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King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday, 26 February 2013 Venue Dulwich Committee Room, King’s College Hospital Members: Prof. Sir George Alberti (GA) Trust Chair Graham Meek (GM) Non-Executive Director, Vice Chair Marc Meryon (MM1) Non-Executive Director Christopher Stooke (CS) Non-Executive Director Faith Boardman (FB) Non-Executive Director Prof. Ghulam Mufti (GM1) Non-Executive Director Tim Smart (TS) Chief Executive Angela Huxham (AH) Director of Workforce Development Dr. Michael Marrinan (MM) Medical Director Roland Sinker (RS) Chief Operating Officer Simon Taylor (ST) Chief Financial Officer Dr. Geraldine Walters (GW) Director of Nursing & Midwifery Jane Walters (JW) - Non-voting Director Director of Corporate Affairs Jacob West (JW1) - Non-voting Director Director of Strategy In attendance: Prof. Sir Robert Lechler (RL) Executive Director (KHP) Sally Lingard (SL) Associate Director of Communications Tamara Cowan (TC) Board Secretary (Minutes) Apologies: Sue Slipman (SS) Non-Executive Director Circulation to: Board of Directors Circulation List

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Page 1: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

King’s College Hospital Board of Directors

PUBLIC AGENDA

Time of meeting 14:30 -17.00

Date of meeting Tuesday, 26 February 2013

Venue Dulwich Committee Room, King’s College Hospital

Members: Prof. Sir George Alberti (GA) Trust Chair Graham Meek (GM) Non-Executive Director, Vice Chair Marc Meryon (MM1) Non-Executive Director Christopher Stooke (CS) Non-Executive Director Faith Boardman (FB) Non-Executive Director Prof. Ghulam Mufti (GM1) Non-Executive Director Tim Smart (TS) Chief Executive Angela Huxham (AH) Director of Workforce Development Dr. Michael Marrinan (MM) Medical Director Roland Sinker (RS) Chief Operating Officer Simon Taylor (ST) Chief Financial Officer Dr. Geraldine Walters (GW) Director of Nursing & Midwifery Jane Walters (JW) - Non-voting Director Director of Corporate Affairs Jacob West (JW1) - Non-voting Director Director of Strategy

In attendance: Prof. Sir Robert Lechler (RL) Executive Director (KHP) Sally Lingard (SL) Associate Director of Communications Tamara Cowan (TC) Board Secretary (Minutes)

Apologies:

Sue Slipman (SS) Non-Executive Director

Circulation to: Board of Directors Circulation List

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Enclosure Lead Time

1. STANDING ITEMS G Alberti 14:30

1.1. Apologies

1.2. Declarations of Interest – to receive

1.3. Chair’s Action

1.4. Minutes of Previous Meeting – 29/01/2013 Enc 1.4

1.5. Matters Arising/Action Tracking Enc 1.5

2. FOR REPORT/DISCUSSION

2.1. KHP Update Verbal A. R Lechler 14:35

2.2. Chair’s and Non-Executive Directors’ Report Enc. 2.1 G Alberti 14:50

2.3. Update on Council of Governors’ Activities Verbal G Alberti 14:55

2.4. Chief Executive’s Report Enc. 2.4 T Smart 15:00

2.5. Finance Report – Month 10 Enc. 2.5 S Taylor 15:10

2.6. Performance Report – Month 10 Enc. 2.6 R Sinker 15:20

2.7. Quality & Safety Focus:

2.7.1. Quarterly Patient Experience Report Enc. 2.7.1 J Walters 15:30

2.7.2. Quarterly DIPC Report Enc. 2.7.2 G Walters 15:40

2.7.3. Quality Priorities 2012-13 & Report –

2013-14 Enc. 2.7.3 G Walters 15:50

3. FOR INFORMATION 16:00

3.1. Confirmed Board Committee Minutes

3.1.1. Equality & Diversity Committee –

29/11/2013 Enc. 3.1.1

4. ANY OTHER BUSINESS 16:05

5. DATE OF NEXT MEETING Tuesday, 26 March 2013 at 14:30 in the Dulwich Committee Room

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King’s College Hospital NHS Foundation Trust Board of Directors - PUBLIC

Minutes of the meeting of the Board of Directors held at 14:30 on Tuesday, 29 January 2013 in the Dulwich Committee Room, King’s College Hospital.

Members: Prof Sir George Alberti (GA) Trust Chair Graham Meek (GM) Non-Executive Director, Vice Chair Chris Stooke (CS) Non-Executive Director Faith Boardman (FB) Non-Executive Director Sue Slipman (SS) Non-Executive Director Prof. Ghulam Mufti (GM1) Non-Executive Director Tim Smart (TS) Chief Executive Roland Sinker (RS) Chief Operating Officer Simon Taylor (ST) Chief Financial Officer Dr. Michael Marrinan (MM) Medical Director Dr. Geraldine Walters (GW) Director of Nursing & Midwifery Angela Huxham (AH) Director of Workforce Development Jane Walters (JW) – Non-voting Director Director of Corporate Affairs Jacob West (JW1) - Non-voting Director Director of Strategy In attendance: Anne Greenough (AG)

Jill Locket (JL) Director of Education and Training, KHP Director of Performance and Delivery, KHP

Sally Lingard (SL) Associate Director of Communications Rita Chakraborty (RC) Assistant Board Secretary (Minutes) James Eales NHS Graduate Management Trainee Marion Mackay

Fiona Clark KCH Charity Governor

Stuart Owen

Governor

Apologies: Marc Meryon (MM1) Non-Executive Director

Item Subject Action

013/01 Apologies The Chair welcomed all public attendees. Apologies for absence were noted.

013/02 Declarations of Interest There were no declarations of interest.

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Item Subject Action

013/03 Chair’s Action There were no chair’s actions

013/04 Minutes of previous meetings – 18 December 2012

The minutes of the meeting held on 18 December 2012 were approved as a correct record.

013/05 Action Tracking/Matters Arising The Francis Enquiry was due to publish its report on 6 February and the recommendations could be far reaching.

013/06 Chair’s and Non-Executive Directors’ (NED) Report

The report on the activities of the Chairman and non-executive directors for the period was noted. Correction: GA did not chair Finance and Performance Committee on 18 Dec.

013/07 Update on Council of Governors Activities

The Chair provided an update on Council of Governor activities:

The recent Governor Development Day was very informative;

The Membership and Community Engagement Committee had discussed the membership strategy and the Trust centenary plans; and

Patient Experience and Safety Committee had received presentations on quality priorities, A&E survey results and improving the patient experience in the Acute Medical Assessment Units.

013/08 Chief Executive’s Report The Board noted the Chief Executive’s report for the period. TS highlighted the following key points:

King’s was the only London FT to be rated ‘green’ for finance and governance at present;

William McKee has been appointed Director of Transition and Transformation. There was some delay with the KHP full business case due to the awaited announcement by the Secretary of State for Health on the future of SLHT but this was expected imminently. Support was expected for the TSA’s recommendation;

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Item Subject Action

The final decision on the Trust’s acquisition of PRUH will be subject to

concluding terms of agreement that the FT regulator and the Trust are content with. Throughout negotiations, the Trust has made it clear that it must maintain its existing financial risk rating from Monitor and that the outcome must be in the best interests of patients at King’s and PRUH; and

There was discussion about recent developments in the Integrated Care strategy. A 24/7 geriatrician hotline was operational. The programme was seeing a change in behaviours with referrals to assessment units, which are GP-led multi-disciplinary teams. A new programme director had been appointed. Fiona Clark commented that there was some anxiety amongst older members of the community that the message about integrated care has not been sufficiently publicised. JW1 responded that a website has been set up, there are more materials being distributed in the community and a public Board has been established including local users. SL offered to take the issues raised to the integrated care communications group.

013/09 Finance Report – Month 9 ST presented the finance report for month 9.

It was noted that the Finance and Performance Committee had conducted an extensive review and discussion around the finance report earlier.

The Board noted the report and the following key points:

Winter pressures were resourced by the local commissioners;

The figures show a £2.4m deficit position after assets impairment but the Trust still remains in operating surplus with a financial risk rating of 3 and this is projected to continue to year end;

2013/14 initial tariffs suggest a 1.5% reduction in income. The Trust is likely to have to implement 2.3% savings. Education and training income will also be tight next year;

CIP targets in tertiary specialties, emergency and diagnostics were the most challenging at present;

In order to reduce the outstanding money from private patients, a more thorough check of each patient’s entitlement should be undertaken before treatment commences. The downward trend in income from some countries was likely to continue; and

Agency spending was high during winter as more temporary medical staff were hired to cope with the increase in patient activity.

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013/10 Performance Report – Month 9 RS presented the performance report for month 9.

It was noted that the Finance and Performance Committee had conducted an extensive review and discussion around the performance report earlier. The Board noted the report and the following key points:

Month 9 performance against core Monitor targets was strong with all access, referral to treatment (with the exception of 62 day cancer wait) and infection control targets achieved;

Performance challenges included A&E with some elective operations cancelled as the result of continuing high levels of emergency admissions. The referral to treatment target was unlikely to be met in Q4;

Five other areas of concern are slips, trips and falls, complaints response times, Mixed Sex Accommodation (MSA) and Maternity and Day Surgery. Actions are in place to manage these; and

Pressures on ED remains a major issue. Despite investment in A&E services and a 24/7 Acute Assessment Unit, the Trust was dealing with unprecedented levels of activity ;

The Board made the following observations:

The criteria for relocating patients involves identifying appropriate patients to move and network collaboration;

The corporate dashboard is reviewed annually to ensure a balance of indicators that: i) provide an early alert, such as data on training and line audits for infection control; and ii) provide assurance on data accuracy, such as KPMG’s scrutiny of 3 indicators and mock CQC inspections.

A more explicit presentation of weak indicators was suggested. Despite the Trust’s comparative good performance, a self-critical approach was welcomed; and

It was noted that if the Trust acquires the PRUH and is able to improve standards there, this will have a positive effect on care and finances at King’s also.

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Item Subject Action

013/11 Quarterly Patient Outcome Report The Board noted and discussed the Quarterly Patient Outcome Report. The report summarised the work of the Public Health Committee and its Health Improvement Groups.

There are high rates of lifestyle related illness and lower than average life expectancy in the local population;

The Trust is encouraging patients to make healthier lifestyle choices; however it is acknowledged that acute hospitals have a limited impact in this area;

Areas that the Committee and its feeder groups are focussing on are smoking, alcohol, obesity and healthy eating, physical activity, mental health, sexual health, oral health, occupational health, maternity and teenage pregnancy, sexual health and HIV, and older people’s health;

Some improvements have been identified in breastfeeding, teenage pregnancy rates and smoking in pregnancy;

A national audit of King’s health promotion showed the Trust was significantly better than the national average for assessing health risk factors but not for providing the appropriate interventions; and

CQUIN targets were being achieved.

The Board offered the following comments:

Given the size of the combined KHP workforce, there were opportunities to change attitudes of staff and their families. The Global Corporate Challenge generated interest at all levels of the organisation;

The proposed PRUH acquisition offered wider geographical reach across south east England;

Hospital visits can be an effective trigger for behaviour change because of patient trust in hospital doctors; and

Programmes run by local councils focus on targeting the population as a whole.

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Item Subject Action

013/12 KHP Update

Prof Anne Greenough presented a comprehensive update on the education and training workstream. Areas covered included:

- Innovative technology and teaching – KCL has adopted the quality mark; a learning hub provides all lectures on video via the website;

- Inter-professional education and training – patient safety is being developed as a vertical strand in the MBBS;

- Increasing research capacity – the quality of trainees is very good;

- Careers management – the model will be rolled out across all disciplines

- Global health education and training – a busy year including research on learning outcomes from electives in low and middle income countries;

- State of the art simulation suite and learning centre;

- CAG education and training leads and metrics – KCL teaching database has now been extended to all NHS consultants; firm survey results mirror the National Student Survey questions and can be split by campus, CAGs, department and individual teachers; there are currently 30 MScs programmes available;

- GMC review – communication needs improvement; the KCH campus needs a state of the art education facility;

- “You said – we did”; and

- South London HIEC – this project has brought together a large number of diverse organisations. An event on 15 March will explore SLHIEC solutions for the future.

The Board offered the following comments:

The NSS undergraduate survey results, GMC review and external review results all need to be taken on board. The expansion of the medical school made it much more challenging for staff to know each student. Prof Greenough responded that this was the case in phases 1 and 2 but that Firms should know their students in the later stage of the course as the numbers are the same as when we were KCH Medical School; and

Real time feedback was available to identify non-attendance of teachers at large lectures.

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Jill Locket, KHP Director of Performance and Delivery, updated the Board on the following:

AHSN licencing will be announced shortly and KHP was hopeful of securing £10m over 5 years;

Tariq Sethi has been appointed CAG Leader for Respiratory, Allergies and Critical Care;

An event will be held on 16 April for the top 250 people to celebrate KHP’s success; and

The re-accreditation process will begin in October 2013.

013/13 Monitor Submission Quarter 3 2012/13 The Board approved the Quarter 3 submission to Monitor.

013/14 Any Other Business

There were no other items of any other business raised for discussion.

013/15 Date of Next Meeting

Tuesday, 26 February 2013 at 14:30 in the Dulwich Committee Room.

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Board of Directors – Public Meeting Action Tracker Enc 1.5

Board of Directors Meeting – 26 March 2013 1 of 1

Meeting Date

Item Action Who Due Date Notes

Not Due

30/10/2012 012/149 PE would return in six months to give an update on progress to implement the cancer patient experience action plan.

PE/LM 30/04/2013

30/10/2012 012/149 JW would undertake some research into the demographics of the cancer survey respondents and report back to the Board in due course.

JW Early 2013

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Enc. 2.4

1 of 4

Report to: Board of Directors Date of meeting: 26 February 2013 By: Tim Smart, Chief Executive Subject: Chief Executive’s Board Report 1. Executive Summary

This has been a very difficult month on a number of fronts, both locally and nationally. We are very pressurised by the volume and acuity of emergency patients, and this is impacting on our ability to meet access targets. Unlike other organisations in the news, we have not yet had to make any really difficult decisions that compromise our ability to meet targets, and we have absolutely no intention of doing anything that compromises patient safety. New capacity is being brought into service, and this will make a difference to patient flows. We were all shocked by the distressing circumstances described by the Francis Report. The Board is digesting what it means for our assurance processes, and will report in due course. We are also starting a series of staff listening events, because one of our values is ‘Inspiring Confidence in Our Care’, and reassuring staff about our focus on patients, and listening to their concerns, is an important leadership process. We are also reviewing any Compromise Agreements which we have with ex staff, and are reviewing everything we do in this area to ensure that we encourage staff to identify concerns where they have them. And we continue to work with vigour and professionalism on the PRUH acquisition, and on the early stages of the KHP full business case. I would like to thank all staff, and the governors, for their engagement in these vital strategic matters. The Trust has been operating under significant financial strain this year, but we are in a position where we expect to breakeven at the close of the financial year. In Monitor’s eyes, we are the highest performing Trust in London, which is a considerable achievement and I appreciate the hard work and commitment that has gone into attaining this. 2. Finance – month 10

At the end of month 10 (January) the Trust has a deficit position of £3.071m, against a year to date planned deficit position of £624k. This is a variance from plan of £2.447m and a positive movement in month of £47k. The Trust’s overall Monitor financial risk rating at month 10 remains at 3. This is in line with the overall risk rating in the annual plan.

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3. Performance – month 10

As expected, January was a very challenging month for performance, with emergency admissions being even higher than expected. Despite this, the Trust achieved the required performance standard of 95% for treatment of all types of accident and emergency attendances within four hours. As planned, the Trust has not achieved the target of 90% for 18 week referral to treatment for admitted patients as the treatment of longer-waiting patients has been prioritised. At the end of the month the patients who remained on the waiting list were within the required targets. Cancer wait access targets have been under pressure in January and there has been a marginal underperformance. However, the Trust remains confident that this can be managed throughout the rest of the quarter in order to achieve the required levels for these indicators. The Trust has had another successful month with regard to hospital acquired infection rates. There have been no reported MRSA bacteraemia in month 10 and it is now over 300 days since our last reported post 48 hour bacteraemia. There have been two reportable C-difficile cases in month 10, resulting in a year to date performance of 47 compared with our quota of 63 cases. The start of month 11 has provided further challenge as emergency attendances remain higher than expected. 4. South London Healthcare Trust and King’s Health Partners

Following submission of the Trust Special Administrator’s final report on the 08 January 2013, the Secretary of State announced his decision on the recommendations on the 31 January 2013. With the exception of the University Hospital Lewisham (UHL) service reconfigurations, all the recommendations were accepted in full. The UHL service reconfigurations will be subject to a review by the NHS Medical Director, Professor Sir Bruce Keogh. The King's team are continuing to prepare a full business case in relation to this transaction. There is now broad agreement that should the transaction proceed, although this is unlikely to happen before 01 July 2013 and, on this basis, the Board will review the business case in early April. If the Board decides to proceed, the business case will be submitted to Monitor for review in mid-April. Work continues within King’s Health Partners on planning the next steps towards creation of a full business case for the potential merger of the three NHS Trusts and closer integration with King’s College London. Following his appointment as Director of Transition and Transformation, William McKee is now beginning to assemble his team and progress development of the business case. However, due to the on-going focus on South London Healthcare Trust this work has of necessity slowed down. The team that has been developing plans for the south London Academic Health Sciences Network (AHSN) held a formal panel interview on 24 January, with the national lead, Sir Ian Carruthers, Sir John Bell, Russell Hamilton from the National Institute for Health Research, and senior industry representatives. We expect to hear by the end of February whether or not the AHSN will be licensed to operate from 01 April 2013. Good progress is being made, in particular with the first of the clinical themes: diabetes. On 01 February a large number of clinicians, academics, patients and other stakeholders from across the network area came together to discuss the needs across the 12 south London boroughs, and began to explore potential solutions.

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5. Integrated Care

There are now 52 GP practices signed up to deliver integrated care across Lambeth and Southwark and 7 Community Multi-Disciplinary Teams (CMDTs) regularly meeting to discuss and action care for older people with complex needs. Work is on-going to simplify the hospital discharge process including looking at assessment and referrals from the acute sector, electronic information sharing, a single point of access for community services and a more responsive community service. The Programme Board has approved the proposals to use a small number of ICT products that support the sharing of patient information across the health and social care settings and work has begun to implement these. 6. Dignity Month

This is Dignity Month, which involves all Board members and governors visiting wards in a programmed and organised way to promote patient dignity. Treating patients with dignity is a fundamental principle which runs through all of the King’s Values. The Innovation in Dignity Care awards on 11 March will celebrate and promote innovation and will be the culmination of a programme of ward visits and masterclasses which champion the importance of dignified care. Ward visits represent an opportunity for interaction across the organisation and for patients, nurses, therapists, housekeeping staff, volunteers, governors and directors to share ideas about how to improve the experience of patients. 7. Capital, Estates & Facilities

Critical Care Unit – Enabling works are to commence in early March for this new purpose built critical care facility with capacity for 60 patients over two floors. Staff are invited to view architectural plans and to gain an understanding of the building process at drop-in events this month. Helideck – Detailed design is underway and a works methodology has been developed in parallel with the Critical Care Unit scheme. Cheyne Wing Ground Floor – Refurbishment of the corridors on the ground floor of Cheyne Wing will commence in early March and take 12 weeks to complete. The works will refurbish floors, walls ceiling, doors and lighting from Renal Outpatients to the central bear pit area. Solar Panel Installation – During February the Estates team will install solar panels on two roof pitches of the Day Surgery Unit. By generating electricity to be used within the estate these solar panels will provide the Trust’s first renewable source of energy. Golden Jubilee Wing Lifts – Works have commenced to upgrade the lifts in the GJW. All lifts will be completed by the end of May 2013.

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8. Media & Events (17 January – 15 February)

Press and broadcast coverage

23 January - King’s Consultant Hepatologist Dr Varuna Aluvihare provided expert comment for a BBC Online article about the UK’s first altruistic liver donation. Dr Aluvihare discussed the risks involved in donating part of your liver. 29 January - Dr Varuna Aluvihare was also interviewed on BBC Radio 4’s Inside Health. Dr Aluvihare provided expert comment on the number of alcohol related deaths in 2012. 9 February - Dr Emer Sutherland, A&E Head of Nursing Tricia Fitzgerald and social worker John Poynton were the focus of an in-depth article in The Sunday Times about how the work of our Emergency Department helps victims of gang violence. In the first scheme of its kind in the UK, youth workers are based in the Emergency Department at King’s so they can talk to victims of gang violence when they are in a “teachable moment”. This work is sponsored not only by the Trust but also by the charities across KHP. 17 January-15 February - There has been extensive media coverage about the Trust Special Administrator’s recommendations to break up South London Healthcare NHS Trust, and make changes to Lewisham’s A&E and maternity services. There has been coverage – albeit on a smaller scale - about the Secretary of State for Health’s decision to recommend King’s acquisition of the Princess Royal University Hospital. However, most of the media attention has been focused on changes to Lewisham, and the potential impact this could have on King’s maternity and A&E services, as well as other hospitals in south east London. Events 31 January – The Minister for Civil Society, Nick Hurd MP officially opened a new volunteers area at King’s, located at the entrance of Hambleden Wing. During his visit, Mr Hurd MP was introduced to some volunteers and heard about what they do, why they do it, and their experience of King’s. Mr Hurd was also given a tour of the Cardiac Catheter Lab, general surgery and our urology outpatient area. Upcoming 21 February – King’s staff and governors will be meeting with key stakeholders from Bromley to discuss the proposed acquisition of the Princess Royal University Hospital. 9. Consultant Appointments

Following Advisory Appointment Committees in the past month, there have been three consultant appointments.

Specialty New/Existing Appointee Start date

Medical Microbiology New Surabhi Taori 01/03/2013

Anaesthetics (Major Surgery)

Existing Derek Amoko

01/03/2013

Anaesthetics (Major Surgery)

Existing Tim Hughes 01/04/2013

10. Chief Executive’s Brief

The CEO Brief for February is attached.

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CHIEF EXECUTIVE’S BRIEF February 2013 Issue 77

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

‘Mid Staffs’ will forever be synonymous with the lowest quality of care that the NHS is capable of

delivering. ‘Francis’ hopefully will be synonymous with a turning point for the culture of the NHS.

Compassionate and kind care at the centre of everything we do. I think that is what our values

mean, and in particular ‘Inspiring Confidence in Our Care’. I hope there won’t be any knee-jerk

reactions to the report, and we at King’s will definitely want to look carefully at its findings and at

the way the Board is connected to the ward. I will keep you informed of our plans, and I hope

anyone in Team King’s who is concerned about quality issues will let us know.

As we come towards the end of another challenging year for the NHS, King’s is in a relatively good

place. Although our finances are as challenged as ever, we have had a very good year in terms of

patient safety, and in terms of strategic development. We have a very strong team, and we are

grateful to everyone for their commitment. At the beginning of last year I remember saying that our

Values would help sustain us, and it seems that is the case, even though we still have financial and

operational performance issues that need to be resolved.

If we acquire the Princess Royal University Hospital in Bromley, it will be the most significant

development at King’s for many years. We will be able to improve healthcare for the populations in

outer southeast London, and this will in turn improve our capacity constraints here on Denmark Hill.

I know that all of us will want to embrace our colleagues in Bromley and welcome them to the

culture that makes King’s great.

However, there are difficulties associated with last week’s announcement by the Secretary of State.

There is a lack of clarity about emergency care at Lewisham, and that will have knock-on effects for

all of King’s Health Partners, as will the downgrading of the maternity provisions at Lewisham. We

will need to invest in more capacity on Denmark Hill, and we will have to work ever more closely

with our colleagues at GSTT to ensure that we can accommodate the increased workload. The

implications for the KHP journey, and the potential merger of the three FTs, are still being assessed.

We are busy planning the events to commemorate the centenary on Denmark Hill, and I am quite

excited about them. We have been making a contribution to the communities around this location

for 100 years, and we are looking forward to the next 100 years. Who would care to imagine what

healthcare will be like in 100 years. We certainly have to navigate some still very tricky waters in the

next few years, but I am optimistic that we will do so.

Last week we received a visit from Nick Hurd MP, the Minister for Civil Society in formal recognition

that our volunteers programme is exemplary and could be used as a model to help improve the

quality of care across the NHS. We have over 700 volunteers now, and they are very representative

of the communities we serve. They undoubtedly improve the quality of care we provide, and I thank

them all. I also thank staff across the hospital for helping them integrate into Team King’s.

Tim Smart

Chief Executive

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

Find out more about new Critical Care Unit

As many of you will know, the Trust is in the

advanced planning stages for a new, cutting edge

critical care facility here on the King’s site.

With capacity for 60 patients, accommodated over 2

floors, the new facility will enhance King’s ability to

care for our sickest patients. It will be equipped with

state of the art assessment and monitoring

equipment, and provide a more appropriate

environment for staff to work in, and patients to be

treated in.

The Trust is holding two drop-in sessions during

February so that staff within the hospital can view

and comment upon the proposals, time line and work

plan. They are as follows:

At these sessions there will be a chance to meet the

architects, review the architectural designs and

drawings, understand how the building process may

impact upon the hospital, and how the new unit will

change the environment we provide to care for

critically ill patients.

Staff Appraisals

Appraisals are a key way for managers to monitor

how their staff are progressing, and an opportunity

for staff to identify ways for them to improve and

progress in their careers. Everyone in the Trust needs

to be appraised, and the details need to be

completed on the Electronic Knowledge and Skills

Framework (e-KSF) by 31 March. If you need a

refresher course on how to use e-KSF, please contact

the HR department on ext 1675 or email

[email protected].

24 Hours in A&E

Filming for series 4 and 5 of 24 Hours in A&E – the

documentary series about our Emergency

Department – begins on 12 February and finishes on

28 March.

The production team have tried their best to meet as

many teams as possible, particularly those that work

closely with the Emergency Department on a regular

basis. However, given the size of the Trust and the

number of people that work here (over 7,000 people),

Time/date Location

12.30-5pm; Monday,

18 February.

Dulwich Room

9am-2pm; Monday, 25

February.

Dulwich Room

it has of course not been possible for them to speak to

everyone.

If you or your team have not been contacted, or you

simply want to find out more about the series, please

contact Chris Rolfe in communications on x 3006 or

email: [email protected].

Staff health & wellbeing drop-in event –

14 February, 11am-2pm, Boardroom

Staff spend their working day looking after the health

of others. In doing so, it is easy for staff to overlook

their own health needs. In order to keep our staff in

tip-top condition, our occupational therapists will be

holding a 'one-stop shop' event in February where

staff can get advice on a variety of different aspects to

help them lead a healthier life. There will be a number

of both internal and external specialists on-hand to

advise staff on physical and mental health, smoking

cessation, losing weight and getting fit, and a great

deal more. The event will be held in the Boardroom on

14 February between 11am and 2pm. There will also

be a number of healthy snacks available for attendees

.

King’s dignity awards - 11 March, 12pm – 2pm,

Boardroom (drop-in event)

In March, we will be holding our annual awards

ceremony for Innovation in Dignity Care. This year’s

finalists represent staff from many areas across the

hospital, including nurses, therapists and

housekeeping staff. It is crucial that we continue to

champion the importance of treating people under

our care as individuals with choice, control and a

sense of purpose in their daily lives.

We initiated these awards to help raise the profile of

privacy and dignity and promote innovation in this

area. The awards give us an opportunity to celebrate

our work, to build on our culture of dignity and

respect, and to improve the quality of care we

provide. Staff, patients and stakeholders have been

invited to attend the awards to hear all about the

innovations in this area that is so fundamental to all

the work we do.

Date of last MRSA bacteraemia: 17 April 2012

Clinical area: Donne Ward (Ambulatory)

Cause: Deep skeletal infection in a patient with previous

MRSA bloodstream infection at another facility.

Page 19: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

Page 1

Report to: Finance and Performance Committee

Date of meeting: 16th February 2013

Subject: Finance Committee Report – Month 10 (January 2013)

Author(s): Simon Dixon, Nicola Hoeksema, Iris Lewis

Presented by: Simon Taylor, Chief Financial Officer

Sponsor: Simon Taylor, Chief Financial Officer

History: First submission to Finance and Performance Committee

Status: Decision/Discussion/Information

1. Purpose The Finance Reports includes information on the Trust’s financial performance and position which

support the in-year submissions to Monitor on a quarterly basis.

This report covers the Income & Expenditure position, Cost Improvement Programme, Capital and

Working Capital Plans.

2. Action required The Board is asked to approve the Finance Report

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Legal: Reporting to Monitor and Commercial Bank

Financial: Trust reports financial performance and position against published plan and notifies the

committee of financial risks, cost pressures and action plans to mitigate any material variance

from financial targets.

Assurance: The summary and appendices provide assurance that the Trust is meeting Financial targets

(internal and those set by Monitor) and is compliant with its terms of authorisation.

Clinical: There is no direct impact on clinical issues

Equality & Diversity: There is no direct impact on E&D

Performance: Financial Performance against annual plan, budgets, CIPs and Monitor Risk Ratings and

Limits.

Strategy: Performance against the Trust’s Annual Plan including Risk Ratings

Workforce: There are implications for workforce recruitment in respect to service developments and

vacancies.

Estates: There are implication on the Trust’s estates strategy.

Reputation: Finance Committee Report is provided to Monitor and Commercial Bankers as additional

information to support the quarterly Monitor Return.

Other:(please specify) None.

3. Key implications

Page 2

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Finance Report

Month 10 (January) 2012/13

Finance Committee

26th February 2013

Enc. 2.5

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Page 4

Contents

Page(s)

Executive Financial Summary 5

Financial Risk Rating Ratios 6

Forecast Outturn Position 2012/13 7 - 9

I&E Summary 10 - 18

CIP Update 19 - 24

Capital, Working Capital & Cash Summary 25 - 35

Statement of Financial Position 36 - 37

Glossary 38

Enc. 2.5

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Page 5

Month 10 Executive Financial Summary

Financial Summary

The Trust is reporting a year to date deficit position of £3.071m, £2.447m adverse from plan, and an favourable movement of £47k from

Month 9. An income accrual has been included in the month 10 position for Winter Pressure and SLHT Business Planning costs incurred to

date (£2.5m). Nursing costs have overspent by £1m in month across all Divisions except Ambulatory Care and these costs partly relate to

Winter Pressure schemes.

The current deficit of £3.071m includes a £6m asset valuation impairment accrual which means the Trust has achieved an operating

surplus of £3.065m to date.

The projected year end position is less straight forward due to the adverse financial movements in Liver, Neurosciences and Ambulatory

Care in months 9 & 10. The projected financial scenarios for year end are shown on page 9 and the mid-case scenario is an operating

deficit of £899k at a financial rating of 3. The CIP adverse variance is £5.9m to date and the year end CIP forecast is an adverse variance

of £8m, a projected movement of £2.1m to year end (page 19). This is a projected £31m (79%) achievement against a plan of £39.1m. The

key variances relate to income targets for RTT activity, Private Patient activity and productivity targets due to bed/theatre capacity issues

and additional activity winter pressures. Non-pay savings have under-delivered in respect to procurement and managing diagnostic

demand.

The overall income position still remains positive with a favourable movement against plan on PCT income to the value of £12.604m; and

off-tariff drug over-performance of £3.324m to date. The additional unplanned activity is not delivering a sufficient margin to compensate for

the adverse CIP performance due to incremental non-pay cost pressures (e.g. agency staff costs and off-site working) and off-tariff drugs.

The Monitor Rating for the year is 3 in line with the Annual Plan target to date.

Annual Budget YTD Budget YTD Actual

Month 10 YTD

Variance

Month 9 YTD

Variance

Movement in

Month

£'000 £'000 £'000 £'000 £'000 £'000

Income (excluding off Tariff Drugs) 622,522 515,747 528,351 12,604 8,127 4,477

Off Tariff drugs Income 24,950 20,792 24,116 3,324 2,600 724

Pay (368,492) (306,802) (308,222) (1,420) (259) (1,161)

Non-Pay (excluding off tariff drugs) (304,198) (243,882) (257,150) (13,268) (9,988) (3,280)

Off Tariff Drugs Expenditure (24,950) (20,792) (24,116) (3,324) (2,600) (724)

Capital Charges, Interest and Dividends 44,172 34,273 34,108 (165) (145) (20)

SLR/Internal Recharges (4) 40 (158) (198) (229) 31

Total (6,000) (624) (3,071) (2,447) (2,494) 47

Enc. 2.5

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Financial Risk Rating Ratios

Page 6

Financial Criteria

Weight

(%) Metric to be scored Month 10

Month 10

Rating

12/13

Plan

12/13 Plan

Rating

Achievement of Plan 10 EBITDA achieved (% of plan) 91.0% 4 96.6% 4

Underlying Performance 25 EBITDA Margin (%) 5.5% 3 5.6% 3

Financial Efficiency 20 Net Return after Financing (%) 0.7% 3 0.8% 3

20 I&E surplus margin (%) 0.5% 2 0.6% 2

Liquidity 25 Liquidity Ratio (days) 16.2 3 16.8 3

FINANCIAL RISK RATING {Weighted Average of Financial Criteria} 3 3

Financial Criteria Metric to be scored

5 4 3 2 1

Achievement of Plan EBITDA achieved (% of plan) 100 85 70 50 <50

Underlying Performance EBITDA Margin (%) 11 9 5 1 <1

Financial Efficiency Net Return after Financing (%) 3 2 -0.5 -5 <-5

I&E surplus margin (%) 3 2 1 -2 <-2

Liquidity Liquidity Ratio (days) 60 25 15 10 <10

Finance Risk Rating Rating 5

Rating 4

Rating 3

Rating 2

Rating 1

Risk of significant breach in Terms of Authorisation in the medium term,

e.g. 9 to 18 months in the absence of remedial action.

Highest Risk - high probability of significant breach of Terms of

Authorisation in the short-term, e.g. less than 9 months, unless remedial

action is taken.

RATING CATEGORIES

Regulatory concerns in one or more components. Significant breach of

Terms of Authorisation unlikely.

No regulatory concerns

Lowest Risk - no regulatory concerns

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The historic variances at month 10 have been used as a basis for the year end financial projection as

disclosed on pages 10 to 17.

The following factors have also been built into the year end forecast:

1) The current bed pressure in respect to General Medicine bed outliers which is having a detrimental

impact on the planned elective activity targets (notably Neuroscience services).

2) Winter pressure schemes to sustain patient safety and quality care (e.g. the mobile critical care service

and quicker Mental Health patient pathways); and to deliver performance improvements (e.g. A&E

access targets and LAS related KPIs by extending AAU). The Trust has submitted bids up to £6.5m but

is expected to receive between £2m and £3m. The key schemes are shown on page 8. The Trust has

already committed to a number of these schemes on the basis that this expected funding will be

received.

3) The expenditure and funding to cover the SLHT business planning and due diligence process is also

incorporated in the forecast.

4) The jointly agreed estimated LSL PCT contract outturn position is factored into the overall Trust income

position.

The Divisional Managers have been involved in and agree to the forecast outturn projections and will need to

ensure these financial targets are achieved to maintain the Monitor Financial rating of 3. There have been

exceptional adverse variances beyond the initial year-end projections for Liver, Neurosciences and Ambulatory

Care (see page 9); and these variances will be reviewed at the Performance meetings on the 27th of February.

Although the Trust has received agreement of the following income flows, no payments have been received to

date.

1) Project Diamond Funding (Tertiary tariff funding and MFF on R&D income)

2) SLHT Business Planning Funding

3) Winter Pressure Schemes Funding (Phases 1 – 3)

The performance monitoring and support documentation is currently being agreed and supplied in respect to

the appropriate income flows.

Forecast Outturn Position 2012/13

Page 7

Enc. 2.5

Page 26: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

Examples of Winter Pressure Schemes

Page 8

Phase Details of scheme to be fundedIntended outcome of scheme e.g., what level of performance

improvement will be achieved, and by when?

ED Nursing shifts to supporting opening of additional CDU

beds

Achievement of 95% target, immediate impact. (admission

avoidance, ability to manage short stay patients more appropriately

while maintaining assessment capacity within the department)

RDL winter pressure beds (from mid Jan 13).These are

necessary to support the move and refurbishment of the Acute

Assessment unit. RD Lawrence ward will house 12 winter pressure

beds during this period

Achievement of 95% target, immediate impact. (additional winter

pressure capacity across medicine to deal with demand)

CC Consultant Saturday and Sunday working - ensure

Consultant and medical cover at weekends is consistent with level of

cover during the week, this will help 'pull-through' of patients into CC

from ED/Major Trauma

Improved flow through of patients into critical care

Provision of additional Beds to support Community Beds

from December - MarchAdditional Elective activity and appropriate cost effective care

Mobile Critical Care Service to manage deteriorating and critically

ill patients outside of CC. CC capacity is routinely operating at over

100%, additional beds approved within new build will not be

operational until spring 2015. This is an interim measure to manage

patients on the wards either as a substitute for ICU admission or in

advance of ICU admission. This will facilitate the ability to flex more

of the existing adult cc bed pool up to Level 3. This will also support

increased ED/Trauma referrals. Out-treat service will facilitate early

discharges and reductions in delayed admissions.

Supporting the rest of the Hospital and making it safe through

increasing CC capacity to meet demand. To be implemented Jan

13

LAS performance - additional nursing & admin shifts Achievement of 95% target, immediate impact. (improved

performance against 15 minutes handover target)

Extending AAU - additional porter, nursing & medical shifts to

support 24/7 opening

Achievement of 95% target, immediate impact. (pull through of

medical patients from ED, freeing capacity for timely assessment of

ED patients 24/7. Supports admission avoidance)

3Elective short stay admissions ward (9 beds) and admissions

loungeImproved RTT performance

1

2

Enc. 2.5

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Forecast Outturn Position 2012/13

Page 9

Division

Year-end

Forecast at

M8

£'000

Year-end

Forecast at

M9

£'000

Year-end

Forecast at

M10

£'000

Winter

Pressure/

South

London

Business

Planning

Costs not

already in

Forecast

Worst Case

Scenario

Mid-Case

Scenario

Best Case

Scenario

LRS -4,445 -5,214 -6,172 0 -6,172 -6,172 -6,172

Networked Services -3,221 -4,098 -5,899 0 -5,899 -5,899 -5,899

Guthrie -1,785 -2,545 -2,514 0 -2,514 -2,514 -2,514

Facilities -1,101 -1,333 -1,603 0 -1,603 -1,603 -1,603

TEAM -851 -1,275 -1,112 0 -1,112 -1,112 -1,112

Commercial services -843 -910 -1,048 0 -1,048 -1,048 -1,048

Ambulatory 110 210 -332 0 -332 -332 -332

PFI -180 -333 -735 0 -735 -735 -735

Operations -439 -350 -448 0 -448 -448 -448

Finance & Information -361 -265 -422 -2,753 -3,175 -3,175 -3,175

Human Resources -139 -193 -67 0 -67 -67 -67

ENPDT 8 -15 -9 0 -9 -9 -9

W&C -614 35 4 0 4 4 4

Corporate 38 158 155 0 155 155 155

Strategic Development 219 243 270 0 270 270 270

Dental 43 79 405 0 405 405 405

Captial Charges 175 600 600 0 600 600 600

CCTD 768 673 673 0 673 673 673

CSDS 2,351 1,519 1,519 0 1,519 1,519 1,519

R&D 1,879 2,282 2,201 0 2,201 2,201 2,201

Income 3,000 5,040 5,464 6,074 11,638 12,388 13,138

Total Forecast Variance -5,388 -5,692 -9,070 3,321 -5,649 -4,899 -4,149

Less planned operating surplus 4,000 4,000 4,000 4,000 4,000 4,000

Financial Gap to breakeven -1,388 -1,692 -5,070 -1,649 -899 -149

Financial Rating 3 3 3 2 3 3

Best case scenario includes full payment for RTT Activity / Winter Pressure Costs / SLHT Planning Costs / Project Diamond Funding

Enc. 2.5

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Page 10

I & E Summary

Income is over-performing by £15.9m YTD. However, £3.3m of this relates to off tariff drugs, without

which the net over-performance drops to £12.6m. PCT patient activity over-performance is being seen

in Emergency activity, and also within Obstetrics, where activity is higher compared to previous years.

There was a favourable movement in month of £5.2m due to increased activity beyond plan in critical

care, day case and outpatient services. Elective and tertiary activity continues to under-perform.

£2.5m of winter pressure / SLHT Business Planning central funding has been accrued this month

based on expected payments from South East London PCTs / NHS London.

Pay is over-spent year to date by £1.4m an adverse movement in month of £1.2m. Nursing moved by

£1.1m this month and is now £3m over-spent YTD. The unfavourable movement this month was

mainly in LRS, NWS, TEAM (additional ED shifts), W&C (PICU/NICU) and CCTD (additional ICU

beds and day surgery weekend lists).

Non Pay is overspent by £17m, an adverse movement of £4m: The main drivers of this overspend are

Drugs (£8.4m) and Clinical supplies (£5.5m). The adverse movement this month was mainly in

clinical supplies and drugs some of which is recovered through off tariff income.

Premises and fixed plant costs (£1.7m):Energy £1m – price inflation, additional insurance costs,

maintenance costs as previously stated.

External Contracts (£2m) :Medihome, Consultancy– this includes EY Business Planning costs,

and various external contractors providing operational and legal support to various projects e.g.

outpatient transformation, interpreting.

Enc. 2.5

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Page 11

I&E Summary

This Chart shows the subjective over and underspends across the trust in month. It is important to note the

relationship between drugs spend and income over-performance, which offset one another.

Enc. 2.5

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Page 12

Temporary Pay Analysis Trend

The graph to the left shows spend on bank and

agency nursing over the previous periods and it

is showing that the trend is on the increase.

This month has seen an increase in CCTD B&A

spend due to additional critical care capacity and

weekend day surgery lists. The Emergency

Department has also seen a significant increase

this month due to additional shifts.

Overall there has been an increase in the

number of shifts being escalated to agencies this

month and a need for more highly skilled nurses,

particularly in ED. This has contributed towards

the increased spend this month.

The graph to the right highlights an increase in

spend on agency medical staffing over the

previous period, with a steady upward trajectory.

This is in the main due to locum cover for recent

consultant vacancies and holiday cover.

Increasing activity demands has also put pressure

on the usage of agency medical staff in order to

achieve planned RTT targets, this must be

monitored closely as access to beds and theatres

will limit productivity.

Enc. 2.5

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Page 13

Temporary Pay Analysis by Division

Agency spend (shown to the left) is 2%

down on the same period year to date last

year, with reductions in CSDS and Critical

Care offset by increases in all other areas.

Agency spend has started to increase and

was particularly high in CCT and Team this

month

Bank spend (shown to the right) is 1% down

on the same period year to date last year,

with reductions in LRS, W&C and Critical

Care, and increase in Networked services,

and TEAM

Enc. 2.5

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Page 14

Divisional Variance Analysis

Material off-track variances to plan are as follows:

Ambulatory - £546k adverse, £881k adverse movement. There was a large adverse movement this month due to a

significant increase in drugs expenditure in January. More information is needed from pharmacy to establish if this is

recoverable through off tariff income.

Cardiac - £1.3m adverse, £200k adverse movement. This is mainly due to income being less than anticipated in

September but FCE’s are now back up to expected levels. This months adverse movement is mainly due

underperformance against elective income targets due to bed pressures.

Neurosciences - £2.5m adverse, £742k adverse movement. Income is £1.1m adverse where Neurosurgery RTT and

CIP targets are not being achieved. Drugs are £646k overspent, although this is mostly recovered through income.

(Removing the effect of drugs will move the income position further adversely). Some beds have been re- opened on

David Marsden ward resulting in an increase in nursing expenditure. This months adverse movement is mainly due

underperformance against elective income targets due to bed pressures and the loss of recovery theatres for 2 weeks.

Liver – £2.2m adverse, £525k adverse movement. Income is over-performing by £803k but the majority of this is off

tariff drugs income. Nursing is £636k overspent, particularly in theatres and LITU. Drugs are £1m overspent, although

this is mostly recovered through income. (Removing the effect of drugs will make the income position adverse). The

maid driver of this months variance is the use of agency staff in LITU and consumable cost relating to off site working.

Surgery - £2.9m adverse, £314k adverse movement. Income is £2.8m adverse, shown in General Surgery and

relating to bariatric RTT activity. Projected RTT income has not yet been achieved in Surgery, as on-site and off-site

options are delayed and expensive. Pay in surgery is beginning to overspend particularly in Medical and Nursing, this

has been steadily increasing over the last few months and relates to Locum cover for ED trauma and the increased

nursing establishments for which budget has yet to be allocated.

Enc. 2.5

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Page 15

Divisional Financial Performance

This Chart shows the Divisional adverse (red) and positive (green) variances against plan.

Enc. 2.5

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Expenditure By Type

Page 16

Annual YTD YTD YTD Last Month Movement

Budget Budget Expend Variance Variance in Month

£'000 £'000 £'000 £'000 £'000 £'000

PAY

Medical Staff (122,487) (102,102) (101,543) 559 708 (149)

Nursing Staff (140,145) (116,561) (119,599) (3,038) (1,954) (1,084)

A&C Staff/Senior Managers (54,477) (45,376) (44,628) 748 681 67

PAMS (18,166) (15,133) (14,626) 507 493 14

Directors (1,419) (1,182) (1,272) (90) (84) (6)

Scientific/Professional (29,745) (24,737) (24,904) (167) (183) 16

Other (2,053) (1,711) (1,650) 61 80 (19)

Sub-total (368,492) (306,802) (308,222) (1,420) (259) (1,161)

NON-PAY

Clinical Supplies (59,416) (49,449) (54,957) (5,508) (4,452) (1,056)

Drugs (58,090) (48,409) (56,802) (8,393) (6,515) (1,878)

Non Clinical Supplies (32,191) (26,885) (28,863) (1,978) (1,402) (576)

PFI (25,617) (21,348) (21,755) (407) (159) (248)

Capital Charges (25,041) (18,395) (18,454) (59) (45) (14)

Interest and Dividends (19,131) (15,878) (15,654) 224 190 34

SLR Recharges (7) (5) (54) (49) (2) (47)

Recharges 11 (35) 212 247 231 16

Misc. Other Operating Exp (65,498) (49,957) (50,989) (1,032) (808) (224)

Sub-total (284,980) (230,361) (247,316) (16,955) (12,962) (3,993)

Total Expenditure (653,472) (537,163) (555,538) (18,375) (13,221) (5,154)

All Income 647,472 536,539 552,467 15,928 10,727 5,201

Income and Expenditure (6,000) (624) (3,071) (2,447) (2,494) 47

Enc. 2.5

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Income and Expenditure by Division

Page 17

Annual Budget YTD Budget YTD Actual YTD Variance

Last Months

Variance Movement

Division Heading £'000 £'000 £'000 £'000 £'000 £'000

Income 103,972 85,788 88,673 2,885 2,889 (4)

Pay (44,099) (36,741) (35,310) 1,431 1,357 74

Non-Pay (24,542) (20,489) (24,365) (3,876) (3,100) (776)

Recharges (174) (145) (147) (2) (1) (1)

AMBULATORY SERVICES Total 35,157 28,413 28,851 438 1,145 (707)

Income 155,054 128,597 129,117 520 480 40

Pay (57,060) (47,549) (48,387) (838) (693) (145)

Non-Pay (46,178) (38,416) (42,457) (4,041) (2,800) (1,241)

Recharges 662 552 635 83 80 3

NETWORKED SERVICES Total 52,478 43,184 38,908 (4,276) (2,933) (1,343)

Income 40,754 33,824 36,324 2,500 2,597 (97)

Pay (66,660) (55,523) (55,171) 352 533 (181)

Non-Pay (55,360) (46,017) (50,684) (4,667) (4,375) (292)

Recharges 0 0 556 556 422 134

CRITICAL CARE, THEATRES AND DIAGNOSTICS Total (81,266) (67,716) (68,975) (1,259) (823) (436)

Income 136,716 114,261 112,908 (1,353) (1,083) (270)

Pay (56,574) (47,017) (48,277) (1,260) (1,142) (118)

Non-Pay (25,887) (21,465) (22,105) (640) (244) (396)

Recharges 340 284 237 (47) (59) 12

LIVER, RENAL AND SURGERY Total 54,595 46,063 42,763 (3,300) (2,528) (772)

Income 73,486 61,110 63,920 2,810 1,776 1,034

Pay (51,068) (42,487) (43,237) (750) (284) (466)

Non-Pay (6,184) (5,151) (6,675) (1,524) (1,251) (273)

Recharges 0 0 0 0 0 0

TRAUMA, EMERGENCY & ACUTE MEDICINE Total 16,234 13,472 14,008 536 241 295

Income 94,257 77,935 79,995 2,060 1,710 350

Pay (53,149) (44,288) (45,223) (935) (758) (177)

Non-Pay (7,819) (6,511) (7,492) (981) (1,033) 52

Recharges 0 0 369 369 356 13

WOMENS AND CHILDRENS Total 33,289 27,136 27,649 513 275 238

Income 16,302 13,585 12,677 (908) (918) 10

Pay (2,774) (2,311) (2,377) (66) (35) (31)

Non-Pay (4,036) (3,364) (3,295) 69 280 (211)

Recharges (1,005) (837) (1,171) (334) (264) (70)

Private Patient Service Total 8,487 7,073 5,834 (1,239) (937) (302)

Income 26,931 21,439 28,853 7,414 3,276 4,138

Pay (37,107) (30,884) (30,240) 644 761 (117)

Non-Pay (95,859) (73,032) (74,747) (1,715) (856) (859)

Interest and Dividends 170 141 (533) (674) (536) (138)

SLR Recharges 11 (35) 212 247 231 16

Recharges (19,131) (15,878) (15,654) 224 190 34

Corporate Services Total (124,985) (98,249) (92,109) 6,140 3,066 3,074

Income 647,472 536,539 552,467 15,928 10,727 5,201

Pay (368,491) (306,800) (308,222) (1,422) (261) (1,161)

Non-Pay (265,854) (214,445) (231,820) (17,375) (13,379) (3,996)

Interest and Dividends 170 141 (533) (674) (536) (138)

SLR Recharges 11 (35) 212 247 231 16

Recharges (19,308) (16,024) (15,175) 849 724 125

Trust total Total (6,000) (624) (3,071) (2,447) (2,494) 47

Enc. 2.5

Page 36: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

Page 18

Private Patient Income

Private Patient Projected Cap % 2012/2013 2011/2012

£'000 £'000

Private patient income * 15,212 16,882

Total patient related income ** 551,998 545,093

Proportion (as percentage) 2.76% 3.10%

* 2012/2013 figures are forecast to year-end based on current month actuals

** 2012/2013 figures as per annual plan

Section 44 of the 2006 Act requires that the proportion of private patient

income to the total patient related income of the NHS Foundation Trust should

not exceed 3.5 per cent, its proportion when the organisation was an NHS

Trust in 2002/03.

Enc. 2.5

Page 37: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

2012/13 CIP YTD Summary

Page 19

CIP variance

CIP

Identified

YTD Target YTD Actuals Variance Forecast

ACLN 1,981 1,650 1,430 -220 -264

CCTD 3,565 2,813 2,380 -434 -776

TEAM 1,104 882 666 -216 -348

LRS 2,580 2,112 1,585 -527 -691

NWS 4,140 3,365 2,558 -807 -948

W&C 2,342 1,927 1,749 -178 -246

Facilities 250 210 148 -62 -77

Corporate 1,243 1,038 1,026 -12 -14

Trustwide 21,913 18,113 14,639 -3,474 -4,699

TOTAL 39,119 32,109 26,180 -5,929 -8,064

PERFORMANCE AGAINST PLAN

Year to date under performance against CIPs amounts to £5,929k, 82% achievement. The forecast Year end CIP variance position is £8.064m, with

the major variances as follows :-

• ACLN: £263k Pharmacy schemes (£209k of which relates to drugs purchase schemes)

• CCTD: £310k MRSA, £300k OP Project, Divisional Income schemes £83k

• TEAM: £216k Reduction in outliers, Divisional Income schemes £108k

• LRS: £267k Reduction in diagnostics tests, £100k immunosuppressant savings, £73k Pharmacy drug purchase schemes, £51k Transplant Co-

ordinator, £47k Hepatitis supplies re-tender, £30k FP10 reduction, £30k Ward shift overlap review

• NWS: £310k Spinal/Neuro consumables tenders (Procurement led), £225k additional EP/ NSTEAC list income, £130k Pharmacy drugs purchase

schemes, £80k Cardiac theatre cross cover income, £70k Libyan BMT patients, £50k coding depth project, £50k Darbopoetin drugs

• W&C: £140k NICU/Maternity Bank & Agency reduction, £59k St Heliers patients, £27k Drug purchase schemes

• Facilities: £70k Reduction in Consultant / Legal fees, £7k wall washing contract reduction

• Corporate: Negligible

• Trustwide: £2.7m RTT, £1m Private patient / commercial income, £350k Noteless, £250k Nursing establishment reviews, £178k Service reviews,

£117k Medical Productivity (due to inclusion in Divisional trackers), £100k HR Workforce

CIP Recovery Action plans

• Finance / CIP meetings held on a monthly basis to discuss and agree recovery plans

• Key focus on RTT, diagnostic tests (MRSA & LRS), and resolution of Procurement tender savings with respect to Spinal

• Implementation of winter pressure capacity developments: AAU, CDU and elective short stay Surgery (transfer of Renal to Dulwich and other satelite

units) to reduce medical outliers

Enc. 2.5

Page 38: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

2012/13 CIP YTD Performance by Key Themes

Page 20

Cost saving

Division

specific

Cost saving

Procurement

Cost saving

Pharmacy

Cost saving

Agency Staff

Reduction

Cost saving

Medical

Productivity

Cost

saving

Integrated

Service

Reviews

Cost saving

Energy

infrastructure

savings

Income

RTT

activity

Income Coding

improvements

Income Commercial

/ Private Patients

Income PCT

Demand

Management

failure

Income Productivity

Gains Total

Original Plan 12,000 2,800 1,000 2,000 200 800 900 8,000 2,000 1,000 9,000 2,600 42,300

Revised Plan 10,180 1,760 0 888 200 178 0 8,218 3,913 1,070 9,000 3,713 39,119

YTD Plan 8,192 1,420 0 724 137 59 0 6,951 3,299 843 7,500 2,984 32,109

YTD Actual 6,285 1,145 0 607 54 0 0 4,864 3,263 0 7,500 2,460 26,180

YTD Variance -1,906 -275 0 -116 -83 -59 0 -2,086 -36 -843 0 -524 -5,929

Key Variance Notes

• £2,086k relates to RTT income under achievement, most notable in Bariatrics (£1.2m), Neurosurgery (£469k), Orthopaedics (£218k),

and Liver (£120k). £3.2m of these schemes are RAG rated Red.

• £843k relates to Private Patient/ Commercial income under achievement. Although at full capacity the activity is low value patient

case-mix and Liver transplant work has been transferred to the Private Sector (London Bridge Hospital). £35k relates to Libyan BMT

patients.

• £524k relates to an income shortfall based on productivity targets (e.g. reduced patient length of stay) across specific Divisional

wards.

• £36k relates to coding optimisation income targets led by the Divisional management teams (£61k), which has been partly offset by a

small over-performance of centrally led Contracts/Coding team targets.

• £452k relates to diagnostics demand management targets not being achieved across specific Divisions.

• £275k relates to Procurement savings schemes the majority of which is due to the Neurosurgery Spinal implant tender (£250k)

• The CIP targets are phased towards the second half of the year. If they were equally spread across the year, the plan to date would be

have been £32.6m. Although a total CIP of £39.1m has been identified to date, £9.0m is red RAG rated.

The data analysis for the and coding optimisation income CIP is based on 8 months’ activity and the savings achieved are potentially over-

stated. The Trust-wide income target above includes RTT activity, PCT activity QIPP and repatriation targets, central coding optimisation

and Private Patient income targets.

Enc. 2.5

Page 39: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

2012/13 CIP YTD Risk Assessment

Page 21

Green Amber Red

ACLN 1,604 33 343

CCTD 2,676 25 865

TEAM 637 18 450

LRS 1,616 149 816

NWS 2,837 263 1,041

W&C 1,762 387 193

Facilities 143 24 83

Corporate 1,109 133 1

Trustwide 14,194 2,524 5,195

TOTAL 26,578 3,554 8,987

RAG RATING OF SCHEMES

£39.119m CIPs identified against a stretch

gross target of £42.3m.

However £9.236m (23.6%) are Red RAG

rated.

RAG ratings are based on YTD performance if

scheme has already started:-

• Red – less than 50% achievement

• Amber – less than 95% achievement

• Green – over 95% achievement

If scheme has not yet started, RAG rating is

based on delivery plan status.

Top 2 Red RAG rating drivers by Division

This section below outlines the key red RAG rated CIP schemes with

reference to the annual CIP scheme target (£). The rating for each scheme

is either on current delivery performance or lack of assurance regarding

future delivery.

ACLN: £281k Drug purchases savings – substitution by Pharmacy

£60k Specific drugs savings – Division to implement

CCTD: £400k Pathology Demand Management - reduced

MRSA testing agreed with Divisions (duplicate tests for

patients moving wards)

£300k Pharmacy rationalisation of OP dispensing services

– substitution required

TEAM: £237k Reduction in Outliers - substitution required

£60k Income from GP appointment – substitution required

LRS: £267k Pathology Demand Management – no detailed plan

£100k Immunosuppressant savings–substitution required

NWS: £300k Additional EP/NSTEAC lists – substitution required

£132k Drug purchases savings – substitution by Pharmacy

W&C: £135k NICU Bank & Agency savings – plan to recruit

£36k Drug purchases savings– substitution by Pharmacy

Trust wide: £2.1m Bariatrics RTT income – capacity issues & demand

£1m Neurosurgery RTT income - capacity issues & demand

Enc. 2.5

Page 40: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

2012/13 CIP YTD Performance by Division

Page 22

Notes ACLN: £220k adverse variance: £219k Pharmacy schemes under achievement (of which £174k relates to drugs

purchase schemes)

CCTD: £434k adverse variance: £258k Demand Management, £100k OP Dispensing Project, £67k activity increase (2

schemes)

TEAM: £216k adverse variance: £121k reduction in outliers (high risk scheme,) £43k Divisional income opportunities,

£25k Coding, £21k Drugs purchases schemes under achievement.

LRS: £527k adverse variance: £178k Diagnostics reduction, £61k Drug purchases schemes, £25k FP10s, £34k

Hepatitis supplies retender, £67k immunosuppressant savings, £40k Transplant co-ordinator vacancy, £24k

Nursing workforce shift pattern overlap reduction

NWS: £807k adverse variance: £250k Neuro Spinal implant tender, £125k Cardiology Saturday lists, £107k Drugs

purchase schemes under achieved, £67k Cardiac Theatre utilisation, £56k additional EP sessions, £35k Libyan

BMT patients, £30k coding depth project, £25k drug substitution scheme

W&C: £178k adverse variance: £87k NICU bank and agency use reduction, £42k additional St Helier patients, £23k

Pharmacy drugs purchase schemes under achievement,

Facilities: £62k adverse variance: £56k Reduction in Consultancy / Legal fees

Corporate: £12k adverse variance: £8.6k reduction in Consultancy costs, £0.8k Occupational Health Drugs purchase savings

not achieving

Trustwide: £3,474k adverse variance: £2,087k RTT income, £808k Private Patient / Commercial income, £233k Noteless,

£167k Nursing establishment review, £78k Medical Productivity, £66k Shift pattern review, £59k Service reviews

Enc. 2.5

Page 41: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

2012/13 CIP YTD Results by Monitor Category

Page 23

Income Pay Drugs

Clinical

Supplies

Non-Clinical

Supplies Other Misc Total

ACLN 568 415 423 218 17 8 1,650

CCTD 439 1,145 136 668 93 333 2,813

TEAM 500 215 47 86 34 0 882

LRS 39 793 656 457 101 66 2,112

NWS 1,681 264 235 1,003 107 75 3,365

W&C 1,020 747 47 94 19 0 1,927Facilities 0 57 0 0 153 0 210

Corporate 13 133 1 0 891 0 1,038

Trustwide 17,509 604 0 0 0 0 18,113

TOTAL 21,768 4,373 1,544 2,525 1,415 483 32,109

SPLIT OF CIP YTD TARGETS BY MONITOR CATEGORY

Income Pay Drugs

Clinical

Supplies

Non-

Clinical

Supplies

Other

Misc Total

ACLN 568 414 205 218 17 8 1,430

CCTD 403 1,142 119 549 92 75 2,380

TEAM 298 227 25 82 34 0 666

LRS 34 685 483 220 98 66 1,585

NWS 1,335 232 101 708 106 75 2,558

W&C 978 647 18 88 19 0 1,749Facilities 0 57 0 0 91 0 148

Corporate 13 133 0 0 880 0 1,026

Trustwide 14,639 0 0 0 0 0 14,639

TOTAL 18,267 3,536 951 1,864 1,338 224 26,180

SPLIT OF CIP YTD ACTUALS BY MONITOR CATEGORY

Income Pay Drugs

Clinical

Supplies

Non-Clinical

Supplies Other Misc Total

ACLN 0 -1 -218 -1 -0 0 -220

CCTD -36 -4 -17 -118 -0 -258 -434

TEAM -202 12 -22 -4 -0 0 -216

LRS -6 -108 -172 -237 -4 0 -527

NWS -346 -32 -134 -295 -0 -0 -807

W&C -42 -101 -29 -7 0 0 -178 Facilities 0 0 0 0 -62 0 -62

Corporate 0 0 -1 0 -11 0 -12

Trustwide -2,870 -604 0 0 0 0 -3,474

TOTAL -3,502 -837 -593 -661 -77 -258 -5,929

SPLIT OF CIP YTD VARIANCES BY MONITOR CATEGORY

Enc. 2.5

Page 42: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

2012/13 CIP Plan by Theme and Division

Page 24

Cost saving

Division

specific

Cost saving

Procurement

Cost saving

Pharmacy

Cost saving

Agency Staff

Reduction

Cost saving

Medical

Productivity

Cost

saving

Integrated

Service

Reviews

Cost saving

Energy

infrastructure

savings

Income

RTT

activity

Income Coding

improvements

Income Commercial

/ Private Patients

Income PCT

Demand

Management

failure

Income Productivity

Gains Total

ACLN 1,168 120 0 0 7 0 0 0 107 0 0 578 1,981

CCTD 2,148 324 0 560 38 0 0 0 0 0 0 496 3,565

TEAM 632 40 0 0 0 0 0 0 34 0 0 399 1,104

LRS 2,078 330 0 0 23 0 0 0 50 0 0 100 2,580

NWS 1,399 744 0 18 14 0 0 0 912 70 0 982 4,140

W&C 711 68 0 310 0 0 0 0 110 0 0 1,143 2,342

Facilities 250 0 0 0 0 0 0 0 0 0 0 0 250

Corporate 1,093 134 0 0 0 0 0 0 0 0 0 16 1,243

Trustwide 700 0 0 0 117 178 0 8,218 2,700 1,000 9,000 0 21,913

TOTAL 10,180 1,760 0 888 200 178 0 8,218 3,913 1,070 9,000 3,713 39,119

SPLIT OF CIP PLANS TARGETS BY PLAN THEME

Enc. 2.5

Page 43: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

Capital Plan

The annual capital budget is £19.244m as at month 10, an increase of £282k on month 9. The additional budget is covered by funding from the

Foundation Trust Financing Facility for the Critical Care Unit of which £3m is expected to be utilised in 2012/13.

Capital Expenditure YTD

Capital expenditure to month 10 was £17.283m against a reforecast year-to-date budget of £16.513m, a YTD overspend of £770k.

The overspend against YTD budget is primarily due to the overspends on the Endoscopy Unit and Units 4 & 6 (below).

Capital Scheme Projected Variances

The forecast overspend to year-end is £3.7m (19% of current capital budget) against the revised plan.

The Trust is exploring measures to reduce the forecast overspend at year end. These will include a review of IT schemes and Minor Works

schemes to potentially defer projects which are not critical or have not been started.

Page 25

Month 10 Capital Summary

Capital SchemeOverspend

£'000Comments

Endoscopy 865

Additional costs due to decontamination equipment requirements, unforeseen works, changes to specification and

contract programme delayed by 3 months caused by work stoppages due to noise (site located in main site with

adjacent clinical services). Provision of a further X-ray room.

AAU move to old Endoscopy area 300 Additional costs due to design requirements and fees. £50k Accelerator fees included.

Units 4 & 6 420Unit 6 change of use of 1st Floor to clinical area (Assisted Conception Unit) and Unit 4 additional cost to include

transformer for power supply.

Emergency Department 100 Additional external works required to install transformers.

Transfer of Renal Services to Dulwich 200 No budget allocated as this is a new project required for Winter Bed Pressure Capacity Planning

Brunel Ward 250No budget allocated. Reconfiguration of Brunel Ward to accommodate additional Winter pressure capacity

requirements.

MRI Building Works 177 Delays due to equipment specifications leading to contract extensions and additional design fees.

PET CT Scanner Design Fees & Enabling Works 100 No budget allocated as this was a new project required to accommodate the purchase of the PET CT Scanner.

Other Major / Minor Work Schemes 369 Overspends due to unplanned essential capital maintenance works.

Medical Equipment Purchases 905Purchase of urgent medical equipment or equipment to support income generating schemes approved through

BRSG in year.

Enc. 2.5

Page 44: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

Page 26

Projected 3 Year Capital Plan

Key Projects

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

1 Maternity (MLU/MAU Expansion) 1,000 (650) 350 - 1,150 1,150

2 Emergency Centre (excludes MH/Suite 1) 500 300 800 100 1,100 1,200

3 Endoscopy (Building costs - incl Decontamination and refurbishment of corridor/steam pipe removal) 2,500 1,000 3,500 - -

4 Clinical Research Facility (Building) 1,338 400 1,738 - -

5 Unit 6 Development 2,127 2,127 - -

6 Mapother House Relocation - 500 500 -

7 Unit 4 Development (2 Floors - Training Rooms / Offices) 1,700 1,700 1,500 (1,500) - -

8 Energy Performance Contract 250 (150) 100 3,500 1,800 5,300 1,600 1,600

9 Windsor Walk Development - development lease space for Paeds expansion - - 10,000 0 10,000

10 Refurbishment/Upgrade of Day Surgery (Start works Oct 2012 Complete Nov 2012) 200 200 - - -

11 Liver Lab Research Facility (Donated £435k) 750 435 1,185 - - -

12 Refurbishment of Brunel Ward (PP) - pending Infill Block 4/5 1,050 (1,050) - - 2,300 2,300 -

13 Byron Adult Cystic Fybrosis Inpatient Facility - pending Infill Block 4/5 1,000 (1,000) - - 430 430 -

14 Renal Dulwich Site - 0 - 1,500 1,500

15 Cardiac Catheter Lab (£4.3m) - pending Infill Block 4/5 - - -

16 Paediatric Expansion (£300k) - pending Infill Block 4/5 0 - 300 300 -

17 Critical Care (2 Storey option incl. Plant) - Phase 1 14,000 12,468- 1,532 30,483 (23,683) 6,800 15,000 15,130 30,130

18 CCU Enabling Works - Upgrading of Underground Oil Tanks and Roadway 1,000 1,000- - -

19 CCU Enabling Works - Fibre Optic Cabling - 500 500

20 CCU Enabling Works - Decanting/Infrastructure (Infill Blk 4) 500 500 1,000 -

21 CCU Enabling Works - Decanting/Infrastructure (Infill Blk 5) 500 (500) - -

22 Critical Care (2 Storey option incl. Plant) - Phase 2 - 0 - 18,200

23 CC Expansion (Waste Compound) - Phase 2 - 0 - 300 (300) - 500

24 CDU Enabling Works 150 150 -

25 AAU move to old Endoscopy 250 250 -

26 Consulting Rooms for ATOS (Funded by ATOS) 20 20 130 130

27 Pharmacy Dispensing Expansion 100 100

28 Helideck (Drawings for submission for Planning Permission) 80 80

29 Portakabin B transfer to Dental Carpark 150 150

30 Pet CT Scanner Enabling Works - 1,200 1,200

31 Cyber Knife Enabling Works - 500 500

32 Other Major Works Refurbishment of Wards (Cathlab/Angio Recovery) 183 (183) - - -

33 MRI - Building Works (BRSG) _ Start 17 Sept (3 months) 500 0 500 - -

34 Ultrasound - Building Works (Single Sex / Diginity) 500 (500) - - -

35 Diabetic Foot Clinic - Environmental (H&S) - ON HOLD 250 (250) - - 250 250

36 Outpatients Refurbishment / Dulwich Transfer (Suite 4) 114 (114) - - -

37 Minor work schemes 1,200 (9) 1,191 1,300 1,300 1,300 1,300

38 Information Technology - Tangible Assets 1,000 (50) 950 1,500 (500) 1,000 1,500 1,500

39 Information Technology - Intangible Assets 500 (337) 163 500 400 900 500 500

40 Medical Equipment new and replacement (incl Donated) 596 362 958 1,000 (500) 500 1,000 1,000

Total 31,558 (12,314) 19,244 40,683 (16,923) 23,760 29,300 18,230 47,530 18,700

Available Funding details

Cash from operations Depreciation non-cash charge 14,996 0 14,996 16,292 0 16,292 17,466 0 17,466

Charitable donations Acorns to Oaks Appeal (CRF) 242 0 242 0 0 0 0 0 0

Charitable Trust (Critical Care Equipment) 0 0 0 349 0 349 0 0 0

Liver Lab Facility Pledges 350 85 435 0 0 0 0 0 0

Paediatric Expansion Funding 300 (300) 0 0 300 300 0 0 0

Cystic Fybrosis Foundation 430 (430) 0 0 430 430 0 0 0

Consulting Rooms for ATOS (Funded by ATOS) 0 20 20 0 130 130 0 0 0

Medical Equipment purchases 0 279 279 0 0 0 0 0 0

PDC Received PDC 0 0 0 0 0 0 0 0 0

Cash from External Loans FTFF (Critical Care Development) 16,000 (12,968) 3,032 30,783 (23,983) 6,800 15,000 15,130 30,130 18,700

Utilisation of Internal Cash Resources (760) 1,000 240 (6,741) 6,200 (541) (3,166) 3,100 (66)

Total 31,558 (12,314) 19,244 40,683 (16,923) 23,760 29,300 18,230 47,530 18,700

2014 / 15

Plan

2014/15

Additional

2014 / 15

Total

2015 / 16

Total

2012 / 13

Plan

2012/13

Additional

2012/13

Total

2013 / 14

Plan

2013/14

Additional

2013/14

Total

Proposed Annual Plan

Enc. 2.5

Page 45: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

Capital Expenditure Summary

Month 10

Page 27

Major works 14,512 12,364 13,774 3,456 17,230

Minor works 1,191 800 540 701 1,241

Medical Equipment 1,452 1,817 1,252 1,105 2,357

IT and infrastructure 838 750 541 297 838

Intangibles (IT) 275 50 200 75 275

Donated - Major Works 455 341 435 20 455

Donated - Medical Equipment 521 391 541 (20) 521

Total Capital Position :

Overspend (+) / Underspend (-) 19,244 16,513 17,283 5,634 22,917

Budget

Period

Budget

Actual to

date

Anticipated

Changes

Y/E

Forecast

Gross capital expenditure b/f 19,244 16,513 17,283 5,634 22,917

Gross Cost 19,244 16,513 17,283 5,634 22,917

Less:

Capital Donations held on Trust, NOF monies 976 732 976 - 976

Total 976 732 976 - 976

Capital Charge against Capital Resource Limit 18,268 15,781 16,307 5,634 21,941

Depreciation non-cash charge 14,996 12,349 12,364 2,632 14,996

PDC Received - - - -

External Borrowings 3,032 - - 3,032 3,032

Internal Cash Resources 240 3,432 3,943 30- 240

FT Capital Plan 18,268 15,781 16,307 5,634 18,268

Variance : + over / (-) under - - - - 3,673

Actual YTD

Budget

Cost to

Complete

Total Cost

12/13

Total per capital category

Expenditure

Annual

Plan

12/13

Period

Budget

Enc. 2.5

Page 46: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

Page 28

Month 10 Working Capital Summary

Working Capital Summary

As at month 10 outstanding debtors totalled £29.8m including Private Patient and Overseas Visitors debts.

Total gross outstanding debts relating to 2011/12 total £2.163m, a decrease on month 9 of £347k (there are a number of

outstanding PCT Credits due to contract under-performance which will be offset against these debtors at year end).

PCT SLA Over-Performance 2012/13:

A net total of £26.576m of PCT SLA over- and under-performance invoices have been raised to date relating to the

period for April 2012 to January 2013.

To date (February 2013), £21.819m has been received leaving a net outstanding balance of £4.756m.

Prudential Borrowing Limit

The Trust’s Tier 1 borrowing limit is £141m for 2012/13.

The Trust is currently utilising £88.656m (63%) of its 2012/2013 Tier 1 Prudential Borrowing Limit (Long-term borrowing) of

£141.0m leaving headroom of £52.344m.

The Foundation Trust Financing Facility agreed in December 2012 to provide external funding to the Trust to finance the

construction of the Critical Care Unit. The Trust will not exceed its Prudential Borrowing Limit as these funds will be drawn

down over 3 years. The Trust’s tier 1 Limit is expected to increase over these years due to the forecast increase in Trust

income.

PCT SLA Over performance 800 794 (6)

PCT SLA Invoices 435 435 0

NCA Invoices 259 243 (16)

Provider-to-provider Diagnostic Service 155 150 (6)

Staff recharges and other NHS organisations 168 112 (56)

Remaining NHS & Non NHS debt related balances 692 429 (263)(Relating to: Clinical, Commercial & Non-commercial trial income, Course fees and

other patient & non-patient related income)

Total Outstanding Debt 2,1632,510 (347)

Outstanding Debt Relating to 2011/12M10

£'000

M9

£'000

MOVEMENT

£'000

Enc. 2.5

Page 47: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

SLA Over-Performance Invoices 2012/13

Page 29

This table has been

prepared as at 15 February

2013 and reflects all

invoices raised and

payments received to that

date.

Monthly PCT SLA Over-

performance invoices are

raised approximately 2

months after the end of the

month to which it relates.

This is due to the SUS

timetable and the data

validation process.

Payment against these

invoices should be

received by the 15th day of

the following month

although if there are any

queries or disputes

outstanding, payment is

delayed.

In effect, it takes the Trust

a minimum of 3 months to

recover the cost of over-

performance from the

PCT.

Quarter 1 Quarter 2 Quarter 3 Net Total Cash ReceivedOutstanding

Cash

Croydon 464,436 945,356 799,241 2,209,034 (970,507) 1,238,527

Bromley 103,544 (94,193) 941,052 950,402 (272,025) 678,377

West Kent 271,728 135,930 641,364 1,049,022 (407,659) 641,363

Surrey 238,137 424,285 476,636 1,139,058 (577,529) 561,529

E of E (All Contracts) 0 277,325 199,482 476,807 476,807

Croydon (for Renal) 143,350 172,439 147,266 463,054 (203,531) 259,523

Kingston 48,290 103,894 57,121 209,306 (48,290) 161,016

Bexley Care 690,419 321,867 187,218 1,199,504 (1,044,385) 155,119

SACS (for EAST SUSSEX PCTs) 211,153 155,882 125,852 492,887 (367,036) 125,851

Medw ay (42,716) 116,040 211,526 284,850 (171,659) 113,191

Brent Teaching 28,651 52,321 87,059 168,031 (64,781) 103,250

Ealing 15,732 (1,566) 88,493 102,660 0 102,660

Wandsw orth (12,346) 121,466 86,662 195,782 (109,120) 86,662

Sutton and Merton 10,627 30,308 86,529 127,464 (40,934) 86,530

Enfield (29,596) 28,010 55,852 54,266 31,144 85,410

Havering 48,858 51,365 82,497 182,720 (108,346) 74,374

Haringey Teaching 12,784 37,243 23,240 73,267 0 73,267

Barking and Dagenham 24,936 28,794 38,537 92,268 (38,188) 54,080

SACS (for WEST SUSSEX PCT) 494,103 222,289 49,766 766,158 (716,392) 49,766

Tow er Hamlets (30,498) 55,528 39,477 64,507 (25,030) 39,477

Westminster 134,747 (9,479) 39,117 164,385 (125,268) 39,117

Barnet 93,476 43,888 6,117 143,482 (104,686) 38,796

Hammersmith and Fulham (26,926) (1,271) 29,129 933 28,197 29,130

Harrow 4,721 34,269 27,930 66,921 (38,991) 27,930

Islington (46,606) (18,922) 40,586 (24,942) 52,058 27,116

Hillingdon (5,374) 14,344 12,926 21,895 0 21,895

Richmond and Tw ickenham (2,397) 23,759 16,756 38,118 (21,361) 16,757

Kensington and Chelsea 87,962 4,199 28,045 120,206 (104,275) 15,931

Eastern and Coastal Kent (330,493) 147,868 (68,154) (250,780) 257,434 6,654

East Midlands SCG (Trent) 44,200 88,368 5,759 138,328 (132,568) 5,760

Lambeth 1,802,501 1,457,225 3,867,401 7,127,127 (7,125,266) 1,861

Lew isham 354,715 334,062 1,925,305 2,614,083 (2,613,823) 260

Southw ark 1,217,352 2,138,916 3,352,394 6,708,662 (6,708,661) 1

E of E (SOUTH ESSEX) 109,529 55,092 0 164,621 (164,621) 0

E of E (NORTH ESSEX) 152,275 8,251 0 160,526 (160,526) 0

E of E (NSC) (85,321) 344,776 0 259,455 (259,455) 0

E of E (Herts) 14,112 3,335 0 17,447 (17,447) 0

E of E (Bedfordshire) 24,482 66,885 0 91,367 (91,367) (0)

Redbridge 6,341 (28,569) (2,823) (25,051) 22,228 (2,823)

East Midlands SCG (Northants) 100,882 (17,302) (11,303) 72,277 (83,580) (11,303)

Waltham Forest (88,472) (48,057) (13,627) (150,156) 136,528 (13,628)

City and Hackney (29,569) 18,190 (14,357) (25,736) 11,379 (14,357)

Yorkshire and Humber SCG 25,777 106,775 (16,521) 116,030 (132,916) (16,886)

East Midlands SCG (Leics) (20,830) 24,773 (18,557) (14,614) (3,943) (18,557)

South West SCG 131,787 374,031 (52,660) 453,158 (475,749) (22,591)

New ham (71,960) (5,288) (26,151) (103,399) 77,249 (26,150)

Camden (1,550) (28,042) (1,581) (31,174) 0 (31,174)

South Central SCG (355,018) (256,871) (46,882) (658,771) 611,890 (46,881)

Hounslow (59,500) 25,625 (68,600) (102,474) 0 (102,474)

East Midlands SCG (Milton Keynes) (175,223) (154,793) (147,704) (477,721) 330,017 (147,704)

Greenw ich Teaching (90,119) (334,369) 84,927 (339,561) 152,563 (186,998)

5,607,093 7,596,252 13,372,343 26,575,689 (21,819,228) 4,756,461

Enc. 2.5

Page 48: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

Working Capital - Debtors

Page 30

Provision for Bad Debts is based on debts outstanding over 6 months.

The NHS Provision has been adjusted for debts which are not contested and are considered recoverable.

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

£ £ £ £ £

NHS BodiesPrimary Care Trusts 9,225,929 2,439,438 2,201,409 259,005 4,326,078

Department of Health / SHA 297,622 154,034 67,907 57,232 18,448

Provider Trusts 6,421,123 3,229,520 1,319,863 723,825 1,147,915

NHS Trade Debtors 15,944,673 5,822,992 3,589,179 1,040,061 5,492,441

Provision for Bad Debts (580,667) - - - (580,667)

NHS Bodies Total 15,364,006 5,822,992 3,589,179 1,040,061 4,911,774

Non NHS BodiesScottish, Welsh & Irish Health Bodies 709,136 90,668 (7,614) 46,323 579,759

King's College London University 4,134,384 127,732 190,619 2,427,408 1,388,627

King's Charitable Trust 49,818 5,169 6,892 - 37,757

Other Non NHS Bodies 2,602,786 880,811 427,495 145,485 1,148,996

Non NHS Trade Debtors 7,496,125 1,104,379 617,392 2,619,215 3,155,138

Provision for Bad Debts (588,492) - - - (588,492)

Non NHS Bodies Total 6,907,633 1,104,379 617,392 2,619,215 2,566,646

Total Accounts Receivable 23,440,798 6,927,372 4,206,571 3,659,277 8,647,579

% of Total Outstanding - Month 10 100% 30% 18% 16% 37%

Month 9 100% 47% 16% 10% 27%

Private Patients Accounts Receivable 3,238,318 1,254,977 372,714 684,080 926,548

Provision for Bad Debts (137,931) - - - (137,931)

Private Patients Accounts Receivable Total 3,100,387 1,254,977 372,714 684,080 788,617

Overseas Visitors Accounts Receivable 3,112,651 217,702 239,906 530,287 2,124,757

Provision for Bad Debts (617,887) - - - (617,887)

Overseas Visitors Accounts Receivable Total 2,494,764 217,702 239,906 530,287 1,506,870

Total PP & Overseas Visitors Accounts Receivable 6,350,969 1,472,679 612,620 1,214,366 3,051,305

Enc. 2.5

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Working Capital - Creditors

Invoiced trade creditors – excludes accruals and employer costs

Page 31

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

£ £ £ £ £

NHS Bodies 6,331,853 1,159,145 2,249,623 1,794,303 1,128,783

Non NHS Bodies 26,841,777 7,356,218 10,188,380 4,878,547 4,418,633

Total 33,173,630 8,515,362 12,438,003 6,672,850 5,547,415

% of Total Outstanding - Month 10 100% 26% 37% 20% 17%

- Month 9 100% 22% 41% 21% 17%

Enc. 2.5

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Page 32

Cash Summary

Cash Balances

The Cash balance at the end of Month 10 was £31.699m against a forecast cash balance of £17.567m.

The Trust’s Working Capital Facility is £35m and the Trust has not utilised this Facility in the current financial year.

Cash Flow Variances

The Cash balance at the end of Month 10 was £31.699m against a forecast cash balance of £17.567m

PCT contract over-performance payments of 4.756m remain outstanding (see page 29).

To 31 January 2013, income of £352k above forecast has been received from the Joint Venture, GSTS Pathology.

This level of income is due to continue for the remainder of the year and the forecast cash flow has been amended

accordingly.

Payroll payments, including National Insurance and P.A.Y.E. were £118k more than forecast to 31 January 201. This

is partly due to an increase in NI, Pension and PAYE payments.

Payments to NHS Professionals for bank and agency staff were £710kmore than forecast in January 20123 due to

previous months delays in payment.

Capital invoice payments were £1.801m more than the re-forecast plan to date due to phasing of capital budgets

compared to the payment of invoices. It is expected that these payments will move in-line with budget over the

remainder of the year.

Revenue creditors were paid £810k less than forecast, February 2013 payments will be increased to cover this

shortfall.

Enc. 2.5

Page 51: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

Cash Flow

Page 33

TOTAL QTR 1 QTR 2 QTR 3 January February March

ANNUAL PLAN 2012/13 2012/13 2012/13 2013 2013 2013

Forecast ACTUAL ACTUAL ACTUAL ACTUAL Forecast Forecast

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

Balance B/F 27,607 27,607 16,969 19,689 21,871 31,699 24,731

Income

NHS Clinical IncomeSouthwark PCT SLA (Excl Merit Awards) 100,926 24,983 25,608 25,041 8,432 8,431 11,131

Lewisham PCT SLA 40,059 9,879 10,027 10,151 3,334 3,334 3,334

Lambeth PCT SLA 85,708 21,403 21,612 21,348 7,116 7,115 7,115

LSL PCT Other (Palliative Care) 4,191 454 184 3,361 1,247 64 64

SLAs : Other PCTs (incl PICU, NICU, BMT, HIV, Neuro Rehab) 183,469 45,541 45,347 47,425 15,718 15,052 15,052

LSCG ( Croydon) 61,715 11,069 20,859 14,730 5,087 5,019 5,019

Provider to Provider Income 16,452 4,210 3,843 4,407 619 1,416 1,416

PCT NCAs 2,554 651 563 641 308 233 233

DoH - patient activity (NSCAG) 23,957 6,066 5,949 5,991 1,268 1,977 1,977

RTA's 1,609 294 383 533 88 133 133

Patient SLA Overperformance 2012/2013 24,489 0 2,879 10,505 9,317 2,293 2,952

Patient SLA Overperformance 2011/2012 3,722 361 1,247 2,114 434 0 0

Private Patients 15,230 3,658 4,145 4,417 986 1,000 1,005

Research and Development 2,511 814 418 205 185 358 358

Training & Educ: SIFT facilities, placement & HD 20,172 5,043 5,043 5,043 5,043 0 0

Training & Educ: MADEL & PGME 14,032 3,529 3,451 3,527 2,152 0 0

Training & Educ: Dental (SIFT) 7,392 1,848 1,848 1,848 1,848 0 0

Training & Educ: SELSHA WDC & Dental NMET 4,017 909 1,115 1,120 1,213 0 0

Merit Awards 3,600 600 1,200 900 0 600 300

Pathology (Joint Venture) 18,586 5,301 5,178 4,657 1,508 1,150 1,150

Caregroup Operational Income 33,531 9,703 6,323 9,105 4,027 2,800 2,803

VAT reclaims 18,997 3,574 5,868 5,055 1,484 1,500 1,500

Consultant's Fees income (Private Patients) 3,160 896 754 387 285 315 315

sub-total 690,079 160,786 173,844 182,511 71,699 52,790 55,857

Expenditure

Pay monthly (incl Pay Awards) 194,876 47,516 47,902 49,247 16,668 16,737 16,737

PAYE/NIC/SUPER (CHAPS) 146,227 36,225 36,514 36,789 12,420 12,233 12,233

Agency Spend (NHSP Bank) 30,308 6,541 7,842 6,661 4,974 2,946 2,500

Consultants' Fees 3,160 896 754 387 285 315 315

PFI project 30,216 8,422 7,779 7,865 2,677 2,050 2,050

AAH 4,367 1,126 1,126 915 400 400 400

Pathology (Joint Venture) 34,414 8,648 8,736 8,630 2,881 2,800 2,800

NHSLA Clinical Negligence 9,988 2,996 2,997 2,997 999 0 0

Non-pay Direct Debits (leases, rates) 11,387 3,462 2,370 2,755 776 850 1,350

Non-pay Revenue Trade Creditors (Incl. CIPs) 190,293 47,162 42,285 55,294 15,646 19,584 18,708

sub-total 655,235 162,994 158,305 171,540 57,726 57,915 57,093

Cash from operations 34,844 (2,208) 15,540 10,972 13,973 (5,125) (1,236)

Capital & Financing Items

Capital gross exp (Purchased) 20,206 4,867 5,832 5,052 3,286 1,590 1,484

Capital gross exp (Donated) 986 156 474 356 0 0 0

Capital Income (Donated) (986) 0 (61) (11) 0 (608) (306)

PDC Dividends (TDR) 8,092 0 3,918 0 0 0 4,174

Loan Received (800) 0 0 0 0 0 (4,200)

Loan Repaid (Energy Centre) 562 281 0 281 0 0 0

Loan Repaid (Business Park) 450 225 0 225 0 0 0

Salix Loan Repaid 124 0 62 0 0 0 62

Capital Element of Finance Lease repayment 733 184 183 183 61 61 61

Interest on investments (74) (16) (20) (21) (7) (5) (6)

Interest Paid on Revolving Credit Facility 70 17 17 18 0 0 18

Interest on Loans (Energy Centre) 488 247 0 241 0 0 0

Interest on Loans (Business Park) 103 53 0 50 0 0 0

Interest on PFI & Finance Leases 7,513 1,879 1,878 1,878 626 626 626

PFI Contingent Rental Payments 2,148 537 537 537 179 179 179

sub-total 39,615 8,430 12,820 8,789 4,145 1,843 2,092

Net Inflow / Outflow (4,771) (10,638) 2,720 2,183 9,828 (6,968) (3,328)

Forecast Balance C/F 22,836 16,969 19,689 21,871 31,699 24,731 21,403

Enc. 2.5

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Analysis of Cash Balances (Monthly)

Page 34

GRAPH A – Monthly Net Cash Balances (incl. Overdraft)

Graph A shows the monthly net cash balance based on actual cash flows.

The level of balances held on the Citi Bank and Natwest accounts are frequently reviewed in order to maximise

interest receivable and minimise interest payable and bank charges.

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13

£'00

0

Date

Monthly Cash Balances NatWest GBS- Citibank

Cash Balance

Enc. 2.5

Page 53: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

Analysis of Cash Balances (Daily)

Page 35

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.

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

28-Feb-12 28-Mar-12 28-Apr-12 28-May-12 28-Jun-12 28-Jul-12 28-Aug-12 28-Sep-12 28-Oct-12 28-Nov-12 28-Dec-12 28-Jan-13

£'00

0

Date

Daily Cash BalancesBalance (£'000)

Enc. 2.5

Page 54: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

Statement of Financial Position (Balance Sheet)

Page 36

Trade and Other Receivables includes NHS and Non-NHS debtors on page 30

Trade and Other Payables includes NHS and Non-NHS Creditors on page 31

STATEMENT OF FINANCIAL POSITION AS AT 31 March 2012

Qtr 1

30 June

Qtr 2

30 September

Qtr 3

31 December 31 January

Consolidated

Annual Plan

Forecast

2012 2012 2012 2013 31 March 2013

£'000 £'000 £'000 £'000 £'000 £'000

NON-CURRENT ASSETS

Intangible Assets 1,276 1,088 941 1,091 1,064 996

Property, Plant & Equipment 271,215 272,160 270,530 269,521 271,440 281,735

Investments in associates (and joined controlled operations) 78 78 78 78 78 78

On-Balance Sheet PFI 75,679 75,155 74,630 74,096 73,920 73,438

Trade and Other Receivables, Non- Current 3,530 3,530 3,530 3,530 3,530 3,530

Total Non-Current Assets 351,778 352,011 349,709 348,316 350,032 359,777

CURRENT ASSETS

Inventories 10,963 11,070 11,151 10,593 10,530 11,500

Trade Receivables 23,535 21,692 27,107 36,174 31,169 26,900

Other Receivables 8,352 19,143 9,016 13,537 14,868 8,800

Impairment of Receivables (2,756) (3,033) (3,592) (3,443) (3,283) (4,000)

Other Financial Assets 8,668 18,455 21,270 8,843 4,351 8,246

Prepayments 3,844 4,056 7,100 6,926 6,826 4,000

Cash & Cash Equivalents 27,607 16,970 19,689 21,871 31,699 22,835

Total Current Assets 80,213 88,353 91,741 94,501 96,160 78,281

CURRENT LIABILITIES

Interest-Bearing Borrowings (1,135) (629) (567) (62) (62) (1,135)

Deferred Income (6,181) (6,793) (6,353) (4,995) (4,469) (4,700)

Provisions (983) (838) (649) (1,107) (1,386) (990)

Current Taxes Payable (7,939) (7,901) (7,787) (8,014) (8,118) (8,200)

Trade Payables (22,849) (16,770) (27,217) (24,555) (33,186) (23,900)

Other Payables (9,742) (14,811) (12,090) (15,445) (13,066) (9,500)

Other Financial Liabilities (26,159) (34,165) (33,716) (34,175) (32,111) (24,529)

Total Current Liabilities (74,988) (81,907) (88,379) (88,353) (92,398) (72,954)

Total Assets less Current Liabilities 357,003 358,457 353,071 354,464 353,794 365,104

NON-CURRENT LIABILITIES

Interest-Bearing Borrowings (12,083) (12,084) (12,084) (12,084) (12,084) (25,948)

Provision (6,232) (6,232) (6,232) (6,232) (6,232) (5,542)

Other Financial Liabilities (76,388) (76,388) (76,388) (76,388) (76,388) (75,659)

Total Non-Current Liablilities (94,703) (94,704) (94,704) (94,704) (94,704) (107,149)

Total Assets Employed 262,300 263,753 258,367 259,760 259,090 257,955

Financed By (taxpayers' equity):

Public Dividend Capital 135,678 135,678 135,678 135,678 135,678 135,678

Revaluation Reserve 85,979 86,212 85,919 85,872 85,841 87,667

Income & Expenditure Reserve 40,643 41,863 36,770 38,210 37,571 34,610

Total Taxpayers' Equity 262,300 263,753 258,367 259,760 259,090 257,955

Enc. 2.5

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Public Sector Payments Policy

Page 37

Public Sector Payments Policy

Paid to NHS Organisations Amount Paid on Time

2012/13 Through AP Direct 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 2,110 2,593 4,703 654 2,593 3,247 31% 100% 69% 69%

May 4,549 3,531 8,080 944 3,531 4,475 21% 100% 55% 62%

June 2,136 3,415 5,551 842 3,415 4,257 39% 100% 77% 67%

July 161 2,861 3,022 111 2,861 2,972 69% 100% 98% 75%

August 2,169 3,919 6,088 1,026 3,919 4,945 47% 100% 81% 76%

September 1,641 4,061 5,702 601 4,061 4,662 37% 100% 82% 77%

October 4,142 2,897 7,039 2,467 2,897 5,364 60% 100% 76% 77%

November 2,312 2,823 5,135 69 2,823 2,892 3% 100% 56% 74%

December 2,873 3,320 6,193 702 3,320 4,022 24% 100% 65% 73%

January 1,443 5,873 7,316 733 5,873 6,606 51% 100% 90% 75%

23,536 35,293 58,829 8,149 35,293 43,442 35% 100% 74%

Paid to Non NHS Organisations Amount Paid on Time

2012/13 Through AP Direct 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 14,533 7,404 21,937 11,715 7,404 19,119 81% 100% 87% 87%

May 14,098 8,438 22,536 7,258 8,438 15,696 51% 100% 70% 78%

June 14,714 8,429 23,143 10,436 8,429 18,865 71% 100% 82% 79%

July 18,757 7,405 26,162 9,734 7,405 17,139 52% 100% 66% 76%

August 12,906 7,414 20,320 5,981 7,414 13,395 46% 100% 66% 74%

September 12,918 7,583 20,501 4,142 7,583 11,725 32% 100% 57% 71%

October 18,644 8,218 26,862 8,178 8,218 16,396 44% 100% 61% 70%

November 14,718 7,549 22,267 5,602 7,549 13,151 38% 100% 59% 68%

December 17,949 7,649 25,598 6,374 7,649 14,023 36% 100% 55% 67%

January 17,421 7,424 24,845 9,142 7,424 16,566 52% 100% 67% 67%

156,658 77,513 234,171 78,562 77,513 156,075 50% 100% 67%

Enc. 2.5

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Glossary

Page 38

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.

Enc. 2.5

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1

Finance and Performance

Committee

2012-13 Month 10

Performance

Roland Sinker

Chief Operating Officer

Enc. 2.6

Page 58: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

Report to: Board of Directors Meeting

Date of meeting: 26 February 2013

Subject: Performance Report, Month 10 2012/2013

Author(s): Peter Fry, Assistant Director of Performance and Contracts

Presented by: Roland Sinker

Sponsor: Roland Sinker

History:

Status: For Information

2

1. Background/Purpose This report provides the details of performance achieved against the governance indicators defined in the

Monitor Compliance framework for the interim Quarter 4 position based on performance reported for January

2013. It also contains an update on the Trust’s contractual position at Q3 in relation to its CQUIN performance.

2. Action required Alongside the Monitor Quarter 4 2012/13 report, the Board is asked to approve the performance reported

against the governance indicators defined in the Monitor Compliance framework for Quarter 4 as detailed within

this Month 10 Performance Report.

Enc. 2.6

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3

Legal: Statutory reporting to Monitor and the DH.

Financial: Trust reports financial performance against published plan.

Assurance: The summary report provides assurance that the Trust has met all targets as defined

within the Monitor compliance framework for the interim Q4 position in 2012/13

based on January 2013 performance, with the exception of 2 cancer waiting time

targets and the RTT Admitted target. The Trust can only achieve an Amber-Green

governance rating for Q4 due to the RTT Admitted target not being achieved in

January 2013.

Clinical: There is no direct impact on clinical issues.

Equality & Diversity: There is no impact on equality & diversity issues.

Performance: The summary report demonstrates that the Trust has achieved all performance

indicators for the interim Q4 position based on January 2013 performance as defined

in the Monitor compliance framework, with the exception of 2 cancer waiting time

targets and the RTT Admitted target.

Strategy: Performance against the Trust’s annual plan forecasts and key objectives.

Workforce: None.

Estates: There is no direct impact on Estates.

Reputation: Trust’s quarterly and monthly results will be published by Monitor and the DH.

Other:(please specify) None.

3. Key implications

Enc. 2.6

Page 60: King’s College Hospital Board of Directors - 251.1 - bod agenda and...King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday,

4

Contents

•Executive Summary

•Trust Performance Summary

•Divisional Performance Summary

•Regulatory/Contractual Performance

• Monitor 2012-13 Q4 position

• CQUIN 2012/13 Q4 update

• Care Quality Commission (CQC) – Quality Risk Profile Update

•Specific Performance Reports

• Emergency Care Action Plan Update

• RTT Q4 Performance Update

• Infection Control Update

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Executive Summary (1/5)

1. Trust Wide 2012-13 Performance for Month 10:

Good Performance

The Trust achieved the 4-hour waiting time standard for January at 95.1% despite the sustained pressure

experienced in the A&E department over the current winter period. RTT waiting time targets were achieved

for Non-admitted and Incomplete pathways in January. However, the Trust did not achieve the RTT

Admitted target of 90% as planned, with 88.8% of patients seen within 18 weeks. Cancer waiting time

targets were achieved in January with the exception of the 2-week wait and 31 day subsequent treatment

for surgery standards.

No further MRSA cases were attributed to the Trust during January so the Trust has 1 case YTD which is

lower than our quota of 4 cases for the YTD position. It is now over 300 days since the first case was

reported this year. 2 further c-difficile cases were reported during January, so the Trust has declared 47

cases to date, lower than our quota of 63 cases for the same period. This compares favourably to the 85

cases that were reported at this point last year.

Performance challenges

ED - Delivery of the 4-hour A&E waiting time standard in Q4 remains a concern, given the continued high

levels of bed occupancy experienced into February on general/acute wards and the critical care units.

The Trust has reported two 12-hour trolley wait breaches for the first week in February predominantly due

to patients waiting for side-rooms, but patient safety was not compromised.

RTT – The Trust continues to utilise off-site capacity from a range of providers to ensure that it can treat its

long-wait and 52-week wait patients, as this is also one of the key areas of focus for the commissioners.

Delivery of the RTT admitted target therefore remains a risk for remainder of Q4 which is in line with our

plan submitted to Monitor. As this indicator has not been achieved in January, Monitor will assess the

Trust as not meeting this standard for Q4 as the target must be achieved for each month in the quarter.

Tertiary transfers – Repatriation bedday delays increased to effectively 9 beds on average per day during

January compared to 7 beds in December due to bed pressures and remains a strategic and clinical risk

as reported last month.

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Executive Summary (2/5)

Diagnostic Waits - There were 218 breaches of the 6-week diagnostic waiting time standard at the end of

January compared to 147 breaches at the end of December. The increase was largely due to 49

breaches in non-Obstetric ultrasound and 84 breaches in endoscopy. Over 4.4% of patients are waiting

over 6 weeks for diagnostic assessment compared to the national 1% target. Current performance

represents a significant risk to the Trust that the backlog will not be cleared by the end of March, as this

indicator is included in the draft Monitor proposals for its 2013-14 Risk Assessment Framework.

Actions

Emergency Access Targets: Additional emergency medical beds have now come on-line as planned.

The outcome of the Root Cause Analysis into the two 12 hour trolley breaches will be reported to the

Finance & Performance and Quality & Governance Committees. To support the delivery of the agreed

divisional actions which form part of the Trust’s Winter Resilience Plan, daily meetings including all

divisional managers continue, chaired by the Assistant Director of Performance & Contracts.

Waiting List Access Targets: Additional on-site capacity for a short-stay elective ward became

operational at the end of January to provide ring-fenced elective activity. Additional off-site capacity

continues to be utilised, and additional lists have been secured at The Lister Hospital for General Surgery

and T&O, and Harley Street for Neurosurgery. The internal audit that has been agreed with our

commissioners to review our RTT monitoring processes has commenced which KPMG are leading on. EY

are supporting the Trust on work around restricting access for out of area care and longer-term off-site

moves.

Tertiary transfers: The Trust plans to provide additional capacity with the proposed Infill 4 and 5

developments will mitigate concerns being raised by other hospitals in relation to the current delays

experienced in transferring tertiary patients to the Trust.

Diagnostic Access Targets: There is a further 2 week delay before the new MRI scanner becomes

operational. Medinet will continue to run lists at the weekend, and will run additional lists during week-

days to fill unused capacity that cannot be run due to the difficulties in recruiting nursing staff for the new

Endoscopy unit. An additional weekend list will be run by KCH staff from 18 February 2013. Additional

weekend lists are being planned to help reduce the level of non-obstetric ultrasound breaches that were

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7

Executive Summary (3/5)

reported at the end of January. The position deteriorated due to the loss of one scanner which could

not be replaced by the manufacturer, and the department is attempting to source an additional

scanner. Additional clinics have been run in February to reduce the echocardiography backlog and

has more than halved the number of breaches. Additional room capacity is being sought in order to

manage the demand and breach position from March onwards.

Health Care Acquired Infection (HCAI): C-difficile remains a risk due to the low trajectory that has

been set for this year. Enhanced actions from the 2011-12 HCAI Action Plan continue into the new

financial year, and additional measures have been incorporated into the Trust’s Winter Resilience

Plan.

Francis Report actions: The final report into the care provided by Mid Staffordshire NHS Foundation

Trust was published on 6 February 2013. An internal working group has been convened with non-

executive and Governor representation as well as senior leadership within the Trust. The group will

provide an initial review of the recommendations within the Francis Report and assessment of key

areas of reporting and Board Assurance that require improvement. An interim report will be taken to

the Finance & Performance Committee in March.

Other areas of concern:

Day Surgery Unit (DSU): Detailed investigations are on-going and a full report on the DSU Action

Plan following the ‘mock’ CQC inspection will be taken to the Finance & Performance Committee in

March.

Mixed Sex Accommodation: There were 27 Single Sex accommodation breaches reported in

January 2012, which represents a slight increase compared to the 23 cases reported in December. All

breaches were delayed discharge patients from surgical and medical critical care units.

Safety indicators: Red shifts, and slips, trips and falls remain high and above target.

A never event due to a retained swab was reported in a Neurosurgery patient. Preliminary findings

have been presented to the Serious Incident committee in February, with the aim of the formal findings

being reported to the March committee meeting.

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8

Executive Summary (4/5)

Supplies of meat products: In light of recent events, Medirest have contacted the Trust to confirm that they

have taken a decision to use only processed beef products where it has been sourced and processed in the

UK and Ireland for the foreseeable future. Medirest has also commenced its own independent DNA testing

programme across all of their processed meat products.

2. Regulatory

• Monitor Q4 position

The Trust achieved all performance indicators in January with the exception of 2 cancer waiting time targets

(31-day subsequent surgery and the 2 week wait for all cancers, and the RTT Admitted target. Although

delivery of the cancer waiting time targets remains a risk, we expect to achieve the targets for Q4 overall.

The Trust is therefore rating itself a provisional score of 2.5 in the Monitor Compliance Framework based on

the January 2013 position, which would give the Trust a governance risk rating of Amber-Red. Due to the

RTT Admitted target not being achieved in January, the best rating for Q4 would be Amber-Green.

• Care Quality Commission (CQC) Quality Risk Profile (QRP)

February 2012 QRP report showing 5 outcomes rated better than expected (previously 6) and 11 outcomes

rated similar to expected (previously 10).

3. Contractual

The Trust is being proactive in working with our lead commissioners who have expressed concerns over our

current RTT and diagnostic waiting performance and the recent 12 hour trolley breaches in A&E, as well as

some issues in relation to incident reporting and A&E exception reporting.

• CQUIN 2012/13

The Trust has submitted Q3 CQUIN evidence and expects to achieve 100% of the CQUIN scheme

standards, with an associated financial value of £2.7m. The Trust has achieved the National Inpatient

CQUIN for this year based on the Inpatient survey and scored 6.85 compared to the 6.70 target, securing

£241k income for Q4. Other CQUIN areas are on track for Q4 and work is on-going to finalise data

collection and reporting functions for the dementia pathway.

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Executive Summary (5/5)

• CQUIN 2013/14

The Trust is awaiting feedback from the Clinical Commissioning Group on the first round of proposals for

CQUIN schemes in 2013-14. In order to release CQUIN funding for 2013-14, the Trust is required to report

to commissioners on five DoH ‘High Impact Innovations’. Information is being collated on Trust plans to

participate in telehealth/telecare, intraoperative fluid management, international and commercial activity, use

of digital technology to reduce unnecessary face to face contacts and supporting carers for people with

dementia. Details of the Specialised Commissioning CQUINs is outstanding but due imminently.

4. Specific Performance Reports

• Emergency Care Action Plan Update

Medicine have continued to use the Cotton (surgical) ward until the middle of February and the additional 12

medical beds have now come on-line as planned. Despite the challenging performance issues that the A&E

department is experiencing into February, the Trust has held off significant steps around restricting access.

Further details on the priority actions can be found in the update later in this report.

RTT Q4 Performance Update

The Trust did not achieve the RTT Admitted target in January 2013 with 88.8% of patients seen within 18

weeks compared to the 90% target. Despite severe bed pressures impacting on elective activity and a 57%

increase in the number of patients cancelled within 7 days of their admission during January compared to

December, the Trust has managed to maintain its backlog position. The number of 52-week wait patients

has reduced from 129 in December to 118 in January, and the plan is to have less than 50 patients waiting

by the end of March.

The Trust continues to utilise significant capacity from a wide range of providers to mitigate against the on-

site bed pressures and improve its long-wait position. Additional list capacity has been secured in February

and March at The Lister Hospital for General Surgery and Harley Street for Neurosurgery.

Infection Control

Further details on the enhanced actions for 2012-13 can be found in the HCAI Action Plan, provided later in

this report.

Enc. 2.6

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10

Contents

•Executive Summary

•Trust Performance Summary

•Divisional Performance Summary

•Regulatory/Contractual Performance

• Monitor 2012-13 Q4 position

• CQUIN 2012/13 Q4 update

• Care Quality Commission (CQC) – Quality Risk Profile Update

•Specific Performance Reports

• Emergency Care Action Plan Update

• RTT Q4 Performance Update

• Infection Control Update

Enc. 2.6

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Trust Month 10 Performance

Summary

Domain* Key Highlights Key Actions

• Adverse financial moves from the projected year-end position to be discussed at the Month 10 divisional performance review meetings. •CCTD division are undertaking a 6-month theatre program which includes looking at improving the pre-assessment pathway to reduce cancellations and improve patient experience/care.

10 5

Clinical

Effectiveness

8

Safety

8 2

Patient

Experience

7

Finance & Operational

Efficiency

2 1

Staffing measures

3

7

Staff Vacancy rate is at 7.1% in January – within the 5-8% target tolerance. Key concerns:

Mandatory & Statutory Training – overall training index score has increased by 2% in Jan to 65 but remains below target Appraisals – 36.1% of staff have had their appraisal performed in-year compared to the 75% target.

*Number of red/green indicators by domain from Trust scorecard

• Focus on staff appraisals to be conducted for the end of March

11

Patient access targets for Emergency care 4-hour performance, Referral to Treatment (RTT) Non-Admitted and Incomplete measures, and all Cancer Waiting Times except for 31 Day Wait for 2nd Treatment (Surgery) have been achieved this month. Elective ALOS has increased to 5.9 days, 1.2 days above the 4.7 day stretch target. Repatriation bedday delays increased from 217 to 265 - effectively 9 beds per day on average for January compared to 7 beds per day last month. Key concerns are: • RTT pathway targets – whilst the 95% Non-Admitted target and 92% Incomplete target were both achieved in January, 88.8% of patients were admitted within 18 weeks in January, therefore not achieving the 90% RTT Admitted target. • Emergency Care – 95.1% of patients were seen in A&E within 4 hours, achieving the 95% target for January Leading indicators for efficiency: Recording of Expected date of discharge (EDD) has decreased to 51.3% across all divisions and the 90% internal target was only achieved by Haematology (95.0%) and Cardiovascular (92.2%) this month.

No new MRSA cases were attributed to the Trust during January and it is now over 300 days since our last reported case. Key concerns are: • HCAI – 1 new VRE case reported this month in Haematology on Davidson Ward. 24 cases have been reported to date which is higher than the internal target of 14 cases, and higher than the 17 cases reported at this point last year. 2 CDT cases were reported during January – 1 in TEAM on Twining and 1 in Surgery on Lister - which means 47 cases have been reported to date compared to the trajectory of 63 cases. • Red AIs and red shifts – 4 Red AIs were reported in January: 1 in Acute Medicine, 1 in Neuro-Imaging, 1 in Neurosurgery and 1 in AAU attributed to another Trust. 43 red shifts were reported in Jan: 17 in TEAM and 26 spread over 6 other Divisions. Leading indicators of safety:

MRSA Screening - 99.4% of elective patients and 97.2% of emergency patients were screened. Hand Hygiene – audit compliance dropped to 85.3% overall in January (compliance was 89.3% for actual audits performed)

Overall HRWD score has dropped by 1% to 85% in January, not achieving the 86% target. Although patient complaints increased slightly to 54, the response rate to complaints continues to improve with just under 50% replied to within 25 days. Key concerns are: 28 Day Cancellation Standard – 4 breaches of this standard in January (2 breaches were due to over running lists, 1 to an

emergency taking priority and 1 for an unknown reason). Single Sex Accommodation – 27 ICU delayed discharge breaches were reported in January compared to 23 last month. Outpatient Cancellations – 8392 hospital-initiated cancellations in January, an increase of nearly 2000 above target.

At Month 10, the Trust has a net variance from plan of -£2.449m. Further details can be found in the Finance part of this paper. Key concerns are: Theatre Utilisation Rate – despite dropping by 1% to 80% in January, the overall rate is still achieving the 80% target. Main

Theatre utilisation dropped by 3.4% to 81.4% in January, still achieving the target. Although DSU Utilisation rose by 5.1% to 78.1%, it is still not achieving the 80% target. Weekend discharges – under 19% of patients were discharged over the weekend in January compared to 25% in December. DNA Rate increased by 0.5% from 12.3% in December to 12.8% in January, and is not achieving the 12.2% target.

• Latest actions and divisional plans can be found in the specific performance update reports in this paper for Emergency Care and RTT performance • Daily meetings continue to be held with the COO to review breaches in A&E • Weekly RTT meetings continue to take place to track longer-waiting patients • Weekly Cancer waiting list meetings continue to take place to track individual patients.

• Continued focus on managing MRSA infection and screening. • Critical Care has been red-rated for January. • Weekly CDT meetings continue to review locally reported cases , and distinguish between true or colonised cases. • Ongoing implementation of an action plan to ensure compliance with the DH document “Start Smart, then Focus” for antimicrobial stewardship.

• Continued focus on patient experience through Energising for Excellence, Safety Express and Ward 20/20 initiatives. • Developing a Trust-wide plan for HRWD

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12

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13

Contents

•Executive Summary

•Trust Performance Summary

•Divisional Performance Summary

•Regulatory/Contractual Performance

• Monitor 2012-13 Q4 position

• CQUIN 2012/13 Q4 update

• Care Quality Commission (CQC) – Quality Risk Profile Update

•Specific Performance Reports

• Emergency Care Action Plan Update

• RTT Q4 Performance Update

• Infection Control Update

Enc. 2.6

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14

Division Areas of Concern

Womens & Children • Finance position

• Ante-natal booking within 12+6 weeks (Obstetrics)

• Discharge Date Compliance (Child Health and Gynaecology)

• Hand Hygiene Audits

• HRWD (Obstetrics)

Liver, Renal and Surgery

• Finance position

• RTT Admitted & Incomplete pathways (Liver & Surgery)

• MRSA Screening

• Elective and Non-Elective ALOS

• Red Shifts

Networked Services • Finance position

• SHMI (Cardiac Services)

• Red shifts

• MRSA screening

• Hand hygiene audit (Neurosciences & Cardiovascular)

TEAM

• Emergency Care Performance (4-hour target)

• Outliers

• HRWD

• CDT and Hand Hygiene Audit

• Red Shifts

Critical Care, Theatres and Diagnostics

• Bed occupancy throughput (Critical Care)

• Hand Hygiene Audits

• Delayed Discharge hours (Critical Care)

• Right on Time starts and Early Finishes (Theatres)

Ambulatory Services & Local Networks

• Finance position

• Outpatient Cancellations by Hospital

• New to Follow Up ratio (Ambulatory)

• Hand Hygiene Audit (Ambulatory)

2012-13 M10 Division Performance

– Key Areas of Concern

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Divisional Summary (1/3)

Women’s

& Children

Liver, Renal

& Surgery

Finance Position: At the end of month 10, the division has an adverse variance of -£4.141m

Liver: Endoscopy median waiting time remains within target at 28 days despite an increase of 9.6 days. Non-

Elective ALOS has reduced by 3.7 days since last month to 12.4 days, but remains below the target of 14.4

days. Elective ALOS is above the target of 6.0 days at 6.7 days. Discharge Date compliance remains low at

4.2%. Under 85% of RTT incomplete pathways are waiting under 18 weeks compared to 92% target. No new

Infection Control cases reported in December. Hand Hygiene audit compliance increased to 76.4% with only 1

of 6 locations not performing audits – 91.7% compliance was achieved in audits performed. MRSA Screening

is 98.4% due to 2 elective and 2 emergency patients not screened. 7 Red Shifts were reported – 2 on Todd, 1

on LICU and 4 on Dawson ward.

Renal: Elective ALOS is above the target of 2.2 days at 2.9 days and Non-Elective ALOS is also above the

target of 9.0 days at 11.2 days. Discharge date compliance has decreased again this month to 38.0%, below

the target of 90.0%. No new Infection Control cases reported. Hand Hygiene audit compliance has dropped

below the target of 95% to 87.2% with 7 out of 8 locations performing an audit – 99.7% compliance was

achieved in audits performed. MRSA Screening is at 100%. 6 Red Shifts reported on Fisk & Cheere ward.

Surgery: Elective ALOS remains above target of 3.6 days at 4.6 days and Non-Elective ALOS also remains

above target of 4.8 days at 8.8 days. Discharge date compliance has improved to 65.1% in December but is

still above the 90% target. 19 repatriation bed day delays in December - an improvement from 36 in

November. Under 74% of RTT admitted patients treated within 18 weeks compared to the 90% target and

79% of RTT incomplete pathways waiting under 18 weeks compared to 92% target. No new Infection Control

cases reported. Hand Hygiene audit compliance improved to 78.5% with all locations performing an audit.

Key Action / Focus Comment

- Finance position

- RTT Admitted & Incomplete

Pathways: Liver & Surgery

- Elective & Non-Elective ALOS

- Discharge date compliance

- Hand Hygiene Audit:

Liver & Surgery

- Red Shifts

- MRSA Screening:

Surgery and Liver

- Repatriation Bed Day

Delays: Surgery

Finance Position: At the end of month 10, the division has an adverse variance of -£823k

Child Health: Elective ALOS has increased significantly above its 3.9 day target to 8.4 days mainly due to the

discharge of 3 patients with a LOS over 30 days, including a 186 day stay in Paediatrics. Non-elective ALOS

has decreased to 4.1 days, remaining slightly above its 3.9 day target. Discharge Date Compliance decreased

further to 58.2%, remaining below the 90% target. There were no new infections this month but Hand Hygiene

Audit compliance has decreased to 85.7%, remaining below the target of 95% - audits were performed in all

locations. Combined MRSA screening increased slightly to 98.5% but there were 2 un-screened emergency

patients on Toni & Guy, 1 patient on Rays of Sunshine and 1 patient on Lion ward. 4 Red Shifts were reported

on NICU.

Gynaecology: Elective ALOS has increased above the 2.4 day target to 3.4 days; Non-Elective ALOS has

decreased further below the 1.8 days target to 1.4 days. Discharge Date Compliance has dropped significantly

to 64.3%, remaining below the 90% target. All Patient Access indicator targets have been achieved with the

exception of the 2 week wait standard where 90.9% was achieved. Hand Hygiene audit compliance has

improved significantly to 90.2% but remaining below the 95% target - audits were performed in all locations.

Combined MRSA screening increased to 99.3%, remaining below the 100% target due to 1 un-screened

emergency patient on Katherine Monk. VTE Assessments performed continues to achieve the 90% target at

94.8%.

Obstetrics: Ante-natal booking within 12+6 weeks has decreased further below the 90% target and adjusted

measures at 62% and 75% respectively. The total C-Section rate remains slightly above the 26% target at

26.4%, whilst the elective rate remains within the tolerance thresholds at 11.5%. All HRWD composite scores

remain below target. Hand Hygiene audit compliance has improved significantly to 80.5%, remaining below

the 95% target - audits were performed in all locations.

- Finance position

- Discharge Date Compliance:

Child Health & Gynaecology

- Cancer Waiting Times:

Gynaecology

- Infection Control: Child Health

- Hand Hygiene Audits

- MRSA Screening:

Child Health & Gynaecology

- Red Shifts: Child Health

- Ante-natal booking within

12+6 weeks (Standard and

Adjusted): Obstetrics

- C-Section Rate: Obstetrics

- HRWD: Obstetrics

15

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Divisional Summary (2/3)

Networked

Services

TEAM

Finance Position: At the end of month 10, the division has an adverse variance of -£4.711m

Cardiovascular: Summary In-hospital Mortality Index (SHMI) has been worse than expected based on the 12-

months rolling position from November last year to January. Elective ALOS has increased from 5.7 days last

month to 6.2 days this month and remains above the 5.2 day target. Non-elective ALOS has increased from 6.9

days last month to 7.1 days this month and is achieving the target of 7.1 days. Discharge date compliance has

increased from 91.1% last month to 92.2% in this month, still achieving the 90% target. No new infections were

reported in January. Hand Hygiene audit compliance has decreased from 92.9% last month to 91.9% and is just

below the 95% target. Emergency readmissions within 30 days(YTD) has reduced from 2.8% last month to 2.6%

this month and remains below the 11.7% target. The HRWD overall section score has decreased from 88% in

December to 87% in January, still achieving the 86% target.

Neurosciences: Non elective ALOS in Neurosurgery is 2 days above target at 15 days, due to 3 patients with

average stay of 138 days each. Elective Neurology ALOS is 2.7 days above target, impacted by 4 patients with

average stay of over 38 days each. Discharge date compliance improved slightly to 66.5%, but remains below

the target of 90%. Repatriation bedday delays rose considerably to 200 days in January from 128 days in the

previous month. Hand hygiene audit compliance improved to 93% from 89.1% but is still below the 95% target.

There were 6 un-screened MRSA emergency patients - 1 on David Marsden, 3 on The Friends’ Stroke Unit (one

of which was General medicine patient), 1 on Murray Falconer and 1 on Kinnear Wilson ward. There were 3 red

shifts - 1 on David Marsden ward and 2 on The Friends’ Stroke Unit.

Haematology: SHMI has improved further to 102 from 115, compared to the expected index of 100. Elective

LOS is 19.4 days in January, above the 16.8 day target due to 19 patients with an average stay of over 32 days

each. Discharge Date Compliance improved to 95%, and is above the 90% target. MRSA screening has

dropped to 95% from 100% due to 3 un-screened emergency Medicine patients on Haematology wards. There

was 1 red shift on RD Lawrence ward. HRWD survey results were below target in all sections with the

exception of Patient Engagement.

.

Comment Key Action / Focus

Finance Position: At the end of month 10, the division has a positive variance of £0.267m

TEAM: SHMI outcomes continue to perform well with an index of 54 compared to the expected index of 100.

Non-Elective ALOS has decreased by 1.1 days, from 6.3 days in December to 7.4 days in January, and

continues to achieve the target of 7.9 days - this is driven by the low ALOS for General Medicine patients. The

number of Outlier bed occupancy has increased from December by an average of 17 beds with TEAM patients

occupying on average 37.9 outlying beds per day in January (with 20.7 beds in Surgery with Medicine now

using the surgical beds on Cotton ward, 4.5 beds in Neurosciences and 3.6 beds in Women’s Health). The

Type 1 Emergency care performance target of 95% was not achieved in January, with 94.4% of patients seen

within 4 hours. Cancer Wait Times were not achieved in January with TEAM with 85% of patients seen within

the 2 week referral standard. Hand hygiene compliance has increased by 4% to 85% in January, but remains

below the 95% target with no data being supplied for 1 location – 91.1% compliance was reported for actual

audits performed. No MRSA or VRE cases were reported in January but 1 CDT case was reported on Twining

ward. The overall HRWD score has achieved its 86% target which was driven by Care Perceptions and

Environment meeting their respective targets. Patient Engagement section score was 84% and is below its

target of 87. Red shifts have decreased by 12 from last month with 17 shifts now reported in January – the main

contributing wards were CDU with 8 Red Shifts and Mary Ray with 5 Red Shifts.

- Outlier patients

- Emergency Care

Performance (4-hour target)

-Infection Control: CDT and

Hand Hygiene audits

- HRWD

- Red Shifts

- Finance position

- SHMI: Cardiac

Services

- Red shifts

- Repatriation bedday

delays: Neurosciences

- MRSA screening

(Emergency patients):

Neurosciences and

Haematology

- Hand hygiene

- Neurosciences &

Haematology LOS

- HRWD: Haematology

Enc. 2.6

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Divisional Summary (3/3)

Critical Care,

Theatres and

diagnostics

Ambulatory

Services and

Local Networks

Finance Position: At the end of month 10, the division has a positive variance of £1.902m

Critical Care (CC): Bed occupancy throughput has increased from 105% last month to 115% this month, and

remains above the 85% target. No new bacteraemia cases reported this month, and Hand Hygiene

compliance has decreased from 84.8% last month to 81.2% this month and remains below the 95% target. 3

Red or Amber adverse incidents were reported in January. Emergency MRSA screening remains at 100%.

Delayed Discharge Hours has increased from 897 hours in December to 1268 hours in January - mainly due

to Networked services (401 hours). Total Level 1 Bed Days Number has increased from 41 beddays in

December to 46 beddays in January.

Diagnostics: Same day CT wait (request pre 9:30am) has increased from 86% in December to 90% in

January and is now achieving the 90% target. Hand Hygiene audit compliance has increased from 62.9% last

month to 71.1% this month but remains below the 95% target. MRSA Screening is at 100%. 7 BBV incidents

reported this month. No adverse incidents reported this month. Reporting Turnaround for Angio & Fluoro IP

has decreased from 1.9 days last month to 0.7 days in January, and is now within the target of 1 day.

Theatres: OTD cancellations (for no theatre team member or anaesthetist) have decreased from 2 last

month to 1 in January. Hand Hygiene Audit compliance has decreased from 96.5% last month to 89.1% in

January and is now below the target of 95%. No adverse incidents reported this month. 16 sessions were

closed with 13 days’ notice or less in January. Main theatre utilisation has decreased from 84.8% last month

to 81.8% in January, but still remains above the target of 80%. Right on time starts have increased from

17.4% to 20.5% this month, and remains below the 51% target. Early Finishes have increased from 30.3% to

34.3% and remain above the 9% target. Outpatient DNA rate has reduced from 17.4% to 12.7% this month

and is below the17.1% target.

Finance Position: At the end of month 10, the division has an adverse variance of-£0.123k

Ambulatory: The Summary Hospital Mortality Index (SHMI) has improved to 86 and continues to achieve the

expected index of 100. Elective ALOS has increased to 5.7 days and is higher than the 3.6 day target, and

whilst Non elective ALOS has reduced to 23.7 days it is above the 12.2 day target due to the discharge of two

long stay Diabetic Medicine patients each with a stay of 84 and 72 days. Hand Hygiene Audit compliance is

80% and therefore below the 95% target. Audits were not performed in 1 area – compliance was 91.4% for

those audits actually performed. MRSA Screening is at 75% and has not achieved its 100% target due to 1

un-screened patient in Endocrinology. Outpatient Cancellations – by Hospital have increased from 1812 to

2164 appointments and remain above the 1475 target. Camberwell Sexual Health Centre (CSHC) Waiting

time < 2hours has failed to meet its 95% target achieving 93%. New to Follow up ratio remains at 2.8, above

the target of 2.7.

Dental: Elective ALOS has decreased from 1.9 to 1.4 days but remains above the 1.1 day target. Non

Elective ALOS has decreased from 2.4 days to 1.9 days, therefore achieving its 2.1 day target. Hand Hygiene

Audit compliance has dropped to 98.6% but remains above the 95% target - audits were completed in all

locations. MRSA Screening remains on target at 100%. Outpatient Cancellations by Hospital have increased

from 585 to 910 and remain above the 473 target. There was 1 breach of the Data Quality composite

indicator, failing to achieve the ‘New NHS No – OP indicator’. OP Coded Activity is 87% and not achieving its

95% target. 17

- Bed occupancy throughput:

Critical Care

- Hand hygiene

- Delayed Discharge Hours:

Critical Care

- Right on Time starts and

Early Finishes (Theatres)

Comment Key Action / Focus

- Finance position

- Non Elective ALOS (Ambulatory)

- Hand Hygiene Audit:

(Ambulatory)

- Outpatient Cancellations by

Hospital

- New to Follow Up ratio:

Ambulatory

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2012-13 M10 Trust & Division

Heatmap (1/2)

18

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2012-13 M10 Trust & Division

Heatmap (2/2)

19

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20

Contents

•Executive Summary

•Trust Performance Summary

•Divisional Performance Summary

•Regulatory/Contractual Performance

• Monitor 2012-13 Q4 position

• CQUIN 2012/13 Q4 update

• Care Quality Commission (CQC) – Quality Risk Profile Update

•Specific Performance Reports

• Emergency Care Action Plan Update

• RTT Q4 Performance Update

• Infection Control Update

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Regulatory/Contractual Performance

2012/13 (1/3)

21

Regulatory

• Monitor Month 10 position:

The Trust has achieved the majority of performance indicator targets in the Monitor Compliance framework for

January with the exception of the 31-day subsequent surgery target, the 2 week-wait (2WW) for all cancers

target and the RTT 18 Week Admitted target. However, the Trust is confident that the cancer waiting time

indicators will be met for Q4 overall. Due to the RTT 18 Week admitted target not being achieved in January,

the best position for Q4 will be an Amber-green governance rating .

A&E attendances and sustained emergency access pressures continued during January, and the Trust

achieved 95.12% performance against the 4-hour waiting time compared to the 95% target. Pressure

continues during February and this target is now at risk for Q4.

The Trust had no MRSA bacteraemia cases reported in January, and therefore maintained 1 attributed case

YTD. This is consistent with the threshold but remains a risk as previously reported.

2 C-difficile cases was reported in January, bringing the number of attributed cases YTD to 47. This is also

below the threshold of 63 cases for the YTD position, but remains a risk.

Actions:

Weekly Cancer waiting list review meetings continue to take place to track individual patients. This includes a

review of patients on 31-day pathways, as well as those on 62-day wait pathways.

Weekly RTT waiting list review meetings continue and further opportunities for weekend working and off-site

options continue to be explored.

Daily A&E breach review meetings are on-going and now extended to include all divisional managers.

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Monitor 2012-13 Q4 interim

position

22

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Regulatory/Contractual Performance

2012/13 (2/3)

23

Regulatory

• CQUIN 2012/13 update.

Q3 evidence has been submitted. The Trust is expecting to achieve 100% of the CQUIN scheme standards,

with an associated financial value of £2.7m.

The Trust has achieved the National Inpatient CQUIN with a score of 6.85 compared to the target of 6.70.

This is an improvement of 0.4 on the 2011/12 national inpatient survey score resulting in £241k of secured

income in Q4.

All CQUIN areas are on track against Q4 targets however, work is on-going to finalise the data collection and

reporting functions for the Dementia pathway.

Actions: Continue to meet with Service and BIU leads to embed reporting along the Dementia pathway and

to monitor Q4 progress with the relevant CQUIN leads. Receive confirmation of Q3 performance from

Commissioners

• CQUIN 2013/14

The Trust is awaiting feedback from the Clinical Commissioning Group on the first round of proposals for

CQUIN schemes in 2013/14. There are four National themes (Dementia, Safety Thermometer, Friends and

Family Test and VTE screening). Local proposals are being worked up for the COPD bundle, Alcohol

Screening, Patient Experience (acute admissions and outpatients), Hospital Acquired Pressure Ulcers,

Cancer and improvements to ‘Choose and Book’.

In order to release CQUIN funding for 13/14 the Trust is required to report to Commissioners on five DoH

High Impact Innovations. Information is being collated on the Trust plans to participate in telehealth/telecare,

intraoperative fluid management, international and commercial activity, as well as the use of digital

technology to reduce unnecessary face to face contacts and supporting carers for people with dementia.

Detail of local Specialised Commissioning CQUINs is outstanding but is due to be released shortly.

Actions: Submit a CQUIN prequalification report to commissioners by end of February and finalise CQUINs

in time for sign off by 1 April 2013. Further detail to be included in future reports to the Board.

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Regulatory/Contractual Performance

2012/13 (3/3)

24

• Care Quality Commission (CQC) Quality Risk Profile (QRP):

The February 2013 QRP profile report was published in 6 February 2013. The report is currently

showing ‘better than expected’ across 5 outcomes (previously 6) and ‘similar to expected’ across 11

outcomes (previously 10).

The CQC has actioned a previous request and excluded Lewisham Hospital Endoscopy Global Rating

Scale data from King’s QRP. This led to adjustments to risk estimates for Outcomes 14: Supporting staff

and Outcome 16: Assessing and monitoring quality of service provision.

Marginal adverse movement from high green to low yellow for Outcome 21: Records due to ‘much

worse than expected’ results in refreshed National Bowel Cancer Audit Project data for patients

receiving a CT or MRI scan. Assurance has been received that this is a resource issue relating to

completion of data submission and that all CT and MRI scans are taken and reported in line with best

practice.

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QRP February 2013 position

25

Analysis of King’s QRP February 2013 (published 6 February 2013):

Overall Risk Estimates

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26

Contents

•Executive Summary

•Trust Performance Summary

•Divisional Performance Summary

•Regulatory/Contractual Performance

• Monitor 2012-13 Q4 position

• CQUIN 2012/13 Q4 update

• Care Quality Commission (CQC) – Quality Risk Profile Update

•Specific Performance Reports

• Emergency Care Action Plan Update

• RTT Q4 Performance Update

• Infection Control Update

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27

Continued Governance arrangements include:

• Winter Action plans for all divisions have now been signed-off and key actions being implemented

• The Emergency Care Board continues to meet monthly and the Emergency Care Board Operational Group

continues to meet weekly.

• The Emergency Care Action Plan continues to be tracked and developed.

• Daily breach review meetings continue and all divisional managers now attend these meetings held at 10am.

• Outcome metrics reflecting the delivery of the action plan are being devised.

Priority actions taken include:

• Focus on weekend discharges as part of TEAM winter plan workshop, a number of actions are now in place to

improve weekend discharges.

• Increased staff at weekends (within the Emergency Department, Wards, Pharmacy and Therapy services).

• Maximise bed availability on a Monday morning by increasing discharge planning on a Thursday/Friday/Saturday

and Sunday.

• Increase use of Medihome.

• 24/7 AAU model introduced.

• Increase nursing and medical staff within the Emergency Department and Acute Assessment Unit at times of peak

demand to manage surges of patients.

• E-vision now reporting real time ED Performance and Phase 2 reporting requirements have been reviewed and

are being developed.

• Additional capacity – Plans to move the existing Acute Assessment Unit from a ward location to a new facility in

the previous endoscopy unit have been escalated and the 12 additional medical beds have now come on-line.

The latest Emergency Care Action Plan can be found in the following pages:

Emergency Care Performance Action

Plan (1/13)

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Emergency Care Performance Action

Plan (2/13)

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Emergency Care Performance Action

Plan (3/13)

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30

Emergency Care Performance Action

Plan (4/13)

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Emergency Care Performance Action

Plan (5/13)

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Emergency Care Performance Action

Plan (6/13)

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33

Emergency Care Performance Action

Plan (7/13)

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34

Emergency Care Performance Action

Plan (8/13)

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Emergency Care Performance Action

Plan (9/13)

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Emergency Care Performance Action

Plan (10/13)

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Emergency Care Performance Action

Plan (11/13)

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Emergency Care Performance Action

Plan (12/13)

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39

Emergency Care Performance Action

Plan (13/13)

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RTT Q4 Performance Update (1/3)

40

1. Referral To Treatment (RTT) January 2013 Update

• The table below summarises the Trust performance since April 2012 against the 3 RTT waiting time

standards that Monitor assesses us against. In addition, the number of 52+ week waiters at the end of

January relative to December are outlined here.

Target Apr May Jun July Aug Sep Oct Nov Dec Jan

Admitted Complete

90% 91.0%

91.2%

85.7% 91.0% 90.1% 90.2% 91.4% 90.1% 90.1% 88.8%

Non-admitted Complete

95% 98.1%

98.2%

98.3% 98.1% 98.2% 97.7% 97.1% 97.1% 97.0% 96.7%

Incomplete 92% 90.1%

90.6%

92.2% 92.6% 92.3% 92.4% 92.8% 92.9% 92.7% 92.8%

52+ Week Waiters January December

General Surgery 83 90

Urology 1 1

T&O 14 13

Neurosurgery 4 8

Cardiothoracic Surgery 1 1

HpB 15 13

Cardiology 0 1

Other Specialities 0 2

Total 118 129

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RTT Q4 Performance Update (2/3)

41

• As planned with Commissioners, RTT Admitted Performance did not achieve the 90% target with 88.8% of patients seen within 18 weeks in January 2013. The Trust is planning not to achieve the admitted target in February and March, as part of a planned approach to treat long-wait patients.

•Specialties that failed to achieve the 90% target in January were:

• General Surgery (78.8%) • Urology (74.6%) • T&O (69.7%) • Neurosurgery (72.0%) • Cardiothoracic Surgery (69.0%)

• The number of 52+ Week waiters reduced from 129 in December to 118 in January. The Trust is planning to have less than fifty 52+ by the end of March.

• January was characterised by severe pressure on both general and critical care beds with a 57% increase in within-the-week hospital cancellations compared to December (the 409 admission cancellations in January was the highest monthly figure for the year to date). • Despite this pressure on elective activity, the Trust has managed to maintain its admitted backlog position while reducing the overall waiting list and the numbers of 52+ week waiters. This has partly been achieved by continuing to utilise weekend onsite and offsite capacity from other providers, wherever possible. • However, bed pressures are continuing into February which further increases the risk to achieving the target backlog trajectory. The Trust’s priority focus remains on using whatever capacity it has available to clearing all 52+ week waiters. • The Trust has continued to achieve its overall non-admitted performance target of 95% but two specialities did not achieve this threshold:

• Cardiology (90.1%) • Neurology (81.4%)

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RTT Q4 Performance Update (3/3)

42

3. Outsourcing Update

• The Trust continues to utilise significant off-site capacity from a wide range providers to help mitigate onsite bed pressures. There is a desire to do more off-site work and maximise utilisation still further, but the main constraint has been the inability of offsite providers to make further capacity available to the Trust. In addition, the Trust is finding it particularly challenging to secure appropriate capacity for patients whose care requires the presence of critical care facilities on-site, especially for HpB patients.

• Whilst off-site capacity is proving vital in maintaining the Trust’s backlog and improving long-wait position alongside current bed pressures – it is not proving effective in clearing historic backlogs.

• The Trust continues to rigorously explore possibilities for procuring more capacity from existing and alternative providers for February and March – and increased capacity has been secured from Lister Hospital for General Surgery and T&O, and from Harley Street for Neurosurgery.

• It is not anticipated that funding from commissioners for the same level of off-site work will continue into 2013/14 – hence future reductions in backlog will need to be achieved via increases in on-site capacity.

• In January the following KCH activity was managed offsite:

Provider Speciality Activity Levels

BMI Blackheath Neurosurgery 2 IP

BMI Chelsfield General Surgery 5 IP

BMI Fitzroy Place General Surgery

Colorectal

1 IP and 1 DC

6 DC

Lister Hospital T&O 4 DC

London Bridge HpB 2 IP

Sloane Hospital T&O 3 IP

Weymouth General Surgery 5 DC

Total 13 IP and 16 DC

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Infection Control: Trust position –

January 2013

43

1. MRSA (post 48 hour) bacteraemias – good performance:

One Trust attributable case reported in 2012-13

• One in Ambulatory (Apr 2012)

MRSA screening:

• 99.4% Elective (in January 2013)

• 97.2% Emergency (in January 2013)

2. VRE bacteraemias – improved performance:

1 case of VRE bacteraemia in January with a total of 23 cases YTD (trajectory of 14 cases for the same

period.)

3. C-difficile – still under DH trajectory for number of cases and have seen a reduction in Q3

compared to Q2:

47 CDT cases reported to DH (as per National Guidance) in 2012-13 (trajectory of 63 cases YTD):

• Surgery - 10 cases compared to 13 in 2011/12 (YTD January)

• TEAM - 6 cases compared to 15 in 2011/12 (YTD January)

• Critical Care - 5 cases compared to 10 in 2011/12 (YTD January)

• Cardiac - 3 case compared to 5 in 2011/12 (YTD January)

Trust attributable CDT Cases over the last 4 quarters:

• 2011-12 Q4 – 18 cases

• 2012-13 Q1 – 11 cases

• 2012-13 Q2 – 25 cases

• 2012-13 Q3 – 12 cases

A further 94 cases have been reported locally as per the April DH testing guidance. All of these cases

have been included in the Root Cause Analysis process and been managed as per Trust CDT guidance.

This continues to place additional pressure on isolation provision.

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C-difficile Action Plan Update

(1/1)

44

Key focus areas:

1. Antimicrobial stewardship

Monthly audits undertaken in all inpatient wards. Results are improving. Work completed to audit

prophylaxis prescribing and administration in theatres. Results shared at appropriate meetings,

highlighted a lack of prophylaxis guidelines in some surgical specialties. These are now being developed.

The Antibiotic Usage Steering Group is leading on the implementation of the “Start Smart then Focus”

action plan. Progress will be reported in the next quarterly report.

2. Hydrogen Peroxide Vapour (HPV) technology

HPV has been used in a number of areas where CDT or multi-resistant gram negative infections

occurred. Work is now underway to develop a proactive HPV programme to work in conjunction with the

reactive programme already in place.

3. CDT root cause analysis

The well established process for reviewing both DH and locally reportable CDT cases has been further

developed so that divisions ensure completion of mitigating actions identified through this process.

4. Multidrug resistant organisms – Child Health

The trust has had cases of children colonised with a multi resistant family of organisms. A working group

comprised of Capital, Estates and Facilities (CEF), Infection Control Prevention (IPC), Medirest and the

division, have been formed to manage this situation. External reviews have taken place over the last few

weeks and the Group is currently working towards completion of an action plan to address issues raised

by the external review.

5. Water management group

A group has been established with key stakeholders, including CEF, Infection Control and Medical

Microbiology, to manage the Trust’s response to new guidance on water quality.

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Report to: Board of Directors

Date of meeting: 26 February 2013

By: Jane Walters, Director of Corporate Affairs

Subject:

Quarterly Patient Experience Report

1. Executive Summary

Delivering a quality service to our patients is one of the Trust’s core strategic priorities - safe, kind and effective care. The publication in February of the Francis Report underlines the importance of our strategy. The Trust has established a group to review the report’s recommendations which will report to the Board in due course.

Preparations are well underway to implement the new Friends and Family Test, results of which are published nationally from April 2013.

Performance in the 2012 CQC National A&E Survey was improved since the 2008 survey. Performance against London peers and other national Major Trauma Centres was encouraging with King’s leading the MTCs in London.

The CQC National Inpatient Survey results 2012 are expected to be published nationally at the end of April/beginning May.

All CQUIN targets for both the national and local patient experience CQUINS were achieved for Quarter 3.

Positive HRWD results for inpatients continued in Quarter 3 and the numbers of patients responding to the outpatient survey is growing steadily.

The number of complaints received was slightly higher last quarter, but in line with previous years. Performance in responding to complaints continues to be below target but improving.

In December, a Quality Accounts Stakeholder Meeting gained valuable input from stakeholders about proposed quality priorities for next year.

Volunteer numbers continue to be upwards of 700. Highlights for the last quarter include invitations to 10 Downing Street and the Cabinet Office to discuss King's approach to volunteering, followed up by a visit from Nick Hurd, Minister for Civil Society in January 2013.

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2. King’s Quality Accounts

2.1. 2012 /13 Quality Account

The quality priorities for patient experience for 2012/13 are :

2.2. National Patient Experience CQUIN This CQUIN is worth £800K this year. A further three wards were identified in Q3:

Kinnier Wilson (Neurosurgery)

David Marsden (Neurology)

Dawson (Liver) They will be putting actions in place to make improvements of 3% overall in 5 patient survey key question areas.

2.3. Local CQUIN: Improving outpatient experience This CQUIN is worth £1.4 million split evenly between development and roll-out of a trust How are we doing outpatient survey and targeted improvement in key aspects of outpatient experience. Q3 targets focussed on achieving responses to the How are doing survey. All targets were met. Suites 3 and 7 have been tasked with making improvements in five key question areas:

If you had to wait for your appointment, were you told how long you would have to wait?

How clean was the Outpatient Department you visited (including any toilets you may have used in the Outpatient Department)?

Did a member of staff explain the results of your test(s) in a way you could understand?

Were you involved as much as you wanted in decisions about your care and treatment?

Overall, how would you rate the care you received in the outpatient department? This quarter text reminders and i-Pads were introduced which have had a positive impact on the numbers of surveys completed by patients. All CQUIN targets to-date have been met.

2.4. Quality Priorities for 2013 – 2014 In December we held a Quality Accounts Stakeholder meeting. Attendance was good with representation across our stakeholders including Governors, Overview and Scrutiny teams, Local Involvement Networks and commissioning colleagues. The Trust presented detailed updates on progress against current priorities and shared potential areas on which to focus for next year’s priorities. For the patient experience metrics, stakeholders were positive about continuing work to embed the outpatient survey and to drive

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improvements across the Trust. There was also interest in both information and support for patients on discharge and improvement work in the Medical Assessment Unit. The Patient Experience Committee considered the comments received and has recommended that the two areas of focus for 2013/14 are improving outpatient experience and improving information for patients on discharge. The draft report will go out for consultation to stakeholders in April.

3. CQC National Patient Survey Programme - 2012 A&E Survey results update

The National A&E Survey results were published on the Care Quality Commission’s website on December 6th 2012.

King’s is rated amber for all sections of the survey – in the expected range

Results were positive with an increase of 3.7 points overall since 2008 and improvement in 4 out of 6 comparable sections, with significant improvement in care and treatment, environment and facilities and leaving the ED.

King’s was ranked 1st amongst the London Major Trauma Centres (MTCs) and 3rd for comparable MTCs nationally.

A number of initiatives are being implemented both to drive and measure improvements.

Friends and Family test is being introduced in the Emergency Department from March 2013.

A How are we doing survey is in development to supplement the Major Trauma survey which is providing useful information from patients to inform service improvement

The ED is continuing to work on improving younger people’s experience of the ED, for example, continuing work with local voluntary groups including Red Thread and the Loughborough Junction Youth Club.

A new collaboration with primary care partners has commenced which aims to improve the meet and greet function, improve communication with GPs, for example info on frequent attenders, addressing community health themes and an integrated IT system

4. External ‘Radar’ The trust regularly monitors a range of external sources of patient experience data from the CQC Quality Risk Profile on websites such as NHS Choices, Patient Opinion and social networking sites including Facebook and Twitter. The rating system on the NHS Choices website has now changed to a star rating system and King’s is currently rated as five star. Recent comments include:

“I had surgery and the team that looked after me was brilliant, they explained to me very

fully what the procedure would involve and they were very professional, kind and caring.

The surgery was successful and they have given me very thorough follow up care and

monitoring. I made a good recovery and returned to work.”

What I liked: My daughter was treated on Lion Ward. The staff were all committed and

very professional, but very caring and sympathetic.

What could have been improved: The car parking was very expensive, maybe if you have

a child in the hospital you should get some of this refunded?

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5. The Friends and Family Test – update The Friends and Family Test has been included in the government’s mandate to the NHS Commissioning Board. Making sure that people have a positive experience of care is a key requirement in the Mandate, published on 13 November 2012. It means every patient will be able to give feedback on the quality of their care, even in hospitals which currently have no established patient survey programme. The rollout plan is:

acute hospital inpatients and accident and emergency patients from April 2013

for women who use maternity services from October 2013

as soon as possible after October, for all those using NHS services. The Friends and Family test is being widely trailed as one of the government’s responses to the Francis Report. Results will be publically available and will play a role in where patients choose to receive their care. It has been announced that the Friends and Family Test will be the only national Patient Experience CQUIN for 2013/14. The CQUIN will be structured with three separate elements:

30 per cent of the funding for phased expansion: NHS providers will need to deliver the nationally agreed roll-out plan to the national timetable. Missing any element of this will result in non-payment of the CQUIN.

40 per cent of the funding for increasing the response rate in the acute inpatient and A&E areas. Initial minimum response rates required are 15- 20%. This presents a particular challenge in A&E due to the high throughput. Going forward, achieving a response rate in the top 50 per cent which also improves on the Q1 response rate will be required.

30 per cent of the funding for increasing the score of the Friends and Family Test question within the 2013/14 staff survey compared with 2012/13 survey results.

6. Summary of patient experience feedback – King’s Patient Experience Report

King’s monthly Patient Experience Report presents integrated patient feedback from patient complaints, Patient Advice and Liaison Service (PALS), How Are We Doing and patient comments. It also monitors performance against CQUIN targets and Eliminating Single Sex Accommodation.

6.1. How are we doing?

Performance over the quarter has been very positive.

The overall HRWD score met the benchmark throughout Q2 and for 2 out of the 3 months in

Q3.

Scores for both patient engagement and care and treatment reached the benchmark of 87 for two months in Q3. Environment scores reached the benchmark in November, but dropped back one point for October and December.

The food rating has remained green for the last 12 months.

Patients rated their experience in Day Surgery green with a score of 92. Maternity scores fell back slightly from 83 to 82.

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Enc 2.7.1

5

Response rates for HRWD were disappointing for the quarter at 37%. Rates will need to improve.

Within the Divisions, Cardiac and Children’s met the overall benchmark for all three months of the quarter and Haematology for two out of three months

The trust also continues to do well in meeting patient expectations for receiving their care in ‘single sex’ accommodation. The average satisfaction score for this quarter was rated green at 91.

In January a revised version of the HRWD inpatient survey was launched which includes the new Friends and Family question, as well as a question on whether a patient was admitted through a planned route or as an emergency. It also includes a question about volunteers to assess their impact on patient experience and a question on whether a patient has diabetes to support staff in improving the experience and care of patients with diabetes.

6.2. Complaints and Patient Advice and Liaison Service (PALS)

Complaints

79

56

80

54

7164 62 63

5358

74

51

20

30

40

50

60

70

80

90

Jan-1

2

Feb-1

2

Mar-

12

Apr-

12

May-1

2

Jun-1

2

Jul-12

Aug-1

2

Sep-1

2

Oct-

12

Nov-1

2

Dec-1

2

No. of Compl ai nts Compl ai nts T r end

There were 176 complaints this quarter. YTD there have been 500 complaints, against a target of 405. We will exceed our end of year stretch target (540), and expect an increase compared with 2011/12 (590). The trend in complaint numbers has remained similar since Q3 11/12, against a pattern of increasing activity.

47% of complaints for YTD were responded to within the target of 25 working days against a target of 70.

The profile of complaints has remained the same for the last two quarters. There was a notable reduction in concerns about inpatient cancellations in Q3 , although conversely PALS report an increase in this area, which suggests that issues remain, and are being picked up through different routes.

Neurosciences received the highest number of complaints during the quarter.

The highest proportion of PALS issues continue to be related to outpatients.

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Enc 2.7.1

6

7. Volunteering King’s volunteers are continuing to play a key role in helping staff and patients. Numbers continue to be high with upwards of 700 volunteers from the local community actively involved in King’s. Highlights for last quarter include invitations to No 10 Downing Street and the Cabinet Office to discuss King's approach to volunteering, and a visit in January from Nick Hurd, Minister for Civil Society, and the Department of Health, to see King's volunteers in action, and as a possible model for wider rollout within the NHS.

8. King’s Patient Experience Transformation Programme We are continuing to drive improvement in patient experience through our Patient Experience Transformation Programme. To summarise progress:

8.1. Video Stories Good progress has been made in developing video patient stories as a method for gathering and using patient experience feedback to drive service improvement. This quarter saw the first four areas trained in the methodology and carrying out their first video stories. Both MAU wards, Mary Ray and Oliver have filmed patients as well as videos in Renal and in the Derek Mitchell Unit as part of the trust’s cancer improvement work. A second tranche of wards and outpatient areas will carry out their first video stories in the New Year and begin to use these to focus in on local areas for improvement. They are Cotton Ward, Elderly Medicine, Radiology and Suite 1 outpatients. Some Governors are involved in the project and receiving training so that they can both produce patient video stories and support staff to introduce video stories across the trust. 8.2. Improving Patient Experience in the Medical Admissions Unit (MAU) Work has begun on Mary Ray and Oliver to get a better understanding of how patients experience these two very busy wards. The diagnostic phase has looked closely at existing data on patient experience and is also gathering new information from patients. Two focus groups are planned as well as observations on the wards. Based on this, a set of actions will be put in place to improve the experience of patients admitted to the MAU which will then be monitored and measured through the How are we doing survey.

9. Recommendation

The Board is asked to note this report, and offer any comments.

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Enc 2.7.2

1. Background/Purpose

A summary of the Infection Prevention and Control activity from October till December 2011

2. Action required

To note the content of the report.

3. Key Implications

Legal: The Trust has a statutory responsibility to ensure compliance under the Hygiene code. The submission of a quarterly report is part of the Code.

Financial: Poor infection control practices and increase in infection rates has a direct financial impact as a result of additional drug costs and increase in Length of Stay

Assurance: The infection Prevention and Control report provides an overview of Infection Control activity and identifying significant trends and developments. This report incorporates the risk register relating to infection control also.

Clinical: Good Infection Prevention and Control practices are key to providing high quality care to King’s patients

Equality & Diversity: The content of this report has no implications for equality and diversity

Performance: Infection rates have a direct impact on length of stay, our Monitor performance rating and our CQC registration status.

Strategy: None

Workforce: None

Estates: None

Reputation: Poor compliance in infection prevention and control standards could adversely affect the reputation of the organisation.

Other: (please specify)

Report to:

Board of Directors Meeting

Date of Meeting:

26 February 2013

Subject:

Infection Control Quarterly Report – Quarter 3; 2012/13

Author(s):

Erika Grobler; Deputy Director of Infection Prevention and Control

Presented by:

Dr Geraldine Walters, Director of Infection Prevention and Control

Sponsor:

Dr Geraldine Walters

History:

Quarterly DIPC report

Status:

For report.

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1

Quarterly DIPC report

2012-13 Quarter 3

Geraldine Walters

Director of Nursing and Midwifery;

Director of Infection Prevention

and Control

Enc. 2.7.2

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2

Contents

• Executive summary

•Trust Performance Summary

• Divisional Performance Summary

• Key focus areas

• Antimicrobial stewardship

• CDT Root Cause Analysis process

• Other areas of note

• ICE pod installation

• Consumables standardisation

• IV line insertion – role of the IV team

Enc. 2.7.2

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3

Executive Summary (1/3)

1. MRSA (post 48 hour) bacteraemias – good performance:

One Trust attributable case reported in 2012-13

• One in Ambulatory (Apr 2012)

MRSA screening:

• 100% Elective (in December 2012)

• 96.6% Emergency (in December 2012)

2. VRE bacteraemias – improved performance:

1 case of VRE bacteraemia in December for a total of 22 cases YTD (trajectory of 13 cases for the same period.)

This does indicate an improvement on Q2 (13 cases in Q2; 6 cases in Q3)

3. C-difficile – still under DH trajectory but number of cases and have seen a reduction in Q3 compared to

Q2:

45 CDT cases reported to DH (as per National Guidance) in 2012-13 (trajectory of 56 cases YTD):

• Surgery - 9 cases compared to 12 in 2011/12 (YTD December)

• TEAM - 5 cases compared to 13 in 2011/12 (YTD December)

• Critical Care - 2 cases compared to 8 in 2011/12 (YTD December)

• Cardiac - 3 case compared to 5 in 2011/12 (YTD December)

Trust attributable CDT Cases over the last 4 quarters:

• 2011-12 Q3 – 22 cases

• 2011-12 Q4 – 18 cases

• 2012-13 Q1 – 11 cases

• 2012-13 Q2 – 25 cases 2012 – 13 Q3 – 12 cases

A further 88 cases have been reported locally as per the April DH testing guidance. All of these cases have been

included in the Root Cause Analysis process and been managed as per Trust CDT guidance. This continues to

place additional pressure on isolation provision.

Enc. 2.7.2

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Executive summary (2/3)

4. E.coli bacteraemia

The Trust has reported 82 cases YTD for 2012/13.

5. Meticillin Resistant Staphylococcus aureus (MSSA) bacteraemia

The Trust has reported 20 post 48 hour cases of MSSA bacteraemia YTD for 2012/13

Key focus areas:

1. Antimicrobial stewardship

Monthly audits undertaken in all inpatient wards. Results are improving. Work underway to audit

prophylaxis prescribing and administration in theatres. Results to be available shortly. The Antibiotic

Usage Steering Group is leading on the implementation of the “Start Smart then Focus” action plan.

Progress will be reported in the next quarterly report.

2. Hydrogen Peroxide Vapour technology

HPV has been used in a number of areas where CDT or multi-resistant gram negative infections

occurred. Areas that have been treated, i.e. surgical and renal wards have shown a marked reduction in

CDT cases.

3. CDT root cause analysis

The well established process for reviewing both DH and locally reportable CDT cases has been further

developed so that divisions ensure completion of mitigating actions identified through this process.

4. Multidrug resistant organisms – Child Health

The trust has had cases of children colonised with a multi resistant family of organisms. A working group

comprised of CEF, IPC, medirest and the division, have been formed to manage this situation.

5. Water management group

A group has been established with key stakeholders, including CEF, Infection Control and Medical

Microbiology, to manage the Trust’s response to new guidance on water quality.

4

Enc. 2.7.2

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5

Executive Summary (3/3)

Other areas of note:

1. ICE pod installation:

Two pods will be installed on Annie Zunz during the first week in December. A further 5 pods to be installed

once bed pressures allow.

2. Healthassure and the Infection Control Gap Analysis

The IPC team is working with others in the Trust to implement the Healthassure system. The Hygiene Code

model will provide a more accurate view of Trust compliance than the systems currently being used. Progress

will be reported as part of this report in the future.

3. Consumables standardisation: The Infection Prevention and Control team will take an active role in the newly established Product Selection Group by

co-opting the appropriate clinical leaders onto the group, i.e. the Continence Nursing team when decisions on

continence products are made.

4. European Directive – provision of safety engineered devices

The Lead IV practitioner is leading on the implementation of safety engineered devices. These are sharp devices that

pose a risk to staff of needlestick injuries. The Trust has implemented safety engineered peripheral cannulaes and

venepuncture equipment. Trials will take place over the next few months on other devices, i.e. hypodermic syringes and

needles and needles for intramuscular and subcutaneous injections.

Enc. 2.7.2

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6

Contents

• Executive summary

•Trust Performance Summary

• Divisional Performance Summary

• Key focus areas

• Antimicrobial stewardship

• CDT Root Cause Analysis process

• Other areas of note

• ICE pod installation

• Consumables standardisation

• IV line insertion – role of the IV team

Enc. 2.7.2

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MRSA bacteraemia

7

Enc. 2.7.2

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VRE bacteraemia

8

Enc. 2.7.2

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C.difficile – DH reportable

9

Enc. 2.7.2

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C.difficile – locally reportable

10

Enc. 2.7.2

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MSSA bacteraemia

11

Enc. 2.7.2

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E.Coli bacteraemia

12

Enc. 2.7.2

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IC scorecard – Dec 2012

13

Enc. 2.7.2

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IC scorecard – Dec 2012

14

Enc. 2.7.2

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IC scorecard – Sept 2012

15

Enc. 2.7.2

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16

Contents

• Executive summary

•Trust Performance Summary

• Divisional Performance Summary

• Key focus areas

• Antimicrobial stewardship

• CDT Root Cause Analysis process

• Other areas of note

• ICE pod installation

• Consumables standardisation

• IV line insertion – role of the IV team

Enc. 2.7.2

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Divisional performance

• Two divisions continue to be identified each month as requiring

additional scrutiny and input from the Infection Prevention and Control

(IPC) team

• The criteria on which this decision is based has been widened to include

the number of non-compliance assurance audits on the Infection Control

Scorecard, but also other potential areas of concern, i.e. any clusters or

outbreaks that have occurred.

• There is also an aim to ensure that all divisions meet with the IPC team

in this way at least once in the financial year.

• Turnaround meetings during Q3:

– October: Cardiac and Child Health

– November: Emergency Department and Liver

17

Enc. 2.7.2

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2012/13 December

Infection Control heatmap (1/2)

18

Enc. 2.7.2

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2012/13 December

Infection Control heatmap (2/2)

19

Enc. 2.7.2

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20

Contents

• Executive summary

•Trust Performance Summary

• Divisional Performance Summary

• Key focus areas

• CRE

• Antimicrobial stewardship

• CDT Root Cause Analysis process

• Other areas of note

• ICE pod installation

• Consumables standardisation

• IV line insertion – role of the IV team

Enc. 2.7.2

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CRE Carbapenemase Resistant Enterobacteraceae

• A group of organisms that normally live in the gut

• Organisms are very resistant to antibiotics, making the treatment of infections due to these

organisms very difficult.

• Prevention is important as treatment options are limited.

• Carbapenemase can be transferred between organisms.

• Infections caused by CRE is associated with high mortality

CRE at KCH

• August 2012 – KCH notified by a hospital in Dublin that three paediatric liver patients

transferred were found to be positive

• September 2012 – Weekly screening of all patients on Rays of Sunshine and Thomas Cook

introduced. Sixteen patients in Child Health have been have been identified in Child Health,

predominantly in Rays of Sunshine.

21

Enc. 2.7.2

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Antimicrobial stewardship (1/3)

22

• The Trust continues to be the only Teaching hospital in London that

undertakes a monthly audit of antimicrobial stewardship; a process

coordinated and managed by the Medical Microbiology team.

• Results for November 2012:

– KPI1 compliance (is an indication recorded) = 96%

– KPI 2 compliance (stop / review date recorded)=79%

– KPI 3 compliance (IV / PO switch not overdue) = 96%

– KPI4 compliance (indication as per guideline) = 91%

Enc. 2.7.2

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Antimicrobial stewardship – Nov data

(2/3)

23

Enc. 2.7.2

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Antimicrobial Stewardship – Nov data

(3/3)

24

Enc. 2.7.2

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CDT root cause analysis

process

Root cause analysis process:

• The weekly CDT review meetings is fully established and has become more

important in reviewing locally reported cases to distinguish true or colonised

cases.

• These review meetings have now been changed to strengthen local Divisional

and Speciality ownership and review.

25

Enc. 2.7.2

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26

Contents

• Executive summary

•Trust Performance Summary

• Divisional Performance Summary

• Key focus areas

• Antimicrobial stewardship

• CDT Root Cause Analysis process

• Other areas of note

• ICE pod installation

• Consumables standardisation

• PICC line insertion – role of the IV team

Enc. 2.7.2

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ICE pod installation

ICE (infection control enclosure)-pod isolation facilities

A product recently brought to the market by Bioquell. It is a semi-

permanent structure that is constructed bespoke for each bed

space. The Trust has ordered 7 (installation w/c 5th Dec) of these

pods to:

• Provide more flexibility in isolation room provision

• Increase the uptake of HPV usage by reducing the time required

to implement this technology.

The first two pods have been installed on Annie Zunz. The further

5 pods will be installed once bed pressures allow.

It is important to note that this technology is not a direct

replacement for increasing isolation room provision but does

provide more flexibility.

27

Enc. 2.7.2

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Consumables standardisation

A group; the Product Selection Group, has been established under the

chairmanship of the Director of Procurement for KHP to work towards

standardisation of clinical consumables to:

• ensure that the quality of consumables used is of a sufficiently high

standard

• to increase patient safety

• to explore economies of scale through joint procurement across

KHP.

The first product range to be worked on will be urinary catheterisation

products.

28

Enc. 2.7.2

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PICC line insertion

role of the IV team

• Peripherally inserted Central catheters (PICC) are used for patients

who require longer term intravenous therapy; i.e. IV antibiotic therapy

or TPN nutrition.

• The IV team are taking on more of a role in inserting PICC lines

(currently undertaken by interventional radiologists) in order to relieve

the pressure on PICC insertion waiting times.

• The team have also commenced pre-assessment of these patients to:

– Improve the consenting process

– Improve the information given to patients

– Improve the utilisation of PICC insertion lists in Radiology

• The team have been given authorisation by the Novel Procedures

Group to trial a new device for keeping PICC lines in place. Currently

around 25% of slots on the insertion lists are used for resiting lines that

have either accidentally been removed or have migrated. This trial will

commence in January 2013.

29

Enc. 2.7.2

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Making King’s First Choice for patients and staff

Quality Priorities &

Accounts

Geraldine Walters

13 February 2013

Enc. 2.7.3

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Quality priorities & accounts

1

The quality accounts keep

us...

Stakeholder involvement

ensures we...

Accountable for quality Match up to our aims

Focussed Focus on the right things

Transparent Stay in touch with those we

serve

Every year, we develop our Quality Priorities in collaboration with our stakeholders, and

publish Quality Accounts based on these.

Enc. 2.7.3

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Our Priorities in context

2

Reduce infections

Achieve zero Never

Events

Reduce hospital

acquired infection

Reduce number of

incidents with high

degree of harm

Pa

tie

nt

Sa

fety

Reduce hospital acquired

infection

Improve patient

experience by using

inpatient feedback

results

Pa

tie

nt

Ex

peri

en

ce

Improve the consistency

of positive inpatient

experience

Improve patient

experience

Eliminate mixed sex

accommodation

Improve cleanliness of

the hospital environment

2009/10 2010/11 2011/12

Pa

tien

t O

utc

om

es

Enhance mortality

performance

Demonstrate best 20%

mortality benchmark

performance

Ensure at least 90% of

all inpatients are VTE

risk assessed before

discharge

Improve end of life care

Improve diabetes care

Reduce avoidable death,

disability, and chronic ill

health from venous

thromboembolism (VTE)

Improve medication safety

Improve identification

and escalation of acutely

ill patients

Minimise harm acquired

in the hospital

Improve end of life care

Improve diabetes care

Improve responsiveness

to inpatients personal

need

Improve outpatient

experience

2012/13

Enc. 2.7.3

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Stakeholder Event 1

3

Explanation of the event & its purpose

Review of 2012/13 priorities & progress

Explanation of candidate priorities for 2013/14

Stakeholders invited to comment on candidate priorities & make suggestions

Enc. 2.7.3

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4

Quality Priorities 2012/13

Priority Objective Target for first 6 months Results Status

Improve the

identification

and escalation

of acutely ill

patients

• To improve the identification and

escalation of acutely ill patients

by establishing a consistent

performance framework across

the organisation.

- Launch Trust scorecard

- Consolidate Trust initatives /

committees

- Pilot root cause analysis process

-Implement ‘Wardware’ observations

tool

- On target

- On target – divisional

reporting system in place

- In place

- 9 wards

Minimise harm

acquired in

hospital

• Use & broaden the use of the

NHS Safety Thermometer &

Safety Express

- Maintain progress in falls/pressure

ulcers

- 90% venous thromboembolism

(VTE) assessed

- 90% appropriate prophylaxis

- 75% written information

- 6 wards with Safety surveys

- 10 wards on Safety Express

- 95.4%

- 94.7%

- 77%

- Yes

- Yes

Improve

diabetes care

• Build on existing work to meet

National Institute for Clinical

Excellence quality standards for

diabetes

- Increase specialist presence

- Link practitioner scheme

- Performance framework

- Progress towards e-insulin sheet &

associated blood glucose meter for

active decision making

- Improved insulin safety

- Dedicated consultant &

specialist nurse

- Scheme prepared to start in

2013

- Diabetes dashboard in place

- Manual electronic record of

blood glucose; no meter

- Improved 2010-2011 (error-

free insulin prescription rises

from 78.0% to 86.2%; error-

free insulin management

rises from 74.1% to 79.8%)

On target At risk Not on target

Enc. 2.7.3

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Quality Priorities 2012/13

5

Priority Objective Target for first 6 months Results Status

Improve end of

life care

• To build on the work in 2011/12 to

improve the coordination of care we

give to patients as they approach

end of life and achieve the locally

agreed CQUIN1 target.

- 90% discharge letters in 2 days to

enable handover of end of life care

- Education and training on end of life

care

- ‘Amber care bundle’ in 5 areas

- 96.2%

- Weekly teaching,

- Reached 5 areas

Improve

responsiveness

to inpatients’

personal needs

• To use a similar framework to

2011/12 to achieve the locally

agreed CQUIN1 target for the

‘responsiveness to personal needs’

composite indicator.

- Identify 3 weakest wards & improve by

3% on basket of survey questions

- Identify further 3 wards to focus on

- 5% improvement

- Identified Kinnier

Wilson, David Marsden

& Dawson

Improve

outpatient

experience

• To roll out an Outpatient feedback

survey and achieve focused

improvement on key issues

identified from our National

Outpatient Survey results.

- Launch outpatient survey in Suites 1,

3, 5, 6 & 7

- Agree targets for future uptake

- Launched in these

areas

- Agreed

On target At risk Not on target

1CQUIN = ‘Commissioning for Quality and Innovation’, a payment framework by which a portion of income providers receive

from commissioners is dependent on achieving certain quality targets.

Enc. 2.7.3

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Quality Priorities for 2013/14

Outcome of first stakeholder meeting

Enc. 2.7.3

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Patient safety

7

Strong support for:

• Effective nursing and medical

assessment of inpatients

• Management of the acutely unwell

patient

Some interest in:

• Surgical safety checklist

Less support for:

• There may be overlap between nurse assessment and patient falls. Perhaps falls could be added into the

assessment priority if adopted?

• Diagnostic test result communication would be likely to be difficult to measure positively:

• Might be hard to get meaningful data

• Might be very expensive to measure

• There was little interest in putting forward VTE, because:

• Good historical performance

• Other avenues to measure

Enc. 2.7.3

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Patient Outcome

8

Strong support for:

• Dementia: focus would be linked with

primary care; makes sense

• COPD: helps to support integrated

care and public health

• Alcohol: supports patient health and

wellbeing

Some interest in:

• Cancer staging: large numbers of

patients presenting acutely

• Mental Heal of adults with physical

illness: relates to effective

assessment

Less support for:

• Acute Kidney Injury (no comments)

• Glaucoma (no comments)

Enc. 2.7.3

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Patient Experience

9

Strong support for:

• Outpatients: would impact on a large

number of patients

• Discharge: improving information to

patients families and carers

Some interest in:

• AMUs: good scope for improvement

Less support for:

• Diabetes: felt this would belong in patient outcomes

• National CQUIN priority questions (no comments)

Enc. 2.7.3

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13/14 Priorities

10

Pa

tien

t S

afe

ty

Pa

tie

nt

Ex

pe

rie

nc

e

Pa

tien

t O

utc

om

es

Management of the acutely unwell patient

Surgical Safety Checklist

Dementia

COPD

Outpatient Experience

Discharge

Enc. 2.7.3

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Enc. 3.1.1

Equality and Diversity Committee Minutes of the meeting of the Equality and Diversity Committee held at 12:00 on Thursday 29 November 2012 in the Dulwich Committee Room, King’s College Hospital

Present: Marc Meryon (MM) Non-Executive Director/Committee Chair Prof. Sir George Alberti (GA) Non-Executive Director/Trust Chair Faith Boardman Non-Executive Director Tim Smart (TS) Chief Executive Angela Huxham (AH) Executive Director of Workforce Development Dr Angela Grainger (AG) Disability Inclusivity Network Sally Lingard (SL) Associate Director of Communications Mark Preston (MP) Associate Director of Human Resources Frank Wood (FW) Joint Staff Committee Attendees: Ben Rhodes (BR) Chaplaincy Team Manager Chris Forster (CF) Head of Asset Management Leonie Mallows (LM) Corporate Governance Officer Apologies: Dr Geraldine Walters (GW) Director of Nursing and Midwifery David Lawson (DL) Director of Procurement Prof. Alan McGregor (AM) Non-Executive Director Lindsay Batty-Smith (LBS) LGBt Forum Carol Bell (CB) Cultural Diversity Network Mr Richard Gullan (RG) Consultants’ Committee Representative Item Subject Action

12/37 Apologies The apologies for absence were noted.

12/38 Declarations of Interest There were no declarations of interest.

12/39 Chair’s Action There had been no Chair’s action.

12/40 Minutes of the Previous Meeting The minutes of the meeting held on 24 July 2012 were approved as a correct record.

12/41 Matters Arising/Action Tracker The progress made on the action tracker was noted. Mapother House The Committee agreed to remove the action relating to Mapother

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Enc. 3.1.1

Item Subject Action

House from the action tracker as it was no longer relevant to this committee. Younger FT Members SL reported that she and Jessica Bush would attend the next Volunteers’ Forum to encourage volunteers, many of whom fall into the 17-21 and 22-29 age categories, to become foundation trust members.

12/42 Equality Delivery System (EDS) Objectives Tracker MP presented the document tracking progress against each of the EDS objectives. He reported that all of the objectives due for completion by the 31 January 2013 were close to completion or complete. In response to comments and questions from Committee members, the following key points were made: It was confirmed that whilst it is possible to put some

measurements in place to analyse the impact of staff development and training on equality and diversity, there is no direct way of measuring the implementation of these strands operationally;

The Trust website is reviewed every six months and changes are

made to enhance this from a user’s perspective, although this is balanced against the resources available;

The Chair commended the progress made to date and suggested

that given the significant progress made to date, it might be appropriate to bring forward the objectives scheduled for completion by January 2014 and to identify action owners.

The Committee discussed the possible impact on implementation of the EDS arising from the potential acquisition of the Princess Royal University Hospital (PRUH) in Bromley. The following key points were noted: A different population would produce different inclusion issues, all of

which would need to be considered and reflected in all EDS documents;

The various integration work streams would need to consider how to embed the EDS and the wider equality agenda through their planning work;

The PRUH should have their own equality objectives and the

merging of the two sets would necessitate a baseline exercise with external benchmarking and guidance in order to produce a neutral view; and

In the event of the Trust acquiring the PRUH, a review of both

organisation’s EDS / equality objectives should be undertaken as soon as possible after the acquisition date.

The final report on the national evaluation of the EDS for the NHS is now available and will be circulated to committee members.

MP/LM

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Enc. 3.1.1

Item Subject Action

12/43 Analysis of the Pension Scheme Membership AH presented analysis of the diversity profiles of staff who were and were not members of the NHS Pension Scheme. Key points included: 24% of staff have opted out of the pension scheme. This is

considered to be an unusually high proportion and is thought to be primarily due to domestic and financial reasons, and possibly related to recruitment from overseas;

The Department of Work and Pensions has introduced auto-

enrolment as part of a commitment to ensure that pensions are available to all workers. The Trust’s date for introducing auto-enrolment is April 2013;

Eligible staff will be auto-enrolled into the pension scheme and will

have to opt-out if they do not wish to remain in the scheme following auto-enrolment. The auto-enrolment process will take place on a three yearly basis.

In discussion the Committee made the following comments and observations: A communications plan will be rolled out, led by the finance team;

The trade union view is that an employer’s contribution to an

employee’s pension is a deferment of salary and therefore employees are encouraged to opt in;

A significant number of people not in the pension scheme are under

the age of 40; As employees contributions rise it is to be expected that an

increased number of people will opt out; and The pensionable age is also increasing and a national group has

been established to review the implications of this.

12/44 Diversity Theme: Faith

BR presented an overview of the work of the spiritual care team to address issues of equality and diversity both within the Trust and in partnership with KHP. Key points included:

There has been an increased rate of emergency call outs and an increase in adult contract funerals. The reasons for the increase in adult contract funerals are being explored;

The team works closely with the palliative care and organ donation teams and, more widely, with the NHS Blood and Transplant London group on barriers to donation due to culture and belief;

A range of spiritual and faith events have taken place this year to try to ensure that staff and patients see their faith represented;

The chaplaincy database record a diverse range of self-reported

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Enc. 3.1.1

Item Subject Action

beliefs and seeks to cater for this range;

A group of volunteers work with the spiritual care team to enable a much greater reach across the Trust and to increase visibility;

As part of the Trust’s centenary, wholeness and healing will be celebrated, remembering in particular those who have benefitted from care at King’s and gone on to lead full lives;

Work with KHP partners includes a spiritual care response to the Liverpool Care Pathway audit and participation in a European project on spiritual assessment via KCL.

The Committee acknowledged the value of the contribution by the spiritual care team to patients, their families and to staff.

12/45 Estates and Facilities 3-year Plan CF presented an update on progress towards the access compliance requirements under the 2010 Equality Act. Key points included: Equality and diversity are part of the design stage when planning

capital projects;

Installations include an induction loop, handrails and a telephone for use by the visually and hearing impaired;

A feasibility study to install an external lift at the main entrance of

Golden Jubilee Wing will be completed by February 2013; and

A comprehensive risk assessment of surrounding roads, walkways and access to the main entrances of the hospital is being undertaken;

A working group has been established to review all main access

roads and walking pathways and traffic routes around the hospital to ensure suitable and safe circulation for disabled persons and public

Due to financial constraints, the previously reported 3-year plan is

likely to be executed over a 6-year period.

FW suggested placing capital project models in public areas to enable the public to engage with and share their views on the Trust’s capital plans. CF responded that on previous occasions models and plans have been available at the Trust Open Day. SL to contact the Transport Feeder Group regarding the availability of accessible information at Denmark Hill station. It was agreed that CF would return with an update towards the end of 2013.

SL/LM

CF/LM

12/46 Staff Diversity Networks Update AG gave a verbal update on the activities of the Disability Inclusivity

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Enc. 3.1.1

Item Subject Action

Network (DIN). Key points included: There has been an increase in the number of people declaring a

disability;

Evaluation of the suitability of access to new buildings is being undertaken by DIN members;

DIN is working with the communications team and ICT to confirm if

it is possible to hold managed online discussions on specific topics via the Trust website in order to gather the views of staff and the local community to widen inclusivity;

A work experience day for children with severe disabilities took

place recently. Further visits are being planned.

In future, reports from the staff diversity networks will follow a pro-forma, which aligns with the Trust’s strategic objectives and equality and diversity strands.

12/47 Equality and Human Rights Update There were no updates Equality and Human Rights issues.

12/48 Any Other Business FW raised concern over the quality of local social care services and whether appropriate checks are carried out to ensure that discharged patients have care provision at home.

12/49 Date of Next Meeting Tuesday 29 January 2013 13:00-14:00 in the Dulwich Committee Room.