STF). The Trust is yet to receive regulator agreement on the level of capital spend for next year.
017/43 Draft presentation to NHSI with First Cut of Bridge into 2017/18 The Committee received and supported the approach employed by the Trust in drafting the planned bridge for presentation to NHSI at the 9 March meeting.
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Item Subject Action
017/44
CIPs Planning 2017/18 The Committee received a progress update on the Cost Improvement Plans (CIP) for 2017/18. The Trust’s 2017/18 target for new savings is £50m. Significant work has been undertaken to ensure a robust and credible efficiency plan is developed for 2017/18, with an approved timetable for delivery. There is a high degree of staff engagement and commitment to delivery of plans. Some work streams, such as medical productivity and theatre efficiency, require more detailed analysis and a longer timescale to validate savings plans. There is still lot of work to be done on completing a robust schedule. The change in approach from cost cutting CIPs this year to a more streamlined and allocated approach of saving with identifiable executive leads was supported. Next year’s CIPs relating to reduced length of stay, outpatients, diagnostics and theatre efficiency savings will be aligned with the Trust’s overall transformation programme.
017/45 Capital Programme The Trust’s 2016/17 Capital spend request was £74.84m. This was revised to £39.9m following regulators’ scrutiny. The Capital spend on key projects, such as the Critical Care build, was prioritised. The Trust will require £40m in Capital spend for 2017/18 to ensure it can provide safe operating structures.
017/46 Any Other Business There were no matters of any other business raised for discussion.
017/47 Date of Next Meeting Tuesday, 28 March 2017 10:45-12:45 in the Dulwich Committee Room.
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