King’s College Hospital Board of Directors - 126.1 - bod agenda and...Dulwich Committee Room Enc 1.4 King’s College Hospital NHS Foundation Trust Board of Directors Minutes of

King’s College Hospital Board of Directors PUBLIC

Time of meeting 3.00pm

Date of meeting Tuesday 25 May 2010

Venue Dulwich Committee Room, King’s College Hospital

Members

Michael Parker Robert Foster Maxine James Prof. Alan McGregor Dr Martin West Vacancy Vacancy Tim Smart Angela Huxham Michael Marrinan Roland Sinker Simon Taylor Dr Geraldine Walters

Chair Non-Executive Director Non-Executive Director Non-Executive Director Non-Executive Director Non-Executive Director Non-Executive Director Chief Executive Director of Workforce Development Medical Director Director of Operations Chief Financial Officer Director of Nursing & Midwifery

Non-voting Directors

Ahmad Toumadj Jane Walters Jacob West

Director of Capital, Estates & Facilities Director of Corporate Affairs Director of Strategy

Attendees Rita Chakraborty Sally Lingard Jenny Yao

Assistant Board Secretary Associate Director, Communications & Marketing Asst Director of Quality Improvement

Circulation to Board of Directors Circulation List

AGENDA Enclosure Exec Lead Time 1. 1.1 Apologies

1.2 Declarations of Interest – to

receive 1.3 Chair’s action 1.4 Minutes of the meeting held on 27

April 2010

1.5 Matters Arising – to consider

Enc. 1.4 Enc. 1.5

M Parker

M Parker

3.00pm 3.05pm

matters arising not covered elsewhere on the agenda

2. FOR REPORT 2.1 Chair’s and Non-Executive

Directors’ Report 2.2 Chief Executive’s Report 2.3 Finance

2.3.1 Finance Report – month 1 2.3.2 Treasury Management – month 1

2.4 Performance Report – month 12 2.5 Quality Focus - Patient Experience

Report 2.6 Staff survey results

Enc. 2.1 Enc. 2.2 Enc. 2.3.1 Enc. 2.3.2 Enc. 2.4 Enc. 2.5 Enc. 2.6

M Parker

T Smart

S Taylor

R Sinker

T Smart/ J Walters

A Huxham

3.10pm 3.15pm 3.20pm 3.30pm 3.40pm 3.50pm

3. FOR DECISION 3.1 Annual Plan 2010/11

3.1.1 Strategic Overview 3.1.2 2010/11 Finance Summary 3.1.3 Financial Templates 2010/11

– 2012/13 3.1.4 Board Statements 3.1.5 Schedule of Assurance 3.1.6 Membership Report

3.2 Trust governance structure and committee terms of reference

3.3 Update on Revised Monitor Code of

Governance

Enc. 3.1.1 Enc. 3.1.2 Enc. 3.1.3 Enc. 3.1.4 Enc. 3.1.5 Enc. 3.1.6 Enc. 3.2 + appx Enc. 3.3

J West/ S Taylor/ J Walters

J Walters

J Walters

4.00pm 4.20pm 4.35pm

4. FOR INFORMATION 4.45pm 4.1 Committee minutes

4.1.1 Finance – 25 March 2010 4.1.2 Finance – 22 April 2010 4.1.3 Performance – 08 April 2010

Enc. 4.1.1 Enc. 4.1.2 Enc. 4.1.3

5. AOB 4.50pm DATE OF NEXT MEETING:

Tuesday, 3 June 2010 at 12.30 pm in the Dulwich Committee Room

Enc 1.4

King’s College Hospital NHS Foundation Trust Board of Directors Minutes of the meeting of the Board of Directors held at 15.00 hrs on Tuesday 27 April 2010 in the Dulwich Committee Room, King’s College Hospital Members

Michael Parker (MP) Robert Foster (RF) Prof. Alan McGregor (AM) Dr Martin West (MW) vacancy vacancy Tim Smart (TS) Michael Marrinan (MM) Roland Sinker (RS) Simon Taylor (ST) Dr Geraldine Walters (GW) Angela Huxham (AH)

Chair Non-Executive Director Non-Executive Director Non-Executive Director Non-Executive Director Non-Executive Director Chief Executive Executive Medical Director Executive Director of Operations Chief Financial Officer Executive Director of Nursing & Midwifery Executive Director of Workforce Development

Non-voting Directors

Ahmad Toumadj (AT) Jane Walters (JW) Jacob West (JW1)

Director of Capital, Facilities & Estates Director of Corporate Affairs Director of Strategy

In attendance Rita Chakraborty Sally Lingard Jenny Yao Dr Charlotte Anderson Sarah Dunton John Moxham Vivian Bazalgette

Assistant Board Secretary (minutes) Associate Director of Communications & Marketing Assistant Director of Quality Improvement Staff Staff Director of Clinical Strategy, King’s Health Partners Trustee, KCH Charity

Governors and public

Humera Manzoor Anis Rahman

Public Public

1

Item

Subject Action

010/53 Welcome and Apologies Apologies – Maxine James.

010/54 Declarations of Interest None.

010/55 Chair’s Action Since the previous Board meeting, the Chair had signed the following tender ratification documents:

Supply of neutral wholesaler services covering the distribution of medical consumables.

Electrophysiology and radiofrequency ablation consumables. These actions were ratified by the Board.

010/56

Minutes of the meeting held on 23 March 2010

The minutes of the meeting held on 23 March 2010 were approved subject to the following amendments:

010/45 Change para 3 to "RF commented that, at a recent King's Fund seminar, some NEDs from other organisations had expressed the view that they did not have the time to acquire in depth understanding of operational issues. Hence, there may be implications nationally implementing the Francis Report recommendation that NEDs should be more aware of operational pressures." 010/46 (Para 2, 1st sentence) Change to "AM commented on the lengthy waiting time in Phlebotomy and the need to address delays."

010/57 Matters Arising 010/39 - national policy concerning end of life care was comprehensive and the specific case concerned a particular aspect of this policy. The Trust was ensuring that the policy was extended to all departments.

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010/44 - Steve Thomas had been appointed to job share with Prof Stephanie Amiel. The final wave of CAG appointments had not yet been confirmed to the Trust. 10/46 - an additional cubicle was being added to the Phlebotomy section to enable more patients to be seen. It was queried as to why patients were not being encouraged to attend GP surgeries for blood tests rather than the Trust. It was suggested that cost might be an issue as the Trust did not charge for the service, therefore there was no cost to the PCT. RS would clarify the situation.

010/58 Chair and NEDs Report The Chair and NEDs Report was noted.

010/59 Chief Executive’s Report

Tim Smart presented the Chief Executive’s Report and outlined the following:

In the run up to the general election, public sector organsiations were in a period of 'purdah' restricting information conveyed to the public on future government initiatives. In the event of a hung parliament, this situation would continue.

The Trust had reported a surplus for the full year - a remarkable achievement given the scale of the challenges. Simon Dixon, Deputy Director of Finance, had negotiated a settlement with the District Valuer that was significantly better than expected. It was recognised that the Trust's financial performance had deteriorated during the year, and lessons had been learnt concerning the need for ever tighter oversight and a swift escalation route.

The Trust had met all national targets in the previous month. The Trust was experiencing an increase in patient acuity.

Collaboration with the London Ambulance Service would enable trauma cases to be treated in the most appropriate setting.

2010/11 would be considerably more challenging than 2009/10 as a result of changing national priorities aimed at increasing out of hospital care.

The Trust would be holding its annual community events for members in May. Events would be publicised via newsletters and email reminders to staff and patients. In response to a suggestion about radio advertising, it was felt that this would change the nature of the meetings to public events rather than member events designed to facilitate members' feedback on the Trust's annual plans.

3

A contingency plan was in place if the PFI contract resulted in delays to the intended location of the Emergency Department CT scanner. TS thanked the KCH charity for their support in the purchase of the scanner.

The Board noted the CEO report and CEO Brief for April.

010/60 Finance Report month 12 Simon Taylor presented the month 12 finance report. Analysis had been carried on the full financial year to ascertain where pressures had occurred. Working capital was £10m above plan. Short term risks included the possibility of requisitions being delayed by staff until the new financial year. Staff cost controls would remain in place until robust savings plans had been delivered. The Board noted the finance report for month 12.

010/61 Draft Plan 2010/11

Simon Taylor presented the draft financial plan for 2010/11 and highlighted the following:

Efficiency savings remained at £50m, as estimated in September 2009 for the downside planning exercise.

Where there was uncertainty, figures were shown in red. Cost Improvement Plans were significantly higher than in

previous years. The capital plan assumed a break even budget. The 3 capital priorities were Maternity, Critical Care and

Trauma services. The Board discussion included the following observations:

The possibility of ring fencing funding for Critical Care earlier than 2011/12. There were short term contingencies to expand capacity and the Business Resource and Strategy Group would consider phasing shortly.

In the event of political changes, forecast figures for 2010/11 were unlikely to alter but there could be implications for years 2 and 3, ie 2011-2013.

There were considerable challenges ahead with risks in some areas that would require rigorous management.

4

Income from commercial developments could contribute in the future, particularly if there was easement in the private patient cap.

The Board noted the Draft Plan 2010/11.

010/62 Performance Report month 11 Roland Sinker presented the performance report for month 11 and drew attention to the following:

The Trust continued to be on target for all national targets with ALOS marginally off target.

There was a minor downward trend in A&E performance over the winter.

ALOS data by division was included in the report. The Board noted the performance report for month 11.

010/63 Draft Annual Plan 2010/11 Jacob West presented a report on the draft Annual Plan to Monitor outlining the context, process, timetable and a summary of the vision and strategic priorities. A fuller summary would be circulated to Board members during the following week with the complete document, including financial projections, presented for Board approval on 25 May. Staff, governors, members and external stakeholders would be invited to give feedback on the Trust’s plans. This year’s document template was more prescriptive and required a detailed 3 year plan. The Board offered the following comments:

Quality of patient care remained the priority. Information circulated internally would be in a more

accessible format AM enquired as to why Cardiology was not listed as a priority

tertiary service under strategic priorities. JW1 responded that collectively, priorities across the KHP organisations were aligned. MM added that the Trust’s aim should be to achieve academic pre-eminence in all lead specialist services within a specified timeframe.

The Board noted the draft objectives for inclusion in the Annual Plan and the process for its completion.

5

010/64 KHP update

Prof John Moxham provided a verbal update on recent developments in King’s Health Partners. CAGs

Frances O’Callaghan had been appointed KHP Director of Performance and Delivery.

King's Health Partners had appointed a second wave of Clinical and Academic Group (CAG) leaders:

o Diabetes, Endocrinology and Metabolism, Nutrition, Obesity, Vision & related Surgeries - Dr Stephen Thomas had been appointed to join Professor Stephanie Amiel as joint Leader.

o Allergy, Respiratory, Critical Care and Anaesthetics - Professor Tak Lee and Dr Richard Beale had been appointed joint Leaders.

o Dental - Professor Nairn Wilson o JM would look into the co-ordination of these recent

announcements. CAG leader appointments in Medicine, Women’s health and

Imaging would follow. The mental health CAGs would be led by ‘trios’ of Clinical,

Managerial and Nursing Leads Guidance and documentation on the accreditation process+

was being considered and further information would be Clinical Strategy

The vertical integration process was progressing The success of capitation funding was reliant on GP

collaboration Research

Graham Thorneycroft was leading on health services A health indicators scorecard was being developed, as were

metrics The Board discussion included the following observations and clarifications:

Frances O’Callaghan’s role would include all aspects of Lynn Carlisle’s previous role as well as ensuring delivery of KHP performance.

In comparison with other London AHSCs, KHP was progressing strongly and this view was shared in the wider health community.

6

Vertical integration with community services was a great achievement which would only be realised if it was a collective endeavour with GST and SlaM.

Robert Lechler’s announcement concerning academic chair appointments showed that only 1 out of 31 of these related to KCH’s Denmark Hill site. The Board needed to ensure academic excellence on this site and this required investment by KCL at the KCH campus. JM would convey the Board’s concerns to RL.

The main threat to the success of KHP’s agenda was how to translate 4 partners’ strategic priorities into a single AHSC.

Discussions with Royal Marsden continued – collaboration on a small scale was most likely.

The Board suggested that Frank Walsh, Director of Research attend a future meeting

Concern had been expressed regarding the KHP communication protocols. SL to investigate.

The Board thanked John Moxham and noted the update on King’s Health Partners.

010/65 Quality Focus

Geraldine Walters presented detailed action plans and updates on the recommendations from 2 reports into Mid Staffordshire NHS Foundation Trust by the Healthcare Commission and an independent enquiry chaired by Robert Francis QC. An initial report had been presented to the Board in March 2010. References to Board committees would be updated once the revised governance structure was agreed. GW noted that recommendation 1 – to not provide a service where it cannot achieve a specified standard – was difficult to assess. In such an event, a decision would be made once information from divisions had been triangulated for verification. Recommendations 4, 19 and others were reliant on the reduced use of temporary staff and fewer vacancies in nursing. GW acknowledged this as a priority. Additional support staff were being brought onto wards to free up nursing time used for administrative work. This would also help staff to attend more clinical training. From May, the monthly trust Patient Experience Report would appear regularly on the Board agenda. The Board noted the report on quality issues.

7

010/66 Single Sex Accommodation Delivery Plan GW presented an action plan to ensure the Trust’s compliance with

same-sex accommodation requirements by April 2011. The main areas of non compliance included day surgery, the clinical decision unit in the Emergency department and intensive care and high dependency areas. The trust was working actively to address areas of non compliance, and instituting more rigorous monitoring of any possible breaches.

There was uncertainty as to how the lead PCT would respond to any non-compliance in terms of with-holding payment. The regular monthly Patient Experience Report to the Board from May would include patient survey data on delivering same sex accommodation It was confirmed that, for areas where compliance was currently not being achieved, such as Day Surgery, better patient information was being produced, and consenting procedures revised The Board noted the report and progress in implementing the Single Sex Accommodation Delivery Plan.

010/67 Staff Pay Awards 2010/11 Angela Huxham presented a report on changes to staff pay structures and pay levels for 2010/11. The Board noted the report on staff pay awards 2010/11.

010/68 Annual Report 2009/10

Jane Walters presented a report on the Trust’s forthcoming annual report and accounts 2009/10, which was a statutory requirement. Some additional reporting sections had been introduced for the year. A separate annual review would be produced as an online document and would serve as the Trust’s ‘corporate brochure’. It would be easily accessible online to all. A further summary version would be produced for distribution to trust members. MP requested that the annual report and accounts should also be produced to the Finance Committee as was the case in previous years. The final draft of the report would be circulated to all Board members

8

9

for comment, and presented to the Audit Committee and Board of Directors for approval on 3 June 2010. The Board noted the report and timetable for production of the annual report.

010/69 Q4 2009/10 Monitor Submission

Tim Smart presented a report with appendices to request the Board’s approval for the signing of the governance declaration (January-March 2010) for submission to Monitor. The Trust would be declaring compliance with all targets (‘green’) following 2 quarters as ‘amber’. The Board APPROVED its signing by the Chief Executive.

FOR INFORMATION

010/70 The Board noted the following confirmed committee minutes: Performance – 11 March 2010 Finance – 19 February 2010

010/71 AOB None

010/72 Date of Next Meeting:

Tues 25 May 2010, 3.00 pm - Dulwich Room.

Enc 1.5

Board of Directors – 25 May 2010 Action tracking list

Agenda Item/Date

Action By whom By when Completed

23 February 2010 none 23 March 2010 010/45 Quality Focus

A systematic review of the recommendations from the Francis Report into Mid Staffordshire NHS Foundation Trust to be presented to the Board.

Geraldine Walters

April 2010 complete

27 April 2010 none

Enc 1.5 BoD Action Tracking 25 May 2010

ENC 2.1

Report to:

King’s College Hospital Board of Directors

Date of meeting:

25 May 2010

By:

Michael Parker, Chairman

Subject: Chairman and Non-Executive Directors’ Report Michael Parker - Chairman 13th April 2010 Go- see visit: Renal Dialysis Unit

Attended Consultant’s Committee

20th Attended meeting with Robert Lechler

Attended PMPA Lecture with Professor Andrew Gray and Angus Anderson re: “The Individual and the State in the Future of Public Services”.

21st Attended Leading For Health Conference

22nd Chaired NED meeting

Chaired Finance & Investment Committee and Commercial Board Meeting

Attended Inclusivity Lunch with Tim Smart

Chaired NED Long-Listing meeting with Russell Reynolds

26th Attended Monitor Event: Board Safety Workshop

27th Chaired Board of Directors meeting

Attended Lilley dinner at the Royal College of Physicians

28th Chaired Wave 3 of CAG Leader Interviews

29th Chaired ACCA Quality Lecture with presentation by Jenny Yao

Attended the Next Generation Chief Executive Programme Launch

30th Attended South East London Health Council

4th May 2010 Attended meeting with Charles Halpin, Director, Your Health Advocate

Chaired NED Short-listing meeting with Russell Reynolds

6th Attended National Breaking Through Induction Session

Attended Governance Committee

Page 1

7th Attended Diversity Practice meeting with Caroline and Paul Campayne

Chaired Consultant Interviews - Intensive Care Medicine

12th Attended and presented awards at the International Nurses Day event

13th Attended Board Away Day re: Equality Diversity & Inclusion, facilitated by Diversity Practice

Attended Performance Committee

Robert Foster 22nd April 2010 Attended NED meeting with Chair

Attended meeting with Sir Cyril Chantler, Chair UCL Partners

27th Attended buddy meeting with Jacob West and Mike Marrinan

Attended Board of Directors meeting

29th Chaired Consultant Interviews - Hepatobiliary Surgeon

3rd May 2010 Attended seminar on EDI

10th Attended and presented at Healthcare Conference, Cavendish Square re “the role of NED in QIPP”


Chaired Performance Committee

Attended briefing meeting with Chair and CE for next Board meeting

Chaired King’s Community event in Brixton

Professor Alan McGregor 19th April 2010 Attended meeting with Geraldine Walters re Academic Nursing

and the Welcome Trust CRF

Attended meeting with Drs Ibrahim and Ireland re: Pathology JV

Attended meeting with John Collinson (KCH Charity) re: Denmark Hill Funding

20th Attended meeting with Dr Al Haq re: Pathology JV

22nd Attended NED meeting with Chair

26th Attended meeting with Dr Jerosz re: Neuroscience CAG

Attended meeting with Dr T J Lasoye re: Establishment of Denmark Hill Clinical Skills and Simulation Training Centre

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Page 3

27th Attended Clinical Directors Meeting


6th May 2010 Chaired Governance Committee

11th Attended meeting with Tim Smart, Robert Lechler and colleagues re: KCL Consultation Document Implications for Academic Activity on Denmark Hill

Go-see Visit: Twinning Ward


Attended Performance Committee

14th Attended Clinical Directors meeting

Attended Medical Workforce Committee

Martin West 20th April 2010 Attended CT Project Board meeting

22nd Attended NED meeting with Chair

Attended Finance & Investment Committee meeting

Attended KCH Commercial Services Ltd Board of Directors meeting

Go-see visit: Princess Elizabeth Ward

Attended Golf Day organising Committee meeting

27th Attended Project Oyster meeting


4th May 2010 Attended ED reconfiguration meeting

360 Diversity telephone feedback

13th Attended Board Away day re: Equality Diversity & Inclusion, facilitated by Diversity Practice

Maxine James 4th May 2010 Chaired Consultant Interviews - Consultant Paediatric

Gastroenterologist

7th Phone call with Nicky Hayes re: Older People Stakeholders meeting

11th EDI Telephone interview with Diversity Practice


Page 1

Report to: Board of Directors Date of meeting: 25 May 2010 By: Tim Smart, Chief Executive Subject: Chief Executive’s Board Report 1. Executive Summary 09/10 will prove to have been a good year for KCH. We achieved all National targets, and we made good progress in equipping ourselves to achieve financial sustainability, in anticipation of a very tough economic period. We are still busier than we would like and we are struggling to maintain momentum on A+E targets, on MRSA, and an Average Length of Stay. This month saw the long-awaited opening by HRH The Princess Royal of the Cicely Saunders Institute which will house the Trust’s multi-disciplinary palliative care team, and also a Macmillan Information and Support Centre for patients, families and professionals. 2. Finance – month 1 The Trust’s financial performance for Month 1 was broadly in line with plan. Income budgets have yet to be finalised and therefore the actual position will be reported to the Board in June. 3. Performance – month 12 I am pleased to inform the Board that the Trust achieved ahead of its national expected limit for both MRSA bacteraemias and C-Difficile, consistently achieved against the 18 week targets and delivered above the required 98% of patients being seen within 4 hours of an attendance at the emergency department. In addition to this, as noted at the board last month, we achieved a ‘Green’ governance rating with Monitor in Q4, following a turn around in our cancer waiting time performance. The new financial year poses many challenges on the performance agenda. As noted to the board previously, we have a significantly reduced target for MRSA bacteraemias, we need to maintain our performance on the national emergency targets, cancer waits and 18 weeks. In addition to this we need to reduce our average length of stay, in light of the financial challenges we have ahead. 4. Strategy/King’s Health Partners

Enc 2.2

Page 2

During the course of the last month leadership appointments have been made to a further four CAGs. These include – Dental (Professor Nairn Wilson); Allergy, Respiratory, Critical Care and Anaesthetics (Professor Tak Lee and Dr Richard Beale); Imaging (Professor Reza Razavi); Women’s (Dr Diana Hamilton-Fairley, Marie McDonald, Professor Lucilla Poston). In addition we appointed Dr Steve Thomas to work alongside Professor Amiel in the Diabetes CAG. The final wave of CAG leader interviews is planned for the 4th June.We will then revisit the Medicine CAG, which is not as well defined as the other CAGs. In parallel to the CAG leader appointment process clinical leaders from both trusts have been asked to get together with their counterparts and consider potential reconfiguration options for their services. This process is being supported by the strategy teams from both trusts and is being progressed through meetings of key clinicians, managers and strategy team members. A key focus in this process is to identify options that improve patient care, delivering efficiencies and meet the strategic objectives of both KHP and the individual Trusts. 5. First Choice Teams in Neurosurgery and Specialist Medicine are leading key pieces of work, now in full implementation phase at ward level. The purpose is to better manage the flow of elective patients and ensure that all patients receive the care they need – when they need it – while maximising bed capacity, minimising waits and cancellations, and reducing costs. 6. Clinical Excellence Awards A review has been undertaken of the demographics of the awards that have been made this year, and has concluded that the process has rewarded a representative group. The external observer (from St George’s) commended us on the fairness and equity of the process. 7. National Inpatient Survey Results Results of the National Inpatient Survey will be published by the CQC on 19 May 2010. A verbal update will be given at the Board meeting. 8. Media/events (16 April – 13 May) Press & broadcast: Nb: Media activity in April/early May was less than usual because of the pre-election period (known as ‘purdah’). Purdah places restrictions on the type of announcements or good news stories public sector organisations such as KCH are able to issue in the run-up to a general election. 1 May – Lambeth Life published an article about a King’s scientist who has invented a new device to help doctors interpret scans more accurately. The Gillian Phantom –

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named after nuclear medical physicist Gillian Clarke – was officially unveiled at a radiology conference in the United States. 11 May – The Nursing Times and the South London Press covered HRH The Princess Royal’s visit to King’s on May 5 to officially open The Cicely Saunders Institute of Palliative Care (a collaboration between King’s College London and Cicely Saunders International – see Events and Visits for more information). 13 May – The Evening Standard reported on news that King’s has become the first hospital in London to offer the use of a new one-off drug for patients that helps surgeons carrying out delicate brain surgery distinguish between tumours and healthy tissue. The chemical in the drug is ‘taken up’ by the cancerous cells in the brain which then show up as bright pink when put under a special light by surgeons. This enables surgeons to more easily distinguish between tumour cells and normal surrounding brain tissue. Events and visits: 5 May – Staff from KCH and KCL joined HRH The Princess Royal to officially open the Cicely Saunders Institute of Palliative Care, located next to the Weston Education Centre on the King’s site. During her visit, HRH was given a guided tour of the Institute, which through research will look at ways of improving the care given to those living with advanced disease and those who are dying. HRH also met with patients and staff connected to the college and hospital. 12 May – King's staff celebrated International Nurses Day, with awards given out to the Nurse, Midwife and Healthcare Assistant of the Year as nominated by colleagues. The event was attended by over 500 members of staff. 11, 13 and 17 May – King’s held its annual series of Community events in May. Members of the public who attended the meetings heard about the Trust strategy for the coming year, and received information on our forward plans. This year, there were presentations on stroke and trauma, and information stands for attendees to visit. 9. Chief Executive’s Brief The May staff briefing is attached for information.

CHIEF EXECUTIVE’S BRIEF May 2010 Issue 48

An update from the Chief Executive to all staff at King’s College Hospital

Public services need strong political direction. Let us hope that the newly formed Conservative /LibDem coalition can provide that. We also hope that this year’s budget settlement for KCH will not be significantly altered by events in Whitehall. The current budget required us to deliver more for less, at higher levels of quality. We are planning for 10% savings at the Trust level, which will be very difficult to achieve, but which will force us to focus on what is really important – delivering high quality care for all our patients, and an efficient and fair workplace environment. There will be no room for waste or duplication, and we will encourage everyone to play their full part. We think that focusing on Average Length of Stay is the right thing to do. If a procedure requires a 3 day hospital stay, then we should perform to that level. It is much better, and safer, for patients, and it is much more efficient for the Trust. All patients should have a discharge plan, and if they don’t, the consultant should be encouraged by the Ward Manager to put one in place. Other challenges this year will be the national target of 98% A&E attendances to be completed within 4 hours, infection control and the delivery of same sex accommodation. Since we became a Trauma Centre, the number of highly acute ED attendances has grown and has threatened the 98% target. The ED team is working with colleagues across the Trust to ensure we get back on track as soon as possible. We have an extremely challenging MRSA target this year – less than one third of last year’s achievement. This means we can’t afford even one MRSA infection per month. So hand hygiene and efficient and safe management of lines are a must, as indeed is effective pre-admission screening wherever that is possible. For same sex accommodation, we are still unable to confirm that mixed sex accommodation has been eliminated at King's. We are working hard to correct this, and have an action plan in place; however, it is important staff understand their role in making sure we deliver on this promise. You will have seen that the process of appointing leaders to King’s Health Partners Clinical and Academic Groups is now well under way, and we are very pleased with the calibre of the people that have now been appointed. Their vital role will now be to unite the areas of clinical service, research, and education and training across the partner organisations over the next few months. Having great people in the right roles is also critical to the Trust succeeding, so I am delighted with the recent appointments to the new Divisional structure, and would like to congratulate Sarah, Ann, Anna, Elaine, Sue and Kath. I would also like to congratulate Chris Rolfe who has been appointed to succeed Mark Graver as Head of Communications. On a much sadder note, I would like to note the passing of Liana Zoitopolous. Liana provided a first class outreach dental service to vulnerable communities in Lambeth and Southwark, and she will be missed by all who knew her. Tim Smart Chief Executive

An update from the Chief Executive to all staff at King’s College Hospital

Pathology services at King’s As many of you will be aware, the pathology sector is changing. In practice, this means there will be fewer large providers of pathology services in the future than there are now. To ensure King’s pathology services remain competitive in this changing climate, we have been exploring the benefits of entering a Joint Venture partnership with GSTS Pathology, a provider of pathology services established by Guy’s and St Thomas’ and Serco, a private company. A strategic partnership of this kind would be beneficial in maintaining our national and international reputation in pathology. In addition, having a single pathology service for King’s Health Partners – rather than two separate competing pathology services as we have at present – would also enhance our combined ability to innovate and drive research forward. Of course, the future of King’s pathology staff is our key priority. They have been kept fully up to date about what is likely to happen in the event of a Joint Venture being formed. All affected staff have been reassured that if the JV were to go ahead, they would remain employees of King’s, and retain their NHS pension rights and other existing benefits. There is still a large amount of work to do in deciding the future direction of King’s pathology Services, and further updates will be issued during the summer. Cicely Saunders Institute Opens at King’s In the first week of May, HRH The Princess Royal officially opened the Cicely Sanders Institute of Palliative Care at King’s. The Institute is a collaboration between King’s College London and Cicely Saunders International. Through research it aims to improve the way in which care is given to those living with advanced disease, and those who are dying. The Institute – located next to the West Education Centre on the King’s site – also houses our own multi-disciplinary palliative care team, as well as a Macmillan Information and Support Centre for patients, families and professionals. The Institute is named after the late Dame Cicely Saunders, who is widely acknowledged as the founder of the modern hospice movement.

International Nurses Day On 12 May, staff from across the Trust came together to celebrate International Nurses Day (IND). King’s was one of many hospitals across the country to mark the day, which celebrates the valuable contribution nurses make to society. As part of the celebrations, awards were presented to Emma Ouldred (Nurse of the Year), Agnes Fempong Manso (Midwife of the Year) and Rubens Goodoree (Healthcare Assistant of the Year) following nominations by colleagues. Thanks to all who helped make the day such a success. More information about IND – plus photos from the event – are available to view on Kingsweb. Emergency Department awarded British Standard for business continuity Our Emergency Department has recently been awarded the BSI 25999 for business continuity by the British Standard Institute; this. King's is the first NHS Organisation in the country to have been accredited. Business continuity is extremely important in developing both internal and external emergency plans, to ensure we deliver a measured response when continue in the event of an emergency incident such as a major loss of power. King's takes business continuity seriously, and in the longer term our intention is for other departments to be certified as well. For further information please contact Liz Wells, Head of Emergency Planning and Clinical Site Management on Ext 2983. Denmark Hill station redevelopment Last month, we heard that Southwark Council had approved Network Rail’s plans to upgrade facilities at Denmark Hill station, including the installation of disabled lifts, a new footbridge, and restoration of the existing footbridge. This is excellent news, and recognition for our long-running campaign. The station is vitally important for our patients and staff, but is in urgent need of improvement. It is thanks to the lobbying efforts of our governors and many of our 8,000 members that the plans have now been given the green-light. Network Rail are expected to begin work in Autumn 2010. For further information, please contact Phil Boorman, Stakeholder Relations Manager, on 4348.

Finance Report

Month 1 (April) 2010/11

Board of Directors

25 May 2010

ENC 2.3.1

Page 2

Budget Update

Please note the following:

• Work is being undertaken to realign budgets with the new divisions and therefore Divisional reporting will commence from Month 2

• CIP’s have not fully been allocated to specific areas and are shown as a positive line

• No income activity figures (spells) have been received and therefore income has been broken even for the month.

• The phasing of the month 1 budgets have determined a deficit budget for month 1 of £1.413m. The actual deficit to date is £790k, a positive variance of £623k.

A n n u a l B u d g e t

M o n th ly Bu d g e t

M o n th ly A c tu a l

M o n th ly V a ria n ce

1 .In co m eC a t A : H e a l th ca re B l o ck I n co m e 450 ,417 37 ,535 37 ,727 193 C a t B :H e a l th ca re V a r i a b l e I n co m e 59 ,805 3 ,750 3 ,864 114 C a t C :N o n H e a l th ca re In co m e 67 ,179 5 ,523 5 ,151 ‐372

S u b ‐ To ta l 577 ,401 46 ,808 46 ,742 ‐66

2 .P a yA d m in i s t ra t i v e a n d C l e r i c a l S ta f f ‐55 ,979 ‐4 ,664 ‐4 ,278 386 A n c i l l a ry S ta f f ‐551 ‐ 46 ‐44 2 M a in te n a n ce S ta f f C o s t s ‐1 ,416 ‐ 118 ‐ 104 14 M e d i ca l D e n ta l S ta f f ‐1 ,232 ‐ 103 ‐ 89 13 M e d i ca l S ta f f ‐108 ,822 ‐9 ,073 ‐8 ,728 345 N u rs i n g S ta f f ‐124 ,124 ‐10 ,341 ‐9 ,974 367 O th e r S c i e n t i f i c Th e ra p e u t i c a n d T e ch n i c ‐18 ,441 ‐1 ,539 ‐1 ,364 175 P ro f e s s i o n a l a n d T e ch n i ca l ‐4 ,304 ‐ 359 ‐ 523 ‐164 P ro f e s s i o n s A l l i e d to M e d i c i n e ‐17 ,086 ‐1 ,428 ‐1 ,319 109 S c i e n t i f i c a n d P ro f e s s i o n a l S ta f f ‐15 ,379 ‐1 ,288 ‐1 ,302 ‐14 S e n i o r M an a g e rs ‐1 ,571 ‐ 131 ‐ 130 0

S u b ‐ To ta l ‐348 ,904 ‐29 ,090 ‐27 ,856 1 ,234

3 .N o n ‐P a yC a p i ta l C h a rg e s ‐20 ,170 ‐1 ,681 ‐1 ,625 56 C l i n i c a l S u p p l i e s a n d S e rv i ce s ‐48 ,114 ‐4 ,025 ‐4 ,047 ‐23 D ru g s ‐46 ,162 ‐3 ,866 ‐3 ,925 ‐58 E s ta b l i s h m e n t E x p e n s e s ‐6 ,404 ‐ 533 ‐ 395 138 E x te rn a l C o n t ra c t s ta f f i n g a n d C o n s u l ta n ‐23 ,845 ‐2 ,039 ‐1 ,936 104 G e n e ra l S u p p l i e s a n d S e rv i ce s ‐2 ,308 ‐ 192 ‐ 138 55 M is ce l l a n e o u s ‐23 ,936 ‐1 ,998 ‐1 ,963 35 P re m i s e s a n d F i x e d P l a n t ‐25 ,629 ‐2 ,131 ‐1 ,888 243 R e s e rv e s / C IP s u n a l l o ca te d 2 ,417 201 ‐1 ,008 ‐1 ,209 S e rv i ce s P ro v i d e d b y n o n ‐N H S b o d i e s ‐426 ‐ 35 ‐39 ‐3 S u b C o n t ra c te d H e a l th ca re ‐ N H S b o d i e s ‐8 ,689 ‐ 724 ‐ 718 6 T ra n s p o rt a n d M o v e a b l e P l a n t ‐5 ,505 ‐ 459 ‐ 379 80

S u b ‐ To ta l ‐208 ,772 ‐17 ,483 ‐18 ,060 ‐577

4 .R e ch a rg e sR e ch a rg e s ‐777 ‐ 70 ‐37 32

S u b ‐ To ta l ‐777 ‐ 70 ‐37 32

5 .In te re s t & D iv id e n d sA s s e t D i s p o s a l sD i v i d e n d ‐8 ,500 ‐ 708 ‐ 708 0 I n te re s t p a y a b l e ‐10 ,500 ‐ 875 ‐ 875 0 I n te re s t re ce i v a b l e 50 4 4 0

S u b ‐ To ta l ‐18 ,950 ‐1 ,579 ‐1 ,579 0

G ran d To ta l 0 ‐1 ,413 ‐ 790 623

Financial Risk Rating Ratios

Page 3

Fina ncia l Crite riaW e ight

(%) M e tric to be score d M onth 1M onth 1 Ra ting

10/11 P la n

10/11 P la n Ra ting

Achie ve m e nt of P la n 10 EBITDA achieved (% of plan) 76.1% 3 71.1% 3

Unde rlying Pe rform a nce 25 EBITDA M argin (% ) 5.2% 3 6.6% 3

Fina ncia l Efficie ncy 20 Return on Assets exc luding dividend (% ) 1.6% 2 4.2% 3

20 I&E surplus m argin (% ) -1.7% 2 0.5% 2

Liquidity 25 Liquidity Ratio (days) 16.0 3 15.0 3

FINANCIAL RISK RATING {W e ighte d Ave ra ge of Fina ncia l Crite ria } 3 3

Fina ncia l Crite ria Me tric to be score d5 4 3 2 1

Achie ve m e nt of P la n EBITDA achieved (% of plan) 100 85 70 50 <50Unde rlying Pe rform a nce EBITDA M argin (% ) 11 9 5 1 <1Fina ncia l Efficie ncy Return on Assets exc luding dividend (% ) 6 5 3 -2 <-2

I&E surplus m argin net of dividend (% ) 3 2 1 -2 <-2Liquidity Liquidity Ratio (days) 60 25 15 10 <10

Fina nce Risk Ra ting Ra ting 5Ra ting 4Ra ting 3

Ra ting 2

Ra ting 1

Risk of s ignificant breach in Terms of Authorisation in the medium term,e.g. 9 to 18 m onths in the absence of remedial ac tion.

Highes t Risk - high probability of s ignificant breach of Term s ofAuthorisation in the short-term , e.g. less than 9 m onths , unless rem edialac tion is taken.

RATING CATEGORIES

Regulatory concerns in one or more components . S ignificant breach ofTerms of Authorisation unlikely .

No regulatory concernsLowest Risk - no regulatory concerns

Variance Analysis

Page 4

The Trust is reporting a deficit of £790k at month 1, a favourable variance to the planned deficit of £623k, although income budgets have yet to be finalised and it is likely that the plan will change for month 2 to show a breakeven plan position.

Income – £66k adverse to plan. As mentioned, the phasing and devolving of income budgets to divisions have yet to be finalised, although contracts have now been agreed. The annual income budget reported does however reconcile to the annual plan. No actual income has been calculated for month 1, and income is therefore shown as breakeven. This will be resolved for Month 2 reports, and budgets will be devolved to divisions.

Pay - £1.2m favourable. Underspends are in all areas with the exception of Professional and Technical and Scientific and professional staff. Once CIP’s are fully allocated and phased to individual lines, most of these underspends will show adverse movements. In some areas too, cost pressures have been funded but not allocated out, and these will have a favourable effect.

Non Pay - £577k adverse. As stated, CIP’s have yet to be fully allocated to individual lines and are under the heading of reserves which is adverse by £1.2m. This is to be allocated out in Month 2 across pay, non pay and income areas. There are small overspends in month 1 against Clinical supplies and Drugs, and these adverse variances will increase once CIP’s are allocated.

CIP – Whilst it is not possible to report in detail against the CIP at month 1, the pay underspend shown of £1.2m is offset by the adverse variance in reserves of the same amount – this variance shows that a good proportion of the CIPs have been met at month 1.

Statement of Financial Position (Balance Sheet)

Page 5

31 March 2010

30 April 2010

31 March 2011

£'000 £'000 £'000 Non-current assetsIntangible assets 1,620 1,556 1,154Property, plant and equipment

337,246 337,466 341,715

Trade and other receivables 4,774 4,774 4,813

Total non-current assets

343,640 343,796 347,682

Current assetsInventories 11,243 11,301 10,100NHS trade receivables 21,487 10,715 23,653Non-NHS trade receivables 1,969 3,037 2,009Other receivables 14,883 27,091 14,310Cash and cash equivalents 12,838 14,230 9,661

Total current assets 62,420 66,374 59,733

Current liabilitiesTrade Payables (11,253) (10,923) (11,793)Other payables (26,804) (35,547) (26,983)Borrow ings (1,783) (1,721) (1,880)Provisions (939) (876) (868)Tax payable (6,892) (7,178) (7,268)Other liabilities (4,262) (243) (3,169)

Total current liabilities (51,933) (56,488) (51,961)

Total assets less current liabilities

354,127 353,682 355,454

Non-current liabilitiesTrade and other payables 0 0 0Borrow ings (91,919) (92,010) (90,247)Provisions (8,068) (8,093) (7,563)

Total non-current liabilities

(99,987) (100,103) (97,810)

Total assets employed 254,140 253,579 257,644

Financed by (taxpayers' equity)Public Dividend Capital 135,528 135,528 135,528Revaluation reserve 81,114 81,154 80,909Donated Asset Reserve 17,378 17,620 20,818Income and expenditure reserve

20,024 19,277 20,389

Total taxpayers' equity 254,044 253,579 257,644

Cash Flow

Page 6

TOTAL Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11Forecast Actual Forecast Forecast Forecast Forecast Forecast Actual Actual Actual Actual Forecast Forecast

£'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s

Balance B/F 12660 12,660 14,228 11,916 10,852 11,240 12,128 9,069 9,641 10,106 9,935 9,245 10,369

IncomeNHS Clinical Income

Southwark PCT SLA (Excl Merit Awards) 102,000 9,843 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500Lewisham PCT SLA 39,000 2,973 3,250 3,250 3,250 3,250 3,250 3,250 3,250 3,250 3,250 3,250 3,250Lambeth PCT SLA 84,000 6,800 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000LSL PCT Other (Palliative Care) 2,800 447 233 233 233 233 233 233 233 234 234 234 234SLAs : Other PCTs (incl PICU, NICU, BMT, HIV, Neu 202,756 14,184 16,896 16,896 16,896 16,896 16,896 16,896 16,896 16,896 16,896 16,896 16,900Provider to Provider Income 13,000 1,301 1,083 1,083 1,083 1,083 1,083 1,083 1,083 1,084 1,084 1,084 1,084PCT NCAs 2,500 132 208 208 208 208 208 208 208 209 209 209 209DoH - patient activity (NSCAG) 23,000 0 3,834 1,917 1,917 1,917 1,917 1,917 1,917 1,916 1,916 1,916 1,916RTA's 1,200 134 100 100 100 100 100 100 100 100 100 100 100Patient SLA Overperformance 2009/2010 4,200 1,390 700 793 600 600 600 100 107Patient SLA Overperformance 2010/2011 22,000 1,200 1,800 1,800 1,800 2,000 2,100 2,100 2,000 3,400 3,800

Non-NHS Clinical IncomePrivate Patients 15,530 1,191 1,294 1,294 1,294 1,294 1,294 1,294 1,294 1,294 1,294 1,294 1,296

Other IncomeResearch and Development 5,386 573 449 449 449 449 449 449 449 449 449 449 447Training & Educ: SIFT facilities, placement & HD 20,170 1,681 1,681 1,681 1,681 1,681 1,681 1,681 1,681 1,681 1,681 1,680 1,680Training & Educ: MADEL & PGME 13,622 1,135 1,135 1,135 1,135 1,135 1,135 1,135 1,135 1,135 1,135 1,135 1,137Training & Educ: Dental (SIFT) 7,683 640 640 640 641 640 640 640 641 640 640 640 641Training & Educ: SELSHA WDC & Dental NMET 3,612 284 301 301 301 301 301 301 301 301 301 301 301Merit Awards 3,500 279 292 292 292 292 292 292 292 291 291 291 291Haven Contract 1,400 118 117 117 117 117 117 117 117 116 116 116 116Caregroup Operational Income 25,918 3,097 2,160 2,160 2,160 2,160 2,160 2,160 2,160 2,160 2,160 2,160 2,158VAT reclaims 9,500 865 792 792 792 792 792 792 792 792 792 790 790Consultant's Fees income (Private Patients) 3,000 382 250 250 250 250 250 250 250 250 250 250 250

sub-total 605,777 47,449 50,915 50,291 50,699 50,698 50,698 50,398 50,506 50,398 50,298 51,695 52,100

ExpenditurePay monthly (incl Pay Awards) 188,891 14,676 15,406 15,848 15,848 15,848 15,848 15,848 15,849 15,849 15,849 15,849 15,849PAYE/NIC/SUPER (CHAPS) 135,622 10,472 11,115 11,379 11,379 11,379 11,379 11,379 11,379 11,379 11,379 11,379 11,381Agency Spend (NHSP Bank) 19,760 500 1,646 1,646 1,646 1,646 1,646 1,646 1,646 1,646 1,646 1,646 1,654Consultants' Fees 3,128 378 250 250 250 250 250 250 250 250 250 250 250Medical School recharges 6,000 0 1,000 500 500 500 500 500 500 500 500 500 500PFI project 21,723 3,329 1,810 1,810 1,811 1,810 1,810 1,810 1,811 1,810 1,810 1,810 1,811AAH 7,440 500 620 620 620 620 620 620 620 620 620 620 620NHSLA Clinical Negligence 7,755 0 776 776 776 776 775 775 775 775 775Non-pay Direct Debits (leases, rates) 19,000 522 1,583 1,583 1,583 1,583 1,583 1,583 1,583 1,583 1,583 1,583 1,587Non-pay Revenue Trade Creditors (Incl. CIPs) 160,031 15,504 13,340 13,340 13,000 13,000 13,001 13,001 13,001 13,036 14,007 14,007 14,011

sub-total 569,350 45,881 47,546 47,752 47,413 47,412 47,412 47,412 47,414 47,448 48,419 47,644 47,663

Cash from operations 36,427 1,568 3,369 2,539 3,286 3,286 3,286 2,986 3,092 2,950 1,879 4,051 4,437

Capital & Financing ItemsCapital gross exp (Purchased) 25,757 0 4,122 2,365 2,505 1,948 1,702 2,021 2,174 1,876 2,175 2,480 2,337Capital Income (KCL/SLAM Funding) -4,336 0 0 -433 -433 -433 -433 -433 -433 -433 -433 -439 -433Capital gross exp (Donated) 3,248 0 311 311 0 300 155 0 1,000 425 100 300 346Capital Income (Donated) -3,248 0 -311 -311 0 -300 -155 0 -1,000 -425 -100 -300 -346Receipts from sale of Capital Assets -2,100 0 0 0 0 0 0 0 0 0 0 0 -2,100PDC Dividends (TDR) 8,500 0 0 0 0 0 4,250 0 0 0 0 0 4,250PDC Received 0 0 0 0 0 0 0 0 0 0 0 0 0Loan Received (Salix) -148 0 -148 0 0 0 0 0 0 0 0 0 0Loan Repaid (Energy Centre) 562 0 0 281 0 0 0 0 0 281 0 0 0Loan Repaid (Business Park) 450 0 0 225 0 0 0 0 0 225 0 0 0Salix Loan Repaid 39 0 0 0 0 0 0 0 0 0 0 0 38Capital Element of Finance Lease repayment 608 0 100 50 51 51 51 51 51 51 51 51 50Interest on investments -50 0 -13 0 0 -13 0 0 -12 0 0 -12 0Interest Paid on Revolving Credit Facility 282 0 70 0 0 70 0 0 71 0 0 71 0Interest on Loans (Energy Centre) 555 0 0 274 0 0 0 0 0 281 0 0 0Interest on Loans (Business Park) 130 0 0 66 0 0 0 0 0 64 0 0 0Interest on PFI & Finance Leases 9,305 0 1,550 775 775 775 775 775 776 776 776 776 776

sub-total 39,554 0 5,681 3,603 2,898 2,398 6,345 2,414 2,627 3,121 2,569 2,927 4,918

Net Inflow / Outflow ( 3,127 ) 1,568 -2,312 -1,064 388 888 -3,059 572 465 -171 -690 1,124 -481

Forecast Balance C/F 9,533 14,228 11,916 10,852 11,240 12,128 9,069 9,641 10,106 9,935 9,245 10,369 9,888

Capital Expenditure Summary

Page 7

Total per capital category Budget to dateBrought

Forward from 09/10

Plan Spend 10/11

Total Budget 10/11

Period Budget Actual YTD

Cost to Complete

Total Cost 10/11

Major works 1,970 13,257 15,227 1,023 832 14,395 15,227Minor works 110 890 1,000 10 0 1,000 1,000Medical Equipment 395 1,112 1,507 7 29 1,478 1,507IT and infrastructure 1,965 710 2,675 222 359 2,316 2,675Intangibles (IT) 0 53 53 0 0 53 53Donated 0 4,207 4,207 234 251 3,956 4,207Total Capital Position :Overspend (+) / Underspend (-) 4,440 20,229 24,669 1,496 1,471 23,198 24,669

BudgetPeriod Budget

Actual to date

Anticipated Changes Y/E Forecast

Gross capital expenditure b/f 24,669 1,496 1,471 23,198 24,669 (Intangible Assets Included Above)Gross Cost 24,669 1,496 1,471 23,198 24,669

Less:Sale of Property - 1-9 Cutcombe Road (excl 3) 2,100 - - 2,100 2,100 Capital Donations held on Trust, NOF monies 4,207 234 251 3,956 4,207 Total 6,307 234 251 6,056 6,307

Capital Charge against Capital Resource Limit 18,362 1,262 1,220 17,142 18,362

Depreciation / DoH Capital Resource Limit 18,362 1,262 1,220 17,142 18,362 FT Capital Plan 18,362 1,262 1,220 17,142 18,362

Variance : + over / (-) under - - - - -

Expenditure

Working Capital - Debtors

Page 8

Total Outstanding 0 - 30 days 31 - 60 days 61 -90 days Over 90 days

£ £ £ £ £

NHS BodiesPrimary Care Trusts 7,261,877 1,899,257 2,122,634 1,166,283 2,073,702 Department of Health / SHA 415,059 35,745 257,638 26,213 95,464 Provider Trusts 4,545,166 335,480 2,006,276 349,763 1,853,647

NHS Trade Debtors 12,222,102 2,270,482 4,386,549 1,542,259 4,022,813 Provision for Bad Debts (1,506,945) - - - (1,506,945)

NHS Bodies Total 10,715,157 2,270,482 4,386,549 1,542,259 2,515,868

Non NHS BodiesScottish, Welsh & Irish Bodies 710,252 197,265 41,487 61,695 409,806 Councils, Legal & Educational bodies 261,982 15,665 40,282 141,640 64,395 Overseas Visitors 774,294 124,490 101,628 - 548,177 King's College London University 208,654 2,161 75,090 1,105 130,298 King's Charitable Trust 39,103 14,063 721 - 24,319 Other Non NHS Bodies 1,562,940 408,386 464,305 117,059 573,189

Non NHS Trade Debtors 3,557,224 762,030 723,513 321,499 1,750,183 Provision for Bad Debts (519,353) - - - (519,353)

Non NHS Bodies Total 3,037,871 762,030 723,513 321,499 1,230,830

Accounts Receivable 15,779,326 3,032,511 5,110,061 1,863,758 5,772,996

% of Total Outstanding - Month 1 100% 19% 32% 12% 37%Month 12 100% 42% 18% 9% 31%

Private Patients Accounts Receivable 4,736,079 895,020 1,180,459 447,681 2,212,919

Working Capital - Creditors

Invoiced trade creditors – excludes accruals and employer costs

Page 9

Per Accounts Payable Ledger Overall Total 0 - 30 days 31 - 60 days 61 -90 days Over 90 days£ £ £ £ £

NHS Bodies 4,712,568 1,572,994 1,343,274 1,302,610 493,691

Non NHS Bodies 6,209,185 2,963,710 3,244,956 0 519

Total 10,921,753 4,536,704 4,588,230 1,302,610 494,210

% of Total Outstanding - Month 1 100% 42% 42% 12% 5%% of Total Outstanding - Month 12 100% 73% 21% 4% 3%

Public Sector Payments Policy

Page 10

Public Sector Payments Policy

Paid to NHS Organisations Amount Paid on Time

2009/10Through

APDirect Debit Total

Through AP

Direct Debit Total % of % of % Paid Cum Ave

£'000 £'000 £'000 £'000 £'000 £'000 AP DD on Target on Target

April 1,126 2,368 3,494 1,016 2,368 3,384 90% 100% 97% 97%1,126 2,368 3,494 1,016 2,368 3,384 90% 100% 97%

Paid to Non NHS Organisations Amount Paid on Time

2009/10Through

APDirect Debit Total

Through AP

Direct Debit Total % of % of % Paid Cum Ave

£'000 £'000 £'000 £'000 £'000 £'000 AP DD on Target on Target

April 11,296 5,540 16,836 8,689 5,540 14,229 77% 100% 85% 85%11,296 5,540 16,836 8,689 5,540 14,229 77% 100% 85%

Glossary

Page 11

CIP – Cost Improvement Plan

SLA – Service Level Agreement

PDC – Public Dividend Capital

PSPP – Public Sector Payment Policy

Working Capital Facility - represents a sum of money reserved by the relevant bank for potential use by the Foundation Trust

Asset - An asset is a resource controlled by the enterprise as a result of past events and from which future

economic benefits are expected to flow to the enterprise

Liability - an entity's present obligation arising from a past event, the settlement of which will result in an outflow of economic benefits from the entity

Equity - the residual interest in the entity's assets after deducting its liabilities

EBITDA – Earnings before Interest, Taxation, Depreciation and Amortisation

EBITDA Achieved (% of Plan) – measures the achievement of earnings against plan

EBITDA Margin (%) – Measures Earnings as a percentage of total income indicating underlying performance

Return on Assets excluding Dividends – Net surplus before Dividends as a percentage of average assets indicating financial efficiency

I & E Surplus margin net of dividends – Net surplus as a percentage of total income indicating financial efficiency

Liquidity Ratio (days) - The liquidity ratio (days) indicates the number of days that net liquid assets can

cover operating expenses without further cash coming from cash sales of fixed or long-term assets.

Treasury Management

Report

Month 1 (April) 2010/11

Board of Directors

25 May 2010

ENC 2.3.2

• The Cash balance at the end of Month 1 was £14.228m. – The forecast cash balance for month 1 was £12.749m.

• The Cash Flow forecast is based on the following assumptions: – All over-performance income for 2010/11 of £22m is received in year.– The outstanding 2009/10 over-performance income of £4.2m is collected in year.– No slippage on capital programmes against the 2010/11 budget and capital creditors will remain constant

throughout the year.– The above assumptions will allow the Trust to maintain the current level of Creditor payments.

• The Trust has utilised 87% of its PBL (Long-term borrowing) of £108m.The month 1 actual figures are: – FTFF Term Loan £ 10.400m– FTFF Facility Loan £ 4.500m– PFI Schemes Finance Leases £ 78.346m– Equipment Finance Leases £ 0.238m– Salix Loan £ 0.247m

£ 93.731m

– The charge against the PBL has reduced due to the impact of the change in calculation of the outstanding PFI liability.

– The long-term borrowing limit is set by Monitor subject to the Trust Annual Plan submission for 2010/11.

• The Trust has a current Working Capital Facility (WCF) Limit of £25m.– This limit was set in December 2006 when the Trust first became a Foundation Trust.– The working capital facility limit is set annually as part of Monitor’s annual risk assessment and is based on their

review of the Trust’s annual plan. – The WCF is included in the liquidity ratio calculation up to a maximum of 30 days operating expenditure.

Consequently the WCF limit would not exceed 30 days operating expenditure. – Based on the 2010/11 planned operating expenditure, 30 days operating expenditure would allow the Trust limit to

increase to be £45m (an increase of £20m).– The Trust is currently looking into the possible cost implications of increasing the Working Capital Facility.

Key Headlines

Page 2

Page 3

1. Cash Flow

TOTAL Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11Forecast Actual Forecast Forecast Forecast Forecast Forecast Actual Actual Actual Actual Forecast Forecast

£'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s

Balance B/F 12660 12,660 14,228 11,916 10,852 11,240 12,128 9,069 9,641 10,106 9,935 9,245 10,369

IncomeNHS Clinical Income

Southwark PCT SLA (Excl Merit Awards) 102,000 9,843 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500Lewisham PCT SLA 39,000 2,973 3,250 3,250 3,250 3,250 3,250 3,250 3,250 3,250 3,250 3,250 3,250Lambeth PCT SLA 84,000 6,800 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000LSL PCT Other (Palliative Care) 2,800 447 233 233 233 233 233 233 233 234 234 234 234SLAs : Other PCTs (incl PICU, NICU, BMT, HIV, Neu 202,756 14,184 16,896 16,896 16,896 16,896 16,896 16,896 16,896 16,896 16,896 16,896 16,900Provider to Provider Income 13,000 1,301 1,083 1,083 1,083 1,083 1,083 1,083 1,083 1,084 1,084 1,084 1,084PCT NCAs 2,500 132 208 208 208 208 208 208 208 209 209 209 209DoH - patient activity (NSCAG) 23,000 0 3,834 1,917 1,917 1,917 1,917 1,917 1,917 1,916 1,916 1,916 1,916RTA's 1,200 134 100 100 100 100 100 100 100 100 100 100 100Patient SLA Overperformance 2009/2010 4,200 1,390 700 793 600 600 600 100 107Patient SLA Overperformance 2010/2011 22,000 1,200 1,800 1,800 1,800 2,000 2,100 2,100 2,000 3,400 3,800

Non-NHS Clinical IncomePrivate Patients 15,530 1,191 1,294 1,294 1,294 1,294 1,294 1,294 1,294 1,294 1,294 1,294 1,296

Other IncomeResearch and Development 5,386 573 449 449 449 449 449 449 449 449 449 449 447Training & Educ: SIFT facilities, placement & HD 20,170 1,681 1,681 1,681 1,681 1,681 1,681 1,681 1,681 1,681 1,681 1,680 1,680Training & Educ: MADEL & PGME 13,622 1,135 1,135 1,135 1,135 1,135 1,135 1,135 1,135 1,135 1,135 1,135 1,137Training & Educ: Dental (SIFT) 7,683 640 640 640 641 640 640 640 641 640 640 640 641Training & Educ: SELSHA WDC & Dental NMET 3,612 284 301 301 301 301 301 301 301 301 301 301 301Merit Awards 3,500 279 292 292 292 292 292 292 292 291 291 291 291Haven Contract 1,400 118 117 117 117 117 117 117 117 116 116 116 116Caregroup Operational Income 25,918 3,097 2,160 2,160 2,160 2,160 2,160 2,160 2,160 2,160 2,160 2,160 2,158VAT reclaims 9,500 865 792 792 792 792 792 792 792 792 792 790 790Consultant's Fees income (Private Patients) 3,000 382 250 250 250 250 250 250 250 250 250 250 250

sub-total 605,777 47,449 50,915 50,291 50,699 50,698 50,698 50,398 50,506 50,398 50,298 51,695 52,100

ExpenditurePay monthly (incl Pay Awards) 188,891 14,676 15,406 15,848 15,848 15,848 15,848 15,848 15,849 15,849 15,849 15,849 15,849PAYE/NIC/SUPER (CHAPS) 135,622 10,472 11,115 11,379 11,379 11,379 11,379 11,379 11,379 11,379 11,379 11,379 11,381Agency Spend (NHSP Bank) 19,760 500 1,646 1,646 1,646 1,646 1,646 1,646 1,646 1,646 1,646 1,646 1,654Consultants' Fees 3,128 378 250 250 250 250 250 250 250 250 250 250 250Medical School recharges 6,000 0 1,000 500 500 500 500 500 500 500 500 500 500PFI project 21,723 3,329 1,810 1,810 1,811 1,810 1,810 1,810 1,811 1,810 1,810 1,810 1,811AAH 7,440 500 620 620 620 620 620 620 620 620 620 620 620NHSLA Clinical Negligence 7,755 0 776 776 776 776 775 775 775 775 775Non-pay Direct Debits (leases, rates) 19,000 522 1,583 1,583 1,583 1,583 1,583 1,583 1,583 1,583 1,583 1,583 1,587Non-pay Revenue Trade Creditors (Incl. CIPs) 160,031 15,504 13,340 13,340 13,000 13,000 13,001 13,001 13,001 13,036 14,007 14,007 14,011

sub-total 569,350 45,881 47,546 47,752 47,413 47,412 47,412 47,412 47,414 47,448 48,419 47,644 47,663

Cash from operations 36,427 1,568 3,369 2,539 3,286 3,286 3,286 2,986 3,092 2,950 1,879 4,051 4,437

Capital & Financing ItemsCapital gross exp (Purchased) 25,757 0 4,122 2,365 2,505 1,948 1,702 2,021 2,174 1,876 2,175 2,480 2,337Capital Income (KCL/SLAM Funding) -4,336 0 0 -433 -433 -433 -433 -433 -433 -433 -433 -439 -433Capital gross exp (Donated) 3,248 0 311 311 0 300 155 0 1,000 425 100 300 346Capital Income (Donated) -3,248 0 -311 -311 0 -300 -155 0 -1,000 -425 -100 -300 -346Receipts from sale of Capital Assets -2,100 0 0 0 0 0 0 0 0 0 0 0 -2,100PDC Dividends (TDR) 8,500 0 0 0 0 0 4,250 0 0 0 0 0 4,250PDC Received 0 0 0 0 0 0 0 0 0 0 0 0 0Loan Received (Salix) -148 0 -148 0 0 0 0 0 0 0 0 0 0Loan Repaid (Energy Centre) 562 0 0 281 0 0 0 0 0 281 0 0 0Loan Repaid (Business Park) 450 0 0 225 0 0 0 0 0 225 0 0 0Salix Loan Repaid 39 0 0 0 0 0 0 0 0 0 0 0 38Capital Element of Finance Lease repayment 608 0 100 50 51 51 51 51 51 51 51 51 50Interest on investments -50 0 -13 0 0 -13 0 0 -12 0 0 -12 0Interest Paid on Revolving Credit Facility 282 0 70 0 0 70 0 0 71 0 0 71 0Interest on Loans (Energy Centre) 555 0 0 274 0 0 0 0 0 281 0 0 0Interest on Loans (Business Park) 130 0 0 66 0 0 0 0 0 64 0 0 0Interest on PFI & Finance Leases 9,305 0 1,550 775 775 775 775 775 776 776 776 776 776

sub-total 39,554 0 5,681 3,603 2,898 2,398 6,345 2,414 2,627 3,121 2,569 2,927 4,918

Net Inflow / Outflow ( 3,127 ) 1,568 -2,312 -1,064 388 888 -3,059 572 465 -171 -690 1,124 -481

Forecast Balance C/F 9,533 14,228 11,916 10,852 11,240 12,128 9,069 9,641 10,106 9,935 9,245 10,369 9,888

1. Analysis of Cash Balances and Borrowings

Page 4

TABLE 1 – Cash at Bank Balances

Positive balances held in Nat West are automatically transferred to the Special Interest Bearing Account. See page 9 for interest rates.

Apr-10£'000

NatWest 3,835

OPG 2,993

GBS- Citibank 7,381

Petty Cash 19

Cash Balance 14,228


Page 5

GRAPH A – Monthly Net Cash Balances (incl Overdraft)

Graph A shows the monthly net cash balance based on actual cash flows and forecast for March 2010.

The Trust utelised its overdraft facility in the last quarter of 2009/10 in order to bring creditor payments in line with its payment policy of 30 days.

The level of balances held on the OPG and Nat West accounts are frequently reviewed in order to maximise interest receivable and minimise interest payable and bank charges.


Page 6

GRAPH B – Daily Movement of Cash Balances (Net of Overdraft)

Graph B shows the fluctuation of cash balances on a daily basis.

This graph highlights the receipt of SLA contract income around the 15th of each month (indicated by the peaks between £30-40m), and the reduction of our cash balance between the 17th and 24th when large monthly payments e.g. payroll, P.A.Y.E and N.I. are paid.

2. Cash Deposits held throughout the Trust

Page 7

• There are currently 18 Petty Cash floats held throughout the Trust totalling

£2,433.

• Included in this is a float of £825 held in the Guthrie Clinic. The other 17 floats

vary from £30 to £200.

• These petty cash balances are continuously reviewed to ensure that the

respective departments are utilising these funds appropriately.

• A cash float of £10,000 is held in our Cash Office on the main site, and a float

of £7,500 is maintained within the change machines for the car park.

3. Details of Facilities – Committed and Uncommitted

Page 8

• The above finance leases and loans do not breach the Prudential Borrowing Limit set by Monitor and represent 87% of the PBL.

• The Tier 1 and Tier 2 limits will be reviewed and updated by Monitor once the 2010/11 annual plan has been submitted.

Pursuant to Section 46 of the Act, the Prudential Borrowing Limit (PBL) for KCH for the year 2009- 2010 (reviewed annually by Monitor) is the sum of the following:

(i) Maximum cumulative long term borrowing : Tier 1 Limit: £85.9mTier 2 Limit: £228mTier 2 Approved: £108 million, and

(ii) Approved working capital facility: not to exceed £25 million.

As at month 1, KCH had the following borrowings against the PBL:(i) £78.584 million Finance Leases including on-balance sheet PFI schemes (Ruskin Wing &

Golden Jubilee Wing), and(ii) £15.147 million in FTFF long-term loans

4. Liquidity and Security of Funding

Page 9

GRAPH C – Actual Liquidity Ratio Days forecast to Year-end

• The liquidity ratio (days) indicates the number of days that net liquid assets can cover operating expenses without further cash coming from cash sales of fixed or long-term assets.Net liquid assets = cash, trade & accrued debtors and unused working capital facility less trade, other & accrued creditors.

• The 2010/11 planned liquidity ratio is 3, giving an overall risk rating of 3.

5. Market Commentaries

Page 10

(Source: The Royal bank of Scotland Group Economics – Chief Economist’s Weekly Brief – 10 May 2010)

Ordinarily, news of a hung parliament in the UK would be enough to spook financial markets seriously, but last week investor attention was firmly focused on events on the continent as the fallout from the Greek crisis intensified. Over the weekend European policymakers took decisive action to try and stop the rot.

The UK general election did not produce the certainty desired by the markets. As the former Liberal Democrat leader, Lord Ashdown, commented "the people of Britain have spoken, we just don't know what they have said yet". The Conservatives won the most votes and the largest number of seats, but fell twenty seats short of an overall majority in the House of Commons. Financial market reaction was downbeat, but fairly muted all things considered. Sterling fell against the euro (down more than 1%) and the greenback (down 2%), while gilt yields increased.

Euro and global equity markets suffered during the week. The deteriorating situation in Greece and fears about contagion to other countries put pressure on the euro and global equity markets. The single currency fell to a fifteen-month low versus the dollar and to its lowest level since 2002 against the yen. Even without the glitch which briefly sent the Dow Jones plunging by more than 1,000 points, political and European uncertainty weighed on stock indices. The FTSE fell 5% during the week, while markets in Japan and the US slumped by over 6%. Fears that the global recovery could be derailed also weighed heavily on commodity markets. Crude oil fell to its lowest level in three months late last week, settling around $77 in New York on Thursday. But things can change quickly in international markets.

Amid signs that market turbulence was reaching a crescendo, European finance ministers met over the weekend to devise a policy response that would restore calm. A €750 billion support package was announced (around a third of which would come from the IMF) that would be used to support Eurozone economies should they encounter funding difficulties. This is equivalent to c8% of Eurozone GDP. In addition, the European Central Bank (ECB) announced that it would intervene in secondary markets to buy sovereign debt, which, by supporting demand, will help member countries to issue bonds and hold down funding costs. This marks a sea change for the ECB, which had eschewed such measures through the previous financial crisis. The ECB, Bank of England, Swiss National Bank and the Bank of Canada also reactivated swap lines with the US Federal Reserve to bring down US dollar interbank lending rates.

The Greek parliament passed a tough austerity package, amid violent protests in Athens. The rescue package opened the way for Greece to draw down €110 billion in bilateral loans to meet its funding needs over the next two years. Greece’s bid to avert default will involve €30 billion of spending cuts aimed at reducing the public deficit to less than 3% by 2014 (from 13.6% last year). The austerity measures include three year freezes on public sector pay, an increase in VAT from 21% to 23%, and a 10% tax rise on fuel and tobacco. The package was not enough to calm the markets and the spread between two year Greek bonds and German bunds jumped to more than 18%.

6. Interest Rates

Page 11

Bank of England Base Rate

The BoE Base Rate for 2010/11 as follows: 08-Apr-10 0.50%

Office of the Paymaster General

•Bank Account – 0.25% Below Base Rate : 0.25%

•Bank of Scotland

•BasePlus Account – Base Rate Plus : 0.38% (varies weekly)

•Corporate Deposit Account – Base Rate : 0.34%

Nat West

•2 Special Interest Bearing Accounts (“SIBA”) : 0.06% below base i.e. 0.44%

•No1 Bank Account – Funds swept daily into No2 Account

•No2 Bank Account – Additional funds swept into SIBA account

- Overdraft rate : Base plus 1% i.e. 1.50%

- Non-Utilisation Fee : charged at 0.375% on the non-utilised balance of the £25m facility.

7. Interest Received, Interest Paid and Fees

Page 12

TABLE 2 – Interest, Fees and Charges

• Planned Interest receivable for 2010/11 was £50k.

• Planned interest payable on overdraft for 2010/11 was £282k.

Apr-10Total

2010/11£ £

Interest Received - OPG 1,116 1,116

Interest Received - NW 1,890 1,890

Interest on Overdraft - NatWest - -

Non-Utelisation Fee - NatWest 7,557- 7,557-

Bank Charges - OPG +CITI 102- 102-

Bank Charges - NatWest 640- 640-

Net Interest and Fees 5,293- 5,293-


Page 13

TABLE 3 – PGO Interest

01 Apr 10 3,771,921 OPG 0.25% O/N 26

02 Apr 10 3,771,921 OPG 0.25% O/N 26

03 Apr 10 3,771,921 OPG 0.25% O/N 26

04 Apr 10 3,771,921 OPG 0.25% O/N 26

05 Apr 10 3,771,921 OPG 0.25% O/N 26

06 Apr 10 4,349,828 OPG 0.25% O/N 30

07 Apr 10 4,341,742 OPG 0.25% O/N 30

08 Apr 10 4,345,987 OPG 0.25% O/N 30

09 Apr 10 4,346,929 OPG 0.25% O/N 30

10 Apr 10 4,346,929 OPG 0.25% O/N 30

11 Apr 10 4,346,929 OPG 0.25% O/N 30

12 Apr 10 4,315,962 OPG 0.25% O/N 30

13 Apr 10 5,291,253 OPG 0.25% O/N 36

14 Apr 10 5,296,948 OPG 0.25% O/N 36

15 Apr 10 8,073,585 OPG 0.25% O/N 55

16 Apr 10 8,341,519 OPG 0.25% O/N 57

17 Apr 10 8,341,519 OPG 0.25% O/N 57

18 Apr 10 8,341,519 OPG 0.25% O/N 57

19 Apr 10 8,346,974 OPG 0.25% O/N 57

20 Apr 10 8,393,794 OPG 0.25% O/N 57

21 Apr 10 8,388,274 OPG 0.25% O/N 57

22 Apr 10 4,866,140 OPG 0.25% O/N 33

23 Apr 10 4,929,806 OPG 0.25% O/N 34

24 Apr 10 4,929,806 OPG 0.25% O/N 34

25 Apr 10 4,929,806 OPG 0.25% O/N 34

26 Apr 10 4,915,943 OPG 0.25% O/N 34

27 Apr 10 4,891,855 OPG 0.25% O/N 34

28 Apr 10 6,428,238 OPG 0.25% O/N 44

29 Apr 10 5,928,958 OPG 0.25% O/N 41

30 Apr 10 2,992,567 OPG 0.25% O/N 20

OPG 0.25% O/N -

Total 1,116

DateAmount Invested

- No 2 Account

Amount Invested - Special Int

Bearing Account Institution Rate Period Interest Received

01 Apr 10 111 8,003,709 NW 0.44% O/N 96.48

02 Apr 10 111 8,003,709 NW 0.44% O/N 96.48

03 Apr 10 111 8,003,709 NW 0.44% O/N 96.48

04 Apr 10 111 8,003,709 NW 0.44% O/N 96.48

05 Apr 10 111 8,003,709 NW 0.44% O/N 96.48

06 Apr 10 2,643 7,961,537 NW 0.44% O/N 96.01

07 Apr 10 2,643 7,934,525 NW 0.44% O/N 95.68

08 Apr 10 0 7,686,187 NW 0.44% O/N 92.66

09 Apr 10 21,078 4,680,899 NW 0.44% O/N 56.68

10 Apr 10 21,078 4,680,899 NW 0.44% O/N 56.68

11 Apr 10 21,078 4,680,899 NW 0.44% O/N 56.68

12 Apr 10 21,078 4,723,882 NW 0.44% O/N 57.20

13 Apr 10 977 4,763,993 NW 0.44% O/N 57.44

14 Apr 10 977 3,479,775 NW 0.44% O/N 41.96

15 Apr 10 0 2,801,499 NW 0.44% O/N 33.77

16 Apr 10 10,515 2,931,555 NW 0.44% O/N 35.47

17 Apr 10 10,515 2,931,555 NW 0.44% O/N 35.47

18 Apr 10 10,515 2,931,555 NW 0.44% O/N 35.47

19 Apr 10 10,515 2,975,240 NW 0.44% O/N 35.99

20 Apr 10 0 3,017,505 NW 0.44% O/N 36.38

21 Apr 10 53,195 1,023,555 NW 0.44% O/N 12.98

22 Apr 10 53,195 17,947,915 NW 0.44% O/N 217.00

23 Apr 10 13,132 3,325,585 NW 0.44% O/N 40.25

24 Apr 10 13,132 3,325,585 NW 0.44% O/N 40.25

25 Apr 10 13,132 3,325,585 NW 0.44% O/N 40.25

26 Apr 10 13,132 3,398,169 NW 0.44% O/N 41.12

27 Apr 10 0 3,504,922 NW 0.44% O/N 42.25

28 Apr 10 0 2,534,223 NW 0.44% O/N 30.55

29 Apr 10 0 603,447 NW 0.44% O/N 7.27

30 Apr 10 114,999 3,594,067 NW 0.44% O/N 44.71

NW 0.44% O/N -

1,822.58

NatWest HASS+ RENT DEPOSIT 67.27

Total Natwest Interest 1,889.84


Page 14

TABLE 5 – Nat West Interest


Page 15

GRAPH E – Interest Received relative to Daily OPG Balance

Graph E shows the relationship of monthly interest received to the daily balance on the OPG account.

The high peaks show the receipt of SLA income from PCTs around the 15th of the month and then the drop off after payment of salaries around the 24th.

The longer the higher balances can be maintained, the higher the interest received.


Page 16

GRAPH F – Interest Paid and Non-utilisation Fee relative to Nat West Balance

Graph F shows the relationship of interest paid on the overdraft and the non-utilisation fee to the balance on the NatWest account.

The peaks around the 23rd of the month, taking the balance to approximately £12-15m, is due to the transfer in of funds to cover the payment of salaries from this account on the 24th. This has the effect of reducing the interest paid on overdraft on a monthly basis.

The non-utilisation fee does not decrease significantly when higher overdraft balances are held.

8. Bank Relationships and Ratings

Page 17

8.1 Relationships

Office of the Paymaster General – 1 Bank Account

This account is being gradually phased out and has been replaced by Citibank – Government Banking Service. NHS SLA funds are now being receipted in the Citibank account although there are still a few that are still using OPG

NatWest – No1 Bank Account

Receipt of smaller income e.g. from private patients

Cleared daily into No2 account

NatWest – No2 Bank Account

Working Capital Facility of £25m available

Payment of salaries

Payment of Creditors through this account

NatWest – 2 Special Interest Bearing Accounts (“SIBA”)

One SIBA contains £180k financial provision set aside to meet the High Activity Sealed Source (HASS) Regulations.

Any additional funds held on the No2 account are automatically ‘swept’ into the 2nd SIBA on which a higher rate of interest is earned.

8. Bank Relationships and Ratings

Page 18

8.2 Ratings

From Standards & Poor’s issue credit ratings of Financial Institutions (long-term / short- term):

Bank of England AAA / A-1+

National Westminster Bank PLC A+ / A-1

Bank of Scotland PLC A+ / A-1

Anglo Irish Bank Corp. PLC BBB / A-2

Bank of Ireland A / A-2

Allied Irish Banks PLC A / A-2

The Standards and Poor’s issue credit rating is a current opinion of the credit worthiness of an obligor with respect to a specific financial obligation. The Standards & Poor’s long-term rating should be at least A+ and the short-term rating should be at least A-1.

10. Foreign Exchange Translation Exposure

Page 19

The Trust currently has no foreign exchange transactions and therefore no exposure or related risk.

Glossary

Page 20

PDC – Public Dividend Capital

OPG – Office of HM Paymaster General

PBC – Prudential Borrowing Code - Code provided by Monitor to determine the limit on the total amount of borrowing of an NHSFT

PBL – Prudential Borrowing Limit - The maximum amount of borrowing (including finance leases and similar items, and including on-balance sheet PFI schemes) that an NHSFT can have outstanding at any time under the PBC.

The PBL consists of 2 components: (i) the maximum Long-Term Borrowing; and (ii) the agreed-upon Working Capital Facility.

Long Term Borrowings – All outstanding borrowing (e.g., borrowings from the Foundation Trust Financing Facility, commercial loans), including all group borrowings that are normally reported on the balance sheet per the NHS Foundation Trust Manual for Accounts and NHS Foundation Trust Capital Accounting Manual; finance leases and similar items; on-balance sheet PFIs; and any Accumulated Dividend. This excludes off-balance sheet PFIs, as well as amounts drawn down from a Working Capital Facility

Working Capital Facility – An irrevocable borrowing facility repayable in the short-term (within 24 months) that an NHSFT may draw from on a temporary basis to smooth cash flow.

Liquidity Ratio (Days) – indicates the number of days that net liquid assets can cover operating expenses without further cash coming from cash sales of fixed or long-term assets.

Net Liquid Assets – cash, trade & accrued debtors and unused working capital facility less trade, other & accrued creditors.

FTFF – Foundation Trust Financing Facility

1

Board of Directors

Month 12 Performance Report

25th May 2010

Roland Sinker

Director of Operations

ENC 2.4

2

Executive Summary

• At month 12 the Trust was on target for 3 out of the 4 key deliverables

• On Target

emergency ‘4 hour wait’ on target, but continued concerns about trend. Recovery plan underway

18 weeks referral to treatment

infection control, although month 1 targets in 20010/11 challenging for MRSA

• Off Target

average length of stay – improvements in month but elective and non elective both marginally off target.

• Other

MRSA screening, data quality concerns, policy being adhered to.

Timely response to complaints

Clinical Coding

333

Emergency Care Performance Target met in month 12

In month 12 the Trust achieved the 98% emergency care target. For type 1 alone the Trust achieved 97.63%, and for all types (1 + 2) achieved 98.02%. The emergency target remains vulnerable to days with extreme surges in activity, particularly in acuity. There has been an increase in Red Phones (pre-notified ambulance arrivals) and patients >74yrs. Both are indicators of high acuity levels, see below.

KCH ranks 15th out of the 25 trusts in London for the 4-week rolling average performance (98.2%) and is best performer in theSEL sector.

The downward trend in performance over the last 5 months is of great concern. The existing recovery plan has been reviewed in light of this continuing trend. The full plan will be signed off with the Director of Operations week commencing 17/5/2010.

4

18 Week Referral to Treatment is meeting the targets

In Quarter 4 the Trust was required to achieve the 18 week referral to treatment targets for admitted (90%) and non admitted (95%) patients in every specialty.

In month 12 we achieved this in all specialties.

We can report that throughout Q4 the Trust achieved the target for each month for all specialties

A dm it t e d p a t ie n t sS p e c ia lt y R T T %G e n e ra l S u r g e r y 9 2 .8U ro lo g y 9 6 .3T r a u m a & O r th o p a e d ic s 9 0 .0O p h th a lm o lo g y 9 3 .1O ra l S u r g e r y 9 8 .7N e u ro s u r g e r y 9 1 .6C a r d io th o r a c ic S u r g e r y 9 4 .3G e n e ra l M e d ic in e 1 0 0 .0G a s t r o e n te ro lo g y 9 8 .3C a r d io lo g y 9 3 .8D e rm a to lo g y 9 2 .4T h o ra c ic M e d ic in e 1 0 0 .0N e u ro lo g y 9 6 .8R h e u m a to lo g y 1 0 0 .0G e r ia t r ic M e d ic in e 1 0 0 .0G y n a e c o lo g y 9 0 .3O th e r 9 4 .0T o ta l 9 4 .7

N o n ‐ A d m it te dS p e c ia lt y R T T %G e n e ra l S u r g e r y 9 7 .6U ro lo g y 9 6 .5T r a u m a & O r th o p a e d ic s 9 7 .2O p h th a lm o lo g y 9 7 .1O ra l S u r g e r y 9 9 .8N e u ro s u r g e r y 9 5 .6P la s t ic S u r g e r y 1 0 0 .0C a r d io th o r a c ic S u r g e r y 1 0 0 .0G e n e ra l M e d ic in e 1 0 0 .0G a s t r o e n te ro lo g y 1 0 0 .0C a r d io lo g y 9 5 .2D e rm a to lo g y 9 6 .0T h o ra c ic M e d ic in e 9 7 .9N e u ro lo g y 9 5 .7R h e u m a to lo g y 9 5 .1G e r ia t r ic M e d ic in e 9 5 .7G y n a e c o lo g y 9 9 .2O th e r 9 7 .8T o ta l 9 7 .6

5

Infection Control is meeting the targets

In month 12 we recorded one additional MRSA bacteraemia case, a total of 26 for the year. This is an improvement of 33% from 2008/09, where we had recorded 39 cases for the year. For the year we have achieved ahead of the national expected limit and ahead of the local expected limit agreed with commissioners. Expected limit for 2010/11 is 9 for post 48 hour cases and in April we have confirmed 2 cases already.

In month 12 we recorded an additional 20 C-Difficile cases, giving us a total of 135 for the year. This is an improvement of 32% from 2008/09, where we had recorded 199 cases. For the year we achieved ahead of the national expected limit. The increase trend since January has been due to increased levels of noro-virus on our wards

In month 12 we recorded 2 additional VRE bacteraemia cases. We finished the year ahead of our expected limit by 6 cases.

MRSA Bacteraemia

0

1

2

3

4

5

6

7

Ap

r-08

Ma

y-08

Jun

-08

Jul-0

8

Au

g-0

8

Se

p-0

8

Oct-0

8

No

v-08

De

c-08

Jan

-09

Fe

b-0

9

Ma

r-09

Ap

r-09

Ma

y-09

Jun

-09

Jul-0

9

Au

g-0

9

Se

p-0

9

Oct-0

9

No

v-09

De

c-09

Jan

-10

Fe

b-1

0

Ma

r-10

Month

Nu

mb

er

of

Ba

cte

rae

mia

s

MRSA Actual

MRSA National Expected Limit

MRSA PCT Expected Limit

C- Difficile

05

10152025303540

Ap

r-08

Ma

y-08

Jun

-08

Jul-0

8

Au

g-0

8

Se

p-0

8

Oct-0

8

No

v-08

De

c-08

Jan

-09

Fe

b-0

9

Ma

r-09

Ap

r-09

Ma

y-09

Jun

-09

Jul-0

9

Au

g-0

9

Se

p-0

9

Oct-0

9

No

v-09

De

c-09

Jan

-10

Fe

b-1

0

Ma

r-10

Month

Nu

mb

er o

f ca

ses

CDIF Actual

CDIF National Expected Limit

VRE Bacteraemia

0

2

4

6

8

10

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

M onth

Nu

mb

er

of

Ca

se

s

V RE A c tual

V RE Trus t Expec ted Limit

6

Average Length of Stay improved but is not meeting the target

Elective average length of stay improved in month 12, achieving 5.2 days against a target of 5. Cardiology saw improvements following the introduction of their ‘ward registrar of the week’ programme, whilst Neuro also improved due to their elective pathway project. Surgery experienced a positive movement in elective LOS by increasing levels of on the day admissions from 59% to 73%. The delivery of the Trusts admission lounge will support this further.

Non-elective average length of stay improved in month but remained marginally off target, achieving an average of 5.9 days against a target of 5.8. The General Emergency Medicine division delivered an average length of stay of 9.6 days in month 12 compared to 10.6 days in month 11. As with elective length of stay, the cardiology and neurosciences experienced improvements due to their focused action programmes on length of stay.

Average Length of Stay - Elective

0

1

2

3

4

5

6

7

8

Mar

-09

Apr

-09

May

-09

Jun-

09

Jul-0

9

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Jan-

10

Feb

-10

Mar

-10

Actual

Target

Average Length of Stay - Non-Elective

0

1

2

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ActualTarget

7

The Trust has not met targets for two consecutive months in 6 areas

Divisions working closely with coding team to improve against internal target. Coding team developing automated feedback tool to clinicians to sign off coding.

The trust is not achieving against its internal coding completeness targets. However the trust is achieving 100% in time for final freeze dates for contract monitoring and is ahead of its coding depth targets.

Coding Completeness by cut off date (within 5 working days)

Divisions to ensure their positions on BBV are reviewed and report back to performance meetings next month.

The trust finished the year reporting 238 BBV incidents compared to 223 in the previous years. Divisions have investigated and state that the increase is due to better awareness and reporting.

H&S – reported BBV incidents

All Divisions are reviewing their processes to ensure 80% compliance is achieved. Patient complaints are reviewing their processes to assist compliance e.g. more effective triage. Performance on complaints was discussed at the Trusts governance committee this month.

In month 12 performance was at 64% against the trust local target of 80%.

Timely response to complaints

All Divisions have sickness case conferences and weekly reviews in place. All divisions have escalated awareness of this indicator to all teams.

The Trust remains off target against the sickness and absence target of 3%, in month 12 reporting a position of 3.3%. The position has remained static for a few months and we need to start to see this turn downwards.

Sickness & Absence

Divisions to meet with Information team to resolve data quality issues.

Month 12 performance improved from 89% to 94%. All divisions have evaluated their performance and report that data quality remains the main reason for non-achievement of the 100% target.

MRSA Screening -Elective

Action PlanStatusKPI

Title of the presentation

Subtitle

1 December 2006

King’s Patient Experience Report

Enc. 2.5

Patient Experience Report

• Integrated monthly patient experience data to inform service improvement launched in December 2009

• Includes a scorecard format monthly overview of :– Complaints– PALS – How are we doing– CQUIN patient experience scores– Delivering Single Sex Accommodation patient experience

• Reports data at Trust, Division, ward and specialty level for inpatients and outpatients

• Near real-time reporting ten working days after the end of the month

• Supports King’s Quality Strategy, CQUIN and DSSA monitoring

Key results for May 2010

• Complaints and PALS– The number of complaints has again fallen in month following a 23%

reduction in 2009/10– A new triage system has been introduced to seek to resolve concerns

immediately they are received. This has resulted in increased PALS activity.

– The main cause of complaint is clinical care and treatment– Most PALS contacts relate to outpatient appointment issues

• How are we doing inpatient survey– The HRWD inpatient survey benchmarks are set at the top quartile of

London teaching hospitals.– The HRWD score has dropped 1 point below the benchmark after the

last 3 months in succession where it has been achieved – HRWD response rates improved (1,402 ) though still below the

benchmark of 50%• CQUIN

– benchmarks reached on 3 out of 5 questions• Single Sex Accommodation (DSSA)

– this is the first month that questions on DSSA have been asked trust wide.

Metric Units Last Mnth This Mnth Target Trend Graph No.

R G

Complaints received Count 63 49 Better 1.6

PALS activity Count 418 384 1.7

Inpatient How are we doing? overall score Score 85 84 85 Worse 1.1

How are we doing? Response Rate % 44 47 50 Better 1.5

Number of How are we doing? surveys completed Count 1435 1402

Inpatient Complaints Count 39 31 Better

Inpatient PALS activity Count 100 110

How are we doing? Patient Engagement Score 86 86 85 No change 1.2

How are we doing? Care Perceptions Score 87 85 87 Worse 1.3

HRWD? Environment Score 74 72 73 Worse 1.4

Were you involved as much as you wanted to be in decisions about your care? Score 82 84 81 Better 1.8

Did you find someone on the hospital staff to talk to about your worries or fears? Score 77 77 75 No change 1.9

Were you given enough privacy when discussing your treatment? Score 93 92 90 Worse 1.1

Did a member of staff tell you about medication side effects to watch for when you went home? Score - 70 90 - 1.11

Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital? Score - 84 90 - 1.12

Did you share a sleeping area with patients of the opposite sex when you were first admitted to a bed on a ward? % of total respondents 9.7 -

Did you share a sleeping area with patients of the opposite sex if you were moved to another ward (or wards)? % of total respondents 4.4 -

While staying in hospital, did you ever use the same bathroom or shower as patients of the opposite sex? % of total respondents 11.2 -

Outpatient Complaints Count 24 18 Better

Outpatient PALS activity Count 318 274

Patient Experience Report - Trust April 10T

rust

2009 King’s College Hospital NHS Foundation Trust. All rights reserved. An application for permission to use this copyright material should be addressed to Rachel Sugarman, Patient Experience Manager, King’s College Hospital NHFoundation Trust, Denmark Hill, London, SE5 9RS, United Kingdom.

Status

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Patient Experience Report April 2010

Trust HRWD? Inpatient Positive Vs Negative Comments Trust Inpatient Data Division breakdown - Inpatients

Trust Outpatient Data Division breakdown - Outpatients

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150

Admissions, discharges andwaiting times

Clinical care

Communication

Equipment, environment andfacilities

Patient transport

Hotel services (inc food)

Staff attitude

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150

Outpatient appointments

Clinical care

Communication


Patient transport


Staff attitude

0 10 20 30 40 50 60 70 80 90 100

Neuro

Cardiac

General & Emergency Medicine

Women's

Children's

Liver

Renal

CC&S

CSDS

Private patients

Specialist medicine

Facilities

0 5 10 15 20 25 30 35 40 45 50 55 60

Neuro

Cardiac

General & Emergency Medicine

Women's

Children's

Liver

Renal

CC&S

CSDS

Private patients

Specialist medicine

Dental

Facilities

0 50 100 150 200 250 300 350 400 450

Admissions, discharges andwaiting times

Clinical care

Communication


Patient transport


Staff attitudeFrom my admission to my subsequent operation, post op and pre op care to my discharge, the care, advice, understanding and help I received was simply outstanding and re-affirmed my belief on how special the NHS and its services are.

I was due to come to the hospital for an appointment at the pain clinic, but when the transport turned up I had not been put down as being in a wheelchair and my wife who is my carer and has to come with me was told that she was not able to come with me, due to this I was unable to come to the hospital for my appointment.

HRWD? Postive Comments HRWD? Negative Comments

PALS Complaints

Focus of the month: Discharge

Patient comment from April"Better communication from doctors to medical staff on the ward. Nurses didn’t know I was to be discharged or when I was discharged - there was no written record of this on the ward. Other patients experienced the same problem."

What are we doing?

One of the trust’s 4 key priorities is improving discharge and reducing the length of time patients spend in hospital. King's aims to be in the top quartile of Trusts in regard to reducing length of stay.

How are we doing? Trust Overall

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HRWD? Score Benchmark

1.1 How are we doing? Patient Engagement

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How are we doing? Care Perceptions

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1.3 How are we doing? Environment

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How are we doing? Response Rates

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Response Rate Benchmark

1.5

Complaints

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No. of Complaints Complaints Trend

1.6 PALS contacts

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No. of PALS Contacts PALS Trend

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CQUIN - Involvement in Care

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1.8 CQUIN - Worries and fears

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CQUIN - Privacy discussing treatemnt

8586

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1.10 CQUIN - Medication side effects

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CQUIN - Contact details after discharge

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1.12

1a 1b 1c 2 3a 3b 3c 4 TOTAL 7a 7b 8 9 TOTAL 10 11 12a 12b 13a 13b 13c 14a 14b 14c 15 16 17 18 19 20 TOTAL

TRUST 89 88 92 84 85 86 90 77 86 82 73 59 75 72 88 71 92 95 94 90 91 89 86 89 78 79 70 84 78 92 85 84 1402

Cardiac 96 95 96 89 79 81 84 82 88 86 72 66 81 76 96 78 96 100 97 95 98 94 92 93 87 81 74 83 80 97 90 87 95

Neuroscience 84 84 90 79 85 86 95 78 85 83 72 51 67 68 89 66 91 95 93 84 92 87 82 88 78 62 61 93 64 89 82 81 77

CC&S 87 85 86 82 89 87 91 70 85 79 74 59 73 71 87 64 92 94 95 93 91 89 88 85 76 77 59 82 81 91 84 82 201

General Medicine 91 90 96 83 81 82 87 77 86 59 83 89 71 76 89 71 94 97 94 92 92 89 86 90 78 75 76 82 71 93 86 84 334

Liver 89 85 91 83 81 80 90 70 84 88 78 56 74 74 87 72 90 94 96 90 92 92 87 89 78 76 68 84 81 92 86 83 114

Renal 87 85 88 80 77 74 85 74 81 74 69 57 66 67 84 75 93 94 94 93 90 88 85 85 77 73 73 79 81 90 85 81 47

Women's 84 85 100 86 89 88 100 79 89 82 72 57 70 70 86 69 91 93 92 86 73 85 83 93 76 83 72 89 82 89 84 83 323

Children's 90 91 90 87 90 94 94 80 90 80 65 57 70 68 88 76 89 93 94 90 89 89 88 91 80 86 66 85 83 91 86 85 169

Specialist Medicine 100 92 100 94 78 72 100 75 89 67 61 51 60 60 81 59 100 100 89 78 75 89 72 88 72 89 70 80 69 83 81 80 9

Private Patients 94 91 88 90 93 95 95 86 92 86 91 77 90 86 90 88 100 100 95 92 94 94 93 92 83 97 78 84 93 98 92 91 33

Benchmark 89 86 90 81 85 86 90 75 85 84 76 57 74 73 89 66 90 95 94 89 90 87 85 87 81 86 90 90 78 93 87 85

RESPONSESOVERALL

How Are We Doing?

EnvironmentPatient Engagement

Division Heat Map Apr-10

Care Perceptions

HRWD QUESTIONS

Involvement in your care1a When you had important questions did you get answers you could understand from doctors?1b When you had important questions did you get answers you could understand from nurses?1c When you had important questions did you get answers you could understand from therapists?2 Were you involved as much as you wanted to be in decisions about your care?3a Did doctors talk in front of you as if you weren't there?3b Did nurses talk in front of you as if you weren't there?3c Did therapists talk in front of you as if you weren't there?4 Did you find someone on the hospital staff to talk to about your worries or fears?

Cleanliness and Food7a In your opinion, how clean was the hospital room or ward that you were in?7b In your opinion, how clean were the toilets and bathrooms that you used in hospital?8 How would you rate the hospital food?9 Did you get enough help from staff to eat your meals?

The Care you Received10 Do you think the hospital staff did everything they could to control your pain?11 How many minutes after you used the call button did it usually take before you got the help you needed?12a Were you given enough privacy when discussing your treatment?12b Were you given enough privacy when being examined or treated?13a Did you have confidence and trust in the doctors treating you?13b Did you have confidence and trust in the nurses treating you?13c Did you have confidence and trust in the therapists treating you?14a How would you rate the courtesy of your doctors?14b How would you rate the courtesy of your nurses?14c How would you rate the courtesy of your therapists?15 How would you rate how well the doctors and nurses worked together?16 Were you ever bothered by noise at night from hospital staff?17Did a member of staff tell you about medication side effects to watch for when you went home?18 Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital19 On the day of discharge, did you experience a delay?20 Overall, did you feel you were treated with respect and dignity while you were in the hospital?

1

BOARD OF DIRECTORSMay 2010

Staff Survey2009

Angela HuxhamExecutive Director of Workforce Development

Enc 2.6

2

National Staff Survey

290,000 staff surveyed across the NHS in 2009

• Sent to every member of staff at King’s• CQC sampled 812 staff, of which 365 took part

• 55% response rate nationally• King’s CQC response rate 45%

3

National Key Findings

Staff Survey Key Findings: National comparisons

2008 2009

Best 20% scores 11 30% 14 35%

Above average 6 17% 9 23%

Average 3 8% 2 5%

Below Average 6 17% 5 13%

Worst 20% scores 10 28% 10 25%

Total 36 40

4

Key Finding

Quality of job design

% of staff able to contribute towards improvements at work

% of staff feeling satisfied with the quality of work and patient care they are able to deliver

Perceptions of effective action from employer on violence and harassment

National Benchmarks

King’s had 14 key findings in the national top 20%

The best 4 are:

5

Statistically significant changes over the last two years

Improved Deteriorated

•Quality of job design

•Work pressure felt by staff

•Hand washing materials always available

•Fairness and effectiveness of incident reporting procedures

•Perceptions of effective action from employer towards harassment and violence

•Staff job satisfaction

•Support from immediate manager

•Staff intention to leave jobs

National Results

6

Key finding scores which have remained in the bottom 20% of national scores from 2008 into 2009

Key Finding 2008 2009

Working extra hours 75% 73%

Using flexible working options 65% 62%

Hand washing materials are always available 54% 52%

Witnessing potentially harmful errors, near misses, or incidents in the last month

46% 43%

Experiencing physical violence from staff in the last 12 months

5% 3%

Experiencing harassment, bullying or abuse from staff in the last 12 months

28% 22%

Equal opportunities for career progression 78% 85%

Areas for improvement

7

The London Context

Key Finding – in London’s top two National Av.

London Av.

KCH

% staff satisfied with the quality of work & patient care they can deliver

74% 78% 82%

Quality of job design (clear content, feedback and staff involvement) +

3.38 3.43 3.49

Work pressure felt by staff *+ 3.11 3.01 2.96

% staff appraised in last 12 months 70% 70% 78%

Perceptions of effective action from employer on violence and harassment +

3.55 3.56 3.70

Impact of health & well-being on ability to perform work or daily activities*+

1.57 1.62 1.57

% staff having equality and diversity training in last 12 months 35% 35% 44%

* Indicates factor where the lower score is better+ Indicates summary scale score

3 key findings ranked top across London acute trusts7 key findings ranked in the ‘top two’26 key findings at or above the London acute average

Best in London score

8

London Benchmarks

Rank London Number of score’s in top two

1 Guy's and St Thomas' NHS Foundation Trust 23

2 Chelsea and Westminster Hospital NHS Foundation Trust 17

3 Imperial College Healthcare NHS Trust 10

4 St George's Healthcare NHS Trust 9

4 University College London Hospitals NHS Foundation Trust 9

6 King’s College Hospital NHS Foundation Trust 7

7 Barts and The London NHS Trust 4

8 Royal Free Hampstead NHS Trust 3

Peer rankings for ‘Top two’ in London scores

9

London Benchmarks

Rank London Number of scores in

bottom two









Peer rankings for ‘bottom two’ in London scores

10

London Benchmarks

Rank London Number of scores at

average and above









Peer rankings for ‘at average and above’ in London

11

National comparisons with English acute trusts:

• Improved across 26 key findings

• Deterioration in 7 key findings

• ‘Quality of job design’ significantly improved

London peer group comparisons:

• 26 key findings better than London average

• The only trust in our London peer group with no bottom ranking score

• ‘Quality of job design’ better than our London peer group average (below London average in 2008)

Changes since 2008

12

Demographic differences

Disability • 15% of respondents reported a long-standing illness, health problem or disability

• There was a marked improvement in quality of staff experience from disabled staff

• More likely to be thinking about leaving their jobs

• More likely to report physical violence from patients

• Less likely to rate job design and work-life balance

Ethnicity • BME staff are more likely to suffer work related injury & work related stress

• White staff are less likely to use flexible working options

• BME staff are more likely to report good communication between senior management and staff

• BME staff are less likely to be thinking about leaving their jobs

• BME & white staff report equal exposure to equality & diversity training

Gender • Men are more likely to report physical violence from patients

• Men are more likely to report feeling able to contribute to improvements at work

• Women are more likely to experience work related injury and feel pressure to attend work when feeling unwell

13

Next steps

• Trust-wide dissemination of results

• Survey results will be reviewed by key stakeholder groups involving staff in the development of Action Plans to improve scores in priority areas

• Action plans will be informed by the approach adopted by top performing Trusts

ENC 3.1.1 FINAL DRAFT FOR BOARD OF DIRECTORS – 25 MAY 2010 v10

KCH Annual Plan 2010/11 Monitor Templates: Strategic Overview Template 1: Vision and key priorities The Trust’s current position: King’s College Hospital NHS Foundation Trust is one of London’s largest and busiest teaching hospitals. We have a reputation for providing excellent local healthcare in the London Boroughs of Lambeth and Southwark, and a range of specialist services for patients across South East England and beyond. We are recognised nationally and internationally for clinical services and clinical research in a range of specialties, including liver disease and transplantation, neurosciences, cardiac services, haemato-oncology and fetal medicine. King’s also plays a key role in the training and education of medical, nursing and dental students, and other health professionals. We are part of King’s Health Partners Academic Health Sciences Centre (AHSC), a pioneering collaboration between King’s College London, and Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts. King’s Health Partners is one of only five accredited AHSCs in the UK and brings together an unrivalled range and depth of clinical and academic expertise, spanning both physical and mental health. Our combined strengths will drive improvements in care for patients, allowing them to benefit from breakthroughs in medical science and receive leading edge treatment at the earliest possible opportunity. Key strengths: Strong operational performance in 09/10, including infection control, 18 weeks referral to treatment and A&E ‘4 hour waits’ Accredited as a Major Trauma Centre and Hyper Acute Stroke Unit As King’s Health Partners, accredited as one of only five Academic Health Science Centres across the country Strong tertiary specialities and a track record in academic and service innovation Key challenges: Finances: Risk rating of ‘3’ at year end FY 2009/10. Significant financial pressures over the next 3 years, and uncertainty over future health

settlements, will require greater efficiencies within the Trust and with local partners, requiring radical new models of service provision. Capacity: managing large volumes of unscheduled care can create financial pressures (for example, by crowding out elective care) and

lead to difficulties in ensuring consistent high quality care. Patient experience: despite some significant progress, more could be done to improve patient experience, including improving the

environment of the Trust Academic: academic programmes need to be better embedded across all clinical services Infection control : increasingly challenging targets for reducing infections Mixed sex accommodation: meeting the national standard in all clinical areas to ensure privacy and dignity Governance: ensuring robust systems of Board assurance across all areas of activity

1

FINAL DRAFT FOR BOARD OF DIRECTORS – 25 MAY 2010 v10

The Trust’s vision over the next three years: Everything King’s does will be focused on patient need. Our patients will experience the highest quality of care in our local services and our global specialties. With King’s Health Partners and our other local health partners, we will lead an integrated and well-managed healthcare system meeting the diverse needs of the many local communities we serve King’s over-arching objectives are to: Deliver high quality, patient-centred and efficient care

1. A relentless focus on quality and safety 2. Improve patient-centred care and experience 3. Achieve financial sustainability through efficiencies within the Trust and with local partners Develop our major acute, tertiary and community services as part of an integrated healthcare system

4. Strengthen our key tertiary services and networks, including liver and neurosciences 5. Become London’s leading major acute hospital, including delivering the Major Trauma Centre and Hyper-Acute Stroke Unit 6. Deliver more integrated care and more care out-of-hospital through our community and local secondary services Transform our workforce and supporting systems

7. Adapt our workforce skills and capacity to deliver new services 8. Establish trust-wide governance and performance management systems that support high quality and efficient care Contribute to the delivery of King’s Health Partners King’s Health Partners Vision: KHP will become the leading AHSC. We will: Drive the integration of research, education and training and clinical care, for the benefit of patients, through Clinical Academic Groups

(CAGs) Consider all aspects of the health needs of our patients when they come to us for help Improve the health and well being across our ethnically and socially diverse communities and work to reduce inequalities Develop an AHSC that draws upon academic expertise in medical science and also basic science, social science, law and humanities

2


Deliver a radical shift in healthcare by identifying “at risk” groups, based on genotype and lifestyle, and helping them to avoid illness Work innovatively with stakeholders in the redesign of care pathways, including the delivery of care closer to home KHP Strategic Objectives: 1. We will be in the top 10 globally, both clinically and academically, in the fields of mental health & neurosciences cardiovascular disease transplantation 2. We will build our capacity to address diseases that have a particularly large impact on our local community, but are also important on a global scale, in the areas of: 3. We will ensure our academic expertise is applied to all our clinical services to pursue our tripartite mission 4. We will strengthen groundbreaking basic science research, not jut in priority areas but across the biomedical spectrum 5. We will be the most highly regarded AHSC in the UK in terms of patient experience and satisfaction, as measured by national statistics and those we develop ourselves 6. We will be the leading AHWSC in the UK in widening access to educational and training opportunities for prospective students in all health related fields 7. We will encourage staff to take responsibility for their own continued professional development, through appropriate programmes and providing them with time to undertake these 8. We will ensure our mental health services and physical health services work collaboratively to treat the entire individual 9. We will constantly seek to reduce costs and improve quality for the benefit of patient care across the partnership and the wider health and social care system 10.We will underpin all these objectives by working with our stakeholders to build information technology and resources to support our efforts

3


Key priorities for the Trust which must be achieved in the three years of the annual plan to underpin the delivery of the Trust’s vision, with milestones of delivery of each over the period of the plan:

Key priority (and timescales) How this priority underpins the strategic vision

Key milestones (2010/11)



1. Improve patient-centred care and patient experience at King’s Deliver care that is reflective of

local communities’ needs, including mental and physical health, and those of patients families and carers’

Raise patient satisfaction with services and make progress towards a hospital estate which improves patient experience and patient journeys

Refocus our services from solely the treatment of ill health to encompass the prevention of ill health in our patient groups

Improve the way we involve patients and the public in changes to the Trust

Supports King’s strategic objective to deliver high quality, patient-centred and efficient care Supports KHP strategic objective 5 Supports KHP strategic objective 8

Transformation Programme project to improve patient experience

Expansion of maternity capacity & MLBU

Fully operational admissions and discharge lounges

Audit mental health provision across all Trust services

To reach the top 20% of acute hospitals in London for the national patient surveys

Complete pilot study of psychological intervention in specific patient group(s)

To reach the top 10% of acute hospitals in London for the national patient surveys

4






2. Provide high quality, safe and effective services that meet patient expectations, and the requirements of commissioners and regulators Reduce average length of stay

(ALOS)

Reduce infection

Improve performance on mortality measures

Supports King’s strategic objective to deliver high quality, patient-centred and efficient care Supports KHP strategic objective 1

Achieve top-quartile ALOS in 25% of specialties

To ensure the risk adjusted mortality rate is lower than 100 in all Divisions

To further reduce infection rate to make sure new national targets are met (e.g. 9 MRSA cases)

Achieve level 3 ARMS assessment

Achieve top-quartile ALOS in 50% of specialties

To ensure the risk adjusted mortality rate is not higher than peer average in all Divisions

To further reduce infection rate to make sure new national targets are met.

Renewal of PSSQ research centre

Achieve top quartile ALOS in all specialties

To ensure the risk adjusted mortality rate is better than peer average in all Divisions

To further reduce infection rate to make sure new national targets, and local stretch targets are met.

3. Achieve financial sustainability Increase operational efficiency

at King’s, for example by reducing average length of stay and better managing demand

Deliver efficiencies across King’s Health Partners through service consolidation and rationalisation

Supports King’s strategic objective to deliver high quality, patient-centred and efficient care Supports KHP strategic objective 9 Supports KHP strategic objective 10

10% efficiency plan delivered



Increase in income from non-core activities, e.g. commercial / R&D / PP by £3million

5






of corporate functions

Deliver efficiencies by working more effectively with our other local health partners

increase income through tertiary services growth, and diversification of income from commercial and other sources

4. Strengthen the key tertiary services at KCH including liver, neurosciences, haemato-oncology, as well as developing proposals for integration of services across KHP Provide additional capacity to

meet unmet demand in key services (on-site and through extended networks)

Support research and educational activity in these services to achieve academic pre-eminence in these services

Raise the national and international profile of these services

Services to be working as part of formal clinical networks

Supports King’s strategic objective to develop our major acute, tertiary and community services as part of an integrated healthcare system Supports KHP strategic objective 1 Supports KHP strategic objective 2

Paediatric trauma bid submitted

Business case for vascular consolidation approved by KHP Boards

Agree Haem-onc strategy & plans for BMT consolidation across KHP

Maurice Wohl Institute (academic neuroscience) completed

Clinical Research Facility opened

Designation as paediatric neuro-surgery centre

Additional critical care capacity completed

6






5. Develop the King’s major acute and specialist emergency hospital Complete the implementation of

the Major Trauma Centre (MTC) and Hyper-Acute Stroke Unit (HASU) and the development of associated networks

Build a broader range of specialist emergency services

Support the academic activity of these services

Supports King’s strategic objective to develop our major acute, tertiary and community services as part of an integrated healthcare system Supports KHP strategic objective 3

Full staffing for HASU and MTC in place

Redevelopment of the Emergency Department commences

Installation of new CT scanner

Investment in Stroke academic posts

Academic posts appointed to support MTC

Completion of major capital programmes in Emergency Department

6. Develop King’s community and local secondary services by delivering more care out of the hospital and more integrated care across acute, primary, community, mental health and social care services Develop new commissioning

and delivery models to encourage integrated care

Develop networks of secondary care with a greater proportion of care delivered in out-of-hospital settings including polysystems and patients’ homes

Supports King’s strategic objective to develop our major acute, tertiary and community services as part of an integrated healthcare system Supports KHP strategic objective 9 Supports KHP strategic objective 8

New KCH Urgent Care Centre established within Emergency Department

Full electronic communication with GPs

Complete detailed plans / business case for polysystem hub at KCH

25% of A&E attendances diverted to UCC

Establish polysystem hub at King’s

KHP integrated community services with Lambeth and Southwark goes live

7






Contribute to the delivery of the SEL Healthcare Strategy, including reduce health inequalities and improving public health

7. Adapt and develop our workforce skills, competencies and capacity in line with changes in service delivery and care pathways and the development of King’s Health Partners Reprofile workforce to ensure

optimum skill mix & build workforce planning skills of service managers

Increase workforce productivity through more efficient staff deployment

Improve workforce development through talent management and professional development

Increase staff engagement by embedding King’s Values and behaviours, and improving staff wellbeing

Supports King’s strategic objective to transform our workforce and supporting systems Supports KHP strategic objective 7.

Systematic review of all workforce skill mix completed

Transformation Programme project to increase medical productivity

talent management strategy agreed

implement Occupational health review

implement “on-boarding” website

Launch health and well being strategy

Roll out of electronic rostering complete

Comprehensive job plan reviews conducted for all consultants, reflecting service redesign and supporting revalidation

8






8. Establish trust-wide systems that support high quality, safe, effective and efficient patient care Implement governance systems

that assure the executive and board about quality of care

Improve our performance systems & align these with KHP - to support clinicians and managers in delivering high quality and efficient care underpinned by academic capability

Develop IT systems that support better clinical care and research within the Trust, across KHP and with local health partners

Supports King’s strategic objective to transform our workforce and supporting systems Supports KHP strategic objective 10

New Board governance systems established

Embed new divisional structures

Web-based performance scorecards

Audit of performance systems across divisions

KHP Performance Council established

Full roll-out of e-prescribing

Joining up of KCH/GSTT networks

Paperless outpatient departments complete

Joint EPR implementation started

9. Contribute to the delivery of King’s Health Partners vision including strengthening the research and education activity at King’s Develop Clinical Academic

Groups (CAGs) & ensure they all have integrated tripartite strategies agreed

Supports King’s strategic objective to contribute to the delivery of King’s Health Partners Supports all KHP objectives

All CAG leaders appointed

First wave CAGs have agreed tripartite strategies & achieve accreditation

First wave service

Clinical Research Facility completed

All CAGs accredited

PSSQ renewal

Simulation training facilities upgraded

9






Implement service changes across the CAGs to improve clinical quality and efficiency

Strengthen the research and educational contribution of all our clinical services

Develop integrated corporate systems across KHP

consolidation proposals agreed across KHP

KHP Partnership agreement signed

Complete any consultation required, and begin implementation of service consolidation proposals across KHP

10


Template 2: Key external impacts

Key external impact Risks to the plan Mitigating actions and residual risk

Overall expected outcome

Measures of progress and accountability

1. A reduction in overall NHS funding, resulting from wider pressures on public expenditure

Overall Trust income falls below levels predicted within the forecasts

Mitigation – Savings plan being

managed via Programme office

Transformation programme established to drive efficiencies

Joint savings work with KHP partners also underway

Objective to increase % of non-clinical income

Residual risk – downside scenario planning – still need to allow for ongoing reductions in funding

Trust remains financially viable, but with reduced margin and reduced Monitor risk rating

Monthly financial position, revised financial forecasts

Accountable lead: CFO / COO

2. Changes to national commissioning and tariff arrangements, including: new baseline for

emergency activity (08/09)

funding linked to quality and patient experience (CQUINS)

Over-performance on emergency activity at 30% tariff (negative margin)

Reduced income if quality targets not met

Mitigation Trauma, stroke and

PAMI emergency activity excluded from activity levels

Working with PCTs to agree appropriate local contracts to manage emergency pathways

CQUINS – agreed

Reduction in low tariff emergency admissions towards baseline – to reduce exposure

Maintain income levels

Monitored via internal performance management systems and regular contract monitoring meetings with PCT

Accountable lead: COO / Director of Nursing

11


Key external impact Risks to the plan Overall expected outcome


Mitigating actions and residual risk

action plans with PCTs

Quality has high profile and is part of trust performance management scorecards

Minimal risk remaining 3. Commissioner-led reviews of specialist services, including Healthcare for London, national commissioning – cancer, cardiovascular & specialist paediatrics

Risk of KCH / KHP not being designated, or not having certain specialist services commissioned any more

Joint work with GSTT on integrated services provision greatly strengthens both parties (e.g. potential to create largest combined vascular centre in London)

Working together we believe the full range of specialist services will be commissioned from KHP. This may require some reconfiguration across KCH and GSTT to achieve optimal service models

Business cases agreed and fully consulted upon

Accountable lead: COO / director of strategy

4. Local commissioning decisions e.g. new demand management measures

Reductions in acute services commissioned may lead to difficulty in removing fixed costs / reducing cost base & time it takes to do so

Lack of appropriate facilities in the community may jeopardise ability to transfer activity

Lack of engagement – hospital clinicians and/or GPs

We have agreed to a phased approach with PCTs (e.g. Diabetes).

Polysystem development to be joint project between Trust and PCTs

Representation on SEL sector strategy implementation

Joint planning with PCTs to ensure we can reduce hospital cost base over coming 1-3 years, in response to shift of care away from acute setting

Contract monitoring

Accountable lead: COO / Director of Strategy

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Key external impact and

Risks to the plan Mitigating actionsresidual risk

Overall expected outcome


5. Ability of other local providers to repatriate patients in timely fashion

Increase in excess bed days and ALOS leading to increased costs

More proactive management – including agreeing referral protocols with local providers

Improvement in repatriation rates and reduced ALOS

Trust performance management systems

Accountable lead: COO

6. London Deanery reconfiguration of post graduate medical and dental education

Potentially diminished status as a recognised provider of high quality specialty training; consequent impact on ability to attract the brightest and best medical trainees

Mitigation:

KHP consortium response to Deanery invitation for accreditation as Lead Providers

Collaborative approach to stage one submissions

KCH accreditation secured in chosen specialties; providing options to bid in stages - once risks and liabilities are fully specified and assessed

Board agreement to proceed at each stage

Accountable lead: COO / Director of Workforce Development

7. National review of the Multi Professional Education and Training (MPET) budget

Potential for proposed re-distribution of funding which adversely impacts Trust revenue budgets

Implementation of ‘Modernising Scientific Careers’

Mitigation:

KCH participation in national consultation and shadow pilot in 2010/11

Accountable lead: COO

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Template 3: Clinical quality

Clinical quality priorities

Contribution to the overall vision

Key actions and delivery risk Performance in 2009/10

3 year targets / measures 2010/11 2011/12 2012/13

1 – Enhance mortality performance

Support King’s objective to deliver high quality, patient centred and efficient care. It also supports KHP strategic objectives 1. & 2.

Actions: - To strengthen further the governance

structure for mortality reviews through Trust Mortality Monitoring Committee and divisional governance meetings.

- Monitor mortality rate monthly using CHKS model

- Triangulate mortality performance using other mortality models

- Further improve coding to ensure data accuracy

- Take actions from mortality reviews to further improve clinical outcomes

Risks - There are no standardised mortality

model in place - King’s treats more complex cases in a

number of specialties and some mortality models are not robust enough to adjust the risks of these cases

King’s standardised mortality ratio (97.7) is similar to the national average as published on NHS Choices.

King’s risk adjusted mortality rate is as expected according to CHKS model.

2010/11 To ensure the risk adjusted mortality rate is lower than 100 in all Divisions. 2011/12 To ensure the risk adjusted mortality rate is not higher than peer average in all Divisions. 2012/13 To ensure the risk adjusted mortality rate is better than peer average in all Divisions.

14






2- Reduce infection

Support King’s objective to deliver high quality, patient centred and efficient care.

Actions: - To embed new Infection control

governance structure and communicate updated Infection Control policy

- Ensure staff have appropriate training on infection control

- To implement actions from Hygiene Code compliance review

Risks risk associated with KCH’s particular complex case mix – e.g. liver ITU, etc

MRSA bacteraemia (post 48 hours) – 17 C Diff – 135 (against target of 202)

2010/11 MRSA target – 9 C Diff target (national) – 162 C Diff target (locally agreed) - 88 2011/12 and 12/12 To further reduce infection rate to make sure new national targets are met.

3 – Improve patient experience

Support King’s objective to deliver high quality, patient centred and efficient care. KHP strategic objective 5.

Actions: - measuring inpatient experience

monthly through King’s How are we doing survey, national inpatient survey results and CQUIN metrics and take actions to improve monthly

- Roll out King’s How are we doing outpatient survey in clinics and Emergency department

Risks: - Ensuring staff engagement in PPI and

patient experience activity - Achieving low response rates for How

are we doing Surveys Influence of local demographic on satisfaction scores

Top performing acute trust in London for the national outpatient survey 2009 Achieved internal benchmark for quarter 4 in HRWD inpatient survey Commenced rollout of outpatient feedback survey

2010/11 Transformation

programme project to improve patient experience

Achieve target satisfaction scores for CQUIN patient experience metrics

To achieve HRWD? IP benchmark

Implement OP survey in main OP Suites and the ED

2011/12 To reach the top

20% of acute hospitals in London

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for the national inpatient survey

Achieve target satisfaction scores for CQUIN patient experience metrics

implementation of OP survey in all areas

Achieve OP benchmark scores

2012/13 To be in the top

10% of acute hospital trusts in London for inpatient satisfaction

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Template 4: Service development strategy

Service development priorities Contribution to the overall vision

Key actions and delivery risk

Key resource requirements

Measures of progress 2010/11 2011/12 2012/13

Organic / innovation: 1. KHP – CAG development in all clinical services

Contributes to the delivery of KHP

Actions - tripartite strategies & implementation plans developed in all CAGs risks – competing operational pressures for key clinical / academic leaders

CAG leaders resourced as part of core KHP budget

2010/11 all CAG leaders appointed 2010/11 first wave CAGs accredited 2011/12 – all CAGs accredited

2. Major Acute and Specialist emergency hospital

Paediatric major trauma centre bid Supports strategic objective 5 – become London’s leading major acute hospital

Secure paediatric neurosurgery designation Complete bid process / required submission

requires investment in 1wte additional consultant paediatric neurosurgeon

Paed neurosurgery designation 2011/12 Paed MTC status approved 2011/12

Expand critical care capacity Supports objective 5, and also 4 – to strengthen key tertiary services

Capital redevelopment required Risk – insufficient funds in capital plan

£9.2m capital Additional income from increased activity £7.8m. Additional revenue cost £5m

capital works completed & additional critical care beds fully opened by 2011/12

Fully implement MTC and Stroke service

Supports strategic objective 5 – become London’s leading major acute hospital

Workforce /recruitment plans implemented Capital works completed

£8m - ED expansion £0.5m - CT scanner

10/11 MTC and HASU fully staffed 11/12 capital works (e.g. ED) to support MTC

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Risk - lack of capital completed

3. Tertiary services development

Expansion of Haemato-oncology beds to accommodate Sussex work

Supports objective 4 – to strengthen key tertiary services

Additional bed capacity identified for haem-onc patients

TBC - Awaiting business case

PYE – 10/11 FYE – 11/12

4. Local and community services

Maternity expansion / MLBU Supports delivery of high quality care, and delivery of more integrated local secondary services

Build programme Risk - Need to manage growing activity in interim period

Capital build - £4.5m Additional staffing costs approx £1million

11/12 – capital works completed and unit opened

Polysystem hub development with PCTs

Supports delivery of more integrated local care

Redesign of care pathways – diabetes. Exploring new models of care, e.g. telemedicine Polysystem design to encompass patients’ psychological and social needs and awareness of ill health prevention

Diabetes modernisation supported by GSTT Charity

Options developed and Business case for KCH polysystem hub – end 2010/11

Urgent Care Centre completion Supports delivery of more integrated local care

UCC completed within ED

Part of ED redevelopment

2010/11 UCC fully implemented

Acquisition etc: Work in collaboration with GSTT on KHP integration (GSTT host) of

Supports delivery of more integrated local

“due diligence” to be completed by GSTT

KCH managerial input to GSTT process

10/11 due diligence completed

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Lambeth and Southwark Community provider services

care KCH involvement in planning full implementation of (community CAG)

11/12 integration fully operational – new CAG in place

Transferred / discontinued activity: OP activity transferred to primary care / poly-systems

Supports delivery of more integrated local care

Work with divisions to review protocols, introduce new service models aiming at reducing OP attendances

£2 m saving agreed for LSL

Reductions in OP demand / activity in line with commissioners’ plans (year on year)

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Template 5: Workforce strategy Key workforce priorities Contribution to the plan Key actions and delivery

risk Key resource requirements


1. workforce planning and reprofiling –- review the structure and capacity of the KCH workforce, including the numbers / grades of staff, and job design - in the context of KHP and KCH service priorities and changing care delivery models.

Supports transformation of workforce & delivery of high quality, patient centred and efficient care

Embed the new divisional structure, which facilitates patient pathways within KCH and enables CAGs to develop systematic process put in place to review organisational structures. Equip service managers to deliver a 3 year workforce capacity plan which informs resourcing and education/ training commissioning

Existing, Workforce Directorate, managerial and change leader resource,

Systematic review of all workforce skill-mix completed – end March 2011

2. workforce productivity and staff performance management – ensure all staff are working as efficiently as possible, and performance is positively managed


Medical productivity project to review job planning and use of benchmarking data Improve induction and appraisals

Workforce Directorate and Change leader support to medical productivity project

fully implement e-rostering

Refresh medical and non medical induction

Fully implement revised annual / job plan review for consultants which also supports revalidation

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Key workforce priorities Contribution to the plan Key actions and delivery risk


Measures of progress 2010/11 2011/12

3 2012/1

3. workforce development Ensure managers are equipped with skills to review workforce needs routinely as part of service development – education and training for the workforce to create competencies and capabilities required


Design roles, career pathways and development opportunities which ensure optimum utilisation of staff capability, skill and competence levels Put in place clear succession plans. Leadership programmes

Workforce Directorate ‘Train the trainers’ in workforce role re-design Training for senior managers in feedback for succession planning

Agreed talent management strategy in place – 2010/11

4. staff engagement, organisational culture and wellbeing of staff - Continue to engage staff in shaping and developing our organisational culture, behaviours and environment


Embed King’s Values into recruitment process and throughout the lifetime of employment - including induction, training, flexible working and appraisal. Use of staff survey to identify key actions and implement plans

Workforce Directorate 2010/11: Fully implement on-

boarding website 2010/11: Implementation of OH

Department review Launch health and

wellbeing strategy 2011/12:

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Template 6: Capital programmes (including estates strategy)

Key capital expenditure priorities

Amounts and timing Contribution to the plan (including service

delivery)


Development: Maternity Unit Cost £4.50 million

Commenced Completion Jan 2011

Supports integrated care & local secondary services

Actions Agree final design with users. Agree Design & Additional PFI costs with HpC Produce tender documents and go out to Tender Risks Start delay, due to negotiations with HpC regarding GJW

CT Scanner Cost £500k Start July 2010 Completion Dec 2010

becoming one of London’s leading major acute hospitals

Actions Agree final design with users. Agree decant plan to clear Suite 4 Agree Design & Additional PFI costs with HpC Produce tender documents and go out to Tender Risks Finding suitable alternative decant space. Start delay, due to negotiations with HpC regarding GJW.

Emergency Dept Expansion Cost £ 8 million Start Jan 2011 Completion June 2012

becoming one of London’s leading major acute hospitals

Actions Agree final design with users. Agree decant plan to clear Suite 1 Agree Design & Additional PFI costs with HpC Risks Finding suitable alternative decant space. Decant plan to ensure operational requirements are provided during the period of the project. Start delay, due to negotiations with HpC

Critical Care Cost £9.2 million Start Jan 2011 Completion Sept 2012

Supports KCH as leading major acute hospital, and strengthens key tertiary services

Actions Agree final design with users. Agree decant plan to clear required areas + costs Agree Design & Additional PFI costs with HpC

22




delivery)


Risks Finding suitable alternative decant space. Decant plan to ensure operational requirements are provided during the period of the project. Start delay, due to negotiations with HpC regarding GJW

Clinical Research Facility Cost £10.8million commenced Completion March 2011

Supports KHP and key tertiary services

Actions ? Risks ?

Maurice Wohl Institute Cost £1.95 million (contribution) Start April 2010 Completion Sept 2010

Strengthens key tertiary services and contributes to the delivery of King’s Health Partners

Actions Agree decant plan for Ronald Macdonald House and Occupation Health. Transfer properties to KCL. Risks Project delay, no alternative accommodation available.

Maintenance: UPS Main Theatres Cost £150

Start April 2010 Completion Sept 2010

Strengthens key tertiary services and supports local secondary care

Actions Agree project programme with users Risks Operating time lost due to project access requirements. Additional costs due to changes in programme to accommodate operational requirements.

New Electrical Sub Station Cost £150k Start Sept 2010 Completion Dec 2010

Achieve financial stability Actions Agree final design. Produce tender documents and go out to Tender Agree shutdown programme Risks Additional costs due to changes in programme to

23




delivery)


accommodate operational requirements

Other capital expenditure: Reconfigure services currently at Dulwich Hospital

Cost £500k Start June 2010 Completion Sept 2010

Supports local secondary service provision

Actions Agree decant plan. Risks No alternative accommodation available

Single sex, Day Surgery & Ward areas

Cost £300k Start June 2010 Completion Mar 2011

Deliver high quality, patient centred efficient care

Actions Find design solution for Day Surgery Agree design requirements with users to comply with latest standards Produce tender documents and go out to Tender Risks Theatre downtime, while project in progress. Losing Theatre Capacity Design solution above funding.

Fire Risk assessment projects Cost £200k Start June 2010 Completion Mar 2011

Supports high quality & safe care

Actions Agree list of projects to reflect the risk and available funding Risks Loss of operational space, while projects are in progress.

Energy Saving projects Cost £50k Start May 2010 Completion Sept 2010

Financial stability Actions Agree list of projects to produce best “Payback” within the available funding. Risks Carbon reduction not sufficient to comply with set target. Resulting in financial penalties

24


Template 7: Operational / financial effectiveness Key operating efficiency programmes

Amounts and timing

Contribution to the plan


Resource requirements

Milestones 2010/11 2011/12 2012/13

1. Reduction in Average Length of Stay - Improve efficiency through trust wide initiatives to reduce ALOS – and improve quality of care & patient safety

£6m impact in 10/11 – through savings and additional income. Reductions in both medical and surgical ALOS

Supports delivery of high quality , patient centred and efficient care.

- increase efficiency of medical assessment unit - introduce surgical admissions unit - fully implement Electronic Patient Status Boards - Reduction in excess bed days (e.g. via Medihome contract) - target specific areas that are not achieving top quartile performance against peers and develop action plans to move towards. Risk – managerial and clinical focus must be maintained

Programme Office - Internally resourced from Change Leaders Team and Trust management teams

10/11 – introduction of surgical admissions unit 10/11 – ensure we understand and have actions in place to move all areas to top quartile length of stay performance 11/12 – all areas achieving top quartile performance 12/13 – maintain top level performance and move selected areas to international benchmarks.

2. Divisional savings plans – Cost Improvement Programmes to be monitored weekly, via Programme Office

Plan for 10/11 of £27m in CIPs


Divisional managers responsible for managing local CIPs & service specific efficiency improvement projects. (Monitoring across the trust via Programme Office) KHP clinical service integration plans progressed Risk – managing both tight controls and redesign projects challenging


10/11 – deliver divisional CIPs and understand the level of requirement for next 5 years. 11/12 – increased CIPs in place by all divisions, with more of a focus on delivering KHP models 12/13 – further implement KHP models of care

25


Key operating efficiency programmes

Amounts and timing




Milestones 2010/11 2011/12 2012/13

3. corporate savings - to be managed for KCH, and initiatives across KHP

£5m in 10/11


KCH corporate savings plans KHP plans for integration / sharing of back office functions Challenges – managing differences in organisational structures and approaches across KHP


10/11 – deliver corprorate CIPs and understand the level of requirement for next 5 years. 11/12 – increased CIPs in place by all corporate areas, with more of a focus on delivering KHP models

4. Trust-wide savings plans – rationalisation of management / administrative functions & redesign of hospital to improve patient pathways and “streaming” through the hospital

£2m in 10/11 Supports delivery of high quality , patient centred and efficient care.

Centralising bed management Centralising OP management Organisational restructuring Challenges – divisional support for centralised processes


10/11 - organisation restructure complete. Trust wide savings plans recognised and delivered 11/12 – 12/13 – further trustwide/KHP models introduced

5. income growth – from growth in tertiary services and diversification of income from commercial and other sources

Total of £7m in 10/11 – from growth in PPs, provider to provider income and commercial income


Divisional plans for income generation, and income from corporate plans to expand commercial activities Risk – income risk where reducing overall funding


10/11 – increased levels of specialist activity, project diamond funding secured, provider to provider/commercial services income recognised.

26


Key operating efficiency programmes

Amounts and timing




Milestones 2010/11 2011/12 2012/13

6. demand management / system wide sustainability

In 10/11: £4.4m LSL-led demand mgmt and poly-system shift. £2m - other PCT demand management. £3.6m Trust-led savings

Supports efficient care

Reductions in clinical activity in by delivering care in alternative settings and / or introducing new service models (includes A&E attendances, emergency admissions and OP attendances - new and f/u) Risk – slow delivery due to time taken to engage clinical staff fully in service redesign

Joint projects in place across KCH, GSTT and Lambeth / Southwark

10/11 – 12/13, Reduced levels of consultant to consultant referrals. Reduced number of follow ups. Improved community care pathways (ie diabetes)

27


Template 8: Leadership and governance Key leadership and governance priorities

Key risks (and gaps) Actions to rectify / mitigate Milestones 2010/11 2011/12 2012/13

Divisional restructuring Restructure divisions across the Trust to improve quality of care, efficiency and accountability

Transition to new divisional structures leads to dip in performance

Adequate transition period allows new divisions to take shape, whilst still maintaining performance management

Handover protocols for new divisional management teams

10/11 divisional re-structuring fully embedded

Succession planning Succession plans at Board level (Directors); and succession plans at other levels of the organisation (clinical, operational and corporate teams)

Perceived preference for external candidates filling senior posts

Perceived bias and lack of transparency in the talent management system and process

Risk of future funding withdrawal (NHS London CPD monies currently fund leadership development, there is no internal budget provision)

Training in assessing Board level potential

Development of transparent assessment process to include post holder self assessment

Training in assessing senior management potential

Development programmes in place for Senior Managers/ Clinicians; Clinical Leaders; Matrons; and front line leaders

June 2010: Assessor training delivered.

July 2010: NHS London Talent Management Toolkit implemented.

July 2011: Succession plans in place to include all Band 8c and equivalent posts.

July 2012: Succession plans in place to include all Band 7 and other team leaders.

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Key leadership and governance priorities

Key risks (and gaps) Actions to rectify / mitigate Milestones 2010/11 2011/12 2012/13

Board effectiveness Continue to develop effective Board leadership of the organisation

Insufficient focus/time on Board development and appraisal.

Changes to Board membership

Tailored induction programme for all new Board members

Dedicated time for Board development sessions e.g. planned facilitated programme on inclusive leadership May 2010

Externally facilitated programme of Board evaluation

Induction programme is ongoing

Board development sessions are scheduled into Board programme

2 year Board evaluation programme (2010/11 -11/12) facilitated by Audit Commission

Board assurance Develop trust governance arrangements to ensure continued effective Board governance and assurance

Short term operational imperatives do not allow sufficient Board and Executive focus on longer term strategic issues

Review of Board governance structures to include a stronger focus on quality and on strategy

Board Assurance framework reviewed bi-annually by the Board

Quality Accounts developed and monitored

New Board structure implemented July 2010

Bi-annual review in each year

Quality Report and Accounts published annually

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Template 9: Regulatory Key regulatory risks Nature of risk Actions to rectify / mitigate and

responsibilities Measures 2010/11 2011/12 2012/13

1. Service Performance and Clinical Quality

Failure to achieve all core national and trust strategic targets leading to breach of terms of authorisation, e.g. 18 weeks referral to treatment target

4 hour ED target

Cancer targets: 2 week wait;31 day target; 62 day wait

Infection Control target for MRSA & CDT

Failure to deliver: Same sex accommodation

requirements quality improvements over a

range of clinical services.

Systematic monitoring of all targets monthly by Performance Committee to the Board of Directors. Strong clinical leadership and performance management targets. Review of Board governance

framework to strengthen monitoring of the 3 dimensions of quality: patient safety, patient experience & patient outcomes

Board of Directors and Governors ‘Go and See’ inspections to all clinical areas.

Governance risk rating year on year. Implementation of new Board reporting structure - 2010/11 Trust to confirm compliance by April 2011 with the exception of the Clinical Decision Unit (CDU) which is incorporated within the redevelopment of the Emergency Department. This project will commence in November 2010. Achievement of Trust benchmark target improvement in patient satisfaction scores year on year.

2. Registration with CQC Failure to maintain unconditional registration (achieved March 2010) of regulated activities under the CQC.

Review of Board governance framework to strengthen monitoring of the 3 dimensions of quality: patient safety, patient experience & patient outcomes

Review existing compliance and assurance management functions.

Implementation of new Board reporting structure and supporting compliance function - 2010/11

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Key regulatory risks Nature of risk Actions to rectify / mitigate and responsibilities

Measures 2010/11 2011/12 2012/13

3. Financial stability, profitability and liquidity

3.1 Commissioning levels and loss of income. Loss of income due to PCT activity decommissioning and poly-system shift. (£10m 10/11). Decommissioning targets: Elective procedures New Outpatient referrals Diagnostics. Higher Outpatient and A&E activity shifts to poly-system community models. SHA/PCT commissioning for key strategic service developments such as Trauma/Critical care, Emergency Care and Maternity. 3.2 Financial funding streams. Efficiency targets on operating costs of £571m): 3.5% 10/11, 4% 11/12,12/13. Net Tariff uplifts (Price inflation on PCT baseline contract value of £452m) : 0% 10/11, -0.5% 11/12,12/13.

To collaborate and share the financial risks with lead commissioners in order to ensure a planned transitional activity reduction in agreed service areas and to develop new patient pathways involving poly-systems. To identify potential savings associated with the activity reduction and income loss. To increase income through tertiary services growth, and diversification of income from commercial sources. To ensure commissioner investment in key strategic developments. To agree a cost improvement programme to ensure cost reductions and to generate additional income from service efficiencies such as reducing ALOS and new tertiary activity. To ensure robust CIP plans are approved by the Board and Divisional Managers/Directors are accountable for the targets. Support from Programme Office and central saving themes such as the

Recurring Income Generation plan for £23m (10/11). Commercial income to increase by 20% (12/13). PCT contracts reflect realistic activity levels and incorporate strategic developments. Recurring Cost reduction plan for 27m (10/11).

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Measures 2010/11 2011/12 2012/13

Market Forces Factor transitional reduction capped at 2%. Potential Clinical Training and Education funding reductions of £9.232m over 4 years from11/12. Marginal rates for activity provision above baseline contract levels for emergency work and specialist work. CQUIN funding increase from 0.5% to 1.5% and dependent on quality improvement. 3.3 Liquidity/Cash-flow. Prompt cash recovery from income generation schemes and PCT contract over-performance activity income to the value of £23m 10/11. Provider to Provider and Private Patient debt recovery. Capital programme to the value £29m (10/11) and a number of sources of funding.

Transformation programme, joint savings work with KHP partners. Review the provision of clinical training in line with the proposed funding stream. To provide financial service line reporting information to ensure patient activity services are financially viable. Risk and performance management frameworks to be embedded across the Trust and linked to the development of Quality Accounts. Improve debt collection processes and procedures. To stop service provision for non payment. Charge interest for late payment and to ensure service level agreements for all clinical and non-clinical services include this provision. To review the working capital facility. To ensure all the capital income streams are obtained prior or in line with actual expenditure.

Quarterly Service Line Reporting to Divisional Managers. Action plans produced to achieve CQUIN targets. Maintain a Monitor risk rating liquidity ratio of 3. Increase the working capital facility with the Trust’s bank.

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33


Measures 2010/11 2011/12 2012/13

4. Private patient income cap Section 44 of the 2006 Act requires that the proportion of private patient income to the total patient related income of the NHS FT should not exceed 3.5%, its proportion in 2002/3. The PP gross income as at 31.3.10 was £14.5m (3%).

The Trust needs to prioritise the PP opportunities to keep within the cap. There is headroom of £2.4m.

PP income is held within the cap.

0

Annual Plan 2010/11 Financial Summary

Board of Directors

25 May 2010

Enc 3.1.2

1

Annual plan Summary

The Trust contracts include 0% price inflation uplift along with real reductions in income due to a 3.5% efficiency target and activity decommissioning. On the expenditure side, drugs and pay pressures are largely unavoidable cost pressures which will have to be met.

Contracts with PCT have been agreed, as have the majority of consortium contracts, based on last years outturn activity less decommissioning/activity shifts.

Expenditure budgets have been compiled, along with Divisional cost pressures. These have been analysed and approved where appropriate to meet last years outturn activity.

Cost improvement programmes have been agreed with divisions. These are challenging and necessarily contain some delivery risk. These total £50m as forecast in the downturn planning.

Whilst the Net position is planned to be breakeven, the operating surplus position is planned as £3m due to a projected £3m impairment.

2

Income analysis• Income

– PCT contracts based on outturn activity have been agreed with the LSL alliance for London.

– PCT income has been reduced by £11.6m compared to King’s proposals as a result of reduction in prices and also due to demand management schemes and Polysystem activity shifts.

– Trauma income and costs have been assumed to total £2.6m for 2010/11.

– Training and Education and other (divisional) income are rolled forward 09/10 budgets

– A significant level of income is assumed above that in the contracts; this is for three reasons;

• There is an element of Demand management reductions from the PCT which do not have robust plans for achievement. As such, it is believed that this activity will still flow to the Trust. This is separate to those schemes where there is a clear plan and pathway to achieve the necessary reductions.

• There is an element of the full year effect of increased income through service developments in 09/10 which are not reflected in PCT contracts

• There is an element which relates to the achievement of additional income in order to achieve the Cost improvement Programme, both with Divisional specific plans, and also centrally driven proposals for reductions in length of stay, and the targeting of additional tertiary activity.

3

Expenditure Analysis

• Expenditure

– Pay budgets are revised 09/10 baselines taking into account incremental drift and the FYE of approved service developments.

– Non Pay budgets starting point is 09/10 baseline budget, with additional cost pressures funded as appropriate

– Pay cost pressures funded are in order to increase the baseline for the full year effect of planned developments in 09/10, and for agreed pressures as a result of activity changes

– Drugs and Clinical supplies cost pressures have been funded to broadly equate to the level of funding required for the level of activity within contracts.

– Other Cost pressures funded include £1.2m for CNST premiums, £3.4m for PFI increases, and £1.2m for patient transport.

– Capital charges are based on estimates for 10/11 and capitalised schemes such as the energy centre

– Asset Impairment calculations for 10/11 particularly regarding the Energy Scheme have been estimated at £3m

4

CIP Detail

CIP targets have been agreed with divisions and have largely been allocated, although some areas still have some CIPs to allocate still.

The first table shows the split between the different subjective headings by Division.

The second shows plans into types of CIP • Cost reduction is a reduction in spend on 09/10, typically Bank and agency.• Redesign/restructure is savings coming from changing the way teams work and generating efficiencies, eg restructuring outpatient clinics• Trustwide schemes are those such as a patient transport call centre which will reduce costs across the trust• Vacancies are where vacant posts are frozen/disestablished• Divisional income is specific Divisional plans to increase income in their areas• LOS and Demand management are as a result of central initiatives

5

CIP Waterfall

Savings Waterfall Chart

6

Planned Capital Expenditure 2010 -2013

Annual Plan Financial Templates 2010/11 – 2012/13

Board of Directors

25 May 2010

ENC 3.1.3

Page 2

Risk Rating

weighting in FRR

calculation 2009-10

Forecasted YTD to

30-Jun-10

Forecasted YTD to

30-Sep-10

Forecasted YTD to

31-Dec-10

Forecasted YTD to

31-Mar-11

Forecast for Year ending 31-Mar-12

Forecast for Year ending 31-Mar-13

Underlying performance

EBITDA YTD from IS 33.235 9.522 19.114 28.705 38.294 41.401 54.504Operating Income YTD from IS 566.013 145.531 291.131 436.732 582.332 570.451 565.096EBITDA Margin metric 5.9% 6.5% 6.6% 6.6% 6.6% 7.3% 9.6%EBITDA Margin rating 25% 3 3 3 3 3 3 4

Achievement of plan

EBITDA YTD from IS actual 33.235 n/a n/a n/a n/a n/a n/aEBITDA YTD from IS plan 46.761 9.522 19.114 28.705 38.294 41.401 54.504EBITDA % of plan achived metric 71.1% 71.1% 71.1% 71.1% 71.1% 71.1% 71.1%EBITDA % of plan achived rating 10% 3 3 3 3 3 3 3

Financial Efficiency

Surplus YTD from IS -1.386 ‐0.071 ‐0.091 ‐0.118 0.269 1.853 4.867Charitable fund surplus YTD (to be removed for 2010) 0.000 0.000 0.000 0.000 0.000 0.000 0.000PDC dividend expense YTD -7.549 ‐2.125 ‐4.250 ‐6.375 ‐8.500 ‐8.633 ‐8.822 Profit (loss) on asset disposals 0.000 0.000 0.000 0.000 0.425 0.000 0.000Impairments & restructuring costs YTD -4.319 ‐0.750 ‐1.500 ‐2.250 ‐3.000 ‐3.000 ‐10.000 Opening net assets 247.430 254.140 254.140 254.140 254.140 257.644 259.822Opening borrowings 9.393 15.056 15.056 15.056 15.056 14.155 13.067Closing net assets 254.140 255.326 255.494 257.014 257.644 259.822 264.582Closing borrowings 15.056 14.698 14.698 14.192 14.155 13.067 11.979Return on assets metric 4.0% 4.2% 4.2% 4.2% 4.2% 5.0% 8.6%Return on assets rating 20% 3 3 3 3 3 3 5

Surplus YTD from IS ‐1.386 ‐0.071 ‐0.091 ‐0.118 0.269 1.853 4.867Charitable fund surplus YTD (to be removed for 2010) 0.000 0.000 0.000 0.000 0.000 0.000 0.000Operating Income YTD from IS 566.013 145.531 291.131 436.732 582.332 570.451 565.096Profit (loss) on asset disposals 0.000 0.000 0.000 0.000 0.425 0.000 0.000Impairments & restructuring costs YTD ‐4.319 ‐0.750 ‐1.500 ‐2.250 ‐3.000 ‐3.000 ‐10.000IS Surplus margin metric 0.5% 0.5% 0.5% 0.5% 0.5% 0.9% 2.6%IS Surplus margin rating 20% 2 2 2 2 2 2 4

Financial Efficiency rating 3 3 3 3 3 3 5

Liquidity

Cash for liquidity purposes (IFRS) 24.244 24.267 24.453 24.886 22.672 21.962 43.046Operating expenditure YTD from IS 532.778 136.009 272.017 408.026 544.038 529.050 510.592WCF in terms of Operating Expenditure YTD 16.9 16.5 16.5 16.5 16.5 17.0 17.6

Liquidity days metric (WCF limited to 30 days) 16.4 16.1 16.2 16.5 15.0 14.9 30.4

Liquidity rating 25% 3 3 3 3 3 2 4

Weighted Average Rating 2.8 2.8 2.8 2.8 2.8 2.6 4.1

Financial Risk Rating 3 3 3 3 3 3 3

Page 3

Financial SummaryFinancial Summary 2009-10 2010-11 2011-12 2012-13

Actuals Plan Plan Plan

Revenue (Total) 566.0 582.3 570.5 565.1

Employee Expenses (335.7) (344.3) (340.6) (333.5)

Drugs (51.9) (51.9) (50.1) (48.2)

PFI operating expenses (20.9) (21.7) (21.9) (22.2)

Other costs (124.3) (126.1) (116.5) (106.7)

Clinical supplies (57.0) (58.6) (56.2) (53.9)

Decrease (increase) in inventories of finished goods & WIP 0.0 0.0 0.0 0.0

Vehicle Fuel costs (ambulance trusts) 0.0 0.0 0.0 0.0

Non-clinical supplies (39.6) (38.4) (36.6) (34.9)

Cost of Secondary Commissioning of mandatory services 0.0 0.0 0.0 0.0

Research & Development expense 0.0 0.0 0.0 0.0

Education and training expense 0.0 0.0 0.0 0.0

Misc. other Operating expenses (27.7) (29.2) (23.6) (18.0)

EBITDA 33.2 38.3 41.4 54.5

Depreciation and amortisation (13.4) (16.5) (17.5) (20.5)

Net interest (8.2) (8.6) (8.5) (8.3)

Interest Income 0.1 0.1 0.1 0.1

Interest Expense on Overdrafts and Work ing Capital Facilities (0.0) (0.3) (0.3) (0.3)

Interest Expense on Bridging loans (0.6) 0.0 0.0 0.0

Interest Expense on Non-commercial borrowings 0.0 (0.7) (0.6) (0.6)

Interest Expense on Commercial borrowings 0.0 0.0 0.0 0.0

Interest Expense on Finance leases (non-PFI) 0.0 (0.0) (0.0) 0.0

Interest Expense on PFI leases & liabilities (7.7) (7.6) (7.6) (7.5)Other (13.0) (13.0) (13.6) (20.8)

Gain (Loss) on Financial Instruments Designated as Cash Flow Hedges 0.0 0.0 0.0 0.0 Gain (Loss) on Derecognition of Available-for-Sale Financial Assets 0.0 0.0 0.0 0.0 Gain (Loss) on Derecognition of Non-Current Assets Not Held for Sale, Total 0.0 0.0 0.0 0.0 Gain (Loss) from investments (NOT charitable funds) 0.0 0.0 0.0 0.0 Dividend Income 0.0 0.0 0.0 0.0 Share of profit (loss) from equity accounted Associates, Joint Ventures, Total 0.0 0.0 0.0 0.0 Other Non-Operating income, Total 0.0 0.4 0.0 0.0 Other Finance Costs (0.2) (0.2) (0.2) (0.2)PDC dividend expense (7.5) (8.5) (8.6) (8.8)Impairment Losses (Reversals) net (on non-PFI assets) (4.3) (3.0) (3.0) (10.0)Impairment Losses (Reversals) net on PFI assets 0.0 0.0 0.0 0.0 Restructuring Costs 0.0 0.0 0.0 0.0 PFI Contingent Rent (0.9) (1.7) (1.7) (1.8)Expenditure of NHS Charitable Funds 0.0 0.0 0.0 0.0 Other Non-Operating expenses 0.0 0.0 0.0 0.0 Income Tax (expense)/ income 0.0 0.0 0.0 0.0

Net Surplus / (Deficit) (1.4) 0.3 1.9 4.9

EBITDA % Income % 5.9% 6.6% 7.3% 9.6%

Page 4

Financial Summary cont…Financial Summary Cont... 2009-10 2010-11 2011-12 2012-13

Cash Flow Actuals Plan Plan Plan

Net Surplus / (Deficit) (1.4) 0.3 1.9 4.9 Change in working capital (8.5) (1.1) (0.8) (2.3)

(Increase)/decrease in inventories (1.8) 1.1 0.5 (0.2)(Increase)/decrease in tax receivable 0.0 0.0 0.0 0.0 (Increase)/decrease in NHS Trade Receivables (5.0) (2.2) (0.3) (1.0)(Increase)/decrease in Non NHS Trade Receivables 0.2 (0.0) (0.0) (0.1)(Increase)/decrease in other related party receivables 0.2 0.0 0.0 0.0 (Increase)/decrease in other receivables 0.5 (0.1) 0.4 0.0 (Increase)/decrease in accrued income (14.1) 0.2 (0.0) 0.0 (Increase)/decrease in other financial assets 18.9 0.0 0.0 0.0 (Increase)/decrease in prepayments (1.0) 0.4 0.0 0.0 (Increase)/decrease in Other assets (non chartable assets) 0.0 0.0 0.0 0.0 (Increase)/decrease in Other assets (charitable assets only) 0.0 0.0 0.0 0.0 Increase/(decrease) in Deferred Income (excl. Donated Assets) 0.9 (1.0) 0.0 0.0 Increase/(decrease) in Deferred Income (Donated Assets) (0.1) (0.0) (0.0) (0.0)Increase/(decrease) in provisions (1.1) (0.6) (0.5) (0.5)Increase/(decrease) in post-employment benefit obligations 0.0 0.0 0.0 0.0 Increase/(decrease) in tax payable 0.4 0.4 0.2 0.1 Increase/(decrease) in Trade Creditors (6.4) 0.5 (0.1) (0.4)Increase/(decrease) in Other Creditors 8.2 0.0 (0.4) 0.0 Increase/(decrease) in PDC Dividend Creditor 0.0 0.0 0.0 0.0 Increase/(decrease) in accruals (7.3) 0.1 (0.3) (0.3)Increase/(decrease) in other Financial liabilities (0.9) 0.1 (0.1) 0.1 Increase/(decrease) in Other liabilities (non chartable assets) 0.0 0.0 0.0 0.0 Increase/(decrease) in Other liabilities (chartable assets) 0.0 0.0 0.0 0.0

Non cash I&E items 33.0 36.1 37.1 47.0 Tax expense 0.0 0.0 0.0 0.0 Finance income/charges 8.2 8.6 (34.9) (38.0)Share of profit/(loss) from equity accounted investments net of cash distributions received 0.0 0.0 8.5 8.3 Other operating non-cash movements (0.6) 0.0 34.9 38.0 Depreciation and amortisation, total 13.4 16.5 17.5 20.5 Impairment losses/(reversals) 4.3 3.0 3.0 10.0 PDC dividend expense 7.5 8.5 8.6 8.8 Other increases/(decreases) to reconcile to profit/(loss) from operations 0.0 (0.5) (0.6) (0.6)

Cashflow from operations 23.1 35.3 38.2 49.6 Cashflow from investing activities (39.7) (22.9) (23.0) (11.0)

Property, plant and equipment - maintenance expenditure 0.0 0.0 0.0 0.0 Property, plant and equipment - non-maintenance expenditure 0.0 0.0 0.0 0.0 Proceeds on disposal of property, plant and equipment 1.9 1.7 0.0 0.0 Purchase of investment property 0.0 0.0 0.0 0.0 Proceeds on disposal of investment property 0.0 0.0 0.0 0.0 Purchase of intangible assets (1.3) (0.4) (0.4) (0.4)Proceeds on disposal of intangible assets 0.0 0.0 0.0 0.0 Expenditure on capitalised development 0.0 0.0 0.0 0.0 Increase/(decrease) in Capital Creditors (0.4) 0.1 0.0 0.0 Other cash flows from investing activities 0.0 0.0 0.0 0.0

Cashflow before financing (16.6) 12.3 15.2 38.6 Cashflow from financing activities (4.4) (15.5) (16.6) (19.0)

Public Dividend Capital received 7.5 0.0 0.0 0.0 Public Dividend Capital repaid 0.0 0.0 0.0 0.0 PDC Dividends paid (7.6) (8.5) (8.6) (8.8)Interest (paid) on bridging loans 0.0 0.0 0.0 0.0 Interest (paid) on commercial loans 0.0 0.0 0.0 0.0 Interest (paid) on non-commercial loans (0.6) (0.7) (0.6) (0.6)Interest (paid) on bank overdrafts (0.0) (0.3) (0.3) (0.3)Interest element of finance lease rental payments - other 0.0 (0.0) (0.0) 0.0 Interest element of finance lease rental payments - On-balance sheet PFI (8.6) (7.6) (7.6) (7.5)Capital element of finance lease rental payments - other (0.1) (0.1) (0.1) 0.0 Capital element of finance lease rental payments - On-balance sheet PFI (0.6) (0.6) (0.7) (0.7)Interest received on cash and cash equivalents 0.1 0.1 0.1 0.1 Movement in Other grants/Capital received 0.0 0.0 0.0 0.0 Drawdown of bridging loans 0.0 0.0 0.0 0.0 Repayment of bridging loans 0.0 0.0 0.0 0.0 Drawdown of non-commercial loans 10.2 0.0 0.0 0.0 Repayment of non-commercial loans (4.5) (1.0) (1.0) (1.0)Drawdown of commercial loans 0.2 0.1 0.0 0.0 Repayment of commercial loans 0.0 (0.0) (0.1) (0.1)(Increase)/decrease in non-current receivables 0.2 (0.0) (0.0) (0.0)Increase/(decrease) in non-current payables (0.6) 0.0 0.0 0.0

Net increase/(decrease) in cash (21.0) (3.2) (1.4) 19.5

Cash and Cash equivalents at PE 12.8 9.7 8.2 27.7

King’s College Hospital NHS Foundation Trust

Board Statements

2010/11

Clinical quality

The board of directors is required to confirm the following:

Mandatory services


Service performance


Risk management


In the event than an NHS foundation trust is unable to fully self certify, it should not insert an ‘X’ in the relevant box. It must provide commentary (using the section provided at the end of this declaration) explaining the reasons for the absence of a full self certification and the action it proposes to take to address it. Monitor may adjust the relevant risk rating if there are significant issues arising and this may increase the frequency and intensity of monitoring for the NHS foundation trust.

The board is satisfied that, to the best of its knowledge and using its own processes (supported by Care Quality Commission information and including any further metrics it chooses to adopt), its NHS foundation trust has, and will keep in place, effective arrangements for the purpose of monitoring and continually improving the quality of healthcare provided to its patients;

The board is satisfied that, to the best of its knowledge and using its own processes, plans in place are sufficient to ensure ongoing compliance with the Care Quality Commission’s registration requirements; and

The board is satisfied that processes and procedures are in place to ensure that all medical practitioners providing care on behalf of the NHS foundation trust have met the relevant registration and revalidation requirements.

The board is satisfied that it expects its NHS foundation trust to be able to continue to provide the mandatory services specified in Schedule 2 and Schedule 3 of its Authorisation.

The board is satisfied that plans in place are sufficient to ensure ongoing compliance with all existing targets (after the application of thresholds), and compliance with all targets due to come into effect during 2010/11.


Board Statements

2010/11

Compliance with the Terms of Authorisation


The board has considered all likely future risks to compliance with their Authorisation, the level of severity and likelihood of a breach occurring and the plans for mitigation of these risks;

The board has considered appropriate evidence to review these risks and has put in place action plans to address them where required to ensure continued compliance with their Authorisation; and

The board will ensure that the NHS foundation trust remains at all times compliant with their Authorisation and relevant legislation;

The board will ensure that the NHS foundation trust will, at all times, have regard to the NHS constitution;

The necessary planning, performance management and risk management processes are in place to deliver the annual plan;

A Statement of Internal Control (“SIC”) is in place, and the NHS foundation trust is compliant with the risk management and assurance framework requirements that support the SIC pursuant to the most up to date guidance from HM Treasury (see http://www.hm-treasury.gov.uk);

The trust has achieved a minimum of Level 2 performance against the requirements of their Information Governance Statement of Compliance (IGSoC) in the Department of Health’s Information Governance Toolkit; and

All key risks to compliance with their Authorisation have been identified and addressed.

For an NHS foundation trust engaging in a major joint venture, or any Academic Health Science Centre, the board is satisfied that the NHS foundation trust has fulfilled, or continues to fulfil, the criteria set out in Appendix D4 of the Compliance Framework.

Issues and concerns raised by external audit and external assessment groups (including reports for NHS Litigation Authority assessments) have been addressed and resolved. Where any issues or concerns are outstanding, the board is confident that there are appropriate action plans in place to address the issues in a timely manner;

All recommendations to the board from the audit committee are implemented in a timely and robust manner and to the satisfaction of the body concerned;


Board Statements

2010/11

Board roles, structure and capacity


Signature Signature

Printed Name Printed Name

Date Date

In capacity as Chairman

Signed on behalf of the board of directors, and having regard to the views of the governors

The management team have the capability and experience necessary to deliver the annual plan; and

The management structure in place is adequate to deliver the annual plan objectives for the next three years.

The board maintains its register of interests, and can specifically confirm that there are no material conflicts of interest in the board;

The board is satisfied that all directors are appropriately qualified to discharge their functions effectively, including setting strategy, monitoring and managing performance, and ensuring management capacity and capability;

The selection process and training programmes in place ensure that the non-executive directors have appropriate experience and skills;

In capacity as Chief Executive & Accounting Officer

O:\SECRETARIAT\BOARD OF DIRECTORS\BOD MEETINGS\2010\MAY 25\PUBLIC\ENC 3.1.5 SCHEDULE OF ASSURANCE 2010.DOC 1

Schedule of Assurance 2010 Self Certification by Board of Directors

The Board of Directors is required to confirm that:

Evidence of Assurance Executive Lead

1 CLINICAL QUALITY 1.1 1.2

The Board is satisfied that, to the best of its knowledge and using its own processes (supported by any relevant Care Quality Commission metrics and including any further metrics it chooses to adopt), its NHS foundation trust has and will keep in place effective arrangements for the purpose of monitoring and continually improving the quality of healthcare provided to its patients. The Board is satisfied that, to the best of its knowledge and using its own processes, plans in place are sufficient to ensure ongoing compliance with the Care Quality Commission’s registration requirements: and

Care Quality Commission Annual Healthcheck rating 2009 for ‘quality of services’ was Excellent ( Fair in previous year)

Standards for Better Health declaration for annual healthcheck 2009/10 – trust declared full compliance against all standards following comprehensive process of review by the Executive, Governance Committee and Board. Mid and year declarations continue to maintain full compliance. Internal audit review provided substantial assurance on the process followed ( February 2010)

Good progress developing Quality Accounts and Quality Report building on 2008/9 Annual Report

Appointment of Assistant Director of Quality

Designation of Executive Director of Nursing and Midwifery as Director of Infection Prevention and Control

Programme of Board Go See visits

MM/GW/RS/JW

ENC 3.1.5


1.3

New Board governance structure strengthening Board quality focus agreed in principle by Board of Directors April 2010, to be implemented by July 2010

Trust ARMS assessment at Level 2 and Maternity assessment at CNST Level 3 – King’s scored 100% against all standards.

Status of NICE guidance implementation closely monitored by the Clinical Effectiveness Committee and a report presented to the Governance Committee on a quarterly basis.

Quarterly updates and annual Infection Control (IC) Report presented by DIPC to Board. IC performance indicators included in divisional and trust score cards and monitored by the Performance Committee.

Unconditional registration with CQC against all Essential Standards under Health and Social Care Act 2008( March 2010)

Non compliance declared against Delivering Single Sex Accommodation – Board agreed action plan to deliver compliance by April 2011.


The Board is satisfied that processes and procedures are in place to ensure that all medical practitioners providing care on behalf of the NHS Foundation trust have met the relevant registration and revalidation requirements

From 16 November 2009 all

doctors were issued with a ‘licence to practice’. Automatic updates are received from GMC/ESR systems link and verification of discrepancies in registration details are promptly dealt with.

GMC consulting on process for revalidation – closing date 4th June 2010. Proposal to commence revalidation in 2011.

Trust has purchased 360° online appraisal system, and piloted this in 5 areas across the Trust. It will be rolled out during 2010.

Trust’s current appraisal scheme requires annual review of performance and job plan. Medical Workforce Committee take overview.

Comprehensive review (Assuring the Quality of Medical Appraisal (AQMAR)) undertaken via NHS London – September 2009 and action plan developed.

Medical rotas and job plans

AH


included in e-Rostering (Allocate) currently being rolled out throughout Trust.

Trust is scoping proposals/feasibility for purchase of online job planning system with GSTT.

2. MANDATORY SERVICES 2.1 The Board is satisfied that it expects its NHS

Foundation trust to be able to continue to provide the mandatory services specified in Schedule 2 and Schedule 3 of its authorisation

The trust continues to offer the full range of specialities listed in the mandatory services schedule

Any redesign/reconfiguration of services involving any potential change to the mandatory services schedule will be presented to the Board for approval ( eg vascular)

PF/AH

3 SERVICE PERFORMANCE 3.1 The Board is satisfied that plans are in place to ensure

ongoing compliance with all existing targets (after the application of thresholds) and national core standards, and a commitment to comply with all targets due to come into effect during 2010/11

Excellent track record of performance against key national targets. Top quartile performer.

Double excellent score in Annual Health Check

Comprehensive performance management structure/process, through to Performance Committee of the Board, First Choice work, Divisional Scorecards etc

Standards for Better Health Annual Declaration and mid year

RS/PF


declaration – fully compliant. Green governance rating 2009/10 Development of Quality

Accounts/Report/Scorecard New soft FM provider appointed in

year, and resulting quality improvements

PEAT score of good for environment, excellent for food and good for cleaning

4. RISK MANAGMENT 4.1 Issues and concerns raised by external audit and

external assessment groups (including reports for NHS Litigation Authority assessments) have been addressed and resolved. Where any issues or concerns are outstanding, the Board is confident that there are appropriate action plans in place to address the issues in a timely manner.

External/internal Audit recommendations included in Symbiant and reported to each Audit Committee. Also included in trust’s Risk register, and where appropriate on the Board Assurance Framework(BAF)

BAF reviewed by Board in year and action plans developed

ARMS General Assessment Level 2 achieved in September 2008 at 100% against all standards.

Maternity CNST level 3 Assessment January 2008 – 100% compliance against all standards.

Quarterly Integrated Risk /Governance reports to Clinical Governance & Risk Committee, Governance Committee, and Divisional/ Trust risk register

JM/JW/JS


Planned Review of BAF July 2009, linking with agreed trust strategy

Trust Risk Management Strategy and Board Assurance Framework Policy reviewed on an annual basis.

Distributed Governance model through Board Committee structure reviewed by Board April 2010, to be implemented by July 2010

Policy of responding to external reviews and recommendations outlining roles, reporting framework and register of actions /timescales for completion

2010 Internal Audit report on BAF and Risk Management confirms substantial assurance.

4.2 All recommendations to the Board from the audit committee are implemented in a timely and robust manner and to the satisfaction of the body concerned.

All Audit Committee minutes reported to Board and recommendations included on Symbiant, and progress in implementation monitored by the Audit Committee.

ST

4.3 The necessary planning, performance management and risk management processes are in place to deliver the annual plan.

Performance Management structures and processes (see 3 above), with regular reports to the Performance Committee and Board

Board Assurance Framework (see 4.6 below), Trust Risk Register and processes, systematic reporting to the Governance Committee and Board Process overseen by Audit

RS/PF/JW


Committee 4.4 A Statement of Internal Control (“SIC”) is in place, and

the NHS foundation trust is compliant with the risk management and assurance framework requirements that support the SIC pursuant to the most up to date guidance from HM Treasury (see http://www.hm-treasury.gov.uk).

Included in Annual Accounts submission. Reviewed by Internal and External Audit

TS/ST

4.5 The trust has achieved a minimum of Level 2 performance against the requirements of their Information Governance Statement of compliance (ISGoC) in the Dept of Health’s Information governance Toolkit

Although the Trust scored an overall rating of 79% on the Information Governance toolkit, 2 of the 65 requirements fell below level 2. These related to the existence of a confidentiality protocol before new procedures are introduced and a full Information Lifecycle Management Strategy and policy. Action plans exist to deliver compliance for 2010/11.

ST

4.6 All key risks to compliance with the Authorisation have been identified and addressed.

Key risks as identified by Board are included in Risk Register, reviewed by the Board on a 3 monthly basis with all red risks

Planned BAF review (section 3 above).

Risk assessment in Trust Strategy and Annual Plan

FT specific risks monitored through trust Risk Register, and relevant Board Committees

See assurances under sections 1 and 3 above

ST/JW/JW1

5. COMPLIANCE WITH THE TERMS OF


AUTHORISATION 5.1 The board will ensure that the NHS foundation trust

remains at all times compliant with their Authorisation and relevant legislation.

Regular reports on Performance and Finance to Performance and Finance Committees, and Board of Directors

Reports to Board of Directors and Board of Governors on quarterly compliance and Annual Plan presented to Board of Directors for formal approval taking into account the views of the Board of Governors

Reports on Governance issues to Governance Committee and Board.

KPMG review on compliance against terms of authorisation - substantial assurance

TS

5.2 The Board will ensure that the NHS foundation trust will, at all times, have regard to the NHS constitution

Continued rollout/implementation of the King’s Values, which are congruent with NHS Values, as enshrined in the constitution

Service elements – eg patients right to private treatment in certain circumstances monitored via Operations and Performance Committees

AH /RS

5.3 The board has considered all likely future risks to compliance with their Authorisation they face going forwards, the level of severity and likelihood of a breach occurring and the plans for mitigation of these risks.

Robust monitoring of performance against national targets through trust Performance Committee.

Board Assurance Framework and Policy

Trust Risk Register and risk assessment process

TS/ST


Risk Management Strategy. Performance assessment of

Executives Investment Committee of the Board of

Directors oversees commercial services strategy and development

Directors’ and officers’ liability insurance in respect of commercial services

KPMG review as above 5.4 The board has considered appropriate evidence to

review these risks and has put in place action plans to address them where required to ensure continued compliance with their Authorisation.

As above TS/ST

5.5 For an NHS FT engaging in a major joint venture, or

any AHSC, the Board is satisfied that the FT has fulfilled, or continues to fulfil the criteria set out in Appendix D4 of the Compliance Framework

Appendix D4 outlines a process of Board self certification, which Boards will be asked to endorse at the point at which the FT enters into a legal agreement ( eg AHSC Partnership Agreement, Pathology JV) These will be presented to the Board for approval at the appropriate time.

ST/JW

6.- BOARD ROLES, STRUCTURES AND CAPACITY 6.1 The Board maintains its register of interests, and can

specifically confirm that there are no material conflicts of interest in the Board.

Yes. Register of Interests maintained and reported in Annual Report. No material conflicts of interest in the Board. Process for declaration of any conflict of interest at all Board meetings

JW

6.2. The Board is satisfied that all Directors are appropriately qualified to discharge their functions effectively, including setting strategy, monitoring and managing performance, and ensuring management

Directors CVs Trust’s Record of Performance Directors’ Appraisal Scheme

AH


capacity and capability.

Board Evaluation process 2008/09 and Integr8 process Spring 2010

6.3 The selection process and training programmes in place

ensure that the Non-Executive Directors have appropriate experience and skills.

Nominations Committee oversees NED selection and recuitment on behalf of Board of Governors

Selection Training provided to Nominations Committee Members

NED Induction Programme Board Development Workshops NED Appraisal Scheme and reports

to Nominations Committee. Board evaluation programme

facilitated by Audit Commission Executive Directors’ appraisal

scheme and reports to Remuneration and Appointments Committee.

JW/AH

6.4 The management team have the capability and experience necessary to deliver the Annual Plan.

Directors’ and Senior Managers’ CVs

IWL Practice Plus Accreditation 2005

Cranfield College 360º Appraisal of Competency and Coaching Programme

King’s Management Coaching Programme

IiP Profile Accreditation Senior Management Mini-MBA Keele Clinical Leadership

Programme

AH


6.5 The management structure in place is adequate to deliver the annual plan objects for the next three years.

Trust Strategy Development Process

Trust Business Planning Process Objectives and Competence-based

Appraisal Scheme Board and Executive Committee

Structure IiP Profile Accreditation in 2007

TS/AH

ENC 3.1.6


Membership Report 2009-2010

DRAFT

Annual Plan 2010-11 Membership Report DRAFT 1

Membership Report

5.1 This section provides details of our membership and our membership development plans. Public Constituency Last year (2009/10) Next year (2010/11)

(estimated) At year start (April 1) 4,343 4,027New members 119 400Members leaving 435 400At year end (March 31) 4,027 4,027Minimum members required under Schedule 1 120 120 Patient Constituency Last year (2009/10) Next year (2010/11)

(estimated) At year start (April 1) 4,098 4,029New members 205 800Members leaving 274 300At year end (March 31) 4,029 4,529Minimum members required under Schedule 1 120 120 Staff Constituency Last year (2009/10) Next year (2010/11)

(estimated) At year start (April 1) 6,292 6,431New members 1,114 900Members leaving 975 900At end year (March 31) 6,431 6,431Minimum members required under Schedule 1 60 60


5.2 Public Membership analysis Population by Age Lambeth & Southwark % of population 0-16 106,250 20.79 17-21 31,267 6.12 22 + 373,518 73.09 Total Population 511,035 100.0 Public constituency Number of members % of membership Age (years) 0-16 0 0.00 17-21 46 1.14 22+ 3,686 91.53 Not stated 295 7.33 Total 4,027 100.0 Ethnicity Number of

members % of membership Population in Lambeth

& Southwark % of population

White 1,923 47.75 320,374 62.69

Black or Black British 1,440 35.76 131,970 25.83

Asian or Asian British 264 6.56 22,115 4.33

Mixed 166 4.12 22,000 4.30

Other 146 3.63 14,576 2.85

Not stated 88 2.18 0 0

Total 4,027 100.00 511,035 100.00


Gender Numbers % of membership Population in Lambeth

& Southwark % of population

Male 1,764 43.80 250969 49.11

Female 2,238 55.57 260066 50.89

unknown 25 0.62 0 0

Socio-Economic Groupings Number of members

% of membership Number within population*

% of population in Lambeth & Southwark

ABC1 3119 71.82 232860 57.93

C2 29 0.67 36641 9.12 D 68 1.57 64564 16.06 E 811 18.67 67885 16.89 Unknown 316 7.28 - -

* NRS Social Grade data 2008 (estimated population)

5.3 Patient Members Patient constituency Number of members % of membership Age (years) 0-16 0 0.00 17-21 21 0.52 22+ 3,840 95.36 Not stated 166 4.12 Total 4,027 100.0


5.4 Election Turnout No elections were held during 2009-10. 5.5 Membership Commentary Membership Categories We have three categories of members: 1. Patient members Anyone who is 16 or over, lives outside the Boroughs of Lambeth and Southwark and has been a patient at King’s - or a carer of a patient - in the last 6 years is entitled to become a patient member. Most of our patient members come from neighbouring London Boroughs and Kent, though we do have patient members from across the UK, due to the specialist services such as Liver transplantation that are carried out at King’s. 2. Public members We have defined our local catchment area as the London Boroughs of Lambeth and Southwark. Any resident of these two Boroughs is entitled to become a public member if they are age 16 or over. Any patient who lives within Lambeth or Southwark and applies for membership will automatically become a Public member. King’s has 6 public constituencies within the Public membership area. These geographic constituencies are based on Borough ward boundaries as indicated in the map below. Each of these constituencies is represented by two elected Governors. 3. Staff members All staff that have employment contracts lasting more than 12 months are automatically opted in to membership. They have the option to opt out should they so wish. Volunteers who work for the Trust and full time employees of King’s contractors are also eligible to become members, though they have to opt in to membership. There are six categories of staff membership who elect governors as follows:


Medical and Dental 1 Governor Nursing and Midwifery 2 Governors Allied Health Professionals, Pharmacy, Scientific and Technical

1 Governor

Managerial, Administrative and Clerical 1 Governor Support Staff 1 Governor

5.6 Membership Development Strategy The Trust’s Membership Development Strategy covers the period 2008 – 2011 and outlines our approach to maintaining and developing an active and involved membership of King’s College Hospital NHS Foundation Trust. It is key to the trust’s approach of placing patients and the public at the heart of what we do.

The strategy lays out the following objectives for membership development over the next three years: to develop a membership that is representative and reflective of the communities served by King’s to develop an informed membership by providing appropriate, accurate and timely information to our members to assist them in making

informed contributions to develop an involved membership where as many members as possible are actively engaged in the development of King’s and its

activities to maintain an efficient and cost-effective structure for managing and developing our membership systems. The objectives are supported by a Membership Development Action Plan which is reviewed by the Membership Committee of the Board of Governors who report progress annually to the Board of Governors and the Board of Directors. a) Membership Recruitment - Changes over the course of the year

The Strategy also sets out targets for membership recruitment as follows: For 2008/09 – 2010/11 the target annual increase is 1,000 members. In autumn 2009, the Governors’ Membership Committee agreed that, given the prevailing financial situation, membership recruitment by direct mail should be postponed for the financial year and reviewed at a later date. It was recognised that this would impact on the Trust’s ability to achieve its planned membership targets in 2009/10. Through the distribution of forms to patients, and other cost-effective activities, we recruited 324 members. 709 members left during the year. Therefore, there was a net decrease of 385, ie 4.8% of total membership. Given that most cost neutral recruitment started towards the end of


2009, it is likely that similar methods when applied over a whole year will result in a higher number of new members. This is reflected in the estimated levels for public and patient member recruitment in 2010/11 (see p.1). In the current financial climate in the NHS, King’s has been working with our Governors on the Membership Committee to develop low cost recruitment methods in order to maintain and increase membership numbers. These include: Mailings to local voluntary sector groups in Lambeth and Southwark, attending local community group meetings and AGMs Promoting membership via Lambeth and Southwark’s Patient and Public Involvement email alerts and newsletters Promoting membership as part of King’s “How are we doing?” patient feedback programme including:

o Giving out a membership application form with the How are we doing? inpatient survey which is given to all inpatients before discharge – this is proving a useful method of recruitment with an average monthly return of between 50 – 70 memberships

o Membership application forms are also being given out with our quarterly How are we doing? survey for Dental outpatients o Information about membership is also being included on a new electronic How are we doing? outpatient survey which is

currently being rolled out across all outpatient areas Locating membership forms and drop-boxes in outpatient areas Including membership information on Trust Comments and Suggestion Cards which is continuing to prove a useful method Developing a membership flyer as part of an on-going partnership with Lambeth College. This will be jointly badged with King’s and

Lambeth College logos and be targeted at students from the College In order to ensure increased representation of younger people aged between 16 and 35, the Trust has also set a target over the next three

years to recruit 1,000 new members from this group. We are tracking progress using a more detailed age breakdown than the standard age categories required by Monitor. There are 929 younger members aged between 16 and 35 (public and patient), a slight reduction from a level of 1,046 in 2008/09. We recruited 122 younger members during 2009/10. The decision to use cost neutral recruitment methods in the coming year will affect our ability to target younger people, especially from our patient population and, consequently, the likelihood of reaching the target of 1,000 new younger members by March 2011. Further information on recruitment is contained within the Membership Development Strategy Action Plan. There was a net increase in staff membership of 139 resulting in a year end total of 6,431. b) A Representative Membership We continue to work hard to ensure that our membership is representative of our local community, and continue to take steps to ensure that membership is accessible to all who are eligible, irrespective of age, gender, race or social background. Our membership database allows us to monitor the demographics of the membership and to address any gaps with targeted recruitment. ‘Black British’ members make up a larger percentage than within the local population, whilst ‘White British’ are under-represented. Annual Plan 2010-11 Membership Report DRAFT 7

Women are slightly over-represented and men are slightly under-represented compared with the local population. Socio-economic data indicates that, compared with the local population our membership is over-represented in the ABC1 category, under-

represented in C2 and D categories and representative in the E category.

5.7 Membership engagement a) Members’ Newsletter ‘Members News’, the members’ newsletter, was sent to all members four times this year. Members’ News is designed to update the membership on events at King’s and activities the Governors are involved with. It also highlights opportunities for members to get more involved in the Trust. Members also receive a summary version of the annual report. Following discussions with the Governor’s Membership Committee, the format of the newsletter was updated and now includes regular updates on the work of the Governors and member involvement. We have also been encouraging members to opt to receive the newsletter online in order to reduce King’s carbon footprint. 30% of our members have responded positively so far. b) Members’ pages on the website For those with internet access, there is a members’ section on the website, updating members on events and providing details of how they can contact Governors. We are in the process of re-designing King’s website and are encouraging members to get involved in the project. c) Involving our membership The trust is continuing to develop its programme of engaging and consulting with its membership. Below are some key highlights for the year. Community Events In May 2010 the Trust will hold a series of community events for Foundation Trust members. The dates will be publicised in our spring 2010 members’ newsletter. Three meetings will be held at King’s and in the wider community. The main purpose of the meetings is to provide members with an opportunity to hear about the Trust’s plans for the future and to share their views. The events will be chaired and attended by Trust Directors. As in previous years, there will also be information stands including stroke, trauma, infection control and deep vein thrombosis. Members will also have an opportunity to meet their Governors and find out more about the work they are involved with at the trust. We recognise that not all members who would like to attend community events are able to come. In order to capture more feedback from members, we will once again place information about the Trust’s future plans on our website during May. Members will be encouraged to email comments via the website. These, along with feedback from the community events, will be reflected in our final strategy. Prior to the events, we will contact over 2,500 members via email to remind them of the forthcoming events and the new information and feedback facility available on our website. Member Seminars


Over the course of last year the Trust held member seminars on a range of clinical topics. Led by our Clinical Nurse Specialists and consultants, these monthly seminars provide attendees with public health information about certain conditions and information on how King’s services within these areas are structured and delivered. Member evaluation continues to be very positive. Members value the opportunity to interact with staff and also to learn more about medical conditions and treatments. The evaluation has also shown that members come from a wide geographical area to attend the seminars. A full programme of seminars has run in 2009-10 with the addition of an evening seminar to enable members in employment to take part. Subjects have ranged from public health issues such as diabetes and stroke to more specialist conditions such as genetic heart disease and a seminar on King’s role as a major trauma centre. This year we have been very pleased to welcome young people studying at Lambeth College to our seminars. Involving members in developing King’s Values During 2009, King’s embarked on a trust wide project to develop a set of core values for the organisation. The aim was to develop a set of values that are unique to the trust and embody what is so special about King’s. The first phase of this project involved talking to over 200 staff in all roles and levels across the hospital. This provided us with some outline values but we wanted to make sure that these matched what was valued by our patients. We held a series of ‘In Your Shoes” events including one for members who had either been patients or a relative or carer of a patient treated at King’s. These events allowed patients to share their stories with staff. We asked patients to tell us about their experience at King’s – both the good and the not so good, how they felt at different times during their care with us and what behaviours made a difference to them. Similar events were held with our Governors and trust volunteers. The stories that people shared and the values that they felt were important helped the trust to refine its values and to ensure that the final values had the priorities of our patients at their heart. South London Line Campaign In 2009, we involved our members in a grassroots lobbying campaign to try and influence the Mayor of London and the Transport Secretary to protect a vital rail service via Denmark Hill, our main serving station. For this campaign, members were encouraged, via email, to sign an online petition to save the South London Line. Members were also mobilised by a lobby postcard campaign, asking them to fill the cards out and send them to their local MPs, so they could make representations on King's behalf. Local MPs have reported that they received hundreds of postcards from our Members and have facilitated a meeting between campaign stakeholders and the Rail Minister. Our local GLA Members also co-ordinated a meeting with the Mayor of London. Following these meetings Transport for London was instructed to carry out a review into local rail services and we are waiting to hear the outcome of that review. Involving members in teaching health professionals of the future – in collaboration with King’s College London In our Winter 2009 members newsletter we invited members to take part in a project being run by King’s College London who use patient stories as part of a multidisciplinary training session for health professionals. The teaching sessions involve medical, nursing and allied health profession students. The sessions enable the students to learn more about their roles. By giving them the opportunity to learn together, we hope they will gain a better understanding and appreciation of the work of different health professionals and what they each contribute to the patient experience of the health service. Getting health professionals to work well together will help to improve the quality of care for patients. We asked members who had been a patient at King’s in the last two years to volunteer to share their patient story of the care they received, both the good and not so good, or of living with long-term health difficulties. The sessions would also allow students to ask questions. After the session, the patient stories were used as case studies so that students could explore issues within the group and to discuss their different roles and responsibilities and how working together effectively would be helpful. We had a tremendous response from our members with over twenty



members willing to take part in the project. So far two sessions have been run where members have shared their stories and the programme is set to continue and grow. Lambeth College Partnership King’s has continued the partnership it began in 2008 with Lambeth College, one of our local further education colleges. Students continue to apply for voluntary work at King’s and also take part in work experience and King’s has also participated in their careers fair. We are also planning a jointly badged recruitment flyer aimed at students. An exciting part of the programme is the King’s Partnership Challenges. The first of these challenges, the ‘Research and Communication Challenge’ took place in the autumn 2009. Health and Social Care students were given the challenge of working with King’s award winning Sexual Health Centre. One of the services of the Sexual Health Centre is to provide self testing kits for Chlamydia and Gonorrhoea. The testing kits currently come with the manufacturer’s information which is highly technical. The aim of this “Research and Communication Challenge” was to encourage more young people to use the kits by getting the students to design a new, more user friendly guide. The students worked in teams to produce new guides, and a poster, and their work was judged by a panel from King’s and Lambeth College in January 2010. The winning team will be working with the King’s communications team to build on their work which will then be used by the Sexual Health Centre. Involvement going forward There are a number of other involvement opportunities being explored for members, for example: Partnership working with Southwark FE College to both recruit and involve young people following the Lambeth College model Involving members in a project to improve the experience of inpatients who have diabetes Involving members in sharing their experiences with patients as part of a new King’s Management and Leadership programme for Lead

Registrars Involving members in a number of “In Your Shoes” events focused on improving the experience of our patients

1

Report to: Board of Directors Date of meeting: 25 May 2010 By: Jane Walters, Director of Corporate Affairs Subject: Proposed changes to Board Governance Structure 1. Executive Summary This paper has been drafted in line with our policy to review governance periodically at KCH to ensure it remains fit for purpose. The current Board Governance structure has been in place since 2004, and was last reviewed in 2007. Although existing structures have served the trust well, a number of significant changes both within the trust and in the external and regulatory environment make this a timely point to review arrangements, to ensure the Board, its Committees and the structures which report into them remain relevant and effective, and facilitate both effective management of the organisation, and Board assurance. This report proposes some changes to the current Board Committee structure, which were approved in principle by the Board of Directors in April 2010. 2. KCH Background The revised Board structure and improvements to the operational, financial and risk management systems of the trust put in place from around 2004 were instrumental in the successful transition to FT status in December 2006. The King’s distributed governance model (Appendix A) has been highly effective in driving improved trust performance and in meeting quality and regulatory requirements, driven by a strong presence on all Board Committees of both Executive and Non Executive Directors. A top level analysis carried out in 2007 showed that around 75% of Board time was then spent on operational issues, and only 25% on strategic matters. This balance has been redressed to some extent by devotion of dedicated ‘private session’ time at each Board meeting, suggesting more of a 66/33% split currently 3. Corporate Governance Guidance A wealth of best practice guidance has been published since the current KCH Committee structure was established in 2004. This includes Monitor’s ‘Code of Governance’ (2006 and 2010), the’ Intelligent Board’ (Appointments Commission 2006), the’ Integrated Governance Handbook’ ( DoH 2006) and the ‘Healthy NHS Board – Principles for Good Governance’ ( National Leadership Council 2010). The ‘Healthy NHS Board’ suggests that NHS Boards (including FT Boards) have three main roles: Formulate Strategy Ensure Accountability Shape Culture

ENC 3.2

2

It could be argued that current Board committee structure is quite strongly focussed on ensuring accountability, with less focus on strategy and organisational culture. It is the role of Board Committees to seek assurance of management performance, but not to manage performance themselves. The Audit Committee provides additional independent assurance to the Board of the robustness of systems and processes in place to manage and mitigate organisational risks. The publication in February 2010 of the Francis report into mid Staffs is timely in terms of this review. David Nicholson urges all NHS Boards: ‘to actively consider the implications for the way that you do your business, how you as a Board assure yourselves and the community that you serve of the quality and safety of the services you provide.’ 4. External Imperatives Changes impacting on the trust externally and in the regulatory environment also point to the need for review of our current structure. These include: Our involvement as a partner in King’s Health Partners and KCH’s own strategy review

process The challenging financial climate, and the need to work increasingly in partnership to

deliver new models of care The increased external focus on quality across the 3 domains of patient safety, patient

experience and patient outcomes The statutory requirement for NHS trusts to publish Quality Accounts Publication of reports into Mid Staffordshire NHS FT Changes to Monitor’s compliance/reporting framework, and new CQC registration

requirements Recent best practice Corporate Governance guidance eg ‘The Healthy NHS Board -

Principles for Good Governance’ (February 2010) 5. Objectives The overarching objectives of this review are to:

Ensure greater Board assurance against the key areas of quality, performance and finance

Provide an enhanced Board and management focus on the 3 dimensions of quality – patient safety, outcomes and experience

Provide a stronger Board focus on strategy 6. Current and proposed arrangements NHS Boards are statutorily required to establish committees responsible for Audit and Remuneration/Appointments. They also have a statutory duty of Quality and Clinical Governance. Otherwise, Boards can establish such Committees as they see fit, although best practice guidance suggests the number of standing committees should be minimised. The current KCH Board Committees (Appendix A) are:

Audit (x5 pa, actual 4) Remuneration and Appointments (x2 pa and as needed, actual 3) Equality and Diversity (x4 pa, actual 4) Finance and Investment (x11 pa, actual 8) Performance (x11 pa, actual 10) Governance (x5 pa, actual 4)

3

Total = 38 meetings pa ( actual =33 )

This paper proposes changes to the current configuration of the Finance and Investment, Performance and Governance Committees, a stronger Board Committee focus on Quality, and the creation of a new Strategy Committee. No changes are proposed to the Audit, Remuneration and Appointments, and Equality and Diversity Committees. The proposed structure is shown in Appendix B. 6.1 Finance and Investment and Performance Committees The Finance and Investment Committee meets monthly, its principal purpose being to review monthly financial performance and treasury function, and to advise the Board on finance issues and investment strategy. The Investment Committee, which oversees commercial strategy and investments has more of a strategic focus, and is in effect a ‘Part 2’ of the Finance Committee. The Investment Committee does not need to meet monthly, as it is not tied to a monthly review cycle, and review of investment strategy tends to lend itself to a longer term focus. The Performance Committee meets monthly, its principal purpose being to oversee the performance of the trust. The trust monthly scorecard, which forms the basis of the monthly performance report includes operational, finance and quality indicators. There is significant overlap and duplication of discussion at Finance and Performance Committees, as operational and financial management are so closely linked. There are also differential reporting timeframes, resulting for example in Month 9 finance reports being considered alongside month 8 Performance reports at the Board. The Directors of Operations and Finance agree that ideally both reports and reporting timeframes should be aligned. 6.1.1 Proposal That a combined monthly Finance and Performance Committee be established to enable both operational and financial performance to be reviewed in the round. This arrangement will also enable the regular monthly monitoring of performance against core quality indicators alongside performance on national targets and compliance with Monitor’s financial risk rating. In order to strengthen compliance further, a draft of the Monitor quarterly submission could be reviewed by the committee prior to presentation to the Board. A separate Investment Committee would be established as a sub committee of a new Strategy Committee, meeting on a less frequent, as needed cycle. 6.2 Governance Committee NHS Trusts have a statutory duty for quality and clinical governance. The Governance Committee, which meets 5 times annually, oversees governance and provides assurance to the Board on quality and safety, with the Audit Committee providing independent assurance of trust wide systems and processes. The Governance Committee reviews trust performance and compliance against NHSLA Acute Risk Management Standards, CQC essential and core standards, and the Board Assurance framework, all of which are linked inextricably to the trust’s quality priorities and performance. The Governance Committee has a strong focus on patient safety. As in most NHS organisations, historically there has been less focus on the two other dimensions of quality – clinical outcomes and patient experience, although in theory both are reported and reviewed through this committee. And while there is a strong monthly operational focus on core aspects of quality and patient safety, the Board also needs to review trend information over a wider remit and longer time frame, and have sufficient time set aside in Committee to consider it.

4

6.2.1 Proposal That the Governance Committee is renamed the ‘Quality and Governance Committee’, responsible for overseeing the three dimensions of quality: Patient Safety Patient Experience Patient Outcomes as well as operational safety, risk management and compliance and information governance. Such a structure would enable sufficient focus on all three elements of the Trust’s quality accounts, progress against which would be reported on a quarterly basis to the Quality and Governance Committee. This would enable proper long term trend analysis and detailed review of issues such as mortality, as well as monitoring of other quality issues not covered elsewhere, including clinical audit. It would also complement and assure the top level monthly reporting against core quality KPIs to the Finance and Performance Committee. This integrated approach would support the recommendations of the Francis report, and provide stronger Board assurance on all aspects of quality, performance and financial management. 6.3 Strategy There is currently no standing Strategy Committee of the Board, and quarterly Board seminars have been used for in depth debate of longer term strategic issues. The attempt to incorporate strategy into the agendas and terms of reference of more operational committees has caused some drift away from primary objectives. 6.3.1 Proposal With the stronger strategic focus on partnership working and developing new models of care, the development of KHP, and the trust’s own strategy review process, the Board will increasingly need to devote more time to strategy matters. It is therefore proposed that a new Strategy Committee is established to review progress against the trust’s strategic objectives and discuss major strategic issues brought to it by strategic management committees. It will oversee: 1. The review of the development of trust-wide strategy and vision 2. Specific strategies including:

Finance and Commercial Estates and Assets Innovation ( R&D, IT etc) Workforce and Education KHP

7. Conclusion The proposed configuration of Board Committees is therefore as follows:

Audit Committee (x4 pa) - no change Remuneration and Appointments (x2 pa and as needed) - no change Equality and Diversity (x4 pa) – no change Finance and Performance Committee (x11 pa) Quality and Governance Committee (x5/6 pa) Strategy Committee (x4 pa)

Total = 31 meetings

5

It is proposed that the new arrangements come into effect from 1 July 2010. The Board committee timetable for the remainder of the year will be revised as required, which as far as possible will adhere to diarised dates to minimise disruption. All Board Committees will be chaired by Non Executive Directors, and relevant Executive Directors will play a more prominent role as lead Executive Director for each committee, working closely with the Non Executive Chair. The new Finance and Performance Committee will be chaired by Michael Parker and the new Strategy Committee by Robert Foster. The Executive will also consider separately the support and resourcing needed to deliver the new structure, and to strengthen compliance and assurance management functions, and draw up plans and terms of reference for new management committees reporting into the Board Committees The terms of reference of Board Committees may need to be revised to reflect the new management committee structure reporting into them, once this has been finalised. 8. Recommendations 1. That Board of Directors approves the Board Committee Structure – shown in Appendix B. 2. That the Board of Directors approves the draft terms of reference for the Strategy, Finance and Performance and Quality and Governance Committees, shown in Appendix C 3. That the Board agrees that the revised Board Committee structure comes into operation with effect from July 2010.

DISTRIBUTED GOVERNANCE FRAMEWORK

Board of Directors

Governance Committee

Equality & Diversity

Committee

Finance & InvestmentCommittee

PerformanceCommittee

Audit Committee

Trust Executive

Remuneration & Appointments

Committee

I NDEPENDENT

ASSURANCE

I NDEPENDENT

ASSURANCE

BOARD

ASSURANCE

MANAGEMENT

ASSURANCE

Enc 3.2Appendix A

BOARD PROPOSED COMMITTEE STRUCTURE

Board of Directors

Equality &Diversity

Committee

Quality &GovernanceCommittee

Performance & Finance

Committee

Audit Committee

Audit Committee

Trust Executive

Infection Control Committee& sub-groups

Clinical Risk Mgmt GroupMedical Devices GroupMedicines Management CtteeResuscitation CommitteeTransfusion CommitteeConsent Working GroupRecords Management GroupHuman Tissue Act GroupPatient Discharge

Remuneration & Appointments

Committee

InformationGovernance

Patient SurveysHRWD + PROMSComplaints and PALSPatient InformationQuality Ward RoundsEnd of Life Care GroupHealthcare for All GroupWeb Advisory GroupNutrition GroupDSSAPPI / Membership

StrategyCommittee

Operational SafetyCommittee

Patient SafetyCommittee

Patient ExperienceCommittee

Patient OutcomesCommittee

InvestmentCommittee

Public Health CommitteeClinical Effectiveness /

Audit CommitteeMortality Monitoring GroupDeteriorating Patient GroupDiabetes Improvement GrpNational InquiriesOrgan Donation CommitteeNew Clinical Procedures

CtteeClinical Guidelines Group

Health & Safety CtteeHealth & Safety Leads Occupational HealthEnvironment CommitteeRadiation ProtectionFire, SecurityMoving & HandlingMandatory TrainingSafeguarding Cttee

BOARD

ASSURANCE

MANAGEMENT

ASSURANCE

I NDEPENDENT

ASSURANCE

I NDEPENDENT

ASSURANCE

Operations CommitteePerformance Improvement

GroupDivisional Monthly Perform-

ance meetingsBusiness Continuity GroupContinuity Planning and

Disaster Recovery

Trust wide Strategy/ Vision/Values

Trust Strategies- Finance & Commercial- Estates & Assets- Innovation (R&D, IT)- Workforce & Education- KHPTransformation BoardBRSGCEFGIT Strategy GroupR&D CommitteeMedical Workforce Cttee

Patient Diversity GroupStaff Diversity GroupCultural Diversity GroupOther Diversity Groups

Internal & External AuditCounter Fraud

Clinical Directors

Nursing & Midwifery Board

ENC 3.2 Appendix B

DRAFT

Name of Committee/Policy Group

Finance & Performance Committee

Chair Trust Chair

Secretariat Membership At least 2 Non-Executive Directors

Chief Executive Chief Financial Officer Executive Medical Director Executive Director of Operations Executive Director of Nursing & Midwifery Executive Director of Workforce Development Director of Capital, Estates & Facilities; Director of Strategy Director of Corporate Affairs Director of Finance Assistant Director of Performance & Contracts Head of Capacity Planning & Service Developments

Quorum 3 members including at least 1 Non-executive and 2 Executive Directors from the CEO, CFO and Director of Operations

Frequency of meetings Monthly Overall Purpose To monitor monthly finance, operational and quality performance of the

Trust. Provide assurance to the Board of compliance against Monitor

governance and financial risk ratings.

Terms of Reference 1. Monitor the Trust’s Balanced Scorecard and other Trust-Wide performance issues, be made aware of the key current performance issues and any indicators where there is a downward trend in performance, and receive assurance that actions are being taken to bring performance back on target.

2. Regularly review the Trust’s performance against the Care Quality

Commissions’ Annual Health Check assessment criteria and plans to address any adverse performance.

3. Receive reports from Divisions on strategy, operational, quality and financial performance against Trust’s KPIs, including plans to address any key performance issues.

4. Review Trust performance against Monitor governance and finance risk ratings prior to submission to the Board

5. To review the following financial areas: - Financial Budgets - Financial Statements - Outline Capital Programme - Delegated limits - Financial Strategy -Working Capital Requirements -Projected and Actual Cash Flow - Use and availability of working capital facilities - Aged debtors and creditors - Capital Programme and major variances - Resource Implications of Risk Assessments from the Quality and Governance Committee - Full year and medium term forecasts

ria vavakis

Text Box

Enc 3.2 Appx C

- Funding requirements - Borrowing requirements - Income and Expenditure - Balance Sheet position

Reports to Board of Directors Receives reports from Reporting Committees Operations Committee

Performance Improvement Group Divisional Monthly Performance Meetings Capital Estates and Facilities Group Business Continuity Group Continuity Planning and Disaster Recovery

Board of Directors Strategy Sub-Committee – Terms of Reference

Strategy Committee

Chair Robert Foster, Non-Executive Director

Secretary Corporate Affairs and Strategic Development Directorate

Membership All Board Members

Frequency Quarterly

Quorum 5 members including at least one Non-executive and two executive Directors. The Committee Chair, the Trust CEO and the Director of Strategy will be required to attend.

Main Purpose of Committee

To assure the Board of progress against delivery of the Trust’s strategy and provide an opportunity to help shape the Trust’s strategy

Terms of Reference

1. To review progress against the Trust’s strategic objectives

2. To review the major functional strategies of the Trust

Format Objective 1: Strategic Development will prepare a strategic matrix which sets out Trust performance against its strategic objectives for each quarter (with input from divisions)

Objective 2: executives will report on two of the Trust’s major functional strategies per quarter, including:

o Workforce

o Finance, commercial and IT

o Estates and Assets

o R&D and academic o KHP and service strategy

Reporting Committees

The major ‘functional’ management committees that have a strategic focus will report in to the Strategy Committee, including: Workforce strategy committee Business Resource and Strategy Group Commercial strategy group Investment Committee IT Strategy group R&D executive group KHP Strategy group Service Strategy group Transformation Board

1

Report to: Board of Directors

Date of meeting: 25 May 2010

Subject: Revised NHS Foundation Trust Code of Governance 2010

Author(s): Rita Chakraborty, Assistant Board Secretary

Presented by: Jane Walters, Director of Corporate Affairs

Sponsor: Jane Walters, Director of Corporate Affairs

History: Previously considered by KE on 17 May 2010

Status: Decision

Introduction Monitor’s Code of Governance was originally published in September 2006. The revised code published in March 2010, reflects statutory and regulatory changes – introduction of NHS Act 2006, creation of the Care Quality Commission, introduction of LiNKs - plus developments in governance best practice. The revised code applies from 1 April 2010 and compliance will be reported in the annual report 2010/11. This code is best practice advice. It is not mandatory guidance and accordingly, non - compliance with the provisions of the code will not in itself give rise to a breach of condition 5(2) of the terms of authorisation (duty to comply with the principles of best practice on corporate governance). NHS foundation trusts are, however, strongly encouraged to take full account of the best practice provisions described in this code. Since March 2008, the trust has published in its annual report a full statement of disclosure as to how it applies the main and supporting principles of the code; secondly, a statement of compliance with the provisions of the code. In the event that the Board of Directors has determined that departure from a code provision is justified, an explanation has been provided, an approach known as ‘comply or explain’. Main changes The main changes from 1 April 2010 are outlined below with the appropriate code provisions: Section A: Directors

ENC 3.3

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Additional supporting principle added regarding the requirements to ensure the trust exercises its functions effectively, efficiently and economically.

A.1.5 The board of directors should ensure that adequate systems and processes are maintained to measure and monitor the NHS foundation trust’s effectiveness, efficiency and economy as well as the quality of its healthcare delivery. The board should regularly review the performance of the NHS foundation trust in these areas against regulatory and contractual obligations and approved plans and objectives. Additional wording to reflect additional focus on board skills, the importance of

appropriate external assurance, and the design and measurement of relevant indicators.

A 1.5 The board of directors should ensure that relevant metrics, measures, milestones and accountabilities are developed and agreed so as to understand and assess progress and delivery of performance. Where appropriate, and in particular in high risk or complex areas, independent advice should be commissioned by the board of directors to provide an adequate and reliable level of assurance. Action: Monitoring of the trust’s progress against performance and service quality will be through the Strategy Committee, Quality Governance Committee and the Finance and Performance Committee. All committees will report to the Board at appropriate intervals (monthly/quarterly). A.3.6 Non-executive directors should receive the necessary information and feel able to raise appropriate challenge of recommendations or decisions of the board, in particular making full use of their skills and experience gained both as a director of the trust and also in other leadership roles. They should expect and apply similar standards of care and quality in their role as a non-executive director of an NHS foundation trust as they would in other similar roles.

Action: The Board will procure advice as necessary

Section B: Governors

Requirement for the identification of a nominated lead governor. (Appendix B to the code outlines the role of the lead governor)

B.1.3 …The annual report should also identify the nominated lead governor… Action: Lead Governor appointed March 2010. The annual report will include the name of the nominated lead governor. The trust will ensure that governors and directors have information on the role of the lead governor as outlined by Monitor. Additional clarification regarding the relative and complementary roles of

boards of governors and the boards of directors.

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B.1.8 The board of governors should ensure its interaction and relationship with the board of directors is appropriate and effective, in particular, by agreeing the availability and timely communication of relevant information, discussion and the setting in advance of meeting agendas and use, where possible, of clear, unambiguous language. Action: continue to hold annual Board to Board workshops between governors and directors, and an annual Board of Governors development day. Board of Governor agendas now circulated to governors in advance of meetings inviting contributions.

B.1.9 Governors should acknowledge the overall responsibility of the board of directors for running the NHS foundation trust and should not use the powers of the board of governors to veto the decisions of the board of directors or otherwise obstruct the implementation of agreed actions and strategies. Through the nominated lead governor, the board of governors should communicate directly with Monitor if the NHS foundation trust is at risk of significantly breaching the terms of its authorisation and if these concerns cannot be satisfactorily resolved.

Action: The trust will ensure that governors and directors have information on the role of the lead governor as outlined by Monitor.

Section C: Appointment, resignation and term of office

Additional provision added where the trust operates two nominations committees.

C.1.5 …the nominations committee responsible for the appointment of non-executive directors should consist of a majority of governors. Action: review the current membership of the nominations committee as part of a review of the trust’s constitution. Additional provision regarding external advisors voting on the nominations

committee. C.1.12 An independent external adviser should not be a member of or have a vote on the nominations committee(s). A change to the terms of appointment length for non executive directors. C.2.2 Non-executive directors, including the chairman, should be appointed by the board of governors for specified terms subject to re-appointment thereafter at intervals of no more than three years and to the 2006 Act provisions relating to the removal of a director…. Any term beyond six years (e.g. two three-year terms) for a non-executive director should be subject to particularly rigorous review, and should take into account the need for progressive refreshing of the board. Non-executive directors may in exceptional circumstances serve longer than six years (e.g. two three-

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year terms following authorisation of the NHS foundation trust), but subject to annual re-appointment. Serving more than six years could be relevant to the determination of a non-executive director’s independence (as set out in provision A.3.1). Action: Terms and conditions of office of Non Executive Directors are determined by the Board of Governors, and any change to current arrangements would need to be agreed by them. At present, the chairman and non-executive directors serve four-year terms of office, to a maximum of two terms (eight years), and annual election thereafter ‘in exceptional circumstances’. Original guidance recommended a maximum of three three-year terms (nine years). The trust’s position is explained in the Annual Compliance Statement. Retention of necessary skills within its board of directors and arrangements

for appropriate succession planning. C.3.1 The board of directors should not agree to an executive member of the board leaving the employment of an NHS foundation trust, except in accordance with the terms of their contract of employment, including but not limited to service of their full notice period and/or material reductions in their time commitment to the role, without the board first having completed and approved a full risk assessment. Action: To be discussed by the Remuneration and Appointments Committee Recommendation that executive directors are re-appointed for a fixed period

of no more than five years has been deleted. Section D: Information, development and evaluation

Additional provision emphasising the need for assurance and challenge of information supplied to the board.

D.1.4 The board of directors, and in particular non-executive directors, may reasonably wish to challenge assurances received from the executive management. They need not seek to appoint a relevant adviser for each and every subject area that comes before the board of directors, although they should wherever possible ensure that they have sufficient information and understanding to take decisions on an informed basis. When complex or high risk issues arise the first course of action should normally be to encourage further and deeper analysis to be carried out, in a timely manner, within the NHS foundation trust. On occasion, non-executives may reasonably decide that external assurance is appropriate.

Additional provisions relating to governor and member involvement with the

forward plan. D.1.5 Governors should canvass the opinion of their members, and for appointed

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governors the body they represent, on the NHS foundation trust’s forward plan, including its objectives, priorities and strategy, and their views should be communicated to the board of directors.

Additional supporting principle relating to chairman’s appraisal. The focus of the chairman’s appraisal will be his/her performance as leader of the board of directors. The appraisal should carefully consider that performance against pre-defined objectives that support the design and delivery of the NHS foundation trust’s priorities and strategy described in its forward plan.

Action: Governors’ Nominations Committee to review the existing appraisal framework to ensure that there is an appropriate focus on the specified areas. Further clarification relating to the removal processes for a governor, including

the use of an independent assessor. D.2.3 There should be a clear policy and a fair process for the removal from the board of any governor who consistently and unjustifiably fails to attend the meetings of the board of governors or has an actual or potential conflict of interest which prevents the proper exercise of their duties. In addition removal from the board of governors may be appropriate where behaviours or actions by a governor or group of governors may be incompatible with the values and behaviours of the NHS foundation trust. Where there is any disagreement as to whether the proposal for removal is justified, an independent assessor agreeable to both parties should be requested to consider the evidence and conclude whether the proposed removal is reasonable or otherwise.

Section F: Accountability and audit

Additional provisions relation to a report to the board of governors regarding: External auditor performance; and Period of time which the external auditor is appointed

F.3.5 The audit committee should make a report to the board of governors in relation to the performance of the external auditor, including detail such as the quality and value of the work, and the timeliness of reporting and fees, to enable the board of governors to consider whether or not to reappoint them. The audit committee should also make recommendations to the board of governors in relation to the appointment, re-appointment and removal of the external auditor and approve the remuneration and terms of engagement of the external auditor.

Action: Audit Committee to present a report to the Board of Governors annually (autumn). F.3.6 The NHS foundation trust should appoint an external auditor for a period of time which allows the auditor to develop a strong understanding of the finances, operations and forward plans of the NHS foundation trust. The current best practice is for a three to five year period of appointment.

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Action: the current auditor contract is for a period of 3 years with effect from 01 April 2009. The Audit Committee should ensure that any further re-appointment of an external auditor takes into consideration current best practice.

Recommendation The Board of Directors is asked to note the changes to Monitor’s Code of Governance for NHS Foundation Trusts and to offer comments on the suggested actions.

Enc 4.1.1 Confirmed Finance Cttee Mins 25 March 10

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King’s College Hospital Board of Directors FINANCE COMMITTEE Minutes of a meeting held at 2.00pm on Thursday, 25 March 2010 in the Dulwich Committee Room, King’s College Hospital Present: Michael Parker (MP) Trust Chair / Chair of Committee Martin West (MW) Non-Executive Director Tim Smart (TS) Chief Executive Simon Taylor (ST) Chief Financial Officer Roland Sinker (RS) – 2.40pm to 3.15pm Executive Director of Operations Angela Huxham (AH) Executive Director of Workforce Development Jane Walters (JW) Director of Corporate Affairs Mike Marrinan (MM) Medical Director Simon Dixon (SD) Deputy Director of Finance In attendance: Ria Vavakis (RV) (Minutes) Item No.

Subject Action By whom & when

10/22 Apologies Maxine James, Geraldine Walters, Ahmad Toumadj, Jacob West

10/23 Declarations of Interest

None.

10/24 Chair’s Action None.

10/25 Minutes of Meeting held on 19 February 2010

The Minutes of the meeting held on 19 February 2010 were approved subject to the following amendments:

Item 10/17 under “Matters arising” - add “the Finance Committee,” after the words “audited accounts”.

10/26 Matters Arising/ Action Tracking

Action tracking 10/17 – FTFF: Completed. 10/17 – Staffing costs: Completed. 10/18 – Finance Report (Month 10): Completed and superseded.

Enc. 4.1.1

Item No.


10/19 – Treasury Management Report (Month 10): ST advised that there are no funds in the Anglo Irish Bank account upon which to report. Matters arising 10/17 – Staffing costs:

MP requested that the paper on staffing costs be renamed.

ST queried how many people had carried forward holiday leave. AH noted that there was no central record of this information. However, going forward, systems have been put in place to even out the peaks and troughs in holiday leave being taken. AH will circulate the workplace scorecard.

AH

FOR REPORT

10/27 Finance Report

ST presented the report. The Trust’s deficit position has reduced from £3.7m to £2.8m in month 11 due to reduced expenditure. Nursing staff costs have plateaued. It is unlikely that these costs can be reduced further without affecting safety levels. There has been a downturn in the level of patient transport being booked. Overperformance Agreement has been reached with Southwark on overperformance. There continues to be an issue in relation to PICU high dependency beds. PF has written to Southwark noting that the minimum overperformance amount which the Trust will accept in relation to these beds is £500,000 and that if this amount is not paid the Trust will commence arbitration. Impairments The Trust is still awaiting a final report from the District Valuer. The level of impairments has been complicated by the planned obsolescence of old buildings. It was noted that a rating consultant could be retained by the Trust to challenge the District Valuer’s conclusions, however, it would be too late to do this in


2

Item No.


respect of the current financial year. CAGs A CAG scorecard is being produced which will include financial elements and possibly also governance issues. Cost reduction activity TS requested clarification as to whether any decisions on cost reduction had been made which would materially affect the ability of any clinical division to perform. ST advised he was not aware of this being the case, although there have been some recent discussions in connection with deferring critical care capital investment plans. RS noted that no decision had yet been made as to where and how to increase critical care capacity. A decision is likely to be made in the next ten days. TS requested that any trade-offs are flagged appropriately to the Finance Committee. Agency and locum spend MW queried why the agency and locum spend in general medicine was much higher than in other divisions. RS noted that this was mainly because it was difficult to recruit permanent staff in general and emergency medicine. The highly skilled migrant programme restrictions have impeded permanent recruitment. This issue is not specific to the Trust, and has enabled locums to manoeuvre their position. Debtors MW queried whether it was possible to push for payments on account from governments. Risk rating TS queried the consequences of a financial risk rating of 3 when the planned target was 4. ST noted that, all other things being equal, the Trust would still be rated ‘good’. It was agreed that future finance reports will reinstate a balance sheet, income and expenditure statement and cashflow statement.

ST

10/28 Treasury Management Report

ST presented the report.


3

Item No.


It was noted that the Trust’s working capital facility had been utilised in month 11. It has since been topped up by funds from the Southwark overpayment. MW queried the amount of the FTFF loan. ST noted that the Trust originally envisaged borrowing £5m, however, borrowing at such a level would have taken the Trust over its prudential borrowing limit and therefore the amount was reduced to £4.5m. It was agreed that ST should write to Nick Rose at FTFF explaining the Trust has reached its prudential borrowing limit.

ST

10/29 CPP and FRG – March 2010

The committee noted the minutes. TS expressed concern that it was not clear from the minutes that the Energy Centre was £960,000 overspent. This was unsatisfactory given that the minutes were the mechanism by which the Board and Finance Committee ensured oversight of these programmes. A full report on the Energy Centre should be made at the next Finance Committee meeting. It was agreed that future finance reports will include a section on capital projects. To include the amount of and explanation for any overspend.

ST

ST

10/30 AOB There was no other business. Next meeting Thursday, 22 April 2010, 2.00pm, Dulwich

Room


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Enc 4.1.2 Finance Cttee Mins 22 April 10 conf

1

King’s College Hospital Board of Directors FINANCE COMMITTEE Minutes of a meeting held at 10.00am on Thursday, 22 April 2010 in the Dulwich Committee Room, King’s College Hospital Present: Michael Parker (MP) Trust Chair / Chair of Committee Martin West (MW) Non-Executive Director Tim Smart (TS) Chief Executive Simon Taylor (ST) Chief Financial Officer Roland Sinker (RS) Executive Director of Operations Geraldine Walters (GW) Executive Director Nursing and Midwifery Jane Walters (JW) Director of Corporate Affairs Mike Marrinan (MM) Medical Director Ahmad Toumadj (AT) Director of Capital Facilities and Estates Simon Dixon (SD) Deputy Director of Finance In attendance: Ria Vavakis (RV) (Minutes) Item No.


10/32 Apologies Maxine James

10/33 Declarations of Interest

None.

10/34 Chair’s Action None.

10/35 Minutes of Meeting held on 25 March 2010

The Minutes of the meeting held on 25 March 2010 were approved subject to the following amendments:

Item 10/27 under ‘Risk Rating’ replace ‘include’ with ‘reinstate’

10/36 Matters Arising/ Action Tracking

Action tracking 10/26 (Action tracking/matters arising) – JW will remind AH to circulate the workplace scorecard. 10/28 (Treasury Management Report) – Completed. Review of Committee Performance – To be

JW/AH

RV

Enc. 4.1.2


2

Item No.


scheduled for May meeting. Matters arising None.

FOR REPORT

10/37 Finance Report – Month 12

ST presented the report. The Trust recorded a deficit of £1.456m for the financial year 2009/10 which included an impairment loss of £4.318m. The impairment was £500k larger than expected and the planned £6m surplus was not achieved. The committee thanked SD and Nicola Hoeksema for closing the accounts so quickly after year end. CAGs IT was noted that, once the CAG structure is fully operational, a reporting system will need to be in place so that any cost overruns can be quickly identified. TS noted that RS and Eileen Sills will still have direct control over month on month performance. CAG leaders are mandated to deliver a 3 to 5 year plan. Their role is that of CAG leader, not CAG ‘manager’. There is still work to be done to make sure this is accurately reflected in the partnership agreement. Locums MW queried whether, in light of the large locum spend in general medicine, that division’s business plan should come to the committee. SD noted that it was difficult to attribute income to emergency activity – income was recognised as admissions in other areas. It was noted that there was a career grade gap affecting emergency departments nationwide and that at some point resident doctors would be available at a non-locum rate. MW stressed that the committee required assurance that locum spend wouldn’t continue to move adversely against budget. Improving margins RS noted that, historically, the Trust has focused on income generation rather than on improving margins. Whilst the concept of contribution is understood by most, often margins are not factored into how divisions


3

Item No.


operate on a daily basis. Divisions need to be managed in some way to beat their budgets. The importance of providing appropriate and timely information (e.g. the cost of overheads) to trigger divisions to think more carefully about margins was stressed. Clear lines of contribution will need to be drawn within the new divisions. Managers must learn to control all costs and not just the CIP which is a marginal amount.

10/38 Treasury Management Report

ST presented the report. It was noted that, unlike other years, there was hardly any debt outstanding. This was due to the deal negotiated with the PCTs regarding overpayment which required the agreed sum to be paid immediately. The committee thanked the members of the Finance Team who negotiated the deal with the PCTs and the District Valuer.

10/39 Draft Annual plan 2010/2011

ST presented the report. It was noted that the Trust would need to achieve more than just a break-even position over the coming financial year. It also reflected the fact that capital expenditure required at least break even to be funded. Income TS indicated that it was likely the Trust would receive £4m of the £100m Diamond Trust payment as last year. Payment is likely to be conditional upon the application of patient level costing and upon medical productivity across the Diamond group. Capital plan There are currently three major projects: maternity, E&D and critical care. All three projects involve the Golden Jubilee Wing. These need to be prioritised and implemented as economically as possible. Discussions have taken place with the HPC board, however, it has indicated that 12 months will be needed to make preparations for the proposed changes to the Golden Jubilee Wing. The HPC funders have also indicated that they will require a 10% payment to consider any changes. AT noted that he is looking into whether the CT


4

Item No.


scanner can be built on the other side of the E&D building (which is not subject to the PFI contract). MM stressed that critical care is operating under capacity and that in patients are being turned away. The clinical priority has been added to by the trauma centre going live. It was agreed that TS and ST would discuss how to leverage conversations with HPC and its funders and report back to the committee. Critical care MM noted that some of the items on the capital pan were the subject of red risk ratings. Critical care issues will also be the subject of inspections and site visits in the near future. Reputational issues may arise if plans aren’t put in place to increase capacity. Critical care issues will be raised with the Board of Directors in May as part of the annual plan process. It was agreed that critical care issues should be put on the agenda for the May meeting of the committee. Contracts with PCTs TS noted that contracts are currently being negotiated with the LSL Alliance and will be signed by NHS Southwark on behalf of all of the PCTs (subject to 75% majority agreement by the PCTs). It was noted that PCTs are increasingly commissioning for what they can afford, rather than what is needed. Action plans need to be put in place to make sure the Trust can deliver on its side of the System Wide Sustainability project without compromising safety. It was noted that the expected lifting of the Private Patient cap was planned to have no contribution in the plan.

TS/ST

RV

10/40 Report on Energy Scheme

ST presented the report. ST noted that one of the causes of project overspends by the Trust was design creep. A system needs to be put in place so that absolute assurance can be provided by design sponsors that the proposed design meets all Trust requirements. It was reported that the Energy Centre


5

Item No.


overspend was affected by a tight deadline which needed to be complied with in order to obtain a £5m grant from the Department of Health. AT noted that the Trust was disputing the cost of a number of items which should have been picked up by Dalkia during the survey stage. MW stressed the importance of conducting adequate due diligence and not rushing into the appointment of designers. He queried whether OB forms had been used and noted that the Trust should follow good NHS practice notwithstanding that the project was not a PFI project. It was noted that the OB forms were not used to price this Centre. TS was concerned that the report did not provide assurance to the committee that similar overspends would be controlled in the future (which the committee requires in order to be able to provide assurance to the Board of Directors that lessons have been learned and will be applied). ST and AT to consider ways in which tender evaluation and design creep issues can be improved to avoid later overspend on capital projects. The process was to be revised and brought back to this Committee in June 2010.

ST/AT

10/41 AOB There was no other business. Next meeting Tuesday 18th May 2010, 2.00pm, Dulwich

Room

ENC 4.1.3

PERFORMANCE COMMITTEE Minutes of the meeting held at 14.00 on Thursday 8th April in The Dulwich Committee Room King’s College Hospital Present: Robert Foster – Chair

Prof. Alan McGregor Tim Smart Mr Mike Marrinan Simon Taylor Roland Sinker Ahmad Toumadj Jacob West Peter Fry Sue Field

Non-Executive Director / Committee Chair Non-Executive Director Chief Executive Executive Medical Director Chief Financial Officer Executive Director of Operations Director of Capital Estates & Facilities Director of Strategy Assistant Director Performance & Contracts Head of Capacity Planning & Service Development

In attendance: Jane Walters

For Item 2.2: Ann Wood Mr Olaf Wender

Director of Corporate Affairs

DM – Cardiac & Neurosciences CD – Cardiac

Apologies: Angela Huxham Dr Geraldine Walters Simon Dixon

Director of Workforce Development Executive Director of Nursing & Midwifery Director of Finance

For Circulation to: Trust Board Members Divisional Managers Action

10/23 Minutes of the Previous Meeting of 11th March 2010 The minutes of the meeting held on 11 March 2010 were approved.

10/24 Matters Arising The Committee noted the remaining outstanding actions.

FOR DISCUSSION: 10/25

Trust Performance Report – Month 11 R Sinker presented the Performance Report on the overall Trust position at the end of month 11 highlighting that 3 of the 4 key areas of performance remain on track - 18 weeks, infection control and emergency ‘4 hour wait’.

Whilst there had been significant improvement in the level of MRSA cases to date in 2009/10 compared with the same period in 2008/09 the Committee raised concern regarding achieving the challenging 2010/11 target (9 cases) and asked for confirmation on the escalation process for each MRSA case. MRSA escalation process to be confirmed

GW

1

2

10/26

Elective average length of stay increased in month, moving further away from target. Non-elective average length of stay improved in month but remained marginally off target. A number of actions at both a trust-wide and divisional level are being taken to reduce length of stay. The Committee requested divisions to explain why they’re not in the upper quartile and what’s driving their longer length of stay. Comparison with upper quartile LOS

T Smart asked that the divisions attending next month’s performance committee demonstrate how ePSB is being used to facilitate discharge. Divisions to demonstrate use of ePSB Cardiac Review A Wood presented a paper highlighting the following key issues within Cardiac Good outcomes, clinically innovative, academically active and patients like the

service Average length of stay for cardiac surgery is the best amongst peers, cardiology

day case rates are the highest in London and a number of initiatives are being taken to reduce cardiology inpatient LOS.

A challenging year financially, a number of actions are being taken to reduce the projected over-spend at year-end.

Interventional cardiology activity has held up but cardiac surgery activity has dropped and waiting lists are short.

Plans to be developed to attract more activity MRSA screening is at 77%, action is being taken to achieve 100%. Joint CAG leaders have been appointed. Priorities for the CAG are developing

the response to the HfL review of Cardiovascular services and reviewing the local Heart Failure Service.

RS

RS

JW/RS/OW

FOR INFORMATION:

10/27

Date of Next Meeting The next meeting will be held on Thursday 13 May 2010 at 2pm in The Dulwich Committee Room at King’s College Hospital.

Documents

King’s College Hospital Board of Directors - 126.1 - bod agenda and...Dulwich Committee Room Enc 1.4 King’s College Hospital NHS Foundation Trust Board of Directors Minutes of