Trust Board › media › 9011 › trust-board...2020/05/26 · Trust Board Location Microsoft Teams Date 26th May 2020 Time 10am AGENDA Time Reference Item Lead Action PRELIMINARY

Trust Board Location Microsoft Teams

Date 26th May 2020

Time 10am

AGENDA

Time Reference Item Lead Action

PRELIMINARY BUSINESS

10.00 TB20/21_

024

Introduction, Apologies & Declaration of Interest To note the apologies for absence and any new declarations of interest from Directors

Sue Musson To note

10.02 TB20/21_

025 Minutes of the Board Meeting held on 28th April 2020 To approve the minutes of the Board of Directors

Sue Musson To approve

10.05 TB20/21_

026 Rolling Action Tracker To discuss any outstanding actions

Sue Musson To note

10.10 TB20/21_

027 Any Urgent Matters Arising To discuss and note any urgent matters arising

Sue Musson/S Warburton

To note

10.12

TB20/21_ 028

Chair’s Update To receive an update on the Chair’s activities and work streams

Sue Musson To note

10.15 TB20/21_

029

Patient / Staff / Volunteer Story : COVID-19 To receive and consider the learning from a patient / staff / volunteer story

D Brown To note

10.30 TB20/21_

030 Committee Assurance Report To note the report for information and assurance

M Warburton/Al

l To note

STRATEGIC CONTEXT, FINANCE & PERFORMANCE

10.40 TB20/21_

031

Integrated Performance Report To discuss and note key issues relating to this report

Operational

Quality

Workforce

Finance

All

To note

11:00 TB20/21_

032 Covid Update To note the report for information and assurance

Beth Weston To note

11:20 TB20/21_

033 Budget/Financial Plan Update To consider update on financial plan

Rob Forster To note

QUALITY & SAFETY

11:40 TB20/21_

035

Annual Declaration of Interests To note the report for information and assurance

Madelaine Warburton

To note

11:45 TB20/21_

036

NHS Provider Licence – Annual Self Certification

To consider and if deemed to approve the declaration

Madelaine

Warburton To

approve

CONCLUDING BUSINESS

11:50 TB20/21_

037

Key messages from the Board and Items for the Risk Register/ Changes to the Board Assurance Framework (BAF) To agree the key messages to be cascaded from the Board

Sue Musson To note

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2 Trust Board Part 1 Public Agenda: 26 May 2020

throughout the organisation and to identify any additional items for the Risk Register or changes to the BAF arising from discussions at this meeting

TB20/21_

038 Chair’s Log To note items for the Chair’s Log

Sue Musson To note

TB20/21_

039

Questions from members of the public Members of the public are reminded that Trust Board meetings are meetings held in public, not public meetings. Members of the public do not have a right to ask questions although the Chair of the meeting may allow this at their discretion at the end of the meeting. Only questions which have been submitted to the Trust in advance of the meeting will be accepted. Questions relating to specific and detailed information that is held by the Trust these questions will generally be dealt with under the Freedom of Information Act 2000 and directed appropriately.

Sue Musson To note

Finish Time:12 pm Resolved: that in accordance with the Public Bodies (Admission to Meetings) Act 1960 representatives of the press and other members of the public are excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.

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Meeting of the Trust Board (Part 1)

held on Tuesday, 28 April 2020 at 10am

Video Conference

Present: Sue Musson (SM) Chair

Steve Warburton (SW) Chief Executive

Dianne Brown (DB) Chief Nurse

Tristan Cope (TC) Medical Director

Mike Eastwood (MW) Non-Executive Director

David Fillingham (DF) Non-Executive Director

Robert Forster (RF) Chief Finance Officer

Debbie Herring (DH) Chief People Officer

Tim Johnston (TJ) Non-Executive Director

Louise Kenny (LK) Non-Executive Director

Angela Phillips (AP) Non-Executive Director

Mandy Wearne (MJW) Non-Executive Director

Beth Weston (BW) Chief Operating Officer

Neil Willcox (NW) Non-Executive Officer

In Attendance: Paul Bradshaw

Clare Morgan

Madelaine Warburton (MW)

Director of Finance – Strategic

Capital (for item TB20.21_019 only)

Director of Strategy

Director of Corporate Governance

Sharon Balmer (SB) Committee Services Officer

(Minutes)

None

External

Core members Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Sue Musson

Steve Warburton

Dianne Brown

Tristan Cope

Mike Eastwood

David Fillingham

Robert Forster

Debbie Herring

Tim Johnston

Louise Kenny

Angela Phillips

Mandy Wearne

Beth Weston

Neil Willcox

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TB20.21_001 Introduction, Apologies and Declaration of Interest

The Chair opened the meeting and welcomed Clare Morgan, Director of

Strategy, to the meeting. She noted that the Board would observe a minute of

silence at 11am to mark the annual International Workers’ Memorial Day to

remember those who had lost their lives to COVID-19.

The Chair noted the importance of recognising the hard work of Trust staff and

celebrating the Trust’s key achievements that were illustrative of exceptional

leadership in the organisation, including:

The operational response to COVID-19 and the quadrupling of critical

care capacity;

The improvement of patient flow and capacity as a result of discharging

patients, working with local system partners;

System working and mutual aid with partner organisations;

Placing 17th nationally for Accident & Emergency (A&E) four hour

performance;

The achievement of the control total for 2019/20 and, as a result, the

receipt of additional Financial Recovery Funding (FRF) of £9.1million

IT enabling working from home and establishing virtual meetings,

alongside other innovations;

The support to staff health and wellbeing including workforce offers;

Procurement sourcing and supply of Personal Protective Equipment

(PPE);

Estates & Facilities responding to demand and maintaining a supply of

oxygen against increased demand;

Outstanding communications throughout the COVID-19 pandemic;

The recruitment for COVID-19 clinical research trials;

The provision of high quality papers for the Board and its Committees;

and

The improvement in performance reporting through the inclusion of

Statistical Process Control (SPC) charts.

TB20.21_002 Minutes of the last meeting

The minutes of the meeting held on Tuesday, 31 March 2020 were agreed as a

true and accurate record.

TB20.21_003 Rolling Action Tracker

SM noted that the action log would be updated with revised completion dates

for the next meeting.

TB20.21_004 Matters Arising

There were no matters arising.

TB20.21_005 Chair's Update

SM provided an outline of the meetings and events she had attended (via tele

or video conference) since the last meeting. In addition to those listed in the

report, there had been a number of conversations with counterparts in

community and mental health trusts to ensure system wide working.

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Discussions on the national Whatsapp group for Chairs had focused on PPE

and testing.

There had been a significant number of queries from MPs, with some specific

questions relating to attendances linked to domestic abuse.

Action: For a combined staff and patient story to be presented to the May

meeting of the Trust Board on COVID-19.

TB20.21_006 Committee Assurance Report

MW introduced the assurance report which summarised the key items

discussed and decisions made at the Committee meetings held since the last

Trust Board meeting.

DF reported that the Quality Committee had met virtually on Wednesday, 22

April 2020 and the meeting had incorporated aspects of the Workforce

Committee in order to reduce the number of meetings and to focus on

workforce issues specifically related to the pandemic. Discussions had

focused on the response to COVID-19 and impact on non-COVID-19 patients.

ME reported that the Finance & Performance Committee had met virtually on

Thursday, 23 April 2020 and had noted strong financial and A&E performance.

The Committee had identified the need to understand what “good” looked like

for non-COVID-19 operational and finance performance in order to enable

oversight and challenge. There had been a helpful discussion on the recovery

plan and how integration plans would be brought forward as part of this. In

addition, it was confirmed that there was an opportunity to resolve legacy

aged-debt through planning for the first quarter of 2020/21.

LK reported that the Research Development & Innovation Committee had met

virtually on Wednesday, 8 April 2020. There were two priorities in relation to

research which were the recruitment for Urgent Public Health (UPH) trials and

the recruitment for local studies. There was a national issue with recruitment

to the recovery plasma trial and clinicians would be encouraged to engage. A

national platform called Agile was to be launched and LK would work with the

Trust to develop the communications strategy for the platform.

It was noted that the Charitable Funds Committee had not met; however the

value of the Trust’s Just Giving page had reached £117,000 following the onset

of the pandemic. Clare Morgan was coordinating the process to allocate the

funds, with executive oversight provided by DB. The Board noted the

incredible generosity shown by the public.

There was a discussion about the effectiveness of the Committees whilst they

worked virtually. It was agreed that the Committees were working effectively

due to the quality of the papers and the constructive enquiry from members.

The Committee noted the report.

TB20.21_007 COVID-19 Response

BW presented the report which set out the governance in place to manage the

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COVID-19 pandemic and the management of COVID-19 and non-COVID-19

risks. The paper also provided an operational update, including mutual aid

arrangements and workforce information as well as the support package

available to staff.

It was reported that significant work had been undertaken to ensure the

continued supply of PPE for staff and the Trust was developing a local COVID-

19 Infection Prevention and Control Policy.

The Trust’s COVID-19 Recovery Plan was in development and would factor in

national guidance on recovery. In response to a question about the ability of

the Trust to respond to national requirements for recovery, it was noted it

would be challenging due to limitations around estates and staffing. Quality

indicators, including the 52 week wait, would need to be factored into planning

and there was a need to maintain patient flow as wider activity resumed in the

Trust.

The Board were advised that the Quality Committee had approved the COVID-

19 Strategic Plan at its April meeting which provided an operational framework

and guidance for the response to COVID-19, and would act as a reference

document for staff at all levels.

There was a discussion about whole system delivery and the work done with

local partners to improve patient flow. It was noted that the Trust’s approach

was recognised as best practice and was being rolled out across Merseyside.

An update would be provided to the next meeting on the arrangements post-

COVID-19.

Action: For an update on whole system delivery of patient flow to be

provided to the May meeting of the Trust Board.


TB20.21_008 Integrated Performance Report

BW reported that nationally, Trusts would continue to be measured against the

A&E four hour and Referral To Treatment (RTT) targets; however, there had

been some relaxation of constitutional standards including 52 week waits and

cancer diagnostics.

BW highlighted that, as a result of initiatives introduced at Aintree site, the

Trust was in the top 20 in the country for A&E four hour wait performance. It

was noted that the overall waiting list had been reduced however there were

challenges around Cancer, Gastro-Intestinal (GI) and Urology waiting lists and

a 52 week wait breach had been declared in Orthopaedics.

It was confirmed for the Board that there was a system in place for contacting

patients on the waiting list and risk assessments had been undertaken to

enable cases to be prioritised based on clinical need. Assurance was provided

that a level of activity had been maintained on elective admissions and day

cases; however, the Quality Committee would monitor the impact on quality

caused by delays.

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Workforce

DH provided an update on workforce related matters, noting that the level of

staff absence had reduced to 18%. It was confirmed that testing for COVID-19

had increased and HR Business Partners were contacting staff who were off

work to support their return, where appropriate.

There was a discussion about the emerging evidence that people from a Black,

Asian and other Minority Ethnic (BAME) background could be

disproportionately affected by COVID-19 and whether any additional support

was required for this cohort of staff.

Quality Dashboard

DB presented the Quality Dashboard which had been discussed in detail at the

Quality Committee. Although there had been a reduction in harms from

hospital acquired infection, Clostridium difficile cases were higher than

expected due to a change in the way cases were attributed to hospitals.

Incident reporting had reduced by 40% but it was too early to say whether this

was because of reduced activity or a reduction in reporting.

TC noted that further work was required to develop the dashboard to enable

Board and Committee oversight.

Finance Report

RF reported that the Trust had achieved its control total for 2019/20, which

equated to a deficit combined position of £25.3million. This incorporated

Financial Recovery Fund (FRF) monies of over £43million. It was noted that

the Trust would receive a further £9.1million of additional funding because it

had achieved its control total.

With regard to the Quality, Effectiveness and Productivity (QEP) Programme, it

was noted that the Trust had achieved £17.5million, which equated to 80% of

the plan. These were predominantly non-recurrent schemes and therefore the

Trust should expect a significant QEP requirement in 2020/21. It was noted

that the Trust would need to capture and sustain the new ways of working and

innovations more effectively to meet demand in the system, as part of the

recovery process.


TB20.21_009 Learning from Deaths

TC presented the report on learning from deaths which provided the data for

the third quarter of 2019/20. The report would be further developed for future

meetings to ensure that it captured learning and identified trends and themes.

TC reported that no deaths had been identified as avoidable as part of the

reviews. It was noted that work was required to align the peer review

processes across the sites.

TC advised that the Medical Examiner interviews were on hold during the

response to the COVID-19 pandemic. Once in place the Medical Examiners

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would bring additional scrutiny to the review process.

SW noted that an overview on how the Trust was reviewing the mortality of

COVID-19 patients was required.


TB20.21_010 Guardian of Safe Working Hours

DH presented the report for quarter 4 of 2019/20 which highlighted the issues

relating to junior doctors’ hours and safe working.

It was noted that reporting on breaks had been suspended in response to the

COVID-19 pandemic. There was a question about the impact on doctors in

training, and it was confirmed that the planned rotations had been cancelled,

rotas were more service based and there was more weekend working.

The Board were informed that the Junior Doctors’ Forum in March had been

cancelled as a result of COVID-19. Assurance was provided that the Trust

continued to work closely with junior doctors who had a strong presence on the

Local Negotiating Committee (LNC) and the Medical Board.

Action: For a report to be provided to a future meeting on junior doctor

morale, satisfaction and how the Trust could flexibly look at the skill mix

in terms of meeting gaps in clinical roles. Also, for an invite to be

extended Junior Doctors for the discussion.


TB20.21_011 Quarterly Risk Report

MW presented the report on the Trust’s risk management arrangements and

Board Assurance Framework (BAF). The BAF was noted as work in progress

pending finalisation of the Trust’s strategic objectives.

With regard to pre-existing risks, it was noted that it would be necessary to

ensure that there was an explicit alignment to the COVID-19 Recovery Plan.

DB informed the Board that there was a process in place for the Divisional

Teams to review risks to ensure consistency.

There was a discussion about the assurance relating to risks reported to the

Workforce & Education Committee whilst the meetings were on hold. It was

confirmed that the risks continued to be managed within the Trust and

oversight of non-COVID-19 workforce risks would resume in July.

The Committee noted the report and the additional work required to align the

BAF to the new vision and strategic values, once agreed.

TB20.21_012 Emergency, Preparedness, Resilience and Response (EPPR) Annual

Assurance Report – Aintree

BW presented the EPPR report which outlined the annual assurance process

undertaken for the Aintree site.

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BW reported that the Royal site had self-assessed as providing substantial

assurance. NHSE/I had undertaken a Check and Challenge process and the

Trust had received a rating of outstanding for EPPR which provided assurance

that it was meeting its duties under the Civil Contingencies Act.

The Board noted the report and congratulated the team on the achievement.

TB20.21_013 Key Messages from the Board and Items for the Risk Register / Changes

to the Board Assurance Framework

The key messages were noted as those listed under the introduction (item

TB20.21_001).

TB20.21_014 Chair's Log

There were no Chair’s Logs.

TB20.21_015 Questions from Member of the Public

There were no questions from the public.

……………………………………………. …………………………………..

Chair Date

Date of next meeting: Tuesday, 26 May 2020

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Action Log – February 2020

Trust Board Action Log – 26 May 2020 (Part 1)

The RAG rating used is as follows:

Green Action completed & Evidenced Amber : Action on track but not complete

Red Action overdue for completion or may not be completed

Key: LUH – Liverpool University Hospitals NHS Foundation Trust

RLH – Royal Liverpool & Broadgreen University Hospitals NHS Trust

AUH – Aintree University Hospital NHS Foundation Trust

Lead Origin Date of

Meeting

Minute /

Reference

Action Action

Deadline

Action Status Agenda

Item

DH LUH March 2020 TB19.20_116 Values & Behaviours Framework For DH to work with Communications to plan the partial roll-out of the Values & Behaviours Framework. Verbal update to be provided to Board.

May 2020

A

BW LUH March 2020 TB19.20_115 Annual Plan For the Service Improvement Team and PMO to keep a record of effective actions and solutions that would be useful to maintain once the organisation was in recovery.

June 2020

A

BW LUH March 2020 TB19.20_114 Integrated Performance Report To review reporting of performance indicators to provide the Board with an understanding of what would continue to be reported during the COVID-19 pandemic. Update : revised reporting to Board which will be developed as part of IPR during 2020/21.

April 2020

G

SW LUH March 2020 TB19.20_114 Integrated Performance Report - COVID-19 For a communication to be sent from the Board to thank staff for their efforts.

April 2020 G

RF LUH March 2020 TB19.20_113 COVID-19 – Standing Financial Instructions For a proposal to be developed for the suspension or relaxation of the SFIs to enable rapid response to COVID-19 matters.

April 2020

A

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Liverpool University Hospitals NHS Foundation Trust

Trust Board Action Tracker – May 2020 2/3

Lead Origin Date of

Meeting

Minute /

Reference

Action Action

Deadline

Action Status Agenda

Item

DH LUH February 2020 TB19/20_94

Cultural Development Update For a staff story to be received from a staff member who has experienced violence and aggression in the work place.

June 2020

A

DB LUH February 2020 TB19/20_93

Integrated Performance Report To use long term trend charts in the safe staffing report.

June 2020 A

SW LUH February 2020 TB19/20_93

Integrated Performance Report For a presentation to be delivered to a future Board meeting to provide further detail on the direction of travel under the Provider Alliance and for this to include references to existing partnership working.

July 2020

A

TC LUH January 2020 TB19/20_66 Learning from Deaths To explore how to align lessons from the learning from deaths process into Trust wide training programmes. Update : TC confirmed revised report July 2020 (20/21_009)

July 2020 (April 2020 )

A

MW LUH January 2020 TB19/20_65 Board Assurance Framework To include a summary of the detailed work undertaken by Executives and Committees to consolidate the BAF risk scores in the April 2020 report. - agenda item 20/21_10

July 2020 (April 2020) A

MW RLH Jun-19 / Apr-19 / Sept 18

19/77 &19/07 & 18/121

Integrated Performance Report For the newly developed IPR to include:

Underpinning analysis for sickness rates

Updated RAG ratings

Risk section

June 2020 (Jul-19)

A

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Trust Board Action Tracker – May 2020 3/3

Chair’s Logs Received

Origin Committee

Issue Recommendation/Action Action Deadline Action Status

None noted.

Chair’s Logs Delegated

Origin Meeting Date

Issues and Lead Officer

Receiving Body Recommendation/ assurance / mandate to receiving body

Action Deadline Action

LUH

Mar 20 COVID-19 – Standing Financial Instructions Robert Forster

Audit Committee For the Audit Committee to monitor the revision of the SFIs for the purpose of the COVID-19 response and provide assurance to the Board.

July 2020

A

LUH

Mar 20 COVID-19 – governance Dianne Brown

Executive Team For the Executive Team to develop a proposal for the governance structure during the COVID-19 pandemic, taking in to consideration the NHSE/I letter regarding releasing capacity and reducing burden.

April 2020 G

Agenda item 20/21_07

LUH Nov 19 Winter Plan

Beth Weston

F&P For the Finance and Performance Committee to receive an evaluation of the Winter Plan – postponed

March 2020 A

RLH May 19 Look Back Exercise Paul Fitzsimmons

Quality Governance Committee

For the Quality Governance Committee to receive a report on the look back exercise on historical unfiled investigation results to seek assurance on any resulting harm and actions to strengthen processes. Update: Scheduled for discussion in March 2020 Quality Committee. Deferring owing to critical items only

June 2020 (July 19)

A

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Trust Board

COVER SHEET

Agenda Item (Ref) TB20-21_028 Date: 26/05/2020

Report Title Chair’s Update

Prepared by Lynn Fazakerley, Senior Executive Assistant

Presented by Sue Musson, Chair

Key Issues / Messages The purpose of the report is to provide the Board with an overview of the activity undertaken by the Chair for the months of April/May

Action required To Note Funding Source (If applicable):

The Board is asked to note the report.

Supporting Executive: Sue Musson, Chair

Impact (is there an impact arising from the report on the following?)

Quality

Finance

Workforce

Equality

☐

☐

☐

☐

Risk

Compliance

Legal

☐

☐

☐

Equality Impact Assessment (if there is an impact on E&D, an Equality Impact Assessment must accompany the

report)

Strategy ☐ Policy ☐ Service Change ☐

Strategic Objective(s)

Deliver outstanding care and

patient experience

Deliver the most effective

treatment to achieve the best

possible patient outcomes

Promote excellence in education,

research & innovation

☐

☐

☐

Provide sustainable healthcare to

meet the needs of our population

Provide strong system leadership

Be a well-governed and clinically-led

organisation

☐

☐

☒

LEVEL OF ASSURANCE:

☒ Acceptable assurance

General confidence in delivery of existing mechanisms/ objectives

☐ Partial assurance

Some confidence in delivery of existing mechanisms / objectives

☐ No assurance

No confidence in delivery

REPORT DEVELOPMENT:

Committee or meeting report considered at:

Date Lead Outcome

None noted.

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Chair’s Update:Trust Board 26th May 2020

2

MAIN REPORT

Chair Activity

In addition to the usual Board business the Chair has attended the following events / meetings since 27

April 2020.

May 2020

11 May NHS Reset: A Chair’s Perspective. Organised by the NHS Confederation

12 May North West Provider/CCG Chairs Briefing

19 May Alan Yates, Chair Cheshire and Merseyside Health and Care Partnership

During this period I have spoken often with Trust Chaircolleagues from the region. In addition to

conveying welcome messages of support, we have discussed strategic responses to the pandemic,

mutual aid and system reset planning.

During this period in addition to chairing Trust Board meetings, I attended the following committees:

New Hospital Committee

Quality Committee

Finance and Performance Committee

I have also met numerous candidates and chaired several AAC panels using platforms such as Go To

Meeting and MS Teams. Where panels are convened physically in Trust meeting rooms, panel

members have observed appropriate social distancing. The Trust continues to attract excellent

candidates for consultant roles, and it is encouraging that recruitment to key roles is proceeding during

this challenging time. I would like to thank Education Centre, IT and HR colleagues for their help and

support.

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Trust Board

COVER SHEET

Agenda Item (Ref) TB20/21_030 Date: 26/05/2020

Report Title Committee Assurance Report

Prepared by Corporate Governance Team

Presented by Madelaine Warburton, Director of Corporate Governance

Key Issues / Messages

The Board has formally approved the delegation of powers to be exercised by formally constituted committees. The terms of reference of the committees and their specific powers are formally approved by the Board in accordance with para 5.3 of the Trust’s Standing Orders.

Committees are responsible for providing assurance to the board in relation to the conduct of its business. The committees are also responsible for managing the strategic risks relevant to its area of responsibility and to provide assurance that the risks are being managed.

This report summarises the key items discussed, decisions made and linkages to key risks discussed by the Committees.

Action required For assurance For assurance

The Board is asked to discuss and note items considered, decisions made, key risks discussed by the Committees and assurances obtained/required.

Supporting Executive: Madelaine Warburton, Director of Corporate Governance


Quality

Finance

Workforce

Equality

☐

☐

☐

☐

Risk

Compliance

Legal

☒

☐

☐


report)




patient experience






☐

☒

☐





organisation

☐

☐

☒

LEVEL OF ASSURANCE:


General confidence in delivery

of existing mechanisms/

objectives


Some confidence in delivery

of existing mechanisms /

objectives

☐ No assurance


REPORT DEVELOPMENT:

Committee or meeting

report considered at:

Date Lead Outcome

The report summarises the discussions held at Board Committees

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2 Committee Assurance Report – Trust Board 26th May 2020

Board Committee Assurance Report

Committee Name Quality Committee

Date of Committee Meeting 22 April 2020

Chair’s Name & Title David Fillingham, Non-Executive Director

Executive Lead Dianne Brown, Chief Nurse

Key Issues

COVID-19 Update

The Committee received an overview of the governance arrangements in place, as well as the activities undertaken and planned to respond to

COVID-19.

Command and control arrangements had been established in the form of a Tactical Coordination Group and an Executive Oversight Group.

There was a clear process to document decision-making and innovation, managed by the Programme Management Office and overseen by the

Executive Oversight Group.

The Committee noted that the approach to the escalation of capacity, the redesign of areas and the management of non-COVID-19 activity had

been successful.

The Committee approved the Coronavirus Strategic Plan.

Workforce Overview

Staff sickness figures had reduced to 2600; of which 1840 were currently COVID-19 related absences.

The Committee noted and welcomed the support available to staff, in particular for their psychological wellbeing.

A nursing control room had been established to provide assurance that there were safe staffing levels in clinical areas and to provide an

overview of the redeployment of staff.

Infection Prevention and Personal Protective Equipment (PPE)

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An update on the supply of Personal Protective Equipment (PPE) was received. The Trust had been successful in maintaining the supply of

PPE to ensure compliance with Public Health England Guidance . A PPE oversight group had been set up with terms of reference and

representation to act as an expert group providing Trust oversight of policy, supply and key decision making.

The Procurement Team were commended for their efforts in engaging with suppliers and leads across the country (and internationally) to

source PPE for the Trust.

Mandatory training had been developed to support the new PPE Policy to help inform staff and reduce uncertainty.

Non-COVID-19 Quality / Quality Dashboard

The Committee was assured that high risk issues were being tracked and monitored. The importance of maintaining oversight of non-COVID-

19 related infections was noted.

Risk & Governance – Business Continuity

A high level summary of the arrangements put in place for quality governance and risk escalation through COVID-19 was received, which were

noted as the minimum requirements for the next three months. Arrangements would return to business as usual as a more steady state

presented.

Decisions Made

The Committee approved the COVID-19 Strategic Plan.

Recommendation

The Board is asked to:

Note the summary report;

Committee Name New Hospital Committee

Date of Committee Meeting 7 May 2020

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Chair’s Name & Title Tim Johnston, Non-Executive Director

Executive Lead Paul Bradshaw, Senior Responsible Officer

Key Issues

Programme Director’s Report

The Committee received the Programme Director’s Report which noted that there had been a focus on Health & Safety on-site to support social

distancing, utilising shift patterns, staggered breaks and improved gatehouse procedures.

The Committee received an update on the two programmes of work for the build, including the Clinical Sciences Services Building (CSSB) and

the main building. It was noted that the full impact of the COVID-19 pandemic was not yet known and could have implications for the timeline

for both programmes of work.

Risk Management Arrangements

The Committee received a report on the framework for the reporting of the programme’s risk. Reporting would be on a monthly basis and

would provide an umbrella framework for future editions of the Programme Director’s Report. Five overarching risks had been identified, to

which operational risks scored at 15 or above would be mapped.

New Royal – Agnes Jones Unit

The Committee noted the achievement of the opening of the new Agnes Jones Unit and the value for money it presented. The first patients

had been received in to the COVID-19 rehabilitation facility on Monday, 4 May 2020.

Business Case

An update on the progress of the new hospital business case was received and the Committee noted that formal approval of the business case

would require both regional and national sign-off. A task and finish group was to be established to ensure the Committee had oversight of the

business case prior to its submission to the Trust Board for approval.

Legal Update

The Committee received an update on the work being undertaken by Addleshaw Goddard.

Decisions Made

None.

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Recommendation

The Board is asked to note the summary report.

Committee Name Finance & Performance Committee

Date of Committee Meeting 28 April 2020

Chair’s Name & Title Mike Eastwood, Non-Executive Director

Executive Lead Robert Forster, Chief Finance Officer

Key Issues

COVID-19 Performance Update

The Trust was in the top quartile in the country for the four hour accident and emergency wait metric following the introduction of initiatives.

The Committee noted the achievement which signalled that the Trust was streaming its activity effectively during the pandemic.

The Committee received assurance that bed and critical care capacity was resilient and would meet the projected COVID-19 requirement.

With regard to non-COVID-19 activity, the Trust had been notified that it would continue to be monitored against the four-hour accident and

emergency and 18 week elective care referral to treatment (RTT) targets.

Integrated Performance Report

The Committee was informed that there had been a significant impact on Referral To Treatment (RTT) performance as a result of the reduction

of elective activity. Mutual aid arrangements were in place and were focused on delivering urgent activity, such as cancer. Assurance was

provided that other life critical conditions were being considered alongside cancer.

The recovery plan was in development and would be structured in three phases. It would support integration plans where appropriate and

factor in learning from the Trauma & Orthopaedics move.

Finance Report M12 2019/20

The Committee received a presentation on the financial headlines for 2019/20. Subject to audit, the Trust had met its control total for 2019/20.

Achieving the control total in the final quarter had secured a total of £43million of Financial Recovery Funds (FRFs).

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The Committee noted the underlying financial improvement and a positive cash position; however, there were significant structural challenges,

including:

The release of balance sheet provisions to support the revenue position;

The level of non-recurrent QEP; and

The pay profile, including agency spend.

The Committee noted that there was a process to resolve the Trust’s aged debt as part of the planning for the first quarter.

2019/20 Transformation Programme Update

The Committee noted that there was a shortfall on the QEP programme. It would be necessary to factor in QEP in the COVID-19 recovery plan

and to model and quantify the impact of the changes made as a result of COVID-19.

Capital Update – April 2020

There were new national capital planning arrangements in place which meant schemes over £250k requiring approval on a national level.

Capital spend relating to COVID-19 had been confirmed and accepted by NHS England/Improvement (NHSE/I).

Cash Regime 2020/21

It was reported that the cash position was positive. There were changes to the cash regime which meant the Trust’s revenue loans would be

frozen and converted to a Public Dividend Capital (PDC); the impact of which had been managed through the FRF.

Decisions Made

None.

Recommendation

The Board is asked to note the summary report.

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1


Integrated Performance Report

May 2020

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2

Contents

Great Care - Operations 4 6 8 10 11

Emergency Access & 4hr Performance

Referral to Treatment & Waiting List Size Cancer Diagnostics Ready for Discharge

Great Care – Quality 15 16 17 18 20 22 24 26

Falls Pressure Ulcers Mortality

Infection Prevention and Control Serious Incidents and Duty of Candour Complaints FFT VTE/MUST/Dementia

Great People 29 36

Summary Sickness Absence

Great Ambition - Finance 41 42 47

Summary Analysis Key Statistics

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3

Great Care – Operations Integrated Performance Report

Executive Lead: Beth Weston, Chief Operating Officer

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4

Great Care - Operations

Great Care

Delivering safe and responsive care. Reducing avoidable mortality through improvements in mortality indicators in line

with our planned trajectories. Providing timely access to services through achieving our trajectories in relation to key access targets. Learning from harm by delivering our Quality and Safety Improvement priorities through 2020-21. Clinical

innovation and improvement. Improving outcomes

Principle Risks

Finance & Performance Committee

BAF6: Inability to provide sufficient operational capacity to meet demand and achieve operational standards for NHS providers BAF18: Failure to deliver integrated clinical IT systems to support safe and efficient patient care across the Trust BAF19: Ineffective financial management, budgetary control, and activity planning BAF23: Ineffective capacity and demand management across the health and social care economy

Quality Committee

BAF7: Failure to adhere to best practice guidelines, SOPs, and clinical standards BAF8: Failure to use meaningful patient outcome data

Summary and Key Challenges

Following the outbreak of the COVID-19 Pandemic, the Trust enacted the Emergency Contingency Plan, resulting in a phased

reduction of routine, urgent, and cancer elective surgery from the 17th March 2020. With effect from the 20th March 2020,

limited elective cancer surgery has taken place due to training and redeployment of theatre staff to support Critical Care services.

As the Trust plans to recover after the first wave of the pandemic, it is vital to reflect on actions and decisions taken during the

incident and diligently prepare for the expected growth in elective waiting times as well as the potential impact on patient safety.

4 Hour Performance – In April 2020 performance has improved compared to March 2020. Whilst focused initiatives were

introduced in ED, particularly at the Aintree site in February 2020, lower volumes of ED attendances and reduced bed occupancy

during April 2020 have facilitated further improvements in the non-elective pathway. There has been an improvement in Type 1

four hour performance across both sites with average type 1 attendances down by 43% compared to the last twelve months.

However, attendances in May 2020 have increased compared to April 2020.

Referral to Treatment (RTT) Performance – The overall waiting list continues to reduce with increased validation by operational

teams. The reduction is also due to lower number of referrals received by the Trust, which can be seen by there being fewer

patients waiting between 0 and 6 weeks. RTT Performance has decreased in April 2020 when compared to March 2020, down

8.6% from 77.3% to 68.6%. The Trust declared eleven 52 week breaches in April; 1 in General Surgery, 5 in Ophthalmology and 5

in Trauma & Orthopaedics

Cancer 62 Day Performance – performance increased to 70.8% in March 2020 from 55.1% in February. Challenges remain in

Breast, Colorectal, Head and Neck, Lung, Upper GI, Urology and Gynaecology. There were 49 breaches of the standard reported.

Diagnostics Performance - Joint DM01 Performance was 69.6% in April 2020, which is a reduction in performance of 54.1%

compared to March 2020.

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4hr Performance

Summary Type 1 attendances have reduced by

approximately 43% (M1 20/21 vs average M1-12 19/20 attends) across both sites. Type 1 performance was 90.0% ED performance was above the expected trajectory in April by 6.3% although footfall was down across all Acute and community venues. Operational plans are in place to deliver improvements, which are monitored via the Operations & Performance Executive Led Group.

COVID-19 Impact: In order to effectively respond to the COVID-19 pandemic, the emergency department has implemented changes to the departmental footprint to support COVID, Non-COVID, and GP Access Unit direct streaming to ED.

Joint Type 1 & 3 4hr Performance was 93.4% in April, which is an improvement of 6.2% from March.

Key Areas of Performance

Whilst focused initiatives were introduced in ED, particularly at the Aintree site in February 2020, lower volumes of ED

attendances and reduced bed occupancy during April 2020 have facilitated further improvements in the non-elective pathway.

Improvements include the period of time a patient currently waits in the emergency department at both sites, which has reduced.

The period of time a patient waits for a senior clinical review has also reduced, approx. 50% of patients were seen with 60mins. In

March, only 28% of patients were seen within 60mins. This provides evidence that patients are being moved through the

Department more efficiently.

There has been a significant special cause statistical variation in overall 4hr Performance across both sites. The Trust is performing

in line with comparator organisations with increased Type 1 4hr Performance. Between April 5th 2020 and May 10th 2020, the

Trust has ranked consistently in the top 6 (out of 20) performing local organisations. Nationally, the Trust is on average in the top

30 (out of 137) ranked organisations.

Type 3 Performance is also showing reduced volumes of attendances but improved overall performance.

The new ambulance handover process at the Aintree site is now established and performance will be monitored at the Acute and

Emergency Weekly performance meeting. Performance in April 2020 showed there was only one (1) handover delay post 60

minutes, the lowest total since recording of this metric commenced.

Through the Non-Admitted Task & Finish Group, non-admitted 4 hour performance was projected to increase by 1.5% per week

supported by an accompanying Safety and Quality Project Plan until 85% was achieved by mid-April 2020, currently for April

aggregated performance is 96.6%. PDSA Cycles in place and reviewed at weekly meetings to monitor impact.

At the Royal site, overnight performance is now supported by increased senior decision maker presence in the Emergency

Department and an overnight SOP has been implemented in the department.

To increase flow out of the Emergency Department and reduce bed occupancy across the site, there has been intense focus on

reducing super stranded patients. The site has introduced twice weekly high level MDT reviews of patients with a length of stay

between 7-20 days. This is further supported by review of the Top 30 Daily RFD patients, and escalation of as appropriate.

Substantive staffing for the discharge lounge has been confirmed which will provide a consistent five day model for early flow.

93.4%

Aintree: 94.0% Target 95% Royal: 92.9%

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6

4hr Performance

In preparation of COVID-19 both Emergency Departments have reviewed the use of the estate to clearly define COVID and Non

COVID pathways in order to segregate the clinical areas in line with IPC guidance.

Reconfiguration within the Emergency Department on both sites has taken place to ensure segregation of patient groups in line

with current IPC guidance. On the Aintree Site the reconfiguration has included relocation of FAU to support redesign of the AEC,

medical assessment area and an extension of the majors cubicles. The Royal site has extended into the R&S clinic.

The average volume of attendances to the department during the COVID pandemic had reduced by 50-60% nationally. This has

largely been attributed to the category 1-2 patients. However, the attendances have recently been increasing to 60-70% on the

Royal site and 80-85% on the Aintree site.

The teams are focusing on a review of the available estate for all patient groups (medical, surgical, frailty) to ensure safe pathways

providing timely assessment are in place from arrival to discharge. The modelling is currently being undertaken to inform the

Trust’s Reset Plan.

Target Trajectory Month YTD SPC Description

95.0% 83.7% 90.0% 90.0% Up Trend

Risk:

Improvement Actions

Action 1: Aintree Non Admitted T&F group

Action 3: Royal long length of stay (LLOS) MDT

Performance driver: Royal Super Stranded vs trajectory Performance driver: Aintree site Ambulance Handover delays

Maximum wait time of four hours from arrival to

admission, transfer or discharge.

AUH 4096: Failure to prevent overcrowding in the

Emergency Department

RLB 4973: Risk of High volume of lodged speciality

patients in the Emergency Department /

Overcrowding

Action 2: Aintree, ringfence two cubicles in the ambulance drop off bay

UCL 91.3%

CL 85.9%

LCL 80.5%

75.0%

80.0%

85.0%

90.0%

95.0%

Ma

r-19

Ap

r-19

Ma

y-1

9

Ju

n-1

9

Ju

l-1

9

Au

g-1

9

Se

p-1

9

Oct-

19

Nov-1

9

Dec-1

9

Ja

n-2

0

Fe

b-2

0

Ma

r-20

Ap

r-20

4h

r P

erf

orm

ance

(A

ll ty

pe

s)

Trust AED 4hr Performance - All types

UCL 113.489CL 85.714LCL 57.940

0

50

100

150

200

250

300

Ma

r-19

Ap

r-1

9

Ma

y-1

9

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

De

c-19

Jan

-20

Feb

-20

Ma

r-20

Ap

r-2

0+60

min

ute

han

do

ver

de

lays

Handover delays (+60 minutes @AUH) c Chart

207.1

177.7

148.3

100.6

150.6

200.6

250.6

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

De

c-18

Jan

-19

Feb

-19

Ma

r-19

Ap

r-1

9

Ma

y-1

9

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

De

c-19

Jan

-20

Feb

-20

Ma

r-20

Ap

r-2

0

Avg

No

. of

pat

ien

ts

Avg No. of Patients Los >21 days (Super stranded) vs

Target

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7

Referral to Treatment

Summary

RTT performance at the Aintree site was 70.2% and at the Royal & Broadgreen sites was 67.7%. There were eleven 52-week breaches reported; one in General Surgery, five in Ophthalmology, and five in Trauma and Orthopaedics. The overall RTT Waiting List Size decreased in April 2020 compared to March 2020 by 4197 patients.

COVID-19 Impact: Deterioration in performance over the coming months is likely to stabilise. Reintroduction of routine referrals via eRS will significantly impact the RTT Waiting List Size.

Joint RTT position in April is 68.7%, which is a decrease of 8.6% from March.

RTT Performance

Waiting List Size vs Target

52 Week Breaches


Following the Trust’s enactment of the Emergency Contingency Plans, the reduction of activity in routine, urgent, and cancer

elective activity has resulted in a deterioration in RTT performance, from 77.3% to 68.6% in April 2020.

The Trust is reporting a total of 11 patients over 52 weeks. All of the patients had dates for their operations cancelled in March

and April as a result of the COVID-19 pandemic. There has also been a rise in the number of patients waiting over 40 weeks, most

significant risks being in General Surgery, Trauma and Orthopaedics and Ophthalmology.

The Trust opened up to choose and book on 14 May 2020. It has been recognised however, that a number of actions are required

in primary care to manage and limit demand during the continuation of the pandemic. In addition, the Trust has to adjust its

processes accordingly and work with primary care colleagues to develop a shared understanding of the current situation, manage

expectations and develop arrangements to more effectively support shared management of care for patients.

Where clinically appropriate, virtual clinics have occurred across all specialities. With the re-opening of choose and book, clinical

divisions are reviewing options for increasing outpatient consultations using a combination of virtual and face to face

consultations whilst ensuring safety and social distancing within the clinic environment.

Divisions have completed a comprehensive validation of waiting lists to ensure appropriateness and priority of patients. As the

organisation enters into the Reset Phase there has been an introduction of new patient clinics for urgent referrals. There has also

been a phased increase in the number of operating sessions for cancer and urgent patients on both the Royal and Aintree sites.

Local Liverpool System Specialist Trusts have worked collaboratively with LUHFT to provide additional theatre capacity during the

COVID-19 pandemic. This support has significantly aided the organisation in the safe and effective management of patients during

the incident whilst supporting significant staff absences within the system. Theatre sessions are being provided at Spire Liverpool

(breast, urology, and ambulatory trauma services), The Walton Centre (spine and head and neck surgery), and Liverpool Heart and

Chest (vascular and UGI procedures).

68.7%

Aintree: 70.2% Royal: 67.7%

-2309

Aintree: -2,844 Royal: +535

11

Aintree: max wait 52 weeks Royal: max wait 52 weeks

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8

RTT Performance

In April 2020, there were 41,816 patients waiting for first definitive treatment. This is the lowest number of patients waiting for

over 12 months. The reduction is due to the lower number of referrals received by the Trust, which can be seen by there being

fewer patients waiting between 0 and 6 weeks

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9

Cancer

Summary

There are challenges in Colorectal, Haem, Head & Neck, Upper GI, Lung, Urology and Gynaecology. An overarching action plan is being developed by the Deputy COO and cancer teams to create a unified PTL to aid earlier treatment and in identifying and escalating risk.

COVID-19 Impact: Whilst 2-week wait attendances have decreased, they have decreased less than the reduction in 2-week wait referrals. Therefore, the Trust has been able to maintain continuity of service provision, as evidenced by 2-week wait performance compliance.

2 Week Wait performance in April is compliant at 95.8%. 31 Day performance is 95.8%. 62 Day performance is 70.8%.

2ww Performance

31 Day Performance

62 Day Performance


2 week wait cancer referrals have continued to be received from GP’s. However, compared to April 2019, the number of referrals

have reduced by 57% (-1,458). Cancer upgrades from secondary care are down a total of -58% (-1,567 referrals). All cancer

referrals are being triaged and clinically prioritised, alternative treatments are being considered and both telephone, virtual, and

face to face clinics are being offered as clinically appropriate.

2 week wait performance continues to be above target. The Trust achieved 95.8% against the 93% target. However, Head & Neck

(20 breaches) and Trauma & Orthopaedics (5 breaches) were non-compliant.

62 Day performance had increased to 70.8% in March with the average performance of the last 12 months being 70.3%. The Trust

has seen an increase in patient cancellations and patient choice due to COVID-19, resulting in a deterioration of performance.

Specialties challenged with target breaches were:

Gynaecology with 1 breach

Colorectal with 8 breaches

Haematology with 2.5 breaches

Head & Neck with 6 breaches

Lung with 1.5 breaches

Upper GI with 3 breaches

Urology with 10.5 breaches

Sarcoma with 1 breach

95.8%


95.8%


70.8%

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10

Cancer Performance

Aintree Site

Royal Site

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

Aintree: Two Week Wait 77.00% 93.90% 95.00% 95.30% 94.70% 95.30% 94.90% 94.00% 96.60% 91.60% 96.40% 94.28%

Royal: Two Week Wait 93.70% 95.00% 88.80% 93.50% 74.90% 73.80% 89.60% 86.60% 84.70% 87.30% 96.90% 96.82%

Joint: Two Week Wait 86.60% 94.50% 91.40% 94.20% 82.60% 81.80% 91.70% 89.90% 89.80% 89.10% 96.70% 95.77%

Aintree: 31 Day 98.30% 97.20% 98.20% 99.20% 95.30% 94.60% 97.20% 95.10% 93.10% 92.10% 94.70% 97.55%

Royal: 31 Day 95.10% 91.00% 94.60% 95.20% 93.67% 94.20% 95.50% 93.90% 92.00% 90.40% 89.50% 94.18%

Joint: 31 Day 96.50% 94.10% 96.20% 96.90% 94.30% 94.40% 96.30% 94.50% 92.60% 91.10% 92.10% 95.74%

Aintree: 62 Day 69.10% 70.20% 60.90% 63.70% 71.00% 68.70%

Royal: 62 Day 74.30% 72.00% 69.30% 74.80% 75.60% 67.40%

Joint: 62 Day 71.40% 71.00% 64.80% 69.40% 73.50% 68.10% 79.10% 77.10% 75.30% 68.90% 55.10% 70.85%

Aintree: 62 Day Screening 92.86% 86.96% 73.33% 85.71% 100.00% 63.16%

Royal : 62 Day Screening 89.19% 85.71% 88.10% 94.92% 92.45% 79.17%

Joint: 62 Day Screening 90.20% 86.15% 84.21% 93.94% 93.22% 74.63% 74.19% 86.11% 87.50% 78.90% 64.60% 75.00%

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11

Diagnostics

Summary

In April 2020, diagnostic performance at Aintree was 62.9% with 3588 breaches of the standard and was 76.4% at the Royal site with 4322 breaches. Whilst performance has reduced considerably in April 2020, March 2020 observed the first statistically significant change in Trust performance due to the impact of COVID-19

Joint DM01 Performance was 69.6% in April, which is a reduction in performance of 54.1% from March


With the exception of a daily inpatient endoscopy and an emergency endoscopy list, all endoscopy procedures stopped with

effect from the 17th

March 2020 when the Trust ceased all elective activity. Endoscopy clinical and nursing staff were redeployed

to support the Trust wide response to the pandemic.

Following a national directive from PHE, all bowel cancer screening, including FIT and Bowel Scope screening, ceased on 24th

March 2020.

Due to the cancelation of activity, the Aintree site was not compliant with the diagnostics DM01 standard. In total 3588 patients

waited in excess of 6 weeks, resulting in a reported position of 62.9%.

The Royal site reported a position of 76.4%, with 4322 patients waiting longer than 6 weeks.

In total there are 7910 patients waiting over 6 weeks and 742 patients waiting over 13 weeks in April 2020. Due to reduced

activity, by the end of May 2020 there will be an estimated 10,000 patients waiting over 6 weeks.

Key Actions

Utilise all available diagnostic capacity that does not compromise services supporting Phase 1 COVID-19 activity.

Use of alternative sites away from the acute COVID-19 patient streams at the Royal and Aintree sites in order to minimise

the risk to outpatients attending for urgent investigations.

Use of Aintree and Royal sites only where equipment is limited and static through the redirection of patients to

alternative access sites for OP Imaging (CT and MRI Scanning). Where imaging can be relocated in relation to transfer of

equipment between LUHFT sites (Ultrasound and Echo), services will undertake a planned transfer to the Broadgreen

Site.

69.6%

Aintree Site: 62.9% Royal Site: 76.4%

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12

Ready For Discharge

Summary

In April there were on average 87 RFD patients per day on the Aintree site and 129 patients per day on the Royal site. This equates to 21% of the Trust’s bed capacity. This is a significant improvement as a result of focused initiatives introduced and working with system partners

The number of patients Ready for Discharge has decreased by 38% in April 2020 compared to March 2020


Local Liverpool System partners have worked collaboratively with LUHFT to review the Ready for Discharge (RFD) pathway. Whilst this was a national mandate under the Covid-19 pandemic incident response, relationships with system partners were already developed but have been further strengthened by the pandemic. The RFD pathway and enhanced support from system partners has significantly improved the organisations ability to safely co-ordinate the discharge of older vulnerable patients groups during the Covid-19 incident and create additional G&A bed capacity. The following organisations have supported this approach:

Mersey Care NHS FT

Liverpool CCG

South Sefton CCG

Liverpool Local Authority

Sefton Local Authority

CSU The outcome has seen an initial improvement in LUHFT RFD position of up to 38% against a backdrop of reduced system capacity due to Covid-19 outbreaks. Work continues on the development of the ‘end to end’ pathway supported by partners, which should see further improvements on this position.

Royal Site: No. of Patients RFD

Aintree Site: No. of Patients RFD

216patients

Aintree Site: 87 Royal Site: 129

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13

Great Care – Quality Integrated Performance Report

Executive Lead: Dianne Brown, Chief Nurse

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Great Care - Quality

Great Care

Delivering safe and responsive care. Reducing avoidable mortality through improvements in mortality indicators in line

with our planned trajectories. Providing timely access to services through achieving our trajectories in relation to key access targets. Learning from harm by delivering our Quality and Safety Improvement priorities through 2020-21. Clinical

innovation and improvement. Improving outcomes

This report highlights the Trust’s position against a range of key quality performance indicators for the month of April

2020.

It is important to outline that as a result of the corona virus pandemic, NHSEI declared a level 4 incident on 30 January

2020 with a range of actions to be enacted by all acute providers from 17 March 2020. In response, the Trust moved

into business continuity and instigated its major incident processes which still remain in place.

The business continuity arrangements have influenced the level, and type, of clinical activity undertaken across the

organisation, with a significant reduction in elective procedures and outpatient appointments taking place during this

period.

It has been recognised that across the country there has been a significant reduction in incident reporting and the

Trust has also seen this trend with the relative decrease in incident reporting between January to the end of April

2020 as follows;

Royal and Broadgreen sites have seen a 24% reduction in reporting patient incidents

Aintree site have seen a 44% reduction in reporting patient incidents.

It is important to note however that this change could be aligned to the change in patient/activity type, rather than an

indication of staff members’ inability to access the incident reporting system, due to the additional task load related to

COVID 19.

In response, the senior team are working with divisional leads to promote reporting and ensure incidents are tracked

routinely and themes and trends reviewed in order to maximise learning and reduce similar harm related episodes or

near misses occurring wherever possible.

Some challenges continue in being able to quickly acquire data from the Aintree Hospital site, as a large proportion of

clinical documentation is paper based. Work is underway, however, to introduce digital systems such as the ADT

whiteboard and PENs, which will support real time data collection and standardise our quality reporting processes

across the organisation.

The quality dashboard has identified that category 2 pressure ulcers (per thousand bed days) are higher than in

previous months and an aggregate review of incidents will be undertaken to establish any potential reasons for this

(for example new clinical interventions being undertaken, such as ‘proning’ patients with covid-19 potentially resulting

in tissue damage).

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15

Falls

Summary

There were less falls reported across the Trust during April, however when measured by applying total falls per thousand bed days, there has been an overall increase in the number of falls incidents by 11%. Whilst this remains within trajectory, work is being undertaken to identify any themes in causation in order to respond and improve. There were 47 falls with harm inclusive of 2 moderate/ severe harms across all sites in April which is a decrease from 65 falls with harm, inclusive of 2 moderate/severe harms, in March.

YTD Trajectory: The Trust is achieving trajectory

There were 165 inpatient falls within the Trust during April 2020 which is a reduction from 206 in March 2020. At the Aintree site there were 64 reported falls and 101 at the RLB site. There were two falls causing Moderate to severe harm, with one reported at each.


There were a total of 165 inpatient falls recorded in April across the Trust which equates to 5.53 per 1000 bed days in comparison

with 206 inpatient falls and 4.9 per 1000 bed days reported in March 2020.

Improvement Plan

A Trust wide Falls Reduction Quality Improvement Programme has been developed and will be presented to the Falls Reduction

Sub-Group in May 2020.

A review of the National Audit of Inpatient Falls (NAIF) 2020 and associated recommendations have now been received and are

being reviewed by the Falls Reduction Operational Groups.

NAIF recommendations will be incorporated into the Falls Reduction Quality Improvement Programme to adopt a whole systems approach to safe care and organisation wide learning. The delivery of this Improvement Programme will be reported via the Clinical Standards and Patient Safety Functional Group and will be monitored via Quality of Care ELG.

5.53 Falls per 1000 bed days 165 falls reported

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16

Pressure Ulcers

Summary

Pressure ulcers in April increased by 12% from March across the Trust. There were 4 category 3 & 4 pressure ulcers reported which calculates to an unchanged position to the previous month of 0.10 ulcers per thousand bed days. The Trust continues to report a much better overall position, when compared to other national peer organisations referring to model hospital data although an aggregate review will be undertaken to understand any common themes in relation to causation so as to develop plans to avoid patients developing pressure ulcers.

Improvement target: Zero tolerance on Hospital Acquired Category 3 & 4 pressure ulcers.

There were 13 Category 2 Pressure Ulcers reported within the Trust, 7 on the Aintree site and 5 on the Royal site and 1 at Broadgreen during April 2020. There were 3 Category 3 and 4 Pressure Ulcers reported within the Trust, all three of which were reported at the Aintree site.


There were 5 Category 2 pressure ulcers reported across our Critical Care Units during April, this was due to patients with COVID-

19 being nursed in a prone position. The Tissue Viability (TV) Team have worked closely with the staff and the proning team to

ensure the correct processes are in place and have liaised with the National and Regional TV Network to source education

packages, and provide advice and support.

Improvement Plan

A regional Cheshire & Merseyside Pressure Ulcer Prevention Policy has been implemented and will be incorporated into the

Pressure Ulcer Quality Improvement Programme from June 2020.

A rapid assessment tool has been developed for Trust acquired low harm pressure ulcers focusing on ASSKING (Risk Assessment,

Skin Inspection, Surface, Keep Moving, Incontinence, Nutrition and Give Information which will encourage a holistic review to safe

care.

Aintree: Category 2 – 7

Category 3 - 3 Royal: Category 2 - 6 Target: Category 2 – 14 pressure ulcers Category 3/ 4 – 0 pressure ulcers

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Mortality

Summary The Trust reported 1.01 for SHMI (Summary

Hospital-level Mortality Indicator). For HSMR (Hospital Standardised Mortality Ratio), the Trust reported 93.05 .

Current performance: The Trust is within expected parameters for both mortality indicators

There are two specific indicators by which Trusts are monitored for their mortality. These are HSMR and SHMI.


The Summary Hospital-level Mortality Indicator (SHMI) reports on mortality at trust level across the NHS in England. This indicator

is produced and published monthly as a National Statistic by NHS Digital.

The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that

would be expected to die on the basis of average England figures, given the characteristics of the patients treated there.

It covers all deaths reported of patients who were admitted to non-specialist acute trusts in England and either die while in

hospital or within 30 days of discharge. The expected number of deaths is calculated from statistical models derived to estimate

the risk of mortality based on the characteristics of the patients (including the condition the patient is in hospital for, other

underlying conditions the patient suffers from, age, gender, method of admission to hospital, month of admission and

birthweight).

HSMR is an indicator of healthcare quality that measures whether the number of deaths in hospital is higher or lower than

expected. Like all statistical indicators it is not perfect, but can be both a measure of safe, high-quality care and a warning sign

available to Trusts.

A score of 100 means that the number of deaths is similar to what you would expect.

For both indicators, the Trust is within expected parameters.

More detailed mortality data and analysis is included in the quarterly mortality and learning from deaths report.

1.01 SHMI 93.05 HSMR

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18

Infection Prevention and Control

Summary The Trust have entered into a new

reporting year for CDiff and have yet to receive the overall annual target from the commissioners which will be discussed at the next Clinical Quality and Performance Group in June. However, the table below shows how the two sites performed against the targets for 19/20.

CDiff Mar 19-Apr 20

No. reported

Target No. with successful

appeal

LUHFT 153 106 43

Royal site 60 53 9

Aintree site 93 56 34

YTD Trajectory: The annual target is yet to be set by the commissioners. Once this has been set and received, a trajectory will be developed.

There were five cases of CDIff reported across the Trust within April 20, with 3 cases reported at the Aintree site and 2 at the Royal site.


There were five reported cases of C.difficile infection reported across the Trust within April 20, with 3 cases reported at the

Aintree site and 2 at the Royal site. Reported cases are of all healthcare associated cases including;

• Hospital onset healthcare associated (HOHA): cases detected in the hospital three or more days after admission

• Community onset healthcare associated (COHA): cases that occur in the community (or within 2 days of admission) when

the patient has been an inpatient in the trust reporting the case in the previous 4 weeks

The table above highlights that both sites were slightly above the target for C.difficile for 2019/20.

One of the significant changes was the requirement in 2019/20 for Trusts to include COHA infections; this inclusion has had a

significant impact on the number of cases reported.

Performance data has not been amended to include the cases which have been successfully appealed by the CCG as having no

lapses in care; this approach would ordinarily provide an accurate picture of cases where there were lessons to be learned.

However, the national guidelines state that successfully appealed cases must remain within the reported numbers and they are

also published within the Public Health England figures. For reference, however, a yellow column in the table above identifies the

number of successfully appealed cases.

5 cases

Aintree: 3 Target: N/K Royal: 2

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Improvement actions

The Trust has been above trajectory due to several periods of increased incidence of infection across sites and divisions. Actions

to reduce cases of C difficile infection are multifaceted.

On the Aintree site a CDI action plan was implemented, which is now complete and a Quality Improvement Initiative aimed at

improving the process for Hydrogen Peroxide fogging is currently in progress.

An integrated CDI Working Group has been established, this group aims to share lessons learned and provide a forum to engage

with community colleagues to reduce the cases of COHAs. The outputs and learning from this were expected in June 2020;

however as a result of the operational pressures caused by the current covid situation, this will be delayed.

Post infection reviews for CDiff infection have been postponed from March, although national surveillance continues for each

case and relevant IPC advice has been maintained. A revised post infection review process was trialled in February and plans are

in progress to recommence post infection reviews from June. It is expected that periods of increased incidence of infection will

reduce and the number of cases appealed, identifying no lapses in care (or deemed unavoidable) will also increase.

Run chart highlighting the number of reported MRSA cases Apr 19 – Apr 20

There was one MRSA bacteraemia reported on Ward 7B at the Royal site within April. As there is a zero tolerance target for MRSA,

this is currently going through the Post Infection Review (PIR) process and the findings from this will be presented to the IPC

group.

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20

Serious Incidents & Duty of Candour

Summary Serious incidents in April were 59% lower

than the 12 month average, with only one serious incident declared from each acute site in April. There is no correct number of SI’s to report in month. Too few is considered indicative of a lack of transparency, and too many indicative of a lack of effective controls and ineffective learning from previous incidents.

Never Events:

YTD Trajectory: There isn’t a currently agreed trajectory for SI rates

There were 2 serious incidents declared during April, which is identical to the number reported in March and below the Trust mean value for the previous 12 months of 4.91


Whilst both March and April reported reduced levels of SI level incidents the linear trend has remained consistent

Serious Incidents

The Trust reported two serious incidents via the strategic executive information system (STEIS), neither of which met the

definition of a Never Event.

Royal & Broadgreen Site

Patient Fall leading to a fractured neck of femur. This case was reported as a serious incident due to the patient having had two

previous falls during the same admission spell, with minimal subsequent falls prevention measures implemented to effectively

prevent future harm.

Investigation due date: 27/07/2020

Aintree Site

A Patient was identified as Lost to Follow up following an ENT clinical appointment in April 2019. The patient should have received

a follow appointment in six weeks, but this was not booked. The patient presented at their GP in January 2020 with a progression

of the presenting symptoms. The GP referred the patient back to the Trust and was seen in Feb 2020 at which point the patient

received a confirmed diagnosis of Cancer.

Investigation due date: 15/07/2020

0

5

10

15

Serious Incident rate

SI rate

Linear (SI rate)

100% Compliance with Duty of Candour 1stLetters

0

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Serious Incidents/Never events Annual:

Since the Trust Merger in October 2019 the Trust reported 35 serious incidents, of which 5 were never events. All serious

incidents were subject to a comprehensive root cause analysis (RCA) with lessons learnt shared across the Trust.

The Trust completed 100% of all comprehensive RCAs within target.

Duty of Candour

The statutory duty of candour (regulation 20 CQC) requirement is made up of three component parts

1. Verbal/Professional duty of candour (as soon as is practicable after identification of the incident )

2. 1st

letter (within 10 working days of the verbal apology)

3. 2nd

letter (within 10 working days of the completion of the investigation report)

The Trust is currently operating across two site specific incident reporting systems (DATIX)

Whilst both systems record verbal and 1st

letter compliance, they do not consistently record the date of completion of the 2nd

letter, primarily as it is assumed that it is sent with the investigation report.

The Trust achieved 100% compliance with both verbal and 1st

letter stages of duty of candour in April 2020.

Due to the varying time scales aligned to concise RCA (28days) and Comprehensive RCA (60 days) the 2nd

letter performance

measurement requires a DATIX system change.

This is planned to take place before the end of June 2020, ensuring that future performance measure are representative of

regulatory compliance as a whole.

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Complaints

Summary Complaints in April were 75% lower than

the 12 month average (M1-10 18/19 vs M1-10 19/20) with reductions seen at both sites (Aintree down by 53% and Royal down by 87%). The reduction appears likely to be linked to significant changes in patient and family interaction with the Trust during the coronavirus outbreak. There has been no effect on the proportion of complaints being upheld or not upheld but there has been an impact, albeit small, on the timeliness of complaints responses.

Statistical Variation: Variation is marginally outside of normal limits. The number of complaints recorded in April was below the lower control limit, albeit marginally. April was the second consecutive month in which the number of complaints was significantly below the mean.

YTD Trajectory: The Trust is achieving trajectory

There were 10 complaints received during April, which is a reduction from the 17 that were received in March and below the Trust target of 48


The Trust was compliant with its internal target to reduce complaints from the levels seen last year. There were 10 formal

complaints recorded in April against a target of 48. There has been a statistically significant variation in the number of complaints

reported in April

At the Royal site, there were 2 complaints reported in April. This is the site at which the most significant change has been seen in

complaints reporting. It would be expected that approximately 16 complaints would be reported in an average month.

At the Aintree site there was a less significant reduction in complaints reporting. However, there was still a reduction of 9

complaints when compared to the expected number of monthly complaints.

The Trust saw significant changes to the ways in which patients, and particularly their families, interact and provide feedback

during March and April. Particularly significant was the introduction of the Family Liaison Service that handled approximately

6,000 calls during April. It seems almost certain that within these calls were contacts that would in normal circumstances have

been recorded formally as complaints but have instead been resolved at source.

There was a marginal reduction during April in the timeliness of response to complaints. Although all complaints were responded

to within 60 days, compliance with the trust’s internal target of 35 days reduced. Breach analysis indicates there were delays in

obtaining clinical sign off for complaints and delays in obtaining sign off by divisional directors. This will be closely monitored

10 complaints

Aintree: 8 Target: 48 Royal: 2

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23

during May and June to ensure that the measures being put in place by the Complaints Team to support the wider Trust Restart

Plan are effective.

There was an increase in the proportion of complaints in relation to concerns that patients had been discharged too early.

Analysis of these complaints indicates that there appears to have been an increase in anxiety following the Trust moving to adopt

the national Hospital Discharge Service Requirements that were issued on 19 March 2020. However, there is no indication from

the analysis these requirements have been incorrectly interpreted or applied by the Trust.

Following a complaint raised on the Aintree site regarding a delay in insulin pumps being provided the Trust have introduced an e-

Form for waivers in line with Trust Standing Financial Instructions (SFIs) to improve timescales for wavier approval processes.

There has also been a harmonisation of ordering processes across all Trust sites.

Following a complaint raised on the Aintree site regarding treatment of a patient on Ward 22 the case was discussed with all of

the ward staff at their Safety and Governance meeting. The staff jointly identified that they could make minor amendments to the

admission process on the ward to better ensure all patients are quickly issued with ID bands. This has since been audited with

early indications showing an increase in compliance.

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Patient and Family Experience (FFT)

Summary While collation of postcard FFT surveys was

suspended in line with national guidance during Covid-19, we have continued to gather FFT surveys via text message and voicemail to monitor patient experience. The significant reduction in activity during April due to Covid-19 meant that there were 56% less patients eligible for FFT. However, the response rate remained consistent with previous months. The Family Liaison Service (FLS) was implemented on 1

st April 2020 to support

patients, families and staff during Covid-19. During April, there were 6369 calls to the service.

Covid-19 has presented many challenges to patient and family experience. However, there was a significant improvement in the FFT recommend rate for ED, while FFT performance for Inpatients and Outpatients remained consistent with previous months.


91.55% 92.39% 92.24% 92.35% 91.51% 91.73% 92.56%

78.31% 80.31% 80.92%

82.43% 80.98%

83.90%

91.01%

93.98% 93.83% 94.36% 93.24% 93.82% 94.40%

92.70%

70.00%

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20

LUH Recommend Scores

Friends & Family - Inpatient recommend Friends & Family - AED recommend Friends & Family - Outpatient recommend

24.29% 22.24%

26.50%

22.70% 22.71% 22.03% 21.13%

18.09% 16.97% 16.79% 17.16% 16.89%

19.08%

24.34%

13.17% 13.22% 12.80% 13.91% 12.83% 13.57% 12.54%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20

LUH Response Rates

Friends & Family - Inpatient response Friends & Family - AED response Friends & Family - Outpatient response

92.70%

Outpatient Recommend Rate

91.01% ED

Recommend Rate

92.56% Inpatient

Recommend Rate

6369 calls to FLS in

April

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25

In response to Covid-19 pandemic, NHSE/I issued guidance that acute providers should stop reporting FFT data to them until

further notice. The guidance advised providers to not use methods of feedback collection that may pose an increased risk of

infection to either staff or patients; however, FFT should still be gathered in a safe manner to give patients an opportunity to give

feedback about their experience. In accordance with this advice, we suspended all collation of FFT by postcard but continued with

gathering FFT surveys by text message and voicemail.

Covid-19 presented unprecedented challenges to providing a positive patient and family experience, particularly the suspension

of visiting for all families, unless specified exceptional circumstances applied. To mitigate these challenges, we rapidly

implemented a Family Liaison Service to support patients, families and staff. The feedback from patients during April 2020 via FFT

was positive, with an improvement in the recommend rate for Inpatients (91.01%) & ED (92.56%), while OP remained at a similar

level (92.70%).

As of April 2020, providers are no longer required to report response rates to NHSE/I (this was planned prior to Covid-19),

however, we should ensure that the proportion of patients providing responses are statistically reliable. During April 2020, due to

the reduction in inpatient and outpatient activity, there was a significant reduction in the number of patients eligible to provide

FFT feedback (33,550 in April 2020 compared with 76,789 in March 2020). In addition, we only obtained FFT responses via text

message or voicemail (no post card responses). However these factors did not impact on the response rate, which improved in ED

from 19.08% in March to 24.34% in April, whilst Inpatient and Outpatient response rates remained consistent with previous

months.

The introduction of the Family Liaison Service has had a significant impact in supporting patients, families and staff across all sites.

After it went live on 1st

April 2020, the service received 6369 calls during April, with widespread feedback on how this helped

patients and families keep in touch with each other. Particular successes for the service have been virtual visiting and relaying of

‘Little Love Notes’ messages, which has received extensive coverage on social media. The Family Liaison Service has been

recognised by NHSE/I as a best practice example of supporting patients, families and staff during Covid-19 and our model has

been adopted at many other providers across the UK.

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VTE/MUST/Dementia

VTE

The Trust has failed against the national standard of 95% against VTE assessment performance.

Trust Performance for April 2020 is 91.4%, a 2.4% reduction on the March figure of 93.8%

Performance by site is broken down below:

Trust performance 91.4%

AUH 87.6%

RLH 95.7%

The Royal site successfully achieved the VTE assessment target against the national standard, however, the Aintree were

marginally below the target. Specific areas of poor performance at the Aintree site included;

Critical Care

Ward 32

Ward 21

Ward 25

Ward 20

Poor performing areas will be escalated to the newly formed Divisional Assurance Groups, where key actions for improvement will

be identified, monitored and fed back. The introduction of digital systems such as PENS and the electronic ADT whiteboard will

also allow for easier capture of assessments and it is anticipated that this will improve performance on the Aintree site.

The Divisions will assess and monitor VTE assessment performance, utilising the newly formed Divisional Assurance Groups,

identify key actions for improvement and will feedback through the Quality of Care ELG.

MUST Screening

Methodology for data collection varies across sites. Performance on Royal and Broadgreen sites, where data is captured

electronically, is usually significantly higher than that on the Aintree site where the audits are performed manually.

As part of the business continuity plan for Dietetics, a MUST audit was completed on the Aintree Site in April 2020. Of the 282

patients reviewed, 73% did have a MUST completed on admission, although the audit did not detail if the assessment was

completed within 6 hours of admission. As a result of MUST screening, 14% of patients were referred to a Dietician.

89.0%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

Feb

-19

Mar

-19

Ap

r-1

9

May

-19

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

Dec

-19

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

pe

rfo

rman

ce

VTE assessments

VTE - Assessment Target

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A comprehensive MUST audit was planned to be undertaken across all sites during April 2020, but due to operational pressures

posed as a result of covid-19, this did not take place. Plans are therefore being drawn up to undertake this important audit so as

to develop a series of actions to bring about sustainable improvement.

Dementia Screening

The Trust has failed against the national standard of 90% of relevant patients receiving appropriate Dementia Screening.

Trust Performance for April 2020 is 71%, a 3.1% reduction on the March figure of 74.1%

Performance by site is broken down below:

Trust performance 71%

AUH 46.5%

RLH 97.2%

The performance on Aintree Site has consistently fallen below that on the Royal and Broadgreen sites and a planned Quality

Improvement Programme aimed at improving this position was unfortunately put on hold due to Covid-19.

However, this project has now been reinstated and the newly appointed Nurse Consultant for Dementia and Delirium will be

working with the Divisional Medical and Nursing leads to deliver the improvement required.

Progress will be overseen by the newly formed Divisional Assurance Groups and the Dementia and Delirium Sub-Group and in

turn, monitored by the Quality of Care ELG.

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Feb

-19

Mar

-19

Ap

r-1

9

May

-19

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

Dec

-19

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

Pe

rfo

rman

ce

Dementia screenings

Dementia - Screening Target

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Great People Integrated Performance Report

Executive Lead: Debbie Herring, Chief People Officer

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Great People

Great People

Improving our nurse recruitment and retention rate. Build an inclusive culture where staff feel supported. Develop a

comprehensive leadership programme to support the new structure. Deliver improvements in staff Equality and Diversity

levels. Deliver improvements to the way we lead the organisation.

Principle Risks

Finance & Performance Committee

BAF3: Insufficient or inappropriate staffing to deliver operational objectives

Workforce Committee

BAF2: Inadequate arrangements for managing staff performance BAF9: Failure to provide or maintain standards in provision of education (content and experience) BAF10: Failure to identify and address training and development needs BAF14: Failure to forecast demand and plan future workforce accordingly BAF29: Failure to create the conditions for an effective organisational culture BAF31: Failure to develop and optimise leadership capacity and capability throughout the hierarchy

Recurrent Challenges & Statistical Changes

Staff Testing Update Staff testing for Covid-19 has now been in place since 2 April 2020 Absence is reported by managers on a daily basis through the Daily SitRep and this is filtered to highlight staff absent for Covid-related reasons (for staff member or their household contact). Testing now takes place through a drive-through system by a Dental Nursing Team at the Dental Hospital over 7-days per week.

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LUH Test information for Staff / Household Contacts:

Dat

es

No

. of

Test

ing

Day

s

Nu

mb

ers

of

Emp

loye

es

con

tact

ed f

rom

SitR

ep

to

off

er t

est

Nu

mb

er o

f Te

sts

(sta

ff +

ho

use

ho

ld

con

tact

)

Nu

mb

er o

f p

osi

tive

Per

cen

tage

of

po

siti

ve t

ests

Nu

mb

er o

f

neg

ativ

e

Per

cen

tage

of

neg

ativ

e te

sts

Spo

ilt t

est

03/04/2020 to 09/05/2020

37

2006

1106

362

32.73%

736

66.55%

8

(0.72%)

Exceptions:

Errors in reporting on Daily Sit Rep by managers – i.e. staff not absent for Covid reasons

Initial time delays of managers reporting absence and the delay resulting in staff member being too late for test.

Incorrect telephone contact information for staff member, so unable to schedule a test.

Staff already tested at another organisation (household members works at another Trust)

Staff with acute symptoms unable to attend test because too unwell Staff with no access to a car unable to travel to the Test centre at the Dental Hospital

Actions taken to address the above The majority of the issues above were experienced in the initial 2 weeks of this process being set up and have now been addressed. The Daily Sit Rep system reporting has been improved making reporting more timely. The timescale for testing has been extended from between Day 3 & 4 of symptoms to Day 1 to 5. Managers are checking and providing correct contact information for staff, to enable timely contact for tests. Issues have been raised relating to staff being unable to attend the test centre due to not having access to a car to travel to the Test site at the Dental Hospital. They are advised not to use public transport / taxi in line with infection control guidance. There have been approximately 55 staff members advising they are unable to travel by car, over the 37 day test period so far. The numbers vary on a daily basis and consideration has been given on ways to address this issue for these staff members. A review is currently taking place, to assess if postal tests could be considered to offer further testing capacity, were staff are unable to travel. The LUH process is more beneficial for both staff and the Trust than using the Regional Test Centres set up (at Haydock, Manchester Airport, Countess of Chester or Mid Cheshire Hospitals or Liverpool). Test results at LUH are now received in approximately 24 hours rather than 72 hours at the Regional Centres. Staff members receive their result by telephone from our own Occupational Health Team and are provided with clinical support if positive for Covid-19. Line managers are advised of the result in order to support staff appropriately when well enough to attend work.

Staff Experience An Exec Led Staff Experience Steering Group has now been established to drive an experience led approach to bringing together staff communications, experience, well-being and innovation. The Trust is using the Clever Together platform to capture staff experience during the Covid response and in addition is also exploring the purchase of a staff App to allow staff without easy access to a PC to give their feedback and access information. To support more immediate feedback, the Trust has received 20 feedback podiums for an initial period of 8 weeks. The first few have already been deployed to the Emergency Departments on both sites, Radiology, Outpatients, Ward 25 on the Aintree site and Ward 6Y on the Royal site. Two of the podiums will also be stationed outside wellbeing hubs to obtain constructive feedback on their use. They are currently all set with the same questions The data will be downloaded on a regular basis and shared with colleagues to address any issues as they arise. Currently the questions are:

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1. How are you feeling today? 2. Today I have had all the resources I needed to do a good job? 3. Today I have felt well informed about what is happening in my team/Trust. 4. Is there anything else you wish to feed back? (this is free text for people to say what they want). Initial high level analysis of the data from the podiums deployed shows that feedback is variable, with some staff reporting very positive experience and others very negative but the majority being somewhere in the middle (which is also consistent with the annual staff survey feedback). There have been 601 engagements to date (people who have provided feedback) but only minimal free text comments. A Standard Operating Procedure for the use of the podiums is being developed to ensure the right people get the data and are able to act on it rapidly. The OD team are assessing the data and highlighting any serious issues or trends and raising them with the relevant operational managers. The mangers of the areas where the podiums are stationed are being sent their data every other day. Any Trust-wide themes will be raised with the Executive team.

Psychological Support

Wellbeing Hubs: To date, 5 formal spaces have been established, 2 at Aintree, 2 at the Royal and 1 at Broadgreen. All have been used in varying capacities and 3 of the hubs have been staffed during key hours by a Staff Helper trained to provide Psychological First Aid and signposting. Numbers have begun to increase as staff awareness is raised. Key themes for support have included:

Staff feeling out of their comfort zones

Staff being moved into roles that they do not necessarily feel that is suitable for their skill set –mainly going into clinical areas and the donning and doffing of PPE

Staff being moved from their normal place of work into other areas including red wards, which they were not entirely comfortable with

Great that there is a space for them to come to for relaxation or to discuss concerns – all seem really grateful for this

Equipment and supplies continue to be provided to make these spaces welcoming for any staff member who needs it. This offer of access to the spaces has been extended to ISS staff (700+ people) on the Royal site. Other wellbeing support: Over 230 clinical staff were called whilst self-isolating at home without symptoms and were offered training in the provision of Psychological First Aid, 133 staff were contacted and 98 participated in the training – this has equipped them with the skills to provide support to distressed colleagues in situ upon their return to work. They described this intervention as making them feel valued and useful. Staff continue to request additional support through the online referral system:

Covid- 19 Mandatory Training update The focus this month is on improving the compliance levels of the Covid-19 mandatory training modules to ensure staff are fully informed about Covid-19. From June 2020 there will be a return to reporting on the full suite of mandatory training modules. The PPE Oversight Group requested a suite of mandatory training modules for staff to support them during the Covid-19 crisis:

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Training Content

Delivery Staff Group

Level 1. Covid-19 Awareness Training

Overview of what is Covid-19 and how it is spread. Myth busters. Social distancing Hand washing Impact not using PPE correctly.

Clinical skills.net ESR F2F to ensure all staff reached x 2. Lecture theatres.

ALL

Level 2. Covid-19 Management of PPE

The use of PPE dependant on the category of the clinical area. Donning and doffing of PPE. Raising PPE concerns.

Clinical skills.net ESR

All Clinical Staff

Level 3. Covid-19 for Managers

Covid-19 Advice for staff. Escalating concerns. Supporting your staff / Compassionate conversations. Challenging your staff

Clinical Skills. Net ESR

All Managers – Band 6 and above. Including Consultants

This training is now live and reportable via ESR for each site. Below is current compliance as of 12

th May 2020:

Exceptions The lower compliance on the Royal & Broadgreen sites is due to an anomaly in data collection methodology with the delivery platforms for the e-learning. When there is completion on ESR there will a real-time data set, whereas the clinical skills platform needs to be manually uploaded onto ESR leaving a lag time of around 24hours.

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There have been some issues with access to both delivery platforms: Clinicalskills.net – Access being impacted by firewall software. IT is resolving this currently. This could delay staff completing modules. ESR – National issues with attaching competencies. Education is attaching these manually to resolve them. This may show a dip in compliance once all competencies attached. In order to drive an improvement trajectory in compliance a daily update is being sent to the Human Resources Services team and presented at the daily operational site meetings. In addition regular communications are being sent to all staff as a reminder of the need to complete.

Actions taken to support Black, Asian, and Minority Ethnic (BAME) staff There is emerging evidence of a disproportionate mortality and morbidity rate amongst black, Asian and minority ethnic (BAME) people, including our NHS staff, who have contracted COVID-19. NHS England has described this as a medical emergency as well as an equality and diversity and inclusion matter. There are a number of actions that are being taken to protect our BAME staff including the risk assessment process being undertaken to understand each individual’s concerns. The Trust has a risk assessment process in place for high risk, vulnerable and pregnant staff and has amended the current process to specifically include BAME staff. This work has been led by the Trust’s site-based Equality Managers. A number of actions have taken place to support this agenda:

All identified BAME staff have been sent a personal letter from the Chief Executive Officer and Chief People Officer which emphasises the support in place within the Trust

BAME ambassadors have been contacted to support colleagues during this difficult and uncertain period

BAME medical staff have been invited to a virtual meeting to take place week commencing 18 May 2020 to review the available evidence and provide a safe forum to raise concerns and provide suggestions on supporting staff a safe environment to work. Learning from this session will be taken forward to provide further sessions for all other staff groups including nursing and AHP staff.

Further communications to be sent to all staff this week to ensure the risk assessment process is clear and to reassure BAME staff who are within a low risk group

Staff Turnover The table below gives the annual turnover rate by professional group for the 12 month period leading up to April 2020. The graph

illustrates the starters and leavers for the same period.

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Staff Group Avg Headcount

Avg FTE Starters Headcount

Starters FTE

Leavers Headcount

Leavers FTE

LTR Headcount %

LTR FTE %

Add Prof Scientific and Technic

763.5 696.57 131 123.53 84 79.95 11.00% 11.48%

Additional Clinical Services

2,381.00 2,122.84 686 580.11 230 194.56 9.66% 9.17%

Administrative and Clerical

2,901.50 2,590.08 357 303.85 333 277.94 11.48% 10.73%

Allied Health Professionals

857 760.93 122 114.48 117 104.88 13.65% 13.78%

Estates and Ancillary

766 578.77 83 54.7 77 50.76 10.05% 8.77%

Healthcare Scientists

350 324.52 50 45.03 54 49.14 15.43% 15.14%

Medical and Dental

1,122.50 1,064.77 367 338.13 224 211.18 19.96% 19.83%

Nursing and Midwifery Registered

3,347.50 3,078.64 380 329.21 334 303.17 9.98% 9.85%

12489 11217.12 1453 1271.58 11.63% 11.34%

Exceptions There is a high level of turnover within the healthcare scientists group, which requires further review and the Trust Workforce Resourcing Group will take this forward as an action. The high level turnover within the Medical and Dental group is due to rotational movement of junior doctors

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Recruitment Pipeline Essential Work has continued despite the current challenges.

The payroll provider ‘switchover’ was completed by end of March 2020 and all LUH employees are now paid through by St. Helens & Knowsley NHS Trust.

Work with Agency staff suppliers has continued to ensure that the Trust continues to receive the agency staff required to support clinical colleagues.

Project work to upgrade the Nursing Roster software was completed in April.

Recruitment has been particularly challenging to support the staffing requirements through national and regional programmes shown below.

April activity Offers made May start June start July start August start

HCA substantive offers 75 5 35 25 10

HCA bank offers 109 5 50 54

Other HCA adverts 62 5 11 30 16

Total 246

Nurse Returners 14 offered to Trust, 10 unsuitable, 4 offers made, 3 started, 1 no response

Medic Returners 6 offered to Trust, 3 unsuitable, 3 offers made, 3 started

5th

year Medical students 87 started 30/03/20

2nd

& 3rd

year Nursing students 232 opted in to the scheme. All started between 14/04/20 and 04/05/20

Trust ‘fast track’ to various bank posts to support Covid

183 requests. 51 Medics, 38 Nurses, 15 Physios, 1 BMS, 48 bank admin 30 subsequently withdrew

plus ‘Normal’ recruitment activity across all staff groups

64 adverts covering 110 wte 257 wte at shortlisting 136 interviews scheduled 771 individuals with offers / employment checks being processed

Workforce Reset Update

The Trust is in the process of developing and implementing a Workplace Reset plan which will complement the Operational Reset

Plan. This reset will meet the requirements set out in the Government’s Our Plan to Rebuild recovery strategy and the TUC

Preparing for the Return to Work paper, including social distancing measures, hygiene, working patterns and arrangements and

staff wellbeing and support.

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Sickness Absence

Summary Given the current situation and workload

within Key Frontline areas absence data is being reported via the daily Sitrep tool. The Workforce team are aware that an amount of absence data has not been recorded formally via ESR and this will be address. Sickness absence is currently reported at 8.65% although it’s important to note this is sickness absence as reported via ESR and does not include any absence due to Medical Suspension or Special Leave.

Statistical Variation: Variation this month is not within normal limits Benchmarking: The Trust is performing in line with comparator organisations

Trajectory: The Trust is not achieving trajectory

Recorded sickness absence within the trust has increased from 7.37% in March, to 8.65% in April 20.

Risks


The Workforce and Business HR team adapted the reporting of absence for the operational teams from week commencing 9th

March 2020. This led to the operational teams reporting workforce absence via a data sheet rather than the workforce systems routinely used. This was to enable oversight of the varying reasons for absence related to COVID following national guidance in relation to self-isolation and also to ease the administrative burden of absence management for the operational teams. In order to manage absence across the Trust the Business HR team has actively supported the testing of staff and also coordinated the team to closely manage the varying reasons for absence due to COVID that can be split in to four broad headings:

Monitoring of absences within those areas critical to treating COVID patients

Monitoring of isolation periods

Maintaining contact with those considered high risk

Non-COVID related absence Appendix 1 provides further detail of the actions being taken by the Business HR team to support the operational teams with the management of absence during this period.

Within one month of adapting their approach to absence management the Trust reported absence of 2839 staff that attributed to

23% of the workforce, with 2076 of those absences related to COVID. At the time of writing this paper (12 May 2020) absence has

steadily declined from that peak to 1878 staff absent, 14% of the workforce with 1197 of those absences being attributed to

COVID.

8.65%

Target 4.5% Trajectory

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Summary for absence by type with staff count and percentage taken from Daily Sit-rep on 12 May 2020

COVID /NON COVID Leave Status N* %

COVID

Confirmed 92 5%

High Risk Group 520 28%

Home Working 46 2%

Isolation with symptoms 363 19%

Isolation WITHOUT symptoms 176 9%

NOT COVID Not Coronavirus related 681 36%

Grand Total 1878 100%

Summary showing staff count and percentage of Active covid absences grouped

Leave Status2 Leave Status N* %

Symptomatic related

absence where absence

is being monitored

Confirmed 92 8%

Isolation with symptoms 363 30%

Isolation WITHOUT symptoms 176 15%

GROUP TOTAL 631 53%

Absences due to

national guidance

High Risk Group 520 43%

Home Working 46 4%

GROUP TOTAL 566 47%

Grand Total

1197 100%

Active absences showing number of staff and percentage by Site & Staff group

ACTIVE BY STAFF GROUP AINTREE ROYAL TOTAL

Staff Group N* % N* % N* %

Add Prof Scientific and Technic 32 2% 48 3% 80 4%

Additional Clinical Services 298 16% 240 13% 538 29%

Administrative and Clerical 136 7% 193 10% 329 18%

Allied Health Professionals 45 2% 45 2% 90 5%

Estates and Ancillary 122 6% 32 2% 154 8%

Healthcare Scientists 5 0% 17 1% 22 1%

Medical and Dental 45 2% 49 3% 94 5%

Nursing and Midwifery Registered 296 16% 275 15% 571 30%

Grand Total 979 52% 899 48% 1878 100%

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The Trust has seen 4615 absences reported due to COVID during this period with 3418 staff having returned. The exceptions that have influenced the management of absence and the mitigating actions to control those are highlighted below.

Exceptions Mitigating actions taken by Business HR

Missing data Data reviewed daily by the Business HR team and corrections made to improve the accuracy of the data

Non-closure of absences Data reviewed daily and in line with required isolation periods to capture the return of staff. Business HR team closing absences on behalf of managers

Incorrect data completed Business HR team working with managers to ensure accurate reflection of absences

ESR not being updated Business HR team recording absence on ESR on behalf of operational managers to ensure absences are captured following COVID management.

Non-recording of high risk staff Significant increase in reporting those high risk has now occurred

Recording of COVID positive staff Business HR team working collaboratively to ensure testing results are reflected in our absence data

In addition to the actions being taken to proactively manage absence from the data, the Business HR team has provided a helpline directing staff to those support mechanisms that will enable their attendance at work and also worked closely with the Trusts Health and Safety and Occupational Health teams to support the risk assessments of staff to enable staff to return to work safely.

Daily SitRep Absence – 21st

March 2020 to 10th

May 2020

Description:

Based on data supplied by managers via the daily Sitrep absence is now reducing. This data includes all absence from work,

whether COVID symptoms related, Isolation due to High Risk or household Symptoms, Special Leave and all non COVID related

sickness absence. All are included to give a full picture of the number of staff unavailable to perform their normal tasks.

Risk:

Although there is regular turnover in the Sitrep system with around 500 records being either created or updated on weekdays

there is concern that absence are not being returned in a timely manner.

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Improvement Actions:

The team’s focus has been to provide support to the operational teams to manage and reduce covid related absence. At the peak of the covid pandemic absence increased to 23%, however, this has continually reduced to 13% (as at 19

th May 2020).

Work continues to improve this position and support the continuous reduction in absence.

Check and Challenge meetings undertaken with Divisional leaders to ensure accuracy of absence reporting and categories for absence are captured. This work is currently underway with further review meetings to be held routinely going forwards.

Pre-covid the Business HR teams focus was on hot spot areas to identify interventions that will support staff and reduce sickness absence. As part of the teams restart, this work will be picked back up.

During the emergency planning period of covid, staging meetings were placed on hold with all staff who have triggered the policy receiving holding letters, the Business HR team now preparing to work with managers to ensure that those are now managed.

Divisional meetings restarting therefore divisional leaders with their respective HRBPs ensuring focus on improving absence position.

Sickness Management training for managers to restart in June, Business HR team adapting this training to encompass covid related absence.

Sickness Absence by Reason (Top 5) – April 2020

Description:

Based on sickness absence data recorded into the ESR system, the above shows the top 5 reason for absence during April 2020

along with the percentage of all sickness recorded in month.

Risk:

Although there is a high amount of sickness absence being recorded in ESR either directly by managers of via the import of

sickness from the Roster there are concerns around under reporting. There are plans in place to review all recorded absence

against the daily Sitrep data in the future to ensure accuracy. There are also concerns around the reasons being used for

recording absence despite guidance being issued to Managers, all Covid related absence should be recorded as ‘S15 Chest &

Respiratory’ to comply with national guidance, but given we know the majority of absence was Covid related from the above

graph this is not reflected in the reasons.

Absence Reason Headcount Abs Occurrences FTE Days Lost %

S13 Cold, Cough, Flu - Influenza 621 630 7,291.52 24.7

S10 Anxiety/stress/depression/other psychiatric illnesses 334 338 6,231.89 21.1

S15 Chest & respiratory problems 385 389 4,186.61 14.2

S98 Other known causes - not elsewhere classified 226 227 3,568.85 12.1

S12 Other musculoskeletal problems 68 69 1,190.19 4.0

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Great Ambition - Finance Integrated Performance Report

Executive Lead: Robert Forster, Chief Finance Officer

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Introduction

This paper presents the finance report for Liverpool University Hospitals NHS Foundation Trust for the first month of

2020/21.

As a result of the impact of COVID-19, a national decision was taken to suspend the traditional financial management

process – including contracting with commissioners (activity driven model), and the resulting formal agreement of

financial plans with NHSI. LUHFT had submitted a fully approved operating plan as agreed by the Board to NHSI for

20/21 – however officially this was suspended.

The Covid 19 crisis response was not be hampered by financial constraint , thus an expenditure driven model was

established for the first 4 months of the year ie. April to July in the first instance. The principle of the interim process

was to ensure all providers achieved a break even position and to concurrently identify and recoup specific Covid

response related costs.

Despite the new interim regime – good financial discipline was/is expected and it is important that organisations

continue to assess performance against the original plan in anticipation of an eventual return to more normal

expectations.

NHSI estimated the possible return expected from the organisation by month based on prior year expenditure and

income predictions – and whilst an estimate it is also necessary to assess the actual position versus this prediction.

On this basis the format of the finance report is different to that of previous months, and provides an overview of

performance through two lenses;

1. Actual Financial position versus the Trust Operating Plan agreed by the Board at the beginning of the financial

year, providing an understanding where actual spend (and resulting income) is landing in comparison to our

original plan.

2. Actual Financial position versus NHSI estimate plan for the month based on prior year run rates of expenditure

and income. This formed the basis of a prepayment to the Trust and thus the final true up position request to

break even.

The Trust has broken even in month 1 in line with the current regime.

This report analyses the key variances to help explain the position and provides detailed analysis of some of the key

drivers and essential financial metrics, important in order to manage the organization in both the current regime and

in preparation for a return to traditional regulation.

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Analysis

I&E

Reported position was £5.400

better than plan

Operating Plan Overview

• The financial position is reported as being balanced, this position consists

of the following key elements;

• Increase in income plan - £1,196k (favourable), but this includes the top-up

payment from NHSI as there is no FRF in the COVID-19 period. Excluding

this gives an underlying £2.3m (adverse). Similar to that reported against

NHSI/E external position.

• Operating expense excluding COVID-19 is £2.9m (favourable), which offsets

the shortfall in planned CIP/QEP, to be at plan.

• Net surplus to plan, but excluding COVID-19 spend is £5.4m (favourable) as

a result of the top-up.

LUHFT

Plan

£m

Actual

£m

Variance

£m

Key Driver

Clinical Income 64.5 62.6 (1.9) Loss of local authorities / overseas

visitors/private patients

Operating Income 12.4 15.5 3.1 Actual includes top-up of £5.4m

(FRF), Loss of car parking /

Catering/non-NHS contracts.

Total Income 76.9 78.1 1.2

Operating Expense (83.3) (80.4) 2.9 Excluding COVID-19 spend

Financing Costs (1.9) (1.9) 0.0

CIP/QEP 2.9 0.0 (2.9)

Total Expense (82.3) (82.3) 0.0

Surplus / (Deficit) (5.4) (4.2) 1.2

Expected operating true-up 0.0 4.2 0.0

Net Surplus/(Deficit) to Plan (5.4) 0.0 5.4

COVID-19 Spend ‘true-up’ 0.0 6.8 6.8 Brings total expense for the month to

£89.1m

Total Expense (82.3) (89.1) (6.8)

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I&E

Reported position was £0.000

better than NHSI/E estimate.

NHSI Estimated Plan Overview

• The financial position is reported as being balanced, this position consists of

the following key elements;

• COVID-19 direct spend - £6,789k (adverse)

• Shortfall in assumed income NHSI plan - £3,448k (adverse)

• Non-recurrent M8-M10 not accounted for in NHSI assimilated contract -

£1,419k (adverse)

• Additional “True Up” income assumed - £10,955k (favourable)

NHSI Estimate

£m

Actual £m

Variance £m

Key Driver

Clinical Income 64.5 62.6 (1.9) Loss of local authorities/overseas visitors/private patients

Operating Income 17.1 15.5 (1.6) Loss of car parking/Catering/non-NHS contracts

Total Income 81.6 78.1 (3.5)

Operating Expense (80.0) (87.2) (7.2) Includes COVID-19 spend of £6.8m

Financing Costs (1.6) (1.9) (0.3) NHSI estimate understated

CIP/QEP 0.0 0.0 0.0

Total Expense (81.6) (89.1) (7.5)

Surplus / (Deficit) 0.0 (11.0) (11.0) Includes COVID-19 spend of £6.8m

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Activity

Reported position was

below operating plan

Key Issues

• Activity plans are based on the Draft Operating Plan 2020/21 and reflect the

methodology outlined in the paper ‘Operational Planning Process 2020/21’

presented to the F&P Committee in December 2019.

• The impact of COVID-19 escalation is clear, with all areas reporting

significant shortfalls on planned throughput. Elective and day case activity

has taken the biggest hit, falling by c82% of predicted levels.

• Despite the numbers of patients presenting with COVID-19, the reduction in

AED attendances by 52% menas that even non-elective admissions is

significantly down on normal monthly levels (-28%).

• Throughput will continue to be affected significantly through May and for a

number of months thereafter. The level of shortfall will likely abate

somewhat as the ‘reset’ plans for non COVID-19 services start to take affect.

2020-21

M01

Type of ActivityActivity

Plan

Activity

Actual

Activity

Variance

Activity

Variance

Accident and Emergncy 24,706 11,865 (12,841) -52.0% (12,841) -52.0%

Daycase 7,086 1,264 (5,822) -82.2% (5,822) -82.2%

Elective 1,133 206 (927) -81.8% (927) -81.8%

Emergency Admissions 8,896 6,407 (2,489) -28.0% (2,489) -28.0%

Outpatient First Attendance 27,593 10,585 (17,008) -61.6% (17,008) -61.6%

Outpatient Follow up 53,362 25,324 (28,038) -52.5% (28,038) -52.5%

Outpatient Procedures 14,307 4,272 (10,035) -70.1% (10,035) -70.1%

Wet AMD 1,258 641 (617) -49.0% (617) -49.0%

Grand Total 138,341 60,564 (77,777) (77,777)

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Capital

Reported position was

behind plan

Key Issues

• Total Capital Programme for 20/21 is £189m (of which c. £154m is the new

hospital CTC

• Planned spend to M1 is £13.8m (new hospital £12m).

• Actual spend to M1 is £7.6m of which new hospital is c. £6.6m including

Project X.

• During M2 a full review of Covid related spend will be separated out of the

reported spend and classified separately.

• The profile and projections for the new hospital spend are being reviewed

during May and June to inform the final cost to complete and profile

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Key Statistics

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COVID SPEND

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Appendix

Performance Report Scorecards

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Great Care Performance Scorecard (1 of 2)

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Great Care Performance Scorecard (2 of 2)

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1

Trust Board

COVER SHEET


Report Title COVID-19 Update

Prepared by Neil Holland, Deputy Chief Operating Officer

Presented by Beth Weston, Chief Operating Officer

Key Issues / Messages This report provides the Board with an update on the Trust’s maintenance of the incident response to the COVID-19 pandemic.

The Trust is responding to national and regional guidance on the reset of elective activity, with the aim to maintain and improve patient safety and experience.

The framework to monitor and operationally manage the risk to the organisation from potential secondary surges of Covid-19 across 2020/21 set out in the Reset Plan.

Action required Funding Source (If applicable): N/a

Funding Source (If applicable): N/a

Supporting Executive: Beth Weston, Chief Operating Officer


Quality

Finance

Workforce

Equality

☒

☒

☒

☒

Risk

Compliance

Legal

☐

☒

☐

Equality Impact Assessment (if there is an impact on E&D, an Equality Impact Assessment must accompany the report)



Deliver outstanding care and patient

experience

Deliver the most effective treatment

to achieve the best possible patient

outcomes



☒

☒

☐

Provide sustainable healthcare to meet

the needs of our population



organisation

☒

☒

☒

LEVEL OF ASSURANCE:





☐ No assurance


REPORT DEVELOPMENT: Committee or meeting report considered at:

Date Lead Outcome

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Trust Board 19 May 2020

COVID-19 Update

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1 Executive Summary

1.1 Introduction The pandemic outbreak of “COVID-19” continues to place pressure on the NHS and Liverpool University

Hospitals FT.

The nationally declared level 4 incident has been maintained throughout April and May 2020. This includes

operating in a business continuity environment and within the Trust’s major incident processes and governance

arrangements.

This paper;

Provides an update on the Trust’s ongoing operational response to the COVID-19 pandemic

Provides an overview of the COVID-19 risk management arrangements & assurance

Emerging national and regional guidance on the reset of elective activity and the Trust’s response

The framework for managing risk of potential secondary surges of COVID-19

1.2 Purpose The paper aims to describe the Trust’s strategic approach to responding to the COVID-19 pandemic.

Provide operational oversight of the current phase of the incident, update on the overarching plan for the

phased reset of elective and outpatient activity.

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2 Introduction

2.1 Introduction

Robust governance structures & processes have been implemented and qualitative and quantitative

measurement is being used to provide assurance on the effectiveness of the Trust’s response to the Covd-19

pandemic.

2.2 National & Regional Covid-19 Developments

On the 29 April 2020 the Trust received national guidance from NHSEI in relation to the development of plans to increase levels of elective activity. The aim being to support the next phase of COVID-19 incident management.

In addition to this, a regional approach has been taken to oversee the system wide reset plan. The aim is to ensure that capacity plans are coordinated and to ensure resource is deployed to areas of greatest need. The detail on how this will achieved has yet to be developed and shared. The Trust has however, has contributed towards the regional plan by submitting demand and capacity data.

2.3 Reset & Governance

The COVID-19 governance structures have been enhanced to support the development and implementation of the organisational Reset Plan. Additional groups have been established to oversee and monitor activities relating to the incident management response and delivery of activity set out in the Reset Plan.

Clear trigger points will help the organisational proactively identify secondary surges and enable swift response.

2.4 COVID-19 Incident Management

Inpatient numbers of Covid-19 positive cases peaked on the 12 April 2020 however, since that time the Trust has seen steadily increasing reductions in COVID-19 inpatient activity. Critical care occupancy has reduced significantly to between a range of 48%-52% occupancy and General & Acute bed occupancy has also reduced to between 50%-55% of overall Trust occupancy.

Trust ‘Ready for Discharge’ (RFD) numbers have also been significantly reduced through a number of system working initiatives undertaken in collaborations with partners.

The stabilisation of the Trust’s occupancy and RFD numbers support the Trust’s ability to safely increase urgent elective activity over the coming month.

2.5 Testing The Trust’s approach to testing for COVID-19 continues to evolve following national guidance. Testing is

available to all staff groups and is now also in place for all patients requiring admission. LUHFT has in line with

national guidance implemented the testing of all care and residential placement admissions at the point of

discharge. This supports the local care sector in the control and management of the virus. Antibody testing is

also in development. This supports the Trust’s continued focus on safety for both staff and patients.

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3 Governance

3.1 Summary

The governance arrangements described in the update provided to the Trust Board in April 2020 remain in

place. This supports the ongoing management of the incident response in addition to supporting and providing

oversight to delivery of the proposed Reset Plan.

Rest Governance Structure

Discussions are underway to understand how the Trust most effectively aligns the reset arrangements to existing

groups and committees within the organisation. This may result in some minor changes to the proposed new

groups.

Proposed New Groups

Trust Strategic Reset Oversight Group (Chaired by COO)

Provide strategic oversight on behalf of the executive team and board sub-committees in relation to the delivery

of the Reset Plan and emerging risks.

Clinical Strategy Group (Chaired by Deputy Medical Director)

Provide the oversight and development of clinical integration during the Covid-19 Pandemic aligned to the

overall Trust strategy.

Operational Rest Group (Chaired by Deputy COO)

Provide oversight of the operational planning and delivery of activity outlined within the Reset Plan, whilst

identifying, mitigating and escalating any emerging risks.

Improvement Rest Group (Chaired by Director of Strategy)

Provide oversight and development of opportunities to support the transformation and new ways of working in

this period.

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4 Operations

COVID Demand

COVID Inpatients The number of COVID positive inpatients peaked on the 12th April 2020 at 390 occupied beds. During the

beginning of the incident, the Trust most closely aligned to the Imperial College modelling that accounted for

non-pharmaceutical interventions such as school closes, case isolation, and social distancing. The reduction in

the number of COVID inpatients has however, been quicker than the modelling suggested.

Critical Care Bed Occupancy The Trust currently has a maximum of 112 critical care beds available to use. The occupancy levels have varied

between 48% and 55%. The number of current critical care beds available meets the requirement identified

through the Trust’s modelling assumptions.

General Bed Occupancy The Trust currently has a maximum of 1630 beds available. The current occupancy level is approx. 50 – 55%. The

number of available beds meets the requirement identified through the Trust’s modelling assumptions.

Ready for Discharge Local Liverpool System partners have worked collaboratively with LUHFT to review the Ready for Discharge (RFD) pathway. Whilst this was a national mandate under the COVID-19 pandemic incident response, relationships with system partners were already developed but have been further strengthened by the pandemic.

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7

The RFD pathway and enhanced support from system partners has significantly improved the organisations ability to safely co-ordinate the discharge of older vulnerable patients groups during the COVID-19 incident and create additional G&A bed capacity. The table below highlights the key initiatives which have been introduced as a result of this collaborative approach: Covid Project System Partner(s) supporting

the initiative Implementation Date Outcome

Development of new Discharge2Assess pathway and SPC for hospital discharge

LUHFT, MerseyCare, LCCG, SCCG, Liverpool LA, Sefton LA & CSU

1 April 2020 Reduction in RFD numbers form 275 – 170 (40%).

Repurposing all sub acute system beds for COVID-19 Pathway to isolate care home patients prior to returning to placement

LUHFT, MerseyCare, LCCG, SSCCG, Liverpool LA, Sefton LA & CSU

1 April 2020 Additional 100+ community IMC beds supporting the Trust during COVID-19. Trust G&A Occupancy 50-55%.

Project X (New Royal Liverpool)

LUHFT, MerseyCare 4 May 2020 Additional capacity to support creation of ‘COVID free’ site – Trust G&A occupancy 50 – 55%.

Outcomes

The outcome of the collaborative working and implementation of focused initiatives has seen an initial improvement in LUHFT RFD position of up to 50% against a backdrop of reduced system capacity due to the COVID-19 outbreak. Work continues on the development of the ‘end to end’ pathway supported by partners, which should see further improvements on this position in the coming weeks and months. Royal Site: No. of Patients RFD

Aintree Site: No. of Patients RFD

Additional Bed Capacity & ‘COVID free’ Areas

The Trust has been supported by both the local authority and community partners in creating additional ring-

fenced, step down capacity across community sites for the transfer of ‘Ready for discharge (RFD)’ patients, at

the point they are deemed medically fit to transfer.

In addition to the community sites, LUHFT have provided access to the New Royal hospital site (Agnes Jones

Unit) which opened on the 3rd of May in support of the Reset Plan. The additional capacity made available has

provided an opportunity to develop a ‘covid free’ area on the Broadgreen site which is in line with planning for

increased levels of elective activity. The Agnes Jones Unit, staffed in partnership with Merseycare, demonstrates

the system response to maintaining safe, accessible care for the North Mersey local population.

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5 Reset Arrangements

5.1 Reset Approach

The COVID-19 Reset Plan is an overarching document, developed to support Liverpool University Hospital NHS

Foundation Trust’s approach in resuming service provision following the surge in demand due to the COVID-19

pandemic. It aims to:

Provide an operational framework and guidance for reset, setting out key processes, roles and

responsibilities across the organisation

Allow the Trust to be predictive and proactive in its decision-making to preserve business continuity,

build resilience, and deliver the best possible care for patients with the resources available by taking a

risk based approach. This will be achieved by using data and clear triggers aligned to response.

The overarching plan will be underpinned and supported by:

Detailed divisional operational plans, These will be collated by each Divisional Director of Operations

and will align activity with quality, safety, and IPC risk assessments

A Workforce Reset Plan, sponsored by the Chief People Officer, is also being developed to support the

new ways of working.

As the Trust plans to recover after the first wave of the pandemic, it is vital to take appropriate actions quickly to

prepare for the expected growth in outpatient referrals, elective waiting times and the potential impact on

patient safety. Although the focus has been on reconfiguring the organisation to respond to the pandemic, it is

imperative to start thinking about how we reset the organisation to deliver activity whilst still managing COVID-

19.

The reset process is dependent on the stabilisation of the COVID-19 incident therefore, clear thresholds and

triggers of COVID-19 surge demand will be used to identify the point at which the organisation responds to either

a surge or resetting of how activity is delivered.

Reset Principles

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Reset Phases

The planning and delivery of recovery will take the form of three distinct phases;

● Stabilisation - Phase 1: Prioritise services and staff to support critical organisational functions in relation to

COVID-19.

● Reset - Phase 2: Support urgent elective clinical activity.

● Reset - Phase 3: Expand elective clinical activity i.e. theatre for all urgent and cancer pathways, and theatre

capacity for cases waiting over 35+ weeks.

Clear triggers and thresholds are in place to enable daily assessment of the situation and enable swift response to

emerging trends. The response is outlined in the diagram above. This illustrates that should there be increasing

concerns in the Trust’s ability to accommodate non elective and elective activity, appropriate actions will be

taken in a sequential manner:

Initiating Reset Phase: when critical care occupancy is below 60%, and/or the trend of COVID positive

inpatients is reducing or stable, and/or the rate of workforce absence is reducing or stable this will

enable the Reset Phase to commence.

Continuing Reset Phase: when critical care occupancy trend is stable, the trend of COVID inpatients is

stable, and the rate of workforce absence is stable the Trust will continue to implement the Reset

Phase as per the Divisional operational plans.

Exiting Reset Phase and Entering Incident Response: when the trend in critical care occupancy is

increasing and/or above 60%, and/or the trend of COVID positive inpatients is rapidly increasing

and/or workforce absence levels increase to above 25% , the Trust will cease activity as per the Reset

Phase and return to Phase 1. This will allow theatre staff and staff from other areas to be redeployed

to support category 1 areas.

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10

6 Risks to Delivery

There are a number of risks that directly affect the Trust’s ability to deliver against the proposed Reset Plan.

These should be both considered and actively reviewed throughout the planning and implementation period of

activity increases. .

Risks include:

PPE: Availability of personal protective equipment to support COVID related clinical activity and Reset Phase

diagnostic, urgent surgical activity and cancer surgical activity.

Critical Care Beds: Availability of critical care beds and ventilators to support COVID related activity, non-

elective activity and Reset Phase 2 elective surgical activity.

Workforce: Availability of appropriately skilled staff due to either redeployment to other areas during the COVID

Incident Management Phase and sickness absence.

Bed occupancy: Availability of appropriate cohort beds to support urgent and cancer elective activity.

Mutual Aid from North Mersey System: Availability of additional system capacity across a range of acute and

community providers to support the LUHFT Covid-19 escalation response (eg Critical Care Beds (Alder Hey &

LHCH), General, Acute & Specialist Beds (LWH & WCN), Community Bed Placements (Liverpool & Sefton CCG/LA)

and Independent Sector Capacity (Spire Liverpool). Withdrawal of this support would significantly reduce the

Trust’s ability to respond in the event of a second surge.

Agnes Jones Unit: The Agnes Jones Unit recently opened to provide additional capacity during the Covid-19 reset

phase, is limited to remain open for a period of 6 months. This needs to be considered in the forward planning of

the overarching rest plan.

The risks outlined below have been recognised both nationally through guidance received and locally within trust

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7 Next Steps

Continue monitoring relating to Covid-19 interdependencies, to inform the operational decision making processes and incident management.

Further develop operational plans to support the implementation of the Trust’s Reset Plan.

Support staff wellbeing through this period through the development of the Workforce Reset Plan.

Provide a further updates to the Trust Board on progress made with implementation of the reset plan.

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Trust Board COVER SHEET


Report Title Budget Financial Plan Update

Prepared by Ian Jones, Deputy Chief Finance Officer / Director of Finance (Operations)

Presented by Robert Forster, Chief Finance Officer

Key Issues / Messages

This paper provides the base budget established for 2020-21 and aligns to the draft operational plan submitted to NHSI/E in March 2020;

Budgets have been prepared in accordance with the paper ‘Operational Planning Process 2020/21’ submitted to F&P Committee in December 2019.

2019/20 budget hierarchies have been re-mapped to the new Divisional and Departmental construct for 2020/21.

Action required For assurance Funding Source (If applicable):

The paper is provided for review and discussion and any further information / assurance required

Supporting Executive: Robert Forster, Chief Finance Officer


Quality

Finance

Workforce

Equality

☐

☒

☐

☐

Risk

Compliance

Legal

☒

☐

☐

Equality Impact Assessment (if there is an impact on E&D, an Equality Impact Assessment must

accompany the report)




patient experience




Promote excellence in

education, research &

innovation

☐

☐

☐




Be a well-governed and clinically-

led organisation

☐

☐

☒

LEVEL OF ASSURANCE:

☐ Acceptable assurance




☐ No assurance


REPORT DEVELOPMENT:

Committee or meeting Date Lead Outcome

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2

report considered at:

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EXECUTIVE SUMMARY

1. This paper provides the base revenue budgets for 2020-21 and aligns to the approved Draft

Operational Plan submitted to NHSI/E in March 2020.

2. Budgets have been prepared in accordance with the principles set out in the paper ‘Operational

Planning Process 2020/21’ submitted to and agreed by the F&P Committee in December 2019.

3. All operational budget hierarchies have been remapped to reflect the current divisional / departmental

split. Corporate departmental structures remain consistent with 2019/20 hierarchies.

4. Divisional / departmental staffing restructures since merger are not accounted for within the baseline

bdgets. This maintains the integrity of the pre-merger position and allows the Trust to map through the

impact of any merger changes (savings/costs) within extant budget and establishment numbers.

5. Pre-committed cases of need of £16.7m were included in the Draft Operating Plan 2020/21 and are

included within this budget. This was represented 53% of the total identified schemes of £35.5m

leaving £18.8m not funded.

6. Detailed budget books at a more granular level (e.g. staff by grade etc.) have been distributed to

divisional / departmental leads week commencing 11 May 2020 and work will take place over the

coming weeks to review the planned/proposed staffing structures post merger against the baseline

budgets set out in this paper and identify savings/costs for review.

7. Whilst the COVID escalation and response impacts upon actual operational delivery post March, the

paper addresses the recurrent operational plans that would have been in place prior to the outbreak.

This ensures a consistency in approach and provides a robust foundation for in-year monitoring and

for 2021/21 budget setting. It is recognised that budgets may need to be adjusted in the future to

reflect the shape of future operations post COVID, which will be considered collectively as a merged

organisation recognising the new macro environment and requirements.

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MAIN REPORT

Introduction

1. This paper provides the base revenue budgets for 2020-21, forming the basis of and aligning to the

approved draft operational plan submitted to NHSI/E in March 2020.

2. Budgets have been prepared in accordance with the principles set out in the paper ‘Operational

Planning Process 2020/21’ submitted to and agreed by the F&P Committee in December 2019

(Appendix 1).

3. The paper is provided for review / discussion and any further information / assurance required.

Governance

4. The review forms part of the governance process of Liverpool University Hospitals NHS FT.

Process recap

Budget Setting and Contracting Process

5. The core elements of budget setting and contracting set out in the paper, ‘Operational Planning

Process 2020/21’, can be summarised as follows:

Generate baseline rollover 2020/21 budgets for all departments based on 2019/20 month 7

recurrent position;

Adjust baseline for full year effect of service developments, QEP schemes as at month 7;

Identify divisional and core pressures through discussion with departmental leads and using

national guidance;

Construct activity plans using month 7 actual throughput as the baseline, adjusted for expected

growth, full year effect of service changes and impact of delivery of key standards (e.g. RTT);

Assess pre-committed approved developments and collate prioritised list of developments for

review (cases of need, see paragraphs 9 to 14);

Outline QEP/CIP programme to deliver the NHSI agreed control total.

6. All operational budget hierarchies have been remapped to reflect the current divisional /

departmental split as shown in figure 1. Corporate departmental structures remain consistent with

2019/20 hierarchies.

Figure 1: Operational Overview

7. It is likely there may be some sub-departmental movements between hierarchies that have not

been picked up through the remapping, i.e. were the line management of an area has shifted,

however these are expected to be minor and will be picked up in the first quarter of 2020/21

through discussion with operational leads / departmental heads.

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Budget Financial Plan Update:Trust Board 26th May 2020 5

8. Divisional / departmental staffing restructures since merger are not accounted for within the

baseline bdgets. This maintains the integrity of the pre-merger position and allows the Trust to map

through the impact of any merger changes (savings/costs) within extant budget and establishment

numbers.

Cases of Need

9. As part of the planning cycle LUH put in place a process for divisional / departmental priorities to be

submitted for consideration within the annual plan for 2020/21.

10. A first cut of these proposals was presented to the Operational Management Board (OMB) in

March 2020 and is included at Appendix 2 of this paper.

11. Proposals were split between pre-committed schemes where approval had already been made,

valued at £16.7m and prioritised schemes requiring/requesting decision, valued at £18.8m.

12. OMB endorsed the inclusion of the pre-committed schemes in the draft annual plan for 2020/21,

which culminated in the reported £34.5m QEP target for the year, but deferred decision on the

prioritised schemes pending further workup.

13. None of the prioritised schemes have therefore been approved for progression at this stage and

do not form part of the base revenue budgets outlined in this paper.

14. Any future approvals will increase the QEP target by an equivalent value, unless funding can be re-

engineered from within the base revenue budgets set out in this paper.

Operational Plan 2020/21

15. The Trust submitted its Draft Operational Plan for 2020/21 to NHSI/E on 5 March 2020. The plan

set out a gross operational planning gap deficit of -£99.4m, supported by a Financial Recovery

Fund allocation of £64.9m to a net deficit of -£34.5m.

16. This -£34.5m, 3.7% of total income, represents the QEP/CIP target for the Trust in 2020/21.

17. Figure 2 summarises the revenue forecast for 2020/21 as set out in the Draft Operational Plan

2020/21. The full finance section of the plan is shown at Appendix 3 of this paper.

Figure 1: Draft Financial Plan

2020/21

£m %

Income (excl qep and frf) 921.3

Operating costs (998.7)

Planned CIP 34.5

EBITDA (42.9) -4.7%

Finance costs (22.6)

Capital donations and grants 0.6

Planned (deficit)/surplus per template (64.9) -7.0%

FRF 64.9

I&E forecast 2020/21 0.0

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Base Budgets 2020/21

18. Base revenue budgets for 2020/21 have been posted under the principles set out above.

19. The following tables set out the hierarchy of the base revenue budgets, showing establishment and

value. Position includes the £34.5m QEP/CIP target, which at this point is held centrally at Trust

level. Divisional / departmental budgets are therefore before QEP/CIP allocations.

Figure 3: Trust summary 2020-21

Figure 4: Trust subjective summary 2020-21

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Figure 5: Divisional summary 2020-21

Figure 5: ACHT Summary 2020-21

Figure 6: Surgery Summary 2020-21

Figure 7: Acute & Emergency Medicine Summary 2020-21

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Figure 8: Diagnostics & Support Services Summary 2020-21

Figure 9: Corporate Summary 2020-21

20. Detailed budget books at a more granular level (e.g. staff by grade etc.) have been distributed to

divisional / departmental leads week commencing 11 May 2020.

21. Divisional Finance Managers will liaise with budget holders over the coming weeks to review the

planned/proposed staffing structures post merger against the baseline budgets set out in this paper

and identify savings/costs for review.

QEP/CIP

22. As noted above, the QEP/CIP target of £34.5m is currently held centrally and has not been

allocated out to Divisions/Departments. Therefore when reviewing budgets, users should have in

mind that savings will need to be made against their baseline allocations so LUH can meet its

break-even target.

23. How the QEP/CIP is allocated has yet to be confirmed, but figure 10 below gives an indicative

allocation to divisions for illustrative purposes and can be used as a guide for budget holders in

considering their 2020/21 QEP/CIP ask.

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Figure 10: Indicative QEP allocations 2020-21

COVID

24. Whilst the COVID escalation and response impacts upon actual operational delivery post March,

the paper addresses the recurrent operational plans that would have been in place prior to the

outbreak.

25. It is essential that the baseline expectation is known in order that there is a consistency in

approach and also to give the organisation a robust foundation for in-year monitoring and for

2021/21 budget setting.

26. This does not deter from the fact that budgets may need to be adjusted in the future to reflect the

shape of future operations post COVID, which may require a reset.

RECOMMENDATIONS

27. The Finance & Performance Committee is asked to note the information contained in this report.

Further reading

Appendix 1: Operational Planning Process 2020/21: F&P, 19 December 2019

Appendix 2: Cases of Need: OMB, 3 March 2020

Appendix 3: Extract form the Draft Operational Plan Narrative 2020/21 Liverpool University Hospitals

NHS Foundation Trust: 5 March 2020

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Appendix 1:

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Appendix 2

OPERATIONAL MANAGEMENT BOARD

COVER SHEET

Agenda Item (Ref) Date: 03/03/2020

Report Title Cases of Need

Prepared by Ian Jones, Interim CFO

Presented by Ian Jones, Interim CFO

Key Issues / Messages Pre-commited schemes £16.7m.

Further prioritised list of £18.8m

Action required Choose an item. Funding Source (If applicable):

To review & prioritise

Supporting Executive:


Quality

Finance

Workforce

Equality

☐

☒

☐

☐

Risk

Compliance

Legal

☐

☐

☐


report)




patient experience






☐

☐

☐





organisation

☐

☐

☒

LEVEL OF ASSURANCE:

☐ Acceptable assurance


☒ Partial assurance


☐ No assurance


REPORT DEVELOPMENT:


Date Lead Outcome

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EXECUTIVE SUMMARY

Executive Summary

2) Divisions / departments were asked to submit cases of need to support safety / capacity as part of the

annual planning round for 2020/21.

3) Initial long list of cases was received, (326 cases), these were then reviewd by divisions/departments

and a prioritised list submitterd (118 cases) for consideration at Operational Management Board. These

include a list of pre-committed schemes from 2019/20 was compiled.

4) The table below summarises the financial ask of pre-committed and divisional prioritised schemes.

£m

Pre-committed 16.666

Prioritised schemes 18.156

34.822

5) The financial forecast for 2020/21 is currently being assessed and will include all pre-committed

schemes in the first cut.

6) The level of investment will need to take account of the financial at assessment. To achieve LUHFTs

control total, the QEP/CIP ask, including full commitment to all pre-committed schemes is £34.5m.

Key Issues / Proposal

7) The table below summarises the cases put forward by Divisions / Departments and those schemes pre-committed.

8) OMB are asked to review the cases and consider what schemes should be invested in, in order of priority.

9) Any decision by OMB will need to be considered in the context of the expected financial position and the

constraints the Trust is working within.

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20

Division Directorate Identified in

Site Issue Comments Forecast 2020/21

PRE-COMMITTED CASES OF NEED

1 SURGERY Orthopaedic reconfiguration

Cost Pressure Returns

AUH Ward pressures, theatres etc TBC

Impact of orthopaedic reconfiguration. Final paer on committed inputs to be finalised. Costs c£1m to £1.6m (therapy/diagnostics)

1,300.0

2 SURGERY Breast Cost Pressure Returns

AUH Outpatient capacity Additional Clinic support requested by CBU,. RGN and HCA support.

19.7

3 SURGERY HPB Cost Pressure Returns


5.6

4 SURGERY Gastro Cost Pressure Returns


8.5

5 SURGERY DDU Cost Pressure Returns

AUH Outpatient capacity Additional Clinic support requested by CBU,. RGN and HCA support. Nutrition Clinic

8.1

6 SURGERY Cancer Services 840589


AUH Cancer Validation Band 8b in cancer services is funded 50% as previously other part of role was with Royal. This is now a pressure as Royal have their own post.

32.0

7 SURGERY DDU - Endoscopy


AUH 2 x Band 8a Endoscopy Nurses to support Cap and Demand

Additional posts proposed and approved in addition to approved business case

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8 SURGERY SAU - 840773 Cost Pressure Returns

AUH Ward pressures/over-establishments

Establishing for additional 2.12 B5 + 1.76 B2 above the Original approved template.

188.0

9 SURGERY Surg Mgt Directorate


AUH Band 8c Div Director of Nursing (theatres & Endo Services)

New post and recruitment to this post substantively has been approved

110.0

10 SURGERY Theatres all, ECC and Day Ward


AUH Agreement to rebanding 19 bd 5 posts to band 6 posts, premium will be a pressure £154k + agreement to overestablish by Bd5 + Bd6

New post and recruitment to this post substantively has been approved

191.9

11 SURGERY Gastroenterology AUH/RLBUH

Capacity constraints Use of medinet on AUH site (1 per month) plus insourced WLI's / OT etc on RLBUH site. Identified as case of need as additional investment of £848.5k, which would take cost doen. Needs review against impact of business cases at AUH and RLBUH legacy organisations

1,371.0

12 SURGERY Critical care Med Dir Office

RLB Rota compliance Additional clinical fellow capacity to meet rota compliance RLBUYH site

330.0

13 SURGERY Urology Cost Pressure Returns

RLBUH

Cancer Specialist Nurse Permanaent post approved through PIG 47.0

14 ACHT Dental Hospital Cost Pressure Returns

RLBUH

Orthodontic Business Case - St Helens / backlog

Potential to be offset by additional income of £464k 100.0 TB

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15 SPECIALIST MEDICINE

All Medicine wards



B3 patient flow posts introduced on all wards (x17), originally planned that this post would be from within B2 establishment but wards are backfilling the rota gaps left by the patient flow role.

600.0


All Medicine wards



Relates to existing pressure of over-establishing HCAs that division were to address following 19-20 investment. Pressure has been reduced but not eradicated.

400.0


Divisional Mgmt Cost Pressure Returns

AUH Management structures and senior nursing

Introduction of additional ACBM / DDDO, matron/snr nurses and uplift ACBMs from B6 to B7

180.0


Medicine - med Mgt Directorate


AUH Management structures and senior nursing

Uplift DDOs to B9 from B8d 40.0


Diabetes Cost Pressure Returns

AUH Outpatient capacity Additional Clinic support requested by CBU,. HCA support.

5.6


Nephrology Cost Pressure Returns


5.6


Endo Cost Pressure Returns


14.1


Thoracic Cost Pressure Returns


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Rheumatology Cost Pressure Returns


2.8


Haematology Cost Pressure Returns


2.8


Haem Cost Pressure Returns

RLBUH

Non-oncology haem business case

Capacity and safe staffing 708.6

26 DCSS CSS Execs RLBUH

Maintenance Contract DaVinci robot 140.0

27 TRUSTWIDE Medicine Execs AUH/RLBUH

Physician Associates - 10 WTE

Future workforce 500.0

28 HR OD Cost Pressure Returns

AUH HR Capacity & Integration

1.00wte recurrentky funded / 0.80wte on secondment - to finish May 20

73.0

29 HR OD Cost Pressure Returns

AUH HR Capacity Senior OD 82.0

30 IT IT Cost Pressure Returns

RLBUH

IT Infrastructure Azure Cloud Solution. Approved at Exec in October. - three year contract. Approved as a cost pressure for budget setting in 20/21 onwards.

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31 N&Q Nursing and Quality

Execs AUH/RLBUH

Regulatory Compliance £227k offset by expected restructure of £113k 114.0

32 ACUTE & EMERGENCY MEDICINE

ED Cost Pressure Returns

AUH Medics - Jnr Middle Grade

Staffing above establishment on Jnr Drs/Middle Grades in order to fill 6 (early)/2 (middle)/6 (late)rota which is what the dept has deemed is required for patient safety. Gross spend on premium staff £680k after agency premium funding has been applied, offset by vacancies (£180k)

500.0


Urgent and Emergency care


RLBUH

Increase in use of private ambulances to facilitate discharge

Represents expected spend over budget in 19/20 and the increase in spend over 18/19 outturn

921.8

34 TRUSTWIDE Operations Assessment AUH/RLBUH

Additional operational and medical leadership capacity

Not quantified in detail - expectation based on MD office assessment plus reflection on operational profile and corporate functions

1,000.0


Elderly Cost Pressure Returns

AUH 2018/19 Winter ward AUH site

Capacity requirement for flow 2,200.0


Medicine Cost Pressure Returns

RLBUH

2018/19 Winter ward RLBUH site

Capacity requirement for flow 2,200.0


Medicine Cost Pressure Returns

RLBUH

2019/20 Winter ward RLBUH/Bgreen site

Peak capacity directive 20-21 3,000.0

Total Pre-committed costs (cost pressure exercise)

16,666.1

37 CASES OF NEED

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38 ACHT ENT/MFU Case of Need Submission

AUH Substantiate the Band 4 Cancer Support Worker ENT / MFU

29.0

39 ACHT ENT/MFU Case of Need Submission

AUH Substantiate the Band 7 CNS – ENT / MFU

55.0

40 ACHT Head & Neck Case of Need Submission

AUH Clinical Fellows (once funding stops)

126.0

41 ACHT Ophthalmology Cost Pressure Returns

RLBUH

Support delivery of increased ocular oncology activity

40.0


RLBUH

Sustainable delivery of existing activity

120.0


RLBUH

Delivery of increase service activity, allowing continued investment into research opportunities

80.0

44 ACHT DERMATOLOGY Cost Pressure Returns

RLBUH

Service capacity 0.4 B8A, 1 X B6, 1 X B7, 2 WTEs band 5, 2 WTEs uplift from band 5 to 6, 2 WTEs uplift from band 6 to 7 part of workforce (GIRFT)

174.0

45 ACHT Dental Hospital Cost Pressure Returns

RLBUH

Uplift of Specialty Dentist salary scale to compete with Community Dental Service

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46 ACHT Theatres,Critical Care & Anesthesia

Case of Need Submission

RLBUH

Increase psychology provision with recruitment of Band 7

48.2

47 ACHT Theatres,Critical Care & Anesthesia


RLBUH

Pre-op nurse B6 32.0

48 ACHT Head & Neck Case of Need Submission

AUH Increased number of nursing staff (10.8 WTE Band 5 and Band 2) for increased side rooms on Ward 28

N/A 366.0

49 ACHT Maxillo-Facial Unit


AUH Requirement to meet the NICE cancer guidelines and deliver cancer targets. Will require recruitment of the 6th Oncology Consultant for MFU (£155,500) , 2 new deformity MFU consultant posts (£191,300) & infrastructure for the 3 new consultant posts (£103,000). £8k of travel/misc non pay costs. £135,000 offset by WLIs. Cost include funding from external orgs, funding for theatres/clinics

357.8

50 DCSS Pharmacy Cost Pressure Returns

RLBUH

Radiopharmacy Capacity Issues. Increased controls and processes following the review in previous year. Current income target is no longer achievable as a result.

300.0

51 DCSS Pharmacy Case of Need Submission

LUH 1 WTE B8a Pharmacist – Rheumatology Benefit: Rheumatology advanced pharmacist role, High Cost Drug management

Medium 58.0


LUH 2 WTE B7 Pharmacist (Critical care – GPICS compliance) (Supported by Surgical Division) Benefit: Compliance with GPICS and CQC requirements Risk register reference: 2611S

15 97.0

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LUH 4 WTE B6 pharmacists (Backfill to allow advanced pharmacists to prescribe) Benefit: Improved quality of prescribing and patient flow Risk Register reference: 3942S, 4185-6M, 4190M, 4194-4201M

15 162.0


LUH EGSU extended cover (5pm-8pm weekdays) on Aintree site 0.4 WTE B7 0.4WTE B6 (supported by Surgical Division) Benefit: More timely medicines reconciliation and pharmacist review to reduce the risk of missed doses or unsafe prescribing, particularly around high risk drugs e.g. antibiotics, in particular gentamicin. The timeframe corresponds to the cover available for AMU and captures a significant number of new admissions. The funded resource cannot meet expanded demand. Risk Register reference: 3919S, 3942S

15 36.0


LUH MAB/FAB cover on Aintree site 1WTE B6, 1WTE B5 tech (supported by Emergency Medicine) Benefit: Provide same pharmacy input into this high turnover ‘admission’ area. Funded resource cannot meet expanded (since inception) demand. Risk Register references: 3918M, 4186M

15 73.0

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LUH Weekend Clinical (Ward) Service – AUH & RLB sites (not full service, not BGH) 2 WTE B8a, 6 WTE B6-7*, 6 WTE B5 tech *depends on requirement for non-medical prescribers or not This would give 7.5hrs cover by 14 WTE on both sites on Saturday and Sunday Benefit: More timely medicines reconciliation and pharmacist review to reduce the risk of missed doses or unsafe prescribing, particularly around high risk drugs e.g. antibiotics, in particular gentamicin. Risk Register references: 3919S, 3918M, 4185-6M, 4190M, 4192M, 4194-4201M

15 820.0

57 DCSS Imaging (Radiology)


RLBUH

New MR and CT scanners 8 additional Band 6 Radiographers to staff additional CT scanner, increase in consultant reporting for additional scanner work, 2 injectors, relocatable scanner

872.0

58 DCSS Radiology Cost Pressure Returns

AUH Radiology CSI on call, Current system has standby rate inc 5.4hrs of work anything additional is paid at time and half. Steady increase in work done over the last few years out of hours its getting too onerous for 1 person (who has been on from 8:30 in the morning then to cover on call from 17:00 until 8:00 the next morning we are looking to move to apart shift part on call service – but do not have sufficient staff resources currently to do this.

216.0

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59 DCSS Radiology Case of Need Submission

AUH Capacity Business case developed to support increase in capacity

1,606.0

60 DCSS Therapies Case of Need Submission

AUH Increase substantive Generic Therapy Assistant establishment to support service delivery across medicine and surgery

TBC 246.2


RLB Additional staffing for Limb Reconstruction service therapy follow-up. To address 1)historical increased surgical activity resulting from increase in consultants and theatre slots, 2)requirement to provide same therapy model to former AUH cohort, 3)additional surgeon appointment Aug 2020 not included in business case as not confirmed. CoN offset by additional £274k income.

15 207.0


RLB Additional staffing requirements due to changes in T&O bed base, leading to loss of w/e services and Early Ortho Discharge service. Case of need submitted October 2019

15 366.5


RLB Critical Care therapy staffing to meet GPICs guidance (joint submission with critical care). Case of need part approved in June 2019.

15 467.5


Respiratory Case of Need Submission

AUH VIC – Increase in Acute bed base 16 662.0

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Respiratory Case of Need Submission

RLB ID 5092. Additional medical and nursing resources needed to manage the sustained increase in demand. Business case submitted to RLBUHT Exec Team in July 2019.

602.2


Medicine (LCSH) Cost Pressure Returns

RLBUH

Liverpool Centre for Sexual Health Business Case. Business Case developed at beginning of 2019/20 financial year following significant increase in demand within service. Outpatient Activity increased by 18% and has shown further growth throughout this yea

372.7


Integrated Medicine


AUH Risk ID 4462 – Recruit to Trusted Assessor Role for Sefton permanently. Funded by the LA for 12 months but will need to fund by the Trust following this. 1 x WTE B7

12 55.0


Clinical Gerontology & Stroke


RLB Increase nurse staffing on ward 11 to facilitate increase in bed numbers requires additional 4 WTE Band 5 Nurses and 2 WTE Band 2 HCAs

12 172.7




RLB Increase STU beds to 23 (add 2) + an additional 1.5 wte Band 3

9 34.4


Integrated Medicine


AUH A new Clinical Model needs to be agreed for 60 beds across Wards 17B, 19 and 34, this will include; Medical Cover (potential primary care led model) Addressing current lack of Pharmacy cover Short term solution – Required immediately in advance of

12 280.0

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business planning 0.5 WTE B6 prescribing pharmacist Indicative Long term solution however model to be decided 3 days of GP 6PA 1 x WTE B8a ANP 1 x WTE B8a prescribing pharmacist or 2 x junior doc (SHO)




RLB North West Stroke model of care and staffing which incorporates Royal Liverpool, Aintree, the Walton Centre and Southport hospitals. Project Manager in place with support from the North West Coast Clinical Network. Business case completed by the end of March 2020 for review by all Trust Boards.

? 269.0


Nephrology Case of Need Submission

RLB Additional 6 PAs needed to facilitate service reconfiguration in neighbouring acute trusts (St Helens & Knowsley + Warrington)

15 60.0


Diabetes & Cardiology


AUH ANP’s for Wards N/A 232.0

74 SURGERY Digestive Diseases


AUH EGSU LAS SPR/Clinical Fellow x 2

12 154.0

75 SURGERY Urology Case of Need Submission

AUH 1 wte Consultant (Urol) ? 120.0

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76 SURGERY Urology Case of Need Submission

AUH 1 wte Fellow (Urol) ? 55.0



RLB Pre-habilitation business case 15 93.0



RLB HPN Expansion Medium 1,183.1

79 SURGERY Gastro Case of Need Submission

RLBUH

Liver transplant proposal 98.0

80 SURGERY EGSU Case of Need Submission

AUH WL co-ordinator 23.0


AUH ANP B8A 56.0


AUH Frailty in-reach 160.0


Accident & Emergency


RLB AMU staffing capacity 500.0 TB

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Acute & Emergency Medicine


AUH 3 mth trial period to open AEC from 11-8pm at weekends. Requires ANP, RGN B5 & HCA B3

15 102.9




AUH Additional ambulance from 11-6pm to support with transfer or GP patients throughout the day to prevent influx at peak times.

m 89.4




AUH Improve patient safety in AMU for High Care Patients. Current 2 x HC beds are staffed per bay, but often 4-6 Additional . 1 x B6 RGN to support (assuming 24/7)

12 262.8




AUH Improve patient safety in ED & complete comfort checks during times of extreme pressure . Increase HCA support by 2 per shift, total-10.09 WTE B2 HCA

15 297.3




AUH Move current B6 Paramedic secondment to permanent. Implement Admin. Liaison role to monitor handover times, ensure accurate details recorded by crews, complete live datix. 1 x B3 Admin

12 203.0




AUH Transfer team to cover AMU/ED to ensure swift & efficient transfer of patients to assist flow. 1 x B5 RGN, 1 x B2 HCA

15 63.8


Integrated Medicine


AUH Additional Discharge coordinators required.

12 130.0

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91 Nursing and Quality

Nursing and Quality


AUH/RLBUH

Investment in new Liberty protection safeguarding standards team

New legislation from October 2020 removes the requirement for Local authorities to oversee the DOLS authorisation process. This will be passed to NHS trusts as a statutory role.

245.0


Nursing and Quality


AUH/RLBUH

Perfect ward audit system System purchased for Aintree wards in 19-20. System to form part of new merged trust ward assurance framework and compliance process. Will aid for future CQC inspection requirements.

102.0


Nursing and Quality


AUH/RLBUH

Uniform replacement and standardisation programme

Key element of post merger work is the rollout of standardisation of uniforms for health professional across all sites. Cost likely to be significantly less - worst case scenario. Potential central pilot scheme

970.0


Nursing and Quality


AUH/RLBUH

Patient safety team investment New patient safety team required to operationalise service plans. 1 x band 7 patient safety officer - responsibility of enhancing the identification and management of the deteriorating patients and 3 x band 4 serious incident investigators at the Royal site (replicating the team introduced at Aintree in 19-20)

131.0


Nursing and Quality


AUH/RLBUH

Expansion of Quality improvement team investment

Links to 2020 corporate investment programme covering 4 key portfolios : SAFER, Length of stay, front door access & Flow and discharge.

322.0


Nursing and Quality


AUH/RLBUH

Dementia team investment NHSI objective that all hospitals are to be dementia friendly by March 2019. Improved provision of care and experience of dementia patients and reduced length of stay. This requires additional funding to have a permanent nursing team team in place with admin support.

113.0


Nursing and Quality


AUH/RLBUH

Learning Disability & Autism Team investment

Part of ongoing work to ensure trust can meet all statutory requirements for providing care to patients with disabilities. This post will ensure the cover

220.3

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at Aintree is in line with current resources at Royal & Broadgreen sites. This team will contribute to transformation of provision of care and experience of patients with a Learning Disability, reduce unnecessary admissions, reduce cancellations of clninc appts and procedures and reduced lenghth of stay.


Nursing and Quality


AUH/RLBUH

Nurse practitioners - temporary upgrades causing 130k pressure, net of avalible vacs at the lower grade(assumed like for like on vacs)

150.0

99 Medical Director

Medical Director Case of Need Submission

AUH/RLBUH

Admin support to associate medical directors

The proposal is to provide a Band 4 PA to ensure that AMD/RO/lead resource is not inapprpriately diverted to admin activities

25.0

100 Medical Director


AUH/RLBUH

Medical support to integration agenda

In phase 2 of post-merger service integration Programme, there are 13 integrations identified across the 5 divisions; local delivery capacity is requested to support delivery. The capacity requirement is time-limited

50.0



AUH/RLBUH

Quality improvement champions Additional local support to develop and embed QI initiatives. Total of 10 PAs

100.0



AUH/RLBUH

Sepsis nurse Substantiating non-recurrent post 19/20 @ AUH

50.0



AUH/RLBUH

AMD for patient experience Clinical input into patient experience 50.0 TB

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105 Estates and Facilities

Facilities Cost Pressure Returns

AUH Proposal for cleaning at AUH to be completed by Domestics and release nursing capacity (recurrent)

945.0


Facilities Cost Pressure Returns

AUH Additional recruitment & rentention payments for band 3, 4 and 5 staff

67.0


Hotel Services Cost Pressure Returns

RLBUH

Proposal for cleaning at Royal to be completed by ISS and release nursing capacity (recurrent)

448.0


Hotel Services Cost Pressure Returns

RLBUH

Smoking support officers - Royal site (recurrent)

79.0

109 Human Resources

Education Cost Pressure Returns

AUH / RLBUH

Room booking system requires alignment and a new system for all sites

Current room booking systems not fit for purpose and can not be accessed across sites in it's current form

24.0

110 Human Resources

Education Cost Pressure Returns

AUH Uneqitable access to up to date resources for trainees and all clinical staff. The point of care tool is currently already in use across the Royal

The service needs to be equitable across the organisation and the point of care tool is essential clinical guidance at the patient bedside thus improving patient safety

53.0

111 Human Resources

HR Cost Pressure Returns

AUH HR Capacity additional business partners (3.00wte band 7 to 8a, 1 additional band 8a and increase of a band 6 to a 7)

90.0

112 Corporate OD Case of Need Submission

LUH Cost of a trust wide electronic Appraisal system

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113 Corporate OD Case of Need Submission

LUH Increasing team capacity at 8a level and Band 5 level to provide the combination of strategic and operational input to drive forward the OD agenda.

82.0

114 Human Resources

Human Resources


AUH / RLBUH

Staff college clinical leadership external training

2nd year of commissioned work 50.0

115 Human Resources

HR Transactional Cost Pressure Returns

AUH / RLBUH

Allocate support to re-implement Medic suite of modules. Case of need to be drafted in the new year. Centralisation of medical staffing to also be considered

50.0

116 Human Resources

HR Transactional Cost Pressure Returns

AUH / RLBUH

Allocate support to reimplement Rostering for Nursing and to implement Safe care module for Nursing

50.0

117 Finance Finance Cost Pressure Returns

AUH/RLBUH

Finance Capacity Additional finance partners to support operational divisional structures (3 wte band 8B)

195.0

Total Prioritised Cases of Need

18,156.7

Total Pre-committed and Prioritised Cases of Need

34,822.8

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Appendix 3

Extract form the Draft Operational Plan Narrative 2020/21 Liverpool University Hospitals NHS Foundation

Trust

6. FINANCE Core Contract Principles and System Working

6.1. The activity assumptions for 2020/21 outlined in Section 3 form the basis of the financial plan and are based on an application of PbR rules and tariff prices. These activity levels have broad agreement from commissioners prior to contract sign-off, however the overall affordability of the contract plan remains a risk.

6.2. 2019/20 sees the end of our contract built around the principles of ‘Acting as One’ (AAO), with a core

block contract arrangement with our core commissioners (Sefton CCG, Liverpool CCG, and Southport & Formby CCG).

6.3. Discussion on extending the AAO agreement that has been in place through the last three years have

been positive and the Trust is optimistic that agreement will be reached. Ultimately sign-up will depend on whether contract offers reflect the broad agreement reached on anticipated activity levels. In the event that it isn’t, then the default position will be a return to a PbR based contract.

6.4. Our belief remains that the AAO agreement and the principals that form its core is a fundamental prerequisite to a joined up approach to tackling the problems faced across the health system and remove the barriers created by a pure payment by results contract.

6.5. We will continue to work collectively with Commissioners to identify pathway changes and

concentrate on how resources can best be used to deliver the services needed. As last year, how the system limits the continued rise in demand for urgent care services is a key issue and risk as we enter 2020/21. A key step will be setting up a joint committee clinically / operationally led to oversee work programmes on delivering services in the most cost effective way and provide the necessary governance framework on a health economy basis.

6.6. All Associate Commissioners will remain on PbR contracts to avoid the potential for referral drift into

the local health economy. For 2020/21 the working assumption is that Knowsley CCG will continue under a PbR based contract, although the closer working relationships with Liverpool CCG may see them re-join the AAO agreement.

Key income assumptions 6.7. The associated income plan has been recast to reflect the revised activity plans at national/local

prices. 6.8. Pass through costs are based on 2019/20 outturn and will remain outside of any Acting as One

agreement, should one be reached. 6.9. There are no material service transfers built into the 2020/21 plan. The expected move of spinal

services to The Walton Centre to improve patient services is currently being worked through operationally and financially. Whilst this will impact on gross income and cost, the working assumption in the draft plan is that the move will be cost neutral, on the basis of a no-win no-loss impact for each respective organisation. Work continues on the redesign of stroke services across the North Mersey Health Economy, however this is not expected to materially impact until 2021/22.

6.10. Whilst LUHFT fully supports the direction of travel to centralise procurement operations to drive greater leverage on prices, the continuation of the top-slice included in the 2019/20 tariff to support the infrastructure costs, without any discernible evidence of cost improvements being delivered outside the Trust’s own saving plans remains a concern and forms part of the overall deficit.

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6.11. Clinical income is projected at £774.0m. This represents an increase of £35.3m on 2019/20 outturn, reflecting principally;

£11.5m, outturn adjustment to block contracts

-£1.6m, loss of cytology contract

£10.4m, net impact of 2020/21 tariff inflation

£10.6m, 2020/21 activity growth

£2.5m, improving RTT performance

£1.9m, other areas 6.12. Other operating income is forecast at £213.9m, compared to an outturn position of £199.3m for

2019/20, an increase of £14.6m. The key changes are:

£21.8m, increase in FRF to £64.9m

-£2.5m, non-recurrent GDE income

-£2.1m, other non-recurrent income sources

-£3.3m, RLBUH LcL income in plan covered non-recurrently by AUH

-£1.0m, shortfall in car park income

+£1.7m, increased SLA income (QEP/Efficiency)

6.13. Figure 6 summarises the projected income position for 2020/21. Figure 6 – Income summary

Gross £m

QEP £m

Net £m

Clinical income 774.0 0.0 774.0

Operating income 212.2 1.7 213.9

Total income 986.2 1.7 987.9

6.14. CQUIN schemes are assumed to be delivered in full and no contract sanctions are imposed.

6.15. At the time of writing this plan contract negotiations have not concluded and there remains a risk that

the affordability of the activity plan for Commissioners could result in contract offers being lower than included in the draft submission. At this stage it is not possible to quantify that risk as provisional offers have not been made.

Key expenditure assumptions 6.16. Through 2019/20 demand for urgent care services has continued to grow. Following significant

growth in each of the last two years, 2019/20 has seen another substantial rise in AED attendances, placing pressure on workforce capacity and trust finances.

6.17. Flow out of the hospital remains compromised due to the lack of capacity in ‘out of hospital’

services/facilities. Medically optimised who are ready for discharge, (RFDs), but still occupy acute beds, have increased from an average of 303 per day in 2018/19 to 319 per day 2019/20.

6.18. Similarly to the last two years the acuity of patients arriving at hospital continues to increase, placing additional burden on staffing to ensure that they remain safe whilst under our care.

6.19. Although an additional 40 beds were built into the recurrent bed base for 2019/20, the increase in demand has resulted in around c55 beds opened as part of 2018/19 winter escalation plans remaining open all year. These beds have been substantiated into the baseline for 2020/21 at a cost of £4.4m based on recruiting substantive staff.

6.20. For winter 2019/20, LUHFT has opened a further c34 beds across its RLBUH sites and the trust

commissioned Ernst Young to undertake an ‘Assessment and Bed Rightsizing’ of the RLBUH site, similar to that undertaken at AUH in 2018/19. This identified a shortfall in commissioned beds, particularly in assessment capacity. As such the winter escalation beds have also been substantiated into the recurrent bed base at a cost of £3.0m.

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6.21. In total £7.4m has been added to the cost base since April 2019 to meet rising demand and maintain flow. These costs are based on LUHFT employing into vacancies. If capacity shortages result in extended use of agency cover to maintain safety, then costs could escalate higher. No provision has been made in the plan for this eventuality.

6.22. Consolidating this additional capacity is consistent with the requirement for the ‘system’ to maintain

peak capacity and to reduce overall bed occupancy. Bed occupancy in January stood at c93%.

6.23. Expenditure budgets for the forthcoming year total £1,021.3m, before QEP and reflect the full year impact to deliver current levels of demand, as well as meeting core cost pressures for 2020/21 through tariff, other emergent cost pressures and quality/safety requirements identified through 2019/20 and the planning process.

6.24. The expenditure plan for the coming year is £58.4m higher than 2019/20 forecast outturn, the main elements being as follows.

Core tariff pressures

6.25. Core cost pressures for pay, non-pay and capital charges total £34.1m and represents 4.4% of contract income. This represents a gap between the headline 2.5% inflation figure in tariff of £14.8m. Of this £8.5m relates to capital charge increases (1.1% of contract income), of which PDC on the new hospital is a material part.

6.26. Even using total income (excl. FRF), where generally there is less scope to apply a standard 2.5%

uplift, the gap between the tariff uplift and assessed costs is still £11.0m greater. This increases the CIP burden by a further 1.1% above the assumed efficiency in tariff.

QEP shortfall 2019/20

6.27. LUHFT had a combined QEP target of £22.1m for 2019/20, c2.5% of total income and significantly above the 1.1% assumed deliverable by organisations and also the stretch of 1.6% for organisations in deficit.

6.28. Whilst the overall programme for the year has been met, the operational pressures faced by LUHFT as outlined above, has limited the scope to reduce costs on a recurrent basis. A significant proportion of the 2019/20 programme has been delivered through non-recurrent means.

6.29. In total £10.6m of savings have been delivered recurrently, c1.2% of total income. The remaining

£11.5m flowing through as a pressure into the underlying 2020/21 position.

Beds 6.30. Additional £3.0m to cover 19/20 peak capacity and EY bed assessment.

6.31. Figure 7 summarises the projected income position for 2020/21.

Figure 7 – Expenditure summary

Gross £m

Outturn expenditure 19/20 962.9

Full year impact of 19/20 pressures and developments

9.8

Core tariff pressures - Pay / non-pay - Capital charges

25.6 8.5

Bed capacity (in addition to the £4.4m in 19/20) 3.0

Non-recurrent QEP 11.5

Total income 1,021.3

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6.32. No account has been taken in this plan of any potential impact from the legacy aged debt and contract sanctions issues, previously discussed with NHSI, that LUHFT inherited from the legacy trust RLBUHT.

6.33. The draft financial plan for 2020/21 is summarised in Figure 8.

Figure 8: Draft Financial Plan

2020/21

£m %

Income (excl qep and frf) 921.3

Operating costs (998.7)

Planned CIP 34.5

EBITDA (42.9) -4.7%

Finance costs (22.6)

Capital donations and grants 0.6

Planned (deficit)/surplus per template (64.9) -7.0%

FRF 64.9

I&E forecast 2020/21 0.0

Efficiency Savings for 2020/21 6.34. Based on current assumptions LUHFT will need to deliver a QEP programme of £34.5m which

represents 3.7% of total income.

6.35. Our aim remains to deliver sustainable efficiency savings that either improve quality, or as a minimum do not lead to any deterioration in quality.

6.36. LUHFT and its legacy organisations has a track record of delivering cost savings and productivity improvements through its formal efficiency programme. The Trust has however been reliant on non-recurrent savings in recent years to meet its financial plan and this forms part of the 2020/21 projections.

6.37. The on-going delivery of cost improvements remains extremely challenging, given the cumulative impact of previous efficiency targets, the demand pressures faced particularly around urgent care provision and the need to maintain performance targets. This is coupled with reductions to adult social care provision, which is nationally recognised as having a significant impact on secondary care. This manifests itself in increased numbers attending Accident and Emergency and the ability to discharge patients in a timely manner back into their communities. As a result, whilst introducing a number of innovations, the anticipated benefits realisation has in some instances been negated to a degree by increased demand, creating a ‘standing still’ effect.

6.38. The delivery of a £34.5m QEP programme will in the Trust’s view be extremely stretching. The

magnitude of the challenge has been exacerbated by the additional bed capacity required to meet demand challenges as well as the estimated shortfall in the national tariff uplift compared to actual cost increase. For LUHFT this has been worsened by PDC costs on the new hospital build.

6.39. We remain convinced that savings above this level will require more fundamental strategic

organisational and pathway reorganisation across the local health economy, including collaboration at scale and delivery of the initiatives being explored by the STP programmes.

6.40. Our internal programme over the planning cycle cross cuts the Lord Carter efficiencies, Model

Hospital, GIRFT reviews and RightCare statistics. Our broad themes remain specialty productivity (theatres, outpatients, beds); clinical support functions, back office functions, procurement, estate and workforce. Our strategic aspiration is where possible to embrace digital solutions to release both capacity and efficiency.

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6.41. The CIP ask can be simplified at a high level as follows

Figure 9: CIP

2020/21

£m %

Tariff efficiency (1.1%) 10.1 1.1

Shortfall in 2019/20 QEP plan 11.5 1.2

Shortfall in 2020/21 headline tariff inflation 11.0 1.2

Peak bed capacity 3.0 0.3

35.6 3.8%

Other net adjustments (1.3) (0.1)

34.5 3.7%

NB: the trust recognises that the planning guidance requests an additional 0.5% QEP requirement from deficit trusts. This would equate to an annual QEP ask of £15.0m based on total income (excl FRF), or £12.4m based on clinical income.

Key themes for 2020/21 6.42. Beds: Continued drive to improve length of stay, (LOS), through revised ways of working,

streamlining of patient pathways and review of front door assessment capacity across all clinical specialties. Progress in this area will likely manifest itself in bringing bed occupancy levels down to more manageable levels. AUHFT is not anticipating any reduction in bed capacity or cash releasing savings from bed numbers in 2019/20.

6.43. We continue to look at different bed models to effectively manage the patient pathways, including provision of ‘step down’ facilities, which may be able to release costs if deliverable.

6.44. Theatres: Improved theatre utilisation, maximising work that can be delivered in daycase or

treatment room facilities. Similarly increasing the use of Pathway care protocols. 6.45. Outpatients: Improving outpatient efficiency, through reduced cancellations, DNAs, new models of

care, with an emphasis on digital technology. 6.46. Procurement: Maximisation of opportunities within the Purchasing Price Index Benchmarking tool;

collaborative working across providers; standardisation of product lines and review of existing contract terms. The risk

6.47. Medicines Management: review opportunities in current prescribing practices, move to alternate

drugs (e.g. bio-similars), reduce wastage and ensure the Trust is adopting best practice across all areas.

6.48. Workforce Optimisers and service reconfiguration: 6.49. Back office functions incl. estates: work across the health economy in line with the STP

submission to maximise the benefits for greater collaboration, although this is more likely to deliver benefits in 2020/21.

6.50. Accelerating merger savings were possible: 6.51. Review of land and building capacity for alternate health / social care / community provision. Any

opportunities will need to form part of the new organisations considerations to ensure that sub-optimal decisions are not made in advance of the merger.

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Control Total 6.52. LUHFT has built in receipt of FRF funding of £64.9m into its overall plan, bringing the underlying

planned deficit down to the net control total of breakeven. This requires a QEP programme of £34.5m to be delivered, representing 3.7% of total income before FRF.

6.53. On the basis of the assumptions outlined above, it is the intention of AUHFT to agree the financial control total for 2020/21.

6.54. Delivery of the control total is dependent on a number of critical factors as outlined in the following section.

Critical Factors within the Plan 6.55. Key deliverables to for the plan are:

Agreement by Commissioners to the full funding of the activity assumptions outlined in the activity planning section at national tariff;

No changes to existing contract arrangements and gain sharing principles within the contract;

Growth does not exceed that included in the activity assumptions;

Any protracted consequences of coronavirus, including workforce shortages;

Full receipt of CQUIN and no contract sanctions;

Full delivery, via evidenced and auditable non-pay cost savings reports from the central NHS procurement function;

Patient acuity and dependency does not increase, requiring an increase in the bed base over and above that planned.

Delivery of cash releasing efficiency savings of £34.5m (recurrent and non-recurrent). Capital Planning 6.56. The Trust’s capital plan is prioritised in terms of consistency with the clinical strategy and

responsiveness to the safety of service provision. This is achieved through the Capital Planning Group which has devolved responsibility to prioritise capital spend within an overall envelope of approved resources.

6.57. The Capital Planning Group reviews the capital requirements that result from the divisional led business planning process in addition to requirements from the Safety and Risk Group and large strategic projects that cover more than one division.

6.58. The capital programme has been reviewed and reduced to ensure that it provides for only contractually committed schemes and schemes that are strategically and operationally necessary in order to provide commissioner requested services. Those schemes that remain in the programme but are not contractually committed (other than the Tower Block Cladding scheme previously mentioned) relate to the replacement of medical equipment, IT equipment, backlog maintenance and health and safety schemes. All of these are deemed essential in order to continue to provide safe and effective services.

Cash 6.59. On the basis of the assumptions set out above, particularly in regard to the intention to agree to the

control total, the Trust’s will not require access to revenue support funding.

Summary 6.60. Despite continuing efforts to stabilise the financial position through the QEP programmes aligned to

Lord Carter, Model Hospital and GIRFT, the Trust has been unable to deliver the level of savings required on a recurrent basis. This is linked to the increasing demand for services from an ageing population with increased co-morbidities, coupled with the unprecedented reductions in adult social care provision.

6.61. The increase in FRF is welcomed by the Trust, however despite this the level of QEP required to meet the control total in 2020/21 is extremely stretching and represents the major risk to delivery of the control total in the coming year. Despite this, at draft planning stage, it is LUHFTs intention to agree to the control total, subject to the full funding of the contract plan by commissioners as outlined in the critical success factors above.

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Trust Board

COVER SHEET


Report Title Annual Declaration of Interests

Prepared by Madelaine Warburton, Director of Corporate Governance


Key Issues / Messages Annual declaration of interests by Board members in accordance with national guidance




Quality

Finance

Workforce

Equality

☐

☐

☐

☐

Risk

Compliance

Legal

☐

☒

☐


report)




patient experience






☐

☐

☐





organisation

☐

☐

☒

LEVEL OF ASSURANCE:





☐ No assurance


REPORT DEVELOPMENT:


Date Lead Outcome

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Annual Declaration of Interests: Trust Board 26th May 2020

EXECUTIVE SUMMARY

1. The NHS Code of Conduct / Code of Accountability requires all staff to demonstrate an absolute

standard of honesty in their dealings with the NHS. All staff1 and officers of the Trust are required

to declare interests where there is an actual or potential possibility of a material conflict between

one or more of the interests.

2. Staff who are defined as ‘decision making staff’ are required to make an annual declaration of

interests in addition to those made at each decision making meeting.

3. Under the Trust Constitution the duties of a director of the Trust include in particular:

A duty to avoid a situation in which the director has (or can have) a direct or indirect interest that

conflicts (or possibly may conflict) with the interests of the Trust.

A duty not to accept a benefit from a third party by reason of being a director or doing (or not

doing) anything in that capacity.

4. Types of interests are defined by the Trust’s Managing Conflicts of Interest Policy which was

updated and approved by the Trust Board in January 2020. The wording within the Policy is

prescriptive and follows the guidance issued by NHS England/Improvement. It includes consistent

principles and rules, providing clear advice about what to do in common situations whilst supporting

good judgement about how to approach and manage interests.

5. Interests fall into the following categories:

a) Financial interests - where an individual may get direct financial benefit from the consequences

of a decision they are involved in making.

b) Non-financial professional interests - where an individual may obtain a non-financial professional

benefit from the consequences of a decision they are involved in making, such as increasing

their professional reputation or promoting their professional career.

c) Non-financial personal interests - where an individual may benefit personally in ways which are

not directly linked to their professional career and do not give rise to a direct financial benefit,

because of decisions they are involved in making in their professional career.

d) Indirect interests - where an individual has a close association with another individual who has

a financial interest, a non-financial professional interest or a non-financial personal interest and

could stand to benefit from a decision they are involved in making.

6. In addition all directors, their nominated deputies and governors are required to comply with CQC

Regulation 5: Fit and proper persons. Directors, deputy directors and governors must certify on

appointment and annually thereafter that they are/remain a fit and proper person.

7. All Board Directors have completed declarations in relation to their relevant and material interests.

These are disclosed in Appendix 1. To support transparent decision-making, the Board’s

declarations of interests is included as an appendix to all Board meeting packs. In addition the

Trust will publish on the Trust website interests declared by all staff which is refreshed on an annual

basis.

Recommendation

8. The Board is asked to note the declarations of interest made.

1 As defined within the Conflicts of Interest Policy

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Trust Board Declarations of Interest

Name Position Year Description of Interest

Steve Warburton

Chief Executive

Officer 2020/21

Wife is employed as a Paediatric Palliative Care Consultant by Alder Hey

Foundation Trust.

Director Liverpool Health Partners

Director Aintree Healthcare Ltd (wholly owned subsidiary of LUHFT - dormant).

Tristan Cope Medical Director 2020/21

Medical Director / Clinical Lead for the North West Recompression Unit. This is a

private provider which holds a contract with NHS England to provide specialist

hyperbaric clinical services for treatment of decompression illness and gas

embolism for NHS patients in the North West of England. This role nominally

forms 1 day per week in my job plan.

Medical advisor to Iqarus / International SOS. I provide specialist diving medical

advice to a company that provides medical support to the offshore commercial

diving industry. This is in the form of clinical advice on the management of

individual divers with medical problems (as part of an on-call rota, telemedicine

advice only) and technical advice on the management of critically ill divers in the

offshore and saturation diving setting.

Sue Musson Chair 2020/21 Nil Return/no declaration to be made

David Fillingham

Non-Executive

Director 2020/21

Chair of Healthier Wigan Partnership; Chair of Trafford Local Care Alliance;

AQuA affiliate; Consultant to the NHSI Vital Signs Programme

Michael Eastwood

Non-Executive

Director 2020/21

Chief Officer, Liverpool Anglican Cathedral

Diocesan Secretary, Liverpool Diocesan Board of Finance

Director of Good Funeral Company

Partner is a trustee of John Moores Foundation and St Mary’s Upton PCC

Mandy Wearne

Non-Executive

Director 2020/21 Founder and Director Inspiration NW Ltd - 2013 - to-date

Tim Johnston

Non-Executive

Director 2020/21

Chairman and shareholder - AMION Consulting Holdings Ltd (no links with LUH)

Chairman and minority shareholder - Langtree Property Partners Holdings Ltd

(no links with LUH)

Chairman - The Big Trust Ltd - Charity (N.B. The charity is working in a minor

way with LUH (previously AUH) on employment and education initiatives

Beth Weston

Chief Operating

Officer 2020/21

Partner is Deputy CEO / Director of Strategy at East Lancashire Hospitals NHS

Trust.

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Name Position Year Description of Interest

Neil Willcox

Non-Executive

Director 2020/21 Director and Shareholder Resman Limited

Louise Kenny

Non-Executive

Director 2020/21

Executive Pro Vice Chancellor University of Liverpool

NED at Liverpool Women's Hospital

Dianne Brown Director of Nursing 2020/21 Nil return/No declarations made

Angela Phillips

Non-Executive

Director 2020/21

Governor RNN Group, colleges South Yorkshire and North Nottinghamshire

Trustee of High Peak Theatre Trust, the operators of Buxton Opera House and

Pavilion Arts Centre

Debbie Herring

Chief People

Officer 2020/21

Husband is a director of Unique Healthcare Solutions Limited which is a

healthcare consultancy company

Robert Forster

Chief Finance

Officer 2020/21 Partner is Director of Finance at Pennine Care NHS FT

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Trust Board

COVER SHEET


Report Title NHS Provider Licence Annual Self-Certification (Condition G6)

Prepared by Gilly Conway, Risk and Governance Consultant


Key Issues / Messages Evidence provided to support the self-certification required by NHS Improvement to confirm the Trust’s continued eligibility to hold an NHS Provider Licence.




Quality

Finance

Workforce

Equality

☐

☐

☐

☐

Risk

Compliance

Legal

☐

☒

☐


report)




patient experience






☐

☐

☐





organisation

☐

☐

☒

LEVEL OF ASSURANCE:





☐ No assurance


REPORT DEVELOPMENT:


Date Lead Outcome

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Provider Licence Self Certification: Trust Board 26th May 2020

2

EXECUTIVE SUMMARY

1. NHS Licence conditions require NHS providers to complete an annual self-certification that

confirms their continued eligibility to hold an NHS provider licence. Self-certification takes the

form of declarations of compliance with conditions G6 (effective systems to ensure compliance

with the conditions of the NHS provider licence, NHS legislation and the duty to have regard to

the NHS Constitution) and FT4 (complied with governance arrangements) which need to be

completed by 31 May and 30 June 2020 respectively.

2. There is no longer a requirement for the Trust to submit its declaration to NHSI. NHSI have

confirmed that they do not intend to undertake any audits of compliance against the self-

certification requirements of the provider licence or to use enforcement powers in the event of a

breach in this financial year, where resource has been prioritised to address Covid19 but that self

certifications are still required

3. Covid-19 has impacted on the timescale for approval of the annual governance statement and the

external audit opinion on the financial accounts which will not be considered until 18 June 2020

by the Audit Committee. Self certification in relation to FT4 wil be sumitted to an extraordinary

meeting of the Trust Board in June (date tbc) at the same time as the Annual Report and

Accounts.

4. This report provides the declaration of confirmation for condition G6 and a summary of the

underpinning evidence.

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Provider Licence Self Certification: Trust Board 26th May 2020

3

MAIN REPORT

INTRODUCTION

1. The annual self-certification provides assurance that NHS providers are compliant with the

conditions of their NHS provider licence. Compliance with the licence is routinely monitored through

the Single Oversight Framework but, on an annual basis, the licence requires NHS providers to self-

certify as to whether they have:

a. effective systems to ensure compliance with the conditions of the NHS provider licence,

NHS legislation and the duty to have regard to the NHS Constitution (condition G6);

b. complied with governance arrangements (condition FT4)

c. for NHS foundation trusts only, the required resources availaible if providing

commissioner requested services (CRS) (condition CoS7 – not applicable to this Trust).

2. The G6 declaration needs to be completed by 31 May 2020 and is the subject of this report. Covid-

19 has impacted on the timescale for the formal approval of the annual governance statement and

the external audit opinion on the financial accounts which will not be considered until 18 June by the

Audit Committee.

3. The FT4 declaration should be completed by 30 June 2020 and a summary of compliance will be

brought to the an extraordinary meeting of the Board in June alongside consideration of the Annual

Accounts and Report. .

CONDITION G6

4. Condition G6(2) requires NHS providers to have processes and systems that:

a. identify risks to compliance with the licence, NHS acts and the NHS Constitution

b. guard against those risks occurring.

5. Providers must complete a self-certification after reviewing whether their processes and systems

were implemented in the previous financial year and were effective (condition G6(3)). It is up to the

provider how they undertake their self-certification process. However, any process should ensure

that the provider’s board understand clearly whether or not the provider can confirm compliance.

6. The self-certification must be published by 30 June 2020 (condition G6(4)).

NEXT STEPS

7. Subject to agreement by the Board, the G6 declaration will be published on the Trust’s website by

30 June 2020.

RECOMMENDATION

8. The Board is asked to approve the declaration (template provided by NHSI - Appendix 1) based on

the underpinning evidence (Appendix 2).

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Appendix 1: G6 self-certification declaration

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Appendix 2: Summary of evidence of compliance

Condition G6 – Systems for compliance with licence conditions

Requirement Evidence

1. The Licensee shall take all reasonable precautions

against the risk of failure to comply with:

a. the Conditions of this Licence,

b. any requirements imposed on it under the NHS Acts,

and

c. the requirement to have regard to the NHS

Constitution in providing health care services for the

purposes of the NHS.

The Trust has implemented a risk management framework through which risks to the

Trust’s objectives and operations, including those pertinent to the Licence, are

identified, monitored and managed.

The Risk Management Strategy was ratified by the Board in October 2019. It

describes the Trust’s the key components of the risk management framework,

including underpinning principles, processes and responsibilities.

The strategy includes the Board’s Risk Appetite Statement.

In January 2020 the Audit Committee approved an implementation plan that

outlines the key tasks required to evolve the risk management framework in

accordance with the ambitions stated in the Risk Management Strategy.

The Trust’s methodology and process for the Board Assurance Framework (BAF)

was ratified by the Board in October 2019 and the detail of the BAF post-merger

has been in development with oversight by the Board.

The BAF is reported quarterly to the Board in conjunction with the most significant

operational risks.

The BAF includes the principal risk ‘Failure to comply with statutory legislative and

regulatory directives’, enabling the Board to monitor and review the associated key

controls and assurances in place.

The effectiveness of the methodology and process for the BAF is reviewed

annually by the Audit Committee with input from Internal Audit.

Relevant sections of the BAF are assigned to Committees of the Board and these

are considered at least quarterly alongside associated significant operational risks.

At an operational level the Quality Governance Framework and Risk Management

Policy & Procedures provide guidance for staff and management about their

responsibilities and the processes that must be followed to identify, treat and

escalate risks. The process of escalation and de-escalation of risk is defined

within the Risk Management Policy.

The effectiveness of the risk management framework will be reviewed on an

annual basis by the Audit Committee – the next evaluation is scheduled to be

2. Without prejudice to the generality of paragraph 1, the steps that the Licensee must take pursuant to that paragraph shall include:

a. the establishment and implementation of processes and systems to identify risks and guard against their occurrence; and

b. regular review of whether those processes and systems have been implemented and of their effectiveness.

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reported in January 2021.

As part of the governance arrangements for the new Trust, a review of the forward

work plans took place to ensure comprehensive coverage of key risks and issues,

including those that relate to compliance with regulatory and contractual

requirements.

Head of Internal Audit opinions for 2019/20:

o MIAA ‘Substantial assurance that there is a good system of internal control

designed to meet the organisation’s objectives, and that controls are

generally being applied consistently’.

o RSM ‘The organisation has an adequate and effective framework for risk

management, governance and internal control’.

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Documents

Trust Board › media › 9011 › trust-board...2020/05/26 · Trust Board Location Microsoft Teams Date 26th May 2020 Time 10am AGENDA Time Reference Item Lead Action PRELIMINARY